Objective To evaluate the impact of an integrated management mode of prenatal diagnosis-postnatal treatment for congenital heart disease (CHD) on perioperative and long-term outcomes of the arterial switch operation (ASO), and to analyze the efficacy of ASO in a single center. Methods This retrospective study analyzed the clinical data of 183 children who underwent ASO at Guangdong Provincial People’s Hospital from 2018 to 2024. The cohort included 106 (57.9%) patients of transposition of the great arteries with intact ventricular septum (TGA/IVS), 61 (33.3%) patients of transposition of the great arteries with ventricular septal defect (TGA/VSD), and 16 (8.7%) patients of Taussig-bing anomaly (TBA). Perioperative indicators were compared between 91 patients in the prenatal-postnatal integrated management group (an integrated group) and 92 patients in the traditional management group (a non-integrated group). Long-term survival and reoperation rates were analyzed using Kaplan-Meier curves. Results The overall perioperative mortality rate was 4.9% (9/183), showing a downward trend year by year. The primary cause of perioperative mortality was low cardiac output syndrome (LCOS), which occurred in 12 patients (6.6% incidence) with a mortality rate of 75.0%. The integrated group had a higher proportion of males (89.0% vs. 72.8%, P<0.05) and lower body weight [3.1 (2.7, 3.3) kg vs. 3.3 (3.0, 3.7) kg, P<0.05] compared to the non-integrated group. The age at surgery was significantly earlier in the integrated group [7 (3, 10) d vs. 14 (9, 48) d, P<0.05], and all children in the integrated group underwent ASO within the optimal surgical window (100.0% vs. 82.6%, P<0.05). Intraoperatively, cardiopulmonary bypass time [173 (150, 207) min vs. 186 (159, 237) min, P<0.05] and aortic cross-clamp time [100 (90, 117) min vs. 116 (97, 142) min, P<0.05] were significantly shorter in the integrated group. Although the integrated group had longer postoperative mechanical ventilation time [145 (98, 214) h vs. 116 (77, 147) h, P<0.05] and higher 48-hour maximum vasoactive inotropic score [15 (10, 21) points vs. 12 (8, 16) points, P<0.05], there was no statistically significant difference in the incidence of severe complications (LCOS, necrotizing enterocolitis, extracorporeal membrane oxygenation) or mortality rate (3.3% vs. 6.5%, P=0.51) between the two groups, despite earlier surgical intervention and a higher proportion of critically ill cases in the integrated group. The length of hospital stay in the emergency surgery group was significantly shorter than that in the elective surgery group [20 (15, 28) d vs. 25 (21, 30) d, P<0.05], suggesting that early surgery may be of potential benefit. A total of 163 patients were successfully followed up for a median of 4.7 years, with a 5-year survival rate of 95.1% and a freedom from reintervention survival rate of 95.1%. There were no late deaths, and the most common postoperative complication was pulmonary artery stenosis. Conclusion The integrated management model allowed critically ill children with lower body weights to safely undergo surgery, significantly optimizing the timing of surgery and shortening intraoperative times. The long-term risk of reoperation after ASO is primarily concentrated on pulmonary artery stenosis, necessitating long-term follow-up and monitoring.

Objective:To explore the clinical effects of axillary propeller flaps in reconstructing the axillary fold scar contracture.Methods:A retrospective cohort study was conducted. From July 2016 to January 2020, 11 patients with anterior axillary fold or anterior and posterior axillary fold scar contractures after burns were admitted to Xiangya Hospital of Central South University, including 7 males and 4 females, aged 8 to 48 years. The lesions involved unilateral axilla in 9 cases and bilateral axilla in 2 cases, with the joint abduction angle of the affected shoulder ranging from 25 to 100°. The axillary fold contracture scars were excised and released, resulting in wound of 8 cm×5 cm-24 cm×20 cm. According to the condition of the residual normal skin in axilla, 2, 3, and 4-leaf propeller flaps with area of 5 cm×3 cm-24 cm×10 cm were designed to repair the wounds after scar excision and release. The donor site wound was closed by suturing directly, and the residual wound that could not be completely sutured was transplanted with free full-thickness skin grafts from the inner thigh or abdomen. The application of 2, 3, and 4-leaf propeller flaps, the joint abduction angle of the affected shoulder immediately after operation, and the survival of the flaps and skin grafts after operation were recorded. The recurrence of scar contracture, the appearance of the flaps, the joint abduction angle of the affected shoulder, and the functional recovery of the affected shoulder joint and upper arm were observed through a follow-up.Results:Among the 13 axillary propeller flaps transplanted in the 11 patients in this group, there were 9 double-leaf propeller flaps, two 3-leaf propeller flaps, and two 4-leaf propeller flaps. The joint abduction angle of the affected shoulder reached 110-165° immediately after operation. All the flaps survived after operation. Nine flap donor sites were repaired with free skin grafts, with skin grafts survived in 7 flap donor sites after operation. Scar erosion in incision and small area of skin graft necrosis developed in 2 flap donor sites. One of the wounds was debrided and repaired by transplantation of split-thickness skin grafts from inner thigh, and the other wound was healed after dressing changes. A follow-up of 6 to 24 months was conducted after surgery, and all the patients had no recurrence of axillary scar contracture; the color of the flap matched the receiving area; the elasticity of flap was good; the joint abduction angle of the affected shoulder reached 120-165°, and the joint pronation and supination, upper arm lifting and circular rotation of the affected shoulder were all good.Conclusions:Reconstruction of the axillary fold scar contracture with axillary propeller flaps has good result, with better flap appearance and recovery of the shoulder joint activity and upper arm function after operation.

Objective To explore the impact of blood-activatingand qi-nourishing therapy on the hypercoagulable state of rats after femur fracture.Methods One hundred and twenty SD rats were randomly divided into 4 groups,namely normal group,model group,low-molecular-weight heparin(LMWH) group,combination group (LMWH + Tongmai Decoction),30 rats in each group.The rat model of femur fracture was established.After successful modeling,LMWH group was given subcutaneous injection of LMWH 600 U/kg,and the combination group was given subcutaneous injection of LMWH 600 U/kg together with gastric gavage of Tongmai Decoction,the model group was given subcutaneous injection of the same volume of normal saline.The treatment lasted for 1-7 days after the surgery.The pathologic features of the left great saphenous vein were observed by HE staining method,and the relative volume,thickness and quantity of the blood vessels were also measured.The plasma D-dimer (D-D) and fibrinogen (FIB) levels were determined by biochemical analyzer,and the plasma levels of whole blood viscosity at low shear rate (WBV-lsr) and whole blood viscosity at high shear rate (WBV-hsr) were measured with hemodynamic detector.Results On day 7 after the modeling,less endothelium cells,agglomerative red cells,and large thrombi were found in the great saphenous vein tissue section of the model group under microscope.Compared with the normal group,the levels of D-D,FIB,WBV-lsr and WBV-hsr in the model group at various time points were increased,the difference being significant (P ＜ 0.05).After 7-day treatment,the levels of D-D,FIB,WBV-lsr and WBV-hsr in LMWH group and combination group were lower than those of the odel group,and the decrease in the combination group was superior to LMWH group(P ＜ 0.05).The blood vessel endothelium cells in the combination group were arranged neatly with same cellular width while without enlargement or swelling,the effect being superior to that of LMWH group.Conclusion Blood-activating and Qi-nourishing therapy can effectively relieve hypercoagulable state of rats after femur fracture.

OBJECTIVE: To evaluate the accuracy with which auditory steady-state response (ASSR), tone burst auditory brain stem response (Tb-ABR) and click-evoked auditory brainstem response (c-ABR) thresholds predict behavioral thresholds, using a within-subjects design. METHOD: ASSR, Tb-ABR and c-ABR thresholds were recorded in a group of adults with normal hearing (58 ears). Evoked-potential thresholds were recorded and compared with behavioral, pure-tone thresholds. RESULT: The results suggested both ASSR and Tb-ABR thresholds had high correlations to pure-tone thresholds. Tb-ABR thresholds were recorded much closer to behavioral threshold than ASSR thresholds. There was a linear relation between c-ABR thresholds and average thresholds of 2 kHz, 4 kHz pure tone audiometry. CONCLUSION Both the ABR and the ASSR provided reasonably accurate predictions of multifrequencies behavioral threshold. Tb-ABR combined with c-ABR may take the accuracy predicted behavioral threshold.
Acoustic Stimulation ; Adolescent ; Adult ; Audiometry, Evoked Response ; methods ; Audiometry, Pure-Tone ; Auditory Threshold ; Evoked Potentials, Auditory, Brain Stem ; physiology ; Humans ; Young Adult