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Objective To identify the risk factors for early fluid overload (FO) following repair in the pediatric patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) complicated with moderate or severe left ventricular dysfunction (left ventricular ejection fraction [LVEF] ＜50％) and evaluate the effect on clinical outcomes.Methods Forty-three pediatric patients with ALCAPA complicated with moderate or severe left ventricular dysfunction,aged 2-128 months,weighing 4.5-34.5 kg,with New York Heart Association Ⅲ or Ⅳ,undergoing ALCAPA repair,were enrolled in this study.The pediatric patients were divided into FO ≥ 5％ group (n =14) and FO＜5％ group (n =29)according to the FO developed within 24 h after operation.The pediatric Risk,Injury,Failure,Loss,and End-Stage Renal Disease criterion was used to diagnose acute kidney injury developed after operation.Factors including age,height,weight,preoperative LVEF,preoperative biomarkers,operative data,postoperative ventilation time,duration of intensive care unit (ICU) stay and related postoperative clinical outcome parameters were recorded.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors for FO ≥ 5％ developed within 24 h after operation.The effect of FO≥5％ on postoperative severe acute kidney injury (Injury and Failure),ventilation time,duration of ICU stay and etc.was assessed.Results Fourteen cases developed early postoperative FO≥5％,and the incidence was 33％.The results of the logistic regression analysis showed that lower preoperative LVEF was an independent risk factor for early postoperative FO ≥ 5％ (P＜0.05).Compared with FO＜5％ group,the postoperative ventilation time and duration of ICU stay were significantly prolonged,the number of pediatric patients who developed pulmonary infection and required reintubation was increased,the number of pediatric patients in whom duration of ICU stay was more than 14 days was increased (P＜0.05),and no significant change was found in the other parameters of clinical outcomes in FO ≥ 5％ group (P＞0.05).Conclusion Lower preoperative LVEF is a risk factor for early postoperative FO in pediatric patients with ALCAPA complicated with a moderate or severe left ventricular dysfunction undergoing repair,and it is not helpful for clinical outcomes in pediatric patients when postoperative early FO≥5％ occurs.
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Objective@#To identify the risk factors for early fluid overload(FO)following repair in the pediatric patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) complicated with moderate or severe left ventricular dysfunction (left ventricular ejection fraction [LVEF]<50%) and evaluate the effect on clinical outcomes.@*Methods@#Forty-three pediatric patients with ALCAPA complicated with moderate or severe left ventricular dysfunction, aged 2-128 months, weighing 4.5-34.5 kg, with New York Heart Association Ⅲ or Ⅳ, undergoing ALCAPA repair, were enrolled in this study.The pediatric patients were divided into FO≥5% group (n=14) and FO<5% group (n=29) according to the FO developed within 24 h after operation. The pediatric Risk, Injury, Failure, Loss, and End-Stage Renal Disease criterion was used to diagnose acute kidney injury developed after operation. Factors including age, height, weight, preoperative LVEF, preoperative biomarkers, operative data, postoperative ventilation time, duration of intensive care unit(ICU)stay and related postoperative clinical outcome parameters were recorded.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors for FO≥5% developed within 24 h after operation.The effect of FO≥5% on postoperative severe acute kidney injury (Injury and Failure), ventilation time, duration of ICU stay and etc. was assessed.@*Results@#Fourteen cases developed early postoperative FO≥5%, and the incidence was 33%.The results of the logistic regression analysis showed that lower preoperative LVEF was an independent risk factor for early postoperative FO≥5% (P<0.05). Compared with FO<5% group, the postoperative ventilation time and duration of ICU stay were significantly prolonged, the number of pediatric patients who developed pulmonary infection and required reintubation was increased, the number of pediatric patients in whom duration of ICU stay was more than 14 days was increased (P<0.05), and no significant change was found in the other parameters of clinical outcomes in FO≥5% group (P>0.05).@*Conclusion@#Lower preoperative LVEF is a risk factor for early postoperative FO in pediatric patients with ALCAPA complicated with a moderate or severe left ventricular dysfunction undergoing repair, and it is not helpful for clinical outcomes in pediatric patients when postoperative early FO≥5% occurs.
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Objective: To detect the thickness of silicon coating film for glass injection bottles by focused ion beam (FIB) emission scanning electron microscopy and investigate the stability and uniformity of the film.Methods: The boron silicon coating injection bottles were selected as the experimental samples and treated with such stability experiments as ultrasonic cleaning, high temperature resistance, heat resistance, water resistance, acid resistance and alkali resistance.The samples were vertically cut by the ion beam from an FIB field emission scanning electron microscope, and the thickness of the cutting face was measured by the built-in measuring module of the scanning electron microscope.Results: The thickness of silicon film was stable and uniform.Conclusion: The film thickness of glass bottles can be accurately detected, and the film stability and uniformity can be reflected directly and objectively by using an FIB double beam field emission scanning electron microscope.
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BACKGROUND:Bone marrow stem cels combined with traditional surgery regimen can significantly improve the therapeutic effects on bone nonunion, which are considered to have an important application value. OBJECTIVE:To explore therapeutic effect of bone marrow mesenchymal stem cels on bone nonunion under micro-damage environment. METHODS:Forty New Zealand white rabbits were selected and randomized into experimental and control groups, 20 rabbits in each group. Bone marrow of the tibia was extracted to isolate and culture bone marrow mesenchymal stem cels. Passage 3 cels with the order of magnitudes of 107 were labeled by superparamagnetic iron oxide nanoparticles. A 15-mm bone defect was made at the middle of the radius of the rabbit forelimb. Bone nonunion appeared at 6 weeks after bone defects. Bone marrow mesenchymal stem cels combined with iliac particles were implanted into the bone defect of rabbits in the experimental group, and only iliac particles were implanted into the bone defect of rabbits in the control group. Within 12 weeks after implantation, the bone nonunion was observed through gross morphology, X-ray observation, and pathological observation. RESULTS AND CONCLUSION:After implantation, a remarkable calus was found in the experimental group, and the bone defect recovered gradualy until it was completely healed; in the control group, there was no calus, and the bone marrow cavity was closed and ful of granulation tissues. In the experimental group, there were actively proliferated cartilage tissues, bone particles were fused, osteoid structures appeared, and osteoblasts proliferated progressively; in the control group, poor cartilage hyperplasia was found, and there were a large amount of dead bone tissues but no fused bone particles and osteoblasts. In the experimental group, X-ray films on the defected radium showed cloudiness-like shadow, the bone marrow cavity was recanalized, and the skeleton was shaped wel; in the control group, few bone particles were absorbed, the bone marrow cavity was partly recanalized, and the injured bone was not healed with osteosclerosis. These findings indicate that under the micro-damage environment, bone marrow mesenchymal stem cels can differentiate into osteoblasts to repair bone defects-induced bone nonunion.
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Objective To identify the risk factors for early postoperative elevation in body temperature in patients undergoing coronary artery bypass grafting (CABG).Methods Nine hundred and forty-one patients of both sexes,aged 14-70 yr,were assigned into hyperthermia (≥ 38 ℃) group or non-hyperthermia (＜ 38 ℃) group according to the bladder temperature at 8h after operation.Factors including age,sex,height,weight,complications (hypertension,hyperlipemia,diabetes),history of smoking and drinking,preoperative blood pressure,heart rate,ejection fraction,routine blood examination,routine urine examination,and respiratory function examination,intraoperative cardiopulmonary bypass (CPB) and hormone,operation time,extubation time,duration of stay in the intensive care unit,and blood pressure,heart rate,ejection fraction,routine blood examination,and routine urine examination at the end of operation,and postoperative analgesia were recorded.The risk factors of which P values were less than 0.05 would enter the multi-factor logistic regression analysis to stratify the risk factors for early postoperative elevation in body temperature after CABG.Results Six hundred and ninety patients developed early postoperative elevation in body temperature (73.3％).Logistic regression analysis showed that preoperative respiratory dysfunction,preoperative ejection fraction ≤ 50％ and CPB were independent risk factors for early postoperative hyperthermia after CABG (P ＜ 0.05).Conclusion Preoperative respiratory dysfunction,preoperative ejection fraction≤ 50％ and CPB are independent risk factors for early postoperative elevation in body temperature in patients undergoing CABG.
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Objective To evaluate the blood-saving effect of tranexamic acid in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).Methods The study was a prospective,randomized and placebo-control trial.Two hundred ASA Ⅰ-Ⅳ patients,aged 18-64 yr,weighing 50-100 kg,were randomized to receive placebo (group C,n =100) or tranexamic acid (group T,n =100).Tranexamic acid 10 mg/kg was intravenously infused over 20 min before skin incision followed by continuous infusion at 10 mg· kg-1 · h-1 until the end of operation in group T.While the equal volume of normal saline was given in group C.The total volume of postoperative chest tube drainage,postoperative massive bleeding and a second thoracotomy for stopping the bleeding were reordered.The requirement for transfusion of allogeneic blood and complications during the perioperative period were also recorded.Results Compared with group C,the total volume of postoperative chest tube drainage and incidences of postoperative massive bleeding and a second thoracotomy for stopping the bleeding were significantly decreased,and the requirement for transfusion of allogeneic red blood cells,platelet and fresh frozen plasma was reduced in group D (P ＜ 0.05).There was no significant difference in the incidence of complications between the two groups (P ＜ 0.05).Conclusion Tranexamic acid exerts the blood-saving effect in patients undergoing CABG with CPB and can significantly reduce postoperative bleeding and transfusion of allogeneic blood.
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Objective To investigate the blood-saving effect of tranexamic acid in off-pump coronary artery bypass (OPCAB). Methods Two hundred and sixty ASA Ⅰ- Ⅲ and NYHA Ⅰ- Ⅲ patients of both sexes,aged 18-64 yr, with body mass index 16-22 kg/m2 , undergoing OPCAB, were randomly divided into 2 groups (n = 130 each): control group (group C) and tranexamic acid group (group T) . Anesthesia was induced with iv injection of midazolam 0.1 mg/kg, fentanyl 5-10μg/kg and pipecuronium 0.1 mg/kg. The patients were tracheal intubated and mechanically ventilated. PEr CO2 was maintained at 35-45 mm Hg. A bolus of tranexamic acid 1 g was infused intravenously within 30 min after indution followed by continuous infusion at 400 mg/h until the end of operation in group T. While equal volume of normal saline was given in control group. Anesthesia was maintained with inhalation of isoflurane and intermittent iv injection of fentanyl and pipecuronium. Venous blood samples were taken before induction, at the end of operation and at 24 h after operation for determination of Hb, platelet count (P1t), prothrombin time (PT) and international normalized ratio (INR). The volume of chest tube drainage was collected and recorded at 6 and 24 h after operation. The requirement for transfusion of allogeneic red blood cells and fresh frozen plasma was also recorded. Results There was no significant difference in Hb, Plt, PTand INR at each time point between the two groups ( P ＞ 0.05). The requirement for transfusion of allogeneic red blood cells and fresh frozen plasma was significantly reduced in group T as compared with group C ( P ＜ 0.05 or 0.01 ). No deaths and complications occurred during hospital stay in the two groups. Conclusion Tranexamic acid exerts the blood-saving effect in OPCAB.
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Objective To investigate the effects of intraoperative intravenous ulinastatin infusion on perioperative lung function in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods Twenty-four NYHA class Ⅰor Ⅱ patients aged 65-75 y undergoing elective OPCABG were randomly divided into 2 groups(n=12 each): control group (C) and ulinastatin group (U). In group U, after tracheal intubation the patients received iv injection of ulinastatin 6 000 U/kg over 30 min followed by iv ulinastatin infusion at 1 000 U·kg-·h-1 until the end of surgery. In group C equal vohtme of normal saline was administered iv instead of ulinastatin. Radial artery and right internal jugular vein were cannulated for BP and CVP monitoring and blood sampling. The patients were premeditated with intramuscular morphine 10 mg. Anesthesia was induced with midazolam 0.1 mg/kg, fentanyl 10 μg/kg and pipecuronium 0.1 mg/kg and maintained with 1%-2% sevoflurane in 70% O2 and intermittent iv boluses of fentanyl and pipecuronium. Blood samples were taken before (T1) and at the end of operation (T2) and at 4, 8, 20 h after operation (T3.5) for determination of plasma CD11/CD18 expression, plasma IL-6 and serum NO concentrations, and blood gases. P(A-a) O2 and respiratory index (RI) (RI=P(A-a)O2/PaO2) were calculated. Mechamcal ventilation time in ICU was recorded. Results The two groups were comparable with respect to age, sex, body weight, duration of anesthesia and surgery, and the number of bypass grafts. The plasma level of IL-6, and expression of CD11 b/CDI8 were significantly increased while serum NO level was significantly decreased after operation as compared to the baseline values before operation (T1) in group C. There was no significant change in the plasma levels of IL-6, CD11b/CDI8 expression and serum levels of NO after operation in group U. P(A-a)O2 and RI were significantly increased after operation in both groups and were significandy lower in group U than in group C. The mechanical ventilation time in ICU was significantly shorter in group U than in group C. Conclusion Intravenous ulinastatin inihsion can significantly protect lung function during OPCABG by inhibiting inflammatory response.
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Objective To determine the risk factom for the development of systemic inflammatory response syndrome(SIRS)in patmnts after off-pump coronary artery bypass grafting(OPCABG).Methods Sixty NYHA Ⅰ or Ⅱ patients,aged 46-73 yr,weighing 54-110 kg,undergoing OPCABG,were studied.Blood samples from intemal iugular vein were taken for determination of the plasma concentrations of IL-6 and IL-10 at 4 h after the surgery by ELISA.SIRS 8COre W88 performed during 24 h after the surgery.The patients were divided into 2 groups:SIRS group(S,SIRS 8core≥2)and non-SIRS group(U,SIRS score<2).Factors including age,sex,weight,percentage of mononuclear cells,concentration of hemoglobin,time of operation,left ventricular ejection firction,whether using proteinase inhibitor or not during surgery and plasma concentrations of IL-6 and IL-10 at 4 h after surgery were reccorded.The risk factors were identified by logistic regression analysis.Results Logistic analysis indicated that percentage of mononuclear cells,concentration of hemoglobin,the plasma concentrations of IL-6 and IL-10 were closely related with the development of SIRS in patients after 0PCABG(P<0.05),Y=0.155+0.52 X1+0.39 X2+0.76X1-0.79X,Conclusion The percentage of mononuclear cells,concentration of hemoglobin,and plasma concentrations of IL-6 and IL-10 after surgery Call be the risk factors for the development of SIRS in patients after OPCABG.