Objective To investigate the riskf actors associated with sepsis following surgery of con-genital heart disease in children, for early-recognizing and diagnosing, improving prognosis and decreasing mortality.Methods Retrospective study wa s employed,52 patients of sepsis and 104 patients of non-sepsis with similar age,sex,na d the same diseases were enrolled during Jan 2012 to Apr 2015 in cardiac intensive care unit.Variables such as age,sex,preoperative infection,delayed sternum closure,diaphragmatic paralysis, exploraot ry chest,cardiopulmonaryb ypass time, placed invasive catheter were included in the research fac-tors.The Logistic regression model was set up,OR and 95%CI were calculta ed.Results In sepsis group,the more shock and dysfunction organs,longre hospital stays,longer ICU stays and higher mortality were found compared to the non-sepsis group[25.32%vs.6.73%,3.5 ±1.1 vs.1.1 ±0.7,(35.1 ±11.2)d vs.(11.3 ±3.1)d,(21.3 ±7.1)d vs.(7.1 ±2.3)d,19.23%vs.4.81%,P<0.05].In the Logistic regres ion mod-e l,variables significantly associated with sepsisw ere preoperative infection,deal yed sternal closure,explorato-ry chest,and placed more invais ve duct,diahp ragmatic paralysis(P<0.05).OR value (95%CI) were 10.53 (1.73,64.2),26.66(2.69,263.83),19.47(1.87,203.02),4.99(1.36,18.31),8.32 (0.12,16.46 ), respectively.Conclusion Preoperative infection,delayed sternal closure,exploratory chest,placed more inva-sive duct,diaphragmatic paralysis are the risk factors of sepsis.Children with sepsis had poor clinical outcome compared to those without sepsis.

AIM: To study the effects of recombinant soluble MHC class Ⅰ chain-related protein A (sMICA) on the cytotoxicity, secretion of IFN-γ, proliferation and apoptosis of peripheral NK cells. METHODS: After NK cells were cocultured with recombinant soluble MICA proteins overnight, the cytotoxicity of NK cell on target cells was detected by flow cytometry. The supemant was collected to determine the concentration of IFN-γ by ELISA. The proliferation of NK cells to sMICA was detected by MTS/PMS. NK cells were labeled with annexin V and PI to analyze their apoptosis. RESULTS: Soluble MICA inhibited the cytotoxicity of NK cells and down-regulated the secretion of IFN-γ, but it showed no effects on the proliferation and apoptosis of freshly isolated peripheral NK cells. CONCLUSION: The soluble MICA shedding from tumor cells could be a pathway of cancer immune evasion by down-regulating the biologic activities of NK cells.

Objective To investigate the correlation between Toll-like receptor2 (TLR2) gene promoter region -597T/C polymorphism and primary ANCA associated small vasculitis (AAV) in Guangxi Han people. Methods A case contrastive control study was adopted in the study. Patients with AAV (patients group, n=110) and healthy people (control group, n = 200) were recruited. Associated serum indexes were detected and polymorphisms of TLR2 gene promoter 597T/C were analyzed by polymerase chain restricted fragment length polymorphisms (PCR-RFLP). Results (1)Three TLR2-597T/C genotypes were discovered in 110 AAV patients, namely, TT, TC and CC, with the frequency of 54.55%,40.00% and 5.45% respectively. And the frequencies of allele T and C were 74.55% and 25.45%. In control group, the genotype frequencies of TT, TC and CC were 56.00%,40.50% and 3.50%, with 76.25% of allele T and 23.75% of allele C. No significant differences were found in neither genotype distribution nor allele frequencies between the patients group and control group ( P > 0 . 05 ) . ( 2 ) Significant differences were found in the incidence of proteinuria rate and the hemoglobin (P< 0.05)in AAV patients. (3)There was no significant difference between AI and CI in TT, TC and CC genotype in AAV patients. Conclusions Polymorphism of TLR2-597T/C may be correlated with the incidence of proteinuria and the level of hemoglobin, while no obvious correlation with the genetic susceptibility of ANCA in vasculitis patients of Guangxi Han people.

Objective:To investigate clinical, histopathological, molecular genetic characteristics, and immunophenotypes of superficial CD34-positive fibroblastic tumor (SCPFT) .Methods:The pathological data were collected from 19 cases of SCPFT from January 2015 to July 2022 in the First Affiliated Hospital of Nanjing Medical University, and analyzed retrospectively.Results:In total, 19 cases of SCPET were enrolled, including 8 males and 11 females. Their age at onset ranged from 16 to 67 years, and the disease duration ranged from 3 months to 3 years. Tumors occurred in the thigh (6 cases), back (4 cases), shoulder (3 cases), abdominal wall (2 cases), popliteal fossa (1 case), lower leg (1 case), foot (1 case) and forehead (1 case). The tumor lengths were 0.8 - 4 (2.36 ± 0.76) cm, with relatively clear borders. Surgical excision was performed in all the 19 cases, and 1 case experienced recurrence. Histopathological examination showed that tumors were located in the dermis and subcutis, and infiltrated the peripheral fat tissues or the dermis; tumors were composed of abundant spindle cells and polygonal cells arranged in interlacing fascicles; cells with nuclear pleomorphism were observed in all cases, and were characterized by large, hyperchromatic and irregular nuclei, intranuclear pseudoinclusions, and prominent nucleoli; the mitotic figure was rare, and tumor necrosis was not found; inflammatory cell infiltration to different extents was observed in the tumor stroma, and lymphocyte sheaths were observed around the tumors in 2 cases. Immunohistochemical staining showed strong diffuse expression of CD34 in the tumor cells in all the 19 cases, the Ki-67 proliferation index was < 10% in 18 cases, and CKpan (2/12), desmin (2/15), and smooth muscle actin (1/19) were focally expressed. Fluorescence in situ hybridization for the detection of PRDM10 gene rearrangements was performed in 3 cases, and identified PRDM10 rearrangements in 2 cases, including 1 case of SCPFT accompanied by lymphocyte sheaths without EWSR1 rearrangements. Conclusion:SCPFT is an intermediate fibroblastic tumor with no characteristic clinical manifestations, often accompanied by PRDM10 rearrangements, and its diagnosis depends on histopathological patterns.

Objective To explore the value of polymerase chain reaction(PCR) to detect pathogens in ventilator-associated pneumonia(VAP) in children undergoing congenital heart disease(CHD) operation. Methods Forty-eight children selected from 95 cases with VAP underwent CHD operation were admitted in the department of CICU in our hospital from November 2016 to July 2017.Sputum specimens were separately collected by the bronchoalveolar lavage(BAL) and endotracheal tube attracts(ETA) methods,and the patho-gens were detected by culture and PCR assay.Results Nineteen specimens were found to be positive after 72 h of culture.A total of 20 pathogens were detected and 2 samples were mixed infection(more than one pathogen),and the positive rate was 39.2%(19/48).For PCR assay,44 pathogens from 31 samples were detected for just 24 h,22 samples were single pathogen infection,9 samples were mixed pathogen infection, and the positive rate was 65.3%(31/48).Compared with culture method,PCR assay could sharply increase the detection rate of every pathogen.Besides,the positive rate of the BAL or ETA for PCR assay was almost the same(45/48). Conclusion PCR assay for detecting pathogens is rapid,accurate and effective,which should be combined with culture method to detect for infectious pathogen.The ETA is the desired method to collect the sputum of the patients.

Objective To estimate the effect of early fluid removal on the early postoperative recov-ery in children after surgical repair of congenital heart disease with enlarged right ventricle via a randomized trial. Methods One hundred and twenty patients with right-sided complex congenital heart defect who un-derwent cardiac surgery by cardiopulmonary bypass during January 2017 to June 2017 were enrolled and were divided into two groups,Group-E and Group-C,when the hemodynamics was stable within 3 hours after the surgery. Patients in Group-E were treated with early fluid removal,but Group-C remained conventional thera-py. The data of the hemodynamics and outcomes were collected from the postoperative day to the 2nd day post-operation. Results Fluid removal therapy was started in Group-E at (4. 39 ± 0. 85) h postoperatively vs (10. 17 ± 2. 77) h in Group-C (P < 0. 05). Patients in Group-E showed lower extravascular lung water index (ELWI),lower fluid overload and lower NT-proBNP compared with patients in Group-C on the first day of post-operation(P < 0. 01). Also, the advantages remained in Group-E on the second day but the ELWI showed no remarkable difference. The rate of reintubation(P < 0. 05),the duration of mechanical ventilation and the length of ICU stay (P < 0. 01)were significantly reduced in Group-E. Conclusion In patients with right ventricle enlarged complex congenital heart defect who underwent cardiac surgery by cardiopulmonary bypass,utilizing early negative fluid balance when the hemodynamics are stable and the right ventricle is ob-viously enlarged could achieve negative fluid balance,get extubated and discharge from ICU earlier,also pres-ent lower extravascular lung water index, lower incidence of weaning-induced pulmonary edema and reintubation.

Objective:To investigate the sedative effect after congenital heart disease surgery in children under the bi-spectral index monitoring(BIS).Methods:A prospective cohort study was performed, we selected 264 children with congenital heart disease who were admitted to the cardiac intensive care unit at Shanghai Children′s Medical Center from September 2018 to August 2019, 126 cases in the intervention group, and 138 cases in the control group.The control group used Ramsay sedation score to evaluate the sedative effect, meanwhile the intervention group was evaluated by Ramsay sedation score and BIS.The incidence of adverse events related to extubation performed within 8 hours after congenital heart disease surgery, and the length of stay in ICU between two groups were compared.The average mechanical ventilation time of the patients whose mechanical ventilation time was more than 8 hours in two groups was compared.The use of sedative drugs midazolam and morphine in children with mechanical ventilation time for more than 24 hours and liver damage, and the incidence of respiratory depression during ventilator withdrawal were analyzed.Results:In children with early extubation, there were 62 cases in the intervention group and 70 cases in the control group.Compared with the control group, the intervention group had a low incidence of extubation-related adverse events (including unplanned extubation, dysphoria after sputum aspiration, and inhalation inhibition after extubation). The average mechanical ventilation time in the intervention group[(8.18±1.95)h] was less than that in the control group[(9.53±1.37)h, P<0.05] of the patients whose mechanical ventilation time was more than 8 hours but less than 24 hours.In children with mechanical ventilation time more than 24 hours, 28 cases were in the intervention group and 35 cases in the control group.The average doses of midazolam and morphine in the intervention group[(1.82±0.40)μg/(kg·min), (8.64±3.03)μg/(kg·h)] were less than those in the control group[(2.73±0.79) μg/(kg·min), (14.32±5.01)μg/(kg·h), all P<0.05]. Among the 28 children in the intervention group with mechanical ventilation time more than 24 hours, 13 cases had liver damage, and 15 cases of the 35 children in the control group had liver damage.The average doses of midazolam and morphine in the intervention group[(1.42±0.51)μg/(kg·min), (6.88±2.17)μg/(kg·h)] were lower than those in the control group[(2.25±0.62)μg/(kg·min), (11.88±3.56)μg/(kg·h), all P<0.05]. The incidence of inhalation inhibition in the intervention group was lower than that in the control group ( χ2=48.303, P<0.05). Conclusion:The sedation after congenital heart disease surgery in children under the BIS is effective.