ObjectiveBy using GAMLSS program, to construct gender-, age- and height percentile-specific reference values of BP for Chinese boys and girls aged 7-17 years. MethodsBP was measured among 5 200 study subjects twice at one visit with mercury sphygmomanometer by adopting AHA international BP measurement recommendations under uniform protocols and measured by trained investigators, with outcomes precision of 2 mmHg. The mean of twice measurements was used for analysis. Standing height was measured by the Nation Standard Protocols, with precision of 1 cm. P50, P90, P95 and P99 centiles were derived for systolic blood pressure(SBP) and diastolic blood pressure(DBP) separately for boys and girls by age and height percentiles using the GAMLSS of LMS equations method. Meanwhile, considering the skewness and kurtosis in the D(μ,σ,υ,τ )-distribution. The cubic-splines function was chosen to fit appropriate models. Height centiles were calculated by LMS-method (μ -σ -λ). Results①Overall, SBP and DBP increased with age among children and adolescents aged 7-17 years, P50 of SBP for those with height within P25-P50 stopped increasing and dropped for 1 mmHg after age of 12 in girls. DBP developed in the similar trend in boys and girls. Boys with height with P25-P90 had higher P95 of SBP and DBP than that in girls (9 mmHg and 4 mmHg respectively). ②The cutoff values of BP elevated with height percentiles increasing within each age group; however, the differences decreased with age increasing in both genders. The difference of BP between subjects with height of P5 and P95 decreased with age. ③Compared with the blood pressure tables for American the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, the SBP cutoff values derived from the current study samples for defining pre-hypertension (P90) and hypertension (P95) among children were 1 to 2 mmHg higher before age of 12 but lower afterwards. The P90 of SBP reached 120 mmHg or over at age of 12 and 13 for Chinese children and American children with median height. Whereas, for children with median height, the median DBP of the current Chinese study samples was 10 mmHg higher than their American counterparts before age of 12, but tended to be similar at age of 17. Conclusions Although based on regional samples, by using GAMLSS statistical method, the first BP reference table by gender, age and height percentiles for a Chinese pediatric population was proposed. It is hoped to give more precise classification of BP for children population, especially for those with extreme height.
Objective To identify the risk factors for renal involvement among pediatric patients with new-onset Henoch Schnlein purpura (HSP). Methods Consecutive patients with new-onset HSP hospitalized in Nanjing Children's Hospital of Nanjing Medical University from December 2009 to November 2010, were recruited and followed up for 6 months since the onset of HSP and were classified by the condition of renal involvement. Gender, age, possible risk factors of renal involvement were analyzed by univariate and multivariate Logistic regression analysis. Results A total of 283 new-onset HSP children were included during the follow-up period and the mean age was 7.2±2.6 years (8 months to 16 years), among 239 patients(84.5%) finished the study, the rate of losing follow-up was 15.5%（44/283 cases）. Palpable purpura was observed in all of the new-onset HSP children, whereas gastrointestinal symptoms and transient arthritis were found in 194(68.6%) and 224(79.2%) children, respectively. Renal involvement was seen in 80 patients (33.5%) and 44 of them(55.0%) were isolated proteinuria. In univariate analysis, ≥8 years at onset, persistent purpura (more than 2 weeks), purpura recurrence, higher level of mean platelet and cystatin C, lower level of serum C3 and albumin， aseptic leucocyturia were identified as risk factors to the outcome. Multivariate logistic regression analysis showed that nephritis was significantly associated with persistent purpura more than 2 weeks(OR=2.474,95%CI:1.367-4.478), aseptic leucocyturia(OR=4.178,95%CI:2.061-8.468), higher level of mean platelet volume more than 10 fL(OR=2.948,95%CI:1.533-5.667) and cystatin C more than 0.8 mg·L-1(OR=2.101,95%CI:1.067-4.134). Conclusions Persistent purpura (more than 2 weeks), aseptic leucocyturia, higher level of mean platelet volume (more than 10 fL) and cystatin C (more than 0.8 mg·L-1) were identified as the risk factors for renal involvement in children with HSP.
Objective To evaluate the growth improvements of 1-6 years age children with dietary behavior problems in Shanghai through interactive interventions. Methods Children aged 1-6 years with dietary behavior problems were selected from three urban districts of Shanghai (Changning, Luwan and Hongkou). After baseline assessments, they were randomized into intervention group and control group. The intervention group received interactive interventions, and the following assessments and interventions were given at the end of the 1st month, the 3rd month, the 6th month, and the 9th month. The control group were evaluated at the baseline and followed up at the end of the 9th month without interactive intervention. Comparisons and stratified analysis of the growth improvements were made between intervention and control groups. Results The study consisted of 490 children aged 1-6 years with dietary behavior problems in Shanghai, 248 in intervention group and 217 in control group completed the intervention and endpoint assessments, and the rate of loss to follow-up was 5.1%. The baseline of the intervention group and the control group was equal. The mean weight increment of the intervention group was (2.0±0.9) kg, which was significantly higher than that of the control group［(1.5±1.1) kg］(P＜0.001). And the mean height increment of the intervention group was (5.7±2.2) cm, which was significantly higher than that of the control group［(4.7±2.1) cm］(P＜0.001). Children aged 1-4 years in the intervention group had a higher increment of weight than the control group (P＜0.05), while children aged 2-3 years in the intervention group had a higher increment of height than the control group (P＜0.01). The growth advantages of the intervention group was declined with age. Intervention group had a better growth trend in their weight-for-height compared with the P50 of the reference curve. Conclusions Interactive intervention is effective in promoting the growth of children with dietary behavior problems in Shanghai.
Objective Nebulized hypertonic saline inhaling may reduce the pathological changes of airway edema and mucus plugging and decrease airway obstruction. To assess the efficacy and safety of nebulized hypertonic saline inhaling as treatment to infants with acute bronchiolitis. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), containing the Cochrane Acute Respiratory Infections Group Specialized Register, EMBASE, PubMed, CNKI, Wan Fang Chinese periodical Database and VIP Chinese periodical Database from the establishment of the database to April 2011, by using the terms(hypertonic saline solution AND bronchiolitis). Randomized controlled trials (RCTs) and quasi-RCTs using nebulized hypertonic saline inhaling alone or in conjunction with bronchodilators as an active intervention in infants up to 24 months of age with acute bronchiolitis were selected. Two review authors independently assessed the potential risk of bias in included studies according to the Cochrane Collaboration's recommendations. Dichotomous data were synthesized using OR and 95% confidence intervals (CI) as the efficacy measures. The mean difference (MD) and 95%CI were used to measure the effect size for continuous outcomes. The meta-analyses were performed using the Cochrane statistical package RevMan 5.1.1. ResultsTen RCTs involving 853 infants with acute bronchiolitis were included. Patients treated with nebulized hypertonic saline inhaling had a significantly shorter mean length of hospital stay compared with the control group(MD=-1.33 d，95%CI：-1.63 to -1.03 d, P<0.000 01). The hypertonic saline group also had a significantly lower post-inhalation clinical score than the control group in the first three days treatment (day 1: MD=-0.77，95%CI :-1.30 to -0.24,P=0.004;day 2:MD=-1.15,95% CI: -1.86 to -0.44,-P-=0.001;day 3: MD=-1.43,95% CI -1.87 to -0.99,P<0.000 01). The effects of hypertonic saline inhaling on improving clinical score were observed in both outpatients and inpatients. Wheezing remission time(MD=-1.16 d,95%CI:-1.43 to -0.89 d，P<0.000 01), cough remission time(MD=-1.12 d,95%CI:-1.34 to -0.89 d，P<0.000 01) and the moist crackles disappearance time(MD=-1.30 d,95%CI:-2.29 to -0.32 d，P-=0.009) were significantly lower in the hypertonic saline group than in control group. Five trials failed to show significant effects of nebulized hypertonic saline inhaling on reducing the rate of hospitalization/risk of readmission. Two trials failed to show significant effects of nebulized hypertonic saline on improving radiograph assessment score. No significant adverse event related to hypertonic saline inhalation was reported. ConclusionsFrequently inhaling hypertonic saline shortened length of hospital stay significantly and relieved symptoms and signs faster than control group for infants with bronchiolitis without apparent adverse effects.
Objective To explore the pathology and prognosis of children with idiopathic membranous nephropathy(IMN). Methods Clinical manifestations, pathology, treatment and prognosis of 16 children with IMN were reviewed to explore the prognosis of children's idiopathic membranous nephropathy. Results From 1979 to July 2010, consecutive 16 patients diagnosed as IMN were analyzed, accounting for 0.94% of all renal biopsy patients, with the ratio of male∶female: 10∶6, the median age: （5.2±2.6） years. Eleven patients were with nephritic syndrome(68.8%), 5 with asymptomatic proteinuria(31.2%), 2 children with hypertension(12.5%), 2 children with renal insufficiency(12.5%）. Fourteen of 16 patients received phathological examination under electronic microscopy, showing that 6 were graded as stage Ⅰ(42.9%), 6 as stage Ⅰ-Ⅱ(42.9%), 1 as stage Ⅱ(7.1%), 1 as stage Ⅱ-Ⅲ(7.1%). No tubular atrophy or interstitial fibrosis were observed. For the patients having proteinuria<50 mg·kg-1, no steroids or immunosuppressants were provided for treatment. The patients having proteinuria<50 mg·kg-1 were given steroids(2 mg·kg-1·d-1). Immunosuppressants were given to non-responders or reliers to steroids. After (34.0±18.7) months, 14 patients were all remitted, and had normal renal function. Conclusions IMN mainly presents as nephritic syndrome. Better prognosis can be expected among patients with younger age, lower pathologic grade, and not combined with interstitial fibrosis. Diagnosis and treatment early can improve the prognosis of children's idiopathic membranous nephropathy.
Objective MiRNAs microarray was employed to determine the differential time-specific expression of miRNAs in ventricular myocardium of fetus with ventricular septal defect (VSD) in the different gestational ages (the first trimester and the second trimester). Methods The VSD group was recruited from the fetuses with VSD aborted for pathological factors, and was divided into VSD subgroups: subgroup 1 for the first trimester and subgroup 2 for the second trimester according to the gestational ages. The control group was chosen from the fetuses of inevitable abortion without cardiac malformations, and was divided into the control subgroups in the same way. The fetal ventricular myocardiums were acquired and RNAs were extracted and processed. The Agilent Human 2.0 microarrays containing 723 known miRNAs were applied to get the data about miRNAs expression changes, the data were analyzed by bioinformatics methods: differential miRNAs expression analysis, target gene ontology analysis and pathway-express analysis. Differential expressions of miRNAs microarray were certificated by real-time PCR. Results VSD group and control group had 6 fetuses, respectively, with 3 fetuses in the first trimester and 3 in the second trimester, respectively. ①There were 33 differential time-specific expression of miRNAs in the 2 VSD subgroups. Expressions of 19 miRNAs were up-regulated in subgroup 1 and down-regulated in subgroup 2. Expressions of 14 miRNAs were up-regulated in subgroup 1 and down-regulated in subgroup 2. ②A total of 2 761 target genes were predicted by bioinformatic methods. The most of target genes were directly associated with the key genes of heart development (such as TBX5,GATA4,TBX1，NKX25, etc.). ③The gene ontology analysis indicated that target genes were mainly related to the cellular process, metabolic process and biological regulation, and accounted for 23.5 %, 18.3%, 17.7% of the total number of target genes, respectively. ④The pathway-express analysis indicated that the WNT signaling pathway played an important role in both VSD subgroups. ⑤Four miRNAs (hsa-miR-19a, hsa-let-7e, hsa-miR-134 and hsa-miR-206) were randomly selected and verified by real-time PCR, the results of quantitative PCR were basically consistent with the microarray results. Conclusions The differential time-specific expression of miRNAs may play an important role in the occurrence and development of fetal VSD malformations, but it needs confirmation by study with larger sample size. These predicted target genes were mainly related to cell growth, differentiation and metabolism; partially were directly associated with the key genes of heart development; partially were key factors of the WNT signaling pathway. The occurrence and development of fetal VSD malformations were the joint results of imbalance gene expression which functioned at different levels under the participation of miRNAs.
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 determine the short term efficacy and safety of sildenafil treatment for pre- or post-opertative pulmonary arterial hypertension(PAH) in children with congenital heart disease(CHD). Methods The Cochrane Central Register of Controlled Trials, EMBASE, PubMed, Database of ongoing controlled trials, CBMweb, CNKI and VIP were searched from the establishment of the database to March 2011. Additional data were sought from the related academic conferences and reference lists of included trials to obtain randomized controlled trials (RCTs) of sildenafil for PAH in children with CHD. The Cochrane Handbook 5.0 was used to evaluate the methodological quality and RevMan 5.0 software, supplied by the Cochrane Collaboration, was used for meta analysis. If suitable data could not be merged, the results of specific trial were described only. Results A total of 130 literatures were searched, three RCTs that met the inclusion criteria were enrolled. The assessment of literature quality showed that one literature with low risk of bias, while the rest with high risk of bias. ①There was no significant difference in mortality prior to discharge between sildenafil group and placebo or conventional treatment group(RR=0.09,95％CI：0.01～1.64). ②The incidence of PAH crisis in sildenafil group was lower than that in the conventional group.There were significant reductions in mean pulmonary arterial pressure (vs placebo or conventional treatment group,MD=-9.1 mmHg，95%CI:-11.3 to -6.9 mmHg; vs prostaglandin E1 group, MD=-5.1 mmHg,95%CI:-7.6 to -2.7 mmHg) and systolic pulmonary ratio arterial pressure (MD=-11.2mmHg，95%CI:-16.5 to -5.9 mmHg) in sildenafil group after 40 min treatment.③Although there was no significant difference in duration of hospitalization between sildenafil group and placebo or conventional treatment group, mechanical ventilation duration was significantly shorter in sildenafil group. ④Increase in PaO2/FiO2 ratio was greater in sildenafil group than that in placebo or conventional treatment group(MD=66.0，95%CI:35.7 to 96.3) after 40 min treatment. ⑤There was slight reduction in mean systemic arterial pressure in sildenafil group(MD=-4.30 mmHg,95%CI:-7.8 to -0.8 mmHg) after 40 min treatment. ⑥Two studies reported no adverse effect occurred in sildenafil group. One study reported ten cases of slight side effect occured in sildenafil group: short lived erections, transient nasal stuffiness and gastrointestinal upset. All complications reversed after discontinuation of the drug. Conclusions Sildenafil can be effective in reducing the elevated PAH without any significant adverse effect during short-term follow-up. However, confirmation of efficacy and long-term safety of sildenafil requires larger, high methodologic quality and long-term follow-up studies.
Objective To summarize the clinical characteristics of infants with central nervous system(CNS) candidiasis. Methods Associated literatures and case histories of 5 cases were analyzed retrospectively, who were diagnosed as CNS candidiasis in Chilren's Hospital affiliated to Capital Medical University from 2009 to 2011. Results The age of 5 cases ranged from 3 to 5 months, averaged 4 months. Four patients were boys and 1 was a girl. None of them had immune defects and underlying diseases. The time interval between presenting initial clinical symptoms and getting a definite diagnosis varied from 2 days to 2 months. Four cases started with recurrent fever. Their mental status was relatively fine without severe toxic symptoms caused by infection. No any apparent symptoms revealing increased intracranial pressure. Four cases experienced convulsive seizure, 1 started with hemiplegia and cerebral infarction. All cases except 1 had abnormal MRI manifestation; 4 cases had cerebrovascular impairment with CNS infection progressing including cerebral infarction and venous sinus infarction, and 1 of these 4 cases developed encephalomalacia where cerebral infarction occurred. The change of cerebrospinal fluid(CSF) with CNS candidiasis was similar with those of purulent meningitis. All cases had increased number of white blood cells with polykaryocytes dominant, decreased glucose concentration and apparently increased protein concentration. One case was treated with fluconazole for 2.5 months and recovered fully without any recurrence in a year. Two cases were treated with fluconazole, amphotericin B and fluorouracil successively for 2 weeks to 1 month and got improved when discharged from hospital. Follow-up study was done for one year as well. One of them was fully healed by taking voriconazole for 2 months , the other one got improved by taking fluconazole for 2 months but with sequelae of disturbance in intelligence and language. The other 2 cases gave up therapy. Conclusions Infants with CNS candidiasis lacked of typical clinical manifestations. The characteristics of CSF were similar with that of purulent meningitis. The glucose concentration of CSF for patients with CNS candidiasis was decreased remarkably without obvious toxic symptoms. Involvement of cerebrovascular disease might happen in CNS candidiasis cases. Etiological investigation earlier was important for definite diagnosis and proper therapy.
Objective To observe the influence of oral multiglycosides administration of tripterygium wilfordi（GTW） and intravenous cyclophosphamide(CTX) on gonads in children with primary nephrotic syndrome and anaphylactoid purpura nephritis. Methods Children who were with steroid resistant or dependant, frequently relapse primary nephrotic syndrome or anaphylactoid purpura nephritis and received oral GTW and/or intravenous CTX treatment in Children's Hospital of Capital Institute of Pediatrics during 1986 to 2005 were recruited and followed up for 5 to 17 years after stopping treatment with GTW and/or CTX. Informations about the marriage, obstetrical history, women's menstrual history, the secondary sexual characteristics, and men's semen were collected. Results A total of 136 children were included, 47 children were followed-up. ①Follow-up of 21 male cases showed: twelve cases received only GTW at 7 to 14 years old, with cumulative dose of GTW being 51-174 mg·kg-1. Among 8 out of 12 treated cases, 6 gave birth to healthy children without any developmental abnormabilities. Wives of the rest 2 cases got pregnant but aborted after pregnancy. Semen analysis from 2 of 4 unmarried cases showed slightly decreased motility but normal sperm density and activity rate. Among 6 cases received only CTX at 3 to 14 years old with cumulative dose of 55-72 mg·kg-1, 2 cases were married and their wives had history of pregnancy but aborted, without history of spontaneous abortion; the other 4 cases received semen analysis with normal sperm density and activity rate, one of them with slightly decreased motility . Three cases received GTW first at 4-9 years old with cumulative dose of 170-701 mg·kg-1 and received CTX at 5-12 years old with cumulative dose of 60-120 mg·kg-1; semen analysis showed 2 cases' results were abnormal, 1 with decreased activity and motility( the interval of receving those two drugs was seven months) and the other with decreased density and motility. ②Follow-up of 26 female cases showed: nineteen cases received only GTW, aged 7 to 14 years, cumulative dose of GTW was 36-190 mg·kg-1. In the 19 cases, 6 were married with 5 cases giving birth to healthy children and 1 case was without pregnancy not taking contraception measures but with menarche at 14 years old and married for one and a half years; the other 13 cases were unmarried with normal menstrual cycles and secondary sexual characteristics. Six cases received CTX only, aged 12 to 15 years, the cumulative dose was 32-213 mg·kg-1; all unmarried cases were with normal menstrual cycles and secondary sexual characteristics. One case received GTW and CTX at different time, GTW at 10 years old with cumulative dose of 87 mg·kg-1 and received CTX at 11 years old with cumulative dose of 160 mg·kg-1; All unmarried cases were with normal menstrual cycles and secondary sexual characteristics. Conclusions The results of this study suggested that oral administration of GTW or intravenous CTX treatment as single treatment at lower cumulative dose(150 mg·kg-1) may be less harmful to male's gonads. Continuous application of GTW and CTX with short interval may be harmful to gonads.
