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 The improvement of the present standardized diagnosis and treatment norms along with the unified symptom-pattern identification will objectify and standardize the diagnosis of symptoms, thus to promote and develop traditional Chinese medicine(TCM). This study presented a method that generated TCM dynamic scales based on the data excavation to be applied to the establishment of symptom differentiation standards on child pneumonia.Methods Seven hospitals were chosen as multicentre participating study unities, whose cases were all consistent with pneumonia diagnosis standard in western medicine and TCM.The non-pneumonia children from Affiliated Hospital of Liaoning University of TCM were taken as verification group. The collected information of clinical symptoms in children pneumonia was manipulated by clustering excavation and association analysis. The analysis of the clustering excavation results was performed to form the basic composition and constituent ratio of each symptom belonged to children pneumonia, symptomatic composition belonged to children pneumonia and differentiation of symptoms and specification scale of TCM in children pneumonia. Child pneumonia differentiation of symptoms and signs scales were produced based on the models composed by penthemeron in symptoms and contribution models composed by penthemeron between symptoms.And the reliability and validity of scales were evaluated.Results The study group and verification group contained 1 063 cases and 2 000 cases, respectively. Through literature review on children pneumonia of TCM, 216 symptoms and penthemeron variances were summarized, which were significant to the diagnosis of children pneumonia and covered 30 aspects related to the children pneumonia. 109 indexes with statistical and clinical significance were obtained after clustering management. The reliabilities of phlegm-heat stagnating in lung, wind-heat stagnating in lung, Qi and Yin deficiency, lung-heat due to Yin deficiency, stagnation of phlegm in the interior, accumulation of phlegm and heat, pathogenic wind-cold factors tightening the lung and pathogenic heat stagnating in lung scales were 0.742,0.583,0.666,0.258,0.370,0.559,0.797 and 0.861,repectively. The symptoms in high validity coefficient: phlegm-heat stagnating the lung symptoms were urination（0.611）, throat symptoms（0.585）, thirsty（0.575）,pulse-frequent(0.548), thick tongue fur(0.442),sputum-quality（0.42）,fever-quality（0.418）, cough-degree（0.412）；wind-heat stagnating the lung symptoms were pharyngeal portion symptoms（0.658）, sweat-degree（0.535）,cough-degree （0. 572）and pulse-frequent（0.52）; Qi and Yin deficiency the symptoms were pulse-weakness（0.876）, pulse-parvus（0.847）, cough-voice（0.742）, slimy tongue fur（0.695）,sputum-quality（0.551）;lung-heat due to Yin deficiency symptoms were pulse-frequent（0.551）, sputum-quality（0.535）, pulse-parvus（0.488）, exfoliative fur(0.409); stagnation of phlegm in the interior the symptoms were pulse-frequent（0.534）, pulse-slippery （0.533）, sputum-quantity（0.41）, thick tongue fur (0.407);accumulation of phlegm and heat the symptoms were pulse-slippery（0.611）, cough-degree(0.598), sputum-quality(0.548), sputum-quantity(0.428), sputum-color (0.427), pulse-frequent(0.425), thick tongue fur(0.406);pathogenic wind-cold factors tightening the lung symptoms were urination（0.927）, throat symptoms（0.900）, mind-degree（0.879）, sputum-quality （0.732）, slimy tongue fur（0.63）, wheezing（0.55）,pulse-tight（0.409）; pathogenic heat stagnating the lung symptoms were cough-degree（0.891）, thirsty（0.824）,sedes（0.813）, fingerprint quality （0.8）, fever-quality （0.771）,fingerprint degree（0.748）, slimy tongue fur（0.642）, cough-voice（0.58），fever-temperature （0.481）.Conclusions The chiasm subjects, data excavation technique were used in the paper to offer a beneficial exploration of the differentiation of symptoms and specification of TCM. Studies showed that data excavation technique was an effective technical method to be used to support the establishment of the symptom differentiation norms and the standards for differentiation of symptoms and signs. The differentiation of symptoms scale assessment of children pneumonia was an effective standardized evaluation method.
Objective To evaluate the value of the procalcitonin(PCT) test for diagnosing neonatal sepsis.Methods A search in Cochrane Library, PubMed, Ovid, Springer, China National Knowledge Infrastructure (CNKI), Wanfang Chinese Periodical Database and Chinese Bio-medicine Database（CBM）was performed to identify relevant articles from Januanary 1990 to October 2009. The language of the researches wasn′t limited. All non-English and non-Chinese articles were translated into Chinese to assess. Inclusion criteria were established based on validity criteria for diagnostic research. Subsequently, the characteristics of the included articles including study background,design information and diagnostic parameters were extracted. Statistical analysis was performed by employing Meta-DiSc 1.4 and SPSS 12.0 software. Heterogeneity of the included articles was tested for selecting proper effect model to 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 was calculated. Finally, sensitivity analysis and comparison of sensitivity among different groups were performed.Results We searched 446 relevant English articles, 98 Chinese articles and 21 other language articles. Thirty-three articles(18 English articles, 11 Chinese articles and 4 other language articles) were included, with total 3 599 newborns. Three articles meeting inclusion criteria were analyzed for the value of the PCT test for the diagnosis of clinical early onset neonatal sepsis (EONS) in umbilical cord blood at birth, the pooled sensitivity,specificity and SROC AUC were 77.7%,82.8% and 0.833 7,respectively. Eight articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of clinical EONS within 0-12 h after birth, the pooled sensitivity,specificity and SROC AUC were 76.7%,87.1% and 0.896 5,respectively. Four articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of clinical EONS within 12-24 h after birth, the pooled sensitivity,specificity and SROC AUC were 76.6%,88.5% and 0.884 4,respectively. Six articles meeting inclusion criteria were analyzed for the value of serum PCT levels for diagnosis of clinical EONS within 24-48 h after birth, the pooled sensitivity,specificity and SROC AUC were 69.8%,88.2% and 0.894 7,respectively. Fifteen articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of clinical late onset neonatal sepsis (LONS), the pooled sensitivity,specificity and SROC AUC were 79.0%,92.3% and 0.963 2,respectively. Fifteen articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of proven LONS, the pooled sensitivity,specificity and SROC AUC were 84.5%,80.9% and 0.934 5,respectively. Significant heterogeneity among studies was observed. Sensitivity analysis showed that differences in PCT assay producer and PCT cutoff, study countries, gestational age and severity of sepsis in the study population may partially explain the between- studies heterogeneity.Conclusions The PCT test showed good accuracy in diagnosing neonatal sepsis, regardless of differences in diagnostic criteria or time points for testing. PCT should be combined with other diagnostic markers to further improve the sensitivity and accuracy in the diagnosis of sepsis.
Objective To assess the efficacy and safety of mycophenolate mofeti in the treatment of proliferative lupus nephritis．Methods We searched the Cochrane library、PubMed、EMBASE、CBMdisc、CNKI、VIP up to 30 June 2009. Three reviewers assessed the quality of including studies， extracted data. Meta-analysis for the result of homogenous studies were made with RevMan 5.0．Results Fourteen studies involving 1 032 participants were included. All included studies were graded on randomization， allocation concealment and blinding. Seven studies were graded B， and the other seven studies were graded C． Meta-analysis based on included studies showed：①Complete remission rate（OR＝2．16，95％CI：1.31-3.55）and total remission rate（OR＝1.51，95％CI：1.10-2.07 ）had statistical significance in MMF compared with CTX. MMF was better than control groups；amenorrhea （OR＝0.16，95％CI：0.05-0.50）infections(after sensitivity analysis) (OR＝0.38，95％CI：0.23-0.61) and leucopenia (OR＝0.43，95％CI：0.27-0.71) had statistical significance. The side effect in MMF was less than in control groups. But mortality、ESRD 、partial remission rate、gastrointestinal symptoms、herpes zoster had no statistical significance.②Amenorrhea （OR＝0.20，95％CI：0.07-0.61）,infections (OR＝0.46，95％CI：0.22-0.99) and leucopenia (OR＝0.12，95％CI：0.03-0.52) had statistical significance in MMF compared with CTX/AZA. The side effect of MMF was less than control groups. But mortality,ESRD ,complete remission rate,partial remission rate,total remission rate,relapse,SCr double,gastrointestinal symptoms and herpes zoster had no statistical significance.Conclusions Present evidences showed the efficacy of MMF and CTX or CTX/AZA was similar， but the safety of MMF was better than CTX or CTX/AZA．
Objective To investigate the role of the FTO gene rs9939609, rs1421085 polymorphism on obesity and relative trials in Chinese Han children and adolescents.Methods Obese/overweights children and adolescents and normal weight children as control aged 6-18 years old were enrolled. Body height and weight were measured and body mass index （BMI）was calculated. Serum fasting plasm glucose ( FPG) , fasting insulin ( FIns) , triglycerid (TG) and cholesterol (TC) were measured. HOMA-IR and QUICKI were calculated. Genomic DNA was extracted from peripheral blood, Taqman-MGB probe was used to detect the FTO rs9939609, rs1421085 polymorphism. Obesity was evaluated by using IOTF BMI standard. Results Obesity group, overweight group and normal control group included 236,239 and 241 children, respectively. ①The levels of FPG,FIns, TG and HOMA-IR were significantly higher in obesity/overweight group than that in normal control group.②The successful rates of rs9939609 typing in obesity group, overweight group and normal control group were 94.9%（224/236）,97.9％（234/239） and 95.9%（231/241）,respectively.The successful rates of rs1421085 typing in obesity group, overweight group and normal control group were 92.8% （219/236）,97.1%（232/239） and 95.4%（230/241）,respectively.The AA genotype frequency of rs9939609 was 2.7% in obesity group and 0.4% in overweight group and there existed significant difference compared with normal control group(genotype frequency 1.7%,P=0.048, OR=1.437). The CC genotype frequency of rs1421085 was 2.7% in obesity group and 0.9 % in overweight group and there existed significant difference compared with normal control group(genotype frequency 1.7%,P=0.076, OR=1.388).③There existed significant difference in BMI between the rs1421085 TC +CC, rs9939609 TA +AA genotypes when compared with their wild TT genotypes(rs9939609: P=0.000 3; rs1421085: P=0.000 5). However, FPG, FIns, TG, TC, HOMA-IR and QUICKI showed no significant difference between the rs1421085 TC +CC, rs9939609 TA +AA genotypes and their wild TT genotypes was not found.Conclusions FTO gene rs9939609 and rs1421085 SNP was firstly reported to be associated with obesity and BMI in Chinese Han children and adolescents, but the significant statistical association among the SNPs and obesity related metabolic parameters.
Objective To explore the the clinical relationship between juvenile systemic lupus erythromatus（JSLE）and diabetes mellitus (DM). Methods The clinical data of four JSLE patients accompanied with DM diagnosed from 2002 to 2008 were collected to summarize clinical features,treatment and prognosis.Results All 4 patients were girls, 3 of them were 12 years old,the other was 8 years old.All the patients were diagnosed JSLE and DM.Two patients were taken insulin stimulation test and glucose tolerance test.One patient had the possibility of T1DM and one patient had the possibility of T2DM.Three onsets were sudden and the patients presented with diabetic ketoacidosis sequently. One patient was accompanied with DM during the processing of the disease,in the other two cases DM occurred after 1 and 3 years treatment respectively.Two patients were also accompanied with thyroid impairment. All 4 patients could be relieved, and after the treatment of DM, the level of blood glucose was steady.In 3 patients with the complication of DM, their growth and development were normal.Conclusions DM may be one of the manifestations of JSLE. Corticosteroid was not the main cause of JSLE complicated with DM. Corticosteroid was the major medicine to treat JSLE accompanied with DM. The immune suppressive drugs could reduce the incidence of elevated blood glucose which was the side effect of corticosteroids. The patients with JSLE should be against the DM preventively. Not only the levels of blood glucose and urine, but also the insulin autoantibody and glutamic acid decarboxylase antibody should be detected in JSLE patients.
Objective To investigate the quinapril resistant effect and its machenism on renal fibrosis of obstructive nephropathy.Methods Thirty Sprague-Dawley rats were randomly assigned to the sham group （n=6）, unilateral ureteral obstruction (UUO) operation group（n=12）or quinapril treatment (10 mg·kg-1·d-1) + UUO operation group (n=12). The renal tissues from each group were collected 14 or 28 days after operation. The interstitial fibrosis was evaluated by Masson＇s trichrome staining. The expressions of α-smooth muscle actin (α-SMA) and transforming growth factor-β1（TGF-β1 ）in renal tissues were detected by immunohistochemical staining. The local expression of TGF-β1 mRNA was detected by in situ hybridization.Results Compared with the sham group, the renal pathological changes displayed a spectrum of changes of tubular atrophy, tubular dilation and interstitial fibrosis in UUO group. These changes were more obvious in the late stage kidney on UUO group(observed on 4 weeks after opration). The renal interstitial volume was increased after UUO operation based on the results of Masson＇s trichrome staining (P<0.001). The results of immunohistochemical staining showed that α-SMA and TGF-β1 protein were highly expressed in tululointerstitium after UUO operation (P<0.001). The interstitial volume, TGF-β1 and α-SMA protein were expressed more abundantly in UUO group 4 weeks after the obstrution. High expression of TGF-β1 mRNA in UUO group was detected by in situ hybridization assay at 2 and 4 weeks time-points after operation (P<0.001). Quinapril treatment successfully inhibited the increasing tendency of interstitial volume, TGF-β1 mRNA, α-SMA and TGF-β1 protein, though failed to reverse completely (P<0.05 or <0.01).Conclusions Quinapril could delay the progression of renal fibrosis in UUO rats. One of the possible machenisms was that quinapril inhibited the secretion of TGF-β1 in impaired kidney, which might decrease the activity of microfibroblasts further.
