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06 July 2014, Volume 29 Issue 7 Previous Issue    Next Issue

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Clinical analysis of autism spectrum disorders. KE Xiao-yan. 2014, 29(7): 481-484.  DOI: 10.7504/ek2014070601 Abstract ( )   PDF (1072KB) ( )   Abstract：The fifth edition of Diagnostic and Statistical Manual of Mental Disorders （DSM-Ⅴ） is released in May 2013.The new term of autism spectrum disorder （ASD） replaced the term of pervasive developmental disorder （PDD）.In this paper，the background for the current definition of ASD，the major changes of DSM-Ⅴ in ASD，the possible effects on the clinical practice of diagnosis and treatment of autism，and the continuous debate on this topic will be reviewed.

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Clinical analysis of mental disorder. DENG Hong-zhu，ZOU Xiao-bing. 2014, 29(7): 485-489.  DOI: 10.7504/ek2014070602 Abstract ( )   PDF (982KB) ( )   Abstract： Intellectual disability（ID），also known as mental retardation（MR），is a common childhood developmental disorders， and is the main cause of children's lifelong disability. In 2013，American Psychiatric Association published“diagnostic and Statistical Manual of Mental Disorders Fifth Edition”（DSM-Ⅴ）diagnostic criteria，which changed the name of ID diagnosis，prompted by the intellectual disability concept according to IQ test scores to the idea which emphasizs mental retardation as a kind of medicine and（or）biological disorders.Clinicians need to make clinical diagnosis based on neuropsychological characteristics of cognitive impairment and adaptation assessment results .

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Analysis of change in clinical diagnosis and treatment of ADHD. ZHENG Yi. 2014, 29(7): 489-496.  DOI: 10.7504/ek2014070603 Abstract ( )   PDF (1027KB) ( )   Abstract： Attention deficit hyperactivity disorder（ADHD）is the most popular mental disorder. It influenced 5%～10% of children and about 4% of adults. There are a huge number of researches about ADHD every year. ADHD is a long-term，chronic condition if it is not treated correctly. ADHD may lead to bed prognosis，even some troubles with the law. So it is very important to make early diagnosis and intervention for ADHD. The new Diagnostic and Statistical Manual of Mental Disorders，5th Edition （DSM-Ⅴ） has a number of changes to ADHD. To master the changes in DSM-Ⅴ is the best way to get quickly and thoroughly updated on diagnostic criteria and classifications of ADHD.

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Clinical analysis of speech and language disorders. Jin Xing-ming. 2014, 29(7): 496-501.  DOI: 10.7504/ek2014070604 Abstract ( )   PDF (990KB) ( )   Abstract：Speech and language disorders are the most common developmentally disabling disorders of childhood. In this article，we explain the professional terms and functions of these two disorders， and introduce the clinical assessment measures and the diagnosis criteria based on the DSM-V published by American Psychiatric Association in 2013. Also， the speech and language therapy is described in it. Besides，the outcome by the longitudinal studies suggest that later talker or slow language development at infant or toddlers is associated with a weakness in language or speech skills in adolescence.

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Present situation of Internet addiction and its influence in children and adolescents. JI Wen-bo*，TAO Ran. 2014, 29(7): 501-505.  DOI: 10.7504/ek2014070605 Abstract ( )   PDF (987KB) ( )   Abstract：With the increase of young internet users，more and more children and adolescents have been addicted to online games.They have become a high-risk group of Internet addiction.Internet gaming disorder has been identified as a new kind of psychiatric disorder in the new revision of the DSM-Ⅴ.Meanwhile，the comorbid psychiatric disorders of Internet addiction include major depressive disorder，ADHD，obsessive-compulsive disorder，social phobia，substance use and other psychiatric disorders.Internet addiction involves a variety of mechanisms, such as psychology and physiology. Internet addiction not only affects physical， psychological and social function in children and adolescents but also brings harm to society.Self prevention，family prevention，school prevention，community prevention and social prevention are of great significance.

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Diagnosis and treatment of neonatal alloimmune thrombocytopenia. SHI Jing，?JIA Cang-song. 2014, 29(7): 506-508.  DOI: 10.7504/ek2014070606 Abstract ( )   PDF (942KB) ( )   Abstracts： Neonatal alloimmune thrombocytopenia （NAIT） is a leading cause of neonatal thrombocytopenia and one of the main reasons for the disease and full-term infants with intracranial hemorrhage.This paper is focused on the NAIT pathogenesis，clinical features， auxiliary examination，diagnosis and intervention and treatment.

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Autoimmune encephalitis in children. WU Ge-fei，LIU Zhi-sheng. 2014, 29(7): 509-514.  DOI: 10.7504/ek2014070607 Abstract ( )   PDF (1024KB) ( )   Abstracts： Child autoimmune encephalitis is characterized by autoimmune antibodies specifically against neuronal proteins and affecting neurotransmitters and excitability. Clinically the most common autoimmune encephalitides are anti-NMDA receptor encephalitis and autoimmune limbic encephalitis. Diagnosis of child autoimmune encephalitis is mainly based on clinical manifestations， imaging examination， detection of autoimmune antibodies in blood and/or cerebrospinal fluid. Corticosteroids and gamma globulin and plasma exchange are the first-line treatment. Early diagnosis and early start of immunotherapy will lead to a good prognosis in some children with autoimmune encephalitis.

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Clinical study of anti-N-methyl-D-aspartate receptor encephalitis in children. JI Tao-yun，ZHANG Yue-hua，WU Ye，ZHANG Xin，WANG Shuang，CHANG Xing-zhi，XIONG Hui，JIANG Yu-wu，QIN Jiong，BAO Xin-hua. 2014, 29(7): 515-519.  DOI: 10.7504/ek2014070608 Abstract ( )   PDF (1128KB) ( )   Abstract： Objective To identify the clinical features and the prognosis of anti-NMDAR encephalitis in children，so as to improve the pediatrician’s awareness about this disease. Methods The clinical features，therapeutic regimen and prognosis of 17 children with anti-NMDAR encephalitis were summarized by a retrospective and follow-up study. Results Among the 17 patients with anti-NMDAR encephalitis，12 were males and 5 were females.Their age varied from 2 to 12 years，and the average age was 5 years 8 months.The most common initial symptoms were convulsions （7 cases） and psychiatric symptoms （7 cases）.The common symptoms in the course of the disease were psychiatric symptoms（17 cases），sleep disorders （16 cases），extrapyramidal symptoms （14 cases），and convulsion （11 cases）.Only 4 patients had autonomic symptoms.The anti-NMDAR antibody were found in all the patients’CSF.The EEG test of 16 patients showed diffused slow background.Tumors were not found in any patient. Fourteen cases were treated with IVIg and methylprednisolone，2 cases only received IVIg therapy and 1 case gave up.Rituximab （2 cases） and cyclophosphamide （1 cases） were administrated in 3 cases with no improvement after the above treatment.The patients had been followed up for 3 to 15 months.Twelve of them recovered completely，2 cases died，2 cases had epilepsy，and 1 case had speech disorder. Conclusion Psychiatric symptoms，sleep disorders，extrapyramidal symptoms and convulsion are the common symptoms of anti-NMDAR encephalitis in children.Tumors and autonomic nervous system dysfunction rarely happen. Immunotherapy is effective in the majority of the patients.The prognosis of anti-NMDAR encephalitis in children is optimistic.

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The investigation of serum 25-hydroxyvitamin D in preschool children. MIAO Mei-hua，SHAO Xue-jun，ZHU Hong，ZHANG Xiao-yan. 2014, 29(7): 520-523.  DOI: 10.7504/ek2014070609 Abstract ( )   PDF (967KB) ( )   Abstracts： Objective To study serum 25-hydroxyvitamin D ［25-hydroxyvitamin D，25（OH）D］ distribution in May in preschool children in Suzhou area， giving scientific basis for the intake and supplementation of vitamin D for children. Methods Totally 852 cases of preschool children（454 cases of male，398 cases of female） aged from 3 to 7 years were selected in May of 2012，and all cases were divided into four groups named as 3～4 year group，＞4～5 year group，＞5～6 year group and ＞6～7 year group.The height and weight of every case were measured and were used to calculate the Body Mass Index（BMI）for evaluating the body shape； according the normal reference values of P85 and P95 of BMI for children below 7 years old provided by WHO，all cases were classified into overweight or no-overweight，obesity or no obesity groups. Serum 25（OH）D levels were measured by ELISA. Results There were 42.37%（361/852）of cases for preschool children in Suzhou area who showed deficiency of serum 25（OH）D，and insufficiency was presented in 40.38%（344/852） of cases.For the distribution of 25（OH）D among age groups， they were 61.20（53.30～75.20）nmol/L，55.50（45.5～65.10）nmol/L，48.30（40.40～57.50）nmol/L and 48.90（40.40～60.20）nmol/L from 3～4 year group to ＞6～7 year group in turn. Comparing every two groups， the serum 25（OH）D declined with the increasing age except between ＞5～6 year and＞6～7 year group（χ2 =18.10，P=0.47），and it was higher in 3～4 year group than that in ＞4～5 year group（χ2 =110.43，P＜0.05），higher in ＞4～5 year group than that in ＞5～6 or ＞6～7 year group（χ2 was 106.11 and 87.75，P＜0.05 for all）.The distribution of serum 25（OH）D in overweight and no-overweight group was 53.97（45.27～66.45）nmol/L and 52.64（42.85～63.80）nmol/L， and they were 55.24（47.29～66.56）nmol/L and 52.71（43.11～63.92）nmol/L for obesity and no-obesity group，there existing significant difference for the distribution of 25（OH）D between every two groups（χ2 was 7.10 and 6.73，P＞0.05）. Serum 25（OH）D and BMI showed positive correlation（r = 0.11，P＜0.05）. Conclusion The overall insufficiency of serum 25（OH）D exists in preschool children in Suzhou area，and positive correlation exists between BMI and serum 25（OH）D in children. It suggests that we should reinforce the monitoring of serum 25（OH）D in preschool children，taking scientific measures to strengthen the intake and supplementation of vitamin D.

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The change and value of NGAL，IL-18 and KIM-1 of urine in early diagnosis of acute kidney injury in children. QIU Hui*， WANG Qian， ZOU Qiu-yang， ZHAO Leng-yue， LI Qing-mei， ZHAO Kai-shu， ZHAI Shu-bo，MA Qing-shan. 2014, 29(7): 524-527.  DOI: 10.7504/ek2014070610 Abstract ( )   PDF (964KB) ( )   Abstracts： Objective To evaluate the change and significance of urinary neutrophil gelatinase-associated lipocalin（NGAL），urinary interleukin-18（IL-18）and urinary kidney injury molecule-1（KIM-1）in the early diagnosis of children with acute kidney injury. Methods From Feb.2011 to Oct.2013 in No.1 Hospital of Jilin University, we had AKI group, non-AKI group and normal control group, including 40 cases respectively.The levels of urinary samples were analyzed by enzyme-linked immunosorbent assay（ELISA）.To analyze the correlation between urinary NGAL， urinary IL-18，urinary KIM-1 and serum creatinine（SCr），and evaluate the early diagnostic value of urinary NGAL，urinary IL-18 and urinary KIM-1. Results （1）Until the serum creatinine was higher，Urinary NGAL, IL-18 and KIM-1 had been rising in AKI group，especially urinary NGAL（P＜0.05）；these indicator levels didn’t change （all P＞0.05）in non-AKI group and healthy group during the study period. （2）The urinary NGAL，IL-18 and KIM-1 levels in the one，two and three groups of AKI gradually increased and were significantly higher than non-AKI group and healthy group（all P＜0.05）. （3）The levels of urinary NGAL， IL-18 and KIM-1 were positively correlated with the levels of serum creatinine in AKI group （all P＜0.05）. Conclusions Compared with non-AKI group and healthy group，urinary NGAL， IL-18 and KIM-1 significantly increase in AKI group， and the levels of these three indicators are both positively correlated with the levels of serum creatinine and the severity of kidney injury，which may be the early predictive biomarkers of AKI in children.

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Clinical analysis of the variants of benign childhood epilepsy with centro-temporal spikes. SHI Xiao-rong，BAO Xin-hua，LIU Xiao-yan，HOU Shao-rong，QIN Jiong，WU Xi-ru. 2014, 29(7): 528-533.  DOI: 10.7504/ek2014070611 Abstract ( )   PDF (1511KB) ( )   Abstract： Objective To study the electro-clinical features and prognosis of the variants of benign childhood epilepsy with centro-temporal spikes（BECT）. Methods Sixty-seven patients with BECT variants were diagnosed in the hospital. They have been followed up for 2 to 10 years.The clinical information, including clinical manifestation，video-EEG，the response to the medical treatment， and the prognosis of the patients, was studied. Results The onset of the seizures in these patients was from 1 year and 6 months to 10 years， and the median age was 4 years and 5 months. The symptoms of BECT variants presented from 2 years and 6 months to 10 years and 6 months，the median age was 6 years. The EEGs of all patients showed abundance of spike and waves in Rolandic areas during wake-up and sleep.In 25 cases （37.3%），the index of discharge in non-rapid eye movements（NREM）was more than 85%.In 42 cases（62.7%），the index was between 50% and 85%.Epileptic negative myoclonus（ENM）was detected in 51 cases（76.1%）by the outstretched arm tests during the EEG recording.All the patients were treated with antiepileptic drugs（AED），only 10 cases were seizure free， and the seizure frequency decreased more than 50% in 5 cases.There were no responses in the other 52 cases.Then the corticosteroid was administered to 50 cases who were resistant to AED. Among them，21 cases were seizure free; in 25 cases，the seizure frequency decreased more than 50%， and only 4 cases had no response to this treatment. Fourteen cases（28%）relapsed 1 month to 1 year and 2 months after corticosteroid therapy.Six months after the corticosteroid therapy， verbal intelligence quotient（VIQ）and performance intelligence quotient（PIQ）increased（P＜0.05）.A long time follow-up of 60 school-aged children showed that 30 cases（50%）had poor school performance. Neuropsychological assessment was performed on 25 cases， and the cognitive decline was observed in 20 cases（80%）. Conclusion BECT variants should be considered in patients with BECT when the seizure frequency increases and new types of seizures present.EEG deterioration and cognitive decline often accompany simultaneously.Seizures are difficult to control with antiepileptic drugs.Corticosteroid therapy is effective in most of the patients. Clinical manifestations，EEG and cognition improve within 6 months after the therapy, but relapse rate is a little bit higher. The long term prognosis of BECT variants is unsatisfying in cognitive function and behavior.

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Diagnostic value of skin prick test in food allergic infants. WEN Xiao-li*，LIAO Yan，LIU Yu-ling，LUO Cui-mei，LONG Xiao-ling，XIE Guang-qing，CUI Bi-yun，LI Lan，FU Si-mao. 2014, 29(7): 534-537.  DOI: 10.7504/ek2014070612 Abstract ( )   PDF (1033KB) ( )   Abstract：Objective To investigate the diagnostic value of mean diameter of SPT in food allergic infants. Methods Totally 91 infants suspected with food allergy （median age 7.35±2.94 months） were selected，and all patients received family history inquiry，skin prick test and open food challenge.The mean diameter of SPT was measured，and OFC was performed to confirm food allergy.Diagnostic value of skin prick test, including the sensitivity and specificity, was calculated.In addition，receiver operating characteristic curve（ROC） was plotted and area under the curve（AUC）was calculated to quantify the accuracy of the parameter.The SPSS software package version 13.0 for windows was used for all statistical analysis. Results A total of 128 babies received food challenge test， in which there were 109 times of OFC positive and 19 times negative；totally 79 infants were diagnosed with FA.The induced symptoms of food challenge test included skin symptoms（70.6%）, gastrointestinal symptoms（20.2%）, rest with crying， coughing， rubbing eyes，etc.（9.2%）.When the rash MD was ≥3 mm，the sensitivity of SPT diagnosis milk，egg white and protein allergy was 19%，60.6% and 60.5% respectively；the area under ROC curve of rash MD in the milk，egg white，protein was 0.718，0.604 and 0.716 respectively； the rates of three food SPT test results complying with the OFC were 44.4%，53.7% and 65.9%，the rates being 62.5%， 58.3% and 31.3% in positive family history；when family history was negative，the area under the ROC curve of rash MD was 0.793. In the cases with positive family history，the area of ROC curve was 0.533.When rash MD of milk，egg white and protein was ≥2.2，5.0，4.7 mm or the rash MD was ≥3.25mm in children with a negative family history，SPT FA diagnostic specificity could be up to 100%. Conclusion SPT has some value in the diagnosis of FA. By finding the critical value of SPT FA and comprehensive analysis of family history，doctors can improve the diagnostic rate of FA. SPT can prevent some suspicious FA infants from food challenge test. It is very important to obtain rapid clinical diagnosis and to reduce the risk and burden to their families.

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Analysis of the BAEP data of healthy children under 14 years old. NING Shu-yao,MAI Jian-ning,LI Jia-ling. 2014, 29(7): 543-546.  DOI: 10.7504/ek2014070613 Abstract ( )   PDF (962KB) ( )   Abstract： Objective To investigate the morphology waveⅠ,Ⅲ,Ⅴpeak latency （PL） and Ⅰ-Ⅲ，Ⅲ-Ⅴ，Ⅰ-Ⅴ interval peak latency （IPL） of normal children’s BAEP， and to establish the normal range standards of the children（from1 day old to 14 years old） in South China. Methods BAEP was detected in 423 children （846 ears） who had passed the audiological tests and denied any disease which would cause hearing loss. Test the 423 cases of normal children under 14 years and record the latency range for waveⅠ,Ⅲ,Ⅴpeak latency （PL） and Ⅰ-Ⅲ,Ⅲ-Ⅴ,Ⅰ-Ⅴ interval peak latency （IPL） of BAEP. Analyze the change of the PL and IPL range as the ages increases. Results We built the normal range of the PL and the IPL of the each group of the children with the software of SPSS13.0. We also found that the data of each wave was related to age increase（P＜0.05）. The wave I was weakly linked with the change of age（r = 0.375）, but the length of wave Ⅲ, wave Ⅴ and IPL was highly linked with age increase（r＞0.8）. Conclusion　Wave I,wave Ⅲ and wave Ⅴ show the different changes as the age increases, and it seems to correlate with the maturity of the central auditory system.