Objective To investigate the morbidity of anomalous coronary origin from the opposite coronary sinus, which may cause sudden death of young athletes in Chinese population.And to identify the imaging characteristics of this anomaly and its clinical significance combined with literature review.Methods The computed tomographic coronary angiography (CTCA) database at TEDA International Cardiovascular Hospital was reviewed.All of the patients diagnosed with isolated anomalous origin of a coronary artery from the opposite sinus of valsalva (anomalous origin of coronary artery, AOCA) and subsequent coursing between the pulmonary artery and the aorta were collected from 14 343 Chinese individuals.The location of anomalous coronary origin, the shape and course of the proximal ectopic arterial segments were identified.The nonatherosclerostic stenotic caliber of the segments and the angle between the ectopic coronary artery and the adjacent aortic wall were assessed.Results Seventy-four patients of AOCA (including the left or right single coronary artery) were diagnosed using CTCA.Among the 74 cases, the potentially serious course of the ectopic coronary artery between the pulmonary artery and the aorta were identified in 59 individuals.Fifty-six cases of ectopic right coronary with interarterial course (anomalous origin of right coronary artery, AORCA) and three patients with anomalous origin of the left coronary artery (AOLCA) were found, including two cases judged as potentially serious origin of either single left coronary artery (n=1) or single right coronary artery (n=1).The morbidity of the potentially serious anomalous origin of coronary artery in Chinese population was established as 4.1‰ (59/14 343).In the subgroup of AORCA, the lumen of initial ectopic segment was frequently compressed and stenotic.In 29 cases (52.7%) the stenosis of the lumen were more than 50%, and in 3 cases (5.4%) the stenosis of the ectopic coronary artery were more than 70%.The incidence of AORCA was 17.7 times higher (56/3) than that of AOLCA in Chinese population.Conclusions Nowadays CTCA is considered the most useful imaging technique in identifying the origin, shape and course of ectopic initial segment of the coronary artery.The significance of these anatomic characteristics, that may induce sudden death in Chinese young athletes, need to be investigated further.

Objective The purpose of this study was to evaluate the hemodynamic effects of an extra-thoracic paraaortic counterpulsation device(ETPACD) with various capacities in an animal model with acute heart failure.Methods The acute heart failure model was successfully induced by snaring branch of anterior descending coronary artery in sheep(weighting 35-42 kg,n =8).The ETPACD is a single port,40 ml,60 ml and 80 ml stroke volume blood chamber designed to be connected to descending aorta through a valveless graft and placed extra-thorax.The hemodynamic indices of 40 ml,60 ml and 80 ml stroke volume were recorded respectively during counterpulsation assistance.Results 40 ml,60 ml and 80 ml ETPACD increased cardiac output 36.98％ (P =0.009),34.16％ (P =0.012) and 53.26％ (P =0.000) respectively,80 ml compared with 60 ml and 40 ml respectively P =0.001,P =0.005.And on diastolic mean aortic pressure 43.40％ (P =0.000)、63.20％ (P =0.000) and 78.76％ (P =0.000),80ml compared with 60ml and 40ml respectively P =0.329,P =0.025.The ETPACD (40 ml,60 ml and 80 ml) increased left carotid artery flow 45.19％ (P =0.007) 、61.51％ (P =0.001) and 81.50％(P=0.000),80 ml compared with 60ml and40 ml respectively P=0.016,P =0.000.Conclusion This study demonstrated that ETPACD (40 ml,60 ml and 80 ml) provided benefit of circulatory support in acute heart failure with better effect on hemodynamic parameters provided by 80 ml.Therefore,ETPACD with larger stroke volume may become a promising counterpulsation device for treatment of heart failure.

Objective To investigate the relationship of the changes of bone density and biochemical marker of bone turnover with osteoporosis in the elderly with type 2 diabetes mellitus(T2DM). Methods A total of 102 elderly patients with type 2 diabetes and 42 healthy subjects (normal controls) were included in this study.The bone mineral density (BMD) of lumbar vertebrae and femur were measured by dual-energy X-ray absorptiometry (DXA).The T2 DM subjects were divided into two groups:osteoporosis group (56 cases) and non-osteoporosis group (46 cases).The levels of total procollagen type Ⅰ amino-terminal propeptide (TP Ⅰ NP),β-isomerized carboxyterminal propeptide (β-CTx),parathyroid hormone (PTH),serum calcium (Ca2+),serum phosphorus (P),alkaline phosphatase (ALP),fasting blood glucose(FBG),glycosylated hemoglobin (HbAlc) and body mass index (BMI) were detected. The correlations between BMD of the osteoporosis group and other related factors were analyzed. Results The BMD values of lumbar vertebrae and femur neck,troch,ward's triangle in the osteoporosis group were decreased as compared with control(t=9.006,6.347,7.387,5.321,P＜ 0.01) and the serum TP Ⅰ NP,β-CTx,PTH,ALP,FBG,HbAlc,Creatinine and albumin/Cr in the osteoporosis group were significantly higher than controls(t=2.212,4.431,2.215,3.544,0.433,1.629,0.365,5.436,P＜0.01 or P＜0.05),the 25-(OH)VD3 in the osteoporosis group was lower than in controls(t=2.700,P＜0.01).Correlation analysis showed TP Ⅰ NP was negatively correlated with the BMD of femoral Troch and Ward's triangle (r=-0.413,-0.375,P＜0.01),and β CTx was negatively correlated with the BMD of femoral Troch (r=-0.301,P＜0.05).The TP Ⅰ NP,β-CTx in the overweight group and obesity group were higher than in normal group(F=50.59,51.28; F =96.20,95.71,all P＜0.01);the melbine group had higher TP Ⅰ NP,β-CTx than the thiazolidinedione and sulfonylurea group(F=32.33,33.35,F=31.07,39.18,P＜0.01);the TP Ⅰ NP,β-CTx in the better blood glucose control group were lower than in the bad control group(F=11.32,13.69,P＜0.01);the TP Ⅰ NP,β-CTx in the group with complication were increased as compared with no complication group(F=52.75,70.34,P＜0.01).Conclusions The spine BMD in elderly T2DM patients is decreased to some degree.The combined application of TP Ⅰ NP and β-CTx is helpful for the early diagnosis of osteoporosis in patients with type 2 diabetes.

Objective To observe the expressions of RANTES , FKN and IP-10 at mRNA and pro-tein levels in human lung epithelial cells (A549) infected by respiratory syncytial virus (RSV), and to eval-uate the changes of them interfered with 15-deoxy-delta12,14prostaglandin J2(15d-PGJ2), rosiglitazone or 2-chloro-5-nitrobenzanilide ( GW9662 ) .Methods A549 cells were seeded in 6-well culture plates and cul-tured overnight in F12K culture solution.Then they were randomly divided into five groups , including group A (15d-PGJ2+RSV group), group B (rosiglitazone+RSV group), group C (DMSO+RSV group), group D (GW9662+rosiglitazone+RSV group) and group E (cell control group).Cells and supernatants were harves-ted from each group at different time points (12 h, 24 h and 48 h) of culture.The expressions of RANTES , FKN and IP-10 at mRNA and protein levels were measured by ELISA and real-time quantitative RT-PCR analysis.Results The expressions of RANTES , FKN and IP-10 at mRNA and protein levels in group C were significantly higher than those in group E at time points of 12 h, 24 h and 48 h (all P<0.05).In group C, the expressions of the three chemokines at mRNA level reached a peak at 24 h, but began to de-crease at 48 h, which showed no statistical significance compared with those at 12 h (all P>0.05).Moreo-ver, the expressions at protein level were peaked at 48h, and had significant difference with those expressed at 12 h and 24 h (all P<0.05).Compared with group C, the expressions of the three chemokines both at mRNA level and protein level were decreased in group A and B as the dose was increased (all P<0.05), and the lowest levels were observed with the intervention of 20 μmol/L of 15d-PGJ2 in group A and 30μmol/L of rosiglitazone in group B .Conclusion The expressions of RANTES , FKN and IP-10 at mRNA and protein levels were increased with RSV infection , and the peaks of mRNA level and protein level were respectively achieved at 24 h and 48 h after infection.PPARγagonists played an anti-inflammatory role through inhibiting the expressions of the three chemokines both at mRNA level and protein level in a dose -de-pendent manner .

OBJECTIVETo investigate the epidemiological characteristics of respiratory syncytial virus (RSV) subtypes and genotypes in southern Zhejiang province, and to determine whether RSV genotypes are correlated with the disease severity of lower respiratory tract infection (LRTI).

METHODNasopharyngeal secretions (NPS) from children under 5 years of age who were hospitalized with LRTI during 5 consecutive seasons from July 1, 2009 to June 30, 2014 were collected. RSV antigen was determined using direct immunofluorescence (DIF). Two hundred strains of RSV were randomly selected from each epidemic season. RNA was extracted and identified as subtype A or B by using reverse transcription-polymerase chain reaction (RT-PCR), and randomly selected strains of the full length attachment (G) genes of both subtype A and subtype B were amplified by PCR and sequencing. Clinical data were collected, and the disease severity between different genotypes were compared simultaneously.

RESULTOf the total 1 000 randomly selected RSV positive samples, 462 (46.2%) and 538 (53.8%) samples were identified as subtype A and B, respectively. It was found that subtype B predominated in the 2009-2010 and 2012-2014 epidemic seasons and subtype A in 2010-2012 epidemic seasons. A total of 112 strains of complete sequences of G genes were obtained, including four subtype A genotypes NA1, NA4, GA2 and ON1, and six subtype B genotypes BA8-10, BA-C, CB1, and GB2. Phylogenetic analysis revealed that 39/52 (75.0%) subtype A strains were classified as NA1 genotype, followed by ON1 genotype (10/52,19.2%) and 44/60 (73.3%) subtype B strains were classified as BA9 genotype, followed by BA8 genotype (6/60,10.0%). BA9 was the predominant genotype among subtype B except 2010-2011 epidemic season, while NA1 was the predominant genotype among subtype A except 2013-2014 epidemic season. Only ON1 and BA9 genotypes were checked out during 2013-2014 epidemic season. There was statistically significant difference in the average severity score of illness in 39 cases infected with NA1 genotype (4.154) and 44 cases of BA9 genotype (3.341) (U=642.500, P<0.05). Furthermore, in the rate of oxygen uptake, the percentage of those infected with NA1 genotype (33.3%) was higher than those infected with BA9 genotype (13.6%) (χ2=4.544, P<0.05). However, there were no significant difference in the age, clinical symptoms, the percentage of intensive care unit admission, length of hospitalization and the outcome of the disease between NA1 and BA9 infection.

CONCLUSIONThe shift of predominant RSV subtype from 2009 to 2014 were B-A-A-B-B in the southern areas of Zhejiang province. Multiple genotypes co-circulated during five RSV epidemic seasons. NA1 and BA9 genotypes were the predominant genotypes of subtype A and B, respectively. Compared with infection with BA9 genotype, NA1 genotype infection was associated with more severe disease and proportion of patients needed oxygen therapy was higher.

Child, Preschool ; China ; epidemiology ; Genotype ; Hospitalization ; Humans ; Infant ; Nasopharynx ; Phylogeny ; Polymerase Chain Reaction ; Respiratory Syncytial Virus Infections ; epidemiology ; Respiratory Syncytial Virus, Human ; genetics ; Respiratory Tract Infections ; epidemiology ; Seasons

OBJECTIVETo describe trends of changes in blood lead levels in children aged 1 - 6 years during the time period before and after introducing lead free gasoline in Shanghai 1997 and 1999.

METHODSBlood lead levels of 1 969 children aged 1 - 6 years were determined by a sampling survey in five districts of Shanghai in August and September, 1997. Blood lead levels of the same population were re-determined by the same method from April to June in 1998 and from August to September in 1999. Filter paper blood lead test was carried out monthly using the filter paper blood lead proficiency testing program of Centers for Disease Control in the United States. The results from blood lead samples were under acceptable ranges during the study.

RESULTSThe geometric means of blood lead levels were 83 microgram/L in 1997, 80 microgram/L in 1998 and 76 microgram/L in 1999, respectively. The prevalence rates of childhood lead poisoning (blood lead level was equal or more than 100 microgram/L) were 37.8% in 1997, 25.7% in 1998 and 24.8% in 1999. The amounts of decrease on average blood lead levels in the five districts between 1997 and 1999 were 10 microgram/L, 11 microgram/L, 6 microgram/L, 4 microgram/L and 2 microgram/L, respectively.

CONCLUSIONLead poisoning is a preventable disease. The average levels of lead in young children in Shanghai decreased significantly after the introduction of lead free gasoline to Shanghai. Lead emissions from vehicles running on leaded gasoline was one of the important contributors to increase the children's blood lead levels in Shanghai. Lead poisoning is not evenly distributed among children in Shanghai, resulting in the different levels of decline.

Child, Preschool ; China ; Environmental Monitoring ; methods ; standards ; Environmental Pollutants ; blood ; Gasoline ; standards ; Humans ; Lead ; blood ; Time Factors

OBJECTIVEGroup A β-hemolytic streptococcus (GAS) or Streptococcus pyogenes may be encountered in diverse clinical situations in children. A rising incidence of invasive group A streptococcus (IGAS) infections has been noted in children in the past three decades. The aim of this study was to summarize the clinical characteristics and antimicrobial resistance of IGAS in children, and to raise the level of diagnosis and treatment of this infection.

METHODThe clinical data from 19 cases of IGAS younger than 14 years old seen from January 2004 to December 2011 treated in the authors' hospital were analyzed. IGAS infections are defined as the isolation of GAS from a normally sterile site in patients.

RESULTThe 19 cases were identified as IGAS infections, among whom 15 were male and 4 were female, and the ratio of them was 3.75. The age ranged from 1 day to 14 years, with a median age of 4 years. The course of disease was 4 h-10 days. The average length of stay was 12.2 days. In 13 cases the episodes of the infection occurred in winter and spring. In 18 cases the infection was community-acquired. Overall, 10 cases had neck or foot dorsum abscess, four cases had purulent peritonitis, and 3 cases were diagnosed as streptococcal toxic shock syndrome (STSS) complicated with empyema, pyopneumothorax occurred in 1 case and neonatal septicemia in another. Three cases had an underlying disease, including 2 cases wounded in a car accident and 1 case of congenital esophageal atresia and tracheoesophageal fistula. Before the isolation of GAS, 5 cases had stayed in ICUs, the length of ICU stay was 1-32 days, 4 cases had received intubation and mechanical ventilation, the ventilation time was 8 h-24 days, 2 cases had received major surgery; 5 cases had other pathogen coinfection, including 4 cases of abdominal pus at the same time and Escherichia coli was isolated, and 1 case had parainfluenza virus type I coinfection. Peripheral blood leucocyte increased in 18 cases, one case dropped off. The C-reactive protein (CRP) levels increased in all patients, including 16 cases who had 14-160 mg/L, 3 cases had levels higher than 160 mg/L. Twenty strains of GAS were isolated from 19 cases' sterile sites, of them 10 strains were isolated from abscess, 4 strains were isolated from blood and another 4 from ascites. Two strains were from the same patient at different times of pleural effusion. All 20 strains displayed a full susceptibility to cefazolin, levofloxacin and vancomycin, and the rates of resistance to both cefotaxime and penicillin were 10.0%. The rates of resistance to erythromycin and clindamycin were 55.0% and 70.0% respectively. Among the patients 3 cases were cured, 14 cases improved, and 2 cases died, of whom 1 case died of STSS secondary to multiple organ dysfunction, 1 case died of basic disease secondary to multiple organ dysfunction.

CONCLUSIONSkin and soft tissues were the most common IGAS infection sites in children, and IGAS infection also can lead to serious STSS and even can be life threatening. Penicillin and cephalosporin are still sensitive for children IGAS infections.

Abscess ; drug therapy ; epidemiology ; microbiology ; Adolescent ; Anti-Bacterial Agents ; pharmacology ; therapeutic use ; Cephalosporins ; therapeutic use ; Child ; Child, Preschool ; Clindamycin ; therapeutic use ; Community-Acquired Infections ; drug therapy ; epidemiology ; microbiology ; Drug Resistance, Bacterial ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Microbial Sensitivity Tests ; Retrospective Studies ; Soft Tissue Infections ; drug therapy ; epidemiology ; microbiology ; Streptococcal Infections ; drug therapy ; epidemiology ; microbiology ; Streptococcus pyogenes ; drug effects ; isolation & purification