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The clinical data of 2 children with refractory Mycoplasma pneumoniae pneumonia complicated with intracardiac thrombosis and pulmonary embolism, treated in Tianjin Children′s Hospital from July 2019 to January 2020, were analyzed retrospectively.One patient was an 8-year-old girl, who was admitted to the hospital mainly because of " fever for 5 days and cough for 2 days" . The other patient was a 7-year-old boy, who was admitted due to " intermittent fever with cough for 24 days and chest pain for 1 day" . Both children were complicated with elevated D-dimer levels and positive antiphospholipid antibody.During the treatment, right cardiac thrombosis and pulmonary embolism occurred in both cases, and the manifestations of thrombosis related symptoms were not typical.After the patients received anticoagulation treatment and thrombolytic therapy with urokinase, the cardiac thrombus dissipated and the pulmonary embolism improved.For refractory Mycoplasma pneumoniae pneumonia complicated with intracardiac thrombosis and pulmonary embolism, thrombolytic therapy can be applied to some children in addition to anticoagulant therapy.
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Objective:To explore the relationship between the type of mutation and clinical features, prognosis, and clinical characteristics of chronic granulomatous disease (CGD) caused by compound heterozygous mutations in the NCF2 gene in children. Methods:The clinical data of 1 case of neonatal CGD caused by compound heterozygous mutations of NCF2 gene at Tianjin Children′s Hospital in August 2019 was analyzed, and domestic and international literatures were searched to summarize the clinical characteristics, gene mutation type and prognosis of CGD caused by NCF2 mutation. Results:The diagnosis of CGD was confirmed by the presence of compound heterozygous mutations c. 196_197insA (p.Arg66Glnfs23X) and c. 1180T>G (p.Tyr394Asp) in the NCF2 gene, accompanied with the clinical manifestations of fever, cough, multiple clumps and nodules in the chest CT at 25 days after birth, and the neutrophil respiratory burst test stimulation index(SI) 23.This new mutation was not reported in the Human Genetic Mutation Database.The child had a residual portion of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity and was followed up until the age of 9 months with an antifungal drug without recurrent infection.A total of 101 cases of CGD patients with NCF2 gene mutation were reported in domestic and international databases.Totally, 33 cases had SI results, with 22 cases below 3, 11 cases above 3, and 8 cases of missense mutations. Conclusions:c. 196_197insA and c. 1180T>G are new mutations in NCF2 gene that can lead to CGD.CGD patients containing missense mutations in the NCF2 gene may have more residual NADPH oxidase activity.
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We retrospectively analyzed 126 children with juvenile idiopathic arthritis (JIA)admitted from January to December 2017,including 65 cases of systemic-onset JIA (SoJIA) and 61 cases of other types of JIA.The value of serum amyloid A protein (SAA) in the identification of the disease activity and infection in children with SoJIA was assessed.The area under the ROC curve of SAA in identification of disease activation of SoJIA patients was 0.934,which was not significantly different with other types of JIA.With the cut-off value of 68.32 mg/L the sensitivity and specificity for diagnosis of SoJIA activity were 0.913 and 0.892 respectively.In SoJIA patients the SAA was closely correlated with ESR and CRP (r=0.721 and 0.699,P＜0.001).The SAA level was significantly higher in the disease active stage than that in stable stage,in the stable stage with infection than that in the stable stage without infection of SoJIA patients.There were also significant differences in platelet and CRP between active disease with infection and active disease without infection.SAA is expected to be used for assessing disease activity of SoJIA,if combined with platelet and CRP,it may be of value in the identification of the complicating infection.
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Objective To investigate the influence of gestational abnormal glucose metabolism on the birth outcome and long-term weight of neonates.Methods Thirty pregnant women with gestational diabetes mellitus (GDM) were enrolled in this study.30 pregnant women with gestational impaired glucose tolerance (GIGT) were selected,and 30 normal pregnant women(NGT) were selected as control group.The weight,length and weight index (PI) of the three groups were collected.The incidence rates of adverse outcomes were collected in the three groups.The long-term weight of the newborns was investigated.According to whether breastfeeding,they were divided into breastfeeding group and non-breastfeeding group.The body mass index (BMI) was compared between 42 days,3 months,6 months and 12 months,respectively.Results There were statistically significant differences in body weight and PI of neonates except length between the control group and the GDM group (t =1.60,P =0.06;t =5.09,P =0.00;t =6.94,P =0.00).There were statistically significant differences in body weight and PI of neonates except length between the control group and the GIGT group(t =1.57,P =0.06;t =4.21,P =0.01;t =5.88,P =0.00).There were no statistically significant differences in the above indices between the GDM group and the GIGT group(all P ＞ 0.05).The incidence rate of macrosomia in the GDM group and the GIGT group was significantly higher than that of the control group (x2 =10.59,P =0.00).The incidence rates of respiratory failure syndrome,cardiovascular disease,hyperbilirubinemia and birth injury among the three groups had no statistically significant differences(x2 =1.23,P =0.54;x2 =2.09,P=0.35;x2 =2.02,P=0.36;x2 =2.09,P=0.35;x2 =4.03,P=0.13).At the birth of 42 days,3 months,6 months,12 months,the BMI of neonates in the GDM group and the GIGT group were slightly higher than those in the control group,but there were no statistically significant differences in BMI index among the three groups of breasffed newborns (F =0.71,P =0.28;F =0.97,P =0.12;F =0.98,P =0.12;F =0.77,P =0.22).At the birth of 42 days,3 months,6 months,12 months,the BMI of neonates in the GDM group and the GIGT group were slightly higher than those in the control group,but there were no statistically significant differences in BMI index among the three groups of breasffed newborns (F =0.77,P =0.34;F =0.89,P =0.10;F =1.12,P =0.09;F =0.55,P =0.67).Conclusion Abnormal glucose metabolism in pregnant women can lead to a significant increase in the incidence of neonatal macrosomia.The body weight and PI of neonates are higher than those without abnormal glucose metabolism in pregnant women,but the abnormal maternal glucose metabolism in pregnant women has no significant influence on the long-term body weight of neonates,and there is no significant difference between NGT and neonates.
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Objective To observe the curative effect of head hypothermia combined with mouse nerve growth factor in the treatment of neonatal moderately severe hypoxic ischemic encephalopathy (HIE).Methods 50 cases of severe HIE were randomly divided into observation group and control group,with 25 cases in each group.Both two groups were given the conventional treatment.The observation group was given head hypothermia treatment in 6 hours after born,to maintain the nasopharyngeal temperature (34.0 ±0.5)℃,anal temperature (35.5 ±0.5)℃,72 hours continuously.At 96 hours after the birth,the nerve growth factor was given.The control group did not give the head mild hypothermia treatment.At 96 hours after birth,the nerve growth factor (methods,dosage and treatment were the same as the observation group)was treated with nutrition and brain nerve.After treatment,the improvements of heart rate,muscle tension,convulsions and disturbance of consciousness were observed in two groups.After 3 days,2 weeks and 4 weeks,the neonatal behavioral neurological assay (NBNA),1 and 3 months after birth,the outfit cranial MRI plain scan and brainstem auditory evoked potential (BAEP)were evaluated.Results NBNA scores of the two groups were compared in 3 days,2 weeks and 4 weeks after birth,the differences were statistically significant (t=2.53, 2.89,3.23,all P<0.05).In the observation group,the abnormal brain MRI was significantly less than the control group,the difference was statistically significant (χ2 =24.125,P<0.05).In the observation group,the number of abnormal auditory evoked potential was significantly less than that of the control group,the difference was statistically significant (χ2 =21.312,P<0.01 ).Conclusion Head hypothermia combined with mouse nerve growth factor therapy for the treatment of neonatal moderately severe HIE has protective effect,it can improve the treatment efficacy, reduce the long-term neurological sequelae,and without adverse reaction.
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Objective To investigate the clinical significance of serum procalcitonin (PCT),C reactive pro-tein(CRP),and lymphocyte subsets CD +19 CD +23 in children with Kawasaki disease (KD).Methods From August 2013 to July 2015 in hospital,30 cases of acute phase KD were selected.According to cardiac color Doppler ultra-sound results,30 patients were divided into coronary artery disease (CAL)group and non coronary artery disease (NCAL)group.The intravenous immunoglobulin (IVIG)before and after treatment,serum PCT,CRP,CD +19 CD +23 were detected.And 30 healthy children were selected as normal control group.Serum PCT was detected by chemilumines-cence immunoassay,CRP was determined by immune latex ratio method,CD +19 CD +23 was measured by flow cytometry. Results The levels of PCT,CRP and CD +19 CD +23 were (1.37 ±0.39)μg/L,(52.24 ±12.99)mg/L,(25.45 ± 11.06)% respectively in KD before IVIG treatment,which were significantly higher than those of KD after treatment [(0.49 ±0.24)μg/L,(37.48 ±6.27)mg/L,(17.23 ±1.97)%]and the control group[(0.05 ±0.00)μg/L, (16.08 ±5.21)mg/L,(15.76 ±2.39)%],the differences were statistically significant (t =6.108,5.983,8.172, all P 0.05 ).Conclusion PCT,CRP and CD +19 CD +23 can be used as important index for early diagnosis and prediction of KD,the levels of CRP and PCT have clinical significance in the assessment of coronary artery lesions.
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Objective To evaluate the distribution and drug resistance of bacteria causing neonatal infectious pneumonia in Jiaxing,and to provide a therapy for clinical doctor to make a correct diagnosis,choose reasonable anti-biotics and avoid abuse of antibiotics.Methods Took expectoration from trachea in condition of asepsis to conduct culture and perform drug-sensitive test from 3025 cases.Results Totally 1 156 strains of aerobic bacteria were iso-lated.875 strains were gram negative bacilli(75.7%),269 strains were gram positive cocci(23.3%),and 12 strains were fungi(1.0%).Klebsiella pneumoiae,Escherichia coil,Acinetobacter baumanni,Enterobacter cloacae were com-mon in gram negative bacilli( respectively 178 cases,151 cases,87 cases,113 cases) .The proportion of the Staphylo-coccus aureus was the largest in gram positive cocci(245 cases) .The results showed that gram-negative bacilli were resistant to cefazolin, ampicillin, piperacillin and sensitive to meropenem, imipenem, piperacillin-tazuobatanna and cefoperazone-sulbactam.The drug resistance was severe of ESBL-positive.Staphylococcus aureus was resistant to penicillin, ampicillin, erythrocin, clindamycin and sensitive to linezolid, vancomycin, nitrofurantoin.Conclusion Gram-negative bacilli are the main bacteria in neonatals with infectious pneumonia.The drug resistance is severe.It is important to make a standard management and isolation.
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Objective To investigate the expression and its clinical significance of bronchial asthma treat-ment in different periods of peripheral blood lymphocyte CD +19 CD +23 .Methods Peripheral blood CD +19 CD +23 expres-sion and IgE levels in serum of 28 cases of children with bronchial asthma and 28 healthy children was detected by electrochemical detection and flow cytometry assay method,the detection results were analyzed.Results The results of serum CD +19 CD +23 in children with asthma,the level of total IgE were (32.51 ±5.08)%,(995.22 ±576.33)IU /L respectively,which were higher than those of the control group(21.29 ±8.68)%,(100.85 ±36.43)IU /L,there were significant differences between the two groups(t =5.846,8.334,all P <0.01);treatment after 1 months,3 months, 6 months CD +19 CD +23 expression rates were (29.37 ±4.82)%,(26.20 ±4.58)%,(23.69 ±4.54)%,total IgE lev-els were (745.41 ±452.89),IU /L(553.23 ±345.26),IU /L(405.87 ±267.96)IU /L,before and after treatment were decreased,the differences were statistically significant(CD +19 CD +23 :F =3.367,IgE:F =26.740,P <0.01 ). Conclusion Peripheral blood lymphocyte CD +19 CD +23 and IgE can reflect the condition of the asthma children,but compared to IgE,CD +19 CD +23 can better reflect the activation of eosinophils and airway inflammation,serum CD +19 CD +23 levels can be used as a diagnosis of asthma,disease status and guide the indicator to determine the treatment of inflammation.
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Objective To evaluate the efficacy and drug-related toxicities of pemetrexed disodium in the treatment of advanced pulmonary adenocarcinoma.Methods A total of 41 patients who had received pemetrexed disodium and cisplatin therapy were retrospectively reviewed.The patients were given respectively pemetrexed disodium (500 mg/m2,1st day) and cisplatin (200 mg/m2,1-4 day) until disease progressed.The clinical outcomes and adverse reactions were observed.Results The CR rate was 7.3 ％ (3/41),PR rate was 22.0 ％ (9/41),SD rate was 31.7 ％ (13/41),PD rate was 39.0 ％ (16/41),the DRR was 29.3 ％ (12/41),DCR rate was 61.0 ％ (25/41),the median PFS was 5 months.The age,sex,smoking history,staging and timing of treatment had not the statistics difference on ORR and DCR.The sex,smoking history,staging and timing of treatment had not the statistical difference on PFS (P ＞ 0.05).The main toxicities were fatigue,nausea,vomiting and myelosuppression.Conclusion The pemetrexed disodium and cisplatin are feasible and welltolerated for advanced pulmonary adenocarcinoma patients.
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The specific immunotherapy is the etiological treatment and remission the symptoms of anaphylactic disease. It includes subcutaneous immunotherapy and sublingual immunotherapy(SLIT). SLIT is a new pathway. Many studies have confirmed its effectiveness in the treatment of anaphylactic disease. Due to its mild side effect, it is used commonly.
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Breast milk is the best food for the newborn.The effect in the development and growth of the neonate is irreplaceable.There are many hormones in the breast milk,including insulin,leptin and thyroxine.The quantity of thyroxine is low and is related to the methods of the mensuration and the duration of the lactation.Breast milk thyroxine may mitigate the transient hypothyroxinaemia of preterm and delay the infants' hypothyroidism.
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Objective To analyze relationship between the gene polymorphism of CYP4F2 and essential hypertension (EH) in China's Han population. Methods 189 EH patients and 187 age-matched controls were used to analysis G20597A polymorphism site of CYP4F2 gene with polymerase chain-restriction fragment length polymorphisms. Results There was no difference of neither genotype nor allele of CYP4F2 (G20597A) between EH and controls through stratified analysis on gender. CYP4F2 gene 20597 G allele carriers had significant association with EH for male in China (81.6% vs 71.3% , P =0.019) , but not with female. After adjustment for cardiovascular risk factors (including smoking, TC, age, genetype, BMI) , the hazard ratio for incident EH in male with CYP4F2 20597GG increased about 2. 689 than that with CYP4F2 20597GA and 20597AA. Conclusion CYP4F2 20597G allele has significant association with male EH, and CYP4F2 20597GG may be an independent predictor of EH for male in china's Han population.
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Objective To investigate the relationship between apolipoprotein E(Apo E) gene poly-morphism and mild cognitive impairment (MCI) in patients with type 2 diabetes mellitus (T2DM), and e-valuate the correlative risk factors. Method 40 cases of type 2 diabetes with MCI and 80 cases of type 2 diabetes without MCI were enrolled in this study. The polymorphism of the Apo E gene was detected by PCR-restriction fragment length polymorphism(PCR-RFLP). According to the clinical data such as course of disease, plasma glucose, plasma fat and body mass index (BMI), the independent risk factors of T2DM and MCI were analyzed by non-conditional logistic regression. Results The frequency of Apo E ε_4 allele in the group of type 2 diabetes with MCI was higher than that without MCI ( 25.0% vs 10. 0% ), and the difference had statistical significance( P < 0. 01 ). The indexes of the statistical significant difference be-twcen the two groups were age, course of disease, postprandial blood glucose ( P2BG), HBA1C, BMI,family history of T2DM, hypertension, diabetic retinopathy, diabetic peripheral neuropathy, Apo E gene. The independent risk factors included diabetic retinopathy ( OR = 3. 452, P < 0. 05 ), diabetic peripheral neuropathy( OR = 3. 252, P <0. 05), Ape E gene( OR = 2. 441, P < 0.01 ), HBA1C ( OR = 1. 372, P <0.05), P2BG(OR = 1. 194, P <0.05), age(OR = 1. 194, P <0.01) and course of disease(OR =1. 142, P <0. 05). Conclusion Apo E ε_4 allele has significant relationship with T2DM and MCI. The age, course of disease, control of plasma glucose, and microvascular complication of diabetes have relation-ship with the cognitive function.
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Objective:To investigate the relationship between tumor necrosis factor-α (TNF-α)-308A/G gene polymorphism and mild cognitive impairment(MCI)in patients with type 2 diabetes mellitus(T2DM),and their correlative risk factors thereof.Methods:Forty cases of T2DM with MCI and 80 cases of T2DM without MCI were selected for this study.The polymorphism of the TNF-α-308A/G was detected by PCR-restriction fragment length polymorphism (PCR-RFLP).According to the clinical data,such as course of disease,plasma glucose,plasma fat and body mass index(BMI),the independent risk factors of T2DM and MCI were analyzed by non-conditional logistic regression.Results:The frequency of TNF-α2 allele was significantly higher in the group of T2DM with MCI than that without MCI (P＜0.01).The indexes of the statistical significant difference between the two groups were the age,course of disease,postprandial blood glucose(P2BG),glycosylated hemoglobin,body mass index,family history of T2DM,hypertension,diabetic retinopathy,diabetic peripheral neuropathy and TNF-α.The independent risk factors included TNF-α,diabetic peripheral neuropathy,diabetic retinopathy,age and P2BG.Conclusion:There is a significant relationship between TNF-α2 allele and T2DM with MCI.There is a significant relationship between the age,control of plasma glucose and microvaseular complication of T2DM with the cognitive funotion.