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Roles of serum leptin and adiponectin on the development of obesity-related hypertension in children and adolescents: the BCAMS study
ZHANG Mei-xian, MI Jie, ZHAO Xiao-yuan, LI Ming, CHENG Hong, HOU Dong-qing
2008, 3 (2): 96-102.
Abstract8040)      PDF (656KB)(2998)      

Objective To explore the effects of serum leptin and adiponectin concentrations on the pathogenesis of obesity-related hypertension for children and adolescents.Methods A total of 3 502 schoolchildren (1 784 boys and 1 718 girls) aged 6-18 years were recruited from the BCAMS study, which was a crosssectional representative populationbased survey on metabolic syndrome for children and adolescents in Beijing. In this study, participants were categorized into four groups (Control group, HBP group, OB group and OB+HBP group) according to the sex, age-specific body mass index (BMI) cutoffs recommended by the Working Group on Obesity in China, and systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) equal to or greater than the 95th percentile for age and gender of schoolchildren in Beijing in 2004. Blood samples were obtained after a 12hour fast, and the levels of plasma insulin, serum leptin and adiponectin were measured by sensitive, specific doubleantibody sandwich enzyme-linked immunosorbent assays (ELISA). Variables including insulin, leptin and adiponectin were skewed distribution and natural logarithmical transformations were performed. Analysis of variance, Spearman correlation, and multivariate regression analysis were conducted.Results Higher BMI, SBP and DBP, lower insulin, leptin and adiponectin levels were found in boys than in girls. There were no differences in BMI, serum leptin and adiponectin levels between the control group and the HBP group. Higher BMI, plasma insulin and serum leptin, and lower adiponectin levels were found in the OB group and OB+HBP group than those in the control group or HBP group. BMI, plasma insulin levels of the participants in the OB+HBP group, but only boys′ serum leptin levels were higher than those in the OB group. Both SBP and DBP had positively correlated with leptin (r=0.260-0.643, P<0.01)and negatively correlated with adiponectin (r=-0.171-0.332, P<0.01) for both genders. After adjusting for insulin or BMI, above correlations became weak or disappeared. The odds ratios (OR) and 95% confidence interval (95%CI) for the prediction of hypertension were elevated in children in the upper quartile of leptin level [2.75(2.28-3.32)] compared with that in the lower quartile. The figures were 1.59(1.31-1.92) in the lower quartile of adiponectin level compared with in the upper quartile. When BMI was included in the models, all ORs for the prediction of hypertension were not significant for both hyperleptinaemia and hypoadiponectinaemia.Conclusions Levels of blood pressure, plasma insulin, serum leptin were higher and serum adiponectin was lower in overweight children than in control group. Leptin and adiponectin may be related to blood pressure through obesity or insulin resistance.

Cited: Baidu(7)
Changes and influencing factors of the cerebral regional oxygenateons in disease neonates: a multicentre randomized clinical trial.
LIU Yun-feng, ZHOU Cong-le, ZHANG Jia-jie, LI Zhi-guang, WANG Dan-hua, WANG Jun-yi,XIE Li-juan, ZHOU Xiao-guang,ZHANG Wei, LIU Ying
2009, 4 (4): 349-355.
Abstract6665)      PDF (1093KB)(2725)      

ObjectiveTo investigate the rules of cerebral oxygen saturation (rSO2) changes in neonates with different diseases using near infrared spectroscopy (NIRS) and give useful information for clinical application. MethodsA multicenter randomized clinical trial was conducted in nine regional large hospitals participated from Jan 2007 to Oct 2008.223 term neonates without special diseases were enrolled as the normal group and the cerebral rSO2 was detected at 1, 2 and 3 days after birth respectively using the NIRS human tissue oximeter (TSAH-100).At the same time,196 neonates with diseases possibly effectting the changes of cerebral oxygenation were enrolled as the disease group and the cerebral rSO2 was detected during acute periods.The statistical differences of the cerebral rSO2 between two groups were analyzed. The disease group was further divided into 3 subgroups: respiration disease subgroup (n=97), circulation disease subgroup (n=44) and brain injury subgroup(n=55).The differences of the cerebral rSO2 among different severities of illness were tested.The relationship between cerebral rSO2 and arterial oxygen pressure (PO2) was discussed in respiration disease subgroup. In addition, the relationship between cerebral rSO2 and heart rates was also investigated in circulation disease subgroup.The relationship between cerebral rSO2 and the mean velocity (Vm) and resistent index (RI) in anterior cerebral artery was also investigated in brain injury subgroup. Results①In disease group the cerebral rSO2 was (56±6)%, which was significantly lower than the normal group (t=21.729,P<0.05). ②The cerebral rSO2 of the neonates with serious respiratory disease was (54±6)%, which was significantly lower than those with mild abnormality (60±3) %( P<0.05). The cerebral rSO2 of the neonates with serious circulation disease was (53±6)%, which was significantly lower than those with mild abnormality (59±3) %( P<0.05). The cerebral rSO2 of the neonates with severe brain injury was (54±4)%, which was significantly lower than those with mild injury (59±3)% ( P<0.05).③In the respiratory disease subgroup the cerebral rSO2 was positively correlated with PO2(y=-62.93+4.75x-0.059x2+0.00024x3).When PO2 was above 60 mmHg,rSO2 was about 62%,cerebral oxygenation was normal. When PO2 was under 50 mmHg,rSO2 was lower than 57%,cerebral hypoxia happened.In the circulation disease subgroup cerebral rSO2 was positively correlated with the heart rates of neonates(y=1.11+0.8241x-0.0027x2). When heart rates were from 105 to 200 per minute,rSO2 was above 58%,cerebral oxygenation was normal. when heart rate were under 105 or above 200 per minute,the rSO2 decreased to 58% ,there would be cerebral hypoxia. In the brain injury subgroup,when rSO2 was below 58%, the mean velocity (Vm) in cerebral anterior artery was compensatively increased and resistent index (RI) was decreased,and the brain injury was serious. ConclusionsThe cerebral hypoxia may happen in patients with serious diseases.NIRS objectively reflected the cerebral oxygenation alteration,and therefore was a valuable and reliable method for monitoring cerebral hypoxia of neonates in clinic and possibly helpful to find cerebral hypoxia in neonates.

Development of blood pressure reference standards for Chinese children
MI Jie,WANG Tian-you,MENG Ling-hui,ZHU Guang-jin,HAN Shao-mei,ZHONG Yan,LIU Gong-shu,WAN Yan-ping,XIONG Feng,SHI Jing-pu,YAN Wei-li,ZHOU Pi-ming
2010, 5 (1): 4-14.
Abstract5398)      PDF (1953KB)(6633)      

Objective To develop a nationally acceptable blood pressure (BP) reference standards for the diagnosis and valuation of hypertension in children and adolescents in China. Methods The current study was based on the data from eleven large-scale cross-sectional BP surveys in mainland China since 2001, the survey sites were representative of national geographical distribution including four municipalities (Beijing, Shanghai, Tianjin, Chongqing) and seven provinces (Hunan, Liaoning, Hebei, Zhejiang, Guangxi, Xinqiang and Guangdong). The surveys which met the following selection criteria were involved to form the reference population sample and pooled database: 1) Subjects were Han nationality and their ages were from 3 to 18 years old; 2) BP levels were measured by auscultation using standard sphygmomanometer and recorded as Korotkoff phase 1(SBP), Korotkoff phase 4 (DBP-K4) and/or Korotkoff phase 5 (DBP-K5); 3) All surveyors were trained before investigations and standard quality control was implemented throughout the BP measuring process; 4) Basic variables, except BPs, were at least included but not limited to age, sex, nationality, height and weight. Totally 112 227 subjects (56 912 males accounting for 50.7%) were enrolled in the reference population sample in this study. SPSS 13.0 software was used to do the descriptive statistical analysis. Centile curves for SBP, DBP-K4 and DBP-K5 were drawn by sex using LMS method. Z scores of Height and BMI were calculated based on the data from the Chinese National Survey on Constitution and Health (CNSCH) in schoolchildren in 2005 to evaluate the nutrition status and development level of the reference population. Results The reference population had an optimal representation of Chinese Han children and adolescents. The resulting curves provided specific cut off points based on age and sex for the diagnosis of high normal BP, hypertension and severe hypertension, respectively. Given the best approach for blood pressure measurement in children and adolescents remained controversial, especially on the choice of K4 or K5 for diastolic blood pressure. So in present study we showed DBP reference standards with K4 and K5, respectively, that is, two sets of SBP/DBP-K4 and SBP/DBP-K5 were developed for the flexible usage in practice. The proposed reference standards of SBP/DBP-K4 were similar to the US fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents, with only exception of the age groups of preschool children and late adolescence. Cut off points for hypertension using DBP-K5 were significantly lower than the US standards.Conclusions The proposed reference standards, which were firstly developed based on the most recently pooled national data and in line with the growth and development characteristics of Chinese children and adolescents, should help for the early screening, diagnosis and evaluation of hypertension in children and adolescents, and were also recommended to be used in national comparisons of prevalence of hypertension.

Study on reliablity and validity of the Chinese version of the Gross Motor Function Classification System for Cerebral Palsy
SHI Wei,WANG Su -juan,YANG Hong,ZHU Mo,WANG Yi
2006, 1 (2): 122-129.
Abstract5310)      PDF (694KB)(4272)      

Abstract Objective To evaluate reliability and validity of the Chinese version of the Gross Motor Function Classification System. Methods 91 children with cerebral palsy(CP; 58 males and 33females; mean age 49.4 months, SD 33months, range 7 to 144 months) were involved, from() Types of CP in the children were hemiplegia, (n=12), spastic diplegia, (n=31), spastic quadriplegia,(n=41), spastic triplegia, (n=1), dyskinetic and mixed, (n=5), ataxic, (n=1). 35 children received a second assessment after a 10 days interval to assess test-retest reliability.() Criterion-related validity was evaluated by comparing GMFCS levels with tests of Gross Motor Function Measure(GMFM) and Peabody Developmental Motor Scale-Gross Motor(PDMS-GM).() Results () Criterion-related validity was excellent between GMFCS levels and test of GMFM and PDME-GM scores(Spearman rs=-0.57 to -0.84). () Conclusions This study extends reliability and validity the Chinese version of GMFCS, supporting its use in clinical practice and research.

Relationship between precosious puberty and obese status in Beijing children and adolescents
CHEN Fang-fang, MI Jie, WANG Tian-you, LI Hui, HOU Dong-qing, CHENG Hong, ZHANG Mei-xian
2007, 2 (1): 14-20.
Abstract5158)      PDF (617KB)(3888)      

Objective To examine the influence of precosious puberty on fatness in children and adolescents of Beijing, and compare their relationship in boys with girls. Methods 19 085 children and adolescents (9 418 boys, 9 667 girls) aged 6-18 years who participated in the program of Beijing Children and Adolescent Metabolic Syndrome study (BCAMS) and had complete anthropometry (weight, height, fat mass percentage by bioelectrical impedance analysis) and sexual maturation(SM) data.Overweight and obesity among children aged 7-18 years were defined according to sexagespecific body mass index (BMI) cutoffs recommended by Chinese Working Group on Obesity (WGOC),the 85th and 95th percentiles of BMI from US 2000 CDC Growth Charts (CDC2000) were used for children aged 6 years. Using the status quo method, the median age for each certain Tanner stage (Ⅱ,Ⅲ,Ⅳ,Ⅴ) was calculated. Based on each individual's age and SM status (Tanner stages: breast stages for girls and testicular volume for boys, pubic hair for both genders), the subjects were classified as early maturers (those who reached a certain Tanner stage earlier than the median age for that stage, and average and later maturers (those who reached a certain Tanner stage equal to and later than the median age for that stage). Using multiple linear regression model, associations between fatness (BMI and FMP) and SM were systematically examined. Logistic regression analysis was performed to test how early maturation affected the risks for overweight and obesity. Results Early SM was positively associated with obesity in both girls and boys. The prevalence of combined overweight in early maturers versus the average and later maturers was 31.0% versus 24.7% in boys and 30.7% versus 11.8% in girls; the figures for obesity were 14.6% versus 9.7% and 13.5% versus 4.4%, respectively. Fatness (BMI and FMP) was associated with early maturation in girls, early maturing girls were fatter than counterparts. But the associations between BMI and FMP with early maturation in boys were in opposite directions, early maturing boys had higher BMI and lower FMP than counterparts. With covariates adjusted and using later maturing as the reference group, odds ratios and 95% confidence intervals for combined overweight were 1.12(0.96-1.31)for boys and 3.39(2.94-3.92)for girls, and for obesities were 1.31 (1.06-1.62) and 3.12 (2.53-3.85), respectively. Conclusions Sexual maturation is associated with obesity in children and adolescents. Maturation status should be taken into consideration when assessing child and adolescent obesity.

The Variants of Benign Childhood Epilepsy with Centrotemporal Spikes
LIU Xiao-yan,ZHANG Yue-hua,BAO Xin-hua,Wu Ye, WANG Shuang,CHANG Xing-zhi,QIN Jiong
2006, 1 (1): 33-39.
Abstract4820)      PDF (642KB)(3252)      

【Abstract】 Objective To research the electro-clinical characteristics, therapeutic response and prognosis of neuropsychology in the children with variants of benign childhood epilepsy with centrotemporal spikes (BECT). Methods Performing video-EEG monitoring for children with BECT who had some variant symptoms including absence-like seizures, jerks, incoordinate movement (Ⅰtype), or speech and oromotor deficits (Ⅱtype). Analyzing the seizures semeiology, electrophysiologic features, neuropsychologic impairments and responses for antiepileptic drugs (AEDs). Results The electroencephalography (EEG) of all 9 cases showed abundance of spike and waves (SW) in rolandic areas during wake and sleep. The SW index were as high as fifty per cent to eighty-five per cent. Ⅰtype variant symptoms included absence-like seizures with secondary bilateral synchronous 2-3Hz spike-wave rhythms during ictal EEG in 5 cases, negative myoclonic seizures confirmed by test of standing-up and extending arms forward in 6 patients. Ⅱ type variant symptoms represented as speech expression disorders in 6 children, five of them had oral-pharynx apraxia and three cases had aphasia. Two patients had both Ⅰtype and Ⅱ type symptoms. Neuropsychologic impairment occurred in seven cases, and appeared more severity in the patients withⅠtype than Ⅱtype variant. Valproic acid only or combined with clonazepam were effective in 6 cases. The clinical and EEG problems were improved in the other three by adding on steroid therapy. Conclusion The variants of BECT often associated with EEG deteriorated. Ⅰtype primarily represents as secondary atypical absences and negative myoclonus ,often with poor neuropsychologic prognosis. A notable characteristic in Ⅱ type is oral-pharynx apraxia and with related good prognosis. Valproic acid, benzodiazepines and adrenocorical hormone were effective for improvement of electro-clinical manifenstation of BECT variants.

Growth reference standards and growth charts of sitting height and leg length for Chinese children and adolescents aged 0-18 years
ZHANG Yaqin, LI Hui, ZONG Xinnan
2021, 16 (3): 197-203.
Abstract4525)      PDF (821KB)(1429)      
Background: Sitting height and leg length are the useful indicators for the linear growth evaluation of children and adolescents, but the growth reference standards of the two indicators have not been reported. Objective: To study and formulate the growth reference of sitting height and leg length of Chinese children and adolescents aged 0-18 years. Design: A cross-sectional survey. Methods: Stature and sitting height of 92,494 healthy urban children aged 0-18 years were measured in two national surveys in 2005 in China—The National Survey on the Physical Growth and Development of Children in the Nine Cities of China (NSPGDC) and The Chinese National Survey on Students' Constitution and Health (CNSSCH). Leg length was calculated by height minus sitting height. Growth reference standards of sitting height and leg length were constructed using the LMS method. Main outcome measures: Reference values of sitting height and leg length. Results: The percentile and the Z-scores reference values of sitting height and leg length for Chinese boys and girls aged 0-18 years were shown and their growth charts were drawn. Sitting height increased about 14 cm, 6 cm and 4 cm during the first, second and third year after birth, respectively. After that, the annual increment of sitting height is nearly 2-3 cm. Then the increments became slightly higher at 11-13 years for boys and 9-11 years for girls and gradually became smaller and smaller. Sitting height nearly stopped increasing at the age of 17 years for boys and 15 years for girls. Leg length increased respectively about 11-12 cm and 6.5 cm during the first and second year after birth, then the annual increment was 4-5 cm during 2-5 years, and leg length stopped increasing nearly at 15 years for boys and 13 years for girls. Conclusion: The growth reference standards of sitting height and leg length were formulated, which provide more data and reference for perfecting the growth evaluation system of children and adolescents in China.
Exploring therapeutic index of desmopressin for treating primary nocturnal enuresis in children
MA Jun, JIN Xing-ming, ZHANG Yi-wen, WU Hong, JIANG Fan
2007, 2 (5): 364-368.
Abstract4395)      PDF (1418KB)(3366)      

Objective Studying the clinical efficacy and therapeutic index of desmopressin for treating primary nocturnal enuresis in Chinese children. Methods The objects of the study were 160 children who were diagnosed as primary nocturnal enuresis(PNE) in department of developmental and behavioral pediatrics of Shanghai children's medical center from April 2003 to August 2006, included 82 boys and 78 girls; The age range was 5 to 16, mean age was (8.26±2.84) years old. PNE diagnosis strictly followed International Classification of Diseases, the 10th edition (ICD-10). Based on Chinese enuretic children's characteristics, the enuresis questionnaire was formed, including general conditions, clinical manifestations, clinical history, birth history, developmental and behavioral history, family history, psychological and social environments, outcomes of psychological tests(including Achenbach children behavioral checklist, Wechsler intelligence scale for children-Revised, Wechsler preschool and primary scale of intelligence), day-time functional bladder capacity, outcomes of laboratory tests(such as urine routine, nocturnal urine specific gravity, x-ray graph of lumbar and sacral vertebrae, ultrasonic graph of urinary system etc), diagnosis, treatment procedure. The variables involved in the questionnaire were 43. All patients were treated with oral desmopressin. Before treatment, the blood pressure was tested. If it was abnormal, desmopressin should not be applied. Desmopressin was taken under the condition of stopping drinking water or any waterful food (like milk, watermelon and so on) after 5 pm. Oral desmopressin was taken with 10~20mL water 30 minutes before bed time. The short-term and long-term efficacy, changes in the period of treatment were observed. Logistic multi-factor analysis was applied to find out the therapeutic index that improved clinical efficacy of desmopressin. Results The short- term and long-term cure rates were 40.6% and 28.1%, respectively; The relapse rate was 57.5% 3 months after stopping desmopressin use. During the first month of treatment, the average frequency of enuretic onsets decreased dramatically from 6.38±1.82 times per week to 3.16±0.95 times per week whereas during the second, third and fourth month of treatment, the average frequency of enuretic onsets decreased mildly from 3.16±0.95 times per week to 2.54±0.69 times per week. Among 160 enuretic children, 85 children never got up to urinate by themselves before treatment, however after treatment there were 23 children who developed the ability to get up to urinate by themselves when the bladder was full during sleep. During the first month of treatment period, the median of enuretic occurrence time postponed apparently from 2~3am to 4~5am. Logistic regression analysis showed the risk factors that decrease efficacy of desmopressin were more than 7 times of bed-wetting onsets(RR=3.15,95%CI:2.84-4.64), less than 5ml/kg of the functional bladder capacity(RR=2.92,95%CI:1.86-3.93), nocturnally first bed-wetting onset after 4 am(RR=1.65,95%CI:1.16-2.55). Conclusions The short-term efficacy of desmopressin was rapid and good but the relapse rate was high, so the long-term efficacy of desmopressin was decreased. The clinical efficacy of desmopressin would be improved dramatically if selecting patients with bigger functional bladder capacity, fewer bed-wetting onsets, nocturnally first bed-wetting onset after 4 am.

Cited: Baidu(4)
Effect of zinc supplementation on mental development and motor development in infants: a meta-analysis
ZHU Di-ling, MAO Meng, YANG Wen-xu, YANG Hui-min
2011, 6 (1): 4-10.
Abstract4328)      PDF (7932KB)(3938)      

Objective To assess the efficacy of zinc supplementation for improving psychomotor developmental and mental developmental outcomes in infants younger than 3 years. Methods According to the requirements of Cochrane systematic review, a literature search was performed among PubMed, EMBASE, Cochrane library, CNKI, VIP and Wanfang data from the establishment of the database till October 2010. Mental developmental index (MDI), psychomotor developmental index (PDI) and development quotient (DQ) of 6-36 months after birth were measured as therapeutic efficacy index.RevMan 5.0 software was used for metaanalysis. The Cochrane handbook 5.0.2 was used to evaluate the methodological quality. Data extraction, quality assessment, and metaanalysis for the results of homogeneous studies were performed by two reviewers. Heterogeneity of the included articles was tested to select proper effective model. Measurement data were expressed as SMD, WMD and its 95%CI. Results Eightyfour articles were searched according to the inclusion and exclusion criteria, 21 reviews, 37 studies without zinc supplementation, 5 studies for pregnant mothers, 5 studies for children older than 3 years, 1 study in which zinc supplementation was not the only different intervention compared with control group and 5 studies without the outcomes were excluded. Ten RCTs meeting the inclusion criteria were enrolled. The assessment of literature quality showed 7 literatures described the method of random allocation in detail,8 literatures described allocation concealment, 8 literatures used double blind method,9 literatures reported complete data addressed and 9 literatures were free of selectively reporting. Only 1 literature described the sources of other bias.There was clinical heterogeneity in the 10 included studies. Nine RCTs (n=2 250) reported PDI with the Bayley Scales of Infant Development or Griffiths Mental Development Scales. There was no significant difference in the PDI between two groups, SMD=0.15(95%CI:-0.12 to 0.42). Eight RCTs (n=2 136) reported MDI with the Bayley Scales of Infant Development. There was no significant difference in the MDI between two groups, WMD=-0.08(95%CI:-1.55 to 1.40). Subgroup analyses were carried out for dosage, formulation (zinc alone or zinc combined with other nutrients) and nutrition status (varying measles case fatality rates). None of these subgroup analyses showed significant difference in the MDI or PDI between groups. One RCT (n=114) reported DQ using the Griffiths Mental Development Scales. The WMD of DQ was -0.72 (95%CI:-7.97 to 6.53). Another RCT (n=70) reported the change in Alberta Infant Motor Scale and did not show significant difference between groups, WMD=0.30(95%CI:-2.09 to 2.69). Conclusions Supplementation of zinc shows no effect on psychomotor development and mental development in infants. Further studies are needed to determine whether the findings are reproducible.

A meta-analysis of drug therapy for Henoch-Schonlein purpura nephritis in children
ZHAO Dan, WANG Jun, LI Hui-fang, ZHANG Yan-wu, DING Jie, YU Li
2007, 2 (2): 88-101.
Abstract4228)      PDF (895KB)(3558)      

Objective To assess the efficacy of drug therapy for Henoch-Schonlein purpura nephritis (HSPN) in children. Methods Medical electronic databases and other sources were searched without language restriction. According to including and excluding cretria,articles were evaluated ( Shekelle PG, et al). Randomized control trials (RCTs) were assessed according to the Juni assessment. Software Rev Man 4.2 was used to assess control trials, and other studies were reviewed and describe. Results Sixty-four papers were included out of 1948 papers. There were 1 article in grade Ⅰa, 6 in grade Ⅰb, 10 in grade Ⅱa, 34 in grade Ⅱb, and 13 in grade Ⅲ. We assessed the efficacy of steroids combined with immunosuppressants (76 cases) vs steroids alone (87 cases) by analyzing 1 RCT (Ⅰb) and 4 control trials (Ⅱa). There were significant differences in cure rate (RD=-0.39, 95% CI: -0.53--0.25) and effective power (RD=-0.43, 95%CI: -0.66--0.20) The efficacies of steroids combined with cyclophosphamide (CTX) pulse therapy (57 cases) vs steroids alone (49 cases) were revealed significant differences in cure rate (RD=-0.48, 95% CI:-0.74--0.23) and effective power (RD=-0.60, 95% CI: -0.81--0.40). CTX used alone was not effective compared to supported therapy from a RCT. Steroids combined with other drugs were confined to non-randomized control trials, so efficacy was difficult to evaluate. Conclusions Drug therapy for HSPN in children is still lack of consistent and common regimens. Steroids combined with immunosuppressants were effective for severe HSPN in children, in which steroids combined with CTX were the most effective; CTX used alone was not effective compared to supported therapy. Nevertheless, multicentre and large-scale RCTs are still needed. In addition, other drug regimens were limited to non-randomized control trials and difficult to evaluate.

Meta-analysis of the value of the procalcitonin test for the diagnosis of neonatal sepsis
YU Zhang-bin,ZHU Chun, HAN Shu-ping, GU Nan, SUN Qing
2010, 5 (1): 25-34.
Abstract4192)      PDF (1949KB)(4136)      

Objective To evaluate the value of the procalcitonin(PCT) test for diagnosing neonatal sepsis.Methods A search in Cochrane Library, PubMed, Ovid, Springer, China National Knowledge Infrastructure (CNKI), Wanfang Chinese Periodical Database and Chinese Bio-medicine Database(CBM)was performed to identify relevant articles from Januanary 1990 to October 2009. The language of the researches wasn′t limited. All non-English and non-Chinese articles were translated into Chinese to assess. Inclusion criteria were established based on validity criteria for diagnostic research. Subsequently, the characteristics of the included articles including study background,design information and diagnostic parameters were extracted. Statistical analysis was performed by employing Meta-DiSc 1.4 and SPSS 12.0 software. Heterogeneity of the included articles was tested for selecting proper effect model to calculate pooled weighted sensitivity , specificity and 95%CI. Summary receiver operating characteristic (SROC) curve was made and the area under the curve (AUC) and Q* index was calculated. Finally, sensitivity analysis and comparison of sensitivity among different groups were performed.Results We searched 446 relevant English articles, 98 Chinese articles and 21 other language articles. Thirty-three articles(18 English articles, 11 Chinese articles and 4 other language articles) were included, with total 3 599 newborns. Three articles meeting inclusion criteria were analyzed for the value of the PCT test for the diagnosis of clinical early onset neonatal sepsis (EONS) in umbilical cord blood at birth, the pooled sensitivity,specificity and SROC AUC were 77.7%,82.8% and 0.833 7,respectively. Eight articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of clinical EONS within 0-12 h after birth, the pooled sensitivity,specificity and SROC AUC were 76.7%,87.1% and 0.896 5,respectively. Four articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of clinical EONS within 12-24 h after birth, the pooled sensitivity,specificity and SROC AUC were 76.6%,88.5% and 0.884 4,respectively. Six articles meeting inclusion criteria were analyzed for the value of serum PCT levels for diagnosis of clinical EONS within 24-48 h after birth, the pooled sensitivity,specificity and SROC AUC were 69.8%,88.2% and 0.894 7,respectively. Fifteen articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of clinical late onset neonatal sepsis (LONS), the pooled sensitivity,specificity and SROC AUC were 79.0%,92.3% and 0.963 2,respectively. Fifteen articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of proven LONS, the pooled sensitivity,specificity and SROC AUC were 84.5%,80.9% and 0.934 5,respectively. Significant heterogeneity among studies was observed. Sensitivity analysis showed that differences in PCT assay producer and PCT cutoff, study countries, gestational age and severity of sepsis in the study population may partially explain the between- studies heterogeneity.Conclusions The PCT test showed good accuracy in diagnosing neonatal sepsis, regardless of differences in diagnostic criteria or time points for testing. PCT should be combined with other diagnostic markers to further improve the sensitivity and accuracy in the diagnosis of sepsis.

Cited: Baidu(15)
Study on cerebral maturation in neonates with different postmenstrual ages based on amplitude-integrated electroencephalogram and sample entropy
LIU Yun-feng, ZHOU Cong-le, ZHANG Dan-dan, WANG Hong-mei, TONG Xiao-mei, DING Hai-yan, HOU Xin-lin, TANG Ze-zhong
2010, 5 (4): 288-293.
Abstract4137)      PDF (1623KB)(4618)      

Objective To investigate cerebral maturation in neonates with different postmenstrual ages (PMA) using amplitude-integrated electroencephalogram (aEEG). Methods Appropriate gestational age neonates without specific diseases and PMA aged from 24 to 52 weeks were selected and grouped according to PMA. Electroencephalogram (EEG) was collected and aEEG waveform was calculated to analyze EEG amplitude changes and sleeping cycle including active sleep (AS) and quiet sleep (QS) in developing neonates. Sample entropy was calculated from EEG to explore the signal complexity changes during brain maturation. Results One hundred and sixty-five neonates were included (133 cases from the First Hospital of Peking University, 12 cases from the Third Hospital of Peking University, 20 cases from Austrilia aEEG database). Study subjects were grouped into <27 weeks (12 cases, all from Austrilia aEEG database), -32 weeks (22 cases, 8 from Austrilia aEEG database), -34 weeks (18 cases), -36 weeks (24 cases), -40 weeks (37 cases), -44 weeks (22 cases) and -52 weeks (30 cases). ①Sleep cycle was maturated with increasing PMA. aEEG showed likely burst suppression pattern without sleep cycle before PMA reached 27 weeks. Immature shaped AS and QS could be observed when PMA reached 32 weeks. Clear sleep cycle, which appeared as alternated AS and QS waveforms, was developed after PMA reached 37 weeks. ②aEEG amplitude in AS and QS was increased along with PMA overally. Amplitude was obviously increased before PMA by 37 weeks and after PMA by 44 weeks; aEEG amplitude was stable during 37 weeks to 44 weeks in PMA (6-20 μV in AS and 7-25 μV in QS). ③Sample entropy was increased during cerebral development before PMA by 37 weeks overally with its value enhanced more in AS than in QS. The fluctuation of sample entropy was decreased with increasing PMA. Fluctuated sample entropy could be observed before PMA by 32 weeks. Sample entropy was decreased after PMA by 37 weeks which indicated that electrical activity in neonatal brain tended to be more regular at this time. Conclusions Electrical activity in neonatal brain was maturated with increasing PMA. aEEG was a simplified method with intuitionistic waveform. It was a useful tool for neonatal cerebral function monitoring.

Cited: Baidu(7)
Association of FTO gene rs9939609, rs1421085 single nucleotide polymorphisms with obesity and matabolic parameters in Chinese Han children and adolescents
CAO Ling-feng,LUO Fei-hong, ZHI Di-jing, CHENG Ruo-qian, SHEN Shui-xian,YANG Yi
2010, 5 (1): 46-50.
Abstract4107)      PDF (913KB)(4254)      

Objective To investigate the role of the FTO gene rs9939609, rs1421085 polymorphism on obesity and relative trials in Chinese Han children and adolescents.Methods Obese/overweights children and adolescents and normal weight children as control aged 6-18 years old were enrolled. Body height and weight were measured and body mass index (BMI)was calculated. Serum fasting plasm glucose ( FPG) , fasting insulin ( FIns) , triglycerid (TG) and cholesterol (TC) were measured. HOMA-IR and QUICKI were calculated. Genomic DNA was extracted from peripheral blood, Taqman-MGB probe was used to detect the FTO rs9939609, rs1421085 polymorphism. Obesity was evaluated by using IOTF BMI standard. Results Obesity group, overweight group and normal control group included 236,239 and 241 children, respectively. ①The levels of FPG,FIns, TG and HOMA-IR were significantly higher in obesity/overweight group than that in normal control group.②The successful rates of rs9939609 typing in obesity group, overweight group and normal control group were 94.9%(224/236),97.9%(234/239) and 95.9%(231/241),respectively.The successful rates of rs1421085 typing in obesity group, overweight group and normal control group were 92.8% (219/236),97.1%(232/239) and 95.4%(230/241),respectively.The AA genotype frequency of rs9939609 was 2.7% in obesity group and 0.4% in overweight group and there existed significant difference compared with normal control group(genotype frequency 1.7%,P=0.048, OR=1.437). The CC genotype frequency of rs1421085 was 2.7% in obesity group and 0.9 % in overweight group and there existed significant difference compared with normal control group(genotype frequency 1.7%,P=0.076, OR=1.388).③There existed significant difference in BMI between the rs1421085 TC +CC, rs9939609 TA +AA genotypes when compared with their wild TT genotypes(rs9939609: P=0.000 3; rs1421085: P=0.000 5). However, FPG, FIns, TG, TC, HOMA-IR and QUICKI showed no significant difference between the rs1421085 TC +CC, rs9939609 TA +AA genotypes and their wild TT genotypes was not found.Conclusions FTO gene rs9939609 and rs1421085 SNP was firstly reported to be associated with obesity and BMI in Chinese Han children and adolescents, but the significant statistical association among the SNPs and obesity related metabolic parameters.

Cited: Baidu(12)
Epidemiologic pictures of Kawasaki Disease in Shanghai from 1998 through 2002
HUANG Guo-ying,MA Xiao-jing,HUANG Min,CHEN Shu-bao,HUANG Mei-rong,QIU Ding-zhong,GUO Zhong-zhen,JIANG Jin-jin,ZHOU Xiao-xun,YU Qing,GUI Yong-hao,NING Shou-bao,ZHANG Tuo-hong,DU Zhong-dong, Hiroshi Yanagawa,Tomisaku Kawasaki
2006, 1 (1): 8-13.
Abstract4058)      PDF (575KB)(4008)      

Objective To investigate the epidemiologic features of Kawasaki disease in the developed area of China. Methods A questionnaire form and diagnostic guidelines for Kawasaki disease were sent to hospitals in Shanghai, which provided with pediatric medical care. All patients with Kawasaki disease diagnosed during January 1998 through December 2002 were recruited in this study. Results A total of 768 patients with Kawasaki disease were reported. The incidence rates of Kawasaki disease for each year were 16.79 (1998), 25.65 (1999), 28.16 (2000), 28.05 (2001), and 36.76 (2002) per 100,000 children under 5 years of age. The male/female ratio was 1.83:1. The age at onset ranged from 1 month to 18.8 years (median 1.8 years). The disease occurred more frequently in spring and summer. Fever was the most common clinical symptom, followed by oral changes, extremities desquamate, rash, conjunctive congestion, lymphadenopathy, extremities swelling, and crissum desquamate. Cardiac abnormalities were found in 24.3% of patients. The most common cardiac abnormality was coronary artery lesions including dilatation (68%) and aneurysm (10%). Two patients died of heart failure and rupture of coronary aneurysm respectively at acute stage. The case-fatality rate of the disease was 0.26%. A second onset of the disease occurred in 1.82% of patients. Conclusion The incidence rate of Kawasaki disease in Shanghai is lower than that reported in Japan, but higher than those in western countries. The increasing trend in incidence, sex distribution and cardiac abnormalities are similar to those in previous reports. The seasonal distribution is similar to the report from Beijing and different from other reports.

Guildlines of evidence-based diagnosis and management for acute fever without source in children aged 0 to 5 years (standard version)
Group of guildlines of evidence-based diagnosis and management for acute fever without source in children aged 0 to 5 years
2016, 11 (2): 81-96.
Abstract4050)      PDF (2101KB)(8140)      
Histopathological study of congenital aortic valve malformation in 32 children
HUANG Ping1 ,WANG Hong-wei,LI Yan-ping,CHENG Pei-xuan,LIU Qing-jun,ZHANG Zhen-lu,LIU Jian-ying
2006, 1 (2): 130-133.
Abstract3974)      PDF (409KB)(3354)      

Objective: To investigate the histopathological characteristics of congenital aortic valve malformation in children. Methods: All the native surgically excised aortic valves from 32 pediatric patients because of symptomatic aortic valve dysfunction due to congenital aortic valve malformation received between January 2003 and December 2005 were studied macroscopically and microscopically. The patients' medical records were reviewed and the clinical information was extracted. The diagnosis was made by the clinical presentation,preoperative echocardiography, intraoperative examination, and postoperative histopathological study, excluding rheumatic or degenerative aortic valve disease, infective endocarditis and primary connectine disorders, eg, Marfan syndrome. Results: Among 32 aortic valves, patient age ranged from 6 to 18 years, with a mean of 14.9 years, and there were 27 men and 5 women, male: female = 5.4:1. There were 5 aortic stenosis (AS, 15.62%), 25 aortic insufficiency (AI, 78.13%) and 2 AS-AI (6.25%) cases, without other valve diseases. Twenty still had other congenital heart diseases: ventricular septal defect,19; patent ductus arteriosus, 2; double chamber right ventricles, 1; aortic right coronary sinus aneurysm, 3. Histopathological examination indicated that the cusp became thickening with unequal size, irregular shape (coiling and prolapse edge), enhanced hardness, and partly calcification. Microscopical investigation showed the unsharp structure of valve tissue, fibrosis, myxomatous, reduce of collagen fiber, rupture of elastic fibers, different degree of infiltration of inflammatory cells, secondary calcareous and lipid deposit, and secondary fibrosis. Conclusion: Congenital aortic valve malformation in children involves male more then female, mostly associated with other congenital heart diseases. Aortic insufficiency is more common in children with congenital aortic valve malformation. Histopathologically, the leaflets of aortic valve are mainly myxomatous, thickening with unequal size, irregular shape (coiling and prolapse edge), reduce of collagen fiber, rupture of elastic fibers, without small vessel proliferation and inflammatory cell infiltration, fibrosis and calcification less seen.

Study on body proportions of 0-18 years old children and adolescents in China
ZHANG Ya-qin,LI Hui, JI Cheng-ye
2010, 5 (5): 349-354.
Abstract3931)      PDF (952KB)(4804)      

Objective To know the growth rhythm of body proportions of 0-18 years old Chinese healthy children and adolescents, and analyze gender difference, regional difference and secular changes of body proportions. Methods Healthy Han children and adolescents in 9 provinces (cities) from two national representative cross-sectional surveys named "The National Growth Survey of Children under 7 years in the Nine Cities of China in 2005" and "The Physical Fitness and Health Surveillance of Chinese School Students in 2005" were enrolled .The data of the above-mentioned two investigations in 1985 were used to analyze the secular changes of the ratio of sitting height to leg length(crown-rump length)(SH/LL). Crown-rump length and length were measured before 3 years old, and from 3 years old onward, sitting height and height were measured . Leg length was obtained by subtracting sitting height (crown-rump length) from height (length). Results ①SH/LL decreased gradually with age and bottomed at 12-13 years of age in boys and 10-11 years of age in girls. Then SH/LL increased slightly and kept flatting after 17 years of age. ②Before 11 years old, the gender difference was not obvious in SH/LL, and after that SH/LL of girls was slightly higher than that of boys. The gender difference was relatively large at the age of 13 years. SH/LL of urban and rural children was similar before 6-7 years of age, after that SH/LL of rural children was slightly higher than that of urban children and then the difference wasn′t obvious after 12-13 years of age. The SH/LL charts were almost coincident in different areas. ③The SH/LL of 7-12 years old children slightly decreased and the SH/LL of preschool and late pubertal children had no obvious change from 1985 to 2005. Conclusions SH/LL is regularly changed with age in 0-18 years old Chinese children and adolescents. There is no gender difference in pre-pubertal children, and SH/LL of girls is higher slightly than that of boys after post-pubertal. There are not obvious urban-rural difference, regional difference or secular change in SH/LL in China.

Cited: Baidu(3)
Update Pubertal Development in Beijing School-aged Girls
HOU Dong-qing,LI Hui,SUN Shu-ying,XIA Xiu-lan,CHEN Fang-fang,MI Jie
2006, 1 (4): 264-268.
Abstract3909)      PDF (488KB)(3907)      

Abstract Objective:To determine the current status of pubertal development and prevalence of sexual precocity among Beijing school-aged girls. Methods:As part of the Beijing Child and Adolescent Metabolic Syndrome Study (BCAMS), a cross-sectional study on the presence of secondary sexual characteristics among 9 778 school-aged girls aged 6~18 years was undertaken in Beijing city from April to October 2004. All participants completed a questionnaire on demographic variables. The stages of breast and pubic hair development were assessed through visual inspection using standardized drawings and descriptions based on Tanner criteria. Palpation was required for the assessment of breast stage in order to distinguish adiposity and galactophore. Age at menarche was collected by self-report. Status quo method or probit transformation analysis were used to calculated the median age at menarche and at onset of breast (B2) and pubic hair (P2). Sexual precocity was defined as onset of B2 or P2 before 8 years, or menarche before 10 years. Results: Among 9 778 girls who participated in this study, 5 040 girls (51 .5%) resided in urban. The median menarcheal age was 12.1 (SD=1.1) years in Beijing girls, urban girls experienced menarche, on average, 0.6 years (7.2 months) earlier than did girls in rural (11.9±1.1 vs 12.5±1.1 years). Tanner breast 2 stage (B2) was present at 9.5±1.2 years of age in all girls, 9.4±1.1 years in urban girls, and 9.6±1.2 years in rural girls. Age at onset of pubic hair (P2) was 11.1±1.1 years, 10.8±1.1 years and 11.4±1.1 years in all, urban girls and rural girls, respectively. Comparison with historical data, menarcheal age of Beijing girls has been advanced by 2.1 years since 1962, when the menarche began at 14.16 years, on average of 0.7 years (8.4 months) per decade during 1962~1982, and decreased to 0.43 years (5.2 months) per decade during 1992~2004. The prevalence rates of sexual precocity diagnosed by menarche, breast and pubic hair were 0.79%, 2.91% and 0.22%, respectively. Conclusions:Urban girls in Beijing experienced earlier menarche and onset of secondary sexual characteristics than rural girls. The secular trend towards earlier menarche was observed in Beijing girls over the past 40 years, but the trend appears to decrease in the most recent decade.

A randomized control trial study of biofeedback and DDAVP in children with primary nocturnal enuresis
WANG Qing-ling, BI Yun-li, XU Hong, CAO Qi, RUAN Shuang-sui
2006, 1 (4): 251-257.
Abstract3903)      PDF (590KB)(3157)      

Objective:To investigate the difference effect of biofeedback and DDAVP on PNE children by a randomized control trial (RCT) study. Methods:PNE children who were diagnosed by pediatricians of children's hospital of Fudan University from July 2005 to January 2006 were divided into two groups randomly, one is DDAVP group and the other is biofeedback group. All patients underwent one month's treatment and three month's follow-up. Items of follow-up included enuresis diary,urine flow rate and AQP2 in urine. Results:All 50 PNE children included 26 boys and 24 girls, whose mean age was 8.4±0.9 years. The effective rate of biofeedback was higher than that of DDAVP at the end of treatment and the third month of follow-up. But there was no significantly difference in cure rate and relapse rate in two groups. Compared with the data before treatment, maximum flow rate, voided volume, ratio of normal curves and ratio of Detrusor-sphincter consistentness increased significantly at the end of treatment in biofeedback-group. Two bands of AQP2 were detected in urine. Density of two bands of patients were significantly lower than that of controls. At the end of treatment density of two bands were significantly higher than that of before treatment in DDAVP group. Conclusion:Biofeedback and DDAVP are both effective therapies for PNE. With higher effective rate within four month, biofeedback is worth applying in PNE children. Biofeedback is helpful for correcting voiding dysfunction and DDAVP can increase AQP2 protein in urine.

Cited: Baidu(9)
The validation of the classification criterion of waist and waist-to-height ratio for cardiometabolic risk factors in Chinese school-age children
MENG Ling-hui,MI Jie
2008, 3 (5): 324-332.
Abstract3886)      PDF (1355KB)(3795)      

Abstract Objective To restudy and identify the cutoffs for waist circumference and waist-to-height ratio that indicate increased risk of cardiovascular risk factors and their clustering that would be consistent with central adiposity in Chinese school-age children.Methods The author of this paper had brought forward 80th percentile of waist circumference by age and gender and waist-to-height ratio equal to 0.46 as the primary cutoffs of school-age children and adolescents central adiposity in the BCAMS study, which was a cross-sectional representative population based survey on Metabolic Syndrome for Children and Adolescents in Beijing. But the cardiovascular risk factors results were based on the finger-stick capillary test in that study. This time a total of 3 525 schoolage children aged 6-18 years were recruited from the BCAMS study. 1 454 schoolchildren aged 7-18 years were recruited from 8 schools in district of Haidian in Beijing. Data of anthropometric measures including weight, height, waist circumference and blood pressure were collected. Venous blood samples were obtained after a 12-hour fast, and the levels of fasting plasma glucose (FPG), triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL-C) and high density lipoproteincholesterol (HDL-C) were measured. In this study high blood pressure (HBP) was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥95 th percentile for age and gender of schoolchildren in Beijing in 2004. Impaired fasting glucose (IFG) was diagnosed according to updated ADA standard of USA (2005, FG≥5.6 mmol·L-1), blood levels of TG≥1.7 mmol·L-1, blood levels of TC≥5.2 mmol·L-1, HDLC≤1.03 mmol·L-1 were defined as raised TG, raised TC and Low HDLC, respectively. For the 1 454 recruited children in Haidian, liver were tested by ultrasonographic, and abnormal hepatic sonograms were diagnosed additionally. Elevated glutamatepyruvate transaminase was diagnosed by ALT≥40.0 U·L-1 and elevated glutamicoxalacetic transaminase was determined by AST≥45.0 U·L-1. Nonalcoholic fatty liver was diagnosed according to the diagnostic criteria of nonalcoholic fatty liver disease recommended by the Fatty Liver and Alcoholic Liver Disease Study Group of Chinese Liver Disease Association. 70 th, 75 th, 80 th, 85 th, 90 th and 95 th percentiles by gender and age for WC, WHtR equal to 0.42, 0.44, 0.46, 0.48, 0.50 and 0.52 were selected as temporary criterions based on primary screening cutoffs brought forward in the last paper of the author. Statistic methods included the followings, measurement data were expressed by mean and standard deviation and analyzed with independent sample t-test, categorical data were compared with chisquare analyze, analysis of covariance adjusted by gender, age and puberty status was used to compare the level of cardiovascularity in stratification, and classical screening study. A probability level of P < 0.05 was used to indicate statistical significance.ResultsMean BMI, systolic blood pressure, diastolic blood pressure, triglyceride and total cholesterol levels were incrementally higher and mean HDL-cholesterol values were incrementally lower with each unit increase in waist circumference and waist-to-height ratio. And the abnormal rates of the cardiovascular risk factors and their clustering increased with WC and WHtR. Both the points at which sensitivity and specificity were equally perfect at sex, agespecified 85th percentile of waist circumference and a waist-to-height ratio of 0.48 optimal cutoffs. At those points positive predictive value and negative predictive value were all optimal.Conclusions Cutoffs of waist circumference at 85th percentile by age and gender and waist-to-height ratio equal to 0.48 are needed in the identification of Chinese school-age children and adolescents at high risk of cardiovascular risk factors and their clustering.

Study of predictive validity and reliability of qualitative general movements assessment for neurological outcome in high risk neonates
YANG Hong, SHI Wei,SHAO Xiao-mei, WANG Yi, CAO Yun, WANG Su-juan, XU Xiu-juan, ZHANG Xu-dong, LIAO Yuan-gui, LI Hui, ZHU Mo
2007, 2 (3): 172-180.
Abstract3873)      PDF (673KB)(3223)      

Objective Prechtl's Qualitative general movements assessment (GMs assessement) was first applied in our clinical research in China. Predictive validity and reliability of GMs assessment for neurological outcome in high risk neonates were studied. Methods According to the inclusion and exclusion criteria, infants who took part in our follow-up clinic after discharged from our neonatal intensive care unit were confirmed as the participants. GMs recordings during preterm GMs and writhing movements period (at least once) and fidgety movements period (at least once) were collected and assessed. Neurological outcome was determined at least after one year old. Peabody Developmental Motor Scale-2(PDMS-2) was adopted to confirm the presence of motor retardation. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Interscorer reliability was tested in 12 infants by 30 observers. 12 infants received a second assessment to assess test-retest reliability after a two month interval by 6 observers. Results 58 (male 34, female 24 )high risk neonates after follow-up (12-40 mos ) were included as study participants. 42 (72%) preterm infants with an average gestational age as (31.4± 2.0)weeks and an average birth weight as (1 642 ±408)gram were included. 16 (28%) fullterm infants with an average gestational age as (38.6 ±1.1)weeks and an average birth weight as (3 401±365)gram were included. During preterm GMs and writhing movements period, 115 GMs recordings with an average of (2.0 ±0.8) times per infant were collected. During fidgety movements period, 89 GMs recordings with an average of (1.5 ±0.6) times per infant were collected. The neurological outcomes were as follows: 7 (12%)infants with spastic cerebral palsy, 5 (9%) infants with motor retardation and 46(79%)with normal motor development. In preterm GMs and writhing movements period, predictive validity was as follows: sensitivity 83%, specificity 78%, positive predictive value 50%, and negative predictive value 95%. In fidgety movements period, predictive validity was as follows: sensitivity 75%, specificity 98%, positive predictive value 90%, and negative predictive value 94%. GMs assessment was found to possess a good interscorer reliability(ICC:0.97-0.99) as well as a moderate testretest reliability(ICC:0.69). Conclusions GMs assessment can be used in high risk infants within 4 to 5 months to give a reliable and valid prediction for later neurological outcome, especially for cerebral palsy. There existed a high interscorer reliability and moderate test-retest reliability in basic observers. As a non-invasive, non-intrusive, simple and economical neurological assessment tool, GMs assessment can be extensively used in China.

Cited: Baidu(40)
Using waist circumference and waist-to-height ratio to access central obesity in children and adolescents
MENG Ling-hui, MI Jie, CHENG Hong, HOU Dong-qing, ZHAO Xiao-yuan, DING Xiu-yuan
2007, 2 (4): 245-252.
Abstract3855)      PDF (601KB)(3399)      

Objective To analyze the distribution of waist circumference and waist-to-height ratio for 3-18 year old children and to explore the related optimal thresholds for schoolchildren in Beijing based on the assessment of cardiovascular risk factors. Methods As part of the Beijing Child and Adolescent Metabolic Syndrome study, a stratified cluster representative sample of 23 422 children aged 0-18 years was selected. Anthropometric measures including height, weight and waist circumference data were collected from about 20 000 subjects aged 3-18 years. Fasting finger-stick capillary whole blood levels of glucose, total cholesterol and triglyceride were measured by Accutrend GCT measuring system. Receiver operating characteristic analysis was used to determine the waist circumference and waist-to-height ratio to discriminate between the presence and absence of the abnormality of these cardiovascular risk factors and to determine the optimal thresholds by age and gender. The second sample was made up of 2 794 children and adolescents (1 456 male and 1 338 female), aged 6 to 17 years, randomly selected from 18 districts in the Beijing area. Systolic and diastolic blood pressure data were collected. Fasting serum lipids including total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, fasting plasma glucose, anthropometric index as height and waist circumference were measured. According to waist circumference and waist-to-height ratio cut off points, test samples were fallen into two groups including a normal group and an obesity group. The average levels and abnormal rates of the cardiovascular risk factors were compared with general linear model analysis between the two groups. Results ① The waist circumference measurements were differed by age, gender and urban-rural residence, and the waist-to-height ratio remained comparatively steady among different groups. ② After adjusting for age, gender, urban-rural residence, the binary logistic regression model results suggested that waist circumference and waist-to-height ratio were important predictors for cardiovascular risk factors. ③ Receiver operating characteristic analysis results showed that the 80th percentile of waist circumference for age and gender, and waist-to-height ratio equal to 0.46 could be taken as the optimal thresholds. There were significant differences for the average levels of systolic and diastolic blood pressure, serum triglyceride, high density lipoprotein cholesterol and their abnormal rates between the groups divided by the two cut off points. Conclusions As in adults, waist circumference is a better predictor of cardiovascular risk factors in schoolchildren. Waist circumference, which can be easily measured, should be collected for schoolchildren during annual routine physical examinations.

Amplitude integrated EEG characteristics of normal full-term newborns:a multicenter clinical study
SHI Yi-yun,CHENG Guo-qiang,SHAO Xiao-mei,ZHUANG De-yi,LIU Deng-li,LIU Xian-zhi,WANG Ji-mei,YAO Ming-zhu,WANG Zhi-zhong,ZHOU Wen-hao,WANG Lai-shuan,CAO Yun
2009, 4 (6): 514-519.
Abstract3849)      PDF (1226KB)(3087)      

ObjectiveTo study the characteristics of amplitude integrated electroencephalogram(aEEG) of normal full-term neonates within 3 days after birth MethodsaEEG was recorded for 3 hours by the first native EEG instrument in 1,2 and 3 days old in normal full-term newborns; voltages of aEEG were calculated with semi-logarithmic formula manually. The background, voltage level and sleep-wake cycle were analyzed. Results①For normal full-term newborns,the background of aEEG was continuous voltage, and sleep-wake cycle was observed in 905% newborns 1 day after birth and 100% newborns 2 and 3 day after birth. ②The average duration of sleep-wake cycle was (699 ± 187)min. The average duration of sleep and awake phase was (220 ± 57)min and (479 ± 171)min,respectively. ③The minimum amplitude of the aEEG background was (128 ± 34), (121 ± 20) and (125 ± 26)μV at the age of 1,2 and 3 days respectively; the maximum amplitude was (375 ± 110),(384 ± 94) and (386 ± 96) μV at the age of 1,2 and 3 days respectively. ④The gestational age,age,gender,mode of delivery and maternal complications during pregnancy had no effect on aEEG voltage and sleep-wake cycle of aEEG among 38-42 weeks of gestational age in normal newborns.The voltages of the upper boundary of wide and narrow band were higher within the first three days at 37- weeks of gestational age newborns than those at 38-42 weeks newborns,especially the voltages of narrow-band(P=0014). ConclusionsIn normal full-term newborns,the aEEG background was continuous voltage and sleep-awake cycle existed;the minimum voltage was>5 μV and the maximum voltage>10 μV.The gestational age, age, gender, mode of delivery and maternal complications during pregnancy had no effect on aEEG in normal full-term newborns.

Cited: Baidu(17)
Study on reliability and unidimension of the Fine Motor Function Measure Scale for children with cerebral palsy
SHI Wei, LI Hui, YANG Hong, SU Yi, ZHANG Jian-ping
2008, 3 (2): 110-118.
Abstract3834)      PDF (959KB)(2986)      

Objective To analyze unidimension,internal reliability and external reliability of the Fine Motor Function Measure Scale (FMFM)for Children with Cerebral Palsy.Methods 696 children with cerebral palsy participated in the study. 481 males(69.1%)and 215 females,the average age was 30.0 months(SD:25.9months),ranged from 2 to 183 months;Types of CP in the children were spastic quadriplegia(n=239,34.3%),spastic diplegia(n=212,30.4%),spastic hemiplegia(n=185,26.6%),athetoid(n=30,4.3%),dystonic(n=21,3.0%),ataxic(n=9,1.3%).The 86 test items formed FMFM sampling scale. All samples were measured by FMFM sampling scale at least once.86 test items of FMFM sampling scale and 696 samples were analyzed by Rasch analysis using the partial credit model(PCM). Unidimension of scale was determined by item misfit criterion(FITI), and the FITI was set as meansquare values (MnSq) from 0.6 to 1.4, At the same time ultimate selected items of the FMFM were determined.Then test-free person measurement and sample-free item calibration of these items components of FMFM were analyzed. The first 23 samples were included for testretest reliability study with a interval of 1 to 7 days. 49 samples were selected for interscorer reliability analysis.ResultsAfter three screenings, 25 items were deleted from 86 items of FMFM sampling scale. Among the remained 61 items, the misfit items were 3, less than 5% of all, suggesting that the majority items of this measure were good in unidimension, The mean standard error of item difficulty measuring was 0.09 (range 0.06-0.15), and the reliability of items was 1.00, showing that these items had good reliability. The item separation value was 38.09, showing that these items had good stratification of difficulty.The mean standard error of the sample ability measure was 0.30 (range 0.21-1.05). The reliability of samples was 0.99, showing that the FMFM had good reliability. The item separation value was 9.13, showing that the FMFM had good stratification of difficulty. finally formal FMFM Scale of 61 items was composed. At the same time the difficulty order and criterion of the ultimate selected item were determined. Correlations between sample ability scores of different item conditions were analyzed and results indicated that FMFM had good test-free person measurement, The Pearson correlation between sample ability scores under different item conditions was very high(r=0.976-0.995). Correlations between items difficulty values of different sample conditions were also analyzed and results confirmed that FMFM had good sample-free item calibration. The Pearson correlation between item difficulty under three sample conditions was very high(r=0.993-0.998). FMFM had good testretest reliability (ICC=0.989 3,95%CI:0.975 3-0.995 4)as well as good interscorer reliability(ICC=0.996 1,95%CI:0.993 2-0.997 8).Conclusions FMFM had excellent unidimension,internal reliability and external reliability,which would lay good foundation for future usage of FMFM. Further studies about validity and responsiveness of FMFM are needed.

The protective effects of mild hypothermia on liver and lung tissues in septic rats
LIU Chun-feng, ZHANG Qu
2008, 3 (1): 45-49.
Abstract3822)      PDF (1108KB)(2789)      

Objective To investigate the effects of mild hypothermia on septic rats, including the energy metabolization of liver and the levels of tumor necrotic factor-α mRNA combined with the ultrastructure changes of liver and lung and to discuss preliminarily whether mild hypothermia treatment(MHT) can decrease the degrees of septic injury . Methods Twenty four Wistar rats were divided randomly into normal control (NC) group, lipopolysaccharide (LPS)group , mild hypothermia theatment (MHT) group . The models of septic rats were prepared.Livers were conservated in liquefacient Nitrogen to determine the levels of Adenine nucleotides, and lactate and lungs were frozen in Eppendorf tubes at -80℃ to determine the levels of TNF-αmRNA.The levels of adenine nucleotides and lactate were determined by high performance liquid chromatography (HPLC) and biochemistry method. The levels of TNFα mRNA were determined by RTPCR method. The ultrastructure changes of liver and lung were investigated using electronic microscope.Finally the data were dealed with SAS statistical software. Results Compared with the NC group rats [ATP (4.990±0.455), ADP(1.632±0.181) ,AMP(1.737±0.407)μmol·g-1(wet) ], the levels of adenine nucleotides in liver tissue of LPS group rats [ATP (4.093 ±0.424), ADP (1. 331±0.136), AMP (1.331 ±0.312)μmol·g-1(wet) ] and MHT group rats[ATP (4.519±0.028),ADP (1.483±0.108),AMP (1.544±0.301)μmol·g-1(wet)]were decreased. The levels of adenine nucleotides were increased significantly in MHT group rats than that in LPS group rats; The lactate levels of MHT group [(1.424±0.213)mmol·g-1(prot)] were lower than that of LPS group[(1.676±0.267)mmol·g-1(prot),P<0.05], and no significant difference was found comparing with NC group[(1.379±0.314)mmol·g-1(prot),P>0.05];Compared with the NC group rats (0.625±0.009,0.631±0.007,0.612±0.011) , the levels of TNF-α mRNA in lung tissue of LPS group rats (1.029±0.055,1.132±0.068,1.107±0.044) and MHT group rats(0.835±0.041、1.056±0.037、1.056±0.032)were increased(P<0.05). The levels of lung TNFα mRNA were lower significantly in MHT group rats than that in LPS group rats(P<0.05); The liver and lung in MHT group rats showed less severe ultrastructure changes than that in LPS group rats electronicmicroscopically. Conclusions Mild hypothermia could slow the energy expenditure in the liver tissue of septic rats, decrease TNF-α mRNA expression in the lung tissue of septic rats, and decrease the severity of liver and lung injury to some extent.

Treatment and prognosis of childhood absence epilepsy in 240 patients: Application of modified diagnostic criteria of childhood absence epilepsy 1989
MA Xiu-wei,ZHANG Yue-hua,LIU Xiao-yan,SUN Hui-hui,WU Hu-sheng,XU Ke-ming,LIANG Jian-min ,QIN Jiong,WU Xi-ru
2008, 3 (6): 419-425.
Abstract3786)      PDF (1002KB)(2672)      

ObjectiveChildhood absence epilepsy (CAE)is one of the idiopathic generalized epilepsy syndrome, characterized by multiple typical absence seizures per day. The aim of this study was to investigate the effectiveness of medical treatment and prognosis of CAE patients from three hospitals in Beijing.MethodsAll patients were collected from the three hospitals between October 1999 and December 2005 as part of a research project to identify susceptibility genes of CAE with the same inclusion and exclusion criteria. The diagnostic criteria of CAE were proposed by the International League Against Epilepsy (ILAE) in 1989. Patients were treated in the three different hospitals. Doctors who collected the patients made a decision of choice of antiepileptic drugs. The effectiveness of medical treatment on seizures and the prognosis of the CAE patients were followed up. ResultsIn a cohort of 339 patients fulfilled the diagnostic criteria of CAE proposed by the ILAE in 1989, 296 of 339 patients met the inclusion criteria of this study, outcome was available in 240 of 296 patients. Among 240 patients, 94 were males (39.2%) and 146 were females (60.8%). The onset age of absence seizures ranged from 3 years and 3 months to 12 years, with a peak around 4 to 8 years (72.5%) of age. Thirty nine patients (16.2%) had a history of febrile seizures. Eighteen patients (7.5%) had a family history of febrile seizures or epilepsy. Twelve patients (5%) subsequently had several generalized toniclonic seizures. One patient had a history of absence status epilepticus. All patients had electroencephalogram pattern with a bilateral symmetric and synchronous discharge of regular 3Hz spikeave discharges after spontaneity or hyperventilation. Valproic acid (VPA) was the first choice of drug therapy in 234 patients. Seizures were controlled in 217 out of 234 patients by VPA monotherapy. Fifteen of 234 patients received clonazepam (7), nazepam (4), or lamotrigine (4) as an add therapy. All of their seizures were controlled. Lamotrigine was the first choice in 4 cases, 3 of them were completely controlled. Topiramate was the first choice in 2 cases, one was also completely controlled. All patients were followed up for 2 to 7 years. One hundred fifty eight patients(65.8%) had withdrawn antiepileptic drugs, complete remission maintained for more than 1 year after withdrawal of medication in 96 patients. No seizure relapsed in patients after medication withdrawal. Complete remission maintained for more than 2 years on medication in 80 patients. Only 2 patients still had seizures on medication. Learning score in the school was beyond the middle level in 171 patients (71.3%).ConclusionsVPA is the first drug for CAE. It is effective in the majority of patients. Lamotrigine and benzodiazepines appear to be effective in resistant absence seizures in combination with VPA. Typical CAE is an epileptic syndrome with an excellent prognosis.

Cited: Baidu(5)
Reference values and determinants of fractional exhaled nitric oxide in 225 healthy children in Suzhou
LIU Yuan-yuan,LU Yan-hong,HAO Chuang-li
2012, 7 (2): 132-135.
Abstract3784)      PDF (783KB)(3179)      

Objectives:The aim of this study was to establish FeNO reference values for healthy school-aged children in Suzhou according to the international guidelines, and to assess the determinants of FeNO. Methods:Children aged 6-14 years were recruited from two public schools in Suzhou. The subjects completed a respiratory questionnaire, and were examined with measurements of FeNO, spirometry and blood eosinophil. Healthy children were screened to establish reference values of FeNO. FeNO was measured with a chemiluminescence analyzer according to American Thoracic Society guidelines (single breath online, exhalation flow 50 mL·s-1). The associations between different determinants (sex, age, height, weight, BMI, peripheral blood EOS count, FEV1/FVC, lung function) and FeNO were analyzed. Results:Finally, a total of 450 children participated in the study, and 225 children fulfilled the inclusion criteria of healthy subjects (107 boys and 118 girls). FeNO data were skewed, and met normal distribution after natural logarithm transformation. The geometric mean of FeNO in 225 children was 11 parts per billion (ppb) (95%CI: 5-28 ppb), the minimum value was below 5 ppb, and the maximum value was 83 ppb. The mean value was 11 ppb (95% CI:5-31 ppb) for boys and 11 ppb (95%CI: 5-25 ppb) for girls. In stepwise multiple regression analysis, peripheral blood EOS count was found to be the best independent variable for the regression equation for FeNO (r=0.291, P<0.000 1). Height (r=0.148, P=0.027) and FEV1 (r=0.138, P=0.038) were significantly correlated with FeNO. FeNO in children aged >9 years was significant higher than that in children aged ≤ 9 years(P=0.002). Sex, weight, BMI and FEV1/FVC were not associated with FeNO. Conclusions:FeNO reference values of healthy children aged 6 to 14 years in Suzhou should be considered to fall between the following ranges: 5-28 ppb, which is slightly higher than European and American children. FeNO levels in healthy school-aged children appear to be affected by EOS count and height significantly, followed by FEV1, and not influenced by sex, age, weight, BMI and FEV1/FVC.

Cyclophosphamide for primary nephronic syndrome of children: A Systematic Review
SUN Qiang, SHEN Ying,PENG Xiao-xia, LI Hua-rong
2006, 1 (2): 89-98.
Abstract3741)      PDF (793KB)(3543)      

Objective To sysmetically review the efficiency and safety of cyclophosphamide against primary nephritic syndrome of children, and try to find the best regime of cyclophosphamide therapy. Method MEDLINE(1963-2004.12), OVID, SPINGER, CNKI database(1994--2004) were searched by using the terms Cyclophosphamide and Nephrotic Syndrome for hunman clinical trials, including unpublished documents from scientific meetings and thesis, and the similar documents listed in the references of above documents were also included . All of the randomized controlled trials were included comparing cyclophosphamide with general medicine and other immunosuppressive agents or comparing different dasage , duration and different methods of cyclophoaphamide medication for the treatment of primary nephritic syndrome of children. Two reviewers independently performed data extraction and appraised using Juni instrument; disagreements were resolved by consensus. Double data were input and analyzed by software of Review Manager 4.2 ,which is recommended by Cochrane Collaboration. Results Thirtteen RCTs were included. Cyclophosphamide with prednisone significantly reduce the one year's relapse risk [3trials; RR0.39,95%CI 0.18 to 0.87]compared with prednisone alone, and there's no data favous cyclophosphmide at one to two years (RR3.45 ,95%CI 0.63 to18.93).there is no observed difference in remission rate at one year[2trials; RR0.94,95%CI 0.30 to 2.98]. Intravenous cyclophosphamide can significantly raise the remission risk at six months and one year compared with oral cyclophosphamide (RR1.76,95%CI 1.03 to 2.98). About duration: eight weeks cyclophosphamide comparing two weeks therapy, can effectively reduce the relapse risk, but long-term effect is unknown ( RR1.42,95%CI 1.15 to 1.75). Twelve weeks cyclophoaphamide comparing eight weeks therapy, there is no significant difference on relapse risk within five years between them (RR1.00,95%CI 0.67 to 1.50). Considering there will be more unpleasant event when the dosage is raised, eight weeks cyclophosphamide therapy is more suitable. Conclusion Cyclophosphamide with prednisone significantly reduce the one year's relapse risk compared with prednisone alone, Intravenous cyclophosphamide can significantly raise the remission risk within one year and has less accumulative dosage ,more safer than oral cyclophosphamide. Further adequately powered and well-designed RCTs are needed to evaluate the long-term effect of cyclophoaphamide.

Cited: Baidu(1)
Streptococcus necrotizing pneumonia in children
YAO Kai-Hu, ZHAO Shun-ying, YANG Yong-hong
2007, 2 (6): 449-454.
Abstract3729)      PDF (1228KB)(3259)      
Molecular epidemiology of norovirus infection in hospitalized children with diarrhea in partial areas of Shanghai, China, 2001-2005
XU Jin, SUN Jia-e, DING Yun-zhen, SU Li-yun, YANG Yi
2008, 3 (5): 340-344.
Abstract3726)      PDF (1287KB)(3394)      

Abstract Objective As a genus of human calicivirus, norovirus has been recognized as the most common cause of foodborne and nosocomial outbreaks of acute nonbacterial gastroenteritis in humans worldwide and the secondly important pathogen for viral diarrhea in hospitalized children. The aim of the present study was to evaluate the prevalence of norovirus in hospitalized children under 5 years old with acute gastroenteritis in the biggest pediatric hospital in Shanghai, China over a long period. The information will provide important data and theoretical basis for development of norovirus vaccine and control of norovirus infection.Methods A total of 5 534 stool samples were collected from hospitalized children with acute diarrhea in children's hospital, Fudan University during 2001 to 2005. 96% of the samples were collected within 5 days after illness onset. After all the samples were tested for rotavirus antigen, systematic sampling was applied to collect 484 samples from all the rotavirus negative stools. RNA was purified from 10% (W/V) of fecal suspensions using TRIzol. RT-PCR was applied for determination of norovirus. A multiple sequence alignment of 170nt nucleotide sequence from region B of the polymerase region sequence was constructed using Clustal W. Phylogenetic trees were constructed using Mega 4.1 software by the neighborjoining methods. Results Of the 45 norovirus infected children, more than onethird (35.6%) were at 6-11 months of age, followed by 12-23 months (22.2%) and 0-5 months (20%). The monthly distribution of norovirus infection illustrated a seasonal peak from August (17%) to November (9.8%). Another small peak was found in May and June. Among the 6 norovirus positive samples in 2001, 2 were identified to be GⅡ-7, one was GⅡ-3 and the other 3 strains were GⅡ-4 genotype. 1 sample belonged to GⅡ-3 and the other 3 were GⅡ-4 in the years of 2002. All the 27 samples during the years of 2003 to 2005 were identified to be GⅡ-4 genotype.Conclusions A seasonal and age distribution of norovirus infections was found in hospitalized children in Shanghai. GⅡ-4 was the most predominant genocluster circulating in the 5 years. Our findings will provide useful data for prevention of norovirus diseases in children in Shanghai.

Meta-analysis of the therapeutic effect of hypothermia on severe brain injury
SUN Jin-qiao, YANG Yi
2007, 2 (3): 165-171.
Abstract3708)      PDF (528KB)(3253)      

Objective Hypothermia as a therapy has been used to treat severe brain injury. However, there is controversy about its therapeutic effect. Therefore, in this study, we summarized the data of severe brain injured patients who were treated with mild hypothermia. Using meta-analysis method, we compared the clinical effectiveness of hypothermia on patients with severe brain injury and investigated the feasibility of hypothermia therapy. Methods PubMed, EMBASE, Ovid, Springer, CNKI database were searched by using the terms Hypothermia and Severe Brain Injury for human clinical trials, including unpublished documents from scientific meetings and thesis, and the similar documents listed in the reference of above documents were also included. All of the randomized controlled trials were included by comparing hypothermia with routine therapy for the treatment of patients with severe brain injury. Two reviewers independently performed data extraction and appraised using Juni instrument; disagreements were resolved by consensus. Double data were input and analyzed by software of Review Manager 4.22, recommended by Cochrane Collaboration. Intracranial pressure (ICP) and curative effects of patients were selected, and the combined OR value and 95% confidence interval (CI) of them were calculated. Results 9 randomized controlled trials involving 1279 children were included. Publication bias was not found through funnel plot analysis. There are 5 publications reported the change of ICP, including hypothermia group (n=479) and routine therapy group (n=473). Compared to the routine therapy, hypothermia could significantly degrade the ICP of patients (post-treatment 24 h, WMD=-4.78, 95%CI: -5.24~ -4.33, P<0.00001; Post-treatment 72h, WMD=-5.13, 95%CI: -6.53~ -3.73, P<0.00001; Post-treatment 7d, WMD=-6.48, 95%CI: -7.56~ -5.40, P<0.00001, respectively.) There are 6 publications reported the prognosis of patients who were treated with hypothermia therapy (n=454) or routine therapy (n=455). The time of follow-up visit was from 6 months to 6 years. Compared to the patients with routine therapy, the prognosis of patients with hypothermia therapy was significantly improved. (OR=2.04, 95%CI: 1.56~2.67, P<0.00001). Conclusions The therapy with hypothermia can degrade the ICP of patients with severe brain injury and improve the prognosis of these patients.

Blood pressure tracking from childhood to adulthood in 412 individuals
ZHANG Ming-ming, MI Jie,WANG Li, LIANG Lu,HOU Dong-qing,WANG Tian-you
2006, 1 (3): 187-192.
Abstract3675)      PDF (492KB)(3249)      

Objective:To examine the tracking of BP from childhood to adulthood.Methods:The "Beijing children and adolescents BP study cohort" consists of 2505 subjects of 6-18 years old who were enrolled in the baseline BP investigation in 1987. Among them, 412 individuals aged 23-37 years were successfully followed up in 2005. In this study, clinical examinations and questionnaire about risk factors of CVD were carried out. Three blood pressure measurements were obtained by trained observers by use of a standardized mercury sphygmomanometer after a 5-minute sitting rest. The classification for hypertension in children and adolescents was based on the BP percentile of healthy children, which were set up during the 1987 study.Results:(1)From 1987 to 2005, the mean of systolic blood pressure (SBP) level and diastolic blood pressure(DBP) level increased with age in both males and females. The BP level increased higher among males than among females. The SBP level increased higher than the DBP level. Before puberty, the BP level increased with age in both males and females. After puberty, the accrescence of BP level was more significantly in males than in females.(2)Taking account of adult height and BMI, there was a positive correlation between the two BP levels during childhood and adulthood, (for SBP r=0.23, P<0.01 in males, and r=0.38, P<0.01 in females; for DBP r=0.29, P<0.01 in males and r=0.19, P<0.01 in females),varying by age and sex.(3)Dividing the subjects into groups according to whose SBP and DBP levels during childhood respectively, ie

Cited: Baidu(32)
Copy number variation of SMN1 and SMN2 genes in spinal muscular atrophy and analysis of its clinical significance
WANG Ji, AN Yu, ZHOU Shui-zhen, WANG Yi, LIU Ren-chao
2013, 8 (3): 216-219.
Abstract3659)      PDF (1039KB)(2871)      

Objective: To study the relation between phenotype of spinal muscular atrophy(SMA) in children and copy number variation of SMN1 and SMN2 gene. Methods: Using genomic DNA multiplex ligation-dependent probe amplification (MLPA) the copy number variations of exon 7 and 8 of SMN1 and SMN2 were detected in children with clinically suspected SMA samples in Children′s Hospital of Fudan University. Genotype and phenotype data were analyzed. Results: The study covered 41 cases of children with suspected SMA. It included 37 cases (90.2%) with deletion of exon 7 and/or 8 of SMN1 gene, the ratio of male to female was 1 to 0.8, the average age of onset was (7.5 ± 7.0) months. There were type Ⅰ 20 cases (54.1%), type Ⅱ 15 cases (40.5%), type Ⅲ 2 cases (5.4%), the average age of onset of type Ⅰ was (2.9±1.8) months, type Ⅱ (10.7±1.9) months and type Ⅲ(30.0±8.5) months. In 37 patients with deletions in SMN1 gene, exon 7 and/or 8 had 2 copies in SMN2 gene in 18 cases, the average age of onset was (4.9 ± 3.9) months. 13 out of 18 cases (72.2%) were type Ⅰ, 5 cases (27.8%) were type Ⅱ. There were 19 patients with increased SMN2 gene copy number (3 or 4), the average age of onset was (9.9±8.5) months, 7 of 19 cases (36.8%) were type Ⅰ, 10 cases (52.6%) were type Ⅱ, 2 cases (10.5%) were type Ⅲ. The parents of 5 cases were performed SMN1 gene detection, heterozygous deletion were found in 9 parents, deletions of exon 7 and 8 were found in 8 parents. In the rest one case, the father was found to be a carrier of deletion of exon 7 and 8, however the mother was a non-carrier. Conclusions: Gene SMN1 exon 7 and/or 8 homozygous deletion mutation was the direct cause of SMA. SMN2 copy number increase was negatively correlated with the severity of the SMA phenotype.

Cited: Baidu(1)
The morbidity of coronary artery lesions caused by Kawasaki disease in Guangzhou Children′s Hospital and the four years follow-up
GUO Yan, YU Ming-hua, LIU Te-chang, ZHANG Li, SU Ling-li, XIE Xiao-fei, LI Shu-hua
2007, 2 (4): 265-270.
Abstract3641)      PDF (544KB)(2903)      

Objective To explore the onset characteristics of coronary artery lesions caused by Kawasaki disease and their changes in 2 years after onset. Methods A colour Doppler echocardiography was performed on 356 patients with Kawasaki disease in Guangzhou Children′s Hospital from January 2001 to December 2004. The ages of patients (242 boys, 114 girls) in acute stage were 1-123 months[(26.3±21.0)months]]. The patients were divided into three groups according to changes in coronary arteries: coronary arterial dilatation(n=72), small or medium coronary aneurysm(n=36) and giant coronary aneurysm group(n=11). The patients with coronary artery lesions were followed-up by echocardiography in 119 cases and ATP stress echocardiographyin in 48cases. The differences of febrile days before diagnosis and the changes in coronary artery were compared respectively among three groups . Results The coronary artery lesions were found in 147 patients(41.3%,147/356) by echocardiography, including 48 cases with coronary aneurysms (13.5%,48/356) and 99 cases with coronary arterial dilatation (27.8%,99/356) . The incidences of coronary artery lesions were 38.1%(40/105) in patients aged<1 y, 40.4%(67/166) in patients aged 1-3 y; 40.7%(22/54) in patients aged 3-5 y; 58.1%(18/31) in patients aged>5 y. The incidence of coronary artery lesions in patients aged>5 y was significantly higher than that in patients aged< 1 y (P<0.05). The febrile days before diagnosis in the giant coronary aneurysm group were more than that in medium or small coronary aneurysm group and the coronary arterial dilatation group[(18.4±12.0)days,(12.9±8.2)days,(7.4±3.6)days,P<0.01]]. By echocardiography, 69 of cases (69.7%,69/99) with coronary atery lesions were found in acute stage, 27 of cases (27.3%) in subacute stage (11-21 d from onset),3 of cases (3.0%) in convalescence (21-60 d from onset). 27 of cases (56.2%,27/48) with coronary arterial aneurysms lesions were found in acute stage, 15 of cases (31.2%) in subacute stage and 6 of cases (12.5%) in convalescence . 119 patients (81.0%,119/147) were followed-up. During two years follow-up, the coronary artery lesions were recovered in all patients in coronary arterial dilatation group and in 77.8%(28/36) patients of medium or small coronary aneurysm group. In giant coronary aneurysm group, the mild or moderate regressions were found in 8 of 11 patients; the aneurysms turned to dilatation in 3 cases; the right coronary artery stinosis was observed in 1 case, which was conformed by coronary angiography. 48 of 119 cases were given ATP stress echocardiography.The results revealed that in coronary arterial dilatation,small or medium coronary aneurysm and giant coronary aneurysm group,the incidences of wall motion abnormalities were 14.8%(4/27),58.8%(10/17)and 75.0%(3/4),respectively , and the rates of decreased coronary flow reserve were 22.2%(6/27)in patients with coronary arterial dilatation, 38.1%(8/21) in patients with coronary aneurysm . the rate of decreased coronary flow reserve in coronary aneurysm group was significantly higher than that in the group of coronary artery dilatation(P< 0.05). Conclusions Most of coronary artery lesions caused by Kawasaki disease were transient.The giant coronary aneurysms may exist for longer time. Echocardiography is helpful for finding the coronary artery lesions and monitoring their changes.Stress echocardiography is useful for the follow-up of Kawasaki disease.

Corticosteroid preventing renal involvement of henoch-schonlein purpura in early stage: a meta-analysis
GUAN Feng-jun,YI Zhu-wen, DANG Xi-qiang, HE Qing-nan, WU Xiao-chuan, HE Xiaojie,HUANG Dan-lin
2006, 1 (4): 258-263.
Abstract3637)      PDF (540KB)(3728)      

Objective Henoch-Sch?nlein purpura (HSP), termed as Henoch-Sch?nlein purpura nephritis(HSPN) when a renal involvement was found, is the most common systemic vasculitis affecting children with whose pathogenesy remaining poorly understood as yet. HSPN is one of the most common secondary renal disease as well as the most serious complication of HSP. The attention being paid globally is attributable to the factor that degree of renal involvement may have some effects on the severity and outcome directly. No definite data as yet on choice of time as for corticosteroids administration. Thus we search all studies that have been published worldwide with regards to the effectiveness of the early administration of corticosteroids for reducing risk to renal involvement in patients with HSP by means of Meta-analysis, in order to give some evidences for the choice of corticosteroids dealing with HSP. Methods Evaluate strictly all the studies that have been searched and adopted the studies in high quality that can be analyzed by means of Meta-analysis. Calculate the odds ratio for renal involvement during the time from initial episode to the end of follow-up between treatment with corticosteroids and control. Revman4.2 software was applied to process the data. Results Totally 5 studies including 398 cases were analyzed. The cumulative cases in treatment group were 206, in which 16 developed renal involvement, while in control were 192 and 42 respectively. The pooled OR was 0.29, with a 95% confidence interval (0.16-0.54). Conclusions corticosteroids being used in early stage of HSP can benefit patients for reducing risk to renal involvement compared with control.

Cited: Baidu(32)
The making of Chinese static facial expression photos and its reliability and validity
GU Li-ping,JING Jin, JIN Yu, XU Gui-feng, LIANG Hua-ni,HUANG Sai-jun, YANG Wen-han,Kazue Igatashi
2009, 4 (5): 442-447.
Abstract3624)      PDF (2592KB)(2791)      

ObjectiveTo develop Chinese static happy, angry, surprised, fearful, sad, disgusted and neutral facial expression photo gallery for future emotion research and to find out a better method for good facial expression picture acquisition. MethodsPeople were grouped by pre-school age, school age ( primary school age, middle school age and academic school age), young people, adult and aged people between 5-year and 80-year-old as the actors showing different facial expressions. Before taking photos, they knew the purpose and agreed to sign the consent. Firstly, all people were standarded to be trained to know the meaning of seven facial emotions,the grades and facial characteristics of seven facial emotions.The facial expression photos were recorded by the same examiner in the same lab. All photos were taken by using Canon IXUS 50 and SAMSUNG S850 under the same mode, and the primary photo gallery was made. Then research team members picked out the well-taken photos to be processed as 10 cm×15 cm facial expression pictures. 60 Chinese university students were asked to identify emotion category in these pictures.Seven pictures of Japanese Female Facial Expression (JAFFE) were used to identify the validity. The pictures were picked out and processed by 28 university students to test their reliability , and to test their validity compared with JAFFE. Results80 pictures were picked out in the first screening. One evaluator was ruled out because of his anxiety and depression, and 59 students (29 boys and 30 girls) screened out 40 pictures, whose discrimination rate was higher than 70%. 21 pictures were picked out to be tested for reliability, validity and emotion grades. The discrimination rates of 21 pictrues were higher than those of JAFFE. Besides pictures angry 1, angry 3, fearful 1-3, sad 3 and disgusted 1-3, the reliability coefficient of the others was higher than 0.7.Compared with JAFFE,the consistency of negative facial expression in 21 pictures was less than the consistency of happy,neutral or surprised facial expression. Conclusions21 facial expression pictures are representative materials for future emotion research.Facial expression and emotion is influenced by different culture.

Cited: Baidu(4)
Genomic copy number variations in three independent neonates with 5p partial monosomy
YANG Lin,NI Jing-wen,ZHAN Guo-dong,WANG Hui-jun,CHEN Chao,HUANG Guo-ying,ZHOU Wen-hao
2011, 6 (2): 86-92.
Abstract3619)      PDF (4582KB)(3738)      

Objective To screen for genomic copy number variants (CNVs) in three independent neonates with 5p partial monosomy using SNP array, identify the relationship between rare CNVs and related phenotypes. Methods Genomic CNVs were dected in the 3 individuals by using cytogenetic whole-genome 2.7M array. Rare CNVs with potential clinical significance were selected for screening the occurence of deletion and its size in region of 50 kb and duplication region that over 150 kb in chromosome 5 p based on the analysis of ChAs software. Postive CNVs and segment of normal reference populatino were excluded. The identified CNVs were analyzed with the references from CNVs database and published literatures. Results Eleven rare CNVs (12.9%) sized from 66-31 328 kb were identified in the 3 neonates. The deletion region and size were 5p15.33-p13.3 and 31 866 kb for case 1, 5p15.33-p15.1 and 15 552 kb for case 2, 5p15.33-p14.3 and 19 312 kb for case 3. Additional duplication ons 9p24.3 -p21.1 were found in case 2 and 7p22.3-p22.2 were found in case 3. Analysis of the association between phenotype and genotype of 3 cases and 5 patients in database suggested that the overlapping region of abnormal cry and voice was located within a 3.86 Mb region on 5p15.33-p15.31 and contained IRX1 and IRX2 genes. The overlapping region of facial dysmorphology was located within a 2.51 Mb region on 5p15.2-p15.1 and contained ANKH gene. Case 3 has Hirschsprung's disease. Conclusions The study established the methology to discover whole genome CNVs in identifying novel submicroscopic deletions and duplications that can not be detected using G-banding cytogenetic technology, allowing an early diagnosis of affected individuals especially neonates without characteristic symptoms. The results allow us to refine the genotype-phenotype correlations for abnormal cry and voice, facial dysmorphology in 5p partial monosomy.

Guidance for Protocols of Clinical Trials——Explanation of SPIRIT 2013 Statement
ZHAO Jing-jing, LONG Yong, LIU Xue-dong
2014, 9 (5): 381-388.
Abstract3619)      PDF (631KB)(4613)      
Association between polymorphisms of UDP-glucuronosyltransferase 1A1 gene and hyperbilirubinemia in neonates: a meta-analysis
YANG Lin, DING Jun-jie, ZHOU Wen-hao
2010, 5 (5): 335-348.
Abstract3590)      PDF (3308KB)(3703)      

Objective To investigate the effects of polymorphism of UDP-glucuronosyltransferase 1A1 gene on hyperbilirubinemia in neonates. Methods According to the requirements of Cochrane systematic review, a literature search was performed among PubMed, EMBASE, Web of sciences, Cochrane library, CNKI, Wanfang data, VIP and CBM from the establishment of the database till February 28th 2010. Revman 5.0 software was used for meta-analysis. Data extraction, quality assessment, and meta-analysis for the results of homogeneous studies were done by two reviewers. The trials were analyzed using relative risk (RR) for dichotomous data, expressed by 95%CI. For homogenous data (P≥0.10), fixed effect model was used to calculate. Results 284 literatures were reviewed. The studies including reviews(n=29), case reports(n=19), foundational researches(n=87), Gilbert syndrome studies(n=57), patent reports(n=3), documents not meeting the major results of meta analysis(n=60), non-English non-Chinese articles (n=7) were excluded. Twenty two studies were enrolled. The variants of UGT1A1 at nt211: ①genotype of A/A+G/A (OR=2.79, 95%CI: 2.26-3.43, P<0.000 01) was more common among cases. Further analysis in the subgroups showed the difference in the genotype distribution between cases and controls in Chinese (OR=2.84, 95%CI: 2.14-3.76, P<0.000 01), Japanese (OR=3.22, 95%CI: 2.03-5.11, P<0.000 01), Malaysian and Thailander (OR=2.41, 95%CI: 1.56-3.72, P<0.000 1) except Caucasian (OR=1.98, 95%CI: 0.49-8.03, P=0.34). ②genotype of A/A (OR=7.05, 95%CI: 4.19-11.85, P<0.000 01) was seen more common among cases. Further analysis in the subgroups showed the difference of this genotype between case and control groups in Chinese (OR=6.47, 95%CI: 3.24-12.94, P<0.000 01), Japanese (OR=3.08, 95%CI: 1.00-9.49, P=0.05), Malaysian and Thailander (OR=21.01, 95%CI:5.21-84.79, P<0.000 1) except Caucasian (OR=5.89, 95%CI: 0.24-145.49, P=0.28). ③A allele frequency (OR=2.78, 95%CI: 2.33-3.31, P<0.000 01) was higher in cases than that in controls. Further analysis in the subgroups showed the difference of this genotype between case and control groups in Chinese (OR=2.82, 95%CI: 2.22-3.58, P<0.000 01), Japanese (OR=2.50, 95%CI: 1.72-3.62, P<0.000 01), Malaysian and Thailander (OR=3.01, 95%CI: 2.07-4.37, P<0.000 01) except Caucasoid (OR=2.47, 95%CI: 0.66-9.25, P=0.18). There were no significant differences between case and control groups in genotype 7/7+6/7 (OR=0.83, 95%CI:0.55-1.24, P=0.36), 7/7 (OR=1.42, 95%CI: 0.92-2.19, P=0.11), 7 allele frequency (OR=0.90, 95%CI: 0.63-1.29, P=0.57) of the variants UGT1A1 at promoter TATA box. Conclusions For Chinese, Japanese, Malaysian and Thailand neonates GLY71ARG variant of UGT1A1 gene is a risk factor to the development of hyperbilirubinemia. Presence of variant (TA)n promoter is an independent risk factor for hyperbilirubinemia in neonates.

Conventional primary therapy combined with corticosteroid on coronary artery aneurysm formation in Kawasaki disease: a meta-analysis
ZHANG Yong-wei, SHEN Jie, HUANG Min, XIAO Ting-ting, XIE Li-jian
2010, 5 (6): 418-423.
Abstract3564)      PDF (7300KB)(4397)      

Objective To assess the effect of conventional primary therapy combined with corticosteroid on coronary artery aneurysm formation in Kawasaki disease. Methods Studies were identified by a systematic search in MEDLINE, EMBASE, Cochrane Library, WANFANG, CNKI and VIP Database from its establishment to June 2010. All clinical controlled trials comparing the addition of corticosteroids to conventional primary therapy for Kawasaki disease were eligible. Quality assessment was investigated according to the Kawasaki disease diagnosis, study design and blinding of outcome detection. The weighted mean difference (WMD) for duration of fever after initiation of therapy and pooled relative risk (RR) for coronary artery aneurysm, re-treatments with intravenous immunoglobulin (IVIG) and adverse events were compiled. Heterogeneity was evaluated by stratified analysis. Stata 11.0 software was used to perform the meta analysis. Results Two hundred and twenty two studies were identified from database search. Thirty studies were selected for further assessment through reading the title and abstract. Seven eligible studies (4 randomized controlled trials and 3 comparative studies) were enrolled in the meta-analysis according to the further assessment. Quality assessments results showed three sudies were scored 2, 3 were scored 6, 1 was scored 5, respectively. Meta-analysis showed the additional corticosteroids therapy to standard therapy was associated with a significant 66% risk reduction of coronary artery aneurysm formation (RR=0.34, 95% CI:0.13-0.89). The overall test for heterogeneity among studies was significant (P=0.06, I2=53.6%). The incidence rate of coronary artery aneurysm was not significantly different in RCT(RR=0.79,95%CI:0.43-1.43), large size samples(>100)(RR=0.73,95%CI:0.42-1.28). Corticosteroid therapy decreased the fever duration after initiation of therapy (WMD=-1.66 d, 95%CI:-2.58 to -0.73 d) and risk of re-treatments with IVIG (RR=0.43, 95%CI:0.31-0.61)but did not decrease the risk of adverse events (RR=0.87, 95%CI: 0.35-2.16). Conclusions The addition of corticosteroids to standard therapy did not decrease the incidence of coronary aneurysms, but could decrease the rates of re-treatment with IVIG and the fever duration after initiation of therapy.

Cited: Baidu(1)