Table of Content

10 July 2017, Volume 25 Issue 7

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Orignal Article

Specification of outpatient service of development behavior pediatrics

JIN Xing-ming

2017, 25(7):  649-651.  DOI: 10.11852/zgetbjzz2017-25-07-01

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In the outpatient service of development behavior pediatrics,the basic pediatric prodeduse should be not only followed,but also the multi-dimensional assessment be taken including the measurement of physical growth,behavioral observation,developmental and psychological tests etc.Then making the specific diagnosis according to the diagnostic criteria (DSM-5,ICD-10,DSM-PC) and clinical characteristics.Besides,four aspect been paid attention in the diagnosis:functional impairment;integration and analysis all assessment Results;the relationship between developmental age and behavior.Afterwards the implementation of the intervention or treatment,such as behavioral modification,family counselling,psychotherapy medication and rehabilitation etc.

Study on the association of methylation level of the promoter region of NPR1 gene with autism spectrum disorder in Han Chinese population in northern China

LI Hai-xin, LIANG Shuang, YANG Xiao-lei, SUN Yi, HAN Pan-pan, JIANG Xi-tao, SUN Cai-hong, WU Li-jie

2017, 25(7):  652-655.  DOI: 10.11852/zgetbjzz2017-25-07-02

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Objective To investigate the DNA methylated status of the promoter region of NPR1 gene in autistic children and explore its role in the etiology of autism spectrum disorder (ASD). Methods Totally 9 pairs of ASD-related monozygotic twins, as well as 30 cases of confirmed autism and 30 healthy controls were selected.The DNA methylation level of the promoter region of NPR1 gene (Chr.1:153652122,Chr.1:153652129) was detected by pyrosequencing.The association of the methylation level of ASD cases with the symptoms of ASD which was evaluated by Social Responsiveness Scale (SRS) was analyzed using pearson's correlation analysis. Results A higher difference than standard was found within 2 pairs of ASD-discordant monozygotic twins on the methylation level of the detected loci.Compared with controls,autistic children had higher methylation levels (P<0.05).In addition,the correlation analysis showed a positive correlation between the autistic behavior pattern and the methylation level of the tested loci (P<0.05). Conclusion The methylation level of NPR1 gene in ASD children is abnormal and is positively related to the social behavior of ASD.

Case-control study on gray matter volume in 3~8 years old male children with autism spectrum disorder

CHEN Lei, WANG Jia, FU Kuang, WU Qiong, GUO Xiao-nan, WU Li-jie

2017, 25(7):  656-659.  DOI: 10.11852/zgetbjzz2017-25-07-03

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Objective To investigate the changes of the gray matter volume (GMV) in 3~8-year-old male children with autism spectrum disorder (ASD) compared with typically developing male controls (TD) and then assess whether these structural changes were associated with autistic behavioral symptoms. Methods Anatomical T1 images of the whole brain were scanned from 31 ASD male children and 31 normally typically developing male children controls aged 3~8 years.We applied voxel-based morphometry (VBM) techniques to obtain GMV of each brain regions.A voxel-by-voxel two sample t-test combined an Alphasim multiple correction were applied to compare the GMV between ASD group and TD group.The correlations between GMV of the brain regions which showed group difference and the clinical symptom severity were examined. Results Differences were detected in regional GMV between the ASD and TD group.Compaired to control,ASD children showed significantly increased GMV in a large cluster(voxel:z=2 981),including the left superior temporal gyrus (x,y,z:-50.5,-9.5,7.5) and the left postcentral gyrus (x,y,z:-61.5,-7.5,31.5).There was no significant correlation between GMV of the two brain regions and any scores of the ADOS,ADI-R and ABC scores,including the total and subscale scores(P>0.05). Conclusion sGMV of the left superior temporal gyrus and the left postcentral gyrus of 3-8-year-old male children with ASD increase.This study provides an Objective imaging evidence for the pathogenesis of damaged communicational ability and somatosensory anomalies in ASD children.

Study relationships among interparental conflict,parental harsh discipline and parent-child attachment in children with attention deficit hyperactivity disorder

WANG Feng, ZHANG Jue-chun, DU Ya-song, ZHOU Guo-quan, XIAO Wei-qin, XIE Hong-tao

2017, 25(7):  660-663.  DOI: 10.11852/zgetbjzz2017-25-07-04

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Objective To study the correlation of interparental conflict and parental harsh discipline with parent-child attachment in school-age children with attention deficit hyperactivity disorder (ADHD). Methods The survey was made in 103 ADHD children (ADHD group) and 103 matched normal children (control group) by kerns security scale (KSS),Children's Perception of Interparental Conflict Scale (CPIC) and self-designed questionnaire of parental harsh discipline.The relationship between interparental conflict,parental harsh discipline and parent-child attachment in children with ADHD was analyzed. Results 1)The KSS scores of mother-child and father-child in ADHD group [(2.66±0.33),(2.68±0.46)] were statistically lower than those in control group [(2.97±0.32),(2.88±0.40)](all P<0.01).2)The CPIC scores of frequency,strength,solution,content and self-blame in ADHD group were statistically higher than those in control group (all P<0.01).3)The scores of mother scolding children were negatively correlated with the KSS scores of mother-child,and the scores of father scolding and spanking children were negatively correlated with the KSS scores of father-child in ADHD group (r=-0.240,-0.234,-0.276,P<0.05 or <0.01).4)Multiple linear regression analysis showed that mother scolding children was significant influential factor of mother-child attachment security (P<0.05),and CPIC frequency and solution were significant influential factors of father-child attachment security (P<0.05 or <0.01). Conclusion sThe poor parent-child attachment of ADHD Children is under the influence of interparental conflict and parental harsh discipline.To establish harmonious marriages of ADHD children's parents and reduce harsh parental discipline are conducive to the improvement of parent-child attachment of ADHD children.

Development of preschool pediatric symptom checklist

REN Fang, ZHANG Jing-song

2017, 25(7):  664-667.  DOI: 10.11852/zgetbjzz2017-25-07-05

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Objective To introduce the preschool pediatric symptom checklist(PPSC)into Chinese version,analysis its reliability and validity and establish its cutoff score. Methods A total of 506 samples aged 18~60 months were enrolled in Shanghai.A toatl of 65 samples were retested the reliability at interval of two to four weeks.Exploratory factor analysis was adopted. Results In Chinese version all the original 18 items were kept and four factors were extracted:externalizing,attention problems,parenting challenges and internalizing,which were accumulated as 49.66% of the total variance.Factor loadings of items were 0.35~0.81.The Cronbach's α coefficient was 0.83.The test-retest reliability was 0.53(P<0.01).ROC analysis yielded a sensitivity of 71.6% at a specificity of 70.6% when the cutting score was 12 for boys and a sensitivity of 67.3% at a specificity of 65.5% when the cutting score was 10 for girls. Conclusion sThe Chinese version of PPSC has good reliability and validity.It also has good sensitivity and specificity when the cutting score is 12 for boys and 10 for girls.It can be used to screen social emotional problems among children between 18 and 60 months.

The chain mediating effects of migrant children' social support and social integration for social capital and life satisfaction

QIU Da-ming, ZHANG Ren-ren

2017, 25(7):  668-670.  DOI: 10.11852/zgetbjzz2017-25-07-06

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Objective To explore the internal mechanism of social capital and life satisfaction. Method A questionnaire survey of 1 229 floating children was conducted to investigate the mediating roles of social capital and life satisfaction of social support and social integration by bootstrap. Results 1) Social capital and life satisfaction was mediated by social support (effect=0.19,60.55%) and social integration (effect=0.05,16.51%) respectively.2) Social capital could affected life satisfaction through the chained mediation of social support and social integration. Conclusion Social capital is affected life satisfaction through the chained mediation of social support and social integration,the effect of social support is better than social integration.

Study on the relationship between internet addiction and childhood maltreatment among adolescents

XU Geng, WANG Lu-han, HAN A-zhu, SU Pu-yu

2017, 25(7):  671-674.  DOI: 10.11852/zgetbjzz2017-25-07-07

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Objective To understand the prevalence of internet addiction in adolescent and explore its relation to childhood abuse and neglect. Methods A survey was conducted among 5 726 middle school students in three cities (Fuyang,Tongling,Tianshui) of Anhui province by the cluster sampling Methods.General situation,Internet Addiction and childhood abuse and neglect were assessed with Anhui Adolescent Health Related Behavior Questionnaire. Results 5.41% boys and 2.93% girls were detected internet addiction,there are significant differences between boys and girls (χ²=47.66,P<0.001).Boys had more childhood physical abuse,emotional abuse,sexual abuse,physical neglect than girls with significant difference (P<0.01).The risk factors for adolescent mild internet addiction included childhood emotional abuse,sexual abuse and physical abuse (P<0.05),childhood sexual abuse was a risk factor for adolescent severe Internet Addiction (P<0.05). Conclusion sInternet addiction is closely related to childhood abuse and neglect.In addition,the influence of childhood abuse and neglect on internet addiction should be concerned.

Status of oxidative stress in children with type 1 diabetes mellitus

ZHAO Yong-xin, XIN Ying

2017, 25(7):  675-678.  DOI: 10.11852/zgetbjzz2017-25-07-08

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Objective To compare the serum levels of oxidative stress index in type 1 diabetic children and healthy children,and explore the changes of oxidative and anti-oxidative ability of children with type 1 diabetes mellitus. Methods A total of 62 type 1 diabetic children were selected as study cases,and 36 healthy children as normal controls.According to duration and infected situation,the study cases was divided into onset group and little long-term group,infected group and un-infected group.Serum levels of oxidative parameters:malondialdehyde (MDA),nitric oxide (NO),and anti-oxidative parameters:glutathione peroxidase (GPx),superoxide dismutase (SOD) were measured.At the same time,fasting blood glucose,c-peptide,glycosylated hemoglobin (HbA1c),blood urea nitrogen in study cases were detected.The significance and correlation among these parameters were analyzed. Results The serum MDA,NO,SOD levels in study cases were significantly higher than controls (P<0.05),while the levels of serum GPx level in cases was significantly lower than controls (P<0.05).In the onset group,MDA,NO,SOD were significantly higher than controls (P<0.05),GPx was significantly lower than controls,too (P<0.05).There was no significance between infected and un-infected groups(P>0.05).There was a positive correlation between levels of MDA and levels of HbA1c (r=0.376,P<0.01). Conclusion sThe significant increase of oxidative stress and decrease of anti-oxidative capacity occurr at onset and in the development of type 1 diabetes mellitus in children.Oxidative stress may take the important role in type 1 diabetes mellitus of children.

Correlation study on expression of CaMKⅡ and ERK in Cerebral Cortex of autism mouse model

SUN Yan-qiu, JIANG Zhi-mei, NIE Ying, GUO Lan-min, LI Xue-mei, WANG Can

2017, 25(7):  679-682.  DOI: 10.11852/zgetbjzz2017-25-07-09

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Objective To explore the role of calmodulin-dependent protein kinase Ⅱ (CaMK Ⅱ )and extracellular signal-regulated kinase ( ERK) in the pathogenesis of autism spectrum disorders. Methods Female Sprague-Dawley rats were given a single intraperitoneal injection of sodium valproate (VPA,600 mg/kg) on 12.5 d after pregnancy,and their offspring were as the model group; while the other pregnancy rats were given normal saline,and their offspring were as the control group.Both groups were observed with the HE staining,immunohistochemistry of CaMK Ⅱ and ERK and image analysis 1,7,14 d and 28 d after birth. Results Compared with the control group,HE staining showed the number of cortical neurons decreased on 1 d and 7 d after birth in the model group,rapidly increased on 14 d after birth,and maintained in high level on 28d after birth.For immunohistochemistry,the integrated optical density (IOD) of CaMKⅡ and ERK were increased in cortex on 1~14 d after birth (P<0.001) in both groups,and were stable 28 d after birth (P>0.05).Compared with the control group,the IOD of CaMK Ⅱ and ERK increased much more at every time point (P<0.001) in the model group.CaMK Ⅱ and ERK were increased on 1 d,7 d (P<0.001),significantly increased on 14 d (P<0.001),and tended to be stable on 28 d after birth (P>0.05). Conclusion The expression of CaMKⅡ and ERK of cerebral cortex neurons increases in the autism model rats,especially in the early time.

Effects of congenital lead exposure on growth indicators and mineral nutrition status in developmental offspring of rats

ZHOU Jian-ping, WANG Fan, ZHONG Bo, YI Xiao-qing, WANG Xue-ying, WANG Jing-jing, JIANG Yong-sheng

2017, 25(7):  683-686.  DOI: 10.11852/zgetbjzz2017-25-07-10

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Objective To explore the effects of congenital lead exposure on physique indicators and mineral nutrition status in developmental offspring of rats. Methods The animal model of congenital lead exposure was established with the use of similar genetic background Sprague Dawley pregnant rats drinking freely 0.1% (low-dose group,LG) and 0.2% (high-dose group,HG) lead acetate solution.The normal control group (NG) was also established.Dynamic measurement of the weights and the tail lengths were adopted to show the physical growth conditions of the offspring rats on 1 to 7 days (1 to 7 d) and 14 days (14 d) after birth.The levels of plasma lead,zinc,iron,and calcium on 36 d and 60 d,serum growth hormone (GH) were measured through the Methods of atomic absorption spectrometry and radioimmunoassay. Results The average birth weight and tail length of offspring rats decreased in congenital lead exposure groups (P<0.01).Compared to group NG,the growth of weight and tail length on 2 to 14 d was significantly slow in groups LG and HG (P<0.01).As for the levels of plasma zinc and iron,there were significant statistical differences among groups NG,LG and HG on both 36 d and 60 d (P<0.01).On 36 d,the offspring rats' plasma calcium in groups NG[(2.03±0.22) mmol/L],LG[(1.75±0.24) mmol/L] and HG[(1.62±0.21) mmol/L] were significantly different (P<0.01).On 60 d,the plasma calcium levels of groups NG,LG and HG were respectively (2.02±0.21)mmol/L,(1.85±0.22)mmol/L and (1.76±0.17)mmol/L (P<0.01).The serum GH of 60 d offspring rats were (2.15±0.35) ng/ml for NG,(1.98±0.24) ng/ml for LG,and (1.86±0.25) ng/ml for HG (P<0.01).There were also significant statistical differences between HG and NG (P<0.01),LG and NG (P<0.01) or HG and LG (P<0.05). Conclusion Congenital lead exposure can lead to intrauterine growth restriction in fetal rats and physique growth delay in offspring rats after birth,which may be related to decreases of GH secretion and deficiency of mineral nutrient zinc,iron and calcium.

Effects of gestational diabetes mellitus on offspring`s health:transmission of metabolic syndrome

HUO Ting-zhu, LUO Xiao-li, MAO Meng

2017, 25(7):  687-691.  DOI: 10.11852/zgetbjzz2017-25-07-11

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Gestational diabetes mellitus has adverse impact on pregnant women and their offspring and increase the risk of metabolic syndrome for the posterity.Meanwhile,the incidence rate of macrosomia or large for gestational age infant will be increased and also the obesity rate of the children.However,the incidence of metabolic syndrome directly caused by gestational diabetes mellitus is still in controversy.Reports have point out that metabolic syndrome have some relations with hyperinsulinism,hyperglycemia and maternal metabolic and immunologic disturbance during pregnancy which can change the metabonomice of the fetus,which may increase the risk of metabolic syndrome.Hence,decreasing and controlling gestational diabetes mellitus,improving maternal realization for health herself and her offspring,adjusting her life styles and behaviors and managing their child after delivery may improve mother and child health and decrease the long term disease burden both for gestational diabetes mellitus and their children's,reduce the transmission of metabolic syndrome.

A review on development of children of parents with severe mental illness

YU Li-ping, CAI Chun-feng

2017, 25(7):  692-694.  DOI: 10.11852/zgetbjzz2017-25-07-12

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Children of parents with severe mental illness is at risk for mental illness or behavioural disorder.However,a significant number of children show resilience and successful adaptation because of some protective factors.Adverse outcomes in children and adolescents are often the result of interaction between parents' mental illness and various factors,and the mechanisms are multidimensional,including a broad range of temperament/heritability and psychosocial factors.This article reviews the recent findings and points the limitation and future research topics based Chinese cultural background.

Etiology of the idiopathic intoeing child assessment and treatment

MA Kang-xia, YU Yan, JIANG Shu-yun

2017, 25(7):  695-698.  DOI: 10.11852/zgetbjzz2017-25-07-13

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Intoeing gait is a common complaint in infants,toddlers and young children,which perplex all the parents and doctors.Intoeing gait can occur on an underlying anatomic or neuromuscular condition,but the majority cases of intoeing gait is idiopathic.Although most of the symptoms and abnormal gait were resolved as the child's development and maturation,but not all cases could be spontaneously correct,and may be secondary to more severe malformations.Treatment for intoeing gait is based on age,underlying cause,and the severity of anatomic or functional issues.To review the up-to-date literature on the causes,diagnosis,and treatment of idiopathic intoeing children,the parents and doctors can be more comprehensive understanding of intoeing gait,in order to select the appropriate treatment and time.

Research and application progress of infant developmental screening scales

XIA Bin, GU Gui-xiong

2017, 25(7):  699-701.  DOI: 10.11852/zgetbjzz2017-25-07-14

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The infant developmental screening scale is used for screen the level of cognitive behavioral development of early childhood,it is simple,rapid and economical.Do diagnostic tests for screening positive infants as early as possible in order to early diagnosis,treatment and intervention.Through the method of literature analysis,compared with the development history and research and application progress of three infant screening scales for the current domestic and international:Denver Development Screening Test(DDST/Denver Ⅱ),Developmental Screening Test( DST),Age&Stage Questionnaires(ASQ),in order to provide a reference for the selection of appropriate infants' developmental screening scale for child health care personnel.

A review on the epidemiological characteristics and influence factors of hand,foot and mouth disease in kindergartens

LIU Tian, XIA Shi-guo, HAO Hai-bo, HUANG Ji-gui, MAO An-lu

2017, 25(7):  702-704.  DOI: 10.11852/zgetbjzz2017-25-07-15

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The hand,foot and mouth disease(HFMD) is entered into the administration list of C Class infectious diseases of the People's Republic of China Law of infectious disease.It is usually epidemic in the kindergartens,and seriously damage children's physical and mental health.Epidemiological characteristics and influence factors of HFMD in kindergartens are reviewed based on the relative references at home and abroad,in order to learn more research works about the virus in time and to provide scientific evidences on the prevention and control of HFMD in kindergartens.

Systematic review of intervention studies for developmental coordination disorder children

ZHUANG Cheng, LI Hong-juan, CHEN Yan-jie

2017, 25(7):  705-708.  DOI: 10.11852/zgetbjzz2017-25-07-16

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Objective s To explore the effect of different intervention Methods on motor ability of children with developmental coordination disorder(DCD),and to provide the theoretical basis for the treatment of DCD children. Methods Studies included in this review were from papers published from Jan,1995 to Mar,2015 which were described as systematic review,(randomized) clinical trial,or crossover design about the effect of motor intervention in children with DCD.A total of 41 studies met the inclusion criteria for the systematic review.Interventions were coded under three types:1) task-oriented intervention,2) process-oriented therapies,and 3) medical supplements.These articles were evaluated according to the Levels of Evidence Oxford and PEDro. Results The evidence level of all the studies included was in the moderate or above.A comparison of three interventions showed that it is obvious strong effects for task-oriented intervention,whereas the process-oriented intervention was weak and treatment with methylphenidate was moderate. Conclusion sTask-oriented intervention is the most effective method for children with DCD to improve their motor performance,and much better than processoriented therapies intervention method.

Effect of comorbid attention deficit hyperactivity disorder on achool-age Asperger syndrome children's academic and social function impairment

LIANG Ya-yong, CHEN Kai-yun, CHEN Bi-yuan, CEN Chao-qun, ZOU Xiao-bing

2017, 25(7):  709-711.  DOI: 10.11852/zgetbjzz2017-25-07-17

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Objective To explore the effect of comorbid ADHD on school-age Asperger syndrome (AS) children's academic and social function impairment. Methods The Vanderbilt ADHD Rating Scales was used to evaluate the diagnosed 90 school-age AS children (male 85,female 5) in out-patient,the age ranged from 6~14 years,Average age was 9.11±2.11.The academic and social function impairment of 44 comorbid ADHD children were compared with pure AS children. Results The academic and social function impairment in AS+ADHD group were serious than the pure AS group,which had a distinguished statistical significance (P<0.01). Conclusion The school-age AS children comorbid ADHD have more serious academic and social function impairment.

Asthma control status and effect factors of 400 asthmatic children in Guiyang

LUO Xin-bing, ZHU Xiao-ping

2017, 25(7):  711-714.  DOI: 10.11852/zgetbjzz2017-25-07-18

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Objective To investigate the status of asthma control and the effect factors of asthmatic children in Guiyang,and provide the basis for further strengthening asthma prevention and treatment. Methods A total of 400 asthmatic children who visited the outpatients departments of Affiliated Hospital of Guizhou Medical University were selected,theses asthmatic children aged 1~14 years old and the course was more than 12 months.Retrospective investigation was conducted to the parents on the status of asthma control and their cognitive level about asthma,theses children were separated into the controlled group and uncontrolled group according to asthma conditions in the past 12 months.Multivariate analysis was carried out on the related factors likely to affect the asthma control. Results In the past 12 months,72.5% asthmatic children had asthma attacks,35.5% asthmatic children had visited the emergency room,and 17.8% asthmatic children had been hospitalized.Family economic condition,parents' education,parents' cognitive level,adhere to normalized medication and regular visits were protective factors of asthma control,personal history of allergy,family history of asthma,and history of passive smoking were risk factors of asthma control. Conclusion sChildren's asthma is poorly controlled in Guiyang area,there is a certain gap compared with the national average city.Parents' cognitive level,treatment adherence,contacting with bad environment are the main factors of asthma control.Understanding and improving the influencing factors can help to improve the level of asthma control.

Epidemiological investigation of children with mental retardation from 0 to 6 years old in Hainan province

LI Ling, LI Xiao-ling, LI Chao, WU Wei-xue, CAI Xiao-fan, FAN Xia-lin, WEI Xiu-hui, SUN Ting-ting

2017, 25(7):  715-717.  DOI: 10.11852/zgetbjzz2017-25-07-19

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Objective To know the prevalence and distribution of mental retardation for children in Hainan province,and to provide scientific basis for the government to carry out the rehabilitation policy and build more rehabilitation institutions for children. Methods Selecting 37 862 children aged 0~6 years old from 18 different cities and counties in Hainan province,using the "child development issues warning signs" questionnaire screening,then the children who were positive after screening were diagnosed by clinical specialist with Gesell Development Diagnosis Scale (GDDS) and Infants-Junior Middle School Students' Social Life Ability Scale. Results In Hainan province, the prevalence rate of mental retardation was 6.1‰.The prevalence rate of mental retardation was not significantly difference among gender (χ²=4.57,P=0.032) and area (χ²=8.46,P=0.037);there was significantly different (χ²=211.81,P=0.000) among the prevalence of mental retardation of children in age;the prevalence rate of mental retardation of children with mild illness was higher than that of children with moderate and severe mental retardation in Hainan province. Conclusion sThe prevalence rate of mental retardation in Hainan province is significantly lower than the average level,which mainly is still mild mental retardation.

Rehabilitation effect of visual music therapy on mental retardation children

WANG Su-li, LI Wen-yan, YUE Bao-zhu, LI Yu-ai, CHEN Jian-gui

2017, 25(7):  718-721.  DOI: 10.11852/zgetbjzz2017-25-07-20

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Objective To explore visual music therapy to mental retardation children's rehabilitation effect. Methods A total of 100 children with mental retardation in children's rehabilitation treatment from June 2013 to June 2015,3 to 6 years old,were randomly divided into observation group and control group with 50 cases in each group.The control group was treated with routine rehabilitation therapy,and the observation group was treated with visual music based on the control group.They were evaluated by Gesell Development Scale and Infants- Junior Middle School Students' Social Life Ability Scale before treatment and after 6 months,to observate improvement of children's intelligence level and of social life ability. Results After treatment,the Gesell Development Scale of adaptability,large movement,fine motor,language and personal social 5 areas development quotient (DQ) and development age (DA) in observation group were better than that of before treatment and the control group,the differences were all statistically significant (all P <0.05).After treatment Infants Junior Middle School Students' Social Life Ability Scale scores and standard scores of two groups were better than that of before; after treatment,the observation group total score and standard score improvement degree of the two groups were higher than that of the control group,the differences were all statistically significant (all P <0.05). Conclusion Visual music therapy can significantly improve the mental retardation and social life ability of children with mental development,it is worth in clinical application.

Analysis of the mutation in phenylalanine hydroxylase gene in a Chinese patient with hyperphenylalaninemia

DAI Xiang, HU Xi-jiang, TONG Jing, CAI Wen-qian

2017, 25(7):  721-723.  DOI: 10.11852/zgetbjzz2017-25-07-21

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Objective To test genetic mutations in phenylalanine hydroxylase (PAH) gene in a patient with hyperphenylalaninemia and her parents,and to investigate the genotype,phenotype and genetic features. Methods Blood samples and clinical data of the proband and her parents were collected.DNA was extracted from the blood samples.The PAH gene mutations were analyzed by polymerase chain reaction(PCR) and direct sequencing.Meanwhile,a total of 120 normal controls were collected. Results Compound heterozygous mutations PAH L367R and F392I were identified in the proband,heterozygous L367R was identified in the mother,heterozygous F392I was identified in the father.L367R was a novel mutation. Conclusion sThe PAH gene mutations L367R and F392I cause hyperphenylalaninemia in the proband,and her parents are carriers of the mutations.The gene testing will be helpful for clinical diagnosis,selecting of therapeutic regimen,and further guidance of procreation.

Value of neutrophil to lymphocyte ratio in early grading diagnosis of neonatal hypoxic ischemic encephalopathy

WU Jie, HAN Ya-mei, ZHANG Juan-li, ZHANG Ya-ting, CHEN Jing, XU Ding

2017, 25(7):  724-727.  DOI: 10.11852/zgetbjzz2017-25-07-22

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Objective To investigate the value of neutrophil to lymphocyte ratio (NLR) in early grading diagnosis of neonatal hypoxic ischemic encephalopathy (HIE). Methods A total of 134 cases were collected in Lanzhou University Second Hospital and were divided into three groups:the mild HIE group (n=42),the moderate and severe HIE group (n=36),and the normal control group (n=56).It was included neonatal general information,birth situation,blood cell count on 1st day,3rd and 7th day,and calculating NLR and platelet to lymphocyte ratio (PLR).The cranial magnetic resonance imaging (MRI) was scaned in the time of 1st week after birth.Univariate factor analysis,receiver operating characteristic curve (ROC curve) and Kappa consistency analysis were used to determine the NLR value. Results Univariate analysis showed that white blood cells count,neutrophils count and NLR levels on 1st day and 3rd day were the risk factors in the moderate and severe HIE group.Compared with the normal controls,NLR levels on 1st day of the moderate and severe HIE patients increased significantly (5.55±1.88 vs 2.63±0.91,P<0.05),relatively,that of the mild HIE patients increased slightly (2.71±0.92 vs 2.63±0.91,P>0.05).The levels of NLR in the moderate and severe HIE group was significantly higher than that of the mild HIE group (5.55±1.88 vs 2.71±0.92,P<0.05);ROC curve showed the efficiency of NLR on 1st day(area under the curve up to 0.959) was the highest with sensitivity of 93.3%,specificity of 81.0% and the optimal cut-off value was 3.43;Kappa analysis showed that the Results of NLR were consistent with that of cranial MRI in 1st week after birth. Conclusion NLR has a certain predictive value for the early grading diagnosis of HIE after asphyxia.

Investigation and analysis of vitamin A,D and E of school-aged children in Jiamusi

WANG Li-min, WANG Wen-juan, ZHANG Xue-ling, LI Chun-yu, WANG Yu, LIU Jie-wei

2017, 25(7):  728-730.  DOI: 10.11852/zgetbjzz2017-25-07-23

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Objective To learn the status of serum vitamin A,D,E level and the nutrition of school-aged children,and to provide the reference for the supplement of micro-nutrients and prevention of related diseases in the age group of children. Methods Totally 6 030 children from the age of six to twelve were recruited in the outpatient and inpatient departments at the First Affiliated Hospital of Jiamusi,the People's Hospital of Jiansanjiang,Central Hospital of Baoquanling etc more than 10 hospitals from May 2015 to April 2016.Vitamin A,D,E levels were directed and the differences were compared by gender,age-group and detecting season. Results The rate of lack of vitamin A was 55.1% and the adequate was 44.9%; the deficiency rate of vitamin E was 0.67% ;the lack rate of vitamin D was 37.9%,the insufficient was 24.2% and the adequate was 37.9%; The stratified analysis showed the levels of different gender was not statistically significant (P>0.05).There was no difference in different age-groups (P>0.05).There existed significantly difference in different seasons (P<0.05). Conclusion The levels of vitamin A,D are lower in school-aged children in Jiamusi area,and the differences of vitamin A,D and E are obvious in different seasons,which should arouse the attention of parents and the medical workers of all levels.

Survey on the use and influencing factors for child restraint system among preschool children in the central city of Shanghai

LI Wei-yi, GAO Shu-na, SU Hui-jia, FU Chao-wei, WANG Ye-jing

2017, 25(7):  731-733.  DOI: 10.11852/zgetbjzz2017-25-07-24

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Objective To investigate the current status of child restraint system(CRS) use,and analyze related factors. Methods A questionnaire survey of children's car taking status was conducted among 1 119 3~6 years old children's parents who owned private car selected through cluster random sampling in Huangpu district.The survey included basic demographic characteristics,the use of CRS etc.Chi square test was used to compare the rates among groups,and multivariate Logistic regression analysis was used to screen the risk factors. Results Of 1 119 parents surveyed,62.02%(694/1 119) reported to have CRSs and 25.92%(290/1 119) reported consistent use of CRS.Multivariate analysis indicated that young age of children,local household registration,One-child family,high level of education of parents,good family economic status were the positive factors for CRSs use.The parents' awareness of importance of children's taking car safety,the frequency and distance of children's car taking significantly influenced the CRS use. Conclusion sThe CRS utilization rate is low.Parents have misunderstandings in using CRS to protect child passengers safety,it is necessary to strengthen the propaganda and education.

Serum uric acid level of 3~6 years old children in urban Tianjin and the suggested reference range

DU Yue-xin, LI Nan, ZHANG Shuang, LIU Gong-shu, ZHANG Tao, LENG Jun-hong, WANG Hua

2017, 25(7):  734-736.  DOI: 10.11852/zgetbjzz2017-25-07-25

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Objective To investigate the serum uric acid level and its distribution in children aged 3~6 years in urban Tianjin,and to explore the reference range of serum uric acid for healthy pre-school children. Methods 26 kindergartens involving 4 083 children aged 3~6 years were randomly selected from the urban Tianjin.Serum uric acid was tested using the peripheral blood from right leech-finger. Results 1)The average level of serum uric acid was (243.0±52.8) μmol/L.There were significant differences of serum uric acid level between sex,age and body mass index(BMI).Serum uric acid levels boys,children aged 5~6 years old,and children with obesity/overweight had higher serum uric acid levels than girls,children aged 3~4 years,and children with normal weight,respectively.2)Normal weight and overweight children were selected to develop the reference range for healthy children,stratified by age and sex.The reference ranges of serum uric acid level are (240.8±101.1)μmol/L for 3~4 years old boys,(236.0±105.4) μmol/L for 3~4 years old girls,(244.1±101.4) μmol/L for 5~6 years old boys,and (236.5±98.6) μmol/L for 5~6 years old girls,respectively. Conclusion sSex,age and BMI may affect children's serum uric acid level.Reference range of serum uric acid for healthy children by different age and sex would give suggestions for clinical practice.

Diagnostic significance of brainstem auditory evoked potential combined with MRI in early neonatalbilirubin encephalopathy

YE Dan-ni, GE Ling-qing, YU Sheng-lin

2017, 25(7):  737-739.  DOI: 10.11852/zgetbjzz2017-25-07-26

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Objective To explore the early diagnostic value of brainstem auditory evoked potential(BAEP) and magnetic resonance imaging(MRI) in the neonates with bilirubin encephalopathy. Methods Retrospective analysis of the relared clinical indicators in 137 neonates with hyperbilirubinemia. Results The levels of serum total bilirubin,serum total bilirubin/albumin were higher in the neonates with abnormal BAEP,abnormal MRI and acute bilirubin encephalopathy than those with normal BAEP,normal MRI and without cute bilirubin encephalopathy (P<0.05).Abnormal rate of BAEP was positively correlated to that of MRI (r=0.466,P<0.05).On the diagnosis of bilirubin encephalopathy,the sensitivity of BAEP(87.18%) was higher than MRI (64.10%),but the specificity of BAEP(78.57%) was lower than MRI(93.88%). Conclusion BAEP and MRI examinations have important clinical value in the early diagnosis of bilirubin encephalopathy in the neonates.

Clinical curative effect of Jiao's scalp acupuncture combined with Zhi nine in early treatment of children with mental retardation

FAN Wei, WANG Rong, DENG Lei, ZHU Hui-min, HUANG Xiao-lan

2017, 25(7):  740-742.  DOI: 10.11852/zgetbjzz2017-25-07-27

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Objective To observe the clinical effect of Jiao's scalp acupuncture combined with Zhi nine in early treatment of children with mental retardation. Method The children were randomly divided into two groups,treatment group including 50 cases and control group including 64 cases,treatment group was treated by scalp acupuncture combined with focal type Zhi nine plus rehabilitation treatment,control group with rehabilitation treatment alone,Gesell scale was used to evaluate the DQ value and total DQ value before and after treatment in 5 areas. Results The DQ and the total DQ values in the five functional areas of the treatment group were significantly higher than control group before treatment (P<0.05), the total DQ value and the DQ value of gross motor,verbal ability,social intercourse functional areas after treatment in the treatment group were significantly higher than control group (P<0.05),but the DQ value of the fine motor and the adaptability region had no significant difference in treatment group. Conclusion Early treatment by Jiao's scalp acupuncture accompanied with Zhi nine has good clinical curative effect on children with mental retardation.

Analysis on the correlation between serum 1,25-(OH)D₃ level and wheezing infants and young children

HOU Ying-ying

2017, 25(7):  743-745.  DOI: 10.11852/zgetbjzz2017-25-07-28

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Objective To explore the expression and clinical significance of 1,25-(OH)D₃ and IgE in wheezing infants and young children. Methods Children with recurrent wheezing children had been randomly enrolled from September 2015 to March 2016 in our hospital.According to the asthma predictive index,they were divided into 2 groups:wheezing group Ⅰ with positive predictive index(n=29)and wheezing group Ⅱ with negative predictive index(n=23).The healthy children had been enrolled randomly as normal control group(n=23).The serum level of 1,25-(OH)D₃ and the IgE was measured. Results The serum levels of 1,25-(OH)D₃ in wheezing groups were lower than those of normal control group,the levels of 1,25-(OH)D₃ in group Ⅰ were lower than the group Ⅱ,the difference was statistically significant (P<0.05);The level of IgE in wheezing groupⅠwas significantly higher than those in wheezing group Ⅱand the control group (P<0.05),while wheezing group Ⅱ group and the control group had no significant difference (P>0.05);There was remarkably negative correlation between vitamin D and IgE in group Ⅰ(r=-0.915,P<0.01). Conclusion The level of 1,25-(OH)D₃ is significantly decline in recurrent wheezing children with atopic,and there is remarkably negative correlation between the serum levels of 1,25-(OH)D₃ and IgE in wheeze children with atopic.

The application of steak retinoscopy in screening of preschool children’s refractive status

LI Jiang, TANG Jian-bo

2017, 25(7):  745-747.  DOI: 10.11852/zgetbjzz2017-25-07-29

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Objective To screen the refractive status of preschool children by using the steak retinoscopy in Huzhou urban,and to find early refractive abnormalities and intervene them as soon as possible. Methods From May to June 2015,a total of 8 329 preschool children from 48 kindergartens in Huzhou urban had been accepted the epidemiological investigation of refractive status.The ophthalmology department doctocrs from our hospital used the Suzhou 66 visual steak retinoscopy to screen the refractive status of preschool children.The children with abnormal refractive were accept cycloplegic diptoscopy test,which helped doctors to make a correct adiagnosis. Results By using the steak retinoscopy to screen the refractive status of 8 329 preschool children from 48 kindergartens in Huzhou urban,abnormal refractive 516 cases,strabismus 5 case,microphthalmus no light perception 1 case ,cataracta 2 cases,corneal nebula 1 case,coloboma iridis pupil displacement 2 cases were found. Conclusion It's a early,rapaid,convenient and effective method to find the refractive abnormalities by using the steak retinoscopy to screen,which is convenient for early intervention and correction.

Liangping county medical institutions at the county level analysis of 48 cases of early neonatal death

ZENG Rui-zhou

2017, 25(7):  748-749.  DOI: 10.11852/zgetbjzz2017-25-07-30

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Objective To understand the cause of the early neonatal death and its influencing factors,and reduce the neonatal mortality provide effective intervention measures. Method Liangping county of chongqing medical institutions at the county level in October 2011-September 2016 (date from October statistics to the following year) 5 years of 48 cases of early neonatal death and neonatal death review data were retrospectively analyzed. Results The county medical institutions at the county level in the past 5 years early neonatal mortality rate was 2.04 ‰;Premature rupture of membranes(27.08%),abnormal amniotic fluid (18.75%),and abnormal umbilical cord (14.58%)were the main obstetric factors;The 3 most important reasons for the early neonatal death were preterm delivery and low birth weight (29.17%),neonatal severe asphyxia (18.75%),and birth defects (14.58%). Conclusion By strengthening medical institutions at the county level of pediatric equipment configuration and the talent team construction,the neonatal mortality rate is reduced.

Study on application and effects of coaching in popularizing early essential newborn care guideline

LI Xia-yun, YUE Qing, WANG Yan, XU Tao.

2017, 25(7):  750-754.  DOI: 10.11852/zgetbjzz2017-25-07-31

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Objective To study on application and effects of coaching in popularizing early essential newborn care guideline and provide clinical training with new idea and method. Methods One province level and one district level maternal and child health hospital in Beijing,Shaanxi and Sichuan were chosen as pilot hospitals.Healthcare professionals were coached during 2 days.The effects were analyzed by comparing the score of theoretical knowledge,practice on washing hands and delivery practice for the breathing baby and non-breathing baby before and after coaching.3 months after coaching,10 maternal were randomly sampled for interviews every hospital to analyze the implementation of neonatal health care measures after intervention. Results Total healthcare professionals got higher score after coaching(16.82±1.00) than before (11.90±2.68)(P<0.001).Healthcare professionals in Beijing,Shaanxi and Sichuan all improved the skills of washing hands, and cleanliness of hands improved significantly(P<0.001).The median score of delivery practice for the breathing baby and non-breathing baby was 41 and 58.After 3 months,87% (52/60) of mothers had skin-to-skin contact with newborns after childbirth,and the mother-to-child skin contact rate was 55% (33/60) within one minute after childbirth,and skin contact continued for 90 minutes accounting for 47% (28/60);breastfeeding rate before discharge reached 77% (46/60),exclusive breastfeeding rate was 48% (29/60). Conclusion sCoaching can be effectively used in early essential newborn care and can help healthcare professionals understand and use early essential newborn care guideline well.Coaching should be populated in future clinical practices.