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 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: In this study, we describe the demographic and clinical characteristics associated with human metapneumovirus（hMPV） infection in patients presenting to a children’s hospital retrospectively. Methods: 878 Specimens were collected over a 2-year period from children hospitalized with acute lower respiratory tract infections (ALRTI) and analyzed for the presence of hMPV using real-time chain reaction assay. To verify the presence and sequence of the virus, traditional RT-PCR primers 450F and 450R were used to amplify the hMPV F gene to ensure reproducibility. GF and GR primers were used to amplify the hMPV G gene and the sequences were used for phylogenetic analysis. All hMPV-postive samples were sent for testing for respiratory syncytial virus (RSV) and human coronavirus NL-63 (HCoV NL-63) by use of polymerase chain reaction. Some of the samples were sent for testing for common respiratory viruses, including influenza A and B viruses, human parainfluenza virus types 1–3 and adenovirus by use of direct immunofluorescence assay (DFA) on cells present in the respiratory specimens. Results: The presence of hMPV was detected in 227 (25.9%) of the 878 children studied and may circulate year-round in the area, peaking during the winter-spring season. Younger children (aged less than 6 months) had the highest rate of positivity. Infections by hMPV showed similar epidemiology and clinical manifestations as for respiratory syncytial virus (RSV) and hMPV infection was related to wheezing, asthma exacerbations or bronchiolitis. HMPV was likely to be found in co-infections with common respiratory virus, especially RSV. HMPV and RSV co-infection might lead to a more severe disease. The phylogenetic tree of the hMPV isolates recovered during 2006-2008 showed two major groups or clusters. The majority of isolates grouped with subgroup A2 virus sequences in Chongqing. Conclusion: This study indicates that hMPV is one of the major respiratory pathogens found in children with lower respiratory tract infections presenting to a children’s hospital in Chongqing. Infant under six months of age seemed to be more susceptible to hMPV.
Objective Regarded tuberculin skin test (TST) as the reference standard, to assess the diagnostic value of two interferon-gamma（IFN-γ） release assays ［QuantiFERON-TB Gold test(QFT) and T-SPOT.TB］ for latent Mycobacterium tuberculosis infection in children. Methods We searched EMBASE（1974-2010.3）, PubMed（1966-2010.3）, Cochrane Library（from establishment to 2010.3）,CNKI（1994-2010.3）, CSJD(1989-2010.3）and Wanfang（2000-2010.3）to find all diagnostic tests about IFN-γ release assays for latent Mycobacterium tuberculosis infection in children. After collecting studies according to inclusion criteria of diagnostic tests, data （study background, design information and diagnostic parameters） were extracted.QUADAS items were used to evaluate the qualities of the included studies. Meta-disc software was used to handle data of included studies and to examine heterogeneity. The effect-model was selected according to outcomes of heterogeneity. All included studies were combined with weighted quantity, sensitivity, specificity, positive likelihood ratio(PLR), negative likelihood ratio(NLR), diagnostic odds ratio(DOR) and their 95％CI were calculated, and SROC curve was drawn. Results We got potentially relevant 285 studies.According to eligibility criteria, 13 studies were included. In 10 studies QFT was compared with TST, the outcomes were as follows: pooled sensitivity 0.40（95%CI：0.37-0.44）, pooled specificity 0.87（95%CI：0.85-0.88）, PLR 6.21（95%CI：3.07-12.54）, NLR 0.46（95%CI：0.31-0.68）,DOR 15.58（95%CI：7.47-32.48）and SROC AUC 0.893 1. Comparing T-SPOT.TB with TST, the outcomes of 4 studies were as follows: pooled sensitivity 0.74（95%CI：0.68-0.79）, pooled specificity 0.84（95%CI：0.81-0.87）, PLR 4.66（95%CI：1.27-17.12）, NLR 0.42（95%CI：0.18-0.99）,DOR 13.71（95%CI：3.71-50.72）and SROC AUC 0.830 6. Conclusions There was not sufficient evidence to support the IFN-γ release assays in the diagnosis of latent Mycobacterium tuberculosis infection in children, and IFN-γ release assays could not be regarded as an effective and feasible method for screening clinically. The diagnostic values of IFN-γ release assays needs to be studied further in future because of the limitation of included studies.
【Abstract】Objective:To investigate the safety and efficiency of using Atorpine and Fentanyl as premedication for elective intubation in neonates. Method: Divide the neonates who receiving elective intubation(62cases) to two groups from 2009 november to 2010 april in NICU of NanJing Children’s Hospital, Group A(30cases)’s premedications are Atropine and Fentanyl , Group B(32cases)’s premedications are placebo. The same procedures are done according to the protocol in two groups. Recorded patients’ basical information, one attempt successful intubation, total attempts, time take to intubate, Goldberg scores and side effects. Result: 30 cases in group A, 32 in group B, There is no statistical significance in patients’ basical information(P>0.05). One attempt successful intubation is 63.3%(19cases) in group A，higher than 13.2%(10cases) in group B(P<0.05),which has statistical significance between groups. Average attempts of each patient is 1.47±0.68in group A lower than2.03±0.82 in group B(P<0.05), Goldberg score is 4.33±1.58 in group A lower than 6.81±1.79in group B(P<0.05). The time take to intubate is 35.77±18.42seconds in group A lower than 54.19±24.10seconds in group B(P<0.05). mouth or nose bleeding is 13.3%(4 cases) in group A lower than 21.9%(7 cases) in group B(P>0.05)，bradyrhythmia（heart rate<100bpm）is 16.7%(5cases) in group A lower than 27.3%(9cases) in group B(P>0.05), serious bradyrhythmia(heart rate<60bpm) is 3.33%(1 cases) in group A lower than 6.25%(2cases) in group B(P>0.05), desatuation (<80%) was 43.3%(13cases) in group A lower than54.5%(18cases) in group B, hard bagging is 6.7%s(2case) in group A and no one in group B, but there is no statistical significance between groups(P>0.05). Conclusion: Atropine and Fentanyl are safe as the premedication used in neonates, which can improve one attempt successful intubation avoiding bouche and nasal cavity tissue damage of repeating attempts. The use of premedication reduces the time taken to intubate. Atropine, fentanyl before elective intubation has led to a good intubation conditions with no adverse events in neonates.
Objective To assess the effectiveness and safety of early different doses of amino acid supplementation in preterm infants. Methods The Cochrane library, PubMed, EMBASE, CNKI and VIP till 31 March 2010 were searched. Two reviewers assessed the quality of included studies and extracted data. All included studies were graded on sequence generation,allocation concealment,blinding,incomplete outcome data,selective outcome reporting and other sources of bias. Statistical analysis was performed employing RevMan 5.0.13. Heterogeneity of the included articles was tested to select proper effective model. Results Fourteen studies (17 articles) were included. Four studies(5 articles) were graded B, 10 studies(12 articles) were graded C. Compared with the early low doses of amino acid intake, early high, very high and extremely high doses of amino acid intake could gain a positive nitrogen balance significantly, the WMDs were 265.27（95％CI： 252.77-277.78）, 154.10（95％CI： 145.00-163.21） and 588.80（95％CI： 574.56-603.04）, respectively. There was no difference in the levels of blood creatinine, blood urea nitrogen, triglyceride, cholesterol, blood glucose, blood bilirabin or blood bicarbonate among groups received early low doses of amino acid intake and early high, very high doses of amino acid intake. There was no difference in the incidences of PDA, CLD, sepsis, NEC or intracranial hemorrhage among groups received early low doses of amino acid intake and early high, very high, extremely high doses of amino acid intake. Compared to the early low doses of amino acid intake, early high, very high doses of amino acid intake gained higher level of serum amino acid. Conclusions Early very high doses of amino acid supplementation (2.0-3.0 g·kg-1·d-1) in preterm infants in 24 h after birth could gain a positive nitrogen balance, did not affect the blood biochemical index, but increased the level of serum amino acid. Further multicentre and large-scale RCTs are still needed to evaluate the potential effectiveness and safety of early different doses of amino acid supplementation in preterm infants.
Objective To investigate cerebral maturation in neonates with different postmenstrual ages (PMA) using amplitude-integrated electroencephalogram (aEEG). Methods Appropriate gestational age neonates without specific diseases and PMA aged from 24 to 52 weeks were selected and grouped according to PMA. Electroencephalogram (EEG) was collected and aEEG waveform was calculated to analyze EEG amplitude changes and sleeping cycle including active sleep (AS) and quiet sleep (QS) in developing neonates. Sample entropy was calculated from EEG to explore the signal complexity changes during brain maturation. Results One hundred and sixty-five neonates were included (133 cases from the First Hospital of Peking University, 12 cases from the Third Hospital of Peking University, 20 cases from Austrilia aEEG database). Study subjects were grouped into <27 weeks (12 cases, all from Austrilia aEEG database), -32 weeks (22 cases, 8 from Austrilia aEEG database), -34 weeks (18 cases), -36 weeks (24 cases), -40 weeks (37 cases), -44 weeks (22 cases) and -52 weeks (30 cases). ①Sleep cycle was maturated with increasing PMA. aEEG showed likely burst suppression pattern without sleep cycle before PMA reached 27 weeks. Immature shaped AS and QS could be observed when PMA reached 32 weeks. Clear sleep cycle, which appeared as alternated AS and QS waveforms, was developed after PMA reached 37 weeks. ②aEEG amplitude in AS and QS was increased along with PMA overally. Amplitude was obviously increased before PMA by 37 weeks and after PMA by 44 weeks; aEEG amplitude was stable during 37 weeks to 44 weeks in PMA (6-20 μV in AS and 7-25 μV in QS). ③Sample entropy was increased during cerebral development before PMA by 37 weeks overally with its value enhanced more in AS than in QS. The fluctuation of sample entropy was decreased with increasing PMA. Fluctuated sample entropy could be observed before PMA by 32 weeks. Sample entropy was decreased after PMA by 37 weeks which indicated that electrical activity in neonatal brain tended to be more regular at this time. Conclusions Electrical activity in neonatal brain was maturated with increasing PMA. aEEG was a simplified method with intuitionistic waveform. It was a useful tool for neonatal cerebral function monitoring.
Objective To explore the clinical features of plastic bronchitis in children with mycoplasma pneumoniae pneumonia and(or) bacterial pneumonia. Methods The study retrospectively reviewed the records of the children with plastic bronchitis who were admitted to Beijing Children's Hospital from January 2007 to March 2010. Subjects were divided into three groups based on the pathogen culture results: mycoplasma pneumoniae pneumonia group, mycoplasma pneumoniae pneumonia with bacterial infections group and bacterial pneumonia group. The data of the three groups such as clinical manifestations, roentgenographic findings, airway mucosal lesions seen through the bronchoscope and the histopathological findings of the bronchial cast were analyzed. Results Fifteen children with plastic bronchitis aged from 2 to 15 years were enrolled into the study. There were 5 cases in mycoplasma pneumoniae pneumonia group, 6 cases in mycoplasma pneumoniae pneumonia with bacterial infections group and 4 cases in bacterial pneumonia group. The children in mycoplasma pneumoniae pneumonia group did not have dyspnea and the extrapulmonary positive signs. One case in mycoplasma pneumoniae pneumonia with bacterial infections group needed NCPAP treatment, and 1 case had extrapulmonary positive signs. Three cases in bacterial pneumonia group needed NCPAP or mechanical ventilation treatment, and 3 cases had extrapulmonary positive signs. Consolidation was the common finding in the CT scan of the lung in all the patients, and 1 case with atelectasis, 3 cases with pleural effusion in mycoplasma pneumoniae pneumonia group; 3 cases with atelectasis, 5 cases with pleural effusion in mycoplasma pneumoniae pneumonia with bacterial infections group; 3 cases with atelectasis, 1 case with pleural effusion in bacterial pneumonia group. Bronchoscopy was performed in all the 15 cases and bronchial casts were removed. Under flexible bronchoscope, the most common mucosal lesions in the three groups were hyperemia and edema, and the severe mucosal lesions were found in children in mycoplasma pneumoniae pneumonia with bacterial infections group (2 cases with segmental bronchi dysventilation). All bronchial casts were type 1 according to Seear's classification in histopathological findings.
Objective To compare the efficacy and safety between laparoscopic and open surgery of pediatric inguinal hernia. Methods All RCTs about laparoscopic and open surgery of pediatric inguinal hernia were searched from PubMed, Cochrane Library, EMBASE, Chinese Biomedical Literature Database, Chinese Science and Technology Academic Journal, China Academic Journal and Wanfang(from establishment to March 2010), to assess operative time(unilateral), intraoperative blood loss, total postoperative complications, recurrence rate of inguinal hernia and time to resume normal daily activities after surgery. The quality of the included studies was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2. Results Five RCTs (586 patients) were included. Two RCTs were graded B, 3 were graded C. Compared with open surgery, laparoscopic surgery decreased intraoperative blood loss （MD=-1.35, 95%CI：-1.80--0.90, P<0.000 01）, but it extended operation time of unilateral inguinal hernia （MD=10.23, 95%CI：4.33-16.14, P=0.000 7）. However, laparoscopic surgery could not lower the recurrence rate of inguinal hernia（RR=0.51, 95%CI：0.15-1.73, P=0.28） and total postoperative complications （RR=0.16, 95%CI：0.02-1.49, P=0.11）, and aslo could not shorten the time to resume normal daily activities after surgery（SMD=-0.19, 95%CI:-0.49-0.11, P=0.21）. Conclusions The current evidence shows that laparoscopic surgery reduce intraoperative blood loss, and can not increase the recurrence rate or total postoperative complications, but can not shorten recovery time. On the contrary, it extends operative time of unilateral inguinal hernia.
