Outcomes of different types of pulmonary atresia in neonates treated by ductus arteriosus stenting / 中华儿科杂志

Objective: To summarize the outcomes of different types of pulmonary atresia in neonates treated by ductus arteriosus stenting. Methods: This study was a retrospective cohort study. A total of 19 neonates who had pulmonary atresia treated by ductus arteriosus stenting in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from April 2014 to June 2021 were included. They were divided into the intact ventricular septum (PA-IVS) group and the ventricular septal defect (PA-VSD) group. Ductus arteriosus stents were implanted by different approaches. These children were followed up regularly at the 1, 3, 6, and 12 months after the surgery and annually since then to evaluate the outcome. Independent sample t-test was used for the statistical analysis. Results: There were 12 children in PA-IVS group and 7 in PA-VSD group. All of them were full term in fants. The gestational age of the PA-IVS group and the PA-VSD group was (38.8±1.1) and (37.7±1.8) weeks, the birth weights were (3.2±0.4) and (3.4±1.1) kg, and the age at operation was (10±9) and (12±7) days, respectively, without significant difference (all P>0.05). Among the 12 children with PA-IVS, 9 had stents successfully implanted through the femoral artery and 3 through the femoral vein. Of the 7 children with PA-VSD, 2 had the stents successfully implanted via the femoral artery and 2 failed, and the remaining 3 had stents successfully implanted via the left carotid artery. There was no postoperative thromboembolism, arteriovenous fistula, pseudoaneurysm or other vascular complications. Five children with PA-VSD who had successful operations were followed up at 6 months of age. They all had the operation for pulmonary atresia, repair of the ventricular septal defect, removal of arterial duct stents, and ligation of the arterial duct. All children survived without any stent displacement or stenosis and biventricular circulation was achieved during the follow-up. Conclusions: Ductus arteriosous stenting can be the first-stage treatment for children with PA-IVS and PA-VSD. In addition to the traditional femoral vein and femoral artery approach, the carotid artery can be used as a route for stent placement.

Inhibitory effect of astragalus membranaceus injection on apoptosis and autophagy induced by enterovirus 71 / 中国生物制品学杂志

@#Objective To investigate the effect of astragalus membranaceus（AM）injection on apoptosis and autophagy of human gastric epithelial cell line（GES⁃1）induced by enterovirus 71（EV71）. Methods GES⁃1 cells were cultured in vitro and divided into infected group（EV71 infected at a MOI of 3 and control group（no virus infected）. The morpho⁃logical changes of EV71 infected cells were observed by inverted microscope. The level of VP1 in GES⁃1 cells infected with EV71 was detected by Western blot；CCK⁃8 assay was used to detect the viability of GES⁃1 cells infected with EV71；Nuclear staining with DAPI was used to observe the morphological changes of nuclear apoptosis infected with EV71. GES⁃1 cells were divided into control group（without virus infection），infection group and AM intervention group with final concentration of 1，2. 5，5 and 10 μg／mL，respectively. Western blot was used to detect the effect of AM intervention on the expression of apoptosis⁃related proteins Caspase⁃3，PARP and autophagy⁃related proteins LC3 and P62 in GES⁃1 cells infected withEV71. CCK⁃8 method was used to detect the effect of AM intervention on the viability of GES⁃1 cells infected with EV71. Results GES⁃1 cells were round，shrunken with nuclear pyknosis and uneven size；VP1 level increased（t = 41. 56，P < 0. 01），cell viability decreased（t = 19. 07，P < 0. 01），Caspase⁃3 and PARP proteins were cut off（t = 35. 29 and 3. 648， P < 0. 01 and 0. 021 8，respectively），LC3Ⅱ／LC3Ⅰ ratio increased（t = 10. 16，P = 0. 000 5）and P62 protein was degraded（t = 68. 68，P < 0. 01）；AM inhibited the degradation of Caspase⁃3，PARP and P62 proteins induced by EV71 （t = 52. 66，59. 60 and 40. 22，respectively，each P < 0. 01）and increased the ratio of LC3Ⅱ／LC3Ⅰ（t = 5. 521，P = 0. 005 3），andreducedtheinhibitoryeffectofEV71ontheviabilityofGES⁃1cells（t =4. 420，P =0. 0115）. Conclusion EV71 infection induced apoptosis of GES⁃ 1 cells and AM intervention inhibited EV71 induced apoptosis by inhibiting EV71 induced autophagy.

Progress in the pathogenesis of congenital bicuspid aortic valves and the associated complications / 国际儿科学杂志

Congenital bicuspid aortic valves(BAV)is one of the most common congenital heart diseases.It is generally diagnosed by echocardiography when deterioration of the abnormal leaflets becomes clinically evident.Patients with BAV are at increased risks of developing serious complications, including aortic stenosis, aortic regurgitation, aortic dilation, aortic dissection and/or aneurysm, which seriously threatens the health of patients.Although its diagnosis and surgical treatment have been clear, the specific pathogenesis has not been completely revealed.Recently, studies have found that gene mutations and related signaling pathway abnormalities are associated with BAV and its complications.And epigenetics and environmental factors are involved in the development and progress of BAV.Understanding the underlying cellular and molecular basis of normal and pathological aortic valve development may improve the preventative and therapeutic approaches to valve degeneration.

Application value of magnetic resonance hydrography of the inner ear in cochlear implantation

SUMMARY OBJECTIVE This study aims to investigate the application value of magnetic resonance (MR) hydrography of the inner ear in cochlear implantation. METHODS 146 patients were enrolled. MR hydrography and spiral CT examinations for the intracranial auditory canal were performed before surgery, and all imaging results were statistically analyzed in order to explore the application value of MR hydrography of the inner ear in cochlear implantation. RESULTS 146 patients (292 ears) were examined. Among these patients, 13 were diagnosed with abnormal vestibular aqueducts (20 ears) by MR hydrography, while five were diagnosed with this disease by CT; 15 patients were diagnosed with inner ear malformation (19 ears) by MR hydrography, while 11 were diagnosed by CT (four were misdiagnosed); five patients were diagnosed with internal acoustic canal stenosis (eight ears) by MR hydrography, while two were diagnosed by CT (three were misdiagnosed); and four patients were diagnosed with cochlear fibrosis (five ears) by MR hydrography, while four were diagnosed by CT (four ears). The correct rate of diagnosis was 77.40% (113/146) based on CT, while the rate was 93.84% (137/146) based on MR hydrography. CONCLUSIONS MR hydrography imaging technique can be applied to the preoperative evaluation of cochlear implantation, providing accurate and reliable anatomic information on the inner membranous labyrinth and nerves in the internal acoustic canal and an accurate basis for the diagnosis of cochlear fibrosis and nerve development. This has a guiding significance for the selection of treatment schemes.

RESUMO OBJETIVO Este estudo visa investigar o valor da aplicação da hidrografia por ressonância magnética (RM) do ouvido interno no implante coclear. MÉTODOS Cento e quarenta e seis pacientes foram inscritos. Os exames da hidrografia por RM e do CT espiral para o canal auditivo intracraniano foram executados antes da cirurgia, e todos os resultados da imagem foram analisados estatisticamente, a fim de explorar o valor da aplicação da hidrografia por RM do ouvido interno no implante coclear. RESULTADOS Centro e quarenta e seis pacientes (292 ouvidos) foram examinados. Dentre esses pacientes, 13 foram diagnosticados com aquedutos vestibulares anormais (20 ouvidos) pela hidrografia por RM, enquanto cinco pacientes foram diagnosticados com esta doença pelo CT; 15 pacientes foram diagnosticados com malformação do ouvido interno (19 ouvidos) pela hidrografia por RM, enquanto 11 pacientes foram diagnosticados por CT (quatro foram diagnosticados erroneamente); cinco pacientes foram diagnosticados com estenose de canal acústico interno (oito ouvidos) pela hidrografia por RM, enquanto dois pacientes foram diagnosticados por CT (três foram diagnosticados erroneamente); e quatro pacientes foram diagnosticados com fibrose coclear (cinco ouvidos) pela hidrografia por RM, enquanto quatro foram diagnosticados por CT (quatro ouvidos). A taxa correta de diagnóstico foi de 77,40% (113/146) com base no CT, enquanto a taxa foi de 93,84% (137/146) com base na hidrografia por RM. CONCLUSÕES A técnica de imagem da hidrografia por RM pode ser aplicada à avaliação pré-operatória do implante coclear, que pode fornecer informações anatômicas precisas e confiáveis sobre o labirinto membranoso interno e os nervos no canal acústico interno, além de uma base exata para o diagnóstico da fibrose coclear e do desenvolvimento do nervo. Isso tem um significado orientador para a seleção de esquemas de tratamento.

Physical Therapy Development in Taiwan, China / 中国康复理论与实践

The development of physical therapy, as well as the education and certification for physiotherapist, and human resources, practice, and future development in Taiwan were introduced.

Efficacy of transcatheter pulmonary valve perforation by micro-guidewire and balloon dilation in neonates with pulmonary atresia with intact ventricular septum / 中华儿科杂志

Objective@#To investigate the safety and efficacy of transcatheter perforation of pulmonary valve by micro-guidewire and balloon dilation in the treatment of neonatal pulmonary atresia with intact ventricular septum (PA-IVS).@*Methods@#The retrospective study included 21 neonates (14 males and 7 females) with PA-IVS who underwent transcatheter micro-guidewire pulmonary valve perforation and balloon dilation in Xinhua Hospital from January 2012 to December 2018. All patients underwent the pulmonary valve perforation by micro-guidewire through the Simmons catheter. During the follow-up period at 1, 3, 6, 12 months postoperatively and annually thereafter, the operative efficacy and the development of the right ventricle (RV) were evaluated by echocardiography. Statistical analyses were performed using t test.@*Results@#A total of 21 neonates with PA-IVS were enrolled, and 13 cases were diagnosed prenatally. The median age of surgery was 6 days, the weight was (3.2±0.5) kg. The balloon/valve ratio was 1.19±0.12, and the RV pressure measured by catheter was (121±33) mmHg (1 mmHg=0.133 kPa) . The immediate postoperative RV pressure was (47±13) mmHg. The median follow-up time was 30 months. All the cases enrolled achieved biventricular circulation without death and serious complications. According to the last follow-up data including 16 cases who were followed up for 1 year or longer, the pulmonary artery transvalvular pressure was (29±15) mmHg. The postoperation ratio of right to left ventricular transverse diameter was significantly higher than that before operation (0.86+0.10 vs. 0.73+0.13, t=-2.96, P=0.006). Compared with preoperative data, the postoperation pulmonary valvular diameter Z-score was significantly higher (-1.41±0.89 vs. -2.83±1.06, t=-3.65, P=0.001) and the tricuspid valvular diameter Z-score was significantly higher (-0.52±0.29 vs. -1.34±0.81, t=-3.55, P=0.001).@*Conclusion@#Transcatheter perforation of pulmonary valve by micro-guidewire and balloon dilation is a safe and effective initial therapy for neonatal PA-IVS.

Risk factors of postoperative acute pulmonary reperfusion injury in neonatal severe pulmonary stenosis or pulmonary atresia / 中国新生儿科杂志

Objective To study the clinical features and risk factors of acute pulmonary reperfusion injury after operation in neonates with severe pulmonary stenosis or pulmonary atresia.Method From February 2014 to February 2018,a retrospective analysis was performed in patients with critical pulmonary stenosis or pulmonary atresia who received percutaneous balloon pulmonary valvuloplasty (PBPV) in the neonatal intensive care unit of our hospital.Clinical characteristics,perioperative cardiac structure,hemodynamic data and biochemical results were collected.The neonates were assigned into injury group if they had acute lung reperfusion injury,and non-injury group if not.The risk factors of acute lung reperfusion injury were analyzed using multi-variate Logistic regression model.Result A total of 32 patients (24 prenatal diagnosis and 8 postnatal diagnosis) with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum were enrolled.The main manifestations were dyspnea and cyanosis.Intravenous prostaglandin E was administered to keep the ductus arteriosus open.The age of operation ranged from 1 to 52 days and the median age was 7.5 days.Postoperative acute lung reperfusion injury occurred in 7 cases (21.9％).Preoperative and intraoperative pulmonary valve annulus diameter,balloon diameter,preoperative hemoglobin,hematocrit and blood albumin were significantly lower in the injury group.The operation duration,total length of hospital stay and postoperative duration were longer than in the non-injury group,the differences were statistically significant (P ＜ 0.05).Multi-variate Logistic regression analysis showed that the diameter of pulmonary valve annulus (OR =5.814,95％CI 1.106 ～30.568),preoperative blood albumin (OR =1.361,95％ CI 1.063 ～ 1.742),and hematocrit (OR =1.173,95％ CI 1.010 ～ 1.363) were risk factors of acute lung reperfusion injury,with statistically significant differences (P ＜ 0.05).Conclusion Acute lung reperfusion injury is one of the common complications after the operation of severe pulmonary stenosis or pulmonary atresia.The severity of pulmonary valve annulus stenosis,preoperative hematocrit and blood albumin level may be the risk factors of postoperative acute lung reperfusion injury.

Evaluation of effect of aortic arch anomalies on fetal cardiac function with the technology of spatio - temporal image correlation / 中华实用儿科临床杂志

Objective To evaluate the cardiac function of fetuses with aortic arch anomalies using spatio -temporal image correlation (STIC). Methods Thirty - two fetuses with aortic arch anomalies in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2015 to October 2016,were included. These fetuses were divided into 2 groups according to hemodynamics:obstructive lesion group(17 cases)and non - obstructive lesion group(15 cases). Comparative analysis of cardiac function of these fetuses was conducted in light of gestational age - matched normal fetuses separately using fetal echocardiography and STIC. The indexes were obtained,which in-cluded diameter of great arteries,left ventricular end diastolic dimension(LVDD),right ventricular end diastolic dimen-sion(RVDD),right ventricular end systolic transverse diameter(RVDS),left ventricular end systolic transverse diame-ter(LVDS),fractional shortening (FS),left ventricular end - diastolic volume(LVEDV),right ventricular end - dias-tolic volume (RVEDV),left ventricular end - systolic volume (LVESV),right ventricular end - systolic volume (RVESV),stroke volume(SV)and ejection fraction(EF)were obtained. Comparison was made between the groups. Results Cardiac function of fetuses with aortic arch anomalies was within normal range,however,FS and EF were lower in these fetuses than those of normal ones,specifically,the development of aorta was worse in fetuses with obstruc-tive lesions (all P < 0. 05). In these fetuses,RVEDV was larger than that of normal fetuses. EDV and SV were larger in the right ventricle(RV)than those of the left ventricle(LV)[RVEDV vs. LVEDV:(1. 681 ± 0. 725)mL vs. (1. 181 ± 0. 565)mL,SV of RV vs. SV of LV:(1. 020 ± 0. 436)mL vs. (0. 643 ± 0. 299)mL],and the differences were all sta-tistically significant(t = - 2. 246,P = 0. 032;t = - 2. 939,P = 0. 006);and EF was higher in RV[EF of RV vs. EF of LV:(61 ± 5)％ vs. (54 ± 5)％],and the difference was statistically significant(t = - 3. 708,P = 0. 001). Meanwhile, aorta and pulmonary artery were both smaller in fetuses with non - obstructive lesions than those of normal fetuses,and the differences were all statistically significant(all P < 0. 05). There were no significant differences between these fetu-ses and normal fetuses in LVDD,LVDS,RVDD,RVDS or RVDD/ LVDD,and there was no significant difference be-tween LV and RV in volumic indices (all P > 0. 05). Conclusions Small aorta and ventricular disproportion may appear in fetuses with aortic arch obstruction. Though ventricular systolic function is within normal range,FS and EF are lower in aortic arch anomaly fetuses than those in normal fetuses. Aortic arch anomalies may have influence on fetal car-diac function.

Analysis of variants located in 3'UTR regions of NOTCH1 and JAG1 genes for children with conotruncal heart defects / 上海交通大学学报（医学版）

Objective · To explore the correlation between variants located in 3' untranslated regions (3'UTR) of NOTCH1 and JAG1 genes and conotruncal heart defects (CTD). Methods · Six hundred CTD children without 22q11 deletion and three hundred healthy children were enrolled in this hospital-based case-control study. Variants located in the 3'UTR regions of NOTCH1 and JAG1 genes were detected by high-throughput sequencing. The accuracy of the variants were verified by PCR and Sanger sequencing. Online software PicTar, TargetScan and microRNA.org were used to make functional predictions. Results · One mutation and three SNPs were found in the 3'UTR of NOTCH1. Three mutations and six SNPs were found in the 3'UTR of JAG1. The genotypic distributions of two SNPs (rs3840074 and rs8708) located in JAG13'UTR between CTD group and the controls were statistically significant (both P<0.05). Results of prediction showed that all the four mutations and two meaningful SNPs could bind to microRNA. Conclusion · The variants located in 3'UTR regions of NOTCH1 and JAG1 genes may be related to the occurrence of CTD.

TIPS versus Endoscopic Therapy for Variceal Rebleeding in Cirrhosis:A Meta-analysis Update / 华中科技大学学报（医学）（英德文版）

Endoscopic therapy (ET) is most common method for preventing variceal bleeding in cirrhosis,but the outcomes are not perfect.Recently,transjugular intrahepatic portosystemic shunt (TIPS) is introduced into clinical practice.However,the beneficial effects of TIPS compared to ET on cirrhotic patients is unknown.The aim of this study was to evaluate and compare the effects of TIPS with those of the most frequently used ET for prevention of variceal rebleeding (VRB) in liver cirrhosis.The PubMed,EMBASE,and Cochrane Library databases were searched from inception to February 2017.The primary study outcomes included the incidence of VRB,all-cause mortality,bleeding-related death,and the incidence of post-treatment hepatic encephalopathy (PTE).The odds ratios (ORs) with 95％ confidence intervals (CI) were pooled for dichotomous variables.Subgroup analyses were performed.Twenty-four studies were eligible and they included 1120 subjects treated with TIPS and 1065 subjects treated with ET.Although there was no significant difference in survival and PTE,TIPS was superior to ET in decreasing the incidence of VRB (OR=0.27;95％ CI,0.19-0.39,P＜0.00001),and decreasing the incidence of bleeding-related death (OR=0.21;95％ CI,0.13-0.32,P＜0.00001).Subgroup analysis found a lower mortality (OR=0.48;95％ CI,0.23-0.97;P=0.04) without any increased incidence of PTE (OR=1.37;95％ CI,0.75-2.50;P=0.31) in the studies of a greater proportion (≥40％) of patients with Child-Pugh class C cirrhosis receiving TIPS,and TIPS with covered stent did not increase the risk of PTE compared to ET (OR=1.52,95％ CI =0.82-2.80,P=0.18).It was concluded that TIPS with covered stent might be considered the preferred choice of therapy in patients with severe liver disease for secondary prophylaxis.

The correlation between mutations in the promoter region of TBX 1 gene and conotruncal heart defects / 临床儿科杂志

Objective To explore the correlation between mutations in the promoter region of TBX1 gene and conotruncal heart defects. Methods A total of 621 children with conotruncal heart defects were recruited. Multiplex ligation-dependent probe ampliifcation (MLPA) was used to detect the copy numbers of chromosomal region 22 q 11 . 2 . Children with 22 q 11 . 2 deletion were excluded. Polymerase chain reaction ampliifcation (PCR) and gene sequencing were applied to analyze promoter region of TBX 1 (-2000 ..+1 ) in 605 children with conotruncal heart defects without 22 q 11 . 2 deletion and 588 healthy children. Bioinformatics software was used to predict and analyze the function of the variable loci. Results There were mutations in the promoter region of TBX 1 gene in children with conotruncal heart defects, including 3 single nucleotide polymorphisms (SNP) sites and 7 rare loci. The incidence of mutation was 1 . 7%. The analysis of 7 rare loci by AliBaba 2 . 1 to showed that 3 of them may inlfuence the combination of trans-acting factors and cis-acting elements of the promoter of TBX 1 gene. Conclusion The mutation in the TBX 1 promoter region may be related to the occurrence of conotruncal heart defects.

The impact of prenatal diagnosis on treatment and prognosis of neonatal pulmonary atresia with intact ventricular ;septum and critical pulmonary stenosis with intact ventricular septum / 临床儿科杂志

Objective To explore the impact of prenatal diagnosis on the early treatment and short and medium term outcome of neonatal pulmonary atresia with intact ventricle septum (PA/IVS) or critical pulmonary stenosis with intact ventricle septum (CPS/IVS). Methods According to the case-control method, twenty-eight neonates with (PA/IVS) or (CPS/IVS) who had percutaneous pulmonary balloon valvuloplasty (PBPV) surgery indications, were divided into the prenatal diagnosis group (n?=?15) and the postnatal diagnosis group (n?=?13). The prenatal diagnosis group was diagnosed in fetal period and the intervention program was since developed . The postnatal diagnosis group was referred from other hospitals, and the intervention program was developed after conifrmation of the diagnosis. All the neonates accepted the PBPV surgery after the hemodynamic parameters stable. All neonates were followed-up at 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. Clinical situations, echocardiography results, and interventional cardiology measurements were compared between two groups. Result The average age and weigh was 7.53?±?3.18 days and 3102.32?±?708.40 g respectively at the time of PBPV surgery in 28 neonates. Among them, 9 neonates were PA/IVS and 19 neonates were CPS/IVS. The mean follow-up time was 18.8?±?5.22 months and there were no death. The ages at admission and at the ifrst treatment were signiifcantly younger in the prenatal diagnosis group than those in the postnatal diagnosis group (P??0.05). Conclusion Prenatal diagnosis is helpful for the early intervention in neonates with PA/IVS and CPS/IVS, and can reduce the complications after surgery.

Comparison of echocardiographic parameters in healthy Chinese children born and living at high altitude or at sea-level / 中华心血管病杂志

<p><b>OBJECTIVE</b>Chronic hypoxia at high altitude might result in cardiopulmonary adaptations including pulmonary arterial hypertension and cardiac remodeling. But little is known about the adaptive changes in healthy children born and living at high altitude. We compared the echocardiographic measurements between the healthy children living at 16 m (Shanghai, n = 220) and 3 700 m (Qinghai, total 257, Han children 117, Tibetan children 140).</p><p><b>METHODS</b>Children's age ranged from 15 d to 14 years. Echocardiography measurements were performed, values of the left and right ventricular dimensions and wall thickness, systolic and diastolic function including cardiac output index (CI), as well as mean pulmonary arterial pressure (mPAP) were obtained.</p><p><b>RESULTS</b>mPAP and right heart dimension, CI, right ventricular anterior wall thickness were significantly higher while ventricular systolic and diastolic function were significantly lower in 3 700 m group than in 16 m group (all P < 0.05). Left ventricular dimension was similar between the two groups. There were no differences on above measured parameters between the Han and Tibetan children from 3 700 m group (all P > 0.05).</p><p><b>CONCLUSIONS</b>Children born and living at high altitude in China have significantly higher mPAP, dilated right heart and lower systolic and diastolic function of both ventricles and higher CI compared to children born and living at see-level. Above parameters were similar between the Han and the Tibetan childen born and living at high altitude. Present study provides reference values for the healthy children living at high altitude.</p>

Massive and painful ascites as a presenting manifestation of systemic lupus erythematosus flare: a case report and literature review / Ascitis dolorosa y masiva como forma de presentación de una reactivación lúpica: Presentación de un caso

Lupus peritonitis (LP) is extremely rare. Acute LP is characterized by rapid onset of ascites and severe abdominal pain, in addition to other well-recognized clinical features of a general systemic lupus erythematosus (SLE) fare. Ascites associated with acute LP has been rarely reported as the prominent feature of a SLE fare. We report a 39-year-old woman who developed massive, painful ascites as the presenting manifestation of a SLE fare. Diagnostic workup ruled out the possibility of hepatic, cardiovascular, infectious, or malignant diseases, and confirmed the presence of a SLE fare. The patient was treated with methyl prednisolone and hydroxychloroquine resulting in dramatic improvement of her condition. During ambulatory follow up, she has remained asymptomatic up to the moment of this writing. Adrenal steroids and hydrocychloroquine may be useful for the management of SLE fares in patients with massive, painful ascites due to acute LP.

La peritonitis lúpica es rara. El cuadro agudo se caracteriza por ascitis de comienzo rápido, dolor abdominal severo y otras manifestaciones de una recidiva de un lupus eritematoso sistémico (LES). Sólo ocasionalmente e ha informado que la ascitis y peritonitis lúpica sean las principales manifestaciones de una recidiva lúpica. Presentamos a una mujer de 39 años que presentó ascitis masiva y dolorosa como la primera manifestación de una reactivación lúpica. El estudio diagnóstico descartó problemas hepáticos, pulmonares, cardiacos, cáncer o infecciones y confirmó la reactivación lúpica. La paciente se trató con metilprednisolona y cloroquina, resultando en una mejoría dramática. Al momento de preparar este informe, la paciente permanece asintomática en control ambulatorio. Los corticoides y cloroquina pueden ser medicamentos útiles para el tratamiento de pacientes con ascitis dolorosa y masiva secundaria a peritonitis lúpica.

Linking Concept of Functional Evaluation for Children with Congenital Heart Disease with ICF-CY / 中国康复理论与实践

@#Objective To determine the concept of functional evaluation for children with congenital heart disease in the views of International Classification of Functioning, Disability and Health (Children and Youth Version) (ICF-CY). Methods Clinical researches on children and adolescents with congenital heart disease nearly a decade were recalled from MEDLINE/PubMed and EMBASE. The concepts extracted were linked with ICF-CY. Results 224 researches were recalled. The oncepts linked with ICF-CY in 12 first categories, 28 second categories, of which 17 items were of body function, 2 of body structure, 6 of activities and participation, and 3 of environmental factors.Conclusion ICF-CY is a useful framework for functional assessment for children with congenital heart disease. It is important to make the measurement uniformity for comparability of the researches.

Clinical value of echocardiography in diagnosing infective endocarditis in children / 中华医学超声杂志（电子版）

Objective To evaluate the value of echocardiography in diagnosing infective endocarditis (IE) in children. Methods The shape, size, echogenicity, distribution of vegetations and valvular function of the heart were observed by transthoracic echocardiography (TTE) in 30 patients with suspected IE. We correlated TTE ifndings with the results of hemoculture and serologic test. Results Vegetations were observed in all patients by echocardiography:seven patients with tricuspid valve vegetations, two with mitral valve vegetations, three with pulmonary valve vegetations, three with main pulmonary artery vegetations, three with aortic valve vegetations, two with aortic valve abscess, and two with vegetations in right atrium. After anti-infection therapy, the size of vegetations in iffteen patients became smaller and the less echogenic than before. Vegetations disappeared in two patients. Vegetation was recurrent repeatedly in one case. Ten patients recovered after operation. Two severe cases died. Five patients underwent TTE again one week after the previous negative TTE. Of them, echocardiography demonstrated vegetations in three cases. However, no vegetations were found in rest two cases because antibiotics had been used at early stage. In addition, echocardiography demonstrated one patient with mitral valve vegetation. But the lesion was ifnally conifrmed to be operating suture. The sensitivity and specificity of TTE in detecting vegetations were 88.0% and 80.0%, respectively. Blood cultures were positive in twenty-seven cases and were negative in three cases. Conclusions The early diagnosis of IE is important to improve patient′s prognosis. It takes a long time in organism cultivation before achieving the clinical diagnosis. TTE can help obtain an early diagnosis stage of IE, and provide the assessment of size and location of vegetation. It plays an important role in treatment and prognosis prediction.

Postoperative follow up of patients with complete atrioventricular septal defect / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the operative efficacy of patients with complete atrioventricular septal defect (CAVSD).</p><p><b>METHODS</b>From January 2003 to June 2006, CAVSD patients underwent operative closure were included in this study. Color Doppler with apical four-chamber view was used to evaluate the degree of valve insufficiency before surgery and 2 days, 1 month, 6 months and 1 year after the surgery. Cardiac catheterization was performed to evaluate pulmonary artery pressure and pulmonary arteriolar resistance (PAR) before surgery in patients whose age were over 6 months. The time of staying at ICU, ventilation time after surgery and the occurrence of pulmonary artery hypertension crisis were recorded.</p><p><b>RESULTS</b>105 CAVSD patients underwent operative closure were enrolled in this study. The mean staying time at ICU was (4.7 +/- 2.4) days, and the mean ventilation time was (1.7 +/- 1.0)days, 9 patients (8.5%) developed pulmonary artery hypertension crisis after surgery. Patients with PAR > 8 Wood unit were older, staying time at ICU and ventilation time were longer compared patients with PAR < 8 Wood unit (all P < 0.05). The incidence of pulmonary artery hypertension crisis after surgery was also significantly higher in patients with PAR > 8 Wood unit compared patients with PAR < 8 Wood unit (P < 0.05). Hospital mortality was 3.8% (4/105). Three out of 4 hospital-dead patients had severe hypoplasia of the atrioventricular valve. Compared with preoperative, degree of valve insufficiency in both sides were relieved after surgery (P < 0.05). The valve insufficiency remained unchanged in 81 patients (77.1%), worsened in 14 patients (13.3%) and improved in 10 patients (9.6%) after surgery.</p><p><b>CONCLUSIONS</b>Our results suggested that early surgical repair for CAVSD was safe and beneficial. Preoperative PAR > 8 Wood unit was associated with increased risk of pulmonary artery hypertension crisis after surgery in patients with CAVSD.</p>

Evaluation of the structure of tricuspid valve with three dimensional echocardiography in hypoplastic right ventricle / 中华超声影像学杂志

Objective To reveal the character of tricuspid valve in hypoplastic right ventricular heart syndrome (HPRVHS) using 3-dimensional echocardiography(3DE). Methods Twenty eight patients with HPRVHS were included in the study, and they were divided into two groups according the degree of tricuspid regurgitation. Eighteen normal children were included as the control. Volume of right ventricle(VRV), area of tricuspid annulus(TVA),proportion of the leaflets and the distance from tips of leaflets to the nearest papillary muscle were measured with 3DE. These data was standardized by body surface area. Results The volume of right ventricle in HPRVHS was significantly less than that in normal group. The area of tricuspid annulus was significantly correlated with volume of right ventricle(r = 0. 90, P < 0. 0001). In the tricuspid regurgitation group, the proportion of area of anterior leaflet to area of tricuspid annulus was significantly higher than non-regurgitation group and normal group(P <0. 0001). Respectively,the proportion of the area of posterior leaflet to the area of tricuspid annulus in regurgitation group was significantly less than normal and non-regurgitation group. The distance from tips of leaflets was significantly shorter in HPRVHS than in normal group. Furthermore, the distance from the tip of septal leaflet to the nearest papillary muscle was shorter in regurgitation group than non-regurgitation group ( P = 0. 0023). Conclusions 3DE could be applied for evaluating the pathologic change of tricuspid valve in congenital heart disease. In HPRVHS, hypoplastic of posterior leaflet and shortness of the cords of septal leaflet could be the cause of tricuspid regurgitation.

Study on the noninvasive estimation of pulmonary vascular resistance by color M-mode echocardiography assisted with computer / 中华超声影像学杂志

Objective To determine the feasibility and accuracy of velocity propagation within main pulmonary artery(VP)from color M-mode Doppler imaging using custom software on a personal computer for noninvasive estimation of PVR.Methods Color M-mode imaging of pulmonary flow was obtained and then transferred to computer,the velocity propagation of pulmonary flow was automatically obtained.Comparative studies among Doppler echocardiography,personal computer and cardiac catheterization for predicting PVR had been done in 20 children with congenital heart disease and 20 normal children.Results Velocity propagations of children with congenital heart disease were significant lower than those of normal children obtained by color Mmode echocardiography[(38.38±18.89)cm/s VS(80.34±15.65)cms,P＜0.01),and correlated well with invasive PVR measurements(r=-0.69,P＜0.01).The correlation and repeatability of VP obtained by the custom software were better than VP obtained by Doppler echocardiography(r=-0.78,P＜0.01).A VP cutoff value obtained by the custom software of 35.910 had a sensitivity of 92.9% and a specificity of 100% to within pulmonary artery obtained by color M-mode echocardiography using custom software on a personal computer.

Survey of studies on adjuvant diagnostic method of stimulating auricular points at home and abroad / 中国针灸

The auricular (including auricular acupoints) adjuvant diagnostic method, besides inspection (including dyeing method), palpation (including thermometric method), tenderness method (including impressing method) and electrical detection, includes the adjuvant diagnostic method of stimulating auricular points as well, it has been mostly studied and used by specialists of western medicine or doctors of integrated Chinese and western medicine. But it hasn't been introduced in the published Chinese monographs of auricular acupuncture yet. This article briefly introduces the adjuvant diagnostic method of stimulating auricular points combined with X-ray radiography; application in fetal heart electronic monitoring and fetal biophysical monitoring; and diagnostic methods of auricle reflex, vascular autonomous signals, and auricle and somatic 7 frequency response regions, which began to be researched abroad 35 years ago. The authors hope it will give some invigoration or illumination to my colleagues in acupuncture, especially those who are interested in auricular acupuncture.