OBJECTIVETo investigate the risk factors for fulminant myocarditis by analyzing clinical symptoms/signs or laboratory findings in children with viral myocarditis.

METHODSThe medical data of 71 children with acute viral myocarditis from March 2005 to September 2008 were retrospectively studied. They were classified into fulminant (n=16) and non-fulminant myocarditis groups (n=55). Chi-square and Student's t-test were used to analyze the clinical presentations, laboratory data, EEG and cardiac ultrasound findings on admission. The multiple regression analysis was used to identify the independent risk factors for fulminant myocarditis.

RESULTSEight children (50%) died in the fulminant myocarditis group, but none in the non-fulminant group. The following factors were closely related to the fulminant course of myocarditis: lower blood pressure, higher serum CK-MB level, positive cTnI, complete atrioventricular block and left bundle branch block, ST segment alterations, prolonged QRS complex, and decreased left ventricular ejection fraction and short axis fractional shortening. Multiple regression analysis revealed that prolonged QRS complex (OR=1.139; CI=1.014-1.279, P<0.05) and decreased left ventricular ejection fraction (OR=0.711; CI=0.533-0.949, P<0.05) were independent risk factors for fulminant myocarditis.

CONCLUSIONSThe mortality of fulminant myocarditis is high in children. Prolonged QRS complex and decreased left ventricular ejection fraction on admission are independent risk factors for fulminant myocarditis in children.

Acute Disease ; Child ; Child, Preschool ; Electrocardiography ; Female ; Humans ; Infant ; Logistic Models ; Male ; Myocarditis ; etiology ; Risk Factors ; Ventricular Function, Left

Objective To establish a model of acute gouty arthritis( AGA) in rats and observe its maintenance time. Methods The AGA model of rats was established by injecting monosodium urate ( MSU) at the concentration of 25 mg/mL into the ankle joint cavity. The rats were observed for 8 d at different time points. Skin temperature, degree of joint swelling, gait, inflammatory cells in synovial fluid, histopathological changes of synovial tissue and other indicators were observed to determine whether the modeling and maintenance time were successful. Results At 3 h after modeling, differ-ences in the swelling of ankle joint, increase of skin temperature, abnormal gait, the number of inflammatory cells in syno-vial fluid, synovial hyperplasia, capillary congestion, and disarrangement of synovial cells in the rats were observed in the saline group and the model group (P <0. 01). At 4 hours after modeling, the above mentioned inflammatory changes in the saline group were significantly reduced, compared with that at 3 h, showing a significant difference (P<0. 01), while the inflammatory changes of the model group were increased significantly compared with that at 3 hours ( P<0. 01 ) , and showed significant difference compared with the saline group (P<0. 01). At 24 h after modeling, the indexes in the rats of saline group returned to normal, but the inflammation of the model group was increased. At 48-72 h after modeling, the local inflammation such as ankle swelling, skin temperature, and abnormal gait of the rats in the model group reached a peak. The inflammation of the ankle joint in the model group was gradually reduced from 96 to 168 h after the model was established, but there were still significant differences in the indexes compared with the blank group (P<0. 01). At 192 h after modeling, the joint swelling, skin temperature and abnormal gait of the rats in the model group returned to normal, however, there were significant differences in the number of inflammatory cells and the pathological changes of synovial membrane compared with the blank group ( P<0. 01 ) . Conclusions A rat model of AGA can be successfully prepared and identified at 4 h after modeling by injection of MSU crystal suspension into the ankle joint cavity. This rat model of AGA can be maintained at least 168 hours after modeling.

Antibodies, Viral ; blood ; China ; epidemiology ; Female ; Humans ; Immunoglobulin G ; blood ; Male ; SARS Virus ; immunology ; isolation & purification ; Seroepidemiologic Studies ; Severe Acute Respiratory Syndrome ; epidemiology ; virology

BACKGROUNDTo find out the timing of serologic responses after illness onset and distribution of IgG antibody to SARS-CoV in SARS cases of transmission chain or non-transmission chain.

METHODSThe IgG and IgM antibodies to SARS-CoV were tested by indirect ELISA in serum samples from 301 clinically diagnosed SARS cases.

RESULTSTotally 158 SARS cases were involved in 15 chains of transmission. The positive rates of SARS-CoV IgG in those chains were 85.70%-100.00% and the overall rate was 94.30% (149/158). The chain of transmission could spread to four generations, but the SARS cases were reduced with increase of generations. There was no significant difference among positive rates of SARS-CoV IgG for generations, Chi square=5.11, P greater than 0.05. The positive rate of SARS-CoV IgG in cases who were not in chain of transmission was 12.59%(18/143) which was statistically significantly different from that of cases in chain of transmission, Chi square=199.64, P less than 0.001. During days 0-7,8-14,15-21,22-30 after onset, the cumulated positive rate of SARS-CoV IgG was 16.67%, 40.00%, 70.00% and 93.10%, respectively, then was kept at the level above 90% and lasted for 217 days. The cumulated positive rate of SARS-CoV IgM during days 0-7 after onset was the same to that of IgG. During days 8-14, 55.17% of cases had seroconversion for IgM which reached a peak (86.96%) during days 21-30. Then the rate rapidly declined.

CONCLUSIONMore than 94% of cases with SARS could produce IgG antibody when they were infected by SARS-CoV. Detecting SARS-CoV IgG could provide a diagnostic evidence for case confirmation. SARS-CoV IgG appeared as early as 7 days after onset and reached the peak at about weeks 4. Then the high rate of antibody was maintained for more than 6 months.

Antibodies, Viral ; blood ; Disease Transmission, Infectious ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin G ; blood ; Immunoglobulin M ; blood ; SARS Virus ; immunology ; Severe Acute Respiratory Syndrome ; immunology ; transmission