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BACKGROUND@#Computed tomography images are easy to misjudge because of their complexity, especially images of solitary pulmonary nodules, of which diagnosis as benign or malignant is extremely important in lung cancer treatment. Therefore, there is an urgent need for a more effective strategy in lung cancer diagnosis. In our study, we aimed to externally validate and revise the Mayo model, and a new model was established.@*METHODS@#A total of 1450 patients from three centers with solitary pulmonary nodules who underwent surgery were included in the study and were divided into training, internal validation, and external validation sets (n = 849, 365, and 236, respectively). External verification and recalibration of the Mayo model and establishment of new logistic regression model were performed on the training set. Overall performance of each model was evaluated using area under receiver operating characteristic curve (AUC). Finally, the model validation was completed on the validation data set.@*RESULTS@#The AUC of the Mayo model on the training set was 0.653 (95% confidence interval [CI]: 0.613-0.694). After re-estimation of the coefficients of all covariates included in the original Mayo model, the revised Mayo model achieved an AUC of 0.671 (95% CI: 0.635-0.706). We then developed a new model that achieved a higher AUC of 0.891 (95% CI: 0.865-0.917). It had an AUC of 0.888 (95% CI: 0.842-0.934) on the internal validation set, which was significantly higher than that of the revised Mayo model (AUC: 0.577, 95% CI: 0.509-0.646) and the Mayo model (AUC: 0.609, 95% CI, 0.544-0.675) (P < 0.001). The AUC of the new model was 0.876 (95% CI: 0.831-0.920) on the external verification set, which was higher than the corresponding value of the Mayo model (AUC: 0.705, 95% CI: 0.639-0.772) and revised Mayo model (AUC: 0.706, 95% CI: 0.640-0.772) (P < 0.001). Then the prediction model was presented as a nomogram, which is easier to generalize.@*CONCLUSIONS@#After external verification and recalibration of the Mayo model, the results show that they are not suitable for the prediction of malignant pulmonary nodules in the Chinese population. Therefore, a new model was established by a backward stepwise process. The new model was constructed to rapidly discriminate benign from malignant pulmonary nodules, which could achieve accurate diagnosis of potential patients with lung cancer.
Subject(s)
Humans , Lung , Lung Neoplasms/diagnostic imaging , Multiple Pulmonary Nodules , Risk Assessment , Solitary Pulmonary Nodule/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Objective: To evaluate the anti-inflammatory activity of Crotalaria ferruginea extract (CFE) and its mechanism. Methods: An intratracheal lipopolysaccharide (LPS) instillation-induced acute lung injury (ALI) model was used to study the anti-inflammatory activity of CFE in vivo. The LPS-induced shock model was used to analyze the effect of CFE on survival. LPS-stimulated RAW264.7 cell model was used to investigate the anti-inflammatory activity of CFE in vitro and the effects on mitogen-Activated protein kinase (MAPK) or nuclear factor-κB (NF-κB) signaling pathways. Results: CFE administration decreased the number of inflammatory cells, reduced the levels of tumor necrosis factor-α (TNF-A), monocyte chemotactic protein-1 (MCP-1), interleukin-6 (IL-6), and interferon-γ, and diminished protein content in the bronchoalveolar lavage fluid of mice. CFE also reduced lung wet-To-dry weight ratio, myeloperoxidase, and lung tissue pathological injury. CFE pre-Administration improved the survival rate of mice challenged with a lethal dose of LPS. CFE reduced LPS-Activated RAW264.7 cells to produce nitric oxide, TNF-α, MCP-1, and IL-6. Furthermore, CFE inhibited nuclear translocation and phosphorylation of NF-κB P65, extracellular signal-regulated kinase, c-Jun N-Terminal kinases, and P38 MAPKs. Conclusions: CFE exhibits potent anti-inflammatory activity in LPS-induced ALI mice, LPS-shock mice, and RAW264.7 cells, and its mechanism may be associated with the inhibition of NF-κB and MAPK signaling pathways. Crotalaria ferruginea may be a useful therapeutic drug for the treatment of ALI and other respiratory inflammations.
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Objective: To evaluate the anti-inflammatory activity of Crotalaria ferruginea extract (CFE) and its mechanism. Methods: An intratracheal lipopolysaccharide (LPS) instillation-induced acute lung injury (ALI) model was used to study the anti-inflammatory activity of CFE in vivo. The LPS-induced shock model was used to analyze the effect of CFE on survival. LPS-stimulated RAW264.7 cell model was used to investigate the anti-inflammatory activity of CFE in vitro and the effects on mitogen-Activated protein kinase (MAPK) or nuclear factor-κB (NF-κB) signaling pathways. Results: CFE administration decreased the number of inflammatory cells, reduced the levels of tumor necrosis factor-α (TNF-A), monocyte chemotactic protein-1 (MCP-1), interleukin-6 (IL-6), and interferon-γ, and diminished protein content in the bronchoalveolar lavage fluid of mice. CFE also reduced lung wet-To-dry weight ratio, myeloperoxidase, and lung tissue pathological injury. CFE pre-Administration improved the survival rate of mice challenged with a lethal dose of LPS. CFE reduced LPS-Activated RAW264.7 cells to produce nitric oxide, TNF-α, MCP-1, and IL-6. Furthermore, CFE inhibited nuclear translocation and phosphorylation of NF-κB P65, extracellular signal-regulated kinase, c-Jun N-Terminal kinases, and P38 MAPKs. Conclusions: CFE exhibits potent anti-inflammatory activity in LPS-induced ALI mice, LPS-shock mice, and RAW264.7 cells, and its mechanism may be associated with the inhibition of NF-κB and MAPK signaling pathways. Crotalaria ferruginea may be a useful therapeutic drug for the treatment of ALI and other respiratory inflammations.
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@#AIM: To observe the effect of sub-bowman keratomileusis(SBK)on the posterior corneal curvature, posterior corneal elevation and anterior chamber parameters.<p>METHODS: Prospective self controlled study. Totally 49 patients(97 eyes)with myopia who had planned for SBK were included in this study, mean posterior corneal curvature, central posterior corneal elevation(PCE), anterior chamber volume(ACV), central and peripheral anterior chamber depth(ACD)were measured by Oculyzer before and 1wk, 1y, 3y after surgery. Repeated measure analysis of variance was adopted for data analysis.<p>RESULTS: There were no significant differences in mean posterior corneal curvature at any time point postoperatively compared with that preoperatively(<i>P</i>>0.05). However, central PCE, ACV and central ACD at 1wk, 1y and 3y postoperatively were all decreased(<i>P</i><0.01). Except for the anterior peripheral ACD at 3y after SBK, other peripheral ACD at any time point postoperatively were all decreased(<i>P</i><0.05).<p>CONCLUSION: The posterior corneal curvature remained stable after SBK, while the central PCE shifted slightly backward and the entire anterior chamber became shallow.
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Neutrophil extracellular trap (NET) is a type of bead-like, fibrous and reticular substances that is actively released by activated inflammatory neutrophils during the stage of infections or inflammatory responses. NET, which is composed of chromatin DNA and multiple intracellular protein components, may wrap pathogens to limit their diffusions. Meanwhile, NET may kill pathogens via a wide range of antibacterial proteins, which is considered as the third antibacterial mechanism of neutrophils, in addition to phagocytosis and degranulation. Recent studies have shown the involvement of NET in the immune response against parasitic infections. This review summarizes the advances of NETs in the immune responses against parasitic infections, so as to provide insights into the elucidation of the pathogenesis and development of therapeutics of parasitic diseases.
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BACKGROUND: Endothelin-1, as a paracrine cytokine derived from endocardium and vascular endothelial cells, can promote the differentiation and maturation of cardiac conduction cells. OBJECTIVE:To explore the effect of endothelin-1 on P19 cells differentiating into cardiac conduction cells in vitro. METHODS: P19 cells were cultured with 1% dimethyl sulfoxide or 100 nmol/L endothelin-1. Afterwards, the changes of early cardiomyocyte transcription factors MEF2C and GATA4, differentiation markers MHC-α and cTnT, important conduction cell transcription factors Nkx2.5 and Tbx5, and differentiation markers Cx40 and ANP were identified by western blot assay, immunofluorescence and real-time PCR. Specific antagonists of endothelin-1 receptors, and blocking PI3K-AKT-mTOR signaling pathway on the differentiation of P19 cells induced by endothelin-1 were evaluated by real-time PCR. RESULTS AND CONCLUSION: Endothelin-1 significantly up-regulated the levels of early cardiac transcription factors, cardiomyocyte structure factors and characteristic conduction system markers. Compared with dimethyl sulfoxide, endothelin-1 was prone to enhance the differentiation of cardiac conduction cells derived from P19 cells. Up-regulation of Nkx2.5 and Cx40 by endothelin-1 was mainly attributed to the ETAsignaling pathway. ETBsignaling pathway may be also involved in a negative feedback regulation pathway. The PI3K-AKT-mTOR signaling pathway can play an important role in the differentiation from P19 cells to cardiac conduction cells triggered by endothelin-1.
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Objective • To analyze the bacterial origin and characteristics, and their influence on the process and prognosis in moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) patients with pancreatic/peri-pancreatic infections due to multiple drug resistant (MDR) Gram-negative bacteria (GNB). Methods • Patients of pancreatitis hospitalized in the Departments of Emergency, Pancreatic Surgery and Critical Care Medicine were enrolled in this study. The patients with pancreatic/peri-pancreatic GNB infections were screened and divided into MDR-GNB group and non-MDR-GNB group. The basic clinical features, the source of resistant bacteria, the progress of the disease and the prognosis were analyzed and compared within two groups. Results • 92(46.70%) out of 197 MSAP and SAP patients were confirmed as GNB infected, 61 cases (66.30%) with MDR strains and 31 cases (33.70%) with non-MDR strains. 117 GNB were isolated. The main MDR strains were Klebsiella pneumoniae (KP) (39/69) and Acinetobacter Baumannii (AB) (22/69). The incidence of percutaneous catheter drainage (PCD) associated MDR bacterial infections in MDR-GNB group was significantly higher than that of non-MDR-GNB group (36.07% vs 12.90%, P=0.020). The MDR-GNB infections could lead to prolonged mechanical ventilation[ (17.65±11.74) d vs (9.67±9.34) d, P=0.001], increased use of carbapenems and special antibiotics (P=0.000), earlier intervention of first laparotomy [(21.92±11.45) d vs (29.36±21.48) d, P=0.032], increased incidence of multiple operations (45.90% vs 22.58%, P=0.029), prolonged total hospitalization [(54.44±42.38) d vs (32.51±27.62) d, P=0.011] and higher mortality (34.43% vs 12.90%, P=0.028). The incidence of MDR-KP infections in death patients was significantly higher than that in the surviving patients (85.71% vs 52.50%, P=0.000), while the other MDR bacteria did not present statistical difference in the two groups. Conclusion • MDR-KP and MDR-AB are the main resistant GNB in MSAP and SAP patients with pancreatic/peri-pancreatic infections. The PCD associated infection is the main source of nosocomial MDR bacterial infections. Infections due to MDR-GNB could lead to prolonged therapy course, increased use of antibiotics, augmented operation, and poor outcome. The infection of MDR-KP is directly related to poor outcome.
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<p><b>OBJECTIVE</b>To establish discriminant functions of diarrhea-predominant irritable bowel syndrome (IBS-D) by studying it from quantitative diagnosis angle, hoping to reduce interference of subjective factors in diagnosing and differentially diagnosing Chinese medical syndromes of IBS-D.</p><p><b>METHODS</b>A Chinese medical clinical epidemiological survey was carried out in 439 IBS-D patients using Clinical Information Collection Table of IBS. Initial syndromes were obtained by cluster analysis. They were analyzed using step-by-step discrimination by taking information of four Chinese medical diagnostic methods and serum brain-gut peptides (BGP) as variables.</p><p><b>RESULTS</b>Clustering results were Gan stagnation Pi deficiency syndrome (GSPDS), Pi-Wei weakness syndrome (PWWS), Gan stagnation qi stasis syndrome (GSQSS), Pi-Shen yang deficiency syndrome (PSYDS), Pi-Wei damp-heat syndrome (PWDHS), cold-damp disturbing Pi syndrome (CDDPS). Of them, GSPDS was mostly often seen with effective percentage of 34. 2%, while CDDPS was the least often seen with effective percentage of 5.5%. A total of 5 discriminant functions for GSPDS, PWWS, GSQSS, PSYDS, and PWDHS were obtained by step-by-step dis- crimination method. The retrospective misjudgment rate was 4.1% (16/390), while the cross-validation misjudgment rate was 15.4% (60/390).</p><p><b>CONCLUSION</b>The establishment of discriminant functions is of value in objectively diagnosing and differentially diagnosing Chinese medical syndromes of IBS-D.</p>
Subject(s)
Humans , Alarmins , Brain , Cluster Analysis , Diarrhea , Classification , Diagnosis , Hot Temperature , Irritable Bowel Syndrome , Classification , Diagnosis , Medicine, Chinese Traditional , Qi , Retrospective Studies , Surveys and Questionnaires , Yang DeficiencyABSTRACT
Objective: To optimize the best processing technology for bran-fried Paeoniae Alba Radix (PAR). Methods: Taking the contents and extract yields of paeoniflorin, oxypaeoniflorin, albiflorin, and gallic acid in PAR as the indexes, the affecting factors on the processing technology of bran-fried PAR was investigated by orthogonal design test and multi-index comprehensive weighted mark method. Results: The best processing technology was to add 10% bran and fry for 8 min at 200°C. Conclusion: The optimal processing technology is stable, and could provide the references for the further study of PAR.
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OBJECTIVE@#To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median sternotomy through right atrium in treatment of common congenital heart diseases.@*METHODS@#Clinical data of 59 cases of common congenital heart diseases treated with minimally invasive right axillary vertical thoracotomy from May, 2011 to February, 2013 and 77 cases of same diseases with traditional median sternotomy in the past three years were retrospectively analyzed, including atrial septal defect, membranous ventricular septal defect and partial endocardial cushion defect. The results were compared from the two groups, including the time for operation and cardiopulmonary bypass, amount of blood transfusion, postoperative drainage, ventilation time, hospital stay, and prognosis.@*RESULTS@#No severe complications happened in both groups, like deaths or secondary surgery caused by bleeding. No significant differences were in CPB time and postoperative ventilator time between groups (P>0.05), while for all of the operative time, the length of incision, postoperative drainage and hospital stay, minimally invasive right axillary vertical thoracotomy was superior to median sternotomy, with statistically significant differences (P<0.05). In six-month followup after operation, no complications of residual deformity and pericardial effusion were found in both groups by doing echocardiography, but mild pectus carinatum was found in 8 patients in the traditional median sternotomy group (traditional group), whereas patients in another group were well recovered.@*CONCLUSIONS@#Minimally invasive right subaxillary vertical thoracotomy for common congenital heart diseases is as safe as traditional median sternotomy, without the increasing incidence of postoperative complications. Additionally, compared with traditional median sternotomy, minimally invasive right subaxillary vertical thoracotomy is better in the aspects of hidden incision, appearance, and postoperative recovery.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Young Adult , Cardiac Surgical Procedures , Methods , Cardiopulmonary Bypass , Heart Defects, Congenital , General Surgery , Minimally Invasive Surgical Procedures , Methods , Postoperative Complications , Epidemiology , Retrospective Studies , Sternotomy , Methods , Thoracotomy , Methods , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To investigate whether electroacupuncture (EA) can promote cell survival and enhance heart function of mesenchymal stem cells (MSCs) therapy.</p><p><b>METHODS</b>MSCs were isolated from bone marrow and expanded in Minimum Essential Medium Alpha (α-MEM). MI was induced in 72 Sprague-Dawley (S-D) rats by ligation of the left anterior descending coronary artery (LAD) for 30 min and reperfusion. MI rats randomly received injection of 1×10(6) DiI-labeled MSCs alone (n =24, MSC group), or plus electroacupuncture (EA) at Neiguan (PC6, n=24, EA+MSC group), or saline (n =24, saline group). EA treatment was performed for 4 days. Another 24 rats were subjected to chest-open surgery without LAD occlusion and treatment (sham group). Three time points, 4, 14 and 28 days (n =8 for each group) were included in this study. The survival of transplanted MSCs and the protective gene expression were analyzed by reverse transcriptase polymerase chain reaction (RT-PCR) and Western blot at day 4 and 14. Left ventricular remodeling, cardiac function, infarction area, fibrosis and capillary density were analyzed at day 28.</p><p><b>RESULTS</b>EA can enhance MSC survival (2.6-fold up) at day 4. Big capillary density was 53% higher in EA+MSC treated group than MSC alone group. Furthermore, the rats treated by EA reduced the fibrosis and had 36% smaller infarct size comparing to MSC alone. EA also attenuated left ventricular remodeling and enhanced the functional recovery of infarcted hearts at week 4.</p><p><b>CONCLUSION</b>EA at Neiguan acupoint can promote the stem cell survival and improve ischemic heart function. EA could become a useful approach in stem cell therapy for ischemia heart diseases.</p>
Subject(s)
Animals , Female , Rats , Apoptosis , Physiology , Cell Survival , Cells, Cultured , Combined Modality Therapy , Methods , Electroacupuncture , Graft Survival , Physiology , Heart , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells , Physiology , Myocardial Ischemia , Therapeutics , Rats, Sprague-Dawley , Ventricular Remodeling , PhysiologyABSTRACT
<p><b>BACKGROUND</b>The application of pulmonary valved conduit to reconstruct the continuity between right ventricles and pulmonary artery is one of the major surgeries. This study aimed to establish an in vivo model of in situ implantation using pulmonary valved conduit in large animals under off-pump condition to validate the long-term effects of artificial pulmonary valved conduit.</p><p><b>METHODS</b>Domesticate juvenile male sheep and tissue-engineered porcine pulmonary valved conduit were used for the experiment: 30 sheep, weighing (15 ± 3) kg (range 13 to 17 kg) were randomly divided into two groups which were all operated under general anesthesia by off-pump surgery (group 1) and left thoracotomy (group 2). Two different off-pump surgical methods were used to perform cannulation in sheep pulmonary artery to replace part of sheep pulmonary artery with pulmonary valved conduit which will work together with sheep pulmonary artery and valves. During the experiments, animal survival, complication rates, operating time and blood loss were recorded to compare the results between groups and to establish a surgical method with minimal invasion, simplicity, safety, and high success rates.</p><p><b>RESULTS</b>In group 1, a total of 15 cases of surgeries were performed, in which two sheep died; the operative mortality was 13.3% (2/15). In group 2, a total of 15 cases of surgeries were performed, and the surgical mortality rate was 0 (0/15). The operation time and blood loss in group 2 was significantly better than that in group 1. The postoperative echocardiograms showed that, after the surgeries by these two methods, the blood flows were normal, and the valves can open and close freely. Autopsy after 6 months showed that the inner wall and the valves of pulmonary valved conduit were smooth with no thrombus formation.</p><p><b>CONCLUSION</b>These two off-pump methods are feasible and safe with fewer traumas; but the second method is better and particularly suitable for the establishment of a juvenile animal model.</p>
Subject(s)
Animals , Male , Heart Valve Prosthesis , Pulmonary Valve , Sheep , Swine , Tissue EngineeringABSTRACT
<p><b>OBJECTIVE</b>To recite early results and long-term outcomes after surgical repair of persistent truncus arteriosus (PTA).</p><p><b>METHODS</b>The clinic data of 54 patients underwent surgical repair for PTA from January 1999 to December 2009 was analyzed retrospectively. There were 36 male and 18 female patients, with a mean age of (9 ± 10) months (range, 1 to 38 months; median, 5 months). Preoperative mechanical ventilation was required in 5 patients. The surgical procedures were closure of ventricular septal defect and re-establishment of continuity between right ventricle and pulmonary artery. The right ventricular outflow tract (RVOT) was reconstructed by direct anastomosis pulmonary artery to right ventriculotomy with anterior wall patch enlargement (28 cases), or by inserting conduits (26 cases). Valvuloplasty were performed in 4 patients with truncal valves moderate to severe insufficiency and aortoplasty in 3 patients with interrupted aortic arch (IAA).</p><p><b>RESULTS</b>There were 3 patients (5.6%) died of pulmonary hypertensive crisis in hospital. The mean duration of ventilation was 6.8 days in 5 patients who were intubated before operation, while the others were 3.6 days. Forty-seven (92.2%) patients were followed-up for mean (6.8 ± 2.5) years (from 2.5 to 11.0 years). There were 2 patients with mild to moderate aortic regurgitation. One patient with aortic arch obstruction underwent balloon dilatation 2 years postoperatively. Among those patients who underwent direct anastomoses, 8 (32.0%) patients had pulmonary branch stenosis at 7 months to 1.5 years postoperatively, 12 (48.0%) patients were freedom from surgical reintervention 5.0 to 11.0 years postoperatively. Among those inserting conduits, 7 patients (31.8%) had conduit stenosis at 2.8 to 7.0 years after operation. Reoperations were performed for RVOT in 15 patients and there was no mortality.</p><p><b>CONCLUSIONS</b>It is difficult to treat the PTA patients with IAA, intra-mural coronary artery or mechanical ventilation support before operation. The technique of direct anastomosis between pulmonary artery and right ventricle offers the potential growth for RVOT, but bilateral pulmonary branch stenosis may be occurred at earlier period of postoperation in some patients.</p>
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Child, Preschool , Female , Humans , Infant , Male , Follow-Up Studies , Retrospective Studies , Treatment Outcome , Truncus Arteriosus, Persistent , General SurgeryABSTRACT
<p><b>OBJECTIVES</b>To Summarize the results of left ventricle retraining in rapid two-stage switch operation and to determine the estimating index of left ventricle retraining and the best time of the second stage operation.</p><p><b>METHODS</b>From September 2002 to September 2007, 21 patients underwent rapid two stage switch operation. There were 13 male and 8 female patients, ageing from 29 to 250 d [mean (103 ± 69) d, median 75 d], weighting from 3.5 to 7.0 kg [mean (5.0 ± 1.2) kg, median 5.0 kg]. After pulmonary band, bedside echocardiography was regularly done every other day. Paired t-test was used to analyze the changes of left ventricular end-diastolic dimension (LVDd), left ventricular posterior wall dimensions (LVPWd), diastolic intra-ventricular septal dimensions (IVSd), left ventricular (LV) mass and LV mass indexed for body surface area.</p><p><b>RESULTS</b>The mean interval was (9 ± 5) d. After the left ventricle preparative operation, the left ventricular to right ventricular pressure ratio (pLV/RV) raised from 0.47 ± 0.15 to 0.91 ± 0.20 (P < 0.01). LV mass indexed for body surface area raised from (30 ± 11) g/m(2) to (60 ± 20) g/m(2) (P < 0.01). Extremely significant difference of LV mass existed between pre-arterial switch operation and pre-left ventricle preparative operation, and significant difference existed in LVDd, LVDd(3), LVPWd and IVSd between the two operative timing points.</p><p><b>CONCLUSIONS</b>The left ventricular function of the transposition of the great arteries can be retraining by the left ventricle preparative operation. The interval of left ventricle retraining should be controlled in 7 to 10 d, and the pLV/RV reach 0.65 and the LV mass index over 50 g/m(2) are two important indicators of the second stage operation of arterial switch operation.</p>
Subject(s)
Female , Humans , Infant , Infant, Newborn , Male , Follow-Up Studies , Retrospective Studies , Transposition of Great Vessels , General Surgery , Ventricular Function, Left , PhysiologyABSTRACT
<p><b>OBJECTIVE</b>To analyze the experience of treatment strategies for pediatric patients with primary cardiac tumors.</p><p><b>METHODS</b>The clinical data of 27 patients with primary cardiac tumors which detected by echocardiography from May 1999 to May 2009 was analyzed retrospectively. There were 20 male and 7 female patients, aged from 24 d to 12.6 years. There were 59.2% less than 1 year old at the time of diagnosis. A single tumor were present in 22 cases and multiple in 5 cases. Surgery was performed for 22 patients due to the varied significant symptoms such as arrhythmia, pericardial effusion, swoon and congestive heart failure with dyspnoea. Five patients were discharged hospital without surgical treatment. The surgical approaches were adopted according to tumor location. Complete surgical resection was performed in 14 patients and partial resection in 8 patients. Seven patients were underwent valve reconstruction, 5 involving the mitral valve and 2 involving the tricuspid valve.</p><p><b>RESULTS</b>Histologic examination of the surgically resected tumors showed rhabdomyomas in 8 cases, fibromas in 5 cases, hemangiomas 3 cases, myxomas in 4 cases, fibrosarcoma in 1 case and yolk sac sarcoma in 1 case. Sixteen cases revealed stable haemodynamic status postoperative. Two cases occurred apparent symptoms of low cardiac output and significant arrhythmias, finally recovery after comprehensive treatment of restoration the heart function. There was a total of 4 patients in-hospital death following surgery due to multiorgan system failure. Of the 18 patients who survived after the surgery were followed up from 1 to 10 years, echocardiography showed the residual mass of the tumor with partial resection, rhabdomyoma diminishing in 2 patients and almost vanishing in 1 patient. The residual mass of one fibrosarcoma patient and one hemangioma patient were not increased. Patients with myxomas had no recur or systemic embolisation after the initial surgery. Five nonsurgical patients were followed up from 1 to 3 years, 2 patients without haemodynamic alterations, 1 patients with giant tumor of left ventricular free wall was died of arrhythmia, the other one was alive; the patient of multiple cardiac tumor with low cardiac output was died of heart failure.</p><p><b>CONCLUSIONS</b>Despite the benign histology of most paediatric primary cardiac tumours, there may be significant associated with morbidity and occasional mortality. Therapy strategies should be individualised: surgery is indicated in cases with significant clinical symptoms and close follow-up is necessary for asymptomatic patients. Total resection is not the only therapeutic aim. Most important is the restoration of the normal haemodynamic heart function.</p>
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Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Follow-Up Studies , Heart Neoplasms , Diagnosis , General Surgery , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To study the significance of plasma D-dimer and von Willebrand factor (vWF) and the therapeutic effect of compound glycyrrhizin in children with cytomegalovirus (CMV) hepatitis.</p><p><b>METHODS</b>Twenty healthy children, 16 asymptomatic cases with CMV infection and 52 cases of CMV hepatitis (21 cholestatic and 31 non-cholestatic) were enrolled. The 52 children with CMV hepatitis were randomly administered with conventional treatment alone or conventional treatment plus compound glycyrrhizin treatment. Plasma D-dimer and vWF levels were measured before and after treatment.</p><p><b>RESULTS</b>Plasma D-dimer and vWF levels in the CMV hepatitis group were markedly higher than those in the healthy control and asymptomatic CMV infection groups (P<0.01). The cholestatic hepatitis group had more increased plasma D-dimer and vWF levels compared with the non-cholestatic hepatitis group (P<0.01). Plasma D-dimer and vWF levels in the CMV hepatitis group were markedly reduced after conventional or compound glycyrrhizin treatment (P<0.01). Compound glycyrrhizin treatment decreased more significantly plasma D-dimer and vWF levels compared with the conventional treatment in children with CMV hepatitis (P<0.01).</p><p><b>CONCLUSIONS</b>The detection of plasma D-dimer and vWF is useful in the early assessment of liver damage in children with CMV hepatitis. Compound glycyrrhizin can decrease obviously plasma D-dimer and vWF levels and might thus provide protective effects against liver damage.</p>
Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Cytomegalovirus Infections , Blood , Drug Therapy , Fibrin Fibrinogen Degradation Products , Glycyrrhizic Acid , Pharmacology , Therapeutic Uses , Hepatitis, Viral, Human , Blood , Drug Therapy , Liver Circulation , von Willebrand FactorABSTRACT
<p><b>OBJECTIVE</b>To investigate the severity related influencing factor and treatment strategy of severe acute pancreatitis with early organ dysfunction.</p><p><b>METHODS</b>From July 2007 to December 2008, 167 patients with severe acute pancreatitis were treated in the Surgical Department of Ruijin Hospital. The relationships between the happening of early organ dysfunction and outcome of the patients were observed, with operative or nonoperative treatment strategy.</p><p><b>RESULTS</b>Among 167 patients, 68 patients have early organ dysfunction, in which 39 with single organ dysfunction and 29 with multiple organ dysfunction. The early organ dysfunction were involved in 47.1% in cardiovascular system, 35.3% in lung and 29.4% in kidney. Aging (P < 0.05) and higher APACHE II score (P < 0.05) predicted a poor prognosis, which were benefit from early operation.</p><p><b>CONCLUSIONS</b>The mortality of the patients with SAP is related to age, and the degree of organ dysfunction as well. In the first phase of the disease, the selection of operation depends on the trends and the degree of early organ dysfunction before infected necrosis happens, with the aid of SOFA score as a scale.</p>
Subject(s)
Humans , Acute Disease , Aging , Multiple Organ Failure , Pancreatitis , Diagnosis , PrognosisABSTRACT
The present study aimed to observe the morphological distribution of bone marrow (BM)-derived Nkx2-5(+) cardiac progenitor cells (CPCs) in bone marrow niche and evaluate the effect of acute myocardial ischemia (AMI) on the mobilizion of BM-derived Nkx2-5(+) CPCs. Animal models of BALB/c mouse AMI, cerebral and hind-limb ischemia were established. Nanogold labeling method, immunofluorescence and Western blot were used to identify the distribution of BM-derived Nkx2-5(+) CPCs and the expressions of Nkx2-5 protein in peripheral blood and BM after AMI. Meanwhile, in different ischemia organ models and after AMD3100 (SDF-1/CXCR4 antagonist) pretreatment in AMI model, Nkx2-5 protein expressions in peripheral blood were also assayed. Nkx2-5(+) CPCs were found to locate in cavitas medullaris. The percentage of Nkx2-5(+) CPCs in blood increased immediately after AMI. Nkx2-5 protein expression in peripheral blood was also upregulated at the timepoint of 24 h post-AMI (P<0.01) and kept stable without further enhancement from day 1 to day 7 post-AMI. In BM, Nkx2-5 protein expression was upregulated immediately after AMI and downregulated afterwards (P<0.01). After AMD3100 pretreatment in AMI group, Nkx2-5 protein expression was significantly inhibited in peripheral blood (P<0.05). In cerebral and hind-limb ischemia models, Nkx2-5 protein expressions were significantly lower than that in AMI group (P<0.01), but with no significant difference to control group. These results suggest that Nkx2-5(+) CPCs are physiologically resident in BM and AMI initiates mobilization of BM-derived Nkx2-5(+) CPCs in a predominant organ-specific manner. In the procedure of mobilization, SDF-1 may play a critical role in a chemoattracted manner.
Subject(s)
Animals , Mice , Bone Marrow , Metabolism , Hematopoietic Stem Cell Mobilization , Homeodomain Proteins , Metabolism , Mice, Inbred BALB C , Myocardial Infarction , Metabolism , Myocardium , Cell Biology , Stem Cells , Cell Biology , Transcription Factors , MetabolismABSTRACT
<p><b>OBJECTIVE</b>Neurally adjusted ventilatory assist (NAVA) is a new mode of mechanical ventilation that delivers ventilatory assist in proportion to neural effort. This study aimed to compare the hemodynamic safety, oxygenation and gas exchange effects ventilated with NAVA and with pressure support ventilation (PSV) in infants who underwent open-heart surgery.</p><p><b>METHODS</b>Twenty-one infants who underwent open-heart surgery for congenital heart disease (mean age 2.9+/- 2.1 months and mean weight 4.2+/- 1.4 kg) were enrolled. They were ventilated with PSV and NAVA for 60 minutes respectively in a randomized order. The hemodynamic, oxygenation and gas exchange effects produced by the two ventilation modes were compared.</p><p><b>RESULTS</b>Three cases failed to shift to NAVA because of the bilateral diaphragmatic paralysis after operation. In the other 18 cases, there were no significant differences in the heart rate (HR), systolic blood pressure (BPs) and central venous pressure (CVP) in the two ventilation modes. The PaO2/FiO2 (P/F) ratio in NAVA was slightly higher than in PSV, but there was no statistical difference. PaCO2 did not show significant differences in the two modes. The peak inspiratory pressure (PIP) and electrical activity of the diaphragm (EAdi) in NAVA were significantly lower than in PSV. The EAdi signal after extubation was higher in infants who needed reintubation or intervention of noninvasive mechanical ventilation than in those who were extubated successfully (30.0+/- 8.4 microV vs 11.1+/- 3.6 microV; P<0.01).</p><p><b>CONCLUSIONS</b>As the first study of application of NAVA in infants in China, this study shows that NAVA has the same homodynamic effects as PSV. However the PIP for maintaining the same level of PaCO2 in NAVA is significantly lower than that in the traditional PSV. Monitoring the EAdi signal after extubation may show the risks of reintubation or intervention of noninvasive mechanical ventilation.</p>
Subject(s)
Female , Humans , Infant , Male , Heart Defects, Congenital , General Surgery , Hemodynamics , Respiration, Artificial , MethodsABSTRACT
<p><b>BACKGROUND</b>The Lecompte (REV) procedure is used to correct abnormal ventriculoarterial connections in patients with congenital heart diseases; it avoids the need for an extracardiac conduit for pulmonary outflow tract reconstruction. The present study aimed to investigate effectiveness and criteria of the REV procedure in children with abnormal ventriculoarterial connections.</p><p><b>METHODS</b>Thirty-eight children (mean age, (2.2 +/- 1.7) years; mean weight, (11.5 +/- 3.8) kg) with abnormal ventriculoarterial connections who had an REV procedure in our hospital from January 1998 to May 2006 were studied. Only 10 patients had the usual anteroposterior relationship of the two great arteries. The infundibular septum between the two semilunar valves was aggressively resected to enlarge it and construct a straighter left ventricular outflow tract and a wide tunnel between the ventricular septal defect (VSD) and the aorta. Eighteen cases had the original REV procedure; 20 had a modified REV procedure.</p><p><b>RESULTS</b>All patients are alive; none developed severe complications. The postoperative right ventricular (RV) to left ventricular (LV) pressure ratio was 0.20-0.45. Five patients had RV dysfunction; 2 patients had a pressure gradient in the RV ventricular outlet of 30.0-34.5 mmHg; 3 cases had a 37.5-47.3 mmHg pressure difference in the RPA. All patients had an RV pressure less than half the systemic pressure. These gradients' magnitudes in all patients were consistent with the post-operative RV to LV pressure ratio (P < 0.05). During the follow-up (mean, (4.2 +/- 0.6) years), 2 patients had an RPA pressure gradient of 24.0-29.3 mmHg which abated to less than 10 mmHg after two years.</p><p><b>CONCLUSIONS</b>The REV procedure provides satisfactory short- to medium-term results. It may be superior to the Rastelli procedure for treating ventriculoarterial connection abnormalities; it allows early, complete anatomic repair and reduces the need for late re-operation, since no extracardiac conduit is needed. Longer follow-up is needed to determine long-term outcomes.</p>