Table of Content

15 June 2017 Volume 35 Issue 6

  

Analysis of prognosis of collapsing focal segmental glomerulosclerosis in children

CAI Xiaoyi, TAN Mei, ZHONG Fazhan, CHEN Ye, ZHONG Fu, GAO Yan, LI Yingjie

. 2017, 35(6):  401.  doi:10.3969/j.issn.1000-3606.2017.06.001

Abstract ( 334 )   PDF (1441KB) ( 240 )  

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　Objective　To analyze the long-term prognosis and prognostic factors of idiopathic collapsing focal segmental glomerulosclerosis (FSGS) and not otherwise specified FSGS in children. Methods　The clinical, pathology and follow-up data of patients with idiopathic collapsing FSGS and not otherwise specified FSGS were analyzed retrospectively by Kaplan-Meier method, univariate and multivariate Cox regression analysis. Results　A total of 64 patients (29 idiopathic collapsing FSGS and 35 not otherwise specified FSGS) were diagnosed by renal biopsy. The 4-year renal survival rate of idiopathic collapsing FSGS and not otherwise specified FSGS were 48.3%, 74.3% respectively. Univariate analysis revealed that the renal survival time were 25.41±3.28 months in idiopathic collapsing patients, and 35.53±2.73 months in not otherwise specified patients. The different is significant (χ2=4.07， P=0.044). Multivariate Cox regression analysis showed that poor treatment response (HR=5.92, P<0.05) and renal insufficiency at early stage (HR=2.45, P<0.05) were independent risk factors of prognosis. Conclusions　Compared with patients with not otherwise specified FSGS, the renal survival time is shorter in idiopathic collapsing FSGS patients. Patients with renal insufficiency and poor response to treatment have poorer prognosis.

Clinical analysis of primary nephrotic syndrome complicated with acute pancreatitis in 14 children

　LI Yuliu, LIU Cuihua, ZHANG Miao

. 2017, 35(6):  406.  doi:10.3969/j.issn.1000-3606.2017.06.002

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 Objective　To explore and provide guidelines for the clinical diagnosis and treatment of primary nephrotic syndrome complicated with acute pancreatitis. Methods　The clinical data of 14 children with primary nephrotic syndrome complicated with acute pancreatitis during September 2013 to September 2016 were retrospectively analyzed. Results　In 14 children (6 males and 8 females) aged 3 to 15 years. all children presented massive proteinuria, hypoalbuminemia, varying degrees of edema, hyperlipidemia and pain in upper abdomen or left hypochondrium. Seven children had nausea and vomiting, and their amylase in serum and urine fluctuated at 392?802 U/L and 561?3180 U/L, and the lipase level was 339.1±2.52 U/L. After supportive treatment, 13 children were cured from pancreatitis except one who gave up the treatment. Conclusion　Due to infection, coagulation disorder, hyperlipidemia and drug application in primary nephrotic syndrome, acute pancreatitis may be induced. Clinician should be alerted to it and early diagnosis and treatment were needed for acute pancreatitis.

Tacrolimus causes acute renal failure in the treatment of nephrotic syndrome in  children: a report of 3 cases

ZHANG Hongwen, XIAO Huijie, YAO Yong

. 2017, 35(6):  409.  doi:10.3969/j.issn.1000-3606.2017.06.003

Abstract ( 366 )   PDF (1101KB) ( 355 )  

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　Objective　To explore the causes of acute renal failure resulted from tacrolimus in the treatment of nephrotic syndrome. Method　The clinical data of acute renal failure caused by tacrolimus in treatment of nephrotic syndrome in 3 children during January 2012 and December 2015 were retrospectively analyzed. Results　There were 2 male and 1 female aged 3, 11， and 13 years respectively. Clinical manifestations were consistent with simple type of primary nephrotic syndrome. One child was frequently recurrent and another two were secondary steroid resistant. The renal pathology showed minimal changes. Acute renal failure occurred within 4 weeks after treatment with tacrolimus on the basis of hormone therapy in all patients who had infection within one week. Renal function recovered to normal within 2 weeks after discontinuation or reduction of tacrolimus combined with anti-infection and diuresis treatment. Two children continued with tacrolimus, but the other one was replaced with cyclosporin A. The renal function of all patients remained normal during the follow-up for 10-42 months. Conclusion　In the first 4 weeks of tacrolimus therapy in children with nephrotic syndrome, infection may lead to reversible acute renal failure.

Clinical analysis of nephrotic syndrome combined with H1N1 influenza in 15 children

　HE Tingyan, YANG Weiguo, HE Yanxia, MA Yijiao, YANG Jun

. 2017, 35(6):  412.  doi:10.3969/j.issn.1000-3606.2017.06.004

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Objective　To explore the clinical features of nephrotic syndrome combined with H1N1 influenza. Methods The clinical manifestations, laboratory and image examinations, treatment, and prognosis of nephrotic syndrome combined H1N1 influenza were retrospectively analyzed in 15 children with. Results　All of 15 children with nephrotic syndrome met the diagnostic criteria of H1N1 influenza. The median age of all children was 4-year-8-month old (2-year-2-month to 6-year-9month). All children were treated with hormone alone or combined with other immunosuppressive drugs. Three cases were severe and another 5 cases were critically ill. Four cases were complicated with recurrence of nephrotic syndrome, 2 of which suffered from acute renal insufficiency. All children were given oseltamivir as antiviral treatment at admission. Four cases took oseltamivir within 48 hours of onset and showed mild symptoms. Fourteen children with H1N1I influenza were cured, their urinary proteins were significantly decreased or converted to negative, and the median hospital stay was 8 days (1 to 25 days). One child died of acute necrotizing encephalopathy and brain herniation. Conclusions　Children with nephrotic syndrome are susceptible to severe or critical H1N1 influenza infections. During the epidemic of H1N1 influenza, the clinical preventive measures should be taken in children with nephrotic syndrome.

The distal renal tubular acidosis caused by ATP6V1B1 gene mutation：a case report

XU Lingyang, YANG Baowang

. 2017, 35(6):  415.  doi:10.3969/j.issn.1000-3606.2017.06.005

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　Objective　To explore the clinical features and gene diagnosis of the distal renal tubular acidosis (dRTA). Methods　The clinical data and gene detection results of one child with dRTA were retrospectively analyzed. The related literatures were reviewed. Results　Four-month-old female was admitted with frequent vomiting and hearing impairment. The laboratory examination showed refractory hypokalemia and it was difficult to correct metabolic acidosis. Gene detection found a new mutation on ATP6V1B1 gene. The diagnosis of dRTA was confirmed. Conclusions　dRTA is a rare disease, ATP6V1B1 gene is the causative gene of the dRTA with sensorineural deafness.

The clinical manifestation and gene mutation of primary renal glucosuria in a child

LI Qun, CHANG Guoying, DING Yu, LI Juan, CHENG Qing, LI Xin, WANG Jian, WANG Xiumin, SHEN Yiping

. 2017, 35(6):  418.  doi:10.3969/j.issn.1000-3606.2017.06.006

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　Objective　To explore the clinical manifestation and gene mutation of primary renal glucosuria (PRG). Methods　The clinical data and gene detection results of a child with PRG were analyzed. Results　A girl aged 2 years and 10 mouths had glucose ++++ by urine dipstick analysis and 22.4 g of the 24 h urine glucose. Her father was urine glucose positive. Genome DNA was extracted from peripheral blood of the girl and her parents, SLC5A2 gene were amplified by PCR for sequencing, including exons and splicing areas. The results showed a homozygous point mutation (c.127-16C>A) in girl, and both of her patents had the same heterozygous mutation. This mutation had been classified to pathogenic mutations by ClinVar data base. Conclusions　The diagnosis of PRG is confirmed in this child and SLC5A2 gene mutation is the cause.

The factors influencing serum trough concentration of vancomycin in pediatric patients with severe gram-positive cocci pneumonia

LI Yuanyuan, ZHANG Guangli, TIAN Xiaoyin, MA Huan, TANG Lin, ZHANG Qiyu, JIA Yuntao, LUO Zhengxiu

. 2017, 35(6):  421.  doi:10.3969/j.issn.1000-3606.2017.06.007

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　Objective　To explore the factors influencing serum trough concentration of vancomycin in pediatric patients with severe gram-positive cocci pneumonia. Methods　The general information, the biochemical test results, and plasma concentration of vancomycin were collected from 93 pediatric patients with severe gram-positive cocci pneumonia. The relative factors influencing trough concentration of vancomycin were analyzed retrospectively.  Results　With the dosage of 40-60 mg/ (kg·d), serum trough concentration of vancomycin were between 10-20 mg/L in 26 patients, <10 mg/L in 54 cases, ≥20 mg/L in 13 cases. The ALT, AST, GFR, and γ-GT were significantly different among three groups (P<0.05); the 10-20 mg/L group had the highest levels of AST and γ-GT, the ≥20 mg/L group had the highest level of ALT and the lowest level of GFR. Multiple linear regression analysis showed that GFR was negatively linearly correlated with the serum trough concentration of vancomycin (R2=0.039, P<0.05). The median serum trough concentration of vancomycin in pediatric patients with GFR≥90, 60?90, 30?60 mL/(min·1.73m2) were 8.66, 18.21, 8.45 mg/L respectively, and the difference is statistically significant (P<0.05). Conclusions The serum trough concentration of vancomycin is negatively linearly correlated with GFR in pediatric patients with severe grampositive cocci pneumonia. The patients with impaired renal function are easier to reach the target serum trough concentration of vancomycin. Clinical use of vancomycin should follow the low doses in the range the guideline recommended, and the serum trough concentration should be closely monitored.

Longitudinal study of early neural development in premature infants with different gestational age and birth weight

YAN Shuyuan, LIU Zhenyu, QIAN Hongyan, KUANG Xiaoni, YU Zhong, TAN Lin, XIA Chan

. 2017, 35(6):  425.  doi:10.3969/j.issn.1000-3606.2017.06.008

Abstract ( 384 )   PDF (1235KB) ( 325 )  

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Objective　To investigate the trend of early neural development in premature infants. Methods　At the age of 12 months and 24 months, Bayley Scales of Infant Development were used to assess the mental development index (MDI) and the psychomotor development index (PDI) in preterm (corrected age) and full-term infants. Results　At 12 months, there was no significant difference in corrected age PDI scores among different gestational age groups (<32 , 32?33+6 and 34?36+6 weeks) (P=0.820). The actual age MDI and PDI scores of full-term infants and premature infants in 34~36+6 weeks group were significantly higher than those of premature infants in <32 and 32－33+6 weeks groups, and the PDI score of full-term infants was significantly higher than that of premature infants in 34－36+6 weeks group (P<0.05). There was no significant difference in actual age PDI scores among different birth weight groups (P=0.166). The actual age MDI and PDI of full-term infants and premature infants in birth weight ≥2500 g group were significantly higher than those of premature infants in <1500 g, 1500~1999 g and 2000~2499 g groups (P<0.05). At 24 months, the actual age MDI scores of full-term infants were significantly higher than those of premature infants in different gestational age and birth weight groups (P<0.05). The actual age MDI curve of premature infants in birth weight <1 500g group showed a downward trend, while the actual age PDI curve showed a significant upward trend. Conclusion　The neurodevelopment of preterm infants at the corrected age of 12 and 24 months reaches the level of full-term infants.

Vitamin D level in cord blood and neonatal outcomes in a birth cohort study in Shanghai

YE Xiuxia, SONG Yuanjin, JIANG Yanrui, LIN Jianhua, ZHANG Yu, BEI Fei, JIANG Fan

. 2017, 35(6):  430.  doi:10.3969/j.issn.1000-3606.2017.06.009

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　Objectives　To detect the cord blood vitamin D level in neonates and to determine the association between the cord blood vitamin D level and neonatal outcomes. Methods　A total of 223 eligible mother-and-singleton-offspring pairs were recruited. The information of mothers’ pregnancy was collected by questionnaires. The weight, length, and head circumference of neonates were measured. The levels of 25(OH)D in cord blood of neonates and in blood of late pregnancy mothers were determined by chemiluminescence immunoassay. Results　The median concentration of 25(OH)D in cord blood was 20.7 nmol/L, and 82.1% of neonate had vitamin D deficiency, and 12.1% had severe vitamin D deficiency (<10 nmol/L). The concentration of 25(OH)D in cord blood was consistent with that in blood of late pregnancy mother. The distribution of concentration of 25(OH)D in cord blood was significantly different in neonates in different seasons of birth (P<0.05). There were more cases <10 nmol/L in winter and spring. The concentration of 25(OH)D in cord blood had no significant associations with the incidences of  low birth weight (LBW) and small for gestational age (SGA) (P>0.05). After the variables of sex, gestational age and birth season are controlled, the birth weight and head circumference were significantly different in neonates with different concentrations of 25(OH)D in cord blood (P<0.05). Conclusions　The concentration of 25(OH)D in cord blood in term neonates was generally lower. The vitamin D status in neonates was consistet with that in their late pregnancy mothers. Cord blood 25(OH) D levels were associated with neonates’ birth weight and head circumference, but it should be confirmed by larger sample size in the future.

Effects of caffeine on cerebral cortical activity in preterm infants

QIAN Ruiying，SUN Jianhua

. 2017, 35(6):  435.  doi:10.3969/j.issn.1000-3606.2017.06.010

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　Objective　To investigate the effects of caffeine on cerebral cortical activity in preterm infants. Methods　The preterm infants with 28-34 week gestational age and without asphyxia at birth were recruited as the subjects from January to September 2016. The infants who received conventional caffeine citrate were assigned to the caffeine group, while the infants with the same postmenstrual age did not receive any drugs that excite respiratory center were assigned to the control group. In the caffeine group, after the use of caffeine citrate stopped, the amplitude integration electroencephalogram (aEEG) recording were performed at 33, 34, 35 weeks of postmenstrual age. All the aEEG recordings were continuously monitored for at least 4 hours. The aEEG images were assessed by Burdjalov scoring system, and the interburst intervals were calculated. The effects of caffeine on preterm infants’ cerebral cortical activity in early life were analyzed. Results　In a total of 49 preterm infants recruited, 21 were in caffeine group and 28 in control group, and the ratio of male and female was 1.45:1. At the same postmenstrual age, the total score and individual scores of aEEG assessed by Burdjalov scoring system were not significantly different between caffeine group and control group. However, the length of interburst interval was significantly shorter in caffeine group than that in control group (P<0.05). All the recruited preterm infants had no seizure-like activity when the aEEG was monitored. Conclusion　The use of caffeine citrate has effects on EEG activity in early life of preterm infants, which may accelerate the brain maturation of preterm infants.

The probability and timing of Miller-Fisher syndrome progressing to Guillain-Barre syndrome or Bickerstaff brainstem encephalitis in childhood

SUN Ruidi, FU Bing, JIANG Jun

. 2017, 35(6):  441.  doi:10.3969/j.issn.1000-3606.2017.06.011

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Objective　To investigate the probability and timing of childhood Miller-Fisher syndrome (MFS) progressing to Bickerstaff brainstem encephalitis (BBE), classical Guillain-Barre syndrome (GBS), and pharyngeal-cervical-brachial (PCBGBS). Methods　The clinical data of 128 children with confirmed MFS diagnosis were retrospectively analyzed. Results　Among 128 children, 60 cases were simple MFS (ocular muscle paralysis, ataxia, reflexes diminished or disappeared, without limbs weakness and lethargy; laboratory tests suggest cerebrospinal fluid protein-cell separation and/or serum anti-GQ1b antibody positive), 28 cases developed MFS/PCB-GBS (met MFS diagnosis criteria, accompanied by weakness of pharynx, neck and upper limb, weakened or disappeared of upper limb reflex, without weakness of lower limb), 22 cases developed MFS/GBS (met MFS diagnosis criteria, accompanied by weakness of limb), 18 cases developed MFS/BBE (met MFS diagnosis criteria, accompanied by lethargy, pyramidal tract positive). There were no differences in the age at onset, the interval from onset to the start of the treatment, Hughes functional grading, and the percentage of cases having a history of preceding infections, the rate of positive serum anti-GQ1b antibody, the ratio of albumin cytological dissociation in cerebrospinal fluid among 4 groups (P>0.05). The interval from MFS onset to progression to MFS/PCB-GBS, MFS/GBS, or MFS/BBE was within 10 days. Conclusions　In children with MFS, 50% developed PCB-GBS, GBS, or BBE, which occurred within 10 days after onset. Clinicians should pay attention to the time window and adjust the medicine rationally.

Clinical characteristics of severe anti-N-methyl-D-aspartate receptor encephalitis in four children

SONG Liang, WANG Yeqing, WANG Gaoyan, PAN Hua, SONG Aiqin

. 2017, 35(6):  446.  doi:10.3969/j.issn.1000-3606.2017.06.012

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　Objective　To explore the clinical features and treatment strategy of severe anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children. Methods　The clinical data and follow-up information of 4 children with severe anti-NMDAR encephalitis were retrospectively analyzed. Results　Four patients (one male and 3 females) were 10 to 13 years old and one child had teratoma combined. In all patients symptoms at onset mainly were psychiatric syndrome and movement disorder, and then progressed to seizures, disturbance of consciousness and central hypoventilation respiratory failure in one month. The anti-NMDAR antibodies in cerebrospinal fluid were positive in all patients. The EEG showed focal or diffuse slow waves. The brain MRI showed no pathological changes at the diagnosis. The treatment included methylprednisolone and large doses of intravenous immunoglobulin (IVIG), ventilator for 5-95 days, and tracheotomy in 2 cases. One case died because of serious infection. In 21-27 months of the follow-up, one case had clinical recovery; 2 cases had the sustained use of immunosuppressive agents and anti-epileptic drugs and the clinical symptoms were significantly improved. The EEG and antiNMDAR antibodies continued abnormal in the patient combined with teratoma. One patient relapsed. Conclusions　The severe anti-NMDAR is more likely in older female children. The central hypoventilation respiratory failure occurs in the early course of the disease. Combination with tumor is high risk factor. Conventional hormone therapy and ventilator treatment is effective. The recovery is slow. It may be relapsed even one year later.

Childhood hypomyopathic dermatomyositis combined with interstitial lung disease: two cases report

JIANG Lu, TANG Hanyun, MIN Yue, LI Xiaozhong

. 2017, 35(6):  450.  doi:10.3969/j.issn.1000-3606.2017.06.013

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　Objective　To discusses the effectiveness of tocilizumab in the treatment of hypomyopathic dermatomysositis (HDM) combined with interstitial lung disease (ILD) in children. Methods　The clinical characteristic, treatment, and prognosis of HDM combined with ILD were analyzed in 2 patients. The related literatures were reviewed. Results　Both ten-year-old girl and 8-year-old boy had shortness of breath after activities, but had no clinical manifestations of muscle damage; both of them had typical rash, but had nornal muscle strength and  muscular tension. Laboratory tests showed the elevation of serum ferritin, lactate dehydrogenase, glutamate aminotransferase, and aspartate aminotransferase. Creatine kinase slightly increased in the initial test, and then was in the normal range in the following tests. The high resolution computed tomography showed that pulmonary interstitial lesions. HDM combined ILD was diagnosed clinically. The girl died after treatment with high-dose hormones, cyclophosphamide, cyclosporine, pirfenidone, and gamma globulin failed. The boy was stabled after conventional hormone treatment plus tocilizumab (240 mg twice). His laboratory indicators were in the normal range in the follow-up. Conclusions　The clinical manifestations and laboratory indicators aren't typical in childhood HDM. The mortality is high. Combined with tocilizumab treatment is effective in one case.

Long term effect of tocilizumab on refractory systemic juvenile idiopathic arthritis

YAO Wen, SUN Li, LIU Haimei, SHI Yu, LI Guomin, ZHOU Lijun, XU Hong

. 2017, 35(6):  454.  doi:10.3969/j.issn.1000-3606.2017.06.014

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　Objective　To summarize the treatment experience of refractory systemic juvenile idiopathic arthritis (JIA) by tocilizumab, and to explore the cost-effective treatment. Methods　The clinical data of 6 pediatric patients with refractory systemic JIA treated by tocilizumab from 2014 to June 2016 were retrospectively analyzed in the aspects of course and effectiveness of tocilizumab, steroid reduction, adverse reaction, and growth. Results　The median age of the six patients (3 males and 3 females) was 6 years, and the course of disease were from 16 to 63 months. All patients were treated by other immunosuppressive agents or biological agents in addition to steroid and traditional anti-rheumatic drug therapy. The courses of tocilizumab treatment were from 7 to 26 months and the median time was 9.5 months. All 6 patients responded to tocilizumab and achieved the clinical remission at different time. After the induced remission, the interval of the treatment intervention was increased from 2 weeks up to 4 weeks in 3 cases, and no disease activity was observed. Except one case, another 5 cases reduced and stopped the use of hormones at 5.8 months after tocilizumab treatment. After hormones was reduced and discontinued, the growth was improved. All 6 patients had no serious adverse reactions. Conclusions　Tocilizumab is safe and effective for patients with refractory JIAs. The steroid can be reduced in short time to improve growth. After remission is induced, the interval of the treatment intervention could be prolonged.

Retrospective analysis in 13 children with Kasabach-Merritt phenomenon and review of literature

ZHAO Yamei, GAO Yijin, ZHOU Ying, MA Jing, PAN Ci, TANG Jingyan

. 2017, 35(6):  458.  doi:10.3969/j.issn.1000-3606.2017.06.015

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　Objective　To improve understanding of the clinical manifestations, diagnosis and treatment of childhood Kasabach-Merritt phenomenon (KMP). Methods　The clinical data of 13 patients admitted for KMP to XXX from January 2010 to January 2016 was retrospectively analyzed, with a review of relevant literature. Results　The patients were 10 males and 3 females. The age of presentation varied from newborn to 5 months. 12 patients had cutaneous manifestations, like petechiae, ecchymosis, jaundice, skin masses, etc, 1 patient had pleural effusion. The location of lesions varied. The laboratory hallmark consists of profound thrombocytopenia and hypofibrinogenemia with elevated D-dimers. The median time from initial presentation to diagnosis was 60 days. After approaches like surgery, corticosteroids, propranolol, interferon, sirolimus, etc, 10 patients got remission while 3 patients died. 6 patients treated with sirolimushad complete response. Conclusions　KMP is characterized with vascular tumor, severe thrombocytopenia and consumptive coagulopathy. Clinically, KMP often presents with early-onset and delay in diagnosis. Surgery is an effective approach for KMP. Sirolimus appears to be a promising treatment for KMP.

Protective effect of miconazole on white matter damage induced by anoxia and ischemia in rats

TANG Wenyan,SU Xuewen,YANG Yinxiang,LUAN Zuo

. 2017, 35(6):  462.  doi:10.3969/j.issn.1000-3606.2017.06.016

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Objective　To explore the protective effect of miconazole on white matter damage (WMD) in neonatal rats. Methods　Three-day-old neonatal SD rats were randomly divided into sham group, WMD model group, 10 mg/(kg·d) miconazole group and 40 mg/(kg·d) miconazole group with 15 rats each. Rats in WMD model group were subjected to the ligation of right carotid artery, and then kept in a chamber with 6% oxygen and 94% nitrogen for 80 min to establish the white matter damage model. The rats in miconazole group were intraperitoneally injected with different doses (10 and 40mg/kg) of miconazole, dissolved in dimethyl sulfoxide (DMSO), for five consecutive days, and rats in WMD model group were injected with the same volume of DMSO. Myelin basic protein (MBP) of white matter was detected by immunofluorescence staining and western blot. Myelin sheaths of corpus callosum were observed by transmission electron microscopy. Weight changes of rats were compared among groups. Results　Immunofluorescence staining and western blot showed that, after treatment with miconazole, the MBP expression level of corpus callosum was higher than in WMD model group (P<0.05). In WMD model group, the myelin sheath of corpus callosum had loose structure and a large number of small vacuoles with decreased thickness of myelin sheath. After treatment with miconazole, myelinolysis induced by anoxia and ischemia could be improved significantly. The increase in weight of rats in WMD model group was significantly less than that in sham group. And after miconazole treatment, the rate of weight gain of rats was increased. Conclusion　Miconazole can significantly reduce the brain white matter damage induced by anoxia and ischemia through promoting myelination, and then improves the growth and development in rats.

Meta-analysis of the efficacy and safety of inhaled corticosteroids for preventing chronic lung disease in preterm infants

WANG Xiaoling, LI Xiong, LEI Xiaoping, KANG Lan, WANG Shenghui, Dong Wenbin

. 2017, 35(6):  467.  doi:10.3969/j.issn.1000-3606.2017.06.017

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Objective　To evaluate the efficacy and safety of inhaled corticosteroids for preventing chronic lung disease (CLD) in preterm infants. Methods　PubMed, EMBASE, CENTRAL, the ISI Web of Knowledge databases, CBM, CNKI, VIP and Wanfang Data were searched for the period up to Oct. 2016. All randomized controlled trials (RCTs) about inhaled corticosteroids for preventing CLD in preterm infants were collected. The RCTs had been screened, data were extracted and assessed. The mata-analysis was performed by RevMan 5.3 software. Result　A total of 12 RCTs were included (a total of 2051 preterm neonates).  Compared with control group, in 28 day old group, the incidence of CLD was not significantly  different between experimental and control groups (RR=0.87, 95%CI:0.74-1.03, P=0.11) and (RR=1.19, 95%CI:0.59-2.43, P=0.63) and  no significant  difference among subgroups budesonide (α), beclomethasone (β), fluticasone (γ)  (RR=0.89, 95%CI:0.69-1.14, P=0.35), (RR=0.86, 95%CI:0.69-1.08, P=0.19) and (RR=0.91, 95%CI:0.60-1.38, P=0.19). In 36 wk postmenstrual age group,the incidence of CLD was decreased in experimental group and in subgroups inhalation (A), Intratracheal administration (B), α, γ (RR=0.70, 95%CI: 0.61-0.80, P<0.00001), (RR=0.74, 95%CI: 0.63-0.87, P=0.0003), (RR=0.57, 95%CI: 0.43-0.76, P=0.0002), (RR=0.67, 95%CI: 0.57-0.78, P<0.00001) and (RR=0.58, 95%CI: 0.36-0.94, P=0.03); but it is not significantly  different in  subgroup β (RR=0.98, 95%CI: 0.69-1.39, P=0.90); There was no difference in the motality in experimental and subgroups A ,B, α, β , γ (RR=1.07, 95%CI:0.86-1.33, P=0.55), (RR=1.24, 95%CI: 0.97-1.59, P=0.09), (RR=0.67, 95%CI: 0.43-1.03, P=0.07), (RR=1.04, 95%CI: 0.811.33, P=0.78), (RR=1.47, 95%CI: 0.79-2.74, P=0.22) and (RR=0.91, 95%CI: 0.47-1.74, P=0.77). No clinically significant adverse effects were observed during the study.  Conclusions　This updated review indicated that early administration of inhaled steroids to very low birth weight preterm neonates was effective in reducing the incidence of CLD. There was no statistically significant effect of inhaled steroids on motality, and there was no significant correlation between the mode of administration and the type of drug delivery, It is recommended to observe the 36 week gestational age as the outcome index. More and larger randomised placebo-controlled trials including long-term follow up are needed to establish the efficacy  and safety of inhalation corticosteroids.
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Study of the nutrition support on traumatic brain injury children

WANG Jingwen

. 2017, 35(6):  475.  doi:10.3969/j.issn.1000-3606.2017.06.018

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　Traumatic brain injury (TBI) children have their own characteristics of energy metabolism. Reasonable nutrition support on neurosurgery patients is very helpful for the postoperative recovery and the prevent of the complications. Reasonable nutritional support  based on early assessment of the gastrointestinal function, is the key factor for successful treatment. In this pape, energy expenditure in TBI children, time and route of nutrient Intake,and acute gastrointestinal injury (AGI) were reviewed in hope to achieve more rational and standardized management for TBI children, and provide more reasonable advise to control AGI.