Objective To compare vein graft patency after endoscopic great saphenous vein harvesting (EVH) and conventional open saphenous veinharvesting (OVH) in coronary artery bypass grafting (CABG), and to identify risk factors for vein graft stenosis. Methods The great saphenous vein was harvested using an EVH method in 60 patients, 34 males and 26 females, who underwent CABG in the General Hospital of PLA between May 2006 and May 2009. The mean patient age was 66.6±9.2 years in the EVH group.The OVH group had 60 patients (40 males and 20 females with a mean age of 65.7±10.6 years), chosen to match the clinical characteristics of the EVH group. 64multislice computed tomography (64MSCT) was used to evaluate vein graft patency at six months and two years postoperatively. We also collected and analyzeddata on possible risk factors for vein graft stenosis. Results The harvesting time was longer in the EVH group than in the OVH group (52.5±13.3 minutes vs. 36.1±18.0 minutes, t=2.13, P＜0.05). The EVH group requireda greater number of repairs to veins than did the OVH group (2.2±13 vs. 0.9±0.6,t=2.60, P＜0.05). There were no statistically significant differences invein length, number of vein grafts, or vein graft flow between the two groups. There was also no significant difference in vein graft patency between the EVH and OVH groups at six months postoperatively (96.2% vs. 94.5%) or at two years postoperatively (90.2% vs. 91.5%). The average of vein graft blood flow was a riskfactor for vein graft stenosis(t=2.61, P=001). Conclusion The EVH vein graft had a good patency rate at six months and two years after the surgery.
ObjectiveTo systematically review the effectiveness and safety of GLP-1 receptor agonists versus DPP-4 inhibitors for type 2 diabetes mellitus (T2DM). MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 4, 2013), WanFang Data, CBM and CNKI were searched electronically for randomized controlled trials (RCTs) about GLP-1 receptor agonists versus DPP-4 inhibitors for T2DM up to April 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2.5 software. ResultsA total of 4 RCTs was included. The results of meta-analysis showed that:compared with DPP-4 inhibitors, GLP-1 receptor agonists were more effective in reducing levels of glycated hemoglobin (MD=-0.46, 95%CI-0.57 to-0.35, P < 0.000 01), fasting blood glucose (MD=-1.13, 95%CI-1.39 to-0.88, P < 0.000 01), and weight (MD=-1.59, 95%CI-1.99 to-1.19, P < 0.000 01). In addition, T2DM patients taking GLP-1 receptor agonists had significantly higher achievement rates of glycosylated haemoglobin ( < 7% and≤6.5%), and higher incidences of nausea (OR=4.31, 95%CI 2.87 to 6.47, P < 0.000 01) and diarrhea (OR=2.11, 95%CI 1.40 to 3.18, P=0.000 4). ConclusionGLP-1 receptor agonists are superior to DPP-4 inhibitors in controlling T2DM patients' levels of blood glucose and reducing weight, but it has more gastrointestinal adverse reaction.
Objective To study the effect and mechanism of recombinant human brain natriuretic peptide (rh-BNP) in alleviating myocardial ischemia-reperfusion (I/R) injury by regulating mitogen activated protein kinase (MAPK) pathway. Methods A total of 128 adult male Sprague-Dawley (SD) rats with specific pathogen free were selected. The SD rats were divided into groups according to random number table, including, sham operation (Sham) group, I/R group, I/R+rh-BNP group, negative control adenovirus (Ad-NC)+Sham group, Ad-NC+I/R group, Ad-NC+I/R+rh-BNP group, p38 mitogen-activated protein kinase adenovirus (Ad-p38MAPK)+I/R group and Ad-p38MAPK+I/R+rh-BNP group, with 16 SD rats in each group. Myocardial I/R injury model was established by ligation of left anterior descending coronary artery. Before modeling, rh-BNP was injected intraperitoneally or adenovirus was injected into myocardium; 180 minutes after reperfusion, the contents of lactate dehydrogenase (LDH), creatine kinase isoenzyme (CK-MB) in serum, myocardial infarction size, the contents of reactive oxygen species (ROS), tumor necrosis factor-α (TNF-α) and the expression of phosphorylated p38MAPK (p-p38MAPK), phosphorylated JNK (p-JNK) and phosphorylated extracellular regulated protein kinases 1/2 (p-ERK1/2) were detected. Results The contents of LDH, CK-MB, myocardial infarction size, the contents of TNF-α, ROS and the expression of p-p38MAPK and p-JNK in I/R group were higher than those in Sham group, p-ERK1/2 expression level was lower than that in Sham group (P<0.05). The contents of LDH, CK-MB, myocardial infarction size, the contents of TNF-α, ROS and the expression of p-p38MAPK in I/R+rh-BNP group were lower than those in I/R group (P<0.05), the expression of p-JNK and p-ERK1/2 had no significant difference compared with I/R group (P>0.05). The contents of LDH, CK-MB, myocardial infarction size, the contents of TNF-α, ROS and the expression of p-p38MAPK in Ad-p38mapk+I/R+rh-BNP group were higher than those in Ad-NC+I/R-rh-BNP group (P<0.05). Conclusion rh-BNP can alleviate myocardial I/R injury, which is related to inhibiting p38MAPK pathway, reducing inflammation response and oxidative stress response.
Interventional micro-axial flow blood pump is widely used as an effective treatment for patients with cardiogenic shock. Hemolysis and coagulation are vital concerns in the clinical application of interventional micro-axial flow pumps. This paper reviewed hemolysis and coagulation models for micro-axial flow blood pumps. Firstly, the structural characteristics of commercial interventional micro-axial flow blood pumps and issues related to clinical applications were introduced. Then the basic mechanisms of hemolysis and coagulation were used to study the factors affecting erythrocyte damage and platelet activation in interventional micro-axial flow blood pumps, focusing on the current models of hemolysis and coagulation on different scales (macroscopic, mesoscopic, and microscopic). Since models at different scales have different perspectives on the study of hemolysis and coagulation, a comprehensive analysis combined with multi-scale models is required to fully consider the influence of complex factors of interventional pumps on hemolysis and coagulation.
Objective To investigate the efficacy and prognostic risk factors of high flow nasal cannula (HFNC) in elderly patients with respiratory failure. Methods Clinical data of 172 elderly patients with respiratory failure admitted to 363 Hospital from April 2020 to August 2022 were retrospectively collected. The patients were divided into an observation group (n=86) and a control group (n=86) according to treatment method. The observation group (54 males, 32 females), mean 68.67±2.36 years old, received HFNC oxygen therapy. The control group (52 males, 34 females), mean 68.12±2.14 years old, received conventional oxygen therapy. According to the prognosis after HFNC treatment, the observation group was subdivided into a poor prognosis group (n=21) and a good prognosis group (n=65). The clinical effects of different treatment methods in the two groups were analyzed, and the risk factors affecting prognosis of elderly patients with respiratory failure treated by HFNC were analyzed by multivariate logistic regression. A line graph model was constructed, and the model was verified by receiver operator characteristic curve and cumulative gain graph. Results Repeated measures ANOVA was conducted on the oxygen therapy indicators of the two groups of patients. The results showed that pH, PaO2, PaCO2, and respiratory rate all have statistical significance in terms of time effect (F=423.25, P<0.001; F=326.25, P<0.001; F=128.79, P<0.001; F=323.16, P<0.001), inter-group effect (F=128.79, P<0.001; F=205.46, P<0.001; F=310.52, P<0.001; F=123.15, P<0.001), and interactive effect (F=111.06, P<0.001; F=198.76, P<0.001; F=134.28, P<0.001; F=112.47, P<0.001). This indicated that the impact of time on pH, PaO2, PaCO2, and respiratory rate differs depending on the treatment method. The scores of acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), the level of brain natriuretic peptide (BNP), the heart rate before treatment, the posterior root of tongue fall, the initial HFNC flow and the duration of HFNC in the poor prognosis group were significantly higher than those in the good prognosis group. Initial PaO2/FiO2 was significantly lower than that in the good prognosis group (P<0.05). Multiple factor analysis showed that APACHEⅡ score>17 points, BNP level>150 ng/L before treatment, heart rate >105 times/min before treatment, posterior root of tongue drop, initial HFNC flow>55 L/min, initial PaO2/FiO2<150 mmHg were independent influencing factors for poor prognosis of elderly patients with respiratory failure treated by HFNC. The histogram model showed that the total score of the above 6 indicators is 284, corresponding to a probability of poor prognosis of 71.6%, which proved that the prediction ability of this model is good. Conclusions The application of HFNC in elderly patients with respiratory failure has a significant effect. APACHEⅡ score, BNP level before treatment, heart rate before treatment, posterior root of tongue fall, initial HFNC flow, initial PaO2/FiO2 are all risk factors affecting the prognosis, which should be paid attention to in clinic to improve the therapeutic effect.
【Abstract】Objective To establish and assess the rat model of postoperative fatigue syndrome (POFS). Methods The rat model of POFS was developed by the partial resection of the liver. The behavioral changes prior and post to operation, the disorder of nutritive intake after operation, stress reaction (pathological changes of mucous membrane in small intestine) and the hepatic albumin gene expression were observed. Results Low body temperature, lower sensitivity and reactivity were found. The serum levels of the iron, total protein, albumin, globulin and so on as the indexes of nutrition obviously dropped. The injury of the mucous membrane resulted from the stress reaction after the resection of the liver. The gene expression of the albumin decreased in the model group.Conclusion The experimental rat model of POFS by partial resection of the liver can be used for the investigation of POFS.
ObjectiveTo analyze the clinical characteristics and surgical treatment results of cardiac tumors.MethodsClinical data of 28 patients with cardiac tumors, who underwent cardiac surgery in our hospital from 2013 to 2019 were retrospectively reviewed. There were 12 males and 16 females. The median age was 11.5 years, ranging 1 month to 69 years; and the median weight was 39.0 (4.8-100.0) kg. All patients underwent tumor resection under cardiopulmonary bypass with general anesthesia, and postoperative pathological analysis was performed.ResultsThere were 27 patients with primary cardiac tumors and 1 patient with secondary cardiac tumor. Among the primary cardiac tumors, there were 16 myxomas, 5 rhabdomyomas, 3 inflammatory myofibroblastomas, 2 fibroids and 2 hemangiomas. The secondary cardiac tumor was chondrosarcoma. A total of 28 cardiac tumors occurred in 29 locations, including 14 in the left atrium, 3 in the right atrium, 1 in the left ventricle, 7 in the right ventricle, 2 in the mitral and 2 in the tricuspid. Cerebral embolism occurred in 6 patients, peripheral vascular embolism in 3 patients, and syncope in 3 patients. There was no death during the perioperative period and in the long term follow-up. Complete resection was performed in 25 patients and partial resection was performed in 3 patients. During the follow-up, 2 patients with myxoma received reoperation for recurrence. Among the 3 patients with partial resection, residual tumor tissue disappeared in 2 patients, and in the other patient, there was no change in the size of the residual tumor tissue during the follow-up compared to that at discharge.ConclusionCardiac surgery is an effective method for patients with primary benign cardiac tumors. However, whether the cardiac tumor tissue can be completely removed depends on the anatomical location of the tumor during the operation. If there are systemic embolism events and syncope, the possibility of cardiac tumors should be considered.