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Current research status of non-antibiotic antibacterial therapies

Journal of Clinical Pediatrics.2015;(6):592-596. doi:10.3969/j.issn.1000-3606.2015.06.023

With the inappropriate use of antibiotics, the situation of bacterial resistance is more and more severe. The emergence of multidrug-resistant (MDR) bacteria has made it difficult to cure the infections in clinical. For treatment the infections caused by MDR and reducucton of the generation of resistant bacteria, researchers are actively studying on the non-antibiotic substances for antibacterial activity. In this paper, the advances in those with conifrmed effects such as phage therapy, metal/chelation therapy, immunization therapy, photodynamic therapy, and nitric oxide (NO)-based therapies, small molecule inhibitors, antimicrobial peptides and Chinese herb were reviewed.

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Cryopyrin-associated periodic syndrome:one case report

Peiwei ZHAO ; Yan DING ; Wei YIN ; Xin YUE ; Xuelian HE

Journal of Clinical Pediatrics.2015;(6):579-582. doi:10.3969/j.issn.1000-3606.2015.06.020

Objective To investigate the clinical features and genetic basis of cryopyrin-associated periodic syndrome (CAPS). Methods The clinical manifestations, laboratory tests, and genetic tests of one case of CAPS were retrospectively analyzed. The related literatures were reviewed. Results A 7 year and eight month old male patient had recurrent fever for 7 years and his whole body was covered with patchy red rash which was itchy and faded with pressure. The limbs and joints were normal. The levels of high-sensitivity C-reactive protein, erythrocyte sedimentation rate, rheumatoid factors were increased. The patient had fundus arteriosclerosis, double conjunctival lesions and nerve deafness on both sides. There was no mutation found in NLRP3 gene coding region, but a heterozygous mutation (-2667G>T) had been found in 5 ' untranslated region. Compared with normal control, the mRNA level of NLRP3 increased 4.2 times and the expressions of IL-1βand IL-18 gene increased 2.2 (P=0.002) and 1.2 times (P>0.05). Conclusions The clinical features of CAPS can be recurrent fever, rash, and joint involved. The oph-thalmologic abnormalities and varying degrees of deafness may occur during the progression. The test of NLRP3 gene may help diagnosis.

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Kozlowski type spondylometaphyseal dysplasia:one case report

Lei SUO ; Zuo LUAN

Journal of Clinical Pediatrics.2015;(6):576-578. doi:10.3969/j.issn.1000-3606.2015.06.019

Objective To investigate the clinical characteristics and diagnostics of Kozlowski type spondylometaphyseal dysplasia (SMDK). Methods The clinical features, laboratory tests and genetic testing of one SMDK case were analyzed. Re-sults A eight-year-old male patient had more than 6 years course of disease. The clinical manifestations were stubby limbs, ifn-gers and toes, varus deformity, knee valgus deformity, scoliosis and lordosis and severe metaphyseal changes. The heterozygous mutations were detected in TRPV4 and NXX3-2 genes. Conclusions Typical clinical features combined with genetic diagnosis facilitate early detection and accurate diagnosis of SMDK.

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Clinical and prognostic analysis of 27 pediatric patients with bronchiectasis caused by Mycoplasma pneumonia and Chlamydia pneumonia

Li ZHANG ; Tao ZHOU ; Simao FU ; Yuling LIU

Journal of Clinical Pediatrics.2015;(6):567-570. doi:10.3969/j.issn.1000-3606.2015.06.016

Objective To explore the clinical characteristics, treatment and prognosis of pediatric patients with bronchiec-tasis caused by Mycoplasma pneumonia (MP) and Chlamydia pneumonia (CP). Methods The clinical data from 27 MP and CP pneumonia pediatric patients with bronchiectasis suggested by the high resolution CT were retrospectively analyzed. Results The morbility rate of bronchiectasis caused by MP and CP pneumonia is 0.56%. The mean age of these patients was 75.4 ± 52.7 months. Among them, 27 cases (100%) had cough, 19 cases (70.4%) had fever, 10 cases (37%) had respiratory distress and 20 cases had lung auscultation. Sixteen cases were MP-IgM positive, 5 cases (18.5%) were CP-IgM positive and 6 cases (22.2%) were positive of both. Eight cases were combined with other pathogens infections, in which 6 cases were bacterial infections. The imaging ifndings showed diffuse bronchiectasis in 13 cases (48.1%) and local bronchiectasis in14 cases (51.9%). The bronchoscopy found endothelium in-lfammation, mucosal swelling, partial erosion and follicular hyperplasia in 16 cases (66.7%), the formation of short column sputum bolt in 5 cases (20.8%), in which 1 case had plastic bronchitis. All patients were treated with macrolides antibiotics, 10 cases (37%) combined with methylprednisolone, 3 cases (11.1%) combined with immunoglobulin and 20 cases (74%) combined with other anti-biotics. The average length of hospitalization was 12±4.3 days. The bronchiectasis sign disappeared within 4 months in 23 cases (92%). Two cases (8%) still had bronchiectasis after 9 to 15 months, with the recurrent pneumonia. Conclusions MP and CP pneumonia can lead to acute bronchiectasis. Most of patients are recoverable with effective treatment.

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Clinical characteristics and treatment of infective endocarditis in children

Lijuan LUO ; Qing CAO ; Yunfang ZHOU ; Shuhua PAN ; Xihua WANG

Journal of Clinical Pediatrics.2015;(6):558-561. doi:10.3969/j.issn.1000-3606.2015.06.014

Objective To study the clinical characteristics, treatment and prognosis of infective endocarditis in children. Methords Clinical data from 83 patients of infective endocarditis admitted from 1998 to 2012 were retrospectively analyzed. Results In a total of 83 patients, there were 53 males and 30 females, and the average age was 6.8±4.6 years. The main clinical characteristics were fever (77.1%) and mild to moderate anemia (71.1%). The C-reaction protein (67.5%), erythrocyte sedimen-tation rate (60.2%), and white blood cell (47.0%) were elevated. Twenty (24.1%) patients had embolism. Blood culture was pos-itive in 56 (67.5%) cases with bacteria mainly being Gram-positive and Streptococcus and Staphylococcus accounted for 89.3%. Vancomycin and other sensitive antibiotics were effective. Neoplasm was detected in 68 cases (82%) by transthoracic echocar-diograerphy. Fifty-ifve (66.2%) patients underwent cardio surgery. Seven patients (8.4%) died. Conclusion In recent years, the distribution of pathogenic bacteria in infective endocarditis had changed. Streptococcus mitis and Staphylococcus aureus has become a major pathogens and need to be treated by vancomycin and other sensitive antibiotics. The detection rate of neoplasm is higher by echocardiography.

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Monitoring and analysis of birth defects in 73498 infants

Min YANG ; Jimei WANG ; Beiqian QIAN ; Jiale DAI ; Xiaolei ZHUANG ; Aiju CHEN ; Yongqin MENG

Journal of Clinical Pediatrics.2015;(6):553-557. doi:10.3969/j.issn.1000-3606.2015.06.013

Objective To understand the occurrence and the related risk factors of birth defects. Methods Descriptive analysis was conducted on birth detect surveillance in the infants during January 2008 to June 2014. Results A total of 777 cases of birth defect were detected in 73498 infants, and the incidence of birth defect was 1.06%. The 5 most common birth de-fects were congenital heart disease, multi ifnger (toe), hypospadias, cleft lip, and palate and deformity of external ear. Compared infants born with no birth defects, male, preterm, low birth weight, twin and multiple births and resident were statistically higher in infants with birth defects (P<0.05). The major risk factors of birth defects were the medication history, spontaneous abortion, gestational diabetes mellitus, and family history. Conclusions The incidence of birth defect can be reduced by providing good health care during pre-marriage and pregnant so as to decrease the occurrence of premature infants, twins and multiple births, and low birth weight as well as improving prenatal diagnosis and intensifying birth defects surveillance.

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Risk and protective factors of periventricular-intraventricular hemorrhage in preterm infants

Yinquan XU ; Ya DONG ; Zhenlang LIN

Journal of Clinical Pediatrics.2015;(6):548-552. doi:10.3969/j.issn.1000-3606.2015.06.012

Objective To identify risk and protective factors of the periventricular-intraventricular hemorrhage (PV-IVH) in preterm infants. Methods By 1:1 case-control study, prenatal and perinatal data were collected and analyzed between preterm infants with PV-IVH and control group from January 2012 to October 2014. The risk and protective factors for the PV-IVH were identiifed by univariate analysis and multivariate conditional logistic regression analysis. Results There were one hundred and thirty-two preterm infants diagnosed of PV-IVH, in which, among whom 6 preterm infants could not be matched to the control infants in the protocol. Finally, 126 pairs of infants were enrolled in the study. There were no differences between two groups in gestational age and birth weight (all P>0.05). Multivariate conditional logistic regression analysis found that BE<-5 mmol/L in the initial blood gas analysis after birth (OR=1.986, 95.0%CI:1.039-3.796), mechanical ventilation (OR=2.913, 95%CI:1.390-6.101), weight gain≤10 g/d in the second week (OR=2.303, 95%CI:1.164-4.558) were risk factors, while number of previous pregnancies≥1 times (OR=0.426, 95%CI:0.229-0.792) was a protective factor for PV-IVH. Conclusions The risk factors of PV-IVH in preterm infants include the lower BE value in the initial blood gas analysis, required mechanical ventilation, and less weight gain in the second week.

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The variation of insulin like growth factor-I and glucose and correlation in children with sepsis

Yang TIAN ; Cuiping ZHU ; Jie HONG ; Yiling HUANG ; Jianning MAI

Journal of Clinical Pediatrics.2015;(6):543-547. doi:10.3969/j.issn.1000-3606.2015.06.011

Objective To explore the variation of insulin like growth factor-I (IGF-I) and glucose and correlation in children with sepsis. Methods Forty-two children with sepsis in pediatric intense care unit were enrolled from January 2009 to January 2010. In the morning (2nd morning) after admission, the blood glucose, serum IGF-I, cortisol, insulin, IL-6, and IGF-binding protein-I (IGFBP-1) were detected. In the 3rd and 5th morning, the serum IGF-1 was detected again. According to the blood glucose level of the 2nd morning, the children with sepsis were divided into hyperglycemia group and normal group. Meanwhile, 60 healthy children were served as control group. The data had been compared among three groups. Results In the 2nd morning, the levels of blood glucose, serum IGF-I, cortisol, insulin, and IL-6 were signiifcantly different among three groups (all P<0.05), but the serum IGFBP-I was not signiifcantly different (P>0.05). Compared with control group, the sepsis children with hyperglycemia and with normal blood glucose all had signiifcantly higher serum levels of cortisol and IL-6, and signiifcantly lower serum level of IGF-I. In the 2nd, 3rd, and 5th morning, the serum levels of IGF-1 were not signiifcantly changed with time in sepsis children with hyperglycemia and with normal blood glucose (all P>0.05). Meanwhile, there were no signiifcant differ-ences in the serum levels of IGF-1 between sepsis children with hyperglycemia and with normal blood glucose in the 2nd, 3rd, and 5th morning (all P>0.05). In children with sepsis, the blood glucose and serum IGF-1 was not correlated in the next morning (r=0.152, P=0.267). Conclusions The serum level of IGF-I decreased but maintain stable in children with sepsis. The change of blood glucose may be not related with IGF-I.

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Changes of surfactant protein-D in serum and cerebrospinal fluid in children with viral encephalitis

Wenjuan WANG ; Xueyu WANG

Journal of Clinical Pediatrics.2015;(6):535-538. doi:10.3969/j.issn.1000-3606.2015.06.009

Objective To investigate the changes of the pulmonary surfactant protein-D (SP-D) in serum and cerebrospi-nal lfuid in children with viral encephalitis (VE). Methods The levels of SP-D in serum and cerebrospinal lfuid were detected by a double-antibody sandwich enzyme-linked immunosorbent assay and compared in thirty children with VE in acute and con-valescent phases and in 12 children without VE. Results The levels of SP-D in serum and cerebrospinal lfuid between groups of VE acute phase and convalescent phase and no VE were statistically signiifcant (F=103.58,118.15, all P<0.01). The levels of SP-D in serum and cerebrospinal lfuid in children with VE in acute phase and in convalescent phase were signiifcantly lower than children without VE (P<0.01). The levels of SP-D in serum and cerebrospinal lfuid in children with VE in convalescent phase were all signiifcantly higher than those in acute phase (P<0.01). In children with VE, the level of SP-D in cerebrospinal lfuid was weakly correlated negatively with the count of nucleated cells. Conclusions SP-D might be involved in the pathogenesis in VE. The detection of SP-D in serum and cerebrospinal lfuid has a certain value for diagnosis of VE.

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Lowe syndrome with novel OCRL mutations in Chinese children:report of two cases

Lina JI ; Chaoying CHEN ; Huarong LI ; Peiwei DU

Journal of Clinical Pediatrics.2015;(6):531-534. doi:10.3969/j.issn.1000-3606.2015.06.008

Objective To study the clinical and genetic features of Lowe syndrome. Methods The clinical data and test results of OCRL gene from two children with Lowe syndrome were analyzed. The related literatures were reviewed. Re-sults Two male patients all presented with low molecular proteinuria, hypercalciuria, rickets and nephrolithiasis. Patient 2 had renal tubular acidosis, glycosuria and cryptochism. Patient 1 was found to have abnormal vision and congenital cataract soon after birth and treated surgically. Patient 1 also had psychomotor retardation and the cranial magnetic resonance ima-ging (MRI) showed agenesis of the corpus callosum. Patient 2 did not have obviously extra-renal symptoms, but was found to have mild cataract by a meticulous ophthalmological examination. MRI showed cerebral hypoplasia and myelination delay and mental retardation was gradually appeared during follow-up. Two OCRL gene mutations were detected. A splice site mutation NG_008638.1:g.46846-46848delTAA/insC was found in patient 1 and a frame shift mutation NM_000276.3:c.321delC in exon 5 was found in patient 2. Both mutations were not reported previously. Conclusions The diagnosis of Lowe syndrome is mainly by clinical manifestations and test of OCRL gene. Lowe syndrome needs to be included in the differential diagnosis of a patient with congenital cataract and renal tubulopathy. Two novel mutations in the OCRL gene were identiifed.

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