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    06 March 2012, Volume 27 Issue 3 Previous Issue    Next Issue

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    The association between vitamin D receptor gene polymorphisms and rickets susceptibility:a Meta-analysis. 
    2012, 27(3): 191-197. 
    Abstract ( )  

    Objective    To assess the relationships between polymorphisms of ForkI,BsmI, ApaI,TaqI in vitamin D receptor gene and the susceptibility to rickets and to investigate whether their associations were dependent upon variants in latitude by Meta-analysis. Methods    A comprehensive search was conducted to identify all studies of the above-mentioned associations.Pooled ORs and their 95% CIs were calculated by either fixed or random effect pooled measure,which was selected on the basis of heterogeneity test among studies.Sub-group analysis was performed based on the different latitudes (high/low latitude).Meta-regression was performed to assess the potentially important covariates exerting substantial impact on between-study heterogeneity. An analysis of influence was conducted, which described how robust the pooled estimator was to removal of each individual study . Publication bias was estimated using modified Egger’s linear regression test. Results    Compared with the controls,for overall and subgroup populations,the FokI polymorphism had a significantly protective effect on the risk of rickets in dominant,recessive and codominant models. For overall population the pooled ORs(95%CI) were 0.40(0.25~0.65),0.41(0.31~0.55) and 0.50(0.38~0.67) respectively. For high latitude area population the pooled ORs(95%CI) were 0.48(0.25~0.93),0.43(0.23~0.80) and 0.55(0.39~0.78) respectively. For low latitude area population the pooled ORs(95%CI) were 0.38(0.21~0.69),0.41(0.29~0.57) and 0.48(0.34~0.68) respectively. The BsmI polymorphism was found contributing significantly to rickets susceptibility for high latitude area population in dominant,recessive and codominant models and for overall population in dominant and codominant models.For high latitude area population the pooled ORs(95%CI)were 2.86(1.33~6.16),3.93(1.11~13.89)and 2.66(1.33~5.31)respectively.For overall population the pooled ORs(95%CI) were 2.15(1.11~4.16) and 1.85(1.09~3.16) respectively.The ApaI polymorphism was found to be a risk factor in the incidence of rickets only for overall population in recessive model.The TaqI polymorphism was found contributing significantly to rickets susceptibility only in recessive model for overall population and high latitude area population.Conclusion    This Meta-analysis suggests that the ForkI polymorphism was associated with a decreased risk of rickets,while the BsmI polymorphism is associated with an increased risk of rickets for only low sun-exposure population.The above-mentioned two associations appear to vary by the sun exposure levels.The ApaI and TaqI polymorphisms are not likely to be associated with rickets susceptibility.

    One case of severe combined immunodeficiency caused by JAK3 mutation and literature Review.
    2012, 27(3): 198-201. 
    Abstract ( )  

    Objective    To report the first JAK3 deficiency patient in China and to have literature review. Methods    On April 25,2011,the blood samples of 1 case of suspected SCID  child,his parents and grandparents were detected with PCR amplification and sequencing of JAK3 gene, single nucleotide polymorphism(SNPs) and TCRVβ analysis in Children’s Hospital of Chongqing Medical University. Results    The mutation of this patient was a compound heterozygous mutation,both alleles being missense mutations. One allele (1308G>A:R403H) was located in the eighth exon of JAK3,which came from her father, the other (3354G>A:R1085Q) located in the twenty-third exon of JAK3,which came from her mother.Her parents and grandmother were carries.We confirmed these mutations were disease-caused mutations not SNPs by sequencing the 9th and 24th exon of JAK3 gene of twenty common people. Unfortunately,we failed to detect The TCRVβ of this patient because of the limited number of circulating T cells. Up to 2007,thirty mutations and thirty-five patients had been registered for JAK3 deficiency in JAK3base. Their immunophenotype was uniformly T-B+NK-SCID,but the clinical phenotype of them varied from classical SCID to almost normal immune function. Conclusion    JAK3 deficiency is a rare autosomal recessive severe combined immunodeficiency disease (SCID),characterized by recurrent bacteria and virus infection,absence of T and NK cells but normal number of poorly functioning B cells in the peripheral blood. The diagnosis depends on stat5 phosphorylation,sequencing of JAK3 gene and detect the JAK3 protein by western blot or flow cytometry, when JAK3 deficiency is suspected. The most effective treatment for JAK3 deficiency is hematopoietic stem cell transplantation (HSCT),and patients who don’t receive HSCT will usually die in infancy.

    A study on efficacy and safety of combine-counter gradient therapy for infants wheezing. 
    2012, 27(3): 202-205. 
    Abstract ( )  

    :Objective    To evaluate the efficacy and safety of combine-counter gradient therapy for infants wheezing. Methods    Totally 97 patients from Asthma and General Clinic form October to December 2010,who received combine-counter gradient therapy were chosen as test group,patients with general treatment as control group.The two groups adopted same synthetic therapy,such as oxygen therapy or pyretolysis. The treatment protocol for test group was oral prednisone 5mg/d,3 days;azithromycin 0.1g/(kg·d),3 days; tulobuterol  patch (0.5mg/d),7 days; loratadine 3ml/d,14 days; montelukast 4mg/d,21 days.Control group had antibiotics (primarily cephamycin or azithromycin )intravenous injection,methylprednisolone, expectorants and inhale corticoids by atomization. Results    Scores of cough, gasping, wheezing rale, recurrence within 1 Month,and charge of therapy and absenteeism rate of parents of test group  were significantly  lower than contol group(P < 0.05). Moreover, treatment protocols of test group were prone to be more easily accepted(P < 0.05). Conclusion    Combine-counter gradient therapy for infants wheezing is effective,convenient and safe,which deserves clinical application.

    The analysis of diagnosis and treatment of 66 cases of pediatric purulent meningitis. 
    2012, 27(3): 206-208. 
    Abstract ( )  

    Objective    To investigate the present situation of  pediatric purulent meningitis,including risk factors, clinical manifastation, diagnosis, treatment,and prognosis in order to provide information for definitive diagnosis and better treatment. Methods    All the clinical and laboratory data of 66 cases of pediatric purulent meningitis, who were admitted to Neurology Department of Children’s Hospital of Fudan University from January 2008 to April 2010,were collected, analysed, compared and summarized. The average age of all the patients was 6 months (from 30 days to 11 years),including 47 infants(71.2%),11 toddlers(16.7%),5 pre-school children (7.6%) and 3 school age cases (4.5%). Results    Most cases in pre-school and school age had risk factors. According to the levels of our diagnosis,33.3% got definite pathogen diagnosis,50.0% got clinical diagnosis, and 16.7% got suspicious diagnosis. The positive rate of initial CSF(cerebral spinal fluid)was 62.5%,much higher than that of CSF in patients treated with antibiotics (29.8%). The rate of abnormal high count of WBC in two different kinds of CSF had significant difference (P = 0.03),while there were no difference in the levels of glucose and protein of CSF. In the 66 cases,80.3% got well or improved,while 19.7% gave up. The course of treatment averaged 21days(5 to 56days),which had no difference between cases with 3 diagnosis levels. Some cases had complications,including subdural effusion, dysaudia,hydrocephalus and subdural empyema. Conclusion    Purulent meningitis continues to be an severe and emergent disease in neonates and children.Diagnosis with different standards according to clinical manifestation helps the management of pediatric purulent meningitis cases.

    Characteristics and application of inner ear CT for sensorineural hearing loss in children.
    2012, 27(3): 209-211. 
    Abstract ( )  

    Objective    To evaluate the characteristics of inner ear multi-slice computed tomography (MSCT) in pediatric sensorineural hearing loss (SNHL) and feasibility and usability of diagnosis of SNHL. Methods    Sixty-five patients have been diagnosed with sensorineural hearing loss (SNHL) by Brainstem Auditory Evoked Response (BAER). Inner ear MSCT scan and coronal multiplanar reformation (MPR) reconstruction were done in all cases. Results    This study showed that 20 cases (33 ears,45 case times) were with inner ear malformations and 12 ears with two different malformations, including 5 ears with cochlear and internal auditory canal (IAC) malformations, 3 ears with cochlear and vestibular malformations, 2 ears with vestibular and IAC malformations, 1 ear with semicircular canal and vestibular malformations, 1 ear with internal auditory canal and IAC malformations; 10 ears with cochlear malformations in 45 cases[including 1 ear with Michel deformity, 2 ears with common cavity deformity, 1 ear with cochlear aplasia, 1 ear with hypoplastic cochlear, 2 ears with incomplete partition types I (IP-I) and 3 ears with incomplete partition types II (IP-II) (Mondini deformity)],7 ears with vestibular malformations, 5 ears with semicircular canal malformations, 8 ears with internal auditory canal malformations, and 15 ears with vestibular malformations. Conclusion    The study shows most children with SNHL have inner ear malformations by MSCT. The inner ear MSCT scan in axial view with 2D MPR for coronal view allows a comprehensive assessment of various congenital ear malformations and provides powerful evidence for further direct therapy and prognosis.

    Clinical significance of urinary leukotriene E4 detection in children with Kawasaki disease. 
    2012, 27(3): 212-213. 
    Abstract ( )  

    Objective    To investigate whether leukotriene can be used as KD monitoring index. . Methods    Urinary leukotriene  E4 (LTE4)level of 68 children with typical KD was detected by enzyme-linked immunosorbent assay(ELISA) before and after treatment,and the Urinary LTE4 level of 55 healthy children was detected by the same methods, and then was a mutual comparison made. Meanwhile ultrasonographic examination was made in KD children. According to the results of ultrasonographic examination, all the 68 KD children were divided into two groups: KD with coronary artery damage in one group(n=8),KD without the damage in the other group(n=60). Results    The Urinary LTE4 level of KD group was significantly higher than that of healthy control group (P < 0.01), but after treatment, there were no significant difference between two groups(P > 0.05). The urinary LTE4 level of KD with coronary artery damage was significantly higher than that of KD without(P < 0.01). The urinary LTE4 level of all KD before treatment was significantly higher than that after treatment  (P < 0.01). Conclusion    In KD patients especially those with coronary artery damage,LTs level is much higher. Urinary leukotriene E4 level can be used as KD clinical monitoring index.It can be considered that through the early intervention by leukotriene receptor antagonist  we may prevent KD coronary artery pathological changes from happening and  so promote the repair of coronary artery damage.

    The clinical efficacy and safety of oxcarbazepine monotherapy for children with newly diagnosed partial epilepsy. 
    2012, 27(3): 214-217. 
    Abstract ( )  

    Objective    To evaluate the long-term efficacy, tolerability and safety of oxcarbazepine (OXC) monotherapy for pediatric patients with partial epilepsy. Methods    A total of 56 newly diagnosed pediatric patients with partial epilepsy were enrolled. The initial dose of OXC was 5~10 mg/(kg·d), and the maintenance dose was 12.7~40.0 mg/(kg·d).With the open-label auto-control method, the efficacy, tolerability and safety of OXC monotherapy were followed up from 3- month to 2 years. Results    Of the 56 patients, 50 cases were followed up for over 6-month,45 cases over 12-month, and 42 cases over 24 months. The seizure frequencies reduced significantly after therapy (P < 0.01). The 3-month,6-month,12-month,18-month,24-month seizure free rates were 64.3%,62.5%,53.6%,55.4% and 64.3% respectively,and total effective rates were 78.6%,73.2%,75.0%,67.9% and 67.9% respectively.Three patients were lost during the study. The withdraw rate was 19.6% (n=11) with a follow-up of 24-month,1 because of skin rash,10 because of incomplete seizure control. Patients’retention of OXC monotherapy was 80.4% for one year, and 75.0% for 2 years. Adverse events tended to be transient and were reported in 16 patients (28.6%),such as drowsiness, rash, irascible,dizziness,headache,asymptomatic hyponatremia,anorexia and fatigue. Conclusion    Oxcarbazepine monotherapy has satisfactory effects in treating pediatric patients with partial seizures. It is well tolerated and safe, and may have a great clinical application value with slight side effects.