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@#The patient, male, 1 year, was admitted to our hospital with cardiac murmur. Cardiac ultrasonography showed "complete atrioventricular septal defect (C-AVSD), secondary orifice atrial septal defect (ASD), patent ductus arteriosus (PDA), left superior vena cava, and pulmonary hypertension". The patient got follow-up at the age of 3, 6, 9 months and 1 year, with no feeding difficulties, no obvious underdevelopment and no history of repeated respiratory infections. Cardiac ultrasonography showed that the ventricular septal defect (VSD) healed spontaneously at 9 months of age. At 1 year of age, he was admitted to the hospital with "partial atrioventricular septal defect (P-AVSD)" and accepted surgery. Intraoperative exploration showed that the primary orifice ASD was 12 mm, the atrioventricular valve was divided into two groups, and the left atrioventricular valve had three leaflets: anterior, posterior, and lateral one. A cleft was between the anterior and posterior leaflets. The annulus was not enlarged with diameter of 13 mm. The right atrioventricular valve developed well, with fibrous hyperplasia and adhesion under the septal valve. No VSD was seen. The cleft was sutured intermittently. Autologous pericardial patch was used to repair the primary orifice ASD, and the coronary sinus was separated into the right atrium. Self-healing of VSD patients with C-AVSD is very rare, suggesting that patients with C-AVSD with normal range of development, and without obvious clinical symptoms and secondary damage, should be followed up and accept elective surgery in clinical practice.
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Objective To investigate the expression of microRNA-1290 in pancreatic cancer and its role in invasion and metastasis of pancreatic cancer.Methods The expression of microRNA-1290 in pancreatic cancer tissue microarray and pancreatic cancer cell lines (AsPC-1,BxPC-3,Capan-2,Panc-1,and MIA PaCa-2) were detected by immunohistochemistry and QT-PCR.The pancreatic cancer cell lines Panc-1 and MIA PaCa-2 in logarithmic growth phase were treated with microRNA-1290 inhibitor,and the invasion and metastasis ability of pancreatic cancer cells were detected by Transwell and wound healing asssay.Western Blot was used to detect the expression of invasion and metastasis-associated proteins cyclooxygenase 2 (COX-2) and matrix metalloproteinase 2(MMP-2) in pancreatic cancer cell lines.Results (1) The expression of microRNA-1290 in pancreatic cancer tissues was significantly higher than that in normal pancreatic tissues and adjacent tissues (P ＜ 0.05).(2) Compared with pancreatic normal epithelial cells (HPDE),the expression of microRNA-1290 was significantly higher in different pancreatic cancer cell lines (P ＜ 0.05).The expression level of MicroRNA-1290 in Panc-1 and MIAPaCa-2 pancreatic cancer cells was significantly higher than that in other pancreatic cancer cell lines (P ＜ 0.05).(3) The number of invasive and metastatic cells was significantly decreased after treatment with microRNA-1290 inhibitor (P ＜0.05).(4) The expression of MMP-2 and COX-2 were decreased in Panc-1 and MIAPaCa-2 pancreatic cancer cells treated with MicroRNA-1290 inhibitor.Conclusion The expression of MMP-2 and COX-2 may be involved in the invasion and metastasis of pancreatic cancer cell by regulating the expression of microRNA-1290 in pancreatic cancer.
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Objective To explore effects and cause of fluid overload on infant following cardiac surgery.Methods This is a single center,(ICU,the Great Wall Affiliated Hospital of Nanchang University)retrospective study,between April 2012 and April 2016,176 infants who aged less than 6 months undergoing pediatric cardiac surgery were included.During consecutive postoperative 7 days,comprehensive treatment strategy for infants following cardiac surgery was adopted,collecting clinical outcomes and calculating data of fluid overload;ROC curve analysising postoperative optimal cutoff value of fluid overload.Hospitalization mortality and the second clinical outcome including low cardiac output syndrome,days on mechanical ventilation,ICU length of stay and hospital length of stay were compared to find risk factors of fluid overload.Results 176 cases of infants included in the study.ROC curves for postoperative seven consecutive days time point of Fo determined the optimal cutoff values of 7.8 ％ for FO (A UC =0.69).The mortality and hospital length of stay is not significant difference between fluid overload above 7.8％ and below or equal to 7.8％,however,the incidence of low cardiac output syndrome was higher in infants with fluid overload above 7.8％,and longer duration of mechanical ventilation,ICU residence time.After multivariable analysis,the postoperative adverse outcomes was associated with low cardiac output syndrome and peak serum creatinine (P ＜ 0.05),and cumulative higher fluid overload on the second day after surgery was associated with postoperative acute kidney injury and low cardiac output syndrome(P ＜ 0.05,respectively).Conclusion Postoperative adverse outcomes in infants with congenital heart disease are associated with peak serum creatinine and low cardiac output syndrome;postoperative acute kidney injury and low cardiac output syndrome are the main causes of fluid overload.Shortening cardiopulmonary bypass time and maintaining fluid overload of postoperative day 2 below 7.8％ will help to the postoperative complications.
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Exertional heat stroke (EHS) is an emergency with a high mortality rate, characterized by acute onset and identification difficulties. EHS prevention focuses on evaluating the environment by professionals, making preventive measures in advance, identifying internal and external risk factors for the onset of disease, carrying out prior heat adaptation and endurance training, monitoring the status of high risk persons in real time. After occurrence of EHS, the key to success treatment is on-site accurate identification and diagnosis and rapid implementation of effective cooling measures, thus winning time of EHS patients transferred to the hospital for the treatment. This article reviews the current status of EHS prevention and treatment in domestic and foreign from the scene to the hospital. Summarizing the recognition, diagnosis, cooling measures, treatment concepts and principles of EHS, we hope to provide a reference for the rescue of EHS in hospital and outside.
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Objective To investigate the therapeutic effects of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic bile duct exploration lithotomy (LBDEL) in treatment of intra/extra-hepatic duct stones. Methods There were 110 patients whose intrahepatic stones located in Ⅰ , Ⅱ hepatic duct and 378 patients whose stones only located in the common bile duct. These patients respectively underwent LBDE combined with choledochoscope laser lithotripsy or ERCP combined with endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to remove the stones. Common bile ducts were performed primary suture or T tube placement in the LBDEL cases. The evaluation was carried out for perioperative complications and postoperative recovery of the surgical methods. Results The residual stone rate was 31.82% in 110 cases. The rate was higher in ERCP group (51.06%) than that in LBDEL group (17.46%) (P < 0.05). Postoperative recovery was better in LBDEL group than that in ERCP group. The residual stone rate was 8.20% in 378 cases. The rate was lower in ERCP group (3.68%) than that in LBDEL group(11.63%) (P < 0.05). Between the two groups, there had no statistical significance in postoperative recovery. The incidences of bile leakage and pulmonary infection were higher in LBDEL group than in ERCP group. The incidences of abdominal cavity infection, acute pancreatitis, digestive tract perforation and gastrointestinal bleeding were higher in ERCP group than that in LBDEL group. 2 of the 378 patients occurred death were happened digestive tract perforation which were induced during ERCP procedure. Conclusion LBDEL and ERCP demonstrated the same therapeutic effects in the treatment of common bile duct stones. However, ERCP has no large advantages in the treatment of hepatolithiasis, and shows higher complication rates. LBDEL has a significant curative effect for intra-and extrahepatic bile duct calculi and can maintain the integrity of Oddi sphincter. This technology is easy to spread to the basic-level hospital to benefit the majority of patients.
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Objective To analyse the relationships between islet β-cell function and infection,inflammation and major organ function in multiple organ dysfunction syndrome (MODS) patients with severe traumatic hemorrhage.Methods A total of 187 cases of MODS patients hospitalized in the 94th Hospital of PLA from January 2013 to January 2016 were selected,and were divided into the MODS survival group (MODS-S group,104 cases) and MODS dead group (MODS-D group).Other 100 healthy subjects were selected as the control group.The fasting blood glucose (GLU0) and insulin (INS0) levels,blood glucose (GLU30) and insulin (INS30) levels after 30 min of glucose loading,and levels of soluble triggering receptor expressedon myeloid cells-1 (sTREM-1),tumor necrosis factor-α (TNF-a),interleukin-6 (IL-6),alanine aminotransferase (ALT),creatinine (Cre) and creatine kinase isoenzyme (CK-MB) in different groups were determined.The insulin-β-cell function was evaluated by homeostasis model assessment of β-cell function (HOMA-β) index and ratio of insulin increment and blood glucose increment after 30 min of glucose loading (ΔINS30/ΔGLU30),and their relationships to other indexes,including sTREM-1,TNF-α,IL-6,GLU0,ALT,Cre and CK-MB,in MODS patients with severe traumatic hemorrhage were analysed.Results The HOMA-β and AINS30/AGLU30 ratio in the MODS-D group were lower than those in the MODS-S group,and levels of sTREM-1,TNF-α,IL-6,ALT,Cre and CK-MB in the MODS-D group were higher than those in the MODS-S group,there were statistically significant differences (P＜0.01).In MODS patients with severe traumatic hemorrhage,HOMA-β and ΔINS30/AGLU30 was both negatively correlated with sTREM-1,TNF-α,IL-6,GLU0,ALT,CreandCK-MB (r=-0.356 4,-0.532 1,-0.345 8,-0.772 1,-0.762 5,-0.684 8,-0.606 4;r=-0.428 5,-0.567 8,-0.487 0,-0.743 6,-0.781 7,-0.717 6,-0.640 1,P＜0.01).Conclusion MODS patients with severe traumatic hemorrhage have islet β-cell dysfunction which may be used as a prognostic and diagnostic indicator.
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Objective To analyse the relationships between islet β-cell function and infection,inflammation and major organ function in multiple organ dysfunction syndrome (MODS) patients with severe traumatic hemorrhage.Methods A total of 187 cases of MODS patients hospitalized in the 94th Hospital of PLA from January 2013 to January 2016 were selected,and were divided into the MODS survival group (MODS-S group,104 cases) and MODS dead group (MODS-D group).Other 100 healthy subjects were selected as the control group.The fasting blood glucose (GLU0) and insulin (INS0) levels,blood glucose (GLU30) and insulin (INS30) levels after 30 min of glucose loading,and levels of soluble triggering receptor expressedon myeloid cells-1 (sTREM-1),tumor necrosis factor-α (TNF-a),interleukin-6 (IL-6),alanine aminotransferase (ALT),creatinine (Cre) and creatine kinase isoenzyme (CK-MB) in different groups were determined.The insulin-β-cell function was evaluated by homeostasis model assessment of β-cell function (HOMA-β) index and ratio of insulin increment and blood glucose increment after 30 min of glucose loading (ΔINS30/ΔGLU30),and their relationships to other indexes,including sTREM-1,TNF-α,IL-6,GLU0,ALT,Cre and CK-MB,in MODS patients with severe traumatic hemorrhage were analysed.Results The HOMA-β and AINS30/AGLU30 ratio in the MODS-D group were lower than those in the MODS-S group,and levels of sTREM-1,TNF-α,IL-6,ALT,Cre and CK-MB in the MODS-D group were higher than those in the MODS-S group,there were statistically significant differences (P＜0.01).In MODS patients with severe traumatic hemorrhage,HOMA-β and ΔINS30/AGLU30 was both negatively correlated with sTREM-1,TNF-α,IL-6,GLU0,ALT,CreandCK-MB (r=-0.356 4,-0.532 1,-0.345 8,-0.772 1,-0.762 5,-0.684 8,-0.606 4;r=-0.428 5,-0.567 8,-0.487 0,-0.743 6,-0.781 7,-0.717 6,-0.640 1,P＜0.01).Conclusion MODS patients with severe traumatic hemorrhage have islet β-cell dysfunction which may be used as a prognostic and diagnostic indicator.
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Objective To examine the levels of plasma tissue factor pathway inhibitor (TFPI) in patients with acute pancreatitis (AP) to assess the clinical value of diagnosis for severe acute pancreatitis ( SAP).Methods Sixty-eight patients were divided into mild acute pancreatitis (MAP)group (n=36) and SAP group (n=32), and twenty volunteers were chosen into normal group ( n=20 ) .Clinical data of these patients were collected, including APACHEⅡscore and Ranson score.Plasma levels of TFPI were measured by ELISA.Results The plasma levels of TFPI in SAP group, MAP group and control group were (4274.25 ±639.83),(3026.81 ±465.76) and (2468.73 ±262.39)pg/ml, respectively(P<0.05).There were significant positive correlations between TFPI and WBC, AST, ALT, TBIL, Cr, PT, APTT, PCT, APACHEⅡscore and Ranson score (P<0.05).The area under the curve (AUC) of TFPI for SAP was 0.902(95%CI=0.845 -0.959, P<0.05 ) .The cutoff value was 4028.83 pg/ml for plasma TFPI with a sensitivity of 87% and a specificity of 78%.Conclusion Plasma levels of TFPI in patients with SAP are significantly increased, which maybe help diagnose SAP.
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Objective To compare the clinical effect of two hemostatic methods for patients with pelvic fracture combined with hemorrhagic shock in the early stage.Methods A retrospective analysis was done on clinical data of 90 patients with unstable pelvic fracture combined with hemorrhagic shock managed by damage control resuscitation from January 2008 to December 2012.Unstable blood pressure and abdominal distension were noted postoperatively.Forty patients in Group A received laparotomy and bilateral internal iliac artery ligation from January 2008 to January 2010.Fifty patients in Group B underwent internal iliac artery embolization from February 2010 to December 2012.Comparative measurement was made on parameters of mortality,24-hour blood transfusion volume,24-hour lactic acid value,postoperative systolic blood pressure,postoperative body temperature,and postoperative prothrombin time (PT).Results Following parameters differed significantly between Groups A and B (P ＜ 0.05):mortality rate (53％ vs 12％),24-hour blood transfusion volume[(3 865.5 ±451.3)ml vs (2 108.8 ±336.4)ml],24-hour lactic acid value[(13.0 ± 2.0)mmol/L vs (5.4 ± 1.2)mmol/L],postoperative systolic blood pressure [(80.50 ± 22.73) mmHg vs (113.23 ± 20.89) mmHg],postoperative body temperature [(32.4 ± 0.2)℃ vs (36.1 ±0.3)℃],postoperative PT [(24.5 ±3.6)s vs (18.4±2.1)s].Conclusion For pelvic fracture combined with hemorrhagic shock,if the indications of abdominal viscera rupture are unclear,the interventional embolization can gain advantage over laparotomy in improving treatment success rate and reducing mortality and complications.
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Objective To examine the levels of serum tissue inhibitor of metalloproteinase in severe sepsis patients with disseminated intra-vascular coagulation (DIC) and evaluate its diagnostic value in severe sepsis with DIC.Methods Sixty patients were divided into 3 groups,namely severe sepsis group (SS group,n =28),severe sepsis with DIC group (SSD group,n =12) and normal group (n =20).Clinical data including APACHE Ⅱ score and DIC score of these patients were collected.Serum levels of TIMP-1 and TIMP-2 of these patients were measured by using ELISA.Results The patients of SS group had higher levels of TIMP-1 (723.74 ± 96.27) and lower levels of TIMP-2 (68.08 ± 14.87) than healthy control subjects (TIMP-1:574.24 ± 79.99,TIMP-2:89.99 ± 18.45) (P ＜ 0.05).The patients of SSD group had higher levels of TIMP-1 (907.56 ± 200.20) and lower levels of TIMP-2 (44.84 ± 22.13) than patients of SS group (P ＜ 0.05).An association was found between TIMP-1 and fibrinogen (FIB) (r =-0.392,P ＜ 0.05),TIMP-1 and D-dimer (r =0.407,P ＜ 0.05),TIMP-2 and PLT (r =0.484,P ＜0.01),TIMP-2 and PCT (r=-0.523,P＜0.01),TIMP-2 and DIC score (r=-0.579,P＜0.01).The areas under the curves (AUC) for TIMP-1/TIMP-2 was 0.896 (95％ CI:0.843 ～ 0.950 (P ＜ 0.05).Conclusions Serum levels of TIMP-1 in patients with severe sepsis complicated with DIC increased and TIMP-2 decreased,suggesting they were valuable in diagnosis of severe sepsis complicated with DIC.
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Objective To investigate the safty and feasibility of simultaneous minimally invasive technique for congenital heart disease (CHD) and pectus excavatum (PE).Methods From July 2006 to June 2011,6 children with PE associated with CHD were treated by simultaneous minimally invasive technique.They were 4 boys and 2 girls,aged from 4 years to 6 years 5 months ( average 5 years and 4 month),.The body weight were from 16 kg to 20 kg [ average ( 18.00 ± 1.79kg ].CT Hailer index were 3.9 - 5.0 ( average 4.35 ± 0.43 ).4 patients with ventricular septal defect (VSD) were treated by minimally invasive closure device,including 3 membranous VSD and 1 subaortic VSD.The defect diameter was 4 - 5 mm.2 cases with atrial septal defect (ASD) were treated using the same technique.the diameter of ASD was 12 - 16 mm.After minimally invasive heart surgery,Nuss operation was carried out in all 6 patients for their PE.Results All operations were successful and patients were extubated 5 - 11 h after operation [ mean ( 8.17 ± 2.04) h ].The pericardial mediastinal drainage was removed at 48 h postoperatively.There were no operative mortality and severe postoperative complications.1 patient had delayed wound healing and was successfully discharged.The plate was removed in 3 cases,and they all had satisfactory outcomes.Conclusion Simultaneous minimally invasive technique is a safe and effeictive mothod for treating pectus excavatum and congenital heart disease.
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Pancreatic cancer is a common malignancy of gastrointestinal system, with features of early metastasis, easy invasion to adjacent tissues and organs and neural metastasis. Therapies include surgery, chemotherapy, radiotherapy, physi-cal and biological therapy and so on. Surgical management, including radical resection and palliative operation, is a major approach. Radiotherapy and chemotherapy could improve the resectional rate and decrease the tumor dissemination. Physical and biological therapies are widely recommended, and there is a rapid progress in zoopery. However, the efficacy of all the thera-pies is far from satisfactory. Recently, the therapy consisting of surgical resection, radiotherapy, chemotherapy, physical and biological therapy in increasing the long-term survival rate and improving the life quality of patients, along with combined thera-py has attracted the attention of surgeons.
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Objective To evaluate the effect of early limited fluid resuscitation in treatment of severe pelvic fracture accompanied with traumatic hemorrhagic shock. Methods A retrospective study was done on 96 patients with severe pelvic fractures accompanied with traumatic hemorrhagic shock admitted into hospital from January 2002 to December 2006. Of all, 55 patients ( routine resuscitation group)were dealt with routine fluid resuscitation and 41 (limited resuscitation group) with limited fluid resuscitation. The injury severity, degree of shock, start time of resuscitation, transfusion volume were statistically analyzed and compared in two groups. Results Routine resuscitation group received transfusion volume of (3 432 ± 1 156) ml, with cure rate of 64% and mortality rate of 36% ; while limited resuscitation group received transfusion volume of (2 685 ± 524) ml, with cure rate of 83% and mortality rate of 17%. There was statistical difference between both groups ( P ＜ 0.05 ). Conclusion Limited fluid resuscitation can improve cure rate of severe pelvic fracture accompanied with traumatic hemorrhagic shock.
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From April 2000 to April 2003 total 103 patients underwent aortic valve replacement and some concomitant cardiac procedures including mitral valve replacement in our hospital. According to the suture technique used in aortic valve replacement, the patients were divided into two groups: group A, 42 patients, the continuous suture technique with some modifications was used; group B, 61 patients, the conventional interrupted suture technique was used. There were no statistical differences between the two groups in age, sex, bodyweight, valve lesion, concomitant cardiac procedure and early mortality. But there were significant differences ([<0.001 approximately 0.012) in aortic cross-clamp time (AOCT) and cardiopulmonary bypass time (CPBT) between the two groups with less time for the group A patients. During a follow-up from 1 to 35 months, in group B, one patient developed perivalvular leak. The incidence of perivalvular leak was 1.7% (1/59). Three patients developed prosthetic bacterial endocarditis, the incidence of which was 5.0% (3/59). All the patients in group A recovered satisfactorily without suture technique or prosthesis associated complications. The modified technique was introduced and illustrated with diagrams, and the reasons for the advantages of the technique over the conventional interrupted suture technique were discussed.
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Aortic Valve/surgery , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/methods , Suture Techniques , Adult , Aged , Female , Follow-Up Studies , Heart Valve Prosthesis , Humans , Incidence , Male , Middle Aged , Postoperative Complications/epidemiology , Retrospective Studies , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To introduce the technique of intrathoracic surgery performed through vertical transaxillary minithoracotomy.</p><p><b>METHODS</b>From March 1989 to March 2001, 316 patients underwent intrathoracic surgery through a vertical transaxillary minithoracotomy. 285 patients suffered from patent ductus arteriosus (PDA), 10 congenital esophageal atresia, 8 congenital pulmonary cysts, 6 congenital emphysema, 1 pulmonary sequestration, 5 mediastinal tumor, and 1 eventration of the diaphragm.</p><p><b>RESULTS</b>All of the patients were successfully treated under satisfactory exposure. No operative mortality and severe postoperative complications occurred.</p><p><b>CONCLUSIONS</b>Intrathoracic surgery performed through a vertical transaxillary minithoracotomy appears to be less invasive, and is a simple, safe, cosmetically acceptable and efficient approach.</p>
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Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Axilla , Cysts , General Surgery , Ductus Arteriosus, Patent , General Surgery , Esophageal Atresia , General Surgery , Lung Diseases , General Surgery , Pulmonary Emphysema , General Surgery , Thoracotomy , MethodsABSTRACT
<p><b>OBJECTIVE</b>To investigate hereditary susceptibility to coronary heart disease (CHD) in apolipoprotein E(apo E) and apo B polymorphisms of youths.</p><p><b>METHODS</b>Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to analyze apoE, apoB Xba I, apoB 3' variable number of tandem repeat (VNTR) genotypes for 244 healthy Han students (among them were 109 students with positive CHD family history).</p><p><b>RESULTS</b>The allele frequencies of apo e4, XbaI x(+), 3'VNTR-B(hypervariable element, HVE>38) in the positive group were obviously higher than those in the negative group(P<0.05), and were significantly correlated with the increase in TC, LDL-C, apoB100 levels (P<0.05).</p><p><b>CONCLUSION</b>The alleles for apo e4, XbaI x(+), 3'VNTR-B may be the important genetic markers of Han CHD.</p>
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Adolescent , Female , Humans , Male , Young Adult , Alleles , Apolipoproteins B , Genetics , Apolipoproteins E , Genetics , Coronary Disease , Genetics , Gene Frequency , Polymerase Chain Reaction , Polymorphism, GeneticABSTRACT
Objective To study the reference range of umbilical artery blood gas and the significance of umbilical artery blood pH on the diagnosis of neonatal asphyxia. Methods Five thousand six hundred and eleven live-births new born in our hospital were consecutively enrolled. The following five items related to birth asphyxia were recorded including antepartum high-risk factors, Apgar scores, umbilical artery blood pH, organ damage, and differential diagnosis on the causes of low Apgar score. Reference range of umbilical artery blood gas, the correlations between the umbilical artery blood pH and the other items were analysed. Results The reference range of umbilical artery blood gas ((x|-)?2s) were pH 7.00 - 7.40, PaO2 0.34 - 6.10 kPa, PaCO2 3.43 - 10.03 kPa, BE 1.5 - - 18. 5 mmol/L. The umbilical artery blood pH was negatively correlated with organ damage (r = - 0. 99,P
