目的 探讨Ⅰ型先天性胆总管囊肿的手术治疗。方法 回顾性分析笔者所在医院1987年3月至2011年6月期间收治的42例Ⅰ型先天性胆总管囊肿患者手术治疗后的效果。结果 本组中2例因并发腹膜炎先行囊肿外引流术后4周再行囊肿空肠吻合术；3例直接行囊肿空肠吻合术；35例行囊肿切除肝总管空肠Roux-en-Y吻合术；2例行囊肿切除间置空肠肝总管十二指肠吻合术。手术成功率为100%。5例内引流术（囊肿空肠吻合术）后均有不同程度的胆道感染症状。37例行囊肿根治术（即囊肿切除肝总管空肠Roux-en-Y吻合或间置空肠肝总管十二指肠吻合术）中有2例囊肿切除肝总管空肠Roux-en-Y吻合术后患者偶有右上腹隐痛不适，经X线钡餐检查，诊断为胆管逆行性感染，抗炎治疗有效；其余病例无腹痛、黄疸、发热、再生结石、吻合口狭窄、癌变及其他手术并发症。结论 囊肿外引流术仅作为急诊手术，待患者一般情况改善后再行第二次手术；囊肿根治术是治疗Ⅰ型先天性胆总管囊肿理想的手术方式。
Objective To study the expression of inducible nitric oxide synthase (iNOS)，endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) in human gastric cancer and their relationship with tumor angiogenesis and to investigate the interaction of NOS and VEGF in gastric cancer. Methods The expression and distribution of VEGF, iNOS and eNOS in 34 gastric cancer specimens were detected with immunohistochemistry. Microvessel density (MVD) was counted with FⅧRAg immune specific staining. Results The expression rates of iNOS, eNOS and VEGF in 34 gastric cancers were 73.5%, 82.4% and 91.2% respectively. The expression of VEGF had a significant positive relation with iNOS, but not with eNOS. The MVDs of VEGF or iNOS positive gastric cancers were obviously higher than those of VEGF or iNOS negative gastric cancers. There was no significant difference between the MVDs of eNOS positive gastric cancers and eNOS negative ones. Conclusion MVD increases with increase of expression of VEGF and iNOS in gastric cancer. It is indicated that VEGF and iNOS can promote gastric cancer angiogenesis. VEGF and iNOS have a significant positive correlation, which suggests that in human gastric cancer, iNOS plays an important role in the production and action of VEGF.
Objective To explore risk factors related to acute kidney injury (AKI) in children who underwent corrective surgery for tetralogy of Fallot (TOF). Methods We retrospectively analyzed the clinical data of 726 children with corrective procedures for TOF aged less than 3 years in our hospital from March 1st 2010 to March 1st 2013. Children with AKI were picked using Acute Kidney Injury Network criteria. Demographic and perioperative variables of the remaining patients were reviewed. Univariate analysis was performed to compare the AKI group (240 patients) with the non-AKI group (486 patients). Multivariable analysis was carried out to identify significant determinants of AKI. Results A total of 240 children were with AKI. The result of univariate analysis showed that there was a statistical difference in age, Nakata index, McGoon ratio, left ventricular end-diastolic volume index (LVEDVI), transannular right ventricular outflow tract (RVOT) patch, or fresh frozen plasma (FFP) in prime solution between the AKI group and the non-AKI group. Multivariable logistic regression showed that in older children (OR=1.425, 95% CI 1.071 to 1.983, P=0.011) with more transfusion of FFP in the priming solution (OR=1.486, 95% CI 1.325 to 2.674, P<0.001) led to higher morbidity of mild AKI. In addition, there was an increase in morbidity related to AKI when children had less Nakata index (OR=0.282, 95% CI 0.092 to 0.869, P=0.013). Conclusion Postoperative AKI increases in older children group. Infusion of more FFP in priming solution increases morbidity of AKI. The less Nakata index is significantly associated with severe AKI.
The success of staged Fontan palliation for patients with single ventricle is related to low pulmonary vascular resistance (PVR). The complications of high PVR in Fontan physiology are numerous, such as low exercise tolerance, low cardiac output, ventricular function failure and protein-losing enteropathy; eventually it leads to failing Fontan. Therefore, a low PVR is crucial in Fontan patients. Now, targeted therapies decreasing PVR has been an advanced research hotspot in Fontan patients. In this review we present an overview of the safety and efficacy of the therapy with bosentan or sildenafil on elevated pulmonary artery pressure and pulmonary vascular resistance in Fontan patients.
Objective To explore the effects of intravenous treprostinil in different doses on the hemodynamics and postoperative outcomes after high-risk total cavo-pulmonary connection (TCPC). MethodsFrom 2018 to 2021, among 189 patients who underwent TCPC in the Department of Pediatric Cardiac Surgery of Fuwai Hospital, 26 high-risk patients who received the intravenous treprostinil therapy were retrospectively analyzed. There were 12 males and 14 females, with an age of 4 (3, 6) years and a weight of 17.6±6.2 kg. The patients were divided into two groups: a high-dose group [15 patients, maintaining dose>10 ng/(kg·min)] and a low-dose group [11 patients, maintaining dose≤10 ng/(kg·min)]. The hemodynamics before treprostinil using and during the first 24 hours after reaching the maintaining dose of treprostinil, and postoperative outcomes of the two groups were investigated. ResultsThe incidence of heterotaxia was higher in the high-dose group (66.7% vs. 18.2%, P=0.021). During the observation period, the mean pulmonary artery pressure decreased from 11.9±3.6 mm Hg to 11.0±3.3 mm Hg in the low-dose group (P=0.013), and from 12.9±4.7 mm Hg to 10.2±3.4 mm Hg in the high-dose group (P=0.001). The decreasing effect in the high-dose group was better than that in the low-dose group (P=0.010). There was no statistical difference in the postoperative outcomes between the two groups (P>0.05). In terms of side effects, patients needed temporarily increased dosage of vasoactive drugs to maintain stable blood pressure during 6-12 h after treprostinil therapy in the high-dose group. ConclusionIn patients after high-risk TCPC, intravenous high-dose treprostinil has a better therapeutic effect on reducing pulmonary artery pressure. However, it should be noted that increased dosage of vasoactive agents may be required to maintain blood pressure stability in patients with high-dose treprostinil.
ObjectiveTo evaluate the diagnostic value of various severity assessment scoring systems for sepsis after cardiac surgery and the predictive value for long-term prognosis.MethodsThe clinical data of patients who underwent cardiac sugeries including coronary artery bypass grafting (CABG) and (or) valve reconstruction/valve replacement were extracted from Medical Information Mark for Intensive Care-Ⅲ (MIMIC-Ⅲ). A total of 6 638 patients were enrolled in this study, including 4 558 males and 2 080 females, with an average age of 67.0±12.2 years. Discriminatory power was determined by comparing the area under the receiver operating characteristic (ROC) curve (AUC) for each scoring system individually using the method of DeLong. An X-tile analysis was used to determine the optimal cut-off point for each scoring system, and the patients were grouped by the cut-off point, and Kaplan-Meier curves and log-rank test were applied to analyze their long-term survival.ResultsCompared with the sequential organ failure assessment (SOFA) score, acute physiology score-Ⅲ (APS-Ⅲ, P<0.001), the simplified acute physiology score-Ⅱ (SAPS-Ⅱ, P<0.001) and logistic organ dysfunction score (LODS, P<0.001) were more accurate in distinguishing sepsis. Compared with the non-septic group, the 10-year overall survival rate of the septic group was lower (P<0.001). Except for the systemic inflammation response score (SIRS) system, the 10-year overall survival rates of patients in the high risk layers of SOFA (HR=2.50, 95%CI 2.23-2.80, P<0.001), SAPS (HR=2.93, 95%CI 2.64-3.26, P<0.001), SAPS-Ⅱ (HR=2.77, 95%CI 2.51-3.04, P<0.001), APS-Ⅲ (HR=2.90, 95%CI 2.63-3.20, P<0.001), LODS (HR=2.17, 95%CI 1.97-2.38, P<0.001), modified logistic organ dysfunction score (MLODS, HR=2.04, 95%CI 1.86-2.25, P<0.001) and the Oxford acute severity of illness score (OASIS, HR=2.37, 95%CI 2.16-2.60, P<0.001) systems were lower than those in the low risk layers.ConclusionCompared with SOFA score, APS-Ⅲ score may have higher value in the diagnosis of sepsis in patients who undergo isolated CABG, a valve procedure or a combination of both. Except for SIRS scoring system, SOFA, APS-Ⅲ, SAPS, SAPS-Ⅱ, LODS, MLODS and OASIS scoring systems can be applied to predict the long-term outcome of patients after cardiac surgery.
ObjectiveTo compare attitudes of nursing undergraduates to patients with mental illness before and after learning psychiatric nursing course and provide evidence for the improvement of teaching of the course. MethodsStigma scale to patients with mental illness was used as a questionnaire for collecting data, which was conducted on nursing undergraduates taking psychiatric nursing course between March and June 2012. Paired t-test was used to compare the differences between students' attitudes before and after learning the course. ResultsSignificant difference was found for danger factor (P<0.05), while there was no statistically significant difference in the social isolation factor and social ability factor before and after the psychiatric nursing course (P>0.05). ConclusionPsychiatric nursing course has a great influence on students' evaluation of the danger of patients with mental illness which reduces the discrimination against the patients.
Objective To investigate the iron deficiency (ID) in children with congenital heart disease (CHD) and find high risk factors of ID. Methods The clinical data of 227 pediatric patients with CHD from February to June 2016 were retrospectively analyzed. The incidence of ID according to the result of iron metabolism examination (serum ferritin <12 μg/L as the diagnostic criteria) was investigated. According to their basic CHD types, patients were divided into a cyanotic group and an acyanotic group. We tried to find the high risk factors of ID in those pediatric CHD patients by comparing their age, gender, growth condition and blood routine test results. Results There were 19.8% pediatric CHD patients complicated by ID. The incidence of ID in the cyanotic patients was higher than that in the acyanotic patients (31.0% vs. 17.3%, P=0.045). In both groups, ID patients presented the characteristics of younger age, higher anemia rate, lower mean corpuscular volume (MCV), lower mean corpuscular hemoglobin (MCH), lower mean corpuscular-hemoglobin concentration (MCHC) and longer red blood cell distribution width (RDW). Conclusion Cyanosis, younger age (infant), anemia, decreased MCV, decreased MCH, decreased MCHC and increased RDW are high risk factors of ID in CHD children.