A signal center follow-up study on the treatment of postural tachycardia syndrome in children / 中华实用儿科临床杂志

Objective To compare the therapeutic effect of Midodrine hydrochloride plus oral rehydration salts,Metoprolol plus oral rehydration salts and simple oral rehydration salts on children with postural tachycardia syn-drome(POTS). Methods One hundred and ninety - two children with POTS were divided into Midodrine hydrochlo-ride plus oral rehydration salts group(84 cases),Metoprolol plus oral rehydration salts group(54 cases)and oral rehy-dration salts group(54 cases). The patients were followed up at the outpatient department after 3 - months treatment. Short - term effect was analyzed by reevaluating the symptom scores,repeating upright test and studying the side effects of the drugs. All the children were followed - up by telephone,mainly investigating on the syndrome recurrence and symptom - free survival by Kaplan - Meier analysis. The follow - up time was 3 to 122(42. 7 ± 24. 3)months. Results Short - term effect showed that the symptom scores were decreased after treatment(t = 21. 536,P ﹤ 0. 001). Head -up test showed that delta heart rate was decreased. The effective rates in the Midodrine hydrochloride plus oral rehydra-tion salts group and the Metoprolol plus oral rehydration salts group were significantly higher than those of the simple oral rehydration salts group(χ2 = 10. 905,P = 0. 004). But no statistical difference was found between the Midodrine hydrochloride plus oral rehydration salts group and the Metoprolol plus oral rehydration salts group(χ2 = 0. 042,P =0. 837). Long - term effect by Kaplan - Meier curve showed that the therapeutic effect of Midodrine hydrochloride plus oral rehydration salts group was significantly higher than any of the other two groups(χ2 = 13. 299,P ﹤ 0. 01),but no statistical difference was found between the Metoprolol plus oral rehydration salts group and the simple oral rehydration salts group(χ2 = 0. 150,P = 0. 699). Conclusions In terms of the short - term result,the effective rates in the Mido-drine hydrochloride plus oral rehydration salts group and the Metoprolol plus oral rehydration salts group were signifi-cantly higher than those of the simple oral rehydration salts group. The therapeutic effect of the Midodrine hydrochloride plus oral rehydration salts was superior to that of the Metoprolol plus oral rehydration salts and the simple oral rehydra-tion salts for POTS children by the long - term follow - up study.

The follow-up study on the treatment of children with postural orthostatic tachycardia syndrome / 国际儿科学杂志

Objective To compare the short-term and long-term therapeutic effects of oral rehydration salts,metoprolol or midodrine hydrochloride in children with postural tachycardia syndrome (POTS).Methods Two hundred and forty-four children with POTS diagnosed in the First Hospital Peking University of from Dec.2004 to Jan.2013 were followed up in clinics or by telephone.They were divided into oral rehydration salt group (n =75),metoprolol group (n =66) and midodrine hydrochloride group (n =103).The patients were followed up for 3 ～ 100 months.Results After 3 months of treatment,the symptom scoring of the three groups was improved greatly as compared with the baseline data.Therapeutic effect of midodrine hydrochloride group was significantly superior to metoprolol group and oral rehydration salt group (x2 =8.750,P =0.013).One hundred and forty-two out of 244 children were followed up and their head-up tilt test(HUT)was repeated.The HR increment of children in 3 groups became smaller as compared with before treatment (P ＜ 0.05).After follow-up,the symptom scoring was improved greatly as compared with the baseline scoring (P ＜ 0.05).The short-term effect of midodrine hydrochloride group was significantly better than that of metoprolol group or oral rehydration salt group (x2 =8.750,P =0.013).The Kaplan-Meier curves showed that the long-term effect of midodrine hydrochloride group was significantly superior to metoprolol group and oral rehydration salt group (89.3％vs 78.8％,P =0.033;89.3％ vs 76.0％,P =0.002).Conclusion Oral rehydration salts,midodrine hydrochloride or metoprolol were all effective for POTS in children.And the short-term and long-term effect of midodrine hydrochloride might be superior to metoprolol and oral rehydration salts.

Changes in plasma nitric oxide and nitric oxide synthase activity in children with orthostatic hypotension / 中华实用儿科临床杂志

Objective To explore the changes in plasma nitric oxide (NO) and nitric oxide synthase (NOS) activity in children with orthostatic hypertension(OHT) and the relationship with blood pressure changes.Methods The OHT group included 51 children who were diagnosed OHT in in-patient and out-patient departments of Peking University First Hospital from Jun.2012 to Jun.2013.Their age range was (12 ± 2) years.At the same time,control group consisted of 28 normal children who received physical examination with their age range of(12 ± 1) years.The diagnosis of OHT was based on the clinical manifestation and head-up tests.Plasma NO was determined by using a nitrate reductase method and plasma NOS activity by a chemical colorimetric method.Results 1.There were no significant differences between OHT group and control group in age,sex ratio,height,weight and body mass index (all P ＞0.05).2.In OHT children,the upright systolic blood pressure was higher than that of the supine [(114 ± 10) mmHg vs (104 ± 9) mmHg,t =-12.853,P ＜ 0.001],and the upright diastolic blood pressure was higher than that of the supine[(73 ±7) mmHg vs(59 ± 8) mmHg,t =-21.859,P ＜0.001].3.Plasma NO level and NOS activity,however,were significantly lower in OHT group than those in the control group [NO:(28.947 ± 6.031) μmol/L vs (35.216 ±6.662) μmol/L,t =4.257,P ＜ 0.001 ; NOS activity:(14.753 ± 3.060) U/mL vs (17.560 ± 4.253) U/mL,t =3.026,P =0.006].4.There was significantly negative correlation between plasma NO and the upright systolic blood pressure(r =-0.276,P ＜ 0.05) and the systolic blood pressure change (r =-0.280,P ＜ 0.05).Conclusions Plasma NO level and NOS activity were significantly lower in OHT children than those in control group.The abnormal vascular endothelial function may play an important role in OHT in children.

Changes of atrial natriuretic peptide and antidiuretic hormone in children with postural tachycardia syndrome and orthostatic hypertension: a case control study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The abnormal blood volume regulation is one of the most important pathogenesis in postural tachycardia syndrome in children. This study was designed to investigate the plasma atrial natriuretic peptide and antidiuretic hormone levels in postural tachycardia syndrome children, and their associations with the changes in heart rate and blood pressure in head-up test.</p><p><b>METHODS</b>Twenty-one postural tachycardia syndrome patients ((12 ± 2) years) and 26 healthy children ((12 ± 1) years) were included. According to blood pressure changes in head-up test, the postural tachycardia syndrome patients were divided into two subgroups: postural tachycardia syndrome with orthostatic hypertension and postural tachycardia syndrome without orthostatic hypertension. The plasma atrial natriuretic peptide and antidiuretic hormone levels were measured using enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>The plasma atrial natriuretic peptide level in postural tachycardia syndrome patients was higher than the control (P = 0.004), whereas the difference in plasma antidiuretic hormone level between postural tachycardia syndrome and controls was not significant (P = 0.222). The plasma antidiuretic hormone level of patients suffering from postural tachycardia syndrome with orthostatic hypertension was much higher than that of children having postural tachycardia syndrome without orthostatic hypertension (P < 0.05). In postural tachycardia syndrome patients, the upright max heart rate was positively correlated with the plasma atrial natriuretic peptide level (r = 0.490, P < 0.05) and the upright systolic blood pressure was positively correlated with the plasma antidiuretic hormone levels (r = 0.472, P < 0.05).</p><p><b>CONCLUSIONS</b>There was a disturbance of plasma atrial natriuretic peptide and antidiuretic hormone in postural tachycardia syndrome children.</p>

The clinical diagnosis and treatment of vasovagal syncope in children / 临床儿科杂志

Vasovagal syncope (VVS) was a neurally-mediated functional disease, a transient disturbance of consciousness triggered by transient cerebral ischemia due to peripheral vasodilation resulting from a variety of incentives, accompanied by the loss of muscle tone and even fainting. Children with VVS are characterized by recurrent syncopal attacks induced by prolonged standing, postural changes and muggy environment, etc. Currently treatments of VVS include non-pharmacological therapy and pharmacological therapy.

Epidemiology and Clinical Management of Pulmonary Hypertension in Children

Pulmonary hypertension (PH) is a clinical hemodynamic syndrome characterized by increased pulmonary artery pressure and pulmonary vascular resistance. It can cause right ventricular failure, and even death. Pediatric PH is not very common, but is a greatly hazardous disease that leads to a high mortality rate. Therefore, many registry organizations have been established in the world to strengthen the study of diagnosis and treatment of the disease, and improve the understanding of pediatric PH. This article reviewed recently published researches, as well as presented a comprehensive understanding of PH, including definition, classification, epidemiology, prognosis and treatment.

Determination of Psoralen and Isopsoralen in Different Effective Extracts of Fructus Psoraleae by RP-HPLC / 中药新药与临床药理

Objective To establish a HPLC method for the assay of psoralen and isopsoralen in different effective extracts of Fructus Psoraleae. Methods HPLC was carried out on the column of Kromasil RP-C18. The mobile phase was methanol -water(65 ∶35). The flow rate was 1.0 mL/min and the UV detection wavelength was 245 nm. Results Good linearity of psoralen was showed within the range of 10.5 ng～525 ng(r= 0.999 3)and isopsoralen within the range of 9 ng～450 ng (r= 0. 999 9). The content of psoralen and isopsoralen differed in different extractions of Fructus Psoraleae. Among them,the extract C (extracted by ethyl acetate ) contained the highest contents of psoralen and isopsoralen,while the contents of psoralen and isopsoralen were very low in the extract D (extracted by n-butyl alcohol) and E (supernatant of water extract). Conclusion The method is simple,accurate and reproducible. The anti-asthma effect and the dose-effect relationship of the different effective extracts of Fructus Psoralea need further pharmacodynamics study.

Quality Analysis of Herba Ephedra / 中药新药与临床药理

Objective To supply evidence for quality control of Herba Ephedra by determining content limit in different batches of medicinal material of Herba Ephedra.Methods A RP-HPLC method was used for the determination of ephedrine and pseudo-ephedrine. The chromatographic conditions were: Kromasil RP-C18(250?4.6 mm,5 ?m) column, a mixture of 0.3 %phosphoric acid-methanol (10∶90) as mobile phase and 213nm as detected wavelengths.Results The contents of the above two alkaloids showed great difference among the 14 patches of tested samples. The content of ephedrine ranged 0.361 %～1.538 %and that of pseudo-ephedrine 0.332～2.087 %. The suggested content limitation of ephedrine should be 1.082 %, and that of psedoephedrine be 1.008 %in the crude Herba Ephedra.Conclusion The established method has been proven to be simple, stable and repeatable, and can be applied for quality control of the crude crude Herba Ephedra and compound prescriptions containing crude Herba Ephedra.