Objective To analyze the clinical features of organic damages in Kawasaki disease(KD),and to improve the diagnosis and treatment level.Methods Two hundred and two cases with KD admitted in Children's Hospital Affiliated to Capital Institute of Pediatrics from Jan.2000 to Oct.2007 were reviewed,and their blood routine,urine,stool routine,liver function,kidney function,chest X-ray,and so on,were investigated.The incidence of organic damages in KD was evaluated.Results Among the 202 KD children,137 were male and 65 were female,the male-female ratio was 2.11.0.Most of them were infants,and 71.3% of them were younger than 3 years old.The damages of hematological system were detected in 78/202 cases(38.6%),respiratory system 76/202 cases(37.6%),cardiovascalar system 68/202 cases(33.7%),urinary system 52/202 cases(25.6%),digestive system 23/202 cases(11.4%),and central nervous system 3/202 cases(1.5%).On the other hand,3 cases complicated with septemia,1 case with juvenile rheumatoid arthritis and 1 case with Henoch-Schonlein purpura.Conclusions The data indicate that the incidence of hematological system involvement in the sick-children with KD were highest,with more than 2 organs involved simaltaneously.Many organic damages were involved in KD and diverse clinical manifestation could be found.Physicians should understand not only the typical features but also the rare symptoms and organic damage so as to prevent misdiagnosis and improper treatment.J Appl Clin Pediatr,2009,24(1):31-32

Objective To investigate the expression of Fas/FasL in children with aplastic anemia(AA) and its clinical significance.To explore the pathogenesis of AA.Methods CD34+ cell counts and the expression of Fas/FasL in 12 children with severe AA(SAA),18 with chronic AA(CAA)and 10 normal children were detected by flow cytometry combining monocolon antibody.Results The expression of Fas in children with AA were significantly higher than that in control group(P0.05).Conclusions Fas/FasL systeam take part in inducing CD34+ cell apoptosis.This may contribute to understanding the decrease number of stem cells and bone marrow failure.

Objective To explore the diagnosis of pediatric clinical hematuria disease. Methods The clinical data of one pediatric patient with IgA nephropathy combined with multiple bladder hemangioma were summarized and analyzed. Results For more than 6 years, 9-year-old female presented with repeated intermittent gross hematuria and persistent microscopic hematuria with the blood clot in urine after several respiratory tract infections. Routine urine test showed protein+++, RBC in full ifeld of vision/HP, and 0 . 54-1 . 02 g of 24 h urine protein quantitation. Early damage index of kidney is mainly based on microalbumin. The ultrasound showed no abnormal abdomen and urinary tract. Also there was no abnormality in enhanced urinary tract CT scan. Renal arteriography showed no ifstula or arteriovenous malformation. Pathological diagnosis of renal biopsy was focal proliferative IgA nephropathy. Cystoscopy examination suggested multiple hemangioma of bladder. Conclusion Bladder hemangioma is a rare condition in childhood. For children presented gross hematuria with blood clots, when the imaging ifnds no abnormalities or other diseases and the treatment of IgA nephropathy is unsatisfatry after diagnosis, the cystoscopy should be performed to exclude the possibility of bladder hemangioma.

ObjectiveTo explore the optimal method of protecting bone marrow in postoperative concurrent chemoradiotherapy of stage Ⅱ - Ⅲ rectal cancer by comparing two techniques of intensitymodulated radiotherapy (IMRT). MethodsFifteen patients with stage Ⅱ - Ⅲ rectal cancer after surgery had CT simulation. Clinical target volume, small bowel, bladder and bone marrow were contoured. Two IMRT treatment plannings with and without bone marrow-sparing (BMS-IMRT and IMRT) were separately designed. The dose distribution was compared based on that 95％ of the planning target volume received the prescribed dose. ResultsBMS-IMRT had an advantage over IMRT in terms of conformity indices ( 1. 06∶1. 04, t =- 2. 61, P =0. 023 ), but inferior to I M RT for homogeneity indices ( 0. 81 : 0. 75, t =- 2. 34, P =0.037)).Compared with IMRT, BMS-IMRT reduced the V5, V10, V20, V30, V40 of bone marrow (97.09％∶98.72％, t=-2.34, P=0.037;92.38％∶96.46％, t=-2.41, P=0.033;83.36％∶91.70％, t=-3. 18, P=0.008;51.47％∶69.65％, t=-4.92, P=0.000;36.34％∶49.57％, t=-2.66, P =0. 021 ). The doses received by small bowel and bladder were similar between BMS-IMRT and IMRT, except that the V20 of bladder was lower in BMS-IMRT (77. 32％∶92. 39％, t =-3.52, P=0. 004). Conclusions BMS-IMRT reduces low dose volume of bone marrow without increasing dose to other risk organs.BMS-IMRT might reduce acute hematologic toxicity and increase the feasibility of postoperative concurrent chemoradiotherapy in stage Ⅱ -Ⅲ rectal cancer.

Objective To analyze the risk factors for the external hydrocephalus (EH) after traumatic brain injury in the infants. Methods The clinical data of 178 cases of infants and young children with traumatic brain injury from March 2004 to April 2009 were retrospectively analyzed. Univariate and logistic regression analysis were performed to identify the clinical risk factors for EH after traumatic brain injury. Results By univariate regression analysis, age, GCS score after trauma, coma duration, brain contusion, subarachnoid hemorrhage and epilepsy were risk factors for external hydrocephalus in the infants and young children (Ps < 0.05). Gender,traumatic wet lung and usage of mannitol were less relevant to EH (Ps >0. 05). The incidence of EH after traumatic brain injury in the infants and young children was 14% (25/178 ). Age ( OR = 0.5743 ) , coma duration after trauma (OR =3.0628) ,subarachnoid hemorrhage (OR =3.7093),brain contusion(OR = 4.7892) and post-trauma epilepsy (OR =2. 9976) were risk factors for EH (Ps < 0. 05). Conclusion Younger than 2 years old, low GCS score, long coma duration, brain contusion, subarachnoid hemorrhage and epilepsy would increase the risk of EH after traumatic brain injury in the infants and young children. This study provides information for the prevention of EH after traumatic brain injury in the infants and young children.

Objective To isolate bioactive compound of enhancing fibrinolysis from secondary metabolites of marine microorganism.Methods The separation of microorganism from seawater samples,screening of producing fibrinolytic compound's strain,selection of the active strain's optimum fermentation medium and refining of active compound were done by the method of selective cultivation,measuring of compound's fibrinolytic activity and semipreparative HPLC,respectively.Results Nine hundred and thirty-six single strains from 31 samples were collected 100 meters off the coast,and cultures of the fungus(FG216) contained enhancing fibrinolytic compound.Compounds from modified Czapek medium as the fermentation medium of FG216 showed significant fibrinolytic effect.Finally,active fraction were isolated and refined from cultures of FG216.Conclusion In this paper,active compound of enhancing fibrinolysis were gained from secondary metabolites of isolated single microorganism from seawater.

Objective To observe the changes of serum ferritin (SF)in neonates with mechanical ventilation and its clinical significance in the ventilation-induced lung injury (VILI). Methods The study was carried out in 36 neonates with mechanical ventilation and 31 neonates without mechanical ventilation in neonate intensive care unit(NICU).SF level in venous blood was measured on 1,24,48,72 hours after mechanical ventilation and 24 hours after mechanical ventilation removal by radioimmunoassay (RIA ).SF level of non-mechanical ventilation group were determined at the same time. Results SF levels in mechanical ventilation groups were significantly higher than those of control group (P

Biomarkers ; blood ; Child ; Child, Preschool ; Critical Illness ; Early Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Gastrointestinal Diseases ; blood ; diagnosis ; etiology ; Humans ; Infant ; Male ; Peptides ; blood ; Severity of Illness Index ; Trefoil Factor-2

Background One of the difficulties in identifying early glaucoma is the variability of perimetry performance.For this reason,a field defect have to be reproduced more than two consecutive examinations before it is confirmed.The relationship between visual field sensitivity and retinal nerve fiber layer (RNFL) thickness may give us a more efficient and objective assessment to the early diagnosis of glaucoma.Objective This diagnostic test was to evaluate the application of functional-structural relationship between automated perimetry and RNFL in the early diagnosis of open-angle glaucoma.Methods Sixty-four eyes of 64 patients with early open-angle glaucoma and 50 eyes of 50 normal volunteers with the matched age and gender were enrolled in Xiangya Hospital January to June 2007.Visual field examinations,including standard automated perimetry (SAP),short wave automated perimetry (SWAP),and imaging of scanning laser polarimetry with variable corneal compensation(GDxVCC),were performed on the subjects with the informed consent.The sensitivity and specificity of the joint or single measurement of GDxVCC,SAP and SWAP under the local diagnostic criteria,and overall diagnostic criteria were calculated.Results According to the overall diagnostic criteria,the sensitivity of GDxVCC,SWAP and SAP were 70％,63％,61％ respectively,and the specificity were 84％,80％,78％,respectively.According to the local diagnostic criteria,the sensitivity of GDxVCC,SWAP and SAP were 78％,86％,78％,respectively,and the specificity were 54％,40％,50％,respectively.With the local diagnostic criteria,the sensitivity and specificity of serial test of GDxVCC,SWAP and SAP were 86％ and 90％ respectively,and the positive likelihood ratio and negative likelihood ratio were 8.59 and O.16,respectively.Conclusions The functional-structural relationship between automated perimetry and RNFL which can provide valuable individual diagnostic information for patients,and serial test of GDxVCC,SWAP and SAP can reduce the false positive rate and improve the diagnostic performance significantly.

Objective To confirm the association between the“Tip-Apex Distance (TAD)”and cut-out of the lag screw from the femoral head.and to analyze other factors leading to the cut-out.Methods The complete radiographic and clinical data of 106 patients with femoral intertrochanteric fractures were available for this study. They were 65 men and 41 women,with an average age of 52.4 years (range,20 to 83 years).According to Evans classification.19 cases belonged to typeⅡ.25 to typeⅢ,32 to typeⅣ,29 to typeⅤ,and one to type R.The bone quality was classified by Singh rating system:44 cases were rated as typeⅥ.34 as typeⅤ,23 as typeⅣand five as typeⅢ.They were treated with open reduction and fixation with 135?dynamic hip screw (DHS).According to the finding of Baumgaertner that“TAD”beyond 25 mm would grcatly increase the risk of cut-out,the patients could be divided into two groups:59 cases with“TAD”less than 25 mm and 47 greater than 25 mm.Results The mean duration of follow-ups was 14.45 months (range,4.5 to 28.0 months).Of the 15 cases whose“TAD”was more than 30 mm,one had the cut-out.Of the seven cases whose“TAD”was more than 40 mm,two had the cut-out (P=0.000). The average age of the three patients was 78.7 years (range:75 to 83 years) and 27.1 years older than that of the 103 patients whose fracture healed (P=0.000).They belonged to the unstable intertrochanteric fracture of the femur (two to Evans type V and one to type R).The reduction was assessed as excellent in 43 cases,good in 47 cases,fair in nine cases (of whom one had the cut-out),poor in seven cases (of whom two had the cut-out). Conclusions The cut-out of the lag screw from the femoral head can be caused by age,fracture type and stability of reduction and“TAD”.The greater the“TAD”value,the greater possibility of cut-out.