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Abstract:OBJECTIVE: To study the effect of intrahepatic cholestasis of pregnancy (ICP) on the functions of the hypothalamic-pituitary-adrenocortical (HPA) axis and adrenal cortex in normal neonates. METHODS: Demographic characteristics, prenatal anxiety and depression, and perceived stress during delivery were investigated in 32 ICP women and 32 controls. The cord blood levels of cortisal, adrenocorticotropic hormone (ACTH), and dehydroepiandrosterone sulfate (DHEAS) were measured by the radioimmunity technique in normal neonates immediately after birth. RESULTS: The scores of prenatal anxiety and depression in ICP women were significantly higher than those in controls (P<0.05 and P<0.01, respectively). There were no significant differences in the perceived stress during delivery between the two groups. The cord blood levels of cortisol and ACTH in neonates from ICP women were significantly lower (P<0.01), while the DHEAS level was significantly higher (P<0.01) than in neonates from controls. The DHEAS/ACTH ratio was significantly higher (P<0.01), while the cortisol /DHEAS ratio was significantly lower in the ICP group (P<0.01) than in the control group. The glycocholic acid level in ICP women was positively correlated with the DHEAS level in neonatal cord blood (r=0.47, P<0.01). CONCLUSIONS: There may be a dissociation between cortisol and DHEAS in neonates with normal birth outcome from ICP women. ICP may result in a decreased responsiveness of HPA axis and an increased secretion of DHEAS by adrenal cortex in these neonates. This suggests that there might be dysfunction of the fetal zones of the adrenal cortex.［Chin J Contemp Pediatr, 2010, 12 (1):5-8］

Abstract:OBJECTIVE: To evaluate the risks and benefits of two transfusion strategies (liberal-transfusion and restrictive-transfusion), as judged by the clinical progress and outcome, in very low birth weight infants. METHODS: The clinical data of 93 hospitalized very low birth weight infants who required blood transfusions were retrospectively studied. The infants were assigned to either the liberal transfusion group (n=58), with higher hematocrit levels, or the restrictive-transfusion group (n=35), with lower hematocrit levels. RESULTS: The infants in the restrictive-transfusion group received more numbers of RBC transfusions compared with the liberal-transfusion group (2.6±1.8 vs 1.8±1.0; P<0.05). Liberal-transfusion was associated with faster weight gain and the duration to return to the birth weight averaged 10 days in the liberal-transfusion group compared with 13 days in the restrictive-transfusion group (P<0.01). The infants in the liberal-transfusion group had shorter duration of mechanical ventilation than in the restrictive-transfusion group (5.5±4.2 days vs 8.0± 5.9 days; P<0.05). There were no significant differences in the incidence of apnea and nosocomial infections between two groups. CONCLUSIONS: The study suggests the possible benefits from liberal-transfusion for clinical recovery in very low birth weight infants. The restrictive transfusion does not decrease the number of transfusions. It in fact increases the number of clinical indicated transfusions. Neonatologists should weigh the advantages and disadvantages on transfusions to make the optimal decision.［Chin J Contemp Pediatr, 2010, 12 (1):9-12］

Abstract:OBJECTIVE: To study the plasma natriuretic peptide (BNP) level in children with pulmonary artery hypertension (PAH) secondary to congenital heart disease (CHD) and its correlation with left ventricular diastolic function. METHODS: Doppler echocardiography was performed on 95 CHD children with PAH (PAH group) and on 42 CHD without PAH (control group). The plasma BNP level was measured using radioimmunity assay. RESULTS: Doppler echocardiography showed that the left ventricular end-diastolic diameter (LVDd), the right ventricular diameter end-diastolic (RVDd), and the pulmonary artery diameter (PAd) increased significantly in the PAH group compared with those in the control group (P<0.05). The PAH group had higher velocity of tricuspid regurgitation (VTR) and higher pulmonary artery systolic pressure (PASP) than the control group (P<0.05). The PAH group also had higher mitral A peak velocity (AV), higher mitral A peak velocity integral (AVI), higher E peak velocity intgral (EVI), and higher ratio of mitral AV to mitral E peak velocity (EV) and AVI/EVI ratio as well as prolonged left ventricular volumetric relaxation time than the control group. PASP was positively correlated with the AV/EV ratio (P<0.05). The plasma BNP level in the PAH group increased significantly compared with that in the control group. In the PAH group, the plasma BNP level was positively correlated with the pulmonary artery pressure and the ratio of AV/EV. CONCLUSIONS: The left ventricular diastolic function is positively correlated with the plasma BNP level in children with PAH secondary to CHD. BNP may play an important role in the generation and development of left ventricular diastolic dysfunction induced by PAH.［Chin J Contemp Pediatr, 2010, 12 (1):13-16］

Abstract:OBJECTIVE: To study the changes in hormone levels and the therapy of pituitary hyperplasia secondary to primary hypothyroidism in children. METHODS: The clinical data of 8 children with pituitary hyperplasia secondary to primary hypothyroidism (5 girls and 3 boys) at ages of 5 to 9 years were studied retrospectively. All of the children had a short stature. They were followed up 1 to 6 years. RESULTS: The thyroid hormone levels decreased and the serum thyroid stimulating hormone (TSH) and prolactin (PRL) levels increased in the 8 children. After 2 to 6 months thyroxine replacement therapy, the levels of free triiodothyronine (FT3), free thyroxine (FT4) and serum TSH and PRL returned to normal, and the pituitary enlargement regressed to normal in the 8 children. Of them, 6 children′s height growth rate increased significantly from 3.1±0.5 cm per year to 11.6±1.7 cm per year (P<0.01). The other 2 cases had low growth rate and then received additional recombinant human growth hormone (rhGH) therapy. Their height growth rate increased by 11 cm per year. Pituitary hyperplasia did not recur in the 8 children during the follow-up. CONCLUSIONS: The thyroid function and pituitary examinations are necessary for children with a short stature. Thyroxine substitution therapy appears to be effective for primary hypothyroidism secondary to pituitary hyperplasia. rhGH replacement therapy after regression of the pituitary enlargement can result in a satisfactory height growth in children with low thyroid hormone levels and growth hormone deficiency.［Chin J Contemp Pediatr, 2010, 12 (1):17-20］

Abstract:OBJECTIVE: Newborns have been the focus group for most studies of cytomegalovirus infection. The objective of the study is to share some preliminary analysis on clinical manifestation differences resulting from cytomegalovirus infection in children of various age groups. METHODS: The clinical data of 108 children with cytomegalovirus infection were retrospectively reviewed. The children were classified into three age groups: <6 months, 6-12 months and >12 months. The differences in clinical manifestations from cytomegalovirus infection among the three age groups were identified. RESULTS: Each age group carried distinctive differences in the occurrence of hepatic damage, jaundice, pneumonia, and hematological manifestations, as well as incidence rate of malformation (P<0.05 or 0.01). The primary clinical manifestations of group<6 months old were hepatic damage(83%), pneumonia(47%) and jaundice (43%). There was a similar proportion of anicteric-hepatitis and icteric-hepatitis; however a low incidence rate of hematological disease (6%) was found in group<6 months old. The primary clinical manifestations of group 6-12 months old were hepatic damage (86%), mostly with no presence of jaundice, pneumonia (33%), and hematological disease (20%). Hepatic damage (52%) and hematological disease (33%) were leading clinical symptoms in group>12 months old where jaundice and pneumonia were rare events. CONCLUSIONS: End-organ damage triggered by cytomegalovirus infection is related to the age of the affected children closely.［Chin J Contemp Pediatr, 2010, 12 (1):21-23］

Abstract:OBJECTIVE: Impulsivity is one of the core symptoms of children with attention deficit hyperactivity disorder (ADHD). In order to understand the neuromechanism of the impulsive behaviors in ADHD children, this study investigated the specific functional areas of the brain by functional MRI. METHODS: The subjects consisted of 10 ADHD children with impulsivity, 7 ADHD children without impulsivity and 9 normal children. A functional MRI examination was performed when the subjects were instructed to finish GO and STOP tasks with the GO-STOP impulsivity paradigm. The MRI data during the two tasks of GO and STOP were averaged and the corresponding activation regions between groups were compared. RESULTS: The data from the GO task revealed that the main activation regions of the normal children included frontal pole (superior frontal gyrus, middle frontal gyrus and medial frontal gyrus); the main activation regions of ADHD children without impulsivity were cerebellum (posterior lobe and anterior lobe bouton) and cingulated gyrus; those of ADHD children with impulsivity were medial globus pallidus and insula. The data from the STOP task showed that the main activation regions of normal children included superior frontal gyrus and middle frontal gyrus; those of ADHD children without impulsivity were middle frontal gyrus and cingulate gyrus; those of ADHD children with impulsivity were uncus and putamen. The activation regions of ADHD children with impulsivity were much fewer than the other two groups. CONCLUSIONS: The behavior of impulsivity-control involves a number of specific functional areas in the cerebral cortex. Compared with normal children, ADHD children without impulsivity have weaker brain function and brain activation, and ADHD children with impulsivity demonstrate much fewer brain activation regions, worse brain function and little awareness of the cerebral cortex.［Chin J Contemp Pediatr, 2010, 12 (1):24-28］

Abstract:OBJECTIVE: To study the expression of transcriptional factors T-bet and GATA3 mRNA and the levels of IFN-γ and IL-4 in blood in children with acute idiopathic thrombocytopenic purpura (ITP) and investigate the tendency of polarization of Th1/Th2 in children with ITP. METHODS: Blood T-bet and GATA3 mRNA expression were examined using RT-PCR and plasma IFN-γ and IL-4 levels were measured using EIASA in children with acute ITP in acute (n=30) and remission stages (n=28). Twenty healthy children served as the controls. RESULTS: Blood T-bet mRNA expression and IFN-γ levels in children with ITP in the acute stage were markedly higher than those in the remission stage and controls (P<0.01). In contrast, blood GATA3 mRNA expression and IL-4 levels in children with ITP in the acute stage were significantly lower than those in the remmission stage and controls (P<0.01). CONCLUSIONS: The high expression of T-bet and IFN-γ and the low expression of GATA3 and IL-4 indicate the existence of Th1 polarization in children with acute ITP. This might be related to the regulation of T-bet and GATA3.［Chin J Contemp Pediatr, 2010, 12 (1):29-31］

Abstract:OBJECTIVE: To study the viral etiology of acute respiratory infection (ARI)in children from Wenzhou, Zhejiang between 2007 and 2008. METHODS: The nasopharyngeal aspirate samples were obtained from 5 097 hospitalized children with ARI. Seven common respiratory viruses, including respiratory syncytial virus (RSV), influenza virus A and B, parainfluenza viruses 1, 2 and 3 and adenovirus, were detected using direct immunofluorescence. RESULTS: Viral agents were identified in 2 209 cases (43.3%).Of the 2 209, RSV was the most frequent (78.1%), followed by parainfluenza 3 (12.4%), influenza virus A (3.0%), adenovirus (2.8%), parainfluenza 1 (1.7%), influenza B (0.5%) and parainfluenza 2 (0.3%). The infants at ages of <3 months and <6 months had higher detection rate of viruses (53.6% and 49.2%, respectively). A highest detection rate of viruses was found in winter. CONCLUSIONS: RSV is the leading pathogen of ARI in children from Wenzhou, Zhejiang between 2007 and 2008. The children at age of less than 6 months are susceptible to respiratory viruses. The viral activity peaks in winter.［Chin J Contemp Pediatr, 2010, 12 (1):32-34］

Abstract:OBJECTIVE: To evaluate the efficacy and safety of ganciclovir therapy for congenital cytomegalovirus (CMV) infection in newborn infants. METHODS: The randomized controlled trials (RCTs) and quasi-RCTs on ganciclovir therapy for congenital CMV were reviewed in the following electronic databases: PubMed (January 1988 to January 2009), EMbase (January 1988 to January 2009), the Cochrane library (Issue 3, 2003 and Issue 1, 2009), the Chinese Journals Full-text Database (January 1994 to January 2009), the Chinese Biological Medical Disc (January 1994 to January 2009) and the Chinese Medical Current Contents (January 1994 to January 2009). Quality assessment, data extraction, and meta analysis were performed. RESULTS: Ten papers were included. Meta analysis showed that the ganciclovir therapy increased the improvement rate (91.4% vs 34.0%; P<0.01) and led CMV infection indexes to become negative in more patients (87.6% vs 15.3%; P<0.01) and decreased incidence of hearing disturbance (4.7% vs 37.2%; P<0.01) as compared with the non-ganciclovir therapy control group. The incidence of the ganciclovir-therapy-related side effects was low. CONCLUSIONS: Ganciclovir treatment may increase the improvement rate and the rate of CMV infection indexes becoming negative, and decrease incidence of hearing disturbance, with few side effects, in newborn infants with CMV infection. However the supporting evidence is not strong due to few trials and more high-quality research is needed.［Chin J Contemp Pediatr, 2010, 12 (1):35-39］

Abstract:OBJECTIVE: Some research has shown that C-reactive protein (CRP), leptin, soluble leptin receptor (sLR) and blood lipids are involved in the development of obesity. This study aimed to investigate the changes of leptin resistance, blood lipids and inflammatory response before and after the exercise therapy in children with obesity. METHODS: Fifty-one obese children at ages of 12 years received an exercise therapy for 2 months. The levels of serum leptin, sLR, triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hs-CRP) were measured before and after the exercise therapy. Forty normal children served as the control group. RESULTS: Compared with the control group, serum levels of leptin, TG, TC, LDL-C and hs-CRP and the body mass index (BMI) in the obese group increased (P<0.01), while the serum level of sLR decreased significantly (P<0.05). The levels of hs-CRP, leptin, TC, TG, LDL-C and BMI in the obese group were significantly reduced after the exercise therapy (P<0.05). In the obese group, the serum leptin level was positively correlated with the levels of blood lipids and hs-CRP (P<0.05); serum levels of leptin and hs-CRP were negatively correlated with the sLR level (P<0.05); the hs-CRP level was positively correlated with the levels of blood lipids (P<0.01). CONCLUSIONS: Leptin resistance and the changes of blood lipids and inflammatory response are found in children with obesity. Exercise therapy can partially improve these changes.［Chin J Contemp Pediatr, 2010, 12 (1):40-42］

Abstract:OBJECTIVE: Resistin was thought to link the obesity to type 2 diabetes. This study aimed to investigate the effect of resistin on insulinoma cell proliferation. METHODS: pcDNA3.1-resistin was transfected into rat insulinoma cells RINm5F. Cell proliferation was assessed by the MTT assay. The resistin and SOCS3 mRNA levels were assessed by RT-PCR. The total Akt level and the phosphorylation status were assessed by Western blot. RESULTS: The over-expressed resistin inhibited the RINm5F cell proliferation (P<0.05). SOCS-3 expression was up-regulated by resistin over-expression (3.2 folds over the control; P<0.05). Akt phosphorylation was down-regulated by resistin over-expression (0.6 fold over the control; P<0.05). CONCLUSIONS: Resistin impairs the rat insulinoma cell RINm5F proliferation. This might be attributed to a down-regulation of Akt level caused by increased SOCS-3 expression.［Chin J Contemp Pediatr, 2010, 12 (1):43-46］

Abstract:OBJECTIVE: To investigate the effets of flurothyl-induced neonatal recurrent seizures on glucocorticoid receptor (GR) expression in the rat brain. METHODS: Forty-eight seven-day-old Sprague-Dawley rats were randomly divided into two groups: control and seizure. Seizures were induced by inhalant flurothyl daily for six consecutive days. Brains were sampled on postnatal days 13, 15 and 19. The expression of GR protein in the cerebral cortex was detected by Western blot and immunohistochemical method. RESULTS: The expression of GR in the cerebral cortical plasma protein was significantly lower in the seizure group than in the control group on postnatal day 15. The expression of GR protein in the cerebral cortical nuclear protein decreased significantly in the seizure group compared with that in the control group on postnatal days 15 and 19 (P<0.05). Compared to the control group, the accumulated optical density (AOD) of GR immunoreactivity (IR) decreased significantly in the parietal cortex on postnatal day 13 (P<0.05), the AOD of GR IR decreased significantly in the parietal cortex and the temporal cortex on postnatal day 15 (P<0.05), and the AOD of GR IR decreased significantly in the parietal cortex, temporal cortex and the frontal cortex in the seizure group on postnatal day 19 (P<0.05). CONCLUSIONS: Recurrent seizures in neonatal rats result in abnormal GR expression in the cerebral cortex which might play an important role in short-term brain injury induced by early recurrent seizures.［Chin J Contemp Pediatr, 2010, 12 (1):47-50］

Abstract:OBJECTIVE: To study the effects of ketamine combined with penehyclidine hydrochloride on the learning and memory abilities and the expression of synaptophysin in the hippocampus CA3 region in the brain of neonatal rats. METHODS: Eighty seven-day-old Sprague-Dawly rats were randomly intraperitoneally injected with 50 mg/kg of ketamine (K group), 2 mg/kg of penehyclidine hydrochloride (P group), 50 mg/kg of ketamine plus 2 mg/kg penehyclidine hydrochloride (PK group) or normal saline (control group). The rats were trained and tested in a Morris water maze 14 days after administration. The immunhistochemical method was used to ascertain the expression of synaptophysin in the hippocampus CA3 region 24 hrs, 14 days and 28 days after administration. RESULTS: In the Morris water maze training, the rats in the PK group performed worst, followed by the K group. The rats from the P and NS groups performed well. Compared with the NS group, the expression of synaptophysin in the K and the PK groups decreased significantly 24 hrs and 14 days after administration (P<0.05). The PK group had lower synaptophysin expression than the K group 24 hrs and 14 days after administration (P<0.05). Up to 28 days after administration, the synaptophysin expression increased in all of the four groups and there were no significant differences between groups. CONCLUSIONS: Ketamine combined with penehyclidine hydrochloride may inhibit more significantly learning and memory abilities and the synaptophysin expression in the hippocampus CA3 region than ketamine alone in neonatal rats. Penehyclidine hydrochloride alone has no effect on learning and memory abilities and the synaptophysin expression. The synaptophysin expression may increase to a normal level by training and with increasing age.［Chin J Contemp Pediatr, 2010, 12 (1):51-55］

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OBJECTIVE: Benzodiazepines (BDZ) have many effects on various kinds of epilepsies, but long-term treatment with BDZ often leads to drug tolerance. This study aimed to seek drugs which can reverse the tolerance of flurazepam (FZP), and to explore the role of neuropeptide Y (NPY) in the reversal effect. METHODS: A rat model of anticonvulsant tolerance to FZP was prepared. The rats with FZP tolerance were randomly assigned to seven groups: FZP-tolerance, and nifedipine, levetiracetam, topiramate, flumazenil, L-NAME and pyridoxamine treatment groups. The tolerance to FZP was evaluated through pentylenetetrazol (PTZ) infusion into a tail vein. The latency to onset of clonic seizure and the PTZ threshold were recorded. The mRNA of NPY receptor Y2 in the hippocampus was determined by RT-PCR, and the distribution of NPY in the hippocampus was examined by immunohistochemistry. RESULTS: In comparison with the blank control group, the average latency to the onset of clonic seizure was shortened, the average PTZ threshold decreased and the expression of NYT and NPY receptor Y2 mRNA decreased significantly in the FZP-tolerance group (P<0.01). In comparison with the FZP-tolerance group, the average latency to onset of clonic seizure was prolonged by 2 times and the average PTZ threshold doubled in the topiramate treatment group. The average latency to onset of clonic seizure was prolonged by 1 time and the average PTZ threshold increased 1 time in the nifedipine, the levetiracetam and the flumazenil treatment groups. The mRNA expression of NPY receptor Y2 increased by 1 or 2 times in the flumazenil, the nifedipine and the topiramate treatment groups when compared with the FZP-tolerance group. CONCLUSIONS: Nifedipine, levetiracetam, topiramate and flumazenil can reverse the anticonvulsant tolerance to flurazepam. NPY may play a role in mediating the reversal effect.［Chin J Contemp Pediatr, 2010, 12 (1):56-61］

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