Objective To investigate the epidemiologic features of Kawasaki disease in the developed area of China. Methods A questionnaire form and diagnostic guidelines for Kawasaki disease were sent to hospitals in Shanghai, which provided with pediatric medical care. All patients with Kawasaki disease diagnosed during January 1998 through December 2002 were recruited in this study. Results A total of 768 patients with Kawasaki disease were reported. The incidence rates of Kawasaki disease for each year were 16.79 (1998), 25.65 (1999), 28.16 (2000), 28.05 (2001), and 36.76 (2002) per 100,000 children under 5 years of age. The male/female ratio was 1.83:1. The age at onset ranged from 1 month to 18.8 years (median 1.8 years). The disease occurred more frequently in spring and summer. Fever was the most common clinical symptom, followed by oral changes, extremities desquamate, rash, conjunctive congestion, lymphadenopathy, extremities swelling, and crissum desquamate. Cardiac abnormalities were found in 24.3% of patients. The most common cardiac abnormality was coronary artery lesions including dilatation (68%) and aneurysm (10%). Two patients died of heart failure and rupture of coronary aneurysm respectively at acute stage. The case-fatality rate of the disease was 0.26%. A second onset of the disease occurred in 1.82% of patients. Conclusion The incidence rate of Kawasaki disease in Shanghai is lower than that reported in Japan, but higher than those in western countries. The increasing trend in incidence, sex distribution and cardiac abnormalities are similar to those in previous reports. The seasonal distribution is similar to the report from Beijing and different from other reports.
Objective：To explore the association between metabolic syndrome (MS) and arterial compliance (AC) in children and adolescents. Methods：337 subjects (188 of men and 149 of women) aged 6 18 (10.95±3.01 ) years, out of 'Beijing Child Metabolic Syndrome Study', were divided into three case groups (one component, two components, three & more components of metabolic syndrome) and one control group based on the Cook's metabolic syndrome definition in children and adolescents. Measurements including anthropometry, blood pressure, fasting plasma glucose and insulin, serum lipid profile were collected. HOMA-IR index was calculated for estimating individual insulin resistance. AC was measured using digital pulse wave analyzing method from the Pulse trace machine (Micro medical, London), and then the stiffness index (SI) was determined. Results：The mean value of SI in MS group was significant higher than the control group (7.69±1.63 m/s vs 6.25±0.86 m/s, P<0.01). With the increasing of the clustering of MS components, SI and HOMA-IR were gradually increased. After taking account of gender, age and pubertal development, the partial correlation analysis showed that the amount of components of MS and HOMA-IR were positively correlated with SI (both P values were less than 0.001). Conclusion：The AC of MS group was significantly lowered in children and adolescents, and with the increasing of the clustering of MS components, AC was gradually decreased. AC assessment in children and adolescents is important in implementing the early prevention for cardiovascular disease.
Collaborative group of multicentre clinical trial for selective head cooling with mild systemic hypothermia in the treatment of HIE
Safety of selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomized trial Objective: Although it had been shown that mild or moderate hypothermia is safe in treatment of neonatal hopoxic-ischemic encephalopathy (HIE) in small scaled pilot clinical study, it is necessary to go on multicentre, randomized, controlled trial to verify its efficacy in neonates with HIE. This multicentre randomized trial is to study the safety of selective head cooling (SHC) with mild systemic hypothermia in neonates with HIE. Methods: Infants qualified for the study if they were ≥36 weeks gestation, ≥2500g birth weight, and ≤ 6 h after birth. Cord blood gas pH≤ 7.0 or base deficit ≥16 mmol/L, or Apgar score≤3 at 1 min, continued ≤5 at 5 min. Neurological findings of neonatal encephalopathy included lethargy, stupor, or coma, with one or more of hypotonia, abnormal reflexes, absent or weak suck or clinical seizures. Exclusion criteria were: major congenital abnormalities, head trauma causing major intracranial hemorrhage, infection or severe anemia. 246 term infants from 16 tertiary referral hospitals with various severity of neonatal encephalopathy were randomly assigned to either head cooling (n=134 ) or control group(n=112). In 29 babies follow up was not available (17 in cooling and 12 in control respectively). Thus 217 allocated to head cooling (n=117) and control group (n=100) respectively.In head cooling group, the nasopharyngeal temperature was maintained at 34℃ with rectal temperature maintained at 34-35℃for 72 h, then rewarming spontaneously. In control group, normal rectal temperature was maintained. During study period, the baby in both groups were given monitor on nasopharyngeal temperature, rectal temperature, heart rate, respiration rate, transcutaneous arterial oxygen saturation and blood pressure. Severe adverse events included death, major cardiac arrhythmia, major venous thrombosis or hemorrhage and severe hypotension despite full support. Na+, K+, Ca2+, glucose, GPT, GOT, BUN, Cr, pH and BE were measured at 72h after treatment. Results: The death was not significantly different (17.9% vs. 25% in cooling and control group respectively, p=0.20). The major reason of death was severe HIE ( 6.8% vs. 7% in cooling and control group respectively , p=0.96) and respiratory failure ( 6.8% vs. 6% in cooling and control group respectively , p=0.8) in both groups. There was one neonate with major cardiac arrhythmia and DIC in control group and two neonates with DIC and severe gastrointestinal hemorrhage respectively in SHC group. The rate of severe adverse events was no differences (1.7%vs. 2% in cooling and control group respectively, p=1.0). In SHC group, most neonates had lower heart rates during the period of hypothermia, but only 4 cases (3.4%) HR were below 80 bpt/min. The systolic and diastolic blood pressures were stable, and no difference between SHC and control group. The rate of abnormal renal function, elevated liver enzymes, metabolic acidosis, hypoglycemia, hyperglycemia, hypocalcaemia, hyponatraemia, and hyperkalaemia were no significantly differences between both groups. The average value of white blood cell, platelet, and the rate of thrombocytopenia were no significantly differences between both groups. Conclusions: These data suggests that selective head cooling with mild systemic hypothermia in neonates with HIE was safety during 72 h therapy.
Abstract Garlic (Allium sativum) extraction has been reported having anti-HCMV efficacy. This study was aimed to investigate the effect of allitridin (diallyl trisulfide, a compound from A. sativum extraction) on the replication of HCMV and the expression of viral immediate-early genes. In HCMV plaque-reduction assay, allitridin appeared a dose-dependent inhibitory ability with EC50 value of 4.2 μg/ml (selective index, SI = 16.7). Time-of-addition and time-of-removal studies showed that allitridin inhibited HCMV replication in earlier period of viral cycle before viral DNA synthesis. Both immediate early gene transcription (ie 1) and IEA expression (IE172 and IE286) was suppressed by allitridin, but not by GCV in a single HCMV cycle format. In addition, allitridin appeared stronger inhibition on IE286 than on IE172. Decrease of viral DNA load in infected cells was also detected under allitridin treatment, probably due to an indirect consequence of the reduction in ie gene transcription. In summary, this study indicated that allitridin has anti-HCMV activity and the mechanism is associated with suppression of ie gene transcription.
【Abstract】 Objective To research the electro-clinical characteristics, therapeutic response and prognosis of neuropsychology in the children with variants of benign childhood epilepsy with centrotemporal spikes (BECT). Methods Performing video-EEG monitoring for children with BECT who had some variant symptoms including absence-like seizures, jerks, incoordinate movement (Ⅰtype), or speech and oromotor deficits (Ⅱtype). Analyzing the seizures semeiology, electrophysiologic features, neuropsychologic impairments and responses for antiepileptic drugs (AEDs). Results The electroencephalography (EEG) of all 9 cases showed abundance of spike and waves (SW) in rolandic areas during wake and sleep. The SW index were as high as fifty per cent to eighty-five per cent. Ⅰtype variant symptoms included absence-like seizures with secondary bilateral synchronous 2-3Hz spike-wave rhythms during ictal EEG in 5 cases, negative myoclonic seizures confirmed by test of standing-up and extending arms forward in 6 patients. Ⅱ type variant symptoms represented as speech expression disorders in 6 children, five of them had oral-pharynx apraxia and three cases had aphasia. Two patients had both Ⅰtype and Ⅱ type symptoms. Neuropsychologic impairment occurred in seven cases, and appeared more severity in the patients withⅠtype than Ⅱtype variant. Valproic acid only or combined with clonazepam were effective in 6 cases. The clinical and EEG problems were improved in the other three by adding on steroid therapy. Conclusion The variants of BECT often associated with EEG deteriorated. Ⅰtype primarily represents as secondary atypical absences and negative myoclonus ,often with poor neuropsychologic prognosis. A notable characteristic in Ⅱ type is oral-pharynx apraxia and with related good prognosis. Valproic acid, benzodiazepines and adrenocorical hormone were effective for improvement of electro-clinical manifenstation of BECT variants.
Objectives This study sought to assess the efficacy and safety of a Chinese herbal compound "Wen Xin" on the premature contraction in children. Methods A blind randomized control trial was conducted in an university children's hospital in 2004. During a 10-month period, all children admitted to the cardiology in-patient ward with newly identified premature contraction were enrolled, and assigned to study and control wings. Children in the control group received routine medical treatment, while children in the study group received "Wen Xin" for at least 3 weeks except the other treatment similar to the controls. Clinical data, a 5-minute electrocardiogram (ECG) and Holter were recorded before and after the study period. Lab studies for kidney, liver functions were performed. The efficacy is classified as excellent if the frequency of premature contraction decreased by 75% or more, good if decreased by 50-74% and no effect if the frequency decline by less than 50% or even increased. Results One hundred and three children aged 1-14 years (59 male, 44 female) were included. Of them, 21 (20.4%) had premature atrial contraction (PAC), 78 (75.7%) had premature ventricular contraction (PVC), 2 (1.9%) had premature junctional contraction, 2 had both PAC and PVC. Fifty-five were assigned in the study wing and 48 in control group. After treatment, both groups showed improvement in symptoms (P>0.05). The total efficacy of "Wen Xin" is 70.9% as assessed by 5-min ECG which is higher than the controls (41.7%，P=0.029)；65.5% as assessed by Holter which is also higher than the controls (37.5%, P=0.045). The efficacy is better for PAC than PVC. Three patients (2.9%) presented mild nausea, vomiting and constipation. Conclusion "Wen Xin" is helpful in reducing the frequency of newly identified premature contraction in children. Except mild nausea, vomiting and constipation, this compound is safe and could be used in the treatment of children with premature contraction.
