Archive

06 October 2010, Volume 25 Issue 10 Previous Issue    Next Issue

---

For Selected:

Download Citations EndNote Ris BibTeX

Toggle Thumbnails

Select

The study of circulating endothelial progenitor cells and inflammatory factors in children with coronary aneurysms late after Kawasaki disease.　 DUAN 　Chao-1, DU Zhong-Dong-1, ZHANG Gui-Rong-1, MO Sui-Gui-2, SUN Xue-Jing-2 2010, 25(10): 759-762.  Abstract ( )   Abstract：Objectives　To evaluate the circulating endothelial progenitor cells （EPC） numbers as well as the serum lipoprotein levels and high sensitivity C-reactive protein （hs-CRP） in children with coronary aneurysms. Methods　Thirty-one children with coronary aneurysms due to Kawasaki disease and twenty-one healthy children were enrolled in this study. Circulating EPCs were determined by flow cytometry， defined as CD34， KDR， CD133 possitive cells. Serum lipoprotein levels were measured by using automatic biochemistry analyzer and their matched reagents. Serum hs-CRP levels were determined by enzyme-linked immunosorbent assay. All data were analyzed by using SPSS 12.0 for windows. Results　The KD group included 9 children with medium aneurysms and 22 children with gaint aneurysms. The duration from the onset of the disease was 1～12.5 years （median 2.53 years）. The hs-CRP levels in KD group was significantly higher than in normal controls［（2.77±1.06）mg/L VS （1.60±1.53）mg/L， P < 0.01］. The number of circulating endothelial progenitor cells between the two groups had no statistical significance （P > 0.05） .The serum levels of TG， TC， HDL-C， LDL-C apo-A1 and apo-B between the two groups had no statistical significance （P > 0.05）. Conclutions　The serum level of hs-CRP is significantly increased in children with KD complicated with medium or giant coronary aneurysm late after the onset of disease， suggesting that children with persistant coronary aneurysms due to Kawasaki disease may have the disposition to premature atherosclerosis in young adulthood. Circulating endothelia progenitor cells and serum lipoprotein levels have no significant changes as compared with normal controls.

Select

MRI study of pituitary gland morphology in idiopathic growth hormone deficiency in stage of adolescent. BAI 　Gang-1a, 2 , SHU Hui-Juan-1a, BO 　Hui-1a, LI Ai-Kuo-1a, GONG Feng-Yang-1a, ZHANG 　Chao-1b, FENG 　Feng-1b, JIN Zi-Meng-1a, CENG Xian-Wei-2, SHI Die-Fan-1a 2010, 25(10): 763-766.  Abstract ( )   Abstract：Objective　To study the changes of shape， size and signal intensity of pituitary gland in idiopathic growth hormone deficiency（IGHD）in adolescent. Methods　Clinical data of pituitary MRI of 100 puberty with IGHD were chosen from the Endocrine Department of Peking Union Medical College Hospital from January 2005 to January 2010．Compared these results with the normal. Results　There were significant difference of the superior shape of the pituitary and the MRI signal between the study group and control group. The height of pituitary gland and the width of pituitary stalk in the study group were significantly smaller than the control group （P < 0.01）. There were three major imaging features of the pituitary MRI in IGHD cases： the pituitary hypoplasia， the posterior lobe of pituitary dystopia or disappear and the pituitary stalk thinning or disappear. Conclusion　There is a remarkable change of the pituitary in IGHD cases.It is necessary to combine the MRI of the pituitary with the clinical and laboratory findings to diagnose IGHD.

Select

The clinical analysis of 126 american children with feeding difficulties.　 YIN Hua-Yang-1, Ajay Kaul2 2010, 25(10): 767-770.  Abstract ( )   Abstract：Objective　To analyse the clinic characteristics of American children with feeding difficulties，and to provide reference for the diagnosis and treatment of feeding difficulties in our country. Methods 　Retrospective analysis was made on 126 children’s medical charts of feeding difficulties at Interdisciplinary Feeding Team in Cincinnati Children’s Hospital Medical Center in USA. All the children were the first time visit. We analyzed the clinical characteristics of children with feeding difficulties including the ages of first visit， reasons for referral， types of feeding， nutritional status，oral functions and co-morbid conditions. Results　The most children with feeding difficulties were under 3 years old， of whom 28（22.2％） were younger than 1 year old and 63（50.0％） were 1 to 3 years old. Of the 126 feeding difficulties children， 91（72.2％） were full oral feeding， 31（24.6％） were provided nutrients by partial enteral feeding and 4（3.2％） were by full enteral feeding. There were 83（65.9％）children with normal status of nutrition，33（26.2％） were mild malnutrition and 10（7.9％） were moderate malnutrition. Ninety （71.4％） children with feeding difficulties had developmental oral function delays， of whom 71（56.3％）had oral-motor skills delays， 42（33.3％） had oral sensitivity problems and 30（23.8％） had swallowing problems. The following three co-morbid conditions were most frequent： 68（54.0％）chronic gastrointestinal conditions， 59（46.8％） neurodevelopmental delays， and 39（30.9％）chronic respiratory diseases. Conclusion　Feeding difficulties are common in infants and young children. Most children present with one or more co-morbid conditions. The children who have chronic gastrointestinal conditions， neurodevelopmental delays and chronic respiratory diseases are at high risk of feeding difficultes.

Select

Investigation on different treatment for congenital adrenal hyperplasia.　 YI 　Qin, TIAN Feng-Yan, TU 　Xiao, WEI 　Gong, LIANG 　Yan, LUO Xiao-Beng 2010, 25(10): 771-773.  Abstract ( )   Abstract：Objective　To investigate the influences on growth velocity and bone age of two different treatments for congenital adrenal hyperplasia and determine the optimal dose and frequency of hydrocortisone. Methods　Clinical data of 18 patients （9 males， 9 females） with congenital adrenal hyperplasia，who were diagnosed and treated in Tongji Hospital affiliated to Tongji Medical College， Huazhong University of Science and Technology from 2005 to 2009，was studied retrospectively. Before May 2007， all of the patients with congenital adrenal hyperplasia were treated with the old method； hydrocortisone dose was divided into two doses or one. Since May 2007， we have tried a new method， it was divided into three doses. At 8 a.m. and 4 p.m.， the dose was both one fourth of the total dose， and at 10 p.m.， the dose was the highest， about one half. According to the different time of first visit， the patients were divided into group A （after May 2007） and group B （before May 2007）. In group B， according to the different treatment methods used， it was divided into group B1 （old method） and group B2 （new method）. Growth velocity （GV）， height age increased （ΔHA）， the ratio of ΔHA/ΔBA （bone age increased） and ΔBA/ΔCA （chronological age increased） were analyzed. Results　The ratio of ΔBA/ΔCA was reduced significantly after changing the frequency and time of taking hydrocortisone （P < 0.05）. The value of ΔHA and ΔHA/ΔBA both decreased in group A compared with group B1 and in group B2 compared with B1， but there were no significant differences between them （P > 0.05）. Gv had no significant difference between group A and group B1， but it significantly decreased in group B2 compared with group B1. Conclusion　The new method of taking hydrocortisone can control the rapid progress of bone age better and does not lead to growth suppression.

Select

The function of specific cytotoxic T lymphocytes （CTLs） in children with primary EBV infection. TAO 　Yao-1, DUAN Gong-Mei-1, XIE Zheng-De-1, ZHOU 　Ling-2, SHEN Hun-Ling-1 2010, 25(10): 774-777.  Abstract ( )   Abstract：Objectives　To study the function of the EBV lytic and latent peptides specific CTLs and analyze the correlations between peripheral EBV Viral Load （VL） and the CTLs responses from primary to persistent infection. Methods 　Six patients with infectious mononucleosis （IM） were enrolled in the study along with four healthy children with past EBV infection as controls. Human leukocyte antigen （HLA） identification was performed by magnetic beads cell sorting （MACS）. Enzyme-linked immunospot （ELISPOT） and Real-time PCR were performed. To determine INF-γ lever secreted by specific T-lymphoayte  & the peripheral EBV VL. Results　ELISPOT and EBV VL in peripheral blood were performed in acute phase， 2 months， 10 months and 20 months after admission for all the cases except one case who lost of follow-up in 20 months. The CTLs responses against lytic peptides and latent peptides in patients were significantly increased （P < 0.05， compared with control）. Among patients with IM the CTLs responses against lytic peptides decayed in contrast against latent peptides increased first then decayed from primary to persistent infection. All of them decreased sharply in 10 months after admission （P < 0.05， compared with 2 months）.Then they were at a low level or undetectable ultimately （P > 0.05， compare 20 months with 10 months）. The results of EBV VL in peripheral blood of case No. 4 were 3.52×103， 6.75×102， 2×102 and negative in the acute phase， 2 months， 10 months and 20 months respectively， and the results of case No. 6 were 2×103 in the acute phase and negative in other time. Four cases in the rest had negative results of EBV VL in peripheral blood all the time. The CTLs response against HLA restricted lytic peptide BMLF1 was positive after primary to persistent infection. Conclusions　There are differences between the CTLs responses against the lytic peptides and the latent peptides and no correlations between EBV VL in peripheral blood and the CTLs responses. The abundant result of the distribution of CTLs response against BMLF1 may play a protective role after primary infection.

Select

Research on the MRI and related factors in the preterm infants with early cerebral white matter damage.　 YIN Xiang-Yun, XUE Xin-Dong, FU Jian-Hua 2010, 25(10): 778-782.  Abstract ( )   Abstract： Objective　To assess the early changes of MRI and its clinical significance in the preterm infants with the cerebral white matter damage（CWMD），based on the data offered by MRI， and to investigate the related factors. Methods　The research was prospectively performed on 262 preterm infants from September 2007 to September 2009 at the neonatal ward of the Shengjing Hospital of China Medical University. All  were performed MRI examination in 7 days；subjects were classified into two groups according to MRI diagnostic criteria： case group and control group. Of case group，29 were followed up. Results　（1）Focal injury，high signal appeared on DWI，with normal or slightly high signal on T1WI，accompanying low or normal signal on T2WI.The diffuse injury，diffusive high signal only on DWI， no abnormal signal on regular MRI. After about two weeks，focal lesions have been shown in two ways：① lesion vanished ② normal or slightly high signal on DWI， while on T1WI high signal and low or normal signal on T2WI，diffuse injury have been change into periventricular leukomalacia（PVL），High signal or miscellaneous （high and low）signal on T2WI，while on T1WI and DWI， miscellaneous signal .（2）Related factors were analyzed.Univariate analysis， perinatal infection， twins， hypocalcaemia， metabolic acidosis， hypoxia，mechanical ventilation and infants infection for preterm CWMD were considered statistically significant. Logistic Regression  analysis showed that perinatal infection， hypoxia and intrauteral embarrassment were risk factors for preterm infants with CWMD. Conclusion　（1）DWI can detect the lesions in early stage of CWMD.（2）The interaction of multiple factors，includly the premature infant CWMD， perinatal infection，hypoxia and intrauteral embarrassment has close relationship with the CWMD.（3）There are no specific clinical manifestations of CWMD，so it is suggested MRI should be performed as a routine in preterm infants，and follow up is necessary if abnormal signal appears.

Select

Significance of Notch1 protein expression in pediatric acute leukemia. WANG Guan-Ling, HU 　Qun, LIU Shuang-You, ZHANG Yao-Dong, ZHANG Xiao-Ling, LIU Ai-Guo, ZHANG Liu-Qing 2010, 25(10): 783-786.  Abstract ( )   Abstract：Objective　To investigate the expression of Notch1 protein in the children with acute leukemia （AL） and to explore the relationship of Notch1 expression with immunophenotype and therapeutic effect. Methods　The Notch1 protein of bone marrow smears was examined by immunohistochemical assay in 49 newly diagnosed children with acute leukemia and 20 control cases without malignant hematologic disease. Immunophenotype of leukemic cells was performed by flow cytometry. The standard chemotherapy regimens were taken to treat the patients. Results　The expression rate of Notch1 protein in T-cell acute lymphoblastic leukemia （T-ALL） （77.8%） was much higher than that of B-cell acute lymphoblastic leukemia （B-ALL） （31.0%， P < 0.05） as well as the control group （（15.0%， P < 0.05）. Notch1 protein expression in acute non-lymphoblastic leukemia （ANLL） （63.6%） was significantly higher than that in the control group （15.0%， P < 0.05）. Additionally， in T-ALL and ANLL groups， there was no correlation between the expression of Notch1 protein and treatment effect. However， in B-ALL patients with more than 6 months of follow-up， Notch1 expression rates in the favorable group（complete remission without relapse） and the unfavorable group （death or relapse） were 21.4%and 80.0% respectively （P < 0.05）. Conclusion　Notch1 expression in childhood leukemia is immunophenotype-specific. Though the expression of Notch1 protein in B-ALL is not high， it may be a poor prognosis factor.

Select

The level of the serum CA，ALD and cardiac function in children with congenital heart disease. GENG Chu-Hua, ZHANG Hong-Yan, LIN Shu-Xiang, XU Zhao-Feng 2010, 25(10): 787-790.  Abstract ( )   Abstract：Objective　To investigate the level of serum catecholamine （CA）［including epinephrine（E）， norepinephrine（NE）， dopamine（DA）］ and aldosterone（ALD） in children with left to right shunt congenital heart disease（CHD），and analyze the correlation between the serum CA， ALD and cardiac function，ventricular volume load， pulmonary artery pressure and myocardial remodeling. Method　Totally 53 cases of left to right shunt CHD and 20 cases of control group were induded in the study. We measured the content of serum CA and ALD in the control group and CHD group. We applied real-time three- dimensional echocardiogram to measure the left atrium diameter （LAD）， left ventricular end diastolic inner diameter （LVEDD）， and cardiac function. Result　（1）The level of serum NE and ALD in CHD group was higher than the control group （P < 0.01）. （2）The level of serum CA and ALD was higher in heart failure group， large shunt group and pulmonary artery hypertension group than in non-heart failure group， small shunt group and  non-pulmonary artery hypertension group（P < 0.01）.（3）The left ventricular end diastolic inner diameter index（LVEDDI）， left ventricular end diastolic volume index（LVEDVI） and left ventricular mass index of heart failure group were larger than those of non-heart failure group（P < 0.01）.（4）There was positive correlation between the serum level of CA and left atrial diameter index （P < 0.01） and LVEDDI （P < 0.01）， LVEDVI （P < 0.01）. Conclusion　The serum CA and ALD may be regarded as an objective parameter in the early diagnosis of heart failure and pulmonary artery hypertension. There is a positive correlation between the serum CA and myocardial remodeling.

Select

Effects of methylprednisolone on vascular endothelial growth factor in early acute lung injury. WANG Lin-Xia, HAN Guo-Jiang 2010, 25(10): 791-793.  Abstract ( )   Abstract：Objective　To explore the effects of methylprednisolone （MP） of different doses on vascular endothelial growth factor （VEGF） of early acute lung injury（ALI），providing a theoretical basis for clinical treatment. Methods　Totally 48 cases who met ALI diagnostic criteria from PICU were randomly divided into 3 groups： group ALI， group HALI （treated by high-dose MP）， group LALI （treated by low-dose MP）. Eight heathy individuals were selected as control group（NC）. Results　（1）As compared with group NC， the serum VEGF and blood lactate were significantly higher，while oxygenation index was significantly lower than in other groups （P <0.05）. （2）Contents of serum VEGF， blood lactate of group HALI and LALI stepped significantly down，but oxygenation index stepped significantly up than group ALI  after 24 h（P < 0.05）； （3）Between group HALI and LALI，the serum VEGF、blood lactate、oxygenation index at 24 h， 48 h and 72 h had no significant differences（P > 0.05）. （4）Compared with group ALL， ARDS（acute respiratory distress syndrome） patients within 72h were stepped up significantly than group HALI and LALI（P < 0.05），but there were no significant differences between the two groups（P > 0.05）. Conclusion　The expression of VEGF is increased in early ALI； low-dose MP can inhibit the progression of ALI by inhibiting the expression of serum VEGF.

Select

The role of diffusion-weighted MR imaging in viral encephalitis of children. MA Yan-Li-1, ZHOU Xiao-Wei-2, FAN Guo-Guang-3 2010, 25(10): 794-797.  Abstract ( )   Abstract：Objective　The aim of this study was to evaluate the role of diffusion-weighted imaging （DWI） in the diagnosis of viral encephalitis and its relationship with the stage of the illness. Methods　We performed conventional magnetic resonance imaging （MRI） including T1WI， T2WI sequences and DWI in 56 patients with viral encephalitis diagnosed on the basis of laboratory，clinical and radiologic findings，in which 29 patients were abnormal. Thirteen patients have received MRI two times. So ，there were 42 case-times of abnormal MRI.Based on the qualitative and quantitative comparison of the conventional MRI and DWI， the patients were divided into three groups. Apparent diffusion coefficient （ADC） values of the involved and contralateral normal brain tissues were computed and compared for each group. Results 　In group Ⅰ （n = 23） DWI was superior to conventional MRI in detecting the encephalitic involved sites and in depicting the borders of the encephalitic lesions. In group Ⅱ （n = 11） DWI was similar to conventional MRI. In group Ⅲ （n = 8） conventional MRI was superior to DWI. Mean ADC values of affected versus contralateral normal brain tissues were 0.45±0.19×10-3 mm2/s VS 0.93±0.06×10-3 mm2/s in group Ⅰ，0.87±0.31×103 mm2/s VS 0.97±0.06×10-3 mm2/s in group Ⅱ， and 1.66±0.60×10-3 mm2/s VS 1.08±0.24×10-3 mm2/s in group Ⅲ. Patients in group Ⅰ had significantly lower ADC values than those in group Ⅱ， while patients in group Ⅲ had the highest ADC values （P < 0.05）. The ADC values were significantly lower in the affected sites than in the unaffected sites of patients in groups I and Ⅱ， but were significantly higher in the affected sites than in the unaffected sites of patients in group Ⅲ （P < 0.05）. There was an excellent correlation between ADC values and duration of the disease （r = 0.874，P = 0.01）. Conclusion　DWI is superior to other conventional diagnostic MR sequences in the detection of early viral encephalitic lesions and depiction of the lesion borders and， in combination with other sequences， DWI may contribute to the determination of the disease phase.

Select

Clinical application of susceptibility weighted imaging in cerebral vascular malformation of children. LI 　Ke-1, JIN 　Zhen-1, ZHANG 　Lei-1 , DING Chang-Gong-2, CENG E-Wei-1 , SHU 　Lei-1, SHI Dong-Chun-1 2010, 25(10): 798-801.  Abstract ( )   Abstract：Objective　To evaluate the diagnostic value of susceptibility weighted imaging （SWI） in cerebral vascular malformation of children. Methods　The imaging data of MRI were retrospectively analyzed in all twenty-seven cases， which included 16 cases of venous angioma， 8 cases of cavernous angioma and 3 cases of arterio-venous malformation. The comparison of SWI and conventional MR sequences was obtained. Results　The dilated draining veins and medulla veins were displayed well on SWI sequence. More brain cavernous angioma lesions could be detected on SWI than those on conventional MR sequences（P < 0.05）. Conclusion　SWI can detect lesions of venous angioma， cavernous angioma and arterio-venous malformation more sensitively than other sequences， which is a reliable diagnostic technique for cerebral vascular malformation of children. SWI has higher clinical value， and should be the routine sequence in the MRI examination.

Select

Perioperative management of children with obstructive sleep apnea-hypopnea syndrome accompanied by pulmonary hypertension. LIU Da-Bei, TAN Zong-Yu, ZHONG Jian-Wen, HUANG Zhen-Yun, SHAO Jian-Bei, CHOU Shu-Yao, ZHOU 　Jing 2010, 25(10): 802-805.  Abstract ( )   Abstract：Objective　To determine the appropriate perioperative management of children with obstructive sleep apnea-hypopnea syndrome accompanied by pulmonary hypertension. Methods　Two children with obstructive sleep apnea-hypopnea syndrome accompanied by pulmonary hypertension were admitted to our department from April 2006 to May 2009； their cases were analyzed and relevant literature was reviewed.  Conventional adenotonsillectomy was performed for one child before controlling pulmonary hypertension.  The other child received preoperative continuous positive airway pressure ventilation， then coblation-assisted adenotonsillectomy was performed. Results　The child who had received preoperative continuous positive airway pressure ventilation underwent an uneventful operation； no intra-or postoperative complications were reported.  In contrast， the child who did not receive preoperative pulmonary hypertension control experienced severe hypoxemia recurrently after surgery， leading to difficulty of extubation.  The child remained in the intensive care unit for two days before being transferred to the general ward.  The two children were followed up for more than three months and both showed improved sleeping with less snoring， open mouth breathing， and dyspnea.  Preoperative apnea-hypopnea indices were 90.0 and 29.2，and postoperative apnea-hypopnea indices were 3.5 and 4.6 for the children.  Lowest nocturnal oxygen saturation also improved after surgery for both children （0.43 and 0.63 vs 0.95 and 0.92）. Conclusion　Pulmonary hypertension is a rare but severe complication of obstructive sleep apnea-hypopnea syndrome in children.  It can result in severe consequences or even death if not appropriately managed.  Surgery is the first-line treatment for children with this syndrome who have enlarged tonsils and adenoids； however， the risk is considerable when accompanied by pulmonary hypertension， and incidence of complications is high.  Thus， perioperative management with continuous positive airway pressure ventilation to control pulmonary hypertension is critical.