Arsenic/toxicity* ; Bangladesh ; Female ; Humans ; Infant, Newborn ; Pregnancy ; Premature Birth/chemically induced* ; Rural Population ; Zinc

Objective: To explore the clinical value of extravascular lung water monitoring for rapid recovery in pediatric patients after complete repair of tetralogy of Fallot (TOF). Methods: A total of 43 pediatric patients received complete repair of TOF were studied. The pulse contour cardiac index (PCCI), global end diastolic volume index (GEDI), stroke volume variation (SVV), systemic vascular resistance index (SVRI), global ejection fraction (GEF), maximum of pressure increase in aorta (dPmax), extravascular lung water index (EVWI) and pulmonary vascular permeability index (PVPI) were recorded by pulse-indicated continuous cardiac output (PICCO) monitoring at immediately enter pediatric ICU (PICU) and 6h, 12h, 18h, 24h post-operation. Meanwhile, the heart rate, blood pressure, central venous pressure (CVP), left atrium pressure (LAP) and balance of liquid were monitored; mechanical ventilation time, PICU stay time, re-intubation,re-occlusion of major aortopulmonary collateral arteries (MAPCAs) and other complications were recorded. Based on post-operative mechanical ventilation time, the patients were divided into 2 groups: Rapid recovery (R) group, patients with mechanical ventilation≤24h, n=29 and Delayed recovery (D) group, patients with mechanical ventilation>24h, n=14. Results: Compared with group D, group R had the shorter mechanical ventilation time (14.2±8.0) h vs (86.3±44.5) h and PICU stay time (2.5±1.7) days vs (5.3±3.6) days, both P<0.05; decreased PVPI at immediately enter PICU and 6h, 12h, 18h, 24h post-operation as (4.9±1.3 vs 6.4±1.5),(5.1±1.8 vs 6.5±1.3),(4.8±2.0 vs 6.5±1.6),(4.4±1.1vs 6.9±1.8), (4.4±2.5 vs 6.5±2.2) respectively, all P<0.05; Lower ELWI at 12h and 18h post-operation as(20.9±6.1) ml/kg vs (26.8±5.7) ml/kg and(19.1±5.5) ml/kg vs (26.7±5.5)ml/kg, both P<0.05. Group R had no patient received re-occlusion of MAPCAs after operation, while Group D had 3. No death, no catheter-related complication occurred in either group. Conclusion: MAPCAs may increase extravascular lung water, pulmonary vascular permeability and cause lung perfusion, therefore affect the early recovery of complete repair of pediatric TOF. PICCO monitoring may conduct bedside quantitative observation of lung perfusion, combining with ELWI and PVPI, clinicians may identify and manage MAPCAs as necessity for rapid recovery in relevant patients.

Objective To analyze the mutation of PreS-S region in occult hepatitis B virus(OHBV) in HBV infected persons with positive HBsAb and investigate the biological mechanisms of the special infectious model.Methods A total of 38 HB-sAb positive OBI serum samples were amplified by Nested PCR and sequenced,HBV genotype and serotype were determined.The amino acid sequences of OHBV were compared to the corresponding sequence of wild-type strains of similar genotype obtained from the GenBank database.Results PreS-S segment of 11 samples were obtained and 8 samples were sequenced successfully.Among which,5 were genotype C and 3 were genotype B.Genotype B were all serotype adw,while genotype C were 1 adw and 4 adr.The mutation rates of PreS-S region,the immunoreactive area and the major hydrophilic region (MHR) were higher in OHBV than the wild-type strains (2.6％ vs 0.8％,x2 =40.23,3.2％ vs 0.3％,x2 =52.13,3.6％ vs 0.6％,x2 =13.25,all P＜0.01) and the substitutions of I126T,Q129R,M133T,F134I,D144E,G145K in α determinant were found in OBI samples.The mutation rate of amino acids in PreS-S region was higher in genotype C than genotype B (3.5％ vs 1.2％,x2--15.98,P＜0.01),meanwhile,the mutation rates in MHR,α determinant and immunoreactive region were higher in genotype C too,but no statistical significance was attained (4.7％ vs 1.7 ％,x2 =2.96,3.6 ％ vs 2.9％,x2 =0.25,4.1％ vs 2.3％,x2 =3.59,all P ＞0.05).Conclusion Mutations in PreS-S region,especially in immunoepitope,might change the virus'immunogenicity leading to escape from immune response and cause OBI with HBsAb positive.

BACKGROUNDOccluders licensed for clinical use are not fit for some special Krichenko E patent ductus arterioses. The Amplatzer vascular plug I (AVP1) has not been licensed for use for closure of patent ductus arteriose. We report our initial experience to occluding special type patent ductus arterioses with the AVP1-a single lobe device of single layer Nitinol mesh for short vessel landing zones.

METHODSPatients referred with small and long Krichenko E patent ductus arterioses 1 mm to 3 mm in diameter underwent occlusion using AVP1. All cases underwent pre-, intra- and post-procedural echocardiography and chest X-ray at the completion of the procedure, the next day and at a 30-day, 3-month and 6-month follow-up visits. Device sizing for device waist diameter and length was based on aortography.

RESULTSFrom April 2008 to June 2012, 26 patients with a mean age of (7.6 ± 8.0) years (range 6 months-32 years) and a mean weight of (23.8 ± 14.8) kg (range 7-67 kg) underwent successful patent ductus arteriose closure. The mean ductus diameter was (2.1 ± 0.7) mm (range 1-3 mm). Transpulmonary (22/26) and transaortic approaches (4/26) were used. No persistent patency was observed after 24 hours and after one month. No device displacement, residual flow and iatrogenic coarctation of the aorta were observed after three months and six months.

CONCLUSIONSThe AVP1 makes it easy to close some Krichenko E patent ductus arterioses. Smaller delivery catheter profile and symmetric cylindrical device shape allow for use for small and long Krichenko E patent ductus arterioses 1 mm to 3 mm in diameter and small patients through transaortic approaches. Broader experience is required to further delineate device and patient selection as well as to document its long-term efficacy and safety.

Adolescent ; Adult ; Child ; Child, Preschool ; Ductus Arteriosus, Patent ; surgery ; Female ; Humans ; Infant ; Male ; Septal Occluder Device ; Young Adult

OBJECTIVETo develop the national neglect norms for urban primary school students in China.

METHODSAccording to multi-stage stratified cluster sampling principle, 24 cities of 13 provinces (municipalities) in China were selected during December 1 to 31, 2008. A total of 1491 students in grade 1 - 3 and 2236 students in grade 4 - 6 were selected. Questionnaire was designed by authors and the final norms were determined through several statistical analysis methods, such as item analysis method, factor analysis method, reliability analysis method. The reliability analysis and validity analysis were used to test the stability and reliability of the norms. The evaluation criteria of the scale was determined by the percentile method, then the initial development of the norm was completed.

RESULTSThe two questionnaires of grade 1 - 3 and grade 4 - 6 students consisted of 55 and 57 items, respectively, whose item loadings were ranged from 0.301 to 0.687 and 0.321 to 0.730, which met the statistical requirements. For grade 1 - 3 students, the scale's total Cronbach α coefficients was 0.914, the total split-half reliability coefficients was 0.896, the Cronbach α coefficients of four level was above 0.737 except medical and social neglect, split-half reliability was ranged from 0.461 to 0.757; for grade 4-6 students, the scale's total Cronbach α coefficients was 0.916, split-half reliability was 0.883, except social neglect, the Cronbach α coefficients of other level was ranged 0.457 to 0.856, split-half reliability was ranged from 0.500 to 0.798. The total neglect cut-off score of the two scales grade 1-3 and 4-6 were 125 and 155, respectively.

CONCLUSIONThe structure of two norms was reasonable. The scales have good stability and reliability.

Child ; Child Abuse ; prevention & control ; statistics & numerical data ; China ; epidemiology ; Female ; Humans ; Male ; Reproducibility of Results ; Schools ; Students ; Surveys and Questionnaires

BACKGROUNDCardiac resynchronization therapy (CRT) device and coronary sinus (CS) lead extraction are required due to the occurrence of systemic infection, malfunction, or upgrade. Relevant research of CS lead extraction is rare, especially in developing countries because of the high cost and lack of specialized tools. We aimed to evaluate percutaneous extraction of CS leads by modified conventional techniques.

METHODSOf 200 patients referred for lead extraction from January 2007 to June 2011, 24 (12.0%) involved CS leads (24 CS leads). We prospectively analyzed clinical characteristics, optimized extraction techniques and feasibility of extraction.

RESULTSComplete procedural success was achieved in 23 patients (95.8%), and the clinical success in 24 patients (100.0%). The leading indication for CS lead extraction was infection (66.7%). Mean implant duration was (29.5 ± 20.2) months (range, 3 - 78 months). Sixteen CS leads (66.6%) were removed with locking stylets plus manual traction by superior transvenous approach. Mechanical dilatation and counter-traction was required to free fibrotic adhesions and extract 4 CS leads (16.7%), which had longer implant duration than other leads ((62.5 ± 12.3) vs. (22.9 ± 14.1) months, P < 0.05). Another 4 CS (16.7%) leads were removed by modified and innovative snare techniques from femoral vein approach. Median extraction time was 11 minutes (range, 3 - 61 minutes) per CS lead, which had significant correlation with implant duration (r = 0.8, P < 0.001). Sixteen patients (66.6%) were reimplanted with new devices at a median of 7.5 days after extraction. Median followed-up was 23.5 months (range, 8 - 61 months), three patients died due to sudden cardiac death (26 months), heart failure (45 and 57 months, respectively).

CONCLUSIONThe modified procedure was proved to be practical for percutaneous extraction of CS leads, especially in developing countries lacking expensive powered sheaths.

Aged ; Cardiac Resynchronization Therapy Devices ; adverse effects ; Coronary Sinus ; surgery ; Device Removal ; methods ; Electrodes, Implanted ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies

Objective To evaluate the clinical feature of patients with atrial septal defects (ASD)and the safety and efficacy of transcatheter closure of ASD in elderly patients.Methods Between May 2000and June 2010,82 patients aged (64.5 + 3.8)years underwent attempted transcatheter ASD closure.Right heart catheterization was performed before intervention.Echocardiography was made at 1 day,1,3,6 months after the procedure.The pre- and post-closure clinical feature,pulmonary artery pressure (PAP) and cardiac function were evaluated.Results In 82 patients,37 (45.1％) patients were associated with pulmonary arterial hypertension ( PAH ).The systolic PAP and mean PAP [ (44.1 ± 12.4) mm Hg ( 1mm Hg = 0.133 kPa) and (25.2 + 6.8) mm Hg,respectively ] were measured by right heart catheterization before the procedure.One patient was unsuitable for closure because of severe PAH.The remaining 81patients underwent successful ASD closure without major complications.After closuring,systolic PAP decreased from (52.7 ± 10.3 )mm Hg to (31.8 ± 6.3) mm Hg ( P ＜ 0.05 ),and mean PAP descended from (30.9 ± 4.7 ) mm Hg to (21.8 ± 3.4) mm Hg( P ＜ 0.05 ) in the 36 patients with PAH.The cardiac function improved post procedure.There were 6 new-onset atrial fibrillations during follow up.Conclusions ASD in elderly patients are commonly associated with PAH.Transcatheter ASD closure is safe and effective in the majority of elderly patients.

Objective To analyze the clinical feature and the effects of transcatheter closure of adult patients with patent ductus arteriosus (PDA). Methods Between January 2000 and April 2009, 139 patients [22 male, aged from 40 to 74:(49.8±6.8) years] with PDA were hospitalized in our hospital. Clinical data and effects of transcatheter closure of PDA were analyzed. Results There were 64 patients with NYHA class Ⅰ, 53 with class Ⅱ, 16 with class Ⅲ and 6 with class Ⅳ before procedure. In 139 patients, pulmonary arterial hypertension (PAH) was found in 107 out of 139 patients (77.0%). Transcatheter PDA closure was not performed in 3 patients due to severe PAH and successfully performed in the remaining 136 patients (97.8%) without major complications. Post procedure aortic angiography evidenced minor residual shunt in 14 cases, small residual shunt in 2 cases and moderate shunt in 1 case. The NYHA class was significantly improved and the PAH significantly reduced [sPAP: (47.3±23.9)mm Hg(1 mmHg=0.133 kPa) vs. (28.1±12.3) mm Hg,P<0.01] post procedure. Conclusion PAH and heart failure were commonly associated with PDA in adult patients. Transcatheter PDA closure is safe and effective in these patients except those with severe PAH.

Objective To investigate the clinical significance of gene methylation of p53-bax mitochondrial apoptosis pathway in the carcinogenesis of cholangiocarcinoma. Methods Promoter hypermethylation of DAPK, P14ARF and ASC genes were detected by methylation-specific PCR. Exon 5-8 of p53 gene were examined by automatic sequencing. Results It was found that 66.7% of 36 cholangiocarcinoma patients had methylation of at least one tumor suppressor gene. The rate of tumor suppressor gene methylation in these cholangiocarcinomas was 25.0% in P14FRF, 30.6% in DAPK and 36.1% in TMS1/ASC. The methylation rate of tumor suppressor gene in tissues adjacent to the cancer tissue was 13.9% including 5.6% in DAPK and 8.3% in TMS1/ASC. p53 gene mutation was detected in 22 of 36 patients(61.1%). Fourteen patients (38.9%)was found to have p53 gene mutation associated with the methylation of tumor suppressor gene. The rate of p53 gene mutation and methylation of tumor suppressor gene were statistically and significantly correlated with the features of tumor biology including differentiation and invasion (P< 0.05). Conclusion DNA methylation of p53-bax mitchondrial apoptosis pathway may be a frequent molecular event in the carcinogenesis of cholangiocarcinoma. Although the methylation rate of ASC, DAPK genes is relatively low, it may be helpful for early diagnosis, p53 gene mutation associated with the methylation of tumor suppressor genes may be correlated with tumor malignant biologic features.

Objective To investigate the clinical significance of gene methylation of p53-bax mitochondrial apoptosis pathway in the carcinogenesis of cholangiocarcinoma. Methods Promoter hypermethylation of DAPK, P14ARF and ASC genes were detected by methylation-specific PCR. Exon 5-8 of p53 gene were examined by automatic sequencing. Results It was found that 66.7% of 36 cholangiocarcinoma patients had methylation of at least one tumor suppressor gene. The rate of tumor suppressor gene methylation in these cholangiocarcinomas was 25.0% in P14FRF, 30.6% in DAPK and 36.1% in TMS1/ASC. The methylation rate of tumor suppressor gene in tissues adjacent to the cancer tissue was 13.9% including 5.6% in DAPK and 8.3% in TMS1/ASC. p53 gene mutation was detected in 22 of 36 patients(61.1%). Fourteen patients (38.9%)was found to have p53 gene mutation associated with the methylation of tumor suppressor gene. The rate of p53 gene mutation and methylation of tumor suppressor gene were statistically and significantly correlated with the features of tumor biology including differentiation and invasion (P< 0.05). Conclusion DNA methylation of p53-bax mitchondrial apoptosis pathway may be a frequent molecular event in the carcinogenesis of cholangiocarcinoma. Although the methylation rate of ASC, DAPK genes is relatively low, it may be helpful for early diagnosis, p53 gene mutation associated with the methylation of tumor suppressor genes may be correlated with tumor malignant biologic features.