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.

Objective To explore the clinical features of plastic bronchitis in children with mycoplasma pneumoniae pneumonia and(or) bacterial pneumonia. Methods The study retrospectively reviewed the records of the children with plastic bronchitis who were admitted to Beijing Children's Hospital from January 2007 to March 2010. Subjects were divided into three groups based on the pathogen culture results: mycoplasma pneumoniae pneumonia group, mycoplasma pneumoniae pneumonia with bacterial infections group and bacterial pneumonia group. The data of the three groups such as clinical manifestations, roentgenographic findings, airway mucosal lesions seen through the bronchoscope and the histopathological findings of the bronchial cast were analyzed. Results Fifteen children with plastic bronchitis aged from 2 to 15 years were enrolled into the study. There were 5 cases in mycoplasma pneumoniae pneumonia group, 6 cases in mycoplasma pneumoniae pneumonia with bacterial infections group and 4 cases in bacterial pneumonia group. The children in mycoplasma pneumoniae pneumonia group did not have dyspnea and the extrapulmonary positive signs. One case in mycoplasma pneumoniae pneumonia with bacterial infections group needed NCPAP treatment, and 1 case had extrapulmonary positive signs. Three cases in bacterial pneumonia group needed NCPAP or mechanical ventilation treatment, and 3 cases had extrapulmonary positive signs. Consolidation was the common finding in the CT scan of the lung in all the patients, and 1 case with atelectasis, 3 cases with pleural effusion in mycoplasma pneumoniae pneumonia group; 3 cases with atelectasis, 5 cases with pleural effusion in mycoplasma pneumoniae pneumonia with bacterial infections group; 3 cases with atelectasis, 1 case with pleural effusion in bacterial pneumonia group. Bronchoscopy was performed in all the 15 cases and bronchial casts were removed. Under flexible bronchoscope, the most common mucosal lesions in the three groups were hyperemia and edema, and the severe mucosal lesions were found in children in mycoplasma pneumoniae pneumonia with bacterial infections group (2 cases with segmental bronchi dysventilation). All bronchial casts were type 1 according to Seear's classification in histopathological findings.

Objective To screen for genome-wide copy number variations (CNVs) in Chinese children with unexplained mental retardation or developmental delay (MR/DD) using high resolution array-comparative genomic hybridization (Array-CGH), identify rare CNVs (microdeletions/ duplications) which may associate with MR/DD, and evaluate the effectiveness of Array-CGH in clinical molecular diagnosis of children with unexplained MR/DD. Methods Children with unexplained MR/DD were recruited for this study by using a high resolution oligo 244 K array for detection of genomic copy number variations. All identified CNVs were analyzed with the references from database of genomic variants (DGV)，database of DECIPHER, and UCSC brower（build 18）, as well as an internal Array-CGH database from the Genetics Diagnostic Lab of Children's Hospital Boston, plus a comprehensive literature review, to determine if the rare CNVs found in these children were associated with MR/DD. Results One hundred and eleven children with unexplained MR/DD were collected from July 2004 to July 2008. The average age was 6 years old and the ratio of male to female was 1.775. Among them, 36 rare CNVs were identified in 28 patients. The average size of CNVs was 1 326 kb (29-8 760 kb) which was undetectable by chromosome analysis. Nineteen patients carried CNVs that may be associated with MR/DD but 1 patient had a CNV with uncertain clinical significance. The diagnostic yield of Array-CGH for these MR/DD children is 17.1% (19/111). 22/36 CNVs (61.1%) found by this study was also reported at least in one of the database and/or literature reviews. A 2 098 kb deletion at 15q11.2-13.1 overlapping with PWS/AS critical region was found in a patient who had global developmental delay, feeding difficulty, tricuspid incompetence, hypotonia, cryptorchidism and foot deformity. His dysmorphism included flat face, sparse hair, hypertelorism, down-slanting eyes and small hands. The MRI showed prominent bilateral frontal and temporal lobe sulcus, enlarged lateral ventricles. Atypical PWS was diagnosed according to his clinic information and Array-CGH finding. The deletion included SNRPN，NECDIN，SnRNAs，UBE3A genes. Conclusions CNV associated with microdeletions/duplications found in Chinese patients was one of the causes for unexplained mental retardation and developmental delay. Array-CGH could detect disease associated rare CNVs effectively which should be applied to clinical molecular diagnostics as a useful evaluation to help differential diagnosis of children with unexplained MR/DD and other ambiguous medical conditions.

Objective To explore the morphologic features of the airway mucosal lesions in children with persisting and non-persisting mycoplasma pneumoniae pneumonia. Methods This study retrospectively reviewed the records of the children with mycoplasma pneumoniae pneumonia who had admitted to Beijing Children′s Hospital and received bronchoscopy from June 2006 to December 2007. According to the process of the disease, they were divided into two groups which were the persisting mycoplasma pneumoniae pneumonia group (the process≥1 month) and the non-persisting mycoplasma pneumoniae pneumonia group (the process<1 month). The data of the two groups such as clinical manifestations, roentgenographic findings, airway mucosal lesions seen through the bronchoscope, and the condition of the treatment and prognosis were analyzed. Results There were 144 children with mycoplasma pneumoniae pneumonia(61 boys and 83 girls) aged from 2 to 15 years with a median of 7.5 years included in the groups. The persisting mycoplasma pneumoniae pneumonia group included 36 cases, and non-persisting mycoplasma pneumoniae pneumonia group included 108 cases. The radiologic findings of all patients in this study presented lobar or sublobar consolidation bilaterally or unilaterally. Twenty-five of 36 cases ( 69%) in the persisting mycoplasma pneumoniae pneumonia group and 48/108 cases (44%) in the non-persisting mycoplasma pneumoniae pneumonia group were with segmental or lobar atelectasis.14/36 cases (39%) in the persisting mycoplasma pneumoniae pneumonia group and 24/108 cases (22%) in the non-persisting mycoplasma pneumoniae pneumonia group were with small or large pleural effusion. Under flexible bronchoscope, the most common mucosal lesions in both groups were bronchial mucosal follicle-like hyperplasia, roughness, hyperemia, edema, microtubule reductus, and increasing mucus secretion，but the degrees and ranges of these lesions in the two groups were different. Bronchial mucosal follicle-like hyperplasia and the increasing mucus secretion were more common in the persisting mycoplasma pneumoniae pneumonia group than in the non-persisting mycoplasma pneumoniae pneumonia group（36/36 cases vs 91/108 cases, 35/36 cases vs 89/108 cases, P<0.05). Meanwhile the lesions such as airway inflammatory stenosis, mucus plug blocking and segmental bronchi dysventilation were the more common changes in the persisting mycoplasma pneumoniae pneumonia group than those in the non-persisting mycoplasma pneumoniae pneumonia group（11/36 cases vs 10/108 cases, 18/36 cases vs 22/108 cases, 24/36 cases vs 44/108 cases, P＜0.05). However, the lesions such as mucosal erosions（3/36 cases）, granulation proliferation（1/36 cases）, plastic bronchitis（4/36 cases） and bronchial obliteration (4/36 cases）were existed only in the persisting mycoplasma pneumoniae pneumonia group. Conclusions The characteristic bronchoscopic findings of the airway mucosal lesions in children with mycoplasma pneumoniae pneumonia were bronchial mucosal follicle-like hyperplasia and increasing mucus secretion. These two lesions meant the airway inflammation was active, and the infection of mycoplasma pneumoniae was out of control. The lesions like mucosal erosions, granulation proliferation, plastic bronchitis or bronchial obliteration indicated the process of mycoplasma pneumoniae pneumonia may be delayed.

Objective Despite major advances in neonatal care during the past few decades,neonatal septicemia has high mortality and morbidity.The usage of CRP has recently been proven to be useful for the diagnosis of neonatal septicemia.A meta-analysis was performed to assess the accuracy of the CRP test for diagnosing neonatal septicemia. Methods VIP, China National Knowledge Infrastructure (CNKI), Wanfang Chinese Periodical Database and Chinese Bio-medicine Database (CBM), Medline, EMBASE, Cochrane library and PubMed were searched to identify retrieve relevant studies on CRP in diagnosis of neonatal septicemia from January 1989 to July 2011.QUADAS tools were used for quality evaluation of literature by two reviewers. Meta-analysis was performed by employing MetaDisc 1.4 and Revman 5.0 software. Heterogeneity of the included articles was tested to select proper efficacy model for 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 were calculated.Finally, sensitivity analysis and comparison of sensitivity among different groups were performed.Descriptive analysis was performed if meta-analysis was inappropriate. Results A total of 739 literatures were reviewed, including 430 relevant English articles and 307 Chinese articles. Twenty studies including 9 English records and 11 Chinese records met the inclusion criteria. Sensitivity and specificity of CRP test for the diagnosis of neonatal septicemia was 0.69（95%CI：0.65-0.72）and 0.87（95%CI 0.86-0.89）. The area under SROC curve was 0.88, Q index was 0.81. The pooled sensitivity , specificity, AUC and Q index for CRP＞8 mg·L-1 were 0.88（95%CI：0.82-0.92）,0.86 （95%CI：0.81-0.90），0.94 and 0.88 respectively.The pooled sensitivity, specificity, AUC and Q index for CRP≥8 mg·L-1 were 0.54（95%CI：0.47-0.61）,0.81（95%CI：0.76-0.85）,0.80 and 0.74 respectively. The pooled sensitivity, specificity ,SROC curve and Q index for CRP 8 mg·L-1 were 0.70（95%CI：0.65-0.74），0.83（95%CI：0.80-0.86）,0.88 and 0.82 respectively .CRP assay method and differences in sample sources may partially explain the heterogeneity. Conclusions CRP test as a non-invasive test is a highly accurate method for diagnosing neonatal septicemian. CRP should be combined with other diagnostic markers to further improve the sensitivity and accuracy in the diagnosis of septicemia.

Objective To assess the effective and safety of Cyclophosphamide in the treatment of Proliferative Lupus Nephritis． Methods We search The Cochrane library 、PUBMED 、EMBASE 、CBMdisc 、CNKI 、VIP to 30 June 2009． Results Twenty-nine studies involving 1900 participants were included。 Meta-analysis showed：① High dose CTX Compared with Low dose CTX，The Doubling of serum creatinine have statistically significant， ② CTX plus steroids Compared with steroids alone，The ESRD、Doubling of serum creatinine and Relapse have statistically significant， The CTX plus steroids are less than control groups；And Stable renal function、Herpes zoster infection and Ovarian failure have statistically significant。 ③ CTX plus steroids Compared with MMFplus steroids，The Complete remission and Total remission have statistically significant；And Amenorrhoea and Leucopenia have statistically significant④ CTX plus AZA Compared with MMF，The Amenorrhoea and Leucopenia have statistically significant。Conclusion Available evidence show：Compared with steroids alone， The effect of CTX plus steroids is better than steroids alone；Compared with MMF plus steroids， The effect of CTX plus steroids is less than MMFplus steroids，and the side effect is higher than MMFplus steroids；Compared with MMF， The effect of CTX plus AZA was similar，but the side effect is higher than MMF；The smallest effective dose and shortest duration of treatment should be used to minimise gonadal toxicity，without compromising efficacy.

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.

Objective To evaluate the efficacy and safety of montelukast for wheeze in infants younger than 2 years old. Methods The Cochrane Library, EMBASE, PubMed, the databases of ongoing trials- Current Controlled Trials, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, Digital Journal of Wanfang Data were searched from establishment to March 2010. Additional data were sought from the related academic meeting, industry and reference lists of included trials. Randomized controlled trials (RCTs) were selected to compare montelukast with placebo in infants younger than 2 years old with wheeze. The Cochrane Handbook 5.0.2 was used to evaluate the methodological quality. The wheeze-related mortality, the score of clinical symptom and therapeutic dose of alleviating wheeze drug were taken were primary outcomes，the adverse effects and quality of life were taken as secondary outcomes. If suitable data could not be merged, the results of specific trial were described only. Results We searched 906 literatures, 6 RCTs that met the inclusion criteria were enrolled. Two RCTs had high dropouts or withdrawals (21.7%, 32.1% respectively). There was clinical heterogeneity in six included RCTs, we could not do meta-analysis and only described the results of every trial. Children who were diagnosed as bronchiolitis, asthma or had similar symptoms of asthma were enrolled into the study. The assessment of literature quality showed 4 literatures discribed the method of random allocation in detail, 3 literatures discribed allocation concealment, 6 literatures used double-blind method, 5 literatures reported the results selectively and 2 literatures discribed the sources of other bias. ①No RCT reported the wheeze-related mortality; ②There was no significant difference in the score of clinical symptom, therapeutic dose of alleviating wheeze drug between the montelukast and placebo (P>0.05); ③There was no significant difference in the adverse effects (diarrhea, fever, vomiting and increased alanine aminotransferase) between the montelukast and placebo (P>0.05). Conclusions Compared with placebo, there is no sufficient evidence that Montelukast has more efficacy or more adverse effects during 20-week treatment for wheeze in infants below 2 years old.

Objective Nebulized hypertonic saline inhaling may reduce the pathological changes of airway edema and mucus plugging and decrease airway obstruction. To assess the efficacy and safety of nebulized hypertonic saline inhaling as treatment to infants with acute bronchiolitis. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), containing the Cochrane Acute Respiratory Infections Group Specialized Register, EMBASE, PubMed, CNKI, Wan Fang Chinese periodical Database and VIP Chinese periodical Database from the establishment of the database to April 2011, by using the terms(hypertonic saline solution AND bronchiolitis). Randomized controlled trials (RCTs) and quasi-RCTs using nebulized hypertonic saline inhaling alone or in conjunction with bronchodilators as an active intervention in infants up to 24 months of age with acute bronchiolitis were selected. Two review authors independently assessed the potential risk of bias in included studies according to the Cochrane Collaboration's recommendations. Dichotomous data were synthesized using OR and 95% confidence intervals (CI) as the efficacy measures. The mean difference (MD) and 95%CI were used to measure the effect size for continuous outcomes. The meta-analyses were performed using the Cochrane statistical package RevMan 5.1.1. ResultsTen RCTs involving 853 infants with acute bronchiolitis were included. Patients treated with nebulized hypertonic saline inhaling had a significantly shorter mean length of hospital stay compared with the control group(MD=-1.33 d，95%CI：-1.63 to -1.03 d, P<0.000 01). The hypertonic saline group also had a significantly lower post-inhalation clinical score than the control group in the first three days treatment (day 1: MD=-0.77，95%CI :-1.30 to -0.24,P=0.004;day 2:MD=-1.15,95% CI: -1.86 to -0.44,-P-=0.001;day 3: MD=-1.43,95% CI -1.87 to -0.99,P<0.000 01). The effects of hypertonic saline inhaling on improving clinical score were observed in both outpatients and inpatients. Wheezing remission time(MD=-1.16 d,95%CI:-1.43 to -0.89 d，P<0.000 01), cough remission time(MD=-1.12 d,95%CI:-1.34 to -0.89 d，P<0.000 01) and the moist crackles disappearance time(MD=-1.30 d,95%CI:-2.29 to -0.32 d，P-=0.009) were significantly lower in the hypertonic saline group than in control group. Five trials failed to show significant effects of nebulized hypertonic saline inhaling on reducing the rate of hospitalization/risk of readmission. Two trials failed to show significant effects of nebulized hypertonic saline on improving radiograph assessment score. No significant adverse event related to hypertonic saline inhalation was reported. ConclusionsFrequently inhaling hypertonic saline shortened length of hospital stay significantly and relieved symptoms and signs faster than control group for infants with bronchiolitis without apparent adverse effects.

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.

Objective To analyze the long-term prognosis of Kawasaki disease (KD) with GCAA. Methods From May 2001 to May 2006, inpatients diagnosed as KD with coronary arterial lesion(CAL) in Guangzhou Women and Children's Medical Centre were enrolled into the study, who were divided into coronary arterial dilation(CAD) group, small or medium coronary artery aneurysm (CAA) group and GCAA group.The follow-up started from discharge after acute stage and ended in May,2009.They were followed up at the end of the 6th month, the 1st year, the 2nd year, and the 3rd year after discharge by echocardiography (Echo); The patients whose CA didn′t return to normal by Echo or whose EKG presented suspectable myocardial ischemia in 3 months after acute stage were underwent ATP stress Echo and coronary angiography. The patients died were taken autopsy and pathological examinations. Results Fifteen patients with GCAA were enrolled into GCAA group. The average age was (2.7±2.6) years(3 months-10 years). One hundred sixty patients with CAD and 59 patients with small or medium CAA were enrolled into control group. ①At the 3 years follow-up time point, in GCAA group 2/15 cases(13.3%) showed normal coronary artery by Echo,which was significantly different from CAD group and small or medium CAA group (P<0.001);1/15 case(6.7%) showed dilation,10/15 cases(66.7%) prestened CAA, including 3 cases with GCAA and 3 cases with stenosis or oclussion in CA. ②The rate of abnormalities of wall motion in GCAA group by ATP stress Echo was significantly different from that in CAD group(χ2＝12.3，P<0.001), but no difference was found from that in small or medium CAA group (χ2＝0.4，P>0.05). Parametric test showed that the rate of abnormalities of wall motion in GCAA group was higher(Z=-4.2，P<0.001). ③In GCAA group, 6/15 cases were underwent coronary angiography. Four out of 6 cases (66.7%) still presented CAA，1/6 case was regressed to CAD.Five out of 6 cases were found stenosis and(or) occlusions , including 1 case with coronary recanalization after occlusion and 1 case with branch vessels. ④2 cases died in GCAA group. Autopsy findings: LCA and RCA were markedly and continuously beaded dilated; The aneurysms contained dark red thrombus, which almost occluded the entire lumen, and mural thickening was also noted. Pathological findings:inflammatory cell infiltration was shown and intimal was thickening. Conclusions The long-term prognosis of children with GCAA caused by KD is poor.The CAL will last for a long time or even causing death.The GCAA will develop to stenosis and occlusions which may lead to ischemic heart disease in late stage. It is useful to apply the Echo combined with ATP stress Echo and coronary angiography in the long-term follow-up of KD with GCAA.

Objective To investigate the pattern of antibacterial consumption in five tertiary children′s hospitals from 2002 to 2006. To see if the Guidelines for antibacterial use in clinical practice have any impact on the use. Methods Five children′s hospitals including Beijing Children′s Hospital affiliated to Capital Medical University Beijing, Tianjin Children′s Hospital of Tianjin Medical University, Children′s Hospital of Fudan University, Chongqing Children′s Hospital affiliated to Chongqing Medical University, Shanghai Children′s Hospital affiliated to Shanghai Jiaotong University, Guangzhou Children′s Hospital Affiliated to Guangzhou Medical College were chosen. The Anatomical Therapeutical Chemical Classification/Defined Daily Doses (ATC/DDD) methodology was used. Aggregate data on antibiotic use (ATC code-J01) were expressed in numbers of DDD/100 patient-days for outpatients and DDD/100 bed-days for inpatients. Antibiotic data were collected for systemic drug in number of packages and doses retrospectively from each hospital computer database for the entire year from 2002 to 2006. In October 2004, national Guidelines for antibacterial use in clinical practice were issued, which divided antibiotics into non-restricted, restricted and special use grades. The trend of DDDs was investigated before and after national Guidelines for antibacterial use in clinical practice were issued. Results ①In outpatient departments of five children′s hospitals, the antibacterial consumption was different from each other. The overall antibiotic consumption decreased after the guideline was issued in some hospitals and the variation in antibiotic use between hospitals was also reduced. ②A significant decrease in non-restricted antibiotics use was observed in outpatient departments of the five hospitals. Also the use of restricted antibiotics was reduced in two hospitals. However, a decrease in the use of first-generation cephalosporins, and an increase in the use of third-generation cephalosporins as well as in the combination of penicillins and β-lactamase inhibitors were observed in outpatient departments. ③The overall use of antibiotic drugs of inpatients was 682, 584, 658, 656 and 499 DDD/100 bed-days for the years 2002 to 2006, respectively. While the overall antibiotic use in 2005 was not greatly changed compared with previous years, by 2006 antibiotic use was decreased by 22.6% and the variation in antibiotic use among hospitals was also reduced. ④The use of non-restricted grade antibacterials reduced one year after the guideline was issued and the use of restricted grade antibacterials remained stable. The antibiotic use may be improved because of the exchange in the top class from third-generation cephalosporins, Ceftriaxone and Cefoperazone to second-generation cephalosporins, Cefuroxime. Conclusions This multicentre survey on antibiotic use in five tertiary children′s hospitals showed that the DDDs were relatively high and considerable variation both in the pattern and amount of antibiotics use could be found in each hospital. The differences of DDDs were observed among five children′s hospitals. The decline in overall antibiotic use, especially in antibiotics of non-restricted grade, and variation in antibiotic use between hospitals may be attributed to the impact of national Guidelines for antibacterial use in clinical practice. The survey indicated that overuse of antibiotics might be reduced. To develop and implement guidelines is therefore crucial for rational use of antibiotics.

Objective To establish the reference ranges for normal values of peripheral blood lymphocyte subpopulations (T, B, and natural killer; NK) in normal Chinese children. Methods The 0-12-year-old children were grouped by age-stages: infant group (0-1-year-old), infant child group (1-3-year-old), preschool age group (3-7-year-old), school age group (7-12-year-old). Then the percentages of lymphocyte subpopulations were determined in 592 normal Chinese children by flow cytometric dual-color and four-color analysis. And the results were statistically analyzed by SPSS 11.5 software. Results The interior-group comparison showed significant differences between sexes in several lymphocyte subpopulations in infant group, infant child group and school age group (P＜0.05); the inter-group comparison showed significant differences between all the lymphocyte subpopulations (P＜0.01), then the result of multiple comparison showed that there were statistically significant between several groups. Conclusion The reference ranges for normal values of peripheral blood lymphocyte subpopulations in 0-12-year-old normal Chinese children should be established in different reference values according to different ages and sexes.

Objective To describe the clinical features and outcome of Wegener′s granulomatosis in children. Methods A retrospective study of 10 patients diagnosed as Wegener′s granulomatosis was conducted at Department of Pediatrics, Peking Union Medical College Hospital from October 1990 to July 2010 to analyze the clinical manifestations, examination results, pathological data, treatment and outcome. Results Of 10 patients, 6 were males and 4 were females. The ages of patients at disease onset varied from 7 to 17.1 years. The median age was 13.9 years. Time for diagnosis ranged from 2 to 24 months and follow-up time ranged from 4 months to 19 years. ①Seven children presented with fever at disease onset, fatigue in 3 patients and weight loss in 2 patients. Upper airway involvement occurred in all patients. Eight patients had pulmonary involvement. Renal involvement occurred in 4 patients. Joints, skin, eyes and nervous system were rarely involved. ②c-ANCA positive reaction was seen in 8 patients. ③Sinus imaging studies were taken in 9 patients, sinusitis in 4 patients, sinus mass in 3 patients and violation of eyes in 2 patients. Eight patients underwent chest CT examination, multiple pulmonary nodules with or without cavity formation in 5 patients, invasive lesions in 2 patients, and pleural effusion in 1 patient. Brain MRI showed ischemic changes in 2 patients. ④Pathological examination (7 nasal mucosa samples, 2 lung samples, 1 kidney sample) showed necrotizing granuloma and (or) vasculitis. ⑤All children were given corticosteroids and cyclophosphamide at the beginning of treatment. Treatment was changed to use glucocorticoid and methotrexate in 2 patients and 1 patient was given cyclosporine A. All patients were remitted after treatment. ⑥Seven patients relapsed, 1 patient had renal insufficiency and 1 patient died of respiratory failure during the period of follow-up. Conclusions The upper respiratory tract, lung and kidney were the most commonly involved organs in Wegener′s granulomatosis. Positive c-ANCA and pathological examination were helpful to the diagnosis. Treatment with corticosteroid and immunosuppressive could achieve good outcome.

Objective To study the feature of treatment, pathology and follow-up in children with primary nephrotic syndrome (PNS). Methods Children with PNS hospitalized in Department of Nephrology of Hunan Children's Hospital from January 2005 to December 2009 who had been followed-up longer than 6 months were included. PNS patients were grouped into <2 years, -5 years, -10 years and >10 years groups according to age. The information of treatment, renal pathological lesion and follow-up data in children with PNS were analyzed. Results Five hundred and thirty-nine children (including 402 boys and 137 girls) with PNS were investigated in the study. The ratio of boys to girls was 2.9. Among them, 159 (29.5%) were under 2 years of age, 269 (49.9%) aged 2-5 years, 84(15.6%) aged 5-10 years, and 27(5.0%) aged over 10 years. ①Among them 274(50.8%) patients showed minimal change disease, 79 (14.7%) patients showed focal segment glomerulosclerosis, 173(32.1%) patients showed mesangioproliferative glomerulonephritis, 6(1.1%) patients showed membranoproliferative glomerulonephritis, and 7(1.3%) patients showed others's pathologic lesion. The proportional distribution of pathologic lesion type in kidney among 4 groups (＜2 years, -5 years, -10 years and ＞10 years) was signifiantly different (P＜0.05). ②The major pathology pattern of children with steroid sensitive and resistant PNS was minimal change disease (62.4% and 69.6%, respectively). The major pathology pattern of children with steroid dependant PNS was mesangioproliferative glomerulonephritis（48.4%）. ③239/539 patients were with complete remission, 75 with partial remission, 61 invalid, 158 with symptomatic control, urine protein (-), but still taking prednisone. Six cases died due to glucocorticoid resistance with severe infection or progression to end-stage renal disease to give up medical treatment. Conclusions In recent years, the age of onset, sex, pathologic lesion type and response to steroid therapy of children with PNS may change, and there existed significant differences in patients with different ages.

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.

The Appraisal of Guidelines for Research & Evaluation (AGREE) instrument has been the important standard for Clinical Practice Guideline appraisal, since released in 2003. The second version, AGREEⅡ was released in 2009. Some domestic researchers has translated and used the instruments. We want to explain each items of AGREE Ⅱ detailedly through appraising Chinese Clinical Practice Guidelines, hoping to provide reference for the domestic researchers understanding and using AGREEⅡ appropriately.

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.