Surgical Treatment of 144 Children with Ventricular Septal Defect and Severe Pulmonary Hypertension

Objective To report the result of surgical treatment for 144 children with ventricular septal defect and severe pulmonary hypertension. Method The diagnosis had been confirmed by cardiac catheter before the operation, Pp/Ps (0. 81±0.09) and Rp (9.41 ±5.37 ) wood. Ventricular septal prothesis was performed under cardiopulmonary bypass. Transthoracic intracardiac monitoring line inserted into pulmonary artery in 117 cases. Results Fourteen cases died of the 144 postoperatively, with mortality of 9.12% . Preoperative Pp/Ps≥0. 8 and Rp≥10 wood made the mortality higher than that of others ( P < 0. 05 ) . 32 persons had post - operative SpPA > 50 mmHg among the survivors and among the children with preoperative Pp/Ps ≥0. 8 and Rp≥10 wood the mortality was 28. 6 % being higher than that among those with Pp/Ps≥0. 8 and Rp < 10 wood. Conclusion The higher the preoperative Pp/Ps and Rp are, the higher the surgical mortality is. The prevention and treatment of postoperative pulmonary hypertension crisis sh     

Comprehensive effective and efficient global public health surveillance

At a crossroads, global public health surveillance exists in a fragmented state. Slow to detect, register, confirm, and analyze cases of public health significance, provide feedback, and communicate timely and useful information to stakeholders, global surveillance is neither maximally effective nor optimally efficient. Stakeholders lack a globa surveillance consensus policy and strategy; officials face inadequate training and scarce resources.Three movements now set the stage for transformation of surveillance: 1) adoption by Member States of the World Health Organization (WHO) of the revised International Health Regulations (IHR[2005]); 2) maturation of information sciences and the penetration of information technologies to distal parts of the globe; and 3) consensus that the security and public health communities have overlapping interests and a mutual benefit in supporting public health functions. For these to enhance surveillance competencies, eight prerequisites should be in place: politics, policies, priorities, perspectives, procedures, practices, preparation, and payers.To achieve comprehensive, global surveillance, disparities in technical, logistic, governance, and financial capacities must be addressed. Challenges to closing these gaps include the lack of trust and transparency; perceived benefit at various levels; global governance to address data power and control; and specified financial support from globa partners.We propose an end-state perspective for comprehensive, effective and efficient global, multiple-hazard public health surveillance and describe a way forward to achieve it. This end-state is universal, global access to interoperable public health information when it's needed, where it's needed. This vision mitigates the tension between two fundamental human rights: first, the right to privacy, confidentiality, and security of personal health information combined with the right of sovereign, national entities to the ownership and stewardship of public health information; and second, the right of individuals to access real-time public health information that might impact their lives.The vision can be accomplished through an interoperable, global public health grid. Adopting guiding principles, the global community should circumscribe the overlapping interest, shared vision, and mutual benefit between the security and public health communities and define the boundaries. A global forum needs to be established to guide the consensus governance required for public health information sharing in the 21st century.     

Pulmonary impairment after tuberculosis and its contribution to TB burden

Background  

The health impacts of pulmonary impairment after tuberculosis (TB) treatment have not been included in assessments of TB burden. Therefore, previous global and national TB burden estimates do not reflect the full consequences of surviving TB. We assessed the burden of TB including pulmonary impairment after tuberculosis in Tarrant County, Texas using Disability-adjusted Life Years (DALYs).     

乳腺癌患者术后功能康复的临床路径

目的 探讨临床路径在乳腺癌术后患者患肢功能康复中的应用效果.方法 用历史对照的研究方法,将84例患者分为两组,每组42例,常规组采用常规锻炼方法,临床路径组按照临床路径方式制定锻炼程序指导功能锻炼.结果 术后功能锻炼正确率临床路径组为100%,常规组为61.9%.术后患肢功能恢复达优率临床路径组为85.7%,常规组为61.9%;术后并发症中患肢水肿发生率临床路径组为9.5%,常规组为28.6%.经统计学处理均有显著性差异（P＜0.05或P＜0.01）.结论 临床路径模式应用于乳腺癌术后功能锻炼,能明显提高患者术后功能锻炼的正确率,有效减少术后并发症,显著提高功能锻炼达优率,使患者在较短时间内恢复自理能力.     

Evaluation of Tumor DNA Sequencing Results in Patients with Gastric and Gastroesophageal Junction Adenocarcinoma Stratified by TP53 Mutation Status

BackgroundGastric cancer (GC) and gastroesophageal junction adenocarcinomas (GEJ) are molecularly diverse. TP53 is the most frequently altered gene with approximately 50% of patients harboring mutations. This qualitative study describes the distinct genomic alterations in GCs and GEJs stratified by TP53 mutation status.Patients and MethodsTumor DNA sequencing results of 324 genes from 3741 patients with GC and GEJ were obtained from Foundation Medicine. Association between gene mutation frequency and TP53 mutation status was examined using Fisher’s exact test. Functional gene groupings representing molecular pathways suggested to be differentially mutated in TP53 wild-type (TP53_WT) and TP53 mutant (TP53_MUT) tumors were identified. The association of the frequency of tumors containing a gene mutation in the molecular pathways of interest and TP53 mutation status was assessed using Fisher’s exact test with a P-value of <.01 deemed statistically significant for all analyses.Results TP53 mutations were noted in 61.6% of 2946 GCs and 81.4% of 795 GEJs (P < .001). Forty-nine genes had statistically different mutation frequencies in TP53_WT vs. TP53_MUT patients. TP53_WT tumors more likely had mutations related to DNA mismatch repair, homologous recombination repair, DNA and histone methylation, Wnt/B-catenin, PI3K/Akt/mTOR, and chromatin remodeling complexes. TP53_MUT tumors more likely had mutations related to fibroblast growth factor, epidermal growth factor receptor, other receptor tyrosine kinases, and cyclin and cyclin-dependent kinases.ConclusionThe mutational profiles of GCs and GEJs varied according to TP53 mutation status. These mutational differences can be used when designing future studies assessing the predictive ability of TP53 mutation status when targeting differentially affected molecular pathways.     

Association between ADIPOQ gene polymor-phisms and the risk of new-onset diabetes mel-litus after liver transplantation

BACKGROUND:New-onset diabetes after transplantation (NODAT) has become one of the major factors that affect the overall survival and long-term life quality in liver transplan-tation (LT) recipients. Previous studies found that the serum adiponectin concentration of diabetic patients is significantly lower than that of healthy subjects. Adiponectin regulates the blood glucose level by increasing body sensitivityto insulin through various mechanisms. In this study, we aimed to in-vestigate the impact of diabetes related gene polymorphisms on the development of NODAT in liver recipients. METHODS: A total of 256 LT patients in a single-center were selected retrospectively for the study. Genomic DNA was extracted from explanted liver tissues, and tested for twelve diabetes mellitus associated single nucleotide polymorphisms by Sequenom MassARRAY. Modified clinical models in pre-dicting NODAT were established and evaluated.RESULTS: The GG genotype of ADIPOQ rs1501299 gene polymorphism was significantly more frequent in NODAT than non-NODAT LT patients (56% vs 39%,P=0.014). Dom-inant model (GG vs GT+TT,P=0.030) and recessive model (GT+GG vs TT,P=0.005) also confirmed the genotype distri-bution difference between NODAT and non-NODAT groups. Age (OR=1.048,P=0.004), BMI (OR=1.107,P=0.041), and blood tacrolimus level at 1-month LT (OR=1.170,P=0.003) were clinical independent risk factorsof NODAT. Furthermore, rs1501299 could improve the ability of clinical model in predict-ing NODAT (AUROC=0.743,P<0.001). CONCLUSION: ADIPOQ rs1501299 gene polymorphism is associated with an increased risk of NODAT, which should be added to the clinical models in predicting the occurrence of NODAT in LT recipients.     

MCS＋血细胞分离机在治疗性红细胞采集术中的应用

目的探讨MCS＋血细胞分离机应用于治疗性红细胞采集（TE）时的操作要点和临床观察指标。方法采用治疗性自体红细胞采集（TAE）程序，选择随机等量补充补偿液，不加添加剂模式。比较采集前后的红细胞（RBC）、红细胞比积（HCT）、血红蛋白（HGB）、B超等结果，观察治疗效果；分析比较机器显示的预计采后HCT值与实际采后的外周血HCT的差别。结果6例病人采集后外周血血常规（血Rt）示RBC、HCT、HGB均明显下降，与采集前比较差异有统计学意义（P〈0．01），原有脾肿大的患者B超均明显缩小；机器显示的预计采后HCT均比实际采后外周血HCT低，差异有统计学意义（P〈0．01）。结论应用MCS＋血细胞分离机进行他是安全有效的。