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Orthostatic intolerance (OI) is the most common type of autonomic mediated syncope in children.Children with OI tend to show intolerance to the postural changes and long-term standing, thus often presenting with such clinical symptoms as dizziness, headache, blackness, and even sudden fainting.Although there is no organic lesion from OI, it can still exert serious impacts on the mental health of children.Therefore, it is of great significance to provide active and effective treatment for children with OI.There is some understanding of OI, but it is still unclear about its pathogenesis, which is believed to be related to dysautonomia and abnormal neurohumoral regulation.In this paper, the focus would be placed on the changes of renin-angiotensin-aldosterone system (RAAS) in neurohumoral regulation and their significance, and an exploration would be performed on the impacts of related treatment on RAAS in children with OI.
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Objective:To investigate the relationship between orthostatic intolerance (OI) and body mass index (BMI), blood lipid and serum protein levels in children and adolescents.Methods:A total of 122 children and adolescents aged from 6 to 17 years old, who were diagnosed with OI at the Department of Pediatric Cardiology, the Second Hospital of Lanzhou University from April 2018 to April 2019, were selected as the subjects.While, 56 children and adolescents in the health management center were selected as the healthy control group during the same period.Subjects were divided into syncope group and non-syncope group according to whether there was syncope in clinical history.The height and body mass of all children were measured, and venous blood were taken to detect blood lipids and serum protein in the morning.Date analysis were conducted with SPSS 22.0 software.Results:(1) The level of triglyceride in the OI group was lower than that in the healthy control group[(0.98±0.45) mmol/L vs. (1.28±1.04) mmol/L], and there was statistically significant( t=2.025, P<0.05); the BMI were respectively (17.56±3.23) kg/m 2 and (16.46±2.58) kg/m 2 in syncope group and non-syncope group, whose result indicated that the BMI in syncope group was higher than that in non-syncope group( t=2.085, P<0.05). (2) The results of binary Logistic regression analysis showed that the triglyceride level was an independent risk factor for OI( OR=0.504, 95% CI: 0.272-0.931, P<0.05). (3) The receiver operating characteristic curve evaluated the predictive value of triacylgly-cerol to OI.Results showed the sensitivity and specificity of OI were respectively 72.1% and 48.2%when the triacylglycerol was 1.09 mmol/L. Conclusions:Low triglyceride level and high BMI may be susceptible factors to OI in children and adolescents.Therefore, the diet of children with OI should be highly valued by clinicians and parents.
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Orthostatic intolerance(OI)is the most common type of neurally mediated syncope in children. At present,the pathogenesis of OI in children is not yet clear,but in recent years,studies have found that the deficiency or lack of calcium,vitamin D are correlated with OI. Calcium ion is a second messenger that participates in the process of intercelluar communication. It has a wide range of biological effects in many tissues and cells in the body. Calcium ion plays an important role in children′s OI and other cardiovascular diseases. Calcium,vitamin D deficiency or abnormality of channel protein kinase may influence the occurrence and outcome of OI by influencing the activation of cardiac mus-cle cells,vascular endothelial cells and platelet. In this paper,the relationship between calcium,vitamin D and OI and its possible mechanism of action are discussed.
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Objective To investigate clinical features and risk factors for recurrent syncope in children with orthostatic intolerance.Methods Patients with orthostatic intolerance and syncope admitted in the Second Hospital of Lanzhou University from January 2014 to June 2015 were retrospectively analyzed by using t test,Chi -square test,and Fisher′s exact probability method.According to frequency of syncope,all cases were divided into 2 groups,the occasio-nal syncope group and the recurrent syncope group.All risk factors including age,gender,body mass index(BMI),in-ducement,the history of motion sickness,family history,syncope -related injuries,performance of head -up tilt table test,and outcomes of head -up tilt table test were studied statistically and compared within 2 different groups.Results A total of 83 cases were enrolled in this study.Among these children,33 cases(39.76%)were assigned as occasio-nal syncope group,in which 17 cases were male and 16 cases were female and the age ranged from 6 to 18 years with the average age of (9.70 ±2.87)years;50 cases(60.24%)were assigned as recurrent syncope group,in which 27 ca-ses were male and 23 cases were female and the age ranged from 6 to 18 years with the average age of (11.24 ±2.83) years.Of all the investigated risk factors,the BMI and the history of motion sickness were significantly different between 2 groups[(18.84 ±3.49)kg/m2 vs (18.16 ±3.68)kg/m2 ,t =4.82,P =0.001;39.39%(13 /33 cases)vs 70.00%(35 /50 cases),χ2 =7.64,P =0.006].No significant difference was found in age distribution(6 -9 years,10 -14 years,15 -18 years)between 2 groups(P =0.428).There were no significant differences in gender (male /female), family history,or syncope -related injuries between 2 groups[17 /16 cases vs 27 /23 cases;3.03%(1 /33 cases)vs 10.00%(5 /50 cases);15.15%(5 /33 cases)vs 20.00%(10 /50 cases),all P >0.05].And no significant difference was found in inducement (prolonged standing,body posture change,emotional stress/emotional stimuli,muggy environ-ment,movement)between 2 groups [78.79% (23 /33 cases)vs 72.00% (36 /50 cases);9.09% (3 /33 cases)vs 14.00%(7 /50 cases);3.03%(1 /33 cases)vs 6.00%(3 /50 cases);12.12% (4 /33 cases)vs 10.00% (5 /50 cases);3.03%(1 /33 cases)and 12.00%(6 /50 cases),all P >0.05].And performances of head -up tilt table test (blurred vision/blacked out,nausea/vomiting,sweating,dizzy/headache,palpation,anhelation /chest tightness,hot, weak)between 2 groups showed no significant differences[18.18%(6 /33 cases)vs 12.00%(6 /50 cases);36.36%(12 /33 cases)vs 50.00%(25 /50 cases);24.24%(8 /33 cases)vs 26.00%(13 /50 cases);51.52%(17 /33 cases) vs 58.00%(29 /50 cases);6.06%(2 /33 cases)vs 16.00%(8 /50 cases);27.27%(9 /33 cases)vs 22.00%(11 /33 cases);33.33%(11 /33 cases)vs 32.00%(16 /50 cases);12.12%(4 /33 cases)vs 16.00%(8 /50 cases),all P >0.05].Also there were no significant differences in outcomes of head -up tilt table test between 2 groups(P =0.589). Conclusions The risk factors for recurrent syncope in children with orthostatic intolerance were low BMI and the his-tory of motion sickness for such children,and more positive and effective clinical intervention can improve the living quality of children with orthostatic intolerance to some extent.
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Syncope is a common emergency condition,which can cause harmful danger to the physical and mental health,quality of living and learning of children.Even,syncope -related body traumatic injuries and anxiety and depression often occur in these children,and some have a high risk of sudden death.So,early diagnosis is of great sig-nificance.Head -up tilt table test is considered the gold standard for the diagnosis of syncope,it plays a significant role in diagnosis,differential diagnosis,treatment and evaluation of therapeutic effects.
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ObjectiveTo study the effect of high altitude (HA) of 4300 m on the hepatic gluconeogenesis in rats and its underlying mechanism. MethodsThirty-six healthy adult male Sprague-Dawley (SD) rats were randomly assigned to group H1 (HA exposure for 1 day, n=6), group H3 (HA exposure for 3 days, n=6), group H7 (HA exposure for 7 days, n=6), group H15 (HA exposure for 15 days, n=6), group H30 (HA exposure for 30 days, n=6), and group C (no HA exposure, n=6). After the treatment, the mRNA and protein levels of glucose-6-phosphatase (G6Pase), and forkhead box transcription factor O1 (FoxO1) in the hepatic tissues were determined by RT-PCR and Western blot, respectively. The content of hepatic glycogen was determined by spectrophotometry, and the blood glucose level was measured using an automatic biochemical analyzer. The one-way analysis of variance (ANOVA) was used to analyze the differences between groups, and the Tukey test was further used to compare the differences between two groups. ResultsCompared with those in group C, the levels of G6Pase and glycogen in the hepatic tissues of rats increased significantly in groups H1, H3, and H7 (P＜0.05), and the expression level of FoxO1 decreased significantly in groups H3, H7, H15, and H30 (P＜0.01). No significant differences in the concentration of blood glucose were observed between the HA-treated groups. ConclusionIncreased hepatic gluconeogenesis and glycogen synthesis in the early phase of HA exposure may be one of the important mechanisms of HA acclimatization. FoxO1 and AMPK are involved in the regulation of hepatic gluconeogenesis. The increased content of hepatic glycogen is associated with the decreased activity of AMPK.
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ObjectiveTo investigate the risk factors for syncope in children with orthostatic intolerance (OI).Methods The clinical data from 136 children with OI were retrospectively analyzed. The children were divided into syncope group and non-syncope group based on the existence of syncope. Results Among the 136 children, 77 children (56.62%) had syncope and 59 children (43.38%) did not have syncope. The differences in BMI, prevalence of inducement of prolonged standing, prevalence of accompanied symptoms of blurred vision/ blacking out, cold sweating and pallor, prevalence of the history of motion sickness and blood flow velocity of MCA were statistically significant between two groups (P<0.05). Conclusions Children with OI who has low BMI, inducement of prolonged standing, accompanied symptoms of blurred vision/ blacking out, cold sweating and pallor, the history of motion sickness, and fast blood flow velocity of MCA, are prone to syncope.
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ObjectiveTo assess the clinical features of noncompaction of ventricular myocardium (NVM) in children. Methods The clinical data from ifve children with NVM were analyzed, including clinical manifestations, ultrasonic cardio-gram(UCG), electrocardiogram, chest X-ray, the process of diagnosis and treatment, and follow up.Results In ifve patients (3 boys and 2 girls) aged 3 months to 12 years, four of them were hospitalized because of pneumonia with heart failure. None of the ifve patients had thromboembolism. Heart enlargement was observed in all ifve patients on chest X-ray. By 2D ultrasonography, 2 patients had cardiac apex involvement, and 3 patients showed involvement of left ventricular wall and interventricular septum. In one patient, congenital partial defect of the endocardial cushion was observed. All patients were followed up for 3 to 36 months. One patient died of heart failure, 3 patients survived, and one patient was lost to follow-up.Conclusions The common clinical manifestation of NVM is the heart failure. UCG is preferred for NVM diagnosis. In children with refractory pneumonia and heart failure, NVM should be suspected.
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<p><b>OBJECTIVE</b>To determine the relationship between the serum sulfur dioxide, homocysteine and the pulmonary arterial pressure in children with congenital heart defects who generated a pulmonary arterial hypertension syndrome (PAH-CHD), and analyze their role in the pathological process of the disease.</p><p><b>METHOD</b>This was a prospective cohort study, children with systemic pulmonary shunt CHD were selected. The patients were divided into three groups: the CHD with no PAH group:n = 20, 10 males, 10 females, 5 with ventricular septal defect (VSD), 8 with atrial septal defect (ASD) and 7 with patent ductus arteriosus (PDA), mean age (1.9 ± 1.8) years; the CHD with mild PAH group:n = 20, 10 males, 10 females, 12 with VSD, 6 with ASD, and 2 with PDA, mean age (1.0 ± 0.8) year; the CHD with moderate or severe PAH group:n = 20, 8 males, 12 females, 12 with VSD, 6 with ASD, and 1 with PDA, 1 with ASD+VSD, mean age (1.8 ± 1.6) year. Twenty healthy children were enrolled from outpatient department as the control group [included 8 males, 12 females, mean age (1.9 ± 1.5) years]. The homocysteine and SO2 concentrations in the serum samples were detected by a modified high performance liquid chromatographic method with fluorescence detection (HPLC-FD), then, multiple comparisons among the groups were performed with analysis of variance, and the pearson correlation.</p><p><b>RESULT</b>The serum homocysteine concentrations were respectively (11.0 ± 2.7) , (11.7 ± 2.5), (12.0 ± 2.1), (14.3 ± 3.2) µmol/L in the control group, CHD with no PAH group, CHD with mild PAH group, and CHD with moderate or severe PAH group. According to the multiple comparisons, the CHD with moderate or severe PAH group had the highest level (P all < 0.05) .While the comparison within the control group, CHD with none PAH group, and CHD with mild PAH group, the differences were not significant (P all > 0.05). The serum sulfur dioxide strength (concentrated as SO3(2-)) were respectively (10.6 ± 2.4), (8.9 ± 2.3), (7.3 ± 2.9), (4.3 ± 2.1) µmol/L in the control group, CHD with none PAH group, CHD with mild PAH group, and CHD with moderate or severe PAH group. CHD with moderate or severe PAH group had the highest level of serum sulfur dioxide (P < 0.05) . The pearson correlation analysis indicated that in the CHD children, the serum homocysteine were positively correlated with the pulmonary arterial pressure (r = 0.481, P < 0.01), while, the sulfur dioxide were negatively correlated with pulmonary arterial pressure (r = -0.553, P < 0.01).In all children, the serum homocysteine levels were negatively correlated with the sulfur dioxide (r = -0.231, P = 0.039).</p><p><b>CONCLUSION</b>The PAH-CHD children had higher homocysteine levels and lower sulfur dioxide levelsl, which demonstrated the disturbance of homocysteine-sulfur dioxide pathway in the sulfur containing amino acids metabolish in the disease. The homocysteine may become a biological marker which reflecting the severities of the PAH-CHD, while the sulfur dioxide can be a new target for the therapy of PAH-CHD.</p>
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Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Biomarcadores , Sangue , Estudos de Casos e Controles , Permeabilidade do Canal Arterial , Sangue , Hipertensão Pulmonar Primária Familiar , Sangue , Cardiopatias Congênitas , Sangue , Defeitos dos Septos Cardíacos , Sangue , Hemodinâmica , Homocisteína , Sangue , Dióxido de Enxofre , SangueRESUMO
Objective To investigate the risk factors for coronary artery lesions (CALs) in children with Kawasaki disease (KD) in Lanzhou. Methods One hundred and seventy-four children with diagnosed KD were divided into CAL group and non-CAL group based on the existence of concurrent CALs. The age, gender, fever duration, intravenous immunoglobulin (IVIG) start time, IVIG dose, C-reactive protein (CRP), serum albumin, erythrocyte sedimentation rate (ESR), platelet (PLT), red blood cell count (RBC), hemoglobin and so on were compared. Results Among the 174 children, 46 children (26.44%) were complicated by CALs and 128 children were not. The differences of average fever duration, IVIG starting time, IVIG dose, PLT, CRP, ESR and RBC were statistically signiifcant (P10 d, start of IVIG af-ter 10 days of fever, increase of PLT, CRP and ESR and decrease of RBC, clinicians should be alert to the risk of concurrent CAL.
