Objective To explore clinical features and therapeutic experience of burns of diabetes patients,for enhancing the curative rate of this diease.Methods The clinical data including the general condition and antishock,blood glucose controlling,surgery,symptomatic and supportive treatments of burns in 46 diabetes patients were analyzed.Results During three to seven days,the fasting plasma glucose of all patients dropped to below 10 mmol/L,and it dropped to below 8 mmol/L in 28 surgical patients.All patients were cured except one died in a bad way occurring multiple organ dysfunction syndrome,and the curative rate reached to 97.8％.Complications occurred in 26 cases and the incidence was 56.5％.Conclusion The burns in diabetes patients are very complicated.It is being effective to combine systemic with local treatments for the condition.

BACKGROUND: Studies have confirmed that nerve growth factor can promote wound tissue to release al kinds of endogenous growth factors and growth factor receptors, which play a positive regulatory role. The nerve growth factor can promote cel proliferation and accelerate wound healing, thus making the wound healing developed from the passive waiting healing to active control healing. OBJECTIVE: To investigate the effects of local application of nerve growth factor on the expressions of transforming growth factor β1 and basic fibroblast growth factor in rat burn wounds. METHODS: Twenty-four adult Sprague Dawley rats were used in the study, and Ⅱ degree deep burn wound was made on the back of rats. Then, these rats were randomly divided into four groups. After burn wound debridement, the wounds were covered with gauzes containing 1, 2.5 and 5 μg/mL nerve growth factor solution and normal saline respectively. At 3, 5, 9 and 14 days after treatment, the wound healing time and percentage of residual wound were observed. Then, wound tissues were cut for histological examination, in order to detect the expressions of transforming growth factor β1 and basic fibroblast growth factor in wounds, as wel as the cel ular DNA cycle. RESULTS AND CONCLUSION: The wound healing time in the treatment groups was shorter than that in the control group, especial y in 5 ug/mL nerve growth factor treatment group (P < 0.01), and the percentage of residual wound in the treatment groups was less than that in the control group. The histological examination showed the number of nucleated cells in the superficial dermis of the treatment groups was significant increased when compared with that in the control group; the expressions of transforming growth factor β1 and basic fibroblast growth factor in the treatment groups at different time points were stronger than those in the control group, and the expressions at 5 and 9 days were stronger than those at 3 and 14 days; percentage of cells in S phase of the treatment groups was significantly increased, especial y in 5 mg/L nerve growth factor group (P < 0.01). The results indicate that local application of nerve growth factor can accelerate wound healing by increasing the expressions of transforming growth factor β1 and basic fibroblast growth factor, stimulating mitosis and promoting proliferation.

Objectives To evaluate the mechanism of mitral regurgitation after mitral valve surgery by quantitative assessment of mitral valve three-dimensional parameters using real-time three-dimensional echocardiography (RT-3DE). Me-thods According to the improved degree of mitral regurgitation (MR), 30 children were divided into two groups after mitral valve repair:MR improved (I) group and residual MR (II) group. And the pre-operative 3-DE parameters were compared with post-operative parameters in two groups respectively. Results In group I, three dimensional parameters, including mitral valve annular area in end-systole and end-dilate (AA1, AA2), PM papillary muscle annular distance (AL-A), AL papillary muscle annular distance (PM-A), inter-papillary distance (PM-AL), the anterior leaflet and posterior leaflet tethering angles (a1, a2, argAL-C-PM), left ventricular volume end-systole and end-dilate (LVEDV, LVESV) were significantly improved after surgery (P<0.05) while the parameters PM-A, PM-AL, argAL-C-PM, LVEDV, LVESV and left ventricular ejection fraction (LVEF) were not significantly changed after surgery in group II, except for the parameters AA1, AA2 and a2 (P>0.05). Conclusions Most of the mitral valve parameters were much better in group I after surgery. However, the malformation of papillary appa-ratus, leaflet tethering strength and left ventricular function were unchanged in group II, which may be the key mechanism of mitral regurgitation after surgery.

Objective To investigate the photodynamic effect induced by laser and use it as a method for purging of minimal residual tumor cells from autologous peripheral blood stem cell grafts. Methods We studied the effect of various concentrations of hematoporphyrin derivative (HPD) combined with of different time of laser irradiation on human leukemia cell line K562, breast tumor cell line MCF-7 and human umbilical cord blood-derived hematopoietic stem/progenitor cells by using MTT assay to compare the photodynamic effect between cell lines of each group. Results HPD or laser irradiation alone had no apparent cytotoxicity while the application of HPD plus laser exposure caused photosensitization. HPD plus laser irradiation was more efficient for killing K562 cells and MCF-7 cells than doing the normal human umbilical cord blood-derived hematopoietic stem/progenitor cells. The photodynamic effect on K562 cells and MCF-7 cells was positively correlated with the increase of treatment duration and HPD concentration. Conclusion These results indicated that the laser photodynamic effect mediated by HPD might be used for purging autologous peripheral blood stem cell grafts in vitro.

Objective To evaluate the importance of factors affecting efficiency of image display quality of realtime three-dimensional echocardiography (RT-3DE) and establish an optimized method for RT-3DE examination and image processing in children. Methods Based on corresponding cardiac acoustic characteristics in children, 87 healthy children (46 boys, 41 girls, mean 36.2 ± 44.2 months) were selected. Three aspects of seven factors were selected, including acquisition windows, gain, compress, post process, smoothing, frequency fusion and 3D vision for RT-3DE examination and analysis using orthogonal test design method. The principal effectiveness analysis of orthngonal test design method and its table L_(18)3~7 were used. The efficiency rate of 3D image display quality was used as the inspection index for orthogonal test. Results According to the average deviation orders of the seven factors, the maximal average deviation was gain. The aspects with maximal average deviation of each factor were at via-subcostal and via-apical acoustic windows, 90 of gain, 60 of compress, E of post process, 5 of smoothing, F3 of frequency fusion and A to B of 3D vision, respectively. Conclusions The optimized method for RT-3DE examination and image processing could be achieved by setting acquisition windows, gain, compress, post process, etc. It is helpful to promote clinical application of RT-3DE and benefits the design of multi-parameter presetting of ultrasound system to optimize RT-3DE examination in children.

Purpose To evaluate features of the left ventricular twist in patients with atrial septal defect (ASD) using speckle tracking imaging (STI) in order to guide clinical application.Materials and Methods Fifty-eight patients with ASD confirmed by ardiac ultrasound in Shanghai Children's Medical Center from October 2015 to January 2016 were enrolled in this study as case group,which were further divided into group ASD-A with 30 cases and group ASD-B with 28 cases according to the volume of right ventricular.The volume of right ventricular was significantly increased in the group ASD-A,but the volume of right ventricular was not significantly increased in the group ASD-B.At the same time,30 normal children with matched age and sex were chosen as control group.The parameters of left ventricular twist motion in each group were measured and compared by using STI.Results In group ASD-A,The basal and apical part of 6 children rotated counterclockwise.Compared with those in the control group,the basal rotation angle and apical rotation angle of left ventricular in group ASD-A were significantly higher (P＜0.01),and the peak twist and torison of left ventricular in group ASD-A were also higher (P＜0.05).Compared with those in the control group,only the apical rotation angle in group ASD-B was higher (P＜0.05),but the rest parameters of the left ventricular twist motion in group ASD-B were not statistically significantly higher (P＞0.05).Conclusion The significant increase in the volume of right heart load in ASD impacts on the basal and apical rotation of left ventricular.

Objective:To assess the efficacy and the safety of the radiofrequency catheter ablation (RFCA) for the septal accessory pathway (AP) in children.Methods:From September 2013 to March 2019, 626 patients plan to underwent RFCA for paroxysmal supraventricular tachycardia (PSVT) in Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine.Among them, 74 consecutive patients with right or left septal APs were included in the study and their clinical and RFCA data were analyzed.Results:The age of these 74 children (45 males, 29 female) was (7.8±3.5) years, ranging from 10 months to 13 years.The body weight (BW) was (27.7±14.4) kg, with 3 patients BW<15 kg.A discordant ventricular wall motion (DVWM) was found in 5 patients, and the combined congenital heart diseases were discovered in 2 patients.A three dimensional mapping system was applied in 69 ablations, and 3 ablations were performed only with the fluoroscopy monitor of 5 cases.According to the AP location, the number of cases located in the anteroseptal, the midseptal, the mouth of coronary sinus, the left posteroseptal and the right posteroseptal, were 28, 18, 10, 10 and 8, respectively.The ablation operations were applied in 72 patients.The initial acute success reached in 67 (93.1%) patients.The ablation energy was (18.0±1.8) W, the fluoroscopy time during the ablations was (4.7±2.7) minutes, and the procedure duration was (151.5±58.6) minutes.One inadvertent complete atrioventricular block (AVB) was noted as the ablation-related complication.All 5 children with the pre-DVWM were recovered after ablations.During a follow-up of (23.8±10.8) months, 4 patients experienced the recurrence of preexcitation syndrome atrioventricular reentrant tachycardia.Conclusions:With the 3D-mapping system, the RFCA of septal APs can be performed safely and effectively in pediatric patients of paroxysmal supraventri-cular tachycardia.However, as the ablation-related complication, AVB should not be ignored.

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.

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.

Objective To investigate the application of polymerase chain reaction and single strand conformation polymorphism analysis(PCR-SSCP)to the screening of gene mutation of exon 13 of the LDLR gene in familial hypercholesterolemia(FH).Methods Peripheral blood DNA of 16 clinically diagnosed FH patients was extracted and the exon 13 coding region of the LDLR gene was amplified by PCR.PCR products were separated by optimized SSCP electrophoresis and visualized by silver staining.DNA fragments with abnormal mobility were sequenced to determine the nature and position of mutations.Results The SSCP electrophoresis conditions were optimized as 8%polyaerylamide(degree of cross linking 49:1)gel without glycerin at a electrophoresis temperature of 10℃ or 8%polyacrylamide gel with 5%glycerin at room temperature,gel thickness of＜0.4 mm,and a voltage of 5 V/cm.DNA fragments were well resolved with the conditions and sequencing of the abnormal bands resuhed in detections of missense mutations of A606T,D601N,Y601D and G636V together with a synonymous mutation of 1959C→T in 4 patients and a sole synonymous mutation of 1959C→T in other 4 patients.Conclusion PCR-SSCP is an effective method for the screening of exon13 mutations of LDLR gene in FH patients.