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Objective:To summarized the experience of 149 cases of critical pediatric cardiac surgery in a single-center during the epidemic period, for providing a safe and feasible management strategy.Methods:Based on the epidemiological characteristics of COVID-19, a strategy consisting of 14 days of isolation was established for the arrangement of cardiac surgery in children during the epidemic period. Retrospective analysis of clinical data of 149 cases of critical cardiac surgery performed from January 23, 2020 to March 20, 2020 under the guidance of this strategy. The primary composite endpoint was death and suspected or confirmed COVID-19.Results:The median age of the children undergoing surgery was 136 days; 73(49.0%) cases were male. Twenty-one cases (14.1%) came from Shanghai, one case (0.7%) came from Hubei Province, and 127 cases (85.2%) came from areas other than Hubei and Shanghai. One patient (0.7%) outside Shanghai who had been isolated for less than 14 days carried emergency surgery under special protection; other 148 patients (99.3%) underwent elective early repair procedure. One patient (0.7%) died, and no COVID-19 was confirmed or suspected.Conclusion:During the COVID-19 epidemic, pediatric cardiac surgery can be safely performed using a specific management strategy, which can be used as a reference when major public health events occur.
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Objective To explore whether using of exogenous pulmonary surfactant( PS) can im-prove recovery of infants suffering postoperative acute respiratory distress syndrome after cardiac surgery and whether kinetic analysis of pulmonary functional change can be helpful to indicate an appropriate dosing scheme. Methods Nineteen infants received an exogenous PS( Curosurf,100 mg/kg,treatment group) due to acute respiratory distress syndrome after cardiac surgery for congenital heart defects. They were compared with 24 patients without its administration despite the same postoperative complication( control group) . Oxy-genation index( OI) and ventilation index( VI) were calculated and fitted with a monoexponential function be-fore and after its use. Other outcomes including chest radiography,duration of mechanical ventilation,inten-sive care unit and hospitalization were also analyzed. Results All infants who received PS survived,whereas three infants in the control group died. The duration of mechanical ventilation and hospitalization were signifi-cantly shorter after PS administration[(21. 3 ± 9. 2) d vs. (31. 1 ± 13. 4) d,t=6. 520,P=0. 004;(30. 2 ± 13. 2)d vs. (41. 3 ± 16. 5)d,t=2. 185,P=0. 03]. The infants received either one (13 cases,subgroup A) or two doses (6 cases,subgroup B) before successful weaning from the ventilator. After the first dose was ad-ministered,the maximal rates of OI and VI change were significantly higher of infants in the subgroup A[OI:(2. 9 ±1. 7) vs. (1. 0 ± 0. 8),t =3. 012,P =0. 02;VI:(16. 6 ± 9. 6) vs. (5. 8 ± 5. 6),t =2. 980,P =0. 02]. Twelve hours after the first dose,both parameters in the subgroup B deteriorated and a second dose was administered 24 h later. Conclusion Exogenous PS is an efficient medication for infants suffering acute respiratory distress syndrome after cardiac surgery. Kinetics analysis of functional change after initial surfac-tant use may be referred for early determination of an optimal dosing scheme.
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Objective To simplify regional citrate anticoagulation(RCA) in continuous veno-venous hemofiltration (CVVH) with a calcium-containing replacement solution for children after congenital heart surgery.Methods The clinical data of 20 children with RCA in CVVH after congenital heart surgery were retrospectively analyzed.All cases were divided into two groups:the traditional group(12 cases) using a calcium-free replacement solution and the modified group(8 cases) using a calcium-containing replacement solution.The blood gas data,plasma ionic calcium,total calcium/ionic calcium ratio,circuit survival time,calcium supplement and the number of adjustments of replacement fluid formula were compared between the two groups after CVVH.Results During RCA-CVVH,serum HCO3-,pH,systemic ionized calcium,and the ratio of total calcium / ionic calcium were higher than those before RCA-CVVH,but all in normal range.There was no significant difference in circuit survival time between two groups [(50.5 ± 2.3) h vs.(48.8 ± 4.7)h,respectively,P ＞0.05].Calcium supplementation in the traditional group was significantly higher than that in the modified group[2.5％ calcium chloride supplementation was(0.43 ±0.11) ml/(kg-h) in the traditional group and(0.13 ± 0.17) ml/(kg-h) in the modified group].The number of replacement solution adjustment was (2.7 ± 1.1) times in traditional group,while the modified group did not change the replacement formula.Conclusion RCA using a calcium-containing replacement fluid in hemofiltration,can reduce the supplement of calcium and the times of the replacement solution adjustment,which is easy to operate.It can be used safely,effectively and conveniently in CVVH children after congenital heart surgery.
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Objective To investigate the early curative effect of Blalock-Taussig(B-T) shunt and summarize the key point in its post-operative intensive care,analyze the related risk factor of its mortality.Methods We collected 71 patients who received B-T shunt in Shanghai Children's Medical Center from June 2015 to June 2017. All of 71 cases were divided into neonates group (25 cases) and non-neonate group (46 cases). All patients were operated through median sternotomy,19 were emergency cases,in which 15 cases were neonates. Eight cases used cardio-pulmonary bypass in our study,in which 4 cases were neonates. Twenty-nine cases received ductus ligation in total 34 patients with patent ductus arterious. Percutaneous heparin was immediately administered after operation as an anticoagulation therapy. Relative large dosage inotropic agents was used after sufficient volume infusion in order to guarantee diastolic pressure higher than 35 mmHg(in neo-nates >30 mmHg,1 mmHg =0. 133 kPa). Ventilator parameter was adjusted to obtain appropriate flow distribu-tion between pulmonary and systemic circulation. In order to avoid excessive pulmonary flow,the target PO2 was set between 40 ～ 45 mmHg. Results Oxygen saturation elevated by 15％ after operation in all 71 cases. Average mechanical ventilation time was 92 hours,mean inotropic agents score was 17. There were 6 dead cases,mortality was 8. 5％ . In neonates,4 cases dead,mortality was 16. 0％ . There was no significant difference in ventilation time,ICU retention day and mortality between neonates group and non-neonates group. The logis-tic regression analysis showed that the body weight and ratio between the shunt conduit diameter and body weight (mm/ kg) were the risk factors for early post-operative mortality[body weight:2500 ～ 3500 g:OR =6. 729,95％ CI =1. 373 ～17. 131;≤2500 g:OR = 7. 832,95％ CI = 2. 563 ～ 28. 325. the ratio between the shunt conduit diameter and body weight (mm/ kg):1. 10 ～1. 15:OR = 4. 204,95％ CI = 1. 195 ～ 23. 926;≥1. 15:OR= 3. 981,95％ CI =1. 195 ～12. 926]. Conclusion B-T shunt is still a high risk operation although it is a palli-ative method. Low body weight and bigger diameter conduit are the significant factors related to its mortality. Strict control of the systemic and pulmonary flow ratio is the key point in the post-operation intensive care.
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Objective To investigate the clinical effects of radical intensity-modulated radiotherapy (IMRT) combined with concurrent chemotherapy in the treatment of metastatic nasopharyngeal carcinoma. Methods Ninety patients with metastatic nasopharyngeal carcinoma in the First Affiliated Hospital of Hainan Medical University from August 2010 to April 2015 were selected as the research objects. All the patients were randomly divided into the observation group (45 cases) and the control group (45 cases) according to the random lottery envelope. The control group was treated with conventional chemotherapy treatment, and the observation group was treated with radical IMRT based on the treatment of the control group. The efficacy of the patients in both groups was evaluated after the treatment for 4 periods. Results The effective rate in the observation group was higher than that in the control group [66.7 % (30/45) vs. 33.3 % (15/45); χ2= 4.552, P＜ 0.05]. In the observation group, there were 3 cases of radiation esophageal injury and 3 cases of lung injury, and the incidence rate was 13.3 % (6/45), bringing the better treatment outcome. The incidence of side effects such as hair loss, nausea and vomiting, liver and kidney damage, bone marrow suppression in the observation group was 71.1 % (32/45), which was higher than that in the control group [66.7 % (30/45)] and there was no significant difference (χ 2= 0.331, P＞ 0.05). All the patients were followed up. 1 yeas and 2 year survival rates in the observation group were 95.6 % (43/45) and 86.7 % (39/45) respectively, while the control group were respectively 75.6 % (34/45) and 64.4 % (29/45) (χ2values were 6.393 and 5.309, both P＜0.05). Conclusion Radical IMRT combined with concurrent chemotherapy for metastatic nasopharyngeal carcinoma can improve the therapeutic effect and show good safety, and the radiation damage would not affect the treatment process.
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Objective To analyze the influencing factors of surgical management for Blalock-Taussig shunt during neonatal period,and to summarize the clinical experience,therefore,to improve the surgical outcome.Methods The clinical data between Jan 2011 and Dec 2016 were reviewed,42 neonates(26 males,16 females)with the mean age from 1 to 29 days,and weight from 2.3 to 4.1 kg,underwent a Blalock-Taussig shunt.The additional operation included PDA retention in 3 patients,right ventricular outflow tract retention in 12 patients,B-T conduit banding in 2 patients and PDA banding in 1 patient.Results The early mortality was 28.6％ (12/42).Univariate analysis revealed low birth weight,waiting time for surgery,preoperative acidosis or cardiac shock,dual pulmonary blood supply,conduit/weight,high IS (inotropic drugs score),unplanned intervention as risk factors for early death.In the multivariate analysis,preoperative acidosis or cardiac shock,conduit/weight,high IS were independent risk factors of early death.Conclusion The mortality rate after the neonatal modified Blalock-Taussig shunt remains high.It can be improved by proper perioperative treatment,immediate surgical treatment and choose suitable conduit size,maintain the stable circulation.
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Objective To observe the expression of apoptosis and invasion genes in different tissues of laryngeal lesions,and to detect the content of proliferation related protein and proliferation inhibition gene.Methods In our hospital,the clinical diagnosis of laryngeal carcinoma,precancerous lesions and vocal polyps in 88 cases of laryngeal carcinoma,surgical excision of lesion specimens cut from the amount of Pro apoptotic genes and promote invasion and proliferation related protein,gene the content of tissue proliferation inhibition gene detection.Results The laryngeal carcinoma group of Pro apoptotic genes nicotinamide adenine dinucleotide phosphate oxidase 1 (NOX1) and large tumor suppressor gene 1 (LATS1) were all significantly lower than lesion group and polyp group (P ＜ 0.05).Laryngeal carcinoma invasion promoting gene tumour necrosis factor receptor associated factor 6 (TRAF6),and cellular FADD-like interleukin1βconverting enzyme inhibitory protein (c-FLIP) content were significantly higher than that of laryngeal pre cancerous lesions and vocal polyps (P ＜ 0.05).The proliferation related protein Cyclin-dependent kinase 6 (CDK6) and E2F1 in laryngeal carcinoma were significantly lower than that in the lesion and polyp group,and cyclin D1 (CCND1),Bmi-1,and Livin contents were significantly higher than that in the lesion group and the polyp group (P ＜ 0.05).The levels of differentiated embryo-chondrocyte expressed gene 1 (DEC-1),IκB kinase 16(IKK16),large tumor suppressor gene 1 (LAST-1),receptor-interacting proteins-1-(RIP-1),and c-myc promoter binding protein-1 (MBP-1) in the tissue of laryngeal carcinoma were significantly lower than those in the lesion group and polyp group (P ＜ 0.05).Conclusions The laryngeal carcinoma invasion promoting gene was higher than that in other tissues,inhibition of gene content was lower than that of other tissues proliferation related protein gene,apoptosis and proliferation,apoptosis and invasion of lesions in gene expression level,proliferation related protein and proliferation inhibition of gene content and laryngeal squamous cell carcinoma were related to laryngeal disease prevention significance of detection.
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Objective To explore the role of human papillomavirus (HPV) in squamous cell carcinoma of the larynx.Methods A cohort of 152 laryngeal squamous cell carcinoma (LSCC) patients,40 premalignant lesions of the larynx,and 40 vocal fold polyp patients was evaluated for the expression of HPV16 E7 protein by immunohistochemistry (IHC).E7 protein expression was correlated with clinicopathological features and outcomes.Results The expression of E7 protein in vocal fold polyp was negative,and it's positive expression in precancerous lesions and laryngeaI carcinomas was 2.5％,and 32.9％,respectively.There were no other significant clinical or demographic differences between pl6-positive and-negative cases.There was no difference in overall survival (OS) between E7-positive and-negative patients with 5-year survival of 79％ and 66％ for p16 positive and negative patients,respectively (P =0.581).There was no statistically significant difference in failure-free survival (FFS) with 5-year FFS of 57.8％ and 42.3％ for p16 positive and negative patients,respectively (P =0.579).Conclusions E7 expression is infrequent in laryngeal carcinomas.There are no statistically significant correlations between E7 IHC status and OS or FFS.
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Objective:To investigate the effect of Yupingfeng on hyaluronic acid (HA) and Foxp3+Treg in patients with nasopharyngeal carcinoma.Methods:A total of 58 cases of nasopharyngeal carcinoma were divided into two groups, 30 cases in the treatment group, 28 cases in the control group. Patients in two groups were treated with synchronous radiotherapy and chemotherapy treatment, the treatment group was treated with the Yupingfeng granules through oral administration, 10 g/time, tid for 2 courses. The serum Foxp3+ Treg markers of each group were detected by flow cytometry assay before treatment and after treatment, and the level of HA in serum was detected by radio immunoassay.Results:After radiotherapy and chemotherapy, the contents of Foxp3+ Treg and HA were significantly decreased in two groups (P<0.05), and the decrease of treatment group was more significantly (P<0.01). Correlation analysis showed positive correlation between Foxp3+ Treg and HA (P<0.05). After treatment, the incidence of side effects in two groups was significantly decreased. And there was significant difference between two groups (P<0.05).Conclusions:Combined chemotherapy and radiotherapy with Yupingfeng treatment can decrease the levles of Foxp3+ Treg and HA in nasopharyngeal carcinoma patients. Yupingfeng can also effectively reduce the side effect due to radiation and chemotherapy.
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Objective To analyze the risk factors in the operative mortality in neonates with congenital heart disease.Methods The surgical outcomes of eongenital heart defects in 231 neonates at Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University of Medicine,during Jan.2011 and Dec.2013 were detected for retrospectively.Patients were analyzed according to Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1).The age,weight at operation,emergency operation,cardiopulmonary bypass,single ventricle surgery,and RACHS-1 score were detected for risk assessments.Results Overall mortality of congenital heart defect in neonates was 9.96％ (23/231 cases).The top three procedures for high mortality were single ventricle palliative surgery.(25.00％,7/28 cases),corrective operation of interrupted aortic arch (21.43％,3/14 cases),and arterial switch operation with ventricular septum defect repair (13.95％,6/43 cases).There was only 1 case of pulmonary atresia with intact ventricular septum repair,and the case was not classified into high mortality category.With the elevation of RACHS-1,the mortality increased.The mortality rate was 6.67％ (2/30 cases) in RACHS-1 as category 2,6.84％ (8/117 cases) in 3,13.75％ (11/80 cases) in 4,and 50.00％ (2/14 cases) in 6.Multivariable analvsis of risk factors for death showed that single ventricle palliative operation,body weight less than 3 000 g,and RACHS-1 were independent risk factors for mortality.Conclusions This study shows the surgical mortality in neonates with congenital heart defect is still high.Further prospective analysis of specific treatment strategies for high risk patients above was needed and the strategy for single ventricle operation in neonates should be optimized.
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Esophageal cancer related gene 4 (ECRG4) serves as a tumor suppressor gene through interacting with NF-κB and p53 pathways.Multiple studies have demonstrated that the down-regulated expression of ECRG4 occurs in a variety of cancer types,indicating a potential application of ECRG4 as a molecular diagnostic marker as well as a therapeutic target
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Objective The bidirectional cavopulmonary shunt (BCPS) is a major step in the staged palliation of functionally univentricular heart defects.Whether to preserve of additional pulmonary blood flow (APBF) has been a highly controversial issue.The purpose is to mathematical model and set out to determine the significa advantages and disadvantages of bidirectional cavopulmonary shunt with additional pulmonary blood flow:a theoretical analysis nce of APBF and the appropriate APBF ratio.Methods We used models of the univentricular circulation after the bidirectional cavopulmonary anastomosis with additional pulmonary blood and to computational analyze the impact of APBF on oxygen delivery,APBF flow on the CVP and SaO2.Results The influence of APBF depends on the ratio of superior vena cava flow to inferior vena cava flow ( QSVC/QIVC ).For QSVC/QIVC ＞ 0.3,APBF may be associated with decreased oxygen delivery.For QSVC/QIVC ＜ 0.3,appropriate APBF may be associated with increased oxygen delivery.A linear relationship exists between the increase of APBF and CVP,and the slope was depended on the value of pulmonary vascular resistance.Estimating APBF from CVP measurements may be a feasible method.A nonlinear relationship between the increase of APBF and oxygen saturation,and estimating APBF from SaO2 measurements may result in errors.BCPS and appropriate APBF may optimal the oxygen delivery with the increase of age and the decrease in QSVC/QIVC.For patients who accepted BCPS without APBF,there is a decreasing tendency of oxygen delivery with the increase of age and the decrease in QSVC/QIVC.For patients who suffered pulmonary arterivenous malformation,there is a more obvious decrease in oxygen delivery.ConclusionFor patients under age who has normal pulmonary vascularbed ( that is,QSVC/QVC ＞ 0.3),elimination of additional pulmonary blood flow can improve the oxygen delivery under a given cardiac output.For patients who with hypoplastic pulmonary vascular or in older patients under age,APBF is necessary to improve oxygen delivery.For patients who have to accept BCPS as the final procedure,preserving of APBF is suggested.
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Objective To investigate the effects of casticin on proliferation and invasion on human breast cancer MCF-7 cells.Methods MTT assay and invasion assay were performed in MCF-7 cells treated with casticin,respectively.The expression of Bax,Caspase-3,MMP-2 and MMP-9 was analyzed by RT-PCR and Western blot.Results Casticin inhibited MCF-7 cells proliferation and invasion in a dose-dependent manner (P ＜ 0.05).Additionally,Bax and Caspase-3 expression was increased in MCF-7 cells treated with casticin,whereas MMP-2 and MMP-9 were down-regulated.Conclusion Casticin may play a critical role in inhibiting breast tumor cell proliferation and invasion,reinforcing its potential in clinical application.