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06 January 2015, Volume 30 Issue 1 Previous Issue    Next Issue

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Treatment progress of  Kawasaki disease at acute stage HU Jian. 2015, 30(1): 1-4.  DOI: 10.7504/ek2015010601 Abstract ( )   PDF (893KB) ( )   Abstract： The incidence of Kawasaki disease（KD） is increasing in Asian countries，even worldwide. Refractory cases still have a strong challenge. Incomplete KD and non-responders to initial IVIG treatment may increase the rate of the coronary artery lesions（CAL）. Because of the rate of resistance to initial IVIG treatment，timely additional treatment can significantly reduce the risk of echocardiologically defined CAL in the majority of patients. It’s important to diminish inflammation， endothelial dysfunction and CAL formation，including application of tumor necrosis factor-alpha antagonist， methylprednisolone pulse therapy，ulinastatin and cytotoxic agents，which helps to decrease the life-long sequelae of the cardiovascular lesions.

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Clinical diagnosis of autoinflammatory disease. SONG Hong-mei， LI Ji. 2015, 30(1): 5-8.  DOI: 10.7504/ek2015010602 Abstract ( )   PDF (904KB) ( )   Abstract： Autoinflammatory diseases or disorders （AIDs） are a group of recurrent non-invasive inflammatory diseases characterized by fever， acute arthritis and elevated acute-phase proteins. The disease was underestimated in large part during the past few years due to insufficient understanding and lack of means of diagnosis. With the increasing advance of genetic diagnosis technology and of research on the mechanism of the inflammatory occurrence and the development and the signal pathway， study about the AIDs has made a rapid progress， which also proposed the new challenge to immunological pediatrician for clinical practice.

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Early identification of systemic vasculitis. WU Xiao- chuan， LI Fang. 2015, 30(1): 9-12.  DOI: 10.7504/ek2015010604 Abstract ( )   PDF (906KB) ( )   Abstract： Systemic vasculitis is a group of vasculitis with common inflammation of the blood vessel and involves multiple organs. It can involve all kinds of vessels of the organs，showing different clinical manifestations and lacking specificity. Through summarizing the clinical manifestation and diagnosis of some common systemic vasculitis in children，we aim to improve pediatricians’s awareness of these diseases，in order to early discover，diagnose and improve the prognosis.

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The role of regulatory B cells in rheumatic autoimmune diseases. TANG Xue-mei. 2015, 30(1): 13-16.  DOI: 10.7504/ek2015010605 Abstract ( )   PDF (948KB) ( )   Abstract： Human B lymphocytes play immune regulating function through producing specific antibodies and cytokines. Regulatory B cells play positive and negative immune regulatory roles by the secretion of various cytokines or cells contact mechanisms， and they play an important role of immune suppression in rheumatic autoimmune diseases， and may bring new hope to the patients with rheumatic autoimmune diseases.

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The influence of allergic diseases on children’s rheumatic diseases. CAO Lan-fang， GUO Ru-ru. 2015, 30(1): 17-20.  DOI: 10.7504/ek2015010606 Abstract ( )   PDF (909KB) ( )   Abstract： Allergic disorders and rheumatic diseases are two common diseases of dysregulated immune system in children， with the feature of long disease course and easy relapse，and the incidence of the two diseases is increasing. All these features are bad for the prognosis of children with the diseases. Prior Th1/Th2 theory deemed that Th1-mediated autoimmune diseases and Th2-mediated allergic conditions are complementary both on the mechanism and incidence， which improve patients’ outcomes with a new balance of T cell subsets. Recent studies， however， have served to challenge the idea that the presence of allergy and autoimmunity are mutually exclusive states and suggest that allergic diseases and rheumatic diseases are risk factors for each other. Clear understanding of the relationship between children’s rheumatic diseases and allergic disorders will have important implications for clinical treatment and diagnosis. This article clarifies the influence of allergic diseases on children’s rheumatic disease.

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The Research advance in systemic lupus erythematosus co-infection. SUN Guang-chao，ZENG Hua-song. 2015, 30(1): 21-24.  DOI: 10.7504/ek2015010603 Abstract ( )   PDF (951KB) ( )   Abstract： The treatment of SLE becomes standard in recent year. Serious complications caused by infection become the leading cause of death in SLE， more than renal involvement and lupus encephalopathy. SLE co-infection mainly connects with the defects in humoral immunity and cellular immunity. And also connect with the disease activity， the dose of hormone and immune inhibitor.

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Clinical diagnosis，treatment and long-term follow-up management in children with allergic diseases. LI Feng，ZENG Hua-song. 2015, 30(1): 25-28.  DOI: 10.7504/ek2015010607 Abstract ( )   PDF (887KB) ( )   Abstract： The allergic diseases which always affect respiratory，digestive and skin systems in children are very popular.At present， the diagnosis technology of allergic disease in children and the accuracy have been greatly improved and so strengthening the long-term follow-up and management is of great significance in reducing the occurrence of allergic disease and its complications.

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Food  allergy  in  children  and  its  related  diseases TANG Su-ping. 2015, 30(1): 29-32.  DOI: 10.7504/ek2015010608 Abstract ( )   PDF (896KB) ( )   Abstract： Food allergy is usually the first step of the allergy march. Clinically， less attention is paid to the related diseases. This paper mainly discussed the children with food allergy and its influence on related diseases， such as eczema， urticaria， allergic rhinitis and asthma， so that we could establish the systematic and comprehensive diagnosis and take comprehensive intervention measures.

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Diagnosis and management of children with atopic dermatitis. TANG Jian-ping. 2015, 30(1): 33-36.  DOI: 10.7504/ek2015010609 Abstract ( )   PDF (914KB) ( )   Abstract：Atopic dermatitis （atopic dermatitis，AD） is a common chronic relapsing inflammatory skin disease，involving 10% to 20% of children. The etiology and pathogenesis of the disease is complex， involving genetic，environmental and immunological factors； skin barrier function is weakened or destroyed， for example， reduced or missing epidermal silk poly protein is the important pathogenic factor. AD has the basic features of severe itching，chronic eczematoid dermatitis，dry skin and repeated attack. It has 3 clinical stages， namely， infancy，childhood and adulthood and adolescence. Some may be

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Allergen specific immunotherapy and management of   follow - up visits for respiratory diseases in children CHEN Shi，ZENG Xia，WANG Ling. 2015, 30(1): 37-41.  DOI: 10.7504/ek2015010610 Abstract ( )   PDF (927KB) ( )   Abstract：The long-term and preventive efficacies of ASIT have been paid great attention recently. To target the efficacy of ASIT，we may focus on：the standardizations of the treatment，patient selection，standardized allergen vaccines，management of adverse reactions，patient education， documentations and management of follow-up visits.

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Children’s digestive tract allergy diagnosis and coping strategies. RONG Zan-hua. 2015, 30(1): 42-46.  DOI: 10.7504/ek2015010611 Abstract ( )   PDF (932KB) ( )   Abstracts：Children’s allergic diseases have become one kind of common chronic diseases，which are seriously harmful to children’s physical and mental health. Digestive tract allergy is one aspect of the allergic diseases， involving， infant colic，oral allergy syndrome，allergic proctocolitis，food protein induced enterocolitis syndrome， gluten allergy disease，eosinophilic esophagitis，eosinophilic gastroenteritis，allergic purpura （abdominal）, etc.. This article focuses on diagnosis and coping strategies，in order to help to improve the level of diagnosis and treatment in clinics.

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Diagnosis and early intervention in Duchenne muscular dystrophy carriers. GAO Yang-jie， Lü Jun-lan. 2015, 30(1): 47-50.  DOI: 10.7504/ek2015010612 Abstract ( )   PDF (904KB) ( )   Abstracts：Duchenne muscular dystrophy is the most common hereditary muscular disease， and most patient died from heart and pulmonary failure around 20 years old. As there is no curable treatment for this disease so far， the effective way to reduce the morbidity is accurate gene diagnosis in both patients and carriers.

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Analysis of nutritional status and the factors related to nutrition in children with chronic kidney disease MENG Qun，WU Dong-xue，LIU Xiao-rong，SHEN Ying. 2015, 30(1): 51-54.  DOI: 10.7504/ek2015010613 Abstract ( )   Abstracts： Objective To evaluate the nutritional status and the factors related to nutrition in children with chronic kidney disease（CKD）. To explore the biological monitoring index of nutritional status of children with CKD. Methods Totally 123 patients with CKD hospitalized in our hospital from 2009 to the end of 2011 were enrolled in this study. Another 168 healthy children were chosen as control group. The height，weight，and insulin-like growth factor binding proteins 3 （IGFBP3） of the two groups were measured. The median percentage of weight for age（W/A），height for age （H/A）and weight for height （W/H）， BMI and glomerular filtration rate （GFR） were also calculated. The nutritional status was assessed according to the methods recommended by American Academy of Pediatrics. The relationship between the nutritional status and GFR， gender as well as the duration of CKD were analyzed. Nutritional knowledge questionnaire for parents of children in CKD group was taken. Results The levels of W/A in 70（56.91%）， H/A in 63（51.22%） and W/H in 60 （48.78%） children with CKD were lower than that of the control group（χ2=78.676，41.853，39.281， P=0.000）， and were positively correlated with the glomerular filtration rate （r=0.552，0.368，0.539； P=0.000）. The serum levels of IGFBP3 were much higher than the control’s（t=2.725， P=0.008）. The number of overweight and obesity was 21 cases （17.07%）. About 76.67% parents of children with CKD had no knowledge of nutrition. Conclusion Malnutrition is the common complication in CKD children.The nutritional status in CKD children is positively related to the glomerular filtration rate. Serum IGFBP3 and GFR can be the biological monitoring index of nutritional status. Obesity in CKD children can’t be ignored.It is important to guide and popularize knowledge of nutrition periodically.

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Observation on short-term efficacy and safety of adalimumab in treatment of  juvenile idiopathic arthritis XU Ying-jie，WU Feng-qi，LAI Jian-ming，KANG Min. 2015, 30(1): 55-58.  DOI: 10.7504/ek2015010614 Abstract ( )   Abstracts： Objective To evaluate the efficacy and safety of adalimumab resistance in children with severe juvenile idiopathic arthritis. Methods Nine patients， who were diagnosed with JIA and had poor prognostic factors （including small age，recurrence，multiple joint involvement，bone destruction）and ineffective conventional therapy，were subcutaneously injected with adalimumab （twice a week，a total of eight times），and at the same time， oral methotrexate or （and） leflunomide were given，supplemented by physical therapy and functional exercise.Clinical efficacy was evaluated based on the ACR pediatric 30，50，70 improvement evaluation criteria，respectively，at a month，two months， three months，four months，five months and six months after treatment，and adverse events were monitored. Results After 1 month，2 months and 6 months， ACR Pedi 30 compliance rates were 89%，100% and 78%，ACR Pedi 50 compliance rates were 78%，89% and 67%，ACR Pedi 70 compliance rates were 11%，67% and 33%，and there were no significant adverse events. Conclusion Adalimumab treatment for severe juvenile idiopathic arthritis has good curative effect.The clinical efficacy is more significant in early course of disease．There is small and low occurrence of adverse reactions.

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Clinical characteristics and prognosis of twenty-two children diagnosed with acute encephalitis with visual impairment. HU Chun-hui，WANG Long-fei，WANG Hua. 2015, 30(1): 59-62.  DOI: 10.7504/ek2015010115 Abstract ( )   Abstracts： Objective To analyze the clinical characteristics and prognosis of acute encephalitis with visual impairment in children. Methods The clinical features， including clinical manifestations，laboratory tests，Flash visual evoked potential and cranial MRI， in 22 patients diagnosed with acute encephalitis with visual impairment in children were retrospectively analyzed. Results The disease course was less than one week in 10 cases. The disease course of eight cases was between one week and two weeks； two cases were between two weeks and four weeks； two cases were over four weeks. Seven cases had visual impairment as the first symptom. One case was with the diagnosis of viral encephalitis with cortical blindness. Nine cases were with the diagnosis of viral encephalitis with optic neuritis. One case was with the diagnosis of encephalitis with neuropapillitis. One case was with the diagnosis of disseminated encephalomyelitis with optic neuritis. Two cases were with the diagnosis of disseminated encephalomyelitis with optic neuritis. One case was with the diagnosis of brainstem encephalitis with exposure keratitis. One case was with the diagnosis of encephalitis with lens opacity and retinal dysplasia. One case was with the diagnosis of ophthalmoneuromyelitis. One case was likely with the diagnosis of Vogt-Koyanagi-Harada syndrome. In all the cases of Flash visual evoked potential，eighteen were abnormal. In the ten cases of fundus photography，seven were abnormal. In all the cases of cranial MRI，ten were abnormal and six suffered from extensive pathological changes in the brain. In the eighteen cases of hormone therapy，fourteen had good effects. The time of post hospitalization follow-up ranged from 6 months to 8 years. The prognosis of 20 patients was good. Two patients’ prognosis was bad. Conclusions There are different kinds of etiology and diseases in children who are diagnosed with acute encephalitis with visual impairment. Flash visual evoked potential and fundus photography are of important significance in the early stages. High doses of IVIG corticosteroids and hyperbaric oxygen therapy play a key role in improving the prognosis of disease.

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Diagnosis of clinical atypical childhood-onset systemic lupus erythematosus. MA Xiao-xue， ZHAO Xing，JIANG Hong. 2015, 30(1): 63-66.  DOI: 10.7504/ek2015010616 Abstract ( )   Abstracts： Objective To compare the application values of American College of Rheumatology （ACR 1997） and Systemic Lupus International Collaborating Clinics （SLICC2009） SLE diagnostic criteria， and summarize the experiences on diagnosis of clinical atypical childhood-onset SLE. Methods Diagnosis process and results of 4 childhood-onset atypical cases were analyzed retrospectively. Results None of the 4 cases can be diagnosed because of the insufficient evidence in accordance with ACR1997 diagnostic criteria， but all are diagnosed in accordance with SLICC2009，in which kinds of lupus skin lesion and pathologic diagnosis of lupus nephritis were increased， and hematological and immunological indexes inspection items were subdivided， which made the atypical cases diagnosed.Conclusion Immunological detection and early nephritic pathological examination is helpful to the diagnosis of SLE atypical cases.

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Significance of procalcitonin in the diagnosis of juvenile idiopathic arthritis. LIU Fan，DING Yan，YIN Wei. 2015, 30(1): 67-70.  DOI: 10.7504/ek2015010617 Abstract ( )   Abstracts： Objective To study the relationship between procalcitonin （PCT） and the pathogenesis of juvenile idiopathic arthritis （JIA）. Methods We tested the values of PCT and CRP of 150 JIA cases. To find the diagnostic value of PCT and CRP in JIA with bacterial infection，we compared the clinical value of PCT and that of CRP， including sensitivity， specificity，positive predictive value and negative predictive value. Besides， we tested the level of PCT in various patterns of JIA. Results PCT value in cases of JIA with bacterial infection was （3.56±0.84）， which was markedly higher than that in JIA cases with virus infection（0.05±0.01）（P＜0.05）and that in JIA disease activited without infection group（0.19±0.01）（P＜0.05）and that in control group .However， there wasn’t significant difference between JIA cases with virus infection and control group. If we considered diagnostic positive threshold of JIA cases without virus infection as PCT≥0.5 μg/L，then its sensitivity， specificity， positive predictive value，negative predictive value ， positive likelihood ratio and negative likelihood ratio were 76.2%，87.6%，50.0%，95.8%，6.14 and 0.27， respectively. In 98.99% of the JIA activity without infection group PCT value was＜0.5 μg/L，the median was 0.2 μg/L. In 66.7% of the JIA activity without infection group，PCT＜0.1 μg/L. Conclusion Testing PCT value has significant role in diagnosing JIA with bacterial infection ， and the prediction value is superior to CRP infection. It can be considered to recommend PCT＞0.5 μg/L as the diagnosis of JIA infection in patients with critical value.