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    CLINICAL RESEARCH
  • ● CLINICAL RESEARCH
    CAI Yue-Ju, SONG Yan-Yan, HUANG Zhi-Jian, LI Jian, QI Jun-Ye, XIAO Xu-Wen, WANG Lan-Xiu
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    Objective To study the effects of postnatal growth retardation on early neurodevelopment in premature infants with intrauterine growth retardation (IUGR).Methods A retrospective analysis was performed on the clinical data of 171 premature infants who were born between May 2008 and May 2012 and were followed up until a corrected gestational age of 6 months. These infants were classified into two groups:IUGR group (n=40) and appropriate for gestational age (AGA) group (n=131). The growth retardation rates at the corrected gestational ages of 40 weeks, 3 months, and 6 months, as well as the neurodevelopmental outcome (evaluated by Gesell Developmental Scale) at corrected gestational ages of 3 and 6 months, were compared between the two groups.Results The growth retardation rate in the IUGR group was significantly higher than in the AGA group at the corrected gestational ages of 40 weeks, 3 months, and 6 months. All five developmental quotients evaluated by Gesell Developmental Scale (gross motor, fine motor, language, adaptability and individuality) in the IUGR group were significantly lower than in the AGA group at the corrected gestational ages of 3 months. At the corrected gestational age of 6 months, the developmental quotients of fine motor and language in the IUGR group were significantly lower than in the AGA group, however, there were no significant differences in the developmental quotients of gross motor, adaptability and individuality between the two groups. All five developmental quotients in IUGR infants with catch-up lag in weight were significantly lower than in IUGR and AGA infants who had caught up well.Conclusions Growth retardation at early postnatal stages may adversely affect the early neurodevelopment in infants with IUGR.

  • ● CLINICAL RESEARCH
    YANG Xiao, ZHANG Xiao-Ai, WU Zhi-Hao, PENG Wei, ZHU Li-Na, WANG Yan
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    Objective To investigate the association between the genetic polymorphism of 2',5'-oligoadenylate synthetase 1 (OAS1) and susceptibility to spontaneous preterm birth (SPTB) and preterm premature rupture of membranes (PPROM).Methods The case-control study consisted of 599 preterm infants including 171 cases of PPROM, and 673 full-term infants without maternal histories of SPTB and PPROM as controls. The single nucleotide polymorphism (SNP) at OAS1 intron 5, rs10774671, was analyzed by polymerase chain reaction-restriction fragment length polymorphism.Results No significant differences were observed between the case and control groups in the frequencies of genotypes (AA, GA, and GG) and alleles (A and G) of OAS1 rs10774671. When the case group was divided into two subgroups with or without PPROM, no significant differences in the genotype and allele frequencies were found between each subgroup and the control group. When the case group was divided into three subgroups with different gestational ages at SPTB, no significant differences in the genotype and allele frequencies were detected between each subgroup and the control group.Conclusions No association is identified between OAS1 SNP and susceptibility to SPTB and PPROM.
  • ● CLINICAL RESEARCH
    LIANG Wei-Ling, WEI Hong-Ying, LIAO Ning, ZHOU Jun-Li
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    Objective To study the mutation types of factor VIII (FVIII) gene in patients from 7 hemophilia A (HA) families and the relationship between FVIII gene mutations and clinical phenotypes.Methods A total of 8 patients from 7 HA families were recruited. The activated partial thromboplastin time (APTT) and factor VIII coagulant activity (VIII:C) in these patients were measured. Polymerase chain reaction (PCR) was performed to analyze FVIII gene intron 1 and 22 inversions. For patients without the FVIII intron inversions, direct sequencing was performed to determine their mutation types and other related members of their families were also tested by PCR and sequencing to analyze the corresponding mutation sites.Results The ranges of APTT and VIII:C of the 8 patients were 91.6-131 seconds and 0.8%-2%, respectively. FVIII gene intron 22 inversion was not detected, while intron 1 inversion was detected in one patient. There were 5 types of mutations in FVIII gene detected in the remaining 7 patients, including 6 patients with mutations in exon 14 and 1 patient with mutation in exon 23; all of the 5 types of mutations were single nucleotide mutations. Among the detected mutations in FVIII gene, p.His1202LeufsX16 (c.3666delA) detected in one patient was found to be a previously unreported mutation in FVIII gene.Conclusions FVIII gene exon 14 is a hot-spot mutation region and p.His1202LeufsX16 is found to be a novel mutation in FVIII gene.
  • ● CLINICAL RESEARCH
    HE Sheng, ZHANG Qiang, CHEN Bi-Yan, HUANG Peng, TANG Yan-Qing, WEI Yuan, CHEN Qiu-Li, ZHENG Chen-Guang
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    Objective To investigate the genotypes and clinical features of children with HbH disease in Guangxi Zhuang Autonomous Region, China.Methods A total of 595 children from Guangxi were recruited. Single-tube multiplex polymerase chain reaction combined with agarose gel electrophoresis, as well as reverse dot blotting, were performed to detect the three α-globin gene deletion mutations (--SEA, -α3.7, and -α4.2) and three non-deletion mutations (Hb Westmead, Hb Constant Spring, and Hb Quong Sze) which are common in the Chinese population.Results Among the 595 cases, five common genotypes were identified, which were --SEA/-α3.7 (232 cases), --SEACSα (174 cases), --SEA/-α4.2 (122 cases), --SEAWSα (35 cases), and --SEAQSα (24 cases). The genotype of THAI deletion associated with α-thalassemia-2 was detected in eight cases. Six β-mutations including CD41-42, CD17-28, CD26, IVS-II-654, IVS-I-1, and CD27-28 were identified in 23 cases. All children with HbH disease had microcytic hypochromic anemia; children with HbH-CS disease had the most severe anemia, and those with HbH-WS disease had the mildest anemia.Conclusions Deletional HbH disease is the main type in children with HbH disease in Guangxi, and some patients also have mild betathalassemia. Non-deletional HbH disease shows more severe phenotype than deletional HbH disease.
  • ● CLINICAL RESEARCH
    YANG Zhen, CHEN Tong-Xin
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    Objective To investigate the major allergens in children with different allergic diseases, and to provide theoretical evidence for the clinical prevention, diagnosis, and treatment of allergic diseases in children.Methods Skin prick test (SPT) was conducted to detect allergens in 1 179 allergic children. According to clinical diagnoses, patients were categorized into six groups:atopic dermatitis (n=140), allergic gastroenteritis (n=37), allergic conjunctivitis (n=77), asthma (n=285), allergic rhinitis (n=301) and allergic co-morbidity (n=329) groups.Results Of the 1 179 patients, 82.0% had positive SPT results; the most prevalent inhalant allergens were Dermatophagoides farinae (68.1%) and Dermatophagoides pteronyssinus (53.5%), while the most common food allergens were milk (5.0%) and eggs (4.8%). The proportions were 84.3% and 83.8% for patients under or equal to 3 years of age in the atopic dermatitis and allergic gastroenteritis groups, respectively. Patients over 4 years of age accounted for the majority of the other four groups. Food as major allergens were found in both atopic dermatitis and allergic gastroenteritis groups; eggs and Dermatophagoides farinae were the most common allergens for the former group, while eggs and milk for the latter group. Inhalant allergens were the major allergens in the allergic conjunctivitis, allergic rhinitis, asthma, and allergic co-morbidity groups, and the most prevalent allergens were Dermatophagoides farinae and Dermatophagoides pteronyssinus.Conclusions There are differences in the distribution of age and allergen types in children with different allergic diseases. Atopic dermatitis and allergic gastroenteritis are prevalent in infants and young children, and food allergens are more common. Patients in allergic conjunctivitis, allergic rhinitis, asthma, and allergic co-morbidity groups are mostly children over 4 years of age, and inhalant allergens are more common.
  • ● CLINICAL RESEARCH
    MU Yun, SUN Chao, WANG Liang, MENG Dong-Mei, SUN Xu-Guo
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    Objective To screen biomarkers which can be used as an auxiliary method in the diagnosis of Henoch-Schönlein purpura (HSP) and to evaluate their diagnostic values by receiver operating characteristic (ROC) curve analysis.Methods A total of 127 children diagnosed with HSP between April 2012 and March 2014 were included in the HSP group and an equal number of healthy children were included in the control group. Twelve parameters, i.e., serum amyloid protein A (SAA), interleukin-6 (IL-6), immunoglobulins (IgA, IgG, IgM, and IgE), C-reactive protein (CRP), white blood cell (WBC) count, complements C3 and C4, anti-streptolysin O, and ferritin, were analyzed. The values of the screened biomarkers for diagnosis of HSP were assessed by ROC curve analysis.Results The HSP group had significantly higher levels of SAA, IL-6, CRP, WBC, IgA, and IgM than the control group (P<0.05). The areas under the ROC curve of SAA, IL-6, WBC, IgA, and IgM for the diagnosis of HSP were higher than 0.7 (P<0.05). The optimal cut-off values of SAA, IgA, IgM, WBC, and IL-6 for the diagnosis of HSP were 3.035 μg/mL, 1 579.5 mg/L, 922.5 mg/L, 8.850×109/L, and 7.035 pg/mL, respectively; the corresponding sensitivities of the optimal cut-off values for the diagnosis of HSP were 95.1%, 75.6%, 72.3%, 78.0%, and 63.4%, respectively, and the corresponding specificities were 90.2%, 85.4%, 82.4%, 70.7%, and 80.5%, respectively.Conclusions SAA, IgA, IgM, WBC, and IL-6 are valuable biomarkers for clinical diagnosis of HSP and among them SAA seems to be the best one.
  • ● CLINICAL RESEARCH
    CAI Xiao-Fang, SUN Ji-Min, LI Wen-Bin
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    Objective To study the correlation between serum procalcitonin (PCT) level and severity of infant muggy syndrome (IMS) and the predictive value of PCT in the development of multiple organ dysfunction syndrome (MODS) in children with IMS.Methods Fifty children with IMS were classified into two groups according to the presence of MODS:MODS (n=29) and non-MODS (n=21). According to a 30-day follow-up result, they were classified into survival (n=36) and deceased groups (n=14). Vital signs, routine biological measurements (arterial blood gas, blood routine, CRP, liver and kidney functions, myocardial enzyme and so on) and the disease severity evaluated by the Pediatric Critical Illness Score (PCIS) within 24 hours of admission were recorded. Serum levels were measured using the semi-quantitative PCT-Q test within 24 hours of admission.Results Forty-seven children (94%) had elevated serum PCT levels (≥0.5 ng/mL) at admission. There were lower PCIS scores, higher rates of MODS and higher levels of serum PCT in deceased patients than survivors (P<0.05). There was a significant negative correlation between serum PCT levels and PCIS scores (r=-0.84, P<0.05). Serum PCT levels in the MODS group were significantly higher than in the non-MODS group (P<0.01). Receiver operating characteristic curve showed that, if the cut-off point of serum PCT level was 10.6 ng/mL, the sensitivity and specificity of PCT were 79.3% and 90.5% respectively, in predicting MODS, with the area under the curve of 0.924 (P<0.01).Conclusions Serum PCT level at admission is correlated with the severity of IMS and it may be an early predictive marker of MODS.
  • ● CLINICAL RESEARCH
    DENG Yong-Chao, WANG Xun, TANG Xi-Chun, HUANG Cai-Zhi, YANG Juan, MO Li-Ya
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    Objective To explore the risk factors for coronary artery lesions (CAL) secondary to Kawasaki disease (KD) in children.Methods The medical data of 895 children with KD were retrospectively reviewed. The patients were classified into two groups according to the presence of CAL:CAL (n=284) and control (n=611). The clinical and laboratory indices were compared between the two groups.The risk factors for the development of CAL in children with KD were identified by multiple logistic regression analysis.Results Male gender (OR=1.712), occurrence of non-CAL complications (OR=2.028), atypical KD (OR=3.655), intravenous immunoglobulin (IVIG) resistance (OR=2.912), more than 5 days of fever duration before IVIG treatment (OR=1.350), and increased serum procalcitonin (PCT) level (OR=1.068) were the independent risk factors for the development of CAL in children with KD (P<0.05), whereas increased serum albumin (Alb) level was a protective factor (OR=0.931, P<0.05). The areas under the receiver operating characteristic curve of serum PCT and ALB for prediction of the development of CAL in children with KD were 0.631 and 0.558, respectively.Conclusions Male gender, atypical KD, occurrence of other non-CAL complications, long duration of fever and IVIG resistance are associated with an increased risk for CAL in children with KD. Serum PCT and ALB have little value in the prediction of CAL in children with KD.
  • ● CLINICAL RESEARCH
    CHENG Chao, LIN Ye-Xin, LI Jiu-Jun, ZHANG Zhi-Jie
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    Objective To explore the risk factors for sepsis caused by multidrug-resistant Klebsiella pneumonia (MDR-KP) and to provide a reference for the prevention of MDR-KP sepsis and rational use of antibiotics.Methods A retrospective case-control study of 41 children with MDR-KP sepsis (case group) and 53 pediatric patients without MDR-KP sepsis (control group) between March 2010 and Febrary 2014 was conducted. Multiple logistic regression analysis was performed to estimate the independent risk factors for MDR-KP sepsis.Results Compared with the control group, the case group had a longer length of stay in the PICU before infection (P<0.05), more prolonged duraion of mechanical ventilation before infection (P<0.05), a larger total number of days of mechanical ventilation (P<0.05), more days of antibiotic use before infection (P<0.05), more types of antibiotics used before infection (P<0.05), and a higher mortality (P<0.05). The logistic regression analysis showed that more types of antibiotics used before infection and use of third-generation cephalosporin and carbapenems were independent risk factors for MDR-KP sepsis (P<0.05).Conclusions Rational use of antibiotics is an effective measure to prevent MDR-KP sepsis.
  • ● CLINICAL RESEARCH
    GU Wen-Jing, ZHANG Xin-Xing, CHEN Zheng-Rong, YAN Yong-Dong, ZHU Can-Hong, HUANG Li, WANG Mei-Juan, SHAO Xue-Jun, JI Wei
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    Objective To compare the detection rates of Mycoplasma pneumoniae (MP) from nasopharyngeal aspirates (NPA) and bronchoalveolar lavage fluid (BALF) in children with pneumonia.Methods A total of 164 hospitalized children with pneumonia were enrolled. NPA and BALF of these children were collected within 24 hours of admission, and MP-DNA was detected by fluorescence quantitative PCR. Venous blood samples of all these children were collected within 24 hours of admission and on days 7-10 of treatment, and serum MP-IgM was detected using ELISA.Results The positive rate of MP-DNA in NAP of the 164 cases was 51.8%, which was lower than 63.4% as the detection rate of MP-IgM in serum (P=0.044), and the two detection rates were moderately consistent with each other (Kappa=0.618, P<0.01). The positive rate of MP in BALF was 71.3%, which was not significantly different with that of MP-IgM in serum (P>0.05), and the detection rates were well consistent (Kappa=0.793, P<0.01). The detection rate of MP in NPA was lower than that in BALF (P<0.01), with moderate consistency between two of them (Kappa=0.529, P<0.01). The median MP copy number in BALF was significantly higher than that in NPA (P<0.01). The MP detection rates in NPA and BALF were significantly different among different courses of disease (P<0.05). As the course of disease extended, the MP detection rates in both NPA and BALF showed a declining trend; children with MP pneumonia of 1-2 weeks' duration and 2-4 weeks' duration had a higher MP-DNA detection rate in BALF than in NPA (P<0.05).Conclusions MP-DNA in BALF has a high sensitivity, with a great significance for early diagnosis of MP pneumonia, while NPA MP-DNA tests may lead to a missed diagnosis.
  • ● CLINICAL RESEARCH
    XIONG Yi, WANG Jian, WEI Di, ZHAO Jun, YE Mei
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    Objective To observe the changes in Th17 cell levels in bronchoalveolar lavage fluid in children of sepsis with acute lung injury and the relationship between the Th17 cell levels and prognosis.Methods Fifty children of sepsis with acute lung injury were enrolled in the study. The percentages of Th17 cells in bronchoalveolar lavage fluid were measured by flow cytometry. The patients of sepsis with acute lung injury were classified into three groups based on the Pediatric Critical Illness Score (PCIS):extremely critical, critical and non-critical. According to the clinical prognosis, the patients were classified into survical and death groups. Th17 cell levels were compared between the two groups. The relationship between Th17 cell levels and the PCIS scores was analyzed.Results With the increase in the severity of sepsis, Th17 cell levels in bronchoalveolar lavage fluid were gradually increased (P<0.05). The Th17 cell levels were negatively correlated to the PCIS scores (r=-0.853; P<0.01). The Th17 cell levels were significantly higher in the death group than in the survival group. Moreover, compared with the survival group, the PCIS scores were lower in the death group (P<0.05).Conclusions The increased Th17 cell levels in children of sepsis with acute lung injury are closely related to the severity and prognosis of patients, suggesting that Th17 cell levels can be used as a predictor of the severity and prognosis.
  • ● CLINICAL RESEARCH
    Buli·Bahati, MA Zhi-Hua, Abulaiti·Abudouhaer
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    Objective To characterize the time distribution of the incidence of Enterobacter cloacae nosocomial infections in children hospitalized in the pediatric intensive care unit (PICU) of the First Affiliated Hospital of Xinjiang Medical University.Methods The clinical data of children with Enterobacter cloacae nosocomial infections in the PICU of the First Affiliated Hospital of Xinjiang Medical University between January 2010 and December 2013 were collected. The monthly number of cases of Enterobacter cloacae nosocomial infections was recorded, and time series analysis was performed using SPSS 21.0 software. The obtained prediction model was verified using the data from January to June in 2014.Results A total of 157 cases of Enterobacter cloacae nosocomial infections were reported in the PICU between January 2010 and December 2013, including 33 cases in 2010, 35 cases in 2011, 37 cases in 2012, and 52 cases in 2013. Time series analysis of the monthly number of cases of nosocomial infections reveals a fitted curve with a clear pattern of seasonal variation (R2=0.702, Ljung-BoxQ=(18)=36.021, P=0.004), with peaks in May, June, and July. The verification using the data from January to June in 2014 showed small differences between the predicted values and the actual values.Conclusions In the PICU of the First Affiliated Hospital of Xinjiang Medical University, the incidence of Enterobacter cloacae nosocomial infections is high in May, June, and July every year. The prediction model is accurate and can provide a reference for infection prevention.
  • ● CLINICAL RESEARCH
    XIE Ting, PAN Jia-Hua, ZHANG Xue
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    Objective To study the clinical value of combined measurement of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), and serum ferritin (SF) in the etiological diagnosis of fever of unknown origin (FUO) in children.Methods The clinical data of 154 hospitalized children who had FUO for at least two weeks were retrospectively analyzed, and they were classified into infection (n=54), rheumatism (n=67), and tumor (n=33) groups according to the diagnosis at discharge. The levels of CRP, ESR, LDH, and SF were compared between the three groups, and the diagnostic values of the four indices alone or together were analyzed using the receiver operating characteristic (ROC) curve.Results Serum CRP and ESR levels were elevated in all the three groups, and increased most significantly in the rheumatism group. Serum LDH level was increased most significantly in the tumor group. SF level was significantly increased in the rheumatism and tumor groups. The area under the ROC curve (AUC) of LDH for diagnosing rheumatism and the AUC of ESR and CRP for diagnosing tumors were lower than 0.7 (P>0.05). The AUC of CRP for diagnosing infection and rheumatism was 0.861 and 0.782, respectively. The AUC of ESR for diagnosing infection and rheumatism was 0.770 and 0.743, respectively. LDH had relatively low AUC, sensitivity, specificity, and Youden's index in diagnosing infection and tumors. SF had the highest AUC, sensitivity, and Youden's index in diagnosing infection, but had the lowest specificity. SF had relatively high AUC, sensitivity, specificity, and Youden's index in diagnosing rheumatism, but had relatively low AUC in diagnosing tumor. The four indices had higher AUC, sensitivity, and specificity in diagnosing rheumatism and tumors when measured together than when measured alone.Conclusions In the etiological diagnosis of FUO in children, CRP, ESR, LDH, and SF have certain clinical significance in the preliminary diagnosis of rheumatic diseases, but have limited value in the diagnosis and differentiation of infectious diseases and malignant tumors. Combined measurement of the four indices is superior to the determination of each one for the etiological diagnosis of FUO in children.
  • ● CLINICAL RESEARCH
    SI-TU Xun, ZHANG Jian-Hui, TAO Jian-Ping, WU Yan-Lan, ZHENG Jian-Bin, LI Ming
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    Objective To investigate the effects of high-volume hemofiltration (HVHF) on hemodynamics, vasoactive factors, and vascular endothelial permeability in children with septic shock by a comparative analysis.Methods Thirty-six children who were diagnosed with septic shock between January 2013 and September 2014 were randomly divided into control and observation groups (n=18 each). Children in the control group were treated with the standard-volume hemofiltration (SVHF), while children in the observation group were treated with HVHF. The hemodynamic indices and levels of vasoactive factors including 6-keto-prostaglandin F1α (6-keto-PGF1α), thromboxane B2 (TXB2), soluble E-selectin (sE-selectin), and endothelium-derived relaxing factor (EDRF) were determined before and after treatment. In addition, the effects of ultrafiltrate on endothelial cell permeability were assessed.Results Compared with the control group, the observation group had significantly higher mean arterial pressure, significantly higher blood oxygen saturation, and a significantly lower heart rate after treatment (P<0.05). The levels of TXB2 and sEselectin were significantly lower in the observation group than in the control group (P<0.05), while the levels of 6-keto-PGF1α and EDRF were significantly higher in the observation group than in the control group (P<0.05). Compared with the control group, the ultrafiltrate significantly attenuated the transepithelial electrical resistance in the observation group (P<0.05).Conclusions Compared with SVHF, HVHF is a more effective approach for improving the hemodynamics and levels of vasoactive factors and reducing the vascular endothelial permeability in children with septic shock.
  • ● CLINICAL RESEARCH
    LU Xiu-Lan, QIU Jun, ZHU Yi-Min, CHEN Peng, ZUO Chao, TANG Liang, LIU Xiao, XIAO Zheng-Hui, DU Yu-Kai
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    Objective To investigate the role of Pediatric Critical Illness Score (PCIS) in evaluating the prognosis and severity of severe hand-foot-mouth disease (HFMD).Methods This study included 424 children with severe HFMD, consisting of 390 survivors and 34 deceased patients. Related physiological parameters and clinical data were collected for calculating PCIS scores. The area under receiver operating characteristic curve (AUC) was employed to assess the performance of PCIS in evaluating the complications and outcomes.Results The median of PCIS scores for survivors was higher than that for deceased patients (P<0.01). Of the 424 children with severe HFMD, only 26 (6.1%) had critical illness according to the severity assessment using PCIS. The AUC (95%CI) of PCIS was 0.74 (0.66, 0.82) in predicting pulmonary edema, 0.82 (0.74, 0.90) in predicting pulmonary hemorrhage, and 0.83 (0.75, 0.92) in predicting death.Conclusions PCIS can predict the complications and prognosis in children with severe HFMD. However, the existing scoring system of PCIS cannot fully assess the severity of HFMD.
  • ● CLINICAL RESEARCH
    QI Yan-Hua, QI Jian-Guang, LIU Yu-Peng, YAN Hui, LIU Xue-Qin, ZHANG Xin, XIAO Hui-Jie, YANG Yan-Ling, DU Jun-Bao
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    Objective To study the clinical features and treatment outcomes of cardiovascular system involvement in children with methylmalonic aciduria combined with hyperhomocysteinemia (MMACHC).Methods The clinical data of 10 children with methylmalonic aciduria combined with hyperhomocysteinemia and who had cardiovascular system involvement were retrospectively analyzed and the treatment outcomes were followed up.Results In the 10 patients, there were 4 cases with initial presentations of cardiovascular system symptoms such as shortness of breath and dyspnea, 3 cases with urinary tract symptoms such as edema, hematuria and proteinuria, and 3 cases with nervous system symptoms such as developmental retardation and convulsions. The 10 patients had different types and severity of cardiovascular injuries. After 3 months to 8 years of follow-up, the congenital heart defects resolved naturally in 2 cases, and the patient with arrhythmia had no obvious changes. In 5 cases of hypertension, blood pressures recovered to normal in 3 cases, and 1 case was lost to follow-up. In 5 patients with pulmonary hypertension, 2 died, 2 recovered, and 1 case had mildly elevated pulmonary artery pressure. Seven patients underwent MMACHC gene testing, and 5 showed c.80A>G mutations.Conclusions Metabolic disease should be taken into account for the children with unexplained pulmonary hypertension and hypertension with the onset of the shortness of breath and dyspnea. The severity of cardiovascular system involvement might be one of the most important factors affecting the prognosis of children with MMACHC. Cardiavascular system involvement of the patients may be related to MMACHC c.80A>G mutations.
  • ● CLINICAL RESEARCH
    CHEN Yu-Li, LUO Jian-Ming
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    Objective To summarize the clinical features of sinusoidal obstruction syndrome (SOS) and to improve the understanding of this disease.Methods A retrospective study was performed on the clinical data of 12 children with SOS including clinical manifestations, laboratory results, imaging findings, treatment, and prognosis.Results Of the 12 cases, 8 were secondary to acute lymphoblastic leukemia, and 4 had undergone hematopoietic stem cell transplantation. Manifestations mainly included abdominal distention (4 cases), hepatomegaly with tenderness (9 cases), splenomegaly (6 cases), and weight increase (10 cases). Biochemical tests revealed varying degrees of liver damage in all cases. In the coagulation function test, the activated partial thromboplastin time (APTT) was prolonged in 7 cases. Out of the 7 patients who underwent serum D-dimer test, 4 showed elevated serum level of D-dimer. In routine blood tests, 4 cases showed decreases in both white blood cells and neutrophils. In addition, varying degrees of thrombocytopenia were observed in 9 cases. Eight patients were subjected to color Doppler ultrasound examination, and diffuse hepatomegaly, inhomogeneous liver parenchyma, unclear or thinner hepatic veins, hydrothorax/ascites, or splenomegaly was observed. Sinusoidal dilatation or hepatic cell infiltration was observed in 2 patients who underwent liver biopsy. Treatments were basically symptomatic and supportive therapies, and the prognosis was good in all patients.Conclusions SOS should be considered in children who present with hepatomegaly, sudden weight gain, liver dysfunction and coagulation dysfunction after they have received chemotherapy for leukemia and hematopoietic stem cell transplantation.
  • ● CLINICAL RESEARCH
    FANG Han, YANG Tian-Lun, ZHOU Huan, JIANG Min-Na, FANG Fang, HUANG Ye-Hong, PEI Zhi-Fang
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    Objective This study examines the impacts of an improved electrode placement on the electrocardiogram (ECG) results in order to determine a better electrode placement for ECG monitoring in children.Methods ECG was recorded using the traditional electrode placement and the modified electrode placement (with shortened electrode distance) respectively in 50 pediatric patients. The amplitudes of P wave and QRS wave on ECG by the two measurements were compared. Furthermore, the impacts of different body positions on the amplitudes of P wave and QRS wave were studied after applying the modified electrode placement.Results There were no significant differences in the amplitudes of P wave and QRS wave on ECG by the traditional electrode placement and the modified electrode placement (P>0.05). When modified electrode placement was utilized, the body position change did not lead to significant changes in the amplitudes of P wave and QRS wave (P>0.05).Conclusions A satisfactory ECG can be obtained with the modified electrode placement independent of patient's body position, suggesting that the modified electrode placement can be used instead of the traditional placement in children.
  • ● CLINICAL RESEARCH
    SUN Gui-Xiang, WANG Bing-Hua, ZHANG Ya-Feng
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    Objective To study the possible relationship between serum zinc levels and attention deficit hyperactivity disorder (ADHD) in Chinese children.Methods Following a systematic search for case-control studies on the serum zinc levels in Chinese children with ADHD published between 2000 and 2015, a Meta analysis was conducted using Stata 12.0 software.Results A total of 17 studies, including 2 177 children with ADHD and 2 900 normal children, were enrolled. The Meta analysis showed that serum zinc levels in children with ADHD were lower than normal children (SMD=-1.33; 95%CI:-2.22, -0.44; P=0.003). The sensitivity analysis indicated that the results were reliable. Egger's test did not find the existence of publication bias.Conclusions Serum zinc levels may be associated with susceptibility to ADHD in children.
  • EXPERIMENTAL RESEARCH
  • ● EXPERIMENTAL RESEARCH
    XU Fa-Lin, CHENG Hui-Qing, WANG Cai-Hong, ZHANG Yan-Hua, GUO Jia-Jia
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    Objective To study the effects of caffeine citrate on myelin basic protein (MBP) expression in the cerebral white matter of neonatal rats with hypoxic-ischemic brain damage (HIBD) and the related mechanism.Methods Forty-eight seven-day-old Sprague-Dawley neonatal rats were randomly assigned to 3 groups:sham operation (n=16), HIBD (n=16) and HIBD+caffeine citrate (n=16). The rats in the HIBD and HIBD+caffeine citrate groups were subjected to left common carotid artery ligation, and then were exposed to 80 mL/L oxygen and 920 mL/L nitrogen for 2 hours to induce HIBD. The rats in the sham operation group were only subjected to a sham operation, without the left common carotid artery ligation or hypoxia exposure. Caffeine citrate (20 mg/kg) was injected intraperitoneally before hypoxia ischemia (HI) and immediately, 24 hours, 48 hours and 72 hours after HI. The other two groups were injected intraperitoneally with an equal volume of normal saline at the corresponding time points. On postnatal day 12, the expression of MBP in the left subcortical white matter was detected by immunohistochemistry, and the levels of adenosine A1 receptor mRNA and A2a receptor mRNA in the left brain were detected by real-time PCR.Results The expression of MBP in the left subcortical white matter in the HIBD group was lower than in the sham operation group (P<0.05). The MBP expression in the HIBD+caffeine citrate group was significantly higher than in the HIBD group, but was still lower than the sham operation group (P<0.05). Real-time PCR showed that the adenosine A1 receptor mRNA expression was significantly higher in the HIBD group than in the sham operation group, and it was significantly lower in the HIBD+caffeine citrate group than in the HIBD group (P<0.05).Conclusions Caffeine citrate can improve brain white matter damage following HIBD in neonatal rats and the protection mechanism might be related with the down-regulation of adenosine A1 receptor expression.
  • ● EXPERIMENTAL RESEARCH
    DUAN Pei-Feng, JIA Xiu-Hong, WANG Jian-Yong
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    Objective To study the effect of safflower injection on the proliferation and apoptosis of human leukemia cell line HEL and the relevant molecular mechanisms.Methods HEL cells were treated with different concentrations of safflower injection. HEL cells without safflower injection treatment were used as the control group. MTT method was used to detect the inhibitory rate of the HEL cells at 24, 48 and 72 hours after various concentrations of safflower injection treatment (10, 20, 30, 40 and 50 mg/mL). The cell cycle and apoptosis were detected using flow cytometry and the HOXB3-mRNA expression was measured by RT-PCR at 48 hours after safflower injection treatment (10, 20 and 30 mg/mL).Results Compared with the control group, various concentrations of safflower injection inhibited HEL cell proliferation in a dose-dependent manner (P<0.05). At 48 hours after various concentrations of safflower injection treatment, the number of treated cells in the G2/M phase increased, but that in the S phase decreased, and the apoptosis rate was significantly higher than that in the control group, with a dose-dependent manner (P<0.05). The expression of HOXB3-mRNA in safflower injection-treated cells decreased in a dose-dependent manner compared with the control group (P<0.05).Conclusions Safflower injection can inhibit proliferation and induce apoptosis of HEL cells in vitro, and its underlying mechanisms may involve down-regulation of the HOXB3-mRNA expression.
  • ● EXPERIMENTAL RESEARCH
    LOU Chun-Yan, LI Min, LI Li
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    Objective To study the dynamic changes in Th17 cells and CD4+ CD25+ regulatory T cells (Treg) in the spleen and to analyze their relationship with airway remodeling.Methods A total of 48 female specific pathogenfree Balb/c mice were randomly divided into control and asthmatic groups. To establish the asthmatic airway remodeling model, the mice were sensitized to ovalbumin (OVA) through intraperitoneal injection of OVA and aluminum hydroxide suspension and challenged by inhalation of aerosol OVA. The matched control group was treated with normal saline instead. In 24 hours after 2-week, 4-week, and 8-week aerosol inhalation, 8 mice were randomly selected from each group and sacrificed. Then histopathological examination of the left lung was performed to measure the degree of airway remodeling. The percentages of Th17 and CD4+ CD25+ Treg cells in total CD4+ cells from the spleen were determined by flow cytometry.Results In the asthmatic group, the ratios of total bronchial wall area to bronchial basement membrane perimeter (WAt/Pbm) and bronchial smooth muscle area to bronchial basement membrane perimeter (WAm/Pbm) significantly increased as the challenge proceeds (P<0.01). The percentage of Th17 cells derived from the cell suspension of the spleen gradually increased and it was positively correlated with the degree of asthmatic airway remodeling (P<0.01). The percentage of CD4+ CD25+ Treg cells from the suspension gradually decreased and it was negatively correlated with the degree of asthmatic airway remodeling (P<0.01).Conclusions In mice with asthma, as the challenge proceeds, the airway remodeling becomes more severe, the percentage of Th17 cells increases, and the percentage of CD4+ CD25+ Treg cells decreases. The immunological imbalance is possibly one of the important factors inducing airway remodeling.
  • ● EXPERIMENTAL RESEARCH
    WU Xi-Ling, DU Li-Zhong, XU Xue-Feng
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    Objective To explore the relationship between the expression of endothelial nitric oxide synthase (eNOS) and NADPH oxidase (NOX) in the lungs of mice treated by chronic hypoxic exposure.Methods Thirty male wild-type (WT) C57Bl/6 mice and thirty male eNOS-knockout (KO) C57BL/6 mice were randomly divided into normoxic groups (exposed to normoxia for 7 days or 21 days), hypoxic groups (exposed to 10% oxygen for 7 days or 21 days), and treatment groups (exposed to 10% oxygen and orally administrated 10 mmol/L 4-hydroxy TEMPO in drinking water for 7 days or 21 days) (n=6 in each group). The remodeling of the small pulmonary arteries was evaluated by the percentage of media wall thickness (MT%). The weight ratio of right ventricle to left ventricle plus septum (RV/[LV+S]) was calculated to evaluate the hypertrophy of right ventricle. Real-time PCR was used to measure the mRNA expression of NOX2, NOX4, and eNOS in mouse lungs. ELISA was used to determine the concentration of reactive oxygen species (ROS) in mouse lungs.Results In WT mice and KO mice, the hypoxic groups had significantly increased pulmonary vascular remodeling and RV/[LV+S] compared with the normoxic and treatment groups (P<0.05), but there were no significant differences between the normoxic and treatment groups (P>0.05). In WT mice, the hypoxic and treatment groups had significantly lower ROS concentrations than the normoxic group (P<0.05), but there were no significant differences between the hypoxic and treatment groups (P>0.05). In WT mice, the mRNA expression of eNOS, NOX2, and NOX4 was significantly higher in the hypoxic group than in the normoxic group (P<0.05), and 4-hydroxy TEMPO reversed their over-expression. In the normoxic group, the KO mice had significantly higher NOX2 and NOX4 mRNA expression than the WT mice (P<0.05); in KO mice, the hypoxic group showed no significant changes in NOX4 mRNA expression (P>0.05), but had significantly reduced NOX2 mRNA expression (P<0.05), as compared with the normoxic group; the treatment group had reduced expression of NOX2 mRNA expression and increased NOX4 mRNA expression (P<0.05), as compared with the hypoxic group.Conclusions eNOS plays a key role in the regulation of expression of NOX2 and NOX4 in the lungs exposed to hypoxia. It suggests that NOX and eNOS may physically interact with one another in pulmonary vascular remodeling induced by chronic hypoxia.

  • ● EXPERIMENTAL RESEARCH
    FANG Liu-Hui, FAN Xiao-Chen
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    Objective To investigate the dynamic expression and role of vitamin D receptor (VDR) in the myocardium of mice with viral myocarditis (VMC).Methods One hundred and twenty 4-week-old male BALB/c mice were selected and assigned into control (n=40) and experimental groups (n=80). The mice in the experimental group were injected intraperitoneally with Coxsackievirus B3 to establish the model of VMC, while the mice in the control group were injected intraperitoneally with an equal volume of DMEM solution. Fifteen mice in the experimental group and ten mice in the control group were sacrificed at 3, 7, 14, or 28 days after injection, and the myocardial specimens were obtained. The dynamic expression of VDR in the myocardium was determined by the immunohistochemical technique. The pathological changes in the myocardium were examined using hematoxylin and eosin staining.Results In the experimental group, the mice had significantly increased expression of VDR after virus injection (P<0.01); the expression of VDR reached the peak at 7 days after injection, and then declined gradually; the expression of VDR remained high at 28 days after injection. At 3, 7, 14, and 28 days after injection, the expression of VDR in the experimental group was significantly higher than that in the control group (P<0.01). Moreover, in the experimental group, the changes in the pathological score of the myocardium were in accordance with the changes in the expression of VDR; the expression level of VDR in the myocardium was positively correlated with the pathological changes in the myocardium in the experimental group (P<0.01).Conclusions VDR may be involved in the inflammatory-immune process in the pathogenesis of VMC.
  • REVIEW
  • ● REVIEW
    XIAO Bin, LIU Min, XU Chang
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    Persistent pulmonary hypertension of the newborn (PPHN) secondary to congenital diaphragmatic hernia (CDH) is one of the main reasons for high mortality of the newborn and a factor that leads to respiratory and circulatory failure in newborns with CDH. PPHN secondary to CDH is severe and difficult to treat, with poor prognosis. Therefore, prenatal intervention aims for preventing the pathological process of CDH, especially the etiological treatment for impeding the development of PPHN, has become a research focus. Given unknown causes and poor outcomes of PPHN, this article summarizes the research advances in pathogenesis and treatment of PPHN secondary to CDH based on related studies so as to provide a reference for relevant studies and clinical treatment.