ObjectiveTo test the social cognitive of normal children and autism spectrum disorder children, and to explore the reliability and validity of Chinese version infant and early children social cognition development screening scale.Methods After translating the screening scale and the instruction manual,843 normal children from children health care clinic and kindergarten without severe illness and 170 children who had diagnosed as "autism" were chosen. Their parents were willing to have facetoface investigation. The simultaneously appearance of children was observed and the screening scale was filled. Lastly,SPSS 13.0 was used to analyse the reliability and validity of the Chinese version screening scale.Results①Reliability analysis: the Chronbach's α coefficients: the coefficient of the whole checklist was 0.96, and those of partial checklists were all above 0.7; The splithalf reliability: the coefficients of the whole scale was 0.94, and each scale was ranged from 0.69 to 0.94; The testretest reliability: the coefficients of whole scale was 0.95, and that of 35 items exceed 0.6, and that of each scale was ranged from 0.79 to 0.95. ②Validity analysis: content validity: the correlation coefficients between most items and whole checklist were ranged from 0.31 to 0.86, and the correlation coefficients between the partial checklists and whole checklist were above 0.5(except item e10), but the relation was poor with each item in other partial checklists; Construct validity: 6 public factors were extracted by principal component analysis, which defined the 60.63% of the full variant. Empirical validity: the difference of different sex children in whole scale and four part scales had no statistically significance. Discriminant validity: The scores of children with autism in whole checklist and each partial checklist were lower than the normal children (P<0.001).Conclusions The test could be operated conveniencely, and the reliability and validity of this checklist is so good that it is useful for clinical evaluation on the social cognition development of young children aged 0.5-3.5 years
ObjectiveTo establish the standard photoes of baby FACS and grade,to analyse the influential factors on the taste from the materials in the amniotic fluids and the conditions in the pregnancy.Methods62 newborns(31 females and 31 males) born after 90 minutes were studied by the four solutions. The relations between facial responses and the materials in the amniotic fluids were analyzed by the correlation matrix. 20 newborns(10 females and 10 males) were followed until 8 months for the taste development. The newborns were divided into IS group(ISsalt、ISsour、ISbitter) and S group (Ssalt、Ssour、Sbitter) according to the sensibility of the newborns to the four solutions and followed until 8 months of life. The intensity of the responses was analyzed by the Spearman correlation and the Wilcoxon test .The distinctions of sex in the intensity to the four solutions were analyzed by the chisquare statistics. The relations between the times of the vomiting in the mothers during the early period of the pregnacy and the intensity of the responses in the infants were analyzed by the Spearman correlation.ResultsThe data showed the values of pH in the amniotic fluids of the mother who favored the foods with sour during the pregnancy were lower than that in the mothers who favored salt foods during the pregnancy（P<0.01）. The data from Wilcoxon test indicated that the intensities of the responses to the sweet solution in the infants aged 6-8 months were the strongest within 8 months of life（P<0.0001）. The responses to bitter in the girls were more sensitive than that in the boys during 3-7 months（P<0.05）and the responses to salt and sour in the girls were more sensitive than that in the boys during 4-5 months（P<0.05）. There was no relation between the times of vomiting of the mothers during the pregnancy and the intensities of the responses in the infants.Conclusions Our studies gave the nine facial action unit photoes, and divided the facial responses into ten grades of intensity first. Then we could use the grades of intensity of facial expressions to analyse the sex difference and the influential factors from the pregnancy on the taste. This method made the taste development to be compared in the different countries. There was no relation between the times of the vomiting in the mothers and the facial expressions in the newborns. The values of pH and the concentrations of the glucose in the amniotic fluids could be changed by the intake foods of the mothers during the pregnancies, and which maybe influence the taste sensitivity of the newborns. The taste developmental order is sweet,sour,salt,bitter.The taste development was different in sex.
ObjectiveTo identify the mean length of utterance and lexical diversity development in preschool Putonghuaspeaking children.MethodsSeventy children aged 36 to 72 months whose first language was Mandarin were random selected from two kindergartens in Shanghai Pudong area and invited to participate. The children had no known hearing problems, neurological and cognitive deficits or stuttering. The children were administered a standardized cognitive text, each child was scored no lower than 1SD below the mean. No children were excluded and the final samples contained seventy children(35 boys and 35 girls) which were divided into seven groups ［（36±1）months，（42±1）months，（48±1）months，（54±1）months，（60±1）months，（66±1）months，（72±1）months］, each group included 10 children. Each child's expressive language was sampled during a play interaction with the same researcher who was trained in the methods of language sampling. Conversational language samples, each lasting approximately 20 min, were based on a play activity with same toys and language topics. The language samples were audiorecorded and transcribed in Chinese characters by the researcher, then analyzed using the computerized Language Analyses(CLAN) computer program to calculate measures of utterance length (MLU) and lexical diversity (LD). Summary statistics were calculated first for each measure. Next it was given that children's language abilities change with age. Age was used as a proxy for general language development and was entered as the criterion variable ,taking either MLU or D as the predictor variable, using a curve estimation procedure. All analysis were done using SPSS.ResultsSummary statistics for MLU and D for each group as a whole showed ,across the entire group, the children's language samples contained an average of 179 complete and fully intelligible utterances(s=29) and 756 intelligible words(s=190). Scores for boys and girls did not differ from each other significantly in any of the measures. The correlation between MLU and D was 0.563, with approximately 30% of the variance in age accounted by its linear relationship with MLU, F(1,68)=31.579,P=0.000. The resulting equation for predicting the child′s MLU according to the child′s age in months was, predicted MLU=（0.023×age）+2.966.The correlation between age and D was 0.373, with approximately 14% of the variance in age accounted by D and D2,F(2,67)=5.47,P=0.006. The resulting equation for predicting the child′s D according to the child′s age was, predicted D=（1.77×age）- 0.014×age2 + 15.02. MLU and D were moderately correlated with each other(r = 0.303,P=0.011),but they were also correlated with age,respectively ,the correlation between MLU and D was also computed after removing the effect of age .The partial correlation was not significant(P=0.115),indicating that when the variance due to age was removed ,there was no statistical relationship between MLU and D in Putonghua sample.Conclusions It is very helpful to understand the development rule of the mean length of utterance and lexical diversity in preschool Mandarinspeaking children and it contributes to explore the language development in preschool children as well as to the basic and clinical research on language devlopment in preschool children.
ObjectiveThe aim of the present study was to evaluate the diagnostic value of acid reflux index (RI) in the pathological gastroesophageal reflux (GER) in children and to discuss the diagnostic criteria of GER.MethodsThe patients performed by esophageal pH monitoring in Children's Hospital of Zhejiang University School of Medicine were all enrolled in this study from 1994 to 2006, except for the cases repeated or unfinished the measurement. According to the BoixOchoa criteria, in which pathological GER was confirmed if BoixOchoa score larger than 11.99, receiver operating characteristic (ROC) of RI was analyzed and the best diagnostic cutoff value for pathological GER was obtained. The difference and goodness of fitness of different results from other diagnostic criteria of pathological GER based on all kinds of RI were compared by statistical method such as McNemar test and kappa test. The sensitivity and specificity among different diagnostic criteria were evaluated.ResultsA total of 4109 cases (male 2 692 and female 1 417) performed esophageal pH monitoring were enrolled in this study. Among them, 476 cases were neonate, 1 553 younger than 1 year, 658 younger than 3 years, 837 younger than 7 years, 513 younger than 12 years, and 72 younger than 16 years. There were thirteen kinds of diseases, including asthma (366 cases), bronchitis (468), pneumonia (385), persist pneumonia (143), chronic cough (184), pharyngitis (29), neonate apnea (102), neonate vomiting (283), neonate pneumonia (105), vomiting and/or upper abdominal pain (1817), hiatal hernia (140), noncardiac chest pain (55), and malnutrition (32). ROC analysis indicated that the diagnostic cutoff value of RI was 2.9, and the sensitivity for pathological GER was 90.4%, while the specificity was 95.6% (false positive rate lower than 5.0%). The area under curve was 0.981, standard error was 0.002, and 95% confidence interval was from 0.977 to 0.984. It showed statistical significance for diagnoses of pathological GER (P=0.000). According to the new diagnostic criteria of pathological GER for both RI 4.0 criteria (RI more than 4.0%) and RI 2.9 criteria (RI more than 2.9%), the difference and goodness of fitness of results from Boix Ochoa criteria were compared in 140 cases with hiatal hernia confirmed by surgery. The goodness of fitness from RI 2.9 criteria was significantly higher than that from RI 4.0 criteria (κ coefficient was 0.892、0.715, respectively, P all equal to 0.000). The sensitivity, accuracy, and negative predictive value for diagnostic pathological GER were significantly higher from RI 2.9 criteria than that from RI 4.0 criteria except for the specificity, while positive predictive value was almost equal between the two criteria. ConclusionsRI 2.9 criteria had of significance value in the diagnosis of pathological GER. It was helpful to improve the sensitivity and accuracy of GER diagnoses in children compared with RI 4.0 criteria.
ObjectiveTo evaluate the physiologic effects of the persistent coronary sequelae of Kawasaki disease(KD) on coronary hemodynamics and to investigate the clinical value of coronary flow reserve(CFR) measurement by transthoracic Doppler echocardiography(TTDE) in long term followup of coronary lesion in children with KD.MethodsThe control group consisted of 25 control subjects［aged 7 months to 11.5 years, mean （5.4±3.5） years］ and KD group consisted of 8 KD patients［aged 1.914.4 years, mean (7.1±4.5) years；5 months to 9.7 years after the onset of KD, mean （2.8±3.2） years］with persistent coronary sequelae in the left coronary artery. The peak diastolic velocity(PDV) and mean diastolic velocity(MDV) in distal left anterior descending coronary artery(LAD) were measured at rest by TTDE in all children. After stable baseline signals were obtained, adenosine triphosphate(ATP) was administered intravenously at a dose of 160μg·kg-1·min-1 sustained for six minutes. Data were recorded at rest and during the last minute of ATP infusion. The ratio of the hyperemic PDV or MDV to baseline was calculated as an index of CFR(PDV) or CFR(MDV). The three main branches of coronary arteries in all KD patients were evaluated carefully by TTDE for the presence of coronary lesions, including ectasia, aneurysm, stenosis and thombi. And 5 of 8 patients underwent computerized tomography arteriography or coronary angiography for further investigation. ResultsAmong the 25 control subjects, CFR values calculated from PDV and MDV both indicated significantly positive correlation with age(r=0.596, 0.591, P=0.002, 0.002). The 95% confidence interval of normal CFR（PDV） data were categorized by age as follows: ≥1.22(<2 years), ≥1.94(~8 years) and ≥2.22(>8 years). The baseline PDV and MDV were (50.0±15.07) cm·s-1 and (35.16±11.52) cm·s-1in KD patients, respectively, much higher than those of control group(P=0.004 and 0.015), while CFR values were much lower ［1.67±0.38 and 1.69±0.47(P=0.002 and P=0.018)］. A significant reduction in CFR was noted in 7 of 8 patients (87.5%) as compared with control subjects. The coronary morphology investigation confirmed aneurysm in left main coronary artery(LM) in one child, coronary aneurysms in LAD in five, aneurysm combined with multiple severe stenosis of LAD in one and aneurysm in LM with complete occlusion of left circumflex coronary artery(LCx) in one.ConclusionsThe present study indicated that coronary flow reserve was reduced in KD patients due to persistent epicardial coronary lesions. CFR measurement by TTDE was noninvasive, technically easy and safe, with great value for long term followup and management of patients with persistent coronary abnormalities of KD.
ObjectiveIn several acute lifethreatening diseases，the 4Gallele in the 4G/5Gpromotor polymorphism in the plasminogen activator inhibitor-1 (PAI-1) gene is associated with higher PAI-1 levels and increased poor outcome，probably by promoting the formation of microthrombi. The aim of the study was to evaluate the effect of the 4G/5G PAI-1 gene polymorphism on the susceptibility, development and outcome in critically ill patients with septic syndrome.Methods Blood samples and clinical information of 148 sepsis children were collected from Guangzhou Children's Hospital in China from Apr to Dec in 2007, and in the corresponding period the blood samples of 181 health children were also collected. The cohort collected were the Han nationality in Guangzhou of China .Allele sepcial polymerase chain reaction (ASPCR)test was used to amplify the genomic DNA extracted from peripheral whole blood to detect the 5G/5G, 4G/5G and 4G/4G genotypes of the PAI-1 gene from 148 sepsis patients and 181 health controls. The frequencies of the genotypes and allele in all groups were calculated by using the genecounting method , while χ2 statistics was used to analyze the differences of genotype distributions between the two groups, and the odds ratios and 95% confidence intervals were calculated to evaluate the risk of genotypes.ResultsNo significant difference was found in the distribution of the 4G/5G PAI-1 genotypes and allele frequencies between the sepsis and the control (χ2=0.79,P>0.05). Mortality of sepsis was significantly correlated with the 4G/4G genotype (χ2=7.35,P<0.05), resulting in an odds ratio of 4.30 (95% CI:1.50-12.29); mortality of sepsis was significantly associated with allele 4G(χ2=9.17,P<0.05) , resulting in an odds ratio of 3.14. (95%CI:1.49-6.61). The susceptibility of developing severe sepsis was significantly correlated with the 4G/4G genotype (χ2=4.44,P<0.05), resulting in an odds ratio of 4.57, (95%CI :1.11-18.78); the susceptibility of developing severe sepsis was significantly correlated with the allele 4G (χ2= 4.35,P<0.05), resulting in an odds ratio of 4.05, (95%CI:1.09-15.08).Conclusions The gene frequecies of the PAI-1 promoter polymorphism in patients with sepsis in children were similar to the general population. 4G/5G promotor polymorphism in the PAI-1 gene was associated with the development and prognosis of sepsis children of Han nationality in Guangzhou. 4G allele and homozygous was the high risk hereditary factor of sepsis. There was no relationship between 4G/5G promotor polymorphisms in the PAI-1 gene and liability of sepsis.
ObjectiveMitochondrial cytopathies represent a heterogeneous group of multisystem disorders which preferentially affect the muscle and nervous systems. The disease has emerged as a major entity among the neurometabolic diseases of childhood with an incidence of 1 in 11,000 children, and also has a high prevalence in adults. They can be caused either by mutations in mitochondrial genome, or by nuclear DNA mutations. The first pathogenic mutation of human mitochondrial DNA (mtDNA) was discovered in 1988. Since then more than 100 mutations of mtDNA have been reported, including point mutations of genes encoding transfer RNA, ribosomal RNA, and proteins, as well as large-scale deletions. However, mitochondrial cytopathy could be easily misdiagnosed because of its complicated clinical features. This study aimed to review the clinical features and analyze mitochondrial DNA mutations in a Chinese patient presenting mitochondrial encephalopathy.MethodsClinical manifestations and laboratory findings of the patient were summarized. The genomic DNA of the patient and 70 normal controls were extracted from peripheral blood with QIAamp DNA Mini Kit. All fragments including 3243、8344、8993 point mutations and 62 other common mutations reported frequently in mtDNA of the patient was amplified by polymerase chain reaction(PCR). Direct-sequencing was performed for mutation analysis. If new mutations were detected, the fragment of the new mutation was amplified by PCR, then restriction fragment length polymorphism (RFLP) was used for polymorphism detection in 70 normal controls. These controls were healthy medical staffs of a hospital, meeting the following conditions: firstly, blood biochemistry, routine blood test and abdomen ultrasound in physical examination were normal; secondly, blood specimen after blood biochemistry remained >2 mL; thirdly, there was no kinship with each other; fourthly,they were under 40 years old; male or female were not limited; lastly, they were all orally informed consent.ResultsThe patient was a boy, admitted into hospital when he was 21 months of age because of anepithymia and hyperdiuresis. He presented as elevated lactate, severe metabolic acidosis, hyperammonniemia and hearing impairment. Brain CT scan showed symmetric diffuse low-density lesions at frontal lobe and parietal lobe and the patient was considered to be with mitochondrial encephalopathy. While muscle biopsy was suggested, his parents refused because of his poor physical conditions. He showed gradually retrocession: firstly hypotonia, then myotonia and coma. The patient died at two years old. His true family history was unknown because he was adopted by his parents. MtDNA 3243、8344、8993 and 62 reported common mutations were not detected in the patient. mtDNA 7496 T→C mutation in tRNAser(UCN) gene was detected in the patient, which affected a highly conserved site. The mutation led to the loss of a restriction site for the endonuclease NcoⅠ, so the tRNAser gene of the patient could not be cleaved while that of 70 normal controls were completely cleaved, suggesting no same mutation was identified in 70 normal controls.ConclusionsMitochondrial cytopathy might be presented as metabolic disorder and neuropathy and should be alerted to. The analysis of mtDNA mutation was worthwhile in the diagnostic evaluation of patients with clinically probable mitochondrial encephalomyopathy. MtDNA 7496 T→C mutation in tRNAser(UCN) gene may cause mitochondrial encephalopathy which has never been reported. This study would be helpful for the future diagnosis and genetic counseling of mitochondrial encephalopathy.
ObjectiveMice asthma model was employed to investigate the role of thymus on the mechanism of the development of allergic diseases. Meanwhile,thymosin was used as an intervention, and the effects and underlying mechanisms of thymosin in allergy therapies were studied. MethodsForty mice were randomly divided into four groups(n=10):asthma model group, OVA+thymosin group, control group and thymosin group.①Establishment of BALB/c mice asthma model: Mice were sensitized by intraperitoneal injection of OVA and airway was challenged by ultrasonic atomizing inhalation of OVA. ②Mice model was evaluated by serum total IgE and lung histopathology. ③Detection of expressions of TSLP, Foxp3 in thymus and TSLP in lung in asthma group and OVA+thymosin group by realtime PCR.Results①Serum level of IgE in asthma model group was higher than that in control group（P<0.05）; Histological analysis demonstrated more severe inflammatory reactions in lungs of asthma model group than that of control group. In asthma model group, the mRNA expression level of TSLP in thymus was significant higher than that in the control group（P<0.01）, expression level of TSLP in lungs was higher than that in control group（P<0.05）, expression level of Foxp3 in thymus was lower than that in control group（P<0.05）. ②Inflammatory changes in lungs of OVA+ thymosin group were much better than those in the asthma model group. The mRNA expression level of TSLP in thymus in asthma model group and thymosin group was significant lower than that in asthma model group（P<0.01）Conclusions①Increased TSLP expression and deceased Foxp3 expression suggested that sensitization itself could influence thymus. ②The changes of the expression of Foxp3 in thymus implied that the relationship of thymus with the onset of OVA induced asthma. ③Thymosin may reverse sensitization by downregulating expression of TSLP in thymus. It suggested that the mechanism of thymosin in allergy therapy was partially by influencing thymus function.
Sepsis is an infection-induced inflammatory syndrome responsible for nearly 10% of all worldwide death.The diverse physiopathologic manifestations of sepsis are mediated by complex cellular and biochemical events including cytokine release from inflammatory cells,microcirculatory and mitochondrial dysfunction,et al.As mitochondria are the specialized organelles for cell energy metabolism and play an important role in controlling the life and death of a cell,and a growing body of evidence indicates that mitochondria contribute significantly to the pathogenesis of sepsis-induced multiple organ dysfunction which is the leading cause of death in septic patients,so more and more attention has been paid to the relationship between sepsis and mitochondria dysfunction.
Objective To search and review the best clinical evidence to choose respiratory therapy of NRDS． Methods After developing chnical questions，we searched the following databases for evidence：MEDLINE (1993～2008年)、tripdatabase(1993～2008)、Cochrane Lib(2008 Issue 2)．The key words were “preterm infant and respiratory distress syndrome、pulmonary surfactant、ventilation“。 Results We found 3 clinical guidelines 、8 systematic reviews、9 randomized controled trials。 Conclusions clinical guidelines、Systematic reviews and randomized controlled trials have provide much convincing evidence for us to choose and utilize the most appropriate treatment。
