Analysis on the characteristics and patterns of work-related musculoskeletal disorders among sonographers in Guangdong Province / 中国职业医学

Objective To analyze the characteristics of work-related musculoskeletal disorders (WMSDs) among sonographers in Guangdong Province, and to explore the disease pattern of the cases. Methods A total of 512 sonographers from 31 hospitals in Guangdong Province were selected as the research subjects using stratified cluster sampling method. The prevalence of WMSDs in the past year was investigated using the Musculoskeletal Disorders Questionnaire, and the characteristics of WMSDs were analyzed. Latent class analysis was used to identify the disease pattern of WMSDs. Results The overall prevalence of WMSDs was 94.3%. The top five affected body parts were right shoulder, neck, right hand/wrist, lower back and right forearm/elbow, with the prevalence of 80.3%, 75.4%, 61.1%, 55.5% and 45.3%, respectively. The prevalence of WMSDs was higher on the right side for the shoulder, hand/wrist, forearm/elbow, hip/leg and knee compared with the left side (80.3% vs 31.3%, 61.1% vs 13.9%, 45.3% vs 10.0%, 17.4% vs 8.6%, 13.1% vs 8.4%, all P<0.05). The prevalence of WMSDs increased with work years, as well the prevalence of WMSDs in the top five affected body parts among the sonographers (all P<0.05). However, there were no statistical differences in prevalence of WMSDs between general hospitals and maternal and child health hospitals, tertiary hospitals and non-tertiary hospitals, Pearl River Delta hospitals and non-Pearl River Delta hospitals; there was also no statistical difference between different genders and age groups of the sonographers (all P>0.05). The best-fit latent disease pattern for sonographers WMSDs comprised three categories： symptom of neck-right shoulder, symptom of neck-lower back-right shoulder-right elbow-right hand/wrist, and symptom of multi-parts above the knees, with the latent probabilities of 0.438, 0.427 and 0.135, respectively. Conclusion The prevalence of WMSDs in sonographers is extremely high, with a dose-effect relationship with work years. The most common affected parts are neck, lower back and right shoulder, right hand/wrist, and right forearm/elbow. The prevalence of WMSDs in the right side of limb was higher than that in the left. WMSDs primarily occur in multiple parts simultaneously. The most common symptoms occur in the neck-right shoulder and neck-lower back-right shoulder-right elbow-right hand/wrist.

Proteomics study of Mycoplasma pneumoniae pneumonia reveals the Fc fragment of the IgG-binding protein as a serum biomarker and implicates potential therapeutic targets / 医学前沿

Macrolide and corticosteroid resistance has been reported in patients with Mycoplasma pneumoniae (MP) pneumonia (MPP). MP clearance is difficult to achieve through antibiotic treatment in sensitive patients with severe MPP (SMPP). SMPP in children might progress to airway remodeling and even bronchiolitis/bronchitis obliterans. Therefore, identifying serum biomarkers that indicate MPP progression and exploring new targeted drugs for SMPP treatment require urgency. In this study, serum samples were collected from patients with general MPP (GMPP) and SMPP to conduct proteomics profiling. The Fc fragment of the IgG-binding protein (FCGBP) was identified as the most promising indicator of SMPP. Biological enrichment analysis indicated uncontrolled inflammation in SMPP. ELISA results proved that the FCGBP level in patients with SMPP was substantially higher than that in patients with GMPP. Furthermore, the FCGBP levels showed a decreasing trend in patients with GMPP but the opposite trend in patients with SMPP during disease progression. Connectivity map analyses identified 25 possible targeted drugs for SMPP treatment. Among them, a mechanistic target of rapamycin kinase (mTOR) inhibitor, which is a macrolide compound and a cell proliferation inhibitor, was the most promising candidate for targeting SMPP. To our knowledge, this study was the first proteomics-based characterization of patients with SMPP and GMPP.

Observed to expected lung area to head circumference ratio at different gestational ages with various measurements in predicting indication for extracorporeal membrane oxygenation in fetuses with isolated left-sided congenital diaphragmatic hernia / 中华围产医学杂志

Objective:To investigate the prediction value of observed to expected lung area to head circumference ratio (o/e LHR), measured at different gestational age with various methods, on indication for extracorporeal membrane oxygenation (ECMO) in fetuses with isolated left-sided congenital diaphragmatic hernia (CDH).Methods:Clinical data of 40 neonates who were diagnosed with left-sided CDH and treated in Guangzhou Women and Children's Medical Center were retrospectively collected from January 2017 to May 2021. The o/e LHRs were prenatally calculated using maximum diameter and tracing method at 22-24 and 31-33 weeks of gestation. According to whether the neonates had indications for ECMO after birth or not, they were divided into ECMO ( n=12) or non-ECMO group ( n=28). Differences in the o/e LHR and general situations between the two groups were analyzed using C hi-square test, independent sample t-test, and non-parametric Mann-Whitney U test. Binary logistic regression was used to analyze the influencing factors for ECMO requirement and receiver operating characteristic (ROC) curve was used to evaluate the value of o/e LHR in predicting the indication for ECMO. Results:Both maximum diameter and tracing method suggested that the o/e LHR at 31-33 gestational weeks was lower than that at 22-24 gestational weeks [maximun diameter method: 40.4 (32.9-51.5) vs 45.1 (36.3-53.4), Z=－2.48, P=0.013; tracing method: 38.6 (33.2-47.6) vs 44.1 (35.9-51.7), Z=－3.29, P=0.001]. There was no statistical difference in o/e LHR detected at the same gestational weeks between the two methods (both P>0.05). Binary logistic regression showed that o/e LHR measured at 31-33 gestational weeks using maximum diameter method was an independent protective factor for ECMO requirement ( OR=0.873, 95% CI: 0.790-0.965, P=0.008). ROC curve analysis showed that the area under the curve for evaluating the predictive value of o/e LHR for ECMO requirement was 0.830 with the sensitivity of 83.3% and the specificity of 71.4% when the cut-off value of o/e LHR at 31-33 gestational weeks was 38.195 measured by maximum diameter method. Conclusions:The o/e LHR measured at 31-33 weeks is lower than that at 22-24 weeks of gestation by both methods. The o/e LHR measured by maximum diameter method at 31-33 weeks of gestation may be useful for predicting the ECMO indication after birth but requiring comprehensive evaluation of clinical conditions due to its insufficient predicting power.

Correlation of serum homocysteine levels with hematoma absorption and cognitive function in elderly patients with cerebral hemorrhage / 中华老年医学杂志

Objective:To analyze the correlation of serum homocysteine(Hcy)levels with hematoma absorption and cognitive function in elderly patients with cerebral hemorrhage.Methods:Clinical data of 80 elderly patients with cerebral hemorrhage admitted to our hospital from January 2017 to July 2019 were retrospectively analyzed.According to serum levels of Hcy(normal range: <15 μmol/L), 21 patients with serum Hcy<15 μmol/L were included in Group A, and 59 patients with Hcy≥15 μmol/L were included in Group B. General data(gender, age, hypertension, diabetes, bleeding part, bleeding volume, etc.), hematoma absorption and cognitive function were recorded and compared between the two groups.The correlation of serum Hcy levels with hematoma absorption and cognitive function in elderly patients with cerebral hemorrhage was analyzed by using Spearman correlation analysis.Results:There was no statistical difference in gender, age, hypertension, diabetes, bleeding location and bleeding volume between the two groups.The speed of hematoma absorption and scores of Montreal Cognitive Assessment(MoCA)were higher in Group A than in Group B[(0.4±0.1)ml/d vs.(0.3±0.1)ml/d, (19.6±4.6)points vs.(16.3±3.3)points, t=3.935 and 3.532, both P=0.000]. Spearman correlation analysis showed that serum Hcy level was negatively correlated with hematoma absorption and cognitive function in elderly patients with cerebral hemorrhage( r=-0.372 and-0.311, P=0.000 and 0.005), indicating that hematoma absorption and cognitive function were worse with the higher serum Hcy levels in elderly patients with cerebral hemorrhage. Conclusions:Serum Hcy levels change in elderly patients with cerebral hemorrhage.As serum Hcy levels increase, the risk for adverse events such as slow hematoma absorption and unsatisfactory improvement in cognitive function in patients increases accordingly.Serum Hcy levels play an important role in the occurrence and development of diseases in elderly patients with cerebral hemorrhage and can be used to evaluate the condition and prognosis of patients with cerebral hemorrhage.

Clinical analysis of methylmalonic acidemia and hyperhomocysteinemia with diffuse lung disease as an initial or main presentation / 中华儿科杂志

Objective@#To improve the awareness of methylmalonic acidemia and hyperhomocysteinemia with diffuse lung disease as an initial or main presentation.@*Methods@#A retrospective analysis of the clinical manifestations, radiological features, laboratory tests, genetic variations, treatments and prognoses was conducted in six children presented with diffuse lung disease and finally diagnosed with methylmalonic acidemia and hyperhomocysteinemia in Ward 2 of Department of Respiratory Diseases, Beijing Children′s Hospital, from August 2017 to November 2018.@*Results@#Six children were included in this study. Two children were male and four were female. The average age of onset was 28 months. The mean age at diagnosis was 34 months. The average interval from onset to diagnosis was 6 months. Four children who underwent genetic tests were found to have variants of gene MMACHC and diagnosed with CblC type. All children had respiratory symptoms and signs as initial or main presentation, which were tachypnea (5 cases), exercise intolerance (5 cases), cough (4 cases), cyanosis (4 cases), clubbing (4 cases), dyspnea (3 cases) and retractions (3 cases). Pulmonary arterial hypertension was found in all six children. Pericardial effusion (4 cases), kidney involvement (3 cases), nervous system involvement (3 cases), gastrointestinal system involvement (3 cases) and anemia (2 cases) also coexisted. The high resolution computed tomography (HRCT) features included dilated pulmonary artery (6 cases), ground-glass opacities (4 cases), diffuse poorly defined ground-glass centrilobular nodules (3 cases), pleural effusion (3 cases), thickening of interlobular septum (2 cases), etc. All children had an elevated concentration of methylmalonic acid in urine and homocysteine in plasma. Genetic tests were performed in four patients, and MMACHC genetic mutations were found in all of them. Clinical manifestations, HRCT features and pulmonary arterial hypertension turned better in five children after treatment. One patient who was not regularly followed-up died.@*Conclusions@#Pulmonary involvement including diffuse lung disease and pulmonary arterial hypertension could coexist with methylmalonic acidemia and hyperhomocysteinemia, which may have respiratory symptoms and signs as the initial or main presentation. Characteristic HRCT features were found in some patients. Plasma homocysteine test is a quick method for screening the disease in children with diffuse lung disease and (or) pulmonary arterial hypertension. Both diffuse lung disease and pulmonary arterial hypertension may turn better after treatment.

Exploratory research on diagnostic essentials of pediatric tuberculous pleurisy / 中华儿科杂志

Objective@#To summarize the clinical diagnostic essentials of pediatric tuberculous pleurisy so as to reduce the misdiagnosis rate.@*Method@#A retrospective study was conducted on 113 cases of tuberculous pleurisy who were seen from August 2006 to September 2014 in the second Department of Respiratory Medicine, Beijing Children′s Hospital Affiliated to Capital Medical University. Meanwhile, another 113 cases of children over 5 years of age with mycoplasma pneumoniae pneumonia complicated with pleural effusion were randomly selected as control group. The following five items were analyzed in relation to the diagnosis: fever, cough, lung lesions, pleural effusion(unilateral or bilateral), adenosine deaminase (ADA) level in pleural effusion, tuberculin skin test(PPD). The sensitivity and specificity of single item and combined items in diagnosis were studied.@*Result@#(1) Among two groups, the proportion of patients with persisting fever was 92.0% (104 cases) and 98.2% (111 cases), while the proportion of patients with cough was 47.8% (54 cases) and 99.1% (112 cases) (χ2=76.3, P<0.01), respectively. There were 25(22.1%) cases and 113(100.0%) cases with lung lesions (except for atelectasis) in two groups (χ2=144.1, P<0.01), respectively. The proportion of patients with unilateral pleural effusion was 94.7%(107 cases) and 71.7%(81 cases)(χ2=21.4, P<0.01) while the patients with positive PPD results was 93.8%(106 cases) and 3.5%(4 cases)(χ2=184.3, P<0.01). The level of ADA in pleural effusion in both groups are comparable[46.4(22.0-70.9)U/L]and[39.5(26.3-78.5)U/L]. (2)The sensitivity of the lack of cough, lack of lung lesions, unilateral pleural effusion and PPD test positive in diagnosis of tuberculous pleurisy were 52.2%, 77.9%, 94.7%, 93.8%, while the specificity was 99.1%, 100.0%, 28.3%, 96.5%, respectively. Among the four items, the specificity of unilateral pleural effusion was only 28.3%, so it needed to be added with other indicators to improve the specificity. The sensitivity of unilateral pleural effusion combined with positive PPD, lack of cough, lack of lung lesions were 88.5%, 50.4% and 73.5%, while the specificity was 96.5%, 99.1%, and 100.0%, respectively, which significantly improved the specificity so as to reduce misdiagnosis.@*Conclusion@#In children aged over 5 years who present with persistent fever and pleural effusion, tuberculous pleurisy should be considered even in the absence of cough or lung lesions(except for atelectasis), or with positive PPD result, any of the three features is specific for the diagnosis. Unilateral pleural effusion is more meaningful for the diagnosis when it is combined with any of the above three features.

Clinical features of pediatric tuberculous pleurisy / 中华实用儿科临床杂志

Objective To sum up the clinical manifestations and laboratory features for the diagnosis of pediatric tuberculous pleurisy,and to improve the recognition of this disease in early stage.Methods A retrospective study of 113 children diagnosed as tuberculous pleurisy from August 2006 to September 2014 in the Second Department of Respiratory Medicine,Beijing Children's Hospital Affiliated to Capital Medical University was conducted.Meanwhile,another 113 cases of children with mycoplasma pneumoniae pneumonia complicated with pleurisy were selected as control group.The general information,clinical symptoms,pleural effusion and imaging features between 2 groups were analyzed and compared by using SPSS 16.0 statistical software.Results The proportion of patients with cough in tuberculous pleurisy group and control group was 47.79％ (54/113 cases) and 99.12％ (112/113 cases) (x2 =76.33,P ＜ 0.01) respectively,and the proportion with severe cough was 3.70％ (2/54 cases) and 97.32％ (109/112 cases) (x2 =144.10,P ＜0.01),while the disease duration was 15.00 (10.00,30.00) days and 10.00 (8.00,14.50) days (W =8 668.00,P ＜ 0.01),respectively,and all the differences between 2 groups were significant.The proportion of patients with low fever,moderate fever,high fever and hyper fever was 8.65％ (9/104 cases),47.12％ (49/104 cases),44.23 ％ (46/104 cases) and 0,respectively in tuberculous pleurisy group,while the proportion was 0.90％ (1/111 cases),18.92％ (21/111 cases),79.28％ (88/111 cases) and0.90％ (1/111 cases) respectively in control group,and the difference between 2 groups was significant(W =9 064.00,P ＜ 0.01).The unilateral effusion ratio in tuberculous pleurisy group and the control group was 94.69％ (107/113 cases) and 71.68％ (81/113 cases),respectively (x2 =21.39,P ＜ 0.01).The monocyte ratio was higher in tuberculous pleurisy group [0.89 (0.76,0.93)] than that in the controlgroup [0.60 (0.30,0.78)] (W =888.50,P ＜ 0.01) and the level of protein in 2 groups was [51.00 (47.35,54.20) g/L] and [42.10 (37.85,46.15) g/L],respectively (W =842.50,P ＜ 0.01).The level of lactate dehydrogenase (LDH) in tuberculous pleurisy group[553.50 (358.00,749.25) U/L] was lower than that in the control group[1 189.10 (670.95,1 820.00) U/L] (W =2 186.00,P ＜ 0.01),and the differences were significant between 2 groups.In addition to pleural effusion,the high density was the main feature of imaging examination in 2 groups.The proportion of patients with atelectasis was 77.88％ (88/113 cases) and 4.42％ (5/113 cases) (x2 =125.90,P ＜ 0.01),while the proportion of patients with consolidation was 4.42％ (5/113 cases) and 72.57 ％ (82/113 cases),respectively (x2=110.80,P ＜ 0.01).All the differences between 2 groups were significant.The sputum culture-positive rate of mycobacterium tuberculosis was only 1.77％ (2/113 cases) and the other pathogen examinations were negative in tuberculous pleurisy group.Conclusions For patients with unilateral pleural effusion,when the onset only has fever (moderate-high fever),and respiratory symptoms are not clear or symptoms are not proportional to radiographic severity,or when high monocytes proportion (＞ 0.70) in pleural effusion and radiographic evidence of compression atelectasis are observed,tuberculous pleurisy should be considered and further questioning of the predisposing factors,purified protein derivative test should be taken so as to diagnose the tuberculous pleurisy at early stage.

Allergic bronchopulmonary aspergillosis: a report of four cases with literature review / 中华儿科杂志

<p><b>OBJECTIVE</b>To understand the clinical characteristics of allergic bronchopulmonary aspergillosis (ABPA) so as to diagnose and treat the disease earlier.</p><p><b>METHOD</b>A retrospective study was conducted on ABPA patients diagnosed in the Second Department of Respiratory Medicine, Beijing Children's Hospital Affiliated to Capital Medical University from April 2010 to March 2014. The literature of children's ABPA retrieved from the databases at home and abroad in recent 10 years were analyzed.</p><p><b>RESULT</b>(1) Among the 4 cases of ABPA, cystic fibrosis (CF) and asthma were diagnosed in 2 and 1 cases, respectively. Cough was present in 3 patients, recurrent wheezing in 2 and chest tightness in 1 case. CT scans showed central bronchiectasis in all 4 cases, while 1 patient had migratory shadows. All cases had elevated serum total IgE, immediate cutaneous reaction to aspergillus fumigatus; A. fumigatus-specific IgE and IgG were positive in 4 cases. The diagnosis of the 4 cases was confirmed according to the history, radiologic investigations and laboratory findings. All of them were improved after the treatment with glucocorticosteroid and antifungal agents (voriconazole or itraconazole). (2) We retrieved articles on the ABPA in the databases at home and abroad published in the recent 10 years, there were 22 foreign reports and only one case in domestic report. Among the 22 foreign cases, 16 patients were CF, 3 were asthmatics. ABPA was diagnosed as the initial presentation in only one case with CF.</p><p><b>CONCLUSION</b>In asthmatics or the patients with allergic disease, if there are highly elevated serum total IgE, central bronchiectasis or recurrent atelectasis in chest imaging, the patients should be further investigated for ABPA. The diagnosed cases of ABPA should be screened for CF routinely.</p>

Clinical analysis of 2 cases with chylothorax due to primary lymphatic dysplasia and review of literature / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics and diagnosis of 2 cases with chylothorax due to primary lymphatic dysplasia and to elevate pediatrician's recognition level for this disease.</p><p><b>METHOD</b>Clinical manifestations of the children were retrospectively analyzed. Primary lymphatic dysplasia was diagnosed by lymphoscintigraphy.</p><p><b>RESULT</b>The first patient was a male aged 2-year-7-month who presented with a history of tachypnea for 43 days, fever and sore throat for 5 days at the early stage of the illness. He had a history of external injury before his illness. Physical examination showed his left chest bulging and left side diminished breath sound. His pleural effusion showed dark red (It was divided into two layers after standing, the upper layer turned into milky white, and the lower turned into hemorrhagic liquid) . White blood cell (WBC) count was 9 000×10(6)/L, mononuclear cell was 0.9, polykaryocytes was 0.1, triglyceride was 12.37 mmol/L in the pleural effusion. Contrast-enhanced lung CT (revascularization) showed pericardial effusion and a massive left sided pleural effusion. The second patient was a male aged 9 years and 6 months, who presented with a history of cough for 24 days, intermittent fever, vomiting, abdominal pain for 19 days, and edema of lower limbs for 4 days. Physical examination showed edema in both eyelids, lower extremities and scrotum. The level of albumin was 14 g/L and the titer of Mycoplasma pneumoniae IgM was 1: 320 in the serum. His hydrothorax pleural effusion showed milk white. White blood cell (WBC) count was 74×10(6)/L, mononuclear cell was 0.78, polykaryocytes was 0.22, triglyceride was 1.01 mmol/L in the pleural effusion. Chyle test showed positive in his pleural effusion and seroperitoneum. High-resolution CT of the lung revealed bilateral interstitial and parenchymal infiltration and both sided pleural effusion. Abdominal ultrasound showed giant hypertrophy of the gastric mucosa and massive ascites. Gastroscopy showed giant hypertrophy of the gastric mucosa. Lymphoscintigraphy revealed primary lymphatic dysplasia in both children.</p><p><b>CONCLUSION</b>Primary lymphatic dysplasia might occur in children and result in dropsy of serous cavity (chylothorax, chylopericardium, chylous ascites). Dropsy of serous cavity showed bloody or milk white. WBC count might elevate with lymphocyte increasing mostly, triglyceride was often higher than 1.0 mmol/L in dropsy of serous cavity. Primary lymphatic dysplasia can be diagnosed by lymphoscintigraphy.</p>

Clinical characteristics of children with Langerhans cell histiocytosis with pulmonary involvement / 中华儿科杂志

<p><b>OBJECTIVE</b>To improve the recognition of the clinical presentation and radiologic manifestation of children with Langerhans cell histiocytosis (LCH) with pulmonary involvement.</p><p><b>METHOD</b>A retrospective analysis was conducted on children who presented with respiratory symptoms or abnormal lung radiologic findings, and finally diagnosed with LCH in Ward 2 of Divison of Respiratory Diseases, Beijing Children's Hospital during the last 4 years.</p><p><b>RESULT</b>Fourteen children (10 boys and 4 girls) were included in this study. Male to female ratio was 2.5: 1. The median age was 1.3 years. Pulmonary involvements were coexisted with other involved organs in all the patients, such as skin (10 cases, 71%), liver (8 cases, 57%), and bone involvement (7 cases, 50%). The most common symptoms were cough and fever (7 cases, 50%). Respiratory symptoms were nonspecific, and 3 children had no respiratory symptom but abnormal findings on lung high-resolution CT (HRCT). The most common HRCT finding was the coexistence of nodules and cysts (6 cases, 43%). Other findings include cysts only (5 cases, 36%), nodules only (1 case), and with neither nodule nor cyst (2 cases, 14%). Pneumothorax was found in 7% of children.</p><p><b>CONCLUSION</b>Pulmonary involvement in children with LCH is easily misdiagnosed, and often coexisted with other involved tissues/organs such as skin and liver. Rash, which is easily missed in physical examination is very important for the diagnosis of LCH. The characteristic findings of lung HRCT (nodules and/or cysts) are helpful for diagnosis.</p>

The serumproteomics research of vinyl chloride workers / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To screen out serum differential proteins between vinyl chloride monomer (VCM)-exposed workers and healthy controls by proteomics and analyze the functions of differential proteins, and to provide a basis for elucidating the pathogenesis of diseases caused by VCM exposure and searching for the protein biomarkers.</p><p><b>METHODS</b>Fasting venous blood was collected from 125 VCM-exposed workers and 40 healthy controls according to accumulated exposure doses. Proteins were precipitated by acetone precipitation. These proteins were identified by 2D-nano LC-ESI-TOF/MS and quantified by isobaric tags for relative and absolute quantitation. The functions of differential proteins were analyzed by gene ontology.</p><p><b>RESULTS</b>A total of 596 proteins were identified, including 194 quantified proteins. There were 21 differential proteins according to the screening criteria (19 upregulated proteins and 2 downregulated proteins), including complement, apolipoprotein, and glycoprotein. The functions of these differential proteins were binding, enzyme regulator activity, catalytic activity, and transporter activity, and they were involved in the biological processes including immune system process and response to stimulus.</p><p><b>CONCLUSION</b>The complement, apolipoprotein, and glycoprotein identified in the proteomics may be related to liver injury caused by VCM exposure, and they could be used as candidate protein biomarkers of diseases caused by VCM exposure.</p>

Clinical features and treatment of refractory Mycoplasma pneumoniae pneumonia unresponded to conventional dose methylprednisolone in children / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the clinical manifestations of refractory Mycoplasma pneumoniae pneumonia (RMPP) which unresponded to methylprednisolone in the dosage of 2 mg/(kg·d) for 3 days.</p><p><b>METHOD</b>Retrospective analysis was performed on the clinical data of 110 children (64 boys and 46 girls) with RMPP. The patients were divided into "effective group" and "ineffective group" according to initial effect of 2 mg/(kg·d) methylprednisolone. The clinical manifestations, laboratory examination, radiological features and bronchofibroscopic findings of the children were compared. In order to seek the reference indexes which indicate nonresponsive to 2 mg/(kg·d) methylprednisolone, an ROC curve was made, of which the diagnostic cut-off was five independent correlation factors while grouping was made according to patients' different response to glucocorticosteroid.</p><p><b>RESULT</b>The effective group had 86 (86/110, 78.2%) children while ineffective group had 24 (24/110, 21.8%). The ineffective group children had the following performance: 16 children (16/24, 66.7%) in ineffective group had ultrahyperpyrexia (T ≥ 40 °C), which was significantly more severe compared to those in effective group (32/86, 37.3%, P < 0.01); the levels of white blood cell (WBC) count, percentage of neutrophils count (N), C-reactive protein (CRP), serum ferritin (SF), alanine transaminase (ALT), lactic dehydrogenase (LDH), creatine kinase isoenzyme (CK-MB) and fibrinogen (Fib) in ineffective group were significantly higher than those in effective group(P < 0.01); while percentage of lymphocyte count (L) was lower than that in effective group(P < 0.01). Proportion of mixed infection in ineffective group was higher than that in effective group (33.3% vs. 4.7%). Radiological manifestations: It was more frequently seen in ineffective group that chest CT scan indicated high density consolidation in no less than a whole pulmonary lobe and pulmonary necrosis (41.7% vs. 0%). Abundant secretions blockage (45.0% vs. 16.9%) and mucosal necrosis (37.5% vs. 8.1%) on bronchofibroscopy were more frequently seen in ineffective group. The critical values of the five independent correlation factors were CRP 110 mg/L, SF 328 mg/L, LDH 478 IU/L, N 0.78, L 0.13.</p><p><b>CONCLUSION</b>Treatment with 2 mg/(kg·d) methylprednisolone can improve clinical symptoms and radiological manifestations of most children with RMPP quickly, but it may be ineffective in some situations such as lasting high fever or ultrahyperpyrexia for more than 7 days, CRP ≥ 110 mg/L, N ≥ 0.78, L ≤ 0.13, serum LDH ≥ 478 IU/L, SF ≥ 328 µg/L, chest CT scan indicating high density consolidation in more than a whole pulmonary lobe involved and moderate-abundant pleural effusion.</p>

Mechanisms of refractory Mycoplasma pneumoniae pneumonia in children / 临床儿科杂志

Most of Mycoplasma pneumoniae pneumonia (MPP) will be controlled after being treated with macrolide antibiotics. But in recent years refractory Mycoplasma pneumoniae pneumonia (RMPP), including severe mycoplasma pneumoniae pneumonia, are increased. RMPP often causes many severe complications and sequelae such as necrotizing pneumonia, bronchiolitis obliterans, bronchitis obliterans, atelectasis and bronchiectasis. Two main mechanisms of MPP are proposed: damages to airway directly by mycoplasma pneumonia (MP), and inflammatory reaction caused by mycoplasma pneumoniae (MP). RMPP is also associated with many other factors such as MP genotype and load, macrolide-resistant MP, airway mucus hypersecretion, hypercoagulability, combined infection with bacteria or viruses, and community acquired respiratory distress syndrome toxin (CARDS Tx). The exploration of mechanisms of RMPP helps us acquire effective treatment and prevent sequelae.

Fetal cisterna magna septa: sonographic feature and its clinical significance / 中华超声影像学杂志

Objective To establish normative data for the fetal cisterna magna septa (CMS) at various gestational age,and to evaluate its clinical significance.Methods A total of consecutive fetal between 14 and 40 gestational week(GW) were included in this prospective study.The length and width of CMS were measured by two-dimensional ultrasonography.Regression analysis was used to study the relationship between the width and length of the fetal cisterna magna septa and gestational age.Twenty-five case of fetuses with the absence of CMS and 12 case of fetuses with the enlargement of CMS were retrospectively analyzed in the past six years in our hospital.Results ①The fetal CMS length and width increased gradually between 14 and 22 GW,then plateaued between 23 GW and 36 GW,and decreased after 37 GW.This ultrasonographic pattern was in agreement with normal development of rhombencephalon.②The absence of CMS in the fetuses were common in Dandy-Walker syndrome,holoprosencephaly,severe hydrocephalus,neural tube defects,rhombencephalon synapsis and Arnold-Chiari malformation.The enlargement of CMS in the fetuses may be shown in physiologic enlargement of posterior fossa.ConclusionsCMS is a potential new marker for normal development of rhombencephalon.The enlargement and absence of CMS are related to various malformations of central neural system,especially in the abnormalities of posterior fossa.

Diagnostic value of echocardiographic detection in the differentiation of normal and coarctation of the aorta in fetuses / 中华超声影像学杂志

Objective To establish normal reference indexes of aorta during gestation and cut-points for detection of fetuses with coarctation of aorta.Methods From long-axis views of the aortic arch,the internal diameter of the aortic root,ascending aorta,transverse aortic arch,aortic isthmus,descending aorta,anonyma,left common carotid artery,left subclavian artery were measured in 234 normal fetuses at different time ranging from 14 to 41 weeks during gestation.Reference values of each aortic segment were constructed by linear regression analysis.The ratio of each aortic segment to the ascending aorta were calculated.ResultsThe internal diameter in each aortic segments increased as pregnancy progressed (P<0.01).In the prenatal diagnosis of fetus with coarctation of the aorta,the ratio of the aortic isthmus to the ascending aorta and descending aorta to the ascending aorta were significantly lower than the normal fetuses(all P<0.01).Conclusions The ratio of the aortic isthmus to the ascending aorta and ratio of descending aorta to the ascending aorta detected by echocardiography may be helpful in the prenatal diagnosis of coarctation of aorta.

Value of transabdominal ultrusonography in detection of cerebellar vermis in fetus / 中华超声影像学杂志

Objective To detect the normal values of fetal cerebellar vermis using transabdominal ultrasonography and assess its clinical significance in the diagnosis of vermal hypoplasia(agenesis). Methods A total of 111 fetuses were evaluated by transabdominal sonography between 20 and 40 weeks of gestation.The mid-sagittal antero-posterior(AP) and cranio-caudal(CC) vermian diameters were measured. A second group of 15 fetuses with cisterns magna were assessed and compared with the value of normal fetuses.0.05) and correlated linearly with gestational age ( AP = - 5.406 + 0. 761 GA, r = 0.97 ; CC = - 5.795 +fissure, second fissure and fastigium may help identify developmental anomalies. Conclusions Transabdominal ultrasonography is a valuable tool in the study of fetal vermis during the second half of pregnancy.

Infant feeding practices and weight gain for length of term normal birth weight infants in the first 6 months of life / 临床儿科杂志

Objective To explore the relationship between infant feeding practices and infants growth,especially the weight gain for length in the first 6 months of life. Methods Two-hundred healthy full-term singlet normal birth weight 5 - 6 months old infants and their main care givers were recruited in Kongjiang community health service center in Shanghai. The questionnaires included infants feeding pattern, feeding environment and care givers feeding behaviors, and were completed on-site by investigators. The birth weight was obtained. The weight and length of infants at 6 months were measured. Results There were 70/200 (35.0%) infants overweight (BMI for age Z score>+1) at 6 months. There were more overweight boys than girls (40.0% vs. 30.9%, x2 = 1.798, P = 0.180). Compared with normal weight infants, the overweight infants had same birth weight (3.30 ± 0.35 kg vs. 3.35 ± 0.32 kg, t =1.010, P = 0.314) and same length at 6 months (67.64 ± 2.10 cm vs. 67.91 ± 1.97 cm, t=- 0.896, P = 0.371). However, the overweight infants gained much more weight for length in the first six months of life. At 6 months, the weight and BMI of overweight infants was significantly higher than that of normal weight infants (9.16 ± 0.67 vs. 7.94 ±0.64, t = 12.324, P 0.05). The grandparents played an important role in infants feeding in Shanghai. There were 39.0% infants fed only by grandparents, and 23.0% infants fed jointly by grandparents and parents (x2 = 0.175, P > 0.05).The care givers' educational level and knowledge of feeding skill were similar in overweight and normal weight infants (x2 = 0.446, t = 0.949, P > 0.05). However, the overweight infants were fed more quickly than normal weight infants (Z = 2.753, P < 0.01), and there was less language communication between care givers and overweight infants during feeding (Z = 2.932, P < 0.01). In overweight infants, the overfeeding behaviors of care givers were positively correlated with BAZ (r = 0.281, P < 0.05). Conclusions Overweight in early life is associated with some particular infants feeding behaviors of care givers in Shanghai. The long term effect of more rapid weight gain for length in the first 6 months of life on the risk of childhood obesity warranted to be further followed and researched.

Content determination of polysaccharides in root of cultivated Glycyrrhiza from different growth time / 中成药

AIM: To measure and compare the content of glycyrrhizic polysaccharides in Glycyrrhiza in three different growth time. METHODS: The contents of polysaccharides were determined by phenol-sulfuric acid method and by reference to glucose, and wavelenth in spectrophotometer was set at 490 nm. RESULTS: There was difference of the content of the extracted polysaccharides among Glycyrrhiza for 1, 2 and 3 year, amounted to 11.75%, 11.07%, 7.88%, respectively. CONCLUSION: Annual glycyrrhiza appeared to be the appropriat crude drug for polysacchrides content. 1.Colle