Abstract:OBJECTIVE: To assess the predisposing factors, frequency and mortality of pneumothorax (PTX) among the newborns hospitalized in a neonatal intensive care unit (NICU) in Isfahan, Iran. METHODS: The data of 43 cases of PTX among the 738 neonates hospitalized in the NICU were analyzed retrospectively according to gestational age, birth weight, Apgar score, type of delivery, age of mother, parity, perinatal asphyxia, resuscitation at birth, side of PTX, mechanical ventilation, surfactant therapy, and underlying lung disorders. RESULTS: Mean gestational age was 31 weeks and birth weight was 1 596 g in the PTX cases. The gestational age of 12 (28%) neonates was less than 28 weeks. Twenty-eight (65%) neonates were below 1 500 g. In total, PTX occurred in 43 (5.8%) neonates. Sixty-three episodes of PTX (97%) were unilateral and 2 (3%) were bilateral. Respiratory distress syndrome (RDS) (40/43, 93%) and mechanical ventilation (37/43, 86%) were common predisposing factors of PTX. Overall, 28 (65%) neonates with PTX died. Birth weight, gestational age and chest tube duration were significantly different between dead and surviving infants. The mortality rate was significantly higher in neonates who required surfactant therapy than that in those who did not require it. CONCLUSIONS: The incidence and mortality of PTX in this study were higher than some other reports and this might be attributed to lower birth weight and gestational age. RDS and mechanical ventilation were the most common predisposing factors for the development of neonatal PTX, and mortality increased with lower birth weight, lower gestational age and more severe underlying primary lung disease.［Chin J Contemp Pediatr, 2010, 12 (6):417-420］

Abstract:OBJECTIVE: To evaluate the efficacy and safety of aripiprazole in the treatment of tic disorder when tiapride is used as a control. METHODS: Sixty-five children aged 6-14 years old with tic disorders were randomly assigned to two groups: aripiprazole (2.5-10 mg/d) and tiapride treatment (25- 400 mg/d). After 12 weeks treatment, the clinical efficacy was assessed by the Yale Global Tie Severity Scale (YGTSS) score and the adverse reactions were observed. RESULTS: The YGTSS score in both groups decreased from the second week of treatment. Compared with the tiapride treatment group, the aripirazole treatment group showed a more decreased YGTSS score ［(29±13)% vs (16±14)%; P<0.01］ by the second week of treatment. The overall effective rate in the aripiprazole and tiapride treatment groups was 91% and 84%, respectively (P>0.05) 12 weeks after treatment. There were no significant differences in the incidence of adverse reactions between the aripiprazole and tiapride treatment groups and no severe adverse events were found in either group. CONCLUSIONS: Low dose aripiprazole is safe and effective for treatment of tic disorders in children, suggesting that it represents a new valid option for the treatment of tic disorder.［Chin J Contemp Pediatr, 2010, 12 (6):421-424］

Abstract:OBJECTIVE: This study examined the biochemical metabolism by proton magnetic resonance spectroscopy ('H-MRS) in order to explore the value of 'H-MRS in idiopathic epilepsy in children. METHODS: Thirty-three children with idiopathic epilepsy (14 cases with history of febrile seizures and 19 cases without) and six normal controls experienced MRI of the skull and brain and single-voxel 'H-MRS examinations of the hippocampi-temporal lobe. The signal intensities of N-acetylaspartate (NAA), eatine+phosphocreatine (Cr), choline-containig compounds (Cho) and lactate (Lac) and the ratios of NAA/ (Cho+Cr) and Lac/Cr were compared between the patients and normal controls. RESULTS: MRI examination showed that only one child with epilepsy had myelin dysplasia. 'H-MRS examination showed that the ratio of NAA/ (Cho+Cr) in the epilepsy group was lower than that in the control group (0.64±0.07 vs 0.73±0.05; P＜0.01). The epileptic children with history of febrile seizures had a more decreased ratio of NAA/ (Cho+Cr) compared with those without the history (0.61±0.07 vs 0.66±0.06; P<0.05). There were no significant differences in the ratio of Lac/Cr between the epilepsy and the control groups. CONCLUSIONS: 'H-MRS may provide early information on brain injury sensitively and non-invasively in children with epilepsy. It may be used for diagnosis and prognosis evaluation of epilepsy.［Chin J Contemp Pediatr, 2010, 12 (6):425-428］

Abstract:OBJECTIVE: To investigate the distribution and frequency of UGTIA6 A541G genetic polymorphism in Han epileptic children from Henan and to evaluate the effect of UGTIA6 A541G genetic polymorphism on serum concentrations of valproic acid. METHODS: The method of gas chromatography was used to assay serum concentrations of valproic acid. UGTIA6 A541G genetic polymorphism was screened by PCR-RFLP. Direct sequencing was used to confirm the expected sequences of each genotype. RESULTS: The genotypic frequencies of UGTIA6 A541G were as follows: AA in 76 cases, AG in 65 cases and GG in 6 cases. The mean values of serum concentrations of valproic acid in patients with A541G AA, AG and GG were 3.91±1.57, 3.59±1.39 and 3.73±1.28 μg/mL, respectively (dose-adjusted trough concentration on a mg/kg basis). There were no significant differences in serum concentrations of valproic acid among the three groups. CONCLUSIONS: UGT1A6 A541G gene polymorphism does not influence serum concentrations of valproic acid in Han epileptic children. Individual differences in serum concentrations of valproic acid may be attributed to many factors.［Chin J Contemp Pediatr, 2010, 12 (6):429-432］

Abstract:OBJECTIVE: To summarize the etiology and treatment of gynecomastia in male children. METHODS: The clinical data of 38 boys with gynecomastia at ages of 2-14 years were retrospectively studied. RESULTS: In the 38 cases, 17 cases were identified as adolescent breast hyperplasia, 2 cases were relevant to primary disease, 4 cases were caused by ingestion of drugs containing hormone, and 15 cases did not show identifiable causes and were diagnosed as idiopathic gynecomastia. For the 3 children with breast development in B3 stage, oral rupixiao was administered (1.34 g, tid) for one month. For 16 children at ages of over 12 years with breast development in B2 stage and with obvious clinical symptoms, oral rupixiao was administered (1.34 g, tid) for 3-5 days. The other patients did not receive drug treatment. In a one month to one year follow-up, most of the patients recovered well. CONCLUSIONS: The etiology of gynecomastia in male children includes adolescent breast hyperplasia, ingestion of drugs containing hormone and secondary causes. Most gynecomastia can be attributed to physiological reasons. Only a few children with obvious clinical symptoms need drug treatment.［Chin J Contemp Pediatr, 2010, 12 (6):433-435］

Abstract:OBJECTIVE: To evaluate the relationship of right ventricular function with the indexes of blood gas in neonates with hypoxic pulmonary hypertension (HPH). METHODS: Sixty-seven neonates with HPH (29 mild, 23 moderate and 15 severe) and 22 gestational age- and weight-matched neonates without HPH (control group) were enrolled. On postnatal days 1, 3 and 7, pulmonary artery systolic pressure (PASP) was measured by pulsed Doppler echocardiography. Systolic wave of ventricular (Sa), early diastolic wave (Ea), late diastolic wave (Aa), and Ea/Aa ratio were determined by the tissue Doppler imaging (TDI) technology. Artery oxygen pressure (PaO2), fractional concentration of inspired oxygen (FiO2), and PaO2/ FiO2 ratio were simultaneously observed. RESULTS: On postnatal day 1, PaO2 and PaO2/FiO2 ratio as well as Ea and Ea/Aa ratio were significantly lower, while PASP was significantly higher in the HPH groups than those in the control group. Sa decreased in the moderate and severe HPH groups, Aa increased in the moderate HPH group, and Aa decreased significantly in the severe HPH group compared with that in the control group. On postnatal day 3, PaO2 and PaO2/FiO2 ratio returned to normal level in the mild and moderate HPH groups, while other indexes remained abnormal. On postnatal day 7, all the indexes above returned to normal level in the mild HPH group; Ea and Ea/Aa ratio were still significantly lower in the moderate HPH group, and the other indexes returned to normal level; in the severe HPH group, only PaO2 and PaO2/FiO2 ratio returned to normal level. CONCLUSIONS: The changes and recovery of diastolic and systolic functions of right ventricular are not paralleled with hypoxia and PASP in neonates with HPH. It is helpful for the diagnosis and treatment of HPH by monitoring PASP and right ventricular function with TDI． ［Chin J Contemp Pediatr, 2010, 12 (6):436-439］

Abstract:OBJECTIVE: To study erythrocyte oxidative stress status and its association with left to right shunt congenital heart disease (CHD) in children. METHODS: A total of 31 children with left to right shunt CHD were enrolled, including 7 cases of atrial septal defect (ASD), 12 ventricular septal defect (VSD), 4 patent ductus arteriosus (PDA), 6 patent foramen ovale (PFO), and 2 complete endocardial cushion defect. Twenty healthy age-matched (1 month to 3 years old) children severed as the control group. The contents of superoxide dismutase (SOD) and malonaldehyde (MDA) in erythrocytes were determined using ELISA. ESR was measured by Westergen. PaO2 and PaCO2 were measured by Blood Gas Analyzer (GEM Premier 3000). RESULTS: The MDA content in erythrocytes in the CHD group was significantly higher, in contrast, SOD content was significantly lower than that in the control group (P<0.05). The CHD children with heart failure had more decreased SOD and more increased MDA contents compared with the control group (P<0.01). The SOD level was the highest in the PFO group and was the lowest in the complete endocardial cushion defect group. The SOD level in the PFO group was significantly higher than that in the ASD, VSD and complete endocardial cushion defect groups (P<0.05). The MDA level was the highest in the VSD group and was the lowest in the complete endocardial cushion defect group. There were significant differences in the MDA level among CHD subgroups (P<0.05). The ESR was negatively correlated to the SOD level (r=-0.191, P<0.05), while positively correlated to PaO2 level in CHD children (r=0.216, P<0.05). There was a negative correlation between SOD and MDA levels (r=-0.312, P<0.05). CONCLUSIONS: Oxidative stress exists in children with left to right shunt CHD. The SOD and MDA contents in erythrocytes can be used as markers for the assessment of severity of the disease. ［Chin J Contemp Pediatr, 2010, 12 (6):440-443］

Abstract:OBJECTIVE: To investigate the expression of interleukin 8 (IL-8), surfactant protein-A (SP-A) and transforming growth factor β1 (TGF-β1) in bronchoalveolar lavage fluid (BALF) of neonates with bronchopulmonary dysplasia (BPD). METHODS: Thirty neonates with BPD and 30 gestational age-, gender-, and birth weight-matched neonates without BPD (control group) were enrolled from December 2007 to October 2009. Non-brochoscopic bronchoalveolar lavage was performed. The levels of IL-8, SP-A and TGF-β1 in BALF were measured using ELISA. RESULTS: The levels of TGFβ1 (47±15 μg/mL vs 34±13 μg/mL) and IL-8 (54±16 μg/mL vs 28±13 μg/mL) in the BPD group were significantly higher than those in the control group (P<0.01). In contrast, the contents of SP-A in the BPD group were significantly lower than those in the control group (35±16 μg/mL vs 42±14 μg/mL;P<0.05). CONCLUSIONS: The increased expression of TGF-β1 and IL-8 in BALF may be involved in abnormal lung development and maturation in neonates with BPD. The low expression of SP-A in the BPD group suggests that the exogenous SP-A administration may be an option for the treatment of BPD.［Chin J Contemp Pediatr, 2010, 12 (6):444-446］

Abstract:OBJECTIVE: To investigate the common causes of recurrent wheezing in young children. METHODS: Electronic bronchoscopy was performed on 67 children with recurrent wheezing or who did not respond to the conventional treatment. RESULTS: The electronic bronchoscopy showed intimitis in trachea and bronchi in 19 cases, intimitis and inflammatory stricture in 11 cases, foreign bodies in the bronchi in 11 cases, trachea and bronchus softening in 19 cases, and bronchopulmonary dysplasia in 3 cases. The other 4 cases presented endometrial tuberculosis, epiglottic cyst, laryngeal papilloma or compression outside trachea (thymus) under the electronic bronchoscope. CONCLUSIONS: In addition to inflammation, trachea and bronchus softening as well as foreign bodies in the bronchi are also the common causes in children with recurrent wheezing or who do not respond to the conventional treatment. Electronic bronchoscopy appears to be an effective way to determine the cause in these children.［Chin J Contemp Pediatr, 2010, 12 (6):447-449］

Abstract:OBJECTIVE: To investigate the nonbacterial pathogens in children with acute respiratory infection (ARI) in Nanjing. METHODS: The presence of Mycoplasma pneumoniae (MP) and Chlamydia trachomatis (CT) was determined by quantitative PCR in the nasopharyngeal samples from 1 592 hospitalized children with ARI. Common respiratory viruses, including respiratory syncytial virus (RSV), adenovirus (ADV), influenza virus types A and B (IVA and IVB), parainfluenza virus types 1, 2, 3(PIV-1, 2, 3) and human metapneumovirus (hMPV), were detected using direct immunofluorescence assay. RESULTS: MP and CT were detected in 25.7% and 2.4% of the 1 592 samples respectively. The overall positive rate of respiratory viruses was 40.9%. Among the viruses, the top detected virus was RSV (61.3%), followed by PIV-3 (6.7%) and hMPV (4.9%). Mixed infection among MP, CT and viruses was observed in 107 cases (6.7%). The infants under 1 year old were susceptible to mix-infection (68/107, 63.6%). CONCLUSIONS: Respiratory virus is the main pathogen responsible for ARI in children from Nanjing. RSV is the most commonly identified virus. MP is also the frequently identified pathogen for ARI in children. Mixed infection is common in infants under 1 year old.［Chin J Contemp Pediatr, 2010, 12 (6):450-454］

Abstract:OBJECTIVE: To examine serum tissue inhibitors of metalloproteinases (TIMP) -1 and -2 levels in children with nonalcoholic fatty liver disease and to investigate possible roles of the two markers. METHODS: One hundred and five obese children were classified into 4 groups: simple obesity (n=44), simple nonalcoholic fatty liver (SNAFL, n=25), and nonalcoholic steatohepatitis (NASH, n=36). Serum TIMP-1 and -2 levels were measured using ELISA. Serum ALT and γ-GT levels were measured with totally automatic enzymatic method. RESULTS: Serum levels of TIMP-1 and γ-GT increased with the disease development from simple obesity to SNAFL and NASH (P<0.05). Both serum TIMP-1 and -2 levels were positively correlated with γ-GT levels (r=0.534，P<0.01; r=0.351, P<0.05, respectively). Ninety-seven percent of children in the NASH group had serum TIMP-1 levels over 2 standard deviations of healthy controls (83.35 μg/ L) compared with 76% in the SNAFL group (P﹤0.05). There were no significant differences in the case proportion with TIMP-2 levels over 2 standard deviations of healthy controls between the NASH and the SNAFL groups. CONCLUSIONS: Both TIMP-1 and -2 may reflect the state of liver fibrosis in children with nonalcoholic fatty liver disease, and serum TIMP-1 appears to be more reliable.［Chin J Contemp Pediatr, 2010, 12 (6):455-458］

Abstract:OBJECTIVE: To study serum insulin-like growth factor 1 (IGF-1) levels and their association with growth and development in infants aged 1-24 mouths. METHODS: A total of 525 healthy infants (125 preterm, 400 term) were enrolled. Serum IGF-1 levels were measured using ELISA 1.5, 4, 6, 8, 12, 18 and 24 months after birth. The body weight and body length were simultaneously measured. RESULTS: Serum IGF-1 levels were the lowest in preterm infants 1.5 months after birth (86±60 ng/mL). Thereafter, serum IGF-1 levels increased, and were significantly higher than those in term infants between 4 and 12 months after birth. Serum IGF-1 levels in term infants were the highest (116±52 ng/mL) 1.5 months after birth during their life of 12 months old. Thereafter, serum IGF-1 levels decreased and reached to a nadir (69±58 ng/mL) 8 months after birth. IGF-I levels were positively correlated with the weight and the height (SDS) in both preterm and term infants. CONCLUSIONS: Serum IGF-1 levels are closely associated with growth and development in infants.［Chin J Contemp Pediatr, 2010, 12 (6):459-461］

Abstract:OBJECTIVE: To evaluate the effectiveness of educational interventions in children with chronic illness and their parents. METHODS: Fifty children with chronic illness and 75 parents participated in the study. Children who were hospitalized between August 2007 and January 2008 and their parents received educational sessions and those who were hospitalized between February and July 2007 and who did not receive the sessions served as the control group. The content of the educational sessions included knowledge of chronic disease, drugs and self-care, and coping skills. The knowledge level, stressors, coping strategies, and psychological conditions of children with chronic illness and their parents were evaluated before discharge and three months after discharge. RESULTS: After educational interventions, the knowledge levels of children and their parents increased and the stressors decreased significantly in the intervention group compared with those in the control group. The children's parents in the intervention group used more active coping strategies (understanding the medical situations through communication with medical staff) than those in the control group. The differences in the medication compliance of children between the two groups were not found. CONCLUSIONS: The educational interventions may result in an improved knowledge level and decrease stressors in children and their parents, and improve stress coping strategies in parents. There is no evidence that the educational intervention can improve the psychosocial conditions of children and their parents.［Chin J Contemp Pediatr, 2010, 12 (6):462-467］

Abstract:OBJECTIVE: To compare the features of brain injury in neonatal rats with different severities of hypoxia-ischemia (HI), and explore the role of microglial activation and cytokines. METHODS: One hundred and twenty 7-day-old rats were randomized to three groups: sham control, mild HI, and severe HI. The rats in the HI groups were subjected to right carotid artery occlusion and 8% oxygen hypoxia exposure (40 minutes, 34.5℃ in the mild HI group; 65 minutes, 35.5℃ in the severe HI group). MRI, microtubule associated protein (MAP2) and TUNEL staining were used to confirm the severity of brain injury. Changes in expression of activated microglia (ED1) and signs of cytokine involvement or oxidative stress (TNF-α, nitrotyrosine) were assessed immunohistochemically. RESULTS: In the mild HI group, MRI scans demonstrated increased T2 values in the ipsilateral subcortical white matter and a slight loss of T2 values in the cortex, corresponding to a medium loss of MAP2 in the ipsilateral cortex. There was an increase in the number of TUNEL positive cells compared to the control group within the subcortical white matter. In the severe HI group, the T2 value increased in the majority of the hemisphere, corresponding to a severe loss of staining for MAP2 in the ispilateral hemisphere. The number of TUNEL positive cells significantly increased in the ipsilateral cortex and white matter. In the mild HI group, ED1, TNF-α and nitrotyrosine expression increased only in the acute stage and was only observed in subcortical white matter. In contrast, after severe HI, the increase in ED1, TNF-α and nitrotyrosine expression was observed in the whole ipsilateral hemisphere and prolonged for weeks. CONCLUSIONS: Following a mild HI a relatively selective white matter injury compares to the pannecrosis in the cortex and white matter following a severe HI. Microglial activation and over-expression of cytokines might contribute to the development of hypoxicischemic brain damage.［Chin J Contemp Pediatr, 2010, 12 (6):468-473］

Abstract:OBJECTIVE: The purpose of this study was to assess weather the immortalized mouse brain endothelial cell line Bend.3 displays the comparative barrier characteristics as the primary brain microvascular endothelial cells (BEMC). METHODS: Immortalized mouse brain endothelial cell line, Bend.3 cells were cultured in transwell inserts and their restrictive characteristics were assessed by transendothelial electrical resistance (TEER) and horseradish peroxidase (HRP) permeability assays. Western blot and direct fluorescent staining methods were used to detect the tight junction protein expression and F-actin distribution. RESULTS: The TEER in Bend.3 cells increased with the prolonged culture time and increased to 82.3±6.0 Ω?cm2 10 days after culture, which was significantly higher than that 3 days after culture (37.3±3.1 Ω?cm2; P<0.05). There were significant differences in the permeability rates for HRP 3 and 10 days after culture ［(4.3±0.20)% vs (2.2±0.05)%］ (P<0.05). Western blot indicated high level expression of tight junction proteins occludin and ZO-1 in Bend.3 cells 10 days after culture. F-actin was visualized around the cell membrane and presented scrobiculate linear fluorescence 10 days after culture.ConclusionsBend.3 cells have similar barrier characteristics to BEMC, and their barrier function may reach to the best effect 10 days after culture.［Chin J Contemp Pediatr, 2010, 12 (6):474-478］

Abstract:OBJECTIVE: To study the effects of valproate acid (VPA) on serum lipid and leptin levels and cerebral cortex in juvenile and adult rats. METHODS: Twenty healthy juvenile female Sprague-Dawley (SD) rats (21-day-old) and twenty healthy adult female SD rats (2-month-old) were randomly divided into four groups (n=10 each): juvenile control, juvenile VPA, adult control and adult VPA. Juvenile and adult VPA groups were fed with VPA 200 mg/kg daily, while the two control groups were fed with normal saline. The body weights were recorded weekly. Six weeks after feeding, serum and brain samples were obtained. Serum lipid levels including total cholesterol (TC), triglycerides (TG) and lower density lipoprotein cholesterol (LDL-C) were determined. Serum leptin (LEP) levels were measured by radioimmunoassay (RIA). Myelin staining and Nissl staining were used to evaluate the changes of brain tissues. RESULTS: The weight and serum LEP and lipid levels in both juvenile and adult VPA groups increased significantly compared with those in the control groups (P<0.05). The juvenile VPA group had more increased serum LEP and lipid levels than the adult VPA group (P<0.05). The Myelin staining showed that the average fiber density in the VPA groups was significantly lower than that in the control groups (P<0.05). The Nissl staining showed that the number of toluidine blue staining neurons in the VPA groups was not statistically different from the control groups. CONCLUSIONS: VPA may increase serum LEP and lipid levels in both juvenile and adult rats, and more increased levels may be found in juvenile rats. Longterm VPA treatment may have an adverse effect on brain myelination, but no effect on neurons.［Chin J Contemp Pediatr, 2010, 12 (6):479-482］

Abstract:ObjectiveTo investigate the effect of bone mesenchymal stem cell (BMSC) transplantation on repair of glomerular podocytes and on the Nephrin expression in rats with puromycin aminonucleoside (PAN) -induced nephrosis. METHODS: Forty-five Sprague-Dawley rats were randomly divided into three groups (n=15 each): a nephrosis model group that received a single intraperitoneal injection of PAN (0.15 mg/g); a BMSC transplantation group that received a single intraperitoneal injection of PAN (0.15 mg/g) followed by BMSC transfusion; a control group that received a single intraperitoneal injection of normal saline. Ten days after injection, the rats were sacrificed. The 24 hrs urinary protein content and serum albumin and cholesterol levels were measured 24 hrs before sacrifice. Changes of glomerular podocytes were observed under an electron microscope. Brdu labeled positive cells in kidneys were measured by immunohistochemical technology. RT-PCR and Western blot were used to assess the expression of mRNA and protein of Nephrin. RESULTS: In the nephrosis model group, urinary protein and blood cholesterol contents increased, plasma albumin content decreased compared with those in the control group. Extensive fusion of podocyte foot processes was observed in the nephrosis model group. The BMSC transplantation group had decreased urinary protein and blood cholesterol contents and increased plasma albumin content compared with the nephrosis model group. Fusion of podocyte foot processes was also improved. Brdu labeled positive cells were seen in kidneys in the BMSC transplantation group, but not in the nephrosis model and the control groups. Nephrin mRNA and protein expression decreased significantly in the nephrosis model group compared with that in the control group. The BMSC transplantation group had increased Nephrin mRNA and protein expression compared with the nephrosis model group. CONCLUSIONS: BMSCs can repair glomerular podocytes in PAN-induced nephrosis rats, and the changes of Nephrin expression may be involved in the process. ［Chin J Contemp Pediatr, 2010, 12 (6):483-487］

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