Objective To investigate the ultrasound imaging findings of anatomical relationship between femoral artery and vein in children of different ages.Methods Sixty-five children aged 4 months-7 years were enrolled in this study.The children were divided into 3 age groups: group Ⅰ＜ 1 yr;group Ⅱ 1-3 yr and group Ⅲ＞ 3,≤ 7 yr.A protable ultrasound machine was used.The probe was placed at the level of inguinal ligament and 2 and 4 cm below inguinal ligament.The children were placed in supine position.The legs were placed in 2 positions:(1)extended and in standard anatomical position and(2)flexed and 45° abducted and 45° laterally rotated.Results The examination showed that at the level of inguinal ligament,the femoral vein lay behind and lateral to femoral artery in 91% of children.At the level of 4 cm below inguinal ligament,the femoral vein lay posterior and lateral to the femoral artery in all children.When the leg was placed in abducted and laterally rotated,the depth of femoral vein was reduced and the vein was less overlapped by artery in all children,especially in preschool children.Conclusion At the level of 4 cm below inguinal ligament,the femoral vein lies posterior and lateral to the femoral artery in children.When the leg is placed in abducted and laterally rotated,the depth of femoral vein is reduced and the vein is less overlapped by artery.It is indicated that femoral vein puncture should be performed at the level of 4 cm below inguinal ligament with the leg flexed and abducted in all children,especially in preschool children.

Objective To establish a simple and useful kidney or bladder orthotopic tumor model used in preclinical pharmacodynamic evaluation.Methods Mouse model of orthotopic renal cancer were established by subrenal capsule implantation.After aspirating urine and irrigating bladder with PBS,the bladder urothelium was slightly impaired to establish the orthotopic bladder tumor model.Then, B-Ultrasound and H&E staining were used to confirm the availability.Results Tumors could be seen 2 weeks after surgery, accompanied by body mass loss of the mice.H&E staining showed that the tumor cells acted as infiltrative growth.The growth of tumor was inhibited by NTX in vivo, the tumor mass inhibitory rate of the KCC-853 orthotopic tumor model was 57.5% of 60 mg/kg NTX treatment and 48.8% in the T24 orthotopic tumor model of 30 mg/kg NTX treatment.Conclusion Our methods for establishing the orthotopic kidney or bladder tumor model are simple and practical.The results indicate that nitroxoline has potential antitumor activity.

Objective The aim of this report was to study the early and mid-term outcome in hospital and follow-up mortality, predictors for late pulmonary stenosis (PAS) and insufficiency of neo-aortic valve (neo-AVI) in patients with transposition of great arteries (TGA) and Taussig-Bing malformation undergoing arterial switch operation ( ASO ). Methods Between January 2004 and December 2007, 169 patients (129 male, 40 female; mean age of [(11.71 ± 26.3 ) months] with TGA or Taussig-Bing malformation underwent ASO. The patients were divided into Group Ⅰ (n = 56 ): TGA with intact ventricular septum and Group Ⅱ ( n = 113 ): TGA with ventricular septal defect (VSD). All patients were followed up in out-patient department by ultrasonic cardiogram. The mean follow-up periods was (27.66 ± 14.6 ) months. Multiple logistic regression analysis was performed to find out the risk factors. Results The overall hospital mortality was 11.24% (19/169)and there was no significant difference between the two Groups. With the improving of perioperative management, the hospital mortality decreased from 16.67% in 2004 to 3.92% in 2007. The overall actuarial survival at 1-, 3- and 5-year follow-up was 94.00%,91.33%, and 91.33%, respectively. The multivariate analysis revealed that age above 6 months was a strong predictor for poor postoperative survival. Predictors for neo-AVI were: combined with VSD, age > 6 months and postoperative neo-AVI Z-score > 1. Predictors for moderate to severe PAS were age ＜ 1 months and pulmonary artery plasty with an unstretchable patch. Conclusion ASO remains the optimal choice for treating various forms of TGA with an acceptable early and mid-term outcome regarding overall survival rate. Patients with TGA should be treated as early as possible. Age >6 months is a predictor for poor postoperative survival and neo-AVI. Mismatch between the neo-aortic root and distal aorta may induce neo-AVI. Unstretchable patch in pulmonary artery plasty may induce PAS.

Abstract: To report a case of Aspergillus salwaensis-induced spinal infection and its laboratory detection. The inflammatory granulation and necrotic tissue samples of a patient with spinal infection were collected from, the Affiliated Hospital of Chengde Medical College on June 17, 2020 for direct smear microscopy and culture, and the isolated strain was identified by microscopy by smear staining, matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF-MS), molecular identification and in vitro antifungal susceptibility test. The patient was 62 years old female and presented with recurrent chest and back pain with no obvious cause. The initial diagnosis was spinal infection, after 7 days of treatment with levofloxacin, the effect was not good. Surgery was then performed remove the lesion via posterior thoracic debridement, and fungal hypha was observed under microscope in tissue specimens. The isolated strains had no typical structure, MALDI-TOF-MS was used for identification for many times, but there was no identification result. After 7 days of fluconazole treatment, the patient's condition improved, and her chest and back pain were alleviated compared to before surgery. The patient was discharged and followed up in the outpatient department, the fungus was later identified as Aspergillus salwaensis by sequence analysis of the internal transcribed spacer (ITS) gene sequencing, and the patient's antifungal medication was changed to voriconazole after with the attending physician. The patient consciously recovered well with no pain in the operative area and normal spinal activity at 1 year follow-up. The possibility of spinal fungal infection should be considered in patients with back pain without a clear cause and poor response to routine antibiotic treatment. Direct smear report of microscopic results are very important for guiding clinical antibiotic selection for rare filament fungi with atypical colony and microscopic morphology and unsuccessful MALDI-TOF-MS identification, molecular biological methods such as ITS sequence analysis can be helpful for early identification of the fungal species, improving identification speed.

Objective Explore the reversibility and potential molecular mechanisms of pulmonary hypertension in pa-tients with complete transposition of the great arteries (cTGA) combined with ventricular septal defect (VSD) in comparison with those with simple VSD. Methods Twenty-four patients with pulmonary hypertension (mean pulmonary arterial pressure was greater than 30 mmHg) were enrolled in our study, in which 10 patients suffered from cTGA with VSD, and the rest 14 pa-tients suffered from simple VSD. Lung specimens were taken from the right middle lobe of lung before cardiopulmonary bypass. The extent of pulmonary hypertension was then graded according to the Heath-Edwards classification. ELISA was used to exam-ine the expression of eNOS, iNOS, ET-1, ET-AR, ET-BR, MMP-2, MMP-9 and TIMP in all the specimens. Results No statistically significant differences in age, height, weight, the size of VSD, and the pulmonary artery pressure before operation were found between the groups. The level of hemoglobin, aortic and pulmonary arterial oxygen saturation, and the reduction value of pulmonary arterial pressure after surgery were significantly higher in the cTGA patients than that in the simple VSD pa-tients (P < 0.05). All patients had grade 0 - Ⅱ Heath-Edwards changes in their lung biopsy samples. The expression of eNOS and MMP-2 was significantly lower in the TGA group than that in the simple VSD group [eNOS: (280.13 ± 101.92) ng/mg vs. (488.41±249.6) ng/mg, P<0.05; MMP-2:(31.68±15.36)ng/mg vs. (69.28±49.12)ng/mg, P<0.05]. There were no statistically significant differences between the two groups regarding the expression of iNOS, ET-1, ET-AR, ET-BR,MMP-9 or TIMP. Conclusion The imbalance of the NOS/ET system and the MMP/TIMP system involves in the development of pulmonary hypertension in patients with TGA combined with VCD. In patients with cTGA, the high oxygenation state in pul-monary circulation may decrease the expression of MMP2 and eNOS, and may affect the progress of pulmonary hypertension to a certain extent.

Objective: Traditional percutaneous ventricular septal defect (VSD) closure had disadvantages of radiation and contrast media reaction in relevant patients. We want to investigate the efifcacy and safety of percutaneous VSD closure under solely guidance of echocardiography.
Methods: A total of 28 VSD patients treated by percutaneous VSD closure under solely guidance of trans-thoracic echocardiography in our hospital from 2014-02 to 2014-10 were summarized. The patients mean age was (9.5 ± 3.1) years with the body weight at (31.3 ± 7.7) kg. The average diameter of VSD was (4.6 ± 0.9) mm, and the clinical follow-up study was conducted by echocardiography at 1, 3, 6 and 12 months after the procedure.
Results: There were 26 patients with successful treatment by percutaneous VSD closure under solely guidance of echocardiography. 1 patient was converted to perventricular closure with trans-esophageal echocardiography guidance because the catheter could not pass through the defect; another patient was converted to surgical repair because of the residual shunt > 2 mm. The average procedural time was (63.3 ± 11.7) min and the mean diameter of symmetrical occluder was (6.6 ± 1.0) mm. There were 2 patients with immediate post-operative residual shunt, and the average in-hospital time was (3.7 ± 1.3) days. All patients discharged without the complications as peripheral vascular injury or cardiac perforation. The average follow-up time was (6.2 ± 3.4) months. The residual shunt disappeared in 2 patients at 1 month follow-up time point. No patients suffered from pericardial effusion, occluder malposition, atrio-ventricular block and aortic valve regurgitation.
Conclusion: Echocardiography guided percutaneous VSD closure is safe and effective, it may avoid the radiation and contrast media reaction in relevant patients.

Objective: In order to avoid the radiation and contrast agent injury, and to extend the echocardiography guided percutaneous ventricular septal defects (VSD) closure, based on femoral artery approach, we assessed the efifcacy and safety of VSD closure via trans-jugular approach solely under the guidance of echocardiography.
Methods: A total of 12 patients with peri-membranous VSD treated in our hospital from 2014-10 to 2015-04 were enrolled. The patients were at the age at (1.2-3.5 with the mean of 2.4 ± 0.8 ) years, the body weight at (7-15 with the mean of 11.6 ± 2.6) kg and the diameter of VSD was (3.5-6 with the mean of 4.8 ± 0.7) mm. The patients received percutaneous VSD closure via transjugular approach solely under the guidance of echocardiography. The procedural effect was evaluated by echocardiography and the follow-up study was conducted at 1, 3 and 6 month safter the procedures.
Results: There were 9 patients successfully ifnished VSD closure via trans-jugular approach. 1 patient was converted to femoral artery approach because the wire could not pass through the defect of ventricular septal; 1 was converted to minimally invasive per-ventricular closure since the catheter could not pass through the defect; 1 was converted to conventional surgical repair due to the residual shunt was more than 2mm. The procedural time was (53-89 with the mean of 67.2±12.5) min, the diameter of symmetrical occluder was (6-8 with the mean of 7.0±0.9) mm. 2 patients had immediate post-operative residual shunt, all patients were recovered and discharged. No peripheral vascular injury and cardiac perforation occurred, the hospitalization time was (3-5 with the mean of 3.6 ± 0.7) days. The follow-up examination was conducted at (1-6 with the mean of 3.9 ± 2.1) months, the slight residual shunt in 2 patients disappeared at 1 month after procedure; no pericardial effusion, occluder malposition, aortic regurgitation and atria-ventricular block occurred.
Conclusion: Echocardiography guided trans-jugular approach of VSD closure is safe and effective, it may particularly avoid the radiation and contrast agent injury in clinical practice.

Objective:To retrospectively analyze the results and mid-term outcomes of 107 patients with corrected congenital transposition of great arteries(CCTGA)who underwent surgical treatment.Methods:A total of 107 CCTGA patients with surgical treatment from January 1996 to October 2005 in our hospital were studied.There were 72 male and 35 female,with the mean age of 11.5±8.4years and mean body weight of 31.6±4.7kg. Among the cohort,81 were levocardia,23 dextrocardia,and 3 medocardia.Initial surgical procedure included single ventricle repair in 14 cases,conventional biventricular repair in 75 and biventricular anatomical repair in 18 cases. 99(93%)patients were followed up with the mean time of 47.8 months.Results:The early operative mortality rate was 4.76% in different procedures.The death rate with single ventricle repair was 0%,conventional biventricular repair 4%,atrial-arterial double switch 0%,atrial-ventricular double switch 40%. The risk factors for operative mortality were lesions with double outlet left ventricle combined with pulmonary stenosis(P<0.01)and Rastelli procedure(P<0.05). 12 patients(12.6%)died during the follow up period,among them,10(83.3%)were in conventional repair group,2(16.7%)in single ventricle repair group,and no death in double switch group. The risk of death during the follow up period of time were conventional biventricular repair,Rastelli procedure and tricuspid regurgitation.Conclusion:Conventional biventricular repair had a disappointing outcome in both operation and in long-term of follow up time. Patients suitable for single ventricular repair had fair short-and mid-term outcomes. Atrial-arterial double switch procedure had good operation and long-term results.

Objective The postoperative outcomes of transposition of the great arteries with severe pulmonary hypertension (PH) are still controversial. Based on relative large data, we evaluated the relationship between preoperative pulmonary hypertension and postoperative early and midterm clinical outcomes. Methods In this retrospective study, a cohort of consecutive patients with TGA was studied. One hundred and one patients underwent artery switch operation between February 2004 and October 2007. Preoperative medical records were reviewed. The mean follow-up period was 22.6 months. All artery switch operations were performed through a median sternotomy utilizing extracorporeal circulation. Deep hypothermia and circulatory arrest were used in 6 patients. After sternotomy, pulmonary arterial pressure was measured directly. According preoperative mean pulmonary pressure ( mPAP), patients were divided into three groups: normal group ( mPAP ＜25mmHg, n =43), moderate PH group ( mPAP between 25 to 50mmHg, n = 47) and severe PH group ( mPAP ≥50mmHg, n = 11 ). The methods of coronary anastomosis were "open trap door" ( 39 cases), "bay window" (61 cases) and "pulmonary artery tunnel" ( 1 case)techniques. Besides repairing of atrial septal defect and ventricular septal defect, ligation of patent ductus arteriosus, concomitsnt operations also involved mitral valvuloplasty (5 patients), tricuspid valvuloplasty (2 patients), pulmonary valvuloplasty (5 patients), pulmonary artery transplantation ( 1 patient ), subvalvular membrane resection ( 2 patients), widening of the right ventricular outflow tract ( 1 patient ) and collateral circulation occlusion ( 1 patient). The early and late postoperative results were compared among different groups. Results After operation, mPAP in severe PH group decreased from (61.2 ± 8.6 ) mmHg to ( 34.6 ± 13.6 ) mmHg( P ＜ 0.01 ). In moderate PH group it decreased from ( 34.5 ± 6.7 ) mmHg to ( 21.3 ± 5.6) mmHg( P ＜ 0.0l ). mPAP was not significantly changed in the control group. Operative mortality was 7.9% ( 8 patients ).The causes of early death were low output syndrome in 3 patients, septicemia in 4, central nervous system complications in 1.There was no difference in the postoperative complication rates among three groups. Also, no significant differences were found between groups regarding the early operative mortality (control group: 7.0%, moderate PH group: 8.5%, severe PH group:9.1%, P = 0.953 ). Combined abnormity contributed to postoperative death. Patients with ventricular septal defect and patent ductus arteriosus had a higher mortality rate. During follow-up 8 patients died: 5 in control group ( 11.6% ), 5 in moderate PH group ( 10.6% ) and 6 in severe PH group (54.5% ), P ＜ 0.01. Causes of midterm death were sudden death in 10, progressive heart failure in 4, pneumonia in 2. The rates of midterm mortality of the three groups were significantly different ( 11.6%,10.6% and 54.5% for control, moderate PH and severe PH group, respectively, P = 0.001 ). Kaplan-Meier survival analysis for patients with different age groups showed that survival rate in group with age older than 1 year was lower ( P = 0.029 ).Conclusion In TGA/PH patients, mPAP lower than 50 mmHg is suitable for artery switch operation and can get satisfying postoperative outcomes. If mPAP higher than 50 mmHg, even though the operation may decrease the pulmonary pressure, radical artery switch operation should not be recommended because of higher late mortality.

Objective: To investigate the safety and efficacy of transthoracic minimally invasive patent ductus arteriosus (PDA) occlusion in infants and young children.
Methods: We retrospectively analyzed 105 infants and young children who received the transthoracic minimally invasive PDA occlusion in our hospital from 2012-10 to 2014-10. According to PDA diameter, patients were divided into 2 groups:Group A, the patients with PDA diameter ≥ 4 mm,n=64 and group B, the patients with 2 mm ≤ PDA diameter < 4 mm,n=41. All patients received the left third parasternal intercostal incision under suprasternal echocardiography guidance. The operative effect was evaluated by transthoracic echocardiography, and the follow-up study was performed at 1 month, 3 months, 6 months period and then annually after the operation by echocardiography.
Results: All 105 patients had successfully implanted PDA occluders. The patients’ gender, age, body weight, tracheal intubation time and the in-hospital time were similar between 2 groups,P>0.05. Compared with Group B, Group A had the larger diameters of PDA (5.7 ± 1.4) mm vs (2.7 ± 0.6) mm, P<0.001, PDA occluders (10.6 ± 1.8) mm vs (7.2 ± 1.3) mm, P<0.001, and the higher rates of moderate and severe post-operative thrombocytopenia 10.9% (7/64) vs 0% (0/41),P=0.028, immediate post-operative residual shunt as 15.6% (10/64) vs 2.4% (1/41),P=0.031. There was 1 patient in Group A suffered from pericardial tamponade due to hemorrhage at 2 days after operation and he was cured by emergent pericardial drainage. The patients were followed-up for (11.6 ± 7.8) months. The 1 month post-operative residual shunt was similar between 2 groups as 1.6% (1/64 ) vs 0% (0/41),P=0.421, and there was no residual shunt at 3 months after the operation. There were no complications of occluder detachment, hemolysis, pericardial effusion, left pulmonary artery or descending aortic stenosis occurred during the follow-up period.
Conclusion: Transthoracic minimally invasive PDA occlusion is a safe and effective method to treat the relevant infants and young children, while the post-operative residual shunt and thrombocytopenia should be closely observed in patients with large PDA.