Outcomes and factors associated with early mortality in pediatric postcardiotomy veno‐arterial extracorporeal membrane oxygenation

Mortality and morbidity of children received veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) support after cardiac surgery remain high despite remarkable advances in medical management and devices. The purpose of this study was to describe outcomes and risk factors of applying VA‐ECMO in the surgical pediatric population. We retrospectively analyzed 85 consecutive pediatric patients (aged <18 years) who received postcardiotomy VA‐ECMO from January 2010 to December 2018. Median (IQR) age at ECMO implantation in this cohort was 12.7 (6.4, 43.2) months, median weight was 8.5 (6.0, 12.8) kg, mean ECMO duration was 143.2 ± 81.6 hours and mean hospital length of stay was 48.4 ± 32.4 days. Seventy‐five patients (88.2%) were indicated for postcardiotomy cardiogenic shock. The successful ECMO weaning rate was 70.6% and in‐hospital mortality was 52.9%. The most common diagnosis was transposition of great arteries (n = 18, 21.2%), while acute kidney injury occurred most often (n = 64, 75.3%). Multivariate logistic regression analysis showed that thrombocytopenia, hemolysis, and nosocomial infection were positively correlated with in‐hospital mortality. Multivariate Cox proportional hazard regression analysis presented that thrombocytopenia significantly increased the 180‐day mortality in patients with successful weaning. Therefore, multiple factors had adverse effects on prognosis. Patient selection and procedures from ECMO implantation to weaning need to be closely monitored and performed in a timely manner to improve outcome.     

Pyriform sinus fistula in children: A comparison of endoscopic-assisted surgery and endoscopic radiofrequency ablation

BackgroundPyriform sinus fistula (PSF) is a rare congenital anomaly, and the preferred definitive treatment is yet to be verified. In this study, we investigated the treatment outcomes of PSF specifically comparing endoscopic-assisted surgery and endoscopic radiofrequency ablation (RA).MethodsThe medical records of patients treated for PSF at the Shanghai Children's Hospital between October 2016 and September 2019 were retrospectively evaluated.ResultsThere were 93 girls and 98 boys. The median age at onset and operation was 3 years and 5 years, respectively. Endoscopic-assisted surgery was performed in 143 patients. During the same period, RA was performed in 48 patients, and 10 of them concurrently underwent incision and drainage of neck abscesses. Longer hospital stay was found in the endoscopic-assisted surgery group than in the RA group (10.50 ± 3.93 vs. 5.02 ± 3.30 days, P < 0.001). Postoperative complications were not significantly different between the two groups, except for neck infection (0 vs. 8.3%, P = 0.004). After a median follow-up period of 21 months, no significant difference was found between the two groups in terms of recurrence (1.4% vs. 0, P = 0.560).ConclusionPatients treated with RA had a significantly shorter hospital stay than those treated with endoscopic-assisted surgery. Outcomes of endoscopic-assisted surgery and RA were not significantly different for the management of PSF and treatment method should be tailored to the patient.Level of evidenceIV.     

基于NF-κB相关信号通路探讨常用中药治疗溃疡性结肠炎研究进展

核转录因子-κB(NF-κB)相关信号通路在溃疡性结肠炎的形成与发展中起到很大的作用。研究显示中药单体及单药可以通过NF-κB信号通路介导减少黏膜炎症反应、抑制肠道上皮细胞凋亡、增强肠道黏膜屏障、调节肠道内菌群丰度等抑制溃疡性结肠炎的发展,但具体的作用机制尚不明确。可能与调节TLR4/NF-κB信号通路、JAK2/STAT3/NF-κB信号通路、PI3K/AKT/NF-κB信号通路、NF-κB/NLRP3信号通路等有关。涉及到的常用药物包括黄连、干姜、鸦胆子、黄芪、肉桂、青黛、雷公藤、黄芩、蒲公英、马齿苋、苦参、青蒿等及其提取物小檗碱、6-姜烯酚、鸦胆子苦醇、黄芪多糖、肉桂醛、雷公藤多苷、黄芩苷、苦参总碱、双氢青蒿素等。故围绕NF-κB相关信号通路对常用治疗UC的中药及其单体作一综述,旨在为进一步深入研究提供思路和参考。     

Bacterial expression of immunoglobulin VH proteins

A bacterial expression system in Escherichia coli has been developed that produces as much as 10 mg/l of culture of the VH protein associated with monoclonal antibodies specific for the 5-dimethylaminonaphthalene-2-sulfonyl (Dns) group. This system has been applied to the expression of the VH genes derived from a low-affinity, IgM-producing hybridoma and from a high-affinity, IgG-producing cell line. The plasmid vectors (contributed by Dr William F. Studier) utilize a T7 expression cassette whose activity is initiated by infection with a lambda phage derivative carrying the T7 RNA polymerase gene. The VH proteins were extracted from the bacterial pellet in 8 M urea and purified by chromatography in 8 M urea. Recombinants with the homologous light (L) chains were prepared to yield VHL molecules. These were used to measure intrinsic affinity for Dns-lysine by resonance energy transfer. The association constants were 7 x 10(6) M-1 and 7 x 10(9) M-1 for the low- and high-affinity systems, respectively. These values are not significantly different from those observed with monoclonal antibodies secreted from the corresponding cell lines. This system lends itself to the quantitative evaluation of the binding properties of the VH protein itself as well as the modulation of affinity by site-directed mutagenesis.     

EB病毒转化的丙型肝炎病人外周血B淋巴细胞中丙型肝炎Ⅱ型？…

目的 观察丙型肝炎病人外周血Ｂ细胞长期存活状态下其中是否仍有丙型肝炎病毒（ＨＣＶ）存在。方法 用ＥＢ病毒感染并使ＨＣＶ阳性外周血Ｂ细胞转化,获得含ＨＣＶ的外周血永生化Ｂ细胞（ＬＣＬ）。而后,每月应用套式ＲＴ－ＰＣＲ检测一次培养细胞和上清中的ＨＣＶ－ＲＮＡ,并用酶切法进行ＨＣＶ基因分型,电镜和免疫电镜观察ＨＣＶ在该细胞中存在的部位及其形态结构特征。结果 经连续１年检测,ＨＣＶ在传代细胞中持续存在,培     

混配农药中氰戊菊酯在小鼠体内的代谢和分布

目的　了解混配农药中氰戊菊酯在小鼠体内的代谢和分布。方法　以14 C -氰戊菊酯为示踪剂 ,静脉注射给药。给药后 0 .5～ 12 0min之间采 9次血样 ,8～ 96 0min之间分别对脑、心脏、肝脏和肺脏采 8次样品。样品用 β闪烁计数仪测量 ,并换算成化学浓度。用残数法计算毒代动力学参数。结果　混配农药中的氰戊菊酯的代谢符合二室开放模型。分布相T1/ 2 α为 2 .7min ,消除相T1/ 2 β为 10 6 .6min ,表观分布容积为 2 .9L/kg ,正向扩散系数k12 (0 .17min-1)大于逆向扩散系数k2 1(0 .0 77min-1)。分布浓度肺脏中最高 ,其次为肝脏、心脏、脑。结论　肺脏优势参与了氰戊菊酯的代谢过程 ,应重视此类农药的肺脏毒性。     

影响淋巴细胞共刺激作用的体外实验研究

目的　观察CD3单抗、CD2 8单抗、PHA和低剂量辐射对淋巴细胞增殖的影响 ,探讨影响T淋巴细胞信号转导的因素。方法　分别以CD3单抗、CD2 8单抗、PHA和低剂量辐射作为作用因素 ,用3H TdR掺入法观察在这些因素作用下 ,淋巴细胞增殖反应情况。结果　CD3单抗和CD2 8单抗联合刺激、PHA和低剂量辐射单独或联合处理 ,均可使淋巴细胞明显增殖。但CD3单抗和CD2 8单抗单独刺激 ,淋巴细胞增殖不明显。结论　CD3单抗和CD2 8单抗联合作用可使淋巴细胞有效增殖 ,PHA和低剂量辐射具有相似作用 ,对细胞免疫调节有重要意义     

垂体腺瘤患者围术期促肾上腺皮质激素与皮质醇变化的研究

为观察垂体腺瘤患者围术期促肾上腺皮质激素 (ACTH)与皮质醇 (COR)的变化 ,选取 2 8例择期脑瘤切除患者 ,分为非垂体瘤组 (Ⅰ组 ,n =7)、生长激素 (GH)升高垂体瘤组 (Ⅱ组 ,n =9)和泌乳素升高垂体瘤组 (Ⅲ组 ,n =1 2 ) ,采用静吸复合全麻。抽取围术期不同阶段的静脉血标本 ,用放免法检测ACTH及COR。结果显示 ,术毕停麻醉2 0min时的ACTH和COR与入院后基础值相比差异显著 (P <0 .0 5) ,且Ⅱ、Ⅲ组与Ⅰ组间差异显著 (P <0 .0 5)。提示 :垂体腺瘤患者术毕时ACTH及COR水平明显高于术前 ,这不同于其他神经外科患者。