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Left ventricular noncompaction(LVNC)describes a rare cardiomyopathy of unknown etiology characterized by the presence of prominent trabeculations and deep intertrabecular recesses.It is one of the three major cardiomyopathies among children.LVNC can have different inheritance patterns, including X-linked recessive, autosomal dominant, and mitochondrial inheritance.Mutations in genes encoding sarcomere or cytoskeletal proteins have been identified as causes of LVNC.As a comprehensive cardiac event with serious complications such as life threatening arrhythmias, heart failure and thromboembolism, LVNC is mainly diagnosed through echocardiography, cardiac magnetic resonance and other examinations.Early improvement of genetic evaluation, screening of family members for the mutation, close follow-up of high-risk patients, and early management of complications will help to improve patients′ quality of life and prognosis.
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Vasovagal syncope(VVS)is a chronic recurrent disease.It is the most common cause of syncope in child and adolescents, accounting for 45%~60% of all syncopal cases.Repeated episodes of syncope severely affect the learning of children and adolescents and the quality of life of their families, which has attracted great attention from clinicians.The pathogenesis of VVS has not been clarified, and it is currently thought to be mainly related to autonomic dysfunction.Therefore, examining and evaluating cardiac autonomic function can help to diagnose VVS and prevent syncope.This article reviews the cardiac autonomic tests such as heart rate variability, QT dispersion and P wave dispersion, heart rate deceleration capacity and heart rate deceleration runs, 24-hour ambulatory blood pressure monitoring, and post-exercise heart rate recovery to explore its effectiveness in the diagnosis of VVS in children.
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Objectives To investigate the clinical manifestation and distribution characteristics of aortopulmonary collateral arteries (APCAs) without cyanotic congenital heart defect, and to analyze the reason of misdiagnosis. Methods The clinical data of 137 APCAs patients without cyanotic congenital heart defect in our hospital from April, 2009 to October, 2010 were reviewed. Clinical characteristics, radiographic findings were analyzed. Results In 137 patients, 99 were combined with pulmonary diseases, 115 cases with heart diseases. Six cases were misdiagnosed in 137 patients. Three cases were misdiagnosed as patent ductus arteriosus. One case was misdiagnosed as cardiomyopathy. One case was misdiagnosed as pulmonary tuberculosis. One case was prolonged the time of antituberculosis therapy because of the lung lesion. There were 130 APCAs (94.9%) originated from descending aorta, five (3.6%) from subclavian artery, one (0.73%) from intercostals artery, one (0.73%) from vertebral artery. Conclusions APCAs exist in the patients without cyanotic congenital heart defect, and APCAs will be narrowed and blocked gradually after birth. However, certain predisposing factors sustain APCAs and increase the pulmonary flow. Patients with APCAs combined with pulmonary disease or heart diseases may be misdiagnosed or diagnosed as a specific disease. Early diagnosis and treatment is critical to prognosis.
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Objective To prepare SDF-1 α-loaded nanoliposome ( SNP )-SonoVue complex and investigate its tracing abilities, sustained-release property and effect on migration of bone marrow mesenchymal stem cells (BMSCs). Methods The SNP was prepared to detect its physical characteristics including particle size,zeta potential, morphology, encapsulation efficiency and drug loading.SNP-SonoVue was constructed to detect the sustained release situation of SNP and SNP-SonoVue after low frequency ultrasound ( LIFU ) irradiation, and the connection of SNP-SonoVue was observed by fluorescence microscope. Effects of SNP-SonoVue on migration of BMSCs were detected to evaluate its bioactivity. BMSCs were divided into 6 groups,including Group A: SDF-1α+ 1% serum medium;Group B: SNP- SonoVue+ 1% serum culture medium;Group C:SNP-SonoVue+ 1% serum culture medium + LIFU ( 1 MHz,0.5 W/cm2, expose 30 s stop 30 s, 4 min);Group D: BNP-SonoVue+1% serum medium;Group E:BNP-SonoVue+1% serum medium+LIFU ( 1 MHz, 0.5 W/cm2, expose 30 s stop 30 s, 4 min),Group F:PBS+1% serum culture medium (control group). Its tracing abilitie were investigated in vitro. Results The average particle size of SNP was(220.4±9.9)nm,and the particle dispersion index(PDI) was(0.172± 0.015), the average zeta potential was ( 35.6 ± 1.7) mv. It was showed spherical dispersion by transmission electron microscopy. The encapsulation efficiency was up to 96.7% and the drug entrapment content was 481.76 ng/mg. Flow cytometric showed the suitable conditions for SNP-SonoVue preparation was that the ratio of SNP quality(mg) to Sono Vue microbubbles number(a) was20:(2.8×109)to40:(2.8× 109). Fluorescence microscopy showed that shells of SonoVue microbubbles connected with large numbers of SNP labeled with red fluorescent DiI. Drug release experiment showed that the cumulative SDF-1α release amount of SNP and SNP-SonoVue exposed to LIFU respectively were ( 68.61 ± 3.97 )% and ( 63.21 ± 5.68)% in vitro within 7 days, and the difference was not statistically significant ( P ＞ 0.05 ). Cell migration experiments confirmed that the transfer function of BMSCs in Group A, Ggroup B and group C was significantly higher than that in control group ( P ＜ 0.05 ), but there was no significant difference among the Group A, Ggroup B and group C ( P ＞0.05). In vitro development experiment showed that the SNP-SonoVue complex had obviously enhanced development effect. Conclusions SNP-SonoVue complex is successfully prepared. It has obviously enhanced development effect and can lead to migration of BMSCs.
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Objective To investigate the effect of Goserelin in protection of the ovarian function of pre-menopausal breast cancer patients. Methods Eighty premenopausal patients with breast cancer randomly divided equally into study group and control group. The two groups were compared in terms of the menstrual status and the levels of E2,FSH,LH before and after chemotherapy. Results The menstrual recovery rates of the study group and the control group were 90% and 57.5%,respectively ,with statistically significant difference between them (P = 0.018). In the study group,the serum E2 decreased gradually to the postmenopausal level,and the serum levels of FSH and LH were also significantly decreased during the treatment. While in the control group ,the E2 levels gradually decreased ,but the levels of FSH and LH significantly increased during the chemotherapy. Conclusions Goserelin can effectively prevent the injury of ovarian function caused by chemotherapy.
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Objective To explore the application of clinical teaching unit (CTU) in the process of pediatric resident standardization training. Method From August 2015 to December 2015, trainers in the department of neonatology were randomly divided into the experimental group and the control group; two groups had the same basic training plan and the same training time. The experimental group needed to par-ticipate in CTU activities outside the rule training plan. Trainers of the experimental group were evaluated by the formative evaluation method, and the theoretical assessment and questionnaire survey were carried out at the end of training. SPSS 18.0 was used for t test. Results The ability of clinical thinking of the experimental group trainers in the practice of CTU was improved, and the scoring rate rose from 57.0％ to 85.7％; the test scores of experimental group had different increase, in which case analysis reflected the ability of clinical thinking was significantly higher than the control group (P<0.05). Conclusion CTU can improve the trainers' independent clinical thinking and other abilities, and gradually help them complete the transition from medical students to physicians.
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This paper is based on conflicting issues in clinical teaching between undergraduates and residents, also around cultivating goals on clinical competency. In order to enhance medicine-education collaboration and conception of continue education and improve clinical teaching management system for integration of undergraduates and residents, five measures should be put into practice. First, define the re-sponsibility of physicians at all levels. Then, accord training standards for clinical teachers' admission. Next, accord clinical teaching norms and documents. In addition, clinical teaching assistants are selected from intermediate physician for guiding clinical teachers. Finally, explore the integration of clinical teaching mood for training between undergraduates and residents, to promote the connection of clinical teaching for graduates and residents.
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Clinical practice record manual contains the information about medical students' clinical studying process, clinical teaching process and the concept of clinical teaching management. First, we should design and optimize clinical practice record manual and then collect and analyze the relevant data. In addition, we should give the analysis to the students, teachers, clinical departments and hospitals on time, and at the same time, get their feedback. Through these steps, we can find and solve the problem efficiently and promote the quality of teaching, learning and management of clinical internship, so as to improve the clinical teaching quality control standard.
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BACKGROUND: The study of cell transplantation to repair injured cardiac muscle and improve cardiac function of dilated cardiomyopathy (DCM) has become a hotspot in recent years. However, the effect of cardiac electrophysiology following transplantation is still unknown.OBJECTIVE: To explore the influence of ailogenic implanted mesenchymal stem cells (MSCs) on cardiac function, structure and electrophysiology of rabbits with DCM.DESIGN, TIME AND SETTING: Randomized controlled animal trial was performed at Electrophysiology Laboratory of Institute of Pediatrics, Chongqing Medical University between January 2004 and May 2006.MATERIALS: Forty-three New Zealand whiterabbits, weighing 3.0-3.5 kg, irrespective of gender, were selected. Adriamycin was produced by Haizheng Medical Products Company of Zhejiang Province, China, No. 050307. The Ultrasonograph SSD-5000 came from Aloka, Japan, and RM6240 multiplying channel electrophysiolograph of Chengdu Instrument Company was applied.METHODS: All animals were randomized into normal group (n=12), cell transplantation group (n=13), and DCM model group (n=13). Except the normal group, adriamycin was applied to create rabbit DCM model, I mg/kg, twice a week for successive 8 weeks. Bone marrow solution was harvested from the remaining 5 rabbits, and MSCs were isolated, amplified and purified using attachment method. Three weeks after modeling, the MSCs were transplanted into left ventricle anterior wall at four sites in cell transplantation group, model group was injected with matching DMEM/FI2 medium, while the normal group was not given any treatment.MAIN OUTCOME MEASURES: At four weeks postoperatively, left ventricular end-diastolic dimension, end systolic dimension,left ventricular ejection fraction, and shortening fraction were monitored by ultrasonograph; the value for monophasic action potential amplitude (MAPA) and the maximum velocity in 0 phase (V,,~), the value for 50% monophasic action potential durations (MAPDs0) and 90% monophasic action potential durations (MAPDg0) were detected by electrophysiolograph. In addition, the cardiac tissues harvested from implanted region were observed by light microscope and electron microscope, and also the expression of cardiac troponin T (cTnT) and connexin 43 (Cx43) was detected through immunohistochemistry.RESULTS: Of 43 rabbits, 9 rabbits each of the transplantation group died of the acute or chronic toxic effects of Adriamycin, finally, 25 rabbits were included in final analysis. Compared with model group, the end systolic dimension was diminished, and the left ventricular ejection fraction and shortening fraction in cell transplantation group were significantly increased (P ＜ 0.05). The MAPDs0 and MAPDgo in cell transplantation group prolonged significantly compared with model group (P ＜ 0.05). In model group,cardiac myocytes appeared mitochondria swelling and hyperplasia, and their sarcomere had different lengths, arranged unevenly,accompanied by abnormal contraction bands. In addition, myolysis was found in parts of myocardium under electron microscope.However, the structural abnormalities in the cell implantation group were less than the DCM model group, and the implanted MSCs could express cTnT and Cx43.CONCLUSION: Allogenic MSCs transplantation can improve cardiac function, lessen structural abnormalities and may inhibit the progression of electrophysiology derangement.
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Objective To study the changes of the transient outward K+ current (Ito),delayed rectifier K+ current(IkDR) and the inward rectifier K+ current(Ik1) of the rat bone mesenchymal stem cells (MSCs) induced by 5-Azacytidine(5-Aza) during proliferating and differentiating process in vitro. Methods MSCs were cultured according to related articles for two weeks and then some of the cells were induced by 5-Azacytidine.The experiment was divided into uninduced(cultured for 6w) and induced(1,2,3 and 4w) cell groups. Each week had twenty cells random tested by the whole-cell patch clamp technology and the K+ currents were identified by corresponding ionic blockers.Results The detection rate of the same type of K+ current during test weeks had no significant deviation;The three types of K+ current intensity were gradually augmented after being inducing cultured for 1,2,3 and 4 weeks(P
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Objective To study the effectiveness and toxicity of ifosfamide(IFO) combined with venorelbine(VRL) in patients with nasopharyngeal carcinoma(NPC) refractory to platinum based chemotherapy. Methods The chemotherapy protocol consisted of intravenous infusion of IFO at the dose of 1200 mg/m2 from day 1 to day 5 with uroprotection of Mesna in infusion at 0,3,6 hours following initiation of IFO and VRL at the dose of 25 mg/m2 at day 1 and day 5. The protocol was repeated every 3 weeks. All patients received at least 2 cycles of chemotherapy. Results Among 25 patients enrolled into the study, 2 patients achieved complete remission, 12 patients achieved partial remission with an total remission rate of 56.0 % and 8 patients had stable disease with clinical benefit rate of 88.0 %. 3 patients had disease progression. Median time to progression was 7.1 months(range:2.0～21.0 months) and 1-year survival rate was 55 %. The main toxicities were myelotoxicity and phlebitis. Conclusion The results indicate that IFO combined with VRL in patients with NPC refractory to platinum based chemotherapy has moderate activity ascompany with tolerable toxicities.
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Objectives To observe the effectiveness of bronchoscope guided microwave heating coagutation therapy(HCT)combined with systematic chemotherapy in treating advanced lung cancer.Methods 44 patien with advanced bronchogenic carcinoma were divided into the test group(22 patients)and the control group(22 patients)randomly.Test group received HCT through needle mono pole microwave antenna guided by bronchoscope combined with the routine Carboplatin and etoposide (CE)regimen.While the control group was treated only by chemotherapy with the routine CE regimen.Results in the 22 patients,8 were completely cured and 12 showed partial recovery,the other 2 without any change.The 91% effective rate was significantly higher than 55% of the control group (P
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Purpose:To study the effectiveness and toxicity of venorelbine combined with fluorouracil/leucovorin in patients with nasopharyngeal carcinoma(NPC) refractory to platinum based chemotherapy.Methods:The chemotherapy regimen consisted of bimonthly intravenous infusion of venorelbine 25 mg/m 2 plus 2-hour infusion of leucovorin 200 mg/m 2 followed by 48-hour infusion of 5-FU 3.0 g/m 2 using an ambulatory pump. Results:Among 30 patients entered into the study,1 patient achieved complete response,15 patients achieved partial response with an overall response rate of 53.3% and 10 had stable disease with clinical benefit rate of 86.7% respectively. 4 patients had disease progression. Median time to progression was 7 months(range:2.0-20.0 months) and the 1-year survival rate was 51%. The main toxicities were diarrhea and myelotoxicity.Conclusions:The results indicate that venorelbine combined with fluorouracil/leucovorin in patients with nasopharyngeal carcinoma refractory to platinum based chemotherapy has moderate activity but comparatively mild toxicity.
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Objective The study is to evaluate autonomic nervous activity and its circadian rhythm over a 24 hour period in children with beta adrenergic receptor (? AR) hypersensitivity and hyperthyroidism by analysis of heart rate variability (HRV), and to discuss the diagnosis value of autonomic nervous tone change in children with ? AR hypersensitivity Methods Indexes of HRV are measured in 23 children with ? AR hypersensitivity, and 13 hyperthyroidism and 26 healthy control Time domain indexes and spectral indexes of HRV are derived and the night day difference of HRV is analyzed Results 1 Spectral indexes over a 24 hour period: In patients with ? AR hypersensitivity and hyperthyroidism, there are significant increases both in low frequency (LF) to high frequency (HF) ratio (LF/HF) and HF normalized units (HF UN ) compared with the control group Whereas there are no significant changes compared with ? AR hypersensitivity and hyperthyroidism 2 Spectral indexes during waking hours: In patients with? AR hypersensitivity and hyperthyroidism, there are no significant difference in LF normalized units (LF UN ), HF UN and LF/HF; whereas there are significance changes compared with normal subject 3 Spectral indexes during sleeping hours: there are no significantly differences in indexes of HF, LF UN and HF UN compared with ? AR hypersensitivity and normal subject, whereas these indexes significance changes compared with hyperthyroidism 4 Time domain indexes change over a 24 hour period: There are significant changes of the night day difference in time domain indexes with? AR hypersensitivity or control group, in which rMSSD and pNN50 are most sensitive indexes Whereas there are significant difference in patients with hyperthyroidism in any time domain indexes of HRV compared with control group or ? AR hypersensitivity, and the night day difference in HRV is significantly smaller compared with ? AR hypersensitivity or control group, the circadian rhythm is almost disappeared Conclusion It is showed that the children with? AR hypersensitivity have no difference from normal subjects in autonomic nervous system activity, but these patients respond differently to the catecholamine stimulus, which results in changes in autonomic balance, and relatively increase of sympathetic nervous activity But cardiac autonomic nervous activity still has a circadian rhythm, which is similar to normal subject The analysis of HRV may play an important role in diagnosis? AR hypersensitivity