Analysis of risk factors of death after cardiopulmonary bypass in children with congenital heart disease less than 5 kg / 中国综合临床

Objective:To investigate the risk factors for surgical death in children with congenital heart disease (CHD) less than 5 kg undergoing cardiopulmonary bypass.Methods:The clinical data of 225 children with CHD who underwent open cardiopulmonary bypass in the First Affiliated Hospital of Air Force Military Medical University from February 2017 to February 2020 were collected for a retrospective case-control study. The independent sample T test was used for inter-group comparison of measurement data, Chi square test or chi squre correction test was used for the comparision between count data. Mann-Whitney rank-sum test was used for rank distribution data and multiple Logistic regression analysis was performed for factors affecting surgical death of children with CHD.Results:Among the 225 cases, 204 (90.67%, 204/225) survived surgery and 21 (9.33%, 21/225) died. Univariate analysis showed that age (2.48±0.68) months and body weight (2.28±0.56) kg in the death group were significantly lower than that in the survival group (4.92±0.65) months ( t=16.33, P<0.001) and body weight (4.26±0.52) kg ( t=16.38, P<0.001), while the proportion of female (66.67% (14/21)), malnutrition (none: 14.28% (3/21); Mild: 42.86% (9/21). Severity: 42.86%(9/21)), palliative surgery proportion (28.57%(6/21)), emergency surgery proportion (71.43%(15/21)), congenital heart surgery risk assessment (RACHS-1) grading ratio (<grade 3: 23.81%(5/21), ≥grade 3: 76.19% (16/21)), CPB time (135.24±11.19) min, aorta blocking time (78.24±8.20) min, operation time (178.43±13.82) min, heart malformation complex ratio (complex: 47.62% (10/21), simple: 52.38% (11/21)), ICU treatment days (4.76±0.77) d, postoperative mechanical ventilation time (121.33±12.66) h were significantly higher than the female survival group (41.67% (85/204), χ2=4.83, P=0.028), malnutrition rate (none: 38.24%(78/204); Mild: 42.15% (86/204)); Severe: 19.61% (40/204) ( z=2.72, P=0.007), palliative surgery proportion 8.82% (18/204), proportion of radicalsurgery91.18% (186/204) ( χ2=5.86, P=0.016), RACHS-1 grading ratio (<grade 3:77.45% (158/204); ≥grade 3: 22.55% (46/204), χ2=27.44, P<0.001), CPB time (106.87±11.12) min ( t=11.12, P<0.001), aorta occlusion time (58.68±9.26) min ( t=9.32, P<0.001), operation time (167.24±13.75) min ( t=3.55, P<0.001), heart malformation complex ratio (complex: 78.92%(161/204), simple: 21.08%(43/204) ( χ2=10.23, P<0.001)), ICU treatment time (3.67±0.87) d ( t=5.52, P<0.001), postoperative mechanical ventilation time (109.74±13.75) h ( t=3.70, P<0.001). Logistic regression analysis showed that operation time ( OR=1.064, 95% CI: 1.019-1.110, P=0.004), postoperative mechanical ventilation time ( OR=1.083, 95% CI: 1.031~1.138, P=0.002), ICU treatment time ( OR=5.317, 95% CI: 2.410-11.730, P<0.001) and malnutrition ( OR=2.974, 95% CI: 1.291-6.850, P=0.010) were independent risk factors for surgical death after cardiopulmonary bypass in children with CHD less than 5 kg. Conclusions:The mortality rate of CHD patients with low body weight less than 5 kg was relatively high. The increase of operation time, ICU treatment time, degree of malnutrition and postoperative mechanical ventilation time will increase the probability of death. Targeted measures should be taken to reduce the surgical mortality of children.

Screening of mitochondrial DNA damage repair genes in rats with septic acute kidney injury / 浙江大学学报·医学版

OBJECTIVE@#: To screen genes involved in mitochondrial DNA (mtDNA) damage repair in rats with septic acute kidney injury (SAKI).@*METHODS@#: Forty male C57BL/6J mice were randomly divided into SAKI group (=28) and sham operation group (=12). The SAKI mouse model was established by cecal ligation and puncture. Blood and kidney samples were collected at 8, 24, and 48 h after surgery. Serum creatinine and urea nitrogen were measured by a dry biochemical analyzer. Serum inflammatory cytokines were detected by ELISA. Histopathological changes were observed with HE staining. The mtDNA damage repair related genes were screened by RNA sequencing and bioinformatics analysis; the mRNA and protein expression levels of related genes were detected by real-time quantitative RT-PCR and immunohistochemisry, respectively.@*RESULTS@#: Symptoms of sepsis were observed in SAKI group, and 16 out of 28 mice were died in the SAKI group; serum TNF-α, IL-6, creatinine and urea nitrogen levels were higher than those in the sham group (<0.05 or <0.01). Histopathological examination in SAKI group showed that renal tubular epithelial cells were swollen, inflammatory cells infiltrated, and a large number of cell vacuoles were seen, suggesting successful modeling. Mitochondrial DNA damage repair related genes and were screened out. The expression of these genes was detected by real-time RT-PCR, and the results were consistent with RNA sequencing trends. Immunohistochemical staining showed that Gadd45α was mainly expressed in the nucleus of renal tubular epithelial cells, and the positive rate of Gadd45α in SAKI group was higher than that in the sham operation group (<0.05).@*CONCLUSIONS@#: and genes are involved in mtDNA damage repair in rats with SAKI, indicating that these genes may be used as new targets for prevention and treatment of SAKI.

The clinical analysis of 34 intermediate and advanced cardiac cancer with concurrent radiochemotherapy treatment / 中国基层医药

Objective To observe the clinical efficacy of concurrent radiochemotherapy in the treatment of intermediate and advanced cardiac cancer.Methods Involved 34 intermediate and advanced cardiac patients,using concurrent radiochemotherapy treatment,the radio treatment with 3D -CRT method,2Gy/time,Qd,5 times per week, total 60Gy/6 week,at the same time,combined with gemcitabine treatment,1 000mg/m2 ,intravenous infusion of 30min.First day and eighth day of medication,forbidding 1 week and used 2 cycles.Results 34 patients all took part in the follow up,the total effective rate was 88.2%,the 1 -,2 -,3 -year survival rate was 70.1%(24 /34),47.0%(16 /34)and 26.5%(9 /34).Adverse reactions were mainly gastrointestinal reaction,bone marrow suppression,etc. Conclusion The concurrent radiochemotherapy treatment can really control the progressive disease,and receive an ideal survival rate,the adverse reactions can limit in tolerance scope.