Background Tetralogy of Fallot(TOF)is the most common cyanotic congenital heart disease.Children with TOF would be confronted with neurological impairment across their lifetime.Our study aimed to identify the risk fac...Background Tetralogy of Fallot(TOF)is the most common cyanotic congenital heart disease.Children with TOF would be confronted with neurological impairment across their lifetime.Our study aimed to identify the risk factors for cerebral morphology changes and cognition in postoperative preschool-aged children with TOF.Methods We used mass spectrometry(MS)technology to assess the levels of serum metabolites,Wechsler preschool and primary scale of intelligence-Fourth edition(WPPSI-Ⅳ)index scores to evaluate neurodevelopmental levels and multimodal magnetic resonance imaging(MRI)to detect cortical morphological changes.Results Multiple linear regression showed that preoperative levels of serum cortisone were positively correlated with the gyrification index of the left inferior parietal gyrus in children with TOF and negatively related to their lower visual spaces index and nonverbal index.Meanwhile,preoperative SpO_(2) was negatively correlated with levels of serum cortisone after adjusting for all covariates.Furthermore,after intervening levels of cortisone in chronic hypoxic model mice,total brain volumes were reduced at both postnatal(P)11.5 and P30 days.Conclusions Our results suggest that preoperative serum cortisone levels could be used as a biomarker of neurodevelopmental impairment in children with TOF.Our study findings emphasized that preoperative levels of cortisone could influence cerebral development and cognition abilities in children with TOF.展开更多
Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces mor...Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces more severe challenges due to the complex anatomical structure of the heart,special pathophysiology,perioperative complications and various concomitant malformations.The survival rate of ECMO for CHD was significantly lower than other classifica-tions of diseases according to the Extracorporeal Life Support Organization database.This expert consensus aims to improve the survival rate and reduce the morbidity of this patient population by standardizing the clinical strategy.Methods The editing group of this consensus gathered 11 well-known experts in pediatric cardiac surgery and ECMO field in China to develop clinical recommendations formulated on the basis of existing evidences and expert opinions.Results The primary concern of ECMO management in the perioperative period of CHD are patient selection,cannulation strategy,pump flow/ventilator parameters/vasoactive drug dosage setting,anticoagulation management,residual lesion screening,fluid and wound management and weaning or transition strategy.Prevention and treatment of complications of bleeding,thromboembolism and brain injury are emphatically discussed here.Special conditions of ECMO management related to the cardiovascular anatomy,haemodynamics and the surgical procedures of common complex CHD should be considered.Conclusions The consensus could provide a reference for patient selection,management and risk identification of periop-erative ECMO in children with CHD.展开更多
Background Vitamin E is the most abundant lipid-soluble antioxidants present in plasma;however,the relationship between serum vitamin E and change in body mass index(BMI)-for-age Z scores in adolescents has not been w...Background Vitamin E is the most abundant lipid-soluble antioxidants present in plasma;however,the relationship between serum vitamin E and change in body mass index(BMI)-for-age Z scores in adolescents has not been well described.Methods This study is a cross-sectional study.Data were analyzed from 4014 adolescents who participated in the National Health and Nutrition Examination Survey.The nutritional status was calculated by BMI Z scores and was classifed into nor-mal weight,overweight,and obese.Multivariable-adjusted logistic regression was used to examine the association between serum vitamin E levels with overweight/obesity.Besides,the interaction effects between potential confounders and vitamin E on obesity were further evaluated.Results After adjusting potential confounders,serum vitamin E levels were negatively associated with overweight/obesity in girls but not in boys.Per standard deviation increment in vitamin E concentrations was associated with a 92%decreased risk of obesity in females.Besides,lower quartiles of serum vitamin E were associated with a higher risk of overweight/obesity in girls.Moreover,the inverse association between serum vitamin E levels and obesity was also found in most subgroups through subgroup analysis.Conclusions Our study supports the negative association between serum vitamin E levels and overweight/obesity in ado-lescents.A higher serum vitamin E level may be associated with a reduced probability of obesity in girls,but not in boys.展开更多
基金supported by the National Natural Science Foundation of China(82270310,81970265).
文摘Background Tetralogy of Fallot(TOF)is the most common cyanotic congenital heart disease.Children with TOF would be confronted with neurological impairment across their lifetime.Our study aimed to identify the risk factors for cerebral morphology changes and cognition in postoperative preschool-aged children with TOF.Methods We used mass spectrometry(MS)technology to assess the levels of serum metabolites,Wechsler preschool and primary scale of intelligence-Fourth edition(WPPSI-Ⅳ)index scores to evaluate neurodevelopmental levels and multimodal magnetic resonance imaging(MRI)to detect cortical morphological changes.Results Multiple linear regression showed that preoperative levels of serum cortisone were positively correlated with the gyrification index of the left inferior parietal gyrus in children with TOF and negatively related to their lower visual spaces index and nonverbal index.Meanwhile,preoperative SpO_(2) was negatively correlated with levels of serum cortisone after adjusting for all covariates.Furthermore,after intervening levels of cortisone in chronic hypoxic model mice,total brain volumes were reduced at both postnatal(P)11.5 and P30 days.Conclusions Our results suggest that preoperative serum cortisone levels could be used as a biomarker of neurodevelopmental impairment in children with TOF.Our study findings emphasized that preoperative levels of cortisone could influence cerebral development and cognition abilities in children with TOF.
基金This study was supported by“the Fundamental Research Funds for the Central Universities”(No.226-2022-00060)National Key R&D Program of China(No.2021YFC2701700).
文摘Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces more severe challenges due to the complex anatomical structure of the heart,special pathophysiology,perioperative complications and various concomitant malformations.The survival rate of ECMO for CHD was significantly lower than other classifica-tions of diseases according to the Extracorporeal Life Support Organization database.This expert consensus aims to improve the survival rate and reduce the morbidity of this patient population by standardizing the clinical strategy.Methods The editing group of this consensus gathered 11 well-known experts in pediatric cardiac surgery and ECMO field in China to develop clinical recommendations formulated on the basis of existing evidences and expert opinions.Results The primary concern of ECMO management in the perioperative period of CHD are patient selection,cannulation strategy,pump flow/ventilator parameters/vasoactive drug dosage setting,anticoagulation management,residual lesion screening,fluid and wound management and weaning or transition strategy.Prevention and treatment of complications of bleeding,thromboembolism and brain injury are emphatically discussed here.Special conditions of ECMO management related to the cardiovascular anatomy,haemodynamics and the surgical procedures of common complex CHD should be considered.Conclusions The consensus could provide a reference for patient selection,management and risk identification of periop-erative ECMO in children with CHD.
基金supported by the China Postdoctoral Science Foundation(2019M651904)the Key Project supported by the Medical Science and Technology Development Foundation,Nanjing Municipality Health Bureau(ZKX19039)+1 种基金the National Key Research and Development Program of China(2017YFC1308105,2016YFC1101001)the National Natural Science Foundation of China(81970265,82000303).
文摘Background Vitamin E is the most abundant lipid-soluble antioxidants present in plasma;however,the relationship between serum vitamin E and change in body mass index(BMI)-for-age Z scores in adolescents has not been well described.Methods This study is a cross-sectional study.Data were analyzed from 4014 adolescents who participated in the National Health and Nutrition Examination Survey.The nutritional status was calculated by BMI Z scores and was classifed into nor-mal weight,overweight,and obese.Multivariable-adjusted logistic regression was used to examine the association between serum vitamin E levels with overweight/obesity.Besides,the interaction effects between potential confounders and vitamin E on obesity were further evaluated.Results After adjusting potential confounders,serum vitamin E levels were negatively associated with overweight/obesity in girls but not in boys.Per standard deviation increment in vitamin E concentrations was associated with a 92%decreased risk of obesity in females.Besides,lower quartiles of serum vitamin E were associated with a higher risk of overweight/obesity in girls.Moreover,the inverse association between serum vitamin E levels and obesity was also found in most subgroups through subgroup analysis.Conclusions Our study supports the negative association between serum vitamin E levels and overweight/obesity in ado-lescents.A higher serum vitamin E level may be associated with a reduced probability of obesity in girls,but not in boys.
