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06 June 2013, Volume 28 Issue 6 Previous Issue    Next Issue

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Clinical，pathologic and genetic features of 17 infants with Becker muscular dystrophy. HAN Chun-xi*，LU Xin-guo，WU Wei-qing，LIN Jing-Xian，CHEN Pan-pan，LIU Wen-qing，XIE Jian-sheng，LIAO Jian-xiang. 2013, 28(6): 419-423.  Abstract ( )   Abstract：Objective    To study the clinical，pathological and genetic features in infants with Becker muscular dystrophy （BMD），with the aim of increasing the possibility of early diagnosis. Methods    The clinical data of 17 infants' who were definitely diagnosed with BMD，based on clinical manifestations，serum creatine kinase，AST，ALT，DMD genetic testing and the results of skeletal muscle histochemical and immunohistochemical studies，were analyzed retrospectively. Results    All of the infants with BMD showed no or only slight clinical manifestations；serum CK，AST and ALT levels were increased significantly in the infant BMD，and there was good correlation between CK levels with AST and ALT，correlation coefficient being （r = 0.892，P＜0.01） and （r = 0.819，P＜0.01）respectively；DMD genetic testing results of non frameshift deletion mutation occurred in 15 cases，accounting for 88%；Ranging in size of muscle fibers was different，necrosis and regeneration of muscle fiber distribution were spotty，and fat and connective tissue were with mild hyperplasia；anti dystrophin-C，N，R antibody stained weakly；positive or negative fibers were of patchy distribution. Conclusion    Elevated serum CK and transaminase are important biochemical marker for diagnosis of infant BMD，and DMD genetic testing and dystrophin immune histochemical examination are an important means of diagnosis of infant BMD.

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Soluble triggering receptor expressed on myeloid cells-1（sTREM-1） in the diagnosis of infectious diseases in infants aged less than 3 months. WANG Xiao-ying，LI Li，LI Er-zhen，MI Rong，KANG Li-min，CUI Xiao-dai，HU Shou-sheng. 2013, 28(6): 424-427.  Abstract ( )   Objective    To detect the serum  levels of soluble triggering receptor expressed on myeloid cells-1（sTREM-1）so as to investigate the significance of sTREM-1 in small infants with infectious diseases. Methods    All subjects were infants aged 7 d ~3 m hospitalized from January 1，2011 to December 31，2011.Ninety-four patients were enrolled .According to the results of the pathogens the patients were divided into three groups： 32 with bacterial infection， 30 with viral infection and 32 controls without infection. Blood samples were collected from the enrolled patients hospitalized in 12 hours .At convalescence  and  recovery time the blood samples were collected from the bacterial infection patients. Serum sTREM-1 was measured by ELISA（enzyme-linked immunosorbent assay）. The data were analyzed by Paired T test and Single factor analysis of variance. Results    The levels of serum sTREM-1 in acute phase in patients of three groups were as follows： the mean level was （240.20 ± 120.25）pg/mL in bacterial infection group， viral infection group （81.26 ± 13.83）pg/mL， no-infection group （69.42 ± 23.69）pg/mL. The bacterial infection  group had higher sTREM-1 level than viral infection group and no-infection group. The difference was of statistical significance. The viral infection group had higher sTREM-1 level than no-infection group. The difference was of no statistical significance. The levels of serum sTREM-1 in acute phase， convalescent phase， recovery phase were as follows： sTREM-1 level in acute phase（240.2 ± 120.25 pg/mL）was higher than convalescent and recovery phase（118.92 ± 59.74； 73.59 ± 35.49 pg/mL）.The difference was of statistical significance. The level of serum sTREM-1 in recovery phase in bacterial infection group was （73.59 ± 35.49 pg/ml），the level in no-infection group（69.42 ± 23.69 pg/mL）.The difference was of no statistical significance. The level of serum sTREM-1：Gram-positive bacterial infection（202.54 ± 107.14 pg/mL）and Gram-negative bacterial infection（210.36 ± 120.93 pg/mL），the difference was of no statistical significance. Serum level of sTREM - 1 to distinguish between bacterial infection and virus infection or are infected area under ROC curve for 0.983 （95% CI 0.96 1.00）， higher than other markers CRP 0.947 （95% CI0.883～1.01）， WBC 0.747 （95% CI0.631～0.864）， PCT 0.950 （95% CI0.907～0.994） .Conclusion    The sTREM-1 has high expression level in serum in infantile bacterial infection. The sTREM-1 is higher in bacterial infection group than that in viral infection group and no-infection group. The sTREM-1 declines with the recovery of the bacterial infection. There is significant difference according to the infection severity. This suggests it may be an index to bacterial infection diagnosis and evaluation of the severity of infection.

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Investigation of the determination of lymphocyte subpopulations in healthy preschool children in Taiyuan.          ZHANG Zhi-ping*， GUO Hui-min， HUANG Rui， ZHANG Jin-li， ZHAI Chao， ZHU Lei. 2013, 28(6): 428-431.  Abstract ( )   Abstract：Objective    To establish the reference ranges for normal values of peripheral blood lymphocyte subsets in healthy Shanxi children of preschool age. Methods    Healthy children aged 3-6 in Taiyuan of shanxi province were enrolled in the study. Relative counts and absolute counts of lymphocyte subpopulations of T cell（ CD3+ CD19-），CD4+ T cell （ CD3+ CD4+），CD8+ T cell（ CD3+ CD8+），B cell（ CD3- CD19+） and NK cell（ CD3- CD16+ CD56+） were detected by three-color flow cytometric analysis. Peripheral blood lymphocyte subsets percentage and absolute counts of lymphocyte subsets in peripheral blood of healthy preschoolers and CD4+ /CD8+ were analyzed， differences of which were compared between male and female. Results    The percentages and absolute values of T cell，CD4+ T cell，CD8+ T cell，B cell and NK cell had no statistically significant difference between the genders （P＞0.05） in 365 healthy preschoolers. The reference ranges for normal values of T cell，CD4+ T cell，CD8+ T cell，B cell and NK cell respectively were 43.8%～80.3% （1563～3929 cells/μL），18.8%～46.7% （738～2001 cells /μL），13.9%～36.1% （5 32～1549 cells/μL），8.5%～24.6% （261～960 cells/μL ），4.9%～24.6% （197～786 cells /μL） and CD4+ /CD8+ was 0.71～2.39. Conclusion    It is important and necessary to establish the normal reference values of peripheral blood lymphocyte subsets for healthy children in the same race and district.It's shown here that there is no statistical difference in the peripheral blood lymphocyte subpopulation distribution between male and female in healthy preschool children.

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Expression and significance of VDR in children with acute leukemia.  ZHENG Min*，HE Yun-yan，LUO Jian-ming. 2013, 28(6): 432-435.  Abstract ( )   Abstract：Objective    To study the expression of vitamin D receptor （VDR） in children with acute leukemia（AL） and to approach the significance of VDR in the occurrence of acute leukemia from transcription and translation. Methods    Total RNA was extracted from bone marrow cells of thirty untreated children with acute lymphoblastic leukemia （ALL），twelve untreated children with acute myeloid leukemia（AML） and thirty cases of nontumorous hematologic disease children（as controls）.Real time fluorescent quantitative PCR （RT FQ-PCR） was used to investigate VDR mRNA expression in the three groups. Peripheral blood mononuclear cells  were extracted from peripheral blood prepared of thirty untreated children with ALL，ten untreated children with AML and thirty healthy children （as controls）.The expression of VDR protein was detected by immunocytochemical staining and Western blots analysis. Results    VDR mRNA was detected in all the acute leukemic children and nontumorous hematologic disease children. The expression of VDR mRNA in children with ALL（1.06 ± 0.31）and in children with AML（1.13 ± 0.34） was significantly lower compared with the expression in the controls（3.10 ± 0.18）（F = 1701.00，P＜0.01） while there was no significant diffrernce between children with ALL and children with AML（P＞0.05）. The results of immunocytochemistry showed the expression of VDR protein in the children with ALL （27.82 ± 1.78%）and in the children with AML （27.10 ± 2.44%） were significantly lower compared with the expression in the control subjects （59.02 ± 3.46%）（F = 1150.26，P＜0.01） while there was no significant difference between the children with ALL and the children with AML（P＞0.05）.The result of Western blots analysis was in accordance with immunocytochemistry. The expression of VDR protein in children with ALL（0.299 ± 0.071）and in children with AML（0.290 ± 0.094）were significantly lower compared with the expression in the control subjects （0.710 ± 0.041）（F = 356.434，P＜0.01）while there was no significant difference between children with ALL and children with AML（P＞0.05）. Conclusion    VDR is expressed in all the acute leukemic children.The expression of VDR mRNA and  protein may have no association with classification of AL.

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Clinical analysis of 18 children with acute leukemia complicated with septic shock.   ZHANG Bi-hong，FU Ru-ting，XUE Hong-man，CHEN Chun. 2013, 28(6): 436-438.  Abstract ( )   Abstract: Objective    To investigate the related factors， clinical features and prognosis of septic shock in children with acute leukemia. Methods    Analyse the clinical features，therapeutic measures，effect and death risk factors of eighteen children with acute leukemia and septic shock in our hospital from Jan.1，2005 to Jun.1，2012. Result    Male children 15 cases （83.3%）， with a mean onset age of 9.8 years， the average strong chemotherapy treatment of 6.5 times. All children’s neutrophile granulocyte count was lower than 0.5 × 109 / L，hypoalbuminemia occurred in 13 cases （13/15，86.7%）， cardiac dysfunction in 12 cases （66.7%）， pneumonia in 13 cases （72.2%）， MODS in 7 cases （38.9%）. Bacterial culture was gram negative （G -） bacillus in 9 cases，including pseudomonas aeruginosa（3 cases）；gram positive（G +） bacteria in 2 cases， both were hemolytic staphylococcus. Among the 18 cases， 1 gave up treatment， 6 cases died， 11 cases were cured， and the mortality rate was 35.3%. Single factor analysis results showed that the use of sensitive antibiotics within 24 hours during fever in the shock-correction group and the death group had statistical significances， as well as the occurrence of MODS in the process of shock rescue （P＜0.05）.Shock merger pneumonia， cardiac dysfunction， and refractory-relapsed patients had no statistical significance. Conclusion    The older boys， agranulocytosis， multiple chemotherapy and hypoalbuminemia are high risk factors of septic shock. Gram negative bacilli is more in bacterial culture， especially pseudomonas aeruginosa.Staphylococcus heamolyticus can’t be ignored. Patients with cardiac dysfunction are common， but CK - MB doesn't increase or increase obviously， Not using sensitive antibiotics within 24 hours since fever occurs and MODS are the high-risk factors causing death. Using sensitive antibiotics as soon as possible and supportting the organ function actively are important measures to reduce the death of children with septic shock.

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Comparison of clinical features in the respiratory infection children caused by human bocavirus，respiratory syncytial virus，human metapneumovirus.  WANG Mei-juan，JI Wei，HUANG Li，GUO Hong-bo，WANG Yu-qing，CHEN Zheng-rong，YAN Yong-dong 2013, 28(6): 439-442.  Abstract ( )   Abstract：Objective    To compare the clinical features among respiratory tract infections associated with human bocavirus（HBoV）， respiratory syncytial virus（RSV） or human metapneumovirus（hMPV）. Method    A total of 1885 nasopharyngeal aspirates  from hospitalized children were collected during February 2009 to January 2010.  We adopted real-time polymerase chain reaction （PCR） for detecting HBoV as well as direct fluorescent assay for detecting RSV， and reverse transcription polymerase chain reaction （RT-PCR） for detecting hMPV. Results    Of 1885 patients， 145（7.69%） patients were identified with HBoV infection. Among them， single HBoV infection was in 120 cases（82.76%）， and 25 of the 145 HBoV -positive children （17.24%） had coinfection with other respiratory virus.HBoV was frequently detected in autumn. The median age of patients with HBoV infection was 22.09 months， which was older than the patients with RSV or hMPV infection.The clinical features were  similar among the three viruses， but tachypnea and wheezing were more common in the patients with RSV infection while fever was even more common in the patients with HBoV infection. Conculsion    HBoV is one of the common viruses that can cause acute respiratory tract infection in children in Sochow area. Clinically， epidemiology of HBoV infection can be discriminated from the infection of RSV or hMPV.

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Determination and analysis of exhaled nitric oxide in 473 healthy children aged 7 to 13 years.  JIANG Chun-ping， LI Zhi-peng， JIN Ya， WANG Jin-rong，ZHENG Jia-xiang. 2013, 28(6): 443-445.  Abstract ( )   Abstract: Objective    To learn the level of exhaled nitric oxide（ENO） in Jinan schoolchildren，setting up normal reference value range and analyzing associate influencing factors. Method    A total of 473 school children in Jinan aged 7 to 13 years were included in this study. By means of filling out the questionnaire and site examination，we selected eligible children and then measured the exhaled nitric oxide and Peak Expiratory Flow （PEF）. Result    The 473 cases of healthy schoolchildren were selected（male 257，female 216）in this study and we concluded the geometric mean and the 95% CI was 7.780（4.656～13.002）× 109 mol/L. We found that ENO’s level of 10～13-years-old children significantly higher than 7～9 year-old children（P＜0.05）. The geometric mean and the 95% CI were 8.680（5.936～12.692）× 109 mol/L and 6.710（3.588～12.546）× 109 mol/L.In our study we found that age had positive relation with ENO （P＜0.05）while gender，height，weight ，PEFR and passive smoking had no significant correlation with ENO（P＞0.05）. Conclusion    The geometric mean and the 95% CI of ENO in children aged 7～13 years in Jinan is 7.780（4.656～13.002）× 109 mol/L， in which 10～13-year- old children was significantly higher than 7～9-years old children （P＜0.05） and the geometric mean and the 95% CI are 8.680（5.936～12.692）× 109 mol/L and 6.710（3.588～12.546）× 109 mol/L. Gender is an independent influencing factor of ENO level.

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Epidemiologic analysis of MP infection in children from 2006 to 2010. CUI Juan， WANG Jia， YAO Hui-sheng， YI Li-li， LI Mo， LU Li-ping， HAN Xiao-hua. 2013, 28(6): 446-448.  Abstract ( )   Abstract：Objective    To summarize the epidemiology of Mycoplasma pneumoniae（MP） infection in children with acute respiratory tract infection（ARI），and to explore the changes of the epidemiological characteristics in the recent five years. Methods    MP was detected using microparticle agglutination method in 183，841 children with ARI. We analyse distribution characteristics of MP by age， season and gender. Results    Among the 183，841 samples，the positive rate was 30.8%. There was significant difference in the infection rate between boys and girls（P＜0.01），girls （35.5%）higher than boys （27.4%）. MP infection rate from 2006 to 2010 was 22.4%，16.8%，25.8%，29.9% and 39.2%，respectively. In 0-to-3-year-old-group，the positive rate for MP was 19.8%，while in 3-to-6-year-old-group and above 6-year-old-group， 38.3% and 48.1% were positive， respectively，Which showed a significant difference in the infection rate between the 3 groups. There were epidemiological differences in infection  incidences by MP in different seasons（spring 26.9% ，summer 31.7%，  autumn  33.5% and winter 31.2%）. The MP infection incidences showed seasonal  differences（P＜0.01）. Conclusion    The incidence of MP infection in the recent 5 years increased year by year，with 2010 as the highest. MP infection can occur through the whole year， especially in autumn. School age children are still the vulnerable infected group with high incidence in girls than boys.

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Complication of broncho-videoscope operation and therapy strategy in children. ZHU Can-hong， JI Wei，HUANG Li， FAN Li-ping，WANG Mei-juan，YAN Yong-dong，WEN Fang. 2013, 28(6): 449-451.  Abstract ( )   Abstract: Objective    To summarize the complication and therapy strategy during and after the broncho-videoscope operation in children. Method    Observe and treat the complications during and after the broncho-videoscope operation in 585 child patients of our hospital. Result    In 585 child patients ，there were 220 complications totally. In ＜1-year-old group ，there were 95 complications； in ＜3-year-old group ，there were 67 complications； in ＜7-years-old group，there were 51 complications；in ＜14-year-old group ，there were 7 complications .The incidence of complication in ＜14-year-old group was the lowest，which was about 10.8%. The incidence of complication in other three groups was about 40%. The bleeding was the most common complication，but the laryngospasm was the severest complication. The incidence of hypoxemia was the highest in ＜1-year-old group，and the incidence of bleeding was the highest in other three groups. Conclusion    All complications are relieved after appropriate treatment， broncho-videoscope operation in children is very safe and dependable.

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The influence of nasal allergy symptoms on children asthma. ZHANG Hui-fang*，PAN Jia-hua*，NI Chen*，ZHENG Li-lin*，HU Chuan-lai. 2013, 28(6): 452-454.  Abstract ( )   Abstract：Objective    To discuss the correlation between bronchial asthma and nasal allergy symptoms in children from 0 to 14 years in Hefei ，China. Methods    Use uniform asthma epidemiological investigation form and randomly stratified cluster sampling to survey the children aged 0 - 14 years living in Hefei city between October 1 and December 31 in 2010， who were divided into the asthma group and non-asthma group according to the the unified program developed by the National Pediatric Asthma Collaborative Group. These data related to nasal allergy symptoms were analyzed by the Chi-square test. Results    This investigation showed that there was significant difference in various nasal allergy symptoms between asthmatic and non-asthmatic children（P＜0.001）. The nasal allergy symptoms were significantly related to asthma. About 73.75% of the children in asthma group without a cold case firstly appeared nasal allergy symptoms， who were mostly less than 5 years old. About 82.96% of the asthmatic children exposed to the cold air easily induced nasal symptoms. In any season， the asthmatic children exposed to pollen were vulnerable to nasal symptoms. Conclusions    The prevalence of asthma increases significantly in the past 10 years.It is important to prevent asthma by controlling the nasal allergy symptoms among children

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Pulmonary artery sling：two case reports and literature review. PEI Liang，LIU Chun-feng，LI Jiu-jun，XU Wei，WANG Li-jie. 2013, 28(6): 455-457.  Abstract ( )   Abstract：Objective    To raise awareness of pulmonary artery sling（PAS）and to improve its early diagnosis and reduce misdiagnosis. Methods    By analyzing the information of two cases， evaluate the importance of  echocardiography，MRI and enhanced + 3D CT in early diagnosis. Results    These two patients had major clinical manifestations of recurring bucking and vomiting，and laryngeal stridor.One case was confirmed by Enhanced + 3D CT，and the another case was confirmed by echocardiography and Enhanced + 3D CT. Conclusions    The infants who had clinical manifestations such as repeatedly bucking and vomiting，laryngeal stridor，pneumonia or respiratory tract infection，and who were treated unsatisfactorily should consider PAS.Echocardiography、enhanced + 3D CT and MRI play an important role in the diagnosis of PAS.

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The dose titration efficacy studies of methylphenidate hydrochloride controlled-release tablets in the treatment of attention deficit hyperactivity disorder with conduct disorder in children. XIAO Hua，YANG Si-yuan，MAI Jian-ning，DU Zhi-hong，MAO Li-jia. 2013, 28(6): 458-460.  Abstract ( )   Abstract：Objective    To study the methylphenidate hydrochloride controlled-release tablets（OROS-MPH）dose titration treatment for children with attention deficit hyperactivity disorder（ADHD）combining conduct disorder（CD）to achieve the best clinical efficacy. Methods    According to the DSM-IV diagnostic criteria of attention deficit hyperactivity disorder（ADHD）combining conduct disorder（CD），120 cases of children were randomly divided into the original dose group and dose titration group.Two groups of children accepted the 24-week treatment of OROS-MPH，in which the original dose group were chosen to 18 mg/day， dose titration group increased to 36 mg/day or 54 mg/day，respectively，in the fifth week and thirteenth week，and after the course of treatment，the following assessments were performed：SNAP-IV scale，Child Behavior Checklist（CBCL）and Treatment Emergent Symptom Scale（TESS）.Results    （1）The best response rate in the dose titration group was significantly higher than original dose group （P＜0.05）.（2）The SNAP-IV hyperactivity / impulsivity， inattention and confrontation behavior items showed a significant difference between dose titration group and original dose group（P＜0.05）.（3）In the CBCL behavior scales，dose titration group and the original dose group showed significant difference in the presence of adverse exchanges，forcedness，hyperactivity，aggression and discipline of the five dimensions（P＜0.05）.（4）The incidence of side effects in both groups of children had no significant difference（P＞0.05）.Conclusion    With different doses of OROS-MPH for the treatment of children with ADHD and CD，effects differ more obviously-the higher dose（36 mg/day-54 mg/day）for the improvement of symptoms is better than lower dose（18 mg/day）.