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Clinical application of atomoxetine in children with attention deficit hyperactivity disorder

Journal of Clinical Pediatrics.2009;(11):1093-1094,1100. doi:10.3969/j.issn.1000-3606.2009.11.025

Atomoxetine as a nonstimulant medicine was approved by the Chinese Food an Drug Administration and provide a new selection of treatment drugs for attention deficit hyperactivity disorder (ADHD). Tomoxetine is a noradrenaline transmitter reuptake inhibitor which can selectively inhibit synapsis noradrenaline transport protein, strengthen noradrenaline's resupination effect, and increase noradrenaline's activity released by synaptic cleft to improve the symptoms of the ADHD patients. Compared with methylphenidate, atomoxetine does not affect the concentration of the neurotransmitter dopamine and does not induce or increase the Tourettes' syndrome, therefore atomoxetine is more suitable to treat ADHD together with Tourettes syndrome. In this article the treatment of atomoxetine for ADHD, including the indications, dosage as well as adverse reactions and efficacy assessment are reviewed.

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Effects of nerve growth factor on the neural cells and Egr-1 gene expression in the brain of childhood intractable epileptics

Qiong FANG ; Yanhui CHEN ; Pengfan YANG ; Min LU

Journal of Clinical Pediatrics.2009;(11):1019-1022,1035. doi:10.3969/j.issn.1000-3606.2009.11.005

Objective To investigate the effect of nerve growth factor (NGF) on the neural cells and expression of early growth response gene-1 (Egr-1 gene) in the hippocampus discharge zone of childhood intractable epileptics. Methods Acutely dissociated cell suspensions of childhood hippocampus discharge zone with non specific pathological changes (n = 16) were exposed to NGF group and control group respectively. There were three subgroups exposed to NGF at the levels of 12.5, 50, 100 ng/ml in NGF group. After 4 hr culturing, the astrocytes and neurons were lablled by Bb immunostain with the specific markers such as GFAP and MAP2. The total number of neural cells was counted under inversion fluorescence microscope and the Egr-1mRNA expression was detected by semiquantitative RT-PCR analysis. Results There were significant differences of the numbers of neural cells survived in hippoeampus region between the NGF group and the non-added NGF group (P < 0.01). Among the different levels of NGF 12.5, 50, 100 ng/ml, the number of the total cultural neurons and GFAP(+) astrocytes, MAP_2(+) neurons were increased with ascending levels of NGF (P < 0.05). At the same time, the expression of Egr-1mRNA (A_(Egr-1)/A_(β-actin)) in the NGF groups was also increased (P < 0.01). There was positive correlation between the number of the survivable neural cells and Egr-1mRNA quantity (r = 0.780, P < 0.01) among the three NGF groups. Conclusions NGF can protect the neural cells of epileptic discharge zone by promoting the expression of Egr-1 gene.

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Treatment of intractable incessant tachycardia in children with Amiodarone

Yun LI ; Aiqing ZHOU ; Jianping YANG ; Min ZHU ; Haiyan ZHANG

Journal of Clinical Pediatrics.2009;(11):1083-1084,1097. doi:10.3969/j.issn.1000-3606.2009.11.022

Objective To improve the understanding of Amiodarone in the treatment of intractable incessant tachycardia in children. MethodsData of 80 patients with intractable incessant tachycardia treated by Amiodarone were summarized. Among them 52 were male,38 were female,and average age was 2.5 years old. ResultsAmiodarone reduced heart rate effectively, with about 90% effective. Simultaneously, it could convert tachycardia into sinus rhythm and succeeded 67% in atrial tachycardia, 92% in paroxysmal supraventricular tachycardia,89% in junctional ectopic tachycardia, 56% in ventricular tachycardia respectively. Use of small dosage of β-receptor blocker together with Amiodarone showed synergy. Hypotension and bradycardia are the main side effects. ConclusionsToo rapid and sustained tachycardia can lead, to hemodynamic disorders and cause heart failure, it requires urgent and adequate treatment. Amiodarone can be used to treat different kinds of intractable incessant tachycardia, and is safe and effective in patients with relatively stable hemodynamis.

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To improve the quality of life of children with epilepsy is the ultimate goal of treatment

Liping ZOU

Journal of Clinical Pediatrics.2009;(11):1005-1006,1013. doi:10.3969/j.issn.1000-3606.2009.11.002

It is the trend worthing a close attention in the 21st century to consider the quality of life while focusing on control of epileptic seizures simultaneously during the treatment of epilepsy and related services. The impact of the epilepsy on many aspects of quality of life are caused by many factors, including the type of epilepsy, site of the epileptic loci, onset age, frequency of attack, duration and course of disease, and especially side effects of anti-epileptic drugs. In the treatment of epilepsy, choice of drugs should be made based on benefits and adverse effects, it is necessary to achieve better therapeutic effects, but also to reduce the impact of drugs on the level of intelligence in children and to promote the single-drug treatment. The purpose of the treatment of epilepsy is no longer aimed at seizure free as the end point, consideration must be given to beth the control of seizure and the improvement of the quality of life.

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The regulation of deferoxamine on HIF-1α expression after hypoxia-ischemia brain damage in neonatal rats

Lihua LI ; Xiaojuan YIN ; Mingxia SHANG ; Zhichun FENG

Journal of Clinical Pediatrics.2010;(3):220-222,250. doi:10.3969/j.issn.1000-3606.2010.03.005

Objective To study the role of deferoxamine(DFO)on regulating hypoxia-inducible factor 1α(HIF-1α)expression after hypoxia-ischemia brain damage(HIBD)in neonatal rats,to explore the therapeutic strategy for HIBD. Methods Postnatal day 10 SD rats were divided into four groups: hypoxia-ischemia(HI)group,DFO-treated group,normal saline(NS)-treated group,and sham operation group. HIBD model was established by the ligation of right common carotid artery following the inhalation of nitrogen-oxygen mixtures containing 92% nitrogen and 8% oxygen. DFO-treated group and NS-treated group were treated by intraperitoneal injection of DFO or NS respectively. The brains were collected at 4 h,8 h,and 24 h after hypoxia. HIF-1α protein expression was detected by Western blot analysis,and HIF-1α mRNA expression was detected by using RT-PCR at each time point. Results The synthetic level of HIF-1α protein increased significantly at 4 h,peaked at 8 h,and decreased at 24 h after HI in HI group,as well as NS-treated group. However,in DFO-treated group HIF-1α protein was peaked at 4 h,maintained higher level at 8 h and 24 h after HI. The level of HIF-1α protein was much higher in HI and DFO-treated groups than those in sham controls(P ＜ 0.05). The synthetic level of HIF-1α protein were higher in DFO-treated groups than those in HI groups at each time point(P ＜ 0.05). HIF-1α mRNA expression was higher in DFO-treated groups than those in HI groups at each time point. Conclusions DFO upregulate HIF-1α protein and mRNA expression in neonatal rats with HIBD. The peak of HIF-1α protein expression are also more advanced and lasted longer after DFO-treatment.

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Diagnosis and treatment of neonatal hypoglycemia

Zhiwei LIU ; Huijun CHEN

Journal of Clinical Pediatrics.2010;(3):212-214,219. doi:10.3969/j.issn.1000-3606.2010.03.003

Neonatal hypoglycemia is a common metabolic problem. The definition and clinical management of neonatal hypoglycemia remains controversial. The concerned reasons are mainly as follows:the course of a physiological decrease and recovery in the level of blood glucose is usually existed in newborn infants after birth;asymptomatic hypoglycemia(many newborn infants' blood glucose level is very low but without any clinical signs or symptoms);and the lack of the complete comprehension for the relationship between neonatal hypoglycemia and the long-term neurologic prognosis. The review describes the etiology,definition and clinical management of hypoglycemia in newborn infants.

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The clinical value of dynamic measurement of cardiac output in early shock neonates

Zhenzhu YU ; Xiaohong LIU

Journal of Clinical Pediatrics.2010;(1):21-23,46. doi:10.3969/j.issn.1000-3606.2010.01.006

Objective To dynamically measure cardiac output in shock neonates and to explore its clinical values.Methods The cardiac output and stroke volume of left ventricle in 30 shock neonates and 30 normal neonates were measured by noninvasive ultrasonic cardiac output monitor (USCOM) and the measurement was repeated in shock neonates after volume expansion and dopamine(2-4μg/(kg·min))treatment.Results The cardiac output and stroke volume of left ventricle in shock neonates ((0.36 ± 0.24) L/min,(3.5 ± 1.5) cm~3) were significantly lower than those in normal neonates ((0.49 ± 0.15) L/min,(2.7 ± 1.6) cm~3)) and however were improved significantly after volume expansion and dopamine treatment ((0.52 ± 0.28) L/min,(3.8 ± 1.8) cm~3).The urine volume was also increased significantly after treatment (P < 0.05).Conclusions Dynamic measurement of the cardiac output in early shock neonates might offer guidance on clinical fluid resuscitation.

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Dysregulation of homeostasis and therapeutic option in septic shock

Chunfeng LIU

Journal of Clinical Pediatrics.2010;(1):10-12,17. doi:10.3969/j.issn.1000-3606.2010.01.003

Septic shock may have a lasting effect on all human endocrinologic, coagulatory and metabolic regulatory circuits with the consequence of severe dysregulation of homoeostasis.Adjunctive therapeutic options like correction of metabolic acidosis, intensive insulin therapy, and modulation of coagulation by drotrecogin alfa (activated) are still controversial.However, these adjunctive therapeutic options should be selected according to the national and international guidelines.

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Biological function of IL-23

Yanchun LI ; Jirong LU

Journal of Clinical Pediatrics.2010;(3):295-296,299. doi:10.3969/j.issn.1000-3606.2010.03.027

Interleukin(IL),generated by immunocytes or non-immune cells,is a group of cell factors that holds many important biological effects. Up to now,with the rapid progress of molecular biology and cell biology technique,29 types(IL-1 ～ IL-29)of IL have been reported since its denomination in 1979. IL-23,one kind of interleukin found in 2000,is composed of p19 and p40 sub group. Recent studies showed that it has various biological functions,such as acting on T cell to make it produce various cell factors,acting on DC and MP to affect the secretion of the relevance cell factors. The biological functions of IL-23 have played an important role in various diseases. This review describes the molecular structure,biological function,and its effects on related diseases.

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Follow-up study of the development in children conceived with assisted reproductive technology

Qian ZHAO ; Hong LI ; Qingxue ZHANG

Journal of Clinical Pediatrics.2010;(3):223-225,230. doi:10.3969/j.issn.1000-3606.2010.03.006

Objective To perform a follow-up study on psychomotor development in children conceived with assisted reproductive technology. Methods A control-matched study was done including 63 infants born after assisted conception (study group)and 65 natural conception infants(control group). The pregnant women agreed to participate in the study when they were at 28 weeks of gestation and were followed-up in a predefine schedule till delivery. The regular developmental assessment was done with the CDCC Scales of Infant Development for the children of two groups till they were 24 months old. Results The mean birth weight and length were lower in the study group than those of the control group. The incidences of preterm birth,low birth weight,and NICU admission were significantly higher in the study group than those of control group. However,these differences were not significant when only singletons were compared between two groups. No statistical differences were found in the mental development index(MDI)and psychomotor development index(PDI)between two groups. Conclusions Psychomotor development of children born after assisted conception is normal at 24 months of age. Since the incidences of preterm birth,low birth weight,and multifetation are significantly higher in children born after assisted conception,their general health and development should be followed up for a longer time.

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