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Objective@#To explore the intelligence, self-concept and psychosocial adaptability among girls with precocious puberty,and to provide theoretical basis for the prevention and treatment of precocious puberty in girls.@*Methods@#Performed the Wechsler Preschool and Primary Scale of Intelligence, the Piers-Harris Children’s Self-concept Scale and the Social Adaptive Quotient for evaluating the intelligence quotient (IQ), self-concept and psychosocial adaptability of 45 precocious girls and 90 normal girls,respectively. The differences between these two groups of girls were analyzed.@*Results@#The level of intelligence of precocious girls (119.80±16.37) was higher than that of normal girls (109.96±17.13)(t=3.19, P<0.01). The total score of self-concept of precocious girls (57.98±6.14) was lower than that of girls in the normal group (61.68±5.16)(t=3.68, P<0.01). Furthermore, the independent functional factors, cognitive functional factors, social self-control factors and ADQ of precocious girls were lower than those of normal girls (P<0.01), and 24.4% of them were at the lower limit of psychosocial adaptability, lower than those of normal girls(U=4.84，P<0.01).@*Conclusion@#Girls with precocious puberty show impairments on the development of intelligence, self-concept and psychosocial adaptability.
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@#Objective To investigate the early safety and efficacy of transapical transcatheter aortic valve implantation (TAVI) for high-risk elderly patients with pure aortic valve insufficiency. Methods A prospective multicenter clinical study of domestic J-valveTM TAVI for high-risk native non-calcified aortic valve insufficiency was conducted from April 2014 to May 2018, and the early postoperative results were analyzed. A total of 82 patients were enrolled, including 62 patients from West China Hospital, Sichuan University, 16 patients from Zhongshan Hospital, Fudan University, and 4 patients from Beijing Fuwai Hospital, National Center for Cardiovascular Diseases. There were 55 males and 27 females. The age was 61-90 (73.8±6.3) years. The logistic EuroSCORE was 10.0%-44.4% (17.5%±8.1%). All patients underwent TAVI using J-ValveTM system. Clinical evaluation and echocardiography were performed preoperatively and 1 month postoperatively. Multislice spiral CT was reviewed before discharge. Results Three patients were transferred to thoracotomy for cardiopulmonary bypass operation, and 1 patient had decreased cardiac function due to leakage of the valve 1 week after surgery. The overall technical and procedural success rate was 95.1% and 93.9%, respectively. During hospitalization, 1 patient died of moderate pericyclosis complicated with multiple organ failure, and 1 patient died of pulmonary infection. Six (7.6%) patients received pacemaker implantation due to new onset Ⅲ° atrioventricular block. Echocardiographic follow-up showed paravalvular leak was observed in the few of patients, mild paravalvular leak was in 13 patients on the 30th day. Two patients showed moderate paravalvular leak. Left ventricular end-diastolic volume decreased from 197.7±66.8 mL (pre-TAVI) to 147.2±53.3 mL (30-day post-TAVI) (P<0.05). Mean pressure gradient was 9.5±4.1 mm Hg (30-day post-TAVI). Conclusion This multicenter study demonstrates that TAVI with the J-Valve system for the treatment of pure aortic regurgitation is associated with sustained clinical and functional cardiovascular benefits in high-risk patients with symptomatic aortic regurgitation early-term follow-up. Our results further support that TAVI with the specific designed J-Valve system is an acceptable alternative therapy for high-risk patients with pure AR. Our result demonstrates good early-term durability and preserved hemodynamic function. The procedure appears to offer an adequate and lasting resolution for selected patients with pure aortic regurgitation.
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@#Objective To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) in adult patients with cardiac surgery, analyze the risk factors associated with the mortality and other severe complications and to discuss prevention methods of complications during ECMO treatment. Methods The clinical data of 26 patients with cardiac surgery, who underwent ECMO because of cardiopulmonary insufficiency ect in Zhongshan Hospital, Fudan University from January 2012 to September 2017, were retrospectively analyzed. There were 19 males and 7 females aged 24–80 (58.0±13.9) years. Results Twelve (42.3%) patients successfully weaned from ECMO and six (23.1%) were discharged from hospital. Among 26 patients, 24 received VA ECMO (veno-arterial ECMO), including 5 after heart transplantation, 9 after heart valve surgery, and 3 were successfully weaned from ECMO. Seven patients with valvular surgery underwent ECMO within 48 hours due to refractory low cardiac output syndrome (LCOS). Eight patients underwent major angioplasty, 3 of whom were successfully weaned from ECMO. Four patients underwent coronary artery bypass grafting and other cardiac surgeries. Patients with VA ECMO were treated with femoral vein-femoral artery cannulation except for 2 patients undergoing femoral vein-radial artery cannulation after major angioplasty. Patients with VV ECMO (veno-venous ECMO) underwent femoral vein-jugular vein cannulation. After ECMO support, 10 patients with bleeding occurred, and 5 patients were successfully weaned from ECMO. All patients had transfusion therapy during the assist period, 7 patients had infection after ECMO support, 4 patients suffered severe distal limb ischemia. There was no significant difference in the lactic acid between the survival and the dead patients before and after ECMO support. However, the decline of serum lactic acid in the survivors was faster than that of the dead patients. The trend was the most significant within 6 h after the operation. Conclusion ECMO is one of the significant treatments for LCOS and refractory hypoxemia after cardiac surgery. The type of cardiac surgery and the timing of catheter placement are key factors for the success of ECMO. The different ways of ECMO intubation, prevention and control of bleeding during ECMO, monitoring and management of internal environment and the strategies of anti-infection are all important for success of ECMO.
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Abstract Objective: To assess the clinical value of four models for the prediction of cardiac surgery-associated acute kidney injury (CSA-AKI) and severe AKI which renal replacement therapy was needed (RRT-AKI) in Chinese patients. Methods: 1587 patients who underwent cardiac surgery in the department of cardiac surgery in the Zhongshan Hospital, Fudan University, between January 2013 and December 2013 were enrolled in this research. Evaluating the predicting value for cardiac surgery-associated AKI (AKICS score) and RRT-AKI (Cleveland score, SRI and Mehta score) by Hosmer-Lemeshow goodness-of-fit test for the calibration and area under receiver operating characteristic curve (AUROC) for the discrimination. Results: Based on 2012 KDIGO (Kidney Disease: Improving Global Outcomes) AKI definition, the incidence of AKI and RRT-AKI was 37.4% (594/1587) and 1.1% (18/1587), respectively. The mortality of AKI and RRT-AKI was 6.1% (36/594) and 66.7% (12/18), respectively, while the total mortality was 2.8% (44/1587). The discrimination (AUROC=0.610) for the prediction of CSA-AKI of AKICS was low, while the calibration (x2=7.55, P=0.109) was fair. For the prediction of RRT-AKI, the discrimination of Cleveland score (AUROC=0.684), Mehta score (AUROC=0.708) and SRI (AUROC=0.622) were not good; while the calibration of them were fair (Cleveland score x2=1.918, P=0.166; Mehta score x2=9.209, P=0.238; SRI x2=2.976, P=0.271). Conclusion: In our single-center study, based upon valve surgery dominant and less diabetes mellitus patients, according to KDIGO AKI definition, the predictive value of the four models, combining discrimination and calibration, for respective primary event, were not convincible.