Clinical analysis of 41 children's urinary calculus and acute renal failure / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the treatment of acute renal failure caused by irrational drug use.</p><p><b>METHOD</b>Data of 41 cases of acute renal failure seen from July 2008 to June 2012 in our hospital were reviewed. Bilateral renal parenchymas diffuse echo was found enhanced by ultrasound in all cases. Calculus image was not found by X-ray. All children had medical history of using cephalosporins or others. Alkalinization of urine and antispasmodic treatment were given to all children immediately, 17 children were treated with hemodialysis and 4 children accepted intraureteral cannula placement.</p><p><b>RESULT</b>In 24 children who accepted alkalinization of urine and antispasmodic treatment micturition could be restored within 24 hours, in 11 children micturition recovered after only one hemodialysis treatment and 2 children gradually restored micturition after hemodialysis twice, 4 children who accepted intraureteral cannula immediately restored micturition. In all children micturition recovered gradually after a week of treatment. Ultrasound examination showed that 39 children's calculus disappeared totally and renal parenchymas echo recovered to normal. The residual calculi with diameter less than 5 mm were found in 2 children, but they had no symptoms. The children received potassium sodium hydrogen citrate granules per os and were discharged from hospital. Ultrasound showed calculus disappeared totally one month later.</p><p><b>CONCLUSION</b>Irrational drug use can cause children urolithiasis combined with acute renal failure, while renal dysfunction can reverse by drug withdrawal and early alkalinization of urine, antispasmodic treatment, intraureteral cannula or hemodialysis when necessary, most calculus can be expelled after micturition recovered to normal.</p>

Comprehensive therapeutic protocol of electroacupuncture combined with Chinese herbs and rehabilitation training for treatment of cerebral infarction: a multi-center randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect of comprehensive therapeutic protocol of electroacupuncture combined with active-blood-and-dissolve-stasis herbs and rehabilitation training for cerebral infarction.</p><p><b>METHODS</b>A multi-center randomized controlled trial was done, three hundred and twenty cases were divided into four groups: electroacupuncture combined with active-blood and dissolve-stasis herbs and rehabilitation training group (group A), electroacupuncture combined with rehabilitation training group (group B), herbs combined with rehabilitation training group (group C) and rehabilitation training group (group D), 80 cases in each group. The following two groups of acupoints were used alternatively in electroacupuncture treatment: the first group including Vasomotor Area, Jianyu (LI 15), Biguan (ST 31), Hegu (LI 4) and Taichong (LR 3); the second group including Motor Area, Quchi (LI 11), Yanglingquan (GB 34) and Shenshu (BL 23). 20 mL Xiangdan injection and 250 mL 5% glucose injection or 250 mL 0.9% sodium chloride injection were used by intravenous drip in herbs treatment once a day. The rehabilitation training was performed by the professional physical therapist. Each group was treated with corresponding treatment protocol. The therapeutic effect was evaluated by index of the mortality or disability rate 3 months after the onset of disease. The intention to treat analysis (ITT) was used in data.</p><p><b>RESULTS</b>The mortality or handicap rate 3 months after the onset of disease of four groups were 17.5% (14/80) in group A, 22.5% (18/80) in group B, 40. 0% (32/80) in group C, and 31.3% (25/80) in group D, respectively. The group A has a best therapeutic effect (vs group C, group D, both P<0.05), and there was no adverse event.</p><p><b>CONCLUSION</b>The combined application of electroacupuncture, active-blood and dissolve-stasis herbs and rehabilitation training is a better treatment for cerebral infarction in clinic.</p>

Clinical features and changes of 5-hydroxytryptamine in children with vasovagal syncope / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate clinical features of childhood vasovagal syncope (VVS) and the possible relationship between changes of plasma and platelet 5-hydroxytryptamine (5-HT) and childhood VVS.</p><p><b>METHOD</b>Forty-one children who were diagnosed as VVS because of positive head-up tilt test (HUTT) in Capital Institute of Pediatrics were enrolled as HUT-positive group, while 36 healthy children as control group. Clinical features of all children were analyzed, and blood samples of all children were obtained. Plasma and platelet 5-HT was measured by enzyme-linked immunosorbent assay (ELISA).</p><p><b>RESULT</b>(1) The mean age of 41 VVS children was (10.5 +/- 1.8) years, and there were more girls than boys with the boys to girls ratio of 1:1.4. (2) Presyncopal symptoms occurred in 33 patients (80.4%), among whom dizziness had a high rate: 78.8%. (3) Commonly, there were some provocation factors before syncope, among which long-time standing was the most common one with the rate of 91.7%. (4) The mean time of positive response in BHUT and SNHUT were (20.6 +/- 8.6) minutes and (5.0 +/- 2.2) minutes, respectively. Duration of syncope was shorter than 5 minutes. (5) HUTT positive response included vasodepressor type with the rate of 61.0%, cardioinhibitory type with 14.6%, and mixed type with 24.4%. (6) There were no significant differences in baseline heart rate, systolic blood pressure and diastolic blood pressure between VVS children and healthy children. And it was the same among different types of VVS children. (7) There were no significant differences in plasma 5-HT between VVS group of baseline or HUTT-positive and control group [(27.51 +/- 1.32) microg/L vs.(27.28 +/- 2.48)microg/L, t = 0.518, P = 0.606; (27.51 +/- 1.32) microg/L vs.(28.05 +/- 1.40) microg/L, t = 2.044, P = 0.167]. There were no significant differences in platelet 5-HT concentration between VVS group of baseline and control group [(82.30 +/- 6.06) 10(9) ng/L vs. (79.88 +/- 5.79) 10(9) ng/L, t = 1.788, P = 0.780].(8) HUTT-positive platelet 5-HT concentration of VVS children was significantly higher than baseline value [(97.90 +/- 6.59) 10(9) ng/L vs. (82.30 +/- 6.06) 10(9) ng/L, t = 11.26, P = 0.00].</p><p><b>CONCLUSION</b>There were no significant changes in plasma 5-HT in children with VVS during baseline, syncope or pre-syncope, which suggests that plasma 5-HT might not be valuable for the prediction of syncope trigger. However, platelet 5-HT of VVS children was obviously higher during syncope and presyncope, which suggests that central serotonergic system might be involved in the pathogenesis of VVS.</p>

Comparison of the reliability of two ELISA kits for detecting IgM antibody against hepatitis E virus / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the reliability of two ELISA kits for detecting IgM antibody against hepatitis E virus (HEV).</p><p><b>METHODS</b>Serum samples from 92 healthy subjects, 71 cases suspected of hepatitis E, 55 patients with confirmed diagnosis of acute hepatitis E, 50 individuals with rheumatoid factor (RF) positive and 54 persons with anti-HAV IgM positive were detected with three hepatitis E diagnostic kits. MP-IgM (MP, Singapore), Wantai-IgM and anti-HEV IgG (Wantai, China). HEV RNA was analyzed with RT-PCR in 52 of 71 cases suspected of hepatitis E.</p><p><b>RESULTS</b>In healthy subjects,cases suspected of hepatitis E and confirmed acute hepatitis E, the concordance between the two anti-HEV IgM reagents was 73.39% (160/218) and the significant differences in the positive rates of two assays were not observed [46.79% (102/218) vs 44.04% (96/218), chi2 = 0.62, P > 0.05]. Of 71 patients suspected of hepatitis E, the sensitivity for diagnosing acute hepatitis E of Wantai-IgM and MP-IgM were 83.08% (54/65) and 78.46% (51/65) (chi2 = 0.16, P > 0.05), respectively. Among those suspected of hepatitis E with HEV RNA positive, the sensitivity of Wantai-IgM was obviously higher than that of MP-IgM [(97.14%, 34/35) vs (74.29%, 26/35), chi2 = 4.9, P < 0.05]. 48 of 55 patients (87.27%) with confirmed diagnosis of hepatitis E were Wantai-IgM positive while 37 (67.27%) was MP-IgM positive (chi2 = 4.0, P < 0.05). The specificity of Wantai-IgM was higher than MP-IgM [100.00% (202/202) vs 89. 11% (180/202), chi2 = 20.05, P < 0.005]. RF and anti-HAV IgM might cause MP-IgM false positive without interference on Wantai-IgM.</p><p><b>CONCLUSION</b>Wantai-IgM should be a good ELISA kit for the diagnosis of acute hepatitis E.</p>