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Insights into postural orthostatic tachycardia syndrome after COVID-19 in pediatric patients

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World Journal of Pediatrics 2024年第3期20卷 201-207页

作者： Ya-Xi Cui Jun-Bao Du hong-fang jin Department of Pediatrics Peking University First HospitalNo.1 Xi-an Men StreetWest DistrictBeijing 100034China State Key Laboratory of Vascular Homeostasis and Remodeling Peking UniversityBeijing 100191China

The pandemic caused by the novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)profoundly threatened human health globally and greatly impacted the world economy[1].While most patients recovered,some suff... 详细信息

关键词： acute patients tachycardia

Baroreflex sensitivity and its implication in neurally mediated syncope inchildren

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World Journal of Pediatrics 2023年第11期19卷 1023-1029页

作者： Ya-Xi Cui Jun-Bao Du hong-fang jin Department of Pediatrics Peking University First HospitalBeijing 100034China Key Laboratory of Molecular Cardiovascular Sciences Ministryof EducationBeijing 100191China

Neurally mediated syncope(NMS)refers to an entity of syncopal disorders that can be triggered by a psychological stimulus,standing for a long time,sudden position change from supine to upright,or a muggy *** syncope(VVS),also known as acute orthostatic intolerance(OI),is the main form of NMS[1]and seriously affects the quality of life of ***,the pathogenesis of NMS has not yet been fully *** mechanisms underlying NMS are considered to involve autonomic regulation abnormalities.

关键词： syncope acute pathogenesis

Management of orthostatic intolerance in children: the state of the art

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World Journal of Pediatrics 2020年第6期16卷 543-548页

作者： Chun-Yan Tao hong-fang jin Jun-Bao Du Department of Pediatrics Peking University First HospitalNo.1Xi'an-men StreetWest DistrictBeijing 100034China Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases Chinese Academy of Medical SciencesBeijingChina Key Laboratory Molecular Cardiovascular Science the Ministry of EducationPeking UniversityBeijing.China

Orthostatic intolerance(OI)is characterized by symptoms and signs of dizziness,headache,visual difficulties,a loss of consciousness,nausea,abdominal discomfort,pallor,tachycardia or hypotension;and OI is primarily elicited by a rapid postural change from supine to standing or prolonged quiet standing which can be resolved by lying down[1,2].About 15%of children and adolescents are affected by OI,with the median peak age of the first OI onset at 15 years[3].OI accounts for a noticeable proportion of emergency department *** or indeliberately,the injection of normal saline always plays a role,which“rescues”the *** or occasional episodes of OI are often overlooked by some patients;and children with recurrent OI symptoms often experience depression,and have diminished quality of life。

关键词： tachycardia injection nausea

Can pediatric vasovagal syncope be individually managed?

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World Journal of Pediatrics 2022年第1期18卷 4-6页

作者： Wen-Rui Xu Jun-Bao Du hong-fang jin Department of Pediatrics Peking University First HospitalNo.1Xi’an-Men StreetWest DistrictBeijing 100034China Key Lab of Molecular Cardiovascular Sciences Ministry of EducationBeijingChina

In children and adolescents,syncope is common and accounts for a considerable proportion of emergency *** underlying diseases of pediatric syncope mainly include neurally mediated syncope(NMS)and cardiogenic *** accounts for 70–80%of pediatric syncopal cases,and one of the most common forms is vasovagal syncope(VVS)[1–3].In children with VVS,owing to the impairment of the barorefex integrity,the sympathetic system usually becomes overexcited after the change in position,leading to forceful contractions of a relatively empty ventricle and fnally causing a sympathetic withdrawal and an increased vagal activity.A relatively insufcient central volume,excessive vasodilation of peripheral vessel,autonomic nervous dysfunction,and neurohormonal disturbance may be aggravating ***,the efectiveness of previously unselected treatments for VVS has not been *** such,a comprehensive assessment of the clinical characteristics,pathogenesis,and biochemical markers is needed to select the corresponding *** individualized treatment for VVS was proposed,several improvements have been made in the feld.

关键词： syncope pediatric treatment

Vascular dysfunction of postural tachycardia syndrome in children

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World Journal of Pediatrics 2018年第1期14卷 13-17页

作者： Wei Bai Si-Yao Chen hong-fang jin Jun-Bao Du Department of Pediatrics Peking University First HospitalBeijing100034China Department of Cardiac Surgery Guangdong CardiovascularInstituteGuangdong General Hospital and GuangdongAcademy of Medical SciencesGuangzhouChina

Background Postural orthostatic tachycardia syndrome (POTS) is a form of orthostatic intolerance, and its incidence in children is approximately 6.8% (1)The pathogenesis of POTS is complex with multiple, overlapping, interacting pathophysi-ological mechanisms. Although the specific pathogenic mechanism has remained perplexing, with the discovery of various gasotransmitters and biological peptides, the vascular dysfunction has aroused overwhelming attention. Data sources On the basis of searching in a wide range of recent original literatures, we reviewed the pathogenesis of vas-cular dysfunction in children with POTS. Results The flow-mediated vasodilation of POTS patients was greater than that of healthy controls, and the vasodilator factors were increased in patients with POTS under basal condition or under a standing position, while the vasoconstriction factors were reduced. Conclusions Vascular dysfunction, as one of pathogenesis in pediatric POTS patients, affects the occurrence and develop-ment of diseases through a variety of factors.

关键词： Children Postural orthostatic tachycardia syndrome Vasodilation

Age and mean platelet volume-based nomogram for predicting the therapeutic efficacy of metoprolol in Chinese pediatric patients with vasovagal syncope

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World Journal of Pediatrics 2024年第9期20卷 957-965页

作者： Xiao-Juan Du Ya-Qian Huang Xue-Ying Li Ying Liao hong-fang jin Jun-Bao Du Department of Pediatrics Peking University First HospitalNo.1 Xi’anmen StreetWest DistrictBeijing100034China State Key Laboratory of Vascular Homeostasis and Remodeling Peking UniversityNo.38Xueyuan RoadHaidian DistrictBeijing100191China Department of Statistics Peking University First HospitalBeijing100034China

Background Vasovagal syncope(VVS)is the most common type of orthostatic intolerance in *** investigated whether platelet-related factors related to treatment efficacy in children suffering from VVS treated with *** Metoprolol-treated VVS patients were *** median duration of therapy was three *** were followed and divided into two groups,treament-effective group and treatment-ineffective *** and least absolute shrinkage selection operator regressions were used to examine treatment outcome ***-operating characteristic(ROC)curves,precision-recall(PR)curves,calibration plots,and decision curve analyses were used to evaluate the nomogram *** Among the 72 patients who complete the follow-up,treatment-effective group and treatment-ineffective group included 42(58.3%)and 30(41.7%)cases,*** patients in the treatment-effective group exhibited higher mean platelet volume(MPV)[(11.0±1.0)fl vs.(9.8±1.0)fl,P<0.01]and platelet distribution width[12.7%(12.3%,14.3%)vs.11.3%(10.2%,12.2%),P<0.01]than those in the treatment-ineffective *** sex ratio was significantly different(P=0.046).A fit model comprising age[odds ratio(OR)=0.766,95%confidence interval(CI)=0.594-0.987]and MPV(OR=5.613,95%CI=2.297-13.711)might predict therapeutic *** area under the curve of the ROC and PR curves was computed to be 0.85 and 0.9,*** P value of the Hosmer-Lemeshow test was *** decision curve analysis confirmed that managing children with VVS based on the predictive model led to a net advantage ranging from 0.01 to *** nomogram is convenient for clinical *** A novel nomogram based on age and MPV can predict the therapeutic benefits of metoprolol in children with VVS.

关键词： Metoprolol Nomogram Retrospective study Therapeutic effect Vasovagal syncope

A predictive model of response to metoprolol in children and adolescents with postural tachycardia syndrome

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World Journal of Pediatrics 2023年第4期19卷 390-400页

作者： Bo-Wen Xu Qing-You Zhang Xue-Ying Li Chao-Shu Tang Jun-Bao Du Xue-Qin Liu hong-fang jin Department of Pediatrics Peking University First HospitalNo.1Xi’an-Men StreetWest DistrictBeijing100034China Department of Medical Statistics Peking University First HospitalBeijingChina Key Lab of Molecular Cardiovascular Sciences Ministry of EducationBeijingChina Department of Physiology and Pathophysiology Peking University Health Science CentreBeijingChina

Background The present work was designed to explore whether electrocardiogram(ECG)index-based models could predict the effectiveness of metoprolol therapy in pediatric patients with postural tachycardia syndrome(POTS).Methods This study consisted of a training set and an external validation *** and adolescents with POTS who were given metoprolol treatment were enrolled,and after follow-up,they were grouped into non-responders and responders depending on the efficacy of *** difference in pre-treatment baseline ECG indicators was analyzed between the two groups in the training *** logistic regression analysis was further conducted on the association between significantly different baseline variables and therapeutic *** models were established to predict therapeutic response to *** receiver-operating characteristic curve(ROC),calibration,and internal validation were used to evaluate the prediction *** predictive ability of the model was validated in the external validation *** Of the 95 enrolled patients,65 responded to metoprolol treatment,and 30 failed to *** the responders,the maximum value of the P wave after correction(Pcmax),P wave dispersion(Pd),Pd after correction(Pcd),QT interval dis-persion(QTd),QTd after correction(QTcd),maximum T-peak-to-T-end interval(Tpemax),and T-peak-to-T-end interval dispersion(Tped)were prolonged(all P<0.01),and the P wave amplitude was increased(P<0.05)compared with those of the *** contrast,the minimum value of the P wave duration after correction(Pcmin),the minimum value of the QT interval after correction(QTcmin),and the minimum T-peak-to-T-end interval(Tpemin)in the responders were shorter(P<0.01,<0.01 and<0.01,respectively)than those in the *** above indicators were screened based on the clinical significance and multicollinearity analysis to construct a binary logistic *** a result,pre-treatment Pcmax,QTcmin,and Tped

关键词： Children Electrocardiography Metoprolol Nomogram Predictor Postural tachycardia syndrome

Vitamin D and Cardiovascular Risk in Children

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Chinese Medical Journal 2017年第23期130卷 2857-2862页

作者： Wen-Rui Xu hong-fang jin Jun-Bao Du Department of Pediatrics Peking University First Hospital Beijing 100034 China

Objective： Vitamin D is a group of fat-soluble molecules that are structurally similar to steroids. Emerging data have led to the hypothesis that Vitamin D plays a role in the regulation of many physiological processes beyond calcium and phosphorus homeostasis. With this review, we aimed to summarize the changes in Vitamin D levels in children with cardiovascular diseases based on the literature. In addition, we also reviewed the potential mechanisms underlying cardiovascular diseases associated with Vitamin D deficiency or insufficiency. Data Sources： The articles in English were searched from PubMed （1968-2016） and EMBASE （1991-2016）, with the keywords of＂Vitamin D AND cardiovascular diseases＂ and ＂Vitamin D AND children.＂Study Selection： Original articles and critical reviews about Vitamin D and cardiovascular risk in children were selected for review. Researches focused on adults were excluded. Results： Studies have shown that several pediatric cardiovascular diseases may be associated with Vitamin D deficiency or insufficiency, including hypertension, orthostatic intolerance, and Kawasaki disease. Conclusions： Vitamin D may play a role in the regulation of the cardiovascular system. Further investigation would hopefully disclose the usefulness of Vitamin D as a biomarker for cardiovascular diseases in children.

关键词： Cardiovascular Diseases Children Vitamin D

Impact of comorbidities on the prognosis of pediatric vasovagal syncope

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World Journal of Pediatrics 2022年第9期18卷 624-628页

作者： Ya-Ru Wang Xue-Ying Li Jun-Bao Du Yan Sun Wen-Rui Xu Yu-Li Wang Ying Liao hong-fang jin Department of Pediatrics Peking University First HospitalNo.1 Xi’an-men StreetWest DistrictBeijing100034China Department of Medical Statistics Peking University First HospitalBeijingChina Key Laboratory of Molecular Cardiovascular Sciences Ministry of EducationBeijingChina

Vasovagal syncope(VVS)is the primary entity of neurally mediated syncope(NMS)in childhood,and its prognosis is usually considered ***,it is found in clini-cal practice that some children with VVS appear to have a frequent recurrence of syncope and poor response to treat-ment[1],which might seriously affect their quality of life[2].In recent years,an increasing number of comorbidities of VVS have been *** et *** that 31%of pediatric patients with NMS suffered from allergic disease[3],and Vallejo M reported that more than 50%of patients had headaches[4].These comorbidities might make the clinical manifestations even more ***,until now,it has been unclear whether comorbidities are associated with the prognosis of children and adolescents suffering from ***,the present study was conducted to examine whether there is any impact of comorbidities on the prognosis of pediatric VVS to better understand the outcome and management of children and adolescents with VVS.

关键词： syncope morbid pediatric