Objective To explore the relationship between obstructive sleep apnea hypopnea syndrome (OSAHS) and blood pressure in children. Methods Overnight polysomnography(PSG) was conducted in the Pediatric Sleep Center of Shanghai Jiaotong University School of Medicine affiliated to Shanghai Children's Medical Center for children aged 3-18 years, who were recruited in outpatient clinic from July 2012 to July 2013 with complaint of sleep snoring. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured for everyone before sleep in the evening. All children were divided into non-OSAHS group and OSAHS group according to PSG result, and then OSAHS group was divided into mild, moderate and severe subgroups according to apnea hypopnea index (AHI) and lowest oxygen saturation (LSaO2). The diagnosis of hypertension was made according to blood pressure reference standards for Chinese children and adolescents 2010. Systolic blood pressure index (SBPI) and diastolic blood pressure index (DBPI) were calculated. Then further analysis was was performed to evaluate the relationship between severities of OSHAS and blood pressure levels. Results A total of 385 children were enrolled in our study, with average age (5.5±2.3) years, 262 boys, SBP (100.6±10.4) mmHg and DBP (63.2±8.5) mmHg. 122 (31.7%) children met the criteria of hypertension and 42(10.9%) were severe hypertension. 261(67.8%) children were in non-OSAHS group, 124(32.2%) were in OSAHS group. In the OSAHS group, 54, 43 and 27 children were classified into mild, moderate and severe subgroups respectively. Compared with non-OSAHS group, the OSAHS group had higher BMI，BMI-Z scores, neck circumference, prevalence of overweight and obesity. ①SBP of OSAHS group was higher than non-OSAHS group, but it lost significance after adjustment of age, sex and BMI-Z. Both of the SBP and DBP statistically varied among different OSAHS severity groups (SBP: F=3.46, P=0.034; DBP: F=4.27, P=0.016), even adjusted by age, sex and BMI-Z scores. ② SBPI and DBPI did not significantly differ between OSAHS and non-OSAHS groups. In the OSAHS group, SBPI and DBPI significantly varied among different severity subgroups (SBPI: F=2.54, P=0.046; DBP: F=3.25, P=0.042). ③The hypertension prevalence was significantly different among 3 OSAHS subgroups. Severe OSAHS children had higher risk of hypertension compared with mild OSAHS children, OR=2.87(95%CI: 1.03~7.99), for severe hypertension, the OR increased to 5.79, (95%CI: 1.45-23.11). Conclusion The prevalence of hypertension is higher in children with sleep snoring than the general population, especially in the children with severe OSAHS. More attention should be paid to monitoring blood pressure for the children with sleep disordered breathing.
Objective To investigate the genetic variation and recombination of norovirus(NV) in children with acute diarrhea in Chongqing. Methods Diarrhea specimens in children with suspected viral diarrhea from January 2012 to December 2012 at the clinical laboratory center of the Affiliated Children's Hospital of Chongqing Medical University were collected. Two regions of NV genome(partial RdRp and capsid N/S region) were respectively amplified by primers of JVl2/JVl3 and GⅠ SKF /GⅠ SKR(COG2F/GⅡ SKR) using RT-PCR．All positive samples were purified and sequenced.The obtained sequences were aligned by DNAstar followed by phylogenetic analysis using MEGA 5.05 software. Some potential recombinant genomes of NV were amplified by PCR using primers JVl2/GⅠ SKR(JVl2/GⅡ SKR) when phylogenetic analysis indicated incongruent clustering for partial sequences of the RdRp and capsid genes in the same samples and recombination analysis was conducted using the SimPlot program. Results A total of 384 pediatric outpatients (248 males and 136 females) were enrolled in the present study, aged from <1 month to 121 months with a mean of (13.1 ± 14.4) months. ①84 of 384 stool specimens were detected as NV-positive(21.9%).The constituent ratio of NV was 96.4%（81/84）in children younger than 60 months.The isolation rates were higher in June, August and September, and the lower ones were in March and April. ②84 positive specimens were classified based on the capsid sequence:37 strains were GⅡ.4 2006b，1 was GⅡ.4 New Orleans 2009，27 were GⅡ.4 Sydney 2012，12 were GⅡ.3，3 were GⅡ.6，3 were GⅡ.13， and 1 was GⅡ.5. GⅡ.4 2006b was the predominant genotype from January to June,while GⅡ.4 Sydney 2012 was the predominant genotype from August to December.③Phylogenetic and Simplot analyses showed that 44 recombinant strains(RdRp/capsid) were detected: 27 were GⅡ.e/GⅡ.4 Sydney 2012 recombinants,1 wasGⅡ.7/GⅡ.6 recombinant, 1 was GⅡ.22/GⅡ.5 recombinant, 12 were GⅡ.12/GⅡ.3 recombinants, 3 were GⅡ.16/GⅡ.13 recombinants. Conclusion The NV recombinant in Chongqing region was at common frequency,after August 2012, the NV predominant strains of GⅡ.4 2006 gradually shifted to the recombination strains of GⅡ.e/GⅡ.4 Sydney 2012,and this is the first report of the detection of GⅡ.22/GⅡ.5 and GⅡ.16/GⅡ.13 novel recombinant NV.
Objective To identify ELANE gene mutations in 2 Chinese cases with congenital neutropenia and to better understand the clinical characters, diagnosis and treatment of this rare disease. Methods Clinical data of the two cases with congenital neutropenia were collected, including clinical manifestations, trends of the absolute neutrophil count (ANC), and immunological function. All 5 exons and flanking regions of ELANE gene were sequenced for the two cases and their families. Results Two cases were diagnosed as neutropenia at the age of 3 months and 1 month respectively, characterized with recurrent infections, including recurrent pneumonia in one case and oral mucosa ulcer in the other. Two cases presented with persistent neutropenia with the ANC less than 1.5×109·L-1, the lowest ANC reached 0.01×109·L-1 for case 1 and 0.09×109·L-1 for case 2, respectively. Screening of blood serum and bone marrow was performed to exclude pathogenic infection, autoimmune disease and hematological malignancies. The respiratory burst of neutrophils and cellular immune function of both cases were normal, except for the elevated serum IgG level. Case 1 had c.661G>GT（p.G221GX）heterozygous nonsense mutation in ELANE gene, case 2 had c.377C>CT（p.S126SL）heterozygous missense mutation. No mutation was found in their family members. Case 2 received hematopoietic stem cell transplantation (HSCT) and presented with normal ELANE gene afterwards, case 1 was treated with G-CSF, both were followed up. Conclusion ELANE gene is the critical pathogenic gene for congenital neutropenia. HSCT is the effective radical treatment for this rare disease.
Objective Primary nocturnal enuresis(PNE) children with normal osmotic concentration who were ineffective to desmopressin (DDAVP) were treated with tolterodine combined with Huai Qi Huang and mental behavioral therapy, to seek the best treatment. Methods PNE children in the outpatient clinic who were ineffective to DDVAP for one month were randomized and allocated into western medicine group (tolterodine oral), Chinese and western medicine group (tolterodine and Huai Qi Huang oral) and combined treatment group (tolterodine, Huai Qi Huang oral and mental behavioral therapy). PNE children and their parents recalled the number of enuresis in one month as the baseline number. Efficacy was evaluated at the end of the treatment and 3 months after the treatment, and intention-to-treat analysis was performed. Results A total of 234 children with enuresis were recruited for analysis, with 78 cases in each group. There was no significant difference in age, gender and baseline number of enuresis (P=0.778；χ2=0.933，P=0.627;F=0.141，P=0.868). The total effective rate in Chinese and western medicine group and combined treatment group was better than western medicine group at the end of the treatment and 3 months after treatment(P=0.017 and <0.001). There was no significant difference in total effective rate between combined treatment group and Chinese and western medicine group at the end of the treatment (P>0.05), but differences were observed 3 months after the treatment(P=0.005). NNT of combined treatment were 6.5（95%CI:3.7-25.3）at the end of the treatment, and 2.4（95%CI:1.8-3.6）3 months after the treatment; NNT of Chinese and western medicine group was 4.6(95%CI:2.7-15.2) 3 months after the treatment, respectively. Conclusion If 2.4 patients were treated by tolterodine, Huai Qi Huang oral and mental behavioral therapy, one of them was effective for long-term efficacy, the confidence intervals was very narrow. The results were reliable.
ObjectiveTo describe the epidemiological and clinical features in hospitalized children with acute respiratory infection caused by novel swine-origin influenza virus and seasonal influenza virus A in Chongqing. MethodsA total of 1 074 nasopharyngeal aspirates were collected in hospitalized children with acute respiratory tract infection enrolled in the department of respiratory medicine in Children's Hospital of Chongqing Medical University from June 2009 to May 2011.The RNA of S-OIVs /seasonal IVA in the sample was examined using real time PCR. Clinical data were recorded and analyzed. ResultsThe presence of IVA was detected in 105 (9.8%) samples of 1 074 cases, including S-OIVs in 15 (1.4%) samples and seasonal IVA in the rest of samples (8.4%). No differences in gender, age and average inpatient hospital stay were found between patients with S-OIVs infection and seasonal IVA infection. ①The prevalence of S-OIVs was 73.3％ (11/15)in summer of 2009, and the incidence of seasonal IVA infection was higher in the summer of 2009 (26/95,27.4%), summer of 2010 (22/95,23.2%) and spring of 2011 (25/95,26.3%). The incidence of both two viruses infection was lower in autumn and winter of 2009-2010. ②The rate of severe pneumonia in patients with S-OIVs and seasonal IVA infection was 1/15(6.7%) and 14/90(15.6%). There were no significant differences in clinical manifestation, white cell counts, CRP level between S-OIVs and seasonal IVA positive cases. 14 of 90 seasonal IVA positive cases were with severe pneumonia and 1 of 15 S-OIVs positive cases was with severe bronchiolitis. ③Five samples were found with single S-OIVs infection among 15 S-OIVs positive cases, other respiratory viruses were detected in 9 samples. Twenty one samples were found to be single seasonal IVA postive among 90 seasonal IVA positive cases, other respiratory viruses were detected in 42 samples. ④Multivariate logistic regression analysis showed that underling heart medical condition (OR=13.60), wheezing (OR=6.82) and co-infection with adenovirus (OR=6.21) were the risk factors of developing severe pneumonia in patients with seasonal IVA infection. ConclusionThe study indicated that the detection rate of S-OIVs infection and seasonal IVA was 1.4% and 8.4% respectively, in hospitalized children with acute airway respiratory infection in Chongqing. Children younger than 2 years old appeared to be susceptible to both virus infections. Diagnosis of non-severe respiratory tract infection was mainly presented in hospitalized patients with S-OIVs and IVA infection in the respiratory medicine division of our hospital. Underling heart medical condition, symptom of wheezing, and co-infection with adenovirus increase the risk of developing severe pneumonia in patients with seasonal IVA infection.
ObjectiveTo improve the diagnosis and differential diagnosis ability for different type of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA) by summarizing patient's echocardiography features and in combination with its clinical and electrocardiogram performances. MethodsThe echocardiography results of twenty-four cases with confirmed diagnosis of ALCAPA by surgery were retrospectively reviewed. According to the development of coronary artery collateral circulation, patients were divided into infantile type and adult type. The different and the common echocardiography features were summarized in two types of ALCAPA. ResultsThe same echocardiography features of infantile and adult types: ①There was no left main coronary artery ostium in left coronary cusp, in stead, the left coronary artery(LCA) was originated from pulmonary artery. ②Left ventricle chamber was enlarged obviously. The segments movement of interventricular septum and anterior wall of left ventricle was disorderd. The systolic function of left ventricle was reduced. ③The fibrosis of left ventricle was extensive and the area of endocardium was significant. ④The echo of mitral chordae tendineae and papillary muscle was enhanced. ⑤The diameter of right coronary artery (RPA) was significantly dilated. ⑥The flow of left coronary descending and circumflex branch was inversed. ⑦The mitral regurgitation was mild or severe. The following features differed in infantile and adult types. The significant collateral vessels were established between the RCA and LCA in adult type, however it was not the case for infantile type. The collateral vessels were less in infantile type. ConclusionThe different types of ALCAPA have some specific echocardiography features. Combining patient's echocardiography features with clinical and electrocardiogram performances, the accurate diagnosis can be achieved.
Objective This study performed a retrospective analysis of clinical and pathological features of seronegative hepatitis B virus-associated glomerulonephritis (sn HBV-GN) to explore the safety and efficacy of immunosuppressant treatment. Methods The patients who had been diagnosed with HBV-GN and serum markers was negative (HBsAg and HBV-DNA) in Beijing Children's Hospital from January 2006 to December 2011 were recruited out. Then the clinical and pathological features were analyzed and followed-up. Results Among 13 patients diagnosed as sn HBV-GN, the ratio of male to female was 1.6∶1, with a mean age at onset of 11.8 years. Nephrotic syndrome was the most common clinical manifestation (11/13), the other two patients (2/13) were with nephritis syndrome. The pathological feature of most patients had atypical membranous nephropathy (11/13, 84.6%) as shown by light microscopy. Immunofluorescence staining most commonly showed IgG and C3, IgA, IgM and C1q deposition was also seen. The HBsAg and HBcAg positive rates were 100% and 76.9%, respectively. The strong positive rate was 23.1% and 15.4%, respectively. Two patients with nephritis syndrome were complete remission. Among the 11 patients with nephritic syndrome, 2 patients treated with antivirus were non-remission; 2 of 3 patients with predinsone were partial remission; 2 of 3 patients with prednisone combined with CsA were partial remission; 3 patients were complete remission, whose therapeutic schedule was prednisone combined mycophenolate mofetil. None of the patients with immunosuppressive agents showed evidence of HBV activity. Conclusion Atypical membranous nephropathy was the most common pathological feature in children with sn HBV-GN. The intensity and type of deposition in immunofluorescence of sn HBV-GN were low. Prednisone combined mycophenolate mofetil was more effective than single prednisone and prednisone combined Cyclosporine A, single antiviral treatment may be ineffective. Results: (1). Among the 13 patients, male:female=1.6:1, with a mean age at onset of 11.85 years, during Adolescence. (2).Clinical feature: Nephrotic syndrome was the most common clinical manifestation (11/13), the other two patients (2/13) was nephritis syndrome. (3). Pathological feature: Most patients had atypical membranous nephropathy (11/13, 84.6%) as shown by light microscopy. Immunofluorescence staining most commonly showed with IgG and C3, IgA、IgM and C1q deposition were also seen. Only IgG existed strong positive deposition. The HBsAg and HBcAg positive rate were 100% and 76.9%, respectively. And the strong positive rate were 21.7% and 13.6% , respectively. (4).Two patients (2/2) with nephritis syndrome were complete remission. Three patient (3/11) in nephritic syndrome were complete remission, whose therapeutic schedule was prednisone combined mycophenolate mofetil. (5) None of the patients with immunosuppressive agents showed evidence of HBV activity. Conclusions: (1) In children, atypical membranous nephropathy was the most common pathological feature in children with sn HBV-GN, which was hard to distinguish from idiopathic membranous nephropathy. So we suggested to perform HBV antigen test in renal to avoid missed diagnosis. (2) The intensity and type of deposition in immunofluorescence of sn HBV-GN were different from seropositive HBV-GN whose deposition was “all bright”. (3) Immunosuppressive agents were safe to use in sn HBV-GN patients. Patients with normal liver function and no evidence of HBV activity do not require antiviral treatment, but liver function and HBV serum markers should be regularly examined. (4) Prednisone combined mycophenolate mofetil was more effective than single prednisone and prednisone combined Cyclosporine A, single antiviral treatment was ineffective.
ObjectiveTo evaluate the situation about carrying out neonatal resuscitation, equipments, personnel training in medical institutions and situations about newborn asphyxia and death in Zhejiang Province. MethodsFive health care institutions (2 city-level and 3 county-level) were randomly selected from each city in total 11 cities. Questionnaire surveys were performed about carrying out neonatal resuscitations practice, personnel training and delivery room, operating room resuscitation equipments, situations about newborn asphyxia and death. ResultsIn total of 49 hospitals from 10 cities were included in the survey. All of 49(100%) hospitals had the ability to carry out neonatal resuscitation. Neonatologist or pediatrician would be the key personnel to resuscitate high-risk newborns in tertiary and secondary hospitals; 89.8% healthcare institutions would at least have one personnel trained for neonatal resuscitation at birth; the number of NICU in tertiary hospitals was more than that in secondary hospitals（87.0% vs 34.6%, P=0.002），98.0% healthcare institutions would regularly deliver (or participant) neonatal resuscitation training. 79.6% healthcare institutions would use training aids.Various confinements personnel training rate was above the county level but below hospital training rate (P<0.001); Above the county level training pediatricians had the highest rate (P<0.05). Delivery room neonatal resuscitation units equipped with airbags and radiation heat rate was 100%,laryngeal mask airway was with the lowest rate; theater masks newborn, neonatal resuscitation bag, laryngoscope, suction tube, endotracheal tube with a rate lower than the delivery room. Live birth per year showed a trend of increase year by year in tertiary and secondary hospitals from 2004 to 2010. Neonatal mortality rates and incidence of birth asphyxia declined in tertiary and secondary hospitals, and higher in tertiary. Severe asphyxia rate in secondary hospital was generally higher than that in tertiary hospital. ConclusionIt's essential to establish regular and systematic training system, to enhance local medical personnel recovery skills and theoretical level, to purchase the necessary resuscitation equipments, and to improve neonatal resuscitation conditions for all level hospitals.
ObjectiveTo analyze the serum levels of 25-hydroxy vitamin D［25(OH)D］ in children with nephrotic syndrome(NS) and relevant factors. MethodsClinical data of NS paitients hospitalized at Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science & Technology from January 2012 to December 2012 were retrospectively collected, and healthy children coming for physical examination were enrolled as normal control group. The serum levels of 25(OH)D were defined as deficiency (≤20 ng·mL-1). Univariate analysis and multivariable logistic regression analysis were performed to explore the possible influencing factors related to vitamin D deficiency. Meanwhile, multi-regression analysis was used to investigate the potential factors affecting serum 25(OH)D level. ResultsA total of 222 subjects were enrolled, including 139 patients with NS and 83 healthy children. The serum 25(OH)D level of NS group was siginificantly higher than control group, (10.3±7.5) vs (29.42±9.85) ng·mL-1, P<0.000 1. The prevalence rates of vitamin D deficiency of NS and control groups were 86.3% and 19.3% (P<0.000 1). The multivariate logistic regression showed that patients with higher weight Z-score (0.151, 95%CI: 0.035-0.649), longer duation of NS (0.143, 95%CI:0.035-0.592), greater 24 h protein amount (28.177,95%CI:3.295-240.970) were significantly assocaited with vitamin D deficiency. Multiple linear regression determined that serum 25(OH)D levels were associated with male, 24 h urinary protein amount, cumulative glucocorticoid dosage and serum calcium level (P<0.05). Serum levels of 25(OH)D were significantly increased after treatment with alfacalcidol for 3 months, (7.2±5.0) to (14.9±11.0) ng·mL-1, P=0.001. ConclusionVitamin D deficiency was significantly associated with urine protein amount. Alfacalcidol supplements may improve vitamin D deficiency in nephritic patients.
ObjectiveTo investigate the effect of obstructive sleep apnea hypopnea syndrome (OSAHS) on the body fat volume of the normal-weight children, to provide the basis for early screening and actively intervention to the obese children. MethodsConsecutive OSAHS children (ages 3-7 years) were recruited from Shanghai Children's Medical Center as the case group, and non-OSAHS children and non-snoring healthy children as the control group. Both of the 2 groups underwent the overnight polysomnography (PSG) and assay to test the composition of the body. The case group was divided into 2 subgroups according to the apnea hypopnea index (AHI): mild OSAHS subgroup (AHI 5-10 times per hour ) and moderate-severe OSAHS subgroup (AHI≥10 times per hour). The relation was analyzed between the sleep architectures, sleep arousal parameters and the body composition of the body of the three subgroups of the case group and the control group. The relation between sleep architecture, arousal parameters and the body composition of the body was studied by multiple linear regression analysis. ResultsThere were 58 cases recruited into the case group. Mild OSAHS subgroup include 28 cases with mild OSAHS and 30 cases with moderate-severe OSAHS, and 63 cases for the control group. Age, gender and BMI Z-score were not significantly different among 4 subgroups (P>0.05). ① There was significant difference in AHI, obstructive apnea index(OAI), nadir SpO2 and respiratory arousal index (RAI), spontaneous arousal index(SAI), sleep pressure score(SPS) in the 4 subgroups. The AHI, OAI, nadir SpO2, RAI and SPS of mild and moderate-severe OSAHS subgroup were siginificantly higher than those in primary snoring subgroup and healthy children subgroup. ② There was no statistically difference in fat free mass, protein, skeletal muscle, resting metabolic rate, visceral fat area，arm circumference and waist hip ratio among the 4 subgroups. Body fat volume and the percentage of body fat were different among the 4 subgroups, with the highest levels in the moderate-severe group. ③ The multiple linear regression analysis indicated that a positive correlation between the body fat volume and the SPS (r=0.641), however it was not correlated with AHI, OAI or nadir SpO2. ConclusionOSAHS maybe associated with the increased body fat volume in the normal-weight children, and it appears to correlate with the sleep fragmentation, but not with the intermittent hypopnea. Introducing SPS interpretation in PSG scoring of normal body weight OSAHS children is helpful in order to make early intervention to prevent the concurrency of obesity.
ObjectiveThe initial insult of hypoxic-ischemic (HI) brain damage (HIBD) is the deprivation of oxygen (O2) to the brain cells, followed by a cascade of brain cell damage including mitochondrial dysfunction. Theoretically, hyperbaric oxygenation (HBO) could affect the recovery of mitochondrial function in HIBD by greatly increasing the O2 delivery diffusion gradient. The objective of this study was to prove the hypothesis that HBO may reduce HI-induced brain injury via affecting brain cell mitochondrial function, and to understand the changing patterns of mitochondrial function following HBO treatment in the first week after HI. MethodsIn the present study, HIBD rat model and flow cytometer were used to explore the change of ΔΨm, the indicator of mitochondrial function of cortex neuronal cells of neonatal rats after HIBD. Neonatal Sprague Dawley (SD) rat pups were randomly divided into normal control, HIBD, and HIBD+HBO groups. The end of HI was considered to be 0 h time point. The HBO treatment was given at 0h time point, and then once a day for consecutive 7 days (in 24 h intervals). Animals were euthanized at 0, 2, 4, 6, 12 h time points (in order to study the ΔΨm changes at the very early stage after a single dose of HBO treatment), and at 2, 3, 4, 5, 6, and 7 d time points (in order to study the ΔΨm changes after a series of HBO treatment). ResultsThe change of ΔΨm of the ipsilateral cortex in both HIBD and HIBD+HBO groups showed fluctuating change pattern. Within 2 h to 12 h after HI insult, ΔΨm of HIBD group recovered to some extent, but ΔΨm of HIBD+HBO group recovered to almost normal level. A secondary drop of ΔΨm was observed in both groups at 1-4 d after HI insult. The secondary drop of HIBD+HBO group was more severe than that of HIBD group. There was a secondary recovery of ΔΨm observed in HIBD+HBO group in 5-7 d after HI insult, but not in HIBD group. The ΔΨm of HIBD+HBO group recovered again to almost normal level at 6 d time point. The ΔΨm of HIBD group in 2-7 d after HI stayed at low level, showing slowly decreasing tendency. ConclusionHBO in the early stage after HI might not be a good therapy to improve the mitochondrial function in the cerebral cortex. The secondary recovery observed in HIBD+HBO group indicated that HBO treatment may protect HI-induced brain damage by improving neural cell mitochondrial function in the cerebral cortex during sub-acute stage after HI.
Tracheobronchopathia osteochondroplastica（TBPO) was one of rare disease.
