Characteristics of pulmonary valve annular motion identified by quantitative tissue velocity imaging in children with pulmonary hypertension / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the characteristics of pulmonary valve annular motion by quantitative tissue velocity imaging (QTVI) in children with pulmonary hypertension.</p><p><b>METHODS</b>The pulmonary valve annular motion was assessed by QTVI in 32 children with pulmonary hypertension and 32 healthy children. The QTVI sample volume was set at the point of pulmonary valve annulus to acquire speed-time curve and the parameters from the views of parasternal aortic short-axis or subxiphoid right ventricular outflow long-axis. The parameters of pulmonary valve annular motion of children with pulmonary hypertension were compared to those of normal children.</p><p><b>RESULTS</b>The speed-time curve of pulmonary valve annulus was similar with that of tricuspid annulus in normal children. Compared to normal children, the ratio of Ea/Aa (the velocity parameter of pulmonary valve annular motion) was significantly lower in children with pulmonary hypertension (0.68 ±0.36 Compared with 1.18 ±0.43, P<0.001); and the value of QTVI-Tei index at the pulmonary annulus was significantly higher (0.82 ±0.34 Compared with 0.37 ±0.05, P<0.001). The QTVI-Tei index was positively correlated with the resistance of pulmonary vessel (r=0.556, P<0.001).</p><p><b>CONCLUSION</b>The ratio of Ea/Aa is decreased, the value of QTVI-Tei index is increased and QTVI-Tei index is positively correlated with the resistance of pulmonary vessel in children with pulmonary hypertension.</p>

Echocardiographic diagnosis of partial anomalous pulmonary venous connection / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate partial anomalous pulmonary venous connection (PAPVC) with echocardiography.</p><p><b>METHODS</b>The right ventricular volume overload was detected by routine echocardiography in 37 child patients, who underwent further echocardiography to find the abnormal locations of pulmonary vein opening at superior, inferior vena cava and right atrium. The ultrasound results were compared with surgical findings.</p><p><b>RESULTS</b>In 30 patients the ultrasound diagnosis was consistent with surgery results, 7 were misdiagnosed by ultrasound with a detective rate of 81.1 %. All 37 PAPVC patients presented varying degrees of right heart enlargement; PAPVC combined with atrial septal defect (ASD) was found in 34 cases.</p><p><b>CONCLUSION</b>The possibility of PAPVC should be considered when unexplained right heart volume overload was detected by echocardiography. Superior, inferior vena cava and right atrium should be inspected when the pulmonary veins were not seen in echocardiography.</p>

Effects of acupoint heat-sensitization moxibustion on the gastrin and motilin in chronic diarrhea patients of Pi-Shen deficiency syndrome / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the therapeutic efficacy of acupoint heat-sensitization moxibustion on chronic diarrhea patients as well as its effects on the levels of gastrointestinal neurotic mediators such as serum gastrin (GAS) and plasma motilin (MTL).</p><p><b>METHODS</b>Sixty chronic diarrhea patients of Pi-Shen deficiency syndrome were randomly assigned to Group A (30 cases, treated with acupoint heat-sensitization moxibustion, once daily) and Group B (30 cases, treated with Changtai Oral Liquid, 10 mL each time, three times daily). The therapeutic course was 4 weeks. Another 20 healthy volunteers were recruited as the health control group. The levels of serum GAS and plasma MTL were detected using radioimmunoassay before and after treatment. The cured rate, the markedly effective case, the effective case, the ineffective case, and the total effective rate were calculated by the end of the treatment.</p><p><b>RESULTS</b>Before treatment the serum GAS level was lower and the plasma MTL level higher in the two patient groups than in the health control group with statistical difference (P<0.05). There was no statistical difference in the symptom integral between the two patient groups and the health control group (P>0.05). After treatment the serum GAS level increased, the plasma MTL level and the symptom integral decreased in the two patient groups, showing statistical difference when compared with the same group before treatment (P<0.05, P<0.01). After treatment the symptom integral was lower in the treatment group than in the control group with statistical difference (P<0.05). There was no statistical difference in the GAS and MTL levels between the two patient groups (P>0.05). The total effective rate for clinical symptoms was significantly higher in Group A than in Group B with statistical difference (93.3% vs 73.3%, P<0.05).</p><p><b>CONCLUSIONS</b>The therapy of acupoint heat-sensitization moxibustion was effective for chronic diarrhea patients of Pi-Shen deficiency syndrome. It could regulate the levels of serum GAS and plasma MTL and improve the patients' clinical symptoms.</p>

Transesophageal echocardiography-guided hybrid therapy for ventricular septal defects in children / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate transesophageal echocardiography (TEE)-guided periventricular device closure for treatment of ventricular septal defects (VSD) in children.</p><p><b>METHODS</b>The Amplatzer device was applied, the size of which was 1 or 2 mm larger than the VSD size assessed by TEE. Via a small lower sternotomy, the device was introduced through right ventricular surface to close the VSD under continuous TEE guidance without cardiopulmonary bypass.</p><p><b>RESULT</b>The procedures were successful in 6 cases, including 4 cases with muscular VSD and 2 cases with perimembranous VSD. The diameter of VSD was 3 mm to 10 mm and one case had pulmonary hypertension. One case of multi-muscular VSD with transposition of the great arteries failed to the treatment because the mitral open was interfered by the device. One case had bundle branch block in ICU stay and returned to normal without special therapy. The average operation time was 30 min and blood loss was 5 approximately 20 ml, no patients required blood transfusion; the average length of ICU stay was 24 h. Patients were discharged 1 to 2 d postoperatively. At a median follow-up for 12 months, all patients were asymptomatic and had no residual ventricular shunts.</p><p><b>CONCLUSION</b>With the guide of TEE, intra-operative hybrid therapy is a safe and effective method for closure of muscular and perimembranous VSD without cardiopulmonary bypass in children.</p>

Role of B7-H1 in pancreatic carcinoma immune evasion / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the role of B7-H1 expression in IL-10 production, the B7-H1 and IL-10 expression levels in pancreatic carcinoma tissues and to analyze the correlation between B7-H1 expression and IL-10 level.</p><p><b>METHODS</b>The mRNA and protein levels expressions of B7-H1 and IL-10 in 35 cases of pancreatic cancer and corresponding paracarcinoma tissues and 5 cases of normal pancreas tissues were detected by RT-PCR, Western blot and immunohistochemistry respectively.</p><p><b>RESULTS</b>The findings for the first time provided the evidences that there was a clear trend for B7-H1 and IL-10 expressions to be most highly expressed in carcinoma tissue, intermediately expressed in paracarcinoma tissue, and expressed at the lowest level in normal pancreatic tissue at mRNA and protein levels. Moreover, there were statistically significant differences in B7-H1 and IL-10 expression between pancreatic carcinoma tissues, corresponding paracarcinoma tissues and normal pancreatic tissues at mRNA and protein levels (P < 0.05). Furthermore, the immunohistochemistry indicated that there were high expression levels of B7-H1 (60.5% +/- 12.7%) and IL-10 (65.3% +/- 16.2%) in pancreatic carcinoma tissues while there were no significant expressions in normal pancreatic tissues. Meanwhile, correlation analysis revealed that B7-H1 expression was significant associated with IL-10 level in tumor tissues at mRNA (P = 0.008, r = 0.841) and protein levels (P = 0.007, r = 0.838).</p><p><b>CONCLUSIONS</b>Over-expression of B7-H1 may be responsible for the increasing IL-10 production in pancreatic cancer, which caused reduced immune response to tumor cells and contributed to pancreatic carcinoma escape from immune attack.</p>

Evaluation of right ventricular function by quantitative tissue velocity imaging and tissue tracking imaging in neonates with congenital hypothyroidism / 中华儿科杂志

<p><b>OBJECTIVE</b>Although several reports documented the association of congenital hypothyroidism (CH) and left ventricular (LV) function in infants or neonates, right ventricular (RV) function in neonates with CH has not been previously studied. The aim of the present study was to assess RV function in neonates with CH before and after thyroxine substitution therapy by quantitative tissue velocity imaging (QTVI) and tissue tracking imaging (TTI).</p><p><b>METHODS</b>Fifty-two neonates aged 18-28 days (25 males and 27 females) with CH and 35 healthy neonates aged 18-28 days (16 males and 19 females) were studied by QTVI, TTI as well as conventional pulsed-wave Doppler echocardiography (PWD). The standard apical four-chamber view for long-axis motion of the right ventricle was used for echocardiographic evaluation. Peak systolic displacement (D), peak systolic velocity (Vs), peak early (Ve) and late (Va) diastolic velocity of tricuspid annule were measured, Ve/Va ratio was calculated as well. Transtricuspid flow velocity during early diastole (E) and late diastole (A) were also measured by pulsed-wave Doppler echocardiography. PWD and E/A ratio were calculated too. For each neonate, serum hormone levels of TSH, TT(3), TT(4), FT(3) and FT(4) were measured with a standard chemiluminescent immunoassay. After 1 month of levothyroxine (L-T(4)) substitution therapy in CH neonates, all the echocardiographic evaluations and biochemical tests were re-evaluated. Correlation analysis was also made between serum thyroid hormones levels and right ventricular function.</p><p><b>RESULTS</b>The indices of right ventricular diastolic function by PWD (E and E/A ratio) in CH group were (45 +/- 10) cm/s and (0.8 +/- 0.3), respectively. Compared with controls, E and E/A ratio in CH neonates were significantly lower (P < 0.001, respectively), while A did not differ between the two groups (P > 0.05). QTVI and TTI showed that right diastolic function (Ve and Ve/Va ratio) as well as right systolic function (Vs and D) in CH group were (3.69 +/- 1.38) cm/s, (0.74 +/- 0.19) cm/s, (4.38 +/- 0.63) cm/s and (0.52 +/- 0.12) cm, respectively. CH neonates had significantly lower Ve, Ve/Va ratio, Vs and D of tricuspid annular velocity (P < 0.001, respectively), whereas there was no significant difference in Va between the two groups (P > 0.05). After 1 month of substitutive therapy, CH neonates showed a significant increase of Ve, Ve/Va ratio, Vs, D, E, and E/A ratio, (6.92 +/- 1.86) cm/s, (1.13 +/- 0.22), (5.92 +/- 1.03) cm/s, (0.78 +/- 0.17) cm, (61 +/- 10) cm/s and (1.1 +/- 0.4), respectively (P < 0.001). Those parameters were positively correlated with serum TT(3), TT(4), FT(3) and FT(4) levels (P < 0.01, respectively), and were negatively correlated with serum TSH levels (P < 0.01, respectively).</p><p><b>CONCLUSIONS</b>Our findings suggest that neonates with CH are associated with right ventricular subclinical systolic and diastolic dysfunction, which can be reversed by early L-T(4) substitution therapy. QTVI and TTI are valuable methods to evaluate right ventricular function in neonates. Systolic and diastolic velocities of the tricuspid annulus measured by QTVI and TTI are useful and accurate to assess RV function in neonates.</p>

Assessment of the characteristics of echocardiography in pediatric patients with total anomalous pulmonary venous connection / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To assess the accuracy of echocardiography in diagnosis of total anomalous pulmonary venous connection (TAPVC).</p><p><b>METHODS</b>A combination of suprasternal, parasternal, subcostal and apical views were employed to diagnose TAPVC and to trace the course of the anomalous pulmonary venous connection, the direction of the inter-atrial shunt, enlargement of right atrium (RA) and right ventricle (RV), superior and inferior vena cava. All pediatric patients underwent surgical repair. The results of echocardiography were compared with surgical findings.</p><p><b>RESULT</b>A total of 28 consecutive pediatric patients with suspected TAPVC were included in this study. The TAPVC diagnosis was confirmed in 26 cases after surgery, partial anomalous pulmonary venous connection (PAPVC) in one case, and Cor Triatriatum and possible TAPVC in another. The diagnostic accuracy of TAPVC by echocardiography in the study was 92.86%. There were 17 supracardiac TAPVC, 11 intracardiac TAPVC. In all patients, enlargement of the RA and RV, inter-atrial right-to-left shunt via atrial septal defects were documented in parasternal and subcostal views. Common pulmonary vein or four pulmonary vein direct to RA or via coronary sinus to RA were the draining sites of intracardiac TAPVC. The enlargement of left innominate vein-right superior vena cava draining to RA was seen in supracardiac TAPVC.</p><p><b>CONCLUSION</b>A combination of suprasternal and subcostal multi-views in echocardiography can increase the diagnostic accuracy of TAPVC in pediatric patients.</p>

Early arterial atherosclerosis and level of plasma homocysteine in simply obese children / 中华儿科杂志

<p><b>OBJECTIVE</b>To understand whether hyperhomocysteinemia and early arterial atherosclerosis exist in simply obese children.</p><p><b>METHODS</b>Totally 68 simply obese children (age 6-14 years, mean 10.8 +/- 2.3 years) were enrolled in this study, 50 were male and 18 were female. Body mass index (BMI) of the obese children was equal to or more than 22. The height of the children was (145 +/- 22) cm. Meanwhile, 26 normal children (age 6 - 14 years, mean 10.9 +/- 2.0 years) were selected as control group, 17 of these children were male and 9 were female. Their height was (148.5 +/- 5.8) cm. There were no significant differences in height and age between the obese and the control children. The carotid intimal-medial thickness (IMT), brachial artery flow-mediated vasodilation were examined by Doppler Flow/Dimension System and the liver was examined by B-mode ultrasound imager. Plasma homocysteine was determined by the automated chemiluminescent enzyme immunoassays. Serum lipid concentration was determined by biochemical analytic method. Blood pressure of the right upper limbs was measured. A detailed medical and family history was systematically recorded.</p><p><b>RESULTS</b>BMI was (27.8 +/- 4.5) in the obese children and (16.2 +/- 2.5) in the controls. There was significant difference between two groups (P < 0.01). The obese children had significantly increased values than the controls for the carotid intimal-medial thickness (P < 0.01). Right carotid IMT, right inner-carotid IMT, left carotid IMT and left inner-carotid IMT were respectively (0.54 +/- 0.13) mm, (0.69 +/- 0.14) mm, (0.52 +/- 0.12) mm and (0.67 +/- 0.14) mm in obese children and were respectively (0.45 +/- 0.04) mm, (0.46 +/- 0.04) mm, (0.45 +/- 0.05) mm and (0.46 +/- 0.03) mm in control groups. Conversely, the flow-mediated brachial artery dilation of the obese children was significantly lower than that of the controls [(11.0 +/- 4.3)% vs. (17.5 +/- 4.9)%, P < 0.01]. The obese children had higher level of plasma homocysteine than the controls [(7.9 +/- 2.7) micromol/L vs. (5.6 +/- 2.1) micromol/L, P < 0.01]. Total cholesterol (TC) in the obese children dramatically increased, so did triglyceride concentration (TG), LDL-cholesterol (LDL-ch) and apolipoprotein-B (apo-B). Of the obese children, had fatty liver or the tendency to fatty liver. Six cases of the 68 obese children (8%) had hypertension. Of the 68 obese children, 57 (84%) had the history of consuming excessive food or taking less exercise. Forty-four percent of the obese children (30/68) came from the obese families in which at least one of the parents or grandparents was obese. Twenty-nine percent (20/68) and 22% (15/68) of the obese children respectively came from the families in which at least one of the parents or grandparents suffered from hypertension or coronary heart disease.</p><p><b>CONCLUSION</b>Early arterial atherosclerotic changes existed in simply obese children. Hyperhomocysteinemia may be an important factor of the obesity-induced early arterial atherosclerosis during childhood.</p>

Influence of congenital hypothyroidism on left ventricular function of neonates / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate left ventricular function in neonates with congenital hypothyroidism (CH) and its correlation with thyroid hormones serum levels.</p><p><b>METHODS</b>M-mode echocardiography [left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS)], pulse wave Doppler [the peak early diastolic mitral inflow velocity (Em), the peak late diastolic mitral inflow velocity (Am)], quantitative tissue velocity imaging (QTVI) [the systolic peak mitral annular velocity (sm), the early diastolic peak mitral annular velocity (em), the late diastolic peak mitral annular velocity (am)] and tissue tracking imaging (TTI) [the systolic mitral annular displacement (MAD)] were evaluated in 35 neonates with congenital hypothyroidism aged 15-28 days and 30 normal neonates in this study. Correlation analysis was also made between left ventricular function and serum TT3, TT4 and TSH levels.</p><p><b>RESULTS</b>Left systolic function parameters (LVEF, LVFS, sm and MAD) were 0.62 +/- 0.08, (28.21 +/- 5.31)%, (2.58 +/- 0.59) cm/s and (0.27 +/- 0.07) cm, respectively, in CH group, and 0.67 +/- 0.06, (31.16 +/- 4.13)%, (3.24 +/- 0.52) cm/s and (0.41 +/- 0.08) cm in control group (P < 0.05, P < 0.01). Left diastolic function parameters (Am, Em/Am, em/am, Em and em) were (0.59 +/- 0.10) m/s, 0.98 +/- 0.18, 0.82 +/- 0.40, (0.57 +/- 0.11) m/s and (2.83 +/- 1.48) cm/s, respectively, in CH group, and (0.65 +/- 0.10) m/s, 1.14 +/- 0.20, 1.25 +/- 0.33, (0.73 +/- 0.11) m/s and (4.46 +/- 1.29) cm/s in control group (P < 0.05, P < 0.01). MAD, sm, Em and em in CH group were greatly lower than that in control group (P < 0.001). Left systolic function (LVEF, sm, MAD) and diastolic function (Em, Am, em, em/am) were positively correlated with TT3, TT4 serum levels (P < 0.05, P < 0.01), and negatively with TT4 serum levels (P < 0.05, P < 0.01). MAD, Em and em were highly correlated with TT4, TSH serum levels (r = 0.700, r = 0.564, r = 0.593, r = 0.564, P < 0.001; r = -0.674, r = -0.521, r = -0.578, r = -0.632, P < 0.001).</p><p><b>CONCLUSIONS</b>Neonates with CH have lower left systolic and diastolic function. Left ventricular function was affected by thyroid hormones. QTVI and TTI are more sensitive parameters in evaluating left ventricular function of neonates with congenital hypothyroidism than conventional echocardiography.</p>

Antitumor effect of immunizations with fusions of dendritic and hepatocellular carcinoma cells in mice / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the effects of immunization with fusions of dendritic cells and H22 cells on tumor-bearing mice and their possible mechanisms.</p><p><b>METHODS</b>Fusion cells of DC and H22 cells were prepared with polyethylene glycol (PEG). Expression of MHC and costimulatory molecules by dendritomas were determined by FACs. To study the antitumor immune preventative and therapeutic effects, fusions were subcutaneously injected into tumor-bearing mice. The cytotoxic T lymphocyte (CTL) activity was determined by LDH method, the expression of TNF-a and IFN-g in tumors were assayed by RT-PCR.</p><p><b>RESULTS</b>The data showed that the hybridomas of DC and H22 cells acquired both DC and H22 cell phenotypes. Immunization of BALB/C mice with DC/H22 fusions induced potent CTL activity (mean CTL activity=0.624+/-0.024, compared with DC + H22, DC, H22 groups, F = 65.46) and a protective immunity against a high dose of H22 tumor challenge. After treatment with hybridomas, the survival time of tumor-bearing mice was greatly extended (x2=18.45). The expression levels of TNF-a and IFN-g mRNA were remarkably increased (TNF-a, F = 47.84; IFN-g, F = 37.23).</p><p><b>CONCLUSIONS</b>The hybridomas of DC and H22 cells could induce effective antitumor immune responses and may have a useful potential in prevention and management of the recurrences and metastases of HCC.</p>

Influence of combined cyclosporine A and tacrolimus with 5-fluorouracil on hepatocellular carcinoma rats / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of combined CsA and FK506 with 5-FU on hepatocellular carcinoma rats.</p><p><b>METHODS</b>A syngeneic rat model of hepatocellular carcinoma was used. Control group (A) underwent 4 ml 5% GS. Treatment group was divided into 3 groups namely, group B: only 5-FU and 5% GS; group C: 5-FU, CsA and 5% GS; group D: 5-FU, FK506 and 5%GS. Cell cycle, apoptosis, necrosis and mitochondrial transmembrane potential were measured by flow cytometry, laser scanning confocal microscopy, and electron transmission microscopy. Statistical analysis was performed by SPSS 10.0 for Windows software. Statistical comparisons were made with ANOVA followed by Dunnett's T3 or LSD test.</p><p><b>RESULTS</b>Compared to the control group, the percentage of apoptotic cells including trifle necrotic cells was significantly higher, and among the treatment group, group D was the highest, and group C was higher than group B. In the treatment group, cell cycle of hepatoma cells was mainly arrested at S phase, but in group D, G0/G1 phase cells were significantly decreased and S phase cells significantly increased. Compared to the control group, mitochondrial transmembrane potential was significantly decreased in the treatment group, among with, group B was the lowest, group C was higher than group D. Morphological changes demonstrated by electron microscopy included dispersed nuclear chromatin, loss of nucleoli, membrane bleeding, cell shrinkage, typical apoptotic bodies and marked swelling of mitochondria in the treatment group. In the control group, however, they were characterized by normal cell ultrastructure.</p><p><b>CONCLUSIONS</b>The present study reveals that 5-FU combined with CsA or FK506 demonstrated a synergistic effect on hepatocellular carcinoma rats. For FK506, the powerful mutual effect is related to the increase of tumor cell's quantity in S phase. Both CsA and FK506 can provide protection on mitochondrial transmembrane potential reduction against hepatoma cells damage from 5-FU.</p>