Recently,echocardiography,such as pulsed wave doppler imaging,tissue doppler imaging,strain and strain rate imaging,speckle tracking imaging as well as velocity vector imaging are being more and more widely used in whole and segmental cardiac functional assessment of congenital heart disease( CHD).With its own technical characteristics,each of them shows advantages and weaknesses in different type of CHD.This paper aims to make a brief review of the latest clinical achievements in those techniques.It will be helpful to reasonable selection or application of these techniques,and more importantly,to better guidance for clinical medication,establishment of surgical outline and assessment of cardiac functional outcomes.

There is a wide variety of diseases resulting in pediatric right heart failure because of children′s special disease spectrum,the main mechanisms include pressure or volume overload,myocardial lesions and arrhythmia,etc.On the basis of adult studies,tailored treatment should be considered in pediatric patients.

Fluid resuscitation is the primary step in the management of acute circulation failure,aims to make a significant increase in cardiac output,and then providing adequate blood perfusion for peripheral tissues.According to Frank-Starling curve,the positive outcome only occurs in patients within a certain range of cardiac function,while in other conditions fluid overload would immediately increase the mortality. Distinguish-ing volume responders form non-responders effectively is still a serious problem common to adult and pediatric physicians at intensive care unit.Volume responsiveness assessment using transthoracic echocar-diography has become a research hotspot during the past few years,this review aims to make a summary of those findings as well as the present situation in pediatric field.

Fulminant myocarditis is one of the most common diseases causing sudden cardiac death in pediatrics and young adults.The pathophysiology of fulminant myocarditis involves both direct myocyte dysfunction and immune-mediated tissue injury,which result in severe damage in cardiac structure and func-tion.It always rapidly developed into cardiogenic shock in several hours.Despite the high mortality rate,if pa-tient response well to a series of progressive treatment,most of them would get complete resolution.Better understanding of the hemodynamic changes of fulminant myocarditis is the key point of rapid diagnosis and proper interventional treatment.In this article we made a summary introduction of those hemodynamic chan-ges in fulminant myocarditis.

Objective To establish a rapid, accurate and sensitive chemiluminescence method for determining sulfydryl-containing drugs. Methods In sulfuric acid solution, glyoxal could be oxidized by potassium permanganate, and weak chemiluminescence could be observed. Chemiluminescence signal could be enhanced in the presence of sulfydryl-containing drugs. Thus, on this basis we established a new method of determining the concentration of sulfydryl-containing drugs with flow injection chemiluminescence analysis. Results Under the optimized conditions, the linear range of methimazole, captopril and acetylcysteine was 1.0×10~(-8)- 5.0×10~(-6), 7.0×10~(-8)-1.0×10~(-6) and 3.0×10~(-8)-1.0×10~(-6)g/mL, respectively. The limit of detection of methimazole, captopril and acetylcysteine was 1.0, 3.9 and 3.7ng/mL, respectively. Conclusion The method was successfully applied to determine the three drugs that contain sulfydryl. Compared with the results of pharmacopeia methods, the results we obtained were satisfactory.

An S-naproxen (S-NAP) molecularly imprinted monolithic stationary phase (MIMSP) with specific recognition for S-NAP and naproxen (NAP) was prepared by in situ technique,utilizing 4-vinylpridine (4-VP) as a function monomer,ethylene glycol dimethacrylate (EDMA) as a cross-linking agent,and low-polar solvents (toluene and dodecanol) as porogenic solvents.The selectivity of the polymers for S-NAP and NAP was evaluated by high performance liquid chromatography (HPLC).The binding characteristics were tested by Scatchard analysis.Racemic NAP could be specifically separated to some extent.At the same time,NAP could be separated from ibuprofen under optimized conditions.Scatchard analysis showed that two classes of binding sites existed in the S-NAP-imprinted polymers,with their dissociation constants estimated to be 1.045 and 5.496 μM,respectively.The results demonstrate that S-NAP and NAP can be recognized specifically on the obtained MIMSP.

An S-naproxen（S-NAP）molecularly imprinted monolithic stationary phase（MIMSP）with specific recognition for S-NAP and naproxen（NAP）was prepared by in situ technique,utilizing 4-vinylpridine（4-VP）as a function monomer,ethylene glycol dimethacrylate（EDMA）as a cross-linking agent,and low-polar solvents（toluene and dodecanol）as porogenic solvents.The selectivity of the polymers for S-NAP and NAP was evaluated by high performance liquid chromatography（HPLC）.The binding characteristics were tested by Scatchard analysis.Racemic NAP could be specifically separated to some extent.At the same time,NAP could be separated from ibuprofen under optimized conditions.Scatchard analysis showed that two classes of binding sites existed in the S-NAP-imprinted polymers,with their dissociation constants estimated to be 1.045 and 5.496 μM,respectively.The results demonstrate that S-NAP and NAP can be recognized specifically on the obtained MIMSP.

Objective To explore the effect of auricular plaster therapy on associated symptoms and quality of life in patients with constipation induced by strong opioid drugs for pain.Methods A total of 60 patients selected were randomly divided into the intervention group and the control group with 30 cases in each group.The intervention group was treated with auriculotherapy based on the pattern/syndrome differentiation after detecting the auricular sensitive acupoints' distribution in patients with opioid-induced constipation after receiving opioid therapy.BFI,self-made scale on symptoms accompanied by constipation and PAC-QOL were used to collect data about constipation symptoms and the level of quality of life before or after the intervention,and still with a subset of the intervention group followed for more than two weeks.Results The BFI and PAC-QOL scores of the intervention and control group were lower after intervention,and the decline score of the two groups showed significant difference.But for the self-made scale,the score of each item was slightly lower compared with that before treatment,which showed no statistically significant difference between groups.A follow-up of 2 weeks showed that the long-term efficacy of auricular plaster therapy was significantly lower than before,but was less desirable than short-term.Conclusions Scientific and reasonable choice of acupoint prescription according to syndrome differentiation can effectively improve symptoms accompanied by constipation and patients' quality of life.

Objective To evaluate the value of integrated use of bedside lung ultrasound and echo-cardiography in PICU.Methods Two cases with respiratory failure and shock were monitored using inte-grated bedside lung ultrasound and echocardiography.Breathing and circulation support solutions were adopt-ed according to Bedside Lung Ultrasound in Emergency(BLUE)and Fluid Administration Limited by Lung Sonography(FALLS).Results Case 1 with acute lymphoblastic leukemia complicated with severe phneu-monia was measured as “B-profile”throughout both lung fields which interpreted as pulmonary edema ac-cording to the BLUE protocol.He was diagnosed as acute respiratory distress syndrome later and supported by non-invasive ventilation according to the lung ultrasonography.After 4 days,the numbers of B line were sig-nificantly reduced with PaO2/FiO2 >300 mmHg(1 mmHg=0.133 kPa)and the improvement in chest X ra-diography was found,ventilation was weaned accordingly.Case 2 was diagnosed as septic shock and acute re-spiratory distress syndrome with volume resuscitation and mechanical ventilation.According to FALLS proto-col,we ruled out obstructive and cardiogenic shock,and assessed the variation in inferior vena cava diameter and aortic systolic velocity-time integral as a guide to fluid therapy.At the 8th hour in PICU,case 2 recovered from shock.Conclusion Integrated use of bedside lung ultrasound and echocardiography is clinically signifi-cant for the rescue of critically ill patient with respiratory failure and shock.

OBJECTIVETo study the correction of algorithm for Varian enhanced dynamic wedge(EDW) factors and compare the dose/monitor unit (MU) deviation measured at the central axis of EDW field with that obtained by manual calculation or using the treatment planning system.

METHODSEDW factors and dose were measured with Thimble ion chamber at 10 cm depth under the water for 6 MV and 10 MV photon on Varian linear accelerator. The corresponding calculations were done with the radiation treatment planning system. An analytic formula, namely the MU Fraction model, was used to calculate the EDW factor, which was corrected with a constant factor. The MU of conventional 2-D planning derived from manual calculating, treatment planning system, and actual measurements were compared.

RESULTSWith the measured results as the standard, the corrected manual calculation deviation of EDW factors was significantly reduced. For photon 6 MV, the maximum deviation reduced from 4.2% to 1.3% for 60° symmetry fields was, and from -4.7% to -1.8% for asymmetric fields. For photon 10 MV, the maximum deviation for all EDW fields was reduced from -3.0% to 1.1%. Comparison of the manual calculations with the measured results showed a MU deviation for symmetric fields within 2%, and more than 5% for some asymmetric fields. The deviation between the calculations of the treatment planning and the measured results was less than 1.5%.

CONCLUSIONConstant factor correction can effectively reduce the deviation of manual calculation. For MU calculation of EDW field in conventional 2-D dimensional treatment planning, the corrected results of symmetric fields meet clinical requirements. While the minimum distance between the field edge and the central axis was less than 4 cm in asymmetric fields, the corresponding special method, measurement or the treatment planning system should be used to calculate the dose/MU.