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@#Objective To quest the risk factors of poor prognoses in children with tetralogy of Fallot (TOF) during perioperative period and evaluate its clinical application values. Methods A retrospective analysis of the clinical data of 119 children who underwent one-stage correction of TOF in Guangdong Provincial People's Hospital from September 2016 to January 2019. The cohort includes 75 males and 44 females, with ages ranging from 3.2-137.1 (13.2±1.4) months and weights ranging from 4.6-21.0 (8.3±0.2) kg. Perioperative poor prognosis was defined as duration of mechanically assisted ventilation >48 h or secondary intubation, vasoactive-inotropic score (VIS) within 48 h >40, postoperative length of stay >14 d, and the occurrence of the major adverse events. Major adverse events were defined as early death, malignant arrhythmia, low cardiac output syndrome, non-fatal cardiac arrest, postoperative reintervention, diaphragm paralysis, and other clinical complications. Univariate and multivariate logistic analyses were used to analyze the correlation between risk factors and poor prognoses. Results There was 1 perioperative death, and 9 with major adverse events. Variables selected by Least Absolute Shrinkage and Selection Operator (LASSO) included 2 preoperative variables (McGoon index, aortic root diameter index) and 4 intra-operative variables [left-right direction of bicuspid pulmonary valve, total length of right ventricular outflow tract (RVOT) incision index, pulmonary valve with commissurotomy, and minimum temperature in cardiopulmonary bypass (CPB)]. Univariate and multivariate logistic analyses were used to the above factors, respectively. The variables with statistical significance (P≤0.05) were McGoon index, aortic root diameter index, left-right direction of bicuspid pulmonary valve, and minimum temperature in CPB. A nomogram was established based on the above factors, and the results showed that the left-right direction of bicuspid pulmonary valve was more risky than the tricuspid pulmonary valve and the anterior-posterior direction of bicuspid pulmonary valve. The lower the McGoon index, the higher aortic root diameter, and the lower temperature in CPB, the higher risk of poor prognostic events in children with TOF. Conclusion The left-right direction of the pulmonary bicuspid valve has a higher risk of poor prognosis than the tricuspid pulmonary valve and the anterior-posterior direction of bicuspid pulmonary valve. With the smaller McGoon index and the larger aortic root diameter, the risk of poor prognoses in children with TOF is higher. The temperature in CPB being lower than medium-low temperature obviously relates to the high incidence of poor prognostic events, which can be used as an auxiliary reference standard for decision-making in pediatric TOF surgery in the future.
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Objective To evaluate the accuracy of 3D models of patients with complex congenital heart disease(CHD) printed by domestic 3D priuters based on cardiac CT data.Methods From April 2018 to June 2018,our hospital used domestic 3D printers to print the hearts of 50 patients with complex CHD.The median age of the patients was 24 months(1 month to 61 years),and the diseases included pulmonary atresia,right ventricular double outlet and transposition of aorta.3 measurement sites(150 in total) were selected for each patient.Pearson correlation coefficient calculation,paired t test and Bland-Altman analysis were performed.Results Pearson correlation coefficient is 0.997.The difference of the measured value of CT-model was tested for normality.P was 0.2 of the D test.The Q-Q graph showed that the data point and the theoretical line were highly overlapped.The mean difference was (-0.07 ± 0.67) mm,P =0.196.In Bland-Altman analysis,the consistency boundary value interval of the difference was(-1.29 mm,1.16 mm) between which there were 143/150(95.33％) points.Conclusion 3D models of patients with complex CHD printed by domestic 3D printers based on cardiac CT data have good accuracy.
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Objective To investigate the potential relationship among brain vessels,hippocampus tissue and cell morphology in depressive rat model.Methods According to the weight-atching principle,thirty SD rats were randomly divided into control group (n =15) and depressive group (n =15).Compared with the control group,the depressive group was handled according to the demand of depressive rat model.After rats were scanned by 3.0 magnetic resonance on the 0th,2nd,4th,6th,8th week,respectively,hippocampus was picked out,taken photos and stained by HE.Microscopeat was used to observe hippocampus cell morphology and brain vessels,and hippocampus was described and analysed by Mimics software.Results Diameter and length of the middle cerebral arteries of the model group decreased with time increasing.Compared with the control group,these changes in the model group were significantly different on the 8th week (left:control group (0.31 ± 0.04),(5.53 ± 0.62) mm,depressive group (0.25±0.02),(4.64±0.61) mm,t =5.20,5.48 respectively,both P＜0.01;right:control group (0.30±0.03),(5.59 ±0.64) mm,depressive group (0.24 ±0.03),(4.72 ±0.67) mm,t =3.96,4.85 respectively,both P ＜ 0.01).The cells morphology of hippocampus was also changed with stimulation time increasing.The numbers of cell in DG area,CA1 area and CA3 area were decreased,with cell shrank,cells nuclear stained strongly and arranged loosely.Besides,the volume of hippocampus tissue in the depressive group also changed correspondingly with time.On the 8th week,it was significantly different (left:control group (40.62 ±2.32) mm3,depressive group (34.18 ±2.25) mm3,t =7.72,P＜0.01;right:control group (40.47 ±2.25) mm3,depressive group (35.63 ±2.48) mm3,t =5.60,P ＜0.01).Conclusion With stress time increasing,brain vessels,hippocampus tissue and cell morphology in depressive rats change obviously,indicating certain correlation among them.
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Compelling medical relation is one kind of administrative legal relationships. In the process of compelling treatment, when illegal or improper treatment by medical staff hurts patient's body, life or psychology, the country must be responsible for compensation to the patient. To effectively avoid the risk of infection due to compelling medical service, the special liability insurance of medical risk for the medical staff should be set up. Furthermore, the patient is supposed to hold the power of receiving legally free cure.