Significance of pediatric early warning score and inflammatory markers in early diagnosis of critical hand foot and mouth disease / 医学研究生学报

Objective Critical hand foot and mouth disease(HFMD)progresses from severe type to critical type very fast with high mortality rate.The article was to explore the significance of pediatric early warning score and common inflammatory markers in early diagnosis of critical HFMD cases. Methods A retrospective analysis was conducted on 236 HFMD cases in Hainan Provincial People's Hospital from January 2014 to December 2016. According to HFMD diagnosis and treatment guidelines(2010 Edition)formulated by the Ministry of Health,the selected cases were divided into the general group(n=88),the severe group(n=128)and the critical group(n=20). The white blood cells(WBC),neutrophils(PMN), serum C reactive protein(CRP),procalcitonin(PCT)and other la-boratory parameters were collected at admission,along with Pediatric Early Warning score(PEWS)and Pediatric Critical Illness Score(PCIS). The data of each group were compared by ROC curve analysis. Results The median number of WBC and PMN in the criti-cal group was 15.36×109/L and 10.09×109/L,respectively,which were significantly higher than those of severe group(P<0.05). However,no significant difference was found between general group and severe group(P>0.05). The serum levels of CRP and PCT in general group were higher than those in severe group and critical group,and the difference was statistically significant(P<0.05). The PEWS[(6.1±2.42)vs(0.99±0.77)]and PCIS[(78.7±13.6)vs(99.03±2.12)]in critical group were significantly higher than those in severe group,which were of statistically significance(P<0.05). According to the ROC analysis,the area under the ROC curve of PEWS early warning score for children was(0.962~1.000),(P<0.05)and the best diagnosis limit PEWS was 3.5. The PEWS and PCIS correlation analysis showed the Pearson correlation coefficient was -0.885(P<0.05). Conclusion Common clini-cal inflammatory markers can not be taken as quantitative indicators for the early diagnosis of critical HFMD. The PEWS is an ideal quantitative index for early diagnosis of critical HFMD.

Association between arterial stiffness and risk of coronary artery disease

To investigate the role of Brachial ankle Pulse Wave Velocity [baPWV] and cfPWV on the risk of Coronary artery disease and the interaction between baPWV and risk factors of Coronary artery disease [CAD]. A case-control study was conducted at Department of Emergency, SunYat-Sen memorial Hospital, China. We collected 332 cases with coronary artery disease and 328 subjects without CAD between February 2012 and October 2013. A multivariate logistic regression analysis was performed to analyze the risk factors of CAD. CAD subjects were more likely to be old age, and have higher BMI, waist-hip ratio, hypertension, fasting glucose, TG, carotid-femoral PWV [cfPWV] and baPWV, and CAD subjects had a lower TC, HDL-C and LDL-C. We found that older age, smoking, higher hypertension, TC, TG, HDL-C, LDL-C, carotid-femoral PWV [CfPWV] and baPWV were associated with risk of CAD. baPWV had significant interaction with age, TC, TG, HDL-C and LDL-C, carotid-femoral PWV [cfWV] was correlated with age, HDL-C and LDL-C. This study showed that baPWV and cfPWV are two independent factors for the risk of Coronary artery disease, and baPWV and cfPWV have interaction with age, TC, TG, HDL-C and LDL-C

Risk factors for intra-abdominal hypertension in children with sepsis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study risk factors for the occurrence of intra-abdominal hypertension (IAH) in children with sepsis.</p><p><b>METHODS</b>A nest case-control study was employed. According to intra-abdominal pressures (IAP) measured by cystometry, 119 children with sepsis were classified into normal IAP (control, n = 80) and IAH groups (n = 39). Risk factors for the occurrence of IAH were investigated by monovariable and multivariable logistic regression analysis.</p><p><b>RESULTS</b>Monovariable analysis showed that there were significant differences in pediatric critical illness score (PCIS), procalcitonin (PCT) level, PaCO(2), blood lactate level, rates of intestinal or intra-abdominal infection, ascites, gastrointestinal dysfunction, mechanical ventilation, shock and multiple organ dysfunction syndrome (MODS) between the IAH and control groups (P < 0.05). Multivariable logistic regression analysis demonstrated that decreased PCIS, MODS, shock, gastrointestinal dysfunction and ascites were major risk factors for the occurrence of IAH.</p><p><b>CONCLUSIONS</b>Children with sepsis who have decreased PCIS, MODS, shock, gastrointestinal dysfunction and ascites are at risk for the occurrence of IAH.</p>

Feasibility of volume perfusion CT (VPCT) imaging in antiangiogenic treatment of rabbit VX2 soft-tissue tumor / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the feasibility of volume perfusion CT imaging to dynamically monitor and evaluate the response of rabbit VX2 soft-tissue tumor to antiangiogenic treatment.</p><p><b>METHODS</b>To establish an experimental animal model of VX2 soft tissue tumor on 20 New Zealand white rabbits. Twenty rabbits were randomly divided into 2 groups. The therapy group was treated with recombinant human endostatin (3 mg·kg⁻¹·d⁻¹) for 7 days, and the control group received saline in the same dose only. Four times of CT volume perfusion scan were performed before treatment and on the second, forth, seventh days of treatment, respectively. The value of blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability (PMB) in the VX2 tumors were measured after scanning. The microvessel density (MVD) and expression of vascular endothelial growth factor (VEGF) in the tumors were determined using immunohistochemical staining.</p><p><b>RESULTS</b>The tumor volume of the therapy group was (1.36 ± 0.73) cm³ on the forth day of treatment and (1.69 ± 0.68) cm³ on the seventh day of the treatment. The tumor volume of the control group was (2.35 ± 0.62) cm³ on the fourth day of treatment and (3.87 ± 0.93) cm³ on the seventh day of the treatment (P < 0.05). On the seventh day of treatment, tumor necrosis ratio of the therapy group and the control group was (25.58 ± 5.51)% and (42.93 ± 4.34)%, respectively (P < 0.05). Comparing the perfusion parameters between the two groups on the same day, and the second, forth, seventh days of treatment, the value of PMB of the therapy group was (70.36 ± 23.46) ml·100 ml⁻¹·min⁻¹, (79.64 ± 13.68) ml·100 ml⁻¹·min⁻¹ and (84.76 ± 3.55) ml·100 ml⁻¹·min⁻¹, respectively, and that in the control group was (26.61 ± 6.47) ml·100 ml⁻¹·min⁻¹, (33.74 ± 16.47) ml·100 ml⁻¹·min⁻¹ and (30.47 ± 10.64) ml·100 ml⁻¹·min⁻¹, respectively (P < 0.05). The value of BF in the therapy group and control group was (71.19 ± 12.21) ml·100 ml⁻¹·min⁻¹ and (43.56 ± 12.21) ml·100 ml⁻¹·min⁻¹, respectively, on the seventh day of treatment (P < 0.05). The parameters on different days in the same group were compared. In the control group, the value of BF on the seventh day of treatment was significantly lower than that before and on the second and forth days of treatment (P < 0.05). However, in the therapy group, the value of PMB on the second, forth, and seventh days of treatment was significantly higher than that before treatment (P < 0.05). MVD of tumor in the control group was increased gradually, whereas increased on the first day and then decreased more in the therapy group. The VEGF expressions did not differ significantly between the experimental and control groups.</p><p><b>CONCLUSIONS</b>Volume perfusion CT is helpful to quantify the tumor perfusion and evaluate the functional changes of tumor vasculature, and then evaluate the early therapeutic effect of antiangiogenic treatment.</p>

Correlations between serum interleukin-18 (IL-18) level, IL-18 gene promoter polymorphisms and the development of sepsis in children / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the correlations of serum interleukin-18 (IL-18) level and IL-18 gene promoter polymorphisms to the development of sepsis in children.</p><p><b>METHOD</b>Using enzyme-linked immunosorbent assay (ELISA), the authors tested the serum IL-18 level in 90 patients with sepsis and 123 normal controls, and their single nucleotide polymorphisms of the promoter region of IL-18 gene at position -607C/A and -137G/C were detected using polymerase chain reaction with sequence specific primers method and sequencing technique.</p><p><b>RESULT</b>(1) The serum IL-18 level in sepsis groups was (196.56 +/- 157.32) pg/ml that was significantly higher than (66.16 +/- 41.63) pg/ml in normal controls (P < 0.01), the more severe the degree of sepsis was, the more significantly higher the serum IL-18 level was. The serum IL-18 level in non serious sepsis group was (152.87 +/- 114.96) pg/ml that was significantly higher than (66.16 +/- 41.63) pg/ml in normal controls, the serum IL-18 level in serious sepsis group was (191.98 +/- 169.72) pg/ml that was significantly higher than that in non serious sepsis group, and the serum IL-18 level in extremely serious sepsis patients was (323.89 +/- 159.35) pg/ml, the difference was highly significant (P = 0.000). The difference was significant among the groups with different severity of sepsis (P < 0.01). There was a negative correlation between PCIS (pediatric critical illness score) of sepsis and the serum IL-18 level (P < 0.01). (2) There were polymorphisms in IL-18 gene promoter of matched healthy children and sepsis in children. The GG genotype frequency (61.8%) of IL-18-137G/C in healthy children was the highest, followed by GC genotype (35.8%) and CC genotype (2.4%) in sequence. The G allele frequency (79.7%) was higher in IL-18-137G/C of healthy children than C allele (20.3%). The GG genotype frequency (71.1%) of IL-18-137G/C in septic children was the highest, the next were GC genotype (26.7%) and CC genotype (2.2%). The G allele frequency (84.4%) was higher in IL-18-137G/C of septic children than C allele (15.6%). The CA genotype frequency (61.0%) of IL-18-607C/A in healthy children was the highest, followed by CC genotype (26.8%) and AA genotype (12.2%). The C allele frequency (57.3%) was higher in IL-18-607C/A of healthy children than A allele (42.7%). The CA genotype frequency (76.7%) of IL-18-607C/A in septic children was the highest, followed by CC genotype (21.1%) and AA genotype (2.2%) in sequence. The C allele frequency (59.4%) was higher in IL-18-607C/A of septic children than A allele (40.6%). (3) The genotype frequency of IL-18-607 CA was 76.7% in sepsis groups that was significantly higher than 61.0% in normal controls, and the genotype frequency of -607 AA was 2.2% in sepsis groups that was significantly lower than 12.2% in normal controls, the difference was significant (P < 0.05). (4) In the order of -137CC, -137GC, -137GG, the serum IL-18 level in normal controls were as follows: (45.67 +/- 28.36) pg/ml, (53.27 +/- 37.91) pg/ml, (76.91 +/- 42.44) pg/ml, and with (140.50 +/- 60.10) pg/ml, (184.42 +/- 157.33) pg/ml, (237.02 +/- 161.76) pg/ml respectively in sepsis groups. In the order of -607AA, -607CA, -607CC, the serum IL-18 level in normal controls were: (48.80 +/- 32.11) pg/ml, (68.41 +/- 42.53) pg/ml, (70.17 +/- 43.87) pg/ml; and with (141.50 +/- 64.35) pg/ml, (151.21 +/- 121.19) pg/ml, (211.16 +/- 163.64) pg/ml respectively in sepsis groups. The difference was not significant among different groups (P > 0.05).</p><p><b>CONCLUSION</b>The serum IL-18 level in sepsis groups was significantly higher than that in normal controls, which was related to the severity of sepsis. It was possible that the genotype of -607CA carriers was susceptible to sepsis, which mean that the genotype of -607CA might be susceptible genotype of sepsis. However, the genotype of -607AA might play an oppose role in the risk of sepsis.</p>

Application of global positioning systems and geographic information systems in drinking water defluoridation project in Liaoning province / 中国地方病学杂志

Objective To establish information management systems of drinking water defluoridation project in water-related endemic fluorosis areas and investigate the status of drinking water defluoridation project in Liaoning, provide the basis for the development of control measures. Methods Global positioning systems (GPS)and geographic information systems(GIS) were used in the study in August 2006 - July 2008. Water defluoridation projects of 1234 in 48 counties(cities, districts) in drinking water type of fluorosis areas were positioned. Latitude and longitude, water samples, water fluoride content were collected or tested. GIS was used to establish information management system of water defluoridation projects. Results We have established information management system for the facilities of decreasing water fluorine in drinking water type of endemic fluorosis regions in Liaoning. One thousand two hundred and thirty four defluoridation facilities distributed in east longitude between 39.39° - 43.37°,north latitude between 119.25° - 125.50°, and altitude between - 6.60 and 801.14 meter in 48 endemic fluorosis counties in 13 cities. Nine hundred and twenty seven facilities for decreasing fluorine were able to supply water regularly, accounting for 75.1% of investigated projects;29 facilities was .not yet completely rebuilt, accounting for 2.4%;278 facilities(supply water for 344 villages) were out of order or discarded for 22.5% of investigated projects.Water fluorine contents of 63 facilities were greater than 1.2 mg/L, accounting for 6.8% of investigation project.Facilities working regularly and water fluorine was in accord with hygienic standard for drinking water facilities were 70.0%. Conclusions The establishment of Liaoning province defluoridation project information management system in the whole province of drinking water type of fluorosis areas provides scientific basis for accurate decision-making on prevention and control of the disease.

Effect of Genciclovir on Cytomegalovirus Infection of Children with Cerebral Palsy / 中国康复理论与实践

@#ObjectiveTo investigate the therapeutic effect of genciclovir on cytomegalovirus (CMV) infection of children with cerebral palsy (CP).Methods36 CP children with CMV infection were randomly divided into treatment group and control group with 18 cases in each group. Children of treatment group were treated by genciclovir with 5 mg/kg i.v. drip q l2 h for 14 days at inductive phase and 7.5 mg/kg i.v. drip qod for 6 weeks at maintain phase. Cases of control group were treated by acyclovir with 5 mg/kg i.v. drip q 8 h for 14 days at inductive phase and 7.5 mg/kg i.v. drip q l2 h for 6 weeks at maintain phase. CMV-DNA contents in urine of two groups were measured before and after treatment.ResultsCMV-DNA contents in urine of two groups were not different before treatment (P>0.05). For control group, CMV-DNA contents were also not different before and after treatment. For treatment group, CMV-DNA contents after treatment significantly decreased compared with pre-treatment and that of control group after treatment (P<0.05).ConclusionGenciclovir is effect and safety for CMV infection of CP children.

Follow up of 16 cases with congenital toxoplasmosis treated with azithromycin / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the therapeutic effects of azithromycin in treatment of congenital toxoplasmosis in children.</p><p><b>METHODS</b>Definite diagnosis of congenital toxoplasmosis was made on the basis of clinical manifestation combined with one or more positive results of the following laboratory tests and excluded other congenital infectious diseases: toxoplasma DNA (TOX-DNA), circulating toxoplasma antigen (TOX-CAG), and toxoplasma IgM antibody (TOX-IgM). All the patients were given oral azithromycin 10 mg/(kg.d) for 6 days followed by 8 days without medication (one course of treatment), and the regimen was persisted for 2 months and then another 2-month treatment was given at a 1-month interval. The authors continued to provide further treatment according to the state of the illness at one month interval. The patients received 2 to 8 (average 5) courses of treatment. The patients were followed-up for 2.5 to 5 (average 4) years.</p><p><b>RESULTS</b>The treatment was effective in all the patients and the patient's condition was improved. The authors repeated in 12 cases the four tests for toxoplasma (TOX-DNA, TOX-CAG, TOX-IgM, and TOX-IgG) 9 months to one and a half years after treatment. In 10 cases all these tests showed negative results, in 2 cases TOX-IgG was positive and in the other 4 cases symptoms disappeared.</p><p><b>CONCLUSION</b>The results of the study showed that oral azithromycin had significant therapeutic effects with little side effect and was well tolerated. Azithromycin may become an alternative therapy in treatment of congenital Toxoplasma gondii infection in children.</p>

Correlation between Toxoplasma infection and occurrence of children with cerebral palsy / 中国康复理论与实践

@#ObjectiveTo investigate whether the Toxoplasma infection is the risk factor of occurrence of children cerebral palsy.Methods236 children with cerebral palsy and 428 normal children were included. Children were laminated to 4 groups by age:-3 months,-6 months,-9 months,-12 months. Final diagnosis was made by one or more finding following: plasma Toxoplasma DNA(TOX-DNA), plasma Toxoplasma circulating antigen(TOX-CAG), plasma Toxoplasma IgM(TOX-IgM), exclusion other congenital infected diseases.ResultsThe OR and 95%CI were 10.13,3.74-27.42 in -3 months,7.71,2.45-24.28 in -6 months,8.84,1.85-42.31 in-9 months(P<0.01 respectively), and 4.30, 0.83-22.28(P>0.05)in -12 months. ConclusionThere is correlation between the Toxoplasma infection and the children cerebral palsy; the earlier Toxoplasma infection, the greater the risk of cerebral palsy. Congenital Toxoplasma infection may be one of important factors in children cerebral palsy.