Objective To share the experience of surgical repair for cor triatriatum in chidren.Methods Between July 2008 and June 2013,24 children with cor triatriatum underwent surgical correction in Cardiac Center of Children's Hospital of Fudan University.The minimum age at the time of operation was 1 month,median age was 5 month;the minimum body weight at the time of operation was 3.5 kg,median body weight was 7.4 kg.Retrospectively analyzed their cardiac anatomy,clinical data,surgical procedures and follow-up data.Results Of all 24 patients,there were 4 patients diagnosed semplice cor triatriatum,and 20 patients diagnosed cor triatriatum associated with other malformation includes cardiac and non-cardiac issues.Procedures were performed on 22 patients to correct all cardiac defects in one stage.1 patient underwent surgical repair for cor triatriatum and Glenn procedure as well.1 patient,diagnosed as cor triatriatum and functional single ventricle S/P Glenn,underwent surgical repair for cor tiratriatum only.2 patients recovered from pulmonary artery hypertension crisis after operation.1 patient dead 17 days post procedure caused by respiratory failure.23 patients discharged from hospital.The longest follow-up was 73 months,at least 12 months after discharge.All alive patients were in New York Heart Association's function class Ⅰ-Ⅱ.Echo assessment revealed normal size of left atriums of almost all alive patients one year after discharge.Till April 2015,no postoperation intervention,no blood flow obstruction at level of pulmonary veins,left atrium or mitral valve.Conclusion Pediatric patients diagnosed cor tiratriatum sinister need intervention,no matter hemodynamic change occurs or not.Right time of surgery is important for successful treatment.

Objective To explore the clinical application and outlook of anterior segment observation with Stratus optical coherence tomography(Stratus OCT).Design Prospective case series.Participants 56 eyes in 38 patients with primary angle closure glaucoma (PACG).Methods Morphological changes of anterior chamber angle (ACA) were observed with Stratus OCT before and 4 weeks after laser iridectomy.Opening status of ACA were described and measured with Photoshop software.Main Outcome Measures Opening degree of ACA and ratio of anterior chamber depth to thickness of cornea.Results To a great deal of extent,Stratus OCT could be used to observe the appearance of ACA. Clear images of ACA could be acquired.The ACA before laser was (15.67?5.33) degree and significantly reopened to(26.56?8.17) degree after laser iridectomy (P=0.000).The ratio of anterior chamber depth to thickness of cornea was also changed from (0.39?0.13) pre-treatment to (0.89?0.32) pest-treatment(P=0.000).Conclusions Stratus OCT could be applied to observe the changes of opening degree of ACA easily.The standard of quantization should be consummated in the future.

Objective: To discuss the experience of early surgical intervention to critical and complex congenital heart diseases (CHD) in neonates. Methods: A retrospective study of clinical records of patients with congenital heart diseases underwent surgical intervention in one single pediatric cardiac center was performed. From January 2009 to December 2017, 841 critical and complex CHD neonates were identified at Department of Cardiovascular Surgery, Children′s Hospital of Fudan University, of which 6.5% were premature. There were 557 male and 284 female patients. The age was (11±9) days, ranging from 0 to 28 days, M(Q_R): 8(17) days. The weight was (3.26±0.57) kg, ranging from 1.9 to 5.0 kg, M(Q_R): 3.3(0.7) kg. There were 189 patients associated with other malformation besides CHD. Before surgery, 13.6% (114/841) patients were on ventilation, and severe acidosis was addressed in 136 patients. All patients underwent surgical interventions, including surgical procedures and hybrid procedures. Results: Emergency surgeries were performed in 35 patients. One hundred patients had palliative procedures, other 633 patients had complete repair, while the rest 108 patients underwent hybrid procedures. The in-hospital mortality was 4.0% (34/841). The ventilation time was 1.5 to 1 130.0 hours, M(Q_R): 94 (116) hours, with the rate of reintubation 3.3% (27/807). The ICU stay time was 1 to 195 days, M(Q_R): 14 (15) days. Conclusion The improvement on early screening and diagnosing, referral system, multidisciplinary cooperation and hybrid invention skills together contributed to better outcomes of critical and complex congenital heart diseases in neonates.

OBJECTIVETo establish an RP-HPLC method for determination of betulinic acid in Callicarpa macrophylla, a commonly used herbal in Yunnan.

METHODA Kromasil-C18 column (4.6 mm x 200 mm, 5 microm) and a mobile phase consisted of acetonitrile-0.1% phosphoric acid (63: 37) were used. The flow rate was 1.0 mL x min(-1) and the UV detector wavelength was 205 nm.

RESULTBetulinic acid was well separated from other compounds in C. macrophylla. The content of betulinic acid in C. macrophylla from different origins showed apparent differences, the content of betulinic acid in C. macrophylla from Yunnan was the highest. The calibration curve was linear in the range of 0.016 6-0.332 mg x mL(-1) of betulinic acid with correlation coefficient 0.999 8. The average recovery of betulinic acid was 98.5%.

CONCLUSIONThe method is simple, accurate and reproducible, and is suitable for the quality control of C. macrophylla.

Calibration ; Callicarpa ; chemistry ; Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; chemistry ; Linear Models ; Quality Control ; Reproducibility of Results ; Sensitivity and Specificity ; Triterpenes ; analysis ; isolation & purification

Abstract: Objective To analyze and compare the effects of different clinical characteristics on the negative conversion time of nucleic acid detection after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection, and to provide a scientific basis for the isolation and treatment of coronavirus disease 2019 (COVID-19). Methods　The epidemiological and clinical data of 228 mild SARS-CoV-2 Omicron variant infected patients diagnosed in Shanghai were retrospectively collected from April 27, 2022 to June 8, 2022 in Wujiaochang designated Hospital, Yangpu District, Shanghai. The negative conversion time of nucleic acid detection was used as the outcome variable, and the patients were divided into A (≤18 days) and B (>18 days). Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of the negative conversion time of nucleic acid detection. Results　The mean nucleic acid conversion time of 228 patients was (18.7±12.1) d, with the median time of 18 (2-46) d. Among them, 120 patients in group A had an average nucleic acid conversion time of (13.2±2.0) d, and 108 cases in group B had an average nucleic acid conversion time of (20.8±1.3) d. Univariate analysis showed that there were no statistically significant differences in the effects of hypertension, coronary heart disease, diabetes, hypokalemia, malignant tumors, neuropsychiatric diseases, chronic digestive diseases on the negative nucleic acid conversion time (P>0.05); however, there were significant differences in the effects of combined cerebrovascular disease, leukopenia, chronic respiratory system diseases and vaccination on the negative nucleic acid conversion time (P<0.05). Further multivariate logistic regression analysis revealed that the combination of chronic respiratory diseases and non-vaccination were significant risk factors for prolongation of negative nucleic acid conversion time (P<0.05). Conclusions The results of this study show that gender, age and whether hypertension, coronary heart disease, diabetes mellitus, hypokalemia, malignant tumor, neuropsychiatric disease and chronic digestive disease have no significant effect on the nucleic acid conversion time, whereas chronic respiratory disease and no vaccination are significantly correlated with the prolongation of nucleic acid conversion time in SARS-CoV-2 Omicron-infected patients.

OBJECTIVEThe protection rate of inoculation with BCG vaccine is only 50 percent, and most of patients with tuberculosis had a history of BCG vaccine inoculation. Adenosine (ADO) has an immunomodulating effect; it promotes immune reaction by increasing number of macrophage and enhancing phagocytosis. The present study was designed to investigate if combined use of adenosine with BCG enhances the anti-Mycobacterium tuberculosis effect of macrophage in mice.

METHODSFifty BALB/C mice were divided randomly into 3 groups: BCG group (n = 21), BCG plus ADO group (n = 21) and control group (n = 8). The mice in BCG and BCG plus ADO groups were inoculated with 0.1 ml BCG intradermally and the mice in BCG plus ADO group were injected intraperitoneally with ADO 30 mg/(kg.d) for 5 days. The mice in BCG group and control group were injected with NS 0.1 ml/d for 5 days. Six weeks after the last injection, all mice were challenged with intravenous 1 x 10(6) CFU human Mycobacterium tuberculosis virulent strain. After challenging, lung and spleen specimens were taken at the 10th, 20th and 30th days from the mice of BCG and BCG plus ADO groups and at the 30th day from mice in control group. The pathological examinations of lung and spleen sections were performed after HE staining and acid-fast staining, and detection of cell apoptosis was also performed.

RESULTSConsolidation with neutrophil infiltration was found in most of the lung tissue taken at the day 30; there were a lot of tuberculous granulomas and Mycobacterium tuberculosis in the lungs of control group. The alveolar septum in BCG gradually became wide and in interstitium lymphocyte infiltration dominated, and there were less tuberculous granulomas but there were large number of Mycobacterium tuberculosis in the lungs from 10th to 30th days after challenging. The widening of alveolar septum and consolidation of lung tissue in BCG plus ADO group became milder with monocytes infiltration, and there were few tuberculosis granulomas and Mycobacterium tuberculosis in the lungs from 10th to 30th days after challenging.

CONCLUSIONADO could increase the number of monocyte-macrophages and promoted anti-bacterial effects of these cells.

Adenosine ; administration & dosage ; immunology ; Animals ; BCG Vaccine ; administration & dosage ; immunology ; Disease Models, Animal ; Drug Therapy, Combination ; Injections, Intradermal ; Injections, Intraperitoneal ; Macrophages ; drug effects ; immunology ; Mice ; Mice, Inbred BALB C ; Mycobacterium tuberculosis ; immunology ; Neutrophil Infiltration ; drug effects ; Phagocytosis ; drug effects ; Tuberculosis, Pulmonary ; immunology ; prevention & control

OBJECTIVETo investigate the bacterial flora and their drug resistance in hospitalized burn patients on tropical islands.

METHODSRetrospective study was carried out to analyze pathogenic microorganisms and their drug resistance characteristics in 392 burn patients hospitalized during 2000-2005.

RESULTS(1) Totally 671 strains of bacteria were isolated, among which Pseudomonas aeruginosa, Staphylococcus aureus, Aerobacter cloacae and Acinetobacter species were predominant, but the isolation rate of Pseudomonas aeruginosa was declining compared with that in 1990's. (2) The resistance rate of Pseudomonas aeruginosa to imipenem and cefepime was 32.2% and 36.7% , respectively, while that to other antibiotics was above 80%. (3) Among 141 strains of Staphylococcus aureus, 89 strains (63.1%) of MRSA were isolated, and none of them were resistant to Vancomycin.

CONCLUSIONPseudomonas aeruginosa, Staphylococcus aureus, Aerobacter cloacae and Acinetobacter species were predominant in tropical islands. The species of the pathogens are changing . The drug resistance rates of Pseudomonas aeruginosa and Staphylococcus aureus are rather high.

Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; pharmacology ; Burns ; drug therapy ; microbiology ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Female ; Humans ; Infant ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Pseudomonas aeruginosa ; drug effects ; isolation & purification ; Retrospective Studies ; Staphylococcus aureus ; drug effects ; isolation & purification ; Tropical Climate ; Young Adult

OBJECTIVETo study the alteration of thymus matrix lymphocyte generator (TSLP) and change of the Th factor in the course of disease development, and to analyze the curative effect of inhalation of Vitamin A (VA) with corticosteroid for the treatment of asthmatic pneumonia.

METHODSAsthmatic pneumonia models were prepared by challenging rats with inhalation of ovalbumin for 4 weeks, and rested for 1 week. The treatment with VA and corticosteroid inhalation for 1 week was followed. The rat thymus and lung specimen were examen by histochemical and immunofluorescence staining.

RESULTSAfter 4 - 5 weeks of stimulation, there were more TSLP-positive cells and alveolar macrophages (AM) found in thymus and lung tissue of asthmatic group, the cell proliferation in spleen and thymus was obvious, and blood Th factors elevated. The inflammation within the lung tissue aggravated gradually. In VA group, the expression of TSLP and Th2 factors were all lowered at the 4th week. The TSLP expression slightly increased at the 5th week, and the cell proliferation within T-cell zone of spleen and thymus was strong at first and weakened later. Alveolar microphages (AM) increased significantly and the inflammation in the lung subsided gradually at the 5th week. In the hormone group, TSLP and Th2 factors expression in both thymus and lung were decreased at the 5th week, while the cell proliferation in thymus and lung was gradually increased. The quantity of AM was decreased, whereas the inflammation of the lung was increased gradually at the 5th week.

CONCLUSIONDuring asthmatic period elevated TSLP expression was accompanied by Th2 type responses while VA and corticosteroid both suppressed TSLP and Th2 factors expression. VA alone promoted T lymphocyte proliferation as well as the antigen elimination function by AM, after ceasing the usage, the lung inflammation abated gradually. In contrast, after ceasing the use of corticosteroid, inflammation aggravated.

Administration, Inhalation ; Adrenal Cortex Hormones ; administration & dosage ; therapeutic use ; Animals ; Asthma ; complications ; Beclomethasone ; administration & dosage ; therapeutic use ; Cytokines ; metabolism ; Pneumonia ; drug therapy ; metabolism ; Rats ; Rats, Sprague-Dawley ; Vitamin A ; administration & dosage ; therapeutic use

OBJECTIVETo sum up the clinical experience in the reparation of burn wounds with different types of skin flaps in patients with severe electrical injury.

METHODSFree skin flap, axile island flap with vascular pedicle and muscular skin flap were employed to repair 64 wounds in 49 cases.

RESULTSSkin flap necrosis happened in 2 cases, congestion and necrosis at the edge of skin flaps in 4 cases, and complete survival of the skin flaps and primary healing of the wounds in the remaining cases.

CONCLUSIONReparation of wounds with proper skin flaps according to the degree of the electrical injury is effective and reliable, which might be beneficial to the prevention of necrobiosis and the infection in deep tissue.

Adolescent ; Adult ; Burns, Electric ; surgery ; Child ; Female ; Humans ; Male ; Middle Aged ; Surgical Flaps

ObjectiveTo introduction of perforator flaps,muscle flaps pedicled by descending branch of lateral circumflex femoral artery,method and their clinical application that multiple soft tissue defects of hand are repaire by muliplefoliated tissue flap only branch lateral circumflex femoral artery.MethodsFifteen patients with multiple soft tissue defects of hand were repaired muliplefoliated tissue flap only pedicled bydescending branch lateral circumflex femoral artery.At first,the anterolateral thigh perforator flap was designed and harvested according to the soft tissue defects of hand, then the descending branch lateral circumflex femoral artery was dissected at the same time the segmented perforator flap,fascia lata flap,rectus femoris muscle flap, vastus lateralis muscle flap, vastus intermedius muscle flap and distal spatium intermusculare flap were harvested in need according to distance among soft tissue defects.The muliplefoliated tissue flap was harvested only pedicled by descending branch lateral circumflex femoral artery, at last muscle flaps and fascia lata flaps were covered by skin graft, so the multiple soft tissue defects of hand were repaired in one time.ResultsNo vascular crisis happened. All skin grafts survived well, the contour of all repaired soft tissue defects was good and protective feeling was recovered by skin grafts of all flaps. All cases were got follow-up and the range was from 6 to 20 months(the average was 8.7 months).Wound of donor site healed well, muscle strength of quadriceps and motion of knee were normal. Three cases were excellent,nine cases were well and 3 cases were good, according to upper extremity function evaluation criteria of Chinese Medical Society for the Surgery of the Hand, the rate of good was 80 percent.ConclusionMultiple soft tissue defects of hand can be repaired by muliplefoliated flap only pedicled by descending branch of lateral circumflex femoral artery. Its advantages included reduction of operation time and treatment, good recovery of hand contour and function. It is a good method to repair multiple soft tissue defects of hand.