Meta-analysis of the risk factors for coronary artery lesion secondary to Kawasaki disease in Chinese children / 中华儿科杂志

<p><b>OBJECTIVE</b>Coronary artery lesion (CAL) is a serious complication of Kawasaki disease (KD). Whether there is CAL and the severity are the most critical factors of the prognosis of KD. The incidence of KD is currently increasing year by year. KD has replaced rheumatic fever as the main entity of acquired heart disease of children. This study aimed to identify risk factors of CAL secondary to KD and take early interventions to prevent CAL or reduce its incidence.</p><p><b>METHOD</b>Literature search was performed at Chinese Academic Literature Main Database, Chinese Science and Technology Periodical Database, Wanfang Periodicals and Dissertation Database, and the Chinese Biomedical Literature Database comprehensively, besides, retrospective retrieval and manual retrieval were also performed from the domestic public actions and the dissertations dating from January, 2000 to December, 2009. RavMan 4.2 provided by Cochrane was used for meta analysis. Fixed or random model was selected according to the results of heterogeneity test. Sensitivity analysis was done according to the different results. The publication bias was evaluated by funnel plots. Odds ratio (OR) and 95% confidence interval (CI) were estimated in the dissertation.</p><p><b>RESULT</b>Twenty studies were confirmed to be eligible. All the 20 studies were retrospective. OR and 95%CI of the risk factors were as follows: age ≤ 1 year, OR = 1.58, and 95%CI (1.23, 2.04), P = 0.0004; male gender, OR = 1.48, 95%CI (1.29, 1.71), P < 0.000 01; WBC > 20 × 10(9)/L, OR = 1.73, 95%CI (1.32, 2.26), P < 0.0001; C-reactive protein (CRP) > 100 mg/L, OR = 2.37, 95%CI (1.49, 3.77), P = 0.0003; fever duration > 10 d, OR = 3.23, 95%CI (2.08, 5.02), P < 0.000 01; use of intravenous gamma globulin (IVIG) > 10 d, OR = 2.50, 95%CI (1.98, 3.16), P < 0.000 01.</p><p><b>CONCLUSION</b>The high risk factors for coronary artery lesion secondary to Kawasaki disease are age ≤ 1 year, male, WBC > 20 × 10(9)/L, CRP > 100 mg/L, fever duration>10 d, and use of intravenous gamma globulin (IVIG) > 10 d.</p>

Mentality and behavior of children with congenital heart diseases / 中华心血管病杂志

<p><b>OBJECTIVE</b>The present study was designed to investigate the influence of Congenital Heart Disease (CHD) on the mentality and behavior in children, and to compare post operative mentality and behavior in children receiving interventional therapy and congenital heart surgery.</p><p><b>METHOD</b>Mentality and behavior of 232 children suffering from CHD were examined with Achenbach Child Behavior Checklist (CBCL) edited by XU Tao-yuan in 1992 and 100 sex, age, education and achievement-matched children with pneumonia were enrolled as controls.</p><p><b>RESULTS</b>The mentality and behavior abnormal rates of the boys and girls suffering from CHD were significantly higher than those of controls (P < 0.01, P < 0.05). The behavior abnormities of the boys presented as depression, social flinch, physical complains, assault and violate rules. Whereas the girls presented as depression, social flinch, physical complains and violate rules. The total cursory mark of postoperative check result of the interventional and surgical children, both in girls and in boys, were significantly lower than those of the preoperative children (P < 0.05). The total and assault cursory mark of postoperative check result of children treated with interventional therapy were significantly lower than those of children treated with the surgical operations (P < 0.05). The abnormal rates of mentality and behavior positively correlated with the disease course.</p><p><b>CONCLUSIONS</b>CHD is associated with increased abnormal mentality and behavior of the children. Early treatment, especially the interventional therapy can significantly improve the mentality and behavior of the children with CHD.</p>

Effect of p21 gene transfection mediated by replication deficient adenovirus on the pulmonary hypertensive rat model / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of transferring p21 gene into lung tissue with recombinant adenovirus with full-length cDNA of p21 inserted in the Wistar rat model of pulmonary hypertension (PAH) induced by left-to-right shunt, study the expression of the desired gene in vivo, find if overexpression of desired gene can inhibit pulmonary hypertension.</p><p><b>METHODS</b>With full-length cDNA of p21 transfected HEK293 cells with clonfectin, and was packed, amplified in order to obtain the high-titer recombinant adenovirus (AdCMV-p21). The infection titer was determined by TCID50 method and was diluted into 1.67 x 10(8) pfu/L. Wistar rats were randomly allocated to control group (n = 10), model group (n = 15), test group (n = 10) and test control group (n = 10). In model group and test group left-to-right shunt pulmonary hypertension was developed by using cuff technique. AdCMV-p21 was transfected into test group and test control group using tracheal inhalation. The mPAP, mRVP and RVHI were measured and compared between every two groups. The left lung was immunohistochemically stained to observe the result of transfection. The right lung was HE stained to observe morphological changes in arteria pulmonalis and calculate WT%.</p><p><b>RESULTS</b>The mRVP, mPAP and WT% in model group and test group were significantly higher than those in control (P < 0.05), which suggested that the rat model of PAH was established successfully. Brown spots in the nucleus of VSMCs of pulmonary artery were seen in test group and test control group, which indicated that AdCMV-p21 was transfected successfully. The rate of transfected cells in test group was (42.8 +/- 11.6)%, which was equal to that of test control group (P > 0.05). In test group, the mPAP was (20.06 +/- 3.40) mm Hg (1 mm Hg = 0.133 kPa), mRVP was (22.53 +/- 2.53) mm Hg, WT% was (30.8 +/- 3.5)%, which were significantly lower than those in model group (P < 0.05), but higher than those in control group and test control group (P < 0.05).</p><p><b>CONCLUSION</b>The recombinant adenovirus could successfully carry p21 and transfect the lung tissue of PAH rat model, and full expression of p21. p21 gene could inhibit the development of PAH.</p>

Plasma levels of adrenomedullin in children with congenital heart disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>This study was designed to investigate the pathophysiological role of adrenomedullin (ADM) in congenital heart disease.</p><p><b>METHODS</b>Forty-eight children with congenital heart disease confirmed by cardiac echocardiography and catheterization were studied. The patients were divided into three groups on the basis of hemodynamic indices measured during cardiac catheterization: high pulmonary blood flow with (group 1) or without (group 2) pulmonary hypertension (mean pulmonary arterial pressure > 20 mmHg) and a cyanosis group (without high pulmonary blood flow) (group 3). Six children who recovered from Kawasaki disease were used as a Control group. Plasma ADM levels were measured by radioimmunoassay.</p><p><b>RESULTS</b>The plasma ADM levels from the femoral vein were significantly higher than those from femoral artery in patients with congenital heart disease. The patients from group 1 and group 3 had higher plasma ADM levels (1.9 +/- 1.8 pmol/L and 2.4 +/- 1.3 pmol/L, respectively) than the controls (1.0 +/- 1.4 pmol/L; P < 0.01). Plasma ADM levels were significantly negatively correlated with mean systemic arterial pressure, oxygen saturation in mixed vein and oxygen saturation in systemic artery (r=-0.401, -0.562, -0.600, respectively; P < 0.01) but positively correlated with pulmonary vascular resistance (r=0.406; P < 0.01).</p><p><b>CONCLUSIONS</b>Plasma ADM levels are increased in congenital heart disease with high pulmonary blood flow and hypertension or with cyanosis. Plasma ADM levels are related to pulmonary arterial resistance and hypoxemia. Increased ADM levels may play roles in reducing the pulmonary arterial resistance and alleviating hypoxemia in these patients.</p>

Clinical Effect and Follow-Up Analysis of Transcatheter Occlusion Therapy on Patent Ductus Arteriosus in Infants / 实用儿科临床杂志

Objective To evaluate the clinical effect of transcatheter closure with Amplatzer duct occluder offers in infants with patent ductus arteriosus(PDA).Methods Thirty-seven PDA infants underwent transcatheter closure of PDA at(8.7 ? 3.3)months and weight of(8.6 ? 3.5)kg.A lateral view aortogram was made to determine the morphology and the narrowest diameter of the ductus and selected the size of the device.Occluder was implanted using the anterograde venous approach.Follow-up evaluations were made with chest X-ray and echocardiogram at 24 hours and 1,6 and 12 months after implantation.Results The narrowest diameter of the ducts measured by angiographically was(3.3 ? 1.5)mm.Ninteen patients(54.29%) achieved immediate complete occlusion.On color Doppler the closure rates at 1 month after implant were 34 cases(97.14%).No residual shunt exsisted in all implanted patients at 6 and 12 months follow-up.Procedure time at(57 ? 43)minutes and fluoroscopy time(23.0?14.9)minutes.Conclusions Percutaneous PDA closure with the Amplatzer duct occluder decice is an safety and effective method for the treatment of PDA in infants,but caution shall be exercised to the anatomic characteristics in the infant age group in solving clinical complications.

Effect of chest wall vibration therapy on bronchiolitis / 中华物理医学与康复杂志

Objective To study the effect of chest wall vibration therapy on bronchiolitis. Methods A total of 64 patients with bronchiolitis were divided into an experimental group and a control group, the former included 34 cases and the latter included 30 cases. The experimental group received both routine treatment and chest wall vi- bration, while the control group only received routine treatment. PaO_2, PaCO_2, SaO_2, Heart Rate (HR) and Respi- ration (R) were observed, respectively, in the experimental group and the control group at the beginning and the end of the third day. Time needed for expectoration and length of hospital stay in the two groups were observed. Results It was shown that PaO_2, PaCO_2, SaO_2 , HR, R were significantly improved at the end of the third day when compared with those at the beginning in both groups(P