Hypertension in children and adolescents is defined as systolic blood pressure(SBP)and/ or dias-tolic blood pressure(DBP)≥95th percentile for age,gender and height,on at least 3 occasions. Primary hypertension is more common among children of older age or adolescents,while secondary hypertension accounts for more cases for younger children. Among causes of secondary hypertension,renovascular diseases,renal parenchymal diseases,cardio-vascular diseases,and endocrine diseases are common. An initial evaluation can be reached after history taking and physical examination,to decide whether it should be primary or secondary hypertension. Laboratory tests and procedures can further confirm the classification and etiology. There is an increase in prevalence of hypertension in children and adolescents,and an in - time diagnosis and evaluation of hypertension is important to help patients receive a better management of their conditions.

Postural tachycardia syndrome (POTS) is one type of orthostatic intolerance.The treatment for POTS including non-drug treatment and medications,such as α-receptor agonists,β-recepter blockers and oral rehydration salts.The prognostic meaning of biomarkers and hemodynamic parameters in the POTS children treated with midodrine hydrochloride are discussed in this paper.

Objective:To discuss the variation of parameters in ambulatory blood pressure for neurally mediated syncope(NMS) in children,and to analyze the diagnostic value of ambulatory blood pressure pattern in children with NMS.Methods: Forty-seven children with NMS [20 males and 27 females,mean age(11.7?2.8) years] who came from Peking University First Hospital from July,2007 to March,2008 were included in the study.Twenty-three healthy children [12 males and 11 females,mean age(11.0?3.2) years] were recruited as control group.And the hemodynamic patterns of NMS were detected.Based on the hemodynamic patterns,they were divided into vasovagal syncope(VVS) group [16 children in total,7 males and 9 females,mean age(11.5?2.8) years] and postural tachycardia syndrome(POTS) group [31 children in total,13 males and 18 females,mean age(11.7?2.9) years].Parameters of children with different hemodynamic patterns in ambulatory blood pressure and diagnostic value of ambulatory blood pressure pattern were analyzed.SPSS 10.0 software was used for the statistical analysis of these data.Results: Mean diastolic pressure of the whole day,mean diastolic pressure in the day-time and mean systolic pressure at night in POTS group were higher than those of the control group,reapectively(P0.05).The systolic pressure differences in the day-time and at night in VVS group and POTS group were lower than those of the control group,respectively(P0.05).The non-spoon pattern rate of fluctuation curve of ambulatory blood pressure in VVS group and POTS group was higher than that of the control group(68.8% vs 17.4%,64.5% vs 17.4%,P0.05).The sensitivity,specificity and diagnostic coincidence of ambulatory blood pressure pattern to NMS was 66.0%,82.6% and 71.4%,respectively.Conclusion: There was autonomic nerve adjustment imbalance in children with NMS.And the diagnostic value of ambulatory blood pressure pattern to children with NMS was high.

Cardiovascular Diseases ; diagnosis ; therapy ; Child ; Humans ; Quality of Health Care

AIM: To explore the effects of hydrogen sulfide (H_2S) on proliferation of vascular smooth muscle cells (VSMC) stimulated by endothelin (ET-1, 10 -7 mol/L ) and mitrogen-activated protein kinase (MAPK) activity in VSMCs. METHODS: Cultured VSMCs were divided into six groups: (1) control group, (2) serum group, (3) endothelin group, (4) NaHS groups, (5) serum+NaHS group, and (6) endothelin+NaHS group. VSMC proliferation was measured by [ 3H]-TdR incorporation and MAPK activity in VSMC was determined by radioactivity assay. RESULTS: ET-1 increased VSMC [ 3H]-TdR incorporation by 2.39 times ( P

Cultivation of academic type of medical graduate students is an important part of medical education system in our country and the individualized cultivation is an important way of training.Frist,the individualized cultivation of academic type of medical graduate students requires that supervisors fully understand the characteristics of the graduate students based on supervisors' subjective feelings and the result of scientific research test of the students.and then divide the students into three types(type A,B and C).With reference to the PDCA cycle management model,the supervisors carry out the individualized cultivation for different types of students in various links of the PDCA cycle,in order to encourage excellent students,urge the average students,and help the students who are behind.From the result of the individualized cultivation of academic type of medical graduate students in single research team,the proportion of students type rose from 2.9％ (type A),65.7％ (type B) and 31.4％(type C) at the beginning to 23.5％(type A),68.6％(type B) and 7.9％(type C) at the time of graduation.The research output is huge,so as to promote the quality of cultivation of academic type of medical graduate students.

Objective: To explore the effects of hydrogen sulfide (H 2S) on hypoxic pulmonary vascular smooth muscle cell (VSMC) apoptosis in rats. Methods: Twenty four Wistar rats were divided into 3 groups: control group ( n =8), hypoxia group ( n =8), and hypoxia +NaHS group ( n =8). The plasma level of H 2S was determined by methylene blue spectrophotometric method. VSMC apoptosis was measured by terminal deoxynucleotidyl transferase biotin nick end labeling (TUNEL). The protein expressions of Bcl 2, Fas and caspase 3 in pulmonary arteries were detected by immunohistochemical technique. Results: Compared with rats in the control group, the plasma level of H 2S decreased by 36% in rats of hypoxic group . The apoptotic rate per area in VSMCs detected with TUNEL was significantly decreased by 52.9% in rats of hypoxic group . The expressing integral score of Bcl 2 of VSMCs was increased by 123.9%,while Fas protein expression of VSMCs was decreased by 45% and caspase 3 protein expression of VSMCs was not significantly changed in rats of hypoxia group. But compared with rats in the hypoxia group, the plasma level of H 2S increased by 65% in rats of hypoxia+NaHS group. The apoptotic rate in VSMCs of TUNEL was significantly increased by 62.5% in rats of hypoxia+NaHS group. The Bcl 2 protein expression of VSMCs was decreased by 36.4% in rats of hypoxia+NaHS group. The expressing integral scores of Fas and caspase 3 were significantly higher in rats of hypoxia+NaHS group than in those of hypoxia group. Conclusion: Hypoxia decreased the pulmonary artery smooth muscle cell apoptosis. H 2S inhibited Bcl 2 protein expression of VSMCs and activated Fas and caspase-3 protein expressions of VSMCs, and therefore promoted the pulmonary artery smooth muscle cell apoptosis.

Objective To investigate the effects of endogenous sulfur dioxide(SO2) on pulmonary vascular inflammation in rats with monocrotaline (MCT)-induced pulmonary hypertension.Methods Thirty-two Wistar rats were randomly divided into 4 groups(n =8 for each group):control group,MCT group,MCT + L-aspartic acid-β-hydroxamate(HDX) group,and MCT + SO2 group.Rats in the MCT group,MCT + HDX group,and MCT + SO2 group were subcutaneously injected with MCT(60 mg/kg) on the first day.For rats in MCT + HDX group,HDX(25 mg/kg,on day 0,7 and 14) was given orally after injection of MCT; and rats in MCT + SO2 group were subcutaneously injected with the SO2 donor sodium sulfite/sodium bisulfate(Na2SO3/NaHSO3,and mole ratio was adjusted to approximately 3:1) each day.Rats in the control group received only the same volume of solvent vehicle only.After 3 weeks,mean pulmonary artery pressure(mPAP) of each rat was evaluated by using a right cardiac catheterization procedure.Immunohistochemistry was used to detect the expression of inflammatory related factor intercellular adhesion molecule-1 (ICAM-1) and the key molecules of nuclear factor-κB (NF-κB) signal transduction pathway,including p65 and inhibitor of NF-κB (IκBα) in the small pulmonary artery endothelial cells.Results The differences in mPAP,expression of ICAM-1,IκBα and p65 in the small pulmonary artery endothelial cells were found among the 4 groups (mPAP:F =53.334,P ＜ 0.01 ; ICAM-1:F =183.82,P ＜ 0.01 ; IκBα:F =142.89,P ＜ 0.01 ; p65:F =105.46,P ＜0.01).The mean pulmonary artery pressure(mPAP) was significantly raised in MCT group rats as compared with that of the control group along with upregulated expressions of ICAM-1 protein and p65 protein in small pulmonary artery endothelial cells,while the expression of IκBα protein in small pulmonary artery endothelial cells was significantly low.After administration of HDX,the mPAP and the expression of ICAM-1 protein and p65 protein in small pulmonary artery endothelial cells further increased compared with those of MCT group,while the expression of IκBα protein in small pulmonary artery endothelial cells was significantly lower than that of MCT group.Whereas with treatment of SO2 derivatives,the mPAP,the expression of ICAM-1 protein and p65 protein in small pulmonary artery endothelial cells were significantly lower than those of MCT group,while the expression of IκBα protein in small pulmonary artery endothelial cells increased significantly compared with that of MCT group.Conclusions Endogenous SO2 might inhibit the activation of NF-κB pathway in the small pulmonary artery endothelial cells,attenuate the pulmonary vascular inflammation and prevent the MCT-induced pulmonary hypertension in rats.

Objective To investigate the clinical effect and the prospect of Infliximab in treatment of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) patients.Methods Clinical features,inflammatory markers and coronary changes were observed in 2 cases of IVIG-resistant KD patients hospitalized in Peking University First Hospital,who were treated effectively by Infliximab.Relevant researches on the mechanism and progress of the Infliximab treatment for IVIG-resistant KD in the last 10 years were reviewed at the same time.Results Two KD patients hospitalized in Peking University First Hospital had been treated with 2 g/kg IVIG for 2 times and followed by methylprednisolone treatment.However,fever and other clinical manifestations occurred again after 2 days and 6 days when temperature returned normal.They both defervesced and all the symptoms were improved after 1 dose of Infliximab (5 mg/kg) by laboratory examinations.Four published literatures of the basic research and 9 retrospective or prospective clinical researches of Infliximab treatment of KD showed that Infliximab alleviated the inflammatory level in the KD patients significantly.Complete remission was up to 72.73％-92.11％.Those KD patients defervesced within 12 h,with dramatic improvement of symptoms and signs.Arthralgia also disappeared in the patients with arthritis.Only 1 case was complicated with hepatitis in the acute phase and cholecystitis in recovery time.A phase 3 randomised,double-blinded,placebo-controlled trial had been done to assess the addition of Infliximab to the standard therapy.Conclusions Infliximab is a feasible choice for IVIG-resistant KD patients.Efficacy and safety of Infliximab for KD treatment have been proved in the literature.However,Infliximab for KD treatment has not been indicated in the drug instruction,so the informed consent from the guardians and Ethics Committee is needed.