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Definition, diagnostic criteria and clinic classification of cerebral palsy

Xiaojie LI ; Jiulai TANG ; Bingxiang MA ; Jiong QIN ; Liping ZOU ; Jiaqin WANG

Chinese Journal of Applied Clinical Pediatrics.2014;29(19):1520-. doi:10.3760/cma.j.issn.2095-428X.2014.19.024

Base on the definition,classification and diagnostic condition of cerebral palsy published by Pediatrics Neurology Group of Chinese Medical Association in 2005 and Child Rehabilitation Committee of Chinese Rehabilitation Medical Association in 2007.Referencing foreign diagnosis and treatment guidelines for child with cerebral palsy and the current paper report,going through more than once discussion,compiled by Chinese Compiling Committee of Rehabilitation and Treatment Guidelines for Cerebral Palsy so as to guide comprehension of the definition of cerebral palsy,enhance the level of diagnosis and classification of cerebral palsy for clinic doctor and all so acting on international convention.

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Analysis of clinical predictors of intractable childhood epilepsy

Li SHI ; Lisu HUANG ; Wen'an WANG ; Xiaoqing SONG ; Dake HE ; Ling LI ;

Chinese Journal of Applied Clinical Pediatrics.2014;29(17):1321-1324. doi:10.3760/cma.j.issn.2095-428X.2014.17.011

Objective To identify clinical predictive factors in intractable childhood epilepsy,to provide some evidence for its early diagnosis.Methods Six hundred and twenty-four children with newly diagnosed epilepsy were retrospectively identified in Xinhua Hospital Affiliated to Shanghai Jiaotong University Medical School(1993-2009).The epileptic children were divided into a drug-responsive epilepsy group (n =584) and an intractable epilepsy group (n =40).Clinical data of patients were retrospectively analyzed,including the gender,age,pathogen,inducement,number of pre-treatment seizures,seizure type,seizure type change,seizure duration,family history,previous history,physical examination,brain CT and initial electroencephalogram(EEG) findings.Single factor analysis and Logistic regression analysis were made in 2 groups.Results Strong univariate associations suggested that some factors could increase the risks of intractable epilepsy:symptomatic or cryptogenic epilepsy,mental retardation,type of infantile spasm,positive neurological examination and large absolute number of pre-treatment seizures,and changes in seizure types in the course of the disease.With multiple Logistic regression,independent predictors of intractability were symptomatic or cryptogenic etiology(OR =3.61),large absolute number of pre-treatment seizures and changes in seizure types in the course of the disease(OR =4.76).Conclusions It's necessary to be wary of intractable epilepsy and to adjust therapy accordingly when seizures were uncontrollable and accompanied by one or more conditions such as symptomatic or cryptogenic epilepsy,large absolute number of pre-treatment seizures,changes in seizure types in the course of the disease.

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Surgical treatment for aortic coarctation and/or aortic hypoplasty associated with intracardiac anomalies in infants

Haijie QI ; Li GONG ; Ming'an PI ; Li WANG ; Xinghua ZHANG ; Yichu CHEN ;

Chinese Journal of Applied Clinical Pediatrics.2014;29(15):1197-1199. doi:10.3760/cma.j.issn.2095-428X.2014.15.021

Objective To summarize the experiences of surgical treatment for aortic coarctation and/or aortic hypoplasty associated with intracardiac anomalies in infants.Methods The clinical data of 51 cases with aortic coarctation and/or aortic hypoplasty hospitalized in Wuhan Children's Hospital between Jan.2010 and Jun.2013 were analyzed retrospectively.Thirty-two patients had received a expanded end-to-end anastomosis and 19 patients had got a end-to-side anastomosis.Autologous pericardial patch,bovine pericardial patch or autologous pulmonary patch was taken according to the circumstances during surgery.Results There were 2 intraoperative deaths because of serious low cardiac output syndrome,and 2 postoperative deaths,which could not take off long-term respiratory assistance after surgery in aortic one child and low cardiac output syndrome in the other.Three patients appeared trachyphonia but recovered basically after 3 months follow-up.Forty-seven patients were followed up for 2 months-3 years,among them,3 patients had significant upper to lower extremity systolic blood pressure gradient[＞20 mmHg(1 mmHg =0.133 kPa)],and a second operation was proposed recently for 1 of them,while the other 2 children were in follow-up.The other 44 patients did not appear obvious restenosis.The 47 cases of children had no neurologic symptoms.Conclusions There have to be positive diagnoses and strictly surgery indications for aortic coarctation and/or hypoplasty associated with intracardiac anomalies in infants.Selective antegrade cerebral perfusion or deep hypothemic circulatory arrest depends on the surgon's discretion.Both expanded end-to-end anastomosis and end-to-side anastomosis can achieve good operation effects.

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Syncope and epilepsy

Liqun LIU ; Yangyang XIAO ; Ding'an MAO ;

Chinese Journal of Applied Clinical Pediatrics.2015;30(1):14-17. doi:10.3760/cma.j.issn.2095-428X.2015.01.004

Syncope and epilepsy are common pediatric clinical symptoms and causes of paroxysmal loss of consciousness.They can be manifested as a sudden attack,transient and reversible loss of consciousness,easily leading to misdiagnosis in clinics.The etiology and pathogenesis of syncope and epilepsy are completely different,and the principle of treatment is also different.Therefore,in clinics,making an early diagnosis and differential diagnosis between syncope and epilepsy has an important significance to improve the treatment and the prognosis of the patients.

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Effect of autophagy and mitochondrial coenzyme Q on cardiac function of rats with acute sepsis

Shengli CHEN ; Jinda HUANG ; Qiyi ZENG ; Yu'e JIA ; Jinhua WANG ;

Chinese Journal of Applied Clinical Pediatrics.2014;29(23):1831-1835. doi:10.3760/cma.j.issn.2095-428X.2014.23.020

Objective To investigate the effects of autophagy on cardiac function and to determine whether the mitochondrial coenzyme Q (MitoQ) prevents cardiac dysfunction,mediated by autophagy,in rats with acute sepsis.Methods Forty-five Sprague Dawley (SD) rats were randomly divided into 9 groups (n =5,each group):control group,4 h lipopolysaccharide(LPS) group,6 h LPS group,12 h LPS group,4 h LPS + Wortmannin group,4 h LPS + MitoQ group,6 h LPS + MitoQ group,MitoQ group and Wortmannin group.Rats in LPS + Wortmannin group and LPS + MitoQ group were intraperitoneally given LPS(10 mg/kg) and followed by an injection of Wortmannin(2 mg/kg) and MitoQ (6.5 μmol/kg) via tail vein 1 hour later,respectively.Rats in each group were given the same amount of normal sodium in addition to different intervention drugs.The cardiac function parameters were measured by a BL-420E + biosignal collection system.Blood samples from abdominal aorta were taken at each time point,and creatine kinase MB isoenzyme (CK-MB) content was detected by using the velocity method.The content of reactive oxygen species (ROS) in isolated myocardial tissues in rats was measured by enzyme-linked immunoadsorbent assay(ELISA).The protein expression of microtubule-associated protein 1 light chain 3 (LC3) was detected by Western blot method.The pathological changes of myocardial tissue were observed by light and electronic microscopy.Results Compared with the control group,the left ventricular systolic pressure(LVSP),the rate of the rise in left ventricular pressure (± dp/dt max) were significantly decreased in 6 h LPS group,6 h LPS + MitoQ group and 4 h LPS + Wortmannin group(P ＜0.05),left ventricular end-diastolic pressure(LVEDP) was significantly increased in these 3 groups(P ＜0.05).The contents of CKMB and ROS in 6 h LPS group,6 h LPS =MitoQ group and 4 h LPS + Wortmannin group were higher than those in the control group(P ＜ 0.05).Electron microscopy showed that the number of autophagic vacuoles increased 6 h after LPS was administered,but did not increase significantly thereafter to 12 h.There was no difference at any time point in the number of autophagic vacuoles in the group given MitoQ and LPS.Immunoblotting demonstrated that the levels of LC3Ⅱ protein in the LPS 6 h group and LPS + MitoQ 6 h group were higher than those in the control group(P ＜0.05),but there was no difference between the LPS 12 h and LPS 6 h groups (P ＞ 0.05).Conclusions The mitochondria-targeted antioxidant MitoQ does not prevent cardiac dysfunction.However,autophagy prevents cardiac dysfunction,and the autophagic capacity or autophagosome-formation rate may determine whether cardiac dysfunction develops.

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The comparative study of calcium-dependent and calcium-independent of dephosphorylation of myosin light chain and its effect on pulmonary artery pressure and right ventricular remodeling in rats

Yongyao YANG ; Tianhe YANG ; Qing'an JIANG ;

Chinese Journal of Applied Clinical Pediatrics.2015;(13):1016-1018. doi:10.3760/cma.j.issn.2095-428X.2015.13.015

Objective To investigate the effects of calcium - dependent and calcium - independent in myosin light chain(MLC)dephosphorylation on pulmonary hemodynamics and right ventricular remodeling,and to observe whether there is a superimposition effect while intervention is conducted in two ways at the same time. Methods Ac-cording to random number table,50 rats were divided into 5 groups:sham operation group,model group,3 mg/(kg·d) ML - 7[MLC kinase(MLCK)inhibitor]treating group(M group),20 mg/(kg·d)Fasudil(Rho kinase inhibitor) treating group(F group)and 3 mg/(kg·d)ML - 7 plus 20 mg/(kg·d)Fasudil treating group(M + F group). The shunt between the abdominal aorta and inferior vena cava was used to establish rat models of pulmonary hypertension in-duced by high pulmonary flow in group of C and the experimental groups. The sham operation group was given a sham operation. MLCK and Rho kinase inhibitor were administrated intraperitoneally to rats with the shunt. After 8 weeks of shunting,mean right ventricular pressure(MRVP),mean pulmonary arterial pressure(MPAP),right ventricular hyper-trophy index(RVHI)and width of inferior venacava were evaluated by the right cardiac catheterization procedure. Results Compared with the sham operation group,MRVP,MPAP,and RVHI were obviously elevated in the model group [(2. 65 ±0. 57)kPa vs(4. 19 ±0. 67)kPa;(2. 42 ± 0. 48)kPa vs(4. 04 ± 0. 61)kPa,F = 295. 368,263. 912,all P ﹤0. 01;(0. 21 ±0. 01)g/ g vs(0. 41 ±0. 03)g/ g,F =247. 024,P ﹤0. 01]. Compared with model group,the MRVP,MPAP and RVHI in M group and F group were decreased significantly[(3. 51 ± 0. 47)kPa vs(4. 19 ± 0. 67)kPa;(3. 68 ± 0. 55)kPa vs(4. 19 ±0. 67)kPa,all P ﹤0. 01;M group:(0. 29 ±0. 02)g/ g,model group:(0. 41 ± 0. 03)g/ g,F group (0. 30 ±0. 03)g/ g,F =247. 024,P ﹤0. 05]. But the MRVP,MPAP and RVHI in M group and F group were higher than those of rats in the sham operation group. The MRVP,MPAP and RVHI of M + F group were elevated much obviously compared with those of the M or F group(P ﹤0. 05). Conclusions The calcium - dependent and calcium - independent in MLC dephosphorylation can respectively restrain the development of pulmonary hypertension and right ventricular re-modeling,and the obvious additive effect can be observed when the 2 drugs are used jointly.

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Effects of microRNA -30c knockdown on proliferation and differentiation of P19 cells

Xuehua LIU ; Shasha ZHU ; Zhangbin YU ; Chun ZHU ; Mengmeng LI ; Shuping HAN ; Xiaoshan HU ; Jin'gai ZHU ; Yuzhu PENG

Chinese Journal of Applied Clinical Pediatrics.2015;(13):992-995. doi:10.3760/cma.j.issn.2095-428X.2015.13.009

Objective To explore the effects of microRNA(miRNA)- 30c knockdown on proliferation,diffe-rentiation of P19 cells. Methods miRNA - 30c knockdown plasmid(miRNA - 30c knockdown group)or no - load vector(negative control group)was transfected into P19 cells by lipo2000 and stable cell lines were selected by Blastici-din;Dual luciferase reporter gene system was used to confirm miRNA - 30c knockdown. Cell counting kit - 8(CCK - 8) assay was adopted to detect cell proliferation activity. An inverted microscope was used to observe morphological chan-ges of P19 cell differentiation. Cells were induced to differentiated to myocardiocyte with dimethyl sulfoxide(DMSO). Differentiation marker genes including cTnT,NKX2. 5,GATA4 relative mRNA expression levels were detected with real - time quantitative polymerase chain reaction,respectively. Results Observation of green fluorescent protein ex-pression under a fluorescence microscope indicated similar transfection efficiencies,and miRNA - 30c knockdown re-leased the activity of target gene Gli2. As a result,miRNA - 30c knockdown vector was constructed successfully(P ﹤0. 001). During differentiation of mouse P19 cells into myocardial cells,the beating cell clusters in miRNA - 30c knockdown cells were much lower than those in the control cells,and cTnT,NKX2. 5,GATA4 in miRNA - 30c knock-down cells showed significantly lower expression than those in the control cells( all P ﹤ 0. 05). Conclusions miRNA - 30c inhibits the P19 cell proliferation and differentiation. This study gives us a new insight of heart develop-ment and we need more efforts on exploring the deep function of heart diseases.

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Correlation of transit time and clinical outcome in 363 cases of premature infants with respiratory failure

Bo LYU ; Xirong GAO ; Yan ZHUANG ; Yue'e XIONG ; Taotao LI ; Zhenye LIU ;

Chinese Journal of Applied Clinical Pediatrics.2015;(14):1087-1089. doi:10.3760/cma.j.issn.2095-428X.2015.14.013

Objective To investigate the correlation between the transport time of preterm infants with respira-tory failure and the clinical outcome. And to determine the transit time in critically ill premature infants. Methods Premature infants in level Ⅱ neonatal ward in Hunan Province Children's Hospital from January 1 to December 31, 2013,admitted to the Neonatal Intensive Care Unit requiring respiratory support(invasive and noninvasive),were re-viewed. All the patients were classified into non - standardized transport group and regulate transport group according to respiratory support that infants in the level Ⅱ neonatal ward required. Data on general information,the time of ventilator application,the time of exposure to oxygen,morbidity of bronchopulmonary dysplasia(BPD),the cure and improvement rate,length of stay,the total length of stay(length of stay in the local hospital and our hospital),and hospitalization ex-penses were collected. Results Among the 363 infants,there were 107 cases in the non - standardized transport group, and 256 cases in the regulate transport group. The time of ventilator application in the non - standardized transport group was longer than that in regulate transport group[(19. 75 ± 19. 53)d vs(13. 02 ± 12. 64)d,t = 18. 706,P ﹤ 0. 05],the time of exposure to oxygen was longer[(30. 60 ±24. 80)d vs(19. 50 ±19. 24)d,t =6. 883,P ﹤0. 05],the morbidity of BPD was higher[57. 01%(61/ 107 cases)vs 18. 36%(47/ 256 cases),χ2 = 53. 934,P ﹤ 0. 05],but the cure and im-provement rate was lower[70. 10%(75/ 107 cases)vs 83. 20%(213/ 256 cases),χ2 = 7. 912,P ﹤ 0. 05],and the total length of stay was longer[(59. 50 ± 34. 02)d vs(34. 48 ± 23. 69)d,t = 22. 967,P ﹤ 0. 05]than that in the regulate group. But there was no significant difference between the length of stay[(43. 99 ±28. 08)d vs(32. 79 ± 23. 76)d,t =2. 012,P ﹥0. 05]in the non - standardized transport group and regulate transport group,with the hospitalization expenses [(6. 55 ±4. 30)vs(4. 99 ±4. 12)thousands yuan,t =0. 552,P ﹥0. 05]. Conclusions The non - standardized transport group has higher morbidity of BPD,but lower cure or improvement rate,and it has longer length of stay. The 2013 edition of Chinese Neonatal Ward Hierarchical Construction and Management Guide(Proposal)is reasonable,level Ⅱ neonatal ward should be in strict accordance with it to transport regional neonatal.

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Relationship between initial absolute lymphocyte counts and the prognosis of children with primary immune thrombocytopenia

Ming'en LYU ; Yang LI ; Wenjie LIU ; Rongfeng FU ; Tiantian SUN ; Cuicui LYU ; Renchi YANG

Chinese Journal of Applied Clinical Pediatrics.2015;30(15):1147-1151. doi:10.3760/cma.j.issn.2095-428X.2015.15.008

Objective To investigate the value of initial absolute lymphocyte counts (ALC) in predicting the prognosis of children with primary immune thrombocytopenia(ITP).Methods The initial clinical data of 214 children with incipient ITP were retrospectively analyzed and followed up for more than one year.Statistical analysis was made to find out the influence factors for the prognosis of patients with ITP in children to evaluate the predictive value of ALC on assessing the prognosis of ITP in children,and to analyze the association between ALC and outcomes and the clinical value of prognostic stratification.Results The remission rate of children with ITP was 71.5％ in 12 months.Multivariate unconditioned Logistic analysis showed that disease duration,the infection history,response to treatment and ALC were independent risk factors for chronic ITP(all P ＜ 0.05).Cutoff value of initial ALC was 3.005 × 109/L,sensitivity and specificity of value were 71.9％,83.6％.Three months and 12 months no remission rate of ITP in children between ALC ＞ 3.005 × 109/L and ≤ 3.005 × 109/L had statistical significant difference (24.2％ vs 64.9％,8.3％ vs 54.2％,x2 =42.13,P ＜0.001).There was no statistical difference in therapy efficacy between 2 groups(x2 =5.098,P ＞ 0.05).Remission rate between the ≤5 years old group and ＞ 5 years old group was statistical difference based on age stratification(x2 =22.371,22.177,all P ＜ 0.01).ITP in children were stratified into low risk group,intermediate risk group,high risk group based on the initial ALC and infection history,with remission rates in 3 month respectively 75.8％,54.1％,22.8％,respectively,and 91.6％,68.4％,31.6％ in 12 months,respectively;there were statistically significant differences (x2 =44.867,68.802,all P ＜ 0.001).Conclusions Initial ALC is an independent effecting factor in the prognosis of children with ITP.Initial ALC could be used for stratifying patients with the infection history before 6 weeks and supposed to be a predictive index for the prognosis of ITP in children.

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Effect of Jade-Screen Powder on expression of microRNA in mouse model of asthma

Xiaoyuan DING ; Hong CAI ; Song WANG ; Qiao′e WANG ; Lei LU ; Chaobin SHEN ; Yating WANG

Chinese Journal of Applied Clinical Pediatrics.2016;(4):284-287. doi:10.3760/cma.j.issn.2095-428X.2016.04.013

Objective To study the effect of Jade -Screen Powder (JSP)on regulating expression of 5 microRNAs associated with helper T cells in asthmatic mouse model.Methods Forty Balb /c mice were randomly di-vided into 4 groups,1 0 mice for each group,namely normal control,asthma model,JSP treatment and Dexamethasone treatment.The mouse models of allergic inflammation on both upper and lower airways were established by ovalbumin sensitization and challenge.Interleukin(IL)-1 3 and IL -1 7 expressions were detected from lung homogenates by ELISA.Hematoxylin and eosin staining was also performed to observe the pathological changes in the lung tissue.The expressions of miR -1 46a,miR -1 46b,miR -21 0,miR -1 26 and miR -21 a were detected by quantitative real time PCR from splenocytes.Results The lower levels of IL -1 3 [(6.382 ±1 .690)μg/L]and IL -1 7 [(24.21 2 ± 1 .250)μg/L]were found in JSP treatment group compared with those in the asthma model group [(20.1 54 ±7.960)μg/L;(50.31 2 ±5.770)μg/L,rseparately],there was significant difference in IL -1 3 between JSP group and the asthma model group,as well as IL -1 7 (t =3.785,P =0.005;t =9.891 ,P =0.000).Same findings were found in Dexamethasone treated group as well [IL -1 3:(9.366 ±3.460)μg/L,IL -1 7:(29.1 32 ±4.960)μg/L;t =2.779, P =0.024;t =6.225,P =0.000].However,upregulation of miR -21 0 was observed in JSP treatment group (2.052 ± 0.871 )compared with that in the asthma model group (4.034 ±1 .379)(3.95 folds,t =2.71 8,P =0.026).Mean-time,the expression of miR -1 26 in JSP group (4.920 ±0.924)and Dexamethasone group (3.862 ±1 .51 0)in-creased compared with asthma model group (6.024 ±0.447)(2.1 5 folds,t =2.405,P =0.043,and 4.48 folds,t =-3.069,P =0.01 5).Conclusions Th2 and Th1 7 T cells participate in the pathogenesis of asthma and the asthmatic process can be inhibited by JSP.JSP may affect the helper T cells by regulating miR -21 0 and miR -1 26.

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