Objectives Extracorporeal membrane oxygenation (ECMO) patients with or without transport both have high hospital mortality rate and there are few data on adult VA-ECMO transport patients. Hence, this study was designed to analyze factors that affect the outcomes of patients with ECMO transport. Methods This study retrospectively enrolled 126 ECMO patients transferred from regional hospital to the First Affiliated Hospital of Zhengzhou University by our ECMO team during June 2012 to Sept 2020. Data were calculated and analyzed. Results The median distance of transportation was 141 (76–228) km, the median transport time consuming was 3 (1.3–4) h, the percentage of complications during transport was 40.5% (except for bleeding on cannula site, and no one death during transport), and the survival rate in hospital was 38.9%. Compared with survivors, the non-survivors were older and showed higher SOFA score, longer time with ECMO assisted, longer time in ICU and in hospital. However, after divided into VA-ECMO and VV-ECMO groups, the older age showed no significant difference between survivors and non-survivors groups of VA-ECMO patients. Moreover, the Cox regression survival analysis showed that higher SOFA score and lactate level indicated higher ICU mortality of VA-ECMO patients while higher SOFA score, higher lactate level, older age and lower MAP after transportation (<70mmHg) indicated higher ICU mortality of VV-ECMO patients. However, there was no significant difference of comorbidities and complications in survivors and non-survivors groups of ECMO patients. Conclusions The transportation for ECMO patients can be feasible performed although life-threatening complications might occur. The SOFA score and the lactate level could be used to evaluate the risk of ICU mortality of transportation ECMO patients. Besides, lower MAP after transportation (<70mmHg) had potential predictive value for short-term outcome of VV-ECMO patients.

Acute respiratory distress syndrome (ARDS) is an acute lung injury associated with high morbidity and mortality. This study aimed to establish an accurate prediction model for mortality risk in ARDS. 70% of patients from the Medical Information Mart for Intensive Care Database (MIMIC-III) were selected as the training group, and the remaining 30% as the testing group. Patients from a Chinese hospital were used for external validation. Univariate and multivariate regressions were used to screen the independent predictors. The receiver operating characteristic curve (ROC) analysis, the Hosmer–Lemeshow test, and the calibration curve were used for evaluating the performance of the model. Age, hemoglobin, heart failure, renal failure, Simplified Acute Physiology Score II (SAPS II), immune function impairment, total bilirubin (TBIL), and PaO 2 /FiO 2 were identified as independent predictors. The algorithm of the prediction model was: ln (Pr/(1 + Pr)) = −3.147 + 0.037 ∗ age − 0.068 ∗ hemoglobin + 0.522 ∗ heart failure (yes) + 0.487 ∗ renal failure (yes) + 0.029 ∗ SAPS II + 0.697 ∗ immune function impairment (yes) + 0.280 ∗ TBIL (abnormal) − 0.006 ∗ PaO 2 /FiO 2 (Pr represents the probability of death occurring). The AUC of the model was 0.791 (0.766–0.816), and the internal and the external validations both confirmed the good performance of the model. A nomogram for predicting the risk of death in ARDS patients was developed and validated. It may help clinicians early identify ARDS patients with high risk of death and thereby help reduce the mortality and improve the survival of ARDS.

目的 比较颈椎一期后前路联合手术与分期后前路联合手术治疗钳夹型颈椎病的临床效果.方法 回顾性分析2012—2016年在郑州大学第一附属医院骨科行手术治疗的58例钳夹型颈椎病患者的临床资料,按手术方式不同分为两组,一期后前路联合手术组(A组)31例,分期后前路联合手术组(B组)27例.比较两组患者手术时间、术中出血量、术后引流量、日本骨科协会(JOA)评分、视觉模拟(VAS)评分和神经功能改善率.结果 两组手术时间比较,差异无统计学意义(P>0.05).A组术中出血量和引流量多于B组,差异有统计学意义(P均<0.05).两组术前、术后3个月及末次随访JOA评分和VAS评分比较,差异无统计学意义(P均>0.05).两组术后3个月及末次随访神经功能改善率比较,差异无统计学意义(P>0.05).结论 两种手术方式对钳夹型颈椎病均有较好的临床疗效,分期手术与一期手术相比,术中出血量及术后引流量较少.对于年龄较大或合并基础疾病较多的钳夹型颈椎病患者,采取分期后前路联合手术治疗,安全性更高.

目的 比较一期后路减压联合前路减压内固定术与一期后路扩大减压固定联合前路减压钢板内固定术治疗颈椎外伤后骨折脱位的效果.方法 选取31例颈椎骨折脱位患者,其中14例患者接受一期后路减压联合前路减压内固定术治疗,设为A组,17例患者接受后路扩大减压固定联合前路减压钢板内固定术治疗,设为B组.记录两组手术时间、术中出血量、手术前后日本骨科协会评分(JOA)改善率等.结果 A组术中出血量为(290.01±102.20)ml,手术时间为(4.12±1.08)h;B组术中出血量为(494.16±262.21)ml,手术时间为(4.95±1.37)h.A组术中出血量较B组少,手术时间较B组短,差异有统计学意义(P均<0.05).A组患者术后3个月和1 a的JOA改善率为(0.66±0.11)％和(0.76±0.12)％,B组患者术后3个月和1 a的JOA改善率为(0.70±0.12)％和(0.80±0.10)％.两组患者术后3个月和1 a的JOA改善率比较,差异无统计学意义(P>0.05).结论 一期前路减压内固定联合后路减压术与一期后路扩大减压固定联合前路减压钢板内固定术治疗颈椎外伤后骨折脱位,均可解除来自椎管前与椎管后方的压迫,恢复损伤节段稳定,且前者具有手术时间短、出血量少、安全性高等优势.

Objective To explore the expression and significance of heme oxygenase-1 (HO-1) on primary myocardial cells during hypoxia/reoxygenation (H/R) injury with curcumin post-treatment.Methods Five groups were set up in this experiment: normal control group;curcumin group (10 μmol/L);H/R group;curcumin (10 μmol/L)+H/R group;curcumin+ZnPP-Ⅸ inhibitors (HO-1)+H/R group.Cell viability,lactate dehydrogenase (LDH) and superoxide dismutase (SOD) activity,and malondialdehyde (MDA) concentration were measured to evaluate cell damage.Cysteinyl aspartate-specific protease (Caspase)-3 was detected.JC-1 probe was used to test cell membrane potential.Western blotting was used to detect the expression of B cell lymphoma/leukemia-2 associated X protein (bax),HO-1 and B-cell lymphoma/leukemia-2 (bcl-2) proteins.Results As compared with H/R group,curcumin could induce the expression of HO-1 and bcl-2,inhibit the expression of bax,but after addition of ZnPP-Ⅸ,the expression of HO-1 and bcl-2 was decreased and the bax expression was up-regulated (P=0.001,0.006,0.007).As compared with control group,the mitochondrial membrane potential in H/R group was decreased significantly (31±7)% vs.100% (P=0.004),curcumin post-treatment could increase the mitochondrial membrane potential (75±16)% vs.(31±7)% (P=0.011),and the addition of ZnPP-Ⅸ blocked the protective effects of curcumin on myocardial cells (19±4)% vs.(75±16)% (P=0.001).Curcumin could increase the viability of myocardial cells and SOD activity,reduce LDH and MDA concentrations,and decline the Caspase-3 activity,which could alleviate cell injury,oxidative stress injury and apoptosis.Conclusion Curcumin can reduce oxidative stress and apoptosis by inducing by the HO-1 expression,which can protect the myocardial cells,and HO-1 inhibitor ZnPP-Ⅸ can block the myocardial protective effect of curcumin.

Objective To establish the original generation of myocardial cells in vitro anoxia/reoxygenation (H/R) model,then to explore the optimum concentration of curcumin post-processing on protection of primary Myocardial cell during hypoxia/reoxygenation (H/R) Injury.Methods The experimental group was divided into 5 groups:normal control group;H/R group;Curcumin concentrations (1,5,10 μmol/L) + H/R group.Through the cell activity determined by methyl thiazol tetrazolium (MTr)method and test lactate dehydrogenase (LDH) activity and malondialdehyde (MDA) concentration and superoxide dismutase (SOD) activity evaluation of cell damage;To detect apoptosis rate by TdT-mediated dUTP nick end labeling (TUNEL) method.Results Compared with control group,cell activity decrease in H/R group (P =0.001),the curcumin group significantly enhanced the activity of cells,especially in the 10 μmol/L group (P =0.017);Compared with control group,the curcumin group of different concentrations significantly decreased the activity of LDH,decreased MDA concentration,increased SOD activity and improve the myocardial cell apoptosis after H/R damage rate significantly.Among them,the effect of 10 μmol/L group was the most obvious (P =0.011,0.001,0.009,0.007),and there was no significant difference compared with the control group (P =0.129,0.083,0.134).Conclusion On the basis of the success of the model,curcumin of different concentrations have protective effects on myocardial cells,anti oxidative stress and anti apoptosis,the concentration of 10 μmol/L is optimum.

The aim of this study was to investigate the effects of and summarize our experiences with extracorporeal membrane oxygenation (ECMO) in supporting donors with unstable respiration and circulation before organ transplantation. The data of 4 brain-dead organ donors (DBDs) from September 2012 to August 2013 were retrospectively analyzed. We performed auxiliary emergency ECMO support for 9.5-78 h before their hepatonephric functions were improved to some extent and then donor liver and donor kidneys were successfully obtained. The 4 donors had auxiliary emergency ECMO support for 78 h, 32 h, 9.5 h, and 14 h, respectively, and we obtained homeostasis and improved their hepatonephric functions. Two kidneys were abandoned due to consolidation, but the other 10 organs were successfully transplanted, although 2 recipients exhibited renal delayed graft function (DGF). The 10 recipients were discharged after healing. ECMO can provide effective respiratory and circulatory support to transplant donors, improve organ function, and provide sufficient time for transplantation; thus, it can effectively assist in the current situation of organ donor shortage.

Objective To improve the management strategy for the infants with low weight and decreased pulmonary artery blood flow undergoing cardiopulmonary bypass(CPB). Methods The clinical data of 38 infants including age,body weight,operation type and CPB conditions including equipment,composition of priming liquids,duration of CPB and clamping time of ascending aorta were retrospectively ana-lyzed,who were less than 5 kg in body weight and underwent CHD operations. The infants aged 20 days to 8 months,weighed 2. 6 ~ 5. 0 kg. All cases used mild hypothermia and moderate hypothermia,Modified ultrafiltration(MUF)and Balanced ultrafiltration(BUF)was used in all pa-tients. Results After cross clamping release,heart beat recovered spontaneously in 34 patients without severe arrhythmia. 38 cases were suc-cessfully weaned from CPB without severe complications. Conclusion Appropriate infant bypass,low prime volume,keeping high HCT and col-loidal pressure adapted perfusion flow rate matching temperature,myocardial preservation and pulmonary protection during CPB,MUF and BUF can lead to good results.

Objective To investigate the supporting effect of extracorporeal membrane oxygenation (ECMO) for respiratory and circulatory instability donors before organ transplantation.Methods During September 2013 to August 2014,4 cases of donation after braindeath (DBD) patients were treated in our hospital.All of 4 cases were treated emergently with ECMO supporting for 9.5-78.0 h,and liver and kidney were removed after liver and kidney functions were improved to some extent and medical procedures completed.Results Four cases were supported for 78.0,32.0,9.5 and 14.0 h,respectively.Internal environment of body was stable.The liver and kidney functions were improved to varying degrees.Four livers and 6 kidneys obtained were successfully transplanted,andf 2 kidneys were abandoned for consolidation.After surgery 2 cases had delayed renal graft function.Ten recipients recovered.Conclusion Donor can be improved by ECMO,which can provide effective support of the respiration and circulation,and improve the function of organs.

目的：探讨体外循环（CPB）辅助技术在腔静脉肿瘤手术治疗中的应用及效果。方法回顾性分析8例腔静脉肿瘤在 CPB 辅助下行手术治疗的相关资料，其中3例为原发或继发下腔静脉平滑肌瘤（其中1例蔓延至右心房），1例为原发性平滑肌肉瘤，1例为肝癌下腔静脉内转移，2例为肾癌下腔静脉转移，1例为胸腺瘤累及上腔静脉及右心房。通过右房原主动脉插管或右心房回输管建立 CPB 行辅助循环。结果8例患者均成功将腔静脉肿瘤完整切除，顺利出院。术后随访显示，1例术后2个月出现肝衰竭死亡，2例分别于术后4、6个月复发再次手术，其余5例随访1 a 无复发。结论 CPB 辅助技术在腔静脉肿瘤手术治疗中的应用，扩大了手术适应证，有效维持血流动力学稳定，同时通过充分暴露术野，保证了肿瘤的彻底切除。

Objective To explore the clinical application and significance of retrograde autologous priming (RAP) combined with modified ultrafiltration (MUF) in infant cardiac surgery.Methods Sixty pediatric patients with cardiac surgery were selected and randomly divided into the control (n =33) and experimental groups (n =27).The experimental group was given RAP and MUF,while the control group was only subjected to the conventional method.The situations of hematocrit (Hct,T1,T2,T3,T4) and lactate (Lac) at different perioperative time points,the filtrate volume of MUF,mechanical ventilation time,hospital stay,intraoperative and postoperative 2-h blood transfusion were observed and compared between the two groups.Results The number of patients receiving perioperative blood transfusion in the experimental group (9) was less than that in the control group (31) (P ＜ 0.05).Intraoperative Hct in the experimental group was lower than in the control group [T2:(25.08 ± 0.50) ％ vs.(26.81 ± 0.52) ％,P ＜ 0.05;T3:(26.04 ± 0.36) ％ vs.(27.79 ± 0.51) ％,P ＜ 0.05].Other indicators showed no significant difference (P ＞ 0.05).Conclusion RAP combined with MUF could effectively reduce hemodilution in pediatric patients,satisfy intraoperative perfusion conditions,and reduce perioperative blood transfusion volume.