Abstract:OBJECTIVE: To study the clinical and biological characteristics and prognosis of t(8;21)/AML1-ETO-positive childhood acute myeloid leukemia (AML). METHODS: The clinical data of 55 children who were diagnosed as t (8; 21)/AML1-ETO-positive AML were retrospectively studied. Event-free survival (EFS), disease-free survival (DFS), and overall survival (OS) rates were estimated by the Kaplan-Meier method. Prognostic factors were evaluated by COX regression analysis software. RESULTS: Of the 55 patients, 4 patients gave up treatment after the diagnosis was confirmed and 4 patients were lost to follow-up after the first chemotherapy course. The remaining 47 patients received a double-induction therapy. The total complete remission (CR) rate was 71% and 94% after the first and second chemotherapy course, respectively. The disease was relapsed in 10 patients (21%). The 5-year EFS, DFS and OS rates were (56.1±7.9)%, (59.8±8.1)%, and (72.0±8.1)%, respectively. Multivariate analysis showed that age was an independent risk factor for the long-term prognosis. The older children had a greater risk of experiencing an accident or death (P<0.05).The 5-year OS rate in 27 patients with regular consolidation chemotherapy was significantly higher than 13 patients with irregular chemotherapy after CR ［(47.5±17.1)% vs (38.9±17.3)%; P<0.01］. CONCLUSIONS: Childhood t(8;21)/AML1-ETO-positive AML is a highly heterogeneous disease, with a high CR rate and a good long-term prognosis. Age is one of the important factors affecting the long-term therapeutic effect. Regular consolidation chemotherapy applied after CR usually is helpful.

Abstract:OBJECTIVE: To explore the expression diversification of CD4+CD25+CD127low regulatory T (Treg) cells and Foxp3 mRNA in the peripheral blood of children with aplastic anemia after the treatment with cyclosporine. METHODS: Fifty children with chronic aplastic anemia were enrolled, among whom 30 received cyclosporine treatment (cyclosporine group) and 20 were treated with conventional methods (conventional group). Twenty healthy children were enrolled as the control group. The expression of CD4+CD25+CD127low Treg cells was detected by flow cytometry. The expression of Foxp3 mRNA was detected by real-time Q-PCR. RESULTS: The expressions of Foxp3 mRNA and CD4+CD25+CD127lowTreg cells showed no significant difference between the cyclosporine and the control groups 6 months after treatment. On the contrary, there were significantly lower expressions of both in the conventional group than in the control group (P<0.05). Meanwhile, the cyclosporine group had significantly higher expressions of Foxp3 mRNA and CD4+CD25+CD127low Treg cells than the conventional group (P<0.05). CONCLUSIONS: The expressions of CD4+CD25+CD127low Treg cells and Foxp3 mRNA in children with aplastic anemia increase after cyclosporine treatment.

Abstract:OBJECTIVE: To investigate the risk factors related to post-asphyxial multiple organ dysfunction (PA-MOD) in neonates. METHODS: A total of 397 neonates with birth asphyxia were enrolled from January 2009 to December 2010.The patients were divided into PA-MOD group (n=179) and non-PA-MOD group (n=218). The risk factors of PA-MOD were retrospectively studied. RESULTS: Multivariate logistic regression analysis showed that severe asphyxia, fetal distress, abnormal labor, and decreased amniotic fluid were the risk factors for PA-MOD among the neonates. Spearman rank correlation analysis showed that the number of the involved organs increased along with the increase of age at admission (P<0.05) and with the decrease of gestational age and birth weight (P<0.05). CONCLUSIONS: The efforts should be made to enhance perinatal care for neonates, especially for preterm infants and low-birh-weight infants, to decrease the incidence of MOD.

Abstract:OBJECTIVE: To study the effect of bacillus bifidus supplementation on the immunity in very-low-birth-weight (VLBW) infants. METHODS: Fifty VLBW infants who were hospitalized in the neonatal intensive care unit were equally randomized into observed and control groups. The observed group received bacillus bifidus for 14 days after birth in addition to the conventional management, which was applied in the control group. The clinical indicators and relevant immunological parameters in the peripheral blood were observed. RESULTS: The times required for brine enema was significantly fewer in the observed group than in the control group (P0.05). In the observed group, the proportions of CD4+ T lymphocytes and the CD4+/CD8+ ratio increased, whilst the proportion of CD3+ and CD8+ T lymphocytes showed no significant change. The levels of immunoglobulin A in the peripheral blood increased in the observed group, while the levels of immunoglobulin M and immunoglobulin G were not statistically changed in the observed group when compared with the control group. CONCLUSIONS: Bacillus bifidus can improve gastrointestinal symptoms of VLBW infants and have a positive effect on their immunity.

Abstract:OBJECTIVE: To study the causes and prognosis of peripheral precocious puberty. METHODS: The levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) were detected by a simplified gonadotrophin-releasing hormone (GnRH) stimulation test. The etiologies of 125 children with peripheral precocious puberty were explored by ultrasound scans and bone age assessment. A total of 102 cases were followed up for 3 months to 7.5 years. RESULTS: The etiological distribution of these children was as follows: exogenous hormones intake (n=80), ovarian cyst (n=11), McCune-Albright syndrome (n=11), congenital adrenal hyperplasia (CAH) (n=5), ovarian teratoma (n=1), masculine adrenal tumor (n=1), feminine adrenal tumor (n=1), and handle pituitary tumor (n=1). The causes in 14 cases were unknown. Follow-up showed that the sexual characteristics of 72 cases due to exogenous hormones intake subsided after 1-6 months. Of 11 cases with ovarian cysts, the sexual characteristics subsided spontaneously in 8 cases after 1 to 4 months, but one case was transformed to central precocious puberty after 2 years and three months. One child with ovarian cysts underwent an operation and than the sexual characteristics subsided. The sexual characteristics of the patient who had an ovarian teratoma subsided after operation. The clinical symptoms of children with McCune-Albright syndrome or CAH were alliaviated partly after treatment, and 7 cases were transformed to central precocious puberty. The clinical symptoms of 2 cases of adrenal tumors subsided after operation. One child with handle pituitary tumor died one year after operation. CONCLUSIONS: Varied causes may contribute to peripheral precocious puberty and therefore must be carefully identified through history taking, physical examination, and auxiliary examinations. The prognosis may differ for patients with different etiologies of peripheral precocious puberty.

Abstract:OBJECTIVE: To study the association of alanine aminotransferase (ALT) with overweight or obesity in children. METHODS: A total of 2889 healthy children and 702 overweight or obese children aged from 7 to 18 years who had received a physical examination were enrolled. Height, body weight, waist circumference, and blood pressure were measured, and the biochemical indicators including blood glucose, blood lipids, ALT, and insulin were detected. The insulin resistance index were calculated. RESULTS: The ALT level was significantly higher in boys than in girls. Along with the increase of BMI, the ALT level increased in the normal, overweight, and obese groups in both boys and girls. ALT was correlated with BMI, waist circumference, triglyceride, and insulin resistance index. Among the overweight or obese children, the boys with the increased ALT level had higher BMI, waist circumference, blood pressure, triglyceride, low density lipoprotein and insulin resistance index than the boys with normal ALT level (P<0.05); the girls with the increased ALT level had higher waist circumference, blood pressure and insulin resistance index and lower high density lipoprotein than the girls with normal ALT level (P<0.05). CONCLUSIONS: ALT is correlated with overweight and obesity and metabolic disorders caused by overweight and obesity such as dyslipidemia and insulin resistance.

Abstract:OBJECTIVE: To study the association between single nucleotide polymorphism (SNP) of insulin-like growth factor I receptor (IGF-IR) gene and idiopathic short stature (ISS). METHODS: A total of 804 children with ISS and 575 normal controls were recruited from 2008 to 2011. IGF-IR gene SNP was genotyped using the Snapshot Multiplex System. RESULTS: The distribution frequency of genotype rs1976667 showed no significant difference between the ISS and the control groups, while that of the allele A of rs1976667 was significantly higher in the ISS group than in the control group (P<0.01). CONCLUSIONS: The allele A at rs1976667 SNP of IGF-IR gene is a risk factor for ISS.

Abstract:OBJECTIVE: To study the risk factors for infection with extended-spectrum beta-lactamase (ESBL) producing strains in children. METHODS: The clinical data of 242 pediatric in-patients with lower respiratory tract infections from February 2009 to January 2011 were retrospectively analyzed. The risk factors of ESBL-producing strain infections were investigated using univariate analysis and multivariate logistic regression analysis. RESULTS: Univariate analysis showed that six factors were related with ESBL-producing strain infections: repeated sucking of phlegm (OR: 2.279, P<0.01), tracheal intubation(OR: 3.101, P<0.01), administration of the third generation cephalosporin for more than three days (OR: 3.628, P<0.01), admission to the pediatric intensive care unit (PICU) (OR: 2.378, P<0.01), indwelling of nasogastric tube (OR: 2.460, P<0.01), prophylactic use of antibiotics (OR: 1.747, P<0.05). Multivariate logistic regression showed that the application of the third-generation cephalosporin for more than three days (OR: 5.672, P<0.01), repeated sucking of phlegm (OR: 3.917, P<0.01), tracheal intubation (OR: 3.717, P<0.01), indwelling of nasogastric tube (OR: 2.961, P<0.01）, and admission to PICU (OR: 3.237, P<0.01）were the independent risk factors for the infections. CONCLUSIONS: The infections of ESBL-producing strains are caused by many factors, among which the application of the thirdgeneration cephalosporin for more than three days, invasive operations, and admission to PICU are the independent risk factors.

Abstract:OBJECTIVE: To study the risk factors for recurrent pneumonia in children without underlying diseases. METHODS: A case-control study was conducted in 106 children with recurrent pneumonia (case group) and 106 age, gender- and weight-matched children with pneumonia but no recurrence (control group). The children in both groups had no underlying disease. The risk factors for recurrent pneumonia were investigated by the Chi-Square analysis and the multivariate logistic regression model. RESULTS: The Chi-Square analysis showed that the percentages with the history of wheezing, allergy (food or medicine) and eczema and the percentage of transient neutropenia in the case group were significantly higher than those in the control group. The multivariate logistic regression analysis showed that the wheezing history (OR=13.387, 95% CI: 5.541-32.343), allergic history (food or medicine) (OR=4.267, 95% CI: 2.081-8.751) and transient neutropenia (OR=3.606, 95% CI: 1.806-7.202) were the independent risk factors of recurrent pneumonia. ConclusionsThe wheezing history, allergic history and transient neutropenia may increase the risk of recurrence of pneumonia in pneumonic children without underlying diseases.

Abstract:OBJECTIVE: To study the effects of intravenous immunoglobulin (IVIG) and aspirin treatment on the functions of circulating endothelial progenitor cells (EPCs) in children with Kawasaki disease (KD) and possible mechanisms. METHODS: Blood samples were obtained in 10 children with KD before and 7 days after the treatment by IVIG and aspirin. MTT method, modified Boyden chamber method and cell culture plate adhesion method were used to assess the functions of EPCs, including proliferation, adhension and migration activities. The plasma levels of tumor necrosis factor-α (TNF-α) and high-sensitivity C reactive protein (hs-CRP) were also measured. RESULTS: The functions of circulating EPCs 7 days after IVIG and aspirin treatment were significantly improved. IVIG and aspirin treatment significantly reduced plasma TNF-α and hs-CRP concentrations. There was a significant linear regression relationship between the reduced plasma TNF-α and hs-CRP levels and the increased functions of circulating EPCs.ConclusionsIVIG and aspirin treatment can improve the functions of circulating EPCs, possibly through reducing plasma concentrations of TNF-α and hs-CRP.

Abstract:OBJECTIVE: To carry out a preliminary study on the emotional problems and parenting locus of control among children with anxiety disorders. METHODS: A total of 110 children with simple anxiety disorders (AD group) and 113 normal children (control group) from September to December 2005 were enrolled. Children were asked to complete the Depression Self-Rating Scale for Children (DSRSC), the Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Parenting Locus of Control Scale (PLOC).A total of 197 valid scales were returned. RESULTS: The scores of somatic, generalized anxiety, separation anxiety, social phobia anxiety, school phobia anxiety, total anxiety, and total depression were all higher in the AD group than in the control group (P<0.01). The score of "education effects" for parents was significantly higher in the AD group than that in the control group (P<0.01). CONCLUSIONS: Children with anxiety disorders tend to have more emotional problems and poorer parental education effects.

Abstract:OBJECTIVE: To study the adverse effects of sleep problems and sleep insufficiency on attention in class and pupils′acadamic achievements. METHODS: A total of 1138 students from four primary schools at ages of 6-12 years were randomly sampled from four districts of Changsha city, Hunan Province June 2009 to April 2010. The inquired items included sleep problems, sleep time, sleep quality, attention in class and academic achievements. Teachers and parents observed the pupils according to the unified requirements for 3 months and then filled out the questionnaires. RESULTS: The total valid inquiry tables were 1091 with the answering rate of 95.87%, including 549 boys and 542 girls. The sleep quality was more poor in children with sleep problems or sleep insufficiency than in children with normal sleep. The sleep quality was reduced and aggravated along with the increasing sleep problems and the reducing sleep time. The attention in class and academic achievements in children with sleep problems or sleep insufficiency were more poor than in children with normal sleep. The sleep quality index was negatively correlated with attention in class and academic achievements. The attention in class was positively correlated with academic achievements. CONCLUSIONS: The decline in sleep quality directly affects the attention in class and reduce the academic achievements in primary school children.

Abstract:OBJECTIVE: To study the health status of the primary school children who remain in their home villages (the "left-behind" children) in a rural area of Hubei Province, Central China, whilst their parents are migrant workers in the cities of China. METHODS: A total of 1000 pupils in the 4th to 6th grade from six rural primary schools in Xiantao City, Hubei Province were enrolled. All subjects were surveyed with questionnaires and received physical examinations. Pupils whose parents had no history of migrant work and who lived with both parents were defined as the control groups. RESULTS: Among the 875 valid questionnaires, there were 590 "left-behind" children and 285 controls. The mean body weight was significantly lower among the "left-behind" children (35.5±7.1 kg) than the controls (36.3±8.8 kg) (P＜0.05). The weight/age z score of "left-behind" children (-0.9811±0.54) was also significantly lower than that of the controls (-0.7012±0.34) (P＜0.05). However, the other physical indicators including body height, height/age z score, thickness of sebum, and body mass index and the common nutrition status showed no significant differences between the two groups. The "left-behind" children scored significantly higher in the Children′s Depression Inventory than the controls (11.4± 7.2 vs 8.0± 5.8, P＜0.01), and the incidence of depression was also significantly higher in "left-behind" children than in controls (15.3% vs 6.0%, P＜0.01). Compared with the controls, the "left-behind" children had significantly higher incidences of antiadoncus (32.0% vs 23.2%; P＜0.01), respiratory tract infections (14.6% vs 9.5%; P＜0.05), and gastrointestinal infections (7.6% vs 3.9%; P＜0.05). CONCLUSIONS: Although the "left-behind" children have normal nutrition status, they tend to have poor mental health and are more susceptible to infections.

Abstract:OBJECTIVE: To investigate the cognition and health education needs on child neglect among parents/carers to the preschool children in Guangdong Province. METHODS: A total of 621 parents/carers of preschool children aged 3-6 years from four cities (Dongguan, Huizhou, Zhongshan, and Foshan) in Guangdong Province completed self-designed questionnaires concerning the cognition and health education needs on child neglects. RESULTS: Only 5.4% of the parents/carers had a good knowledge of child neglect, and 55.9% had never heard about this term. About 90.5%-90.7%of the surveyed parents/carers were willing to learn more about child neglect and 94.6%-97.4% of them agreed that education on child neglect was necessary. It was found that normal brochures, books, newspapers, and magazines were the preferred way of education for parents/carers (77.0%); also nearly half of the parents/carers welcomed courses (55.6%) or lectures (49.1%). Most of them believed that awareness raising activities should be carried out in kindergarten (70.5%), public places (61.4%) or by providing collective training for teachers in kindergarten (59.6%). CONCLUSIONS: Most parents/carers of preschool children in Guangdong Province have a poor knowledge of child neglect. Efforts should be made to strengthen awareness raising activities on this topic via appropriate pathways.

Abstract:OBJECTIVE: To study the effects of intestinal trefoil factor (ITF) on Toll-like receptors (TLR) 2 and 4 expression in intestinal tissue and on intestinal injury in young rats with endotoxemia. METHODS: A total of 24 10-day-old Wistar rat pups were equally randomly divided into three groups: a control group, intraperitoneally injected with normal saline 1 mL/kg; an endotoxemia group, intraperitoneally injected with lipopolysaccharide (LPS) 5 mg/kg and an ITF group,intraperitoneally injected with rITF 0.1 mL/each plus LPS 5 mg/kg. Rats were sacrificed 3 h after injection. A segment of distal ileum was dissected for pathologic examinations under an optical microscope (hematoxylin-eosin staning). The mRNA expressions of TLR2 and TLR4 were detected by reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: The structure of the small intestine remained normal in the control group. Edema of interstitial substance and epithelium were observed in both LPS and ITF groups, whereas such changes were significantly lower in the ITF group than in the LPS group. The ITF group had significantly higher TLR2 mRNA expression than the NS and LPS groups (P＜0.01), whereas the mRNA expression of TLR4 in the ITF group was significantly lower than in the NS and LPS groups (both P＜0.01). CONCLUSIONS: ITF can alleviate intestinal injury in young rats with endotoxemia, which may be related to the down-regulation of TLR4 mRNA expression.

Abstract:OBJECTIVE: To explore the effects of low-dose chlorpyrifos (CPF) exposure on dopaminergic (DA) neurons in the midbrain substantia nigra and neural behavioral development in neonatal rats. METHODS: Postnatal 11 day old Sprague-Dawley rats were randomly assigned into CPF, menstruum dimethysulfoxide (DMSO) and normal saline (NS) groups. The rats in the CPF group were injected with low-dose CPF (5 mg/kg?d) on postnatal days 11-14. The two control groups were injected with DMSO or NS respectively. The rats were sacrificed on postnatal days 15, 20, 30, and 60. Body weight gain, outward appearance of brain tissue, the coefficient of brain and the water content of brain tissue were measured. Tyrosine hydroxylase (TH) expression in DA neurons in the midbrain substantial nigra was examined by immunohistochemical straining. Immune electron microscopy was used to examine the subcellular structure of DA neurons. Open field test, grip strength test, slope test and Morris water maze test were used to examine the neurobehavioral changes. RESULTS: The outward appearance of brain tissue was normal in the three groups. There were no significant differences in the absolute value of body weight gain, the coefficient of brain and the water content of brain tissue among the three groups. CPF exposure decreased the level of TH immunoreactivity (P<0.05) in the substantia nigra of CPF group since postnatal day 30 compared with the DMSO and NS groups. The subcellular structures of some DA neurons in the CPF group were impaired. Decreased motor activity and learning and memory impairments were observed in the CPF group compared with those in the DMSO and NS groups (P<0.05) since postnatal day 30.ConclusionsCPF exposure during the neonatal period can cause long-term motor activity and learning and memory impairments in accompany with DA neurons damage in the midbrain substantia nigra.

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