Objective To present the growth reference values for children aged 0 to 6 years in Lhasa. Methods Healthy neonates after birth within 24-48 h at the Obstetrical and Gynecological Department of People′s Hospital of the Tibet Autonomous Region, healthy children aged 1 to 6 years from the Maternal and Child Health Hospital of Tibet Autonomous Region and children aged 3 to 6 years from 5 kindergartens in Lhasa were included. Enrolled participants were divided into neonate, 1 year, 2 years, 3 years, 4 years, 5 years and 6 years groups including at least 600 participants (half were males and half were females) in each group. Unifing the measurement tools, weight, length/height, sitting height, head circumference, chest circumference, arm circumference and triceps skinfold were measured directly using the method described by "Child Health Care (Fourth Edition)" and BMI was calculated. Extreme values were deleted before establishing the growth standardized values. LMS software light version was used to construct the smoothed percentile curves of parameters by age and sex. All parameters were evaluated with China references in 2005 and WHO references in 2006 using Z-score, respectively. Results A total of 4 330 (2 114 males, 2 216 females ) normal Tibetan children from January 2012 to June 2013 were enrolled in the study. Deleted data only accounted for 0.28% of the total data. The number of participants was reliable for constructing the smoothed growth curves. The mean and standard deviation and the 3rd, 5th,10th, 25th, 50th, 75th, 85th, 90th, 95th, 97th smoothed percentile curves for each parameter were constructed, respectively. Eighteen parameters showed significantly larger values in Tibetan males than those in females, and only six parameters showed significantly larger values in Tibetan females than those in males. Generally, Tibetan males showed larger values than females in physical development indicators. BMI values of Tibetan children aged 2 to 5 years gradually declined with age. Tibetan children growth charts were slightly lower than WHO child growth standards, and significantly lower than China child growth standards. Conclusion The mean and standard deviation and percentile curves of each parameter could be applied to facilitate the standardization assessment of growth for Tibetan children in clinical pediatrics and public health.
Objective To study the subject domain knowledge of discipline development of pediatric cardiovascular medicine worldwide using multiple statistical and social network analysis, to build visualized knowledge-mapping. Methods The Pubmed under the Mesh term "Cardiovascular Disease" within all the journals of cardiovascular disease medicine, and journals of general medicine and pediatrics with impact factors above 1 were searched in December 2012. Then the whole period was diveded into 4 stages, 1966-1980, 1981-1990, 1991-2000 and 2001-2010. After core keywords had been identified by Bicomb and Endnote X6 in each stage, the co-occurrence matrix was built. Transformation, dimensionality reduction and clustering of the co-occurrence matrix were performed by SPSS 22.0 software, leading the strategic plot to be built. The visualized network images were drawn using Ucinet 6.0. Results Finally 50 200 articles were included in the analysis. The visualized domain knowledge-mapping was successfully built, and it directly reflected the structure of knowledge-mapping of the discipline development, and key clusters were formed as well. Early term of the development of pediatric cardiovascular medicine headed slowly with limited directions, and the pediatric cardiovascular physiopathology and etiology were the domain research area. In the middle term, the development surrounded congenital heart disease, and cluster analysis was improved well. But the emerging research topics needed more contribution to be made to catch up the development of mature topics. Besides, echocardiography was carried into practice and made great contribution to this subject development. In the latest term, comprehensive treatment and protective strategies of congenital heart disease became the core of whole subject with new technology such as cardiac catheterization and heart transplantation. The research network went more balanced and scientifically with great knowledge updated and much more focuses were identified in social network. Conclusion The multiple statistical and social network analysis, and finally built visualized knowledge-mapping demonstrates that the subjects of pediatric cardiovascular medicine have developed well during last almost 60 years. New treatments and diagnostic methods play important roles in subject development, the network of pediatric cardiovascular medicine have become mature and completed, and congenital heart disease is the most core research area for pediatric cardiovascular doctors and investigators.
Objective To determine the prevalence of cardiometabolic risk factors such as hypertension,diabetes and dyslipidemia through health assessment examination among obese children and adolescents. Methods This study was based on 1 809 obese children and adolescents, aged 7 to 17 years from 17 schools in Beijing. The data of anthropometric measurements were collected, including weight, height ,body composition and age. All subjects had a clinic examination containing a fasting blood, blood pressure and liver ultrasonography.Overweight,obesity and severe obesity were assessed by WGOC criteria with BMI. Results A total of 1 809 children and adolescents were recruited in the examination. The prevalence of hypertensnion,dyslipidemia and impaired fasting glucose (IFG) was 30.8%,43.3% and 66.6% while the prevalence of dysfunction of liver, non-alcohol fatty liver, and acanthosis nigricans was 11.6%，16.0% and 21.9%,the prevalence of hypertension,IFG,dysfunction of liver,non-alcohol fatty liver and the proportion of children with 2 or more cardiometabolic risk factors in males was higher than that in females. Severe obesity contributed 29.9% to the obese children and adolescents,the prevalence of hypertension, dyslipidemia,hepatic dysfunction and non-alcohol fatty liver in severe obesity was higher than that in moderate obesity.The proportion of children with 2 or more cardiometabolic risk factors in severe obese children was higher than that in moderate obese children. Conclusion Cardiometabolic risk factors (such as hypertension, diabetes and IFG, dyslipidemia) are common in obese children,the prevalence increases with obese degree. The cardiovascular metabolic dysfunction should be highly noticed.
Objective To analyze the characteristics of growth spurt during puberty in girls and its relationship with sexual development. Methods Data came from the monitoring measurements of physical growth of two schools in Beijing during 2000 to 2013. Height, weight, body mass index, menarche age(MA) and the development of breast for girls were analyzed in this study. The means both of peak height velocity (PHV) and age at peak height velocity (PHA) were calculated. The analysis of variance method was used to compare the difference of height increments among the girls with different MA and the difference of BMI among different Tanner stages of breast development. Results Physical growth data of 2 211 girls met the inclusion criteria among 4 632 medical monitoring database during 2000 to 2013 were selected. Among them, height of 161 girls was measured at least 4 times and PHV was observed, and height was measured at least twice and MA was recorded of 415 girls in 2013, development of breast was checked of 527 girls in 2013. The means of PHV and PHA were（8.3±1.0）cm per year and （11.3±1.0）years respectively. Significantly, the smaller the MA was, the higher the height increment was before and after MA. In the 11-13 years groups, the greater the Tanner stage of breast development was, the higher the average BMI was. The means of BMI of girls with same age but with different Tanner stages were significantly different. Conclusion Girls reached the PHV at about the age of 11.3 years and the peak value was 8.3 cm per year. The increments of height before and after menarche were negatively correlated with MA.In the early phase, breast development was positively correlated with BMI.
Objective To investigate the prevalence of constipation and defecation of community children aged 0 to 4 years. Methods Children aged 0 to 4 years lived in Daxigou community health service centers (survey site) in Yuzhong District of Chongqing were enrolled into the survey. A questionnaire and telephone inquiries were investigated to get the growth and nutritional status of children from October to December 2013. The prevalence of constipation was obtained according to modified Rome Ⅲ criteria. Sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were calculated combined Bristol Stool Form Scale type 1 to 3 with major items of the diagnostic criteria. Results There were 1 206 children in total under 4 years old in the community, 1 050 of which received questionnaires, 1 000 questionnaires were retrieved, 972 questionnaires were valid including 535 males and 437 females. The prevalence of constipation for children was 5.6% (55/972). Stool types of 55 children diagnosed as constipation were all Bristol stool type 1 to 3. Bristol stool type 6 was the major stool type in 0-4 months and -6 months groups and stool type 4 was the major stool type in groups over 8 months. Sensitivity and specificity of the criteria of defecation less than twice per week and history of defecation pain or difficult combined with Bristol stool type 1 to 3 was 100% and over 96.8%, respectively and positive likelihood ratio of the former was higher than that of the latter (142.9 vs 31.3). Conclusion The prevalence of constipation was 5.6% in children aged 0 to 4 years. Bristol stool chart shape provides a quantitative diagnostic indicator for constipation children.
Objective To analyze the intestinal microbial community diversity and its dynamic change in preterm infants with necrotizing enterocolitis (NEC) by 16S rDNA PCR denaturing gradient gel electrophoresis（PCR-DGGE）. Methods The preterm infants diagnosed as NEC during August 2009 to December 2012 in Children′s Hospital of Chongqing Medical University and Children′s Hospital of Shenzhen were recruited as NEC group, and was divided into three subgroups according to stage Ⅰ, Ⅱ and Ⅲ, with 7 infants in each group. The infants without NEC in the two hospitals during the same period were taken as the control group, selected by matching the gestational age, days of age, birth weight with each NEC subgroup and 7 infants in each control subgroup. The stool samples of the NEC infants were collected at 1, 3, 5, 7 and 9 day point after admission. And the band richness S and Shannon index of them by DNA amplification and DGGE were analyzed. TA Cloning Kit and sequencing were used to investigate the distribution of bacteria and common dominant bacteria in the NEC group and control group. Results ①The Shannon index of NEC subgroup stage Ⅰ,Ⅱ and Ⅲ on day 1 after admission was 2.01±0.73, 1.93±0.27 and 1.54±0.36 respectively, which were lower than those of the matched control subgroups (2.65±0.26, 2.74±0.16, 2.56±0.22 respectively, P<0.05);and in NEC stage Ⅲ, it was lower than that of NEC stageⅠ and Ⅱ(P < 0.05) .②In 10 infants in NEC group and 10 infants in control group 5 time points stool samples were obtained; it showed that the Shannon index of the control group kept relatively stable level; and the Shannon index of NEC group elevated gradually with delayed admission time,and about 9 days later, it almost reached the level of the control group,P>0.05.③The result of molecular coling and sequencing from DGGE showed that the main bacterial types of NEC did not significantly differ from the control group, but the proportions of bifidobacterium, lactobacillus and escherichia coli in NEC group were lower, whlie the proportions of klebsiella and bacteroides sp were higher than that in control group. Conclusion The reduction of intestinal bacteria in types and quantity, especially the decrease of probiotics, may lead to relative advantages for klebsiella, which may be an important factor in the pathogenesis of NEC.
Objective To investigate whether IL28B polymorphisms are associated with the effect of immunoprophylaxis for maternal-infant transmission of hepatitis B virus infection. Methods Three groups of children were involved in this research, they were immunoprophylaxis success, immunoprophylaxis failure and control groups. A total of 109 children whose mothers were positive for HBsAg / HBeAg received three doses of hepatitis B vaccine (at 0, 1 and 6 months of age) alone, or combined with HBIG (within 12 hours after birth and in 2 weeks of age); among which, 65 cases were identified as immunoprophylaxis success for they had positive serum HBsAb after vaccination, 44 cases were immunoprophylaxis failure for they failed to develop detectable serum HBsAb and had positive HBsAg after vaccination. The control group including 221 healthy children whose mothers were negative for both serum HBsAg and HBeAg also received three doses of hepatitis B vaccine (at 0, 1 and 6 months of age) and had positive serum HBsAb after vaccination. Genotype analysis was performed among three groups for IL28B rs12979860, rs12980275 and rs8099917. Results No significant differences were observed in genotype frequency distribution among three groups at the polymorphic sites, rs12979860（P=0.266) and rs12980275（P=0.051）. However, considerable differences were observed concerning the distribution of the rs8099917 genotypes among three groups (P=0.009), frequencies of TT genotype were higher in immunoprophylaxis success group when compared with immunoprophylaxis failure group (P=0.008). The odds ratio for immunoprophylaxis response was 6.48（OR=6.48，95% CI：1.27-32.0，P=0.025）for TT versus TG/GG at rs8099917 after adjustment for age and gender. Conclusion The frequencies of TT genotype of IL28B rs8099917 were higher in immunoprophylaxis success children compared with immunoprophylaxis failure children.
Objective To explore an assay that can evaluate the coagulation disorders in children with SLE, to investigate the correlation of disease activity of SLE and coagulation disorders and to monitor the events of bleeding or thrombosis and guiding clinical management. Methods SLE pediatric patients and healthy controls were recruited. The illness status of SLE patients was divided by SLEDAI scores. TEG parameters of patients and healthy controls were analyzed. Results A total of 39 SLE patients performed 58 TEG examinations. The mean age of patients was 11.3±2.6（5-17）years. TEG was performed as follows: 15 examinations in severe activity status,15 examinations in moderate activity status, 11 examinations in mild activity status and 17 examinations in no activity status. The mean age of healthy control group was 27.7±3.7（24-33）years. ①Among the SLE pediatric patients, bleeding and thrombosis were seen in 1 and 3 patients, respectively. Their TEG curves were different significantly.②Compared with the control group, the TEG variables of SLE pediatric patients showed hypercoagulability, whose R and K times were shortened, LY30 was decreased and CI was increased (P<0.05).③Hypercoagulability of SLE pediatric patients with higher SLEDAI scores was more obvious, whose R-time was shortened，α-angle and CI were increased (P<0.01). Furthermore, there was negative correlation between K-time and SLEDAI (r=-0.429, P<0.01) as well as R-time and SLEDAI (r=-0.402, P<0.01); also, there was positive correlation between α-angle and SLEDAI (r=0.458, P<0.01)as well as CI and SLEDAI (r=0.445, P<0.01) . Conclusion SLE pediatric patients with coagulation disorders showed hypercoagulability or hypocoagulability.TEG could distinguish them clearly. SLE pediatric patients showed hypercoagulability and was associated with disease activity. TEG could be a potential tool to evaluate the coagulation status of SLE.
Objective To explore if the peripheral endothelial function of patients with Kawasaki disease(KD) is associated with circulating CRP levels during acute phase before treatment, or coronary artery lesion (CAL), providing evidence to support the possibility to use endothelial function as a measure of recovery of vascular endometrium from inflammation. Methods Patients diagnosed as KD and treated in Children′s Hospital of Fudan University with complete clinical personal and clinical data were recruited at their follow up hospital visit. Peripheral endothelial function was examined by using EndoPat2000 with standard protocol by the same trained nurse, RHI was reported and analyzed including the distribution of RHI measurement. The correlation between RHI and CRP levels during acute phase of disease, and with CAL was analyzed by generalized linear model. Results In total 26 eligible patients were recruited, including 21 males, aged 5 to 13 years, and the duration after treatment ranged from 2 months to 5 years. The patients had average BMI of 0.93 s compared with the national level for the given age at recruitment. The mean level of CRP before treatment was 91.9 mg·L-1, the mean RHI at follow-up visit was 1.3 mL·mm-1 Hg×100. The original RHI measurement met normal distribution. After adjustment of age and Z score of body mass index (Z-BMI), RHI was negatively correlated with CRP percentiles （R2= 0.411 9，Pmodel=0.025 3，b= -0.483,PCRP＝0.019）. Patients with CAL had significantly lower RHI levels compared with patients who had no CAL, (1.04 ±1.10) vs (1.34 ±0.08) mL·mm-1 Hg×100, P=0.054. CRP levels at acute phase were not significantly different between the two groups of patients. Conclusion Patients with Kawasaki disease had impaired endothelial function during the recovery phase, and was significantly correlated with their inflammation severity before IVIG treatment. Patients with CAL had worse endothelial function than those without CAL. Non-invasive peripheral endothelial function can be considered as a biomarker to indicate recovery of vascular endometrium function for KD patients.
Objective The echocardiographic performance of fetal cardiac pulmonary atresia (PA) with intact ventricular septum (IVS) complicated by right ventricular dependent coronary circulation (RVDCC) was investigaed to improve the accuracy of diagnosis of this disease. Methods The echocardiographic characteristics of 4 fetal cases of PA/IVS complicated by RVDCC, diagnosed during September 2010 to May 2013 were analyzed. The PA/IVS cases with RVDCC were compared with the cases without RVDCC and controls. Results Specific echocardiographic characteristics: ① Significant right ventricular dysplasia, right ventricular hypertrophy could be observed. Dysplasia of tricuspid valve was observed and its Z score was significantly reduced. ② Right ventricular myocardial coronary sinus gap was open. ③ Blood flow from right ventricle to coronary artery could be seen. Conclusion PA/IVS complicated by RVDCC can be diagnosed accurately through fetal echocardiography. Once the disease was diagnosed, appropriate therapeutic measures should be taken as soon as possible.
Diffuse alveolar hemorrhage (DAH) is a clinical syndrome that can be a manifestation of multiple different causes. antineutrophil cytoplasmic antibody (ANCA) - associated vasculitides is one cause of diffuse alveolar hemorrhage, and is a rare disease in children. We present 2 cases of ANCA- associated vasculitides which misdiagnosed with idiopathic pulmonary haemosiderosis. One was an 8-yr-old girl, who was diagnosed as IPH for about 5 years, and finally diagnosed with ANCA- associated vasculitides. Another was a 12-yr-old boy, who had been treated with propylthiouracil (PTU) for about two year because of hyperthyroidism. He had the triad of idiopathic pulmonary haemosiderosis, and progressed rapidly, at last, PTU indued ANCA- associated vasculitides was diagnosed. Glucocorticoids in combination with other immunosuppressants are main therapied for ANCA- associated vasculitides. For DAH, identification of the underlying etiology is of utmost importance and dictates treatment.
