Objective To summzarize the impacts of respiratory syncytial virus (RSV) infection in the early period(< 72 h) on the postoperative course after open-heart surgery in pediatric patients, and to discuss the expe-riences on therapeutic strategies. Method From March 2005 to March 2008, 39 patients diagnosed to be RSV in-fection confmned by RSV antigen test were prospectively enrolled into RSV-infeetion group. Anoth.er 39 patients were randomly 1 : 1 matched with age and same type of congenital heart disease (CHD) during the same period who also underwent open-heart surgery without RSV infection (nonRSV-infection group) as control group. The medical records of these patients were retrospectivdy reviewed. The duration of mechanical ventilation (MV), length of ICU stay and hospital stay were compared between the two groups with Paired Student's t test. Meanwhile Fisher' s exact test was used to compare the differences in noninvasive positive pressure ventilation, incidence rate of re-intubafion and severe postoperative complications between groups. Patients in both groups were further divided into subgroups aceonting to differences in age, cyanosis and pulmonary arterial pressure in order to identify the dif-ferent impacts of RSV infection in patients in different settings. Results All the patients were survived and dis-charged home. RSV infection significantly prolonged the duration of MV, ICU and hospital stay (all P < 0. 05).In addition, it significantly increased the incidence of pulmonary atelectasis (P < 0.05). In patients under 6 months old, RSV infection resulted in prolongation of MV, ICU and hospital stay (all P <0.05); furthermore, it significantly increased the incidence of complications of low cardiac output syndrome and bacteria co-infection (both P = 0.05). In patients over 24 months, RSV infection had no significant impacts in all the parameters which are compared between the two groups. In patients with cyanotic CHD, RSV infection significantly prolonged the duration of MV, ICU stay and hospital stay (all P < 0.05). In patients with cyanotic CHD, RSV infection significantly prolonged the duration of ICU stay and hospital stay (P <0.05). In patients with pulmonary hyper-tension, RSV infection significantly prolonged the duration of MV, ICU and hospital stay(all P <0.05), and in-creased the incidence rate of concomitant infection (P < 0.05). However, in patients without pulmonary hyper-tension, RSV infection only significantly increased the length of hospital stay (P < 0.05). Conclusions RSV in-fection in the early period after open-heart surgery in pediatric patients has significant adverse impacts on the post-operative course, especially in those patients under 6 months old, patients with pumonary hypertension or cyanotic CHD. Early diagnosis, and effective circulatory and respiratory support,alone with antivirus results in a satisfied outcome.

Objective To explore the impacts of Danhong injection on physiological and biochemical indicators in malnourished mice at physiological low doses, evaluate its safety, and test the practical value of safety re-evaluation of Traditional Chinese Medicinal ( TCM) injections. Methods A total of 32 ICR mice during growth period were selected to set up corn deficient nutrition mice model. Mice were assigned into the normal control group (given 0. 9% saline), Danhong injection at low, medium and high dosages (0. 2, 0. 4 and 0. 6 mL) groups (n=8 in each group);Mice were administered with respective medications intraperitoneally for 7 consecutive days. Blood samples were taken and mice were executed on the 8th day. All 9 kinds of organ or tissue were obtained completely, to measure related physiological and serum biochemical parameters. The safety of Danhong injection was evaluated by using Benefit and Damage Index - General Score ( BDI-GS ) system. Results The Danhong injection showed only slight damages on major organs or tissues, the BDI values were all above 0. 85, and the GS values were all above 9. 0;BDI values for Danhong injection at different dosages were all above 1. 0 for spleen and pancreas, showing better replenishing and healthy effects, and the differences were of statistical significance compared with the normal control group (P<0. 05 or P<0. 01). Meanwhile, it exerted obviously hypoglycemic effect. Conclusion Danhong injection is of rather low risk under physiological dosages, and therefore is safe to use. The mal-nutrition model combined with the BDI-GS system may be developed as a novel approach for safety re-evaluation of TCM injection in clinic.

Objective To explore the expression levels and clinical significance of serum Gasdermin D(GS-DMD)and angiotensin converting enzyme 2(ACE2)in children with Kawasaki disease(KD).Methods A to-tal of 90 children with KD treated in the hospital from January 2020 to January 2022 were collected as KD group.According to whether the children with KD had coronary artery lesions(CAL),the KD group was di-vided into CAL group(32 cases)and non-CAL group(58 cases),and 50 children with fever due to acute re-spiratory infection admitted to the hospital during the same period were selected as fever control group.An-other 50 children with oblique inguinal hernia who underwent elective surgery in the same period were selected as the control group.Serum GSDMD and ACE2 levels were detected by enzyme-linked immunosorbent assay.The correlation between serum GSDMD,ACE2 and clinical indicators was analyzed by Pearson correlation.Multivariate Logisitic regression was used to analyze the influencing factors of CAL occurrence in KD pa-tients.The diagnostic value of serum GSDMD and ACE2 for CAL in children with KD was analyzed by receiv-er operating characteristic(ROC)curve.Results The serum GSDMD and ACE2 levels in KD group were higher than those in fever control group and control group,and the differences were statistically significant(all P＜0.05).Compared with the non-CAL group,the fever duration,gamma globulin treatment time,erythro-cyte sedimentation rate,platelet count,C reactive protein,GSDMD and ACE2 levels of KD children in the CAL group were significantly higher,while the blood sodium and albumin were significantly lower,with statistical significance(all P＜0.05).The results of Pearson correlation analysis showed that serum GSDMD and ACE2 levels in KD group were positively correlated with fever duration,gamma globulin treatment time,erythrocyte sedimentation rate,platelet count and C reactive protein(all P＜0.05),and negatively correlated with blood sodium and albumin(all P＜0.05).Multivariate Logistic regression analysis showed that the increase of ser-um GSDMD and ACE2 was an independent risk factor for the development of CAL in KD children.ROC curve analysis results showed that the area under the curve(AUC)and 95％CI of the combined detection of serum GSDMD and ACE2 for CAL in KD children were 0.918(0.868-0.949).The AUC and 95％CI of serum GS-DMD and ACE2 were significantly higher than that of serum GSDMD and ACE2[0.838(0.789-0.887)and 0.865(0.811-0.912),respectively],and the differences were statistically significant(Z=5.116,4.217,all P＜0.05).Conclusion The combined detection of serum GSDMD and ACE2 has high diagnostic value for CAL in children with KD.

Objective To summary the clinical experience of ECMO for failure to separate from bypass after arterial switch operation of TGA.Methods 8 TGA patients (6 boys and 2 girls,aged 1 day to 3.5 years and weighing 2.7-11.0 kg,3 VSD intact and 5 with VSD,others complicated malformation including COA,left ventricular outtract stenosis) were treated with VA ECMO owing to failure to separate from bypass caused by low output syndrome after ASO between July 2007 and June 2016.We collected the medical records and analyzed the indication,management and complication of ECMO for this patient population.There were two stages of ECMO supporting for low output after ASO,The first stage was to improve tissue perfusion and correct inner environment by high flow supporting,and the second stage was ventricular function training.ECMO was weaned when the blood pressure was more than 60 mmHg and the difference value of systolic pressure and diastolic pressure was 15-20 mmHg under medium dose inotropics supporting.Volume infusion was limited strictly during ECMO.Results The running time were 22-300 h.5 patients were weaned from ECMO successfully and 4 patients discharged to home.The long-term follow-up of echocardiography indicated normal cardiac function in 3 patients.1 older child had left cardiac failure again after weaning from ECMO 12 days later;he was supported by LVAD subsequently.LVAD was weaned after 236h supporting,unfortunately,He died from cardiac failure 50 days after LVAD weaning.3 patients could not wean from ECMO and died.The main complications were bleeding and pericardial tamponade.Conclusion VA ECMO was effective treatment for failure to separate from bypass after switch operation of TGA.The high mortality was seen in patients with intramural coronary arterial.The myocardial structure perhaps changed secondary in older TGA children,ECMO and LVAD can be used as short-term circulatory transition to artificial heart or transplant.Bleeding was the main complication of this population;surgical hemostasis and accurate coagulation management were the guarantee for successful ECMO running.

Objective:To investigate the risk factors for nonunion after surgery for femoral shaft fractures in order to reduce them.Methods:The clinical data were retrospectively analyzed of the 804 patients with femoral shaft fracture who had been treated from January 2014 to December 2020 at Department of Orthopaedics, Xijing Hospital. There were 575 males and 229 females, aged from 18 to 96 years (average, 43.7 years). The patients were divided into 2 groups according to whether nonunion had occurred after surgery: a nonunion group of 112 cases and a fracture healing group of 692 cases. The preoperative general data, such as age, gender and fracture type, as well as intraoperative and postoperative data, such as operation time, internal fixation method, reduction method and internal fixation failure, were compared between the 2 groups. Items with P<0.05 were included in the multivariate logistic regression analysis to identify the risk factors for nonunion. Results:There were statistically significant differences between the nonunion group and the fracture healing group in smoking history, drinking history, injury mechanism, injury type, multiple injuries, fracture AO classification, fixation method, internal fixation failure, postoperative infection and use of non-steroid anti-inflammtory drugs ( P<0.05). Multivariate logistic regression analysis showed that smoking ( OR=3.261, 95% CI: 2.072 to 5.133, P<0.001), high energy injury ( OR=2.010, 95% CI: 1.085 to 3.722, P=0.026), multiple injuries ( OR=3.354, 95% CI: 1.985 to 5.669, P<0.001), AO type 32-C fracture (type 32-C fracture used as a reference, P=0.034), internal fixation failure ( OR=3.517, 95% CI: 1.806 to 6.849, P<0.001), external stent fixation (external stent fixation used as a reference, P=0.009) were the risk factors for nonunion after femoral shaft fractures. Conclusions:After surgery for patients with femoral shaft fracture, special attention should be paid to those with a smoking habit, high-energy injury, multiple injuries, AO type 32-C fracture, external stent fixation or a failed internal fixation, because they are high-risk groups prone to postoperative nonunion.