Objective To summarize the feasibility of the application of the self-made bipolar venous cannulae to repair atrial septal defect(ASD)totally through thoracoscope in children.Methods Twenty-eight children,aged 4.2?1.3 years in average and weighed 14.6?3.9kg,were diagnosed as congenital ASD.Among these patients 3 were complicated by moderate to severe pulmonary hypertension,4 by partial pulmonary venous teratosis and 3 by tricuspid valve insufficiency.During the operation,patients were placed in a supine position,and the right shoulder was padded 30? higher than the left.A tracheal cannula was inserted and air was given with high frequency jet ventilation.Three small thoracotomies with a diameter of 2 to 3 cm were made in the 4th intercostal space on the right side of the sternum and the 4th and 7th intercostal spaces on the right middle axillary line.The cardiopulmonary bypass(CPB)was set up through the right femoral artery and femoral vein with bipolar femoral venous cannulae.The ASD was repaired through the thoracoscope.Results In all the 28 patients,the mean extracorporeal circulation time was 53.5?17.8min,and cross-clamp time was 25.2?7.9min.Automatic heart beat recovered after the declamping of the aorta in all the patients.No serious complication occurred.Heart murmur vanished,and ultrasonic examination was negative.Half a year after operation,ECG showed that the size of right ventricle and right atrium became maller in size,the diameter of pulmonary artery diminished,and the cardiac function was improved(P

0.05).Compared with group A,the aortic occlusion time,ventilation time and the length of stay in ICU were shorter in groups B and C(P0.05)were found between group B and C in the aortic occlusion time,ventilation time and length of stay in ICU.Conclusion TTS is a safe and reliable surgical madality for the treatment of pediatric cardiac diseases.Patients weighed over 20kg are strong enough to withstand TTS and may recover sooner.

30 mm in 100 patients.The ASD was associated with atrial septal aneurysm in 2 patients.An incision 2~3 cm in length was made in the 4th intercostal space of the right parasternum to expose the right atrium,at which a purse-string suture was placed.A double-lumen delivery catheter was then punctured into the right atrium,and passed through the defect to the left atrium under the guidance of transesophageal echocardiography.An occluder made of a nickel-titanium metal alloy and 4 mm bigger than the defect was released to engage on the defect.The delivery catheter was then withdrawn.Results The operation was successfully accomplished in all the 206 patients.The operation time was 18~32 min(mean,26?7 min). No surgery-related death happened and no occluder dislodgment occurred.Mechanical ventilation was stopped at 5 hours after operation,and all the patients got out of bed on the operation day.Colour Doppler imaging 3 days after operation showed complete occlusion of the ASD without residual shunt.The length of hospitalization was 4?2 days.Follow-up examinations for 6 months in 186 patients and for 3~4.5 years in 57 patients by using Colour Doppler imaging revealed no residual shunt and normal cardiac functions.Conclusions Mini-incision transthoracic occlusion of atrial septal defect is safe and reliable in patients contraindicated to transcatheter closure.

Objective To evaluate the reconstruction of right ventricle outflow tract (RVOT) with BalMedic pulmonary valved conduit in multiple medical center.Methods Since January 2007,50 patients age (4.90 ± 7.63) years (range 6 month to 39 years),weight (16.20 ± 13.69) kg (range 4.50 to 65.0 kg),had been corrected by reconstruction of RVOT.There were 22 patients with pulmonary atresia and ventricular septal defect (PA/VSD) ; 10 patients with corrected transposition of the great arteries and pulmonary stenosis (C-TGA/PS) ; 7 patients with truncus; 4 patients with double outlet of right ventricle and pulmonary stenosis (DORV/PS) ; 3 patients with tetralogy of Fallot (TOF) ; 2 patients with complete transposition of the great arteries and pulmonary stenosis (TGA/PS) ; and each 1 with aortic stenosis (AS) and pulmonary stenosis (PS).Fifty BalMedic pulmonary valved conduits were implanted between pulmonary and RVOT underwent cardiopulmonary bypass.There were different diameter of pulmonary valved conduit included 10 mm to 24 mm depend on the patients weight and pulmonary size.All patients were followed up after operation on 1 month,3-6 months and more than 12 months.Results There was no death.Three patients were lost followed up after 12 months and one late death.There were no pulmonary valve stenosis about 91.1％,moderate pulmonary regurgitation 16.0％,no RVOT obstruction 95.6％,no main pulmonary artery stenosis 80.0％,and no right and left pulmonary artery stenosis 73.0％.Conclusion These results demonstrated that the BalMedic pulmonary valved conduit is reliable and effective in surgical procedure,but the long-term results should be followed up continually.

Objective To study the etiology, clinical features, risk factors of septic shock and multiple organ dysfunction syndrome /multiple organ failure (MODS/MOF) caused by gastroenteritis infection in the pediatric intensive care unit (PICU). Methods Case records of patients with gastroenteritis complicated by septic shock and MODS/MOF admitted to PICU in Children's hospital affiliated to Shanghai Jiaotong University from January 2000 to December 2004 were reviewed for etiology, case fatality rate, prognosis and relationship with MODS/MOF. Univariate analyses were performed to analyse the risk factors associated with septic shock and MODS/MOF. Results During the 5 years, 1 536 patients with critical illness were admitted and MODS/MOF associated with gastroenteriitis infection developed in 28 patients. The overall mortality of patients with MODS/MOF associated with gastroenteriitis was 75%. The mean age was (1.9?3.4)years and 19 cases(67.8%)were under 1 year. The patients with MODS/MOF involved (3.7?0.9)organs or systems on average. The numbers of involved organs systems were circulatory in 28 patients(100%), gastrointestinal system in 21(75%), lung in 20(71.4%), kidney in 14(50%),brain in 9(32.4%),blood in 9(32.4%) and liver in 5(17.9%). The first dysfunctional system was gastrointestinal tract in 13(46.4%),circulatory in 11(39.3%),and lung in 4(14.3%). The average volume of fluid resuscitation was (46.2?12.6)ml/kg and range from 30 ml/kg to 75 ml/kg in the first hour. The average fluid was (92.7?33.9)ml/kg and range from 70 ml/kg to 120 ml/kg in 6 hours. The cases fatality of patients with or without successful volume resuscitation were 66.7% (12 in 18 cases) and 90%(9 in 10 cases) in 6 hours respectively.Univariate analyses indicated the following risk factors: numbers of failed organ and lower pediatric critical illness score(P

Objective To observe the effects of hydrotalcite on histological ulcer healing quality in patients with Helicobacter pylori (Hp) positive active gastric ulcer .Methods A total of 145 patients with H p positive active gastric ulcer were divided into two groups .The control group was treated with esomeprazole ,amoxicillin and furazolidone triple therapy .The treatment group was treated with above triple therapy and hydrotalcite .After four-week treatment ,gastroendoscopy was repeated .The sections of gastric biopsy specimens were stained with hematoxylin-eosin (HE) staining ,Van Gieson staining , Alcian blue-periodic acid stiff (AB-PAS ) staining , streptavidin-perosidase (SP ) immunohistochemistry staining and computer imaging analysis technology were applied to observe maturity type of mucosal structure at the margin of ulcer ,the content of collagen and neutral mucus ,and the changes of expression of epithelial growth factor receptor (EGFR) and basic fibrobast growth factor (bFGF) before and after treatment .Paired samples t test was performed for comparison before and after treatment .F test and Chi-square test were used for comparison between two groups .Results The percentage of maturity type of regenerated mucosal structure of treatment group was 62 .9% (39/62) ,however that of control group was 40 .6% (26/64) ,and the difference was statistically significant (χ2 =13 .09 , P=0 .03) .Compared with those before treatment , the content of collagen in granulation tissue and neutral mucus in regenerated mucosa increased in both groups after treatment , and the increase was more significant in treatment group ((55 .1 ± 10 .4)% and (45 .8 ± 7 .1)% ,respectively);and the differences were statistically significant (F= 12 .85 and 18 .17 ,both P<0 .01) .Compared with those before treatment ,the percentage of EGFR and bFGF positive cells of both two groups increased , and the increase was more significant in treatment group ((49 .5 ± 8 .4)% and (48 .8 ± 9 .4)% ,respectively) ,and the differences were statistically significant (F=12 .17 and 18 .73 ,both P<0 .01) .Conclusion Hydrotalcite combined with anti-H p triple therapy can improve the maturity degree of structure and function of regenerated mucosa at the margin of ulcer in patients with H p positive active gastric ulcer and then improve the healing quality of ulcer .

Objective:The study was attempted to improve the manipulation and eliminate patient's fear for gastroscopy combined with intravenous injection.Methods:A total of 1350 patients wasrandomized into test group (n=1100 given intraveous protofol and midazolam)and the control (n=250,without anesthetics).Patient's feeling,heart rate,blood oxygen saturation,blood pressure,operative duration and operator' satisfaction were recored and analysed.Results:Data in test group showed less complaints,easier manipulation,high satisfaction and no difference in operative duration and blood oxygen saturation as compared with the control.After intravenous administration of protofol and midazolam,patient's heart rate and blood pressure (systolic and diastolic pressure) significantly decreased.Conclusions:With intravenous use of protofol and midazolam,gastroscopy can be achieved effectively,painlessly and safely.

Objective To investigate the clinicalmanifestation,monitoring and therapeutic measure of severe enterovirus 71 ( EV71 ) infection in children.MethodsForty-five cases of severe EV71 infectionwere admitted in our PICU from May 2010 to Sep 2011.The vital sign and arterial blood pressure,central venous pressure,mixed venous oxygen saturation,dynamic non-invasive heart function and urine volume were monitored.Forty-five cases were divided into 3 stages according to clinical manifestation:( 1 ) nervous system involvement stage; (2) respiratory system involvement stage; ( 3 ) circulatory system involvement stage ( compensation and decompensation).We adopted individualized remedy measure according to different stages.ResultsIn 45 cases,38 cases discharged from hospital,the cure rate was 84.4％.Among all the 38 cases,nervous system involvement was found in 19 cases,respiratory system involvement was found in 12 cases,circulatory system involvement was found in 7 cases.Seven cases died,who had circulation failure.ConclusionWe should identify severe EV71 infection early.Positive control of high fever,appropriate liquid treatment,control of high blood pressure,early respiratory support,preventment of circulation failure are the key measures for treatment.Individualized monitoring and treatment are effective in children with severe EV71 infection.

ObjectiveTo evaluate the relationship of human papillomavirus(HPV) intection with expressions of cell cycle regulatory proteins cyclin D1,E and their dependent kinase inhibitor p27 in bowenoid papulosis(BP).MethodsTissue specimens were obtained from the lesions of 44 patients with BP,and circumcised foreskin tissue from 10 males served as the control.Gene chip was used to determine the genotypes of HPV,and immunohistochemistry to quantify the expressions of cyclin D1,E,p27,in these specimens.Results Of the 44 BP specimens,all were positive for HPV DNA,38(86.36％) for high risk types of HPV,and 6 for low risk types of HPV.Of the high risk HPV-positive specimens,30(68.18％) harbored HPV16,16 harbored single HPV 16,14 harbored other types of HPV besides HPV 16,8 harbored other high risk types of HPV.HPV 6 predominated in low risk HPV-positive specimens.The expression of cyclin D1 was significantly higher in patients with high-risk HPV(u =53.00,P＜ 0.05),with both high and low risk HPV(u =5.00,P＜ 0.01) and with low risk HPV (u =22.50,P＜ 0.05) than in normal human controls,and higher in patients with both high and low risk HPV (u =44.00,P＜ 0.01) and with low risk HPV (u =22.50,P＜ 0.05) than those with high risk HPV.In the case of cyclin E expression,patients with high risk HPV (u =0.00,P ＜ 0.01 ),with both high and low risk HPV (u =4.00,P ＜ 0.01 ),and with low risk HPV(u =1.50,P ＜ 0.01 ) were higher than normal human controls,and patients with high risk HPV were higher than those with low risk HPV(u =11.00,P ＜ 0.01).No significant difference was observed in the expression of p27 between patients with high and low risk types of HPV.A significant increase was observed in the expression of p27 in patients aged ＞ 50 years compared with patients aged 20-30 years(u =47.00,P＜ 0.05) and aged 31-50 years (u =55.50,P＜ 0.05),as well as in the expression of cyclin E in patients aged ＞ 50 years compared with those aged 20-30 years(u =45.50,P ＜ 0.05),and in female patients compared with male patients (u =137.50,P＜ 0.05).ConlusionThere is a significant difference in the expression of cyclin D1,E and p27 among patients with BP infected with different types of HPV.

Objective To analyse the risk factors and prognosis of new on-set postoperative atrial fibrillation in different age and gender groups.Methods The study is a retrospective analysis in 516 patients from a single center.All cases were divided into 5 groups by ages as:＜ 40 years (n =61),40-49 years (n =97),50-59 years (n =115),60-75 years (n =140),and ＞ 75 years(n =103).We retrospectively analysed the difference in the occurrence-and recurrence-rate of POAF,risk factors,feature of coronary artery in different age and gender groups.Results There were no statistics differences in the same age group.The major risk factors were smoking,family history of coronary artery disease and hyperlipaemia in age ＜40 years group and 40 ～ 49 years group.while the major risk factors were hypertension and diabetes in the 60-75 years group and age ＞ 75 years group.The percentage of smoking patients decreased along with adding age.There was obviously statistical difference in the recurrence-rate of POAF across all groups during 24 follow-up months (P ＜ 0.05).The number of coronary lesion was increased with age.There were more ostial lesions in the 60-75 years group and age ＞ 75 years group.Conclusion There are different risk factors and characteristics among POAF patients in different age and gender groups.It is of great significance for us that comprehensive clinical intervention measures are taken to prevent recurrence of AF.