OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway(MSDP)in Chinese patients with acute coronary syndrome(ACS).METHODS In this multicenter,prospective,open label,single-arm and...OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway(MSDP)in Chinese patients with acute coronary syndrome(ACS).METHODS In this multicenter,prospective,open label,single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals.A total of 998 hospitalized patients aged≥18 years and diagnosed with ACS were included.The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines.The primary endpoint was the percentage of patients achieving the target dose at discharge(V2).The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge(V4),and percentage of patients experiencing bradycardia(heart rate<50 beats/min),hypotension(blood pressure<90/60 mmHg)and transient cardiac dysfunction at V2 and V4.RESULTS Of the 998 patients,29.46%of patients achieved the target dose(≥95 mg/d)at V2.The total population was divided into two groups:target group(patients achieving the target dose at V2)and non-target group(patients not achieving the target dose at V2).There was significant difference in the reduction of heart rate from baseline to discharge in the two groups(-4.97±11.90beats/min vs.-2.70±9.47 beats/min,P=0.034).There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2(0 vs.0,P=1.000)and V4(0.81%vs.0.33%,P=0.715).There was no significant difference in the proportion of hypotension between the two groups at V2(0.004%vs.0.004%,P=1.000)and V4(0 vs.0.005%,P=0.560).No transient cardiac dysfunction occurred in two groups during the study.A total of five adverse events(1.70%)and one serious adverse event(0.34%)were related to the pathway in target group.CONCLUSIONS In Chinese ACS patients,the feasibility and tolerability of the MSDP have been proved to be acceptable.展开更多
Objective: To assess the effects of traditional Chinese medicine YiQiFuMai on cardiac function during the progression of ischemic heart failure. Methods: Rabbits were divided into sham, heart failure, and YiQiFuMai gr...Objective: To assess the effects of traditional Chinese medicine YiQiFuMai on cardiac function during the progression of ischemic heart failure. Methods: Rabbits were divided into sham, heart failure, and YiQiFuMai groups. The ischemic heart failure model was established in New Zealand white rabbits, which were intraperitoneally injected with YiQiFuMai injection and 0.9% sodium chloride after the operation. After six weeks, cardiac function was examined by ultrasound;serum BNP levels were measured by ELISA;p-AKT, eNOS, ICAM-1 and VEGF levels were evaluated by real-time PCR and Western-Blot;pathological changes of the myocardial tissue were observed by H&E staining;CD31 expression in tissue samples was analyzed by immunohistochemistry. The ultrastructure and microcirculation of myocardial tissue specimens from the three groups were assessed by transmission electron microscopy. Results: YiQiFuMai decreased serum BNP levels, and increased LVEF and reduced LVEDD at 6 weeks postoperatively. In addition, YiQiFuMai can improve myocardial damage and microcirculation structure, as assessed by histology and transmission electron microscope. At the molecular level, treatment with YiQiFuMai resulted in increased eNOS, VEGF and p-AKT levels but reduced ICAM-1 amounts compared with the heart failure group. Conclusion: Ischemic heart failure damages the microvascular structure and functions of the myocardium. Treatment with YiQiFuMai potentially ameliorates microcirculatory damage and alleviates cardiac failure by improving endothelial function and angiogenesis, and inhibiting inflammatory cell adhesion.展开更多
BACKGROUND Adult severe myocarditis is primarily caused by infection with any number of a variety of viruses.It arises quickly,progresses rapidly,and may lead to severe heart failure or circulatory failure presenting ...BACKGROUND Adult severe myocarditis is primarily caused by infection with any number of a variety of viruses.It arises quickly,progresses rapidly,and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock with a high hospital mortality rate.AIM To analyze the risk factors affecting the short-term prognosis of adult acute severe myocarditis(ASM).METHODS Adult patients with ASM(ASM group,n=218)and acute nonsevere myocarditis(ANSM group,n=80)who came to our department from January 2014 to January 2020 were enrolled in this study.Patients with ASM were divided into the ASM survival group(n=185)and ASM nonsurvival group(n=33)according to the treatment results during hospitalization.The clinical symptoms,laboratory examinations,treatment methods,complications,and the relationship between the treatment results of the two groups were retrospectively compared and discussed.The risk factors for death in patients with severe myocarditis were analyzed by binary logistic regression.A follow-up to 5.5 years was conducted on patients in the ASM survival group and ANSM group after discharge,and the readmission rate and incidence rate of dilated cardiomyopathy were analyzed.RESULTS Compared with the ASM survival group,the ASM nonsurvival group had longer QRS complex,higher incidence of cardiogenic shock,higher serum creatinine(SCr,235μmol/L vs 89μmol/L,P<0.05),higher sensitive cardiac troponin I(cTnI,4.45μg/L vs 1.66μg/L,P<0.05)and brain natriuretic peptide(BNP,1756 pg/mL vs 401 pg/mL,P<0.05).The binary logistic regression revealed that there were statistical differences between the two groups in SCr,cTnI,and BNP values(all P<0.05).After discharging from the hospital,patients in the ASM group and ANSM group had no significant differences in the readmission rate and incidencerate of dilated cardiomyopathy.CONCLUSION Elevated SCr,cTnI,and BNP are independent predictors for poor prognosis in patients with ASM.The long-term prognosis of patients in the ASM survival group is good.展开更多
Background Febuxostat,a novel nonpurine selective inhibitor of xanthine oxidase(XO),may be used in the prevention and management of atrial fibrillation(AF).The purpose of this study was to evaluate the effects of febu...Background Febuxostat,a novel nonpurine selective inhibitor of xanthine oxidase(XO),may be used in the prevention and management of atrial fibrillation(AF).The purpose of this study was to evaluate the effects of febuxostat on atrial remodeling in a rabbit model of AF induced by rapid atrial pacing(RAP)and the mechanisms by which it acts.Methods Twenty-four rabbits were randomly divided into four groups:sham-operated group(Group S),RAP group(Group P),RAP with 5 mg/kg per day febuxostat group(Group LFP),and RAP with 10 mg/kg per day febuxostat group(Group HFP).All rabbits except those in Group S were subjected to RAP at 600 beats/min for four weeks.The effects of febuxostat on atrial electrical and structural remodeling,markers of inflammation and oxidative stress,and signaling pathways involved in the left atrium were examined.Results Shortened atrial effective refractory period(AERP),increased AF inducibility,decreased mRNA levels of Cav1.2 and Kv4.3,and left atrial enlargement and dysfunction were observed in Group P,and these changes were suppressed in the groups treated with febuxostat.Prominent atrial fibrosis was observed in Group P,as were increased levels of TGF-β1,Collagen I,andα-SMA and decreased levels of Smad7 and eNOS.Treatment with febuxostat attenuated these differences.Changes in inflammatory and oxidative stress markers induced by RAP were consistent with the protective effects of febuxostat.Conclusions This study is the first to find that febuxostat can inhibit atrial electrical and structural remodeling of AF by suppressing XO and inhibiting the TGF-β1/Smad signaling pathway.展开更多
BACKGROUND Tension pneumothorax of the contralateral lung during single-lung ventilation(SLV)combined with artificial pneumothorax can cause cardiac arrest due to bilateral pneumothorax.If not rapidly diagnosed and ma...BACKGROUND Tension pneumothorax of the contralateral lung during single-lung ventilation(SLV)combined with artificial pneumothorax can cause cardiac arrest due to bilateral pneumothorax.If not rapidly diagnosed and managed,this condition can lead to sudden death.We describe the emergency handling procedures and rapid diagnostic methods for this critical emergency situation.CASE SUMMARY We report a case of bilateral pneumothorax in a neonatal patient who underwent thoracoscopic esophageal atresia and tracheoesophageal fistula repair under the combined application of SLV and artificial pneumothorax.The patient suffered sudden cardiac arrest and received emergency treatment to revive her.The recognition of dangerous vital sign parameters,rapid evacuation of the artificial pneumothorax,and initiation of lateral position cardiopulmonary resuscitation while simultaneously removing the endotracheal tube to the main airway are critically important.Moreover,even though the sinus rhythm was restored,the patient’s continued tachycardia,reduced pulse pressure,and depressed pulse oximeter waveform were worrisome.We should highly suspect the possibility of pneumothorax and use rapid diagnostic methods to make judgment calls.Sometimes thoracoscopy can be used for rapid examination;if the mediastinum is observed to be shifted to the right,it may indicate tension pneumothorax.This condition can be immediately relieved by needle thoracentesis,ultimately allowing the safe completion of the surgical procedure.CONCLUSION Bilateral pneumothorax during SLV combined with artificial pneumothorax is rare but can occur at any time in neonatal thoracoscopic surgery.Therefore,anesthesiologists should consider this possibility,be alert,and address this rare but critical complication in a timely manner.展开更多
Perioperative neonatal pneumothorax(NP)is rare but very fatal.Most of the surgeries and treatments in the neonatal period are time-limited or emergent,and there are often some risk factors for pneumothorax before surg...Perioperative neonatal pneumothorax(NP)is rare but very fatal.Most of the surgeries and treatments in the neonatal period are time-limited or emergent,and there are often some risk factors for pneumothorax before surgery.Physicians,surgeons and anesthesiologists need to identify possible risk factors for pneumothorax before surgery in preterm babies,patients receiving mechanical ventilation and those with underlying lung disease.The clinical presentation of NP is nonspecific,and patients may rapidly develop life-threatening complications if not promptly diagnosed and managed.This review highlights recent progress in the identification of risk factors,clinical manifestations,diagnosis and management of NP during the perioperative period.展开更多
BACKGROUND Ductal spasm is a rare but life-threatening complication of cardiac catheterization in neonates with pulmonary atresia and an intact ventricular septum.In patients with ductal-dependent pulmonary blood flow...BACKGROUND Ductal spasm is a rare but life-threatening complication of cardiac catheterization in neonates with pulmonary atresia and an intact ventricular septum.In patients with ductal-dependent pulmonary blood flow,ductal spasm may lead to refractory hypoxemia and severe hemodynamic instability,which need to be treated in perfect order.CASE SUMMARY We present a male infant with a gestational age of 39 wk,and his fetal echocardiography showed pulmonary atresia.At 28 d of age,transcatheter pulmonary valvuloplasty with balloon dilatation was performed.Two hours after the operation,the patient's pulse oxygen saturation continued to decrease.The patient was then transferred to receive cardiac catheterization.During catheterization,the invasive blood pressure and pulse oxygen saturation suddenly decreased,and repeated aortography revealed partial occlusion of the ductus arteriosus.It no longer changed when pulse oxygen saturation rose to 51%after approximately 20 min of maintenance therapy.Therefore,a ductal stent was used for implantation.Hemodynamics and hypoxemia were improved.CONCLUSION We should know that ductal spasm may occur during pulmonary atresia and intact ventricular septum cardiac catheterization.Understand the pathophysiology of ductal-dependent pulmonary blood flow and make comprehensive perioperative preparations essential to deal with hemodynamic disorders caused by ductal spasm.展开更多
Background Preoperative planning for children with congenital heart diseases remains crucial and challenging.This study aimed to investigate the roles of three-dimensional printed patient-specific heart models in the ...Background Preoperative planning for children with congenital heart diseases remains crucial and challenging.This study aimed to investigate the roles of three-dimensional printed patient-specific heart models in the presurgical planning for complex congenital heart disease.Methods From May 2017 to January 2018,15 children diagnosed with complex congenital heart disease were included in this study.Heart models were printed based on computed tomography (CT) imaging reconstruction by a 3D printer with photosensitive resin using the stereolithography apparatus technology.Surgery options were first evaluated by a sophisticated cardiac surgery group using CT images only,and then surgical plans were also set up based on heart models.Results Fifteen 3D printed heart models were successfully generated.According to the decisions based on CT,13 cases were consistent with real options,while the other 2 were not.According to 3D printed heart models,all the 15 cases were consistent with real options.Unfortunately,one child diagnosed with complete transposition of great arteries combined with interruption of aortic arch (type A) died 5 days after operation due to postoperative low cardiac output syndrome.The cardiologists,especially the younger ones,considered that these 3D printed heart models with tangible,physical and comprehensive illustrations were beneficial for preoperative planning of complex congenital heart diseases.Conclusion 3D printed heart models are beneficial and promising in preoperative planning for complex congenital heart diseases,and are able to help conform or even improve the surgery options.展开更多
To the Editor:A 70-year-old female was admitted for severe precordial pain.Electrocardiograph on admission showed ST-segment elevation myocardial infarction (STEMI) with inferior wall,examination showed cardiogenic sh...To the Editor:A 70-year-old female was admitted for severe precordial pain.Electrocardiograph on admission showed ST-segment elevation myocardial infarction (STEMI) with inferior wall,examination showed cardiogenic shock,noninvasive blood pressure (NIBP) 50/30 mmHg (1 mmHg =0.133 kPa),and cardiac troponin I positive.She was diagnosed as acute myocardial infarction (AMI) with cardiogenic shock.Fluid resuscitation and inotropic agents were administered immediately,and systolic blood pressure increased to about 90 mmHg.The patient was transferred to catheterization laboratory immediately after administration of a loading dose of aspirin and clopidogrel.展开更多
Severe acute respiratory distress syndrome(ARDS)is commonly seen in intensive care units(ICUs).It is characterized by capillary endothelium and alveolar epithelium damage that results in significant increases in capil...Severe acute respiratory distress syndrome(ARDS)is commonly seen in intensive care units(ICUs).It is characterized by capillary endothelium and alveolar epithelium damage that results in significant increases in capillary permeability and extravascular lung water.展开更多
Background:Microsatellite instability(MSI)is a key biomarker for cancer immunotherapy and prognosis.Integration of MSI testing into a next-generation-sequencing(NGS)panel could save tissue sample,reduce turn-around ti...Background:Microsatellite instability(MSI)is a key biomarker for cancer immunotherapy and prognosis.Integration of MSI testing into a next-generation-sequencing(NGS)panel could save tissue sample,reduce turn-around time and cost,and provide MSI status and comprehensive genomic profiling in single test.We aimed to develop an MSI calling model to detect MSI status along with the NGS panel-based profiling test using tumor-only samples.Methods:From January 2019 to December 2020,a total of 174 colorectal cancer(CRC)patients were enrolled,including 31 MSI-high(MSI-H)and 143 microsatellite stability(MSS)cases.Among them,56 paired tumor and normal samples(10 MSI-H and 46 MSS)were used for modeling,and another 118 tumor-only samples were used for validation.MSI polymerase chain reaction(MSI-PCR)was performed as the gold standard.A baseline was built for the selected microsatellite loci using the NGS data of 56 normal blood samples.An MSI detection model was constructed by analyzing the NGS data of tissue samples.The performance of the model was compared with the results of MSI-PCR.Results:We first intersected the target genomic regions of the NGS panels used in this study to select common microsatellite loci.A total of 42 loci including 23 mononucleotide repeat sites and 19 longer repeat sites were candidates for modeling.As mononucleotide repeat sites are more sensitive and specific for detecting MSI status than sites with longer length motif and the mononucleotide repeat sites performed even better than the total sites,a model containing 23 mononucleotide repeat sites was constructed and named Colorectal Cancer Microsatellite Instability test(CRC-MSI).The model achieved 100%sensitivity and 100%specificity when compared with MSI-PCR in both training and validation sets.Furthermore,the CRC-MSI model was robust with the tumor content as low as 6%.In addition,8 out of 10 MSI-H samples showed alternations in the four mismatch repair genes(MLH1,MSH2,MSH6,and PMS2).Conclusion:MSI status can be accurately determined along the targeted NGS panels using only tumor samples.The performance of mononucleotide repeat sites surpasses loci with longer repeat motif in MSI calling.展开更多
基金supported by the National Key Research and Development Program of China(2016YFC1300300)。
文摘OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway(MSDP)in Chinese patients with acute coronary syndrome(ACS).METHODS In this multicenter,prospective,open label,single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals.A total of 998 hospitalized patients aged≥18 years and diagnosed with ACS were included.The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines.The primary endpoint was the percentage of patients achieving the target dose at discharge(V2).The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge(V4),and percentage of patients experiencing bradycardia(heart rate<50 beats/min),hypotension(blood pressure<90/60 mmHg)and transient cardiac dysfunction at V2 and V4.RESULTS Of the 998 patients,29.46%of patients achieved the target dose(≥95 mg/d)at V2.The total population was divided into two groups:target group(patients achieving the target dose at V2)and non-target group(patients not achieving the target dose at V2).There was significant difference in the reduction of heart rate from baseline to discharge in the two groups(-4.97±11.90beats/min vs.-2.70±9.47 beats/min,P=0.034).There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2(0 vs.0,P=1.000)and V4(0.81%vs.0.33%,P=0.715).There was no significant difference in the proportion of hypotension between the two groups at V2(0.004%vs.0.004%,P=1.000)and V4(0 vs.0.005%,P=0.560).No transient cardiac dysfunction occurred in two groups during the study.A total of five adverse events(1.70%)and one serious adverse event(0.34%)were related to the pathway in target group.CONCLUSIONS In Chinese ACS patients,the feasibility and tolerability of the MSDP have been proved to be acceptable.
文摘Objective: To assess the effects of traditional Chinese medicine YiQiFuMai on cardiac function during the progression of ischemic heart failure. Methods: Rabbits were divided into sham, heart failure, and YiQiFuMai groups. The ischemic heart failure model was established in New Zealand white rabbits, which were intraperitoneally injected with YiQiFuMai injection and 0.9% sodium chloride after the operation. After six weeks, cardiac function was examined by ultrasound;serum BNP levels were measured by ELISA;p-AKT, eNOS, ICAM-1 and VEGF levels were evaluated by real-time PCR and Western-Blot;pathological changes of the myocardial tissue were observed by H&E staining;CD31 expression in tissue samples was analyzed by immunohistochemistry. The ultrastructure and microcirculation of myocardial tissue specimens from the three groups were assessed by transmission electron microscopy. Results: YiQiFuMai decreased serum BNP levels, and increased LVEF and reduced LVEDD at 6 weeks postoperatively. In addition, YiQiFuMai can improve myocardial damage and microcirculation structure, as assessed by histology and transmission electron microscope. At the molecular level, treatment with YiQiFuMai resulted in increased eNOS, VEGF and p-AKT levels but reduced ICAM-1 amounts compared with the heart failure group. Conclusion: Ischemic heart failure damages the microvascular structure and functions of the myocardium. Treatment with YiQiFuMai potentially ameliorates microcirculatory damage and alleviates cardiac failure by improving endothelial function and angiogenesis, and inhibiting inflammatory cell adhesion.
文摘BACKGROUND Adult severe myocarditis is primarily caused by infection with any number of a variety of viruses.It arises quickly,progresses rapidly,and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock with a high hospital mortality rate.AIM To analyze the risk factors affecting the short-term prognosis of adult acute severe myocarditis(ASM).METHODS Adult patients with ASM(ASM group,n=218)and acute nonsevere myocarditis(ANSM group,n=80)who came to our department from January 2014 to January 2020 were enrolled in this study.Patients with ASM were divided into the ASM survival group(n=185)and ASM nonsurvival group(n=33)according to the treatment results during hospitalization.The clinical symptoms,laboratory examinations,treatment methods,complications,and the relationship between the treatment results of the two groups were retrospectively compared and discussed.The risk factors for death in patients with severe myocarditis were analyzed by binary logistic regression.A follow-up to 5.5 years was conducted on patients in the ASM survival group and ANSM group after discharge,and the readmission rate and incidence rate of dilated cardiomyopathy were analyzed.RESULTS Compared with the ASM survival group,the ASM nonsurvival group had longer QRS complex,higher incidence of cardiogenic shock,higher serum creatinine(SCr,235μmol/L vs 89μmol/L,P<0.05),higher sensitive cardiac troponin I(cTnI,4.45μg/L vs 1.66μg/L,P<0.05)and brain natriuretic peptide(BNP,1756 pg/mL vs 401 pg/mL,P<0.05).The binary logistic regression revealed that there were statistical differences between the two groups in SCr,cTnI,and BNP values(all P<0.05).After discharging from the hospital,patients in the ASM group and ANSM group had no significant differences in the readmission rate and incidencerate of dilated cardiomyopathy.CONCLUSION Elevated SCr,cTnI,and BNP are independent predictors for poor prognosis in patients with ASM.The long-term prognosis of patients in the ASM survival group is good.
基金supported by the Beijing Natural Science Foundation(Z141100002114050)
文摘Background Febuxostat,a novel nonpurine selective inhibitor of xanthine oxidase(XO),may be used in the prevention and management of atrial fibrillation(AF).The purpose of this study was to evaluate the effects of febuxostat on atrial remodeling in a rabbit model of AF induced by rapid atrial pacing(RAP)and the mechanisms by which it acts.Methods Twenty-four rabbits were randomly divided into four groups:sham-operated group(Group S),RAP group(Group P),RAP with 5 mg/kg per day febuxostat group(Group LFP),and RAP with 10 mg/kg per day febuxostat group(Group HFP).All rabbits except those in Group S were subjected to RAP at 600 beats/min for four weeks.The effects of febuxostat on atrial electrical and structural remodeling,markers of inflammation and oxidative stress,and signaling pathways involved in the left atrium were examined.Results Shortened atrial effective refractory period(AERP),increased AF inducibility,decreased mRNA levels of Cav1.2 and Kv4.3,and left atrial enlargement and dysfunction were observed in Group P,and these changes were suppressed in the groups treated with febuxostat.Prominent atrial fibrosis was observed in Group P,as were increased levels of TGF-β1,Collagen I,andα-SMA and decreased levels of Smad7 and eNOS.Treatment with febuxostat attenuated these differences.Changes in inflammatory and oxidative stress markers induced by RAP were consistent with the protective effects of febuxostat.Conclusions This study is the first to find that febuxostat can inhibit atrial electrical and structural remodeling of AF by suppressing XO and inhibiting the TGF-β1/Smad signaling pathway.
文摘BACKGROUND Tension pneumothorax of the contralateral lung during single-lung ventilation(SLV)combined with artificial pneumothorax can cause cardiac arrest due to bilateral pneumothorax.If not rapidly diagnosed and managed,this condition can lead to sudden death.We describe the emergency handling procedures and rapid diagnostic methods for this critical emergency situation.CASE SUMMARY We report a case of bilateral pneumothorax in a neonatal patient who underwent thoracoscopic esophageal atresia and tracheoesophageal fistula repair under the combined application of SLV and artificial pneumothorax.The patient suffered sudden cardiac arrest and received emergency treatment to revive her.The recognition of dangerous vital sign parameters,rapid evacuation of the artificial pneumothorax,and initiation of lateral position cardiopulmonary resuscitation while simultaneously removing the endotracheal tube to the main airway are critically important.Moreover,even though the sinus rhythm was restored,the patient’s continued tachycardia,reduced pulse pressure,and depressed pulse oximeter waveform were worrisome.We should highly suspect the possibility of pneumothorax and use rapid diagnostic methods to make judgment calls.Sometimes thoracoscopy can be used for rapid examination;if the mediastinum is observed to be shifted to the right,it may indicate tension pneumothorax.This condition can be immediately relieved by needle thoracentesis,ultimately allowing the safe completion of the surgical procedure.CONCLUSION Bilateral pneumothorax during SLV combined with artificial pneumothorax is rare but can occur at any time in neonatal thoracoscopic surgery.Therefore,anesthesiologists should consider this possibility,be alert,and address this rare but critical complication in a timely manner.
文摘Perioperative neonatal pneumothorax(NP)is rare but very fatal.Most of the surgeries and treatments in the neonatal period are time-limited or emergent,and there are often some risk factors for pneumothorax before surgery.Physicians,surgeons and anesthesiologists need to identify possible risk factors for pneumothorax before surgery in preterm babies,patients receiving mechanical ventilation and those with underlying lung disease.The clinical presentation of NP is nonspecific,and patients may rapidly develop life-threatening complications if not promptly diagnosed and managed.This review highlights recent progress in the identification of risk factors,clinical manifestations,diagnosis and management of NP during the perioperative period.
文摘BACKGROUND Ductal spasm is a rare but life-threatening complication of cardiac catheterization in neonates with pulmonary atresia and an intact ventricular septum.In patients with ductal-dependent pulmonary blood flow,ductal spasm may lead to refractory hypoxemia and severe hemodynamic instability,which need to be treated in perfect order.CASE SUMMARY We present a male infant with a gestational age of 39 wk,and his fetal echocardiography showed pulmonary atresia.At 28 d of age,transcatheter pulmonary valvuloplasty with balloon dilatation was performed.Two hours after the operation,the patient's pulse oxygen saturation continued to decrease.The patient was then transferred to receive cardiac catheterization.During catheterization,the invasive blood pressure and pulse oxygen saturation suddenly decreased,and repeated aortography revealed partial occlusion of the ductus arteriosus.It no longer changed when pulse oxygen saturation rose to 51%after approximately 20 min of maintenance therapy.Therefore,a ductal stent was used for implantation.Hemodynamics and hypoxemia were improved.CONCLUSION We should know that ductal spasm may occur during pulmonary atresia and intact ventricular septum cardiac catheterization.Understand the pathophysiology of ductal-dependent pulmonary blood flow and make comprehensive perioperative preparations essential to deal with hemodynamic disorders caused by ductal spasm.
文摘Background Preoperative planning for children with congenital heart diseases remains crucial and challenging.This study aimed to investigate the roles of three-dimensional printed patient-specific heart models in the presurgical planning for complex congenital heart disease.Methods From May 2017 to January 2018,15 children diagnosed with complex congenital heart disease were included in this study.Heart models were printed based on computed tomography (CT) imaging reconstruction by a 3D printer with photosensitive resin using the stereolithography apparatus technology.Surgery options were first evaluated by a sophisticated cardiac surgery group using CT images only,and then surgical plans were also set up based on heart models.Results Fifteen 3D printed heart models were successfully generated.According to the decisions based on CT,13 cases were consistent with real options,while the other 2 were not.According to 3D printed heart models,all the 15 cases were consistent with real options.Unfortunately,one child diagnosed with complete transposition of great arteries combined with interruption of aortic arch (type A) died 5 days after operation due to postoperative low cardiac output syndrome.The cardiologists,especially the younger ones,considered that these 3D printed heart models with tangible,physical and comprehensive illustrations were beneficial for preoperative planning of complex congenital heart diseases.Conclusion 3D printed heart models are beneficial and promising in preoperative planning for complex congenital heart diseases,and are able to help conform or even improve the surgery options.
文摘To the Editor:A 70-year-old female was admitted for severe precordial pain.Electrocardiograph on admission showed ST-segment elevation myocardial infarction (STEMI) with inferior wall,examination showed cardiogenic shock,noninvasive blood pressure (NIBP) 50/30 mmHg (1 mmHg =0.133 kPa),and cardiac troponin I positive.She was diagnosed as acute myocardial infarction (AMI) with cardiogenic shock.Fluid resuscitation and inotropic agents were administered immediately,and systolic blood pressure increased to about 90 mmHg.The patient was transferred to catheterization laboratory immediately after administration of a loading dose of aspirin and clopidogrel.
基金the grants from Science and Technology Fund of Tianjin Health Bureau(No.2015KZ015)the Tianjin Third Central Hospital National Natural Science Foundation Incubation Project of China(No.2019YNR1)the Natural Science Foundation of Tianjin(No.19JCYBJC2600).
文摘Severe acute respiratory distress syndrome(ARDS)is commonly seen in intensive care units(ICUs).It is characterized by capillary endothelium and alveolar epithelium damage that results in significant increases in capillary permeability and extravascular lung water.
文摘Background:Microsatellite instability(MSI)is a key biomarker for cancer immunotherapy and prognosis.Integration of MSI testing into a next-generation-sequencing(NGS)panel could save tissue sample,reduce turn-around time and cost,and provide MSI status and comprehensive genomic profiling in single test.We aimed to develop an MSI calling model to detect MSI status along with the NGS panel-based profiling test using tumor-only samples.Methods:From January 2019 to December 2020,a total of 174 colorectal cancer(CRC)patients were enrolled,including 31 MSI-high(MSI-H)and 143 microsatellite stability(MSS)cases.Among them,56 paired tumor and normal samples(10 MSI-H and 46 MSS)were used for modeling,and another 118 tumor-only samples were used for validation.MSI polymerase chain reaction(MSI-PCR)was performed as the gold standard.A baseline was built for the selected microsatellite loci using the NGS data of 56 normal blood samples.An MSI detection model was constructed by analyzing the NGS data of tissue samples.The performance of the model was compared with the results of MSI-PCR.Results:We first intersected the target genomic regions of the NGS panels used in this study to select common microsatellite loci.A total of 42 loci including 23 mononucleotide repeat sites and 19 longer repeat sites were candidates for modeling.As mononucleotide repeat sites are more sensitive and specific for detecting MSI status than sites with longer length motif and the mononucleotide repeat sites performed even better than the total sites,a model containing 23 mononucleotide repeat sites was constructed and named Colorectal Cancer Microsatellite Instability test(CRC-MSI).The model achieved 100%sensitivity and 100%specificity when compared with MSI-PCR in both training and validation sets.Furthermore,the CRC-MSI model was robust with the tumor content as low as 6%.In addition,8 out of 10 MSI-H samples showed alternations in the four mismatch repair genes(MLH1,MSH2,MSH6,and PMS2).Conclusion:MSI status can be accurately determined along the targeted NGS panels using only tumor samples.The performance of mononucleotide repeat sites surpasses loci with longer repeat motif in MSI calling.
