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06 May 2013, Volume 28 Issue 5 Previous Issue    Next Issue

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A meta-analysis of α-adrenoceptor agonists and β-blockers for the treatment of postural orthostatic tachycardia syndrome in children. 2013, 28(5): 357-360.  Abstract ( )   Abstract:Objective To evaluate the efficacy of treating postural orthostatic tachycardia syndrome （POTS） in children with metoprolol and midodrine hydrochloride.Methods According to inclusion and exclusion criteria， clinical trails were selected from the databases PubMed （1990-2011）， EMBASE （1990-2011）， ELEVIER （1990-2011） and CNKI （1990—2011）. The studies were then assessed based on the Juni assessment， and meta-analysis was completed using the Review Manager 4.2 software.Results Totally 7 clinical trails were selected. Funnel plot analysis showed possible publication bias. Meta-analysis of the seven studies showed that metoprolol （OR = 4.21，95%CI：2.24～7.91， P＜0.01） and midodrine hydrochloride （OR = 7.71，95%CI：3.37～17.62，P＜0.01） were more effective than placebos in treating POTS. Furthermore ， weighted independent t-test revealed that the weighted mean percentage of responders for midodrine hydrochloride was higher than that for metoprolol（92.5% ± 3.9% vs. 80.9% ± 10.7%，t = -10.687，P＜0.01）.Conclusion Metoprolol and midodrine hydrochloride are effective in treating POTS. Metoprolol can be more effective than midodrine hydrochloride.

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Clinical analysis of polyarticular and oligoarticular juvenile idiopathic arthritis. 2013, 28(5): 361-365.  Abstract ( )   Abstract：Objective To investigate characteristics of clinical manifestation and therapy in children with oligoarticular and polyarticular juvenile idiopathic arthritis （JIA）. Methods The medical records of 89 children with polyarticular or oligoarticular JIA in Children's Hospital of Chongqing Medical University from 2006 to 2011 were retrospectively reviewed. Results Totally 42 boys and 47 girls（M∶F ratio，1∶1.1） were included in the study， nearly a half （48.31%） were older than the age of 8 years.There were 37 cases of oligoarticular JIA，no case of extended oligoarthritis，and 52 cases of polyarticular JIA， consisting of 10 cases of rheumatoid factor positive （RF+） and 42 cases of rheumatoid factor negative（RF-）. Oligoarticular and polyarticular JIA were mainly characterized with joint symptoms， while systemic and extra-articular symptoms were rare. Oligoarthritis predominantly involved legs， with the knee joints（28.00%） mostly affected， followed by the ankles （21.33%） and hips（17.33%）. Polyarthritis also affected the large joints at onset， knees （20.00%） and ankles（18.50%）， but usually in association with small joints of the hands（18.00%） and wrist joints（16.00%）. Chronic uvitis was recognized in 4 cases （4.50%）， without ANA positive. Laboratory investigations were just used to help differential diagnosis. There was a high positive rate of HLA-B27（27.78%）. Sixty-one patients were treated with a combination therapy of NSAIDs and DMARDs. For the 28 refractory cases， the treatment with tumor necrosis factor receptor-antibody fusion protein was effective without adverse reaction. Conclusion Patients suffering from polyarthritis are more than those from oligoarthritis， which both mostly affect the school-age children. The females with polyarthritis are significantly more than males.There is a high positive rate of HLA-B27， and low rate of antinuclear antibody and occurrence of iridocyclitis. DAS28 is a suitable criteria to evaluate clinical response in JIA. Methotrexate has been proved safe and effective for polyarthritis. Tumor necrosis factor receptor - antibody fusion protein is safe and effective to relieve the joint symptom， which helps to improve the prognosis of JIA.

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Effect assessment of tacrolimus in treating children with steroid-dependent and steroid-resistant nephrotic syndrome 2013, 28(5): 366-369.  Abstract ( )   Abstract：Objective To investigate the clinical efficacy and safety of tacrolimus （FK506） therapy for children with steroid-dependent and steroid-resistant nephrotic syndrome （NS）. Methods From Jun.2007 to Dec.2011 in Guangzhou Medical College Guangzhou First Municipal People's Hospital，42 children with primary nephrotic syndrome were enrolled，in which 32 cases were steroid-dependent NS （SDNS） and 10 cases were steroid-resistant NS （the SRNS）. The indicators were tested before treatment and 12 weeks later，including （1） the 24h urinary protein excretion，blood urea nitrogen （BUN），serum creatinine （Scr），plasma albumin （Alb），blood and urine β2-microglobulin （β2-MG）；（2） lipid testing indicators：total cholesterol （TC），triglyceride （TG）；（3）hypercoagulable state indicators：the prothrombin time （PT），activated partial thromboplastin time （APTT ），the plasma concentration of fibrinogen （Fib） and blood D-dimer （D-dimer）. Results Tacrolimus combined with steroid therapy had significant effects.The clinical and biochemical indicators improved significantly after treatment （P＜0.05 or P＜0.01）；lipids and hypercoagulability-related indicators also improved significantly；proteinuria significantly reduced.Complete remission was achieved in 29 cases，partial remission in 10 cases，no remission in 4 cases.Eleven cases of simple type NS got complete remission，and 18 cases of nephritis type NS got complete remission，partial remission in 9 cases，no remission in 4 cases.Pathological type：5 cases of minimal change disease（complete remission），5 cases of focal segmental glomerulosclerosis（3 no remission，2 partial remission），six cases of mesangial proliferative glomerulonephritis（4 complete remission，2 partial remission）.Mild gastrointestinal reaction occurred in 4 cases and diarrhea in 2 cases.Conclusion The tacrolimus and steroid combination therapy for children with steroid-dependent and steroid-resistant NS can reduce proteinuria，reduce high cholesterol and improve the hypercoagulable state；the majority of children get complete remission；steroid-resistant nephrotic syndrome also has a significant improvement in the treatment.This combined treatment is safe and effective with fewer adverse reactions.

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The electroclinical features of benign infantile epilepsy in 49 patients 2013, 28(5): 370-373.  Abstract ( )   Abstract：Objective To summarize the electroclinical features and outcome of benign infantile epilepsy（BIE）. Methods BIE patients were collected in Pediatric Department of Peking University First Hospital.The clinical and EEG data of patients were analyzed.The treatment effects and outcome of patients were followed up.Results In 49 BIE patients，21 were male and 28 were female. The seizure onset age ranged from 3 months to 13 months.Partial seizures were observed in 26 patients（53.1%），secondarily generalized seizures in 23 patients（46.9%）；39 patients （76.9%） had a history of cluster seizures.No patients had history of status epilepticus；24 patients had a family history of seizures；15 patients had a family history of benign familial infantile epilepsy.The interictal EEG was normal in 33 （67.3%） cases.The interictal discharges were recorded in 16 cases.Ten of sixteen cases had interictal discharges in lateral or bilateral Rolandic area. Ictal video EEG was recorded in 4 patients.Ictal discharges originated from temporal region in three patients and from occipital region in one patient.Five patients were not treated with antiepileptic drugs，and 44 patients accepted antiepileptic monotherapy. Treatment time ranged from 2 months to 24 months ［（12.5±9.9） months］.All patients were followedup over two years ，and no one had seizure relapse. Conclusion The features of BIE include the onset age before one year old，manifesting partial seizures or secondarily generalized seizures，and usually a cluster of seizures；normal interictal EEG or small spikes in Rolandic area；good response to antiepileptic drugs and benign outcome.

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Molecular epidemiology and antimicrobial resistance of methicillin-resistant staphylococcus aureus. 2013, 28(5): 374-377.  Abstract ( )   Abstract：Objective Methicillin-resistant staphylococcus aureus is. To understand the change tendency of its molecular epidemiology and detect the evolution of drug-resistance between them. Methods 83 non-repetitive clinical strains of Methicillin-resistant staphylococcus aureus were collected from December 2009 to December 2010 .The genotypes of SCCmec and SPA were deterinned by multiplex PCR and the PVL gene was detected. Antimicrobial resistance detected by K-B disk diffusion method . Results Among 83 isloates of MRSA， SCCmecⅢ、SCCmecⅡ、SCCmecⅣa and nontypable isolates accounted for 32.5 %（27/83）， 7.2%（6/83），42.2%（35/83）， 18.1%（15/83） respectively .SCCmec type I and V strains were not discovered in this study. The isolates with PVL gene accounted for14.5 % （12/83），it is about14.3% in SCCmecⅣa.The main SPA genotypes of isolate strains were t163、t437、t037； the differences between them was siginificant and the antimicrobial-resisitance of SCCmecⅢ was no higher than SCCmecⅣ. The Antimicrobial-Resistance of SCCmecⅢ is lower than before，but SCCmecⅣa is on the contrary Conclusion SCCmeccⅣ-spa-t163 was the main popular strain . Antimicrobal-resistent spectrum of SCCmecⅣa is expanding，especially clindamycin and erythrocin.

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Compliance and safety of ketogenic diet therapy for children with intractable epilepsy. 2013, 28(5): 378-381.  Abstract ( )   Abstract：Objective To evaluate the compliance and safety of the ketogenic diet （KD） in children with intractable epilepsy. Methods This was a prospective，open-label study of intractable epilepsy patients treated with the classic KD with a lipid-to-nonlipid ratio 4：1.83 of cases（49 males and 34 females），who were managed and followed-up through multidisciplinary KD special group from May 2011 to December 2012.The variables related to the compliance and safety were also analyzed. Results ①At 5 days，3 and 6 months after initiation，92.8%（77/83），70.7%（53/75），and 57.1%（32/56） patients remained on the diet.②The main causes to stop the treatment of 26 cases included poor efficacy accounting for 27%（7/26），the children’s rejection for KD accounting for 19%（5/26），a poor compliance of parents accounting for 15%（4/26），the infection and accidental death 12%（3/26）.The cause of treatment discontinued was the noncompliance of the patients or the parents in the early days； inefficiency and the infection were the main causes to stop the therapy in the near future； the stopping of treatment according to abnormal nutrition indicators in long-term.③The side effect was drowsiness，fatigue，intolerance of gastrointestinal tract and abnormal blood lipids in the early days.The tolerance of gastrointestinal tract got better in the near future， and the main side effect was the abnormal blood lipids in this period. Three dead cases were not relative with KD. Conclusion The KD is a safe and effective alternative therapy for intractable childhood epilepsy.Multidisciplinary KD special group is beneficial to children with KD treatment.

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Study of normal cerebral white matter in children from birth to 2 years with diffusion tensor imaging. 2013, 28(5): 382-385.  Abstract ( )   Abstract：Objective The purpose of this study was to use diffusion tensor imaging to investigate the status of cerebral white matter（WM） maturation in the first 2 years after birth. Methods A total of 67 children ranging in age from birth to 24 months underwent conventional MRI and diffusion tensor imaging with gradient encoding in fifteen directions， all on a 1.5T MRI system. All children were divided into six groups according to month. Fractional anisotropy was measured in five deep WM structures （posterior limb of internal capsule， anterior limb of internal capsule， genu and splenium of corpus callosum， optic radiation） and four peripheral WM regions（associational WM underlying prefrontal， occipital cortex， temporal lobe and centrum semiovale）. Results In the same months of age， different parts of the white matter FA values were significantly different；the deep white matter FA values were higher than the shallow；in birth-to-28 days baby， corpus callosum FA values was the highest in deep white matter ，followed by the corpus callosumknee， posterior limb of internal capsule， optic radiation and limb of internal capsule；in the shallow white matter，centrum semiovale was the highest， followed by the temporal lobe， frontal lobe and occipital subcortical white matter. With increasing month-old， white matter FA values of the various parts gradually increased，showing positive correlation. In the same parts of the white matter，FA values change in different rate for different ages，which was a statistically significant （P＜0.05）. Conclusion Combination of T1WI and T2WI and diffusion tensor imaging can be used for quantitative evaluation of cerebral white matter development of children in the first 2 years after birth..

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Analysis of risk factors for coronary artery lesion secondary to Kawasaki disease in children. 2013, 28(5): 386-388.  Abstract ( )   Abstract：Objective To explore the risk factors in children with coronary artery lesion （CAL） complication in Kawasaki disease（KD）. Methods Retrospective analyses of the clinical data from 143 children with KD from 2009 to 2011 in Shandong Provincial Hospital were performed in terms of 11 aspects including the fever duration，hemoglobin （Hb），erythrocyte sedimentation rate （ESR），C-reaction protein （CRP），white blood cell count （WBC），blood platelet （PLT），and the patients’gender and age. 143 children were divided into two groups according to whether these KD patients were with or without CAL.Both single factor and multivariate logistic regression analyses were performed. Results Single factor analysis showed that fever duration over 10 days，ESR，PLT，CRP，ALB，cTnI and NT-porBNP were risk factors to KD complicated with CAL （P＜0.05 or P＜0.01）.Multivariate logistic regression analysis showed that a fever duration over 10 days，decrease of ALB and increase of cTnI were significant risk factors to KD complicated with CAL（P＜0.05）. Conclusion Fever duration over 10 days，decrease of ALB and increase of cTnI are important risk factors to KD complicated with CAL.