Objective Hypothermia as a therapy has been used to treat severe brain injury. However, there is controversy about its therapeutic effect. Therefore, in this study, we summarized the data of severe brain injured patients who were treated with mild hypothermia. Using meta-analysis method, we compared the clinical effectiveness of hypothermia on patients with severe brain injury and investigated the feasibility of hypothermia therapy. Methods PubMed, EMBASE, Ovid, Springer, CNKI database were searched by using the terms Hypothermia and Severe Brain Injury for human clinical trials, including unpublished documents from scientific meetings and thesis, and the similar documents listed in the reference of above documents were also included. All of the randomized controlled trials were included by comparing hypothermia with routine therapy for the treatment of patients with severe brain injury. Two reviewers independently performed data extraction and appraised using Juni instrument; disagreements were resolved by consensus. Double data were input and analyzed by software of Review Manager 4.22, recommended by Cochrane Collaboration. Intracranial pressure (ICP) and curative effects of patients were selected, and the combined OR value and 95% confidence interval (CI) of them were calculated. Results 9 randomized controlled trials involving 1279 children were included. Publication bias was not found through funnel plot analysis. There are 5 publications reported the change of ICP, including hypothermia group (n=479) and routine therapy group (n=473). Compared to the routine therapy, hypothermia could significantly degrade the ICP of patients (post-treatment 24 h, WMD=-4.78, 95%CI: -5.24~ -4.33, P<0.00001; Post-treatment 72h, WMD=-5.13, 95%CI: -6.53~ -3.73, P<0.00001; Post-treatment 7d, WMD=-6.48, 95%CI: -7.56~ -5.40, P<0.00001, respectively.) There are 6 publications reported the prognosis of patients who were treated with hypothermia therapy (n=454) or routine therapy (n=455). The time of follow-up visit was from 6 months to 6 years. Compared to the patients with routine therapy, the prognosis of patients with hypothermia therapy was significantly improved. (OR=2.04, 95%CI: 1.56~2.67, P<0.00001). Conclusions The therapy with hypothermia can degrade the ICP of patients with severe brain injury and improve the prognosis of these patients.
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 testretest 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 investigate the normal range of the time-domain index of heart rate varibility (HRV) in 920 healthy children aged from 3 to 12 years old, explore the correlation between HRV and age or sex, and study the changes of HRV in children with asymptomatic ventricular premature contraction and long QT interval. Methods 920 healthy children were randomly divided into three groups according to their ages as follows: group I (n=274), 3 to 6 years old; group Ⅱ(n=365), 7 to 10 years old; group Ⅲ(n=281), 11 to 12 years old. The organic heart diseases or other chronic diseases were excluded depending on case history and physical examination or x-ray. Routine ECG at body surface and Holter were used to record the HRV. Five time-domain indexes of HRV were recorded for 24 hours. The relationship between age or sex and HRV was analysed. The difference of HRV between normal children and asymptomatic children with ventricular premature contraction or with long QT interval (QTc >450 ms) was compared. Children with ventricular premature contraction were divided into four groups according to Lown classification as follows: grade 0, normal children without any types of arrhythmia; grade 1, abiogenetic premature contraction (<30 beats/hour); grade 2, frequent premature contraction (≥30 beats/hour); ≥grade 3, pathological ventricular premature contraction. Results The normal ranges of HRV in children of three age categories were obtained. ① The five time-domain indexes (SDNN, SDANN, SDNNIDX, PNN50 and RMSSD) of children were different from those of adults.② Among the five time-domain indexes, SDNN, SDANN and SDNNID were increased with age, while PNN50 and RMSSD showed a decreasing trend of group Ⅱand group Ⅲ. ③ There were significant differences in the five timedomain indexes among three age groups (P<0.01).④ The five timedomain indexes of HRV were higher in males than in females. The comparison showed significant differences in SDNN, SDANN and SDNNIDX between male and female (P<0.05), but no differences were found in PNN50 and RMSSD. The comparison within each age group showed significant differences in SDNN and SDANN between male and female in group Ⅱ and groupⅢ, but no difference in group I. ⑤ No significant differences were found in five time-domain indexes between normal children and asymptomatic children with ventricular permature contraction. ⑥ Similarly, no significant differences were found in five time-domain indexes between normal children and asymptomatic children with long QT interval. Conclusions ① HRV was increased with age in children; ② There was significant difference in HRV between male and female in each age stage, suggesting the variance in the development of autonomic nervous system between male and female; ③ There was no difference in HRV between normal children and asymptomatic children with ventricular permature contraction or long QT interval, suggesting no difference in tensity of autonomic nervous system between normal children and asymptomatic children with arrhythmia. Analysis of HRV may be a useful method of monitoring the occurance of hazardous arrhythmia.
Objective To investigate the infection status of pneumonia mycoplasma (MP) and pneumonia chlamydia (CPn) in children with acute respiratory-tract infection in pediatric out-patient department. Methods The pharyngal samples of children suspected with acute respiratory-tract infection in out-patient department were collected for detecting the MP and CPn by nest PCR. In total, 314 cases aged from 2 months to 14 years were detected, including 131 females and 183 males. Results Among 314 cases, 50 cases were positive for MP or CPn, the positive infection rate of MP or CPn was 15.92%. Among 50 positive cases, 46 (16.6% of all cases) infected with MP and 4 with CPn (1.3% of all cases). The ratio of male and female infected cases was 1.3∶1. The infected children aged from 4 months to 12 years. Among 46 cases infected with MP, 10 (21.7%) were complicated with respiratory virus infection, most of whom (9/10, 90%) with acute upper respiratory infection. The major clinical symptoms of MP infected cases were fever, cough and running nose, but only few cases had headache, muscle pain and gastrointestinal symptoms. Eight patients were with fever and tonsil rankle. The blood routine tests of infected cases showed that white blood cell counts and CRP were normal and neutrophils accounted for 52.2%. All 4 children infected with CPn had fever accompanied by running nose. Among 50 cases infected with MP or CPn, most of them (40/50) showed acute upper respiratory infection, in addition 22 (44%) were younger than 3 years old and 18 (36%) were 3 to 12 years old. Lower respiratory tract infection was shown with the rate of 12% and 8% in children younger than 3 years old and 3 to 12 years old, respectively. The MP infection rate was higher in Spring and in Winter than in other two seasons. CPn was easily infected on September, October and December, but in sporadic. Conclusions MP and CPn infection are the important pathogens of pediatric acute respiratory infection. Infected children get younger and younger. MP and CPn infection do not have specific symptoms compared to other pathogen infection. Earlier pathogen diagnosis by nPCR can guide earlier proper treatment.
Objective To investigate the trend of rates of recovery and drug resistance of H.influenzae, S.pneumoniae, S.pyogenens and M.catarrhalis collected from children with respiratory tract infection in Children's Hospital of Fudan University from 2000 to 2006. Methods A total of 29 416 patients were submitted to the trial. According to the routine technique of culture and test, four pathogens were collected from the sections of nasopharynx and sputum samples.Susceptibility test was performed by KB method and E-test. Results S. pyogenes were isolated by the rates of 10.7% to 2.4% from the nasopharynx, and the recovery rates were kept increasing （P=0.01） from 2000 to 2006. The frequent isolates were 1.7%-8.9% for H.influenzae,1.1%-5.9% for S.pneumoniae and 0.7%-4.7% for M.catarrhalis from sputum samples, however,all of thier changes were no statistically significant(P＞0.05). The recovery rates of H.influenzae collected from sputum samples were higher than that of M. catarrhalis（P=0.026）. There were no S. pyogenes isolates collected from sputum samples. The resistant rates of H.influenzae isolates to Ampicillin were ranged from 15.0% to 30% and no significant trend was found（P=0.4）. However, the resistant rates of H.influenzae isolates to Cefaclor, ranging from 2.5% to 11.2%,showed a significant increase (P=0.005). About 4.%-27.3% of S.pneumoniae were resistant to penicillin(PRSP), and 35.0%-61.2% were intermediate. Both of them showed significant increase statistically （P<0.05）. All of S.pyogenes isolates were highly susceptible to penicillin. But over 85% of S.pyogenes isolates were resistant to Erythromycin. Our data also indicated that about 95% of M. catarrhalis were β-lactamase positive. Conclusions The most frequent isolate was S.pyogenes collected from nasopharynx, and its recovery rate was kept increasing. Most of S.pyogenes isolates were resistant to Erythomycin.The changes of recovery rates of H.influenzae, S.pneumoniae and M.catarrhalis from sputum samples were not statistically significant. The resistant rates of H.influenzae isolates to Cefaclor and S.pneumoniae isolates to Penicillin showed a significant increase statistically.
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.
