OBJECTIVE To analyze the distribution characteristics of warfarin drug-gene polymorphism in Han children from Beijing area. METHODS Data of nine warfarin drug-gene loci about VKORC1 rs9923231， CYP2C9 rs1799853*2 and rs1057910*3， CYP4F2 rs2108622， APOE rs429358 and rs7412， ABCB1 rs1045642， EPHX1 rs1051740 and rs2234922 were collected from dept. of cardiovascular medicine， Children’s Hospital Affiliated to Capital Institute of Pediatrics from March 2019 to March 2023， and the population data reported in domestic and foreign literature were compared. RESULTS In Beijing area， the frequency of APOE rs429358 mutant genotype was higher in males （19.8%） than in females （13.5%）（P＜0.05）. VKORC1 rs9923231 was dominated by homozygous mutant genotype （83.3%）， which was consistent with children in Japan （82.2%）， and higher than that of predominantly Caucasian children in the UK， Sweden， the United States， and Germany （10.4%-18.3%）（P＜ 0.05）； CYP2C9 was dominated by *1/*1 type （91.9%）， which was consistent with children in Japan （94.6%）， and higher than that of predominantly Caucasian children in the UK， Sweden， the United States， and Germany （66.1%-73.4%）（P＜0.05）. The frequency of EPHX1 rs1051740 mutant genotype was higher in adults （78.5%） than in children （63.5%）（P＜0.05）. CONCLUSIONS More mutations of VKORC1 rs9923231 and ABCB1 rs1045642 are found in Han children from Beijing area. The distribution of warfarin drug-gene polymorphisms in Han children from Beijing area is different among different genders， as well as compared with other countries， and Chinese Han adults. Therefore， caution should be exercised when using the reported data.

Objective    To explore the safety and effectiveness of different interventional approaches for the treatment of patent ductus arteriosus (PDA) in children. Methods    The children (≤7 years) who underwent interventional treatment for PDA from 2019 to 2020 in our hospital were retrospectively included. The patients were divided into 3 groups according to the procedures: a conventional arteriovenous approach group, a simple venous approach group, and a retrograde femoral artery approach group. The clinical efficacy of the patients was compared. Results     A total of 220 patients were included. There were 78 males and 142 females, with an average age of 3.21±1.73 years, weight of 14.99±5.35 kg, and height of 96.19±15.77 cm. The average diameter of the PDA was 3.35±1.34 mm. A total of 85 patients received a conventional arteriovenous approach, 104 patients received a simple venous approach, and 31 patients received a retrograde femoral artery approach. The diameter of PDA in the retrograde femoral artery group was smaller than that in the other two groups (3.44±1.43 mm vs. 1.99±0.55 mm; 3.69±1.17 mm vs. 1.99±0.55 mm, P<0.001); the contrast medium usage [40 (30, 50) mL vs. 20 (20, 30) mL; 35 (25, 50) mL vs. 20 (20, 30) mL, P≤0.001] and operation time [32 (26, 44) min vs. 25 (23, 30) min; 29 (25, 38) min vs. 25 (23, 30) min, P<0.05] in the simple venous approach group were significantly less or shorter than those in the other two groups; the length of hospital stay of the conventional arteriovenous group was longer than that in the other two groups [3 (3, 5) d vs. 4 (3, 6) d; 4 (3, 5) d vs. 4 (3, 6) d, P<0.05]. There was no significant difference in postoperative complications. Conclusion    It is safe and effective to close PDA through simple venous approach. The retrograde femoral artery approach has the advantage of simplifying the surgical procedure for PDA with small diameters.

Various of long-lasting and persistent bradyarrhythmia can induce cardiomyopathy.The pathogenesis of bradycardia-induced cardiomyopathy(BIC) is not clear,which is possibly related to significantly prolonged ventricular diastole,overloaded volume,changes of atrioventricular activation sequence,changes of atrioventricular sequence contraction,myocardial hypoperfusion,effect of neuroendocrine,etc.Diagnosis of disease includes a medical history of persistent bradycardia;relevant clinical symptoms (fatigue,dizziness,black Meng even syncope);the signs and symptoms of right or left heart failure in serious cases;electrocardiogram prompt bradycardia;echocardiography shows dilation of heart,less obvious reduction left ventricular ejection fraction (compensatory),but the left ventricle index can be decreased.Treatment is mainly to early identify the causes of bradycardia and remove it and pharmacotherapy,cardiac pacemaker therapy.Heart function can be back to normal after therapy(cardiac pacemaker).

Objective To determine if fetal stem cells can enter the maternal circulation during pregnancy and re-pair the injuries of maternal heart.Methods C57 female mice at the age of 6-8 weeks were randomly assigned to three groups:sham control, surgery without pregnancy, and surgery with pregnancy ( n=8,eath group) .The control sham group was developed by opening and closing of the chest.The other two groups underwent heart surgery.The myocardial infarc-tion ( MI) model was induced by ligation of the left anterior descending coronary artery.Half of the surgical mice mated with e-GFP transgenic male mice, and another half group was not.Electrocardiogram ( ECG) and echocardiographic images were recorded at pre-operation, post-operation and postpartum.The collected data were used to evaluate the heart function. The GFP expression was detected by immunohistochemistry and q-PCR.Results When compared with the sham group, both the ischemia surgery groups with and without pregnancy, the ECG ST segment was significantly increased.This meas-urement indicated that the myocardial ischemia surgery was successful, and no significant difference in the ST segments be-tween two ischemia surgery groups was found.However, when ECG was measured in the surgical mice after postpartum, their myocardial ischemia was dramatically improved when compared with that of the ischemia surgery only mice.Echocar-diographic images also indicated that both the surgery groups had myocardial ischemia, however, no significant difference was observed in the pregnant mice before and after postpartum.The order of the cardiac function indexes from high to low was the sham group, surgery with pregnancy group, and surgery with no pregnancy group;in particular, the cardiac func-tion of pregnancy group was significantly enhanced compared with that of the surgery with no pregnancy group (P<0.05). More importantly, both immunofluorescence and q-PCR results showed that the embryonic stem cell translocation through circulation system with GFP expression in the heart of pregnancy group, while negative in other two groups.Conclusions Embryonic stem cells can be transferred into the maternal circulation of pregnant mice, and play a role in the repairing of their cardiac injuries.

[ABSTRACT]OBJECTIVETo investigate the diagnosis, treatment method, key points of operation, and postoperative complications of high-risk esophageal foreign body.METHODSA retrospective analysis of 41 cases of high-risk esophageal foreign body from January 1996 to December 2014. After adequate preparation, the foreign body was removed via esophageal endoscope under general anesthesia.RESULTSThe foreign bodies in 41 patients were removed via esophageal endoscope once or twice. Two cases suffered postoperative subcutaneous emphysema, that may be a result of a small perforation in esophagus. Emphysema was disappeared by fast, rehydration and anti-infection for 6 to 8 days, and other serious complications did not occur.CONCLUSIONMost high-risk esophageal foreign bodies can be removed through rigid esophagoscopy. Some of the foreign bodies of the patients were difficult to remove, some patients were presented with mediastinal emphysema and pneumothorax due to esophageal perforation, and some foreign body stuck in oesophagus so long to cause esophageal mucosa ulcer. In these conditions, foreign bodies should be removed by lateral neck incision or thoracotomy.

Objective To explore the possible role of sulfur dioxide (SO2) in endoplasmic reticulum stress (ERS) protein expression in myocardial tissue of rats with left to right shunt.Methods A total of 24 male Sprague Dawley rats were randomly divided into sham group(n =8),shunt group(n =8)and shunt plus SO2 donor group (n =8).The rats of shunt group and shunt plus SO2 donor group,an abdominal aorta and inferior vena cava shunting was created.Na2SO3/NaHSO3 was administrated intra-peritoneally in rats of shunt plus SO2 donor group.Eight weeks later,the ratio of quantity of pulmonary to quantity of system (Qp/Qs) was measured ; Heart weight/body weight (HW/BW) and right ventricle/left ventricle + ventricular septum [RV/(LV + SP)] were detected;Expressions of collagen type Ⅰ in right ventricle myocardial tissue was measured by enzyme linked immunosorbent assay (ELISA) ;High performance liquid chromatography was used to measure SO2 content in right ventricle myocardial tissue.Glucose regulated protein 78 (GRP78),c-jun N-terminal kinase(JNK) and phosphorylation-c-jun N-termina kinase(p-JNK) mRNA and protein expressions in RV myocardial tissue were detected by Western blot and real time-polymerase chain reaction(RT-PCR).Results After 8-weeks shunting,Qp/Qs in the shunt and shunt plus SO2 groups were higher significantly than those of the sham group(all P ＜ 0.05).Compared with sham group,HW/BW,RV/LV + SP and expressions of collagen type Ⅰ in the shunt group were significantly higher(all P ＜ 0.05).Treatment of SO2,HW/BW and RV/LV + SP and collagen type Ⅰ in the shunt group were lower significantly(all P ＜ 0.05).The level of SO2 of RV in shunt group increased significantly compared with sham group (all P ＜ O.05),but significantly lower than that of shunt plus SO2 donor group (P ＜ 0.05).Compared with sham group,the expressions of GRP78,JNK and p-JNK mRNA and protein in RV increased significantly in shunt group(P ＜ 0.05).After treatment with SO2,the expressions of GRP78,JNK and p-JNK mRNA and protein decreased significantly (P ＜ 0.05).Conclusion SO2 might protect RV myocardial tissue of the rats with left-right shunt by regulating the expressions of ERS.

Objective To evaluate the effect of a pilot intervention on setting up a hospital-based neonatal resuscitation leading group in 12 hospitals. Methods One provincial-level, two prefecturelevel and one county-level hospitals in Jiangxi, Liaoning and Hunan province were selected to participate in the intervention. A neonatal resuscitation leading group was set up in each hospital to investigate the mode of resuscitation practice training and re-training, improve and carry on the cooperation between obstetricians and pediatricians, record the steps of neonatal resuscitation of asphyxia cases and lead the exploration of the problems occurred during the process in their own hospital. The changes of asphyxia incidence and neonatal resuscitation process were analyzed to evaluate the effect of the intervention. Results (1) Incidence of neonatal asphyxia during intervention period: 315 neonatal asphyxia cases were recorded, among which 89.5 % (n = 282) were mild and 10. 5% (n=33) cases were severe asphyxia. The mean one-minute Apgar score was the lowest in county-level hospitals (5. 40±1.56), followed by provincial-level hospitals (5.63 ±1.67)and prefecture-level hospitals (6.03 ± 1.41). (2) Resuscitation was not performed according to the guidelines in 47. 9% (151/315) of asphyxia cases. Bag and mask ventilation was not performed according to guideline in 36. 5% (115/315) of cases. (3) Changes of asphyxia incidence after the intervention: the incidence of asphyxia in provincial-level (4.23 % vs 2.66 %, χ2 = 5. 021, P＜0.05)and prefecture-level (2.83% vs 1.67%, χ2 = 4. 948, P＜0.05) hospitals decreased significantly after the intervention. The incidence of severe asphyxia in both provincial-level (χ2 =3. 001, P＞0.05) and prefecture-level (χ2= 0. 966, P＞ 0. 05) hospitals decreased with no statistical significance. The asphyxia incidence in county-level hospitals decreased from 2. 48% to 1. 22% (χ2 = 2. 989, P =0. 084). The incidence of severe asphyxia in county-level hospitals decreased from 0.39% to 0. 00%(χ2=2. 567, P= 0. 035). Conclusions Setting up a hospital-based neonatal resuscitation leading group is an effective method to strengthen resuscitation practice training, promote the cooperation between departments, improve the level of neonatal resuscitation practice and therefore decrease the incidence of neonatal asphyxia in the hospital.

Objective To explore the characteristics of the flow velocity waveform of superior vena cana (SVC) in a rat model with chronic monocrotaline-induced pulmonary hypertension by echocardiography.Methods The chronic pulmonary hypertension model was developed by monocrotaline solution (60 mg/kg) injection into the abdominal cavity in 32 SD rats.Eight rats with the placebo injected served as controls.An examination of the flow velocity waveform of SVC was performed by Doppler echocardiography via supraclavicular fossa before and 28-day after the injection.The pulmonary arterial systolic pressure was measured by pressure-guided micro-catheter 28-day after the injection both in the control and the pulmonary hypertension model group.Results Chronic monocrotaline-induced pulmonary hypertension was successfully developed in 29 rats.The flow velocity waveform of SVC showed that the ratio of the maximum reverse peak flow velocity due to atrial contraction (VAR) to the maximum systolic peak flow velocity (Vs) and VAR increased dramatically 28-day after the monocrotaline solution injection in both sides of SVC (P ＜0.01), while only the Vs of the right SVC significantly decreased (P ＜0.05).Conclusions The changes of VAR/Vs ratio and VAR in rat model with chronic monocrotaline-induced pulmonary hypertension suggested that the changes of flow velocity waveform of SVC have indicating features in reflecting pulmonary hypertension.

Objective To investigation the relation of leptin to birth weight and insulin in preterm and term neonates and to explore whether a functional “adipoinsular axis” might exist in preterm and term neonates. Methods A total of 264 preterm and term newborns were recruited and categorised according to gestation length. Anthropometric measurements were performed at birth. Leptin, fasting glucose and insulin were measured at 3 days of life. Results Serum leptin was significantly higher in term than in preterm. The relation between serum leptin and gestation followed a non-linear pattern; The slope of the curve began to increase after 34 weeks gestation. Serum leptin was associated with birth weight and insulin in newborn more than 32 weeks gestation(r=0.240, 0.227, P

Objective To study the serum and gastric juice levels of epidermal growth factor (EGF) in response to early minimal enteral nutrition (MEN) in premature infants with severe illness and evaluate the clinical significance of early MEN. Methods Premature infants with critical score