Association of liver damage with coronary artery lesion and no response to intravenous immunoglobulin in the acute stage of Kawasaki disease / 中国当代儿科杂志

OBJECTIVES@#To summarize the clinical features of liver damage in children in the acute stage of Kawasaki disease (KD), and to investigate the clinical value of liver damage in predicting coronary artery lesion and no response to intravenous immunoglobulin (IVIG) in children with KD.@*METHODS@#The medical data were collected from 925 children who were diagnosed with KD for the first time in Beijing Children's Hospital from January 1, 2016 to December 31, 2017. According to the presence or absence of abnormal alanine aminotransferase (ALT) level on admission, the children were divided into a liver damage group (n=284) and a non-liver damage group (n=641). A logistic regression analysis was used to investigate the clinical value of the indicators including liver damage in predicting coronary artery lesion and no response to IVIG in children with KD.@*RESULTS@#Compared with the non-liver damage group, the liver damage group had a significantly earlier admission time and significantly higher serum levels of inflammatory indicators (P<0.05). The liver damage group had a significantly higher incidence rate of coronary artery lesion on admission than the non-liver damage group (P=0.034). After initial IVIG therapy, the liver damage group had a significantly higher proportion of children with no response to IVIG than the non-liver damage group (P<0.001). In children with KD, coronary artery lesion was associated with the reduction in the hemoglobin level and the increases in platelet count, C-reactive protein, and ALT (P<0.05), and no response to IVIG was associated with limb changes, the reduction in the hemoglobin level, the increases in platelet count, C-reactive protein, and ALT, and coronary artery lesion (P<0.05).@*CONCLUSIONS@#Compared with those without liver damage, the children in the early stage of KD with liver damage tend to develop clinical symptoms early and have higher levels of inflammatory indicators, and they are more likely to have coronary artery lesion and show no response to IVIG treatment.

Detection of Subclinical Anthracyclines' Cardiotoxicity in Children with Solid Tumor / 中华医学杂志(英文版)

<p><b>Background</b>Cardiotoxicity is one of the most serious chronic complications of anthracyclines therapy. Assessment of the left ventricular ejection fraction (LVEF) fails to detect subtle cardiac dysfunction of left ventricular (LV). This study aimed to detect and evaluate new parameters of subclinical anthracyclines' cardiotoxicity in children with solid tumor.</p><p><b>Methods</b>A detailed echocardiographic examination was performed in 36 children with hepatoblastoma or rhabdomyosarcoma after receiving anthracyclines' chemotherapy and 36 healthy controls from January 2015 to December 2016. The LVEF, ratio of early diastolic peak velocity of transmitral flow (E) and septal diastolic e' mitral annular peak velocity (e'), tricuspid annular plane systolic excursion (TAPSE), and LV global longitudinal strain (GLS) were evaluated using M-mode, tissue Doppler imaging (TDI), and two-dimensional speckle tracking echocardiography (2D-STE), respectively. Echocardiographic parameters were compared between patient group and healthy controls. All patients were divided into two subgroups based on their anthracyclines' cumulative dosage (<300 mg/m subgroup and ≥300 mg/m subgroup).</p><p><b>Results</b>All patients had no presentation of heart failure and LVEF within normal range (65.7 ± 5.1%). Compared with healthy controls, the mean E/e' increased significantly (7.9 ± 0.7 vs. 10.2 ± 3.5, t = 3.72, P < 0.01), mean TAPSE decreased significantly (17.2 ± 1.3 mm vs. 14.2 ± 3.0 mm, t = -4.03, P < 0.01), and mean LV GLS decreased significantly (-22.2% ± 1.9% vs. -17.9% ± 2.9%, t = -5.58, P < 0.01) in patient group. Compared with subgroup with anthracyclines' cumulative dosage < 300 mg/m, mean LV GLS decreased significantly (-18.7 ± 2.7% vs. -16.5 ± 2.1%, t = 2.15, P = 0.04), the mean E/e' increased significantly (9.1 ± 1.5 vs. 11.5 ± 4.9, t = -2.17, P = 0.04), and mean TAPSE decreased significantly (14.2 ± 2.1 mm vs. 12.5 ± 2.2 mm, t = -2.82, P = 0.02) in subgroup with anthracyclines' cumulative dosage ≥300 mg/m.</p><p><b>Conclusions</b>LV GLS is helpful in the early detection of subclinical LV dysfunction using 2D-STE. E/e' and TAPSE are other sensitive parameters in detecting subclinical cardiac dysfunction of both ventricles by TDI. These parameters show significant change with different anthracyclines' cumulative dosage, so cumulative dosage should be controlled in clinical treatment.</p>

Fluoxetine is Neuroprotective in Early Brain Injury via its Anti-inflammatory and Anti-apoptotic Effects in a Rat Experimental Subarachnoid Hemorrhage Model / 神经科学通报·英文版

Fluoxetine, an anti-depressant drug, has recently been shown to provide neuroprotection in central nervous system injury, but its roles in subarachnoid hemorrhage (SAH) remain unclear. In this study, we aimed to evaluate whether fluoxetine attenuates early brain injury (EBI) after SAH. We demonstrated that intraperitoneal injection of fluoxetine (10 mg/kg per day) significantly attenuated brain edema and blood-brain barrier (BBB) disruption, microglial activation, and neuronal apoptosis in EBI after experimental SAH, as evidenced by the reduction of brain water content and Evans blue dye extravasation, prevention of disruption of the tight junction proteins zonula occludens-1, claudin-5, and occludin, a decrease of cells staining positive for Iba-1, ED-1, and TUNEL and a decline in IL-1β, IL-6, TNF-α, MDA, 3-nitrotyrosine, and 8-OHDG levels. Moreover, fluoxetine significantly improved the neurological deficits of EBI and long-term sensorimotor behavioral deficits following SAH in a rat model. These results indicated that fluoxetine has a neuroprotective effect after experimental SAH.

Clinical efficacy and prognosis with advanced Wilms' tumor in children / 中华实用儿科临床杂志

Objective To analyze the clinical data of 12 children with advanced Wlims' tumor in children from Feb.2009 to Jun.2012.All cases were diagnosed by pathology and to analysis the clinic efficacy and treatment experience were analyzed.Methods Of 12 patients,10 cases were male and 2 cases were female.The medium age of 12 patients was 2.54 years old(9 months-15 years old).According to pathological stage and clinical stage of The National Wilms' Tumor Study Group(NWTSG),5 cases belonged to stage lⅢ,and 7 cases stage Ⅳ.Six cases were well-differentiated tissue type,and 6 cases were poorly differentiated tissue type according to NWTSG.In all patients,different ways of chemotherapy and radiotherapy were selected according to clinical stage and tissue type differentiation.If a patient had repeated recurrence after common surgery and chemotherapy,would treated by antologous peripheral blood stem cell transplantation(APBSCT).Statistic analysis was used to analyze the clinical characters and efficacy and prognosis for 12 patients.Results 1.Initial symptoms:in 12 cases,8 cases presented abdominal mass (66.6％),2 cases with abdominal pain and fever(12.7％),and 2 cases with hematuria(12.7％).2.Eleven cases followed up to Jan.2013,the medium time was 31.5 months(8-131 months).Of 12 cases,1 case give up therapy and follow-up and 11 cases were followed up.Of those 11 cases followed-up,4 cases had complete remission(CR),and 1 case had remission in part(PR),the conditions of 5 cases were progressively worse,1 case replapsed,and 4 patients died.Total survival rate was 63.63％ (7/11 cases),and mortality was 36.37％ (4/11 cases),and free survival rate was 36.37％ (4/11 cases),of that,1 patient of stage Ⅳ,relapsed 3 times after common radiotherapy and chemotherapy,achieved complete remission after high dose chemotherapy (Melphalan + Carboplatin + Etoposide,CEM) and APBSCT.The estimated 3-yearsurvival rate was 51.4％.Conclusions The prognosis of advanced Wilms' tumor is poor,and the mortality is still high.High dose chemotherapy with APBSCT may be a valuable method for advanced cases.