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06 September 2017, Volume 32 Issue 9 Previous Issue    Next Issue

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Interpretation of the 2017 edition of Diagnosis，Treatment，and Long-term Management of Kawasaki Disease：A Scientific Statement for Health Professionals from the American Heart Association LIN Yao*，LI Xiao-hui，SHI Lin，et al 2017, 32(9): 641-648.  DOI: 10.19538/j.ek2017090601 Abstract ( )   Kawasaki disease（KD） is an acute vasculitis of childhood，which is the leading cause of acquired heart disease in children in developed countries. Its annual incidence has been increasing year by year. The 2017 edition of Diagnosis，Treatment，and Long-term Management of Kawasaki Disease：A Scientific Statement for Health Professionals from the American Heart Association has identified new evidence of pathological processes. The diagnosis of KD is based on the non-specific clinical pictures. Evaluation of suspected incomplete KD is simplified. Patients believed to be at high risk for IVIG-resistance and development of coronary artery aneurysms may benefit from an improved primary adjunctive therapy. Z value is used to evaluate and classify the coronary artery complications of KD. The long-term management of KD becomes more standardized.

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Paying attention to the bone diseases related to metabolic disorder of calcium and phosphorus and genetic bone diseases LIANG Yan，LUO Xiao-ping 2017, 32(9): 649-654.  DOI: 10.19538/j.ek2017090602 Abstract ( )   Childhood and adolescence are key periods for bone development and mineralization. Bone diseases in childhood and adolescence can result in skeleton deformities, decreased adult height and changed peak bone mass. It would be very important to early diagnose and treat bone diseases in childhood and adolescence. According to the clinical manifestation, laboratory examinations and X-ray, bone diseases can be classified as metabolic bone disorders of calcium and phosphate, and genetic bone diseases. The pathogenesis, clinical manifestations, biochemical and radiological features of bone disease in childhood and adolescence were summarized. Progress in radiological examinations and treatment of these diseases were reviewed.

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Use and safety of bisphosphonates in pediatric osteoporosis ZHANG Hui-wen，JIANG Wen-jun 2017, 32(9): 655-659.  DOI: 10.19538/j.ek2017090603 Abstract ( )   Bisphosphonates are one of classical drugs in orthopaedics department used for prevention of bone resorption in adulthood. In recent years，bisphosphonates have been increasingly used in pediatric patients for the treatment of osteoporosis，and studies have shown the safety and effective result of BPs in increasing bone density and reduce the rate of fracture. However，considering adverse reactions of BPs in adult patients，the potential consequences in children still should be monitored. The current well-defined criteria for the use of BPs in pediatrics are still not clear，and the children will still need to be closely followed up. This review focused on the latest advances of bisphosphonate treatment in pediatric patients，introducing some of the clinical general measures and recommendations that have been reported，and discussing the common and potential adverse effects.

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Clinical application of markers of bone metabolism in children WANG Fei，LI Pin 2017, 32(9): 660-664.  DOI: 10.19538/j.ek2017090604 Abstract ( )   The skeletal features of children are longitudinal growth and faster conversion of bone. Bone metabolism markers can sensitively reflect early bone metabolism status，which is useful in assessing growth situation，understanding the pathophysiology of metabolic bone disease and monitoring treatment. The different stages of age，race，sex，puberty，hormone regulation，nutritional status，diurnal changes and metabolic bone diseases can all affect the determination of bone metabolism markers in children and the establishment of the normal reference values. In this review，we will review the advances in bone formation and bone resorption markers and their applications in pediatric clinical practice.

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Inborn errors of metabolisms characterized by bone diseases HUANG Yong-lan 2017, 32(9): 664-669.  DOI: 10.19538/j.ek2017090605 Abstract ( )   Inborn errors of metabolism（IEM） are rare conditions that represent more than 750 diseases. Most are inherited as an autosomal recessive trait. In this article we document the IEM characterized by bone metabolism disorders in children，focusing on more common and treatable conditions，such as richets，osteomalacia，osteoporosis and osteopetrosis. Most of these conditions involve metabolic disorders of calcium，phosphate，vitamin D，PTH，alkaline phosphatase and lysosomal.

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Progress in the diagnosis and treatment of hypophosphatemic vitamin D resistant rickets ZHANG Cai，LUO Xiao-ping 2017, 32(9): 669-673.  DOI: 10.19538/j.ek2017090606 Abstract ( )   Hypophosphatemic Vitamin D resistant rickets is a group of metabolic bone diseases characterized by increase renal excretion of phosphate and hypophosphatemia. Regulation of phosphate homeostasis includes a complicated feedback network，in which parathyroid hormone（PTH），fibroblast growth factor-23（FGF23） and 1，25-（OH）D3 are key regulatory factors. With the understanding of phosphate regulation and the pathogenesis of this disease，progresses have been made in the diagnosis and treatment in hypophosphatemic rickets recently. In this review，based on the mechanisms of phosphate regulation，we explain the pathogenesis and clinical manifestations of hypophosphatemic rickets，and summarize up-to-date diagnostic and therapeutic approaches.

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Vitamin D deficiency and endocrine diseases in children　　 CHEN Rui-min，YUAN Xin 2017, 32(9): 673-679.  DOI: 10.19538/j.ek2017090607 Abstract ( )   Vitamin D is one of the most important nutrients to maintain human health. Recent studies have found that vitamin D is not only involved in the calcium and phosphorus metabolism，but also，through antioxidant stress，regulates cell proliferation and differentiation，apoptosis，and through other non-classical pathways or alternative ways，participates in the metabolism and immune regulation，and is closely related to endocrine，autoimmune and tumors. This article reviews the relationship between vitamin D and endocrine diseases including obesity，diabetes，growth hormone/nsulin-like growth factor-1，thyroid disease，adrenal disease and hyperparathyroidism.

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Diagnostic strategies of hypercalcemia in children WANG Chun-lin， LIANG Li 2017, 32(9): 679-682.  DOI: 10.19538/j.ek2017090608 Abstract ( )   Hypercalcemia in children has often been in lack of specific clinical symptoms and is not easy to be found. PTH dependent hypercalcemia and non-PTH dependent hypercalcemia is classified based on the serum parathyroid hormone（PTH） level in hypercalcemia children. Primary hyperparathyroidism is the main cause of PTH dependent hypercalcemia in children. Etiology of hypercalcemia in children is complicated，and in the newborn and infants it’s mainly iatrogenic and common genetic factors；children and adolescents，the primary hyperparathyroidism is the main factor. Clinical diagnosis can be made according to symptoms/ signs，serum PTH，parathyroid hormone-related proteins，vitamin D metabolites and other laboratory indexes.

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Diagnosis  and  treatment  of  osteoporosis  in  children XIONG Feng 2017, 32(9): 682-686.  DOI: 10.19538/j.ek2017090609 Abstract ( )   Osteoporosis in children is one group of bone diseases caused by multifactors，including primary and secondary osteoporosis. Along with the improvement of treatment and the more survival of chronic diseases，the secondary osteoporosis have being a seriously harmful bone disorders for children’s health. Because of the concealing and nonspecific manifestations of osteoporosis in children，osteoporosis is misdiagnosed frequently by pediatrician. At present，there are more recognition about the pathogenesis，clinical manifestations，diagnostic criteria，treatment and prevention of osteoporosis in children. therefore，pediatricians，parents and the society should pay more attention to children’s osteoporosis and improve the diagnosis，treatment and prevention.

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Clinical characteristics and outcome of adolescent patients with acute lymphoblastic leukemia YU Jiao-le，WU Min-yuan，ZHANG Rui-dong，et al 2017, 32(9): 687-692.  DOI: 10.19538/j.ek2017090610 Abstract ( )   Objective　To summarize the clinical characteristics and outcome of adolescent patients with acute lymphoblastic leukemia（ALL） treated with Chinese Children’s Leukemia Group（CCLG）-2008 protocol over a 5-year period from 2008 to 2013. Methods　Clinical features，immunophenotypes，cytogenetic abnormalities and prognosis of adolescent patients aged 10 to 18 were compared with younger patients under 10 years old. Results　During 2008—2012，723 patients with ALL were enrolled in our study. About 14.11% of them were 10- to 18-year old patients. Compared to younger ones，adolescent patients demonstrated a higher incidence of T-cell lineage phenotype（14.71% vs 5.8%），t（9；22）（8.82% vs. 4.99%），t（1；19）（8.82% vs. 5.15%）， and significantly lower frequency of t（12；21）（21.74% vs. 8.82%）. In intermediate group， the 5-year overall survival rate（OS） and event-free survival rate（EFS） of adolescent patients was compatible with paediatric patients，（92.88% vs. 90.86%） and （77.09% vs. 82.9%），respectively. However，the EFS of adolescent patients with high-risk ALL was worse than paediatric patients（42.78% vs. 54.12%）. Conclusion　Despite the increased incidence of adverse prognostic factors，the survival rate of adolescent patients has been improved when treated with paediatric ALL protocol. However，the poor prognosis of adolescent patients in the high-risk group remains to be the current challenge.

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Association between polymorphisms of IL12RB1 and IL12RB2 genes and the susceptibility to tuberculosis in Chinese Han children GUO Yan*，LI Ying-jia，QI Hui，et al 2017, 32(9): 693-697.  DOI: 10.19538/j.ek2017090611 Abstract ( )   Objective　To explore the association between polymorphisms of IL12RB1 and IL12RB2 genes and the susceptibility to tuberculosis（TB） in Chinese Han children. Methods　A case-control study was performed in 362 Chinese Han pediatric TB patients admitted to Beijing Children’s Hospital between February 2005 and October 2011，and 400 healthy controls. MassARRAY was used for genotyping in 16 single nucleotide polymorphisms（SNPs） of IL12RB1 and IL12RB2 genes. Logistic regression was used to analyze differences of allele and genotype distributions of SNP polymorphisms between the two groups，and the multifactor dimensionality reduction（MDR） method was used for analyzing the association between the interactions of SNPs and susceptibility to TB. Results　No statistical difference was found in the allele，genotype and haplotype distributions of all SNPs in IL12RB1 and IL12RB2 genes between the two groups（P > 0.0036）. The MDR method results indicated that there was no association found between the interactions of all SNPs and susceptibility to TB（P > 0.0036）. Conclusion　No association is found between polymorphisms of IL12RB1 and IL12RB2 genes and susceptibility to TB in Chinese Han children.

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Study of mixed infections in hospitalized children with community-acquired pneumonia 2017, 32(9): 698-703.  DOI: 10.19538/j.ek2017090612 Abstract ( )   Objective　To study the mixed infections in hospitalized children with community-acquired pneumonia （CAP）. Methods　We retrospectively reviewed the medical records of CAP patients admitted to Children’s Hospital of Soochow University from January 2015 to December 2015. Samples were tested for multiple pathogens.Results　One or more pathogens was detected in 647（76.5%） of 846 cases；34.63％ cases were considered mixed infection. The rates of mixed infection in ＜6-month，＜1-year，＜3-year，＜5-year， ≥5-year group were 24.2%，43.5%，43.8%，36.8% and 27.3% respectively. The most frequent combinations of pathogens were those of virus plus bacteria in ＜6-month  and ＜1-year group，virus plus MP in ＜3-year and ≥ 5-year group， and MP plus bacteria in＜5-year group．Rhinovirus-H.influenzae was the most commonly found combination of virus and bacteria. The most frequent etiological agent in virus coinfected with MP was rhinovirus. S.pneumoniae was the most important pathogen for bacteria coinfected with MP. No significant difference in clinical characteristics，complications，PICU admission or hospital stay was observed between the patients with mixed infections and those with monomicrobial CAP. Conclusion　Mixed infections account for certain proportion in the cause of CAP. The positivive rate in patients in＜1-year and ＜3-year groups is significantly higher than that in other age groups. Patients of different ages present with different combinations of pathogens. Mixed infections have no relationship with CAP patients’ mortality.

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Sleep questionnaire scale in snoring children: Development and evaluation WU Yun-xiao*，XU Zhi-fei，FENG Guo-shuang，et al 2017, 32(9): 704-707.  DOI: 10.19538/j.ek2017090613 Abstract ( )   Objective　To work out sleep questionnaire scale which is suitable for investigating the sleep disorder status in snoring chilren in order to apply to clinical work. Methods　A total of 1017 children with over 2 months of snoring or mouth breathing aged 3 to 14 years were selected，and according to the scale formulation specifications，the item pool was formulated by combining with the theoretical knowledge of common sleep disorders in children and consulting a large number of literature. Then the primary scale was formed after the expert group modified or deleted some items. Forty items were selected as the final scale by using factor analysis method and then its reliability and validity was evaluated . Results    The sleep questionnaire scale in snoring children was composed of five dimensions，40 items. In the aspect of reliability，the total Cronbach；alpha coefficient of the scale was 0.7373. The Cronbach’α coefficient of other dimensions was 0.5789 in snoring symptoms at night，0.6769 in symptoms associated with sleep and related diseases，0.7983 in behavioral symptoms，0.6038 in daytime sleepiness symptoms and 0.8354 in others’ evaluation on childrens’ drowsiness，respectively. In the aspect of structure validity，confirmatory factor analysis showed that the standardized coefficient load in 60% of entries was greater than 0.4，which was acceptable. Conclusion    Sleep questionnaire scale in snoring children has good reliability and acceptable validity.

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Clinical study on the efficacy and safety of nebulized fluticasone propionate inhalation solution compared with oral prednisone in children with acute exacerbation of asthma ZHANG Han*， SHANG Yun-xiao， SHEN 2017, 32(9): 708-712.  DOI: 10.19538/j.ek2017090614 Abstract ( )   Objective    To investigate the efficacy and safety of fluticasone propionate（FP） inhalation solution compared with oral prednisone（PRE） in Chinese pediatric and adolescent subjects（aged 4 to 16 years） with an acute exacerbation of asthma. Methods    This was a randomized， double-blind， double-dummy， active-controlled， parallel-group， multi-center，non-inferiority study involving subjects（aged 4 to 16 years old，inclusive） with an acute exacerbation of asthma［to compare the morning Peak expiratory flow（AM PEF）. Oral PRE once daily 2 mg/（kg·d），up to 40 mg/d for 4 d，then 1 mg/（kg·d） or half of the original dose，up to 20 mg/d for 3 d） for 7 d. The study comprised a 7-d treatment period and a 14-d follow-up period］. Results    In terms of the primary efficacy endpoint mean AM PEF，the low limit of 95% CI was -9.64 L/min，which was above the pre-defined non-inferiority margin -12 L/min.  Conclusion　FP inhalation solution was shown to be non-inferior to oral PRE in the treatment of acute exacerbation of asthma in Chinese pediatric and adolescent patients. FP inhalation solution demonstrates good safety.

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Present situation of the research on the clinical prevention and treatment methods of iron-deficiency anemia in preterm infants WU Qing-qing，TANG Qing-ya 2017, 32(9): 713-716.  DOI: 10.19538/j.ek2017090615 Abstract ( )

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Parathyroid adenoma in children with not high blood calcium level：A report of 1 case GAO Ping，ZHU Jian-fang，WANG Chuan-kai，et al 2017, 32(9): 717-719.  DOI: 10.19538/j.ek2017090616 Abstract ( )