Objective To compare the treatment outcomes between minimally invasive perventricular device occlusion (MIPDO) and right subaxillary incision surgical repair(RSISR) on perimembranous ventricular septal defect(PmVSD) in children less than 15 kilograms.Methods From January,2010 to January,2013,a total of 530 infants(age ＜ 3 years,weigh ＜ 15 kg) with PmVSD enrolled and they were divided into two groups according to different treatment methods at random.Group 1 (265 cases) was arranged perventricular device closure with modified occluders through a lower partial median sternotomy under transesophageal echocardiography (TEE) guidance;group 2 (265 cases) was arranged surgical repair on cardiopulmonary bypass(CPB) through a right subaxillary small incision.A prospective randomized controlled study was performed between two groups on success rate,operation time,volume of blood loss and transfusion,length of intubation and ICU stay,complications,expenses and follow-up results etc.Results All patients in two groups obtained effective treatment with no death or serious life-threatening complications.Group 1:255 cases (96.23％) underwent successfully MIPDO.The remainder 10 cases (3.77％) who failed in attempt were successfully converted to conventional open heart operation by extending the original incision.Different arrhythmias arose in 30 cases(11.76％),including incomplete left bundle branch block(ILBB) in 3 cases(1.18％),complete right bundle branch block(CRBB) in 3 cases(1.18％),incomplete right bundle branch block(IRBB) in 16 cases(6.27％),Ⅰ° atrioventricular block(Ⅰ°AVB) in 8 cases(3.14％);trivial residual shunt(RS) in 18 cases(7.06％);newly arose trivial tricuspid regurgitation(TR) in 29 cases(11.37％).Group 2:All the patients(100％) underwent successful surgical repair through right subaxillary incision.Different arrhythmias occurred in 116 cases (43.77％),including transient complete atrioventricular block(CAVB) and ILBB in 2 cases respective(0.75％),junctional ectopic tachycardia(JET) in 1 cases(0.38％),CRBB in 61 cases(23.02％),IRBB in 52 cases(19.62％);trivial RS in 16 cases (6.04％);newly arose trivial TR in 11 cases(4.15％);heart dysfunction in 17 patients(6.42％).All patients were followed up for more than 12 months,and there were no newly happened or aggravated valve regurgitation or late onset CAVB in two groups.The final treatment effects are similar in both groups.But group 1 was significantly superior to group 2 in the aspects of operation time,volume of blood loss and consumption,length of intubation and ICU stay,hospitalizations and costs(all P ＜ 0.05).The incidence of TR is higher in group 1 (P ＜ 0.05),and that of right bundle branch block was higher in group 2 (P ＜ 0.05).The incision is longer in group 2,but in a less exposed location.CPB is not needed in group 1,but anticoagulant drug is required for 3-6 months.Conclusion Both RSISR and MIPDO are effective treatment methods of PmVSD.Though having some limitations,MIPDO which characterized by simple procedure,minimal invasion,quick recovery,saving of medical resources could not only minimize the surgical trauma to patients,but also ensure the safety of operation to the maximum extent.However,the patient selection is vital.For selected patients,especially those of moderate PmVSDs with obvious clinical symptoms but no cardiac valve regurgitation,it is an ideal approach.

Objective To review our clinical experience with primary surgical repair of tetralogy of Fallot in neonates and premature infants and to discuss the timing of repair and major factors in treating this patients perioperatively.Methods From January 2012 to September 2015,a series of 19 consecutive neonates and premature infants(M/F =12/7) with tetralogy of Fallot were admitted in our center to receive surgical treatment,with a mean age of(17.3 ± 5.5) days(12-28 days) and a mean body weight of(2.9 ±0.7) kg(2.1-4.3 kg).All the 19 cases were symptomatic with cyanosis,saturation on room air 0.79 ± 0.12 (0.48-0.92),and shortness of breath.Before operation,2 cases were receiving an infusion of prostaglandin E1,5 were mechanically ventilated.7 were more than moderate anemia with hemoglobin of 55-87 g/L.All the patients received echocardiography,ECG and chest X-ray.The McGoon ratio and Nakata index were 1.09 ± 0.30 (0.8 to 1.6) and (135.5 ± 54.2) mm2/m2 (63-212 mm2/m2) respectively.18 cases received one-stage surgical repair and 1 premature infant under two-stage operation with the VSD closure after right ventricular outflow tract(RVOT) transannular patch augmentation.All the VSDs in the 18 cases were closed with continuous suture and RVOT were enlarged with autologous pericardium patch transannularly or not.Balanced and modified ultrafiltration were applied in all the patients.Patients were strictly followed up with a standard protocol focusing on right ventricular function and arrythmia.Several characteristics(e.g.time of operating,mechanical ventilation and ICU stay,complications,hospital stay time,cost of hospitalization) were compared between this group of patients and other TOF patients during the same period in our center.Results All the one-stage operations were successful.There was no mortality and major complication.Mean CPB and aortic clamping time were(111.5 ± 31.6)min (76-153min) and (73.3 ± 11.6) min (64-89 min) respectively.10 VSDs were closed with transventricular approach,6 witht transatrial appraoch and 2 with transatrial-ventricular approach.12 cases (66.7 ％) had a transannular RVOT patch,4 (22.2 ％) with single RVOT patch and 2 (11.1％) with transannular RVOT and left pulmonary artery patch.Atrial communication were left open in 15 cases (83.3 ％).The time of mechincal ventilation and ICU stay were (123.7 ± 59.5) h (39-239 h) and (10.1 ± 3.2) days (5-19 days) respectively.All the patients were followed up for (31.8 ± 15.7) months (9-57 months).There was no mortality and major complication.ECG showed that there was no severe arrythmia except for 3 complete right branh bundle block.The latest echocardiography results showed that right heart function was normal in all the cases and RVOT grandients was less than 30mmHg except one with 35 mmHg.There were 2 cases with residual shunt less than 2 mm and 8 cases with pulmonary valvular regurgitation less than moderate degree.Compared with other TOF cases during the same period,there was no difference according to the data mentioned above except with more time of mechnical ventilation and ICU stay and more cost of hospitalization.Conclusion Primary repair of TOF can be performed safely in symptomatic neonates and premature infants,regardless of age and body weight,with favorable early and mid-term results.Excellent teamwork and accurate prenatal and postnatal diagnosis were the two major factors in yeilding good results in these patients.

Objective To discuss one-stage surgical repair of interrupted aortic arch ( IAA) in neonates and young in-fants, summarize follow-up results and subsequent treatments.Methods From September 2010 to December 2014, a series of 38 consecutive neonates and young infants ( M/F =26/12 ) with IAA were admitted in our surgical group to receive surgical treatment, with a median age of 11 days(1 day to 5 months) and a median body weight of 4.1 kg(1.8 to 5.8 kg).IAA was type A in 24 cases, type B in 13 cases and type C in 1 case.Associated cadiovascular anomalies were common except 2 cases, including atrial septal defect(n=23), ventricular septal defect(n=36), left ventricular outlet tract obstruction(LVOTO)(n=7), anomalous left pulmonary artery from aorta(n=1), truncus arteriosus(n=1).There were 5 cases of airway stenosis in 28 cases of CT angiography and 3D airway reconstruction.All the 38 cases were admitted with differential cyanosis.36 cases were recieved one-stage surgical repair except 2 cases died before operation.35 cases of IAA associated with intracardiac anom-alies were repaired through a median sernotomy.Cardiopulmonary bypass(CPB) was performed with two canulations in ascend-ing aorta and main pulmonary artery.Selective cerebral perfusion(n=21) or circulatory arrest(n =14) was carried out with body temperature of 18℃-23℃.After the patent ductus arteriosus tissue was completely resected , a continuous end-to-end or end-to-side suturing with 7/0(8/0) prolene was performed.In 1 type B cases with expected excessive anastomotic tension, the left subclavian artery was cut off to release the aortic arch .The associated anomalies were repaired during the cooling or re-warming period.Chest close was delayed to carry out no more than 24-72 h postoperatively in 16 cases.The other one type A IAA case without intracardiac anomaly was repaired through a standard left posterior lateral incision .Patients were strictly fol-lowed up with a standard protocol.Complications such as aortic arch restenosis, new LVOTO, new airway stenosis, and so on, were specialy focused on during the follow-up period.If needed, reoperation or transcatheter intervention was applied to treat the complications.Results Two cases died before operation and another 2 died in the early period postoperatively because of pulmonary hypertension crisis and severe tracheal stenosis, respectively.Sudden death was in 1 case during the follow-up peri-od.Median CPB time was 138 min(105-208 min) and median selective cerebral perfusion or circulatory arrest time was 24 min(16-35 min) .Mechanical ventilation time was 2-25 days.Blood pressure difference between the upper and lower limbs was less than 20 mmHg in all the patients before discharge.29 cases(85.29%) was followed up for 28 months(9 -60 months).3 cases were received reoperation in 5 cases of newly detected LVOTO.One case received reoperation in the 7 preop-erative LVOTO cases because of newly detected LVOTO(blood pressure gradient more than 40 mmHg).Two cases with aortic arch restenosis received percutaneous transcatheter ballon dilation .One case with new left main bronchus stenosis after opera-tion was strictly followed up.Conclusion IAA is a rare and severe congenital heart disease.Positive surgical repair should be performed after definite diagnosis being made .Although satisfactory results can be obtained with one-stage primary operation , IAA is a kind of progressive chronic disease.New postoperative LVOTO should be focused on becasue it will need reoperation or even the third operation .

OBJECTIVE To explore the drug-resistant situation and patients′ basis condition of clinical isolated Enterococcus from Jan to Dec in 2008 to offer evidence for drug-resistant monitoring and clinical antibiotics usage.METHODS All clinical specimens were isolated and cultured and identification conform to Standard′ Operation.The bacteria were identified by using the automatic microorganism analyzer VITEK-2,and bacteria′s drug susceptibility tests were performed using counterparts panel.RESULTS 273 strains Enterococci were isolated,of which E.faecalis were 158 strains,E.faecium were 109 strains,the others were 6 strains.The isolated HLAR E.faecalis were 80 strains and HLAR E.faecium were 10 strains,the isolated.ratio of HLAR was different(P

OBJECTIVE To explore the clinical efficacy of adenoidectomy in treating pediatric secretory otitis media,sinusitis and snoring. METHODS A retrospective study was conducted to analyze the clinical features,therapeutic methods and prognosis of 68 children in hospital who underwent adenoidectomy to treat secretory otitis media,sinusitis or snoring. RESULTS The conditions of the 68 children were marked improved after the removal of hypertrophic adenoids. The total clinical effectiveness rate was 100 % and the cure rate was 86.8 %. CONCLUSION Hypertrophic adenoids is a fundamental cause of pediatric secretory otitis media,sinusitis and snoring. The removal of hypertrophic adenoids is a safe and effective method for treating pediatric secretory otitis media,sinusitis and snoring.

BACKGROUND: Ginkgetin has been widely acknowledged as having multiple pharmaceutical values in domestic and abroad. In many western countries, ginaton is imported in large amount. Domestic production of ginkgetin is great, however, seldom applied and there is no ginaton agent for injection.OBJECTIVE: To observe the effects of the increased contents of total flavonoid glycoside and quercetin glycoside of ginkgetin injection on memory function of mice, superoxide dismutase (SOD) activity in myocardial tissues and hemorrheological indexes of rabbits with ischemia-reperfusion injury.DESIGN: Randomized control animal experiment.SETTING: Hebei Medical College of Employees.MATERIALS: Ninety Kunming mice (3-4 months old), weight (25±1) g and thirty-two Japanese rabbits (3-4 months old) were selected. Self-made high-purity ginkgetin injection [5 mL containing 17.5 mg ginaton, of which there were 8.7 mg ginkgo flavonoid glycoside (49.8%) and 4.61% lactone];Ginkgetin injection made in German (Jinnaduo): Manufactured by Schwabe Germany [5 mL containing 17.5 mg ginaton, of which there were 4.2 mg ginkgo flavonoid glycoside (24%)].METHODS: The experiment was conducted in the Central Department of Experimental Animal, Hebei Medical College of Employees from September to November 2002. ①Ninety mice were randomly divided into 6 groups:1, 2 mL/kg self-made ginkgetin injection group, 1, 2 mL/kg German ginkgetin injection group, model group and control group with 15 mice in each group. Mice in the model group and control group were intraperitoneally injected with normal saline, mice in each group were intraperitoneally injected respectively with testing medicine for 10 continuous days,One hour after the 10th day of administration, mice were intraperitoneally injected with 2 mL/kg scopolamine hydrobromide and dysmnesy models were duplicated. Ten minutes after that, mice were put in the step-down instrument for 36V-voltage-stimulus after accommodation. Measurements were re-performed respectively at 5 minutes and 24 hours after training.Latency and times of electric shock within 5 minutes were recorded.②Thirty-two Japanese rabbits were selected and randomly divided into normal control group, German ginkgetin injection group, 1 mL/kg, 0.5 mL/kg self-made ginkgetin injection group with 8 rabbits in each group. Medicineswere continuously injected into aural veins. Three days after administration, blood was collected to detect the hemorheological indexes. ③Thirtytwo rabbits were randomized into 4 groups: 1 mL/kg, 2 mL/kg self-made ginkgetin injection group, 2 mL/kg German ginkgetin injection group and normal saline group with 8 ones in each group. Rabbit models with ischemia-reperfusion injury in myocardial tissues were established, rabbits were ligated for 30 minutes and then unclamped to get ischemic reperfusion injury in myocardial tissues, testing drugs were injected via carotid artery at the moment of reperfusion according to different groups. Before reperfusion and 30, 60 minutes after reperfusion, blood was drawn from the arteria femoralis, activity of SOD in plasma was measured. Animals were executed to obtain myocardial tissues so as to measure SOD activity.MAIN OUTCOME MEASURES: ①Latency and times of shock within 5 minutes in the experiment were recorded. ②Hemorheological indexes and determination of SOD activity in myocardial tissues.RESULTS: All experimental animals were involved in the analysis of results and no one died. ①Test for memory: Latency and times of errors in step down test in the injection group were better than those in the control group, and differences were significant (P ＜ 0.01 or 0.05). Times of errors within 5 minutes in 1 mL/kg self-made ginkgetin irjection group was less than that in the German ginkgetin injection group and the differences were obvious.②Hemorheological indexes: Whole-blood viscosity low shear value,rigid index of red cells and gathering index of red cells etc. in injection groups decreased. ③SOD activity: Compared with control group, that was significantly increased in 1, 2 mL/kg self-made ginkgetin injection group and were in a dose-dependent manner. Those were obviously increased in the 1 mL/kg German ginkgetin injection group. Increase in SOD activity of ischemic myocardial tissues in the 1 mL/kg self-made ginkgetin injection group was more significant than that in the 2 mL/kg German ginkgetin injection group.CONCLUSION: Both self-made and German ginkgetin injections can enhance the ability of memory; While at the basis of same dose, self-made high-purity ginkgetin injection is superior to German ginkgetin injection.

BACKGROUND: Percutaneous vertebroplasty (PVP) is usually used for osteoporotic thoracolumbar fractures,which has various advantages such as easy to operate, short operation time, less trauma, rapid recovery,analgesic effect and so on. But its application is restricted due to nerve compression symptoms and pulmonary embolism caused by bone cement leakage. Thereafter, how to reduce the leakage of bone cement is an issue of concern.OBJECTIVE: To investigate the relationship between the lumbar quantitative computed tomography (QCT) values and contrast agent dispersion in osteoporotic thoracolumbar fractures. METHODS: Sixty cases of osteoporotic thoracolumbar fractures undergoing PVP were enrolled, and received QCT examination before surgery, and contrast agent was injected intraoperatively. X-ray examination was conducted to detect the bone mineral density, contrast agent dispersion and leakage of bone cement, and the relationship between the lumbar QCT values and contrast agent dispersion as well as leakage of bone cement.RESULTS AND CONCLUSION: (1) There were 110 vertebral fractures, and 74 vertebrae with contrast agent diffusing more than vertebral midline, accounting for 67.3%. There was significant difference in the contrast agent dispersion among groups (P < 0.05). (2) The bone cement leakage showed no significant difference among groups after injected with bone cement by unilateral or bilateral approach (P > 0.05). (3) These results suggest that contrast agent dispersion in osteoporotic thoracolumbar fractures has a certain relationship with the lumbar QCT values, and lumbar QCT values with more contrast agent dispersion, but the lumbar QCT values have no correlation with bone cement leakage. Therefore, choosing a appropriate approach based on the QCT values and contrast agent dispersion can reduce leakage and improve the safety of PVP.

Objective Transesophageal echocardiography (TEE) guided, minimally invasive perventricular device occlusion of ventricular septal defects ( VSDs) without cardiopulmonary bypass ( CPB) has been applied in multiple centers. We reported experiences and the mid-term results. Methods Four hundred and thirty-two cases from 4 cardiac centers were involved in the study. There were 235 males and 197 females, aged from 3 months to 15 years, with a body weight varying from 4.0 to 26.0 kg. Three hundred and fifty-one patients had perimembranous VSDs, 57 had intracristal or supracristal VSDs and 24 had muscular VSDs (17 had multiple muscular VSDs). The diameter of the VSD ranged from 3 to 12 (5.3 ±1.6 ) mm.For those with perimembranous or muscular VSDs, a 3 to 5 cm inferior sternotomy was made, but for those with intracristal or supracristal VSDs, a 2 to 3 cm incision was made parastemally through the left third intercostal space. Being monitored and guided with TEE, the device was deployed to occlude the VSD through the puncture at the free wall of the right ventricle. TEE was used for assessing the residual shunting, the left and right ventricular outlet tracts, valvular function and for detecting any arrhythmia, The devices would be released if the heart rhythm was normal, as well as the residual shunting and valvular regurgilalion were not detected. Results The procedure was completed successfully in 417 cases(96.5% ) and converted to traditional surgical closure with CPB in the other 15 cases(3.5% ). Concentric devices were used in 238 cases(57.1% )and eccentric devices were used in 179 patients(42.9% ). Successful procedures finished in less than 90 minutes, and the deployment and evaluation of the devices were completed in 5 to 60 (18. 2 ± 8.6) minutes. No residual shunt and detectable aortic or tricuspid insufficiency and arrhythmia was observed. Patients were extubated within 2 hours and discharged 3 to 5 days after the operation. During fellow-up period from 3 months to 2 years, no clinically significant complications occurred. Conclusion The minimally invasive device closure of VSD under TEE guidance without CPB is proved to be a simple, safe and effective treatment for a considerable number of children with VSD. Its use in the clinical practice should be encouraged.