Objective:To explore the anticoagulant strategies during perioperative period for the patients with long-term anticoagu-lation therapy to show the important role of clinical pharmacist in drug treatment. Methods:The anticoagulant regimen during the peri-operative period participated by clinical pharmacists for one patient with long-term use of warfarin was reviewed, and combined with the related literatures, the drug choice, the administration time, dosage and treatment course were analyzed. Results: The clinical phar-macists could optimize the anticoagulant regimen by using the pharmacokinetic knowledge to decrease the risk of hemorrhage and embol-ism to the largest extent. Conclusion:During the perioperative period, warfarin should be withdrawn at least 5 days before the opera-tion, and the international normalize ratio ( INR) should be monitored. After the operation and no further bleeding, low molecular weight heparin combined with warfarin can be used in 12h, and INR should be monitored. Low molecular weight heparin can be with-drawn till the standard is reached. If the patient undergoes operation for many times, low molecular weight heparin is suggested to be used for anticoagulation during the whole operation period.

Objective:To evaluate the value of mitral annulus displacement(TMAD) measured by two-dimensional speckle tracking imaging in evaluating left ventricular(LV) systolic function before and after immunoglobulin(IVIG) treatment in children with Kawasaki disease(KD).Methods:Thirty-five hospitalized children with acute KD(KD group) and 40 healthy volunteers(control group)were enrolled from September 2020 to March 2021 in the Third Affiliated Hospital of Zhengzhou University. All participants underwent echocardiography.Left ventricular ejection fraction(LVEF) and left ventricular short axis shortening(LVFS) were calculated from M-mode echocardiography. All children had their apical four-chamber and two-chamber view recorded and stored in real time, and the images of the KD group were recorded in the acute, subacute and convalescent stages, respectively. The data was analyzed by QLab 13.0 offline quantitative analysis software. The TMAD parameters between the KD group and the control group were compared. And the TMAD parameters at different periods in the KD group were compared. Pearson correlation analysis was conducted to evaluate associations between TMAD parameters and LVEF and N-terminal B-type natriuretic peptide(NT-proBNP) in children with acute KD.Results:①The parameters of TMAD AP4 MV1, TMAD AP4 MV2, TMAD AP2 MV1, TMAD AP2 MV2, TMAD AP4 Midpt, TMAD AP4 Midpt%, TMAD AP2 Midpt and TMAD AP2 Midpt% were decreased in patients with KD at different periods than those of the control group(all P<0.05), while there was no significant difference in LVEF between the two groups( P>0.05). ②After IVIG treatment, the values of TMAD AP4 MV1, TMAD AP4 MV2, TMAD AP2 MV1, TMAD AP2 MV2, TMAD AP4 Midpt, TMAD AP4 Midpt%, TMAD AP2 Midpt and TMAD AP2 Midpt% in subacute stage of KD were higher than those in acute stage(all P<0.05), the values of TMAD AP4 Midpt% and TMAD AP2 Midpt% in the convalescent stage of KD were higher than those in the subacute stage(all P<0.05). ③The parameters of TMAD were positively correlated with LVEF( r=0.36, 0.40, 0.32, 0.28, 0.42, 0.46, 0.35, 0.37; all P<0.05) and negatively correlated with NT-proBNP( r=-0.61, -0.57, -0.40, -0.60, -0.63, -0.47, -0.61, -0.36; all P<0.05). Conclusions:TMAD measured by two-dimensional speckle tracking imaging can quickly and accurately evaluate left ventricular systolic function in children with KD before and after IVIG treatment, and TMAD combined with NT-proBNP can provide a new method for clinical management of KD.

Objective To observe the value of quantitative analysis technique for evaluating left atrial function in children with Kawasaki disease(KD).Methods Totally 43 children with KD(KD group)who would undergo intravenous immunoglobulin(IVIG)therapy were prospectively enrolled,including 23 with(ectasia subgroup)and 20 without coronary artery ectasia(non-ectasia subgroup),while 50 healthy children were enrolled as control group.Children in KD group.Echocardiography was performed in acute phase(10-12 hours before IVIG therapy),subacute phase(1 week after therapy)and convalescent phase(6-10 weeks after therapy)of KD.The left atrial reservoir strain(LASr),early diastolic conduit strain(LAScd),late diastolic contractile strain(LASct),left ventricular global longitudinal strain(LVGLS),basal segment,middle segment and apical segment longitudinal strain(LS)were measured.Strain parameters of different periods were compared between groups and subgroups in KD group,and left atrial strain parameters in KD subgroup were compared among different periods.Pearson correlation analysis was used for evaluation of the correlations of left atrium and left ventricle strain parameters in children with acute KD.Results LASr,LAScd,LASct,LVGLS and left ventricular segment LS of KD group in acute and subacute phase were all lower than those of control group(all P＜0.05),while the basal segment LS of KD group in convalescent phase was lower than that of control group(P＜0.05).In KD group,compared with acute stage,LASr,LAScd,LASct,LVGLS and left ventricular segment LS significantly increased in subacute phase(all P＜0.05),while in convalescent phase,LASr,LAScd,LASct,LVGLS,middle segment LS and apical LS further increased(all P＜0.05).LASr and LAScd in acute phase of KD group were positively correlated with LVGLS,middle segment LS and apical segment LS(r=0.43-0.67,all P＜0.05).In the acute and subacute phases,no significant difference of left artial LS parameters was found between subgroups within KD group(all P＞0.05).LASr and LAScd in convalescent phase of ectasia subgroup were lower than those of non-ectasia subgroup(all P＜0.05),while no significant difference of LASct was found between subgroups within KD group(P＞0.05).Conclusion Quantitative analysis technique could be used to evaluate left atrial function in KD children.Changes of left atrial function in KD children were closely related to left ventricular systolic function,which was affected by coronary artery ectasia in convalescent phase.

Objective: Constructing and applying the multi-module training program for junior midwives to improve the training quality. Methods: The training program was constructed according to different modules of core competence. 11 junior midwives were selected from a hospital in Zhengzhou as trainees. The training effect was evaluated. Results: Their core competence has been enhanced in theory knowledge, operating skills and training satisfaction (P < 0.05). After training, the rate of episiotomy and the rate of postpartum hemorrhage were lower than before (P<0.05). Conclusion The multi-module training program can improve the core competence of junior midwives, which provides effective training method and promotes the quality of training.

OBJECTIVE: To investigate the morbidity of congenital heart defects(CHDs) in children with anorectal malformation, and to summarize appropriate treatment. METHODS: The clinical data and echocardiographic findings of 155 children with congenital anorectal malformations from the Third Affiliated Hospital of Zhengzhou University during January 2016 and October 2019 were reviewed. According to the surgical findings of anorectal malformations, the patients were categorized as the high/intermediate group and the low group; the CHDs were classified as minor CHDs and major CHDs. Multiple logistic regression was used to analyze the correlation of wingspread classification, and extracardiac malformations with the severity of CHDs. RESULTS: Out of 155 children with anorectal malformations, 47 (30.3%) had different types of cardiac structural malformations, including 18 cases of minor CHDs (11.6%) and 29 cases of major CHDs (18.7%). Sixty children (38.7%) had extracardiac malformations, of which 38 cases (24.5%) had a single extracardiac malformation, 15 cases (9.7%) had multiple extracardiac malformations, 6 had trisomy 21 syndrome, and 1 had VATER syndrome. Multivariate logistic regression analysis showed that wingspread classification of anorectal malformation and extracardiac disorders were independent risk factors for major CHDs. The probability of major CHDs in children with high/intermediate anorectal malformation was 4.709 times higher than that with low anorectal malformation ( CONCLUSIONS The morbidity of major CHDs is higher in severe cases with high/intermediate anorectal malformation and acute cases without fistula or with obstructed fistula and cases with multiple congenital disorders. Echocardiography can define the type and severity of CHDs, which are useful to develop the optimal diagnosis and treatment plan for children with anorectal malformation.
Abnormalities, Multiple ; Anorectal Malformations/therapy* ; Child ; Heart Defects, Congenital/mortality* ; Humans ; Retrospective Studies