Objective To compare the effects of oral Sildenafil(SIL)and intravenous prostaglandin E_1(Alprostadil,PGE_1)in treatment of postoperative pulmonary hypertension(PH)associated with congenital heart defects(CHD).Methods Data were collected from 24 children with postoperative mPAP≥35 mmHg in our hospital between August 2004 and March 2005.These children were randomly divided into three groups:8 children(group A)initially received SIL(0.35 mg/kg,orally by nasal gastric tube),followed by the addition of intravenous PGE_1(20 ng/kg per min)at 40 min.The second group of 8 children(group C)initially received intravenous PGE_1 followed by the addition of SIL at 20 min(dose as above).And remains(group B)were placebo-controlled.The changes of hemodynamic variables,arterial blood gas,lung static compliance(C)and work of breathing(W)were measured after drugs were given.Results Compared with group B,the mPAP and mPAP/mSAP was significantly reduced(P

Objective To explore the effect of joint mobilization and quadriceps setting on nitric oxide(NO) and tumor necrosis factor(TNF) of the experimental knee osteoarthritis in rabbits. Methods Rabbits model of knee osteoarthritis was induced by papain. 32 rabbits were divided into 4 groups randomly, 8 in each group. The changes of contents of NO and TNF in synovia were detected.Results Expression of NO and TNF in synovia of all treatment groups decreased compared to the control group(P<0.01).Conclusion Joint mobilization and quadriceps setting can decrease the level of NO and TNF in synovia.

ObjectiveTo observe the clinical efficacy of electroacupuncture plus constraint-induced movement therapy (CIMT) in recovering neurologic function of patients with spastic hemiplegia.MethodSixty patients with post-stroke spastic hemiplegia were randomized into an electroacupuncture group, a CIMT group, and an electroacupuncture+CIMT (integrated) group to receive corresponding intervention in addition tothe ordinary rehabilitation treatment, 20 cases in each group. Before treatment and after 4-week treatment, the modified Ashworth Scale, Clinical Neurologic Deficit Scale, Short-form Fugl-Meyer Assessment Scale (FMA), and Berg Balance Scale (BBS) were adopted for evaluation and comparison.ResultAfter 4-week treatment, the Ashworth score and neurologic deficit score were significantly reduced in the three groups (P<0.01), and the scores in CIMT group were significantly lower than that in the electroacupuncture group (P<0.05), and the scores in the integrated group were markedly lower than that in the other two groups (P<0.05); the FMA and BBS scores were significantly increased after intervention in the three groups (P<0.01), and the scores in CIMT group were higher than that in the elctroacupuncture group (P<0.05), and the scores in the integrated group were higher than that in the other two groups(P<0.05).ConclusionElectroacupuncture plus CIMT can reduce the muscular tension of the affected limb in patients with spastic hemiplegia, and improve the neurologic function, motor function, and the quality of life of the patients.

OBJECTIVE: To explore the influence of adult craniofacial structures on obstructive sleep apnea hypopnea syndrome (OSAHS). METHOD: This study compared the measurements of the height, body weight,neck circumference, the mallampati oropharyngeal score grading, thyromental distance, thyromental angle, lobule-mental distance, mental-lower lip distance of 50 patients with OSAHS with those of 50 controls. RESULT: Statistical findings showed that OSAHS patients were different from controls in the following ways: (1) higher neck circumference; (2) larger thyromental angle; (3) higher Mallampati scores; (4) higher body mass index; (5) shorter mental-lower lip distance. CONCLUSION A crowded posterior oropharynx and a steep thyromental plane are associated with OSAHS. The adult craniofacial structures of bony and soft tissue determine the dimension of upper airway during sleep andpaly an important role in the development of OSAHS.
Adult ; Case-Control Studies ; Cephalometry ; Facial Muscles ; anatomy & histology ; Female ; Humans ; Male ; Skull ; anatomy & histology ; Sleep Apnea, Obstructive ; etiology

BACKGROUND:Compared with the cone stem,short stem holds good matching with femoral canal,and remarkably reduces the risk of prosthesis loosening.OBJECTIVE:To further investigate the clinical efficacy of Accolade Ⅱ stem for Crowe type Ⅰ developmental dysplasia of the hip.METHODS:Clinical data of 16 patients with Crowe type Ⅰ developmental dysplasia of the hip undergoing total hip arthroplasty using Accolade Ⅱ stem were collected,the length of both lower limbs before and after surgery was compared,and the Visual Analogue Scale,functional recovery of the hip and general conditions were observed at 12 weeks postoperatively.RESULTS AND CONCLUSION:(1) The change in length of both lower limbs before and after surgery had significant difference (P ＜ 0.05),and 10 patients (62％) with the same length of both lower limbs before surgery,and 15 cases (94％) after surgery.(2) The postoperative acetablar abducent angle was 41°-54° (average 46.9°).(3) The Visual Analogue Scale and Harris hip scores after surgery were significantly improved compared with baseline (P ＜ 0.05).(4) The intraoperative blood loss was 147 mL on average,the mean operation time was 72 minutes,and the hospitalization time was 7.2 days.(5) All patients recovered well and no complications occurred at 3 months postoperatively.(6) To conclude,Accolade Ⅱ stem is safe and reliable for Crowe type Ⅰ developmental dysplasia of the hip,and exhibits good functional recovery of the hip.

Objective We aimed to recent experience at our hospital in the diagnosis and treatment of pericardial effusion after cardiac surgery and to identify risk factors for its development.Methods We searched our hospital for patient who had cardiac surgery with cardiopulmonary bypass from January 2002 through December 2010.For patient with pericardial effusion,medical records were reviewed to evaluate its manifestations and management.To identify risk factors for effusion,patients with effusions were compared with patients without effusions.All patients had routine postoperative echocardiographic examination.Results Of 22462 patients identified,509 (2.3％) had pericardial effusion.Compared with patients without pericardial effusion,ages,sex,cardiac function and so on were no significant( P ＞ 0.05 ).Body,valve cardiac diseases,and cardiopulmonary bypass time and so on were significant ( P ＜ 0.05 ).Among 509 patients with pericardial effusion,262 patients (51.4％) of whom had specific symptoms.Clinical features of tamponade were documented in 51 patients( 10.1％ ).Pericardial effusions were evacuated by echocardilgraphy-guided pericardiocentesis ( n =27,10.3％ ) or surgical drainage ( n =15,5.7％ ).Pericardial effusion resolved after left thoracocentesis for pleural effusion in 5 patients ( 1.9％ ) ; The Other patients with pericardial effusion were treated conservatively.Indeperdent risk factors for pericardial effusion were large body,valve cardiac operations,and prolonged cardiopulmonsry bypass.Conclusion In our study,pericardial effusion occurred in 2.3％ of patients,and symptoms were nonspecific.Several factors,mainly related to preoperative characteristics and type of operation,predispose patients to effusion,echocardiography-guided pericardiocentesis is effective and safe in these patients with pericardial effusion.

Objective To study the therapeutic window of rapamycin(RPM) concentration in primary recipients of renal transplantation. Methods An open label, multi center study was performed. One hundred primary renal allograft recipients with cadaveric donors were enrolled from 4 transplantation centers in China. The immunosuppressive regimen was triple therapy,i.e.RPM combined with CsA and steroid. A loading dose of RPM 6 mg/d was administered within 48 hours after transplantation, then a maintaining dose of 2 mg/d was administered. The whole blood concentration of RPM was measured by HPLC method. Results The whole blood concentration of RPM in this group was (6.65?2.75)ng/ml, the 10th and 90th percentile for RPM concentration was 3 2 ng/ml and 10 26 ng/ml,respectively.9 5%(8/84)patients suffered from acute rejection during the 6 month period after transplantation in this study, and the concentration of RPM in these was lower than that in non rejection patients(P=0.001). Hyperlipidemia and liver dysfunction were the most frequently adverse events, and RPM concentration was significantly associated with the concentration of triglyceride. Conclusions 4～8 ng/ml is a suitable level for RPM concentration. Regular drug monitoring and reasonable dose modulation may increase the validity and security of RPM.

Objective To summarize clinical experience of using extracorporeal membrane oxygenation (ECMO) in rescuing children with acute fulminant myocarditis (AFM).Method Data of 12 children with acute fulminate myocarditis (6 boys and 6 girls,median age 8.3 (0.6,13.0) years,median weight 33.1 (6,61) kg) who were rescued with ECMO in Children's Hospital,Zhejiang University from September 2009 to August 2015 were analyzed retrospectively.The analysis focused on the intervene timing of ECMO for the cardiogenic shock and hypoperfusion caused by heart failure and(or) lethal arrhythmia and the essentials of ECMO cardiopulmonary resuscitation (ECPR) for cardiac arrest in pediatric AFM were summarized.Result The median ECMO duration was 110(22,240) h.Ten cases survived and 2 were dead of the total of 12 patients.Six ECPR patients survived and 2 were dead in the total of 8 ECPR patients.The complication of 10 survivors were cannula site bleeding (3 cases),hypematremia and intracranial hemorrhage (1 case),limping (1 case),hoarse voice (1 case),and cerebral injury (1 case).Conclusion The key points of improving ECMO rescuing outcome for the AFM children are grasping the ECMO intervene timing and training skilled ECMO team.For ECPR patients,keeping effective chest compressions resuscitation is the key to achieve survival and improve the quality of life.

Objective To document the impact of conversion to mycophenolate mofetil (MMF)at different time points after transplantation on the renal function of renal function.Methods A longterm,multicenter,non-interventional and observational study was done.Two cohorts were included:One was Switch cohort (340 cases) including renal allograft recipients who switched to MMF at least 6 months after renal transplantation and followed up for 4 years after switch; The other was Stay cohort (123 cases),including renal allograft recipients who received MMF treatment after transplantation and followed up for 4 years after enrollment.Results GFR values of patients in Switch cohort was significantly increased after switch,and the change in GFR slope was 3.1 mL· min-1 · year-1 (P＜0.01).GFR values of patients in Stay cohort kept steady before and after enrollment,and the change in GFR slope was 0.44 mL·min-1 ·year-1 (P＞0.05).Statistically significant difference in the onset time of GFR decline (defined as 20％ decline from the baseline) was observed among subgroups within Switch cohort (P＜0.01),but there was no significant difference among subgroups within Stay cohort (P＞0.05).Stay cohort was 12％ higher than in Switch cohort every year.Conclusion Conversion to MMF ＞6 months or even many years after transplantation can obviously improve the renal function of recipients.The earlier conversion can benefit improvement of the renal function.

Objective:To investigate the preoperative ascending aorta diameter in patients with acute type A aortic dissection in the Chinese population, compares and analyze the differences in preoperative blood biomarkers, and evaluate the impact of the preoperative ascending aorta diameter in this part of patients on the short-term prognosis of patients.Methods:A collection of 641 patients with acute type A aortic dissection who were enrolled in the " Acute Aortic Syndrome High-Risk Early Warning and Intervention Study" project from January 2018 to January 2020 were collected. Divide the patients into two groups (group Ⅰ<55 mm, group Ⅱ≥55 mm) according to the preventive intervention value of ascending aorta diameter recommended by the guideline for studying preoperative ascending aorta diameter difference in blood biomarkers and the influence of ascending aorta diameter on the short-term prognosis of patients. All patients had CT scans to assess the diameter of the ascending aorta before operation.Results:In this study, all patients with acute type A aortic dissection had a mean preoperative ascending aorta diameter of (46.9±9.7)mm. The preoperative ascending aorta diameter of all patients was less than 55 mm, accounted for 84.1%. Male patients were more likely to have aortic dissection than females; most patients' age was less than 60 years old. The preoperative blood inflammatory index counts were higher in the ascending aorta diameter ≥55 mm group. However, the long-term prognosis of patients with different ascending aorta diameters before surgery was not apparent in this study. The preoperative survival rate and short-term survival rate of patients with ascending aorta diameter <55 mm were higher than those of other groups, but the difference was not statistically significant.Conclusion:In patients with acute type A aortic dissection, the diameter of the ascending aorta is usually less than 55 mm. Moreover, the blood inflammatory index counts are high in the preoperative ascending aorta diameter ≥55 mm group. Meanwhile, patients with smaller ascending aorta diameter have better survival rate and short-term prognosis.