The earliest record of chest trauma surgery was B.C 3000 years. Before 15th century, chest trauma surgery only focused on simple wound treatment of the chest wall. At the beginning of 20th century, treatment of organ injury in the thoracic cavity appeared. In the 50's-80's of the 20th century, complete structure and knowledge of modern chest trauma surgery came into being. Since the 90's of the 20th century, development of new techniques such as minimally invasive surgery, new concepts such as fast-track surgery and damage control surgery, new materials, multidisciplinary cooperation, Internet technology, and translational medicine all have contributed to outcome improvement of patients with chest trauma, and will contribute to the development of chest trauma surgery in the future.
Based on the charming quality theories and characteristics of hospital outpatient services in China, this paper defined and analyzed the quality of hospital services, and then made several corresponding recommendations for improving charming quality of outpatient services. The aim is to explore an effective way to tap the potential needs of the patients and to retain some loyal patients, under the impact of the hospital competitiveness.
ObjectiveBased on the rat in situ perfusion system, to explore the effect of up-regulating Chemokine (C-X-C motif) receptor 4 (CXCR4) expression on bone marrow neutrophils in modulating its ECC-related rapid release. MethodsTwelve SD rats were randomly divided into fucoidan perfusion group (F, n=6) and control group (C, n=6) after in situ perfusion system establishment. Rats in F group received perfusion of fucoidan solution (total volume 6 ml, 1 h) and C group received buffer only. Femurs from two groups were dissected after one-hour perfusion and bone marrow tissues were collected. The neutrophil CXCR4 expression in two groups were compared using flowcytometry. Eighteen SD rats were randomly divided into fucoidan perfusion group (F', n=6), fucoidan and AMD-3100 perfusion group (F+AMD3100, n=6) and control group (C', n=6) after in situ perfusion system establishment. Rats received desired interventions before stimulation from ECC plasma. After that, 40-min perfusions of buffer were added and total counts of neutrophil in perfusates were compared. ResultsThe percentages of CXCR4 (+) cell and CXCR4 expression fluorescence in F group were 4.71%±0.21% and 161.3±7.8 respectively while the values were 1.11%±0.11% and 58.4±6.5 respectively in C group. Values in F group were both significantly higher than those in C group (P<0.05). The total counts of neutrophil in perfusates from F' group, F+AMD3100 and C' group were 261 393.7±12 470.6, 872 635.2±10 430.6 and 818 675.2±10 708.8, respectively. Statistically differences were observed between each other (P<0.05). ConclusionBone marrow neutrophil CXCR4 expression of SD rat could be effectively up-regulated by perfusion of fucoidan within the in situ perfusion system. ECC-plasma-stimulated bone marrow neutrophil release in rat could be inhibited by fucoidan induced up-regulation of neutrophil CXCR4 expression, and this inhibition effect could be canceled by AMD-3100 intervention.
The concept of enhanced recovery after surgery(ERAS) has been well accepted by medical providers, which can be realized by a multidisciplinary team approach and minimally invasive surgical technology performed during perioperative periods. As the outcomes of the ERAS protocols, well effects are anticipated, and consistent outcomes are actually obtained. At the same time, there are some aspects which are not consistent including ① the evolution and challenge of ERAS concept:connotation and extension, ② consensus and arguments on the evaluation standard of ERAS protocol, ③ the cause of poorly compliance in medical providers and patient, ④ the function of multimodal programme and multidisciplinary team approach in ERAS protocol, which one is better? ⑤ methods and barriers of implementing enhanced recovery in clinic application.
ObjectiveTo analyze the variation of perioperative concentration of mitochondrial DNA (mtDNA) in circulation system after cardiac surgery with cardiopulmonary bypass (CPB). MethodsBetween July and December 2014, 40 continuous patients underwent aortic valve replacement (AVR) and mitral valve replacement (MVR) in Department of Cardiovascular Surgery, West China Hospital, Sichuan University, including 16 males and 14 females with their mean age of 48.7±11.0 years and mean body weight of 59.0±6.9 kg. Perioperative mtDNA concentrations of circulatory blood were tested at different time points:before general anesthesia (T1), 1 min before CPB (T2), reperfusion of the ascending aorta (T3), 6 h after operation (T4), 24 h after operation (T5), 48 h after operation (T6). ResultsAll the surgeries were successfully performed without early death. Postoperative complications were low cardiac output syndrome in 3 cases and acute kidney failure in 1 cases. The concentration of mtDNA in circulation system rising gradually after CPB. The mtDNA concentration of T3, T4 and T5 were significantly higher than T1 (P < 0.05). The peak level was observed at T5 and the mtDNA concentration of T6 was still significantly higher than that of T1 (P < 0.05). ConclusionThe concentration of mtDNA in circulation system was rising after CPB and peak level appeared at 24 h after CPB.
ObjectiveTo evaluate the efficacy and reversible effect of anti-VCAM-1 ultrasound-targeted microbubbles on extracorporeal circulation (ECC) related bone marrow neutrophil releasing. MethodsThirty-six male SD rats were randomly divided into 6 groups with 6 rats in each group, including an antibody group (group A), antibody with ultrasound group (group AU), targeted microbubble group (group T), targeted microbubble rupture group (group TU), post-ECC plasma simulation group (group MC) and control group (group C) after in situ perfusion model establishment. Rats in group C received buffer perfusion for 4 cycles, and rats in other groups received perfusion for 5 cycles. After buffer perfusion for the first cycle, post-ECC plasma was infused to each group from the second cycle to the fifth cycle in group MC, A, AU, T and TU. Rats in group A and AU received injection with anti-VCAM-1 antibodies, while rats in group T and TU were given anti-VCAM-1 targeted microbubbles after the second perfusion cycle. Same ultrasound radiation was given to group AU and TU in the third perfusion cycle. Neutrophil counts from perfusate were compared among the 6 groups. ResultsUnder simulated inflammatory condition after ECC, compared with group MC, significant reduction of neutrophil count released from bone marrow was found in group A and T, especially in group T (P < 0.05). After ultrasonic radiation, neutrophil mobilization recovered in group TU and its neutrophil count was significantly higher than that of group T (P < 0.05). There was no significant difference in neutrophil count between group A and AU in each perfusion cycle (P > 0.05). ConclusionsAnti-VCAM-1 targeted microbubbles can block the binding of VCAM-1 and its ligand, and form a barrier on the surface of bone marrow sinusoids endothelium to inhibit neutrophils migrating and releasing. The binding of VCAM-1 and its ligand on microbubbles is separated by cavitation of disrupting microbubbles with ultrasound, and neutrophils recover the ability to cross the sinusoidal endothelium of bone marrow in inflammatory conditions to achieve the controllability of neutrophil releasing.
Objective To discuss the application value in increasing the frequency of monitoring and ensuring the safety of anticoagulation therapy in patient self-monitoring (PST) and self-management (PSM) of portable coagulometer. Method This non-randomized prospective controlled study was conducted in 100 patients receiving oral warfarin anticoagulation therapy after heart valve replacement and met the inclusion criteria in our hospital between March 2013 and April 2014 year. All the patients were divided into three groups including an outpatient follow-up group(outpatient group), a self-monitoring group and a self-management group. Meanwhile, the patients in the outpatient group visited professional institutions, performed international normalized ratio (INR) testing with central lab and adjusted the dosage of orally administered warfarin by the doctors. And the other two groups performed INR testing with CoaguChek XS portable coagulometer by themselves, and the patients in the self-management group performed management by themselves. The follow-up time was 6 months. The dates of time in therapeutic range (TTR), fraction of time in therapeutic range (FTTR) and anticoagulation complications in the three groups were analyzed and compared. Results There was no significant difference in the INR results obtained from the follow-up time among the three groups (P=0.845) . TTR value of INR of the outpatient group, the self-monitoring group, and the self-management group was 45.9% (4368.0 days/9517.0 days), 61.2% (6057.0 days/9897.0 days), and 65.4% (2833.8 days/4333.0 days), respectively with a statistical difference among the three groups (P<0.001) . FTTR value of INR obtained from the outpatient group, the self-monitoring group, and the self-management group was 48.3% (99 times/205 times), 60.7% (164 times/270 times), and 64.9% (100 times/154 times) respectively. There was a statistical difference in the FTTR between the outpatient group and the self-monitoring group (P=0.007) , and also between the outpatient group and the self-monitoring group (P=0.002) . But there was no statistical difference between the self-monitoring group and the self-management group (P=0.392) . There were not any major bleeding and thrombosis complications in all study. And there was no statistical difference in the total complications, thrombosis, and bleeding complications rates between the outpatient group and the self-monitoring group, and also between the outpatient group and the self-management group (P>0.05) . Conclusions The patients receiving oral anticoagulation after heart valve replacement or their care providers were able to perform PST and PSM. The use of portable coagulometer for self-monitoring and self-management can increase the frequency of anticoagulation monitoring and achieve better INR target value control. PST and PSM could achieve higher quality of anticoagulation management and life and without increasing the risk of oral anticoagulation than the traditional monitoring method. The monitoring frequency of once a month is reasonable for the patients receiving oral anticoagulation more than half a year after heart valve replacement.
ObjectiveTo introduce the role of three dementional computed tomograph (3D-CT) for patients underwent transcatheter aortic valve implantation (TAVI) procedure in perioperative evaluation. MethodsFrom April 2014 to June 2015, we retrospectively analyzed clinical data of 28 patients with severe aortic stenosis underwent successful TAVI procedure using new second-generation device, who were enrolled in this study including 12 males and 16 females at mean age of 72.8±4.5 years. We used 3D-CT to get the perioperative relative evaluation, including valve morphology and calcification degree, annular diameter, aoronary ostium height, ascending aorta, aortic sinus diameter, left ventricular-aortic angle, optimal intraoperative angiogram projection angle. Based on the evaluation by 3D-CT image, the prosthesis size, balloon size, best intraoperative imaging projection angle and approach of apex were then chosen. ResultsAll patients with severe aortic stenosis underwent successful TAVI procedure with mean logistic Euro-SCORE I:26.2%±7.9%. CT image revealed that mean aortic annular diameter was 24.6±1.8 mm with mean valve prosthesis size 25.8±1.1 mm and pre-dilation balloon size 23.1±1.2 mm and 76.8% patients were of tricuspid aortic valve with severe calcification and 25% patients were of asymmetric calcification. Optimal intraoperative angiogram image was achieved in 92.9% patients with the help of preoperative CT image. There was a statistic difference in mean transvalvular gradient after valve implantation (54.1±15.3 mm Hg vs. 13.1±8.5 mm Hg, P<0.05). And there was no mortality or severe complication postoperatively. Conclusion3D-CT image palys an important role during perioperative evaluation of TAVI procedure and it can be helpful for Chinese doctors to operate TAVI successfully.
ObjectiveTo observe systemic inflammatory response (SIR)of patients in different stages after the onset of aortic dissection (AD), and preliminarily explore a new staging system of AD based on SIR. MethodsFrom September 2011 to February 2012, 46 AD patients were admitted to the Department of Cardiovascular Surgery, West China Hospital of Sichuan University. There were 33 male and 13 female patients with their age ranging from 22 to 77 years (53.2±13.6 years). Blood samples were collected in 9 different periods after the onset of AD (0-12 hours (T1), 12-24 hours (T2), 24-48 hours (T3, 1-2 days), 48-96 hours (T4, 2-4 days), 96-168 hours (T5, 4-7 days), 168-336 hours (T6, 7-14 days), 336-720 hours (T7, 14-30 days), 720-1440 hours (T8, 30-60 days) and > 1 440 hours (T9, > days))to measure blood concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), endotoxin (ET), white blood cell (WBC)and neutrophils (Neut). SIR changes after the onset of AD were summarized. ResultsBlood concentrations of different inflammatory mediators were all significantly elevated within 14 days (T1-T6), significantly decreased in 14-60 days (T7-T8), and returned to normal range 60 days (T9)after the onset of AD. Peak levels of ET and TNF-α appeared in T1 with 263.42±29.98 pg/ml and 86.75±18.83 pg/ml respectively. Peak level of IL-6 appeared in T2 with 95.70±22.64 pg/ml. Peak level of CRP appeared in T5 with 123.74±54.78 mg/L. There was no obvious peak level of WBC or Neut. ConclusionDisease progression of AD can be divided into 3 stages including acute stage (within 14 days), subacute stage (14-60 days)and chronic stage ( > 60 days)based on the degree of SIR.
ObjectiveThrough comparing the efficacy of levosimendan with dopamine for severe valvular disease patients with atrial fibrillation surgery to explore the efficacy and safety of levosimendan used in cardiac surgery. MethodsWe allocated 48 severe valvular disease patients with atrial fibrillation surgery into a dopamine group (24 patients with 15 males and 9 females at age of 55.0 ± 17.4 years) and a levosimendan group (24 patients with 18 males and 6 females at age of 52.3 ± 16.2 years) by random digital table in the Affiliated Hospital of Luzhou Medical College between February and June 2014. The effects of the two groups were compared. ResultsHospitalization time (18.7±8.6 d vs 20.6±7.5 d, t=11.52, P=0.02) and the incidence of acute kidney injury(1/24 vs 5/24, χ2=25.30, P=0.01) in the levosimendan group were lower than those in the dopamine group. There was no statistical difference between the two groups in other early clinical outcomes. At each postoperative time point, there was no statistical difference in creatine kinase isoenzyme (CK-MB) between the two groups. While 6 to 48 hours after operation, there were significant differences in cardiac troponin (cTnI) and brain natriuretic peptide(BNP) level between the two groups (P < 0.05). Five days after operation, the left ventricular ejection fraction(LVEF) in the levosimendan group was higher than that in the dopamine group with statistical difference. ConclusionLevosimendan used for severe valvular disease with atrial fibrillation surgery is safe and effective, and has certain myocardial protection and renal protection effect, while its mechanism still needs further study.