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Common cause of cardiogenic syncope and emergency treatment

Chinese Pediatric Emergency Medicine.2010;17(6):492-494. doi:10.3760/cma.j.issn.1673-4912.2010.06.004

Cardiogenic syncope is the relatively common type of syncope in children. The state of illness is more serious at the onset,the prognosis of partial patients is very dangerous,even it can cause cardiac sudden death, so clinical doctors pay close attention to cardiogenic syncope. The common pathogeny of cardiogenic syncope in children includes serious arrhythmia, obstruction of the outflow tract of heart, restricted diastole of heart or weak systole of heart. Before the particular cause of disease is determined,some examinations and laboratory tests should be made. In this article, the writer introduces detailed methods of the emergent treatment.

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The immune function influence of the CD4 + T helper cell after the treatment of continuous blood purification in a porcine model with multiple organ dysfunction syndrome

Jian ZHANG ; Li ZHAO ; Juan QIAN ; Yanwen YANG ; Hong REN ; Xiaowei HU ; Ying WANG ; Biru LI

Chinese Pediatric Emergency Medicine.2010;17(6):522-525. doi:10.3760/cma.j.issn.1673-4912.2010.06.017

Objective To investigate the levels of Th1 and Th2 cell in the peripheral and the cytokines (IFN-γ,TNF-α,IL-12,IL-10,IL-4) in the culture medium at different time in the porcine model with multiple organ dysfunction syndrome(MODS) after continuous blood purification(CBP). Methods Twenty-four young porcines were given intravenous infusion of endotoxin to induce MODS, then were randomly divided into 2 groups:CBP group(n = 12) and MODS group without CBP(n = 12). Continuous venovenous hemodiafiltration (CVVHDF) was the main mode for CBP. At baseline, onset of MODS, and 2 h,4 h,6 h after treatment of CVVHDF,we picked the blood respectively to separate the T helper cell using the beads,detected the Th1 and Th2 cell by FACS and detected the cytokines (IFN-γ,TNF-α,IL-12,IL-10,IL-4) in the culture medium by ELISA. Results The MODS group showed a obvious rise in TNF-α,the drop tendency in IL-12,IFN-γ,IL-10,Th1/Th2 ratio, and no significant change in IL-4. After the treatment, the CBP group showed the drop in TNF-α and IL-4;and increase in IL-12,IFN-γ,IL-10 and Th1/Th2 ratio. Conclusion CBP helps to dear immune function,and restore the balance of Th1/Th2 in porcine MODS model.

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Application of inhaled nitric oxide in the early period after Fontan operation

Zhien ZHOU ; Xiaosheng SUN ; Shanxiu YAN ; Jun FENG ; Lunde HE ; Daozhuang WANG ; Shuozeng DENG

Chinese Pediatric Emergency Medicine.2010;17(6):519-521. doi:10.3760/cma.j.issn.1673-4912.2010.06.015

Objective To evaluate the effects of inhaled nitric oxide(INO) in the early period after Fontan operation. Methods Twenty children receiving INO [(10 ～ 25) × 10 -6] after fight heart bypass for congenital heart disease were evaluated. The changes of hemodynamic and respiratory parameters were observed at two different intervals. The levels of methemoglobin (MetHb)and nitrogen dioxide(NO2)were monitored. Results In INO therapy group,CVP decreased from (20.8±4.8) mm Hg to (14.3±1.8) mm Hg,TPG decreased from (16.3 ±3.0) mm Hg to (8.8±2. 1) mm Hg,PaO2/FiO2 increased from (70.3±16.9) mm Hg to (120.5 ±14.0) mm Hg,and arterial oxygen saturation increased from 0. 78 ±0. 14 to 0. 91 ±0. 09 ,blood lactic acid level decreased from (3.98 ± 0. 86) mmol/L to (1.29 ± 1.60) mmol/L. No toxic side effect was observed. Conclusion INO has no significant long-term effect on patients after Fontan operation, but it can improve respiratory function, and reduce the incidence of low cardiac output syndrome and high cava pressure caused by reactive elevation of pulmonary vascular resistance in the early postoperative period after Fontan operation.

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Pancreatic enzymes in evaluation of pancreatic damage in critically ill children

Fang LIU

Chinese Pediatric Emergency Medicine.2010;17(6):564-567. doi:10.3760/cma.j.issn.1673-4912.2010.06.037

Critically ill children are often complicated with multiple organ damage. When the pancreas was involved, kinds of pancreatic enzymes would elevate, which suggested the high risk complication of pancreatic damage was really existed. The changes of pancreatic enzymes under different critical conditions such as shock, surgery, injury, etc. were reviewed, as well as the clinical significance of different pancreatic enzymes, so as to provide evidence for acknowledge the early biological signs in early phase of critically ill children with pancreatic damage,to decrease the mortality of complications and to improve the prognosis of critically ill children.

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Diagnosis and treatment of vasovagal syncope in children

Cheng WANG ; Lijia WU

Chinese Pediatric Emergency Medicine.2010;17(6):488-491. doi:10.3760/cma.j.issn.1673-4912.2010.06.003

Eighty percent of unexplained syncope children can be diagnosed of vasovagal syncope (VVS). Positive head-up tilt test (HUTT) leads to the diagnosis of VVS. However,organical diseases which can cause syncope should be excluded before HUTT was taken. The therapies of VVS include nonpharmacological therapy (health education, head-up training, water and salt supplement), pharmacological therapy (β-blockers, α-receptor agonists, fludrocortisone, selective serotonin reuptake inhibitors, angiotension converting enzyme inhibitors, et al.) and pace maker.

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Clinical analysis of systemic lupus erythematosus in 13 children with the first symptom of thrombocytopenic purpura

Xingang ZHANG ; Xiaofei WANG ; Ning ZHANG ; Xiaoli ZHANG ; Li JIANG ; Hong WANG

Chinese Pediatric Emergency Medicine.2010;17(6):513-515. doi:10.3760/cma.j.issn.1673-4912.2010.06.012

Objective To review the diagnosis and treatment of children with systemic lupus erythematosus. Methods 13 children of systemic lupus erythematosus with acute immune thrombocytopenic purpura as the first symptom were analyzed retrospectively, who were admitted from Jan 2004 to Jun 2009 in our hospital. Results Thirteen cases were diagnosed as acute immune thrombocytopenie purpura according to clinical manifestations and bone marrow examination results. Hormones and intravenous gamma globulin treatment were ineffective. The immune parameters and other clinical manifestations were monitored. According to the characteristics of blood system change and the response to hormone, other immunosuppressive agents such as cyclosporine A ,mycophenolate mofetil and cyclophosphamide were adminitrated. Thirteen children were diagnosed finally as systemic lupus erythematosus at 2 to 24 months from onset. Other immunosuppressive treatment was effective. Conclusion For children with thrombocytopenia, especially adolescent girls, we should pay attention to dynamic monitoring of anti-nuclear antibodies and other immunological parameters,for fear of the possibility of systemic lupus erythematosus.

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Effects of perinatal and postnatal cytomegalovirus infection on infantile physical and neuro-psychological development

Zhaoxue MENG ; Huiying CUI ; Huihong ZHU ; Boxin ZHANG ; Hua HUANG ; Jingyu DONG ; Nanfeng LIU ; Haiyan JIANG ; Fangsheng XU

Chinese Pediatric Emergency Medicine.2010;17(6):508-510. doi:10.3760/cma.j.issn.1673-4912.2010.06.010

Objective To study the effects of perinatal and postnatal cytomegalovirus(CMV) infection on infantile physical development and nerves mental growth. Methods We observed forty-eight cases of perinatal and postnatal CMV infection infants and twenty-two cases of non-CMV infected infants. We compared the physical development between two groups at birth ,3 months and 1 year of age, and evaluated development quotient (DQ) at 1 year of age. Results There were no significant differences of baby length,weight, head circumference between two groups at birth and 3 months (P > 0.05). The averages of baby length,weight,and head circumference were all in the normal range,which showed no significant differences between two groups(P > 0. 05). There were no significant differences in DQ of rough movement,accurate movement, adaptability, language and sociality ability between two groups at 1 year of age (P > 0.05). The averages of total DQ were in the normal range, which showed no significant difference between two groups as well (P > 0. 05). According to the evaluation hierarchies, DQ values of two groups were mostly in normal level range, and there also was no significant difference(x2 = 1. 026, P > 0. 05). Conclusion The perinatal and postnatal cytomegalovirus(CMV) infection has no significant adverse effects on infantile physical development and neuro-psychological development.

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Association of IL-10-592A/C polymorphism with respiratory syncytial virus bronchiolitis

Yu WANG ; Wenxian CAI ; Fenghai NIU

Chinese Pediatric Emergency Medicine.2010;17(6):511-512. doi:10.3760/cma.j.issn.1673-4912.2010.06.011

Objective To explore the association of IL-10-592A/C polymorphism with the susceptibility to respiratory syncytial virus(RSV) bronchiolitis and disease severity,and to explore the impact of IL10-592A/C polymorphism upon total serum IL-10 levels in children with RSV bronchiolitis. Methods One hundred children (patients group) admitted to hospital with RSV bronchiolitis and 100 healthy children (control group) were recruited. PCR restriction length fragment polymorphism assay was used to detect the single nucleotide polymorphisms of IL-10-592A/C. Total serum IL-10 levels in patients group were assayed with ELISA. Results The genotype frequency of IL-10-592A/C were AA 44% ,AC 38% ,CC 18% in patients group ,and AA 41% ,AC 42% ,CC 17% in the control group,it showed no significant difference between two groups (χ2= 0. 33, P > 0. 05) . The frequency of each allele were A 63%, C 37 % in patient group, and A 64% ,C 36% in the control group,there was no significant difference in allele frequency between two groups (χ2=0. 43 ,P >0. 05) . There was no significant difference in total serum IL-10 levels between different genotype of IL-10-592A/C (F = 0. 87, P > 0. 05) . The differences in genotype frequency of IL-10-592A/C were not significant between mild and moderate to severe cases (χ2= 2. 67, P > 0. 05) . Conclusion IL-10-592A/C gene polymorphisms do not correlated with RSV bronchiolitis.

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The exploration of pediatric emergency medical mode in second class general hospitals

Hua WANG ; Yanjie CHEN ; Dinghua TANG

Chinese Pediatric Emergency Medicine.2010;17(6):516-518. doi:10.3760/cma.j.issn.1673-4912.2010.06.014

Objective To explore the pediatric emergency medical mode in critical ill children by pediatrics specialty and nurses,using equipments of ICU for adults in second class general hospital. Methods We retrospectively analyzed the effect of establishing the pediatric observation unit in the adult observationdistrict and the prognosis and disease spectrum of pediatric critical patients in our emergency ICU in the past five years. Results 5 076 pediatric patients had been admitted to the emergency observation unit accounting for 3.40% of outpatient yearly. There were 464 critically ill children,accounting for 9. 14% of children into the observation unit,251 cases (54. 09%) were transported to other hospitals,35 cases (7.54%) were admitted to emergency ICU due to transport high-risk, 14 cases required ventilator support. The disease spectrum based mainly on childhood accident,including trauma,poisoning and drowning,etc. The other major diseases were severe infection and fulminant myocarditis. After the treatment such as stopping bleeding, respiratory supporting ,correcting shock, and maintaining the function of important organs,77. 14 % were improved or recovered. The survival rate of children with mechanical ventilation was > 85%. Conclusion In our country,the pediatric emergency medical service system is inadequate. The critical illness treatment model of using the advantages of equipments and nurse' s team of adult ICU in second class general hospital ,combining with pediatrician trained in PICU is feasible and consistents with our national conditions.

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Clinical application of fluorescent probe PCR for detection of mycoplasma pneumoniae

Xiaohua HAN ; Shuxiu LI ; Shuqin LI ; Ning CHEN ; Kuixiu HE ; Hong TANG ; Sukun LU ; Haitao LU

Chinese Pediatric Emergency Medicine.2010;17(6):505-507. doi:10.3760/cma.j.issn.1673-4912.2010.06.009

Objective To explore the clinical application of FP-PCR method to detect MP-DNA.Methods Five hundred and sixty-three children suspected of MP infection were enrolled in experimental group. FP-PCR was adopted to detect MP-DNA. MP-DNA was re-detected later in 60 children. At the same time,MP-Ab (MP antibody) was detected by means of particle agglutination. MP-Ab was re-detected one or two weeks later. Also 20 healthy children were selected as the control group. Results The positive rate of MP-DNA and MP-Ab were 34. 99% and 35.52% respectively,which showed no significant difference (x2 =0. 31, P > 0. 05). The coincidence of the two methods was 97. 69%. But the positive rate of MP-DNA was significantly higher than that of MP-Ab in the early stage(30. 48% vs 10. 16%) (x2 = 74. 46, P < 0. 05).The sensitivity and specificity of FP-PCR were 96. 00% and 98.62% respectively. The result of reviewed MP-DNA was consistent with the clinical diagnosis. Conclusion FP-PCR method is very sensitive, convenient and stable. It is fit for the clinical application ,especially the diagnosis of early MP infection. It helps to identify those who had been infected with MP before.

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