Objective A retrospective study was undertaken to evaluate the outcomes of the newborns with pulmonary atresia with intact ventricular septum(PAIVS),in order to delineate strategies for the optimal management of PAIVS. Methods From July 2003 to July 2008,17 neonates with PAIVS underwent surgical treatment.The mean age at operation was(1 5.6±8.6)d and the mean weight was(3.54±0.44)kg.Initial surgical treatment included:Blalock-Taussig shunt (BT shunt)in 2 cases,closed pulmonary valvotomy and BT shunt in 1 case,right ventricular outlet tract reconstruction(RVOTR)in 2 cases,RVOTR and BT shunt in 11 cases. Results The mean duration of mechanical ventilation and intensive care unit stay were(35.5±35.1)h and(8.7±5.9)d,respectively.Two early deaths were reported inside the hospital(2/17,11.8%).Multivariable analysis demonstrated that mechanical ventilation before surgery was the risk factor for in-hospital mortality(r=1.02,P<0.01).The rest 15 cases were followed up with the average time of 19 months(2 months to 5 years)and no death was reported. Conclusions Neonates with PAIVS should be operated early.Individualized treatment strategy and regular follow-up are helpful to achieve better short-term outcome.

PurposeTo evaluate and describe fetal cardiac development and hemodynamics high risk pregnancy by using ultrasound technique. Methods Two-hundred and thirty-three pregnancies were prospectively studied by using the detailed fetal echocardiographic procedure( fetus gestational age from 19 weeks to 39 weeks). Cardiac chamber size, internal diameter of great arteries were documented together with the presence of inflow and outflow wave patterns. In utero diagnoses of variety of congenital heart defects were also conducted. ResultsCardiac chamber size and internal diameter of great arteries showed a positive correlation with the increasing of gestational age. Left and right ventricles were demonstrated the same size during whole fetal observational period. Blood flow through mitral valve and tricuspid valve were typically 'M' type. By comparing 'e' wave and 'a' wave, this inflow blood velocity pattern was dominant by 'a' wave, though the ratio of a/e gradually decreased during the fetal development period. Blood velocity in aorta and pulmonary artery remained steady along with the gestational age. The detection rate of verity types of congenital heart diseases in this sample population was 5.7% (13 cases) ,the major problem was the complex heart malformation. The occurrence of fetal cardiac arrhythmia was 14 cases (16 % ), with the majority of atrial premature beat. Conclusions Fetal echocardiography can be used to evaluate and monitor the change of cardiac anatomy, structure and hemodymanics during the different gestational age. This has provided a new approach to the further understanding of fetal cardiac development, and is importantto the screening of congenital heart disease during pregnancy.

Bilingual teaching is a new measure to enhance the quality of education in universities and to meet the requirement for a WTO member.Conducting bilingual teaching in medical schools is to aim at cultivating high-quality doctors and improving Chinese medical science.This article interprets the concept and goal of bilingual teaching and analyzes the history and mode of bilingual teaching in China.The methods of conducting medical bilingual teaching,the construction of the teaching resource and the evaluation of the curriculum have also been discussed.

Objective To knockout and identify the Antigen 43 (Ag43) in the Escherichia Coli JM109 .Methods Mutation group Ⅱ introns RNA protein complexes (RNP) gene sequence was obtained by Sigma Company′s TargeTron Gene Knockout Sys‐tem and Ag43 gene specific designed PCR primers amplification ,then ,to acquired Ag43 specific recombinant RNP plasmid pACD4K‐Ag4 ,this gene sequence was inserted into the plasmid pACD4K‐C of RNA′s expression .Finally ,pEGFP‐Ag43 was trans‐formed into JM109 and inserted the group Ⅱ intron into the Ag43′s locus by IPTG inducing expression .Results The best insertion locus was between 1 812 and 1 913 .Through the agarose electrophoresis gel ,the RNP gene sequence was consistent with the expec‐ted value (350 bp) .The pEGFP‐Ag43 vector was correctly constructed which was proofed by endonuclease Nhe Ⅰ and Hind ⅡI di‐gestion as predicted products (3 646 and 4 029 bp;7 000 and 550 bp ,respectively ) .The PCR and gene sequence results indicated that the group Ⅱ intron was inserted into the locus between 1 812 and 1 913 in the Ag43 gene .Conclusion Successful knockout of the Ag43 in Escherichia Coli JM109 found basis to further study the Ag43′s function and regard the coli as host bacteria of Ag43 chimeric protein recombinant .

The article sums up the thinking and methods of the top-quality courses of Pediatrics constructed by the pediatric bed-sided teaching(PBL courses) and clinical training.The aim of the courses is to combine gradually lecture,question,discussion and practice,encourage active discussion,emphasize clinical ability and establish a new teaching method of pediatrics.

Pediatrics is a medical discipline,studying children health,growth and development,health care and disease prevention.To ignite medical students' interest in pediatrics,cultivate their creativity and ability in clinical practice,since February 2004,Pediatric Department in Children's Hospital of Fudan University has implemented the teaching pattern that combines traditional teaching practice with problem based learning(PBL) in students of seven-year medical training program,which has received positive feedback and wide approval from the students.

Facing a transformation of society and new problems of health care system in the twenty-first century,traditional medical modals have many challenges.The new modes of modern medicine have been formed.The medical education reform must adapt new medical modes to cultivate high quality medical talents.And at the same time the course of pediatrics should be constantly innovated to construct the first class teaching staff,first-rank teaching contents,teaching methods,teaching material and teaching administration.

Objective To establish the reference ranges for fetal cardiac axis in the mid-second trimester and to evaluate the use of fetal cardiac axis in prenatal diagnosis.Methods 6744 unselected singleton pregnancies were enrolled from September 2008 to October 2010.Routine screening scan of second trimester and fetal echocardiography were performed at 18- 23+6 weeks gestation.Fetal cardiac axis was measured on the four-chamber view of the heart.Results The 6744 fetuses had a mean cardiac axis of (37.03 ± 6.10)°,ranging from 9.80° to 102.41°. Using above or below 95％ range of population (26.63° -49.40°) as a cut-off,there were significant difference of cardiac axis between normal group [(36.96 ± 5.91)°,P ＜0.01] and the group with heart defects [(43.12 ± 15.67)°,P ＜0.01],the group with intrathoricic anomalies or abdominal wall defect [(51.74 ± 15.97)°].ConclusionsThe reference ranges of fetal cardiac axis for local population in mid-second trimester may helpful for detecting congenital defects.Presence of an abnormal cardiac axis in the fetuses is associated with a substantial risk of congenital heart disease and/or other extra cardiac defects.

Objective To investigate the relationship between coronary artery lesion and cardiac function in coronary atherosclerotic heart disease (CHD) patients.Methods Ninty cases of patients with CHD who were hospitalized for chest pain in Air Force PLA General Hospital and scheduled for coronary angiography were selected.Noninvasive hemodynamie testing was performed before coronary angiography.According to the results of coronary angiography,74 patients with coronary artery stenosis were selected as disease group,persons with an additional angiography showed no coronary artery stenosis and excluded from other systemic diseases in physical examination center(30 cases) were chosed as control group.According to the results of coronary angiography,the Gensini score system was used to quantify the degree of coronary artery disease,the patients were divided into two groups according to the score.:high score group (Gensini score＞ 20 points,40 cases) and low score group (Gensini score≤20).And the relationship between coronary artery stenosis and cardiac function was analyzed by comparing the two groups of noninvasive hemodynamics cardiac function indexes,BNP and LVEF values.Results The levels of C,SV,CO,CI,HI and LVEF in the disease group were significantly lower than those in the control group (P＜0.05),Q-B/B-X was significantly higher than that in the control group (P＜0.05);There were statistically significant of BNP and LVEF between Gensini high score and low score group (P＜0.05).The Pearson correlation analysis showed there was significantly negatively correlated between Gensini score and C,SV,CO,CI,HI,LVEF,and significantly positively correlated btween Gensini score and Q-B/B-X,BNP.Conclusion The degree of coronary artery lesion was negatively correlated with cardiac function,and the worse the disease,the worse the heart function.

Objective To evaluate the effect of different kind of intravenous immunoglobulin (IVIG) therapy in treating Kawasaki disease (KD) and preventing cardiac consequences (coronary artery lesion, CAL). Methods A questionnaire form and guideline for KD diagnosis were sent to 50 hospitals providing pediatric medical care in Shanghai. The data from a total of 1 682 KD patients were collected. It included 1 064 males and 618 females from 1998 through 2008 in Shanghai. The average age of the KD patients was (2.57±2.33) years old (0.1-18.8 years).The patients had been divided into 6 groups for different IVIG therapy, which included 1 g/kg once, 2 g/kg once, 0.4-0.5 g/kg five times, 1 g/kg twice, 2 g/kg twice and others. SAS 6.12 software was used for statistical analysis. Results In all KD patients, the patients treated with IV1G in 5th-10th day of illness has the least cardiac complication and CAL incidence and the group with IVIG therapy of 1 g/kg twice also has the least cardiac complication and CAL incidence. Conclusions The best doses of IVIG in treating KD is 1 g/kg twice and the IVIG therapy should be used in 5th-10th day of KD illness.