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Objective:To assess the accuracy of lung ultrasound(LUS) to predict pneumonia in pediatric patients using meta-analysis.Methods:The PubMed, the Cochrane Library, EMbase databases from January 2015 to March 2020 were searched.The retrieved outcome data to evaluate the efficacy of LUS for the diagnosis of pneumonia in patients under 18 years of age were included.Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies.Meta-analysis was then conducted using MetaDisc 1.4, RevMan 5.3 and Stata 15.0 softwares.Results:Twelve diagnostic studies were included, which involved 2 484 patients.The results of meta-analysis showed that compared with the gold standard, the sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio of LUS were 0.90(95% CI 0.88-0.91), 0.88(95% CI 0.85-0.90), 8.64(95% CI 3.79-19.72), 0.12(95% CI 0.06-0.26) and 77.58(95% CI 28.39-211.99), respectively.The area under the summary receiver operating characteri stic curve was 0.96.Subgroup analysis showed that there was no difference in LUS′s diagnostic accuracy for pneumonia with different department, different diagnostic gold standard, and different level of sonographer training. Conclusion:Current evidence shows that LUS has a high accuracy in the diagnosis of pneumonia in children.
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A 13-year-old girl initially complained of thrombocytopenia 3 years ago and had positive antinuclear antibody(ANA),weakly positive anti-double-stranded (anti-ds) DNA antibodies and decrease of C3 1 month ago.She was admitted to the ward following dyspnea and intermittent cough for three days this time.The initial diagnosis was systemic lupus erythematosus (SLE).The clinical manifestation after admission involved multiple organs such as liver,kidney and spleen.However,cirrhosis could not be explained by SLE.Besides,anti-dsDNA as a specific index for SLE was only weakly positive in this case and the decrease of C3 was independent to activity of the disease.Abnormal signals in bilateral basal ganglia confirmed by MRI could not be explained by SLE,either.Therefore,the initial diagnosis as SLE was suspicious.Further laboratory test showed low ceruloplasmin and increased 24 urine Cu to correct the diagnosis as hepatolenticular degeneration (HLD) and pulmonary infection.Gene sequence analysis revealed heterozygous mutation in ATP7B gene (a splice site mutation:c.1708-5T ＞ G;a missense mutation:c.2333G ＞ T,p.Arg778Leu).HLD should be suspected in any patient with liver abnormalities of uncertain causes along with involvement of multiple systems.Gene sequence analysis is helpful to early diagnosis of HLD.
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Objectives A rare case of juvenile dermatomyositis (JDM) complicated by myelodysplastic syndrome (MDS) was reported in order to improve the understanding of the disease in its clinical signs, differential diagnosis and treatment. Meth-ods The course of the disease, clinical characteristics and the process of diagnosis and treatment were analyzed. Specimens of bone marrow, lymph nodes, muscles were examined by histopathological or immunohistopathological means and lfow cytometry. Results The diagnosis of JDM complicated by MDS was made based on the clinical manifestations, related laboratory results and the accompanying changes in hematological and bone marrow examinations. Conclusions JDM complicated by MDS is very special and rarely seen in China and its pathological mechanism and strategy of diagnosis and treatment should be further explored.
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Objective To investigate the short axis systolic function of children with single-left ventricle(LV),and to appraise the clinical value of velocity vector imaging(VVI) on assessing it.Methods The study group consisted of 14 patients with single-LV.The control group consisited of 14 age-matched normal children.VVI was used to analyse the circumferential and radial strain and strain rate of regional single-LV at the level of papillary muscle.Results Compared with values in control group,single-LV circumferential strain values were significantly lower in anterior septum,posterior septum,anterior wall,lateral wall and inferior wall(all P ＜0.05).Single-LV circumferential strain rate values were significantly lower in anterior septum,posterior septum,anterior wall,lateral wall and posterior wall compared with controls(all P ＜0.05). In control group,circumferential strain and strain rate were higher in inferior septum and anterior septum compared with other segments( P ＜0.05).Single-LV radial strain values were significantly lower in all segments compared with values in control (P ＜ 0.05).In control group,radial strain and strain rate of papillary muscle level showed no significantly difference( P ＞0.05).Conclusions Circumferential and radial systolic ventricular function are impaired in children with single-LV.VVI can beused as a quantitative tool in evaluating the short axis systolic function of single-LV.
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Objective To investigate the longitudinal systolic ventricular function of children with single ventricle, and to appraise the feasibility and clinical value of velocity vector imaging (VVI) on assessing it. Methods The study group consisted of 30 patients with functional single ventricle. The control group consisted of 30 age- and gender-matched normal children. Using Sequoia C512 echocardiography machine,the peak velocity(V),peak displacement(D) ,strain(S) ,and strain rate(SR) were measured. Results Basel and median velocities,as well as basel and median displacements of rudimentary chamber side(RCS), were lower than those of septum[Basel velocity (1. 93 ± 0. 71)cm/s vs (3. 53 ± 1. 07)cm/s;Median velocity (1.19±0. 57)cm/s vs (2. 03 ± 0. 90) cm/s; Basel displacement (2. 53 ± 1.65) mm vs (6.21 ± 2. 12)mm;Median displacement(1. 26 ± 1. 06)mm vs (3. 21 ± 1.37)mm]. The values of strain of all the six segments of single ventricle were significantly lower than Corresponding segments of the control group [ basel nonrudimentary chamber side(NRCS) ( - 16. 17 ± 4. 37) % vs ( - 19. 66 ± 3. 47) % ; Median NRCS ( - 15. 23 +4.36)% vs (-19.64± 4. 75)%; Apical NRCS (-13.84 ± 5.79)% vs ( - 16. 7 ± 4. 15)%; Basel RCS(-10. 54±5.35)% vs (-19.49±3. 74)%;Median RCS ( - 10. 16 ± 5. 26)% vs ( -20. 83 ± 3. 82)% ;Apical RCS ( - 10. 97 ± 5. 22) % vs C - 18. 11 ± 4.43) %]. Aside from basel strain rates of NRCS, strain rates of all the other five segments of single ventricle were significantly lower than Corresponding segments of the control group [Median NRCS ( - 1. 21 ± 0. 42)s-1 vs (- 1.49 ± 0. 24)s-1 ;Apical NRCS ( - 1.10 ±0.41)s-1 vs (-1.47 ± 0.24)s-1;Basel RCS ( - 1.07 ± 0. 35) s-1 vs (- 1. 49 ± 0. 22) s-1; Median RCS (-0.97± 0.34)s-1 vs ( -1.48 ± 0. 20)s-1 (Apical RCS ( - 0. 93 ± 0. 39)s-1 vs ( - 1. 48 ± 0. 22)s-1]. Conclusions Longitudinal systolic ventricular function is impaired in children with functionally single ventricle. VVI can be used to asses ventricular systolic performance in children with functionally single ventricular.
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Objective To evaluate regional right ventricular function by ultrasonic strain rate imaging in postoperative children with conotruncal defects(CTD). Methods All 27 postoperative CTD children had magnetic resonance imaging evaluation of right ventricular end-diastolic volume and end-systolic volume to calculate right ventricular ejection fraction (RVEF). The ultrasonic parameters of peak systolic strain rate (SRs), peak early diastolic strain rate (SRe), peak late diastolic strain rate(SRa) and strain (S) were obtained at the basal,middle and apical segment in curve of right ventricular anterior wall in 27 postoperative CTD children and 27 normal children. The correlation between SRs,S and RVEF were evaluated. Results Compared with healthy children,SRs,S,SRe,SRa were significantly reduced in postoperative CTD children (P ＜ 0.01 ), there were different distribution rules between postoperative CTD children and normal children,and all indexes had no statistical descrepancy among the basal, middle and apical segment ( P ＞0.05). SRs in basal segment of the right ventricular anterior wall correlated well with RVEF ( r = 0.89,P ＜ 0. 01 ). Conclusions Regional right ventricular function still was reduced in postoperative CTD children, and could be accurately evaluated by ultrasonic strain rate imaging.