Abstract:

OBJECTIVE: Lead poisoning is a potentially devastating problem among young children. Chronic low level lead exposure can lead to learning disabilities and behavior changes such as colic, insomnia, hyperactivity, impaired growth, hearing loss and upper extremity weakness. The purpose of this cross-sectional study was to determine the blood lead level in children with neurological disorders in comparison with healthy controls. METHODS: lead concentrations were measured by flame atomic absorption spectrometry in 100 children aged 1-10 years and suffering from various neurological disorders. One hundred age- and sex-matched healthy children served as controls. RESULTS: The mean blood lead concentration was higher in children with neurological disorders than in controls (113.2±47.5 μg/L vs 84.7±38.0 μg/L; P<0.01). Overall, 44% of children with neurological disorders and 19% of controls were found to have increased blood lead levels, i.e.>100 μg/L. CONCLUSIONS: An increase in blood lead level in children might be related to neurological disorders. The measurement of blood lead level might be included in diagnostic eveluation of children with neurological disorders.［Chin J Contemp Pediatr, 2009, 11 (11):873-876］

Abstract:OBJECTIVE: To clone UreB gene of Helicobacter pylori (H. pylori) isolated from children to pGEX-4T-1 expression plasmid, and do sequence analysis. METHODS: A pair of specific primer was designed according to H. pylori UreB gene in the GenBank. Using H. pylori strains isolated from children as a template, a UreB gene was obtained by PCR. After EcoR I and Not I digestion, the PCR production was linked with pGEX-4T-1 which was digested with the same enzymes. The recombinant plasmid was transformed into E.coli BL21 and identified by double enzyme digestion and sequence analysis. The sequence results were compared with the gene sequence in the GenBank. RESULTS: A UreB gene was successfully amplified from children′s H. pylori strain GZCH1. It was 1 710 bp in size. The objective band was identified by double enzyme digestion. DNA sequence showed that UreB was in the correct open reading frame. The sequence comparison analysis showed that DNA and amino acid sequence identities of UreB gene with other strains were 98%. The sequence of UreB of H. pylori strain GZCH1 was submitted to GenBank (accession number：FJ455126). CONCLUSIONS: UreB of H. pylori strain GZCH1 is successfully cloned to pGEX-4T-1, which provides a basis for research of oral H. pylori vaccine.［Chin J Contemp Pediatr, 2009, 11 (11):877-880］

Abstract:OBJECTIVE: To evaluate the effects and the toxicity of the protocol of CDV combined with CiE as pre-operative chemotherapy in childhood stage IV neuroblastoma. METHODS: The clinical data of 27 children aged from 1.2 to 8 years with neuroblastoma in stage IV was retrospectively studied. The primary sites of the diseases were abdomen (n=21), posterior mediastinum (n=4) and pelvic cavity (n=2). Twenty-three patients had bone marrow metastasis. Twelve patients had bone metastasis. All patients were treated with the CDV protocol (cyclophosphamide+doxorubicin+vincristine) for 3 cycles and the CiE protocol (cisplatin+etoposide) for 2 cycles. Neuroblastoma therapeutic response evaluation criterion and common terminology criteria for adverse events of National Cancer Institute were used to evaluate effects and chemotherapy-related toxicity. RESULTS: All patients received the pre-operative chemotherapy. The overall response rate was 82%. After chemotherapy, 24 patients received operations. Total resection of primary tumor was found in 14 patients (58%) and part resection in 10 patients (42%). The most common chemotherapy-related toxicity was bone marrow suppression: grade IV suppression of neutrophils (n=27), reduction in hemoglobin (III grade, n=7; IV grade, n=20) and reduction in platelet (III grade, n=2; IV grade, n=25). Infection was found in all patients and was controlled with antibiotics.I or II grade lesions of digestive, liver and kidney were found and could be recovered after therapy. Grade I neurotoxicity occurred in 2 patients (7%). The heart function damage was not found in any of patients. CONCLUSIONS: The protocol of CDV combined with CiE as pre-operative chemotherapy might be effective in children with stage IVneuroblastoma.［Chin J Contemp Pediatr, 2009, 11 (11):885-887］

Abstract:OBJECTIVE: Recent studies have shown that integrin-linked kinase (ILK) plays an important role in the pathogenesis and development of some kidney diseases. This study aimed to investigate the relationship between ILK and renal glomerular damage in children with Henoch-schonlein purpura nephritis (HSPN). METHODS: One hundred and eighty-eight HSPN children (aged 3 to 17 years) were assigned to five groups according to the classification of the International Study of Kidney Disease in Children (ISKDC): grade ≤IIa (n=62), grade IIb(n=42), grade IIIa(n=29), grade IIIb(n=40) and grade≥IV(n=15). Fifteen children with basement membrane nephropathy served as the control group. ILK expression on glomeruli was ascertained by immunohistochemical staining. The relationships of ILK expression on glomeruli with glomerular histopathologic lesions and urinary protein excretions were examined. RESULTS: The positive areas of ILK expression on glomeruli in the control, grade≤IIa, grade IIb, grade IIIa, grade IIIb and grade≥IV groups were (3.35±1.01)%, (4.88±1.13)%, (9.64±1.36)%, (11.27±1.68)%, (17.42±3.0)% and (20.62±2.32%), respectively. There were significant differences in the ILK expression between groups (P<0.01). ILK expression on glomeruli increased with increased urinary protein excretions. There were significant differences in the ILK expression in children with different urinary protein excretions (P<0.01). CONCLUSIONS: ILK might be involved in the process of renal glomerular histopathologic damage and the production of proteinuria in children with HSPN.［Chin J Contemp Pediatr, 2009, 11 (11):888-891］

Abstract:OBJECTIVE: To investigate the clinical utility of multiplex ligation-dependent probe amplification (MLPA) for detecting 22q11 deletion and duplication in congenital heart disease (CHD) cases and to study the incidence of 22q11 deletion and duplicaton in different kinds of CHD. METHODS: Forty-eight probes of which 25 located in 22q11 low copy number region (LCR 22s A-H), 7 in 22q11 surrounding region (CES, 22q13) and 16 in chromosomes 4, 8, 10 and 17 were selected to detect 22q11 deletion and duplication in 181 preoperative children with CHD and 14 fetuses with serious CHD or CHD with multiple malformations. In these cases, karyotype analysis was also performed. RESULTS: MLPA demonstrated that 7 cases had 22q11 deletion ［6 cases from CLTCL1 to LZTR1(LCR A-D) and 1 case from CLTCL1 to PCQAP (LCR A-C)］ and that 1 case had 22q11 duplication，spanning from ZNF74 to LZTR1(LCR B-D). The phenotypes of heart defect included ventricular septal defect, atrioventricular septal defect, pulmonary stenosis and tetralogy of Fallot. Karyotype analysis showed that 1 case had 21q deletion ［46, XY, 21q］, 1 case had mosaic trisomy 8 ［ 47,XY,+8/46, XY(1∶2)］ and 4 cases had trisomy 21. One of the 4 cases with trisomy 21 had concurrent 22q11 duplication. CONCLUSIONS: MLPA is a rapid, sensitive, site-specific and relatively inexpensive method for diagnosis of 22q11 deletion and duplication in CHD. 22q11 deletion and duplication may cause various kinds of CHD, suggesting that genetic detection should be performed routinely in CHD patients.［Chin J Contemp Pediatr, 2009, 11 (11):892-896］

Abstract:Objective: To determine the plasma level of Epstein-Barr virus (EBV) DNA in children with EBV-associated diseases, and to investigate the dynamic changes of EBV DNA level after initial infection as well as the relationship between EBV-DNA level and the diseases severity. Methods: The subjects consisted of 73 children with primary EBV infection (infectious mononucleosis, pneumonia，etc.) and 18 children with severe EBV-associated diseases (chronic active EBV infection, hemophagocytic lymphohistiocytosis, etc.). The plasma EBV DNA level was detected by a real-time PCR assay．Results: The plasma EBV DNA level decreased with the infection time in children with primary EBV infection. Two weeks after infection, plasma EBV DNA was almost undetectable. The positive rate of plasma EBV DNA in children with severe EBV-associated diseases increased significantly when compared with that in children with primary EBV infection (89% vs 16%; P<0.05). Conclusions: The level of EBV replication may be reduced with the infection time. Dynamic determination of blood EBV DNA is useful for the evaluation of disease severity in children with EBVinfection.［Chin J Contemp Pediatr, 2009, 11 (11):897-900］

Abstract:OBJECTIVE: To study the antifungal treatment and intensive chemotherapy in children with acute leukemia and invasive aspergillosis. METHODS: The diagnosis and treatment of 4 cases of childhood acute leukemia complicated by invasive aspergillosis between July 2007 and July 2008 were studied retrospectively. RESULTS: Three children who underwent remission induction chemotherapy for ALL and one who underwent consolidation chemotherapy for AML developed invasive aspergillosis. One child with proven aspergillosis and 3 with possible aspergillosis all had halo sign on CT at diagnosis. Voriconazole or amphotericin B was given as primary therapy. Improvements of fungal lesions were shown by CT after two to four weeks of antifungal therapy. Complete radiologic remissions were achieved between 4 months and one year. The intensive chemotherapy schedule was continued in all of 4 cases. The median time from fungal infection to the continuation of chemotherapy was 35 days. None showed recurrence of fungal infection. CONCLUSIONS: The halo sign on CT may be a reliable indicator for the early diagnosis of invasive aspergillosis. The preemptive antifungal therapy on the basis of the identification of a halo sign and the reversal of immunosuppression may improve the outcome of invasive aspergillosis. Prolonged antifungal treatment during subsequent cycles of chemotherapy permits completion of scheduled intensive chemotherapy without fungal recurrence.［Chin J Contemp Pediatr, 2009, 11 (11):901-904］

Abstract:OBJECTIVE: The incidence of invasive fungal infection (IFI) has risen dramatically along with the prolongation of immunocompromised individuals′ lifespan. This study aimed to investigate the incidence of IFI among highrisk pediatric patients and to evaluate the diagnostic value of circulating (1，3)-β-D-glucan (BG) in IFI. METHODS: High-risk pediatric inpatients from hemato-oncology department and ICU were enrolled from November 2007 to June 2008. All the patients had persistent fever for 4 to 7 days or longer. Circulating BG levels were detected once or twice weekly until the signs and symptoms improved, or IFI was excluded, or death. Circulating BG levels were determined by the GKT-5M Set Kinetic Fungus Detection Kit. Detection of plasma BG was judged positive when the level was ≥10 pg/mL. RESULTS: A total of 130 patients were enrolled. Two patients with candidemia were classified as proven IFI, 20 as probale IFI, 7 as possible IFI, and 101 without IFI. The patients with proven or probable IFI had a longer length of hospital stay (P＜0.05) and an increased mortality rate (P＜0.05）. The patients with IFI demonstrated a higher plasma level of BG than those without IFI (P＜0.01）. The sensitivity, specificity, positive and negative predictive values for plasma BG detction were 81.8%, 82.4%, 48.6% and 95.7% respectively. Positive BG results occurred before the abnormal results on computed tomography scan or fungal culture or simultaneously in 72.2% of the cases. CONCLUSIONS: IFI is not rare among pediatric high-risk patients. Circulating BG detection is accurate to a certain extent in the diagnosis of IFI. It is a useful adjunct means for IFI screening in high-risk patients.［Chin J Contemp Pediatr, 2009, 11 (11):905-908］

Abstract:OBJECTIVE: Cysteinyl leukotriene (CysLTs) plays an important role in airway inflammation and remodeling in asthma. Measurement of urinary leukotriene E4 (LTE4) is a sensitive and noninvasive method of assaying total body CysLTs level. This study aimed to evaluate the clinical significance of urinary leukotriene E4 (LTE4) in childhood asthma. METHODS: Sixty children with acute asthma were randomly divided into montelukast (leukotriene receptor antagonist) treatment and conventional treatment groups (n=30 each). Urinary LTE4 levels were measured using ELISA and the airway resistance Rint was assessed by the lung function instrument at the acute and the convalescence phases. Twenty healthy children were used as the control group. RESULTS: Urinary LTE4 levels in asthmatic children at the acute and the convalescence phases were significantly higher than those in the control group (P<0.01). The urinary LTE4 levels at the convalescence phase were significantly reduced compared with those at the acute phase in asthmatic children (P<0.01). More significantly decreased urinary LTE4 levels were noted in the montelukast treatment group than the conventional treatment group at the convalescence phase (P<0.01). In the acute phase, there was no correlation between urinary LTE4 level and Rint in asthmatic children. CONCLUSIONS: Urinary LTE4 level is significantly increased in children with acute asthma. Urinary LTE4 is a useful marker for the diagnosis of asthma and can be as a predictor of asthma control and marker of susceptibility to treatment with leukotriene receptor antagonists.［Chin J Contemp Pediatr, 2009, 11 (11):909-912］

Abstract:OBJECTIVE: To study the effect of cesarean section birth based on different indications on attentiveness in school children. METHODS: A total of 308 school children were assigned to three groups according to their birth model: natural delivery (n=105), cesarean section due to social factors (n=101) or medical factors (n=102). The integrated visual and auditory continuous performance test (IVA-CPT) was performed for assessing attentiveness. RESULTS: The IVA-CPT demonstrated that there were significant differences in the quotients of combination control, auditory response control, combination attention, auditory attention, visual attention, auditory vigilance, visual concordance, visual vigilance and visual attention among the three groups (P<0.05). The results of the IVA-CPT in the group of cesarean section due to medical factors was obviously poorer than that of the natural delivery group and the group of cesarean section due to social factors. However no significant differences were observed between the groups of natural delivery and of cesarean section due to social factors. CONCLUSIONS: Cesarean section itself has no significant impacts on attentiveness in school children, while medical indications for cesarean section may contribute to major cause of attention deficit disorder.［Chin J Contemp Pediatr, 2009, 11 (11):913-916］

Abstract:OBJECTIVE: This study aimed to investigate the mechanism of primary cortical neuron injury induced by high concentrations of copper by observing the effect of aceticum culture-medium on apoptosis of rat primary cortical neurons and expression of cleaved caspase-3, caspase-8 and caspase-9. METHODS: Primary cortical neurons were cultured for 72 hrs and then exposed to different concentrations of aceticum culture-medium (20, 40 and 80 μM). The viability of neurons was detected by the MTT method. Apoptosis was observed by Hoechst33258 and flow cytometry Annexin-V/PI. Expression of caspase-3, caspase-8 and caspase-9 was measured by Western blot. RESULTS: Following incubation with aceticum culture-medium, apoptosis of neurons was induced. The viability of neurons was remarkably reduced and the rate of apoptosis was tremendously increased in a concentration-dependent manner. Caspase-8 and caspase-9 were activated in 20 μM of copper aceticum culture-medium 4 hrs after incubation and peaked at 48 hrs in various concentrations of copper aceticum culture-medium, presenting with a time and concentration-dependent manner. The activated caspase-3 was observed in 20 μM of copper aceticum culture-medium 24 hrs after incubation, which was later than the activated caspase-8 and caspase-9. Caspase-3 expression reached a peak 48 hrs in various concentrations of copper aceticum culture-medium, presenting with a time and concentration-dependent manner. CONCLUSIONS: The apoptosis of primary cortical neurons can be induced by copper. Caspase-3, caspase-8 and caspase-9 cascade reaction may involve in the apoptosis of copper-induced rat primary cortical neurons.［Chin J Contemp Pediatr, 2009, 11 (11):917-922］

Abstract:OBJECTIVE: This study examined the effects of prenatal application of taurine on mRNA expression of protein kinase A-cAMP response element binding protein (PKA-CREB) signal pathway and glial cell line-derived neurotrophic factor (GDNF) in fetal rat brains of intrauterine growth restriction (IUGR). METHODS: Pregnant rats were randomly divided into 4 groups: normal control, IUGR model, low-dose (100 mg/kg?d) and high-dose (300 mg/kg?d) taurine treatment IUGR (n=5 each). IUGR was induced by food restriction throughout pregnancy. PKA, CREB and GDNF mRNA expression in brains of newborn rats was detected by reverse transcription-polymerase chain reaction (RT-PCR). RETHODS: PKA, CREB and GDNF mRNA expression in the IUGR model group was significantly higher than that in the normal control group (P<0.05). Compared with the IUGR model group, mRNA expression of PKA and CREB in both the low-dose and high-dose taurine treatment groups increased significantly (P<0.05); GDNF mRNA expression in the high-dose taurine treatment group also increased significantly (P<0.01). CONCLUSIONS: Taurine can increase mRNA expression of PKA, CREB and GDNF in fetal rat brains of IUGR. This suggests that prenatal application of taurine may increase neurogenesis of the central nervous system and endogenous secretion of neurotrophic factors, thus providing neuroprotective effects. ［Chin J Contemp Pediatr, 2009, 11 (11):923-926］

Abstract:OBJECTIVE: To study the effects of prolonged 75% oxygen exposure on the expression of vascular endothelial growth factor (VEGF) and its receptors (VEGFR1 and VEGFR2) in the neonatal rat lungs and to elucidate the effects of prolonged exposure of high concentration of oxygen on lung vascular development and its relationship with bronchopulmonary dysplasia (BPD). METNODS: Forty-eight Sprague-Dawley rat pups were randomly exposed to air (control group) and 75% oxygen (experimental group) 12 hrs after birth. The rats were sacrificed 7, 14 and 21 days after exposure and their lungs were sampled. The lung sections were stained with hematoxylin and eosin for histological evaluation. Expression of VEGF, VEGFR1 and VEGFR2 protein and mRNA was detected by immunohistochemistry and RT-PCR. RETHODS: After being exposed to 75% oxygen for 21 days, lung tissues had pathological changes as “new” BPD. Expressions of VEGF protein (10.9±2.7 vs 30.8±6.4), VEGFR1 protein (5.4±1.4 vs 15.6±3.4) and VEGFR2 protein (11.3±2.6 vs 21.7±4.5) on day 21 in the experimental group decreased significantly as compared with the control group (P<0.05). The expression of VEGF mRNA (1.6 vs 3.3), VEGFR1 mRNA (0.4 vs 6.6) and VEGFR2 mRNA (0.5 vs 4.9) on day 21 in the experimental group also decreased significantly as compared with the control group (P<0.05). CONCLUSIONS: Prolonged exposure of high concentration of oxygen may cause BPD possibly by inhibiting lung vascular development in neonatal rats.［Chin J Contemp Pediatr, 2009, 11 (11):927-930］

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Abstract:OBJECTIVE: This study aimed to investigate the value of the liver function test in the differential diagnosis of infantile hepatitis syndrome (IHS) and biliary atresia (BA) by analyzing seven conventional serological markers in this test using receiver operating characteristic (ROC) curves. METHODS: Serum levels of seven conventional serological markers: alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidase (γ-GT), alkaline phosphatase (ALP), total bilirubin (TB), conjugated bilirubin (CB) and serum albumin (ALB) were measured in 103 children with IHS and 60 children with BA. ROC curves were used to evaluate the sensitivity, specificity, positive and predictive values and optimal cut-off. The united tests (parallel test and serial test) of γ-GT, TB and CB were performed to elevate diagnostic efficiency. RESULTS: Compared with the IHS group, the BA group had significantly increased serum ALT, AST, γ-GT, TB and CB levels (P<0.01). The area under ROC (AUCROC) of AST, γ-GT, CB and TB was 0.77, 0.881, 0.841 and 0.87, respectively. γ-GT showed the highest AUCROC, specificity, positive predictive value and positive likelihood ratio in the diagnosis of BA, followed by CB, TB and AST in turn. The negative predictive value of CB was the highest, followed by TB. The negative likelihood ratio of CB was the lowest but its Youden index was the highest. The Youden index of γ-GT and TB was lower than that of CB. After the parallel tests, the sensitivity and negative predictive value of γ-GT, CB and TB increased to 100%. After the serial tests, the specificity of γ-GT, CB and TB increased to 90.4% and the positive predictive value increased to 87.5%. CONCLUSIONS: The measurement of γ-GT, TB and CB levels are valuable in the differential diagnosis of BA and IHS. An imaging examination is required in the parallel test positive patients.［Chin J Contemp Pediatr, 2009, 11 (12):953-956］

Abstract:OBJECTIVE: The pathogenesis of mesangial proliferative glomerulonephritis (MsPGN) and mechanisms of glucocorticoid (GC) resistance have not been fully identified. Cytotoxic T-lymphocyte antigen-4 (CTLA-4) is an important inhibitor of T-lymphocyte activation. The objective of the study is to investigate the CTLA-4 expression and apoptosis in lymphocytes of children with MsPGN and the effects of dexamethasone (Dex) on the CTLA-4 expression and apoptosis. METHODS: Blood samples were collected from 36 children with MsPGN and 30 healthy children. CTLA-4 expression in in vitro cultured lymphocytes with or without Dex treatment was measured by flow cytometry following direct immune fluorescene. The rate of apoptosis in the lymphocytes was evaluated by annexin V-FITC and propidium iodide staining. RESULTS: The CTLA-4 expression and apoptosis in lymphocytes from children with MsPGN were significantly lower than those in the healthy control children in the absence or presence of Dex treatment (P＜0.05). There was a positive correlation between CTLA-4 expression and apoptosis in lymphocytes (P＜0.05). CONCLUSIONS: Abnormal CTLA-4 expression may participate in the pathogenesis of MsPGN and be one of mechanisms of GC resistance.［Chin J Contemp Pediatr, 2009, 11 (12):957-960］

Abstract:OBJECTIVE: To study the differences of the antimicrobial-resistant profiles between the isolates of Staphylococci aureu from children and from adults. METHODS: Staphylococci was identified by the plasma coagulase test，Staphylococci monoclonal antibody and VITEK-32 fully automated microbiology analyzer．Antimicrobial susceptibility testing was done by the K-B disk diffusion for 84 Staphylococci isolates from children and 74 Staphylococci isolates from adults. Cefoxitin was used for detecting methillicin-resistant Staphylococcus aureus (MRSA) by the disk diffusion test．RESULTS: Seven (8%) MRSA isolates were found in Staphylococci isolates from children compared with 35 MRSA isolates (47%) in those from adults (P<0.01). All strains were susceptible to vancomycin． All strains from children were susceptible to fusidic acid．The resistant rates of the isolates from children to cefazolin, cefuroxime, gentamicin, cefoxitin, and levofloxacin were significantly lower than those from adults (P<0.01). CONCLUSIONS: The antimicrobial resistance of the Staphylococcus aureus isolates from adults is more prevalent than that in the isolates from children．［Chin J Contemp Pediatr, 2009, 11 (12):910-912］

Abstract:OBJECTIVE: To investigate the distribution and the antibiotic susceptibility of pathogenic bacteria in children from Guiyang with lower respiratory infection (LRI). METHODS: The nasopharyngeal aspirate samples were obtained from 893 hospitalized children with LRI between August 2006 and June 2008. An antibiotic susceptibility test was performed using the VITEK system and the Kirby-Bauer diffuse method after bacteria were identified. RESULTS: Five hundred and forty-three patients (60.8%) were bacteria-positive. A total of 598 strains (30 kinds of bacteria) were obtained from the sputum samples. Of them, 533 strains (89.1%) were gram-negative and 57 were gram-positive (9.8%). Escherichia coli (E. coli) and Kleb-siella pneumoniae (K. pneumoniae) were common in gram-negative strains. They were susceptive to piperacillin/tazobactam, amikacin, ciprofloxacin, and levofloxacin, especially to imipenem. Streptococcus pneumoniae (S. pneumoniae) and Stapthylococcus aureus (S. aureus) were common in gram-positive strains. S. pneumoniae was susceptive to penicillin and cefazolin sodium, but S. aureus was resistant. Both were high susceptive to vancomycin, and resistant to roxithromycin. CONCLUSIONS: Gram-negative bacteria are the main pathogens in children from Guiyang with LRI, and E. coli and K. pneumoniae are common. The antibiotic susceptibility of pathogenic bacteria varies with different strains of bacteria. A reasonable selection of antibiotics should be based on the antibiotic susceptibility test.［Chin J Contemp Pediatr, 2009, 11 (12):964-966］

Abstract:OBJECTIVE: To study the clinical features and treatment of serious brainstem encephalitis caused by enterovirus 71 (EV71) infection. METHODS: The clinical data of 32 hospitalized children with serious brainstem encephalitis caused by EV71 infection between May and December 2008 were retrospectively reviewed. RESULTS: The children whose age was younger than 3 years old accounted for 88% (22 cases). Fever (>38.5℃) lasting at least 3 days, frequent vomiting and limb twitch were presented as the main manifestations in the 32 children. Cyanosis, tachypnea, tachycardia and cold extremities were observed, and pulmonary edema or even pulmonary hemorrhage occurred in 8 children 3 to 4 days after the onset. The 32 children received a medical treatment: reduction of intracranial pressure with mannitol or frusemide, inhibition of inflammation reactivity with gamma globulin and methylprednisolone, and improvement of cardiac function and pulmonary edema with innotropic agents, fluid restriction and positive mechanical ventilation. CONCLUSIONS: Vegetative nerve functional disturbance is the main clinical feature of brainstem encephalitis caused by EV71 infection in children. An early identification and treatment of pulmonary edema or hemorrhage is of great importance.［Chin J Contemp Pediatr, 2009, 11 (12):967-969］

Abstract:OBJECTIVE: To study the correlation between glucose-6-phosphate dehydrogenase (G-6-PD) activities and three common mutations of G-6-PD gene G1388A, G1376T and A95G and investigate the effects of G-6-PD gene mutations on neonatal jaundice in Nanning, Guangxi. METHODS: One hundred and twenty-four neonates from Nanning, Guangxi, with hyperbilirubinemia were enrolled. The ARMS-PCR and PCR/REA methods were used to determine G-6-PD gene mutations. G-6-PD activities were measured using the NBT method. The incidence of acute bilirubin encephalopathy and the peak bilirubin concentration 72 hrs after birth were compared between the neonates with different genotypes and between the G-6-PD mutation and normal groups. The risk of blood serum bilirubin >340 μmol/L was evaluated by logistic regression analysis. RESULTS: Of the 124 cases, gene mutations were found in 37 cases, including G1388A (n=20), G1376T (n=14), A95G (n=4) and G1388A+A95G (n=1). Five cases (25%) showed normal G-6-PD activities in the G1388A gene mutation group and 4 (29%) had normal G-6-PD activities in the G1376T G1388A gene mutation group. All of 4 cases of A95G G1388A gene mutation showed a deficiency of G-6-PD activities. There were no significant differences in the incidence of acute bilirubin encephalopathy and the peak bilirubin concentration 72 hrs after birth between the G1388A and G1376T G1388A gene mutation groups. The incidence of acute bilirubin encephalopathy, the peak bilirubin concentration 72 hrs after birth and the risk of serum bilirubin >340 μmol/L in the G-6-PD mutation group were not different from the normal group. CONCLUSIONS: G1388A, G1376T and A95G are common G-6-PD gene mutations in Nanning, Guangxi. The false negative results may be received when the NBT method is used for diagnosis of G-6-PD deficiency. There are similar effects on the incidence of acute bilirubin encephalopathy and the peak bilirubin concentration 72 hrs after birth between different gene mutation groups. G-6-PD gene mutations alone may not contribute to the development of acute bilirubin encephalopathy and the changes of peak bilirubin concentration 72 hrs after birth and the risk of serum bilirubin >340 μmol/L.［Chin J Contemp Pediatr, 2009, 11 (12):970-972］

Abstract:OBJECTIVE: To investigate the changes of N-terminal pro-brain natriuretic peptide (NT-proBNP) in neonates with hypoxic-ischemic encephalopathy (HIE) complicated by myocardial ischemic injury. METHODS: Thirty-five neonates with HIE (17 cases with concurrent myocardial injury and 18 cases without) were enrolled. Twenty healthy neonates were used as the control group. Plasma NT-proBNP levels were measured using enzyme immunoassay. RESULTS: The mean plasma NT-proBNP levels in patients with myocardial injury (338.8±76.2 fmol/mL) were significantly higher than those in patients with non-myocardial injury (137.5±45.1 fmol/mL) and in the control group (113.7±53.6 fmol/mL) (P<0.01). The NT-proBNP levels in mild, moderate and severe HIE neonates were 141.3±41.6, 271.8±118.1 and 347.2±85.1 fmol/mL, respectively. Compared with the control group, the NT-proBNP levels in the moderate and the severe HIE groups significantly increased (P<0.01). There were significant differences in the NT-proBNP level among the mild, moderate and severe HIE groups (P<0.05). In patients with myocardial injury, the NT-proBNP levels significantly decreased in the convalescent phase compared with those in the acute phase (225.0±80.0 fmol/mL vs 338.8±76.2 fmol/mL (P<0.01). CONCLUSIONS: Plasma NT-proBNP levels increase in neonates with HIE complicated by myocardial ischemic injury in the acute phase. Detection of NT-proBNP levels may be useful in the diagnosis of myocardial ischemic injury and the severity evaluation of HIE.［Chin J Contemp Pediatr, 2009, 11 (12):973-975］

Abstract:OBJECTIVE: High noise levels (>70 dB) in the neonatal intensive care unit (NICU) are common in some primary hospitals. This study aimed to investigate the noise in the NICU on auditory system and intelligence development in premature infants. METHODS: One hundred premature infants with respiratory distress syndrome who needed mechanical ventilation therapy were randomly divided into observation and control groups according to the use of earmuffs. The duration of mechanical ventilation therapy lasted for 2 to 15 days in the two groups. After weaning from mechanical ventilator, the auditory brainstem response, cranial B-ultrasonography, and the intelligence development assessment were performed. RESULTS: The percentage of total (23% vs 47%) and mild hearing loss (15% vs 35%) in the observation group was significantly lower than that in the control group (P<0.05) 2 to 3 days after weaning from mechanical ventilator. The incidence of periventricular hemorrhage intraventricular hemorrhage (PVH-IVH) or periventricular leukomalacia (PVL) in the observation group was significantly lower than that in the control group (21% vs 42%; P<0.05). The intelligence development assessment performed in the first 6 and 12 months of life showed that the mental development index and the psychomotor development index in the observation group were much higher than those in the control group (P<0.05). CONCLUSIONS: The noise in the NICU can result in mild hearing loss and retardation of intelligence development and increase the incidence of PVHIVH and PVL in premature infants. The use of earmuff may reduce the adverse events.［Chin J Contemp Pediatr, 2009, 11 (12):976-979］

Abstract:OBJECTIVE: To investigate the risk factors and the pathogens of nosocomial infection in preterm infants. METHODS: The medical data of 197 preterm infants with nosocomial infection were retrospectively studied. RESULTS: The incidence of nosocomial infection was 22.2% (197/887). Small gestational age (OR=4.125, P<0.05), low birth weight (OR=5.450, P<0.05), mechanical ventilation therapy (OR=4.435, P<0.05) and delayed enteral feedings (OR=3.765, P<0.05) were found to be important risk factors for nosocomial infection. Klebsiella was the main pathogen (22.3%), followed by Staphylococcus (18.4%). CONCLUSIONS: Hygienic handwashing, decreasing invassive procedures and an early start of enteral feeding are crucial for preventing nosocomal infection in preterm infants. Klebsiella is the main pathogen of nosocomal infections［Chin J Contemp Pediatr, 2009, 11 (12):980-982］

Abstract:OBJECTIVE: Peripherally inserted central catheter (PICC) is widely used to provide a long-term access for the administration of total parenteral nutrition and medications. Catheter-related infections (CRI) are common complications of PICC. The purpose of this retrospective study was to investigate the role of low-dose heparin added to the total nutrient admixture (CTNA) in the prevention of CRI. METHODS: Eighty-three neonates who underwent PICC received TNA with (heparin group, n=43) or without heparin (0.5 U/ mL) (control group, n=40). The incidence of CRI was compared between the two groups. RESULTS: The incidences of catheter obstruction (5% vs 20%) and the catheter-tip colonization (2% vs 18%) in the heparin group were significantly lower than those in the control group (P<0.05). None of the neonates in the heparin group had clinical evidence of catheter-related bloodstream infection, but 5 cases in the control group (P＜0.05). CONCLUSIONS: The administration of low-dose heparin in TNA may decrease the incidences of catheter obstruction and CRI.［Chin J Contemp Pediatr, 2009, 11 (12):983-985］

Abstract:OBJECTIVE: This study examined the levels of exhaled nitric oxide (eNO) and peripheral blood eosinophils (EOS) as well as the correlation between the two markers in children with bronchial asthma (AS)，AS complicated by allergic rhinitis (AS/AR) and chronic cough variant asthma (CVA), in order to explore the value of eNOS detection in children with AS. METHODS: The eNO level was measured using light-emitting electrochemical photometry in 12 children with AS, 29 children with AS/AR and 10 children with CVA. Peripheral blood EOS was counted by blood cell counter (Coulter JT). Forced expiratory volume in one second (FEV1) was assessed by lung function measurement. Thirty children without atopic disease and acute respiratory infection as well as without a family history of atopic diseasea served as the control group. RESULTS: The levels of eNO and blood EOS in the AS, the AS/AR and the CVA groups were significantly higher than those in the control group (P<0.01). The AS/AR group showed increased levels of eNO (50.3±6.7 ppb) and EOS (5.9±4.2×109 ) compared with the AS (30.5±8.8 ppb and 4.2±3.2×109 respectively) and the CVA groups (26.0±3.2 ppb and 3.7±6.9×109 respectively) (P<0.05). There were no significant differences in eNO and EOS levels between the AS and the CVA groups. The eNO level was positively correlated with the EOS level (r=0.51, P<0.05), but not with FEV1 (r=0.144, P>0.05) in the AS group. CONCLUSIONS: NO is highly expressed in children with symptoms of atopy and can reflect the levels of eosinophilic airway inflammation in children with AS.［Chin J Contemp Pediatr, 2009, 11 (12):986-988］

Abstract:OBJECTIVE: To examine the expression of matrix metalloproteinases (MMP)-2, -9, tissue inhibitor of matrix metalloproteinase (TIMP)-1 and hs-CRP, and their relationship with coronary artery in children with Kawasaki disease. METHODS: One hundred and fifty-one children with Kawasaki disease (111 cases with coronary artery damage and 40 cases without) and 60 healthy children were enrolled. The expression of MMP-2, MMP-9 and TIMP-1 was detected using ELISA, and the hs-CRP concentration was measured using the endpoint nephelometry. RESULTS: There were significant differences in the level of MMP-2, MMP-9 and hs-CRP between the patients with or without coronary artery damage and the healthy children (P<0.05). The levels of MMP-2, MMP-9 and hs-CRP were the highest in the cardiovascular damage group (P<0.05). There were positive correlations between MMP-2, MMP-9 and TIMP-1 in children with Kawasaki disease. CONCLUSIONS: MMP-2, MMP-9, TIMP-1 and hs-CRP may play important roles in the development of Kawasaki disease. The combined measurement of MMP-2, MMP-9 and hs-CRP may be useful in the evaluation of the severity in children with Kawasaki disease.［Chin J Contemp Pediatr, 2009, 11 (12):989-991］

Abstract:OBJECTIVE: To study the function of the hypothalamus-pituitary-adrenal (HPA) axis in children with attention deficit hyperactivity disorder (ADHD). METHODS: One hundred and twenty-eight boys with ADHD at ages of 6 to 14 years were enrolled. The diagnosis and grouping of ADHD were based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV): ADHD-predominantly inattention type (ADHD-I, n=44), ADHD-predominantly hyperactive impulsivetype (ADHDHI, n=32) and ADHD-combined type (ADHD-C, n=52). Thirty healthy boys served as the control group. Plasma levels of cortisol and adrenocorticotropic hormone (ACTH) were measured by automatic particle enzyme immunoassay and electrochemiluminescence respectively at 8∶00 am. The intelligence level was tested by Raven′s standard progressive matrices. RESULTS: The children with ADHD had lower IQ score (84.5±11.3) than the control group (94.6±12.4) (P<0.01). There were significant differences in the IQ score among the three ADHD subgroups (P<0.01). The IQ score in the ADHD-I and the ADHD-C groups was significantly lower than that in the control group. The mean plasma cortisol level in the ADHD group (226.5± 129.1 nmol/L) was significantly lower than that in the control group (384.5±141.4 nmol/L) (P<0.01). The three ADHD subgroups showed significantly decreased plasma cortisol level compared with the control group (P<0.01). The plasma level of cortisol was the lowest in the ADHDHI group (154.4±71.6 nmol/L), followed by the ADHDI group (219.4±117.7 nmol/L) and the ADHD-C group (258.3±136.4 nmol/L). There were no significant differences in plasma concentration of ACTH between ADHD and control children. CONCLUSIONS: In the non-stress state, the HPA axis may be dysfunctional in children with ADHD, which may be attributed to the under reactivity of the HPA axis. Lower plasma cortisol has fewer impacts on the cognitive-behavior function, but it may closely be related to attention deficit, hyperactivity and impulsive behaviors.［Chin J Contemp Pediatr, 2009, 11 (12):992-995］

Abstract:OBJECTIVE: To investigate the treatment outcome and risk factors for intractable seizures in children with tuberous sclerosis complex（TSC）complicated by epilepsy. METHODS: The medical data of 66 cases of TSC were retrospectively studied. RESULTS: Of the 66 children with TSC, 47 cases were available for follow-up. The follow-up period ranged from 7 months to 9.3 years (average 4.5±2.6 years). The patients′ present average age was (7.7±4.1) years (median 8 years). Among the 47 cases, 19 (40%) had infantile spasms, 24 (51%) had tonic seizures, 15 (32%) had partial seizures, and 3 (6%) had tonic-clonic seizures, and additionally, multifocal seizures, atonic seizures, atypical absence seizures and hypomotor seizures each appeared in 1 case (2%) respectively. The average number of antiepileptic drugs used was 1.9±0.86 (median 1). Among the 47 patients, 12 (26%) still had epileptic seizures and 33 (70%）were seizure-free, and 4% were dead. Three cases underwent surgery and continued to receive medication after surgery. The three patients were seizurefree in a 1.5 years follow-up. Among the 30 children over 7 years old, 17 cases (57%) were enrolled in ordinary schools, 3 cases (10%) in special schools and the other 10 cases were off-school for disabilities of intelligence and speech. The non conditional logistic regression showed that the age of onset (RR=1.8, 95% CI 1.0- 3.2, P=0.050), administration of multiple antiepileptic drugs (RR=4.8, 95% CI 1.2-18.6, P=0.024), tonic seizures (RR=0.003, 95% CI 0.0- 0.2, P=0.04) and sex (RR=0.016, 95% CI 0.0-0.5, P=0.017) were risk factors for intractable seizures. CONCLUSIONS: The majority (70%) of children with TSC complicated by epilepsy can be seizure-free with suitable treatment. The risk factors of poor outcome in seizure control may involve in the early onset age, tonic seizures and the administration for multiple anti-epileptic drugs.［Chin J Contemp Pediatr, 2009, 11 (12):996-998］

Abstract:OBJECTIVE: To study the relationship between human parvovirus B19 infection and childhood idiopathic thrombocytopenic purpura (ITP) by the principle of evidence based medicine. METHODS: Papers related to the relationship between human parvovirus B19 infection and childhood ITP published between 1994 and 2008 were retrieved electronically from the Chinese Journals Full-text Database and the Wanfang Data. These relevant papers on case-control trials were statistically studied by meta analysis. RESULTS: Eight papers that met the inclusion criteria were included for this meta analysis. Five hundred and sixteen cases of childhood ITP and 246 healthy controls were enrolled. The meta analysis showed that the incidence of human parvovirus B19 infection in the ITP group was significantly higher than that in the control group (OR=13.71, 95% CI=7.07-26.59, Z=7.75, P<0.01). CONCLUSIONS: Human parvovirus B19 infection is closely associated with childhood ITP.［Chin J Contemp Pediatr, 2009, 11 (12):999-1001］

Abstract:OBJECTIVE: To compare the effects of Montessori education and traditional education on the intellectual development in children aged 2 to 4 years. METHODS: Children aged between 2 to 3 years who were enrolled in a kindergarten in September 2006 were randomly assigned to the Montessori education and the traditional education groups. In addition to receiving the traditional education, the Montessori education group participated in the two-hour Montessori pedagogical activities every day. The intellectual development was evaluated by the Neuropsychological Development Examination Format for Children Aged 0~6 years published by Capital Pediatrics Research Institute at enrollment and one year after the trial. RESULTS: There were no significant differences in the intelligence growth level between the Montessori education and the traditional education groups at enrollment. After one year, the levels of fine movements, adaptation ability, language, and social behavior developments in the Montessori education group were significantly higher than those in the traditional education group (P<0.05 or 0.01). The intelligence increasing scores of the large motor ability, fine movements, language, social behavior and development quotient in the Montessori education group were also higher than those in the traditional education group (P<0.05 or 0.01). CONCLUSIONS: Montessori education can promote the development of large motor ability, fine movements, language, and social behavior in children.［Chin J Contemp Pediatr, 2009, 11 (12):1002-1005］

Abstract:OBJECTIVE: To investigate the differences of psychological and behavioral development between children aged 1 to 3 years fostered by grandparents and those by parents. METHODS: Psychological and behavioral development of 443 children aged 1 to 3 years fostered by their grandparents and of aged-matched 443 children fostered by their parents were assessed with DST, an intellectual developmental screening test developed by Pediatric Hospital of Fudan University in Shanghai. RESULTS: The abilities of social adaptation and intelligence development in children fostered by their grandparents were obviously retarded as compared with those in children fostered by their parents. CONCLUSIONS: There are shortcomings in psychological and behavioral development in children aged 1 to 3 years fostered by grandparents.［Chin J Contemp Pediatr, 2009, 11 (12):1006-1007］

Abstract:OBJECTIVE: Human STEAP4, a novel obesity-related gene, is associated with insulin sensitivity regulation in human adipocytes. This study aimed to explore the regulative role of TNFα on STEAP4 gene in matured human adipocytes. METHODS: Human preadipocytes were cultured and differentiated into matured adipocytes in vitro. Fully differentiated adipocytes (Day 17) were treated with different concentrations of TNFα (0, 5, 10, 25 and 50 ng/mL) for 24 hrs. Total RNA and protein were extracted from the adipocytes. Levels of STEAP4 mRNA and protein expression were determined by real-time quantitative RT-PCR and Western blot respectively. RESULTS: Different concentrations (5, 10, 25 and 50 ng/mL) of TNFα treatment for 24 hrs resulted in a significant increase in the STEAP4 mRNA expression of human matured adipocytes.The maximal effect was seen in the 50 ng/mL of TNFα treatment group. In parallel, STEAP4 protein synthesis in matured adipocytes increased in response to TNFα treatment of different concentrations (5, 10, 25 and 50 ng/mL) for 24 hrs. The maximal up-regulated effect was seen in the 25 ng/mL of TNFα treatment group. CONCLUSIONS: TNFα can up-regulate STEAP4 mRNA expression in human matured adipocytes.［Chin J Contemp Pediatr, 2009, 11 (12):1008-1011］

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