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Common complication of central venous catheter for pediatric blood purification

Chinese Journal of Applied Clinical Pediatrics.2016;31(17):1281-1285. doi:10.3760/cma.j.issn.2095-428X.2016.17.001

Pediatric blood purification requires reliable access to the circulation.Central venous catheters play an important role in the delivery of pediatric blood purification.A central venous noncuffed,nontunneled catheter is the best choice for short-term(less than 3 weeks) blood purification.A cuffed,tunneled catheter is preferable to long term(more than 3 weeks) blood purification.However,there are many complications associated with central venous catheters,such as catheter-induced thrombosis,catheter-related infection,and central vein stenosis.This article reviews the prevention and treatment of complications most frequently occurring with central venous catheters.

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Clinical features and pathogens analysis of complicated and non-complicated urinary tract infections in infants

Hongying ZHANG ; Yubin WU

Chinese Journal of Applied Clinical Pediatrics.2016;31(17):1300-1303. doi:10.3760/cma.j.issn.2095-428X.2016.17.006

Objective To summarize the clinical and pathogenic characteristics of urinary tract infection(UTI)in infants,and to provide reference for clinical diagnosis and treatment.Methods One hundred and eighty-eight cases of hospitalized infants with UTI diagnosis standard in Department of Pediatric Renal Rheumatism Immunology,Shengjing Hospital Affiliated to China Medical University from January 2012 to January 2015 were collected,and on the basis of the imaging they were divided into complex group(complicated UTIs) and non-complex group(non-complicated UTIs),the differences between 2 groups in the general condition,clinical manifestations,serological examination,urine culture and distribution of pathogenic bacteria and drug sensitivity results were analyzed.Results Among 188 UTI infants,148 were male and 40 were female,50 cases were in complex group (26.6％),and 138 cases were in non-complex group (73.4％).In complex group,the prevalence of prenatal ultrasound abnormalities (34.0％),the incidence of recurrent infections(24.0％),the number of fever incidence(78.0％),and peripheral WBC count [(16.4 ± 4.3) × 109/L] were higher than those in non-complex group[1.5％,10.9％,58.7％,(14.6 ± 3.5) × 109/L] (all P ＜ 0.05),and the naked eye hematuria incidence was lower than that of the non-complex group (14.0％ vs 34.8％,P =0.006).In complex group,pneumonia klebsiella bacteria positive rate was higher than that of non-complex group (22.0％ vs 2.9％,P =0.000),and the positive rate of Escherichia coli was lower than that of non-complex group(26.0％ vs 46.4％,P =0.000).There was no difference in the drug sensitivity and resistance of the pathogenic bacteria in the urine culture of 2 groups.Conclusions For fever,increased peripheral WBC,repeated infection and urine culture for Klebsiella pneumoniae UTI infants,in particular,should be alert to the prese-nce of urinary tract abnormalities,timely improve the urinary system ultrasound and urinary tract contrast is very necessary.

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Clinical analysis of 28 cases of atypical hemolytic uremic syndrome

Guiju ZHANG ; Xiaorong LIU ; Qun MENG ; Jianfeng FAN ; Nan ZHOU ; Zhi CHEN

Chinese Journal of Applied Clinical Pediatrics.2016;31(17):1311-1314. doi:10.3760/cma.j.issn.2095-428X.2016.17.009

Objective To investigate the treatment of atypical hemolytic uremic syndrome (aHUS) in their acute phase and relate the prognostic factors.Methods Twenty-eight patients with aHUS treated in Department of Nephrology,Beijing Children's Hospital Affiliated to Capital Medical University from January 2011 to March 2015 were collected,the outcomes of the treatment were summarized.Results All the patients were given plasma exchange (PE)treatment,21 patients with hemodialysis (HD) treatment;13 patients with H factor (FH) antibody were further treated with corticosteroid therapy,and 1 patient was treated with the combination of mycophenolate mofetil.Evaluation of patients' indices were conducted at month 3.Out of the 28 patients,there were 13 patients with complete remission;of the 14 patients showed improvement,6 patients were complicated with hypertension and 4 patients with renal dysfunction.One patient,with ongoing hemodialysis,did not show restoration of renal function.There was no death in children.Statistical analysis showed that the acute phase serum creatinine levels were (430.0 ± 124.7) μmol/L and (265.6 ± 90.8)μmol/L for the group with remaining kidney injury and the group with complete remission,respectively,the difference was statistically significant(P ＜0.01).The levels of FH for the 2 groups were (206.5 ± 134.9) mg/L and(415.4-±214.1) mg/L,and the difference was statistically significant (P ＜ 0.01) as well.Statistical analysis showed that differences were no statistically significant between the 2 groups of patients on their age,platelets,complement C3,complement C4,hemoglobin and lactate dehydrogenase (all P ＞ 0.05).For the group with positive antibody,its average serum creatinine was (346.4 ± 112.5) μmol/L.For the group with negative antibody,its average serum creatinine was (297.0 ± 89.3) μmol/L.The FH for group with positive antibody and group with negative antibody were (307.4 ±187.3) mg/L and (379.8 ± 203.5) mg/L,respectively.The differences were not statistically significant (all P ＞0.05).Conclusions PE is an effective treatment for aHUS at acute phase,and corticosteroid and immunosuppressive therapy are effective for patients with positive anti-FH antibody.For patients with severe kidney injury at acute phase,the possibility of long-term kidney damage is high.Low concentration of serum FH indicates a poor prognosis.

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Analysis of phenotypic heterogeneity of male patients with X-linked Alport syndrome from one family

Yanqin ZHANG ; Jie DING ; Fang WANG

Chinese Journal of Applied Clinical Pediatrics.2016;31(17):1318-1320. doi:10.3760/cma.j.issn.2095-428X.2016.17.011

Objective In this study,the phenotype heterogeneity of 2 male patients with X-linked Alport syndrome from one family was analyzed and the likely reasons were discussed by reviewing the literature.Methods The clinical data at the time of diagnosis and during 5 years follow-up of 2-male patients with X-linked Alport syndrome from one family were collected.The α5 (Ⅳ) chain expression in the epidermal basement membrane was detected by indirect immunofluorescence method.COL4A5 gene mutations in skin fibroblasts and genomic DNA were detected by using reverse transcription polymerase chain reaction and direct sequencing and PCR sequencing methods from skin fibroblasts and genomic DNA,respectively.Results The diagnostic age of patient Ⅲ 1 was 14 years old.He had only microscopic hematuria,and proteinuria was negative.A negative α5 (Ⅳ) chain staining pattern was detected in his epidermal basement membrane.After 5 years follow-up without drug treatment,he was 19 years old,had persistent microscopic hematuria and normal renal function.The urinary microalbumin was 19.2-31.8 mg/L.The diagnosis age of patient Ⅱ 4 was 29 years old.The hematuria and proteinuria were found at 22 years old.He was treated with tripterygium wilfordii for 1 year.His disease progressed to an end stage of renal disease and he received hemodialysis therapy at 24 years old.He had the renal transplantation surgery at 29 years old,just 2 months before he came to hospital.And his renal function was restored.After 5 years follow-up,his urine examination and renal function were normal.Both patients had a missense mutation c.3650G ＞ A(p.G1217D) in exon 41 in COL4A5 gene.Conclusions The different phenotypes of 2 male patients from one family with X-linked Alport syndrome were reported.The most possible reason for this is somatic mosaic variants in COL4A5 gene based on literature review.Physicians should be alert to phenotype heterogeneity in male X-linked Alport syndrome despite having the same gene mutation.

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Diagnosis of a boy with sporadic Alport syndrome using next generation sequencing and literature review

Li LI ; Si WANG ; Feng ZHAO ; Xiaojing NIE ; Jun HUANG ; Zihua YU

Chinese Journal of Applied Clinical Pediatrics.2016;31(17):1321-1324. doi:10.3760/cma.j.issn.2095-428X.2016.17.012

Objective To study the feasibility of testing three disease-causing genes for Alport syndrome,COL4A3,COL4A4 and COL4AS,in diagnosing patients with sporadic Alport syndrome by using targeted capture and next generation sequencing.Methods The clinical data of a 9-year-old boy suspected with Alport syndrome were collected.Genomic DNA was extracted using standard procedures from the peripheral blood leukocytes of the patient and his parents,respectively.Targeted capture and next generation sequencing and Sanger sequencing were applied to analyze the mutations in the 3 disease-causing genes.Clinical data of cases reported already with autosomal recessive Alport syndrome caused by the mutations in the COL4A4 gene were summarized.Results The patient was presented with neither family history of hematuria nor chronic renal failure.Haematuria and proteinuria were found at the age of 1 year.The patient presented with episodes of macrohaematuria and gradually developed nephrotic-level proteinuria.At the age of 8 years 7 months,bilateral sensorineural hearing loss was diagnosed.So a probable diagnosis of Alport syndrome was postulated.A compound heterozygous pathogenic mutations of 3578-1G ＞ A and 3967 C ＞ T(Q1323X) were identified in the COL4A4 gene in the patient.The mutation of 3578-1G ＞ A was inherited from his father,and the mutation of Q1323X from his mother.The patient was decisively diagnosed with autosomal recessive Alport syndrome.Conclusions The test of COL4A3,COL4A4 and COL4A5 genes can help diagnose patients with sporadic Alport syndrome by using targeted capture and next generation sequencing.

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Characteristics of electrocardiographic parameters of the right heart in 75 cases of early newborns with varying gestational age

Ling YANG ; Jianwen XU

Chinese Journal of Applied Clinical Pediatrics.2016;31(17):1336-1338. doi:10.3760/cma.j.issn.2095-428X.2016.17.016

Objective To observe the characteristics of electrocardiographic parameters of the right heart in the early newborns with different gestational age.Methods Seventy-five cases of early newborns from January 2014 to January 2015 were selected.They were divided into 4 groups according to gestational age,15 cases in group A (28-30 weeks),18 cases in group B (＞30-33 weeks),17 cases in group C (＞33-37 weeks) and 25 cases in group D (＞ 37-40 weeks).All newborns were examined by the synchronous 12-lead ECG machine,and the changes in ECG time limit detection results,QRS amplitude and RV1 amplitude were compared among groups.Results (1) There was a significant difference in P-R intervals among group A [(0.090 ± 0.011) s],group B [(0.095 ± 0.012) s],group C [(0.098 ± 0.013) s] and group D [(0.105 ± 0.014) s] (F =7.458,P ＜ 0.05).The P-R intervals of group A,group B and group C were much shorter than those of group D (P ＜ 0.05);the comparison of QRS duration and QTc among groups had no statistical significance (F =1.626,1.569,all P ＞ 0.05).(2) In group A:QRS amplitude was:(4.430 ± 1.380) mV,RV1 amplitude:(0.850 ± 0.420) mV;in group B:QRS amplitude was:(4.800 ± 1.350) mV,RV1 amplitude:(1.012 ± 0.425) mV;in group C:QRS amplitude was:(5.200 ± 1.600) mV,RV1 amplitude:(1.210 ± 0.520) mV;in group D:QRS amplitude was:(5.800 ± 1.800) mV,RV1 amplitude:(1.509 ± 0.525) mV.There were significant differences in QRS and RV1 amplitude among 4 groups (F =7.002,16.870,all P ＜ 0.05).The QRS amplitude changes in group A and group C were far less than those in group D (P ＜ 0.05),the RV1 amplitude changes in group A,group B,and group C were far less than those in group D (P ＜ 0.05),and there was no difference between among other groups (all P ＞ 0.05).Conclusions There are correlations between the electrocardiographic parameters of right heart and the gestational age of newborn infants.These parameters,including the P-R intervals,the amplitude of QRS and RV1,increase with the gestational age.

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Pediatric multiple magnetic foreign body ingestion:3 cases report and literature survey

Jun SUN ; Weijue XU ; Zhibao LYU ; Xiong HUANG ; Yibo WU ; Qingfeng SHENG

Chinese Journal of Applied Clinical Pediatrics.2016;31(17):1339-1342. doi:10.3760/cma.j.issn.2095-428X.2016.17.017

Objective To enhance awareness of the dangerous of multiple magnets ingestion in children and to explore the optimal treatment of it.Methods The clinical data of 3 cases with multiple magnet ingestion were retrospectively studied based on literature review.Results Ingestion of multiple magnets (range:2-5 magnets) magnets occurred in 3 cases.Age ranged from 1 to 8 years old.Magnet sources included:2 from children's family,1 from their kindergarten.All patients had several bowel perforations(range:2-4).One case was completed by laparoscopic,1 case was converted to open suegery after laparoscopy,1 case was done by open surgery.All cases got complete recovery after surgical treatment,and no complications occurred by follow-up.Conclusions Ingestion of multiple magnets may show minimal initial physical manifestations at beginning but may result in significant complications later.Two or more magnets separated from each other along the gastrointestinal tract can attract each other across bowel walls,with may result in pressure necrosis,bowel perforation,and fistulas formation and even death.Early surgical consultation with an aggressive surgical approach is recommended.Family and society should be aware of the dangers of magnet ingestion.

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Fever, abdominal distension, polyserositis

Lijing CAO ; Ximin HUO ; Meixian XU ; Xiaoming WANG ; Suzhen SUN

Chinese Journal of Applied Clinical Pediatrics.2016;31(17):1352-1355. doi:10.3760/cma.j.issn.2095-428X.2016.17.020

Objective To provide useful information for the diagnosis and differentiation through exploring the tumor with polyserositis as the initial symptom.Methods There was a case present with fever,poor spirit,abdominal distention and edema in Children's Hospital of Hebei Province.The characteristics and results of physical examination were summarized and discussed according to the condition evolution phases.The possible etiological factors were analyzed.The treatment was adjusted.Further physical examination was improved.The final diagnosis was tracked.Results After getting admitted to hospital,the patient received CT scan and ultrasound examination for many times.The results suggested the pericardial effusion,pleural effusion,peritoneal effusion and cardiac insufficiency.The child had made a slight improvement through treatment.However,he had hemiparesis.Cerebral infarction was demonstrated through magnetic resonance imaging(MRI),magnetic resonance angiography (MRA),magnetic resonance venography (MRV).Ultrasound showed that there was more pericardial effusion,aortic root solid low echo mass,pulmonary arterial wall stiffness,left and right pulmonary artery blood flow speed increased.Neck and chest enhanced CT showed mediastinal lesions.Pathology examination results suggested myeloid sarcoma after referral to superior hospital.Conclusions When children had an unexplained polyserositis,more comprehensive analysis were needed.The illness condition should be explained with Monism as far as possible.Repeated inspections would be necessary when the pathogenesis was not clear.Careful watch for the tumor should be kept.

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Progress and perspectives in definition of acute respiratory distress syndrome

Chunfeng LIU

Chinese Journal of Applied Clinical Pediatrics.2016;31(18):1364-1367. doi:10.3760/cma.j.issn.2095-428X.2016.18.002

Acute respiratory distress syndrome(ARDS) is a disease of acute onset characterized by hypoxemia and infiltrates on chest radiographs that affects both adults and children of all ages.This article reviewed the evolution of the definition of ARDS over nearly five decades,with a special focus on the new pediatric definition,also discuss recommendations for future definition of this syndrome.

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Pharmacological treatments for acute respiratory distress syndrome:recent advances and recognition

Ying WANG ; Juan QIAN

Chinese Journal of Applied Clinical Pediatrics.2016;31(18):1368-1371. doi:10.3760/cma.j.issn.2095-428X.2016.18.003

Although acute respiratory distress syndrome (ARDS) has been the focus of extensive basic science and clinical research over the past 40 years,its pathogenesis is not clear.The therapies for ARDS have been not consensus.In addition to the lung-protective ventilatory strategies,effective pharmacologic therapy for ARDS remains extremely limited and still continue to explore and study.This paper reviews the cunent pharmacotherapies to treat ARDS,including neuromuscular blockers,corticosteroids,neutrophil elastase inhibitor,antioxidants,granulocyte macrophage-colony stimulating factor,β2 adrenergic receptor agonists,pulmonary vasodilators.

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