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06 December 2010, Volume 25 Issue 12 Previous Issue    Next Issue

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Detection and analysis of HCoV-NL63 in the children with acute respiratory tract infections. CHEN Yun-huan，WU Yan-an.Fujian Proivincial Hospital，Fujian Medical University，Fu 2010, 25(12): 916.  Abstract ( )   Abstract：Objective　To establish a real-time fluorescent quantitative PCR assay to detect the human coronavirus NL63 from nasopharyngeal samples of children with acute respiratory tract infections in Fuzhou. Methods　The specific primers and Tap-man probes were designed targeting the 1a gene. The aimed fragment of 1a gene was amplified with PCR and ligated into a PMD18-T Easy vector for standards. A total of 151 clinical specimens were subsequently tested after determination of the sensitivity and specificity of the established real-time PCR. Amplify and preliminarily analyse the N gene. Results　The specificity of this assay was excellent. The linear amplification of the assay ranged from 101 copies/μL to 1010 copies/μL. Two of 151 clinical specimens（1.3%） were tested positive for HCoV-NL63. Conclusion　The real-time fluorescent quantitative PCR assay is successfully established to detect HCoV- NL63 .

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Analysis of antibiotic resistance and resistance mechanism of Haemophilus influenzae in children with acute respiratory tract infection. JI Wei，WU Jun-hua，SHAO Xue-jun，HUANG Lu，LUO Ya-li. Respiratory Department，Childr 2010, 25(12): 920.  Abstract ( )   Abstract：Objective　To investigate antibiotic resistance and mechanism of antibiotic resistance of Haemophilus influenzae （HI） in children with acute respiratory tract infection in Suzhou. To determine beta-lactamase genes of Haemophilus influenzae， possible genetic mutation and the possible relationship between minimal inhibitory concentrations（MICs） of beta-lactamases antibiotic and genetic mutation. Methods　The susceptibility of 135 clinical isolates of Haemophilus influenzae were calculated using E-tests， and beta-lactamases of these stratins were detected. Besides， the beta-lactamases genes were detected by net-polymerase chain reaction （n-PCR） followed by DNA sequencing. The  sequences of drug resistance genes were compared with the published sequence in GeneBank. Results　The beta-lactamase positive rate of HI was 31.1%. The MIC90 and MIC50 of HI to ampicillin，ampicillin/sulbactam，cefaclor and chloramphenicol were（32 μg/mL，1 μg/mL）、（2 μg/mL， 0.75 μg/mL）、（24 μg/mL，3 μg/mL） and （8 μg/mL，0.5 μg/mL） respectively. Among the isolated 135， TEM genes were detected in 53 HI. Beta-lactamase geneTEM was detected in 39.3%of HI．No ROB gene was detected. About 28.3% of TEM gene had been mutated. The mean minimal inhibitory concentration of beta-lactamases antibiotic in HI that had mutant TEM genes was higher than that of no-mutant TEM gene. Conclusion  Ampicillin resistance in HI influenzae isolates from children in this region is challenging．The resistance mechanism of beta-lactamase antibiotics is of production beta-lactamase TEM and 28.3% of TEM gene has been mutated. The production of TEM and its mutation is one of the most important factors that leads to the high resistance to beta-lactamase antibiotics.

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Working memory in children with attention deficit hyperactivity disorder： a near-infrared spectroscopy study. XIAO Ting*，KE Xiao-yan，SUN Yan-li，PAN Heng-zu，YANG Hong-yu，HONG Shan-shan，HANG Y 2010, 25(12): 924.  Abstract ( )   Abstract：Objective　To investigate the working memory profiles in children with Attention Deficit Hyperactivity Disorder （ADHD）. Methods　We investigated 39 children with ADHD （DSM-IV）， including ADHD combined type（ADHD-C）（n = 14），ADHD inattentive type （ADHD-I） （n = 14） and ADHD hyperactive/ impulsive type（ADHD-HI） （n = 11）， and 19 normal controls matched for age， sex， handedness， and intelligence during a working memory task. Prefrontal brain activity was measured by concentration changes of oxygenated haemoglobin （oxyHb）. Functional near-infrared spectroscopy （NIRS） was used to obtain the oxyHb. Results The results of working memory task： （1）ADHD children had more total errors （3.51±3.025） and comparison errors（2.41±2.149）than controls（P < 0.05）.（2）There was no significant difference in reaction time between ADHD and control group （P＞0.05）.（3）ADHD-C patients had more reaction errors（1.71±2.016）than ADHD-HI’s（P < 0.05） ；on comparison errors，ADHD-HI children had more than ADHD-C’s（P < 0.05），and ADHD-I children also had more than ADHD-C’s（P < 0.05）.But there was no significant difference between ADHD-I and ADHD-HI group.（4） ADHD-HI group had longer reaction time than ADHD-I’s （P < 0.05）.The results of NIRS： （1） There was no significant difference in concentration changes of oxygenated haemoglobin （oxyHb） between ADHD and control group when they performed working memory task.（2）Concentration levels of oxyHb in ADHD-C decreased in the left-down prefrontal cortex area during performing reaction commission than ADHD-I［（-2.46±9.62 ）×10-4 vs.（10.47±14.18）×10-4 P < 0.05］.Conclusion　There are significant deficiencies in working memory in children with ADHD；ADHD subtypes differ in working memory profile.

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Electroclinical features of the variants of benign childhood epilepsy with central temporal spikes. ZHANG Yue-hua，LIU Xiao-yan，YANG Zhi-xian，BAO Xin-hua，XIONG Hui，WU Ye，WANG Shuang 2010, 25(12): 928.  Abstract ( )   Abstract：Objective　To study the electroclinical features of the variants of benign childhood epilepsy with central temporal spikes （BECT）. Methods　Video electroencephalography （EEG） monitoring was performed in 29 BECT patients who had some atypical symptoms during the course of the disease， and some of them were examined simultaneously with electromyography （EMG）. The seizure semiology， electrophysiological features，responses to antiepileptic drugs and corticosteroids were analyzed. Results　The onset age of partial seizures during sleep was from 2 to 8 years. The atypical symptoms following disease onset was from 2 to 57 months. The clinical presentations of the variants of BECT included hand trembling and objects dropping （n = 27）， head nodding and instability or dropping attack during standing （n = 4）， speech deterioration （n = 13）， oromotor deficits （n = 11）， and aphasia （n = 3）. Cognitive decline could be observed in 18 cases. The typical rolandic seizures were exaggerated in 14 patients during atypical symptoms occurrence. The EEG of all 29 patients showed abundance of spike and waves （SW） in rolandic areas during wake-up and sleep. The SW index was 50％～85％ during slow sleep in all cases. Video EEG monitored epileptic negative myoclonus （ENM） in 27 patients confirmed by outstretched arms test， atypical absences with secondary bilateral synchronous 2～3 Hz spike-wave rhythms during ictal EEG in 11 patients. Valproic acid only or combined with clonazepam， levetiracetam or lamotrigine were effective in 11 patients. The clinical symptoms and EEG SW were improved in 18 patients by adding corticosteroid therapy. Conclusion　The clinical presentations of the variants of BECT include ENM， atypical absences， oral pharynx apraxia and cognitive deterioration. The clinical presentations are associated with EEG deterioration. Antiepileptic drugs therapy or combined therapy with corticosteroids is effective in improving electroclinical manifestations of the variants of BECT.

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Investigation into the effects of sotalol combined with propafenone in the treatment of pediatric atrial tachycardia. LI Xiao-mei，ZHANG Yan，BAO Min，ZHANG Yi. Pediatric Cardiologic Department，the Fir 2010, 25(12): 932.  Abstract ( )   Abstract：Objective　To evaluate the efficacy and safety of the combination use of sotalol with propafenone to treat pediatric atrial tachycardia. Methods　A total of 42 children （male 19，female 23，aged 7 days～14 years）diagnosed with atrial tachycardia in our hospital were treated by oral anti-arrhythmic drugs. 24-hour holter monitoring and wireless remote realtime monitoring system were used to evaluate the efficacy. Cardiac function was evaluated by echocardiogram. Side effects of drugs were closely detected during the whole process. Results　Twenty-one cases were firstly treated by single sotalol，but no one was were completely cured，20 were partially cured（95.2%），and 1 was ineffective （4.8%）. Forty-one cases were finally treated by sotalol plus propafenone，30 were completely cured （73.2%），9 were partially cured （21.9%） and 2 were ineffective（4.9%）. The effective dose of sotalol was 4.9～5.7 mg/（kg·d），and the effective dose of propafenone was 9～10.5 mg/（kg·d）. Five cases of incessant atrial tachycardia complicated by tachycardiomyopathy （5/17，29.4%） were treated by amiodarone plus metroprolol，1 was completely cured and the others’ cardiac fuction were obviously improved after treatment although none of them were completely cured，they all reverted to sotalol plus propafenone while cardiac function became nearly normal. Injury of thyroid function happened in 3 cases after treatment of oral amiodarone for 3～8 months and all recovered during 1 month after withdrawing the drug. The therapy continued for 6 months to 1 year after disappearance of arrhythmia. During the 1～9 months of follow-up period after withdrawing drugs 31 cases  were completely cured， while only 1 case of intermittent atrial tachycardia recurred at the 8th month after withdrawing the drug. Conclusion　Sotalol is a safe and effective anti-arrhythmic drug which can be used to treat pediatric atrial tachycardia；the effective dose is 4.9～5.7 mg/（kg·d）；combination use of sotalol plus propafenone is obviously more effective with satisfactory safety than single use of sotalol；short-term use of amiodarone is safe for children，while long term use（> 3 months） might lead to thyroid function injury，and can be used as transitional drug for patients diagnosed with tachycardiomyopathy.

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Investigation of the change of Th cell in induced sputum of children with asthma. LIU Yu，LI Cheng-rong， LI Qiu，WANG Guo-bing，ZU Ying，JIA Shi-lei. Department of Mo 2010, 25(12): 936.  Abstract ( )   Abstract：Objective　Explore the role of Th cell and related cytokines in immune pathogenesis of children with asthma. Methods　Twenty children with asthma and 20 age-matched healthy children were studied. Flow cytometric analysis was used to detect the percentage of Th1，Th2，Th17 and CD4+CD25+ regulatory T （Treg） cells. The induced sputum from those children was collected to count and classify inflammatory cells. Realtime PCR was used to analyze the expression of T-bet，IFN-γ，GATA3，IL-4，Foxp3，TGF-β，RORrt，IL-17A，IL-8 and TNF-α mRNA in peripheral blood mononucear cell and induced sputum. Results　（1）The percentages of Th1 and Treg cell in children with asthma were significantly lower than those in healthy controls（P < 0.05），and there was no significant difference in the percentages of Th2 and Th17 cell between asthma patients and controls （P > 0.05）； （2） Expression levels of the T-bet，Foxp3，IFN-γ，TGF-β in the children during acute phase of asthma were significanttly lower than those in healthy control subjects（P < 0.05）， but the expression levels of the GATA3，RORγt，IL-4 and IL-17A were of no difference between the two groups； （3）The number of neutrophils and eosonophils in induced sputum significantly， increased in the children with acute phase asthma（P < 0.05）；（4） Expression levels of GATA3，IL-4，IL-5，RORγt，IL-17A，IL-8 and TNF-α in indued sputum were significanttly increased in asthmatic children （P < 0.05），but there were no difference about the expression levels of T-bet，IFN-γ，Foxp3 and TGF-β between the two groups. Conclusion　Increase of Th2 and Th17 transcription factors and cytokines in airway of children with asthma might play an impaortant role in airway inflammation.

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Clinical analysis of 15 cases of neonatal congenital hyperinsulinism hypoglycemia. SU Chang，GONG Chun-xiu.The Capital Medical University Affiliated Beijing Childre 2010, 25(12): 940.  Abstract ( )   Abstract： Objective　To study the diagnosis and treatment of neonatal Congenital Hyperinsulinism Hypoglycemia（CHI）. Methods　The clinical data of 15 newborn babies with CHI，who were diagnosed in Beijing Children’s Hospital between 2000 and 2010，were retrospectively reviewed. Results　Sex ratio of boys to girls was 10：4. Time variation in disease onset： from less than 1 hour after labor to 25 days. ten of 15 patients were large for gestational age； 8 of them were macrosonias. Convulsion，cyanosis，lethargy，refusing milk sucking，irritability and sweating were common symptoms. The laboratory findings displayed persistent hypoglycemia and hyperinsulinism in all of the 15 newborn babies. There were no urine and blood ketones elevating in all of the 15 newborn babies. Nine infants were treated with oral diazoxide，but only 2 of them showed effectiveness to the therapy. One patient was given subtotal pancreatectomy and the blood glucose level was restored to normal after operation. Two newborn babies died within 2 weeks. Of the other 13 newborn babies，only 3  who were effectively treated had normal intelligence. Nine of them presented mental retardation in a 5-year follow-up. Conclusion　The measurement of blood glucose，blood insulin and urinary ketones is helpful in the diagnosis of persistent hyperinsulinemic hypoglycemia of infancy. Most patients have no response to diazoxide therapy. Whenever drug treatment is comfirmed unresponsive，operation should be considered.