Objective To assess the value of prenatal ultrasonography in diagnosing fetal absent pulmonary valve syndrome(APVS). Methods This was a retrospective study of 8 fetuses with absent pulmonary valve syndrome. Fetal echocardiography and segmental analysis were used to determine the atrial situs,atrioventricular connections and ventriculoarterial relationships. Cardiac chamber dimensions,Doppler studies of the atrioventricular valve and semilunar value were recorded, and cardiothoracic ratio were calculated. Results Levocardia,normal situs and atrioventricular connections were present in all cases. All cases showed typical signs:severe dilatation of the pulmonary trunk and it's branches, and concurrent occurrence of pulmonary valve stenosis and regurgitation. In 6/8 there was an associated ventricular septal defect,overriding aorta and absent arterial duct(Fallot-like APVS),while in 2/8 there was an assoiciated intact ventricular septal and patent arterial duct. Extracardiac malformations were detected in 5 cases.Conclusions APVS can be accurately diagnosed by prenatal ultrasonography but we should pay more attention to the ventricular septal and arterial duct,due to the existence of two variants.

Acupuncture Points ; Diagnosis, Differential ; Humans ; Medicine, Chinese Traditional

Objective To observe the analgesic effects of dexmedetomidine combined with dif-ferent-doses of sufentanil in patients undergoing spine surgery.Methods Sixty patients(ASA grade Ⅰor Ⅱ degree,age 18-70 years)undergoing spine surgery were randomly assigned into three groups ac-cording to PCA formulation(n =20):3 μg/kg sufentanil group (group S1),1.5 μg/kg dexmedetomi-dine+ 2 μg/kg sufentanil group (group S2 )and 1.5 μg/kg dexmedetomidine + 1 μg/kg sufentanil group (group S3).The same anesthesia method was applied among three groups.Patient-controlled intravenous analgesia pump was applied before 30 minutes prior to the end of surgery.The drugs in each group were diluted to 1 50 ml and infused by a pump at a rate of 3 ml/h with a patient-controlled analgesia (PCA)bolus of 0.5 ml and lock time of 30 minutes.VAS and Ramsay scores at 2 h(T0 ),4 h (T1 ),8 h(T2 ),12 h(T3 ),24 h(T4 )and 48 h(T5 )after surgery were estimated.Postoperative nausea and vomiting,bradyrhythmia and hypersomnia were also recorded.Results Compared with group S1, VAS of groups S2 and S3 was significantly decreased at T1-T5 (P <0.05).There were also no signifi-cant difference in the incidence of postoperative nausea and vomiting,bradyrhythmia and hypersomnia among three groups.Conclusion Dexmedetomidine of 1.5 μg/kg can significantly reduce the dosage of sufentanil on postoperative analgesia in patients undergoing spine surgery,and decrease the rate of postoperative nausea and vomiting without any bradyrhythmia and hypersomnia.

Objective To investigate the expression of procalcitonin (PCT) and C-reactive protein (CRP),and endotoxin in bloodstream infection with different microorganisms,so as to assess the value of these inflammatory cytokines in early diagnosis of sepsis in bloodstream infections patients.Methods Data of 152 septic bloodstream infected patients with 90 male and 62 female aged from 62 to 102 years and 79.2 ± 16.3 years in average admitted from January 2012 to December 2013 were analyzed retrospectively.According to the results of blood culture,the microorganisms could be categorized into gram-negative bacteria,gram-positive bacteria and fungus groups,and the levels of serum CRP,PCT,and endotoxin were compared among these groups of bloodstream infections patients within 24 hours after admission.Results (1) A total of 152 strains of microorganisms were surveyed including 92 gram-negative strains (61.18％),43 gram-positive strains (28.29％),and 16 fungal strains (10.53％).In the gram-negative strains,Klebsiella pneumoniae (n =29),Acinetobacter baumannii (n =24),Escherichia coli (n =23),Burkholderia cepacia (n =9) and Pseudomonas aeruginosa (n =4) were the most common isolates.In the Gram-positive strains,13 strains of Staphylococcus aureus were isolated.(2) In the gram-negative bacterial bloodstream infections group,there were 60 (64.52％) patients with endotoxin positive,and there were no endotoxin positive cases with detected gram-positive bacteria and fungal bloodstream infections.The median levels of PCT were significantly different among the three groups [gram-negative strains group:7.760 (3.365,28.585) ng/mL,gram-positive strains group:0.705 (0.265,3.225) ng/mL,fungal infection group:1.245 (0.543,1.998) ng/mL].In the fungal bloodstream infection group,the mean level of CRP was higher than that in other two groups [gram-negative strains group:(126.01 ± 66.53) mg/L,gram-positive strains group:(77.58 ±54.21) mg/L,fungal infection group:(140.14 ±71.21) mg/L].(3) The receiver operating characteristic (ROC) curve of inflammatory cytokines was made for the diagnostic value in bloodstream infections.ROC curve used to distinguish between gram-positive bacterial bloodstream infections group and fungal group showed that AUCPCT+CRP =0.791.When PCT cut-off value was 0.92 ng/mL,and CRP cut-off value was 68.00 mg/L,the sensitivity was 50％ and the specificity was 95.5％.ROC curve used to distinguish between the gram-negative bacterial bloodstream infections group and fungal group showed that AUCPCT+CRP+LPS =0.947.When PCT cut-off value was 2.16 ng/mL and CRP cutoff value was 94.10 mg/L,and endotoxin was positive,the sensitivity was 82.8％ and the specificity was 100％.ROC curve used to distinguish between gram-negative bacterial bloodstream infections group and gram-positive bacterial group showed that AUCPCT+CRP+LPS =0.947.When PCT cut-off value was 2.68 ng/ mL,CRP cut-off value was 106.5 mg/L,endotoxin was positive,the sensitivity was 74.2％ and the specificity was 97.7％.Conclusions Gram-negative bacteria were the most common microorganisms in bloodstream infections in ICU patients.Compared with single inflammatory cytokine,the serum concentrations of PCT,CRP and endotoxin used together could provide more sensitivity and specificity for the early diagnosis of bloodstream infection with different microorganisms.

Objective To evaluate the feasibihty and clinical value of laparoscopic hepatectomy for liver tumors.Methods Laparoscopic hepatectomy from May 2010 to Oct 2013 was summarized including 27 cases of primary hepatocellular carcinoma,5 cases of liver hemangioma,3 cases of hepatic nodular hyperplasia,2 cases of liver metastases of colorectal cancer,2 cases of liver cystadenoma and 1 case of liver cyst.The diameter averaged at (4 ± 4) cm.Results All patients were successfully operated,no perioperative death.Irregular hepatectomy was performed in 21cases,hepatic left lateral lobectomy in 12 cases,segment VI resection in 4 cases and left hepatectomy in 3 cases.Operative time averaged (166 ± 109) min.Average blood loss was (480 ± 233) ml.Tumor margin was positive in two HCC cases.Bile leakage and ascites developed in one each patient,who were then cured by conservative treatment.Conclusions Laparoscopic hepatectomy for liver tumors is safe and feasible.

Objective:To investigate the effect of donor lymphocyte infusion (DLI) by intra-bone marrow (IBM) or intravenous (IV) on the incidence of graft-versus-host disease(GVHD) after allogeneic peripheral hematopoietic stem cell transplantation (allo-PBSCT).Methods:Female C57BL/6 mice as recipients received total body irradiation (TBI) on day 0,followed by injection of peripheral hematopoietic stem cells from mobilized male BALB/c with granulocyte-colony stimulating factor (rhG-CSF),and DLI was performed via IV or IBM.The extent of GVHD was compared in recipients received allogeneic IBM-DLI with those received IV-DLI.The percentage of donor-derived cells and CD4~+CD25~+ regulatory T cells (Tregs) was detected by flow cytometry.14 days after DLI,the levels of IL-4 and interferon (IFN)-γ were tested by ELISA.Results:It was found that the frequency and severity of GVHD were reduced in IBM-DLI compared with that of IV-DLI (P＜0.01).7 days after transplantation,the percentage of H-2~d-positive cells was over 95% in all surviving transplanted mice;and 14 days after transplantation,the percentage of Tregs detected as CD4~+CD25~+ was significantly higher in recipients treated with IBM-DLI than those treated with IV-DLI(P＜0.01).Compared with that of the recipients in IBM-DLI group,the level of IL-4 was significantly decreased,while the level of IFN-γ were elevated in group IV-DLI (P＜0.01).Conclusion:IBM-DLI could induce the proliferation of Tregs and the Th polarizing to Th2,resulting in decreasing the incidence and alleviating severity of GVHD after allo-PBSCT.

Decompression, Surgical ; adverse effects ; Humans ; Keratitis ; etiology ; Male ; Middle Aged ; Trigeminal Nerve ; surgery ; Trigeminal Nerve Diseases ; complications ; etiology

Adult ; Aged ; Axilla ; innervation ; surgery ; Brachial Plexus ; surgery ; Breast Neoplasms ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; methods ; Mastectomy, Radical ; adverse effects ; methods ; Middle Aged ; Pain, Postoperative ; etiology ; Somatosensory Disorders ; etiology

Objective To assess the effects of dynamic monitoring of plasma Pro-B-type Natriuretic Peptide(Pro-BNP) in the evaluation of prognostic value and myocardial dysfunction in patients with septic shock.Methods The levels of plasma Pro-BNP were tested in 102 patients with septic shock on the 1,3,and 5 days.Data on ICU mortality and 28-day mortality were collected.The patients were divided into non-dysfunction group (CI＜3.0) and cardiac dysfunction group (CI≥3.0) according to levels of hemodynamic variables ( CI level).The prognostic value of plasma Pro-BNP was analyzed.Results Plasma Pro-BNP levels on the 1,3 and 5 days in 28-day survivors have a significant declining trend [( 1649.0 ± 257.5 ) ng/L,( 1867.6 ± 291.7 ) ng/L vs.(1229.9 ± 194.5) ng/L),while plasma Pro-BNP levels in non-survivors have an increasing trend [(4128.8 ± 1051.1),( 5315.9 ± 925.4 ) vs.( 6899.9 ± 1327.9 ) ng/L].There is statistical significance of plasma Pro-BNP levels at day 1,3 and 5 for the two groups ( t=3.057,5.083,and 6.290 respectively,P＜0.01 ).The 28-day mortality and Plasma Pro-BNP levels in cardiac dysfunction group were higher than of non-dysfunction group ( 28-day mortality:62.1％ vs.20.0％;Pro-BNP1:( 1592.8 ± 362.2 )ng/L vs.( 4556.6 ±732.7 ) ng/L;Pro-BNP3:( 2933.6 ± 421.7 ) vs.( 5768.5 ± 793.7 ) ng/L,Pro-BNP5:( 3014.5 ± 587.5 ) ng/L vs.(8873.9 ± 1670.1) ng/L ( x2=20.635,P=0.000,t=3.626,3.154,3.310,P＜0.01].Pro-BNP level greater than 3053 ng/L on the 5-day was an independent prognostic indicator of 28-day mortality ( sensitivity:88.4％;specificity:91.5 ％ ).Pro-BNP level greater than 2378 ng/L on the 5-day was an independent prognostic indicator of hospital mortality ( sensitivity:84.9％;specificity:91.8％ ).In multivariate logistic regression analyses,Pro-BNP level and APACHE score were independent predictors of 28-day mortality and hospital mortality.Conclusion Plasma Pro-BNP level shows obvious significance in evaluation of sepsis-induced myocardial depression severity in patients with septic shock.Pro-BNP level in ICU at day 5 after inclusion is an independent prognostic marker of mortality in septic shock.

Objective To evaluate the value of two-dimensional strain imaging in assessing right ventricular function of recipient fetus in TTTS pregnancies.Methods Sixteen TTTS pregnancies and 19 normal monochorionic diamniotic pregnancies(controls) were included.Doppler studies of the umbilical artery,umbilical vein,ductus venosus,middle cerebral artery,atrioventricular valve and semilunar value were recorded in both fetus,and myocardial performance index of both ventricles was calculated.Longitudinal peak systolic strain of right ventricular were calculated and compared between recipient fetus and other fetus.Results Cardiothoracic ratio and myocardial performance index of right ventricular showed significant differences between recipient fetus and controls.Right ventricular strain was decreased in recipient fetus compared with controls.Conclusions Two-dimensional strain imaging can be used to evaluate right ventricular myocardial function in the recipient fetus of TTTS.