Serum soluble CD40 ligand expression in children with Kawasaki disease in acute phase and its clinical significance / 中国综合临床

Objective:To investigate the expression of soluble CD40 ligand (sCD40L) in serum of children with Kawasaki disease at acute stage and its diagnostic value in coronary artery disease (CAL).Methods:This study adopts case-control study method. Select 127 children with Kawasaki disease admitted to Xuzhou Children's Hospital affiliated to Xuzhou Medical University from August 2021 to August 2022. They are divided into CAL group and non-CAL group according to the degree of coronary artery involvement. Select 30 healthy children who have physical examination in this hospital at the same time as the healthy control group, and select another 30 children with acute upper respiratory tract infection and fever admitted to this hospital at the same time as the fever control group.Compare the sex, age and laboratory indicators of children with Kawasaki disease with or without CAL, and compare the difference between the serum sCD40L level of children with Kawasaki disease with or without CAL and the fever control group and the healthy control group, the serum sCD40L level of children with different degrees of coronary artery dilation, and analyze the correlation between the serum sCD40L and various laboratory indicators of children with Kawasaki disease and the influencing factors of children with Kawasaki disease complicated with CAL, To evaluate the screening effect of serum sCD40L for Kawasaki disease complicated with CAL. The measurement data with normal distribution is expressed by xˉ± s, the comparison between the two groups adopts independent sample t-test, the comparison between multiple groups adopts one-way ANOVA, and the comparison between two groups adopts LSD method and Bonferroni correction; The measurement data of non-normal distribution is expressed by M( Q1, Q3), and the comparison between the two groups is conducted by Mann-Whitney U test. Pearson method and Spearman mothod were used for correlation analysis. Logistic regression model was used to analyze the influencing factors of children with Kawasaki disease complicated with CAL. The diagnostic value of serum sCD40L level in Kawasaki disease complicated with CAL was analyzed by drawing the ROC curve. Results:All 127 children with Kawasaki disease were divided into CAL group (45 cases) and non-CAL group (82 cases) according to the presence or absence of CAL. The serum level of sCD40L in CAL group was higher than that in non-CAL group, healthy control group and fever control group ((7.03±0.91) μg/L vs (4.66±1.23), (1.73±0.96), (2.21±1.08) μg/L), the difference was statistically significant (all P<0.001). The serum level of sCD40L in children with coronary artery dilation in CAL group was lower than that in children with small CAA, medium CAA and large CAA ((6.04±0.22) μg/L vs (6.95±0.69), (8.02±0.57), (8.23±0.26) μg/L), the difference was statistically significant (all P<0.001). Serum sCD40L level and platelet count (PLT), C-reactive protein (CRP), N-terminal pro brain natriuretic peptide (NT-proBNP), interleukin-6 (IL-6), IL-8 and tumor necrosis factor (TNF-α) in children with Kawasaki disease All were positively correlated ( r=0.31, P<0.001, r=0.32, P<0.001, r=0.26, P=0.003, r=0.58, P<0.001, r=0.27, P=0.002, r=0.39, P<0.001). Serum sCD40L, IL-6 and NT-proBNP were the risk factors of complicated CAL in children with Kawasaki disease (odds ratio 1.21, 1.06 and 1.01, 95% confidence interval 1.03-1.43, 1.01-1.12, 1.00-1.01, P values were 0.022, 0.011 and 0.039, respectively). The area under the curve of serum sCD40L in diagnosing Kawasaki disease complicated with CAL was 0.928 (95% confidence interval: 0.885-0.971), and the optimal critical value was 5.60 μg/L, the sensitivity was 97.8% and the specificity was 79.3%. Conclusions:The level of serum sCD40L increased in children with Kawasaki disease in acute phase, especially in children with CAL. The level of serum sCD40L increased with the severity of CAL, which is a risk factor for Kawasaki disease complicated with CAL, and has certain diagnostic value for Kawasaki disease complicated with CAL.

Effect of family management intervention on disease management ability of parents and family function with coronary artery lesions in Kawasaki disease / 中国实用护理杂志

Objective:To investigate the intervention effects and influencing factors of family management intervention on parents' disease management ability, family function of children with coronary artery lesions in Kawasaki disease.Methods:This was a quasi experimental study. Conveniently, 88 parents of children with Kawasaki disease coronary artery lesions from the Children's Hospital of Chongqing Medical University from March 2020 to June 2021 were selected for the study, and they were divided into the control group and the intervention group according to the order of the first consultation with 44 cases in each group. In the control group, conventional care and health education were used, while in the intervention group, a 6-month family management intervention was implemented on the basis of the control group. Family Management Measure (FaMM), Family Assessment Device (FAD) were used to assess the parents' disease management ability, family function before and after the intervention, respectively.Results:A total of 88 study subjects completed the pre-intervention survey in this study, and a total of 79 study subjects were surveyed when they returned to the hospital for review at the end of 6 months of intervention, including 40 in the intervention group and 39 in the control group, with a missed rate of 10.23% (9/88). There was no significant difference in the score of FAD, FaMM, Kawasaki disease knowledge questionnaire before the intervention between the two groups ( P>0.05). The scores of FAD in the intervention group was (21.58 ± 4.60) points, which was lower than that in the control group (24.62 ± 5.28) points, and the difference was statistically significant ( t=2.73, P <0.05). The scores of FaMM in the intervention group was (46.83 ± 6.02) points, which was higher than that in the control group (42.72 ± 6.09) points, and the differences was statistically significant ( t=-3.01, P <0.05). The age of the child, and whether the child was an only child were the influencing factors of the difference in disease management ability, and the difference in the family function of the parents of the child, respectively (all P<0.05). Conclusions:Family management intervention can improve the disease management ability of the parents of children with coronary artery lesion, improve family function. In the future, targeted interventions can be conducted according to different ages of children, and different family members' composition in order to obtain better intervention effects.

Analysis of coronary angiographic findings in 117 children with Kawasaki disease and coronary artery lesion / 中华实用儿科临床杂志

Objective:To analyze the coronary angiographic (CAG) characteristics of coronary artery lesion (CAL) in children with Kawasaki disease (KD), and to clarify the necessity of CAG in the diagnosis and treatment of KD combined with CAL in children.Methods:It was a retrospective study to analyze the clinical data, electrocardiogram, echocardiography, time and findings of CAG in children with KD and CAL who underwent CAG in Shanghai Children′s Medical Center of Shanghai Jiao Tong University School of Medicine from January 2013 to August 2022.The distribution, type, severity, and prognosis of CAL were analyzed.Results:A total of 117 children with KD and CAL were included in the analysis.The onset age of KD was from 2 months to 12.8 years old, and the age of performing CAG was from 8 months to 18.1 years old.A total of 234 coronary artery lesions were detected in 117 cases.Among them, CAL in the right coronary artery (RCA), left anterior descending branch (LAD), left main coronary artery and left circumflex artery were detected in 96 branches(41.1%), 78 branches(33.3%), 44 branches(18.8%), and 16 branches(6.8%), respectively.Unilateral coronary artery involvement was detected in 43 cases (36.8%), of which LAD was the dominant; while bilateral involvement was detected in 74 cases (63.2%), among which, LAD and RCA were the most involved arteries.Stratified by the degree of coronary involvement, large coronary aneurysms and severe coronary stenosis were most frequently occurred in the RCA and LAD.In contrast, 10 cases (13.6%), 20 cases (24.3%), 55 cases (45.8%) and 37 cases (67.3%) of intraluminal lesions were found in small, medium and large coronary aneurysms, and stenosis or occlusion, respectively.The incidence of intraluminal lesions tended to be higher in the site of severe lesions.CAG showed stenosis or occlusion in a total of 55 cases, and collateral circulation at varying degrees was found in cases of severe stenosis or occlusion.Conclusions:CAL in children with KD are complex and varied.Although clinical symptoms, routine electrocardiogram and cardiac ultrasound may indicate severe CAL.Their applications are limited by the diagnosis of the type (especially stenosis), degree, and extent of CAL, as well as the detection of extracoronary lesions.CAG is of great significance to identify vascular lesions and guide clinical management of KD combined with CAL in children.

Research advances in genetic polymorphisms in Kawasaki disease / 中国当代儿科杂志

Kawasaki disease (KD) is a systemic inflammatory vascular disorder that predominantly affects children and is the leading cause of acquired heart disease in children. Although the etiology of this disease remains unclear, genome-wide association and genome-wide linkage studies have shown that some susceptible genes and chromosomal regions are associated with the development and progression of KD. With the advancement of high-throughput DNA sequencing techniques, more and more genomic information related to KD is being discovered. Understanding the genes involved in the pathogenesis of KD may provide novel insights into the diagnosis and treatment of KD. By analyzing related articles and summarizing related research advances, this article mainly discusses the T cell activation-enhancing genes that have been confirmed to be closely associated with the development and progression of KD and reveals their association with the pathogenesis of KD and coronary artery lesions.

Role and mechanisms of CHI3L1 in coronary artery lesions in a mouse model of Kawasaki disease-like vasculitis / 中国当代儿科杂志

OBJECTIVES@#To explore the role and potential mechanisms of chitinase-3-like protein 1 (CHI3L1) in coronary artery lesions in a mouse model of Kawasaki disease (KD)-like vasculitis.@*METHODS@#Four-week-old male SPF-grade C57BL/6 mice were randomly divided into a control group and a model group, with 10 mice in each group. The model group mice were intraperitoneally injected with 0.5 mL of lactobacillus casei cell wall extract (LCWE) to establish a mouse model of KD-like vasculitis, while the control group mice were injected with an equal volume of normal saline. The general conditions of the mice were observed on the 3rd, 7th, and 14th day after injection. Changes in coronary artery tissue pathology were observed using hematoxylin-eosin staining. The level of CHI3L1 in mouse serum was measured by enzyme-linked immunosorbent assay. Immunofluorescence staining was used to detect the expression and localization of CHI3L1, von Willebrand factor (vWF), and α-smooth muscle actin (α-SMA) in coronary artery tissue. Western blot analysis was used to detect the expression of CHI3L1, vWF, vascular endothelial cadherin (VE cadherin), Caspase-3, B cell lymphoma-2 (Bcl-2), Bcl-2 associated X protein (Bax), nuclear factor κB (NF-κB), and phosphorylated NF-κB (p-NF-κB) in coronary artery tissue.@*RESULTS@#The serum level of CHI3L1 in the model group was significantly higher than that in the control group (P<0.05). Compared to the control group, the expression of CHI3L1 in the coronary artery tissue was higher, while the expression of vWF was lower in the model group. The relative expression levels of CHI3L1, Bax, Caspase-3, NF-κB, and p-NF-κB were significantly higher in the model group than in the control group (P<0.05). The relative expression levels of vWF, VE cadherin, and Bcl-2 were lower in the model group than in the control group (P<0.05).@*CONCLUSIONS@#In the LCWE-induced mouse model of KD-like vasculitis, the expression levels of CHI3L1 in serum and coronary arteries increase, and it may play a role in coronary artery lesions through endothelial cell apoptosis mediated by inflammatory reactions.

Platelet-to-lymphocyte ratio as a biomarker for predicting coronary artery lesions in Chinese children with Kawasaki disease: a Meta analysis / 中国当代儿科杂志

OBJECTIVES@#To systematically evaluate the value of the platelet-to-lymphocyte ratio (PLR) in predicting coronary artery lesions (CAL) in Chinese children with Kawasaki Disease (KD).@*METHODS@#A comprehensive search was conducted in databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data, China Biomedical Literature Database, and China Science and Technology Journal Database from inception to December 2022. The quality of the included literature was assessed using the Newcastle-Ottawa Scale, and a Meta analysis was performed using Stata 15.1.@*RESULTS@#A total of ten published reports, involving 3 664 Chinese children with KD, were included in this Meta analysis, of whom 1 328 developed CAL. The Meta analysis revealed a sensitivity of 0.78 (95%CI: 0.71-0.83), specificity of 0.71 (95%CI: 0.61-0.80), overall diagnostic odds ratio of 8.69 (95%CI: 5.02-15.06), and an area under the curve of the summary receiver operating characteristic of 0.82 (95%CI: 0.78-0.85) for PLR in predicting CAL in the children with KD. The sensitivity, specificity, and area under the curve of summary receiver operating characteristic were lower for PLR alone compared to PLR in combination with other indicators. Sensitivity analysis demonstrated the stability of the Meta analysis results with no significant changes upon excluding individual studies. However, a significant publication bias was observed (P<0.001).@*CONCLUSIONS@#PLR demonstrates certain predictive value for CAL in Chinese children with KD.

Predictive value of Apelin-13 on coronary artery lesion in Kawasaki disease / 中华实用儿科临床杂志

Objective:To investigate the relationship between the level of Apelin-13 and coronary artery lesion (CAL) in patients with Kawasaki disease (KD), and assess the predictive value of Apelin-13 for CAL in acute phase of KD.Methods:A total of 240 children with KD treated in Chengdu Women and Children′s Central Hospital from September 2017 to October 2019 were recruited, and were divided into KD with CAL (KD-CAL) group and KD without CAL (KD-NCAL) group.Thirty children with acute upper respiratory infection and 30 healthy children were recruited into the febrile control group and the healthy control group, respectively.Blood routine and serum levels of albumin, C-reactive protein (CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP) and Apelin-13 were mea-sured in KD children prior to intravenous gamma globulin injection and after the diagnosis of children in the febrile control group and physical examination of children in the healthy control group.The clinical data of children in each group were compared, and the risk factors of KD complicated with CAL and the predictive value of Apelin-13 were determined by using receiver operating characteristic (ROC) curve and multiple Logistic regression analysis. Results:Apelin-13 and hemoglobin in children with KD were significantly decreased compared with those in the healthy control group and fever control group (all P<0.001). However, white blood cell(WBC) count, platelet count, CRP and NT-proBNP in KD group were significantly increased compared with those in the healthy control group and fever control group (all P<0.001). Serum albumin in KD children was significantly lower than that in the healthy control group ( P=0.004), and there was no difference when compared with the fever control group ( P=0.485). Apelin-13 and hemoglobin were significantly decreased in KD-CAL group compared with KD-NCAL group ( t=10.102, P<0.001; t=2.034, P=0.043), while NT-proBNP and CRP were significantly increased ( t=5.982, 3.728, all P<0.001). Multiple logistic regression analysis showed that Apelin-13 and NT-proBNP were independent predictors of CAL in KD.The ROC curve analysis showed that the cut-off value of Apelin-13 for predicting CAL was 2.99 μg/L, with an area under the curve (AUC) of 0.869 (95% CI: 0.820-0.909), sensitivity of 77.78% and specificity of 88.67%.While NT-proBNP cutoff value of 822 ng/L yielded sensitivity of 57.78% and specificity of 84.62% for predicting CAL with an AUC of 0.718(95% CI: 0.656-0.774). Conclusions:Apelin-13 plays a protective role in KD complicated with CAL, and could be used to predict CAL in the acute phase of KD.

Relationship between microRNA-208 and the pathogenesis of coronary artery lesion in Kawasaki disease / 国际儿科学杂志

Kawasaki disease(KD) is a febrile vasculitis in childhood.It has become the most prominent cause of pediatric secondary cardiovascular disease as it is associated with coronary artery lesion(CAL). Even though intravenous immunoglobulin treatment has greatly lowered the incidence of coronary artery aneurysm, the existence of IVIG-resistant KD indicates a part of patients are still at a high risk of CAL, which brings them a huge psychiatric and financial burden.Therefore, studying the pathogenesis of CAL associated with KD is of great significance.This article reviews the related mechanism of KD and the associated CAL.Meanwhile, it illustrates the connection between microRNA-208 and CAL, on which basis the perspective of microRNA-208 possibly involving in the KD-associated CAL is given.

Advances in single-cell RNA sequencing for Kawasaki disease / 国际儿科学杂志

Kawasaki disease, an acute self-limited systematic vasculitis, predominantly affects children under 5 years old.One of the most common complications is coronary artery lesions.Currently, the pathogenesis mechanism of Kawasaki disease is considered to be multifactorial, including genetic susceptibility, impaired immune response, inflammatory injury and so on.Over the past decade, by interpreting the unique gene expression pattern on single-cell level, single-cell RNA sequencing is able to identify new or rare cell subsets and construct cell trajectories.These applications are widely applied to researches of cardiovascular diseases.This review summarizes the development of single-cell RNA sequencing and its applications in researches of the pathogenesis of Kawasaki disease, including animal model and acute phase of Kawasaki disease.

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.

Influencing factors of coronary artery lesions in children with Kawasaki disease / 西安交通大学学报(医学版)

【Objective】 To study the influencing factors of blood source indicators related to coronary artery lesions in children with Kawasaki disease (KD). 【Methods】 Clinical data of children diagnosed with KD admitted to our hospital from January 1, 2015 to December 31, 2019 were retrospectively analyzed. Baseline data comparison and multivariate Logistic regression analysis were used to compare the differences in blood source indicators between the coronary artery lesion (CAL) group and the non-coronary artery lesion (nCAL) group, and the receiver operating characteristic (ROC) curve was drawn. 【Results】 There were significant differences in sex, erythrocyte sedimentation rate (ESR), lymphocyte count (L#) and red blood cell distribution width (RDW) between the CAL group and the nCAL group (P<0.05). Male, lower ESR, lower L#, and higher RDW were independent risk factors for CAL. OR values and their 95% confidence intervals (95% CI) were 0.279 (0.117, 0.669), 0.973 (0.955, 0.992), 0.675 (0.513, 0.889), and 2.433 (1.313, 4.506), respectively. The sensitivity and specificity of RDW for predicting CAL were 37.3% and 86.4%, the best cutoff value was 13.45%, the area under curve (AUC) was 0.616, and 95% CI was (0.514, 0.718) (P<0.05). ESR and L# had no predictive value for CAL. 【Conclusion】 Blood source indicators of children with Kawasaki disease, including blood routine and inflammatory indicators, especially RDW, have certain predictive value for coronary artery lesions. They can be combined with echocardiography to evaluate disease progression.

Age-related differences in clinical characteristics of Kawasaki disease

This study aimed to examine and summarize clinical characteristics of Kawasaki disease (KD) at different ages to further strengthen clinicians understanding of children with KD, improving the level of diagnosis, and reducing coronary artery complications of KD. A total of 398 patients with KD who were diagnosed between January 2016 and December 2017 were reviewed retrospectively. These participants were allocated into three groups according to age: group A (<1 year, n=62), group B (≥1 and <5 years, n=286), and group C (≥5 years, n=50). Clinical manifestations, laboratory results, and echocardiographic findings were compared among the groups. Most (71.86%) patients with KD were aged 1-5 years. The prevalence of cervical lymphadenopathy was lowest in group A. The duration of fever before admission was longest in group A. The rate of cervical lymphadenopathy and laboratory data were different among the groups. Group A had higher frequencies of gastrointestinal involvement, neurological symptoms, and redness at the Bacillus Calmette-Guerin inoculation site than the other groups. Infants aged <1 year with KD often have a longer duration of fever before admission, a lower prevalence of cervical lymphadenopathy, and a higher prevalence of gastrointestinal and neurological symptoms.

The mechanism of high mobility group box 1 in coronary artery lesions of Kawasaki disease / 国际儿科学杂志

Kawasaki disease(KD)is a common acute febrile vasculitis in children, but the etiology and pathogenesis of KD are unknown.The most serious complication is coronary artery lesions.The damage of vascular endothelial cell may be the key mechanism of coronary artery lesions in KD.It is found that serum levels of high mobility group box 1(HMGB1) increase in the acute phase of KD, especially in children with coronary artery lesions, and that the gene of HMGB1 is associated with coronary artery lesions in Korean children with KD.HMGB1 is a non-histone DNA binding protein related to inflammation, which plays an important role in promoting the apoptosis of coronary artery endothelial cells in KD.The article reviews the mechanism of HMGB1 in coronary artery lesions of KD.

Progress of diagnostic and prediction model of Kawasaki disease / 中国小儿急救医学

Kawasaki disease(KD) is an acute systemic medium and small vasculitis which commonly occurred in children under 5 years old.Coronary artery lesion(CAL) is the most important complication of KD.So KD is the leading cause of acquired heart disease in children.Due to the lack of gold standard for early diagnosis, accurate diagnosis of KD and early prediction of critical KD are the major clinical challenges.Early accurate diagnosis of KD, prediction of sensibility for intravenous immunoglobulin and prediction of CAL are of great application value in clinical diagnosis, treatment and reduction of CAL.So, we reviewed the progress of diagnostic and prediction model of KD.

Pathogen infection and pathogenesis of Kawasaki disease / 国际儿科学杂志

Kawasaki disease,also known as mucous skin lymph node syndrome,is a systemic vascular inflammatory disease mainly occurring in children under the age of 5 years,which has become the main cause of the acquired heart disease in children.The etiology and pathogenesis of Kawasaki disease have not been clearly defined since the initial report of Kawasaki disease in 1967.In recent years,the epidemiology of Kawasaki disease has highly suggested that the pathogenesis of Kawasaki disease is related to infection.It is reported that there are dozens of pathogens known to be associated with Kawasaki disease,including bacteria,viruses,mycoplasma pneumoniae,chlamydia,etc.This article reviews the pathogens related to Kawasaki disease reported in recent years,aiming to introduce the pathogens that cause the Kawasaki disease and its association with coronary artery lesions (CALs),the main complication of Kawasaki disease,so as to provide clinical guidance for the research of Kawasaki disease pathogenesis.

Pathogen infection and pathogenesis of Kawasaki disease / 国际儿科学杂志

Kawasaki disease, also known as mucous skin lymph node syndrome, is a systemic vascular inflammatory disease mainly occurring in children under the age of 5 years, which has become the main cause of the acquired heart disease in children.The etiology and pathogenesis of Kawasaki disease have not been clearly defined since the initial report of Kawasaki disease in 1967.In recent years, the epidemiology of Kawasaki disease has highly suggested that the pathogenesis of Kawasaki disease is related to infection.It is reported that there are dozens of pathogens known to be associated with Kawasaki disease, including bacteria, viruses, mycoplasma pneumoniae, chlamydia, etc.This article reviews the pathogens related to Kawasaki disease reported in recent years, aiming to introduce the pathogens that cause the Kawasaki disease and its association with coronary artery lesions(CALs), the main complication of Kawasaki disease, so as to provide clinical guidance for the research of Kawasaki disease pathogenesis.

Clinical implications in laboratory parameter values in acute Kawasaki disease for early diagnosis and proper treatment / 소아과

PURPOSE: This study aimed to analyse laboratory values according to fever duration, and evaluate the relationship across these values during the acute phase of Kawasaki disease (KD) to aid in the early diagnosis for early-presenting KD and incomplete KD patients. METHODS: Clinical and laboratory data of patients with KD (n=615) were evaluated according to duration of fever at presentation, and were compared between patients with and without coronary artery lesions (CALs). For evaluation of the relationships across laboratory indices, patients with a fever duration of 5 days or 6 days were used (n=204). RESULTS: The mean fever duration was 6.6±2.3 days, and the proportions of patients with CALs was 19.3% (n=114). C-reactive proteins (CRPs) and neutrophil differential values were highest and hemoglobin, albumin, and lymphocyte differential values were lowest in the 6-day group. Patients with CALs had longer total fever duration, higher CRP and neutrophil differential values and lower hemoglobin and albumin values compared to patients without CALs. CRP, albumin, neutrophil differential, and hemoglobin values at the peak inflammation stage of KD showed positive or negative correlations each other. CONCLUSION: The severity of systemic inflammation in KD was reflected in the laboratory values including CRP, neutrophil differential, albumin, and hemoglobin. Observing changes in these laboratory parameters by repeated examinations prior to the peak of inflammation in acute KD may aid in diagnosis of early-presenting KD patients.

Correlation between heart rate variability and severity of coronary artery lesion in patients with coro -nary heart disease / 心血管康复医学杂志

Objective :To study correlation between heart rate variability (HRV) and severity of coronary artery le-sion in patients with coronary heart disease (CHD) and its significance .Methods :A total of 171 CHD inpatients from our department of cardiology were selected .All CHD patients were diagnosed by coronary angiography or cor- onary CT .Severity of coronary artery lesion was judged by Gensini scoring system .According to coronary stenotic degree ,patients were divided into coronary no stenosis group (n＝30) ,mild group (stenosis＜50%,n＝51) ,medi-um group (stenosis 50% ～75%,n＝46) and severe group (stenosis＞75%,n＝44).The 24h ambulatory ECG moni-toring was performed in all patients ,HRV indexes were compared among all groups and their correlation with sever-ity of coronary lesion degree were analyzed .Results :There were significant difference in standard deviation of nor-mal to normal RR intervals calculated over the 24 h period (SDNN) ,standard deviation of normal to normal RR in-tervals in all 5 min segments of the entire recording (SDANN) ,root-mean square of differences between successive normal to normal intervals (rMSSD) and adjacent normal RR interval difference ＞ 50ms stroke accounted for a per-centage of 24h total RR interval (PNN50) among four groups ,and HRV indexes significantly reduced along with coronary lesion aggravated , P＜0.05 or ＜0.01. Multi-factor Logistic regression analysis indicated that HRV inde-xes were independent risk factors for coronary artery lesion aggravation (OR＝1.359～3.254 ,P＜0.05 or ＜0.01). Spearman correlation analysis indicated that SDNN ,SDANN ,rMSSD and PNN50 were significant inversely correla-ted with Gensini score (r＝ -0.510～ -0.271 ,P＜0.05 all).Conclusion : HRV possesses certain clinical application value assessing coronary lesion severity in CHD patients .

Application of evidence - based perioperative nursing in transradial interventional treatment by using sheathless guiding - catheter for coronary artery lesions / 介入放射学杂志

Objective To investigate the application of evidence - based perioperative nursing in transradial interventional treatment by using sheathless guiding-catheter for coronary artery lesions. Methods The evidence-based nursing team researched for the relevant literature and evidences. According to the theory of critical evidence - based nursing, evidence - based perioperative nursing measures were carried out for 30 patients with coronary artery diseases who were receiving transradial interventional treatment by using sheathless guiding-catheter. Results The success rate of puncturing was 100％. After the procedure only two patients developed radial artery complications, and after promptly treatment no severe consequences occurred. The treatment achieved the desired clinical results. Conclusion Evidence-based nursing measures can regulate nursing behavior, and presciently make the nursing work in a standardized and sequenced way, thus, the nursing work is changed from the passive mode to an active mode. Therefore, evidence - based perioperative nursing is worth of clinical application(J Intervent Radiol, 2018, 27:281 -284)

Research progress in the treatment of Kawasaki disease / 国际儿科学杂志

Kawasaki disease is an autoimmune vascufitis syndrome that occurs in children under 5 years of age.Its greatest harm is coronary artery disease,including coronary artery dilatation,coronary artery aneurysm and so forth.Moreover,myocardial infarction may occur in severe cases.In the acute phase of Kawasaki disease,high-dose intravenous immunoglobulin(IVIG) combined with aspirin can be used as the standard therapy for the treatment of Kawasaki disease,but 10％ to 20％ of the patients still have resistance to the initial IVIG treatment.There is an increased risk of coronary artery damage in these patients.Additional treatment is required for IVIG non-reactivity Kawasaki disease,and some new therapies are emerging,such as repeated use of IVIG,glucocorticoid and IL-1 receptor antagonists,etc.In the recovery period of Kawasaki disease,anticoagulant and prophylaxis therapy are the main choices,and surgical or interventional therapy may be performed as appropriate for the patients with severe coronary artery disease.This article reviews the research progress in the treatment of Kawasaki disease.