Case-control study in pediatric septic shock with cardiomyopathy / 中国小儿急救医学

Objective:The risk factors and survival conditions of cardiomyopathy in childhood septic shock were retrospectively analyzed.Methods:Children with septic shock admitted to the PICU at Children′s Hospital of Chongqing Medical University from January 2015 to March 2021 were collected.The case group included children with septic shock and cardiomyopathy.The propensity score matching method was used to match children with septic shock without cardiomyopathy in a 1∶2 ratio as the control group.Basic clinical data, myocardial biomarkers, cardiac ultrasound indicators, organ function indicators and clinical outcome indicators were collected from two groups.Results:Forty-six patients were included in the case group and 92 patients in the control group.There were no significant differences in age, sex, pediatric critical care score, and basic disease between two groups.Moreover, left ventricular ejection fraction[51.0%(43.0%, 62.0%) vs.65.5%(60.6%, 69.0%)], left ventricle short-axis shortening rate (FS)[26%(21%, 33%) vs.35%(32%, 38%)], and oxygenation index(PaO 2/FiO 2)[324.0(234.3, 400.0) mmHg vs.400.0(265.8, 445.0)mmHg] in case group were lower than those in control group, while the incidence of the ST segment changes of the ECG index (21.7% vs.3.3%), lactate[3.20(1.20, 5.87)mmol/L vs.1.80(1.20, 3.40)mmol/L], and vasoactive drug score[25.14(14.84, 42.70)points vs.15.04(10.00, 26.70) points] in case group were higher than those in control group, the differences were all statistically significant (all P<0.05). The differences of PICU mortality (15.2% vs.14.1%) and 28 d mortality (29.1% vs.29.3%) between two groups were not significant ( P>0.05). The Logistic regression analysis showed that the FS was associated with cardiomyopathy occurring in septic shock[ OR (95% CI): 0.795 (0.714~0.870), P<0.001]. Children with septic shock with elevated cardiac troponin I had an increased risk of death. Conclusion:FS is an independent risk factor for cardiomyopathy in septic shock.There is no difference in survival between septic shock with and without cardiomyopathy.Cardiac troponin I is associated with the prognosis of septic shock in children.

Case-control study in pediatric septic shock with cardiomyopathy / 中国小儿急救医学

Objective:The risk factors and survival conditions of cardiomyopathy in childhood septic shock were retrospectively analyzed.Methods:Children with septic shock admitted to the PICU at Children′s Hospital of Chongqing Medical University from January 2015 to March 2021 were collected.The case group included children with septic shock and cardiomyopathy.The propensity score matching method was used to match children with septic shock without cardiomyopathy in a 1∶2 ratio as the control group.Basic clinical data, myocardial biomarkers, cardiac ultrasound indicators, organ function indicators and clinical outcome indicators were collected from two groups.Results:Forty-six patients were included in the case group and 92 patients in the control group.There were no significant differences in age, sex, pediatric critical care score, and basic disease between two groups.Moreover, left ventricular ejection fraction[51.0%(43.0%, 62.0%) vs.65.5%(60.6%, 69.0%)], left ventricle short-axis shortening rate (FS)[26%(21%, 33%) vs.35%(32%, 38%)], and oxygenation index(PaO 2/FiO 2)[324.0(234.3, 400.0) mmHg vs.400.0(265.8, 445.0)mmHg] in case group were lower than those in control group, while the incidence of the ST segment changes of the ECG index (21.7% vs.3.3%), lactate[3.20(1.20, 5.87)mmol/L vs.1.80(1.20, 3.40)mmol/L], and vasoactive drug score[25.14(14.84, 42.70)points vs.15.04(10.00, 26.70) points] in case group were higher than those in control group, the differences were all statistically significant (all P<0.05). The differences of PICU mortality (15.2% vs.14.1%) and 28 d mortality (29.1% vs.29.3%) between two groups were not significant ( P>0.05). The Logistic regression analysis showed that the FS was associated with cardiomyopathy occurring in septic shock[ OR (95% CI): 0.795 (0.714~0.870), P<0.001]. Children with septic shock with elevated cardiac troponin I had an increased risk of death. Conclusion:FS is an independent risk factor for cardiomyopathy in septic shock.There is no difference in survival between septic shock with and without cardiomyopathy.Cardiac troponin I is associated with the prognosis of septic shock in children.

The role of Drp1 mediated mitochondrial dynamics balance in sepsis induced cardiomyopathy / 中华急诊医学杂志

Objective:To analyze the effect of inhibiting excessive mitochondrial fission mediated by dynamic related protein 1 (Drp1) on the function of injured cells and mitochondria in the septic myocardium, and to explore the protective effect of maintaining mitochondrial dynamic balance in the pathogenesis of sepsis induced cardiomyopathy(SIC).Methods:Rat H9C2 cardiomyocytes were cultured and stimulated with lipopolysaccharide (LPS) to establish a model of SIC. Mitochondrial division inhibitor 1 (Mdivi-1) was given 30 min before LPS stimulation. They were divided into the control group, LPS stimulated group (LPS), Mdivi-1 control group (Mdivi-1), and LPS+Mdivi-1 intervention group (LPS+Mdivi-1). CCK-8 was used to detect the cell viability, and lactate dehydrogenase (LDH) was used to detect cellular damage. A MitoTracker probe was used to observe mitochondrial morphology by laser scanning confocal microscopy, JC-1 staining was used to detect mitochondrial membrane potential level, a DCFH-DA probe was used to detect total ROS level, and an AnnexinV-FITC/PI probe was used to detect the cell apoptosis ratio. The expression levels of mitochondrial fission protein Drp1 and fusion proteins Optic Atrophy 1(Opa1) and Mitofusin2 (Mfn2) were detected by real-time PCR and Western blot. One-way ANOVA was used to compare the differences between groups, and the LSD- t test was used for pairwise comparisons between groups. Results:Compared with the control group, cell viability, the average length of mitochondria and the mitochondrial membrane potential were decreased, and ROS production, the cell apoptosis rate and LDH were increased in the LPS group (all P<0.05). After Mdivi-1 intervention, compared with the LPS-stimulated group, the cell viability was increased, myocardial cell damage was reduced, the average length of mitochondria was prolonged, mitochondrial dysfunction was alleviated, and the cell apoptosis rate was inhibited in the LPS+Mdivi-1 group (all P<0.05). Conclusions:Mdivi-1 might inhibit mitochondrial fission mediated by Drp1, maintain mitochondrial dynamic balance, alleviate mitochondrial dysfunction and protect myocardial cells from LPS-induced injury.

A cohort study of developing a death risk prediction model in patients with septic shock based on MIMIC-Ⅲ database / 中华危重病急救医学

Objective:To develop and validate a model for predicting death risk in septic shock patients using LASSO-Logistic methods.Methods:A retrospective cohort study was conducted. Based on the open-source database Medical Information Mart for Intensive Care-Ⅲ v1.4 (MIMIC-Ⅲ v1.4), the septic shock patients meeting the Sepsis-3 criteria were included, and the data on demographic characteristics, major signs, laboratory examinations, hospitalization, and outcomes were extracted. Predictive variables were selected by LASSO regression and predictive models were derived using Logistic regression. The calibration of the model was evaluated using the Hosmer-Lemeshow test and discrimination was evaluated using the receiver operator characteristic curve (ROC curve).Results:A total of 693 patients with septic shock were enrolled, in which 445 patients survived and 248 patients dead within 30 days and the mortality was 35.8%. Logistic regression model was constructed according to nine predictive variables and outcome variables screened by LASSO regression method, which showed that advanced age, Elixhauser index, blood lactic acid (Lac), K + level and mechanical ventilation were associated with increased 30-day mortality [odds ratio ( OR) and 95% confidence interval (95% CI) was 1.023 (1.010-1.037), 1.047 (1.022-1.074), 1.213 (1.133-1.305), 2.241 (1.664-3.057), 2.165 (1.433-3.301), respectively, all P < 0.01], and reduced systolic blood pressure (SBP), diastolic blood pressure (DBP), body temperature, and pulse oxygen saturation (SpO 2) were also associated with increased 30-day mortality [ OR (95% CI) was 0.974 (0.957-0.990), 0.972 (0.950-0.994), 0.693 (0.556-0.857), 0.971 (0.949-0.992), respectively, all P < 0.05]. The calibration curve showed that the predicted risk of septic shock death risk prediction model had good agreement with the real situation. ROC curve analysis showed that the area under the ROC curve (AUC) of the prediction model was 0.839 (95% CI was 0.803-0.876), which could distinguish patients at risk of death from those at risk of survival. Conclusions:The septic shock death risk prediction model has a good ability to identify the 30-day mortality risk of septic shock patients, including nine hospital readily variables (age, Elixhauser index, mechanical ventilation, Lac, K +, SBP, DBP, body temperature and SpO 2). The model could be used by clinicians to calculate the risk of death in septic shock individuals.

Evaluation of the effect of CBL teaching on high simulation training for Children's first aid skills / 中华医学教育探索杂志

Objective:To explore the teaching effect of case-based learning (CBL) teaching combined with high-fidelity simulation (HFS) system training mode in first aid skills training for postgraduates majoring in pediatrics.Methods:In this study, 200 pediatrics graduate students in emergency clinical rotation were randomly divided into 4 groups: control group, traditional lecture teaching combined with simple simulation training; CBL group, CBL case combined with simple model training; HFS group, traditional lecture teaching combined with high-fidelity simulation training; CBL+HFS group, CBL case combined with high-fidelity simulation training. All the data were statistically analyzed with STATA 14.0 software.Results:Recent assessment results showed that in cardiopulmonary resuscitation, electroshock therapy, tracheal intubation skills, the average score of the CBL group was higher than that of the control group, and the average score of the HFS group was higher than that of the control group, with statistically significant differences ( P<0.05). In terms of non-technical ability, the average score of CBL group was higher than that of control group, and that of HFS group was higher than that of control group, with statistically significant differences ( P<0.05). There was interaction and cooperation between CBL and HFS, and the analysis results of the long-term assessment results were the same as those of the short-term assessment results. Conclusion:CBL combined with HFS is helpful to improve the first aid technical ability and non-technical ability of postgraduates majoring in pediatrics, which is worth further popularizing.

Progress in detoxification of inhibitors generated during lignocellulose pretreatment / 生物工程学报

Lignocellulose can be hydrolyzed by cellulase into fermentable sugars to produce hydrogen, ethanol, butanol and other biofuels with added value. Pretreatment is a critical step in biomass conversion, but also generates inhibitors with negative impacts on subsequent enzymatic hydrolysis and fermentation. Hence, pretreatment and detoxification methods are the basis of efficient biomass conversion. Commonly used pretreatment methods of lignocellulose are chemical and physic-chemical processes. Here, we introduce different inhibitors and their inhibitory mechanisms, and summarize various detoxification methods. Moreover, we propose research directions for detoxification of inhibitors generated during lignocellulose pretreatment.

Role of mitochondrial DNA in acute lung injury/acute respiratory distress syndrome induced by sepsis / 中华危重病急救医学

Sepsis is a common disease the field of critical care medicine. It is easy to be complicated by acute lung injury (ALI) or even acute respiratory distress syndrome (ARDS), which lead to high mortality. Although domestic and foreign scholars have carried out a large number of research on the pathogenesis of sepsis-related ALI/ARDS, it has not been fully elucidated so far. Recent studies have found that mitochondrial DNA (mtDNA) may play an important role in sepsis-related ALI/ARDS. This article reviews the current role of mtDNA in the pathogenesis of sepsis-related ALI/ARDS, with a view to providing new clues and evidence for the treatment of sepsis-related ALI/ARDS.

A preliminary study on perioperative nursing-sensitive quality indicators of type A aortic dissection / 中国实用护理杂志

Objective:To establish evidence-based perioperative nursing quality indicators of TAAD which assess and monitor the quality of nursing care in Chinese hospitals.Methods:Based on the "structure-process-result" three dimensional quality evaluation model, the perioperative nursing quality sensitivity index of TAAD and its calculation formula as well as data collection method were extracted from domestic and foreign literature. The results were demonstrated and revised by using Delphi method.Results:Sixteen sensitive indicators of perioperative quality of care for TAAD such as pain relief rate, preoperative dissection rupture mortality,emergency surgery and incidence of transfusion reactions were constructed.After two rounds of expert consultation, the expert positive coefficients were 91.6% and 100%, the expert authority coefficients were 0.96 and 0.93, and the coefficients of variation were 0.000-0.278.Conclusion:The perioperative nursing quality sensitivity indicators of TAAD were scientific and reliable,which can be applied to clinical utilization,and to inspire the nursing team to formulate an efficient specialist nursing strategy.

Analysis of risk factors for delirium after coronary artery bypass grafting / 中国实用护理杂志

Objective:To investigate the incidence and risk factors of delirium after coronary artery bypass grafting(CABG) and evaluate the predictive efficacy of these risk factors.Methods:The Confusion Assessment Method for the Intensive Care Unit(CAM-ICU) was used to evaluate the incidence of delirium in 314 CABG patients. Multivariate Logsictic regression analysis was used to determine the independent risk factors for delirium after CABG.Results:The incidence of delirium after CABG was 24.8%(78/314). The incidence of delirium after CABG was 25.7%(54/210) in the training set, and 23.1%(24/104) in the validation set. American Society of Anesthesiologists Physical State≥4 points, cardiopulmonary bypass, Mini-Mental State Examination <27 points, mechanical ventilation time, postoperative midazolam application, and serum albumin <30 g/L were independent risk factors for delirium after CABG.In the training set and validation set, patients with delirium score> 2.11 were in high-risk groups, and patients with delirium score ≤2.11 were in low-risk groups.Conclusions:The established delirium predictive model can not only stratify the risk of delirium, but also provide clinical scientific basis for postoperative delirium prevention and early screening.

A qualitative study on the work experience of responsible nurses in day surgery department based on ERAS concept / 中国实用护理杂志

Objective To understand the working experience of responsible nurses after the day surgery in the ward under the concept of accelerated rehabilitation surgery, in order to provide reference for the development of targeted interventions. Methods In this study, 10 primary nurses in 4 departments of day surgery in Shanghai Tenth People′s Hospital were interviewed by using the method of objective sampling in April_ May, 2018. The semi_ structured interview was conducted using the phenomenological research method in the qualitative study, and the Colaizzi phenomenological data was used. The analysis method analyzes the interview data. Results Through the repeated refinement, analysis and extraction of the interview data, the following two themes reflecting the work experience of the daytime surgical department responsible nurses: own growth and harvest, difficulties and challenges. Conclusion Based on the concept of accelerated rehabilitation surgery, daytime surgery is carried out to encourage responsible nurses to continuously improve their knowledge level and interpersonal communication skills. The nurses'professional identity is continuously improved. At the same time, due to the increase in nursing workload, the increase in nurse training needs and the incomplete workflow make nursing management Facing new problems and challenges.

A qualitative study on the work experience of responsible nurses in day surgery department based on ERAS concept / 中国实用护理杂志

Objective@#To understand the working experience of responsible nurses after the day surgery in the ward under the concept of accelerated rehabilitation surgery, in order to provide reference for the development of targeted interventions.@*Methods@#In this study, 10 primary nurses in 4 departments of day surgery in Shanghai Tenth People′s Hospital were interviewed by using the method of objective sampling in April-May, 2018. The semi-structured interview was conducted using the phenomenological research method in the qualitative study, and the Colaizzi phenomenological data was used. The analysis method analyzes the interview data.@*Results@#Through the repeated refinement, analysis and extraction of the interview data, the following two themes reflecting the work experience of the daytime surgical department responsible nurses: own growth and harvest, difficulties and challenges.@*Conclusion@#Based on the concept of accelerated rehabilitation surgery, daytime surgery is carried out to encourage responsible nurses to continuously improve their knowledge level and interpersonal communication skills. The nurses' professional identity is continuously improved. At the same time, due to the increase in nursing workload, the increase in nurse training needs and the incomplete workflow make nursing management Facing new problems and challenges.

Clinical analysis of drug hypersensitivity syndrome in 22 children / 临床儿科杂志

Objective To analyze the clinical diagnosis and treatment of drug hypersensitivity syndrome (DIHS) in children. Method The allergenic drugs, clinical manifestations, laboratory examinations, treatment effects, complications and prognosis in 22 children with DIHS were analyzed retrospectively. Results All 22 patients had a medication history and fever. Among them, 90.9% patients had erythema morbilliforme, 90.9% had liver damage, 18.2% had renal damage, 54.5% had superficial lymph node enlargement and 36.4% had granulocytosis. Five patients had serious complications. One patient was complicated by autoimmune hemolytic anemia, 3 patients had transaminase elevated greater than 10 times and 1 patient died due to hepatic failure, hepatic encephalopathy and multiple organ failure. The treatment mainly included the use of glucocorticoid and gamma globulin, and, if necessary, plasma exchange. Conclusion The incubation period of children with DIHS is long, and the skin lesions are mainly erythema morbilliforme. Most of the affected organs are mainly liver, and some of patients can be combined with eosinophilia. Glucocorticoid therapy is effective.

The status and influencing factors of the physician-nurse collaboration in feeding critically ill patients / 中国实用护理杂志

Objective To investigate the status and influencing factors of cooperation of doctors and nurses in the nutritional support of critically ill patients, and provide the basis for future improve the physician-nurse collaboration in the nutritional support. Methods Doctors and nurses who from ICU in Soochow were investigated by the Nurse-Physician Collaboration Scale (NPCS). Results The doctors′score of physician-nurse collaboration in the nutritional support of critically ill patients was 87.42 ±15.73, which was significantly higher than 80.97 ± 13.80 the nurses′(t=3.279, P= 0.001).In addition, under the item 1, 3, 5 in the dimension one as well as the total items in the dimensions two and three, the doctors′score was similarly higher than the nurses, and the differences are also statistically significant (Z=-3.894--1.964, all P<0.01 or 0.05). Technical titles, educational level and age was significantly related to the cooperative level between doctors and nurses respectively (χ2=11.037, P=0.012;F=3.488, P=0.037; F=3.499, P=0.016). Conclusions Doctors have higher levels of perceived collaboration than nurses in the nutritional support of critically ill patients, while both require further improvement. We should highlight the physician-nurse collaboration in feeding critically ill patients, and should improve the nutrition quality through standardized process management and active team cooperation.

Application of serum TK1 levels in diagnosis of non small cell lung cancer / 国际检验医学杂志

Objective To investigate the variation of serum Thymidine Kinase 1(TK1) in patients with non‐small cell lung canc‐er(NSCLC) and its clinical value .Methods Serum TK1 level of 129 patients with NSCLC and 90 healthy volunteers were measured by sensitive chemiluminescence dot‐blot assay .The serum TK1 level variation of 76 patients with NSCLC were compared before and after operation .Results Serum TK1 level of NSCLC patients were significantly higher than the level of healthy control group(PStage Ⅳ >Stage Ⅰ + Ⅱ >Stage Tis ,comparison between each other was of statistical differ‐ence(P<0 .05) .The serum TK1 level of NSCLC patients at 30th day after surgery was remarkably lower than which before surger‐y(P=0 .001 ,P<0 .01) .The serum TKl level was correlated with lymphatic metastasis(P<0 .01) ,but not with other factors such as pathology types ,age ,sex and smoking .The serum TK1 measurement was high sensitivity and specificity to the diagnosis of NSCLC .Conclusion The serum TK1 level detection has important clinical significance in diagnosis and evaluation of NSCLC pa‐tients .

The impact of head nurse's transformational leadership style on emotional labor and psychological empowerment of nurses / 中国实用护理杂志

Objective The study aimed to investigate the influence of head nurse's transformational leadership style on emotional labor and psychological empowerment of nurses.Methods Totally 851 staff nurses from four 3A hospitals were investigated with the Transformational Leadership Style Sub Scale of Multifactor Leadership Questionnaire,Psychological Empowerment Scale and Emotional Labor Scale.Results The head nurse's transformational leadership style scored (2.41±0.81).The psychological empowerment of nurses scored (3.27±0.47),its autonomy dimension scored (3.81±0.50),staying at medium level.The emotional labor of nurses scored (3.68±0.61),its deep acting dimension scored (4.67±0.76),which was above medium level.The indirect correlation coefficient between head nurse's transformational leadership style and emotional labor (r=-0.13) was far higher than direct correlation coefficient (r=-0.04).The psychological empowerment was the full mediation variable by which head nurse's transformational leadership style influence emotional labor of nurses.Conclusions Head nurse's transformational leadership style can enhance nurse's selfefficacy,cognition of work significance and work autonomy,so that nurse's deep acting and positive perception of emotional display can be increased,and nurse's emotional exhaustion and job burnout can be decreased to retain nurses.

Occurrence and Molecular Identification of Giardia duodenalis from Stray Cats in Guangzhou, Southern China

The objective of this study was to genetically characterize isolates of Giardia duodenalis and to determine if zoonotic potential of G. duodenalis could be found in stray cats from urban and suburban environments in Guangzhou, China. Among 102 fresh fecal samples of stray cats, 30 samples were collected in Baiyun district (urban) and 72 in Conghua district (suburban). G. duodenalis specimens were examined using light microscopy, then the positive specimens were subjected to PCR amplification and subsequent sequencing at 4 loci such as glutamate dehydrogenase (gdh), triose phosphate isomerase (tpi), beta-giardin (bg), and small subunit ribosomal RNA (18S rRNA) genes. The phylogenetic trees were constructed using obtained sequences by MEGA5.2 software. Results show that 9.8% (10/102) feline fecal samples were found to be positive by microscopy, 10% (3/30) in Baiyun district and 9.7% (7/72) in Conghua district. Among the 10 positive samples, 9 were single infection (8 isolates, assemblage A; 1 isolate, assemblage F) and 1 sample was mixed infection with assemblages A and C. Based on tpi, gdh, and bg genes, all sequences of assemblage A showed complete homology with AI except for 1 isolate (CHC83). These findings not only confirmed the occurrence of G. duodenalis in stray cats, but also showed that zoonotic assemblage A was found for the first time in stray cats living in urban and suburban environments in China.

Occurrence and Molecular Identification of Giardia duodenalis from Stray Cats in Guangzhou, Southern China

The objective of this study was to genetically characterize isolates of Giardia duodenalis and to determine if zoonotic potential of G. duodenalis could be found in stray cats from urban and suburban environments in Guangzhou, China. Among 102 fresh fecal samples of stray cats, 30 samples were collected in Baiyun district (urban) and 72 in Conghua district (suburban). G. duodenalis specimens were examined using light microscopy, then the positive specimens were subjected to PCR amplification and subsequent sequencing at 4 loci such as glutamate dehydrogenase (gdh), triose phosphate isomerase (tpi), beta-giardin (bg), and small subunit ribosomal RNA (18S rRNA) genes. The phylogenetic trees were constructed using obtained sequences by MEGA5.2 software. Results show that 9.8% (10/102) feline fecal samples were found to be positive by microscopy, 10% (3/30) in Baiyun district and 9.7% (7/72) in Conghua district. Among the 10 positive samples, 9 were single infection (8 isolates, assemblage A; 1 isolate, assemblage F) and 1 sample was mixed infection with assemblages A and C. Based on tpi, gdh, and bg genes, all sequences of assemblage A showed complete homology with AI except for 1 isolate (CHC83). These findings not only confirmed the occurrence of G. duodenalis in stray cats, but also showed that zoonotic assemblage A was found for the first time in stray cats living in urban and suburban environments in China.

Application of PDCA cycle to improve nurse's adaptation to assessment model based on cases tracking / 中国实用护理杂志

Objective To discuss the effect of the PDCA cycle in enhancing the case care ability of nurses in order for nurses to adapt to the assessment model of cases tracking.Methods The training was carried out for enhancing nurses' ability of case care according to the PDCA cycle.Results The scores of the case care,the quality of care in wards and the patient satisfaction degree increased significantly after applying the PDCA cycle compared with those before.The aims of ensuring medical safety,improving the work quality,and increasing patient satisfaction were achieved.Conclusions Training nurses' ability of case care following the PDCA cycle can effectively improve the nurses' ability of case care,make them adapt to the case tracking assessment model,which is worthy of promotion.

Genotyping of Giardia duodenalis Isolates from Dogs in Guangdong, China Based on Multi-Locus Sequence

This study aimed to identify the assemblages (or subassemblages) of Giardia duodenalis by using normal or nested PCR based on 4 genetic loci: glutamate dehydrogenase (gdh), triose phosphate isomerase (tpi), beta-giardin (bg), and small subunit ribosomal DNA (18S rRNA) genes. For this work, a total of 216 dogs' fecal samples were collected in Guangdong, China. The phylogenetic trees were constructed with MEGA5.2 by using the neighbor-joining method. Results showed that 9.7% (21/216) samples were found to be positive; moreover, 10 samples were single infection (7 isolates assemblage A, 2 isolates assemblage C, and 1 isolate assemblage D) and 11 samples were mixed infections where assemblage A was predominant, which was potentially zoonotic. These findings showed that most of the dogs in Guangdong were infected or mixed-infected with assemblage A, and multi-locus sequence typing could be the best selection for the genotype analysis of dog-derived Giardia isolates.

The early postoperation complications and treatments in 30 children with total anomalous pulmonary venous connection / 中国小儿急救医学

ObjectiveTo summarize the early postoperation complications and treatments in children with total anomalous pulmonary venous connection (TAPVC).MethodsThirty TAPVC children who were treated with corrective operation and transferred into PICU were collected.Patients were monitored routinely for electrocardiogram,blood pressure and SpO2.The routine treatment measures included mechanical ventilation,sedation,hemostasis,positive inotropic agents,diuresis,vasodilator,antibiotics and symptomatic treatment.Adrenaline or isoproterenol was used when low cardiac output syndrome appeared and temporary pacemaker was employed in the case of bradycardia.Alprostadil and sildenafil were added instantly after corrective operation when severe preoperative pulmonary hypertension or reactive postoperative pulmonary hypertension was present.ResultsThe early postoperation complication was found in 30 cases of TAPVC,which included 13 cases of pneumonia (43.3％ ),8 of arrhythmia (26.7％ ),7 of low cardiac output syndrome (23.3％),6 of respiratory failure (20.0％ ),4 of pulmonary hypertension ( 13.3％ ),3 of pulmonary edema or atelectasis( 10.0％ ) and 1 of pneumorrhagia ( 3.3％ ).Two cases died postoperatively.The interval of stay in PICU was 1 ～ 21 d and the mean time was (5.95 ± 4.94) d.ConclusionOccurrence of respiratory complications is high among early postoperative complications of TAPVC.Therefore,preventing pulmonary infection and maintaining pulmonary function should be viewed as the key points in early postoperative monitoring and managing.In addition,more attention should also be paid on correction of arrhythmia,prophylaxis and treatment of low cardiac output syndrome and pulmonary hypertension crisis,which may improve the postoperative survival rate and care quality of TAPVC.