Adrenal Cortical Hormones Research Articles

A Rare Case of Co-occurrence of Multiple Endocrine Neoplasia Syndrome and Congenital Adrenal Hyperplasia

Multiple endocrine neoplasia type 1 (MEN1) and congenital adrenal hyperplasia (CAH) are rare monogenic hereditary endocrinopathies with a prevalence of 1–9 cases per 100,000 and 9–15 cases per 100,000, respectively. MEN1 is characterized by the development of multiple endocrine and nonendocrine organ tumors, including parathyroid, pituitary, and duodenopancreatic neuroendocrine tumors (NETs), which constitute the classical triad of the disease. CAH is associated with genetic defects in enzymes and transport proteins involved in the synthesis of adrenal cortical steroid hormones. Overall, cases of the combination of two hereditary diseases in one patient are extremely rare. In this article, we describe a clinical case of the combination of MEN-1 with all three classical components and CAH, which, taking into account the low prevalence of both diseases, represents scientific interest. To date, only one similar case has been described in the literature. In addition, the paper discusses the pathogenetically determined combination of CAH and Ehlers-Danlos syndrome, known as the CAH-X syndrome.

Cherry leaf decoction inhibits NMDAR expression and thereby ameliorates CUMS- induced depression-like behaviors through downregulation of α2δ-1

Depression is a complex and prevalent mental illness. Cherry leaf is a traditional Chinese herbal medicine, which has confirmed to exert a certain antidepressant effect, but its potential neural regulation mechanism is not clear. This paper aims to investigate the improved action of cherry leaf decoction (CLD) on chronic unpredictable mild stress (CUMS) rats and its potential neural regulation mechanism by verifying the role and function of NMDAR regulatory target α2δ-1 in depression due to CUMS. Male SD rats were subjected to random stressors persisting for 5 weeks to establish the CUMS depression rat model. CLD could effectively alleviate depression-like behaviors of CUMS rats in behavioral tests including sucrose preference test, forced swimming test, tail suspension test and open field test. After the administration of the CLD, the expression of corticotropic-releasing hormone (CRH) in the hypothalamus was inhibited. Moreover, the levels of CRH, adrenal cortical hormone (ACTH) and corticosterone (CORT) in serum also decreased significantly. CUMS upregulated the expressions of α2δ-1, N-methyl-d-aspartate receptor 1 (NR1), NR2A and NR2B, and enhanced the binding ability to of α2δ-1 and NR1, which were reversed by CLD. The results demonstrated that CLD could ameliorate depression-like behaviors due to CUMS, which was related to the fact that CLD down-regulated α2δ-1 level and interfered with α2δ-1 binding to NR1, thereby reducing NMDAR expression and ultimately inhibiting HPA axis activity.

Mushroom Poisoning and Treatments

The poisoning mushroom can affect the human body and is even lethal. This review summarizes gastroenteritis, hemolytic and liver damage caused by poisoning mushroom, as well as therapy methods for a variety of toxins. The main symptoms of gastroenteritis include acute nausea, abdominal pain, and diarrhea. For that, the common treatments include vomiting, gastric lovage and catharsis. The manifestation of hemolytic contains interic, acute anemia, liver adds spleen enlargement. The main approaches used to alleviate the effects are cortisone and atrium biacrbonate. Moreover, serious anemic people can use adrenal cortical hormones or Transfusion Therapy. The symptoms of liver damage are quite similar to gastroenteritis and hemolytic, but the manifestation is instruction regarding form doctors and over-the counter medicines. With prompt treatment, most minor symptoms can be cured. However, if the toxin has damaged the endoplasmic reticulum from liver nucleus, it would be difficult for patients to recover. Future research may focuse on precise treatment methods of mushroom positioning. More efforts should be made to facilitate the awareness of people about poisoning mushrooms to prevent mushroom poisoning.

The preclinical pharmacological study of a novel intravenous anesthetic, ET-26 hydrochloride, in aged rats.

BackgroundET-26 hydrochloride (ET-26HCl) is a novel analogue of etomidate approved for clinical trials. However, all results from recent studies were accomplished in young adult animals. The objective of this study was to evaluate the efficacy and safety of ET-26HCl in aged rats.MethodsAged Sprague-Dawley rats were randomly divided into three groups (three males and three females in each group) were given dose of two-fold of median effective dose (ED50) of ET-26HCl, etomidate and propofol: the measurements of loss of the righting reflex (LORR) and cardiovascular and respiratory function after injection at the two-fold dose of the median effective dose were used for evaluation of effectiveness and safety, and the modified adrenocorticotropic hormone-stimulation experiment was used to evaluate the inhibition effect of the drugs on the synthesis of adrenal cortical hormones.ResultsThere was no significant difference in the onset time among propofol, etomidate and ET-26HCl. The duration of propofol (850.5 ± 77.4 s) was significantly longer than that caused by etomidate (489.8 ± 77.0 s, p = 0.007) and ET-26HCl (347.3 ± 49.0 s, p = 0.0004). No significant difference was observed in the time to stand and normal activity among drugs. A total of 66.7% of rats in the ET-26HCl group were evaluated to have mild hematuria. Then, etomidate and ET-26HCl had a milder blood pressure inhibition effect than propofol. Apnea was observed in all rats administered propofol and the duration for this side effect was 45.0 ± 9.0 s. For etomidate and ET-26HCl, no apnea was observed. No other clinical signs of side-effect were observed, and no rats died. No significant difference was observed in corticosterone concentrations between ET-26HCl and solvent group. However, rats administered etomidate had lower corticosterone concentrations than those administered ET-26HCl at 15, 30, and 60 min.ConclusionsOur results indicate ET-26HCl in aged rats is an effective sedative-hypnotic with stable myocardial and respiratory performance and also have mild adrenocortical suppression. Thus, these findings increase the potential for the clinical use of ET-26HCl in the elderly population.

Evaluation of Adrenal Cortical Function in Neonatal and Weanling Laboratory Beagle Dogs.

The most common target organ for toxicity in the endocrine system is the adrenal gland, and its function is dependent upon the hypothalamus and pituitary gland. Histopathologic examination of the adrenal glands and pituitary gland is routinely performed in toxicity studies. However, the function of the adrenal gland is not routinely assessed in toxicity studies. Assessment of adrenal cortical function may be necessary to determine whether a histopathologic finding in the adrenal cortex results in a functional effect in the test species. As juvenile toxicity studies are more commonly performed in support of pediatric indications for pharmaceuticals, it is important to establish historical control data for adrenal gland function. In this study, adrenal cortical function was assessed in control neonatal and weanling beagle dogs as part of an ongoing juvenile toxicology program. Measurements of serum adrenocorticotropic hormone (ACTH), cortisol prior to and following administration of exogenous ACTH, and aldosterone were conducted beginning at 2 weeks of age continuing through 26 weeks of age. Serum electrolyte concentrations were determined at 4, 13, and 26 weeks of age. Dogs as young as 2 weeks of age synthesize and secrete adrenal cortical hormones and exhibit a functional hypothalamic pituitary adrenal axis.

Research Protocol For A Pilot Study. The Effect Of ST (36) And Ren12 In The Control Of Hyperglycemia In Diabetic Patients

These acupunture points stimulated with EA have shown their hypoglycemic effect in animal models. One of the main mechanisms by which this effect is supported is the regulation of the hypothalamic-pituitary-adrenal axis, regulating the secretion of adrenal cortical hormone.

Effects of transcranial direct current stimulation on cognitive function in delayed encephalopathy after carbon monoxide poisoning

Objective: To investigate the effect of transcranial direct current stimulation (tDCS) on cognitive function of delayed encephalopathy after carbon monoxide poisoning (DEACMP) . Methods: A total of 58 patients with DEACMP admitted to the Emergency Medicine Department of Hudson International Peace Hospital from January 2018 to January 2020 were included. According to the random number table, the patients were randomly divided into study group and control group, with 29 patients in each group. Patients in both groups were given nutritional nerve therapy, improved microcirculation, adrenal cortical hormone and other drugs, as well as hyperbaric oxygen and rehabilitation training, once per day. The study group was treated with tDCS (electrode pads were placed and current stimulation was given 30 min/time) 1/d on the basis of conventional treatment, while the control group was treated with tDCS pseudo stimulation (electrode pads were placed and current stimulation was given for 10 s) 1/d for 30 days consecutively. The auditory event-related potential P300 (ERP-P300) was tested before and 30 days after treatment, and the Mini-Mental State Examination (MMSE) scale, Barthel index (BI) and the National Institutes of Health Neurological Impairment score (NIHSS) were used to evaluate and analyze the patients. Results: There was no significant difference in scores between the two groups before treatment (all P>0.05) . After 30 days of treatment, the MMSE score, orientation, memory, attention and computing power, and language ability of the study group were all higher than those of the control group, and the differences were statistically significant (P<0.05) . 90 days after treatment, the BI of the study group was higher than that of the control group (P<0.05) . After 30 days of treatment, the NIHSS score of the study group was significantly lower than that of the control group (P<0.05) . The latency of ERP-P300 in the study group was shorter than that in the control group, and the amplitude was higher than that in the control group at 30 days after treatment, and the difference was statistically significant (P<0.05) . The latency of ERP-P300 was negatively correlated with the total MMSE score before and after DEACMP treatment (r=-0.837, -0.819, P<0.05) . The latency of ERP-P300 was negatively correlated with orientation, attention and computing power, and language ability before treatment (r=-0.698, -0.675, -0.742, P<0.05) . Conclusion: TDCS treatment can help improve the cognitive function of DEACMP patients, and ERP-P300 test can help determine the cognitive function severity of patients.

Biosynthesis and Industrial Production of Androsteroids

Steroids are a group of organic compounds that include sex hormones, adrenal cortical hormones, sterols, and phytosterols. In mammals, steroid biosynthesis starts from cholesterol via multiple steps to the final steroid and occurs in the gonads, adrenal glands, and placenta. This highly regulated pathway involves several cytochrome P450, as well as different dehydrogenases and reductases. Steroids in mammals have also been associated with drug production. Steroid pharmaceuticals such as testosterone and progesterone represent the second largest category of marketed medical products. There heterologous production through microbial transformation of phytosterols has gained interest in the last couple of decades. Phytosterols being the plants sterols serve as inexpensive substrates for the production of steroid derivatives. Various genes and biochemical pathways involved in phytosterol degradation have been identified in many Rhodococcus and Mycobacterium species. Apart from an early investigation in mammals, presence of steroids such as androsteroids and progesterone has also been demonstrated in plants. Their main role is linked with growth, development, and reproduction. Even though plants share some chemical features with mammals, the biosynthesis is different, with the first C22 hydroxylation as an example. This is performed by CYP11A1 in mammals and CYP90B1 in plants. Moreover, the entire plant steroid biosynthesis is not fully elucidated. Knowing this pathway could provide new processes for the industrial biotechnological production of steroid hormones in plants.

Effects of dietary γ-aminobutyric acid supplementation on antioxidant status, blood hormones and meat quality in growing-finishing pigs undergoing transport stress.

γ-Aminobutyric acid (GABA) is a natural nonprotein amino acid distributed in animals, plants and microbes. GABA is an inhibiting neurotransmitter which takes great effect in mammalian central nervous system. We carried out the research to study the influence of GABA on blood hormone concentrations, antioxidant status and meat quality in fattening pigs after transportation. The 72 pigs with a starting weight of approximately 32.67±0.62kg were randomly allocated to 2 groups based on dietary treatments, containing 6 replicates with 6 pigs in each. The pigs were fed dietary supplementation of GABA (0 or 30mg/kg of diets) for 74days. Twelve pigs were randomly selected from each group and assigned to the either 1hr of transport (T group) or no transport (N group), resulting in two-factor factorial design. Compared to the control, GABA supplementation increased average daily gain (ADG) (p<.01) and decreased feed-gain ratio (F/G) (p<.05). The pH45min was lower and drip loss was greater in the longissimus muscles (LM) of post-slaughter of transported pigs (p<.05). The pH45min of 0/T group (group with 0mg/kg GABA and transport) was significantly lower than the pH45min of the 30/T group (diet×transport; p<.05). GABA supplementation significantly increased serum glutathione peroxidase (GSH-Px) concentration (p<.05) before transportation. Following transport, pigs fed GABA had decreased concentrations of serum malonaldehyde (MDA), adrenal cortical hormone and cortisol (p<.05). The results indicate that feeding GABA significantly increased the growth performance of growing-finishing pigs. The transportation model negatively impacted meat quality, antioxidant indexes and hormone parameters, but dietary supplementation of GABA could suppress the rise of drip loss of LM, ACTH and COR and suppress the drop of pH45min of LM after transportation stress in growing-finishing pigs. Feeding GABA alleviated transportation stress in pigs.

Bacillus amyloliquefaciens BLCC1-0238 Can Effectively Improve Laying Performance and Egg Quality Via Enhancing Immunity and Regulating Reproductive Hormones of Laying Hens.

In this study, we sought to evaluate the effects of dietary Bacillus amyloliquefaciens (B. amyloliquefaciens) BLCC1-0238 supplementation on laying performance, egg quality, antioxidant enzyme activities, reproductive hormone, and immunity of laying hens. A total of 240 Hy-Line Brown laying hens (28weeks old) were randomly divided into four groups, and three replicates per group (n = 20 per replicate). The control group was fed a standard basal diet, and the three treatment groups were provided the basal diet supplemented with either 0.01%, 0.03%, or 0.06% B. amyloliquefaciens BLCC1-0238 (2×1010CFU/g), respectively. Hens were allowed 2weeks to acclimate prior to initiation of the 8-week experiment. It was observed that dietary supplementation with 0.01% or 0.03% B. amyloliquefaciens BLCC1-0238 significantly increased egg production and egg mass. However, no significant differences in feed intake, egg weight, and feed conversion ratio among the four groups were observed. Different levels of B. amyloliquefaciens BLCC1-0238 supplementation also significantly increased egg shell strength and thickness. With respect to the levels of reproductive hormones in the hens, B. amyloliquefaciens BLCC1-0238 supplementation significantly reduced serum adrenal cortical hormone (ACTH) levels, while increasing estradiol (E2) and follicle-stimulating hormone (FSH) secretion in the treatment groups compared to the control group. Relative to the control group, supplementation with 0.03% and 0.06% B. amyloliquefaciens BLCC1-0238 was observed to significantly increase serum glutathione S-transferase (GST) concentration, and supplementation significantly reduced serum IL-1 and IL-6 levels, whereas IL-4 levels increased for all concentrations tested. In conclusion, supplementation of a basal chicken diet with B. amyloliquefaciens BLCC1-0238 can improve laying performance and egg quality through the reduction of stress responses, up-regulation of growth hormones, and supporting immunity in laying hens.

Clinical analysis of blood purification technology in the treatment of 23 cases with severe toadstool poisoning

Objective To observe the curative effect and experience of blood purification technology in the treatment of severe mushroom poisoning. Methods A total of 23 patients with severe mushroom poisoning in the Central Hospital of Pulandian District of Dalian were collected.On the basis of general therapy (emetic, gastric lavage, oral activated charcoal, catharsis, atropine, adrenal cortical hormone, symptomatic and supportive treatment), the patients were given blood purification therapy: hemoperfusion, 2 hours each time, 1 time every two days; application in series with hemodialysis, hemoperfusion; bedside hemofiltration was performed (8-10)h/ time. Results Of the 23 patients, 22 cases had liver injury (95.7%), 7 cases had renal injury (30.4%), 3 cases had central nervous system damage (13%), and 4 cases had other 17.4%.Hemoperfusion was performed in 22 patients, with an average of (3.6±0.4)times per day, and 19 patients with bedside hemofiltration, with an average of (2.9±0.5)times per patient.Outcome: 21 cases were improved, 2 cases died. Conclusion Blood purification treatment should be done as early as possible for mushroom poisoning patients, and it is an effective method for the treatment of severe mushroom poisoning. Key words: Hemodafitration; Mycotoxicosis; Poisoning; Multiple organ failure

Surgical treatment of ACTH-ectopic syndrome

ACTH-ectopic syndrome is a severe, multiple-symptom disease characterized by secretion of adrenocorticotropic hormone (ACTH) by ectopic tumor, increased release of adrenal cortical hormones and clinical picture of hypercorticism. Diagnosis and treatment of ACTH-ectopic syndrome is still difficult problem despite the achievements of modern medicine. There are several unresolved issues including optimal diagnostic algorithm, indications for various surgical procedures and their optimal dates. This review is devoted to these questions.

Stimulatory Effect of Intermittent Hypoxia on the Production of Corticosterone by Zona Fasciculata-Reticularis Cells in Rats

Hypoxia or intermittent hypoxia (IH) have known to alter both synthesis and secretion of hormones. However, the effect of IH on the production of adrenal cortical steroid hormones is still unclear. The aim of present study was to explore the mechanism involved in the effect of IH on the production of corticosterone by rat ZFR cells. Male rats were exposed at 12% O2 and 88% N2 (8 hours per day) for 1, 2, or 4 days. The ZFR cells were incubated at 37 °C for 1 hour with or without ACTH, 8-Br-cAMP, calcium ion channel blockers, or steroidogenic precursors. The concentration of plasma corticosterone was increased time-dependently by administration of IH hypoxia. The basal levels of corticosterone production in cells were higher in the IH groups than in normoxic group. IH resulted in a time-dependent increase of corticosterone production in response to ACTH, 8-Br-cAMP, progesterone and deoxycorticosterone. The production of pregnenolone in response to 25-OH-C and that of progesterone in response to pregnenolone in ZFR cells were enhanced by 4-day IH. These results suggest that IH in rats increases the secretion of corticosterone via a mechanism at least in part associated with the activation of cAMP pathway and steroidogenic enzymes.

Adrenal obliteration by balloon-occluded retrograde venous ethanol injection in a swine model

Purpose: To evaluate the effects of adrenal obliteration by balloon-occluded retrograde venous ethanol injection.Material and methods: We inserted a micro-balloon catheter into the left adrenal vein of six pigs and retrogradely injected absolute ethanol (0.06 ml/kg) under balloon occlusion. Two pigs were sacrificed on day 3, 7, and 14 after the procedure, respectively. We evaluated adrenal cortical and medullary hormones of the left renal vein, venograms, magnetic resonance imaging scans obtained before and after the procedure, autopsy and microscopic findings, and the weight of the bilateral adrenal glands.Results: The hormone levels were extremely high on day 3 after the procedure. Post-procedure, partially-enhanced parenchyma and shaggy veins were observed. On the post-mortem examination, the left adrenal glands showed hemorrhage and adhesion on the third and seventh day and fatty proliferation 14 days after the procedure. Microscopic examination revealed hemorrhagic necrosis on day 3, inflammatory cell infiltration on day 7, and partial fibrosis 14 days after the procedure. The weight of the left adrenal gland on day 14 was lower than that of the right gland.Conclusions: This procedure elicited partial adrenal infarction with a high catecholamine concentration in the left renal vein.

Histocytological and histochemical features of the adrenal gland of Adult Egyptian native breeds of chicken (Gallus Gallus domesticus)

BackgroundAvian adrenal gland is one of the most important endocrine glands as it regulates several vital physiological functions. Removal of such gland leads to death of bird. ObjectiveThe present investigation aims to illustrate morphological, histocytological and histochemical features of adrenal gland of Adult Egyptian native breeds of Chicken (Gallus gallus domesticus) by means of gross anatomy, light and transmission electron microscope. Materials and methodsThirty chickens of 6months old were collected from Beni-Suef province, Egypt. Immediately after sacrifying the birds, right and left adrenals were subjected to histomorphological, histochemical and ultrastructural examinations. ResultsGrossly, the adrenal glands were situated cranio-medially to the kidneys with yellowish color. Histologically, they were ensheathed with thin collagenous connective tissue capsule containing many blood vessels and associated with numerous autonomic ganglia. The parenchyma was composed of mixture of cortical and medullary tissues as well as numerous blood sinusoids. The cortical tissues were demarcated in two distinct zones; subcapsular and inner. The cells of subcapsular cortical zone (SCZ) contained more lipid droplets and less mitochondria than the inner cortical cells do. Two types of chromaffin cells were distinguished; epinephrine (E-) and norepinephrine (NE-) producing cells. The former contained spherical moderate electron-dense secretory granules. The latter contained abundant pleomorphic intensely electron-dense secretory granules. ConclusionHigher cortical tissues on the expense of medullary ones may be the need for increased production of adrenal cortical hormones (glucocorticoids and mineralocorticoids) in the chicken that lives in areas which water conservation is important.

Real world analysis to explore clinical features of Shenxiong glucose injection combined with other medications

To explore the real world clinical medication and combination characteristics of Shenxiong glucose injection. The basic information of patients with Shenxiong glucose injection, traditional Chinese and western medicine diagnosis information, doctor advice information and laboratory test information from the hospital information system(HIS) of 19 tertiary hospitals in China. Apriori algorithm was adopted to establish the models, and Clementine 12.0 was used for correlation analysis to analyze the real world clinical medication and combination characteristics of Shenxiong glucose injection. Among 8 316 patients in the study, 523 kinds of western medicine and 148 kinds of traditional Chinese medicine(TCM) were used. In combined application, the single western medicine with highest use frequency was aspirin(1 908 cases, 22.94%), and single Chinese medicine with highest use frequency was Shuxuetong injection (771 cases, 9.27%); the most common TCM pair was Xianling Gubao capsule+Lugua Duotai injection(rules support degree was 2.55%), and the most common western medicine pair was aspirin+atorvastatin(degree of association rules was 10.15%). They were often used in combination with antibiotics, blood-activating and stasis-dissolving prescription, and adrenal cortical hormone drugs. Shenxiong glucose injection was often used in combination with antiplatelet drugs and blood-activating and stasis-dissolving prescription in clinical application to enhance the effects of anti-platelet aggregation and blood-activating and stasis-dissolving; it was often used in combination with antibiotics to treat cor pulmonale, and incompatibility shall be noticed to ensure efficacy enhancement under the premise of clinical medication safety.

Efficiency of oral administration of glucocorticosteroid for treating nasal inflammation

The pathological basis of nasal inflammation is still not well defined. Extensive studies showed the immune response mediated by T cells played an important role in the pathogenesis of nasal inflammation. The inflammation in the nasal membrane could be considered as the common routines for the development of chronic sinusitis(CRS), allergic rhinitis and allergic fungal sinusitis.Glucocorticosteroid, a compound with similar structure with the adrenal cortical hormone, has been commonly used for the treatment of nasal inflammation. To date, its efficiency via nasal membrane has been well acknowledged in clinical practice, while the efficiency of oral administration is still not well defined. In this study, we aim to investigate the efficiency of oral administration of glucocorticosteroid for treating nasal inflammation.

Molecular Imaging in the Management of Adrenocortical Cancer: A Systematic Review.

Adrenocortical cancer (ACC) is an uncommon primary neoplasm of the adrenal cortex with dismal prognosis. It often presents with symptoms and signs of adrenal cortical hormone hypersecretion and abdominal mass effect or is incidentally detected as an adrenal mass on imaging performed for other indications. Endocrine evaluation, comprehensive staging, and meticulous resection are crucial to ensure the best possible outcome. Despite extensive initial surgical resection, local and distant metastases are not uncommon with disappointing 5-year survival, although progress is being made at high-volume centers. Accurate restaging of recurrent disease is important to guide further management. Mitotane, external beam radiation and chemotherapy, and newer anticancer systemic treatments are used as adjunctives for inoperable disease and distant metastases. Contrast-enhanced CT and MRI are first-line imaging modalities for evaluation of ACC to characterize adrenal masses and to determine tumor resectability. Emerging literature supports F-FDG PET/CT use to determine the malignant potential of adrenal masses. In patients with a diagnosis of ACC, FDG PET/CT is sensitive for detecting metastatic disease, and its tumor accumulation has been correlated to pathology, Weiss scores, and prognosis. Metomidate, labeled with C for PET or with I for SPECT/CT, allows characterization of an adrenal mass as being of adrenocortical origin with high specificity. Taking advantage of its adrenocortical avidity, metomidate has been labeled with I for radionuclide therapy in a subset of ACC. In this review, we describe how nuclear medicine imaging, and specifically PET, can assist surgical management of ACC.

Clinical analysis of 73 pediatric patients with completely atrioventricular conduction block

Objective To explore the causes, clinical characteristics and prognosis of children's completely atrioventricular block(CAVB). Methods The clinical data of 73 patients with CAVB were analyzed retrospectively from January 2004 to December 2013 at the Cardiology Department, Nanjing Children's Hospital Affiliated to Nanjing Medical University.Within those 73 patients, 34 patients were male and the others were female, from 3 months old to 12.5 years old, the mean age of 6 years. Results There were 21 congenital CAVB patients and 52 acquired CAVB patients with myocarditis undergoing ventricular septal defect (VSD) closure operation.All congenital CAVB patients were refractory to drug therapy.Electrocardiogram and echocardiogram were performed in 19 cases without clinical symptoms during follow-up, but 2 cases had permanent pacemaker implanted.Among 27 fulminant myocarditis, Adams-Stokes attacks were found in 15 cases, 3 cases had Adams-Stokes attack in 15 cases with sequelae of myocarditis, and 2 out of 6 cases undergoing VSD closure operation had Adams-Stokes attack, and other 4 cases without clinical symptoms were followed up periodically.The acquired CAVB patients were given energy composition and intravenous megavitamin C. The cases with fulminant myocarditis were given adrenal cortical hormone and intravenous gamma globulins simulta-neously.A total of 27 acquired CAVB patients were implanted temporary pacemaker and 5 with permanent pacemaker.Among 52 acquired CAVB patients, 31 cases were cured, 9 cases were improved, 11 cases were ineffective, and 1 case died. Conclusions Most congenital CAVB children without clinical symptoms need clinical follow-ups.Myocarditis is a major cause of acquired CAVB.The CAVB prognosis caused by fulminant myocarditis may be related to antimely implanting the temporary pacemaker timely.Permanent pacemaker should be implanted in patients who have no response to drug therapy with frequent Adams - Stokes or heart failure. Key words: Complete atrioventricular block; Pacemaker; Prognosis; Child

Rescue and Nursing of Acute Severe Viral Myocarditis in Children

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To explore clinical rescue and nursing measures for children with acute severe viral myocarditis. &lt;strong&gt;Method: &lt;/strong&gt;Patients in the hospital were immediately given positive anti-heart failure, anti-shock therapy and correct treatment of arrhythmia. Large doses of gamma globulin, adrenal cortical hormone, pulse therapy, direct current cardioversion, vitamin C, oxygen inhalation, ECG and other treatments were given. &lt;strong&gt;Results&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;58 cases were rescued successfully and the prognosis was good. However, there were 3 cases of patients with severe myocardial damage, ECG, ventricular fibrillation, and 1 invalid death. &lt;strong&gt;Conclusion: &lt;/strong&gt;In the treatment of acute severe viral myocarditis of children, timely, accurate and safe implementation of various rescue measures is the key to improving the success rate.&lt;/p&gt;