Objective Approach to safe and effective lung protection strategies on ventricular septal defect infants during perioperation.Methods There were 4 groups as blank control group,ambroxol group,methylprednisolone group and ulinastatin group.We tried to find a safe and effective stratege on lung protection by comparing each other on the respiratory function indexes and inflammation biomarkers.Results Postoperation of VSD repair,respiratory function indexes such as Ppeak,oxygenation index inspiratory resistance and mechanical ventilation time were significantly different (P ＜ 0.05) among the 4 groups.The inflammation biomarkers such as WBC,CRP and PCT had no differences the first day(P ＞0.05),and were statistically significant the third day (P ＜ 0.05).Conclusions Ambroxol,methylprednisolone and ulinastatin all are effective drugs for lung protection.Considering about the clinical curative effect and side effects,ambroxol is more safe and effective relatively.

Objective To establish a standardized scoring system after tetralogy of Fallot (TOF) correction and explore its clinical application values.Methods During the period of Jan.2006 and Apr.2014 at the Third Affiliated Hospital,Zhengzhou University and Henan Provincial People's Hospital,a total of 624 infants undergoing stage Ⅰ anatomic correction were selected and their common clinical parameters such as liver size,systolic blood pressure,urinary volume,oxygenation index and occurrences of complications were recorded and scored.The cases were divided into low-risk,medium-risk and high-risk groups according to scores.The relevant endpoint parameters,including mortality or survival,on-pump time,intensive care unit(ICU) duration,hospitalization and medical expenses were recorded to analyze their relationship with postoperative scores.Results The data indicated that the short-term mortality after repair of tetralogy of Fallot was 5 ％.Moreover,there was no statistical difference (P =0.309) in the mortality between the lowrisk group (total score ＜ 3 and mortality of 0) and medium-risk group,and the mortality of the medium-risk group was statistically different(P ＜ 0.001) from that of the high-risk group (total score ＞ 7 and mortality of ＞ 80％).The postoperative standby time,ICU stay,total hospital stays and cost increased with the rise of the score(P ＜ 0.001),and there were no statistical differences in hospital stays(P =0.469) and cost(P =0.365) between the medium-risk group and the high-risk group.Conclusions Based upon common clinical parameters,a standardized scoring system has been successfully established for patients after TOF correction,which plays an important role in gauging the disease progression and predicating the immediate postoperative outcomes of TOF.

Objective: To summarize the clinical experience and short-term outcome of minimally invasive occlusion in patients with peri-membranous ventricular septal defect (PmVSD) via right subaxillary route under trans-esophageal echocardiography (TEE) guidance.
Methods: A total of 122 PmVSD patients treated in our hospital from 2014-01 to 2015-07 were summarized. There were 54 male and 68 female with the mean age of (2.7±2.2, 0.5-9.7) years, mean body weight of (13.9±6.0, 6.1-38.0) kg and mean PmVSD diameter of (3.8±0.8, 2.5-7.0) mm. The patients were taken left lateral position, a (2-3) cm incision was performed along right mid-axillary line between the 3rd rib and 4th rib, the thoracic entrance was at 4th inter-costal space. A purse-string suture was conducted on right atrial surface, a special hollow probe was inserted into right atrium and crossed tricuspid into right ventricle under TEE guidance; the probe was adjusted to the point or crossed VSD into left ventricle followed by guide wire insertion to establish a deliver pathway, and ifnally, occlusion device was regularly deployed to close the defect. Post-operative ECG, TEE and chest X-ray were conducted for followed-up study.
Results: There were 119/122 (98.4%) patients occluded successfully and 3 failed patients were converted to cardiopulmonary bypass surgery at the original incision. The average size of occluder was (4.9±1.1, 4-10) mm and all devices were concentric. The patients were followed up at the mean of (8.3±5.0, 1.0-19.8) months, during that period, 12/119 (10.1%) had new mild tricuspid regurgitation, 16 (13.4%) suffered from incomplete right bundle branch block, 4 (3.4%) had small residual shunt and 2 of them were self-closed at 1 and 3 months after operation respectively. There were no complete atrio-ventricular block, no new aortic valve regurgitation and no device dislocation.
Conclusion: Minimally invasive occlusion of PmVSD via right subaxillary route under TEE guidance was a safe, effective, feasible and better cosmetic method for treating relevant patients; while its long-term outcome should be further observed.

OBJECTIVETo explore a combined application of tissue expansion, perforator flaps and super-thin flaps in reconstruction of extensive face and neck scars.

METHODSIn the first stage, the position and course of the perforators were confirmed with the multi-detector computed tomography ( MDCT) and color Doppler ultrasound. The expanders were implanted between subdermal vascular plexus and superficial fascia. In the second stage, the expanded super-thin perforator flaps were transferred to resurface the extensive defects and deformities in the face and neck.

RESULTS26 cases with extensive facial and cervical scars were included in this study. Except for one case with necrosis at the distal end, the other 25 flaps survived completely. The maximum flap size was 35 cm x 10 cm with a pedicle of 8 cm x 4 cm. Long-term follow-up showed that this combined application provided thinner flap than the conventional pre-expanded flap, thus avoiding secondary flap debulking and revisions. All the patients got improvement in contours, facial features and emotional expression.

CONCLUSIONSThe combined application of tissue expansion, perforator flaps and super-thin flaps is a practical method which has advantages in feature recontouring and recovery of delicate emotions in reconstruction of extensive face and neck scars.

Cicatrix ; surgery ; Face ; surgery ; Humans ; Multidetector Computed Tomography ; Neck ; surgery ; Perforator Flap ; transplantation ; Reconstructive Surgical Procedures ; Tissue Expansion ; methods

Objective:To compare the effects of patellar position on the balance of soft tissue during the operation and the postoperative outcomes in minimally invasive total knee arthroplasty via a midvastus approach.Methods:From December 2018 to February 2019, a total of 55 patients were enrolled for primary total knee arthroplasty via a midvastus approach. All patients were randomly divided into 2 groups by random number table. During the operation, the gap balance technique was used with patella reduced or subluxated to complete the osteotomy and balance of soft tissue. The changes of gap and varus-valgus angle were compared between the patellar reduction group and the patellar subluxation group in both extension and flexion position. These data were also compared before and after reducing patellar in the patellar subluxation group. Furthermore, the differences of femoral prosthesis rotation, mechanical femoral axis to tibial axis angle, Knee Society score (KSS), visual analogue scale (VAS) and range of motion (ROM) were compared between the two groups.Results:All patients finished 6 months follow-up, including 27 patients in the patellar reduction group and 28 patients in the patellar subluxation group. After osteotomy and soft tissue balance during the operation, there was no significant difference in gap and varus-valgus angle between two groups in either extension or flexion position. While in the patellar subluxation group, the flexion gap was 10.5±0.3 mm with patella subluxated, less than 11.0 ± 0.3 mm after reducing the patella. The varus-valgus angle was 1.5±0.3 with patella subluxated, less than 2.3±0.4 degree after reducing the patella. The difference was statistically significant ( t=4.180, P<0.001; t=7.642, P<0.001). There was no significant difference in extension gap and varus-valgus angle before and after patella reduction in the patellar subluxation group ( P>0.05). The rotation angle of the femoral component in the patellar subluxation group was -0.49°±1.2°, and the external rotation angle was smaller than that in the patellar reduction group (0.24°±1.3°). The difference was statistically significant ( t=2.116, P=0.039). At one month after operation, ROM of the patellar reduction group was 109.6°±8.5° which was higher than that of the patellar subluxation group (104.9°±8.6°, t=2.048, P=0.046). There was no significant difference in ROM between the two groups at 3 and 6 months ( P>0.05). Moreover, there was no significant difference in KSS and VAS at 1, 3 and 6 months after operation ( P>0.05). Conclusion:In the minimally invasive total knee arthroplasty, it is suggested to balance the soft tissue as much as possible with the patellar reduced. Otherwise, the consequence of increased flexion space, increased varus and increased internal rotation of femoral prosthesis should be considered. The patients undergoing soft tissue balance with patella reduced have better ROM in the early stage postoperatively.

Objective To study the distribution of diseases in Medical Information Mart for Intensive Care Ⅲ(MIMIC-Ⅲ) database in order to provide reference for clinicians and engineers who use MIMIC-Ⅲ database to solve clinical research problems. Methods The exploratory data analysis technologies were used to explore the distribution characteristics of diseases and emergencies of patients (excluding newborns) in MIMIC-Ⅲ database were explored; then, neonatal gestational age, weight, length of hospital stay in intensive care unit (ICU) were analyzed with the same method. Results In the MIMIC-Ⅲ database, 46 428 patients were admitted for the first time, and 49 214 ICU records were recorded. There were 26 076 males and 20 352 females; the median age was 60.5 (38.6, 75.6) years, and most patients were between 60 and 80 years old. The first diagnosis in the disease spectrum analysis was firstly ranked by circulatory diseases (32%), followed by injury and poisoning (14%), digestive system disease (8%), tumor (7%), respiratory disease (6%) and so on. Patients with ischemic heart disease accounted for the largest proportion of circulatory disease (42%), the proportion of these patients gradually increased with age of 60-70 years old, then decreased. However, the proportion of patients with cerebrovascular disease declined first and then increased with age, which was the main cause of death of circulatory system disease (ICU mortality was 22.5%). Injury and poisoning patients showed a significant decrease with age. Digestive system diseases were younger than the general population (most people aged between 50 to 60 years), and non-infectious enteritis and colitis were the main causes of death (ICU mortality was 18.3%). Respiratory infections were predominant in infected patients (34%), but circulatory system infections were the main cause of death (ICU mortality was 25.6%). Secondly, in the neonatal care unit, premature infants accounted for the vast majority (82%). As the gestational age increased, the duration of ICU was decreased, and the mortality was decreased. Conclusions The diseases distribution of patients can be provided by MIMIC-Ⅲ database, which helps to grasp the overview of the volume and age distribution of the target patients in advance, and carry out the next step of research. Meanwhile, it points out the important role of exploratory data analysis in electronic health records analysis.

Objective: To compare the difference in imaging and clinical effects between gap balance technique and measured resection technique in total knee arthroplasty (TKA). Methods: We recruited 300 patients undertaking TKA from July 2014 to July 2016. TKA were performed by using gap balance technique or measured resection technique randomly. The intraoperative rotation of femoral prosthesis, changes of joint line, osteotomy volume, preoperative and postoperative KSS score, WOMAC score, VAS and ROM were compared between the two groups. Results: A total of 292 patients were included in the present study, and 248 patients were successfully followed up for 2 years. The operation duration of the gap balance group was 65.9±14.1 min, which was significantly less than that of the measured osteotomy group 70.5±16.5 min (t=2.36, P=0.02). The rotation angle α of the femoral prosthesis measured on CT scan postoperative in gap balance group was 0.67°±1.71°, which was significantly smaller than that of the measured resection technique group 1.25°±2.53° (t=2.12, P=0.03). The external rotation angle β between the osteotomy plate and femoral posterior condyle line in the gap balance group was 1.25°±1.26°, which was significantly greater than that of the measured resection technique 0.28°±0.19° (t=6.57, P<0.01). The bone cut volume of femoral medial posterior condyle in gap balance group 9.85±1.37 mm showed a statistically difference (t=2.02, P=0.04) compared with that of the measured osteotomy group 9.52±1.19 mm. The KSS score was 83.8±10.2 in the gap balance group after 1 month. It was superior to the measured resection technique group of 80.5±9.4 with statistical significance (t=2.65, P=0.01). The knee ROM was 101.7°±12.7° in the gap balance group at 1 month after surgery, which was better than that in the measured resection technique group 98.2°±11.8° (t=2.25, P=0.03). Conclusion The axis of the femoral prosthesis was more consistent with STEA in the gap balance group of TKA. The gap balance group had better ROM and KSS functional scores at the first month after surgery. However, there was no statistical difference in knee function at the 2-year follow-up between the two groups.

BACKGROUND: Cholecystectomy is a standard surgery for patients suffering from gallbladder diseases, while the causal effects of cholecystectomy on colorectal cancer (CRC) and other complications are still unknown. METHODS: We obtained genetic variants associated with cholecystectomy at a genome-wide significant level ( P value <5 × 10 -8 ) as instrumental variables (IVs) and performed Mendelian randomization (MR) to identify the complications of cholecystectomy. Furthermore, the cholelithiasis was also treated as the exposure to compare its causal effects to those of cholecystectomy, and multivariable MR analysis was carried out to judge whether the effect of cholecystectomy was independent of cholelithiasis. The study was reported based on Strengthening the Reporting of Observational Studies in Epidemiology Using Mendelian Randomization guidelines. RESULTS: The selected IVs explained 1.76% variance of cholecystectomy. Our MR analysis suggested that cholecystectomy cannot elevate the risk of CRC (odds ratio [OR] =1.543, 95% confidence interval [CI]: 0.607-3.924). Also, it was not significant in either colon or rectum cancer. Intriguingly, cholecystectomy might decrease the risk of Crohn's disease (OR = 0.078, 95% CI: 0.016-0.368) and coronary heart disease (OR = 0.352, 95% CI: 0.164-0.756). However, it might increase the risk of irritable bowel syndrome (IBS) (OR = 7.573, 95% CI: 1.096-52.318). Cholelithiasis could increase the risk of CRC in the largest population (OR = 1.041, 95% CI: 1.010-1.073). The multivariable MR analysis suggested that genetic liability to cholelithiasis could increase the risk of CRC in the largest population (OR = 1.061, 95% CI: 1.002-1.125) after adjustment of cholecystectomy. CONCLUSIONS The study indicated that cholecystectomy might not increase the risk of CRC, but such a conclusion needs further proving by clinical equivalence. Additionally, it might increase the risk of IBS, which should be paid attention to in clinical practice.
Humans ; Mendelian Randomization Analysis ; Irritable Bowel Syndrome ; Colorectal Neoplasms/genetics* ; Cholelithiasis/complications* ; Cholecystectomy/adverse effects* ; Genome-Wide Association Study ; Polymorphism, Single Nucleotide

Objective:To explore the risk factors of puncture- or catheter-related lower extremity venous thrombosis after surgery for congenital heart disease(CHD).Methods:A retrospective analysis was performed on 683 children with venipuncture or venous catheterization in the lower extremities who underwent surgery for CHD in Children′s Heart Center Intensive Care Unit, Henan Provincial People′s Hospital from January 2017 to December 2018, and there were 55 children suspected thrombosis, among whom, 26 cases of thrombosis confirmed by ultrasound were included in the thrombosis group, and 29 cases without thrombosis seen by ultrasound were assigned to the control group.A comparative analysis was carried out to see whether there were statistical differences in the possible risk factors between the 2 groups, and the risk factors of puncture- or catheter-related lower extremity venous thrombosis after operation of CHD.Results:The incidence of puncture- or catheter-related lower extremity venous thrombosis after surgery for CHD was 3.81% (26/683 cases). The differences between the thrombosis group and the control group in age (62 d vs.92 d), weight [(3.92±0.66) kg vs.(4.61±0.86) kg], CHD postoperative critical score (Vasoactive-Ventilation-Renal score, VVR)[(29.58±15.50) scores vs.(22.14±11.72) scores], peak blood lactate within 24 hours after surgery [(3.59±0.66) mmol/L vs.(1.71±1.13) mmol/L], postoperative blood transfusion[76.9%(20/26 cases) vs.34.5%(10/29 cases)], co-infection[53.8%(14/26 cases) vs.24.1%(7/29 cases)], cyanotic congenital heart disease [84.6%(22/26 cases) vs.34.5%(10/29 cases)] and puncture difficulty[69.2%(18/26 cases) vs.17.2%(5/29 cases)] were statistically significant(all P<0.05). Logistic regression analysis showed postoperative VVR score ( OR=0.88, 95% CI: 0.77-0.99, P=0.04), blood lactate peak within 24 hours after surgery ( OR=6.62, 95% CI: 1.35-32.46, P=0.02), and cyanotic congenital heart disease ( OR=0.04, 95% CI: 0.00-0.63, P=0.04) were risk factors for venous thrombosis in the lower extremities. Conclusions:High postoperative VVR score, high 24 h blood lactate peak after surgery and cyanotic congenital heart disease are high risk factors for puncture- or catheter-related lower extremity venous thrombosis after surgery for CHD.

Objective Objective To evaluate the biomechanical effects of using a new injectable calcium phosphate cement to consolidate the fixation of osteoporotic intertrochanteric fracture. Method Five matched pairs of human cadaver femora were used to produce the model of intertrochanteric fracture. All fractures were fixed with dynamic hip screws(DHS),and divided into two groups. In the CPC consolidation group of each pair, CPC was used to grout the hip screw and to fill the posteromedial defect. All femora were subjected to biomechanical test. Result Under the loading of 500 N, in the CPC consolidation group, the mean axial stiffness was (691.93±18.90) N/mm and the horizontal shear stiffness was (5553.84±27.47) N/mm. The mean lateral and medial strength was 5.15±0.35 MPa and (4.13±0.24) MPa. The torsion stiffness was 0.41 and the ultimate loading was (3580±286)N. In the control group, the mean axial stiffness was (453.45±19.75) N/mm, the horizontal shear stiffness was (3848.87±22.63) N/mm, the mean lateral and medial strength was (3.12±0.37) MPa and (1.80±0.21) MPa, and, the torsion stiffness was 0.35 and the ultimate loading was (2512±189)N. Consolidation fixation with CPC increased each of the biomechanical efficiency（P<0.05）. Conclusion CPC consolidation of osteoprotic femoral head and the medial defect of intertrochanteric fracture could significantly improve the overall stability and decrease the rate of postoperative complication.