Objective To analyze the etiology of community-acquired pneumonia in hospitalized children. Methods A retrospective descriptive study was undertaken among pediatric patients with community-acquired pneumonia admitted to Beijing Children's Hospital from December 2012 to November 2013.Clinical data including gender, age, hospitalization time, etiology and other data were collected. The etiology characteristics of these patients in different ages and seasons were analyzed. Results ①1 853 hospitalized children aged from 28 days to 18 years with community-acquired pneumonia were included,and 1 447(78.1%)patients were positive for at least one pathogen. The bacteria positive rate was 27.0%, and the most frequent detected bacteria was streptococcus pneumonia, followed by haemophilus influenza and klebsiella pneumonia. The virus positive rate was 22.5%, the most common detected virus was respiratory syncytial virus,followed by adenovirus. Mycoplasma pneumonia positive rate was 48.7%. Mixed infection rate was 23.0%. ②With the growth of the age, the proportion of cases with single bacterial or viral infection decreased sharply, the proportion of cases with mycoplasma pneumoniae infection increased significantly, and the proportion of cases with multiple pathogens increased. Streptococcus pneumoniae infection often occurred in cases under 3 years of age (75.9%). Haemophilus influenzae infection (75.0%) and klebsiella pneumonia infection (68.4%) were found commonly in cases under 1 year of age. Respiratory syncytial virus infection was much more common in infants under 1 year of age (76.2%), adenovirus infection was more common in children under 3 years of age (82.3%). ③Single bacterial infection occurred the most commonly in spring while single virus infection occurred predominantly in winter, and single mycoplasma pneumoniae infection occurred the most commonly in autumn. Mixed pathogen infection occurred the most commonly in winter and spring; non-confirmed pathogens infection occurred the most commonly in spring. Streptococcus pneumoniae infection was more common in winter and spring, and haemophilus influenza infection was more common in spring. Klebsiella pneumoiae infection often occured in winter and spring. Respiratory syncytial virus infection was much more common in winter, and adenovirus infection was more common in winter and spring. Conclusion Mycoplasma pneumoniae most commonly infects children older than 5 years. Instead, bacterial and virus often infect children under 1 year old. Bacterial and viral infections occurs commonly in winter，while mycoplasma pneumoniae infections often occurs in summer and autumn.

Objective Prechtl's Qualitative general movements assessment (GMs assessement) was first applied in our clinical research in China. Predictive validity and reliability of GMs assessment for neurological outcome in high risk neonates were studied. Methods According to the inclusion and exclusion criteria, infants who took part in our follow-up clinic after discharged from our neonatal intensive care unit were confirmed as the participants. GMs recordings during preterm GMs and writhing movements period (at least once) and fidgety movements period (at least once) were collected and assessed. Neurological outcome was determined at least after one year old. Peabody Developmental Motor Scale-2(PDMS-2) was adopted to confirm the presence of motor retardation. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Interscorer reliability was tested in 12 infants by 30 observers. 12 infants received a second assessment to assess test-retest reliability after a two month interval by 6 observers. Results 58 (male 34, female 24 )high risk neonates after follow-up (12-40 mos ) were included as study participants. 42 (72%) preterm infants with an average gestational age as (31.4± 2.0)weeks and an average birth weight as (1 642 ±408)gram were included. 16 (28%) fullterm infants with an average gestational age as (38.6 ±1.1)weeks and an average birth weight as (3 401±365)gram were included. During preterm GMs and writhing movements period, 115 GMs recordings with an average of (2.0 ±0.8) times per infant were collected. During fidgety movements period, 89 GMs recordings with an average of (1.5 ±0.6) times per infant were collected. The neurological outcomes were as follows: 7 (12%)infants with spastic cerebral palsy, 5 (9%) infants with motor retardation and 46(79%)with normal motor development. In preterm GMs and writhing movements period, predictive validity was as follows: sensitivity 83%, specificity 78%, positive predictive value 50%, and negative predictive value 95%. In fidgety movements period, predictive validity was as follows: sensitivity 75%, specificity 98%, positive predictive value 90%, and negative predictive value 94%. GMs assessment was found to possess a good interscorer reliability(ICC：0.97-0.99) as well as a moderate testretest reliability(ICC：0.69). Conclusions GMs assessment can be used in high risk infants within 4 to 5 months to give a reliable and valid prediction for later neurological outcome, especially for cerebral palsy. There existed a high interscorer reliability and moderate test-retest reliability in basic observers. As a non-invasive, non-intrusive, simple and economical neurological assessment tool, GMs assessment can be extensively used in China.

Objective：To examine the tracking of BP from childhood to adulthood.Methods：The "Beijing children and adolescents BP study cohort" consists of 2505 subjects of 6-18 years old who were enrolled in the baseline BP investigation in 1987. Among them, 412 individuals aged 23-37 years were successfully followed up in 2005. In this study, clinical examinations and questionnaire about risk factors of CVD were carried out. Three blood pressure measurements were obtained by trained observers by use of a standardized mercury sphygmomanometer after a 5-minute sitting rest. The classification for hypertension in children and adolescents was based on the BP percentile of healthy children, which were set up during the 1987 study.Results：（1）From 1987 to 2005, the mean of systolic blood pressure (SBP) level and diastolic blood pressure(DBP) level increased with age in both males and females. The BP level increased higher among males than among females. The SBP level increased higher than the DBP level. Before puberty, the BP level increased with age in both males and females. After puberty, the accrescence of BP level was more significantly in males than in females.（2）Taking account of adult height and BMI, there was a positive correlation between the two BP levels during childhood and adulthood, (for SBP r=0.23, P<0.01 in males, and r=0.38, P<0.01 in females; for DBP r=0.29, P<0.01 in males and r=0.19, P<0.01 in females),varying by age and sex.（3）Dividing the subjects into groups according to whose SBP and DBP levels during childhood respectively, ie

Objective Henoch-Sch?nlein purpura (HSP), termed as Henoch-Sch?nlein purpura nephritis(HSPN) when a renal involvement was found, is the most common systemic vasculitis affecting children with whose pathogenesy remaining poorly understood as yet. HSPN is one of the most common secondary renal disease as well as the most serious complication of HSP. The attention being paid globally is attributable to the factor that degree of renal involvement may have some effects on the severity and outcome directly. No definite data as yet on choice of time as for corticosteroids administration. Thus we search all studies that have been published worldwide with regards to the effectiveness of the early administration of corticosteroids for reducing risk to renal involvement in patients with HSP by means of Meta-analysis, in order to give some evidences for the choice of corticosteroids dealing with HSP. Methods Evaluate strictly all the studies that have been searched and adopted the studies in high quality that can be analyzed by means of Meta-analysis. Calculate the odds ratio for renal involvement during the time from initial episode to the end of follow-up between treatment with corticosteroids and control. Revman4.2 software was applied to process the data. Results Totally 5 studies including 398 cases were analyzed. The cumulative cases in treatment group were 206, in which 16 developed renal involvement, while in control were 192 and 42 respectively. The pooled OR was 0.29, with a 95% confidence interval (0.16-0.54). Conclusions corticosteroids being used in early stage of HSP can benefit patients for reducing risk to renal involvement compared with control.

ABSTRACT Objective To investigate the prevalence of type 2 diabetes mellitus in children and adolescents in Shanghai，and to study the high risk factors of type 2 diabetes mellitus in children and adolescents in Shanghai. Methods Screening for type 2 diabetes mellitus using morning urine and blood testing among school children aged from 1l to 18 years in 12 schools in Shanghai. Results (1) 125 Children tested positive in the first urine-glucose screening and 15children tested positive in the second screening． (2)5Children were diagnosed as type 2 diabetes mellitus，the prevalence was 4.79／10,000． (3)The prevalence of type 2 diabetes mellitus was 4.34／10,000 for boys and 5.68／10,000 for girls；3.87／10,000 for those aged 11 to 14years and 5.69／10,000 for those aged l5 to 18years． (4)5 Children diagnosed as type 2 diabetes mellitus were overweight or obesity, and they a11 had DM family histories． (5)5 Children diagnosed as type 2 diabetes mellitus were a11 negative in the examination of GADAB，ICA and IAA． Conclusion Our screening program showed that the prevalence of type 2 diabetes mellitus in children and adolescents was high．The prevalence of type 2 diabetes mellitus increased with the age，and girls had a higher risk of type 2 DM compared with boys．Obesity and T2DM family history were high risk factors for type 2 diabetes mellitus in children and adolescents．

ObjectiveIn several acute lifethreatening diseases，the 4Gallele in the 4G/5Gpromotor polymorphism in the plasminogen activator inhibitor-1 (PAI-1) gene is associated with higher PAI-1 levels and increased poor outcome，probably by promoting the formation of microthrombi. The aim of the study was to evaluate the effect of the 4G/5G PAI-1 gene polymorphism on the susceptibility, development and outcome in critically ill patients with septic syndrome.Methods Blood samples and clinical information of 148 sepsis children were collected from Guangzhou Children's Hospital in China from Apr to Dec in 2007, and in the corresponding period the blood samples of 181 health children were also collected. The cohort collected were the Han nationality in Guangzhou of China .Allele sepcial polymerase chain reaction (ASPCR)test was used to amplify the genomic DNA extracted from peripheral whole blood to detect the 5G/5G, 4G/5G and 4G/4G genotypes of the PAI-1 gene from 148 sepsis patients and 181 health controls. The frequencies of the genotypes and allele in all groups were calculated by using the genecounting method , while χ2 statistics was used to analyze the differences of genotype distributions between the two groups, and the odds ratios and 95% confidence intervals were calculated to evaluate the risk of genotypes.ResultsNo significant difference was found in the distribution of the 4G/5G PAI-1 genotypes and allele frequencies between the sepsis and the control (χ2=0.79,P>0.05). Mortality of sepsis was significantly correlated with the 4G/4G genotype (χ2=7.35,P<0.05), resulting in an odds ratio of 4.30 (95% CI:1.50-12.29); mortality of sepsis was significantly associated with allele 4G(χ2=9.17,P<0.05) , resulting in an odds ratio of 3.14. (95%CI:1.49-6.61). The susceptibility of developing severe sepsis was significantly correlated with the 4G/4G genotype (χ2=4.44,P<0.05), resulting in an odds ratio of 4.57, (95%CI :1.11-18.78); the susceptibility of developing severe sepsis was significantly correlated with the allele 4G (χ2= 4.35,P<0.05), resulting in an odds ratio of 4.05, (95%CI:1.09-15.08).Conclusions The gene frequecies of the PAI-1 promoter polymorphism in patients with sepsis in children were similar to the general population. 4G/5G promotor polymorphism in the PAI-1 gene was associated with the development and prognosis of sepsis children of Han nationality in Guangzhou. 4G allele and homozygous was the high risk hereditary factor of sepsis. There was no relationship between 4G/5G promotor polymorphisms in the PAI-1 gene and liability of sepsis.

Abstract Objective To evaluate the reliability and validity of the Chinese version of Manual Ability Classification System (MACS).Methods Patients with cerebral palsy(CP) were involved from two rehabilitation centers in Shanghai. Three assessment methods were used to evaluate the manual function levels, including locale assessment by professional, locale assessment by family career and video assessment by professionals. Eight assessing scenes were set for these children to mimic the normal living activities, including drinking with cups, using spoon ,opening and closing small bottles, cleaning face, wringing towels, turning pages of a book, writing, and releasing buttons. Two occupational therapists did the locale assessments. All the activities performed by these children were videotaped and rescored by the same two occupational therapists and one physiatrist at least one week later (the longest interval between locale assessment and video assessment was 10 months). The family career read Chinese version of MACS then scored their children according to their performance at home and at locale as well. Professionals explained the terms for parents if needed but they didn′t discuss the classification results with parents. Testretest reliability was analyzed by comparing scores of locale assessment and video assessment, Intertester reliability was analyzed by comparing scores of different estimator（family career,occupational therapist and physiatrist）.Criterionrelated validity was evaluated by comparing MACS levels with scores of Fine Motor Function Measure(FMFM) .Results One hundred and twentyfour children (77 males and 47 females; mean age: 6.7 years, SD: 2.6 years, age range: 4 to 18 years) with CP were involved from two rehabilitation centers in Shanghai. 97 children in the 4 to 7year band, 24 children in the 8 to 12year band, 3 children in the 13 to 18year band. Types of CP in these children were spastic quadriplegia (n=27), spastic diplegia (n=48), spastic hemiplegia (n=38), athetotic （n=5）,dystonia (n=4) and ataxic (n=2). Gross motor function classification system levels were: Ⅰ(n=51), Ⅱ(n=32),Ⅲ(n=15)，Ⅳ（n=14），and Ⅴ （n=12）. Chinese version of MACS was found to possess satisfactory testretest reliability(ICC=0.94 and 0.87) as well as excellent intertester reliability (ICC=0.85-0.96). Criterionrelated validity was moderate between MACS levels and scores of FMFM (Spearman r=-0.71).Conclusions This study extended reliability and validity of the Chinese version of MACS. Results indicated that Chinese version of MACS was a valid and reliable measure of manual functions in Chinese children with CP. Environment factors should be considered in assessment. Participation of family career in scoring was very valuable. With the help of family careers, the scores might reflect children′s practical manual function levels more precisely.

Objective To investigate the effect of diet consultation and metabolic risk factors during pregnancy on gestational outcomes. Methods Subjects were consecutive pregnant women who accepted routine prenatal examination and delivery in the International Peace Maternity and Children's Health Hospital of China Welfare Institute in Shanghai from May 2010 to April 2012. The retrospective cohort was analyzed to evaluate the effect of diet consultation intervention on gestational complications among women with gestational diabetes mellitus (GDM). Stepwise logistic regressions analysis was used to evaluate the effect of metabolic risk factors on birth weight and macrosomia, respectively. Results ①Analyses were performed among 10 421 subjects. The mean of gestational week at the first prenatal visit was 20.8 (19.4-22.4) weeks. The mean of fasting blood glucose (FBS), triglyceride (TG) and total cholesterol(CHOL) was (4.4±0.4), (1.4±0.6) and (4.7±0.8) mmol·L-1, respectively. The mean of SBP and DBP was (111.3±11.5) and (67.9±13.3) mmHg. The prevalence of GDM was 15.8%. The mean of birth weight was (3 355.4±426.0) g and the prevalence of macrosomia was 6.2%. ②Among 812 pregnant women with diagnosed GDM, 570 accepted diet consultation at least once and the rest of 242 women never went to the diet consultation. No significant between-group differences were observed in variables in the baseline characteristics, including age, education, weight in 20th gestational week and biochemical tests at first prenatal visit. Compared with the control group the mean of birth weight, the prevalence of macrosomia and gestational hypertension in intervention group were reduced, (3 347.4±19.6 g vs 3 450.3±35.6 g, P=0.007; 6.7% vs 15.6%, P=0.001; 26.3% vs 47.9%, P<0.001), respectively. With the increase of times of visiting nutrition intervention, the mean of maternal gestational weight gain and birth weight declined (r=-0.126, P=0.003; r=-0.112, P=0.002), and the prevalence of macrosomia was also decreased. ③Stepwise multiple logistic regressions showed the body weight at 20th gestational week(OR=1.08, 95%CI: 1.07-1.09), gestational weight gain (OR=1.10, 95%CI: 1.07-1.12) and GDM(OR=1.63, 95%CI: 1.22-2.19) significantly increased the risk of the neonatal macrosomia. Conclusion The findings show that the elevated metabolic risk factors in pregnancy increase the risk of adverse gestional outcomes, diet consultation help improve the neonatal outcomes. The findings call for the urgent need for early and throughout management of metabolic risk factors and diet consultation among pregnant women during pregnancy to achieve better control the adverse gestation outcomes.

Objective To investigate procalcitonin（PCT）and CRP as markers of systemic and localized bacterial infections. Methods The cases of infectious diseases were recruited retrospectively in a children' hospital. Severe sepsis, septicemia with positive blood culture were recruited as systemic bacterial infection group. Acute suppurative tonsillitis, urinary tract infection and pyogenic osteomyelitis and septic arthritis were recruited as localized bacterial infection group. Infectious mononucleosis, hand foot and mouth disease were recruited as viral infection group. The value and positive rates of serum PCT and CRP among these groups were compared. The receiver operator characteristic curve (ROC) was drawn for PCT and CRP to diagnose systemic and localized bacterial infections, and the sensitivity and specificity were evaluated and the area under roc curve (AUC) and 95%CI were analyzed. Results One hundred and forty eight cases were recruited, 19 in systemic bacterial infection group, 55 in localized bacterial infections group and 74 in viral infection group. ①The levels of serum CRP and PCT and the positive rate of PCT were lower in localized bacterial infection group than in systemic bacterial infection group（CRP: 21.35 vs 76.0 mg·L-1, P=0.001; PCT:0.10 vs 28.09 μg·L-1, 32.7% vs 100%, P<0.001）. The levels of serum CRP and the positive rate were higher in localized bacterial infection group than in viral infection group（21.35 vs 4.0 mg·L-1, P<0.001; 73.1% vs 27.0%, P<0.001). The levels and the positive rate of serum CRP were not significantly different in these two groups. There were no significant differences of WBC in three groups. The positive rate of WBC was higher in systemic bacterial infection group than in viral infection group（84.5% vs 54.0%，P=0.017),but no significant difference was found between systemic bacterial infection group and localized bacterial infection group. There were no significant differences between localized bacterial infection group and viral infection group. ②In patients with localized bacterial infection, the level and the positive rate of serum PCT were higher in systemic inflammatory response syndrome (SIRS) group than non-SIRS group（0.40 vs 0.08, P =0.002; 60.0% vs 17.1%, P =0.001）, but there was no significant difference in the level and the positive rate of serum CRP between two groups. ③The AUC of ROC was 0.99 for PCT and 0.84 for CRP to diagnose systemic bacterial infection. It was 0.54 for PCT and 0.78 for CRP to diagnose localized bacterial infection, respectively. Conclusions In our study, PCT was identified as a sensitive marker of systemic bacterial infection and localized bacterial infections progressing into sepsis. As an indicator of bacterial infection, CRP was batter than PCT in localized infections.

ObjectiveTo study the characteristics of amplitude integrated electroencephalogram(aEEG) of normal full-term neonates within 3 days after birth MethodsaEEG was recorded for 3 hours by the first native EEG instrument in 1,2 and 3 days old in normal full-term newborns; voltages of aEEG were calculated with semi-logarithmic formula manually. The background, voltage level and sleep-wake cycle were analyzed. Results①For normal full-term newborns,the background of aEEG was continuous voltage, and sleep-wake cycle was observed in 905% newborns 1 day after birth and 100% newborns 2 and 3 day after birth. ②The average duration of sleep-wake cycle was （699 ± 187）min. The average duration of sleep and awake phase was （220 ± 57）min and （479 ± 171）min,respectively. ③The minimum amplitude of the aEEG background was （128 ± 34）, （121 ± 20） and （125 ± 26）μV at the age of 1,2 and 3 days respectively; the maximum amplitude was （375 ± 110）,（384 ± 94） and （386 ± 96） μV at the age of 1,2 and 3 days respectively. ④The gestational age,age,gender,mode of delivery and maternal complications during pregnancy had no effect on aEEG voltage and sleep-wake cycle of aEEG among 38-42 weeks of gestational age in normal newborns.The voltages of the upper boundary of wide and narrow band were higher within the first three days at 37- weeks of gestational age newborns than those at 38-42 weeks newborns,especially the voltages of narrow-band(P=0014). ConclusionsIn normal full-term newborns，the aEEG background was continuous voltage and sleep-awake cycle existed;the minimum voltage was>5 μV and the maximum voltage>10 μV.The gestational age, age, gender, mode of delivery and maternal complications during pregnancy had no effect on aEEG in normal full-term newborns.

Objective To evaluate the value of the procalcitonin(PCT) test for diagnosing neonatal sepsis.Methods A search in Cochrane Library, PubMed, Ovid, Springer, China National Knowledge Infrastructure (CNKI), Wanfang Chinese Periodical Database and Chinese Bio-medicine Database（CBM）was performed to identify relevant articles from Januanary 1990 to October 2009. The language of the researches wasn′t limited. All non-English and non-Chinese articles were translated into Chinese to assess. Inclusion criteria were established based on validity criteria for diagnostic research. Subsequently, the characteristics of the included articles including study background,design information and diagnostic parameters were extracted. Statistical analysis was performed by employing Meta-DiSc 1.4 and SPSS 12.0 software. Heterogeneity of the included articles was tested for selecting proper effect model to calculate pooled weighted sensitivity , specificity and 95%CI. Summary receiver operating characteristic (SROC) curve was made and the area under the curve (AUC) and Q* index was calculated. Finally, sensitivity analysis and comparison of sensitivity among different groups were performed.Results We searched 446 relevant English articles, 98 Chinese articles and 21 other language articles. Thirty-three articles(18 English articles, 11 Chinese articles and 4 other language articles) were included, with total 3 599 newborns. Three articles meeting inclusion criteria were analyzed for the value of the PCT test for the diagnosis of clinical early onset neonatal sepsis (EONS) in umbilical cord blood at birth, the pooled sensitivity,specificity and SROC AUC were 77.7%,82.8% and 0.833 7,respectively. Eight articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of clinical EONS within 0-12 h after birth, the pooled sensitivity,specificity and SROC AUC were 76.7%,87.1% and 0.896 5,respectively. Four articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of clinical EONS within 12-24 h after birth, the pooled sensitivity,specificity and SROC AUC were 76.6%,88.5% and 0.884 4,respectively. Six articles meeting inclusion criteria were analyzed for the value of serum PCT levels for diagnosis of clinical EONS within 24-48 h after birth, the pooled sensitivity,specificity and SROC AUC were 69.8%,88.2% and 0.894 7,respectively. Fifteen articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of clinical late onset neonatal sepsis (LONS), the pooled sensitivity,specificity and SROC AUC were 79.0%,92.3% and 0.963 2,respectively. Fifteen articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of proven LONS, the pooled sensitivity,specificity and SROC AUC were 84.5%,80.9% and 0.934 5,respectively. Significant heterogeneity among studies was observed. Sensitivity analysis showed that differences in PCT assay producer and PCT cutoff, study countries, gestational age and severity of sepsis in the study population may partially explain the between- studies heterogeneity.Conclusions The PCT test showed good accuracy in diagnosing neonatal sepsis, regardless of differences in diagnostic criteria or time points for testing. PCT should be combined with other diagnostic markers to further improve the sensitivity and accuracy in the diagnosis of sepsis.

Objective To evaluate the intervention effects on children with dietary behavior problems in Shanghai through a comprehensive intervention (at multiple time points) follow-up study. Methods Children aged 1-6-years with dietary behavior problems were selected from three districts of Shanghai (Changning, Luwan and Hongkou). "Shanghai Children′s Dietary Behavior Questionnaire and Follow-up Intervention Questionnaire" was prepared. Children were recruited into the study by professionally trained pediatricians, and randomly divided into intervention and control groups by using sealed envelops. Both the intervention group and control group were divided into 5 subgroups according to age, and 3 subgroups according to nutritional status. The intervention group received interactive interventions and respective assessments at T0(baseline), T1(end of the 1st month), T2(end of the 3rd month), T3(end of the 6th month) and T4(end of the 9th month). The control group were evaluated at T0 and followed up at T4. Comparisons of dietary behavior were made before and after the interventions between intervention and control groups. Results From January to October 2009, 462 children with dietary behaviour problems were recruited, including 245 in intervention group and 217 in the control group. ①The comprehensive dietary behaviour problem scores of the intervention group were 19.7±0.0 at T0 and 14.2±0.3 at T4, decreased dramatically (P<0.01), while the scores of the control group were 19.7±0.5 at T0 and 19.6±0.1 at T4, showing no significant change (P>0.05). ②The scores of all age subgroups in the intervention group decreased with more interventions made (P<0.01). Among all the age subgroups, the 3-year-old group had the largest Δ(T0-T4), while the 6-year-old group had the smallest Δ(T0-T4). There was significant difference between 3-year-old and 6-year-old groups (P<0.01). The average number to treat (NNT) of the intervention group was 2.5 (95% CI:2.1-3.0). There was significant difference of the overall retention rate of dietary behaviour between intervention and control group (P<0.001). ③The dietary behaviour problem scores of both severe malnutrition and normal nutrition subgroups of intervention group decreased (P<0.01). In the control group, the difference of the scores Δ(T0-T4) was not statistically significant for either nutrition subgroup (P>0.05). ④Controlling for the natural improvement of dietary behaviour with time passed, all the dietary behaviour problems of the intervention group children were eventually improved (P<0.05). While "no fixed eating location", "eating and playing toys" changed less, the rest of the dietary behaviour problems all improved by a large margin. However, the effects of intervention on different dietary behaviour problems occurred at different time points. "Eating slow", "strong preference to some food", "eating and doing other things" were improved earlier; "eating less", "no fixed eating location", "no interest in food" were improved later. The NNT of nine dietary behaviours was 1.4~2.5. The difference of misconduct retention rate between intervention and control groups was statistically significant (P<0.05). Conclusions Reasonable dietary behavior intervention could improve children′s unhealthy eating behaviors. The interactive intervention strategy proposed here could markedly improve the dietary behavior of children in Shanghai.

Objective To establish the reference ranges for normal values of peripheral blood lymphocyte subpopulations (T, B, and natural killer; NK) in normal Chinese children. Methods The 0-12-year-old children were grouped by age-stages: infant group (0-1-year-old), infant child group (1-3-year-old), preschool age group (3-7-year-old), school age group (7-12-year-old). Then the percentages of lymphocyte subpopulations were determined in 592 normal Chinese children by flow cytometric dual-color and four-color analysis. And the results were statistically analyzed by SPSS 11.5 software. Results The interior-group comparison showed significant differences between sexes in several lymphocyte subpopulations in infant group, infant child group and school age group (P＜0.05); the inter-group comparison showed significant differences between all the lymphocyte subpopulations (P＜0.01), then the result of multiple comparison showed that there were statistically significant between several groups. Conclusion The reference ranges for normal values of peripheral blood lymphocyte subpopulations in 0-12-year-old normal Chinese children should be established in different reference values according to different ages and sexes.

Objective To evaluate the relationship between platelet-activating factor(PAF)/platelet-activating factor-acetylhydrolase(PAF-AH) and neonatal infection and to observe the trends of plasma PAF level and PAF-AH activities during the course of infection by measuring plasma PAF levels and PAF-AH activities in neonates with infection. Methods Neonates admitted to the neonatal ward of Children′s Hospital of Fudan University from July to December in 2008 were enrolled. According to the locations and severity of infection, the patients were divided into 3 groups, general infection group, local infection group and non-infection group. Plasma samples of infection groups were taken within 48 h after infection, others were taken during hospitalization period. Besides, plasma samples were taken on the first, third, fifth and seventh day of infection from the neonates who had severe infection with organ dysfunction to observe the trends of plasma PAF levels and PAF-AH activities during the course of infection. The plasma PAF levels were measured by ELISA, and PAF-AH activities were measured using PAF Acetylhydrolase Assay Kit from Cayman Chemical Company.The plasma PAF levels（μg·L -1） and PAF-AH activities（μmol·L-1·min-1） were compared in different groups and the changes of the plasma PAF levels and PAF-AH activities in severe general infection neonates were compared. Results Total 247(146 boys and 101 girls) neonates were enrolled in the study. Average age, gestational age and birth weight were 9.2（1~57）d, 35.85（27~43）weeks and 2 517（906~4 750）g, respectively. General infection group, local infection group and non-infection group included 91,63 and 93 neonates, respectively. ①Multiple linear regression analysis showed that the plasma PAF levels had relation with severity of infection（P=0.000），no relation with sex,gestional age,birth weight and age；The plasma PAF-AH activities had relation with severity of infection and age（both P=0.000）,but had no relation with sex,gestational age and birth weight.The plasma PAF-AH activities were lower in early stage neonates than that in late stage neonates.②Mean plasma PAF levels were significantly higher in infants with general infection (9.5±8.1) than those in infants with non-infection group (5.3±3.2)and local infection group (4.6±3.5)(P=0.000). In early stage or late stage neonates, plasma PAF-AH activities of general infection group (5. 7±2.7, 7.0±2.5) were significantly lower than those of non-infection group (7.3±2.9, 9.7±2.2, respectively) and local infection group (7.3±2.5, 9.7±2.7, respectively).③The plasma PAF levels of 9/12 alive children with multiple organ dysfunction in the course of 1-7 d decreased and plasma PAF-AH activities increased.It was opposite in 3/12 deaths.④Infants with sepsis caused by Gram negative bacteria had higher plasma PAF levels and lower PAF-AH activities than those with sepsis caused by Gram positive bacteria (P=0.005). Conclusions Plasma PAF levels were positively correlated and PAF-AH activities were negatively correlated with the severity of infection. Plasma PAF levels and PAF-AH activities showed variations during the course of infection. The trends of variations may be correlated with the prognosis.

Objective Group A rotavirus is the most important pathogen leading to dehydrating diarrhea in young children in worldwide scope. This study aimed to study the epidemiology of rotaviruses in hospitalized children in Shanghai, China during the years 2001－2005. The information will provide important data and theoretical bases for study and production of rotavirus vaccine. Methods Systematic sampling was applied for collection of 363 fecal samples from hospitalized children with rotavirus diarrhea in children's hospital, Fudan University. ELISA was used to detect rotavirus in stool samples, and then nested RT-PCR was applied for determination of rotavirus genotypes. Result The largest proportion of children with rotavirus diarrhea was in the 6－11 month age group, followed by the 12－23 months age group(29.8% and 26.7% respectively). 79.9% of children with rotavirus diarrhea were younger than 2 years of age. 97 rotavirus positive samples were detected in November, accounting for 26.7%, the other predominant months were October(49 samples, 13.1%) and December(54 samples, 14.9%). 62.3% of children with rotavirus diarrhea were detected during October to January of the next year. Among G genotypes of rotavirus in 2001, G3(47.1%) was the most predominant, followed by G1 at 28.8%, G4 at 8.0% and G2 at 6.9%. In the year of 2002, G3 was accounted for 62.0%, followed by G1(21.0%) and type frequency was 5.0% for G2 and G4 together. G3 increased to 74.6% in 2003 and G1 was the secondly prevailing type but decreased to 18.6%. All the other samples in 2003 could not be typed. During the year of 2004, G3 type continued to increase to 85% and G1 dropped to 1.7%. G3 accounted for 87.7% in 2005 but G1 turned up to 7%. Several mixed infection of G types were detected in 2001, 2002 and 2005 such as combination of any two types of G1, G2 and G3. Only one G9 was detected in 2001 in all the 363 samples. The dominant P type in 2001 was P［8］(79.3%), followed by P［4］(6.9%) and P［6］(2.3%). For the year of 2002, P［8］ was accounted for 52%, followed by P［4］ (11.0%). 19.0% of the samples contained mixed types of P［4］ and P［8］, and 6% were mixed infection of P［4］, P［6］ and P［8］. P［8］ was still the most dominant P type in 2003 with high frequency of 91.5% and all the others were mixed types of P［4］ and P［8］. 81. 2% of samples in 2004 were P［8］ and the others could not be typed. During 2005, P［8］ was accounted for 87.7% and 3.5% of P［6］ was found. 4 of P［9］ were only detected in 2001. The most predominant combination of genotype was P［8］G3 from 2001 to 2005, with high frequency exceeding 50% each year except frequency of 36.0% in 2002. Other common stains included P［8］G1in 2001 and 2004, accounting for 38.6% and 18.6% respectively. Combination of G3 and mixed infection of P types in 2002 and combination of G3 and untypable P types in both 2004 and 2005 were also found. Other minor genotypes included P［8］G4 (12.2%) in 2001 and combination of P［8］ and untypable G types. Conclusions The characterization of rotavirus genotypes demonstrated some circulating characteristics from year to year in Shanghai district in recent 5 years. G3 and P［8］ and combination of P［8］G3 were the most predominant circulating genotypes. Some other common strains and unknown strains were also present in different years.

ObjectiveTo summarize the clinical features of brainstem encephalitis associated with hand, foot and mouth disease(HFMD) of Guangdong in 2008 and provide the basis for the diagnosis of the disease. MethodsThe clinical data of 19 children diagnosed as brainstem encephalitis associated with HFMD in May to July 2008 were collected. The clinical manifestation, laboratory examination, neuro-electrophysiology, imaging examination, treatment， prognosis and other characteristics were analyzed. The results were statistically analyzed by single factor and multiple factors analysis between above group and control group. ResultsThe data of 19 cases with brainstem encephalitis associated with HFMD were as follows, ① All of the 19 cases had fever and rash. The neurological symptoms such as limb tremor, abnormalities of eye movements(ocular drift or superduction), irritability, panic, walking instability and consciousness dysfunction were prevalent. The cranial nerves were damaged mainly on the single side, glossopharyngeal and vagus nerve paralysis were more common. Fifteen cases had respiratory failure, and three patients had pulmonary hemorrhage. ②Peripheral blood WBC number rised in 8 cases.Cerebrospinal fluid pressure ascended in 4 cases. ③EEG examination showed 8 cases were abnormal, and 14 cases were found abnormal in brainstem auditory evoked potential . ④X-ray of three cases showed lungs exudative lesions.Head CT examinations found nothing abnormal ,while 3 cases had abnormal MRI manifestations. ⑤ Two patients died of central respiratory and circulatory failure.Seventeen patients were cured and showed no neurological symptoms when followed up for 6 months. ⑥Single factor Logistic analysis showed brainstem encephalitis had great possibility to occur when following conditions appeared,such as limb tremor,change of respiratory rhythm,respiratory failure, abnormalities of eye movements(ocular drift or superduction) ,bucking in drinking,deviated mouth , tongue tremor,poor distal circulation,cross-paralysis and abnormal BAEP.Multiple factors Logistic analysis showed that limb tremor,abnormalities of eye movements(ocular drift or superduction) and abnormal BAEP were the risk factors for HFMD combined with brainstem encephalitis(OR=436.9,52.2,93.5,respectively). ConclusionsPeripheral blood WBC, blood glucose and cerebrospinal fluid examinations were not specitic for brainstem encephalitis associated with HFMD. In children cases of HFMD showing limb tremor, abnormalities of eye movements(ocular drift or superduction) and above mentioned symptoms, brainstem encephalitis was suggested. BAEP had good diagnostic value for brainstem injury. Most cases with brainstem encephalitis associated with HFMD had good prognosis after timely and standard treatment.

ObjectiveTo evaluate the value of fetal echocardiography for the prenatal diagnosis of congenital heart disease. MethodsA search in Cochrane Library, PubMed, OVID, Springer, China National Knowledge Infrastructure (CNKI), Wanfang Chinese Periodical Database and Chinese Bio-medicine Database（CBM）was performed to identify relevant English and Chinese language articles from Jan 1990 to Jan 2009. Inclusion criteria were established based on validity criteria for diagnostic research. Subsequently, the characteristics of the included articles were extracted. Statistical analysis was performed by employing Meta-DiSc 1.4 and SPSS 12.0 software. Heterogeneity of the included articles was tested, which was used to select proper effect model to calculate pooled weighted sensitivity and specificity. Summary receiver operating characteristic (SROC) curve was made and the area under the curve (AUC) was calculated. Finally, sensitivity analysis was performed. ResultsEighteen articles were included, with a total of 77 939 fetuses. Seven articles meeting with inclusion criteria were analyzed for the value of basic cardiac echocardiographic examination (BCEE) for the prenatal diagnosis of congenital heart disease. The pooled sensitivity and specificity were 41.7% and 99.9% respectively, AUC=0.978 7. Twelve articles meeting with inclusion criteria were analyzed for the value of extended cardiac echocardiographic examination (ECEE). The pooled sensitivity and specificity were 66.9% and 99.9% respectively, AUC=0.995 6. The sensitivity of ECEE was significantly higher than that of BCEE（χ2=63.93，P<0.05）.The random-effect model was used in the analysis because of the heterogeneity. The layering research and sensitivity analysis were performed on the BCEE and ECEE. The sensitivity of BCEE and ECEE for the prenatal diagnosis of congenital heart disease during the second to third trimester was significantly higher than that during the second trimester（χ2= 5.47，39.37，P<0.05）;The sensitivity of ECEE for the prenatal diagnosis of congenital heart disease for the fetuses of low-risk pregnant women was lower than that of the unselected or high-risk pregnant women（χ2=81.82，156.58，P<0.05）；The sensitivity of ECEE for the prenatal diagnosis of congenital heart disease for the fetuses of unselected pregnant women was not different from that of high-risk pregnant women（χ2=1.67，P>0.05）. ConclusionsThe results suggested that fetal echocardiography was highly accurate and suitable for the prenatal diagnosis of congenital heart disease. Further multicentre and prospective studies are still needed to optimize the ultrasound section and screening subjects by a cost-effectiveness analysis, and develop an operation guideline on fetal echocardiography for the prenatal diagnosis of congenital heart disease suitable for China.

Objective To investigate the role of the FTO gene rs9939609, rs1421085 polymorphism on obesity and relative trials in Chinese Han children and adolescents.Methods Obese/overweights children and adolescents and normal weight children as control aged 6-18 years old were enrolled. Body height and weight were measured and body mass index （BMI）was calculated. Serum fasting plasm glucose ( FPG) , fasting insulin ( FIns) , triglycerid (TG) and cholesterol (TC) were measured. HOMA-IR and QUICKI were calculated. Genomic DNA was extracted from peripheral blood, Taqman-MGB probe was used to detect the FTO rs9939609, rs1421085 polymorphism. Obesity was evaluated by using IOTF BMI standard. Results Obesity group, overweight group and normal control group included 236,239 and 241 children, respectively. ①The levels of FPG,FIns, TG and HOMA-IR were significantly higher in obesity/overweight group than that in normal control group.②The successful rates of rs9939609 typing in obesity group, overweight group and normal control group were 94.9%（224/236）,97.9％（234/239） and 95.9%（231/241）,respectively.The successful rates of rs1421085 typing in obesity group, overweight group and normal control group were 92.8% （219/236）,97.1%（232/239） and 95.4%（230/241）,respectively.The AA genotype frequency of rs9939609 was 2.7% in obesity group and 0.4% in overweight group and there existed significant difference compared with normal control group(genotype frequency 1.7%,P=0.048, OR=1.437). The CC genotype frequency of rs1421085 was 2.7% in obesity group and 0.9 % in overweight group and there existed significant difference compared with normal control group(genotype frequency 1.7%,P=0.076, OR=1.388).③There existed significant difference in BMI between the rs1421085 TC +CC, rs9939609 TA +AA genotypes when compared with their wild TT genotypes(rs9939609: P=0.000 3; rs1421085: P=0.000 5). However, FPG, FIns, TG, TC, HOMA-IR and QUICKI showed no significant difference between the rs1421085 TC +CC, rs9939609 TA +AA genotypes and their wild TT genotypes was not found.Conclusions FTO gene rs9939609 and rs1421085 SNP was firstly reported to be associated with obesity and BMI in Chinese Han children and adolescents, but the significant statistical association among the SNPs and obesity related metabolic parameters.

ObjectiveTo test the effect of nonnutritive sucking (NNS), music therapy (MT), and combined NNS and MT (NNS + MT), versus no intervention, on heart rate, transcutaneous oxygen (SpO2) levels, and pain behavior of neonates in intensive care units had being blood taken by a heel-stick procedure.MethodsA within-subjects, counter-balancing, repeated-measures design was conducted in the newborn medical center of Nanjing Children Hospital, comparing SpO2 levels, heart rate, and pain behavior outcomes(NIPS) in 80 neonates. The neonates with good general state of health had been selected. Those with the nervous system disorders (intracranial hemorrhage, hypoxic ischemic encephalopathy) were ruled out and sedative and acesodyne were given. All patients had been divided into four groups (NNS,MT,NNS+MT and control) randomly according to admission number(AD). The effct of various intervention (NNS,MT,NNS+MT and control) on SpO2 levels, heart rate, and pain behavior outcomes(NIPS) had been recorded.SPSS 11.0 ANOVA variance test and Post Hoc were used to analyze all the valid data.ResultsRepeated-measures multivariate analysis of variance revealed statistically significant differences in outcomes across all interventions. One-way analysis of variance revealed that the 3 comfort interventions significantly reduced neonate heart rate, improved their SpO2 levels , and reduced their pain behavior. Posthoc scheffe tests revealed that NNS + MT had the strongest effect on neonates SpO2 levels and pain behavior; MT alone had the strongest effect on neonates' heart rate. The significant difference had been seen in all groups compared with control (P<0.05) except NNS in heart rate and SpO2. There were no significant difference in the MT,NNS+MT subgroups.ConclusionsWTBZ〗Health professionals using NNS + MT when doing heel-sticks can improve the SpO2 levels of neonates and reduce their pain. Using MT alone can improve the heart rate of neonates.

Objective To investigate the levels of the enteroovirus 71 and C4 genetype antibody (EV71-lgG) among children in Guangzhou area, and the relationship between EV71-IgG and hand, foot and mouth disease (HFMD). Methods EV71 diagnostic antigen was prepared from EV71 C4 genotype samples isolated from children with HFMD in Children's Hospital, Guangzhou Women and Children's Medical Center to establish the method of diagnostic EV71-IgG kits and laboratory evaluation. Blood samples of healthy children confirmed to be without fever and symptoms of HFMD by physical examinations in our hospital were collected from January to March in 2010 to be tested for EV71-IgG antibody. Swab specimens were collected from outpatient and inpatient children with HFMD in our hospital in 2010 to be tested for specific EV71 nucleic acid. Results ① The cut-off value of kit established by our laborary was 0.148. Compared with the cell neutralization tests, the accordancy rate was 100% for positive rate and 92% for negative rate. There was no cross reaction with Coxsackie A16 virus antibody. ②Serum samples were from 819 healthy children, including 481 males and 338 females. EV71-IgG positive rate in children aged under 1 year was the highest (60%, 60/100), and EV71-IgG positive rates of -2-year-old, -3-year-old, -4-year-old, -5-year-old and -14-year-old groups were 39.3%（72/183）, 12.9%（15/116）, 27.1%（38/140）, 14.2%（16/113） and 22.8%（38/167）。There was no significant difference between different genders. ③ A total of 4 780 children with positive EV71 were enrolled, including 3 070 males and 1 718 females. There were 310（6.5%） children in <1-year-old group, 1 157（24.2%） in -2-year-old, 1 337（280%） in -3-year-old, 1 094（22.9%） in -4-year-old, 450（9.4%） in -5-year-old, 432（9.0%） in -14-year-old groups. ④ In each group EV71 - IgG antibody positive rate was opposite to the tendency of EV71 positive rate. In <1-year-old group, EV71 - IgG positive rate was the highest while EV71 positive rate was the lowest. In -3-year-old group, EV71 - IgG positive rate was the lowest while EV71 positive rate was the highest. Conclusions In Guangzhou area, EV71-IgG positive rate in children aged under 1 year was the highest. EV71 positive rate was significantly associated with EV71-IgG positive rate.

Objective To describe and analyze the trends and determinants of birthweight in Beijing from 1996 to 2010. Methods 63 661 babies born in two hospitals in Beijing in 1996, 1997, 1998, 1999, 2000, 2005, 2010 were included to describe the trend of birthweight. The 11 006 birth records of those babies born in Beijing obstetric and gynecologic hospital in 2010 were collected to analyze the determinants of birthweight. The chi-square test and chi-square test for trend were used to estimate the distribution of categorical variables between groups, analysis of variance was used to test the difference of birthweight among years, linear regression analysis was applied to analyze the determinants of birthweight. Results The birthweight increased from 1996 to 2000 rapidly, and then decreased slowly. The mean value of birthweight in 2010 was 3 331 g, and it was higher than the national level. The linear regression analysis suggested that maternal age, body mass index, gestational weight gain, gravidity, parity, gestational weeks and gestational diabetes mellitus were positively correlated with birthweight, the gender of neonate (female), degree of maternal education, oligohydramnios, multiple gestation and gestational hypertension were negatively associated with birthweight. According to the American Institution of Medicine (IOM) guidelines on maternal health weight gain, more than half of the women had excessive gestational weight gain from 2000. Conclusions The birthweight increased rapidly before 2000, and then decreased slowly. Maintaining a normal maternal body mass index and an appropriate gestational weight gain, avoiding preterm birth and prevention of gestational diabetes mellitus and hypertension will be helpful to get normal birthweight.

Objective To summarize the clinical phenotype charateristics of Prader-Willi syndrome in neonates for screening earlier and making further molecular genetic diagnosis for appropriate patients. Methods The data from thirteen Prader-Willi syndrome neonates that had been definitely diagnosed with molecular biological methods from August 2009 to August 2011 were collected retrospectively. For each patient, the presence or absence of the major and minor features according to the diagnostic criteria was recorded. The typical clinical phenotype of Chinese neonates with Prader-Willi syndrome was analyzed. Results A total of 13 neonates diagnosed as Prader-Willi syndrome were recruited in the study, including 9 males and 4 females. The age of onset was 4-28 days. Nine cases were caused by deletion of 15q11.2-q13 from the paternal and 4 cases were caused by maternal uniparental disomy. The major phenotype in neonatal period included skin hypopigmentation in 13 cases (100%) which was significantly different from abroad, and central hypotonia in 13 cases (100%), hypogonadism in 12 cases (92.3%), weak cry in 12 cases (92.3%), feeding difficulty in 11 cases (84.6%); minor phenotypes included characteristic facial features in 5 cases ( 38.5%), thick viscous saliva in 5 cases (38.5%). In addition, older mothers' age was found in 9 cases（69.2%）; amniotic fluid contaminated in 8 cases（61.5%）, hydramnios in 3 cases（23.1%）, premature rupture of membrane in 5 cases（38.5%）, anomal fetal position in 4 cases（30.8%）, intrauterine embarrassment in 9 cases（69.2%）, all these were dangerous in perinatal period between mother and fetus. Conclusions Skin hypopigmentation and central hypotonia in neonatal period could be taken as the preliminary screening criteria and Prader-Willi syndrome molecular genetic test should be performed for Chinese neonates.

Objective To explore the association between hypoalbuminemia and the severity and prognosis of sepsis in children. Methods Children diagnosed as sepsis in PICU in Hunan Provincial Children's Hospital from February to July 2010 were retrospectively collected. Clinical manifestation, laboratory examination index, related parameters of disease severity and prognosis were extracted . According to albumin levels within 24 h admission into PICU, the patients were divided into severe hypoalbuminemia group (≤25 g·L-1), moderate hypoalbuminemia group (-30 g·L-1), mild hypoalbuminemia group (-35 g·L-1) and normal albumin group (> 35 g·L-1). The correlation of albumin levels with clinical manifestations, laboratory index and relevant outcome were analyzed. The relevance of albumin levels and the prognosis was analyzed by Logistic regression. Results A total of 212 cases meeting with sepsis criteria were analyzed, including 24 cases in severe hypoalbuminemia group, 50 in moderate hypoalbuminemia group, 61 in mild hypoalbuminemia group and 77 in normal albumin group. ① The incidences of diarrhea, abdominal distension, bowel sound weakened, stress ulcer, edema and MODS> 3 in severe hypoalbuminemia group were significantly elevated (P<0.05）. ②With the serum albumin levels decreasing , the incidences of WBC count, CRP≥8 mg·L-1 and PCT＞2 mg·L-1 , glucose ≥6.7 mmol·L-1 and lactate levels were increased(P<0.05). ③With the serum albumin levels decreasing, PRISM Ⅲ, the incidences of severe sepsis and septic shock were significantly elevated, while PICS was declined (P<0.05). ④Logistic regression analysis showed that PRISM Ⅲ≥8, severe sepsis and septic shock, severe hypoalbuminemia were death risk factors in children with sepsis , OR(95%CI) was 8.20（1.325-18.96），2.85（1.34-10.73）and 1.22（1.02-15.78） respectively. ⑤The albumin levels in survival group 1, 3 and 7 days after admission were significantly higher than the death or abandon group in the corresponding period, and there were significant differences. Conclusions Hypoalbuminemia can be used as an indirect inflammatory infection indicator to reflect the degree of severe infection. The albumin level≤25 g·L-1 can be used as the death risk factors in children with sepsis.

Objective To investigate the relationship of inflammatory cytokines、coagulation function and pediatric critical illness score in children with severe pneumonia complicated with sepsis.Methods From January 2010 to November 2012, the children who stayed in PICU of Fujian Provincial Maternal and Children Hospital for more than 24 h and had been diagnosed as severe pneumonia complicated with sepsis were identified. According to the pediatric critical illness score (PCIS) criteria, three groups including extremely critical group (＜70 scores），critical group (70-80 scores） and non-critical group (＞80 scores）were recruited, and their inflammatory cytokines and coagulation function were measured at the same time.Results A total of 101 children comprising 47 males and 54 females were enrolled, 53 children were in non-critical group, 42 children in critical group and 6 children in extremely critical group. ① With the children's critical condition getting worse, interleukin-6, soluble P-selectin and D-dimer levels increased, platelet count level decreased, with significant differences among three groups (P<0.05). The C-reactive protein level increased with the decrease of PCIS, but with no significant difference between the extremely critical group and the critical group, but the levels were significantly lower than that in the non-critical group (18.3 vs 37.8 vs 46.9, P= 0.003). The white cell counts did not significantly differ from each other among three groups (P＞0.05). ② In this research, there was positive correlation between interleukin-6, soluble P-selectin, D-dimer and PCIS, negative correlation between platelet count and PCIS and no correlation between white blood cell leve

ObjectiveTo evaluate the value of nuchal translucency (NT) as a screening test for fetal abnormalities in the first trimester ultrasound examination.MethodsA search in Cochrane Library, PubMed, OVID, Springer, China National Knowledge Infrastructure (CNKI) and Chinese Bio-edicine Database（CBM）was performed to identify relevant English and Chinese articles between Jan 1990 and August 2008. Criteria for inclusion were established based on validity criteria for diagnostic research. Subsequently, the characteristics of the included articles were extracted. Statistical analysis was performed with Meta-iSc 1.4. Heterogeneity of the included articles was tested to select proper effect model to calculate pooled weighted sensitivity and specificity. Summary receiver operating characteristic curve(SROC) was made and the area under the curve (AUC) was calculated. Finally, sensitivity analysis was performed.ResultsTwelve articles were included, with a total of 112 099 fetuses. Nine articles meeting inclusion criteria were analyzed for the value of screening for cardiac abnormalities by nuchal translucency thickness above the 95th percentile for gestational age. The pooled sensitivity and specificity was 29.8%, 96.9%，respectively, AUC=0.804 7. Seven articles meeting inclusion criteria were analyzed for the value of screening for cardiac abnormalities by nuchal translucency thickness above the 99th percentile for gestational age. The pooled sensitivity and specificity was 18.9%, 99.3%，respectively, AUC=0.971 2. Five articles meeting inclusion criteria were analyzed for the value of screening for fetal abnormalities by nuchal translucency thickness above the 95th percentile for gestational age. The pooled sensitivity and specificity was 25.0%, 98.3% respectively, AUC=0.183 0. The sensitivity of screening for cardiac abnormalities by nuchal translucency thickness above the 95th percentile for gestational age was significantly higher than the nuchal translucency thickness above the 99th percentile for gestational age（χ2=6.58， P<0.05）,no difference was found in the specificity. The random?瞖ffect model was used in the analysis of screening for cardiac abnormalities by nuchal translucency thickness above the 95th or 99th percentile for gestational age because of the heterogeneity. The fixed-ffect model was used in the analysis of screening for fetal abnormalities by nuchal translucency thickness above the 95th percentile for gestational age because of the homogenicity. ConclusionsThe results suggest that screening for fetal abnormalities by NT thickness above the 95th percentile for gestational age has a low accuracy and is unsuitable for prenatal screen. At present it is incompletely clear on the sensitivity and specificity of screening for different kinds of fetal abnormalities by NT thickness. Screening for cardiac abnormalities by first trimester NT thickness has a high accuracy and specificity and can be reliably used in prenatal screen. We need the further systemic reviews to evaluate the value of NT as a screening test for different kinds of fetal abnormalities. Further multi?瞔entre and prospective studies are badly needed to be performed to optimize the standard of nuchal translucency thickness, evaluate the value of NT as a screening test for fetal abnormalities (especially cardiac abnormalities) in the first trimester ultrasound examination by a cost-effectiveness analysis, and develop an operation guideline on first trimester nuchal translucency thickness measurement for the prenatal screening of cardiac abnormalities in China.

Objective FTY720 is a novel immune modulating drug which obtained through structural modification of ISP-1, an immunosuppressive substance newly purified from Cordyceps sinensis , a Chinese herb traditionally used in the treatment of renal diseases. In recent years, the role of FTY720 in the immune mediated glomerulonephritis has been demonstrated, but its effects on renal interstitial fibrosis, a major determinant for prognosis, remain uncertain. The present study is aimed to examine the role of FTY720 in the inhibition of renal interstitial fibrosis in rats with unilateral ureteral obstruction(UUO). Methods Forty-five male SD rats were randomly divided into sham-operated(SHAM), operated UUO and UUO treated with FTY720 (UUO+FTY720) groups. Unilateral ureteral obstruction was induced in SD rats by ligation of the left ureter 0.5 mg·kg-1·d-1 of FTY720 or saline was administrated through daily gavage started three days before the operation until being sacrificed. Five rats in each group were sacrificed 7, 14 and 21 days after UUO or Sham-surgery. In order to investigate if renal fibrosis closely correlates with renal insufficiency, 24-hour urine protein, blood urea nitrogen (BUN) and serum creatinine were determined. The renal tubular interstitial fibrosis lesion and the expression of α-SMA and COL-Ⅲ were detected by pathdogical examine and immunohistochemistry and scored . Results The amount of 24 hours urine protein was (9.7±1.7) mg·d-1 at day 14 after operation in FTY720 treated group, much lower than that in UUO group, which was (15.5±1.5 ) mg·d-1at the same time (P<0.05). Serum creatinine was （123.0±15.8) μmol·L-1,（65.9±6.1）μmol·L-1,（51.4±6.9）μmol·L in UUO group at days 7,14,21 , respectively and （41.8±4.5）μmol·L-1（39.5±7.9）μmol·L-1,（38.5±4.5）μmol·L-1 in FTY720 treated group at days 7,14,21 , respectively. The level of creatine in FTY720 treated group were significantly lower than that in UUO group. The Blood urea nitrogen was (16.1±3.2）mmol·L-1,（10.7±1.7）mmol·L-1 in UUO group and （8.1±1.0 ）mmol·L-1,（7.0±0.8）mmol·L-1 in FTY720 treated group at days 7,14 respectively. The levels of urea nitrogen was significantly lower in FTY720 group than that in UUO group (P<0.05). The renal pathological evaluation indicated that the number of infiltrated inflammatory cells in renal interstitial was fewer in FTY720 group than that in UUO group, and the score of renal interstitial fibrosis was lower in FTY720 group than that in UUO group. Immunohistochemistry study revealed that α-SMA expression was limited to vessels in SHAM group, but extended to renal tubules and interstitium in UUO and FTY720 treated group, while relatively weaker expression was observed in FTY720 group than in UUO group. Some collagen Ⅲ expression was found in SHAM group, which was much enhanced in UUO group at days 7,14,21 and mainly distributed in renal interstitium, the expression in FTY720 group was also increased compared to SHAM group, but much lower than that in UUO group. Conclusions Novel immunomodulator FTY720 can obviously inhibit infiltration of inflammatory cell , transdifferentiation of renal tubule cell , extracellular matrix accumulation and interstitial fibrosis, thus prevent renal disease progression.

Objective：To investigate the difference effect of biofeedback and DDAVP on PNE children by a randomized control trial (RCT) study. Methods：PNE children who were diagnosed by pediatricians of children's hospital of Fudan University from July 2005 to January 2006 were divided into two groups randomly, one is DDAVP group and the other is biofeedback group. All patients underwent one month's treatment and three month's follow-up. Items of follow-up included enuresis diary，urine flow rate and AQP2 in urine. Results：All 50 PNE children included 26 boys and 24 girls, whose mean age was 8.4±0.9 years. The effective rate of biofeedback was higher than that of DDAVP at the end of treatment and the third month of follow-up. But there was no significantly difference in cure rate and relapse rate in two groups. Compared with the data before treatment, maximum flow rate, voided volume, ratio of normal curves and ratio of Detrusor-sphincter consistentness increased significantly at the end of treatment in biofeedback-group. Two bands of AQP2 were detected in urine. Density of two bands of patients were significantly lower than that of controls. At the end of treatment density of two bands were significantly higher than that of before treatment in DDAVP group. Conclusion：Biofeedback and DDAVP are both effective therapies for PNE. With higher effective rate within four month, biofeedback is worth applying in PNE children. Biofeedback is helpful for correcting voiding dysfunction and DDAVP can increase AQP2 protein in urine.

Objective The purpose of this cross-sectional study was to examine the prevalence of behavior problems and associated protective and risk factors among children aged 3 to 6 years in Huangpu district of Guangzhou. Methods A community-based sample of 1 170 children was assessed with the Strengths and Difficulties Questionnaire(SDQ), Behavioral Style Questionnaire(BSQ), Family Environment Scale(FES) and a self-administered questionnaire including demographic characteristicts and children′s pre-,peri- and postnatal condition. Results Totally 11.4%(134/1 170) children were rated as abnormal without significant gender differences. The most prevalent behavior problem was peer problem(23.2%), followed by hyperactivity(16.6%),conduct(11.8%),emotion(8.4%) and prosocial(8.4%). Multiple linear regression models explained 50% of the total variance of SDQ total difficulties score for children.Paternal educational,cohesion and intellectual-cultural orientation of family environment were significant protective factors against behaviour problems. Joint family,child′s medical history(congenital diseases,brain injury),temperamental low persistence, low adaptability, negative emotionality,low rhythmicity,high intensity and high activity were associated with higher SDQ total difficulties score (P<0.05). Conclusions This study is consistent with previously reported risk factors for child behavior problems, and supports the need for a focus on early intervention and prevention strategies in the child mental health field.

Objective The aim was to study the clinical characteristics, diagnostic standards and genetic features of MELAS and try to find the association between the A3243G mtDNA mutation rate and clinical phenotypes.Methods PCRRFLP for screening the heteroplasmic A to G transition at nucleotide 3243 of the mitochondrial tRNALeu(UUR) of blood cells and muscle, neuroradiological examination, blood level of lactic acid and muscle biopsy analyses were performed on the 272 patients suspected to be with MELAS in Beijing Children′s Hospital，the Capital Medicine University, during the years of 20012008. Eighteen patients with molecular genetic abnormalities of mitochondrial DNA A3243G mutation were taken as the gene diagnosis group for MELAS. Four patients with ragged red fibers on muscle biopsy specimens and with the absence of A3243G mutation were taken as the pathology diagnosis group for MELAS. Comparisons of clinical, laboratorial and neuroradiologic features between two groups were performed. The A3243G point mutation in the mtDNA of blood cells was also detected in some of their parents, maternal relatives(mother and siblings) by using PCRRFLP.ResultsEighteen patients showed heteroplasmy with a mutant load of mtDNA A3243G mutation ranging from 9.0% to 50.0% in blood cells and from 42.4% to 64.8% in muscle tissues in 4 of them. The main clinical features were characterized by epilepsy,exercise intolerance, progressive dementia, fever, vomiting,vision loss, short stature and hypertrichosis on back. Strokelike episodes were found in 7 patients. Laboratory studies revealed elevated serum lactate with levels at 4.2-10.8 mmol·L-1. Cranial CT scan showed calcifications in the bilateral basal ganglia in 9 cases and MRI showed infarctlike lesions in 11 cases, involving the lateral temporaloccipital and parietal lobes in 6 cases, the bilateral parietal occipital lobes in 4 cases, the frontal lobes in 2 cases. The A3243G point mutation in the mtDNA of blood cells was detected in 37 persons from 14 families. The study showed the A3243G mutation was found in 5/10 of the mothers, the mutation rates were 3.0％, 5.0%,11.8%, 21.3% and 26.9%, respectively, and in 4/7 of the siblings 19.3％,33.3%,37.5％ and 41.5%, respectively, all of them were asymptomatic.Conclusions MELAS was the most common maternally inherited mitochondrial disease with various clinical phenotypes and A3243G mutation of the mtDNA accounted for most MELAS in Chinese children. The proportion of mutant mtDNA was not related to the course of the disease but to the age.

Objective The aim of this study was to assess the quality of clinical practice guidelines(CPGs)using the Appraisal of Guidelines for Research and Evaluation Ⅱ(AGREE Ⅱ) instrument, and to provide a reference for promotion, development and adaptation of the guidelines. The recommendations were compared among guidelines for children and adolescents vitamin D supplementation, and the basic consensus and dispute were focused. Methods PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang Chinese Periodical Database, VIP Chinese Periodical Database, National Guideline Clearinghouse and relevant web sites were searched for the guidelines on children and adolescent vitamin D supplementation. The common characteristics of guideline were descriptively analyzed. AGREE Ⅱinstrument was used to evaluate the quality of CPGs. Intraclass correlation coefficient (ICC) was used to examine the conformance of the raters′ evaluation scores. The recommendations of the included guidelines were extracted, analyzed and compared to find the similarities and differences. Results A total of 9 CPGs were identified from the United States, China, Canada, France, Poland and Australia/ New Zealand. The guidelines were published from 2006 to 2012, 3 of them were evidence-based (EB) and 2 used GRADE method, 1 used AHRQ evidence grading system, the rest of 6 were non-EB CPGs made by consensus of experts and article review. ①The AGREEⅡinstrument rated CPGs among 6 domains. "Scope and purpose", "clarity and presentation", and "applicability"were averagely scored ≥50%, "stakeholder involvement", "rigor of development" and "editorial independence" were scored 48%, 42% and 28% respectively and needed improved. EB CPGs had higher quality scores compared with non-EB CPGs for “rigor of development” and “editorial independence”. ② The main recommendations of CPGs were similar. However, there were 5 main differences summarized among CPGs. For prevention of VD deficiency, 400 IU·d-1 of VD was considered as a safe dose for 0-1 year-old group and therefore worthy to be recommended. For treatment of VD deficiency, America(ES) CPGs recommend 2 000 IU·d-1 of VD for at least 6 weeks(1-18 years group). For sun exposure, America and Australia/New Zealand CPGs held different recommendations. For supplement of VD2 or VD3, there was no consensus among included CPGs. For 25OHD level, nearly all CPGs agreed to the increased prevalence of rickets when 25OHD <30 nmol·L-1. For pregnant and lactating women, CPGs recommend that this group should pay attention on VD supplementation, or maintain appropriate 25OHD level. Conclusions ①The overall quality of the included CPGs is still to be improved, and EB CPGs have higher quality scores for “rigor of development”. ②400 IU·d-1 of VD is considered as a safe dose to preventing VD deficiency for all 0-18 years-old groups and therefore worthy to be recommended. ③The recommendations of China CPGs have absorbed the high quality CPGs from other countries, so adaptation and development of Chinese own high-quality CPGs is urgently needed.

Objectives：The role of NK cell function as an etiological or prognostic factor in EBV-HLH remains unclear. The present study tried to investigate the expression of NK cell surface activating receptors and CD107a in EBV-HLH patients. Methods：EBV-HLH patients and age- and sex-matched normal controls were selected from August 2009 to May 2011 in Beijing Children′s Hospital. Multicolored immunofluorescence flowcytometric analysis was performed to detect NK cellsurface activating receptors, perforin and IL-2 stimulated NK cells in peripheral blood from EBV-HLH patients and controls. Results:Eight cases were enrolled in EBV-HLH group and 8 normal children were enrolled in control group. ①There was no statistical difference between EBV-HLH patients and normal controls in NK cell surface activating receptors (NKP30, NKP46, NKG2D, DNAM-1 and 2B4), perforin or basic CD107a expression (P>0.05). ②There was no statistical difference in basic CD107a, CD107a/K562, CD107a/2B4/P815, CD107a/NKG2D/P815 or CD107a/2B4/NKG2D/P815 expression between EBV-HLH group and control group. ③Basic CD107a expression, CD107a/K562 and CD107a/NKG2D/P815 expression in normal controls significantly changed 48 hours after IL-2 stimulation, while such difference was not seen in EBV-HLH patients (P>0.05). Conclusions:The present results indicated that there may be some defects in responding to IL-2 in EBV-HLH patients.

Objective To observe clinical progression in severe cases with enterovirus 71 (EV71) infection, attempt to explore the neurologic invasive pathways, and introspect on the " Clinical expert consensus of EV71 infection severe cases (referred to expert consensus) " after EV71 infection. Methods Unsurvival cases of EV71 infection were selected from nine hospitals in Guangxi (12 cases) from 2008 to 2010，and in Guangzhou Women and Children′s Medical Center (2 cases) from2011 to 2012, to analyze these 14 cases in clinical manifestations and features of autopsy. Results 14 unsurvival cases of EV71 infection, male: female =7∶7 , aged from 7 to 36 months, the average age was (19.0 ± 9.8) months. The autopsy common features of 14/14 cases were the brainstem cribriform necrosis and malacia formation, 10 cases involved in the medulla oblongata, and there were no inflammatory cells in other organs. Nine symptoms/signs (34.6%) in the expert consensus hadn′t been recorded. Both seizure and disturbance of consciousness in stage 4 had occurred with the symptoms / signs in stage 2 simultaneously. The symptoms/signs could be observed at the beginning were fever, rash, vomiting, startle, seizure, fatigue; 42.9% cases appeared various neurological symptoms orderly, simultaneously or alternately until death. The 12/14 cases average survival duration after onset of symptoms/ signs was 72.4 h, and after appearing any abnormal basic vital signs in stage 3(mean duration 65.5 h) was 6.9 h, and after appearing neurologic symptoms/ signs in stage 2 (mean duration 39.8 h) was 32.6 h. Conclusion ①The cause of death for confirmed EV71 infection was brainstem function failure; ②It is speculated that EV71 neurologic invasive pathways existed; ③It is recommended that neurologic specialist assessment for special clinical indicators is needed after EV71 infection; ④Seizure and confusion should be included in the earlier observation indicators; ⑤It is proposed that indicators of neurologic specialist assessment would be used in the fuller clinical staging study of EV71 infected neurologic involvement, to provide sufficient time of observation and intervention for clinicans.

Objective Individuals with autism have been demonstrated to have deficit in cognizing facial expression. This study aimed to explore the cognitive profile of facial emotional expressions in young children with autism.Methods Forty five children with autism and forty five normal controls matched on chronological age and gender were recruited to view passively five kinds of basic facial emotional expression pictures which presented on computer screen in a quiet room. The responses of each child were recorded by a web camera. Then visual attention and self emotional responses of all children toward the emotional expressions were coded from the videotaped observations.Results The data of 82 children were included in the analysis because 8 children did not finish the entire experiment. The difference of the firstlooking time toward five kinds of facial expression between groups was not significant while expression effect within group was significantly showed that children looked longer to happy and angry expression than fearful expression at the first time. Autistic children′s times of backlook and total looking time toward all kinds of facial expression were significantly less than normal controls′(P＜0.05). The score of self emotional response to different expression was significantly different in normal children(P＜0.05) including positive and negative response, which showed the score of positive emotion toward happy expression was higher than that toward other expressions, the score of negative emotion toward happy expression was lower than that toward angry and fearful expressions and the scores of negative emotion toward sad and surprise expression were also lower than that toward fearful expressions, while that was not obvious in children with autism. Autistic children showed indifferent to all facial expressions or abnormally positive emotional response to negative facial expression as to happy expression.Conclusions Young children with autism not only show less visual attention to facial expression, but also have impairments in perceiving facial expression especially in comprehending negative emotional expressions that maybe relate to early abnormal development of amygdala in autism.

Abstract Objective To improve the prenatal diagnosis accuracy of isolated total anomalous pulmonary venous connection (TAPVC) by analyzing and accumulating fetal echocardiography features accurately diagnosed by fetal echocardiography. Methods Fetal echocardiographic signs and accumulated fetal echocardiography features were retrospectively analyzed in 8 cases with prenatal diagnosis of isolated TAPVC which was confirmed by neonatal echocardiography, surgery or autopsy from May 2011 to February 2014. Results Diagnosis of TAPVC was made in 8 fetuses, including 5 with supracardiac connection, 2 with infracardiac connection and 1 with cardiac connection. Only 2 fetuses were diagnosed TAPVC in other hospitals before, including 1 fetus diagnosed as abnormal vessel in liver and infracardiac TAPVC, 1 fetus diagnosed as infracardiac TAPVC combined with descending vertical vein obstruction. Other 6 fetuses were all misdiagnosed, including 2 with hypoplastic left heart syndrome and coarctation of aorta, 1 with dilated coronary sinus and left superior vena cava, 1 with abnormal vessal nearby superior vena cava combined with stenosis, 1 with left superior vena cava and 1 with small diameter of left heart. Stenosis along the vertical vein pathway or the connection of the vertical vein to pulmonary venous confluence was identified in 5 fetuses. In 1 terminated of pregnancy case with infracardiac connection, autopsy confirmed the prenatal diagnosis. Other 7 fetuses were born and performed surgery after birth, 1 case with infracardiac connection died in 1 week after surgery and other cases recovered well. The echocardiography characters of fetuses diagnosed with TAPVC：① The normal shape of left atrium disappeared and left atrium became round or oral and narrow especially in the latter phase of pregnancy. ② The distance was increased between left atrium and the descending aorta (Dao) and an abnormal pulmonary venous confluence presented posterior to the left atrium in most cases, and the ascending vertical vein or descending vertical vein could be seen. ③ The ventricular proportion was normal at the earliest gestation, but the right heart was dilated after 26 weeks. ④ A dilated coronary sinus could be seen in fetuses with cardiac TAPVC and a dilated superior vena cava in the fetus with supracardiac TAPVC and the dilated hepatic vessel in infracardiac TAPVC fetuses as well. ⑤ Color Doppler imaging could show the draining trace and whether existed vertical vein obstruction. Conclusion The isolated TAPVC is easy to be misdiagnosed when the ventricular proportion is normal at the earliest gestation. More attention should be paid on more angle and more exam views when performing fetal echocardiography. The fetal echocardiography can reduce misdiagnosis at the latter phase of pregnancy.

Objective To evaluate the diagnostic value of Mycobacterium tuberculosis (M.tb) multiple antigen proteinchip on childhood tuberculosis. Methods Serum samples were collected from 79 cases of childhood tuberculosis patients, 33 cases of nontuberculosis patients，15 children with latent tuberculosis infection and 30 healthy children. Positive rate of PPD skin test and bacteriological examination in tuberculosis patient group were calculated. Mycobacterium tuberculosis multiple antigen protein-chips were used to detect three antibodies to lipoarabinomannan (LAM), recombinant Mr 16000 and Mr 38 000 antigens simultaneously in all groups.The results were adjusted by the Protein Chip Reader equipment.If any of the three antibodies or more than one showed positive, then the result could be determinded as positive. The positive rates of protein-chip method in different groups were calculated and the sensitivity, specificity, positive predictive value, negative predictive value of the proteinchip were also calculated . The relationships among the positive rate of protein-chip and the age of patient, duration of illness, duration of antituberculosis treatment , administration of corticosteroids and type of tuberculosis were analyzed by Logistic regression and χ2 test. Results The positive rate of M.tb multiple antigen protein-chip was 34.2% in childhood tuberculosis, which was lower than that of PPD skin test (84.8%) and higher than that of bacteriological examination(12.7%). In the non-tuberculosis patient group, the positive rate was 6.1%, in the latent tuberculosis infection group it was 0, and 0 in the healthy control group respectively. The false negative rate of the control group was 2.6%. The sensitivity, specificity detected by protein chip were 34.2%，97.4% respectively. Positive predictive value was 93.1%，negative predictive value was 58.5%. The positive rate of protein-chip method was related to duration of illness by Logistic regression, it was 18.9%（6/32）when the illness duration <1 month, 21.6%（8/37）when the illness duration between 1 and 3 month, and 100% （13/13）in those whose illness duration was longer than 3 months. Current statistical data showed there was no significant correlation between testing positive results and factors such as ages, antiTB treatment duration, corticosteriods administration and type of turberculosis. The differences of the positive rate of chip testing in different TB types might be related to the differences of the illness durations in different TB types. Conclusions The Mycobacterium tuberculosis multiple antigen protein-chip method might be a supplementary way in diagnosing childhood tubercuiosis. But the sensitivity was low, and not suitable for early diagnosis.

Objective To investigate whether the variation of the pathogenicity of enterovirus71(EV71) was related to the variation of the nucleotide sequencing of the virus of the full length genomes of EV71 strains isolated from pediatric patients with hand, foot and mouth disease (HFMD) presenting different symptoms in Beijing from 2008 to 2009. Methods Five EV71 strains in 2008 and 4 EV71 strains in 2009 isolated from Laboratory of Virology of Capital Institute of Pediatrics were chosen, of which 4 EV71 strains were isolated from severe HFMD children with high fever, continuous convulsion and loss of consciousness. Five EV71 strains were isolated from mild HFMD children.The full length genomes from 9 EV71 strains isolated from children with various clinical presentations were sequenced by amplification with RT-PCR and sequencing of 10 overlapped gene fragments covering full length of the genomes. Their nucleotide and amino acid sequences were aligned and phylogenetic relations of the sequences were analyzed by using DNAStar and MEGA software (version 4.1). Results The full length of 9 EV71 strains isolated from children in Beijing from 2008 to 2009 was 7 405 bp or 7 406 bp (Poly A tail not included) with a deletion in the 5′UTR for 6 out of these 9 strains. The overall nucleotide sequence identities of these 9 EV71 isolates were in the range of 96.3%-99.4%, while amino acid sequence identities were 98.2%-99.6%. The homology of the nucleotide sequences of VP1 of these 9 EV71 isolates was 96.9%-99.9%, while the homology of the amino acid sequences was 98.3%-100.0%. The majority of nucleotide changes were located at the third codon positions which caused silent mutations, thus the deduced amino acid sequence changes among those 9 EV71 isolates were scanty. The residue 144 in the VP2 protein and the residues 140 and 263 in the 3D polymerase (3Dpol) which were T, R and I were substituted by S, K and V, respectively in 3 out of 4 neurovirulent strains. Two bases, G and A at the nucleotides 208 and 254 in the 5′UTR were substituted respectively by A and G in the same 3 of those 4 neurovirulent strains. The nucleotide sequences of 9 EV71 isolates in the 5′UTR, P1, P2, P3 and 3′UTR regions exhibited the highest homology to the subgenotype C4 of EV71. However, when compared with CVA16 prototype strain G10, the nucleotide identities within the 3D and 3′UTR regions were higher than those of known genotypes A, B, C1-C3 and C5 of EV71. These 9 EV71 isolates formed a branch with other EV71 isolates circulating in mainland China and Taiwan previously identified as genotype C4 on the two phylogenetic trees. Conclusions The data from this study suggests that mutations at the residue 144 in the VP2 protein (T→S), the residues 140 and 263 in the 3Dpol (R→K and I→V) and the nucleotide 254 in the 5′UTR (A→G) may be associated with the severity of clinical presentations. Based on the entire VP1 gene sequences, the EV71 viruses circulating in Beijing from 2008 to 2009 should be classified as the subgenotype C4. The nonstructural protein encoding genomic regions may play a role in the evolution of EV71.

Objective To investigate the variation of peripheral blood lymphocyte subpopulations and immune function in severe hand, foot and mouse diseaseHFMD children. Methods Severe HFMD children hospitalized from May to December 2008 were enrolled into the study. Relative counts of CD3+CD19-, CD3+CD4+, CD3+CD8+, CD3-CD19+ and CD3-CD16+CD56+ of recruited children were detected on the day of admission or the next day. Peripheral blood lymphocyte subpopulations of critical HFMD children were detected again on the second day after receiving the treatment of IVIG and methylprednisolone. The differences of lymphocyte subpopulations before and after treatment and the severity of the disease were analyzed. Results One hundred and forty-five severe and critical HFMD children were enrolled. Among 24 cases aged from 2 d to younger than 12 months, 17 were boys, with 13 being severe HFMD and 4 being critical HFMD. Among 7 girl cases, 4 were severe HFMD and 3 were critical HFMD. One hundred and eighteen cases were younger than 6 years of age, of them 71 were boys including 32 severe HFMD cases and 39 critical HFMD cases, 47 were girls including 25 severe HFMD cases and 22 critical HFMD cases. ①The percentages of NK cells in 2 d-<12 month group showed an increasing trend and the percentages of B cells in -6 years group also showed an increasing trend. ②The percentages of B cells in severe HFMD group showed an decreasing trend, but the percentages of NK cells showed significantly increasing trend which were two times higher than normal. The percentages of T cells and NK cells in critical HFMD group all showed an decreasing trend and the percentages of B cells showed a significantly increasing trend which were two times higher than normal. The comparison between two groups showed the percentages of T cells and NK cells in critical HFMD group were significantly lower than those in severe HFMD group P<0.05. The percentages of B cells in critical HFMD group were significantly higher than those in severe HFMD group P<0.05, which were close to normal. ③The percentages of T cells and NK cells in critical HFMD group increased significantly after treatment.P<0.05. The percentages of B cells in critical HFMD group after treatment were significantly lower than those before treatment P<0.05. Conclusions The increased B cells may serve as an indicator of a critical HFMD. Use of IVIG and methylprednisolone is helpful to the recovery of immune function of critical HFMD children.

Objective To explore the effects of serum leptin and adiponectin concentrations on the pathogenesis of obesity-related hypertension for children and adolescents.Methods A total of 3 502 schoolchildren (1 784 boys and 1 718 girls) aged 6-18 years were recruited from the BCAMS study, which was a crosssectional representative populationbased survey on metabolic syndrome for children and adolescents in Beijing. In this study, participants were categorized into four groups (Control group, HBP group, OB group and OB+HBP group) according to the sex, age-specific body mass index (BMI) cutoffs recommended by the Working Group on Obesity in China, and systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) equal to or greater than the 95th percentile for age and gender of schoolchildren in Beijing in 2004. Blood samples were obtained after a 12hour fast, and the levels of plasma insulin, serum leptin and adiponectin were measured by sensitive, specific doubleantibody sandwich enzyme-linked immunosorbent assays (ELISA). Variables including insulin, leptin and adiponectin were skewed distribution and natural logarithmical transformations were performed. Analysis of variance, Spearman correlation, and multivariate regression analysis were conducted.Results Higher BMI, SBP and DBP, lower insulin, leptin and adiponectin levels were found in boys than in girls. There were no differences in BMI, serum leptin and adiponectin levels between the control group and the HBP group. Higher BMI, plasma insulin and serum leptin, and lower adiponectin levels were found in the OB group and OB+HBP group than those in the control group or HBP group. BMI, plasma insulin levels of the participants in the OB+HBP group, but only boys′ serum leptin levels were higher than those in the OB group. Both SBP and DBP had positively correlated with leptin (r=0.260-0.643, P<0.01）and negatively correlated with adiponectin (r=-0.171-0.332, P<0.01) for both genders. After adjusting for insulin or BMI, above correlations became weak or disappeared. The odds ratios (OR) and 95% confidence interval (95%CI) for the prediction of hypertension were elevated in children in the upper quartile of leptin level ［2.75(2.28-3.32)］ compared with that in the lower quartile. The figures were 1.59(1.31-1.92) in the lower quartile of adiponectin level compared with in the upper quartile. When BMI was included in the models, all ORs for the prediction of hypertension were not significant for both hyperleptinaemia and hypoadiponectinaemia.Conclusions Levels of blood pressure, plasma insulin, serum leptin were higher and serum adiponectin was lower in overweight children than in control group. Leptin and adiponectin may be related to blood pressure through obesity or insulin resistance.

Objective Many countries analyzed the trend of hour-specific transcutaneous bilirubin after birth and developed hour-specific transcutaneous bilirubin nomogram for predicting the risk of neonatal hyperbilirubinemia. The predictive value of hour-specific transcutaneous bilirubin nomogram for neonatal hyperbilirubinemia was systematically reviewed. Methods The Cochrane library, PubMed, OVID, Springer, CNKI, VIP, Wanfang from January 1990 to March 2011 were searched. Two reviewers assessed the quality of including studies independantly, extracted data. Statistical analysis was performed employing Office Excel 2003 and SPSS 16.0. Results Ten studies were included. Six studies were assessed as B-class, four studies were C-class. The hour bilirubin percentile curve values of different countries and races showed some differences. India had the highest bilirubin percentile curve values, followed by Greece, Israel and China, and United States. In the high-risk areas, the rate of bilirubin within 24h after birth increased the fastest; the rate of bilirubin within 36 h after birth increased the fastest in the medium and low risk areas. India had the highest increased rate of bilirubin, followed by China, United States, Israel, and Greece. In the high-risk areas, the sensitivity of hour-specific transcutaneous bilirubin nomogram for predicting neonatal hyperbilirubinemia was 26.9%-75.0%, the specificity was 89.4%-97.3%; the sensitivity and specificity was 78.7%-100.0% and 48.3%%-82.3% respectively for the medium-risk areas, as well as 98.7%-100.0% and 24.4%-56.1% for low-risk areas. AUC was 0.766-0.990. Thailand had the highest accuracy for predicting neonatal hyperbilirubinemia, followed by India and China, and United States was the lowest. Conclusions The hour-specific transcutaneous bilirubin nomogram showed high predictive accuracy for neonatal hyperbilirubinemia, and was valuable in clinical application. The hour bilirubin percentile curve values vary among different countries and races. It is suggested that countries develop hour-specific transcutaneous bilirubin nomogram based on their own countries' value of bilirubin change and take it as the reference standard of intervention.