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06 March 2011, Volume 26 Issue 03 Previous Issue    Next Issue

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Study on drug-resistance and genetic types of methicillin-resistant Staphylococcus aureus isolated in children with pneumonia.　　 WANG Qun*，YANG Yong-hong，GENG Wen-jing，WU De-jing，YUAN Lin，YU Sang-jie，SHEN Xu-z 2011, 26(03): 183.  Abstract ( )   To investigate the drug-resistance and genetic types of methicillin-resistant Staphylococcus aureus（MRSA）isolated from pneumonia in children，and provide information for clinical diagnosis and treatment. Methods　The patients with pneumonia from six hospitals in China between September 2008 and March 2009 were investigated. The MRSA strains were isolated from sputum of lower respiratory tract；the strains were identified by cefoxitin slip test；clinical information about these MRSA was also collected. The minimal inhibitory concentrations （MIC ） of 12 antibiotics against MRSA were determined by agar dilution method according to the guidelines of the clinical and laboratory standards institute，and the data were analyzed by WHONET 5.4 software. The multilocus sequence typing （MLST） of MRSA was performed as described previously ，and the SCCmec types were determined by the multiplex PCR assay. Results　Forty-seven strains of MRSA were separated from the patients with pneumonia；the most common age with pneumonia caused by MRSA was from 15d to 6 years old. The SCCmec types of most MRSA strains were type Ⅲ，type IV and typeⅤ.The most common type of MLST of MRSA-IV and MRSA-Ⅴwas ST59. All MRSA isolates were found to be resistant to penicillin and oxacillin，and susceptible to vancomycin. Resistance to other antimicrobial drugs tested was relatively higher and multidrug resistance was also observed. Conclusion　The most common age with pneumonia caused by MRSA is before school age. The SCCmec types of most MRSA strains are type III ，type IV and typeⅤ.The most common type of MLST of MRSA-IV and MRSA-Ⅴis ST59. Antimicrobial susceptibility tests show high resistance of many antimicrobials and multiple drugs.

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Analysis of the cellular immunity features in children with noval H1N1 influenza.　　 CHU Chu，JI Wei，JIA Ying，LIU Jing，ZHOU Wei-fang，CHEN Zheng-rong. 2011, 26(03): 187.  Abstract ( )   To approach variance of the cellular immunological function of the confirmed cases of those  children with H1N1 influenza. Methods　A total of 86 confirmed cases with the novel H1N1 influenza A virus infection，including critical group and severe group ，were diagnosed according to the criteria of the Center for Disesse Control and Prevention of China from October 2009 to January 2010 in our department . Their cellular immunity function were tested with flow cytometry，and the lymphocyte subsets of 23 children in the Department of Surgery were set as the control group. Results　Compared with group，percentage of CD3+，CD3+CD4+，CD3+CD8+ subsets decreased obviously in critical group and severe group，with no significant variance between them； percentage of CD19+CD23+，CD3-CD19+ subsets were presented as control group > severe group > critical group，with obvious statistical variance with each other； percentage of CD3-CD16+CD56+ decreased remarkably in group severe group； however，no statistical result was found with the ratio of CD4+ /CD8+ among all the groups. Conclusion　In Suzhou，children with the pandemic （H1N1） 2009 virus infection have obvious disorder in their cellular immunity function. T lymphocytes are extensively depressed early in the course；B lymphocytes are involved in the virus clearance；decrease of percentage of NK cells has correlation with those critical cases.

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Analysis of the clinical and EEG characteristics of Ohtahara syndrome in 15 children.　　 YANG Zhi-xian*，YANG Xiao-tong，ZHANG Yue-hua，LIU Xiao-yan，QIN Jiong. 2011, 26(03): 190.  Abstract ( )   To analyze the clinical and EEG characteristics，treatment，prognosis and evolution of Ohtahara syndrome （OS）. Methods 　Review the clinical，EEG and neuroimaging data of 15 patients with OS，and also follow up the treatment，prognosis，and  volution. Results 　Of the 15 patients，12 were male，and 3 were female. The age of onset was from 1 d to 50 d. The onset age was less than one month in 12 patients and less than 10 days in 9 patients. Partial seizures as the onset type were observed in 11 out of 15 patients. All patients had tonic spasms seizures in the course of the disease and 11 patients also had partial seizures with tonic spasms seizures in one EEG monitoring. Further，tonic spasms seizures associated with partial seizures in a single ictal event （combined seizures） were recorded in 7 patients. The age of first EEG monitoring was from 2 m to 4 m. Interictal EEG showed suppression-burst （S-B） pattern in 7 cases， hypsarrhythmia mixed with S-B in 7 cases，and S-B in one hemisphere and hypsarrhythmia in contralateral in one case. Pregnancy or birth history was abnormal in 4 cases. Neuroimaging abnormalities were found in 12 cases，of which hemimegalencephaly malformations presented in 5 cases. Except one case，antiepileptic drugs were unsatisfactory in 14 cases. Hormone therapy was also poor in 7 patients who had been treated. All the children had psychomotor development deficits. The evolution in follow-up 6 cases included seizure control，infantile spasms or then followed by LGS or focal epilepsy. Conclusion　OS is severe epileptic encephalopathy of very early life. There is a male predominance. Tonic spasms seizures are the characteristic seizure type in OS. Partial seizures can occur before，at the same tim or after tonic spasms seizures disappear，especially combined with tonic spasms seizures in a single attack. Structural brain abnormalities are common in OS. This disease has a poor response to treatment and a bad prognosis. Clinical and EEG evolution may have several different forms of outcomes.

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Clinical analysis of 4 children with severe combined immunodeficiency.　　 LV Hai-tao， HAN Xiao-hua，WANG Jia，LIU Li-yun. 2011, 26(03): 195.  Abstract ( )   To improve the understanding about severe combined immunodeficiency（SCID） and enhance early diagnosis and treatment. Methods　Totally 4 children with severe combined immunodeficiency were collected from 2007 to 2009 in Shengjing Hospital of China Medical University， and the clinical manifestations， family history， imaging data， related lab test results and treatment effects were analyzed. Results　The four children were all boys； the mean age of first symptoms occurring was 2.5 months； the clinical findings were frequent infections of respiratory tract， skin and oral cavity， which occurred shortly after birth. Two cases had definite family history. Imaging data of 4 cases showed thymus absence. Cellular and humoral immune function were all abnormal，in T cell < 20% 3 cases，and 1 was 29%， CD16+CD56+（NK%） > 2% or IgG > 2.0 g/L was observed in 2 out of 4 cases.B cells were increased in 4 cases， but the B cell function was obviously reduced.The gene detection result of 4 cases was T-B+SCID. Four cases died， 3 cases died of recurrent multi-system infection and 1 died of immunological rejection. The mean age at death was < 6 months. Conclusion　If infants have recurrent， severe， multi-position， refractory infection shortly after birth and Chest imaging prompted the thymus shadow is very small or absent， SCID should be suspected and immune function test should be made in time， so that an early diagnosis can be made ，and treatment with haemopoietic stem cell transplant can be given earlier.

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Clinical study of valproate associated hyperammonemia in children with epilepsy.　　 HUA Qing*， ZOU Li-ping，LI Zi-pu，ZHOU Xiao-bin. 2011, 26(03): 200.  Abstract ( )   To investigate the development of hyperammonemia and its significance in epilepsy children after taking valproate acid. Methods　A total of 78 children with complete data who only took VPA were collected in the Affiliated Hospital of Qingdao University Medical College from Jan. 2006 to Jun. 2010. Compare the change of blood ammonia level before and after taking VPA in epileptic children and study the correlation between the hyperammonia with or without symptoms and dose and concentration of drug and the cause of epilepsy. Results　Twenty-one cases had valproate associated hyperammonemia in 78 epileptic children using valproate only. The blood ammonia level in ICE group was significantly higher than SE group （P < 0.05 ），but the dose and blood concentration of VPA was lower in ICE group（P < 0.05）.The dose of VPA was lower in the asymptomatic-ICE group than the asymptomatic-SE group（P < 0.05）， but there was no difference between the asymptomatic-ICE group and the asymptomatic-SE group in blood ammonia level and concentration of VPA （P > 0.05）. The blood ammonia level was significantly higher in symptomatic-ICE group than symptomatic-SE group（P < 0.05），but the dose and concentration of VPA were significantly lower（P < 0.05） in the symptomatic-ICE group。There were no differences between asymptomatic-ICE group and symptomatic-ICE group or the asymptomatic-SE group and symptomatic-SE group in the blood ammonia level and the dose and blood concentration of VPA（P > 0.05）. Conclusion 　Clinical physicians should pay close attention to the epilepsy children taking VPA， and once hyperammonemia occurs，VPA administration should be stopped at once.

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A　survey of sensory integrative dysfunction and attention deficit and hyperactivity in 56 children with autism.　　 WU Bao-zheng*，LI Xue，LIU Jing. 2011, 26(03): 203.  Abstract ( )   To study the occurrence of sensory integrative dysfunction and attention deficit and hyperactivity in children with autism. Methods　Fifty-six consecutive children meeting the autism criteria of DSM-IV in outpatient department were rated with Autism Behavior Checklist （ABC）， Conner’s Parent Symptom Questionnaire and Sensory Integrative Schedule （SIS）. Those above six years old were diagnosed according to the criteria of DSM-IV for attention deficit hyperactivity disorder （ADHD）. Results　The rate of sensory integrative dysfunction was 87.5 % in children with autism. Most items of SIS negatively correlated with the factors of ABC （r = -0.272～-0.685，P < 0.05 and 0.01）. The rate of hyperactivity in children with autism was 58.9 %. About 75.9% children aged above 6 years old met the symptom criteria of DSM-IV for ADHD. Children with hyperactivity or meeting the symptom criteria of DSM-IV for ADHD had  higher ABC total and body movement score and lower score of some factor of SIS （P < 0.05）. Conclusion　The children with autism usually have sensory integrative dysfunction， attention deficit and hyperactivity. Autistic children with sensory integrative dysfunction or attention deficit or hyperactivity have more severe autistic core symptom. It is necessary to intervene the sensory integrative dysfunction or attention deficit or hyperactivity in children with autism.

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Clinical analysis of 4 case of Niemann-Pick disease type C.　　 DENG Xiao-lu，YIN Fei，MAO Hua-xiong，PENG Jing. 2011, 26(03): 207.  Abstract ( )   To summarize and analyze the clinical features，diagnostic approaches and treatment of  Niemann-Pick disease type C （NPC） in children. Methods　Data of 4 cases of NPC children being followed up from 2006 to 2010 in Xiangya Hospital， Central South University were collected and analyzed. Results　Among the 4 cases， age of onset of clinical signs ranged from 6 months to 10 years. The primary symptoms were instability of gait，alalia， and splenomegaly. Clinical features included visceral signs，cortical signs and extrapyramidal signs. Brain stem signs included vertical supranuclear ophthalmoplegia （3 cases），dysarthria （3 cases）， and dysphagia （2 cases）. Bone marrow biopsy showed Niemann-Pick cells （2 cases） and sea-blue histiocytes （2 cases）.Brain MRI showed either normal （2 cases） or mild encephalatrophy （2 cases）.The EEG presented abnormal in 4 cases which showed slow background activity.Epileptiform discharges were found in 3 cases of the patients. Activity of acid sphingomyelinase was performed in 2 cases，and the results were normal.Four patients were given low-fat diet and mixed vitamin.Two patients receiving antiepileptic drugs treatment did not show significant improvement. The follow-up ranged from 1 month to 4 years.One patient died，and three patients showed retrogressive mental and motor development with brain stem signs.Conclusion 　NPC is a fatal autosomal recessive disorder. Clinical features are hepatosplenomegaly， ataxia， neurodegenerative changes and brain stem dysfunction. Until recently， there has been no available disease-specific therapies for NPC.Miglustat is available to   stabilize the disease course and prolongs lifespan.

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Evaluation of effects of Ambrocol oral liquid on lower respiratory tract infection in children through Meta-analysis.　　 LI Nan 2011, 26(03): 210.  Abstract ( )   Based on peer-reviewed random-controlled studies，effects of Ambrocol oral liquid on lower respiratory tract infection in children were evaluated. Methods　Through Meta-analysis，articles between 2005—2010 were studied to review published data in random-controlled studies related to the effects of Ambrocol oral liquid on lower respiratory tract infection symptoms， such as cough， expectoration， gasp and wet rale in children. Results　Forty-eight peer-reviewed papers published during 2005 to 2010 were selected in this study. Homogeneity test showed that fixed effect model should be selected for weighing and pooling data of assessing the efficacy，and random effect model should be selected for weighing and pooling data of duration of cough， expectoration and gasp. The combined odds ratio means of efficacy in children with infectious pneumonia with Ambrocol oral liquid intervention were 3.98（3.31～4.78）. The combined means of duration of expectoration and gasp were -1.31（-1.75～-0.87） and -1.26（-1.45～-1.06）， respectively. Conclusion　Ambrocol is effective for the lower respiratory tract infection in children.

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Study on the characters of the asthmatic children’s behavior and the psychological status of their mothers.　　 LIN Ju-qing*，HUANG Chun-xiang，ZHANG Li-gang. 2011, 26(03): 215.  Abstract ( )   To study the characters of the asthmatic children’s behavior and the psychological status of their mothers， and to provide the evidence for the synthesis treatment and the early intervention in the clinical practice. Methods　Totally 96 children with asthma and 96 healthy children were investigated about their psychological behavior with Achenbach Children Behavioral Scale （CBCL）；their mothers were investigated about their psychological status with Symptom Checklist 90 （SCL-90）. Results　The occurrence rate of behavioral problems was 38.5% in the asthmatic children， which was higher than the normal children’s 15.7%；the difference was significant （P < 0.005）. The scores of the asthmatic children in the somatization， dumps， anxiety， social intercourse flinch and disobeying were higher than the normal children’s， while the social adaptive ability was lower； the difference was significant（P < 0.05）. The scores of the mothers’ SCL-90 showed a great difference between two groups， which was mainly in anxiety， depression， hostility， phobic anxiety and psychoticismo， the difference being significant（P < 0.05）. Conclusion　Children with asthma show more psychological problems than the normal children. The mothers of the asthmatic children are more likely to develop psychological symptoms，so we should perform psychological and behavioral interventions as well as drug therapy on the asthmatic children in the clinical practice.

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Study of the change of plasma HCY and serum lipid and their correlation in obese children.　　 ZHANG Li-juan*，MA Lu-yi，SUN Guo-hua，LV Lin-lin. 2011, 26(03): 218.  Abstract ( )   To study the changes of plasma homocysteine， serum lipid in simple obese children，and the relations between plasma homocysteine，serum lipid and cardiovascular and cerebrovascular diseases， and to provide a new path to prevent and cure the simple obesity in children and cardiovascular and cerebrovascular diseases in adulthood. Methods　Thirty-four cases of simple obese children were collected in the First Affiliated Hospital of Dalian Medical University from December 2008 to December 2009，25 cases of healthy children were selected in our study in the same period. Liver morphology was detected by Color Doppler ultrasound. Venous blood was taken after 12 hours fasting. The levels of total plasm homocysteine（HCY）， cholesterol（TC），triglyceride（TG）， high-density lipoprotein（HDL-Ch），low-density lipoprotein（LDL-Ch） and plasma lipoprotein（a）［ LP（a）］ were determined. Results　Liver morphology changed in 18 cases of simple obese children，while only 1 in healthy children. TC，TG and LDL-Ch in simple obese children were significantly higher than those of control group，the difference being statistically significant（P < 0.05）. Serum HDL-Ch and LP（a） between the two groups had no obvious difference（P > 0.05）. The levels of plasma HCY in the simple obese children［（10.91±2.57）μmol/L］ was significantly higher than control group ［（5.13±1.12）μmol/L］ （P < 0.05）. The level of plasma HCY and blood lipid had no obvious relevance. Conclusion　Simple obese children are more susceptible to suffer from fatty liver than healthy children；it is closely related to the lipid metabolism. The level of HCY is significantly higher in simple obese children， which has no obvious relevance to blood lipid，and it is one of independent risk factors of cardiovascular and cerebrovascular diseases.