Objective To compare the difference of effect while using homograft pericardium patch and Gore- tex patch in staged repair of tetralogy of Fallot（TOF） to enlarge the right ventricular outflow tract （RVOT）. Methods Twenty-eight patients with TOF who underwent the staged complete repair were divided into 2 groups according to the date of surgery. Gore-rex group, 13 cases, their RVOT were enlarged with Gore-tex patches. Cryopreserved homograft pericardium patch group, 15 cases, their RVOT were enlarged with cryopreserved homograft pericardium patches. Clinical results and follow-up results were compared. Results There were 1 operative death in Gore-tex patch group （7. 7%）, and 1 early postoperative death in cryopreserved homograft pericardium patch group （6. 7%）. Hemostasia time, the pericardial cavity drainage volume in cryopreserved homograft pericardium patch group were less than those in Gore-tex patch group （P〈0. 01）. All patients were followed-up for 0.8-4.5years. The residual obstruction rate at RVOT level in Gore-tex patch group was higher than that in cryopreserved homograft pericardium patch group by echocardiography （P〈0.01）. No calcification shadow was found on the chest X-ray. Conclusion Homograft pericardium is the tissue with high density and intensity, its elasticity and compliance are good. Using homograft pericardium patch may be helpful to decrease the residual obstruction of RVOT after operation. It can be adapted as a repairing material in heart surgery.
Under the new era background of actively advocating the " active health” in the elderly, the prevention methods of falls not only include environmental modification, reasonable drugs, emotional support, disease prevention and control, etc., but exercise should also be integrated into them. Exercise training can significantly improve muscle strength, balance, and mobility in the elderly, thereby reducing the risk of falls. This paper reviews the biomechanical causes of falls in the elderly, the sports training prescriptions for fall prevention in the elderly, and the research prospects of sports training for fall prevention in the elderly. It is hoped that the elderly population could establish an active healthy lifestyle based on sports training, elevate the physical fitness continuously, reduce the fall injury, and improve the quality of life through strength, balance, and endurance training.
ObjectiveTo investigate if the ratio of pulmonary valve annulus, which is the proportion of pulmonary valvular annulus size to total size of aortic valvular annulus and pulmonary valvular annulus, can better guide the choice of surgical approach than the value of z.MethodsA retrospective analysis was made for 254 patients who underwent total correction of tetralogy of Fallot in Guangdong General Hospital between January 2016 and January 2018. There were 154 males and 100 females with an average age of 14.60±18.76 years. The patients were categorized into two groups, a transannular patch group (TAP, n=164) and a non-TAP group (n=90). The sizes of pulmonary and aortic valvular annulus were evaluated in each group, and the cutoff value of proportion of pulmonary valvular annulus for TAP was calculated.ResultsBoth proportion of pulmonary valvular annulus and z-scores were smaller in the TAP group than those in the non-TAP group (0.29±0.06 vs. 0.36±0.06, P<0.001; –4.04±2.13 vs. –2.06±1.84, P<0.001, respectively). In receiver operating characteristics analyses, proportion of pulmonary valvular annulus and the z-score cutoff values were 0.353 (area under the curve 0.781, 95%CI 0.725–0.831) and –2.13 (area under the curve 0.766, 95%CI 0.709–0.817), respectively, demonstrating that the proportion of pulmonary valvular annulus was a more powerful diagnostic tool as a predictor of TAP.ConclusionOur results suggest that the proportion of pulmonary valvular annulus is an effective predictor for TAP and can be easily applied to clinical practice.
ObjectiveTo investigate the diagnostic value of serum neutrophil gelatinase-associated lipocalin (NGAL) for early acute kidney injury (AKI) after tetralogy of Fallot (TOF) surgery. MethodsWe retropectively analyzed the clinical data of 113 patients underwent TOF surgery in our hospital bewteen April 2012 and April 2014. There were 67 males and 46 females at the average age of 8.28±4.75 months ranging from 5 months to 18 months. According to the different clinical manifestation of AKI, those patients were devided into a group A, group B, and group C. In the group A, there were 78 patients with 43 males and 35 females at the mean age of 8.18±3.72 months. In the group B, there were 20 patients with 12 males and 8 females at the mean age of 8.25±1.27 months. In the group C, there were 15 patients with 12 males and 3 females at the mean age of 8.09±2.92 months. We collected the blood in different time before and after the operation. At the same time, we carried on one-way analysis of variance to detect the differences among the three groups. ResultsThere was no statistical difference in the level of serum NGAL among the 3 groups before operation. Compared to pre-operation, there was no statistical difference in the level of serum NGAL among the different time of the group A (P>0.05). There was oliguria and potassium increased in the group B. After strengthening cardiac and lightening heart load, urine volume recovered. There was a transient rise in serum NGAL and the summit is 199.90±49.44 ng/ml at the 8th hour. Compared with that before operation, there was a statistical difference. After 12 hours, the serum NGAL decreased to the normal level. The serum NGAL levle of Group C had constantly increased and there was a statistical difference compared with that before the surgery. After the treatment of peritoneal dialysis, the serum NGAL returned to the normal level. The area under receiver operating characteristic (ROC) curve of serum NGAL in the group C was 0.881 (95%CI:0.73-1.00, P<0.05). ConclusionThe detection of serum NGAL level can be valuable for early diagnosis and treatment for AKI after TOF surgery.
Abstract: Objective To investigate the method of improving effect, by investigating and analyzing the possible risk factors affecting shortterm outcome after total correction of tetralogy of Fallot (TOF). Methods Data of 219 patients who received total correction of TOF were divided into two groups according to the length of postoperative stay in hospital and recovery of heart function in the near future. Group A(n=110): patients had good recovery of heart function classified as gradeⅠorⅡ（NYHA classification）, and could smoothly be discharged from the hospital within two weeks without serious complications. The left ventricular ejection fraction (LVEF) had to exceed to 0.50 during 6 months followup visit. Group B(n=109): patients had worse recovery of heart function classified as grade Ⅱ or Ⅲ, and could not be discharged within two weeks with severe complications. LVEF was less than 0.50 during 6 months followup visit. The clinical data of two groups were compared, and risk factors affecting shortterm outcome after total correction of TOF operation were analyzed by logistic regression and model selection. Results There were good recovery of heart function classified as gradeⅠorⅡ(NYHA classification）in discharge, no death, and LVEF all exceeded to 0.50 in group A; there were 8 deaths in group B (7.34 %), and recovery of heart function was worse classified as grade Ⅱ or Ⅲ, with LVEF being less than 0.50（Plt;0.01）. Amount of postoperative daily thoracic drainage, assisted respiration time, time of inotropic agent stabilizing circulation, and the average length of postoperative stay in group A were all less or short than those in group B（Plt;0.01）. But the bypass and clamping time of group B were exceeded group A. The ratio of patching astride annulus in group B was greater than that in group A, and Nakata index was less than that in group A(Plt;0.01). The results of logistic regression and model selection indicate: age at repair (OR=0.69), oxygen saturation(OR=0.98), haematocrit before operation (OR=0.94), and patching astride annulus (OR=46.86), Nakata index (OR=16.90), amount of postoperative daily thoracic drainage (OR=0.84), presence of arrhythmia(OR=0.87), and wound infection(OR=63.57) have significant effect with shortterm outcome after total correction of TOF operation. Conclusions The probable methods to improving effect of shortterm outcome after total correction of TOF are an earlier age at repair, decreasing haematocrit, rising oxygen saturation before surgery, performing a palliative operation facilitating development of arteriae pulmonalis in earlier time, improving the surgical technique, and strengthening the perioperative care.
Abstract: Objective To analyze the surgical treatment of tetralogy of Fallot (TOF) with anomalous coronary artery (ACA) crossing the right ventricular outflow tract (RVOT), in order to improve the outcome of the disease. Methods The clinical data of 26 patients of TOF with ACA crossing the RVOT of Fu Wai Hospital from Oct.1996 to Feb.2006 were analyzed retrospectively. A double ventriculotomy superior and inferior to ACA were used in 11 patients, one ventriculotomy inferior to ACA were used in 6 patients and superior to ACA for 4 patients, 2 patients needed extra cardiac conduits, and 3 patients received other approaches. Results There were 2 operative death （7.7%）and no late deaths. Follow-up was extended 1 to 100 months, all of them had no residual ventricular septal defect(VSD) and their right ventriclepulmonary artery gradient were 27.3±15.6 mmHg. Conclusion Preoperative identification of ACA in patients with TOF is necessary. The surgeon should be careful in inspection of distribution of coronary artery during operation, and undergo the individualized surgical procedures based on the extent of RVOT obstruction and distribution of the ACA.
Objective To explore risk factors related to acute kidney injury (AKI) in children who underwent corrective surgery for tetralogy of Fallot (TOF). Methods We retrospectively analyzed the clinical data of 726 children with corrective procedures for TOF aged less than 3 years in our hospital from March 1st 2010 to March 1st 2013. Children with AKI were picked using Acute Kidney Injury Network criteria. Demographic and perioperative variables of the remaining patients were reviewed. Univariate analysis was performed to compare the AKI group (240 patients) with the non-AKI group (486 patients). Multivariable analysis was carried out to identify significant determinants of AKI. Results A total of 240 children were with AKI. The result of univariate analysis showed that there was a statistical difference in age, Nakata index, McGoon ratio, left ventricular end-diastolic volume index (LVEDVI), transannular right ventricular outflow tract (RVOT) patch, or fresh frozen plasma (FFP) in prime solution between the AKI group and the non-AKI group. Multivariable logistic regression showed that in older children (OR=1.425, 95% CI 1.071 to 1.983, P=0.011) with more transfusion of FFP in the priming solution (OR=1.486, 95% CI 1.325 to 2.674, P<0.001) led to higher morbidity of mild AKI. In addition, there was an increase in morbidity related to AKI when children had less Nakata index (OR=0.282, 95% CI 0.092 to 0.869, P=0.013). Conclusion Postoperative AKI increases in older children group. Infusion of more FFP in priming solution increases morbidity of AKI. The less Nakata index is significantly associated with severe AKI.
Abstract: Objective To evaluate the protective effects of Ulinastatin on the peri-operative liver and renal function in patients undergoing cardiac surgery for tetralogy of Fallot (TO F). Methods Thirty-eight patients with TOF were divided into Ulinastatin group and control group according to admission sequence, 19 cases in each group.For Ulinastatin group, intravenous Ulinastatin was given with a dosage of 10 000U /kg at 1h before operation, 1h and 24 h after operation. For control group, no Ulinastatin was given. 10 ml fresh urine and 2 ml blood samples were collected before operation, and postoperative 1h, 10h, 24h, 48h and 72h, respect ively. The liver and renal functions were measured. Fluid intake, urine output, chest drainage, dosage of furosemide, durations of mechanical ventilation and intensive care unit ( ICU ) stay were recorded. Results Neither arrhythmia nor low cardiac output syndrome occurred for both groups. No peri-operative death. Compared with control group, dose of furosemide, period of mechanical ventilation were lower, while urine output was higher in Ulinastat in group; the aberrant climax value of urine pro tein and N-acetylglucosam inidase (NAG) were lower in Ulinastatin group (10h post-operat ively, urinem icroalbum in: 65. 2 ± 58. 3mg/L vs. 71. 8 ±58. 9mg/L ; urine transferrin: 5. 8 ± 3. 6mg/L vs. 7. 4 ± 5. 4mg/L ; urine immunoglobulin G: 26. 9±20. 3mg/L vs. 31. 3±23. 3mg/L ; 1h post-operat ively; urine NAG: 61. 4±81. 6U /L vs. 76.1±48. 5 U /L ; P lt; 0. 05) and maintained in shorter period (P lt; 0. 05) , it returned to baseline value at 48h and 72 h post-operatively. The value of alanine aminotransferase (ALT) significantly increased post-operatively at every time points in control group (P lt; 0. 01) , w hile no obvious change in Ulinastat in group (P gt; 0. 05). The increased value of aspartate aminotransferase (AST ) in Ulinastatin group was significantly lower than that in control group (10h post-operat ively: 144. 4±20. 8U /L vs. 202. 7±74. 1U /L ; P lt; 0. 01). The value of AST returned to baseline value at 48h and 72h post-operat ively. Conclusion U linastatin is an effect ive strategy for protecting peri-operat ive liver and renal function of the patients with tetralogy of Fallot and the clinical application of Ulinastatin is safe and effective.
ObjectiveTo assess the methodological quality of systematic reviews of Tai Chi for preventing falls in the elderly and the quality of evidence for outcome indicators.MethodsPubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang Data, CBM and VIP databases were electronically retrieved. According to the inclusion criteria and exclusion criteria, the final articles were selected and the relevant literature information was extracted by reading the abstract and the full text. The methodological quality of the included systematic reviews was evaluated using AMSTAR 2 tool, and the quality of the outcome indicators of the included systematic reviews was further graded according to the GRADE system.ResultsA total of 11 systematic reviews/meta-analyses were included. The AMSTAR 2 evaluation showed that 10 studies were in critically-low methodological quality, and 1 study was in low methodological quality. The GRADE evaluation results showed that among the 36 outcome indicators included, there were 10 intermediate quality indicators, 20 low-level quality indicators and 6 extremely low-level quality indicators. Among the indicators of intermediate quality, single-leg stand test (MD = 5.33, 95%CI 3.35 to 7.32, P< 0.01; WMD = 1.76, 95%CI −7.00 to 10.52, P< 0.01), time up and go test (MD = 1.04, 95%CI 0.67 to 1.41, P< 0.01), the berg balance scale (MD = 2.18, 95%CI 0.93 to 3.43, P< 0.01), number of falls (RR = 0.82, 95%CI 0.73 to 0.92), P< 0.01), the incidence of 2-falls (OR = 0.69, 95%CI 0.49 to 0.97, P< 0.01) and the incidence of 3-falls (OR = 0.39, 95%CI 0.21 to 0.73, P< 0.01). The results of the above indicators were statistically significant, indicating that Tai Chi was better than control group.ConclusionsAt present, the methodological quality of relevant systematic reviews of Tai Chi for preventing falls in the elderly was relatively low and the quality of the evidence was not good, so it can’t be proved that Tai Chi can effectively prevent falls in the elderly, which needs to be further studied at a high level.
ObjectiveTo summarize cardiopulmonary bypass (CPB) management experience in tetralogy of Fallot (TOF) infants weighing less than 8 kg. MethodsA total of 120 TOF infants weighing less than 8 kg received surgical repair in Wuhan Union Hospital from July 2009 to August 2013. There were 85 males and 35 females with their age of 1-18 months and body weight of 4-8 kg.The diagnosis of all the patients was made with echocardiography and diagnostic cardiac catheterization. Moderate hypothermia or profoundly hypothermic CPB with low-flow perfusion was used according to different surgical procedures. Imported membrane oxygenators and 4:1 cold blood cardioplegia were used. Zero-balance ultrafiltration during CPB and modified ultrafiltration during rewarming were performed. ResultsCPB time was 65-200 (115.3±9.6) minutes, and aortic cross-clamping time was 40-110 (60.3 ±10.2) minutes. A total of 112 patients received moderate hypothermia and low-or moderate-flow perfusion, and 8 patients received profound hypothermia and low-flow perfusion. Ultrafiltration volume was 780.5±50.3 ml, and hematocrit (HCT) increased to 0.35-0.40 after modified ultrafiltra-tion. Heart beat was automatically recovered in 114 patients (95%) after aortic unclamping. Weaning off CPB was successful in 119 patients, and 1 patient received extracorporeal membrane oxygenation because of difficult weaning from CPB. Postoperative mechanical ventilation time was 26.5±14.5 hours, and length of ICU stay was 121.5±16.5 hours. Five patients died of low cardiac output syndrome, and the other 115 patients were discharged successfully. ConclusionAppropriate hemodilution and colloidal pump priming solutions, perfusion methods suitable with surgical procedures, 4:1 cold blood-potassium cardioplegia, continuous zero-balance ultrafiltration during CPB and modified ultrafiltration during rewarming to maintain reasonable HCT and colloid osmotic pressure are all crucial factors in CPB management for surgical repair of TOF in infants.