Objective To investigate the association of PPAR gamma Pro12Ala polymorphisms with conroy heart disease(CHD). Methods One hundred eighty impatients were recruited in the study. Venous blood samples were collected after 12 h of fasting from all patients. DNA was extracted and Pro2Ala polymorphism in the PPAR gamma 2 genes was genotyped through the PCR-RFLP. The frequency and distribution of Pro2Ala polymorphism in Chinese Han population with CHD were analyzed. Gensini Score based on coronarography were used to grade the coronary. Results There were a total of 135 CHD patients,of which 52 were affected with single coronary lesion,43 with multi-coronary lesion,and 45 were normal. The frequency of P12/P12, A12/P12 in the coronary lesion group were 92.6% (125/135) and 7.4% (10/135) which were similar to that of 93.3% (42/45) and 6.7% (3/45)(P =0. 548). In the single coronary lesion group, the frequencies of P12/P12 and A12/P12 were 94.0% (42/52)and 9.6% (5/52) ,and 90.0% (36/40) and 10.0% (4/40) in the bi-coronary lesion group,97.7% (42/43) and 2.3% (1/43) in the multi-coronary lesion group,with no significant difference among the three groups( P ＞0.05).There were no significant difference on the frequency of P12/P12 and A12/P12 between various subgroups defined according to Gensini score (P = 0. 246). Compared to the frequency in non-obese, the frequency of A12/P12 were significantly higher in the obese ( P = 0.028 ). In PPAR gamma 2 genes B the Exton BstuI enzyme restriction site genes, BMI,waist-hip ratio and total cholesterol in the carriers of P12A genotype were significantly higher than those in the P12P genotype carriers ( P ＜ 0. 05 ). Conclusions PPAR gamma Pro12Ala polymorphisms might not be associated with CHD in Chinese Han population. The frequency of A12/P12 in obese is significantly higher than that in non-obese. PPAR gamma Pro12Ala polymorphisms might be associated with adiposity and lipid metabolism.

Objective To investigate the regulation of miR-1 and miR-133 a on L-type calcium channel β2 subunit ( Cavβ2 ) and α1C subunit during rat cardiomyocyte hypertrophy .Methods Cardiomyocyte hypertrophy was in-duced by isoproterenol (ISO, 10μmol/L).The targets of miR-1 and miR-133a were predicted by online database microCosm and Targetscan , respectively .The 3′untranslated region sequences of Cavβ2 andα1C were respectively cloned into reporter vector and then transiently transfected into HEK 293 cells.The luciferase activities of samples were measured for demonstrating the expression of luciferase reporter vector .The protein expression of Cavβ2 andα1C were evaluated by Western blot .The expression levels of Cavβ2 andα1C were inhibited by RNAi to determine theeffectsofCavβ2andα1Concardiomyocytehypertrophy.Results 1)Cavβ2wasoneofpotentialtargetsof miR-1,α1C was the one of potential targets of miR-133a.2) The luciferase activities of HEK293 cells with the plasmid containing widetype Cavβ2 3′UTR sequence or α1 C significantly decreased ( P <0.05 , P <0.01 ) . 3 ) Upregulation of the miR-1 and miR-133 a by miR-1 mimic and miR-133 a mimic transfection suppressed pro-tein expression of Cavβ2 and α1C, respectively(P<0.01, P<0.05).4)Downregulation of Cavβ2 andα1C by RNAi could markedly inhibit the increase of cell surface area ( P<0.01 ) , mRNA expression of ANP andβ-MHC (P<0.05).Conclusions Cavβ2 is the target gene of miR-1 and α1C is the target gene of miR-133a.miR-1 and miR-133a can negatively regulate the expression of L-type calcium channel Cavβ2 andα1C subunit, inhibi-ting cardiomyocyte hypertrophy.

Objective To explore the impact of elective caesarean section and vaginal delivery on maternal pelvic floor dysfunction. Methods A total of 131 pregnant women from January 2014 to March 2015 in our hospital were divided into observation group which re-ceived elective caesarean section and control group which received vaginal delivery.All the maternal and neonatal clinical data were counted. The occurrence of pelvic floor dysfunction disease in postpartum women after 6 to 8 weeks was observed.The occurrence of vaginal wall pro-lapse,uterine prolapse,stress urinary incontinence (SUI)and maternal pelvic floor muscle damage between two groups were compared and analyzed.Results There were varying degrees anterior vaginal wall prolapse phenomenon occured on 31 cases in obervation group,the pro-lapse rate was 67.39%,compared with 92.94% of the control group,the difference was statistically significant (P <0.05).Observation group with 13 cases of descent vaginae posterior,the prolapse rate was only 28.26%,compared with 75.29% of the control group,the differ-ence was statistically significant (P <0.05 ).The maternal uterine prolapse rate of observation group was about 13.04%,compared with 35.29%(30 cases)of the control group,the difference was statistically significant (P <0.05).Observation group with 6 cases of maternal SUI, the probability is about 13.04%,compared with 29.41% of control group,the difference was statistically significant (P <0.05).There was no significant difference in deep and shallow maternal pelvic floor muscle between two groups(P >0.05).Conclusion To adopt elective cesar-ean section has a lower probabilities of postpartum pelvic floor dysfunction disease than that by vaginal delivery for maternal women,which is propitious to the recovery of pregnant women,while it has nothing to do with pelvic floor muscle damage.

Amid the progress of public hospitals reform,the paper probed into the influences and opportunities of the health reform on the development the hospital pharmacy.They discussed the roles of pharmacists in medical service,and recommended on building the pharmaceutical service system in view of the current caliber of the pharmacists.

Objective To investigate the features and influence factors of cardiac function in preterm infants.Methods One hundred and eleven preterm infants were divided into three groups according to the gestational age which was 28-31+6,32-33+6 and 34-36+6 weeks respectively.Fifty term-birth infants at gestational age of 37-41+6 weeks were taken as control group.The cardiac function was examined by SonoSite 180 PLUS color Doppler ultrasonic diagnostic apparatus.The parameters of cardiac function included heart rate,peak flow rate of aorta valve orifice (AV),peak flow rate of pulmonary artery valve orifice (PV),cardiac output (CO),stroke volume (SV),left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),the ratio of early (E) and late (A) diastolic velocities of mitral and tricuspid valves (MVE/A,TVE/A).Within one week after delivery,the cardiac function was examined,and the cardiac function of preterm infants with different gestational age were compared.Another 162 preterm infants were divided into four groups according to the time at examination as 12 h-,24 h-,72 h-and 1 week-28 d.The influence factors of cardiac function were determined by multi-factor linear regression analysis.Results The AV,PV,CO,LVEDV,LVESV and SV increased with the increasing of gestational age.MVE/A (1.13±0.17,1.14±0.18,1.13±0.18) and TVE/A (0.90±0.16,0.90±0.13,0.90±0.15) of 28-31+6,32-33+6 and 34-36+6 weeks group were higher than those of control group (1.28±0.17 and 1.04±0.20),respectively (P＜0.05).PV of 72 h-group and 1 week-28 d group were higher than that of 12 h-group [(79.60±11.22) cm/s and (78.86±13.64) cm/s vs (72.61±8.56) cm/s](P＜0.05).The heart rate of 1 week-28 d group was higher than that of other three groups (P＜0.05).Both CO and SV were positively related to body weight and gestational age (r=0.55 and 0.36,0.61and 0.52,respectively,P＜0.05).Conclusions The left ventricular pump function increases with the increasing of gestational age,while the diastolic function of left and right ventricle of preterm infants does not change significantly in the first month of life.The PV of preterm infants significantly increases 72 h after delivery.The body weight and gestational age are important influence factors of cardiac function in preterm infants.

Objective To investigate the dynamic change and correlation of the pulmonary ventilative function, mechanic and cardiac function in the term infants. Methods Twenty hundred term infants were divided into A 、B 、C and D groups by age which was 0 ～ 24 h, ～ 72 h, ～ 1 w and 28 d respectively. The lung ventilative and mechanical function were measured respectively by using techniques of tidal breathing flow-volume loop(TBFVL)and the single occlusion. The Master screen Paed-lung function devices of Germanic JAEGER Co. was be used in this study. The parameter of pulmonary function including minute volume(MV) ,tidal volume (TV), respiratory system compliance(Crs) and respiratory system resistance (Rrs). The cardiac function were measured by using SonoSite 180 PLUS color Doppler ultrasonic diagnostic apparatus. The main parameter of cardiac function including cardiac output(CO) and stroke volume(SV). Results The TV of A, B ,C and D group were 20. 2 ± 3.78,21. 1 ± 3.71,22. 3 ± 4. 48 and 23. 9 ±4.90 (ml)respectively, the TV of C and D group were higher than that of A group, and the TV of D group was higher than that of B group (P ＜ 0. 05).There were no significantly difference of Crs, Rrs among A, B, C and D group(P ＞ 0. 05). The CO of A,B,C and D group were 0.93 ±0. 23,0.93 ±0.23,1.02 ±0.21 and 1.08 ±0.27 (L/min) ,the CO of D group was higher than that of A and B groups (P ＜ 0. 05). The CO was negative correlation with Rrs (r = - 0. 16,P ＜ 0. 05) and positive correlation with MV、 TV、 Crs (r was 0. 50、 0. 54、0. 13 respectively, P ＜ 0. 05).Conclusion The lung ventilative function is mature gradually with increasing age. The cardiac output has been obviously improved for postnatal 1 week in the term infants. The pulmonary ventilative function and mechanic parameter are important effective factors of cardiac function.

Objective To investigate the time and risk factors for spontaneous closure of patent ductus arteriosus (PDA) in preterm infants. Methods One hundred and seventy-seven preterm infants with arterial ductus unclosed were divided into three groups according to their gestational age as 28-31+6 weeks group (n=44),32-34+6 weeks group (n=59) and 35-36+6 weeks group (n=74).PDA was diagnosed by echocardiography in time of ≤12 h,-24 h,-48 h,-72 h,-96 h,-120 h,-144 h and ＞144 but ≤168 h after birth.The parameters of cardiac function included peak flow rate of aorta valve orifice,peak flow rate of pulmonary artery valve orifice,cardiac output,stroke volume,ejection fraction,the ratio of early (E) and late (A) diastolic velocities of mitral and tricuspid valves.The risk factors of arterial ductus spontaneous closure were determined by Logistic regression analysis.Results The cumulative spontaneous closure rates of preterm infants in three groups were 95.5％,100.0％ and 100.0％ within 168 h after birth respectively. There were significant differences of cumulative spontaneous closure rate in different time among three groups (x2 =4.23,7.45,12.46,7.14,4.75,6.47,3.89 and 3.89 respectively,P＜0.05).After spontaneous closure of PDA during 12-24 h, peak flow rate of pulmonary artery valve orifice increased [(0.69±0.12) cm/s vs (0.65±0.12) cm/s,t=2.37,P=0.02],peak flow rate of aorta valve orifice [(0.65±0.11) cm/s vs (0.69±0.12) cm/s,t=2.51,P=0.02] and ejection fraction [(63.00±8.50) ％ vs (66.00±8.50) ％,t=2.34,P=0.02] decreased.Logistic regression analysis showed that,the risk factors of preterm infants with arterial ductus unclosed within 24 hours after birth were gestation age (OR =1,825,95％CI:1.239-2.689),1 min Apgar score 0-3 (OR=1.946,95％CI:1.572-3.527) and early onset sepsis (OR=3.215,95％CI:1.245-5.463) ; gestation age (OR=3.270,95％CI:1.852-5.774),twins (OR=3.634,95％CI:1.489-8.871),1 min Apgar score 0-3 (OR=3.752,95％CI:2.156-5.436),Ⅲ-Ⅳ stage of respiratory distress syndrome (OR=2.897,95％CI:1.764-5.348) and early onset sepsis (OR=3.172,95％CI:2.134-6.437) were the risk factors of preterm infants with arterial ductus unclosed during 24-48 hours after birth; and gestational age (OR=2.471,95％CI:1.087-5.613),1 min Apgar score 0-3 (OR=2.985,95％CI: 1.469-5.736), Ⅲ-Ⅳ stage of respiratory distress syndrome (OR =3.645,95％ CI:1.879-6.282),fluid volume excess (OR =4.135,95％CI:2.146-7.428) and early onset sepsis (OR=3.246,95％CI:2.146-4.526) for those with arterial ductus unclosed during 48-72 hours after birth. Conclusions The spontaneous closure rate of arterial ductus in the newborn infants whose gestational age over 28 weeks was above 90％ in the first week after birth.There was no difference of left ventricular pump function between before and after the spontaneous closure.Reducing the incidence of premature birth,twins,severe asphyxia,severe respiratory distress syndrome, fluid excess and early onset sepsis might improve the spontaneous closure of arterial ductus.

Objective To summarize the clinical features of children with viral encephalitis accompa-nied with respiratory failure,and to improve the early diagnosis and treatment. Methods The clinical data of 64 cases with viral encephalitis combined with respiratory failure in our unit from May 2005 to May 2015 were analyzed retrospectively. Results All children were characterized by sudden onset. Among them, 60 cases (93. 7%) had fever,50 cases(78. 1%) had convulsion onset,46 cases(71. 8%) had consciousness disorders, 30 cases(46. 8%) had positive pathological signs. Most of them developed respiratory failure in acute stage. Total 56 cases occurred central respiratory failure,6 cases occurred central respiratory failure with peripheral respiratory failure,2 cases occurred respiratory and circulatory failure. Total 46 cases underwent cerebrospinal fluid examination. Routine biochemical test found 32 abnormal cases,of which 10 cases had intracranial hyper-tension and 19 cases had leukocytosis,and 17 cases had increased protein content. Ten cases were positive in cerebrospinal fluid etiology examination,including herpes simplex virus positive in 8 cases,EB virus positive in 1 case,and coxsackie virus positive in 1 case. There were 6 of 64 cases with abnormal CT scans and 29 of 34 cases with abnormal MRI. The results of EEG examination were abnormal in all patients for the first time. The EEG of 48 cases showed diffuse slow waves-δ activity. EEG examination showed generalized discharges or focal discharges during treatment in 22 cases. Five cases of electrophysiological examination showed cervical spinal cord anterior horn injury. Total 24 cases were complicated with stress ulcer,4 cases with liver damage,6 cases with heart damage,4 cases with renal damage,1 case with lung damage. All cases underwent mechanical ventilation for 2-50 days. Total 33 cases(51. 5%) improved and discharged,14 cases died during hospitaliza-tion,17 cases were given up treatment. Total 25 cases had variety of neurological dysfunctions left. Total 14 cases with epilepsy were followed up for 3 months to 6 years in our department,of which 8 cases were medical-ly intractable epilepsies. Conclusion The children with viral encephalitis complicated with respiratory failure have acute onset,rapid progress,high disability and mortality. Early diagnosis and evaluation,effective mechani-cal ventilation in time,and protecting organ function,help to improve the prognosis.

Objective To summary the clinical characteristics of epileptic spasm(ES)that is the unique form of seizures in childhood. Methods A total of 149 patients with ES who visited our hospital from May 2009 to June 2015 were collected. The documents of clinical data, treatment and outcome were analyzed retrospectively. The statistical analysis of some clinical characteristics and prognosis of patients were performed. Results There were 97(65.1%) male and 52 (34.9%) female in the 149 patients. The onset age of ES was from 30 days to 42 months (median value was 6 months) including 17 patients more than 12 months.The peak age of onset was 4-7 months. One hundred and forty-seven patients manifested clustered spasm. One pair of twins showed single spasm.Other types of seizure were seen before ES onset in 13 (8.7%) patients, and after ES onset in 42 (28.2%) patients.Eighty-three patients (55.7%) were diagnosed as West syndrome (WS). There were 46 patients (30.9%) with cryptogenic cause, 103 patients (69.1%) diagnosed with symptomatic epilepsy, in which 69 patients were with a clear cause. The proportions of developmental delay in the cryptogenic and symptomatic patients were 74.5% and 92.2% after the onset of the ES. The degree of developmental delay was linearly related to the course of ES. The hyperarrhythmia of electroencephalogram (EEG) background was seen in 122 patients (81.9%), and there was no significant difference in hyperarrhythmia between different etiology groups or different onset age groups. The short-term efficiency of topiramate evaluated within one month was 30.5% in 59 newly diagnosed patients. The short-term effective rate of adrenocorticotropic hormone (ACTH) was 80.3% in total 76 patients, but single ACTH treatment was associated with an increased recurrent rate. Conclusion ES is a highly age dependent seizure type that mainly found in WS,which typically follows a EEG hyperarrhythmia and developmental delay. The treatment of ES is difficult. ACTH combined with effective antiepileptic drugs (AEDS) is currently the most reasonable drug treatment program.

Objective To investigate the clinical characteristics and causes of recurrent purulent meningitis and its treatment.Methods The clinical data of 36 children with recurrent purulent meningitis were analyzed retro-spectively at Tianjin Children′s Hospital from 1 995 to 201 4.Based on the underlying illness,the following examinations were done respectively:brainstem electric response audi -ometry(BERA),temporal bone computed tomography,head magnetic resonance imaging(MRI),spinal core MRI,and blood immunoglobulin,etc.Results There were 24 boys and 1 2 girls involved in this study.The age of the initial onset in these patients ranged from 20 months old to 1 5 years old,with the average age of 5 year and 9 months old.There were 2 to 7 episodes in these cases.The etiology was identi-fied:1 9 cases (52.78%)with congenital anatomical abnormalities,1 2 cases of congenital inner ear malformation with cerebrospinal fluid (CSF) leakage,1 case of ear -nose CSF leakage,6 cases of pilonidal sinus.Fifteen cases (41 .67%)had anatomical abnormalities,1 2 cases had head and facial trauma,1 case had nasal polyps surgery,1 case (2.77%)had a history of chronic mastoiditis,and 1 case had a history of cochlear implant surgery;1 case of congenital humoral immunodeficiency disease X -linked agammaglobulinemia -free;1 case (2.77%)had humoral immunodefi-ciency disease.The anti -infection treatment was adopted in the acute -phase and then CSF rhinorrhea repair,CSF oto-rrhea,cerebrospinal fluid leakage,repair of the inner ear,pilonidal sinus resection,supplementary intravenous immuno-globulin around once every 3 months was given respectively in the restoration -phase.Thirty -three cases revealed no recurrence up to 8 months till 1 0 years follow -up,3 cases lost -to -follow -up.Conclusions The recurrent purulent meningitis is a serious infectious disease of the central nervous system,which may result in disabled condition even life -threatening.In order to avoid purulent meningitis recurrence,the corresponding treatment should be chosen ac-cording to different causes.