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@#Objective To compare and investigate the efficacy and differences of modified B-T shunt, central shunt and right ventricle-pulmonary artery (RV-PA) connection in the treatment of pulmonary atresia with ventricular septal defect (PA/VSD). Methods A total of 124 children with PA/VSD underwent initial palliative repair in Shanghai Children's Medical Center from September 2014 to August 2019, including 63 males and 61 females, aged 7 days to 15 years. They were divided into in a modified B-T shunt group (55 patients), a central shunt group (22 patients) and a RV-PA connection group (47 patients). The clinical data of these children were retrospectively analyzed. Results There were 9 early deaths after palliation, with an early mortality rate of 7.3%. The mean follow-up time was 26.5±20.3 months, with 5 patients lost to follow-up, 5 deaths during the follow-up period, and 105 survivors. The 1-year and 5-year survival rates were both 89.7%. The monthly increased Nakata index was 5.2 (–0.2, 12.3) mm2/m2, 9.2 (0.1, 23.6) mm2/m2, 6.3 (1.8, 23.3) mm2/m2 in the modified B-T shunt group, the central shunt group, and the RV-PA connection group, respectively, with no statistical difference among the three groups. The 1-year survival rate was 85.3%, 78.4%, 95.2%, and the 5-year (4-year in the central shunt group) survival rate was 85.3%, 58.8%, 95.2% in the three groups, respectively, with a statistical difference among them (P<0.05). The complete repair rate was 36.5%, 19.0% and 67.4% in the three groups, respectively, with a statistical difference among the three groups (P<0.001). Conclusion All these three palliative surgical approaches can effectively promote pulmonary vascular development. But compared with systemic-pulmonary shunt, RV-PA connection has a lower perioperative mortality rate and can achieve a higher complete repair rate at a later stage, which is beneficial for long-term prognosis.
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Objective:To analyze the application effect of the information platform based on the Internet of Things (IoT) in the screening and management of patients with chronic obstructive pulmonary disease (COPD).Methods:In this cross-sectional study, 151 062 residents who participated in the screening in the districts covered by 33 general hospitals and 289 primary medical institutions within the framework of Henan Provincial Center for COPD Prevention and Treatment from November 2021 to October 2022 were included as the subjects. Spirometer based on the IoT was used to conduct pulmonary function tests for subjects who scored 16 points or more with COPD Screening Questionnaire (COPD-SQ), and the subjects were evaluated and managed through the structured electronic data in the information platform. The distribution characteristics and follow-up of the subjects and COPD patients were described and the application effect of this strategy in patients screening and management was analyzed.Results:A total of 151 062 residents with complete basic information in the information platform completed the questionnaire. High-risk population of COPD accounted for 26.5% (40 042/151 062) of the population who received the questionnaire screening, and more than 50% had respiratory symptoms, such as chronic cough (59.4%), or shortness of breath (77.6%). The proportion of high-risk population increased with age, especially after 50 years old. Compared with non-smokers, the proportion of high-risk group was significantly higher (77.1% vs 16.4%) in the group with smoking index over 600. Biofuel exposure (61.3% vs 22.1%) and family history of respiratory diseases (64.2% vs 22.6%) were associated with an increased proportion of high-risk groups, with statistically significant differences ( P<0.001). 5 268 patients were diagnosed with COPD by pulmonary function tests, and the prevalence of COPD in high-risk groups was 27.8% (5 268/18 965), the prevalence rate of male was 34.0% (3 942/11 588), which was higher than that of female 18.0% (1 326/7 377). 2 950 patients (56.0%) completed at least one follow-up of symptom questionnaire and 510 patients (9.7%) completed more than one follow-up of pulmonary function test. Conclusion:The screening and management strategy of COPD based on the IoT and information technology can improve the efficiency of COPD screening, and improve the status quo of under-diagnosis and discontinuous follow-up of COPD.
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Objective:To summarize the prognosis of medullary thyroid carcinoma (MTC) patients with biochemical recurrence (the increase of postoperative calcitonin and no abnormal imaging) and to investigate the optimal cut-off value of calcitonin for postoperative structural recurrence (with imaging abnormality).Methods:Literature retrieval was conducted for PubMed, CNKI, EMbase, Web of Science, Cochrane and other databases, and literatures related to the increase of calcitonin after MTC surgery were included. Review Manager 5.4 software was used for Meta-analysis of the recurrence and death. SPSS 23.0 software was used and receiving operating characteristic (ROC) curve was used to analyze the rising folds of postoperative calcitonin level in comparison with the maximum value of experiment detection, and to predict the outcome of biochemical recurrence transforming to structural recurrence, and then the optimal cut-off value could be worked out.Results:A total of 7 studies including 1 005 MTC patients (276 cases of biochemical recurrence and 542 cases of biochemical cure). Meta-analysis showed that structural recurrence rate in postoperative biochemical recurrence group [40.6% (112/276) vs. 2.2% (12/542); OR = 27.99, 95% CI 14.57-53.78, P < 0.001] and mortality [10.0% (19/190) vs. 0.96% (3/312); OR = 7.26, 95% CI 2.42-21.84, P < 0.001] were higher than those in the biochemical cure group (normal postoperative calcitonin level and no disease state). The data of 89 MTC patients with biochemical recurrence were collected in another 4 studies. ROC curve analysis showed that area under the curve of the rising folds of postoperative calcitonin level in predicting structural recurrence was 0.825; according to the cut-off value at all sections, the optimal cut-off value of the increased postoperative calcitonin was 50 times, the sensitivity was 66. 7%, the specificity was 88.6%. Conclusions:MTC patients with postoperative biochemical recurrence have higher structural recurrence rate and mortality compared with patients with normal postoperative calcitonin. The postoperative elevation of calcitonin more than 50 times the maximum value of the laboratory detection can be taken as the critical diagnostic value, when more than 50 times is prone to structural recurrence.
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Objective:To analyze the early postoperative mortality and long-term reoperation of ASO and to explore the surgical risk and the reasons of long-term reoperation.Methods:The clinical data and follow-up data of ASO children undergoing surgery in Shanghai Children Medical Center from January 2010 to December 2020 were analyzed retrospectively. Four groups were divided into transposition of the great vessels(TGA/IVS) , transposition of the great vessels with ventricular septal defect(TGA/VSD) , Taussig-bing anomaly(TBA) , and two stage ASO(Ⅱ-ASO) groups. χ2 test was used to analyze the early mortality and long-term reoperation rates of ASO in different groups. Results:A total of 861 ASO patients were included in this study and 108 died early(12.5%, 108/861) . Seven hundred and fifty three cases were followed up and 102 cases were lost(13.5%, 102/753) . The median follow-up time was 7.23 years and the quartile interval was 4.74-9.37 years old. Sixty six patients(10.1%, 66/651) underwent long-term reoperation. Four patients(6%, 4/66) died after reoperation. In 241 cases of TGA/IVS, 24 cases(10%) were performed reoperation. In 256 cases of TGA/VSD, 23 cases(9%) had reoperation. In 126 cases of TBA, 18 cases(14.3%) for reoperation. And in 28 cases of Ⅱ-ASO only 1 case(3.6%) had reoperation. Among all the reoperation cases, there were 36 cases(2 deaths) for pulmonary angioplasty, 2 cases for pulmonary stenting, 10 cases for right ventricular outflow tract obstruction(RVOTO) repair, 2 cases for aortic valvularplasty, 5 cases for aortic valve replacement(2 deaths), 4 cases for aortic anastomotic stenosis repair, 3 cases for left ventricular outflow tract obstruction(LVOTO) repair, 2 cases for VSD residual shunt repair and 2 cases for coarctation of the aorta(CoA) correction.Conclusion:The early mortality rate of ASO surgery is still higher than that of developed countries. Long-term follow-up after ASO surgery should focus on right ventricular outflow tract stenosis and aortic valve insufficiency.
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Objective:To study the changes of stenotic segment trachea diameter, trachea length and carina angle before and after slide tracheoplasty.Methods:From January 2010 to January 2018, 77 children with congenital tracheal stenosis(female=36) with complete clinical data accepted slide tracheoplasty in Shanghai Children's Medical Center were selected as the observation group. The diameter of stenosis segment, the length of stenosis segment, the full length of trachea and carina angle were measured by CT image, and the ratio of stenosis segment length to full trachea length was calculated. A group of children with normal trachea morphology and the same sample number, and they had no significant difference in age, height and weight were selected as the control group.Results:The median operative age of 77 children in the observation group was 1.3(1.1, 1.9)years old, the height was 76.0(72.0, 83.0)cm, and the weight was 9.0(7.9, 10.8)kg. The age, height and weight of 77 children in the control group were 1.5(1.0, 2.0) years old and 78.0(71.0, 85.0) cm, 9.2(7.9, 11.0) kg respectively. After slide tracheoplasty, the diameter of trachea in the stenotic segment of children increased from 2.7 mm to 4.4 mm, which was increased by 63.0%( P<0.001), but still smaller than that of children in the control group(6.1 mm). The average length of trachea was shortened by 0.7 cm( P<0.001), and there was no significant difference between the total length of trachea(5.4 cm) and the total length of trachea(5.5 cm). The postoperative carina angle decreased by 27.9°( P<0.001), there was no significant difference in postoperative carina angle between the observation group(93.0°) and the control group(90.7°). Conclusion:The diameter of reconstructed trachea in children with CTS is significantly increased, the length and carina angle of trachea become smaller after slide tracheoplasty. The morphology of trachea is more similar to children in the control group.
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Objective:To investigate the efficacy and safety of the modified gasless unilateral axillary approach (MGUAA) endoscopic thyroid surgery in treatment of papillary thyroid microcarcinoma (PTMC) .Methods:From Jan. 2019 to Dec. 2019, 90 patients receiving PTMC (cT1N0M0, cI stage, 8th, 2017 AJCC) therapy by modified gasless unilateral axillary approach endoscopic thyroid surgery (MGUAA group, n=41) , and conventional open thyroid surgery (OS group, n=49) were retrospectively analyzed. Ninety patients were enrolled in the study, including 14 males and 76 females,with the mean age (42.1±12.0) years.The effectiveness of central lymph node dissection (CLND) , the operation time, the types of operation, the amount of drainage, the duration of hospital stay, the related complications, the postoperative pain of neck and axillary and the cosmetic satisfaction were compared between the two groups.SPSS 25.0 statistical software was used for statistical analysis, the measurement data was expressed by ±s, paired t test was used to compare the measurement data between groups, and Chi-square test was used to campare the count date between groups. Results:The mean age (35.0±8.6) years and the amount of surgical bleeding (12.3±7.3) ml in the MGUAA group were significantly lower than those (48.1±11.1) years and (16.1±4.3) ml in the OS group ( P<0.01) , while the mean operation time (99.1±19.5) min, the mean amount of drainage (221.4±67.9) ml and the postoperative drainage tube placement time (5.0±0.8) days were significantly higher than those of (70.6±17.8) min, (98.3±63.7) ml and (3.8±1.0) days in the MGUAA ( P<0.01) . There was no significant difference in the number of lymph nodes of CLND or the duration of hospital stay between the two groups ( P>0.05) . In terms of surgical complications, the transient recurrent laryngeal nerve injury, the postoperative hematoma, the postoperative infection, and the lymphatic leakage had no significant difference between the two groups ( P>0.05) . The MGUAA group had significant advantages in avoiding the postoperative dysphagia in front of neck, the postoperative pain of neck, and cosmetic satisfaction over the OS group [ (0.0% vs 28.6%) , (14.6% vs 71.4%) , (1.1±0.3) score vs (2.4±0.5) score ( P<0.01) ]. Whereas in axillary area pain on the surgical side, the MGUAA group was inferior to the OS group ( P<0.01) . Conclusion:The modified gasless unilateral axillary approach endoscopic thyroid surgery is a feasible, safe and cosmetically operation for PTMC (cT1N0M0, cI stage, 8th, 2017 AJCC) .
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Objective:To summarize the morphological characteristics and clinical experience of pulmonary artery sling(PAS) combined with anomalous bronchial branching, and provide new considerations for surgically treating PAS.Methods:A retrospective review of surgical experience of all patients with anomalous bronchial branching from January 2012 to December 2018 at Shanghai Children's Medical Center was conducted. There are 4 types according to the morphology of anomalous bronchial branching: tracheal bronchus, bronchial trifurcation, bridging bronchus, tracheal bronchus combined with bronchial trifurcation. The proportion of patients with anomalous bronchial branching combined with PAS was counted. The rate of tracheoplasty for four types was determined. We measured the interbronchial and subcarinal/subpseudocarinal angles before and after tracheoplasty.Results:140 patients were included in our study. The tracheal diameter of 11(21%, 11/53) patients with tracheal bronchus and 4(9%, 4/44) patients with bronchial trifurcation was normal. Among these patients, 125 patients had congenital tracheal stenosis(CTS). 115 patients underwent tracheoplasty. The rate of tracheoplasty of bridging bronchus was higher than tracheal bronchus(100% vs. 60%, P=0.000). One-stage surgery was performed in 76(61%) patients who had PAS. The interbronchial and subcarinal/subpseudocarinal angles were significantly reduced postoperatively( P=0.000). Conclusion:It is difficult to explain merely with vascular compression in patients with PAS with CTS and anomalous bronchial branching. One-stage slide tracheoplasty is currently the optimal option.
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Objective:To investigate the effects of miR-125b on radiosensitivity of cervical cancer cells and its possible downstream mechanism.Methods:The expression of miR-125b and Foxp3 in cervical cancer tissues and cells was detected by RT-qPCR. The HeLa cells were irradiated with 0, 2, 4 and 6 Gy of X-rays. The expression of miR-125b and Foxp3 in each group was detected by RT-qPCR. After downregulation of miR-125b expression and 6 Gy X-ray irradiation, the proliferation ability of HeLa cells was detected by MTT assay, and the expression of Bax and Bcl-2 proteins were detected by Western blot. The relationship between miR-125b and Foxp3 was detected by Targetscan and Dual luciferin reporter assay. After downregulation of Foxp3 expression and 6 Gy X-ray irradiation, the proliferation ability of HeLa cells was detected by MTT assay, and the expression of Bax and Bcl-2 proteins were detected by Western blot. The effects of miR-125b on radiosensitivity of HeLa cells through Foxp3 were detected. After down-regulation of Foxp3, the contents of IL-10 and TGF-β in supernatant were detected by ELISA.Results:The expression of miR-125b in the tissues and cells of cervical cancer was significantly decreased, while the expression of Foxp3 was significantly increased. The expression of miR-125b in HeLa cells was increased after radiation in a dose dependent manner. The expression of Foxp3 in HeLa cells was decreased after radiation in a dose dependent manner. After 6 Gy X-ray irradiation of HeLa cells, down-regulation of miR-125b increased the cell proliferation capacity, significantly reduced the expression of Bax and increased the expression of Bcl-2. miR-125b targets Foxp3 and negatively regulates Foxp3 expression. After 6 Gy X-ray irradiation of HeLa cells, down-regulation of Foxp3 significantly reduced the proliferation capacity of HeLa cells, increased the expression of Bax and decreased the expression of Bcl-2. Overexpression of miR-125b can enhance radiosensitivity of HeLa cells through Foxp3.After 6 Gy X-ray irradiation, down-regulation of Foxp3 reduced the expression of IL-10 and TGF-β in cells.Conclusions:Upregulation of miR-125b enhances the radiosensitivity of cervical cancer cells by targeting and negatively regulating Foxp3, and the mechanism of that may be related to the down-regulation of Foxp3 to reduce the expression of IL-10 and TGF-β in the cells.
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Due to the special geographical location and the complex ecosystem types, plateau wetlands play important ecological roles in water supply, greenhouse gas regulation and biodiversity preservation. Napahai plateau wetland is a special wetland type with low latitude and high altitude, and its microbial diversity was rarely studied. The diversity of microbial communities in the Napahai plateau wetland was analyzed using metagenomics method. Among the microbes detected, 184 phyla, 3 262 genera and 24 260 species belong to the bacterial domain, 13 phyla and 32 genera belong to the archaeal domain, and 13 phyla and 47 genera belong to the fungal domain. Significant differences in species diversity between soil and water were observed. Acidobacteria, Proteobacteria and Actinobacteria were dominant phyla in soil, while Proteobacteria and Bacteroides were dominant phyla in water. Since the carbon and nitrogen metabolism genes were abundant, the pathways of carbon fixation and nitrogen metabolism were analyzed. Calvin cycle, reductive tricarboxylic acid cycle and 3-hydroxypropionic acid cycle were the main carbon fixation pathways, while Proteobacteria, Chloroflexi, and Crenarchaeota were the main carbon-fixing bacteria group. As for the nitrogen cycle, nitrogen fixation and dissimilatory nitrate reduction were dominant in water, while nitrification and denitrification were dominant in soil. Proteobacteria, Nitrospirae, Verrucomicrobia, Actinobacteria, Thaumarchaeota and Euryarchaeota contributed to the nitrogen cycle. The study on microbial diversity of Napahai plateau wetlands provides new knowledge for the comprehensive management and protection of wetland environment in China.
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Carbon , Ecosystem , Metagenomics , Nitrogen , Soil Microbiology , WetlandsABSTRACT
Objective:To explore the clinical value of procalcitonin (PCT) in predicting mortality of patients with acute biliary pancreatitis (ABP).Methods:The clinical data of 196 ABP patients admitted in the emergency department of Ruijin Hospital Affiliated to Shanghai Jiaotong University Medical College from January 2013 to June 2017 were analyzed retrospectively. The enrolled patients were divided into survival group ( n=176) and death group ( n=20) according to clinical outcome, and their clinical characteristics, laboratory results(including WBC, CRP, PCT), APACHEⅡ score, BISAP score, modified Marshall score, SOFA score and CTSI at admission were compared between two groups. The ROC curve and AUC were used to evaluate the effectiveness of PCT and multiple scoring systems in predicting mortality in ABP patients, and the Delong test was used to compare the predictive efficacy of various methods at 1-2 d, 3-4 d, and 5-7 d days after onset. Results:The PCT level, APACHEⅡ score, BISAP score, modified Marshall score, SOFA score, and CTSI of patients in the death group were significantly higher than those in the survival group [6.98(3.12, 13.64) μg/L vs 0.55(0.17, 1.74) μg/L, 12.00(6.00, 18.75) vs 6.00(3.00, 9.00), 3.20±1.47 vs 1.59±1.05, 2.85±0.37 vs 1.96±0.64, 5.50(4.00, 9.50) vs 2.00(1.00, 4.25), 5.05±2.33 vs 3.39±1.74], and all the differences were statistically significant (all P values <0.05). The AUC of PCT for predicting death was 0.881 (95% CI 0.820-0.938)and the cut-off value was 2.44. The predictive value of PCT was similar to that of the modified Marshall score, BISAP score and SOFA score, but higher than that of APACHEⅡ score and CTSI (all P values <0.05). The predictive AUC of PCT at 3-4 days after onset was higher than that of modified Marshall score, BISAP score and SOFA score, and were significantly higher than those at 1-2 days after onset. Conclusions:PCT can be used to predict the mortality of ABP within 7 days of onset. The predictive value of PCT was comparable to the modified Marshall score, BISAP score and SOFA score, and the best predictive time was 3-4 days after onset.
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Objective:To investigate the role of miR-483-5p in adrenocortical cancer (ACC) and its possible mechanism.Methods:Quantitative real-time polymerase chain reaction was conducted to estimate the expression of miR-483-5p and CDK15 in ACC tissues and cell lines. The effects of miR-483-5p on proliferation were determined in vitro using CCK-8 proliferation assays, the changes of invasion of ACC cells were examined by Transwell. The molecular mechanism underlying the relevance between miR-483-5p and CDK15 was confirmed by luciferase assay and rescue assays.Results:We found a relatively higher miR-483-5p (2.36±1.02 vs 1.09±0.43) and lower CDK15 (0.57±0.26 vs 1.06±0.32) expression in ACC specimens and cell lines. CDK15 was verified as a direct target of miR-483-5p by luciferase assay. over-expression of miR-483-5p promoted proliferation (24 h: 0.26±0.03 vs 0.23±0.04, 48 h: 0.56±0.05 vs 0.41±0.03, 72 h: 0.73±0.04 vs 0.59±0.03) and invasion (95.78±4.66 vs 23.89±2.52) by down-regulating CDK15 expression.Conclusion:miR-483-5p plays a tumorigenesis role in ACC progression by down-regulating CDK15 expression, which may lead to a novel insight to the potential biomarker and novel therapeutic strategies for ACC.
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In the era of big data, hospital′s research data platform development is faced with challenges in how to strengthen the deep and efficient application of medical big data in their clinical research. The authors studied such problems of a tertiary hospital in Henan as low data value density, difficulty in structuring medical text language and mismatch between clinical research thinking and ability, in terms of the use of existing clinical data exploration system and effective use of data. Based on results of the study, they summarized relevant measures for effective use of medical data and considerations in the establishment of a clinical research big data center.For example, combination of " pre-structuring" and " post-structuring" in data collection for data quality control; exploration of deep mining of medical text data using machine learning technology based on unstructured text data, and perfection the intelligent analysis application function of clinical research big data; enhancement of talent training to promote clinicians′ capacity in using clinical big data; and enhancement of multi-disciplinary teambuilding and composite talent cultivation, for the purposes of more efficient use of medical big data and higher efficiency and quality of clinical research.
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Objective:Explore a predictive model for predicting postoperative hospital mortality in children with congenital heart disease.Methods:We retrospectively analyzed the characteristics of all children with congenital heart disease from January 1, 2006 to December 31, 2017 at Shanghai Children's Medical Center. Each procedure was assigned a complexity score based on Aristotle Score. In-hospital death prediction models including a procedure complexity score and patient-level risk factors were constructed using logistic regression analysis and machine learning methods. The predictive values of the models were tested by C-index. Results:A total of 24 693 patients underwent CHD operations were include in the study, there were 585 (2.4%) in-hospital deaths. In-hospital mortality for each procedure varies between 0 to 77.8%, with 32 procedures with 0 death record. The prediction model constructed using logistic regression found that in addition to the complexity score, other risk factors included age, height, operation history, echocardiography characteristics as well as certain laboratory test results (mainly coagulation factors) were significantly correlated with in-hospital death. Receiver operating curve analysis showed that prediction with only the complexity score resulted in an AUC of 0.654 (95% CI: 0.628-0, 681, P<0.01) while model containing patient-level risk factors had significant higher prediction value with AUC of 0.886 (95% CI: 0.868-0.904, P<0.01). Training with machine learning method resulted in a final prediction model with high prediction value ( AUC 0.889, with a sensitivity value for death prediction of 0.817). The key risk factors in machine learning model are in general agree with the logistic regression model however with subtle differences. Conclusion:Through combination of procedure complexity score with pre-operative patient-level factors, predictive model constructed using regression or machine learning method had high accuracy in in-hospital mortality prediction.
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@#To evaluate the surgical strategy and follow-up for pulmonary atresia with intact ventricular septum (PA/IVS) in our heart center. Methods From January 2008 to December 2018, 151 patients with PA/IVS were divided into two groups: a one-stage surgery group (26 patients), including 17 males and 9 females at an average age of 14.7±13.2 months, and a staged surgery group (125 patients) including 72 males and 53 females at an average age of 6.4±6.3 months. The clinical effectiveness of the two groups were analyzed. Results All patients were followed up for 1-11 years. Eighteen patients died and 19 patients were lost to follow-up. The 1-year, 5-year and 10-year survival rate was 90.2%, 87.0%, and 85.2%, respectively. Two patients died in the one-stage surgery group. Twelve patients died after initial surgery, and 4 patients died after final operation in the staged surgery group. The Z value of tricuspid valve (P=0.013) and severe right ventricular dysplasia (P=0.025) were the risk factors of postoperative death in the patients with PA/IVS. Furthermore, 58 patients completed final operation, and the total number of the final operation (including one-stage radical surgery) accounted for 55.6% (84/151). Five patients accepted the re-operation intervention in the medium-term follow-up. The rest of the patients recovered well. Only 2 patients were classified as grade Ⅲ in cardiac function, and the rest patients were classified as gradeⅠ-Ⅱ. Conclusion According to the degree of right ventricular hypoplasia, the age at operation and the presence or absence of coronary artery malformation, the individualized surgical strategy could significantly improve the success rate of PA/IVS, and early completion of right ventricular decompression operation is conducive to improve the chance for biventricular repair.
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Objective@#The purpose of this report was to discuss and evaluate the timing and outcome of reintervention for children with postoperative valve disease.@*Methods@#The clinical data of 139 patients with postoperative valve disease who received reintervention at SCMC from Sep. 2004 to Mar. 2019 were retrospectively analysed, including 85 males and 54 females. The age ranged from 8-175 months, and the weight ranged from 6.2-75.9 kg. With a mid-long term follow-up (2-133 months), the echocardiography result showed: 40 cases of aortic valve disease, 49 cases of mitral valve disease, 32 cases of tricuspid valve disease and 18 cases of pulmonary valve disease. All patients underwent reintervetion treatment, the distribution of reintervention methods were shown as follow: 47 cases of valve replacement, 40 cases of valvuloplasty, 23 cases of annuloplasty and 29 case of valve reconstruction.@*Results@#There were 6 in-hospital deaths with a mortality of 4.3%. The death cases included 2 cases of aortic disease, 2 cases of mitral disease, 1 case of tricuspid disease and 1 case of pulmonary disease. The early postoperative causes of death were acute myocardial failure, multiple organ failure and severe hyoxemia. Three delayed deaths occurred 8-26 months after operation because of cardiac insufficiency and cardiac shock. All survivors were under a follow-up of 4-148 months. The echocardiography showed the velocity of 92.3% valve stenosis patients had decreased significantly (P<0.05); the insufficient grades of 84.9% patients had reduced and maintained under morderate degree. 6 cases occurred aggravated insufficiency or stenosis and received reoperation in mid-term follow-up included 3 cases of aortic valve, 2 cases of pulmonary valve and 1 case of mitral valve. The cardiac function of survival patients has been improved after reintervtion, 83.1% patients maintained cardiac function at NYHA Ⅰ/Ⅱ at follow-up. The long-term survival rates of 4 valve disease were all over 90%.@*Conclusion@#The anatomical structure of chilidren’s valve is complicated and various, valve insufficiency and stenosis often occured after operation. The timing of reintervetion should focus on clinic symptom and cardiac function.The operation should be individually designed according to valve anatomy, which could effectly correct abnormal valve structure, promote cardiac function and improve living quality.
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Da Vinci robot has been widely used in pancreatic surgery nowadays. Pancreatic surgery is known as a difficult procedure in general surgery due to its surgical difficulty, complex anatomy, severe postoperative complications and high perioperative mortality. Vascular variation is another key point in surgical operation, which demands lots of attention and careful management. In physiological state, abdominal blood vessels may vary in different phenotypes, which occasionally cause troubles to surgeons, resulting in increased risk of vascular injuries, perioperative hemorrhage, hepatic or bile duct ischemia and consequent leakage and the like. Based on the previous research and our experience, it is recommended that the vascular variations be treated by specific surgical approaches and techniques in robot-assisted pancreatic surgery.
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Objective The purpose of this report was to discuss and evaluate the timing and outcome of reintervention for children with postoperative valve disease.Methods The clinical data of 139 patients with postoperative valve disease who received reintervention at SCMC from Sep.2004 to Mar.2019 were retrospectively analysed,including 85 males and 54 females.The age ranged from 8-175 months,and the weight ranged from 6.2-75.9 kg.With a mid-long term follow-up (2-133 months),the echocardiography result showed:40 cases of aortic valve disease,49 cases of mitral valve disease,32 cases of tricuspid valve disease and 18 cases of pulmonary valve disease.All patients underwent reintervetion treatment,the distribution of reintervention methods were shown as follow:47 cases of valve replacement,40 cases of valvuloplasty,23 cases of annuloplasty and 29 case of valve reconstuction.Results There were 6 in-hospital deaths with a mortality of 4.3％.The death cases included 2 cases of aortic disease,2 cases of mitral disease,1 case of tricuspid disease and 1 case of pulmonary disease.The early postoperative causes of death were acute myocardial failure,multiple organ failure and severe hyoxemia.Three delayed deaths occurred 8-26 months after operation because of cardiac insufficiency and cardiac shock.All survivors were under a follow-up of 4-148 months.The echocardiography showed the velocity of 92.3％ valve stenosis patients had decreased significantly (P ＜0.05);the insufficient grades of 84.9％ patients had reduced and maintained under morderate degree.6 cases occurred aggravated insufficiency or stenosis and received reoperation in mid-term follow-up included 3 cases of aortic valve,2 cases of pulmonary valve and 1 case of mitral valve.The cardiac function of survival patients has been improved after reintervtion,83.1％ patients maintained cardiac function at NYHA Ⅰ / Ⅱ at follow-up.The long-term survival rates of 4 valve disease were all over 90％.Conclusion The anatomical structure of chilidren's valve is complicated and various,valve insufficiency and stenosis often occured after operation.The timing of reintervetion should focus on clinic symptom and cardiac function.The operation should be individually designed according to valve anatomy,which could effectly correct abnormal valve structure,promote cardiac function and improve living quality.
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To investigate the value of renal resistive index (RRI) in early predictor and discriminator of severe acute pancreatitis (SAP)-related acute kidney injury (AKI). Methods A retrospective observational study was conducted. SAP patients complicated with AKI (within 1 week of onset) and admitted to intensive care unit (ICU) of Ruijin Hospital Shanghai Jiaotong University School of Medicine from January 2016 to June 2019 were enrolled. The RRI within 24 hours admission was measured. Clinical data such as acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), intra-abdominal pressure (IAP), arterial blood lactate (Lac), oxygenation index (PaO2/FiO2), base excess (BE), serum creatinine (SCr), urine output, norepinephrine (NE) and RRI were collected. Within 24 hours and 7 days after ICU admission, patients were grouped according to AKI classification criteria of Kidney Disease: Improving Global Outcomes (KDIGO), and the differences of relevant parameters were statistically analyzed. Influence factors of AKI grading were screened by Logistic regression analysis. Pearson correlation analysis was used to analyze the correlation between RRI and other parameters. The predictive value of RRI for AKI classification was analyzed by receiver operating characteristic (ROC) curve. Results A total 57 patients were included, with an average age of (54.6±13.5) years old, and APACHEⅡscore of 21.8±5.6. Within 24 hours, the number of patients suffered from stage 1-3 AKI were 19 (33.3%), 18 (31.6%) and 20 (35.1%), respectively. On day 7, the number of patients suffered from stage 0-3 AKI were 21 (36.9%), 8 (14.0%), 9 (15.8%) and 19 (33.3%), respectively. The higher APACHEⅡ score, CVP, IAP, Lac, NE dosage and RRI were found in the group with higher AKI grades, especially in the group with stage 3 AKI on day 7. RRI of patients with stage 3 AKI was significantly higher than that of patients with stage 1 and 2 AKI within 24 hours (0.74±0.04 vs. 0.65±0.05, 0.68±0.05, both P < 0.05). Similarly, RRI of patients with stage 2 and 3 AKI were significantly higher than that of patients with stage 0 and 1 AKI on day 7 (0.70±0.04, 0.74±0.04 vs. 0.65±0.05, 0.66±0.05, all P < 0.05). Multivariate Logistic regression analysis showed that RRI was an independent factor of AKI classification [odds ratio (OR) = 3.15, 95% confidence interval (95%CI) = 1.09-9.04, P < 0.05], and IAP and CVP also had significant impacts on AKI grading [OR value was 2.11 (95%CI = 1.16-4.22), 3.78 (95%CI = 1.21-12.90), both P < 0.05]. ROC curve analysis showed that the area under curve (AUC) of RRI for predicting AKI ≥2 stage was 0.87 (P < 0.05); the cut-off ﹥ 0.71, sensitivity was 71% and specificity was 83%. The correlation analysis showed that RRI was positively correlated to a certain extent with IAP and lactic acid (r1 = 0.49, r2 = 0.39, both P < 0.05). Conclusion High RRI on ICU admission was a significant predictor for development of severe AKI during the first week, and RRI can help predict the tendency of AKI in SAP.
ABSTRACT
To analyze the outcomes of early Fontan failure after Fontan takedown. Methods A retrospective study of early Fontan Failure(EFF) children undergoing Fontan takedown from November 2013 to December 2017 was performed. Fontan takedown was defined as takedown back to an intermediate circulation, superior cavopulmonary connection. Fontan takedown was performed in 14 patients. There were 9 boys and 5 girls. Children were on average aged(4. 3 ± 1. 4) years when they had Fontan procedure. The mean weight was(14. 3 ±2. 7)kg. Operative procedure was extra-cardiac Fontan in 5 children, 9 had intra-cardiac Fontan. Fenestration was used in 11/14 patients. The outcomes were summarized with statistics, and risk factors for mortality after Fontan takedown were identified. Results The mortality after Fontan takedown was 4/ 14(28. 6％). In two patients(14. 3％), ECMO was followed after takedown, one of them died after two days. The time of ICU stay and hospital stay was relatively long(17. 0 ±11. 2)days and(33. 8 ±19. 4)days. The interval time between the Fontan procedure and the takedown operation is the risk fact after Fontan takedown. Conclusion Fontan takedown can be used as an effective management for the early Fontan failure, still with a high risk of mortality. Early diagnosis and takedown is recommended for EFF.
ABSTRACT
Objective To evaluate the performance of the Sendai Guidelines,Fukuoka Guidelines and Pancreatic Cystic Lesions Management Guidelines (Chinese guidelines) in predicting malignant mucinous pancreatic cystic neoplasms (PCN).Methods A retrospective analysis of 196 patients,who received surgery and were pathologically identified as PCN or intraductal papillary mucinous neoplasms (IPMN),underwent surgical resection in Ruijin Hospital affiliated with Shanghai Jiao Tong University from January 2003 to April 2017 was performed.The differences on clinical and pathological parameters between malignant mucinous and benign mucinous PCN were compared.The accuracy,sensitivity,specificity,positive predictive value (PPV)and negative predictive value (NPV) of the indications for surgery in the Sendai,Fukuoka and Chinese Guidelines in predicting malignant mucinous PCN were calculated.Results Of 196 patients,39 patients (19.9％) were confirmed as malignant tumors and 157 patients (80.1％) were confirmed as benign tumors by pathology.There were significant differences on age,symptoms (abdominal pain,jaundice or pancreatitis),tumor solid composition,pancreatic duct diameter,tumor site,tumor diameter ＞3 cm,and serum CA199 level between malignant and benign patients (all P ＜0.05).But there were no significant differences on gender distribution,tumor diameter,mural nodules and the proportion of mucinous cystic neoplasm (MCN)and intra-ductal papillary mucinous neoplasm (IPMN).165 patients (84.2％) met the Sendai Guidelines,153 patients (78.1％) met the Chinese guideline,and only 61 patients (31.1％) met the Fukuoka Guidelines.All 39 patients with malignant tumors met the indications in Sendai Guidelines and Chinese guidelines,and only 35 patients had the indication for surgery in the Fukuoka Guidelines.The accuracy,sensitivity,specificity,PPV and NPV of the Fukuoka Guidelines for predicting the malignancy were 84.7％,89.7％,83.4％,57.4％ and 97.0％,compared to 35.7％,100％,19.8％,23.6％ and 100％ for the Sendai and 41.8％,100％,27.4％,25.5％ and 100％ for the Chinese guidelines,respectively.Conclusions The performance of the Chinese guideline is slightly better than the Sendai Guidelines,while both of them can lead to a larger number of patients undergoing unnecessary surgical resection.Though the rate of missed diagnosis could reach 10.3％,the Fukuoka Guidelines gets the highest accuracy.