Background: Corticosteroids are commonly used in neonatal cardiac surgery to reduce inflammation. Previous studies have shown that administering methylprednisolone (MP) during the perioperative period can reduce the inflammatory response. However, the impact of MP on postoperative clinical outcomes in neonates remains unclear. Thus, this study aimed to assess the effects of MP on postoperative inflammation and clinical outcomes in neonates undergoing cardiac surgery involving cardiopulmonary bypass (CPB).Methods: This was a prospective, non-randomized, unblinded, controlled trial in which the clinicians determined treatment assignment. A total of 86 neonates who underwent cardiac surgery with CPB between December 2020 and August 2023 were included. After induction of anesthesia, the MP group received a single dose of 30 mg/kg MP, while the placebo group received an equal volume of saline solution. Primary endpoints were plasma interleukin (IL-6, IL-8, and IL-10) and D-dimer concentrations. Composite outcomes included death, respiratory infection, cardiac arrest, need for extracorporeal membrane oxygenation, acute kidney injury, low cardiac output syndrome, and need for prolonged mechanical ventilation.Results: Consistent with the observed anti-inflammatory effects, MP administration was associated with significantly lower levels of proinflammatory cytokines (IL-6, IL-8) and higher levels of the anti-inflammatory cytokine (IL-10). MP did not significantly reduce the likelihood of the composite outcome (p = 0.664), with 25 patients (58.1%) in the MP group and 23 patients (53.5%) in the placebo group experiencing such outcomes. The MP group also showed a significantly lower postoperative vasoactive-inotropic score and higher postoperative procalcitonin levels and nadir mixed venous oxygen saturation during the first 24 hours. No significant differences in postoperative D-dimer, blood glucose, or insulin administration were observed between the two groups.Conclusions: Prophylactic administration of 30 mg/kg MP in neonates undergoing cardiac surgery with CPB did not result in a statistically significant improvement in clinical outcomes compared with placebo. However, this intervention was associated with a reduction in the inflammatory response.The Clinical Trial Registration: ChiCTR 2000040230, https://www.chictr.org.cn/showproj.html?proj=64716.

In September 2016, Typhoon Meranti triggered a large-scale slope failure upstream of Hongye Village, Taitung, Taiwan. The resulting debris flow inundated residential areas, causing extensive property damage. Thus, two questions remain: (1) How can such events be accurately reconstructed? and (2) Are there more effective check dam arrangements that mitigate risk without exacerbating downstream impacts? Therefore, the necessity and effectiveness of check dam mitigation structures are determined under varying debris flow magnitudes in this study. Using the iRIC Morpho2DH two-dimensional numerical model, a Baseline Case was calibrated through back-calculation, achieving a coverage index (CI) of 0.694 and a mean deposition thickness error below 20

Wave erosion of slopes can easily trigger landslides into marine environments and pose severe threats to both the ecological environment and human activities. Therefore, near-shore slope monitoring becomes crucial for preventing and alerting people to these potential disasters. To achieve a comprehensive understanding, it is imperative to conduct a detailed investigation into the dynamics of wave erosion processes acting on slopes. This research is conducted through flume tests, using a wave maker to create waves of various heights and frequencies to erode the slope models. During the tests, seismic signals, acoustic signals, and pore pressure generated by wave erosion and slope failure are recorded. Seismic and acoustic signals are analyzed, and time-frequency spectra are calculated using the Hilbert–Huang Transform to identify the erosion events and signal frequency ranges. Arias Intensity is used to assess seismic energy and explore the relationship between the amount of erosion and energy. The results show that wave height has a more decisive influence on erosion behavior and retreat than wave frequency. Rapid drawdown may potentially cause the slope to slide during cyclic swash and backwash wave action. As wave erosion changes from swash to impact, there is a significant increase in the spectral magnitude and Power Spectral Density (PSD) of both seismic and acoustic signals. An increase in pore pressure is observed due to the rise in the run-up height of waves. The amplitude of pore pressure will increase as the slope undergoes further erosion. Understanding the results of this study can aid in predicting erosion and in planning effective management strategies for slopes subject to wave action.

Background: Refractory hemorrhage is generally considered a relative contraindication to the application of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Previous reports have presented the use of ECMO in the presence of various hemorrhages. Methods: Our clinical experience involves six pediatric patients supported with ECMO for postcardiotomy refractory hemorrhage. Results: All patients were weaned from ECMO successfully. Only one patient died of protein-losing enteropathy two months after ECMO weaning. The ECMO duration ranged from 32 to 134 hours. Conclusion: In our experience, ECMO could be used for postcardiotomy refractory hemorrhage. The timing of ECMO implantation, anticoagulation regimen and auxiliary measures are the keys to successful treatment.

After the breach of a landslide dam, the sediment in the breach opening will be carried downstream by the breach flood. The river channel will also be eroded by the flood, resulting in bed load transport. Three large-scale dam breach tests were conducted to investigate the sediment transport behavior after a dam breach. The topography data of the creek channel were measured before and after the dam breach tests to understand the sediment transport behavior. The sediment transport simulations of the dam breach tests were conducted using the iRIC Nays2DH software. The simulations focused on three types of test setups: the single dam, single dam with a spur dike, and double dam models. The terrain (DEM) for the numerical model input was designated based on the LiDAR results, and a flow hydrograph during the dam breach tests was applied. The accuracy of the simulations was assessed using the “coverage index” and “mean absolute percentage error”. A numerical parametrical study was performed to find the major parameters that influenced the simulations. The results showed that the dynamic behavior of water flow and sediment during the dam breach processes were effectively captured by the iRIC Nays2DH simulation, but with limitations. The average flow velocity of the flood in the single dam case was the fastest among the three types of dam breaches. Due to the contraction of the creek channel caused by the spur dike, severe erosion occurred locally, and the flow rate increased in the narrowed section. Water impoundment between the two dams after the first dam breach and the consequent breach of the second dam were also well-simulated for the double dam breach. The findings and simulations in this study help explain dam breaches better and can guide researchers working on sediment transport during dam-breach floods.

Objective We retrospectively analyzed the clinical results and complications of applying flow study in patients with pulmonary atresia and ventricular septal defect and major aortopulmonary collateral arteries（PA/VSD/MAPCAs） during cardiopulmonary bypass（CPB）. Methods Patients with PA/VSD/MAPCAs enrolled in flow study during CPB were collected from January 2016 to December 2020. The mean pulmonary artery pressures（mPAP） in flow study and the complications were analyzed. Results A total of twenty-nine patients underwent flow study during operations including 11 males and 18 females, with a median age of 33 months and an average body mass of 11.42±3.41 kg. Twenty patients achieved VSD closure（mPAP 15.95±4.67 mmHg） and nine patients’ VSD were closed with salvage VSD fenestration（mPAP 31.11±4.51 mmHg）. One patient died of pulmonary hypertensive crisis. Five patients underwent re-intubation in ICU. Conclusion The flow study was an effective procedure in patients with PA/VSD/MAPCAs. We shoud be more cautious for patients with VSD fenestration. It is challenging for perfusionists to improve preoperative preparation, be familiar with surgical procedures, and conduct good management during surgery, so as to ensure the surgical safety of patients.

Background Pediatric postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO) patients have high mortality and morbidity. There are currently three scoring systems available to predict mortality: the Pediatric Extracorporeal Membrane Oxygenation Prediction (PEP) model, Precannulation Pediatric Survival After VA-ECMO (Pedi-SAVE) score, and Postcannulation Pedi-SAVE score. These methods provide risk stratification scores for pediatric patients requiring ECMO for cardiac support. However, comparative validation of these scoring systems remains scarce. We aim to assess the ability of these models to predict outcomes in a cohort of pediatric patients undergoing VA-ECMO after cardiac surgery, and identify predictors of in-hospital mortality. Methods A retrospective analysis of 101 children admitted to Fuwai Hospital who received VA-ECMO from January 1, 2010 to December 31, 2020 was performed. Patients were divided into two groups, survivors (n = 49) and non-survivors (n = 52) according to in-hospital mortality. PEP model and Pedi-SAVE scores were calculated. The primary outcomes were the risk factors of in-hospital mortality, and the ability of the PEP model, Precannulation Pedi-SAVE and Postcannulation Pedi-SAVE scores to predict in-hospital mortality. Results Postcannulation Pedi-SAVE score accessing the entire ECMO process had the greatest area under receiver operator curve (AUROC), 0.816 [95% confidence interval (CI): 0.733–0.899]. Pre-ECMO PEP model could predict in-hospital mortality [AUROC = 0.691 (95% CI: 0.565–0.817)], and Precannulation Pedi-SAVE score had the poorest prediction [AUROC = 0.582(95% CI: 0.471–0.694)]. Lactate value at ECMO implantation [OR = 1.199 (1.064–1.351), P = 0.003] and infectious complications [OR = 5.169 (1.652–16.172), P = 0.005] were independent risk factors for in-hospital mortality. Conclusion Pediatric cardiac ECMO scoring systems, including multiple risk factors before and during ECMO, were found to be useful in this cohort. Both the pre-ECMO PEP model and the Postcannulation Pedi-SAVE score were found to have high predictive value for in-hospital mortality in pediatric postcardiotomy VA-ECMO.

Background: Total cavopulmonary connection (TCPC) is an important operation for the treatment of complex congenital heart disease. Epidemiology and outcomes for pediatric patients with acute kidney injury (AKI) following extracardiac TCPC have not been well documented. This study investigates the prevalence, risk factors, and outcomes of AKI in children after extracardiac TCPC surgery. Methods: We retrospectively evaluated patients (age at surgery <18 years) who underwent extracardiac TCPC surgery between January 2008 and January 2020 in the Pediatric Cardiac Surgical Center of Fuwai Hospital, Beijing, China. AKI was defined according to the pediatric-modified risk, injury, failure, loss of function, and end-stage renal disease criteria. Results: A total of 377 pediatric patients were induded in this study; 123 patients (32.6%) had some degree of AKI. Among the patients with AKI, 101 (82.1%) were diagnosed with AKI-risk (AKI-R), while 22 (17.9%) were diagnosed with acute kidney injury/failure (AKI/F) (16 with AKI, and 6 with AKF). Preoperative estimated creatinine clearance (OR: 1.039, 95% CI: 1.024-1.055, P<0.001), neutrophil-to-lymphocyte ratio (OR: 1.208, 95% CI: 1.128-1.294, P<0.001), and renal perfusion pressure (OR: 0.962, 95% CI: 0.938-0.986, P=0.002) on postoperative day (POD) 0 were significantly associated with AKI after TCPC. Having previously undergone a bidirectional Glenn was significantly associated with the severity of postoperative AKI (OR: 0.253, 95% CI: 0.088-0.731, P=0.011). Furthermore, AKI was associated with prolonged mechanical ventilation time, prolonged intensive care unit stay, and composite adverse outcome. Compared with non AKI patients, the 10-year survival rate of patients with severe AKI was significantly lower (95.5% vs. 65.9%, P=0.009). Conclusions: Although the incidence of AKI was high in patients undergoing TCPC surgery, most cases were AKI-R. Severe AKI was significantly associated with early adverse outcomes and poor long-term survival.

Many measures have been proposed for myocardial protection in pediatric congenital heart surgeries, but little data is available for China. This study investigates myocardial protection strategies in pediatric cardiopulmonary bypass (CPB) throughout China. Online questionnaires were delivered to 100 hospitals in 27 provinces. The number of yearly on-pump pediatric cardiovascular surgeries in these hospitals varied greatly. About 91.0% of respondents believe that each surgery should have at least two perfusionists, while only 64.0% of hospitals actually met this requirement. For pediatric patients, crystalloid cardioplegia was more prevalent than blood-based cardioplegia. Histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid solution were dominant among crystalloid cardioplegia. Del Nido cardioplegia and St. Thomas blood-based cardioplegia ranked the top two in the popularity of blood-based cardioplegia. Dosages varied among different kinds of cardioplegia. In the choice of different cardioplegia, perfusionists mainly focused on myocardial protective effect and cost. Hypothermia of cardioplegia solution was maintained by ice buckets in 3/4 of the hospitals in this survey. In conclusion, the essence of myocardial protection management during pediatric CPB was cardiac arrest induced by cardioplegia under systemic hypothermia. However, there is no uniform standard for the type of cardioplegia, or dosages. Therefore, well-designed multicenter randomized controlled trials are warranted to provide tangible evidence for myocardial protection of cardioplegia in pediatric CPB.

目的 总结本院小儿先天性心脏病(CHD)心脏术后难治性出血应用体外膜氧合(ECMO)辅助治疗的临床经验.方法 回顾性分析本院2016年4月至2018年11月期间因小儿心脏术后难治性出血应用ECMO辅助治疗的5例患儿,其中男3例,女2例.记录患儿一般资料、ECMO建立前、ECMO期间、ECMO撤机后等相关临床资料,总结心脏术后难治性出血患儿行ECMO管理经验.结果 5例患儿在手术间因难治性出血无法维持循环和呼吸功能而行ECMO,均成功脱机,仅1例患儿在撤机2月后因蛋白丢失性肠病死亡,ECMO运行时间88～134 h.结论 ECMO是治疗CHD心脏术后难治性出血的有效手段,ECMO建立时机、ECMO期间抗凝管理方案和辅助管理措施是治疗成功的关键.

This study proposes a numerical coupling approach to simulate seismic signals of rockfalls and conducts a parametric analysis to explore the characteristics of the seismic signals generated by rockfalls. To validate the approach, three field rockfall tests were selected for comparison. The rockfall velocity, duration, seismic frequency, Husid plot, Arias intensity, and spectrogram of the seismic signals were compared. We found that friction between rocks and the ground affects rock falling behavior. In addition, the local damping and Rayleigh damping assignments in the numerical model have strong effects on the simulation results. The volume of the falling rock and the falling speed of the rock affect the Arias intensity. The coupling approach proposed could be extended and can potentially be used as a useful tool in rockfall hazard estimations.

Dam models were constructed in an indoor flume to test dam breach failure processes to study the seismic signals induced. A simple dam breach model was also proposed to estimate hydrographs for dam breach floods. The test results showed that when the retrogressive erosion due to seepage of the dam continues, it will eventually reach the crest at the upstream side of the dam, and then trigger overtopping and breaching. The seismic signals corresponding to the failure events during retrogressive erosion and overtopping of the dam models were evaluated. Characteristics of the seismic signals were analyzed by Hilbert–Huang transform. Based on the characteristics of the seismic signals, we found four types of mass movement during the retrogressive erosion process, i.e., the single, intermittent, and successive slides and fall. There were precursor seismic signals found caused by cracking immediately before the sliding events of the dam. Furthermore, the dam breach modeling results coincided well with the test results and the field observations. From the test and modeling results, we confirmed that the overtopping discharge and the lateral sliding masses of the dam are also among the important factors influencing the evolution of the breach. In addition, the widening rate of the breach decreases with decreased discharge. The proposed dam breach model can be a useful tool for dam breach warning and hazard reduction.

Seismic and acoustic signals induced by rock falls and rock avalanches always contain abundant information about movement processes. By simultaneously monitoring and analyzing the characteristics of the two physical signals, there is a better opportunity to closely interpret the behaviors of the processes closely. This study conducted small-scale rock fall field tests on a creek bank. Three types of field tests including single large rock fall, single small rock fall, and rock-mixture fall tests were carried out. Low cost and easy-to-install accelerometers and microphones were used to record both seismic and acoustic signals, respectively. The results affirm that the characteristics of the seismic and acoustic signals are generally similar and correlated due to the signals being caused by the same event energy sources. The attenuation of acoustic signals was less than that of seismic signals and high-frequency portion of the seismic signals attenuates quickly in stratum. It was also shown how the surface wave velocity of the stratum of the test site was estimated. In addition, the larger the rock mass, the lower the seismic frequency was found to be. The possible practical significance of this study is provided, and the simultaneous use of acoustic and seismic signal monitoring to rock falls/landslides is promoted.

Background: Chylothorax is a severe complication after total cavopulmonary connection (TCPC) in children. This study was performed to evaluate the incidence, risk factors, and short- and long-term prognosis for chylothorax. Methods: We retrospectively reviewed the electronic records of patients who underwent TCPC between January 2008 and December 2020 in Fuwai Hospital. Patients were divided into two groups based on the occurrence of post-operative chylothorax. Univariate and multivariate analyses were performed to identify risk factors, and long-term survival was estimated by the Kaplan–Meier method. Results: Of 386 patients included in our study, chylothorax occurred in 60 patients (15.5%). Compared with the non-chylothorax group, the prevalence of prolonged intensive care unit (ICU) stay (p = 0.000) and post-operative hospital stay (p = 0.000) were greater in patients with chylothorax. Post-operative adverse events in terms of infection (p = 0.002), ascites (p = 0.001), prolonged pleural effusion (p = 0.000), and diaphragmatic paralysis (p = 0.026) were more frequent in chylothorax patients. The median follow-up duration was 4.0 (2.0, 6.8) years. The chylothorax group had significantly lower survival rates at 1 year (92.4 vs. 99.3%, p < 0.001) and 10 years (84.6 vs. 91.6%, p < 0.001), respectively. Having a right dominant ventricle [odds ratio (OR) = 2.711, 95% confidence interval (CI) = 1.285–5.721, p = 0.009] and a higher peak central venous pressure (CVP) on post-operative day (POD) 0 (OR = 1.116, 95% CI = 1.011–1.233, p = 0.030) were the risk factors for the development of chylothorax after TCPC operation. Conclusion: The incidence of chylothorax in patients undergoing TCPC is lower than previously reported but is associated with poor early- and long-term survival. Having a right dominant ventricle and a higher peak CVP on POD 0 are the risk factors for chylothorax after TCPC operation.

When a coseismic landslide is triggered by an earthquake, seismic stations close to the location of the landslide will simultaneously record the seismic signals caused by the earthquake and landslide, causing confusion between the two signals. This complicates the separation of the two signals, and subsequently the explanation of the coseismic landslide process from the signals recorded. Therefore, the use of a numerical approach is a more practical methodology for systematic analysis of the characteristics of seismic signals generated by the motion of coseismic landslides. In addition, in-depth study of various factors (parameters) that affect the seismic signals of coseismic landslides can be rapidly achieved. This study proposed a dynamic numerical coupling approach, which can simultaneously simulate the earthquake response of the ground and the behavior of the coseismic landslide process as well as trace the seismic signals generated by the two geological phenomena. PFC and FLAC codes were coupled to accomplish the numerical approach. The PFC was to simulate the sliding process of the masses, including rupture and dispersal of the rock masses during movement and collisions as well as the deposition patterns of the masses. The FLAC enabled the input of acceleration history at the base of the FLAC model and the calculation of the propagation of the seismic waves in the strata and the interaction of the seismic disturbances with the PFC model. The Tsaoling coseismic landslide due to the 1999 Chi-Chi earthquake was chosen to serve as an example for the approach, due to the presence of the strong motion station CHY080 in close proximity to the main scarp of the Tsaoling landslide, and its recordings of the seismic signals induced by the coseismic landslide and the Chi-Chi earthquake. The study shows that the numerical evaluation of the energy contribution of the Tsaoling coseismic landslide is approximately 66% of the energy contribution to the seismic signal of the monitoring station in the simulation. A parametric study was also performed on input acceleration, friction of the sliding surface, particle friction, particle bond strength and Rayleigh damping. This study concludes that the major key parameters are normal parallel bond strength, Rayleigh damping and the residual friction of ‘wall elements’ in that they are very sensitive and significantly influence the landslide process and seismic signals of the simulations. The results of the simulations were able to account for most of the physical mechanisms of the coseismic landslides. The coupling approach employed can provide a quantitative basis for evaluating the effects of the parameters on the characteristics of the seismic signals. It can also be extended to assess seismic signals generated from other types of coseismic mass movements.

Background Oxygen delivery during cardiopulmonary bypass (CPB) is closely related to postoperative acute kidney injury (AKI). The value of critical indexed oxygen delivery (DO 2 i) is a key indicator to reflect oxygen supply in cardiovascular surgery. However, the target DO 2 i value for neonates undergoing hypothermic CPB remains unclear. Methods One hundred and twenty-six consecutive newborns (≤28 days) undergoing arterial switch operations were retrospectively divided into two groups according to AKI occurrence. Baseline characteristics, intraoperative variables, and clinical outcomes were collected. Multivariate logistic regression analysis and receiver-operating characteristic curve were performed to investigate the association between DO 2 i and AKI. Results Neonates in the no-AKI group ( n = 67) had significantly higher nadir bypass flow and DO 2 i during the hypothermic phase compared with the AKI group ( n = 59). AKI group had remarkably higher incidences of hepatic dysfunction and peritoneal dialysis requirement compared with newborns without AKI. Mixed venous oxygen saturation (SvO 2 ) was comparable between the two groups. Base excess (BE)( P = 0.011) value during the hypothermic phase of the AKI group was higher than the no-AKI group. Multivariate analysis showed that hypothermic DO 2 i was negatively associated with AKI. The cut-off value of hypothermic DO 2 i was 269 mL min −1 m −2 . Conclusions The importance of hypothermic DO 2 i should be highlighted, even when SvO 2 was satisfactory. A lower threshold of DO 2 i > 269 mL min −1 m −2 may help protect neonates from the risk of postoperative AKI. Impact The key message of our article is that the lower threshold of DO 2 i > 269 mL min −1 m −2 may help protect neonates from the risk of AKI after on-pump hypothermic cardiovascular surgery. The critical DO 2 i value for neonates undergoing hypothermic CPB remains unclear, and our study may add new evidence for this matter based on the 6-year experience of our center. In this study, the lowest critical value of DO 2 i in neonatal hypothermic CPB is determined for the first time, which provides a reference for intra-CPB management strategy to improve the postoperative outcomes of newborns.

Seismic signals are usually generated during landslides or movement of soil mass due to collisions and friction among the soil particles and masses. The seismic signals will be different when different sliding (movement) types occur. This study discusses the landslide process and seismic signals produced by soil ruptures to understand the nature of the signals, which could help in predicting landslides as well as understanding different landslide processes. Physical model tests were performed to record the seismic signals generated during the sliding processes. The self-potential (SP), pore water pressure (PP), and volumetric water content (VWC) were also measured to assist the interpretation of the failure processes. Based on the characteristics of the seismic signals recorded, three slide types were identified: intermittent slide, successive slide, and single slide. Precursor signals prior to the single slide event were found in both the seismic and SP signals and therefore the monitoring of these two kinds of precursors has the potential for real-world application in landslide prewarning. In addition, the landslide areas of the tests were correlated with Arias intensities ( I A ) in a linear relationship. The relationship has the potential to be implemented in estimating a landslide’s scale for a fast landslide response decision.

BACKGROUND:Histidine-tryptophan-ketoglutarate (HTK) is a solution commonly used for organ transplantation. However, there is no certified fixed regimen for on-pump heart surgery in neonates. We aimed to retrospectively evaluate the outcomes related to different HTK dosages and to analyze the safety of high-dosage perfusion. METHODS:A total of 146 neonates who underwent on-pump heart surgery with single-shot HTK perfusion were divided into two groups according to HTK dosages: a standard-dose (SD) group (n = 63, 40 mL/kg < HTK ≤ 60 mL/kg) and a high-dose (HD) group (n = 83, HTK >60 mL/kg). Propensity score matching (PSM) was performed to control confounding bias. RESULTS:The SD group had a higher weight (3.7 ± 0.4 vs. 3.4 ± 0.4 kg, P < 0.0001), a lower proportion of complete transposition of the great artery (69.8% vs. 85.5%, P = 0.022), a lower cardiopulmonary bypass (CPB) time (123.5 [108.0, 136.0] vs. 132.5 [114.8, 152.5] min, P = 0.034), and a lower aortic x-clamp time (82.9 ± 27.1 vs. 95.5 ± 26.0 min, P = 0.005). After PSM, 44 patients were assigned to each group; baseline characteristics and CPB parameters between the two groups were comparable. There were no significant differences in peri-CPB blood product consumption after PSM (P > 0.05). The incidences of post-operative complications were not significantly different between the two groups. There were no significant differences in ventilation time, intensive care unit stay, and post-operative hospital stay (P > 0.05). Follow-up echocardiography outcomes at 1 month, 3 to 6 months, and 1 year showed that left ventricular ejection fraction and end-diastolic dimension were comparable between the two groups. CONCLUSIONS:In neonatal on-pump cardiac surgery patients, single-shot HD (>60 mL/kg) HTK perfusion had a comparable heart protection effect and short-term post-operative prognosis as standard dosage perfusion of 40 to 60 mL/kg. Thus, this study provides supporting evidence of the safety of HD HTK perfusion.

目的 探讨肥厚型梗阻性心肌病(HOCM)患儿行改良扩大Morrow手术围术期的特点及体外循环管理方法.方法 回顾性分析2013年1月至2018年12月在本院接受改良扩大Morrow手术的49例HOCM患儿围术期资料及体外循环管理要点.结果 49例患儿,年龄(5.3±3.4)岁,体重(17.9±8.0) kg,转机时间(115.7±47.0) min,阻断时间(74.1 ±27.1) min,辅助时间(31.83±34.67) min.使用HTK液进行心肌保护的患者41例(83.7％),改良St.Thomas液患者8例(16.3％),自动复跳率32例(65.3％).患儿术后气管插管时间17(8,22)h,ICU时间2(1,3)d.其中1例低心排患儿转中由体外循环直接转为体外膜氧合(ECMO),辅助时间126 h后撤机,存活出院;2例术后因肺部感染死亡;4例安装永久起搏器.结论 改良扩大Morrow手术是治疗儿童HOCM的有效治疗方法,体外循环过程足量的心肌灌注,充分的辅助时间,选择合适的心脏停搏液是围术期心肌保护的重点.对于术后低心排血量综合征患儿积极的ECMO辅助是有效的治疗方法.

Floods and erosion often cause landslides of riverbanks and induce problems such as river blockage, shift of river center, or flooding from rising riverbeds. Instrumentation and monitoring are often used to explore landslide and erosion behavior of riverbanks. Therefore, this study identified landslide types and characteristics of their seismic signals due to toe erosion of riverbanks through riverbank models with various instrumentation sensors in a laboratory flume. To induce landslides in the riverbank model, a test was set up for water to flow through the toe of the riverbank model. Seismic signals of each landslide event were measured during the tests with accelerometers. Nonpolarized electrodes were installed for observing the self-potential changes during the test. Water content and pore water pressure gauges were installed in the riverbank model. In addition, water levels were recorded. The Hilbert–Huang transform method was used to analyze the characteristics of seismic signals caused by water flow and riverbank landslides. Time points, landslide frequency distributions, and the characteristics of several landslide events in the riverbank models were estimated using the seismic signals. This study identified three types of landslides: single, intermittent, and successive. Moreover, changes in self-potential signals, pore water pressure, and water content during the tests were examined and were found to correspond to the landslide process of the riverbank model.