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06 August 2018, Volume 33 Issue 8 Previous Issue    Next Issue

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Expert consensus on the application of L-carnitine to treating epilepsy in children（2018） 2018, 33(8): 561-565.  DOI: 10.19538/j.ek2018080601 Abstract ( )

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Focusing on pediatric critical care rehabilitation and rehabilitation evaluation 2018, 33(8): 566-569.  DOI: 10.19538/j.ek2018080602 Abstract ( )   With the rapid development of pediatric critical care medicine in recent years，the mortality of children in intensive care unit（ICU） has decreased significantly. A large proportion of surviving patients still have physical dysfunctions several years after discharge. The functional status and quality of life of these patients begin to become focus problems，and pediatric critical care rehabilitation，a new interdisciplinary field，has attracted people’s attention. Rehabilitation evaluation runs throughout the medical activities of pediatric critical care rehabilitation. Because the related work began late with weak foundation in our country，it hasn’t been done in many hospitals yet. Therefore，it is urgent to realize the importance of rehabilitation evaluation and to improve the pediatric critical care rehabilitation and rehabilitation evaluation.

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Rehabilitation technique for critical children 2018, 33(8): 570-573.  DOI: 10.19538/j.ek2018080603 Abstract ( )   Critical rehabilitation in children can prevent secondary damage，stimulate recovery potential and improve long-term function. The utilization of rehabilitation technique in critical children needs evaluating state of illness and functional disabilities as well as ensuring security. The objective of this article is to summarize the current evidence regarding rehabilitation technique in the critical children，including consciousness promoted rehabilitation，electrical stimulation，passive and active range of motion，positioning，strength training，swallowing therapy and so on. Early rehabilitation plays an important role in prognosis of critically ill children. The article introduces the technique，timing and application of critical rehabilitation，so as to guide the clinical practice.

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Contents and modes of the neonatal intensive rehabilitation ZHANG Hai-qing*，CHEN Yan-ni 2018, 33(8): 574-578.  DOI: 10.19538/j.ek2018080604 Abstract ( )   The improvement of neonatal intensive care unit equipment has rapidly increased the survival rate of critically ill newborns，but the incidence of related diseases has also increased. Premature birth is the most important cause of disease and infant mortality now. The newborn brain has strong plasticity and rapid development，which is the best time for early intervention and rehabilitation. Evaluation of neurological and sensorimotor aims to make plans for early intervention and rehabilitation，which contributes to improving the myelinated nerve fibers and establishing the development of benign circulation of cerebral cortex. It is conducive to the development in children’s sports，intelligence，language and audio-visual acuity. The parents’ participation and team work are very important to the prognosis and neurodevelopment of critical neonates.

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Rehabilitation in children with respiratory critical diseases HOU Mei，SUN Dian-rong，JIN Guo-sheng 2018, 33(8): 578-583.  DOI: 10.19538/j.ek2018080605 Abstract ( )   Respiratory critical disease is common in ICU. Airway obstruction，inspiratory muscle weakness and decreased coughing ability can aggravate the basic pathological injury and increase the risk of death. Survivors with post-intensive care syndrome（PICS） not only affects dysfunction，and lead to a difficult participation in school and social activities as well as lower quality of life. ICU Practice guidelines of the early mobilization and physical therapy management advice can significantly reduce the mortality rate，promote disease recovery，reduce the ICU and total length of hospital stay，and prevent and reduce the PICS，which improves the quality of life. Various respiratory critical rehabilitation techniques in adults has developed rapidly，but it is limited in pediatric clinical research and experience. Pediatric ICU workers，children and family members need to change ideas and improve the awareness of early rehabilitation. It’s importent to explore the safe and effective optimization rehabilitation plan suitable for pediatric respiratory critical diseases.

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Rehabilitation of severe cardiovascular disease in children ZHU Deng-na，LI Lin-chen，XIA Bing 2018, 33(8): 583-585.  DOI: 10.19538/j.ek2018080606 Abstract ( )   Rehabilitation of cardiovascular disease in children is an important part of the pediatric severe rehabilitation，and rehabilitation of heart failure and postoperative congenital heart disease are main content of the rehabilitation of children’s cardiovascular disease. Most developed countries have established a professional team consisting of physicians and rehabilitation physicians for rehabilitation of cardiaovascular disease，and have accumulated rich experience. At present，our country has just started. The article briefly describes the assessment，rehabilitation，and prognosis of the severe case rehabilitation in children with cardiovascular diseases，and hopes to provide references for the rehabilitation and development of children with cardiovascular diseases in China.

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Children’s rehabilitation in intensive disease of the nervous system RUAN Wen-cong，LI Hai-feng 2018, 33(8): 586-588.  DOI: 10.19538/j.ek2018080607 Abstract ( )   The range of children’s diseases of the nervous system is very mide. Since some of these lead to perceptual disorder，dyskinesia and social adaptation disorder，which severely affect children’s return to the society and daily life. Hence，more and more experts have realized the importance of rehabilitation in nervous system disease. Rehabilitation treatment is also regarded as a necessary item，according to the latest CPGs（Clinical practice Guidelines） both at home and abroad. Children’s rehabilitation in nervous system should follow the principles below： firstly，follow the principles of pediatric neurodevelopment；secondly，make early detection and early rectification；thirdly，perform multidisciplinary cooperation；fourthly，make the individualized treatment programs guided by functions.

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Postoperative rehabilitation of hydrocephalus and brain trauma in children ZHU Deng-na，YANG Yong-hui，YANG Lei 2018, 33(8): 589-592.  DOI: 10.19538/j.ek2018080608 Abstract ( )   Children with postoperative hydrocephalus and brain trauma are often left with varying degrees of neurological dysfunction，and the comprehensive rehabilitation therapy for children with postoperative hydrocephalus and brain trauma plays an important role in the field of children’s severe rehabilitation medicine. Accurate rehabilitation assessment and early rehabilitation intervention are closely related to the prognosis of children with postoperative hydrocephalus and brain trauma. The article will briefly introduce the rehabilitation evaluation，timing of rehabilitation intervention，rehabilitation treatment for the children with postoperative hydrocephalus and brain trauma and the methods for promoting wakefulness in children with consciousness disorder ，so as to help the doctors to correctly evaluate and treat the children with postoperative hydrocephalus and brain trauma.

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Rehabilitation of unintentional injuries and acute poisoning in children CAO Jian-guo，YANG Xue 2018, 33(8): 592-595.  DOI: 10.19538/j.ek2018080609 Abstract ( )   Unintentional injuries and acute poisoning are leading causes of disability and morality in children.The main type of unintentional injuries in children include falls，traffic accident，foreign body injury，drowning and acute poisoning. Severe patients often suffer from acute hypoxic-ischemic brain damage，which causes a series of neurological deficits，such as disorders of consciousness，physical and cognitive deficits，and dysphagia. Early rehabilitation is benefical for minimizing sequelae of the primary injury，preventing secondary injury and complications，promoting rapid rehabilitation and maximizing positive outcomes. The manegement of consciousness disturbance and various neurological dysfunction is the most important in early rehabilitation.

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Postoperative rehabilitation of scoliosis orthopedic surgery in children DU Qing 2018, 33(8): 595-598.  DOI: 10.19538/j.ek2018080610 Abstract ( )   Scoliosis orthopedic surgery is one of the most important problems in pediatric orthopedic surgery，and there is a high risk of nerve injury during surgery as well as trunk imbalance after scoliosis correction. Postoperative rehabilitation treatment is important for the functional recovery of children with scoliosis orthopedic surgery. The article describes and summarizes the development of postoperative rehabilitation of scoliosis orthopedic surgery in recent years，aiming to provide reference for the reasonable formulation and implementation of such children’s rehabilitation program.

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Rehabilitation of children with multiple injuries HU Ji-hong，GUO Chun-guang 2018, 33(8): 598-601.  DOI: 10.19538/j.ek2018080611 Abstract ( )   With the development of society，spectrum of children’s disease is changing，and children with severe trauma are increasing year by year. Multidisciplinary cooperation is often needed for the treatment of multiple trauma. The work of rehabilitation doctors and therapists in the process of  polytrauma disposal is how to reduce the complications and promote the functional recovery and shorten the course of the disease. Rehabilitation assessment helps to fully understand the level of disease severity and dysfunction in children with multiple trauma. When to start and how to do the rehabilitation intervention are common problems faced by rehabilitation doctors and therapists.

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Nutrition support therapy for children with multiple organ dysfunction syndrome LIU Yun，ZHOU Lin 2018, 33(8): 602-605.  DOI: 10.19538/j.ek2018080612 Abstract ( )   Multiple organ dysfunction syndrome is one of the common pediatric critical illnesses. Due to the metabolic characteristics of MODS：the body which is in metabolic disorders and nutrients utilization disorders needs timely nutritional supplement，and the body cannot effectively use nutrients and excrete metabolites due to organ dysfunction，it is particularly important to provide reasonable nutritional support treatment to patients with MODS. Knowing about the characteristics of metabolism in patients with MODS，using nutrition screening tools to assess nutrition status，and according to the measured energy consumption，developing a reasonable nutrition support scheme are very meaningful to children with MODS.

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Influence of long-term inhalation of corticosteroids at low dose on the height of Chinese children with mild to moderate asthma 2018, 33(8): 606-617.  DOI: 10.19538/j.ek2018080613 Abstract ( )   Objective　To investigate the effects of long-term inhalation of corticosteroids at low dose on the height of  Chinese children with mild to moderate asthma. Methods　From August 2015 to July 2016，a total of 966 prepubertal children aged 3.0 to 9.5 years from the Cooperative Group of Asthma，the Subspecialty Group of Respiration，the Society of Pediatrics，Chinese Medical Association were enrolled for the analysis of the cross-sectional questionnaire survey，in which 173 were asthmatic children who had received at least 12-month ICS treatment at low dose and stopped the ICS treatment at least 6 months before enrollment，415 were asthmatic children who had received any ICS treatment for no more than 2 months in a year or who didn’t receive ICS treatment，and 378 were healthy controls. The analysis of variance（ANOVA） test was used to compare height standard deviation score（SDS）and height velocity among these three groups. The t test was used to analyze changes of height indicators across time in the long-term ICS treatment group. Results　No difference was found in the height SDS and weight SDS at enrollment，or in the height SDS and weight SDS one year before enrollment，or in growth velocity and weight velocity among these three groups. In the long-term ICS treatment group，the height SDS slightly decreased at withdrawal of ICS treatment（-0.62±2.75） compared to that at the start of ICS treatment（-0.23±1.71） and one year before enrollment（-0.20±2.91），but significantly increased after at least six months of withdrawal of ICS（enrollment）（0.15±1.39）. The height SDS after five years of treatment with ICS was -0.95±1.41，which was significantly reduced compared to the height SDS after one to three years of treatment（0.17±1.40，P＝0.020） or three to five years of treatment（0.32±1.27，P＝0.013）. Conclusion　Long-term treatment（＜five years） with ICS at low dose is not associated with height reduction in prepubertal children with mild to moderate asthma.

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Zero-fluoroscopy radiofrequency catheter ablation for pediatric atrioventricular nodal reentrant tachycardia guided by three-dimensional mapping CUI Lang，YUAN Yue，LIN Li，et al 2018, 33(8): 618-621.  DOI: 10.19538/j.ek2018080614 Abstract ( )   Objective　To explore the feasibility of zero-fluoroscopy radiofrequency catheter ablation（RFCA） for pediatric atrioventricular nodal reentrant tachycardia（AVNRT） using three-dimensional mapping compared with conventional mapping. Methods　We randomly selected 100 patients with AVNRT who received RFCA in Beijing Children’s Hospital from January 2010 to January 2018，50 patients used three-dimensional mapping for Zero-fluoroscopy RFCA（EnSite Velocity™ Cardiac Mapping System）（group A） and 50 patients used conventional mapping（group B）. Comparisons of RFCA success rate，complication rate，recurrence rate，and total fluoroscopy dose between group A and group B were made. Results　Success rate，complication rate，recurrence rate and total procedure time were not significantly different between the two methods. Total fluoroscopy dose was significantly reduced in group A compared with group B［0 mGy vs. （75.68±18.02） mGy，P＜0.001）］. Conclusion　Compared with conventional mapping，using EnSite Velocity™ Cardiac three-dimensional mapping in RFCA for pediatric AVNRT can complete zero-fluoroscopy dose with similar success rate and safety.

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Acute poisoning in children：A clinical analysis of 521 cases ZHANG Han-hua，FANG Ying，REN Xiao-xia，et al 2018, 33(8): 622-625.  DOI: 10.19538/j.ek2018080615 Abstract ( )   Objective　To explore the clinical features of acute poisoning in children to search for effective preventive measures. Methods　A total of 521 cases of acute poisoning in Xi’an Children’s Hospital from January 2012 to January 2017 were collected and all clinical data were retrospectively analyzed. Results　Among the 521 cases of acute poisoning，291 cases（55.9%） were boys，and 230 were girls（44.1%）. Acute poisoning occured in all ages of children and  children in infancy period and pre-school period were more susceptible（257 cases and 147 cases）； poisoning occured mostly at home（508 cases， accounting for 97.5%）， and in the countryside（431cases， 82.7%）； the most common season was summer（187cases，35.9%）. The intoxication from digestive tract was the most common in all intoxicated pathways （492 cases，94.4%）. After timely and reasonable treatment，most children had a good prognosis. Conclusion　Acute poisoning is most common in infants and preschool children. The majority of the patients are from rural areas. The most common season is summer. The most common intoxication is digestive tract.

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Efficacy and safety of carnitine for epileptic children using valproic acid：An evidence-based evaluation HUANG Zong-yao*，LUO Rong，ZHANG Chuan，et al 2018, 33(8): 626-632.  DOI: 10.19538/j.ek2018080616 Abstract ( )   Objective　To systematically review the effectiveness and safety of carnitine for patients with epilepsy using valproic acid（VPA）. Methods　The clinical trials about carnitine for patients with epilepsy using VPA were searched in PubMed，Cochrane Library，EMbase，CBM，CNKI，Wanfang Data and VIP from the date of their establishment to March 2017.Literature screening and methodological quality assessment were completed by two reviewers independently. Meta-analysis was conducted using RevMan 5.3 software. Results　A total of ten trials involving 206 patients were finally enrolled. The results of meta-analysis indicated that：（1）the carnitine for epileptic children who were intoxicated with VPA could decrease concentration of ALT and AST［ALT：MD＝-63.97，95%CI（-64.98，-62.96），P＜0.00001；AST：MD＝-55.14，95%CI（-56.52，-53.76），P＜0.00001］ .（2）Carnitine for epileptic children who had high risk factors of liver injury using VPA could decrease concentration of ALT and AST［ALT：MD＝-12.53，95%CI（-15.32，-9.75），P＜0.00001；AST：MD＝-19.45，95%CI（-36.50，-2.40），P＝0.03］. Conclusion　Current evidence suggests that carnitine improves the liver function indicators with fewer adverse reactions and decreases concentration of ammonia，and improves the life quality of patients. However，due to the limited quantity and quality of the included studies，more multicenter high quality RCTs with large sample size are needed to verify the above conclusion.

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Clinical analysis of 30 children with Alport syndrome by gene diagnosis ZHAO Ying-ling，YU Li，ZHANG Yao，et al 2018, 33(8): 633-637.  DOI: 10.19538/j.ek2018080617 Abstract ( )   Objective　To investigate the clinical significance of the clinical phenotype and gene mutation detection in children with Alport syndrome. Methods　The data of 30 children with gene mutation admitted to Guangzhou First People’s Hospital，Guangzhou Medical University from January 2013 to June 2017 were retrospectively analyzed. Collect peripheral blood samples from children and their family members .Then use gene sequencing exon sequence capture technology to find out whether there was mutation gene，including Ⅳ type collagen alpha 3 chain（COL4A3），alpha 4 chain（COL4A4） or alpha 5 chain（COL4A5）. Gene mutations of related family members were identified by Sanger method. Results　The 30 children with AS were diagnosed by gene detection. Renal biopsy was performed in 18 cases（60.00%） of 30 children with AS，and the results of light microscopy were various. Electron microscopic examination revealed diffuse thinning，thickening and delamination of the glomerular basement membrane（GBM） in 5 cases（16.67%）. The electron microscopic examination showed thin basement membrane disease in 4 cases（13.33%）. Three cases（10.00%） of immunofluorescence showed type Ⅳ collagen alpha 3，alpha 5 chain negative in renal tissue. Totally 22 cases were diagnosed with X linkage dominant hereditary Alport syndrome（XL-AS） by gene text，and 8 new mutation sites of COL4A5 were found. Genetic diagnosis showed 8 children were autosomal recessive inheritance，and 3 new COL4A4 mutations were found. Conclusion　The clinical manifestations of children with Alport syndrome are diverse and lack of specificity，and the pathological types of renal tissue are different. It is difficult to diagnose early. Gene detection helps to early diagnose of AS，to judge the prognosis of the children，and to avoid unnecessary drug treatment.

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Clinical analysis of marginal vitamin A deficiency in the neonates GUO Qin，XU Hao，ZHANG Dong-jia 2018, 33(8): 638-641.  DOI: 10.19538/j.ek2018080618 Abstract ( )

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Analysis of the nutritional problems related to the high incidence rate of extrauterine growth restriction in the very low birth weight infants HU Fang-wen，TANG Qing-ya 2018, 33(8): 642-647.  DOI: 10.19538/j.ek2018080619 Abstract ( )

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Research progress in the executive function of epileptic children ZHANG Han-zi，CHENG Da-zhi，CHEN Qian 2018, 33(8): 648-651.  DOI: 10.19538/j.ek2018080620 Abstract ( )

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Clostridium difficile enteritis in children：A report of 1 case YANG Hong-bin，FANG Ying，REN Xiao-xia，et al 2018, 33(8): 652-653.  DOI: 10.19538/j.ek2018080621 Abstract ( )

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Ataxia-telangiectasia combined with malignant T-cell lymphoma in children：A report of 1 case XING Qian-lu，TIAN Mao-qiang，PENG Long-ying，et al 2018, 33(8): 654-656.  DOI: 10.19538/j.ek2018080622 Abstract ( )