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06 May 2016, Volume 31 Issue 5 Previous Issue    Next Issue

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Interpretation of the Guidelines for Diagnosis of Syncope in Children（2016） HU Jin-wei，YAN Xiao-juan，WANG Yuan-fei，DONG Xiang-yu 2016, 31(5): 321-325.  DOI: 10.7504/ek2016050601 Abstract ( )   Syncope is a common and frequently occurring disease in pediatric clinics，and is also one of the common complaints in Department of  Pediatric  Emergency，which is characterized by rapid onset，temporary and reversible loss of consciousness. The recurrent syncope can affect not only the physical and psychological health but also the quality of life of the children and even lead to the risk of sudden death. Therefore，early diagnosis，differential diagnosis，risk assessment and analysis have become particularly important for the children with syncope. In order to improve the diagnosis of syncope in children and provide a reference for clinical pediatricians in the diagnosis and treatment of syncope，the author makes a simple analysis and supplements conceptions of the definition，classification，differential diagnosis and the diagnostic value of head-up tilt test by reading the 2016 guidelines.

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Treatment progress of pediatric respiratory extracorporeal life support：Interpretation of Indications for Pediatric Respiratory Extracorporeal Life Support YANG Chun-feng，DAI Xin-lun，LI Yu-mei 2016, 31(5): 326-329.  DOI: 10.7504/ek2016050602 Abstract ( )   Extracorporeal life support（ECLS），also known as extracorporeal membrane oxygenation（ECMO），has been used to treat critically ill patients with respiratory and cardiovascular failure. ECLS has been validated as a life-saving therapy，which improves the survival. According to Extracorporeal Life Support Organization Registry Report 2012，the number of pediatric patients（30 days to 18 years） supported for respiratory failure is increasing. Indications for pediatric respiratory extracorporeal life support are not clear before. Now ELSO has put forward the indications for pediatric respiratory extracorporeal life support，which is interpretated in the article.

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Poliovirus vaccine immunization strategy in China after the eradication of wild poliovirus SHEN Jun，ZHU Qi-rong 2016, 31(5): 330-332.  DOI: 10.7504/ek2016050603 Abstract ( )   At present，the world has entered the strategic stage of eradicating wild and vaccine derivative poliovirus before 2018. China has successfully eradicated wild poliovirus and the vaccination policy needs to be changed immediately. Inactive poliovirus vaccine（IPV） should be introduced into Chinese routine immune program gradually.

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Continuing  promotion  of  children’s  immunization YANG Xi-qiang 2016, 31(5): 333-336.  DOI: 10.7504/ek2016050604 Abstract ( )   Vaccination is one of the most effective means of prevention to infectious diseases. The adverse reactions rate is increasing year by year， although vaccination is widely carried out. Standardized supervision and correct understanding of the adverse events following immunization are very important to ensure the health and safety of population. It is urgent to strengthen class Ⅰ planned immunization coverage，eradicat poliomyelitis and eliminate regional measles（Rubella）， promote class Ⅱ（optional） vaccination coverage， carry out the fundamental research of the new vaccine， and strengthen supervision of the vaccine-preventable disease， vaccines and vaccination.

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Common clinical manifestations of adverse reactions caused by vaccination in children and their management FANG Feng 2016, 31(5): 336-340.  DOI: 10.7504/ek2016050605 Abstract ( )   Vaccinations remain crucial for the eradication of infectious diseases. However，adverse reactions caused by vaccines are unavoidable，to which pediatricians should pay more attentions and give proper management in time. The common manifestations of adverse reactions caused by vaccines will be understood by pediatricians in four aspects，including general reactions，abnormal reactions，post-vaccination phenomena and basic managements.

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Immune response and safety evaluation of combined vaccination 2016, 31(5): 340-343.  DOI: 10.7504/ek2016050606 Abstract ( )   Combination vaccines are the direction of development advocated actively by WHO，which is the way to minimize the number of injections children received，reduce  the cost of service，mitigate abnormal reactions to inoculation and improve timely vaccination coverage. Paying attention to the  combination vaccine from the aspects of vaccine formula，immunologic response，clinical evaluation，safety and effectiveness can promote the expanding application of combination vaccine gradually，and will be of great importance in bringing combination vaccine into Expanded  Programme on Immunization.

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Vaccination for children with immune-associated diseases SONG Hong-mei，XIAO Juan 2016, 31(5): 343-347.  DOI: 10.7504/ek2016050607 Abstract ( )   Immune-associated diseases include primary immune deficiencies（PID）， secondary immune deficiencies due to human immunodeficiency virus（HIV） infection， inflammatory rheumatoid diseases and allergy/atopic diseases. Vaccination of such children requires some special considerations and precautions which is a great challenge for primary care and specialty clinicians. To address and discuss the relevant issues of vaccination of the patients can provide some useful information to the clinicians.

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Effect of BCG vaccination and the adverse reactions LIU Er-yong，ZHOU Lin，ZHAO Shun-ying，LI Hui-min 2016, 31(5): 347-349.  Abstract ( )   China’s BCG strains derived from Denmark in the 1950s. Protection of different BCG strains from TB varies. The best use of BCG vaccine is to prevent life-threatening forms of tuberculosis，tuberculous meningitis and disseminated TB in infants. The adverse reactions of BCG vaccination include localized abscess，lymph node tuberculosis，osteomyelitis and disseminated BCG infection. The most common BCG accident is to mistakenly inoculate into muscles or subcutaneous tissue，and over-dose-related accidents. Appropriate and immediate treatment is urgently needed.

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Underlying disease spectrum of syncope in children and adolescents in the past 30 years and health economic analysis: A single center report LIN Jing，WANG Yu-li，ZHANG Qing-you，LIAO Ying，QI Jian-guang，LIU Ping，JIN Hong-fang，ZHANG Chun-yu，YAN Hui，CHEN Yong-hong，LIU Xue-qin，DU Jun-bao 2016, 31(5): 350-355.  DOI: 10.7504/ek2016050609 Abstract ( )   Objective    To analyze the underlying disease spectrum of syncope in children， and evaluate the diagnostic procedures and economic value. Methods    A total of 935 children ［421 males（45%） and 514 females（55%）， aged 1～18 years， mean age（11.2 ± 3.1）］ with syncope were chosen from Outpatient and Inpatient Department of Peking University First Hospital from Jan. 1985 to Dec. 2014. The underlying disease spectrum of syncope in children and the economic value of syncope diagnostic procedure were studied. Results    From 1985 to 1994， the neutrally mediated syncope（NMS） accounted for 6.7% of the syncope children， and 89.3% of syncope children were with unclear reasons. From 1995 to 2004， the NMS accounted for 62%， mainly including vasovagal syncope（VVS） and postural tachycardia syndrome（POTS），and the syncope with unclear reasons decreased to 28.3%. From 2005 to 2014， the NMS was the main underlying disease of the syncope， accounting for 80.7%， mainly including VVS and POTS. Cardiac syncope acouted for 5.4%. Unexplained syncope decreased to 13.9%. The average length of hospital stay shortened significantly［（5.3±3.9） vs. （6.6±4.4） day， t＝3.964， P＜0.001］. The diagnosis costs of syncope children were decreased （P＝0.048）， and the total cost of hospitalization was also decreased （P＜0.001）. Conclusion    With the discovery of new diseases， more and more underlying diseases of syncope are diagnosed. VVS and POTS are the most common diseases in syncope of children. The diagnostic procedure has a good economic value.

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Risk factors for retinopathy of prematurity： A meta-analysis LIN Yi，YAN Chao-ying 2016, 31(5): 356-360.  DOI: 10.7504/ek2016050610 Abstract ( )   Objective    To evaluate the risk factors for retinopathy of prematurity（ROP）for effective prevention. Methods    Studies were identified through literature search in Cochrane Library，PubMed，MEDLINE，Wanfang Periodicals Database，China Science Periodical Database and Chongqing VIP Science and Technology Journal Full-text Database up to October 2015. RavMan 5.3 provided by Cochrane was used for the meta-analysis. Results    Ten studies were confirmed to be eligible. The meta-analysis showed as following： low gestational age（WMD： -1.76；95%CI： -1.98—1.54， P＜0.01）， blood transfusion（OR：3.44；95%CI：2.41—4.90，P＜0.01），sepsis（OR：2.37；95%CI：1.57—3.57，P＜0.01），necrotizing enterocolitis （OR： 6.65；95%CI：3.46—12.78，P＜0.01），patent ductus arteriosus（OR：2.39；95%CI：1.74—3.29，P＜0.01），BPD（OR：4.75；95%CI：3.44—6.56，P＜0.01），oxygen therapy（OR：2.72；95%CI：1.83—4.05，P＜0.01），RDS（OR：2.53；95%CI：1.70—3.79，P＜0.01），asphyxia（OR：2.99；95%CI：1.72—5.19，P＜0.01），low birth weight（WMD：-238.19；95%CI：-320.93—155.44，P＜0.01）. The differences were all significant statistically. Conclusion    Low gestational age，blood transfusion，sepsis，necrotizing enterocolitis，BPD，patent ductus arteriosus，oxygen therapy，RDS，asphyxia，low birth weight are risk factors of ROP.

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Study of enterococci from midstream urine in children CHEN Ye，XIE Yong-qiang，OU-YANG Shan，DENG Hui，LIAO Yu-ru，LI Ying-jie 2016, 31(5): 361-364.  DOI: 10.7504/ek2016050611 Abstract ( )   Objective    To investigate the distribution and antimicrobial resistance of enterococci isolated from urine in children. Methods    The clinical data and drug sensitivity test of pediatric patients who had enterococci isolated from midstream urine in Guangzhou Women and Children’s Medical Center from January 2011 to December 2014 were analyzed. Results    Totally 82 enterococcal isolated were detected；E.faeium accounted for 64.6%（53 strains），and E.faecalis accounted for 35.4%（29 strains）. E.faeium was susceptible to tigecycline，vancomycin，quinupristin and dalfopristin，and linezolid. E.faecalis was susceptible to tigecycline，vancomycin，nitrofrantoin，linezolid，quinolones and penicillin. The prevalence of vancomycin-resistant E.faeium and E.faecalis was 1.9%and 3.4%，respectively. Conclusion    The main enterococci isolated from urine are E.faeium.Different kinds of enterococci have different clinnical characteristics. Enterococci are still highly susceptible to vancomycin. Clinical pediatricians should pay attention to the opportunistic pathogenicity of enterococci.

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Diagnostic significance of N-terminal pro-brain natriuretic peptide in acute phase of incomplete Kawasaki disease LIU Ya-ping，YANG Ting-ting，HU Xiu-fen，LU Hui-ling 2016, 31(5): 365-368.  DOI: 10.7504/ek2016050612 Abstract ( )   Objective    To observe the changes of the plasma level of N-terminal pro-brain natriuretic peptide（NT-proBNP） in the acute phase of incomplete Kawasaki disease（IKD），and explore its value in the diagnosis of IKD，and then further study its value in predicting IVIG non-responsiveness. Methods    The plasma level of NT-proBNP and other laboratory data，including white blood cell（WBC） count，proportion of neutrophils（N%），platelet（PLT） count，CRP，ESR，alanine aminotransferase（ALT），aspartate aminotransferase（AST） and albumin，were detected in 129 children with IKD  and 110 children with typical Kawasaki disease（TKD） in Department of Pediatrics，Tongji Hospital Tongji Medical College，Huazhong University of Science and Technology from Jul.2013 to Dec.2014. A total of 65 children with respiratory tract infection were selected as the control group. The differences among the three groups were analyzed by ANOVA. Meanwhile，the ROC curve analysis was used to evaluate the diagnostic value of NT-proBNP and the other laboratory items with statistically significant differences. Comparisons were finally made. All the Kawasaki disease patients received IVIG 2g/kg and oral aspirin after admission. The t-test was used to compare the difference between the IVIG-non-responsive group and the IVIG-responsive group. Results    The level of NT-proBNP in IKD group（796.24±1324.26） ng/L） was significantly higher than that in the control group（168.85±208.24） ng/L，P＜0.05），but had no significant difference compared with TKD（1362.70±2576.49） ng/L）. The area under the ROC curve of NT-proBNP in diagnosis of Kawasaki disease was 0.786. At the optimal cutoff point of 191.5 ng/L，sensitivity and specificity were 70.0%and 76.9%，respectively. The results were similar to albumin，WBC count，CRP and ESR. The NT-proBNP level of IVIG-non-responsive group and the IVIG-responsive group were （1215.15±1663.33） ng/L and （1043.66±2056.45） ng/L，respectively. The difference was not statistically significant. Conclusion    The plasma level of NT-proBNP significantly increases in the acute phase of IKD. It can be used as a useful reference index in the early diagnosis of IKD，but it is of no help to the early prediction of IVIG non-responsiveness.

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Ovarian immature teratoma（OIT） with gliomatosis peritonei（GP） in children：A report of one case and review of the literature ZHANG Chi，LI Yang，DENG Xiao-geng，WU Yao-hao，WANG Lin，XU Hong-gui，XUE Hong-man，GUO Hai-xia，FANG Jian-pei，WENG Wen-jun 2016, 31(5): 369-372.  DOI: 10.7504/ek2016050613 Abstract ( )   Objective    To explore the diagnosis and therapeutic procedure of a child case of ovarian immature teratoma （OIT） associated with gliomatosis peritonei（GP）. Methods    The clinical features and pathological characteristics of a child case of OIT associated with GP admitted in 2014 in SUN Yat-sen Memorial Hospital，SUN Yat-sen University were analyzed retrospectively；the treatment method and follow-up data were analyzed as well，and related literatures were reviewed. Results    A nearly 2-year-old girl presented with a 10-day history of painless increasing abdominal girth was hospitalized. A computed tomography（CT） examination of the abdomen revealed a large and complex mass containing tissue of fat，calcified nodules and liquid density，accompanied by a large amount of ascetic fluid，consistent with a malignant teratoma. The patient’s alpha-fetoprotein（AFP） level was elevated to 295.98 μg/L （reference range＜25 μg/L）. Exploratory laparotomy showed a large right ovarian mass with an irregular surface measuring 20 cm×15 cm×15 cm. A total of 1000 mL of clear ascite fluid with several cystic masses floating in it was drained. In addition，there were multiple nodules，1 cm to 2 cm in diameter，noted on the surface of the pelvis，abdominal wall，peritoneum，and both sides of undersurface of the diaphragm and hepatic hilar region. The right ovarian tumor，omentum majus and the mass on the undersurface of the right diaphragm were resected. The pathologic examination revealed an OIT（WHO grade III）， and the abdominal implants revealed mature glial tissue. Immunohistochemically， the tumor was positive for NSE， Syn， S-100 protein and vimentin，as well as part of bcl-2 and about 20% Ki67，but negative for CgA. The serum AFP after the surgery was 179.50 μg/L （reference range＜25 μg/L）. After the surgery，the patient was given 6 cycles of cisplatinum，etoposide （VP16） and bleomycin（PEB） therapy and had an uneventful recovery with a normal AFP level after 2 cycles of chemical therapy. A computed tomography（CT） scan of the abdomen after 4 cycles of therapy showed the peritoneum，omentum and the mesentery were thickened，especially the peritoneum around the liver and on the sub-phrenic surface；in addition，the right ovary was not well seen. A PET/CT after 5 cycles of chemical therapy showed low density and calcification in right costophrenic angle，liver capsule and hepatic hilar region. Serum AFP was 1.58 μg/L. The patient was doing well with no evidence of recurrence till now. Conclusion    OIT with GP is a rare condition in children. Combination therapy including surgery and chemotherapy should depend on the classification of OIT. Treatment for GP still requires clinical research.

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Clinical features of 5α-reductase type 2 deficiency and the gene mutation：An analysis of 8 cases HOU Le-le，LIANG Li-yang，OU Hui，et al 2016, 31(5): 373-375.  DOI: 10.7504/ek2016050614 Abstract ( )

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Immunization strategy in children with chronic kidney disease ZHAO Dan，DING Jie 2016, 31(5): 376-378.  DOI: 10.7504/ek2016050615 Abstract ( )

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Progress of diagnosis and treatment of overactive bladder syndrome GAO Hong-ying，WU Yu-bin 2016, 31(5): 379-385.  DOI: 10.7504/ek2016050616 Abstract ( )

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Genetic background and clinical features of dyskeratosis congenita ZHOU Li-na，AN Yun-fei，ZHAO Xiao-dong 2016, 31(5): 386-390.  DOI: 10.7504/ek2016050617 Abstract ( )

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Research progress of sleep problems and sleep disorders in children with attention-deficit/hyperactivity disorder FAN Qiong-li，CHEN Li 2016, 31(5): 391-395.  DOI: 10.7504/ek2016050618 Abstract ( )

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Advances in the diagnosis and treatment of children with Philadelphia chromosome like acute lymphoblastic leukemia YAO Xin-yuan，YU Jie 2016, 31(5): 396-400.  DOI: 10.7504/ek2016050619 Abstract ( )