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。     

基于慢性乙型病毒性肝炎诊断路径的实验诊断学教学模式初探

探讨建立涵盖慢性乙型病毒性肝炎(CHB)诊断与鉴别诊断、治疗、药物选择及毒副作用预测、疗效监测、预后评估等全过程的疾病临床检验诊断路径的教学模式。根据CHB临床诊疗指南, 制订与疾病不同阶段相关的实验室检查检测策略, 建立CHB临床检验诊断路径, 以武汉大学第一临床学院2016级和2017级八年制本科生为研究对象, 通过随堂问卷比较其课堂教学效果。本研究首先建立了获得临床医生认可的CHB临床检验诊断路径, 其涵盖CHB疾病的诊断与鉴别诊断、治疗、药物选择及毒副作用预测、疗效监测、预后评估等全过程。该路径应用于2017级临床医学本科生课堂教学后, 教学质量评估指标均有较大程度的提升。此外, 随堂测验得分也有显著提高。综上, 基于CHB临床检验诊断路径的实验诊断学教学模式, 实现了实验诊断学与临床医学的融合, 提升了学生对CHB诊疗中各种实验室检查检测的整体认识, 教学质量得到了提高。     

牛磺酸对大鼠心脏模拟缺血再灌注损伤的保护作用

在离体大鼠心脏模拟缺血再灌注(I/R)损伤的模型上观察了牛磺酸的心肌保护作用。实验结果发现预先给大鼠牛磺酸灌胃(300mg/kg)三日或再灌注同时给药(20mmol/L),对心肌均有保护作用,明显减少心肌细胞内的Mb、LDH的漏出,降低心肌MDA的生成,减轻细胞内钙的聚集,促进心肌ATP含量的恢复。在本实验条件下预防应用牛磺酸较再灌注的同时应用更为有效,表现为更大程度地减少LDH漏出,抑制心肌MDA生成和钙聚集。结果证明牛磺酸具有心肌保护作用,对于防治心肌I/R损伤可能具有临床应用价值。