Table of Content

15 August 2014 Volume 32 Issue 8

  

Clinical analysis of 64 cases of non-traumatic pneumomediastinum in children

ZHAO Jiajia, ZHANG Weixi, LI Changchong

. 2014, 32(8):  701.  doi:10.3969 j.issn.1000-3606.2014.08.001

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　Objective　To investigate the underlying causes, clinical characteristics, treatment and prognosis of nontraumatic pneumomediastinum (PM) in children. Methods A retrospective analysis of the clinical data of 64 children diagnosed with non-traumatic PM in Yuying Children’s Hospital Affiliated to Medical University from Jan 2003 to Dec 2013 was performed. Nineteen children with SPM and the other 45 with clear causes of non-traumatic PM were divided into two groups for comparison. According to age, 64 cases were divided into 0-6y group and 6-18y group for further comparison. Results A total of 64 patients with non-traumatic PM were collected. Nineteen of them aged 14.90±2.00 y had SPM with unknown etiology, and 84.2% were male. The other group of 45 patients aged 4.26±4.45y, and 55.6% of this group were male. The common causes were pneumonia or other lower respiratory tract infection, asthma and foreign body inspiration. The patients with SPM were always with chest pain. While the patients with clear causes of non-traumatic PM were more complained of dyspnea, coughing, subcutaneous emphysema. The treatment of patients with SPM was bed rest, oxygen uptaking, antitussive, anti-infection and other conservative therapy. All the patients with clear causes of non-traumatic PM had favorable prognosis with the treatment of actively curing primary disease and timely mediastinal air drainage, subcutaneous air drainage and thoracic close drainage. In 35 cases younger than 6 years old, the most common causes were pneumonia or other lower respiratory tract infection, none had SPM. In 29 cases older than 6 years, 19 of them had SPM. Conclusions Etiologies of pneumomediastinum varied with age in children,which should be vigilantly examined, especially for those younger than 6 years old. The key of the treatment to nontraumatic PM with clear etiologies was to treat its primary disease.

Clinical features of 203 infants with pulmonary tuberculosis

GONG Chunzhu, ZHU Chaomin

. 2014, 32(8):  705.  doi:10.3969 j.issn.1000-3606.2014.08.002

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Objectives To summarize the clinical features and relevant factors of 203 cases with infantile pulmonary tuberculosis. Methods Clinical data of 203 infantile with pulmonary tuberculosis were retrospectively reviewed. Results Among 203 infants, 127 (62.6%) were from country, 76 (37.4%) from city; 64.5% of city infants have received BCG vaccination, which is higher than 46.5% in country infants ; 78 cases (38.4%) have clear evidence for active tuberculosis exposure, 26 cases (12.8%) have suspicious tuberculosis exposure; 175 cases (86.2%) have fever, 165 cases (81.3%) have respiratory symptoms, 107 cases (52.7%) have pulmonary signs, 80 cases (39.4%) have hepatosplenomegaly; Etiology was confirmed in 91 cases (44.8%); 54.7% of patients were found with concurrent extrapulmonary tuberculosis, and the most commonly seen was formis tuberculous meningitis. In this study, the misdiagnosis rate is 39.9%, and 84.0% patients were often misdiagnosed as bronchial pneumonia; Vaccinated BCG rate is lower in infants with severe tuberculosis (44.83%) than that of infants with mild tuberculosis (74.14%). Conclusions Infantile pulmonary tuberculosis is featured with acute onset, severe clinical performance and easily complicated with extrapulmonary tuberculosis, atypical clinical performance, and high misdiagnosed rate which needs early detection and diagnosis. Unvaccinated BCG and active tuberculosis exposure were important clues for the diagnosis of infantile pulmonary tuberculosis.

Diagnostic value of fiberobronchoscopy in endobronchial tuberculosis

MENG Yanni, CHEN Yanping, LI Xiulong, HUANG Jianbao

. 2014, 32(8):  709.  doi:10.3969 j.issn.1000-3606.2014.08.003

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Objective To assess the value of fiberobronchoscopy in the diagnosis of endobronchial tuberculosis. Methods A total of 67 children suspected of endobronchial tuberculosis in our ward from March 2010 to December 2012 had been tested by chest CT and fiberobronchoscopy, mycobacteria culture, liquid-based interlayer vessel technique and FQ-PCR from bronchoalveolar lavage fluid and biopsy. Results 50 patients were clinically diagnosed as endobronchial tuberculosis. The positive rate of FQ-PCR (60%) and liquid-based interlayer vessel technique (42%) are higher than that of mycobacteria culture (20%), which showed no significant difference with biopsy. The positive rate of the combined detection (FQ-PCR and liquid-based interlayer vessel technique) is significantly higher than that of mycobacteria culture and biopsy. Conclusions Fiberobronchoscopy is effective for the diagnosis of endobronchial tuberculosis.

Application of fiberoptic bronchoscopy in diagnosis and treatment of refractory and persistent wheezing in infants

ZHAO Qianye, ZHOU Xuhua, SHI Sujie, WANG Yifen, CHEN Guoqing

. 2014, 32(8):  713.  doi:10.3969 j.issn.1000-3606.2014.08.004

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Objective To investigate the roles of fiberoptic bronchoscopy in diagnosis and treatment for infants with refractory and persistent wheezing. Methods From Jun. 2012 to Dec. 2013, 52 hospitalized children with age between four 4 months and 1 year old were recruited for fiberoptic bronchoscopy, who had been wheezing for at least four weeks and treated ineffectively with conventional anti-inflammatory agents: budesonide and compound ipratropium bromide solution. Then, the pathogenesis of refractory and persistent wheezing was summarized based on clinical features, detection of CT imaging of threedimensional airway reconstruction and cardiac CT, results of bronchoscopy inspection, and bronchoalveolar lavage fluid culture. Results Among the 52 cases,  0 were with ground glass-like changes (76.92%) in pulmonary spiral CT testing, 4 with mosaic perfusion syndrome (7.69%), 8 with segmental pulmonary consolidation (15.38%), 8 with obstructive pulmonary emphysema (15.38%), and 1 with left primary bronchial foreign body. In addition, through bronchofibroscopy, there were 52 cases with imflammation (100%),3 with tracheal stenosis (5.77%), 3 with left and/or right main bronchus stenosis of the external pressure, 18 with bronchomalacia(34.62%), 2 cases with foreign body (3.84%), one in trachea (1.92%), the other in left main bronchus (1.92%), 10 with bronchial mucus plug (19.23%), and 8 (15.38%) with congenital airway malformations (including 3 at tracheal bronchus, 1 at left upper lobe bronchial stenosis and 1 at bronchial Bridge). The culture of bronchoalveolar lavage fluid were conducted for all patients. The positive rate of bronchoalveolar lavage fluid was 9.62% (5/52 cases), including 2 cases with tip Escherichia coli, 2 with Haemophilus influenzae, and 1 with Acinetobacter baumannii. Conclusions First, infection is the primary cause of refractory and persistent wheezing, which is persistent in airway resulted from multi-drug resistant bacteriua. Second, refractory and persistent wheezing is often caused by multi-factors including infection, congenital airway malformations, the endogenous and exogenous foreign body, cardiovascular malformation, etc. These factors often lead to difficult wheezing control. The last, the diagnosis rate of the refractory and persistent wheezing can be improved by combination of fiberoptic bronchoscopy and lung spiral CT.

A study on the relationship between pregnant, neonatal risk factors and childhood asthma

JIA Chunmei, WANG Junqing, CHEN Xiaoqin, WANG Dongmei, JIANG Cairong, JIANG Li

. 2014, 32(8):  716.  doi:10.3969 j.issn.1000-3606.2014.08.005

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Objective To explore the relationship between childhood asthma and pregnant and neonatal risk factors, thus provide evidence for early prevention of childhood asthma. Methods 162 children diagnosed asthma and 213 healthy children in pediatric outpatient and the inpatient services of our hospital who was born and living in Baotou city were retrospectively analyzed. The pregnancy related factors (parity, fever during pregnancy, pregnancy-induced hypertension syndrome, gestational diabetes mellitus, history of overdose in early-pregnancy) and the neonatal period related factors (surface defects, asphyxia, rough placenta, birth weight, number of fetus during this pregnancy, gestational age, premature birth, cesarean section) were investigated. The sex and age showed no significance between childhood asthma and control group. Results Eight pregnant and neonatal factors (fever during pregnancy, pregnancy-induced hypertension syndrome, history of overdose in early-pregnancy, surface defects, asphyxia, rough placenta, birth weight, premature birth, cesarean section) showed significant difference between the two groups (P<0.05). Multifactor regression analysis found fever during pregnancy (OR=9.43, 95%CI:3.08~28.82), rough placenta (OR=2.15, 95%CI:1.29~3.59), premature birth (OR=5.16, 95%CI:1.53~17.39) and cesarean section (OR=4.05, 95%CI:2.40~6.86)are independent risk factors for childhood asthma. Conclusions Fever during pregnancy, abnormal placenta; premature birth and cesarean section are likely risk factors of childhood asthma.

Analysis on clinical features and plasma SLPI levels in children with Mycoplasma pneumoniae pneumonia

SHEN Xiameng, HUA Chunzhen, WANG Xiaofang, PANG Fuzhen

. 2014, 32(8):  720.  doi:10.3969 j.issn.1000-3606.2014.08.006

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Objective To analyze the clinical features and the plasma secretory leukocyte proteinase inhibitor (SLPI) levels in children with Mycoplasma pneumoniae pneumonia (MPP). Methods Clinical data and plasma SLPI levels of 136 children with MPP were retrospectively analyzed. Results From July 2011 to June 2013,136 children (male 80, female 56) with MPP were included in the study. The onset ages of all children ranged from 11 months to 14 years (mean age, 6.2±3.0 years), and 82.4% of the cases were at the age of 4 to 14 years. One hundred and twenty six cases (92.7%) with long-last high fever, 83.8% with cough, 74.3% with rale were found in the study. Small or large patchy shadows in chest X-ray radiography were found in all the cases. At the acute phase, 72.1% with low white blood cell count, 59.6% with normal neutrophil cell and 63.2% with higher high sensitive C-reactive protein (hs-CRP) were observed. The SLPI level at the acute phase in 85 cases was (9.3±8.8) ng/ml, which was significant lower than that at the convalescent phase (11.8±8.0 ng/ml, Z = 3.08, P = 0.002). Conclusions The clinical features of MPP are usually presented with high fever, cough, higher hs-CRP, normal or lower white blood cell and neutrophil cell count, small or large patchy shadows in chest X-ray radiography. The plasma SLPI level at the acute phase was significantly lower than that in convalescent phase in children with MPP.

Clinical value of detecting serum N-terminal pro-brain natriuretic peptide and cardiac troponin I in children with severe pneumonia

HUANG Caizhi, MO Liya, YANG Juan, DENG Yongchao, LI Aiguo

. 2014, 32(8):  724.  doi:10.3969 j.issn.1000-3606.2014.08.007

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Objective To study the clinical value of serum N-terminal pro-brain natriuretic peptide (NT-ProBNP) and cardiac troponin I (cTnI) levels in children with severe pneumonia. Methods A total of 72 children with severe pneumonia in pediatric intensive care unit were divided into heart failure (HF) group and non-HF group according to the occurrence of heart failure, and 30 healthy children were selected as control group. Serum NT-ProBNP and cTnI levels were detected and analyzed. Results Compared with control group, NT-ProBNP and cTnI levels were significantly higher (P<0.01) in HF and non-HF group. The levels of NT-ProBNP and cTnI in HFgroup were both significantly higher (P<0.01) than that in non-HFgroup. Serum NTProBNP level was positively related to the level of cTnI(P=0.000) in children with severe pneumonia. The abnormal rate of cTnI in HF group was significantly higher (P=0.037) than that in non-HFgroup. The difference of the abnormal rate of NTProBNP between the two groups was not significant (P=0.375), however, the abnormal rate of NT-ProBNP was significantly higher (P=0.036) than that of cTnI in non-HF group. Conclusions There was obvious myocardial damage in children with severe pneumonia. NT-ProBNP and cTnI could be important serological markers to assist diagnosis of myocardial damage and its severity.

Pathological typing and clinical features in 70 cases of pediatric interstitial pneumonia

LI Min, WEI Zehong, YAN Xin, SONG Tao, DONG Yuan, ZHAO Minzhu, LIU Yunzhi, LI Jianbo, TANG Renkuan

. 2014, 32(8):  727.  doi:10.3969 j.issn.1000-3606.2014.08.008

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Objective　To better understand pathological types of pediatric interstitial pneumonia and improve clinical diagnosis by analyzing the clinical records and pathological typing of interstitial pneumonia. Methods 70 cases of children diagnosed as interstitial pneumonia by autopsy were retrospectively analyzed. Results The number of males was more than that of females. There was a significant predominance of infants less than 2 years. The clinical features include acute onset, rapid development, short duration and atypical clinical manifestations. Most patients had poor prognosis and curative effect with general therapies. Twelve cases had dubious etiology. Pathologic types of 58 cases with unclear etiology were diffuse alveolar damage type (DAD type, 38/58), desquamative interstitial pneumonia type (DIP type, 5/58), lymphoid interstitial pneumonia type (LIP type, 3/58), DAD type complicating DIP type (6/58), DAD type complicating LIP type (2/58), DAD type complicating respiratory bronchiolotitis-associated interstitial lung disease type (RB-ILD type, 3/58), DIP type complicating LIP type (1/58). Conclusions The confirmed diagnosis rate was relatively low for pediatric interstitial pneumonia. Postmortem examination was helpful for diagnosis and improving clinical diagnosis and pathological typing.

A clinical trial of duo positive airway pressure ventilation versus nasal continuous positive airway pressure in treatment of preterm infant with neonatal respiratory distress syndrome after INSURE

Dai Liying, ZHANG Jian, WANG Lili

. 2014, 32(8):  732.  doi:10.3969 j.issn.1000-3606.2014.08.009

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Objective To explore the efficacy of duo positive airway pressure ventilation in treating preterm infant with neonatal respiratory distress syndrome (RDS). Methods 65 preterm infants admitted to the neonatal intensive care unit from December 2012 to December 2013 were randomly divided into DuoPAP group (34 cases) or NCPAP (31 cases) group. Blood gas analysis(pH value, PaO2, PaCO2 and OI) at 1h, 12h, 24h, and 72h, and incidence of apnea, pulmonary air leak, repeated application of pulmonary surfactant and non-invasive ventilation failure at 72h in the two groups were measured and compared after using intubate surfactant extubate (INSURE). Results OI after non-invasive ventilation at 1h, 12h, and 24h was significantly higherin DuoPAP group than that in NCPAP group P<0.01). PaCO2 after non-invasive ventilation at 1h, 12h, 24hand 72h was significantly lower in DuoPAP group than that in NCPAP group (P<0.01). PaO2 after non-invasive ventilation at 1h and 12h was higher in DuoPAP group than that in NCPAP group, and there was significant difference between the two groups (P<0.01). The incidence of non-invasive ventilation failure, apnea in 72h was lower in DuoPAP group than that in NCPAP group, and there was significant difference between the two groups (P<0.05). Conclusions Compared with NCPAP, DuoPAP is more feasible for improving oxygenation, decreasing the need for mechanical ventilation in 72h in preterm infants with neonatal RDS.

Clinical significance of angiotension II in children with IgA nephropathy

RU Liang, ZHANG Xin, ZHU Hongtao,GUO Yanfang

. 2014, 32(8):  736.  doi:10.3969 j.issn.1000-3606.2014.08.010

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Objective To investigate the clinical significance of the changes of angiotensionⅡ (AngⅡ) in children with IgA nephropathy (IgAN). Methods Thirty children diagnosed as primary IgA nephropathy by renal biopsy (IgAN group) and 30 healthy children (control group) were recruited from May 2008 to December 2012. The serum and urine AngⅡ were measured by ELISA and compared between IgAN group and control group. The AngⅡ expression in the renal tissue of IgAN group was detected by immuno-histochemical method, and was correlated with other clinical data.. Results Urine AngⅡ was significantly higher in the primary IgAN group than that of control group (P < 0.05); AngⅡ expression in the urine is positively correlated with proteinuria (r=0.37, P=0.046), and is associated with the severity of clinical presentation; AngⅡ expression in kidney tissue increased with the severity of the renal histopathologic grading (r=0.69, 0.79, P=0.000), while AngⅡ in blood and proteinuria, AngⅡ expression in kidney tissue were not significantly correlated with the number of crescents. Conclusions Urine AngⅡ in children with IgAN is significantly correlated with the severity of the pathologic stage and the level of proteinuria. Urine AngⅡdetection may be useful to assess the progress and prognosis of chronic kidney disease.

Urine neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 in predicting acute kidney injury of critically ill children

Zhong Fazhan, Gao Yan, Deng Huiying, Liao Xin

. 2014, 32(8):  740.  doi:10.3969 j.issn.1000-3606.2014.08.011

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Objective To test the predicative roles of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1( KIM-1 ) for acute kidney injury (AKI) in critically ill patients. Methods Children from pediatric intensive care unit, were randomly divided into four groups: critically ill patients with AKI (group 1 ), critically ill patients with non- AKI (group 2) , chronic kidney disease group (group 3), healthy control group (group 4). 1.5 ml venous blood and urine specimens were collected and kept under -70°C. Serum creatinine , urine NGAL and urine KIM-1 were analyzed. Results Compared with group 2, group 3 and group 4, the urine NGAL and urine KIM-1 increases obviously in group 1 (P<0.05). There is no significance of urine NGAL and urine KIM-1 between group2, group3 and group 4 (P> 0.05). The concentration of urine NGAL increased more than 10 times of base-line level 2 days before the diagnosis of AKI under the Acute Kidney Injury Network standard with area under curve (AUC) 0.955 (P <0.05) , and the concentration of urine KIM-1 increased more than 5 times of base-line level 1 day before AKI with AUC 0.878 (P <0.05). The AUC was 0.984 (P <0.01) when they were combined. There is negative correlation between the increased times of urinary KIM-1, urinary NGAL and vally value of creatin clearance rate. Conclusions The concentrations of urine NGAL and urine KIM-1 are useful early biomarkers for predicting AKI, especially when they were combined.

The MRP1 expression in childhood acute lymphoblastic leukemia and its clinical significance

QIU Baoling, WU Dong, HONG Dan, ZHOU Qi, LU Jun, FAN Junjie, CENG Jiannong, HU Shaoyan

. 2014, 32(8):  745.  doi:10.3969 j.issn.1000-3606.2014.08.012

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Objective Multidrug resistance-associated protein 1 (MRP1) has been reported with a close correlation with tumor multi-drug resistance. Real-time quantitative PCR (QRT-PCR) was performed to detect the MRP1 gene expression in childhood acute lymphoblastic leukemia (ALL) and its clinical significance was analyzed. Methods Sixty-seven denovo ALL patients and 10 healthier children as bone marrow donor were studied. The chemotherapy was given according to CCLG-2008 protocol. SPSS software was employed to analyze the data and p-value below 0.05 was regarded as statistic significance. Results MRP1 expression level showed a close correlation with ALL risk, the median of MRP1 expression was 4.28 (2.75~6.12), 5.62 (4.99~8.60) and 7.56 (3.66~11.13) for standard-risk group (SR), intermediate-risk group (IR) and high-risk group (HR), respectively. MRP1 mRNA expression in T-ALL group was 7.71 (6.49~14.35), which is higher than that of B-ALL (5.18(3.89~8.46)) (P<0.01). The rate of leukemia cells’ sensitivity to prednisone on 7th day was 70.6% in high expression group (n=34), which was significantly lower than that in low expression group (n=33, 90.9%, P=0.035). The complete remission rateon 33th day was 64.7% in high expression group, and 87.9% in low expression group, which showed a significant difference between them (P=0.026). Conclusions In children ALL, the expression of MRP1 is closely related with immunophenotyping, treatment response, hazard level and disease relapse.

Application of narrow band imaging system in diagnosis and treatment of Peutz-Jeghers syndrome in children

GU Zhujun, LIU Haifeng,HU Zhihong, ZHANG Ting, CHENG Weiwei, LIU Hong

. 2014, 32(8):  750.  doi:10.3969 j.issn.1000-3606.2014.08.013

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Objective　To investigate the clinical significance of narrow-band imaging (NBI) system in the diagnosis and treatment of Peutz-Jeghers syndrome (PJS) in children. Methods To retrospectively summarize the clinical data of 15 cases diagnosed with PJS, and compare with 70 cases diagnosed with juvenile polyp. And all of the polyps were further diagnosed with pathological examination and the histological type should be analyzed.The polyps of 15 children with PJS were diagnosed with the white light imaging (WLI) and the NBI system, respectively. The pit patterns of various polyps was observed with NBI. We made a comparison between the sensitivity and specificity of NBI and WLI in diagnosis of adenomatous polyps. Result 76 lesions in 15 cases were detected by the WLI and NBI system,including adenomatous polyps (12) and harmatoma (64) which were further diagnosed by pathological examinations.By using the NBI system,69.7% (53/76)PJS polyps (pit patterns)were diagnosed as type Ⅰ and 27.6% (21/76) PJS polyps were diagnosed as type Ⅱ or Ⅲ .By using the NBI system，the sensitivity and specificity for diagnosing PJS polyps were 83.3% (10/12)and 98.4％ (63/64)，which were obviously higher than those by using the WLI system (P<0.05). Conclusion Observation of pit patterns of polyps by the NBI system can help predict the pathological changes of PJS polyps.By using the NBI system,the sensitivity and specificity of the diagnosis of adenomatous polyps are higher than those by using the WLI system.It has guiding significance to choose the method to remove a polyp.

Assessment of infantile hypertrophic pyloric stenosis with ultrasonic measurements

TIAN Hui, JU Hongjuan, LIU Zhentong, CAO Yanmei, ZHANG Tongdi

. 2014, 32(8):  754.  doi:10.3969 j.issn.1000-3606.2014.08.014

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　Objective　To determine whether pyloric measurements with ultrasound, that muscle thickness and channel of pyloric, correlated with weight and age in patients with hypertrophic pyloric stenosis (HPS). Methods A retrospective analysis was conducted on 111 cases diagnosed with HPS by operation from 2008 to 2012. Pearson correlation and linear regression analyses were used to determine if there were sta¬tistically significant associations between these combinations of factors: age and pyloric muscle thickness, weight and pyloric muscle thickness, age and pyloric length, and weight and pyloric length. Results Patients’mean age was 39.1 d (8-92 days). Their mean weight was 4.3 kg (2.2-7.9 kg). Mean pyloric muscle thickness was 4.8 mm (2-4.6 mm), and mean pyloric length was 17.5 mm (12-23.5 mm). Pearson correlation coefficient analysis showed a significant correlation between age and muscle thickness (r=0.6, P<0.001) as well as weight and muscle thickness (r=0.486, P<0.001). No significant correlation was found be¬tween pyloric length and age or weight. Linear regression analysis demonstrated similar results. Conclusions In patients with HPS, pyloric muscle thickness was directly related to age and weight. Smaller and younger infants with suspected diagnosis of HPS should be followed up even though the minimum diagnostic criterion for muscle thickness or length was not found on ultrasound.

Diagnosis of one case with 7p15.3p22.1 microdeletion by applying array-based comparative genomic hybridization

PENG Wei, YANG Xiao, LIU Xin, WU Honglin, WANG Yan

. 2014, 32(8):  757.  doi:10.3969 j.issn.1000-3606.2014.08.015

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Objective To investigate the diagnosis of a case with 7p15.3p22.1 microdeletion by applying array-based comparative genomic hybridization (array-CGH) and to analyze the relationship between the clinical manifestations and 7p15.3p22.1 microdeletion. Method Array-CGH technique was used to detect genomic copy number variations (CNVs) in an infant with normal karyotype after conventional chromosomal karyotyping. Results Array-CGH detected 7p15.3p22.1 deletion (chr7: 6777262-23981753), which was confirmed as pathogenic CNV after comparative analysis with database. Conclusion Array-CGH could serve as a useful complement for G-banding to be used in the clinical cytogenetic diagnosis.

Association between polymorphism of CD40 gene and clinical characteristics in Kawasaki disease

DONG Qizhang,ZHANG Chao, LI Yueru

. 2014, 32(8):  760.  doi:10.3969 j.issn.1000-3606.2014.08.016

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Objective To investigate the association between nucleotide polymorphisms (rs1569723 in CD40 gene) and clinical characteristics in Kawasaki disease (KD) in Han Chinese children. Methods A case-control study was performed，and 179 children with KD and other 197 normal children served as controls were included. The SNP genotypes were detected using PCR-RFLP, and all data were analyzed by SPSS 19.0. Results It was found that the SNP (rs1569723) was associated with KD (P=0.048), and the frequency of A allele in KD group was higher than that in control group (OR=1.505, 95%CI:1.095-2.070, P=0.012). SNP genotypes were associated with rash and lymphadenopathy (P=0.041, 0.047), but not associated with conjunctival hyperemia, hand-foot edema, oral mucosa lesions, and coronary artery lesion (P=0.688,0.758, 0.557, 0.552). Conclusions Genotypes of SNP (rs1569723) were associated with KD susceptibility, and A-allele is a risk allele. The SNP loci might be associated with rash and lymphadenopathy in KD in Han Chinese.

Clinical significance of procalcitonin in the differentiation of blood stream infection and contamination

Zhang Ye, Zhang Lin, Wu Guoxiong, Liu Ying

. 2014, 32(8):  763.  doi:10.3969 j.issn.1000-3606.2014.08.017

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Objective To preliminarily explore the role of serum procalcitonin (PCT) quantization in differntiating coagulase-negative staphylococci (CNS) blood stream infection and contamination derived from blood culture in children. Methods Clinical data of 83 cases of CNS derived from blood culture in People’s Hospital of Changning city, Hunan province between January, 2013 and December, 2013 were retrospectively reviewed. The cases were divided into blood stream infection group and contamination group. The basic demographic characteristics, origins of patients, C reactive protein, time to positivity of blood culture (TP), procalcitonin were compared between the two groups, and the diagnostic performance of PCT according to the ROC curve were analyzed. Results Age, gender, C reactive pretein and TP showed no difference between blood stream infection group (n=38) and contamination group (n=45)(P>0.05), while the proportion of contamination of patients from medical wards was higher than that from surgery wards (P<0.05). PCT was significantly higher in blood stream infection group than that of contamination group (P<0.001). The diagnostic sensitivity, spectivity, accuracy of PCT in differentiating the two groups were 86.8%, 82.2% and 84.3%, respectively, at the best cutoff of 0.195 ng/ml. Conclusions PCT may be a good marker for differentiating CNS blood stream infection and contamination derived from blood culture in children, and may help clinicians make early and reasonable selection of antibiotics.

The impact of bacterial lysate on asthma prevention in mouse

LIU Jing, ZHOU Xiaojian, HONG Jianguo

. 2014, 32(8):  767.  doi:10.3969 j.issn.1000-3606.2014.08.018

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Objective To establish mouse allergic asthma model and observe the effect of bacterial lysates (OM-85BV) on airway inflammation. Methods Forty-eight 4 to 6 weeks healthy male BALB/c mice were used as research subjects and randomly divided into six groups, a: control group; b: OM-85BV contral group; c: allergic asthma model; d: dexamethasone group (Dex group); e: OM-85BV A group; f: OM-85BV B group (the intervention time was prolonged 10 days than group e). BALB/c mice were sensitized and challenged with ovalbumin (OVA). Mice in groups c, d, e and f were intraperitoneally administered with antigen (OVA)-Al(OH)3 on days 1, 8 and 15, others were administered by PBS. From the 17th day to the 26th day, Mice in group f were treated with OM-85BV and others were treated with normal saline. In the next days, mice in groups c, d, e and f were intranasal given OVA for 5 consecutive days. Additionally, mice in groups b, e and f were treated with OM-85BV before challenge, while mice in the group d were administered by Dex, others were treated with normal saline at the same dose. Twenty four hours after the last intranasal administration, mice were anesthetized and dissected. Lungs were lavaged with PBS and bronchoalveolar lavage fluid (BALF) was obtained. The total inflammatory cells and eosinophils in BALF were counted. The total IgE levels of blood serum and IFN-γ/IL-4 levels of lavage were detected. The removed parts of lung tissue were collected for histological examination. Results Compared with groups a and b, lung tissue biopsies by HE staining from the asthma group showed obvious airway inflammation. The situation of groups d and f was significantly improved than group c, while the differences between groups e and c were not evident. Total cells and the number of eosinophils in BALF of group c (90.3±13.94×104/ml) were significantly higher than that in groups a and b. Compared with the control group, levels of IL-4 in BALF (119.03±19.92 pg/ml) and IgE in serum (15.86±1.97 ng/ml) increased and levels of IFN-γ in BALF (90.50±13.51 pg/ml) reduced significantly. The corresponding levels of groups d, e and f were significantly improved than group c (P<0.01). Conclusions Administered by OM-85BV helps regulate the balance between Th1/Th2 in asthmatic mice, reduce airway inflammation, and prevent the occurrence and development of airway inflammation

Effects of NS1619 on airway remodeling and expression of α-SMA and PDGF-BB in asthmatic mice

HONG Can, WU Yi, ZHAO Zhongxiu

. 2014, 32(8):  772.  doi:10.3969 j.issn.1000-3606.2014.08.019

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　Objective　To study the mechanism of NS1619 on airway remodeling in asthmatic mice. Methods A total of 24 healthy female BALB/c mice were randomly divided into 3 groups: the control group, the oval albumin (OVA) group (the asthma group) and the NS1619 group (the intervention group), 8 mice in each group. Asthma group was induced with OVA, challenged by continuous inhalation with 5% OVA from day 19 to 23, then changed to 3 times per week from day 24 to 55. Intervention group was inhaled with NS1619 (30 μmol/L) before OVA. Control group was given with normal saline. The thickness of airway smooth muscle and the area of collagen deposition in lung tissue slices were observed by HE and Masson staining, measured by a computer assisted image analysis system. The concentration of α-smooth muscle actin (α-SMA) in cells was detected by immunohistochemistry. The expression of platelet derived grouth factor-BB, PDGF-BB (PDGF-BB) in serum was measured by immunosorbent assay. Results Compared with the asthma group, the pathologic changes of lung tissue, the thickness of airway smooth muscle and collagen deposition in the group treated with NS1619 were significantly decreased (P<0.05). Compared with the asthma group, the levels of α-SMA in cells and PDGF-BB in serum in NS1619 treated group were significantly decreased (P<0.05). Conclusions NS1619 partly inhibited airway remodeling in asthmatic mice, partially by down-regulating the expression level of α-SMA and PDGF-BB.

The expression and role of integrin-linked kinase in neonatal rats after hypoxia-ischemia brain damage

PAN Lingli,QU Yi, LUO Lili, ZHAO Jing, LI Jiao, TANG Jun, WU Jinlin, LI Xihong, MU Dezhi

. 2014, 32(8):  776.  doi:10.3969 j.issn.1000-3606.2014.08.020

Abstract ( 295 )   PDF (1581KB) ( 252 )  

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Objective To investigate the possible function of integrin-linked kinase (ILK) / protein kinase B (PKB/Akt) signaling in repair of neonatal rat hypoxia-ischemia brain damage (HIBD). Methods Postnatal day 10 SD rats were randomly divided into hypoxia ischemia (HI) group and sham control group. Rat brains were collected at 0 h, 4 h, 6 h, 12 h, 24 h, 48 h and 72 h after hypoxia ischemia damage. Immunofluorescence staining was used to observe the distribution and expression of ILK. Western blot was used to detect the expression of ILK, Akt, phosphorylated Akt (p-Akt) and vascular endothelial growth factor (VEGF). Lentiviral vectors expressing ILK shRNA were constructed to inhibit the expression of ILK in neonatal rats. After intracerebroventricular injections of LV-ILK shRNA lentivirus and LV-control respectively, HIBD model was established. Rat brains were collected at 4 h and 24 h after HIBD. Western blot was used to detect the expression of ILK, p-Akt, and VEGF. TdT-mediated dUTP-biotin nick end labeling (TUNEL) staining was used to detect cell apoptosis. Results Immunofluorescence staining showed that ILK was widely distributed in cortex and hippocampus both in HI group and sham control group. ILK located at cell membrane and cytoplasm. Western blot results demonstrated that ILK protein increased after HI, with a peak at 24 h, and maintained higher level than those in sham control group. The p-Akt protein significantly increased at 4 h after HI, and significantly decreased in the following 24 h, and then increased again, with a peak at 48 h, but the level of p-Akt protein was higher than that of sham control group. The VEGF protein increased at 4 h after HI, with a peak at 12 h, higher than that of sham control group. The expression of Akt protein showed no significant difference between HI group and sham control group. Lentiviral vectors containing RNAi targeting ILK was applied successfully in vivo. At 4 h and 24 h after HIBD model, the expression of ILK, p-Akt, and VEGF proteins in right side brain received LV-ILK shRNA significantly decreased compared with those of right side brain received LV-control at the same time point. And cell apoptosis significantly increased in LV-ILK shRNA group. Conclusions The expression of ILK, p-Akt, VEGF proteins increased after HI. By inhibiting the expression of ILK, the expression of p-Akt and VEGF proteins can be reduced, and cell apoptosis could increase in newborn rats after HIBD. The results suggest that ILK may induce the expression of VEGF through activating the PI3K/Akt signaling pathway, and promote cell survival and angiogenesis after HIBD.

Establishment of bone marrow failure mouse model and detection of FGF2 expression

CAO Ping, JIANG Shayi, QIAO Xiaohong, XIE Xiaotian, LI Fuxing

. 2014, 32(8):  782.  doi:10.3969 j.issn.1000-3606.2014.08.021

Abstract ( 355 )   PDF (1189KB) ( 211 )  

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Objective　Previous study found that fibroblast growth factor-2(FGF2) expression was at a low level in bone marrow of children with aplastic anemia. In this study, we established a bone marrow failure animal model to investigate whether FGF2 is involved in bone marrow failure. Methods BALB/c mice were irradiated by 5.0 Gy ray, and then infused with 1×106 lymphocytes from allogeneic mice lymph node. Peripheral blood cells and bone marrow mononuclear cells counting and bone marrow pathology were done. FGF2 protein in bone marrow mononuclear cells was measured by ELISA. Results Compared with the control group, the counting of hemoglobin, white blood cell, platelet and bone marrow mononuclear cell in aplastic anemia mouse model were significantly deceased (P<0.05). Moreover, FGF2 expression in aplastic anemia mouse model were significantly reduced (P<0.05). Conclusions 5.0 Gy ray irradiation and then 1×106 lymphocyte infusion in mice can induce bone marrow failure similar to the features of aplastic anemia. The low expression of FGF2 in bone marrow of aplastic anemia patients may play an important role in the pathogenesis of aplastic anemia.

Analysis of 15 case with Bartter syndrome and literature review

Yang Xuejun, Li Qiu

. 2014, 32(8):  785.  doi:10.3969 j.issn.1000-3606.2014.08.022

Abstract ( 380 )   PDF (1185KB) ( 448 )  

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Objective To investigate the clinical manifestations, diagnosis and treatment of Bartter syndrome in children. Methods Clinical data of 15 patients with Bartter syndrome in Children`s Hospital Affiliated to Chongqing Medical University was analyzed, and pertinent literatures were reviewed. Results Bartter syndrome is an autosomal recessive inherited renal disorder characterized by hypokalemia, hypochloremia, metabolic alkalosis, vomiting, growth retardation, the activation of the renin-aldosterone axis, normal blood pressure. Genetic analysis is the most reliable way for diagnosis. Comprehensive therapy with antisterone, indomethacin, catopril and potassium have remarkable effect. Conclusions Bartter syndrome should be considered when children have unreasonable continuous hypokalemia, hypochloremia, metabolic alkalosis and growth retardation. It can be clinically diagnosed by clinical manifestation and hydrochlorothiazide test, and genetic analysis is the most reliable way. It can be ameliorated by potassium and magnesium supplementation, antialdosterone medications, prostaglandin inhibitors and antisterone. Considering the following electrolyte disturbances, infections, growth retardation, kidney failure and even death，Bartter syndrome need lifelong treatment, early diagnosis and treatment is of the most importance.

Effects of leukotriene receptor antagonists on airway remodeling and Th17 cells/CD4⁺ CD25⁺ regulatory T cells expresson in asthma

Reviewer：LI Li, Reviser：LI Min

. 2014, 32(8):  789.  doi:10.3969 j.issn.1000-3606.2014.08.023

Abstract ( 358 )   PDF (1176KB) ( 593 )  

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The airway remodeling of bronchial asthma is the result of repeated airway inflammation. Its occurrence is a complex process involving many cytokines, inflammatory mediators and associated cellular components, of which leukotrienes are important mediators of inflammation in the airway remodeling. Many factors influence Airway remodeling. In recent years, effects of Th17 cells and CD4+CD25+ regulatory T cells (CD4+ CD25+ treg cells) on airway remodeling is growing in importance. Leukotriene receptor antagonist is an effective drug in the treatment of asthma and can suppress airway remodeling. But the exact mechanisms and its impact on the proportion of Th17 cells/CD4+CD25+treg cells is not yet clear. Therefore, the clarification of the changes of Th17 cells/CD4+CD25+treg cells expression in airway remodeling and the specific pathways, biological effects, influence of the proportion of Th17 cells/CD4+CD25+treg cells expression after leukotriene receptor antagonist intervene can provide a new target for prevention and the treatment of asthma in the future.

Application and progress of magnetic resonance imaging in diagnosis of pediatric tumors

WANG Xiaoxia, ZHONG Yumin

. 2014, 32(8):  793.  doi:10.3969 j.issn.1000-3606.2014.08.024

Abstract ( 341 )   PDF (1182KB) ( 287 )  

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　Magnetic resonance imaging (MRI), featuring as no ionizing radiation, higher soft tissue resolution and multiplanar imaging, has been widely used in the diagnosis of pediatric tumors. Conventional MRI techniques mainly provide information on morphological information of tumors but cannot display physiological and pathological changes in tumors. In recent years, with rapid development of MRI hardware and software, some functional MRI technologies have been applied in clinical practice and have become an important trend on pediatric oncology. These techniques include perfusion-weighted imaging, diffusion-weighted imaging, magnetic resonance spectroscopy, susceptibility weighted imaging. These new technologies can demonstrate the microstructural information of tumors, which will provide more helpful information for diagnosis, treatment and follow-up in pediatric tumors when combined with conventional MRI techniques.