Objective To summzarize the impacts of respiratory syncytial virus (RSV) infection in the early period(< 72 h) on the postoperative course after open-heart surgery in pediatric patients, and to discuss the expe-riences on therapeutic strategies. Method From March 2005 to March 2008, 39 patients diagnosed to be RSV in-fection confmned by RSV antigen test were prospectively enrolled into RSV-infeetion group. Anoth.er 39 patients were randomly 1 : 1 matched with age and same type of congenital heart disease (CHD) during the same period who also underwent open-heart surgery without RSV infection (nonRSV-infection group) as control group. The medical records of these patients were retrospectivdy reviewed. The duration of mechanical ventilation (MV), length of ICU stay and hospital stay were compared between the two groups with Paired Student's t test. Meanwhile Fisher' s exact test was used to compare the differences in noninvasive positive pressure ventilation, incidence rate of re-intubafion and severe postoperative complications between groups. Patients in both groups were further divided into subgroups aceonting to differences in age, cyanosis and pulmonary arterial pressure in order to identify the dif-ferent impacts of RSV infection in patients in different settings. Results All the patients were survived and dis-charged home. RSV infection significantly prolonged the duration of MV, ICU and hospital stay (all P < 0. 05).In addition, it significantly increased the incidence of pulmonary atelectasis (P < 0.05). In patients under 6 months old, RSV infection resulted in prolongation of MV, ICU and hospital stay (all P <0.05); furthermore, it significantly increased the incidence of complications of low cardiac output syndrome and bacteria co-infection (both P = 0.05). In patients over 24 months, RSV infection had no significant impacts in all the parameters which are compared between the two groups. In patients with cyanotic CHD, RSV infection significantly prolonged the duration of MV, ICU stay and hospital stay (all P < 0.05). In patients with cyanotic CHD, RSV infection significantly prolonged the duration of ICU stay and hospital stay (P <0.05). In patients with pulmonary hyper-tension, RSV infection significantly prolonged the duration of MV, ICU and hospital stay(all P <0.05), and in-creased the incidence rate of concomitant infection (P < 0.05). However, in patients without pulmonary hyper-tension, RSV infection only significantly increased the length of hospital stay (P < 0.05). Conclusions RSV in-fection in the early period after open-heart surgery in pediatric patients has significant adverse impacts on the post-operative course, especially in those patients under 6 months old, patients with pumonary hypertension or cyanotic CHD. Early diagnosis, and effective circulatory and respiratory support,alone with antivirus results in a satisfied outcome.

Objective To study the therapeutic effects of prostaglandin E1 on the neonates with transposition of the great vessels with intact ventricular septum (TGV/IVS) retrospectively. Method From January 2004 to June 2009, 34 neonates with TGV/IVS were enrolled in this study. The pulse rate and oxygen saturation (SpO2) of patients were measured percutaneouly at admission. Lipo-prostaglandin E1 (Lipo-PGE1) was administered via peripheral vein with pumping infusion continuously after diagnosis by echocardiography in order to keep the ductus arteriosus (DA) patent. The dose and the time required for the Lipo-PGEl to produce effect were recorded. The changes of SpO2 before and after administration of Lipo-PGE1 were observed. The changes of DA's diameter detected by using echocardiography before and during the operation. Results In all patients the initial dose of Lipo-PGEl was 5 ng/( kg·min) except 3 patients whom larger dosed were required to give guided by the change of SpO2 with 10 ng/(kg·min) in two patients and 15 ng/(kg·min) in one patient. The time required for Lipo-PGE to produce the effect was 5-15 minutes in most infants with mean of (12 ± 3) minutes. The mean SpO2 of the patients measured at admission was (80.05±7.64)%, and it was (86.41±4.83)% two hours before operation (P < 0.05). The average diameter of DA was (0.37±0.08) cm at the time diagnosis and it was (0.51 ±0.15) cm during the operation. The adverse effects occurred in two patients and one of them had apnea and was treated mechanical ventilation. Conclusions Lipo-PGE1 given by continuous pumping infusion via peripheral vein in dose of 5 ng per kilogram per minute can maintainthe DA patency and promote the systemic oxygenation and perfusion, improving the circulation and oxygenation and correcting the acidosis until the plastic surgery performed. Most of the adverse effects of PGE1 are dose related.

Humans ; Hydrocarbons, Brominated ; toxicity ; Occupational Exposure ; standards

Objective To study the feasibility of laparoscopic cholecystectomy in low pneumoperitoneum pres sure and the effct of low pressure pneumoperitoneum on liver enzymes.Methods A total of 128 cases of laparoscopic gallbladder resection for gallbladder stones or chronic acalculous cholecystitis patients came from outpatient of Department of Two General Surgery of Daxing Hospital Affiliated to Capital Medical University from Jan.2010 to Apr.2015.Patients with odd hospital numbers were divided into the conventional pressure group (group A:12-14 mmHg,n =64).Patients with even numbers were divided into the low pressure group (group B:8-10 mmHg,n =64).The venous blood was respectively collected at the first day and second day preoperatively to determine and compare the contents of alanine aminotransferase (ALT) and aspartate aminotransferase(AST) in two groups.The mean and standard deviation of the above indexes and operation time of two group patients are compared.Results All patients were successfully completed surgery.The average operation time of group A was (65 ± 6.5) minutes,and group B was (61 ± 8.2) minutes,and there was no significant difference between the two groups (t =2.212,P =0.976).Compared with the A group,the B group had less effect on the aminotransferase,the data of the two groups were significantly different (P ＜ 0.05).Conclusion Laparoscopic gallbladder resection underwent the low pneumoperitoneal pressure (8-10 mmHg) is safe and feasible,doesnt extend the operation time,and helps to reduce the effect of pneumoperitoneum pressure on transaminase,which is much important for patients with abnormal aminotransferase preoperative.

Objective To evaluate the effect of popliteal fossa fixed method to reduce the setup errors in patients with postoperative cervical carcinoma by CBCT of TrueBeam Linear accelerator.Methods 30 cases of postoperative cervical cancer patients were randomly divided into two groups,group A with popliteal fossa fixed method by trapezoidal fixation,group B with traditional vacuum pad fixation.CBCT was used to record both setup errors and rotational errors,Stroom extension formula was used to calculate the PTV expansion value coming from the two different fixation methods.Results There was significant difference in setup errors between group A and group B.The setup errors in the left-right direction (X),cranial-caudal direction (Y) and anterior-posterior direction (Z) were (0.19±0.14) cm,(0.17±0.12) cm and (0.13±0.11) cm in group A,respectively.On the contrary,the setup errors in X,Y and Z were (0.24±0.19) cm,(0.25±0.21) cm and (0.22±0.18) cm in group B,respectively.The rotational errors were 0.05°±0.02° in group A,comparing with 0.5°±0.21° in group B (P =0.00).The PTV expanded margin in group A was 0.56 cm in X direction,0.51 cm in Y direction,0.40 cm in Z direction,in comparing with 0.73 cm,0.78 cm and 0.67 cm in group B,respectively.Group A remarkably reduced the PTV,pelvis,small intestine,bladder and rectum irradiated volumes [(1 167±271) mm3 vs (1 379±297) mm3,(84±12) mm3 vs (130±17) mm3,(81±51) mm3 vs (117±64)mm3,(62±40) mm3 vs (75±47) mm3,(21±16) mm3 vs (31±21) mm3].Conclusion Popliteal fossa fixed method can reduce setup errors and improve the stability of positioning,more suitable in precise radiotherapy for postoperative cervical cancer patients,which has the value of further validation.

Objective To investigate the effectiveness of pinacidil,an opener of ATP-sensitive K+ channels,in protecting the myocardium of immature rabbit hearts from ischemic reperfusion injury.Methods Rabbit hearts underwent 30 min of global normothermic ischemia followed by 30 min of reperfusion on the modified Langendorff apparatus.Fifty-two isolated hearts of 3 - 4 week-old immature rabbits were divided into 4 groups randomly.During ischemia,3 different cardioplegic solutions were administered intermittently by infusion every 15 min(20-25 mi each time in all groups).Group 1:control group(n = 13);group 2:Krebs-Henseleit(K-H)solution with potassium(16 mmol/L)(n = 1:3);group 3:K-H solution with potassium(16 mmol/L)and pinacidil(50 μmol/L)(n = 13);group 4:K-H solution with potassium(16 mmol/L),pinacidil(50 μmol/L)and glibenclamide(10 μmol/L)(n = 13).The pre-ischemic and post-ischemic myocardial functions were assessed by the percentage recovery of the left ventricular developed pressure(LVDP);the left ventricular end-diastolic pressure(LVEDP);both the Positive peak and negative peaks of the first derivative of the left ventricular pressures(± dp/dtmax);coronary flow;the level of creatine kinase(CK),lactic dehydrogenase(LDH)and aspartate transcarbamoylase(AST)in coronary sinus venous effluent;and by myocardial ultrastructural changes. Results Before myocardial ischemia,there were no significant differences among the four groups in any of the parameters mentioned above.Post-ischemic recovery of LVDP,LVEDP,± dp/dtmax,coronary flow,the level of CK,LDH and AST,and myocardial ultrastructural changes were better in group 3 than those in the three other groups.Conclusions As a new and effective composition,pinacidil can significantly improve myocardial protection from cardioplegia for immature rabbit hearts.

OBJECTIVETo investigate the clinical features of familial papillary thyroid carcinoma (FPTC) and the criteria for its diagnosis and surgical treatment.

METHODSOne hundred and forty-five patients with PTC were investigated randomly between January 1999 and November 2001, and 17 of them were from 7 families. Of the 17 patients, 14 were operated on at this hospital, and 3 were operated elsewhere. The specimens from the 17 patients were confirmed pathologically. They accounted for 9.3% (14/145) of all PTC patients.

RESULTSThe patients were aged from 30 to 74 years (mean 45 years). The diameter of original focuses ranged from 0.8 to 2.8 cm (mean diameter 1.7 cm). Of the 17 patients with PTC, 8 (47.5%) had bilateral carcinoma. In 3 families, 3 patients suffered from PTC (42.8%). In 4 families, other members suffered from benign thyroid tumor or non-tumorous thyroid disease. Among the 17 patients, 10 had nodular goiters. Thyroidectomy, unilateral thyroidectomy plus isthmusectomy, and combined radical operation were performed in 8, 9, 14 patients, respectively. Early metastatic spread to local regional lymph nodes was noted in 14 patients (82.3% or 14/17).

CONCLUSIONSIn this study, a FPTC rate of 10% was found. Almost 50% of FPTC patients had bilateral carcinoma. The frequency of metastatic spread to local-regional lymph nodes was high. Follow-up survey of family members should be performed in a long period of time.

Adult ; Aged ; Carcinoma, Papillary ; genetics ; pathology ; surgery ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Thyroid Neoplasms ; genetics ; pathology ; surgery ; Thyroidectomy

OBJECTIVETo introduce the technique of intrathoracic surgery performed through vertical transaxillary minithoracotomy.

METHODSFrom March 1989 to March 2001, 316 patients underwent intrathoracic surgery through a vertical transaxillary minithoracotomy. 285 patients suffered from patent ductus arteriosus (PDA), 10 congenital esophageal atresia, 8 congenital pulmonary cysts, 6 congenital emphysema, 1 pulmonary sequestration, 5 mediastinal tumor, and 1 eventration of the diaphragm.

RESULTSAll of the patients were successfully treated under satisfactory exposure. No operative mortality and severe postoperative complications occurred.

CONCLUSIONSIntrathoracic surgery performed through a vertical transaxillary minithoracotomy appears to be less invasive, and is a simple, safe, cosmetically acceptable and efficient approach.

Adolescent ; Axilla ; Child ; Child, Preschool ; Cysts ; congenital ; surgery ; Ductus Arteriosus, Patent ; surgery ; Esophageal Atresia ; surgery ; Female ; Humans ; Infant ; Infant, Newborn ; Lung Diseases ; congenital ; surgery ; Male ; Pulmonary Emphysema ; congenital ; surgery ; Thoracotomy ; methods

Objective:To understand the status quo of nutrition knowledge, attitude and behavior of nurses in class A tertiary hospital and its influencing factors, and to provide reference for the development of reasonable and standard nutrition training courses.Methods:The knowledge, attitude and behavior of nutrition of 207 nurses in 28 class A tertiary hospitals from 17 provinces cities on October 25-26, 2019 were investigated Questionnaire on Nutritional Knowledge, Attitude and Behavior Cognition of Nurses.Results:The scores of nurses′ nutritional knowledge, attitude and behavior were (69.70 ± 2.92), (82.76 ± 4.97) and (64.90 ± 4.77) respectively. There were significant differences in nurses′ nutritional knowledge, attitude and behavior at different ages, nursing ages, whether they had children, the highest educational background, department rotation, technical titles, administrative positions, employment methods, article publication, whether they had participated in nutrition training courses and in different regions ( F values were 6.80-60.95, t values were 2.94-7.08, all P<0.05). The main factors affecting nutrition knowledge were region, nursing age, the highest educational background, department rotation and whether they had participated in nutrition training courses ( t values were -6.88-6.73, all P<0.05). The main factors affecting nutritional attitude were region, nursing age and the highest educational background ( t=-2.22, 6.84, 3.21, all P<0.05). The main factor affecting nutritional behavior was nursing age ( t=5.45, P<0.05). Conclusions:Nurses′ nutritional attitude level is excellent, but their mastery of nutritional knowledge and nutritional nursing behavior level need to be improved. Reasonable, scientific and feasible nutritional training courses should be formulated according to the influencing factors of their nutritional knowledge, attitude and behavior, so as to improve nurses′ nutritional knowledge, belief and behavior level and improve the nutritional status and prognosis of hospitalized patients.

Objective To observe the clinical curative effect of unilateral biportal endoscopy(UBE)in the treatment of extreme lateral lumbar disc herniation(ELLDH).Methods From June 2019 to June 2022,25 patients with ELLDH were treated with UBE-guided discectomy,including 16 males and 9 females.The age ranged from 26 to 62 years with a mean of(53.67±17.45)years.History ranged from 3 d to 10 years.There were 9 cases of internal foraminal type(type Ⅰ),13 cases of external foraminal type(type Ⅱ)and 3 case of mixed type(type Ⅲ).There were 8 cases of L4/5 space and 17 cases of L5/S1 space.All the patients underwent anterior and lateral lumbar X-rays,CT and MRI scans before surgery.The visual analogue scale(VAS)pain score and Oswestry disability index(ODI)assessed lower limb and lower back pain and functional recovery before surgery and at 3 d and 3 months after surgery,respectively.Macnab criteria evaluated the immediate surgical outcome.Results The UBE technique was used to treat ELLDH.The operative time was(79.79±23.97)min,the intraoperative bleeding volume was 40～80 mL,with an average of(55.80±10.74)mL.Follow-up time was(7.02±4.26)months.Preoperative VAS of lower limb was(7.04±0.92),lower back VAS was(3.49±1.52),ODI was(35.03±2.97)%.Compared with the preoperative results,the lower limb VAS was(2.17±0.61),lower back VAS was(1.48±0.43),and ODI was(18.77±3.15)%on day 3 after surgery,lower limb VAS was(1.38±0.65),lower back VAS was(1.03±0.48)and ODI was(6.05±1.80)%on the 3 months after surgery were improved(P＜0.05).The excellent and good rate was 96.0%(excellent 20,good 4,fair 1),and no obvious complications were observed during the follow-up.Conclusion UBE is effective,with little trauma,clear intraoperative visual field,good intraoperative experience,and less traumatic and safe in the treatment of ELLDH.