Deep hypothermic circulatory arrest (DHCA) is an important assistant technique for complex cardiac surgery, which creates convenient operating conditions for surgery, and is also one of the measures to protect the brain during operation. However, the complications caused by this technique cannot be ignored, and it should be noticed that the occurrence of intestinal injury is relatively insidious, but brings great pain to patients and significantly reduces the quality of life after operation. Studies have shown that intestinal ischemia-reperfusion injury is induced by DHCA. It causes mast cells to activate and release many inflammatory mediators that destroy the intestinal mucosal epithelium barrier, and eventually lead to intestinal injury. This article reviewed the research progress of mast cells in the mechanism of DHCA-induced intestinal injury.
Objective To observe the changes of inflammatory cytokines in brain protective methods, study the inflammatory mechanism during cerebral protection tissues in different cerebral Methods Eighteen healthy adult dogs were randomly divided into three groups （6 dogs in each group）： normothermic cardiopulmonary bypass （NCPB group）, deep hypothermic circulatory arrest （DHCA group）, and intermittent selective antegrade cerebral perfusion （ISACP） during DHCA（DHCA＋ISACP group）. After operation the water contents in brain tissue were measured ,the hippocampus were removed, and radio-immunity analysis （RIA） was used to measure the content of interleukin-1β（IL-1β） and tumor necrosis factor-alpha （TNF-α） of the hippocampus tissue. The morphology of the hippocampus were examined by transmission electron （TE） microscopy. Results The contents of IL-1β and TNF-α of DHCA group was higher significantly than those of NCPB group and DHCA＋ISACP group （P〈0.01）, there was no significant difference between NCPB group and DHCA＋ISACP group （P〉0.05）. And the contents of TNF-α and IL-1β were positive linear correlated with degree of edema of brain tissues （r = 0. 987, 0.942; P〈 0.01）. TE examination revealed that the damage of the uhrastructure in the DHCA group was more severe than that in NCPB group and DHCA＋ISACP group. Conclusions This experiment revealed that long duration DHCA can bring some damages to the brain and that ISACP during long-term DHCA has brain protective effects to some extent. IL-1β and TNF-α play an effective role in the brain damage of long-term DHCA.
In recent years, transesophageal echocardiography has a trend toward miniaturization, so it has great clinical significance and broad clinical application prospect in the management of Cardiac Surgery ICU patient. This paper presents the characteristics of miniaturized transesophageal echocardiography and its clinical application. And we also focused on the contrast between miniaturized transesophageal echocardiography and standard transesophageal echocardiography and transthoracic echocardiography.
Abstract: Objective To assess the feasibility of transferring major histocompatibility complex (MHC) gene into the thymus to mitigate xenograft rejection. Methods By molecular cloning technique, we extracted and proliferated the-H-2K d gene from donor mice (MHC class Ⅰ gene of Balb/c mice) and constructed the expression vector plasmid of pCI-H-2K d. Twenty SD rats were selected as receptors, and by using random number table, they were divided into the experimental group and the control group with equal number of rats in each group. By ultrasoundguided puncture and lipofection method, the pCI-H-2Kd was injected into thymus of SD rats in the experimental group and meanwhile, empty vector plasmid of pCIneo was injected into thymus of SD rats in the control group. Subsequently, we transplanted the donor mice myocardium xenografts into the receptor rats, and observed the xenograft rejection in both the two groups. Results The survival time of the xenotransplanted myocardium in the experimental group was significantly longer than that in the control group (14.61±2.98 d vs. 6.40±1.58 d, t=-7.619,Plt;0.05). Microtome section of transplanted myocardium in the control group showed a relatively large amount of lymphocyte infiltration and necrosis occurred to most part of the transplanted myocardium, while microtome section of experiment group showed no lymphocyte infiltration and most of the cells of the transplanted myocardium were still alive. After mixed lymphocyte culture, the reaction of receptors to donor cells in the experiment group was obviously lower than that in the control group (t=4.758, P=0.000).After the count by flow cytometer, the xenoMHC molecules were expressed in the receptors’ thymus with a transfection efficiency of 60.7%. Conclusion Our findings suggest that xenograft rejection can be mitigated substantially by donor’s MHC gene transferring into receptor’s thymus. This may provide theoretical and experimental evidence for inducing xenotransplantation tolerance.
Objective To introduce the method and effect of common cardiop ulmonary bypass(CPB) switched to closed extracorporeal circulation by medtronic extracorporeal membrane oxygenation(ECMO) package. Methods From Junuary 2007 to June 2008, common CPB switched to closed extracorporeal circulation by Medtronic ECMO package adding blood reservoir and artery microembolus filtrator was used to 15 patients with grave heart disease to provide CPB support during operation on heart and cardiac function support after operation. The circulation was built through femoral arteryfemoral veinsuperior vena cava intubation or aortaright auricle intubation. There were 10 male and 5 female aged from 6582 years (74.0±9.3 years) and weighed from 6389 kg (69.0±11.4 kg). There were 11 cases with old myocardial infarction, 1 case with acute myocardial infarction, 1 case with old myocardial infarction complicated with mitral stenosis and mitral incompetence, and 2 cases reopened and undergone double valve replacement. Results For all the 15 patients, the closed circulation time was 31112 min（77.3±21.5 min）. The CPB time was 51-84 min（69.7±9.8 min）. The ostoperative mechanical ventilation time was 414 h（8.3±2.9 h）. The 24 hchest drainage was 110-360 ml（227.3±80.4 ml）. All patients were cured and discharged successfully with cardiac function classification in grade ⅠⅡ. Thirteen cases were followed up. The followup time was 412 months. Their cardiac function recovered well and no complication occurred. Conclusion This method could provide effective support for heart and lung before operation，during operation and after operation. This method could save material cost. The heparin paintcoat could reduce inflammatory reaction and it is good for patients’ recovery.
Objective To investigate the method and short-term effectiveness of arthroscopic reconstruction of anterior cruciate l igament (ACL) using RetroButton-allogeneic tendon-interference screw. Methods Between June 2009 and October 2009, 23 patients with ACL rupture were treated by arthroscopic reconstruction with RetroButton-allogeneic tendon-interference screw. There were 15 males and 8 females with an average age of 32.5 years (range, 19-46 years), including 17 left knees and 6 right knees. The injury causes were sport trauma (13 cases), traffic accident (8 cases), and fall ing injury(2 cases). There were 7 acute cases (lt; 6 weeks) and 16 chronic cases (gt; 6 weeks). Among the cases, 11 cases compl icated by medial meniscus injury, 6 by lateral meniscus injury, 3 by the both injuries, and 5 by articular cartilage injury. All cases had no injuries of posterior cruciate l igament, medial or lateral collateral l igament, or posterolateral structure. The time from injury to operation ranged from 3 weeks to 32 months. Lysholm and International Knee Documentation Committee (IKDC) scores were used for subjective evaluation, while Lachman test and KT-1000 measurement for objective evaluation. Results All wounds healed by first intention. The symptoms of unstable knee were improved obviously. No high fever, infection, or immunologic rejection were observed. Refractoriness synovitis and joint effusion occurred in 1 case after operation, and was improved after articular cavity flushing for 7 times within 3 weeks. All cases were followed up 10-17 months (mean, 14.7 months). There were significant differences in Lysholm score, IKDC score, Lachman test, and KT-1000 measurement between pre-operation and last follow-up (P lt; 0.05). Conclusion Arthroscopic reconstruction of ACL with RetroButton-allogeneic tendon-interferencescrew is simple and safe, and its short-term effectiveness is satisfactory.
Objective To improve accuracy of clinical diagnosis through analyzing the CT characteristics and clinical manifestations of patients with benign lung diseases whose CT manifestations initially led to a suspicion of lung cancer. Methods This study collected 2 239 patients of benign lung disease verified by postoperative pathology in the Department of Thoracic Surgery, Beijing Chao-yang Hospital from June 2006 to December 2016. Lesions of 173 patients (101 males and 72 females with a mean age of 56.0 years) were considered very likely to be malignant on preoperative contrast CT scan, which were sorted to 20 types of lung diseases, and the 20 types of diseases contained 907 patients diagnosed or misdiagnosed. Statistical analyses were performed using the CT and clinical characteristics of the 173 patients. Results Among the 907 patients with benign lung disease, the benign pathologies that were most commonly misdiagnosed by preoperative enhanced CT were pulmonary leiomyoma (100.0%), pulmonary actinomycosis (75.0%), pulmonary cryptococcosis (71.4%), sclerosing hemangioma (50.0%) and organizing pneumonia (44.2%). Among the 173 patients with benign diseases, the most common diseases were tuberculosis (29.5%), organizing pneumonia (28.9%), pulmonary hamartoma (6.4%) and pulmonary abscess (6.4%). In the 173 patients, 17.3% had fever, 56.6% coughing, 8.7% yellow sputum, 28.9% hemoptysis, 16.2% chest pain, 18.5% elevated leukocyte counts and 4.6% elevated carcinoembryonic antigen levels. Most of the CT manifestations consisted of nodular or mass shadows, 70.5% of which had foci≤3 cm and manifestations were similar to those of lung cancer, such as a spiculated margin (49.1%), lobulation (33.5%), pleural indentation (27.2%) and significant enhancement (39.3%). Furthermore, some patients had uncommon tumor signs, such as calcification (12.7%), central liquefactive necrosis (18.5%), satellite foci (9.8%) and multiple pulmonary nodules (42.2%). Moreover, 24.3% of the patients had enlarged lymph nodes of the mediastinum or hilum. Conclusion As the CT manifestations of some benign lung conditions are similar to those of lung cancer, careful differential diagnosis is necessary to identify the basic characteristics of the disease when the imaging results are ambiguous, and the diagnosis of a lung disease need incorporate the patients' clinical characteristics and a comprehensive analysis.
Objective To investigate the surgical procedure selection, operation technique and safety of anatomic sublobar resection for pulmonary nodules. Methods The clinical data of 242 patients with clinical stage ⅠA lung cancer who underwent anatomic sublobar resection in our hospital between 2017 and 2020 were retrospectively analyzed. There were 81 males and 161 females with a median age of 57.0 (50.0, 65.0) years. They were divided into 4 groups according to the surgical methods, including a segmentectomy group (n=148), a combined segmentectomy group (n=31), an enlarged segmentectomy group (n=43) and an anatomic wedge resection group (n=20). The preoperative CT data, operation related indexes and early postoperative outcomes of each group were summarized. Results The median medical history of the patients was 4.0 months. The median maximum diameter of nodule on CT image was 1.1 cm, and the consolidation/tumor ratio (CTR) was ≤0.25 in 81.0% of the patients. A total of 240 patients were primary lung adenocarcinoma. The median operation time was 130.0 min, the median blood loss was 50.0 mL, the median chest drainage time was 3.0 d, and the hospitalization cost was (53.0±12.0) thousand yuan. The operation time of combined segmentectomy was longer than that of the segmentectomy group (P=0.001). The operation time (P=0.000), intraoperative blood loss (P=0.000), lymph nodes dissected (P=0.007) and cost of hospitalization (P=0.000) in the anatomic wedge resection group were shorter or less than those in the other three groups. There was no significant difference in the drainage time, total drainage volume, air leakage or postoperative hospital stay among the four groups (P>0.05). Conclusion The combined application of segmentectomy and wedge resection technique provides a more flexible surgical option for the surgical treatment of early lung cancer with ground glass opacity as the main component.
Abstract: Objective To observe the influence of various methods of cerebral protection during deep hypothermic circulatory arrest (DHCA ) on S-100 protein. Methods Eighteen dogs were randomly and equally divided into three groups: the deep hypothermic circulatory arrest (DHCA group ) , the DHCA with retrograde cerebral perfusion (DHCA + RCP group ) , and the DHCA with intermittent antegrade cerebral perfusion (DHCA + IACP group ). Upon interruption of cardiopulmonary bypass (CPB) , the nasopharyngeal temperature was slowly lowered to 18℃, before CPB was discontinued for 90 minutes, after 90 minutes, CPB was re-established and the body temperature was gradually restored to 36℃, then CPB was terminated. Before the circulatory arrest, 45min, 90min after the circulatory arrest and 15min, 30min after re-established of CPB, blood samples were drawn from the jugular veins fo r assay of S-100 protein. Upon completion of surgery, the dogs was sacrificed and the hippocampus was removed from the brain, properly processed for examination by transmission electron microscope for changes in the ultrastructure of the brain and nerve cells. Results There was no significant difference in the content of S-100 protein before circulatory arrest among all three groups (P gt; 0.05). After circulatory arrest, DHCA and DHCA +RCP group showed an significant increase in the content of S-100 protein (P lt; 0.01). There was no significant difference in the content of S-100 protein after circulatory arrest in DHCA + IACP group. Conclusion Cerebral ischemic injuries would occur if the period of DHCA is prolonged. RCP during DHCA would provide protection for the brain to some extent, but it is more likely to cause dropsy in the brain and nerve cells. On the other hand IACP during DHCA appears to provide better brain protection.
Objective To compare the early effectiveness between SuperPATH approach and traditional Hardinge approach in total hip arthroplasty (THA). Methods Between May 2015 and March 2016, 154 patients (173 hips) undergoing initial THA were included. THA was performed by SuperPATH approach in 64 cases (70 hips) in group A and by traditional Hardinge approach in 90 cases (103 hips) in group B. There was no significant difference in gender, age, body mass index, type of disease, and Harris hip score (HHS) between 2 groups (P>0.05). The incision length, operation time, intraoperative blood loss, postoperative drainage volume, transfusion rate, ambulation time, length of stay, and complications were recorded. The HHS and visual analogue scale (VAS) were compared between 2 groups before operation and at 1 day, 3 days, 1 week, 3 weeks, 6 weeks, 12 weeks, and 24 weeks after operation. And the relative parameters were measured for imaging evaluation of prosthesis position. In addition, the stratification analysis was performed on 92 patients (100 hips) who received the SuperPATH technology. Results The incision length, ambulation time, and length of stay in group A were significantly less than those in group B (P<0.05); the operation time, transfusion rate, and intraoperative blood loss of group A were significantly higher than those of group B (P<0.05); and there was no significant difference in postoperative drainage volume between 2 groups (t=1.901,P=0.071). The follow-up period was 6 to 15 months (mean, 9 months). The VAS scores at 1 day, 3 days, and 1 week after operation in group A were significantly lower than those in group B (P<0.05), but the HHS scores at 1 day, 3 days, 1 week, and 3 weeks after operation in group A were significantly higher than those in group B (P<0.05). At 24 weeks after operation, the acetabular cup abduction and the proportion within the safe zone showed no significant difference between 2 groups (P>0.05); the anteversion angle and limb length difference in group A were significantly greater than those in group B (P<0.05), and the proportion of anteversion angle within the safe zone and eccentricity and recovery rate were significantly lower than those in group B (P<0.05). In the stratification analysis, the operation time, incision length, intraoperative blood loss, transfusion rate, and VAS score at 1 day after operation in the former 30 hips were significantly higher than those in the latter 70 hips (P<0.05). Great trochantern fracture and dislocation of the hip joint occurred in 1 and 2 of the former 30 hips, but no complications occurred in the latter 70 hips. No injury of nerve or blood vessel, deep vein thrombosis, infection, and prosthetic loosening were observed in the 2 groups. Conclusion Compared with the Hardinge approach, the SuperPATH approach shows the advantages in little trauma, fast recovery, satisfactory effectiveness, and slight early postoperative pain, but it shows the disadvantages of much intraoperative blood loss and long operation time. In addition, SuperPATH approach needs a more anteverted angle, a smaller eccentricity, and a learning curve, so the mid-term and long-term outcomes still need further follow-up study.