Objective The incidence of acute pulmonary injury occurred after cardiopulmonary bypass for fallot tetrad has been high. The severity of pulmonary ischemia-reperfusion has been found to be reduced with ulinastatin (UTI) in the animal models and clinical practice. We evaluated the effect of pulmonary artery perfusion with a hypothermic protective solution containing ulinastatin on the inflammatory response in the lung during cardiopulmonary bypass. Methods 30 children with tetralogy of Fallot (TOF) were randomly assigned into control group and protective group, 15 cases in each group. Patients would be excluded if they had signs of infections, such as the white blood cell count was over 12000 per microliter, the temperature was above 38 centi-degree and the c-reaction protein was more than 8 mg/L. Operation with routine approaches was performed in the control group and the pulmonary artery was infused with 4℃ protective solution in the protective group while the heart stoped beating. Plasma tumor necrosis factor α (TNF-α) 、CD11b and Myeloperoxidase (MPO) were measured intraoperatively and postoperatively. Blood gas、pulmonary function and clinic index of the patients were also monitored. Results The level of TNF-α was lower in the protective group as compared with that in the control group immediately and 3 hours after closing the sternum [(11.15±2.47) pg/ml vs. (14.21 ±5.55) pg/ml, P<0.05; (12.01 ±2.69) pg/ml vs. (15.94 ±4.86)pg/ml,P <0.01]. The MFI of CD11b was lower in the protective group as compared with that in the control group at 3 and 6 hoursafter closing the sternum (126.23±36.05 vs. 156.98±48.34, P<0.05; 137.27±38.85 vs. 173.27±67.43, P<0.05). The level of MPO was lower in protective group as compared with that in the control group at 3 hours, 6 hours and 24hours after closing the sternum [(156.52±17.57)U/L vs.(178.45±35.68)U/L, P<0.05; (178.28±23.63) U/L vs.(224.66±49.66)U/L, P<0.01;(130.52±57.50)U/L vs. (96.50±14.49)U/L, P<0.05]. The duration of mechanical ventilation was significantly shorter in the protective group than that in the control group (17.60±6.39 vs. 23.70±8.51,P<0.05). Alveolar-arterial oxygen pressure difference (A-aDO2, calculated as [FiO2×713-5/4×PaCO2]-PaO2) in the protective group was less than that in the control group at 3 and 6 hours after closing the sternum [(120.92±33.08)mm Hg vs. (145.52±39.38)mmHg, P<0.05;(74.76±40.16)mm Hg vs. (112.50±44.16)mmHg, P<0.01]. Dynamic compliance (Cdyn) in protective group was lower than that in control group at 3 and 6 hours after closing the sternum [(0.59±0.11)ml·cmH2O-1·kg-1 vs. (0.46±0.17)ml·cmH2O-1·kg-1, P<0.05;(0.67±0.09)ml·cmH2O-1·kg-1vs. (0.53±0.18)ml·cmH2O-1·kg-1,P<0.05). Conclusion Perfusion with hypothermic protective solution containing UTI to the pulmonary artery during cardiopulmonary bypass may reduce the inflammatory responses substantially in the lung after bypass and had a role in the lung protection.

Objective To evaluate the accuracy of different methods for estimating blood loss during burn wound excixion and skin grafting in pediatric patients with severe burn. Methods Twenty pediatric patients of both sexes aged 7 days-8 yr weighing 4-22 kg undergoing burn wound excision and skin grafting were enrolled in this clinical study. Two methods were used for estimating blood loss during operation: Method Ⅰ: surgical surface area (SSA). MethodⅡ: the product of SSA and blood volume (BV). Total blood loss was calculated: total blood loss = BV ( Hct0 - Hctx ) ÷ Hct0 + Tx. Hct0 =Hct before operation. Hctx =Hct at the end of operation. Tx =total amount of blood transfusion. Results The correlation between the total blood loss and SSA was 0.776. The correlation between the total blood loss and the product of SSA and BV was 0.889. The difference was statistically significant. Conclusion The product of SSA and BV is more accurate in estimating blood loss during burn wound excision and skin grafting in children with severe burn.

In order to digitize the radiotherapy quality control data, convenient to carry on the dynamic quantitative analysis to the equipment condition, this paper presents a low-cost open radiotherapy quality control platform based on REDCap. The platform uses the REDCap data acquisition system as a carrier to achieve the digital storage of this data, anytime, anywhere data entry, and can be easily derived for data analysis by creating REDCap research projects and inputting radiotherapy quality control data. It is proved that REDCap can be used in the construction of radiotherapy quality control platform.

Objective To compare the application effects of laryngeal mask airway anesthesia and endotracheal intubation anesthesia in interventional occlusion for young-age patients with congeni-tal heart disease.Methods A total of 102 young-age patients with congenital heart disease undergo-ing interventional occlusion were enrolled and randomly divided into control group and observation group using a random number table method,with 51 patients in each group.The control group re-ceived endotracheal intubation anesthesia,while the observation group received sevoflurane anesthesia via laryngeal mask airway.The awakening time,extubation time,incidence of laryngeal spasm,and incidence of lung infection were compared between the two groups.Additionally,hemodynamic pa-rameters[heart rate(HR),mean arterial pressure(MAP)],oxidative stress indicators[malondial-dehyde(MDA),superoxide dismutase(SOD)],and myocardial injury indicators[creatine kinase-MB(CK-MB),heart-type fatty acid-binding protein(H-FABP)]levels at different time points were compared.Results The observation group had shorter awakening time and extubation time,and low-er incidence of lung infection and laryngeal spasm compared with the control group(P＜0.05).Before anesthesia(T0),there were no statistically significant differences in HR,MAP,MDA,SOD,CK-MB,and H-FABP levels between the two groups(P＞0.05).During laryngeal mask insertion or intuba-tion(T1),during arteriovenous puncture(T2),and immediately after occluder placement(T3),the observation group had lower HR,MAP,CK-MB,and H-FABP levels compared with the control group(P＜0.05).At T1,T2,and T3,the MDA levels in both groups were higher than that at T0,and the SOD levels were lower than that at T0;however,the observation group had lower MDA lev-els and higher SOD levels compared with the control group(P＜0.05).Conclusion Compared with endotracheal intubation anesthesia,sevoflurane anesthesia via laryngeal mask airway has a bet-ter application effect in interventional occlusion for young-age patients with congenital heart disease,thereby effectively maintaining intraoperative hemodynamic stability,shortening awakening time and extubation time,and exhibiting higher safety.

Objective To compare the application effects of laryngeal mask airway anesthesia and endotracheal intubation anesthesia in interventional occlusion for young-age patients with congeni-tal heart disease.Methods A total of 102 young-age patients with congenital heart disease undergo-ing interventional occlusion were enrolled and randomly divided into control group and observation group using a random number table method,with 51 patients in each group.The control group re-ceived endotracheal intubation anesthesia,while the observation group received sevoflurane anesthesia via laryngeal mask airway.The awakening time,extubation time,incidence of laryngeal spasm,and incidence of lung infection were compared between the two groups.Additionally,hemodynamic pa-rameters[heart rate(HR),mean arterial pressure(MAP)],oxidative stress indicators[malondial-dehyde(MDA),superoxide dismutase(SOD)],and myocardial injury indicators[creatine kinase-MB(CK-MB),heart-type fatty acid-binding protein(H-FABP)]levels at different time points were compared.Results The observation group had shorter awakening time and extubation time,and low-er incidence of lung infection and laryngeal spasm compared with the control group(P＜0.05).Before anesthesia(T0),there were no statistically significant differences in HR,MAP,MDA,SOD,CK-MB,and H-FABP levels between the two groups(P＞0.05).During laryngeal mask insertion or intuba-tion(T1),during arteriovenous puncture(T2),and immediately after occluder placement(T3),the observation group had lower HR,MAP,CK-MB,and H-FABP levels compared with the control group(P＜0.05).At T1,T2,and T3,the MDA levels in both groups were higher than that at T0,and the SOD levels were lower than that at T0;however,the observation group had lower MDA lev-els and higher SOD levels compared with the control group(P＜0.05).Conclusion Compared with endotracheal intubation anesthesia,sevoflurane anesthesia via laryngeal mask airway has a bet-ter application effect in interventional occlusion for young-age patients with congenital heart disease,thereby effectively maintaining intraoperative hemodynamic stability,shortening awakening time and extubation time,and exhibiting higher safety.

Objective:To identify the risk factors for postoperative pulmonary complications (PPCs) in pediatric patients undergoing malignant tumor resection.Methods:Medical records of pediatric patients who underwent open abdominal malignant tumor resection at Children′s Hospital affiliated to Zhejiang University School of Medicine from August 2019 to July 2023, with length of hospital stay ≥48 h, were retrospectively collected. Patients were divided into PPC group and non-PPC group based on the occurrence of PPCs within 7 days postoperatively. Variables with P<0.05 in the univariate analysis were included in the binary logistic regression analysis to identify the risk factors for PPCs. Results:A total of 605 pediatric patients who underwent abdominal malignant tumor resection were finally included, among which 391 children developed PPCs, with an incidence of 64.6%. Binary logistic regression analysis showed that body weight ( P=0.001), American Society of Anesthesiologists Physical Status classification ( P<0.001), preoperative hypoalbuminemia ( P=0.013), preoperative chemotherapy ( P=0.003), tumor compression/encasement of major abdominal vessels ( P=0.002), anesthesia duration ( P<0.001), intraoperative fluid intake (ml·kg -1·h -1, P<0.001), intraoperative use of hypotensive agents ( P=0.047), and concurrent resection of mediastinal tumors via abdominal approach ( P<0.001) were risk factors for PPCs in children undergoing malignant tumor resection. Age ( P<0.001) was identified as a protective factor for PPCs. Conclusions:Body weight, American Society of Anesthesiologists Physical Status classification, preoperative chemotherapy, preoperative hypoalbuminemia, tumor compression/encasement of major abdominal vessels, anesthesia duration, intraoperative fluid intake, intraoperative use of hypotensive agents, and concurrent resection of mediastinal tumors via abdominal approach are risk factors for PPCs in pediatric patients undergoing open abdominal malignant tumor resection, whereas age is a protective factor for PPCs.