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Objective:To study the clinical characteristics of double aortic arch (DAA) combined with aortoesophageal fistula (AEF), and summarize the diagnosis and treatment experience.Methods:Retrospective analysis was performed on the diagnosis and treatment of a newborn with hemorrhagic shock caused by DAA combined with AEF in the Guangzhou Women and Children's Medical Center. The key searching words included "double aortic arch", "aortoesophageal fistula", "vascular ring", "newborn or neonate", and "infant, newborn". The relevant reports were retrieved from databases of CNKI, Wanfang, VIP, PubMed, Springer Link, Google Scholar, Web of Science, Embase, Cochrane Library and OVID, to summarize the clinical features, diagnosis and treatment experience of neonates with DAA and AEF. The retrieval deadline was December 31, 2020.Results:A full-term female newborn was hospitalized for dyspnea immediately after birth, and failed to evacuate from the ventilator for several times. The patient was fed with nasogastric tube and transferred to our hospital because of hemorrhagic shock occurring in 32 days after birth, and gastrointestinal bleeding occurred repeatedly with the maximum bleeding volume reaching 200 ml/time. DAA was diagnosed by cardiac ultrasound and CT, AEF hemorrhage was finally confirmed by gastroscopy, aortography and operation. DAA correction and esophagus repair were successfully performed, and the infant recovered well after the operation. At 9-month old, the infant grew and developed well. At present, no reports of DAA combined with AEF neonates have yet to be published in medical literatures in China. Seven English language literatures included 7 cases of AEF complicated with DAA in neonatal period, 5 cases survived and 2 cases died have so far been reported. All patients have a long history of gastric tube indwelling.Conclusions:The incidence of DAA combined with AEF is rare in the newborn with respiratory and swallowing difficulties as the first manifestation. The disease symptoms progressed rapidly, and life-threatening digestive tract hemorrhage may occur, which often requires surgical treatment. Prolonged gastric tube retention should be avoided in DAA children to prevent the occurrence of AEF.
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Objective:In May 2019, the 2018 version of Criteria and practical guidance for determination of brain death in children in China was published, which was revised by Brain Injury Evaluation Quality Control Center of National Health Commission, making the determination of brain death for pediatric patients in China more standardized and orderly.However, there is currently lacking of direction for the implementation of the above criteria for determining brain death to patients supported on extracorporeal membrane oxygenation(ECMO) in China.We successfully completed the determination of brain death and the organ transplantation(as a donor)for a pediatric case with severe brain injury and pneumorrhagia supported by VA-ECMO in our PICU, which provided clinical references for the revision of the guidelines for determination of brain death for pediatric patients in China. Methods:By referring to the international guidelines of Determination of Brain Death/ Death by Neurologic Criteria: The World Brain Death Project published in JAMA in August 2020, we performed a determination of brain death for a case of pediatric patient with severe brain injury and pneumorrhagia supported by VA-ECMO(blood flow 720 to 750 ml/min, gas flow 600 mL/min, oxygen concentration 65% to 70%)in our PICU. Results:The results of the determination of brain death included: Glasgow coma scale was 2T, all brainstem reflexes disappeared, three confirmation tests(electroencephalography, transcranial Doppler, short latency somatosensory evoked potential)all met the criterias for determination of brain death, apnea test(AT)showed PaCO 2>60 mmHg and elevated >20 mmHg than that before AT.We performed twice determination of brain death, interval time was >12 h. Finally, we successfully completed the determination of brain death and the organ transplantation(as a donor)for the case. Conclusion:The successful experience in the determination of brain death in the pediatric patient with severe brain injury and pneumorrhagia supported by VA-ECMO will provide clinical references for the revision of the guidelines for determination of brain death for pediatric patients in China.
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Objective To explore the change of glyoxalase I in type 2 diabetic ocular muscles palsy (DOMP) and its associations with advanced oxidation protein products (AOPP) and oxidative stress. Methods 58 DOMP patients, 50 T2DM and 30 normal controls were enrolled in this study. Levels of blood lipids, fasting blood glucose, hemoglobin A1c, insulin, serum glyoxalase I, AOPP, malondialdehyde (MDA), superoxide dismutase (SOD) and total antioxidant capacity (T-AOC) were measured. Homeostasis model assessment was performed to evaluate the status of insulin resistance (IR). Results Levels of high-density lipoprotein cholesterol, SOD and T-AOC were positively correlated with glyoxalase I and inversely associated to AOPP. Levels of triglycerides , low-density lipoprotein cholesterol , fasting blood glucose , hemoglobin A1c , IR and MDA were negatively correlated with glyoxalase I and positively related to AOPP. AOPP had an inverse association with glyoxalase I (r = -0.823, P < 0.001). Multivariate regression analysis showed that serum levels of glyoxalase I (Sβ = 0.554) and AOPP (Sβ= -0.469) were influencing factors of groups. Conclusion Serum glyoxalase I levels were significantly decreased in DOMP and correlated with AOPP and levels of oxidative stress , which suggest that glyoxalase I could play crucial roles on the development of DOMP.
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Objective To investigate the effects of advanced oxidation protein products (AOPP) in type 2 diabetic ocular muscles palsy (DOMP). Methods 58 DOMP patients and 50 type 2 diabetes patients were included in the research. Hemoglobin A1c (HbA1c), blood glucose (FPG), fasting insulin (FINS) and triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) were measured and recorded. Homeostasis model assessment was performed to evaluate the status of insulin resistance (HOMA-IR), basal insulin secretion (HOMA-β) and the insulin sensitivity index (ISI). Serum AOPP was measured by enzyme linked immunosorbent assay. Unconditional logistic regression model was used to evaluate the influencing factors of DOMP. Results The DOMP group showed higher levels of plasma AOPP, TG, LDL, FPG, FINS, HbA1c and HOMA-IR, but lower levels of HDL, HOMA-β and ISI than those of the T2DM group. Unconditional logistic regression analysis revealed that AOPP was an independent risk factors for DOMP (OR =3.01, P = 0.002). Conclusion AOPP may be involved in the pathogenesis of DOMP. AOPP could be a useful indicator for monitoring the development of DOMP and for evaluating its severity.
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Objective To evaluate the effect of high volume hemofiltration (HVHF) treatment on inflammatory cytokine clearance and hemodynamics in children with sepsis.Methods Thirty-four cases of septic children were randomly divided into two groups:the control group(17 cases) was administrated with the routine therapy,while the observation group(17 cases) was underwent with HVHF treatment on the basis of routine therapy.The inflammatory cytokines and hemodynamics were analyzed before and after the treatment.Results (1) Before treatment,the levels of tumor necrosis factor (TNF)-α in the control group and observation group were (103.6 ±26.1) ng/L and (106.6 ±31.6) ng/L,and the levels of interleukin(IL)-6 were (772.8 ± 92.4) ng/L and (761.3 ± 89.2) ng/L,respectively.The concentration of TNF-α and IL-6 were markedly reduced in both two groups after treatment (P ＜ 0.05),with TNF-α and IL-6 reducing to (85.6±23.7) ng/L,(63.6 ±26.4) ng/L and(109.7 ±38.5) ng/L,(78.1 ±24.7) ng/L,respectively.Most importantly,the reduction in the observation group were significantly higher than that in the control group(P ＜ 0.05).(2) Before treatment,no significant differences between the observation group and the control group were observed in hemodynamics,including mean arterial pressure,saturation oxygen,and heart rate(P ＞ 0.05),whereas after the treatment,mean arterial pressure and saturation oxygen in the observation group were significantly elevated compared with those of the control group [(100.4 ± 12.1) mmHg vs.(82.2±11.7) mmHg(l mmHg=0.133kPa),(94.2±5.3)％ vs.(91.4±3.2)％,P＜0.05],andheart rate in the observation group[(85.1 ± 17.3) times/min] was significantly lower than that of the control group [(98.7 ± 18.5) times/min] (P ＜ 0.05).Conclusion HVHF treatment on septic children efficiently promotes the clearance of inflammatory cytokines and improves hemodynamic property,and thereby leads to protection of organ function and the better prognosis for septic children.
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Objective To observe the clinical effects of insulin glargine combined with novonorm in treatment of patients with newly diagnosed type 2 diabetes. Methods 112 cases of newly diagnosed type 2 diabetes patients were randomly separated into observation group(56 cases)and control group(56 cases). Observation group was treated with insulin glargine combined with novonorm. Control group was treated with novolin30R. The levels of FPG,2hPG and HbA1c before and after treatment,the control time of blood sugar,amounts of insulin and incidence of low blood sugar were observed in both groups. Results Compared with pre-treatment, FPG,2hPG and HbA1 c were significantly decreased (all P ＜0.05) after treatment, but there were no significant differences in both two groups (P ＞0. 05). The control time of blood sugar, amounts of insulin and incidence of low blood sugar in observation group were significantly lower than those in control group (all P ＜ 0.05). Conclusion Insulin glargine combined with novonorm in treatment of patients with newly diagnosed type 2 diabetes could effectively control blood sugar,shorten the control time of blood sugar,decrease amounts of insulin,and low incidence of low blood sugar.