Mortality in Children with Severe Hand, Foot and Mouth Disease in Guangxi, China

Objective: To analyze the clinical features of children with hand foot and mouth disease(HFMD) who died. Methods: 331 deaths due to HFMD between 2010 and 2014 wereincluded in this retrospective study; 15 autopsies were performed. Results: Most deathswere seen in children aged below 3 y, and with enterovirus 71 infection (91%). The mean(SD) duration of HFMD from onset to death was 3.7(2.9) d. The mean (SD) age of fastprogressors (from onset to death less than 4 days) was 17.4 (9.2) mo. Most of them werediagnosed as stage 3 and stage 4 of HFMD. Various pathological changes were observed inbrain after autopsy, especially in brain stem and medulla. Conclusions: The brain stemencephalitis with the neurotropism of enteroviruses seems to be the main contributor to thedeath in HFMD

A clinical analysis of children with invasive pulmonary fungal infections after biliary atresia surgery / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features of invasive pulmonary fungal infections (IPFIs) after biliary atresia (BA) surgery and related risk factors.</p><p><b>METHODS</b>A retrospective analysis was performed for the clinical data of 49 children with IPFIs after BA surgery, including clinical features, lung imaging findings, and pathogenic features. The risk factors for IPFIs after BA surgery were also analyzed.</p><p><b>RESULTS</b>The most common pathogens of IPFIs after BA surgery was Candida albicans (17 strains, 45%), followed by Candida tropicalis (7 strains, 18%), Aspergillus (6 strains, 16%), Candida krusei (3 strains, 8%), Candida glabrata (3 strains, 8%), and Candida parapsilosis (2 strains, 5%). Major clinical manifestations included pyrexia, cough, and shortness of breath, as well as dyspnea in severe cases; the incidence rate of shortness of breath reached 78%, and 35% of all children had no obvious rale. The multivariate logistic regression analysis showed that age at the time of surgery, time of glucocorticoid application, cumulative time of the application of broad-spectrum antibiotics, and recurrent cholangitis were major risk factors for IPFIs after BA surgery.</p><p><b>CONCLUSIONS</b>The three most common pathogens of IPFIs after BA surgery are Candida albicans, Candida tropicalis, and Aspergillus. It is important to perform surgery as early as possible, avoid recurrent cholangitis, and shorten the course of the treatment with broad-spectrum antibiotics and glucocorticoids for decreasing the risk of IPFIs.</p>

Effects of ursodeoxycholic acid on mRNA expression of MDR3 and FXR in infants with cholestatic hepatitis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To analyze the effects of ursodeoxycholic acid (UDCA) on the mRNA expression of multidrug resistance protein 3 (MDR3) and farnesoid X receptor (FXR) in infants with cholestatic hepatitis.</p><p><b>METHODS</b>Twenty-eight infants who were diagnosed with cholestatic hepatitis between July 2008 and July 2010 were included in the study. These patients received treatment with UDCA. The mRNA expression levels of MDR3 and FXR were measured by real-time quantitative RT-PCR with SYBR Green I, before and after treatment with UDCA.</p><p><b>RESULTS</b>After treatment with UDCA, the infants with cholestatic hepatitis had significantly decreased serum levels of total bilirubin, direct bilirubin, alanine aminotransferase, and gamma-glutamyltransferase (P<0.05) and significantly increased mRNA expression of MDR3 (P<0.05). No significant change in mRNA expression of FXR was observed, however (P>0.05).</p><p><b>CONCLUSIONS</b>UDCA improves liver function indices in infants with cholestatic hepatitis, which may be related to up-regulated mRNA expression of MDR3.</p>

NF-κB levels in the liver of young rats with endotoxemic liver injury / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study hepatic NF-κB level following endotoxemic liver injury, and its relationship with hepatic TNF-α and IL-6 levels in young rats.</p><p><b>METHODS</b>Forty 18-day-old rats were randomly assigned to a normal control and an endotoxemia group. Endotoxemia was induced by lipopolysaccharide injection (LPS, 5 mg/kg). The endotoxemia group was subdivided into four groups sampled at 2, 6, 12 and 24 hrs after LPS injection (n=8 each). Pathological changes in liver cells were observed under a light microscope. TNF-α and IL-6 levels in liver tissue homogenates were measured using ELISA. Reitman-Frankel was used to measure serum ALT concentrations. NF-κB activation level in liver tissues was detected by immunohistochemistry.</p><p><b>RESULTS</b>Liver tissue injury was the most obvious 6 hrs after LPS injection under the light microscope, and the damage rating of liver tissues was significantly higher in the endotoxemia group than that in the normal control group at all time points (P<0.05). ALT levels in the endotoxemia group were significantly higher than those in the normal control group 6, 12 and 24 hrs after LPS injection (P<0.05). NF-κB p65 protein expression in liver cells (percentage of nuclear positive cells) in the endotoxemia groups was significantly higher than that in the normal control group (P<0.05). TNF-α and IL-6 levels in liver tissue homogenates in the endotoxemia groups were significantly higher than those in the normal control group 6 and 12 hrs after LPS injection (P<0.05).</p><p><b>CONCLUSIONS</b>Endotoxemia can cause liver injury, resulting in liver cell damage and changes in liver function. NF-κB activation is involved in endotoxemic liver injury which may be mediated by inflammatory cytokines TNF-α and IL-6 synthesis.</p>

Genetics Research of Multidrug Resistance Protein 3,Farnesoid X Receptor Gene in Intrahepatic Cholestasis / 实用儿科临床杂志

The etiology and pathogenesis of intrahepatic cholestasis are complex,and those are not still very clear in current.Studies suggest that genetic factors play an important role in the pathogenesis of the disease.Some familial cholestasis have been confirmed by gene mutation causing.Bile secretion process regulated by a number of bile relation gene at the molecular level.Farnesoid X receptor (FXR) gene is related to intrahepatic bile secretion process.Bile secretion is indirect control by FXR which formats a complex network,becoming more attention to researcher in recent years.