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1.
J Affect Disord ; 304: 12-19, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35176338

RESUMO

BACKGROUND: Trauma experience increases the risk of suicidal ideation, but little is known about potentially psychological mechanisms underlying this relationship. This study aims to examine the relationship between coronavirus disease 2019 (COVID-19)-related traumatic event (CTE) exposure and suicidal ideation among hospital workers, and identify mediating roles of sleep disturbances in this relationship. METHODS: Workers in seven designated hospitals in Wuhan, China, were invited to participate in an online survey from May 27, 2020, to July 31, 2020. Participants completed a self-report questionnaire to evaluate demographic characteristics, level of CTE exposures, nightmare frequency, insomnia severity, symptoms of depression and anxiety, and suicidal ideation. A series of correlation analyses were performed, and a mediation model was generated to examine correlations between CTE exposure, sleep disturbances, and suicidal ideation. RESULTS: A total of 16,220 hospital workers were included in the final analysis, 13.3% of them reported suicidal ideation in the past month. CTE exposure was significantly associated with insomnia severity, nightmare frequency, and suicidal ideation. After controlling potential confounders, nightmares but not insomnia, depression, or anxiety were shown to be independent risk factors for suicidal ideation. Pathway analyses showed that the relationship between CTE exposure and suicidal ideation was fully mediated by nightmares (proportion mediated 66.4%) after adjusting for demographic characteristics and psychological confounders. LIMITATIONS: Cross-sectional design precluded the investigation of causal relationships. CONCLUSIONS: CTE exposure increases risk of hospital workers' suicidal ideation that is mediated by nightmares, suggesting nightmares intervention might be considered as a component when developing suicide prevention strategies.


Assuntos
COVID-19 , Distúrbios do Início e da Manutenção do Sono , Estudos Transversais , Sonhos/psicologia , Humanos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Ideação Suicida
3.
Front Pediatr ; 9: 655074, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34046375

RESUMO

Background: Acute necrotizing encephalopathy of childhood (ANE) is a rare but rapidly progressing encephalopathy. Importantly, the exact pathogenesis and evidence-based treatment is scarce. Thus, we aimed to identify the clinical, imaging, and therapeutic characteristics that associated with prognosis of pediatric ANE patients. Methods: A retrospective study was conducted on pediatric patients with ANE who were admitted to Wuhan Children's Hospital between January 2014 and September 2019. All cases met the diagnostic criteria for ANE proposed by Mizuguchi in 1997. The clinical information and follow-up data were collected. The prognostic factors were analyzed by trend chi-square test and Goodman-Kruskal gamma test. Results: A total of 41 ANE patients ranging in age from 8.9 to 142 months were included in this study. Seven cases (17%) died, and the other 34 survivors had different degrees of neurological sequelae. Factors tested to be significantly correlated with the severity of neurological sequelae were the intervals from prodromal infection to acute encephalopathy (G = -0.553), conscious disturbance (r = 0.58), endotracheal intubation (r = 0.423), elevation of alanine aminotransferase (r = 0.345), aspartate aminotransferase (r = 0.393), and cerebrospinal fluid protein (r = 0.490). In addition, dynamic magnetic resonance imaging (MRI) evaluation on follow-up revealed that the total numbers of brain lesion location (χ2 = 6.29, P < 0.05), hemorrhage (r = 0.580), cavitation (r = 0.410), and atrophy (r = 0.602) status were significantly correlated with the severity of neurological sequelae, while early steroid therapy (r = -0.127 and 0.212, respectively) and intravenous immunoglobulin (IVIG) (r = 0.111 and -0.023, respectively) within 24 h or within 72 h after onset showed no association. Conclusions: Intervals from prodromal infection to acute encephalopathy (≤1 day), total numbers of brain lesion location (≥3), the recovery duration of hemorrhage and atrophy (>3 months), and the presence of cavitation predict severe neurological sequelae in pediatric patients with ANE. Early treatments, including steroid therapy and IVIG, had no correlation with better outcomes. Further studies are needed to establish a consensus guideline for the management of ANE.

4.
Chem Res Toxicol ; 34(4): 1091-1100, 2021 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-33656317

RESUMO

Pyridinium aldoximes are best-known therapeutic antidotes used for clinical treatment of poisonings by organophosphorus nerve-agents and pesticides. Recently, we found that pralidoxime (2-PAM, a currently clinically used nerve-agent antidote) could also detoxify tetrachloro-1,4-benzoquinone (TCBQ), which is a carcinogenic quinoid metabolite of the widely used wood preservative pentachlorophenol under normal physiological conditions, via an unusually mild and facile Beckmann fragmentation mechanism accompanied by radical homolysis. However, it is not clear whether the less-chlorinated benzoquinones (CnBQs, n ≤ 3) act similarly; if so, what is the structure-activity relationship? In this study, we found that (1) The stability of reaction intermediates produced by different CnBQs and 2-PAM was dependent not only on the position but also the degree of Cl-substitution on CnBQs, which can be divided into TCBQ- and DCBQ (dichloro-1,4-benzoquinone)-subgroup; (2) The pKa value of hydroxlated quinones (Cn-1BQ-OHs, the hydrolysis products of CnBQs), determined the stability of corresponding intermediates, that is, the decomposition rate of the intermediates depended on the acidity of Cn-1BQ-OHs; (3) The pKa value of the corresponding Cn-1BQ-OHs could also determine the reaction ratio of Beckmann fragmentation to radical homolysis in CnBQs/2-PAM. These new findings on the structure-activity relationship of the halogenated quinoid carcinogens detoxified by pyridinium aldoxime therapeutic agents via Beckmann fragmentation and radical homolysis reaction may have broad implications on future biomedical and environmental research.


Assuntos
Benzoquinonas/química , Carcinógenos/química , Agentes Neurotóxicos/química , Oximas/química , Halogenação , Concentração de Íons de Hidrogênio , Hidrólise , Estrutura Molecular , Relação Estrutura-Atividade
5.
Free Radic Biol Med ; 163: 369-378, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33352220

RESUMO

We have recently found that penicillamine, a classic copper-chelating thiol-drug for Wilson's disease, can delay tetrachlorohydroquinone (TCHQ) autooxidation via a previously unrecognized redox-activity. However, its underlying molecular mechanism remains not fully understood. In this study, we found, interestingly and unexpectedly, that superoxide dismutase (SOD) can significantly shorten the delay of TCHQ autooxidation by penicillamine, but not by ascorbate; SOD can also markedly increase the yields of the oxidized form of penicillamine. Similar effects were observed with a recently-developed specific and sensitive superoxide anion radical (O2•-) probe CT-02H, which was also employed to successfully measure O2•- generated from both TCHQ and TCHQ/penicillamine systems for the first time. More importantly, addition of extra O2•- (KO2/18-crown-6) can further prolong the delaying effects by penicillamine and slow down penicillamine consumption. Taken together, an unexpected critical role of O2•- in TCHQ/penicillamine interaction was proposed: O2•- may regenerate penicillamine, thereby continuously reducing TCSQ•- to TCHQ and finally delaying TCHQ autooxidation; In contrast, if O2•- were eliminated, which can not only markedly change the reaction equilibrium, accelerate the rate of interaction, and ultimately shorten the delay of TCHQ autooxidation by penicillamine, but can also accelerate penicillamine oxidation to form its corresponding disulfide solely via redox reaction without any minor nucleophilic reaction. These findings not only further support our previously-proposed redox mechanism for the protection against TCHQ-induced cytotoxicity by penicillamine, but also reveal a new mode of action for O2•- in the inhibition of haloquinoids-induced toxicity by thiol antioxidants.


Assuntos
Penicilamina , Superóxidos , Antioxidantes , Oxirredução , Penicilamina/farmacologia , Superóxido Dismutase/metabolismo
6.
Front Neurol ; 12: 756746, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35002921

RESUMO

Background and Purpose: To assess the safety and effectiveness of oral methylprednisolone (oMP) in comparison with intramuscular adrenocorticotropic hormone (imACTH) and oral prednisolone (oP) therapies in children with infantile spasms (IS). Methods: In this prospective, open-label, non-blinded, uncontrolled observational study, children (aged 2-24 months) with newly diagnosed IS presenting with hypsarrhythmia or its variants on electroencephalogram (EEG) were included. It was followed by imACTH, oP, or oMP (32-48 mg/day for 2 weeks followed by tapering) treatments. Electroclinical remission/spasm control, relapse, and adverse effects were evaluated in the short-term (days 14 and 42) and intermediary-term (3, 6, and 12 months) intervals. Results: A total of 320 pediatric patients were enrolled: 108, 107, and 105 in the imACTH, oMP, and oP groups, respectively. The proportion of children achieving electroclinical remission on days 14 and 42 was similar among the three groups (day 14: 53.70 vs. 60.75 vs. 51.43%, p = 0.362; day 42: 57.55 vs. 63.46 vs. 55.34%, p = 0.470). The time to response was significantly faster in the oMP group (6.5 [3.00, 10.00] days vs. 8.00 [5.00, 11.00] days for imACTH and 8.00 [5.00, 13.00] days for oP, p = 0.025). Spasm control at 3, 6, and 12 months was also similar in the three groups (P = 0.775, 0.667, and 0.779). The relapse rate in the imACTH group (24.10%) was lower than oMP (30.77%) and oP groups (33.33%), and the time taken for relapse in the imACTH group (79.00 [56.50, 152.00] days) was longer than oMP (62.50 [38.00, 121.75] days) and oP groups (71.50 [40.00, 99.75] days), but the differences were not statistically significant (p = 0.539 and 0.530, respectively). The occurrence of adverse effects was similar among the three groups. Conclusions: The short and intermediary-term efficacy and recurrence rates of oMP are not inferior to those of imACTH and oP for the treatment of IS. Significantly, the time to achieve electroclinical remission with oMP was quicker than that with imACTH and oP. Considering its convenience, affordability, and the absence of irreversible side effects, oMP can serve as a form of first-line treatment for newly diagnosed IS.

7.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(9): 970-974, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-32933628

RESUMO

OBJECTIVE: To study the association of motor nerve conduction block (CB) with different subtypes of childhood Guillain-Barré syndrome (GBS). METHODS: A retrospective analysis was performed on the clinical and nerve electrophysiological data of 50 children with GBS. According to the results of nerve electrophysiology, the children were divided into an acute inflammatory demyelinating polyneuropathy (AIDP) group with 29 children and an acute motor axonal neuropathy (AMAN) group with 21 children. According to the presence or absence of motor nerve CB, the children with AMAN or AIDP were further divided into subgroups: group AMAN with or without motor nerve CB (n=10 and 11 respectively) and group AIDP with or without motor nerve CB group (n=19 and 10 respectively). The subgroups were compared in terms of age of onset, sex, Hughes Functional Grading Scale (HFGS) at nadir for the most severe involvement of motor function, and short-term prognosis based on HFGS score at 1 month after disease onset. RESULTS: Motor nerve CB was reversible in children with AMAN. AMAN children with motor nerve CB had a significantly lower HFGS score than those without motor nerve CB at 1 month after onset (P<0.05). AIDP children with motor nerve CB had a significantly higher HFGS score than those with motor nerve CB at 1 month after onset (P<0.05). CONCLUSIONS: AMAN with reversible motor nerve CB suggests mild nerve fiber lesion and has better recovery than AMAN and AIDP without motor nerve CB in short term.


Assuntos
Síndrome de Guillain-Barré , Criança , Humanos , Condução Nervosa , Prognóstico , Estudos Retrospectivos
8.
Front Psychiatry ; 11: 774, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32903695

RESUMO

Tic disorders (TD) are a group neuropsychiatric disorders with childhood onset characterized by tics, i.e. repetitive, sudden, and involuntary movements or vocalizations; and Tourette syndrome (TS) is the most severe form of TD. Their clinical manifestations are diverse; and are often associated with various psychopathological and/or behavioral comorbidities, including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, depression, and sleep disorders. Individual severity and response to treatment are highly variable, and there are some refractory cases, which are less responsive to conventional TD treatment. TD/TS are also common in the Chinese pediatric population. To help improve the understanding of TD for pediatricians and other health professionals, and to improve its diagnosis and treatment in China, the Chinese Child Neurology Society (CCNS) has developed an Expert Consensus on Diagnosis and Treatment of TD in China, which is based on our clinical experience and the availability therapeutic avenues. It is focused on clinical diagnosis and evaluation of TD and its comorbidities, psychological and educational intervention, nonpharmacological therapy, pharmacological treatment, including traditional Chinese medicine and acupuncture, as well as prognosis in children with TD in China. A summary of the current status of TD and up-to-date diagnosis and treatment recommendations for TD in China is presented here.

10.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(6): 578-582, 2020 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-32571455

RESUMO

OBJECTIVE: To study the clinical features of asymptomatic or subclinical coronavirus disease 2019 (COVID-19) in children. METHODS: A retrospective analysis was performed for the clinical data of 53 children who were confirmed with asymptomatic or subclinical COVID-19, including epidemiological history, clinical typing, co-infection, time to clearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid in nasopharyngeal swabs, laboratory examination results, length of hospital stay, and treatment outcome. RESULTS: The children with asymptomatic or subclinical COVID-19 accounted for 30.5% (53/174) in children with COVID-19 hospitalized in the COVID-19 ward of Wuhan Children's Hospital. All cases occurred with familial aggregation. Among the 53 children, 35 (66%) had asymptomatic infection and 18 (34%) had subclinical infection. Mycoplasma infection was found in 17 children (32%). For the 53 children, the mean time to clearance of SARS-CoV-2 nucleic acid in nasopharyngeal swabs was 9±4 days. Most laboratory markers were maintained within the normal range. The mean hospital stay was 11±4 days. Lung CT of 18 children with subclinical COVID-19 showed ground-glass opacities, linear opacities, and patchy opacities, with relatively limited lesions. CONCLUSIONS: There is a high proportion of children with asymptomatic or subclinical COVID-19 among the children with COVID-19 hospitalized in the COVID-19 ward. The transmission risk of asymptomatic or subclinical COVID-19 should be taken seriously.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , COVID-19 , Criança , Humanos , Estudos Retrospectivos , SARS-CoV-2
11.
World J Pediatr ; 16(3): 260-266, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32504360

RESUMO

BACKGROUND: The clinical characteristics and outcome of COVID-19 in children are different from those in adults. We aimed to describe the characteristics of infants under 1 year of age (excluding newborns) with COVID-19. METHODS: We retrospectively retrieved data of 36 infants with SARS-CoV-2 infection in Wuhan Children's Hospital from January 26 to March 22, 2020. Clinical features, chest imaging findings, laboratory tests results, treatments and clinical outcomes were analyzed. RESULTS: The mean age of the infected infants was 6.43 months, with a range of 2-12 months. 61.11% of the patients were males and 38.89% females. 86.11% of the infants were infected due to family clustering. Cough (77.78%) and fever (47.22%) were the most common clinical manifestations. Chest CT scan revealed 61.11% bilateral pneumonia and 36.11% unilateral pneumonia. 47.22% of the infants developed complications. Increased leucocytes, neutrophils, lymphocytes, and thrombocytes were observed in 11.11, 8.33, 36.11 and 44.44% of infants, respectively. Decreased leucocytes, neutrophils, thrombocyte and hemoglobin were observed in 8.33, 19.44, 2.78 and 36.11% of infants, respectively. Increased C-reactive protein, procalcitonin, lactate dehydrogenase, alanine aminotransferase, creatine kinase and D-dimer were observed in 19.44, 67.74, 47.22, 19.44, 22.22 and 20.69% of infants, respectively. Only one infant had a high level of creatinine. Co-infections with other respiratory pathogens were observed in 62.86% of infants. CD3 (20.69%), CD4 (68.97%), CD19 (31.03%) and Th/Ts (44.83%) were elevated; CD8 (6.9%) and CD16+CD56 (48.28%) was reduced. IL-4 (7.69%), IL-6 (19.23%), IL-10 (50%), TNF-α (11.54%) and IFN-γ (19.23%) were elevated. Up to March 22, 97.22% of infants recovered, while a critical ill infant died. When the infant's condition deteriorates rapidly, lymphocytopenia was discovered. Meanwhile, C-reactive protein, D-dimer, alanine aminotransferase, creatine kinase, creatinine, IL-6 and IL-10 increased significantly. CONCLUSIONS: In the cohort, we discovered that lymphocytosis, elevated CD4 and IL-10, and co-infections were common in infants with COVID-19, which were different from adults with COVID-19. Most infants with COVID-19 have mild clinical symptoms and good prognosis.


Assuntos
Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , COVID-19 , China , Infecções por Coronavirus/terapia , Feminino , Humanos , Lactente , Masculino , Pandemias , Pneumonia Viral/terapia , Estudos Retrospectivos , Resultado do Tratamento
12.
World J Pediatr ; 16(3): 232-239, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32333248

RESUMO

In the early February, 2020, we called up an experts' committee with more than 30 Chinese experts from 11 national medical academic organizations to formulate the first edition of consensus statement on diagnosis, treatment and prevention of coronavirus disease 2019 (COVID-19) in children, which has been published in this journal. With accumulated experiences in the diagnosis and treatment of COVID-19 in children, we have updated the consensus statement and released the second edition recently. The current version in English is a condensed version of the second edition of consensus statement on diagnosis, treatment and prevention of COVID-19 in children. In the current version, diagnosis and treatement criteria have been optimized, and early identification of severe and critical cases is highlighted. The early warning indicators for severe pediatric cases have been summarized which is utmost important for clinical practice. This version of experts consensus will be valuable for better prevention, diagnosis and treatment of COVID-19 in children worldwide.


Assuntos
Infecções por Coronavirus , Coronavirus , Pandemias , Pneumonia Viral/epidemiologia , Betacoronavirus , COVID-19 , Criança , Consenso , Humanos , SARS-CoV-2
13.
World J Pediatr ; 16(3): 251-259, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32193831

RESUMO

BACKGROUND: An outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was first detected in Wuhan, Hubei, China. People of all ages are susceptible to SARS-CoV-2 infection. No information on severe pediatric patients with COVID-19 has been reported. We aimed to describe the clinical features of severe pediatric patients with COVID-19. METHODS: We included eight severe or critically ill patients with COVID-19 who were treated at the Intensive Care Unit (ICU), Wuhan Children's Hospital from January 24 to February 24. We collected information including demographic data, symptoms, imaging data, laboratory findings, treatments and clinical outcomes of the patients with severe COVID-19. RESULTS: The onset age of the eight patients ranged from 2 months to 15 years; six were boys. The most common symptoms were polypnea (8/8), followed by fever (6/8) and cough (6/8). Chest imaging showed multiple patch-like shadows in seven patients and ground-glass opacity in six. Laboratory findings revealed normal or increased whole blood counts (7/8), increased C-reactive protein, procalcitonin and lactate dehydrogenase (6/8), and abnormal liver function (4/8). Other findings included decreased CD16 + CD56 (4/8) and Th/Ts*(1/8), increased CD3 (2/8), CD4 (4/8) and CD8 (1/8), IL-6 (2/8), IL-10 (5/8) and IFN-γ (2/8). Treatment modalities were focused on symptomatic and respiratory support. Two critically ill patients underwent invasive mechanical ventilation. Up to February 24, 2020, three patients remained under treatment in ICU, the other five recovered and were discharged home. CONCLUSIONS: In this series of severe pediatric patients in Wuhan, polypnea was the most common symptom, followed by fever and cough. Common imaging changes included multiple patch-like shadows and ground-glass opacity; and a cytokine storm was found in these patients, which appeared more serious in critically ill patients.


Assuntos
Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Adolescente , COVID-19 , Criança , Pré-Escolar , China , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Pandemias , Índice de Gravidade de Doença
14.
Curr Med Sci ; 40(2): 275-280, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32207032

RESUMO

Since December 2019, COVID-19 has occurred unexpectedly and emerged as a health problem worldwide. Despite the rapidly increasing number of cases in subsequent weeks, the clinical characteristics of pediatric cases are rarely described. A cross-sectional multicenter study was carried out in 10 hospitals across Hubei province. A total of 25 confirmed pediatric cases of COVID-19 were collected. The demographic data, epidemiological history, underlying diseases, clinical manifestations, laboratory and radiological data, treatments, and outcomes were analyzed. Of 25 hospitalized patients with COVID-19, the boy to girl ratio was 1.27:1. The median age was 3 years. COVID-19 cases in children aged <3 years, 3.6 years, and ≥6-years patients were 10 (40%), 6 (24%), and 9 (36%), respectively. The most common symptoms at onset of illness were fever (13 [52%]), and dry cough (11 [44%]). Chest CT images showed essential normal in 8 cases (33.3%), unilateral involvement of lungs in 5 cases (20.8%), and bilateral involvement in 11 cases (45.8%). Clinical diagnoses included upper respiratory tract infection (n=8), mild pneumonia (n=15), and critical cases (n=2). Two critical cases (8%) were given invasive mechanical ventilation, corticosteroids, and immunoglobulin. The symptoms in 24 (96%) of 25 patients were alleviated and one patient had been discharged. It was concluded that children were susceptible to COVID-19 like adults, while the clinical presentations and outcomes were more favorable in children. However, children less than 3 years old accounted for majority cases and critical cases lied in this age group, which demanded extra attentions during home caring and hospitalization treatment.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Adolescente , COVID-19 , Criança , Pré-Escolar , China , Infecções por Coronavirus/diagnóstico por imagem , Feminino , Humanos , Lactente , Masculino , Pneumonia Viral/diagnóstico por imagem , SARS-CoV-2 , Tomografia Computadorizada por Raios X
15.
J Huazhong Univ Sci Technolog Med Sci ; 37(3): 433-438, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28585150

RESUMO

Mild encephalopathy/encephalitis with a reversible splenial (MERS) lesion is a clinic-radiological entity. The clinical features of MERS in neonates are still not systemically reported. This paper presents five cases of MERS, and the up-to-date reviews of previously reported cases were collected and analyzed in the literature. Here we describe five cases clinically diagnosed with MERS. All of them were neonates and the average age was about 4 days. They were admitted for the common neurological symptoms such as hyperspasmia, poor reactivity and delirium. Auxiliary examinations during hospitalization also exhibited features in common. In this report, we reached following conclusions. Firstly, magnetic resonance imaging revealed solitary or comprehensive lesions in the splenium of corpus callosum, some of them extending to almost the whole corpus callosum. The lesions showed low intensity signal on T1-weighted images, homogeneously hyperintense signal on T2-weighted images, fluid-attenuated inversion recovery and diffusion-weighted images, and exhibited an obvious reduced diffusion on apparent diffusion coefficient map. Moreover, the lesions in the magnetic resonance imaging disappeared very quickly even prior to the clinical recovery. Secondly, all the cases depicted here suffered electrolyte disturbances especially hyponatremia which could be easily corrected. Lastly, all of the cases recovered quickly over one week to one month and majority of them exhibited signs of infections and normal electroencephalography.


Assuntos
Encefalopatias/diagnóstico por imagem , Corpo Caloso/diagnóstico por imagem , Encefalite/diagnóstico por imagem , Hiponatremia/diagnóstico , Convulsões/diagnóstico por imagem , Encefalopatias/tratamento farmacológico , Encefalopatias/fisiopatologia , Cefoperazona/uso terapêutico , Corpo Caloso/efeitos dos fármacos , Corpo Caloso/patologia , Eletroencefalografia , Encefalite/tratamento farmacológico , Encefalite/fisiopatologia , Hospitalização , Humanos , Hiponatremia/tratamento farmacológico , Hiponatremia/fisiopatologia , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Fenobarbital/uso terapêutico , Recuperação de Função Fisiológica/fisiologia , Convulsões/tratamento farmacológico , Convulsões/fisiopatologia , Cloreto de Sódio/uso terapêutico , Equilíbrio Hidroeletrolítico
16.
Neurology ; 88(23): 2183-2191, 2017 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-28476759

RESUMO

OBJECTIVE: To investigate the involvement of human leukocyte antigen (HLA) loci in aromatic antiepileptic drug-induced cutaneous adverse reactions. METHODS: A case-control study was performed to detect HLA loci involved in aromatic antiepileptic drug-induced Stevens-Johnson syndrome in a southern Han Chinese population. Between January 1, 2006, and December 31, 2015, 91 cases of Stevens-Johnson syndrome induced by aromatic antiepileptic drugs and 322 matched drug-tolerant controls were enrolled from 8 centers. Important genotypes were replicated in cases with maculopapular eruption and in the meta-analyses of data from other populations. Sequence-based typing determined the HLA-A, HLA-B, HLA-C, and HLA-DRB1 genotypes. RESULTS: HLA-B*15:02 was confirmed as strongly associated with carbamazepine-induced Stevens-Johnson syndrome (p = 5.63 × 10-15). In addition, HLA-A*24:02 was associated significantly with Stevens-Johnson syndrome induced by the aromatic antiepileptic drugs as a group (p = 1.02 × 10-5) and by individual drugs (carbamazepine p = 0.015, lamotrigine p = 0.005, phenytoin p = 0.027). Logistic regression analysis revealed a multiplicative interaction between HLA-B*15:02 and HLA-A*24:02. Positivity for HLA-A*24:02 and/or HLA-B*15:02 showed a sensitivity of 72.5% and a specificity of 69.0%. The presence of HLA-A*24:02 in cases with maculopapular exanthema was also significantly higher than in controls (p = 0.023). Meta-analysis of data from Japan, Korea, Malaysia, Mexico, Norway, and China revealed a similar association. CONCLUSIONS: HLA-A*24:02 is a common genetic risk factor for cutaneous adverse reactions induced by aromatic antiepileptic drugs in the southern Han Chinese and possibly other ethnic populations. Pretreatment screening is recommended for people in southern China.


Assuntos
Anticonvulsivantes/efeitos adversos , Predisposição Genética para Doença , Antígeno HLA-A24/genética , Síndrome de Stevens-Johnson/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , China , Feminino , Seguimentos , Antígeno HLA-B15/genética , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Síndrome de Stevens-Johnson/etnologia , Adulto Jovem
17.
Guang Pu Xue Yu Guang Pu Fen Xi ; 35(3): 765-71, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26117894

RESUMO

An atmosphere-pressure Dielectric Barrier Discharge in Ar/NH3 mixtures between cylinder electrodes is studied by Optical Emission Spectroscopy and the main particles of atmosphere-pressure Ar/NH3 DBD plasma are NH, N, N+, N2, Ar, H(α) and OH. NH is decomposition products of NH3, and NH(c 1π) and NH(A 3π) are two kinds of excited-state neutral particles and produced by penning ionization of Ar* and NH3. The nitrogen active atom is detected at 674.5 nm which may provide the experimental foundation for the synthesis of ε-Fe3N ferroparticles by the atmosphere-pressure Ar/NH3 DBD plasma. The intensities of main particles are analyzed at different NH3 flow rate and applied voltage peak-peak value. The results show that the spectral line intensities of various particles increase with the rise of the applied voltage peak-peak value at the same NH3 flow rate, and first increase and then decrease with the increase of the NH3 flow rate at the same applied voltage peak-peak value. The applied voltage peak-peak value being kept constant, the spectral line intensity of nitrogen active atom first increases and then decreases with the increase of the NH3 flow rate. When NH3 flow rate is 20 mL x min(-1), the spectral line intensity of nitrogen active atom reaches a maximum at the same applied voltage peak-peak value. The spectral line intensity of nitrogen active atom decreases gradually with increasing the applied voltage peak-peak value at the same NH3 flow rate and it is mainly because of the translation of discharge mode from multi-pulse APGD to filamentary discharge in the atmosphere-pressure Ar/NH3 DBD. The microdischarge channels overlap and the microdischarges affect each other in multi-pulse APGD; hence the increasing rate of the spectral line intensity is quicker in multi-pulse APGD than in filamentary discharge with increasing the applied voltage peak-peak value. When the applied voltage peak-peak value is up from 4 600 to 6 400 V, the single-pulse and two-pulse APGD mode which are two kinds of homogeneous DBD mode are found in the atmosphere-pressure Ar/NH3 DBD and the increasing rate of the spectral line intensity is quicker in multi-pulse APGD than in filamentary discharge which is beneficial to synthesize ε-Fe3N ferroparticles.

18.
Zhongguo Dang Dai Er Ke Za Zhi ; 17(6): 560-4, 2015 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-26108313

RESUMO

OBJECTIVE: To study the association between two single nucleotide polymorphisms (SNP), rs2295080 and rs2536, in mammalian target of rapamycin (mTOR) gene and the susceptibility to pediatric epilepsy. METHODS: A case- control study was performed on 480 children with epilepsy (116 cases of refractory epilepsy) and 503 healthy children. SNP rs2295080 and rs2536 in the mTOR gene were detected by polymerase chain reaction restriction and fragment length polymorphisms (PCR-RFLP). Genotype and allele frequencies of SNP rs2295080 and rs2536 were compared between the children with epilepsy and healthy controls. RESULTS: There were no significant differences in the genotype and allele frequencies of SNP rs2295080 between the children with epilepsy and healthy controls. There were no significant differences in the genotype frequencies of SNP rs2536 between the two groups either, but the frequency of G allele of SNP rs2536 was higher in children with epilepsy than that in healthy controls (P=0.042, OR=1.344, 95%CI: 1.010-1.789). CONCLUSIONS: SNP rs2536 of mTOR gene may be associated with the risk of pediatric epilepsy.


Assuntos
Epilepsia/genética , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único , Serina-Treonina Quinases TOR/genética , Epilepsia/etiologia , Frequência do Gene , Genótipo , Humanos , Risco
19.
Int J Clin Pharmacol Ther ; 52(8): 684-92, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24887335

RESUMO

OBJECTIVE: This study was to establish the population pharmacokinetic (PPK) model of pharmacologically active metabolite of oxcarbazepine (OXC) and to estimate PPK parameters for the optimal individuation administration of OXC in Chinese children with epilepsy. METHODS: The pharmacologically active metabolite, 10-monohydroxy derivative of OXC (MHD)was used as the analytical target for monitoring therapy of OXC. A total of 840 MHD serum samples from 466 children with epilepsy were analyzed using high-performance liquid chromatography with UV detection. Patients' clinical data were retrospectively collected. Population pharmacokinetics analysis was performed using a non-linear mixed-effect model with Phoenix NLME 1.2. Pharmacokinetic parameters were estimated according to a one-compartment model with first-order absorption and elimination. Effects of age,gender, total body weight (TBW), daily doseper weight (DDPW) and use of concomitant antiepileptic drugs (AEDs) were analyzed.Bootstrap and predictive check were used simultaneously to validate the final population pharmacokinetics models. RESULTS: The final PPK model of MHD was: Ka = 0.645 h⁻¹, V(L) = (11.3 + (age - 90.5) x 0.0282 + (TBW - 25.0) x 0.402) x e(0.0689), CL (L/h) = (0.557 + (DDPW - 20.8) x 0.00367 + (gender) x (-0.0636)) x e(0.120). The final PPK model was demonstrated to be suitable and effective by the bootstrap and predictive check. CONCLUSIONS: A PPK model of MHD in Chinese children with epilepsy was successfully established. PPK parameters of MHD could be predicted accurately by this model. This model may be very useful for establishing individual dosage guidelines of OXC in Chinese children with epilepsy.


Assuntos
Anticonvulsivantes/farmacocinética , Carbamazepina/análogos & derivados , Epilepsia/tratamento farmacológico , Modelos Biológicos , Adolescente , Anticonvulsivantes/uso terapêutico , Carbamazepina/farmacocinética , Carbamazepina/uso terapêutico , Criança , Pré-Escolar , Cromatografia Líquida de Alta Pressão/métodos , Feminino , Humanos , Lactente , Masculino , Dinâmica não Linear , Oxcarbazepina , Estudos Retrospectivos
20.
Zhongguo Dang Dai Er Ke Za Zhi ; 16(4): 393-6, 2014 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-24750837

RESUMO

OBJECTIVE: To study the clinical features and mutations in methyl-CpG-binding protein 2 (MECP2) gene among children with classical Rett syndrome in China. METHODS: PCR and direct sequencing were employed to analyze the three exons of MECP2 gene in 9 children recently diagnosed with Rett syndrome and their parents. RESULTS: Heterozygous mutations were identified in 5 out of 9 patients, with a mutation rate of over 50%; there was one case of insert mutation (c.913insT) and 4 cases of missense mutation (exon 3: c.316C>T (R106W); exon 4: c.502C>T (R168X), c.808C>T (R270X), and c.1126C>T (P376S). A new mutation (c.913insT) was found. No mutations were detected in their parents. Two patients had MECP2 mutations in the transcriptional repression domain (TRD). They had almost lost language functions and were found to have significantly delayed development compared with other patients. CONCLUSIONS: Mutations in MECP2 gene were detected in 5 confirmed cases of Rett syndrome, and most of them were on exon 4. Mutations in the TRD of MECP2 protein may affect the language ability and development in children with Rett syndrome.


Assuntos
Proteína 2 de Ligação a Metil-CpG/genética , Mutação , Síndrome de Rett/genética , Pré-Escolar , Feminino , Humanos , Lactente , Desenvolvimento da Linguagem , Síndrome de Rett/psicologia
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