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    06 June 2010, Volume 25 Issue 06 Previous Issue    Next Issue

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    Clinical analysis of 18 cases of idiopathic interstitial pneumonia in children.
    CHE Li-Kun-·Mu-Za-Mo-Er, MI Na-Wa-Er-·Yi-Mi-Chi, CHEN  Jun
    2010, 25(06): 448. 
    Abstract ( )  

    Abstract:Objective In order to reduce misdiagnosis of idiopathic interstitial pneumonia (IIP) in children we summarized the etiology, clinical characteristics, treatment and follow-up results of 18 cases. Method The clinical epidemic investigations were used in our present study. A retrospective analysis was made on the pediatric patient's clinical materials,who were diagnosed with IIP. Some of the serum indexes were compared with those of 35 children who came to our hospital for physical examination. Results The etiology was unknown in these patients; we just found some background factors. The main symptoms were progressive dyspnea and dry cough; most of patients usually had no fever, but had weight loss, fatigue and poor appetite. Fine crackles could be heard on the base of bilateral lungs, accompanied with cyanosis and clubbed fingers. Prior to being admitted to the hospital, the patients were misdiagnosed with bronchopneumonia, asthma or pulmonary tuberculosis etc. Blood test showed that WBC was elevated, ESR was accelerated, CRP and LDH,TNF-αand IL-8 levels were increased,but α-AT decreased. X ray film indicated diffused infiltrating change and HRCT characterized by reticulate, honey comb and frosted change. Lung function test (>8 years) showed restrictive ventilation function impairment;blood gas analysis and monitoring showed persistent hypoxemia. The patients received systemic corticosteroid pulse therapy combined with intravenous gamma immunoglobulin, azithromycin taken orally, inhaled Fluticasone aerosol therapy and follow. Twelve cases clinically resolved, 3 cases died; there was no improvement in 3 case and they gave up treatment. Conclusion The etiology is uncertain in this cohort, and childhood IIP is easily misdiagnosed and under-diagnosed. The duration and degree of disease is prolonged. Most patients have   persistency or recurrent symptoms. The key point of early diagnosis is clinical manifestations, laboratory test results and imaging studies. Although the treatment effect is not ideal in this cohort, combination therapy can improve symptoms in some patients. Pulmonary biopsy is very difficult to perform in the clinic.

    Clinical efficacy studies of low-molecular-weight heparin in the treatment for sepsis.
    LI  Ying, QU  Dong, LI  Jie
    2010, 25(06): 453. 
    Abstract ( )  

    Abstract:Objective To evaluate the efficacy of low molecular weight heparin in patients with sepsis . Methods A total of 24 patients with sepsis were randomly divided into LMWH treatment group and control group. Both groups were examined TAT,AT-Ⅲ,PC,PS,PLT,PT,APTT,Fbg,D-d,FDP and severity score. Results PC and PS in these two groups were increased after treatments,and those of LMWH treatment group were increased more significantly than those of control group; there was a significant difference between these two groups (P < 0.001). TAT in these two groups fell  after treatments,and that of LMWH treatment group fell more significantly than that of control group, but there was no statistic difference between these two groups (P > 0.05). Severity score in these two groups was increased after 2 days′treatment; severity score in LMWH treatment group was increased more significantly than that of control; there was a significant difference between these two groups (P < 0.05). Conclusion Low dosage of low molecular weight heparin treatment in patients with sepsis is effective on improving function of hemorrhagic-coagulation and the clinical condition without complications of bleeding.

    The electrophysiology and clinical characteristics of the children with Guillain-Barré syndrome.
    2010, 25(06): 456. 
    Abstract ( )  

    Abstract:Objective To study the epidemiology,clinical and electrophysiological characteristics of the children with Guillain-Barré syndrome. Methods Retrospectively analyze the electrophysiological and clinical data of 77 children wtih GBS in our hospital. Results According to clinical and electrophysiologic findings,32 patients manifested acute inflammatory demyelinating polyradiculoneuropathy(AIDP), 34 had acute motor axonal neuropathy(AMAN),4 had acute motor and sensory axonal neuropathy(ASMAN), 4 were inexcitable, 2 were unclassified and 1 had Miller-Fisher syndrome. The 77 patients included 53 boys and 25 girls.There were 27 boys and 5 girls in AIDP group and 18 boys and 16 girls in AMAN group. The AMAN group wer clearly seasonal (June 4 to August 28) .The mean time from the onset of illness to nadir was 7.09±3.17 days in the AIDP group and 4.94±1.59 days in the AMAN group. The mean disability score at nadir by the Hughes scale of 12 cases in AIDP group and 9 cases in AMAN group was ≤3,and 20 cases in AIDP group and 25 cases in AMAN group was ≥4.The number of cases in the respiratory muscle paralysis, cranial nerve palsy and autonomic symptoms in the AMAN was more than in the AIDP group,but there was no statistical significance. In the sensory nerve involvement, the AIDP was obviously more severe than in the AMAN group. Conclusion The incidence of the AMAN and the AIDP group is similar in north Chinese children.Compared with AIDP group,the AMAN group has seasonal characteristics and gender differences. Between the two groups, besides sensory nerve involvement ,there was no significant difference in the clinical feature and severity. However, the clinical progress of the AMAN is faster than the AIDP group.

    Study of the GRPR polymorphisms in ADHD children.
    CHEN Yan-Ni, HUANG Yan-Xia, ZHANG  Jie, SHAO Dong-Dong, ZUO Xue-Mei, HE  Chi
    2010, 25(06): 460. 
    Abstract ( )  

    Abstract:Objective To study the GRPR polymorphisms in ADHD children and analyze the sequence of the second exon of GRPR. Methods The DNA was taken from the periphery blood. The PCR of the second exon of 120 children with ADHD and 126 normal children was sequenced. We used Chi-square test to know difference of genotype and haplotype between ADHD and normal control group, and among inattention, hyperactivity and impulsivity compound group. Result There were TT, CC and TC polymorphisms in the second exon of GRPR in 661 and 450 sits. There was no difference between ADHD and normal control group(χ2 = 0.30,0.52,1.34,0.30;all P > 0.05). There was no difference among inattention, hyperactivity and impulsivity compound group(χ2 = 0.37,0.49,0.63,all P > 0.05). Conclusion The research has not proved the relationship between ADHD and the second exon of GRPR.

    The changes of serum and urinary IFN-γ, IL-13 and TGF-β1 in children with primary nephrotic syndrome and their relationship.
    ZHOU Jiang-Jin, KANG Guo-Gui, ZHANG  Qi, CHEN Hui-Qin, KANG You-Qun
    2010, 25(06): 463. 
    Abstract ( )  

    Abstract:Objective To investigate the changes of  serum and urinary interferon -gamma (IFN-γ), interleukin-13 (IL-13) and transforming growth factor beta 1 (TGF-β1) in the children with primary nephrotic syndrome (PNS) and their relationship. Methods The levels of IFN-γ, IL-13 and TGF-β1 in the serum and urin of 22 children with PNS were assayed at admission and alleviation respectively by ELISA . The relationship among IFN-γ, IL-13 and TGF-β1 in serum and urin was detemined by linear correlation analysis .In addition,20 healthy children were included as control group. Results The levels of serum and urinary IFN-γ and IL-13 at admission were significantly higher than the control group (q = 24.186, 29.727, 33.866, 26.422 respectively,all P < 0.01), and markedly dropped, but were still significantly higher than the control group (q = 9.074,7.000, 4.073, 6.195 respectively,all P < 0.01)at alleviation . The serum and urinary TGF-β1 was markedly increased and dropped at admission and alleviation respectively(q = 19.192,28.160 respectively,all P < 0.01), and not significanty different ( q = 0.581, 0.251 respectively,all P > 0.05) compared to the control group at alleviation . Serum IFN-γ and serum IL-13 had a significant positive correlation (r = 0.35,P < 0.01),but not significantly correlated to serum IFN-γ with serum TGF-β1 and serum IL-13 with serum TGF-β1 . Each correlation of IFN-γ, IL-13 and TGF-β1 in urin respectively and each relation of them in serum and urin were not markedly found . Conclusions IFN-γ、IL-13、TGF-β1 may be involved in the pathogenesis of PNS . The cytokines may exist a certain degree of relationship, but the majority is not close .

    Correlation between TNF-αconcentration and TLR4 expression in children with dilated cardiomyopathy.
    XIE Cheng-Hui, ZHONG Jia-Rong, ZHANG  Jing, LI  Xin, BAI Yong-Gong, JI Xiao-Juan
    2010, 25(06): 466. 
    Abstract ( )  

    Abstract:Objective To observe the correlation between the expression of Toll-like receptor 4(TLR4)in monocytes and the concentration of TNF-αin children with dilated cardiomyopathy (DCM ),in order to explore the relationship between TLR4 and the occurrence and development of children with DCM. Methods In 18 children with DCM, TLR4 level in monocytes was measured by flow cytometry; the concentration of TNF-αin serum was determined by ELISA;left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV) and left ventricular mass(LVmass) were detected by echocardiography. Seventeen healthy children served as controls. Results The mean fluorescence intensity( MFI )of TLR4 in monocytes was higher in children with DCM at preliminary diagnosis, compared to that of treatment of one year . TNF-αhad a similar result(P < 0.05).Moreover,they were both higher in chidren with DCM compared with controls. The improvement of LVEF, LVEDV, LVESV and LV mass in children with DCM correlated with the decrease of TLR4MFI and with the concentration of TNF-α. Conclusion Upregulation of TLR4 in monocytes of children with DCM may play a critical role in the mechanism of cardiac damage through the secretion of inflammatory factors,which mediates the development and progression of children with DCM. 

    Clinical study on death-related factors of neonatal shock. 
    YAO  Kai, FU Jian-Hua, HU Hua-Wen, XUE Xin-Dong
    2010, 25(06): 469. 
    Abstract ( )  

    Abstract: Objective To analyze variables associated with death of neonatal shock and to determine the death-related factors. Methods The clinical data of fifty cases of neonatal shock in NICU of Shengjing Hospital affiliated to China Medical University from January 2007 to April 2009 were retrospectively analyzed. Compare the clinical characteristics of the survivors and the dead children. Both univariate analysis and multivariate Logistic regression analysis were used to find out the variables associated with death and death-related factors. Results Twenty-six infants survived and 24 died; the overall death rate of the neonatal shock was 48.0%. Fourteen of 36 term neonates died ( the death rate 38.9%) while 10 of 14 preterm neonates died ( the death rate 71.4%); 29 cases were septic shock (58.0%). Septic shock in these shock patients made up the most proportion. Nine among 14 (64.3%) preterm infants in the research had septic shock. Septicemia was found to be main primary disease of septic shock. Forty-two shock patients had failure of organ function,among which failure of respiratory function took the first place (73.8%). Univariate analysis showed that gestational age, weight at onset of shock, dates after birth, Apgar score at 5mins, pH, blood pressure and multiple organ failure were associated with death of neonatal shock (P < 0.05). Multivariate Logistic regression analysis showed that there were three significant predictors: gestational age (odds ratio 0.006, 95% confidence interval 0.000-0.583,P = 0.028), blood pressure (odds ratio 0.025, 95% confidence interval 0.002-0.297, P = 0.004) and multiple organ failure (odds ratio 14.949, 95% confidence interval 1.181-189.250,P = 0.037). Conclusion Gestational age, blood pressure and multiple organ failure are related to the death of neonatal shock.

    Clinical analysis of noncompaction of ventricular myocardium in 123 children.
    XU Yan-Mei
    2010, 25(06): 472. 
    Abstract ( )  

    Abstract: Objective To explore the clinical features of noncompaction of the ventricular myocardium(NVM) in 123 children. Methods Clinical manifestation, electrocardiogram, chest X-ray and echocardiogram of 123 patients as well as 31 cases of cardiac catheterization and 24 of cardiac CT of NVM were studied. Results Among 123 patients, 50 suffered from chest discomfort, short breath and much sweat, 110 were cardiac dilatation, and a decrease of the intensity of heart sounds was found in 30 children; 65 coexisted with cardiac abnormalities;104 patients had ST-T change on electrocardiogram. Cardiac arrhythmia was found in 29 cases; 98 cases of cardiothoracic ratio > 0.5 were noticed in chest X-ray. Echocardiograph examination showed that numerous prominent ventricular trabeculations and deep intertrabecular recesses were presented in ventricle. Characteristic changes of image in cardiac catheterization and cardiac CT were found as well. Conclusion Clinical features of NVM in children are a depressed cardiac function and arrhythmia, an infrequency of systemic embolization with a higher rate of coexistence of cardiac abnormalities. Echocardiography is a reliable promising diagnostic tool for NVM.

    Clinical study on amoxicillin clavulanate (7 : 1) oral suspension children with urinary tract infection.
    LIAO  Wei, DIAO Cong-Min, WEN En-Yi, ZHANG Yu-Beng, WANG Li-Yan, HE Zhou-Mei, YANG  Wang, LV Kui-Lin
    2010, 25(06): 475. 
    Abstract ( )  

    Abstract:Objective To observe the effect of amoxicillin clavulanate oral suspension for children with urinary tract infection, so as to provide evidence for clinical treatment. Methods A total of 68 children with urinary tract infection were divided into amoxicillin clavulanate  group and amoxicillin clavulanate sequential therapy group. The effect and bacteria clearance of two groups were assessed and compared. Results The efficiency rate of amoxicillin clavulanate group was 91.4%, and that of amoxicillin clavulanate sequential therapy group was 93.9%,there being no difference in two groups (P > 0.05) ;The Bacteria clearance rate in amoxicillin clavulanate group was 81.3%,and that in amoxicillin clavulanate sequential therapy group was 85.7%,there being no significant difference in two groups (P > 0.05). Conclusion Amoxicillin clavulanate oral suspension for the children with urinary tract infection is safe,effective and economicd,with is worth clinical appliation.