Objective To evaluate the clinical outcomes of lactose-free formulas in the treatment of children suffering from acute diarrhea. Methods MEDLINE, EMBASE, the Cochrane Library and Chinese databases of CNKI, Wanfang Database were searched from their inception to February 2013. Reference lists of relevant trials were also scanned manually. Randomized controlled trials involving lactose-free formulas for the treatment of acute diarrhea for children younger than 3 years old were enrolled into this review. Treatment failure rates and duration of diarrhea were extracted as primary outcome, and weight gain as secondary outcome. Data were synthesized and analyzed by using the Review Manager software. The risks of bias of the included trials were assessed. Results A total of 14 studies involving 1 275 participants, published in Chinese and English, were included in the meta-analysis. Funnel plot showed there was no apparent publication bias. Treatment failure rates were lower for lactose-free formulas compared with lactose containing formulas (risk ratio: 0.46, 95% confidence interval：0.35-0.60, P<0.000 01), especially for subgroup with all degrees of dehydration. Those who received lactose-free formulas in comparison with lactose containing formulas had shorter duration of diarrhea (days) (mean difference:-0.95, 95% confidence interval:-1.15 to -0.74, P<0.000 01). No significant increase in weight gain was observed during dietary treatment of lactose-free formulas according to six included trials. Conclusion Compared with lactose containing formulas, lactose-free formulas were more effective in decreasing treatment failure rates of acute diarrhea and shortening duration of the illness, especially in reducing the treatment failure rates for infants with severe dehydration. More new and high-quality clinical trials should be taken to provide further evidence.
Objective To compare the efficacy and safety of azithromycin with amoxicillin/clavulanic acid in the treatment of acute otitis media using meta-analysis methods. Methods The Wanfang, VIP, CNKI, PubMed, Cochrance library and EMBASE database establishment were selected to search the randomized controlled studies that compared azithromycin with amoxicillin/clavulanic acid in the treatment of acute otitis media from initiation establishment of database to August, 2013. Outcomes included clinical cure, treatment failure rates and adverse events. RevMan 5.0 software was used for data analysis. Categorical variables were expressed using the odds ratio (OR) and 95% confidence intervals (95% CI). Heterogeneity was analyzed using I2 test. Results A total of 13 randomized controlled trials (5 081 patients) were included. Meta-analysis showed that there were no significant differences of clinical cure rate within 10 days (OR=0.69, 95%CI: 0.46-1.02) ,clinical cure rate within 10-19 days (OR=0.88, 95%CI: 0.68-1.13) ,clinical cure rate within 20-29 days (OR=0.99, 95%CI:0.83-1.19), clinical cure rate after 30 days (OR=1.00, 95%CI: 0.72-1.39) and cure failure rate (OR=0.87, 95%CI: 0.65-1.17) was not statistically significant. There were less patients with nausea (OR=0.44, 95%CI:0.20-0.97), rash (OR=0.48, 95%CI:0.31-0.75), diarrhea (OR=0.38, 95%CI: 0.25-0.57) and loose stools (OR=0.41, 95%CI: 0.20-0.81) in azithromycin group than that in amoxicillin clavulanic acid group. Conclusion Compared with amoxicillin/clavulanate treatment of children with otitis media, the meta-analysis showed that azithromycin had non-inferior efficacy, but less adverse events such as nausea, rash, or diarrheaand loose stools.
Objective To evaluate the value of white blood cell count (WBC), C reactive protein (CRP) and glucose of peripheral blood in detection of severe hand, foot and mouth disease (HFMD) with neurological involvement , and to provide the reference for clinical diagnosis of severe HFMD. Methods The sick children with HFMD admitted to Children's Hospital of Fudan University from Jan 2009 to Dec 2010, were recruited and divided into the mild HFMD (stage 1) and the severe HFMD (stage 2) according to HFMD clinical criterion. All the cases were reviewed by Electronic Medical Record. Severe HFMD in this research were those with neurological involvement but not patients with cardiopulmonary dysfunction. WBC, CRP and glucose of all the patients were collected on the first day of admission, and compared by using stata 10.0 software. Receiver operating characteristic (ROC) analysis was performed. The best diagnostic value was found by calculating their area under the curve (AUC) and Youden index. Results ①A total of 920 patients were recruited into this study. 681 patients were categorized into stage 1 and 239 patients were categorized into stage 2. ②WBC, CRP and glucose of these two groups were all in abnormal distribution. The median WBC was 11.4×109·L-1(range 3.1×109·L-1-39.8×109·L-1) and 11.3×109·L-1(range 4.9×109·L-1- 26.3×109·L-1) for stage-1 subjects and stage-2 subjects, respectively. . The median CRP of two groups was both 8mg·L-1 (stage 1 range: 8-160mg·L-1, stage 2 range: 8-77 mg·L-1). The median glucose of stage 1 was 5.0mmol·L-1 (range 3.5-11.7 mmol·L-1), and of stage 2 was 5.6 mmol·L-1 (range 3.5-15.7 mmol·L-1). (3) Using student-t test to analyze WBC after log transformtaion, there was no significant difference in WBC between two groups (P=0.427). Non-parametric test was used to analyze CRP and glucose, the results showed significant difference (P<0.001). (4) AUC of WBC, CRP and glucose was 0.512, 0.405 and 0.625. The best diagnostic value of WBC was 7.85×109·L-1 (sensitivity 88.7%, specificity 18.4%). The best diagnostic value of glucose was 5.25 mmol·L-1 (sensitivity 60.7%, specificity 59.0%). (5) Combining two best diagnostic values and using diagnostic testing, achieving sensitivity of 37.3% and specificity of 81.2%. Conclusion WBC counts and glucose levels showed low validity in detection of severe HFMD with neurological involvement. CRP levels could not to be used to predict severe HFMD. Serial test in this research did not increase the diagnostic validity. Clinical doctors should pay more attention to clinical features and signs.
Objective To explore the effect of lactoferrin fortified formula milk for infants with breastfeeding on growth and development and iron metabolic homeostasis. Methods In this prospective multi-center controlled intervention study , a total of 260 infants aged 4-6 months old were selected from six maternal and children's health care hospitals. All subjects were divided into two groups with the sequence of outpatient: lactoferrin fortified formula milk group (fortified group, FG, containing lactoferrin 38 mg·100 g-1 milk and iron element 4 mg·100 g-1 milk) and no lactoferrin fortified milk group(control group, CG, containing lactoferrin 0 mg/100g milk and iron element 4.2 ·100 g-1 milk) for 3 months. The levels of weight, height and head circumference and the concentration of hemoglobin (Hb), serum ferritin (SF), serum transferring receptor (sTfR) were measured and sTfR-SF index (TFR-F index), total body iron content (TBIC) and HAZ, WAZ and WHZ were computed before and after intervention, respectively. Results A total of 213 (including 115 in FG, and 98 in CG) infants were completed the intervention trial and all the measurements of biochemical indicators. There was no significant difference in the average amount of daily intake of formula milk ［(94.3±9.8) g vs (88.2±8.7) for FG and CG, P>0.05］ and iron element ［(3.8±0.4) mg vs (3.7±0.6) mg for FG and CG, P>0.05］ between FG and CG. The average amount of daily intake of lactoferrin for infants in FG group was (35.8±3.7) mg. The levels of weight, WAZ, WHZ, Hb, SF, TFR-F index and TBIC of infants after intervention in FG were all significantly higher than those of infants in CG. The changes of index were (2 213±82) vs (2 033±77) g for weight, (0.82±0.22) vs (-0.05±0.01) for WAZ, (0.74±0.32) vs (0.20±0.06) for WHZ, (13.9±4.1) vs (7.2±1.8) g·L-1 for Hb, (1.37±0.08) vs (0.55±0.04) μg·L-1 for SF, (0.86±0.11) vs (0.39±0.05) for TFR-Findex and (19.4±8.8) vs (9.1±3.4) mg·kg-1 for TBIC, P<0.05, but significantly lower (P<0.001) for the prevalence of anemia (4.1% vs 7.5%), iron deficiency (13.9% vs 24.4%) and the iron deficient anemia (1.7% vs 8.2%). Conclusion The effect of intervention of latoferin fortified formula milk on iron metabolic homeostasis of infant with exclusively breastfeeding was mainly manifested on total body iron content and iron absorption in intestine.
Objective To investigate the effect of diet consultation and metabolic risk factors during pregnancy on gestational outcomes. Methods Subjects were consecutive pregnant women who accepted routine prenatal examination and delivery in the International Peace Maternity and Children's Health Hospital of China Welfare Institute in Shanghai from May 2010 to April 2012. The retrospective cohort was analyzed to evaluate the effect of diet consultation intervention on gestational complications among women with gestational diabetes mellitus (GDM). Stepwise logistic regressions analysis was used to evaluate the effect of metabolic risk factors on birth weight and macrosomia, respectively. Results ①Analyses were performed among 10 421 subjects. The mean of gestational week at the first prenatal visit was 20.8 (19.4-22.4) weeks. The mean of fasting blood glucose (FBS), triglyceride (TG) and total cholesterol(CHOL) was (4.4±0.4), (1.4±0.6) and (4.7±0.8) mmol·L-1, respectively. The mean of SBP and DBP was (111.3±11.5) and (67.9±13.3) mmHg. The prevalence of GDM was 15.8%. The mean of birth weight was (3 355.4±426.0) g and the prevalence of macrosomia was 6.2%. ②Among 812 pregnant women with diagnosed GDM, 570 accepted diet consultation at least once and the rest of 242 women never went to the diet consultation. No significant between-group differences were observed in variables in the baseline characteristics, including age, education, weight in 20th gestational week and biochemical tests at first prenatal visit. Compared with the control group the mean of birth weight, the prevalence of macrosomia and gestational hypertension in intervention group were reduced, (3 347.4±19.6 g vs 3 450.3±35.6 g, P=0.007; 6.7% vs 15.6%, P=0.001; 26.3% vs 47.9%, P<0.001), respectively. With the increase of times of visiting nutrition intervention, the mean of maternal gestational weight gain and birth weight declined (r=-0.126, P=0.003; r=-0.112, P=0.002), and the prevalence of macrosomia was also decreased. ③Stepwise multiple logistic regressions showed the body weight at 20th gestational week(OR=1.08, 95%CI: 1.07-1.09), gestational weight gain (OR=1.10, 95%CI: 1.07-1.12) and GDM(OR=1.63, 95%CI: 1.22-2.19) significantly increased the risk of the neonatal macrosomia. Conclusion The findings show that the elevated metabolic risk factors in pregnancy increase the risk of adverse gestional outcomes, diet consultation help improve the neonatal outcomes. The findings call for the urgent need for early and throughout management of metabolic risk factors and diet consultation among pregnant women during pregnancy to achieve better control the adverse gestation outcomes.
Objective To analyze and summarize the clinical features and the warning signs of children with PID, in order to investigate the application value of the warning signs to early identification of PID. Methods According to the classification issued by the International Union of Immunological Societies (IUIS) Primary Immunodeficiency Diseases (PID) Classification Committee in 2011 and the diagnostic criteria made by Pan-American Group for Immunodeficiency (PAGID) and European Society for Immunodeficiencies (ESID), the cases diagnosed as PID above were retrieved . Secondary immunodeficiencies about the cases of hypogammaglobulinemia and combined T and B cell immunodeficiency were excluded. All cases screened out were read, definite, probable or possible diagnoses were made. At last, the warning signs of cases with both definite and probable diagnosis were analyzed. Results 174 children with PID were included, the boys/girls ratio was 4.4:1. Predominantly antibody deficiencies were the most frequent finding (58.0%), followed by combined T and B cell immunedeficiencies (19.5%), congenital defects of phagocyte (10.9%), other well-defined immunodeficiency syndromes (5.7%) and diseases of immune dysregulaton (5.7%). 75 children (43.1%) had a history of recurrent respiratory tract infections, which were common in predominant antibody deficiencies. Diarrheal diseases were common in other well-defined immunodeficiency syndromes. Sepsis was more common in children with SCID and CGD. The occurrence of abnormal reactions after BCG vaccination was particularly high in CGD and significantly different from other types. Malnutrition was very common in 72 children (41.4%) without significant differences. There were significant differences in signs of lymphadenectasis and hepatosplenomegaly in which CGD and diseases of immune dysregulaton were the most common. Thrush was common in SCID. Nine children (47.4%) with CGD were found presenting perianal abscess, which was more common than other types. Pathogen evidence was found in 107 children(61.5%). 85 cases (48.8%) were followed up and 28(32.9%) were dead. There were 124 cases meeting the definite or probable diagnosis, among them 106(85.5%) had 2 or more warning signs. 119 children (96.0%) needed intravenous antibiotics to clear infections. 51 children (41.1%) failed to gain weight or grow normally. 52 children (41.9%) were suffering from recurrent respiratory tract infections. 28 children(22.6%) had a family history of PID. Conclusion The warning signs can be good indictors to PID. Need for intravenous antibiotics, failure to thrive and family history are useful to early identification of PID. Otitis media, central nervous system infection, sepsis and recurrent respiratory tract infection are more common in predominant antibody deficiencies. Deep-seated infections and abnormal reaction after BCG vaccination are significant to CGD. High attention is expected to be paid to chronic recurrent diarrhea.
Objective To investigate the clinical features, prognosis and prognostic factors of recurrent Kawasaki disease (KD). Methods The clinical data of 77 children with recurrent KD admitted to Children's Hospital of Chongqing Medical University from Jan. 1994 to Oct. 2012 were retrospectively studied and compared with their initial onset．Long-term followed-up was completed for children with recurrent KD. 77 KD patients hospitalized in 2001-2007 and without recurrence of KD in 5 years after treatment were selected randomly as case-control group, and potential risk factors for recurrence were analyzed. Results KD relapsed 2 months to 7 years (average 1.6 years) after the first onset in the 77 children. Compared with the initial KD onset , the clinical symptoms were less severe and the total fever duration was remarkably shorter in the recurrent KD patients［(7.6±3.1) d vs (8.9 ± 3.8) d，P＜0.05］. The levels of WBC and CRP were remarkably lower in the recurrent KD group(P＜0.05). The incidence of CAL did not increase compared with the initial KD group (13.3% vs 17.8%，P＞0.05) in the acute stage. 7 cases were detected CALs at first onset and recurrence, including 1 case with CAA in initial onset and recurrence. 52 out of 77 recurrent cases with recurrent KD were effectively followed up for 6 months to 6 years and 5 months. 1 case of recurrence with small CAA appeared coronary artery dilatation at different location during the follow-up, with recurrent coronary artery dilating after 4 years and 7 months. Multiple Logistic regression analysis showed that age<3 years,sex, fever duration>10 d, CAL、white blood cell counts >20.00×109·L-1 weren't the independent risk factors of KD recurrence. Conclusion The interval between the two episodes of KD recurrence is mostly within 1 year. Recurrent KD may be not associated with an increased incidence of CAL. Coronary artery dilation may occur in a new part or relapse after retraction in the acute stage.
Objective To investigate the epidemiology and clinical manifestation of acute lower respiratory tract infections (ALRIs) in hospitalized infants，and to analyze the clinical characteristics of severe ALRIs. Methods Information about ALRIs for infants was collected who were admitted to Children's Hospital of Fudan University from March 1st, 2011 to February 29th, 2012. Patient information included demographic characteristics, clinical presentation, accessory examination, etiology, treatment, prognosis, and disease burden. Results (1) A total of 1726 children with ALRIs were included in this study, comprising 25.3% of hospitalized infant patients, with peak proportion in autumn and winter. There were more preterm, low-birth-weight and under-six-month infants in severe ALRIs group. (2) The main clinical symptom characteristics of ALRIs infants were cough (70.3%) and fever (12.2%). Severe ALRIs infants commonly had tachypnea, cranosis and apnea. (3) The blood gas analysis showed elevated PaCO2and reduced PaO2 and SaO2 in the severe ALRIs infants. Among all ALRIs infants, 91.3% patients had confirmed pneumonia by X-ray. (4) The etiologic agents were identified in 1249 (72.4%) ALRIs infants. Respiratory syncytial virus (RSV) was detected in 913 cases (52.9%), which was the most predominant pathogen. In severe ALRIs group, more RSV, bacteria and co-infection were detected. (5) 69.5% severe ALRIs patients had underlying illness, with congenital heart disease being the commonest, followed by hyperbilirubinemia, bronchopulmonary dysplasia, airway abnormalities and undernutrition. (6) The median length of hospital stay and cost of ALRIs infants in hospital were 9 days and ￥6 864 RMB respectively, where both of these figures were higher in severe cases than in mild to moderate cases. Conclusion Severe ALRIs was the common disease in hospitalized infants aged below 6 months. RSV was the most important pathogen. Severe ALRI infants had high incidence of underlying illnesses and disease burden.
Objective To summarize and review the clinical data of a child with primary hyperoxaluria type 1 so as to improve its knowledge . Methods Clinical data of the case with PH 1were summarized, including clinical manifestations, imaging features and family investigation. AGXT gene analysis was performed in his family. Mutations of AGXT gene were scanned in normal control and related literatures were reviewed also. Results The age at onset was 3 years old. The first symptom was gross hematuria and followed by pain in back. He was diagnosed as urolithiasis. Urolithiasis recurred after removal of intraluminal stones by shock wave and endoscope. The patient was quickly progressed to end-stage renal disease within 7years. Multiple stones were found in kidney and ureter by ultrasonography, X-ray and computed tomography scan. Calcium oxalate monohydrate was confirmed by ingredient analysis of stone. No additional patient was identified in the family. c.242C>A and c.823_824dupAG heterozygous mutations in AGXT gene were detected in patient. AGXT gene analysis showed his father and mother had c.823_824dupAG and c.242C>A heterozygous mutations, respectively. c.242C>A heterozygous mutations is novel. These two mutations were not found in control subjects. Conclusion PH 1is a rare autosomal recessive disease. The disease should be considered when the patient had multiple and recurrent urolithiasis. Analysis of stone ingredient and AGXT gene is very useful for diagnosis. AGXT gene analysis is becoming first-choice method for diagnosis because it is noninvasive. Early diagnosis and management help to improve the outcome. The novel c.242C>A in our study extends the spectrum of AGXT gene mutations.
Objective To discuss the correlation of minimal residual disease (MRD) and clinical characteristics as well as its prognostic significance in acute lymphoblastic leukemia (ALL) patients with MLL gene rearrangements. Methods The patients with ALL at Beijing Children's Hospital from May 2004 to December 2009 were enrolled. The MRD level was detected by real-time quantitative PCR method with immunoglobulin, T-cell receptor gene rearrangements and MLL fusion transcripts as targets. The differences of clinical characteristics and events free survival (EFS) rates between different MRD groups were compared with Chi-square and Kaplan-Meier method respectively. Results 14 cases were detected for MRD level at the end of induction therapy. Patients with high MRD level (≥10-4) at the end of induction therapy had higher WBC counts at diagnosis and poorer prednisone responses than patients with low MRD level (<10-4). The different EFS rate was found in patients with different MRD level, a 5-year EFS rate of 100% in low level patients and (37.5±17.1)% in high level group, respectively. Conclusion The MRD level at the end of induction therapy could distinguish the patients with different prognosis and implement the individual therapy to improve the patients' outcomes.
Objective To investigate the expression of IgA1 and hepatocyte growth factor(HGF) in gastric mucosa of children with Henoch-Schonlein purpura(HSP) and its effect on the gastric mucosa injury of HSP,and to provide a new foundation for clinical diagnosis. Methods Twenty gastric mucosa specimens of HSP children with persistent or recurrent abdominal pain were collected (HSP group).IgA1 and HGF protein expressions in gastric mucosa of HSP group, non-HSP gastritis group(n=10) and control group(n=4) were detected with immunohistochemistry method. Results ①In HSP group,IgA,IgA1 protein expressed in the surface mucous cells of gastric mucosa, mesenchymal cells, inflammatory cells of lamina propria,they(0.61±0.02,0.58±0.05) were significantly higher than the non-HSP gastritis group(0.55±0.04,0.38±0.03) and the control group(0.14±0.03,0.13±0.05),meanwhile IgA1/IgA(0.94±0.02) was also higher than that in non-HSP gastritis group(0.69±0.06)(P<0.01);②HGF protein expressed in tubular gland cells of lamina propria, it(0.50±0.01) was also higher than that in non-HSP gastritis group(0.39±0.08) and the control group (0.16±0.03)(P<0.01). ③The expression of IgA1 in gastric mucosa was positively correlated with the expression of HGF(r=0.892, P<0.01). Conclusion ①IgA,IgA1 and HGF were expressed on gastric mucosa of HSP ,and the expressions of IgA1 and HGF were positively correlated. Prompting aberrant glycosylation of IgA1 deposited is the main reason causing pathological damage, and HGF may play an antagonistic role to IgA1. ②IgA1 and HGF may be the new pathological indicators for diagnosis in no-rash HSP children.
Objectives: Systematacially analysing the situation of the citations of Clinical Practice Guidelines (CPGs) published in domestic medical journals. Methods: We used “Zhinan” or “Zhiyin” as the term in the title to search WANFANG, VIP and CNKI, and used “Zhinan” in CBM to do a subject heading search until December, 2012. We screened and included the guidelines which met the eligibility criteria, extracted the data of the included studies, and analysed the data with the Excel software. Results: A total of 380 Chinese CPGs were included, among which 172 (45%) guidelines with the citations. The total number of citations was 6255 (citations of a single guideline ranging from 1 to 283), with a mean of 36. Journals were the most important source of citations with 5767(92%). The journal which offered the largest number of citations in Chinese was Chinese Journal of Cardiology, and in English was N Engl J Med. For the study design of citations, 545 studies (8.7%) were systematic reviews or Meta-analysis and 517 studies (8.3%) were RCTs. Average citation number of Cochrane systematic reviews per guideline was 0.4. Conclusions: Guidelines published in domestic journals were low in the proportion of citations reported and with a small average citation number per paper. They mainly cited the studies in the English journals, but the proportion of systematic review citing was low.
0bjective To improve the recognition of clinical and pathological features of IgA-dominant acute postinfectious glomerulonephritis in children. Methods The clinical and pathological data of child with IgA-dominant acute postinfectious glomerulonephritis was analyzed retrospectively, and combined with literature analysis of the clinical characteristics, diagnosis, pathogenesis, treatment and prognosis．Results The case showed gross hematuria, proteinuria, AKI, antistreptolysin O(ASO)titer increased, serum IgA increased. Renal pathological histology showed mild glomerular mesangial cell proliferation under light microcopy, immunofluorescence showed IgA and C3 deposition in the glomerular mesangial area and capillary loops. Under the electron microscope，glomerular subepithelial "hump" electron dense deposits with less mesangial deposits were seen. For this case renal function recovered , hematuria and proteinuria disappeared at 9 weeks. Conclusions IgA dominant acute postinfection glomerulonephritis has atypical clinical and pathological characteristics, diagnosis rely on early renal biopsy, the short-term prognosis is good, long-term prognosis remains to be seen.
