Acute gastrointestinal injury (AGI) after cardiopulmonary bypass (CPB) is associated with poor prognosis. This study aimed to evaluate the effect of preoperative probiotic supplementation on the incidence of AGI in patients undergoing CPB procedure. This was a double-blind, randomized controlled trial conducted in a single center. The patients undergoing HVR with CPB between September 2022 and February 2023 were randomly assigned to receive either probiotic (Lac group) or placebo (Placebo group). The probiotic was administered daily for seven days prior to surgery.Univariate and multivariate logistic regression analysis was performed to identify independent risk factors for AGI. A P-value < 0.05 was considered statistically significant. Gut microbiota composition was assessed using 16 s rRNA analysis. A total of 52 patients were randomly assigned to two groups (26 in the Lac group, 26 in the Placebo group). Patients were followed for at least 30 days after surgery. During the follow-up period, 15 of the 52 patients (28.85

Download This Paper Open PDF in Browser Add Paper to My Library Share: Permalink Using these links will ensure access to this page indefinitely Copy URL Copy DOI

OBJECTIVES:For a long time, the association of the false lumen status and the outcomes of patients suffering from aortic dissection has been unclear, so this review article aims to study whether the unobstructed of the false lumen is related to the outcome of patients suffering from aortic dissection.METHODS:We performed this systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta Analyzes Protocols (PRISMA) statement 2009 and registered with PROSPERO (CRD42022381869). We searched PubMed, the Cochrane library, Web of Science and Embase to collect potential studies. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. The main outcome is long-term survival. Data included in the study were summarized using the risk ratio or mean difference and 95% confidence interval.RESULTS:There were 16 trials, 2829 patients in total, with a mean age of 62.1 years. Compared with completely thrombosed false lumen, patent group has better long-term survival (risk ratio (RR), 0.88; 95% CI, 0.79 to 0.97; p = 0.01; I2 = 58%) and smaller yearly aortic growth rate (mean difference (MD), 1.03; 95% CI, 0.23 to 1.82; p = 0.01; I2 = 98%). In addition, patients with a patent false lumen had a lower risk of aortic event (RR, 0.81; 95% CI, 0.68 to 0.97; p = 0.02; I2 = 37%), but higher risk of aortic rupture (RR, 7.02; 95% CI, 2.55 to 19.3; p = 0.0002; I2 = 0) and hospital death (RR, 2.72; 95% CI, 1.45 to 5.08; p = 0.002; I2 = 0).CONCLUSION:Completely thrombosed of the false lumen is more beneficial to the long-term survival of patients with aortic dissection. And the risk of aortic rupture and hospital death in patients with patent false lumen is 7 times and 3 times that of patients with complete thrombosed false lumen. It is expected to provide individualized medical care for different types of patients according to different false lumen status to minimize death and related complications.

Cardiac tumors are a rare disease in clinical practice.Two patients with primary cardiac malignancies were admitted to our hospital from May 2020 to July 2020.The first patient's heart tumor is non-Hodgkin's lymphoma, which originated in the right atrium and invaded part of the right atrium and superior vena cava.The tumor was completely removed and the right atrium and superior vena cava were reconstructed after surgery.The prognosis of the patients after chemotherapy is fair.The second patient's tumor also originated in the right atrium, which was an epithelioid hemangioendothelioma, it was highly malignant and had a wide range of tumor invasion.The right atrium, left atrium, right ventricle, aortic root, and superior and inferior vena cava were all involved and could not be completely surgically removed, so the patient's prognosis is poor.

Review question / Objective: (1) the population treated with sutureless aortic valve or TAVR regardless of operative risk (2) the intervention was sutureless aortic valve replacement with no restrictions on the valve style (rapid-deployment or sutureless valve) (3) the comparison was TAVI with no restrictions on the valve style (balloon-or self-expandable valve) or delivery route (4) outcomes studied included any of the following: all-cause mortality, stroke, new permanent pacemaker implantation (PPI), moderate-to-severe paravalvular leak (PVL), more-than-mild residual aortic regurgitation (AR), new renal replacement therapy, myocardial infarction, new atrial fibrillation, major vascular complication, major or life-threatening bleeding event, length of stay, ICU length of stay, postoperative mean aortic gradient, cardiopulmonary bypass time and cross-clamp time (5) the study design was randomized controlled trials (RCT) or comparative cohort studies using propensity-matched analysis.

Type A aortic dissection (AD) is a critical and severe disease with high mortality. The Sun's operation is a standard surgical method for this kind of disease at present. For the procedure, an elephant trunk stent is inserted into the true lumen of the descending aorta and the aortic arch is replaced. A patient was admitted to the First Hospital of Lanzhou University due to sudden chest and back pain for 6 days. Computed tomography angiography (CTA) showed type A AD. Ascending aorta replacement, Sun's operation, and ascending aorta to right femoral artery bypass grafting were performed. After surgery, the patient's condition was worsened. The digital subtraction angiography (DSA) showed the elephant trunk stent was inserted into the false lumen of AD, leading to the occlusion of the large blood vessel at the distal part of the abdominal aorta and below. Although we performed intima puncture and endovascular aortic repair, the patient was still dead.

BACKGROUND:The CL-V full-carbon bileaflet mechanical heart valve is a novel Chinese-made prosthetic valve. This study evaluated the mid-term outcomes of the CL-V bileaflet mechanical heart valve after implantation in Chinese patients. METHODS:This study retrospectively enrolled a total of 38 consecutive patients who underwent elective mechanical heart valve replacement (MHVR) with two different valve types from April 2004 and May 2010, including 18 patients with the CL-V bileaflet mechanical heart valve (44.4% male, mean age 47.4±6.2 years, mean body weight 64.7±11.9 kg) and 20 patients with the St. Jude mechanical heart valve (45.0% male, mean age 49.7±7.6 years, mean body weight 66.1±11.1 kg). All patients underwent follow-up clinical evaluations in the outpatient department at all-time points. RESULTS:No complications occurred during the mean 61.3 months follow-up time (range, 47-102 months). The cardiothoracic ratios (52.7%±4.5% vs. 50.1%±4.0%), left atrium diameter (46.5±7.6 vs. 44.8±9.3 mm), left ventricular diastolic diameter (47.6±4.9 vs. 48.2±8.5 mm) and left ventricular ejection fraction (65.4%±8.7% vs. 64.5%±8.0%) were not significantly different between the two groups (P>0.05). Transthoracic Doppler echocardiography showed that the hemodynamic indexes were not significantly different between the two groups at 1 year and 3 years (P>0.05). Furthermore, no significant differences were found between the two groups in hemocompatibility indexes at both 6 months and 3 years postoperatively (P>0.05). CONCLUSIONS:The mid-term follow-up results of the CL-V bileaflet mechanical heart valve were similar to those of the St. Jude Medical heart valve, which showed stable hemodynamics and good blood compatibility. Chinese-made CL-V bileaflet mechanical heart valves can be a substitute for St. Jude Medical heart valves, and can be widely used in cardiac surgery. TRIAL REGISTRATION:Chinese Clinical Trial Registry ChiCTR2000034158.

目的:探讨延伸至心脏的静脉内平滑肌瘤病发病机制、临床特点、手术治疗方式;提高对延伸至心脏的静脉内平滑肌瘤病的认识.方法:回顾性分析兰州大学第一医院收治的3例延伸至心脏内的静脉内平滑肌瘤病患者临床资料、诊治过程,并复习相关文献.结果:3例患者均成功行手术治疗,其中2例一期一站式经胸腹联合切口行"子宫、附件、盆腔肿物切除+心脏、下腔静脉肿物取出术",另1例患者手术分2期进行,一期先行"右心房肿物切除+三尖瓣成形术",术后1周二期行"全子宫切除+双侧附件切除+下腔静脉肿物取出+右侧输尿管支架植入术".3例患者均手术成功,术后康复出院.结论:延伸至心脏的静脉内平滑肌瘤病临床少见,彻底切除瘤体是治疗本病的关键.手术需多学科联合,可一期一站式完成,也可分期分站式完成,2种手术方式临床治疗效果满意.

目的:系统评价合并慢性肾脏疾病(CKD)的主动脉瓣狭窄患者经导管主动脉瓣置入术(TAVI)有效性和安全性.方法:计算机检索PubMed、The Cochrane Library、EMbase、Web of science、知网、万方和中国生物医学文献数据库,收集CKD患者TAVI术预后的相关研究,检索时限从建库至2020年7月.由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata15.0软件进行Meta分析.结果:共纳入17篇研究,包括128732例患者,其中CKD组有55394例,无CKD组有73338例.Meta分析结果显示:TAVI术后CKD组患者30天(RR=1.39,95％CI:1.33～1.46,P＜0.001)及1年(RR=1.31,95％ CI:1.27～1.36,P＜0.001)的全因死亡率;30 d(RR=1.37,95％ CI:1.07～ 1.76,P=0.012)及1年(RR=1.45,95％CI:1.25～ 1.67,P＜0.001)的心血管死亡率均高于无CKD组患者.CKD组患者在术后急性肾损伤(AKI)(RR=1.40,95％CI:1.21～1.61,P＜0.001)及出血事件(RR=1.32,95％CI:1.27～ 1.38,P＜0.001)方面,也有较高的发生风险.结论:接受TAVI的患者中,CKD的存在显著增加了患者术后死亡率及并发症发生率.

目的:小儿常见先天性心脏病的外科治疗探讨.方法:选取本院收治的先天性心脏病患儿100例,所有患者均采用外科手术及时治疗.结果:所有患者术后无死亡,已出院.术后第一天有2例PDA左肺不张.ICU中的气雾剂治疗还不够,而痰却被左主支气管阻塞.在基本麻醉下,使用纤维支气管镜进行抽吸并通过气溶胶理疗进行治愈.经过6个月至5年的随访,没有死亡.与术前相比,所有儿童均发育良好,其身体和免疫功能得到改善.结论:及时治疗先天性心脏病患儿,治疗有效率高,建议对应的医生及时检查患儿病症,制定有效的治疗措施,帮助患儿恢复健康.

目的:探讨"Hybrid技术"在治疗成人瓣膜病合并粗大动脉导管未闭(PDA)中的有效性和安全性,并分析该术式的近、中期临床疗效.方法 :回顾性分析2015年5月至2019年4月,在兰州大学第一医院心外科住院的8例成人瓣膜病合并粗大PDA患者的临床资料,其中女性5例,男性3例,年龄25～56岁,平均(32.8±4.5)岁.8例患者手术分两期进行,一期在全麻下经胸小切口行动脉导管未闭封堵术,术后3～6个月二期在全麻低温正中开胸体外循环下行心脏瓣膜置换术.术前、术后1、3、6个月分别行超声心动图及X线片检查,测量心胸比、LVEDD、LVEF、肺动脉收缩压.结果 :所有患者均顺利完成手术,8例患者术前心胸比为(0.75±0.04),一期动脉导管封堵术后心胸比缩小为(0.69±0.16),二期瓣膜置换术后心胸比缩小为(0.61±0.48).术前LVEDD为(66.83±8.82)mm,一期封堵术后缩小为(59.64±8.61)mm,二期瓣膜术后缩小为(54.69±6.73)mm.术前LVEF为(53.59±4.13)％,一期封堵术后为(55.86±3.97)％,二期瓣膜术后为(54.73±4.06)％.术前肺动脉收缩压为(68.94±11.25)mmHg,一期封堵术后降为(59.43±9.68)mmHg,二期瓣膜术后降为(50.74±8.36)mmHg.术后患者临床症状较术前明显改善,随访结束,8例患者无死亡,无急性心力衰竭及低心排,无封堵器脱落移位,无导管再通,无溶血、无瓣周漏及其他特殊并发症.结论 :"Hybrid技术"可成功治疗成人瓣膜病合并粗大PDA,有效降低手术风险,临床近中期疗效满意,可成为治疗此类患者的一种安全、有效的方法.

The purpose of this case report is to describe the multimodal cardiac magnetic resonance (CMR) imaging features of an invasive thymoma extending into the superior vena cava and right atrium. This unusual case indicates that multimodal CMR can not only reveal the morphological features of thymoma but also enable the identification of histological types, which provides a reasonable surgical plan in the perioperative management. .

目的 探讨康复训练对先天性心脏病患儿术后恢复的积极影响.方法 将该院2017年4月—2019年6月期间收治的82例先天性心脏病患儿纳入该研究中,按照入院顺序分组,方法为1:1比例随机分组,所选患儿均接受心脏手术治疗,观察组41例患儿术后给予针对性康复训练,对照组41例患儿术后开展一般指导,对比2组患儿干预效果.结果 观察组患儿撤呼吸机时间、监护时间、体外循环时间、住院时间均明显低于对照组,差异有统计学意义(P<0.05);观察组、对照组术后并发症发生率(4.88％vs21.95％)对比差异有统计学意义(P<0.05);观察组康复训练质量评分(95.26±6.28)分,明显高于对照组(84.84±5.31)分,对比差异有统计学意义(P<0.05);观察组患儿家属对康复训练的满意度评分高于对照组,差异有统计学意义(P<0.05).结论 先天性心脏病患儿术后给予针对性康复训练,可提高术后恢复效果,减少并发症,提高就诊满意度,临床效果显著,能够促进患儿预后.

目的:比较接受孙氏手术与去分支化杂交手术治疗的急性Ⅰ型主动脉夹层患者的围术期及术后短期预后. 方法:纳入2015年3月至2017年5月在兰州大学第一医院心血管外科行Ⅰ型主动脉夹层广泛修复手术患者85例,其中行孙氏手术患者(孙氏组)64例,行去分支化杂交手术患者(去分支化组)21例,比较两组患者围术期及术后短期生存状况. 结果:与孙氏组相比,去分支化组患者年龄大,肥胖、术前合并肝功不全者比例高,主动脉阻断及体外循环时间短,术后呼吸机辅助呼吸时间短,围术期红细胞及冷沉淀使用量少,ICU住院时间及术后住院时间短,肺部感染率低(P均＜0.05).两组的在院死亡率和术后1年生存率无统计学差异. 结论:去分支化杂交手术是治疗急性Ⅰ型主动脉夹层的新方法,适用于高龄、高危人群,短期预后良好.

一般资料 患者,男性,55岁,主因突发腰背部撕裂样疼痛10 h于2018年5月13日急诊入院.患者于入院10 h前无明显诱因突发腰背部疼痛,呈撕裂样并逐渐加重,伴有胸闷气短不适.无头晕、头痛,无恶心及呕吐.就诊当地医院,疑“主动脉夹层”可能,转诊我院,入院前CTA检查示:A型主动脉夹层,我科会诊后以“A型主动脉夹层”收住.既往高血压病史多年,未行系统诊治,血压控制状况不详,有“乙型肝炎”病史,否认其他病史,家族既往无相关病史,非马方综合征.入院查体:T:36.7℃,P:113次/min,R:19次/min,BP:170/100 mmHg(1 mmHg=0.133 kPa),身高178 cm,体质量95 kg,双侧血压及脉搏相差不大,神志清,精神欠佳,急性病容,心肺体查未见明显异常.腹平软,剑突下无压痛、反跳痛,肝脾肋下未触及,双下肢无水肿.

临床资料 患者,男,66岁,主因“间断胸闷气促25年,加重8月”收住入院.体检示:一般可,血压118/78 mm Hg,颈静脉不充盈,右胸下部听诊呼吸音减低,可闻及湿罗音,心界左下扩大,心率89次/min,心律齐,主动脉瓣区有粗糙喷射性收缩期杂音,腹部(—),四肢脉搏细弱,双下肢轻度水肿.辅助检查:心脏超声示主动脉瓣环钙化,瓣叶增厚、钙化、粘连,二叶式主动脉瓣,瓣口开放面积0.65 cm2,最大跨瓣压差110 mm Hg,主动脉瓣环内径为19 mm,左心房内径34 mm,左心室舒张期末内径71 mm,左心室射血分数(LVEF) 29％.主动脉及冠状动脉(冠脉)计算机断层扫描血管造影(CTA)示患者主动脉瓣Type 0型二叶瓣,中度钙化,钙化集中在左瓣窦,左右冠脉均发自左瓣窦.

Objective: The aim of this study was to determine the diagnostic accuracy of different computer-aided diagnostic (CAD) systems for thyroid nodules classification. Methods: A systematic search of the literature was conducted from inception until March, 2019 using the PubMed, EMBASE, Web of science, and Cochrane library. Literature selection and data extraction were conducted by 2 independent reviewers. Numerical values for sensitivity and specificity were obtained from false negative (FN), false positive (FP), true negative (TN), and true positive (TP) rates, presented alongside graphical representations with boxes marking the values and horizontal lines showing the confidence intervals (CIs). Summary receiver operating characteristic (SROC) curves were applied to assess the performance of diagnostic tests. Data were processed using Review Manager 5.3 and Stata 15. The methodological quality of included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Trial registration number: PROSPERO CRD42019132540

Factors influencing responsiveness to warfarin at treatment onset time were not well identified in Chinese patients undergoing heart valve replacement. We sought to select the most relevant factors that associated with patient response to warfarin early after heart valve surgery. In this observational study, 289 patients starting warfarin therapy early after heart valve replacement surgery were enrolled. CYP2C9 *1, *2, *3, and *5; VKORC1-1639 G>A, CYP4F2 V433M, and GGCX rs11676382 genotypes; clinical characteristics, response to therapy, and bleeding and thrombosis events were collected. The primary outcomes were the time to the first INR equal to or more than lower limit of therapeutic range and the warfarin dose requirements. Stepwise multiple linear regression was performed to develop a dosing algorithm to predict the warfarin dose requirements. The results of univariate analysis showed lone VKORC1-1639 G>A, CYP2C9 *1/*3, cefazolin, cefoperazone-sulbactam, increased BMI, Δhemoglobin, and white blood cell count could significantly affect patient responsiveness to warfarin in the initial period of anticoagulation. Multivariate analysis resulted in an equation: Accumulated warfarin doses (mg) = 17.068 VKORC1-1639 G>A − 4.261 hypertension + 0.593 BMI − 0.115 age − 4.852 CYP2C9 *1/*3 − 2.617 cefazolin − 4.902 cefoperazone-sulbactam − 4.537, which could explain 40.2% of the variability in warfarin dose needed to reach the first INR equal to or more than lower limit of therapeutic range. Both genetic and clinical factors contributed to anticoagulation effect of warfarin in the initial period of treatment. Our findings could provide a basis for the personalized management of warfarin use in the early stage of anticoagulation in northern Chinese patients.