Objective:To evaluate the feasibility of transcatheter atrial septal defect(ASD) closure with deficient rim.Methods:From January 2017 to November 2019, patients at the Department of Pediatric Cardiology, Chengdu Women′s and Children′s Central Hospital were diagnosed as the secondary ASD and divided into 2 groups based on whether it has deficient rim[the deficient rim group (experimental group) and non deficient rims group (control group)]. The complications should be followed for 1-2 years.Results:A total of 66 patients, including 17 males (25.8%) and 49 females (74.2%), had the median age of 4 years and 2 months (2 years and 1 month-16 years), and the median body mass was 15.0 kg, ranging from 9.0 kg to 60.0 kg, with 23 cases (34.8%) in the experimental group and 43 cases (65.1%) in the control group.There were no statistically significant differences in gender, age, body weight, size of ASD, fluoroscopic dose, electrocardiogram, and pulmonary artery pressure between the two groups (all P>0.05). The immediate success rate was 95.4%(63/66 cases). There were no statistically significant differences between the surgical success rate [91.3%(21/23 cases) vs.97.6%(42/43 cases)] and the incidence of residual shunt [30.4%(7/23 cases) vs.16.2%(7/43 cases)](all P>0.05). And there were no statistically significant differences of the incidence of residual shunt between groups at each follow-up point ( P>0.05). No arrhythmia occurred in the experimental group during follow-up, and 1 case of atrioventricular block in the control group persisted until the time of publication.A total of 4 cases of frequent atrial premature beats or non-paroxysmal atrial tachycardia returned to normal at the follow-up node 6 months after intervention. Conclusions:Under the selection of appropriate cases and skilled catheter technology, the transcatheter treatment of ASD in children with deficient rims is feasible.

OBJECTIVE To investigate the resistance of clinical isolated strains to the commonly used antibacterials in our hospital 2007-2008.METHODS Clinical isolated strains and sensitivity of drugs were detected by ATB system.The result of drug sensitivity was judged by CLSI standard and analyzed with statistical software WHONET5.3.RESULTS Altogether 3150 strains bacteria were isolated,17.4% were Gram-positive strains and 82.6% were Gram-negative strains,and the top five isolates were Pseudomonas aeruginosa,Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii,and Staphylococcus aureus.The reasistance rate of Gram-positive strains to minocycline was 15.4%.Five VRE strains were isolated.Various Enterobacteriaceae bacteria were sensitive to imipenem meropenem,cefoperazone-sulbactam and piperacillin-tazobactam,and their rate was 86.5% to 97.7%.Some of Acinetobacter and Stenotrophomonas maltophilia were multidrug resistant.CONCLUSIONS It is serous that multidrug resistance of isolated strains of the patients exists in our hospital.

Objective To explore the diagnostic value of N‐terminal Pro‐Brain Natriuretic Peptide (NT‐proBNP) in Kawasaki disease (KD) in children .Methods Ninety one children with KD were collected and 80 patients with acute upper respiratory infec‐tion were used as controls .Plasma NT‐pro BNP concentrations and other laboratory date were collected in the acute of KD .The re‐lationships between NT‐pro BNP values and different clinical and laboratory data in the acute phase were sought .Results The mean plasma NT‐pro BNP concentration in patients with KD in the acute phase was (1 042 .38 ± 528 .7)pg/mL ,significantly higher than those of control group(458 .6 ± 412 .3)pg/mL (P<0 .05) .The results of linear correlation analysis indicated that plasma NT‐pro BNP was positively correlated with CRP (r= 0 .442 ,P< 0 .05) ,and negatively correlated with Hematocrit ,Albumin and Na (r= -0 .216 ,r= -0 .204 ,r= -0 .315 ,respectively ;P<0 .05) .According to ROC analysis ,the AUC of NT‐pro BNP for detection of KD were 0 .881 ,sensitivity and specificity was 70 .1% and 84 .0% respectively for the cut‐off value of 530 pg/mL .Conclusion Our findings showed that NT‐proBNP would elevate in the acute stage of KD and was a reliable marker for the diagnosis of KD .A high level of NT‐pro BNP is associated with systemic inflammatory responses and increased vascular permeability .

Objective To investigate the correlation between red blood cell distribution width (RDW) and the cardiac function in children with acute heart failure,and to explore the clinical value in evaluating the degree of heart failure.Methods From July 2013 to October 2015,75 cases of children with acute heart failure who were hospitalized in Chengdu Women and Children's Central Hospital were collected and assigned as 3 groups.Heart function classification was done by using a modified Ross scoring system,and each group included 25 cases of class Ⅱ,Ⅲ,Ⅳ.Indices of red blood cell,haemoglobin,RDW,concentration of plasma N-terminal pro brain natriuretic peptide (NT-proBNP),and left ventricular ejection fraction (LVEF) were recorded.SPSS 17.0 software was statistically used for comparing cach index among groups and correlation analysis.Results Red blood cells and haemoglobin were not statistically different among groups (F =0.802,1.372,all P ＞ 0.05).RDW,NT-proBNP concentration and LVEF were significantly different among groups (F =31.388,29.300,x2 =56.952,all P ＜ 0.01),and significantly increased with the progression in the order of class Ⅳ group ＞ class Ⅲ group ＞ class Ⅱ group [RDW:(16.6 ± 1.3) ％ ＞ (15.4 ± 1.1) ％ ＞ (13.9-± 1.3) ％,NT-proBNP:(506.6 ± 190.2) ng/L ＞ (1 028.1 ± 356.8) ng/L ＞ (1 884.1 ± 358.6) ng/L,all P ＜ 0.01].According to LVEF =50％ as the cut-off point,children with acute heart failure were divided into LVEF decreased group and LVEF retention group,former group's RDW and NT-proBNP were significantly higher than the latter group[RDW:(16.7 ± 1.3)％ vs.(13.9 ±1.1)％,NT-proBNP:(1 787.4-±368.6) ng/Lvs.(657.4-± 291.1) ng/L,all P ＜0.01].According to NT-proBNP levels,the children with acute heart failure were divided into low,medium,and high NT-proBNP group,and RDW in the high NT-proBNP group[(17.3 ±0.9)％] was significantly higher than that of medium [(15.4 ± 0.7) ％],and that of low level group [(13.7 ± 1.2) ％] (all P ＜ 0.01).The correlation analysis between RDW,NT-proBNP as well as LVEF showed that RDW was significantly positive correlated with NT-proBNP (r =O.869,P ＜ 0.01),and negatively related with LVEF (r =-0.962,P ＜ 0.01).Conclusions RDW is closely related to the cardiac function in children with acute heart failure.RDW is increased with the aggravating of acute heart failure,which can indirectly reflect the NT-proBNP concentration and LVEF change and suggests that RDW can be used as a convenient and useful index monitoring the level of cardiac function in children with acute heart failure,and the assessment of the severity of acute heart failure.

Objective To compare surgical gastrojejunostomy and endoscopic stenting in palliation of malignant gastric outlet obstruction.Methods This retrospective study investigated patients treated for malignant gastric outlet obstruction from January 2007 to January 2014 in the first affiliated hospital of Nanjing Medical University.Endoscopic stenting was placed in 29 patients and surgical gastrojejunostomy was performed in 42 patients.The outcomes assessed included diet scores,time to diet,length of hospital stay,treatments fees and complications.Results Both endoscopic stenting and surgical gastrojejunostomy can relieve patients' syndrome with significant higher GOOSS score compared with that before treatment (P ＜0.05),but score improves faster in stenting group.Clinical success for endoscopic stenting and surgical gastrojejunostomy was 96.6％ and 92.9％ respectively,and technical success was 100％ for both of them.Endoscopic stenting group was found to have lower early complication rate(3.4％ VS 23.8％,P ＜0.05),higher late complication rate(24.1％ VS 6.9％,P ＜0.05),less time to diet,hospital stay and treatment fees(all P value ＜ 0.05)than surgical gastrojejunostomy group.The major complication after endoscopic stenting is re-obstruction while it is infection and leak of anastomotic site for surgical group.There were no significant differences in complication between two groups (27.6％ VS 11.9％,P ＞ 0.05).Conclusion Both endoscopic stenting and surgical gastrojejunostomy can relieve patients' syndrome effectively and safely,but endoscopic stenting improves GOOSS scores more rapid with less time to diet,less early complication rate and easy-dealing late complications,also it needs less hospital stay and fees.It's a better choice for patients with less survival expectation.

BACKGROUND: The occurrence and severity of acute high-altitude disease(AHAD) are determined by the speed entering the highland, the altitude of highland and seasons. The association between obesity and AHAD has not been fully investigated.OBJECTIVE: To investigate the association between obesity and acute high-altitude in people exposed rapidly to the highland.DESIGN: Comparative observation.SETTING: Department of Cardiology, General Hospital of Chinese PLA and Department of Cardiology, Tibetan General Hospital of Chinese PLA.PARTICIPANTS: The experiment was conducted at the Department of Cardiology, General Hospital of Tibetan Military Area Command of Chinese PLA in August 2006. Totally 82 Henan subjects aged 28-45 years were selected from the male workers constructing the Qinghai-Tibet Railway and their managers with acute high-altitude exposure. They had never been to the highland before, and all agreed to the detection.METHODS: ①Every subject completed the AHAD self-report questionnaire at sea level and 12 hours and 24 hours after ascending high-altitude. The items in the questionnaire included symptoms of headache, gastrointestinal symptoms,fatigue or weakness, dizziness, and insomnia. Each symptom was graded from 0-3 with 0 as no symptoms, 1 as mild symptoms, 2 as moderate symptoms, and 3 as severe symptoms and a total score of 15. A score of 4 or more could by identified as AHAD. ②The height and body mass were measured to calculate the body mass (BMI). Those with BMI≥28 kg/m2 served as the obesity group [n =39, mean age (35±8) years], and those with BMI of 18.5-23.9 kg/m2 as the normal body mass group [n =43, mean age (35±8) years]. ③Arterial blood was taken to evaluate arterial oxygen saturation (SO2), arterial oxygen pressure (PaO2) and arterial carbon dioxide pressure (PaCO2) at baseline and 24 hours after ascending high-altitude. ④The measurement data was compared by t test.MAIN OUTCOME MEASURES: BMI, vital capacity of lungs, SO2, PaO2 and PaCO2 levels of obese and normal people.RESULTS: Totally 39 obese people and 43 normal people were involved in the result analysis. ①AHAD score: No symptom was reported at sea level in all participants (scored 0), but the AHAD scores in the obesity group were significantly higher than those in normal group 12-hour and 24-hour after ascending high-altitude. ②Blood gas analysis:At sea level, there were no statistical differences in the levels of SO2, PaO2, and PaCO2 between two groups (P ＞ 0.05).But 24 hours after ascending high-altitude, SO2 and PaO2 of the obesity group were much lower than in the normal group (P＜ 0.01), and PaCO2 was significantly higher than in the normal group (P＜ 0.01).CONCLUSION: Obese men are more vulnerable to high-altitude hypoxia than people with normal body mass. Obesity is an important risk factor for the development of acute high-altitude disease.

Objective To explore the potential role of endogenous vascular elastase (EVE) in pathogenesis of coronary ar-tery lesions (CAL) in Kawasaki diseases (KD). Methods A total of 60 children with KD admitted from Jan. 2012 to Apr. 2013 were enrolled, and at the same time 60 febrile children with respiratory infection were enrolled as controls. The left and right coro-nary artery diameter value was measured by ultrasonic cardiogram. The levels of EVE, matrix metalloproteinases (MMP)-9 and transforming growth factor (TGF)-β1were determined by enzyme-linked immunosorbent assay and their correlations with coro-nary artery diameter were analyzed. Results The levels of EVE, MMP-9 and TGF-β1 in KD children in the acute phase were significantly higher than those in control group (P<0.01). Meanwhile, the level of EVE in KD children with coronary artery le-sion (CAL) is significantly higher than that in KD children without CAL. The results of correlation analysis indicated that the levels of EVE, MMP-9 and TGF-β1 were positively correlated with coronary artery diameters (r=0.64~0.79, P<0.01). Conclu-sions EVE plays an important role in the CAL of KD may through inducing the produce of MMP-9, TGF-β1 and finally caus-ing the formation of CAL.

This study aims to save cost of sampling for estimating the area under the amlodipine plasma concentration versus time curve in 24 hours (AUC(0-24 h)). Limited sampling strategy (LSS) models was developed and validated by mutiple regression model within 4 or fewer amlodipine concentration values. Absolute prediction error (APE), root of mean square error (RMSE) and visual predict check were used as criterion. The results of Jackknife validation showed that fifteen (9.4%) of the 160 LSS based on regression analysis were not within an APE of 15% by using one concentration-time point. 156 (97.5%), 159 (99.4%) and 160 (100%) of the 160 LSS model were capable of predicting within an APE 15% by using 2, 3, 4 points, separately. Limited sampling strategies have been developed and validated for estimating AUC(0-24 h) of amlodipine. The present study indicated that the implemention of both 5 mg and 10 mg dosage could enable accurate predictions of AUC(0-24 h) by the same LSS model. This study shows that 12, 4, 24, 2 h after administration are key sampling time points. The combination of (12, 4), (12, 4, 24) or (12, 4, 24, 2 h) might be chosen as sampling hours for predicting AUC(0-24 h) in practical application according to requirement.

Child ; Contracture ; congenital ; therapy ; Humans ; Male ; Neck Muscles ; pathology ; Torticollis ; congenital

Objective To study the influence of IL-33 on the Hematopoietic stem cells and progenitor cells . Methods Cells from the peripheral blood , spleen, thymus and bone marrow were stained with indicated antibodies and analyzed by flow cytometry . The LT-HSCs were sorted and culture using in vitro clonogenic assay . Results The percentage of B cells and T cells was decreased and the percentage of M cells was increased in the peripheral blood from IL -33 transgenic mice .Compared with the wildtype mice , the number of HSCs , MPPs and CLP was decreased;meanwhile the number of CMP and GMP was increased in the bone marrow from IL-33 transgenic mice .An in vitro clonogenic assay showed that LT-HSCs increased the ability to self-renew from IL-33 transgenic mice .And the percentage of S-G2-M stage hematopoietic stem cell was increased from IL-33 transgenic mice .Conclusion IL-33 increase the myeloid differentiation in hematopoietic stem cells .