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Objective To investigate the risk factors for postoperative prolonged mechanical ventilation in neonates and young infants with complicated congenital heart disease. Methods A retrospective analysis of 150 children (80 males and 70 females, aged ≤ 6 months, RACHS-1 grade ≥ 3) with complex congenital heart disease who were admitted to Children's Heart Surgery Department of Anzhen Hospital from January 2016 to December 2017 was conducted. These data were collected: the demographic data, history of cardicvascular-related diseases, type of surgery, preoperative complications, CPB, CPB time, deep hypothermia, blood gas index, delayed chest closure (DCC), pacemaker; minimum oxygenation index in the first 24 h after operation, maximum vasoactive-inotropic score (VIS), failed extubation and postoperative complications. Logistic regression model was used to analyze the risk factors of prolonged mechanical ventilation within neonates and young infants after complicated congenital heart surgery. Results Forty-two patients (28％) required PMV with mechanical ventilation ≥ 72 h. Univariate analysis showed age, weight, RACHS-1 grade, previous history of cyanosis, history of pneumonia, emergency surgery, preoperative mechanical ventilation, preoperative EF, deep hypothermia, CPB time＞ 132 min, intraoperative minmum pH value, intraoperative maximum blood glucose and lactic acid concentrations, DCC, application of pacemakers, maximum VIS within 24 h after surgery, minimal OI and postoperative complications may be the risk factors of prolonged postoperative mechanical ventilation in neonates and young infants with complicated congenital heart disease (P ＜ 0.05). Multivariate Logistic regression analysis showed that the CPB time＞132 min (OR = 11.04, 95％ CI 2.07-58.96, P = 0.005), intraoperative maximum lactate (OR = 1.53, 95％ CI 1.07-2.20, P = 0.021) and failed extubation (OR = 17.28, 95％ CI 2.46-121.20, P = 0.004) were independent risk factors for prolonged postoperative mechanical ventilation in neonates and young infauts with complicated congenital heart disease. Conclusion CPB time＞132 min, intraoperative maximum lactic acid concentration and failure of extubation can be used as predictors of prolonged postoperative mechanical ventilation in neonates and young infants with complicated congenital heart disease.
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Objective To explore the expression of vascular endothelial growth factor (VEGF) and apoptosis of the tumor cells in the different regions of rabbit liver VX2 tumor after radiofrequency ablation (RFA).Methods Forty-eight experimental rabbits were implanted with VX2 tumor.After successfully established the model,the rabbits were randomly divided into control group (n=6) and RFA group (n=42).In the RFA group,7 rabbits at each time point were killed at immediately,1 day,2 days,1 week,2 weeks,3 weeks after RFA,and the tumor specimens were retained and performed with HE staining,VEGF,Annexin V-FITC/PI labeling,flow cytometry analysis.The changes of VEGF and apoptosis of the cells in different periods and different zones after RFA were observed.Results After the operation,the difference of the VEGF value of the needle zone,coagulation necrotic zone and junction zone had statistically significant (all P＜0.05).The difference of the VEGF value in each zone between immediately and the other time points after operation by pairwise comparisons were significantly different (all P＜0.05).The VEGF value of the needle zone and coagulation necrotic zone reached the peak after operation immediately,which declined from 1 day to 3 weeks after operative.And VEGF of the junction zone increased from immediately to 1 week after operation,and declined 2 weeks after operation.There were significant differences in the apoptosis rate of the three zones after RFA compared with control group (all P＜0.05).The apoptosis rate in all zones were at the peak on the 1 day after operation,and then showed a downward trend.Conclusion The reduction of VEGF and apoptosis of tumor cells in the needle zone and coagulation necrotic zone are significant,but tumor remnant remains visible in the junction zone.In the third week after RFA,the proliferation of the remaining tumor cells can be recurrent to preoperative levels,which suggests that the further treatment should be performed at this period.
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Objective To study the protective effects of crocetin on myocardial ischemia-reperfusion injury, and their correlation with the signaling pathway of serine/threonine protein kinase (Akt)/glycogen synthase kinase (GSK)-3β/nitric ox?ide synthase (eNOS). Methods Forty healthy SD rats were divided into normal group (N), ischemia reperfusion group (IR) and 5, 10 and 15 mg/L of crocetin groups (CRO1, CRO2 and CRO3) by random number table method. The values of heart rate (HR), coronary flow (CF) and left ventricular pressure measurement (LVDP, LV+dp/dtmax, LV-dp/dtmax) 30 minutes after reperfusion were compared between five groups. TTC staining was used to detect the infarct volume. Spectrophotometric method was used to determinate the expression of lactate dehydrogenase (LDH) and creatine kinase (CK-MB). The levels of Akt, the phosphorylation of Akt (p-Akt), GSK-3β, phosphorylation of GSK-3β(p-GSK-3β), eNOS and phosphorylation of eNOS (p-NOS) were detected by Western blot assay. Results The HR, CF, LVDP, LV+dp/dtmax and LV-dp/dtmax were significantly lower 30 min after reperfusion in IR group than those of N group and crocetin groups (P<0.05). The myocardial infarction area was bigger in IR group than that of crocetin groups. The expression levels of LDH and CK-MB were signifi?cantly higher in IR group than those of N group and crocetin groups (P<0.05). The reperfusion index was higher in CRO3 group than that of CRO1 group. The infarction area, LDH and CK-MB expressions were significantly decreased in CRO3 group than those of CRO1 group (P<0.05). There were no significant differences in expressions of Akt, GSK-3βand eNOS between IR group, N group and crocetin groups. But p-Akt, p-GSK-3βand p-NOS were significantly decreased in IR group than those of N group and crocetin groups. The p-Akt, p-GSK-3βand p-NOS were significantly increased in CRO3 group than those of CRO1 group (P<0.05).Conclusion Crocetin has protective effects on myocrdial ischemia reperfusion injury in rats, which may be involved in the enhancing the phosphorylation of signalling pathway of Akt/GSK-3β/eNOS.
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Objective To retrospectively analyze the correlation between uterine fibroid and ovarian blood supply, and to discuss the visualization of ovarian artery and uterine ovarian branch in uterine arterial embolization. Methods A total of 363 patients with clinically-confirmed uterine fibroid were enrolled in this study. Uterine arterial embolization was carried out in all patients. The visualization of ovarian artery and uterine ovarian branch during angiography was recorded. After the procedure the changes of uterine fibroid and ovarian functions were followed up. The results were statistically analyzed. Results The blood supply of uterine fibroid could be divided into three types: unilateral artery as the main source of blood supply (34.16%), bilateral balanced blood supply (43.80%) and unilateral uterine artery (22.04%). The visualization rate of uterine ovarian branch in bilateral balanced blood supply type was significantly higher than that of other two types (P<0.05). The visualization rate of ovarian artery at the side which was lack of blood vessels was higher than that at the opposite side (P< 0.05). Transient ovary functional impairment was observed in patients with visualization of uterine ovarian branch, which restored to normal in three months. No significant difference in the reduction of the tumor mass existed between each other among the different blood supply types. Conclusion The blood supply types of uterine fibroids have a parallel relationship with the ovarian blood supply from ovarian artery and/or uterine ovarian branch. Special attention should be paid to the uterine arterial embolization of the side that is lack of blood vessels, and it is needed to carefully observe the embolization extent, the flow velocity, etc. during the performance of embolization so as to avoid ovarian function impairment.
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Objective To compare the cost-effectiveness and cost-utility of venlafaxine and mirtazapine in patients with treatment-resistant major depression (TRD).Methods One hundred and five patients with TRD were enrolled in this study and grouped into venlafaxine treatment (n=50) and mirtazapine treatment (n=55) based on the double-blind randomization scheme generated by computer.The treatment costs of antidepressants during 8 weeks were calculated,the rates of clinical response and remission were taken as treatment effectiveness,and the quality-adjusted life years (QALYs) as treatment utility.The descriptive analysis and nonparametric test were used to compare the cost-effectiveness and cost-utility of different groups.Results During 8 weeks,the treatment cost of antidepressant was ￥ 1 396.44 for venlafaxine and ￥ 1 206.90 mirtazapine,and the difference between two groups was ￥ 189.54.The cost-effectiveness ratios between venlafaxine and mirtazapine were very close (differed ￥ 0.06 for remission rate and ￥ 1.08 for response rate respectively).There was no significant difference for cost-utility ratios between two groups (physical functioning Z=-0.15,P＞0.05 ; mental health Z=-0.54,P＞0.05).Conclusion Both cost-effectiveness and cost-utility of venlafaxine in patients with TRD are close between venlafaxine and mirtazapine.
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Objective To evaluate the efficacy of antidepressants plus cognitive-behavioral education and self-management preventing the recurrent or deterioration of depression.Methods Outpatients with non-episode depression,Hamilton Rating Scales of Depression 17 items (HAMD17 ≥3),entered openly intervention group (n =30) and control group (n =30),and were followed up one year.Patients in intervention group received intervention,including treatment as usual,group education of cognitive behavior,self-help group attendance and self-management of depressive mood.Patients in control group only received treatment as usual.The primary outcome was time to recurrent or deterioration of depression.Kaplan-Meier methodology was used to evaluate differences of survival curves between two different groups.Results There were significant differences for risk of recurrent or deterioration (x2 =5.70,P ＜ 0.05) and one-year rate of recurrent or deterioration (intervention group 27％ (8/30),control group 53％ (16/30),x2 =4.44,P ＜ 0.05) between two groups,but not for average time of recurrent or deterioration (intervention group (4.75 ± 2.49) months,control group (6.63 ± 3.10) months,t =-1.48,P ＞0.05).There were no significant differences for risk of drop-out (x2 =1.66,P ＞ 0.05),one-year rate of drop-out (intervention group 13％ (4/30),control group 23％ (7/30),x2 =1.00,P ＞ 0.05) and average time of drop-out (intervention group (7.25 ± 3.78) months,control group (4.00 ± 2.58) months,t =1.71,P ＞ 0.05) between two groups.Conclusion Antidepressants plus cognitive-behavioral education and self-management can effectively prevent the recurrent or deterioration of depression.