Objective: To explore the basic condition of subjective self consistency and congruence and general well-being of soldiers. Methods: 225 soldiers in Chong-qing were required to complete the SCCS and GWB. Results: ①There are notable difference in SCC among educational levels. ②There are notable difference in GWB among army years. ③All factors of SCC positively correlated with GWB; Some factors of SCC had significant direct effects on GWB. Conclusion: The level of soldiers'SCCS and GWB is in order, the army should strengthen mental health education.

Objective In order to reveal the effect of extracorporeal shock wave therapy (ESWT) with ultrasonic orientation for soft tissue disorders of the shoulder. Methods 151 cases of severe disorders of the shoulder were treated with ESWT. The course of disorders was longer than 3 months. Among them, 65 cases were of subacromial bursitis (SB) and 86 of tenosynovitis of long-tendon of biceps muscle (ILBM). The treatment point of ESWT was oriented with color Doppler ultrasonography, while the pain-point was determined with tenderness combining with local anatomic markers. The energy density of ESWT was 0.12-0.16 mJ/mm2, and 1-2 shock-points were selected for each treatment, the number of shock waves were 800-1000 times, each course consisted of 2-5 times, with an interval of 5 days. 25 of 65 cases of SB were refered for ESWT by ultrasonic orientation, other 40 by pain-point orientation; 31 of 86 cases of ILBM were refered for ESWT of ultrasonic orientation, other 55 by pain-point orientation. The satisfactory rate of SB and ILBM with ESWT were compared between 2 different orientation cases. Results Through 6 months follow up, the satisfactory rates of SB and ILBM with ESWT were 89.6% and 92.3% respectively in cases of ultrasonic orientation, while in cases of pain-point orientation, the satisfactory rates of SB and ILBM with ESWT were 67.6% and 73.6% respectively, the difference of satisfactory rates was significant between 2 groups. Conclusion The effect of the ESWT with ultrasonic orientation is better than the ESWT with pain-point orientation both for SB and ILBM. The ultrasonic orientation plays an important role in promoting the satisfactory rates of ESWT.

Objective To evaluate the efficacy and safety of intra-arterial thrombolysis with recombinant tissue-plasminogen ac-tivator(rt-RA) for treatment of acute cerebral infarction (ACI) .Methods The randomized controlled trials (RCT ) of intra-arterial thrombolysis with rt-PA for treatment of ACI were selected from Cochrane Library ,Medline ,Embase and CBM by the computer re-trieval .A meta analysis of the data were analyzed by using RevMan 5 .1 software .Results A total of 473 patients in 9 selected RCTs were involved in the systematic review .Meta-analysis results disclosed suggested that the effectiveness of intra-arterial thrombolysis treated ACI group was better than that of intravenous thrombolysis group [RR= 1 .26 ,95% CI(1 .09 ,1 .45) ,P=0 .002] .No difference was observed between the two groups in intracranial hemorrhage and mortality rate .Conclusion The current evidence showed that ,the clinical effect of intra-arterial thrombolysis with rt-PA for treatment of ACI was obviously superior to that of intravenous thrombolysis ,but the result still needs to be confirmed by large-sample RCTs .

Objective To investigate the values of urine neutrophil gelatinase associated lipocalin (NGAL), kidney injury molecular-1 (KIM-1) and interleukin-18 (IL-18) in the diagnosis of acute kidney injury (AKI) in children after cardiopulmonary by-pass (CPB). Methods Sixty-seven patients who had undergone CPB were recruited from March to June 2013 and assigned to acute kidney injury group (AKI group) or non-acute kidney injury group (non-AKI group) according to the pediatric RIFLE (pRIFLE) cri-teria. Serum and urine samples were collected from each patient at 30 min, 2 h, 4 h, 24 h, 48 h and 72 h after CPB for serum and urine creatinine, urine NGAL, KIM-1 and IL-18. All the data were evaluated by receiver operator characteristic curve (ROC) analysis and area under curve (AUC) analysis. Results Twenty-three cases (34.3%) had AKI in 67 children after CPB. Among them 15 cases were risk-stage AKI, 4 cases injury-stage AKI, 3 cases failure-stage AKI and 1 cases loss-stage AKI. The levels of urine NGAL/Ucr were higher in AKI group than those in non-AKI group at 4h, 48h and 72h after CPB (P<0.05). The cut-off value of NGAL/Ucr was 1.200 at 4 h after CPB, the sensitivity and specificity for prediction of AKI were 0.864 and 0.561, and the AUC was 0.671 (95%CI:0.537-0.804). The levels of urine KIM-1/Ucr were higher in AKI group than those in non-AKI group at 48h and 72 h after CPB (P<0.05). The cut-off value of KIM-1/Ucr was 1.162 at 24h after CPB, the sensitivity and specificity for prediction of AKI were 0.773 and 0.512, and the AUC was 0.698 (95%CI:0.563-0.834). The levels of IL-18/Ucr were higher in AKI group than those in non-AKI group at 4 h after CPB (P<0.05). The cut-off value of IL-18/Ucr was 0.04 at 4 h after CPB, the sensitivity and specificity for predici-ton of AKI were 0.773 and 0.561, and the AUC was 0.655 (95%CI:0.510-0.800). Conclusions It is indicated that urine NGAL, KIM-1 and IL-18 may have important clinical values for early prediction of AKI.

The pulmonary artery sling (PAS)is a rare congenital cardiovascular disease and usually associated with airway stenosis and cardiovascular anomalies. Abnormal left pulmonary artery oppress trachea and esophagus can cause respiratory tract obstruction or esophageal compression symptoms,such as recurrent wheezing,cough,lung infec-tions,difficulty of breathing or swallowing. Once diagnosed,the patients has surgical indications,but due to the lack of specific clinical manifestations,missed diagnosis or misdiagnosis for other respiratory diseases may occur. The surgical method of PAS is mainly the left pulmonary transplantation,whether perform tracheoplasty remains controversial.

Objective To investigate the complications and management of nitinol self-expandable metal stent (cSEMS) in treatment of refractory esophageal strictures in children. Methods The clinical data were reviewed for 9 pediatric patients with refractory benign esophageal disorders from May 2009 to December 2016, specially designed cSEMS were applied to them, data about effects and complications were collected during regular follow-ups. Results Successful cSEMS placement was performed in 9 children, the symptom of dysphagia was obviously alleviated after implantation, all patients underwent vomiting and chest pain 1~7 days after operation; 1 case could not put up with the pain, so the stent had to be removed in 36 hours after implantation; 2 cases developed a recurrent stricture within 3 months after stent removal, growth of mild granulation tissue was found in 1 case; In the case with esophageal fistulas, migration and poor adherence to the esophagus was occurred in 3 days after implantation, then a new designed cSEMS with bigger proximal tip was planted in the same place 1 week later, 2 months after stent removed, fistula was healed. Conclusion Placement of cSEMS is safe and effective in treating pediatric patients with refractory esophageal stricture. However, complications associated with stent placement should not be ignored, individually designed stent and timely management of the complications are quite important in order to enhance clinical efficacy.

Objective To investigate the clinical features and prognostic factors of children with gigantic thoracic tumors.Methods Clinical data were collected from the database of Cardiothoracic Surgery,Shanghai Children's Hospital between January 2009 and June 2015.The analyses were mainly focused on the clinical data of 76 cases of thoracic giant tumor that underwent surgical treatment,Univariate survival analysis was performed with Kaplan Meier method.Results Pathological results showed that 35 cases were benign tumors and 41 cases were malignant tumors.For benign tumors,the main pathological classification were ganglioneuroma in 12 cases,vascular tumors in 9 cases,germ cell tumors in 8 cases.For malignant tumors,the main pathological classification were neuroblastoma in 13 cases,ganglioneuroblastoma in 7 cases and lymphoma in 7 cases,etc.After surgical resection 31 cases of benign tumors were long-term survival.The 5 year survival rates of 70 patients with gigantic thoracic tumors was more than 75％,39 patients with malignant tumors were more than 50％.Single factor in Kaplan Meier analysis showed that gender,location of primary tumor were not associated with neurogenic tumor prognosis(P ＞ 0.05).The age of patients,tumor stage,tumor pathological type,whether chemotherapy are associated with prognosis of neurogenic tumors the difference has statistical significance (P ＜ 0.05).Conclusion Surgical resection is a prognostic factor for patients with benign thoracic giant tumor.The recurrence and metastasis rates of malignant tumor is high.Its prognosis is poor.The survival time of patients with postoperative chemotherapy or radiotherapy can be prolonged.The most common children gigantic thoracic tumors are neurogenic tumors,There is no correlation between the prognosis of neurogenic tumors and sex or primary site.While age,tumor stage,pathology and whether with chemotherapy are associated with neurogenic tumor prognosis.

OBJECTIVETo investigate the new biomarkers of acute kidney injury, as well as to confirm the values of response gene to complement 32 (RGC-32) for early diagnosis of acute kidney injury by comparing the values of serum creatinine (Scr) and cystatin C (CysC) in children who had undergone cardiopulmonary bypass (CPB).

METHODSixty-seven patients who had accepted CPB were recruited from the cardiac surgery intensive care unit, Children's Hospital Affiliated to Shanghai Jiao Tong University from March to June 2013 and assigned to acute kidney injury group (group AKI) or non-acute kidney injury group (group non-AKI), on the basis of the definition by the pediatric RIFLE (pRIFLE) criteria. Also 30 healthy control children were recruited. Serum samples were taken regularly from each patient after CPB at 30 min, 2 h, 4 h, 24 h, 48 h and 72 h for RGC-32. Serum samples were tested by enzyme linked immunosorbent assay (ELISA) which was employed to determine the levels of serum RGC-32. Scr and CysC were analyzed by HITACHI 7180 automatic biochemical analyzer. All the data were analyzed by receiver operator characteristic curve (ROC) and area under curve (AUC).

RESULTThe incidence of AKI was 34% (23/67), including 15 cases with risk stage AKI, 4 cases with injury stage AKI, 3 cases with failure stage AKI, 1 cases with loss stage AKI. Three out of four subjects with Failure stage AKI and the one case with Loss stage all accepted renal replacement therapy. CPB group had a higher level of serum RGC-32 than that of pre-operation after CPB 30 minute [(2.88 ± 0.68) µg/L vs. (1.39 ± 0.31) µg/L, P < 0.05]. At the same time, comparing with the non-AKI group, the levels of serum RGC-32 were higher than that of controls 30 min, 2 h, 4 h, 24 h and 48 h after CPB (t = 2.560, 2.180, 2.818, 2.226, 3.017; P < 0.05). The values for the AUC were determined for RGC-32 as 0.770, 0.707, 0.768, 0.728,0.723 and 0.770 after CPB 30 min, 2 h, 4 h, 24 h, 48 h and 72 h. The values for sensitivity of serum RGC-32 30 min, 2 h and 4 h after CPB was 0.914, 0.824, 0.824 and the values for specificity of serum RGC-32 was 0.619, 0.667, 0.810, respectively. But the values for sensitivity of CysC was 0.625, 0.813, 0.813, and specificity 0.571, 0.619, 0.571, respectively. The values for sensitivity of Scr was 0.625, 0.625, 0.813 and specificity was 0.571, 0.571, 0.524, respectively.

CONCLUSIONThe sensitivity of serum RGC-32 for detecting AKI was much higher than that of Scr and serum CysC in children who had accepted CPB, and that RGC-32 may be a new biomarker for early detection of AKI. However, the conclusion needs to be further elucidated.

Acute Kidney Injury ; blood ; diagnosis ; etiology ; Area Under Curve ; Biomarkers ; blood ; Cardiopulmonary Bypass ; adverse effects ; Case-Control Studies ; Cell Cycle Proteins ; blood ; Creatinine ; blood ; Cystatin C ; blood ; Female ; Heart Defects, Congenital ; surgery ; Humans ; Infant ; Intensive Care Units, Pediatric ; Male ; Muscle Proteins ; blood ; Nerve Tissue Proteins ; blood ; Postoperative Complications ; Predictive Value of Tests ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity

Objective:To analyze and clarify the causes, types, risk factors and treatment principles of early postoperative tachycardia in children with congenital heart disease.Methods:A retrospective analysis of the clinical data of 2 126 children with primary radical congenital heart surgical procedure in Shanghai Children′s Hospital from January 2014 to December 2020, including 1 322 cases of ventricular septal defect or ventricular septal defect combined with atrial septal defect, 421 cases of atrial septal defect, 194 cases of tetralogy of Fallot, D-transposition of the great artery or double outlets of right ventricle combined with pulmonary stenosis, and 189 cases of other complex congenital heart disease. The surgical method is a median sternal skin incision or a small right axillary skin incision, and cardiopulmonary bypass is established routinely. The age, body mass, disease type, cardiopulmonary bypass and aortic occlusion time, vasoactive drug use, ECG monitoring and other indexes were observed and monitored.Results:There are 425 cases of early postoperative tachycardia in 2 126 children with congenital heart disease, with an incidence of 20.0%. The incidences of sinus tachycardia, borderline ectopic tachycardia, atrial tachycardia and ventricular tachycardia were 14.8%(314/2 126), 4.5%(96/2 126), 0.8%(17/2 126) and 0.5%(10/2 126), respectively. Logistic regression analysis revealed that the low age ( OR=1.98, 95% CI: 1.25-2.65, P<0.01), low weight ( OR=2.35, 95% CI:1.86-2.75, P<0.01), large ventricular septal defect ( OR=1.56, 95% CI:1.09-2.06, P=0.02), complex congenital heart disease ( OR=2.03, 95% CI: 1.57-2.52, P<0.01), long duration of cardiopulmonary bypass ( OR=1.77, 95% CI: 1.23-2.28, P<0.01), long aortic cross-clamp time ( OR=1.89, 95% CI:1.20-2.55, P<0.01), acidosis ( OR=1.63, 95% CI:1.11-2.14, P<0.01), and the combination usage of vasoactive drugs ( OR=1.86, 95% CI:1.23-2.48, P<0.01) were significantly associated with the occurrence of early postoperative tachycardias. Conclusion:This study has important clinical guiding value for predicting early postoperative tachycardia in children with congenital heart disease, clarifying its causes and types, and timely handling, so as to improve the postoperative survival rate of children.