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 investigate the relationship of heart rate variability (HRV), heart rate deceleration capacity (DC) and intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) in children with the acute stage of KD.Methods:A total of 679 patients with KD in Chengdu Women and Children′s Central Hospital from August 2015 to May 2019 were selected.In healthy control group, 150 children obtained physical examination at the same time.Prospective cohort study was applied to analyze the data.According to the effect of initial IVIG treatment within 14 days, patients were divided into IVIG-sensitive group and IVIG-resistant group.General clinic information, HRV, DC, blood routine, liver function, cardiac troponin I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP), high sensitivity C-reactive protein(hs-CRP) and erythrocytesedimentation rate (ESR) before initial IVIG treatment of the 2 groups were compared.Multivariate Logistic regression was applied to analyze the risk factors of IVIG-resistant KD. Results:Among 679 KD patients, 3 cases were lost, among the rest 676 cases, 586 cases were in IVIG-sensitive group, and 90 cases were in IVIG-resistant group.The HRV and DC indexes of IVIG-sensitive group and IVIG-resistant group were lower than those of the healthy control group, and the differences among the 3 groups were statistically significant (all P<0.05). Meanwhile, standard deviation of N-N intervals (SDNN) [(65.84±38.22) ms vs.(82.56±21.41) ms, P=0.004], and low frequency (LF)[ (192.59±114.10) ms 2vs. (258.18±162.75) ms 2, P=0.048] of IVIG-resistant group were lower than those of IVIG-sensitive group.White blood cell (WBC), platelets(PLT), hs-CRP, ESR, alanine aminotransferase(ALT), cTnI and NT proBNP in IVIG sensitive group and IVIG-resistant group were all higher than those in the healthy control group (all P<0.05). Further more, ESR[(90.32±37.91) mm/1 h vs. (65.81±25.34) mm/1 h, P=0.019], cTnI [(0.83±0.35) μg/L vs. (0.52±0.18) μg/L, P=0.037] and NT-proBNP [(854.64±293.02) ng/L vs. (584.95±177.11) ng/L, P=0.011] in IVIG-resistant group were higher than those of IVIG-sensitive group.Multivariate Logistic regression analysis demonstrated that SDNN ( OR=0.783, 95% CI: 0.0341-0.979, P=0.021), and NT-proBNP ( OR=1.195, 95% CI: 1.061-1.428, P=0.34) were independent risk factors for predicting IVIG-resistant KD. Conclusions:SDNN and NT-proBNP may be independent predictors of IVIG-resistant KD.

The application indications of imaging examination and cardiac catheterization in the diagnosis, treatment and follow-up of Kawasaki disease, especially cardiovascular sequelae, are further improved by the Japanese Circulation Society/Japanese Society for Cardiovascular Surgery 2020 Guideline on Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease that also standardizes the long-term management program of Kawasaki disease in three different stages, namely, school, the adolescent/young adult and adulthood stage.In order to enhance the understanding of domestic medical staff with the latest knowledge, this paper focuses on the application progress of diagnostic imaging and cardiac catheterization in the diagnosis, treatment and long-term management of cardiovascular sequelae of Kawasaki disease in the guide.

We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB-IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415-1.757; P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.
Female ; Humans ; Uterine Cervical Neoplasms/drug therapy* ; Prospective Studies ; Quality of Life ; Neoplasm Staging ; Chemoradiotherapy ; Chemotherapy, Adjuvant/adverse effects* ; Adjuvants, Immunologic ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Retrospective Studies