1.Simultaneous minimally invasive technique for congenital heart disease and pectus excavatum
Jianhua LI ; Weize XU ; Zewei ZHANG ; Zili CHEN ; Jiangen YU ; Zhuo SHI ; Liang HANG
Chinese Journal of Thoracic and Cardiovascular Surgery 2011;27(11):654-655
Objective To investigate the safty and feasibility of simultaneous minimally invasive technique for congenital heart disease (CHD) and pectus excavatum (PE).Methods From July 2006 to June 2011,6 children with PE associated with CHD were treated by simultaneous minimally invasive technique.They were 4 boys and 2 girls,aged from 4 years to 6 years 5 months ( average 5 years and 4 month),.The body weight were from 16 kg to 20 kg [ average ( 18.00 ± 1.79kg ].CT Hailer index were 3.9 - 5.0 ( average 4.35 ± 0.43 ).4 patients with ventricular septal defect (VSD) were treated by minimally invasive closure device,including 3 membranous VSD and 1 subaortic VSD.The defect diameter was 4 - 5 mm.2 cases with atrial septal defect (ASD) were treated using the same technique.the diameter of ASD was 12 - 16 mm.After minimally invasive heart surgery,Nuss operation was carried out in all 6 patients for their PE.Results All operations were successful and patients were extubated 5 - 11 h after operation [ mean ( 8.17 ± 2.04) h ].The pericardial mediastinal drainage was removed at 48 h postoperatively.There were no operative mortality and severe postoperative complications.1 patient had delayed wound healing and was successfully discharged.The plate was removed in 3 cases,and they all had satisfactory outcomes.Conclusion Simultaneous minimally invasive technique is a safe and effeictive mothod for treating pectus excavatum and congenital heart disease.
2.Studying the association of plasma S100A12 and noninfectious pulmonary complication in infants and young children following cardiopulmonary bypass
Xiwang LIU ; Qixing CHEN ; Qiang SHU ; Chi CHEN ; Shanshan SHI ; Zhuo SHI ; Jiangen YU ; Ru LIN ; Linhua TAN
Chinese Journal of Emergency Medicine 2012;21(10):1134-1139
Objective To examine the kinetics of plasma S100A12 and soluble receptor for advanced glycation end products (sRAGE) in infants and young children undergoing cardiopulmonary bypass ( CPB),and to investigate whether they could protective the occurrence of noninfectious pulmonary complication (NPC) after cardiac surgery.Methods This was a case-control study.The subjects included all children aged <3 years old who underwent cardiac surgery with CPB during the period from June 1st to July 31st 2011.The patient who showed pulmonary inflammation or had abnormal liver or renal function before surgery was excluded.The remain patients were divided into 2 groups according to whether they had developed NPC postoperatively.Twenty patients were grouped into NPC because they developed the complications of pleural effusion,chylothorax,partial lung collapse,pulmonary hypertensive crisis,airway disorders,pneumothorax,pneumomediastinum,or phrenic nerve palsy.Forty patients were categorized into the no-NPC group.Plasma concentrations of S100A12 and sRAGE were measured using ELISA at baseline,before CPB,immediately after CPB,1 h,12 h and 24 h after operation.Differences concentrations between two groups were analyzed with t test.A stepwise logistic regression analysis was used to indentify the independent risk factor for NPC.A P value <0.05 was considered statistically significant.Results Plasma levels of S100A12 and sRAGE dramatically increased immediately after CPB ( P < 0.01 ).The levels of sRAGE dropped to lower than baseline level (P <0.05),while S100A12 was still at high level 24h after operation (P <0.01 ).Levels of S100A12 and sRAGE immediately after CPB in NPC group were significantly higher than the no-NPC group (P < 0.05).Twenty-four hours after operation,levels of S100A12 were still higher in NPC group than no-NPC (P < 0.01 ),while levels of sRAGE were similar in the two groups ( P > 0.05 ).In the stepwise logistic regression analysis,plasma S100A12 level immediately after CPB remained as a independently predictor for postoperative NPC (OR =1.042,95% CI:1.010 ~ 1.076,P =0.011 ).Levels of S100A12 immediately after CPB were positively associated with mechanical ventilation time ( r =0.47,P < 0.01 ),duration of surgical Intensive Care Unit ( r =0.407,P =0.002) and hospital stay ( r =0.421,P =0.01 ).Conclusions Plasma levels of S100A12 and sRAGE were significantly increased immediately after CPB and the elevated plasma S100A12 immediately after CPB served as an early reliable biomarker of the occurrence and the prognosis of NPC after CPB in infants and young children.
3.Transaxillary minithoracotomy in intrathoracic surgery for 316 infants and children.
Qiang SHU ; Zewei ZHANG ; Xiongkai ZHU ; Jianhua LI ; Ru LIN ; Jiangen YU ; Zili CHEN
Chinese Medical Journal 2003;116(7):1008-1010
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
4.Consideration of countermeasures to promote family doctor contracting rate and first-return-visit rate in primary care institutions
Fei SHENG ; Ping LU ; Liqing ZHOU ; Bihua CHEN ; Chuntao YI ; Jiangen CHEN ; Fulai SHEN ; Tiantian DENG ; Dongjian XU ; Liling MAO
Chinese Journal of General Practitioners 2024;23(2):180-184
Based on the analysis of the existing problems and implementation dilemmas in family doctor contracting and first-return-visits faced by primary medical institutions in China, the authors propose countermeasures to provide reference for managers of primary health care institutions.
5.Practice of Huzhou in promoting the reform of countywide medical and health governance system
Yan CHEN ; Kewei CAI ; Xuqiang HU ; Yuan SHEN ; Guoqiang LU ; Xiaoming YU ; Liming SHEN ; Jiangen MA ; Jincai WEI
Chinese Journal of Hospital Administration 2023;39(6):417-421
The construction of a countywide community for medical and health services is designed to upgrade the service capacity of primary medical and health institutions, to promote resource sharing and collaborative services, and promote the hierarchical medical system. Huzhou of Zhejiang province has launched its initiative in building a countywide community for medical services since 2018. The authors summarized its main practices in promoting the integration of the management system and optimizing operating mechanism of countywide medical and health institutions, promoting the reform of the county medical and health governance system, as well as the achievements and shortcomings, with a view to providing reference for promoting the high-quality development of the countywide medical and health service system.
6. Diagnosis and individualized drug therapy for the rejection with hyperglycemia after liver Transplantation
Yining CHEN ; Yun XIAO ; Xiaoyu HAN ; Lulu HUANG ; Hanbin XIONG ; Yu FU ; Baolin WANG ; Jiangen AO ; Jiake HE ; Yining CHEN ; Yun XIAO ; Xiaoyu HAN ; Lulu HUANG ; Jiake HE ; Yining CHEN ; Yun XIAO ; Xiaoyu HAN ; Lulu HUANG ; Jiake HE ; Jingsheng MA ; Xiaohui GUO ; Lin ZHONG ; Jiake HE ; Jiake HE
Chinese Journal of Clinical Pharmacology and Therapeutics 2023;28(5):550-555
AIM: To establish individualized drug therapy strategy for patients with rejection and hyperglycemia after liver transplantation. METHODS: Clinical pharmacist collaborated with the surgeons and participated in the diagnosis and treatment of rejection and hyperglycemia after liver transplantation. Taking together liver function, therapeutic drug monitoring, drug-drug interactions between tacrolimus and wuzhi capsule, individualized drug therapy was adapted to improve the prognosis. RESULTS: The patient recovered well and survived in good health till now. CONCLUSION: It is highly suggested that clinical pharmacists actively involved in treatment of more severe and difficult-to-treat disease and design the individualized dosing regimens. This will largely contribute in reduced adverse drug reaction, improved safety and effectiveness in drug use as well as the quality of life in the "post-transplantation era".