Archive

06 April 2012, Volume 27 Issue 4 Previous Issue    Next Issue

---

For Selected:

Download Citations EndNote Ris BibTeX

Toggle Thumbnails

Select

A study of cough variant asthma treated with budesonide suspension nebulization in childhood. 2012, 27(4): 270-274.  Abstract ( )   Objectives    To study the efficacy of budesonide inhalation suspension （BIS） nebulization in cough variant asthma （CVA） patients aged 5 years or younger. Methods    In an open-label， multicenter， non-interventional study， 903 CVA patients aged 5 years or younger （ male： 536， female： 367， mean age 2.8±1.2a） were recruited and prescribed for BIS（1～2mg/d for 7 weeks）.There were 5 visits during the study. Changes of symptom scores，bronchodilator usage， compliace and disease control level were analized after treatment. Results    The withdraw rate was 8.97% （81/903） . About 42.64% of the total 903 patients were with at least one other allergic disease， such as allergic rhinitis， allergic dermatitis and allergic conjunctivitis. After 7-week BIS nebulization， the total symptom score （ 4.0 at week 1 vs 0.5 at week 7）， daytime symptom score （2.4 at week 1 vs 0.3 at week 7）， nocturnal symptom score （ 1.5 at week 1 vs 0.2 at week 7） decreased significantly in CVA children （P < 0.001，respectively）. The ratio of CVA children who had used brochodilator for symptom relief decreased significantly （39.42% at week 1 vs 2.99% at week 7， P < 0.001）. The median number of days for as-needed bronchodilator usage at week 1 was 5.8 days， while at the end of the study it reduced to 3.9 days. At week 7， 87.49% of children still had good compliance. In CVA children， the effective control rate increased （34% at screening vs 89.92% at week 7， P < 0.001）. No spontaneous adverse events were reported. Conclusion    BIS nebulization improves the symptom scores and reduces as-needed bronchodilator usage with good compliance and safety profile in young children with CVA.

Select

Clinical characteristics of vasovagal syncope and postural orthostatic tachycardia syndrome in children. 2012, 27(4): 275-280.  Abstract ( )   Objective　To investigate the clinical evidence for differential diagnosis between vasovagal syncope （VVS） and postural orthostatic tachycardia syndrome （POTS） in children. Methods　Forty children ［aged 6～18 yrs， median （11.8 ± 2.9） yrs］ who were diagnosed with VVS and 165 children ［aged 5～19 yrs， median （11.4±2.7） yrs］ who were diagnosed with POTS in the clinics of Peking University First Hospital from March 2009 to April 2011 were recruited in the study. History-taking，including clinical manifestation， family history， life style， physical examination， standing test and head-up tilt test， etc， was done for each patient. Clinical characteristics of VVS and POTS in children were summarized by comparing the two groups. Results　There were some similar characteristics between VVS and POTS. Both VVS and POTS were usually at school-age or adolescent period. Their symptoms mostly occurred in summer and autumn. Most patients had trigger of symptoms and presyncope symptoms. Moreover， most patients had complaint after the episodes. The symptoms would be relieved when supine in most patients. The frequence of syncope was higher in the children with VVS than those with POTS （P < 0.001）， while the frequence of dizziness was higher in the children with POTS than those with VVS （P < 0.001）. The percentage of patients whose fathers have a family history of orthostatic intolerance in children with VVS was higher than that of children with POTS （P < 0.05）. Conclusion　Head-up tilt test is an important and objective examination in differential diagnosis between VVS and POTS in children. The frequence of syncope and dizziness could be used as a reference indication to help differentiate diagnosis between VVS and POTS.

Select

Six cases of Crouzon syndrome and literature review.     2012, 27(4): 281-284.  Abstract ( )   Objective    To improve of awareness of Crouzon syndrome.Methods    Clinical data of 6 cases were summarized with literature review.Results    Characteristic facial features of Crouzon syndrome included coronal craniosynostosis with variable involvement of other calvarial sutures ， brachycephaly， hypertelorism， proptosis， beaking of the nose， maxillary hypoplasia and mandibular prognathism . There was no deformity of the hands and feet. It was often complicated with visual disorder， hearing loss ，nasal obstruction and airway obstruction.Conclusion    Crouzon syndrome is an autosomal dominant disorder of facial development.We remain relatively ignorant about the developmental pathogenesis of the disorder. While most developmental research has focused on the impact of these mutations on the development of the calvaria， the most challenging clinical manifestation of the FGFR mediated craniosynostosis may be midfacial hypoplasia. There is no permanent control method for Crouzon syndrome. It becomes increasingly important to focus on research that will impact the patients we treat.

Select

The clinical features and prognosis of nonconvulsive status epilepticus in children：analysis of 12 cases.   2012, 27(4): 285-288.  Abstract ( )   Objective    To study the clinical and EEG features，therapeutic response and prognosis of nonconvulsive status epilepticus （NCSE）in children.Methods    The clinical and EEG data of 12 children with NCSE were analyzed and therapeutic response and prognosis were followed up. Results    The median onset age of symptoms was（6.22±3.72）years.The median duration of seizures was 35h. There were 3 children with absence status epilepsy（ASE）and 9 with psychomotor status epilepsy（PSE）. The clinical presentations of NCSE included impairment of consciousness（n=12），speech deterioration （n=9），behavior change （n=8），subtle motor findings such as eyelid twitching（n=5），illusion（n=2），eating more food than ever or thirsty（n=2），  and vegetative manifestation（n=1）. The ictal EEG of NCSE showed slow activity with generalized spike-and-slow wave discharges and slow waves（n=3），and continuous or periodic focal discharges（n=9），which was predominant with θ or δ activity（n=5），spike-and-slow wave discharges（n=4），discharges in temporal region（n=3），out of temporal region（n=2） and temporal with other regions（n=4）.The control ratio of intravenous diazepam between ASE and PSE had no statistically significant difference（P > 0.05）.Six children had cognitive  impairment.Conclusion    The main manifestations of NCSE are consciousness，speech deterioration and behavior change.The diagnosis can be made by ictal EEG.The prompt and effective manipulation of NCSE may  reduce cognitive impairment.

Select

Assessment of intelligence structure in children with primary nocturnal enuresis： a voxel-based morphometry study. 2012, 27(4): 289-291.  Abstract ( )   Objective    To assess the working memory impairment and explore the differential of gray matter MR density alterations in children with primary nocturnal enuresis（PNE）using voxel-based morphometry（VBM）method.Methods    75 right-handed PNE children（M/F=39∶36，average age 10.4±1.3 years） and 72 age-matched， right-handed，healthy controls（M/F=40∶32，10.0±1.2 years） were recruited for the study. First，intelligence tests were performed using Chinese Wechsler Young Children Scales of Intelligence（C-WISC） in PNE children and controls. The full intelligence quotient（FIQ），verbal IQ（VIQ），performance IQ （PIQ） and memory/caution（M/C）factor were measured.Voxel-based morphometry（VBM）of a high-resolution 3 Tesla，T1-weighted MR images，processed using VBM5，was performed in the PNE children and controls. Student t test was performed to test the differences of the gray matter density（GMD）of the PNE children and controls.Results    The FIQ，VIQ and PIQ in the PNE group were within the normal range and did not significantly differ from the control group.The M/C factor was statistically lower in the PNE group.Compared with normal controls，PNE children showed lower GMD in right dorsolateral prefrontal cortex（dLPFC）and left cerebellum（P＜0.001）.Conclusion    Impairment in working memory was detected in PNE children， and the structural abnormalities of  the right dLPFC and left cerebellum might involved in their deficits.

Select

Research into the correlation between childhood asthma control test and lung function 2012, 27(4): 292-295.  Abstract ( )   Objective    To investigate relationship between childhood asthma control test（C-ACT）and lung function.Methods    During the clinic visit，273 asthma patients completed the Chinese version of C-ACT and underwent spirometric measurments at the same time.The correlation between C-ACT with FEV1% and PEF% were analyzed.The patients were categorized into 4 groups based on the degree of airway responsiveness（AR）， 1）severe group（PC20=0.5mg/mL）， 2） moderate group （PC20= 2mg/mL）， 3） mild group（PC20=8mg/mL）， 4） minimal group（PC20=16mg/mL），and then the relationships between C-ACT score and AR as well as ventilation function of each group were assessed by one-way ANOVA.Results     Significant correlation was observed between C-ACT score and FEV1%（r = 0.25；P＜0.01） ，PEF%（r = 0.34；P＜0.01）.When the patients less than 7 years or suffering upper respiratory tract infection（URI） 4 weeks before seeing the doctor were excluded，C-ACT score demonstrated good correlations with PEF%（r = 0.52；P＜0.01） and moderate correlations with FEV1%（r = 0.42；P＜0.01）. C-ACT score difference had statistical significance between severe group and minimal group （mean ［SD］：21.7 ［2.4］ vs.23.6 ［2.5］； P＜0.01） ，but no significant difference between moderate group and mild group.Conclusions     There is moderate correlations between C-ACT score and ventilation function and AR，and being less than 7 years or suffering URI 4 weeks before seeing the doctor may be two factors that influence this relationship.

Select

Evaluation of the diagnostic value of exhaled nitric oxide test in children with asthma. 2012, 27(4): 296-299.  Abstract ( )   Objective    Compare exhaled nitric oxide （FeNO） levels test with current lung function test in order to assess the clinical value of FeNO at the asthma diagnosis. Method    Collect 93 suspected asthma patients who have repeated coughing，occasionally with wheexing in our hospital  from May 2009 to June 2010 . Use the NO analyzer （Medisoft  Hypair FeNo） to test FeNO levels， and the test process sticked to the  American Thoracic Society guidelines. At the same time use Medisoft hyp `Air-type pulmonary function instruments to do the basic pulmonary function tests， bronchial provocation and dilation test.The results combined with the clinical information were regarded as the “gold standard” as well as the reference of FeNO diagnosis value， in order to evaluate  the FeNO in asthma differential diagnosis. Result    Among 93 patients，53 patients in bronchial provocation test were positive and 14 cases in bronchodilation test were postive，who had final diagnosis of bronchial asthma. The remained 26 cases who were negative in bronchial provocation test were diagnosed as non-asthma. The level of FeNO in asthma group was higher than non-asthma group ［（43.60±38.86）×10-9 mol／L VS （26.16±17.00） ×10-9 mol／L，P < 0.05］. There was no significant correlation between exhaled NO and FEV1 % in asthmatic children （ r =0.06 ， P >0.05）.A linear correlation of FeNO with PD20FEVl was revealed in the cases with who were positive in bronchial provocation test.  Conclusion    FeNO has its significance in diagnosis and differential diagnosis of asthma， but compared with  conventional lung function and bronchial provocation test，it still has some limitations， which needs further study.

Select

Allergen sensitization changes in asthmatic children receiving inhaled corticosteroid therapy for five years.    2012, 27(4): 300-302.  Abstract ( )   Objective    To assess the allergen sensitization changes in asthmatic children receiving inhaled corticosteroid （ICS） therapy for 5 years. Methods    The retrospective study was carried out in 133 asthmatic children receiving treatment of ICS from 2003-2004 in Shenzhen Children’s Hospital. The patients were assessed by  questionnaire and skin prick tests （SPT）.Results    Totally 133 patients finished the SPT before and after five years. The positive rate of SPT in 133 cases was 91% before five years，which was not significantly different（P > 0.05）from that of  the patients （89.5%）after five years . There was no significant increase in food and inhalant hypersensitivity  （P > 0.05），but Cockroach and Tree-pollen increased obviously，and milk and eggs were reduced significantly.Conclusions    Allergen sensitization changes in asthmatic children received inhaled corticosteroid therapy for five years are small.Inhalant allergens increase obviously， but the tendency of food hypersensitivity is reduced.Dermatophagoldes pteronyssinus and Dermatophagoides farina are still the main allergen.

Select

The effect of asthma predictive index in assessing prognosis of infant with recurrent wheeze.     2012, 27(4): 303-305.  Abstract ( )   Objective    To study the effect of asthma predictive index in assessing prognosis of infant with recurrent wheeze. Method    Totally 129 recurrent wheeze children were enrolled in the study in random，of whom43 infants were assigned asthma predictive index positive （A group）， 86 to asthma predictive index negative （B group）， and 69 to control group（C group）.They were tested tidal breathing pulmonary function in remission. Compare minute ventilation（MV），tidal volume/kg（VT/ kg），respiratory rate（RR），inspiratory time（Ti），expiration time（Te），ratio Ti to Te（Ti/ Te），ratio of time taken to reach peak tidal expiratory flow to total expiratory time（TPEF / TE），ratio of volume taken to reach peak tidal expiratory flow to total expiratory volume（VPEF /VE），peak expiratory flow（PTEF）and ratio of tidal expiratory flow respectively at 25%，50% and 75% remaining expiration to peak expiratory flow（TEF25%、TEF50%、TEF75%）between groups. Totally 67 children completed the 4 years of follow-up. Among these children， A group had 26， B group had 23 and C group had 18. They all used impulse oscillometry to test. Compare impedance at 5Hz（Z5），reactance at 5Hz（X5），resonant frequency（Fres），resistance at 5Hz（R5） and resistance at 20Hz（R20）between groups. Result    In comparison with B group and C group， TPEF / TE，VPEF /VE，Ti/Te，TEF25%，TEF50% and TEF75% were significantly lower， TE was higher in A group， which had significant statistical difference（P＜0.01）；compare B group with C group， B group had much lower TPEF / TE and VPEF /VE， which had significant difference（P＜0.05）. In the follow-up children，in comparison with B group and C group，  X5 was lower， Fres was higher in A group， which had statistical significant difference（P＜0.01）. Compared to B group， A group had much higher Z5， which had statistical difference（P＜0.05）. Conclusion    Recurrent wheeze infant can result in lung function impairment at an early age. In asthma predictive index positive children，lung function impairment will continue to preschool age， which may develop into asthma later and need an early intervention.