Objective To study the clinical and laboratory characteristics of chronic active Epstein-Barr virus(EBV) infection (CAEBV) in children and to provide a basis for the diagnosis and treatment of CAEBV. Methods The clinical data of 13 children with CAEBV, as well as 15 cases of acute EBV infection (AEBV) as controls, wereanalyzed, including clinical manifestations, EBV antibodies, EBV DNA, and peripheral blood lymphocyte subsets.Results Both groups of patients had infectious mononucleosis-like symptoms such as fever, hepatomegaly,splenomegaly, and lymphadenectasis, but CAEBV patients had a longer course of disease and continuous and recurrentsymptoms. Compared with the AEBV group, the CAEBV group had a significantly higher EBV DNA load in peripheralblood (P<0.05), a significantly higher VCA-IgG titer (P<0.05), and significantly lower numbers of white blood cells,lymphocytes, B cells, total T cells, CD4⁺ T cells, and CD8⁺ T cells in peripheral blood (P<0.05). Among 13 CAEBVpatients followed up, 8 cases died, 2 cases showed an improvement, 2 cases had a recurrence, and 1 case was lost tofollow-up after being transferred to another hospital. All the AEBV patients were cured and had no recurrence during theone-year follow-up. Conclusions The clinical manifestations of CAEBV vary in children. It is difficult to distinguish CAEBV from AEBV early. More attention should be paid to CAEBV because of its severe complications, poorprognosis, and high mortality. Measurement of EBV DNA load, VCA-IgG titer, and lymphocyte subsets in peripheralblood may be helpful in the diagnosis and differential diagnosis of CAEBV.

Objective To investigate the impact of timing of nasojejunal feeding tube placement and enteralnutrition on clinical outcomes in children with acute pancreatitis. Methods A retrospective analysis was performedon the clinical data of 31 children with acute pancreatitis, who received nasojejunal feeding between January 2008 andJuly 2013, to investigate the relationship of abdominal symptoms/signs and serum amylase level with the tolerabilityof catheterization and success rate of enteral nutrition. The treatment outcome and incidence of adverse reactions andcomplications were compared between the early enteral nutrition group (≤7 days from the onset of the disease) and lateenteral nutrition group (>7 days from the onset of the disease). Results Abdominal symptoms/signs and serum amylaselevel were independent of the tolerable rate of catheterization and success rate of enteral nutrition. Compared withthe late enteral nutrition group, the early enteral nutrition group had a shortened time to normal serum amylase level,significantly reduced incidence of systemic complications, length of hospital stay, and hospitalization expenses, and lessweight gain. The tolerable rate of catheterization and success rate of enteral nutrition showed no significant differencebetween the two groups. Similarly, no significant differences were found in the increase in albumin level after enteralnutrition, duration of enteral nutrition, incidence of adverse reactions, and incidence of local complications. Conclusions Abdominal symptoms/signs and serum amylase level cannot be used as a measure of whether nasojejunal feeding tubeplacement and enteral nutrition can be performed. Early enteral nutrition can better improve clinical outcomes in childrenwith acute pancreatitis, and it is feasible.

Objective To study the clinical characteristics of pediatric hemorrhagic fever with renal syndrome(HFRS), and to improve its understanding so as to reduce the misdiagnosis. Methods A retrospective analysis wasperformed on the clinical data of 26 children with HFRS between January 2009 and December 2012. Results Theage of disease onset was mainly distributed between 7 and 14 years (23 cases, 88%), and the male-to-female ratio was1.89:l. The clinical manifestations of pediatric HFRS varied. The early symptoms resembled those of a cold, and in thecourse of HFRS, most patients developed digestive symptoms such as vomiting and abdominal pain. The laboratoryexaminations usually implicated platelet changes, and the imaging examinations revealed polyserous effusions. Theprominent complication was myocardial injury. Conclusions Pediatric HFRS mainly occurs in school-age children,more commonly in males. HFRS does not have typical clinical manifestations or symptoms, so it should be distinguishedfrom cold or appendicitis at the early stage. When applying the fluid replacement therapy, the cardiac function should becarefully monitored in case of heart failure.

Objective To study the changes and significance of serum hydrogen sulfide (H₂S) levels in childrenwith benign infantile convulsions associated with mild gastroenteritis (BICE). Methods Forty-two hospitalized childrendiagnosed with BICE were recruited to the observation group, and 46 children admitted due to acute gastroenteritis alonewere recruited to the control group. Serum H₂S levels were measured by a spectrophotometer. Results The serumH₂S level in the observation group was significantly lower than in the control group (28±12 μmol/L vs 45±10 μmol/L; P<0.01). The patients with a number of convulsions greater than or equal to two had significantly lower serum H₂Slevels than those with a number less than two (P<0.05). The number of convulsions was negatively correlated withserum H₂S level in BICE patients (r=-0.485, P=0.001). When a convulsion exceeded 5 minues in duration, the durationwas negatively correlated with serum H₂S level (r=-0.736, P=0.004). Conclusions The reduction in endogenous H₂S level might be one of the causes of convulsions in BICE patients. The degree of reduction in H₂S level is associated withthe number of convulsions and the duration of convulsion (when it exceeds 5 minues). Further investigation is needed todetermine the clinical significance of these results.

Objective To study the clinical features of early-onset epileptic encephalopathies (EEEs) of unknowncause, and to identify pathogenic microdeletion/microduplication of EEEs by genome-wide analysis of copy numbervariations (CNVs). Methods The clinical data of 60 children diagnosed with unexplained EEEs between July 2012 and April 2013 were obtained and analyzed. Specimens were collected from the selected children and their parents.Single nucleotide polymorphism array was used to detect genome-wide CNVs, and fluorescence in situ hybridizationwas performed to verify the results and analyze the source of the parents, further to identify suspected pathogenic CNVsof EEEs. Results Among the 60 children with unexplained EEEs, 34 were diagnosed with West syndrome, 3 withOhtahara syndrome, 3 with Dravet syndrome, and 20 with unclassified EEEs. In total, 77% of the patients were associatedwith moderate to severe mental retardation. Head imaging test implied that 35% of the patients had brain dysplasiaor astrophy. Among 54 patients, 17% showed microcephalus. After treatment, 28 patients had clinical seizures undercontrol, 16 out of control, 5 dead, and 1 lost to follow-up. Genome-wide analysis of CNVs showed that 7 pathogenic orsuspected pathogenic CNVs were present in 5 patients. Conclusions EEEs of unknown cause are associated with highphenotypic heterogeneity and poor prognosis. Genome-wide CNVs analysis can demonstrate pathogenic or suspectedpathogenic CNVs. This research expands the gene bank of EEEs and improves the understanding about possible etiologyof unexplained EEEs. The results provide a reference for genetic counseling regarding reproduction in the patient'sfamily.

Objective To investigate the preventive effect of behavioral therapy plus flunarizine in children withmigraine. Methods Ninety pediatric patients with migraine between January 2011and January 2014 were randomlydivided into treatment group (45 cases) and control group (45 cases). The treatment group received behavioral therapy in addition to oral flunarizine, while the control group received oral flunarizine alone. All patients were followed upfor 3 months to evaluate the therapeutic effect by the Pediatric Migraine Disability Assessment Score (PedMIDAS)and improved Bussone headache index. Results There were no significant differences in Ped MIDAS (P>0.05) andimproved Bussone headache index (P>0.05) between the control and treatment groups before treatment. Significantdifferences were observed in PedMIDAS (16±8 vs 20±10; P<0.05) and improved Bussone headache index (25±18 vs37±21; P<0.05) between the two groups after 3 months of treatment. Conclusions Preventive treatment of behavioraltherapy plus oral flunarizine shows a better clinical efficacy than oral flunarizine alone in children with migraine andholds promise for clinical application.

Objective To investigate the clinical manifestations, diagnosis, and treatment of peripheral primitiveneuroectodermal tumor (pPNET) in children and the survival of patients treated with the CCG7942/POG9354 protocol.Methods A retrospective analysis was performed on the clinical data of 10 patients with pPNET admitted from October 2008 to October 2013. Of the 10 patients, 3 had metastasis, while others had no metastasis. The 7 patients withoutmetastasis were treated with the Children's Cancer Study Group 7942 (CCG7942) protocol, and the other 3 patients with metastasis with the Pediatric Oncology Group 9354 (POG9354) protocol. The therapeutic response and chemotherapy related toxicities were evaluated by WHO criteria and Common Terminology Criteria for Adverse Events (version 4.0).Results In the 7 patients treated with the CCG7942 protocol, 4 achieved a complete remission (CR), 1 had stabledisease, 2 developed progressive disease (PD), and 2 had recurrence. In the 3 patients treated with the POG9354 protocol, 1achieved a CR, 2 developed PD, 2 had recurrence, and 2 died. For the 7 patients without metastasis, the survival timewas 5-60 months, and the event-free survival rate was 71%. For the 3 patients with metastasis, the survival time was 13-25 months, and the event-free survival rate was 33%. All patients developed grade 4 bone marrow suppression, and othergrade 1-2 toxicities, including gastrointestinal reactions, liver function impairment, and renal function impairment, werealso seen. Conclusions CCG7942 protocol is effective and safe for children with non-metastatic pPNET. However,POG9354 protocol has unsatisfactory efficacy in children with metastatic pPNET, so further studies are needed toimprove the therapy for this disease.

Objective To investigate the influencing factors for lymphocyte subsets in children 0 to 6 years of age.Methods Umbilical artery blood samples from 45 healthy full-term infants and venous blood samples from 79 healthychildren between 0 and 6 years were collected. According to the methods of delivery, the full-term infants were dividedinto vaginal delivery group (n=22) and cesarean section group (n=23). Healthy children were divided into different agegroups:28 days to 12 months (n=25), 1-3 years (n=26), and 3-6 years (n=28). Lymphocyte subsets were examined byflow cytometry. The influencing factors including delivery method, sex, and age, which might have an effect on the lymphocyte subsets, were analyzed. Results There were significant differences in T and Ts cell counts, percentage of Bcells, and percentage and count of natural killer (NK) cells between the full-term infants of vaginal delivery and cesareansection (P<0.05). The absolute counts and percentages of different lymphocyte subsets showed no significant differences between males and females in healthy children (P>0.05). The counts of all lymphocyte subsets except Ts and NK cellsvaried significantly between different age groups (P<0.05). Conclusions Lymphocyte subsets in children under 6years of age are more profoundly affected by age. Delivery method is also a contributing factor in newborn infants. Thereference range of lymphocyte subsets in children should be established for different age groups.

Objective To investigate the characteristics of immune function in newborn infants of different gestational ages. Methods A total of 115 premature infants free of infection between June 1, 2012 and June 1, 2013 were divided into two groups according to their gestational age at birth:early preterm infant group (28-33⁺⁶ weeks,n=57) and late preterm infant group (34-36⁺⁶ weeks, n=58). Meanwhile, 88 full-term infants (37-41⁺⁶ week) wererecruited to the control group. Venous blood samples were collected within 24 hours after birth. The percentages oflymphocyte subsets, such as CD3⁺, CD4⁺, CD8⁺, and CD19⁺ T cells and natural killer (NK) cells were measured by flow cytometry, and the absolute count of each population was calculated using the results from routine blood work.Concentrations of serum IgG, IgA, and IgM were measured by immunoturbidimetry. Results Both preterm infantgroups had significantly higher percentages of CD3⁺ and CD4⁺ T cells and CD4⁺/CD8⁺ ratio (P<0.05) and significantlylower percentages of CD8⁺ and CD19⁺ T cells and NK cells (P<0.05), as compared with the full-term infant group. Theabsolute counts of total lymphocytes, CD3⁺, CD4⁺, CD8⁺, and CD19⁺ T cells, and NK cells in both preterm infant groupswere significantly lower than those in the full-term infant group (P<0.05), and the above parameters in the late preterminfant group were significantly higher than those in the early preterm infant group (P<0.05). Both preterm infant groups showed significantly lower concentrations of serum IgG than the full-term infant group (P<0.05), while no significant differences in concentrations of serum IgA and IgM were observed between the three groups (P>0.05). Conclusions Neonatal gestational age has an effect on cellular and humoral immunity. The immune function gradually improves with increasing gestational age.

Objective To evaluate the clinical value of intestinal fatty acid-binding protein (Ⅰ-FABP) in full-termnew born infants with necrotizing enterocolitis (NEC). Methods Forty-one full-term infants with a confirmed diagnosisof NEC from February 2012 to January 2014 were recruited as case group (stage I:24 cases; stage Ⅱ-Ⅲ:17 cases).Sixty-two children diagnosed with non-digestive diseases in the same period were recruited as the control group. Serumlevels of Ⅰ-FABP and C-reactive protein (CRP) were determined by enzyme-linked immunosorbent assay. The diagnosticvalue of I-FABP for NEC was assessed using the receiver operating characteristic (ROC) curve. Results Stage Ⅰ andstage Ⅱ-Ⅲ cases in the case group had significantly higher serum Ⅰ-FABP levels than the control group (P<0.05), andstage Ⅱ-Ⅲ cases had significantly higher serum Ⅰ-FABP levels than stage Ⅰ cases (P<0.05). The area under the ROCcurve for serum Ⅰ-FABP was 0.85 (95% CI:0.78-0.92), with the optimal cut-off point of 2.25 ng/mL. Under this cut-offpoint, the sensitivity and specificity were 80.49% and 70.19%, respectively. There was no significant difference in serum CRP level between the case and control groups (P>0.05). Conclusions In newborn infants with NEC, serum I-FABPlevel increases significantly in stage I, and it is correlated with the disease severity. Therefore, serum I-FABP can beused as a biomarker for the diagnosis of NEC.

Objective To study the dynamic prevalence and epidemiological characteristics of birth defectsdistribution in the Tongzhou District of Beijing between 2006 and 2012. Methods Data collected from the birthdefects surveillance system in the Tongzhou District of Beijing between 2006 and 2012 were used. The prevalenceand trends of birth defects were analyzed, also the proportion of birth defects in prenatal diagnosis was calculated.Results Between 2006 and 2012, 1 165 cases of birth defects were identified among 92 340 births, with a prevalenceof 12.62‰. The prevalence of birth defects showed an increased trend during the seven years (χ²=6.77, P<0.01). Theprevalence in the flowing population (13.27‰) was higher than that in the permanent residents (11.55‰), and the formershowed an upward trend during the seven years (χ²=25.02, P<0.01). The top five birth defects were congenital heartdefects, polydactyly, cleft lip and/or palate, neural tube defects, and external ear malformation in turn. The prevalenceof congenital heart defects and the unspecified congenital malformation increased while that of neural tube defectsdecreased. There was also an upward trend of the prenatal diagnosis for congenital heart defects (χ²=14.80, P<0.01).Conclusions The prevalence of birth defects increased in the Tongzhou District of Beijing from 2006 to 2012, andit was mainly caused by the increased prevalence of birth defects in the flowing population, the increased number ofunspecified birth defects and the improvement of diagnosis technology for congenital heart defects.

Objective To investigate the prevalence, clinical characteristics, treatment, and prognosis of neonatal respiratory failure (NRF) in Huai'an, Jiangsu Province, China, in 2010. Methods The clinical data of all NRF cases inthe hospitals of Huai'an in 2010 were prospectively collected and analyzed using descriptive epidemiological methods.Results Among 60 986 live births in Huai'an in 2010, there were 556 (0.91%) cases of NRF. The average birth weightof newborns with NRF was 2 433±789 g, with 53.8% determined as low birth weight and 64.1% as preterm. The majorcauses of NRF were respiratory distress syndrome, pneumonia, asphyxia, sepsis, and pulmonary hemorrhage. Among thenewborns with NRF, 23.7% were accompanied by certain birth defects. Fourteen percent of newborns with NRF received pulmonary surfactant (PS) therapy, and the median time of the first dose of PS was 5 hours (range:0-51 hours). Nasalcontinuous positive airway pressure treatment, conventional mechanical ventilation, and high-frequency ventilation wereused in 67.9%, 33.3%, and 13.7% of patients, respectively. The cure and improvement rate of NRF patients was 73.9%(411/556), and the mortality rate was 22.5% (125/556). The average hospitalization expenses were 9 270 (range:196-38182) Yuan. Conclusions High morbidity, high mortality and high medical costs make NRF a serious challenge in Huai'an. It is essential to improve the quality of perinatal care and develop new techniques and new models in neonatal respiratory therapy in order to reduce the morbidity and mortality of NRF.

Objective To explore the mechanism and effect of maternal high-fat diet before and during pregnancyon bone growth of neonatal offspring rats. Methods Forty female Sprague-Dawley rats were divided into high-fatdiet and control groups (n=20) that were fed with 35% high-fat diet and standard chow, respectively. After 8 weeks, 8female rats from each group were sacrificed for liver pathological examinations and the other female rats were matedwith male rats and fed continuously with 35% high-fat diet and standard chow throughout gestation, respectively. Thebody lengths (from apex nasi to end of tail) of the offspring rats from both groups were measured within 24 hours afterbirth. Enzyme-linked immunosorbent assay was used to detect serum insulin-like growth factor (IFG-I) levels. Liverpathological changes were observed under a light microscope. The expression of insulin receptor substrate 1 (IRS-1) and phosphorylation IRS-1 (Phospho-IRS-1) in tibia and femur samples were detected by immunohistochemistry.The expression of mitogen-activated protein kinase (MAPK) and phosphorylation MAPK (Phospho-MAPK),phosphatidylinositol 3-kinase (PI3K) and phosphorylation PI3K (Phospho-PI3K), protein kinase B (AKT1) andphosphorylation AKT1 (Phospho-AKT1) in tibia and femur samples were detected by Western blot. Results Theoffspring rats from the high-fat diet group showed a significant shorter body length compared with those from the control group (P<0.05). The level of serum IGF-I in offspring rats from the high-fat diet group decreased by 20.1% incomparison to those from the control group, but there was no significant difference between the two groups (P>0.05).Fatty degeneration was found in livers of both high-fat diet-fed maternal rats and their offspring rats under a lightmicroscope. There were no significant differences in IRS-1 and Phospho-IRS-1 expression in chondrocytes of tibia andfemur samples between the offspring rats of the two groups (P>0.05). The protein expression of MAPK in chondrocytesof tibia and femur samples of offspring rats from the high-fat diet group was higher than that from the control group(P<0.05). There were no significant differences of PI3K and AKT1/Phospho-AKT1 between the offspring rats of the twogroups (P>0.05). Conclusions A maternal high-fat diet before and during pregnancy may affect the bone growth ofoffspring rats in utero, which is possibly associated with the decreased IGF-I level. However, further study on the exactmechanism of IGF-I on the bone growth is needed.

Objective To study the expression of fatty acid binding protein 4 (FABP4) in lungs and bron choalveolar lavage fluid (BALF) of preterm rats exposed to 60% O₂ and to elucidate the relationship between thechanges of FABP4 expression and the pathogenesis of bronchopulmonary dysplasia (BPD). Methods Hyperoxiclung injury was induced by exposing to 60% O₂ in Spraque-Dawley rats within 6 hours after birth. Rats exposedto air were used as the control group. The lungs from groups aged postnatal days 3, 7 and 14 were removed and dissected from the main bronchi for analysis. Eight rats of each group were used to assess expression of FABP4 inlungs by immunohistochemistry and ELISA. Lung FABP4 mRNA levels were measured by semi-quantitative reversetranscription polymerase chain reaction. The levels of FABP4 in BALF were measured using ELISA. Results FABP4 immunoreactivity was detected in the majority of alveolar macrophages, bronchial epithelial cells and endothelial cells.FABP4 protein levels in lung tissues in the hyperoxic exposure group increased significantly compared with the controlgroup on days 3, 7 and 14 after birth (P<0.05), and FABP4 mRNA levels in lung tissues also increased significantly inthe hyperoxic exposure group compared with the control group on days 7 and 14 after birth (P<0.05). The hyperoxicexposure group demonstrated increased FABP4 levels in BALF compared with the control group on days 7 and 14after birth (P<0.05). Conclusions FABP4 levels increase in preterm rat lungs after hyperoxic lung injury, which maycontribute to the pathogenesis of BPD.

Objective To study the role of tranilast in the pathogenesis of myocardiac fibrosis in viral myocarditis.Methods Seventy-two BALB/C mice were randomly divided into control, model and intervention groups (n=24 each). Mice in the model and intervention groups were infected with Coxsackievirus B3 to induce viral myocarditis.The intervention group was given with tranilast (200 mg/kg) by gavage until sacrifice for sampling, while the other twogroups were administered with the same volume of normal saline. Cardiac tissues were obtained from 8 mice on 7, 14and 28 days after modeling. The mast cell number was observed by toluidine blue staining and thionine staining. Thecardiac tissues were stained with hematoxylin and eosin as well as masson trichrome to observe the pathological changesin cardiac tissues. The mRNA and protein expression of osteopontin and transforming growth factor-β1 was measuredby RT-PCR and immunohistochemistry respectively. Results In the model group, the mRNA and protein expression ofosteopontin reached the highest level on the 7th day, decreasing from the 14th day, and became to the least on the 28thday; while the expression of TGF-β1 increased from the 7th day, reaching a peak on the 14th day, and decreased slightlyon the 28th day. The mRNA and protein expression of TGF-β1 and OPN was lower in the intervention group thanthe model group (P<0.05), but higher than the control group (P<0.05). The expression of OPN mRNA was positivelycorrelated to the number of mast cells. Conclusions Tranilast can reduce myocardial fibrosis by decreasing the numberof mast cells, inhibiting the expression of TGF-β1 and OPN.

No abstract available

Objective To investigate the dynamic changes of intestinal 16S rDNA metagenome in healthy infants.Methods Seventeen fecal samples were collected at ages of 3 days, 1 month, 6 months and 1 year in 5 infants. Totalbacterial DNAs were extracted and submitted high throughout sequencing on the V6 viable region of 16S rDNA. Tagsand Operational Taxonomic Units (OTU) were then obtained and analysis of taxonomy, abundance and alpha diversitywere performed. Results In total 2 190.66 Mbp raw data in 17 samples were produced. The OTU numbers rangedfrom 36 to 308. The dominate phylum included Proteobacteria, Firmicutes and Bacteroidetes and Actinobacteria. The bacterial families >1% increased from only 2-4 per sample on day 3 to 7 at 1 or 6 months, 10 at 12 months. The averagenp Shannon and Simpson index on day 3, at 1 month, 6 months and 1 year were 1.117, 1.460, 2.088, 2.50 and 0.443, 0.408,0.229, 0.143 respectively. Conclusions Infants' intestines harbor abounding bacterial genomes. Distinct individual differences exist in infants in terms of intestinal bacterial abundance and composition. The abundance and diversity ofgut bacteria increase over time.