Abstract Objective To evaluate the relationship between 5,10methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphisms and congenital heart disease (CHD).Methods PubMed, EMBASE, Ovid, Springer，China National Knowledge Infrastructure, Vip Chinese Periodical Database, Wanfang Chinese Periodical Database and Chinese Biomedicine Database were searched for the casecontrol study on the association of MTHFR gene C677T polymorphisms with CHD from Jan 1994 to Jan 2009. According to inclusion criteria, articles were evaluated. Poorquality studies were excluded, and RevMan 4.2 software was applied for investigating the heterogeneity among individual studies and calculating the pooled odds ratio (OR) and 95% confidence interval（CI）.Results 18 eligible studies were included. Statistics of the combined data revealed a significant difference between the offsprings with CHD carrying of TT/CC, (TT+CT)/CC of MTHFR gene C677T and controls, the pooled OR of TT/CC and (TT+CT)/CC was 1.55（1.24-1.93）and 1.15（1.06-1.42）（P<0.05）; there was no difference between the offsprings with CHD carrying of CT/CC of MTHFR gene C677T and controls, the pooled OR was 1.15（0.99-1.34）（P>0.05）. There was a significant difference between the CHD of offspring with paternal TT/CC, (TT+CT)/CC of MTHFR gene and controls, the pooled OR of TT/CC and (TT+CT)/CC of MTHFR gene C677T was 1.84（1.23-2.74）and 1.33（1.04-1.71）（P<0.05）; there was no difference between the CHD of offspring with paternal CT/CC of MTHFR gene C677T and controls, the pooled OR was 1.25（0.96-1.62）（P>0.05）. There was no association between the CHD of offspring and maternal MTHFR gene C677T, the pooled OR of maternal TT/CC, CT/CC and (TT+CT)/CC was 1.20（0.92-1.56），1.03（0.86-1.24） and 1.07（0.90-1.27）（P>0.05）, respectively. The results of transmission disequilibrium test (TDT) analysis showed that no allele transmission disequilibrium of MTHFR gene 677T existed in CHD nuclear families，OR=0.90，95％CI:0.79-1.12（P>0.05）．Conclusions The results suggested the offspring and paternal MTHFR gene 677TT, 677(TT+CT) were both risk factors for the CHD; there was no association between maternal MTHFR gene C677T and onset of CHD in offspring.
Abstract Objective To evaluate the reliability and validity of the Chinese version of Manual Ability Classification System (MACS).Methods Patients with cerebral palsy(CP) were involved from two rehabilitation centers in Shanghai. Three assessment methods were used to evaluate the manual function levels, including locale assessment by professional, locale assessment by family career and video assessment by professionals. Eight assessing scenes were set for these children to mimic the normal living activities, including drinking with cups, using spoon ,opening and closing small bottles, cleaning face, wringing towels, turning pages of a book, writing, and releasing buttons. Two occupational therapists did the locale assessments. All the activities performed by these children were videotaped and rescored by the same two occupational therapists and one physiatrist at least one week later (the longest interval between locale assessment and video assessment was 10 months). The family career read Chinese version of MACS then scored their children according to their performance at home and at locale as well. Professionals explained the terms for parents if needed but they didn′t discuss the classification results with parents. Testretest reliability was analyzed by comparing scores of locale assessment and video assessment, Intertester reliability was analyzed by comparing scores of different estimator（family career,occupational therapist and physiatrist）.Criterionrelated validity was evaluated by comparing MACS levels with scores of Fine Motor Function Measure(FMFM) .Results One hundred and twentyfour children (77 males and 47 females; mean age: 6.7 years, SD: 2.6 years, age range: 4 to 18 years) with CP were involved from two rehabilitation centers in Shanghai. 97 children in the 4 to 7year band, 24 children in the 8 to 12year band, 3 children in the 13 to 18year band. Types of CP in these children were spastic quadriplegia (n=27), spastic diplegia (n=48), spastic hemiplegia (n=38), athetotic （n=5）,dystonia (n=4) and ataxic (n=2). Gross motor function classification system levels were: Ⅰ(n=51), Ⅱ(n=32),Ⅲ(n=15)，Ⅳ（n=14），and Ⅴ （n=12）. Chinese version of MACS was found to possess satisfactory testretest reliability(ICC=0.94 and 0.87) as well as excellent intertester reliability (ICC=0.85-0.96). Criterionrelated validity was moderate between MACS levels and scores of FMFM (Spearman r=-0.71).Conclusions This study extended reliability and validity of the Chinese version of MACS. Results indicated that Chinese version of MACS was a valid and reliable measure of manual functions in Chinese children with CP. Environment factors should be considered in assessment. Participation of family career in scoring was very valuable. With the help of family careers, the scores might reflect children′s practical manual function levels more precisely.
Abstract Objective To observe the alteration of pulmonary function in toddlers with pneumonia caused by M.pneumoniae(MP).Methods We detected the concentration of serum specific antibody against MP(IgM) with the agglutination test to support the diagnosis of MP infection,and a titer of 1∶160 or greater was considered as positive. The reagents were purchased from the Fujitsu Corporation of Japan.The pulmonary function of 77 hospitalized toddlers with pneumonia caused by MP who fulfilled the exclusion criteria was tested respectively during acute phase and compared with the 120 healthy toddlers . There were three exclusion criteria.One was cough lasting more than 2 weeks upon hospitalization,another was multiple infections, and the other was the children who combined with asthma . In these two groups,younger than 2 years old toddlers were compared with elder than 2 years old ones.Pediatric pulmonary function laboratory type 2600 (Sensor Medics Corporation,USA) was used to detect tidal flow volume curve,which could partially replace the maximum expiratory flow volume curve.Parameters showing small airway function were ratio of the volume to reach peak tidal expiratory flow to total expiratory volume(%VPF),ratio of tidal expiratory flow at 25% remaining expiration to peak expiratory flow(25/PF),and ratio of inspiratory time to total respiratory time(Ti/Tt).Parameter showing large airway function was ratio of midtidal expiratory flow to midtidal inspiratory flow(ME/MI).Passive expiratory flow volume technique was used to examine respiratory system static compliance and total airway resistance.Open nitrogen washout method was used to measure functional residual volume.Results In the toddlers from 1 to 2 years of age,during the acute phase of pneumonia caused by MP,the respiratory rate (RR) and peak tidal expiratory flow(PTEF) were significantly increased,Ti/Tt,%VPF,25/PF,ME/MI,functional residual capacity per kilogram (FRC/kg) and respiratory system compliance per kilogram (Crs/kg) were significantly decreased comparing with those normal toddlers.In the toddlers from 2 to 3 years of age,PTEF was significantly increased,Ti/Tt,%VPF and 25/PF were significantly decreased,but there was no significant difference in Crs/kg and FRC/kg.During acute phase,the tidal breathing flowvolume (TBFV) loops both displayed a concave expiratory curve.And the results of the pulmonary function testing in 1-3 years old toddlers with pneumonia caused by MP were coincided with their clinical manifestations.The younger group was more severe than the elder group,and the difference was significant (P<0.05) . In the younger group,more patients (51.2%) had productive cough than in the elder group(26.5%).More patients had moist rales in lungs and spotpatchy shadows in chest Xray in the younger ( in order,44.2% , 83.7%) than the elder (23.5%,41.2%).The clinical signs of fever and wheezing/dyspnea were similar in these two groups.Conclusions Higher resistance in small and large airway and higher RR,lower FRC/kg and Crs/kg could be seen in the toddlers from 1 to 2 years of age with pneumonia caused by MP.And only the resistance in small airway was higher in the toddlers from 2 to 3 years of age.Pulmonary function test was a valuable way for surveillance of the alteration during acute phase in toddlers with pneumonia caused by MP.
Abstract Objective To assess whether supplementation of formula with LCPUFAs is beneficial to mental development of term infants.Methods Eligible studies were identified by searching Cochrane library, PubMed,EMBASE, CMBdis and CNKI. No language restrictions were applied. Two reviewers assessed the quality of included studies and extracted data and processed metaanalysis. All randomized and quasi randomized trials comparing LCPUFAs supplemented formula vs nonsupplemented formula and with clinical endpoints were reviewed. Neurodevelopmental outcomes and physical growth were measured by Bayley scales of infant development (BSID). RevMan 4.3.2 was used to do the statistical analyses. Results There were six randomized clinical trials that met with the inclusion criteria of this systematic review,including 894 term infants. Studies were graded in term of randomization, allocation concealment and blinding. Five studies were graded A and one studies were graded B. Subgroups were divided according to the age. Metaanalysis basing on included studies showed that the effect on MDI ,WMD of 12monthsubgroup was -1.66(95％CI：-4.09 to 0.76，P＝0.18)，WMD of 18monthsubgroup was -0.70(95％CI：-2.90 to 1.51，P＝0.54) and pooled WMD was -1.13(95％CI：-2.76 to 0.50，P＝0.17. The effect on PDI, WMD of 12monthsubgroup was -1.14(95％CI：-4.39 to 2.12，P＝0.49），WMD of 18monthsubgroup was 0.70(95％CI：-0.88 to 2.27，P＝0.39) and pooled WMD was -0.35（95％CI：-1.07 to 1.77，P＝0.63. There were no significant differences in the psychomotor development index of term infants between two groups. Pooled meta-analysis of the data did not show any statistically significant benefit of LCPUFAs supplementation on either mental or psychomotor developmental index of BSID. The evidence was not strong enough to judge whether the formula fortified with LCPUFAs had beneficial effects on the mental development of term infants than that without.Conclusions The results of most of the well conducted RCTs had not show beneficial effects of LCPUFAs supplementation of formula on the neurodevelopmental outcomes of term infants.
Abstract Objective To evaluate the efficacy of intravenous lowdose erythromycin for the prevention and treatment of feeding intolerance in preterm infants.Methods The Cochrane Library, PubMed, EMBASE, China Biological Medicine Database, VIP,WangFang and CMAC were searched up to the year of 2008. Handsearches and additional searches were also conducted. RCTs of erythromycin for feeding intolerance in preterm infants were included.Two reviewers independently extracted data from eligible studies and evaluated the quality of included studies. Metaanalysis was performed for the results of homogeneous studies by the Cochrane Collaboration′s software RevMan 5.0.17.Results 18 RCTs involving a total of 1200 premature infants were included.The metaanalysis showed: ①Primary outcomes:erythromycin prevention group（WMD= -4.18,95%CI：-6.29 to -2.08) and treatment group(WMD= -4.69,95%CI:-6.38 to -3.00) could achieve full enteral feeding earlier.However，there was no significant difference in the treatment group by subgroup analysis(WMD=-5.15,95%CI:-12.60 to 2.30) and between the treatment group and the control group by sensitivity analysis(WMD= -5.48,95%CI:-11.66 to 0.69).②Secondary outcomes：There was no significant difference in the duration of hospitalization(WMD=-1.10,95%CI:-3.65 to 1.37) and the incidence of NEC(OR=1.01,95%CI:0.24 to 4.22) between the erythromycin prevention group and the control group.In comparison of daily average weight gain(WMD=4.29,95%CI:-2.06 to 10.64) and the incidence of NEC(OR=0.68,95%CI:0.18 to 2.56),the metaanalysis showed no significant difference between the erythromycin treatment group and the control group; Some advantages were shown from erythromycin treatment group in resumption of birth weight(WMD=-2.45, 95%CI:-2.87 to -2.04), time of symptom disappeareing(WMD=-1.22, 95%CI:-1.33 to -1.11) and the duration of hospitalization(WMD=-9.70,95%CI:-11.92 to -7.49) compared with the control group.Conclusions There is no enough evidence to recommend the use of intravenous lowdose erythromycin for preterm infants ≤32 weeks′GA with or preterm infants at risk of feeding intolerance. Future research is needed to determine if there is a more precise dose range where erythromycin might be effective in shortening the time for parenteral nutrition and duration of hospitalization in preterm infants >32 weeks′GA. Erythromycin may have a role in improving the symptoms of feeding intolerance.
Abstract Objective To compare the quality of life (QOL) in adolescents with epilepsy and asthma using SF-36 scale(the medical outcomes study 36-item shortform health survey).Methods QOL of children with epilepsy (n=85), healthy children (n=87) and children with asthma (n=81) (matched with sex, age and level of education) as control followed up in the outpatients of Children′s Hospital of Fudan University were evaluated. These children respectively received survey in neurologist outpatients, child health care outpatients and respirologist outpatients. SF-36 scale was included in QOL assessment.Results Reliability and validity of SF36 scale were retested. The Kappa of reliability and validity test was 0.87 and 0.86. All the children had no difference in family population and family income (P>0.05). The ages of children were 14-18 years old, the average age was ［(15.6-15.7)±1.3］ years old. There was no difference in onset age, disease course and the frequency of attacks between epilepsy group and asthma group (P>0.05). 70 epilepsy patients and 59 asthma patients received one kind of drug. 63 epilepsy patients and 56 asthma patients never forgot the medication. There was no difference in the number of drug and medication compliance between two groups(P>0.05). 36 epilepsy patients were seizure free lasting more than one year,other 79 patients were out of control.29 asthma patients were without acute attack, the largest peak expiratory flow (PEF) always kept above 80%, other 52 asthma patients were active. The QOL of children with epilepsy was lower than that of healthy children, including total score(Z=-5.123,P<0.01) and other eight items(physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, mental health ) (Z=-4.459, -3.253, -2.877, -5.150, -4.311, -3.283, -3.604, -4.351, P<0.01), and much more serious than that of children with asthma in total score(Z=3.600,P<0.01) and other four items(physical functioning, bodily pain, general health, vitality) (Z=-5.382, -2.667, -4.416, -3.087, P<0.01). The QOL of children with asthma was lower than that of healthy children, including total score(Z=-3.600,P<0.01) and other four items(physical functioning, bodily pain, general health, vitality ) (Z= -5.382, -2.667, -4.416, -3.087, P<0.01). The QOL of children with epilepsy under control was lower than that of children with asthma under control in total score(Z=-6.118,P<0.01) and other six items (role physical, social functioning, role emotional, mental health, general health, vitality) (Z=-4.048,-3.019, -5.588, -4.756, P<0.01; Z=- 2.976, -1.972, P<0.05). The QOL of children with epilepsy out of control was poorer than that of children with asthma out of control in total score(Z=-4.914,P<0.01) and other five items (physical functioning, general health, role emotional, mental health, social functioning) (Z=-2.627, -3.152, -4.026, -3.664, P<0.01; Z=-2.340, P<0.05). The emotion function and mental health in epilepsy group were much poorer than those in asthma group. Psychological barriers in children with epilepsy were persistent regardless the seizure frequency. Conclusions The QOL of children with epilepsy and asthma was obviously poorer than that of healthy children. The QOL of children with epilepsy was damaged much more seriously than that of children with asthma. SF36 scale can evaluate the QOL of chronic paroxysmal disorders such as epilepsy and asthma. SF-36 scale can be used as a means of the degree of disease control, auxiliary evaluation of the efficacy of the treatment of disease. Besides reasonable usage of medications, comprehensive management including psychological intervention should be applied to children with epilepsy to improve the social function and QOL.
Abstract Objective To determine whether early applying of B-NCPAP(with PEEP 8cm H2O ) or PS plus B-NCPAP (with PEEP 5cm H2O ) can provide better effects in prophylaxis and treatment of neonatal respiratory distress syndrome.Methods B-NCPAP 8 group :73 neonates aged 0.5 h, with gestational age of 28 to 37 weeks, and the foam tests of amniotic fluid were negative or probably negative , receiving B-NCPAP(starting at a pressure of 8 cmH2O with binasal prongs). B-NCPAP 8 group was divided into 2 subgroups: 48 neonates in prevention subgroup(B-NCPAP 8 P), received B-NCPAP before development of NRDS, 25 in treatment subgroup(B-NCPAP 8 T), received B-NCPAP after development of NRDS. PS+B-NCPAP 5 group :58 neonates aged 6 h, with gestational age of 28 to 37 weeks, and the foam tests of amniotic fluid were negative or probably negative , receiving PS plus B-NCPAP(starting at a pressure of 5 cmH2O with binasal prongs ). PS+B-NCPAP 5 group was divided into 2 subgroups:36 neonates in prophylactic subgroup (PS+B-NCPAP 5 P), received PS before development of NRDS,22 in treatment subgroup(PS+B-NCPAP 5 T), received PS after development of NRDS.Results In 48 B-NCPAP 8 P infants,41 infants were improved, the prophylactic achievement ratio was 85.4%.7 infants got dyspnea after 4-6 h of B-NCPAP,5 of them finally were improved, while 2 infants needed PS and mechanical ventilation . In 36 PS+B-NCPAP 5 P infants,32 infants were improved, the prophylactic achievement pencentage was 88.9 %, 4 infants got dyspnea , 3 of them finally were improved, while 1 infant needed PS and mechanical ventilation and 1 infant finally died of NRDS, the mortality rate was 2.7%. In 25 B-NCPAP C infants ,24 of them were improved, the curative ratio was 96% ,only one of them got dyspnea after 4-6 h of B-NCPAP and needed be given PS and mechanical ventilation after 24 h treatment of B-NCPAP. In 22 PS+B-NCPAP 5 C infants ,18 of them were improved, the curative ratio was 81.8% ,one infant died, the mortality rate was 4.5%. The total time of supplemental oxygen administration, assisted ventilation, hospitalization and cost of hospitalization of B-NCPAP 8 group was shortened compared with PS+B-NCPAP 5 group either in prevention or in treatment .Conclusions Early B-NCPAP(with PEEP 8 cmH2O ) applying provided an equivalent effect compared with PS plus B-NCPAP (with PEEP 5 cmH2O ) in prophylaxis and treatment of neonatal respiratory distress syndrome.
Abstract Objective To identify the first fifty words of children in the language development and accumulate experiences for later study of large scale.Methods A random sample of 610 children of 0-3 years of age from six communities of the Qingpu district in Shanghai was selected for the study. A questionnaire including 837 words according to the MacArthur Communicative Development Scale and the Mandarin Children's LanguagePlay Developmental Scale was developed for this study. It might be involved all words of 0-3 years old children who expressed in their early life. The 0-3 Years old Chinese Children Care and Development Group(CCCDG) was organized including developmental and behavioral pediatricians, kindergarten teachers, senior education researchers. The formal and close investigation was proceeded to get the full information about how many words a child at a certain age was able to express. All information in the questionnaire was obtained from either parents filling out the questionnaire or testing the children on the spot. All parents were trained in advance to ensure the questionnaires were filled out exactly in order to objectively reflect the contents and quantity of the words the children could express. However, there were still some parents who got along with their children a so short time that they were unable to be sure about the words their children could express. Apart from this, the children were not willing to cooperate with researchers. The questionnaires containing incomplete or wrong information were removed. SAS 6.12 software was applied for the statistic analysis. The sequence of the first fifty words was determined in terms of the vocabularies expressed in about 50% children at the ages.Results The numbers of words in different percentiles and age groups, average word growth from birth to 36 months of age was showed. During 0-9 months, among all samples about 50% children could express 1 word, but about 25% children could express 3 words, about 10% children could express 7 words, about 5% children were able to express 13 words ; From 10 to 12 months, 50% children were able to express 2 words, however the simple sounds imitated by children or the real words understood by children could not be recognized; From 13 to 15 months, 50% children were able to express 7 words. From 15 to 18 months, 50% children were able to express 40 words. Thus the size of vocabularies increased with age, the spurt of vocabularies′ growth could be seen from 15 months. Till 19 months the vocabularies grew from 7 to 47 words. The first 50 words could be classified as 4 categories,i.e., personal nomination, object nomination,animal nomination and others. With the quantity of vocabulary growing, the proportion of certain category to all the vocabularies was changed constantly. For example, the proportion of personal nomination was 70% when children achieved 10 words(about 15-16 months of age), this was absolutely overwhelming percentage. But when children achieved 50 words(about 19-20 months of age), the proportion of object nomination was 38% which was predominant over that of other categories,for instance, personal nomination decreased to 26%,and verb 8%. There were various changing trends in proportion of these four categorized words. Conclusions The results showed the language developmental pattern of Chinese children′s acquisition of the first 50 words and its contents. It accmulated experiences for later study of large scale.
