Objective To analyze the distribution of waist circumference and waist-to-height ratio for 3-18 year old children and to explore the related optimal thresholds for schoolchildren in Beijing based on the assessment of cardiovascular risk factors. Methods As part of the Beijing Child and Adolescent Metabolic Syndrome study, a stratified cluster representative sample of 23 422 children aged 0-18 years was selected. Anthropometric measures including height, weight and waist circumference data were collected from about 20 000 subjects aged 3-18 years. Fasting finger-stick capillary whole blood levels of glucose, total cholesterol and triglyceride were measured by Accutrend GCT measuring system. Receiver operating characteristic analysis was used to determine the waist circumference and waist-to-height ratio to discriminate between the presence and absence of the abnormality of these cardiovascular risk factors and to determine the optimal thresholds by age and gender. The second sample was made up of 2 794 children and adolescents (1 456 male and 1 338 female), aged 6 to 17 years, randomly selected from 18 districts in the Beijing area. Systolic and diastolic blood pressure data were collected. Fasting serum lipids including total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, fasting plasma glucose, anthropometric index as height and waist circumference were measured. According to waist circumference and waist-to-height ratio cut off points, test samples were fallen into two groups including a normal group and an obesity group. The average levels and abnormal rates of the cardiovascular risk factors were compared with general linear model analysis between the two groups. Results ① The waist circumference measurements were differed by age, gender and urban-rural residence, and the waist-to-height ratio remained comparatively steady among different groups. ② After adjusting for age, gender, urban-rural residence, the binary logistic regression model results suggested that waist circumference and waist-to-height ratio were important predictors for cardiovascular risk factors. ③ Receiver operating characteristic analysis results showed that the 80th percentile of waist circumference for age and gender, and waist-to-height ratio equal to 0.46 could be taken as the optimal thresholds. There were significant differences for the average levels of systolic and diastolic blood pressure, serum triglyceride, high density lipoprotein cholesterol and their abnormal rates between the groups divided by the two cut off points. Conclusions As in adults, waist circumference is a better predictor of cardiovascular risk factors in schoolchildren. Waist circumference, which can be easily measured, should be collected for schoolchildren during annual routine physical examinations.
Objective Biliary atresia is a common, cholestatic disease with unknown cause and poor prognosis in infants. The pathologic change of biliary atresia is the key to understand its pathogenesis and prognosis. The aim of this study is to observe the pathomorphologic changes in liver and triangular cord of porta hepatis in early biliary atresia and to assess the relationship between the differentiated degree of fibroblast in triangular cord of porta hepatis and the liver fibrosis scores. Methods From September 2005 to May 2006, 21 cases of biliary atresia ［(66±20) days old］ underwent Kasai procedure. Liver tissues and triangular cord of porta hepatis were taken during operation. 5 cases of cholestasis syndrome and 10 cases of choledochal cyst were taken as control group. Liver biopsy was done in the control group. The micro-and ultra-structure of the liver and porta hepatis were assessed between biliary atresia and the control group. Phillip CM-120 transmission electron microscope was used to examine the ultra structure features, including hepatocyte, canalicule and fibroblast. Semi-quantitatively the difference of the liver fibrosis grading between biliary atresia and control group was evaluated with a 3 grade staging system. The differentiated degree of fibroblasts in triangular cord of porta hepatis were assessed： ① juvenile type: above 50% FBs were juvenile；② senior type: above 50% FBs were senior；③median type: between juvenile and senior type. The differentiated degree of FB in porta hepatis were assessed in relation to the liver fibrosis score. SPSS software was used for statistical analysis. Results ①The pathologic changes of early biliary atresia were characterized by inflammation and fibrosis in the hepatic portal area. In control group, mild to moderate degree of bile canaliculus hyperplasia could be seen in pathological slices of limiting plate. The inflammatory reaction and liver fibrous degree were milder than that of the biliary atresia group. Bile canalicular hyperplasia of biliary atresia was more severe and inflammatory reaction was wider than those in control group. Moderate to severe degree of debris necrosis, accompanied by increased liver fibrosis, disappearance of lobular structure, and the formation of numerous pseudo-lobule formation were observed in the biliary atresia group. The fibrosis scores in biliary atresia (Ⅰ: 2 cases, Ⅱ: 12 cases, Ⅲ: 7 cases) were significantly higher than that in the control group (Ⅰ: 8 cases, Ⅱ: 5 cases, Ⅲ: 2 cases). The significant difference was found in the liver fibrosis score between biliary atresia and control group(P=0.01).②In biliary atresia, all cases of extrahepatic biliary system showed triangular cord in porta hepatis. The triangular cord of porta hepatis was characterized by canalicular hyperplasia, atresia or stenosis of the bile ducts, inflammation infiltration, cholestasis, and interstitial fibrosis.③The ultrastructure features of biliary atresia included activation of FB, loss of microvilli, dense deposit in hepatocytes and liver sinusoid, and canalicular dilatation.④The differentiated degree of FB in triangular cord of porta hepatis were positively correlated to the liver fibrosis score (P=0.04) in biliary atresia group. It suggested that the differentiation of FB in triangular cord of porta hepatis or in liver could accelerate the progress of hepatic fibrosis and cirrhosis. Conclusions The main pathologic changes of biliary atresia were inflammation and fibrosis in the hepatic portal area. The ultra-structure features of biliary atresia suggested that the differentiated degree of FB in triangular cord of porta hepatis were positively correlated to the liver fibrosis score.
Objective To describe the disease spectrum of stroke in childhood, especially to analyze the characteristics of potential etiologies and risk factors of children stroke. Methods This study retrospectively reviewed the records of nearly all 1 month to 16 years old children who were admitted to Beijing Children′s Hospital from Jan 1996 to Jun 2006 (many of these cases were inpatients of Neurology Department). Patients were eligible for enrollment in this study if they fulfilled the following conditions:①diagnosed as arterial ischemic stroke (AIS) or hemorrhagic stroke (HS) ;② an acute focal neurological deficit of sudden onset that persisted more than 24 hours;③neuroimaging evidence of cerebral infarction or intracranial hemorrhage. Patients with transient ischemic attack (TIA) and those who had prenatal and neonatal stroke and/or had venous infarction were excluded. As a result, a total of 251 children with the diagnosis of stroke were included in this study to analyze the disease spectrum of childhood stroke. Results 156 boys (62.2%) and 95 girls (37.8%) were included in the analysis. Age ranged from 0.33 to 16.00 years with a mean of (4.37±3.98) years and a median of 2.67 years. Most patients came from north China, and children from the countryside were more than urban residents. AIS was diagnosed in 157 patients (62.5%) and HS in 94 (37.5%). No significant difference in season distribution was found between both groups. In the AIS group, idiopathic stroke (32.5%) was the most common subtype (among which 9.8% had transient infection before stroke attack), hematological stroke accounted for 10.8% and cardiac stroke was diagnosed in 8.9% of cases. Male patients (n=92; 58.6%) were more than female patients (n=65; 41.4%) in AIS group, no differences was found in gender or age among AIS subtypes (P＞0.05 by χ2 test). Hyperglycemia (10.2%) and hyperlipidemia (9.6%) were the most common possible risk factors for the AIS group, whereas seizure (20.4%) and dysphasia (15.9%) were the most common clinical manifestation in our AIS cohort. No difference were found in risk factors or clinical manifestation among different subtype(P＞0.05). Moyamoya disease (57.6%) was the major etiology in vascular or arteriopathic stroke, followed by idiopathic vasculitis (21.2%) and cerebrovascular malformation (12.1%). In cardiac stroke, congenital heart disease and arrhythmias accounted for 35.7% of the cases while acquired heart disease accounted for only 28.6% of the cases. For hematologic stroke, nutritional iron deficiency anemia (70.6%) was the major contributive factor, while only one patient had positive anticardiolipin antibody and one patient had a positive D-dimer test. In the group of other determined etiology, the two most common etiologies were infection (n=19, 45.2%) and head injury (40.5%). 31.6% of these patients had viral encephalitis, and 21.1% had varicella zoster virus infection. Of 94 patients with HS, 39 (41.5%) had intracerebral hemorrhage, 38 (40.4%) suffered multiple loci hemorrhage, 13 patients had subarachnoid hemorrhage, 6 patients had arteriovenous malformation (6.4%), 4 patients had subdural hemorrhage, and in five patients no etiology was found. Vitamin K deficiency was a major risk factor in 72 of 94 HS (76.6%).Most of these vitamin K deficiency cases came from rural area (56 of 72, 77.8%) and occurred in relatively younger infants ［average age (1.54±0.55)months］. Conclusions Ischemic stroke in children is much more common than haemorrhagic stroke. Many cases are idiopathic. Genetic predisposition combined with transient infection may be involved in stroke development during childhood. Vitamin K deficiency is a major risk factor in young infants with haemorrhagic stroke.
Objective To explore the onset characteristics of coronary artery lesions caused by Kawasaki disease and their changes in 2 years after onset. Methods A colour Doppler echocardiography was performed on 356 patients with Kawasaki disease in Guangzhou Children′s Hospital from January 2001 to December 2004. The ages of patients (242 boys, 114 girls) in acute stage were 1-123 months［（26.3±21.0）months］］. The patients were divided into three groups according to changes in coronary arteries: coronary arterial dilatation(n=72), small or medium coronary aneurysm(n=36) and giant coronary aneurysm group(n=11). The patients with coronary artery lesions were followed-up by echocardiography in 119 cases and ATP stress echocardiographyin in 48cases. The differences of febrile days before diagnosis and the changes in coronary artery were compared respectively among three groups . Results The coronary artery lesions were found in 147 patients（41.3%，147/356） by echocardiography, including 48 cases with coronary aneurysms (13.5%,48/356) and 99 cases with coronary arterial dilatation (27.8%,99/356) . The incidences of coronary artery lesions were 38.1%(40/105) in patients aged<1 y, 40.4%(67/166) in patients aged 1-3 y; 40.7%(22/54) in patients aged 3-5 y; 58.1%(18/31) in patients aged>5 y. The incidence of coronary artery lesions in patients aged>5 y was significantly higher than that in patients aged< 1 y (P<0.05). The febrile days before diagnosis in the giant coronary aneurysm group were more than that in medium or small coronary aneurysm group and the coronary arterial dilatation group［(18.4±12.0)days,(12.9±8.2)days,(7.4±3.6)days，P<0.01］］. By echocardiography, 69 of cases (69.7%,69/99) with coronary atery lesions were found in acute stage, 27 of cases (27.3%) in subacute stage (11-21 d from onset),3 of cases (3.0%) in convalescence (21-60 d from onset). 27 of cases (56.2%,27/48) with coronary arterial aneurysms lesions were found in acute stage, 15 of cases (31.2%) in subacute stage and 6 of cases (12.5%) in convalescence . 119 patients (81.0%,119/147) were followed-up. During two years follow-up, the coronary artery lesions were recovered in all patients in coronary arterial dilatation group and in 77.8%(28/36) patients of medium or small coronary aneurysm group. In giant coronary aneurysm group, the mild or moderate regressions were found in 8 of 11 patients; the aneurysms turned to dilatation in 3 cases; the right coronary artery stinosis was observed in 1 case, which was conformed by coronary angiography. 48 of 119 cases were given ATP stress echocardiography.The results revealed that in coronary arterial dilatation,small or medium coronary aneurysm and giant coronary aneurysm group，the incidences of wall motion abnormalities were 14.8％（4/27）,58.8％（10/17）and 75.0％（3/4）,respectively , and the rates of decreased coronary flow reserve were 22.2%（6/27）in patients with coronary arterial dilatation, 38.1%(8/21) in patients with coronary aneurysm . the rate of decreased coronary flow reserve in coronary aneurysm group was significantly higher than that in the group of coronary artery dilatation（P< 0.05）. Conclusions Most of coronary artery lesions caused by Kawasaki disease were transient.The giant coronary aneurysms may exist for longer time. Echocardiography is helpful for finding the coronary artery lesions and monitoring their changes.Stress echocardiography is useful for the follow-up of Kawasaki disease.
Objective The purpose of this study was to investigate the sleep structure, epileptiform discharge, and periodiclimb movement during sleep (PLMS) in children with attention deficit hyperactivity disorder (ADHD), and the difference in sleep structure among ADHD subtypes. Methods A total 54 children who were diagnosed as ADHD in the Capital Institute of Pediatrics clinics from 2005.6 to 2006.11 in accord with DSMⅣ criteria (7 females and 47 males with a mean age of 9.5±2.4 years old)and 30 normal control children（6 females and 24 males with a mean age of 9.2±2.3）underwent comprehensive overnight PSG assessment. In the ADHD group, 31 children were classified as combined type ADHD (ADHD-C); 15 children as predominant inattention type ADHD (ADHD-I); and 8 children as predominant hyperactivity/impulsivity type ADHD (ADHD-H). Analytic parameters included percentage of stage Ⅰ、stage Ⅱ、stage Ⅲ、stageⅣand stage REM, latency to REM, sleep latency, total sleep time, sleep efficiency, number of arouses, and time of arouse. Results ①Compared with normal control, children with ADHD showed decreased latency to REM, increased sleep latency, and decreased sleep efficiency(P<0.05). There was no significant difference in the percentage of stage Ⅰ、 stage Ⅱ、 stage Ⅲ、stage Ⅳ and stage REM, total sleep time, number of arouses, and time of arouse between the two groups(P>0.05). ②Compared with the subgroup of ADHD-I, ADHD-C showed increased percentage of stage Ⅱ (P<0.05). There were no significant differences in the data between the ADHD-I subgroup and ADHD-C subgroup(P>0.05) .③The prevalence of PLMS was 37.0% in ADHD group versus 13.3% in normal control. The difference of prevalence rate was statistically significant between the two groups(P<0.05). The prevalence rate of PLMS with an index higher than 5 was 24.1% in ADHD group, and the prevalence of PLMS was 10.0% in matched normal control group. The observed difference of prevalence between the two groups was not statistically significant (P=0.09).④ In ADHD group and normal control group, epileptiform discharge was not detected. Conclusions ①Children with ADHD displayed significant abnormalities during sleep, including decreased latency to REM, difficult to fall asleep, and decreased sleep efficiency. These sleep disorders may be responsible for the daytime behavioral disorder of children with ADHD such as hyperactivity, impulsivity, and inattention.②In comparison with ADHD-I subgroup, ADHD-C showed increased percentage of stage Ⅱ.The increased percentage of stage Ⅱ in ADHD-C was correlated with more severe sleep disorders than those observed in ADHD-I. ③The higher prevalence rate of PLMS in ADHD group may be one of the factors adversely affecting the sleep quality of the sick children. ④Although no epileptiform discharge was found in ADHD group in this study, EEG monitoring may still be necessary when ADHD children are under stimulant medication.
Objective Epinephrine attenuates inflammation by inhibiting the production of pro-inflammatory cytokines, such as tumor necrosis factor(TNF)-α, interleukin (IL)-1β and by increasing the production of anti-inflammatory cytokine IL-10 in vivo and in vitro. In sepsis, activative inflammatory cells and excessive production of pro-inflammatory cytokines lead to tissue injury, multiple organ failure, and death. The liver is one of the major organ that can be damaged in sepsis and it may also trigger multiple organ dysfunction syndrome. Attenuation of hyper-inflammation may be of clinical benefit in the treatment of tissue injury associated with sepsis. So the aim of the study was to investigate the effects of epinephrine on sepsis-associated liver injury in rats. Methods Fifty SD rats were randomly divided into five groups (n=10): saline control group received intravenous 0.9% saline 2.4 mL·kg-1·h-1; LPS group received intravenous lipopolysaccharide(LPS) (Escherichia coli serotype 0111:B 4) 6 mg·kg-1); small dose epinephrine treatment group received an intravenous infusion of epinephrine 0.12μg·kg-1·min-1 after LPS intravenous injection; medium-dose epinephrine treatment group received an infusion of epinephrine 0.3μg·kg-1·min-1 after the LPS intravenous injection; large-dose epinephrine treatment group received an infusion of epinephrine 0.6 μg·kg-1·min-1 after LPS intravenous injection. Hepatic injury was evaluated by determining the levels of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and by liver pathological examination. Blood samples were taken 0, 2 and 6 h later and the levels of serum TNF-α, IL-1β and IL-10 were detected by enzyme-linked immunoadsorbent assay (ELISA). At the same time points, the levels of serum ALT and AST were also detected. The liver pathological changes were observed at 6 h. Results In LPS group, serum levels of ALT and AST were increased significantly compared with control group (all P<0.05) at 2 h and 6 h. Pathological examination showed that LPS could cause severe congestion of hepatic sinusoids and hepatocyte necrosis. Compared with LPS group, large-dose epinephrine reduced serum levels of ALT and AST (P<0.05) and ameliorated the damage of liver tissue. In LPS group, serum levels of TNF-α, IL-1β, IL-10 were all increased compared with control group (all P<0.05). Compared with LPS group, serum levels of TNFα were significantly reduced (P<0.05), whereas IL-10 was elevated (P<0.05) in large-dose epinephrine treatment group. Serum IL-1β levels were unaffected by large-dose epinephrine treatment. Small-dose and medium-dose epinephrine could not reduce the levels of serum AST and ALT and could not reduce the liver injury induced by LPS. Compared with LPS group, levels of serum TNF-α ,IL-1β and IL-10 were also unaffected by small-dose and medium-dose epinephrine treatment( all P＞0.05) at any time points. Conclusions Epinephrine reduced the liver injury caused by LPS，down-regulated pro-inflammatory cytokines production and up-regulated anti-inflammatory cytokines production in rats. The anti-inflammatory effects may in part explain the protective effects of epinephrine on sepsis-associated liver injury. These results suggested that epinephrine may be useful in the treatment of liver injury associated with sepsis, shock, and other diseases associated with systemic inflammation.
