Objective:To investigate the relationship between the level of Apelin-13 and coronary artery lesion (CAL) in patients with Kawasaki disease (KD), and assess the predictive value of Apelin-13 for CAL in acute phase of KD.Methods:A total of 240 children with KD treated in Chengdu Women and Children′s Central Hospital from September 2017 to October 2019 were recruited, and were divided into KD with CAL (KD-CAL) group and KD without CAL (KD-NCAL) group.Thirty children with acute upper respiratory infection and 30 healthy children were recruited into the febrile control group and the healthy control group, respectively.Blood routine and serum levels of albumin, C-reactive protein (CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP) and Apelin-13 were mea-sured in KD children prior to intravenous gamma globulin injection and after the diagnosis of children in the febrile control group and physical examination of children in the healthy control group.The clinical data of children in each group were compared, and the risk factors of KD complicated with CAL and the predictive value of Apelin-13 were determined by using receiver operating characteristic (ROC) curve and multiple Logistic regression analysis. Results:Apelin-13 and hemoglobin in children with KD were significantly decreased compared with those in the healthy control group and fever control group (all P<0.001). However, white blood cell(WBC) count, platelet count, CRP and NT-proBNP in KD group were significantly increased compared with those in the healthy control group and fever control group (all P<0.001). Serum albumin in KD children was significantly lower than that in the healthy control group ( P=0.004), and there was no difference when compared with the fever control group ( P=0.485). Apelin-13 and hemoglobin were significantly decreased in KD-CAL group compared with KD-NCAL group ( t=10.102, P<0.001; t=2.034, P=0.043), while NT-proBNP and CRP were significantly increased ( t=5.982, 3.728, all P<0.001). Multiple logistic regression analysis showed that Apelin-13 and NT-proBNP were independent predictors of CAL in KD.The ROC curve analysis showed that the cut-off value of Apelin-13 for predicting CAL was 2.99 μg/L, with an area under the curve (AUC) of 0.869 (95% CI: 0.820-0.909), sensitivity of 77.78% and specificity of 88.67%.While NT-proBNP cutoff value of 822 ng/L yielded sensitivity of 57.78% and specificity of 84.62% for predicting CAL with an AUC of 0.718(95% CI: 0.656-0.774). Conclusions:Apelin-13 plays a protective role in KD complicated with CAL, and could be used to predict CAL in the acute phase of KD.

Objective:To investigate the relationship of heart rate variability (HRV), heart rate deceleration capacity (DC) and intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) in children with the acute stage of KD.Methods:A total of 679 patients with KD in Chengdu Women and Children′s Central Hospital from August 2015 to May 2019 were selected.In healthy control group, 150 children obtained physical examination at the same time.Prospective cohort study was applied to analyze the data.According to the effect of initial IVIG treatment within 14 days, patients were divided into IVIG-sensitive group and IVIG-resistant group.General clinic information, HRV, DC, blood routine, liver function, cardiac troponin I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP), high sensitivity C-reactive protein(hs-CRP) and erythrocytesedimentation rate (ESR) before initial IVIG treatment of the 2 groups were compared.Multivariate Logistic regression was applied to analyze the risk factors of IVIG-resistant KD. Results:Among 679 KD patients, 3 cases were lost, among the rest 676 cases, 586 cases were in IVIG-sensitive group, and 90 cases were in IVIG-resistant group.The HRV and DC indexes of IVIG-sensitive group and IVIG-resistant group were lower than those of the healthy control group, and the differences among the 3 groups were statistically significant (all P<0.05). Meanwhile, standard deviation of N-N intervals (SDNN) [(65.84±38.22) ms vs.(82.56±21.41) ms, P=0.004], and low frequency (LF)[ (192.59±114.10) ms 2vs. (258.18±162.75) ms 2, P=0.048] of IVIG-resistant group were lower than those of IVIG-sensitive group.White blood cell (WBC), platelets(PLT), hs-CRP, ESR, alanine aminotransferase(ALT), cTnI and NT proBNP in IVIG sensitive group and IVIG-resistant group were all higher than those in the healthy control group (all P<0.05). Further more, ESR[(90.32±37.91) mm/1 h vs. (65.81±25.34) mm/1 h, P=0.019], cTnI [(0.83±0.35) μg/L vs. (0.52±0.18) μg/L, P=0.037] and NT-proBNP [(854.64±293.02) ng/L vs. (584.95±177.11) ng/L, P=0.011] in IVIG-resistant group were higher than those of IVIG-sensitive group.Multivariate Logistic regression analysis demonstrated that SDNN ( OR=0.783, 95% CI: 0.0341-0.979, P=0.021), and NT-proBNP ( OR=1.195, 95% CI: 1.061-1.428, P=0.34) were independent risk factors for predicting IVIG-resistant KD. Conclusions:SDNN and NT-proBNP may be independent predictors of IVIG-resistant KD.

The application indications of imaging examination and cardiac catheterization in the diagnosis, treatment and follow-up of Kawasaki disease, especially cardiovascular sequelae, are further improved by the Japanese Circulation Society/Japanese Society for Cardiovascular Surgery 2020 Guideline on Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease that also standardizes the long-term management program of Kawasaki disease in three different stages, namely, school, the adolescent/young adult and adulthood stage.In order to enhance the understanding of domestic medical staff with the latest knowledge, this paper focuses on the application progress of diagnostic imaging and cardiac catheterization in the diagnosis, treatment and long-term management of cardiovascular sequelae of Kawasaki disease in the guide.

Objective:To assess the value of CD4 + and CD8 + T-lymphocyte counts for the diagnostic classification and prognosis of coronavirus disease 2019 (COVID-19). Methods:A total of 95 COVID-19 adult patients admitted to Shanghai Public Health Clinical Center, Fudan University from January to March 2020 were recruited. The CD4 + and CD8 + T-lymphocyte counts among ordinary, severe and critical patients, as well among the cured, improved, unimproved and death patients were compared. The area under receiver operating characteristic curve (AUROC) was used to evaluate the value of CD4 + and CD8 + T-lymphocyte counts for the clinical diagnosis and prognosis of COVID-19. The comparison among groups was performed by Mann-Whitney U test. Results:A total of 95 COVID-19 cases including 68 common, 11 severe and 16 critical cases were enrolled. The counts of CD4 + and CD8 + T-lymphocyte of patients in common, severe and critical groups were 419 (309, 612), 267 (212, 540), 141 (77, 201)/μL, and 238 (153, 375), 128 (96, 172), 92 (51, 144)/μL, respectively, with significant differences ( Z=24.322 and 15.956, respectively, both P<0.01). The counts of CD4 + and CD8 + T-lymphocyte of the death, unimproved, improved, and cured patients were 149 (143, 349), 315 (116, 414), 344 (294, 426), 745 (611, 966)/μL, and 106 (43, 501), 176(67, 279), 194(188, 432), 429(276, 564)/μL, respectively, with significant differences ( Z=36.083 and 16.658, respectively, both P<0.01). The optimal cut-off point of CD4 + T-lymphocyte counts was 237/μL for critical COVID-19 with AUROC 0.911 (95% confidence interval ( CI) 0.833-0.989, P<0.01), with the sensitivity of 86.1% and specificity of 87.5%. For predicting severe and critical cases, the optimal cut-off point of CD4 + T-lymphocyte counts was 405/μL with AUROC 0.863 (95% CI 0.727-0.999, P=0.001), with the sensitivity of 78.6% and specificity of 74.6%. Conclusions:The conditions of patients with COVID-19 are aggravated with CD4 + and CD8 + T-lymphocyte counts decreasing. CD4 + T-lymphocyte counts may be an indicator for diagnostic classification of COVID-19 and prognostic indicator for severe and critical patients.

Objective:To explore influence on physical development of children aged 18 months from HIV-positive mothers for prevention mother to child transmission of HIV (PMTCT) in Guangxi Zhuang autonomous region, and provide evidence for the improvement PMTCT program.Methods:This retrospective case control study was conducted in 554 HIV negative infants aged 18 months whose HIV positive mothers had received PMTCT services reported through PMTCT system database from January 1, 2010 to December 31, 2017 and 1 109 healthy infants born in 2017, whose mothers were healthy, in Lingshan, Luzhai, and Hengxian counties, ranking top three counties with high HIV infection prevalence, in Guangxi. PMTCT data and physical development data such as height, weight and head circumference of children aged 18 months were collected. The physical dysplasia in the infants was defined as at least one of the three main indicators of height, weight and head circumference below the normal range.Results:The number of HIV-positive mother and their infants in the case group were 667 and 554 respectively, and the PMTCT rates were 91.15 % (608/667) and 96.57 % (535/554) respectively. HIV positive rate, mortality rate and mother to child transmission rate of the infants aged 18 months were 1.44 % (8/554), 3.07 % (17/554) and 1.91 % (8/418) respectively, and the physical examination results of the infants aged 18 months showed that the physical dysplasia rate was 30.51 % (169/554). Among the 1 109 infants in the control group, the physical dysplasia rate was 9.83 % (109/1 109). The difference between the case group and the control group was significant ( P<0.01). Conclusion:The PMTCT rates of HIV positive mother and their children were more than 90.00 %, respectively. However, poor physical development rate of infants aged 18 months were more than 30.00 %. The possible influence of PMTCT on physical development of the infants aged 18 months of HIV positive mother’s needs to be further studied.

OBJECTIVE:To observe therapeutic efficacy and safety of lansoprazole triple therapy in the treatment of Helicobacter pylori (Hp) associated gastric ulcer.METHODS:A total of 80 patients with Hp associated gastric ulcer were randomly divided into control group (40 cases) and combination group (40 cases).Control group was given Lansoprazole capsules 30 mg once in the morning or before bedtime,for 6 weeks.Combination group was given Lansoprazole capsules (same usage and dosage as control group)+Clarithromycin tablets 0.5 g,twice a day+Amoxicillin dispersible tablets 1 g,twice a day,for consecutive 1 week,and then given Lansoprazole capsules 30 mg once in the morning or before bedtime,for 5 weeks.Patients with amoxicillin allergy were switched to Metronidazole tablets 0.4 g,twice a day.Hp eradication rate of 2 groups were observed;recrudescence rate of Hp negative patients and the recurrence of effective patients were observed after 6,12 months of treatment.The leve1s of Th1 cytokines (IFN-γ,IL-2,IL-12) and Th2 cytokines (IL-4,IL-6,IL-10) were observed before and after treatment,and the occurrence of ADR was recorded.RESULTS:There was no statistical significance in total response rate of ulcer healing,Hp eradication rate or the incidence of ADR between 2 groups (P＞0.05).After 6 months of treatment,there was no statistical significance in recurrence rate between 2 groups (P＞0.05).The recurrence rate of combination group after 12 months of treatment and recrudescence rate of combination group after 6,12 months of treatment were significantly lower than those of control group,with statistical significance (P＜0.05).Before treatment,there was no statistical significance in Th1 type cytokines and Th2 cytokines between 2 groups (P＞0.05).After 1 week and 6,12 months of treatment,the levels of INF-γ,IL-2,IL-12 and IL-6 in 2 groups were significantly lower than before;the levels of INF-γ,IL-2 and IL-12 in combination group were significantly lower than control group after 12 months of treatment.After 1 week and 6,12 months of treatment,the levels of IL-4 and IL-10 in 2 groups were significantly higher than before;those indexes of combination group were significantly higher than those of control group after 12 months of treatment,with statistical significance (P＜0.05);but there was no statistical significance in the level of IL-6 between 2 groups (P＞0.05).CONCLUSIONS:Lansoprazole triple therapy shows significant therapeutic efficacy for Hp associated gastric ulcer,improve cytokines level and reduces recurrence rate and recrudescence rate without increasing the incidence of ADR.

Objective To investigate the correlation between red blood cell distribution width (RDW) and the cardiac function in children with acute heart failure,and to explore the clinical value in evaluating the degree of heart failure.Methods From July 2013 to October 2015,75 cases of children with acute heart failure who were hospitalized in Chengdu Women and Children's Central Hospital were collected and assigned as 3 groups.Heart function classification was done by using a modified Ross scoring system,and each group included 25 cases of class Ⅱ,Ⅲ,Ⅳ.Indices of red blood cell,haemoglobin,RDW,concentration of plasma N-terminal pro brain natriuretic peptide (NT-proBNP),and left ventricular ejection fraction (LVEF) were recorded.SPSS 17.0 software was statistically used for comparing cach index among groups and correlation analysis.Results Red blood cells and haemoglobin were not statistically different among groups (F =0.802,1.372,all P ＞ 0.05).RDW,NT-proBNP concentration and LVEF were significantly different among groups (F =31.388,29.300,x2 =56.952,all P ＜ 0.01),and significantly increased with the progression in the order of class Ⅳ group ＞ class Ⅲ group ＞ class Ⅱ group [RDW:(16.6 ± 1.3) ％ ＞ (15.4 ± 1.1) ％ ＞ (13.9-± 1.3) ％,NT-proBNP:(506.6 ± 190.2) ng/L ＞ (1 028.1 ± 356.8) ng/L ＞ (1 884.1 ± 358.6) ng/L,all P ＜ 0.01].According to LVEF =50％ as the cut-off point,children with acute heart failure were divided into LVEF decreased group and LVEF retention group,former group's RDW and NT-proBNP were significantly higher than the latter group[RDW:(16.7 ± 1.3)％ vs.(13.9 ±1.1)％,NT-proBNP:(1 787.4-±368.6) ng/Lvs.(657.4-± 291.1) ng/L,all P ＜0.01].According to NT-proBNP levels,the children with acute heart failure were divided into low,medium,and high NT-proBNP group,and RDW in the high NT-proBNP group[(17.3 ±0.9)％] was significantly higher than that of medium [(15.4 ± 0.7) ％],and that of low level group [(13.7 ± 1.2) ％] (all P ＜ 0.01).The correlation analysis between RDW,NT-proBNP as well as LVEF showed that RDW was significantly positive correlated with NT-proBNP (r =O.869,P ＜ 0.01),and negatively related with LVEF (r =-0.962,P ＜ 0.01).Conclusions RDW is closely related to the cardiac function in children with acute heart failure.RDW is increased with the aggravating of acute heart failure,which can indirectly reflect the NT-proBNP concentration and LVEF change and suggests that RDW can be used as a convenient and useful index monitoring the level of cardiac function in children with acute heart failure,and the assessment of the severity of acute heart failure.

Objective Radiological grade of splenic injury was seldomly used in China trauma center now,though it had been established in 1994 by American Association for Surgery of Trauma (AAST) and widely used.The present study is aimed to analyze the imaging grade and clinical characteristics of traumatic splenic rupture in children,discuss the feasibility of conservative treatment,and the role of radiographic grading during clinical treatment.Methods Information (including age,gender,severity based on radiological findings,treatment strategies,and clinical outcome) regarding 59 hospitalized splenic injury patients whose injuries occurred between 2008 and 2014 was retrospectively analyzed.Results Between 2008 and 2014,59 pediatric patients with splenic injury were treated in our institution.Median age was 9.5 years (range,3 months to 16 years).Of all patients,41 (69.5%) were male.The injuries were primarily caused by traffic crash (45.7%),stumbling/falling from a height (38.9%).According to AAST,5 cases were grade Ⅰ,26 patients grade Ⅱ (44.1%),and 21 cases grade Ⅲ (35.6%),6 over grade Ⅳ,and only one was unclear.Of all patients,25 cases were with the other organs complications.All patients underwent fasting,bed rest,and antibiotics.Only 1 case was transferred to operation during the conservative treatment.Forty-nine patients underwent with CT scan over 2 times.Conclusion Imaging classification helps guide clinical treatment.Conservative treatment is feasible for traumatic splenic injury in children.Early imaging classification of splenic injury may be helpful in clinical judgment,and reduce children radiation exposure.

Objective To explore the risk factors of Schistosoma japonicum infection in the residents in Xingzi County,Ji?angxi Province. Methods Six administrative villages from different areas were randomly selected by the cluster sampling meth?od as the study sites in Xingzi Country in 2013,and all the residents aged 5 years or above were investigated epidemiologically, and the schistosome infection was surveyed by Kato?Katz technique. The risk factors of schistosomiasis were analyzed by using the Chi?square test analysis and multivariate Logistic regression model. Results In 2013,there were 2 050 residents received the stool examination and 146 persons were positive,the schistosome infection rate was 7.1%. The Chi?square test showed that gender,age,occupation and education level were associated with the population infection rate(χ2=26.485、16.836、25.700、90.805,all P<0.05). The multivariate Logistic regression mode showed that the probability of schistosomiasis for the male was 3.041 times as much as that for the female;the probability of schistosomiasis for the illiteracy and primary education level crowd was 8.870 times as much as that for the college degree or above crowed;the probability of schistosomiasis for the junior middle school education level crowd was 5.598 times as much as that for the college degree or above crowed;the probability of schistoso?miasis for the high school education level crowd was 2.995 times as much as that for the college degree or above crowed;the probability of infection of fishermen was the highest,which was 3.053 times as much as that for the other professional crowds. Conclusions The risk factors of schistosome infection mainly include gender,occupation and the education level. We should strengthen the health education of schistosomiasis control,protection against the infested water contact,and so on.

Objective To evaluate the effect and mechanism of bone morrow MSCs transplantation in swine with AMI by cell biology and molecular imaging methods including PET/CT, SPECT, and MRI. Methods Twenty?four Chinese mini?swine ( ( 25 ± 5 ) kg ) were randomly divided into 2 groups: MSCs group ( n=12) and control group ( n=12) . Myocardial infarction was induced in swine hearts by occlusion of the LAD. Thirty minutes later, the MSCs group received autologous MSCs transplantation through in?tramyocardial injection into the peri?infarcted areas (2×107,2 ml) and the control group was subjected to cell culture medium in the same way. At the 1st and 4th weeks after MSCs transplantation, myocardial glu?cose metabolism, myocardial perfusion and cardiac function were evaluated in the two groups through PET/CT, SPECT and MRI. The minimum FDG mean signal intensity ( MSI ) , summed MSI, SRS, SRS%, LVEF, ESV, stroke volume ( SV) and cardiac output ( CO) were calculated. On the 4th week, HE and Masson′s Trichrome stains were performed. Mann?Whitney u test and non?parametric Wilcoxon test were used. Results (1) As evaluated by PET in the 1st week, the MSI and summed MSI in MSCs group were less than those in control group ( 22. 10 ± 3. 18 vs 35. 70 ± 3. 02, z=-2. 65; 1 013. 50 ± 29. 37 vs 1 084. 00 ± 21?15, z=-1.97;both P<0.05) . Compared to the minimum MSI and summed MSI in the 1st week, those in MSCs group increased significantly (34.00±4.25, z=-2.81;1 075.50±28.30, z=-2.80;both P<0?01) in the 4th week. SRS and SRS% decreased in the 4th week compared to those in the 1st week (20.20±2.24 vs 23.80±1.58, (29.80±3.31)% vs (35.10±2.34)%;both z=-2.08, both P<0.05). The averaged MSI in left ventricular infarction area (MSI<70) also increased (56.25±3.54 vs 48.14±2.71;z=-2.80, P<0.01). The a?bove?mentioned parameters had no statistically significant differences in the 4th week compared to those in the 1st week in the control group (all P>0.05). (2) In the 1st week, the perfusion variables had no signifi?cant differences between the two groups ( P>0.05) . There was no significant difference in any perfusion vari?ables between the 1st and 4th weeks in the two groups, respectively (P>0.05). (3) As evaluated by MRI, the cardiac functional parameters had no significant differences between the two groups at the 1st week. In the MSCs groups, LVEF increased significantly ((54.41±2.62)% vs (47.54±2.43)%;z=-2.60, P<0.01) and ESV reduced significantly ((22.85±1.91) vs (27.07±1.67) ml;z=-2.70, P<0.01) in the 4th week com?pared to those in the 1st week; SV and cardiac CO in the 4th week also increased significantly ((29.35± 1?84) vs (26.52±1.46) ml, (2.23±0.14) vs (1.96±0.13) L/min;z=-2.09 and -1.99, both P<0?05). In the control group, there were no significant differences in the cardiac functional parameters between the 1st and 4th weeks ( all P>0.05) . Conclusions Four weeks after MSCs transplantation for AMI, cardiac func?tion and myocardial glucose metabolism improved significantly but without significant myocardial perfusion improvement. Therefore, the cardiac function improvement might be associated with increased myocardial glucose metabolism.