ObjectiveTo evaluate the value of nuchal translucency (NT) as a screening test for fetal abnormalities in the first trimester ultrasound examination.MethodsA search in Cochrane Library, PubMed, OVID, Springer, China National Knowledge Infrastructure (CNKI) and Chinese Bio-edicine Database（CBM）was performed to identify relevant English and Chinese articles between Jan 1990 and August 2008. Criteria for inclusion were established based on validity criteria for diagnostic research. Subsequently, the characteristics of the included articles were extracted. Statistical analysis was performed with Meta-iSc 1.4. Heterogeneity of the included articles was tested to select proper effect model to calculate pooled weighted sensitivity and specificity. Summary receiver operating characteristic curve(SROC) was made and the area under the curve (AUC) was calculated. Finally, sensitivity analysis was performed.ResultsTwelve articles were included, with a total of 112 099 fetuses. Nine articles meeting inclusion criteria were analyzed for the value of screening for cardiac abnormalities by nuchal translucency thickness above the 95th percentile for gestational age. The pooled sensitivity and specificity was 29.8%, 96.9%，respectively, AUC=0.804 7. Seven articles meeting inclusion criteria were analyzed for the value of screening for cardiac abnormalities by nuchal translucency thickness above the 99th percentile for gestational age. The pooled sensitivity and specificity was 18.9%, 99.3%，respectively, AUC=0.971 2. Five articles meeting inclusion criteria were analyzed for the value of screening for fetal abnormalities by nuchal translucency thickness above the 95th percentile for gestational age. The pooled sensitivity and specificity was 25.0%, 98.3% respectively, AUC=0.183 0. The sensitivity of screening for cardiac abnormalities by nuchal translucency thickness above the 95th percentile for gestational age was significantly higher than the nuchal translucency thickness above the 99th percentile for gestational age（χ2=6.58， P<0.05）,no difference was found in the specificity. The random?瞖ffect model was used in the analysis of screening for cardiac abnormalities by nuchal translucency thickness above the 95th or 99th percentile for gestational age because of the heterogeneity. The fixed-ffect model was used in the analysis of screening for fetal abnormalities by nuchal translucency thickness above the 95th percentile for gestational age because of the homogenicity. ConclusionsThe results suggest that screening for fetal abnormalities by NT thickness above the 95th percentile for gestational age has a low accuracy and is unsuitable for prenatal screen. At present it is incompletely clear on the sensitivity and specificity of screening for different kinds of fetal abnormalities by NT thickness. Screening for cardiac abnormalities by first trimester NT thickness has a high accuracy and specificity and can be reliably used in prenatal screen. We need the further systemic reviews to evaluate the value of NT as a screening test for different kinds of fetal abnormalities. Further multi?瞔entre and prospective studies are badly needed to be performed to optimize the standard of nuchal translucency thickness, evaluate the value of NT as a screening test for fetal abnormalities (especially cardiac abnormalities) in the first trimester ultrasound examination by a cost-effectiveness analysis, and develop an operation guideline on first trimester nuchal translucency thickness measurement for the prenatal screening of cardiac abnormalities in China.
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.
ObjectiveTo investigate the situation of serotype distribution of Streptococcus pneumoniae (S.pneumoniae) isolated from Chinese children hospitalized for pneumonia and to evaluate coverage rate of pneumococcal conjugate vaccine in the isolates, especially of the 7-alent pneumococcal conjugate vaccine (PCV7, covering the serotype 4, 6B, 9V, 14, 18C, 19F, and 23F).MethodsFrom February 16, 2006 to February 16, 2007, the following four centres, located in different parts of mainland China, took part in the study: Beijing Children's Hospital, Beijing (Beijing); Pediatric Hospital of Fudan University, Shanghai (Shanghai), Guangzhou Children's Hospital, Guangzhou (Guangzhou) and Shenzhen Children's Hospital, Shenzhen (Shenzhen). Children less than 5 years old with clinical pneumonia, who were admitted to the in patient department of the four hospitals, were enrolled in the study after the informed consents were obtained from parents or legal guardian. Clinical pneumonia was defined as the subjects who had at least three of the followings: fever (temperature ≥ 38.0 ℃), tachypnea (≥ 50 breaths per minute for infants, or ≥ 40 breaths for children 12-60 months old), cough, auscultation findings indicative of lower respiratory disease (including rhonchi, crackles, or bronchial breath sounds), and/or chest indrawing. Hypopharyngeal aspirates specimens were collected from the enrolled children and were sent to a local laboratory for bacterial culture. The pneumococcal isolates from aspirates were determined for the serotype using type-specific sera, while the other ones from blood, cerebrospinal fluid, pleural fluid in medical practice. All data were sent to the department for Clinical Data Management & Statistical Analysis of APEX China Co., Ltd. and were analysed with the software SAS version 8.2. The χ2 test and Fisher's accurate probability method was performed for comparing the proportions.ResultsA total of 279 isolates of S.pneumoniae were recovered from respiratory aspirate and pleural fluid. The isolation rate of S. pneumoniae in deep respiratory aspirate was 9.7% (278/2 865). Serotype 19F was the most frequent type observed (60.6%). Other frequently observed serotypes in decreasing order of frequency, were serotypes 19A (9.7%), 23F (9.3%) and 6B (5.4%). Any of the other identified types were found in less than 10 strains. The frequency of serotype distribution also showed difference among the four cities. The most remarkable one was serotype 19F covered only 28.6% (18/63) in Beijing in compared with 62.2%-75.45% isolates in the other three cities (χ2=38.71，P<0.001). The serotype 19A, which was not covered by the PCV7, was the second commonest type and was very frequent in Beijing (20.6%, 13/63) and Shanghai (16.9%, 11/65). Of all these isolates, 81.0% (226/279) were covered in the PCV7. The coverage rates of PCV7 among cities: only 46.0% (29/63) in Beijing, while 80.0% (52/65), 98.4% (60/61) and 94.4% (85/90) in Shanghai, Guangzhou and Shenzhen, respectively (χ2=72.62，P<0.001). Compared to the PCV7, the 9, 10, and 11 alent vaccine coverage rates did not increase significantly because the additional serotypes 1, 3, 5, or 7F were isolated rarely while the 13-alent vaccine coverage rates had little increase in Guangzhou and Shenzhen, but 18.6% and 28.6% increase in Beijing (χ2=10.74，P<0.01) and Shanghai (χ2=11.53，P<0.01) as the additional serotype 19A was common.ConclusionsSertotypes 19F, 19A, 23F and 6B were the common types among the pneumococcal strains isolated from Chinese children hospitalized for pneumonia. The case that the PCV7 could cover most of the isolates suggested the preventive effect of the vaccine on penumococcal infection was valid at present in China.
ObjectiveHuman cytomegalovirus (HCMV) is a main pathogen responsible for a variety of congenital defects and pediatric infections. Mannan binding lectin (MBL) is a serum lectin that mediates phagocytosis and activates complement. Its deficiency has been associated with increased susceptibility to infectious diseases, mainly in childhood. The aim of this study was to explore the relationship between genetic polymorphism and protein level of MBL and HCMV infection in children.Methods104 children diagnosed as HCMV infection (64 males and 40 females ranging from one to twenty-four months old with a mean age of 4.29 months), were investigated. All patients were seropositive for HCMV-IgM antibody tested by ELISA, and with HCMV DNA varied from 4×103 copies/ml to 7×106 copies/ml detected by quantitative-PCR in urine. All patients had clinical symptoms and single or multiple organ damages (including hepatitis, pneumonitis, colitis, thrombocytopenia and involvement of central nervous system). 50 patients were followed up until they were recovery (seronegative for HCMV IgM antibody). 105 healthy, symptom-free children from the same area were assessed as control. Genomic DNA of total 209 cases including both patients and controls were extracted from blood according to standard phenol-phloroform procedure. Six SNPs in the MBL2 gene (-550G/C, -221C/G and +4C/T of the promoter, CGT52TGT, GGC54GAC and GGA57GAA of the exon 1) were analyzed by a sequencing-based typing method. A DNA fragment including promoter region and exon 1(953 bp) was obtained by polymerase chain reaction (PCR) amplification using the sense primer 5′ -CCT GCC AGA AAG TAG AGA GG-3′ and anti-ense primer 5′-CCA GGC AGT TTC CTC TGG AAG G-3′. PCR products were observed by agarose gel electrophoresis and subjected to DNA sequencing. The concentrations of plasma MBL were measured in 105 healthy controls and 50 HCMV-infectious patients at both acute and convalescent phases by a sandwich enzyme immunoassay with a human MBL ELISA kit.ResultsMutations at the +4 site of the promoter and the codon 52 or codon 57 of the exon 1 were not found in this study. There was no significant difference between the frequency of type B mutation at the codon 54 of the exon 1 in HCMV?瞚nfectious patients and that of the healthy controls. Compared to the controls, the frequency of L variant at the promoter -550 site was significantly higher in patients (56.7% vs 34.3%, P=0.001), while the frequency of wild haplotype HYPA was lower (47.6% vs 62.8%, P=0.002). The frequency of complete genotype of high expression group (YA/YA) was lower (41.3% vs 60.0%, P=0.007), and that of low expression group (YA/XA, YA/YB, XA/XA) was higher (52.9% vs 29.5%, P=0.001) in patients compared with the controls. The MBL protein levels of patients in both acute and convalescent phases significantly decreased when comparing to the controls (P=0.019 and P=0.000, respectively).ConclusionsLow MBL protein level as a result of genetic polymorphism seems to be correlative with HCMV infection in children. It can be speculated that as an acute response protein and a pattern-ecognition molecule of the innate immune system, MBL may play a role in protecting children from HCMV infection.
bjectiveTo explore the association of P2X7 gene polymorphisms with the susceptibility to pediatric tuberculosis in Chinese Han.MethodsGenomic DNA was extracted from peripheral blood by EDTA anticoagulation , using a standard salting procedure. The concentration and purity of DNA were estimated spectrophotometrically. The 1513A/C polymorphism was detected via RFLP, by using the restriction enzyme HaeII. The polymorphism at position -762 in the promoter of the P2X7 gene was studied by allele-specific PCR. Products were run on 1.5% agarose gel stained with ethidium bromide, whereupon it was visualized using an UV transilluminator. Statistical analyses were carried out using SPSS software, version 11.5 (SPSS Inc., Chicago, IL, USA). The Hardy-einberg equilibrium (HWE), which indicated the absence of discrepancy between genotype and allele frequency, was determined for both control subjects and patients. Overall genotype frequencies in each patient group were compared using a 3×2 χ2 test, and a 2×2 χ2test was also used to detect any significant difference between the two groups in terms of allele frequency. Patient and clinical information was collected from patient files, and all participating subjects and parents gave written, informed consent.ResultsFrom Jan, 2005 to Sep, 2008, ninety?瞫ix cases of pediatric tuberculosis admitted to Beijing Children′s Hospital were identified by clinical manifestation, culture and X-ray results, and by other means, including forty-one active pulmonary tuberculosis and fifty five extrapulmonary tuberculosis. Three hundred and eighty four children, who were inpatients children for physical examination in surgery department, were collected as controls. The mean age was 5.5 years old (SD: 4.5; range: three months??15 years old) for patients and 5.9 years old(SD: 4.0; range: three months??16 years old) for control subjects. All controls were matched with tuberculosis patients by age, sex, and area. Members of both patient and control groups were of Chinese Han ancestry. The genotypic and allelic frequencies of two different SNPs of the P2X7 gene were analyzed. The frequencies of the alleles were found in HWE. The frequency of A/C and C/C genotype at the 1513 site was higher in tuberculosis patients（38.5% and 8.3%） than in controls（31.0% and 11.5%）, but no statistical difference was obtained(χ2=2.306，P=0.316). Similarly，the frequency of 1513C in tuberculosis patients and controls (27.6% and 27%) had no statistical difference (χ2=0.033，P=0.856). The frequency of C/C genotype at the -762 site was high in all the subjects enrolled（56.4%）,while the frequencies of -762 C in tuberculosis patients and controls were 77.4% and 71.7%, no statistical difference was obtained (χ2=22.670，P=0.102). There were no significant associations between each of the genotypic or allelic distributions and pulmonary or extrapulmonary TB. ConclusionsThe 1513 and -762 polymorphisms in human P2X7 gene had no association with pediatric tuberculosis in China. Although the mechanism of protection or pathogenicity by these genotypes had not been fully elucidated, we considered these apparently discrepant results to be of interest. Individual SNP within genes varied markedly among different racial groups, the number of subjects enrolled was different, the P2X7 receptor gene was not the major gene to produce a marked effect. Thus, further studies are needed to clarify whether the polymorphisms in P2X7 gene is associated with tuberculosis or susceptive to tuberculosis.
ObjectiveTo test the effect of nonnutritive sucking (NNS), music therapy (MT), and combined NNS and MT (NNS + MT), versus no intervention, on heart rate, transcutaneous oxygen (SpO2) levels, and pain behavior of neonates in intensive care units had being blood taken by a heel-stick procedure.MethodsA within-subjects, counter-balancing, repeated-measures design was conducted in the newborn medical center of Nanjing Children Hospital, comparing SpO2 levels, heart rate, and pain behavior outcomes(NIPS) in 80 neonates. The neonates with good general state of health had been selected. Those with the nervous system disorders (intracranial hemorrhage, hypoxic ischemic encephalopathy) were ruled out and sedative and acesodyne were given. All patients had been divided into four groups (NNS,MT,NNS+MT and control) randomly according to admission number(AD). The effct of various intervention (NNS,MT,NNS+MT and control) on SpO2 levels, heart rate, and pain behavior outcomes(NIPS) had been recorded.SPSS 11.0 ANOVA variance test and Post Hoc were used to analyze all the valid data.ResultsRepeated-measures multivariate analysis of variance revealed statistically significant differences in outcomes across all interventions. One-way analysis of variance revealed that the 3 comfort interventions significantly reduced neonate heart rate, improved their SpO2 levels , and reduced their pain behavior. Posthoc scheffe tests revealed that NNS + MT had the strongest effect on neonates SpO2 levels and pain behavior; MT alone had the strongest effect on neonates' heart rate. The significant difference had been seen in all groups compared with control (P<0.05) except NNS in heart rate and SpO2. There were no significant difference in the MT,NNS+MT subgroups.ConclusionsWTBZ〗Health professionals using NNS + MT when doing heel-sticks can improve the SpO2 levels of neonates and reduce their pain. Using MT alone can improve the heart rate of neonates.
