Heart failure is one common critical cardiovascular disease in children.Angiotensin convening enzyme inhibitors plays an important role in the treatment of pediatric heart failure.In this paper,the pharmacological mechanism,pharmacokinetics,clinical studis and application of angiotensin converting enzyme inhibitors in the treatment of pediatric heart failure were concerned.

Objective To investigate pediatric infective endocarditis(IE) risk factors and the feature of pathogen.Methods We conducted a retrospective study of 46 cases who were diagnosed as IE from January 2000 to June 2007.Sixteen variables such as sex,primary disease,infectious site,complication,culture result and therapeutic measure were selected for logistic regression analysis.Results Forty-six IE patients accounted for 0.78‰ of all the hospitalized patients during the same period.Of 46 cases,40 had heart diseases.The incidence rate of left-sided endocarditis was higher than that of right-sided endocarditis.Twenty-four had positive blood culture result,one patient had positive culture from vegetation sample.The total positive culture rate was 54%.Gram-positive bacteria were found in 15 cases,and the most common organisms were α-hemolytic streptococcus.Gram-negative bacteria were in 7 cases and fungus infection was present in 3 cases.After antiboitic treatment,40 were cured,6 died.In the logistic regression model,the variables significantly associated with death included negative blood culture (OR=25.127,95%CI=1.110-363.236),hematological system disease (OR=28.620,95%CI=2.261-354.448) and multiple organ failure (OR=19.843,95%CI=0.786-221.754).Conclusion Streptococcus viridans is the most common pathogen in pediatric IE in our hospital.Higher incidence in the left heart than that in the right heart is found.Negative blood culture,hematological system disease and MOF are the risk factors in IE patients.

Objective To systematically review the changes in the intensity of postoperative pain under ketamine anesthesia in children.Methods We searched the Cochrane Library,PubMed,OVID,EMBASE,and Chinese Biomedical Database for prospective randomized controlled trials involving the changes in the intensity of postoperative pain under ketamine anesthesia in children.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Evaluation indexes included pain score and analgesic consumption during 6 h after operation,pain score and analgesic consumption during 6-24 h after operation,duration of sensory block (caudal block),side effects during 24 h after operation (postoperative nausea and vomiting and psycho-mimetic manifestations).Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0 software.Results Fifteen prospective randomized controlled trials involving 955 patients were included in our Meta-analysis.The patients were divided into 2 groups:control group ( n =455) and ketamine group ( n =500).The pain score and analgesic consumption during 6 h after operation were significantly decreased after general anesthesia with ketamine.The pain score during 6-24 h after operation and analgesic consumption during 6 h after operation were significantly decreased after local anesthesia with ketamine.The duration of sensory block was prolonged and the analgesic consumption during 6 h after operation was significantly reduced after caudal block with ketamine.There was no significant difference in the incidence of postoperative nausea and vomiting and psycho-mimetic manifestations between the two groups.Conclusion The intensity of pain and analgesic requirement during 6 h after operation are significantly reduced under ketamine anesthesia in children.

Objective To investigate the influence of PBL combined with CBS education on reporting cognition and reporting intention of adverse events.Methods Using convenience sampling method,66 registered nurses working for over 6 months were extracted as the study object.The training group was set up and the training files were established,PBL combined with CBS mode were implemented for 6 months from March to August 2013,once a month,2 hours per time.Training cases were designed and written,teaching staff was organized to carry out the training,problems were raised in class and discussed on site.Training staff looked up relevant data,collected information,organized another focused discussion and summarized the results.The Adverse Event Reporting Cognitive Questionnaire and Adverse Nursing Event Reporting Intention Questionnaire were adopted to evaluate reporting cognition and reporting intention before and after the training.Results After the implementation of PBL combined with CBS education,cognition of nurses for adverse events scored (7.23±1.20),higher than that before the intervention,(6.48±1.49),t=3.17,P ＜ 0.01.The numbers of nurses to report adverse events such as potential vulnerabilities and not doing any harm were 42 and 45 before the intervention,while 53 and 56 after the intervention.Conclusions Using PBL combined with CBS model to implement educational interventions can improve reporting cognition and report intention on nursing adverse events of nurses.

Asthma is a common disease in children. Adherence to inhaled glucocorticoid therapy directly affects the outcome of asthma. The article mainly reviews the adherence status, assessment method, patient barriers to non-adherence and intervention strategy,so as to provide references for clinical practices and scientific research of nursing staff.

Furthering of the health reform calls for better health care system,greater public financing,and deepened reform of public hospitals.Introduced in this paper are the actions taken and outcomes of the health reform in Changchun city,including the essential medicines system to minimize drug prices,improvement of the primary healthcare system to minimize people's financial burden,greater public spending to enhance public welfare nature of medical institutions,enhanced competencies of primary medical institutions to introduce rational classification of patient flow,and enhanced equity of public services to promote people's health.On such basis,further reform proposals were made for Changchun's health reform.

ObjectiveTo investigate the role of nuclear factor kappa B (NF-κB), epidermal growth factor (EGFR) and Mucin 1 (MUC1) in hepatolithiasis associated with intrahepatic cholangiocarcinoma. MethodsSpecimens were taken from 90 patients who underwent hepatectomies from August 1989 to June 2009 at the Second Affiliated Hospital of Sun Yat-sen University. The specimens were stained immunohistochemically for NF-κB, EGFR and MUC1. There were 33 patients who had hepatolithiasis associated with intrahepatic cholangiocarcinoma (the experiment group). 32 patients with hepatolithiasis served as the control group, and 25 patients with normal intrahepatic bile ducts taken at 1-2cm distal to benign hepatic neoplasm served as the blank group. The immunohistochemical staining were performed on tissue slices. Results NF-κB positive rate was 51.5％ (17/33), 25％(8/32) and 4％ 1/25) in the experiment group, the control group and the blank group respectively,P＜0. 01 ; EGFR positive rates were 57. 6％ (19/33), 31.3％ (10/32) and 0 (0/25) respectively,P＜0. 01; MUC1 positive rates were 54. 5％ (18/33), 28. 1 ％ (9/32), 0 (0/25) respectively,P＜0. 01. There were significant differences for high level expressions of EGFR and MUC1 among histopathologic grading, tumor invasion and metastasis. The survival rates of patients with EGFR and MUC1 expressed tumor were lower than of patients with non-expressed tumout (P＜0. 01). ConclusionsNF-κB is probably involved in the early stage of intrahepatic cholangiocarcinogenesis. Overexpressions of NF-κB, EGFR and MUC1 play coordinately and important roles during intrahepatic cholangiocarcinogenesis. High level expressions of EGFR and MUC1 are related to the malignant degree of cholangiocarcinoma and to worse prognosis.

Objective To compare the efficacy of rcmifentanil combined anesthesia and fentanyl or sufentanil combined anesthesia in patients undergoing cardiac surgery.Methods We searched the Coehrane library,PubMed,EMBASE,OVID and Chinese Biomedical Database for prospective randomized controlled trials involving the comparison of the efficacy of remifentanil combined anesthesia and fentanyl or sufentanil combined anesthesia in patients undergoing cardiac surgery.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Evaluation indexes included the mechanical ventilation time after operation,duration of stay in hospital,and level of cardiac troponin,mortality,requirement for positive inotropic drugs and incidence of hyperalgesia and myocardial infarction during perioperative period.Meta-analysis was conducted using the RevMan 5.0 software.Results Sixteen prospective randomized controlled trials involving 1473 patients were included in our Meta-analysis.The patients were divided into 2 groups:fentanyl or sufentanil group ( n =644) and remifentanil group ( n =573).Compared with fentanyl or sufentanil group,the mechanical ventilation time after operation and duration of stay in hospital were significantly shortened,the level of cardiac troponin during the perioperative period was significantly decreased and the requirement for positive inotropic drugs during the perioperative period was significantly reduced ( P ＜ 0.05),and no significant change was found in the incidence of hyperalgesia or mortality of myocardial infarction during the perioperative period in remifentanil group ( P ＞ 0.05 ).Conclusion The efficacy of remifentanil combined anesthesia is better than that of fentanyl or sufentanil combined anesthesia in patients undergoing cardiac surgery.

Objective To investigate the effect of S-1 on serum thymidine kinase-1 ( TK1 ) , vascular endothelial growth factor ( VEGF ) and insulin-like growth factor-1 (IGF-1) and tumor biomarkers, estrgen levels and quality of life in patients with advanced breast cancer.Methods 69 cases with advanced breast cancer from January 2014 to May 2015 in the hospital were selected and randomly divided into two groups.34 cases in control group were treated by conventional therapy, and 34 cases in experimental group were treated with S-1.Serum TK1, VEGF and IGF-1, tumor biomarkers, estrogen level and quality of life score were compared pre-and post-treatment.ResuIts Compared with control group, the levels of VEGF, IGF-1 and TK1 were lower (P<0.05), serum CA125, CEA and CA15-3 concentrations were lower (P<0.05),the LH, E2 and E1 levels were lower (P<0.05) and the survival quality score was higher in experimental group ( P<0.05 ) .ConcIusion S-1 has better clinical curative effect in treatment of patients with advanced breast cancer, and effectively reduce serum TK1, VEGF, IGF-1, tumor biomarker levels, improve the quality of survival, which has important significance.

Objective To explore the indication and the methodology of transcatheter closure of coronary artery fistula.Methods Altogether 17 cases for intervention,included 13 using the Cook corp coil(2 detachable and another 11 un-detachable);1 with the Pfm corp detachable coil;3 with the AGA corp Amplatzer-Duct.The other 26 cases underwent surgery. Results Intervention group,showed 3 failure cases because of selecting too small and un-detachable coil in early stage with final displacement.Fourteen cases were successful.Follow-up 3 years showed no residue shunt and other complications.All patients were successful with surgery.Conclusions Transcatheter closure of the coronary artery fistula is mild invasive,short hospitalization,safe,and effective under proper indications.