CJCP
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2015 Vol.  17 No.  10
Published: 2015-10-15
OVERSEAS PEDIATRIC RESEARCH
CLINICAL RESEARCH
CASE ANALYSIS
EXPERIMENTAL RESEARCH
CLINICAL EXPERIENCE
CASE REPORT
REVIEW
OVERSEAS PEDIATRIC RESEARCH
1019 Caitlin Jantzen, Abhay Lodha, Mirea Lucia, Shoo K Lee, Xiang Y Ye, Koravangattu Sankaran
Effects of nosocomial infection trends on neonatal outcomes in preterm infants <33 weeks of gestational age in Canadian NICUs Hot!

Objective To characterize recent trends of nosocomial infection (NI) among preterm infants admitted to Canadian Level 3 NICUs during 2008-2012, and its association with neonatal outcomes. Methods A retrospective observational cohort study was performed including infants born <33 weeks gestational age and admitted to 24 NICU sites participating in the Canadian Neonatal NetworkTM during 2008-2012. NICU sites were classified into three groups according to their baseline NI rates in 2008 [Low NI group (≤14%), Medium NI group (14.1%-19%) and High NI group (>19% )], and NICU sites were also classified according to their NI trend during 2008-2012 (decreased, null and increased). Trends in NI were further examined for each baseline-NI group. Trends for a composite outcome indicating mortality or severe morbidities (intraventricular hemorrhage grades ≥3 or periventricular leukomalacia, retinopathy of prematurity stages ≥3, bronchopulmonary dysplasia or necrotizing enterocolitis stages ≥2) were examined for each baseline-NI and trend-NI NICU site groups using multivariable logistic regression analyses adjusted for potential confounders. Results Baseline high NI group showed significantly decreased trends in NI rates, while for with medium or low baseline NI groups showed no significant trends in NI rates. The composite outcome (mortality during NICU stay or any severe neonatal morbidity such as intraventricular hemorrhage grades 3-4, periventricular leukomalacia, retinopathy of prematurity stages 3-5, bronchopulmonary dysplasia and necrotizing enterocolitis stages 2-3) decreased significantly for sites with decreased (OR=0.89, 95% CI=0.85-0.93) or null (OR=0.94, 95% CI=0.90-0.98) NI trends, but no significant trends in the composite outcome were detected for sites with increased NI rates. Conclusions The neonatal outcome is possibly influenced by NI rates and trend. The trend in the mortality and the risk of bronchopulmonary dysplasia, retinopathy of prematurity stage ≥3 and intraventricular hemorrhage >2 were significantly decreased for sites with decreased NI trend, suggesting that these improved outcomes may be associated with effort to decrease NI rate.
2015 Vol. 17 (10): 1019-1027 [Abstract] ( 3387 ) [HTML 1KB] [PDF 1464KB] ( 1123 )
CLINICAL RESEARCH
1028 ZHANG Ming-Ming, LI Yi-Ping, YU Sheng-Lin
Comparison of clinical features of purulent meningitis between small-for-gestationalage and appropriate-for-gestational-age infants
Objective To study the differences in the clinical features of purulent meningitis (PM) between smallfor-gestational-age (SGA) and appropriate-for-gestational-age (AGA) infants. Methods The clinical data of 58 fullterm infants with PM were analyzed retrospectively. The infants were classified into a SGA group (13 cases) and an AGA group (45 cases) according to their birth weight and gestational age. Clinical manifestations, laboratory results, and outcomes were compared between the two groups. Results The incidence of decreased muscle tone in the SGA group was significantly higher than that in the AGA group (P<0.05);the positive rate in the Pandy's test for cerebrospinal fluid in the SGA group was significantly higher than that in the SGA group (P<0.05). Brain imaging examination showed that the incidence of brain injuries in the SGA group was significantly higher than that in the AGA group (P<0.05). Conclusions SGA infants with PM display a higher risk of brain injury, suggesting a poorer outcome, compared with AGA infants.
2015 Vol. 17 (10): 1028-1031 [Abstract] ( 3650 ) [HTML 1KB] [PDF 1215KB] ( 761 )
1032 CHEN Dan, MAO Jian
Evaluation of therapeutic effects and safety of different treatment methods for premature patent ductus arteriosus
Objective To explore the clinical treatment methods and their effects in the treatment of premature patent ductus arteriosus (PDA) and to summarize the experience of surgical treatment for PDA. Methods Nineteen premature infants who were diagnosed with PDA and received surgical treatment betwen January 2013 and December 2014 were selected as the surgical group, and 19 premature infants with PDA who did not receive surgical treatment during the same period were selected as the non-surgical group. The differences in medical history, clinical conditions, mortality, and major complications between the two groups were analyzed, and the characteristics of surgical treatment and its clinical effects were analyzed from the aspects of preoperative preparation and surgical results. Results Compared with the surgical group, the gestational age and birth weight in the non-surgical group were significantly greater (P<0.01), and Apgar scores for 1 and 5 minutes after birth were significantly higher in the non-surgical group (P<0.05). The PDA diameter, time to confirmed ultrasonic diagnosis, and duration of auxiliary ventilation in the surgical group were greater than in the non-surgical group, and the incidence of drug therapy, left atrium/aortic root (LA/AO) ratio >1.3, and the square of catheter diameter/birth weight (d2/BW) ratio >9 mm2/kg in the surgical group was significantly higher than in the non-surgical group (P<0.05). Compared with the non-surgical group, the surgical group had a significantly higher incidence of bronchopulmonary dysplasia (P<0.01), and there were no significant differences in the incidence of death, cerebral white matter damage, intracranial hemorrhage, and necrotizing enterocolitis between the two groups (P>0.05). Conclusions For premature infants with clinical symptoms and no improvement after conservative medical treatment or drug therapy, surgical ligation is a relatively safe and effective treatment method for PDA.
2015 Vol. 17 (10): 1032-1038 [Abstract] ( 3975 ) [HTML 1KB] [PDF 1307KB] ( 952 )
1039 FU Hui-Ling, LIU Li, ZHANG Juan, WANG Quan-Li
Clinical features, prevention and treatment of respiratory distress syndrome in neonates of different gestational ages in tertiary hospitals in Northwest China
Objective To investigate the clinical features, prevention and treatment of respiratory distress syndrome (RDS) in neonates of different gestational ages (GA) in the tertiary hospitals in Northwest China. Methods A total of 440 neonates diagnosed with RDS between January and December, 2011 in 12 tertiary hospitals in Northwest China were enrolled and classified into three groups:early preterm (GA<34 weeks;n=247), late preterm (GA 34-36+6 weeks;n=131) and full-term (GA≥37 weeks;n=62). The clinical data, including perinatal factors, prevention and treatment, complications and prognosis, were comparatively analyzed among the three groups. Results The rate of multiple births in the early preterm group was higher than the other two groups. The two preterm groups showed a higher incidence of premature rupture of membranes than the full-term group. The full-term group had a higher rate of cesarean section without contractions than the two preterm groups. The early preterm group had the highest application rate of antenatal steroids. Compared with the other two groups, the early preterm group had a higher application rate of pulmonary surfactants (PS) and an earlier time of first application of PS. The full-term group had a lower resuscitation rate than the two preterm groups. The early preterm group showed a higher incidence of patent ductus arteriosus and intracranial hemorrhage than the other two groups. The cure rate of RDS (78.2%) was the highest in the full-term group, followed by the late preterm group (58.6%) and the early preterm group (42.9%). Conclusions RDS infants of different GA in Northwest China have significant differences in perinatal factors, antenatal prevention, PS treatment, complications and prognosis.
2015 Vol. 17 (10): 1039-1044 [Abstract] ( 3833 ) [HTML 1KB] [PDF 1330KB] ( 884 )
1045 CHEN Shu-Shu, LIU Ling, HU Pin, SHI Bi-Zhen, FU Yi-Kang, LUO Rui, XIE Cai
Analgesic effect of fentanyl in neonates during mechanical ventilation
Objective To study the analgesic effect and safety of fentanyl in neonates receiving mechanical ventilation. Methods Thirty neonates receiving mechanical ventilation between December 2010 and February 2011 were randomized into drug intervention group and control group (n=15 each). In addition to the conventional treatment for both groups, the drug intervention group received fentanyl as the analgesic treatment. Heart rate, respiratory rate, blood pressure changes, and premature infant pain profile (PIPP) score before treatment and at 30 minutes, 2 hours, and 4 hours after treatment were recorded in both groups. Follow-up visits were performed for these infants after discharge, and the CDCC intellectual development scale for infants was applied to measure mental development index (MDI) and psychomotor development index (PDI) at 3, 6, 9, and 12 months of age. Results The respiratory rate and heart rate decreased in the drug intervention group after fentanyl treatment compared with the control group (P<0.05), and the PIPP scores in the drug intervention group was significantly lower than in the control group (P<0.05). The results of follow-up visits showed no significant differences in MDI and PDI at 3, 6, 9 and 12 months of age between the drug intervention and control groups (P>0.05). Conclusions Fentanyl can relieve the pain response in neonates receiving mechanical ventilation, with no long-term adverse effects on neurodevelopment.
2015 Vol. 17 (10): 1045-1050 [Abstract] ( 4246 ) [HTML 1KB] [PDF 1307KB] ( 945 )
1051 LI Bin, MA Hui-Min, WANG Xiao-Xue, LI Yun-Qian, LIU Hong-Bo, HONG Lian-Zhe, LI Xiong, ZHENG Wei-Hua, OU Wei-Lin
Expression and significance of toll-like receptors 7 and 8 in brain and lung tissues of death cases caused by EV71 infection
Objective To study the significance of toll-like receptors (TLR)-7 and-8 in the pathogenesis of infection caused by Enterovirus type 71 (EV71) through measuring the expression of TLR7 and TLR8 in brain and lung tissues from the death cases caused by EV71 infection. Methods Nine children who died of EV71 infection (EV71 group) were selected as study subjects, and 7 children who died of accidents or non-infectious diseases were used as the control group. Brain and lung tissues from the death cases in both groups at autopsy were collected, and immunohistochemistry was applied to detect the expression of TLR7 and TLR8 in lung and brain tissues in both groups. Integrated optical density (IOD) was applied for semi-quantitative analysis of the expression of TLR7 and TLR8. Results Immunohistochemical results showed that the expression of TLR7 and TLR8 in lung and brain tissues was strongly positive in the EV71 group, and the IOD values in the EV71 group were also significantly higher than those in the control group (P<0.05). There was no significant difference in the expression of TLR7 and TLR8 between lung and brain tissues in the EV71 group (P>0.05). Conclusions TLR7 and TLR8 are highly expressed in lung and brain tissues from the patients who die of severe EV71 infection, suggesting that TLR7 and TLR8 may be involved in the pathogenesis of brain and lung damages caused by severe EV71 infection.
2015 Vol. 17 (10): 1051-1055 [Abstract] ( 3980 ) [HTML 1KB] [PDF 2362KB] ( 916 )
1056 SHU Lin-Hua, XU Jiang-Jiang, WANG Shu, ZHONG Hai-Qin, DONG Xiao-Yan, JIANG Kun, ZHANG Hui-Yan, XIONG Qin, WANG Chao, SUN Ting, SUN Chao, LU Quan
Distribution of pathogenic microorganisms and its relationship with clinical features in children with community-acquired pneumonia
Objective To study the distribution of pathogenic microorganisms in different genders, age groups and seasons in children with community-acquired pneumonia (CAP) and the relationship between the distribution of pathogenic microorganisms and clinical features. Methods A total of 1 155 children with CAP were enrolled, among whom there were 670 boys and 485 girls, with a mean age of 3.1±2.8 years (range:one month to 14 years). Indirect immunofluorescence assay, particle agglutination test, enzyme-linked immunosorbent assay, colloidal gold method. and bacterial culture were applied to determine common respiratory pathogenic microorganisms in sputum, throat swabs, blood samples, bronchoalveolar lavage fluid, and urine. Results A total of 758 specimens (65.63%) were tested positive by pathogen detection. The top three dominant pathogens were Mycoplasma pneumoniae (MP, 43.64%), bacteria (15.12%), and respiratory syncytial virus (RSV, 9.26%), and the rate of mixed infection was 16.02%. The rates of MP infection between boys and girls with CAP were different (40.8% vs 47.6%;P<0.05). The MP detection rate was the highest in the age group of 6-14 years (77.4%) and the lowest in children younger than 1 year (11.2%), while the detection rates of bacteria and RSV were the highest in children younger than 1 year (21.2% and 17.2%, respectively). The MP detection rate was significantly higher in summer and autumn than in winter and spring, while the detection rates of bacteria and RSV in summer and autumn were significantly lower than those in winter and spring. Among children who were MP positive, fever, chills, cough, crackles were more likely to appear;children with RSV infection were more likely to have wheezes;children with bacterial infection were less likely to have cough. Serum levels of C-reactive protein and procalcitonin were associated with bacterial infection (OR=1.747 and 1.418, respectively;both P<0.05). Conclusions MP plays a more and more important role in the pathogenic microorganisms of CAP in children. Prevalence and outbreaks of MP infection among children should be alerted in summer and autumn. There are differences in the detection rate of various pathogenic microorganisms in CAP children with various age groups. The clinical features of children with CAP caused by different pathogenic microorganisms are different.
2015 Vol. 17 (10): 1056-1061 [Abstract] ( 4535 ) [HTML 1KB] [PDF 1426KB] ( 1136 )
1062 LI Jie, PAN Jia-Hua
Clinical efficacy of montelukast for the treatment of bronchiolitis in infants
Objective To observe the effect of montelukast treatment on levels of serum leukotriene B4 and urinary leukotriene E4 in infants with bronchiolitis. Methods Seventy-five children who were diagnosed with bronchiolitis between June 2014 and December 2014 were randomly assigned into two groups, one with thirty-eight cases as the montelukast treatment group and another thirty-seven cases as the control group. All of the children were given routine medical treatment. The children in the montelukast treatment group were additionally given montelukast daily (4 mg once a day, for 7 days). The serum leukotriene B4 and urinary leukotriene E4 levels were measured using ELISA before and after treatment. The relationship between serum leukotriene B4 and urinary leukotriene E4 levels was analyzed by Peason correlation analysis. Results After 7 days of treatment, the serum leukotriene B4 and urinary leukotriene E4 levels in the montelukast treatment and control groups were significantly reduced compared with before treatment (P<0.05). The montelukast treatment group showed significantly lower serum leukotriene B4 and urinary leukotriene E4 levels than the control group (P<0.05). The remission time of cough, wheezing and lung wheezes and the length of hospital stay in the montelukast treatment group were significantly shortened compared with the control group (P<0.05). There was a positive correlation between serum leukotriene B4 and urinary leukotriene E4 levels (r=0.723, P<0.05). Conclusions Montelukast has a reliable clinical curative efficacy for bronchiolitis in infants, possibly by decreasing serum leukotriene D4 and urinary leukotriene E4 levels.
2015 Vol. 17 (10): 1062-1065 [Abstract] ( 4345 ) [HTML 1KB] [PDF 1287KB] ( 1286 )
1066 ZHAI Ting-Ting, PAN Jia-Hua
Comparison of clinical application of exercise challenge test and methacholine challenge test in measurement of airway hyperresponsiveness
Objective To compare the advantages and disadvantages between exercise challenge test (ECT) and methacholine challenge test (MCT) in the measurement of airway hyperresponsiveness (AHR), in order to identify a better and safer method to measure AHR. Methods Forty-seven children with controlled asthma after regular treatment were enrolled. ECT and MCT were performed for each child successively, and sensitivity was obtained through comparison with the golden standard (PD20). The occurrence of bronchospasm symptoms during the two tests was recorded. Results Taking PD20 as the gold standard, in children with moderate or severe AHR, the sensitivity of MCT (61%) for the measurement of AHR was significantly higher than that of ECT (9%) (P<0.05). The consistency between MCT results and PD20 was relatively high (κ=0.614), while the consistency between ECT results and PD20 was relatively low (κ=0.006). However, in the MCT, the incidence of bronchospasm symptoms was high and positively correlated with the incidence of cough and chest distress (P<0.05). Conclusions MCT has a higher sensitivity for the measurement of AHR, but has a higher incidence of adverse events, compared with ECT in children with controlled asthma after regular treatment.
2015 Vol. 17 (10): 1066-1069 [Abstract] ( 3889 ) [HTML 1KB] [PDF 1240KB] ( 734 )
1070 RAN Jing, WANG Cheng, ZOU Run-Mei, WU Li-Jia, LIN Ping, LI Fang, XU Yi
Time-dependent heart rate variability in the head-up tilt test in children with postural orthostatic tachycardia syndrome
Objective To study the time-dependent heart rate (HR) variability in the head-up tilt test (HUTT) in children with postural orthostatic tachycardia syndrome (POTS) and to explore the HR diagnostic criteria for POTS in children. Methods A retrospective analysis was performed on the clinical data of 105 children diagnosed with POTS with HR ≥120 beats per minute (bpm) within the first 10 minutes of HUTT between January 2007 and December 2014. Their HR variability within the first 10 minutes of HUTT was analyzed. Results The HR of children with POTS increased gradually from the supine position to a 60° head-up tilt position, and the increase in HR was 24±12 bpm at the beginning of HUTT, 30±14 bpm at 3 minutes of HUTT, 32±13 bpm at 5 minutes of HUTT, and 38±12 bpm at 10 minutes of HUTT. The average maximal HR increase within the first 10 minutes of HUTT was 43±10 bpm. Conclusions In children with POTS, the HR variability gradually increases with time, and therefore, it is suggested that HR increase ≥40 bpm is more suitable for diagnosis of POTS in children.
2015 Vol. 17 (10): 1070-1073 [Abstract] ( 4334 ) [HTML 1KB] [PDF 1269KB] ( 668 )
1074 MA Xiao-Jing, HUANG Guo-Ying, ZHANG Jing, GAO Yan, LIANG Xue-Cun, CHEN Wei-Da
Diagnosis of noncompaction of the ventricular myocardium by echocardiography
Objective To evaluate the value of echocardiography in the diagnosis of noncompaction of the ventricular myocardium (NCVM) and to elucidate the echocardiographic characteristics of NCVM. Methods This study included 53 patients (28 boys and 25 girls), with an age for initial diagnosis of 15 days to 18 years, who were diagnosed with NCVM by echocardiography between May 2006 and May 2015. Transthoracic two-dimensional echocardiography and color Doppler were performed for qualitative diagnosis, and the end-diastolic non-compacted layer/compacted layer (N/C) ratio measured in the parasternal ventricular short-axis sectional view was selected as the criterion for quantitative diagnosis. Results The excessively prominent ventricular trabeculae and deep inter-trabecular recesses were all seen in 53 cases, and the blood flow in the cardiac chambers was connected to the inter-trabecular recesses. The areas involved in NCVM were mainly the apex (100%) and the middle segment of the left ventricular lateral wall (98%), followed by the middle segment of the left ventricular posterior wall (49%) and the middle segment of the left ventricular inferior wall (42%). In 53 children with NCVM, the N/C ratio was 4.3±1.9 (2.1-10.0). Cardiac insufficiency was found in 83% (44/53) of the children with NCVM, and the left ventricular ejection fraction for these children was (43±9)%. Conclusions Echocardiography can be used in the qualitative and quantitative diagnosis of NCVM and in the evaluation of cardiac function. The apex and the middle segment of the left ventricular lateral wall are often involved in NCVM, accompanied by decrease in the left ventricular ejection fraction.
2015 Vol. 17 (10): 1074-1078 [Abstract] ( 4182 ) [HTML 1KB] [PDF 1558KB] ( 959 )
1079 LIU Li-Jun, YU Jing, LI Yu-Ning
Clinical characteristics of Henoch-Schönlein purpura in children
Objective To explore the clinical characteristics of Henoch-Schönlein purpura (HSP) in children. Methods The clinical data of 325 hospitalized children who were diagnosed with HSP between June 2012 and June 2014 were analyzed retrospectively. Results In the 325 children with HSP, the incidence of HSP was higher in winter and spring, with 33.9% and 27.4%, respectively. Infection was the major factor to induce HSP (57.2%). The incidence of renal damage in children with purpura accompanied by abdominal symptoms and children with purpura accompanied by abdominal and joint symptoms was 60.3% and 48.9%, respectively, with statistically significant differences compared with children with purpura alone (P<0.05). In 32 children with purpura nephritis, the pathological grades of IIIa and IIIb were more common, accounting for 28% and 31%, respectively. In 325 children, an increased serum D-dimer level was observed in 260 children (80.0%), an increased peripheral IgA content in 101 children (46.3%), and a decreased CD4+ cell percentage in 62 children (56.4%). Conclusions A high incidence of HSP is often seen in spring and winter. HSP is often induced by upper respiratory tract infection. Renal damage is more likely to occur in children with digestive tract symptoms, with IIIa and IIIb as the common pathological grades of renal damage.
2015 Vol. 17 (10): 1079-1083 [Abstract] ( 5233 ) [HTML 1KB] [PDF 1365KB] ( 1476 )
1084 WANG Chun-Mei, LUO Yuan, WANG Ying-Chao, SHENG Guang-Yao
Roles of follicular helper T cells and follicular regulatory T cells in pathogenesis of Henoch-Schönlein purpura in children
Objective To study the roles of follicular helper T (Tfh) cells and follicular regulatory T (Tfr) cells in the pathogenesis of Henoch-Schönlein purpura (HSP) in children. Methods Peripheral blood samples were collected from 40 HSP children and 25 healthy controls. The percentages of Tfh and Tfr cells were measured by flow cytometry;the mRNA expression levels of Bcl-6, c-MAF, Blimp-1, and PD-1 in peripheral blood were measured by real-time polymerase chain reaction. Results Compared with the controls, the children with HSP had significantly increased percentage of Tfh cells and Tfh/Tfr ratio but a significantly reduced percentage of Tfr cells in the peripheral blood (P<0.05). Compared with the controls, the children with HSP had significantly increased mRNA expression of Bcl-6 and c-MAF but significantly reduced mRNA expression of Blimp-1 in CD4+ T cells (P<0.05), and had significantly increased mRNA expression of PD-1 but significantly reduced mRNA expression of Blimp-1 in CD4+CD25+ regulatory T cells (P<0.05). Conclusions Abnormal percentages of Tfh and Tfr cells may be involved in the pathogenesis of HSP in children, and over-expression of Bcl-6, c-MAF, and PD-1 mRNA and inhibited expression of Blimp-1 mRNA may be considered as important reasons for abnormal percentages of Tfh and Tfr cells.
2015 Vol. 17 (10): 1084-1087 [Abstract] ( 4282 ) [HTML 1KB] [PDF 1342KB] ( 863 )
1088 TENG Xu, XU Ling-Fen, SUN Mei, GUO Jing
Efficacy of infliximab in the treatment of Crohn's disease in children
Objective To evaluate the efficacy and safety of infliximab in the treatment of Crohn's disease in children. Methods Thirteen children who were diagnosed with Crohn's disease and received routine comprehensive treatment and infliximab (5 mg/kg) between January 2011 and December 2014 were enrolled. The changes in their clinical manifestations, laboratory indices, and Pediatric Crohn's Disease Activity Index (PCDAI) after the 30-week treatment were analyzed retrospectively. Meanwhile, endoscopy was performed to evaluate therapeutic effects. Results The symptoms such as abdominal pain, diarrhea, and bloody stool were relieved soon after infliximab treatment, with no recurrence observed;after the 30-week treatment, the white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and the PCDAI decreased, while the hemoglobin increased significantly compared with those before treatment (P<0.05). After infliximab treatment, two children underwent endoscopy. The endoscopy showed that one child was cured, and the other child failed to respond to the treatment. No adverse drug reactions were seen in all patients. Conclusions Infliximab treatment has significant clinical effects in children with Crohn's disease, with no obvious adverse reactions, and therefore, it can be applied as one of the preferred alternatives for treatment of Crohn's disease in children.
2015 Vol. 17 (10): 1088-1092 [Abstract] ( 4389 ) [HTML 1KB] [PDF 1598KB] ( 870 )
1093 TAO Yue-Hong, ZENG Bi-He, Nazir Sharif
Effects of HPGA suppression on predicted adult height in girls with central precocious puberty
Objective To study the relationship between the suppression of the hypothalamic-pituitary-gonadal axis (HPGA) and the predicted adult height (PAH) in girls with central precocious puberty (CPP) during the treatment with gonadotropin-releasing hormone analogue (GnRHa), in order to provide guidance for individualized GnRHa dose adjustment in clinical practice. Methods The clinical data of 75 CPP girls were collected, and then height, bone age (BA), uterine and ovarian volumes, and peak luteinizing hormone (LH), peak follicle-stimulating hormone (FSH), and estradiol (E2) levels were recorded at different time points of GnRHa treatment. PAH at each time point was calculated. PAH improvement (ΔPAH=PAH-target height) and its relationship with the degree of HPGA suppression were analyzed. Threshold effect analysis was applied to determine the best HPGA suppression range forΔPAH. Results After GnRHa treatment, PAHs were improved markedly compared with the data in the early stage of treatment. ΔPAH showed a negative correlation with ΔBA. At 24 months of treatment, ΔPAH was also negatively correlated with LH. Uterine volume controlled between 2.3 and 3.0 mL, LH level controlled below 0.8 IU/L, and FSH controlled below 2.4 IU/L could slow down the growth of BA and improve PAH. Conclusions GnRHa treatment can improve the PAH of CPP girls. Selection of an appropriate therapeutic dose for GnRHa to control uterine volume, LH and FSH levels within certain ranges can slow down the growth of BA and improve PAH.
2015 Vol. 17 (10): 1093-1097 [Abstract] ( 4482 ) [HTML 1KB] [PDF 1403KB] ( 816 )
1098 WEN Yi-Jiang, GUO Jia, ZHOU Zhi-Guang, LUO Zi-Qiang, HE Guo-Ping
Changes in fasting serum cortisol levels in adolescents with type 1 diabetes and elevated depressive symptoms
Objective To study the changes in serum cortisol levels in adolescents with type 1 diabetes (T1DM) and elevated depressive symptoms. Methods Twenty-eight adolescents with T1DM and 31 healthy peers were assessed for depressive symptoms using a depression self-rating scale developed by the Epidemiological Survey Center. Selected subjects were classified into four groups:T1DM with elevated depressive symptoms group (n=15), T1DM without elevated depressive symptoms group (n=13), elevated depressive symptoms without T1DM group (n=15), and normal control group (n=16). Fasting blood samples were collected in the morning, and the levels of serum cortisol were compared among the four groups. The correlations of serum levels of cortisol and glycosylated hemoglobin A1c (HbA1c) with the score of depression self-rating scale were evaluated by Pearson correlation analysis. Results The fasting serum cortisol levels in the 28 T1DM patients were significantly higher than in the 31 healthy peers (P<0.01). The fasting cortisol levels in the T1DM with elevated depressive symptoms group were significantly higher compared with those in the elevated depressive symptoms without T1DM group and normal control group (P<0.01). In adolescents with T1DM, serum HbA1c level was positively correlated with the score of depression self-rating scale (r=0.481, P=0.010). Conclusions The fasting serum cortisol levels in adolescents with T1DM and elevated depressive symptoms are significantly increased, suggesting that the patients with comorbidity of T1DM and depression develop dysfunction of the corticotropin-releasing hormone-adrenocorticotropic hormone-cortisol axis. The elevated depressive symptoms may be associated with a poor control of glucose metabolism.
2015 Vol. 17 (10): 1098-1102 [Abstract] ( 4128 ) [HTML 1KB] [PDF 1423KB] ( 930 )
1103 LIU Yu-Peng, DING Yuan, LI Xi-Yuan, WANG Hai-Jun, SONG Jin-Qing, YE Jin-Tang, WU Tong-Fei, YANG Yan-Ling
Acute brainstem encephalitis and myelitis in a girl with isolated methylmalonic aciduria due to MUT gene defect
Methylmalonyl CoA mutase deficiency due to MUT gene defect has been known as the main cause of isolated methylmalonic acidemia in Mainland China. This study reported a patient with isolated methylmalonic aciduria (MUT type) characterized as acute brainstem encephalitis and myelitis. The previously healthy girl presented with fever, lethargy and progressive weakness in her extremities at the age of 3 years and 2 months. Three day later, she had respiratory distress and consciousness. Cranial MRI revealed bilateral symmetrical lesion of pallidum, brain stem and spinal cord, indicating acute brainstem encephalitis and myelitis. Her blood propionylcarnitine (6.83 μmol/L vs normal range 1.0 to 5.0 μmol/L) and urinary methylmalonic acid (133.22 mmol/mol creatinine vs normal range 0.2 to 3.6 mmol/mol creatinine) increased significantly. Plasma total homocysteine was normal. On her MUT gene, a reported mutation (c.1630_1631GG>TA) and a novel mutation (c.1663C>T, p.A555T) were identified, which confirmed the diagnosis of methylmalonic aciduria (MUT type). After cobalamin injection, protein-restricted diet with the supplements of special formula and L-carnitine, progressive improvement has been observed. The clinical manifestation of patients with methylmalonic aciduria is complex. Metabolic study and gene analysis are keys for the diagnosis and treatment of the disorder.
2015 Vol. 17 (10): 1103-1106 [Abstract] ( 4447 ) [HTML 1KB] [PDF 1457KB] ( 1082 )
1107 GENG Ya-Nan, ZHANG Hong-Yan
Association of FGF23 gene polymorphism with Kawasaki disease and coronary artery lesions
Objective To study the distribution of polymorphism of c.212-37insC (rs3832879) in intron 1 of fibroblast growth factor 23 (FGF23) gene and its association with Kawasaki disease (KD) and coronary artery lesions (CAL). Methods Forty children with KD were enrolled in this study, among whom 16 children had concurrent CAL. Twenty-six age-matched healthy children were enrolled as controls. PCR and gene sequencing were applied to explore the distribution of polymorphism of c.212-37insC (rs3832879) in FGF23 gene in KD patients and controls. Results Among 40 children with KD, 14 (35%) carried the polymorphism of c.212-37insC (rs3832879) in FGF23 gene;among 26 controls, 6 (23%) carried such polymorphism. There was no significant difference in genotype distribution at this locus between the two groups (P=0.30). Among 16 children with CAL, 9 (56%) carried the polymorphism at this locus;among 24 children without CAL, 5 (21%) carried such polymorphism. As for the comparison of two subgroups with and without CAL, the difference in genotype distribution at this locus had statistical significance (P=0.02, OR=4.89, 95%CI:1.21-19.71). Conclusions The polymorphism of c.212-37insC (rs3832879) in FGF23 gene may not be associated with the pathogenesis of childhood KD, but it may be associated with the development of CAL in children with KD.
2015 Vol. 17 (10): 1107-1111 [Abstract] ( 3555 ) [HTML 1KB] [PDF 1569KB] ( 653 )
1112 ZOU Ze-Qiao, YUE Li-Jie, REN Yan-Fei
Association between CYP1A1*2A polymorphism and susceptibility to childhood acute lymphoblastic leukemia:a Meta analysis
Objective To explore the association between CYP1A1*2A polymorphism and susceptibility to childhood acute lymphoblastic leukemia (ALL) through a Meta analysis. Methods Inclusion and exclusion criteria were formulated and English and Chinese databases (PubMed, OVID Database, CBM, CNKI, and Wanfang Data) were searched comprehensively. The studies (from January 1999 to April 2015) related to the association between CYP1A1*2A polymorphism and susceptibility to childhood ALL were collected. STATA 12.0 Software was applied to perform the Meta analysis for the articles included. Results A total of 12 articles were included for analysis (11 English articles and 1 Chinese article), which involved 3 355 cases in total. The results of the Meta analysis showed a significant association between CYP1A1*2A polymorphism and susceptibility to childhood ALL (allele model:OR=1.31, 95%CI:1.07-1.61;dominant model:OR=1.33, 95%CI:1.13-1.56;codominant model:OR=1.30, 95%CI:1.10-1.54). According to the results of a subgroup analysis based on ethnic origin, an increased risk of childhood ALL was observed in both Asian subgroup (dominant model:OR=1.57, 95%CI:1.19-2.08;codominant model:OR=1.61, 95%CI:1.20-2.17) and the Caucasian subgroup (allele model:OR=1.31, 95%CI:1.04-1.63;dominant model:OR=1.22, 95%CI:1.00-1.49). Conclusions CYP1A1*2A polymorphism may be associated with the genetic susceptibility to childhood ALL.
2015 Vol. 17 (10): 1112-1118 [Abstract] ( 3857 ) [HTML 1KB] [PDF 1957KB] ( 680 )
EXPERIMENTAL RESEARCH
1119 LI Wei, DU Jun-Bao, JIN Hong-Fang
Effects of hydrogen sulfide donor on production of adrenomedullin and atrial natriuretic peptide in rats with atherosclerosis
Objective Endogenous hydrogen sulfide (H2S), a novel gasotransmitter in cardiovascular regulation, plays an important protective role in the development and progression of atherosclerosis (AS). This study was designed to explore the effects of H2S donor on the production of adrenomedullin (ADM) and atrial natriuretic peptide (ANP) in AS rats. Methods Male Sprague-Dawley rats were randomly divided into control group (n=10), AS group (n=10), and AS+NaHS group (n=10). Rats in the AS and AS+NaHS groups were given 3-day intraperitoneal injections of vitamin D3 and 8-week high-fat diet to induce AS, and the rats in the AS+NaHS group were intraperitoneally injected with H2S donor NaHS. Oil red O staining was applied to detect changes in the areas of the atherosclerotic plaques in the aortic root and the coronary artery;sulfide-sensitive electrode method was used to measure the plasma concentration of H2S. ADM and ANP levels in plasma were determined by radioimmunoassay. Results Compared with the control group, marked atherosclerotic plaques were observed in the aortic root and the coronary artery in AS rats. Moreover, plasma H2S level decreased significantly, ADM level increased, and ANP level decreased significantly in AS rats (P<0.01). However, after the treatment with H2S donor NaHS for 8 weeks, the above changes in AS rats were reversed, demonstrated by significantly reduced areas of the atherosclerotic plaques in both the aortic root and the coronary artery, significantly increased plasma H2S level, significantly decreased plasma ADM level, and significantly increased plasma ANP level (P<0.01). Conclusions H2S plays an important regulatory effect on vasoactive peptides ADM and ANP in AS rats.
2015 Vol. 17 (10): 1119-1123 [Abstract] ( 3977 ) [HTML 1KB] [PDF 1926KB] ( 839 )
1124 CHEN Lian-Hui, LIANG Li, ZHU Wei-Fen, WANG Ying-Min, ZHU Jian-Fang
Effects of intrauterine growth restriction and high-fat diet on serum lipid and transcriptional levels of related hepatic genes in rats
Objective To study the effects of intrauterine growth restriction (IUGR) and high-fat diet on the growth, lipid metabolism, and related hepatic genes in rat offspring. Methods The rat model of IUGR was established by food restriction during the entire pregnancy. After weaning, 32 normal rats and 24 offspring rats with IUGR were randomly allocated to standard diet group or high-fat diet group. At the age of 10 weeks, fasting plasma glucose and blood lipid were examined. Additionally, pathological sections for hepatic tissues were observed, and the transcriptional levels of related hepatic genes were measured. Results At the age of 10 weeks, there was a significant difference in body weight between IUGR rats and normal rats on standard diets, but no significant difference in body weight was observed between the two groups on high-fat diets. Compared with the normal rats, IUGR rats showed increased energy intake and increased levels of fasting plasma glucose, total cholesterol, and triglyceride on both standard and highfat diets. High-fat diets reduced the concentration of serum triglyceride in both normal rats and IUGR rats. IUGR and high-fat diets aggravated the fat accumulation in the liver. Two-factor analysis of variance showed that at the age of 10 weeks, the expression of genes related to lipid metabolism in the liver, PGC-1α, CPT-1, SREBF-2, HMGR, LDLR and SREBF-1, differed significantly between IUGR and normal rats. Compared with standard diets, high-fat diets increased the expression of PPARα, SREBF-1, SREBF-2, ABCG5, and CYP7A1 in both normal rats and IUGR rats. IUGR and high-fat diets had an interactive effect on LDLR expression. Conclusions Hyperlipidemia and fat accumulation in the liver observed in IUGR rats may be related to increased appetite and regulation disorder in genes related to fatty acid oxidation at the transcriptional level. High-fat diets may aggravate fat accumulation in the liver in rats, which may be related to increased expression of genes related to regulation of fatty acid synthesis at the transcriptional level and reduction in secretion of triglyceride.
2015 Vol. 17 (10): 1124-1130 [Abstract] ( 3695 ) [HTML 1KB] [PDF 2587KB] ( 768 )
CASE ANALYSIS
1131 LIU Ying-Ting, YANG Ming-Hua, CAO Li-Zhi, HUANG Ye-Hong, XIE Min, YANG Liang-Chun, YANG Hui, TANG Xing
Painless skin nodules and ecchymosis in a school-aged girl
A 7-year-old girl was admitted to Xiangya Hospital due to systemic lymphadenectasis for 2 months and skin ecchymosis for 3 days. Nine months ago, the girl experienced painless nodules in the left lower extremity with no apparent causes. Three months later, dermatorrhagia and ecchymosis occurred in many regions such as the periocular areas, conjunctiva, oral mucosa, perineal area, and groin, with a "raccoon sign" in both eyes;superficial lymphadenectasis and hepatosplenomegaly were also observed in many regions. The pathological sections for the skin nodules showed malignant tumors in lymphohematopoietic cells, and in combination with clinical manifestations, immunohistochemistry, and positive results for CD4, CD56, and CD123 by bone marrow flow cytometry, the girl was diagnosed with blastic plasmacytoid dendritic cell neoplasm. Then high-risk ALL regimen was applied as the chemotherapy for this girl. At present, the girl has been followed up for 3 months;ecchymosis has disappeared, and the enlarged lymph nodes have shrunk. No abnormal cells have been found in bone marrow morphological examination, and bone marrow flow cytometry has shown that primitive precursor cells account for 1.5% and express CD33, CD34, CD123, and CD117.
2015 Vol. 17 (10): 1131-1136 [Abstract] ( 3648 ) [HTML 1KB] [PDF 2152KB] ( 846 )
CLINICAL EXPERIENCE
1137 YANG Hai-Hua, CHEN Yong-Xiong, WEI Hai-Yan
Clinical characteristics and therapy of idiopathic hypoparathyroidism in 30 infants

No abstract available
2015 Vol. 17 (10): 1137-1139 [Abstract] ( 2793 ) [HTML 1KB] [PDF 1213KB] ( 731 )
CASE REPORT
1140 WAN Yuan-Yuan, ZHNG Le-Ping, WU Jun, et al
Neurofibromatosis complicated by acute lymphoblastic leukemia in a boy

No abstract available
2015 Vol. 17 (10): 1140-1141 [Abstract] ( 2874 ) [HTML 1KB] [PDF 1399KB] ( 769 )
REVIEW
1142 TIAN Fang, SHI Wen-Jing
Progress in management of patent ductus arterious in preterm infants with gestational age of <28 weeks
Patent ductus arteriosus (PDA) is a common problem encountered in the early neonatal period, particularly in preterm infants. Optimal management of PDA in preterm infants remains controversial. Despite considerable historical and physiological data indicating a persistent PDA may be harmful, robust evidence of long-term benefits or harms from treatment is lacking. This has been equated to a lack of benefit but is also a reflection of the fact that many clinical trials were designed to assess the effects of short-term (2-8 days) rather than prolonged exposure to a PDA. No clinical trials have been designed to assess the effects of prolonged exposure of persistent PDA on morbidity and mortality of very premature infants. Significant changes in management of PDA, i.e., less treatment for PDA, have evolved in recent years. This paper reviews the current literature and evidence for treatment options and research progress of PDA in infants with gestational age of <28 weeks.
2015 Vol. 17 (10): 1142-1147 [Abstract] ( 4367 ) [HTML 1KB] [PDF 1639KB] ( 1096 )
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