Application of ultrasonic cardiac output monitor in evaluation of cardiac function in children with severe pneumonia / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical application of ultrasonic cardiac output monitor (USCOM) in evaluation of cardiac function in children with severe pneumonia.</p><p><b>METHODS</b>Twenty-nine children with severe pneumonia were enrolled in the observation group and forty-three children with common pneumonia were enrolled in the control group. The USCOM was used to measure the cardiac function indices in the two groups. The results were compared between the two groups. The changes in cardiac function indices after treatment were evaluated in the observation group.</p><p><b>ESULTS</b>The observation group had a significantly higher heart rate and significantly lower cardiac output, systolic volume, and aortic peak velocity than the control group (P<0.05). There were no significant differences in cardiac index or systemic vascular resistance between the two groups (P>0.05). In the observation group, the heart rate, cardiac output, systolic volume, aortic peak velocity, cardiac index, and systemic vascular resistance were significantly improved after treatment (P<0.05).</p><p><b>CONCLUSIONS</b>The USCOM is a fast, convenient, and accurate approach for dynamic measurement of cardiac function and overall circulation state in children with severe pneumonia. The USCOM can provide a basis for diagnosis, treatment, and evaluation of the disease, which is quite useful in clinical practice.</p>

Clinical features of respiratory distress syndrome in neonates of different gestational ages / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study clinical features of respiratory distress syndrome (RDS) in neonates of different gestational ages (GA).</p><p><b>METHODS</b>According to GA, 133 neonates with RDS were classified into GA <34 weeks group (n=66), GA 34-36 weeks group (late preterm neonates; n=31), and GA ≥37 weeks group (full-term neonates; n=36). The mothers' medical history during pregnancy and the condition of the neonates at birth were retrospectively analyzed, and the clinical data were compared between groups.</p><p><b>RESULTS</b>Prenatal corticosteroids supplementation in the GA <34 weeks group was more common than that in the GA 34-36 weeks group (P<0.05). Compared with the GA ≥37 weeks group and the GA 34-36 weeks group, the GA <34 weeks group showed a significantly lower rate of primary diseases, a significantly later time of the development of dyspnea (P<0.05), and a higher rate of intraventricular hemorrhage (P<0.05). Serum albumin levels in the GA <34 weeks group were significantly lower than in the GA ≥37 weeks group (P<0.05). The GA ≥37 weeks group and the GA 34-36 weeks group showed a significantly higher reuse rate of pulmonary surfactant (P<0.05). Use of high-frequency oscillatory ventilation was more common in the GA ≥37 weeks group compared with the GA <34 weeks group (P<0.05).</p><p><b>CONCLUSIONS</b>The clinical features of RDS are different across neonates of different GA, suggesting that the pathogenesis of RDS may be different in neonates of different GA.</p>

Suggestions for standardized management of nomenclature and classification of neonatal diseases / 中国当代儿科杂志

Nomenclature and classification of diseases are not only related to clinical diagnosis and treatment, but also involved in the fields such as management and exchange of medical information, medical expense payments, and medical insurance payment. In order to standardize clinical physicians' diagnostic and treatment activities, medical records, and the first page of medical records, this article elaborates on the basic principles and methods for nomenclature and classification of diseases with reference to international nomenclature of diseases and international classification of diseases. Meanwhile, in view of the problems in clinical practice, this article proposes the classification of neonatal diseases, the basic procedure and writing rules in the diagnosis of neonatal diseases, and death diagnosis principles.

Meta-analyses of the associations of genome-wide association study- linked gene loci with Kawasaki disease / 中华儿科杂志

<p><b>OBJECTIVE</b>Kawasaki disease (KD) is a common autoimmune vasculitis. It has been regarded as the leading cause of acquired heart disease in children. This study aimed to assess the relationship between genome-wide association study (GWAS)-linked gene loci and KD.</p><p><b>METHOD</b>By March of 2013, the published GWAS literatures of KD were retrieved from the databases including PubMed, MEDLINE, Web of Science, Cochrane Library, CNKI, VIP and Wanfang, and the gene loci associated with KD at genome-wide significance of P < 5.0×10(-8) were determined. For each of the gene loci, one single-nucleotide polymorphism (SNP) with strong association with KD was chosen for meta-analysis. Then the published case-control studies reporting the associations of the SNPs with KD were collected from English and Chinese databases with the same criteria. The Meta-analyses were conducted with RevMan 5.1 software after screening and evaluation.</p><p><b>RESULT</b>A total of 4 gene loci including FCGR2A, BLK, CD40 and HLA were observed having association with KD at genome-wide significance of P < 5.0×10(-8) in at least one GWAS. The risk alleles of the SNPs in the gene loci were all more common in patients with KD relative to controls in the systematic reviews with 8, 4, 6 and 4 extracted case-control studies, respectively[ FCGR2A rs1801274: P < 0.001, OR = 1.40, 95% CI (1.30, 1.51); BLK rs2254546: P < 0.001, OR = 1.69, 95% CI (1.52, 1.88); CD40 rs4813003: P < 0.001, OR = 1.31, 95% CI (1.22, 1.41); HLA rs2857151: P < 0.001, OR = 1.41, 95% CI (1.27, 1.57)]. The significant publication bias was not observed in the meta-analyses.</p><p><b>CONCLUSION</b>Our results confirmed the overall association of the 4 gene loci with KD in observed populations, together with the consistent presence of the relationship between BLK or HLA and KD in the populations, suggesting that it is hopeful to find the genetic marker combination predicting the risk of KD, the formation of secondary coronary artery lesions and the resistance of intravenous immunoglobulin, by further seeking the function SNPs of the gene loci and investigating the effect on the important clinical phenotypes of KD.</p>

Association of new functional SNP rs72689236 of CASP3 with Kawasaki disease: a meta-analysis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the association of rs72689236, a new functional single nucleotide polymorphism (SNP) of the gene encoding caspase-3 (CASP3), with the occurrence and development of Kawasaki disease by a meta analysis.</p><p><b>METHODS</b>A literature search was performed using databases at home and abroad according to inclusion and exclusion criteria, to acquire studies on the relationship between rs72689236 and Kawasaki disease published up to November 2012, including case-control studies and transmission disequilibrium tests. An integrated meta analysis was performed using RevMan 5.1 software after the studies were screened and evaluated.</p><p><b>RESULTS</b>Six studies were extracted for systematic review of the association between rs72689236 and Kawasaki disease. The frequency of allele A of the SNP was significantly higher in patients with Kawasaki disease than in the controls (OR=1.34, 95%CI=1.24-1.46, P<0.001); the risk for Kawasaki disease in children with allele A (AA+AG) increased by approximately 44% compared with children with GG (OR=1.44, 95%CI=1.27-1.65, P<0.001). The frequency of allele A of the SNP was significantly higher in Kawasaki disease patients with coronary artery lesions than in those without coronary artery lesions (OR=1.51, 95%CI=1.10-2.07, P= 0.01); the risk for coronary artery lesions in Kawasaki disease patients with allele A (AA+AG) increased by approximately 59% compared with Kawasaki disease patients with GG (OR=1.59, 95%CI= 1.00-2.53, P=0.05]. No association between this SNP and the therapeutic effect of intravenous immunoglobulin (IVIG) was found in patients with Kawasaki disease.</p><p><b>CONCLUSIONS</b>The allele A of functional SNP rs72689236 of CASP3 increases the risk for Kawasaki disease, and it may be used as the genetic marker for susceptibility to coronary artery lesions as a complication of Kawasaki disease. Currently, there is still no sufficient evidence that this SNP has an impact on the therapeutic effect of IVIG in patients with Kawasaki disease, and more studies are needed to investigate the feasibility of its application in individualized treatment.</p>

Association of CASP3 gene single nucleotide polymorphisms with Kawasaki disease in Chinese children patients / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>The minor allele T of rs113420705 (C/T) in caspase-3 gene (CASP3) has been found to significantly increase the risk of Kawasaki disease (KD) and complicate coronary artery lesions (CALs) in Japanese children. In this study, we have explored association of single nucleotide polymorphisms (SNPs) of CASP3 gene and clinic phenotypes of KD.</p><p><b>METHODS</b>A total of 238 unrelated KD patients and 364 healthy controls with matched age, gender and ethnic origins were recruited. Genotypes of the 3 SNPs were determined with PCR-restriction fragment length polymorphism (PCR-RFLP) and DNA sequencing. Allelic, genotypic and haplotypic frequencies were compared between patients and controls, patients with and without CALs, and patients resistant to and responsive to intravenous immunoglobulin (IVIG) treatment.</p><p><b>RESULTS</b>The T allele and T carriers of rs113420705 were significantly more common in KD patients than controls. A significant difference was also detected in haplotype distribution between patients and controls, where two haplotypes involving the T allele of rs113420705 showed higher frequencies in the patient group. Allelic and genotypic frequencies of the 3 SNPs were similar between patients with and without CALs and those resistant to and responsive to IVIG treatment.</p><p><b>CONCLUSION</b>Our results suggested that CASP3 probably plays an important role in KD. The T allele of rs113420705 may provide a useful marker for KD susceptibility, although no association between this SNP and clinical prognosis and treatment effect of KD has been found among the selected Chinese children patients.</p>

Association study of a functional SNP rs28493229 of ITPKC gene and Kawasaki disease in a Chinese population / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>Kawasaki disease (KD) is a form of acute multi-systemic vasculitis with unknown etiology. It is the leading cause of acquired heart disease in children due to the frequent occurrence of coronary artery lesions (CALs). Recently, a C allele of rs28493229 (G/C) in inositol 1,4,5-trisphosphate 3-kinase C (ITPKC) gene was found to significantly increase the risk for KD/CALs in Japanese population. It is important to confirm such finding in Chinese population to enable prognosis and personalized therapy for KD.</p><p><b>METHODS</b>A case-control study was performed. The patient group has included 206 unrelated patients with KD, and the control group included 285 age, gender and ethnically matched children who never had KD. Genotyping of rs28493229 was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and DNA sequencing. The allele, genotype and C allele carrier frequencies were compared between the two groups, patients with or without CALs, and patients who were resistant or responsive to (intravenous immunoglobulin, IVIG) treatment.</p><p><b>RESULTS</b>Frequency of the C allele of rs28493229 was significantly lower in both groups than that in the Japanese population (P< 0.01). No significant difference was detected between the two groups in terms of allele, genotype and C carrier of rs28493229 frequencies. Such frequencies were also similar between patients with or without CALs, resistant or responsive to IVIG treatment.</p><p><b>CONCLUSION</b>Our study has failed to prove any association between rs28493229 and KD/CALs in Chinese patients, which indicated that the C allele of rs28493229 may not be used as a molecular marker for determining KD susceptibility, prognosis and effect of treatment. The much lower frequency of C allele does not support its significance in the occurrence of KD/CALs in Chinese population. It is still necessary to find functional SNPs in ITPKC gene which is associated with KD/CALs in Chinese population.</p>

Effect of bilirubin on expression of toll-like receptor 4 in cord blood monocytes / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effect of different concentrations of bilirubin on expression of toll-like receptor 4 (TLR4) in cord blood monocytes (CBMC).</p><p><b>METHODS</b>Under the sterile condition, umbilical vein blood samples were obtained from normal full-term newborns, and the monocytes were in vitro separated by the method of gelatin/plasma coated flasks. The monocytes were preincubated with various concentrations (0-307.8 μmol/L) of bilirubin dissolved in bovine albumin solution for 1 hr. Bilirubin-treated CBMC were further cultured with LPS (1 μg/mL) to induce cellular activation for 24 hrs, and then the CBMC were collected. The expression of TLR4 in monocytes was measured by indirect immunofluorescence method.</p><p><b>RESULTS</b>Bilirubin at the concentrations of 102.6, 153.9, 220.6 and 307.8 μmol/L inhibited the expression of TLR4 of CBMC. The inhibition effect increased with the increasing concentration of bilirubin.</p><p><b>CONCLUSIONS</b>Bilirubin can inhibit the TLR4 expression of CBNC in a dose-dependent manner.</p>

Value of serum soluble interleukin-2R, interleukin-6 and C-reactive protein in the early diagnosis of Kawasaki disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Immunovasculitis is a pathologic process of Kawasaki disease (KD) in the early stage and it is more likely to result from abnormal immunoactivation. It is thus speculated that the serum levels of some cytokines have changed before immunovasculitis occurs, suggesting the cytokines may be useful markers for the early diagnosis of KD. In this study, we measured the serum levels of soluble interleukin-2 receptors (sIL-2R), interleukin-6(IL-6) and high-sensitive C-reactive protein (hs-CRP) in patients with KD to evaluate the significance of these cytokines in the early diagnosis of KD.</p><p><b>METHODS</b>Serum levels of sIL-2R and IL-6 were measured by rapid one-step sandwich enzyme immunoassay and the serum hs-CRP level was measured by Dade Behring BN ProSpec in 32 KD patients before and after intravenous immunoglobulin (IVIG) therapy. Twenty healthy children were used as the controls.</p><p><b>RESULTS</b>Before IVIG therapy serum levels of sIL-2R (9253.41 +/- 2568.38 pg/mL vs 2161.53 +/- 696.92 pg/mL; P < 0.05), IL-6 (57.19 +/- 45.78 ng/mL vs 7.04 +/- 1.69 ng/mL; P < 0.05) and hs-CRP (117.69 +/- 42.05 mg/L vs 1.15 +/- 0.54 mg/L; P < 0.05) in KD patients were significantly higher than those in healthy controls. After IVIG therapy in KD patients serum IL-6 levels returned to normal and sIL-2R and hs-CRP levels decreased significantly but remained significantly higher than controls (P < 0.05). There was a positive correlation between sIL-2R and hs-CRP levels (r=0.60, P < 0.01). IL-6 levels positively correlated with hs-CRP levels in KD patients before IVIG therapy (r=0.68, P < 0.01).</p><p><b>CONCLUSIONS</b>IL-2R, IL-6 and hs-CRP are activated in the development of KD, and they may be of important value in the early diagnosis of KD.</p>

Clinical value of serum matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 for the prediction and early diagnosis of coronary artery lesion in patients with Kawasaki disease / 中华儿科杂志

<p><b>OBJECTIVE</b>Kawasaki disease (KD) complicated with coronary artery lesion (CAL) seriously threatens survival quality and life of patients, suggesting that it is very important to early predict the risk of CAL and to early diagnose the disease. Nevertheless, up to now there has been no specific clinical biochemical marker for it because of the poor understanding of the pathological process of KD with CAL. Matrix metalloproteinases (MMPs) and their specific tissue inhibitor of metalloproteinases (TIMPs) play an important role in arterial wall extracellular matrix breakdown and remodeling and are involved in CAL in other diseases. In the present study the practical value of serum MMP-9 and TIMP-1 levels in the prediction and early diagnosis of CAL in KD patients was investigated.</p><p><b>METHODS</b>All subjects were from Chinese population. Serum levels of MMP-9 and TIMP-1 were measured by rapid one-step sandwich enzyme immunoassay in 59 KD patients including 15 with CAL and 44 without CAL by 2 D-echocardiography and coronary angiography, and 20 normal healthy children as controls. Blood samples of patients were obtained before and after intravenous immunoglobulin (IVIG) treatment in acute stage, subacute stage and convalescent stage as well. Serum MMP-9 and TIMP-1 levels and the ratio of MMP-9/TIMP-1 were compared by statistical method in KD patients and controls, as well as in KD with CAL and without CAL.</p><p><b>RESULTS</b>In acute stage serum MMP-9 and TIMP-1 levels and the ratio of MMP-9/TIMP-1 were higher (P < 0.01) in patients with KD than those in healthy children. After IVIG treatment in KD patients serum MMP-9 level and the ratio of MMP-9/TIMP-1 decreased (P < 0.01). Before IVIG treatment serum MMP-9 level and the ratio of MMP-9/TIMP-1 were higher (P < 0.01) in patients with CAL than those in patients without CAL, and in acute stage after IVIG treatment serum MMP-9 level of KD patients with CAL was still higher than that of KD patients without CAL.</p><p><b>CONCLUSION</b>In acute stage of KD serum MMP-9 level and the ratio of MMP-9/TIMP-1 were higher in patients with CAL than those in patients without CAL, suggesting that during acute phase of KD the great increase in serum MMP-9 and the imbalance of the MMP-9/TIMP-1 ratio might be high risk factors of KD coronary artery lesion. Therefore, the measurement of serum MMP-9 and TIMP-1 might be of important clinical value in the prediction and the early diagnosis of KD with coronary artery lesion.</p>

Clinical and immunological studies on neonatal infectious pneumonia / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore etiology, clinical manifestation and immunological changes of infectious pneumonia of neonates in Chengdu area.</p><p><b>METHODS</b>Serum specimens were collected from 111 infants with infectious pneumonia. Eight viral and mycoplasmal specific serum IgM antibodies were detected by enzyme linked immunosorbent assay (ELISA); C reactive protein (CRP), total IgG and its subclasses, IgA and IgM were determined by rate scattered nephelometry; T lymphocyte subpopulations were detected by biotin-streptavidin-peroxidase method, and clinical and other laboratory data were analyzed.</p><p><b>RESULTS</b>(1) Etiological agents: specific serum IgM antibodies were positive in 40 of 111 cases (36.0%) with pneumonias. All the 30 control infants were negative for the specific serum IgM antibodies. Among 111 infants with infectious pneumonia, 20.7% had single viral or mycoplasmal infection, 40.5% had bacterial infection, 15.3% had viral and mycoplasmal infection with bacterial infection; 23.4% had infection with unknown agents. (2) The most common clinical manifestations were tachypnea and cyanosis. The next were cough, milk choking, rales, retractions of the supraclavicular, intercostal and subcostal areas. Roentgenographic examination commonly revealed vague opacities, increased density and patchy infiltration. (3) Immune status: (1) CD(3), CD(4) cell counts of infants with pneumonias were lower than those of the controls while their serum IgA, IgM concentrations were higher than those of the control. (2) The CD(3) and CD(4) cell counts of the group with bacterial infection were lower than those of the control group. (3) The serum IgA concentration of the group with viral and mycoplasmal infection was higher than those of the control group and the group with unknown infection. (4) The serum IgM concentration of the group with bacterial infection was higher than those of the control group. (5) There were no significant differences in CD(8) cell counts, CD(4)/CD(8), concentration of serum IgG and IgG(1 - 4) between pneumonia group and the control group, and among various infectious groups and the control.</p><p><b>CONCLUSION</b>Pathogens of neonatal infectious pneumonia in Chengdu area included single viral or mycoplasmic infection or bacterial infection, viral and mycoplasmal infection with bacterial infection, and unknown infection. Immunological changes of newborn infants suffered from infectious pneumonia included declined CD(3) and CD(4) cell counts, particularly in bacterial infection.</p>

Role and Clinical Significance of Myeloid Differentiation Protein-2 in Endotoxin Signal Transduction / 实用儿科临床杂志

Myeloid differentiation protein-2(MD-2)can separately and simultaneously bind lipopolysaccharide(LPS)and toll-like receptor 4(TLR4)has been shown to play critical roles in mediated recognition responses to LPS by TLR4 and signal transduction induced by LPS.MD-2 can be bound by LPS,not TLR4.The cells have no responsiveness or weak responsiveness to LPS without MD-2.MD-2 can be secreted into blood plasma,formed soluble MD-2 and remotely regulated cells that contained TLR4 without MD-2.MD-2 has been shown to play important roles in endotoxin signal transduction.MD-2 is a small molecular,short nucleic acid fragment,easily regulated should become a new potential anti-inflammatory target.

Leves of Tumor Necrosis Factor Alpha,Interleukin-1 Beta,Interleukin-6 in Serum and Cerebrospinal Fluid in Children with Intracranial Infection / 实用儿科临床杂志

Objective To investigate the fuction of tumor necrosis factor alpha(TNF-?),interleukin-1 beta(IL-1?) and interleukin-6(IL-6) in children with intracranial infection.Methods TNF-?,IL-1? and IL-6 levels of serum and cerebrospinal fluid(CSF) were determined in the purulent meningitis group(25 cases),tuberculous meningitis group(17 cases),viral meningitis group(30 cases)and control group(20 cases)by enzyme-linked immunosorbent assay(ELISA).Results The levels of TNF-?,IL-1? and IL-6 obviously increased in CSF compared with that in the serum (Pa