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Vol 14, No 4
Vol 14, No 4 August 2018 ISSN 1708-8569
Review articles
Original articles
Brief report
Letters to the editors
Current status of screening, diagnosis, and treatment of neonatal congenital heart disease in China
  Xiao-Jing Ma, Guo-Ying Huang
  [Abstract] [Full Text] [PDF]  
Review articles:
Multifarious diagnostic possibilities of the S100 protein family: predominantly in pediatrics and neonatology
  Anna Medkova, Josef Srovnal, Jarmila Potomkova, Jana Volejnikova, Vladimir Mihal
Background: Numerous articles related to S100 proteins have been recently published. This review aims to introduce this large protein family and its importance in the diagnostics of many pathological conditions in children and adults.
Data sources: Based on original publications found in database systems, we summarize the current knowledge about the S100 protein group and highlight the most important proteins with focus on pediatric use.
Results: The S100 family is composed of Ca2+ and Zn2+ binding proteins, which are present only in vertebrates. Some of these proteins can be used as diagnostic markers in cardiology (S100A1, S100A12), oncology (S100A2, S100A5, S100A6, S100A14, S100A16, S100P, S100B), neurology (S100B), rheumatology (S100A8/A9, S100A4, S100A6, and S100A12), nephrology and infections (S100A8, S100A9, S100A8/A9, S100A12). The most useful S100 proteins in pediatrics are S100A8, S100A9, heterodimers S100A8/A9, S100B and S100A12.
Conclusions: The S100 family members are promising biomarkers and provide numerous possibilities for implementation into clinical practice to optimize the differential diagnostic process.
  [Abstract] [Full Text] [PDF]  
Kaposiform hemangioendothelioma in children: a benign vascular tumor with multiple treatment options
  Irene Schmid, Anne K. Klenk, Monika Sparber-Sauer, Ewa Koscielniak, Rebecca Maxwell, Beate Haberle
Background: Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor affecting infants and young children. Although benign, it can be associated with an aggressive locally growing tumor and/or a life-threatening Kasabach每Merritt phenomenon (KMP). To date, only reviews of limited cases have been performed. We, therefore, conducted a comprehensive literature search to collect relevant data and make recommendations for future treatment trials.
Methods: Review of the available literature between 1993 and 2017 revealed a total of 105 publications involving 215 patients of less than 21 years of age. To this, we added 12 from our department and 4 from the Cooperative Weichteilsarkomstudie database.
Results: We found that KMP was present in 79% of the infants, in 47% of the 1-5-year olds, in 43% of the 6-12-year olds, and in 10% of the 13-21-year-old patients. KMP was present in nearly all (94%) patients with retroperitoneal tumors and in all patients with extra-regional tumors. The median size of a KHE without KMP was 12 cm 2 as compared to 49 cm 2 when associated with a KMP. With complete (not further classifiable if R0 or R1) resection, all patients were cured. If inoperable, response regarding KMP/regression of tumor size was seen in 29/28% with steroid-, 47/39% with vincristine-, 44/43% with interferon alpha-, 65/61% with anti-platelet agents-, and in 97/100% with sirolimus-containing therapies.
Conclusions: Patients with progressive KHE should undergo resection whenever it is considered a safe option. If inoperable, sirolimus should be the fi rst choice for treating KMP and reducing tumor size.
  [Abstract] [Full Text] [PDF]  
Barrett* s esophagus in children: what is the evidence?
  Maja Raicevic, Amulya K. Saxena
Background: This study systematically reviewed etiology, prevalence, treatment and outcome of Barrett*s esophagus (BE) in the pediatric population.
Methods: PubMed® was searched for terms "Barrett*s esophagus§ and ※children§. End points were age of patients, etiology, association with other syndromes, treatment, incidence of carcinoma and outcome. This review was conducted according to the PRISMA guidelines. Data were collected, entered and analyzed into a Microsoft Excel® spreadsheet database.
Results: Search revealed 278 articles published between 1984 and 2017, of which 18 met the inclusion criteria. There were 130 patients for analysis with a mean age 10.6 years (0.8-17.2 years). BE was diagnosed in 80 patients with confirmed gastroesophageal reflux (GER) only; further 20 patients were neurologically impaired and had GER, 13 after esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) repair with associated GER, 6 post-chemotherapy, 1 after post caustic burns, 1 after esophageal replacement with stomach, 1 after peptic esophageal stricture, 1 with secretory diarrhea, 1 with Fanconi anemia, 1 tetralogy of Fallot, and 5 healthy children. Regarding treatment, 26 were on medical treatment only, 16 had surgeries combined with medical treatment, 80 patients underwent surgery only, 1 was on diet management, 4 were on surveillance only and 2 were never treated for BE as death occurred because of associated conditions. Fundoplication was the most commonly performed surgery (82.2%). Adenocarcinoma was found in one 23-year-old patient. Mean follow-up was 3.45 years (10 months-13 years) and long-term outcome showed recurrences in 8 and esophago-mediastinal fistula and
proximal esophagus ulcer in 1. There were 7 lethal outcomes which were not directly associated with BE.
Conclusions: Although BE is considered a premalignant condition; incidence of carcinoma in pediatric population is low. Long-term follow-up with endoscopies and biopsies seems to be advisable for BE evidence and malignant alterations.
  [Abstract] [Full Text] [PDF]  
Original articles:
Antibiotic usage in Chinese children: a point prevalence survey
  Jiao-Sheng Zhang, Gang Liu, Wen-Shuang Zhang, Hai-Yan Shi, Gen Lu, Chang-An Zhao, Chang-Chong Li, Yan-Qi Li, Ya-Nan Shao, Dai-Yin Tian, Ming-Jie Ding, Chun-Yan Li, Li-Juan Luo, Xiao-Yan Dong, Ping Jin, Ping Wang, Chun-Mei Zhu, Chuan-Qing Wang, Yue-Jie Zheng, Ji-Kui Deng, Mike Sharland, Ying-Fen Hsia, Kun-Ling Shen, Yong-Hong Yang
Background: Children as a population have high antimicrobial prescribing rates which may lead to high resistance of bacteria according to data from some single-center surveys of antibiotic prescribing rates in China. The acquirement of baseline data of antibiotic prescribing is the basis of developing intervention strategies on inappropriate antimicrobial prescriptions. Few studies show clearly the pattern and detailed information on classes of antibiotics and distribution of indications of antibiotic prescriptions in children in China. This study aims to assess the antibiotic prescribing patterns among children and neonates hospitalized in 18 hospitals in China.
Methods: A 24-hour point prevalence survey on antimicrobial prescribing was conducted in hospitalized neonates and children in China from December 1st, 2016 to February 28th, 2017. Information on the antibiotic use of patients under 18 years of age who were administered one or more on-going antibiotics in the selected wards over a 24-hour period was collected. These data were submitted to the GARPEC (Global Antimicrobial Resistance, Prescribing and Efficacy in Children and Neonates) web-based application (https ://pidrg-database.sgul.ac.uk/redcap/). For statistical analysis, Microsoft Excel 2007 and SPSS 22.0 were used.
Results: The antibiotic data were collected in 35 wards in 18 hospitals from 9 provinces. In total, 67.76% (975/1439) of the patients (n = 1439) were given at least one antibiotic, including 58.1% (173/298) of neonates (n = 298) and 70.3% (802/1141) of children (n = 1141). In neonates, the three most frequently prescribed antibiotics were third-generation cephalosporins (41.7%), penicillins plus enzyme inhibitor (23.8%), and carbapenems (11.2%). In children, the three most frequently prescribed antibiotics were third-generation cephalosporins (35.5%), macrolides (23.2%), and penicillins plus enzyme inhibitors (15.9%). The most common indication for antibiotics was proven or probable bacterial lower respiratory tract infection (30.9% in neonates and 66.6% in children).
Conclusions: Antibiotics are commonly prescribed in the Chinese children population. It is likely that the third-generation cephalosporins and macrolides are currently overused in Chinese children. Efforts must be made to ensure safe and appropriate antibiotic prescribing to reduce and prevent the future development of antibiotic resistance.
  [Abstract] [Full Text] [PDF]  
Necrotizing pneumonia caused by refractory Mycoplasma pneumonia pneumonia in children
  Xia Wang, Li-Jia Zhong, Zhi-Min Chen, Yun-Lian Zhou, Bei Ye, Yuan-Yuan Zhang
Background: To investigate the clinical features of necrotizing pneumonia (NP) caused by refractory Mycoplasma pneumonia pneumonia (RMPP).
Methods: A retrospective observational study was carried out in patients with NP caused by RMPP who were admitted to our hospital from January 2008 to December 2015, and the clinical manifestations, laboratory data, imaging performances, hospital courses and outcomes were analyzed.
Results: Twenty-five patients with NP caused by RMPP were collected, with a median age of 5.1 (4.0-7.9) years. The mean duration of fever and hospital stay was 21.0 ㊣ 8.9 and 19.9 ㊣ 9.9 days, respectively. The levels of lactate dehydrogenase (LDH), C-reactive protein, interleukin (IL)-6, IL-10 and interferon-gamma were elevated. Meanwhile, the pleural fluid cell count, LDH and protein were also increased. 80.0% of the patients had pleural effusion; and a high incidence of lobar atelectasis and pulmonary consolidation was found the patients. The mean duration from the onset of symptoms to the discovery of necrotic lesions was 21.0 ㊣ 6.9 days. 80.0% of the patients were administrated corticosteroids, and bronchoalveolar lavage was extracted separately from all patients. Of the 20 patients who presented with pleural effusion, 11 underwent thoracocentesis alone and 2 underwent chest drainage. All patients received prolonged courses of antibiotics (32.2 ㊣ 8.7 days). All patients were discharged home and recovered without surgical intervention; and chest lesions were resolved or only minimal residual fibrotic changes were residual within 3.0 (2.0-6.0) months.
Conclusions: Necrotizing pneumonia caused by RMPP is severe, however, self-limiting and reversible. Good outcomes can be achieved with appropriate management.
  [Abstract] [Full Text] [PDF]  
Incidence and risk factors of post-phototherapy neonatal rebound hyperbilirubinemia
  Ismail Mohamed Elhawary, Eman Abdel Ghany Abdel Ghany, Walaa Alsharany Aboelhamed, Shahinaz Gamal Eldin Ibrahim
Background: To determine the incidence and risk factors of post-phototherapy rebound hyperbilirubinemia because data about bilirubin rebound in neonates are lacking and few studies have concerned this condition.
Methods: A prospective observational study was conducted on 500 neonates with indirect hyperbilirubinemia who were treated according to standard guidelines. Total serum bilirubin (TSB) was measured at 24-36 h after phototherapy; significant bilirubin rebound (SBR) is considered as increasing TSB that needs reinstitution of phototherapy.
Results: A total of 124 (24.9%) neonates developed SBR with TSB increased by 3.4 (2.4-11.2) mg/dL after stopping phototherapy. Multiple logistic regression model revealed the following significant risk factors for rebound: low birth weight (B = 1.3, P < 0.001, OR 3.5), suspected sepsis (B = 2.5, P < 0.001, OR 12.6), exposure to intensive phototherapy (B = 0.83, P = 0.03, OR 2.3), hemolysis (B = 1.2, P < 0.001, OR 3.1), high discharge bilirubin level (B = 0.3, P = 0.001, OR 1.3), and short duration of conventional phototherapy (B = − 1.2, P < 0.001, OR 0.3).
Conclusions: SBR should be considered in neonates with hemolysis, low birth weight, suspected sepsis, short duration of conventional phototherapy, exposure to intensive phototherapy, and relatively high discharge TSB. These risk factors should be taken into account when planning post-phototherapy follow-up.
  [Abstract] [Full Text] [PDF]  
Gestational weight gain among minority adolescents predicts term birth weight
  Maheswari Ekambaram, Matilde Irigoyen, Johelin DeFreitas, Sharina Rajbhandari, Jessica Lynn Geaney, Leonard Edward Braitman
Background: In adolescents, there is limited evidence on the independent and additive effect of prepregnancy body mass index (BMI) and gestational weight gain on infant birth weight. Data also show that this effect may vary by race. We sought to examine the impact of maternal prepregnancy BMI and gestational weight gain on birth weight and risk of large for gestational age (LGA) in term newborns of minority adolescent mothers.
Methods: This was a retrospective cohort study of 411 singleton live term infants born to mothers ≒ 18 years. Data were abstracted from electronic medical records.
Results: Gestational weight gain was related to infant birth weight ( = 0.36, P < 0.0001), but BMI was not ( = 0.025, P = 0.61). On regression analysis, gestational weight gain, gestational age and Hispanic ethnicity were independent predictors of birth weight, controlling for maternal age, BMI, parity, tobacco/drug use and preeclampsia. The probability of having an LGA infant increased with weight gain [adjusted odds ratio (aOR) 1.14, 95% confidence interval (CI) 1.07-1.21] but not with BMI. Mothers who gained weight in excess of 2009 Institute of Medicine (IOM) recommendations had a greater risk of having an LGA infant compared to those who gained within recommendations (aOR 5.7, 95% CI 1.6-19.5).
Conclusions: Minority adolescents with greater gestational weight gain had infants with higher birth weight and greater risk of LGA; BMI was not associated with either outcome. Further studies are needed to examine the applicability of the 2009 BMI-specific IOM gestational weight gain recommendations to adolescents in minority populations.
  [Abstract] [Full Text] [PDF]  
Impact of hospital volume on outcomes of percutaneous ASD/PFO closure in pediatric patients
  Parth Bhatt, Achint Patel, Varun Kumar, Anusha Lekshminarayanan, Viranchi Patel, Srilatha Alapati, Zeenia Cyrus Billimoria
Background: We investigated the effect of hospital volume on percutaneous closure of atrial septal defect/patent foramen ovale (ASD) among pediatric patients.
Methods: We identified patients undergoing percutaneous closure of ASD with device using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure code 35.52 from the National Inpatient Sample, years 2002-2011. Patients with age ≒ 18 years and primary diagnosis code 745.5 for ASD were included. Hospital volume was calculated using unique identification numbers and divided into tertiles for analysis. Multivariate regression analysis was performed to determine independent predictors of procedure-related complications which were coded using specific codes released by Healthcare Cost and Utilization Project.
Results: 6162 percutaneous ASD closure procedures were analyzed. There was no mortality associated with percutaneous ASD closure. Cardiac complications (9.5%) were most common. On multivariate analysis, age increment of 3 years decreased the odds of developing complications (OR 0.83, 95% CI 0.79-0.87, P < 0.001). Odds of developing complications in the 2nd (OR 0.74, 95% CI 0.62-0.89, P = 0.007) and 3rd tertiles (OR 0.34, 95% CI 0.27-0.42, P < 0.001) were lower as compared to the 1st tertile of hospital volume.
Conclusion: Increasing annual hospital volume is an independent predictor of lower complication rates in percutaneous ASD closure cases with no associated mortality in pediatric patients.
  [Abstract] [Full Text] [PDF]  
Assessment of cardiac function in infants with transposition of the great arteries after surgery: comparison of two methods
  Fan Yang, Roberta Iacobelli, Jian-Ming Wang, Fiore Salvatore Iorio
Background: Assessment of cardiac function is crucial in pediatric patients undergoing cardiovascular surgery, monitoring cardiac output and changing hemodynamic conditions during surgery accordingly is important to improve post-surgical outcome. We aimed to measure cardiac index (CI) and maximal rate of the increase of left ventricular pressure dp/dt (max) with the pressure recording analytic method (PRAM, MostCare®) and compared it with transthoracic echocardiographic cardiac index estimation in infants with transposition of the great arteries (TGA) undergoing surgical correction.
Methods: We enrolled 74 infants with TGA consecutively into this study. CI and dp/dt (max) were measured with PRAM and echocardiography at 0, 4, 8, 12, 24 and 48 h postoperatively. Blood brain natriuretic peptide (BNP) and blood lactate (Lac) were measured at baseline and after operation.
Results: The median age at surgery was 13 days (range 1-25 days) with an average weight of 3.24 kg (range 2.31-4.17 kg). CI estimated by PRAM was 1.11 ㊣ 0.12 L/min/m2 (range 0.69-1.36) and by Doppler echocardiography was 1.13 ㊣ 0.13 L/min/m2 (range 0.76-1.40). dp/dt (max) estimated by PRAM was 1.31 ㊣ 0.03 mmHg/s (range 1.23-1.43) and by Doppler echocardiography was 1.31 ㊣ 0.04 L/min/m2 (range 1.25-1.47). CI (r = 0.817, P < 0.001) and dp/dt (max) (r = 0.794, P < 0.001) measured by two methods were highly correlated with a linear relation. Blood BNP and lactate increased to the highest level at 8-12 h post-operatively.
Conclusions: In the early post-operative period, PRAM provides reliable estimates of cardiac index and dp/dt (max) value compared with echocardiographic measurements. PRAM through mostcare® is a reliable continuous monitoring method for peri-operative management in children with congenital heart disease.
  [Abstract] [Full Text] [PDF]  
Non-fluoroscopic percutaneous transcatheter closure of atrial septal defects in children under transesophageal echocardiographic guidance
  Wei-Ze Xu, Xin-Yi Shou, Jian-Hua Li, Jian-Gen Yu, Ze-Wei Zhang, Jin Yu, Jing-Jing Ye
Background: This study sought to investigate the feasibility, safety and effectiveness of transcatheter closure of atrial septal defects (ASDs) under the guidance of transesophageal echocardiography (TEE) in children.
Methods: We reviewed the medical records of patients who underwent percutaneous ASD closure at our center from August 2016 to December 2017. For a total of 88 patients who were identified as having a single-hole defect and were undergoing percutaneous transcatheter ASD closure, a procedure completely guided by TEE was performed. There were 31 male patients and 57 female patients. The patients* mean age was 60.09 ㊣ 36.42 months (13-182 months), and their mean body weight was 20.16 ㊣ 10.04 kg (9-77 kg). Patients were followed up by performing transthoracic echocardiography and obtaining chest X-rays and electrocardiograms.
Results: The transcatheter closure of ASDs was successful in all patients. The mean ASD size was 11.58 ㊣ 5.31 mm (3-28 mm), and the mean size of the occlusion device was 16.07 ㊣ 5.29 mm (6-36 mm). The mean procedural times were 13.33 ㊣ 2.82 minutes (6-16 minutes). The mean hospitalization costs were 27,259.66 ㊣ 2507.04 RMB (25,200.00-33,911.45 RMB). The mean postoperative hospital stay was 3.22 ㊣ 0.53 days (3-5 days). Residual shunt, occlusion device shedding or displacement, and pericardial effusion were not observed during or after the operation.
Conclusion: Percutaneous transcatheter ASD closure completely guided by TEE is a feasible, safe, non-invasive and easy procedure.
  [Abstract] [Full Text] [PDF]  
Association of sleep quality with sociodemographic factors and lifestyle in adolescents from southern Brazil
  Tiago Rodrigues de Lima, Diego Augusto Santos Silva
Background: Good sleep quality is an essential component for growth, development, and physical and mental health of the individual, in addition to being a positive indicator of health and well-being. The objective of this study was to estimate the prevalence of poor sleep quality and to identify the association of poor sleep quality with sociodemographic factors, lifestyle, weight status, and associated aerobic fitness in adolescents.
Methods: This study included 1110 students aged 14-19 years from city of Sao Jose/SC, Brazil. Sleep quality of the subjects was assessed using a questionnaire and classified as adequate and low. Independent variables were gender, age, monthly household income, maternal education, school shift, global physical activity, proper diet, screen time, sleeping hours of full week, sleeping hours of weekdays, sleeping hours of weekends, weight status, and aerobic fitness. Binary logistic regression was used to estimate odds ratios and confidence intervals of 95%.
Results: Prevalence of poor sleep quality was 60.4%. More likely to have poor sleep quality were identified in female students (OR 1.68, 95% CI 1.11每2.55), whose mothers had higher levels of education (OR 1.44, 95% CI 1.20每1.73) and low aerobic fitness (OR 1.80, 95% CI 1.02每3.19).
Conclusion: Adolescents who were most likely to report poor sleep quality were female, those whose mothers had a higher educational level and had low aerobic fitness. Students with sedentary risk behavior were less likely of reporting poor sleep quality.
  [Abstract] [Full Text] [PDF]  
The role of melatonin and cortisol circadian rhythms in the pathogenesis of infantile colic
  Tolga İnce, Hakkı Akman, Dilek Çimrin, Adem Aydın
Background: Despite the high prevalence of infantile colic, the pathogenesis remains incompletely understood. Cortisol and melatonin hormones affect gastrointestinal system development in several ways, and interestingly, both cortisol and melatonin*s circadian rhythms begin around the 3rd month in which infantile colic symptoms start to decrease. We hypothesized that infantile colic might associate with desynchronization of normal circadian rhythms of these hormones. In this study, we aimed to investigate the role of melatonin and cortisol in the pathogenesis of infantile colic.
Methods: Patients who were diagnosed as infantile colic according to Wessel*s ※rule of three§ were enrolled in the colic group. We measured the saliva melatonin and cortisol levels of colic group and control group infants. In both groups, the saliva samples were taken in mornings and at evenings, at the time of diagnosis and 6th month.
Results: Fifty-five infants finished the study. Melatonin circadian rhythm developed earlier in the control group than the infantile colic group in our study. We found no significant difference between the daily mean cortisol levels. However, infants with colic had flatter daily cortisol slope than controls which pointed out the probability that they had a less clearly defined cortisol rhythm than infants without colic.
Conclusions: We found an association between melatonin levels and infantile colic. However, more research is needed to fully understand the role of hypothalamic-pituitary-adrenal axis and hormone*s role on infantile colic physiopathology.
  [Abstract] [Full Text] [PDF]  
Ex utero intrapartum treatment for giant congenital omphalocele
  Xu‑Yong Chen, Ji‑Xin Yang, Hong‑Yi Zhang, Xiao‑Feng Xiong, Khalid Mohamoud Abdullahi, Xiao‑Juan Wu, Jie‑Xiong Feng
Background: To determine whether ex utero intrapartum treatment (EXIT) is an appropriate approach for managing fetuses antenatally diagnosed with giant congenital omphaloceles.
Methods: We retrospectively reviewed patients with omphaloceles who underwent either an EXIT procedure or a traditional repair surgery. Basic and clinical parameters including gender, gestational age, birth weight, maternal blood loss, operative times and operative complications were analyzed. During the 6每12-month follow-ups, postoperative complications including bowel obstruction, abdominal infections, postoperative abdominal distension were monitored, and survival rate was analyzed.
Results: A total of seven patients underwent the EXIT procedure and 11 patients underwent the traditional postnatal surgery. We found no differences in maternal age, gestational age at diagnosis, gestational age at delivery and birth weight between the two groups. In the EXIT group, the average operation time for mother was 68.3 ㊣ 17.5 minutes and the average maternal blood loss was 233.0 ㊣ 57.7 mL. The operation time in the EXIT group (22.0 ㊣ 4.5 minutes) was shorter than that in the traditional group (35 ㊣ 8.7 minutes), but the length of hospital stay in the EXIT group (20.5 ㊣ 3.1 days) was longer than that in the traditional group (15.7 ㊣ 2.5 days, P < 0.05). During the follow-up, one patient in the EXIT group had an intestinal obstruction, one developed abdominal compartment syndrome and one died in the traditional group.
Conclusions: In our experience, EXIT is a safe and effective procedure for the treatment of giant congenital omphaloceles. However, more experience is needed before this procedure can be widely recommended.
  [Abstract] [Full Text] [PDF]  
Brief report:
Association of T-helper cell cytokine level with age in patients with biliary atresia: a preliminary study
  Fu-Bang Li, Xiao-Li Shu, Wei-Zhong Gu, Xiao-Xia Zhao, Shou-Jiang Huang, Hong Zhao, Ke-Rong Peng, Jin-Fa Tou
Background: The pathogenesis of biliary atresia (BA) is associated with an inflammatory process involving the biliary tree. This study aimed to investigate the association of T-helper cell cytokine levels with age in patients with BA.
Methods: Twenty-eight patients with BA were divided into three groups according to their age (< 2 months, 2每3 months, and ≡ 3 months). All the patients underwent Kasai portoenterostomy. Blood samples were collected from the patients preoperatively, and the liver tissue specimens were obtained during surgery. We detected serum levels of interleukin (IL)-1汕, IL-12p70, interferon (IFN)-污, IL-6, IL-10, and transforming growth factor (TGF)-汕1 and liver expression of IL-1汕, IL-6, and TGF-汕1.
Results: The serum levels of IL-1汕, IL-12p70, IL-6, and IL-10 in patients aged ≡ 3 months were significantly higher than those in patients aged < 2 months. There were no significant age-related differences in the IL-1汕, IL-6 and TGF-汕1 expression levels in the liver tissue of patients with BA.
Conclusions: The serum levels of IL-1汕, IL-6, IL-10 and IL-12p70 showed significant age-related differences in patients with BA. Interpretation of the role of cytokines in BA needs to take patient*s age into consideration.
  [Abstract] [Full Text] [PDF]  
Letters to the editors:
Consecutive occurrence of benign epilepsy with centro-temporal spike and childhood absence epilepsy: true coexistence or atypical evolution?
  Eun Hye Lee, Hoi Soo Yoon
  [Abstract] [Full Text] [PDF]  
BECTS and CAE: a possible neurobiological continuum
  Alberto Verrotti, Chiara Mazzocchetti
  [Abstract] [Full Text] [PDF]  
Liver transplantation due to cerebrotendinous xanthomatosis end-stage liver disease
  Cong-Huan Shen, Zheng-Xin Wang
  [Abstract] [Full Text] [PDF]  
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