Abstract:

OBJECTIVE: To study the characteristics of brain damages in utero in order to establish more effective treatment. METHODS: Clinical data of 115 neonates with brain damages which developed in utero were studied retrospectively: types of brain damages, high risk factors associated with brain damages, relationship between the degree of brain damages and high risk factors and neurological signs. Follow up was done to observe the prognosis in survivals. RESULTS: Of the 115 patients, 71 ( 61.7% ) had intracranial hemorrhage and 44 ( 38.3% ) showed cerebral parenchyma lesions; 64 ( 55.6% ) had high risk factors associated with brain damages; 34 ( 29.6% ) had abnormal neurological signs: convulsion, hypertonia or irritability. The degree of brain damages was correlated with the high risk factors and neonatal neurological signs. Of the 55 follow up patients, 16 ( 29.1% ) had neurological sequels. CONCLUSIONS: It is necessary to understand the characteristics of brain damages which develop in utero to enable early diagnosis and intervention and to improve the survival rate and prognosis.

Abstract:

OBJECTIVE: To investigate the frequency of heterozygous α 1 antichymotrypsin(α 1 ACT) deficiency and the types of gene mutation in childhood asthma. METHODS: The plasma level of α 1 ACT was detected using the rocket immunoelectrophoresis in 90 children with asthma (asthma group), 195 healthy children (normal children control group) and 198 healthy adults (normal adult control group). The frequency of heterozygous α 1 ACT deficiency was determined by studying the family history in the 3 groups. The clinic data of the children with or without heterozygous α 1 ACT deficiency were analyzed. Gene exon Ⅱ and exon Ⅲ were detected by PCR and restriction endonuclease mapping techniques in the 5 cases with heterozygous α 1 ACT deficiency. RESULTS: The frequency of heterozygous α 1 ACT deficiency in the asthma group ( 4.4% ) was markedly higher than that in the normal child control group (0) and the normal adult control group ( 0.5% ) (both P< 0.05 ). The age of the onset of asthma was smaller, the number of times of hospitalization for asthma were greater, and the positive rate of the radioactive allergen sensitive test was higher in the children with heterozygous α 1 ACT deficiency than those without deficiency (P< 0.05 or 0.01 ). No variants of Bonn 1 and Bochum 1 were found in the 5 cases with heterozygous α 1 ACT deficiency. CONCLUSIONS: There is a possible association between heterozygous α 1 ACT deficiency and childhood asthma; the variants of Bonn 1 and Bochum 1 are not correlated with childhood asthma.

Abstract:

OBJECTIVE: To study the chaotic characteristics and power spectrum characteristics of heart period signals (HPS) in children with asthma. METHODS: The parameters of the chaotic characteristics and the power spectrum characteristics of HPS were detected using a computerized system for analyzing chaotic characteristics of HPS in 47 children with asthma and 103 normal children. These parameters were tested in the remission phase in 18 of the 47 asthmatic children to analyze their changes.RESULTS: Of the parameters of the chaotic characteristics, relative dispersion of heart period (HRD), lyapunov exponent of heart period (HLE) and heart cycle chaosness (HCC) ( 4.50 ± 2.06 , 3.17 ± 1.26 and 26.34 ± 13.78 , respectively) in the children with asthma were all lower than those in the normal children ( 7.29 ± 1.62 , 5.09 ± 0.99 and 51.08 ± 17.32 , respectively)(P< 0.01 or 0.05 ). Of the parameters of the power spectrum, the power value in very low frequency band (PVV), power value in low frequency band (PVL), power value in high frequency band (PVH), power rate in very low frequency band (PRV), power rate in low frequency band (PRL), power rate in high frequency band (PRH), ratio of power in very low frequency band to that in high frequency band (RVH), ratio of power in low frequency band to that in high frequency band RLH and total frequency band power (TFP)[( 320.61 ± 372.28 ) ms 2, ( 221.00 ± 243.86 )ms 2, ( 224.38 ± 327.51 )ms 2, ( 42.84 ± 18.47 )%, ( 26.58 ± 17.63 )%, ( 2.72 ± 2.74 ), ( 1.79 ± 1.58 ), and ( 827.44 ± 933.22 ) ms 2, respectively] differed from those in the normal children (P< 0.01 or 0.05 ). These abnormal parameters of asthmatic children got recovery with different degrees in the remission phase. CONCLUSIONS: The complexity of the heart state is reduced in children with asthma, and the control ability of the autonomic nervous system for the heart is also depressed. The functional disorder of autonomic nerves of asthmatic children in the attack phase might be temporary and reversible.

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OBJECTIVE: To study the relationship between bone marrow relapse and the level or changes of minimal residual disease (MRD) in childhood acute lymphoblastic leukemia (ALL). METHODS: The MRD level was detected using the modified limiting dilation PCR and nested PCR in 46 children with ALL; the data was analyzed using the Kaplan Meier method and COX model. RESULTS: The MRD level of the 46 patients by the time of complete remission (CR) was positively correlated with marrow relapse (r= 0.4396 ,P< 0.05 ). There was a significant difference in the MRD level between marrow relapse children and non relapse children ( 7.359 ×10 -3 vs 3.954 ×10 -4 ; P< 0.05 ). The cases whose MRD was persistently positive or changed from negative to positive during CR had a higher relative risk for relapse (P< 0.05 ). CONCLUSIONS: The MRD level by the time of CR and the qualitative findings in the period of CR are important markers in accessing the prognosis in childhood ALL. MRD detection by PCR can be used to identify the relative risk for relapse and make more effective treatment and prophylaxis regimens for relapse in childhood ALL.

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OBJECTIVE: To establish a rapid diagnostic method which is convenient, inexpensive and relevant to the national situation of China. METHODS: We adopted the filter paper method to detect the presence of blood lead from July, 1996 to December, 1996. S&S 903 filter paper was selected. The filter paper was first used to detect blank lead, followed by diffusion of blood samples on the paper, and the stability of the method and the recovery of lead from the filter paper samples were tested. RESULTS: ① Using aqueous lead standards, the blank of filter paper contained ( 5.2 ± 2.1 ) μg/L of lead; and ( 1.3 ± 0.4 ) μg/L after the correction using blood lead standards. ② The paper diffusion of blood and lead levels were stable if a drop of blood was between 30 to 50 μl in volume. A blood drop of less than 20 μl would give lower lead level readings. ③ The filter paper method showed a correlation of 0.9391 , 0.9708 , 0.9666 and 0.9553 , respectively (P< 0.01 ) if the tests were performed within 4 weeks. ④ Recovery of lead from the filter paper samples ranged from 95.5% to 123.7% . CONCLUSIONS: The filter paper method to detect lead in the blood is basically established.

Abstract:

OBJECTIVE: To investigate the effect of low-dose hepacarin in the treatment of the primary nephrotic syndrome in children. METHODS: Eighty two children with the primary nephrotic syndrome in the hypercoagulable state were studied prospectively. All the patients were administrated with prednisone 2 mg/kg·d (maximum dose ≤ 60 mg/d). Fifty two of them, besides prednisone, were administrated with hepacarin (50 IU/kg·d, intravenous injection for 4 weeks), who formed the treatment group. The other 30 belonged to the control group. RESULTS: There was no significant difference in remission (negative proteinuria) between the treatment group and the control group (P> 0.05 ). The time taken for remission was shorter in the treatment group [( 13.08 ± 4.75 ) d] than that in the control group [( 19.33 ± 4.48 ) d] (P< 0.01 ), so was the initial diuresis time [( 9.64 ± 2.65 ) d vs ( 17.07 ± 3.99 ) d](P< 0.01 ). The plasma fibrinogen recovery efficiency in the treatment group ( 93.3% ) was significantly higher than that in the control group ( 65.4% ) (P< 0.05 ). However, no significant difference in the urinary FDP recovery efficiency was found between the two groups. CONCLUSIONS: Low dose hepacarin had an obvious anticoagulation effect. Although it can not improve the remission rate of urinary protein in the treatment of the primary nephrotic syndrome in children, it can shorten the induced remission time and enhance diuresis effects.

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OBJECTIVE: To study the value of a newly developed and non invasive test, the Helicobacter pylori (H.pylori) stool antigen (HpSA) test, in the diagnosis of H.pylori infection in children. METHODS: A commercial kit using ELISA (enzyme linked immunosorbent assay) detected HpSA in the stools of 48 children with symptoms of the upper digestive tract. The detection results of the HpSA test were compared with the biopsy urease test, histology test and serology test. RESULTS: The diagnostic accuracy of the 4 tests for H. pylori infection was as follows: stool antigen test 95.8% , biopsy urease test 95.9% , histology test 97.9% , and serology test 83.7% . The specificity and sensitivity of the HpSA test for the diagnosis of H.pylori infection was 100% and 93.6% , respectively.CONCLUSIONS: The HpSA test for the diagnosis of H.pylori infection, being highly accurate, sensitive and specific, is a simple, reliable and non invasive method.

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OBJECTIVE: To study the clinical features of Henoch Schonlein purpura (HSP) in Chinese children. METHODS: The clinical features of 184 children with HSP were analyzed retrospectively. RESULTS: ① The age of onset of all the 184 children with HSP was over two years and the mean age was ( 7.8 ± 2.6 ) years. Of the 184 children, 67.4% developed HSP during the fall and winter months; 62.5% of the HSP patients revealed evident predisposing factors, mainly upper respiratory infection. ② Of all the patients, 89.1% had typical purpura as the presenting cutaneous sign. The distribution of rash in the lower extremities, buttock and upper extremities was 100%, 47.3% and 17.4% , respectively. Gastrointestinal involvement and arthritis occurred in 60.9% and 44.6% , respectively. Of all the patients, 52.2% developed HSP nephritis manifested as isolated hematuria and/or proteinuria ( 68.8% ) and the main pathological types were grade Ⅰ～Ⅲ ( 85.2% ). ③ Erythrocyte sedimentation increased in 44.0% of the patients; Antistreptolysin O titers (ASOT) and levels of immunoglobulin A (IgA) increased in 24.1% and 63.7% of the cases, respectively. The levels of immunoglobulin G (IgG), immunoglobulin M (IgM) and complements were normal in most patients. CONCLUSIONS: HSP in children has its own clinical and episodic features.

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OBJECTIVE: To study the relationship between liquid gastric emptying time and different types of chronic gastritis in children. METHODS: Sixty one cases of chronic gastritis were diagnosed by the gastroscope and they were divided into three types according to the pathologic changes under the gastroscope: simple congestive edema gastritis (CEG), gastritis companying duodenal bulb erosion (GDBE) and gastritis companying bile reflux (GBR). Fifteen children who had no pathologic changes under the gastroscope were used as the controls. Liquid emptying time was detected with real time ultrasonography. RESULTS: Except in GDBE, gastric emptying time in CEG [( 92.0 ± 10.1 ) min] and GBR [( 120.6 ± 13.6 ) min] was remarkably prolonged compared with the normal controls [( 52.8 ± 8.3 ) min](P< 0.01 ). CONCLUSIONS: Liquid gastritis emptying time in children with chronic gastritis is correlated to the pathologic changes under the gastroscope. Determining liquid gastritis emptying time might be useful in selecting drugs and estimating curative effects in the treatment of different types of chronic gastritis.

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OBJECTIVE: To evaluate the diagnostic value of serum cardiac troponin Ⅰ (CTn Ⅰ) in the neonatal meconium aspiration syndrome (MAS) with myocardial lesions. METHODS: Serum CTn Ⅰ and CK MB levels were determined by the chemiluminoimmunoassay and enzyme assay in 65 neonates of MAS with or without myocardial lesions (n=35 and n=30, respectively) and 15 normal newborns. RESULTS: The serum CTn Ⅰ level in the neonates of MAS with myocardial lesions [( 0.67 ± 0.13 ) ng/ml] was much higher than that in those without myocardial lesions [( 0.07 ± 0.05 ) ng/ml] and normal neonates [( 0.07 ± 0.03 ) ng/ml] on day 2～3 of life (P< 0.05 ). CONCLUSIONS: CTn Ⅰ appears to be one of the specific markers for the diagnosis of MAS with myocardial lesions in neonates.

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OBJECTIVE: To explore the relationship between the common diseases of hospitalized pediatric patients and integrated management of childhood illness (IMCI). METHODS: A retrospective review of the medical records of 3 468 children (raging 1 week～5 years) with pneumonia, diarrhea, malnutrition, measles and malaria (5 diseases for IMCI) admitted between 1995～2000 was done. RESULTS: ① Of the 3 468 cases, 62.1% and 34.1% had pneumonia and diarrhea, respectively. Only 3.3% of the cases had malnutrition, but malnutrition was commonly associated ( 62.1% ) with the 5 diseases for IMCI. ② In the children between 1 week～2 months, pneumonia was the greatest cause of death ( 32.1% ), followed by late neonatal hyperbilirubinemia ( 25.0% ) and delayed vitamin K deficiency ( 23.2% ); late neonatal hyperbilirubinemia was the most common disease ( 43.8% ). In the children between 2 months～5 years, pneumonia was also the greatest cause of death ( 25.4% ), followed by intracranial infection ( 23.6% ) and septicemia ( 10.9% ); pneumonia, acute upper respiratory tract infection and diarrhea were the most common diseases ( 20.2% , 16.8% and 10.5% , respectively). ③ During the study period, the cases of the 5 diseases for IMCI accounted for 21.0% and 2.1% of all the cases admitted to the Department of Pediatrics and to the Infectious Diseases Unit, respectively; 1.2% of pediatric outpatients were hospitalized. CONCLUSIONS: In Guangdong Province, China, besides pneumonia, diarrhea and malnutrition, IMCI for children aged 1 week～2 months must include late neonatal hyperbilirubinemia, hemorrhagic disease (delayed onset) of newborns due to vitamin K deficiency. Acute upper respiratory tract infection and intracranial infection should be added to the IMCI for children aged 2 months～5 years. In addition, it is necessary to improve the services in the outpatient department and to strengthen the cooperation between the Pediatric and Infectious Diseases Departments.

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OBJECTIVE: To evaluate the value of video-assisted thoracospic surgery (VATS) for the treatment of pediatric empyema thoracis. METHODS: Forty three children with empyema thoracis between January, 1992 and February, 2001, over a period of 9 years, were treated by conventional therapy (thoracentesis, chest tube drainage or thoracotomy debridement; Group A, n=28) and VATS (Group B, n=15). Postoperative parameters of the two groups were reviewed retrospectively. RESULTS: The duration of fever, antibiotical therapy, chest tube drainage and hospitalization in Group B was shorter than those in Group A [( 2.8 d ± 1.7 ) d vs ( 5.7 ± 2.1 ) d, ( 7.6 ± 2.5 ) d vs ( 13.8 ± 4.7 ) d, ( 3.8 ± 1.6 ) d vs ( 5.8 ± 2.4 ) d, ( 10.4 ± 3.0 ) d vs ( 17.8 ± 5.6 ) d, respectively] (P< 0.01 ). There was no difference in the incidence of postoperative complications and in mortality between the two groups. CONCLUSIONS: VATS for empyema thoracis was efficacious and less traumatic, and the duration of treatment was short. However, the treatment should be intervened as early as possible.

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OBJECTIVE: To study the relationship between apoptosis and glomerulosclerosis by establishing an experimental animal model of glomerulosclerosis. METHODS: The rat model of glomerulosclerosis was established by left nephrectomy and intravenous injection of Daunomycin (model group, n=30). The other 30 rats (control group) were injected with normal saline at the same time as the model group. Apoptosis was assayed by terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) in the two groups. RESULTS: ① The features of renal histopathology of the model group rats was resembled primary focal segmental glomerulosclerosis in human. ② No significant apoptosis was noted within two weeks in either the control group or the model group. The phenomenon of apoptosis initiated at 4th week. The level of apoptosis in the model group was significantly higher than that in the control group [( 5.4 ± 1.2 ) vs ( 1.6 ± 0.8 )] (P< 0.01 ) at 4th week. The number of apoptotic cells reached the highest level at 6th and 8th weeks ( 8.6 ± 2.8 and 10.1 ± 1.9 , respectively) compared with the control group ( 1.8 ± 0.8 , 1.7 ± 0.5 , respectively) (P< 0.01 ). ③ The total number of apoptotic cells was negatively correlated to the number of glomerular cells from 4th to 8th weeks (r= -0.85 , P< 0.01 ); however, there was a positive correlation between them after 8 weeks (r= 0.91 , P< 0.01 ) in the model group. CONCLUSIONS:  There is a significant correlation between apoptosis and glomerulosclerosis. Apoptosis might play an important role in decreasing glomerular resident cells.

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