Influencing Factors of HIV/ AIDS Death Based on Bayesian Cox Proportional Hazard Regression Model / 中山大学学报(医学科学版)

ObjectiveTo understand the composition of related characteristics of HIV/AIDS cases in Lanzhou and analyze the influencing factors of AIDS-related deaths. MethodsThe information of HIV/AIDS cases reported in Lanzhou from 2011 to 2019 was collected， the method of survival was used analysis and Bayesian Cox Proportional Hazard Regression Model was constructed to analyze the related factors of death. ResultsA total of 2 312 HIV/AIDS patients were selected in this study， including 45 AIDS-related deaths. The results of multivariate regression showed that the older the patients were， the higher the risk of death was； the risk of death of AIDS patients at the time of diagnosis was 13.91 times higher than that of HIV-infected patients； Patients who received CD4 testing had a lower risk of death than those who did not； The risk of death was 0.22 times higher among those who received antiretroviral therapy than those who did not receive antiretroviral therapy. ConclusionsAge at diagnosis， course of disease， antiviral therapy were the influencing factors of AIDS-related death in HIV/AIDS patients in Lanzhou. Therefore， it is necessary to strengthen health education for AIDS-related groups， advocate early detection， early diagnosis， and early treatment， expand the coverage of AIDS testing and treatment， prolong the survival time of AIDS patients.

Analysis of HIV-1 genetic subtype and pretreatment drug resistance among men who have sex with men infected with HIV-1 from 19 cities of 6 provinces in China / 中华流行病学杂志

Objective: To investigate the distribution of HIV-1 genetic subtypes and pretreatment drug resistance (PDR) among men who have sex with men (MSM) from 19 cities of 6 provinces in China. Methods: From April to November 2019, 574 plasma samples of ART-naive HIV-1 infected MSM were collected from 19 cities in Hebei, Shandong, Jiangsu, Zhejiang, Fujian, and Guangdong provinces, total ribonucleic acid (RNA) was extracted and amplified the HIV-1 pol gene region by nested polymerase chain reaction (PCR) after reverse transcription. Then sequences were used to construct a phylogenetic tree to determine genetic subtypes and submitted to the Stanford drug resistance database for drug resistance analysis. Results: A total of 479 samples were successfully amplified by PCR. The HIV-1 genetic subtypes included CRF01_AE, CRF07_BC, B, CRF55_01B, CRF59_01B, CRF65_cpx, CRF103_01B, CRF67_01B, CRF68_01B and unrecognized subtype, which accounted for 43.4%, 36.3%, 6.3%, 5.9%, 0.8%, 0.8%, 0.4%, 0.4%, 0.2% and 5.5%, respectively. The distribution of genetic subtypes among provinces is statistically different (χ2=44.141, P<0.001). The overall PDR rate was 4.6% (22/479), the drug resistance rate of non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors, and protease inhibitors were 3.5% (17/479), 0.8% (4/479) and 0.2% (1/479), respectively. The PDR rate of recent infections was significantly higher than that of long-term infections (χ2=4.634, P=0.031). Conclusions: The HIV-1 genetic subtypes among MSM infected with HIV-1 from 19 cities of 6 provinces in China are diverse, and the distribution of subtypes is different among provinces. The overall PDR rate is low, while the PDR rate of recent infections was significantly higher than that of long-term infections, suggesting the surveillance of PDR in recent infections should be strengthened.

TCMATCOV--a bioinformatics platform to predict efficacy of TCM against COVID-19 / 中国中药杂志

There is urgent need to discover effective traditional Chinese medicine(TCM) for treating coronavirus disease 2019(COVID-19). The development of a bioinformatic tool is beneficial to predict the efficacy of TCM against COVID-19. Here we deve-loped a prediction platform TCMATCOV to predict the efficacy of the anti-coronavirus pneumonia effect of TCM, based on the interaction network imitating the disease network of COVID-19. This COVID-19 network model was constructed by protein-protein interactions of differentially expressed genes in mouse pneumonia caused by SARS-CoV and cytokines specifically up-regulated by COVID-19. TCMATCOV adopted quantitative evaluation algorithm of disease network disturbance after multi-target drug attack to predict potential drug effects. Based on the TCMATCOV platform, 106 TCM were calculated and predicted. Among them, the TCM with a high disturbance score account for a high proportion of the classic anti-COVID-19 prescriptions used by clinicians, suggesting that TCMATCOV has a good prediction ability to discover the effective TCM. The five flavors of Chinese medicine with a disturbance score greater than 1 are mainly spicy and bitter. The main meridian of these TCM is lung, heart, spleen, liver, and stomach meridian. The TCM related with QI and warm TCM have higher disturbance score. As a prediction tool for anti-COVID-19 TCM prescription, TCMATCOV platform possesses the potential to discovery possible effective TCM against COVID-19.

Transcatheter closure of patent ductus arteriosus with the new Amplatzer Duct OccluderII / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the indications, methodology and results of the transcatheter closure of patent ductus arteriosus (PDA) with the new Amplatzer Duct Occluder II (ADO-II).</p><p><b>METHOD</b>Totally 51 patients underwent transcatheter closure of PDA with the new ADO-II. The devices were delivered by 4F or 5F sheath through arterial or venous side respectively. The descending aorta angiography and transthoracic echocardiography was performed to evaluate the device position, residual shunt and complications caused by the device during and after implantation.</p><p><b>RESULT</b>Forty-nine patients had successful transcatheter closure of the PDA without significant residual shunts and artery obstruction during the short-term follow-up. One patient received the ADO-II dislodgment and first generation ADO re-implantation for the obvious descending aortal obstruction caused by ADO-II. Another patient had the ADO-II dislodgment and left pulmonary artery shaping surgery, because the ADO-II implantation led to obstruction of the left pulmonary artery. Both the obstructions in these two patients were ameliorated afterwards.</p><p><b>CONCLUSION</b>The transcatheter closure using the ADO-II is safe and effective for the non-window type PDA with a small size.</p>

Comparative study on heart function assessment of left single ventricle in children by echocardiography the doppler myocardial performance index and tissue doppler imaging / 中华实用儿科临床杂志

Objective To explore the accuracy of heart function assessment of the left single ventricle problems in children by three-dimensionalechocardiography (3 DE),the doppler myocardial performance index (MPI) and tissue doppler imaging(TDI).Methods Twenty-nine healthy children (the healthy control group) and 29 children with problems in the single left ventricles (the case study group) were enrolled in this study.End-diastolic volume (EDV),end-systolic volume(ESV) and ejection fraction(EF) were acquired by using IE 33 system and Q-lab software between 2 groups.MPI was calculated from doppler tracings on the ventricular inflow and outflow,and the velocity profile of atrioventricular annular was obtained by TDI.Max(dp/dt) of the left single ventricle was estimated by atrioventricular regurgitation using simplified Bernoulli equation.Results EDV,ESV and MPI in the case study group were higher than those of the healthy control group(t =2.821,5.287,2.085,all P ＜0.05),and EF of the case study group was lower than that of the healthy control group(t =-13.840,P ＜ 0.05).Em,Am and Em/Am on the side of the left ventricular lateral wall of mitral annulus in the control group were higher than those of the case study group at the nonresidual cardiac cavity side(t =-3.059,2.219,-4.762,P ＜ 0.05) ;Sm and Em/Am in the healthy control group at mitral annular lateral ventricular septal side were higher than those in the case study group at the residual cardiac cavity side(t =-2.200,-2.962,P ＜0.05).Q-Sm interval in healthy control group was lower than that in the case study group(t =2.345,P ＜ 0.05).There was a negative correlation between Max (dp/dt) and MPI in the case study group (r =-0.57,P ＜0.05),there was a positive correlation between Max(dp/dt) and EF and Q-Sm interval in the case study group(r =-0.74,0.62,P ＜ 0.05).Conclusions Impaired ventricular functions can be found in patients with left single ventricle problems,which can be assessed accurately by 3DE.

Diagnostic value and misdiagnosis analysis of tetralogy of Fallot by prenatal echocardiography / 中华实用儿科临床杂志

Objective To evaluate the diagnostic value of prenatal echocardiography in fetus with tetralogy of Fallot(TOF),and to analyze the reason of misdiagnosed in order to improve the echocardiographic diagnosis.Methods A retrospective echocardiographic review of 36 fetuses with TOF confirmed by prenatal magnetic resonance imaging (MRI) or postnatal echocardiography.Results Among 36 cases of TOF fetuses,31 cases (86.1 ％) were diagnosed correctly by echocardiography,and in the remaining 5 cases,4 cases(11.1％) were misdiagnosed [2 cases misdiagnosed as ventricular septal defects (VSD),2 cases misdiagnosed as double outlet of right ventricles],and 1 case (2.8％) was missed diagnoses at 20 weeks gestation and confirmed as TOF at 36 weeks gestation based on the echocardiographic findings of malalignment type VSD,overriding aorta,pulmonary stenosis,and right ventricular hypertrophy.Malalignment type VSD,overriding aorta,and pulmonary stenosis were observed in 31 cases with TOF diagnosed by prenatal echocardiography,right ventricular hypertrophy was observed only in 6 cases.The most common associated anomalies were tricuspid regurgitation in 13 cases(36.1％),aortic insufficient in 6 cases(16.7％),absent pulmonary valve in 4 cases(11.1％),right-side aortic arch in 4 cases(11.1％),persistent left superior vena cava in 3 cases(8.3％),and complete atrioventricular septal defect in 1 case (2.8％).Conclusions Combining visualization of TOF in four-chamber view,outflow tract view,and three vessels view,TOF can be accurately diagnosed by prenatal echocardiography.

Efficacy of the transcatheter closure of perimembranous and muscular ventricular septal defects with the Amplatzer duct occluder II / 中华心血管病杂志

<p><b>OBJECTIVES</b>To evaluate the feasibility and efficacy of transcatheter closure of perimembranous ventricular septal defects (pmVSD) with aneurysmatic formation and muscular ventricular septal defects (mVSD) with Amplatzer duct occluder II.</p><p><b>METHODS</b>This retrospective analysis included 48 cases received transcatheter closure of pmVSD aneurysmatic formation or mVSD from February 2011 to March 2012 in our hospital (42 pmVSD with aneurysmatic formation and 6 mVSD). Median age was 5.2 years (range: 1.8 - 15 years), and median weight was 20.2 kg (range: 12 - 44 kg). Amplatzer duct occluder II was selected depending on the condition of ventricular septal defect. The device was implanted by antegrade or retrograde approach. Complications such as residual shunt, valvular regurgitation and arrhythmia were evaluated by echocardiography or angiography. Median follow-up was 9.5 months (range: 1 - 13 months).</p><p><b>RESULTS</b>The mean ratio of pulmonary (Qp) to systemic (Qs) blood flow was 1.35 ± 0.15 before transcatheter closure. The diameter of exit hole of ventricular septal defects was (2.46 ± 0.53) mm measured by transthoracic echocardiography, and (2.35 ± 0.40) mm by angiography. Successful implantation of the device was achieved in 46 patients (96%) and unsuccessful in two cases due to acute aortic insufficiency. Forty-two (92%) patients were closed successfully, and trivial residual leak was evidenced in four patients and remained unchanged during follow-up. One patient with mVSD still had trivial residual shunt at 6 months post procedure. New trivial tricuspid insufficiency was observed in 1 patient (2.1%) during follow-up. Two patients developed procedural related left anterior fascicular block and remained unchanged during follow-up.</p><p><b>CONCLUSIONS</b>pmVSD with aneurysm and mVSD could be successfully treated with Amplatzer duct occluder II. However, the long waist and large disc of the device could interfere with tricuspid valve function and cause tricuspid insufficiency.</p>

Retrospective cohort study on period of incubation and survival among former commercial plasma donors infected with HIV in Hebei province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To examine the state of incubation period and survival time of former commercial plasma donors (FCPDs) infected with HIV.</p><p><b>METHODS</b>All objects infected with HIV were from Hebei province and found from general investigation for FCPDs in 1995. The infector cohort by 142 cases was used to estimate incubation period. In the infector cohort, the time which infectors entered the cohort was their infection time, which was the middle value of the origin date, which was January 1, 1995. The onset of AIDS was defined as an outcome event. End point of observation was Dec 31, 2010. There were 192 months in all from beginning to end. The AIDS cohort by 57 cases was used to estimate the survival of the patients. In the patient cohort, the time of AIDS onset was defined as the time entering the cohort, and death of AIDS was defined as an outcome event. The cumulative incidence ratio, cumulative mortality, illness intensity and mortality intensity were analyzed through Kaplan-Meier.</p><p><b>RESULTS</b>During the observation period, 123 cases of 142 infectors developed into AIDS, the cumulative incidence was 86.42% (123/142) and the intensity was 8.53/100 person-years and the median time of incubation period was 112.0 months (95%CI: 108.8 - 115.2). The death dates of 57 patients were from 1 to 24 months after onset. The cumulative mortality was 100%, and the intensity was 250.66/100 person-years and the median survival time was 3.0 months (95%CI: 1.8 - 4.2). It was estimated that the median time was 115.0 months (9.6 years) from infection to death.</p><p><b>CONCLUSION</b>The median times of incubation and median survival time were 112.0 and 3.0 months, respectively.</p>

A retrospective cohort study on the natural history of AIDS caused by blood transfusion / 中华流行病学杂志

Objective To study the natural history of AIDS,caused by blood transfusion.Methods All HIV infections and AIDS patients were from Hebei province,including those infected through blood transfusion around 1995,that were identified as through general census of former commercial plasma donors (FCPDs).Among those objects being observed during the incubation period,354 had HIV infections( including 142 cases infected via plasmapheresis and 212 cases caused by transfusion) but had not been treated by HAART before the onset of disease.Objects being observed during the survival period,141 were AIDS patients (including 57 cases infected via plasmapheresis and 84 cases causes by transfusion) but had not been treated by HAART before and after the onset of disease.All infectors and AIDS patients were under follow-up on the progress of illness or death,respectively.Results By December 31,2010,the cumulative incidence among HIV infections was 88.70％ ( 314/354),with the incidence density as 9.14/100 person-years ( 314/3435.75 )and the median incubation period was 113 months.Of 142 HIV infections in the blood donation group and 212 infections in the blood transfusion group,the incubation periods were 112 months and 115 months,respectively.All of the 141 patients died 34 months after the onset,with the death-strength as 204.70/100 person-years (141/68.88) and the period of survival was 4 months.Among those 57 FCPDs infections,they were all died 24 months after the onset,with the death-strength as 250.66/100 person-years (57/22.74) and the survival was 3 months.The other 84 infections who were blood recipients,all died 34 months after the onset,with the death-strength as 182.05/100 person-years (84/ 46.14) and the survival was 4 months.Conclusion Through this study,we noticed that the natural history of all the AIDS patients was caused by blood transmission.It was important to evaluate the natural history of HIV epidemics among both FCPDs and blood recipients,occurred before and after 1995.

Comparative study on the effect of highly active antiretroviral therapy (HAART) in patients with HIV infection acquired by blood transfusion and paid plasma donation / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To study the effect of HAART in patients with AIDS acquire by blood transfusion and paid plasma donation.</p><p><b>METHODS</b>All AIDS patients whose disease was caused by blood transfusion and commercial plasma donation came from the domicile of Hebei Province. In the group of cases of blood transfusion in whom the infection was caused by one-time blood transfusion before and after 1995, there were 189 cases, of whom 105 cases on HAART were designated as observation group, and 84 cases who were not on HAART were designated as control group. The group of AIDS patients who were former commercial plasma donors (FCPDs) had 120 patients who were identified in the survey of 1995, of whom 63 cases on HAART were designated as observation group and 57 cases who were not on HAART were as control group. Onset dates were defined as the dates into the queue. Death due to AIDS was regarded as an outcome event. Subjects who were enrolled into the observation group and control group were epidemiologically followed up regularly. Observation was ended on December 31, 2010.</p><p><b>RESULTS</b>Mortality of patients after HAART from groups of FCPDs and blood recipients were 4.42/100 person-years and 6.13/100 person-years, respectively. The survival rates of HAART groups were 80% in FCPDs for 110 months and 72% in blood recipients for 90 months, respectively. Meanwhile the mortality of no HAART groups were 182.05/100 person-years and 250.66/100 person-years, respectively. Mean survival of patients whose disease was caused by plasma donation and blood transfusion were 4 months and 3 months, respectively.</p><p><b>CONCLUSIONS</b>Whether the HIV infection was caused by plasmapheresis or blood transfusion, the effects of HAART did not show difference. HAART cold reduce the death intensity and prolong survival.</p>

Evaluation of early monitoring of cardiotoxicity induced by anthracyclines / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Anthracyclines (ANT) are effective for leukemia and solid tumors. However the long-term life quality of patients is seriously affected by ANT-related cardiotoxicity. The aim of this study was to evaluate the value of two dimension echocardiography (2DE) and serum biochemical indicators in monitoring ANT-related cardiotoxicity.</p><p><b>METHODS</b>Seventy children who received ANT chemotherapy (ANT dose: 124 ± 73 mg/m2) and were followed up for 22 ± 13 months were enrolled. 2DE with aspects of conventional indexes (left ventricular diameter and wall thickness, ejection fraction, E/A), myocardial performance index (MPI) and tissue Doppler imaging (TDI) were performed. Serum levels of troponin (CTnI) and brain natriuretic peptide (BNP) were measured. Thirty-seven healthy children served as the control group.</p><p><b>RESULTS</b>There were no significant differences in conventional indexes of 2DE between the ANT and the control groups. The MPI of left and right ventricular in the ANT group increased significantly compared with that in the control group (0.237 ± 0.06 vs 0.203 ± 0.06, 0.171 ± 0.05 vs 0.140 ± 0.04 respectively; P<0.01). TDI showed the late diastolic peak velocity in the basal and middle sections of left ventricular, interventricular septum and right ventricular in the ANT group were significantly higher than the controls. There were significant differences in the ratio of early to late diastolic peak velocity of the middle section of left ventricular and the basal and middle sections of the interventricular septum between the two groups (P<0.05). The changes of MPI and TDI became more obvious with the increased dose of ANT. There were no significant differences in serum CtnI and BNP levels between the two groups.</p><p><b>CONCLUSIONS</b>The heart function of patients who received ANT chemotherapy needs to be monitored for a long term. MPI and TDI can be used as early indexes for monitoring the heart function.</p>

Following surveillance on HIV infection after blood transfusion / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To study epidemiological features of HIV infection after blood transfusion and the situation of transmission among members of family.</p><p><b>METHODS</b>The persons infected with HIV through blood transfusion and their intrafamilial transmission in some city were analyzed and testing methods of ELISA, Western-blot, RT-PCR and subtype analyzing were used. The whole surveillance data came from residents investigation around problem medical centres and HIV monitoring network around Hebei province.</p><p><b>RESULTS</b>173 people infected with HIV after blood transfusion in some city, including 89 cases found in hospital and 84 cases in CDC, accounted for 68.7% (173/252) of all of infected persons by blood transfusion in Hebei province. The rate of intrafamilial transmission, spousal transmission and mother-to-child transmission((MTCT) were 32.0% (49/153),17.0% (26/153) and 32.7% (32/98), respectively. Most of persons infected with HIV were youth among who the female were more than the male. Childbearing and women's ailments were the main cause of blood transfusion from 1990 to 1999, and traumatism surgery took second place. Infected persons by HIV blood, whose time to diagnostic were the year from 1999 to 2009, spread over Kangtai hospital and other hospital which accounted for 45.1% (78/173) and 42.2% (73/173), respectively. The genetype of all patients were B' subtype.</p><p><b>CONCLUSION</b>The medical centers at the grass-roots level in some city resulted in outbreak of infected persons by HIV blood because of having no screening test antibody of HIV for liid blood donors.</p>

Investigation on status of HIV-1 infection among blood recipients from 1994 to 1998 in certain areas of China / 中华流行病学杂志

Objective To study the infection status of HIV-1 among blood recipients from 1994 to 1998 in certain areas of Hebei province. Methods A general investigation was set up among all the people in 15 townships of certain areas from November 2003 to February 2005. An epidemiological investigation was conducted among people who had received blood from donors, during 1994 and 1998. Blood samples were collected. ELISA was used in preliminary screening and Western-blot (WB) was used among people who showed a positive result in the preliminary screening. Results The infection rate of HIV-1 after blood receipt was 15.54% (92/592) , and the infected persons were all appeared in five medical centers of 6 townships which located at the west part of the area. HIV-1 infection happened over the years, and reaching the zenith in the year 1995. Most of the infected persons were young women. Procreation was the main cause of blood transfusion for women and trauma was for men. Conclusion A typical HIV outbreak happened in certain areas after blood transfusion in Hebei.

Retrospective cohort study on the rate of mother-to-child transmission among mothers infected with human immunodeficiency virus type 1 through blood transfusion / 中华流行病学杂志

Objective To study the rate of mother-to-child transmission (MTCT) on HIV-1. Methods All local residents from 8 townships in a region were screened for mothers who had a history of only one blood transfusion and 63 were found HIV-1 positive. A further study on these HIV-1 positive mothers and their children was conducted with the emphasis on the date of receiving blood transfusion, date and type of nationality, history regarding breastfeeding and so on. Sera specimens from 84 children born from 63 HIV-1 positive mothers were screened, using ELISA for HIV-1 antibody, and positive specimens were confirmed by Western-blot. Results The rate of MTCT was 32.1% (27/84) for children with all risk factors related to MTCT. Another 36.8% (7/19) were related to factors on intrauterine, intrapartum and breastfeeding, 35.7% (5/14) to intrapartum and breastfeeding factors, 14.3% (2/14) to intrauterine and intrapartum factors, 37.9% (11/29) to breastfeeding factor alone. By group combination analysis, the MTCT rate was 36.9% (24/65) with breastfeeding, 11.8% (2/17) with artificial feeding, and the former was significantly higher than the latter. Conclusion HIV-1 MTCT rate among mothers caused by a single blood transfusion varied with different risk factors. Breastfeeding played an important role in MTCT, appeared in our study.

Clinical diagnosis of anomalous origin of the left coronary artery from the pulmonary artery in 22 cases / 中华儿科杂志

<p><b>OBJECTIVE</b>To discuss the diagnostic methods and features of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).</p><p><b>METHODS</b>A total of 22 cases of ALCAPA hospitalized between 2000 and 2007 were recruited and divided into infant group (age < or = 1 year, n = 10) and older children group (age > 1 year, n = 12). The patients' history, electrocardiography (ECG) and echocardiography were reviewed and analyzed retrospectively. ECGs were analyzed as follows: (1) Q wave and T wave inversion in lead I, (2) Abnormal Q wave and T wave inversion in lead aVL, (3) Q wave in lead V(5-6), (4) T wave inversion and ST changes in lead V(4-6), (5) LV hypertrophy. Echocardiograms were analyzed as follows: (1) Continuity of the left coronary artery (LCA) and pulmonary artery (PA), (2) Retrograde shunt into PA, (3) Increased papillary muscle echodensity, (4) Right coronary artery (RCA) dilation, (5) Collateral signals within the ventricular septum.</p><p><b>RESULTS</b>The presence of cardiomegaly in X-ray film (18/22), aVL QT pattern in ECG (17/22), retrograde color Doppler flow into pulmonary artery (20/22), anterior lateral papillary echogenic (17/22) and collateral vessel signals (16/22) in echocardiography were high in both groups (P > 0.05). The presence of clinical symptoms and abnormal Q wave in leads Iand V(5-6) in ECG were significantly higher in the infant group than in the older children group (P < 0.05). But the presence of right coronary artery dilation was significantly lower in the infant group than in the older children group (P < 0.05).</p><p><b>CONCLUSION</b>Different diagnostic features were found in infant and older children patients. With combination of patient history, electrocardiogram and echocardiogram, accurate diagnosis could be obtained in most pediatric patients with ALCAPA.</p>

A case-control study on the risk factors for attempted suicide in patients with major depression / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the environmental risk factors on attempted suicide in patients with major depression, and to study the interaction between factors as single nucleotide polymorphism(SNP) of TPH2 gene rs7305115 associated to attempted suicide in major depression.</p><p><b>METHODS</b>Paired case-control study on 215 suicide attempters with major depression (92 male, 123 female) and molecular biological techniques were used to study the relation between TPH2 gene rs7305115 SNP,interrelated environmental factors and the rate of attempted suicide. Controls were paired with cases according to the same gender, similar age (no more than 3 years) and from the same district.</p><p><b>RESULTS</b>There were remarkably significant differences in gene types and gene frequency between case and control groups (P < 0.001). Data from multivariate conditional logistic regression model analysis showed that hopelessness, negative life-events and family history of suicide were relationship of attempted suicide in patients with major depression with OR values as 0.33 (95% CI: 0.22-0.99), 7.68 (95% CI: 5.79-13.74), 6.64 (95% CI: 2.48-11.04), 2.98 (95% CI: 1.17-5.04) respectively. There was no first level interaction between any of the two risk factors.</p><p><b>CONCLUSION</b>Results from the study supported the idea that hopelessness, negative life-events and family history of suicide were risk factors of attempted suicide in major deprbssion while TPH2 gene rs7305115 A/A might be the protective factor.</p>

Congenital coronary artery fistula in children:The interventional management and outcome / 介入放射学杂志

Objective To assess the safety and efficacy of transcatheter closure of congenital coronary artery fistulas(CAFs).Methods Retrospective analysis was performed on 19 patients mean age of(5.5?4.1) years treated from February 1995 to December 2005 with transcatheter closure of CAFs using transcatheter spring coil embolization,Amplatzer PDA occluder or Amplatzer plug.One case had a residul fistula postoperatively associated with patent duetus arteriosus(PDA).Results The abnormal parameters included mean fistula diameter(3.7?1.6)mm(2.5-8.2 mm),pulmonary mean pressure(28.0?5.0)mmHg(25.0-67.0 mmHg)and pulmonary to systemic shunt(Qp/Qs)1,6?0.8(1.0-2.3).The sites of the fistulas were originated in right coronary artery 11,left anterior descending coronary artery or left circumflex coronary artery 8. Abnormal communication sites of these fistulas were to right ventricle in 14 and right atrium in 5.Various occlusion devices used to close these fistulas included one Giantureo coil in 10,2-4 Gianturco coils in 3, Duct-Occlud in 3,Amplatzer duct occluder in 2 and Amplatzer plug in 1.The post-operative residul fistula with PDA was treated successfully with PDA occlusion.The immediate,one month and one year complete occlusion rates were 55.6%(10/18),88.9%(16/18),100%(18/18),respectively.The coil slipped into the left pulmonary artery in 1 case and correction was obtained by retrieving with forceps.Follow-up studies at 3 months to 4.3 years showed complete abolition of shunt in all patients with no evidence of recanalization leading to recurrences of shunt.Conclusion Transcatheter closure of CAFs is a safe and effective alternative to surgical repair.

Diagnostic value of the currently used criteria and brain natriuretic peptide for diagnosing congestive heart failure in children with congenital heart disease / 中华儿科杂志

<p><b>OBJECTIVE</b>To improve the accuracy of diagnosis of heart failure (HF) has been the focus of research for a long time. The diagnosis for HF with congenital heart disease, however, is more difficult. The aim of the study was to evaluate the diagnostic criteria for HF in children and examine the value of plasma brain natriuretic peptide (BNP) and NT-proBNP for diagnosing HF in pediatric patients with congenital heart disease, and to look for the most valuable index for the diagnosis according to the multifactor analysis.</p><p><b>METHODS</b>Totally 118 children with congenital heart disease were enrolled. They were diagnosed using modified Ross score, Qingdao criteria, NYU PHFI, and plasma BNP and NT-proBNP. According to modified Ross score as the referent criteria, other diagnostic criteria and plasma BNP and NT-proBNP were studied. The sensitivity, specificity and area of the ROC curve were examined. Logistic regression analysis was used to select the valuable index for diagnosing HF.</p><p><b>RESULTS</b>(1) The value of each clinical criteria: 1 The sensitivity of Qingdao criteria for diagnosing HF was 47.9%. The specificity was 100% and the accuracy was 57.6%. 2 There were 52 patients younger than six months in whom 27 (51.9%) were breast fed. Only 25 children were measured with Ross score. The Ross score was positively correlated with the modified Ross score (r = 0.948). The area under the ROC curve of Ross score diagnosing HF was 0.985, and the sensitivity was 88%, while the specificity was 100%. 3 NYU PHFI score was positively correlated with the modified Ross score. The area under the ROC curve of the NYU PHFI diagnosing HF was 0.964, and the sum of sensitivity and specificity was favorite when > or = 8 was set as the cut-off point. If > 2 was set as cut-off point, it had a high sensitivity but a low specificity. The sensitivity of NYU PHFI was 100% > was set 2 as cut-point for diagnosing HF, but the specificity was 4.5%. (2) Plasma BNP and NT-proBNP were positively correlated with the modified Ross score, and increased with the severity of congestive HF. The area under the ROC curve of BNP was 0.880, and the cut-off line was > or = 349 pg/ml. The area under the ROC curve of NT-proBNP was 0.981, and the cut-off line was > or = 499 fmol/ml. (3) Logistic regression analysis showed that in multifactor analysis, only plasma concentration of NT-proBNP, dyspnea, tachycardia, tachypnea, failure to thrive were the independent predictors for diagnosing HF. (4) Plasma concentration of NT-proBNP incorporated with clinical criteria would improve its accuracy.</p><p><b>CONCLUSION</b>All the clinical criteria commonly used were valuable for diagnosing HF in children with congenital heart disease, but each has its own limits, such as the low sensitivity of Qingdao, the low adaptation of Ross score because of the high breast-feeding rate in our country and the low specificity of NYU PHFI when > 2 was set as the cut-off point. Plasma concentrations of BNP and NT-proBNP were valuable for diagnosing HF in children with congenital heart disease, and NT-proBNP was the independent predictor for HF.</p>

Pathological diagnosis of conotruncal defects by transthoracic three-dimensional echocardiography / 中华儿科杂志

<p><b>OBJECTIVE</b>Recently, it has been demonstrated in several studies that three-dimensional echocardiography (3DE) with any cut view interpretation of the cardiac morphological structures and its dynamic three-dimensional display can conform to the need of accurate anatomical diagnosis of complex congenital heart diseases including conotruncal defects (CTD). 3DE can not only provide functional and morphological information of CTD to decide on surgical repair but also simulate the intra operative visualization of complex anatomical cardiac structures to improve the understanding of the anatomy of CTD, but there have been scarce studies to assess systematically the potential noninvasive diagnostic value of transthoracic 3DE for CTD in children. Thus, this study attempted to evaluate the diagnostic value of transthoracic 3DE for the pathological diagnosis of CTD in children.</p><p><b>METHODS</b>HP Sonos 5500 echocardiographic system interfaced with Tomtec 3DE imaging system (echo-view 4.2 software) was used to diagnose 210 patients (132 male, 78 female, aged 0-15 years, mean 3.2 +/- 3.2 years) with CTD in Shanghai Children's Medical Center from May 2000 to November 2003, including 62 patients with double outlet right ventricle, 48 patients with transposition of great arteries, 48 patients with tetralogy of Fallot, 38 patients with pulmonary atresia with interventricular septal defect and 14 patients with persistent truncus arteriosus. Diagnostic method consisting of ten designed 3DE sectional views and Van Praagh's sequential segmental approach in congenital heart diseases was used in this study. And the results were compared with those diagnosed by two-dimensional echocardiography (2DE) and angiocardiography. Surgical findings were considered as the "gold standard".</p><p><b>RESULTS</b>There were 526 image acquisitions of transthoracic 3DE in the 210 patients with CTD including 200 through subcostal window, 254 through parasternal window and 72 through apical window, among which 477 image acquisitions (93.2%) could demonstrate good spatial cardiovascular structures. Meanwhile, six 3DE sectional views of the diagnostic method of the ten designed 3DE sectional views were identified for the diagnosis of CTD as follows: en-face view of atrial and ventricular septa from left ventricle (L1a); en-face view of atrial and ventricular septa from right ventricle (L2a); four-chamber view of whole-heart oblique frontal plane (Ha and Hb); en-face view of atrial-ventricular valve from atria (S1a) and en-face view of atrial-ventricular valve from ventricles (S2a). The 3DE sectional diagnosis showed that 3DE could provide more information of inner cardiac structure than 2DE, such as ventricular configuration identification, atrial-ventricular and ventricular-arterial continuity, location and shape of ventricular septal defect (VSD), and appreciation of the defects related with aorta and pulmonary arteries, etc. In 147 cases of surgical repair, both 3DE and 2DE were in accordance with the surgical findings, but 3DE had new findings in 18 (12.2%) cases and corrected the diagnoses in 10 (6.8%) cases as compared with 2DE.</p><p><b>CONCLUSION</b>The 3DE sectional diagnostic method could make a successfully sectional diagnosis of pathological morphology in CTD by demonstrating more spatial information of inner cardiac structure than 2DE and angiocardiography.</p>

Diagnostic value of plasma concentration of pro-brain natriuretic peptide in congestive heart failure in pediatric patients with ventricular septal defects / 中华儿科杂志

<p><b>OBJECTIVE</b>The value of plasma brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) can reflect cardiac function and therefore can be used for diagnosing congestive heart failure (CHF) and evaluating cardiac function. There are few reports, however, on the value of BNP and NT-proBNP in pediatric cases of congenital heart defect. The aim of this study was to assess the value of plasma NT-proBNP in the diagnosis of CHF and evaluation of cardiac function in pediatric patients with ventricular septal defect (VSD).</p><p><b>METHODS</b>Fifty-one patients with VSD aged from 2 months to 2 years old (mean 7.9 months) were enrolled. According to the modified Ross Score, the patients were divided into three groups, no CHF group (20 patients), mild CHF group (18 patients) and moderate to severe CHF group (13 patients). Fifteen age-matched normal children were used as controls. Plasma NT-proBNP was measured using enzyme immunoassay. All patients had complete echocardiographic study, including measurement of left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic wall stress (LVSEWS), heart rate corrected mean velocity of circumferential fiber shortening (mVcFc), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and contractility index (Con). The correlation between plasma NT-proBNP level and modified Ross Score and echocardiographic cardiac functional indexes was determined. The sensitivity, specificity and ROC curve of plasma NT-proBNP for diagnosing CHF was studied.</p><p><b>RESULTS</b>Plasma NT-proBNP was positively correlated with modified Ross Score (r = 0.75, P < 0.01). Plasma NT-proBNP concentration in moderate to severe CHF group (2061 +/- 908) fmol/ml was significantly higher than that of mild CHF group (810 +/- 335) fmol/ml, and Plasma NT-proBNP concentration in mild CHF group was higher than that in no CHF group (309 +/- 68) fmol/ml. 97.14% of normal controls and subjects in no CHF group had their plasma NT-proBNP below 400 fmol/ml. 83.3% of children in mild CHF group had their plasma NT-proBNP between (400-1400) fmol/ml while in moderate and severe CHF group 84.6% of children had their plasma NT-proBNP beyond 1400 fmol/ml. Plasma NT-proBNP was also positively correlated with LVEDVI and LVSEWS. There was no correlation among mVcFc, LVEF, LVFS, Con and plasma NT-proBNP concentration. Using plasma NT-proBNP concentration > or = 400 fmol/ml as cut-point for diagnosing CHF, the sensitivity was 89.3%, the specificity was 91.2%, and the area under the ROC curve was 0.944.</p><p><b>CONCLUSIONS</b>Plasma NT-proBNP level could be used to assess cardiac function and diagnose CHF in pediatric patients with VSD.</p>