Objective To summarize the clinical experiences of total cavopulmonary connection (TCPC), investigate the applications and short and mid term effects. Methods From 1999 to 2007,31 patients with complex congenital heart disease underwent TCPC. All patients were divided into child group(≤16 years old ,n =21 ) and a-dult group( n = 10 ), including 15 cases of functional univentricle, 8 cases of complete atrioventricular septal defect with double outlet of right ventricle, 3 cases of transposition with double outlet right ventricle, 3 cases of tricuspid atresia, 1 case of double outlet of right ventricle with hypoplastic left heart. 1 case of corrected transposition of the great arteries with TOF. Among them, 1 patient had cortriatriatum, 10 patients had left superior vena cave, moderate or severe mitral valve insufficiency occurred in 1, moderate atrioventricular valve insufficiency occurred in 3.28 pa-tients underwent TCPC with cardiopulmonary bypass ( CPB ) and 3 patients without CPB ;Of them, 21 patients were treated with extracardiac conduit and 10 cases with intratrial lateral tunnel. Results There was no early death,post-operative death or large quantities of pleural effusion in child group;but two deaths and three patients with large quantities of pleural effusion in adult group. One case caught up in inferior venous stasis and was cured. Follow- up was carded out from 6 months to 6 years. 26 patients were in NYHA class Ⅰ ,2 patients in NYHA class Ⅱ and only one patient in NYHA class Ⅲ. Conclusions TCPC is effectively used for complex congenital heart disease which can not be corrected in anatomy;serious postoperative complications often occur in adults. Atrioventricular valve in-sufficiency decisively affects the short and midterm effects, even the long-term effects.

Objective To study the brain protection of sequential double-sided antegrade cerebral perfusion to central nervous system in arotie arch surgery. Methods 24 patients received aortic arch replacement under deep hyperthermic circulatory arrest (DHCA) ,with fight-sided, and following double-sided, and left-sided,if necessary, antagrade cerebral perfnsion through right axillary arterial cannula or right femoral arterial eannula homeochronously. Post-operation recovery and the central nervous complications (CNC) were recorded and analyzed. Results 2 cases died, one of whom died of refractory low cardiac output syndrome and the other died of late massive gastrointestinal tract hemorrhage. No patient suffered severe CNC. Conclusion Sequential double-sided antegrade cerebral perfusion combined with DHCA can provide good brain protection in arotic arch replacement.

Objective To explore the impact of mindfulness on sleep and the mediating role of resilience.Methods A total of 540 medical staff in a three first-class hospital were assessed by five facet mindfulness questionnaire (FFMQ),Pittsburgh sleep quality index(PSQI) and Connor-Davidson resilience scale(CD-RISC).Results The average PSQI scores of medical staff was (6.67±3.20),of which the total score was equal or above 8 accounting for 37.04％.The positive rate of each factor of PSQI (factor score ≥2) was 51.67％ for daytime function,37.22％ for sleeping time,and 24.07％ for subjective sleep quality.The total score of PSQI was (6.67±3.20),the score of FFMQ was (119.55±9.90),and the score of CDRISC was (59.50± 12.77).PSQI was negatively correlated with FFMQ and CD-RISC (r=-0.29,-0.24;both P＜0.01),and there was a significant positive correlation between FFMQ and CD-RISC (r=0.48,P＜0.01).The factors of FFMQ associated with CD-RISC were followed by the description of mindfulness,the action of awareness,the non-reaction and the observation of mindfulness.The multi-linear regression analysis showed that resilience played a part mediating role between mindfulness and sleep quality,with a mediating effect of 20.9％.Conclusion Mindfulness has a positive impact on the quality of sleep of medical staff through resilience.

Objective To discuss nursing of cerebral complications for total aortic arch replacement at aortic dissection.Methods A total of 56 cases with total aortic arch replacement at aortic dissection were selected, and blood pressure was actively controlled before the operation, profound hypothermic circulatory arrest, antegrade cerebral perfusion and proper dose of cerebral protective agent were adopted during the operation.Hyoxemia was actively corrected after the operation with close observation of the disease to maintain homeostasis.Results Neurologic complications occurred in 15 patients after operation (26.8%), 2 patients died with multiple organ failure, 2 patients were discharged without cure, and 52 patients were cured and discharged.Conclusion Perfusion technology and cerebral protective measures adopted during the operation of total aortic arch replacement at aortic dissection and close observation of the disease from the nursing staff during perioperation can prevent occurrence of cerebral complications and promote patients''recovery.

Objective To discuss application of intra-aortic balloon pump(IABP) combined with coronary artery bypass grafts(CABG) on low cardiac output in patients with left trunk and coronary multivessel lesions and its nursing.Methods A total of 24 low cardiac output patients with left trunk and coronary multivessel lesions were given intra-aortic balloon pump,hemodynamic index was monitored,and their vital organs were supported and protected,disease observation and nursing of complications was enhanced during IABP.Results After intra-aortic balloon pump,24 patients had increased systolic pressure,average arterial pressure and urine volume,and decreased heart rate.And 14 CABG cases were smoothly performed under supporting of IABP.The remaining 10 patients had steadiness hemodynamic index after CABG,among whom 7 cases occurred complications,2 with renal insufficiency (8.3％),3 with puncture place bleeding (12.5％),and 2with lower limb ischemia.A total of 20 patients were recovered after surgery,and 4 patients gave up treatment for multiple organ failure.Conclusion CABG perioperative jointed with intra-aortic balloon pump may rectify the abnormal hemodynamics of patients with severe left trunk and coronary artery disease,improve cardiac function.Rigorous disease observation and efficient nursing intervention can decrease complications and promote the patients recovery.

Objective To discuss nursing of cerebral complications for total aortic arch replacement at aortic dissection.Methods A total of 56 cases with total aortic arch replacement at aortic dissection were selected, and blood pressure was actively controlled before the operation, profound hypothermic circulatory arrest, antegrade cerebral perfusion and proper dose of cerebral protective agent were adopted during the operation.Hyoxemia was actively corrected after the operation with close observation of the disease to maintain homeostasis.Results Neurologic complications occurred in 15 patients after operation (26.8%), 2 patients died with multiple organ failure, 2 patients were discharged without cure, and 52 patients were cured and discharged.Conclusion Perfusion technology and cerebral protective measures adopted during the operation of total aortic arch replacement at aortic dissection and close observation of the disease from the nursing staff during perioperation can prevent occurrence of cerebral complications and promote patients''recovery.

Objective To discuss application of intra-aortic balloon pump(IABP) combined with coronary artery bypass grafts(CABG) on low cardiac output in patients with left trunk and coronary multivessel lesions and its nursing.Methods A total of 24 low cardiac output patients with left trunk and coronary multivessel lesions were given intra-aortic balloon pump,hemodynamic index was monitored,and their vital organs were supported and protected,disease observation and nursing of complications was enhanced during IABP.Results After intra-aortic balloon pump,24 patients had increased systolic pressure,average arterial pressure and urine volume,and decreased heart rate.And 14 CABG cases were smoothly performed under supporting of IABP.The remaining 10 patients had steadiness hemodynamic index after CABG,among whom 7 cases occurred complications,2 with renal insufficiency (8.3％),3 with puncture place bleeding (12.5％),and 2with lower limb ischemia.A total of 20 patients were recovered after surgery,and 4 patients gave up treatment for multiple organ failure.Conclusion CABG perioperative jointed with intra-aortic balloon pump may rectify the abnormal hemodynamics of patients with severe left trunk and coronary artery disease,improve cardiac function.Rigorous disease observation and efficient nursing intervention can decrease complications and promote the patients recovery.

This paper presents a method for estimating three-dimensional (3D) motion of coronary arteries from single-plane X-ray angiogram sequences on two views. Firstly, original images are preprocessed and two-dimensional (2D) vessel skeletons are extracted. 2D motion estimation is performed along the skeletons in two images. Then geometrical transformation matrix between views is obtained based on perspective projection model for X-ray angiography system, and 3D coordinate of spatial points are calculated. The 3D motion estimation and reconstruction algorithm is applied along the two image sequences to accomplish 3D reconstruction of vessel skeletons and motion vectors between consecutive time instants. Its effectiveness has been demonstrated on clinical single-plane coronary artery angiograms and potential errors are discussed.
Algorithms ; Coronary Angiography ; methods ; Coronary Disease ; diagnostic imaging ; Electrocardiography ; Humans ; Imaging, Three-Dimensional ; methods ; Movement ; Radiographic Image Interpretation, Computer-Assisted

Objective To investigate value of peripheral NLR and PLR for the survival of patients with neuroblastoma.Methods The clinical data of 41 neuroblastoma patients were analyzed by the Kaplan-Meier,Log-rank test,and multivariate COX regression.Results NLR,PLR levels of neuroblastoma patients were significantly higher than that in the healthy control group (1.81 ±0.29 vs.1.07 ±0.29,P ＜ 0.01) (169 ± 23 vs.76 ± 3,P ＜ 0.01);The elder the age,the higher the clinical stages,the higher the serum levels of NSE,and urine VMA were,the higher was the NLR (x2 =3.93,6.286,7.676,6.689,all P＜0.05) and PLR (x2 =4.111,5.707,8.019,8.922,all P ＜0.05).The higher the serum level of LDH,the higher was the NLR (x2 =7.769,P =0.02).3-year overall survival in low NLR group was 84％ and that in high NLR group was 73％ (x2 =4.002,P =0.045);3-year progression-free survival in low NLR group was 74％ and that in high NLR group was 50％ (x2 =4.082,P =0.043);3-year progression-free survival of low PLR group was 85％ and high PLR group was 38％ (x2 =9.388,P =0.002).The clinical stages,MYCN genetic expression,NLR levels were independent factors for the overall survial in patients with neuroblastoma (P ＜ 0.05).Conclusion Pretreatment NLR level can effectively predict the prognosis of neuroblastoma.

Objective To prepare a dissolvable microneedle(DMN)with a tip-layer loaded with hyaluronic acid(HA)modified sinomenine hydrochloride liposomes(HA-SMH-Lip),as well as characterize,evaluate its in vitro transdermal permeability,cellular uptake ability,and anti-inflammatory ability.Methods HA-SMH-Lip-DMNs were prepared by a two-step casting method,and the drug loading capacity was determined using HPLC.The morphology,skin permeation properties and in vitro transdermal ability were investigated by scanning electron microscopy,puncture assay and Franz diffusion cell method.Fluorescent microneedles were prepared by replacing HA-SMH-Lip with fluorescein isothiocyanate liposomes(HA-FITC-Lip/FITC-Lip).The uptake behavior of inflammation cells on HA-FITC-Lip-DMNs/FITC-Lip-DMNs was investigated using a flow cytometer and a fluorescence microscope.To evaluate the anti-inflammatory activity of HA-SMH-Lip-DMNs,the levels of inflammatory factors including nitric oxide(NO),tumor necrosis factor α(TNF-α),interleukin 1β(IL-1β),and IL-10 in cell supernatants were measured using an ELISA kit.Results The prepared HA-SMH-Lip-DMNs have uniform shape and size,integral and visually pleasing array,and an average drug loading of(114.01±1.04)μg.Additionally,they have good puncture ability.The results of in vitro transdermal experiments showed that the accumulated amounts of HA-SMH-Lip-DMNs were(101.47±2.91)μg·cm-2 at 36 hours.Its transdermal ability was better than that of the SMH solution group and SMH liposome group.In vitro cellular uptake results indicated that HA-FITC-Lip-DMNs were more effectively taken up by RAW 264.7 cells(P＜0.01).Compared to the model group,HA-SMH-Lip-DMNs group significantly reduced TNF-α,IL-1β,and NO levels while increase IL-10 levels(P＜0.01).Conclusion The prepared HA-SMH-Lip-DMNs have a complete and beautiful morphology with excellent cellular uptake capability,remarkable in vitro transdermal performance,and potent anti-inflammatory properties.HA-SMH-Lip-DMNs are expected to become a new type of transdermal drug delivery system.