Objective To sysmetically review the efficiency and safety of cyclophosphamide against primary nephritic syndrome of children, and try to find the best regime of cyclophosphamide therapy. Method MEDLINE(1963-2004.12), OVID, SPINGER, CNKI database(1994--2004) were searched by using the terms Cyclophosphamide and Nephrotic Syndrome for hunman clinical trials, including unpublished documents from scientific meetings and thesis, and the similar documents listed in the references of above documents were also included . All of the randomized controlled trials were included comparing cyclophosphamide with general medicine and other immunosuppressive agents or comparing different dasage , duration and different methods of cyclophoaphamide medication for the treatment of primary nephritic syndrome of children. Two reviewers independently performed data extraction and appraised using Juni instrument; disagreements were resolved by consensus. Double data were input and analyzed by software of Review Manager 4.2 ,which is recommended by Cochrane Collaboration. Results Thirtteen RCTs were included. Cyclophosphamide with prednisone significantly reduce the one year's relapse risk [3trials; RR0.39，95%CI 0.18 to 0.87]compared with prednisone alone, and there's no data favous cyclophosphmide at one to two years (RR3.45 ,95%CI 0.63 to18.93）.there is no observed difference in remission rate at one year[2trials; RR0.94，95%CI 0.30 to 2.98]. Intravenous cyclophosphamide can significantly raise the remission risk at six months and one year compared with oral cyclophosphamide (RR1.76，95%CI 1.03 to 2.98). About duration: eight weeks cyclophosphamide comparing two weeks therapy, can effectively reduce the relapse risk, but long-term effect is unknown ( RR1.42，95%CI 1.15 to 1.75). Twelve weeks cyclophoaphamide comparing eight weeks therapy, there is no significant difference on relapse risk within five years between them (RR1.00，95%CI 0.67 to 1.50）. Considering there will be more unpleasant event when the dosage is raised, eight weeks cyclophosphamide therapy is more suitable. Conclusion Cyclophosphamide with prednisone significantly reduce the one year's relapse risk compared with prednisone alone, Intravenous cyclophosphamide can significantly raise the remission risk within one year and has less accumulative dosage ,more safer than oral cyclophosphamide. Further adequately powered and well-designed RCTs are needed to evaluate the long-term effect of cyclophoaphamide.
Objective: Although hypothermia was protective against brain injury after asphyxia in animal hypoxic-ischemic models, the efficacy of hypothermia in term infants with hypoxic-ischemic encephalopathy (HIE) is still uncertain. It is necessary to go on a multi-center, randomized, controlled trial to verify its efficacy in neonates with HIE. The purpose of this multi-centre randomized trial was to investigate the efficacy of selective head cooling (SHC) with mild systemic hypothermia in neonates with HIE. Methods: Infants qualified for the study if they were ≥36 weeks gestational age, ≥2500 g birth weight, and ≤ 6 h after birth. The inclusion criteria also included cord blood gas pH ≤ 7.0 or base excess ≤-16 mmol/L or Apgar score ≤3 at 1 min, continued ≤5 at 5 min. Abnormal neurological findings included lethargy, stupor, or coma, with one or more of hypotonia, abnormal reflexes, absent or weak sucking or clinical seizures. Exclusion criteria were: major congenital abnormalities, head trauma causing major intracranial hemorrhage, infection or severe anemia. 187 term infants from 16 tertiary referral hospitals with various severity of HIE were randomly assigned to either head cooling (n=104) or control group (n=83). In 30 babies follow-up were not available (16 in cooling and 14 in control group respectively). Thus total 157 infants were allocated to either head cooling (n=88) or control group (n=69). In head cooling group, the nasopharyngeal temperature was maintained at (34±0.2)℃ with rectal temperature beyond 34.5℃for 72 h then rewarmed spontaneously. Normal rectal temperature at 36-37.5℃ was maintained in control group. During study period, the babies in both groups were monitored on nasopharyngeal temperature, rectal temperature, heart rate, respiration rate, transcutaneous arterial oxygen saturation and blood pressure. Neurodevelopmental outcome was assessed by using Gesell's Development Diagnosis at 18 months follow-up. Mental retardation was defined as development quotient (DQ) <70. Severe disability was defined as with either cerebral palsy or mental retardation. The primary outcome was a combined end point of death and severe disability. Results: Death and severe disability occurred in 28 of 88 infants (31.8 percent) in the hypothermia group and 35 of 69 infants (50.7 percent) in the control group respectively (odds ratio [OR], 0.45; 95％ confidence interval [CI], 0.23 to 0.86; P=0.02). eighteen infants (20.5 percent) in the hypothermia group and 22 (31.9 percent) in the control group died (OR, 0.54; 95% CI, 0.26 to 1.11; P=0.10). 10 of 70 infants (14.3 percent) in the hypothermia group and 13 of 47 (27.7 percent) in the control group had severe disability (OR, 0.43; 95% CI, 0.17 to 1.11; P=0.07). For moderate HIE, the rate of death and severe disability was 24.2％ in the hypothermia group as compared with 52％in the control group (OR, 0.29, 95% CI, 0.10-0.9; p=0.03). For severe HIE, the rate of death and severe disability was 55.6% in the hypothermia group as compared with 73.3％in the control group (p=0.13). Conclusions SHC with mild systemic hypothermia reduceed the risk of death or disability in infants with moderate or to severe HIE, especially in those with moderate HIE.
Objectives：(1)To study the airway epithelial cell apoptosis in asthmatic rat with airway remodeling (2) To investigate the regulation role of BUD(Budesonide) on airway remodeling and apoptosis in asthmatic rat airway epithelium.Methods:Thirty male rats were randomly divided into control group (group C) ,airway remodeling group(group A) and BUD treated group(group B), each group had 10 rats. In the experiment,a rat asthma model was established by the ovalbumin challenged methods. The rats from group A and group B were sensitized by injecting 1ml mixture (contain 1mg OVA and 100mg aluminum hydroxide) at first and eighth days, and challenged with an aerosol of 1% OVA on fifteenth day .The challenge were repeated every other day in the following 12 weeks , 30 minutes one time . group C was injected and challenged by 0.9% sodium chloride. in additional ,The rats of group B were treated 1mg nebulized BUD.An hour after last challenge,the animals were anesthetized and then sacrificed,and the sample of the lung tissue was collected. The left lung tissue was collected and embedded in paraffin ,sectioned. Hematoxylin and eosin staining,Masson's Trichrome stain, Periodic Acide Schiff'staining were performed. Histological changes were detected under light or electronic microscope.immunohistochemistry assays were used to detemined the status of cleaved caspase-3 in airway epithelium.Result:(1)The result of light microscope observation: Compared with group C,light microscope of HE-stained lung tissue showed that there were infiltration of numerous inflammatory cells around the bronchus ,and airway epithelium damaging in the group A. Airway smooth muscle cell proliferation , airway wall thickness ,mucous plugs were found in group A. Enhenced goblet cell hyperplasia in PAS stained sections and excessive collagen deposition in Subepithelial area were found in group A. Pathologic change in BUD treated group were abated in comparasion to group A. yet excessive collagen deposition in Subepithelial area were found in group B (2)The result of TEM:Subepithelial basement membrane thickness and collagen deposition were obviously observed under TEM in both group.A and group B. Infiltration of EOS and AT-II cells damaging were found in group A,and abated in group B.(3)The results of image analysis: compared with the total bronchial wall area(wat), group A(110.01±13.77) was significantly higher than group C(77.25±7.56) (P<0.01), group B (92.85±15.16)was significantly lower than group A (110.01±13.77)(P<0.05)，but higher than group C（P<0.05）.Compared with the smooth muscle area, group A(45.39±7.51) was significantly higher than group C(25.72±4.05) (P<0.01), group B(36.48±4.70) was significantly lower than group A(45.39±7.51) (p<0.05)，but significantly higher than group C（P<0.01）compared with the percentage of collagen deposition area: group A (12.79±3.75) was significantly higher than group C (3.16±0.90)(P<0.01),group B (9.09±1.46) was significantly lower than group A (P<0.05)，but higher than group C (P<0.01)..(4) The results of immunohistochemistry assays: the cleaved caspase-3 imumunoreactive cells increased in rat epithelium in both group A[(10.49±2.82),(9.58±1.86)] and group B [(10.58±2.51)，(10.65±2.36)]in comparasion to that of group C[(2.86±1.17),(2.44±1.0)] (both P<0.01). No significant difference between group A and group B was found( both P>0.05) Conclusion : (1) The apoptosis in the epithelium of asthmatic rat with airway remodeling was significantly increased.(2) BUD treatment fail to inhibit apoptosis in asthmatic rat (3) BUD treatment partly inhibit airway remodeling
[Abstract] Objective To determine the drug-resistance rate of gram-positive cocci isolated from petients of 5 pediatric hospital located in different areas in China. Methods From Jan 1st 2000 to Dec 31st 2004,a total of four type pathogenic strains were isolated from 5 pediatric hospital,and the number of the strains is 8215. The all 8215 strains were tested using Kirby-Bauer method. According to the criteria of guidelines of NCCLS of each year. R% were calculated to show the resistance and intermediate，and the S% for susceptible rate of bacteria to the compound tested. Results Among a total of 4004 strains of S. aureus, the detectable rates of methicilin-resistant Staphylococcus aureus(MRSA) were 7.15%，and the rate of resistance to erythromycin was 61.96% while the rate was rising. All isolates were susceptible to vancomycin;2402 strains of S. pneumoniae were isolated. The rate of penicillin unsusceptible Streptococcus pneumoniae (PRSP) was 63.42%， and the rate of resistance to erythromycin was 86.22% while the rate of both were went up; The total strains of 432 Group A streptococci were all susceptible to penicillin, with the rate of resistance to erythromycin was 68.47% which was rising by year; 2.73% of all 1377 isolated Enterococcus strains were found intermediate to vancomycin，and the rate of ampicillin resistance was 51.91%. The rate of resistance to erythromycin was 88.10%. Conclusion Except Group A streptococci, G＋ coccus have a high resistance rate to penicillin; almost all G＋ coccus were susceptible to vancomycin and teicomycin, but resistant to erythromycin with a trend of rising. MRSA was low in rate,and we haven't find VRSA and VISA.Antimicrobial resistant coccus of pediatric has already become a serious problem in China. Ongoing surveillance study on the antimicrobial resistance of gram-positive coccus is necessary for appropriate antimicrobial use in pediatric clinical work.
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.
Objective: To investigate the histopathological characteristics of congenital aortic valve malformation in children. Methods: All the native surgically excised aortic valves from 32 pediatric patients because of symptomatic aortic valve dysfunction due to congenital aortic valve malformation received between January 2003 and December 2005 were studied macroscopically and microscopically. The patients' medical records were reviewed and the clinical information was extracted. The diagnosis was made by the clinical presentation，preoperative echocardiography, intraoperative examination, and postoperative histopathological study, excluding rheumatic or degenerative aortic valve disease, infective endocarditis and primary connectine disorders, eg, Marfan syndrome. Results: Among 32 aortic valves, patient age ranged from 6 to 18 years, with a mean of 14.9 years, and there were 27 men and 5 women, male: female = 5.4:1. There were 5 aortic stenosis (AS, 15.62%), 25 aortic insufficiency (AI, 78.13%) and 2 AS-AI (6.25%) cases, without other valve diseases. Twenty still had other congenital heart diseases: ventricular septal defect,19; patent ductus arteriosus, 2; double chamber right ventricles, 1; aortic right coronary sinus aneurysm, 3. Histopathological examination indicated that the cusp became thickening with unequal size, irregular shape (coiling and prolapse edge), enhanced hardness, and partly calcification. Microscopical investigation showed the unsharp structure of valve tissue, fibrosis, myxomatous, reduce of collagen fiber, rupture of elastic fibers, different degree of infiltration of inflammatory cells, secondary calcareous and lipid deposit, and secondary fibrosis. Conclusion: Congenital aortic valve malformation in children involves male more then female, mostly associated with other congenital heart diseases. Aortic insufficiency is more common in children with congenital aortic valve malformation. Histopathologically, the leaflets of aortic valve are mainly myxomatous, thickening with unequal size, irregular shape (coiling and prolapse edge), reduce of collagen fiber, rupture of elastic fibers, without small vessel proliferation and inflammatory cell infiltration, fibrosis and calcification less seen.
