Treatment and prognosis of 826 infants with critical congenital heart disease: a single center retrospective study / 中华心血管病杂志

Objective: To analyze the current status of clinical treatment and factors influencing postoperative mortality in infants with critical congenital heart disease (CCHD) in China, optimize the perioperative management of CCHD, and provide a new scientific basis for clinical decision-making for the optimal management of these patients. Methods: This is a retrospective single-center study. Infants diagnosed with CCHD in Guangdong Provincial People's Hospital from January 2017 to December 2019 (aged 0-1 years at admission) were enrolled. General clinical information, inpatient treatment information, prognosis and complications were collected and analyzed. Multivariate logistic regression analysis was used to explore the independent risk factors of postoperative death in infants with CCHD. Results: A total of 826 infants with CCHD were included, including 556 males (67.3%) and the age at first admission was 51.0 (5.0,178.3) days. 264 (32.0%) cases were tetralogy of Fallot and 137 (16.6%) cases were total anomalous pulmonary venous return. 195 cases (23.6%) were diagnosed prenatally. 196 cases (23.7%) were treated with prostaglandin. The preoperative invasive ventilation time was 0 (0, 0) hour, and the postoperative invasive ventilation time was 95.0 (26.0, 151.8) hours. A total of 668 cases (80.9%) underwent surgical treatment. The age was 100.5 (20.0, 218.0) days during operation and the operation time was 190.0 (155.0, 240.0) hours. Sixty-two cases (7.5%) received medical treatment, and 96 cases (11.6%) gave up treatment. A total of 675 cases (81.7%) were discharged with improvement, 96 cases (11.6%) were discharged after giving up treatment, 55 cases (6.7%) died and 109 cases (13.2%) were readmitted within one year. Complications occurred in 565 (68.6%) cases, including pneumonia in 334 cases (40.4%) and cardiac arrhythmias in 182 cases (22.0%). Multifactorial analysis showed that delayed chest closure (OR=49.775, 95%CI 3.291-752.922, P=0.005), prolonged post-operative invasive ventilator ventilation (OR=1.003, 95%CI 1.000-1.005, P=0.038) and cardiac hypoplasia syndrome (OR=272.658, 95%CI 37.861-1 963.589, P<0.001) were the independent risk factors for mortality in CCHD infants post-operation. Conclusions: Tetralogy of Fallot and total anomalous pulmonary venous return account for the majority of infants with CCHD. The proportion of infants diagnosed prenatally was less than 1/4. The majority CCHD infants received surgical treatment. The main complications are pneumonia and arrhythmia. Delayed chest closure, prolonged postoperative invasive ventilator ventilation and low cardiac output syndrome are the independent risk factors for postoperative death in infants with CCHD.

Ascorbic acid influences on extracellular matrix and structure of rabbit bone marrow mesenchymal stem cells / 中国组织工程研究

BACKGROUND: The effect of extracellular matrix on stem cells is the focus of tissue engineering. However, there are few reports about the synthesis and secretion of extracellular matrix as well as its effects on cells. OBJECTIVE: To isolate, culture and identify rabbit bone marrow mesenchymal stem cells (BMSCs), and to explore the changes of extracellular matrix and whole structure under the intervention of ascorbic acid. METHODS: Rabbit BMSCs were isolated by differential adherent method of the bone marrow, and the expression of CD44, CD45 and CD31 was identified by flow cytometry. The BMSCs were cultured in the culture medium containing 20 mg/L ascorbic acid. Then the cell morphology, gross structure, ultrastructure, and histological changes of BMSCs were observed. The expression of extracellular matrix related genes was detected by RT-PCR. RESULTS AND CONCLUSION: Over 95% passage 2 BMSCs could express CD44, but the expression levels of CD45 and CD31 were extremely low. Intervention with ascorbic acid enhanced the proliferation of BMMSCs with unclear cell boundaries. A cell-sheet structure formed at 10-14 days after intervention. Hematoxylin-eosin staining results showed a layered cell arrangement, and Masson staining findings showed a large amount of extracellular matrix composition. Abundant endoplasmic reticula and vesicle-like structure were observed under the transmission electron microscope. RT-PCR findings showed that ascorbic acid significantly increased the expression of fibronectin mRNA in the BMSCs (P < 0.05), but slightly increased the mRNA expression of collagen type I. All these findings indicate that ascorbic acid not only increases the proliferation and transformation of rabbit BMSCs, but also promotes the synthesis and secretion of extracellular matrix, which has great potential in tissue engineering applications.

Research advances in circular RNAs / 中国组织工程研究

BACKGROUND:Unlike linear RNAs,circular RNAs (circRNAs) are a novel type of RNA which can form covalently closed circles and are highly expressed in eukaryotic transcriptomes.In the plenitude of naturally occurring RNAs,circRNAs and their biological role are underestimated for years.Recent studies have discovered thousands of endogenous circRNAs in mammalian cells.OBJECTIVE:To review the formation,properties,and functions of circRNAs,and their potential significance in diseases.METHODS:A computer-based search for literature in CNKI and PubMed databases published from January 2000 to December 2016 was performed using the keywords of "circRNA,miRNA,function,mechanism" in English and Chinese,respectively.Finally,62 eligible articles were included for analysis.RESULTS AND CONCLUSION:CircRNAs are largely generated from exonic or intronic sequences,and reverse complementary sequences or RNA-binding proteins are necessary for circRNA biogenesis.A majority of circRNAs that are conserved across specie are stable and resistant to RNaseR,and often exhibit tissue/developmental-stage-specific expression.Recent research has revealed that circRNAs can function as microRNA sponges,regulators of splicing and transcription,and modifiers of parental gene expression.Emerging evidence indicates that circRNAs might play important roles in atherosclerotic vascular diseases,neurological disorders,prion diseases and cancer;exhibit aberrant expression in colorectal cancer;and serve as diagnostic or predictive biomarkers of some diseases.Similar to microRNAs and long noncoding RNAs,circRNAs are arousing general interest in the field of RNA and widely participate in the life process.

Clinical study of neonatal cardiac output measurement methods / 中华儿科杂志

<p><b>OBJECTIVE</b>To assess agreement between the ultrasonic cardiac output monitor (USCOM) and conventional echocardiography (ECHO) in the measurement of cardiac output in newborn infants, investigate the accuracy and clinical utility of the USCOM in healthy neonates. To explore a more convenient, faster, more accurate hemodynamic monitoring method, for improving the outcome of the critically ill neonates.</p><p><b>METHOD</b>From October 1(st), 2011 to March 31(st), 2012, a total of 49 infants were included, 20 were term infants, 29 were preterm infants. Cardiac outputs were measured by both ultrasonic cardiac output monitor and echocardiography in all the infants, 60 times measurements were done in both the term infants the preterm infants. The cardiac output of the left and right ventricles, heart rate, diameter and velocity time integral of the aortic valve and pulmonary artery valve of each infant were recorded. The consistency of two methods was analyzed as described by Bland-Altman.</p><p><b>RESULT</b>Term the term infant group includea 20 term infants, 11 were male and 9 were female, the mean gestational age were (38.1 ± 0.56) weeks, mean age were (2 ± 1) days, mean weight were (3.2 ± 0.29) kg, mean Apgar score were 10. The mean left ventricular output measured by Echo was (242.3 ± 38.9) ml/(kg·min), measured by USCOM was (211.7 ± 38.5) ml/(kg·min); The mean right ventricular output measured by ECHO was (318.9 ± 47.0) ml/(kg·min), measured by USCOM was (340.7 ± 76) ml/(kg·min). Agreement between Echo and USCOM for left ventricular output (LVO) was (bias, ± limits of agreement, mean % error): (30.6 ± 51.1) ml/(kg·min), 21%, and for right ventricular output (RVO): (-21.8 ± 105) ml/(kg·min), 33.2%. The diameter of the aortic valve and pulmonary artery valve measured by conventional echocardiography were significantly larger than that estimated by ultrasonic cardiac output monitor (P < 0.001). The velocity time integral of the pulmonary artery valve measured by ultrasonic cardiac output monitor were significantly larger than measured by conventional echocardiography (P < 0.001). The heart rate, velocity time integral of the aortic valve measured by two methods had no significant differences (P > 0.05). The preterm neonates group included 29 preterm infants, 18 were male and 11 were female, the mean gestational age were (32.6 ± 2.8) weeks, mean age were (2 ± 1) days, mean weight were (1.88 ± 0.57) kg. All the infants were diagnosis as preterm infant, low birth weight. The mean left ventricular output measured by ECHO was (259.8 ± 70) ml/(kg·min), measured by USCOM was (235.6 ± 61.8) ml/(kg·min), the mean right ventricular output measured by ECHO was (318.9 ± 47.0) ml/(kg·min), measured by USCOM was (340.7 ± 76) ml/(kg·min). Agreement between Echo and USCOM for left ventricular output (LVO) was (bias, ± limits of agreement, mean % error): (24.1 ± 71.2) ml/(kg·min), 27.4%, and for right ventricular output (RVO): (-29.5 ± 192.9) ml/(kg·min), 51.8%. The diameter of the aortic valve and pulmonary artery valve measured by conventional echocardiography were significantly larger than estimated by ultrasonic cardiac output monitor (P < 0.001). The velocity time integral of the pulmonary artery valve measured by USCOM were significantly larger than that measured by conventional echocardiography (P < 0.001). The heart rate, velocity time integral of the aortic valve measured by two methods had no significant differences (P > 0.05).</p><p><b>CONCLUSION</b>Agreement between USCOM and conventional ECHO in the LVO measurement is acceptable, both in the term group and the preterm group. LVO measurement measured by USCOM is recommended. The accuracy and clinical utility of the USCOM in neonates is acceptable. USCOM is a convenient, fast and accurate hemodynamic monitoring method in neonates. While the agreement between USCOM and conventional ECHO in the RVO measurement is poor, especially in the preterm group, the results of the RVO cannot be considered interchangeable in the two methods.</p>

Analysis of the difference of risk factors between each stage of necrotizing enterocolitis / 中华实用儿科临床杂志

Objective To discuss the differences of the risk factors between Bell Stage Ⅰ and Stage Ⅱ/Ⅲ of neonatal necrotizing enterocolitis (NEC),in order to provide theoretical basis for better preventing and treating NEC of each stages.Methods Eighty seven NEC neonates'references from 2009 to 2011 were all analyzed retrospectively to find out relative risk factors.They were divided into 2 groups according to Bell stage:stage Ⅰ and stage Ⅱ/Ⅲ.Twenty four items were compared between the 2 groups,including perinatal factors,feeding methods,complications,RBC perfusion,etc,using SPSS 17.0 software to make single factor analysis,for the sake of finding out relative risk factors.Results The comparison of gestational age,birth weight,onset age,and onset weight between 2 groups has no statistical significance (P ＞ 0.05).The mortality of stage Ⅱ / Ⅲ was higher than stage Ⅰ (P ＜ 0.05).Seven of 24 items have statistical difference in the comparison (P ＜ 0.05),including:Gestational diabetes mellitus,amniotic fluid disorders,respiratory failure,hypothyroid,anemia,sepsis,RBC perfusion,indicating that these items may correlate to incidence and severity of NEC.Conclusions Gestational diabetes mellitus,amniotic fluid disorders,respiratory failure,hypothyroid,anemia,sepsis,RBC perfusion are risk factors that influence the severity of NEC.

Retrospectively study of 507 critically ill children in long distance interhospital transport / 中华实用儿科临床杂志

Objective To improve the quality of transportation of critically ill children in long distance interhospital transport.Methods The clinical data,diagnosis and outcomes of 507 critically ill children transported from other hospitals in long distances to PICU of Guangdong General Hospital,between Aug.2008 and Jul.2011,were analyzed retrospectively.Results Among 507 critically ill children,336 cases were male and 171 cases were female,aged from 29 days to 15 years(median age was 11 months) and weighted from 2.5 to 80.0 kg(median weight was 8.0 kg).The transport durations ranged from 90 to 990 min (median duration was 264 min),among which 121 cases(23.9％)took 121 to 240 min,288 cases (56.8％) took 241 to 480 min,72 cases(14.2％) took more than 480 min.The transfer distance ranged from 74 to 620 km (median distance was 266 km),249 cases(49.1％) of which were transferred from hospitals ranging from 101 to 200 km,133 cases(26.2％) less than 100 km.The top 3 diseases were cardiovascular diseases(169 patients,33.3％),respiratory diseases (128 patients,25.2％) and neural diseases (85 patients,16.8％).None of the patients died on the way and all of them received further treatment.In the end,486 cases discharged,13 cases gave up and 8 cases died.Conclusions During the long distance interhospital transport,a specialist retrieval team with adequate equipments and preparation,close monitoring on the way,can effectively improve the quality of long distance interhospital transportation.

Incidence and short-term outcome of physiologic bronchopulmonary dysplasia in very preterm infants / 中华实用儿科临床杂志

Objective To investigate the incidence and short-term outcome of very preterm infants with physiologic bronchopulmonary dysplasia (BPD).Methods Data of very preterm infants with gestational age of no more than 32 weeks admitted into Guangdong General Hospital between Mar.2011 and Feb.2012 were prospectively collected.Oxygen withdrawing test was performed in these infants at postmenstrual age of 36 weeks.Infants who failed to pass the test or who were ventilated were diagnosed as physiologic BPD.Results Sixty-six infants were admitted,of whom 6 were excluded for more than 36 weeks of postmenstrual age at admission.Eighteen infants(30.0％) were diagnosed as classic BPD.Among them,at testing time point,4 cases did not need supplemental oxygen,13 cases needed oxygen sup-plementation and 1 case needed mechanical ventilation.Thirteen infants underwent oxygen withdrawing test and 6 cases passed.Eight cases (13.3％) were diagnosed as physiologic BPD.The incidences of apnea or bradycardia were of no differences between infants passing or failing to pass oxygen withdrawing test.All infants survived to discharge without supplemental oxygen.Conclusions The incidence of infants with physiologic BPD is significantly lower than that with classic BPD.Restrictive saturation of percutaneous oxygen can decrease the incidence of infants with supplemental oxygen,with no more adverse events.More research are needed on physiologic BPD.

Effects of different arterial oxygen partial pressures on serum protein S100β and neuron specific enolase during cardiopulmonary bypass in infants with cyanotic congenital heart disease / 中华儿科杂志

<p><b>OBJECTIVE</b>A prospective study was conducted to probe into the relationship between arterial oxygen partial pressure (PaO2) and brain injury during cardiopulmonary bypass (CPB) in infants with cyanotic congenital heart disease (CHD).</p><p><b>METHOD</b>Enrolled in the study were 45 cyanotic infants, who were less than three years old and underwent corrective cardiac surgery from August 1(st), 2010 to January 31(st), 2011 at Guangdong General Hospital. All the infants had a pulse oxygen saturation (SpO2) lower than 85% and were randomly allocated into three groups by a specific computer program. In controlled group 1 (G1 group), PaO2 levels were controlled at 80 - 120 mm Hg (1 mm Hg = 0.133 kPa) during CPB; in controlled group 2 (G2 group), PaO2 levels at 120 - 200 mm Hg during CPB; while in uncontrolled group (G3 group), PaO2 levels were at 200 - 400 mm Hg during CPB. Blood samples were collected just before starting CPB, at the end of CPB, and at 3 h, 5 h, and 24 h after CPB (T1, T2, T3, T4, T5) for the determination of serum concentrations of protein S100β, neuron specific enolase (NSE), and adrenomedullin (ADM) by ELISA.</p><p><b>RESULT</b>Protein S100β rose significantly after starting CPB. In group G3, it reached a peak of (699 ± 139) ng/L by the end of CPB, significantly higher than those in groups G1 and G2 [(528 ± 163) ng/L and (585 ± 155) ng/L], and was positively correlated with PaO2 levels (r = 0.526, P < 0.01). NSE levels of group G1 were continuously rising after starting CPB and reached significantly high levels at 3 h or 5 h after CPB [(12.2 ± 3.4) µg/L and (12.3 ± 3.7) µg/L], while those of group G2 rose significantly during CPB [(10.9 ± 4.8) µg/L] and even higher at 3 h or 5 h after CPB [(12.6 ± 5.1) µg/L and (13.2 ± 5.4) µg/L]. NSE levels of group G3 rose significantly during CPB and maintained at a high level [(12.2 ± 5.7) µg/L] afterwards. There was no significant difference in serum ADM concentrations among different time points in each group and among these three groups. All the infants were discharged from the hospital without any obvious nervous symptom and sign.</p><p><b>CONCLUSION</b>High PaO2 during CPB in infants with CHD might cause an increase of serum protein S100β and NSE, indicating that brain injury might become worse with a higher PaO2 and might be positively correlated with PaO2 during CPB.</p>

Accuracy of the ultrasonic cardiac output monitor in healthy term neonates during postnatal circulatory adaptation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Echocardiography is regarded as a gold standard for measuring hemodynamic values. The ultrasonic cardiac output monitor (USCOM) is a new method for measuring hemodynamics and could provide non-invasive point of care guidance. So far, there are no published USCOM reference values for neonates, nor has USCOM's accuracy been established in this population. We aimed to determine the accuracy and clinical utility of the USCOM in healthy neonates relative to published echocardiographic data, to establish normal hemodynamic parameters that it measures, and to assess the possible role of USCOM as an alternative to echocardiography as a trend monitor.</p><p><b>METHODS</b>Right and left heart hemodynamics of 90 normal neonates were measured during circulatory adaptation over the first three days of life using the USCOM and automated oscillotonometry.</p><p><b>RESULTS</b>Heart rate showed a significant decline from days one to three, from 126 to 120 (P < 0.001). Systolic, diastolic and mean arterial pressures all increased significantly from 66 to 71 mmHg, 33 to 38 mmHg and 44 to 49 mmHg, respectively (P < 0.001 in each case). Right ventricular cardiac index (RV-CI) showed no change with a mean of 5.07 L × min(-1) × m(-2). Left ventricular cardiac index (LV-CI) declined from 3.43 to 3.00 L × min(-1) × m(-2) (P < 0.001). RV-CI exceeded LV-CI on all three days by a mean of 61%. The systemic vascular resistance index (SVRI), based on LV-CI, increased significantly over the three days from 1083 to 1403 dyne × sec × cm(-5) × m(2) (P < 0.001).</p><p><b>CONCLUSIONS</b>Normal neonatal hemodynamic values, as indicated by USCOM, were established. LV-CI measurement showed excellent agreement with published echocardiographic studies. RV-CI was constant and exceeded LV-CI for all three days of this study. It may be falsely high due to flow velocity measurement errors arising from the pulmonary branch arteries, and may represent a limitation of the USCOM method. The progressive rise of arterial pressure and SVRI despite a declining LV-CI may indicate functional closure of the ductus arteriosus, with the greatest change occurring within the first 24 hours. Evidence of closure of the foramen ovale was not observed.</p>

Airway obstruction caused by large blood vessel anomalies: assessment by flexible bronchoscopy / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the diagnostic value and safety of flexible bronchoscopy in congenital great vessel diseases complicated with airway compression.</p><p><b>METHOD</b>The medical records of patients with great vessels abnormalities who were admitted to the neonatal intensive care unit (NICU) from October 2005 to June 2009 were retrospectively reviewed; 34 cases were diagnosed as airway compression by flexible bronchoscopy, 10 cases as vascular ring, 24 cases as aortal arch obstruction. The age of the patients was 6 d - 11 m, body weight 2.2 - 8.7 kg [(4.6 +/- 1.4) kg]. Recorded airway abnormalities detected by bronchoscopy and CT, cardiac vascular defects and airway compression were consistent with the findings on operation. The relation between the airway compression and cardiac vascular abnormalities, treatment of the airway compression and outcome were analysed.</p><p><b>RESULT</b>Bronchoscopic assessment was successfully performed in NICU or operating room for all the patients. (1) Initial presentation of the 34 cases were tachypnea, stridor, refractory lung infection and prolonged mechanical ventilation. (2) Extrinsic compression was found in all the 10 cases with vascular ring by bronchoscopy initially which indicated vascular ring, airway compression was mainly of lower part of trachea. Diagnosis of 9 cases was consistent with CT diagnosis and in 1 case the diagnosis was confirmed by surgery; among these cases, 7 had congenital tracheal stenosis. (3) In the 24 cases with aortic obstructive lesion, 5 were detected to have tracheal stenosis by CT before correction of vascular abnormality, among whom one case was indicated to have tracheal stenosis by bronchoscopy, the other 19 cases were found with airway compression by bronchoscopy during or after vascular correction. Among the 24 cases, 21 had left main bronchial stenosis, 2 had congenital tracheal stenosis. Airway compression diagnosed by bronchoscopy agreed with the findings of CT. Two cases developed transient decrease of oxygen saturation, 5 cases developed transient tachycardia.</p><p><b>CONCLUSION</b>Flexible bronchoscopy plays an important role in assessment of the airway compression complicated with great vessel abnormalities. Bronchoscopy is an accurate, convenient, safe and rapid way for airway assessment, but further examination of the peripheral structure and vascular malformation need combined examination with CT.</p>

Evaluation of Diagnosis and Preoperative Management of 53 Cases with Interrupted Aortic Arch in Infancy / 实用儿科临床杂志

Objective To evaluate diagnosis and preoperative management of cases with interrupted aortic arch(IAA)in infancy.Methods Fifty-three infants who were admitted to our hospital from Jan.2001 to Nov.2007 were involved.Clinical data,findings of echocardiogram(Echo),spiral CT,MRI,angiocardiography,preoperative management,surgical repair and postoperative outcome were analyzed retrospectively.Results There were 38 boys and 15 girls,weighted 2.18-10.0(4.32?1.60)kg,aged 1 day to 12(3.05?3.53)months,of which 50.94% were neonates.Symptoms at presentation were 90.57% with tachypnea and 83.02% with difficulty in feeding.Eighty three point zero two percentage cases had different degree of congestive heart failure,37.74% of which were in grade Ⅲ heart function.All cases had weakened femoral pulse.All cases were performed Echo,38 cases of them diagnosed as IAA,6 cases as IAA or severe coarctation of aorta(CoA);they were diagnosed as IAA by CT,and 9 as severe CoA who were diagnosed as IAA via CT or operation.Thirty-three cases were performed CT,of which 15 underwent surgical repair,cardiovascular abnormalities revealed by CT were the same as those in surgical findings.Three cases were taken MRI,and 7 cases were performed angiocardiography.According to the results of Echo,CT,MRI,angiocardiography and surgical findings,35 cases were type A,15 cases were type B and 3 cases were type C.Preoperative treatment included maintaining patent ductus areriosis,management of heart failure and supportive treatment.After proper preoperative management of medication,most cases with congestive heart failure were improved.Twenty-six cases underwent surgical repair,16 survived,10 died du-ring perioperative stage.Main cause of death was severe low cardiac output.Conclusions Value of Echo in diagnosis of IAA is limi-ted.Combination of Echo with CT or MRI is a convenient and safe way to diagnose IAA,it can replace the traditional method of Echo combined with angiocardiography.Proper preoperative management is helpful to patients with IAA to pass to surgical repair,and makes for successful operation.

Diagnosis and Management of Vascular Ring Combined with Tracheal Compression in Infants and Neonates / 实用儿科临床杂志

Objective To explore the diagnosis and therapy experience of vascular ring combined with tracheal compression in infants and neonates.Methods Sixteen cases(including 7 boys and 9 girls,aged 1 day to 12 months)with vascular ring combined with tracheal compression hospitalized in Guangdong General Hospital from Jun.2004 to Dec.2009 were enrolled.In these 16 children,13 cases had congenital heart malformations.All children underwent X-ray,echocardiography and spiral computed tomography examination.Nine cases received bronchoscopy study.Fifteen cases performed surgical division of vascular ring with cardiopulmonary bypass and 1 case underwent vascular ring division and tracheoplasty.Eleven cases received management of congenital heart defect simultaneously.Results Vascular ring anomalies included pulmonary artery sling in 5 children,right aortic arch-left ligmentum/aberrant left subclavian artery in 8 cases,double aortic arch in 1 case,innominate artery compression in 1 case,and pulmonary sling combined with right aortic arch-aberrant left subclavian artery in 1 case.There were 2 ring-sling complex cases in this study.The diagnosis of vascular ring were correctly made by echocardiography in 7 children and made by spiral computed tomography in all 16 cases.Two cases combined with tracheal ring died.In the follow-up study of 11 cases,5 cases were still vulnerable to wheezing.Conclusions The common presentation of tracheal compression in infants and neonates associated with vascular ring are tachypea,stridor,and dyspnea.Multi-slices spiral computed tomography is an important imaging modality.Surgical divisions of vascular ring are safe procedure in most cases and tracheal compression can be relieved by this operation.In patients with severe tracheal stenosis,tracheoplasty should be recommended.