Postoperative pulmonary artery stenosis is one of the popular complications.The disappointing results of surgical treatment for such lesions led to the introduction of interventional procedures (balloon angioplasty and stent implantation).Balloon angioplasty is applicable for branch pulmonary artery stenosis,however,balloon dilation alone rarely been effective in the long-term for these lesions.Since pulrmonary artery stenting was introduced in 1991,indications and use of stents for dealing with pulmonary artery stenosis have played a leading role in recent times.Intravascular stents are effective for stenotic artery dilation,can reduce right ventricle pressure and improve heart function.Excellent mid-and long-term results after stenting of postoperative pulmonary artery stenosis are demonstrated by numerous researches,with the new developments in stent design,indications for pulmonary artery stent implantation are likely to widen in the future.

Objective To compare the sedative efficacy with oral or rectal chloral hydrate in pediatric patients by using Meta-analysis method.Methods Ten randomized controlled trials about the sedative efficacy with oral or rectal chloral hydrate in pediatric patients were retrieved.Meta-analysis was carried out using the RevMan 5.0 software.Results The results showed that the sedative efficacy with rectal medication was better than that with oral way.Nausea and vomiting occurred in 95 children with oral chloral hydrate,bowel movement occurred in 57 children with rectal chloral hydrate.Conclusions The sedative efficacy with rectal chloral hydrate was better than that with oral way.The safety in pediatric sedation with chloral hydrate should be emphasized in order to avoid adverse reaction.

Objective To explore the cause of secondary QT interval shortening. Method The data of a child with vasovagal syncope and cardiac depression in whom shortened QT interval was induced in head-up tilt test (HUTT) was analyzed retrospectively, and the related literatures were reviewed. Result A 12-year-old boy visited for fainting when brushing his teeth in the morning. ECG showed sinus bradycardia, heart rate at 55 times /min and normal QT and QTc interval. Dynamic electrocardiogram showed sinus rhythm, mean heart rate at 70 times/min, atrial anterior contraction 3 times, normal mean QT and mean QTc. UCG showed approximately normal heart structure and the left ventricular systolic function. There was no abnormality in EEG and cranial CT. His fasting blood glucose was 5.2 mmol/L. The basal tilt test was positive with vasovagal syncope and cardiac depression. During the tilt table test, Holter monitoring showed that sinus arrest occurred in the child when upright tilt for16 min, and then fainted. Time of sinus arrest was 2.9 s and 11.4 s, respectively, and artificial chest compressions were performed. The QT interval was shortened (QT=330 ms), and so was QTc interval (QTc=320 ms). The ratio of QT/QTp was 78% (the lower limit of normal QT interval was 88% of QTp) before sinus arrest occurred. Conclusion Increased vagal tone may induce QT interval shortening.

Objective To investigate the effects of Baicalin on intestinal mucosal injury in rats with partial common bile duct ligation (PCBDL).Methods Forty male Wistar rats were randomly divided into 4 groups equally:sham operation,PCBDL,PCBDL1 and PCBDL2.Rats in PCBDL,PCBDL1 and PCBDL2 groups were subjected to partial common bile duct ligation.Baicalin [80 mg/(kg · d)] was fed in PCBDL1 group (for 2 weeks) and PCBDL2 group (for 3 weeks),while for other groups,9 g/L saline in the same volume was fed.Ileum mucosa were prepared for microscopic examination.The intestinal mucosal injury in rats was observed and scored.The level of NF-κB mRNA expression by Fluorescent in Situ Hybridization,and the level of NF-κB protein were determined by immunohistochemistry.Results 1.Compared with PCBDL group (3.2 ± 0.5),the pathological severity scores of intestinal mucosa significantly declined (F =21.120,P ＜ 0.01) in PCBDL1 group (1.9 ± 0.2) and PCBDL2 group (1.5 ± 0.3).2.Compared with sham operation group(0.066 ± 0.006),PCBDL1 group (0.107 ± 0.011),and PCBDL2 group (0.098 ± 0.010),NF-κB expression in PCBDL group (0.155 ± 0.012) presented significantly up-regulation (F =76.8,P ＜ 0.01).3.Compared with sham operation,PCBDL1 group,and PCBDL2 group,the positive expression rates of NF-κB mRNA of intestinal mucosal epithelium in PCBDL group significantly increased.Conclusions It is suggested that Baicalin exert protective effects on the intestinal mucosal injury in rats with PCBDL,partially by inhibiting NF-κB mRNA,down-regulating NF-κB protein expression of intestinal mucosal epithelial cells.

OBJECTIVE:To establish a method for the contents determination of 9 components in Guizhi decoction,and com-pare the effects of traditional decoction method and the extracting machine decoction method on these contents in Guizhi decoction. METHODS:HPLC was performed on the column of Agilent Zorbax SB-C18 with mobile phaseof acetonitrile- 0.1% phosphoric ac-id(gradient elution)at a flow rate of 1.0 ml/min,the detection wavelength was 230 nm,254 nm and 280 nm,the column tempera-ture was 25℃,and the injection volume was 10μl. RESULTS:The linear range was 0.410 2-210.0μg/ml for gallic acid(r=0.999 9), 0.994 0-254.5μg/ml for albiflorin(r=0.999 9),1.636 0-1 675.0μg/ml for paeoniflorin(r=0.999 9),0.988 3-506.0μg/ml for liquiri-tin(r=0.999 6),0.987 3-31.59 μg/ml for coumarin(r=0.999 5),0.486 8-124.6 μg/ml for cinnamic acid(r=0.999 5),2.458 0-314.6μg/ml for cinnamaldehyde(r=0.999 5),0.034 3-1.096 μg/ml for 2-methoxy cinnamaldehyde(r=0.999 8),and 1.711 0-219.0 μg/ml for glycyrrdhizic acid (r=0.999 7);RSDs of precision,stability and reproducibility tests were lower than 5%,recoveries were 93.56%-103.19%(RSD=4.00%,n=9)、101.51%-107.32%(RSD=2.21%,n=9)、95.08%-103.76%(RSD=2.87%,n=9)、100.82%-105.73%(RSD=1.85%,n=9)、85.08%-89.12%(RSD=1.40%,n=9)、92.31%-99.12%(RSD=2.71%,n=9)、99.17%-102.32%(RSD=1.24%,n=9)、100.15%-103.98%(RSD=1.18%,n=9)、99.93%-102.61%(RSD=1.03%,n=9). The content of total effective components from the extracting machine decoction method was 4 565μg/g,that from the traditional decoc-tion method was 2 742 μg/g.CONCLUSIONS:The method is simple,stable and reproducible,and can be used for the simultaneous determination of 9 componentsin Guizhi decoction. The contents of gallic acid,albiflorin and 2-methoxy cinnamaldehyde are first re-ported. The total effective components from the extracting machine decoction method are higher than that from the traditional decoc-tion method.

OBJECTIVEThe Pul-stent is a new cobalt alloys stent, specially licensed for pulmonary artery stenosis. The aim of this study was to investigate the value of the stent implantation as the treatment of postoperative pulmonary artery stenosis.

METHODClinical practice was carried out to evaluate effectiveness, safety and maneuverability of Pul-stent in the defined clinical setting. Transthoracic echocardiography, chest roentgenography and electrocardiography were carried out as follow-up studies at 1 and 3 months after procedures.

RESULTTen patients (7 males and 3 females) received Pul-stent implantation in left or right pulmonary arteries (9 stents in left and 1 stent in right). For 9 cases transcatheter stent implantation was performed and in I case hybrid procedure. The median age was 7. 9 years (range 3. 4 - 13. 7 years). The median weight was 22. 3 kg (range 13 - 32 kg). Among them 6 cases were post surgical repair of tetralogy of Fallot, 2 cases were after Fontan procedures, 1 patient was post surgical repair of pulmonary atresia with ventricular septal defect, and 1 patient had stenosis at Glenn pathway. The pressure gradient at the stenosis decreased from (31. 6 ± 10. 2) mmHg(1 mmHg =0. 133 kPa) to (7. 3 ± 10. 3) mmHg, and the diameter of the narrowest segment increased from (4. 0 ± 2. 3) mm to (9. 6 ± 2. 7) mm, the right ventricle to aortic pressure ratio decreased from 0. 54 to 0. 36, all of these improvements were statistically significant (t = 3. 9, -9. 7, 4. 5; P =0. 008, 0. 000, 0. 004). The total procedure time ranged from 55 to 220 min (median 117 min) , and the fluoroscopy time ranged from 9 to 67 min (median 26 min). There were 2 cases of post-stenting pneumorrhagia. No stent fracture, stent malposition and other severe complications were observed. Initial follow-up of 1 and 3-months showed good results with maintenance of improved caliber of the stented vessel, and the gradient across the stenosis area measured by echocardiography was (32. 0 ± 14. 6) mmHg after 3 months. Compared with before stentifng ((40.6 ± 15. 2) mmHg) and 1 month later ((30. 6 ± 13. 6) mmHg), the difference was not statistically significant (t =2. 2,1. 76; P =0. 07, 0. 10).

CONCLUSIONPul-Stent tracking and delivery was excellent, the initial experience has shown that Pul-stent implantation was effective and safe in treating post-operative branch pulmonary artery stenosis. Further follow-up study should be conducted to make sure whether those good results would be kept constant.

Constriction, Pathologic ; Female ; Follow-Up Studies ; Fontan Procedure ; Humans ; Male ; Postoperative Complications ; Pulmonary Artery ; pathology ; Pulmonary Atresia ; Stents

Objective Patients with single-ventricle physiology pose a wide variety of therapeutic challenges.Pulmonary artery or anastomosis stenosis in single-ventricle physiology will have only subtle hemodynamic derangements due to the lack of the pumping chamber to force blood across the stenosis.This study aimed to evaluate the feasibility and usefulness of the stent implantation for treatment of branch pulmonary artery and anastomosis stenosis in children with univentricular hearts.Methods Retrospective analysis of 8 implanted stents between March 2014 and January 2015 in Shanghai Children's Medical Center.Transthoracic echocardiography,chest roentgenography and electrocardiography were carried out as follow-up studies at the second day after operation and 1,3,6,12 months after the procedure.Results In all of eight patients (6 males and 2 females),5 cases were post-Glenn operation and 3 cases were post-Fontan operation.The median age was 6.6 years (range 4.0-8.5 years).The median weight was 19.5 kg(range 13.8-25.6 kg).9 stents were implanted successfully in all patient,6 in left pulmonary arteries,2 in right pulmonary arteries and 1 in anastomosis.All stents were placed in the target lesion without any complication.The diameter of the narrowed segment improved from (3.63 ± 2.06) mm to (7.89 ± 1.62) mm (P ＜ 0.01).During follow-up no other complication occurred except thrombus in one patient because of discontinuation anticoagulation.Conclusion Branch pulmonary arterial stenosis in single-ventricle patients may often be underestimated due to the low pressure venous system and/or the development of venovenous collaterals bypassing and decompressing the pulmonary circuit.In these patients,even mild stenosis should be treated aggressively,especially in the presence of pleural effusions,pericardial effusions,protein-losing enteropathy and low-output states.Stent implantation is an effective method of treating branch pulmonary artery stenosis.

Objective To evaluate the diagnostic value of invasive cardiac catheterization for restrictive cardiomyopathy (RCM) and constrictive pericarditis (CP).Methods Twenty-seven children with CP or RCM hospitalized in Department of Cardiology,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiaotong University from February 2002 to December 2015,were selected,including 10 patients who had been surgically documented CP and 17 patients with RCM who underwent cardiac catheterization.Intracardiac pressure waveforms were recorded and all the measurement indexes of pressure of all the patients were analyzed.The changes of cardiac pressure under deep breathing in 9 patients with local anesthesia was recorded.Results There were significant differences in pulmonary artery pressure,difference between left ventricular end-diastolic pressure (LVEDP) and right ventricular end-diastolic pressure (RVEDP),and the ratio of RVEDP/right ventricular systolic pressure between group RCM and group CP [(50.2 ± 12.0) mmHg(1 mmHg =0.133 kPa) vs.(38.1 ±6.8) mmHg,(7.8±5.5) mmHgvs.(1.8 ±4.7) mmHg,0.27 ±0.10vs.0.45 ± 0.20,respectively;t =2.912,2.787,2.418,all P ＜ 0.05].However,there was overlapping for these criteria,and the predictive sensitivity of any of the criteria was less than 66.7％.In patients with CP,reciprocal changes in the filling between right ventricle and left ventricle occurred during respiration.In patients with RCM,the right ventricle and left ventricle pressures moved concordantly with respiration.The systolic area index was greater in group CP than that in group RCM (1.20 ± 0.03 vs.0.70 ± 0.14),and the difference was significant (t =6.152,P ＜ 0.01).The systolic area index had a sensitivity of 100.0％ and a predictive accuracy of 100.0％ for the identification of patients with surgically proven CP.Conclusions Measurements in catheterization,especially the ratio of right ventricular to left ventricular systolic area during inspiration and expiration is a reliable catheterization criterion for differentiating CP from RCM.

Objectives To explore the clinical symptoms, therapy and prognosis of tachycardia-induced cardiomyopathy (TIC) in children. Methods Clinical data of 22 children with TIC from July 2007 to July 2012 were retrospectively analyzed. Results TIC was mostly seen in male infants and 81.82%of TIC was caused by atrial arrhythmias. The clinical symptom relieved after arrhythmia and ventricular rates were under control with average effective treatment time of (14.00 ± 8.20) days. Ten patients had tachycardia recurrence, 7 of them had atrial arrhythmia and their clinical symptoms were improved after treatment;while 3 of them showed longer time of therapy with average treatment time of (19.50±8.40) days (P<0.05). Five children underwent radiofrequency ablation before school age and got good therapeutic effect. The post-treatment echocardiographic parameters showed cardiac function of TIC children was significantly improved after treatment, including left ventricular end-diastolic diameter index, left ventricular end-systolic diameter index, left ventricular ejection fraction and shortening score (all P<0.05). Conclusions Childhood TIC is a reversible myocardial dysfunction and its prognosis is good. TIC can be induced by various types of tachyarrhythmias and normally by atrial arrhythmia. The preferred treatment of TIC is administration of antiarrhythmic drugs but radiofrequency ablation is needed to ventricular arrhythmias induced TIC.

Objective To evaluate the effects of astragalus on liver injury and TGF-β1 mRNA expression in immature rats with obstructive jaundice(OJ).Methods Forty immature male Wistar rats were randomly divided into a control,a shamoperation,an OJ,and an OJ+A groups.Wistar rats in the OJ and OJ+A group were subjectedto common bile duct ligation(CBDL),while the sham group had the bile duct mobilized but not tied.The control,sham,and OJ groups were giyen 0.5ml of normal saline by intrapedtoneal injection daily.In the OJ+A group,250mg/100g body weight of astragalus injection was applied intraperitoneally daily from day 1 to 7 of the study.All animals were sacrificed on postoperative day 8.Liver tissue and peripheral blood were colleered.Serum Alanine aminotransferase(ALT),Aspartate aminotransferase(AST),and total cholic acid(TCA)level were detected.Hepatic morphological findings were observed by light microscopy.TGF-β1 mRNA were extracted from liver and measured by reverse transcription polymerase chain reaction(RT-PCR).Data were analyzed using chi-square test and student's test(-x±s),P＜0.05 was considered statistical significance.Results ①Serum AST,ALT,and TCA value in each OJ group were significantly higher than that of the control and sham operation groups.②In the control and sham operation group,normal structure of the liver remained,but in the OJ group,obvious degeneration of hepatocytes was detected,such as cholastasis,starch accumulation and fatty degeneration.Kupffer cells and dilated Disse'space were common in the OJ group.In the OJ group.histopathologic findings of the liver demonstrated intense degree of fibrosis,but in the OJ+A group.typical changes of large duct obstruction were significantly improved after astragalus injection treatment.③The TGF-β1 mRNA over-expression in the OJ group was seen compared with the control and the OJ+A groups.Conclusion ①In growing rat model of experimental obstructive jaundice,hepatic morphology and liver biochemical tests altered significantly.②The administration of astragaius can ameliorate liver damage and diminish expression of TGF-β1 mRNA of hepatic tissue,thus administration of astragalus may be effective in preventing hepatic injury in growing rats with obstructive jaundice.