Polio antibody levels in infants during 2015-2016 in Shanghai before and after polio vaccination strategy adjustment / 上海预防医学

Objective To investigate the neutralized antibody level of poliomyelitis among healthy children before and after implementation of the new immunization strategy in Shanghai. Methods The poliomyelitis levels of healthy children were detected by neutralization test of the micro cells. Results The neutralizing antibody positive rates were 100% for polioⅠand polioⅢ before and after implementation of the new immunization strategy.GMTs (geometric mean titers) for polioⅠwere 1:1 047.46 before it, and 1:254.70 after it; those for polio Ⅲ were 1:513.52 before it and 1:185.49 after it. Conclusion The neutralized antibody levels of the poliomyelitis among healthy infants maintain a high level before and after implementing the new immunization strategy in Shanghai.

Responsiveness of stroke volume variation and central venous pressure during acute normovolemic and hypervolemic hemodilution / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Stroke volume variation (SVV) is a robust indicator of fluid responsiveness during volume change. We compared the sensibility of SVV by Vigileo/Flotrac to central venous pressure (CVP) when volume changes in patients undergoing intraoperative acute normovolemic hemodilution (ANH) and acute hypervolemic hemodilution (AHH).</p><p><b>METHODS</b>Forty patients were randomly divided into an ANH group (n = 20) and an AHH group (n = 20). All patients received general anesthesia and were mechanically ventilated. Data were collected from 7 different time-points in the ANH group: baseline, after withdrawal of 5%, 10%, and 15% of the estimated blood volume (EBV) and after replacement with an equal volume of 6% hydroxyethyl starch 130/0.4 (HES) in 5% EBV increments to baseline. There were four time points in the AHH group: baseline, after 5%, 10%, and 15% expansion of the EBV with 6% HES. At each time-point, CVP, SVV and other hemodynamic parameters measurements were obtained.</p><p><b>RESULTS</b>After removal of 10% and 15% EBV, SVV significantly increased from 10.9 ± 3.0 to 14.1 ± 3.4 and 10.9 ± 3.0 to 16.0 ± 3.3 (P < 0.01), and returned to a final value of 10.6 ± 3.4 after volume replacement. The CVP value was unchanged after removal and replacement of 15% of the EBV. There were no significant changes in SVV after 5%, 10% whereas there was a significant reduction after 15% (8.2 ± 1.7) expansion of the EBV compared with baseline (9.9 ± 1.8) (P = 0.033). However, there was a significant increase in CVP after 10% (10.3 ± 2.4), 15% (11.3 ± 2.2) expansion of the EBV compared with baseline (8.2 ± 2.7) (P < 0.01).</p><p><b>CONCLUSION</b>SVV is a more sensitive parameter for volume than CVP during hypovolemia, on the contrary CVP is more sensitive than SVV during hypervolemia.</p>

Clinical value of echocardiography in diagnosing infective endocarditis in children / 中华医学超声杂志（电子版）

Objective To evaluate the value of echocardiography in diagnosing infective endocarditis (IE) in children. Methods The shape, size, echogenicity, distribution of vegetations and valvular function of the heart were observed by transthoracic echocardiography (TTE) in 30 patients with suspected IE. We correlated TTE ifndings with the results of hemoculture and serologic test. Results Vegetations were observed in all patients by echocardiography:seven patients with tricuspid valve vegetations, two with mitral valve vegetations, three with pulmonary valve vegetations, three with main pulmonary artery vegetations, three with aortic valve vegetations, two with aortic valve abscess, and two with vegetations in right atrium. After anti-infection therapy, the size of vegetations in iffteen patients became smaller and the less echogenic than before. Vegetations disappeared in two patients. Vegetation was recurrent repeatedly in one case. Ten patients recovered after operation. Two severe cases died. Five patients underwent TTE again one week after the previous negative TTE. Of them, echocardiography demonstrated vegetations in three cases. However, no vegetations were found in rest two cases because antibiotics had been used at early stage. In addition, echocardiography demonstrated one patient with mitral valve vegetation. But the lesion was ifnally conifrmed to be operating suture. The sensitivity and specificity of TTE in detecting vegetations were 88.0% and 80.0%, respectively. Blood cultures were positive in twenty-seven cases and were negative in three cases. Conclusions The early diagnosis of IE is important to improve patient′s prognosis. It takes a long time in organism cultivation before achieving the clinical diagnosis. TTE can help obtain an early diagnosis stage of IE, and provide the assessment of size and location of vegetation. It plays an important role in treatment and prognosis prediction.

Detection of exon 7 mutations of PAH gene in classical phenylketonuria by high-resolution melting analysis / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To establish a simple, rapid, inexpensive and sensitive method for detecting hot region for mutations in exon 7 of PAH gene.</p><p><b>METHODS</b>High-resolution melting (HRM) technology was used to detect a c.728G>A mutation in exon 7 in 88 patients with classical type phenylketonuria. Suspected mutations were validated by direct DNA sequencing.</p><p><b>RESULTS</b>The results detected by HRM are in good agreement with the results obtained by direct sequencing.</p><p><b>CONCLUSION</b>HRM analysis is a simple, rapid, inexpensive and sensitive method for detecting hot mutational region in exon 7 of PAH gene.</p>

Study on the mutations of phenylalanine hydroxylase gene in patients with phenylketonuria in Shanxi province / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To study the mutations in exons 3, 6, 7, 11 and 12 of the phenylalanine hydroxylase gene (PAH) in Shanxi population.</p><p><b>METHODS</b>The mutations in exons 3, 6, 7, 11 and 12 and flanking sequences of PAH gene were detected by PCR-DNA sequencing, in 59 patients with phynelketonuria(PKU) and 100 healthy children from Shanxi province.</p><p><b>RESULTS</b>By sequence analysis, three single nucleotide polymorphism (SNP) Q232Q (CAA>CAG), V245V (GTG>GTA) and L385L (CTG>CTC) were detected in both the patients and healthy children, with the frequencies of nt 696, 735 and 1155 of the PAH cDNA up to 96.2%, 76.1% and 7.6% in patients respectively, and 97.0%, 77.3% and 8.3% respectively in the healthy controls. In addition, 72 different mutations accounting for 61.0% of mutant alleles were identified in the patients only. In exon 3, R111X, H64>TfsX9 and S70 del were found accounting for 5.1%, 0.8% and 0.8%; EX6-96A>G in exon 6 was found accounting for 10.2%. In exon 7, R243Q was the highest incidence accounting for 12.7%, followed by Ivs7+2 T>A(5.1%) and T278I(2.5%); the lowest incidences were G247V, R252Q, L255S, R261Q and E280K accounting for 0.8 %, respectively. In exon 11, Y356X (5.9%) and V399V (5.1%) were found; in exon 12, R413P and A434D were found accounting for 5.9% and 2.5%. In total, 9 missense mutations, 3 splice site mutations, 2 nonsense mutations and 2 deletions were included in 16 kinds of different mutations.</p><p><b>CONCLUSION</b>The mutation characteristics and distribution in exons 3, 6, 7, 11 and 12 of the PAH gene have been identified, and it suggested that the EX6-96A>G and R243Q were the hot spots of PAH gene mutations in Shanxi PKU population.</p>

Effects of propofol anesthesia and sevoflurane anesthesia on the differentiation of human T-helper cells during surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Surgical stress causes a helper T-cell type 2 (Th2)-dominant status and disturbs the Th1/Th2 cytokine balance. Anesthesia can suppress the stress response to surgery, therefore it may inhibit the imbalance in the Th1/Th2 ratio. In this study, we assessed if propofol anesthesia and sevoflurane anesthesia influence the Th1/Th2 cytokine balance, and which anesthesia method better attenuates this ratio.</p><p><b>METHODS</b>Twenty-eight patients with an American Society of Anesthesiologists (ASA) physical status of I undergoing laparoscopic cholecystectomy were selected. They were randomly allocated into two groups of 14. Group 1 received propofol anesthesia by a target-controlled-infusion (TCI) pump and group 2 received sevoflurane anesthesia. Non-invasive blood pressure, heart rate, and end-expiration CO2 partial pressure were monitored during anesthesia. The depth of anesthesia was measured using the bispectral index (BIS), and maintained between 50 and 60. During surgery we adjusted the doses of propofol and sevoflurane according to the BIS. Samples of peripheral blood were taken before the induction of anesthesia (T1), after the induction of anesthesia (T2), at the beginning of surgery (T3), at the end of surgery (T4) and on the first day after surgery (D1). Blood samples were analyzed to give the Th1/Th2 ratio and plasma level of cortisol.</p><p><b>RESULTS</b>Non-invasive blood pressure, heart rate and end-expiration CO2 partial pressure were not notably different in the two groups. At T4, the percentage of T1 cells was higher in group 1 and had statistical significance (P < 0.05). The percentage of T2 cells was not significantly different in the two groups. At T4, the difference in the Th1/Th2 ratio was significantly different. At T3, T4, and D1, the plasma level of cortisol was lower in group 1 (P < 0.05).</p><p><b>CONCLUSION</b>Compared with sevoflurane, propofol can preferably promote Th cells to differentiate into Th1 cells and inhibit surgical stress. Propofol may therefore be immunoprotective for such patients.</p>

Therapeutic effect of Cheatham-Platinum stent implantation for vessel stenosis associated with congenital heart disease in children and adolescents / 中华儿科杂志

<p><b>OBJECTIVE</b>Although NuMED Cheatham-Platinum (CP) stent was specifically designed to treat vascular obstructions associated with congenital heart disease (CHD), its application in pediatric patients is relatively uncommon, especially in the pulmonary artery stenosis. The aim of this study was to evaluate the immediate-, early- and intermediate-term results of CP stent implantation in the treatment of vessel stenosis associated with CHD in children and adolescents.</p><p><b>METHODS</b>From August 2005 to May 2007, 5 consecutive patients (3 boys and 2 girls) diagnosed as vascular stenosis associated with CHD underwent CP stent implantation in our institution. One patient had native coarctation of the aorta (CoA) and four patients had pulmonary artery stenosis. The median age and weight of patients were 12 years (range 4 - 15 years) and 24 kg (range 20 - 51 kg), respectively. The CP stent and NuMED Balloon-in-Balloon catheter were selected according to digital subtracted angiography measurements. After checking for correct position by angiography, the inner balloon and outer balloon inflated successively to expand the stent to desired diameter.</p><p><b>RESULTS</b>Totally 6 stent placement procedures were performed and 8 CP stents (8-zig, 22 - 39 mm in length) were implanted in these 5 patients. All stents but one in a case of right pulmonary artery stenosis were immediately successfully placed in the target lesions without displacement during the procedures. For this case, a repeat procedure was performed and a second CP stent was reimplanted successfully 11 months later. After the procedure, the systolic pressure gradient across the stenosis decreased from (43.43 +/- 25.61) mm Hg (1 mm Hg = 0.133 kPa) to (3.29 +/- 3.09) mm Hg (t = 4.320, P < 0.01) and the narrowest diameter of the stenotic vessels increased from (6.86 +/- 2.04) mm to (13.44 +/- 4.02) mm (t = -4.508, P < 0.01). The percentage of pulmonary artery flow to the ipsilateral lung increased from 11.0% and 13.0% to 47.5% and 52.2% after the procedure in 2 cases of unilateral pulmonary artery branch stenosis, respectively. The ratio of right ventricular to aortic systolic pressure decreased from 62.3% and 72.2% to 27.0% and 33.3% in 2 cases of bilateral branch pulmonary artery stenosis, respectively. Upper limb blood pressure of one case of native CoA dropped greatly from 206/133 mm Hg to 156/95 mm Hg. During a median follow-up of 20 months (range 13 - 34 months), the results have been stable without complications except 2 stents which developed intrastent restenosis 6 months after the procedure.</p><p><b>CONCLUSION</b>Our experience suggests that the CP stent implantation is safe and feasible for the treatment of vessel stenosis associated with CHD in children and adolescents. The immediate-, early- and interim results are encouraging, but long-term results remain to be further evaluated and demand many more cases to be studied.</p>

Postoperative follow up of patients with complete atrioventricular septal defect / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the operative efficacy of patients with complete atrioventricular septal defect (CAVSD).</p><p><b>METHODS</b>From January 2003 to June 2006, CAVSD patients underwent operative closure were included in this study. Color Doppler with apical four-chamber view was used to evaluate the degree of valve insufficiency before surgery and 2 days, 1 month, 6 months and 1 year after the surgery. Cardiac catheterization was performed to evaluate pulmonary artery pressure and pulmonary arteriolar resistance (PAR) before surgery in patients whose age were over 6 months. The time of staying at ICU, ventilation time after surgery and the occurrence of pulmonary artery hypertension crisis were recorded.</p><p><b>RESULTS</b>105 CAVSD patients underwent operative closure were enrolled in this study. The mean staying time at ICU was (4.7 +/- 2.4) days, and the mean ventilation time was (1.7 +/- 1.0)days, 9 patients (8.5%) developed pulmonary artery hypertension crisis after surgery. Patients with PAR > 8 Wood unit were older, staying time at ICU and ventilation time were longer compared patients with PAR < 8 Wood unit (all P < 0.05). The incidence of pulmonary artery hypertension crisis after surgery was also significantly higher in patients with PAR > 8 Wood unit compared patients with PAR < 8 Wood unit (P < 0.05). Hospital mortality was 3.8% (4/105). Three out of 4 hospital-dead patients had severe hypoplasia of the atrioventricular valve. Compared with preoperative, degree of valve insufficiency in both sides were relieved after surgery (P < 0.05). The valve insufficiency remained unchanged in 81 patients (77.1%), worsened in 14 patients (13.3%) and improved in 10 patients (9.6%) after surgery.</p><p><b>CONCLUSIONS</b>Our results suggested that early surgical repair for CAVSD was safe and beneficial. Preoperative PAR > 8 Wood unit was associated with increased risk of pulmonary artery hypertension crisis after surgery in patients with CAVSD.</p>

Noninvasive preoperative estimation of pulmonary vascular resistance of the patients waiting for two staged Fontan procedure / 中华儿科杂志

<p><b>OBJECTIVE</b>Noninvasive method for estimating the pulmonary vascular resistance (PVR) was used in patients waiting for two staged Fontan procedure to observe the relationship between estimated PVR and surgical results.</p><p><b>METHODS</b>Thirty-three candidate patients for two staged Fontan procedures were randomly selected for this trial. Preoperative hemoglobin (HGB), hematocrit (HCT) and pulse oxygen saturation (SpO2) were measured. Estimated PVRs were then calculated by the regression equations. The cases were divided into three groups of low risk group with PVR less than 2.4 wood, high risk group with PVR between 2.4 to 3.2 wood, and extremely high risk group with PVR more than 3.2 wood. The incidences of postoperative low cardiac output and multi-organ failure were compared. Simultaneously, the cases without or with postoperative severe low cardiac output and multi-organ failure after operation were divided into two groups. The preoperative HGB, HCT and estimated PVR among the groups were analyzed.</p><p><b>RESULTS</b>The rates of postoperative severe low cardiac output and multi-organ failure were 10.0%, 32.4% and 63.6% for the patients of low, high and extremely high risk groups respectively. The difference was significant (P < 0.01). The preoperative HGB, HCT, SpO2 and PVR were all significantly different between the patients without or with postoperative severe low cardiac output and multi-organ failure. The PVR (HGB) were (2.53 +/- 0.56) wood and (3.24 +/- 0.58) wood respectively. The PVR (HCT) were (2.59 +/- 0.58) wood and (3.21 +/- 0.79) wood respectively. The PVR (SpO2) were (2.22 +/- 0.55) wood and (2.93 +/- 0.58) wood, respectively. The differences were all significant (t = 3.25, 2.52 and 3.33 respectively, P < 0.01 or 0.05).</p><p><b>CONCLUSIONS</b>Preoperative estimated PVRs calculated by HGB, HCT and SpO2 were comparable with the postoperative results. Thus, the invasive preoperative estimation of pulmonary vascular resistance could be a method in estimating the surgical indication and predicting the surgical result for two stage Fontan procedure.</p>

Possible role of DNA polymerase beta in protecting human bronchial epithelial cells against cytotoxicity of hydroquinone / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To explore the toxicological mechanism of hydroquinone in human bronchial epithelial cells and to investigate whether DNA polymerase beta is involved in protecting cells from damage caused by hydroquinone.</p><p><b>METHODS</b>DNA polymerase beta knock-down cell line was established via RNA interference as an experimental group. Normal human bronchial epithelial cells and cells transfected with the empty vector of pEGFP-C1 were used as controls. Cells were treated with different concentrations of hydroquinone (ranged from 10 micromol/L to 120 micromol/L) for 4 hours. MTT assay and Comet assay [single-cell gel electrophoresis (SCGE)] were performed respectively to detect the toxicity of hydroquinone.</p><p><b>RESULTS</b>MTT assay showed that DNA polymerase beta knock-down cells treated with different concentrations of hydroquinone had a lower absorbance value at 490 nm than the control cells in a dose-dependant manner. Comet assay revealed that different concentrations of hydroquinone caused more severe DNA damage in DNA polymerase beta knock-down cell line than in control cells and there was no significant difference in the two control groups.</p><p><b>CONCLUSIONS</b>Hydroquinone has significant toxicity to human bronchial epithelial cells and causes DNA damage. DNA polymerase beta knock-down cell line appears more sensitive to hydroquinone than the control cells. The results suggest that DNA polymerase beta is involved in protecting cells from damage caused by hydroquinone.</p>

Anomalous origin of the left coronary artery from the pulmonary artery: report on 10 cases / 中国当代儿科杂志

<p><b>OBJECTIVE</b>The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary artery abnormality. This study aimed to investigate the clinical characteristics, diagnosis and treatment of the disorder.</p><p><b>METHODS</b>The medical data, including common clinical presentations, the findings of the digital subtraction angiogram (DSA), echocardiograms and the electrocardiograph (ECG), surgical records and the outcome, of 10 children with ALCAPA between June 2001 and February 2005 were retrospectively reviewed.</p><p><b>RESULTS</b>Diaphoresis, fantod, breathlessness and difficult feeding were commonly presented in the patients with ALCAPA. ECG, echocardiography and DSA examinations showed characteristic changes in these patients. The Takeuchi procedure was performed in 4 patients, direct aortic reimplantation in 4 cases and aortic reconstruction in 2 cases. After operation the symptoms of 8 patients were improved but 2 died.</p><p><b>CONCLUSIONS</b>ALCAPA patients have characteristic clinical manifestations and lab findings. This is helpful in making an early diagnosis of ALCAPA. Early surgical treatment can improve the patients' outcome.</p>

Study on the value assessment of various screening programs regarding cervical cancer screening strategy in the rural areas of China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the application value and feasibility of various cervical screening methods and to explore a rapid and efficient cervical cancer screening program for the women in the rural areas of China.</p><p><b>METHODS</b>We sequentially conducted human papillomavirus (HPV) DNA test by hybrid capture-2 (hc2) with cervical cells, liquid-based thinprep cytology test (TCT), visual inspection with acetic acid (VIA), visual inspection with iodine (VILI), colposcopy respectively for the 2499 married women between 30 and 49 years from Xiushui county of Jiangxi province. All the detection methods were performed independently under double-blind design. Women who were diagnosed positive for having any VIA,VILI and colposcopy inspection or for those women who were diagnosed negative for VIA, VILI and colposcopy but with positive result of HPV or TCT test underwent cervical biopsy directly and endocervical curettage (ECC)when necessary. We performed cervical biopsy endocervical curettage within two weeks to observe the sensitive (SE), specificity (SP), negative predict value (NPV) and positive predict value (PPV) of these detection methods when used alone or combined each other, including HPV test, TCT inspection, VIA, VILI, and colposcopy, the pathological diagnosises of cervical tissue were confirmed by IARC (International Agency for Research on Cancer) while the cytological findings were underegone through the updated program of TBS (The Bethesda System) in 2001.</p><p><b>RESULTS</b>A total of 2499 women underwent the screening and found 443 women who were diagnosed as HPV positive, 337 women with abnormal cervical cytology and 27 women with ASC-H, 157 cases with ASCUS; 103 cases with HSIL, 49 cases with LSIL and 1 cervical cancer. According to the pathological findings. There were 181 women diagnosed as cervical intraepithelial neoplasia (CIN) or cervical cancer, including 81 cases with CIN1 37 cases with CIN2,60 case cervical cancer. The sensitivity rates of HPV, TCT, HPV+ TCT, VIA, VILI, VIA+VILI and colposcopy were 96.67%, 89.47%, 97.98%, 56.57%, 36.36%, 63.64% and 39.39%, and the specificity rates were 85.00%, 96.91%, 86.97%, 94.60%, 96.23%, 92.97% and 98.14% respectively.</p><p><b>CONCLUSION</b>HPV + TCT seemed to be more sensitive than other screening methods in the cervical cancer screening program.</p>

Association of vitamin D receptor gene Apa I polymorphism with vitamin D deficiency rickets / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the association between vitamin D receptor (VDR) gene Apa I polymorphism and vitamin D deficiency rickets in children of Shanxi Han ethnic group, and to explore the significance of individual hereditary factors in the development of rickets.</p><p><b>METHODS</b>This was a case control study. The grouping criteria were serum 25(OH)D(3) level, blood bone alkaline phosphatase and clinical symptom, respectively. The laboratory test methods were enzyme linked immunoassay and radioimmunoassay. PCR-RFLP technology was applied to examine VDR gene Apa I site polymorphism and Hardy-Weinberg hereditary balance test was used to examine the coincidence of gene distribution.</p><p><b>RESULTS</b>Frequencies of AA, Aa and aa genotypes were 5.0%, 52.5% and 42.5% in the rickets group and 4.4%, 55.9% and 39.7% in the control group, respectively. Frequencies of A and a genotypes were 31.3% and 68.7% in the rickets group and 32.3% and 67.7% in the control group, respectively. There was not significant difference in the frequency distribution of VDR genotype and allelic genes between two groups (chi(2) = 0.089, P > 0.05; chi(2) = 0.028, P > 0.05). There was significant difference in the serum 25(OH)D(3) between two groups (t = -8.919, P < 0.01).</p><p><b>CONCLUSION</b>The distribution of VDR gene Apa I polymorphism in children of Han ethnic group is balanced relatively. The Frequency of a allelic genes is 67.7% which is therefore the superior gene. VDR gene polymorphism might not be important in an individual's susceptibility to development of vitamin D deficiency.</p>

Quantitative analysis of pulegone in Herba Schizonepetae / 中国中药杂志

<p><b>OBJECTIVE</b>To establish the determination method of pulegone in Herba Schizonepetae.</p><p><b>METHOD</b>HPLC method was developed for the determination of pulegone in Herba Schizonepetae. The separation was performed on C18 column with MeOH-H2O (80:20) as a mobile phase. The detection wavelength was set at 252 nm.</p><p><b>RESULT</b>The quantitation of pulegone in Herba Schizonepetae varied from 0.2-0.7 mg x g(-1). The average recovery is 96.2%, RSD 0.81%.</p><p><b>CONCLUSION</b>The method is simple, rapid and accurate.</p>

Evaluation of physiological index on treadmill exercise testing of 294 healthy children in Shanghai area / 中华儿科杂志

<p><b>OBJECTIVE</b>Dynamic exercise is often used to evaluate the backlog function of cardiovascular system, and the treadmill test is a commonly used dynamic exercise protocol. The study aimed to assess the exercise capacity and cardiovascular response to treadmill exercise in healthy children, and create normal reference values of exercise testing in native children.</p><p><b>METHODS</b>Two huadveds and ninety-four healthy children aged 5 to 14 years were tested using the Bruce protocol on treadmill.</p><p><b>RESULTS</b>Mean exercise capacity in boys increased from 12.2 METs at the age of 5 to 6 years, to 15.2 METs at the age of 13 to 14 years. Mean exercise capacity in girls increased from 11.7 METs at the age of 5 to 6 years, to 12.6 METs at the age of 13 to 14 years. Sex difference was obvious in exercise capacity of children except those at the age of 5 to 6 years. There was no obvious correlation between exercise capacity and the ratio of weight to height. Maximal heart rate ranged from 187 to 235 beats/min. Systolic blood pressure increased gradually until peak exercise was achieved. The mean systolic blood pressure of boys at maximal exercise increased by 38.6 percent compared to resting level, and the girls increased by 34.4 percent. After maximal exercise, mean systolic blood pressure reached resting level in 6 minutes but diastolic blood pressure varied. All children had sinus rhythm at rest. No arrhythmia was recorded during treadmill exercise. However, arrhythmia was found in five children in early recovery period. The incidence of exercise-induced arrhythmia was 1.7 percent.</p><p><b>CONCLUSION</b>Sex difference and age difference was obvious in exercise capacity. In the 21st century, the exercise capacity of children in Shanghai area has approached to the developed country. Using MET as the standardized criterion of exercise capacity is advantageous to standardize maximal or submaximal exercise workloads of all kinds of protocols. Exercise-induced arrhythmia in the early recovery period in children without structural heart disease may not be pathological, but it is necessary for those children to be followed-up.</p>

Arrhythmia in the long-term follow-up after intracardiac repair of tetralogy of Fallot / 中华儿科杂志

<p><b>OBJECTIVE</b>The long-term success of intracardiac repair of tetralogy of Fallot is hampered by the occurrence of arrhythmias. The aim of the present study was to determine the incidence of arrhythmias after intracardiac repair of tetralogy of Fallot and their correlation with surgical and clinical findings.</p><p><b>METHODS</b>The study group consisted of 54 patients, 35 males and 19 females. They underwent repair at a mean age of 51 months (range 17 to 117 months). The median age at the time of study was 9.4 years (range 5 to 14 years), and the mean duration of follow-up was 4.3 years (range 2.8 to 9.0 years) after surgery. The follow-up study included routine ECG, 24 hour Holter, echocardiography and exercise testing.</p><p><b>RESULTS</b>The incidence of ventricular arrhythmia was 33 percent, and 1 patient had non-sustained ventricular tachycardia. All patients with elevated right ventricular pressure had ventricular arrhythmias, and 28% of patients with normal right ventricular pressure had ventricular arrhythmias (P < 0.05). 53% of patients had significant ventricular arrhythmias when the duration of cardiopulmonary bypass was > or = 90 minutes, as opposed to 23% when it was < 90 minutes (P < 0.05). There was no significant difference in prevalence of ventricular arrhythmias between mild pulmonary regurgitation and severe pulmonary regurgitation (21% vs 40%, P > 0.05). No significant difference was found in the incidence of ventricular arrhythmias between follow-up in five years and more than five years (32% vs 34%, P > 0.05). Age at surgery correlated with the prevalence of ventricular arrhythmias (r = -0.221, P < 0.05). Eight patients (15%) had supraventricular arrhythmias.</p><p><b>CONCLUSION</b>The frequency of ventricular arrhythmias correlated with elevated right ventricular systolic pressure, the duration of cardiopulmonary bypass, and the age at surgery. No correlation was found between pulmonary regurgitation and the duration of follow-up. Exercise-induced frequent multiform premature ventricular complexes were associated with abnormal hemodynamic status and high risk of ventricular tachycardia.</p>