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Catecholaminergic polymorphic ventricular tachycardia(CPVT)is a highly fatal inherited arrhythmia induced by emotional stress or exercise.It can be triggered by rapid polymorphism of ventricular tachycardia and ventricular fibrillation, and may lead to syncope or sudden death, with a poor prognosis.Genetic testing is one way to diagnose the disease.It has been found that the disease is related to abnormalities of RyR2, CASQ2, TECRL and other genes, whose mutations affect calcium homeostasis and lead to abnormal electrophysiological activity of the heart, leading to delayed depolar(DADs), and subsequently to malignant arrhythmia.This paper reviewes the mutation of the new pathogenic gene TECRL gene in catecholamine sensitive ventricular tachycardia, through the understanding and learning of the mutation gene reported in the previous literature, in order to further explore the pathogenesis of the disease, learn to deal with the occurrence of malignant arrhythmia, and promote the clinical precise treatment of the disease.
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In order to make up for the innovation deficiency in the traditional residency training model and the shortcomings of active learning and lifelong learning, evidence-based medicine is introduced into the residency training of dental general practitioners. Theoretical knowledge training of evidence-based medicine is conducted through online course learning. PICO mode is used to conduct evidence-based analysis of clinical cases under the guidance of the instructor, so that trainees can get familiar with the process of evidence-based analysis. Students can finally design and complete the application cases of evidence-based medicine, and teachers give evaluation guidance. Through this process, students can learn and master the knowledge of evidence-based medicine step by step, thus obtaining better teaching results.
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In December 2019, the endemic of COVID-19 broke out in Wuhan, China. The disease is highly contagious and quickly spreads at home and abroad, causing great concern. However, there are no definite effective antiviral drugs in clinical use. Given the urgency of the COVID-19 outbreak, based on the diagnosis and treatment recommendation and relavant researches, this article describes the optional antiviral drugs such as remdesivir, oseltamivir, arbidol, lopinavir/ritonavir, ribavirin, and interferon-α to provide a reference for treatment of COVID-19.
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In December 2019, COVID-19 broke out in Wuhan, China. The disease is highly contagious and quickly spreads at home and abroad, causing great concern. However, there are no definite effective antiviral drugs in clinic. Given the urgency of the COVID-19 outbreak, based on the diagnosis and treatment recommendation and previous researches, this review describes the optional antiviral drugs such as remdesivir, oseltamivir, Arbidol, lopinavir/ritonavir, ribavirin, and interferon-α to provide a reference for the infection therapy.
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The guideline for diagnosis and treatment of adult community-acquired pneumonia (CAP) (2007 edition) jointly formulated by the Infectious Diseases Society of America ( IDSA) and the American Thoracic Society ( ATS) has a great impact on the clinical management for CAP in China.In October 2019, the two societies revised and updated the guide again.Compared with the 2007 guideline, the new guideline is more concise ; some contents were deleted and some contents have been updated.The main updated points are obvious changes in the compiling mode , the reduced recommendation intensity for macrolides in CAP treatment ,and more emphasizing the relevance of diagnosis and treatment activities to the clinical practice.
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Objective Carbapenem-resistant Enterobacteriaceae infections is becoming a major challenge to clinicians, which resulted in extremely high mortality owing to the limited antibiotics option.It is urgently to explore strategies to manage such bacterial infections.So far,the research is mainly focused on the research and development of new drugs,as well as the re-evaluation of classic antimicrobial drugs and the combined treatment regimens.Tigecycline is available in our country,but the clinical effect is still doubtful.Polymyxin has a good effect on drug sensitivity test in vitro,but the clinical dosing has not been established.Carbapenems combining with other drugs as optimizing treatment program is also being explored.Carbapenemase-inhibitor combination has not yet listed on Chinese market.In the mean time,it is urgent to prevent and to control carbapenem-resistant Enterobacteriaceae bacterial infection.
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Objective@#To explore the effects of continuous veno-venous hemodiafiltration (CVVHDF) as a rescue therapy in children with Kawasaki disease (KD) complicated with multiple organ dysfunction syndrome (MODS).@*Methods@#The medical records of 5 patients diagnosed as KD with MODS treated with CVVHDF, who were admitted to pediatric intensive care unit (PICU) of Shanghai Children's Hospital from November 2015 to October 2017 were retrospectively collected. The inflammatory factors and parameters of organ function before and after CVVHDF treatment were analyzed. Wilcoxon test was used to compare the changes of parameters before and after CVVHDF treatment.@*Results@#The pediatric critical illness score (PCIS) and the pediatric risk of score mortality score Ⅲ (PRISMⅢ) were 74.0 (70.0, 81.0) and 14.5 (12.5, 17.0), respectively. The duration of CVVHDF treatment was 46.0 (24.5, 48.0) h. The levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), blood lactic acid were significantly decreased after the CVVHDF treatment (0.4 (0.1, 28.8) vs. 142.0 (123.1, 1 454.6) ng/L, Z=-2.023, P=0.043; 0.1 (0.1, 9.3) vs. 1.7(1.1, 30.0) ng/L, Z=-2.023, P=0.043; 1.2(1.1,1.4) vs. 2.5(2.4, 2.7) mmol/L, Z=-2.041, P=0.041 respectively). Moreover, the lung, liver and kidney function were significantly improved as indicated by the ratio of PaO2 to FiO2 (380.0 (182.5, 397.5) vs. 160.0 (52.5, 185.0)mmHg (1 mmHg=0.133 kPa), Z=2.041, P=0.041), the level of total bilirubin ((14.9±1.3) vs. (86.4±9.9) μmol/L), and the levels of creatinine (2 cases: 24.0vs. 103.0 μmol/L, 38.0 vs. 142.0 μmol/L).@*Conclusion@#CVVHDF as an adjuvant therapy can rapidly reduce the levels of IL-6 and TNF-α,and improve the organ functions in children with KD complicated with MODS.
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Objective To explore the value of transesophageal atrial pacing (TEAP) and temporary cardiac pacing in the treatment of acute intractable tachyarrhythmia in children. Method The clinical data of children with acute intractable tachyarrhythmia treated with TEAP (48 cases) or temporary cardiac pacing (6 cases) from January 2014 to December 2017 were retrospectively analyzed. Results In the 48 cases aged 1 day to 13 years (28 males and 20 females) treated with TEAP, 25 cases had paroxysmal supraventricular tachycardia, in which there were 15 cases of rapid atrial flutter, 5 cases of atrial tachycardia and 3 cases of left ventricular idiopathic bundle branch reentrant tachycardia. The rates of successful cardioversion to sinus rhythm through TEAP were 84％, 80％, 20％ and 100％ respectively. In the 6 cases aged 2 to 10 years (1 male and 5 females) treated with temporary cardiac pacing, there were 5 cases of fulminant myocarditis and 1 case of noncompaction of the ventricular myocardium and their conditions were well controlled after treatment. Conclusion TEAP and temporary cardiac pacing have good curative effect in the treatment of acute intractable tachyarrhythmia in children. However, temporary electricity therapy can only temporarily rectify the hemodynamic abnormality threatening the life of children, and active comprehensive treatment for the primary diseases should be carried out simultaneously.
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Objective To investigate the acute phase expression of serum cytokines in children with Kawasaki disease (KD) and its association with coronary artery lesions (CALs). Methods Expression of 13 cytokines in serum of 104 KD patients including 11 cases with CALs and 74 febrile control cases admitted to the hospital from October 2016 to March 2017 were retrospectively analyzed. Results Interleukin (IL)-8, IL-1, IL-2, IL-6, IL-10, IL-17A, IL-18, tumor necrotic factor-α and SCD25 (IL-2R) were declined significantly after intravenous immunoglobulin administration (IVIG) in KD patients (all P<0.05). Compared with the fever control group, Pre-IVIG, an IL-17A level ≥ 0.155 pg/mL had a sensitivity of 50% and 93.2% specificity for predicting KD; IL-18 level ≤ 15.43 pg/mL had a sensitivity of 71.2%, and the specificity was 54.1%; SCD25 (IL-2R) ≥ 29475.29 pg/mL had a 65.4% sensitivity and 81.1% specificity for predicting KD. Before IVIG treatment, the level of IL-10 was significantly lower in KD patients with CALs than in those without CALs. Conclusions Determination of various cytokines profile may be helpful for predicting the disease prognosis and targeting treatment strategies in patients with KD.
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Objective To explore clinical characteristics of J wave syndromes. Methods Clinical data was retrospectively analyzed in a child with fainting and showing big J wave in ECG. Meanwhile, related literatures were reviewed. Results A 10-year-old boy was admitted to hospital with fainting. ECG showed J point up, reflecting Osbron wave. There was no abnormality in EEG and cranial CT. Ultrasound cardiograph showed approximately normal heart structure and left ventricular systolic function. Fainting was frequently occurred during follow-up and accompanied by malignant arrhythmia. Conclusions Patients with J wave syndromes has high risks of malignant arrhythmia and sudden cardiac death.
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Objective To analyze the possible risk factors of IVIG non-response of Kawasaki disease (KD),Shanghai Children's Hospital and Shanghai Junze Software develop an research platform,which is based on E-Science model.Through the mathematical model by integrating the risk factors to explore the method of effective prediction for IVIG non-response,and to provide the clinical basis for timely and effective treatment and prognosis of the disease.Methods The data of KD children who were hospitalized in Shanghai Children's Hospital from January 2013 to November 2016 were included.The indexes included gender,age,time of IVIG treatment,and laboratory examinations.The multivariate logistic regression was used to analyze the influencing factors of IVIG non-response.The indexes in the model were deduced according to the independent variables of the logistic regression equation.The ROC curve and the area under the curve were calculated for the new prediction model.The sensitivity and specificity of the new prediction model were calculated according to the cutoff value.Finally,the new model was compared with the Kobayashi and Egami scoring model.Results The levels of CRP,NLR,LDH,ALB and FDP in children with KD were influencing factors for IVIG nonresponse (P ＜ 0.05).According to the logistic regression equation,the sensitivity and specificity of the model used to predict IVIG non-response were 69.7％ and 80.4％,respectively,and the area under the ROC curve was 0.825 (95％ CI:0.769-0.882).Kobayashi and Egami scoring models were tested,the sensitivity and specificity of the new scoring system were better than previous ones.Condusion The scoring model established in this study has a good effect in predicting IVIG non-response in KD patients and could be used in clinical practice,and it is worthy to be validated and adjusted by large-scale data.
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Objective To investigate the advantages of glucocorticoid combined with traditional meth-ods and to explore glucocorticoid use in appropriate time in the whole course of the disease and the appropriate dose.Methods With reference to Kawasaki disease(KD)diagnostic criteria,363 cases of patients with KD were enrolled,and divided into conventional treatment group and combined hormone group randomly. Combined hormone group according to clinical manifestations can be divided into sub groups as typical KD and atypical KD group. We analyzed respectively before and after 1 week treatment in two groups of children with the onset of age,gender,heating duration after treatment, IVIG treatment time, hospitalization days and total hospitalization expenses,tips and course of acute stage,recovery period the relevant indexes to the test,and coronary artery le-sion( CAL) in one month. Results Thermal process after treatment,hospitalization duration and hospitalization expenses decreased significantly in combined hormone group compared with conventional treatment group. The difference between the two,in the clinical laboratory indexes and CAL have no obvious difference. In different types of KD, the thermal process after treatment, hospitalization days and hospitalization expenses, have de-creased significantly in typical KD sub group when treating with combined hormone therapy comparing with hor-mone therapy atypical sub group. Other clinical laboratory indexes and CAL have no obvious differences in com-pared between the sub groups. Conclusion Combined hormone therapy for KD patients,plays an important role in shortening the thermal process after treatment and reducing the hospitalization expense.
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Objective To investigate the advantages of glucocorticoid combined with traditional meth-ods and to explore glucocorticoid use in appropriate time in the whole course of the disease and the appropriate dose.Methods With reference to Kawasaki disease(KD)diagnostic criteria,363 cases of patients with KD were enrolled,and divided into conventional treatment group and combined hormone group randomly. Combined hormone group according to clinical manifestations can be divided into sub groups as typical KD and atypical KD group. We analyzed respectively before and after 1 week treatment in two groups of children with the onset of age,gender,heating duration after treatment, IVIG treatment time, hospitalization days and total hospitalization expenses,tips and course of acute stage,recovery period the relevant indexes to the test,and coronary artery le-sion( CAL) in one month. Results Thermal process after treatment,hospitalization duration and hospitalization expenses decreased significantly in combined hormone group compared with conventional treatment group. The difference between the two,in the clinical laboratory indexes and CAL have no obvious difference. In different types of KD, the thermal process after treatment, hospitalization days and hospitalization expenses, have de-creased significantly in typical KD sub group when treating with combined hormone therapy comparing with hor-mone therapy atypical sub group. Other clinical laboratory indexes and CAL have no obvious differences in com-pared between the sub groups. Conclusion Combined hormone therapy for KD patients,plays an important role in shortening the thermal process after treatment and reducing the hospitalization expense.
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Objective To investigate protective effects of polysaccharides from Platycarya strobilacea Sieb.et Zucc on cerebral ischemia-reperfusion injury in rats.MethodsForty Wistar rats were randomly divided into four groups:sham group,model group,Rehmannia glutinosa polysaecharide low,and high dose groups.Each group was given oral administration for 7 days.After 1 h of last administration, the CIRI (cerebral ischemia-reperfusion injury) group was produced inserting 5-0 line into the internal carotid artery.Neurological functional score was evaluated according to the method of Zea longa's score, meanwhile,infarct size was detected by TTC staining.Levels of superoxide dismutase (SOD) activity,malondialdehyde (MDA), IL-10, IL-1β and TNF-α contents in cerebral tissues were measured.TUNEL staining was used to assess the number of TUNEL-positive cells of the ischemic cortex.Western blot was used to analyze the expressions of Nrf2 and HO-1 in cerebral tissues.ResultsCompared to model group, Platycarya strobilacea a polysaccharides could significantly improve neurogical functions,greatly decrease the contents of MDA, IL-10 and IL-1β in cerebral tissues,improve SOD activity and IL-10 content in cerebral tissues,and effectively reduce cerebral infarct range.Meanwhile Platycarya strobilacea polysaccharides could enhance the expressions of Nrf2 and HO-1 in cerebral tissues.ConclusionPlatycarya strobilacea polysaccharides have beneficial effects on rats with cerebral ischemia-reperfusion injury, which may be mediated at least in part by the Nrf2/HO-1 pathway.
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Objective To investigate the protective effects of luteolin on cerebral ischemia-reperfusion injury in rats.Methods 40 SD rats were randomly divided into four groups:sham group,model group,luteolin low and high dose groups.Each group was given oral administration for 7 days.After 1 h of last administration,the CIRI ( cerebral ischemia-reperfusion injury) group was produced inserting 5-0 line into the internal carotid artery.Then levels of IL-10, IL-1βand TNF-αcontents in myocardial tissues were measured.Meanwhile,infarct size was detected by TTC staining and number of BrdU +and Nestin + were measured by immunohistochemical methods.Results Compared with model group, luteolin could significantly decrease the levels of TNF-αand IL-1βin cerebral tissues(P<0.05),improve IL-10 content in cerebral tissues(P<0.05),and effectively reduce myocardial infarct range(P<0.05).Meanwhile luteolin could improve the expressions of BrdU + and Nestin + in cerebral tissues(P <0.05).Conclusion Luteolin has beneficial effects on rats with cerebral ischemia-reperfusion injury and improves endogenous neural stem cells proliferation.
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Objective@#To screen and identify the mutations in Kawasaki disease by targeted enrichment of genomic region sequencing technique and investigate susceptibility genes associated with coronary artery lesion.@*Method@#This was a case-control study.A total of 114 patients diagnosed as Kawasaki disease treated in Shanghai Children′s Hospital between December 2015 and November 2016 were studied and another 45 healthy children who were physically examined in outpatient department were enrolled as control group. Patients were divided into two groups based on the results of echocardiogram. Peripheral venous blood was obtained from patients and controls. Genomic DNA was extracted. SeqCap EZ Choice libraries were prepared by targeted enrichment of genomic region technology. Then the libraries were sequenced to identify susceptibility genes associated with coronary artery lesion in patients diagnosed as Kawasaki disease.Susceptible genes were identified by Burden test, Pearson chi-square test or Fisher′s exact probability test.@*Result@#There was statistically significant difference in TNFRSF11B(rs2073618)G>C(p.N3K)mutation and GG/GC/CC genotype between Kawasaki disease group and control group(χ2=15.52, P=0.00). There was statistically significant difference in TNFRSF13B(rs34562254)C>T(p.P251L)mutation(χ2=10.40, P=0.01)and LEFTY1(rs360057)T>G(p.D322A)mutation(χ2=8.505, P=0.01)between patients with coronary artery lesions and those without.@*Conclusion@#Targeted enrichment of genomic region sequencing technology can be used to do primary screening for the susceptible genes associated with coronary artery lesions in Chinese Kawasaki patients and may provide theoretical basis for larger sample investigation of risk prediction score standard in Kawasaki disease.
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Objective To investigate the effects of T-type calcium channel inhibitors (ProTx-1,micromolar Ni2+ and Mibefradil) on Monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH) in rats.Methods Forty male Sprague-Dawley rats were randomly divided into 5 groups:normal control group,MCT group,ProTx-1 group,micromolar Ni2+ group and Mibefradil group (8 cases in each group).The right ventricular systolic pressure (RVSP),the right ventricular hypertrophy index (RVHI),and the index of pulmonary vascular remodeling(MA％) were measured on day 28 after MCT-treatment.Western blot was used to detect the expression of proliferating cell nuclear antigen(PCNA) and Cleaved Caspase-3 in pulmonary artery.Results (1)RVSP and RVHI in MCT group were significandy higher than those in the other 4 groups (F =21.55,P ＜ 0.01;F =15.63,P ＜ 0.01).The two indexes in 3 intervention groups were higher than those in normal control group (all P ＜ 0.05),nevertheless,significantly lower than those in MCT group,and 3 intervention groups showed no significant differences (all P ＞ 0.05).(2) MA％ in normal control group [(23.43 ± 1.95) ％] was lower than that in MCT group [(80.42 ± 4.30) ％],ProTx-1 group [(60.35 ± 3.83)％],micromolar Ni2+ group[(62.44 ± 3.81)％] and Mibefradil group[(58.66 ± 4.23)％] (F =216.2,P ＜ 0.01);3 intervention groups showed no significant differences (all P ＞ 0.05),however,they were all significantly lower than that in MCT group.(3) The expression of PCNA in MCT group was higher than that in normal control group,meanwhile,3 intervention groups were significantly lower than that in MCT group.The expression of Cleaved Caspase-3 in MCT group was higher than that in normal control group,nevertheless,3 intervention groups showed no significant changes compared with MCT group,respectively.Conclusions T-type calcium channel inhibitors could ameliorate the progression of MCT-PAH in rats,mainly through suppressing the proliferation of pulmonary artery smooth muscle cells.
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Objective To explore the clinical characteristics and treatment of paroxysmal supraventricular tachycardia (PSVT) in children. Methods The clinical data of 67 children with PSVT were analyzed retrospectively, and the therapeutic effects of different treatments were compared. Results The clinical manifestations of infants were paleness, shortness of breath, irritability and sweating, and children showed chest tightness, palpitations, abdominal discomfort and fatigue. The curative effect of electric cardioversion, transesophageal atrial pacing, physical therapy, and drug therapy was statistically different (P<0.05), The different cardioversion rates of them were observed for the treatment of paroxysmal supraventricular tachycardia. The cardioversion rate of transesophageal atrial pacing, was the highest, and the rate of physical therapy was the lowest. There was no significant difference in the cardioversion rate between propafenone, digoxin and amiodarone. Conclusion The clinical manifestations of PSVT in infants are atypical and easily to be ignored. There are many methods for treatment of PSVT. The vagus nerve can be stimulated first, and, if no response, either drugs or electric cardioversion and transesophageal atrial pacing can be used. The cardioversion rate of transesophageal atrial pacing is higher. The drug effectiveness for the treatment of PSVT depends on many factors, and our choice of medication varies from person to person.
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Objectives To explore the clinical features and pathogenesis of Kawasaki disease (KD) combined with sterile pyuria. Methods A total of 420 patients diagnosed of KD were recruited and divided into pyuria group ( 95 patients) and control group ( 325 patients) according to urine routine examination on admission. The clinical data between the two groups were compared. Results There was no difference in gender, age, and the incidence of atypical KD (P all?>?0 . 05 ). The levels of C-reactive protein, D-dimer concentrations, fibrinogen degradation products, alanine aminotransferase, aspartate aminotransferase, and urine retinol binding protein were higher in pyuria group than those in control group (all P>?0 . 05 ). No difference was found in the duration of fever before admission between two groups (P>?0 . 05 ). However, pyuria group had longer duration of fever after treatment with immunoglobulin (P?0.05). Conclusion The morbidity of sterile pyuria in KD patients was 22 . 6%. KD patients with sterile pyuria have more intense inlfammatory response, markedly high coagulation condition, and mild or subclinical renal damage.
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Objective To study the effect of telbivudine (TBV) on the ratio of CD4+ CD25+CD127low/-regulatory T cell (Treg) of HBeAg-positive chronic hepatitis B (CHB). Methods The ratios of Treg before and after treatment for 12, 24, 36 and 48 weeks with TBV of thirty-five patients with HBeAg-positive CHB were detected. Results Ratios of Treg were (12.55 ± 1.78)%, (10.42 ± 1.04)%, (9.55 ± 0.74)%, (8.78 ± 0.67)%, (8.74 ± 0.71)%respectively before and after treatment of 12, 24, 36 and 48 weeks and all the values were lower than its former one (P < 0.05), except the 48 weeks′. Conclusions The ratio of Treg of HBeAg (+) CHB decreases after treatment with TBV.