Objective To investigate the algorithm and efficacy of interventional treatment for combined congenital heart diseases. Methods Thirty-four patients (12 males and 22 females) with combined congenital heart disease underwent simultaneous transcatheter therapy. The types of the congenital heart defect combination were as follow: ASD and PS (16 cases); ASD and VSD (7 cases); ASD and PDA (3 cases); ASD and MS (2 cases); VSD and PDA (3 cases); Taussig-Bing and PDA(1 case); PDA, ASD and PS (1 case); ASD, VSD and PDA (1 case). The algorithm of transcatheter intervention was: PBPV or PBMV at first followed by the occlusion of VSD, PDA and ASD successively. Transthoracic echocardiography (TTE) and X-ray examination were done 3d, 1 m and 3 m after the procedure to evaluate the outcome of the procedure. Results All patients were treated successfully at one time. No complications occurred during and immediately after the procedure. There was no residual shunt and all the occlusion devices were found in the suitable site evaluated by means of TTE and X-ray right after the procedure. In 16 patients with ASD and PS, the systolic pressure across the pulmonary valve decreased from (53?20) mm?Hg to (14?10) mm?Hg (P

Objective To explore the related factors of school refusal behavior in child and adolescent.Methods Investigated 141 students who had school refusal behavior in the department of psychiatry as the case group. 109 students were chosen randomly from 3 different grades in different schools as the control group. Two experienced psychiatrists made diagnosis according to DSM-Ⅳ criteria, the case group completed the direct factor investigation of School Refusal and the general condition questionnaires. The control group completed the general condition questionnaire only. Results 61 (43.7%) of the case group were diagnosed mental disorder according to DSM-Ⅳ ,17(28.91% ) of them were diagnosed mood disorder, which was the most in all kinds of mental disorder in case group. The results showed that age (P = 0.0003 ), location (P = 0. 035 ) and family income (P ＜ 0. 01 )were the most important factors for school refusal behavior in child and adolescent. The opinions of child and parent on the school refusal factors were quite different (P ＜ 0. 05 ). The former three direct reasons of school refusal were study pressure (6.47%) ,much more examinations and homework( 6.03% ) ,and willing to stay at home only (5.63%). Conclusion Mental disorder is the main causation of school refusal behavior. Age, location and family income are related closely to school refusal behavior. Study pressure, peer difficulty and poor parent-child relationship are direct factors of school refusal behavior.

Objective To evaluate the clinical effect of interventional occlusion for atrial septal defect(ASD) with domestic occluder by X-ray in combination with echocardiography.Methods 38 patients with ASD were all implanted with domestic occluder.The imageological data before and 6 months after treatment were analysed and compared.Results There were no residual shunts after interventional treatment.The heart surface area,right inferior pulmonary artery diameter,the base lines of pulmonary cone,the diameters of pulmonary trunk and the degree of protrusion of pulmonary cone were all decreased after operation(P

This paper develops a type of x-ray unit which can produce x-ray image suitable for medical diagnosis. The unit is composed of a CCD image sensor with high sensitivity and high resolution, a digital image acquisition board, and a suit of computer software. The software can be applied as the doctor's workstation with the functions of patient register, image process and image management. Some styles of digital radiography technology are introduced briefly, and the principle of the x-ray unit as well as its hardware and software designs are presented particularly.

ObjectiveTosurvey obsessive-compulsivesymptomof childrenandadolescents.Methods4335 children and adolescents aged ( 13.88 ± 2.44) year-old (47.7％ male) were measured with leyton obsessional inventory-child version (LOI-CV).ResultsThe frequency of total yes/no score of LOI-CV manifests as normal distribution,while the frequency of total interfering score manifests as J curve.Total yes/no scores of female were higher than that of male ( ( 8.55 ± 3.87 ),(8.21 ± 3.99),t =2.86,P ＜ 0.01 ) ; the difference of country and city were not significant ( ( 8.57 ± 3.86),( 8.35 ± 3.9 ),t =1.32,P ＞ 0.05 ).Primary school ( n =937 ),junior high school ( n =1906 ),senior high school ( n =1492 ) exited significant difference ( (7.86 ± 3.82),( 8.52 ± 3.93 ),( 8.55 ± 3.891 ) respectively,F =11.03,P ＜ 0.01 ).The total interfering scores of male were higher than that of female ( ( 11.35 ± 9.10),( 10.76 ± 8.84),t =2.18,P =0.03 ).The total interfering scores of country were higher than that of city( ( 11.86 ±9.18),( 10.88 ±8.92),t=2.61,P＜0.01 ) ;the difference of primary school,junior high school and senior high school were significant ( ( 10.05 ± 8.76 ),( 11.73 ± 9.17),( 10.77 ± 8.76),F =12.088,P ＜ 0.01 ).The total interfering score from grade four of primary school to grade three of senior high school were( 10.0 ± 8.78),( 10.01 ± 8.64),( 10.19 ± 8.92),( 11.43 ±9.16),(11.40 ±8.67),(12.58 ±9.76),(10.32 ±8.42),(10.19 ±8.38),(12.48 ±9.69) respectively(F=5.90,P＜0.01 ).The two grades of the highest total interfering score were grade three of junior high school and grade three of senior high school.ConclusionObsessive-compulsive symptom are common in children and adolescents.Children and adolescents of male grade three of junior high school or senior high school in the country are more probably interfered by obsessive-compulsive symptom.

Objective: To analyze the impact factors of occluder choice for transcatheter closure of adult large atrial septal defect (ASD). Methods: Data of 65 patients with large ASD were retrospectively analyzed. The relationships of occluder choice for transcatheter closure of ASD and the diameter, shape and edge of defect were observed. Results: ASD in all patients were successfully occluded, with 40 mm diameter occluders in 26 cases, 42 mm diameter occluders in 24 cases and ≥ 44 mm diameter occluders in 15 cases. There was no difference of defect maximum diameter (Dmax), minimum diameter (Dmin), Dmin/Dmax nor the added value of occluder (all P>0.05) among the above three, whereas there were statistical differences of Dmax, Dmin and the added value of Dmin/Dmax<0.80 (n=24) and ≥0.80 (n=41) occluders (all P<0.05). Meanwhile, significant differences of diameter and the added value of occluders were noticed between patients with distance of defect aortic margin or posterior inferior margin <5 mm (n=45) and those ≥5 mm (n=20, all P<0.05). Conclusion: For intervention treatment of adult large ASD, the diameter, shape and edge of defect are the impact factors of choice of occluder.

ObjectiveTo develop school refusal reason inventory (SRRI)for children and adolescents in China and assess its reliability and validity.MethodsThe primary SSRI was made based on clinical interviews and literatures.Pretest was carried out in a small sample from a clinic.Then the final SSRI was developed after qualitative analysis and item analysis.SRRI,the Screen for Child Anxiety Related Emotional Disorders(SCARED) and Child Depression Inventory(CDI) were administered to school refusers from 7 schools in Shenyang.All the schools were selected from Shenyang City and its countryside by cluster sampling.Some of the students were retested after one month.Descriptive statistics and exploratory factor analysis were carried out to examine the reliability and validity of SRRI based on all the data.Results Item analysis indicated correlation coefficients between all the items and the total marks were higher than 0.3,and they were significant.All the critical ratios of the items were higher than 0.3.The 43 items were divided into six factors ( educational modality,factor of teachers,relationship with classmates,separated anxiety,study attitude and study environment) by exploratory factor analysis.The factor loading values were 0.372 ～0.848.The cronbach's α of each factor was 0.827,0.831,0.759,0.623,0.821 and 0.808.Retest reliability was 0.644 (P ＜ 0.01 ).Its correlation coefficient with SCARED was 0.452 and 0.548 with CDI.ConclusionAccording to Chinese cultural back ground,the SSRI corresponds with psychometric indexes.There are good reliability and validity.It is helpful to understand the reasons of school refusal behavior in children and adolescents.

Objective: To compare the efficacy and safety of Cardi-O-fix patent foramen ovale (PFO) occluder and Amplatzer PFO occluder for the treatment of patients with PFO. Methods: A total of 246 consecutive patients (105 males and 141 females) with PFO were prospectively enrolled from May 30, 2013 to March 30, 2015 in our hospital. PFO interventional closure was applied according to the anatomical structure of the disease and patients′ wishes.Cardi-O-fix PFO occluder was used in 180 cases (COF group), Amplatzer PFO occluder was used in the remaining 66 cases (Amp group). Post-procedure safety including recurrent stroke, transient ischemic attack, death, and complete closure rate, and efficacy including procedure related complications of different devices were compared during the 12 months follow-up. Results: (1) Rate of transient ischemic attack was similar between COF group and Amp group at 12 months after procedure(1.1%(2/180) vs. 1.5%(1/66), P=1.000). There was no recurrent stroke and death during the 12 months follow-up period.Complete closure rate was similar between COF group and Amp group at 12 months after the procedure(90.6%(163/180)vs. 86.4%(57/66), P=0.355). (2) Three cases(1.7%) of paroxysmal atrial fibrillation were observed in COF group during the 12 months follow-up period, 1 patient converted spontaneously to sinus rhythm and 2 patients received successful pharmacologic conversion and converted to sinus rhythm. One patient(1.5%)developed paroxysmal atrial fibrillation and was pharmacologically converted to sinus rhythm in the Amp group. There was no significant difference in rate of paroxysmal atrial fibrillation between the two groups(P=1.000). There was no complications such as occluder translocation, erosion, pericardial effusion and puncture site bleeding in the 2 groups during the 12 months follow-up. Conclusion Efficacy and safety are similar for PFO treatment with Cardi-O-fix PFO occluder or Amplatzer PFO occluder in this patient cohort.

OBJECTIVETo observe the effect of oversized occluder on endothelialization post percutaneous closure of experimental atrial septal defect (ASD) in dogs.

METHODSASD was established with the help of transthoracic echocardiography in 18 dogs. ASD size was (6.0 ± 0.2) mm. Dogs were randomly divided into normal size group (implanted with 8 mm occlude, n = 9) and oversized group (implanted with 12 mm occluder, n = 9). Dogs were randomly killed at 3, 6 and 14 months after percutaneous closure. The endothelialization process on device surface was observed by scanning electron microscope.

RESULTSFour animals died around 1 month post procedure. Microscopic sections from normal group showed nearly complete endothelialization at 3 months after device implantation and complete endothelialization at 6 and 14 months after device implantation. While microscopic sections showed lack of endothelialization at 3 months post implantation, nearly endothelialization at 6 months, and complete endothelialization at 14 months after device implantation in oversized group.

CONCLUSIONIncomplete endothelialization of occluder surface is observed at 6 months after implantation of an oversized ASD occluder device in this model.

Objective To explore the nursing measures of patients with congenital hyperinsulinism during hospitalization and to develop nursing strategies. Methods A total of 131 patients with congenital hyperinsulinism were enrolled in the Department of Endocrinology and Metabolism, Beijing Children′s Hospital. The patients were divided into four nursing stages for the treatment of children. The first stage: diagnosed as soon as possible and minimized hypoglycemia on children caused by injury; the second stage: patient feeding, monitoring diazoxide caused by gastrointestinal tract, circulatory system adverse reactions; the third stage: monitoring blood glucose changes, timely adjustment of octreotide dosage; the fourth stage: perioperative period of care, the prognosis of the full mission;throughout the focus of care was to keep the vein pass patency to maintain normal blood sugar. Results The number of patients receiving one to four stages of nursing were 131, 104, 18, 5 cases, respectively. The number of patients with satisfactory results after treatment was 27, 71, 15, 1, respectively. For patients who did not receive satisfactory glycemic control of the 15 patients were followed up, of which 5 cases were lost, 6 cases with improvement of hypoglycemia symptoms 2 years later, 4 cases were dead due to multiple organ damage. Conclusions The treatment of congenital hyperinsulinism patients is responsible for the long process, targeted care measures should be carried ou aiming at different treatment methods in order to obtain a satisfactory care effect.