Table of Content

15 July 2014 Volume 32 Issue 7

  

An analyze of medium and long term follow-up of arrhythmias after transcatheter closure of ventricular septal defect in children

ZHENG Hongyan, ZHANG Zhiwei, LI Yufen, LI Jianglin, QIAN Mingyang, WANG Shushui, XIE Yumei, LI Junjie

. 2014, 32(7):  601.  doi:10.3969 j.issn.1000-3606.2014.07.001

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　Objective　To observe and analyze the medium and long term follow-up data of arrhythmias after transcatheter closure of children with ventricular septal defect (VSD). Methods Retrospectively analyzed the clinical data of 1071 children with VSD, who successfully underwent transcatheter device closure, at l, 3, 6, 12 months and every year post procedure from March 2002 to December 2010. Results Of all 1071 children, 272 cases (25.4%) were observed of having arrhythmias within 1 month after intervention, mainly including atrioventricular block (AVB), branch block, junctional tachycardia, atrial and ventricular tachycardia, frequent contractions, etc. Among them, 22 cases (2.1%) had above II degree AVB, complete left bundle branch block (CLBBB) and other causes of serious arrhythmias. After treatment, all cases got better and no permanent pacemaker was necessary. After 1 to 107 months (2.8±1.7 years) follow-up, 161 cases (18.2%) were observed of having persistent abnormal ECG mainly caused by AVB and branch block, including 10 cases (1.1%) with serious arrhythmias. In 4 cases with late-onset AVB, 3 cases had already appeared AVB in early postoperative, 1 case had recurrence CLBBB, left ventricle enlarge, and died of heart failure during follow up. Four cases were implanted permanent pacemaker. Conclusion During follow-up, serious arrhythmias after VSD closure, such as AVB or CLBBB, have high risk of recurring. Conduction block arrhythmias may reappear or worsen, while arrhythmias like tachycardia and premature heart rhythm mostly return to normal.

The relationship of serum miR-30a and heart failure in children with congenital heart disease

XIA Xi

. 2014, 32(7):  607.  doi:10.3969 j.issn.1000-3606.2014.07.002

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Objectives To explore the relationship of serum miR-30a and cardiac function in children with congenital heart disease (CHD), and the diagnostic value of serum miR-30a to heart failure. Methods From January 2013 to June 2013, 65 children with CHD were enrolled, and divided into the HF group (patients with heart failure, n=40) and the Non-HF group (patients without heart failure, n=25) according to modified Ross score. The serum miR-30a expression level was quantified by real-time PCR. Left ventricular ejection fraction (LVEF) was tested by echocardiography. The correlation between miR-30a and modified Ross score and LVEF were evaluated with Spearman's analysis. The area under the receiver-operating characteristic (ROC) curve for miR-30a was examined. Results The expression level of miR-30a in HF group was higher than that in Non-HF group, the LVEF was lower in HF group than that in Non-HF group (all P<0.001). The serum miR-30a level was positively correlated with modified Ross score (r=0.63, P<0.01) and negatively correlated with LVEF (r=-0.32, P<0.01). According to ROC analysis, the AUC of miR-30a for detection of HF was 0.7440. Conclusion The expression level of serum miR-30a was closely correlated with the cardiac function, which can be as a biomarker for indicating the heart failure in CHD.

Correlation between the changes in structure and function of cardiovascular and bone age index in children with left to right shunt congenital heart disease

LANG Yuanyuan, LIU Yang

. 2014, 32(7):  610.  doi:10.3969 j.issn.1000-3606.2014.07.003

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Objective　To investigate the changes in bone age, and the correlation between the changes in structure and function of cardiovascular and bone age index in children with left to right shunt congenital heart disease (CHD) such as atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA). Methods One hundred and thirty children diagnosed CHD had been enrolled, including 52 cases of ASD, 46 cases of VSD and 32 cases of PDA. The cardiac structure and function indicators had been detected by ultrasonic. The anteroposterior film of left hand and wrist had been taken. The bone age had been assessed according to “China children bone age score” atlas, and the bone age index (BAI) had been calculated. The differences of bone age among each group had been compared. The linear correlation of the cardiac structure and function indicators with BAI had been analyzed. Results The BAI was statistically different among ASD, VSD and PDA groups (P<0.05). The BAI of PDA group was higher than those of ASD and VSD groups (all P<0.05). The BAI was also statistically different among the groups with different pulmonary artery pressures (P=0.000). The BAI was higher in small defect size group than that in large defect size group (P=0.002). The defect size was negatively correlated with BAI in both ASD and VSD groups (r=-0.48, -0.54, all P<0.05), The pulmonary artery systolic pressure and pulmonary-to-systemic blood flow ratio (QP/QS) were negatively correlated with BAI in ASD, VSD and PDA groups (r=-0.64--0.38,all P<0.05). Conclusion The bone age and BAI of children with left to right shunt CHD are significantly lower than those of healthy children of the same age . The extent of bone age delay is related with PASP, defect size and shunt volume in children with left to right shunt CHD.

One case report of successfully occluded aortopulmonary septal defect in young infant

YI Rongsong, ZENG Hongjun,LEI Xianqiang

. 2014, 32(7):  614.  doi:10.3969 j.issn.1000-3606.2014.07.004

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Objective　To explore the method and efficacy of intervention aortopulmonary septal defect (APSD) in young infant. Methods A four month old APSD infant had undergone interventional treatment using homemade ventricular septal defect occluder, and was followed up to observe the curative effect. Results The APSD had been successfully closured, and the clinical symptoms improved instantly. The follow-up showed heart function improved, heart shadow reduced, and growth well. Conclusions APSD interventional therapy is a safe, effective treatment in young infant.

Study on the risk factors for coronary artery lesions in children with Kawasaki disease in Lanzhou

ZHU Lin, NIU Shaomin, DONG Xiangyu, YANG Yinan, NI Qian

. 2014, 32(7):  616.  doi:10.3969 j.issn.1000-3606.2014.07.005

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Objective To investigate the risk factors for coronary artery lesions (CALs) in children with Kawasaki disease (KD) in Lanzhou. Methods One hundred and seventy-four children with diagnosed KD were divided into CAL group and non-CAL group based on the existence of concurrent CALs. The age, gender, fever duration, intravenous immunoglobulin (IVIG) start time, IVIG dose, C-reactive protein (CRP), serum albumin, erythrocyte sedimentation rate (ESR), platelet (PLT), red blood cell count (RBC), hemoglobin and so on were compared. Results Among the 174 children, 46 children (26.44%) were complicated by CALs and 128 children were not. The differences of average fever duration, IVIG starting time, IVIG dose, PLT, CRP, ESR and RBC were statistically significant (P<0.05). Conclusions When KD children has the fever durations >10 d, start of IVIG after 10 days of fever, increase of PLT, CRP and ESR and decrease of RBC, clinicians should be alert to the risk of concurrent CAL.

Anthropometric indicators correlated with blood pressure in children

ZHANG Yaodong, TAN Lina, LUO Shuying, CHEN Yongxing, WEI Haiyan

. 2014, 32(7):  620.  doi:10.3969 j.issn.1000-3606.2014.07.006

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Objective To investigate the correlation of anthropometric indicators and blood pressure in children. Methods A total of 6 790 children aged 6 to 13 years were inspected by random sampling. The body mass index (BMI), waist circumference (WC), hip circumference (HC), and blood pressure were measured. The waist/hip ratio (WHR) and waist/height ratio (WHtR) were calculated. The data wrer analyzed by SPSS16.0 statistical software. Results The detection rate of hypertension in children was 5.57%. After controlling for age, both in male and female children, the BMI, WC, HC, WHR, WHtR and systolic blood pressure showed a significant positive correlation by partial correlation analysis (all P<0.05). Both in male and female children, the BMI, WC, HC, WHR, and WHtR were significantly higher in children with hypertension than those in children with normal blood pressure (all P<0.05). Among all subjects, 280 children (4.12%) were obese, 622 children (9.16%) were overweight. The detection rates of hypertension were significantly different among obese, overweight and normal weight children (P<0.01). The detection rate of hypertension was significantly higher in obese children than that in overweight and normal weight children. The systolic and diastolic blood pressure were all significantly higher in obese and overweight children than that in normal weight children (P<0.05). Conclusion The hypertension prevalence of children aged 6 to 13 years in Zhengzhou is in the low to median level in the same age groups. The BMI, WC, HC, WHR, WHtR are significantly correlated with blood pressure in both gender, and the correlation is the most obvious in HC.

The value of multislice computed tomography in diagnosis of vascular rings associated with airway abnormalities in children

　LI Xu, YU Yongqiang, QIAN Yinfeng, HU Kefei, ZHU Ming, ZHONG Yumin

. 2014, 32(7):  625.  doi:10.3969 j.issn.1000-3606.2014.07.007

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Objective　To explore the value of multislice computed tomography (MSCT) in diagnosis of vascular rings associated airway abnormalities in children. Methods CT image data were retrospective analysis in 159 cases of vascular rings, including multiplanar reconstruction (MPR), maximum and minimum density project reconstructions. The relationship between the vascular rings and airway had been observed. Results Of 159 cases of vascular rings associated with airway stenosis in 101 cases, the main airway stenosis in 79 cases, left main bronchial stenosis in 14 cases, right main bronchus in 8 cases, tracheal bridge in 14 cases, tracheal bronchial in 11 cases, symmetry bronchial in 2 cases. Conclusions Vascular ring often causes compression of airway narrow and dysplasia. MSCT can clearly display vascular rings and its relationship with airway, providing help for surgical and reasonable treatment.

A ten-consecutive-years study of pathogenic bacteria distribution and drug resistance in children with sepsis

XIAO Shufang, WU Qian, LI Bin, LI Yangfang, HUANG Hailin, NI Linxian

. 2014, 32(7):  629.  doi:10.3969 j.issn.1000-3606.2014.07.008

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Objective To determine the pathogenic bacteria distribution and drug resistance in children with sepsis. Methods From 2002 to 2011, a ten consecutive years of monitoring of pathogenic bacteria distribution, drug resistance in pediatric patients with sepsis were conducted. Results From 2002 to 2011, 2 493 strains of pathogenic bacteria were detected in 68 419 specimens of blood culture. The positive rate was 3.64%. Among them, 1 913 strains (76.73%) were the gram-positive bacteria (G+ bacteria), 562 strains (22.54%) were gram- negative bacteria (G- bacteria) and 18 strains (0.72%) were fungi. From 2002 to 2006, 959 strains (4.73%) of pathogenic bacteria were detected in 20 287 specimens of blood culture. Among them, the G+ bacteria was 731 strains (76.23%), G- bacteria was 228 strains (23.77%). From 2007 to 2011, 1 534 strains (4.73%) of pathogenic bacteria were detected in 48 132 specimens of blood culture, G+ bacteria was 1 182 strains (77.05%), G- bacteria was 334 strains (21.77%), fungi was 18 strains (1.17%). The positive rate of blood culture, the pathogenic bacteria distributions of G+, G-, and fungi were significantly different between the first and the second 5 years (P<0.01). The positive rate of G+ bacteria tended to increase and the positive rate of G- bacteria tended to decrease. Comparing between the first and second 5 years, the positive rate of coagulase-negative staphylococci, Klebsiella, Alcaligenes, fungi tended to increas, and the positive rate of Staphylococcus aureus, Enterococcus, Pseudomonas, Salmonella tended to decrease. The distribution of pathogens in different age groups of children with sepsis also were significantly difference (P<0.001). Over the 10 years, G+ positive bacteria were highly resistant to penicillin and erythromycin, but not resistant to Vancomycin. ESBLs positive E. coli strains and Klebsiella Trevisan became highly resistant to antibiotics. Salmonella was sensitive to commonly used antibiotics. Conclusions Coagulase negative staphylococcus was the most common pathogenic bacteria in children with sepsis in the last 10 years, multiple pathogenic bacteria also show a growing trend in drug resistance.

Retrospective analysis the long-term retention rate of levetiracetam mono or combination therapy of infant epilepsy

FENG Xuefei, CHEN Yuxia, LIU Ling, XIANG Shang, XIAO Nong

. 2014, 32(7):  633.  doi:10.3969 j.issn.1000-3606.2014.07.009

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Objective To analysis the long-term retention rate of Levetiraceram (LEV) monotherapy or combination therapy of infant epilepsy. Methods The clinical data of patients with infant epilepsy treated by LEV had been retrospectively analyzed from July 2006 to June 2007. Results Sixty patients with infant epilepsy treated by LEV had been recruited, 20 cases with partial seizures, 19 cases with generalized seizures, 21 cases with epilepsy syndrome. Among them 21 cases was intractable epilepsy. The retention rates of LEV in 6-month, 1-year, 2-year, 3-year and 4-year were 95.5%, 75.0%, 60.0%, 51.7%, and 38.3%. The most common reason for withdrawal was lack of effect (43.2%). COX regression model suggested that duration > 1 month (RR=2.91, 95% CI: 1.16~7.30) and refractory epilepsy (RR=2.30, 95% CI: 1.22~4.32) were risk factors of withdrawal (all P<0.05). After treatment, the seizure frequency significantly reduced compared with baseline (P<0.01). To the end of the follow-up, the efficiency was 100% and the complete remission rate was 69.57% in 23 cases continued treatment. The main side effect were fatigue (56.0%), and sleep increased, irritability, and so on. Conclusions LEV monotherapy or combination therapy has well long-term retention rate, maintains well efficacy and tolerability in infant epilepsy.

The neuron-specific enolase levels of the cerebrospinal fluid in children with convulsion

LI Xiaohua, WANG Jichun, CHAOLUMEN Qiqige, YANG Guanglu, REN Shaomin, FU Liang

. 2014, 32(7):  637.  doi:10.3969 j.issn.1000-3606.2014.07.010

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Objective To explore the levels of neuron-specific enolase (NSE) of the cerebrospinal fluid (CSF) in children with convulsion. Methods Ninety children with convulsion were enrolled. According to the frequency of convulsion attack, the children were divided into brief convulsion group 51 cases and prolonged convulsion group 39 cases, further, based on the etiology, the children were divided into viral encephalitis (VE) group, idiopathic epilepsy (EP) group, and febrile convulsion (FS) group. CSF was collected within 24-48 h convulsion attack. Twenty-three children with elective surgery were selected as a control group. CSF was collected before surgery. The NSE level of CSF were measured by ELISA method and compared among groups. Results The NSE levels of CSF in prolonged convulsion group and brief convulsion group were significantly higher than that in control group, while the NES levels of CSF in prolonged convulsion group were significantly higher than that in brief convulsion group (all P<0.05). Among the prolong convulsion group or the brief convulsion group, the VE group had the highest NSE level of CSF, which was significantly higher than EP group and FS group (all P<0.01), and the difference between EP group and FS group was not statistically significant (P>0.05). Conclusions Convulsion contributed to higher NSE levers of CSF, especially in children with prolonged convulsion attack or with VE. The NSE level of CSF can be regarded as an early objective indicator of brain damage after convulsions.

The clinical analysis of abnormal blood glucose level in term infants with asphyxia

ZHANG Lingjun, LI Weiguo，SHENG Qiuming, DAI Jinsheng，CHU Chenjuan

. 2014, 32(7):  640.  doi:10.3969 j.issn.1000-3606.2014.07.011

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Objective To investigate the clinical significance of monitoring blood glucose in term infants with asphyxia. Methods The blood glucouse within 24 hours of admission and prognosis were retrospectively analyzed in full-term neonates with asphyxia admitted from January, 2011 to December, 2012. Results　Among 256 term infants with asphyxia, 95 cases (37.11%) had abnormal blood glucose, 63 cases (24.61%) were hypoglycemia and 32 (12.50%) were hyperglycemia. The incidence of mild asphyxia and severe asphyxia, the number of damaged organ were significantly different among infants with hypoglycemia, normal blood glucose, and hyperglycemia (all P<0.001). Among 256 term infants, 206 cases were mild asphyxia, 50 cases were serve asphyxia. The incidence of abnormal blood glucose and hyperglycemia were significantly higher in infants with serve asphyxia than those in infants with mild asphyxia (P<0.01). Among 256 term infants, 227 cases (88.67%) had organ damaged. 96 cases involved one organ, 72 cases involved two organs, and 59 cases involved three or more organs. The incidence of abnormal blood glucose, hypoglycemia, hyperglucemia were significantly different among infants invoved one, two or threr and more organs. The incidence of hyperglycemia was the highest in infants with three or more organ damaged, and the incidence of hypoglycemia was the highest in infants with two organ damaged. Conclusions The term infants with severe asphyxia and more organ damaged were prone to with abnormal blood glucose.

The high risk factors and clinical analysis of respiratory distress syndrome in neonates at different gestational age

DAI Miaoying, LI Shaobing, HU Jinhui, CHA Li, WU Rong

. 2014, 32(7):  644.  doi:10.3969 j.issn.1000-3606.2014.07.012

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Objective To compare the high risk factors, complications, treatment and prognosis of respiratory distress syndrome (NRDS) in neonates at different gestational age (GA). Methods Between August 2012 and July 2013, 156 neonates with RDS were selected and distributed into 3 groups, 42 early preterm (GA<34weeks), 52 late preterm (GA 35 to 36 weeks), and 62 in term group (GA ≥ 37 weeks). Retrospectively analysis was performed for high risk factors, complications, treatment and prognosis of the three groups. Results In 156 neonates with RDS, the male and female proportion was 2.25: 1. All groups had more males, but the gender difference has no statistical significance in three groups (P=0.923). The onset time of RDS and the hospitalization time both show an increasing trend of statistical significance (P<0.05). Comparing the difference of high risk factors for RDS of the 3 groups, birth asphyxia, placental abnormalities, multiple pregnancy, premature rupture of membranes was most common in early preterm group, and followed by late preterm group, and C-section was most common in term group and unexplained preterm was more common in early preterm group than that in late preterm group (all P<0.05). Among the three groups, the ratio of pulmonary surfactant application was the lowest in the term group, the ratio of X-ray grade over II was highest in early preterm group, oxygen and hospitalization time were the longest in early preterm group (P<0.05). The risks of complicated with pulmonary infection, intracranial hemorrhages and bronchopulmonary dysplasia were the highest in early preterm group and the risk of complicated pneumothorax was the highest in term group. Among three groups, the recovery rate was the lowest in the early preterm group (P<0.01). Conclusion The clinical characteristics, high risk factors, complications and treatment responses of RDS in neonates with different GA were different, so GA should be considered for diagnose and treatment. For the term infants, the elective caesarean section should be strictly controlled, in order to reduce the incidence of RDS.

The pilot study of combined detection of thyroid stimulating hormone and free thyroxine in screening for congenital hypothyroidism in neonates

YAO Yingzi, JIANG Ling, ZHANG Cuimei, HUANG Xiang, LIANG Rui, HIANG Lianhong, WAN Z hidan, YAN Xueqin

. 2014, 32(7):  649.  doi:10.3969 j.issn.1000-3606.2014.07.013

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Objective To explore the clinical significance of combined detection of thyroid stimulating hormone (TSH) and free thyroxin (FT4) in dried blood spots in screening for congenital hypothyroidism (CH) in neonates. Methods The TSH and FT4 levels in dried blood spot were measured by time-resolved fluorescence immunity in live born neonates from June to December 2013. If the screening was positive, the blood was drawn and the serum TSH and FT4 were measured and compared with the results from dried blood spots. Results In a total of 31 199 neonates screened, 12 cases were diagnosed with CH and the prevalence rate of CH was 1/2 600; 4 cases were hyperthyropinemia and no pituitary CH was detected. There was no significant difference between TSH or FT4 levels in dried blood spot and those in serum in neonates diagnosed with CH (P>0.05). Conclusions Combined detection of TSH and FT4 in dried blood spot can be used for neonatal screening of CH. It can be applied for early distinguishing CH from hyperthyropinemia, and also helpful for early diagnosis and treatment of central CH.

Clinical analysis of incipient neonatal hyperbilirubinemia at Nanjing areas

YANG Yang, LIU Yun, KAN Qing, QIU Jie, WU Yue, ZHOU Xiaoguang, LI Yong

. 2014, 32(7):  653.  doi:10.3969 j.issn.1000-3606.2014.07.014

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Objective To investigate the epidemiological characteristics of incipient neonatal hyperbilirubinemia. Methods The clinical data of admitted neonates with hyperbilirubinemia were retrospectively analyzed from June 2012 to May 2013. Results Two hundred and eight-four neonates with hyperbilirubinemia were enrolled and the ratio of male:female was 1.51:1. For the causes of hyperbilirubinemia, the incidences of ABO hemolytic and sepsis were higher in term infants than those in preterm infants, and the incidences of pneumonia, necrotizing enterocolitis and intracranial hemorrhage were higher in preterm infants than those in term infants (P<0.05). Compared with the preterm infants, the term infants had jaundice appearance and peak at earlier time, shorter duration of jaundice, faster decline rate of jaundice, higher levels of albumin and indirect bilirubin at the peak of jaundice (P<0.01). In the term infants, the time of jaundice appearance and peak were earlier in hemolytic group than those in non-hemolytic group (P<0.05). In preterm infants, the peak of transcutaneous bilirubin was higher in hemolytic group than that in non-hemolytic group (P<0.05). Six cases with bilirubin encephalopathy had abnormalities cranial MRI imaging, and the MRI was not entirely consistent with the peak level of bilirubin. Conclusions There are clinical differences between hemolytic and non-hemolytic hyperbilirubinemia in both term and preterm infants.

One case report of group B streptococcus infection caused neonatal purulent meningitis and subdural effusion

CHEN Jie, LI Qin

. 2014, 32(7):  658.  doi:10.3969 j.issn.1000-3606.2014.07.015

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Objective To discuss the early recognition and treatment of group B streptococcus (GBS) infection caused neonatal meningitis and subdural effusion. Method The onset, clinical manifestations, diagnosis and treatment process were retrospectively analyzed in one case of typical GBS infection caused neonatal meningitis and subdural effusion. Results The subject was late-onset GBS infection, with insidious onset, rapid progress, slow clinical recovery, and highly sensitive to vancomycin. During the treatment, the subject had relapses. The subdural effusion had been found. After extension of vancomycin treatment, the subject recovered. Conclusions The late onset GBS infection should be taken seriously in clinical, pay attention to the complications such as purulent meningitis, subdural effusion, hydrocephalus, and be early treated with adequate and effective antibiotics.

The changes of serum procalcitonin, interleukin-6 and C reactive protein in children with Henoch-Schönlein purpura combined with surgical complications

LI Binde, YAN Lubin, DA Yichen, SHEN Yang, LI Gang, LI Laiyuan

. 2014, 32(7):  660.  doi:10.3969 j.issn.1000-3606.2014.07.016

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Objective To investigate the changes of serum procalcitonin (PCT), interleukin-6 (IL-6) and C reactive protein (CRP) in children with Henoch-Schönlein purpura (HSP) combined with surgical complications. Methods From January 2010 to June 2013, 48 children with HSP combined surgical complications were enrolled, the fasting venous blood were obtained in day 1, 3, 5 of admission and before discharge. Meanwhile, 30 healthy children were selected as control. Results Compared with the control group, the levels of serum PCT and IL-6 in day 1, 3, 5 of admission, and the levels of serum CRP in day 1, 3 of admission were higher in children with HSP combined with surgical complications (all P<0.01). The differences of levels of serum PCT, CRP and IL-6 in day 1, 3, 5 of admission and before discharge were statistically significant between surgical group and non-surgical group. All these indicators showed a gradual downward trend. Compared with surgical group, the levels of serum PCT and IL-6 in day 3, 5 of admission and serum CRP in day 5 of admission were significantly lower in nonsurgical group (P<0.05). There were positive linear correlations between the level of serum PCT and IL-6, and between the level of PCT and CRP (r=0.48, 0.62, P<0.01). Conclusions The changes of serum PCT, IL-6 and CRP may be associated with the occurrence of surgical complications in children with HSP, monitor these indicators may help to assess the condition and to guide the treatment.

Clinical analysis of death cases in pediatric intensive care unit

ZHANG Hui, WANG Ying, LI Biru, QIAN Juan, HU Xiaowei, REN Hong, ZHANG Jian

. 2014, 32(7):  664.  doi:10.3969 j.issn.1000-3606.2014.07.017

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Objectives To analysis the main characteristics and changes of the internal death in pediatric intensive care unit (PICU) in the past five years. Methods The clinical data of 330 death cases in PICU internal medicine were retrospectively analyzed from January 2008 to December 2012. Results The mortality rate in PICU dropped from 5.85% to 3.96% from 2008 to 2012. Among 330 death cases, 136 cases (41.2%) were infants, 73 cases (22.1%) were toddlers, 51 cases (15.45%) were preschoolers, and 70 cases (21.21%) were school-age and adolescence. In different years, the differences of distribution of death in different age groups were statistical significance (χ2=6.90, P=0.009). In all years, the infant had the highest death rate. As the time progresses, the death rate of the infant and young children decreases, while the death rate of the school-age and adolescence increases. Among the diseases caused death, the cardiovascular disease was the most common disease (33.94%), followed by hematologic malignancy (31.52%). The difference of distribution of the diseases caused death in different age group was statistically significant (P<0.01). The cardiovascular disease was main cause of death in infant, and the hematologic malignancy was the main cause of death in other three age groups. Within 24 h admission, the pediatric critical illness score (PCIS) had been assessed, 67.49% was critical and 15.48% was extremely critical. The hospitalization time was negatively correlated with PCIS (r=－0.313, P<0.001). Conclusions In the past five years, the mortality in PICU declined year by year. Cardiovascular disease in infancy and hematologic malignancy in non infancy are the leading cause of death in children. Admission in critical or extremely critical condition is the reason of early death in hospital.

A study on the quality of life for children with chronic cough

ZHANG Cui, SONG Jun, XIN Yue, TANG Yan, LU Jinquan, ZHANG Fan

. 2014, 32(7):  668.  doi:10.3969 j.issn.1000-3606.2014.07.018

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Objective To explore the impact of chronic cough on children’s life quality, and to observe their life quality after drugs and psychological intervention. Methods One hundred 9 to 12 years old children with chronic cough were randomly selected. The drugs and psychological intervention were administrated. The children had been follow-up. The children’s quality of life was assessed by “Inventroy of Subjective Life Questionnaire” before and after treatment. Meanwhile 100 healthy children were randomly selected as a control group. Results With the prolonged treatment, the recovery rate and effective rate in children with chronic cough increased. Before the treatment, the scores of family life, peer interaction, self cognitive, experience of depression, experience of anxiety, cognitive and emotional component, and overall satisfaction were significantly lower in children with chronic cough than those in healthy children (P<0.05). After the treatment, the scores of family life, peer interaction, self cognitive, experience of depression, experience of anxiety, physical experience, cognitive and emotional component, and overall satisfaction were significantly improved in children with chronic cough (P<0.05), even the scores of physical experience and emotional component were significantly higher in children with chronic cough than those in healthy children (P<0.05). Conclusions The quality of life in children with chronic cough decline, however, drug and psychological intervention can improve their quality of life.

The value of rapid species identif ication of Mycobacterium tuberculosis by two kinds of multi-locus polymerase chain reaction in children

LI Xiaoying, HUANG Yanfeng, PAN Yun, ZHU Chaomin, LIU Ruixi, LI Meihua, SU Wei

. 2014, 32(7):  672.  doi:10.3969 j.issn.1000-3606.2014.07.019

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Objective To evaluate the clinical value of multi-locus polymerase chain reaction (PCR) for identifying Mycobacterium tuberculosis complex isolated in children. Methods The isolates were collected and were first determined by PNB/TCH medium. 7-point PCR sites including 16SrRNA, Rv0577, IS1561, Rv1510, Rv1970, Rv3877/8 and Rv3120, and 4-point PCR sites including ropB, RD1, RD8 (present), RD8 (deleted) were used to amplify them by PCR. Results Total of 204 isolates were collected, in which 199 were Mycobacterium tuberculosis, 3 were Mycobacterium bovis, and 2 were non-tuberculous mycobacteria by the PNB/TCH method. 4-point PCR analysis showed that 196 were Mycobacterium tuberculosis, 2 were Mycobacterium bovis, 3 were BCG species and 3 were non-tuberculous mycobacteria. 7-point PCR analysis showed that 191 were Mycobacterium tuberculosis, 2 were Mycobacterium bovis, 3 were BCG species, 4 were African Mycobacterium type I, 1 was Mycobacterium caprae, 1 was Mycobacterium microti and 2 were non-tuberculous mycobacteria. Conclusion Compared with the conventional method, the PCR identification in 4-point PCR method and 7-point PCR method could rapidly identify the BCG among the complex group in children tuberculosis. 7-point PCR method was able to identify all the subspecies of Mycobacterium, except Africa Mycobacterium. 4-point PCR method would be more rapid and easier in the identification of BCG strains.

The expression of basic fibroblast growth factor and transforming growth factor β1 in virus myocarditis in mice

LU Tailing, LU Ming, LIU Yuncui

. 2014, 32(7):  677.  doi:10.3969 j.issn.1000-3606.2014.07.020

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Objective To investigate the possible role of basic fibroblast growth factor (bFGF) and transforming growth factor β1 (TGF-β1) in mice with Coxsackie viral myocarditis and their relationship. Methods Eighty male BALB/c mice, 4 weeks old, were divided randomly into study group (n=40) and control group (n=40). The study group was repeated intraperitoneally injected with Coxasckie viral B3 to establish the model of viral myocarditis, while the control group was injected with virus-free Eagle’s medium in the same period. On the 7th, 14th, 28th and 42th day after the first injection, 8 alive mice selected randomly from each group were sacrificed to examine the myocardial collagen volume fraction (CVF) by Masson dyeing, and to detect the protein and mRNA expression of bFGF and TGF-β1 by RT-PCR and immunohistochemistry. The correlations were analyzed. Results At each time point, the expressions of protein and mRNA of bFGF and TGF-β1 both in study group were significantly higher than those in control group (P<0.01), and gradually increased over time. The expressions of protein and mRNA of bFGF
and TGF-β1 were positively correlated with CVF (r=0.86~0.95, all P<0.01). In addition, the expressions of protein and mRNA of bFGF also had positive correlation with the expression of protein and mRNA of TGF-β1 (r=0.94, 0.92, P<0.01). Conclusion bFGF and TGF-β1 may promote the occurrence and development of myocardial fibrosis in viral myocarditis, which may provide a new target for future treatment of myocardial fibrosis.

Biofilms produced by Haemophilus influenzae in vitro and antibiotics sensitivity changes

GAO Xue, SHANG Xiaoling, QIAO Haixia, ZHANG Yanxia, ZHANG Cunhui, ZHANG Yutuo

. 2014, 32(7):  682.  doi:10.3969 j.issn.1000-3606.2014.07.021

Abstract ( 401 )   PDF (5876KB) ( 491 )  

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Objective To establish a biofilm (BF) models of Haemophilus influenza in vitro, and to observe the changes of antibiotic susceptibility after the BF fromation. Methods Thirty strains Haemophilus influenzae isolated from adenoids of children with adenoidal hypertrophy and cultured in a 96-well plate. The BF was identified by crystal violet staining and scanning electron microscopy (SEM). The minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and the minimum biofilm bacteria biofilm clear concentration (MBEC) of ampicillin (AMP), ceftriaxone (CRO), levofloxacin (LVFX) and azithromycin (AZM) were individually detected. Result All of 30 strains of Haemophilus influenzae formed various BF. After BF is formed, the increase of MBEC for different antibiotics was inconsistent with the increase of MIC and MBC. The difference was statistically significant (MBEC/MBC, H=91.54; MBEC/MIC, H=87.91; all P<0.001). The MBEC of AMP was the highest, up to 100 times than the MBC and MIC. The MBEC of CRO was dozens of times than the MBC and MIC. The MBEC of LVFX and AZM were most close to those of MBC and MIC. Conclusion After the formation of BF, resistance to antibiotics of Haemophilus influenzae is enhaced. LVFX and AZM showed more favorable effect on Haemophilus infuenzae BF.

Systematic review of clinical guidelines for Guillain-Barré syndrome in children

ZHANG Hongliang, LIAO Yimei, LIU Taotao

. 2014, 32(7):  686.  doi:10.3969 j.issn.1000-3606.2014.07.022

Abstract ( 420 )   PDF (1270KB) ( 10994 )  

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Objective To systematic review the methodological quality of guidelines for Guillain-Barré syndrome (GBS) in children, to provide a reference for clinical evidence-based medicine. Methods Guidelines concerning GBS were electronically retrieved from PubMed, EMbase, CBM, Wanfang data, CNKI and Vip. The guide databases includes major medical institutions and industry sites such as NGC, GIN, TRIP , CDC, IDSA, AAP, WHO, Chinese Health and Family Planning Committee website, library of clinical guidelines China and Chinese clinical guidelines for collaboration. All the data were searched from inception of the database or network to Oct. 2013. Two reviews independently screened literature according to the inclusion and exclusion criteria, and assessed the quality of guideline using the AGREEⅡ . Intraclass correlation coefficient (ICC) was used to examine the conformance of the raters' evaluation scores. Results A total of 5 guidelines concerning GBS were included, with a time range from 2003 to 2012, and origins from USA, EU and Canada. The final recommendation levels of the 5 articles were level B. According to the AGREEⅡ, domain 3 and 4 showed the higher scores, and scores were generally low in domain 5. Plasma exchange (PE) and intravenous immuneglobulin (IVIG) showed positive effects on the treatment of GBS. But it was not recommended that combined PE and IVIG. Corticosteroids are also not recommended for GBS treatment. Conclusions The recommendations of medicines for GBS are basically consistent. However, the classification criteria of the levels of evidence and recommendation are still unconsistent and suboptimal. The guidelines on GBS should be improved in “Applicability” in future.

Three cases report and literature review of X-Linked agammaglobulinemia

LI Xiaolin, FU Simao, LIU Yuling, ZHANG Li, LIN Guomo, PAN Xiaofen

. 2014, 32(7):  690.  doi:10.3969 j.issn.1000-3606.2014.07.023

Abstract ( 332 )   PDF (1198KB) ( 694 )  

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Objective To analyze the clinical features, diagnosis and treatment of X-Linked Agarnmaglobulinemia (XLA). Methods Clinical features, cellular and humoral immune functions, treatment and prognosis from 3 patients with XLA were retrospectively reviewed. Results The age of onset were from 11 months to 6 years in these 3 cases, however, the median age of diagnosis was 12 years. All patients showed multiple recurrent bacterial infections, arthritis involved large joints such as knee, ankle, elbow and hip. Laboratory examination revealed the decrease of serum gammmaglohulin and absence of B lymphocytes in the peripheral blood. All 3 patients were identified BTK mutations, which were frameshift mutation and nonsense mutation in exon 3, frameshift mutation in exon 10, missense mutation in exon 18. After XLA was diagnosed, the patients were managed by intravenous gammagloulin (IVIG) replacement. The non-steroidal anti-inflammatory drugs (NSAIDs) were administrated in patients combined arthritis. The small dose of hormones had been applied. All patients had a significantly improvement. Conclusions The clinical features of XLA have greater variability, with recurrent bacterial infections. Markedly decreased and absent tosils and lymph nodes, serum immunoglobulin may be one of the warning signs for early diagnosis of XLA. IVIG and NSAIDs can be jointly treatment of XLA with arthritis. The steroid and immunosuppressant agents should be used with caution.

Report one child with idiopathic hypereosinophilic syndrome

WANG Huaili, ZHANG Yuanyuan, ZHUO Zhihong, WANG Dao, XIE Lei, CHEN Xiaoxin, LI Haiying

. 2014, 32(7):  694.  doi:10.3969 j.issn.1000-3606.2014.07.024

Abstract ( 449 )   PDF (1776KB) ( 320 )  

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Objective To discuss the diagnosis and treatment of idiopathic hypereosinophilic syndrome (IHES) in children. Method The course and treatment process of a 6-year-old child with IHES had been retrospectively analyzed. Result The boy was admitted for abdominal discomfort and poor appetite, quickly developed into abdominal distension, dyspnea, jaundice, edema, and worsen hepatosplenomegaly. Routine blood test showed that the eosinophilia was 186.39×109/L. Bone marrow smear showed that the mature eosinophilcell granulocyles significantly increased to 90.4%. The FIL1P1-PDGFRα fusion gene detection, parasites and antibodies tests were all negative. CT and other examinations indicated that the digestion, circulation, blood and nervous system were all affected. The diagnosis of IHES was considered. Hydroxycarbamide and steroids applied, the eosinophil decrease, however, the symptoms no relief, eventually developed to the multiple organ failure. Conclusion IHES is rare in children. Further studies are necessary regarding the treatment and prognosis.