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06 July 2010, Volume 25 Issue 7 Previous Issue    Next Issue

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Influence of probiotics on the intestinal flora and bile composition in infantile hepatitis syndrome.　 LIN 　Chi, YAN Xiao-Min, HUANG Zhi-Hua 2010, 25(7): 520.  Abstract ( )   Abstract：Objective　To explore influence of probiotics （lactobacillus acidophilus） on the intestinal flora and bile composition in infantile hepatitis syndrome（IHS）. Methods　Researchers randomly assigned 60 IHS children who were the patients in Tongji Hospital from Mar.2002 to May 2008 into treatment group and control group in desired random number table. The treatment group received Lactobacillus LB sachet （two times a day， a packet each time，15 days as a course of treatment）and the control group received freeze dried culture medium，both on the basis of basic therapies such as UDCA（three times a day， 25 mg each time） and liver protection therapy. Total bilirubin（TB），direct bilirubin（DB），alanine aminotransferase（ALT）， γ-glutamyltranspeptidase（γ-GT）， totle bile acid（TBA） of serum and intraduodenal drain（bile） were observed before and after the treatment. SPSS 10.0 software was used to analyze the data. Results　After two treatment courses， the effective rates were 92.86% in the treatment group and 74.07% in the control group respectively. Significant differences were observed between the two groups（P < 0.05）. Compared with the control group，the levels of TB，DB，ALT，γ-GT and TBA in serum of treatment group reduced significantly（P < 0.05），and the liver size reduced obviously（P < 0.05），while the level of TB，DB，γ-GT and TBA in bile of treatment group increased significantly （P < 0.05） . There was no obvious side effect in the two groups. Conclusion　There is intestinal flora disturbance in infantile hepatitis syndrome. Probiotics （Lactobacillus acidophilus） and UDCA can increase the excretion of bile flow， improve the function of liver， and stabilize the balance of intestinal flora， which has significant curative effect on infantile hepatitis syndrome （IHS）.

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Study on the relationship of blood pressure with BMI，FMP and waist circumference among children and adolescents in Beijing. HOU Dong-Jing-1, CHENG 　Gong-2a, WANG Tian-Wei-2b, WANG 　Li-2b, DIAO 　De-2b, ZHANG Meng-Meng-2b, MI 　Jie-2a 2010, 25(7): 524.  Abstract ( )   Abstract：Objective　To analyze the relationship between blood pressure and BMI，waist circumference（WC） and fat mass percentile（FMP） among children and adolescents（7～17 years） in Beijing. Methods　As part of the Beijing Children and Adolescent Metabolic Syndrome Study（BCAMS），data of weight， height， FMP，WC， and blood pressure were collected from 19 488 subjects aged 7～17 years from April to October in 2004. Overweight and obesity were defined according to BMI，WC and FMP criteria. Analyze the relationship between blood pressure and BMI，WC and FMP，as well as the change and trend of hypertension. Results　The levels of SBP and DBP increased in the order of normal weight to overweight and obesity. With age and gender controlled，BMI，WC and FMP were independently positively correlated with SBP and DBP （P < 0.001）. The incidence of hypertension was significantly higher in the BMI，WC and FMP overweight and obesity groups than in the normal group，and the difference had statistical significance. The relative risk of hypertension in the obesity group is 3 to 7 times that of the normal group，and the risk in BMI obesity/FMP obesity group and the BMI obesity/abdominal obesity group was 7.3 and 6.8 times that of the normal group respectively.Conclusion　BMI，WC and FMP are closely related to SBP and DBP in children and adolescents. BMI is a better index for hypertension：the heavier the childrn，the higher the risk of hypertension.

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Tricuspid injury in transcatheter closure procedure of perimembranous ventricular septal defects：a clinical analysis of 8 cases. WANG Shu-Shui-1a, ZHANG Zhi-Wei-1a, JIAN Meng-Yang-1a, LIANG Dong-Po-1a, CHEN Ji-Mei-1b, LI Dun-Jie-1a, DING Si-Qun-1b, Zhang-　Xu-1a, LI Bo-Ning-2, LI Yu-Fen-1a 2010, 25(7): 528.  Abstract ( )   Abstract：Objective　To study prevention and treatment methods for tricuspid injury in transcatheter closure procedure of perimembranous ventricular septal defects（PMVSDs）. Methods　Eight cases with tricuspid injury in transcatheter closure procedure of PMVSDs were enrolled from Oct. 2002 to Dec. 2009. Tricuspid stenosis presented in 4 cases，of whom 2 needed surgery. The right disc and screw of PMVSDs occluder got entangled into the chordae of anterior tricuspid leaflet in both operative cases. Tricuspid regurgitation occurred in 4 cases. Three cases received surgery repair and device removal. The operation finding was anterior papillary muscle rupture in 1， anterior papillary muscle rupture combined with anterior tricuspid leaflet tear in 1 and chordae tendineae of septal leaflet stretched by device screw in 1 case. Another patient with mild to moderate tricuspid regurgitation and septal leaflet prolapse also received follow-up study. Results　Among the 5 patients with surgery， tricuspid valve got to normal in 4 cases and valve flow velocity slightly accelerated in 1 case. In the follow-up study， there were no clinical symptoms in the cases with mild or mild to moderate tricuspid injury with no repair. Conclusion　In procedure of transcatheter closure of PMVSDs， passing the arteriovenous circuit wire through tricuspid chordae can lead to tricuspid injury. Sever tricuspid injury should be repaired by surgery.

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Clinical study on early drip feeding in premature and very low birth weight infant. MA Lian-Mei, WANG Bao-Hong, FEI Lian-Beng, TUN Fu-Ling, HU 　Yan 2010, 25(7): 532.  Abstract ( )   Abstract：Objective　To observe the effect of early drip feeding and the occurrence of its correlated complications in premature and very low birth weight infants，and study its clinical application value. Methods　From June 2006 to December 2008 at the Affiliated Hospital of Binzhou Medical College Hospital ，45 cases of very low birth weight babies in premature infants were randomly divided into two groups. Twenty-three cases with early drip feeding were included in study group and 22 cases with early nasogastric tube feeding in control group. Milk amount increasing speed， body weight increasing speed， the time of beginning oral feeding，total enteral feeding， recovery time of birth weight， completely meconium excretion time， all acumulative phototherapy time， hospital stay time and correlated complications were compared between the two groups. Results　Compared with the control group， body weight increased faster in study group （P < 0.05），and milk amount obviously increased more in study group （P < 0.01）.The time of beginning oral feeding， the time of total enteral feeding，recovery time of birth weight，completely meconium excretion time， all acumulative phototherapy time and hospitalization period were obviously shorter in study group than in control group（P < 0.01）.The incidence rates of aspirated pneumonia，gastric hemorrhage and stomatitis in study group decreased compared with control group（P < 0.05）.The incidence rates of apnoea，emesia and abdominal distension in study group obviously reduced compared with control group（P < 0.01）. Conclusion　Early drip feedling can quickly boost the survivability of enteral feeding in premature very low birth weight infant， shorten the clinical course and reduce the occurrence of  clinically complications. It is worthy of clinically application and extension.

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Investigation into serum lipids level in children aged 2～14 -year old in Chongqing. ZHANG Zhi-Rui, CHEN 　Yuan, DIAO 　Lu, XIANG 　Beng, ZHOU Li-Gang 2010, 25(7): 535.  Abstract ( )   Abstract： Objective　To explore the normal value of serum lipids and the correlation between atherogenic index and serum lipid in healthy children aged 2 to 14. Methods　The serum TG， TC， HDL-C and LDL-C were detected by Siemens 2400 automatic biochemical analyzer in 988 healthy children. The atherogenic index LDL-C/ HDL-C and （TC－HDL-C）/HDL-C were calculated. Results　（1）The diagnostic criteria of lipid disorder were as follows： 2～ < 4-year-old： TC > 4.02 mmol / L， TG > 1.25 mmol / L， HDL-C < 0.83 mmol / L， LDL-C > 2.26 mmol / L； 4～ < 7-year-old： TC > 4.47mmol / L， TG > 1.35mmol / L， HDL-C < 0.90 mmol / L， LDL-C > 2.55 mmol / L； 7～ < 10-year-old： TC > 4.78 mmol / L， TG > 1.42 mmol / L， HDL -C < 0.99 mmol / L， LDL-C > 2.49 mmol / L； 10～ < 13 -year-old： TC > 4.71 mmol / L， TG > 1.49 mmol/L， HDL-C < 0.89 mmol / L， LDL-C > 2.44 mmol / L； 13～14 -year-old： TC > 5.00 mmol / L， TG > 1.48 mmol / L， HDL-C < 0.95 mmol / L， LDL-C > 2.96 mmol/L. （2）The criteria of atherosclerosis index in children aged 2 ～，4～ ， 7 ～ ， 10 ～ and 13 ～ 14-year-old were： LDL-C/HDL-C > 2.38， > 1.98， > 1.95， > 2.35 and > 2.28； （TC－HDL-C）/ HDL-C > 2.59， > 2.55， > 2.11， > 2.46 and > 2.50， respectively. （3）The levels of serum TC， TG， HDL-C and LDL-C increased with age. （4）The atherosclerosis index had significant positive correlation with TG and LDL-C. Conclusion　Criteria of serum lipids for children aged 2 to 14 years in Chongqing are established. The level of serum lipids is a dynamic process for children. The predictive value of atherosclerosis index should be noted in children with lipid disorder.

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Clinical analysis of 125 children with typhoid fever from 1993 to 2008 in Chongqing area. TU Rong-Hua, LIANG 　Ji, HU Gong-Mei 2010, 25(7): 539.  Abstract ( )   Abstrat：Objective　To summarize the clinical characteristics of typhoid fever in children and to provide the clinical experiences for early diagnosis and treatment. Methods　A retrospective analysis was made on the clinical data of 125 children with typhoid fever in Chongqing from 1993 to 2008. Results　 110 cases（88.0%） were from 5 to 14 years old. The cases were more common in summer or autumn （77， 61.6%）. The common clinical features were fever （124， 99.2%）， hepatomegaly （91， 72.8%）， splenomegaly （65， 52.0%）， gastrointestinal manifestations （103， 82.4%） and respiratory manifestations （71，56.8%）. WBC was in the normal range in 97（77.6%）， and only 16（12.8%） presented leucopenia. Eosinophils reduced or disappeared in 28/33 （84.8%）. Anemia existed in 85（68.0%）， 84/85（98.8%） of whom presented mild or moderate. The overall positive rate of bacterial cultures was 77.0%. The positive rate of blood cultures， marrow cultures， stool cultures and Widal test were 68.2% （75/110）， 55.0% （22/40）， 7.4% （5/68） and 42.7% （50/117）， respectively. Widal test was positive in 27 cases with negative bacterial cultures. The susceptibilities of clinical strains to ceftazidime， cefepime， ceftriaxone， cefotaxime， cefoperazone， levofloxacin （6/6） and ciprofloxacin were 100%（26/26）、100%（33/33）、93.3%（14/15）、96.9%（62/64）、66.7%（10/15）， 100% and 100%， respectively. Basing on the results of antimicrobial susceptibility testing， the patients with poor therapeutic effect initially were treated by sensitive antibiotic and the curative effect were prominent：123 children cured while 2 died because of misdiagnosis. Conclusions　Typhoid fever is sporadic in Chongqing. The peak age of onset ranges from 5 to 14 years old. It is more common in summer and autumn. The clinical manifestations of typhoid fever in children are atypical. The positive rate of Widal test is low， but it is still of great significance to the cases with negative bacterial culture. The third-generation cephalosporins and quinolones remain susceptible to the treatment for children with typhoid fever in Chongqing.

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Safety of methylphenidate hydrochloride in the treatment for childhood benign epilepsy with centrotemporal spikes combined with attention deficit hyperactivity disorder. LIANG Hui-Ci, YANG Sai-Yuan, DAI 　Jin, YANG 　Li, YAN Cui-Fang, BO Li-Wen, MAI Jian-Ning 2010, 25(7): 543.  Abstract ( )   Abstract：Subject　To explore whether use of methylphenidate hydrochloride（Ritalin） will induce the attack of benign children epilepsy with centrotemporal spikes combined with attention deficit hyperactivity. Methods　A total of 40 cases of BECTS and ADHD ，whose clinical attack stopped for more than 6 months after the treatment with anti-epileptic drugs， were given Ritalin. EEG was reexamined every 6 months， and at the same time，the attention and behavior situation with CONNER'S scale and Achenbach child behavior checklist （CBCL）were reevaluated. The seisure frequency，type and adverse events after using Ritalin were recorded and compared with the dada before using Ritalin.Results　Totally 37 cases of the 40 received the treatment for more than 6 months，which resulted in obvious improvement. Four cases had side effects.Attacks increased in two cases a week after using Ritalin; one case developed sleep difficulty 2 days after using Ritalin;another case had one seizure attack after using Ritalin for one year. The attacks were under control after withdrawal of Ritalin. There was no significant difference （P > 0.05） between the induced symptoms before and after taking Ritalin. Conclusion　It is safe to use methylphenidate hydrochloride to treat children with BECTS combined and ADHD， while controlling seizures with antiepileptic drugs.

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Efficacy and safety of amoxicillin and clavulanate for oral suspension combined with rabeprazole for helicobacter pylori eradication in children. ZHU Li-Meng 2010, 25(7): 545.  Abstract ( )   Abstract：Objecive　To compare the efficacy and safety of 10-day sequential treatment（including rabeprazole， amoxicillin and clavulanate for oral suspension，clarithromycin） and 7-day traditional trigeminy therapy （including omeprazole， amoxicillin and clarithromycin） for the eradication of helicobacter pylori（HP）in children. Methods　From Oct.2006 to Aug.2009，123 children with gastropathy with Hp infection，in Luoyang Locomotive Hospital of Henan，were divided into two groups.The control group （41） was treated with traditional trigeminy therapy for 7 days，while the treatment group（82）was treated with 10-day sequential treatment.Cure rates of the ulcer healing and Hp eradication were assessed  after treatment course of  7-10 days，while the symptom scores and the side effect were evaluated and investigated after the treatment. Results  The healing rate of ulcer in control group was 40%（2/5），which was 55.5%（5/9） in the treatment group，the difference being statistically significant（P＜0.05）. The Hp eradication rate was 92.68%（76/82）and 70.73%（29/41）in treatment group and control group， respectively .There was significant statistical difference（P＜0.05）. The total symptom score of treatment group before treatment was（56.89±4.32）， and after treatment it was （14.96±2.13），while that of control group before treatment was （58.75 ± 5.12） and （21.42 ± 3.78） after treatment（P＜0.05 or P＜0.01），the change of treatment group being more significant（P＜0.01）. The side effect rate of treatment group was lower than that of control group （6.1% VS 17.1%，respectirely，P＞0.05）. Conclusion　The 10-day sequential treatment，including rabeprazole，amoxicillin and clavulanate for oral suspension and clarithromycin，is much more efficient with lower side effect than 7-day traditional trigeminy therapy for Hp eradication in children with gastropathy with Hp infection.

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A Meta-analysis of medication for intravenous immunoglobulin resistant Kawasaki disease. MO 　Hong-a, Li-Xue-Ying-b, Du-Jun-Bao-a 2010, 25(7): 551.  Abstract ( )   Abstract：Objective　This study was aimed at evaluating present randomized controlled trials （RCT） regarding the drug therapy for intravenous immunoglobulin （IVIG） resistant Kawasaki disease （KD）. Methods　According to inclusion and exclusion criteria， articles were selected from medical electronic databases. RCT were then assessed based on the Juni assessment， and meta-analysis was completed by the Review Manager 4.2 software. Indications to evaluate effects were the change of body temperature and change of coronary artery situation detected by ultrasound-cardiogram. The results were stated as relative risk （RR） or odd ratio （OR）， with a 95% confidence interval （CI） and a P < 0.05 significant level. Results　In total， three RCT were selected. Funel plot analysis showed possible publication bias. Meta-analysis of the three RCT， including all 59 patients in the 2nd intravenous immunoglobulin treatment group and 66 patients in the glucocorticosteroid treatment control group， indicated that after their first doses of IVIG treatment， the temperatures of IVIG resistant KD patients who received 2nd IVIG treatment could be more effectively improved than those who received glucocorticosteroid treatment （RR = 1.29，95% CI：1.10～1.52，P = 0.002）； but there were no differences on the incidence of coronary artery aneurysm between two groups （OR = 0.91，95% CI：0.33～2.49，P = 0.85）. Conclusion　The Meta-analysis of currently published RCT demonstrates that the 2nd IVIG can more effectively improve the temperature than glucocorticosteroid in IVIG resistant KD patients； but there were no differences on the incidence of coronary artery aneurysm between two groups.