Objective To evaluate the diagnostic value of Mycobacterium tuberculosis (M.tb) multiple antigen proteinchip on childhood tuberculosis. Methods Serum samples were collected from 79 cases of childhood tuberculosis patients, 33 cases of nontuberculosis patients，15 children with latent tuberculosis infection and 30 healthy children. Positive rate of PPD skin test and bacteriological examination in tuberculosis patient group were calculated. Mycobacterium tuberculosis multiple antigen protein-chips were used to detect three antibodies to lipoarabinomannan (LAM), recombinant Mr 16000 and Mr 38 000 antigens simultaneously in all groups.The results were adjusted by the Protein Chip Reader equipment.If any of the three antibodies or more than one showed positive, then the result could be determinded as positive. The positive rates of protein-chip method in different groups were calculated and the sensitivity, specificity, positive predictive value, negative predictive value of the proteinchip were also calculated . The relationships among the positive rate of protein-chip and the age of patient, duration of illness, duration of antituberculosis treatment , administration of corticosteroids and type of tuberculosis were analyzed by Logistic regression and χ2 test. Results The positive rate of M.tb multiple antigen protein-chip was 34.2% in childhood tuberculosis, which was lower than that of PPD skin test (84.8%) and higher than that of bacteriological examination(12.7%). In the non-tuberculosis patient group, the positive rate was 6.1%, in the latent tuberculosis infection group it was 0, and 0 in the healthy control group respectively. The false negative rate of the control group was 2.6%. The sensitivity, specificity detected by protein chip were 34.2%，97.4% respectively. Positive predictive value was 93.1%，negative predictive value was 58.5%. The positive rate of protein-chip method was related to duration of illness by Logistic regression, it was 18.9%（6/32）when the illness duration <1 month, 21.6%（8/37）when the illness duration between 1 and 3 month, and 100% （13/13）in those whose illness duration was longer than 3 months. Current statistical data showed there was no significant correlation between testing positive results and factors such as ages, antiTB treatment duration, corticosteriods administration and type of turberculosis. The differences of the positive rate of chip testing in different TB types might be related to the differences of the illness durations in different TB types. Conclusions The Mycobacterium tuberculosis multiple antigen protein-chip method might be a supplementary way in diagnosing childhood tubercuiosis. But the sensitivity was low, and not suitable for early diagnosis.
Objective Ventricular septal defect is the most common congenital heart disease. Transcatheter closure and surgical repair are the radical cure. Studies on ventricular septal defects treated by transcatheter closure versus surgery were summarized. Through a Meta analytic review, the effectiveness and safety of two procedures were discussed. Then suitable treatment would be selected partly based on this study. Methods The articles about ventricular septal defect treated by transcatheter closure and surgical repair were selected through searching medical databases. According to including and excluding criteria,articles were searched through medical databases from Jan.,2002 to Dec.,2006 without language restriction as follows:Chinese Medical Current Contents(CMCC),Database of Chinese Scientific and Technical Periodicals,Chinese Conference Papers Darabase,Pubmed Database,OVID Database and EBSCO Database.The articles were searched through the key words in Chinese and English,they were ventricular septal defect,transcatheter closure,surgical repair.After two evaluators abstraction data including basal information,intervention measures and clinical prognosis were finally agreed with other three evaluators. According to including and excluding criteria, articles were evaluated (Shekelle PG, et al). The age, weight, defect size, and hospitalization days were analysed statistially; the success rate, residual shunt rate and complication rate were analyzed by RevMan 4.28. Results There were seven papers corresponding to criteria. All of them did not apply random control study(IIa). The age was similar in two groups, but the VSD size in transcatheter group were lower than surgical group, the weight in transcatheter group were higher than surgical group. The success rate in transcatheter group(97.8%) was lower than surgical group(99.2%), P=0.007. The mortality was similar in two groups(0 vs 1.4%,P=0.51). Residual shunt rate was similar in two groups(2.5%vs 3.2%,P=0.91). Complication rate in transcatheter group(10.1%) was lower than surgical group(25.7%),P＜0.000 01. Arrhythmia rate was similar in two groups(5.48%vs 6.64%,P=0.61). Postoperation infection rate in transcatheter group(0) was lower than surgical group(7.65%),P=0.002. Conclusions Transcatheter closure has the advantages of less vulnerarble, recovering faster and safe. But it is selective and the further outcome needs to be followed up. If the patient with ventricular septal defect is suitable, transcatheter closure will be the first choice.
Objective To explore the energy intakes of the infants with different growth velocities. Methods 202 infants aged 4-12 months were observed, who were brought for the serial measurements in the Department of Primary Child Care，Children′s Hospital, Chongqing Medical University from November 2004 to December 2005. The weights and the recumbent lengths were measured during the visit by two professional staffs. The physical growth was assessed with CDC2000 reference. All the infants were divided into 3 groups, such as group 4-5 months, group 6-8 months, group 9-12 months. 70 infants whose Z score change of weight for age (⊿WAZ) was between-2 to -0.67 during two secular visits were defined as deceleration of weight growth, and other 132 infants whose Z scores of weight for age were -0.67≤⊿WAZ≤0.67 were defined as normal growth. The food intakes of all the infants were collected by using methods of 24 h dietary recall or dietary weighting and for sequential 3 days. The averages of the three day dietary intakes were daily intake. The food intakes were calculated by Chinese Food Composition 2002 and infant food introduction. Results ①The growth levels in both groups were similar. There was no significant difference between weight, height, WAZ, LAZ and WLZ in two groups ②The feeding frequencies of two groups were about 6 times; the milk intakes of deceleration group were 785 g·d-1、754 g·d-1 and 676 g·d-1 in 4-5 months,6-8 months and 9-12 months, which were lower than the normal group (P<0.05); the other food intakes were same in two groups (P>0.05). The protein intakes in the deceleration group and normal groups were near to WHO guide and Chinese RNI. The total energy intakes were 2 393 kJ·d-1（572 kcal·d-1）、2 699 kJ·d-1（645 kcal·d-1） and 3 092 kJ·d-1（739 kcal·d-1） for 4-5momths, 6-8month and 9-12months in deceleration groups, which were lower than the normal groups; The energy intakes per kg in deceleration groups,322 kJ·kg-1·d-1（77 kcal· kg-1·d-1） in 4-5 months, 322 kJ·kg-1·d-1（77 kcal· kg-1·d-1） in 6-8months, 310 kJ·kg-1·d-1（74 kcal· kg-1·d-1）in 9-12 months were lower than normal groups (P<0.05). The energy densities were 2.7 kJ·g-1（0.65 kcal·g-1）, 2.7 kJ·g-1（0.64 kcal·g-1）, 2.9 kJ·g-1（0.69 kcal·g-1）in deceleration groups,respectively. It was similar between the two groups (P>0.05). ③The results by logistic regression analysis showed that low energy intake was the risk factor (OR=3.947), and higher maternal education level was the protective factor (OR=0.437). Conclusions ①The energy intakes in the infants with ⊿WAZ <-0.67 were lower than those in infants with -0.67≤⊿WAZ≤0.67. ②The sufficient milk intake was the key to maintain energy intakes during infancy. ③The food intake was the main factor influencing the energy intakes to maintain the energy density.
Objective To observe the changes of serum VEGF and PEDF levels in premature infants, and to discuss the roles of VEGF and PEDF in pathogenesis of ROP and the predicting values for the development of ROP. Methods Preterm infants admitted into Children's Hospital, Fudan University from Jun.2006 to Jan.2007 were chosen according to the inclusion and exclusion criterion. Those whose birth weight(BW) ≤2 000 g or gestational age(GA) ≤34 weeks joined in ROPscreen, and those who were diagnosed as ROP according to ICROP were included into ROP group. Those who didn't develop ROP were divided into <32 weeks group, -33+6 weeks group, -36+6 weeks group. Serum collections were done at postnatal day(d)7, d14, d21,d28 and d35. VEGF and PEDF levels were detected by ELISA. All data were analyzed by SPSS 13.0, with Linear Mixed ModelsRepeated, Correlations, T-Test and Univariate Analysis of Variance. Results 170 preterm infants were included according to the inclusion and exclusion criterion, 6 of them were out of study for giving up therapy by parents, 11 of them developed ROP, those all were stage Ⅰ -Ⅲ ROP. In the remained 153 nonROP infants, the number of GA<32 weeks was 54, -33+6weeks was 48, -36+6weeks was 51. In those preterm infants, serum VEGF levels decreased with advancing postnatal age(r=－0.167，P=0.000), and maintained stable after d21 (compared with d7: d14, P=0.010; d21, P=0.000). serum PEDF levels of preterm infants didn't change within the first 2 postnatal weeks (P=0.713), but after the first 2 postnatal weeks, they increased with advancing postnatal age(r=0.287，P=0.000) (compared with d7: d21, P=0.008; d28, P=0.001; d35, P=0.000). GA′s influence on VEGF and PEDF levels was more significant than BW. The smaller the GA, the higher would be the VEGF and PEDF levels. With the synergistic action of BW, the serum VEGF and PEDF levels in preterm infants were negatively correlated with GA (r=－0.162，P=0.027; r=-0.165，P=0.024). Regardless of GA, the serum PEDF/VEGF ratios of the neonates maintained constancy, and increased with advancing postnatal age within the first 4 postnatal weeks (r=0.237, P=0.000). Serum VEGF levels in ROP group were lower than those in nonROP group within the first 3 postnatal weeks (P=0.000), and even increased with advancing postnatal age. There was no statistical difference between the serum PEDF levels of ROP group and nonROP group within the first 5 postnatal weeks. But in ROP group, the serum PEDF levels didn't increase with advancing postnatal age. The serum PEDF/VEGF ratio of the ROP group was significantly higher than that of nonROP groups at d7 (P=0.036), and decreased with advancing postnatal age within the first 5 postnatal weeks (r=－0.449, P=0.047). Conclusions In this study, the tendency of serum VEGF, PEDF levels and PEDF/VEGF ratios in ROP were changed within 3 postnatal weeks. The results suggested that: if the serum VEGF level was lower at birth than the same GA preterm infants, and did not decrease with advancing postnatal age; PEDF level did not increase with advancing postnatal age; PEDF/VEGF ratio was high at d7 and decreased with advancing postnatal age; it may probably indicate the occurrence of ROP. And this may help clinical doctors predict the occurrence of ROP earlier, and take effective measurements to protect and relieve the development of ROP.
Objective Primary nocturnal enuresis (PNE) is one of the common diseases in childhood. It is not only a disease of the body but also has an impact on children's mentality and behavior development. Because PNE imposed the burden of cost and psychology on the patients and their families, more and more attention of families and society is paid to it. In several studies PNE was proved to depress the selfconcept of the patients. But only a few oversea studies discussed the change of the selfconcept after the enuresis treatment. There were few data about the Chinese PNE children. In this study, we will preliminarity discuss the impact of PNE on mentality and also discuss the effect of enuresis treatment on selfconcept in 8-16 years old patients through observing the change of PiersHarris children selfconcept scale scores. Methods 8-16 years old children who were diagnosed as PNE in enuresis center of Children′s Hospital of Fudan University from July 2005 to January 2006 were enrolled. The patients were excluded if they had hypertension, other diseases that could cause bedwetting or other factors which maybe had an impact on children's mentality such as divorced parents, chronic diseases, and so on. Before treating enuresis all the patients would finish the first PiersHarris children′s selfconcept scale under the doctor's guidance. Then the patients were divided into three groups to accept one month treatment. One was biofeedback group, one was desmopressin acetate group, another was Chinese traditional medicine group. After finishing the treatment the patients underwent followup. Three months later patients were required to answer the PiersHarris children's selfconcept scale again. Special software was used for psychology analysis. Then the patients′ selfconcept were evaluated in respects of behavior, intellectual and school status, physical appearance and attributes, anxiety, popularity, happiness and satisfaction. Results There were 54 PNE patients included 29 boys and 25 girls, whose mean age was (10.0±0.6) years. 15 patients had mild enuresis, 20 had moderate enuresis and 19 had serious enuresis. As for selfconcept before treatment, the average score of anxiety of the 54 patients was significantly lower than normal (P<0.01) and there was no significant difference between the mild, moderate and serious groups. Then 12 patients underwent biofeedback therapy, 14 accepted desmopressin acetate and 28 took Chinese traditional medicine. After treatment 44 patients were followed up and were found that the score of anxiety increased significantly (P<0.05). Compared with pretreatment, score of anxiety was increased obviously in desmopressin acetate group (P<0.05). In addition, the score of relieved patients increased significantly after treatment (P<0.05). Conclusions Before treatment the selfconcept score of anxiety of PNE children was decreased. After treating enuresis it could be improved, which was significant in patients who had good curative effects.
Objective This study focused on the diverse characteristics and the clinical significance of serum specific IgE of egg and cow milk in infants with allergic disease. Methods The results of egg and (or) cow milk serum sIgE of 855 infants(less than 36 months of age) were reviewed and statistically analysed.All of the infants were diagnosed as suffering from allergic diseases from Nov.2003 to Nov.2007 in Children' Hospital of Fudan University. Results The positive rate of egg sIgE was 50.1%（396/791）, and that of cow milk sIgE was 43.0%（324/754） for all tested cases. The positive rates of egg sIgE were all around 50% in every stage of age, but in the stage of ≤6months it was lower than the others(44%); The positive rate of cow milk sIgE in the earlier period of infancy was low (31.5%), but it was ascendant with the age increasing, it was about 50% after 18 months. A higher positive rate of egg sIgE in the infants with eczema, especially in the stage of ≤6months(70.6%) was detected, then dropped to 45.0% and approached to 71.4% at 36months age; the positive rate of cow milk sIgE was 20% in infants with eczema in the stage of age ≤6months, reached 50% in the stage of 36 months.In wheezing disease, the positive rates of egg and cow milk sIgE were relatively low (16.7%,15.4%) in the stage of age≤6months,and increased in the stage of age 24months, then decreased. The positive rates of egg and cow milk sIgE in infants with pneumonia were about 30% in the stage of age <12months, and increased to 50% to 60% in the period of 12months to 24months, then hit 60%70% in the period of 24months to 36months. The levels of serum sIgE of egg were distributed from 0.59 kUA·L-1 to 2.67 kUA·L-1 (25-75 percentiles), only 5% of the infants reached to 26.90 kUA·L-1. The levels of serum sIgE of cow milk were distributed from 0.53 to 2.19 kUA·L-1(25-75 percentiles), 5% of the infants reached to 7.76 kUA·L-1. There was a descending tendency of serum sIgE of egg levels in age dependent, the mean of serum sIgE levels of cow milk was 4.05kUA/L, then up to an extent from 1.5 kUA·L-1 to 2.0 kUA·L-1 after 12months. The mean of serum sIgE levels of egg was 16.84 kUA·L-1 and became lower in 12 to 36months(6.80 kUA·L-1to 1.49 kUA·L-1). There was a positive correlation between the serum sIgE levels of egg and cow milk in 233 infants with both egg and cow milk sIgE positive. Conclusions The positive rates of egg and cow milk serum sIgE were different according to the months of age and kind of disease during infancy. It was helpful for the diagnosis of allergic diseases by detection of egg and cow milk sIgE in infants. The positive rates of egg and cow milk sIgE were high in infants with pneumonia and needed to further study. Generally, the levels of egg and cow milk sIgE were lower in infants and showed an age dependent decrease, this is a remarkable feature of egg and cow milk allergy in infants. The levels of sIgE between egg and cow milk displayed a positive correlation, and suggested that the allergic response was partially dependent on individual immune status at least.
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 TNFα mRNA were determined by RTPCR 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 TNFα 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 electronicmicroscopically. 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.
Military pediatrics is concerned with the health of children and adolescents, their physical and mental growth and development, their prevention and treatment of injury and diseases under military action. Military pediatrics has a long history, which is not only a special area of military medicine but also an important part of pediatrics. This is the first paper in Chinese to review the history, concept and progress.
