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06 October 2011, Volume 26 Issue 10 Previous Issue    Next Issue

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Clinical and radiological features of methotrexate-induced acute encephalopathy in children with acute lymphoblastic leukemia. QI Pei-jing，WANG Bin，ZHOU Xuan，WU Min-yuan 2011, 26(10): 748.  Abstract ( )   Abstract：Objective　To investigate the clinical and radiological features of methotrexate（MTX）-induced acute encephalopathy in children with acute lymphoblastic leukemia（ALL）. Methods　We reviewed clinical and radiological data of this complication in childhood acute lymphoblastic leukemia treated from July 1，2005 to August 31，2009 in Beijing Children Hospital. Results　Seven patients experienced acute encephalopathy within 3～10 days after receiving high-dose i.v. and/or intrathecal MTX. The signs and symptoms varied at presentation： hemiparesis，dysphasia，seizure，weakness and facial palsy. All patients recovered after 3～5 days. Acute encephalopathy occurred associated with the dosage of MTX，the age of the patients and MTX metabolism. Four patients had restricted diffusion by diffusion-weighted image（DWI） in the deep white matter，esp. centrum semiovale and corona radiate. Conclusion　Acute MTX encephalopathy often manifests transient and focal motor function deficit. Restricted diffusion on DWI is a sensitive sign of acute MTX encephalopathy.

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Expression and significance of bcl-2 in childhood B-ALL cells. LIU Xiu-qin，SUN Li-rong，ZHANG Teng-long 2011, 26(10): 752.  Abstract ( )   Objective　To study the bcl-2 mRNA expression in bone marrow mononuclear cells of childhood B-ALL，investigate the effect of bcl-2-ASODN on proliferation，apoptosis and sensitivity to chemotherapy of childhood B- ALL cells in vitro，speculate the role of bcl-2 in the mechanism，development and prognosis of childhood B-ALL，and make a perspective on the clinical application of ASODN in the future. Methods　Bone marrow mononuclear cells of childhood B-ALL were used. The expression of bcl-2 was detected by Real-time Quantity PCR. Bcl-2-ASODN was transferred into cells mediated with lipofectin. Twenty-four hours later，detect the expression of bcl-2 by Real-time Quantity PCR，proliferation of leukemia cell by MTT assay and，cell apoptosis with flowcytometry. Then add chemotherapy drugs to study the chemotherapy sensitvity of leukemia cells. Results　The results showed that the bcl-2 mRNA expression in childhood B-ALL was higher than control，especially in chemotherapy resistant group，and the bcl-2 mRNA expression was down regulated by chemotherapy in sensitive group. Bcl-2-ASODN was able to down-regulate bcl-2 mRNA expression，induce apoptosis of B-ALL cells，and enhance the effect of chemotherapy to inhibit cell growth. Conclusion　Bcl-2 pLays an important role in childhood B-ALL. The sensitivity of childhood B-ALL cells to chemotherapy is enhanced by bcl-2-ASODN，which suggests that inner bcl-2 in leukemia cells can bring about side effect of drug resistance.

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Analysis of the factors related to acute leukemia in 64 children SUN Yan，HU Qun，ZHANG Liu-qing，LIU Ai-guo，LIU Shuang-you，XIONG Hao，SHU Mei-rong，Z 2011, 26(10): 756.  Abstract ( )   Abstract：Objective　To explore the cause of death ，the time of death and the related factors in the children with acute leukemia. Methods　Retrospectively analyze the clinical information of the 64 dead cases of AL who were admitted to  our hospital from January 2000 to June 2009. Results　The time from diagnosis to death was 1 day to 50 months；34 cases died in 1 month （early death） （53.1%），18 cases within 6 months（28.1%），12 cases more than 6 months（18.8%）.  Infection-related deaths occurred in 45 case（70.3%），of which 25 cases died from respiratory tract infection（55.6%），4 cases from gastrointestinal infection and 4 septicemia ，2 cases skin infections，1 case urinary tract infection and 1 otitis media； recurrence-related deaths occurred in 29 cases，of which 14 died from with bone marrow relapse and 15 from marrow foreign recurrence，11 cases intracranial infiltration or recurrence，2 cases lung and testicular recurrence； bleeding-related deaths occurred in 26 cases，of which 16 cases died from intracranial hemorrhage and 7 cases from disseminated intravascular  oagulation（DIC），2 cases pulmonary hemorrhage and 1 gastrointestinal bleeding； chemotherapy-related side effects happened in 2 cases，1 case had pancreatitis and 1 renal failure. Analysis showed infection was the first place among the death causes （P < 0.05）. Multiple factors analysis showed boys，infants，children at high risk，high white blood cells and organ infiltration at first diagnosis had relations with AL death（P < 0.05）. Multiple factors analysis also showed infants，high white blood cell，high-risk children，high lactate dehydrogenase （LDH ） levels and M3 patients had relation with early death（P < 0.05）. Conclusion　The death of AL in children occurs mainly in remission induction. Causes of death are the infection as the first，followed by disease recurrence，bleeding and drug toxicity； boys，infants， children at high risk，high white blood cell anemia and organ infiltration at first diagnosis have relation with AL death. Infants，high white blood cell anemia，high-risk children and high LDH levels have relation with AL early death.

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Head circumference measurements in children with autism. TAN Ying-hua，XI Chun-yan，WANG Yong-juan，WANG Li-bo，HAN Jing-jing. 2011, 26(10): 760.  Abstract ( )   Abstract：Objective　To assess the head circumference in children with autism. Methods　One hundred and fifty-six children with autism （74 children ≤ 3 years and 82 children  > 3 years， respectively） and 141 well-matched healthy controls（58 children ≤3 years and 83 children > 3 years， respectively） were investigated by measuring the head circumference. Results　The autistic children demonstrated significantlyhigher head circumference than the control children in the ≤3 years group （P < 0.05）.Compared to the healthy controls， the autistic individuals also manifested more macrocephalus（P < 0.05）. However， when the children who displayed macrocephalus were excluded， there was no significant difference in the head circumference between the two groups. Conclusion　Head circumference abnormalities are a common feature of autistic patients and may provide some clues to the pathogenesis of autism.

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The FOXP3 gene expression in children with Hen?ch-Sch?nlein purpura during acute phase and analysis of its significance. MA Ji-jun，SONG Li，HU Jian. 2011, 26(10): 763.  Abstract ( )   Abstract：Objective　This study aimed to explore the relationship between the gene expression of FOXP3 and the pathogenesis of Hen?ch-Sch? nlein purpura in children during the acute phase. Methods　The mRNA expression of FOXP3 in the peripheral blood determined in 50 HSP children （HSP group），34 KD children（KD group and 50 children who would receive tonsillectomy with normal physical examination（control group） respectively. Results　Altogether 44 cases were included in the final statistical anaylsis，17 in HSP group，14 in KD group and 13 in control group. The mRNA expression of FOXP3 in patients with HSP was remarkably decreased compared to the healthy controls，and there was significant difference between the two groups （P < 0.05）. The mRNA expression of FOXP3 in patients with KD was also decreased compared to the healthy controls，the difference showing statistical significance （P < 0.05）.But no statistical difference was found in the mRNA expression of FOXP3 in patients with HSP and KD（P > 0.05）. Conclusion　The decrease of FOXP3 expression might be the indication of immune imsbalance of systematic vasculitis in children，not the specific manifestation of HSP.

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Meta-analysis of association between angiotensin converting enzyme gene insertion/deletion polymorphism and risk of HSP and HSPN. ZHAO Pei-wei，HE Xue-lian，DING Yan，KANG Shi-xiu，LUAN Jiang-wei，YIN Wei. 2011, 26(10): 767.  Abstract ( )   Abstract：Objective　To investigate whether there is an association between angiotensin converting enzyme （ACE） gene insertion/deletion （I/D） polymorphism and Henoch-Sch?nlein Purpura （HSP） as well as Henoch Sch?nlein Purpura Nephritis （HSPN）. Methods　（1） A computerized literature search from PubMed，CNKI and Wanfang database was conducted from the early establishment to March 1st 2011，and all the related articles were collected. All the data were analyzed by Stata 11.0. The pooled value of the odds ratios（OR） and 95% confidence interval（95%CI） for D/I were calculated. The pooled statistics were calculated by using the fixed effect model if P value of heterogeneity test was more than 0.1，otherwise a random effect model was used. Results　Five articles were indentified for the analysis of relation between ACE I/D polymorphism and HSP risk，and also five articles were included for analysis of HSPN . By conducting a meta-analysis we found that there was a positive association between D allele and HSP/HSPN （OR = 1.23，95% CI：1.04～1.46，P = 0.015；OR = 1.49，95%CI：1.01～2.19 ，P < 0.001）. Conclusion　ACE gene I/D polymorphism is associated with HSP risk and HSPN risk.

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Effect and safety of rhEPO in the treatment of neonatal hypoxia ischemic encephalopathy：a systematic review and Meta-analysis. ZHOU Kuang-guo*，ZHOU Xiang-yang，CHANG Li-wen.* 2011, 26(10): 770.  Abstract ( )   Abstract：Objective　To assess the effectiveness and safety of recombinant human erythropoietin （rhEPO） in the treatment of hypoxic ischemic encephalopathy （HIE） neonates．Methods　CNKI，PubMed and Cochrane Library were searched．The relevant meeting records were manually searched. Quality assessments of RCTs were carried out．Results　Fourteen studies were included. The difference of mortality between two groups had no significance（OR = 0.60，95%CI：0.18-1.98）. But in rhEPO group，the incidence of cerebral palsy and mental retardation was lower and the pooled ORs for them were （OR = 0.41，95%CI：0.17-0.99） and （OR = 0.37，95%CI：0.18-0.75），respectively. Scores of NBNA （WMD = 2.80，95%CI：1.72-3.88） and DQ （WMD = 11.65，95%CI：6.97-16.34） were better in rhEPO group. In the aspect of safety，the incidence of side reaction was not significantly different，P > 0.05. Conclusion　Though rhEPO can’t decrease the mortality of HIE neonates，it can improve neonatal mental prognosis and the therapy is safe by now. However，this conclusion should be extended cautiously because of the limited number of studies.

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Review and follow-up study on coronary aneurysms secondary to Kawasaki disease. BAI Xin-feng，TIAN Jie，ZHANG Jing. 2011, 26(10): 777.  Abstract ( )   Abstract：Objective　To explore the high risk factors and prognosis of coronary aneurysms（CAA） caused by Kawasaki disease（KD）. Methods　 Clinical data of 3902 patients with KD admitted to Children’s Hospital of Chongqing Medical University from January 1993 to December 2009 were collected and retrospectively reviewed. Risk factors associated with coronary artery lesion were analyzed. Chi-square test and logistic regression were performed. The followed-up 46 CAA cases’ recovery situation in 1 month，3 months，6 months，1，2，3，4，5 years，longer than 5 years and the long-term clinical effect of different IVIG doses were analyzed. χ2 test were performed. Results　（1）Chi-square test showed that gender，age，duration of fever，administration time of IVIG，hemoglobin （Hb），erythrocyte sedimentation rate （ESR） and serum albumin were significantly related to CAA（P < 0.05）. Multiple logistic regression analysis identified Hb，ESR and the administration time of IVIG were independent risk factors of CAA（P < 0.05）. （2） The retraction time of small CAA，middle CAA and GCAA are gradually extended （P < 0.05）. Dosage of IVIG and age were not significantly related to retraction duration of different sizes of CAA （P > 0.05）. Conclusion 　Hb < 100 g/L，ESR > 50mm/h and the administration time of IVIG later than 10th days are the high risk factors of CAA caused by KD. The retraction duration of CAA is associated with size of CAA，but is not associated with dosage of IVIG and age.