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Objective:To assess the value of acoustic radiation force impulse (ARFI) elastography in the diagnosis of children with biliary atresia.Methods:A prospective survey of infants with hepatitis syndrome and hyperbi-lirubinemia in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2017 to December 2018 was performed.The children with hepatitis syndrome were divided into the biliary atresia group( n=45) and non- biliary atresia group( n=30). Thirty children with hyperbilirubinemia were selected as the control group.Shear wave speed (SWS) of all infants was collected by ARFI ultrasound and compared among 3 groups.Receiver ope-rating characteristic curve(ROC curve) was used to analyze the optimal threshold value for SWS in the diagnosis of biliary atresia. Results:The mean SWS values in the biliary atresia group, non-biliary atresia group and the control group were (1.79±0.29) m/s, (1.26±0.12) m/s and (1.08±0.06) m/s, respectively.Compared with the control group, the mean SWS values in the biliary atresia group and non-biliary atresia group were significantly higher ( t=165.43, 15.75, all P<0.05). The mean SWS value in the non-biliary atresia group was significantly lower than that in the biliary atresia group ( t=90.27, P<0.05). With the non-biliary atresia group as reference, the area under the ROC curve of SWS for diagnosis of biliary atresia was 0.98(95% CI: 0.95-1.00), the optimal threshold was 1.45 m/s, and the sensitivity and specificity were 88.9% and 96.7%, respectively. Conclusions:Rapid non-invasive ARFI elastography is effective in the diagnosis of biliary atresia, and thus has important value for early diagnosis and treatment in clinical practice.
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Objective To summarize the clinical manifestations,diagnosis and treatment of perinatal tuberculosis.Methods We retrospectively analyzed the clinical data of six infants with perinatal tuberculosis treated in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2000 to December 2016.Results (1) The six patients were at the age of 27 to 60 days at the onset,while the mean ages of full-term and preterm infants were (31 ± 4) and (55± 6) days,respectively.Three mothers were diagnosed with active tuberculosis (two of which were diagnosed after parturition).(2) Three infants were admitted to the hospital with fever including two having respiratory diseases,one with external auditory canal secretions and deviated mouth,and two with secretions in the external auditory canal and masses in the head and neck.One was diagnosed as hepatosplenic tuberculosis,three as miliary tuberculosis (one was complicated by tuberculous meningitis and one with tuberculous meningitis and cervical lymph node tuberculosis),one with left cervical and temporal tuberculosis,and one with miliary tuberculosis complicated with left temporal,external auditory canal and cervical lymph node tuberculosis.(3) Two cases were positive for purified protein derivative skin test and two were positive for tuberculosis infection T cell spot test.Five cases were negative in anti-tuberculosis antibody test.Typical miliary shadows in the lungs of three infants were shown on chest X-ray.Two cases received auriculotemporal CT/MRI,indicating space-occupying lesions and destruction in the middle ear and mastoid process.Cranial MRI findings indicated one case had tuberculous meningitis.Diagnosis of three cases were confirmed by biopsy or after operation.(4) All six patients survived.Four cases recovered after combined treatment of isoniazid,rifampicin and pyrazinamide and two were transferred to a specialized hospital for further treatment.(5) All six patients were fully recovered in follow-ups at 2-3 years after discharge with normal development comparing with healthy children of the same age.Conclusions Perinatal tuberculosis,with nonspecific clinical manifestations,has a low incidence of infection but a high mortality rate.Suspected cases require full consideration including clinical symptoms,dynamic observation of laboratory findings and imaging features,and pathological examination when necessary.Maternal history of tuberculosis should be consulted and timely treatment is mandatory to improve the outcomes.
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Objective To investigate the validity and clinical value of application of nasal continuous positive airway pressure (NCPAP) in neonatal respiratory distress syndrome (NRDS) after weaning from mechanical ventilation.Methods The 92 infants with NRDS received mechanical ventilation were randomly divided into the group of NCPAP (46 cases) and the group of oxygen via head box (46 cases) by systematic sampling method.The successful rate of weaning from mechanical ventilation,and incidence of complications such as apnea,broncho-pulmonary dysplasia,ventilator-associated pneumonia,intraventricular hemorrhage,periventricular leukomalacia,retinopathy of premature infant were compared between the 2 groups.Results The group of NCPAP,41 cases were successful of weaning from mechanical ventilation,the successful rate was 89.13％ (41/46).The group of oxygen via head box,33 cases were successful of weaning from mechanical ventilation,the successful rate was 71.74％(33/46).There was statistical difference between the 2 groups (P ＜0.05).The incidences of apnea and broncho-pulmonary dysplasia in the group of NCPAP were significantly lower than those in the group of oxygen via head box [15.22％ (7/46) vs.36.96％ (17/46),6.52％ (3/46) vs.21.74％ (10/46)],there were statistical differences between the 2 groups (P ＜ 0.05).There were no statistical differences in the incidences of ventilator-associated pneumonia,intraventricular hemorrhage,periventricular leukomalacia,retinopathy of premature infants between the 2 groups (P ＞ 0.05).Conclusion NCPAP is more effective than directly removing respirator in the infants with NRDS weaning from mechanical ventilation,it deserves further study and application in clinical practice.
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Objective To retrospectively explore the incidence and causes of apnea after operation for retinopathy of prematurity(ROP). Methods The clinical data of 17 premature infants with operation for ROP(ROP group)and the other 23 premature infants without ROP(control group)were collected.The occurrence of apnea(time of onset and remission and original diseases) was recorded after operation in ROP group and at adjusted 37 weeks of gestational age in control group.Follow-up was conducted for 4 weeks,and the prevalences of apnea were compared between these two groups.Results There was significant difference in prevalenees of apnea between ROP group and control group ( 52.9%vs 21.7%,P<0.05).In ROP group,time of occurrence of apnea was (38±40)h after operation,and time of remission was (126±145)h after onset.Among the infants with apnea,there were 3 cases of pneumonia(33.3%),1 case of hypoglycemia(11.1%)and 5 cases with unexplained causes(55.5%). Conclusion Infants after operation for ROP are more prone to apnea,and pediatricians and ophthalmologists are required to collaborate in the perioperative care.
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Objective To explore the changes and their correlation of event-related potential(ERP)and the plasma levels of monoamine neurotransmitter in the patients with epilepsy.Methods ERP and the plasma levels of noradrenalin(NE),dopamine(DA) and 5-hydroxytryptamine(5-HT) were tested in 50 patients with epilepsy,and the results were compared with the normal controls.Results The latency of N2,P3 of ERP and the amplitude of P3 in the epilepsy group were significant longer and lower than those in the normal control group(all P