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Objective:To estimate the diagnostic value of anti-cyclic citrullinated peptide (CCP) antibody for juvenile idiopathic arthritis (JIA) by Meta-analysis.Methods:The databases, including Wanfang Database, VIP citation databases, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc, Excerpta Medica Database (EMbase), PubMed, Cochrane Library, were searched for the studies related to the diagnostic value of anti-CCP antibody for JIA. After extracting literature data and assessing the articles by Quality Assessment of Diagnostic Accuracy Studies tool. The sources of heterogeneity, sensitivity (SEN), specificity (SPE), area under the curve (AUC) were calculated by the summary receiver operator characteristic (SROC) curve by Stata 12.0 software.Results:A total of 30 literature reports were included in this Meta-analysis. The heterogeneity and the threshold effect of the included articles were tested, a mixed effects model was selected to calculate the pooled weighted SEN [0.16, 95% CI(0.11, 0.22)], SPE [0.99, 95% CI(0.98, 0.99)] and AUC [0.86, 95% CI(0.83, 0.89)]. The sensitivity estimates were highly heterogeneous, which was partially explained by the higher sensitivity in the rheumatoid factor-positive polyarthritis (RF+PA) subtypes [0.65, 95% CI (0.51, 0.76)] than in the other subtypes. The ability of diagnostic differentiation between of JIA and healthy children was better than the diagnostic differentiation between JIA and other patients ( Z=7.9, P<0.01). Conclusion:Although anti-CCP antibody cannot be used as an early diagnostic indicator of JIA, it can provide a certain guiding role in the initial screening and early treatment of the disease. CCP has clinical value in the differential diagnosis of RF+PA subtypes.
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Objective@#To investigate the correlation between cord blood vitamin D level and recurrent respiratory tract infection in infants.@*Methods@#From August 2014 to July 2015, 298 neonates in the Second Hospital of Jiaxing were selected in this study.The serum levels of 25-hydroxyvitamin D[25(OH)D] were measured by enzyme-linked immunosorbent assay(ELISA) in umbilical cord blood of neonates.The incidence of respiratory tract infection in infants was followed up.@*Results@#There were 53.1%(158/298) newborns with vitamin D deficiency(deficiency group), 24.8%(74/298) neonates with inadequate vitamin D(inadequate group), 22.1%(66/298) infants with adequate vitamin D(adequate group). The incidence rates of recurrent respiratory infections in vitamin D deficiency group, inadequate group and adequate group were 29.7%(47/158), 17.6%(13/74), 10.6%(7/66), respectively.The incidence of recurrent respiratory tract infection among the three groups was statistically significantly different(χ2=11.114, P=0.01).@*Conclusion@#Vitamin D nutrition level of neonates has a significant correlation with infants with respiratory tract infection, especially lower respiratory tract infection.Therefore, it is necessary to pay attention to the supplement and detection of vitamin D during pregnancy, so as to reduce the incidence of infant respiratory diseases in the region.
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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 explore and observe the clinical characteristics and laboratory testing results of children with infectious mononuclear cells syndrome (IM),in order to improve diagnostic level.Methods 152 children with IM were selected,and the clinical manifestations,laboratory testing were retrospectively analyzed.Results There were a variety of clinical symptoms,the main clinical manifestations included fever 138 cases(90.8％),swollen lymph nodes 145 cases(95.4％),angina 112 cases (73.7％),hepatosplenomegaly 28 cases(18.4％),double eyelid edema 25 cases(16.4％),rash 7 cases(4.6％).Laboratory-testing of white blood cell count ＞ 10 × 109/L in 125 cases (82.2 ％),atypicallymphocyte proportion were more than or equal to 10％ in 48 cases (31.5 ％),liver function damage in 58 cases (38.2％),myocardial damage in 38 cases (25％),abnormal urine analysis in 30 cases (19.7％),thrombocytopenia 2 cases (3.4％).Conclusion Clinical symptoms of IM children are diversity,in some cases the clinical sympotoms are not typical,to improve the understanding of this disease can reduce the rates of missed diagnosis and misdiagnosis.
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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 compare the clinical application effect of bi -level positive airway pressure ( BiPAP) and nasal continuous positive airway pressure ( CPAP) in the treatment of preterm infants with neonatal respiratory distress syndrome ( NRDS) .Methods 64 neonates with NRDS were divided into the BiPAP group ( n=35) and NCPAP group (n=29) according to the randomized controlled study method.The blood gas index before and after 2,12 hours of treatment,the total time for ventilation,length of stay,and the incidence rate of abdominal disten-sion,gastroesophageal reflux,bronchopulmonary dysplasia,intraventricular hemorrhage,ventilator-associated pneumo-nia in the two groups were compared.Results The levels of pH and PaO2 in the BiPAP group were higher than those in the NCPAP group in noninvasive respiratory support for 2,12h(t=2.391,2.556,2403,2.355,P=0.020,0.013, 0.019,0.022).The incidence rates of hypoxemia,apnea,re-intubation mechanical ventilation rate after 12h in the BiPAP group were lower than those in the NCPAP group(t=5.049,4.988,4.215,P=0.025,0.026,0.040).The length of stay and mechanical ventilation time in the BiPAP group were shorter than those in the NCPAP group( t=-2.096,-2.669,P=0.041,0.010).Conclusion Compared with NCPAP,early application of BiPAP can obviously reduce the invasive respiratory support rate of children with NRDS with intubation.It is worthy of promotion.
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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 curative and prophylactic effects of pulmonary surfactant (PS) on neonatal respiratory distress syndrome (NRDS) by two different administration means. Methods 35 neonates with NRDS were divided into groups Ⅰ and Ⅱ randomly, prophylactic group were randomly divided into groups Ⅲ and Ⅳ, the means of administration in all patients was through tracheal tube. Neonates in group Ⅰ and Ⅲ, were given curosurf in several times with different posture, group Ⅱ and IV were given in one time with supine position. Blood gas analysis, index of mechanical ventilation, the duration of mechanical ventilation, hours of oxygen requirement and hospitalization between Ⅰ and Ⅱ group, the incidence of NRDS between Ⅲ, and IV group were analyzed and compared before and after treatment. Results After treatment for 6 and 24 hours, the oxygenation and lung function of group Ⅰ and Ⅱ improved respectively (P<0.05), the total times of assisted ventilation, Supplemental oxygen therapy and hospitalization were significantly decreased, the differences of those index were no significant between Ⅰ and Ⅱ group (P0.05), the incidence of NRDS have no different between Ⅲ and IV group. Conclusion Pulmonary surfactant is effective and safe for treating and prophylacting NRDS, and have no relationship with the means of administration.
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Objective To study the role of IL 12 and IL 13 mRNA in children with asthma. Methods Use of semi quantitative RT PCR, IL 12 and IL 13 mRNA in peripheral blood mononuclear cell (PBMC), as well as total IgE in serum from children with asthma, which is in the period of acute phase, were detected. Results Compared with control group, The expression level of IL 12 mRNA were decreased and that of IL 13 mRNA were increased in asthmatic children; The sicker the patient was, the lower expression of IL 12 mRNA, the higher expression of IL 13 mRNA; No matter how the IgE level was, there was significantly different between the expression of IL 12 and IL 13 mRNA. Conclusion IL 12 and IL 13 may be one of the factors causing bronchial chronic inflammation.