Neck dissection(ND)is one of the main treatment methods for oral and maxillofacial malignancies.Although ND type is in con-stant improvement,but intraoperative peal-pull-push injury of the accessory nerve,muscle,muscle membrane,fascia and ligament induced shoulder syndrome(SS)is still a common postoperative complication,combined with the influence of radiochemotherapy,not only can cause pain,stiffness,numbness,limited dysfunction of shoulder neck and arm,but also may have serious impact on patient's life quality and phys-ical and mental health.At present,there is still a lack of a systematic evaluation and rehabilitation management program for postoperative SS of oral and maxillofacial malignant tumors.Based on the previous clinical practice and the current available evidence,refer to the relevant lit-erature at home and abroad,the experts in the field of maxillofacial tumor surgery and rehabilitation were invited to discuss,modify and reach a consenusus on the etiology,assessment diagnosis,differential diagnosis,rehabilitation strategy and prevention of SS,in order to provide clinical reference.

Objective    To define the patient characteristics and perioperative management, and to define the mortality and its risk factors after arterial switch operation (ASO). Methods    We conducted a bidirectional cohort study with 571 consecutive patients undergoing ASO from 1997 to 2016 in our hospital. We enrolled patients who underwent ASO before 2012 retrospectively and after 2012 prospectively and followed up all the patients prospectively. Demographic characteristics, clinical information and mortality of these patients were summarized. Joinpoint regression analysis was used to identify the time trend of the overall mortality. Kaplan-Meier survival analysis was used to evaluate the mid- and long-term survival rate after ASO. Cox proportional hazards regression models were used to explore the potential factors associated with mortality. The cumulative incidence of complications after ASO was predicted using competing risk models. Results    Several aspects of patients’ characteristics and perioperative management in our center differed from those in the developed countries. The overall mortality and in-hospital mortality after ASO was 16.3% and 15.1%, respectively. The overall cumulative survival rate at 5, 10 and 15 years after ASO was 83.3%, 82.8% and 82.8%, respectively. A significant decrease of overall mortality from 1997 to 2016 was observed. Independent risk factors of mortality included earlier ASO (1997-2006), single or intramural coronary anatomy and longer cardiopulmonary bypass time. Ten years after ASO, re-intervention, arrhythmia, pulmonary and anastomotic stenosis were the most common complications with a cumulative incidence over 10%. Conclusion    Significant improvements in the results of the ASO were observed and the postoperative mortality rate is close to reports from developed countries. Nonetheless, we have identified the need for further improvement in the early and late postoperative periods after ASO. Pulmonary stenosis, anastomotic stenosis and arrhythmia should be paid attention to during the long-term follow-up after ASO.

Objective    To explore the correlation between perioperative blood transfusion and acute kidney injury (AKI) after heart transplantation. Methods    A retrospective study was performed on 67 patients who underwent heart transplantation in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital from January 2016 to December 2018, and finally 63 patients were included according to the exclusion criteria. There were 53 males and 10 females with an average age of 44.3±12.9 years. Twenty patients who adopted continuous renal replacement therapy (CRRT) after heart transplantation were divided into a RT group and the other 43 patients who did not use CRRT were divided into a non-RT group. Baseline characteristics, perioperative blood transfusion data and clinical prognosis were compared between the two groups. Results    The preoperative baseline characteristics of the two groups were basically the same. There were significant differences in perioperative infusion of red blood cells and plasma, postoperative 24 h bleeding and re-exploration (P<0.05) between the two groups. The area under the receiver operating characteristic (ROC) curve was 0.923 (95%CI 0.852 to 0.995, P<0.001). The ROC curve showed that perioperative infusion of red blood cells more than 18 mL/kg would increase the incidence of AKI after heart transplantation. Conclusion    Perioperative blood transfusion is closely related to AKI after heart transplantation. The more blood transfusion is in clinics, the higher incidence of renal injury is and the worse prognosis is. It is suggested that various blood-saving measures can be carried out.

Objective To identify the risk factors of ventilator-associated pneumonia (VAP) in infants after surgical correction for tetralogy of Fallot (TOF).Methods This study performed at Guangdong general hospital in China,130 infants (less than 12 months,mechanical ventilation time≥48 h) undergoing surgical correction for TOF were included between January 2013 and December 2017.Ventilator-associated pneumonia was defined according to the CDC/NHSN definitions guidelines issued in 2008.T test or Wilcoxon rank sum test was used in univariate analysis,and the variables with P ＜ 0.05 in the univariate analysis were added to a multiple logistic regression to identify the risk factors of VAP in infants after surgical correction for Tetralogy of Fallot.The area under the receiver operating characteristic (ROC) curve was calculated as a measure of accuracy.Results A total of 130 infants were included,however,VAP was found in 34 (26.2％) infants.The single variables significantly associated with a risk of VAP were:pre-operative hypoxic,pre-operative pneumonia,pre-operative mechanical ventilation support,prolonged cardiopulmonary bypass time,reintubation,pulmonary atelectasis,pleural effusion hydrothorax,prolonged mechanical ventilation support time,low cardiac output and transfusion of erythrocyte concentrate or fresh frozen plasma.Multiple logistic regression analysis showed prolonged cardiopulmonary bypass time (OR =1.02),reintubation (OR =16.111),pulmonary atelectasis (OR =8.133),low cardiac output (OR =7.649) and prolonged mechanical ventilation support time (OR =1.014) were independent risk factors for VAP in infants after TOF surgical correction.The area under the curve demonstrates the accuracy of the model.Conclusion The occurrence rate of VAP was high and risk factors for VAP after TOF surgical correction were complex.These results can be used to prevent and reduce the occurrence of VAP.

Objective: To investigate the expression of HOXA terminal transcript antisense RNA (HOTTIP) in hepatocellular carcinoma (HCC) tissues and to explore its effect on proliferation, invasion and migration in HepG2 cells. Methods: A total of 60 cases with HCC tissues undergoing excision surgery and 60 cases of corresponding paracancerous tissues from January 2012 to June 2018 in Dandong First Hospital of Liaoning Province were collected. The expressions of HOTTIP in HCC tissues and paracancerous tissues were detected by using real-time quantitative polymerase chain reaction (RT-qPCR), and the relationship between the expression and clinicopathological features was analyzed. HepG2 cell line with high expression of HOTTIP constructed by cell transfer technique was treated as the experimental group, and the empty plasmid pcDNA3.1-NC was treated as the control group. The effect of HOTTIP on the proliferation of HepG2 cells was detected by using CCK-8 method, and the effect of HOTTIP on invasion and migration of HepG2 cells was detected by using Transwell assay. Results: The expression of HOTTIP mRNA in HCC tissues was higher than that in paracancerous tissues, and there was no statistically significant difference (1.9±0.6 vs. 0.9±0.7, t = 6.069, P < 0.01). The whole HCC cases were divided into the high expression group (30 cases) and the low expression group (30 cases) according to the median value (1.92) of the expression of HOTTIP mRNA. The expression of HOTTIP was related with TNM stage, differentiation degree and lymph node metastasis (χ² values were 10.800, 8.076, 5.711, all P < 0.05), but not with age, gender, tumor diameter, number of tumors, hepatitis and alpha fetoprotein (AFP) levels (all P > 0.05). The results of RT-qPCR showed that the expression of HOTTIP mRNA in HepG2 cells was increased after transfection of overexpressed HOTTIP and the differences was statistically significant compared with the control group (63±6 vs. 13±9, t = 9.129, P < 0.01). The results of CCK-8 method showed that the proliferation activity of cells was enhanced after the overexpression of HOTTIP in HepG2 cells (24 h, 36 h, 72 h at 490 nm absorbance was 1.497 ± 0.017 vs. 0.826±0.006, 2.002±0.025 vs. 1.211±0.020, 3.257±0.042 vs. 1.772±0.021), and the differences were statistically significant (t values were 5.321, 7.349, 8.793, all P < 0.01). In Transwell invasion assay, the number of cells transferred into the basement membrane in the experimental group was more than that in the control group (101±9 vs. 41±11), and the difference was statistically significant (t = 6.839, P < 0.01). In Transwell migration assay, the number of cells transferred into the basement membrane in the experimental group was more than that in the control group (112±9 vs. 53±11), and the difference was statistically significant (t = 7.105, P < 0.01). Conclusion The expression of HOTTIP in HCC tissues is up-regulated, and the overexpression of HOTTIP can promote the proliferation, invasion and migration of HCC cells.

Objective: To investigate the expressions of hypoxia inducible factor-1α (HIF-1α) and autophagy related protein Beclin-1 in colon cancer and their clinical significances. Methods: From January 2017 to December 2018, 120 patients with colon cancer who were admitted to Dandong First Hospital were selected. The expressions of HIF-1α and Beclin-1 in colon cancer and corresponding adjacent tissues were detected by immunohistochemical SABC method. The relationship of the expressions of HIF-1α and Beclin-1 with the clinicopathological features of colon cancer patients was also discussed. The expressions of HIF-1α and Beclin-1 in 20 pairs of fresh colon cancer and paracancerous tissues were detected by Western blot. Results: The results of immunohistochemistry showed that the positive expression rates of HIF-1α and Beclin-1 proteins in colon cancer tissues were significantly higher than those in paracancerous tissues [75.0% (90/120) vs. 21.7% (26/120), 60.8% (73/120) vs. 12.5% (15/120)], and the differences were statistically significant (χ ² values were 68.343 and 60.359, both P < 0.01). The results of Western blot showed that the expressions of HIF-1α and Beclin-1 proteins in 20 pairs of fresh colon cancer tissues were significantly higher than those in paracancerous tissues (1.98±0.66 vs. 0.76±0.55, 1.50±0.40 vs. 0.46±0.35), and the differences were statistically significant (t values were 6.912 and 8.315, both P < 0.01). The expressions of HIF-1α and Beclin-1 in colon cancer tissues were related to TNM stage, degree of differentiation, depth of infiltration, lymph node metastasis and nerve invasion (HIF-1α: χ ² values were 9.074, 15.215, 10.101, 11.610 and 9.979; Beclin-1: χ ² values were 11.285, 4.858, 24.436, 9.354 and 4.632; all P < 0.05), but not with age, sex, tumor location, tumor diameter and vascular tumor thrombus (all P > 0.05). There was a positive correlation between the expressions of HIF-1α and Beclin-1 proteins in colon cancer (r = 0.483, P < 0.01). Conclusion The expressions of HIF-1α and Beclin-1 proteins in colon cancer tissues are significantly increased, and the interaction between them is involved in the occurrence and development of colon cancer.

Objective    To explore the feasibility of ultrasound diagnosis of diaphragmatic paralysis in patients with ventilation after congenital heart disease surgery. Methods    There were 542 patients with congenital heart disease after surgery, difficult to be weaned off the ventilator or suspected diaphragmatic paralysis of the patients, respectively, in the ventilator continous positive pressure breathing (CPAP) mode and completely independent breathing state, whose ultrasound examination of diaphragm function was conducted to determine the presence of diaphragmatic paralysis in our hospital between January 1, 2013 and April 30, 2016. There were 327 males and 215 females at age of 14±32 months. The results of ultrasound diagnosis between ventilator CPAP mode and completely spontaneous breathing mode were compared. Results    Five hundred and forty-two patients underwent ultrasound diaphragmatic examination. The results of bedside ultrasound were completely diagnosed: in completely spontaneous breathing, 82 patients who were diagnosed as diaphragmatic paralysis, including 39 on the right, 25 on the left, 18 on both sides; in CPAP mode, 82 patients who were diagnosed as diaphragmatic paralysis, 38 on the right, left 25, bilateral 19. Using ultrasound in CPAP mode to diagnose diaphragmatic paralysis after congenital heart disease surgery, compared with the completely spontaneous breathing state, the sensitivity was 100.0% and the specificity was 99.9%. Conclusion    It is accurate and feasible to diagnose the presence of diaphragmatic paralysis in patients with ventilation after congenital heart disease surgery.

BACKGROUNDSince 2010, two versions of National Guidelines aimed at promoting the management of ST-segment elevation myocardial infarction (STEMI) have been formulated by the Chinese Society of Cardiology. However, little is known about the changes in clinical characteristics, management, and in-hospital outcomes in rural areas.

METHODSIn the present multicenter, cross-sectional study, participants were enrolled from rural hospitals located in Liaoning province in Northeast China, during two different periods (from June 2009 to June 2010 and from January 2015 to December 2015). Data collection was conducted using a standardized questionnaire. In total, 607 and 637 STEMI patients were recruited in the 2010 and 2015 cohorts, respectively.

RESULTSSTEMI patients in rural hospitals were older in the second group (63 years vs. 65 years, P = 0.039). We found increases in the prevalence of hypertension, prior percutaneous coronary intervention (PCI), and prior stroke. Over the past 5 years, the cost during hospitalization almost doubled. The proportion of STEMI patients who underwent emergency reperfusion had significantly increased from 42.34% to 54.47% (P < 0.0001). Concurrently, the proportion of primary PCI increased from 3.62% to 10.52% (P < 0.0001). The past 5 years have also seen marked increases in the use of guideline-recommended drugs and clinical examinations. However, in-hospital mortality and major adverse cardiac events did not significantly change over time (13.01% vs. 10.20%, P = 0.121; 13.34% vs. 13.66%, P = 0.872).

CONCLUSIONSDespite the great progress that has been made in guideline-recommended therapies, in-hospital outcomes among rural STEMI patients have not significantly improved. Therefore, there is still substantial room for improvement in the quality of care.

Aged ; China ; epidemiology ; Cross-Sectional Studies ; Female ; Hospital Mortality ; Hospitals ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; ST Elevation Myocardial Infarction ; epidemiology ; mortality ; surgery ; Surveys and Questionnaires

Objective    To explore the value of extracorporeal membrane oxygenation(ECMO) combined with hypothermia therapy for children patients with refractory cardiac arrest after congenital heart disease surgery. Methods    From January 2013 to June 2016, we conducted a prospective study of 23 children (18 males, 5 females at age of 7±11 months) who underwent ECMO for refractory cardiac arrest after congenital heart disease surgery. All patients were randomly divided into two groups: a standard group (11 patients) and a hypothermia group (12 patients). The patients of the standard group received standard therapy (the core body temperature maintaining at 37.0℃) and the hypothermia group received hypothermia therapy (the core body temperature maintaining at 33.0℃). The hospital discharge rate, the rate of weaning from ECMO and the morbidity were compared between the two groups. Results     Eleven of 23 patients (47.8%) were weaned from ECMO successfully and 7 of 23 patients (30.4%) discharged from hospital. The hospital discharge rate between the hypothermia group (n=6, 50.0%) and the standard group (n=1, 9.1%) had no statistical difference (χ2=4.537, P=0.069). The rate of weaning from ECMO of the hypothermia group (n=9, 75.0%) was higher than that of the standard group (n=2, 18.2%, χ2=7.425, P=0.006). The morbidity between the two groups had no statistical difference. Conclusion    Extracorporeal cardiopulmonary resuscitation can improve the survival rate of the children who suffered from refractory cardiac arrest after congenital heart disease surgery. There is no evidence that ECMO combined  with hyperthermia therapy is better than the only ECMO in improving the discharge rate. But ECMO combined with hypothermia therapy has higher rate of weaning from ECMO than that of the only ECMO.

Objective The study aimed to explore the development direction of congenital heart disease surgery through comparing Europe with Guangdong General Hospital(GDGH) in data of ECHSA Congenital Database.Methods The data between 2009 to 2015 of Europe and GDGH were extracted from ECHSA Congenital Database.The data of Europe and GDGH were compared by basic information,operating difficulty and mortality.Results The results of Europe and GDGH were patient number(71 763 vs 13 119),procedure/patient ratio(126.2％ vs 104.1％),age[(75.91 ± 146.18) months VS(105.80 ± 172.18) months],the proportion of neonate (18.2％ vs 4.4％),Aristotle mean score (7.00 vs 6.67),30 days mortality (2.98％ vs 1.73 ％).The proportion of neonate palliative operation of Europe was more than that of GDGH.In adult group,Europe was more of reoperation and of GDGH was more of primary surgery.Conclusion The surgical treatment of congenital heart disease of GDGH is developing and is close to the mean average of Europe.The proportion of neonate,complex surgery and reoperation is lower than Europe.