Background Environmental pollutants can affect N⁶-methyladenosine (m⁶A) level in the body, but the change of m⁶A level in kidney after being exposed to cadmium (Cd) and the molecular mechanism of renal injury need to be further studied. Objective To analyze the associations of m⁶A modification and methyltransferases/demethylases with microRNA-21 (miR-21) and transforming growth factor- β1 (TGF - β1) in kidney of rats exposed to Cd. Methods Twenty-four SPF male SD rats were divided into 4 groups, with 6 rats in each group, and were exposed to Cd by subcutaneous injection of 2.0, 1.0, and 0.5 mg·kg⁻¹ cadmium chloride (CdCl₂) and equal volume of normal saline for 2 weeks, 7 d a week, respectively. The levels of N-acetyl-β-D-glucosidase (UNAG) and albumin (UALB) in urine, and the levels of m⁶A methylation and TGF-β1 in kidney were detected by enzyme-linked immunosorbent assay (ELISA). The level of blood urea nitrogen (BUN) was measured by urease method. The levels of renal oxidative stress indicators such as malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) were detected by total bile acid method, water-soluble tetrazolium asssay, and colorimetric method respectively. The relative levels of TGF-β1, methyltransferases, and demethylases in kidney were measured by reverse transcription-polymerase chain reaction. The expression of miR-21 in kidney was detected by fluorescent quantitative polymerase chain reaction. Results After 2 weeks of exposure to Cd, the body weights of rats in the 2.0 and 1.0 mg·kg⁻¹ cadmium chloride groups decreased, and the ratio of kidney/body weight and the levels of BUN, UNAG, and TGF-β1 mRNA and protein increased in the 2.0 mg·kg⁻¹ cadmium chloride group (P<0.05). The expression levels of m⁶A modification, methyltransferases METTL3, METTL14, Wilms’ tumor 1-associated protein (WTAP), and miR-21 were increased both in the 2.0 and 1.0 mg·kg⁻¹ cadmium chloride groups, with significant differences compared with the control group (P<0.05). The results of correlation analysis showed that the m⁶A modification level was negatively correlated with SOD (r=−0.4489, P<0.05) and GSH-Px (r=−0.4874, P<0.05), METTL3 was negatively correlated with MDA (r=−0.5158, P<0.05), while there was a positive correlation between FTO and GSH-Px (r=0.4802, P<0.05). In addition, miR-21 was positively correlated with METTL3 (r=0.7491), METTL14 (r=0.6157), and WTAP (r=0.6660) (P<0.05), TGF-β1 was positively correlated with METTL3 (r=0.5025, P<0.05) but negatively correlated with FTO (r=−0.5634, P<0.05) . Conclusion Cd can induce m⁶A methylation and up-regulation of METTL3, METTL14, WTAP, and miR-21 expression levels in rat kidney tissues, indicating that m⁶A and miR-21 may be associated with Cd-induced renal fibrosis.

Objective:To evaluate the strategy and safety of the radiofrequency ablation (RFA) on ventricular arrhythmias (VAs) originating from the pulmonary sinus cusp (PSC) in pediatric patients.Methods:Retrospective study.Fifteen patients with VAs originating from the PSC who were intervened by RFA in the Department of Pediatric Cardiology, Guangdong Provincial People′s Hospital between March 2014 to July 2020 were enrolled.All the patients met the indication criteria for RFA in pediatric patients.The electrocardiogram, ablation method of ablation were analyzed.Different curved catheters were selected for RFA according to the age and weight of the patients.The catheter was then inserted in a " U" or inverted " P" shape to the PSC.The long-term effect of ablation were reviewed.Results:The mean age and body weight of 15 patients with VAs originating from the PSC were (11.6±2.6) (6-15) years and (39.9±12.2) (19-65) kg, respectively.The electrocardiogram recorded during VAs originating from the PSC showed left bundle branch block and inferior axis with monomorphic R pattern, as well as a QS-wave in aVR and aVL.The electrocardiogram characteristics varied in patients with VAs originating from the PSC.The ideal excitation point was not found in the right ventricular outflow tract or the ablation was unsuccessful in all patients, and the earliest target was mapped and RFA was successful.Among the 15 patients, the successful ablation site was in the lower regions of the PSC, involving the right cusp in 11 patients(73.3%), the anterior cusp in 3 patients(20.0%), and the left cusp in 1 patient(6.7%). The earliest potential recorded at the PSC ablation site preceded the QRS complex onset by (27.3±6.0) ms.During the follow-up period for (2.7±2.0) years, no recurrence of VAs or complications were recorded.Conclusions:Under the premise of gentle catheterization procedure and appropriate radiofrequency energy, ablation was effective, safe and with low recurrence rate to eradicate VAs originating from the PSC in children.

The epidemic of COVID-19 has become the topmost public health threat worldwide. The authors suggested that in addition to strengthening the organization and leadership of the abovementioned work, greater attention be paid to establishing and improving the prevention and control mechanism.Furthermore, special efforts should be given to the safety of the medical workers, by strengthening their infection monitoring and outbreak management. Medical workers in different work areas and positions should be placed under careful protection with due cleaning and disinfection measures. The protection during specimen collection, transportation and medical waste management should also be prioritized. Such special issues in the management of pediatric patients, as allocation of nurses, the screening and management of caregivers, the problem of breastfeeding, and the disinfection of children′s toys and diapers were discussed. This paper also put forward management suggestions for the outpatient department, isolation ward and other key departments, which aim to guide the prevention and control of COVID-19 nosocomial infection in the pediatric outpatient and ward.

Objective:To explore the application of implantable cardioverter defibrillator(ICD) in the prevention of sudden cardiac death for children and adolescents, the treatment of adverse events and follow-up studies.Methods:A total of 19 pediatric patients (12 males, 7 females) were admitted in the Department of Pediatric Cardio-logy, Guangdong Provincial People′s Hospital from January 2008 to March 2019, and their previous inpatient and outpatient data including medical history, ICD implantation method, postoperative program control, the use of antiarrhythmic drugs, proper/improper discharge of ICD and management of ventricular electrical storm were collected retrospectively and follow-up study was carried out.Results:A total of 19 pediatric patients were included, all of whom had once syncope or more before ICD implantation.The age at the time of ICD implantation was (12.30±2.08) years, and the weight was (40.00±13.93) kg.Eleven patients were implanted in the subpectoralis major space, 6 cases in the subfascial space, and 2 cases in the left abdomen and left armpit, respectively.All patients received oral antiarrhythmic drugs after surgery.The follow-up period was 3.2 years(0.3-11.1 years). All the children survived without complications such as electrode fracture, dislocation, venous thrombosis, cardiac perforation, capsular hematoma, rupture, and infection.Twelve cases (63.2%) had discharge events, including 10 cases (83.3%) of appropriate recognition/treatment events, and 2 cases (16.7%) of inappropriate recognition/treatment events, while 5 cases were ventricular electrical storms.Totally, 7 ICD cases (36.8%) were equipped with remote monitoring system, and 4 cases (57.1%) were detected whit adverse reactions, which were timely handled online and offline, thus avoiding adverse consequences.Conclusions:Currently, ICD is the most effective treatment for the prevention of sudden cardiac death in children and adolescents.According to age, weight and developmental conditions, different implantation methods should be selected.Appropriate/inappropriate discharge events after implantation should be identified in time, drug treatment should be optimized, and radiofrequency ablation should be performed if necessary.

Objective:To explore the effect of negative affect on internet addiction among college students, and the mediating effect of fatigue.Methods:Totally 8 371 freshmen from North China University of Science and Technology were assessed with Chen Shuhui Chinese Network Scale, Fatigue Assessment Scale and Positive Negative Emotion Scale.SPSS 23.0 was used to analyze the data and test the intermediary effect.Results:Both of the total score of internet addiction scale and the scores of each factor were negatively correlated with positive emotions scores ( r=-0.337- -0.269, P<0.01). However, theose were positively correlated with the negative emotion scores( r=0.338-0.417, P<0.01), the fatigue severity scores( r=0.029-0.040, P<0.01), and the environment specific score and the result score of fatigue( r=0.021-0.028, P<0.05). The emotion and fatigue of college students could predict internet addiction, which could explain 36.9% variation of total score of internet addiction( F=979.336, P<0.01). Fatigue played a part in mediating between internet addiction and negative emotions. Conclusion:Negative emotions not only directly affect the degree of internet addiction of college students, but also indirectly affect the degree of internet addiction of college students through part of the intermediary role of fatigue.

The pneumonia caused by the novel coronavirus (2019-nCoV), which began in December 2019, has become the most serious public health problem, threatening people's health and life. This threat is posing a severe challenge on the diagnosis and treatment of 2019-nCoV infection, the prevention and control of hospital cross infection of medical staff. It is suggested that in addition to strengthening the organization and leadership of the abovementioned work, establishing and improving the prevention and control mechanism deserve greater attention. Furthermore, special attention should be given to the safety of the medical staff, strengthening their infection monitoring and outbreak management. Medical staff in different work areas and positions should be placed under careful protection, cleaning and disinfection measures. The protection during specimen collection, transportation and medical waste management should also be prioritized. This paper also put forward management suggestions for the outpatient department, isolation ward and other key departments. These measures are proposed to provide a guidance for the prevention and control of 2019-nCoV nosocomial infection in the pediatric outpatient and ward.

Objective To evaLuate the Long?term effects of cardiac resynchronization therapy (CRT) in chiLdren with right ventricLe?paced heart faiLure. Methods Five chiLdren with chronicaLLy right ventricuLar?paced heart faiLure underwent operation of upgrading to CRT in Guangdong CardiovascuLar Institute between JuLy 2009 to January 2015. The first time the patients were impLanted with endocardiaL permanent pacemaker was (11.6 ± 4.6) years oLd. The New York Heart Association (NYHA) functionaL cLassification, QRS duration, Left ventricuLar end diastoLic diameter (LVDd), Left ventricuLar ejection fraction (LVEF), standard deviation of peak systoLic time of Left ventricuLar waLL (TS?SD) and foLLow?up data were retrospectiveLy anaLyzed. Comparison between pre?and post?operation was performed using paired t test. ResuLts CRT significantLy improved the NYHA cLass toⅠ?Ⅱdegree, reduced the QRS duration ((126±9) vs. (182±21) ms, t=-7.480, P=0.002) and the Z?score of LVDd (2.8±1.1 vs. 4.7±0.9, t=-2.880, P=0.045), and increased the LVEF (43% ± 10% vs. 28% ± 6%, t=3.350, P=0.029). No significant difference was found regarding the TS?SD ((48±17) vs. (95±41) ms, t=-2.240, P=0.090) pre?and post?CRT. The Longest foLLow?up period was 9 years. During foLLow?up, 1 case died of ventricuLar fibriLLation 2 years after upgrading, and 2 cases underwent CRT repLacement due to battery depLetion 7.2 years and 5.8 years after upgrading, respectiveLy. ConcLusion CRT couLd be considered for chiLdren with chronicaLLy right ventricuLar?paced heart faiLure and improve heart function significantLy.

Objective To investigate the status on accuracy of estimation in applying Richmond Agitation-Sedation Scale (RASS) by nurses of Intensive Care Unit (ICU) for sedation of critically ill patients and to explore its influencing factors. Methods From November 2016 to January 2017, we selected 206 ICU patients and 38 ICU nurses of a ClassⅢ Grade A hospital in Beijing by convenience sampling. Research group and ICU nurses respectively assessed patients' agitation-sedation state with the RASS and analyzed its differences as well as influencing factors. Results There were 143 patients assessed by ICU nurses with the RASS in accordance with that in research group with 69.4% for the accuracy rate. Logistic regression analysis showed that the influencing factors of accuracy of estimation in RASS included sedative, score of Glasgow and delirium (OR=0.065, 1.424, 0.201;P＜0.05). Conclusions The accuracy of estimation in applying RASS by ICU nurses is at a middle level. We should pay attention to patients with sedative, delirium and the low score of Glasgow during applying RASS for critically ill patients.

Objective To explore the changes of mTOR signaling in LPS/D-gal-induced acute hepatitis in mice . Methods Twenty-six healthy adult female ICR mice were divided into two groups:the control group and experimental group, 13 mice in each group .LPS/D-gal was used to induce acute hepatitis in the mice .The survival of mice was moni-tored within 24 hours after LPS/D-gal challenge .At 6 hours after challenge , samples of serum and liver tissue were collect-ed for further analysis.Results Injection of LPS/D-gal resulted in acute death of the mice within 24 hours.At 6 hours post LPS/D-gal injection , the blood levels of ALT and AST were significantly increased .The mRNA expression of inflammatory cytokines Tnfa and Il6 was up-regulated in LPS/D-gal-induced hapatitis , in which DNA fragmentation and activation of caspase-3 were subsequently observed .Immunoblot analysis showed that both mTOR pathway and NF-κB pathway were ac-tivated.Unexpectedly , inhibition of mTOR signaling could neither decrease the apoptosis in the liver nor increase the sur -vival of mice .Conclusions The results of the present study indicate that mTOR signaling may play pleiotropic roles in the pathogenesis of LPS/D-gal-induced hepatitis .

Objective To assess right ventricular (RV) regional and global volume and systolic function in patients with right coronary artery disease by real time three-dimensional echocardiography(RT-3DE).Methods RT-3DE images were acquired in 20 normal controls (Group A),30 patients with right coronary artery stenosis(Group B) and 10 patients with RV myocardial infarction(Group C).Volumetric RT-3DE images were analyzed by use of TomTec software,which provided regional (inflow,body and outflow) and global end diastolic volume(EDV),end systolic volume(ESV),stroke volume(SV) and ejection fraction(EF).RT-3DE quantitative data were analyzed to test repeatability.Results Compared with group A and group B,EDV and ESV of body and global were larger in group C;ESV of inflow and outflow were larger (P ＜0.05).EDV of group C was larger than group B(P ＜0.05).Compared with group A and group B,the EF of inflow,outflow and global in group C were lower(P ＜0.05).The EF of body in group C were lower than group B(P ＜0.05).There was no significant difference in regional and global volume and EF between group A and group B(P ＞0.05).The intra-observer and inter-observer's variability was low and consistency was high.Conclusions In patients with RV myocardial infarction,RV regional and global volumes were enlarged and systolic function was impaired.Evaluating right ventricular regional and global volume and function in patients with right coronary artery disease by RT-3DE has high repeatability.