Expert consensus on the prevention and treatment of drowning in children / 中国当代儿科杂志

Drowning is a leading cause of accidental injury in children and has a great impact on family and society. The prevention and treatment of drowning is of great importance for reducing mortality rate. This consensus reviews the literature on the epidemiology, rescue, resuscitation, and acute clinical management and prevention of drowning. The panel determines the score of available evidence according to the criteria of Oxford Centre for Evidence-Based Medicine and then makes recommendations on evidence based on such criteria, so as to provide a basis for further reducing the mortality and disability rates caused by drowning.

Clinical and biological characteristics of childhood acute myeloid leukemia with EVI1 gene positive expression / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the expression of ecotropic viral integration site (EVI1) gene in childhood acute myeloid leukemia (AML) and the clinical features of EVI1-positive children with AML.</p><p><b>METHODS</b>The clinical data of EVI1-positive children with AML were collected and analyzed. RT-PCR and real-time quantitative PCR were used for qualitative and quantitative analysis of expression of EVI1. Flow cytometry (FCM) was used for determining the immunophenotypes of bone marrow cells. Multiparameter FCM was used for monitoring minimal residual disease. The karyotypes were determined.</p><p><b>RESULTS</b>Of 241 children with AML, 33 (13.7%) were positive for EVI1 expression. There were no significant differences in age at first visit as well as the white blood cell count, hemoglobin level, and platelet count in peripheral blood between EVI1-positive and EVI1-negative children with AML (P>0.05), but EVI1-positive children had a significantly increased proportion of females compared with EVI1-negative children (P<0.05). The change in EVI1 expression was not synchronous with clinical remission and the change of MRD: some children had clinical remission or negative conversion of MRD before negative conversion of EVI1, while some had negative conversion of EVI1 before clinical remission or while MRD showed positive. EVI1 gene was usually co-expressed with other fusion genes. CD33 (100%), CD38 (88%), and HLADR (76%) were highly expressed in EVI1-positive children with AML. Abnormal chromosome structure or number was found in 15 patients. Compared with EVI1-negative children, EVI1-positive children had significantly lower complete remission rates after the first course of treatment (P<0.05).</p><p><b>CONCLUSIONS</b>EVI1-positive children with AML have a poor short-term prognosis. In the development of AML, the activation of EVI1 gene is not isolated, but the result of interactions with other genes or chromosome abnormalities, and the mechanism of activation and its function need further study.</p>

Clinical characteristics of childhood leukemia with EVI1 gene and BCR/ABL gene co-expression / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics of ecotopic viral integration site-1 (EVI1) and BCR/ABL positive childhood leukemia.</p><p><b>METHODS</b>Clinical data of four children with EVI1 and BCR/ABL positive leukemia and eight children with BCR/ABL positive but EVI1 negative chronic myeloid leukemia (CML) were retrospectively analyzed.</p><p><b>RESULTS</b>In the four children with EVI1 and BCR/ABL positive leukemia, two were initially diagnosed with chronic phase of CML, one with accelerated phase of CML and one with high-risk acute lymphoblastic leukemia (ALL). There were no significant differences in clinical characteristics at diagnosis between the patients with EVI1 and BCR/ABL positive leukemia and BCR/ABL positive but EVI1 negative leukemia. CD33 and CD38 were highly expressed and t(9;22) abnormality was present in all patients with EVI1 and BCR/ABL positive leukemia. Two of the 3 children with EVI1 and BCR/ABL positive CML achieved complete remission one or three months after treatment. Acquired negative status conversion occurred for EVI1 but not BCR/ABL in one CML case. The 3 children with EVI1 and BCR/ABL positive CML survived 20, 13 and 14 months, respectively, without recurrence. The child with EVI1 and BCR/ABL positive ALL failed to achieve complete remission after the first course of treatment and discontinued further treatment.</p><p><b>CONCLUSIONS</b>Co-expression of EVI1 and BCR/ABL fusion gene can be found in childhood CML and ALL. The relatively rare leukemia has not significant difference respect to clinical characteristics. Prognosis of the disease needs to be determined by clinical studies with a larger sample size.</p>

Therapeutic effects of a combination of high-dose immunoglobulin and cyclosporine A in children with aplastic anemia / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of a combined immunotherapy, high-dose immunoglobulin (HDIG) plus cyclosporine A (CsA) plus prednisone (P), in children with aplastic anemia (AA) and to explore the association of peripheral blood lymphocyte subsets, peripheral blood cells and marrow CD34+ cells with therapeutic effects in AA.</p><p><b>METHODS</b>The clinical data of 46 children with AA and who received the combined immunotherapy of HDIG + CsA + P were retrospectively studied.</p><p><b>RESULTS</b>Of the 46 children with AA, 31 (67.4%) were responded to the combined immunotherapy. The binary logistic regression analysis showed low absolute neutrophil count (B=4.703, p<0.05), low percentage of peripheral blood CD4+ cells (B=0.142, p<0.05) and low ratio of peripheral blood CD4+/CD8+ (B=2.945, p<0.05)were associated with poor therapeutic effects. The ratio of CD34+/karyocytes of bone marrow in children with AA was lower than that in normal individuals, but it was not significantly related to the therapeutic effect.</p><p><b>CONCLUSIONS</b>The combined immunotherapy (HDIG+CsA+P) was effective in children with AA. The absolute neutrophilcount, the percentage of peripheral blood CD4+ and the ratio of peripheral blood CD4+/CD8+ were important prognostic factors in AA.</p>

Therapeutic effectiveness of the ALL-XH-99 protocol for childhood acute lymphoblastic leukemia / 中国当代儿科杂志

<p><b>OBJECTIVE</b>The ALL-XH-99 protocol for the treatment of childhood acute lymphoblastic leukemia (ALL) has been performed in the Union Hospital for 10 years. This study aimed to evaluate the therapeutic effectiveness of the protocol for childhood ALL and to investigate the prognostic factors for childhood ALL.</p><p><b>METHODS</b>This is a retrospective study. The eligible patients were treated with the ALL-XH-99 protocol. However a minor modification based on the ALL-XH-99 protocol was performed in this study, i.e., the high-risk patients as the low- and moderate-risk patients were not administered with cranial irradiation. Event-free survival (EFS) was evaluated using the Kaplan-Meier method and the differences of the EFS among groups were compared with the log-rank test. Prognostic factors for childhood ALL were investigated by the stepwise Cox proportional hazard model.</p><p><b>RESULTS</b>One hundred fifteen patients were eligible for the ALL-XH-99 protocol clinical study. The 115 patients consisted of 62 low-risk, 12 moderate-risk and 41 high-risk patients. The overall EFS at 5 years in the 115 patients was 69.0 +/- 5.0%. The 5-year-EFS in the low-risk, moderate-risk and high-risk patients was 82.0 +/- 6.0%, 77.0 +/- 15.0% and 43.0 +/- 11.0%, respectively (P <0.01). Relapse occurred in 16 patients (13.9%) in a median time of 17 months. Without administering cranial irradiation to all of the patients, the incidence of CNS leukemia relapse (2/115, 1.7%) was not higher than that previously reported. Multivariate analysis showed that the risk degree of leukemia, the presence of t (9; 22)/bcr/abl fusion gene and leukocyte count were independent adverse prognostic factors for ALL and their hazard ratio was 1.867, 3.397 and 2.236 respectively.</p><p><b>CONCLUSIONS</b>The therapeutic effectiveness of the ALL-XH-99 protocol for childhood ALL is satisfactory, with an EFS rate comparable to that of the developed countries. t (9; 22)/bcr/abl is the most important adverse independent prognostic factor for childhood ALL. Cranial irradiation may be eliminated to reduce late adverse effects in all of ALL patients.</p>

Effects of intrathecal ouabain and tizanidine injection for treatment of neuropathic pain in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effects of intrathecal ouabain and tizanidine injection for treatment of neuropathic pain in rats.</p><p><b>METHODS</b>Male SD rats weighing 250-300 g were randomly divided into 5 groups (n = 6), namely the control group, ouabain group, tizanidine group, combined ouabain and tizanidine injection group, and the antagonist group. Intrathecal catheter was implanted 7 days before spinal nerve ligation to establish the neuropathic pain model. Mechanical withdrawal threshold (MWT) before and after intrathecal administration of the agents was recorded in the rats. Isobolographic analysis was performed to evaluate the interactions between the agents.</p><p><b>RESULTS</b>Intrathecal injection of ouabain (0.25-5 microg) or tizanidine (0.5-5 microg) alone produced dose-dependent analgesic effect against the neuropathic pain (P < 0.05). Isobolographic analysis revealed a synergistic interaction between ouabain and tizanidine. Intrathecal pretreatment with atropine (5 microg) or yohimbine (20 microg) antagonized the effects of ouabain and tizanidine administered alone or in combination (P < 0.05).</p><p><b>CONCLUSION</b>Intathecal injection of ouabain or tizanidine produces dose-dependent analgesic effects against neuropathic pain, and their synergistic effect after combined injection probably involves the cholinergic transmission and alpha2 receptor.</p>

Meta-analysis on acupuncture and moxibustion for treatment of ulcerative colitis / 中国针灸

<p><b>OBJECTIVE</b>To assess the effectiveness and safety of acupuncture and moxibustion for treatment of ulcerative colitis.</p><p><b>METHODS</b>Randomized controlled trials or clinical controlled trials of acupuncture and moxibustion for interfere of ulcerative colitis in recent 10 years were reviewed and Meta-analysis was made for the literature results.</p><p><b>RESULTS</b>Altogether 11 papers of clinical study were enrolled. Heterogeneous tests were conducted for the results of the 11 studies, as a result, chi2 = 8.55, P = 0.67. The fixed effect model was used for statistical analysis, after combination OR = 3.82, confidence interval of 95% was 2.65-5.52. The rhombus was located at the right side of the medium line. After Z test, Z = 7.14, P < 0.01, the therapeutic effect and the cured rate in the treatment group were significantly higher than those of the control group.</p><p><b>CONCLUSION</b>The therapeutic effect of acupuncture and moxibustion on ulcerative colitis is superior to that of western medicine with safety and less adverse reactions.</p>

Changes of Blood Coagulation and Fibrinolysis Function in Acute Leukemia Children Complicated with Disse-minated Intravascular Coagulation and Their Significances / 实用儿科临床杂志

Objective To observe the changes of antithrombin activity(AT) and D-dimer in acute leukemia(AL)children complicated with disseminated intravascular coagulation(DIC) and to explore the changes of blood coagulation and fibrinolysis function.Methods Twenty-seven AL children without DIC were selected as AL group and 25 childern complicated with DIC were selected as observe group,36 health children were as control group.Plasma level of AT,D-dimer,fibrinogen,activated partial thromboplastin time and prothrombin time were tested by color substrate,immuno-latex turbidimetry,and coagulation method.And the rusults of AL group were compared with observe group and control group by SPSS 10.0 software.Results PT was significantly prolonged and the D-dimer in AL group and observation group were significantly higher than those in control group(Pa