Clinical effect and safety of clopidogrel combined with aspirin in antithrombotic therapy for children with Kawasaki disease complicated by small/medium-sized coronary artery aneurysms / 中国当代儿科杂志

OBJECTIVE@#To study the clinical effect and safety of clopidogrel combined with aspirin in antithrombotic therapy for children with Kawasaki disease (KD) complicated by coronary artery aneurysm (CAA).@*METHODS@#A total of 77 KD children who were diagnosed with multiple small/medium-sized CAAs by echocardiography between January 2013 and June 2018 were enrolled. They were randomly divided into observation group with 38 children (treated with clopidogrel and aspirin) and control group with 39 children (treated with low-molecular-weight heparin and aspirin). All children were followed up regularly, and the first 3 months of the course of the disease was the observation period. The children were observed in terms of the change of the coronary artery and the incidence of complications.@*RESULTS@#At month 3 of follow-up, among the children in the observation group, 6 had normal coronary artery, 11 had coronary artery retraction, 19 had stable coronary artery, and 2 progressed to giant coronary aneurysm; among the children in the control group, 7 had normal coronary artery, 12 had coronary artery retraction, 19 had stable coronary artery, and 1 progressed to giant coronary aneurysm; there was no significant difference in the change of the coronary artery between the two groups (P>0.05). There were 2 cases of epistaxis and 6 cases of skin ecchymosis in the observation group, and 1 case of epistaxis and 7 cases of petechiae and ecchymosis at the injection site in the control group, and no other serious bleeding events were observed in either group.@*CONCLUSIONS@#Clopidogrel combined with low-dose aspirin is safe and effective in antithrombotic therapy for children with KD complicated by CAA.

Relationship between heart rate variability and coronary artery lesion in children with Kawasaki disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To explore the correlation of heart rate variability (HRV) indices with cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in children with Kawasaki disease (KD) and their prognostic value.</p><p><b>METHODS</b>A total of 130 children with KD were assigned into coronary artery lesion (CAL) group (n=47) and non-coronary artery lesion (NCAL) group (n=83). Meanwhile, 110 healthy children and 29 children in the recovery stage of non-cardiovascular diseases were selected as control and non-KD groups, respectively. Patients in the four groups received 24-hour HRV monitoring. Levels of serum cTnI and NT-proBNP were measured in the KD and the non-KD group.</p><p><b>RESULTS</b>Compared with the controls of the same sex and age, the KD patients had significantly reduced standard deviation of all normal sinus RR intervals (SDNN), mean of SDNN (SDNN index), percentage of successive normal sinus RR intervals>50 ms (pNN50), very low frequency (VLF), low frequency (LF), and high frequency (HF) but a significantly increased LF/HF ratio (P<0.05). The HRV indices including SDNN, standard deviation of all mean 5-minute RR intervals (SDANN), SDNN index, root mean squared successive difference, pNN50, VLF, LF, and HF in the CAL group all significantly decreased compared with those in the control and non-KD groups, while the LF/HF ratio was higher in the CAL group than in the control group (P<0.05). The serum levels of cTnI and NT-proBNP in the CAL and NCAL groups were significantly higher than those in the non-KD group (P<0.05). In children with KD, serum cTnI level was negatively correlated with SDNN and HF but positively correlated with the LF/HF ratio (P<0.05); serum NT-proBNP level was negatively correlated with SDNN, SDANN, and HF (P<0.05).</p><p><b>CONCLUSIONS</b>HRV indices have certain clinical significance in assessing CAL of children with KD.</p>

The role of endogenous vascular elastase in coronary artery reconstruction in Kawasaki disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the role of endogenous vascular elastase (EVE) in coronary artery between reconstruction among pediatric patients with Kawasaki disease (KD).</p><p><b>METHODS</b>Sixty children who were diagnosed with KD between January 2012 and April 2013 were selected as the case group, and peripheral venous blood samples were collected on days 0-11 (pathological stage I) and days 12-25 (pathological stage II) after the onset of disease; another 60 children without KD who visited the hospital due to acute fever during the same period were selected as the control group, and fasting peripheral venous blood samples were collected in the acute stage of fever. For both groups, serum levels of EVE and interleukin-6 (IL-6) and plasma vascular endothelial growth factor (VEGF) level were measured by enzyme-linked immunosorbent assay. For the case group, ultrasonic cardiography was used to detect coronary artery lesions (CALs) at the first, second and fourth weekends. The correlations of EVE level with IL-6 and VEGF levels were evaluated by Pearson correlation analysis.</p><p><b>RESULTS</b>Serum levels of EVE and IL-6 in the case group in pathological stages I and II were significantly higher than in the control group (P<0.05), but plasma VEGF levels in stages I and II were significantly lower than in the control group (P<0.05); in the case group, EVE and IL-6 levels were significantly higher in stage II than in stage I (P<0.05). In pathological stage II, KD patients with CALs had significantly higher serum levels of EVE and IL-6 but significantly lower plasma VEGF levels compared with those without CALs (P<0.05); KD patients with coronary artery aneurysms (CAAs) had significantly higher serum levels of EVE and IL-6 but significantly lower plasma VEGF level compared with those without CAAs (P<0.05 for all). EVE level was positively correlated with IL-6 level (r=0.915, P<0.05), yet negatively correlated with VEGF level (r=-0.769, P<0.05).</p><p><b>CONCLUSIONS</b>EVE may participate in coronary artery reconstruction in children with KD. To interfere EVE activity may reduce and prevent CALs.</p>

Plasma concentration of growth-differentiation factor-15 in children with congenital heart disease: relation ship to heart function and diagnostic value in heart failure / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the correlation between growth differentiation factor-15(GDF-15) and cardiac function in pediatric patients with congenital heart disease, and the diagnostic value of GDF-15 in heart failure(HF).</p><p><b>METHODS</b>From March 2011 to May 2012, 97 pediatric patients with congenital heart disease(CHD) who consecutively attended Chengdu Women's & Children's Central Hospital were enrolled in the study and assigned to HF (patients with heart failure, n=71) and Non-HF(patients without heart failure, n=26) groups. HF was defined as patients presenting with modified Ross score≥3. Plasma concentrations of GDF-15 and NT-proBNP were determined using ELISA. Left ventricular ejection fraction(LVEF) was tested by echocardiography. The correlation between GDF-15 and modified Ross score, LVEF and NT-proBNP was evaluated with Spearman's analysis. The area under the receiver-operating characteristic(ROC) curve for GDF-15 was examined, and the cut-off concentration of GDF-15 for diagnosing HF was detected.</p><p><b>RESULTS</b>The HF group demonstrated higher levels of GDF-15 and NT-proBNP, and a lower LVEF level (P<0.01) than the Non-HF group. Plasma GDF-15 level was positively correlated with modified Ross score and plasma NT-proBNP concentration (r=0.705, r=0.810 respectively; P<0.01), and negatively correlated with LVEF(r=-0.391, P<0.01). According to ROC analysis, the AUC of GDF-15 for detection of HF was 0.757. Sensitivity and specificity was 68.8% and 71.2% respectively for the cut-off value of 1306 ng/mL.</p><p><b>CONCLUSIONS</b>Plasma GDF-15 levels are significantly elevated in children with HF induced by CHD. Plasma GDF-15 levels are related to cardiac function, LVEF and plasma concentration of NT-proBNP. GDF-15 may potentially indicate HF in pediatric patients with CHD.</p>

Effect of glycemic control on progress of left ventricular structure and diastolic dysfunction in adolescent with type 1 diabetes mellitus / 中华实用儿科临床杂志

Objective To investigate the effect of glycemic control on progress of left ventricular structure and diastolic dysfunction in adolescents with type 1 diabetes mellitus (T1 DM).Methods A total of 36 T1DM adolescent patients(observation group) and 36 age-matched healthy controls (healthy control group),who consulted doctors in Chengdu Women and Children's Central Hospital between Dec.2009 and Dec.2010,were recruited into the study.Patients in the observation group were performed standard treatment for glycemic control.All patients were followed-up for 2 years.At the end of the study,the patients in observation group were divided into 3 subgroups according to the average HbA1 c level:excellent glycemic control group [glycosylated hemoglobin (HbA1 c) ＜ 7.6％],good glycemic control group(7.6％ ≤HbA1c≤9.0％) and bad glycemic control group(HbA1c ＞9.0％).All of the subjects were evaluated by means of echocardiography for assessment of left ventricular structural and functional parameters.Results Left ventricular posterior wall depth (LVPW),left ventricular mass index (LVMI) and isovolumic relaxation time (IVRT) were elevated,while E/A was decreased in the observation group compared with the healthy control group at baseline (all P ＜ 0.05).There was no significant difference between 2 groups in interventricular septum thickness (IVS),left ventricular end-diastolic dimension(LVEDd) and cardiac systolic function(all P ＞ 0.05).Echocardiographic parameters of left ventricular structure and function were unchanged in well-controlled patients.At the end of follow-up,mild-control group and non-control group demonstrated increased IVS,LVPW and LVMI,and exacerbated left ventricular diastolic function in the present of IVRT prolonging and E/A decreasing.Conclusions There is an inclination in T1 DM adolescent patients developing to left ventricular diastolic dysfunction,and improved glycemic control can delay the progress of left ventricnlar hypertrophy,but it can't ameliorate the decreased diastolic dysfunction.Whereas,non-improved glycemic control can accelerate left ventricular remodeling and exacerbate diastolic dysfunction in T1DM adolescent patients.

Risk factors for coronary artery lesions in children with Kawasaki disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study risk factors for the development of coronary artery lesions (CAL) in children with Kawasaki disease (KD).</p><p><b>METHODS</b>The clinical data of 527 children with KD between January 2006 and January 2009 were retrospectively reviewed. A total of 15 potential factors associated with occurrence of CAL were evaluated by univariate analysis and multivariate logistic regression analysis.</p><p><b>RESULTS</b>The univariate analysis showed that age, gender, KD type, starting time of intravenous immunoglobulin (IVIG) treatment, response to IVIG treatment, additional treatment with corticosteroids, duration of fever and serum C-reactive protein level were significantly different between patients with and without CAL (P<0.05). Multivariate logistic regression analysis showed that an age of less than 1 year (OR=2.076, P<0.05) or greater than 8 years (OR=1.890, P<0.05), male sex (OR=1.972, P<0.05), incomplete KD (OR=1.426, P<0.05), delayed starting time of IVIG treatment (10 days after onset) (OR=3.251, P<0.05), no response to IVIG (OR=2.301, P<0.05) and fever duration of more than 10 days (OR=1.694, P<0.05) were independent risk factors for the development of CAL, whereas early starting time of IVIG treatment (before 5 days after onset) was a protective factor (OR=0.248, P<0.05).</p><p><b>CONCLUSIONS</b>The occurrence of CAL is associated with many factors in children with KD. Age of less than 1 year or greater than 8 years, male sex, incomplete KD, delayed IVIG treatment after onset, no response to IVIG treatment and prolonged fever duration have been identified as risk factors for the development of CAL.</p>

Characterizations of atrial contractions triggering paroxysmal atrial fibrillation and the effect of atrial fibrillation prevention pacing / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the electrocardiographic characterizations of atrial contractions(AC) triggering paroxysmal atrial fibrillation(AF), and to explore the effects of AF prevention pacing on their electrocardiographic characterizations.@*METHODS@#Twenty-four patients with the implantation of AF therapy pacemaker(Vitatron 900E) were analyzed by AC triggering paroxysmal AF with Holter monitoring in the study. AC compluing interval, compensatory pause and frequency 2 minutes before the AF or during the AC were compared between the induced paroxysmal AF group and noinduced paroxysmal AF group, and the preventive effect of AF on the post-PAC response program was investigated.@*RESULTS@#There was significant difference in the AC compluing interval [(352.3 +/-30.4) vs (421.8 42.5)ms], compensatory pause [(963 +/-109) vs (733 +/-124) ms], and frequency [(34.8 +/-18.9) vs (12.7 +/-8.7)/min] 2 minutes before the AF or during the AC in the induced paroxysmal AF group, compared with those in the noinduced paroxysmal AF group (all P<0.05). The AF of 7 patients were controlled by atrial overdrive pacing therapy, 17 patients by post-AC-response or/and post-exercise control therapy, 6 patients by the above therapy combining with cordarone (0.2g/d).@*CONCLUSION@#AC triggering paroxysmal AF is related to the compluing interval, compensatory pause and frequency 2 minutes before the paroxysmal AF or during the AC, AF prevention pacing may be helpful for the paroxysmal AF induced by AC.

Detecting the activity of antibodies induced by recombinant TGFbeta1 vaccine / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To measure the neutralization activity in vitro of the antibodies induced by recombinant TGFbeta1 vaccine and to evaluate the vaccine's anti-liver fibrosis activity.</p><p><b>METHODS</b>Balb/c mice were immunized with a fusion protein of the human TGFbeta1 epitope-inserted into a hepatitis B core antigen using a prokaryotic expression system. The antibody produced by the recombinant vaccine was determined using ELISA. The biological activity of the anti-TGFbeta1 antibody induced by the vaccine was measured by MTT using mink lung epithelial cell Mv-1-Lu as inhibiting cells. The fusion protein was used as a vaccine in a mice hepatic-fibrosis model.</p><p><b>RESULTS</b>A high titer of anti-TGFbeta1 antibody and a low of anti-HBc antibody were detected in the mice after the immunization. The serum antibodies induced combined with the fusion and antigenic peptide prevented the TGFbeta1 inhibiting activity in the Mv-1-Lu cell.</p><p><b>CONCLUSION</b>Recombinant fusion protein can be used as a cytokine vaccine to induce high titers of anti-TGFbeta1 antibodies. Our results show the potentiality of the fusion protein to be used as a vaccine for preventing liver fibrosis.</p>

Effect of atrial pacing on the sleep apnea syndrome in elderly patients / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the efficacy of atrial pacing to increase the heart rate during sleep in elderly patients with sleep apnea syndrome.@*METHODS@#Sixteen elderly patients with central type or obstructive type sleep apnea received permanent atrial-synchronous ventricular pacemakers for symptomatic sinus bradycardia were analysed in this study. All patients received polysomnographic evaluations for 3 consecutive nights. All patients were evaluated at the base-line, and then were randomly divided into 2 groups at the first night. In the following 2 nights, one group was monitored in spontaneous rhythm model and the other in dual-chamber pacing model with atrial overdrive (increasing by 15 beats per minute on the basic rate of the mean nocturnal sinus), and then the two groups were switched at the third night. The total duration and number of episodes of sleep apnea or hypopnea were analyzed, and compared between the two models.@*RESULTS@#The mean 24 h sinus rate in the spontaneous rhythm mode was 55+/-9 beats per minute at the base line, as compared in the 72+/-4 beats per minute in the atrial overdrive pacing model. There was statistic significant difference between the 2 models (P0.05 ]. The hypopnea index reduced from 9+/-3 in the spontaneous rhythm model to 3+/-3 in the atrial overdrive pacing model (P<0.01). The index of apnea and hypopnea was 28+/-21 in the spontaneous rhythm model, as compared with 10+/-13 in the atrial overdrive pacing model (P<0.01).@*CONCLUSION@#Atrial overdrive pacing can significantly reduce the number of episodes of central type or obstructive type sleep apnea, but doesn't decrease the total sleep time in elderly patients with sleep apnea syndrome.

Fusion of TGF-beta 1 antigenic determinant and HBV core antigen as an anti-TGF-beta 1 vaccine / 中华肝脏病杂志

<p><b>OBJECTIVES</b>To examine the expression and purification of the TGFbeta1 vaccine from prokaryotic expression system and to determine the antigenicity of the fusion protein of recombinant vector pET28a/ HBcAg1-71-TGFbeta132-HBcAg89-144.</p><p><b>METHODS</b>The reconstructed vector pGEMEX-1/CTC was subcloned to pET28a and transformed into E. coli BL21 (DE3). The recombinant 6xHis- HBcAg1-71- TGFbeta132- HBcAg89-144 was to be expressed after induction by IPTG and purified with Ni-NTA-His affinity chromatography. The detection of the formation of core-like particles was done under an electron microscope and of their antigenity by using ELISA and Western blot.</p><p><b>RESULTS</b>A 2.46 x 10(4) protein was obtained by optimizing the conditions for both expression and purification. The protein had the TGFbeta1 antigenicity but not a HBc antigenity and the formed core-like particles were bigger than natural core particles.</p><p><b>CONCLUSION</b>The recombinant fusion protein in the prokaryotic expressed system can be used as an anti-TGFbeta1 vaccine to inhibit hepatic fibrosis.</p>