OBJECTIVE:To develop machine learning models that predict the need for continuous renal replacement therapy (CRRT) following acute type A aortic dissection (ATAAD) repair. This approach aims to facilitate early identification of at-risk patients and enable timely intervention. DESIGN:A retrospective observational cohort study. SETTING:A large single-center specialty hospital dedicated to cardiovascular diseases. PARTICIPANTS:A total of 588 ATAAD patients who underwent total arch replacement with frozen elephant trunk between October 2020 and October 2024. INTERVENTIONS:The dataset was divided into training (70%, n = 412) and validation (30%, n = 176) sets. Lasso regression was applied for feature selection, and seven machine learning models were trained and validated using fivefold cross-validation. Model performance was evaluated based on the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, F1 score, and area under the precision-recall curve (AUPRC). The best-performing model was selected, and SHapley Additive exPlanations analysis was conducted to identify key predictive features. MEASUREMENTS AND MAIN RESULTS:Lasso regression identified several key predictors, including peak intraoperative lactate, blood transfusion volume, renal artery involvement, myoglobin, cystatin C, and creatine kinase MB. The XGBoost model demonstrated the best performance (AUC = 0.96, accuracy = 0.96, sensitivity = 0.93, specificity = 0.96, F1 = 0.79, AUPRC = 0.83). SHapley Additive exPlanations analysis revealed that peak intraoperative lactate was the most significant predictor. CONCLUSION:The XGBoost model effectively predicts the requirement for CRRT after ATAAD surgery, enabling early risk identification and intervention.

OBJECTIVES:Deep hypothermic circulatory arrest (DHCA) is known to trigger a systemic inflammatory response and ischaemia-reperfusion injury, leading to exacerbated lung dysfunction. Ulinastatin (UTI) is a commonly used anti-inflammatory drug in clinical settings, but its protective effects may vary depending on the timing and dosage. METHODS:A rat model of DHCA was established, and 2 different doses of UTI (5/10 × 104 U/kg; low/high dose) were administered. We measured the levels of inflammatory factors using enzyme-linked immunosorbent assay kits and assessed the functional indicators of lung tissue injury. All rats (n = 18) underwent the standard cardiopulmonary bypass (CPB) procedure with DHCA. RESULTS:Following rewarming, the levels of interleukin-6 (IL-6), IL-10, tumour necrosis factor (TNF)-α, and neutrophil elastase 2 (ELA-2) gradually increased in rats exposed to DHCA. Compared to the DHCA group, both the UTI groups exhibited significant reductions in IL-6 (DHCA vs DHCA+UTI-H, 8931.68 ± 650.31 vs 2498.05 ± 552.16), TNF-α (DHCA vs DHCA+UTI-H, 633.74 ± 74.53 vs 221.19 ± 31.63), and ELA-2 (DHCA vs DHCA+UTI-H, 4.94 ± 0.49 vs 3.29 ± 0.34), while remarkably increased the IL-10 (DHCA vs DHCA+UTI-H, 975.04 ± 110.33 vs 3081.27 ± 554.10) levels 4 hours after weaning from CPB (all P < 0.05). Interestingly, the high dose of UTI demonstrated a dose-dependent inhibition of inflammation. Meanwhile, we found that UTI contributed to maintain haemodynamic stability, improve tissue perfusion, and reduce hypoxia, as evidenced by elevated heart rate, blood pressure, haematocrit and oxygenation index, and decreased glucose and lactate. Reduced pathological changes in lung histopathology were also observed after UTI intervention, especially in 10 × 104 U/kg group. CONCLUSIONS:This study revealed that administration of low to high doses of UTI during DHCA could reduce the release of inflammatory factors, exert anti-inflammatory effects, and alleviate lung injury.

Deep hypothermic circulatory arrest (DHCA) can cause systemic inflammatory response (SIR) and ischemia-reperfusion (I/R) injury, potentially exacerbating organ failure. Ulinastatin (UTI) is a frequently employed anti-inflammatory medication in clinical practice, but different timing and dosage may influence its protective efficacy. 24 rats were randomly divided into four groups. Three different doses of UTI (3/10/30 × 104 U/kg; low/medium/high dose) were administered in the DHCA rat model, with a control group that underwent DHCA without UTI administration. Inflammatory markers and routine clinical indicators of myocardial, hepatic, and renal tissue injury were evaluated. All rats underwent the standard DHCA procedure. Interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and neutrophil elastase (ELA-2) levels in rats exposed to DHCA gradually increased after rewarming. Compared with the DHCA-only group, both the low dose of UTI (UTI-L) and the medium dose of UTI (UTI-M) significantly reduced IL-6 (p = 0.017, p = 0.022 ), TNF-α (p = 0.003, p < 0.001), ELA-2 levels ( p = 0.018, p = 0.001), and elevated IL-10 levels ( p < 0.001, p < 0.001) 4 h post-weaning from cardiopulmonary bypass (CPB). In addition, compared with the DHCA group, both the UTI-L and UTI-M group showed significantly lower levels of cardiac troponin I (p = 0.001, p = 0.001), creatine kinase muscle and brain isoenzyme (CK-MB) (p < 0.001, p < 0.001), creatinine (p < 0.001, p < 0.001), blood urea nitrogen (p = 0.002, p = 0.021), aspartate transaminase (p < 0.001, p < 0.001) and alanine aminotransferase (p < 0.001, p < 0.001) at the end of the experiment. The hematoxylin-eosin staining results of kidney and liver tissue damage were alleviated in the UTI-L and UTI-M groups. The high dose of UTI (UTI-H) group did not exhibit dose-dependent anti-inflammatory effects and was associated with aggravated injury to the heart, liver, and kidney. This study demonstrated that the administration of low to medium doses of UTI during DHCA significantly attenuated the levels of IL-6, TNF-α, and ELA-2, elevated the level of the anti-inflammatory factor IL-10, and provided protective effects on myocardial, hepatic, and renal tissues.

Extracorporeal membrane oxygenation (ECMO) is commonly a transitional treatment way used in patients with severe heart and lung problem. Deoxidized blood is extracted through venous intubation, and then returned to the arterial or venous system after oxygenation. There is a risk of intubation-related infection in arterial or venous intubation. Once the infection occurs, it will prolong the patient's length of hospitalization stay, increase the mortality and medical expenses. Longer duration of ECMO and higher simplified acute physiology score (SAPS) were risk factors for infection. At present, the main diagnostic method for infection is blood culture. Ultrasound-guided percutaneous cannulation can reduce the occurrence of infection; if infection still occurs, antibiotics should be actively treated. In order to bring reference for clinical work, this article reviews the incidence, risk factors, diagnostic criteria, prevention strategies, treatment methods and other key points of ECMO intubation-related infection.

To the Editor: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used as a bridge in patients with advanced heart failure (AdHF) while waiting for heart transplantation (HTx). Many studies reported by developed countries have confirmed the advantages of VA-ECMO in terms of bridge to left ventricular assist device (LVAD) or HTx, with stabilizing the condition and improving the possibility of further treatment of patients.[1–3] Recent data from the Extracorporeal Life Support Organization (ELSO)[4] indicated that ECMO used as a bridge has increased by 20.5% over a decade. However, to date, there are few studies on the bridge experience of VA-ECMO in the mainland of China. This study reviewed patients with AdHF from 2015 to 2022, and selected those who received VA-ECMO as a bridge while waiting for HTx. We aimed to examine the clinical course and outcomes of patients with AdHF, and to describe our initial experience utilizing VA-ECMO as a bridge for these patients. The single-center, retrospective, observational study was approved by the institutional ethic review board of Fuwai Hospital (No. 2022-1777), and the need for informed consent was waived. The VA-ECMO circuit comprised of an arterial cannula (Edwards Lifesciences, Irvine, CA, USA), a venous cannula (Edwards Lifesciences), an oxygenator kit (BE-PLS 2050, Maquet, Rastatt, Germany), and a centrifugal pump drive and console (Jostra Medizintechnik AG, Hirrlingen, Germany). All patients underwent VA-ECMO by femo-femoral cannulation. A 5–7 French (Fr) cannula was placed in the distal end of femoral artery to provide sufficient perfusion and thus prevent limb ischemia. Indications for VA-ECMO initiation should be based on following indexes: (1) systemic systolic arterial blood pressure <90 mmHg, or continuous inotropic therapy is required to maintain systemic systolic arterial blood pressure at a level of 90 mmHg; (2) urine output <0.5 mL∙kg-1∙h-1; (3) cardiac index <1.8 L∙min-1∙m-2; (4) left atrial pressure or capillary wedge pressure >20 mmHg; and (5) uncorrectable/continuous metabolic acidosis. Intravenous unfractionated heparin was used for anticoagulation to maintain an activated partial thromboplastin time (aPTT) of 160–180 s or an activated clotting time (ACT) of 50–70 s. Upon VA-ECMO support, patients were anticipated to bridge to HTx or LVAD [Figure 1]. LVAD implantation was performed in the operating room by surgeons. Left heart support has been achieved by cannulating the apex of the left ventricle and the ascending aorta. Two types of domestic LVAD were used for patients with AdHF: CH-VAD (CH Biomedical, Inc., Suzhou, China) and EVAHEART (Chongqing EVAHEART Medical Device Co., LTD., Chongqing, China). CH-VAD has fully magnetically levitated centrifugal pumps and provides a continuous flow. EVAHEART has a distinctive hydraulic circulation system and a unique impeller design, which can ensure to maintain a high end-systolic peak flow and arterial pulsatility.Figure 1: The bridge strategy of VA-ECMO. HTx: Heart transplantation; LVAD: Left ventricular assist device; VA-ECMO: Veno-arterial extracorporeal membrane oxygenation.Cardiopulmonary bypass (CPB) was conducted during cardiac surgery. During the HTx operation, the nasopharyngeal temperature was targeted to reduce to 28–30°C. During the LVAD implantation operation, the nasopharyngeal temperature was targeted to maintain at 34–35°C. Right ventricular assist was performed in patients who developed early right ventricular failure after surgery. The right ventricular assist was cannulated from right atrium to pulmonary artery with centrifugal pump drive and console (Jostra Medizintechnik AG, Hirrlingen, Germany). Continuous data were expressed as mean ± standard deviation or median (Q1, Q3), where appropriate. Categorical data were presented as the proportion of numbers (n/N). Paired student t-tests were used to test the laboratory variables (pre-ECMO vs. 96th hour post-ECMO initiation). A Kaplan–Meier estimate was performed to plot the survival curves between patients bridged to HTx and LVAD. P values <0.05 were considered significant. All analyses were performed with using IBM SPSS Statistics for Windows, version 21.0 (IBM Corporation, Armonk, NY, USA). In total, 17 patients (average age, 36.5 ± 10.9 years) were included and 11 were men [Supplementary Table 1, https://links.lww.com/CM9/B688]. AdHF resulted from various etiologies, but dilated cardiomyopathy was the most represented, accounting for 7/17 in the overall cohort. The median left ventricular ejection fraction (LVEF) was 25% (22%, 34%). The median lactate was 2.4 (1.4, 4.7) mmol/L. Before ECMO deployment, 9 of 17 patients required cardiopulmonary resuscitation (CPR) and 10 of 17 patients underwent invasive mechanical ventilation. In our study cohort, 8/17 patients were bridged to HTx, 4 of 17 were bridged to LVAD, and 5 of 17 were only supported with ECMO [Supplementary Figure 1, https://links.lww.com/CM9/B688]. After 96 h of ECMO support, the creatine, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels declined significantly (P <0.05) [Supplementary Table 2, https://links.lww.com/CM9/B688]. Lactate, creatine, AST, and ALT levels were higher at all time-points in patients who were only supported with ECMO. No statistically significant difference were seen for the laboratory tests between patients bridged to HTx and patients bridged to LVAD [Supplementary Figure 2, https://links.lww.com/CM9/B688]. The median CPB time was longer in patients who underwent HTx than that in those who underwent LVAD (248 min vs. 195 min). There was no distinct difference of the median aortic cross-clamping time in these patients. Patients who underwent HTx had received 5 (1, 8) units red blood cell intraoperatively, and patients who underwent LVAD implantation had received 6 (3, 7) units red blood cell intraoperatively [Supplementary Table 3, https://links.lww.com/CM9/B688]. Ten patients were successfully weaned from VA-ECMO after HTx or LVAD implantation. The median ECMO duration was 141.5 h in patients bridged to HTx, 272.5 h in patients bridged to LAVD, and 249.0 h in patients who were only supported with ECMO. Patients who were only supported with VA-ECMO all suffered from acute kidney injury (AKI) and received continuous renal replacement therapy (CRRT) [Supplementary Table 4, https://links.lww.com/CM9/B688]. During the 1-year follow-up, 7 patients were survived. Patients bridged to HTx had relatively favorable survival compared with those bridged to LVAD (5/8 vs. 2/4) [Supplementary Figure 3, https://links.lww.com/CM9/B688]. In this study, we described our experience utilizing VA-ECMO as a bridge to HTx or LVAD in patients with AdHF. Most patients had severe cardiovascular and non-cardiovascular illness. Despite these patients' unfavorable initial risk profile, VA-ECMO could facilitate the systemic function recovery, and allow them to overcome the hemodynamically unstable stage. Although VA-ECMO could function as a bridge strategy in AdHF patients, several factors may affect the prognosis. First, ealy recognition of high-risk patient for ECMO initiation is very important. The progress of chronic heart failure is gradual and subtle. During the acute onset, these patients often suffer from mutiliple organ dysfuction due to irreversibily of drugs. Not only could VA-ECMO help stabilize the patient's condition and improve end-organ perfusion, but it can provide the possibility of further treatment for these patients.Therefore, for acute exacerbations of chronic heart failure, early adoption of ECMO therapy may be benefit for long-term treatment and survival. Second, a prolonged duration of ECMO may increase the risk of complications, thereby leading to unfavorable outcomes. Patients supported by VA-ECMO should be given priority of HTx or LVAD to increase the survival.[2,5] Given our findings and previous reports, we suggest that decision-making in bridging from VA-ECMO to HTx or LVAD should be made early if no recovery signs occurred. Third, further treatment is an important determinant of survival. We observed that the 1-year survival was non-inferior in patients bridged to LVAD compared with patients bridged to HTx. With the increasing number of candidates for HTx and the shortage of donor hearts in China, many AdHF patients may face a prolonged waiting time, thus miss the optimal timing for recovery. Besides, for HTx patients, the immunotherapies were required to prevent rejection of cardiac allograft, which may be associated with an increased risk of infections. LVAD is a durable mechanical circulatory support, which has improved long-term survival for AdHF patients. When a prolonged waiting time for donor heart is expected, these patients may be benefit from LVAD as a substitute therapy. Forth, right ventricular dysfunction may occur after ECMO decannulation and cause unfavorable outcomes. In our center, we chose the system of ROTAFLOW centrifugal pump (Jostra Medizintechnik AG, Hirrlingen, Germany) to conduct the short-term right ventricular support. The system could easily regulate the pump speed and flow volume to achieve the right ventricular support. In conclusion, VA-ECMO can be used as a bridge to HTx or LVAD for patients with AdHF experiencing a hemodynamically unstable stage, which may improve the possibility of further treatment and better prognosis. Domestic LVAD could be a promising alternative therapy to HTx, and further study regarding the potential benefit of domestic LVAD is warranted. Funding The research was supported by a grant from CAMS Innovation Fund for Medical Sciences (CIFMS) (No. 2020-I2M-C&T-B-054). Conflicts of interest None.

OBJECTIVE:To investigate the incidence and risk factors of acute kidney injury (AKI) stage 3 in adult patients under veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. DESIGN:A retrospective case-control study. SETTING:Single center, Fuwai Hospital. PARTICIPANTS:Adult VA-ECMO patients age ≥18 years and older treated between January 2020 and December 2022 were included. INTERVENTIONS:The patients were grouped by whether they developed AKI Kidney Disease: Improving Global Outcomes (KDIGO) stage 3 or <3. Multivariate logistic regression was performed t"o evaluate risk factors of AKI stage 3. MEASUREMENTS AND MAIN RESULTS:Among enrolled patients, 40 (53.3%) developed AKI stage 3. The in-hospital mortality of AKI stage 3 patients was significantly higher than that of AKI stage <3 patients (67.5% vs 34.3%; p = 0.004). Multivariate logistic regression analysis revealed that concomitant hypertension (odds ratio [OR], 0.250; 95% confidence interval [CI], 0.063, 0.987), p = 0.048), pre-ECMO hemoglobin (OR, 0.969; 95% CI, 0.947-0.992; p = 0.009), pre-ECMO lactate (OR, 1.173; 95% CI, 1.028-1.339; p = 0.018), and pre-ECMO creatinine (OR, 1.014; 95% CI, 1.003-1.025; p = 0.011) were independent risk factors for AKI stage 3. CONCLUSIONS:This study found a high incidence (53.3%) of AKI stage 3 in adult patients with VA-ECMO support and an association with increased in-hospital mortality. Concomitant hypertension, low pre-ECMO hemoglobin, and elevated pre-ECMO lactate and pre-ECMO creatinine were independent risk factors for AKI stage 3 in patients receiving VA-ECMO. It is imperative to identify and adjust these risk factors to enhance outcomes for those supported by VA-ECMO.

OBJECTIVE:To evaluate the predictive value of somatosensory evoked potentials (SEPs) for the efficacy of closed reduction combined with over-extension reduction technique (PVP) in managing thoracolumbar spinal compression fractures. METHODS:Data were collected from 125 patients who underwent closed reduction with PVP and SEP monitoring from February 2021 to July 2023. We evaluated surgery success rates, incidence of bone cement leakage, and patient recovery outcomes including vertebral anterior height, Oswestry Disability Index (ODI), and Cobb angle restoration. SEP results were analyzed to categorize patients into effective and ineffective treatment groups. Differences in SEP waveforms between these groups were examined, and ROC analysis was used to assess the predictive value of these differences. Multivariate logistic regression was employed to identify risk factors affecting treatment efficacy. RESULTS:Post-treatment assessments showed significant improvements in vertebral anterior height, ODI, and Cobb angle. SEP monitoring correlated well with intraoperative findings and physical examinations. During reduction, changes in SEP latency and amplitude were noted in 37 patients, with 7 patients meeting SEP amplitude alarm criteria, which normalized after adjustments. During PVP, 28 patients exhibited SEP amplitude fluctuations and 5 experienced a 30% reduction in amplitude following initial cement injection, with no significant latency changes. Treatment was deemed effective in 93 patients and ineffective in 32. SEP amplitudes during vertebral compression and PVP were significantly lower in the effective group (P<0.05). The AUC for predicting treatment efficacy was 0.819 and 0.859, respectively. Multivariate analysis revealed low preoperative vertebral compression ratio, number of fractures, and abnormal SEP amplitudes as independent risk factors for treatment outcomes. CONCLUSION:SEP monitoring provides an accurate reflection of spinal cord function during closed reduction with PVP, aiding in predicting treatment safety and efficacy. The use of SEP monitoring is thus recommended for clinical application in this context.

Mechanical loads such as exercise and gravity make the muscle and bone structure adaptively remodel, always maintaining a dynamic and stable state. However, in the absence of mechanical stimulation and gravity unloading, mechanically corresponding cells and damaged tissues will adaptively change the remodeling mechanism, and even chronic inflammation will trigger fat infiltration in muscle and bone marrow tissue, which may easily lead to osteoporosis, sarcopenia and other degeneration. Sexual diseases; during adaptive remodeling, mechanical stimuli can be delivered through fluid-applied deformation stress（tensile and compressive） or shear strain, allowing adhesion molecules in mechanically responsive cells to sense mechanical strain and translate it into Biochemical reactions, through mechanochemical coupling with their niches, regulate fundamental mechanisms of cell biology, such as lineage commitment, tissue formation and maturation, and ultimately result in structural changes in extracellular matrix components, adhesion molecules, and cytoskeletons, Results ing in Affects fracture resistance and muscle strength; recent research shows that the phenomenon of aging is closely related to epigenetic regulation caused by mechanical stimulation and pathological changes. Based on this, this paper reviews the mechanochemical niche conditions of mechano-responsive cells, elucidates the remodeling mechanisms of muscle and skeletal structures, and provides new targets for the prevention and treatment of diseases and aging processes.

As an effective means of cardiopulmonary support, extracorporeal life support (ECLS) plays an important role in the treatment of various severe cardiopulmonary failures [1, 2]. The emergency establishment of ECLS and the use of ECLS in critically ill patients can be used as a means of life support, to strive for more effective and thorough treatment opportunities for the next step, and to provide a new choice for critically ill patients with high mortality and disability rate under the conventional transport mode.

Introduction Red blood cell (RBC) transfusion is associated with adverse outcomes, but there are few studies on the RBC volume. This study aimed to evaluate the relationship between intraoperative RBC volume and postoperative adverse outcomes for on-pump cardiac surgery. Methods Adult patients undergoing on-pump cardiac surgery from 1 January 2017 to 31 December 2018 were included. Those transfused with more than 6 units of RBC were excluded. The clinical characteristics of four groups with various RBC volume were compared. We analyzed the relationship between RBC volume and adverse outcomes through multivariable logistic regression. Results 12,143 patients were analyzed, of which 3353 (27.6%) were transfused with 1–6U RBC intraoperatively. The incidence of death, overall morbidity, acute kidney injury and prolonged mechanical ventilation were increased stepwise along with incremental RBC volume. After adjusting for possible confounders, patients transfused with 1–2U were associated with a 1.42-fold risk of death (99% CI, 1.21–2.34, p = 0.01) compared with patients without RBC, patients with 3–4U were associated with a 1.57-fold risk (99% CI, 1.32–2.80, p = 0.005) and patients with 5–6U had a 2.26-fold risk of death (99% CI, 1.65–3.88, p < 0.001). Similarly, the incidence of overall morbidity, acute kidney injury and prolonged mechanical ventilation increased several folds as the RBC numbers increased. Conclusions There was a significant dose-dependent influence of incremental intraoperative RBC volume on increased risk of adverse outcomes for on-pump cardiac surgery patients. Patient blood management practice should aim to reduce not only transfusion rate but also the volume of blood use.

绝经后骨质疏松症是目前临床上的常见病,但其发病机制较为复杂,中医学"肾主骨""脑为髓海","肾满髓充"是维持骨生长发育和骨代谢平衡的生物学基础,反之,"肾虚髓枯"则是绝经后骨质疏松症发病的潜在核心.随着现代医学对骨质疏松症发病本质及相关危险因素的认识不断深入,发现"下丘脑-垂体-肾上腺轴"的衰退和功能紊乱与内分泌代谢、骨微观免疫等关系密切,是绝经后骨质疏松症发病的重要生物学代谢轴.因此,将中医学"肾虚髓枯"理论与脑肾代谢轴进行靶向位点结合研究,明确两者之间的发病关联性及信号互通互调效应,并通过补肾益髓法进行生物学干预效应,具有较高的研究价值和临床意义.该综述主要以上述思路为基点,明确绝经后骨质疏松症的发病机制,以进一步指导临床.

筋骨并重理论是中医骨伤科学重要的基础理论,阐释了筋骨之间生理联系、病理相关的机制,对中医学"以筋养骨"等治疗理念起到了推动性的作用,"筋束骨利关节"高度概括了两者的关系.骨质疏松症(osteoporosis,OP)筋-骨系统力学生物学特性失衡,这与现代医学所讲的力学源性平衡因素改变如出一辙.本文通过对人体力学平衡特点和OP患者筋骨失衡的力学源性分析,综述了力学对OP患者骨生物力学特性的改变,以此为临床上通过力学干预OP提供了可靠依据,并在"筋骨并重""动静结合"等理论指导下,更好地应用于临床,具有一定意义.

体外冲击波(Extracorporeal shock wave,SW)早期在泌尿系结石的治疗中被广泛应用,其主要原理是其产生的适度当量冲击波对病变靶点异常组织的振动解离效应.慢性筋骨病是骨科筋骨系统较为常见的一种慢性疼痛性疾病,近年来诸多学者尝试将体外冲击波应用于骨科慢性筋骨病的治疗,发现其疗效显著.因此,以"筋骨并重"理论为切入点来探讨体外冲击波对慢性筋骨病的治疗效应依据充分.但其对肌肉-骨骼系统的筋骨病变的治疗机制目前尚不十分清楚.其机制可能是体外冲击波对肌肉-骨骼系统的筋骨病变靶点具有弥散式修复重建效应,将机械能量学刺激转化为生物学效应从而调整了"筋骨失衡"的生物力学紊乱及筋骨内环境失调状态,最终重建了筋骨软组织生物力学平衡.基于此,文章主要从体外冲击波对慢性筋骨病治疗的理论溯源、机制研究及临床应用等方面展开,以明确其治疗慢性筋骨病的筋骨生物力学机制,以期能够更好地指导临床.

Background Hyperbilirubinemia (HB) is a serious complication in aortic arch surgery, which is associated with acute kidney injury (AKI). The association between HB and chronic kidney disease (CKD) is unknown. The aim of this study was to investigate the impact of HB associated AKI on CKD after aortic arch surgery. Methods We reviewed 284 patients who underwent aortic arch surgery from 2016 to 2020 in our hospital. AKI was defined as a 50% increase in sCr from baseline value within the first 7 postoperative days. HB was defined as total bilirubin > 51.3 μmol/L. Patients were divided into 3 groups based on AKI and HB: HB associated AKI (HB-AKI) group (AKI patients suffered HB within the first 7 postoperative days); AKI without HB group and Non-AKI group. Results Follow-up for 204 patients ranged from 3 to 12 months. Kaplan–Meier analysis showed that the 1-year cumulative incidence of CKD was highest in HB-AKI (32.6%) than AKI without HB (17.8%) and Non-AKI (7.4%, log-rank test, p < 0.001), and the incidence of CKD was higher in HB group than that in Non-HB group (26.7% vs. 13.9%, log-rank test, p = 0.015). Preoperative sCr (HR 1.010, 95% CI 1.004–1.016, p = 0.001), AKI without HB (HR 2.887, 95% CI 1.133–7.354, p = 0.026) and HB-AKI (HR 4.490, 95% CI 1.59–12.933, p = 0.005) were associated with CKD during 1-year follow-up. Conclusions Patients suffering HB associated AKI were at more increased odds of CKD than patients suffering AKI without HB after aortic arch surgery.

腰椎间盘突出症(lumbar disc herniation,LDH)是一种由脊神经根受压和/或刺激引起的疼痛综合征,典型症状为腰痛(low back pain,LBP)伴有下肢放射性疼痛、感觉异常和/或肌肉无力等症状,严重影响患者的生活质量[1].LDH的发病率为31％,终生患病率为60％～80％[2],其中只有3％～5％的LDH患者患有LBP伴腰神经病(lumbar radiculopathy,LR)症状[3].阶梯化治疗是目前治疗LDH的有效方案,早期保守治疗可减缓病情发展,有效避免手术治疗.其中腰椎牵引是治疗LDH的常用方法,在临床保守治疗中应用广泛,也是各种手法治疗的基础.在英国和美国,分别有41％和77％的LDH患者通过腰椎牵引进行治疗[4、5],在缓解LBP症状方面有一定的疗效[6、7].

Introduction: Extracorporeal membrane oxygenation (ECMO) is an imperative short-term cardiopulmonary support device now. We aimed to provide a single-center experience of veno-arterial (V-A) ECMO management and identify the risk factors of in-hospital mortality. Methods: We conducted a retrospective review of adult patients who received V-A ECMO between 2009 and 2019 in a cardiovascular disease center. The risk factor analysis of in-hospital mortality was conducted. Results: The study reviewed 236 patients, with an overall survival rate of 68.2%. The survivors’ blood lactate concentration is significantly lower than non-survivors [7.4 (7.8) vs 11.1 (9.7), p = 0.002]. Patients who received heart transplantation were with higher in-hospital survival rate. Survivors developed less hepatic dysfunction, acute kidney injury and myocardial damage [23 (14.3%) vs 19 (25.3%), p = 0.039; 81 (50.3%) vs 51 (68%), p = 0.011; 24 (14.9%) vs 22 (29.3%), p = 0.009, respectively], with higher rate of continuous renal replacement therapy (CRRT) [56 (34.8%) vs 53 (70.7%), p < 0.001]. Fewer survivors’ 24 hours and total chest drainage was over 1000 mL, and the rate of re-exploration as well as red blood cell and platelet transfusion were lower in survivors. In multivariate analysis, female, pre-ECMO blood lactate concentration, hyperlipidemia, CRRT, and 24 hours chest drainage ⩾ 1000 mL were risk factors of early mortality. Conclusions: By providing a general description of V-A ECMO practice at a single-center in China. Post-heart transplant graft failure was associated with numerically, the greatest survival in our practice. Furthermore, female sex, pre-ECMO blood lactate concentration, hyperlipidemia, CRRT, and high blood loss in chest drains are predictors of mortality in patients who undergo V-A ECMO.

Abstract Objectives To investigate the clinical effect of percutaneous vertebroplasty (percutaneous vertebroplasty, PVP) and percutaneous kyphoplasty (percutaneous kyphoplasty, PKP), PVP) in the treatment of osteoporotic vertebral fracture (osteoporotic vertebral compression fractures, OVCF). Methods From March 2016 to June 2019, we treated the patients who were admitted to our hospital from March 2016 to June 2019. The clinical data of 150 OVCF patients were analyzed retrospectively, and it was divided into PKP group (group A), PVP group (group B) and PVP + traditional Chinese medicine hyperextraction reduction method group (group C) according to different operation methods, and 50 cases in each group. Preoperative, postoperative 1d,3-month,6-month,1-year pain-visual analogue scale (VAS) was used to assess the degree of pain relief of the back and back of the patient, and the range of motion of the thoracolumbar spine was assessed. The recovery of degree, the recovery of kyphosis Cobb angle, the refracture of injured vertebrae and adjacent vertebrae after operation, and the trend of long-term stability of spine were followed up. Results The operation was smooth and there were no complications such as incision infection and deep venous thrombosis. At 3 months and 6 months after operation, there was significant difference between PVP overextended reduction group (group C) and PKP group (group A), PVP group (group B). The recovery rate of Cobb angle in sagittal plane of injured vertebrae was compared before and after operation. 1 day, 3 months, 6 months, 1 year follow-up. There was no significant difference between group C and group A and group B (P < 0.05). There was no significant difference between group B and group C (P < 0.05). The improvement rate of VAS in the three groups was significantly lower than that before operation, the pain was relieved and the function of daily life was improved significantly. On the 1st day, 3 months, 6 months and 1 year after operation, the improvement rate of VAS in group C was significantly different from that in group A. there was no significant difference between group B and group B (P < 0.05). There was no significant difference between group B and group C (P > 0.05). There was no significant difference in the improvement rate of ODI between group C and group A. there was no significant difference in the improvement rate of ODI between group C and group A. there was no significant difference in the improvement rate of ODI between group C and group A at 1 day, 3 months and 1 year after operation. During the follow-up of 6 months after operation, there was significant difference between group C and group A and group B (P < 0.05). There was significant difference between group C and group A at 1 month and 3 months after operation, and there was significant difference between group B and group B at 1 month, 3 months after operation (P < 0.05), and there was significant difference between group B and group B at 1 month and 3 months after operation (P < 0.05), and the risk of fracture and adjacent vertebral fracture was significantly higher than that in group B (P < 0.05). Year-to-year comparison of three groups There was no significant difference (P > 0.05). There was a significant difference between group C and group A and B at 1 month, 3 months and 6 months after operation (P < 0.05). One year after operation, there was no significant difference among the three groups (P > 0.05). Conclusions The three methods of reduction and fixation (PKP,PVP and PVP) are effective in relieving pain, strengthening vertebral body, stabilizing injured vertebra, restoring vertebral body height and correcting kyphosis of thoracolumbar spine. However, in the course of long-term follow-up, simple PVP The residual low back pain or recurrence in patients with PKP, the loss of the height of injured vertebrae, the occurrence of fractures and even the complications of refracture of adjacent vertebrae after enhanced operation, resulting in the decrease of the balance and long-term stability of spinal muscle and bone system. And then increase the degeneration process of the thoracolumbar segment of the spine.

With the advent of posttraumatic elbow rehabilitation, prevention of elbow stiffness has become a key part of the development of sports medicine. In order to clarify the time point of joint movement after internal fixation to the elbow and to provide a mechanical model for individualized diagnosis. This paper uses electromagnetic wave detection technology to quickly detect the bioelectrical impedance signal of the patient's lesion location, then passes the message to the upper control system for processing, summarizes the improved Hilbert–Huang transform to deep learning, and deep learning algorithms and computer technology are used to mine the bioelectrical impedance signal of the elbow joint. The simulation and human experiment results show that bioelectrical impedance signals can clarify the pathogenesis of elbow joint stiffness and the relationship between rehabilitation treatment time and duration. It has the advantages of low cost, high fitting accuracy, strong robustness, and noninvasiveness.

目的 通过单中心随机对照试验评价新型改良低预充体外循环系统(FUWAI-SAVE系统)的临床效果.方法 单中心单盲随机对照试验,研究对象为体外循环(ECC)下心脏外科手术围ECC期阜外输血风险分层预测评分患者.将以1:1的比例随机分配受试者接受FUWAI-SAVE系统和常规ECC系统下行心脏外科手术.结果 主要结局指标为围ECC期红细胞输注率.次要结局指标包括围ECC期其他血制品输注率及各血制品输注量、血红蛋白、炎性指标、ECC并发症发生率、院内死亡率及其他不良结局.结论 验证FUWAI-SAVE系统的有效性与安全性.

目的 观察氨甲环酸对于不同体外循环预充液用于成人体外循环预充对术后凝血功能的影响.方法 采用双盲、随机对照研究方法,272例18岁以上于2019年6月至2019年12月于本院行体外循环下心脏手术患者,分为白蛋白预充组(lg/kg)(A组,n=68)、羟乙基淀粉130/0.4电解质注射液组(40ml/kg)(B组,n=68)、预充氨甲环酸(30mg/kg)且白蛋白预充组(lg/kg)(C组,n=68)、预充氨甲环酸(30mg/kg)且羟乙基淀粉130/0.4电解质注射液组(40ml/kg)(D组,n=68),应用血栓弹力图测定检测转前、鱼精蛋白中和后15min、转后4h及术后24h的凝血功能.结果 四组患者年龄、身高、体重、性别、手术种类及术前心功能差异均无统计学意义(P＞0.05),体外循环时间、主动脉阻断时间、术后呼吸机辅助通气时间、ICU监护时间、术后24h红细胞用量差异均无统计学意义(P＞0.05);24h胸液引流量B组显著高于其余三组(P=0.009).组间比较,Pt在T2时点B组与A组、C组、D组有显著性差异(P=0.005);MA值在T2时点A组与B组、C组、D组有显著性差异(P=0.023、0.016、0.033),B组与C组、D组有显著性差异(P=0.001、0.005);MA值在T3时点A组与C组、D组有显著性差异(P=0.022、0.026),B组与C组、D组有显著性差异(P=0.032、0.028);α角在T2时点A组与B组、C组、D组有显著性差异(P=0.035、0.026、0.019),B组与C组、D组有显著性差异(P=0.009、0.004),T3时点B组与C组、D组有显著性差异(P=0.032、0.043).结论 氨甲环酸能显著改善体外循环术中、术后凝血功能,有效减少手术后出血量,对于不同预充液引起的凝血功能障碍,可起到改善作用.