Objective To compare the clinical effectiveness and safety of interventional closure using septal occluder with surgical closure of secundum atrial septal defect (ASD) in this systematic review of controlled trials. Methods The Cochrane Controlled TrialRegistry, MEDLINE,CBMA and EMBASE were searched for all controlled trials. Data were extracted for procedural failure rate、residual shunt rates、major complication rates and minor complication rates. The software RevMan 4.2.8 was used for data analysis. Treatment effects on these outcomes were summarized as relative risk (RR) with 95% confidence interval (CI). Results 13 articles identified were eligible controlled trials and included. All were reporting about the effect of transcatheter closure and surgery on secundum atrial septal defect. All controlled trials did not apply randomizationand enforce allocation concealmentOnly one of the 13 trials was analyzed on an intention-to-treat basis.The combined results showed that the procedural failure rate of transcatheter closure group (n=1 085) was higher than that of surgery（n＝631）（9 controlled trials, 4.61% vs 0.32％，RR＝5.48，95% CI：2.28 -13.21，P＝0.000 1）. Although the instant residual shunt rates of transcatheter closure group（n＝495）were higher than that of surgery（n＝182）（2 controlled trials, 3.84% vs 0，RR＝7.61，95% CI：1.04-55.99，P＝0.05）,they were similar in one year of follow up in both groups(n＝402/182)（1.74% vs 0％，RR＝3.54，95% CI：0.45- 27.72，P＝0.23）.Total complication rates of surgery group（n＝845）and transcatheter closure group（n＝1 191）were 28.52％ and 6.8%， respectively（13 controlled trials, RR＝0.24，95% CI：0.19- 0.31, P< 0.000 01），major complication rates of each group were 4.23% and 1.56 % respectively（12 controlled trials, n＝1 155/780，RR＝0.37，95% CI：0.21-0.64）(P＝0.000 4),arrhythmias rates of each group were 11.25% and 3.85% respectively（9 controlled trials, n＝806/622，RR＝0.34，95% CI：0.21-0.53，P<0.000 01）. Conclusions Although the procedural attempt successful rate of transcatheter closure group was lower than that of surgery group, the residual shunt rates of both groups were similar.In the transcatheter closure group,the complication rate was lower than that of surgery group.
Objective To examine the influence of precosious puberty on fatness in children and adolescents of Beijing, and compare their relationship in boys with girls. Methods 19 085 children and adolescents (9 418 boys, 9 667 girls) aged 6-18 years who participated in the program of Beijing Children and Adolescent Metabolic Syndrome study (BCAMS) and had complete anthropometry (weight, height, fat mass percentage by bioelectrical impedance analysis) and sexual maturation(SM) data.Overweight and obesity among children aged 7-18 years were defined according to sexagespecific body mass index (BMI) cutoffs recommended by Chinese Working Group on Obesity (WGOC)，the 85th and 95th percentiles of BMI from US 2000 CDC Growth Charts (CDC2000) were used for children aged 6 years. Using the status quo method, the median age for each certain Tanner stage (Ⅱ，Ⅲ，Ⅳ，Ⅴ) was calculated. Based on each individual's age and SM status (Tanner stages: breast stages for girls and testicular volume for boys, pubic hair for both genders), the subjects were classified as early maturers (those who reached a certain Tanner stage earlier than the median age for that stage, and average and later maturers (those who reached a certain Tanner stage equal to and later than the median age for that stage). Using multiple linear regression model, associations between fatness (BMI and FMP) and SM were systematically examined. Logistic regression analysis was performed to test how early maturation affected the risks for overweight and obesity. Results Early SM was positively associated with obesity in both girls and boys. The prevalence of combined overweight in early maturers versus the average and later maturers was 31.0% versus 24.7% in boys and 30.7% versus 11.8% in girls; the figures for obesity were 14.6% versus 9.7% and 13.5% versus 4.4%, respectively. Fatness (BMI and FMP) was associated with early maturation in girls, early maturing girls were fatter than counterparts. But the associations between BMI and FMP with early maturation in boys were in opposite directions, early maturing boys had higher BMI and lower FMP than counterparts. With covariates adjusted and using later maturing as the reference group, odds ratios and 95% confidence intervals for combined overweight were 1.12（0.96-1.31）for boys and 3.39（2.94-3.92）for girls, and for obesities were 1.31 (1.06-1.62) and 3.12 (2.53-3.85), respectively. Conclusions Sexual maturation is associated with obesity in children and adolescents. Maturation status should be taken into consideration when assessing child and adolescent obesity.
Objective To explore the development of pulmonary function of normal toddlers between 1 and 3 years old. Methods Totally 120 normal toddlers were divided into 2 groups according to their age , ie, 1-2 years old , -3 years old. Pediatric pulmonary function laboratory type 2600 (Sensor Medics Corporation, USA ) was used to detect tidal flow volume curve, which can partially replace the maximum expiratory flow volume curve. Parameters showing small airway function were the ratio of the volume to reach peak tidal expiratory flow to total expiratory volume, the ratio of tidal expiratory flow at 25% remaining expiration to peak expiratory flow, and ratio of inspiratory time to total respiratory time. Parameters showing large airway function were the ratio of mid-tidal expiratory flow to mid-tidal inspiratory flow. Passive expiratory flow volume technique was used to examine respiratory system static compliance and total airway resistance. Open nitrogen washout method was used to measure functional residual volume. Results No significant difference was found between male and female toddlers (P＞0.05). Between the two groups, the difference of respiratory rate was not significant（27 vs 26，t＝1.512，P＞0.01）. The values of tidal volumes in the -3 years group were notably higher than in the 1-2 years group （0.123 vs 0.091，t＝8.587，P<0.01）, but the values of tidal volumes per kilogram body weight were not significantly different （0.009 1 vs 0.008 6，t＝1.959，P＞0.01）. The peak tidal expiratory flow in the elder group was similarly distinctly higher than that in the other group. The measured tidal breathing flow volume loops were both displayed uncharacteristic ellipse. The ratioes of inspiratory time to total respiratory time, the volume to reach peak tidal expiratory flow to total expiratory volume, tidal expiratory flow at 25% remaining expiration to peak expiratory flow and mid-tidal expiratory flow to mid-tidal inspiratory flow were not significantly different between two groups （P＞0.05）. But the ratio of peak tidal flow to tidal volume （1.095 vs 1.257,t＝2.098，P<0.05）and the respiratory system resistances （2.071 vs 2.697，t＝3.761，P<0.01）were evidently lower in the elder group than in the younger.The respiratory system compliances（0.352 vs 0.254，t＝4.297，P<0.01）and functional residual capacities （0.271 vs 0.211，t＝8.468，P<0.01）were significantly higher in the elder group than that in the younger, but the values per kilogram body weight were not significantly different ( P＞0.01). It was shown that the values of tidal volume, peak tidal expiratory flow, respiratory system static compliance, residual volume were significantly different (P<0.01), between two groups. The values of each parameter mentioned above were increased with age, and were positively correlated with body weight (r=0.457, 0.849, 0.572, 0.319). Conclusions Tidal breathing flow volume loop could show functions of small and large airways and partially replace the maximum expiratory flow loop. The parameters were stable in toddlers and could be used as reasonable index to evaluate the pulmonary function changes in pulmonary diseases. The ventilatory function, residual volume, respiratory system static compliance and peak tidal flow were increased with the age, which coincides with the rule of development of toddlers.
Objective Congenital heart disease (CHD) is the most popular cardiovascular disease of paediatrics. Ventricular septal defect (VSD) accounts for 50%. This study was to evaluate the treatment efficiency of transcatheter closure of ventricular septal defect(VSD) using the homemade occluder device. Methods Seventy-five patients with VSD underwent attempted transcatheter closure using the homemade occluder device at a median age of 8.5 years old (ranging from 3.0 to 14). The mean VSD diameter at its left ventricular side was 6.5±3.6 mm (ranging from 3.0 to 14.0) The left ventricular graphies(LVG) were performed to evaluate the closure results immediately after the operation. Echocardiography and ECG were performed 1 day and 1 month respectively after the closure to find whether there was residual shunt or recanalization. Results ①The technical success rate of the group was 98.7%. ②LVG showed that 65（87.8%） patients had complete closure immediately after the operation, 9（12.2%） had a trivial to small shunt immediately after the operation. Within 24-48 h, color Doppler revealed complete closure in 74 patients（98.7%） and a trivial to small shunt in 2 patients（2.3%）.Two cases had Ⅲ°atrial ventricular block and returned to normal after 4-10 days with medical treatment. One patient developed hemolysis 24h after the operation and recovered after 7 days with medical treatment. ③ Echocardiography revealed complete closure in 71 patients（94.7%） and a trivial to small shunt in 2 patients（2.7%）1 month after the operation. ④ There were 70, 68, 21, 15,and 12 patients who were followed up 3 months, 6 months, 1 year, 2 years, and 3 years after the operation, respectively. Two cases who had a trivial to small shunt recovered after 3 months and 6 months respectively. Conclusions Transcatheter method of VSD occlusion using homemade VSD occluder is safe and effective. It had a high technical success rate, satisfied and reliable immediate and short-term results. Further clinical trials should be undertaken to assess the long-term safety and results.
Objective To investigate the prevalence of suicide behaviors and their related factors among adolescent students in Shanghai. Methods The self-completed anonymous questionnaires, which included center for epidemiologic studies depression scale (CES-D), self-rating anxiety scale (SAS), adolescent self-rating life events check list (ASLEC), beck hopelessness scale and a general questionnaire were administered to a random sample of grade 5-9, grade 10 and 11 students from 9 primary to high schools in Shanghai in late April 2003. The concept of the suicide behaviors in this study was defined according to the youth risk behaviors surveillance system(YRBSS) from American Center for Disease Control and Prevention(CDC). It included suicide ideation, suicide plan and suicide attempt. Chi-square test was used to assess the gender and grade differences of suicide behaviors. Logistic regression model was applied to identify the factors associated with the suicide ideation in the students. Results 2 416 completed questionnaires were obtained from 2 513 participants. Male: 1 190; female:1 226, aged from 10-17 years old. During the 12 months preceding the survey, there were 368（15.23%,368/2 416） students had ever experienced suicidal ideation, 141（5.84%,141/2 416） students made suicide plans and 42（1.74%,42/2 416）students had actually attempted suicide. Suicide ideation was reported in 178（14.96%,178/1 190）boys and 190(15.50%,190/1 226) girls. Eighty (6.72%,80/1 190) boys and 61 (4.98%,61/1 226) girls reported suicide plans, while 24 (2.02%,24/1 190) boys and 18(1.47%,18/1 226) girls reported suicide attempts. There was no statistical significant difference between the rates of these suicide behaviors in boys and those in girls(P>0.05). The suicide ideation was increased by the student's grade of school(P<0.05 ). The highest rate of suicide attempt was in grade 11(5.17%,6/116), the second was in grade 6(2.52%,13/516), and the lowest one was in grade 5(0.86%,3/347),(P<0.05). Among all students, suicide ideation was strongly related to the scores of CES-D, SAD, ASLEC and Beck's hopeless scale. Suicide ideation was also related to the school, family's residency status in the students of primary schools (grade 5). Among the students of middle schools, suicide ideation was also related to the peer relationship, father's educational level and child-mother communication. Among the students of high schools, suicide ideation was related to school achievement, free time and child-father communication. Conclusions Suicide behaviors among the adolescent students in Shanghai should be seriously concerned. Different key points of intervention for suicide behaviors should be put on different age groups of students. Early recognition and treatment of emotional disorders among the adolescent students and raising their ability to cope with the negative life events will be helpful to reduce the suicide behaviors in adolescent students.
Objective This study was to investigate the changes of APAF1（apoptotic protease activating factor 1）gene expression during 3T3-L1 preadipocyte differentiation (0-10 d), and to analyze the regulation of TNF-α on APAF1 gene expression in matured 3T3-L1 adipocytes. Methods 3T3-L1 preadipocytes were cultured in vitro and differentiated into matured adipocytes by adding of insulin, 3-isobutyl-1-methyxanthine (MIX), and dexamethasone (DEX). Oil Red O staining was used to identify the matured adipocytes. To further evaluate the linkage between APAF1 gene and differentiation or de-differentiation, TNF-α which can promote the matured adipocytes to de-differentiation was used to interfere 3T3-L1 matured adipocytes. TNF-alpha (1.0 ng·mL-1) was added to the culture medium of differentiated 3T3-L1 cells (day 10) for various periods (2, 6, 12, 24 h). Total RNA and protein of these cells were then extracted. The levels of APAF1 mRNA was evaluated by RT-PCR. Western-Blot was used to detect the protein levels of APAF1. Results ① In preadipocytes, the levels of APAF1 gene mRNA remained higher. In the presence of DEX, MIX and insulin, 3T3-L1 preadipocytes were gradually differentiated into matured adipocytes. In preadipocytes (day 0), lipid droplets were rarely visible, while many more lipid droplets were visible in matured adipocytes (day 10). ② The levels of APAF1 mRNA was down-regulated and reached the lower level in fully differentiated adipocytes. Compared to the day 0, approximately 55% decrease of APAF1 mRNA expression was found in day 10. There was a significant difference between any two detected phases in the levels of APAF1 mRNA (P＜0.05＝, except for at the stage of day 1-4, day 6 and day 8-10 (P＞0.05). The protein levels of APAF1 (0, 2, 4, 6, 8,10 d) were detected and found that, with the differentiation, there was a similar decreasing trend in protein levels except for day 2-6.③Treatment of day 10 3T3-L1 adipocytes with TNF-α (1.0 ng·mL-1) resulted in the increase of APAF1 mRNA levels with a timedependent manner. A significant increase of APAF1 mRNA was elicited by TNF-α after as short as 6 h. Compared to the 0 h, about 2.11 folds increase of APAF1 mRNA was found at 24 h while 1.52 folds at 6 h. Except for 0-2 h, there was a significant difference (P＜0.05）between any two detected phases in the levels of APAF1 mRNA. To further confirm this, we evaluated the protein levels of APAF1 and found that there was a significant difference (P＜0.05）between any two detected phases except for 6-12 h. Conclusions ① Our results confirmed that both the mRNA and protein levels were gradually decreased during 3T3-L1 preadipocyte differentiation. Down-regulated expression of APAF1 may contribute to the differentiation, maturation and adipogenesis of adipocytes. APAF1 gene may be related to the etiology of obesity;② TNF-α up-regulates the expression of APAF1 in matured adipocytes and this up-regulation may facilitate the de-differentiated effects of TNF-α on matured adipocytes.
Owing to the trait of polygenic disease, the environmental triggers, genetic polymorphism, difference of genetic expression and their interaction, the genetic studies on asthma were at the initial stage with some achievements by now. Candidate genes have been localized in the genetic regions involved in asthmatic initiation and progression with the contemporary molecular genetic strategy, such as positional cloning , genetic polymorphism linkage analysis, genetic chip technology and methods of proteome .The chromosomal position and function of some candidates were summarized in this article.
