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06 August 2019, Volume 34 Issue 8 Previous Issue    Next Issue

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Scientific attention to intervention and all-round development of children with autism spectrum disorders CHEN Yan-ni*，XIAO Nong，ZHANG Yi-ran 2019, 34(8): 617-621.  DOI: 10.19538/j.ek2019080601 Abstract ( )   Autism spectrum disorder（ASD） is a developmental disorder disease，with social interaction and communication disorders，stereotyped behavior and narrow interest. As autism knowledge popularization，more and more autism was intervention，however，more concentrated the youth. Pediatricians should also pay attention to the intervention result and the other life stage.

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Research progress in mechanisms underlying autism spectrum disorders HUANG Guan-qun*， HAN Ding-ding，QIU Shen-feng，et al 2019, 34(8): 622-628.  DOI: 10.19538/j.ek2019080602 Abstract ( )   The autism spectrum disorders（ASDs） are a complex group of neuropsychiatric conditions defined by impairment in three core behavioral domains：social interaction，verbal and non-verbal communication，and restricted interests/repetitive behaviors. Extensive genetic studies have led to the identification of many autism susceptibility genes，and increased understanding on the contribution of de novo and inherited copy number variation. Here，we seek to place recent genetic findings within a developmental and brain circuit context， and approach the basic understanding of autism neuropathology from multiple genetic，molecular，cellular and neural circuit domains. The authors reviewed literatures that interrogates brain mechanisms of ASDs utilizing animal models，primarily in mice. Understanding genetic data within a brain development context will shed light on how individual risk genes operate to determine patient symptomatology，which will inform circuit specific behavioral interventions leading to better intervention and disease outcomes.

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Multidisciplinary research and intervention of autism spectrum disorder JING Jin，WANG Xin 2019, 34(8): 628-632.  DOI: 10.19538/j.ek2019080603 Abstract ( )   Autism spectrum disorder（ASD）is a set of heterogeneous neurodevelopmental conditions commonly with co-morbidity，which can lead to life-long disability and the etiology is still unclear. Individuals with ASD have impaired development of social interaction, cognition，language and adaptive behavior in children，adolescents and adults. Multidisciplinary collaboration in research and intervention is a trend to explore etiological mechanisms and clinical transformation from different levels；it is advocated that different professionals provide help for ASD patients and their family to support decision making in clinical diagnosis，education，health and social care.

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Issues related to language and social communication disorders in children with autism spectrum disorders DU Qing*，HE Hong-xiang 2019, 34(8): 632-637.  DOI: 10.19538/j.ek2019080604 Abstract ( )   Social communication disorders and language disorders are commonly found in children with autism spectrum disorders，and it is also one of the indicators for assessing the severity of the syndrome. This study analyzed the characteristics of language difficulties and social communication disorders in children with ASD. Then，seven evidence-based treatment methods of language rehabilitation for children with ASD were introduced，including Comprehensive Behavioral Treatment for Young Children，Pivotal Response Treatment，Natural Teaching Strategies，Language Training（Production），Scripting，Story-based Interventions and Social Skills Package. The interventions recommended by American Speech-Language-Hearing Association（ASHA） were also introduced. It is of great significance to provide the early intervention of language disorders for children with ASD. Community-based and family-based intervention models should be promoted，and parent training should be actively carried out，so that children with ASD can obtain language rehabilitation during the critical period of language learning.

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Behavior management of children with autism spectrum disorder LI Ling，ZENG Gang 2019, 34(8): 637-640.  DOI: 10.19538/j.ek2019080605 Abstract ( )   Autism spectrum disorder（ASD） is a neurodevelopmental disability that occurs in childhood，characterized by two core disabilities in social interaction and communication，and the presence of repetitive behavior and restricted interest. Thus，the intervention of ASD focuses on improving behavioral disturbances by effective behavior management. Applied behavior analysis（ABA） is a science，which has been applied to the intervention of ASD and has been proved to be evidence-based. In the behavior management of ASD，instructors should master the basic principle of behavior，and apply the evidence-based strategies and treatments to carry out the work under guidelines of theory.

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Emotional awareness and bullying prevention in children with autism spectrum disorder HOU Mei，YU Xiao-ming，LUO Guang-jin 2019, 34(8): 641-644.  DOI: 10.19538/j.ek2019080606 Abstract ( )   Emotional disorder is one of the main clinical symptoms of autism spectrum disorder（ASD），which is related to the lack of emotional awareness，social cognition and alexithymia. It is often manifested as difficulty in recognizing，distinguishing and processing emotional information of oneself and others，resulting in making inappropriate emotional reactions. Children and adolescents with ASD often participate in school bullying as the perpetrator，victim，or victim-perpetrator，and this brings about a series of negative physical and mental effects on them. Bullying prevention should not only include interventions for core symptoms and comorbidities of ASD，but also involve building partner empathy and social skills，teacher responsibility and supportive services，parental involvement，and social integration.

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Motor skill disorder of children with autism spectrum disorder QIU Hui-ying，XU Kai-shou 2019, 34(8): 645-648.  DOI: 10.19538/j.ek2019080607 Abstract ( )   Children with autism spectrum disorder（ASD） may suffer from motor skill dysfunction，and perform as motor delay，coordination disorder，fitness decline，visual-motor integration disorder and so on，which disturb their daily life，school-based activities，and other social activities. Due to the obvious core symptoms of children with ASD，the problem of motor skills may be ignored. Children with ASD should be monitored for the motor development at their early stage and be evaluated with proper assessment tools. Children with ASD should be trained with individualized plan according to their features in order to develop motor skills and improve the core symptoms. As evidence of motor intervention for children with ASD is increasing，we should pay more attention to the motor skill dysfunction problem in children with ASD and make them benefit from the motor intervention and sport program.

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Comorbidity and drug treatment of autism spectrum disorder CHE Yue-ping，DING Li，RUAN Wen-cong，et al 2019, 34(8): 648-652.  DOI: 10.19538/j.ek2019080608 Abstract ( )   Autism spectrum disorder（ASD） is a group of multi-factor brain development disorders. At present，ASD treatment is still based on behavioral intervention，for there are no specific drugs. ASD comorbidities are extremely common in children with ASD，and the presence of comorbidities has an important impact on the treatment and prognosis of ASD. In recent years，the etiology and behavioral intervention of ASD has become a research hotspot at home and abroad，but there are few studies on comorbidity and drug intervention. Therefore, we summarize relevant literatures at home and abroad, hoping to be helpful for clinical research on ASD comorbidity and drug treatment.

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Rehabilitation intervention modes for children with autism spectrum disorder CHEN Ying-jin*，CAO Jian-guo 2019, 34(8): 652-655.  DOI: 10.19538/j.ek2019080609 Abstract ( )   The purpose of the paper is to introduce the classification of intervention modes，and introduce some methods and their progress in China based on the evidence-based practice（EBP） and mixing methodologies.

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Retrospect and prospect of pediatric critical care medicine in China LI Jiu-jun，WEI Ke-lun，LIU Chun-feng 2019, 34(8): 656-659.  DOI: 10.19538/j.ek2019080610 Abstract ( )

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Distribution of vaccine-related genotypes and antimicrobial susceptibility among the Bordetella pertussis isolates LI Li-jun，YUAN Lin，JIA Ju，et al 2019, 34(8): 660-665.  DOI: 10.19538/j.ek2019080611 Abstract ( )   Objective　To summarize the clinical characteristics of children with pertussis and investigate the distribution of virulence-related genotypes and antimicrobial susceptibility among the Bordetella pertussis isolates. Methods　The clinical information of 224 culture-positive pertussis cases in Beijing Children’s Hospital，Capital Medical University from 2015 to 2016 was collected. Antimicrobial susceptibility was determined by E-test and Kirby-Bauer（KB） disk diffusion methods. A fragment of the 23S rDNA genes was detected for drug-resistance mutation and antigen genotypes. Results　The 224 culture-positive pertussis cases were from 14 provinces or municipalities. Among the 224 subjects，150 patients（67.0%） were younger than 6 months old and 176 patients（78.6%） were unvaccinated or not fully vaccinated individuals. The commonest virulence-associated genotype was ptxA1/ptxC1/ptxP1/prn1/fim2-1/fim3-1/tcfA2，with frequencies of 90.6%（203/224）. All erythromycin-resistant strains were determined A2047G mutation in 23S rDNA sequences，and the strains were the ptxP1 genotype（203/224）. Eighteen ptxP3 strains were identified in the present study and all ptxP3 strains were sensitive to erythromycin. All isolates were determined low MIC against sulphamethoxazole/trimethoprim（0.004-0.500 mg/L）. Conclusion　The culture-positive pertussis cases are mostly infants and young children unvaccinated or not-fully vaccinated. The isolates genotyped as ptxA1/ptxC1/ptxP1/prn1/fim2-1/fim3-1/tcfA2 are widespread，which are highly resistant to erythromycin. The high-virulent strains harboring ptxP3 are rare，and are sensitive to erythromycin. Sulphamethoxazole/trimethoprim is effective to treat pertussis caused by erythromycin-resistant isolates.

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Spinal muscular atrophy complicated with pulmonary infection：A clinical analysis of 36 children ZHANG Jie-jing，LYU Fang-fang，WEN Shun-hang，et al 2019, 34(8): 666-669.  DOI: 10.19538/j.ek2019080612 Abstract ( )   Objective　To summarize the clinical features of spinal muscular atrophy complicated with pulmonary infection in children，and to improve clinicians’ understanding of the disease and improve the prognosis. Methods　The clinical data of 36 children with SMA complicated with pulmonary infection，who were admitted to Yuying Children’s Hospital of the Second Affiliated Hospital of Wenzhou Medical University from January 1，2008 to December 31，2017，were retrospectively analyzed. Results　Among of the 36 patients，19 were typeⅠ，9 were typeⅡ，and 8 were typeⅢ. The common clinical manifestations and signs were fever，cough，shortness of breath，laborious breathing，three-concave signs，and crackles in the lungs. Respiratory failure occurred in 11 children，including 7 children（63.6%） with typeⅠ SMA，2 children（18.2%） with typeⅡ SMA and 2 children（18.2%） with typeⅢ SMA. Imaging findings showed 5 cases of scoliosis，3 cases being typeⅡ SMA，and 2 being typeⅢ SMA. Pathogenic tests were positive in 18 children：10 cases（55.5%） of type Ⅰ SMA，4 cases（22.2%） of typeⅡ SMA，4 cases（22.2%） of typeⅢ SMA；nosocomial mixed infection with conditioned pathogens was common，among which Burkholderia cepacia was the most common. Three patients died in the hospital，22 patients improved and discharged，and the remaining 11 patients gave up treatment. The number of hospitalizations，the incidence of severe pneumonia and respiratory failure was significantly different between the first 5 years（2008-2012） and the last 5 years（2013-2018）（P＜0.05）.  Conclusion　SMA is verysusceptible to pulmonary infection. We should be alert to opportunistic pathogenic bacteria infection and use mechanical ventilation in time for respiratory failure patients. Active and effective respiratory care can reduce the incidence of pulmonary infection and improve the prognosis of SMA children.

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Effect of aspirin on anti-platelet aggregation function in children with Kawasaki disease MENG Li*，LI Xiao-hui，LIU Jing-jing，et al 2019, 34(8): 670-674.  DOI: 10.19538/j.ek2019080613 Abstract ( )   Objective　To evaluate the anti-platelet aggregation function of aspirin in children with Kawasaki disease（KD）. Methods　The clinical data of KD patients who was admitted to Capital Institute of Pediatrics-Peking University Teaching Hospital from September 2016 to September 2018 was retrospectively analyzed. All the children were treated with aspirin routinely：high-dose（30-50） mg/（kg·d） in acute stage and low-dose aspirin（3-5） mg/（kg·d） in the recovery period. Then the light transmission aggregometry（LTA）was used to determine the platelet aggregation rate of different doses of aspirin in order to evaluate the anti-platelet aggregation function， and the risk factors of aspirin resistance（AR） were analyzed by statistical method. Results　（1）The platelet aggregation rate（AA%） after treatment with high-dose and low-dose aspirin in children with KD was 30.3%（1.2%，7.1%） and 2.9%（1.5%，60.4%），respectively，and there was no significant difference in platelet inhibition between different doses of aspirin（P＝0.174）. （2）The incidence of AR was 9.75%（23/236） in the high-dose aspirin group and 8.05%（19/236） in the low-dose aspirin group. There was no significant difference in the incidence of AR between the two groups（P＝0.617）. （3）In the 19 children with AR and 217 children with aspirin sensitivity（AS） in oral low-dose aspirin treatment group，the age，sex，coagulation，biochemistry and other related indexes did not significantly differ between the two groups. Conclusion　The anti-platelet aggregation function of aspirin in KD children is not related to the dosage. AR is present in the treatment of Kawasaki disease，and the incidence of aspirin resistance is not related to dosage.

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Transcatheter device closure for perimembranous ventricular septal defects with aortic valve prolapse：Effect and prognosis 赵文婥，傅立军，沈　捷，吉　炜，陈轶维，李　奋 2019, 34(8): 675-679.  DOI: 10.19538/j.ek2019080614 Abstract ( )   Objective　To evaluate the the effect and prognosis of transcatheter device closure for perimembranous ventricular septal defects（PmVSDs） with aortic valve prolapse（AVP）. Methods　The clinical data of 1108 patients who underwent percutaneous closure from January 2011 to January 2017 were collected to conduct this retrospective study，mainly including transthoracic echocardiography，digital subtraction angiography data，occluder type and sociodemographic information（age，weight and gender）. T-test and Mann-Whitney U test were used to compare group measurement data. Wilcoxon signed rank test was used for the nonnormal distribution of paired design data. Fisher exact test was used for the four fold table. Monte Carlo approximation exact probability method was used for the R×C table.Multiple Logistic-regression analysis was used to estimate the risk factors of AR. Results　Compared with 10（0.9%） of 1053 patients without AVP，8（14.5%）of the 55 children with preoperative AVP presented aggravated postoperative aortic regulation（AR） and AR usually occurred in the long-term follow-up（＞1 year）. None of the AR progressed to moderate or severe. There were no significant changes in left ventricular ejection fraction，left ventricular shortening rate or AR before and after interventional operation in PmVSDs with AVP. Conclusion　Percutaneous closure for ventricular septal defect combined with AVP is an effective alternative to surgery when using appropriate occluders，meeting related standards and operated in an experienced cardiovascular center.

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Transcatheter interventional therapy for pulmonary stenosis in infants LUO Gang，LIU Na，WANG Kui-liang，et al 2019, 34(8): 680-684.  DOI: 10.19538/j.ek2019080615 Abstract ( )   Objective　To summarize the experience of percutaneous balloon pulmonary valvuloplasty for pulmonary stenosis in infants，and to evaluate its necessity，safety and effectiveness. Methods　From January 2009 to December 2018，68 cases of pulmonary stenosis were treated by percutaneous balloon pulmonary valvuloplasty. The clinical data before and after operation were analyzed retrospectively. Results　The mean age was （6.34±3.6） months. The mean operation weight was （7.81±2.11） kg. The preoperative body weight/age Z score was -0.80±1.38，and growth restriction was in 22 cases（32.4%），cyanosis in 15 cases（22.1%） and tachypnea in 23 cases（33.8%）. The mean right ventricular/left ventricular length-diameter ratio was 0.56±0.73 by echocardiography，the mean cardiothoracic ratio was 0.56±0.43 by chest radiography，and the average value of preoperative oxygen saturation was 94.74±6.10. The mean systolic pressure ratio of right ventricle/left ventricle before operation was 0.68±0.26. After balloon dilation，the mean pressure gradient of pulmonary valve decreased from （75.57±18.61） mmHg to （22.37±5.21） mmHg，and the mean systolic pressure of right ventricle decreased from （83.78±22.44） mmHg to （54.16±20.81） mmHg. The immediate success rate of operation was 100%. There were no serious arrhythmia，cardiac perforation，rupture of tendon chordae，vascular injury or other complications during the operation. The proportion of mild to moderate pulmonary regurgitation was 53.3% in early stage after operation，and there was no severe regurgitation. The restenosis rate was 2.94% during the follow-up period of 3 months to 10 years. The pulmonary valve regurgitation degree of 32 children who were followed up for more than 5 years did not further aggravate，and no specific management was carried out. No obvious right ventricular dysfunction was found in all patients. Compared with the toddlerhood infants undergoing PBPV in our center，the babyhood infants had obvious clinical symptoms and serious condition. The early and medium-long-term follow-up after operation was satisfactory. There was no significant difference in the effect of operation in the low-weight or low-age infants in babyhood. Conclusion　PBPV is necessary for the treatment of pulmonary stenosis in infants. The technique is safe and feasible，and the follow-up results are effective.

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Changes in body mass index of postural tachycardia syndrome in children and adolescents WANG Shuo*，TAN Chuan-mei，YANG Mao-sheng，et al 2019, 34(8): 685-688.  DOI: 10.19538/j.ek2019080616 Abstract ( )   Objective　To discuss the relationship between body mass index and postural tachycardia syndrome in children and adolescents. Methods　The clinical data of 127 children and adolescents were retrospectively analyzed，who were diagnosed with postural tachycardia syndrome （POTS） in the Department of Pediatric Cardiovasology，Children’s Medical Center，the Second Xiangya Hospital，Central South University，from August 2009 to June 2018，which included 63 males and 64 females and their ages were from 4 to 17 years old（mean age 11.31±2.53）（POTS group）. A total of 107 healthy children and adolescents including 64 males and 63 females were included as the control group，who had a health examination in the health care clinic in the hospital during the same period （aged 7 to 17，with a mean age of 11.60±3.27）. Body length and body mass were measured and body mass index（BMI） calculated. Statistical analysis was conducted with SPSS 22.0 software. Results　（1）Duration and frequency of syncope：the duration of syncope was （8.13±13.76） months in POTS group and the frequency of syncope was （1.45±4.43）times. （2）BMI intergroup comparison：comparing POTS group with control group，there was no difference in age，length or body mass（P＞0.05），and BMI was significantly lower［（17.32±2.65） kg/m2  vs. （18.17±2.42） kg/m2， t＝2.655， P＜0.01］ in POTS group. （3）BMI classification：low body mass was higher in POTS group（69.29%， 88/127） than in control group（56.69%， 72/127）；normal body mass was lower in POTS group（29.13%， 37/127） than in control group（41.73%， 53/127）， χ2＝4.444， P＜0.05. Conclusion　BMI of POTS group decreases significantly in children and adolescents， and it is lower in girls than in boys.

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Study on the physical growth status of birthweight discordant twins under 4 years old WAN Yan-nan*， SUI Ya-nan， XU Xi-ming， et al 2019, 34(8): 689-693.  DOI: 10.19538/j.ek2019080617 Abstract ( )   Objective　To study the physical growth characteristics of birthweight discordant twins（BDT） under 4 years old. Methods　The physical growth characteristics of BDT under 4 years old born from September 2010 to December 2017 in child health care system of Children’s Hospital of Chongqing Medical University were analyzed retrospectively. R 3.5.3 was used to clean up the database，analyze the distribution of different degree of birthweight discordance，and draw the fitting curves.  More than 20% of birth weight difference was taken as inclusive criteria of BDT. BDT were divided into preterm or full-term groups，and low birthweight or normal birthweight groups respectively. SPSS 19.0 software was used for statistical analysis. Results　A total of 141 pairs of BDT were included，accounting for 15.4%（141/916）. The degree of birthweight difference in premature BDT was higher than that of full-term BDT（t＝3.820，P＜0.001）. The growth discordance of preterm BDT lasted longer. Physical growth of low/very low birthweight BDT was slower than that of normal birthweight BDT under 4 years old. The growth status of BDT didn’t reach the average level of WHO growth chart by the time of the last follow-up. Conclusion　Birthweight discordance of twins could have long-lasting effects on further growth and development. Preterm twins have higher degree of birthweight discordance，and the growth discordance lasts longer. Low birthweight is an important reason for growth retardation of the lighter BDT. Growth of BDT should be monitored regularly to increase follow-up compliance.

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Study on related factors of postoperative complications after endoscopic treatment for colon polyps in children YANG Hong-bin*，FANG Ying，REN Xiao-xia，et al 2019, 34(8): 694-698.  DOI: 10.19538/j.ek2019080618 Abstract ( )   Objective　To investigate the clinical characteristics and related factors of postoperative complications in children with colon polyps treated by endoscopy. Methods　Clinical data of 379 hospitalized children who underwent electronic colonoscopic polypectomy in Children's Hospital Affiliated to Xi’an Jiaotong University from January 2014 to December 2016 were collected and retrospectively analyzed. Results　Among 379 patients with polypectomy，36 patients（9.1%） had related complications，including fever in 6 patients（1.6%） and bleeding in 30 patients（7.9%）；there was no intestinal perforation. Among the 30 cases of bleeding，26 cases（6.9%） were with minor bleeding，and 4 cases（1.1%） were with massive bleeding. The bleeding was successfully stopped by emergency endoscopy，and no additional surgery was performed. Univariate correlation analysis found that the duration of hematochezia，the location of the polyp，being with pedicle or not，the method of resection and postoperative braking were significantly correlated with postoperative complications（P＜0.05）. Multi-factor Logistic regression analysis found that： the longer the time of hematochezia，the higher the risk of postoperative complications，OR value being 1.08 ［95%CI：（1.03，2.14），P＝0.003］. Patients with non-rectal polyps（including transverse colon，ascending colon and ileocecal） were 18.88 times more likely to have postoperative complications than patients with rectal polyps ［95%CI：（2.23，159.74），P＝0.007］. The risk of postoperative complications in patients with pedicle was 11.424 times higher than that in patients without pedicle［95%CI：（2.42，53.91），P＝0.002］. Conclusion　Endoscopic resection of colon polyps in children is safe and effective，and postoperative bleeding is the most common complication. The longer period of hematochezia，the polyp being farther away from the anus，and being with pedicle increases the risk of postoperative complications. The use of titanium clips，strict postoperative braking and softening stool can reduce the occurrence of complications.

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Clinical and prognostic characteristics of aggressive fibromatosis in children：A report of 27 cases QIN Hong*，REN Qing-hua，YANG Shen，et al 2019, 34(8): 699-703.  DOI: 10.19538/j.ek2019080619 Abstract ( )   Objective　To investigate the clinical characteristics，treatment strategies，and prognosis of aggressive fibromatosis in children. Methods　A retrospective analysis was performed in 27 cases of aggressive fibromatosis from January 2007 to January 2018 in Beijing Children’s Hospital，Capital Medical University. Results　There were 16 males and 11 females in 27 cases of aggressive fibromatosis，with a median age of 65（35，96） months at diagnosis. Tumor locations were as follows: abdominal wall（n＝3），abdominal cavity（n＝5），and extra-abdominal（n＝19）. Preoperative imaging examination showed that the median maximum diameter of primary tumors was 9.8（5.3，12.1） cm. Upfront surgery was performed in all of the cases，and 10 cases received adjuvant chemotherapy combined with methotrexate and vinorelbine. Among the 27 cases，9 cases survived without disease，15 cases survived with disease，and 3 cases died of tumor recurrence or progression. The 5-year overall survival and event-free survival rates were 85.8% and 32.6%，respectively. Further analysis of survival showed that positive surgical margin was associated with tumor recurrence. Conclusion　Aggressive fibromatosis is a rare，intermediate tumor in children. It is easy to relapse after incomplete surgical resection. Chemotherapy plays a role in controlling the growth of tumors. Most of the children have good prognosis，but some of them may be disabled or even die because of persistent，fast-growing tumors.

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Research progress in the prevention and treatment of bronchopulmonary dysplasia in preterm infants with hydrocortisone MAO Wei-ying，ZHOU Jian-guo，CHEN Chao 2019, 34(8): 704-709.  DOI: 10.19538/j.ek2019080620 Abstract ( )

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Research progress in the prevention and treatment of bronchopulmonary dysplasia in preterm infants with macrolides LIU Zi-yun，FU Jian-hua 2019, 34(8): 710-713.  DOI: 10.19538/j.ek2019080621 Abstract ( )

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Research progress in autoinflammatory nephropathy HUANG Shan，YI Zhu-wen 2019, 34(8): 714-720.  DOI: 10.19538/j.ek2019080622 Abstract ( )