Research on fuII - term brain metaboIites in predicting Iong - term neuroIogicaI deveIopment in preterm infants / 中华实用儿科临床杂志

Objective To kxplork thk valuk of dktkcting brain mktabolitks of prktkrm infants at full tkrm for prkdicting thk nkurodkvklopmkntal lkvkl,and to providk thk basis for karle clinical intkrvkntion. Methods Thirte casks of prktkrm infants wkrk collkctkd from thk Nkonatal Intknsivk Cark Rnit and Nkuro - Akhabilitation Dkpartmknt of Guangzhou Zomkn and Childrkn＇s Mkdical Ckntkr bktwkkn Mae 2015 and March 2016,thkn thke wkrk chkcckd be adopting brain magnktic rksonanck imaging and magnktic rksonanck spkctroscope at corrkctkd full tkrm,and assksskd be using Llbkrta Infant Motor Scalk(LIMS)and Gkskll dkvklopmkntal scalk kvaluation at corrkctkd agk of 6 months and corrkctkd of agk 1 ekar old. ResuIts In thk 30 casks of prktkrm infants,19 casks wkrk malk,11 casks wkrk fkmalk,and thk gkstational agk was 27+3 -31 wkkcs,and avkragk gkstational agk was(28. 8 ± 1. 0)wkkcs,and thk birth wkight was 800-1 400 g[(1 176. 3 ± 145. 1)g]. Thk stude found that meo-inositol( MI),MI╱crkatink( Cr)in basal ganglia wkrk nkgativkle corrklatkd with thk dkvklopmknt quotiknt at corrkctkd agk of 1 ekar old(r﹦ -0. 465,-0. 532;all P＜0. 05). Factic acid(Fac)╱Cr in hippocampus was nkgativkle corrklatkd with dkvklopmkntal quotiknt at corrkctkd agk of 6 months(r﹦ -0. 420,P＜0. 05);Fac,Fac╱Cr in pkrivkntricular wkrk nkgativkle corrklatkd with dkvklopmkntal quo-tiknt at corrkctkd agk of 1 ekar old(r ﹦ -0. 405,-0. 386;all P ＜0. 05). Fac╱Cr in pkrivkntricular was nkgativkle corrklatkd with LIMS scorks at corrkctkd agk 1 ekar old(r﹦ -0. 380,P＜0. 05);Fac,Fac╱Cr in ckrkbkllum wkrk nkga-tivkle corrklatkd with dkvklopmknt quotiknt at corrkctkd agk of 1 ekar old(r﹦ -0. 393,-0. 394;all P＜0. 05). Thkrk was no corrklation bktwkkn frontal lobk mktabolitks and nkurodkvklopmkntal lkvkl(P＞0. 05). ConcIusions Prktkrm infants brain mktabolitks at full tkrm contributk to prkdicting nkurodkvklopmkntal lkvkl. MI,Fac,MI╱Cr,Fac╱Cr ark of valuks for prkdicting nkurodkvklopmkntal lkvkl,and MI╱Cr is thk bkst prkdictor. Lmong frontal lobk,basal ganglia, hippocampus,pkrivkntricular and ckrkbkllum,thk pkrivkntricular is thk bkst arka for prkdicting nkurodkvklopmkntal lkvkl. Corrkctkd agk of 1 ekar old maebk thk bkst timk to prkdicting nkurodkvklopmkntal lkvkl.

Logistic regression analysis of 1GA6FA2 matched case control study on the early risk factors for refractory epilepsy in children / 中华实用儿科临床杂志

Objective To analyze the clinical characteristics of epileptic children at early stage,and to explore the high risk factors for children′s refractory epilepsy(RE)in order to provide evidence for the early and timely treatment of RE.Methods A total of 147 epileptic patients with correct diagnosis and reasonable treatment were enrolled.Forty-nine patients were classified as drug non-responsive epilepsy(DNR-EP group).The remaining 98 patients were classified as drug-responsive epilepsy(DR-EP group).With multiple conditional Logistic regression,the clinical characte-ristics between the 2 groups were compared to identify the early predictors for RE.Results Single factor Logistic regression analysis showed that the initial age of onset <1 year,more than 20 seizures before treatment in a week,focal seizures,more than 2 kinds of epileptic seizures,changes in seizure type in the course of disease,neurological impairment,early intellectual disability,abnormal cranial magnetic resonance imaging(MRI),fixed focal abnormalities on video electroencephalogram(VEEG) after seizure-free interval,diffused anomaly of non-epileptic wave in VEEG before treatment,poor response to initial antiepileptic drugs(AEDs) therapy,compliance with the characteristics of epileptic encephalopathy at early stage significantly increased in DNR-EP group.Then multivariate conditional Logistic regression analysis demonstrated that more than 20 seizures before treatment in a week(OR=2.679,P=0.043),more than 2 kinds of epileptic seizures(OR=4.364,P=0.013),fixed focal abnormalities on VEEG after seizure-free interval(OR=3.898,P=0.008),poor response to initial AEDs therapy(OR=2.611,P=0.036),and compliance with the characteristics of epileptic encephalopathy at early stage(OR=6.022,P=0.002) were the risk factors for developing into RE.Conclusions Children are likely to develop into RE if they have more than 20 seizures before treatment in a week,with more than 2 kinds of epileptic seizures,fixed focal abnormalities on VEEG after seizure-free intervals,poor response to initial AEDs therapy,and compliance with the characteristics of epileptic encephalopathy at early stage.

Longitudinal study of the tendency and influential factors for behavior problem among preschool children / 中华实用儿科临床杂志

Objective To analyze the tendency and influential factors and relationship for behavior problem among 3 to 6 years old preschool children.Methods By a prospective study,the questionnaire survey was carried out in 551 parents of 3 to 6 years old children from kindergarten in Guangzhou,including General Situation Questionnaire,the Strengths and Difficulties Questionnaire(parent version) and 3-7 years old children Behavioral Style Questionnaire.The data were collected at baseline and 1 year follow-up,and were analyzed by the prospective study method.Results Baseline survey 733 valid questionnaires,551 questionnaires were followed up (follow-up rate was 75.2％),the effective questionnaires were 526 (effective rate was 95.5％).The detection rate of behavior problem reduced by age (t =1.975,P =0.049),especially in the kind problem of conduct (t =2.888,P =0.004),friendship (t =2.572,P =0.010) and prosocial behavior(t =-3.329,P =0.001).In the mean time,the degree of cutting down in girls was more obvious than in boys (t =2.359,P =0.019).The influential factors include mother'age,parental education level,structure of family and children' temperament.Children's gender and whether the only child has no significant effect on behavior problems,and the family income only affects the change of behavior problems.Conclusions The detection rate of behavior problem reduce by age and influenced by many factors.Intervention measures must be synthetically considered various related factors.

Study on the cerebral hemodynamic changes by transcranial Doppler ultrasonography from emergency ;periods to stable periods in severe acute encephalopathy children / 中国小儿急救医学

Objective To evaluate the correlations between the cerebral hemodynamic changes of severe acute encephalopathy with the clinical features from emergency periods to stable periods and the value of transcranial Doppler ultrasonography( TCD)in cerebral function assess. Methods Thirty patients with acute brain diseases by assisted mechanical ventilator from Jun 2014 to May 2015 in PICU were included and followed up to Nov 2015,then grouped by Glasgow Coma Scale( GCS),MRI,prognosis( mental sequelae after half a year). Each subject was examined through the temporal bone window by TCD at emergency peri-ods and stable periods. The systolic cerebral blood flow velocity( sCBFV),and pulsatility index( PI)of bilat-eral middle cerebral artery( MCA),anterior cerebral artery,posterior cerebral artery were analyzed. Multivari-ant analysis of variance,repeated measures analysis of variance was conducted to compare sCBFV and PI of MCA among groups in different clinical periods. The variants included sex,disease diagnosis,prognosis, MRI,GCS,and the first abnormal TCD. The variation within groups was tested via a Hotelling T2 test. All sCBFV and PI of each artery and the D-value of sCBFV between the different periods were compared accord-ing to the prognosis groups. Results (1)Five patients could be lateralized,and their lateralization of MRI focus was consistent with the abnormal sides of sCBFV in the stable periods.(2)The D-value of sCBFV in left MCA between the different periods in the poor prognosis group was significantly higher than that in the good prognosis group[(71. 93 ± 58. 21)cm/s vs.(33. 20 ± 30. 23)cm/s,t = -2. 287,P =0. 033].(3) Multivariant analysis of variance showed that GCS classification and disease diagnosis were significantly cor-related with the cerebral hemodynamic changes respectively(P =0. 042,0. 005,respectively).(4)sCBFV and PI of left MCA reduced significantly in the stable periods than those in the emergency periods( P =0. 002,0. 003,respectivly). Conclusion The cerebral hemodynamic changes by TCD from emergency peri-ods to stable periods are consistent with the clinical status,dynamic evaluation by TCD may facilitate the evaluation of brain dysfunction in the severe acute encephalopathy.

The variation of insulin like growth factor-I and glucose and correlation in children with sepsis / 临床儿科杂志

Objective To explore the variation of insulin like growth factor-I (IGF-I) and glucose and correlation in children with sepsis. Methods Forty-two children with sepsis in pediatric intense care unit were enrolled from January 2009 to January 2010. In the morning (2nd morning) after admission, the blood glucose, serum IGF-I, cortisol, insulin, IL-6, and IGF-binding protein-I (IGFBP-1) were detected. In the 3rd and 5th morning, the serum IGF-1 was detected again. According to the blood glucose level of the 2nd morning, the children with sepsis were divided into hyperglycemia group and normal group. Meanwhile, 60 healthy children were served as control group. The data had been compared among three groups. Results In the 2nd morning, the levels of blood glucose, serum IGF-I, cortisol, insulin, and IL-6 were signiifcantly different among three groups (all P0.05). Compared with control group, the sepsis children with hyperglycemia and with normal blood glucose all had signiifcantly higher serum levels of cortisol and IL-6, and signiifcantly lower serum level of IGF-I. In the 2nd, 3rd, and 5th morning, the serum levels of IGF-1 were not signiifcantly changed with time in sepsis children with hyperglycemia and with normal blood glucose (all P>0.05). Meanwhile, there were no signiifcant differ-ences in the serum levels of IGF-1 between sepsis children with hyperglycemia and with normal blood glucose in the 2nd, 3rd, and 5th morning (all P>0.05). In children with sepsis, the blood glucose and serum IGF-1 was not correlated in the next morning (r=0.152, P=0.267). Conclusions The serum level of IGF-I decreased but maintain stable in children with sepsis. The change of blood glucose may be not related with IGF-I.

Clinical features and imaging examination analysis of bacterial meningitis in children / 中华实用儿科临床杂志

Objective To investigate the clinical features and the imaging examination changes of bacterial meningitis in children of different age groups,and to offer theoretical basis for the clinic diagnosis of bacterial meningi-tis. Methods The sick children with bacterial meningitis treated in Guangzhou Women and Children′s Medical Center from January 2011 to June 2013,were recruited and divided into three groups according to the age,including newborns group,infants group and more than 1 year group. Eighty-nine cases with purulent meningitis were recruited,included 58 males and 31 females. Among them,there were 34 cases in the newborns group,41 cases in the infants group and 14 ca-ses in the more than 1-year group. The information on the clinical features,laboratory examination and the imaging ex-amination were summarized and analyzed,and were compared among the 3 groups. Results (1)Among them,54 cases with high fever,44 cases with respiratory symptoms,12 cases with alimentary tract symptoms. (2)The major neurologi-cal features included convulsions(44 cases,49. 4%),fatigue(36 cases,40. 4%),vomiting(21 cases,23. 6%),cervical rigidity(9 cases,10. 1%),fontanel full(7 cases,7. 9%),headache(6 cases,6. 7%),limb paralysis(5 cases,5. 6%). The percentage of high fever,vomiting,headache,cervical rigidity in the more than 1 year group were significantly more than those of the newborns group and the infants group(χ2=10. 093,12. 063,34. 466,7. 177,all P<0. 05). (3)Among them,whitebloodcell(WBC)accountswerefrom2.20to60.60×109/L,themeanwas(16.49±10.37)×109/L.Hy-persensitive C-reaction protein concentration in blood was 4. 00 to 376. 53 g/L,the mean was (131. 07±86. 91) g/L. In cerebrospinal fluid(CSF),WBC accounts were from 1 to 21 800×106/L,the mean was (910. 05±274. 07)×106/L, the glucose concentration from 0. 00 to 4. 50 mmol/L,the mean (1. 72±1. 03)mmol/L,the protein concentration from 0. 42 to 4. 89 g/L,the mean was(1. 64±1. 03)g/L. In 40 cases with atypical CSF change, 23 cases with CSF glucose ratio(CSF glucose/blood glucose) less than or equal to 0. 4, and 15 cases with blood cultures positive. (4)The image examination showed magnetic resonance imaging( MRI) abnormalities in 51/75 cases,computerized tomography( CT) scan abnormalities in 15/30 cases. The percentage of convulsions,the brain MRI abnormalities and the MRI display rate of bacterial meningitis in the infants group were significantly more than those of the newborns group and the more than 1 year group(χ2=11. 768,9. 047,7. 674,all P<0. 05). The display rate of meningitis and subdural hydroma by the brain MRI were significantly more than those of the head CT scan(χ2=7. 430,5. 291,all P<0. 05). Conclusions Be-cause of the atypical clinical features of bacterial meningitis in newborn and infant, lumber puncture should be per-formed in all doubtful cases who had a fever and/or seizure. CSF glucose less than or equal to 0. 4 of simultaneously ob-tained blood glucose value,the enhanced MRI sequence or blood cultures were useful for the likelihood of meningitis,if CSF chemistries and cytology vary atypically. The MRI sequence can significantly mostly improve the display rate of bacterial meningitis than the enhance CT.

The factors influencing the prognosis of herpes simplex virus encephalitis / 中华实用儿科临床杂志

Objective To evaluate the factors influencing prognosis and to explore the pathological mechanism in which herpes simplex virus encephalitis(HSE) was one of the severe types of acute viral encephalitis in children and had poor prognosis.Methods Twenty-one children with HSE were diagnosed by the clinical syndrome of focal encephalitis and HSV DNA-PCR positive in cerebrospinal fluid(CSF) from Jan.2012 to Oct.2013,among whom,19 patients were treated with intravenous Acyclovir,30 mg/(kg · d) 48 hours after onset and were followed up for 6 to 24 months.Clinical data were collected including Glasgow Coma Score,the brain magnetic resonance imaging(MRI),and electroencephalography(EEG).All MRI examinations including plain scan and contrast enhancement were carried out at the beginning of admission and 1 month after the onset of symptoms.The clinical outcomes were divided into two levels accoming to the severity of the neurological deficit,then the data were analyzed by using Logistic regression and Fisher's exact probability method.The OR value was calculated.Results Eighteen children survived,of whom 5 cases had no neurological deficit(27.8％),3 cases were left with mild impairment(16.7％),and the above 8 cases were thought to have better outcome.Six cases had moderate impairment (33.3％) and 4 cases had severe impairment(22.2％) and 1 child died,and these 11 cases were thought to have worse outcome.Patients aged between 1 month and 10 years,average (2.03 ± 2.23) years old.The mean GCS score was (9.68 ± 2.65) scores,the GCS of the patients were more than 7except for one death child with 3 scores.The multiple factor analysis showed that EEG,age,GCS and the range and character in MRI were significantly correlative to the prognosis(P ＜ 0.05).The single factor analysis illustrated that age 1-4 years old(OR =30,95％ CI 2.066-366.510,P =0.002),GCS ≤ 10 scores(OR =27.518,95％ C1 2.066-366.510,P =0.004)and the wide necrosis existence involving diffuse white matter or deep nuclei of MRI findings (OR =12,95 ％ CI 1.294-111.323,P =0.017) indicated the worse outcome.Conclusions Age,GCS score,nature and damage degree of MRI lesions are the main important factors affecting the prognosis of children's HSE.HSE in children is apt to involve the cortex such as frontal lobe,parietal lobe even diffuse white matter or deep nuclei,which indicates the poor prognosis.

Characteristic surface myoelectric signals of maximum isometric voluntary contraction of the wrist flexors and extensors in children with hemiplegic cerebral palsy / 中华物理医学与康复杂志

Objective To study the characteristic surface myoelectric signals generated by children with hemiplegic cerebral palsy (HCP) during maximum isometric voluntary contraction (MIVC) of the wrist flexors and extensors.Methods Sixty-eight children with HCP 2 to 14 years of age were assessed with surface electromyography (sEMG).The electrodes were applied on the skin over the wrist flexors and extensors.The integrated EMG signals (iEMGs),root mean square amplitudes (RMSs) and co-contraction ratios during MIVC were recorded and analyzed.Results In a MIVC,the RMS,iEMG and co-contraction ratio were all significantly different between the involved and uninvolved hands,though the iEMGs of the wrists of the two hands were strongly correlated.The RMSs of the wrists of the involved and uninvolved hands were also strongly positively correlated when grasping maximally using the involved hand.Conclusions The involved hand of children with HCP has excessive co-activation of the wrist flexors,poor muscle recruitment and little isolated selective control of movement.It may be very important to facilitate wrist extensor contraction,inhibit wrist flexor co-activation and induce involved hand use to improve the hand function of children with HCP.

Effects of Electro-acupuncture and Functional Training on Gross Motor Function of Children with Cerebral Palsy / 中国康复理论与实践

@#Objective To observe the effects of electro-acupuncture and functional training on gross motor function of children with cerebral palsy. Methods 137 children with cerebral palsy were divided into observation group (n=81) and control group (n=56). The observation group received electro-acupuncture and functional training, and the control group received functional training only. Results The scores of Gross Motor Function Measure (GMFM) increased in both group after treatment (P<0.01), and it was significantly higher in the observation group than in the control group (P<0.01). Conclusion Electro-acupuncture and functional training is superior to functional training in gross motor function.

Diagnosis and treatment of acute paralysis in children / 中国小儿急救医学

Acute paralysis is one of commonest childhood neurological diseases with multiple etiologies.The hand foot mouth disease,intracranial infection,stroke and so forth become the main causes of acute paralysis.Timely treatment of the primary disease and early implementation of the motor function rehabilitation can prevent and decrease motor disability.

An epidemiological study on sleep time in children aged 2 to 12 years in Yuexiu district,Guandzhou / 中国基层医药

Objective To assess the age-specific sleep time among children 2 to 12 years of age in Yuexiu district,Guangzhou,China,and to identify the related factors.Methods 1734 children,aged 2 to 12 years were randomly selected from two elemental schools and two kindergartens in Yuexiu district of Guangzhou under strict quality control system,their parents were interviewed with questionnaire to look into their familial and social environment,as well as sleep related factors.Results The total sleep time among children less than 6 years of age in Yuexiu district,Guangzhou was less than that among children the same age in other provinces in China.The factors were related to children's inadequacy of total time included age,sleep problems,the history of sleep snoring in father and mother,feeding manners,difficulty at sleep onset.Conclusion The total sleep time among children at lower age in Yuexiu district,Guangzhou is on the low side.The main influencing factor of insufficiency of sleep time among children is the family environmental factors,the sleep time should be recognized by family and society.