Myocarditis is one of the most common acquired heart diseases in children,and one of the most common causes of a pediatric dilated cardiomyopathy phenotype.The myocarditis is a difficult issue in the diagnosis and the optimal means of therapy.A recent Pediatric Cardiomyopathy Registry (PCMR) analysis in the largest group of pediatric myocarditis patients ever studied confirmed that the most common outcome in pediatric myocarditis was cardiac recovery,but approximately 30％ of pediatric myocarditis patients would die or undergo heart transplantation.Animal studies and adult experience suggested that autoimmunity might contribute to cardiac dysfunction in myocarditis.Immunosuppressive and immunomodulating therapy for pediatric myocarditis remains controversial.Small case series have shown benefit of these therapies in pediatric myocarditis.A limited number of biomarkers associated both good (recovery) and poor (death or transplantation) outcomes could be identified.We should do our best to find these biomarkers in the future.

Syncope is a common clinical problem in children and adolescents. It is a major challenge for practicing physicians, and medical resource utilization and expenses associated with syncope management are enormous. A diagnostic protocol to syncope must be developed for children and adolescents for convenient and effective final diagnosis, and an analysis of cost-effectiveness is meaningful. Thus, according to the studies of syncope in children in China,the Chinese Pediatric Cardiology Society proposed the guidelines for diagnosis of syncope in children in China, and developed a simplified diagnostic protocol for children and adolescents with syncope. According to a multi-center prospective study,the diagnostic protocol in children and adolescents with syncope results in an improvement of diagnostic yield.

Arrhythmia-induced cardiomyopathy (AIC) is a myocardial disease condition in which left ventricular dysfunction and cardiomegaly are induced or mediated by atrial or ventricular arrhythmias.The pathophysiological mechanisms remain unclear.Early recognition of AIC and provision of prompt treatment with pharmacological or ablative techniques could result in symptom resolution and recovery of ventricular function.But,the long-term prognosis of these patients is not clear and needs further observation and research.

Objective: To explore the effects of ligustrazine on the secretion of hydrogen sulfide in the ventricular tissues of rats under physiological condition.Methods:32 rats were divided into control group,high dose group of ligustrazine(150?g/ml),medium dose group of ligustrazine(15?g/ml) and low dose group of ligustrazine(1.5?g/ ml) at random.The left and right ventricular tissues were incubated in 37℃ thermostatic water bath for 4 hours with Krebs solution as supernatant.After incubation of the ventricular tissues,the sensitive electrode-based method was used to detect the content of H2S in the supernatant.Results: In the left ventricular tissues,there were on dif-ference of the H2S level betweenthe 1.5?g/ml ligustrazine group(0.17?0.03),15?g/ml ligustrazine group(0.17?0.03)and control group.However,compared with control group, the H2S level in hige dose group of ligustrazine decreased obviously(P0.05),but the H2S level in the 150?g/ml ligustrazine group(0.46?0.09)was significantly lower than that in the control group(0.64?0.13)(P

Objective To investigate the prevalence of metabolic syndrome in patients with maintenance hemodialysis, and to analyze the potential risk factors. Methods The clinical data of 472 patients with maintenance hemodialysis from 7 blood purification centers were collected. Patients were divided into the MS group and the non-MS group. The demographic data , anthropometric examinations , dialysis prescription and results of laboratory were compared between these two groups. Multivariate Logistic regression analysis was performed to analyze the risk factors of MS. Results The morbidity of MS was 34.75%. There were significant differences in weight , waist circumference , waist-hip ratio , frequency of dialysis , time of hemodialysis perweek , urea reduction ratio, urea clearance index (Kt/v), iron, intact parathyroid hormone (iPTH), leukocytes, high sensitivity C-reactive protein (hs-CRP) between these two groups (P < 0.05, resectively). Multivariate Logistic regression analysis revealed that iron (OR = 1.084, P = 0.042), iPTH (OR = 1.754, P = 0.035), waist-hip 1ratio (OR = 2.013,P = 0.021), hs-CRP (OR = 4.245,P = 0.000)were correlated with MS. Conclusion The morbidity of MS in patients with maintenance hemodialysis is higher. Iron, iPTH, waist-hip ratio, hs-CRP are potential risk fctors of MS for the patients with maintenance hemodialysis.

OBJECTIVETo analyze the clinical value of 24-hour urinary sodium determination in children with postural tachycardia syndrome (POTS).

METHODFifty-eight POTS children and 10 healthy children (control group) from Peking University First Hospital during June 2012 to May 2014 were enrolled. Their 24-hour urinary sodium and plasma sodium levels were compared. Correlation analysis was done between 24-hour urinary sodium and symptom scores in children with POTS. All patients were treated with oral rehydration salts. The POTS patients were divided into hyponatriuria group (urinary sodium < 124 mmol/24 h) and hypernatriuria group (urinary sodium ≥ 124 mmol/24 h). Kaplan-Meier curve was used to analyze the effects of different 24-hour urinary sodium levels in children with POTS receiving rehydration salts therapy.

RESULTThe 24-hour urinary sodium levels of children with POTS were significantly lower than that of control group ((110. 0 ± 45. 8) vs. (221. 3 ± 103. 6) mmol/24 h, t =3. 339, P = 0. 008), while no statistical significance was found in plasma sodium between the two groups ((139. 7 ± 2. 1) vs. (139. 7 ± 2. 3) mmol/L, t = 0. 082, P = 0. 935). Pearson correlation analysis showed that 24-hour urinary sodium and severity of symptoms in children patients were negatively correlated (r = - 0. 654, P < 0. 001) . Urinary sodium < 124 mmol/24 h was used as the cut-off value, there were 43 cases in hyponatriuria group and 15 cases in hypernatriuria group. The symptom scores were significantly higher in hyponatriuria group (10. 2 ± 3. 7 vs. 5. 0 ± 1. 8, P < 0. 001), there was no significant difference in other basic information and hemodynamic data between groups (P > 0. 05). Logistic regression analysis revealed that urine sodium < 124 mmol/24 h was independent risk factor for effectiveness of rehydration salts in POTS patients (OR = 0. 043, 95% CI:0. 004 - 0. 499, P = 0. 012). Kaplan-Meier survival analysis showed the long-term effect of patients receiving oral rehydration salts in hyponatriuria group was significantly better than that in hypernatriuria group (86. 0 % vs. 60. 0%, χ2 = 8. 471, P = 0. 004).

CONCLUSIONTwenty-four hours urinary sodium is a good indicaor for guiding children with POTS receiving rehydration salts therapy.

Case-Control Studies ; Child ; Fluid Therapy ; Hemodynamics ; Humans ; Postural Orthostatic Tachycardia Syndrome ; urine ; Rehydration Solutions ; Salts ; Sodium ; urine

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.

ATP-sensitive potassium channel(KATP) consists of a 4.4 complex of an inwardly rectifying Kir6.x pore plus a sulfonylurea receptor,which is an ATP-binding cassette transporter.KATP has been indentified in a variety of tissues and recognized as an important drug target.It connects cell metabolism with cell electric activity.KATP has been proposed to play protective roles during heart failure,arrhythmia,myocardial infarction,stress,myocardial ischemia and hypertension.In this review,a summary of KATP is presented with molecular structure,localization,regulation,cardiovascular protective effect and its mechanisms.

Objective To analyze the symptoms and signs in forty-five Lambert-Eaton myasthenia syndrome (LEMS) patients retrospectively. Characteristics of electrophysiological examinations were investgated. Methods Forty-five LEMS patients were reviewed and information gathered regarding clinical complains neurological symptoms, and other concomitant diseases. The records showed that repetitive nerve stimulation (RNS) and nerve conduction velocity (NCV) were performed in all patients. Needle electromyography (EMG) and skin sympathetic response (SSR) were performed in some patients. Results (1) The mean age of neurological clinical onset age was (51.2 ±6. 8) years old. The two most common symptoms were slight weakness of lower extremities ( n = 35 ) and upper extremities (n= 5). Dysarthria was found in 3 patients and neck weakness in 2 patients. Tendon reflex decreased and disappeared in 38 patients. Autonomic nervous system manifestations were presented in 30 patients. (2) RNS increasing was observed in all patients from 156% to 636%. Low frequency RNS abnormalities were found in 29 patients.Sensory nerve conduction velocity abnormalities or sensory nerve conduction velocity combined motor nerve conduction velocity abnormalities were found in 19 patients ( 42% ). Of the 30 patients who underwent a needle EMG examination, 20 had myogenic or neurological damage. Thirteen abnormal findings were observed in 25 patients who underwent SSR examination. Conclusion The most common manifestations were weakness in lower extremities and autonomic nervous system dysfunction. Many abnormal electrophysiological results were found in LEMS patients, including NCV and EMG abnormalities. These findings indicated that clinical manifestations exceed the neuromuscular junction and perhaps included the peripheral nerve and muscle.

AIM To explore the effect of long-term nebulized inhalation of nitroglycerin (Neb-NTG) on high pulmonary blood flow-induced pulmonary artery hypertension (PAH). METHODS 24 male Wistar rats were randomly divided into shunting group, Neb group and control group. An arteries-venous shunt was performed between the abdominal aorta and inferior vena cava shunting was produced in rats of Neb and shunt groups. Twelve weeks after the operation, nebulized nitroglycerin was inhaled by rats in the Neb group using pressurized air ejection mobilization, while nebulized saline was inhaled by rats of the other two groups. Ten minutes inhalation was given each day for each rat. After three weeks of inhalation, pulmonary artery systolic pressure (PASP) and mean pressure (PAMP) of each rat were evaluated by using a right cardiac catheterization procedure. Systemic arterial pressure (SAP) was reorded continuously by catheterization procedure. The ratio of right ventricular mass to body weight (RV/BW) and the ratio of right ventricular mass to left ventricular plus septal mass (RV/LV+S) were detected. Pulmonary vascular microstructure was measured. RESULTS PASP, RV/BW and RV/LV+S were significantly increased in shunt rats as compared with those of normal controls (P0.05). Muscularization of small pulmonary artery was obviously decreased in Neb-group compared with shunt group. CONCLUSION Long-term Neb-NTG ameliorates high pulmonary blood flow-induced PAH and pulmonary vascular remodeling.