Endothelial Cells ; pathology ; Endothelium, Vascular ; cytology ; pathology ; Humans ; Mucocutaneous Lymph Node Syndrome ; pathology

Childhood hypertensive crisis is a relatively rare emergency event,and is associated with a high risk of morbidity and mortality.Children in this situation need rapid,safe and effective treatment to release clinical symptoms,relieve injuries of target organs,improve quality of life,and reduce mortality.Many kinds of anti-hypertension drugs have been used in children for decades,but most data were extrapolated from studies in adult.There is limited number of randomized controlled trials in children.Therefore it is still difficult to choose drugs for pediatric hypertensive crisis based on evidence-based medicine.This paper sought to summarize the experience of medical management of childhood hypertensive crisis in children.

Objective To determine the risk factors for coronary artery lesions (CALs) in patients with Kawasaki disease (KD).Methods The clinical records of 2331 patients with KD from January 2005 to December 2014 in Beijing Children's Hospital,Capital Medical University were retrospectively analyzed.The relationship between the following factors and CALs was analyzed by univariate and multivariable Logistic regression analysis:age,gender,incomplete KD,total fever duration,intravenous immunoglobulin(IVIG) treatment resistance,white blood cell count,C-reactive protein (CRP),platelet count,sodium and albumin.Results The incidence of CALs was 36.0％(840/2331 cases).Univariate Logistic regression analysis indicated that male patients,incomplete KD,total fever duration ≥10days,IVIG treatment resistance,CRP＞100mg/L,platelet count＞300×109/L and albumin＜35 g/L were associated with CALs (all P＜0.05).Multivariable Logistic regression analysis identified that male patients (OR=1.698,95％ CI 1.383-2.084,P＜0.001),incomplete KD (OR=2.730,95％ CI 2.121-3.515,P＜0.001),total fever duration ≥10 days (OR=2.556,95％ CI 1.975-3.307,P＜0.001),CRP＞100 mg/L (OR=1.556,95％ CI 1.274-1.900,P＜0.001) and albumin＜35 g/L (OR=1.665,95％ CI 1.323-2.096,P＜0.001) were the independent risk factors for CALs.Conclusions The main damage in patients with KD is CALs.The male children with KD,incomplete KD,total fever duration ≥10 days,CRP＞100 mg/L and albumin＜35 g/L were prone to CALs.

Objective To analyze the spectrum of underlying diseases in children with transient loss of consciousness (TLOC) through a multi-center and large sample clinical research.Methods Nine hundred and thirty-seven children with TLOC who came from Beijing,Hunan province,Hubei province and Shanghai of China from Aug 1999 to Apr 2011 were recruited in the present study,and then the spectrum of underlying diseases in children with TLOC was analyzed.Results In 937 children with TLOC,903 cases (96.4％ )were children with syncope,34 cases (3.6％) were non-syncope.And in 903 children with syncope,213 cases (23.6％) had vasovagal syncope (VVS) with vasoinhibitory response,46 cases (5.1％ ) had VVS with cardioinhibitory response,112 cases ( 12.4％ ) had VVS with mixed response,268 cases (29.7％ ) had postural tachycardia syndrome,22 cases (2.4％) had orthostatic hypotension,19 cases (2.1％ ) had situational syncope,21 cases (2.3％ ) had cardiogenic syncope,and 202 cases (22.4％ ) had unexplained syncope.Conclusion In children with TLOC,syncope was the most common underlying disease.And in children with syncope,the most common was VVS,followed by postural tachycardia syndrome.In three different hemodynamic patterns of VVS,the most common pattern was VVS vasoinhibitory pattern.

Objective To assess the value and feasibility of 64-slice spiral CT in diagnosis of coronary artery aneurysm in the follow-up of young children with previous Kawasaki disease. Methods Twelve boys (mean age 5.1 years) for follow-up (ranged 1.1 to 5.1 years) with known Kawasaki disease and coronary artery aneurysms underwent coronary CT angiography using 64-slice spiral CT.The number,location,shape and size of each coronary artery aneurysm were recorded and compared with those of echocardiography performed simutaneously. Results A total of 30 coronary artery aneurysms were identified with mean diameter of(7.5±3.8) mm,and mean maximum length of (12.4±9.1) mm.10 aneurysms were small in size,7 aneurysms were medium in size and 13 were giant aneurysms.Fourteen aneurysms were saccular,and the remaining 16 were fusiform. Among the aneurysms in left coronary artery,7 of them were located in the main branch,9 were located in the proximal segment of the anterior descending branch,4 were located at the middle segment of the anterior descending branch,and 2 were located in the circumflex branch.Among the aneurysms in right coronary artery,6 of them were located in the proximal segment,9 were located in the middle segment,and 4 were located at the distal segment.Nine of the aneurysms involved 2 segments of the coronary arteries,and one involved 3 segments.Six stenotic segments were found. Calcification was found in 5 aneurysms and 3 of them had thrombosis. Echocardiography failed to detect 8 aneurysms of small size and located in the middle or distal segments of the coronary arterys.Conclusion The 64-slice CT angiography proved valuable for monitoring young children with Kawasakidisease.

To investigate the effects of metallothionein (MT) on isolated rat heart, 16 Wistar rats were randomly divided into 2 groups. In control group (group C), distilled water was injected intraperitoneally and 24 h later isolated hearts were perfused with Langendorff and stored at 4 degrees C for 3 h with histidine-tryptophan-ketoglutarate (HTK) solutions, and then isolated hearts were perfused for 2 h by Langendorff. In experimental group (group E), 3.6% ZnSO(4) was injected intraperitoneally, 24 h later isolated hearts were perfused by Langendorff and stored at 4 degrees C for 3 h with HTK solutions, and then the isolated hearts were perfused for 2 h with Langendorff. MT content, the recovery of hemodynamics, myocardial water content (MWC), lactate dehydrogenase (LDH) and creatine kinase (CK) leakage, adenosine triphosphate (ATP) and malondialdehyde (MDA) content, superoxide dismutase (SOD) activity, myocardial cell Ca(2+) content, Ca(2+)-ATPase activity of mitochondria ([Ca(2+)-ATPase](m)) and its Ca(2+) content ([Ca(2+)](m)), synthesizing ATP activity of mitochondria ([ATP](m)), and the ultrastructure of cells were examined. There were a significant increase in group E in hemodynamic recovery, ATP content, SOD activity, [Ca(2+)-ATPase](m) activity, [ATP](m) activity, and substantial reduction in MWC, LDH and CK leakage, MDA content, myocardial cell Ca(2+) content, [Ca(2+)](m) content, and the ultrastructural injury were obviously milder than that of group C. This study demonstrated that MT has protective effects on isolated rat heart.
Cardiotonic Agents/*pharmacology ; Creatine Kinase/*metabolism ; L-Lactate Dehydrogenase/metabolism ; Metallothionein/biosynthesis ; Metallothionein/*pharmacology ; Myocardium/*metabolism ; Myocardium/ultrastructure ; Random Allocation ; Rats, Wistar ; Superoxide Dismutase/metabolism ; Zinc Sulfate/pharmacology

Cardiovascular disease(cardiomyopathy, myocardial infarction, heart failure)seriously endanger child health.Although the incidence in children is not very high, the prognosis is usually poor due to limited treatment options.With the rapid development of stem cell technology and regenerative medicine in recent years, stem cell transplantation has been proved to be able to promote cardiomyocyte regeneration, improve myocardial remodeling and left ventricular ejection fraction(LVEF), so as to alleviate cardiovascular diseases fundamentally.Mesenchymal stem cells(MSCs), a kind of pluripotent adult stem cell with profound self-renewal capacity and multi-directional differentiation potential, have been gradually applied in the treatment of children′s cardiovascular diseases, such as cardiomyopathy, myocardial infarction and end-stage heart failure, and initial success has now been achieved.This review is to summarize the advance of MSCs in the treatment of cardiovascular diseases in children.

To investigate the effects of metallothionein (MT) on isolated rat heart, 16 Wistar rats were randomly divided into 2 groups. In control group (group C), distilled water was injected intraperitoneally and 24 h later isolated hearts were perfused with Langendorff and stored at 4℃ for 3 h with histidine-tryptophan-ketoglutarate (HTK) solutions, and then isolated hearts were perfused for 2 h by Langendorff. In experimental group (group E), 3.6% ZnSO4 was injected intraperitoneally, 24 h later isolated hearts were perfused by Langendorff and stored at 4℃ for 3 h with HTK solutions, and then the isolated herts were perfused for 2 h with Langendorff. MT content, the recovery of hemodynamics, myocardial water content (MWC), lactate dehydrogenase (LDH) and creatine kinase (CK) leakage, adenosine triphosphate (ATP) and malondialdehyde (MDA) content, superoxide dismutase (SOD) activity, myocardial cell Ca2+ content, Ca2+-ATPase activity of mitochondria ([Ca2+-ATPase]m) and its Ca2+ content ([Ca2+]m), synthesizing ATP activity of mitochondria ([ATP]m), and the ultrastructure of cells were examined. There were a significant increase in group E in hemodynamic recovery, ATP content, SOD activity, [Ca2+-ATPase]m activity, [ATP]m activity, and substantial reduction in MWC, LDH and CK leakage, MDA content, myocardial cell Ca2+ content, [Ca2+]m content,and the ultrastructural injury were obviously milder than that of group C. This study demonstrated that MT has protective effects on isolated rat heart.

The incidence of incomplete Kawasaki disease(iKD) has bean increasing year by year.Significant individual differences in manifestations, insidious onset, and lack of specific symptoms and effective diagnostic biomarkers often result in delayed diagnosis or misdiagnosis, which makes iKD children at higher risk of cardiovascular complications such as coronary artery dilation or coronary aneurysm and even secondary thrombosis or sudden death.The purpose of this review was to introduce the diagnosis and treatment of iKD, and thus provide evidence for clinicians.

BACKGROUNDCoronary artery damage from Kawasaki disease (KD) is closely linked to the dysfunction of the endothelial progenitor cells (EPCs). The aim of the present study was to evaluate the modulatory effect of granulocyte colony-stimulating factor (G-CSF) on EPCs and elastin breakdown of coronary arteries in a KD mouse model.

METHODSA Lactobacillus casei cell wall extract (LCWE)-induced KD model was established in C57BL/6 mice that were subsequently administrated with recombinant human G-CSF (rhG-CSF). Nω-nitro-L-arginine methyl ester (L-NAME) was administrated for the negative intervention. Evaluations included coronary artery lesions, EPC number and functions, and the plasma concentration of nitric oxide (NO).

RESULTSElastin breakdown was found in the coronary arteries of model mice 56 days after injection of LCWE. The number of circulating EPCs, plasma concentration of NO, and functions of bone marrow EPCs, including proliferation, adhesion, and migration abilities, were all lower in the KD model group compared with those in the control group. After administration of rhG-CSF, the number of circulating EPCs and plasma concentration of NO were increased significantly compared with those in the KD model group. There were also increases in the functional indexes of EPCs. Furthermore, rhG-CSF administration improved the elastin breakdown effectively. However, these protective effects of rhG-CSF on coronary arteries were attenuated by L-NAME.

CONCLUSIONThe present study indicated that the administration of G-CSF prevents elastin breakdown of the coronary arteries by enhancing the number and functions of EPCs via the NO system, and then accelerates the repair of coronary artery lesions in the KD.

Animals ; Coronary Vessels ; cytology ; drug effects ; metabolism ; Disease Models, Animal ; Elastin ; metabolism ; Endothelial Progenitor Cells ; cytology ; Granulocyte Colony-Stimulating Factor ; therapeutic use ; Male ; Mice ; Mice, Inbred C57BL ; Mucocutaneous Lymph Node Syndrome ; blood ; drug therapy ; metabolism ; NG-Nitroarginine Methyl Ester ; pharmacology ; Nitrogen Oxides ; blood