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06 August 2020, Volume 35 Issue 8 Previous Issue    Next Issue

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Procedures for emergency management of syncope HUANG Yu-juan*，HUANG Min 2020, 35(8): 577-580.  DOI: 10.19538/j.ek2020080601 Abstract ( )   Syncope is defined as transient loss of consciousness（TLOC） due to cerebral hypoperfusion，characterized by a rapid onset，short duration，and spontaneous complete recovery. Syncope is a common pediatric emergency，accounting for 1% to 3% of pediatric emergencies. The emergency management of syncope includes three aspects：the diagnosis of syncope and the differential diagnosis with other transient loss of consciousness，the initial syncope evaluation（careful history taking，physical examination，electrocardiography），and management of syncope in the emergency department based on risk stratification.

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Diagnosis of postural tachycardia syndrome in children LI Yan 2020, 35(8): 580-582.  DOI: 10.19538/j.ek2020080602 Abstract ( )   Postural tachycardia syndrome（POTS） is one of the most common causes of syncope in children. The main symptoms include dizziness，headache，palpitation，complexion change，blurred vision，fatigue or syncope after position change or prolonged standing. By head-up test or head-up tilt test（HUTT），patients with POTS can be diagnosed and treated at an early stage，and the children’s syncopal episode can be further reduced.

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Mental health and psychogenic pseudosyncope in children TIAN Hong 2020, 35(8): 582-585.  DOI: 10.19538/j.ek2020080603 Abstract ( )   Psychogenic pseudosyncope（PPS） is classified as a psychiatric disorder other than true appearance of transient loss of consciousness（TLOC）. The quality of life in patients with PPS is affected seriously by psychological problems such as anxiety and depression. Clinically its episodes may resemble vasovagal syncope（VVS），as both involve apparent loss of consciousness，accompanied by similar prodrome symptoms and causative factors. Sometimes it is difficult for physicians to make an initial differential diagnosis between the two diseases in daily clinical practice. The incidence of PPS is likely underestimation for insufficient recognition. Therefore，identification and treatment of PPS for children in early time is very important for their mental health.

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Treatment for children with neurally mediated syncope WANG Yuan-yuan，JIN Hong-fang，DU Jun-bao 2020, 35(8): 585-588.  DOI: 10.19538/j.ek2020080604 Abstract ( )   Neurally mediated syncope is a common disease in children，which seriously damages the physical and psychological health of children. It is of great significance to give timely and effective treatment. With the joint efforts of scholars at home and abroad，the progress has been made in the treatment of children with neurally mediated syncope，especially the individualized treatment strategy，which significantly improves the therapeutic effect. In the future，it is still necessary to explore new strategies for intervention and prevention，optimize the prediction technology of personalized treatment，and make unremitting efforts to improve the physical and mental health of children.

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Research advances in relationship between circadian rhythm and orthostatic intolerance in children WANG Cheng，CAI Hong 2020, 35(8): 588-592.  DOI: 10.19538/j.ek2020080605 Abstract ( )   Circadian rhythm widely exists in living organism, and it is regulated by the biological clock，which keeps life activities showing a rhythmic oscillation with a period of approximately 24 hours. Growing evidence has shown that circadian rhythms are closely related to the physiological function of the cardiovascular system，and blood pressure，heart rate，hormone secretion，endothelial function，vasoconstriction and vasodilation are regulated by the biological clock. Clinically，syncopal episodes peak in the morning，and abnormal blood pressure circadian pattern exists in most children with orthostatic intolerance（OI）. Simulated microgravity can lead to circadian rhythm disorders in rats’ cardiovascular system. It suggests that circadian rhythms play an important role in the occurrence and development of OI. The paper introduces the relationship between circadian rhythm and OI as well as its possible mechanism.

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Relationship between catecholamines and orthostatic intolerance in children ZHAO Cui-fen，KONG Qing-yu 2020, 35(8): 592-595.  DOI: 10.19538/j.ek2020080606 Abstract ( )   The most common types of orthostatic intolerance（OI） are vasovagal syncope（VVS） and postural tachycardia syndrome（POTS）. Catecholamines（CA） include norepinephrine（NE） and dopamine（DA）. Norepinephrine is mainly secreted by the end of sympathetic nerve as a neurotransmitter，which can increase heart rates and enhance contraction of myocardia and vessels；dopamine is a precursor for the synthesis of NE in the body，and is also one of the neurotransmitters secreted by the central nervous system and ganglia，which is related to the emotions and feelings of human beings. The paper mainly introduces the relationship between catecholamine and VVS and POTS.

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Serotonin, prolactin and cortisol and vasovagal syncope SHI Lin， DENG Yan-jun 2020, 35(8): 595-599.  DOI: 10.19538/j.ek2020080607 Abstract ( )   Pathogenesis of vasovagal syncope（VVS） is still unclear. Central serotonin（5-HT） is a neurotransmitter synthesized from tryptophan and stored in vesicles. 5-HT is released into synaptic space by serotoninergic neurons，binding to different serotonin receptors（5-HTRs） on the postsynaptic membrane，exerting their different biological effects. Central 5-HTRs involved in cardiovascular regulation mainly include 5-HT1AR，5-HT2AR，5-HT3R and 5-HT7R，in which 5-HT1AR is activated to reduce sympathetic reflex，increase vagus reflex，and cause the decrease of blood pressure and/or heart rate；5-HT3R is involved in Bezold-Jarisch reflex. Central 5-HT can promote prolactin（PRL） excretion by binding with 5-HT1A，5-HT1B，5-HT2A/2C and other receptors，while central 5-HT can promote cortisol（Cor） excretion by binding with 5-HT1A，5-HT1B，5-HT2A/2C，5-HT4 receptors. Therefore，the levels of PRL and Cor are positively correlated with central 5-HT. In patients with VVS，the level of PRL and Cor increased significantly in syncope or pre-syncope，which suggests that central 5-HT may be related to the pathogenesis of VVS.

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Vitamin D and neurally mediated syncope in children DONG Xiang-yu，XIAO Yao 2020, 35(8): 599-603.  DOI: 10.19538/j.ek2020080608 Abstract ( )   Vitamin D（VD） is a collective term for lipophilic steroid derivatives，which is one of the essential nutrients for human body and participates in the regulation of various biological processes in vivo. It has been indicated that VD can not only regulate the metabolism of calcium，phosphorus and fat and autoimmunity，but also regulate the balance of autonomic nervous system. Its deficiency or insufficency may be involved in the pathogenesis and pathophysiological process of autonomic nervous mediated syncope（NMS）.

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Syncope related to coronary artery anomaly in children XIAO Yan-yan 2020, 35(8): 603-606.  DOI: 10.19538/j.ek2020080609 Abstract ( )   Syncope is often seen in children and affects their physical and mental health. Although cardiogenic syncope only accounts for a small part of the causes of syncope，it can cause serious consequences and attract clinical attention. In addition to neurally-mediated syncope，cardiogenic syncope caused by coronary artery anomaly，has imposed a heavy burden on society and the family because of the unpredictable consequence. The article made a summary about syncope related to coronary artery anomaly in children.

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Diagnosis and treatment of cardiogenic syncope in children YUAN Yue，CHU Xin-yuan 2020, 35(8): 606-609.  DOI: 10.19538/j.ek2020080610 Abstract ( )   Syncope is one of the most common diseases in children. According to the etiology， it can be divided into autonomic nerve mediated syncope， cardiogenic syncope and a small part of unexplained syncope. According to the epidemiology， cardiogenic syncope is the second etiology of syncope in children. In recent years， it has gradually attracted more and more attention from clinicians because of its clinical crisis and severe condition， which requires accurate and active rescue as early as possible， and it is with high rate of sudden death，high risk and poor prognosis. The article comprehensively analyzes the progress of diagnosis and treatment of cardiogenic syncope in children to provide clinicians with a deeper understanding of cardiogenic syncope， so as to improve the survival rate and quality of life after syncope in children.

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Risk stratification and prognosis analysis of children with myocarditis YANG Xi，LI Jia，LIU Gui-ying 2020, 35(8): 610-614.  DOI: 10.19538/j.ek2020080611 Abstract ( )   Objective　To evaluate the clinical and therapeutic characteristics and prognosis in high-risk children with myocarditis assessed by cardiac magnetic resonance（CMR）. Methods　A retrospective cohort study was performed in seventy children with myocarditis，who were treated in Department of Pediatrics，Beijing Anzhen Hospital of Capital Medical University from January 2018 to July 2019. Children with the presence of myocardium edema and/or late gadolinium enhancement in CMR were in the high-risk CMR group（n＝29） and those without CMR abnormalities were in the CMR control group（n＝41）. Clinical characteristics，treatment and rate of adverse cardiovascular events during the follow-up were compared between the two groups. Cox regression analysis was used to evaluate the risk factor for prognosis. Results　Among the 70 children（aged 5 to 18 years，mean age 7.6±5.3），43 were male（61.4%） and 27 were female（38.6%）. The incidences of chest pain，fatigue and chest distress were similar between the two groups（P＞0.05）. However，there were significant differences in the levels of serum creatinine kinase MB，cardiac troponinⅠ，and left ventricular ejection fraction between the two groups（all P＜0.05）. Moreover，children in the high-risk CMR group were more likely to use the steroids and captopril（all P＜0.05）. After 3.7 months of follow-up，the rates of adverse cardiovascular events was significantly different between the two groups（31.3% vs. 19.5%，P＜0.05）. Cox regression analysis results showed that CMR high-risk images and cardiac troponinⅠ were the risk factors for adverse cardiovascular events. Conclusion　Children with high-risk CMR images of myocarditis often have no typical clinical demonstrations，but they are in a severe condition；although steroids and  captopril were used for active treatment，the incidence of adverse cardiovascular events is high in short-term follow-up. Therefore，early screening，monitoring，treatment and follow-up should be given great attention in patients with high risk CMR images of myocarditis.

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Exploration of balloon delivery pathway establishment in infantile critical pulmonary stenosis BING Zhen，PAN Si-lin，LUO Gang，et al 2020, 35(8): 615-619.  DOI: 10.19538/j.ek2020080612 Abstract ( )   Objective　To explore the delivery pathway establishment strategy and its influencing factors of percutaneous balloon pulmonary valvuloplasty（PBPV） in infantile critical pulmonary stenosis（CPS）. Methods　The clinical data of 30 infants with CPS who underwent PBPV from June 2014 to June 2018 in Qingdao Women and Children’s Hospital were analyzed retrospectively. Groups were divided according to the different methods of delivery pathway establishment（Group A：the conventional method was used to establish the delivery pathway；Group B：the conventional method failed in establishing the delivery pathway and coronary artery guide-wire was used to establish the delivery pathway；Group C：coronary artery guide-wire was used to assist the establishment of the balloon delivery pathway）. The data of age，body weight，body surface area（BSA），the diameter of pulmonary valve ring，the diameter of valve orifice，the ratio of balloon valve ring，preoperative transpulmonary valve pressure gradient，pulse oxygen saturation（SpO2），right ventricular systolic pressure（RVSP），operation time and complications during delivery pathway establishment were compared among the three groups. Results　Delivery pathway for PBPV was successfully established in the three groups，and there were no  serious complications such as tricuspid valve injury，pericardial tamponade or death. There were statistical differences in age，body weight and body surface area between group A and group C，group B and group C（P＜0.05），and no statistical differences between group A and group B（P＞0.05）. There were statistical differences in the diameter of pulmonary valve ring and valve orifice among group A，group B and group C（P＜0.05）. There was no statistical difference in the ratio of balloon valve ring among the three groups（P＞0.05）. There was no statistical difference in SpO2 or RVSP among groups A，B and C before treatment（P＜0.05）. There were statistical differences in operation time between group A and group B，group B and group C（P＜0.05），but no statistical difference between group A and group C（P＞0.05）. Conclusion　Age，body weight，BSA，and the diameter of pulmonary valve ring and valve orifice are important factors for choosing the way of delivery pathway establishment in infants with CPS. When conventional methods don’t work in establishing the delivery pathway，coronary artery guide-wire，especially double coronary artery guide-wire method，can be used to establish balloon delivery pathway. It is safe and effective，which is worth popularizing and applying.

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Clinical and pathological features of primary IgA nephropathy in children at a single medical center：A report of 303 cases BAO Yu，SHEN Hui-jun，LU Zhi-hong，et al 2020, 35(8): 620-625.  DOI: 10.19538/j.ek2020080613 Abstract ( )   Objective　To investigate the clinical manifestations and pathological features of primary IgA nephropathy and the relationship between them in children. Methods　The clinical manifestations，clinical typing，pathological characteristics and immunophenotyping of 303 children with primary IgA nephropathy diagnosed by renal biopsy from January 2014 to December 2019 in Department of Nephrology，Children’s Hospital，Zhejiang University School of Medicine，were analyzed retrospectively. Results　Among the 303 patients，196 were male（60.7%） and 107 were female（35.3%）；the average age was （10.2 ± 2.4） years old. A total of 169 cases had definite inducement（55.8%）. There were 199 cases of isolated hematuria（65.7%），31 cases of hematuria and albuminuria（10.2%）. In all clinical types，pathological changes were mainly grade Ⅱ（129 cases，42.6%）. IgA+IgM+IgG was the main immune complex in chronic nephritis. IgA+IgG and IgA+IgM+IgG were the main immune complex in acute nephritis. The immune complex of other types was mainly IgA+IgG. Among the pathological grades，IgA deposition was most common in grade Ⅰ，IgA+IgG in grade Ⅱ and Ⅲ，and IgA+IgM+IgG in grade Ⅳ and Ⅴ. In Oxford classification，the most common pathological type was M0E0S0T0C0，and 1/3 of all patients had two or more lesions. In isolated hematuria，M0E0S0T0C0 was the most common pathological type. In hematuria，acute nephritis，isolated albuminuria and chronic nephritis，non-M0E0S0T0C0 accounted for the majority. In nephrotic syndrome and acute nephritis，all cases were non- M0E0S0T0C0. In Lee’s classification，the pathological changes of grade Ⅰ and grade Ⅱ were mainly M0E0S0T0C0. With the increase of grade，the proportion of non- M0E0S0T0C0 increased. The pathological changes of grade Ⅳ and grade Ⅴ were all non- M0E0S0T0C0. Conclusion　The clinical manifestations of children’s primary IgA nephropathy are various. Most of them are isolated hematuria type. The most common pathological type is grade Ⅱ. The immune complex deposition is related to the pathological type. The immune complex deposition of high-grade is mainly IgA+IgM+IgG deposition. There is a good correlation and consistency between Lee’s pathological grade and Oxford classification. The diversity of clinical manifestations，the degree of pathological changes are of great significance in guiding clinical therapy and controlling its progression.

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Detection and clinical analysis of drug-resistant mutation sites in children with Mycoplasma infectious lobar pneumonia WU Bing-xia*，ZHANG Li，ZHANG Wei，et al 2020, 35(8): 626-630.  DOI: 10.19538/j.ek2020080614 Abstract ( )   Objective　To learn about the detection of drug-resistant mutation sites in the 23S rRNA V region of bronchial alveolar lavage fluid（BALF） in children with mycoplasma（MP） infectious lobar pneumonia，and compare the clinical data of children in the site mutation group with those without the mutation. Methods　The clinical data of 69 cases of BALF in children with lobar pneumonia admitted between January 2018 and January 2019 to the Department of Pediatrics，First Affiliated Hospital，School of Medicine，Shihezi University，were analyzed retrospectively. The MP-DNA and 23 SrRNA V region mutation sites（A2063G，A2064G，A2063C，and A2063T） were detected by real-time fluorescence quantitative PCR（RTQ-PCP） in the above specimens. According to the results，the MP-positive children were divided into the site mutation group and the non-mutation group，and the clinical data of the two groups were compared. Results　Of the 48 children with MP infectious lobar pneumonia，37 cases（77.1%） of site mutations were detected. The mutation rates from high to low were A2063G，A2064G，A2063C and A2063T；the patients in the site mutation group were with higher serum CRP，PCT and LDH levels，increased proportion of extrapulmonary complications，prolonged fever，length of hospital stay，prolonged use of antibiotics and antipyretics，and significantly increased proportion of methylprednisolone and IVIG. The above differences were statistically significant（P＜0.05）. Conclusion　The detection rate of resistance mutation sites in 23S rRNA V region of children with MP infectious lobar pneumonia in this area is high，and A2063G and A2064G are still the main types. There are multiple resistance mutation sites in the same child. In the children with MP infectious lobar pneumonia whose CRP，PCT and LDH levels are increased significantly and are with severe pulmonary disease，and the possibility of MP resistance should be considered when there are more extrapulmonary complications and longer average fever and hospital stay.

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Meta-analysis of response inhibition capability in children and adolescents with attention deficit hyperactivity disorder YU Xiao-hui，SONG Tao，LIU Ru-lan，et al 2020, 35(8): 631-636.  DOI: 10.19538/j.ek2020080615 Abstract ( )   Objective　To explore the difference in response inhibition capability between children with attention deficit hyperactivity disorder（ADHD）and healthy children. Methods　By systematically searching CNKI，Wanfang，VIP，Pubmed，Embase，Cochrane Library，a total of 6 Chinese and English databases，the authors collected relevant literature on the response inhibition of ADHD children and adolescents from August 1988 to February 2020，and extracted the relevant data of stop-signal-reaction time（SSRT） in all signal-stop tasks. Newcastle-Ottawa Scale（NOS） was used to evaluate the quality of the included studies. RevMan5.3 was used to conduct meta-analysis. Results　A total of 19 studies were finally included，with 826 ADHD cases and 574 controls. Heterogeneity results showed that there was mild heterogeneity among the studies（χ2＝47.18，P＝0.02，I 2＝36%）. Fixed effects model was used for statistical analysis. The weighted mean difference（WMD） was 55.77（95%CI：48.36 to 63.17），and the difference was statistically significant （χ2＝14.76，P＜0.00001）. Subgroup analysis showed that the differences in SSRT between ADHD children and control groups in each subgroup were statistically significant. Bgger’s test suggested that there was no obvious publication bias. Conclusion　The children with ADHD have significantly reduced response inhibition capability than healthy children，and the lack of response inhibition capability may be the main reason for behavioral and emotional disorders in ADHD.

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Clinical characteristics and gene mutation analysis of dopamine-responsive dystonia in children：A report of 6 patients HAN Feng*， HE Ying-zhong， ZHOU Yun-qing， et al 2020, 35(8): 637-641.  DOI: 10.19538/j.ek2020080616 Abstract ( )   Objective　To analyze the clinical and genetic mutation characteristics of children with Dopa-responsive dystonia（DRD）. Methods　The clinical manifestations，laboratory tests and treatment effects of DRD in 6 patients admitted to neurology clinic from August 2016 to March 2019 were retrospectively analyzed. Results　Of the 6 patients with DRD，two were male and four were female. The age ranged from 13 months to 11 years and 5 months. The initial symptom was lower limb dysmobility，and the disease was progressing. The main symptoms on visiting doctors were foot varus（3 cases），abnormal posture（4 cases），involuntary movement（3 cases），spastic torticollis（1 case），epileptic seizures（1 case），and mental and growth retardation（1 case）. Five patients were with diurnal fluctuation. Six patients received gene detection，and five patients had mutations in GCH1 gene［4 were novel mutations，c.131C＞G（p.Ala44Gly），c.325T＞C（p.Tyr109His），c.225C＞G（p.Tyr75*）and c.5dupA（p.Lys3Glufs*62）］. One patient had  heterozygous mutations in TH gene，c.698G＞A（p.Arg233His）and c.971_982dup，and the latter was a novel mutation. Six patients were treated with Madopar，and significant improvement was observed in five cases. Three patients showed excitement and  lower limbs jitter during the treatment，and the symptoms disappeared after adjusting the drug dose in two patients. Conclusion　The majority of DRD manifests as limb dysfunction and/or gait abnormality with diurnal fluctuation，and there is no exact correlation between genotype and phenotype. The newly discovered four GCH1 mutations and one TH mutation have enriched the gene mutation profile of DRD.

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Clinical analysis of prognostic factors of severe sepsis in children: A report of 178 cases WANG Yi，TANG Xiao-jing，ZHANG Hua，et al 2020, 35(8): 642-645.  DOI: 10.19538/j.ek2020080617 Abstract ( )   Objective　To explore the risk factors of prognosis of severe sepsis in children. Methods　The clinical data of 178 children with severe sepsis admitted from April 2018 to June 2019 to Department of Critical Medicine，Affiliated Children’s Hospital of Xi’an Jiao Tong University，were analyzed retrospectively. The data were analyzed by SPSS20.0 statistical software. Prognosis of severe sepsis was taken as the dependent variable. Categorical variables were compared using a Pearson’s Chi-square test. An independent sample t-test was performed to compare the paired differences of quantitative variables with normal distribution. Binary Logistic regression was used to evaluate all the variables，and then receiver operating characteristic（ROC） was used to predict the specificity of the variables with predictive value. The area under the curve（AUC）＞0.5 was considered as with predictive value. Results　A total of 178 children with serve sepsis were collected，including septic shock，sepsis with acute respiratory distress syndrome and sepsis with multiple organ dysfunction syndrome. There was no significant difference in age，gender，prothrombin time（PT），activated partial thromboplastin time（APTT），international normalized ratio（INR），serum albumin（ALB）or blood urea nitrogen（BUN） between the survival group and death group. Logistic regression analysis showed that serum creatinine（CRE），blood lactate（Lac） and procalcitonin（PCT） might be the prognostic variables. ROC curve showed that CRE-related sensitivity was 0.736，specificity was 0.745，critical concentration was 148.5 mmol/L and AUC was 0.625；PCT-related sensitivity was 0.679，specificity was 0.904，critical concentration was 16.7 ng/L and AUC was 0.865；Lac-related sensitivity was 0.786，specificity was 0.862，critical concentration was 3.70 mmol/L and AUC was 0.875. Those values had predictive value of prognosis. Meanwhile，the fitting degree of PCT and Lac was relatively high，and the specificity was higher than that of CRE. Conclusion　CRE，PCT and Lac are independent risk factors for the prognosis of serve sepsis in children.

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Disease spectrum analysis of hospitalized children in Naqu area of Tibet：A report of 9901 cases YANG Yong-chang，Jimeiduobujie，SHI Yi，et al 2020, 35(8): 646-648.  DOI: 10.19538/j.ek2020080618 Abstract ( )

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Research progress in nasopharyngeal microbiome in children DING Yi-jun，WANG Tian-you 2020, 35(8): 649-654.  DOI: 10.19538/j.ek2020080619 Abstract ( )

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Advances in the application of pulmonary ultrasonography in neonates ZHANG Ying 2020, 35(8): 655-659.  DOI: 10.19538/j.ek2020080620 Abstract ( )

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One case of severe Mycoplasma pneumoniae pneumonia with toxic epidermal necrolysis SA Ri-na，ZHAO Yan-fang，WANG Ai-qiong 2020, 35(8): 660-663.  DOI: 10.19538/j.ek2020080621 Abstract ( )