Chinese perfusion practice survey results in 2021: current situation and challenge / 中华胸心血管外科杂志

Objective:To investigate the current situation of cardiopulmonary bypass(CPB) in China and analyze the causes, to guide the formulation and implementation of technology standard.Methods:The survey task force sent out a nationwide survey to obtain up-to-date information on perfusion practice by ChSECC(Chinese Society of Extracorporeal Circulation). The unit of analysis for the survey was the medical center performs CPB. The survey consisted 48 questions covering four topics of qualifications, including certification and education, policies and practices, device and equipment, techniques used.Results:There were 540 of the 714 centers for an overall response rate of 76%. According to the annual number of CPB, they were divided into 4 groups: group A(≤50 cases/year), group B(50-100 cases/year), group C(100-500 cases/year) and group D(≥500 cases/year). The response rate of center with more than group D last year was 100%. Most of the perfusionists had certification issued by ChSECC. Although there were more than 80% of group D performed regular training and assessment of perfusionist, the result was still not ideal enough. Low utilization of safety equipment was not depend on the annual operation volume in most of responding centers. Ultrafiltration and blood protection technology had high application rate in group D compared with group A and B.Conclusion:The certification rate of perfusionists are high. Lower the number of annual CPB cases, lower the proportion of regular evaluation and training, and lower rate of standards performance. No matter the amount of CPB, the application rate of safety equipment is not ideal. Higher the number of CPB cases, higher the utilization rate of CPB related technologies.

Observation of neuropsychological development status in children after surgical treatment of congenital heart diseases / 中华胸心血管外科杂志

Objective To observe neuropsychological development status in children after surgical treatment of congenital heart diseases(CHDs)and analyze the risk factors. Methods 89 children who received outpatient review in Fuwai Hospital from September 2015 to March 2016 after surgical treatment of CHDs were recruited in this study and 90 normal children were recruited as the control group. The children with CHDs were divided into simple CHDs group(RACHS- 1 score≤2)and com-plex CHDs group(RACHS- 1 score≥3)according to RACHS- 1 classification. Neuropsychological development status was meas-ured according to pediatric-psychological mental test scale developed by Capital institute of pediatrics,Beijing and statistical a-nalysis was compared. Results The measurements of neuropsychological development showed the normal children behaved better than the children with CHDs(P < 0. 05). The simple CHDs group achieved better distribution of development quotient than complex CHDs group(P = 0. 032)and there was no difference between the normal control group and simple CHDs group (P = 0. 420). Multivariate regression analysis indicated that younger age at cardiac surgery,lower preoperative blood urea ni-trogen(BUN),higher preoperative creatinine(Cr)and prolonged duration of cardiopulmonary bypass(CPB)accounted for low-er scores in the test scale(P < 0. 05). Conclusion Distinct neuropsychological difficulties could be present especially in chil-dren with complex CHDs. Younger age at cardiac surgery,preoperative BUN,Cr and CPB duration were perioperative factors that were associated with long-time neuropsychological development.

Cardioplegia solution plus metformin protects isolated rat hearts / 中华胸心血管外科杂志

Objective To evaluate the protective value of cardioplegia solution plus metformin in different cardiac arrest time and concentration of metformin in isolated rat hearts .Methods There were 36 male Sprague–Dawley rats divided into six groups randomly, according to the duration of cardioplegic arrest(30 min or 60min) and the concentrations of metformin(50μmol/L or 100 μmol/L) .Langendorff-perfused Sprague-Dawley rat hearts were perfused for 20 minutes with Krebs-Henseleit buffer followed by 30 or 60 minutes of crystalloid cardioplegia or plus metformin (50 or 100 μmol/L) and 60 minutes of reperfu-sion.The left ventricular performance was recorded at 5 time points.The expressions of AMPKαand phosphorylation of AMPKαwere detected by western Blot.The changes of myocardial mitochondria were observed under transmission electron mi-croscope.Results There were no significant differences in Con(A), 50(A) and 100(A) groups in LVDP, ±dp/dtmax and HR.Compared with Con(B) group subjected to 60 minutes of ischemia followed by 60 minutes of reperfusion, the 100(B) group significantly improved myocardial performance , and the ratio of p-AMPKα/AMPKαwas the highest in all 6 groups.The structure of myocardial mitochondria in 100(B) group was better protected than that of Con(B) group.Conclusion These findings suggested that the left ventricular performance was protected in rat heart perfused by cardioplegia plus 100 μmol/L after 60 minutes cardioplegic arrest .The mechanism may be the activation of AMPK and the protection of structures of myocardial mitochondria.

Risk factors and outcomes of severe hemolysis during extracorporeal membrane oxygenation：a 5-year ;single-center retrospective analysis / 中华危重病急救医学

Objective To investigate the risk factors of severe hemolysis during extracorporeal membrane oxygenation (ECMO). Methods The clinical data of adult patients undergoing ECMO after cardiac surgery admitted to Fuwai Hospital from December 2010 to October 2015 were retrospectively analyzed. Demographic characteristics, renal function, primary disease, operation data, ECMO related data and outcomes were recorded. Patients were divided into normal free hemoglobin (FHB) group (FHB ≤ 500 mg/L) and severe hemolysis group (FHB > 500 mg/L) according to the FHB level during ECMO support. The parameters before and after ECMO support were compared between the two groups. Logistic regression was used to identify the independent risk factors of severe hemolysis. Results A total of 81 patients including 19 patients with severe hemolysis was enrolled, and 62 in normal FHB group. There was no difference in cardiopulmonary bypass (CPB) time, clamping time, lactate level before ECMO, cardiopulmonary resuscitation, intra-aortic balloon pump use and central catheter insertion between two groups. The maximums of serum creatinine (SCr) and FHB levels were higher in severe hemolysis group as compared with those in normal FHB group [maximal SCr (μmol/L): 281.02±164.11 vs. 196.67±87.31, maximal FHB (mg/L): 600 (600, 700) vs. 200 (100, 300)], the incidence of clots in circuit or oxygenator, infection, and hemofiltration in severe hemolysis group was increased [26.3% (5/19) vs. 4.8% (3/62), 31.6% (6/19) vs. 12.9% (8/62), 36.8% (7/19) vs. 14.5% (9/62), all P < 0.1]. As well as outcomes including the rate of site of surgery or intubation bleeding and acute renal failure [ARF, 57.9 % (11/19) vs. 30.6% (19/62), 94.7% (18/19) vs. 41.9% (26/62)], and the survival rate was lowered [10.5% (2/19) vs. 51.6% (32/62), all P < 0.05]. As result of univariate analysis, clots in circuit or oxygenator, infection and hemofiltration were associated with severe hemolysis. It was showed by logistic regression analysis that the clots in circuit or oxygenator was a risk factor of severe hemolysis during ECMO [odds ratio (OR) = 6.262, 95% confidence interval (95%CI) = 1.244-31.515, P = 0.026]. Conclusions The clots in circuit or oxygenator were independent risk factors of severe hemolysis during ECMO. Severe hemolysis can induce the increase of the rate of bleeding in the operation site or intubation and the rate of ARF, and decrease of the survival rate.

Outcome analysis of ECMO applying in extracorporeal cardiopulmonary resuscitation in adult cardiac arrest patients / 中华胸心血管外科杂志

Objective Summarizing single clinical experience with extracorpomreal membrane oxygenation(ECMO) as a supplement to extracorporeal cardiopulmonary resuscitation(ECPR) in adult patients with cardiac arrest to explore new ideas.Methods We retrospectively analyzed the characteristics of 17 patients who underwent ECMO as part of ECPR from July 2005 to September 2014 at Fuwai Hospital,and analyzed the differences between the survival group(n =6) and the in-hospital death group.Results The mean CPR time was(44.53 ± 21.39) min.The support duration of ECMO was(106.38-± 70.43) h.12 patients of all were successfully weaned from ECMO,and 6 patients survived to hospital discharge.There were significant differences between the two groups in terms of the last serum creatinine and blood lactate acid level before ECMO,and the time to lactate normalization.11 patients died,7 patients developed bleeding,and 8 cases developed infection.Conclusion Single-center data showed that applying ECMO as a means of ECPR improved the survival rate in cardiac arrest patients.Additionally,creatinine and lactic acid were good indicators for assessing prognosis.Refractory circulatory dysfunction and neurologic complications have an adverse impact on the survival of cardiac arrest patients.

Advances in the application of extracorporeal membrane oxygenation in the treatment of severe burn / 中华烧伤杂志

Extracorporeal membrane oxygenation (ECMO) is a kind of technique that uses extracorporeal circulation system to draw patients' blood into the circuit, and then oxygenate the blood when it passes along the membrane, followed by returning the blood into patients. At present, ECMO is mainly used in treating patients with respiratory failure and circulatory failure, for whom the conventional treatment such as mechanical ventilation and vasoactive drugs are invalid. ECMO can provide cardiopulmonary support for burn patients with respiratory failure or circulatory failure, and put the heart and lung at rest. The purpose of this paper is to review the application of ECMO in the treatment of severe burn.

The dynamic observation of plasma concentration of antimicrobial agents during balanced ultrafiltration in vitro / 中华胸心血管外科杂志

Objective Routine perioperative intravenous antimicrobial agents,was administered as surgical prophylaxis.However,whether balanced ultrafiltration during extracorporeal circulation can remove antimicrobial agent remains unclear.The concentrations of antimicrobial agent in plasma and ultrafiltrate samples were measured in this pseudo-extracorporeal circulation model.Methods Extracorporeal circulation consisted of cardiotomy reservoir (Ningbo Fly Medical Healthcare CO.,LTD.Ningbo,China),D902 Lilliput 2 membrane oxygenator (Sorin Group Asia Pte Ltd,Beijing,China) and Capiox (R) AF02 pediatric arterial line filter (Terumo Corporation,Beijing,China).HEMOCONCENTRATOR BC 20 plus (MAQUET Cardiopulmonary AG,Hirrlingen,Germany) was placed between arterial purge line and oxygenator venous reservoir.Fresh donor human whole blood was added into the circuit and mixed with Ringer's solution to obtain a final hematocrit of 24％-28 ％.After 30 minutes of extracorporeal circulation,zero-balanced ultrafiltration was initiated and arterial line pressure was maintained at approximately 100 mm Hg(1 mm Hg =0.133 kPa) with Hoffman clamp.The rate of ultrafiltration (12 ml/min) was controlled by ultrafiltrate outlet pressure.Identical volume of plasmaslyte A was dripped into the circuit to maintain stable hematocrit during 45 minutes of experiment.Plasma and ultrafiltrate samples were drawn every 5 minutes and concentrations of antimicrobial agent (including Cefmetasole and cefotiam) were measured with high performance liquid chromatography.Results All these two antimicrobial agents were detected in ultrafiltrate,demonstrating hemoconcentration may remove antimicrobial agent.The concentration of plasma antimicrobial agent decreased lineally with the increase of ultrafiltrate volume.At end of balanced ultrafiltration,the concentration of plasma cefotiam was (104.96 ± 44.36) μg/ml,which is about (44.38 ± 7.42) ％ of the initial concentration (238.95 ± 101.12) μg/ml; the concentration of plasma cefmetazole decreased linearly to (25.76 ± 14.78) μg/ml,which is about (49.69 ± 10.49) ％ of the initial concentration (51.49 ± 28.03) μg/ml.The total amount of cefotiam in ultrafiltrate is (27.16 ± 12.17)％ of the total dose administered,whereas cefmetasole in ultrafiltrate is (7.74 ±4.17)％.Conclusion Balanced ultrafiltration may remove antimicrobial agent from serum and has significant influence on plasma concentration of antimicrobial agent.The strategy of surgical prophylaxis should consider this unique technique during extracorporeal circulation.

Study on the incidence and risk factors of HCV infection among heroin addicts who were on methadone maintenance treatment in Dehong prefecture,Yunnan province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To determine the incidence and risk factors of HCV infection among heroin addicts who were receiving methadone maintenance treatment(MMT)in Dehong prefecture, Yunnan province.</p><p><b>METHODS</b>All heroin addicts who were HCV negative at the initiation of MMT in June 2005 through March 2012, in Dehong prefecture, were included in this cohort analysis. HCV incidence was calculated and related risk factors determined by using Cox proportional hazard regression model.</p><p><b>RESULTS</b>A total of 2390 MMT clinic attendants were qualified for this cohort study by March 2012. 731(30.6%) of them had never received any follow-up HCV testing so were recognized as loss to follow-up. The other 1659 (69.4%) participants had received at least one follow-up HCV testing and were observed for a total of 3509.12 person-years(py). During this period 99 new HCV infections or HCV sero-converters were identified. The overall HCV incidence was 2.82/100 py and was 3.62/100 py for 2006, 5.36/100 py for 2007, 6.71/100 py for 2008, 2.56/100 py for 2009, 1.90/100 py for 2010, and 0.44/100 py for 2011, respectively. Results from multiple regression analysis, using Cox proportional hazard model, indicated that after controlling for confounding variables, those who were unemployed, being injecting drug users(IDUs)or HIV positive at entry into the MMT program were more likely to be newly infected with HCV or HCV sero-converted during the follow-up period than those who were peasants, non-IDUs or HIV negative at entry into the MMT program(HR = 2.02, 95% CI:1.18-3.48; HR = 9.05, 95% CI:5.49-14.93; HR = 2.12, 95% CI: 1.37-3.56), respectively.</p><p><b>CONCLUSION</b>The incidence of HCV infection among MMT clinic attendants was decreasing since 2009 in Dehong prefecture. Those who were unemployed, injecting drug users and HIV positive were at higher risk of HCV infection.</p>

The pilot observation of cerebral blood flow during aortic arch reconstruction surgery in piglet's animal model / 中华胸心血管外科杂志

ObjectiveA single pump and double arterial lines piglet model was established in this piglet's experiment.The preliminary study of cerebral blood flow proportion and distribution was performed continuously during the procedure.MethodsEight female piglets were utilized in this study.The body weight ranged from 18 kg to 22 kg.The right atrium was carmulated for venous drainage.Double arterial lines were established through cannulating into right carotid artery and ascending aortic aorta.Selective antegrade cerebral perfusion (SACP) through right carotid artery started after bladder temperature was decreased to 20℃ and the perfusion from ascending aortic aorta was interrupted.The perfusion through ascending aortic aorta resumed following 60 minutes of circulatory arrest.Traditional rewarming strategy was adopted and the experiment ended when bladder temperature attained 36℃.The real-time blood flow in the double arterial lines was monitored using a TS410 transit-time tubing flowmeter (Transonic Systems Inc.,Ithaca,NY).Blood pressure in femoral artery,intra-circuit pressure was recorded every five minutes interval.Regional cerebral oxygen saturation ( rSO2 ) was assessed with NIRO-200 oximeter using Near-infrared spectroscopy (Hamamatsu Photonics,Hamamatsu City,Japan )and mixed venous oxygen saturation ( SvO2 ).Blood samples were drawn for blood chemistry measurement prior to extracorporeal circulation,before circulatory arrest and at the end of experiment.ResultsArterial blood pressure was maintained at (60 ± 20) mm Hg.Total blood flow perfusion was(85.30 ±6.81)ml · kg-1 · min-1 and(14.42 ±1.76) ml · kg-1 · min-1 in right carotid artery.The proportion of cerebral blood flow was (16.72 ± 2.77 )％ of total perfusion.Cerebral blood perfusion was controlled with( 15.11 ± 0.44)ml · kg - 1 · min - 1 during SACP.Compared to SvO2,rSO2 remained stable during the procedure.The plasma concentration of

Results of 50 adult patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock / 中华胸心血管外科杂志

Objective Extracorporeal membrane oxygenation is a cardiopulmonary supportive therapy. Since 2004, our institution has adopted venoarterial ECMO for adult patients who otherwise could not be weaned from cardiopulmonary bypass and patients experiencing postcardiotomy cardiogenic shock and/or pulmonary dysfunction unresponsive to conventional treatment algorithms. In this study, we reviewed our experience with ECMO support and tried to identify measurable values which might predict in-hospital mortality. Methods From January 2004 through December 2008, 50 of 21,298 adult patients received VA ECMO. We retrospectively analyzed clinical records of these 50 consecutive patients. Demographics, preoperative measurements, clinical characteristics at the time of ECMO implantation, ECMO related complications and in-hospital mortality were collected. Logistic regression analyses were performed to investigate predictors of mortality. A p value ≤0. 05 was accepted as significant. Results Mean ECMO duration was ( 110 ± 17 ) hours. 38 patients were weaned from ECMO and 33 patients survived upon discharge. The overall survival was 66%. In univariate analyses, duration of ECMO support, receiving cardiopulmonary resuscitation prior to ECMO setup, ECMO setup in ICU, pre-ECMO plasma lactate level, infection, lower limbs ischemia, renal failure, experiencing at least one ECMO related complications were all associated with in-hospital death. In a multiple logistic regression adjusted for other factors mentioned above, blood lactate level before initiation of ECMO was a risk factor associated with in-hospital mortality (OR 1. 27 95% CI 1. 042-1. 542 ). To evaluate the utility of pre-ECMO lactate in predicting mortality, a conventional receiver operating characteristic curve was produced. Sensitivity and specificity were optimal at a cut-off point of 12.6 mmol/L, with an AUC of 0. 752. The positive and negative predictive values were 73.3% and 83.9% respectively. Conclusion ECMO is a justifiable alternative treatment for postoperative refractory cardiac and pulmonary dysfunction which could rescue more than 60 percent of otherwise fatal patients. Patients with pre-ECMO lactate above 12.6mmol/L are at higher risks for in-hospital death. Evidence based therapy for this group of high risk patients is needed.

Study on incidence of HIV infection among heroin addicts receiving methadone maintenance treatment in Dehong prefecture, Yunnan province / 中华流行病学杂志

Objective To determine the incidence and risk factors of HIV infection among heroin addicts receiving methadone maintenance treatment(MMT)in Dehong prefecture,Yunnan province.Methods All heroin addicts who were HIV negative at the initiation of MMT in June 2005 and through June 2011,in Dehong prefecture were included in the cohort analysis.HIV incidence was calculated and related risk factors determined by using Cox proportional hazard regression model.Results A total of 3154 MMT clinic attendants were qualified for this cohort study.By June 2011,1023(32.4％)of them had never received any follow-up HIV testing so were thus referred as loss to follow-up.The other 2131(67.6％)members had received at least one follow-up HIV testing and were observed for a total of 4615.86 person-years.During the period,22 new HIV infections or seroconverters were identified,making the overall HIV incidence as 0.48/100 person-years.The HIV incidence was higher among those who were unemployed,never married,self-reported being injecting drug users(IDUs)and HCV positive at entry into the MMT program.None of those who were always negative on follow-up-urine-testing of morphine was discovered as HIV newly infected during the follow-up period.Data from multiple regression analysis under Cox proportional hazard model indicated that after controlling for confounding variables,non-IDUs at the entry point for the MMT program,were less likely to be HIV newly-infected or seroconverted than IDUs(HR=0.29,95％CI:0.11-0.76).Conclusion MMT prograqm in Dehong prefecture was demonstrated to be fairly effective in reducing HIV transmission through drug use.Those HIV negative attendants at the MMT clinic who were IDUs or keep using drugs during the treatment,were at higher risk of HIV seroconvertion.More efforts were needed to improve the follow-up and HIV testing programs for the MMT clinic attendants.

Adherence and related determinants on methadone maintenance treatment among heroin addicts in Dehong prefecture, Yunnan province / 中华流行病学杂志

Objective To determine the adherence to and its determinants of methadone maintenance treatment (MMT) among heroin addicts in Dehong prefecture in Yunnan province from 2005 to 2009. Methods A dynamic cohort analysis was conducted with the time of treatment initiation as the time of cohort entry, to calculate the proportion of adhering to the treatment at different time points after initiation of the treatment, and to study the determinants of adherence.Results A total of 3758 had been treated. Among them, 95.8% were males, 75.8% aged between 20-39 years, 90.4% were peasants or unemployed, 57.0% were ethnic minorities, 35.0% were single and 55.5% were married with spouses, 43.9% were illiterate or educated at most primary school. The age of first using drugs averaged at 23.93 years. About 96.3% of the study subjects had used heroin and 21.7% were HIV-infected. The minimum time under MMT was less than 1 month and the maximum 61 months. The median methadone dose at first delivery was 25 ml, with the minimum 1 ml and the maximum 330 ml. By the end of the study or observation period, a total of 1798 patients had withdrawn from treatment and 1960 were still under treatment. The proportions of adherence to or still being under the treatment after 1,3,6,9, 12,24, 36,48 and 60 months treatment were 0.919,0.847,0.756, 0.690, 0.637, 0.519, 0.417, 0.360 and 0.321, respectively. Multiple regression analysis using Cox proportional hazard model indicated that withdraw from the methadone maintenance treatment was significantly associated with location of the treatment clinics, year of treatment initiation, marital status, HIV infection status, methadone dose of first delivery and the result of last urine test for heroin use. Conclusion MMT attendants in Dehong prefecture had a relatively high withdraw rate and low adherence rate. More efforts are needed to provide tailored counseling and education to MMT attendants, to provide family and community support, appropriate methadone dose at first delivery, and to better coordinate with local police department.

The impact of type 2 diabetes on endothelium of great saphenous vein in patients with coronary heart disease / 中华胸心血管外科杂志

ObjectiveTo study the impact of type 2 diabetes mellitus on endothelium of great saphenous vein in patients with coronary heart disease.MethodsPatients undergoing coronary artery bypass grafting were selected, 20 with type 2 diabetes mellitus (experimental group) and another 20 patients without (control group).The rings of great saphenous vein in I cm length were taken from those patients and then divided into 3 segments.The structure of endothelium was evaluated by the microscope and the changes of venous tone were measured in organ chamber at 37C with a constant supply of oxygen.Venous vasoconstriction was induced by phenylephrine (10-5 mol/L) and vasodilatation induced by nitroglycerin or acetylcholine (10-9 ～ 10-5 mol/L).ResultsMore damages of ultrastructure of the endothelium of saphenous vein were found in experimental group than in control group.There were no significant differences regarding the venous tone between the two groups (P ＞0.05) when vasoconstriction induced by phenylephrine and vasodilatation by nitroglycerin.However, the vasodilatation induced by acetylcholine was significantly decreased in experimental group than in control group (P ＜ 0.05).Conclusion Type 2 diabetes mellitus can aggravate the damage of endothelium of saphenous vein in patients with coronary artery disease.

Effect of smoking on great saphenous vein tone / 中华胸心血管外科杂志

Objective To observe the effect of smoking on the great saphenous vein tension. Methods The rings of great saphenous vein in 3mm long of selected from 31 patients with coronary artery bypass grafting were divided into three groups :smoking over 10 years( group A, n = 12 ), ex-smoking over 1 years ( group B, n =9 ) and non-smoking( group C, n =10). The changes of the tone were measured in organ chamber at 37℃ with a constant supply of oxygen when vasoconstriction induced by phenylephrine ( 10 -9 - 10 -5 mmol/L), and vasodilatation by acetylcholine ( 10 -9 - 10 -5 mmol/L) or nitroglycerin( 10 -9 - 10 -4 mmol/L)after the rings were precontracted by 10 -5 mmol/L phenylephrine. Results Vasoconstriction induced by phenylephrine and vasodilatation by nitroglycerin is no significant difference among three groups. Compared with group A, vasodilatation by acetylcholine was significantly increased in group B or C, while there is no significant difference between group B and C. Conclusion Smoking has a deleterious effect on the endothelial function of great saphenous vein, however, smoking cessation over 1 year may help to restore the endothelial function impaired by smoking.

Design and clinical application of HZ-01-A level detector and pressure monitor / 中国组织工程研究

BACKGROUND: Mortality related to cardiopulmonary bypass can be lowered by intra-operative monitoring system.Monitoring liquid level and pressure is extremely indispensable for examination of cardiopulmonary bypass(CPB).OBJECTIVE: To design a CPB safety system including an arterial line pressure monitor and low-level sensor,and to evaluate its safety and effects in clinical settings.METHODS: The safety system was composed of pressure transducer,photoelectric transmitter,photoelectric detector,core controller,and liquid crystal display.The principles of reflection and refraction were applied to the design of level sensor.The pressure measurements were converted into electronic signals and processed.According to two principles above-mentioned,fluid level detector and pressure monitor were designed.Thirty patients with the age of 1-75 years receiving cardiac surgery with cardiopulmonary bypass were enrolled.The arterial line pressure at different pump flows was measured and the alarm function of the level sensor was also validated.RESULTS AND CONCLUSION: Cardiopulmonary bypass arterial line pressure increased with the pump flow.Arterial line pressure detected by HZ-01-A safety system also increased with the pump flow increasing,which was highly related to the pump pressure.HZ-01-A safety system could alarm when the arterial line pressure and reservoir level exceeded the pre-determined thresholds.HZ-01-A safety system could be safely and effectively applied to clinical cardiopulmonary bypass and improve bypass safety by accurately detecting the pressure and reservoir level.

Extracorporeal membrane oxygenation for treatment of cardiorespiratory function failure in adult patients / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the experience on venoarterial extracorporeal membrane oxygenation (ECMO) in adult patients with cardiac failure.</p><p><b>METHODS</b>From February 2005 to June 2008, 45 patients (male 34, female 11) undergoing cardiogenic shock required temporary ECMO support. Average age was (49.0 +/- 14.1) years. Average body weight was (67.0 +/- 12.8) kg. Coronary heart disease occupied in 21 cases, valve disease occupied in 8 cases, and cardiomyopathy occupied in 7 cases. All the patients could be divided into 3 groups: post-cardiotomy (group 1, n = 31), post-transplantation (group 2, n = 5), decompensate of chronic heart failure (group 3, n = 9). Fourteen patients need cardiac resuscitation before ECMO support. ECMO implantation was performed through the femoral vessels or axillary artery or through the right atrium and ascending aorta.</p><p><b>RESULTS</b>Average support duration of ECMO was (126.7 +/- 104.3) h. Twenty-seven patients could be successfully weaned from support (60.0%), additionally, 5 were bridged to heart transplantation. The in-hospital mortality was 42.2% (19/45). Twenty-six patients (57.8%) could be successfully discharged. The discharge rate was 58.1% in group 1, 4/5 in group 2 and was 4/9 in group 3. Twelve patients were re-operated for hemostasis. Three patients need femoral arterial thrombectomy because of ischemia of lower extremity. Additional intra-aortic balloon pumps were used in 11 patients, with 6 patients successfully discharged. The mortality rate for patients with acute renal failure treated by continuous renal replacement therapy under ECMO support was obviously high (7/9). The dominant mode of death was multisystem organ failure (9/19).</p><p><b>CONCLUSION</b>Early indication, control of complications, and paying attention to the treatment after ECMO support could improve our results with increasing experience.</p>

Retrospective analysis of 100 patients managed by extracorporeal membrane oxygenation / 中华外科杂志

<p><b>OBJECTIVE</b>To describe the experience with extracorporeal membrane oxygenation (ECMO) for cardiorespiratory support of 100 patients.</p><p><b>METHODS</b>Retrospective analysis of the medical files of 100 patients submitted to the implant of extracorporeal membrane oxygenation system for cardiorespiratory assistance of acute and refractory cardiogenic shock from December 2004 to September 2008. There were 67 males and 33 females, age ranged from 5 d to 76 years with a mean of (28+/-26) years, body mass ranged from 3.8 to 100.0 kg with a mean of (42+/-30) kg. The inter-surface of the ECMO equipment system was completely coated by heparin-coating technique. All patients were applied veno-artery ECMO and activated clotting time was maintained between 120 and 180 s and heparin usage dose was 5 to 20 Uxkg(-1)xh(-1). Mean blood flow was 40 to 220 mlxkg(-1)min(-1) during ECMO assistant period.</p><p><b>RESULTS</b>The shortest ECMO time was 12 to 504 h with a mean of (119+/-80) h. Sixty-one patients (61.0%) weaned off successfully from ECMO, 55 of them (90.2%) were discharged and 6 died of post-operative complications. Thirty-nine patients could not weaned off from ECMO. Total survival discharge rate was 55.0%. Mean aortic pressure before ECMO in survived patients was significantly higher than that of dead patients (P=0.038). Lactic acid concentration of artery blood before ECMO in survived patients was significantly lower than that of dead patients (P=0.005).</p><p><b>CONCLUSIONS</b>ECMO is an effective mechanical assistant therapy method for cardiac and pulmonary failure after cardiac surgery. Earlier usage of ECMO for heart lung failure patient and avoiding the main organs from un-recovery trauma are key success.</p>

Expression of heat-shock transcription factor 1 and X-linked inhibitor of apoptosis protein-associated factor-1 in gastrointestinal cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the expressions of X-linked inhibitor of apoptosis protein (XIAP)-associated factor-1 (XAFI) and heat-shock transcription factor 1 (HSF1) and their relationship in human gastrointestinal cancers.</p><p><b>METHODS</b>Immunoblotting was used to analyze the expressions of HSF1 and XAF1 in gastric and colon cancer tissues and in gastrointestinal cancer cells. The gastrointestinal cancer cells were tranfected with a eukaryotic expression vector containing HSF1 gene fragment or subjected to RNA interference to induce up- or down-regulation of HSF1 expression, and the consequence changes in XAF1 expression in the cells was measured. XAF1 expression was also assayed in the cells after stress stimulation for HSF1 expression.</p><p><b>RESULTS</b>The expression of HSF1 was higher in gastrointestinal cancer tissues than in normal tissues. The expression of XAF1 and HSF1 was inversely correlated in the cancer cell lines, and stress stimuli of the cells up-regulated the expression of HSF1 but down-regulated XAF1 expression.</p><p><b>CONCLUSION</b>HSF1 expression is increased in gastrointestinal cancer tissues to result in suppressed expression of XAF1, which may be one of the reasons for the low expression of XAF1 in association with the defect of the apoptosis mechanisms in the cancer cells</p>

Clinical features of unexpected sudden death clustered in 7 families in Yunnan Province / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the clinical features of unexpected sudden death (SUD) clustered in families in Yunnan province.</p><p><b>METHODS</b>This retrospective study analyzed the clinical features of SUD occurred between July to September 2005 in 7 families in Yunnan province.</p><p><b>RESULTS</b>All 16 SUD patients shared common clinical features such as fatigue and repeated syncope and one group of SUD patients (n = 8 from 4 families) presented with the gastric intestinal tract manifestations including nausea, vomiting, abdominal pain and diarrhea with suspected dietary history and abnormal laboratory enzyme findings (GOT/GPT, CK/CKMB, LDH/LDH1 etc.). In SUD patients without gastric intestinal tract manifestations (n = 8 from 3 families), there were no clear symptoms before death and repeated ventricular tachycardia and ventricular fibrillation were recorded in one survivor. There was no clear evidence for the involvements of hereditary and infectious factors for observed SUD.</p><p><b>CONCLUSION</b>The reason for the unexpected sudden death clustered in 7 families in Yunnan remains unclear. Repeated syncope and fatigue served as the common clinical features in the presence or absence of gastric intestinal tract manifestations in all SUD cases. Further studies are needed to clarify the pathology and detailed clinical manifestations of SUD occurred in this area.</p>

Change of lactic acid concentration in patients receiving extracorpOreal membrane oxygenation / 中国组织工程研究

BACKGROUND:Extracorporeal membrane oxygenation(ECMO)adopts heparin-coated oxygenator as key membrane oxygenation,which is a covalent bonding of artificial material surface with mucopolysaccharide on one side of heparin.Thas artificial materials can stimulate human vascular endothelial function partly,leading to decrease production of lactic acid,increase biocompatibility of the matedals,prevent thrombogenesis and relieve inflammatory reaction after operation.OBJECTIVE:To discuss the relationship between the plasma lactic acid level and the prognosis of patients after ECMO applied with heparin-coated oxygenator.DESIGN:Self-controlled clinical study,grouping by age and survival prognosis.SETTING:Department of Cardiopuimonary Bypass,Fuwai Cardiovascular Hospital,Chinese Academy of Medical Sciences.PARTICIPANTS:Forty patients received ECMO in Fuwai Cardiovascular Hospital,Chinese Academy of Medical Sciences were selected from December 2004 to September 2006.They suffered from failing weaning of cardiopulmonary bypass postcardioctomy,cardiogenic shock based on dilated cardiomyopathy or cardiogenic shock based on coronary heart disease.All patients were divided into four groups according to age and survival prognosis:adult survival group,adult death group,infant survival group and infant death group.METHODS:All the patients received venoarterial ECMO support treatment.ECMO perfusion system consisted of centrifugal pump,water tank,heparin-coated membrane oxygenator(Jorstra Novalung,Germany)and corollary circuits (Bioline Coating,Germany,batch number:SFDA-I-20063450801).MAIN OUTCOME MEASURES:The concentrations of lactic acid were measured at the ECMO institution,6 hours later,the median time at ECMO support,6 hours before weaning off and at the time of weaning.RESULTS:①In 26 patients of adult groups,20 of them(76.9%)weaned from ECMO,16 of them(61.5%)survived and 10 of them died.In 14 patients of infant groups,7 of them weaned from ECMO(50%),5 of them(35.7%)survived and 9 of them died.②The concentrations of lactic acid in two survival groups were significantly lower than those in death groups(P＜0.05 or 0.001).The concentration decreased significantly at the time points of median time,6 hours before weaning off and at the weaning time,compared with the level at the time of ECMO institution(P＜0.01),indicating a decreasing concentration of lactic acid.CONCLUSION:①The concentration of lactic acid in patients after ECMO decreascs obviously.②Patients with high lactate level at the weaning time show unfavourable prognosis.