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06 November 2012, Volume 27 Issue 11 Previous Issue    Next Issue

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Meta-analysis: evaluation of interferon-γ release assay for diagnosis of pediatric tuberculosis. 2012, 27(11): 825-829.  Abstract ( )   Abstract: Objective    To evaluate the role of interferon-γ release assays and Tuberculin Skin Test（TST）in diagnosis of pediatric tuberculosis. Methods    We searched databases （PUBMED， MEDLINE， OVID，CNKI） between January 1990 and February 2011， performing manual searches of the references from relevant articles and corresponding with the authors of some articles for complete information. Results    For QuantiFERON-TB Gold In-Tube， the pooled sensitivity was low in active tuberculosis， 67%（95%CI， 62%-72%）for sensitivity， 91%（95%CI， 86%-95%）for specificity.For T-SPOT.TB， the pooled sensitivity was 57%（95%CI， 53%-62%）and the pooled specificity was high， 88%（95%CI， 84%-91%）.For TST， the pooled sensitivity and specificity were both low （70% vs 43%）， especially in BCG vaccinated children（38%）.  Conclusion    Sensitivities of the 3 tests are lower than those in adults， while IGRA is clinically useful to confirm or refute a positive TST result in children in areas with a high incidence of BCG vaccination or non tuberculous mycobacteria （NTM） infection where TST has low positive predictive value.

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The  detection  and  clinical  significance of HMGB1，  TNF-α and T lymphocyte subsets  in  peripheral  blood  of  respiratory syncytial virus  bronchopneumonia. YOU Hai-zhang*， ZHOU Wei-fang， JI Wei， CHU Chu， JIN Meifang，LIU Fen-ju， CHEN Qi 2012, 27(11): 830-833.  Abstract ( )   Abstract：Objective    To  investigate  the  expression  and  clinical  significance  of  high  mobility  group  box-1 （HMGB1）  protein  mRNA  in  peripheral  blood  mononuclear  cells （PBMCs）  ， the  levels  of  plasma  tumor  necrosis  factor-α （TNF-α） and T lymphocyte subsets in respiratory syncytial virus  （RSV） bronchopneumonia. Methods    The  expression  of  HMGB1 mRNA  was  detected in  peripheral  blood  mononuclear  cells（PBMCs）  of  52  patients with    bronchopneumonia: 25 patients  infected with respiratory  syncytial  virus， 27 patients with respiratory  syncytial  virus  and  germ and 23  normal controls  by reverse transcription-polymerase  chain  reaction  （RT-PCR）.  The  levels  of  plasma    TNF-α  was  measured  by  enzyme  linked  immunosorbent  assay （ELISA）. T lymphocyte subsets were tested with flow cytometry. Results    （1）The  expression  levels of  HMGB1 and  TNF-α were  significantly different among three  groups  （P＜0.05）. The expression level of  HMGB1  in  polyinfection  group was higher than that in RSV group（P＜0.05）. （2）The  percentages of CD3+，CD3+CD8+，CD3-CD19+，CD19+CD23+  and CD3-CD（16+56）+ were  significantly different among three  groups  （P＜0.05）.  （3） The  percentages of CD3+，CD3+CD8+ and CD3-CD（16+56）+  were not different between polyinfection  group and  RSV group （P＞0.05），but lower  than those in control group（P＜0.05）. （4） The  percentage of  CD3-CD19+  was  not different between polyinfection  group and  RSV group （P＞0.05），but higher  than that in control group（P＜0.05） . （5） The  percentages of  CD3+CD4+ and CD4+CD25+  were of no statistical significance  among three  groups（P＞0.05）.（6）The  percentages of CD19+CD23+ and CD4+CD25+  were higher in polyinfection  group than those in RSV group（P＜0.05）. Conclusion    HMGB1  may play  a role  in  immunopathogenesis  of  bronchopneumonia with  RSV and germ infection；the mechanism of action of  HMGB1 may be different compared  with  TNF-α .

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Etiologic analysis of 8172 cases of acute respiratory cract infection in hospitalized children. WANG Yu-qing，JI Wei，CHEN Zheng-rong，YAN Yong-dong，ZHOU Wei-fang，GUO Hong-bo. 2012, 27(11): 834-839.  Abstract ( )   Abstract：Objective    To investigate etiology of acute respiratory infection in hospitalized children. Methods    From Oct 2005 to Sep 2009， 8172 hospitalized children with ARI were chosen， of which 6599 cases were detected seven common viruses’ antigen and hMPV gene using direct immunofluorescence and RT-PCR， 6404 specimens were cultured for bacteria；7842 cases were detected the antibodies against MP by ELISA. Then analyze and study the positive cases. Results    The positive specimens of one or more pathogens detected were 4756（58.2%） of 8172 cases.Bacterial infections were 1883（29.4%） in 6404 cases. Viral infections were 1886（28.2%） in 6599 cases. Mycoplasma pneumoniae were 2630（33.5%） in 7842 cases. The top four of bacterial detection rate were SP（10.8%）， HI（4.8%），SA（4.7%） and MC（3.4%）；the top four of virus detection rate were RSV（15.8%），hMPV（8.3%），PIV-3（2.1%） and IVA （2.0%）. Pathogen mixed infection rate was 16.9%； virus mixed with bacteria infection was the most common， detection rate of 。～1y group were highest for the SP， HI， SA，RSV and PIV-3， higher detection rate in 3～5y for hMPV， higher in 3～5y and ＞5y for MP. In terms of seasonal distribution， detection rate of bacteria was lowest in autumn， no difference between the other three seasons；detection rate of RSV was higher in winter and spring， hMPV higher in winter and spring， PIV-3 higher in summer， IVA lower in summer；detection rate of MP was higher in summer and autumn. Conclusion    MP is the most common important pathogen of children ARI in local area， followed by viruses； bacteria was the most common in mixed infections. The most common pathogens of bacteria and virus are SP， HI， SA， MC and RSV， hMPV， PIV-3， respectively. Virus and bacteria infection is more common in infants less than 1 year. Mycoplasma pneumoniae infection is more common in children older than 3 years.

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Discussion of balloon dilatation bronchoplasty in management of bronchial stenosis in children.   NI Cai-yun，LIU Xia，MA Jing， HAN Xiao-rong， ZHANG Zhong-xiao，LI Juan，NIU Tie-hua 2012, 27(11): 840-844.  Abstract ( )   Abstract：Objective    To discuss the effect and security of balloon dilatation using a bronchoscope in the management of benign tracheobronchial stenosis. Methods    A total of 156 child patients with proximal benign tracheobronchial stenosis were managed by balloon using the flexible electronic bronchoscope. Of these patients，146 were with pneumonia， 4 patients with tuberculosis infection， 1 patient with granulation tissue by airway extraneous material，5 patients after tracheal intubation. Results    The 156 patients obtained 1-3 times of balloon dilatation. In these patients， the curative effects of 139 patients were excellent， 12 patients effective， and 5 patients invalid. In 139 excellent patients， the airway average diameter in narrow segmental bronchus was increased and the ventilatory capacity of closed lung was increased above two-thirds in 134 patients and the dyspneic respiration with main bronchus stenosis disappeared in 5 excellent patients. In 12 effective patients， the ventilatory capacity of closed lung was increased from one-third to two-thirds after therapy with balloon dilatation. In 5 invalid patients， the ventilatory capacity of closed lung was not changed， although the partial airway stenosis was removed. So， the total effect rate was 96.8% after therapy with balloon dilatation. After follow-up periods of 1-6 months， the airway dilated by balloon did not become narrow again and closed lung did not appear again through chest X-ray or CT. No severe complication was found in any patient.Conclusion    Airway plasty with high pressure balloon dilatation using flexible electronic bronchoscope is an effective，safe， simple and rapid method for treatment of proximal benign tracheobronchial stenosis in child.

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Study on safety of diagnosis and treatment by flexible fiberoptic bronchoscope in pediatric patients with respiratory diseases.  LU Gen， JIN Rong， SU Shou-shuo， CHEN Min， HUANG Li ， LU Qiao-ying. 2012, 27(11): 844-847.  Abstract ( )   Abstract: Objective    To explore the diagnostic and therapeutic value and the safety of fiberoptic bronchoscope in the children with respiratory diseases.  Methods    Clinical data form 567 pediatric patients with respiratory diseases，including atelectasis of unknown origin， recurrent or prolonged wheezing， chronic cough and hemoptysis，were retrospectively analyzed form August 2004 to March 2011. Under local anesthesia， fiberoptic bronchoscope was used with the methods of straight inspection，bronchoalveolar lavage fluid examination and biopsy and bronchus brush examination to identify the pathogeny and to perform therapy with bronchoalveolar lavage and injecting medicine. Results    In 567 patients， fiberoptic bronchoscopy was performed 593 times. Under fiberoptic bronchoscope， endotracheitis was the most common， followed by airway foreign body and airway or blood vessel congenital malformation． In 197 patients with atelectasis of unknown origin， inflammation was found in 115 patients（58.4%）， followed by airway foreign body（37.1%） and endobronchial tuberculosis （3.4%）.After bronchoalveolar lavage and administration of drugs，68.7%（79/115）patients with atelectasis were cured in two weeks and 91.3%（79/115）patients were cured in one month. In 164 patients with recurrent wheezing or chronic cough，inflammation was found in 73 patients（44.5％），followed by airway foreign body in 34 patients（20.7%），airway or blood vessel congenital malformation in 25 patients（15.2%） and endobronchial tuberculosis in 7 patients（4.4％）．In 119 patients with airway foreign body，  foreign body was removed in 98 patients by fiberoptic bronchoscope （82.4%）. The positive rate of bronchoalveolar lavage was 19.5% and gram - positive or gram - negative bacteria in 127 cases （127/264 48.1%）. Some transient and mild complications were observed in 151 times during and 24 hours after fiberoptic bronchoscopy. Meanwhile，most of complications were slight and transient. All adverse reactions disappeared after symptomatic therapy. There was no case of severe complications，such as sudden cessation of respiration and heart beat or anesthesia hypersensititivity. Conclusion    The fiberoptic bronchoscope examine is one of the important methods in differential diagnosis and trestment of respiratory diseases ，providing proof for clinical diagnosis and therapy in children. Pediatric fiberoptic bronchoscopy is relatively safe and reliable in spite of its mild complications.

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Genetic characteristics of enterovirus 71 in 2011 in Guangzhou. XU Yi ， LUO Dan， YE jia-wei， TAN Li-mei， FANG Chun-xiao， BI Feng， WANG Yi， PENG 2012, 27(11): 848-851.  Abstract ( )   Abstract：Objective    To  study the  aetiological features of  hand-foot-mouth  disease and the genetic characteristic of EV7 l in Guangzhou in 2011. Mehtods    Totally 63 blood，pharynx swab and stool samples of hand-foot-mouth disease were collected from Guangzhou Women and Children Medical Center in 2011.Twelve EV7l positive samples were used to isolate  the  virus and  EV7l strains’VPl  were sequenced and phyletic evolution was analysed. Results  The affinities of 12 clinical isolates of Guangzhou area in 2011were far from A， B subtype， and the affinities of nucleotide homology and amino acid homology were less than 85% and 96.5%. With the C subtype genetic type being relatively close， nucleotide， amino acid homology over 88.5% and 97.5%， especially with the C4 subtype affinities of recently， the nucleotide and amino acid homology were 92.9% ~ 94.6% and 97.9% ~ 98.9%. Conclusions    Totally 12 EV71 isolates strains of Guangzhou area in 2011 belong to subtype C4a in the evolutionary process.

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Clinical and radiological characteristics of 22 epidemic encephalitis B cases.   DU Zhi-hong，PENG Bing-wei，LI Xiao-jing，LIANG Hui-ci，LIN Hai-sheng，CHEN Wen-xio 2012, 27(11): 852-855.  Abstract ( )   Abstract：Objective   Analyze the clinical data of the 22 cases of epidemic encephalitis B，summarize the clinical and radiologic features and improve the diagnosis and treatment of encephalitis.Methods    Clinical symptoms and signs，and radiological features were analyzed by statistical description.Results    All 22 cases of encephalitis showed high fever， unconsciousness， convulsions and limb paralysis，of which 4 patients showed symptoms and signs of Parkinson's syndrome.In addition，21 cases showed bilateral thalamus damage，of which 4 cases with Parkinson's syndrome had cerebral peduncle of midbrain damage by radiographic examination.Conclusion    In addition to the common clinical symptoms and sighs of viral encephalitis，Parkinson's syndrome and hypothalamus and midbrain damage by radiographic examination are found in most patients with epidemic encephalitis B.

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Retrospective study of different doses of ACTH therapy for infantile spasms.  CUI Chen，WANG Shuang，CHANG Xing-zhi，QIN Jiong 2012, 27(11): 856-859.  Abstract ( )   Abstract：Objective    To summarize clinical characteristics of infantile spasms（IS）， to compare the short-term efficacy and side effects of high-dose and low-dose ACTH therapy，and to investigate influencing factors on the resolution of spasms. Methods    Clinical data of IS patients who were treated with ACTH for the first time were investigated retrospectively.These patients were admitted to Peking University First Hospital from January 2005 to December 2010.These patients were divided into high-dose and low-dose groups according to initial ACTH doses.Clinical efficacy on spasms， resolution of hypsarrythmia and side effects were compared between these two groups.Logistic regression was used to explore risk factors for clinical control of spasms. Results    A total of 198 patients were included into the study. Their clinical data，EEG characteristics and brain imaging were fully investigated.Complete cessation of spasms was achieved in 37.3%（25/67） of the high-dose group and 45.0%（59/131） of the low-dose group.No significant difference was found between these two groups. EEG was reevaluated in 120 patients after ACTH therapy.In the high-dose group hypsarrythmia disappeared in 42.2%（19/45） of the patients，and 58.7%（44/75） in the low-dose group， no significant difference on the resolution of hypsarrythmia was seen between the two groups. In the high-dose group， 52.2%（35/67）of patients experienced side effects of ACTH while it was 32.8%（43/131） in the low-dose group，the difference being significant between the two groups. Treatment lag（TL），defined as the time from onset of spasms to the initiation of ACTH treatment， was an independent risk factor for the cessation of spasms.About 59.0%（36/61） of patients with TL no more than 1 month achieved cessation of spasms；as for patients with TL longer than 1 month， the cessation of spasms occurred in 34.8%（48/137） . The difference was significant between the two groups. Conclusions    The study shows similar efficacy between different doses of ACTH on cessation of spasms， and on resolution of hypsarrhythmia. High-dose ACTH has more side effects compared with low-dose one.Treatment lag is an independent risk factor for the cessation of spasms.

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The clinical value of different methods of predicting adult height applied to patients with idiopathic short stature.     LV Sheng，DONG Wen-ke，WANG Wei，DONG Zhi-ya，NI Ji-hong，CHEN Feng-sheng，WANG De-fen 2012, 27(11): 860-862.  Abstract ( )   Abstract：Objective    To compare three different PAH methods and analyze their predictive value in idiopathic short stature（ISS） patients .Methods    Thirty-two ISS patients were followed up to adult without accepting any treatment for growth， mean age being 11.9 ± 1.9 years-old， mean HtSDS being -2.62 ± 0.63.For each patient.We assessed bone age with G-P and TW3 method， and estimated PAH with corresponding B-P， TW3 and curve method. We compared final adult height （FAH） and the mean value of PAH with each method by single factor analysis of variance and correlations analyze in order to analysis their predictive value and influence factors. Results    There was not significant difference in the mean value of PAH with three methods （t = 4.33，P＞0.05）.Significant correlation was  found in the FAH and PAH with three methods（P＜0.01），and the correlation coefficient of FAH and PAH was 0.8918 with B-P method，0.740 with TW3 method and 0.821 with curve method. In boys whose bone age was less than ten years， no significant difference was found in the mean value of PAH with three methods（P＞0.05）.However，the error of prediction with TW3 method was more than other methods. The mean value of bone age based on G-P method roughly（9.93 ± 2.25）was significantly different compared with that based on G-P method carefully（10.54 ± 2.23），thus the prediction of adult bone age wassignificantly different with corresponding bone age（P＜0.01）.Conclusion    All of these three methods of PAH are suitable for ISS patients. Furthermore， predictive efficiency with B-P method is equal to curve method， better than TW3 method. Assessment of BA with G-P method needs to be more careful in order to avoid error. It should be more careful to predict adult height with TW3 method when their bone ages are too low.

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Study of efficacy of single low-dose intravenous immunoglobulin in elevating platelet counts. ZHAO Wei-hong，HUA Ying，LU Xin-tian，MA Yue-hong，SUN Qing. 2012, 27(11): 863-865.  Abstract ( )   Abstract：Objective    To evaluate the efficacy of single low-dose intravenous immunoglobulin （IVIG） in treatment for children with newly diagnosed immune  thrombocytopenia （ITP）. Methods    Of 62 children with newly diagnosed ITP，30 patients admitted to hospital before October 2009 were initially given standard-dose prednisone（steroids group），and 32 from October 2009 to April 2011 initially received IVIG ［400 mg/（kg·d）］ treatment for 1～5 days（IVIG group）.Platelet counts were evaluated after presentation days 1，3，5 and in the follow-up. Results    The mean platelet counts in steroids group and IVIG group were 10 × 109/L and 6 × 109/L before treatment.By day 1 after treatment，43.57%children in IVIG group had rapid platelet count recovery，reaching safe level （30 × 109/L），which was higher than 3.33% in steroids group（P＜0.01）.By day 3 and 5，the percentage of cases with platelet count increasing above 30 × 109/L in steroids group and IVIG group were 46.67% vs 65.63% and 80.00% vs 81.25%，respectively.After 7～42 months of follow-up，there were 3.45% in steroids group and 3.23%in IVIG group whose platelet count didn't turn normal.No intracranial hemorrhage or death was recorded. Conclusion    Childhood ITP patients treated with one low-dose IVIG （400 mg/kg） demonstrate a higher percentage with platelet count increasing above 30 × 109/L on the second day；compared with those treated with prednisone initially，the effect is much better.