Objective:To analyze the distribution of clopidogrel metabolism-related gene variability in Kawasaki disease (KD) children with coronary artery lesions (CAL) across different age groups and the impact of genetic variability on the efficacy of clopidogrel antiplatelet therapy.Methods:A retrospective cohort study was conducted. Clinical data were collected from 46 KD children with CAL who were hospitalized in the Cardiovascular Center of Children′s Hospital of Fudan University between January 2021 and August 2022 and were treated with clopidogrel, including gender, age, body mass index, course of KD, CAL severity grade, and baseline platelet count. According to their age, the children were divided into ≥2-year-old group and <2-year-old group. Their platelet responsiveness was assessed by adenosine diphosphate-induced platelet inhibition rate (ADPi) calculated via thromboelastography, and children were categorized into high on-treatment platelet reactivity (HTPR) and normal on-treatment platelet reactivity (NTPR) groups. Genotypes of CYP2C19, PON1 and ABCB1 were detected. The t test, one-way analysis of variance and Chi-square test were used for intergroup comparison. Results:Among the 46 KD children with CAL, 34 were male and 12 were female; 37 were ≥2-year-old and 9 were <2-year-old; 25 cases were in the HTPR group and 21 cases were in the NTPR group, with 19 HTPR and 18 NTPR in the ≥2-year-old group, and 6 HTPR and 3 NTPR in the <2-year-old group. Genetic analysis showed that 92 alleles among the 46 children, with frequencies of CYP2C19*1, CYP2C19*2, CYP2C19*3, CYP2C19*17, PON1 192Q, PON1 192R, ABCB1 3435C, ABCB1 3435T at 59% (54/92), 32% (29/92), 9% (8/92), 1% (1/92), 36% (36/92), 64% (59/92), 63% (58/92) and 37% (34/92), respectively. Analysis of the impact of genotype on ADPi revealed that in children aged ≥2 years, those with CYP2C19*1/*3 genotype had significantly lower ADPi than those with CYP2C19*1/*1 genotype ((34±15)% vs. (61±29)%, t=2.18, P=0.036). There were also no significant difference in ADPi among children with PON1 192Q homozygous, PON1 192R heterozygote and PON1 192R homozygous genotypes ((40±22)% vs. (52±33)% vs. (65±27)%, F=2.17, P=0.130), or among those with ABCB1 3435C homozygous, ABCB1 3435T heterozygote and ABCB1 3435T homozygous genotypes ((55±34)% vs. (60±27)% vs. (49±24)%, F=0.33, P=0.719). In <2-year-old group, there were no significant differences in ADPi across CYP2C19*1/*1, CYP2C19*1/*2 and CYP2C19*2*2 genotypes ((40±20)% vs. (53±37)% vs. (34±16)%, F=0.37, P>0.05). There were no significant differences in ADPi across CYP2C19*1/*1 and CYP2C19*1/*3 genotypes ((44±27)% vs. (42±20)%, t=0.08, P>0.05). There were no significant differences in ADPi across PON1 192Q homozygous, PON1 192R heterozygote and PON1 192R homozygous genotypes (45% vs. (55±27)% vs. (24±5)%, F=1.83, P>0.05). There were no significant differences in ADPi across ABCB1 3435C homozygous, ABCB1 3435T heterozygote and ABCB1 3435T homozygous genotypes ((36±16)% vs. (50±35)% vs. 45%, F=0.29, P>0.05). The risk analysis of HTPR in different genotypes revealed that in children aged ≥2 years, carrying at least 1 or 2 loss-of-function alleles of CYP2C19 was a risk factor for HTPR ( OR=4.69, 10.00, 95% CI 1.11-19.83, 0.84-119.32, P=0.033, 0.046, respectively), and PON1 192R homozygosity and carrying at least one PON1 192R allele were protective factors against HTPR ( OR=0.08, 0.13, 95% CI 0.01-0.86, 0.01-1.19, P=0.019, 0.043, respectively). Conclusion:KD children aged ≥2 years carrying CYP2C19 loss-of-function alleles and PON1 192Q are more likely to develop HTPR.

OBJECTIVETo evaluate the efficacy and safety of evaluation,treatment and follow-up of Kawasaki coronary artery disease based on the clinical severity classification.

METHODThis study evaluated 52 patients admitted to the Children's Hospital of Fudan University between July 2005 and December 2013 who were diagnosed with Kawasaki Disease with coronary artery disease.Inclusion criteria were a disease course of more than two months, initial echocardiography showing severity of grade IV and above, and confirmation of disease severity by angiography. Of those studies, 44 were male and eight were female, aged 6 to 142 (average 41) months. Treatment was planned according to protocols in "Suggestions for Management of Kawasaki Coronary Artery Disease" with follow-up. Those patients with grade IV and above confirmed by angiogram were given oral low-dose asprin and warfarin, and those with grade Vb were given coronary artery bypass grafting (CABG) after comprehensive evaluation. Analysis was carried out for diagnosis, treatment, complications, and results of follow-up.

RESULT(1) Satisfied images were shown by the angiography of all 52 cases. Forty five patients (86%) had giant aneurysm or multiple aneurysms, with thrombosis found in 10 of 45 patients (22%). Coronary artery lesions occurred in 138 coronary branches, and more common in left anterior descending branch (47 branches, with incidence 34%) and right coronary artery (48 branches, with incidence 35%). There were no complications during or after angiography. (2) After angiography, 49 patients remained at grade IV or above, and three improved to grade III. Ultimately, clinical severities of coronary artery disease included three patients at grade III, 31 patients at grade IV, nine patients at grade Va, and nine patients at grade Vb. (3) Thirty-eight patients were properly using aspirin and warfarin, and two patients with severely elevated international normalized ratio (INR) levels presented with knee joint and gastric hemorrhage, both of which were treated successfully.Patients with INR levels between 1.5 and 2.5 did not show signs of hemorrhage. (4) In follow-up visits between 6 months and 8 years, one patient had representation of thrombosis on angiography, but did not lead to coronary stenosis; four patients were improved from grade IV to either grade III or II. The remaining showed no new thrombotic formation or stenosis. (5) Of the nine grade Vb patients, five underwent coronary artery bypass grafting. The youngest of these patients, a 22 months old girl, died intraoperatively. The remaining four recovered postoperatively and were followed up for 8 to 90 months. One patient had a preoperative left ventricular ejection fraction (LVEF) of only 32.8%, with LVEF remaining abnormal post-CABG, between 35% and 44%. The remaining three patients had normal heart size, cardiac function, and electrocardiogram.Of the other four grade Vb patients, two were contraindicated for surgery due to severe heart failure and loss of myocardial activity. Two other cases are being followed up closely due to their young age of 9 months.

CONCLUSIONCoronary angiography is safe and efficacious in children, and even in infants.It is the current gold standard tool for grading Kawasaki coronary artery disease. Proper anticoagulation therapy can markedly decrease the incidence of coronary artery occlusion in patients with Kawasaki coronary artery disease. Safe ranges of corrected INR should be between 1.5 and 2.5 after taking warfarin. CABG is an effective treatment for severe coronary artery disease with myocardial ischemia.

Aspirin ; therapeutic use ; Child ; Child, Preschool ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; complications ; therapy ; Disease Management ; Echocardiography ; Electrocardiography ; Female ; Humans ; Infant ; Male ; Mucocutaneous Lymph Node Syndrome ; complications ; therapy ; Treatment Outcome ; Ventricular Function, Left ; Warfarin ; therapeutic use

Objective To evaluate the clinical value of real-time 3 dimensional echocardiography (RT-3DE) for measurement of right ventricular function in the repaired tetralogy of Fallot (TOF) compared to cine magnetic resonance imaging (c-MRI).Methods Thirty-seven randomly selected patients with repaired TOF from Jan.2000 to Jun.2007 in Children's Hospital,Fudan University underwent both RT-3DE and c-MRI for the data of right ventricular enddiastolic volume (RVEDV),right ventricular end-systolic volume (RVESV),right ventricular ejection fraction (RVEF),which were compared to evaluate the reproducibility and correlation of two ways on right ventricular function.Results All the patients completed both RT-3DE and c-MRI on the same day.The correlation for RVEDV,RVESV,RVEF measured by 2 methods was high (r =0.933,0.943,0.911,P =0.000,0.000,0.105),and it showed that consistency existed in RVEF,as difference was only (1.2 ± 4.5) ％.Comparison with c-MRI,RVEDV and RVESV measured by RT-3DE was underestimated,in which difference was (-17.4 ± 16.9) mL,(-9.3 ± 10.5) mL.Conclusions RVEF with RT-3DE can be assessed with acceptable accuracy,but it is not so good for RVEDV and RVESV.Further study needs to be performed to make sure the value of RT-3DE on the assessment of right ventricular function in repaired TOF.

0.05 ) between the left ventricular stroke volume with RT-3DE ( 24.58 ? 3.44 )ml,the right ventricular stroke volume with RT-3DE ( 23.58 ? 3.18 )ml and those values measured with Swan-Ganz pulmonary thermodilution method ( 25.64 ? 3.18 )ml.Furthermore,there was well correlation between the left ventricular stroke volume and the right ventricular stroke volume with RT-3DE (r= 0.93 ).They were also well correlated with those values with Swan-Ganz pulmonary thermodilution method (r= 0.85 ,r= 0.92 ).However,there was significant difference (P

Seventy-five preschool children with hemoglobin content below 11 g/dl in kindergartens and nurseries were divided into five groups. The first, second and third groups were given 10 mg, 20 mg and 30 mg of iron in the form of ferrous sulfate syrup respectively every day for two months, while the fourth and fifth groups were given 100 mg ascorbic acid and 100 mg ascorbic acid plus 10 mg iron respectively every day for one month. The average hemoglobin content in the order of the five groups were 9.6?1.16, 10.6?1.34, 9.7?0.91, 9.7?0.85 and 11.0?1.86 g/dl respectively before treatment. After 1-2 months of iron or ascorbic acid therapy, the average hemoglobin contents raised to 12.0?.31, 12.0?1.06, 12.0?0.79, 11.0?1.86 and 12.7?1.37 g/dl respectively. There were highly significant differences (P

300Riboflavin (?g/g creatinine) 0N-MN (mg/g creatinine) 5

The subjects were all Chinese male adults. The average age, body weight and height were 37.9 (24-44) yr, 64.3 (51.5-74.0) kg and 173 (157-180) cm respectively in the first group, and 30.2 (24-41) yr, 67.7 (56.5-70.0) kg and 171 (170-176) cm respectively in the second group.The subjects in the first group were studied for 70 days for the N balance response at graded protein intakes of 0.42, 0.60, 0.73, 0.90 and 1.05 g/kg /day on Chinese mixed diet, during 5 experimental periods respectively. Each period took ten days preceded by one day of low protein diet, and was followed by three days of free choice diet The sequence of protein intakes during the study was 0.60, 0.73, 0.42, 0.90 and 1.05 g/kg/day. Six subjects in the second group were given a mixed diet ata protein level of 0.93 (0.91-0.94) g/kg/day for three months.In the N balance data of the first group, all subjects were in negative balance at protein intake of 0.42, 0.60 and 0.73 g/kg/day and all in positive N balance at 1.05 g/kg/day. Most of the subjects were in positive N balance at 0.90 g/kg/day. The linear regression analysis of N balance response of individual subject is that the intercept at zero balance of individuals ranged from 129.4-192.5 mg N/kg/day with the mean of the group of 147.7? 18.6mg N/kg/day or 0.92?0.12 g protein/kg/day. The five of the six subjects in the second group were in positive N balance, when on a mixed diet of 0.93 ?0.02 g protein/kg/day for three months.The results obtained indicated the mean protein requirement of these subjects based on the linear regression analysis of N balance response of individuals was 147.7 ? 18.6 mg N/kg/day or 0.92?0.12 g protein/kg/day. If 97.5% is to be covered, the safe level of protein intake should be 1.16 g protein/ kg/day.

The growth curves and diet of 185 babies in rural area near Beijing from 6 months to 18 months old have been studied. Infants were divided into 3 groups according to their diet taken:(1) 89 babies had breast milk only;(2) 66 babies took more than 250g animal milk per day besides breast milk;(3) 30 babies who did not have breast milk and only animal milk was taken. All the babies were gradually transferred to an ordinary cereal based diet during the weaning period. To half of them a soybean and cereal based formula fortified with minerals and vitamins was supplied, which would provide 6.6g protein and 141 kcal and some other nutrients per day.The results showed that the growth curves of body weight and height of children were much better than the data obtained in 1975, but still lagged behind that of the urban children, especially for the body weight. The weight curves of the babies who took animal milk seemed higher than the other groups. Female babies who were fed with breast milk and supplemented with the weaning food have a better weight and height curves than non-supplemented ones, but this was not seen in males. The hemoglobin contents of the babies who took animal milk when they were 18 months old were lower than that of the 6 months old, but there were no differences in the breast milk groups, and the lowering of the hemoglobin level in the animal milk groups could be corrected by adding weaning food in the diet. When the babies were 6 months old, 39.3% of them had a hair zinc content below the lower limit of the normal range, and it became to 47.6% when they were 18 months old. So zinc deficiency of the babies were present in this local area, and it should be fortified into the weaning food.

Dietary intake and biochemical parameters of zinc nutritional status in 270 pregnant women and 44 nonpregnant women have been studied and the results were as follows: 1.Dietary zinc intake was about 60% of RDA in both groups.2.The mean plasma Zn concentration declined progressively during gestation; the mean SOD activities and plasma Cu/Zn and alkaline phosphatase activities increased progressively.3.The zinc nutritional status of pregnant women in Beijing was poor. Using plasma Zn concentration less than 10.71 ?mol/l as a low limit, the incidence of zinc deficiency was 6.5%, 20.2% and 25.7% at each of three trimesters respectively.4.Plasma Zn concentration is more sensitive in evalution of nutritional status than hair Zn concentration. Plasma Cu/Zn could reflect zinc nutritional status. The mean SOD activities had similar trend with plasma Zn during pregnancy, and positive correlation with plasma Zn in second trimester (r= 0.2236,P

Using the micromethod of Farmer and Abt, plasma vitamin C content of 9S boys and girls in a middle school was determined throughout the year 1954 to 1955. A dietary survey was also carried out every month of the year, for calculating the vitamin intake. The results of the present study are as follow:1. When the diet contains ample amount of fresh leafy vegetables in season, a satisfactory plasma vitamin C level can be maintained. When the diet is limited in fresh vegetables, plasma vitamin C readily decreases in those seasons.2. There is a significant seasonal variation of plasma vitamin C content Highest values are obtained in winter, the maximal content occurring in December. The minimal value is observed in June. This corresponds to the variation in the. level of vitamin C intake in different seasons. There is no significant difference between Autumn and Winter.3. No definite correlation between plasma vitamin C content and the condition of the gums was observed in the present study.4. The plasma vitamin C content of Chinese and English school children observed by some other authors was lower than that obtained in the present investigation. It is believed that the increase plasma vitamin C of the subjects in this study is mainly due to improvement of the living condition of the population and widespread education of the people in the fundamentals of nutritional science in recent years.