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Objective This retrospective,single-center study evaluated short-and mid-term results of minimally invasive surgery to occlude ventricular septal defects(VSDs) through right subaxillary approach.Methods The procedure was performed on 624 children,224 boys and 205 girls;aged(2.4 ± 2.2) years;mean weight(12.3 ± 10.2)kg between January 2014 to December 2017 at the Children' s Heart Center of Henan Province People' s Hospital.An approximately 2 cm right subaxillary incision was made between the third and fifth ribs.The right atrium or ventricle was punctured under the guidance of transencephalographic echocardiography(TEE).The VSD was occluded under TEE guidance.Results The mean size of VSDs was(4.2 ±0.9)mm,and the occluder measured(5.2 ± 1.2)mm.Asymmetrical occluders were used in 28 patieuts and symmetrical occluders in 596 patients.The operative time was(58.5 ± 20.2) minutes,and the time in the intensive care unit (ICU) was(19.4 ±6.7) h.Blood loss was(10.4 ±9.5) ml.There were no deaths among these patients.Occluder displacement occurred in two cases.The complications such as Ⅲ degree atrioventricular block,new aortic regurgitation,reoperation foi massive bleeding,and serious infection were not observed.All patients were followed up for 6-48 months.There were 15 cases of residual shunt after operation.Eight cases were self-closed during follow-up,and 5 cases were still followed up.No complications such as reoperation,aortic regurgitation,atrioventricular block or occluder abscission was observed during the follow-up period.Conclusion Occluding VSDs using the right subaxillary approach is safe and effective.Short-term and midterm results are satisfactory.Further follow-up is required regarding long-term results.
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<p><b>OBJECTIVE</b>To assess the association of coagulation factor V gene polymorphisms with unexplained recurrent spontaneous abortion (URSA) among ethnic Han Chinese from Wenzhou area.</p><p><b>METHODS</b>Ninety-six patients with URSA and 103 females with a history of normal pregnancy were recruited. Genotypes of coagulation factor V gene were determined through target sequence capture and high-throughput sequencing. The results were confirmed with a MassARRAY system. Allelic and genotypic frequencies between the two groups were compared.</p><p><b>RESULTS</b>Nineteen single nucleotide polymorphism (SNPs), except coagulation factor V Leiden, were identified in the two groups. The frequencies of rs9287090 allele A, rs1046712 allele T and rs1800594 allele G of the URSA group were lower than those of the control group (6.77% vs. 16.50%, 3.12% vs. 13.11%, 10.94% vs. 18.45%, respectively). After Bonferroni and false discovery rate correction, rs9287090 and rs1046712 were significantly associated with URSA (corrected P<0.05). Although genotypic distribution of rs9287090 and rs1046712 also differed between the two groups, the corrected P value showed no significance (corrected P>0.05). A complete linkage disequilibrium (r=1, D'=1) of rs6022 and rs6029 was observed for the haplotype block rs6022-rs6029-rs6028. The frequencies of rs6022 allele A and rs6029 allele T were higher in the URSA group with corrected insignificance (75.00% vs. 65.53%, corrected P>0.05). Furthermore, significantly more A-T-T haplotype was found in the URSA group (75.00% vs. 65.50%, OR=1.578, 95%CI:1.021-2.438, χ=4.248, P<0.05).</p><p><b>CONCLUSION</b>The decreased rate of rs9287090 allele A, rs1046712 allele T, and rs1800594 allele G may contribute to the susceptibility to URSA among ethnic Han Chinese from Wenzhou area. The rs6022 allele A and rs6029 allele T may also predispose to URSA.</p>
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Objective To explore the association between the C46T polymorphism of coagulation factor Ⅻ (FⅫ) gene and the involvement of FⅫ activity (FⅫ:C) in patients with unexplained recurrent spontaneous abortion (URSA), and to elucidate its role in the pathogenesis of URSA. Methods This study included 203 patients with URSA (URSA group) and 171 healthy women with at least one child and no history of infertility or miscarriage (control group) in the southern area of Zhejiang Province. The C 46T polymorphism of the FⅫ gene was analyzed with matrix-assisted laser desorption/ionization time of flight-mass spectrometry (MALDI-TOF-MS) in all subjects. The values of prothrombin time, activated partial thromboplastin time (APTT), fibrinogen, FⅫ:C and other coagulant parameters were determined. The frequency distribution of the wild-type (CC), heterozygote (CT), homozygote (TT) genotypes and C and T alleles were compared between the patients and controls. A comprehensive analysis of association was conducted between C46T genotypes and the FⅫ:C levels in URSA patients. Results The CC, CT, TT genotypes of the FⅫgene were observed in 7 (3.4%, 7/203), 83 (40.9%, 83/203) and 113 (55.7%, 113/203) patients with URSA versus 7 (4.1%, 7/171), 46 (26.9%, 46/171) and 118 (69.0%, 118/171) controls. The frequency of CT in the patients with URSA was significantly higher than that in controls, but the frequency of TT in the patients was lower than that in controls (χ2=7.939, OR=1.884, 95%CI:1.210-2.935, P<0.05). The frequencies of allele C and allele T were observed in 97 (23.9%, 97/406) and 309 (76.1%, 309/406) patients with URSA versus 60 (17.5%, 60/342) and 282 (82.5%, 282/342) controls. The distribution frequency of allele T in URSA group was lower than that in control group (χ2=4.510, OR=1.475, 95%CI:1.029-2.115, P<0.05). The FⅫ:C levels in the patients were (102±13)%in CC genotype, (78±11)%in CT genotype and (59± 9)%in TT genotype, respectively. The differences of the FⅫ:C levels between the CC and CT, CT and TT, CC and TT genotypes in the patients were significant (all P<0.05). Conclusions The low level of FⅫ:C maybe result from the T allele of the FⅫgene in URSA patients. The CT genotype might be relative to the pathogenesis of URSA in a Chinese Han female population from the southern area of Zhejiang province.
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Objective To investigate the influence of maternal and child care bedside on early development of newborns and maternal depression and anxiety,lactation.Methods From January 2013 to June 2015,120 cases of healthy full -term newborns and maternal admitted in our hospital were randomly divided into control group and observation group,60 cases in each group.The two groups of newborns and mothers were given routine care,including care and neonatal umbilical buttocks care,maternity care,including genital or abdominal incision dressing,newborns were routinely vaccinated.In the control group,the newborns were taken to a public bath chamber concentrated bath. The observation group was implemented maternal and child care bedside manner Based on this,at the bedside of the newborn bathing and massage,swimming daily with newborns.Anxiety score (SAS)and depression scale score (SDS)for depression and anxiety were evaluated before and after the two groups of mothers nursing,and maternal milk yield variation were observed at different time,measured neonatal neurological assessment score (NBNA)and height,body mass index,head circumference growth.Results After treatment,the SAS and SDS scores of mothers of the two groups were decreased compared with before treatment,which in the observation group decreased more significantly, the differences were statistically significant (t =3.46,4.21,all P <0.05).After care,the maternal milk productions of the two groups started to grow,which of the observation group were always increased better than the control group, the differences were statistically significant (χ2 =9.34,4.53,6.79,all P <0.05).The newborn NBNA scores,head circumference,height,improvement in the quality index of growth in the observer group were better than the control group,the differences were statistically significant (t =1.98,1.65,2.73,3.63,all P <0.05).Conclusion Maternal and child bedside care can significantly improve maternal depression and anxiety scores,increase maternal lactation, and has a certain role in promoting early neonatal development,it is worth clinical application.
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<p><b>OBJECTIVE</b>To assess the association of human leukocyte antigen DQ gene polymorphisms with unexplained recurrent spontaneous abortion (URSA) among ethnic Han Chinese from Wenzhou region.</p><p><b>METHODS</b>Fifty couples with URSA (URSA group) and 66 couples with normal pregnancy history (control group) were recruited. The alleles of HLA-DQA1 and HLA-DQB1 were analyzed by polymerase chain reaction with specific sequence primers (PCR-SSP) in all subjects. The frequency distribution of HLA-DQ alleles, odds ratios (OR) between each group and sharing of HLA-DQ alleles were calculated.</p><p><b>RESULTS</b>The frequency distribution of HLA-DQB1*03:03 allele in the females with URSA was significantly higher than that healthy females (21.00% vs. 9.85%, OR=2.433, 95%CI: 1.232-4.894, χ(2)=5.657, P<0.05). The HLA-DQB1*05:03 allele was present among the healthy females with a frequency of 3.03%, and was not detected among females with URSA. For both males and females, the HLA-DQB1*05:02 allele were only typed in control group with frequencies of 6.06% and 5.30%, respectively. The sharing of HLA-DQA1 alleles in couples with URSA was increased compared with the control group (70.27% vs. 44.64%, OR=2.931, 95%CI: 1.216-7.067, P<0.05).</p><p><b>CONCLUSION</b>The increased sharing of HLA-DQA1 alleles may contribute to the susceptibility of URSA among ethnic Han Chinese from Wenzhou region. The allele of HLA-DQB1*03:03 in the females may be predisposing factor for URSA. However, the HLA-DQB1*05:02 allele in both gender and HLA-DQB1*05:03 allele in females may confer a protective effect.</p>