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06 October 2012, Volume 27 Issue 10 Previous Issue    Next Issue

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Changes of ambulatory blood pressure in 24 huors in children with vasovagal syncope. 2012, 27(10): 754-756.  Abstract ( )   Objective  To discuss the changes of ambulatory blood pressure monitoring（ABPM） in children with vasovagal syncope （VVS）.Methods A total of 72 children 〔VVS group，32 males，40 females，mean age （10.98±1.86）years〕 were enrolled in this study，who came from Children Syncope Outpatient Department or Inpatient Department of the Second Xiangya Hospital of Central South University from Sep 2008 to Feb 2010.After confirmed diagnosis of VVS by positive head-up tilt test （HUTT），each patient was given ABPM.Forty healthy children （19 males，21 females，mean age 10.24 ± 2.01 years） were as controls （control group）.Parameters of ABPM in children were analyzed.SPSS 17.0 software was used for the statistical analysis of these data.Results （1）Mean pressure：24-hour mean systolic pressure （24hSBP），24-hour mean diastolic pressure （24hDBP），daytime mean systolic pressure （DSBP） and nighttime mean systolic pressure （NSBP） in VVS group were higher than those of the control group （P＜0.05）.（2）Blood pressure pattern：the ratio of non-spoon pressure pattern was higher than that of spoon pressure pattern with VVS （67%vs.18%，P ＜0.05）.NDBP （P＜0.05） and NSBP （P ＞0.05） were decreased and the systolic pressure differences and diastolic pressure differences in the daytime and at nighttime were higher in spoon pressure pattern than those of non-spoon pressure pattern with VVS （P＜0.05）.（3）Diagnostic experimental evaluation：the specificity，sensitivity，diagnostic coincidence，positive predict value and negative predict value of non-spoon pattern of ambulatory blood pressure pattern to VVS was 82.5%，66.67%，72.32%，87.27% and 57.89%，respectively.The Youden index was 45.28%.Conclusion There is autonomic nerve adjustment imbalance in children with VVS during asymptomatic time periods，especially the sympathetic nerve.The non-spoon pattern rate of fluctuation curve of ambulatory blood pressure in VVS children is higher，which is of diagnosis value to VVS children.

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Effect of different concentration of Tanshinone IIA on the activation of nuclear factor-kappa B and the expression of inflammatory cytokines in peripheral blood mononuclear cells （PBMC） of the acute phase of Kawasaki disease.  2012, 27(10): 757-759.  Abstract ( )   WANG Yan*，YU Jie，LI Xiao-jing，ZHOU Min，HUANG Cheng，WANG Xue-mei.* Key Laboratory of Child Development and Disorders Cofounded by Chongqing and Ministry of Education ，Chongqing Key Laboratory of Pediatrics，Chongqing International Science and Technology Cooperation Center for Child Development and Disorders，Children’s Hospital of Chongqing Medical University，Chongqing 400014，China Objective    To explore the inhibition effect of Tanshinone IIA on the activation of nuclear factor-kappa B （NF-κB） and the expression of TNF-α，IL-8 in peripheral blood mononuclear cells （PBMC） of the acute phase of Kawasaki disease（KD） and to explore the pathogenesis of KD and to explore the anti-inflammatory effect of Tanshinone IIA. Methods    PBMCs were isolated and purified from peripheral blood of 20 KD children and 20 healthy children by density gradient centrifugation. In every sample PBMC were divided into five groups.The first group was cultured naturally， the second one was stimulated by phorbol 12-myristate-13-acetate （PMA），while other groups were stimulated by PMA and TanshinoneIIA which was treated with different concentrations.Each group was cultured in carbon dioxide incubator. Activation of NF-κB in PBMCs was determined by immunocytochemistry， and ELISA was used to measure the concentration of TNF-α，IL-8 in supernatant. Results    Under PMA culturing， the activation of NF-κB was significantly higher than the blank group both in KD and control group（P＜0.05）； in supernatant of the two， the expression of TNF-α，IL-8 was significantly higher than the blank group（P＜0.05，P＜0.01）.Under PMA+ final concentration of 3mg / l Tan II A culturing， the activation of NF-κB in KD and control group was significantly lower than the PMA group（P＜0.05）； the expression of IL-8 in KD and control group and the expression of TNF-α in KD group were significantly lower than the PMA group（P＜0.05），while the control group，concerning of TNF-α， there was no significant decline（P＞0.05）. Under PMA+ final concentration of 10mg / l Tan II A culturing， the activation of NF-κB in KD and control group was significantly lower than the PMA group（P＜0.05）； in supernatant of the KD and control group the expression of TNF-α and IL-8 was significantly lower too， and the PMA+ final concentration of 10mg / l Tan II A group was lower than the PMA+ final concentration of 3mg / l Tan II A group（P＜0.05） both in the KD and control group. There was obvious positive correlation between the activation of NF-κB in PBMCs and the expression of TNF-α，IL-8 in the cultured supernatant（r = 0.817，r = 0.782，P＜0.01），and there was also obvious positive correlation between the expression of TNF-α and IL-8（r = 0.709， P＜0.01）.Conclusion    The activation of NF-κB is enhanced and the expression of TNF-α，IL-8 is increased in PBMC of the acute phase of Kawasaki disease，which may be involved in immune inflammatory response and may mediate immune vasacular injury. The anti-inflammatory mechanism of TanshinoneIIA in PBMC of the acute phase of Kawasaki disease may inhibit the activation of NF-κB and the subsequent expression of TNF-α and IL-8，and this anti-inflammatory effect has a dose-dependence

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The intelligence profiles of 114 children with Asperger syndrome. 2012, 27(10): 760-762.  Abstract ( )   Objective    The intellectual profiles of children with AS were studied in order to better interpret their behavioral characteristics.Methods    Totally 114 children of 6.08~14.24 years old with AS were examined by the China-Wechsler Intelligence Scale for Children （C-WISC） and all subtests were administrated.Results    The level of intelligence of chidren ranged from mildly impaired to very superior；the average verbal intelligence quotient，（VIQ），performance intelligence quotient（PIQ）and full intelligence quotient（FIQ） were respectively 101.52±18.72，88.30±17.40 and 94.90±17.75；There was statistically significant difference between the VIQ and PIQ among children with AS and a tendency of VIQ＞PIQ was showed（P＜0.01）. The differences between scores on three Kaufman factors was significant（P＜0.01）. Children with AS scored the highest on similarity，vocabulary and information subtests and scored the lowest on picture completion，picture arrangement and coding subsets in full scale；score on comprehension subtest was the lowest in the verbal scale and scores on block design and object assembly subtest were the highest in performance scale.Conclusion    The intelligence structures of children with AS are not balanced，which is characterized by a combination of assets and deficits.

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Clinical analysis of 12 cases of children with eosinophilic gastroenteritis. 2012, 27(10): 763-765.  Abstract ( )   Objective    To approach the diagnosis and treatment of eosinphilic gastroenteritis in children. Methods    In 12 cases of children with eosinophilic gastroenteritis in Nanjing Children's Hospital Affiliated to Nanjing Medical University from May 2009 to Nov.2011，the clinical manifestations，laboratory data，endoscopic and pathological findings and treatment were collected and analyzed. Results    In the 12 patients，mucosal type was present in 8 cases，muscle-type in 1 case，and serous type in 3 cases. Most of the pediatric eosinophilic gastroenteritis had no specific clinical manifestations. From direct endoscopic vision，edema and erosion were the main performance of gastrointestinal mucosa. Histopathologic examination revealed that there was dense infiltration in gastrointestinal mucosa lamina propria by eosinophils. The effects of dietetic and antianaphylactic treatments were good. Conclusion    The clinical manifestations of pediatric eosinophilic gastroenteritis are various and nonspecific. The dietetic and antianaphylactic treatments have obvious therapeutic effect . About 1 to 2 weeks of glucocorticoids therapy can rapidly alleviate the symptoms，and it continues for 3 months by reducing the dosage gradually.

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A clinical multi-center study of the efficacy and safety of an amino acid-based formula in the treatment of infants with food protein allergy.     2012, 27(10): 766-769.  Abstract ( )   Objective    To investigate the efficacy and safety of enteral nutritional powder （AA-PA， an amino acid-based formula） therapy in treatment of the infants with food protein allergy.Methods    The prospective， blind， controlled， multi-center trial was performed.Two hundred and forty-eight infants with cow’s milk allergy or food protein allergy，with exclusion of positive diagnostic serum-specific IgE values to soy protein were randomized either to be treated with an amino acid-based formula （n = 124） or soy protein-based formula （n = 124） for 12 weeks. The weight， height， allergic clinical manifestations， adverse events and adverse reactions were estimated in pre-treatment and 4th ，8th and12th week during treatment respectively. The serum total protein and albumin were measured in pre-treatment and 12th week during treatment respectively.Results    The feeding of enteral nutritional powder satisfied the need of growth and improved significant clinical manifestations for food protein allergy in two groups. In amino acid-based formula group there was a significantly increase in the weight，compared with the soy protein-based formula group，the different value between week 4 and base weight：0.65kg ± 0.45 kg vs 0.61 kg ± 0.47 kg， P = 0.6720； between week 8 and base weight：1.22 kg ± 0.73 kg vs 1.02 kg ± 0.65 kg， P = 0.0368； between week 12 and base weight：1.74 kg ± 0.91 kg vs 1.39 kg ± 0.87 kg， P = 0.0022. The height， clinical manifestations， serum total protein and albumin during observation were similar in both groups. The adverse event rate was 44.35% in amino acid-based formula group and 45.16% in soy protein-based formula group， observed almost in respiratory and digestive system. No statistical significance was noticed in all safety parameters in amino acid-based formula group compared with soy protein-based formula group.Conclusion    The amino acid-based formula proves to be an effective substitute formula for the infants with cow’s milk allergy or food protein allergy， and it is superior to soy protein-based formula in weight gain and safety and is well tolerated.

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Clinical observation on infliximab and etanercept in the treatment of juvenile idiopathic arthritis. 2012, 27(10): 770-773.  Abstract ( )   ：Objective    To observe and evaluate the clinical effect and adverse effects of the infliximab and etanercept in  treating patients with juvenile idiopathic arthritis （JIA）.Methods    There were 26 patients of JIA treated with anti-TNF therapy from June 2008 to December 2011.All patients were divided into two groups， including those treated with in?iximab（11 patients） and those with etanercept（15 patients）.We assessed clinical effects by DAS28，inactive disease standards and clinical remission（CRM/CR）， evaluating adverse reactions of two drugs as well.Results    After a follow up of 3 to 31 months，the clinical symptoms and laboratory indexes of two groups were all improved.We have found statistical differences in CRP of infliximab at the beginning of therapy and after 3 months，in ESR of etanercept at the beginning of therapy and after 6 months，in swollen joint counts of etanercept at the beginning of therapy and after 3，12months（P＜0.05），in the numbers of tender joints （or pain with activity） of etanercept at the beginning of therapy and after 3，6 months.Our study also showed statistically signi?cant differences in DAS28 values at the beginning of therapy and after 3，6 months in etanercept，and at the beginning of therapy and after 3 months in infliximab.There was obvious decrease of DAS28 values in etanercept compared with infliximab in the treatment of 3，6 months，but infliximab group much lower than etanercept one in 12 months.We found no signi?cant differences in short term clinical effect between the two drugs（P＞0.05）.Except rushes and pain caused by injection，there were no other side effects in the two groups.Conclusion Both in?iximab and etanercept can reduce DAS28 values and improve joint function in patients with JIA.We find no signi?cant differences in the responses，remissions or adverse effects between both drugs in the short term.There are no serious adverse reactions in both groups.

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Study of MRP1 expression in peripheral blood of children with refractory epilepsy.   2012, 27(10): 774-776.  Abstract ( )   Objective    To investigate the expression of multidrug resistant-associated protein 1 in the peripheral blood of children with refracotory epilepsy. Methods    The expression of MRP1 was detected by RT-PCR and Western blot in children with intractable epilepsy，epilepsy controlled by anti-epileptic drugs （AEDs） and healthy children.Results    The two methods showed that MRP1 expression in intractable epilepsy was higher than that in epilepsy controlled by anti-epileptic drugs （AEDs） and healthy children（P＜0.05）， and there was no difference between epilepsy controlled by anti-epileptic drugs （AEDs） and healthy children.Conclusion    MRP1 overexpresses in peripheral blood of children with refractory epilepsy.

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Efficacy and safety of Azithromycin and Erythromycin for respiratory mycoplasma infection in children: a meta-analysis.   2012, 27(10): 777-781.  Abstract ( )   Objective    To study the efficacy and safety of Azithromycin and that of Erythromycin for respiratory Mycoplasma infection in children. Methods    All RCTs about Azithromycin and Erythromycin for Mycoplasma pneumonia were searched in PubMed，Embase，Cochrane Library， CNKI，VIPH，Wanfang database，etc，until Feb，2012. We included the RCTs that compared Azithromycin with other medicine in the treatment of respiratory Mycoplasma infection in children.The quality evalutions were under the Cochrane Handbook 5.0.2， and the data were combined quantitatively by RevMan 5.0 software. Results    There were 4 RCTs concluded. Three researches were to compare “Azithromycin oral VS Erythromycin oral”. One research was to compare “Azithromycin oral VS Erythromycin ivgtt”. Totally 538 children， Azithromycin oral group 319， control group 219. The Meta-analysis results showed that the clinical response conditions were as follows: the clinical response of “Azithromycin oral group” was better than “Erythromycin oral group” during the period ≤15 days or ≥1 month，there being no statistical difference between “Azithromycin oral group” and “Erythromycin ivgtt group” during the period ≤15 days after the treatment. Adverse effects: compared with “Erythromycin oral”and “Erythromycin ivgtt” group， the children in the “Azithromycin oral”group suffered less diarrhea and/ or vomiting after the treatment（OR = 0.22，95%CI:0.11～0.43；OR = 0.23， 95%CI:0.12～0.42）. Conclusion    In the treatment of respiratory Mycoplasma infection in children， the clinical effect of oral Azithromycin is better than that of oral Erythromycin during the period ≤15 days or ≥1 month， while the former effect is of no statistical difference from Erythromycin ivgtt. Adverse reactions: compared to erythromycin oral or ivgtt，the patients in Azithromycin oral group tend to have less diarrhoea and/ or vomiting. All in all，Azithromycin is a good choice for the treatment of respiratory Mycoplasma infection in children.