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Objective:Postoperative venous obstruction (PVO) is the most severe complication of total anomalous pulmonary venous connection (TAPVC), and facing challenging re-intervention with high mortality. We aimed to review and analyze the follow-up and management of postoperative PVO in our center.Methods:We conducted a retrospective study of the patients with isolated TAPVC admitted in our center from October 2013 to October 2019. All available data and images of PVO patients were reviewed, such as the initial perioperative medical records, patients’ follow-up records, results of patients’ echo and CT angiography. Re-intervention including hybrid technique, sutureless technique, and patch augmentation, were carried out for postoperative PVO patients. The results were reviewed and analyzed to find the risk factors for adverse prognosis.Results:A series of 174 isolated TAPVC patients were admitted in our center and 169 received surgical treatment and 26 (26/169, 15.4%) had postoperative PVO. The diagnosis was made at a median time of 11.5 (0-77) weeks after initial operation and within 6 months of surgery in 22 (22/26, 84.6%) of the 26 patients. The subtype of TAPVC patients with postoperative PVO were: supracardiac 11 cases (11/26, 42.3%), cardiac 7 cases (7/26, 26.9%), infracardiac 5 cases (5/26, 19.2%), and mixed 3 cases (3/26, 11.5%). Bilateral obstruction and stenosis with diffusely small pulmonary veins were in 12 (12/26, 46.2%) and 3 cases (3/26, 11.5%) respectively. PVO progressed to worse condition in all the 26 cases during follow-up period. 8 (8/26, 30.8%) postoperative PVO patients underwent 10 re-interventions: one cases had 3 re-interventions. Five-year survival for patients with postoperative PVO was worse than those without postoperative PVO ( HR=6.46, 95% CI: 2.34-17.85, P<0.01). Risk factors for death or re-intervention in postoperative PVO patients were earlier presentation after TAPVC repair ( HR=0.85, 95% CI: 0.73-0.99, P=0.04) and an increased number of lung segments affected by obstruction ( HR=1.74, 95% CI: 1.01-2.99, P=0.04). Conclusion:Risk factors for death or re-intervention in postoperative PVO patients were earlier presentation after TAPVC repair and an increased number of lung segments affected, which should be focused on during strict follow-up period. Early re-intervention should be taken before irreversible secondary changes occur in these patients.
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Objective@#To reviewe our clinical experience on biventricular surgical repair of Swiss-cheese ventricular septal defects with two-patch and right ventricle apex excluding technique in 9 infants.@*Methods@#From March 2014 to March 2019, a series of 9 patients(M/F=2/7) with Swiss-cheese ventricular septal defects were admitted in our center to receive surgical treatment, with a median age of 4.8(2-12) months and a median body weight of 4.5(3.7-6.8) kg. All the 9 cases were symptomatic with shortness of breath and sweating. All the patients received echocardiography, ECG and chest X-ray. 3 patients with other intracardiac anomalies received CT angiography and 1 with severe pulmonary hypertension had transcatheter angiography. 4 cases of 9 had antenatal echocardiography but with no positive findings. The median cardiothoracic ratio was 0.63(0.58-0.72). 8 cases underwent one-stage surgical repair with the two-patch and right ventricle apex excluding technique and 1 case received a second-stage surgical repair with the same technique following a previous pulmonary artery banding procedure. The surgical repair was carried out with cardiopulmonary bypass under moderate hypothermia and using HTK cardioplagia to stop the heart in all the 9 cases. 2 fresh autologous pericardium patchs were used to closure defects of the outflow tract area and the apex trabecular defects respectively by excluding the apex of the right ventricle from the right ventricular inflow. Other intracardiac anomalies were corrected simultaneously. Patients were strictly followed up with a stanard protocol.@*Results@#All the operations were successful. Median cardiopulmonary bypass time and aortic clamping time were 96(68-167)min and 68(43-122)min respectively. Delayed chest closure were done in 2 cases within 48-72 hours postoperatively. The time of mechincal ventilation and ICU stay were 131.3(32-328)hours and 8.7(5-31)days respectively. All the patients were discarged in 11.5(9-42)days after operation. There was no mortality and major complication except for 1 case of low cardiac output syndrome, 2 cases of ventilator associated pnumonia and 2 cases of residual shunt(less than 2 mm). All the patients were followed up for 3.2 years(1 month-9 years). There was no death and major complication. The latest echocardiography results showed that the left and right heart function was normal in all the cases.@*Conclusion@#Biventricular surgical repair of Swiss-cheese ventricular septal defects with two-patch of fresh autologous pericardium and right ventricle apex excluding technique in infants can be relatively easy with favorable early and mid-term results. Long term results need to be evaluated with more cases.
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In recent years, plant extracts have been widely developed and used, but the pollution of heavy metals has threatened the safe application of plant extracts. Therefore, effective removal of heavy metal pollution in plant extracts has become an urgent problem to be solved and a research hotspot at home and abroad. At present, the widely used heavy metals removal technologies include flocculent precipitation, adsorption, molecular sieve and so on. Other new technologies and materials are also being applied to the removal of heavy metals from plant extracts, such as microbiological methods, nanotechnology, ion/molecular imprinting techniques, biomimetic materials, etc. This paper reviews the related literature about the principle and application of removal of heavy metals in plant extracts in recent years, summarizes the characteristics of each method, and prospects the development trends and prospects for the future.
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Objective To explore the thinking and methods of integration curriculum. Methods The content of theory and experiment of the biochemistry,molecular biology, cell biology, medical genetics are optimized, streamlined and integrated to form theory course and experiment experimental course of " basis fo life", namely"four in two". Forming a teaching team across departments, multi-disciplinary teaching is carried out. The theory takes " cell-moleculeinheritance-disorders" as the main line, interspersed with " flipped class model" . The experimental course deletes repeated confirmatory experiments and adds some comprehensive experiments. The course assessment and performance evaluation are carried out with the combination of formative assessment and summative evaluation. Results The teaching mode of integration curriculum has been carried out in the experimental class of undergraduate students for two years. Compared with the theoretical examination scores, the results of the experimental class were significantly higher than that of the control class, and the difference was statistically significant (P＜0.05) . 24 students took part in research in experimental class, but only 10 students did in control class.Conclusion The implementation of integrated curriculum can promote student’s independent learning, improve student’s ability to analyze and solve problems, and mobilize student’s interest in scientific research practice. It provides useful reference and experience for the integration of basic course in the life science field of higher medical colleges.
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Objective: To evaluate the feasibility ofin vitro balloon dilatation for treating aortic coarctation infants younger than 6 months. Methods: A total of 13 aortic coarctation infants treated in our hospital from 2011-01 to 2015-12 were summarized. The patients were at the mean age of 3.4 months (from 20 days to 6 months), with the mean body weight of 4.8 kg (from 3.6 kg to 6.2 kg) including 9 male. Aortic coarctation segments were resected during the operation and the resected segments were expanded by percutaneous transluminal angioplasty (PTA) via (2-4) times diameter balloon dilatation. The diameters of resected aortic segments were recorded before and after expansion; the change of vascular middle smooth muscle layer was observed by HE staining. Results: There were 8 cases with non-restricted ventricular septal defect (VSD) and 3 of them received staging operation, 2 with atrial septal defect (ASD), 3 with bicuspid aortic valve, 3 with patent ductus arteriosus (PDA) and 1 with pericardial effusion. The resected aortic segments presented that 9 patients had diaphragm type narrow and 4 had tube type narrow. After PTA, the diameters of resected aortic segments were slightly increased for the mean of 0.2 mm and no obvious change was observed; HE staining showed that the vascular inner mucosa was shed, while the middle smooth muscle layer was intact. Conclusion: Balloon dilatation had the poor effect for treating aortic coarctation infants younger than 6 months; surgical procedure could be applied for treating the relevant patients.
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Objective To discuss one-stage surgical repair of interrupted aortic arch ( IAA) in neonates and young in-fants, summarize follow-up results and subsequent treatments.Methods From September 2010 to December 2014, a series of 38 consecutive neonates and young infants ( M/F =26/12 ) with IAA were admitted in our surgical group to receive surgical treatment, with a median age of 11 days(1 day to 5 months) and a median body weight of 4.1 kg(1.8 to 5.8 kg).IAA was type A in 24 cases, type B in 13 cases and type C in 1 case.Associated cadiovascular anomalies were common except 2 cases, including atrial septal defect(n=23), ventricular septal defect(n=36), left ventricular outlet tract obstruction(LVOTO)(n=7), anomalous left pulmonary artery from aorta(n=1), truncus arteriosus(n=1).There were 5 cases of airway stenosis in 28 cases of CT angiography and 3D airway reconstruction.All the 38 cases were admitted with differential cyanosis.36 cases were recieved one-stage surgical repair except 2 cases died before operation.35 cases of IAA associated with intracardiac anom-alies were repaired through a median sernotomy.Cardiopulmonary bypass(CPB) was performed with two canulations in ascend-ing aorta and main pulmonary artery.Selective cerebral perfusion(n=21) or circulatory arrest(n =14) was carried out with body temperature of 18℃-23℃.After the patent ductus arteriosus tissue was completely resected , a continuous end-to-end or end-to-side suturing with 7/0(8/0) prolene was performed.In 1 type B cases with expected excessive anastomotic tension, the left subclavian artery was cut off to release the aortic arch .The associated anomalies were repaired during the cooling or re-warming period.Chest close was delayed to carry out no more than 24-72 h postoperatively in 16 cases.The other one type A IAA case without intracardiac anomaly was repaired through a standard left posterior lateral incision .Patients were strictly fol-lowed up with a standard protocol.Complications such as aortic arch restenosis, new LVOTO, new airway stenosis, and so on, were specialy focused on during the follow-up period.If needed, reoperation or transcatheter intervention was applied to treat the complications.Results Two cases died before operation and another 2 died in the early period postoperatively because of pulmonary hypertension crisis and severe tracheal stenosis, respectively.Sudden death was in 1 case during the follow-up peri-od.Median CPB time was 138 min(105-208 min) and median selective cerebral perfusion or circulatory arrest time was 24 min(16-35 min) .Mechanical ventilation time was 2-25 days.Blood pressure difference between the upper and lower limbs was less than 20 mmHg in all the patients before discharge.29 cases(85.29%) was followed up for 28 months(9 -60 months).3 cases were received reoperation in 5 cases of newly detected LVOTO.One case received reoperation in the 7 preop-erative LVOTO cases because of newly detected LVOTO(blood pressure gradient more than 40 mmHg).Two cases with aortic arch restenosis received percutaneous transcatheter ballon dilation .One case with new left main bronchus stenosis after opera-tion was strictly followed up.Conclusion IAA is a rare and severe congenital heart disease.Positive surgical repair should be performed after definite diagnosis being made .Although satisfactory results can be obtained with one-stage primary operation , IAA is a kind of progressive chronic disease.New postoperative LVOTO should be focused on becasue it will need reoperation or even the third operation .
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Objective: To summarize the experience for treating pulmonary venous obstruction in patients after total anomalous pulmonary venous connection (TAPVC) operation. Methods: A total of 16 patients with post-TAPVC pulmonary venous obstruction in our hospital from 2011-01 to 2015-12 were retrospectively analyzed including10 male. All patients received echocardiography, electrocardiogram and chest X-ray examinations at pre-discharge, 1, 3, 6, 12 and 24 months post-operation. Pulmonary venous obstruction was diagnosed by echocardiography measured pulmonary vein (PV) lfow speed>2m/s. The time of re-operation was determined by clinical manifestations as recurrent heart failure and growth retardation; sutureless technique and conventional patch enlarge technique were used in the second operation. Results: No one lost contact in all 16 patients. There were 7/16 patients with anastomotic stenosis (1 mixed type, 3 infracardiac type, 2 supracardiac type and 1 cardiac type), 7 patients with one PV stenosis, 2 with two PV stenosis and nobody with three or more PV stenosis. Based on per-operative Darling classiifcation, there were 2 patients with mixed type, 5 with infracardiac type, 5 with supracardiac type and 4 with cardiac type. Most post-operative PV stenosis occurred at 3-6 months after the surgery. There were 5 patients receive re-operation, 4 with sutureless technique, 1 with conventional patch enlarge technique and all of them suffered from anastomotic stenosis. 2 patients died and 3 were followed-up. Conclusion: Post-operative anastomotic stenosis was the main indication for re-operation in patients after TAPVC; early operation could better improve the clinical condition.
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Objective To evaluate the effect on the booster immunization of different dosage of hepatitis B vaccine among children and to provide suggestions for booster immunization.Methods Children aged 5 -1 4 years old were randomly selected who had received the primary immunization of hepatitis B vaccine under 1 year old but had not received the booster immunization in Yuhuan county.A total of 547 children received 5 μg hepatitis A and B combined vaccine boost immunization and 688 children received 1 0 μg hepatitis B vaccine boost immunization in 2009.The anti -HBs levels before and after the boost immunization were detected.Results The anti -HBs positive rates of children received 5 μg and 1 0 μg vaccine boost immunization were 97.81 % and 96.08% respectively and the positive rates in the antibody negative children were 94.78% and 93.62% respectively.While the Geometric Mean Titer (GMT) of anti -HBs were 1 433.1 8 mIU /mL and 21 1 1 .43 mIU /mL respectively,which were both significantly higher than those before the boost immunization (P <0.001 ).The increase of GMT of children received 1 0 μg hepatitis B vaccine was significantly higher than that of children received 5 μg hepatitis A and B combined vaccine (P <0.05).Conclusion Both dosages of hepatitis B vaccine booster immunization are effective for children aged 5 -1 4 years old and 1 0 μg hepatitis B vaccine boost immunization has the better effect.
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Objective To study the efficiency of booster immunization with different recombinant hepatitis B vaccines.Methods 2789 children aged over 10 years who had completed the basic immunization of hepatitis B vaccine under 1 year old were selected.All the sampled children were classified into four groups (A,B,C and D) and immunized with different hepatitis B vaccines produced by different campanies respectively.Before booster immunization,their blood plasma specimens were detected for hepatitis B virus (HBV) surface antigen (HBsAg),antibodies to HBV surface antigen (anti-HBs) and antibodies to HBV core antigen (anti-HBc) by chemiluminescence.In each group,the anti-HBs positive children were immunized with one dosage and anti-HBs negative children were immunized three dosages of the same vaccine.Their blood specimens were collected again after 1 month,and detected for anti-HBs.Results The anti-HBs positive rates of A,B,C and D group were 36.43%,37.59%,42.91% and 46.46% respectively before immunization while 89.20%,91.52%,90.96% and 85.45% respectively after immunization with one dosage,99.12%,99.47%,98.87% and 98.85% respectively after immunization with three dosages.The differences of anti-HBs positive rates in the four respective groups showed statistical significances between any two rates of pre-immunization,post-immunization with one dosage and post- immunization with three dosages (all P＜0.05).The anti-HBs positive conversion rates of four groups were 83.01%,86.41%,84.16% and 72.82% respectively after immunization with one dosage.The anti-HBs positive conversion rate of four groups were 98.62%,99.16%,98.03% and 97.84% respectively after immunization with three dosages and the difference of positive conversion rates in each group showed statistical significances between booster immunization with one dosage and booster immunization with three dosages.The average GMTs in anti-HBs positive children in the four groups were 2853.21,6254.23,3581.40 and 3021.32 mIU/ml respectively after immunization with one dosage.The average GMTs of anti-HBs negative children in the four groups were 273.08,648.52,387.87 and 245.36 mIU/ml respectively after immunization with one dosage,and were 632.30,2341.14,563.97 and 394.08 mIU/ml respectively after immunization with three dosages.Conclusion Our data showed that it would be suitable to anyone to use the four vaccines for anti-HBs positive children aged over 10 years with one dosage and for anti-HBs negative children aged over 10 years with three dosage booster immunization.
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Objective To investigate the effect of oral alpha-lipoic acid (ALA) supplement on brachial-ankle pulse wave velocity (baPWV),supine systolic blood pressure (SBP) and diastolic blood pressure (DBP) in overweight/obese individuals.An 8-week double-blind,randomized,placebo-controlled and cross-over trial with a 4-week washout between cross-over periods.Methods Sixty-three males and 40 females aged 22-57 years old who met the inclusion criteria as (1) Han ethnicity;(2) 20-60 years old;(3) BMI≥25 kg/m2 and having at least one of the following risk factors:borderline hypertension (130 mm Hg≤SBP＜140 mm Hg and/or 85 mm Hg≤supine DBP＜90 mm Hg),dyslipidemia(fasting total cholesterol≥5.2 mmol/L or HDL-C＜1.04 mmol/L),or impaired fasting glucose (6.1 mmol/L≤fasting glucose＜7.0 mmol/L);(4)Not on any antioxidant gender.Group 1 received 8 weeks ALA (1200 mg/day) followed by 4-week washout period and followed by another 8 weeks placebo;while Group 2 received 8 weeks placebo (1200 mg/day)followed by 4-week washout period,and followed by ALA treatment for 8 weeks.BaPWV and supine blood pressure were measured at the beginning of 1st phase and 2nd phase and at the endpoint of the whole trial.Mixed effect linear regression model was performed to compare the change of baPWV and supine blood pressure between ALA group and placebo group.Results BaPWV decreased -33.03 cm/s ± 130.70 cm/s for ALA group and increased 5.66 cm/s ± 139.89 cm/s for placebo group,supine systolic blood pressure decreased -4.09 mm Hg±9.18 mm Hg for ALA group and -2.32 mm Hg±8.16 mm Hg for placebo group.Supine diastolic blood pressure decreased -1.29 mm Hg ± 6.55 mm Hg for ALA group and -0.48 mm Hg±6.63 mm Hg for placebo group.These three mix-effect models did not show significant effect of ALA treatment after adjustment on baseline values,sex,age,treatment sequence or period.Conclusion The current trial did not provide evidence that oral intake of ALA for 8 weeks had significant effects on lowering baPWV,supine systolic blood pressure or supine diastolic blood pressure.
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Medical biochemistry is a very important basic curricular in medicine teaching.But its theory is abstract,so it is difficult for teachers to teach.On the other hand,the students feel it hard to learn too,because they don't know how these theories are applied.We have applied case-based teaching in medical biochemistry teaching.These methods effectively improve students' enthusiasm to study and to train their scientific thinking in preliminary.Following this way we have explored a new way to elevate teaching qualities and search new teaching model and to further reform present medical biochemistry teaching model.