Objective To analyze the risk factors in the operative mortality in neonates with congenital heart disease.Methods The surgical outcomes of eongenital heart defects in 231 neonates at Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University of Medicine,during Jan.2011 and Dec.2013 were detected for retrospectively.Patients were analyzed according to Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1).The age,weight at operation,emergency operation,cardiopulmonary bypass,single ventricle surgery,and RACHS-1 score were detected for risk assessments.Results Overall mortality of congenital heart defect in neonates was 9.96％ (23/231 cases).The top three procedures for high mortality were single ventricle palliative surgery.(25.00％,7/28 cases),corrective operation of interrupted aortic arch (21.43％,3/14 cases),and arterial switch operation with ventricular septum defect repair (13.95％,6/43 cases).There was only 1 case of pulmonary atresia with intact ventricular septum repair,and the case was not classified into high mortality category.With the elevation of RACHS-1,the mortality increased.The mortality rate was 6.67％ (2/30 cases) in RACHS-1 as category 2,6.84％ (8/117 cases) in 3,13.75％ (11/80 cases) in 4,and 50.00％ (2/14 cases) in 6.Multivariable analvsis of risk factors for death showed that single ventricle palliative operation,body weight less than 3 000 g,and RACHS-1 were independent risk factors for mortality.Conclusions This study shows the surgical mortality in neonates with congenital heart defect is still high.Further prospective analysis of specific treatment strategies for high risk patients above was needed and the strategy for single ventricle operation in neonates should be optimized.

Objective To explore the effect of inferior hypothermy treatment on serum TNF and IL-6 in patients with severe cerebral trauma.Methods 46 patients were randomly divided into two groups:inferior hypothermy group(24 C88e8)and normal group(22 cases).There are the same basic treatments within the two groups,in the inferior hypothermy group we also sive them hypothermy treatment rectal temperature:32～34℃ which need to last for nearly 4～5 days,at the same time we give patients the lyric cocktail.the TNF,IL-6 and GCS grades on the lst and 14th day were tested.Results TNF and IL-6 as compared with normal group are higher than the inferior hypothermy group,the differences between the two groups are of statistical significance(P＜0.01).The difference of GCS grades between the two groups are of stafictical significance(P＜0.05).Conclusion The inferior hypothermy tbempy which inhibits TNF and IL-6 releasing after severe cerebral trauma and the following damages plays a very important role in the cerebral trauma therapy.

OBJECTIVE To provide references for clinical diagnosis of catheter-related bloodstream infections(CRBSIs) and focus on studying the spectras of pathogenic bacteria and the drug sensitiveness. METHODS A total of 137 patients enrolled from Jan 2005 to Dec 2007 in our hospital with positive catheter cultures were admitted to our retrospective analysis.Pathogenic bacteria,contaminant bacteria and the drug sensitiveness of main pathogenic bacteria were analyzed. RESULTS From them 80 patients were diagnosed CRBSIs.Among 92 strains of pathogenic bacteria,43(46.7%) strains were Gram-positives,31(33.7%) coagulase negative staphylococci(CNS) strains,31(33.7%) Gram-negative bacilli strains and 18(19.6%) were Candida strains. CONCLUSIONS CNS are the most common bacteria of CRBSIs,and the second are Candida.The common pathogen show multi-drug resistance.

BACKGROUND:Osteoblasts with high purity and activity are essential for bone metabolism research. OBJECTIVE:To explore a simple and effective culturing method of primary osteoblasts. METHODS:Osteoblasts were isolated from the parietal and frontal bones of newborn Sprague-Dawley rats using trypsin and collagenase digestion and tissue explant method. The morphology of osteoblasts was observed by inverted phase contrast microscope and transmission electron microscope;the cells was counted to draw the growth curve;the osteoblasts were identified by alkaline phosphatase BCIP/NBT staining and alizarin red staining. RESULTS AND CONCLUSION:The cells showed spindle, triangle or polygon shapes, having two or three protrusions. There were abundant mitochondria and endoplasmic reticulum under electron microscope, which presented the typical characteristics of osteoblasts. The cell growth was slow intially, accelerating at the 3rd day, and peaking at the 7th day. The cells were highly positive for alkaline phosphatase staining and were stained orangered through the alizarin red staining. To conclude, the cells isolated using enzymatic digestion combined with tissue explant method exhibit the typical characteristics and functions of osteoblasts, and this method is an ideal way to culture primary osteoblasts.

Objective To investigate the effect of Dexamethasone (Dex) on the proliferation and apoptosis of osteoblasts in vitro and to explore its underlying mechanism.Methods Osteoblasts were acquired by primary culturing from new born SD rats.The inverted microscope was used to observe the cellular appearance.The cells were identified by alkaline phosphatase staining and alizarin red staining.The third generation osteoblasts were divided into four groups.Cells were incubated with different concentrations (0,10-8 mol/L,10-7 mol/L,10-6 mol/L) of dexamethasone for 12 hours,24 and 48 hours.Cell Counting Kit-8 was performed to evaluate the inhibitory effect on cell proliferation.The apoptosis rate was analyzed by flow cytometry with Annexin Ⅴ-FITC/PI double staining.The fluorescence microscopy was used to test the nuclear alteration and the expression of caspase-3.Western blot assay was applied to detect the expression of Bcl-2,Bad,caspase-3 and phosphorylated Akt.One-Way analysis of variance was used to determine the difference between groups.LSD-t was used to compare the difference between any two groups.Results Com-pared with the control group,dexamethasone at dose of 10-8 mol/L,10-7 mol/L and 10-6 mol/L inhibited the proliferation of osteoblasts,most evidently in 48 hours (0.980±0.028 vs 1.143±0.017,t=5.454,P＜0.05;0.798±0.057 vs 1.143±0.017,t=1 1.555,P＜0.05;0.728±0.031 vs 1.143±0.017,t=13.908,P＜0.05).Dexamethasone at dose of 10-7 mol/L and 10-6 mol/L induced apoptosis of osteoblasts at 48 hours,showing significant difference compared with control group [(9.8± 2.6)％ vs (4.1±0.8)％,t=3.508,P＜0.05;(12.4±2.6)％ vs (4.1±0.8)％,t=5.140,P＜0.05].However,10-8 mol/L of dexamethasone had no apparent effect in inducing apoptosis of osteoblasts [(4.9±1.2)％ vs (4.1±0.8)％,t=0.470,P ＞0.05].The immunofluorescene staining result showed that the expression of caspase-3 protein was significantly increased in 10-7 mol/L and 10-6 mol/L dex group (t=4.320,8.475,P＜0.05).The Western blotting results showed that dexamethasoneat the concentration of 10-7 mol/L,10-6 mol/L could significantly increase the expression of Bad and caspase-3 and down-regulate the expression of Bcl-2 and p-Akt.The expression of Bcl-2 was markedly reduced by 53.8％,78.4％ (t=4.019,5.988;P＜0.05),The expression of p-Akt decreased by 37％,49.6％ (t=2.067,3.491;P＜0.05),the expression of Bad protein increased by 276.9％ and 334.8％ respectively (t=7.342,8.872;P＜0.05),the expression of caspase-3 protein were increased by 138.0％ and 193.9％ (t=5.510,7.750;P＜0.05).Conclusion Dexamethasone is capable of inhibiting the proliferation of osteoblast,as well as augmenting the apoptosis.The mechanism of this process is probably related to reduction of the level of Bcl-2 expressionand up-regulation the expression of Bad,caspase-3 with the effects of inhibiting the PI3K/Akt signaling pathway.

Objective:To summarize cardiac function feature and its support method after ALCAPA(anomalous origin of left coronary arteries from pulmonary artery) operation. Analysis its early outcome and risk factors of its mortality.Methods:Review the clinical data of 108 ALCAPA cases treated in Shanghai Children Center between January 2005 and December 2017. All the cases were divided into two groups according to their ages when they received the surgery: group 1<1 yr; group 2>1yr. Adopted LVEF(left ventricle ejection fraction) and LVEDD(left ventricle end-diastolic diameter) Z-score as a parameter to describe the cardiac function change after operation. Summarize the selection and application of vasoactive agents and its score(VIS) after operation, indirectly reflect the post-operative cardiac function. Analysis the opportunityofinitiation and termination of mechanical circulation support and the timefor mechanical ventilationevacuation. Adopt the logistic analysis to find the risk factors of early death risk factors after ALCAPA operation. Results:Cardiac function had little improve in early period after ALCAPAoperation, did not attained normal range in fifth day post-operative, LVEF was 0.42 in group 1 and 0.45 in group 2, respectively. The application of vasoactive agents tended to choose α, β receptor-agonist, which epinephrine and norepinephrine is the preferred and VIS score was high in early period. Mechanical circulation support was used in 18 cases. 12 cases died in our group, mortality was 11%. Logistic regression analysis implied that low age and low level of LVEF before operation is the risk factor for mortality. Conclusion:Cardiac function was still in low level in early period after ALCAPA operation, depended on higher dosage of vasoactive agents and mechanical circulation support if necessary. We recommend the LVEF index for evacuated from mechanical circulation support and mechanical ventilation is over 0.40 and 0.35 respectively, and other clinical sign should be considered simultaneously. Low age and low LVEF level before operation is the risk factors for early death after ALCAPA operation.

Objective To observe the effect of different Nasointestinal feeding tube catheterization techniques on patients with ICU brain dysfunction.Methods Totally 51 patients were divided into the traditional blind intubation group(26 cases)and the ultrasound guided group(25 cases)according to the random number table.The efficacy of catheterization was evaluated using first catheterization success rate,final catheterization success rate,catheterization time,and complications.Results The ultrasound guided catheterization group has a higher success rate for the first catheterization compared to the traditional blind insertion group;There was no statistically significant difference in general information,final catheterization success rate,catheterization time,and incidence of complications between the two groups.Conclusion The two kinds of nasogastric tube placement techniques are safe and effective in patients with ICU brain dysfunction,ultrasound guided catheterization can improve the success rate of first catheterization and have better efficiency.

CircRNA is a single-stranded, covalently closed non-coding RNA, whose mechanism mainly involves sponge adsorption of micro RNA (miRNA), regulation of protein transcription and post-transcriptional levels, interaction with RNA-binding proteins and few coding proteins of circRNA. Meanwhile, because of its abundant expression, highly conserved and dynamic changes, circRNAs have promising applications such as becoming biomarkers of diseases, developing circRNA vaccines and gene editing therapies for circRNAs. Cardiovascular diseases are the leading cause of death from diseases worldwide, and existing therapeutic approaches can delay the development of heart diseases, but are still limited by the unknown pathogenesis and therapeutic targets. Many studies have reported the mechanistic link between circRNAs and cardiac diseases, therefore, this review is to explain the progress of circRNA research in cardiovascular diseases and to illustrate the three clinical applications in which circRNAs are currently involved.

Objective To investigate the feasibility of inserting and detaining nasointestinal feeding tube in small bowl guided by bedside ultrasound(US)in critically ill elderly patients.Methods This was a retrospective study.Sixty four aged patients(≥ 60 years)in general ICU,the Second Affiliated Hospital of Jiaxing College,received the US-guided nasointestinal feeding tubes inserting and detaining.Feeding tubes passed through nasal and went into the stomach by manual blind method.Under US-guiding condition,the tube passed through the pyloric sphincter and further into the duodenum or jejunum.Finally the correct position of the tube head was assessed by bedside X-ray examination.Results The US-guided nasointestinal feeding tube-detaining technique was successfully operated in 57 patients(89.1％).The feeding tube heads were in the duodenum in thirty four cases(53.1 ％),and in proximal jejunum in twenty-three cases(35.9％).The untoward reaction included the bleeding of nasal cavity in 1 case,and hypotension in another case.Conclusions Bedside US-guided nasointestinal feeding tube placement is safe and feasible in aged critical patients.

Objective To analyze the influencing factors of surgical management for Blalock-Taussig shunt during neonatal period,and to summarize the clinical experience,therefore,to improve the surgical outcome.Methods The clinical data between Jan 2011 and Dec 2016 were reviewed,42 neonates(26 males,16 females)with the mean age from 1 to 29 days,and weight from 2.3 to 4.1 kg,underwent a Blalock-Taussig shunt.The additional operation included PDA retention in 3 patients,right ventricular outflow tract retention in 12 patients,B-T conduit banding in 2 patients and PDA banding in 1 patient.Results The early mortality was 28.6％ (12/42).Univariate analysis revealed low birth weight,waiting time for surgery,preoperative acidosis or cardiac shock,dual pulmonary blood supply,conduit/weight,high IS (inotropic drugs score),unplanned intervention as risk factors for early death.In the multivariate analysis,preoperative acidosis or cardiac shock,conduit/weight,high IS were independent risk factors of early death.Conclusion The mortality rate after the neonatal modified Blalock-Taussig shunt remains high.It can be improved by proper perioperative treatment,immediate surgical treatment and choose suitable conduit size,maintain the stable circulation.