Objective To evaluate the safety and mid- to long-term efficacy of surgical correction of isolated partial anomalous pulmonary venous connection (IPAPVC). Methods We retrospectively collected consecutive patients who were diagnosed with IPAPVC and underwent surgical correction at Fuwai Hospital of Chinese Academy of Medical Sciences and Fuwai Yunnan Cardiovascular Hospital from June 2009 to May 2019, summarized the basic preoperative and intraoperative data of patients, analyzed the postoperative and mid- to long-term follow-up results. Results A total of 54 patients were enrolled, including 29 males and 25 females, with an average age of 16.20±2.40 years, ranging from 1 month to 62 years. There were 28 (51.9%) patients with varying degrees of arrhythmia, 22 (40.7%) patients with cardiac insufficiency, and 39 (72.2%) patients with pulmonary hypertension. According to Bordy's typing, 14 (25.9%) patients were classified as type A, 23 (42.6%) type B, 4 (7.4%) type C, 5 (9.3%) type D and 8 (14.8%) mixed type. Transthoracic echocardiography was performed in the whole group of patients and the accuracy of staging diagnosis was 66.7% (36/54), and cardiac CT angiography (CTA) was performed in 37 patients and the accuracy of staging diagnosis was 94.6% (35/37). All surgical procedures were assisted with cardiopulmonary bypass, aortic cross-clamping time was 0-219 (67.02±5.23) min, cardiopulmonary bypass time was 40-261 (105.09±5.23) min, and there was no serious intraoperative complication. Postoperative tracheal intubation time was 0-230 (13.33±4.20) h, intensive care unit stay was 0-13 (1.89±0.28) days, postoperative hospital stay was 5-18 (7.20±0.38) days, and follow-up time was 16-140 (62.58±5.12) months. There were 2 (3.7%) all-cause postoperative deaths, including 1 in-hospital death and 1 death during the follow-up, and there was no intraoperative death. Among the survivors, there were 3 patients with surgery-related complications: 1 patient had atrial septal defect with the second surgical treatment, 1 early obstruction of the superior vena cava and 1 arrhythmia. Two patients had complications of IPAPVC (atrial fibrillation, collateral circulation) prior to surgery and underwent the second surgery with a poor prognosis, and 1 patient had preoperative cardiac insufficiency and atrial fibrillation, whose symptoms persisted for a long time during the follow-up. Conclusion IPAPVC accounts for a lower percentage of partial anomalous pulmonary venous connection, transthoracic echocardiography combined with CTA improves diagnostic accuracy, and IPAPVC should be treated with elective surgery after diagnosis. The surgical approach should be individualized with imaging features such as disease staging, number of drains and drainage location. Surgical treatment of IPAPVC is safe and effective, and regular follow-up is warranted.

Objective    To explore the natural changes of procalcitonin (PCT) in the early period after pediatric cardiac surgery with cardiopulmonary bypass (CPB). Methods    A prospective and observational study was done on patients below 3 years of age, who underwent cardiac surgery involving CPB, with the risk adjustment of congenital heart surgery (RACHS) score of 2 to 5 and free from active preoperative infection or inflammatory disease. Blood samples for measurement of PCT, C-reactive protein (CRP) and white blood cell (WBC) were taken before surgery and daily for 7 days in postoperative period. Infections and complications within 7 days after operation were investigated. According to the presence or absence of infection and complications within 7 days after operation, the enrolled children were divided into an infection+complications group, a simple infection group, a simple complication group, and a normal group. Results     Finally, 429 children with PICU stay≥ 4 days were enrolled, including 268 males and 161 females, with a median age of 8.0 (0.7, 26.0) months. There were 145 children in the simple infection group, 38 children in the simple complication group, 230 children in the normal group and 16 children in the infection+complications group. The levels of PCT, CRP and WBC were significantly higher after CPB. CRP and WBC peaked on the second postoperative day (POD) and remained higher than normal until POD7. PCT peaked on POD1 and would generally decrease to normal on POD5 if without infection and complications. Age, body weight, RACHS scores, the duration of CPB and aortic cross-clamping time were correlated with PCT level. There was a statistical difference in PCT concentration between the simple infection group and the normal group on POD 3-7 (P<0.01) and a statistical difference between the simple complication group and the normal group on POD 1-7 (P<0.01). A statistical difference was found between the simple infection group and the simple complication group in PCT on POD 1-5 (P<0.05). Conclusion    WBC, CRP and PCT significantly increase after CPB in pediatric cardiac surgery patients. The factors influencing PCT concentration include age, weight, RACHS scores, CPB and aortic cross-clamping time, infection and complications.

Osteosarcoma， a common primary bone malignancy， features high heterogeneity， poor prognosis， high propensity for local invasion and distant metastasis， and high mortality. At the moment， the major therapy is the combination of neoadjuvant chemotherapy and limb salvage surgery， which remarkably reduces the disability rate and fatality rate. However， long-term use of chemotherapeutic drugs leads to the acquisition of drug resistance by osteosarcoma cells and reduces the sensitivity of the tumor cells to the drugs. Thus， this therapy is not satisfactory. In recent years， amid the advancement in the treatment of tumor， Chinese medicine has attracted extensive attention for the obvious therapeutic effect and few adverse reactions. Phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） /mammalian target of rapamycin （mTOR） signaling pathway， as a classic cancer signaling pathway， is abnormally activated in osteosarcoma cells， which affects the proliferation， invasion， and metastasis of osteosarcoma cells by influencing the cycle of tumor cells， inhibiting apoptosis and autophagy of tumor cells， and promoting tumor angiogenesis. According to clinical research， Chinese medicine monomers influence proliferation， apoptosis， and autophagy of osteosarcoma cells and angiogenesis by regulating the activity of proteins in PI3K/Akt/mTOR signaling pathway， thereby suppressing osteosarcoma tissues and cells. Moreover， they can reverse the resistance of tumor cells to multiple anticancer drugs. Based on the knowledge and experience of Chinese medicine in the treatment of osteosarcoma， this paper reviews the role of PI3K/Akt/mTOR signaling pathway in the treatment of osteosarcoma by Chinese medicine monomers， which is expected to serve as a reference for the application of Chinese medicine in the treatment of osteosarcoma.

Objective To evaluate the efficacy of pulmonary surfactant(PS)in the treatment of acute respira﹣tory distress syndrome(ARDS)in the infants after congenital heart disease(CHD)operation. Methods The trial Was conducted from January 2012 to June 2017 in FuWai Hospital,and 90 infants Who had ARDS after cardiac surgery Were enrolled. They Were divided into 2 separate groups,PS group(conventional therapy +PS treatment,43 cases)and con﹣trol group(conventional therapy,47 cases). The clinical data,including age,body Weight,risk adjustment for congenital heart surgery 1(RACHS－1)degree,cardiopulmonary bypass( CPB)time,aortic occlusion time,mechanical ventila﹣tion time,intensive care unit(ICU)care time,mortality,complications,partial pressure of oxygen[pa(O2 )],fraction of inspiration O2(FiO2 )and pa(O2 )／FiO2(P／F),Were collected and analyzed. Results The average age,body Weight, RACHS－1 degree,CPB time and aortic occlusion time had no difference betWeen the 2 groups(P＞0. 05). After 24 h of treatment,pa(O2 )in PS group Was(94. 76 ± 13. 25)mmHg(1 mmHg﹦0. 133 kPa),Which Was significantly higher than that in control group[(67. 59 ± 7. 47)mmHg](P﹤0. 01). P／F in PS group Was 170. 37 ± 20. 62,Which Was sig﹣nificantly higher than that in control group(102. 65 ± 15. 29)( P﹤0. 01),While FiO2 in PS group Was(55. 18 ± 6. 89)%,Which Was significantly loWer than that in control group[(68. 59 ± 9. 59)%](P﹤0. 01). The mean me﹣chanical ventilation time[(194. 39 ± 26. 30)h]and ICU care time[(11. 64 ± 3. 26)d]of the experimental group Were shorter than control group[(288. 63 ± 26. 42)h and(16. 65 ± 4. 18)d],and the differences Were statistically significant(P﹤0. 01). Eight deaths occurred,PS group had 1 infant dead,and the control group had 7 deaths,so the mortality in PS group Was 2. 32%,loWer than that in control group(14. 89%),and the difference Was statistically sig﹣nificant(P﹤0. 01). Postoperative complications occurred in 23 patients,of Which PS group had 9 cases postoperative complications and control group had 15 cases,so the incidence of complications in PS group Was 20. 93%,loWer than that in control group(31. 91%),and the difference Was statistically significant(P ﹤0. 01). Conclusions PS has good efficacy in treating ARDS in infants With ARDS after congenital heart disease operation.

Objective     To recognize the risk factors of unplanned re-interventions within 30 days after pediatric cardiac surgery and evaluate the outcome of re-interventions. Methods     We retrospectively analyzed the clinical data of 202 children in Fuwai Hospital between January 1, 2015 and August 31, 2017. There were 115 males and 87 females at average age of 32.4 months with range of 3 days to 14 years. Results     There were 202 children who underwent unplanned re-intervention during 30 days post-operation, including 54 re-adjustments of pulmonary blood flow, 34 re-corrections for residual cardiac abnormalities, 28 cardiopulmonary resuscitations, 38 for coagulation problems, 19 pericardial drainages, 11 palliative re-operations to deliver heart load and 6 diaphragmatic folds and 12 others. The mortality rate among children who underwent unplanned re-inventions after cardiac surgery was 10.9% (22/202). It was much higher than those free from re-interventions (0.7%). Time of mechanical ventilation was 284.3 (11–2 339) h, and mean ICU stay was 17.7 (1–154) d, significantly longer than those free from re-interventions at the same period. Conclusion     Unplanned re-interventions after pediatric cardiac surgery is associated with higher mortality rate and longer recovery time. Early identifying risk factors and re-intervention can reduce the complications and improve the prognosis.

Objective To evaluate the efficacy of pulmonary surfactant (PS) on severe acute respiratory distress syndrome (ARDS) in different age baby with congenital heart disease. Methods We divided 43 baby patients into two separate groups including a little baby group (12 patients with age less than 3 months) and an infants group (31 patients with age of 3 months to one year). Both groups of patients were treated with intratracheal PS at the same time. The clinical data were collected and analyzed. Results The little baby group had lower body weight. There was no statistical difference in the cardiopulmonary bypass (CPB) time, operation blocking time, mechanical ventilation time, ICU stay time between the two groups (P>0.05). Before treatment, arterial partial presurre of oxygen (PaO2), fractional oxygen concentration in inspire gas (FiO2), the ratio of arterial PO2 to the inspired oxygen fraction (P/F) and arterial-alveolar N2 difference or gradient (a/A) had no difference between the two groups (P>0.05). After treatment, PaO2 and P/F of both groups were significantly lower than before (P<0.05), and FiO2 and P/F were significantly higher than before (P<0.05). After 24 h of treatment, PaO2 and P/F of the little baby group was significantly higher than that of the infants group (P<0.05), and FiO2 and P/F were significantly lower than those of the infants group (P<0.05). Conclusion PS treating severe ARDS in little baby with congenital heart disease has better effect than infants.

Objective: To explore the relationship between pre-operative severe cyanosis (SC) and the early post-operative recovery in pediatric patients with corrective operation of Tetralogy of Fallot (TOF) Methods: A retrospective cohort study was conducted in 271 pediatric TOF patients who received corrective operation in our hospital from 2010-03-01 to 2013-03-01. Based on pre-operative hemoglobin≥180g/L, the patients were divided into 2 groups: SC group,n=48 and Non-SC group,n=223. Univariate analysis was performed to compare the differences between 2 groups; binary Logistic regression analysis was carried out to identify significant changes which was defined byP<0.01 in univariate analysis. Results: Univariate analysis indicated that compared with Non-SC group, the patients in SC group had the higher incidence of post-operative complications,P<0.001, longer time to reach negative fluid balance,P=0.006 and prolonged mechanical ventilation time,P=0.001; while the post-operative kidney injury was similar between 2 groups,P=0.036. Binary Logistic analysis presented that the patients in SC group needed prolonged mechanical ventilation time (OR=3.432, 95% CI 1.014-5.978,P=0.015), longer time to reach negative fluid balance (OR=4.823, 95% CI 2.586-8.941,P=0.002), the higher incidence of post-operative complications (OR=14.322, 95% CI 7.114-26.251,P<0.001). Conclusion: Pediatric TOF patients with pre-operative SC had the higher incidence of early post-operative complications, prolonged mechanical ventilation time and longer time to reach negative fluid balance those resulting delayed post-operative recovery.

Objective To explore the risk factors for prolonged mechanical ventilation in children with trans-position of great arteries and intact ventricular septum who underwent arterial switch operation. Methods This study was a retrospective,single center study. One hundred and twenty patients with transposition of great arteries and intact ventricular septum who underwent primary arterial switch operation between January 2014 and December 2016 at Fuwai Hospital were eligible for this study. The data of patients from pediatric intensive care unit database and electronic medical records were collected. The data related to postoperative respiratory assist time were collected,including demo-graphic data,preoperative diagnosis,intraoperative data,and postoperative recovery data. The patients were divided into 2 groups according to ventilation time which were prolonged mechanical ventilation group(ventilation time > 72 hours) and non - prolonged mechanical ventilation group(ventilation time ≤72 hours). The data of 2 groups were analyzed by using single factor analysis,and the P≤0. 2 factors were processed into Logistic regression analysis. Results Ninety -six patients were enrolled including 22 patients in prolonged ventilation group and 74 patients in non - prolonged me-chanical ventilation group. No statistical significance was found in 2 groups in gender,age,weight,preoperative lactate, hemoglobin,use of prostaglandin E1,mechanical ventilation,cardiopulmonary time,aortic clamping time,the ratio of left ventricular pressure to right ventricular pressure,immediate postoperative plasma lactate,and vasoactive inotropic score. The weight and postoperative left atrial pressure were significantly different between 2 groups with P < 0. 2. Weight were (3. 5 ± 0. 9)kg in prolonged mechanical ventilation group and (3. 9 ± 1. 0)kg in non - prolonged mechanical ventila-tion group (P = 0. 117). Left atrial pressures were (7. 9 ± 1. 9)mmHg(1 mmHg = 0. 133 kPa)in prolonged mechani-cal ventilation group and (6. 7 ± 2. 0)mmHg in non - prolonged mechanical ventilation group(P = 0. 015). The weight and left atrial pressure were processed into Logistic regression analysis and the results revealed that high left atrial pres-sure was the risk factor for ventilation prolongation(OR = 1. 048,P = 0. 020). Respiratory assist time in prolonged and non - prolonged ventilation group was 112(80,194)h and 26(17,46)h,respectively;ICU time in prolonged and non - prolonged ventilation group was 10(1,14)d and 4(3,6)d,respectively;and all the differences were significant (all P = 0. 000). The number of death in each group was 1 with no significant difference(P = 0. 420). Conclusions High left atrial pressure is the risk factor for prolonged mechanical ventilation in children with transposition of great ar-teries and intact ventricular septum following primary arterial switch operation.

Objective To investigate the methods of early identification and early intervention for newborn with life-threatening congenital heart disease.Methods Between January 2010 and December 2010,223 neonates with serious congenital cardiac malformations were hospitalized in PICU of Fuwai Hospi-tal.Results The most type of cardiac lesions was complete transposition of the great arteries,accounting for 59%(131 cases),and the second was total anomalous pulmonary venous connection,17%(39 cases).For the primary clinical symptoms,the most common were any cyanosis,dyspnea and cardiac murmur,accounting for 91 %(204 cases),56%(125 cases)and 53%(1 18 cases),respectively.Fifty-nine cases developed into critical conditions such as severe hypoxia,metabolic acidosis and heart failure and were sent to PICU for emergency rescue.Early intervention included maintaining ductus arteriosus open,correcting internal environ-ment disturbances,treatment of heart failure,and surgical treatment as soon as possible.Four cases died before operation and 10 cases were abandoned to continue care,which all died within 12 days after discharge.In 209 cases who received operation,9 cases died.The total operation mortality was 4.3%.Within 3 to 63 month following-up,the late death was in 2 cases,2 cases received two-stage corrective operation,and three for reop-eration.The others all were in normal cardiac function and growth.Conclusion Most of neonatal life-threat-ening congenital cardiac malformations were ductus dependent such as transposition of the great arteries and total anomalous pulmonary venous connection,which the baby needs immediate diagnosis and management for survival.Early recognition,appropriate preoperative management and operation as soon as possible are the key to rescue.

Objective To determine the solubility and apparent oil/ water partition coefficient of sitafloxacin in different solvents. Methods High performance liquid chromatography (HPLC) was used. The column was Dikma Diamonsil C18 (2) (4. 6 mmí250 mm,5 μm). The mobile phase was 0. 05 mol·L-1 KH2 PO4 solution (pH was adjusted with H3 PO4 to 2. 4)-acetonitrile (7030). The column temperature was set at room temperature. The flow rate was 1. 0 mL·min-1 . The detection wavelength was 295 nm and the injection volume was 10 μL. The solubility of sitafloxacin and the apparent oil/ water partition coefficient at pH 2. 0,4. 3,5. 8,6. 6,7. 4,8. 0,10. 0 and 11. 2 were determined. Results The equilibrium solubility of sitafloxacin in water was 0. 44 mg·mL-1 and the apparent oil/ water partition coefficient was 0. 23 (lgP= -0. 64) at (37±2) ℃ . Sitafloxacin has the lowest equilibrium solubility (0. 13 mg·mL-1 ) and the highest apparent oil/ water partition coefficient in pH7. 4 buffer solution system. At pH>10 and pH<5. 8,the solubility of sitafloxacin increased obviously and apparent oil/ water partition coefficient decreased. Conclusion Sitafloxacin is insoluble in water and also poorly soluble in oil,but its solubility could be improved significantly in acidic or alkaline solution.