Table of Content

15 January 2014 Volume 32 Issue 1

  

Original Article

Opinion in development of clinical immunology WANG Xiaochuan (Department of Clinical Immunology, Children's Hospital of Fudan University, Shanghai 201102, China)

. 2014, 32(1):  1-3. 

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Clinical immunology is one of the newly developed clinical specialties and is still in its infancy. The definition of the specialty and specialists, the professional academic organization and the category of specialty are in the process of improving. This article reviews the clinical immunology's phylogeny and summarizes its characteristics. Hoping to attract the attention of pediatrics.

Predictive value of catalase, paraoxonase, malondialdehyde level for children with Henoch-Sch?nlein purpura　WU Lijuan, LIU Cuihua, TIAN Ming (Department of Kidney and Rheumatology, The Children's Hospital of Zhengzhou, Zhengzhou 450000, Henan, China)

. 2014, 32(1):  4-7. 

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　Objective　To investigate the significance of serum catalase (CAT), paraoxonase (PON) and malondialdehyde (MDA) in children with Henoch-Sch?nlein purpura (HSP). Methods A total of 47 children with HSP were selected from April 2009 to October 2011, meanwhile 20 healthy children were selected as normal controls. The serum CAT, PON, MDA were detected and compared between two groups, and the association of CAT, PON and MDA levels with urine protein levels were analyzed in children with HSP. Results In children with HSP, the levels of CAT and PON were significantly lower and MDA levels were significantly higher than those in the control group (P<0.05). HSP patients with hematuria or proteinuria had significantly lower levels of CAT and PON than those without hematuria or proteinuria, while HSP patients with proteinuria have significantly higher level of MDA than those without proteinuria (P<0.05). In children with HSP, the serum levels of CAT and PON were negatively correlated with urine protein levels (r=-0.674, -0.647, P<0.05) while MDA level was positively correlated with urine protein levels (r=-0.659, P<0.05). Conclusions The levels of CAT and PON were decreased and MDA was increased in children with HSP, and so they can be used to evaluate the severity of nephropathy.

Detection of Th17/Treg cells balance in peripheral blood in children with Henoch-Sch?nlein purpura complicated by Mycoplasma pneumoniae infection　ZHANG Guohui¹, WU Fuling², LI Xiaomei², HAN Zhaodong³, LI Ying-ying², SHI Tao² (1.Department of Pediatrics, Binzhou Medical University, 2.Department of Pediatrics of Affiliated Hospital, 3.Clinical Medicine Experiment Centre of Affiliated Hospital, Binzhou Medical University, Binzhou 256603, Shandong, China)

. 2014, 32(1):  8-11. 

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　Objectives　To investigate the role of Th17/Treg cells imbalance in the pathogenesis of Henoch-Sch?nlein purpura (HSP) complicated by Mycoplasma pneumoniae (MP) infection in children. Methods Eighteen MP-IgM-positive HSP children (HSP-MP group), 40 MP-IgM-negative HSP children (HSP group), 23 MP-IgM-positive non-HSP children (MP group) and 19 healthy children (control group) were enrolled. The percentages of Th17 and Treg cells in peripheral blood in all objects were detected by flow cytometric analysis (FCM), and serum levels of IL-17, IL-6 and TGF-β were measured by ELISA. Results The percentage of Th17 cells and the levels of IL-17 and IL-6 in HSP-MP group were significantly higher than those in other three groups (P<0.05). The percentage of Th17 cells and the levels of IL-17 and IL-6 in HSP group and MP group were significantly higher than those in control group (P<0.05). The percentage of Treg cells in HSP-MP group were significantly lower than those in other three groups (P<0.05). The percentage of Treg cells in HSP group and MP group were significantly lower than those in control group (P<0.05). There was no significant difference in the percentage of Th17 and Treg cells and the levels of IL-17 and IL-6 between HSP group and MP group (P>0.05). There was no significant difference in level of TGF-β among the four groups (P>0.05). Conclusions The imbalance of Th17/Treg cells in peripheral blood may contribute to the development of HSP complicated by MP infection in children.

Analysis of correlation between IgA-AECA and ICAM-1 in children with Henoch-Sch?nlein purpura　CHEN Baiyu, YANG Guanglu, REN Shaomin (Department of Pediatrics, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia, China)

. 2014, 32(1):  12-14. 

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　Objectives　To detect the levels of anti-endothelial cell IgA antibodies (IgA-AECA) and intercellular adhesion molecule-1 (ICAM-1) in children with Henoch-Sch?nlein purpura, and to analyze the correlation between IgA-AECA and ICAM-1. Methods A total of 36 children with HSP were enrolled， 26 without renal impairment (HSP group), and 10 with renal impairment (HSPN). The concentrations of IgA-AECA and ICAM-1 in serum were detected by enzyme linked immunosorbent assay (ELISA). Results The serum levels of IgA-AECA and ICAM-1 in HSPN group were significantly higher than those in HSP group (P<0.01). The serum level of IgA-AECA showed positive correlation with the level of ICAM-1 (r=0.746, P<0.01). Conclusions IgA-AECA may play an important role in the development of HSP and HSPN by up-regulating the express of ICAM-1.

Relationship between hypoalbuminemia and prognosis of disseminated intravascular coagulation in newborns 　LIAO Zhenyu, GAO Xirong (Department of Neonatology, Hunan Children's Hospital, Changsha 410007, Hunan, China)

. 2014, 32(1):  15-18. 

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　Objective　To explore the relationship between hypoalbuminemia and prognosis in newborns with disseminated intravascular coagulation (DIC). Methods A total of 142 newborns diagnosed with DIC were divided into normal albumin group (≥30 g/L) and hypoalbuminemia group (<30 g/L) according to the albumin levels within 24 hours of admission. Moreover, the relationship between albumin levels and clinical manifestation, laboratory indices and prognosis of newborns with DIC were analyzed. Results The occurrence rate of hypoalbuminemia in 142 DIC newborns was 68.3% (97/142). The mortality of newborns with DIC in hypoalbuminemia group was 42.3%, significantly higher than that of normal albumin group (22.2%) (P<0.05). Compared with normal albumin group, in hypoalbuminemia group, the rates of shock and multiple organ dysfunction were significantly higher, the prothrombin time (PT) and activated partial thromboplastin time (APTT) were significantly longer, and the platelet count (PLT) was significantly reduced (P<0.05). The level of serum albumin in non-survived group was sinificantly lower than that of the survived group (P<0.05). Conclusions Hypoalbuminemia is common among newborns with DIC, and serum albumin level is closely related to the prognosis.

Influence of residual amniotic fluid index on pregnancy and newborn outcome in preterm premature rupture of the membranes　ZHANG Xiuyun (Department of Gynecology and Obstetrics, Ningdong Hospital, Ningxia Hui Autonomous Region, Ningdong 750001, Ningxia, China)

. 2014, 32(1):  19-22. 

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　Objective　To investigate the effects of residual amniotic fluid index (AFI) on pregnancy and newborn outcome in preterm premature rupture of the membranes (PPROM). Methods The clinical data of 653 cases of pregnant women with PPROM admitted to hospital from February 2005 to December 2012 were retrospectively analyzed. All participants were divided into two groups according to AFI cutoff value determined by ROC curve, group A (AFI ≤ 40 mm, n=252) and group B (AFI > 40 mm, n=401). Pregnancy outcome and newborn prognosis of the two groups were compared and analyzed. Results The interval between rupture of membranes and delivery in group A was (69.54±14.25) h, significantly shorter than that in group B (136.96±9.54) h (P<0.01). There was no difference in gestational age at membrane rupture, cesarean section rate, the rates of fever and placental abruption between two groups (P>0.05). The case fatality rate of newborns in group A was 3.57%, significantly higher than that of group B (1.25%) (P<0.05). However, there was no difference in 1-minute Apgar score, birth weight, sex ratio, gestational age, the rates of asphyxia, fetal distress and perinatal infection between two groups (P>0.05). Logistic regression analysis revealed that AFI≤40mm was an independent risk factor for neonatal death (OR=2.31, P<0.05) and asphyxia (OR=3.05, P<0.05), moreover, gestation age at membrane rupture was an independent risk factor for neonatal death (OR=1.79, P<0.05). Conclusions AFI was related closely with several adverse maternal and neonatal outcomes in PPROM, and so AFI≤40mm can be used as pregnancy termination threshold to reduce the occurrence of adverse pregnancy outcome.

The clinical analysis of 24 cases of neonatal paroxysmal supraventricular tachycardia treated with transesop-hageal atrial pacing　 WEI Dong, GONG Xiaohui, QIU Gang, YAN Chongbing, SUN Jingjing (Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai 200040, China)

. 2014, 32(1):  23-25. 

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　Objectives　To improve the knowledge in the treatment of neonatal paroxysmal supraventricular tachycardia (PSVT) with transesophageal atrial pacing (TEAP). Methods Clinical data of 24 newborns with PSVT treated with TEAP were analyzed retrospectively. Results A total of 24 term PSVT newborns (14 males and 10 females) with an ave-rage age of (8.46±8.28) d (15 h~28 d) were enrolled in this study. Successful conversion to sinus rhythms after using TEAP once was seen in 11 cases, in 5 cases after using TEAP twice, and in 3 cases after using TEAP three times; atrial fibrillation occurred in one case after 2nd TEAP and successful conversion to sinus rhythms finally occurred after using TEAP twice more; TEAP had no effect in four cases. Between PSVT newborns having successful conversion after using TEPA once and other PSVT newborns, there were no differences in incidences of birth asphyxia, respiratory or digestive infection, sepsis, congenital heart diseases, myocarditis, hypocalcemia, hyponatremia, abnormal myocardial enzymes, abnormal heart shadow on chest X-ray, recurrence rate of PSVT, and heart rate, blood pressure and hospitalization time. Conclusions TEPA is an effective treatment for neonatal PSVT.

Value of heart murmurs, dyspnea and transcutaneous oxygen satuation in screening for neonatal congenital heart diseases HU Yu¹, YU Jing¹, GUAN Lirong¹, LI Zhuoya², ZHENG Xiaolan¹, WU Xiaofang¹, WANG Xiaoshuang¹ (1.Department of Pediatrics, Mianyang Central Hospital; 2.Department of Pediatrics, Mianyang City People's Hos-pital , Mianyang 621000, Sichuan, China)

. 2014, 32(1):  26-29. 

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　Objective 　To explore a more reliable and easy-to-use method for the screening of neonatal congenital heart diseases (CHD). Methods Totally 5 350 newborns delivered from January 2012 to December 2012 were involved in this study. All participants received cardiac color ultrasound to make a definite diagnosis which was used to evaluate the validity, reliability and benefit ratio of such indicators as heart murmur, dyspnea and transcutaneous oxygen satuation (SpO₂)<95% in the screening of neonatal CHD. Results The sensitivity and specificity were in the range of 29.03% to 81.71%, reliability was 39.10% to 81.35%, and benefit ratio was 1.49% to 99.37% when heart murmur, dyspnea and abnormal SpO₂ were used separately as the screening indicators for CHD. When their combination such as heart murmurs plus dyspnea, heart murmurs plus abnormal SpO₂, dyspnea plus abnormal SpO₂, and heart murmurs plus dyspnea plus abnormal SpO₂ were used for screening, the sensitivity was decreased, while the specificity, reliability and benefit ratio were increased. Conclusions The combination of heart murmur, dyspnea and abnormal SpO₂ is useful in the screening of neonatal congenital heart disease.

Study on changes in heart rate deceleration capacity and variability and their correlation in healthy infants　YI Lanfen, WEN Hongxia, QIU Mei (Department of Electrocardiogram, Wuhan Children's Hospital, Wuhan 430016, Hubei, China)

. 2014, 32(1):  30-32. 

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　Objectives　To observe the changes in heart rate deceleration capacity (DC), acceleration capacity (AC) and heat rate variability (HRV) and their correlation in healthy infants. Methods A total of 82 healthy infants who were divided into early infant group (<6 months) and late infant group (6-12 months) received 24 h dynamic electrocardiogram examination. The DC and AC value, time domain indices (SDNN, SDANN, RMSSD, PNN50) and frequency domain indices (LF, HF) of HRV were measured automatically by computer and compared between two infant groups. Moreover, the association of DC, AC value and HRV indices was analyzed. Results In late infant group, the DC value was (3.96±1.53) ms, higher than that in early infant group (3.20±1.44) ms, while the AC value was (-3.84±1.10) ms, lower than that in early infant group (-3.11±0.95) ms, and the differences were significant (P<0.05). The DC value derived from 24-hour Holter recordings was negatively related to heart rate (r=-0.56, P=0.000), while positively related to SDNN, SDANN, RMSSD, PNN50, LF and HF (r=0.25~0.75, P<0.05). The AC value derived from 24-hour Holter recordings was positively related to heart rate (r=0.78, P=0.000), while negatively related to SDNN, SDANN, RMSSD, PNN50, LF and HF (r=-0.88~-0.56, P<0.01). Conclusions The DC value and HRV indices are increased with age while AC value was decreased with age. The DC and AC value are closely associated with heart rate and HRV indices.

Correlation between genotype and phenotype in patients with phenylalanine hydroxylase deficiency　SUN Yun, ZHANG Jingjing, SUN Yijun，CHEN Yuling, ZHANG Jin, HUANG Meilian, LIANG Xiaowei, JIANG Tao (Neonatal Screening Center, Nanjing Maternal and Child Health Hospital Affiliated to Nanjing Medical University, Nanjing 210004, Jiangsu, China)

. 2014, 32(1):  33-37. 

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　Objective　To explore the characteristics of the phenylalanine hydroxylase (PAH) gene mutations in the patients with phenylalanine hydroxylase deficiency (PAHD) in Jiangsu area, and to analyze the mutational spectrum of PAH and the correlation between genotype and phenotype in patients with PAHD. Methods Totally 70 children with PAHD and their parents were involved in this study. All 13 exons and their flanking intronic sequences of PAH gene were directly sequenced in these patients. Results 125 different mutations were detected with the relative frequency of 89.29% among 140 allelic genes. The prevalent mutations were EX6-96A>G (15.20%)，R243Q (14.40%) and R241C (13.60%). The prevalent mutations in classic phenylketonuria（PKU） were R243Q and EX6-96A>G (42.86%). The prevalent mutations in moderate PKU were EX6-96A>G, R241C and R111X (40.74%). The prevalent mutations in mild PKU were R241C，EX6-96A>G and R243Q (57.89%). The prevalent mutations in mild HPA were R241C and R243Q (40.00%). The consistency between prediction of the biochemical genotype and the observed phenotype was 65.63%, especially in classic PKU (81.25%). Significant correlations were disclosed between pretreatment levels of phenylalanine and AV sum (r=-0.77, P<0.001). Conclusions The frequency distribution of common PAH gene mutation in Jiangsu area was different from the other regions, the genotype of PAHD patients has correlation with the phenotype.

Application of fever risk score in children aged 3 months to 5 years having acute fever without obvious infection focus　ZHU Yidong¹, ZHOU Jianfeng², CHAI Jiannong¹, XU Yongmei¹, XIA Xiaohong¹ (1.Department of Pediatrics, Changshu No.1 People's Hospital, Changshu 215500, Jiangsu, China; 2.Changshu Traditional Chinese Medical Hospital, Changshu 215500, Jiangsu, China)

. 2014, 32(1):  38-42. 

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　Objective　To discuss the clinical value of fever risk score in evaluation of acute fever children without obvious infection focus aged 3 months to 5 years. Methods The fever risk score was composed of fever duration, living status, daily frequency of antipyretic administration, capillary refill time, periphery white blood count, neutrophil count, C reaction protein. A total of 839 children aged 3 months to 5 years with acute fever (body temperature ≥38℃) without obvious infection focus were evaluated prospectively by fever risk score and followed up. The sensitivity, specificity, positive and negative predictive values of fever risk score were calculated. Results Among 839 children, 94 children with a score of 0 had no serious disease and were treated at home, and antibiotics were orally administered in 24 children (25.54%). Among 474 children having the scores of 1~3, 141 children were diagnosed with serious illnesses, 112 children (23.63%) were hospitalized or under observation and 248 children (52.32%) were given antibiotics. Among 271 children having the score of 4, 167 children were diagnosed with serious illnesses and 17 with critical illnesses, 271 children (100%) were hospitalized or under observation and 250 children (92.25%) were given antibiotics. There were significant differences in incidence of serious illness and usage rate of antibiotics between children with scores of 0~3 and ≥ 4 (P<0.01). If score ≥ 1 was set as cut point, the sensitivity, specificity, negative predictive value, and positive predictive value for diagnosing serious diseases were 100%, 17.70%, 100% and 41.34%, respectively. If score ≥ 4 was set as cut point, the sensitivity, specificity, negative predictive value, and positive predictive value for diagnosing critical illnesses were 100%, 69.10%, 100% and 6.27%, respectively. Conclusions The fever risk score may be an available, easy-to-use tool to evaluate the condition of acute fever without obvious infection focus in children aged 3 months to 5 years for clinic doctors.

Analysis of pathogen and anti-microbial resistance in children with urinary tract infection and nephrotic syndrome accompanied by urinary tract infection RU Liang¹, LUO Qiong¹, GUO Yanfang² (1.Department of Pediatrics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang, China; 2. Department of Pedia-trics, Shanghai Pudong New Area Gongli Hospital, Shanghai 200135, China)

. 2014, 32(1):  43-47. 

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　Objective　To study the differences in pathogen, antimicrobial resistance between children with urinary tract infection (UTI) and nephrotic syndrome (NS) accompanied by UTI. Methods The clinical data and the results of midstream urine culture were collected and analyzed from children with UTI and NS accompanied by UTI. Results Among 44 UTI children and 52 NS children accompanied by UTI, there were 35 (79.55%) and 31 (59.62%) children had symptoms, respectively, and the difference was statistically significant (P<0.05). Forty-four pathoge- nic strains and 53 pathogenic strains were isolated from blood samples obtained from 44 UTI children and from 52 NS children accompanied by UTI, respectively. Escherichia coli was the dominant bacterial community in both UTI children and NS children accompanied by UTI, and the difference in isolation rate between two groups was not significant (P>0.05). However, the cocci isolation rate in UTI children (15.91% ) was significantly lower than that in NS children accompanied by UTI (33.96%) (P<0.05). The drug resistance of Escherichia coli was high isolated from both UTI children and NS children accompanied by UTI. Conclusions Compared with UTI children, the clinical manifestations of NS children accompanied by UTI were not typical. Asymptomatic bacteriuria was common and gram-negative bacilli were the dominant pathogenic bacteria with high antimicrobial resistance in NS children accompanied by UTI. The infection rate of gram-positive cocci was increased. So prior to the results of urine culture, the antibiotics with enzyme depressor should be chosen first.#br#Key words:　 urinary tract infection;　nephrology syndrome;　pathogen;　anti-microbial resistance

Fatty acid compositions of human breast milk in five regions of China　CHEN Aiju¹, ZHANG Weili¹, JIANG Minghua¹, HE Jiamin¹, WU Shengmei¹, HUANG Qitai², ZHENG Min² (1.Shanghai Institute for Pediatric Research, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; 2.Beijing Nutrition Institute, Shengyuan Nutritional Food Co., Ltd, Beijing 101101, China)

. 2014, 32(1):  48-54. 

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　Objective　To update the data of the fatty acid compositions in human milk from different regions of China. Methods A total of 156 healthy postpartum lactating women, who all deliver full-term infants were selected from five cities which were Shanghai, Chongqing, Changchun, Guangzhou and Hohhot. The human milk samples of postnatal day 1 to 7 and postnatal day 42 were collected successively from every participants. The fatty acid compositions of human milk were analyzed by high-resolution capillary gas chromatography. Results The total fatty acid (TFA) content in human milk was significantly increased from postnantal day 1 to 7 and postnantal day 42 (P<0.01). TFA content was higher in human milk on postnatal day 42 of Shanghai (34.96g/L), but lower in Guangzhou (29.72g/L). The saturated fatty acid (SFA) was significantly increased in human milk from postnatal day 1 to 7 and decreased on postnatal day 42 (P<0.05). The percentage of SFA in human milk was higher on postnatal day 42 in Hohhot (37.43%), but lower in Changchun (32.80%). The percentage of monounsaturated fatty acids (MUFA) in human milk was higher on postnatal day 42 in Chongqing (44.06%), but lower in Changchun (32.57%). Oleic acid (C18:1n-9) was one kind of MUFA with highest level in human milk. The percentage of oleic acid in human mild was higher on postnatal day 42 in Chongqing (39.97%). The percentage of linoleic acid (LA) in human milk was higher on postnatal day 42 in Changchun (30.82%), but lower in Chongqing (18.40%). The percentage of α-linolenic acid (ALA) in human milk was higher on postnatal day 42 in Changchun (2.12%), but lower in Guangzhou (0.79%). The percentage of docosahexaenoic acid (DHA) in human milk was higher on postnatal day 42 in Shanghai and Guangzhou (both were 0.41%), but lower in Hohhot (0.19%). The percentage of arachidonic acid (AA) in human milk was higher on postnatal day 42 in Guangzhou. Conclusions The study showed that the fatty acid compositions of human milk were significantly different in different regions of China.

Effects of perinatal factors on neonatal outcomes ZHAO Yuxiang, YUE Hongni, YANG Zhanhua (Neonatal Department of Huaian Maternal and Child Health Hospital, Huaian 223002, Jiangsu, China)

. 2014, 32(1):  55-58. 

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　Objective　To explore the effects of hypertensive disorder complicating pregnancy (HDCP) and premature rupture of membranes (PROM) on neonatal outcomes Methods　A total of 60 615 infants born in 151 hospitals in Huai'an from Jan 2010 to Dec 2010 were divided into differenct groups based on the presence of the HDCP and PROM. The clinical data were recorded and compared. Results　The gestational age and birth weight in HDCP group were significantly lower than those in non-HDCP group (P<0.05). The maternal age and the incidence rates of pregnant anemia, preterm, low birth weight, cesarean section, abnormal amniotic fluid, congenital anomalies, asphyxia, intracranial hematoma and case fatality rate were significantly higher in HDCP group than those in non-HDCP group (P<0.05). The gestational age and birth weight in PROM group were significantly lower than those in non-PROM group (P<0.05). The incidence rates of preterm, low birth weight, abnormal amniotic fluid, mild asphyxia, hypertensive disorder, pregnant anemia were significantly higher in PROM group than those in non-PROM group (P<0.05). Conclusions　HDCP and PROM may have severe impacts on neonatal outcomes.

The effect of CD40 message activation on the renal tubular epithelial cells CHEN Yanjie², LI Xiaozhong¹, MEI Jun², GU Li² (1.Department of Kidney, Soochow University Affiliated Children's Hospital, Suzhou 100034, Jiangsu, China; 2.Department of Pediatrics, The Tenth People's Hospital Affiliated to Tongji University, Shanghai 200072, China)

. 2014, 32(1):  62-65. 

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　Objective　To explore the effect of CD40 message activation on the renal tubular epithelial cells (HK2). Methods After HK2 cells are activated by agonistic anti-CD40 monoclonal antibody 5c11 at 5 and 10 μg/ml, their proliferation and apoptosis were tested with MTT and flow cytometry respectively at day 3, 6 and 9. Simultaneously, level of RANTES (regulated upon activation, normal T cell expressed and secreted) in culture supernatant of HK2 cells was measured by ELISA. Results The expression of CD40 in HK2 cells was 78.9%. After activation for 9 days with 5c11 of different concentrations, the proliferation of HK2 cells (OD value) was decreased as 5c11 concentrations increased by MTT test, and the difference among groups was significant (P<0.01). However, the apoptosis rate of HK2 cells was increased at day 6 and day 9 by flow cytometry, and the difference was significant (P<0.01). The level of RANTES was elevated as 5c11 concentrations and time increased, and the differences were significant (P<0.05). Conclusions The expression of CD40 in HK2 cells plays important roles in regulating the proliferation, apoptosis and inflammatory factor release of renal tubular cells.

Expression of connexin 43 in dilated cardiomyopathy and its correlation with left ventricular ejection fraction　YUAN Yonghua¹, HE Xuehua¹, FANG Yibing¹, XIA Xiaohui² (1.Department of Pediatrics, 2.Deparment of Ultrasonography, Hunan People's Hospital, Changsha 410005, Hunan, China)

. 2014, 32(1):  66-69. 

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　Objective　To observe the expression of connexin 43 (Cx43) in left ventricular myocardium of rats with dilated cardiomyopathy (DCM) induced by adriamycin, and its correlation with left ventricular ejection fraction (LVEF). Methods The dilated cardiomyopathy model was established by intraperitoneal injection with adriamycin in Wistar rats. The LVEF of rats in DCM group and normal control group was investigated with echocardiogram at the end of the 8^th week and 12^th week, respectively. Meanwhile, myocardial Cx43 distribution was observed by immunohistochemical and image analysis techniques and Cx43 mRNA expression was tested by reverse transcriptase polymerase chain reaction (RT-PCR). Results Compared with the control group，the expressions of Cx43 protein (average gray value) and Cx43 mRNA and LVEF were all decreased significantly at the end of the 8t^h week and 12^th week respectively in DCM group (P<0.05). The expressions of Cx43 protein and Cx43 mRNA in rat myocardium were positively correlated with LVEF (r=0.89 and 0.91, P<0.01). Conclusions Decreased expressions and heterogeneous distribution of Cx43 were observed in myocardium of rats in DCM model group. It is suggested that Cx43 may participate in the pathological process of DCM.

The impact of fluid resuscitation on clinical outcome of pediatric septic shock: a meta-analysis　LIU Jie^1,2, TAO Yexuan^2,3, CAI Wei^1,2,3 (1.Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine; 2.The Key Laboratory of Pediatric Gastroenterology and Nutrition of Shanghai; 3.Department of Nutrition, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China)

. 2014, 32(1):  70-75. 

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　Objectives　To systemically review the evidence from clinical trials comparing the use of crystalloids and colloids for fluid resuscitation in children with septic shock. Methods Medline, SCI, Embase, Cochrane Library, Google scholar and Chinese Biomedicine Database were searched for randomized controlled trials in children ages one month to 15 years with septic shock published between Jan, 2003 and May, 2013. The form or volume of transfusion with crystalloids or colloids was the only difference between the intervention and control groups. Methodological quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 and Jadad’s score scale. RevMan 5.0 statistical software was used for meta-analysis. Results In 181 relative articles, 8 trials met the criteria. On fatality rate, 5 trails compared colloids with crystalloids, and the fixed model was applied RR＝0.95, 95%CI:0.76~1.19 (P=0.66); 3 trails compared different forms of colloids, and the fixed model was applied RR＝0.47, 95%CI :0.14~1.63 (P=0.23); 4 trails compared fluid resuscitation with traditional therapy, after excluded one trail, the fixed model was applied RR＝1.44, 95%CI:1.13~1.83 (P=0.003). On complication of pulmonary edema, 2 trails compared colloids with crystalloids, and the random effect model was applied RR=1.11, 95%CI :0.13～9.71 (P=0.93); 4 trails compared fluid resuscitation with traditional therapy, and the random effect model was applied RR=0.83, 95%CI:0.21～3.29 (P=0.79). On 8-hour emergency rescue, 2 trails compared colloids with crystalloids, and the fixed model was applied RR＝2.43, 95%CI:0.71~8.36 (P=0.16); 2 trails compared fluid resuscitation with traditional therapy, and the fixed model was applied RR=0.43, 95%CI:0.19~0.97 (P=0.04). Conclusions There is no significant difference between colloids and crystalloids in the effect of fluid resuscitation for children with septic shock.

Chediak-Higashi syndrome complicated by chronic active Epstein-Barr virus infection: a case report　LI Xufang^1,2, FANG Feng¹, XU Sanqing¹ (1.Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China; 2.Department of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou 510000, Guangdong, China)

. 2014, 32(1):  76-79. 

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　Objectives　To discuss the clinical features, diagnosis and treatment, probable mechanisms of Chediak-Higashi syndrome (CHS) complicated by chronic active Epstein-Barr virus (CAEBV) infection. Methods Diagnosis and treatment of one case of CHS child complicated by CAEBV infection was analyzed and literature review was performed. Results The 19-month-old girl had a history of recurrent infections since birth. On examination, the child was found having anemia appearance with grey thinning hair, and reduced pigment in bilateral iris surrounded by spoke-wheel-like structures. Moreover, fine crackles in lungs and enlarged liver and spleen were also found. Hematological parameters revealed progressive pancytopenia. The level of high-sensitivity C-reactive protein (hs-CRP) was increased. A positive sputum culture for Pseudomonas aeruginosa was observed. Elevated level of EBV DNA was found in the child's peripheral blood. Screening test for phenylketonuria was negative. An optical microscopy examination of her hair showed groups of pigment scattered along the length of the hair shafts. Hemophagocytic histiocytosis was present in smears of bone marrow aspirate. Electron microscope examination of myeloid cell showed the presence of giant lysosomal granules in the intracytoplasm of some segmented neutrocyte. Conclusions The diagnosis of CHS was confirmed by the presence of the distinctive cytoplasmic lysosome granules in leukocytes or in other cells not only depending on peripheral blood films or bone marrow aspirate smears, but also on electron microscope examination of myeloid cell. Treatment for CHS is limited. The immune and hematologic defects may be reversed by bone marrow transplantation.

Progress of research in immune mechanism of human cytomegalovirus evasion of natural killer cells Reviewer: SUN Min, Reviser: QIAN Jihong (Department of Neonatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China)

. 2014, 32(1):  80-82. 

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　Human cytomegalovirus (HCMV) is a member of β-herpesvirus subfamily, with a high infection rate, worldwide spread. It can hardly be eliminated completely after primary infection, causing lifelong, persistent infections. NK cells play a vital role in the innate immunity. HCMV adopts a series of measures to avoid the NK cell killing. The immune evasion mechanism is very complicated, such as encoding host gene homologue, microRNA. This article review the mechanisms by which the HCMV evade the NK cell killing.

Relationship between thymic stromal lymphopoietin and allergic diseases　Reviewer: ZHANG Chunxia¹, CHEN Baiyu² (1.Department of Pediatric, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, Inner Mongolia, China; 2.Graduate School, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia, China)

. 2014, 32(1):  83-84. 

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　Thymic stromal lymphopoietin (TSLP) is a type of interleukin 7-like cytokine which was reported by Friend for the first time in 1994. Since then, an increasing number of researches have showed that TSLP exists and plays potential pathoge-nic role in the allergic diseases. In this review, the recent progress in the relationship between TSLP and allergic diseases was summarized.

Research progress of neural stem cell transplantation in the treatment of severe cerebral palsy in child　Reviewer: ZHOU Juhua, FANG Suzhen, ZHOU Xizhong, Reviser: LI Hong (Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong, China)

. 2014, 32(1):  85-87. 

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　Cerebral palsy (CP) is one of the most common diseases of the nervous system leading to developmental disabi-lity. Comprehensive rehabilitation is still the main treatment in children with mild to moderate CP, but it has limited effects for children with severe CP. Stem cell transplantation is a new treatment for this disease which has obtained some meaningful results based on extensive studies including basic experiments and clinical researches. Currently, stem cell transplantation is still in its infancy, subject to many restrictions in the clinical application. This review will summarize the research progress of stem cell transplantation in children with severe cerebral palsy in recent years.

Hyper-IgE syndrome: recent progress in diagnosis and treatment　Reviewer: LI Chunxiao, Reviser: YU Hong (Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China)

. 2014, 32(1):  88-91. 

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　The hyper-IgE syndrome (HIES) is a complex and rare primary immune deficiency characterized by eczema and extremely elevated IgE serum level as well as recurrent skin and pulmonary infections. There are two forms of this disease: the autosomal dominant form (AD-HIES) which is associated with STAT3 mutation and the autosomal recessive form (AR-HIES) which is caused by TYK-2 or DOCK8 mutation. There are differences in pathogenesis, clinical manifestations, treatment and prognosis between AD-HIES and AR-HIES. This review will focus on genetic characteristics, pathogenesis, clinical manifestations, diagnosis and treatment of HIES.