Objective To assess the feasibility of implementing screening-diagnosis-evalation system in the rural areas of China, and to provide evidence for widespread use of the system. Methods ①Screening for CHD: Five survey sites (Minhang, Kunshan, Ningyang, Fuling and Huairou) were selected. The children aged 0-3 years were screened by trained and qualified pediatricians and child care physicians. Positive-screened result was defined as one or more of the indicators including family history of CHD, difficulty in breathing, cyanosis, special face, heart murmur, abnormal pulse oximetry, and other congenital malformations. ②Diagnosis of CHD: For children with positive result in screening, diagnosis was made by qualified pediatric echocardiographers who had taken standardized training. ③Evaluating for CHD: Assessment was made by qualified pediatric cardiologists. ④ Information management of CHD: Network system for the children with CHD in rural areas was established. The data were filled in by network for remote management. Results ①Screening for CHD: From August 1st 2011 to August 1st 2012, screening was performed for a total of 63,839 children, including 23 637 cases in Minhang, 16 338 in Kunshan, 10 031 in Ningyang, 9 833 in Fuling and 4 000 in Huairou. Among those, 736 cases had positive-screened results. ②Diagnosing for CHD: Echocardiographic diagnosis was performed in 734 cases of positive-screened children, among them, 278 cases were confirmed as CHD patients, accounting for 4.4‰ of the screened population, including ventricular septal defect (138 cases), atrial septal defect (77 cases), patent ductus arteriosus (36 cases), pulmonary stenosis (8 cases), tetralogy of Fallot (7 cases), pulmonary atresia (3 cases), atrioventricular septal defect (3 cases), total anomalous pulmonary venous return (2 case), aortic coarctation (2 case) and single ventricle (2 case). ③7 and 3-indicator combination (murmur+cyanosis+ abnormal pulse oximetry) had the same sensitivity for screening CHD (95.68%), the specificity was 99.26% and 99.32%, respectively. Positive predictive value and negative predictive value of 7 and 3-indicator combination had no significant difference. ④Evaluating for CHD: All of the 266 cases diagnosed as CHD were undertaken assessment. Among them, 122 cases received surgery and had good outcome, and the remaining were followed up without obvious symptoms. Conclusion Establishment of the screening-diagnosis-assessment system for CHD can achieve early detection, early diagnosis and timely intervention for the patients in the rural areas of China.
Objective To identify a new screening and transferring system based on the current high-risk infants health system by urinary ultrasound screening and follow-up of renal pelvis dilation(RPD) in 0-3 months old high-risk infants. Methods In the three-level transferring system, high-risk infants were identified in community health service(CHS) and then transferred to maternal and child health hospital(MCH) for screening of CAKUT. Cases with RPD were followed-up in MCH and/or transferred to academic pediatric hospital according to designed criteria and path. Cases transferred were examined for further investigations for confirmative disgnosis. Results Between Jun.1st, 2010 and May.31th, 2012, screening of 3 743 0-3 month-old infants yielded 338(9.0%) positive cases of RPD. Overall RPD positive rate and proportion of different RPD grading significantly differed between males and females.A subgroup of 285 in 338 infants with postnatally detected RPD was followed up, further investigation yielded a specific diagnosis in 6 cases, 3 cases were with ureteropelvic junction obstruction(PUJO), 2 with megaloureter and 1 with duplex kidney combined with ectopic ureter. 3 cases of them underwent surgery.During follow-up for (5.4±4.5) months, averagely 86.4% (241 out of 279 cases) recovered, the rate were 91.9%, 76.3% and 22.2% for mild, moderate and severe RPD patients, respectively. RPD pesisted in only 17 cases and deteriorated in 5 cases. The absolute quantity and relative percentage of high-risk infants screened in the second year of study was obviously higher than that of the first year（83.0% vs 64.1%）, the positive rate of RPD was 7.8% and 9.46% for 1st year and 2nd year.The rate of RPD transferred and loss of follow-up were not significantly different between the two years. Conclusion Our data suggest that the screening and three-level transferring system of CAKUT by adding urinary ultrasound screening to the current high-risk infants health system in CHS and MCH should be feasible. The academic pediatric hospital is supposed to set up training and scientific research, higher professional quality requirements are proposed to doctors in maternal and child health hospital.
Objective To evaluate the value of the proealcitonin(PCT) test for diagnosing meningitis in children. Methods A comprehensive electronic search was performed to retrieve relevant studies on PCT in diagnosis of meningitis in children.The time from the initiation of the database to July 2013,QUADAS items was used to evaluate the quality of the included studies.Pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,summary receiver operating characteristic curve(SROC),and the heterogeneity of the included studies were analyzed by using the Meta-Disk software.Finally,the sensitivity analysis and analysis for heterogeneity cause were performed and Stata 12.0 software was used to assess the publication bias with funnel plot. Results A total of 12 literatures were reviewed,including 7 relevant English articles,5 Chinese articles.①The pooled sensitivity of procalcitonm test for the diagnosis of meningitis in children was 0.95(95%CI:0.92,0.97),the specificity was 0.89(95%CI:0.86,0.92),the positive likelihood ratio was 11.09(95%CI:5.73,21.49),and the negative likelihood ratio was 0.07(95%CI:0.05,0.11),diagnostic odds ratio was 122.01(95%CI:65.08,228.75).SROC area under the curve(AUC) was 0.977 7,Q* was 0.933 0 .②The sensitivity analysis of removing studies with sample capacity < 50 , domestic and retrospective studies showed the confidence interval of the diagnostic parameters had a lot of overlapping with the original data.③Specificity, positive likelihood ratio had significant heterogeneity. Research areas, PCT test method and diagnostic criteria may not be the cause of heterogeneity of BM.④The sensitivity , specificity SROC AUC and Q* were the largest when cut-off point of 5 μg·L-1was used for the the diagnosis of meningitis in children. Conclusion The use of PCT for the diagnosis of BM in children has a high sensitivity and specificity,but there is heterogeneity between the studies,PCT should be combined with specific clinical situations in the diagnosis of meningitis in children.
Objective To investigate the risk factors and clinical features of the late high-risk preterm brain injury diagnosed by DWI combined with conventional MRI. To analyze the dynamic MRI signal characteristics and the diagnostic value of DWI at the early time. Methods A total of 649 late preterm infants met the inclusion criteria, their MRI images were reanalyzed and the related clinical data were collected. The risk factors and clinical features of different types of brain injury were analyzed, the MRI signal characteristics, injury location and the ending of different types of CWMD were investigated. Results ①In the 332 late preterm infants with brain injury (51.2%), 271 cases(41.8%) showed white matter damage, in which the focal cerebral white matter damage was the main type. In the 112 (17.3%) intracranial hemorrhage cases, 62 cases (55.4%) showed subarachnoid hemorrhage. ②The male(OR=1.510, 95％CI：1.067-2.136, P=0.020), vaginal delivery(OR=2.367, 95％CI：0.251~22.294, P=0.000), early onset of sepsis(OR=2.194, 95％CI：1.159-4.155, P=0.016) and asphyxiation rescues(OR=3.784, 95％CI：1.908-7.506, P=0.000) were the risk factors of non hemorrhagic cerebral injury. The risk factors of hemorrhagic cerebral injury were vaginal delivery (OR=7.195, 95％CI：4.249-12.184, P=0.000) and early onset of sepsis (OR=2.692, 95％CI：1.185-6.117, P=0.018). The preterm infants with non hemorrhagic cerebral injury were characterized by hypocalcaemia（OR=2.593，95％CI：1.343-5.005，P=0.005）, late onset of sepsis（OR=1.533，95％CI：1.012-2.323，P=0.044）and seizures（OR=4.006，95％CI：1.790-8.970，P=0.001）. The preterm infants with hemorrhagic cerebral injury were characterized by seizures and hyperglycemia. ②There were different injury locations and endings in differten types of CWMD. Focal CWMD was often involved one site of damage only (65.3%), mainly concentrated in the lateral ventricle posterior (53.5%). 97.1% of focal CWMD were characterized by disappearing or decreasing of the lesion range. Widespread CWMD was often involved corpus callosum and internal capsule (79.2%), and diffuse CWMD was often combined with gray matter injury, accounting for 50%, and all developed into PVL. ④Within the first two weeks of white matter damage, DWI had high sensitivity and 98% were characterized by high signal. T1WI also showed normal or slightly high signals, with or without low signals on T2WI. High signal on DWI of focal CWMD could last for more than 3 weeks, but diffuse CWMD had short duration (within 2 weeks). Conclusion Late preterm infants are still vulnerable to perinatal factors and suffer from different types of brain damage. MRI and DWI should be done for the high-risk late preterm infants within 2 weeks after birth, in order to detect the damage as early as possible. The prognosis of focal CWMD is good. However, the infants with diffuse CWMD have poor prognosis, and need to be followed up and receive early suitable recovery as soon as possible.
Objective Wilson's disease (WD) is a rare autosomal recessive disorder. We have evaluated 53 WD cases in children (52 families) from the Chinese Han population to expand our knowledge of ATP7B mutations and clinical features. Methods Cases of children diagnosed as WD in Jul 2005- Feb 2012 were analyzed retrospectively with clinical symptoms and laboratory test results. The cases were categorized into hepatic group and neurologic group by disease region and categorized into clinical type and subclinical type by presentation. The coding and promoter regions of the ATP7B gene were analyzed by direct sequencing of genomic DNA. Then the genotype-phenotype correlations were analyzed. Results 53 cases of WD (52 probands) were collected (male, n=37; female, n=19; age range, 2.5 -13.5 years). 52 cases were with liver disease(98.5%), 41 cases with diagnosed hepatic presentation (6.0±2.3)years and 12 cases as neurologic presentation (9.5±3.0) years. 19 and 34 cases were clinical type and subclinical type, respectively. Alanine transpeptidase(ALT) level was higher in the hepatic group however the level of 24 h urinary copper, serum bile acid(SBA), and positive rate of K-F ring were higher in neurology group. ALT/AST ratio and ALT or AST level were higher in the subclinical type than that in the clinical type but the age at onset, 24 h urinary copper, positive rate of K-F ring and SBA were lower in subclinical type than that in clinical type. 97 pathogenicity alleles (91.5%) with thirty six different mutations were identified in these patients. The frequency of homozygotes, combined heterozygotes and heterozygotes were 8 36 and 9, respectively. 23 types of missense mutation, 8 types of frameshift mutations, 2 types of nonsense mutation and 3 types of splice mutation were found. Frequency of missense mutation, synonymous mutation, homozygotes or heterozygotes were not associated with the age of onset, K-F rings, or the level of ALT, AST, 24 h urinary copper, serum ceruloplasmin(SCp). Common mutations included p.Arg778Leu (34/97), p.Pro992Leu (15/97) and p.Ala874Val (5/97), their frequencies did not significantly differ in hepatic and neurologic groups, clinical and subclinical types. Patients with p.Ala874Va/Pro mutation had smaller age of onset (P=0.017, 0.000). 6 cases with splicing mutations were also associated with high serum ceruloplasmin (P=0.000). Conclusion Wilson's disease in Chinese children almost all had liver damages and dominant hepatic presentations. Therefore exons (8, 11, and 13) and mutations (p.Arg778Leu, p.Pro992Leu, p. Ala874Va/Pro) should be considered high priority for cost-effective testing in China. The relationship between phenotype and genetype was not found. But patients with p.Ala874Va/Pro mutation develop disease early and patients with splicing mutations were associated with high serum ceruloplasmin.
Objective To investigate the feasibility and safety of dexamethasone solution pretreatment catheter in the prevention of phlebitis caused by PICC in premature infants. Methods 186 cases of low-birth-weight premature infants requiring PICC were randomly divided into two groups. Both groups were treated with standard operating procedure in PICC. 92 cases were in group A（intervention group）, PICC catheter was immersed using 0.08 mg·mL-1 dexamethasone aqua 50 mL before intubation. 94 cases were in the group B（control group） , PICC catheter was immersed using physiological saline 50 mL. Catheter were treated for 5 min for both groups. Two groups were compared in the incidence rate of phlebitis, time of occurrence, the severity of phlebitis and other complications except phlebitis. Results The incidence of phlebitis was 14.1%, the average time of occurrence was (4.4±1.0) days for intervention group, versus 33%, (2.8 ±0.8) days in the control group. The intervention group had slighter phlebitis than the control group. All the above were statistically significantly different. The other catheter related complications were not statistically different between two groups. Conclusion The use of dexamethasone solution pretreatment catheter could reduce the frequency and severity of PICC-associated phlebitis, and could delay the occurrence time of phlebitis in low-birth-weight premature infants receiving PICC operations. The other catheter related complications were not increased.
Objective Through meta analysis to study the bone metabolism in epileptic children receiving valproic acid. Methods VIP、wanfang、CNKI、CBM、EMCC、Pubmed、OVID databases and Cochrance library were searched, included studies were all case-control studies and Review Manager 5.2 was used to analyze the data. The Newcastle Ottawa Scale (NOS) was used to evaluated the bias of included studies. Results A total of 14 case-control studies (10 in English, 4 in Chinese) were included. Meta analysis showed that valproic acid had influenced bone mineral density, 25-OH-VtiD, parathyroid hormone, but no influence on calcium（MD=0.01，95％CI:-0.05 to 0.06,P=0.13）, phosphorus(MD=-0.03,95%CI：-0.19 to 0.13,P=0.67), alkaline phosphatase(MD=0.37,95%CI:-19.02 to 19.77,P=0.97). Bone mineral density and 25-OH- VitD levels were lower in the VPA group than in the control group(MD=-0.03,95%CI：-0.06 to -0.00，P=0.03; MD=-2.46，95%CI：-4.37 to -0.55，P=0.01, respectively). Significantly higher parathyroid hormone level was found in valporic aid group than in control group(MD=4.83, 95%CI:1.15 to 8.50，P=0.01). Conclusion The study results indicated that valproic acid did affect bone metabolism in epileptic children
Objective To investigate the prevalence of hypertension in representative sample of children and adolescents aged 7-17 years in Shanghai, by using the current national age- and gender-specific cutoffs(NBPR) and using a new cutoffs including height percentiles(BPCH). Methods The data were from the 2010 routine survey of Shanghai Municipal Center for Students' Physical Fitness and Health Surveillance involving 3 300 boys and girls respectively. Hypertension was defined as average SBP/DBP equal to or above the 95th percentile. BPCH was constructed by using GAMLSS program, for gender, age and height percentiles, based on non-overweight study subjects from 1991-2009 Chinese Health and Nutrition Survey. Children and adolescents' with inconsist results dignosed by BPCH and NBPR were analyzed, heights of them were compared by Z-score. Results The prevalence rate of hypertension diagnosed by NBPR was 11.3% for males and 10% for females. The rate was 6.9% for males and 6% for females by using NBPR. The prevalence rate increased with age by NBPR whereas it kept approximately stable by BPCH. The Kappa index of hypertension was 0.583 in male and 0.695 in female using the two references, and the consistent rate was 93%,95% respectively. 377 samples (5.7% in total) were diagnosed as hypertensive by both cutoffs. 50 (boys:42, girls: 8) hypertensive children were in BPCH who were missed by NBPR, with mean height lower than mean height of total samples by 17 cm in boys（Z=-0.78，P<0.000 1）and 11 cm in girls（Z=-1.29,P=0.015 9）respectively. There were 329 students (5% in total) diagnosed by NBPR but missed by BPCH, with mean height being higher than average levels,13.9 cm in boys（Z=0.31,P<0.000 1）and 10.2 cm in girls(Z=0.39, P<0.000 1). Conclusion It is suggested that height should be considered in diagnosis of hypertension and included in cutoffs for accurate estimation of blood pressure in children and adolescents.
Objective To investigate the association of endothelial progenitor cells (EPCs) with the development of bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP) and other complications in infants with very low birth weight. Methods Infants with gestational age less than 32 weeks and birth weight below 1 500 g were prospectively selected who were hospitalized at neonatal intensive care unit. EPCs level was determined by flow cytometry at different time points (at birth, 7, 14, 21, 28 days of age and 36 weeks' postmenstrual age). Plasma vascular endothelial growth factor (VEGF), stromal cell-derived factor-1 (SDF-1) and granulocyte-macrophage colony-stimulating factor (GM-CSF) concentrations were determined by immunochemical assays. Clinical and outcome data were collected. Results Sixty-eight infants were analyzed in this study, including 20 who developed BPD, 10 developed ROP, 8 had intraventricular hemorrhage (IVH) comprising case groups, and rest of 30 patients as control group. No difference was observed in the number of EPCs at birth between BPD infants and control infants. Compared with the control group, EPCs level decreased at day 7, CD34+KDR+: (0.019 ±0.009) % vs (0.026±0.012)%, P<0.05; KDR+CD133+: (0.004±0.002)% vs (0.008±0.004)%, P<0.01; CD34+KDR+CD133+: (0.005±0.002)% vs (0.008±0.004)%, P<0.05 and day 21 in infants who later developed BPD. BPD infants had persistent lower VEGF concentration compared with the control infants at all time points from birth to day 21. No between-group difference in VEGF was found at day 28 or 36 weeks' postmenstrual age. There was no difference in the concentrations of SDF-1 and GM-CSF at different time points between two groups. No different was observed in EPCs count between infants with ROP and the control infants at any time points from birth to day 28. However, a trend of increasing KDR+CD133+, (0.010±0.003)% vs (0.007±0.003)%, P=0.053, and CD34+KDR+CD133+ EPCs ,(0.009±0.005)% vs (0.006± 0.003)%, P=0.06, was noted in the infants with ROP at the 36 weeks' postmenstrual age. EPCs count did not differ between infants with IVH and the controls infants at different time point. Conclusion Reduced EPCs and VEGF level at early life may be associated with development of BPD in preterm infants. However, the exact mechanism underlying the EPCs and BPD needs further investigation.
Objective To study the correlation between serum neuron-specific enolase (NSE) dynamic concentration and neonatal hypoxic-ischemic encephalopathy (HIE) in its acute phase and its imaging of intracranial structure changes. Methods 107 cases of HIE were hospitalized to neonatal ward in Guangzhou Women and Children's Medical Center. Patient's imaging data were statistically analyzed. According to "Neonatal Hypoxic-ischemic Encephalopathy Diagnostic Criteria" developed by the Branch of Pediatric of the Chinese Medical Association of Neonatology Group in 2005, 107 cases of the HIE were classified into mild, moderate and severe groups, respectively, serum NSE levels were determined daily from day 1 to 7. To evaluate the correlation between serum NSE levels and brain structure changes, brain CT image data were reviewed during accute phase to 36 month old. Results 34 cases of the HIE mild subgroup, 41 cases of moderate subgroup, 32 cases of severe subgroup and 30 cases of control group were analyzed. ①The NSE levels reached peak at the 2nd days after birth in both HIE group and control group, and decreased with the age. The concentrations of serum NSE in the patients with moderate and severe abnormal imaging of head CT were significantly higher than the control group and the mild group(P<0.05); ②The mild, moderate and severe CT changes were 21, 20 and 29 patients with HIE. To predict severe CT changes with the NSE level 49.8 ng·mL-1at the 2nd days after birth in acute phase, the sensitivity and specifity were 62.5% and 86.0%, respectively. ③In survival children with HIE, the CT of 89 patients were followed up for 3-36 months after birth, among them，40 cases with abnormal CT findings. To predict severe CT changes after acute phase with the NSE level 45.7 ng·mL-1at the 2nd days after birth, the sensitivity and specifity were 71.4% and 88.3%, respectively. Conclusion The serum NSE levels were related to the intracranial morphological changes in HIE cases.
Objective In order to find out the relationship between birth weight and systolic and diastolic blood pressure in preschool children. Methods Date for 4 642 healthy preschool children aged 2 to 6 were collected. All these children were born in Shanghai Minhang Maternal and Child Health Hospital. After rest in the sitting position for 5-10 min, the blood pressure (BP) and heart rate (HR) were measured on the right arm at the level of the heart, using appropriate size of cuff, by automated BP recorder (Model 45NEO-E6, Welch Allyn, USA). Elevated blood pressure was defined as systolic blood pressure (SBP)and/or diastolic blood pressure(DBP) equal or greater than the 95th percentile for gender and age, according to the reference based on Japanese preschool children(1997). Low birth weight was defined as <2 500 g and macrosomia as ≥4 000 g. Multiple regression models were used to analyze the association between birth weight and childhood hypertension. Results In total 4 642 children were analyzed in this study, with 2 458 (52.9%) being boys. The proportions of low birth weight and macrosomia were 3.2%(148/4 642) and 5.4%(251/4 642),respectively. The prevalence rate of hypertension was more common in boys than girls(9.4% vs 6.9%，P<0.05). Trend of negative correlation between birth weight and childhood DBP was observed in children with birth weight over 4 000 g. With gender, age, heart rate, body height and body weight adjusted, the relationship between birth weight and childhood hypertension was not significant in either low birth weight or macrosomia group. Rapid heart rate may increase the risk of hypertension at childhood (OR=2.55, 95%CI:1.96-3.33). Conclusion Blood pressure levels of preschool children were not significantly associated with birth weight. Rapid heart rate may increase the risk of hypertension.
Objective To observe the expression of dynamin related protein-1（Drp-1） of the renal interstitial tissue in rat model induced by unilateral ureteral obstruction (UUO) and the renoprotective effect of erythroprietin. Methods Renal interstitial fibrosis rat model was produced by unilateral ureteral obstruction, eighty-one rats were randomly allocated to shame operation group, UUO model group and treated group. After operation rats in treated group were given subcutaneous injection with erythroprietin 3 000 U·kg-1 once a week until rats were sacrificed. Rats in sham-operated group and UUO model group were given subcutaneous injection with identical normal saline. In each group, nine rats were chosen randomly to be sacrificed at the 7th , 14th and 21st day after operation for histological examination. Renal tissues were examined by HE and Masson stain. Immunhistochemistry was performed for Drp-1 in the renal interstitum. Results The renal function (serum Cr and BUN) damage in treatment group was lower than that in the model group at day 21(P<0.01), and obviously higher than the sham group (P<0.05). Compared with the UUO model group, the score of the renal interstitial damage and fibrotic area of treated group was decreased markedly at three time points（P<0.05, respectively). The scores of the renal interstitial damage and fibrotic area of treatment group were higher than those of the sham group (P<0.05). The expression of Drp-1 of treated group was decreased markedly at three time points（P<0.05) compared with the UUO model group, and was increased compared with sham group(P<0.05). Conclusion The expression of Drp-1 increased during rat renal interstitial fibrosis. Erythroprietin maybe alleviates the degree of renal interstitial fibrosis by down -regulating the expression of Drp-1.
Objective The aim of this study is to count and analyze the baseline of diagnostic systematic reviews or meta-analyses published by Chinese authors. Methods We search the Chinese Biomedical Literature Database (CBM), PubMed, EMBASE, Cochrane Library, Web of Knowledge to identify systematic reviews or meta-analyses on diagnostic test. The cut off for inclusion of the systematic reviews or meta analyses was December 31st 2011. According to the inclusion and exclusion criteria included meta-analyses or systematic reviews on diagnostic test published by Chinese authors. The study that meet the condition were selected and then analysis them by using the Excel software. Results A total of 3 214 researches were retrieved and according to the exclusion and inclusion criteria, we included 235 systematic reviews or meta analyses at last. Including 235 Chinese researches and 77 English researches. The number of published articles was increasing yearly. The 312 reviews were all written by Chinese authors and were published in 169 different Journals. 74 (23.72%) being published in Science Citation Index (SCI) journals. About 235 Chinese reviews only 134 (57.02%) were published in journals cited by Chinese Science Citation Database (CSCD). The authors’ average number is 4. The number of researches by hospital and university cooperation was 105 (33.65%).165 (52.88%) reviews use QUADAS as quality evaluation criteria. Fifteen diseases systems were reported, the top three were tumor(32.31%), certain infectious and parasitic diseases (10.26%) and digestive system disease (10.26%). 90 reviews (28.85%) were fund theses. We identified the gold standards diagnostic methods. The most common one is pathologic biopsies (26.51%). A wide range of diagnostic tests featured in the reviews, with laboratory technologies (50.96%) and imaging technologies (45.19%) being the most common category of test evaluated. Conclusion The number of systematic reviews on diagnostic test showed an increasing tendency annually in domestic. A kinds of data indicated that along with the fast development , diagnostic tests in EBM has been paid to more and more great attention in recent years. Excepting the laboratory techniques and the imaging techniques, all the other techniques occupied only a tiny proportion of the total. A greater part of trials used no gold standard, it will possibly affect the studies’ universality.
