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Objective@#To analyze the clinical characteristics of Kawasaki disease in infants and explore the risk factors of coronary artery abnormities in Kawasaki disease.@*Methods@#The clinical data of 300 children with Kawasaki disease from January 1, 2018 to December 31, 2018 were retrospectively analyzed, including laboratory tests and coronary ultrasound results.The clinical characteristics of infants with Kawasaki disease and elderly children with Kawasaki disease were compared.The risk factors of coronary artery injury in infants with Kawasaki disease were analyzed.@*Results@#The majority of infants with Kawasaki disease were atypical Kawasaki disease, and the typical changes of conjunctival congestion, perianal changes and plaque were significantly higher than those of elderly children (P<0.01). Leukocyte count and platelet count were higher in the infant group, and the number of children with abnormal liver function was significantly higher than that in the older group (P<0.05). Coronary artery dilatation occurred in 11% of infants with Kawasaki disease, and most of them returned to normal within 3 months.Logistic model design was used to analyze the risk factors of coronary artery injury in infants with Kawasaki disease.It was found that boys and CRP increased significantly were the risk factors of coronary artery injury in infants with Kawasaki disease.@*Conclusion@#Infant Kawasaki disease has its own characteristics.The incidence of coronary artery injury is high.Timely diagnosis, differential diagnosis and symptomatic treatment may reduce the incidence of coronary artery injury.At the same time, follow-up should be maintained to monitor the changes of coronary artery by echocardiography.
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Objective To investigate the clinical features and prognosis in ventricular noncompaction children. Methods Thirty-four cases who diagnosed with ventricular noncompaction were included in this study in Shengjing Hospital of China Medical University from January 2012 to May 2018. According to age, the children were divided into infantile type( age <1 year old) and juvenile type( age≥1 year old) . We ana-lyzed the clinical features,laboratory tests and prognosis. Results The average age at diagnosis was 3 years and 2 months. The sex ratio was 2. 4:1. Of these,32 cases were left ventricular noncompaction,1 was right ventricular noncompaction, and 1 was biventricular noncompaction. There were no statistically significant differences in family history,arrhythmia,and thrombotic events between infantile type and juvenile type. Heart failure was the first reason for most children,while older children often presented with fatigue when at diag-nosis. More than half of them showed significant left ventricular ejection fraction(LVEF) decreasing,and non-compacted layer to compacted layer(N/C) ratio showed negative correlation with LVEF(r= -0. 74, P<0. 001). Sixty-five percent(22/34) of the patients presented abnormal electrocardiogram. During the follow-up,one patient died of pulmonary embolism. No significant LVEF improvement was found in 35％(12/34) of the patient. The COX proportional hazards model showed that N/C ratio was an independent risk factor for poor prognosis of ventricular noncompaction(OR=14. 46,95％CI 1. 712 -120. 234,P<0. 05). Conclusion Children with ventricular noncompaction showed different clinical features and prognosis. Early diagnosis,treatment and long term follow up are key issues for the prognosis.
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Objective To compare the clinical features of classic Kawasaki disease (CKD) and in-complete Kawasaki disease (IKD),and to explore the risk factors of coronary artery abnormities in Kawasaki disease. Methods We collected the clinical data of 320 children with Kawasaki disease from July 1,2017 to June 30,2018,including 244 children with CKD (CKD group) and 76 children with IKD (IKD group). The risk factors of coronary artery abnormities in children with Kawasaki disease were explored. Results In ad-dition to coronary artery injury ( 5%), some patients showed other rare complications such as cholestasis (1. 6%),intestinal obstruction(0. 6%),atlantoaxial subluxation (0. 9%),macrophage activation syndrome (0. 9%) and Kawasaki disease shock syndrome (0. 3%). The age onset in CKD group was earlier than that in IKD group. WBC, CPR, NT-proBNP in CKD group were significantly higher than those in IKD group (P<0. 05). After one week of treatment,WBC and CRP decreased significantly in group IKD,and there was no significant difference in PLT count. Multivariate logistic model was used to analyze the risk factors of cor-onary artery abnormities in Kawasaki disease. It was found that 25-OH VitD reduction ( OR ＝2. 851,P <0. 05) was a high risk factor for coronary artery injury in KD. Conclusion Kawaski disease should be diag-nosed early, treated for organ damage and supplemented with vitamin D. After discharge, coronary artery changes should be monitored regularly.
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Cardiogenic shock is caused by dysfunction of the cardiac pump,resulting in multiple or-gan failure and metabolic disturbances. Because of its rapid onset,various manifestations,rapid progress and high mortality rate,it becomes one of the critical diseases in pediatrics. Early diagnosis and active treatment is the key to improve prognosis. The application of hemodynamic monitoring and mechanical circulatory assist devices play an increasingly important role in the treatment of cardiogenic shock in children.
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Cardiogenic shock is caused by dysfunction of the cardiac pump,resulting in multiple or-gan failure and metabolic disturbances. Because of its rapid onset,various manifestations,rapid progress and high mortality rate,it becomes one of the critical diseases in pediatrics. Early diagnosis and active treatment is the key to improve prognosis. The application of hemodynamic monitoring and mechanical circulatory assist devices play an increasingly important role in the treatment of cardiogenic shock in children.
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Ambulatory blood pressure monitoring(ABPM)system can record patients blood pressure of 24 h on the predetermined time. The primary data forms the graph,the curve and the general report by operation of the related software after the analysis and statistics processing. Patients keep daily life condition,so the blood pressure data is more accuracy. ABPM can provide the dynamic change of the patients 24 h blood pressure,including the 24 h blood pressure survey data,the undulation situation and the change tendency. ABPM has become an useful element in the evaluation and follow - up of hypertension in adults. And ABPM is increasingly used to evaluate the blood pressure of children and adolescents in recent years. The ABPM has been shown to differ significantly values.
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Myocardial metabolism activating drugs can increase the energy supply and decrease the energy consumption of the myocardial cells,playing a role in the nourishment and protection of cardiac muscles and the optimization of the energy metabolism.It is the adjuvant drug in treatment of myocarditis,myocardiosis,severe arrhythmia,acute or chronic heart failure and cardiosurgery,with an irreplaceable role in the salvage therapy of severe angiocardiopathy.Due to its safety and little side effects,it has been widely used in pediatrics.
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Objective To evaluate the treatment effect and security of transcatheter arterial chemoembolization(TACE)combined with sorafinib for intermediate-advanced hepatocellular carcinoma.Methods From July 2008 to November 2010,the treatment effects of two groups of patients with advanced hepatocellular carcinoma were retrospectively analyzed and compared,including 44 patients treated by sorafenib combined with TACE(test group)and the other 44 patients treated only with TACE(control group).To assess the treatment effect based on mRECIST,the time for patients' tumor progression(TTP),overall survival(OS)time and adverse events were recorded.Survival rate were analyzed using KaplanMeier method and Log-rank analysis in SPSS 18.0.Results Till January 2011,24 patients(54.5％)survived and 20 patients(include patients lost to visit)died(45.5％)among the test group,13 patients survived(29.5 ％)and 31 patients(include patients lost to visit)died(70.5 ％)among the control group.No complete remission condition was observed in all patients.Among the test group,1 patient got partial remission,24 ones remain stable and 19 patients got progression.While among the control group,conditions remained stable in 21 patients and progressed in rest 23 ones.The disease control rate(DCR)in the test group and control group were 56.8％(25/44)and 47.7％(21/44)respectively,with no statistical significance(x2 =0.729,P =0.393).The median overall survival time(mOS)of test group and control group were 21.0(95 ％ CI:14.9-27.1)months and 10.0(95 ％ CI:6.4-13.6)months respectively,and the difference reached statistical significance(x2 =7.436,P =0.006).The median time to tumor progression(mTTP)of test group and control group was 1 1.0(95％ CI:8.7-13.3)and 6.0(95％ CI:3.9-8.1)months respectively,and the difference had statistical significance(x2 =10.437,P =0.001).The adverse events of test group mainly included hand-foot skin reaction,loss of appetite,fever,fatigue and diarrhea.The adverse events of control group mainly included fever,loss of appetite,nausea,vomiting and fatigue.The incidences of hand-foot skin reaction,baldness,diarrhea were significantly higher in test group than those in the control group(P ＜0.05).In most patients,these side effects were mild-to-moderate,and alleviated remarkablely after symptomatic treatment.Conclusions Compared with TACE alone,TACE combined with sorafenib can prolong the OS and TTP significantly for the patients with intermediate-advanced hepatocellular carcinoma.However,the DCR of the two groups has no statistical significance.
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ObjectiveTo investigate the relationship between the change of circulating endothelial cell (CEC) level and coronary artery lesion (CAL) of Kawasaki disease (KD),and to further explore the method for early diagnosis of KD.MethodsThirty KD children were recruited for study,including 23 children with complete type of KD and seven children with incomplete KD.According to the results of echocardiography,the KD group was divided into CAL group (9 cases) and non-coronary artery lesion (NCAL)group (21 cases).Ten healthy children were enrolled as control group.Double-blind and controlled trial was conducted,and Hladovec method was applied for CEC counting.Results The CEC level was ( 1.09 ±0.60) × 107/L in KD group,which was higher than that of control group [ (0.38 ±0.14) × 107/L],and the difference was statistically significant ( t =2.85,P ＜ 0.01 ).The CEC level in the CAL group [ ( 1.84 ± 0.24) × 107/L] was higher than that of the NCAL group[ (2.01 ±0.38) × 107/L],and the difference was statistically significant ( t =2.24,P ＜ 0.05 ).The CEC level was ( 1.16 ± 0.63 ) × 107/L in the complete type of KD group and (0.83 ± 0.45 ) × 107/L in the incomplete KD group,which showed no significant difference between the two groups ( t =1.86,P ＞ 0.05 ).CondusionCEC level was elevated significantly in the acute phase of KD.The CEC level in CAL group was higher than that of NCAL group in acute phase.CEC level detection may be helpful for the early diagnosis of KD.
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Kawasaki disease is far more frequent in children than in adults. The pathogenesis of Kawasaki disease is unknown, but it involves changes to the coronary artery and other diverse clinical manifestations. There are currently no specific laboratory diagnostic indexes, and especially since the disease is rare in adults, so it is extremely easy to misdiagnose or to overlook entirely. Our retrospective analysis of an diagnosis of and treatment for Kawasaki disease in an adult provides a guide to clinical doctors in terms of understanding Kawasaki disease, early diagnosis of it, and improved prognosis.
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Adult , Humans , Male , Aspirin , Therapeutic Uses , Mucocutaneous Lymph Node Syndrome , Diagnosis , Therapeutics , gamma-Globulins , Therapeutic UsesABSTRACT
Objective To study the changes of plasma endothelial microparticles (EMP) in children with Kawasaki disease (KD) and its relation to coronary artery lesions (CAL).Methods The participants in this study were 30 children with KD (24 children with typical KD and 6 cases with incomplete KD).All KD patients met the diagnostic criteria established by the Japanese Kawasaki Disease Research Committee.According to the course of KD,3 phases were divided:the acute phase,the subacute phase and the convalescent phase.We evaluated the presence of CAL using two-dimensional echocardiographic examination,and then the KD children were divided into two groups,including 24 children without CAL and 6 children with CAL.Ten children with fever and rash and 10 healthy children were studied as control.The levels of CD31+/CD42b- EMP were measured by flow cytometry.Results The level of EMP was significantly higher in the acute phase [ (8.18 ± 2.29) ％ ] than those either in the convalescent phase [ (2.77 ± 0.85 ) ％ ] of KD or the healthy children [ ( 1.34 ± 0.38 ) ％ ] (P ＜ 0.01 ).The level of EMP was also significantly higher in the subacute phase [ (5.93 ± 1.05 )％ ] than those either in the convalescent phase of KD or the healthy children (P ＜0.01 ).The level of EMP was higher in the children with fever [ (3.66 ± 1.16) ％ ] than that in the healthy children ( P ＜ 0.05 ).Furthermore,the level of EMP during the acute phase was also higher in KD patients with CAL than in those without CAL(P ＜0.01 ).Conclusion The measurement of EMP may be useful for the early diagnosis of KD and the identification of CAL.