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??Abstract??Objective??To study the GRPR polymorphisms in ADHD children and analyze the sequence of the second exon of GRPR. Methods??The DNA was taken from the periphery blood. The PCR of the second exon of 120 children with ADHD and 126 normal children was sequenced. We used Chi-square test to know difference of genotype and haplotype between ADHD and normal control group?? and among inattention?? hyperactivity and impulsivity compound group. Result??There were TT?? CC and TC polymorphisms in the second exon of GRPR in 661 and 450 sits. There was no difference between ADHD and normal control group??χ2 = 0.30??0.52??1.34??0.30??all P > 0.05??. There was no difference among inattention?? hyperactivity and impulsivity compound group??χ2 = 0.37??0.49??0.63??all P > 0.05??. Conclusion??The research has not proved the relationship between ADHD and the second exon of GRPR.     

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目的探讨弥散加权成像(DWI)、常规磁共振成像(MRI)在新生儿低血糖性脑损伤不同阶段的动态变化。方法回顾分析了2005年9月至2008年9月,中国医科大学附属盛京医院新生儿科收治的经MRI确诊的20例低血糖性脑损伤患儿(病例组)的临床资料,并随机选取同期住院MRI正常的20例单纯性低血糖患儿为对照组。结果病例组平均最低血糖值低于对照组(P<0.01),低血糖持续时间长于对照组(P<0.01)。病例组于低血糖发生后3.8(1～11)d完成首次MRI检查,受累部位主要为枕叶11例、枕顶叶8例,顶叶1例,受累部位在DWI均表现为高信号,常规MRI相应部位12例表现为T1加权成像(T1WI)、T2加权成像(T2WI)正常信号,仅6例表现为T1WI低信号、T2WI高信号;11例于首次检查后11.4(8～15)d完成第2次MRI检查,首次检查受累部位DWI7例转为正常信号,4例低信号,常规MRI均表现为T1WI低信号、T2WI高信号。3例于6个月随访,提示枕叶DWI正常信号,T1WI低信号、T2WI高信号。结论新生儿低血糖性脑损伤早期DWI表现为异常高信号的部位,与晚期常规MRI表现为T1WI低信号、T2WI高信号的部...     

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??Abstract??Objective??To investigate alterations of circulating levels of the inflammatory markers— reflecting brain and adipose tissue inflammation—in the fetal growth restriction??FGR??fetuses and newborns??and explore its possible relation ship with adverse intrauterine development. Methods??Sixty parturients??hospitalized in Shengjing hospital of China Medical University??giving consecutively birth either to 30 appropriate for gestational-age??AGA?? singleton infants ??AGA group ?? or 30 FGR full-term singleton infants ??FGR group????were recruited.Plasm hs-CRP??PAI-1??S100B and leptin levels were determined by enzyme link immune assay??ELISA??in the umbilical cords blood ??UC ?? and venous blood from neonates on postnatal day 1 ??D1?? and day 4??D4??. Results??The birth weight??body length and the body mass index ??BMI?? of the FGR neonates were significantly lower compared with those of AGA group ??P < 0.05??.The leptin levels of UC in the FGR neonates were lower than that in the AGA groups??P < 0.05????and correlated positively with the birth weights and the BMI??P < 0.05??.Plasma hs-CRP levels did not differ significantly at all time points between AGA and FGR groups??P > 0.05??.hs-CRP levels in Umbilical cords blood were significantly decreased when compared with D1 hs-CRP in both AGA and FGR groups ??P < 0.05????and D1 hs-CRP was significantly increasedwhen compared with respective D4 hs-CRP??P < 0.05??.Plasma PAI-1 and S100B levels did not differ significantly at all time points between AGA and FGR groups??P > 0.05????and did not correlated with the birth weights and the BMI. Conclusion??Despite the lower birth weight??BMI and leptin levels in FGRs?? there was no difference for the levels of inflammatory markers hs-CRP and PAI-1 between IUGR and AGA fetuses/neonates.The CRP level in both studied groups fluctuated from fetus to neonate stage might attribute to parturition stress and adaptation recovery.     

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目的探讨高胆红素血症新生儿血中内皮微粒与胆红素的关系及在疾病中的意义。方法 2009年10月至2011年2月中山大学附属一院新生儿科及产科住院的新生儿78例,根据有无黄疸分为试验组(44例)和对照组(34例),试验组中33例光疗治疗后采血分析。试验组光疗前、后采血行胆红素及内皮微粒测定,对照组采血行内皮微粒测定。结果试验组血内皮微粒光疗前为1792.0(574.5,2456.0)个/μL、光疗后为789.0(540.0,999.0)个/μL,与对照组414.0(321.8,866.0)个/μL比较,差异有统计学意义(P均<0.05)。试验组光疗前、后血内皮微粒比较,差异有统计学意义(P<0.05)。试验组光疗前、后血内皮微粒与血胆红素均成正相关(r分别=0.592、0.575,P<0.05)。结论高胆红素血症新生儿和非高胆红素血症新生儿相比,血内皮微粒显著升高,提示高胆红素可能对血管内皮造成损伤。     

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??Abstract Objective??To investigate the regulatory mechanism of neuropeptide substance P??SP?? in lung injury induced by hyperxia and the relationship between SP and extracellular signal-regulated protein kinase??ERK??signal transduction pathway. Methods??The primary premature rats type II alveolar epithelial cells??AEC?? were isolated and purified.They were randomly divided into 3 groups?? including air group?? hyperxia group and SP intervention group. Air??21% oxygen?? group and hyperxia??95% oxygen?? group were placed in the closed oxygen chamber for 48 h respectively. With regard to SP intervention group?? SP??1×10-6 mol/L?? was added before the exposure.As following?? the group was exposed to 21% and 95% oxygen for 48 h respectively. Sample of each group was obtained at 12??24 and 48 h and morphologic change of AEC?? was observed under electron microscope.MTT and flow cytometry was employed to detect the growth rate and apoptosis rate respectively.Dynamic change of phosphorylated ERK was determined using Western blot. Results??Growth rate of AEC?? in hyperxia group decreased signifcantly and the apoptosis rate increased remarkbly compared to air group.The growth rate increased notablely and the apoptosis rate decreased obviously after the intervention of SP.Meanwhile?? the morphologic injure improved signifcantly.Hyperxia stimulation could result in activation of ERK phosphorylation??and the expression of phosphorylated ERK increased remarkbly in the impaired AEC?? induced by hyperxia.Nevertheless??the expression of ERK increased notably after the intervention of SP. Conclusion??SP could promote the proliferation and inhibit the apoptosis of AEC?? exposed to hyperxia via suppressing activation of ERK signal and then inhibiting the apoptosis??which has a protective effect on AEC??under oxidative stress.     

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??Objective??To investigate the changes and clinical significance of serum ferritin??SF??levels in children with systemic lupus erythematosus??SLE??. Methods??The serum ferritin levels of 58 children with SLE were measured by Chemiluminescence before and after treatment??and serum ferritin levels were measured in 30 normal children. Results??The serum ferritin levels were significantly higher in children with SLE than those in healthy controls as well as in active children than in inactive children with SLE.And the serum ferritin leveis were significantly decreased after treatment??Moreover?? the serum levels of ferritin were positively correlated with anti-ds-DNA antibody levels and SLEDAI??SLE Disease Activity Index??in children with SLE. Conclusion??The serum ferritin levels in children with SLE are significantly higher than those in normal children. Serum ferritin levels aree positively correlated with disease activity in children with SLE.Therefore serum ferritin levers can be a useful laboratory marker to diagnose SLE in children.     

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??Objective To explore features of the change of vitamin D level and bone mineral density in children with inflammatory bowel disease??IBD??. Methods From January 2014 to September 2014??thirty-two children with IBD??study group?? and thirty age and gender-matched healthy children??control group?? were enrolled in the study. The children of study group and control group were tested for bone alkaline phosphate??BALP????bone gla protein??BGP?? and 25??OH??D3 in blood serum by enzyme-linked immunosorbent assay??ELISA????and the clinical data such as calcium??phosphorus and albumin??ALB?? in blood serum were collected. Results There were 15 patients??9 males and 6 females?? with ulcerative colitis??UC?? and 17 patients??10 males and 7 females?? with Crohn’s disease??CD?? in the study group. There were 30 children??19 males and 11 females?? in control group. The level of BGP??U??332.5??P??0.444?? and BALP??U??350??P??0.637?? in blood serum showed no significant difference between the study group and the control group. 25??OH??D3 concentration??t??-2.876??P??0.006????BMD??U??39.5??P??0.05?? ??calcium??t??-6.654??P??0.05????phosphorus??U??216.5??P??0.007????and ALB ??U??25??P??0.05?? showed significant difference between the study group and the control group. In study group??25??OH??D3 concentration and BMD showed positive correlation??rs??0.504??P??0.005????while 25??OH??D3 and blood albumin levels showed negative correlation??rs??-0.315??P??0.019??. There was significant difference betweenUC/CD group and control group in Z score of BMD??U??29.5??P??0.05??U??10??P??0.05????but no statistical difference between UC and CD patients in Z score of BMD ??P??0.10??. Conclusion Most child patients with IBD have insufficient or lack of vitamin D and are more likely to have reduced bone mineral density.     

儿童血管迷走性晕厥的治疗

<正>血管迷走性晕厥(vasovagal syncope,VVS)的发作常导致儿童躯体的意外伤害,严重者影响患儿的身心健康。一些诱因可引起患儿发病,应尽量避免这些诱因,包括:晨起、运动、闷热环境、精神刺激、持久站立及体位改变等。VVS     

儿童血管迷走性晕厥的诊断

<正>晕厥是儿童时期常见病症[1],据美国流行病学调查发现,其发病率呈上升趋势。20世纪50年代为71.9/10万,到20世纪80年代末90年代初则上升为125.8/10万。有20%～25%的男孩和40%～50%的女孩至少经历过一次晕     

心脏自主神经系统调节在儿童血管迷走性晕厥中的研究现状

血管迷走性晕厥(vasovagal syncope,VVS)是自主神经介导性晕厥中最常见的一种类型,其发病机制复杂。自主神经系统包括交感神经和副交感神经,心脏受两者双重支配并保持平衡。目前普遍认为VVS存在心脏自主神经调节功能的失衡。文章就VVS中心脏自主神经主要神经递质的作用、心脏自主神经功能的评价指标及针对自主神经功能失衡的治疗等方面的研究进展作一介绍。     

血管迷走性晕厥儿童心率变异性分析

目的探讨血管迷走性晕厥(VVS)儿童的心率变异性(HRV)。方法对27例不明原因晕厥患儿经直立倾斜试验(HUTT)检查阳性并诊断为VVS的HRV进行分析(研究组),并将29例健康儿童作为对照(对照组)。采用康泰TLC3000A12通道动态心电图分析系统描记未发生晕厥时24h心电图,分析时域指标和频域指标,应用SPSS11.0软件进行统计学处理。结果研究组低频功率(LF)与对照组比较明显降低(P<0.05);频域指标与时域指标在不同年龄段差别不明显(P>0.05);女性时域指标中SDANN及VLF、LF较男性明显降低(P<0.05);血管抑制型与混合型VVS的HRV指标差异不明显。结论VVS儿童基础自主神经功能发生改变;HRV主要受性别影响,而年龄影响不明显;HUTT不同反应类型VVS的HRV不存在差别。     

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??Objective??To explore the changes of plasma C-type natriuretic peptide??CNP?? in children with VVS. Methods??Thirty-one children??male 16?? female 15?? with VVS were included in the study??and all of them were diagnosed by detailed history taking?? physical examination and related laboratory inspections as well as head-up tilt test. The mean age was ??11±3?? years. Another 32 healthy children??male 17??female 15?? were taken as a control group??who were confirmed as healthy by detailed history??physical examination??and standing test??etc. Their mean age was??11±2?? years. Finapres Medical System??Finapres Medical System-FMS??the Netherlands?? was used to continuously monitor heart rate and blood pressure during HUTT??and ECG was performed. Sandwich immunoluminescence assay was used to test plasma CNP. Results??No differences were found in age??height??weight??supine systolic blood pressure??diastolic blood pressure and mean arterial pressure between VVS group and control group??P?? 0.05??. The plasma CNP level in VVS group was higher than that of control group in supine position???35.7±21.5??ng/L vs. ??23.2±8?? ng/L??P??0.01??. The plasma CNP was positively correlated with syncope frequency in VVS group??r??0.85??P??0.05??. However??no significant differences were found in plasma CNP between supine position and positive response in HUTT in VVS group???36.3±21?? ng/L vs. ??42±57?? ng/L??P??0.05??. Conclusion??The plasma CNP level in VVS group is higher than that of control group in supine position. The plasma CNP is positively correlated with syncope frequency in VVS group??which might play a role in the pathogenesis of VVS in children.     

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??Objective??To evaluate the chronotropic competence in children with vasovagal syncope ??VVS??. Methods??Thirty-nine patients??17 males??22 females??age ranging from 8-16 years?? with syncope were included in the study??and 28 were diagnosed with VVS??including 15 cases of vasodepressor type??9 cases of mixed type??and 4 cases of cardioinhibitory type??11 were with unexplained cause of syncope. A treadmill test was performed and heart-rate response during exercise was evaluated by the chronotropic reserve. Demographic data and change of heart rate??blood pressure during test and CRI were compared between the 2 groups and different types of VVS. Furthermore??based on CRI??patients with VVS were divided into the normal chrontropic group??n??10?? and CI group??n??17??. By following the recurrence of syncope of 2 groups??the effect of CI on the prognosis of VVS in children was observed. Results??There were no significant differences between children with VVS and with unexplained syncope in sex??age??BMI??baseline heart rate??MaxMET or baseline blood pressure. But during exercise test??peak heart rate and CRI were significantly lower in children with VVS than in unexplained syncope. The incidence of CI in children with VVS was significantly higher than that in children with unexplained syncope??64.3% vs. 27.3%??P??0.05??. The incidence of CI in VVS with vasodepressor-type in children was significantly lower than those with cardioinhibitory-type and mixed-type. During following-up period??the recurrence rate of syncope in VVS children with CI was significantly higher than that of children without CI. Patients with CI had significantly worse prognosis compared to those without CI??Log-rank??P??0.028??. Conclusion??Chrontropic competence is significantly altered in children with VVS??especially in cardioinhibitory-type and mixed-type in children. CI is the significant predictor for poor prognosis in children with VVS.     

儿童血管迷走性晕厥反复发作相关因素分析

目的探讨影响儿童血管迷走性晕厥(VVS)反复发作的相关因素。方法收集125例确诊为VVS患儿的临床资料,根据晕厥首次发作至直立倾斜试验之前5年内的发作次数,分为晕厥发作次数2、3次的低频次组及≥4次的高频次组,对两组患儿资料进行统计分析。结果 125例VVS患儿中,低频次组84例(67.2%),高频次组41例(32.8%)。单因素分析结果显示,直立倾斜试验检查年龄、晕厥发作时间、发作诱因、晕车史、阳性家族史是VVS高频次发作的相关因素。非条件logistic回归分析结果显示,发作诱因(OR=3.723,95%CI:1.163~11.918,P=0.027)、晕车史(OR=5.929,95%CI:2.066~17.015,P=0.001)、阳性家族史(OR=6.794,95%CI:2.006~23.013,P=0.002)是VVS高频次发作的独立危险因素。结论非持久站立引起的其他发作诱因、晕车史、阳性家族史对预测VVS患儿高频次晕厥发作具有重要临床意义。     

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目的探讨鉴别血管迷走性晕厥(VVS)及体位性心动过速综合征(POTS)的临床依据。方法 2009年4月至2011年4月于北京大学第一医院儿科门诊就诊并确诊为VVS的儿童40例,年龄6～18岁,平均(11.8±2.9)岁;POTS儿童165例,年龄5～19岁,平均(11.4±2.7)岁。评价与检查手段包括临床表现、家族史、生活习惯、直立试验以及直立倾斜试验。结果 VVS和POTS在儿童时期的共同特征包括学龄期及青春期多发、女孩稍多于男孩、发作季节以夏秋季多见、多数患儿有诱因和发作先兆、发作后仍有不适、平卧后症状可缓解。在VVS儿童中以晕厥为主要表现者明显多于POTS(P<0.001),在POTS儿童中,以头晕为表现的患儿明显多于VVS(P<0.001)。VVS患儿中父方有直立不耐受家族史者明显多于POTS患儿(P<0.05)。结论直立倾斜试验是鉴别VVS与POTS的重要客观检查手段。晕厥及头晕的发生频率对于临床鉴别诊断VVS与POTS具有参考价值。     

儿童血管迷走性晕厥的临床诊治

血管迷走性晕厥(vasovagal syncope,VVS)是由自主神经介导、多种因素触发引起周围血管扩张致一过性脑缺血所致的短暂性意识障碍,同时伴有自主肌张力丧失,不能维持站立姿势而晕倒。患儿通常表现为反复发生的晕厥,诱因多为持久站立、体位改变、环境闷热等。目前VVS的治疗主要包括药物和非药物治疗。