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.

Applied research of deep hypothermic circulatory arrest and regional cerebral perfusion in pediatric aortic arch surgery / 中华胸心血管外科杂志

Objective To observe and evaluate the effects of the deep hypothermic circulatory arrest(DHCA) and regional cerebral perfusion(RCP) in pediatric aortic arch surgery.Methods According to different methods of CPB,70 infants less than 3-month-old with CoA or IAA were undergone corrective surgery with DHCA or RCP.The bypass time,aortic clamp time,DHCA or RCP time,ventilation time,ICU stay time and post-operative complications were recorded and compared between two groups.Results The incidence of neurological complications was significantly higher in DHCA group.The CPB time was significantly longer in the RCP group,and the RCP time was significantly longer than DHCA time.Blocking time,ventilator intubation time,ICU residence time,postoperative renal dysfunction,low cardiac output,puhnonary inflammation and hospital mortality was no significant difference between the two groups.Conclusion RCP is an effective cerebral protection technique.Compared with DHCA,RCP works better in sustained brain cerebral perfusion and is suitable for complex aortic arch operation in children.It has a better effort in protection of the neurological system than DHCA.

Textual Research on the Editions' Origin and Circulation of Yizong Baojing (Master's Precious Mirror of Medicine) / 浙江中医药大学学报

[Objective] Make textual research on the version origin of Yizong Baojing. [Method] Take the Lingyunlou carving copy of Yizong Baojing in Jiaqing Wuwu year(1798) of Qing Dynasty as the master copy, and lithographic copy of Shanghai Feiying Publishing House in the end of Qing Dynasty as the main checked copy, in the same time, take lithographic copies of Shanghai Wenruilou and Shanghai Jinzhang Publishing House in Minguo Times as reference copies, make careful investigation to many wondering points on version origin of the book, point out the problems and make serious comparison and analysis.[Result]Yizong Baojing was firstly carved in Jiaqing Wuwu year 3(1798) of Qing Dynasty, and published by Lingyunlou, thus came the Lingyunlou carving copy in Jiaqing Wuwu year(1798) of Qing Dynasty; to the end of Qing Dynasty, it was issued lithographical y by Shanghai Feiying Publishing House referring to the primary carving copy, then published by Shanghai Wenruilou, i.e. the lithographic copy of Shanghai Feiying Publishing House. This book is combined by many predecessors'medical books, very possibly from booksel ers or merchant of literature.[Conclusion]The study on the version origin of Yizong Baojing offers basic foundation for offspring's col ecting and studying the book, helpful to ancient TCM books protection and u-tilization, as wel as the development of TCM undertaking.

Neuoprotective effect of gradient perfusion-rewarming after deep hypothermia crculatory arrest / 中华胸心血管外科杂志

ObjectiveTo evaluate the neuroprotective effect of gradient perfusion-rewarming after deep hypothermia circulatory arrest (DHCA) in piglets.Methods12 Shanghai piglets (3-4 weeks old) were randomly divided into two groups of A (experiment group) and B (control group),average weight (9.78 ±0.93)kg.Animal CPB model is completed with microinvasive technique.DHCA duration is 90 min in two groups.During the rewarming period,group A was rewarmed with gradient perfusion strategy,maintain the temperature for 15 min every 5 ℃ elevation of the core temperature.Group B was rewarmed according normal consistent rewarming strategy.PH-stat management is adopt in both groups.Blood gas analysis,rectal temperature,heart rate,ECG,blood flow rate of carotid artery,glumatic acid/aspartate level of jugular vein and protein NFB of brain tissue are monitored during and/or after the cardiopulmonary bypass (CPB).ResultsDuration of rewarming in group A is (67.3 ± 7.8) min,and (41.8 ± 3.6)min in group B (P ＜ 0.05).Sample collected at the beginning of CPB,15 min of rewarming,30 min of rewarming and 45 min of rewarming show that there is no difference between the blood flow rate at 15 min of rewarming; difference are shown at the 30 min and 45 min of rewarming (P ＜ 0.5 ).High performance liquid chromatography ( HPLC ) analysis show the obvious difference of glumatic acid level of jugular vein at 30 min of rewarming and 45 min of rewarming ( P ＜ 0.5),this kind of difference of aspartate can only be seen at the 45 min of rewarming.Histologic evaluation shows gradient rewarming has a better effect on preservation of CA1 area neuron in hippocampus,however,Immunohistochemistry doesn't find the same effect.ConclusionControlled gradient perfusion-rewarming strategy can improve the neuroprotective effect during DHCA,keeping the balance of the blood flow,cerebral local temperature and brain metabolism might be the mechanism.

A case series of 8 children supported with extracorporeal membrane oxygenation / 中华胸心血管外科杂志

Objective The use of extracorporeal membrane oxygenation (ECMO) as a treatment for the failure of cardiopulmonary function after cardiac surgery is increasing and has been reported to be 3% to 5% in the cases with congenital heart disease. We reviewed our experience with ECMO in children who received heart surgery for congenital heart disease and complicated with severe heart failure postoperatively. Methods Eight patients received ECMO, seven was due to the failure to wean from bypass and one had fulminant myocarditis. Import membrane oxygenator,veno-arterial mode ECMO and right atriumascending aortic cannulation were used in 7 cases and peripheral cannulation via femoral veno-artery route was used in 1 case.Supportive intervention persisted from 65 to 498 hours, with flow rate maintained at 80 to 120 ml per minute per kilogram body weight. Results Five patients died, with a mortality of 62.5%, and 3 cases discharged, with a survival rate of 38%. Bleeding occurred in 5 cases, thrombosis occurred in 2 cases, hemolysis was identified in 1 case and DIC was observed in 1 case.One case had liver failure and 2 cases had malnutrition. Oxygenator plasma leakage occurred in 2 cases. Mean arterial blood pressure increased significantly after the establishment of ECMO as compared with that before the procedure [( 60.2 ± 7.8 )mmHg vs. (48. 1 ± 5.2 ) mmHg, P≤0.05]. The arterial concentration of lactate decreased significantly, from (5. 1 ± 0. 8 )mmol per liter before ECMO to ( 3.6 ±0. 5 )mmol per liter after ECMO, P ＜0.05. Conclusion For patients who survived the congenital heart surgery and no residual anatomic deformity, ECMO can be used as early as possible as a treatment for severe heart failure which resulted from coexistent of left and right ventricular and pulmonary insufficiency. An overall mortality may be decreased by ECMO technique as it plays a substitution role for gas exchange in the lung. As a result, the concentration of oxygen and the airway pressure used during ventilation, and the resultant lung injury can be reduced. Appropriate strategies involve transfusion of fresh platelet and packed red blood cells, replacement of frozen plasma and blood products, as well as rational use of vasoactive drugs and heparin, and maintaining a stable internal environment. Following strategies are also recommended: using continuous arterio-venous hemofiltration and durable heparin-coated membrne oxygenator, reducing hemorrhagic complications, monitoring pressure on both side of the film, identifying plasma leakage carefully and reducing the mechanical complications.

Production of Main Chinese Medicinal Materials in Ancient Hangzhou / 浙江中医药大学学报

It had fertile countryside land,rich products,dense population and creeks and lakes in ancient Hangzhou and its neighbour area,where there is a good place for planting medicinal materials.It had long history of planting medicinal materials with abundant output,pure and good nature,and much varieties;among which,some famous and costly medicinal materials,such as "eight Zhe's" and "eighteen Hangs",were not only adopted broadly by court,royalty and doctors,but purchased by many businessmen and sold far to abroad as well;they seemed to be in the leading place in China.

Origin of Zhejiang Medicine in Early Qin Era / 浙江中医药大学学报

In early Qin era,Zhejiang people engaged on medical health care undertakings;Hemudu Site finds out the herbal fossil,such as Gorgon,and healthy dry-column structural architecture relics;people of that time used simple medical machinery for diseases,the TCM cans for decoction and healthy tools for food,e.g.loop,mined well,buried dead body,had "Rescord of Tongjun Taking Herbs",Yue King paid attention to population development and people weal and woe;all display the brilliant history of Zhejiang medical origin in early Qin era from different sides.

Central and Provincial Medical and Health Organs Established in Zhejiang in South Song Dynasty / 浙江中医药大学学报

In South Song Dynasty,its capital being in Lin’an(present Hangzhou) greatly promoted the development of politics,economy,education,sci-tech and culture in Zhejiang,thus it brought along breakthrough of medicine.There’re comparatively perfect central and provincial medical organs in Zhejiang,such as Royal Drugstore,Taiping Huimin Bureau,Huimin Heji Bureau,Huimin Bureau and Drug-delivery Bureau,which made great achievements on showing solicitude for the mass,diagnosing and treating disease,standard actions,preparing medicine and giving alms to the army and the people,etc.,making outstanding contributions for the medical and health cause in Zhejiang.

Combination of balanced ultrafiltration with modified ultrafiltration attenuates pulmonary injury in patients undergoing open heart surgery / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To explore the effects of ultrafiltration technique in preventing and relieving pulmonary injury in children undergoing open heart surgery and cardiopulmonary bypass (CPB).</p><p><b>METHODS</b>Thirty cases with congenital heart defects were divided into a control group and an experimental group. In the control group, conventional cardiopulmonary bypass was used without ultrafiltration; while in the experimental group, cardiopulmonary bypass with balanced ultrafiltration and modified ultrafiltration were used. Pulmonary static compliance (Cstat), airway resistance (Raw), alveolar-arterial oxygen difference (A-a DO2), hematocrit (HCT), serum albumin (Alb), interleukin-6 (IL-6), endothelia-1 (ET-1) and thromboxane (TXB2) were measured.</p><p><b>RESULTS</b>The pulmonary function was improved, HCT and serum albumin concentrations were increased, and some harmful medium-size solutes were decreased in the experimental groups compared with the control group.</p><p><b>CONCLUSIONS</b>Combination of balanced ultrafiltration with modified ultrafiltration can effectively concentrate blood, exclude harmful inflammatory mediators, and attenuate lung edema and inflammatory responsive pulmonary injury.</p>