Advance of mesenchymal stem cells in the treatment of cardiovascular diseases in children / 国际儿科学杂志

Cardiovascular disease(cardiomyopathy, myocardial infarction, heart failure)seriously endanger child health.Although the incidence in children is not very high, the prognosis is usually poor due to limited treatment options.With the rapid development of stem cell technology and regenerative medicine in recent years, stem cell transplantation has been proved to be able to promote cardiomyocyte regeneration, improve myocardial remodeling and left ventricular ejection fraction(LVEF), so as to alleviate cardiovascular diseases fundamentally.Mesenchymal stem cells(MSCs), a kind of pluripotent adult stem cell with profound self-renewal capacity and multi-directional differentiation potential, have been gradually applied in the treatment of children′s cardiovascular diseases, such as cardiomyopathy, myocardial infarction and end-stage heart failure, and initial success has now been achieved.This review is to summarize the advance of MSCs in the treatment of cardiovascular diseases in children.

The diagnosis and treatment for incomplete Kawasaki disease / 中国小儿急救医学

The incidence of incomplete Kawasaki disease(iKD) has bean increasing year by year.Significant individual differences in manifestations, insidious onset, and lack of specific symptoms and effective diagnostic biomarkers often result in delayed diagnosis or misdiagnosis, which makes iKD children at higher risk of cardiovascular complications such as coronary artery dilation or coronary aneurysm and even secondary thrombosis or sudden death.The purpose of this review was to introduce the diagnosis and treatment of iKD, and thus provide evidence for clinicians.

Echocardiographic and clinical retrospective study of 35 patients with Kawasaki disease combined with coronary artery thrombosis / 中华实用儿科临床杂志

Objective To summarize the echocardiographic findings and clinical characteristics of Kawasaki disease(KD) complicated with coronary artery thrombosis (CAT).Methods Thirty-five patients with KD combined with CAT were enrolled,who were admitted to Beijing Children's Hospital,Capital Medical University between July 2005 and August 2016.The clinical characteristics and echocardiographic findings during follow-ups were retrospectively studied.According to whether the childrenhad been complicated with myocardial ischemia,the patients were divided into 2 groups:ischemic group and non-ischemic group.The duration of fever,the time when the intravenous immunoglobulin(IVIG) was first injected,the time when coronary artery aneurysms (CAA) was formed,the maximum diameter of CAA and inflammatory index inthe acute phase were compared between 2 groups.Results All of the 35 children diagnosed as KD combined with CAT suffered firom CAA,and the coronary thrombosis was detected in all the cases with aneurysms.Thirty-five patients had 99 branches of CAA,of which the maximum diameter of CAA was (9.6 ± 3.1) mm(4.0-19.0 mm).Fifty-four plots of CAT were detected in the aneurysms.The diameter of CAA that thrombosis located was larger than that of which the thrombosis was not located[(10.9 ± 2.8) mm vs.(7.9 ± 2.6) mm],and the difference was significant(P ＜0.01).During 4 months to 10 years and 8 months [(39.2 ±29.5) months] follow-ups,CAA regressed in 32 branches [32.3％ (32/99 branches)],of which 4 branches [4.0％ (4/99 branches)] completely regressed to the normal diameter.The maximum diameter of CAA regressed was smaller than the maximum diameter of CAA consistence [(7.3 ± 1.9) mm vs.(10.6 ± 3.0) mm],and the difference was significant (P ＜ 0.01).Out of 35 patients,15 cases [42.9％ (15/35 cases) had myocardial ischemia,while the other 20 cases[57.2％ (20/35 cases)] didn't have.Among 15 cases with myocardial ischemia,6 cases[17.1％ (6/35 cases)] had myocardial infarction,4 cases [11.4％ (4/35 cases)] had heart failure,and 1 case[2.9％ (1/35 cases)] died of acute heart failure complicated with severe ventricular arrhythmia.Compared with non-ischemic group,the children in the ischemic group had longer duration of fever[(19.1 ± 7.8) d vs.(12.1 ± 3.3) d],higher white blood cell account in the acute phase[(24.8 ± 13.5) × 1012/L vs.(19.7 ±4.0) × 1012/L],later treatment of IVIG [(13.9 ± 5.5) d vs.(9.8 ±3.8) d],and earlier CAA formation [(16.0 ±4.9) d vs.(20.9 ± 14.5) d],and the differences were statistically significant (all P ＜ 0.05).Conclusions CAT of children with KD commonly originates from CAA.Patients who have more serious inflammatory reaction in the acute phase,earlier formation,heavy severity and longer consistence of CAA are prone to have myocardial ischemia.Echocardiographic study plays an important role in monitoring CAA,detecting the CAT and finding the early left ventricle dysfunction,which is of clinical significance.

Risk factor analysis of coronary artery lesions in children with Kawasaki disease / 中华实用儿科临床杂志

Objective To determine the risk factors for coronary artery lesions (CALs) in patients with Kawasaki disease (KD).Methods The clinical records of 2331 patients with KD from January 2005 to December 2014 in Beijing Children's Hospital,Capital Medical University were retrospectively analyzed.The relationship between the following factors and CALs was analyzed by univariate and multivariable Logistic regression analysis:age,gender,incomplete KD,total fever duration,intravenous immunoglobulin(IVIG) treatment resistance,white blood cell count,C-reactive protein (CRP),platelet count,sodium and albumin.Results The incidence of CALs was 36.0％(840/2331 cases).Univariate Logistic regression analysis indicated that male patients,incomplete KD,total fever duration ≥10days,IVIG treatment resistance,CRP＞100mg/L,platelet count＞300×109/L and albumin＜35 g/L were associated with CALs (all P＜0.05).Multivariable Logistic regression analysis identified that male patients (OR=1.698,95％ CI 1.383-2.084,P＜0.001),incomplete KD (OR=2.730,95％ CI 2.121-3.515,P＜0.001),total fever duration ≥10 days (OR=2.556,95％ CI 1.975-3.307,P＜0.001),CRP＞100 mg/L (OR=1.556,95％ CI 1.274-1.900,P＜0.001) and albumin＜35 g/L (OR=1.665,95％ CI 1.323-2.096,P＜0.001) were the independent risk factors for CALs.Conclusions The main damage in patients with KD is CALs.The male children with KD,incomplete KD,total fever duration ≥10 days,CRP＞100 mg/L and albumin＜35 g/L were prone to CALs.

Granulocyte colony-stimulating factor ameliorates coronary artery elastin breakdown in a mouse model of Kawasaki disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Coronary artery damage from Kawasaki disease (KD) is closely linked to the dysfunction of the endothelial progenitor cells (EPCs). The aim of the present study was to evaluate the modulatory effect of granulocyte colony-stimulating factor (G-CSF) on EPCs and elastin breakdown of coronary arteries in a KD mouse model.</p><p><b>METHODS</b>A Lactobacillus casei cell wall extract (LCWE)-induced KD model was established in C57BL/6 mice that were subsequently administrated with recombinant human G-CSF (rhG-CSF). Nω-nitro-L-arginine methyl ester (L-NAME) was administrated for the negative intervention. Evaluations included coronary artery lesions, EPC number and functions, and the plasma concentration of nitric oxide (NO).</p><p><b>RESULTS</b>Elastin breakdown was found in the coronary arteries of model mice 56 days after injection of LCWE. The number of circulating EPCs, plasma concentration of NO, and functions of bone marrow EPCs, including proliferation, adhesion, and migration abilities, were all lower in the KD model group compared with those in the control group. After administration of rhG-CSF, the number of circulating EPCs and plasma concentration of NO were increased significantly compared with those in the KD model group. There were also increases in the functional indexes of EPCs. Furthermore, rhG-CSF administration improved the elastin breakdown effectively. However, these protective effects of rhG-CSF on coronary arteries were attenuated by L-NAME.</p><p><b>CONCLUSION</b>The present study indicated that the administration of G-CSF prevents elastin breakdown of the coronary arteries by enhancing the number and functions of EPCs via the NO system, and then accelerates the repair of coronary artery lesions in the KD.</p>

Use of anti-hypertension drugs in childhood hypertensive crisis / 中国小儿急救医学

Childhood hypertensive crisis is a relatively rare emergency event,and is associated with a high risk of morbidity and mortality.Children in this situation need rapid,safe and effective treatment to release clinical symptoms,relieve injuries of target organs,improve quality of life,and reduce mortality.Many kinds of anti-hypertension drugs have been used in children for decades,but most data were extrapolated from studies in adult.There is limited number of randomized controlled trials in children.Therefore it is still difficult to choose drugs for pediatric hypertensive crisis based on evidence-based medicine.This paper sought to summarize the experience of medical management of childhood hypertensive crisis in children.

The spectrum of underlying diseases in children with transient loss of consciousness / 中国小儿急救医学

Objective To analyze the spectrum of underlying diseases in children with transient loss of consciousness (TLOC) through a multi-center and large sample clinical research.Methods Nine hundred and thirty-seven children with TLOC who came from Beijing,Hunan province,Hubei province and Shanghai of China from Aug 1999 to Apr 2011 were recruited in the present study,and then the spectrum of underlying diseases in children with TLOC was analyzed.Results In 937 children with TLOC,903 cases (96.4％ )were children with syncope,34 cases (3.6％) were non-syncope.And in 903 children with syncope,213 cases (23.6％) had vasovagal syncope (VVS) with vasoinhibitory response,46 cases (5.1％ ) had VVS with cardioinhibitory response,112 cases ( 12.4％ ) had VVS with mixed response,268 cases (29.7％ ) had postural tachycardia syndrome,22 cases (2.4％) had orthostatic hypotension,19 cases (2.1％ ) had situational syncope,21 cases (2.3％ ) had cardiogenic syncope,and 202 cases (22.4％ ) had unexplained syncope.Conclusion In children with TLOC,syncope was the most common underlying disease.And in children with syncope,the most common was VVS,followed by postural tachycardia syndrome.In three different hemodynamic patterns of VVS,the most common pattern was VVS vasoinhibitory pattern.

Value of 64-slice spiral CT angiography for follow-up of young children with coronary artery aneurysms due to Kawasaki disease / 中华放射学杂志

Objective To assess the value and feasibility of 64-slice spiral CT in diagnosis of coronary artery aneurysm in the follow-up of young children with previous Kawasaki disease. Methods Twelve boys (mean age 5.1 years) for follow-up (ranged 1.1 to 5.1 years) with known Kawasaki disease and coronary artery aneurysms underwent coronary CT angiography using 64-slice spiral CT.The number,location,shape and size of each coronary artery aneurysm were recorded and compared with those of echocardiography performed simutaneously. Results A total of 30 coronary artery aneurysms were identified with mean diameter of(7.5±3.8) mm,and mean maximum length of (12.4±9.1) mm.10 aneurysms were small in size,7 aneurysms were medium in size and 13 were giant aneurysms.Fourteen aneurysms were saccular,and the remaining 16 were fusiform. Among the aneurysms in left coronary artery,7 of them were located in the main branch,9 were located in the proximal segment of the anterior descending branch,4 were located at the middle segment of the anterior descending branch,and 2 were located in the circumflex branch.Among the aneurysms in right coronary artery,6 of them were located in the proximal segment,9 were located in the middle segment,and 4 were located at the distal segment.Nine of the aneurysms involved 2 segments of the coronary arteries,and one involved 3 segments.Six stenotic segments were found. Calcification was found in 5 aneurysms and 3 of them had thrombosis. Echocardiography failed to detect 8 aneurysms of small size and located in the middle or distal segments of the coronary arterys.Conclusion The 64-slice CT angiography proved valuable for monitoring young children with Kawasakidisease.