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06 April 2009, Volume 24 Issue 04 Previous Issue    Next Issue
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Vitamin D receptor gene polymorphisms and susceptibility to pediatric tuberculosis among the Chinese Han population. JIAO Wei-wei,LI Zhao-na,SUN Lin,ZHAO Shun-ying,LI Hui-min,JIAO An-xia,GUO Ya-jie,JIANG Zai-fang,SHEN A-dong. 2009, 24(04): 264-266 .  Abstract ( )   Objective　To study the relation of vitamin D receptor （VDR） gene polymorphisms with susceptibility to pediatric tuberculosis （ TB） in Chinese Han population. Methods　The study samples included 125 pediatric TB patients and 446 matched healthy controls. Genetic polymorphisms of the VDR gene （FokI and TaqI） were analyzed by PCR-RFLP. The association analysis was performed using chi-square test by SPSS version 12.0. Results　There was no significant association between the overall risk of disease and any allele or genotype of the two VDR loci analyzed. The FF， Ff and ff genotype frequencies in patients and controls were 29.6%， 51.2%， 19.2% and 27.6%， 50.9%， 21.5%， respectively. The TT， Tt and tt genotype frequencies were 90.4%， 9.6%， 0 and 86.8%， 13.0%， 0.2%， respectively. When patients were stratified according to gender， it is found that the alleles and genotypes were distributed almost equally in case and control groups. Conclusion　No association was found between VDR polymorphisms （either allele or genotype） and susceptibility to pediatric TB in Chinese Han population.

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Changes of expression of IFN-γ，IL-4，T-bet and GATA-3 mRNA during house dust mites specific immunotherapy for children with allergic LI Fu-guang，WANG Fang，DU Ying,LI Yu-qin. 2009, 24(04): 267-269 .  Abstract ( )   Objective　To survey the changes of expression of IFN-γ， IL-4， T-bet and GATA-3 mRNA in peripheral blood mononuclear cells （PBMCs） in house dust mites specific immunotherapy （SIT） for patients with allergic asthma. Methods　The periphery venous blood of the allergic asthma patients was harvested three times： pre-SIT， post-SIT for 16 weeks and post-SIT for 1 year. The IFN-γ， IL-4， T-bet and GATA-3 mRNA in PBMCs were detected by SYBR GreenⅠ RT-PCR. At the same time， the clinical effects were detected. Results　As the progression of the SIT， the clinical symptom was alleviated， and the ratios of IFN-γ to IL-4 and T-bet to GATA-3 on mRNA expression level rised gradually. Conclusion　The SIT is efficient for the patients with allergic asthma； the disequilibrium of TH1/TH2 is retrieved； the transcription factors T-bet and GATA-3 may play an important role in pathogenesis of asthma and the SIT.

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Study of viral etiology of acute lower respiratory tract infection in children. LIU Chun-yan,XIE Zheng-de,Richard Gonzalez,REN Li-li,KONG Xiao-hui,HU Ying-hui,YAO Yuan,YANG Yan,QIAN Su-yun,GENG Rong,SHEN Kun-ling,WANG Jian-wei. 2009, 24(04): 270-273 .  Abstract ( )   Objective　To investigate the viral pathogens of lower respiratory tract infection （ALRTI） in children. Methods　Totally 572 children with clinical diagnosis of ALRTI during the period of March 2007 to February 2008 were involved in our study. One nasopharyngeal aspirate specimen was collected from each patient. （RT） PCRs were performed to detect common respiratory tract viruses including respiratory syncytial virus （RSV）， rhinovirus （RV）， influzenza virus type A and B （IFA， IFB）， parainfluenza virus （PIV） type 1-4 ， adenovirus （AdV）， enterovirus （EV）， human coronavirus （HCoV）， human metapneumonia virus （hMPV） and human bocavirus （HBoV）. Results　At least one viral pathogen was detected in 444 out of 572 patients and the overall positive rate was 77.6%. The most common virus was RSV （48.3%）， followed by RV （27.1%） and PIV （13.3%）. The etiological spectrum of ALRTI varied in different age group. RSV， RV and PIV were the most predominant pathogens in children less than 5 years old while RV， IFV and RSV were the most common pathogens in children older than 5 years of age. Two or more viruses were identified in 158 out of 572 cases. The mixed infection rate was high （40.2%） in infants under 1 year old while it decreased to 14.0% in children older than 5 years of age. Conclusion　RSV， RV and PIV are the most predominant pathogens in children less than 5 years old while RV， IFV and RSV are the most common pathogens in children older than 5 years of age in Beijing area.

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Relationship between renal blood flow parameters and urine prote in newborns with asphyxia. LEI Xiao-yan,SUN Yong-hong，DONG Jiao，WANG 2009, 24(04): 274-276 .  Abstract ( )   Objective　To study the relationship between renal blood flow parameters and urine protein in newborns with asphyxia. Methods　To test the levels of αl-MG， MA， TRF and IgG in fresh urine of 71 cases of neonatal asphyxia and 20 cases of normal newborns， from January 2004 to December 2007 in the People's Hospital of Gansu Province， and to test the blood BUN， Cr， CO2-CP， Ca2+，K +， Na +and Cl-， respectively，to test renal artery blood flow parameters（PSFV， RI， EDFV， TAMX and PI） on the 1st， 3rd and 7th day after birth. Results 　（1）The urine αl-MG， TRF， MA and IgG in the newborn asphyxia were significantly higher than the normal group （P < 0.05）； TRF and αl-MG in the severe asphyxia group were significantly higher than those of the mild asphyxia group （P < 0.01 ）. （2 ）The renal artery EDFV in asphyxia group were lower than those of the normal group in 1st， 3rd and 7th day， there being significant differences （P < 0.05） ； the renal artery RI and PI were higher than those of the normal group， there being significant differences （P < 0.05）. （3）The renal blood flow parameters EDFV and MA， TRF， αl-MG， IgG were negatively correlated （P < 0.01）， RI， PI and MA， TRF， αl-MG IgG were positivly correlated （P < 0.01）. Conclusion　The test of renal blood flow can estimat the level of protein in urine， which is time-saving ， convenient ，with less influence of external factors； in particular ，it can be observed continuously. Similarly， according to the levels of urine protein，we can estimate the situation of renal blood flow and judge whether the newborn is suffering from renal vasospasm， renal ischemia and early kidney damage， which can be supply an evidence for application of the drugs of renal blood vessel.

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Rapid diagnosis of purulent meningitis in neonates by 16SrRNA microarrays. YANG Zu-qin,LIN Zhen-lang，SHANG Shi-qiang,WU Yi-dong,DU 2009, 24(04): 277-280 .  Abstract ( )   Objective　To explore a new technique of rapid diagnosis of purulent meningitis in neonates. Methods　Cerebrospinal fluid（ CSF ） specimens from 24 cases of suspected purulent meningitis were detected by 16SrRNA Microarrays in the Children’s Hospital affilated to Zhejiang University from August 2003 to February，2006； the bacterial cultures of CSF were done as controls at the same time. Results　（1） The PCR amplified products of 49 strains were tested by the gene chip hybridization， including 33 Gram-positve and 16 Gram-negative strains. Using the amplified DNA of the 33 Gram-positive bacteria as templets， there were positive findings for the two universal probes and the one Gram-positve probe. The Gram-negative probes and universal probes showed positive results when 16 Gram-negative bacteria were used as templates. Each strain specifically hybridized with its own probe. （2） 1pg（10-12g）（10 copies）were detected by 16S rRNA gene chip hybridization at least in the PCR amplified products of Εscherichia coli-enteric bacterium， equaled to 2 bacteria nearly. （3） Of the 24 cases，11 were positive by 16S rRNA Microarrays， the positive rate 45.83% （11/24） being significantly higher than that of CSF culture （12.50%） （3/24） （P < 0.01）. Conclusion　16SrRNA Microarrays with higher specificity and sensitivity， demanding less CSF， is rapid and reliable for diagnosing purulent meningitis in neonates. So it has considerable value of application.

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The clinical features and neurologic outcome of acute disseminated encephalomyelitis in children. LI Shu-hua,ZHOU Shui-zhen，ZHANG Lin 2009, 24(04): 281-285 .  Abstract ( )   Objective　To describe the clinical features and neurologic outcome of acute disseminated encephalomyelitis（ADEM） in children.Methods　A study on medical record and follow-up information of prospective efficacy was conducted in 68 children with ADEM. Results　（1）The age of patients at onset ranged from 1 to 15.3 years， with a median of 6.5 years，with the inpatients numbers increasing year by year. （2）An infectious event preceded the onset of illness in 57.4% of patients， and a vaccination event in 4.4% of patients， while the others were cryptogenic. （3）Clinical classification： 42（61.8%）cases had presentations of the brain， 18（26.4%）of the brain and spinal cord， 8（11.8%）of the spinal cord； the most common presenting symptoms were fever， palsy， seizures，changes in mental status ，extrapyramidal syndrome，consciousness impairment， cognitive handicap， sphincter muscle disturbance and ataxia and some patients appeared linguistic functional disturbance and cranial palsy. （4）Increased IgG index and/or oligoclonal band positive were present in the cerebrospinal fluid of 77.2% of cases.（5） prognosis： ①near-future curative effect of corticosteroid treatment： 55.9% of cases showed initiation effective in 3 days， 26.5% in 7 days， 17.6% after 1 week； 48.5% of cases improved in 1 week， and 11.2% improved spontaneously ，while one case died. ②prospective efficacy ： 48 cases whose course was longer than one year and 20 cases less than one year course. At the end of follow-up： 38 cases recovered； 9 cases had disability（whose course longer than one year）； relapse was seen in 7 cases； 8 cases were in follow-up；5 cases lost follow-up. Conclusion　ADEM in childhood often occur at the age of 3 to 12 years. The presenting symptoms are various and complicated； the states of the illness vary from slight to severe and the course varies from short to long. Neuroimaging（especially brain MRI） is extremely important in early diagnosis of ADEM when a patient presenting a polysymptomatic encephalopathy. Most children with ADEM present a good outcome in long-term follow-up； some patients with severe condition recover after 6 months， and a few have disability of nervous system.

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Determination of serum cytokines in children with tourette’s syndrome and clinical significance. RUAN Yi-yan,LI Er-zhen,CHEN Qian,XU Ke-ming,CUI Xiao-dai,MA Lian-hua,FU Jin 2009, 24(04): 286-288 .  Abstract ( )   Objective　To explore the pathogenic role of serum cytokines and its clinical significance in Tourette’s Syndrome （TS）. Methods 　Serum IL-6， IL-8 and TNF-αwere determined by ELISA in 58 children with TS and 30 healthy subjects. Those TS children whose immune functions were abnormal were divided randomly into two groups and were treated respectively by using simple immunomodulator and by using dopaminergic receptor antagonists while using immunomodulator. Results　（1）Compared with control， the levels of serum IL-6 and IL-8 in TS group were depressed（P < 0.01）and TNF-α were increased（P < 0.01）. （2）The levels of serum IL-6，IL-8 and TNF-αin TS group after treatment were increased more than those of before treatment（P <0.01and P <0.05）；（3） After 8W of treatment， the level of IL-8 was higher in the group treated by simple immunomodulator than that by dopaminergic receptor antagonists while using immunomodulator（P <0.05）， the curative effect between the two groups having no significant difference. （4） There were significant positive correlations among IL-6， IL-8 and TNF-α（P <0.01）. Conclusion　There is abnormal expression of cytokine in children with Tourette’s syndrome. The disequilibrium of cytokine network may play a role in the pathomechanisms of TS. Simple immunotherapy may be effective in treating TS whose immune functions are abnormal.

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Inhaled iloprost in the evaluation of pulmonary arterial hypertension associated with congenital heart defects in children. ZHANG Xu，ZHANG Zhi-wei,QIAN Ming-yang,SHI Ji-jun,LI Jun-jie,PAN Wei,LI Yu-fen. 2009, 24(04): 289-292 .  Abstract ( )   Objective　 We investigated the safety and efficacy of acute vasodilator testing using inhaled iloprost in PAH associated with CHD in children， in comparison with the traditional vasodilator phentolamine. Methods Fifty patients with PAH associated with CHD were collected from the Department of Pediatric Cardiology in Guangdong Cardiovascular Institute. Each patient received left and right heart catheterization followed by acute vasodilator testing using either direct injection of phentolamine into pulmonary artery or inhaled iloprost. After testing ， right heart catheterization was repeated. Hemodynamic parameters were calculated according to Fick’s principle. After evaluating the nature of PAH， patients were divided into two groups， the ‘functional’ PAH group and the ‘occlusive’ PAH group. The functional group received surgery. Diagnosis was corrected if we found the original ‘functional’ patient is actually ‘occlusive’ during follow-up. Results Phentolamine significantly increased the heart rate while inhaled iloprost only had slight effect. Both vasodilators lowered the mean pulmonary arterial pressure（mPAP） and pulmonary vascular resistance（PVR） and increased pulmonary blood flow（Qp）. Phentolamine decreased the mean systemic arterial pressure（mSAP） and systemic vascular resistance（SVR） and increased systemic blood flow（Qs） as well， while inhaling iloprost had no obvious effect on the systemic circulation. After inhaled iloprost， the decrease of mPAP and the ratio of pulmonary to systemic vascular resistances（Rp/Rs）， as well as the increase of the ratio of pulmonary to systemic blood flow（Qp/Qs）， were more significant in the ‘functional’ group than in the ‘occlusive’ group（P value 0.016， 0.024 and 0.030 respectively）. As for phentolamine injection， the decrease of mPAP and PVR were more significant in the ‘functional’ group than in the ‘occlusive’ group（P value 0.017 and 0.004 respectively）. Conclusion　Inhaling iloprost and pulmonary injection of phentolamine can both effectively differentiate the functional and occlusive PAH in CHD. Phentolamine influenced both pulmonary and systemic pressure， resistance， and blood flow， while inhaling iloprost mainly has effect on the pulmonary circulation. Inhaling iloprost can help to maintain hemodynamic stability and precedes phentolamine.

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Clinical study on vitamin A status and significance of supplement in premature infants. CHEN Lu,FENG Qi. 2009, 24(04): 293-296 .  Abstract ( )   Objective　To investigate vitamin A basic nutritional status， influencing factors and the efficacy of routine vitamin A supplement in premature infants. Methods　Premature infants within 24 h of age were selected randomly to examine plasma retinol concentration. Full term infants worked as control. Premature infants received Vitamin A parenteral （1650 U/d） and/or enteral （750 U/d）， and some of them were followed up about every 2 weeks. Plasma retinol level was detected by high-performance liquid chromatography （HPLC）. Results　One hundred and forty-seven premature infants and 40 full term infants were enrolled. Basic serum retinol levels in premature infant were lower than that in full term infants， （0.161±0.051）μg/mL and （0.187±0.055）μg/mL， t = 2.812， P = 0.005. Retinol level had positive relation with birth weight， β = 0.177， P = 0.015. The incidence of VAD （retinol level < 0.200 μg/mL） at birth was higher in premature infants， 78% vs 65%， χ2 = 2.623， P = 0.105. Thirty-one premature infants were followed up about 2 weeks later with enteral and/or parenteral nutrition. Significant increase of plasma retinol level and reduction of VAD incidence were noted， （0.168±0.046） μg/mL vs. （0.203±0.063）μg/mL， t = 2.611， P = 0.014； 100% vs. 48%， χ2 = 18.954， P < 0.001. No relation was showed between basic retinol levels， amount and method of vitamin A supplement with the follow-up levels. Basic retinol levels had no influence on clinical outcomes， such as infection， chronic lung disease and retinopathy of prematurity. Conclusion　Premature infants have a poor vitamin A nutritional status and high incidence of VAD. Current routine vitamin A supplement has benefits to the improvement of its nutritional status in a short period.

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Influence of overweight and obesity on bone strength in children. ZHANG Ya-qin,LI Hui,WU Xiu-juan. 2009, 24(04): 297-299 .  Abstract ( )   Objective　To analyze status of bone strength in obese and overweight children. Methods　Subjects were 1270 children and adolescents （aged 2～18） undergoing a routine medical screen， and the were categorized as overweight or obese using weight for height standard of WHO/NCHS for 2～6 years and BMI for 7～18 years children. Bone strength was assessed by quantitative ultrasound methods. Body composition was measured by body composition instrument. Results　In pre-school children， tibial and radialis bone strength of obese group was worse than normal weight group， and the descending risk of bone strength in obese group was 6.87 and 2.24 times of normal children. Bone strength was not different in overweight and normal weight groups. In school children， tibial bone strength of obese group and overweight group， normal weight group was in the increasing order； the descending risk of bone strength in obese and overweight group was 9.73 and 2.54 times of normal group respectively. Radialis bone strength of obese group was worse than overweight group and normal weight group， while the bone strength of overweight group and normal weight group was not different. Bone strength of different position was different in obese children. Fat percentage had negative correlation with bone strength in obese children （r - radius = -0.33， r - tibia = -0.35）. Conclusion　Status of obese children’s bone strength is worse than normal weight children. We should pay attention to bone health of obese children and measure multi-sites bone strength.

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Clinical effectiveness of intranasal midazolam administration in acute children seizures control. ZHU Jin,ZHANG Yu-qin,ZHANG Pei-yuan,LI Hong,LIU Xiao-jun. 2009, 24(04): 300-301 .  Abstract ( )   Objective　A total of To study the effectiveness and security of intranasal midazolam for acute seizures in children. Methods　93 cases were randomly divided into two groups， observation group of 49 cases and control group of 44 cases. In observation group， 0.16～0.32 （0.24±0.05）mg/kg midazolam was supplied in nasal drip. In control group， 0.04～0.10（0.077±0.021）mg/kg clonazepam was injected intravenously. Results　It was effective in observation group and the efficacy rate was 87.76%, while it was effective in 39 cases in control group and the efficacy rate was 88.64%. There was no significant difference between two groups（P > 0.05）.In observation and control group， the effectiveness occurred at 1～7（2.13±1.30）min and 1～5（1.96±1.08）min later separately. There was no significant difference between two groups（P > 0.05）. The efficacy and the control time of tic in generalized and secondarily generalized seizures of the groups had no significant difference between two groups（P > 0.05）. There was no side effect in observation group. After 30 minutes of administration， one child had respiratory resistance in control group. Conclusion　The curative effect of intranasal midazolam and intravenous clonazepam was equivalent in acute seizure control. Intranasal midazolam is more convenient and safer.

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Sleeping disorders in the children of 6～14 years old and analysis of the impacting factors in Ningxia. CHEN Yan-xiang，YANG Wen,SUN Xiao-rong 2009, 24(04): 302-304 .  Abstract ( )   Objective　To know the occurring rate and related factors of sleeping disorder in children of 6～14 years in Ningxia. Methods　From Feb to July of 2007，6000 children aged 6～14 years old were investigated with questionnaire in 13 schools in townships， counties and rural areas in Ningxia， and the occurring situation of sleeping disorder， family， environmental and social factors were interviewed by specialized professionals. Results　Totally 5 632 questionnaires were taken back and callback rate was 93.87%. The incidence rate of sleep disorders was 16.26%. Among them，somnambulating ones in 62 cases（6.5%）， snoring in 243 cases（25.7%），mouth breathing 167 cases（17.6% ）， suppressed waken up 137 cases（14.5%）， apnea 33 cases（3.5%）， limbs spasm 173 cases （18.3%），and enuresis 132 cases （13.9%）．The incidence rate of the symptoms was different among age groups， in which the incidence rate of apnea was relatively high in 6～8 years old， and so was enuresis for those more than 8～14 years old. The main risk factors that affected sleep were premature delivery，nose inflammation and parents snoring. Conclusion　Sleeping disorder is common in the children of 6～14 years in Ningxia. Many factors have impacts on children sleeping. Pediatricians，doctors for child care and parents should pay much attention to children sleeping disorders．

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The clinical evaluation of hypertonic saline and exercise bronchial provocation tests in children with asthma. LIU Yan-yu,SHANG Yun-xiao，ZHANG Han，ZENG Lin-mei,SHU Lin-hua,HAN Xiao-hua,CAI Xu-xu. 2009, 24(04): 305-306 .  Abstract ( )   Objective　To compare exercise with hypertonic saline challenges in children with asthma so as to choose a safe and suitable empirical method to detect the airway reactivity in children with asthma. Methods　Thirty-four patients in children with asthma （5 to 13 years） were selected. The exercise challenge tests and hypertonic saline challenge tests were performed on the same patients within certain intervals. Results　The hypertonic saline challenge test was more sensitive than exercise challenge test （P < 0.01）. Conclusion　The sensitivity of hypertonic saline provocative test is superior to exercise challenge in children with asthma， and the method is simple， safe and with fewer side effects.