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06 August 2016, Volume 31 Issue 8 Previous Issue    Next Issue

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Interpretation of Managing Possible Serious Bacterial Infection In Young Infants When Referral Is Not Feasible ZOU Biao，SHU Sai-nan 2016, 31(8): 561-564.  DOI: 10.7504/ek2016080601 Abstract ( )   Young infants（≤59 days old） with possible serious bacterial infection（PSBI） should be hospitalized. However，for the past few years，existing evidence demonstrates that in resource-limited settings many young infants with signs of PSBI do not receive the recommended inpatient treatment because such treatment is not accessible，acceptable or affordable to families. The first treatment guideline for PSBI has been published in 2015，which provides the direction for practice.

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Paying attention to the individualized management of pediatric functional cardiovascular diseases SUN Chu-fan，DU Jun-bao 2016, 31(8): 565-567.  DOI: 10.7504/ek2016080602 Abstract ( )   Pediatric functional cardiovascular diseases involve a series of dysfunctions which can affect children’s physical and mental health. They include vasovagal syncope，postural tachycardia syndrome，orthostatic hypotension，orthostatic hypertension and beta-adrenoceptor hyperfunction，etc. Since the above-mentioned diseases have various therapeutic response，with the research progress of the disease mechanisms and prognosis，great progress has been made in individualized management of pediatric functional cardiovascular diseases. In the future，great attention should be paid to the individualized diagnosis and treatment of the diseases so as to improve the diagnostic and therapeutic technology.

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Application of precision medicine in the study of molecular genetics of congenital heart disease SHENG Wei， HUANG Guo-ying 2016, 31(8): 568-571.  DOI: 10.7504/ek2016080603 Abstract ( )   The etiology of congenital heart disease is complex， involving genetic and environmental factors. Precision medicine promotes the genetic studies of congenital heart disease by combining clinical medicine，basic medicine and translational medicine together，promotes the development of molecular genetics of congenital heart disease and lays the foundation for the development of individualized prevention and treatment of diseases.

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The differential diagnosis of vasovagal syncope and postural tachycardia syndrome in children based on biomarkers TIAN Hong 2016, 31(8): 572-574.  DOI: 10.7504/ek2016080604 Abstract ( )   Vasovagal syncope（VVS） and postural orthostatic tachycardia syndrome（POTS） are the two common types of neurally mediated syncope in children. It is sometimes hard to identify the VVS from POTS merely depending on the symptoms. Studies of translational medicine recently have shown that the circulating biomarkers， hydrogen sulfide（H2S） and serum iron both have predict value in assessing the therapeutic efficacy and differentiating between VVS and  POTS.

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Genetic progress and prospect of precise diagnosis in pediatric cardiomyopathy YANG Shi-wei，QIN Yu-ming 2016, 31(8): 574-578.  DOI: 10.7504/ek2016080605 Abstract ( )   With the development of modern molecular   genetics in the last decades， great genetic progress has been made in pediatric cardiomyopathy，and lots of disease-causing genes and mutations have been identified. It is very important to carry out genetic testing in pediatric cardiomyopathy， and it is a necessary prerequisite toward the development of more specific therapy and an important aspect of creating increasingly personalized medical approaches. Compared with adult cardiomyopathy， the etiology and clinical manifestations of pediatric cardiomyopathy are more complex， and how to identify the disease-causing mutation in the large number of genetic variations in cardiomyopathy patients becomes a new challenge.

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Recent advances in genetic research into neurally mediated syncope in children HUANG Min，HUANG Yu-juan 2016, 31(8): 578-582.  DOI: 10.7504/ek2016080606 Abstract ( )   Neurally mediated syncope（NMS）is the most common type of syncope，whose exact pathogenesis is still unknown. The characteristics of family cluster show that NMS has a genetic mechanism. In recent years，genetic researches of NMS are mainly concentrated on the candidate gene polymorphisms of autonomic nervous system，neurotransmitter and vasoactive molecules，family history and twin study.

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Precision  medicine  for  long  QT  syndrome  in  children XIAO Yan-yan，JIN Mei，HAN Ling 2016, 31(8): 582-585.  DOI: 10.7504/ek2016080607 Abstract ( )   Long QT syndrome（LQTS） is the first found genetic ion channel disease. LQTS patients can show various clinical types， from a lifetime of being asymptomatic to infantile sudden death， which can cause malignant ventricular arrhythmia， syncope， epileptic seizures， cardiac arrest and  sudden cardiac death. The genetics of LQTS pathogenesis is currently considered specific genetic mutations that can lead to abnormal procedure of depolarization and repolarization of cardiac muscle cell. At the molecular level， the pathogenesis of LQTS is the 15 different susceptible gene mutations of alpha and beta subunit that encoded ion channels. KCNQ1，KCNH2 and SCN5A mutations account for more than 90% of all mutations in patients with LQTS，and the remained 12 mutations account for only less than 10%. Precision medicine for LQTS mainly lies in the application of beta receptor blockers. Currently it’s believed that beta receptor blockers is better in the treatment of LQTS1 than in LQTS2 and LQTS3. Patients with LQT3 have low beta adrenergic receptor density， and attacks are mainly related to rest and slow heart rate. Sodium channel blockers are more often recommended in clinical treatment，such as mexiletine，fluorine carney，etc.

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Precision diagnosis and treatment of pediatric hypertension LI Xue-mei， YU Xian-yi 2016, 31(8): 585-589.  DOI: 10.7504/ek2016080608 Abstract ( )   Hypertension in children is common， and the prevalence of primary hypertension and number of children with obesity are  increasing with the changing dietary choices. The treatment mainly includes the non-drug treatment and the drug treatment. Dietary modification， such as the Dietary Approaches to Stop Hypertension（DASH） diet， weight control， and regular aerobic exercise are the cornerstones of therapy for primary hypertension. For symptomatic hypertension，or when diabetes mellitus or target organ damage appears drug treatment is necessary. Specific medication choice for hypertension management is determined by the underlying cause of hypertension and the comparative adverse effect profiles. Antihypertensive medication should be initiated at a starting dose and gradually increased to effective dose. If it’s ineffective at a maximum dose，an additional medication can be added.

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Long-term follow-up of POTS children treated with midodrine hydrochloride:  predictive significance of baseline erythrocytic hydrogen sulfide production level SUN Chu-fan*，LI Hong-xia，YANG Jin-yan，LI Xue-ying，WANG Yu-li，LIU Ping，FENG Xue-li，CHEN Yong-hong，JIN Hong-fang，DU Jun-bao 2016, 31(8): 590-593.  DOI: 10.7504/ek2016080609 Abstract ( )   Objective    To explore the value of baseline erythrocytic hydrogen sulfide production level in predicting the long-term survival of postural tachycardia syndrome（POTS） children treated with midodrine hydrochloride. Methods    Twenty-eight children（male 12，female 16） with POTS were included in the study，and all of them were diagnosed with POTS in Department of Pediatrics，Peking University First Hospital from 2009 to 2012. Their mean age was（11.5±2.5）years old. They were treated with midodrine hydrochloride. Twenty-eight children with POTS were divided into two groups according to the baseline erythrocytic hydrogen sulfide production level. GroupⅠconsisted of 10 POTS children whose erythrocytic hydrogen sulfide production level was less than or equal to 27.1 nmol/（min·108 erythrocytes），and group Ⅱ consisted of 18 POTS children whose erythrocytic hydrogen sulfide production level was higher than 27.1 nmol/（min·108 erythrocytes）. The mean follow-up time was（5.3±1.8）years. The orthostatic intolerance symptom score and the symptom-free survival were compared between the two groups by Kaplan-Meier curve. Results    After 5.5 years of follow-up，the symptom score of children in group Ⅰ was markedly higher than that of group Ⅱ（χ2=3.458，P＜0.05）. The symptom-free survival of group Ⅰ was lower than that of group Ⅱ （χ2=10.848，P＜0.05）. Conclusion    The baseline erythrocytic hydrogen sulfide production level is an useful indicator in predicting the long-term survival of POTS children treated with midodrine hydrochloride.

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Current situation of bone metabolism and bone mineral density changes in hemophilia children CHENG Xiao-ling*，HUO Ai-hua， PENG Yun，TANG Ling，WEI Yun-yun，ZHANG Ning-ning，WANG Yan，ZHEN Ying-zi，CHEN Zhen-ping，WU Run-hui，WANG Xiao-ling 2016, 31(8): 594-597.  DOI: 10.7504/ek2016080610 Abstract ( )   Objective    analyze the current status of bone metabolism and bone mineral density（BMD） in moderate/severe hemophilia children，to provide data for improving the life quality of Chinese children with hemophilia. Methods    Bone metabolism and BMD data were analyzed for 28 cases of moderate/severe hemophilia children diagnosed in Hemophilia Center of Beijing Children Hospital from October 2014 to February 2015. Results    （1）The median age of 28 cases of hemophilia children was 12.9（range 6 to 18 years） years old；hemophilia A 22 was in cases（78.6%），hemophilia B 6 cases（21.4%）； Severe hemophilia children was in 19 cases（67.9%），moderate hemophilia children 9 cases（32.1%）. The mean of BMD was （151.86±25.93） g/L，which was significantly lower than the normal children［（191.48±20.36） g/L］，P＜0.05. There was no relationship in Age，time of the first bleeding, as well as frequency of bleeding with BMD（P＞0.05）. But significant correlation was found between BMD and outdoor activities/school activities participation（P＝0.0002 and 0.0016）. Conclusion    BMD of hemophilia children without bone metabolic abnormalities is significantly lower than that of the normal children in China. Reducing joint bleeding and increasing the outdoor activities，rather than supplement calcium blindly will be the key point to improve the life quality of hemophilia children.

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Study on the self-consciousness and the related influencing factors of children with primary nocturnal enuresis LIU Xiao-mei， LIAO Ming-hui， ZHANG Ji-shui， ZHOU Wei-ran， SHEN Ying 2016, 31(8): 598-602.  DOI: 10.7504/ek20160806011 Abstract ( )   Objective    To investigate self-consciousness and its relevant factors in children with primary nocturnal enuresis（PNE）， to know the characteristics of children with PNE who may appear self-consciousness disorders， and to analyze the related influencing factors of self-consciousness disorders in those children who have primary nocturnal enuresis. Methods    In Beijing Children’s Hospital，Capital Medical University，a total of 158 children with primary nocturnal enuresis were recruited to the enuretic group from August 2011 to August 2014. Subjective questionnaire was used to collect the general information，get the medical history of enuresis. Piers-Harris Children’s Self-Concept Scale（PHCSS） was used to test the patients’ self-consciousness，and compare with the general norm data of healthy children so as to evaluate the  patients’ self-consciousness. Results    The detection rate of PNE children with low self-consciousness was significantly higher than the general norm data of healthy children. In children with PNE，the scores of behavior，intelligence and school situation，physical appearance and attributes and the total score in boys were much lower than girls，and boys had higher incidence of self-consciousness disorder than those of girls. All factor scores and the total score in the older group were much lower than those in the younger group. The factor score of happiness and satisfaction in PNE children of single parent family was lower than that in core family and large family. All factor scores and the total score in PNE children with poor family relationship were lower than those with harmonious family relationship. The factor scores of physical appearance and attributes，gregariousness，happiness and satisfaction and the total score in PNE children with moderate or poor family economic status were much lower than those with good family economic status. The worse the academic performance and peer relations，the lower the self-consciousness scale factor scores and total score of PNE children. Those results were statistically significant（P＜0.05）. Conclusion    PNE children have lower self awareness than healthy children. Pediatricians should treat enuresis actively and reduce the occurrence of self-consciousness dysfunction.

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Investigation and clinical analysis of norovirus and rotavirus infection in 942 children with acute diarrhea CUI Xiao-shuang， FENG Guo-shuang， JIN Fang， XU Xi-wei 2016, 31(8): 603-607.  DOI: 10.7504/ek20160806012 Abstract ( )   Objective    To explore the epidemiological features of NV and RV infection and to investigate the clinical features and prognosis of NV infection. Methods    Stool specimens（without pus，mucus or blood） were collected from children less than 3 years old with acute diarrhea within 7 days admitted from November 2012 to October 2013 in Beijing Children’s Hospital，Capital Medical University. Stool specimens were screened for NV and RV using immunochromatographic test（ICG）. History was investigated and the severity was evaluated by Vesikari scale. Follow-ups were conducted via phone calls. The epidemiological features， clinical manifestations and prognosis of children infected with NV were analyzed and compared with those infected with RV. Results    Among the total 942 samples，RV was detected in 329（34.9%） samples，while NV was detected in 137（14.5%） samples. Rate of co-infection was 9.7%（91/942）. The seasonal distribution of RV detection showed a peak of incidence from September to February the following year，but NV detection showed sporadic distribution. The times and duration of diarrhea and vomiting were similar in two kinds of infection，but fever，vomiting，severe diarrhea（with fatigue，sleepiness or lethargy） were significantly more common in RV infection（P＜0.05）. NV infection had a higher incidence of respiratory symptoms，such as cough and rhinorrhea. Mean Vesikari severity score was （8.98±2.94） in NV infection，remarkably lower than（10.45±3.04）in RV infection（P＜0.05）. Most patients recovered in＜7 days，but NV infection was likely to have longer duration. Conclusion    RV is still the leading cause of acute viral diarrhea，and NV is also a significant cause. NV infection occurs year-round，while RV infection shows a peak in autumn and winter. Fever，vomiting and severe diarrhea with dehydration are more common in RV infection. NV infection has a higher rate of respiratory symptoms and longer recovery period.

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Changes of vitamin D  level and bone mineral density in children with inflammatory bowel disease ZHOU Jin*，GUO Shu，HUO Ai-hua，YU Fei-hong，XU Xi-wei 2016, 31(8): 608-611.  DOI: 10.7504/ek20160806013 Abstract ( )   Objective    To explore features of the change of vitamin D level and bone mineral density in children with inflammatory bowel disease（IBD）. Methods    From January 2014 to September 2014，thirty-two children with IBD（study group） and thirty age and gender-matched healthy children（control group） were enrolled in the study. The children of study group and control group were tested for bone alkaline phosphate（BALP），bone gla protein（BGP） and 25（OH）D3 in blood serum by enzyme-linked immunosorbent assay（ELISA），and the clinical data such as calcium，phosphorus and albumin（ALB） in blood serum were collected. Results    There were 15 patients（9 males and 6 females） with ulcerative colitis（UC） and 17 patients（10 males and 7 females） with Crohn’s disease（CD） in the study group. There were 30 children（19 males and 11 females） in control group. The level of BGP（U＝332.5，P＝0.444） and BALP（U＝350，P＝0.637） in blood serum showed no significant difference between the study group and the control group. 25（OH）D3 concentration（t＝-2.876，P＝0.006），BMD（U＝39.5，P＜0.05） ，calcium（t＝-6.654，P＜0.05），phosphorus（U＝216.5，P＝0.007），and ALB （U＝25，P＜0.05） showed significant difference between the study group and the control group. In study group，25（OH）D3 concentration and BMD showed positive correlation（rs＝0.504，P＝0.005），while 25（OH）D3 and blood albumin levels showed negative correlation（rs＝-0.315，P＝0.019）. There was significant difference between UC/CD group and control group in Z score of BMD（U＝29.5，P＜0.05；U＝10，P＜0.05），but no statistical difference between UC and CD patients in Z score of BMD （P＝0.10）. Conclusion    Most child patients with IBD have insufficient or lack of vitamin D and are more likely to have reduced bone mineral density.

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Analysis of the relationship between pregnancy dyslipidemia and fetal congenital heart disease BA Hong-jun，WANG Hui-shen， ZHANG Xing， LI Shu-juan， ZHU Ling， LI Yun-quan， LIN Yue-se， LI Xuan-di 2016, 31(8): 612-614.  DOI: 10.7504/ek20160806014 Abstract ( )   Objective   To investigate the relationship between the presence of dyslipidemia in pregnant females and the risk of congenital heart defects（CHD）. Methods   A total of 54 pregnant females at 24 to 28 weeks（w） of gestation admitted between March 2013 and June 2014 in Department of Pediatric Cardiology，First Affiliated Hospital of SUN Yat-sen University were enrolled in the study . The case group included 18 females who had a fetus with cardiac defects，and each case was matched with 2 controls with no pregnancy complications. The mean ages were 29.06（SD=3.11） years and 29.03（SD=3.9） years in the case and control groups，respectively. The main outcome measurements were total cholesterol（TC），triglycerides（TG），low-density lipoprotein cholesterol（LDL-c），high-density lipoprotein cholesterol（HDL-c），apolipoprotein and homocysteine. Results   Patients in the case group had a significantly higher mean LDL-c（4.15 mmol/L vs. 3.45 mmol/L） and apolipoprotein B （2.23 g/L vs. 1.78 g/L）（all P＜0.05） than those in the control group. Correlation analysis indicated that LDL-C（r=0.32，P=0.017），apolipoprotein B（r=0.33，P=0.016） and homocysteine（r=0.34，P=0.011） were associated with fetal congenital heart disease.Conclusion    Serum LDL-cholesterol and apolipoprotein B levels in the case group are significantly higher than those in the control group. Pregnancy dyslipidemia may be associated with a higher incidence rate of CHD.

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Analysis on the correlation of heart rate variability parameters with troponin Ⅰ and N-terminal pro-B-type natriuretic peptide in children with Kawasaki disease ZHONG Yu-qiang 2016, 31(8): 615-618.  DOI: 10.7504/ek20160806015 Abstract ( )   Objective   To analyze the correlation of heart rate variability（HRV） parameters with troponinⅠ（cTnⅠ） and N-terminal pro-B-type natriuretic peptide（NT-proBNP） in children with Kawasaki disease（KD）. Methods   According to presence or absence of coronary artery lesion（CAL），the enrolled 118 children with KD as KD group were divided into CAL group（n＝43） and non-CAL（NCAL） group（n＝75）. Meanwhile，32 children without cardiovascular disease in convalescent period and 106 healthy children at the same term were respectively selected as non-KD group and control group. Long-term HRV parameters were detected in each group，and levels of cTnⅠ and NT-proBNP were detected in KD group and non-KD group. Results   HRV parameters in KD group were all higher during recovery phase than those during acute phase，except for LF/HF value lower than that during acute phase （P＜0.05 or P＜0.01）. HRV parameters in KD group were all lower than those in control group，except for LF/HF value higher than that in control group （P＜0.05 or P＜0.01）. Each index in time domain of HRV and high frequency （HF），low frequency （LF） and very low frequency （VLF） in CAL group were all lower than those in control group and non-KD group （P＜0.05 or P＜0.01），and SDANN，SDNN and PNN50 were also lower than those in NCAL group （P＜0.01）. Besides，the LF/HF value in CAL group was higher than that in control group，non-KD group and NCAL group （P＜0.05 or P＜0.01）. The levels of cTnⅠ and NT-proBNP in CAL group and NCAL group were significantly higher than those in non-KD group，in which the level of cTnⅠ in CAL group was also higher than that in NCAL group （P＜0.01）. The level of cTnⅠ was negatively correlated with SDNN and HF in children with KD，while positively correlated with LF/HF value （P＜0.01）. The level of NT-proBNP had a significantly negative correlation with SDANN，SDNN and HF （P＜0.01）. Conclusion   The heart autonomic nervous function is damaged in children with KD. HRV parameters have a certain clinical value for assessment of CAL in children with KD.

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Systemic lupus erythematosus complicated by macrophage activation syndrome： clinical analysis of 3 cases CUI Wan-lin，ZHANG Qian-zhong，ZHANG Yan，et al 2016, 31(8): 619-621.  DOI: 10.7504/ek20160806016 Abstract ( )

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Application of warfarin （an anticoagulant） in the precision treatment of cardiovascular diseases in children ZHANG Qing-you 2016, 31(8): 622-624.  DOI: 10.7504/ek20160806017 Abstract ( )

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Significance of biomarkers in the clinical diagnosis and treatment of cardiovascular diseases in children TIAN Jie，SUN Hui-chao 2016, 31(8): 625-628.  DOI: 10.7504/ek20160806018 Abstract ( )

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Treatment progress in inflammatory cardiomyopathy in children GUO Xiao-min，DU Jun-bao 2016, 31(8): 629-632.  DOI: 10.7504/ek20160806019 Abstract ( )

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Relationship between Helicobacter pylori infection and gastrointestinal flora in children ZHANG Qing-qing，YU Yi，XU Chun-di 2016, 31(8): 633-636.  DOI: 10.7504/ek20160806020 Abstract ( )

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One case report of catecholaminergic polymorphic ventricular tachycardia induced by treadmill exercise testing in children YANG Gui-ming，JIANG Rong，ZHAO Sheng，et al 2016, 31(8): 637-638.  DOI: 10.7504/ek20160806021 Abstract ( )

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One case of Menetrier disease with edema as the first onset symptom ZHANG Xiao-ge, CHEN Guo-qiang, LI Zhi-juan, et al 2016, 31(8): 639-640.  DOI: 10.7504/ek20160806022 Abstract ( )