The advance on the prenatal diagnosis and management of fetal long QT syndrome / 中华实用儿科临床杂志

Long QT syndrome(LQTS)is a rare and inherited cardiac channelopathy with high lethality,which is characterized by prolonged QTc interval and frequent malignant arrhythmia,the cause of the disease is that mutations of genes coding for cardiac ion channel subunit or channel associated proteins. Since some fetal LQTS may die in utero or neonatal period,thus,prenatal suspicion or diagnosis of fetal LQTS may improve their outcome and prognosis. There-fore,this review prepares to discuss around the prenatal diagnosis and management of fetal LQTS.

Clinical and etiological characteristics of secondary nosocomial bacterial infections associated with infectious mononucleosis in children / 中华实用儿科临床杂志

Objective To investigate the clinical manifestations and pathogenic characteristics of nosocomial bacterial infection in children with infectious mononucleosis (IM).Methods A retrospective analysis was performed for IM children from January to December 2015 in West China Second University Hospital.According to whether there was the process of secondary bacterial infection,the patients were divided into the secondary infection group and the non-infection group.The clinical manifestations and pathogenic bacteria were analyzed.Results Two hundred and sixteen children with IM were enrolled,of whom,177 cases (81.9％) were in the non-infection group,and 39 cases (18.1％) were in the secondary infection group.The patients in non-infection group were (4.7 ± 3.2) years old,and the patients in secondary infection group were (7.0 ± 3.8) years old,and the difference was statistically significant (t =3.066,P ＜ 0.05).The secondary infection group included bacterial tonsillitis in 17 cases,bronchial pneumonia in 11 cases,otitis media in 5 cases,cervical bacterial lymphadenitis in 3 cases,periorbital cellulitis in 2 cases,and sepsis in 1 case.Meanwhile,3 cases of concomitant thrush were observed in the secondary infection group.The rate of nosocomial bacterial infection in IM children [18.1％ (39/216 cases)] was significantly higher than the incidence of nosocomial infection [1.53％ (644/41 992 cases)] in the same period,and the difference was statistically significant (x2 =368.474,P ＜ 0.01).The patients with secondary bacterial infection were treated with antibiotics,and the pathogenic bacteria were mainly gram-negative bacteria,which was consistent with pharyngeal tonsil colonization bacteria on admission.In 212 cases (98.1％) with IM,variant lymphocytes increased,and there was no significant difference between 2 groups in the variation of lymphocyte composition (x2 =2.087,P ＞ 0.05).C-reactive protein (CRP) level of IM children on admission was (11.3 ± 17.4) mg/L,while the secondary infection group was (10.2 ±9.7) mg/L and the non-infection group was (11.5 ± 18.1) mg/L,and there was no significant difference between the 2 groups (t =1.309,P ＞ 0.05).CD3 +,CD4+,CD8 + lymphocytes in the secondary infection group were 0.877 6 ± 0.031 8,0.079 0 ± 0.032 5 and 0.682 1 ± 0.053 5,compared with the non-infection group,while CD3 + lymphocytes (t =12.652,P ＜ 0.01) and CD8 + lymphocytes (t =-9.723,P ＜ 0.01) increased significantly,but the proportion of CD4+ lymphocytes decreased significantly (t =18.341,P ＜0.01).Conclusions The IM children are susceptible to nosocomial bacterial infection,which is more obvious in school-age children.Secondary respiratory tract infections are the most common type,and pathogenic bacteria may be caused by the dissemination of colonization bacteria in the pharyngeal tonsils.The CRP and variant lymphocytes on admission could not be used as the marker for predicting noscoomial bacterial infection in IM.

Transcatheter occlusion of patent ductus arteriosus in a preterm infant and review of literatures / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of haemodynamically significant patent ductus arteriosus (hsPDA), and the indications of percutaneous transcatheter PDA occlusion.</p><p><b>METHOD</b>The data of a preterm infant admitted to West China Second Hospital in December. 2013, who finally underwent percutaneous transcatheter PDA occlusion were analyzed With the key words of"preterm"patent ductus arteriosus"transcatheter", Pubmed were searched and potentially relevant reports were retrieved and assessed by manual sorting from 2005 to 2015. Relevant reports in literature were reviewed.</p><p><b>RESULT</b>A preterm infnat at gestational age of 35 weeks with birth weight of 1 900 g was admitted to our department. Oral ibuprofen for closure of the patent ductus arteriosus failed, and the patient exhibited the features of"ventilator dependent"PDA of premature infants. On the 30th postnatal day, with the body weight of 1 950 g, under basal anesthesia, the infant underwent percutaneous transcatheter PDA occlusion, and the procedure successfully occluded the ductus with Amplatzer duct occluder (ADO). The ventilator was weaned 19 hours post procedure, and the child was discharged 7 days post operation with good recovery, and her growth and development was good. Follow-up for 13 months indicated that the intelligence and physical development evaluated by Bayley scales of infant development test were at the same level of normal age-matched infants. Fifty-two preterm infants treated with percutaneous transcatheter PDA occlusion in 8 reports were enrolled. The preterm infants were born at 23-35 gestational weeks, with PDA diameter of 1-4 mm. The occlusive device included coil, ADO, ADO Ⅱ, ADO Ⅱ AS, AVP Ⅱ and AVP Ⅳ respectively, with body weight of 870-2 610 g on operational days and age of 11-90 postnatal days. All those infants either failed or had contraindications to drug therapy, and exhibited as hsPDA cases. Percutaneous transcatheter PDA occlusions were performed successfully in all 52 cases, and there were no serious procedure-related complications.</p><p><b>CONCLUSION</b>Percutaneous transcatheter PDA occlusion in preterm infants is feasible and showed positive short-term and long-term effects, which provides an important alternative way for patients with the problem. The indications for transcatheter PDA occlusion include premature infants with hsPDA in whom drug therapy failed or is contraindicated.</p>

Clinical Observation on Vacuum Sealing Drainage for Open Tibial Fractures of Gustilo Grade-Ⅲ / 昆明医科大学学报

Objective To compare the clinical effect of vacuum sealing drainage and traditional methods on open tibial fractures of Gustilo grade-Ⅲ.Methods Seventy-eight patients with open tibial fractures of Gustilo grade-Ⅲ were divided into two groups,43 patients in observation group were treated by vacuum sealing drainage,while 35 patients in control group were treated by traditional methods.The operative quality,postoperative recovery condition,clinical effect and rate of adverse reaction were analyzed between two groups.Results As for the hospital stays,healing time of wound and fracture,the observation group were significant shorter than control group (P＜0.05).The excellent and good rate of observation group was 83.72％,which was significantly higher than that of control group 65.71％ (P ＜0.01).The adverse reaction rate of observation group was 6.98％,which was significantly lower than that of control group 17.14％ (P＜0.05) Conclusions Vacuum sealing drainage used for treatment of open tibial fractures of Gustilo grade-Ⅲ can shorten wound and fracture healing time,reduce the incidence of adverse reaction and improve the clinical effect.It is worth of popularization and application.

Effect of matrine on cell proliferation, apoptosis and autophagy of human medullobIastoma D341 cells in vitro / 中国药理学与毒理学杂志

OBJECTIVE To explore the effect of matrine induced proliferation, apoptosis and auto-phagy on human medulloblastoma cell line D341 in vitro. METHODS D341 cells in vitro were incubated with matrine 0, 0.5, 1.0, 1.5 and 2.0 g.L-1 for 24, 48 and 72 h, respectively. The proliferation of D341 cells was analyzed using Cell Counting Kit-8 assay. Apoptosis was detected by flow cytometry. The mor-phologic change of cells was observed under a transmission electron microscope. The expression of Bax, Bcl-2, caspase 3, microtubule associated protein 1 light chain 3 (LC3) and beclin1 was detected by Western blotting, and the expression of LC3 and beclin1 was detected by Western blotting with or without the autophagy inhibitor 3-methyladenine(3-MA). 3-MA was added 1 h before matrine and the final concentration of 3-MA was 5 mmol.L-1 . RESULTS Matrine significantly inhibited the proliferation of D341 cells. There was a concentration-effect relationship ( r24 h = 0.994, r48 h = 0.992, r72 h = 0.996, P<0.01). Matrine could induce the cell apoptosis (r24 h = 0.937, r48 h = 0.947, r72 h = 0.987, P<0.01). When the concentration of matrine was 2.0 g.L-1 , the inhibitory effect on D341 cell proliferation (r=0.999, P<0.01) and the induction of cell apoptosis (r=0.990, P<0.01) had a time-dependence. When the concen-tration of matrine was 2.0 g.L-1 , the ultrastructure of the D341 cells had obvious change. Cells with acoustic cavitation bubble structure, chromatin condensation, and marginalization were observed after matrine treatment for 24 h. After 48 h treatment with matrine, nuclear chromatin condensation and more vacuoles in the cytoplasm were observed. After 72 h treatment with matrine, cells exhibited apoptotic characteristics with obvious nuclear chromatin condensation, and nuclear fragmentation, significantly increased the larger cytoplasmic vacuoles. Western blotting analysis showed that matrine could increase the expression of Bax (r24 h =0.981, r48 h =0.967, r72 h =0.998, P<0.01), and decrease the expression of Bcl-2 (r24 h = -0.977, r48 h = -0.989, r72 h = -0.968, P<0.01). Matrine could increase the expression of caspase 3 when the effect time was 48 h (r48 h =0.995, P<0.01). Matrine also increased the expression of beclin1 (r24 h =0.989, r48 h =0.986, r72 h =0.966, P<0.01). The autophagy inhibitor 3-MA could reduce this effect ( P < 0.05). Matrine decreased the expression of LC3-Ⅰ but increased the expression of LC3-Ⅱ and thus the ratio of LC3-Ⅰ/ LC-Ⅱ was decreased (r24 h = -0.795, r48 h = -0.886, r72 h = -0.901, P<0.05). 3-MA could reduce the effects of matrine on LC3-Ⅰ and LC3-Ⅱ expression of D341 cells (P<0.05). CONCLUSION Matrine can inhibit proliferation, induce apoptosis and promote autophagy of D341 cells in vitro.

Clinical features correlated with MMP-9, VEGF expression in invasive pituitary adenoma patients / 中国基层医药

Objective To investigate the relationship in clinical features of invasive pituitary adenoma patients and their aggressive,matrix metalloproteinase 9 (MMP-9),vascular endothelial growth factor (VEGF) expression and tumor invasiveness of pituitary adenomas.Methods 96 patients with pituitary adenoma were selected,46 cases of invasive pituitary adenomas,50 cases of non-invasive pituitary adenomas,MMP-9,VEGF expression were detected by immunohistochemical assay,their expression levels were analyzed with tumor invasiveness correlation.Results MMP-9,VEGF expression in invasive pituitary adenomas strongly positive rates were 54.35％,52.17％,the total positive rates were 89.13％,95.65％,which were significantly higher than the non-invasive pituitary adenomas MMP-9,VEGF strong positive expression rate of 16.00％,20.00％,the total positive rates were 44.00％,56.00％ (x2 =15.618,9.416,21.631,20.090,all P ＜ 0.05);MMP-9,VEGF for invasive pituitary volume under positive circumstances,the maximum diameter was significantly higher than non-invasive of the group (t =4.32,3.67,2.49,2.54,all P ＜ 0.05),and MMP-9,VEGF were under negative circumstances invasive and non-invasive pituitary adenoma group,the difference was not statistically significant(t =1.56,1.47,0.53,0.21,all P ＞ 0.05);By correlation analysis,invasive pituitary adenoma MMP-9 expression was positively correlated with VEGF levels (r =0.734,P ＜ 0.01).Conclusion Invasive pituitary adenomas of MMP-9 and VEGF expression increased,MMP-9 and VEGF can be used as auxiliary judge biological indicators of invasive pituitary adenomas.

The microsurgical anatomic research of the internal auditory canal area on the retrosigmold approach / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the safety of the circular round window and discus anatomic landmarks of posterior wall of internal auditory canal by investigating the microscopic anatomy of internal auditory canal area of the retrosigmold approach, which can provide the anatomical basis for acoustic neutrinomas surgery.@*METHOD@#Fifteen adult cadaver heads (30 sides) fixed with formalin were used in the study. The retrosigmold approach operations were imitated to dissect the blood vessels and nerves in internal auditory canal area by opening round bony window and removing posterior wall of internal auditory canal.@*RESULT@#Fifteen specimens of 30 sides circular bone window were opened without injury with transverse sinus and sigmoid sinus. The vertical distance between the highest point of bone window margo superior and the lowest point of transverse sinus margo inferior was (4.02 ± 0.32) mm. The vertical distance from the most anterior point of bone window leading edge to the most posterior point of sigmoid sinus trailing edge was (6.31 ± 0.43) mm. The internal auditory canal tubercle located in the anterior superior position of internal auditory canal. The vertical distance from the highest point of internal auditory canal tubercle to the upper margin of internal auditory canal was (2.31 ± 0.32) mm. To expose the whole internal auditory canal, the length and width of the internal auditory canal posterior wall removal was (7.29 ± 0.32) mm, (4.12 ± 0.29) mm. Within this removal range, no case of cochlea, semicircular canal or venous was injured in 30 specimens.@*CONCLUSION@#The method of opening round window through retrosigmold approach is simple, practial and convenient. With little variation and easiness of location, the sinternal auditory canal tubercle can be used in the identification of the internal auditory canal. When exposing the whole internal auditory canal, the removal scope of the posterior wall should be paid more attention to, in order to avoid the damage of cochlea, semicircular canal and jugular bulb.

Visualized knowledge-mapping study in the subjects in pediatric clinical education based on multiple statistical and social network analysis / 中华医学教育探索杂志

Objective To study the subject domain knowledge of clinical education of pediatrics in our country with multivariate statistical analysis and social network study,research on the domain subject distribution and knowledge cluster,and then built visualized knowledge-mapping,so as to predict and guide the developmental trend in this field.Methods We searched the CNKI with MESH keywords (pediatrics OR children OR infants) AND clinical education OR bedside education OR interview of clinics in March,2013.679 articles were enrolled in and then imported into Bicomb.After core keywords had been identified by Bicomb,a word text matrix and co-occmrence matrix of words to articles were built.Systemic clustering of the co-occmrence matrix was finished by SPSS 20.0,leading the strategic plot to be built.Then draw visualized network in Ucinet 6.0.Results Totally 679 articles about pediatrics education were included.The number of core keywords was 66,and the lowest frequency of core keywords was 5.With multivariate statistical analysis and social network study,the visualized domain knowledge-mapping was successfully built,and it directly reflected the structure of subject knowledge-mapping of pediatric clinical education in our country,and then key clusters were formed,in which the clusters of participation model of clinical education and applications of clinical education had been well developed,and had been the dominant subject in pediatric clinical education.Whereas the unbalanced developed cluster of Exploration in refommtion of clinical education was now in rapid development with the introduction of new technology and innovative teaching model.At the same time,the nursing clinical education cluster has been separate cluster,but needed further and enhanced research.Conclusion The well developed subjects of participation model of clinical education applications of clinical education stood in the center of the subject do main knowledge-mapping,and with several clusters following.And the study of refomation of clinical education makes a great contribution to the progress of the subject.The nursing teaching needed balanced development.

Current ethical status and challenges in fetal cardiac intervention / 中华实用儿科临床杂志

With the development of fetal medical imaging and minimal invasive interventional therapy,fetal cardiac intervention has taken into clinical practice in few medical centers.Fetal cardiac therapy may alter the abnormal hemodynamics of fetal circulation,which can lead to recruit hypoplastic ventricle,to create a two-ventricle circulation after birth,to remodel the fetal pulmonary vascular bed whose outlet is obstructed,and to provide a better prognosis for the suffered children.However,according to the limitations and risks of this cutting edge technique,as well as the dilemmas to balance the interests among fetus,mother/parents and doctor/medical institution,ethical challenges never fade away ever since the first beginning in this rising field.Following the encouraging research results published,the risk of the technique has been partly taken control.So in current status,how to balance the interests among three participants and to establish optimal routine clinical practice are the most challenging problems.

Effects of matrine on apoptosis and related protein expression in human medulloblastoma D341 cells / 中国病理生理杂志

AIM:To investigate matrine-induced apoptosis of human medulloblastoma D 341 cells and the ex-pression of Bax , Bcl-2, serine/threonine kinase Akt and phosphorylated Akt ( p-Akt) in vitro.METHODS: D341 cells were divided into experimental groups ( added with matrine at different concentrations ) and control group ( under the same conditions without matrine).The proliferation of D341 cells was analyzed by CCK-8 assay.Apoptosis was detected by An-nexin V-FITC/PI double staining and the expression of Bax , Bcl-2, Akt and p-Akt was detected by Western blotting .RE-SULTS:Matrine significantly inhibited the proliferation of D 341 cells and increased the apoptosis in a dose-and time-de-pendent manner .The cell apoptosis was characterized by chromatin condensation with margination of chromatin to the nu -clear membrane , increased when and larger cytoplasmic vacuoles , and formation of apoptotic body after treatment with ma-trine.The expression of Bax increased , while the expression of Bcl-2 and p-Akt decreased when the drug concentration gradually increased .CONCLUSION:Matrine induces the apoptosis of human medulloblastoma D 341 cells in vitro by acti-vation of Bax, down-regulation of Bcl-2 and reduction of p-Akt expression level in the PI3K/Akt signaling pathway.

Protective effect of dexamethasone on stress response induced by intrauterine balloon aortic valvuloplasty in a fetal lamb model / 临床儿科杂志

Objective To investigate the protective effect of dexamethasone on stress response induced by intraute-rine balloon aortic valvuloplasty (IUBAV) in a fetal lamb model. Methods Twenty-four near term twin pregnant goats were randomly assigned to control group (n=12) and dexamethasone group (intracardiac injection of dexamethasone) (n=12). Ultrasound guided IUBAV model was established. According to the combination of treatment and operation, 48 fetal lambs were divided into four groups. The following parameters were dynamically monitored by ultrasound, which were fetal and neonatal heart rate (HR), cardiac rhythm, aortic resistance index (RI) and pulsatility index (PI). On established IUBAV model, blood samples and liver tissue specimens were taken from fetal/neonatal goats for detection of blood glucose (Glu), lactate acid (LA), plasma epinephrine (E), norepinephrine (NE), cortisol (Cort), hepatic glycogen staining. Results IUBAV resulted in increased values of Glu, LA, E, NE and Cort levels, and decreased pH value, there were significant differences between pre-and 3h-post procedure (P<0.05), and significant differences were also existed in these values between pre-and 3d-post procedure (P<0.05). After administrating dexamethasone, the changes of Glu, LA, E, NE, Cort and pH levels were suppressed effectively. Fetal hepatic glycogen was consumed in large amounts due to IUBAV while recovered 3 days after IUBAV by glycogen staining. After administrating dexamethasone, hepatic glycogen consumption related to IUBAV was obviously inhibited. After IUBAV, fetal aortic RI was increased, and there was significant differences compared with pre-procedure (P<0.05). Up to 3d-post procedure, the values of RI recovered to some extent, but statistical difference was exist-ed compared with pre-procedure (P<0.05). After administrating of dexamethasone, increased aortic RI was effectively sup-pressed. Conclusions IUBAV could lead to reversible stress response and increased aortic RI in a fetal lamb model which could be alleviated by dexamethasone.