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Objective To identify the risk factors of ventilator-associated pneumonia (VAP) in infants after surgical correction for tetralogy of Fallot (TOF).Methods This study performed at Guangdong general hospital in China,130 infants (less than 12 months,mechanical ventilation time≥48 h) undergoing surgical correction for TOF were included between January 2013 and December 2017.Ventilator-associated pneumonia was defined according to the CDC/NHSN definitions guidelines issued in 2008.T test or Wilcoxon rank sum test was used in univariate analysis,and the variables with P ＜ 0.05 in the univariate analysis were added to a multiple logistic regression to identify the risk factors of VAP in infants after surgical correction for Tetralogy of Fallot.The area under the receiver operating characteristic (ROC) curve was calculated as a measure of accuracy.Results A total of 130 infants were included,however,VAP was found in 34 (26.2％) infants.The single variables significantly associated with a risk of VAP were:pre-operative hypoxic,pre-operative pneumonia,pre-operative mechanical ventilation support,prolonged cardiopulmonary bypass time,reintubation,pulmonary atelectasis,pleural effusion hydrothorax,prolonged mechanical ventilation support time,low cardiac output and transfusion of erythrocyte concentrate or fresh frozen plasma.Multiple logistic regression analysis showed prolonged cardiopulmonary bypass time (OR =1.02),reintubation (OR =16.111),pulmonary atelectasis (OR =8.133),low cardiac output (OR =7.649) and prolonged mechanical ventilation support time (OR =1.014) were independent risk factors for VAP in infants after TOF surgical correction.The area under the curve demonstrates the accuracy of the model.Conclusion The occurrence rate of VAP was high and risk factors for VAP after TOF surgical correction were complex.These results can be used to prevent and reduce the occurrence of VAP.
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Objective To summarize the clinical experience of surgical intervention for cardiac neoplasm in a fetus . Methods A 32-year-old pregnant woman was admitted to our hospital for complaint of fetal cardiac neoplasm .A separated het-erogenic cardiac occupying lesion was identigied at right atrium of the fetus by echocardiography , whose size is 2.85 cm ×2.25 cm, but the pathogenic origin still remained uncertain, maybe originate from ether pericardium or atrium.The annulus of tri-cuspid valve was compressed nearly 50% with the presence of amount of pericardial effusion.The fetal heart rate decreased at some fetal position resulting in the compression to the heart.So an Ex-utero Intrapartum Therapy(EXIT) procedure was per-formed under the supply of placenta at the 32 weeks of pregnancy.Cesarean section was performed with intact umbilicus and fe-tal circulation by obstetricians.Consequently, the median sternotomy of this fetus and pericardiotomy were performed , with 30 ml clear pericardial effusion drained .The tumor was confirmed to be giant right atrial neoplasm after the intraoperative explora-tion.Considering on the high risk of the cardiopulmonary bypass and limited time for EXIT , the giant atrial neoplasm was left alone with delayed sternum closure after the effectively decompression of the heart .The omphalotomy was successfully per-formed after the EXIT surgery.The neoplasm resection and the repair for its defect on right atrium were performed with cardiop-ulmonary bypass 2 days later.Results Convalesce of this mother was quite good after cesarean resetion .Hemodynamics of the premature baby was satisfatory after the resection of right atrial neoplasm which pathological report was benign hemangioma . Conclusion Via multiple disciplines collaboration , EXIT intervention for fetus is feasible and safe under adequate prepara-tion.
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Objective To investigate the application of delayed sternal closure (DSC) following neonatal cardiac surgery.Methods We retrospectively analyzed clinical data of 360 neonatal patients underwent cardiac surgery through median sternotomy in Guangdong General Hospital between June 2009 and June 2014.These neonates were divided into 2 groups:DSC group (190 cases) and non-DSC group(170 cases).Comparing the differences between 2 groups,we analysed the application of DSC following neonatal cardiac surgery and the effect of DSC on surgical site infection.Results The cardiopulmonary bypass time,cross clamp time and mechanical ventilation time were longer in DSC group than in non-DSC group.The mortality rate in the DSC group(20.53％) was markedly higher than that in the non-DSC group(5.29％).However,there was no statistical difference in the incidence of sternal wound infection between 2 groups.Conclusion As an effective treatment for neonates with severe cardiac surgery,DSC doesn' t increase the incidence of surgical site infection.
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Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality in the world. So far, there has been substantial progress toward understanding the pathophysiology and treatment of CVDs. There are multiple cell signaling cascades, some of which are beneficial or compensatory and others deleterious. The balance between these pathways determines the outcome as a diseased or non-diseased state. Protein phosphorylation, which is mediated by enzymes, called protein kinases, is a major mechanism for transducing external stimuli into intracellular signals. Electively targeting of signaling pathways using protein kinase inhibitors would have a potential advantage over receptor blockers. By now, there are types of protein kinase inhibitiors available for treating several diseases. The success of kinase inhibitors in cancer treatment has strongly supported application in the treatment of CVDs. Here, we will review several kinds of protein kinases as potential targets for CVDs and some difficulty in identifying a protein kinase as a putative therapeutic target for CVDs.
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BACKGROUND: Moxonidine is the second-generation high-selective central antihypertensive drug, while clonidine is the first-generation antihypertensive drug that is used in clinic with many side effects.OBJECTIVE: To compare the characteristics between moxonidine and clonidine in renal-hypertensive rats.DESIGN: Randomized controlled animal experiment.SETTING: Department of Pharmacology, Medical College, Nantong University.MATERIALS: The experiment was conducted in Medical College, Nantong University between September and December 2004. Totally 110 SD rats aged 60 days with the body mass of (180±30) g were used in the study.METHODS: Left renal artery stenosis in SD rats was established by inserting silver clip with the inner diameter of 0.2 mm or 0.25 mm, while the right renal artery was not received, so as to establish two-kidney one-clip(2K-1C) renal hypertensive models. ①Changes of blood pressure and heart rate in awake rats with renal hypertension were determined with arteria caudilis indirect manometric method, oral administration once or consecutively. The experiment of depressurization with once oral administration:The rats were randomly assigned into 5 groups with 10 rats in each group:1 mg/kg, 3 mg/kg, 10 mg/kg moxonidine hydrochloride groups, 1 mg/kg clonidine hydrochloride group were considered as positive control group,while saline group as negative control group. On the basis of the effect of moxonidine hydrochloride on blood pressure, blood pressure was measured at 1, 4, 24, 48, 72 hours after moxonidine administration, and compared with that before administration or the effect of saline. The experiment of depressurization with consecutively oral administration once a day. The grouping was the same to above-mentioned. Successive administration was for 7 days, once a day. The blood pressure and heart rate were determined at 1 hour before and after administration, and observed for 3 days after drug withdrawal. Recommended dose of moxonidine hydrochloride for human was about 0.4 mg/kg, while the oral dose for rats were around 0.04 mg/kg based on the animals' surface area. ②Changes of blood pressure and heart rate in anaesthesia rats with renal hypertension with a catheter on the carotid artery directly: 0.2 mg/kg drug liquor was given with gastric perfusion. The rats were randomly divided into 5 groups with 10 ones in each group: 0.13,0.4, 1.3 mg/kg moxonidine hydrochloride groups, 0.13 mg/kg clonidine hydrochloride group and saline control group. Mean arterial pressure was determined before and after administration at different time.MAIN OUTCOME MEASURES: Changes of blood pressure and heart rate in conscious and anesthetized renal-hypertensive rats before and after being administrated orally once or consecutively.RESULTS: All the rats were involved in the result analysis, without drop out during the trial. ①Moxonidine showed a dose-dependent effect on depressurization and descent of heart rate after once large dose oral administration in conscious renal-hypertensive rats. The 10-fold higher doses of moxonidine caused the same effects of clonidine. The decreasing of heart rate was little and short after consecutively small dose of oral administration of moxonidine, and which was similar to clonidine in percentage of depressurization. ②In anesthetized renal-hypertensive rats, moxonidine showed a dose-dependent effect on depressurization after once oral administration. There was no significant difference between moxonidine and clonidine in percentage of depressurization after 3 to 10-fold higher dose administration (P ＞ 0.05).CONCLUSION: The once higher dose oral administration of moxonidine has dose-dependent effect on depressurization for renal-hypertensive awake rats. Anesthesia. The effect of 10-fold dosage of moxonidine is equal to that of clonidine. The effect of 3-10-fold dosage of moxonidine is equal to that of clonidine in anesthesia renal-hypertensive rats. The small dose oral administration continuously of both moxonidine and clonidine with the same volume has the same depressurization effect in renal-hypertensive rats.
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0.05). CONCLUSION: The effects of 10 mg?kg -1 m oxonidine on reduced blood pressure and heart rate in SHR is equal to the effect s of 1 mg?kg -1 clonidine after once large dose oral administration. T here is no significant difference between the moxonidine and clonidine of the sa me dose in reducing blood pressure after repeatedly small dose oral administrati on in SHR.
ABSTRACT
Cardiovascular diseases(CVDs) are a major cause of morbidity and mortality in the world.So far,there has been substantial progress toward understanding the pathophysiology and treatment of CVDs.There are multiple cell signaling cascades,some of which are beneficial or compensatory and others deleterious.The balance between these pathways determines the outcome as a diseased or non-diseased state.Protein phosphorylation,which is mediated by enzymes,called protein kinases,is a major mechanism for transducing external stimuli into intracellular signals.Electively targeting of signaling pathways using protein kinase inhibitors would have a potential advantage over receptor blockers.By now,there are types of protein kinase inhibitiors available for treating several diseases.The success of kinase inhibitors in cancer treatment has strongly supported application in the treatment of CVDs.Here,we will review several kinds of protein kinases as potential targets for CVDs and some difficulty in identifying a protein kinase as a putative therapeutic target for CVDs.