Purpose To investigate the diagnostic value of fetal echocardiography in total anomalous pulmonary venous connection (TAPVC),and to analyze the reasons ofmisdiagnosis so as to improve accuracy of prenatal diagnosis.Materials and Methods The prenatal echocardiographic data of 24 cases of TAPVC confirmed by postnatal echocardiography and prenatal MRI from October 2001 to December 2015 in Children's Hospital Affiliated to Nanjing Medical University and Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine were retrospectively analyzed.Results In 24 cases,there were 14 fetuses of supracardiac type,7 cases of intracardiac type,2 cases of infracardiac type,and 1 case of mixed type.15 fetuses had TAPVC only,whereas 9 cases were associated with other cardiovascular anomalies,most commonly including bilateral right atria,single atrium,single ventricle,common atrioventricular valve and pulmonary stenosis.On 4-chamber views,the common sonographic sign was absent of pulmonary venous return to the left atrium in 24 cases (100.0％),and the presence of venous confluence between left atrium and descending aorta was observed in 22 cases (91.7％).In all 24 cases,1 case was missed diagnosis,and 3 cases were misdiagnosed as persistent left superior vena cava,common pulmonary vein atresia and patent left atrial cardinal vein.Conclusion TAPVC can be accurately diagnosed by fetal echocardiography,but it is prone to be misdiagnosed.

Purpose To explore the correlation between fetal cardiac function and interventricular septal thickness in fetuses of gestational diabetes mellitus (GDM) mothers. Materials and Methods Thirty-nine GDM mothers were involved in the study and divided into group MH (fetuses of GDM mothers with interventricular septal hypertrophy) and group NMH (fetuses of GDM mothers with normal interventricular septal thickness). Ultrasonic cardiogram was performed for both groups to assess such variables as interventricular septum thickness at end diastole (IVSd), left ventricular ejection fraction (LVEF), left ventricular fraction shortening (LVFS), right ventricular fraction shortening (RVFS), the ratio of E and A of mitral flow (E/AMV), the ratio of E and A of tricuspid flow (E/ATV), peak velocity of aortic valve (VPAO), peak velocity of pulmonary valve (VPPA) and myocardial performance index (MPI). The results were further compared with those of control group. Results The VPAO, VPPA, LVEF and LVFS in group NMH were significantly higher than those in control group (P<0.05). The VPAO, VPPA, LVEF, LVFS and RVFS in group MH were significantly higher than those in control group whilst the E/AMV and E/ATV significantly lower than those in control group (P<0.05). The LVEF, LVFS and RVFS in group MH were significantly higher than those in group NMH whilst the E/AMV and E/ATV significantly lower (P<0.05). MPI in group MH was significantly higher than that in group NMH (P<0.05), whilst both were significantly higher than that in control group (P<0.05). The LVEF, LVFS, RVFS, VPAO and VPPA were positively correlated with IVSd (r=0.48, 0.51, 0.45, 0.30, 0.30;P<0.05). Conclusion Cardiac function in fetuses of GDM mothers may be associated with interventricular septal thickness.

Objective Analyse the causes,diagnosis and treatment for delayed hemorrhage after distal radical gastrectomy.Methods Retrospective study on 45 patients combined with intro-abdominal hemorrhage after distal radical gastrectomy from January 2008 to June 2013.Results Thirteen patients combined with delayed hemorrhage in these 45 patients,all of 13 patients had intro-abdominal hemorrhage in 1week to 4 weeks after operation.And 5 of the 13 patiens were intermittent intro-abdominal hemorrhage 1 week after operation,these patients were demonstrated the blood come from gastroduodenal artery pseudoaneurysm fracture by CT and DSA examine,and they were cured by interventional embolization.Other 8 patients were marginal ulcer hemorrhage diagnosed by gastroscope,and they stoped bleeding with the help of gastroscope.Conclusions The causes of delayed hemorrhage after distal radical gastrectomy were complicated,and CT,DSA and endoscope can use for diagnosis.What was more,interventional embolization and endoscope were helpful for curing the intro-abdominal hemorrhage,avoiding re-operation.

Objective To find out the risk factors of postoperative low cardiac output syndrome(LCOS) of patients undergoing cardiac valvular surgery in ICU in order to provide basic for prevention and control measures.Methods Ninety-six valve replacement patients with valvular heart disease were enrolled as our subjects and they were hospitalized in ICU of the First People's hospital of Yichang from Jan.2008 to May.2013.The patients postoperative LCOS (Dopamine ＞ 10 μg/(kg · min)) were served as observation group (n =41),and the other were control groups(n =55).All data of the patients were recorded.Non-conditions Logistic regressions analysis were adopted to analyze the independent risk factors which resulted in LCOS undergoing cardiac valvular surgery.Results Of 96 patients undergoing cardiac vavular surgery,41cases (42.7％) had postoperative LCOS.Single factor analysis showed that hepatomegaly (P =0.007),course of diseases ≥ 15 years (P =0.042),cardiopulmonary bypass ≥ 120 min (x2 =3.937,P =0.047),pre-operative cardiac function ≥ Ⅲ degree (P =0.003) were the independent risk factors of postoperative LCOS undergoing cardiac valvular surgery.The Logistic multi factor regression analysis showed that the independent risk factors of postoperative LCOS undergoing cardiac valvular surgery included course of diseases ≥ 15 years (OR =2.825,95％ CI =(1.015-7.861)),Pre-operative cardiac function ≥ Ⅲ degree (OR =7.306,95％ CI =(2.050-26.035),P=0.002).Conclusion Course of diseases ≥15 years and Pre-operative cardiac function≥ Ⅲ-Ⅳ degree are the independent risk factors of LCOS undergoing cardiac valvular surgery.

Objective To investigate the risk factors of acute kidney injury following coronary artery bypass graft(CABG).Methods Twenty-six patients suffering from acute kidney injury following CABG as the patient group and 59 individuals without impairment of renal function as the control from January 2008 to September 2012 in the First People's Hospital of Yichang according to a retrospective case-control study and nonconditional multivariable Logistic regression analysis method..Results Among the 85 patients undergoing CABG,26 suffered acute kidney injury following CABG with a morbidity rate of 30.59％.Identified risk factors for acute kidney injury following CABG included pre-operative mederale-sever cardiac insufficiency,prolonged mechanical ventilation,prolonged stay in ICU and anemia before surgery.The identified independent risk factor of acute kidney injury following CABG was pre-operative mederale-sever cardiac insufficiency (OR =3.206,95％ CI:1.067-9.631).Condusion Pre-operative mederale-sever cardiac insufficiency was an independent risk factor of acute kidney injury following CABG.

This study analyzed the pesticide residue and heavy metal contents in Panaxnotoginseng (Burk.) F.H.Chen to provide the basis for the quality criterion of pollution-freemedicinal materials and slices of notoginseng.We randomly collected 100 samples of notoginseng from farmer's markets,producing areas of notoginseng and internet markets.We entrusted the third-party authoritative testing institutions to detect 203 items of the pesticide residues and 4 items of heavy metals.According to relative standards of Japan,Korea,the United States and the European Union,we analyzed and summarized the data in this study.We confirmed the 25 species of pesticides with high operating frequency and detection rate and the limited amount index of 4 heavy metals.In conclusion,these results enriched the limited amount index of the pesticide residues and heavy metal contents based on the previous notoginseng standard system serving as the quality criterion of pollution-free notoginseng,which was applicative and operable.

Objective To analyze the process of triage in disaster rescue action performed by a mobile medical unit so that the rescue process can be improved , the efficiency of rescue enhanced , and the decision on health service in rescue action is supported.Methods The process of triage in disaster rescue action was modeled based on stochastic Petri net while the performance of the model was analyzed quantitatively .Results and Conclusion The critical factor which affects the efficiency of rescue work is obtained by analyzing the performance of the model .

Objective To assess lipid status of pregnant women with GDM based on the lipid reference intervals for pregnant women .Methods Maternal blood and venous cord blood samples were collected in 81 well-controlled GDM mothers and 86 control subjects .The total cholesterol (CHOL) ,trigalloyl glycerol (TRIG) ,high-density lipoprotein cholesterol (HDL) ,low-density lipo-protein cholesterol (LDL) ,apolipoprotein A1 (ApoA) ,apolipoprotein B (ApoB) and lipoprotein (a) levels were measured by auto-matic biochemical analyzer .We used a normal pregnancy specific lipid reference interval (PSR) and normal non-pregnant reference intervals (NPR) respectively to assess the lipid status of pregnant women with GDM .Results Compared with normal control group ,the Apo A ,HDL and LDL levels in GDM group were significantly lower (P<0 .05) .The HDL ,LDL and Lp(a) levels of GDM cord blood were significantly lower (P<0 .05) .The weight of offspring birth of GDM pregnant women with low level HDL was significantly higher (P<0 .05) ,and that of GDM pregnant women with high level LDL offspring birth weight was significantly lower (P<0 .05) .Maternal HDL was not correlated with birth weight (r= -0 .190 ,P=0 .103) .Parent LDH and birth weight was negatively correlated (r= -0 .252 ,P=0 .029) .Conclusion The reference range of normal pregnancy-specific lipid we had estab-lished is more scientific for assessment of blood lipids .

Objective To evaluate regional right ventricular function by ultrasonic strain rate imaging in postoperative children with conotruncal defects(CTD). Methods All 27 postoperative CTD children had magnetic resonance imaging evaluation of right ventricular end-diastolic volume and end-systolic volume to calculate right ventricular ejection fraction (RVEF). The ultrasonic parameters of peak systolic strain rate (SRs), peak early diastolic strain rate (SRe), peak late diastolic strain rate(SRa) and strain (S) were obtained at the basal,middle and apical segment in curve of right ventricular anterior wall in 27 postoperative CTD children and 27 normal children. The correlation between SRs,S and RVEF were evaluated. Results Compared with healthy children,SRs,S,SRe,SRa were significantly reduced in postoperative CTD children (P ＜ 0.01 ), there were different distribution rules between postoperative CTD children and normal children,and all indexes had no statistical descrepancy among the basal, middle and apical segment ( P ＞0.05). SRs in basal segment of the right ventricular anterior wall correlated well with RVEF ( r = 0.89,P ＜ 0. 01 ). Conclusions Regional right ventricular function still was reduced in postoperative CTD children, and could be accurately evaluated by ultrasonic strain rate imaging.

Objective To analyze the level of cardiac troponin I (cTnI) in children with left-to-right shunt congenital heart disease (CHD). Methods In this study, 146 children with secundum atrial septal (ASD) defect, 132 children with ventricular septal defect (VSD) and 300 healthy children were recruited. The levels of cTnI and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured and their correlation with clinical data was analyzed. Results The serum cTnI and NT-proBNP levels in both ASD and VSD patients were signiifcantly higher than those in normal children (H=3.89 and 5.27, P<0.01). The serum cTnI and NT-proBNP levels in VSD patients were signiifcantly higher than those in ASD patients (P<0.05). The ratio of pulmonary to systemic arterial pressure (Pp/Ps), pulmonary vascular resistance index (PVRI) and standardized left ventricular end diastolic volume in VSD patients were signiifcantly higher than those in ASD patients (P<0.05). Multiple regression analysis showed that Pp/Ps was signiifcantly correlated with cTnI in VSD patients. (β=0.81, SE=0.03, P=0.000). Conclusions Signiifcant volume and pressure overload due to a left-to-right shunt induce myocardial injury and could lead to irreversible myocardial remodeling in children with CHD. The serum cTnI level is a sensitive biomarker for myocardial damage in VSD patients.