Objective To identify the suitable echocardiographic predictor,the standard 2-demensional echocardiography and speckle tracking imaging (STI) techniques were applied for the late referred children with transposition of great arteries with intact ventricular septum (TGA-IVS) after neonatal period.Methods 22 children with TGA-IVS after neonatal period were enrolled.According to the intraoperative left ventricular (LV)/right ventricular systolic pressure ratio,they received pulmonary artery banding (PAB group,n =10) or arterial switch operation (ASO group,n =12).15 body surface area matched healthy children were served as control group,Echocardiography was performed before the operation.The dynamic images in basal and apical short axis view were collected respectively.Meanwhile,using the STI technique,the rotation curves at apex and base was analyzed.Results All the patients discharged eventually.A right to left bulging of the ventricular septum was observed in all the patients by the 2D short-axis view.There were no differences in wall thickness and ejection fraction between control,PAB and ASO group.Compared with the control group,the end diastolic diameter,end diastolic volume and indexed LV mass in PAB and ASO group were significantly reduced,however,no difference in the end diastolic diameter and volume and LV mass was observed between the PAB and ASO group.The hypoplasia of LV in PAB and ASO group was associated with an extended time to peak basal rotation and reduced basal rotation and global torsion.Furthermore,the shorter time to peak apical rotation and reduced apical rotation and global torsion were only observed in PAB group.Conclusions The standard echocardiography could be useful for the initial evaluation for regressed LV of the children with TGA-IVS.However,STI allows a much more precious approach to the assessment of LV regressing after neonatal period.The apical rotation and global torsion might be the better predictor to identify the borderline or regressed LV for the surgical management for the children with TGA-IVS.

Objective To review the surgical results of 28 cases of endecardial cushion defect combined with double-ori-rice mitral valve. Methods Of 860 consecutive patients with endocardial cushion defect, double-orifice mitral valve was iden-tiffed in 28 patients (3.26% ) form October 1996 to November 2007. Intracardiac deformities were corrected simultaneously during the operation. Preoperative mitral valve function, surgical procedures and incidence of pestoperative mitral valve dys-function were reviewed and compared between patients with total endecardial cushion defect ( group Ⅰ, n = 11 ) and partial en-docardial cushion defect ( group Ⅱ, n = 17). Results There were 4 operative deaths in group Ⅰ caused by severe pulmonary inflammation in 3 cases and low cardiac output in 1 case. Two cases were identified as severe mitral valve dysfunction or steao-sis in reoperaticu or autopsy. There was no later death. Mitral valve function is not eatisfactory in group Ⅱ as compared with group Ⅰ in 3 to 89 months of follow-up( averaging 33 months). Conclusion Double-orifice mitral valve is a high risk factor for operative death in total endocardial cushion defect and the longer term results of partial endocardial cushion defect combined with double-orifice mitral valve is not satisfactory.

Objective To analyze the clinical features and the effect of therapy on cutaneous emphysema of chest wall and/or pneumomediastinum complicated in severe acute triphosgene poisoning patients.Methods Among 81 triphosgene poisoning patients,5 complicated with cutaneousemphysema of chest wall and/or pneumomediastinum were analyzed in respect of the clinical data including age,gender,arterial blood gas (ABG),modes of mechanical ventilation support and so on.Results Five patients consisting of 3 males and 2 females,aged (23.20 ± 5.17) years,were complicated with cutaneous emphysema of chest wall and/or pneumomediastium with a prevalence rate of 0.06％.Of them,4 were alleviated completely and 1 died of acute respiratory distress syndrome (ARDS).There was no significant difference in arterial blood gas analysis (ABG) between patients with cutaneousemphysema and/or pneumomediastinum and patients without ( P ＞ 0.05 ).Conclusions Triphosgene-induced acute lung injury treated with mechanical ventilation support with high PEEP is highly suggested as high risk factor for the formation of cutaneous emphysema of chest wall and/or pneumomediastinum in severe acute Triphosgene poisoning patients.It is very important to set the PEEP level of mechanical ventilation support as low as possible for avoidance of alveolar rupture.

Objective To study the current prevention and control status of iodine deficiency disorders (IDD) and learn the current situation of iodized salt consumption at household level in non-high iodine areas in 2015,this surveillance was conducted.Methods In 2015,according to National Surveillance Program on Iodine Deficiency Disorders,the surveillance was conducted at county level in 31 provinces,municipalities,autonomous regions (provinces) and Xinjiang Production and Construction corps (Xinjiang Corps).In each county city,district,banner (county),5 townships were randomly selected according to their sub-area positions of east,west,south,north and center;4 villages were randomly sampled in each chosen township;15 households were randomly selected in each chosen village.Edible salt sample was collected from each household.The iodine level in salt was determined by direct titration;the salt samples from Sichuan and other enhanced salt samples were detected by arbitration.Results There were totally 2 840 counties that reported the surveillance data.In total,849 193 salt samples were examined,including 845 906 salts determined by direct titration and 3 287 samples determined only by semi-quantitative detection.Weighted by population,the national coverage rate of iodized salt was 98.37％.At provincial level,the coverage rate of iodized salt was higher than 95％ except Tianjin,Shanghai and Shandong.At county level,2 669 counties had a coverage rate of iodized salt higher than or equal to 95％,171 counties were lower than 95％,and 31 counties were less than 80％.The national consumption rate of qualified iodized salt was 94.57％ (except 11 counties in Tibet).At provincial level,the consumption rate of qualified iodized salt was higher than 90％ except Shanghai (66.84％),Tianjin (79.14％),Tibet (82.09％) and Qinghai (89.22％).At county level,totally 2 633 counties had a rate of qualified iodized salt higher than 90％,and 196 counties were lower than 90％.The mean of iodine content in iodized salt was (25.37 ± 4.57) mg/kg.At provincial level,the means of iodine content in iodized salt were in the range of 23.51-28.95 mg/kg and the variable coefficient (CV) was in the range of 12.17％-27.37％,the CV was higher than 15％ in 24 provinces and Xinjiang Corps.Conclusions The coverage rate of iodized salt and the qualified iodized salt at national level are in a good condition.However,the problem of non-iodized salt is still serious in some provinces.

Objectives To understand current situation in national prevention and control of iodine deficiency disorders (IDD),and to evaluate the progress in eliminating IDD in 31 provinces and Xinjiang Production and Construction Corps (Corps) in China.Methods In 2011,30 units were sampled in each of 31 provinces and Corps in China based on the sampling method of Probability Proportional to Size.After excluding townships of water iodine level higher than 150 μg/L,1 primary school was chosen in each unit,by the randomized sampling method,40 students in cach school were sampled for examining their thyroid volume,among them,12 students were tested for their urinary iodine level and for their household salt iodine level and per capital daily salt intake.Near the location of these primary schools,3 townships were chosen,5 pregnant women and 5 lactating women in each township were sampled to test their urinary iodine level.Besides,1 water sample was sampled according to the location in each village (east,west,south,north,and middle) in non-central water supplying villages,and 2 tap water samples in central water supplying villages.The ultrasound was used to detect goiter size according to the diagnostic criteria for endemic goiter; As3+-Ce4+ catalytic spectrophotometry using ammonium per sulfate digestion (WS/T 107-2006) was used to test the urinary iodine level; the testing method recommended by the National Iodine Deficiency Disorders Reference Lab was applied to test the water iodine level,the direct titration method among the generic methods of iodide testing for salt production industry (GB/T 13025.7-1999) was used to determine the salt iodine level; and the arbitration method was adopted for quantitative determination in case of well salt or special salts and the salt intake was estimated based on three-day weighed food record.Evaluation standards are as follows:urinary iodine level of children:deficient is the median of urinary iodine (MUI) less than 100 μg/L,adequate is MUI at 100-199 μg/L,more than adequate is MUI at 200-299 μg/L,and excessive is MUI equal to or greater than 300 μg/L;salt iodine:definition of qualified iodized salt is (35-± 15) mg/kg; non-iodized salt (GB 5461-2000) is iodine less than 5 mg/kg; definition of unqualified iodized salt is iodine between 5-＜ 20 mg/kg or higher than 50 mg/kg.The total population of the sixth national census was used for statistical data correction.Results Among 31 provinces and Corps,children's goiter rate was 2.4％,which was obviously lower than the IDD elimination standard at the national level (＜ 5％); the national iodized salt coverage rate was 98.0％ and the consumption rate of qualified iodized salt was 95.3％,both figures had achieved the national standard (the iodized salt coverage should be greater than 95％ and the consumption rate of qualified iodized salt greater than 90％).The median of salt iodine was at 30.2 mg/kg; the MUI of children,pregnant women and lactating women was 238.6,184.4 and 174.4 μg/L,respectively.Urinary iodine of children was higher than adequate level,of both pregnant women and lactating women were at adequate level.The surveillance results of water iodine in 25 provinces revealed that the median was at 5.6 μg/L; the salt intake surveillance results among students' households in 24 provinces and the Corps revealed that the daily intake was 10.1 g per person a day.Conclusions National IDD prevention and control strategy integrated with universal salt iodization as a key measure has achieved remarkable impacts.IDD has been eliminated at the national level.

Objective The postoperative outcomes of transposition of the great arteries with severe pulmonary hypertension (PH) are still controversial. Based on relative large data, we evaluated the relationship between preoperative pulmonary hypertension and postoperative early and midterm clinical outcomes. Methods In this retrospective study, a cohort of consecutive patients with TGA was studied. One hundred and one patients underwent artery switch operation between February 2004 and October 2007. Preoperative medical records were reviewed. The mean follow-up period was 22.6 months. All artery switch operations were performed through a median sternotomy utilizing extracorporeal circulation. Deep hypothermia and circulatory arrest were used in 6 patients. After sternotomy, pulmonary arterial pressure was measured directly. According preoperative mean pulmonary pressure ( mPAP), patients were divided into three groups: normal group ( mPAP ＜25mmHg, n =43), moderate PH group ( mPAP between 25 to 50mmHg, n = 47) and severe PH group ( mPAP ≥50mmHg, n = 11 ). The methods of coronary anastomosis were "open trap door" ( 39 cases), "bay window" (61 cases) and "pulmonary artery tunnel" ( 1 case)techniques. Besides repairing of atrial septal defect and ventricular septal defect, ligation of patent ductus arteriosus, concomitsnt operations also involved mitral valvuloplasty (5 patients), tricuspid valvuloplasty (2 patients), pulmonary valvuloplasty (5 patients), pulmonary artery transplantation ( 1 patient ), subvalvular membrane resection ( 2 patients), widening of the right ventricular outflow tract ( 1 patient ) and collateral circulation occlusion ( 1 patient). The early and late postoperative results were compared among different groups. Results After operation, mPAP in severe PH group decreased from (61.2 ± 8.6 ) mmHg to ( 34.6 ± 13.6 ) mmHg( P ＜ 0.01 ). In moderate PH group it decreased from ( 34.5 ± 6.7 ) mmHg to ( 21.3 ± 5.6) mmHg( P ＜ 0.0l ). mPAP was not significantly changed in the control group. Operative mortality was 7.9% ( 8 patients ).The causes of early death were low output syndrome in 3 patients, septicemia in 4, central nervous system complications in 1.There was no difference in the postoperative complication rates among three groups. Also, no significant differences were found between groups regarding the early operative mortality (control group: 7.0%, moderate PH group: 8.5%, severe PH group:9.1%, P = 0.953 ). Combined abnormity contributed to postoperative death. Patients with ventricular septal defect and patent ductus arteriosus had a higher mortality rate. During follow-up 8 patients died: 5 in control group ( 11.6% ), 5 in moderate PH group ( 10.6% ) and 6 in severe PH group (54.5% ), P ＜ 0.01. Causes of midterm death were sudden death in 10, progressive heart failure in 4, pneumonia in 2. The rates of midterm mortality of the three groups were significantly different ( 11.6%,10.6% and 54.5% for control, moderate PH and severe PH group, respectively, P = 0.001 ). Kaplan-Meier survival analysis for patients with different age groups showed that survival rate in group with age older than 1 year was lower ( P = 0.029 ).Conclusion In TGA/PH patients, mPAP lower than 50 mmHg is suitable for artery switch operation and can get satisfying postoperative outcomes. If mPAP higher than 50 mmHg, even though the operation may decrease the pulmonary pressure, radical artery switch operation should not be recommended because of higher late mortality.

This research amplified the phyA gene with the designed and synthesized primers specific for the phyA gene full-length coding sequence. The phyA gene was from Aspergillus niger F246 by the polymerase chain reaction(PCR), which is selected and identified in our laboratory. After sequncing the coding sequence, it was confirmed that the construction of cloning vector was succeeded. The phyA gene fragment was recovered from the pMD18T-phyA and ligated with prokaryotic expression vector pET30a+ to construct the recombinant expression plasmid pET30a+ -phyA. It was expressed with IPTG induction in E. coli for high efficiency. A new protein band with apparent molecular weight 50 kDa was detected in the lysate of the transformed cell by using SDS-PAGE. The amount of the soluble fusion protein was about 40% of large intestine bacillus soluble protein of transformed cells, estimated by absorbance scanning of SDS-PAGE and protein quantitation. It's phytase activity was eight times over the natural phyase. So this research provides the basis of the study on obtaining large and high active phytase and developmant of the new microbial ecologicalagent.
6-Phytase ; biosynthesis ; genetics ; Aspergillus niger ; enzymology ; genetics ; Base Sequence ; Cloning, Molecular ; Escherichia coli ; genetics ; metabolism ; Genes, Fungal ; Genetic Vectors ; Molecular Sequence Data ; Recombinant Fusion Proteins ; biosynthesis ; genetics

Objective:To monitor iodized salt consumption and evaluate iodine deficiency status in 2014 in China.Materials and Methods:In 2014,a nationwide cross-sectional survey was conducted in 31 provinces (in this study,provinces,autonomous regions and municipalities in Mainland China were named as provinces).Probability proportional to size sampling method was adopted to recruit children ages 8-10 and pregnant women.47,467 children's and 18,994 pregnant women's urine samples were collected and 47,706 children's thyroid volumes were examined.Iodine content in salt was determined with 46,900 edible salt samples from children's households;urinary iodine concentration (UIC) was tested from children and pregnant women's urine samples;thyroid volume of children was assessed by ultrasound.Results:The national coverage rate of iodized salt and consumption rate of qualified iodized salt were 96.3％ and 91.5％,respectively.Median iodine content in iodized salt was 25.2 mg/kg.In 22 of 31 provinces,the provincial coverage rates of iodized salt were over 95％.And consumption rates of qualified iodized salt were more than 90％ in 21 provinces.In this study,the national median urinary iodine concentration (MUIC) of children in China was 197.9 μg/L.At the provincial level,MUIC of children in 19 provinces was 100-199 μg/L,which in 12 provinces was 200-299 μg/L.The national MUIC of pregnant women in 2014 was 154.6 μg/L,slightly higher than the lower limit of the WHO criteria for adequate (150-249 μg/L).At the provincial level,MUIC of pregnant women in 18 provinces was 100-149 μg/L,which in 13 provinces was 150-249 μg/L.The national prevalence of goiter among children in 2014 was 2.6％,of which only Shandong province (5.6％) exceeded the national standard (5％).Conclusions:In China,iodine deficiency disorders (IDD) has been eliminated since 2005.And in 2014,the IDD-free status still remained.

Objective To observe the high iodine induced thyroid goiter condition,iodine nutritional status and coverage rate of non-iodized salt in high water iodine areas.Methods The household non-iodized salt was monitored in counties (cities,regions) of high water iodine areas and high iodine diseased areas in Tianjin,Hebei,Shanxi,Jiangsu,Anhui,Shandong,Henan and Shaanxi provinces.Among the monitoring sites,where the water iodine were 150-300 μg/L or higher than 300 μg/L,50％ of the them were selected to investigate the water iodine,children urinary iodine and thyroid volume of children in high iodine counties.Results Household edible salt was monitored in 110 counties of 8 provinces,with a total of 25 597 salt samples.The number of non-iodized salt was 24 640,and the coverage rate of non-iodized salt was 96.3％.After being weighted based on the population of counties,the coverage rate of non-iodized salt was 96.9％.In all,73 survey areas include 183 663 people,64 monitoring sites (87.7％) where the water iodine level were higher or equal to 150 μg/L and the median of water iodine was 250.8 μg/L.Totally 5 991 children aged 6-12 were measured thyroid volume,the total goiter rate was 6.2％,the children thyroid goiter rate was higher than 5％ in Hebei,Shanxi,Henan,Tianjin and Shandong provinces.Totally 4 618 children were detected urinary iodine,the median urinary iodine concentration was 373.0 μg/L,and the children median urinary iodine concentration was exceeded 300 μg/L in Tianjin,Hebei,Shanxi,Jiangsu and Shandong provinces.The children urinary iodine concentration and goiter rate increased gradually with increasing of water iodine content.Conclusions The non-iodized salt coverage rate is high in high water iodine areas,most monitored areas have changed drinking water sources,but the median water iodine concentration is still higher than 150 μg/L.Children median urinary iodine concentration is higher than 300 μg/L,iodine is in a excessive status.The children total goiter rate is higher than 5％.Some countermeasures are proposed to search low iodine water,change water sources,do health education,and add other surveillance measures,such as thyroid function detection on target groups,and so on.

Objective:To explore the risk factors of early delayed recovery after right ventricular-extrapulmonary arterial(RV-PA)conduit reconstruction.Methods:From 2017 to 2021, the children with RV-PA conduit reconstruction, who were treated in our hospital were retrospectively analyzed.The demographic data and peri-operative clinical data of the patients were collected for statistical analysis.Results:Fifty-five patients were included in the study.The patients were sequenced by the length of ICU stay.The time at the 75th percentile was defined as the critical value for grouping.According to the ICU stay time of the children, they were divided into normal recovery group(ICU stay ≤7 days, n=40)and delayed recovery group(ICU stay>7 days, n=15).The mechanical ventilator time in the whole group was 24(0, 1 408)h, and the ICU stay time was 4(1, 67)d.Six cases required extracorporeal membrane oxygenation (ECMO) support, and two cases died.In the multivariate Logistic regression analysis of two groups, long cardiopulmonary bypass(CPB) time( OR=1.034, 95% CI 1.009-1.061, P=0.009)and poor right ventricular function( OR=9.536, 95% CI 1.010-90.037, P=0.049)were independent risk factors for early delayed recovery. Conclusion:The risk of RV-PA conduit reconstruction is high.The proportion of ECMO support is increased.The mortality rate is higher.Right heart dysfunction and prolonged CPB time are risk factors for delayed postoperative recovery.