Hemodynamic monitoring is an essential part in the care of children with congenital heart disease during perioperative period to guide clinical management.Currently,there are several methods available for hemodynamic monitoring.The invasive methods include the Fick method,thermodilution method,using the Swan-Ganz catheter and the pulse contour method.The noninvasive methods include partial carbon dioxide resorption,impedance method.In this paper,the principle,advantages and disadvantages of these monitoring methods in children undergoing cardiopulmonary bypass surgery were reviewed.

The purpose of the present work was to investigate the innovative self-assembling system, "beads", prepared by continuously shaking alpha-cyclodextrin and soybean oil without the use of organic solvents and surfactants at room temperature. Berberine hydrochloride previously dissolved in soybean oil was chosen as a model drug to explore the shape, structure, drug loading and in vitro release of beads. The particle size and drug loading of berberine hydrochloride-loaded beads were (2.25 +/- 0.23) mm and (67.02 +/- 0.64) microg x g(-1), respectively. Confocal microscopy showed that the core-shell structure of beads could contain poorly water soluble drugs or lipophilic drugs in the lipid core. The drug release rate and cumulative releases of beads were both higher than those of raw medicine of berberine hydrochloride in simulated intestinal fluid. These results suggested that beads were the novel and potential lipid-based drug delivery system for lipophilic or poorly water soluble traditional Chinese medicine.
Berberine ; administration & dosage ; Drug Delivery Systems ; Particle Size ; Solubility ; Soybean Oil ; administration & dosage ; alpha-Cyclodextrins ; administration & dosage

Objective To compare the difference in pulse pressure variation(PPV)to predict volumetric response in children with ventricular septal defect(VSD)and tetralogy of Fallot(TOF). Methods VSD group consisted of 38 patients,aged 1.05 ± 0.75 years,while TOF group consisted of 36 patients,aged 1.15 ± 0.68 years. After separation from cardiopulmonary bypass,fluid infusion therapy was administered. PPV was recorded using pressure recording analytical method along with cardiac index(CI)before and after fluid infusion. Patients were considered as responders to fluid loading when CI increased ≥15%.Receiver operating characteristic(ROC) analysis was used to assess the accuracy and cutoffs of PPV to predict volumetric response.Results The PPV val-ues before and after fluid infusion were significantly lower in TOF group than that in VSD group(P < 0.01 for both).In VSD group,27 were responders and 11 nonresponders.ROC curve area was 0.89 and cutoff value 17.4%. In TOF group,26 were responders and 10 nonresponders.ROC curve area was 0.79 and cutoff value 13.4%.Con-clusion PPV is predictive of volumetric response in VSD and TOF patients following cardiac surgery.PPV's pre-dictivity and cutoff value are higher than the former. PPV is affected by right ventricle-pulmonary artery circula-tion,under-fluid infusion should be avoided in TOF due to lower PPV,over-fluid infusion should be avoided in VSD due to higher PPV.

Objective To evaluate the value of diffusion tensor imaging(DTI)in cognitive impairment of patients with acute cerebral infarction.Methods Diffusion tensor images were obtained from 30 volunteers who underwent clinical MR imaging and were found to have no abnormalities on conventional MR images and 30 patients who were clinically diagnosed cerebral infarction and were found to have infarction lesions on conventional MR images.Color-coded FA images and three-dimensional color-coded tensor images were reconstructed.For volunteers,average apparent diffusion coefficient(ADC)and fractional anisotropy(FA)were measured in some main white matter structures of peripheral white matter, basal ganglia,and cerebral peduncle,etc.For infarction patients,ADC and FA were measured and compared between infarction lesions and corresponding contralateral normal regions.Pearson correlation analysis was used to determine correlation with cognitive impairment.Results In infarction patients group, FA and ADC of lesions unrecovered declined.Change in ADC and FA had positive correlation with cognitive impairment of patients with acute cerebral infarction.Conclusion DTI has positive correlation with cognitive impairment of patients with acute cerebral infarction.

Plasma obestatin level was determined in patients with impaired glucose regulation and type 2 diabetes mellitus.The plasma obestatin levels in patients of both groups were significantly decreased as compared with that in controls.Plasma obestatin level was negatively correlated with body mass index,HbA_(1C),waist-to-hip ratio,plasma insulin and HOMA-IR.Obestatin level seems to be related with metabolic disorder.

Objective To evaluate the difference between stroke volume measured by electrical cardiometry-Icon (Osypka Medical, Berlin, Germany) and pressure recording analytical method-MostCare (Vygon, Vytech, Padova, Italy), and to assess their nursing demand, safety and sutibility.Methods From March to September in 2016, twenty-six infants undergoing open heart surgery using CPB were enrolled. After helping anesthesiologist to complete general anesthesia, invasive arterial pressure monitoring was established to use MostCare. After positioning, four electrodes were placed on patients skin. Stoke volume index along with cardiac index (CI), heart rate, systolic and diastolic pressure were recorded before surgical incision (t0), after pericardiotomy (t1), weaning from CPB and aortic catheter withdrawed (t2), after skin closure (t3). Pearson correlations were calculated and agreement were compared by Bland-Altman analysis between the two devices. Meanwhile, by observing and analyzing factors that affect correct readings of the two devices, to eliminate factors related with nursing. Adverse events related to the using of the two devices were recorded.Results No adverse events showed up in surgery, the process of surgery were not affected. Specialized intraoperative nursing ensure the two devices providing reliable and continuous readings. A good linear correlation was found between Icon-and MostCare-SVI at each time point (r=0.84,0.66,0.87,0.81;P<0.001 for all). At Bland-Altman analysis the mean difference (ml/m2), 95% limits of agreement (ml/m2), and percentage error between the two devices at four time points were (-0.4,-8.4-7.6,27.2%), (-7.2,-17.4-3.4,42.6%), (-1.8,-7.9-4.6,29.7%), (-1.2,-6.1-4.0,25.6%), respectively.Conclusions In children undergoing open heart surgery, except the period from thoractomy to pre-cardiopulmonary bypass, Icon-and MostCare-SVI readings were interchangeable. Sufficient preoperative preparation, specialized intraoperative nursing can ensure the two devices function safely and correctively.

Objective? To use near-infrared spectroscopy (NIRS) to monitor the effects of peripheral artery catheterization on limb muscle oxygen saturation (SmO2) in infants and children. Methods? Totally 60 children aged under 36 months receiving selective operation in Children's Hospital, Capital Institute of Pediatrics between March and September 2017 were selected. NIRS was used to monitor and record the SmO2 of muscle of thenar or gastrocnemius muscle on the limbs of both sides before and after trachea cannula and artery cannulation under general anesthesia. The original SmO2 values of the limbs with or without cannulation were taken as controls to observe the changes of SmO2 of the limbs with cannulation after cannulation. Results? There was no statistically significant difference in original SmO2 values of the limbs with or without cannulation before cannulation (P＞0.05). The SmO2 values of the limbs with cannulation dropped after cannulation, which were lower than the values of the limbs without cannulation (P＜0.001). The decreasing range of SmO2 values of the children aged under 6 months were larger than those of the children aged between 6 and 12 months and between 12 and 36 months; and the decreasing range of SmO2 values of the children weighing under 10 kg were larger than those of the children weighing between 10 and 20 kg (P＜ 0.001). Conclusions? NIRS can accurately reflect the changes of SmO2 after artery cannulation in real time. NIRS used in monitoring helps to assess limb perfusion more precisely. Monitoring should be enhanced for limb perfusion in children aged under 6 months and weighing under 10 kg.

OBJECTIVETo determine the optimal position of hypoglossal nerve in hypoglossal-facial nerve anastomosis and the eligibility of hypoglossal-facial nerve anastomosis with the cervical loop.

METHODSThe cervical course and adjacent structures of the hypoglossal nerve were observed on 21 adult cadavers. The hypoglossal nerve and facial nerve were taken from 3 fresh specimens, and the number of the fasciculus and the cross-sectional area of the nerve were measured.

RESULTSThe facial nerve trunk were monofascicular with a cross-sectional area of 5.1-/+0.2 (range 4.6-5.7) mm(2). The number of the fasciculus and the cross-sectional areas of the nerve trunk and the fasciculus were 1.6-/+0.8 (range 1-4) mm(2) , 7.5-/+0.7 mm(2) (range 6.8-8.0) mm(2), and 4.7-/+0.6 (4.1-5.5) mm(2), respectively, at the proximal segment of the hypoglossal nerve, 3.6-/+0.5 (1-5) mm(2) , 5.6-/+0.5 (4.9-6.1) mm(2) , and 1.6-/+0.4 (0.9-2.2) mm(2) at the distal segment, and 2.4-/+0.8 (1-3) mm(2), 1.1-/+0.7 (0.6-2.2) mm(2), and 0.5-/+0.3 (0.3-1.2) mm(2) at the cervical loop.

CONCLUSIONThe cervical loop is inadequate for facial nerve anastomosis and the proximal segment is large enough to allow partial harvesting of the hypoglossal nerve for neurotisation of the facial nerve.

Anastomosis, Surgical ; methods ; Cadaver ; Facial Nerve ; anatomy & histology ; surgery ; Humans ; Hypoglossal Nerve ; anatomy & histology ; surgery ; Nerve Transfer ; methods

OBJECTIVETo investigate Chinese medicine (CM) patterns and epidemiological characters of patients with influenza-like illness (ILI) syndromes in clinics in China.

METHODSA prospective multi-center observational epidemiology survey on the clinical CM patterns of ILI and its prevalence was conducted from September 2009 to April 2010. A unified survey questionnaire was developed for data collection of ILI symptoms and CM patterns. Totally 45 hospitals from 22 provinces, municipality cities and autonomous regions of China participated this study. The collected data were input by EPI-data v3.1 and analyzed by SPSS 18.0, which included descriptive analysis and Chi-square test for group comparison.

RESULTSA total of 5,967 ILI patients were included in the study. The proportion of the 18-34 aged group (56.2%) was the largest; students (41.0%) were more than other occupations. Majority of the patients had the wind-heat invading Lung (Fei) syndrome (76%), while in Southwest China mainly wind-heat invading Lung syndrome and wind-cold tightening the exterior syndrome occurred. The typical symptoms of ILI were ranked as fatigue (80.9%), cough (72.2%), sore throat (67.2%), muscular soreness (67.1%), headache (65.4%), aversion to cold (60.1%), thirst (55.1%) and nasal obstruction (48.1%).

CONCLUSIONSThe ILI patients in clinics were mainly teenagers and young adults. In regard to CM syndrome, wind-heat invading Lung syndrome prevailed in all regions except the Southwest China. The characteristics of CM syndrome of ILI patients may be relevant to age and region distribution.

Adolescent ; Adult ; Age Distribution ; Body Temperature ; China ; epidemiology ; Female ; Hospitals ; Humans ; Influenza, Human ; epidemiology ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Prevalence ; Seasons ; Sex Characteristics ; Syndrome ; Time Factors ; Young Adult

Objective To study the relationship between regional cerebral tissue oxygen saturation (rScO2) and hemodynamic parameters under different end-tidal carbon dioxide partial pressure (PetCO2) levels during anesthesia induction period in children undergoing ventricular septal defect(VSD) repair.Methods A total of 25 patients aged from 2 to 37 months (median 6 months) were enrolled,who received selective VSD repair at Beijing Anzhen Hospital from April to May 2017.After admission,anesthesia induction and intubation,invasive radial artery pressure were established routinely and hemodynamic device-MostCare was used,Fore-Sight was used to monitor rScO2 of the right frontal brain.By means of adjusting mechanical ventilation parameter,PetCO2 was maintained at 30 (T1),35 (T2),40 (T2),45 (T3) mmHg(1 mmHg =0.133 kPa) in sequence.Pulse oxygen saturation (SpO2),heart rate (HR),systolic pressure (SysP),difference between dicrotic pressure (DicP) and diastolic pressure (DiaP) (Pdic-a),stroke volume index (SVI),cardiac index (CI),systemic vascular resistance index (SVRI),and pulse pressure variation (PPV) were recorded at T1,T2,T3 and T4.Results (1) Comparison among groups:rScO2 at T4,T3,T2 and T1 were (80.5 ± 4.0) ％,(78.2 ± 4.6) ％,(74.4 ± 5.7) ％,(70.8 ± 6.5) ％,respectively,rScO2 at T2,T3 and T4 were higher than that at T1,and the differences were statistically significant (all P ＜ 0.05).SysP at T3 [(85 ± 9) mmHg] and T4 [(84 ± 10) mmHg] were lower than that at T1 [(92 ± 15) mmHg],and the differences were statistically significant (all P＜0.05).DicP at T2[(64 ± 12) mmHg],T3[(60 ± 10) mmHg],and T4 [(59 ±9) mmHg] were significantly lower than that at T1 [(68 ± 15) mmHg],and the differences were statistically significant (all P ＜ 0.05).DiaP at T2 [(44 ± 6) mmHg],T3[(41 ±6) mmHg],and T4 [(41 ±6) mmHg]were lower than that at T1 [(47 ±7) mmHg],and the differences were statistically significant(all P ＜ 0.01).SVRI at T4 [(1 382 ± 262) dyne · s cm-5 · m2] was significantly lower than those at T1 [(1 486 ± 241) dyne · s cm-5 · m2],T2 [(1 440 ± 279) dyne · s cm-5 · m2] and T3 [(1 418 ±266) dyne · s cm-5 · m2],and the differences were statistically significant (all P ＜ 0.05).PPV at T3 [(11 ± 4) ％] and T4 [(13 ± 5) ％] was significantly lower than that at T1 [(18 ± 12) ％],and the differences were statistically significant (all P ＜ 0.05).(2) Correlation analysis:in total population,PetCO2 was positively correlated with rScO2 (r =0.582,P ＜ 0.01).At T1,rScO2 was positively correlated with DiaP and DicP (r =0.600,0.658,all P ＜ 0.01),as well as SysP,CI,SVI,Pdic-a (r =0.460,0.424,0.522,0.534,all P ＜ 0.05),rScO2 was negatively correlated with HR and PPV (r =-0.450,-0.490,all P ＜ 0.05).At T2,rScO2 was positively correlated with DiaP and DicP (r =0.689,0.692,all P ＜ 0.01),as well as SysP,SVI (r =0.534,0.445,all P ＜ 0.05).At T3,rScO2 was positively correlated with SysP (r =0.495,P ＜ 0.05),and negatively correlated with PPV (r =-0.562,P ＜ 0.01).At T4,the rScO2 was not correlated with any hemodynamic parameters (P ＞ 0.05).Conclusions During anesthesia induction in ventricular septal defect children,rScO2 increases significantly with the increase in PetCO2.When PetCO2 is at 30 and 35 mmHg,rScO2 is mainly affected by hemodynamics.When PetCO2 is at 40 and 45 mmHg,rScO2 is mainly affected by PetCO2,but less affected by hemodynamics.