Objective To evaluate effects of maternal hypothermic cardiopulmonary bypass on fetal homodynamic and carbohydrate metabolism. Methods Twenty pregnant sheep were divided into four groups randomly: control group(n=5),normothermic group (35-36℃)(n=5), mild hypothermic group(32-34℃)(n=5) and moderate hypothermic group (28-31℃)(n=5).Thoracotomy was performed without CPB in the control group. Routine CPB was established with different temperature in other three groups. The temperature of normothermic group was kept normal; the left two groups were cooled down to the set point of temperature and then rewarmed back to normal level. Fetal and maternal temperatures, heart rate,mean blood pressure(BP), pulse index (PI) of fetal umbilical artery (UA) and internal carotid artery (CA) were evaluated at cooling and rewarming stages. Biochemical indicators including blood glucose and lactic acid were also measured at the same time. Results There are no differences in mesn BP of ewas and fetal lambs between the different groups (P＞0.05). CA PI value of mild hypothermic group and moderate hypothermic group were significantly higher than those of control group and normothermic group (P＜0.05). There was no difference of UA PI in the four groups, but PI increased following the prolonged duration of CPB. There was no difference change of blood glucose in the four group of fetus, which was significantly lower than the ewe groups. An upward trend of fetal blood lactic acid with time was observed in three CPB groups. The whole level of fetal blood lactic acid was much higher than that of maternal blood of lactic acid. Conclusion Cooling of maternal bypsss decreases fetal heart rate significantly,and fetal heart rate recovered to base line following rewarming phase. There was no signicant effect of CPB on fetal mean BP. However, CPB impacted on the blood flow of fetal brain and umbilical artey. Hypothermia CPB can increase fetal blood glucose and blood lactic acid dramatically.

OBJECTIVE To investigate the distribution of bacteria detected from blood culture of pediatric patients and to observe the antibiotic resistance of these bacteria. METHODS The BacT/Alert blood culture system was applied for culture.Species identification and antibiotic resistance tests were performed by the VITEK automicroscan system. RESULTS Coagulase-negative staphylococcus(CNS) and Staphylococcus aureus accounted for 67.2% and 7.8%, respectively.The proportion of Gram-negative bacteria was 14.4%.The resistant rate of CNS and S.aureus to oxacillin was 85% and 36%,respectively.The strains producing the extended spectrum beta-lactamases(ESBLs) of Gram-negative bacteria were often detected. CONCLUSIONS Gram-postive bacteria are the main pathogens detected from the blood culture of pediatric patients.Detection rate of CNS is the highest.Multiresistant strains are common.

Child ; Exostoses, Multiple Hereditary ; genetics ; Female ; Humans ; Mutation ; N-Acetylglucosaminyltransferases ; genetics ; Pedigree

Objective To investigate the differences in dosimetry between conformal radiotherapy (CRT),field-in-field intensity-modulated radiotherapy (FIF-IMRT),and intensity-modulated radiotherapy (IMRT) after breast-conserving surgery for left-sided breast cancer.Methods A total of 31 patients who underwent breast-conserving surgery for left-sided breast cancer were randomly selected,and the plans for CRT,FIF-IMRT,and IMRT were developed.The dose-volume histogram (DVH) was used for self-control study,and the non-parametric test was used to compare the differences in target volume and doses to organs at risk (OARs).Results All the three methods met the requirements of the prescribed doses.The CRT group had a higher V105 of the target volume and higher heart V30 and Dmax (P=0.000,0.000,0.000).The IMRT group had higher V5 and Dmean (P=0.000,0.000),as well as a higher lung V5 and a lower lung V40 (P=0.000,0.000).The FIF-IMRT group had the lowest Dmean (P=0.000),and the IMRT group had significantly higher Dmean and Dmax of the right lung and the spinal cord than the other two groups (P=0.000,0.000,0.000,0.000).The FIF-IMRT group had a significantly lower single hop count than the other two groups (P=0.000).Conclusions CRT has a good dose distribution in the target volume,but greatly injures the surrounding tissues.FIF-IMRT can well protect OARs and cause less damage to the device.

OBJECTIVETo observe the therapeutic effect of tongluo yangyin recipe (TLYYR) in patients with diabetic peripheral neuropathy (DPN).

METHODSNinety-nine patients with diabetes mellitus type 2 were assigned, according to the order of their visit, to two groups: 61 in the treated group and 38 in the control group. They were given the same information about diabetes mellitus and treated with the same therapy: strict diet control and Western drugs for hypoglycemia. In addition, the treated group received one dose (200 mL) of TLYYR in water decoction every day in two portions, while the control group had vitamin B1 100 mg and vitamin B12 250 microg administered daily via intramuscular injection. The course for all patients was 28 days.

RESULTSThe treated group experienced a therapeutic effect superior to that of the control group, with the difference between the total effective rates and the markedly effective rates (P<0.05, P<0.01). The blood levels of total cholesterol (TC) and triglyceride (TG) fell, the hemorrheological manner improved, the transmission velocity of the median nerve and common peroneal nerve significantly increased in the treated group after treatment (P<0.05), although the treatment showed no significant influence on blood glucose level (P>0.05).

CONCLUSIONTLYYR could promote blood microcirculation, improve nutritional metabolism of peripheral nerve, and thus accelerating DPN repair.

Aged ; Blood Glucose ; Diabetic Neuropathies ; drug therapy ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Hemorheology ; Humans ; Lipids ; blood ; Male ; Middle Aged ; Synaptic Transmission ; drug effects ; Treatment Outcome

Objective In order to optimize the Fontan circulation,a technique for direct total cavopulmonary connection was devised.To evaluate its surgical feasibility as well as surgical outcomes,our clinical experience was retrospectively reviewed.Methods From August 2005 to March 2012,23 consecutive patients underwent modified extracardiac Fontan operation with direct total cavopulmonary connection.Clinical profile of the patients,and procedural variables were examined and analyzed.Results All patients had adequately developed main and branch pulmonary arteries.Inferior caval vein was contralateral to the pulmonary trunk main pulmonary artery in 7 cases,ipsilateral in 8,and others in 8.There was 1 hospital death.The other 22 patients remained hemodynamically stable postoperatively.Prolonged effusions (n =13,62％) was a challenging problem.No obvious stenosis was found at the direct cavopulmonary anastomosis.Conclusion we are convinced that a direct total cavopulmonary connection is feasible in select subset of patients.This modified Fontan procedure retains the advantage of extracardiac connections together with the avoidance of prosthetic materials.

Objective The aim of this study is to retrospectively analyze surgical management of absent pulmonary valve syndrome(APVS).Methods Between January 2005 and January 2012,totally 11 children with APVS underwent primary surgical correction.There were 7 boys and 4 girls.Age at surgeries range from 1 to 5 years,and wcight from 10.2-17.5 kg,with average (12.3 ± 3.4) kg.Surgical procedures include VSD repair,pulmonary arteries reconstruction and RVOT reconstruction with monocusp valve.5 cases chose Lecompte maneuver as an option to release compression to bronchus,5 cases underwent fibroscopy inspection and airway secretion suction,and 4 cases adapted deep hypothermic circulatory arrest (DHCA)during correction procedures.All survivors are routinely followed-up with echocardiogram.Results All 11 cases survived,2 of them suffered from frequent lungs infections during the first year post surgery.No case exists bronchus or pulmonary arteries compression.Conclusion APVS is a rare congenital heart defect,which may challenge perioperative managements and operations.Ideal surgical correctiou includes RVOT reconstruction,decompression of bilateral bronchus,and airway inspection with fibroscopy.However,compression of intrapulmonary bronchi by abnormally branching pulmonary arteries may expose patients to a relative long time of medication therapy after surgical correction.A large number of patients with long-term follow-up are needed to draw definitive conclusions on this strategy' s effectiveness.

Objective Konno-Rastan procedure is one option to cope with complex multilevel left ventricular outflow tract obstruction (LVOTO),which continues to pose a serious challenge to cardiac surgeons.The aim of this study is to retrospectively analyse indications for Konno-Rastan procedure,and to review the safeguards and pitfalls.Methods Between January 1996 and August 2012,totally 13 children with multilevel LVOTO underwent Konno-Rastan procedure.There were 8 boys and 5 girls.Age at surgeries ranged from 5 to 13 years,and weight from 12 to 51 kg with median of 21 kg.The pathology of this cohort includes:8 cases of congenital aortic valvular stenosis,3 cases of congenital aortic valvular stenosis combined with supravalvular stenosis,1 case of congenital aortic stenosis combined with VSD,coarctation and RVOT obstruction,1 case of aortic stenosis s/p percutaneous balloon aortic valvuloplasty.All patients have secondary diffuse tunnel LVOTO.Diameter of aortic ring ranges from 12.0 to 16.4 mm,and pressure gradient across the stenotic region ranges from 90-151 mm Hg.8 cases were implanted with St.Jude AG19 while 5 cases implanted with St.Jude AG17.Results All 13 cases survived.The 4th patient was implanted permanent epicardial pacemaker for transient Ⅲ AVB.The 4th and 5th patients were found residual ventricular septal repture at the nadir of ventricular incision,one underwent redo procedure while another is being followed up.All cases take cumadine to sustain INR at 1.8-2.5.No death emerges during follow-up period.The motality is 0％,the incidence rate of B is 7.7％,residual VSD 15.4％ and endocarditis 7.7％.Conclusion Konno-Rastan procedure is a promising techi.to relieve LVOTO.However,this complex procedure may lead to several fetal complications.Success of the surgery demands perfect operations.

Objective To explore the role of endogenous and exogenous β-glucuronidase( β-G) in the development of primary common duct stones.Method Using modified Fishman method to test the activities of the endogenous and exogenous β -G in 35 patients with primary common duct stones(experimental group) and 11 patients with cystic polypus (control group) respectively.Results The activities of endogenous β -G in the bile of experimental group and control group were (7859.1 ± 738.5 ),(2174.9 ± 348.4 ) U/L(P ＜0.01).While the activities of exogenous β-G in experimental group and control group were (6786.1 ±544.3),(1504.7 ±655.7) U/L (P ＜0.01).In experimental group,there were significant statistical differences in the activities of the exogenous β -G in the sample obtained on the day of operation and 7 days after operation from 13 cases with the acute inflammation [(8935.7 ± 845.9),(2176.1 ± 956.7) U/L]and from 22 cases with the chronic inflammation [(5137.2 ±540.7),(1838.8 ±733.3) U/L],and there were significant higher in the activities of the exogenous β -G in the sample obtained on the day of operation from the acute inflammation compared to those from the chronic inflammation (P ＜ 0.05 ).Conclusions There is obvious correlation between either endogenous or exogenous β -G with primary common duct stones.And the endogenous β -G might be one of the fundamental cause in the development of primary common duct stones.

AlM: To study the clinical effect of the application of microscopic pterygium resection combined with different concentration of mitomycin C ( MMC) .
METHODS:A total of 110 cases of pterygium patients (120 eyes) were randomly divided into control group (58 eyes) and observation group (62 eyes) according to the odd and even number method. The control group adopted the pterygium resection combined 0. 3mg/mL MMC, and the observation group was given pterygium resection combined 0. 2mg/mL MMC. The cure rate and the recurrence rate, eyesight before and after the treatment, two groups of cornea and sclera wound healing situation, the incidence of postoperative complications were compared.
RESULTS: The cure rate and recurrence rate of the control group was 84. 5% and 15. 5% respectively, and the observation group was 93. 6% and 6. 5% respectively, the differences were statistically significant (P<0. 05). There were statistical differences of vision of the two groups before and after treatment (P<0. 05), and there were no statistical differences of the two groups between the two groups after treatment (P>0. 05). The cornea, sclera, wound healing time of the observation group were less than the control group, and there were statistical differences between the two groups ( P < 0. 05 ). The incidence of complications was 13. 8% in the control group and 3. 2% in observation group, with statistically significant difference (P<0. 05).
CONCLUSlON: The application effect of microscopic pterygium resection combined with MMC is remarkable, and the joint of 0. 2mg/mL concentration of MMC is more safe and effective, and is worth popularizing in clinical application.