Objective The aim of the current study was to investigate the body height distribution profile and prevalence of short stature of children and adolescents aged from 6 to 18 years in Shanghai.Methods One urban district and one suburban district in Shanghai were selected. 70 431 children and adolescents aged from 6 to 18 years were recruited. Body heights were measured and were evaluated using a local growth standard. Short stature was defined as the body height was two standard deviation below the mean body height in each sex matched age group. The prevalence of short stature was calculated and standarized using the local population data.Results ①The mean body heights in boys were (153.33±17.93) cm and those in girls were (149.75±14.50) cm. Body heights were significantly higher in boys than that in girls (P<0.000 1). ②There existed triple phases character about the growth profile in Shanghai children and adolescents. The boy′s heights were higher than those of girls between age 6 to 9 years, girl′s growth spurt appeared after 10 years old and the body heights were higher than those of boys between age 10 to 11 years, and finally boy′s heights were higher than those of girl′s between age 12 and 18 years. The body heights of boys nearly stoped increasing after 16 years old while the heights in girls stoped increasing after 15 years old. ③The body heights of children in Shanghai were higher than the average values of the national growth charts. The heights in each group of urban boys increased by (6.4±2.1) cm and suburban boy′s heights increased by (10.5±2.5) cm between 2003 and 1975, while the heights in each group of urban girls increased by (4.8±0.9) cm and suburban girl′s heights increased by (8.6±1.9) cm in the same time. However, the heights in each group of urban boys only increased by (0.8±1.2) cm(-0.1-3.1 cm) and suburban boy′s heights increased (3.5±0.9) cm(2.2-5.6 cm) between 2003 and 1995, the heights in each group of urban girls increased by (0.7±1.0) cm(-0.3-2.8 cm) and suburban girl′s heights increased (3.3±0.9) cm(2.1-5.4 cm) in the same period. ④The overall short stature crude morbidity rate (CMR) was 3.77％, and the standardized morbidity rate (SMR) was 3.26%，the rate was significantly higher in boys than that in girls. The short stature CMR in urban area was 2.78％, and the SMR was 2.57%，the rate was significantly lower in urban area than that in suburban area (CMR 4.51%, SMR 3.75%).The short stature prevalence was higher before 14 years old.Conclusions The growth profile in Shanghai children and adolescents showed triple phases character. Boys′heights were higher than those of girls′ among age from 6 to 9 years and from 12 to 18 years, while the girls′s heights were higher than those of boys′ between age 10 to 11 years. The body heights in Shanghai children and adolescents were higher than those of the national survey results, there existed a significant height increase between 1975 and 2003 in all age groups. The heights continued to increase between 1995 and 2003 in Shanghai suburban children and adolescents, however the body heights increased little in urban children and adolescents. The overall short stature standardized morbidity rate was 3.26%, the rate was significantly lower in urban area than that in suburban area. The overall SMR was significantly lower than that of other developing countries. Future targeted etiology study may disclose the pathogenesis of short stature in Shanghai, and may be beneficial for establishing proper intervention measures for short stature children and adolescents.
Objective To compare the training efficacy of the peerled tuition model and physician tuition model on the pediatric first aid training for caregivers and teachers (PedFACTs).Methods Teachers working in the kindergarten in Shanghai were recruited in two times. The number of teachers in each district or county was selected on the basis of the proportion of teachers of the district or county possessing in Shanghai. The first recruited teachers received first aid tuition from experienced clinical staff, and the second recruited teachers received first aid tuition from teachers instructors. The teachers in both of two models received American pediatric first aid for caregivers and teachers courses translated and modified into Chinese. The courses included small group activity, video presentation, PedFACTs challenge and first aid kit. The first aid knowledge in the two models was evaluated before and after the training. The theoretical assessment consisted of 37 multiplechoice questions addressing the treatment and prevention of common emergencies, which were developed from the American examination papers for the teachers, Instructor′s Resource Manual for Pediatric First Aid for Caregivers and Teachers and the text book Pediatric First Aid Training for Caregivers and Teachers. A score of 80% of the assessment or greater was required to pass in accordance with American Academy of Pediatrics examination guidelines. Trainees practical skills were also tested at the end of the course, including cardiopulmonary resuscitation, management of a blocked airway on a child, management of a blocked airway on an infant. All analyses were done using SPSS.Results 148 teachers were recruited at two times, 83 at the first time and 65 at the second time.The demographics of the two models were not significant different in terms of district, age, education background, occupation, whether received first aid training or not, length of teaching experience and so on(P>0.05). There was no statistical significance in theoretical score before(t=1.631, P=0.105) or after(t=0.849, P=0.397) the training between the peerled tuition model and physician tuition model. There was also no statistical significance in practical total score(t=1.676,P=0.096), the score of cardiopulmonary resuscitation(t=1.747,P=0.062), the score of management of a blocked airway on a child(t=1.762,P=0.080), the score of management of a blocked airway on an infant(t=1.149,P=0.252) between the two models. Before the training, 89.2% of trainees considering their first aid knowledge common or poor in the model of peerled tuition was similar to that (92.8%) in the model of physician tuition (χ2=0.570,P=0.450); 73.8% of trainees in the model of peerled tuition had litttle or no confidence in providing first aid for the injured children, it was similar to that(70.7%) in the model of physician tuition (χ2=0.179,P=0.676). But after training, 86.2% of trainees considering their first aid knowledge good or very good in the model of peerled tuition was significantly higher than that (44.6%) in the model of physician tuition (χ2=26.983,P<0.01); 95.4% of trainees were confident or very confident to provide first aid for the injured children in the model of peerled tuition was significantly higher than that(68.7%) in the model of physician tuition (χ2=13.565,P<0.01). The passing rate of theoretical assessment in trainees aged ≤40 years was 98.1%; 89.5% in trainees aged past 40 and just under 46 years; 81.8% in trainees aged ≥46 years. The passing rate of practical assessment in trainees aged ≤40 years was 97.2%; 94.7% in trainees aged past 40 and just under 46 years; 77.3% in trainees aged ≥46 years. The differences of theoretical or practical passing rate between ages were statistically significant, while not significant between models, district, kind of kindergarten, educational background, occupation, length of teaching experience, whether received first aid training or not, whether studied the knowledge of injury or not.Conclusions The model of peerled tuition in PedFACTs is not only proved to have the same efficacy as the model of physician tuition, but also shows the advantages in strengthening trainees′ confidence in PedFACTs.
Objective To evaluate the development of the great arteries after arterial switch operation (ASO) for transposition of the great arteries (TGA).Methods From March 2001 to March 2007, we carried out ASO for 72 cases with TGA or TaussigBing anormaly in the cardiovascular center of Children′s Hospital of Fudan University. Patients were followup by using echocardiography after ASO. The size of the great arteries in TGA patients after ASO was compared with normals.Results 72 cases dignosed as TGA were undergoing ASO, 6 cases were death during the ASO.10 cases were loss of followup. 32 cases of TGA with intact ventricular septum (TGA/IVS) and 24 cases of TGA with ventricular septum defect (TGA/VSD) (n=24) were evaluated at (86.46±23.51)m (from 18 to 168 months) after ASO by using echocardiography.The diameter of neoaortic root was from 13.8 mm to 26.4 mm(16.97±2.71) and the mean Z score of it was 1.10±0.70(t=6.936，P<0.001). There were 12 cases (21.4%) with diameter of neoaortic root beyond 90% confidence interval for controls and 44 cases (78.6%) within 90% confidence interval for controls. The diameter of neoaortic valve annulus was from 12.9 mm to 23.3 mm(16.27±2.38) mm and the mean Z score of diameter of it was 0.66±0.65(t=4.52，P<0.001). All of these 56 cases with diameter of neoaortic valve annulus were within 90% confidence interval for controls. The diameter of pulmonary artery was from 10.6 mm to 17.0 mm(14.29±1.92) mm and the mean Z score of it was -0.95±1.33 (t=-3.2，P=0.005).There were 16 cases (28.6%) with diameter of pulmonary artery below 90% confidence interval for controls and 40 cases (71.4%) within 90% confidence interval for controls. The diameter of pulmonary valve annulus was from 10.5 mm to 16.0 mm(14.00±1.92) mm and the mean Z score of it was 0.05±1.85(t=0.132，P=0.897). There were 14 cases (25.0%) with diameter of pulmonary valve annulus below 90% confidence interval for controls and 42 cases (75.0%) within 90% confidence interval for controls. Mild aortic regurgitation was observed in 16 cases (28.6%) and there was no relation with the interval time of followup(P=0.899). Neoaortic stenosis was not found. Trivial mild and mild supravalvular pulmonary stenosis occured in 5 cases (8.9%) and 2 cases (3.6%) respectively.Conclusions Midterm followup outcome after ASO for TGA showed the dilation of neoaortic root and valve annulus and the reduction of pulmonary artery while satisfactory size of pulmonary valve annulus. Mild aortic regurgitation and supravalvular pulmonary stenosis were frequent complications though with low grade.
Objective Individuals with autism have been demonstrated to have deficit in cognizing facial expression. This study aimed to explore the cognitive profile of facial emotional expressions in young children with autism.Methods Forty five children with autism and forty five normal controls matched on chronological age and gender were recruited to view passively five kinds of basic facial emotional expression pictures which presented on computer screen in a quiet room. The responses of each child were recorded by a web camera. Then visual attention and self emotional responses of all children toward the emotional expressions were coded from the videotaped observations.Results The data of 82 children were included in the analysis because 8 children did not finish the entire experiment. The difference of the firstlooking time toward five kinds of facial expression between groups was not significant while expression effect within group was significantly showed that children looked longer to happy and angry expression than fearful expression at the first time. Autistic children′s times of backlook and total looking time toward all kinds of facial expression were significantly less than normal controls′(P＜0.05). The score of self emotional response to different expression was significantly different in normal children(P＜0.05) including positive and negative response, which showed the score of positive emotion toward happy expression was higher than that toward other expressions, the score of negative emotion toward happy expression was lower than that toward angry and fearful expressions and the scores of negative emotion toward sad and surprise expression were also lower than that toward fearful expressions, while that was not obvious in children with autism. Autistic children showed indifferent to all facial expressions or abnormally positive emotional response to negative facial expression as to happy expression.Conclusions Young children with autism not only show less visual attention to facial expression, but also have impairments in perceiving facial expression especially in comprehending negative emotional expressions that maybe relate to early abnormal development of amygdala in autism.
Objective To assess the efficacy of sublingual immunotherapy for asthma in children sensitive to mite and provide evidence for clinical therapy and future trialMethods PubMed,EMBASE,the Cochrane Central Register of Controlled Trials (Clinical Trials),CBM and CNKI were searched till November 30 2008，using the terms(asthma AND specific immunotherapy AND mite AND control trial).According to inclusion and exclusion criteria ,articles were evaluated by three reviewers. Randomised controlled trials (RCTs) were assessed according to the Juni assessment .Software RevMan 4.2.10 was used to carry out statistical analysis. Analysis was performed by the method of standardised mean differences (SMD) using a randomeffects model. P values < 0.05 were considered statistically significant. Subgroup analyses were performed according to the type of allergen administered and the duration of treatment.The materials which could not be pooled were carried out the descriptive analysis.Results 11 articles involved 722 participants identified were eligible randomised controlled trials. The symptom scores SMD = -174（95%CI:-283 to -064）indicated sublingual immunotherapy with mite allergen for children asthma could reduce asthma symptom scores .In term of treatment duration and the type of allergen administered,subgroup analysis indicated sublingual immunotherapy with mite allergen could reduce asthma symptom scores during 4 and 6 months whereas increasing duration of treatment beyond 12 months did appear to increase the treatment efficacy and reduce asthma symptom scores in Dermatophagoides pteronyssinus (D.p)group. There was significant heterogeneity, most likely due to widely differing scoring systems between studies.Medication scores SMD=-156（95%CI:-295 to -017）suggested that medication scores were lower in treatment group than in control group. According to treatment duration and the type of allergen administered, we performed subgroup analysis indicated sublingual immunotherapy with mite allergen could reduce medication scores in Dermatophagoides pteronyssinus (D.p.)group but not in mixed allergen of D.p / D.f (Dermatophagoides farinae).FEV1 was used to assess the lung function. The results were FEV1 SMD=007（95%CI:-072 to 086）and FEV1% SMD=-002（95%CI:-085 to 081）.There was no significant change of FEV1 and FEV1% between treatment group and control group. Antibody levels of blood serum,specific IgE change tendencies were not significant in two groups. But the specific IgG4 change in the treatment group was higher significantly than in the control group.Conclusions Sublingual Immunotherapy with mite allergen is helpful for reducing the children allergy asthma symptoms and medication scores , restoring normal immunologic process. Increasing duration of treatment did not clearly increase efficacy. The total dose of allergen administered may be important but suffcient data were not available to analyse this factor. Meanwhile it was safe for children. But there was no enough evidence to indicate that the sublingual immunotherapy with mite allergen treatment group and the control group were different in the specificity IgE level and the lung function. Further multi-centre and large scale RCTs are still needed to be performed to evaluate the efficacy of sublingual immunotherapy for asthma in children who are sensitive to mite.
目的 总结国内、外抗惊厥药治疗新生儿窒息后缺氧缺血性脑病文献的研究结果，采用Meta分析方法综合评价抗惊厥药治疗新生儿窒息后缺氧缺血性脑病的临床效果，探讨抗惊厥药治疗新生儿窒息后缺氧缺血性脑病的可能性。方法 制定原始文献的纳入标准、排除标准及检索策略，检索PubMed、EMBASE、Ovid、Springer和中国期刊全文数据库等，获得抗惊厥药治疗新生儿窒息后缺氧缺血性脑病的相关文献，使用国际Cochrane中心推荐的方法进行文献质量评价后，采用RevMan 4.22软件对满足纳入标准的抗惊厥药治疗新生儿窒息后缺氧缺血性脑病的RCT研究进行Meta分析。选取死亡率、严重神经系统发育障碍、惊厥发生率、不良反应等作为观察指标，进行定性、定量综合评估。结果 符合纳入标准的5篇RCT研究进入Meta分析，无一项研究有充分的方法学质量和尺度来证明抗惊厥药的使用能有效的降低死亡率或严重神经系统发育障碍。对5项研究的Meta分析显示，围产期窒息后给予巴比妥类药物或常规治疗对死亡率、严重神经系统发育障碍或两者的合并结局均无明显差异。结论 目前，尚不建议对存在围产期窒息的足月儿给予抗惊厥药作为临床常规治疗，远期仍需足够容量的研究来检验抗惊厥药治疗新生儿窒息对降低死亡率或严重神经系统发育障碍率的效用。
Objective To explore the effect of valproate acid(VPA) treatment on the neutrophilic function in epileptic children and analyze its mechanism,then further instruct clinic application of VPA.Methods Newly diagnosed epileptic children were recruited in the outpatient clinic of our hospital from October 2006 to July 2008.The autoactivation levels of neutrophils ,including autoactivation rates and stimulation index, were detected before and after 6 months VPA treatment respectively by flow cytometry with dihydrorhodamine as fluorochrome. In vitro, the changes of neutrophilic function were explored at different VPA concentration (control, 50 ,100 and 200 μg·mL-1 respectively) and different time points( 6,18 and 24 h respectively) through the culture of whole blood collecting from healthy children ，and the feature of the changes of neutrophilic function was studied at different VPA concentrations and different time points.Results 29 newly diagnosed epileptic children were recruited, within which there were 13 boys and 16 girls, 22 general seizures and 7 focal seizures; their age ranged from 8monthold to 193monthold and the average age was 60.5±49 months before VPA treatment compared to 14monthold to 200 month old and 65.8±54.5 months after VPA treatment respectively. The autoactivation rate of neutrophils before VPA treatment was (6.41±3.14)%,while the rate was (12.30±7.73)% after VPA treatment. The stimulation index was 440.6±32.4 and 429.6±26.5 ,respectively.There were significant differences between the two groups in autoactivation rate of neutrophils and stimulation index(P﹤0.05)，but no difference between general seizures and focal seizures. In vitro,the neutrophlic function degraded significantly in a timedepending way with the culture time prolonged;at 50 μg·mL-1 VPA concentration,the neutrophilic function increased little after 6 h whole blood culture,but degraded strikely after 24 h whole blood culture;at 200 μg·mL-1 VPA concentration,the neutrophilic function dropped dramatically at all time points.Conclusions The phenomenon of autoactivation of neutrophils exists in epileptic children treated with VPA,the neutrophilic function degrades in a timedepending and concentrationdepending way. VPA monotherapy ,though within the therapeutic blood concentration, will attenuate the neutrophlic function significantly.The impact of VPA on neutrophilc function has no relationship with the type of seizures. Maybe VPA can modulate neutrophilic function by influencing its phagocytosis and oxidation. Epileptic children′s antiinfective function may be attenuated.
Objective To intensify the recognition of hepatitis B infection in patient with hematopoietic stem cell transplantation and pay much attention to treatment earlier to enhance event free survival of hematopoietic stem cell transplantation. Methods The clinical data of 97 consecutive patients with allogenic stem cell transplantion in our institute were retrospectively analysed. By view of the experience of successful rescue of 2 patients with HBV infection, the significance of earlier intervention was discussed.Results Since May 2001,97 cases of allogenic stem cell transplantation had been performed in our hospital. Among them 2 cases were accompanied hepatitis B on +41 d(case 1) and +14 months(case 2) after transplantation. Case 1 was normal for live and kidney function and negative for HBV seroreaction at the rate of 5/6 to matched unrelated donor hematopoietic stem cell transplantation. But by reviewing the pretransplantation blood sample we found this patient was in the latency of HBV infection(HBVDNA reached to 1.17×106 copies·mL-1). The onset of HBV infection was so severe that obvious jaundice and a great deal of ascites occurred within 3 days and it rapidly progressed to liver and kidney failure within 5 days with ALT 3 195 U·L-1, PT 38.4 s, KPTT>120 s, TT>100 s, TBIL 7 mg·L-1, DBIL 2.8 mg·L-1, HBVDNA 1.08×108 copies·mL-1 and disuria occurred with Cr 251 μmol·L-1. After treatment with lamivudine the patients recovered within 2 weeks. But HBV infection recurred with the amount of HBVDNA from 3.50×104 copies·mL-1 to 2.05×106 copies·mL-1 on +130 d after transplantation accompanied with flare of chronic GVHD and immunosuppressive therapy was added. Unfortunately the emergence of YMDD motif polymerase mutations resulted in lamivudine resistance on +315 d after transplantation and Adefovir Dipivoxil was given till now (+3.5 y after transplantation) to maintain the normal liver and kidney function. In case 2 it was found that antiHBs(+), antiHBc(+), antiHBe(+) with normal ALT, HBVDNA was found during chemotherapy and the first year of 6/6 matched unrelated donor hematopoietic stem cell transplantation. Because of chronic extensive GVHD immunosuppressive therapy was intensified 12 months after transplantation , ALT 168 U·L-1, HBVDNA 5×108 copies·mL-1 and HBsAg（+）, HBeAg（+） were found 15 months after transplantation . From that time Lamifudine was given till now (4.5 y post transplant) with ALT fluctuated between 40-80 U·L-1 and HBVDNA 1×103-1×104 copies·mL-1.Conclusions HBV infection was not rare in patients with hematopoietic stem cell transplant. It is important to monitor the virus and to treat it early. Screening HBVDNA before transplant will contribute to find latency HBV infection. Reverse seroconversion of HBV after HSCT is possible among HBsAb(+),HBcAb(+) recipients.
Objective Respiratory syncytial virus（RSV） is one of the principal causes of bronchiolitis and pneumonia in young children. There is no safe and effective vaccine. A DNA vaccine against RSV was constructed and its immune efficacy in mice was investigated.Methods The fulllength fusion genes of an RSV long strain were subcloned into pcDNA3.1(-) and the pcD-F constructs were transfected into Hela cells. Protein expressions were evaluated by Western blot analysis of lysed cells. Specific pathogenfree, female BALB/c mice, 6- to 7-weeks old, were inoculated with pcD-F by intramuscular (im) immunization and challenged by RSV long strains. On 0, 5, and 14 days after RSV challenge, 6-7 mice were killed and blood and lung specimens were collected at each time point. ELISA and ELISPOT assays were applied respectively for determination of RSVspecific antibody titers in serum and IFN-γproducing cells in spleens. RSV-RNA copies in lung tissues were detected by realtime PCR. Sections stained with hemotoxylin and eosin were examined by microscopy for evidence of lung inflammation.Results The band recognized by the antiRSV-F monoclonal antibody was observed from pcD-F transfected Hela cells. The average geometric anti-RSV antibody titer was 1∶60 in mice vaccinated with pcD-F plasmid before challenge. A significantly higher titer (1∶250) was produced in mice immunized with pcD-F on 14 days post challenge compared with controls, P<0.05. The RSVspecific IFN-γproducing cells in vaccinated mice were 99 spots/1×105 cells on 5 days post challenge, significantly higher than in the controls (9 spots/1×105 cells). Control mice also showed a slightly increased RSVspecific cellular response on 5 days (9 spots/1×105 cells) and 14 days (18 spots/1×105 cells) after challenge, but this response was significantly lower than that in im immunization group. The vaccinated mice showed milder pulmonary inflammatory changes in lungs and effective RSV clearance compared with controls on 5 days post RSV challenge.Conclusions The study demonstrated that pcD-F was an effective DNA vaccine against RSV. Our study provides implication for the prevention strategy of RSV infection.
