Objective To evaluate the intervention effects on children with dietary behavior problems in Shanghai through a comprehensive intervention (at multiple time points) follow-up study. Methods Children aged 1-6-years with dietary behavior problems were selected from three districts of Shanghai (Changning, Luwan and Hongkou). "Shanghai Children′s Dietary Behavior Questionnaire and Follow-up Intervention Questionnaire" was prepared. Children were recruited into the study by professionally trained pediatricians, and randomly divided into intervention and control groups by using sealed envelops. Both the intervention group and control group were divided into 5 subgroups according to age, and 3 subgroups according to nutritional status. The intervention group received interactive interventions and respective assessments at T0(baseline), T1(end of the 1st month), T2(end of the 3rd month), T3(end of the 6th month) and T4(end of the 9th month). The control group were evaluated at T0 and followed up at T4. Comparisons of dietary behavior were made before and after the interventions between intervention and control groups. Results From January to October 2009, 462 children with dietary behaviour problems were recruited, including 245 in intervention group and 217 in the control group. ①The comprehensive dietary behaviour problem scores of the intervention group were 19.7±0.0 at T0 and 14.2±0.3 at T4, decreased dramatically (P<0.01), while the scores of the control group were 19.7±0.5 at T0 and 19.6±0.1 at T4, showing no significant change (P>0.05). ②The scores of all age subgroups in the intervention group decreased with more interventions made (P<0.01). Among all the age subgroups, the 3-year-old group had the largest Δ(T0-T4), while the 6-year-old group had the smallest Δ(T0-T4). There was significant difference between 3-year-old and 6-year-old groups (P<0.01). The average number to treat (NNT) of the intervention group was 2.5 (95% CI:2.1-3.0). There was significant difference of the overall retention rate of dietary behaviour between intervention and control group (P<0.001). ③The dietary behaviour problem scores of both severe malnutrition and normal nutrition subgroups of intervention group decreased (P<0.01). In the control group, the difference of the scores Δ(T0-T4) was not statistically significant for either nutrition subgroup (P>0.05). ④Controlling for the natural improvement of dietary behaviour with time passed, all the dietary behaviour problems of the intervention group children were eventually improved (P<0.05). While "no fixed eating location", "eating and playing toys" changed less, the rest of the dietary behaviour problems all improved by a large margin. However, the effects of intervention on different dietary behaviour problems occurred at different time points. "Eating slow", "strong preference to some food", "eating and doing other things" were improved earlier; "eating less", "no fixed eating location", "no interest in food" were improved later. The NNT of nine dietary behaviours was 1.4~2.5. The difference of misconduct retention rate between intervention and control groups was statistically significant (P<0.05). Conclusions Reasonable dietary behavior intervention could improve children′s unhealthy eating behaviors. The interactive intervention strategy proposed here could markedly improve the dietary behavior of children in Shanghai.
Objective To investigate the effects of polymorphism of UDP-glucuronosyltransferase 1A1 gene on hyperbilirubinemia in neonates. Methods According to the requirements of Cochrane systematic review, a literature search was performed among PubMed, EMBASE, Web of sciences, Cochrane library, CNKI, Wanfang data, VIP and CBM from the establishment of the database till February 28th 2010. Revman 5.0 software was used for meta-analysis. Data extraction, quality assessment, and meta-analysis for the results of homogeneous studies were done by two reviewers. The trials were analyzed using relative risk (RR) for dichotomous data, expressed by 95％CI. For homogenous data (P≥0.10), fixed effect model was used to calculate. Results 284 literatures were reviewed. The studies including reviews（n=29）, case reports（n=19）, foundational researches（n=87）, Gilbert syndrome studies（n=57）, patent reports（n=3）, documents not meeting the major results of meta analysis（n=60）, non-English non-Chinese articles (n=7) were excluded. Twenty two studies were enrolled. The variants of UGT1A1 at nt211: ①genotype of A/A+G/A (OR=2.79, 95%CI: 2.26-3.43, P<0.000 01) was more common among cases. Further analysis in the subgroups showed the difference in the genotype distribution between cases and controls in Chinese (OR=2.84, 95%CI: 2.14-3.76, P<0.000 01）, Japanese (OR=3.22, 95%CI: 2.03-5.11, P<0.000 01), Malaysian and Thailander (OR=2.41, 95%CI: 1.56-3.72, P<0.000 1) except Caucasian (OR=1.98, 95%CI: 0.49-8.03, P=0.34). ②genotype of A/A (OR=7.05, 95%CI: 4.19-11.85, P<0.000 01) was seen more common among cases. Further analysis in the subgroups showed the difference of this genotype between case and control groups in Chinese (OR=6.47, 95%CI: 3.24-12.94, P<0.000 01）, Japanese (OR=3.08, 95%CI: 1.00-9.49, P=0.05), Malaysian and Thailander (OR=21.01, 95%CI:5.21-84.79, P<0.000 1) except Caucasian (OR=5.89, 95%CI: 0.24-145.49, P=0.28). ③A allele frequency (OR=2.78, 95%CI: 2.33-3.31, P<0.000 01) was higher in cases than that in controls. Further analysis in the subgroups showed the difference of this genotype between case and control groups in Chinese (OR=2.82, 95%CI: 2.22-3.58, P<0.000 01), Japanese (OR=2.50, 95%CI: 1.72-3.62, P<0.000 01), Malaysian and Thailander (OR=3.01, 95%CI: 2.07-4.37, P<0.000 01) except Caucasoid (OR=2.47, 95%CI: 0.66-9.25, P=0.18). There were no significant differences between case and control groups in genotype 7/7+6/7 (OR=0.83, 95%CI:0.55-1.24, P=0.36), 7/7 (OR=1.42, 95%CI: 0.92-2.19, P=0.11), 7 allele frequency (OR=0.90, 95%CI: 0.63-1.29, P=0.57) of the variants UGT1A1 at promoter TATA box. Conclusions For Chinese, Japanese, Malaysian and Thailand neonates GLY71ARG variant of UGT1A1 gene is a risk factor to the development of hyperbilirubinemia. Presence of variant (TA)n promoter is an independent risk factor for hyperbilirubinemia in neonates.
Objective To know the growth rhythm of body proportions of 0-18 years old Chinese healthy children and adolescents, and analyze gender difference, regional difference and secular changes of body proportions. Methods Healthy Han children and adolescents in 9 provinces (cities) from two national representative cross-sectional surveys named "The National Growth Survey of Children under 7 years in the Nine Cities of China in 2005" and "The Physical Fitness and Health Surveillance of Chinese School Students in 2005" were enrolled .The data of the above-mentioned two investigations in 1985 were used to analyze the secular changes of the ratio of sitting height to leg length(crown-rump length)(SH/LL). Crown-rump length and length were measured before 3 years old, and from 3 years old onward, sitting height and height were measured . Leg length was obtained by subtracting sitting height (crown-rump length) from height (length). Results ①SH/LL decreased gradually with age and bottomed at 12-13 years of age in boys and 10-11 years of age in girls. Then SH/LL increased slightly and kept flatting after 17 years of age. ②Before 11 years old, the gender difference was not obvious in SH/LL, and after that SH/LL of girls was slightly higher than that of boys. The gender difference was relatively large at the age of 13 years. SH/LL of urban and rural children was similar before 6-7 years of age, after that SH/LL of rural children was slightly higher than that of urban children and then the difference wasn′t obvious after 12-13 years of age. The SH/LL charts were almost coincident in different areas. ③The SH/LL of 7-12 years old children slightly decreased and the SH/LL of preschool and late pubertal children had no obvious change from 1985 to 2005. Conclusions SH/LL is regularly changed with age in 0-18 years old Chinese children and adolescents. There is no gender difference in pre-pubertal children, and SH/LL of girls is higher slightly than that of boys after post-pubertal. There are not obvious urban-rural difference, regional difference or secular change in SH/LL in China.
Objective To explore the relationship between fetal echogenic intracardiac focus (EIF)and chromosomal abnormalities in fetuses of pregnancies with high risk factors. Methods Clinical data and EIF results were collected from pregnancies with high risk factors in Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from February 2007 to January 2010. Participants whose fetal EIF was positive were enrolled into EIF case group, and those with negative fetal EIF were grouped into EIF control group. The distribution, diameter and number of EIF, karyotype examination results, detection of other system malformations and chromosomal abnormal soft targets, as well as follow-up results of EIF were collected. The relationship between EIF and chromosomal abnormalities in fetus was analyzed. Results In total 4 008 pregnancies with high risk factors were enrolled. Two hundred and twenty-seven(5.7%) pregnancies were in EIF case group and 3 781(94.3%) in EIF control group. ①227 fetuses(5.7%) were detectable for EIF.Among them, 213（93.8 %） were solitary, 215（94.7%） were in the left ventricle, 8（3.5％） were in the right ventricle and 4(1.8%) were in the biventricle. The diameters of EIF were 1.6-6.5 mm and the EIF diameters of 216 cases(95.2%) were 2-3 mm. ②Among 8 cases (3.5%) identified chromosome abnormalities in EIF case group, 5 were Down′s syndrome, 1 was Turner syndrome and 2 were balanced translocation. In EIF control group, 88/3 781(2.3%) chromosome abnormalities were identified, including 41 with Down′s syndrome,12 with 18-trisomy syndrome, 2 with 13-trisomy syndrome, 12 with Turner syndrome, 16 with familial balanced translocation and 5 with inversion. There was no relationship between EIF and chromosome abnormalities(OR=1.53, 95%CI: 0.73-3.20), also no relationship between EIF and Down′s syndrome(OR=2.05, 95%CI: 0.80-5.25). ③In EIF case group, 18 cases were identified with other chromosome abnormal soft targets including 1 with Down′s syndrome. There was no relationship between EIF combined with other ultrasonic soft targets and Down′s syndrome(OR=5.37，95％CI：0.70-41.27). In EIF control group, 64 cases were detectable for chromosome abnormal soft targets. ④In EIF case group, 33 women stopped pregnancy. The remaining 194 cases came to the hospital for follow-up according to the schedule. EIF gradually became pale, smaller or disappeared with increased gestational ages in 181/194 cases(93.3%). EIF disappeared in 7 cases(3.6%) after birth and still existed in 1 case after 1 year. Conclusions There is no relationship between EIF in fetus of pregnancies with high risk factors and chromosome abnormalities. The relationship between EIF combined with other ultrasonic soft targets and chromosome abnormalities needs further study.
Objective To study the shifts in percentiles of length and weight during the first 2 years of life and analyze the factors affecting children′s length. Methods Data of children from physical examination at Department of Child Health Care of Children′s Hospital of Chongqing Medical University were collected retrospectively from August 1996 to December 2008 and prospectively from January 2009 to March 2010. Follow-up was carried out according to the principle that the first physical examination was finished younger than 2 months ±15 d of age, follow-up must be taken more than 6 times from the first time to 1 year old and more than 2 times from 1 year old to 2 years old. Length and weight of children were measured by nurses and the data of parents′ length were recorded. According to the follow-up ages， children were grouped to <2 months, -4 months, -6 months, -8 months, -10 months, -12 months, -18 months and -24 months groups. The data measured at the first visit was analyzed as the basic ones. CDC Growth Chart(2000) of America was used as the references. While the percentiles of growth chart shifted up or down at least one main percentile were defined as "catch-up" or "catch-down" to analyze the data. Results In total 331 children（3 421 measurements） were enrolled into the study, 152 were collected from August 1996 to December 2008 and 179 were collected from January 2009 to March 2010. One hundred and seventy-two participants were boys and 159 were girls. The average basic Z scores of all the participants were 0.18±0.67. ①One hundred and seventy-nine of 331 children(54.1%) children with 246 measurements showed catch-up growth, 229 measurements caught up 1 major percentile and 17 measurements caught up 2 major percentiles. Fifty-six of three hundred and thirty-one children(16.9%) with 63 measurements caught down 1 major percentile and none caught down 2 major percentiles. The average length of all ages was between P50 and P75. ②Shifts of linear growth in 3 to 6 month， -12 month and -24 month were connected with mothers′ height and children′s basic length, shifts in 7 to 12 month were connected with father′s height also. ③Three hundred and nine measurements showed catch-up growth, 232 measurements caught up 1 major percentile and 77 caught up 2 major percentiles. Six hundred and forty-one measurements showed catch-down growth, 596 measurements caught down 1 major percentile and 45 measurements caught down 2 major percentiles. The average weight of all ages was unstable. Conclusions The size at birth only reflected the growth during fetuses, which do not decide the growth afterward. Basic length and heritage should be taken into consideration when assessing the shifts of linear growth during first 2 years.
Objective To evaluate the efficacy and safety of montelukast for wheeze in infants younger than 2 years old. Methods The Cochrane Library, EMBASE, PubMed, the databases of ongoing trials- Current Controlled Trials, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, Digital Journal of Wanfang Data were searched from establishment to March 2010. Additional data were sought from the related academic meeting, industry and reference lists of included trials. Randomized controlled trials (RCTs) were selected to compare montelukast with placebo in infants younger than 2 years old with wheeze. The Cochrane Handbook 5.0.2 was used to evaluate the methodological quality. The wheeze-related mortality, the score of clinical symptom and therapeutic dose of alleviating wheeze drug were taken were primary outcomes，the adverse effects and quality of life were taken as secondary outcomes. If suitable data could not be merged, the results of specific trial were described only. Results We searched 906 literatures, 6 RCTs that met the inclusion criteria were enrolled. Two RCTs had high dropouts or withdrawals (21.7%, 32.1% respectively). There was clinical heterogeneity in six included RCTs, we could not do meta-analysis and only described the results of every trial. Children who were diagnosed as bronchiolitis, asthma or had similar symptoms of asthma were enrolled into the study. The assessment of literature quality showed 4 literatures discribed the method of random allocation in detail, 3 literatures discribed allocation concealment, 6 literatures used double-blind method, 5 literatures reported the results selectively and 2 literatures discribed the sources of other bias. ①No RCT reported the wheeze-related mortality; ②There was no significant difference in the score of clinical symptom, therapeutic dose of alleviating wheeze drug between the montelukast and placebo (P>0.05); ③There was no significant difference in the adverse effects (diarrhea, fever, vomiting and increased alanine aminotransferase) between the montelukast and placebo (P>0.05). Conclusions Compared with placebo, there is no sufficient evidence that Montelukast has more efficacy or more adverse effects during 20-week treatment for wheeze in infants below 2 years old.
Objective To determine the changes in antimicrobial resistance and proportion of Streptococcus pyogenes, Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae and Moraxella catarrhalis isolated from the children with respiratory tract infections from 2006 to 2009. Methods Patients diagnosed as respiratory tract infection in Children′s Hospital of Fudan University from 2006 to 2009 were enrolled into the study and throat swabs or sputum specimens were collected to make bacteria culture. The susceptibility test was performed with KB method according to the criteria of Clinical and Laboratory Standards Institute (CLSI 2006-2009) . The resistance of Streptococcus pneumoniae to penicillin was assayed with E-test according to the criteria of CLSI 2009. Results From 2006 to 2009, a total of 1 225 Streptococcus pyogenes, 341 Streptococcus pneumoniae,297 Staphylococcus aureus, 248 Haemophilus influenza and 237 Moraxella catarrhalis isolates were collected from respiratory tract samples of out-patients and in-patients of Children′s Hospital of Fudan University. Streptococcus pyogenes was still the prime pathogen in the upper respiratory tract, and its proportion was ranged from 74.5％ to 78.8％ from 2006 to 2009. The proportion of Haemophilus influenzae and Moraxella catarrhalis increased anually both in upper and lower respiratory tract. The drug resistant monitoring showed that erythromycin resistance rates of Streptococcus pyogenes varied from 86.8％-94.7％,and Streptococcus pyogenes isolates resistant to penicillin were not found. About 1.4%-20.8% of Streptococcus pneumoniae were resistant (PRSP) or intermediate (PISP) to penicillin ,and the resistant rates kept increasing (P=0.007) from 2006 to 2009. 91.1%-97.9% of Streptococcus pneumoniae isolates were resistant to erythromycin. Staphylococcus aureus resistant to erythromycin was ranged from 50.0% to 54.9%, and methicillin-resistant Staphylococcus aureus(MRSA) was ranged from 7.7% to 11.4%. Streptococcus pyogenes, Streptococcus pneumoniae and Staphylococcus aureus were all sensitive to vancomycin. The β-lactamase positivities of Haemophilus influenza and Moraxella catarrhalis isolates were 17.0％-31.3％ and 83.1%-100% respectively, both Haemophilus influenzae and Moraxella catarrhalis were highly susceptible to the second and third generation cephalosporins, the enzyme inhibitor complex and the quinolones. Conclusions Penicillin was still the first choice to treat the infection caused by Streptococcus pyogenes and Streptococcus pneumoniae in children. Streptococcus pyogenes, Streptococcus pneumoniae and Staphylococcus aureus were still highly resistant to erythromycin. Both second and third generation cephalosporins showed good therapeutic effects against β-lactamase positive Haemophilus influenzae and Moraxella catarrhalis.
Objective To investigate the immediate efficacy, complications and midterm outcomes of balloon angioplasty in young infants with critical aortic coarctation who presented with left ventricular dysfunction. Methods The clinical data of children younger than 6 months with discrete native coarctation, who underwent balloon angioplasty from 2006 to 2009 in our institute, were retrospectively collected. All the procedures were performed under general anesthesia, using a retrograde femoral artery approach. During the procedures, the peak-to-peak gradient was recorded on pullback, and an aortogram was obtained in lateral and antero-posterior views. Results All six patients presented with clinical signs of left ventricular dysfunction and significant cardiomegly on chest X-ray. The mean age was (91±44) d and mean weight was (4.7±1.0) kg. Successful reduction in the post angioplasty gradient (＜20 mmHg) was achieved in 5 patients and decreased in gradient by more than 50% in one patient. Six cases were all immediate successful. There were significant improvements in pre versus post angioplasty coarctation diameters ［(2.18±0.48) vs (4.00±0.83) mm］ and systolic gradient across the coarctation site ［(46±11) vs (14±7) mmHg］. The follow-up time was ranged from 6 to 49 months. Left ventricular dysfunction was reversed in all patients shortly after balloon angioplasty combined with medical treatments. There were 2 cases of restenosis, who were successfully relieved by the repeat balloon angioplasty and free from restenosis in the follow-up period. One infant showed aneurysm formation after the initial angioplasty, which regressed spontaneously over 18 months when the repeat angioplasty was performed. No aneurysm formation was found after the second balloon dilation. Conclusions The preliminary experience suggests that in infants younger than 6 months with critical native coarctation, balloon angioplasty can be used as a life-saving alternative to surgical repair. However, long-term follow-up is mandatory to the evaluation of the procedure-related complication, including restenosis, aneurysm formation and approach artery injury.
Objective To observe and identify that 13-cis-retinoic acid can induce differentiation of stem cells of neuroblastoma, to provide experimental evidence for clinical application of 13-cis-retinoic acid for the treatment of neuroblastoma. Methods Bone marrow aspirates were obtained from children with neuroblastoma at stage IV，tumor cells were collected and cultivated in the serum-free stem cell medium containing DMEM-F12, 20 μmol·L-1 EGF, 20 μmol·L-1 bFGF and 2% B27；A mesh sieve with 400 holes was used to leach the medium which contained neurospheres, collected the neurospheres which could not get through the mesh sieve and then reaked up the clusters of neurospheres using mechanical method to produce the suspension of single cell neurospheres. A single cell neurosphere was placed into DMEM/F12 differentiation medium with 10% FBS to cultivate, added 13-cis-retinoic acid into differentiation medium to make the final density of 5 μmol·L-1 and then observed morphological changes of the cells after adding 13-cis-retinoic acid into differentiation medium one day 0, day 3 and day 9, respectively. The RNAs of neuroblastoma neurospheres were extracted with the cases after 0 day, 3 days and 9 days induction, respectively, then they were reverse transcripted to obtain cDNA. RT-PCR method was used to detect the change of expression level of stem cell Oct-4 gene during the process of induction. Neurosphere cells without induction or with induction by 5 μmol·L-1 13-cis-retinoic acid were added respectively into DMEM/F12 differentiation medium with 1% FBS. Adding these two groups of cells into sterile coverslip treated by Poly-D-Lysine, then the cell immunofluorescence technology was used to determine the difference of neuro-progenitor cell marker-nestin after cells adhesion to the coverslip. Results Primary suspended neurospheres could be observed after cultivation in the serum-free stem cell medium for 4-6 days. Neurosphere cells cultivated in the serum medium began to grow and adhere to the coverslip. The growing neurosphere cells were in the shape of star or triangle, the cell processes were blunt and short. After adding 5 μmol·L-1 13-cis-retinoic acid into the medium, the growing speed of cells slowed down, morphogenesis of the cells changed greatly, cell processes increased in number and it′s shape became longer then connected into network. The result of RT-PCR revealed that the uninduced NB neurosphere cells could express Oct-4, the ability to express Oct-4 of the NB neurosphere cells induced by 13-cis-retinoic acid decreased after 3 days and under the same condition the ability to express Oct-4 almost disappeared after 9 days. It was evident that the ability to express Oct-4 of the NB neurosphere cells induced by 13-cis-retinoic acid was decreased as time elapsed. Cell immunofluorescence indicated that the NB neurosphere cells without induction could express nestin, the ability to express nestin of the NB neurosphere cells induced by 13-cis-retinoic acid was weaken greatly after 9 days. Conclusions 13-cis-retinoic acid could induce differentiation of stem cells of neuroblastoma efficiently in vitro.
