Objective：To study the efficacy and tolerability of montelukast, a leukotriene receptor antagonist, as monotherapy in the treatment of 5 to 14yearold children with mild persistent bronchial asthma. Methods：In this double-blind, randomized, placebo controlled trial, children aged 5-14 years with mild persistent asthma diagnosed using the Childhood Asthma Management Guidelines in China were enrolled. All patients completed the questionnairs to collect baseline data at the first treatment. After a 2-week placebo run-in period, they were enrolled and randomly allocated to placebo or monterlukast sodium groups. Patients received either montelukast (5 mg chewable tablet) or matchingimage placebo once daily at bed-time for 12 consecutive weeks. All the patients were assessed at week 4, week 8 and week 12 according to the asthma daily cards, which included following measurements: daytime and nighttime asthma symptom score, short acting beta agonist (SABA) usage, medical resource utilization for asthma and peak expiratory flow rates(PEF). Spirometry was performed before and after treatment. Side effects were also judged during the 12 weeks of therapy. Results：A total of 126 subjects were reruited in the trial, and 112 subjects completed the study, with 35 from the placebo group and 77 from the montelukast sodium group. Compared with placebo group, PEF and lung function were significantly improved after 12 weeks treatment in montelukast group(P<0.05). Daytime and nighttime asthma symptom score, SABA usage and medical resource utilization for asthma were significantly reduced after 12 weeks treatment (P<0.01). Significant clinical improvement(P<0.05) was also noted after 4 weeks treatment. No adverse events were observed in the two groups. Conclusions：These results suggested that montelukast was an effective and safe controller as monotherapy in children with mild persistent asthma.
Objective:To observe the effectiveness and complications of the balloon dilation expanding metallic airway stent via fiberoptic bronchoscope for treatment of tracheal stenosis. Methods:Case 1, a 4-month-old girl, had severe congenital heart disease with tracheal stenosis. She was extubated three times unsuccessfully after the cardiac surgery in two months. Case 2, a 22-month-old girl, had EB virus-associated hemophagocytic lymphoid tissue hyperplasia with left bronchus stenosis, which resulted in repeated lung infections and left emphysema. The agreement about the operation risk was signed by the parent. Balloon expandable stents were inserted into the trachea for the 2 infants. The stents were placed on balloon catheters and inserted into the desired position bronchoscopically by local anesthesia. They were expanded and fixed in the place by inflating the balloon to an appropriate diameter. The stents were 24 and 29 mm in length and 4 mm in diameter. Results:Two patients were relieved of airway obstruction after being inserted the stents. No granulation tissue developed over the stents. Stents were in the place for 2 to 3 months after insertion without any other complication. Conclusions:Balloon expandable metallic stents can be left for a prolonged period to relieve tracheal obstruction of tracheal stenosis in the near future, but the long-term effect is still needed.
Objective:To compare the efficacy of nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) in neonatal respiratory distress syndrome (NRDS). Methods:Standard literature search strategy for the Cochrane Neonatal Review Group was performed. Searches were made in PubMed, EMBASE,Ovid, Springer and CNKI databases with the terms of newborn OR preterm AND respiratory distress syndrome AND nasal intermittent positive pressure ventilation AND nasal continuous positive airway pressure. Only RCTs or quasi-RCTs which involved NIPPV versus NCPAP were included and the rate of endotracheal ventilation, successful extubation, outcome as well as the condition of apnea of prematurity, the incidence of bronchopulmonory dysplasia (BPD), retinopathy of prematurity(ROP), intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL), and length of stay were taken as the observation items. Results:A total of 103 literatures were reviewed. Thirteen eligible randomized controlled trials were included. The results of quality assessment showed that 13 studies described the method of random allocation. Twelve studies mentioned allocation concealment and 2 studies did not use blinding method for participants. Included studies had no significant difference in regard to baseline when enrolled. In the meta-analysis of trial data, as compared with NCPAP, NIPPV significantly reduced the incidence of endotracheal ventilation (OR=0.39, 95%CI:0.23-0.56, P<0.000 01), increased the successful rate of extubation (OR=0.15, 95%CI:0.08-0.31, P<0.000 01), and had a better outcome (OR=0.30, 95%CI:0.13-0.68, P=0.004). Moreover, as compared with NCPAP, NIPPV improved apnea of prematurity (WMD=-0.48, 95%CI:-0.58--0.37, P<0.000 01), decreased the incidence of ROP (OR=0.36,95%CI:0.15-0.87, P=0.02）, but there was no significant incidence reduction in BPD (OR=0.59, 95%CI:0.29-1.16), IVH and PVL(OR=0.54, 95%CI:0.24-1.20), or length of stay (WMD=-2.97, 95%CI:-11.26-532）. Conclusions:In the treatment of NRDS, NIPPV significantly reduced entracheal ventilation, increased successful extubation, improved apnea of prematurity, decreased the incidence of ROP, and had better outcome as compared with NCPAP. However, there was no evidence supporting that NIPPV could reduce the incidence of BPD, IVH and PVL. Larger sample size RCTs are needed to investigate the long-term efficacy of NIPPV in neonatal respiratory intensive care.
Objective:To evaluate the association between vitamin D receptor(VDR) gene polymorphsims and nutritional vitamin D deficiency rickets. Methods:PubMed, Springer, Science Direct, Web of Science, China National Knowledge Infrastructure, VIP Chinese Periodical Database and Wanfang Chinese Periodical Database were searched for the case-control study on the association of VDR gene polymorphisms with rickets (up to February 2011). Meta-analysis of all the eligible studies was performed, which focused on four most commonly investigated VDR polymorphisms: FokⅠ, ApaⅠ,BsmⅠ and TaqⅠ.The best genetic model in pooled analyses was selected. Stata 11.0 software was applied for investigating the heterogeneity among individual studies and the pooled odds ratio(OR) and 95% confidence interval(CI) were calculated. Sensitivity analyses were performed by excluding studies with controls inconsistent with Hardy-Weinberg equilibrium. Results:A total of 19 eligible studies were included. ①Codominant genetic model was used to analyze the FokⅠ single nucleotide polymorphisms (SNPs). There was no heterogeneity among included studies. Subgroup analyses showed that FokⅠ SNP was significantly associated with rickets (FF vs ff: OR=4.59，95%CI:2.98-7.07;FF vs Ff:OR=2.58，95%CI:1.79-3.73) in Asian population. However, the association was not significant in Caucasian population(FF vs ff:OR=2.50，95%CI:0.76-8.19;FF vs Ff: OR=1.18，95%CI:0.66-2.10). ②Dominant genetic model of A allele(AA+Aa vs aa)was used to analyze ApaⅠ SNP. There was no significant heterogeneity among included studies. No significant association between ApaⅠ SNP and rickets was found in Asian population (OR=1.04, 95%CI: 0.72-1.49) and Africans (OR=0.98, 95%CI: 0.57-1.71). But in Caucasian population,a study suggested that aa genotype was a protective factor for rickets (AA+Aa vs aa, OR=5.50, 95%CI: 1.22-24.75). ③Dominant genetic model of B allele(bb vs Bb+BB) was used to analyze BsmⅠ SNP. Metaanalysis showed that there was a modest but statistically significant association between the SNP and rickets (bb vs Bb+BB, OR=0.46, 95%CI: 0.23-0.92) in Asian group. Only one study in Africans showed that there was no confirmed assiciation between BsmⅠ SNP and rickets (OR=1.65, 95%CI: 0.95-2.88). ④The recessive model of A allele was used to analyze TaqⅠ SNP. No significant association was observed between TaqⅠ SNP and rickets in racial subgroups. Sensitivity analyses generated similar results to those of the primary analyses. Conclusions:The results suggest that there was a trend of association between the VDR polymorphisms and rickets. The current findings confirmed that FF genotype was a risk factor for rickets in Asian populatin, however, the bb genotype was a protective factor. Because there are few studies on the association study in Caucasian and African population, additional studies are required to reach a clearer conclusion.
Objective：The purpose of this study was to analyze the features and shortterm outcomes in severe asphyxiated neonates with or without acute kidney injury (AKI) in order to validate the applicability of the criteria and classification of AKI. Methods：Severe asphyxiated neonates with SCr values twice and records of urine output were enrolled and retrospectively analyzed. The criteria proposed by Acute Kidney Injury Network were applied to diagnose the occurence of AKI. All neonates enrolled were divided into two groups, AKI group and non-AKI group. Clinical features and short-term outcomes were compared between the two groups. Results：A total of 17/30 (56.7%) patients were diagnosed to be with AKI, the rest of 13/30 patients who did not meet the criteria of AKI were divided into non-AKI group. Ten of 17 AKI patients only fulfilled urine criteria but not SCr criteria, 7 patient fulfilled both criteria. For 13 out of 17 patients in AKI group, the grade of the classification by urine output was higher than those calssified by creatinine criteria. Three patients had the same urine stage as SCr stage, 3 had higher urine stage than SCr stage and 1 had lower urine stage than SCr stage. Seven patients with high SCr（SCr>133 μmol·L-1） and fulfilled the diagnostic criteria of acute renal failure. The proportion of bad prognosis (29.4% vs 15.4% for AKI group and nonAKI group, P=0.368) and the average days of hospital stay ［(14.7±13.9) d vs (13.7±9.6) d, P=0.83］ were not statistically different between the AKI and non-AKI groups. According to the creatinine criteria, there were 7 neonates diagnosed as AKI, and the prognosis was statistically different between AKI-scr group and non AKI-scr group (P=0.016). Conclusions：More than a half of severe asphyxia neonates reached the criteria of AKI. The criteria by measuring urine output seemed more sensitive than that by detecting the increase of serum creatinine. The increase of serum creatinine might suggest bad prognosis. Studies with large sample size and long term follow-up are needed for further investigation on AKI in neonates.
Objective：To assess the efficacy and adverse effects of different doses of ACTH on infantile spasms（IS）. Methods:Systematic review and meta-analysis of RCTs were performed to compare the effects of different doses of ACTH on IS. The standard literature search strategy included electronic literature search and manual literature search．Electronic search was carried out in databases including PubMed, EMBASE, Ovid, ScienceDirect, China National Knowledge Infrastructure (CNKI), Wanfang Chinese periodical database, CiNii (National Institute of Informatics Scholarly and Academic Information Navigator) and Medical Online (Japanese medical literature database). As a supplement, references in previous reviews and studies identified as relevant were examined by manual search. The methodological quality of included RCTs was assessed according to randomization method, allocation concealment, blinding (participants, researchers and outcome assessors), loss of follow up, selective data reporting and other bias. Review Manager 5.0 was used for statistical analysis．Effects were expressed as Peto odds ratio and 95％confidence interval (CI) for dichotomous data. P<0.05 was considered as statistically significant．Data inappropriate for combining analysis were discussed descriptively. Results:A total of 4 RCTs fulfilled the inclusion criteria. The methodological quality evaluation revealed 1 RCT with moderate bias risk and 3 RCTs with high bias risk. Meta-analysis showed there was no significant difference among different doses of ACTH on cessation of spasms (OR=1.09，95%CI:0.54-2.17，P=0.82), on resolution of hypsarrhythmia (OR=1.04，95%CI: 0.43-2.51，P=0.94) and on the relapse rate (OR=1.27, 95%CI: 0.64-2.54，P=050). Descriptive analysis showed adverse effects including hypertension and gaining weight occurred more often in high-dose group than those in low-dose group. Subgroup analysis showed similar efficacy on clinical cessation of spasms (symptomatic patients: OR=0.96, 95%CI:0.43-2.17, P=0.92; cryptogenic patients: OR=2.76, 95%CI：0.36-21.12, P=0.33) and EEG resolution of hypsarrhythmia (symptomatic patients: OR=0.66, 95%CI: 0.20-2.23,P=0.50; cryptogenic patients: OR=2.23, 95%CI:0.52-9.57,P=0.28) both in symptomatic and cryptogenic IS patients. In symptomatic IS patients, the relapse rate of different doses of ACTH also had no significant difference (OR=1.00, 95%CI: 0.33-3.02, P=1.00). Conclusions:In a certain range, different doses of ACTH may have similar effects on cessation of spasms, resolution of hypsarrhythmia and relapse rate in treating IS. Low-dose ACTH may have less adverse effects than highdose. The included RCTs have relatively small sample size and low quality, so further evidence from more RCTs are needed to reach a conclusion.
Objective:To summarize the occurrence, the site and the risk of thromboembolism complication in children with nephrotic syndrome(NS). Methods:The data of children with NS complicated with thromboembolism admitted in Peking University First Hospital from July 1996 to May of 2011 were analyzed restropectively. Gender, the onset age of thromboembolism, symptom, site, short-term prognosis, serum albumin, fibrinogen and D-dimmer were investigated. Results:There were 8 NS children complicated with thromboembolism with an average age of 10.6 years old including 7 boys and 1 girl. All children had symptoms such as headache, vomitting, convulsion, abdominal pain, bloody stool, gross hematuria, hemoptysis and chest pain. There were 6 children (75%) with venous thromboembolism including portal vein, mesenteric vein, pulmonary embolism, renal vein, inferior vena cava and cerebral venous sinus thromboembolism. There were 3 children with pulmonary embolism, 2 with renal vein thrombus and 2 with intracranial venous sinus thrombosis. Two children had arterial thromboembolism including lower limb arterial thrombus in 1 child and internal carotid arterial thrombus in 1 child. All the children were diagnosed by imaging techniques such as ultrasound, CT, MRI, MRA, MRV and lung perfusion. Seven children had low serum albumin below 20 g·L-1. All children had elevated serum fibrinogen above 4 g·L-1. Seven children had elevation of serum D-dimmer. All children received anticoagulants, 2 showed poor response and underwent amputation surgery and bowel resection, respectively. Conclusions:In children with NS, the occurrence of pulmonary embolism was not rarer than renal vein thrombosis. Male teenagers with hypoalbuminemia, hyperfibrinogemia and elevation of serum D-dimmer should be paid more attention to the complications of thromboembolism.
Objective:To summarize the clinical manifestations, diagnosis and treatment of Andersen-Tawil syndrome(ATS). Methods:One case of ATS was reported in clinical features, process of genetic diagnosis, treatment and follow-up. The literatures were reviewed. Results:A twelve years and ten months old girl, who was initially admitted to the hospital because of loss of consciousness with convulsion for three hours while electrocardiogram showed ventricular tachycardia, ventricular fibrillation and polymorphic ventricular tachycardia. The patient had the history of paroxysmal bilimbs weakness and chest distress without source. In physical examination, deep-set eyes, ocular hypertelorism, arrhythmias and flaccid symmetric quadriparesis were observed. A transient reduced serum potassium and abnormal myocardial enzymes were found. Peripheral nerve conduction study was made and showed normal result. EMG showed peripheral nerve damage. Urine metabolic diseases analysis (GS/MS) and genetic analysis of mitochondrial disease showed normal results. KCNJ2 gene analysis showed heterozygosis of two missense variants. The condition of the patient was improved after being treated with amiodarone and metoprolol, but the frequent ventricular ectopy was difficult to suppress with pharmacological therapy. The patient was plated of an implantable cardioverter defibrillator one month after discharge and given flecainide100 mg·d-1. The arrhythmias was improved after the treatment. Till now, the follow-up has been maintained for 8 months and the patient is without convulsion. Conclusions:ATS is characterized by cardiac arrhythmias, periodic paralysis and dysmorphic facial/skeletal features, and can be diagnosed by clinical characteristic and KCNJ2 gene analysis.
Objective:To observe the effect of dexamethasone on histopathologic change of lung tissue of rats with mycoploasma pnermoniae pneumonia and the influence of dexamethasone on lung tissue in rats. Methods:Ninety-five rats were randomly divided into four groups：azithromycin group(n=25), dexamethasone group(n=25), azithromycin+dexamethasone group(n=25) and control group(n=20) by dropping mycoplasma pnermoniae bactieria liquid to nose of rats on day 0, 1, 2, and 3. Four groups recieved interventions on the 4th day: azithromycin (10 mg·kg-1) daily for azithromycin group, dexamethasone (0.5 mg·kg-1) for dexamethasone group, azithromycin (10 mg·kg-1) SQ and dexamethasone (0.5 mg·kg-1) IP once daily for azithromycin+dexamethasone group and sterile 0.9% saline for control group. Five rats for intervention groups and 4 for control group were sacrificed on day 1,3,5,8 and 10. Lung tissues were processed and fixed, histopathologic score (HPS) was determined by a pathologist who was unaware of the grouping information. Results:①On day 1 of interventions, lymphocytes infiltration at different degrees was seen in lung tissue or around blood vessels in all groups. On day 5, more lymphocytes infiltration around bronchioli and blood vessels was observed in control and dexamethasone groups, but reduced lymphocytes filtration was seen in azithromycin and azithromycin+dexamethasone groups. On day 10, the observation kept the same for control and dexamethasone groups, but further reduced lymphocytes infiltration was seen only around terminal bronchiolis in the other two groups. ②Histopathologic score(HPS) showed that at different time points after treatment in control group, HPS of lung tissue maintained at higher level, significantly higher than those in azithromycin and azithromycin+dexamathasone groups. In dexamethasone group, HPS of lung tissue at different time points showed an increasing trend that suggested increased inflammatory infiltration. In azithromycin and azithromycin+dexamethasone groups, 5, 8, 10 days after treatment inflammatory infiltration was decreased, and azithromycin+dexamethasone group was better than azithromycin group. Conclusions:After 3 days treatment, combination therapy of azithromycin and dexamethasone significantly reduced lung HPS compared with the control group, dexamethasone group and the group using azithromycin alone.
