CJCP
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2021 Vol.  23 No.  9
Published: 2021-09-22
STANDARD·PROTOCOL·GUIDELINE
CLINICAL RESEARCH
EXPERIMENTAL RESEARCH
CASE REPORT
REVIEW
STANDARD·PROTOCOL·GUIDELINE
867 Shaanxi Provincial Diagnosis and Treatment Center of Kawasaki Disease
Expert consensus on the use of intravenous immunoglobulin in children with Kawasaki disease Hot!
Kawasaki disease is an acute, self-limited vascuitis that mainly occurs in children under 5 years of age. Intravenous immunoglobulin (IVIG) has become an effective treatment regimen, which can effectively reduce the incidence of cardiovascular complications. However, there has been no consensus or clinical guidelines for the application of IVIG in children with Kawasaki disease till now. This consensus is developed based on the current research progress on the application of IVIG in children with Kawasaki disease in China and overseas, with reference to the diagnosis and treatment guidelines for Kawasaki disease in China and overseas, and the opinions of experts. This consensus provides recommendations on the clinical application strategy of IVIG in children with Kawasaki disease and the prevention and treatment of its adverse reactions. Citation:
2021 Vol. 23 (9): 867-876 [Abstract] ( 2621 ) [HTML 1KB] [PDF 678KB] ( 1007 )
CLINICAL RESEARCH
877 WANG Hui-Min, LIU Chuan-He, LIU Chang-Shan, WANG Ying, HAN Zhi-Ying, SUN Xin, CHEN Xing, AN Shu-Hua, DUOLIKUN Muzhapaer, LU Ai-Ping, WANG Min, CHENG Yan, YIN Xiao-Mei, LIU Han-Min, WANG Hong, HUA Shan, DONG Li, HUANG Ying, JIANG Yi, XIONG Jian-Xin, DING Sheng-Gang, ZHAO Shun-Ying, WANG Jin-Rong, HUANG Gui-Min, MU Jing-Hui, CHEN Yu-Zhi
Efficacy of Huaiqihuang granules as adjuvant therapy for bronchial asthma in children: a real-world study
Objective To study the efficacy of Huaiqihuang granules as adjuvant therapy for bronchial asthma in children. Methods A multicenter, prospective, and registered real-world study was performed for the children, aged 2-5 years, who had a confirmed diagnosis of bronchial asthma in the outpatient service of 21 hospitals in China. Among these children, the children treated with medications for long-term asthma control (inhaled corticosteroid and/or leukotriene receptor antagonist) without Huaiqihuang granules were enrolled as the control treatment group, and those treated with medications for long-term asthma control combined with Huaiqihuang granules were enrolled as the combined treatment group. The medical data of all children were collected. Outpatient or telephone follow-up was performed at weeks 4, 8, 12, 20, 28, and 36 after treatment, including asthma attacks and rhinitis symptoms. A statistical analysis was performed for the changes in these indices. Results There was no significant difference in the frequency of asthma attacks or rhinitis attacks between the two groups before treatment (P>0.05). After treatment, the combined treatment group had significantly lower frequencies of asthma attacks, severe asthma attacks, and rhinitis attacks compared with the control treatment group (P<0.05). There was no signification difference in the incidence rate of adverse reactions between the two groups (P=0.667). Conclusions Huaiqihuang granules in addition to medications for long-term asthma control can alleviate the symptoms of bronchial asthma and rhinitis and improve the level of asthma control in children with bronchial asthma, with good safety and little adverse effect. Citation:
2021 Vol. 23 (9): 877-881 [Abstract] ( 2574 ) [HTML 1KB] [PDF 566KB] ( 792 )
882 HU Yang, WU Liu-Hong, GUAN Hui-Jie, WU Su-Yun, LIU Long-Zhen, CAI Rui-Qing, XU Yan-Jie, ZHANG Yi-Zhuo, SUN Xiao-Fei, ZHU Jia
Quality of life and related demographic factors in long-term survivors of childhood non-Hodgkin's lymphoma
Objective To evaluate the quality of life and related demographic factors in long-term survivors of childhood non-Hodgkin's lymphoma (NHL). Methods A retrospective analysis was performed on the medical and demographic data of the NHL patients who received treatment in the Sun Yat-sen University Cancer Center and achieved long-term survival at follow-up, with an age of <18 years at initial diagnosis and a present age of ≥18 years. A questionnaire survey was performed using 36-Item Short-Form Health Survey (SF-36) and the symptom subscale of the Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30). The health status of long-term survivors of NHL was evaluated by comparing the scores of various dimensions of the SF-36 scale of general adult population in the United States (American norm) and those of the SF-36 scale of general adult population in Hong Kong, China (Hong Kong norm). The correlation between the score of each dimension of the scale and demographic characteristics was evaluated. The symptoms of long-term NHL survivors were evaluated according to the score of QLQ-C30 scale. Results A total of 23 patients with NHL with complete follow-up data were enrolled. The pathological types included diffuse large B-cell lymphoma in 10 patients, Burkitt lymphoma in 4 patients, T-cell lymphoblastoma in 5 patients, B-cell lymphoblastoma in 3 patients, and natural killer/T cell lymphoma in 1 patient. All patients received the chemotherapy regimen containing anthracyclines and alkylating agents. The median present age was 26.2 years (range: 16.9-55.8 years), and the median age at initial diagnosis was 10.4 years (range: 2.4-17.6 years). Among the 23 patients, 6 were married and had children and 2 had chronic diseases. There was no significant difference between the long-term survivors and the US norm in role physical, general health, role-emotional, and mental health (P>0.05), while the long-term survivors had significantly better scores of the other dimensions than the US norm (P<0.05). Similar results were obtained for the comparison between the long-term survivors and the China Hong Kong norm. Age at initial diagnosis was negatively correlated with the scores of social functioning, role physical, and general health in the SF-36 scale (P<0.05), and the present age of patients was positively correlated with the score of physical functioning and was negatively correlated with the score of general health (P<0.05). The urban and rural distribution of patients was related to the general health status (P<0.05). In addition, the long-term survivors of childhood NHL had relatively low scores of the symptom domain of QLQ-C30, and few moderate or severe symptoms were found. Conclusions Long-term survivors of childhood NHL tend to have a good overall health status, with no significant differences compared with the general population. Age at initial diagnosis is the main demographic factor that affects patients' quality of life. Citation:
2021 Vol. 23 (9): 882-888 [Abstract] ( 2104 ) [HTML 1KB] [PDF 558KB] ( 649 )
889 ZHU Yao, GAO Lei, HUANG Zhong-Ling, WU Jia-Yin, NI Yan, WANG Ya-Juan, JI Tong-Zhen, WEI Jin-Zhu, ZHANG Chun-Xiu, BA Rui-Hua, OU Fen-Fen, MA Si-Min, HE Ming-Yuan, LIN Rong, PENG Bin, LIN Xin-Zhu
Current status of group B Streptococcus infection in neonates: a multicenter prospective study
Objective To investigate the incidence of maternal group B Streptococcus (GBS) colonization and neonatal early-onset GBS disease (GBS-EOD), and to study the factors associated with the development of GBS-EOD in the offspring of pregnant women with GBS colonization. Methods A total of 16 384 pregnant women and 16 634 neonates delivered by them were enrolled prospectively who had medical records in Xiamen Maternal and Child Care Hospital, Beijing Obstetrics and Gynecology Hospital of Capital Medical University, and Zhangzhou Zhengxing Hospital from May 1, 2019 to April 30, 2020. Unified GBS screening time, culture method, and indication for intrapartum antibiotic prophylaxis (IAP) were adopted in the three hospitals. The incidence rates of maternal GBS colonization and neonatal GBS-EOD were investigated. A multivariate logistic regression analysis was used to identify the factors associated with the development of GBS-EOD in the offspring of pregnant women with GBS colonization. Results In these three hospitals, the positive rate of GBS culture among the pregnant women in late pregnancy was 11.29% (1 850/16 384), and the incidence rate of neonatal GBS-EOD was 0.96‰ (16/16 634). The admission rate of live infants born to the GBS-positive pregnant women was higher than that of those born to the GBS-negative ones (P<0.05). The live infants born to the GBS-positive pregnant women had a higher incidence rate of GBS-EOD than those born to the GBS-negative ones [6.38‰ (12/1 881) vs 0.27‰ (4/14 725), P<0.05]. The multivariate logistic regression analysis showed that placental swabs positive for GBS and positive GBS in neonatal gastric juice at birth were independent predictive factors for the development of GBS-EOD (P<0.05), while adequate IAP was a protective factor (P<0.05) in the offspring of pregnant women with GBS colonization. Conclusions GBS colonization of pregnant women in late pregnancy has adverse effects on their offspring. It is important to determine prenatal GBS colonization status of pregnant women and administer with adequate IAP based on the indications of IAP to reduce the incidence of neonatal GBS-EOD. Citation:
2021 Vol. 23 (9): 889-895 [Abstract] ( 2084 ) [HTML 1KB] [PDF 645KB] ( 755 )
896 DU Zuo-Ping, XIAO Chuan-Xu, ZENG Yi-Xie, CHEN Kai
Risk factors for treatment failure of heated humidified high-flow nasal cannula as initial respiratory support for preterm infants
Objective To study the risk factors for treatment failure of heated humidified high-flow nasal cannula (HHHFNC) as initial respiratory support for preterm infants. Methods A retrospective analysis was performed on the medical data of the preterm infants who were admitted from January 2018 to April 2021 and received HHHFNC for initial respiratory support after birth. According to whether it was necessary to upgrade to noninvasive continuous positive airway pressure or invasive mechanical ventilation within 72 hours after treatment, they were divided into a failure group and a success group. Univariate and multivariate logistic regression analyses were used to determine the risk factors for failure of HHHFNC as initial respiratory support. Results A total of 166 preterm infants were included, among whom 48 (28.9%) experienced the treatment failure of HHHNFC as initial respiratory support. The univariate analysis showed that compared with the success group with 118 infants, the failure group had significantly lower gestational age and birth weight and a significantly higher proportion of infants with fraction of inspired oxygen >35%, flow rate >6 L/minute, patent ductus arteriosus (PDA), respiratory distress syndrome (RDS), or use of pulmonary surfactant (P<0.05). The multivariate logistic regression analysis showed that gestational age <32 weeks, PDA (>1.5 mm and left atrium/aorta diameter ratio >1.4), fraction of inspired oxygen >35%, flow rate >6 L/minute, and presence of RDS were risk factors for the treatment failure of HHHNFC as initial respiratory support (P<0.05). Conclusions The preterm infants with a gestational age of <32 weeks or the presence of RDS tend to have a high risk of failure of HHHNFC as initial respiratory support. The risk of failure of HHHFNC as initial respiratory support increases in infants with oxygen concentration >35% and/or flow rate >6 L/minute, or the presence of PDA, suggesting an upgrade of respiratory support should be considered. Citation:
2021 Vol. 23 (9): 896-902 [Abstract] ( 1840 ) [HTML 1KB] [PDF 752KB] ( 619 )
903 HE Xiao-Guang, HUANG Tian-Li, XU Feng-Dan, XIE Hao-Qiang, LI Jin-Feng, XIE Cai-Xuan
Clinical features and prognosis of severe meconium aspiration syndrome with acute respiratory distress syndrome
Objective To study the clinical features and prognosis of neonates with severe meconium aspiration syndrome (MAS) and acute respiratory distress syndrome (ARDS). Methods A retrospective analysis was performed on the medical data of 60 neonates with severe MAS who were admitted from January 2017 to December 2019. According to the presence or absence of ARDS, they were divided into two groups: ARDS (n=45) and non-ARDS (n=15). Clinical features and prognosis were compared between the two groups. Results Among the 60 neonates with severe MAS, 45 (75%) developed ARDS. Arterial blood gas analysis showed that the ARDS group had a significantly higher median oxygenation index within 1 hour after birth than the non-ARDS group (4.7 vs 2.1, P<0.05), while there was no significant difference between the two groups in white blood cell count, C-reactive protein (CRP), and interleukin-6 (IL-6) on admission and the peak values of procalcitonin, CRP, and IL-6 during hospitalization (P>0.05). The ARDS group had a significantly higher incidence rate of shock than the non-ARDS group (84% vs 47%, P<0.05). There was no significant difference between the two groups in the incidence rates of persistent pulmonary hypertension, pneumothorax, pulmonary hemorrhage, hypoxic-ischemic encephalopathy, intracranial hemorrhage, and disseminated intravascular coagulation (P>0.05). The ARDS group required a longer median duration of mechanical ventilation than the non-ARDS group (53 hours vs 3 hours, P<0.05). In the ARDS group, 43 neonates (96%) were cured and 2 neonates (4%) died. In the non-ARDS group, all 15 neonates (100%) were cured. Conclusions Neonates with severe MAS and ARDS tend to develop respiratory distress earlier, require a longer duration of mechanical ventilation, and have a higher incidence rate of shock. During the management of children with severe MAS, it is recommended to closely monitor oxygenation index, give timely diagnosis and treatment of ARDS, evaluate tissue perfusion, and actively prevent and treat shock. Citation:
2021 Vol. 23 (9): 903-908 [Abstract] ( 2190 ) [HTML 1KB] [PDF 564KB] ( 823 )
909 BAI Wen-Juan, FANG Xiu-Ying, SHI Quan, TIAN Yi-Li, ZHENG Duo, CHEN Shu-Yuan, WANG Ying-Jie, MAO Jian
Correlation of electroencephalogram background evolution with the degree of brain injury in neonates with hypoxic-ischemic encephalopathy
Objective To study the correlation of electroencephalogram (EEG) background evolution with the degree of brain injury in neonates with hypoxic-ischemic encephalopathy (HIE). Methods A retrospective analysis was performed for 56 neonates with HIE who underwent continuous video electroencephalogram (cVEEG) and brain magnetic resonance imaging (MRI) examinations. According to clinical symptoms, they were divided into a mild group with 3 neonates, a moderate group with 36 neonates, and a severe group with 17 neonates. EEG background grading and MRI score were determined for each group to analyze the correlation of EEG background evolution with the degree of brain injury. Results Compared with the moderate group, the severe group had significantly lower gestational age and Apgar score at 5 minutes after birth, a significantly higher resuscitation score, significantly lower base excess in umbilical cord blood or blood gas within 1 hour, a significantly higher proportion of neonates on mechanical ventilation, and a significantly higher incidence rate of short-term adverse outcomes (P<0.05). For the neonates in the mild and moderate groups, MRI mainly showed no brain injury (67%, 2/3) and watershed injury (67%, 16/24) respectively, and EEG showed mild abnormality in 62% (13/21) of the neonates on the 3rd day after birth. For the neonates in the severe group, MRI mainly showed basal ganglia/thalamus + brainstem injury (24%, 4/17) and whole brain injury (71%, 12/17), and EEG showed moderate or severe abnormalities on the 3rd day after birth. EEG background grading was correlated with clinical grading, MRI score, and short-term outcome on days 1, 2, 3 and 7-14 after birth (P<0.01). The highest correlation coefficient between EEG grading and MRI score was observed on the 3rd day after birth (rs=0.751, P<0.001), and the highest correlation coefficients between EEG grading and clinical grading (rs=0.592, P=0.002) and between EEG grading and short-term outcome (rs=0.737, P<0.001) were observed 7-14 days after birth. Among the neonates with severe abnormal EEG, the neonates without brain electrical activity had the highest MRI score, followed by those with status epileptics and persistent low voltage (P<0.05). Conclusions There is a good correlation between EEG background grading and degree of brain injury in neonates with HIE, which can help to evaluate the degree and prognosis of brain injury in the early stage.
2021 Vol. 23 (9): 909-915 [Abstract] ( 1993 ) [HTML 1KB] [PDF 1688KB] ( 703 )
916 ZHANG Xiao-Li, LIU Yan-Chao, XIA Lei, XU Fa-Lin
Role of Neonatal Behavioral Neurological Assessment combined with magnetic resonance diffusion tensor imaging in evaluating white matter development in preterm infants
Objective To study the correlation of fractional anisotropy (FA) on magnetic resonance diffusion tensor imaging with Neonatal Behavioral Neurological Assessment (NBNA) score in preterm infants, and to study the role of FA in evaluating white matter development from the perspective of imaging. Methods A prospective study was performed for 98 preterm infants who were admitted to the Neonatal Intensive Care Unit of the Third Affiliated Hospital of Zhengzhou University within 24 hours after birth from October 2016 to January 2020. According to the results of NBNA, they were divided into an abnormal group with 51 infants (NBNA score <37) and a normal group with 47 infants (NBNA score ≥37). The FA values of 10 regions of interest were collected and compared between the two groups. The correlations of FA value and umbilical arterial blood gas pH value with the NBNA score were analyzed. Results Compared with the normal group, the abnormal group had significantly lower FA value of the posterior limb of the internal capsule and umbilical arterial blood pH (P<0.05). The FA value of the posterior limb of the internal capsule and umbilical arterial blood pH were positively correlated with the NBNA score (r=0.584 and 0.604 respectively, P<0.001), and the FA value of the posterior limb of the internal capsule was positively correlated with umbilical arterial blood pH (r=0.426, P<0.05). Conclusions The FA value of the posterior limb of the internal capsule can quantitatively reflect white matter development in preterm infants and is correlated with the NBNA score. The combination of the two indices can help to evaluate white matter development in preterm infants more accurately and objectively. Citation:
2021 Vol. 23 (9): 916-921 [Abstract] ( 1827 ) [HTML 1KB] [PDF 630KB] ( 600 )
922 LI Cheng, SUN Rui-Di, FENG Li, JIANG Jun
Risk factors associated with the need for mechanical ventilation in children with Guillain-Barré syndrome
Objective To study the risk factors associated with the need for mechanical ventilation in children with Guillain-Barré syndrome (GBS). Methods The medical data of 107 children with GBS were retrospectively reviewed. According to whether mechanical ventilation was required, the children were divided into a mechanical ventilation group with 16 children and a non-mechanical ventilation group with 91 children. The risk factors associated with the need for mechanical ventilation in children with GBS were identified by a multivariate logistic regression analysis. Results Among the 107 children, 16 (15.0%) required mechanical ventilation. Compared with the non-mechanical ventilation group, the mechanical ventilation group had a significantly higher proportion of children with facial and/or bulbar muscle weakness, a significantly shorter duration from the onset to the peak of the disease, and a significantly higher Hughes Functional Grading Scale score at the first visit (P<0.05). Facial and/or bulbar muscle weakness and short duration from the onset to the peak of the disease were risk factors associated with the need for mechanical ventilation in children with GBS (OR=5.053 and 1.239 respectively, P<0.05). Conclusions Facial and/or bulbar muscle weakness and short duration from the onset to the peak of the disease may increase the risk of mechanical ventilation in children with GBS. Citation:
2021 Vol. 23 (9): 922-926 [Abstract] ( 2000 ) [HTML 1KB] [PDF 491KB] ( 577 )
927 YIN Dong-Hao, GUO Ya-Li, CAO Tong-Tong, PAN Chang-Lu, ZHAO Gao-Jie, HU Yan
Effect of animal protein diet on the prognosis of children with Henoch-Sch?nlein purpura
Objective To study the association of animal protein diet with the recurrence of Henoch-Sch?nlein purpura (HSP)/skin rash and the risk factors for recurrence of HSP. Methods A prospective analysis was performed for 121 children with HSP who were admitted to the Beijing Children's Hospital from October to December 2020. The children were given the doctor's advice of the same diet (animal protein diet could be added after 1 week without new-onset skin rash). Follow-up was performed at the outpatient service for half a year. According to the presence or absence of animal protein intake, the children were divided into an observation group with 65 children and a control group with 56 children. The times of skin rash recurrence, the incidence of HSP recurrence, and the incidence of kidney injury were compared between the two groups. According to the presence or absence of recurrence, the children were divided into a recurrence group with 32 children and a non-recurrence group with 89 children. A questionnaire on food frequency was used to record the daily intake of animal protein in the two groups. A multivariate logistic regression analysis was used to identify the risk factors for recurrence of HSP in children. Results There was no significant difference between the observation and control groups in the times of skin rash recurrence, the incidence rate of HSP recurrence, and the incidence rate of kidney injury (P>0.05). There was no significant difference in the daily intake of animal protein between the recurrence and non-recurrence groups (P>0.05). The multivariate logistic regression analysis showed that presence of kidney injury at initial onset, respiratory infection after cure for the first time, and lack of exercise control after cure for the first time were independent risk factors for the recurrence of HSP in children (P<0.05). Conclusions There is no significant association between animal protein diet and the recurrence of HSP or skin rash. Timely treatment of kidney injury, avoidance of infection after cure, and limitation of strenuous exercise may help to reduce the recurrence rate of HSP in children. Citation:
2021 Vol. 23 (9): 927-932 [Abstract] ( 1917 ) [HTML 1KB] [PDF 544KB] ( 581 )
933 LIU Ai-Liang, ZHENG Yue-Jie, SU Zhe, WEI Ju-Rong, YANG Qin, WANG Cong-Cong, LI Jia-Hui
Clinical features of obstructive sleep apnea in children with obesity
Objective To study the clinical features of obstructive sleep apnea (OSA) in children with obesity. Methods A retrospective analysis was performed on the medical data of 33 obese children aged 7-15 years, who were diagnosed with OSA and received polysomnography (PSG) in the Department of Respiratory Medicine in Shenzhen Children's Hospital. Fifty OSA children with normal body weight, matched for sex and age, were enrolled as the control group. Results Among the 33 obese children with OSA, the three most common daytime symptoms were inattention in 30 children (91%), somnolence in 22 children (67%), and morning fatigue in 21 children (64%), and the three most common nocturnal symptoms were snoring in 27 children (82%), mouth breathing in 20 children (61%), and sweating in 16 children (49%). Compared with the reference values of normal children, both the OSA + obesity group and the control group had prolonged light sleep, shortened deep sleep, and a significantly shortened rapid eye movement (REM) period, while there was no significant difference in these indices between the two groups (P>0.05). The apnea-hypopnea index, obstructive apnea/hypopnea index, and oxygen desaturation index in both REM and non-REM periods in the OSA +obesity group were significantly higher than those in the control group (P<0.05), while the lowest blood oxygen saturation during sleep was significantly lower in the OSA + obesity group (P<0.05). Conclusions The children with obesity and OSA have the main daytime symptoms of inattention, somnolence, and morning fatigue and the main nocturnal symptoms of snoring, mouth breathing, and sweating. There is no significant difference in sleep structure between OSA children with obesity and those with normal body weight; however, respiratory events and blood oxygen saturation decline are more severe in OSA children with obesity. Citation:
2021 Vol. 23 (9): 933-937 [Abstract] ( 2428 ) [HTML 1KB] [PDF 526KB] ( 1028 )
938 CONG En-Zhao, CAI Yi-Yun, WANG Yun, WU Yan
Association of depression and suicidal ideation with parenting style in adolescents
Objective To study the association of depression and suicidal ideation with parenting style in adolescents. Methods The cluster sampling method was used to select 6 195 junior and senior high school students in Xinxiang City of Henan Province, China, from 2014 to 2018. The survey tools included a general social information questionnaire, the Parental Bonding Instrument, and the Kutcher Adolescent Depression Scale (11 items). A multivariate logistic regression analysis was used to identify the association of depression and suicidal ideation with parenting style in adolescents. Results There were 6 194 valid questionnaires in total, including 2 586 boys (41.75%) and 3 608 girls (58.25%), with a mean age of (16.4±1.9) years (range: 11-20 years). Among these 6 194 students, 1 333 (21.52%) had depression, and 508 (8.20%) had suicidal ideation. Depression in adolescents was positively correlated with maternal control (OR=1.059, P<0.001) and paternal control (OR=1.061, P<0.001), but negatively correlated with maternal care (OR=0.937, P<0.001) and paternal care (OR=0.917, P<0.001). Suicide ideation in adolescents was positively correlated with maternal control (OR=1.110, P<0.001) and paternal control (OR=1.076, P<0.001), but negatively correlated with maternal care (OR=0.895, P<0.001) and paternal care (OR=0.914, P<0.001). Conclusions Parental care may decrease the risk of depression and suicide ideation, while parental control may increase the risk of depression and suicide ideation in adolescents. Citation:
2021 Vol. 23 (9): 938-943 [Abstract] ( 4089 ) [HTML 1KB] [PDF 545KB] ( 1533 )
944 XU Jin-Yun, WANG Yong, WU Yong, GU Jiao-Wei
Safety and efficacy of eltrombopag in the treatment of children with immune thrombocytopenia: a Meta analysis
Objective To systematically assess the efficacy and safety of eltrombopag in the treatment of children with immune thrombocytopenia (ITP). Methods PubMed, Embase, Cochrane Library, Weipu Data, CNKI, and Wanfang Data were searched for studies on eltrombopag used for the treatment of children with ITP. RevMan 5.3 and R version 3.6 were used to perform a Meta analysis of included studies. Results A total of 11 studies were included, with 2 randomized controlled trials and 9 cohort studies. The Meta analysis of the 9 cohort studies showed that eltrombopag had a response rate of about 70% (95%CI: 65%-76%) in the treatment of children with ITP, with no serious adverse events. The Meta analysis of the randomized controlled trials showed that the eltrombopag group had a higher response rate than the placebo group (RR=2.64, 95%CI: 1.58-4.44, P<0.05), while there was no significant difference in the incidence rates of adverse events and serious adverse events between the two groups (P>0.05). Conclusions Eltrombopag has good efficacy and safety as a second-line treatment regimen for children with ITP.
2021 Vol. 23 (9): 944-950 [Abstract] ( 2101 ) [HTML 1KB] [PDF 857KB] ( 755 )
EXPERIMENTAL RESEARCH
951 TAN Jun-Jie, YU Sheng-You, ZHANG Yao, HAO Zhi-Hong, YU Li
Effect of tacrolimus on the expression of Park7 in glomerular podocytes injured by puromycin aminonucleoside
Objective To study the effect of puromycin aminonucleoside (PAN) on the apoptosis of mouse podocyte clone 5 (MPC-5) and the expression of recombinant human Parkinson's disease 7 (Park7) and to study the protective mechanism of tacrolimus (FK506) against MPC-5 injury. Methods MPC-5 cells were cultured in vitro and then divided into three groups: blank control (control), PAN, and FK506. The cells in the PAN group were added with PAN (with a concentration of 50 mg/L) to establish a model of MPC-5 injury, and those in the FK506 group were added with PAN (with a concentration of 50 mg/L) and FK506 (with a concentration of 5 mg/L). An inverted microscope was used to observe the morphology and structure of MPC-5 cells at 12, 24, and 48 hours after treatment. Flow cytometry was used to measure cell apoptosis rate. Quantitative real-time PCR was used to measure the mRNA expression of Park7. Western blot and immunofluorescent staining were used to measure the protein expression of Park7. Results The control group had a large number of foot processes of the cell body at all time points, with tight connections between cells and a normal morphology. Compared with the control group, the PAN group had a significantly smaller cell volume at all time points, with loose connections between cells and the presence of ruptured cells. Compared with the PAN group, the FK506 group had an increased cell volume at all time points, with tighter connections between cells and a better morphology. The PAN group had a significantly higher apoptosis rate than the control group at all time points. Compared with the PAN group, the FK506 group had a significant reduction in the apoptosis rate at all time points (P<0.01). The PAN group had a significantly higher mRNA expression level of Park7 than the control group at all time points. Compared with the PAN group, the FK506 group had a significant reduction in the mRNA expression level of Park7 at all time points (P<0.01). Western blot showed that the PAN group had a significantly higher protein expression level of Park7 than the control group at all time points. Compared with the PAN group, the FK506 group had a significant reduction in the protein expression level of Park7 at all time points (P<0.01). Immunofluorescent staining showed that in the PAN group, there was a significantly lower expression of Park7 protein in cell membrane and cytoplasm, with a dense cluster distribution and increased fluorescence intensity. Compared with the PAN group, the FK506 group had a significant improvement in the distribution of Park7 protein. Conclusions PAN can act on MPC-5 cells and cause morphological and structural damage and apoptosis of MPC-5 cells, as well as upregulated mRNA and protein expression of Park7. FK506 can downregulate the mRNA and protein expression of Park7 in the model of MPC-5 injury, maintain cellular homeostasis, reduce proteinuria, and delay glomerulosclerosis.
2021 Vol. 23 (9): 951-958 [Abstract] ( 1731 ) [HTML 1KB] [PDF 989KB] ( 627 )
959 HUI Chao, LIU Xin
Regulatory effect of NLRP3 on airway inflammatory response and pyroptosis in mice with asthma
Objective To study the regulatory effect of the NOD-like receptor, pyrin domain-containing 3 (NLRP3) on airway inflammatory response and pyroptosis in mice with asthma. Methods The NLRP3 wild-type (WT) C57BL/6J mice were divided into two groups: NLRP3-WT control and NLRP3-WT asthma. The mice with NLRP3 knockout (KO) were divided into two groups: NLRP3-KO control and NLRP3-KO asthma (n=10 each). A model of asthma was prepared by intraperitoneal injection of ovalbumin + aluminium hydroxide for sensitization and ovalbumin inhalation for challenge. Enhanced pause, an index for airway responsiveness, was measured for each group. Hematoxylin and eosin staining was used to observe the histomorphological changes of lungs and determine the inflammation score for each group. Bronchoalveolar lavage fluid was collected from each group to determine the numbers of neutrophils, eosinophils, and lymphocytes and measure the content of interleukin-1β (IL-1β) and interleukin-18 (IL-18). Western blot was used to measure the expression of NLRP3, cleaved caspase-1, and Gasdermin D-N in lung tissue of each group. Results Compared with the NLRP3-WT control group, the NLRP3-WT asthma group showed morphological changes including airway smooth muscle thickening and inflammatory cell infiltration. Compared with the NLRP3-WT asthma group, the NLRP3-KO asthma group had significant improvements in the above morphological manifestations. Compared with the NLRP3-WT control group, the NLRP3-WT asthma group had significant increases in the enhanced pause, the inflammation score of lung tissue, the numbers of neutrophils, eosinophils and lymphocytes in bronchoalveolar lavage fluid, and the levels of IL-1β and IL-18 in bronchoalveolar lavage fluid (P<0.05). The expression of NLRP3, cleaved caspase-1, and Gasdermin D-N in lung tissue also significantly increased in the NLRP3-WT asthma group (P<0.05). The above indices in the NLRP3-KO asthma group were significantly lower than those in the NLRP3-WT asthma group (P<0.05). Conclusions The overexpression of NLRP3 is associated with the pathogenesis of asthma, which may be related to the molecular mechanisms of the activation of airway inflammatory response and pyroptosis. Citation:
2021 Vol. 23 (9): 959-964 [Abstract] ( 2567 ) [HTML 1KB] [PDF 769KB] ( 958 )
CASE REPORT
965 FAN Xi-Yong
Snijders Blok-Campeau syndrome caused by CHD3 gene mutation: a case report
A one-year and two-month old girl indicated large head circumference, widely spaced eyes, narrow palpebral fissures, strabismus on the right eye, broad and low nasal bridge and low-set ears. She had knee over extension and foot eversion on both sides while standing with help. She also had hypotonia and was not able to stand or walk independently. She can say "ma ma" unconsciously. In the neuropsychological developmental assessment, delayed development was shown on gross motor function, fine movement, adaptive capacity, speech and social behavior function. A de novo heterozygous mutation, c.3872G>A(p.G1291D), likely pathogenic, was detected in the CHD3 gene via the next generation sequencing. Snijders Blok-Campeau syndrome was confirmed. It is an extremely rare disease with only 60 cases reported globally. This case expands the CHD3 gene mutation sites and suggests that rare diseases need to be considered and genetic tests should be performed in children with intellectual developmental delay and abnormal facial features, so as to help early diagnosis. Citation:
2021 Vol. 23 (9): 965-968 [Abstract] ( 2689 ) [HTML 1KB] [PDF 758KB] ( 923 )
REVIEW
969 SHAO Shu-Ming, TIAN Hong-Rong
Neurodevelopmental outcomes of infants of diabetic mothers
With the increase of the incidence of pre-pregnancy diabetes mellitus and gestational diabetes mellitus, the number of infants of diabetic mothers (IDMs) are increasing year by year. IDMs may be associated with poor perinatal outcomes and may have a negative impact on neurodevelopment, but there are relatively few studies on the neurodevelopmental outcomes of IDMs. This article reviews the relevant literature and summarizes the neurodevelopmental outcomes of IDMs from the aspects of sensory and perception, motor, language, intellectual development, neuropsychiatric disorders, neurological examination and drug effect, so as to provide reference for clinical work. Citation:
2021 Vol. 23 (9): 969-974 [Abstract] ( 2276 ) [HTML 1KB] [PDF 496KB] ( 834 )
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