BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their gly...BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their glycemic control outcomes.We hypothesize that proximal small intestinal bypass(PSIB)is superior in blood glucose reduction over Roux-en-Y gastric bypass(RYGB)and jejunoileal bypass(JIB).AIM To compare the effectiveness of PSIB,RYGB,and JIB in lowering blood glucose.METHODS Rats with streptozotocin-induced diabetes were randomly divided into PSIB,RYGB,JIB,and sham-operated groups.Body weight,food intake,fasting blood glucose level,oral glucose tolerance test,insulin tolerance test,liver enzymes,and blood lipids were measured.RESULTS Postoperatively,only the JIB group had a lower body weight compared to the sham group.The food intake of the rats in all three surgical groups was significantly less than that in the sham group.Fasting blood glucose was reduced in all surgical groups and was lower in the PSIB group than in the RYGB and JIB groups.Glucose tolerance and insulin sensitivity improved in all three surgical groups compared to the sham group,but the improvement appeared earliest in the PSIB group.At six weeks postsurgery,the PSIB group showed a reduction in alanine transaminase levels and maintained a normal lipid profile.CONCLUSION PSIB demonstrated excellent hypoglycemic effects in the early postoperative period,and had better efficacy than RYGB and JIB.展开更多
The incidence of saphenous vein graft aneurysms(SVGAs)after coronary artery bypass grafting(CABG)is approximately 0.07%;[1]however,the true incidence is likely underreported because of their frequent incidental discov...The incidence of saphenous vein graft aneurysms(SVGAs)after coronary artery bypass grafting(CABG)is approximately 0.07%;[1]however,the true incidence is likely underreported because of their frequent incidental discovery.[2]Due to its rarity,knowledge mainly comes from case reports and small case series,though some decision algorithms have been proposed in systematic reviews.展开更多
BACKGROUND Cardiopulmonary bypass(CPB)is a life-support technology widely used in surgery.Review articles reflect research advances in a certain topic or field within a certain period of time.AIM To perform a bibliome...BACKGROUND Cardiopulmonary bypass(CPB)is a life-support technology widely used in surgery.Review articles reflect research advances in a certain topic or field within a certain period of time.AIM To perform a bibliometric analysis of the review articles that focused on CPB for cardiovascular surgery.METHODS This study was based on a bibliometric analysis.Data were acquired from the Web of Science and basic bibliometric parameters were analyzed and visualized using VOSviewer and Excel.RESULTS We identified 141 review articles on CPB.Generally,the number of publications increased,and most of them were published in the 2010s(n=57,40.4%)and the 2020s(n=45,31.9%).There were 113(80.1%)narrative review articles,21(14.9%)meta-analysis studies and 7(5.0%)systematic review papers.The United States(n=25,17.7%)and China(n=21,14.9%)were the leading countries in terms of publication number.The articles were published in 98 different journals.The Journal of Cardiothoracic and Vascular Anesthesia(n=14,10.0%)and Perfusion-United Kingdom(n=11,7.8%)were preferred by the authors.The high-frequency keywords included inflammatory response,children,acute kidney injury,meta-analysis and off-pump,except for CPB and cardiac surgery.Inflammatory response had the closest relationship with CPB during cardiac surgery.The complications of CPB,including inflammatory response,kidney injury and ischemia,caught lots of concern.CONCLUSION The rapid increase of review papers shows that the research on CPB in cardiac surgery is increasingly being emphasized by scholars and clinical staff worldwide.Meta-analysis has been widely conducted to analyze clinical controversies and further guide clinical practice.Strategies to improving the outcomes of patients undergoing cardiac surgery with CPB are the hot spots in this field.展开更多
BACKGROUND The EuroSCORE II is a globally accepted tool for predicting mortality in patients undergoing cardiac surgery.However,the discriminative ability of this tool in non-European populations may be inadequate,lim...BACKGROUND The EuroSCORE II is a globally accepted tool for predicting mortality in patients undergoing cardiac surgery.However,the discriminative ability of this tool in non-European populations may be inadequate,limiting its use in other regions.AIM To evaluate the performance of EuroSCORE II in patients undergoing coronary artery bypass graft(CABG)surgery at a hospital in Bogotá,Colombia.METHODS An observational,analytical study of a retrospective cohort was designed.All patients admitted to Hospital Universitario Mayor Méderi who underwent CABG between December 2015 and May 2020 were included.In-hospital mortality was the primary outcome evaluated.Furthermore,the performance of EuroSCORE II was assessed in this population.RESULTS A total of 1009 patients were included[median age 66 years IQR=59-72,78.2%men].The overall in-hospital mortality was 5.5%(n=56).The median mortality predicted using EuroSCORE II was 1.29(IQR=0.92-2.11).Non-ST-segment elevation myocardial infarction was the most common preoperative diagnosis(54.1%),followed by ST-segment elevation myocardial infarction(19.1%)and unstable angina(14.3%).Urgent surgery was performed in 87.3%of the patients(n=881).Mortality rates in each group were as follows:Low risk 6.0%(n=45,observed-to-expected(O/E)ratio,5.6),moderate risk 3.0%(n=5,O/E ratio 1.17),high risk 5.0%(n=4,O/E ratio 0.94),and very high risk 7.6%(n=2,O/E ratio 0.71).The overall O/E ratio was 4.2.The area under the curve of EuroSCORE II was 0.55[95%confidence interval:0.48-0.63]CONCLUSION EuroSCORE II exhibited poor performance in this population owing to its low discriminative ability.This finding may be explained by the fact that the population comprised older individuals with higher ventricular function impairment.Moreover,unlike the population in which this tool was originally developed,most patients were not electively admitted for the surgery.展开更多
Annular pancreas is a rare congenital anomaly formed by a thin band of pancreatic tissue that encircles the descending duodenum and leads to partial or complete obstruction.Annular pancreas is estimated to occur in le...Annular pancreas is a rare congenital anomaly formed by a thin band of pancreatic tissue that encircles the descending duodenum and leads to partial or complete obstruction.Annular pancreas is estimated to occur in less than 5/100,000 people;however,the true incidence is unknown given that annular pancreas is frequently asymptomatic and only an incidental finding on cross-sectional imaging or autopsy examination.1,2 When symptomatic,patients typically present with abdominal pain,nausea and vomiting,or postprandial fullness due to gastric outlet obstruction.3 Other and less common presentations include peptic ulcer disease,biliary obstruction,or symptoms of acute or chronic pancreatitis.展开更多
BACKGROUND Laparoscopic one anastomosis gastric bypass(OAGB)has grown in popularity in recent years for the treatment of morbid obesity.Despite routine practice,the utility of early postoperative upper gastrointestina...BACKGROUND Laparoscopic one anastomosis gastric bypass(OAGB)has grown in popularity in recent years for the treatment of morbid obesity.Despite routine practice,the utility of early postoperative upper gastrointestinal(UGI)swallow studies to detect complications following OAGB has been questioned.AIM To evaluate the effectiveness and cost-efficiency of performing routine UGI studies on the first postoperative day(POD)after OAGB.METHODS A retrospective cohort analysis of a prospectively collected database was conducted to identify all consecutive patients who underwent OAGB between January 2019 and July 2022.Patient demographics,operative data,and postoperative complication rates were analyzed.Reports from all imaging studies were retrospectively reviewed,and complications were recorded.The institutional review board waived the requirement for informed consent.RESULTS A total of 385 patients were included.All patients had an iodine-based contrast swallow study on the first POD.Abnormal findings were observed in 4 patients(1%),none of which were correlated with postoperative complications.Two patients(0.5%)required reoperation due to complications although both had normal UGI study results.Sensitivity and positive predictive value of UGI studies for detecting complications were 0%,while specificity and negative predictive value were 99%and 98%,respectively.Based on hospital charges the overall cost of all the UGI swallow studies performed in our study was 95865 USD.CONCLUSION The study findings showed that performing routine UGI swallow studies on the first POD after laparoscopic OAGB is ineffective in detecting complications and is not cost effective.Normal UGI studies might mislead clinicians in the postoperative period and thus should be omitted in favor of close clinical monitoring.展开更多
BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous gra...BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous grafts,the safety of transfemoral access via direct graft puncture,especially when performed twice within a short period,remains unclear compared to alternative access methods.We present a case demonstrating the safety and efficacy of direct graft puncture for transfemoral access during balloon aortic valvuloplasty(BAV)and TAVR.CASE SUMMARY An 82-year-old man presented with dyspnea on exertion.Echocardiogram was significant for severe aortic stenosis.Following a heart team discussion,the patient was scheduled for a balloon valvuloplasty followed by staged TAVR.Based on pre-TAVR computed tomography angiogram,the aortobifemoral graft was deemed as an appropriate access site.Micropuncture needle was used to access the right femoral artery graft,and the sheath was upscaled to 10 Fr.He underwent successful intervention to ostial left anterior descending and left circumflex arteries,and BAV with 22 mm Vida BAV balloon.Hemostasis was achieved using Perclose.For TAVR,an 8 Fr sheath was inserted via the right femoral bypass graft.The arteriotomy was pre-closed with two Perclose ProGlides and access was upsized to 18F Gore DrySeal.A 5Fr sheath was used for left femoral bypass graft access.Patient underwent successful TAVR with 29 mm CoreValve.Hemostasis was successfully achieved using 2 Perclose for right access site and one Perclose for left side with no postoperative bleeding complications.CONCLUSION BAV and TAVR are feasible and safe through a direct puncture of the aortofemoral bypass graft with successful hemostasis using Perclose.展开更多
BACKGROUND Diabetes mellitus(DM)is linked to an earlier onset and heightened severity of urinary complications,particularly bladder dysfunction,which profoundly impacts patient quality of life.Overactive bladder(OAB)i...BACKGROUND Diabetes mellitus(DM)is linked to an earlier onset and heightened severity of urinary complications,particularly bladder dysfunction,which profoundly impacts patient quality of life.Overactive bladder(OAB)is a common storage disorder of the lower urinary tract and is characterized by urgency,frequency,and nocturia.Several factors contribute to bladder dysfunction in diabetic individuals,including changes in urothelial signaling,detrusor morphology,and central nervous system regulation.The transient receptor potential vanilloid type 1 channel,expressed by bladder urothelial cells,is upregulated in OAB and plays a crucial role in ATP release during bladder filling.This ATP release subsequently activates purinergic receptor P2X3,further exacerbating OAB symptoms.AIM To clarify the mechanism of Roux-en-Y gastric bypass(RYGB)metabolic surgery to improve OAB in type 2 DM(T2DM).METHODS The model of T2DM was induced by feeding a high-fat diet to mice for 16 weeks.After 16 weeks,sham operation and RYGB operation were performed.The related indexes of glucose metabolism were also detected to evaluate the therapeutic effect,and the recovery degree of bladder function and micturition behavior of mice was assessed by urodynamics and micturition spot analysis.RESULTS Compared with the normal mice in the sham group,T2DM mice had increased urine spot count,uncontrolled urination behavior,shortened urination interval,and reduced bladder capacity.Immunohistochemistry and immunofluorescence costaining showed that Transient receptor potential vanilloid type 1(TRPV1)and purinergic receptor P2X3 were both expressed in mouse bladder epithelial layer,and they had the same localization.In the bladder of T2DM mice,the mRNA and protein expression of TRPV1 and P2X3 were significantly increased.The ATP content in urine of T2DM mice was significantly higher than that of the sham group.After RYGB operation,the glucose metabolism index of the RYGB group was significantly improved compared with the OAB group.Comparing the results of urine spots,urodynamics,and histology,it was found that the function and morphological structure of the bladder in the RYGB group also recovered obviously.Compared with the OAB group,the expression of TRPV1 and P2X3 in the RYGB group was downregulated,and the level of inflammatory factors was significantly decreased.RYGB significantly decreased the content of ATP in urine and activated AMPK signaling.CONCLUSION RYGB downregulated the expression of TRPV1 by inhibiting inflammatory factors,thus inhibiting the enhancement of P2X3 by TRPV1.RYGB directly inhibited the activity of P2X3 by inhibiting ATP synthesis in the bladder epithelium to improve OAB.展开更多
Kataveni et al’s meta-analysis offers an important contemporary synthesis of randomized evidence comparing fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass grafting(CABG)in...Kataveni et al’s meta-analysis offers an important contemporary synthesis of randomized evidence comparing fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass grafting(CABG)in multivessel coronary artery disease(CAD).The pooled analysis found no significant difference in all-cause mortality or stroke,yet CABG was superior in reducing myocardial infarction,major adverse cardiac events,and repeat revascularization.These results confirm CABG’s durability even in the era of physiological lesion assessment and second-generation drug-eluting stents.From a traditional Chinese medicine(TCM)perspective,multivessel CAD corresponds to syndromes such as“heart vessel obstruction”and“Qi and blood stagnation”,in which local blockage is compounded by systemic imbalance.While revascularization addresses the structural impediment to blood flow,TCM approaches,including herbal medicine,acupuncture,and lifestyle therapy,aim to improve microcirculation,reduce inflammation,and support recovery,potentially mitigating recurrent ischemic events.This commentary argues that future research should integrate optimal revascularization strategies with rigorously evaluated TCM interventions to address both the anatomical and systemic dimensions of CAD and improve long-term patient outcomes.展开更多
The Front Variable Area Bypass Injector(FVABI)is a key to bypass ratio adjustment for a Variable Cycle Engine(VCE).In order to study the role of the FVABI with the Core Driven Fan Stage(CDFS)duct,firstly,the engine by...The Front Variable Area Bypass Injector(FVABI)is a key to bypass ratio adjustment for a Variable Cycle Engine(VCE).In order to study the role of the FVABI with the Core Driven Fan Stage(CDFS)duct,firstly,the engine bypass with the CDFS duct model and the equivalent engine bypass without the CDFS duct model are designed using the concept of a jet boundary line.By comparing the difference between airflow driving forces in the two engine bypass models,the quantitative effects of the injection from the CDFS duct on the mass flow rate of the engine bypass airflow are obtained under different combinations of pressure difference and area ratios.Then,the CDFS duct injection characteristic map is obtained through the typical experiment of the FVABI.Based on this map,the performance model of the FVABI is developed.Finally,the turbofan engine model with the Variable Inlet Guide Vane(VIGV),the First Variable Cycle Engine model(VCE1)with the CDFS duct and without the VIGV,and the Second Variable Cycle Engine model(VCE2)with the CDFS duct and VIGV are built.The gain on the engine bypass ratio adjustment range caused by the injection from the CDFS duct is clarified by comparing the three engine models.It is concluded that the bypass ratio adjustment range of the variable cycle engine with the FVABI is about twice that of the traditional turbofan engine.展开更多
Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce ...Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution was obtained in both cases, confirmed by endoscopic and functional esophageal assessment, together with symptoms questionnaire. Conclusion: The association of Latarjet nerves sectioning or truncal vagotomy with re-sleeve gastrectomy plus gastrointestinal anastomosis (antrojejunal), in a revision for a failed sleeve, can represent a technical approach, to reproduce RYGB results, without exclusions and with duodenum endoscopic accessibility maintenance. It maybe could be applied for primary surgeries. Additional studies are necessary to confirm this hypothesis.展开更多
OBJECTIVE:To evaluate the efficacy of electroacupuncture(EA)intervention on myocardial protection and postoperative rehabilitation in patients undergoing cardiac surgery with cardiopulmonary bypass(CPB).METHODS:Eight ...OBJECTIVE:To evaluate the efficacy of electroacupuncture(EA)intervention on myocardial protection and postoperative rehabilitation in patients undergoing cardiac surgery with cardiopulmonary bypass(CPB).METHODS:Eight databases,including Pub Med,Embase,the Cochrane Library,Web of Science,Chinese Bio Medical Literature Database,China National Knowledge Infrastructure Database,Wanfang Data,China Science and Technology Journal Database,and two clinical trial registries,were searched.All randomized controlled trials(RCTs)related to EA intervention in cardiac surgery with CPB were collected.Based on the inclusion and exclusion criteria,two researchers independently screened articles and extracted data.After the quality evaluation,RevMan 5.3 software was used for analysis.RESULTS:Fourteen RCTs involving 836 patients were included.Compared with the control treatment,EA significantly increased the incidence of cardiac automatic rebeat after aortic unclamping[relative risk(RR)=1.15,95%confidence interval(CI)(1.01,1.31),P<0.05;moderate].Twenty-four hours after aortic unclamping,EA significantly increased the superoxide dismutase[standardized mean difference(SMD)=0.96,95%CI(0.32,1.61),P<0.05;low],and interleukin(IL)-2[SMD=1.33,95%CI(0.19,2.47),P<0.05;very low]expression levels and decreased the malondialdehyde[SMD=-1.62,95%CI(-2.15,-1.09),P<0.05;moderate],tumour necrosis factor-α[SMD=-1.28,95%CI(-2.37,-0.19),P<0.05;moderate],and cardiac troponin I[SMD=-1.09,95%CI(-1.85,-0.32),P<0.05;low]expression levels as well as the inotrope scores[SMD=-0.77,95%CI(-1.22,-0.31),P<0.05;high].There was no difference in IL-6 and IL-10 expression levels.The amount of intraoperative sedative[SMD=-0.31,95%CI(-0.54,-0.09),P<0.05;moderate]and opioid analgesic[SMD=-0.96,95%CI(-1.53,-0.38),P<0.05;low]medication was significantly lower in the EA group than in the control group.Moreover,the postoperative tracheal intubation time[SMD=-0.92,95%CI(-1.40,-0.45),P<0.05;low]and intensive care unit stay[SMD=-1.71,95%CI(-3.06,-0.36),P<0.05;low]were significantly shorter in the EA group than in the control group.There were no differences in the time to get out of bed for the first time,total days of antibiotic use after surgery,or postoperative hospital stay.No adverse reactions related to EA were reported in any of the included studies.CONCLUSIONS:In cardiac surgery with CPB,EA may be a safe and effective strategy to reduce myocardial ischaemia-reperfusion injury and speed up the recovery of patients after surgery.These findings must be interpreted with caution,as most of the evidence was of low or moderate quality.More RCTs with larger sample sizes and higher quality are needed to provide more convincing evidence.展开更多
The Bypass Dual Throat Nozzle(BDTN)is a novel fluidic Thrust Vectoring(TV)nozzle,it switches to TV state by opening the valve in the bypass.To greatly manipulate the BDTN,the dynamic characteristics in the TV starting...The Bypass Dual Throat Nozzle(BDTN)is a novel fluidic Thrust Vectoring(TV)nozzle,it switches to TV state by opening the valve in the bypass.To greatly manipulate the BDTN,the dynamic characteristics in the TV starting process should be analyzed.This paper conducts numerical simulations to grasp the variation processes of performances and the flow field evolution of BDTN and Dual Throat Nozzle(DTN).The dynamic responses of TV starting in typical DTN models are investigated at first.Then,the TV starting processes of BDTN in different Nozzle Pressure Ratio(NPR)conditions are simulated,and the valve opening durations(T)are also considered.Before the expected TV direction is achieved in the DTN,the jet is deflected to the opposite direction at the beginning of the dynamic process,which is called the reverse TV phenomenon.However,this phenomenon disappears in the BDTN.The larger injection width of DTN intensifies unsteady oscillations,and the reverse TV phenomenon is strengthened.In the BDTN,T determines the delay degree of performance variations compared to the static results,which is called hysteresis effect.At NPR=10,the hysteresis affects the final stable performance of BDTN.This study analyses the dynamic characteristics in DTN and BDTN,laying a foundation for further design of nozzles and control strategies.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM)is often accompanied by impaired glucose utilization in the brain,leading to oxidative stress,neuronal cell injury and inflammation.Previous studies have shown that duodenal je...BACKGROUND Type 2 diabetes mellitus(T2DM)is often accompanied by impaired glucose utilization in the brain,leading to oxidative stress,neuronal cell injury and inflammation.Previous studies have shown that duodenal jejunal bypass(DJB)surgery significantly improves brain glucose metabolism in T2DM rats,the role and the metabolism of DJB in improving brain oxidative stress and inflammation condition in T2DM rats remain unclear.AIM To investigate the role and metabolism of DJB in improving hypothalamic oxidative stress and inflammation condition in T2DM rats.METHODS A T2DM rat model was induced via a high-glucose and high-fat diet,combined with a low-dose streptozotocin injection.T2DM rats were divided into DJB operation and Sham operation groups.DJB surgical intervention was carried out on T2DM rats.The differential expression of hypothalamic proteins was analyzed using quantitative proteomics analysis.Proteins related to oxidative stress,inflammation,and neuronal injury in the hypothalamus of T2DM rats were analyzed by flow cytometry,quantitative real-time PCR,Western blotting,and immunofluorescence.RESULTS Quantitative proteomics analysis showed significant differences in proteins related to oxidative stress,inflammation,and neuronal injury in the hypothalamus of rats with T2DM-DJB after DJB surgery,compared to the T2DM-Sham groups of rats.Oxidative stress-related proteins(glucagon-like peptide 1 receptor,Nrf2,and HO-1)were significantly increased(P<0.05)in the hypothalamus of rats with T2DM after DJB surgery.DJB surgery significantly reduced(P<0.05)hypothalamic inflammation in T2DM rats by inhibiting the activation of NF-κB and decreasing the expression of interleukin(IL)-1βand IL-6.DJB surgery significantly reduced(P<0.05)the expression of factors related to neuronal injury(glial fibrillary acidic protein and Caspase-3)in the hypothalamus of T2DM rats and upregulated(P<0.05)the expression of neuroprotective factors(C-fos,Ki67,Bcl-2,and BDNF),thereby reducing hypothalamic injury in T2DM rats.CONCLUSION DJB surgery improve oxidative stress and inflammation in the hypothalamus of T2DM rats and reduce neuronal cell injury by activating the glucagon-like peptide 1 receptor-mediated Nrf2/HO-1 signaling pathway.展开更多
BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to ...BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to patients'unhealthy lifestyles and dietary habits,inadequate understanding of the disease,and poor disease management compliance.Thus,searching for more targeted nursing intervention models that can enhance patients'self-management abilities and reduce the risk of readmission after CABG surgery is significant.AIM To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.METHODS A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample.The patients were divided into two groups using an odd-even number grouping method.The control group received routine nursing care,while the case management group received specialized nursing outpatient case management.The differences in psychological status,adherence to medical treatment,self-care ability,knowledge mastery,quality of life scores,and the occurrence rate of MACE were compared between the two groups.RESULTS After the intervention,the case management group had lower scores on the selfrating depression scale and self-rating anxiety scale and lower MACE rate,as well as higher scores for adherence to a healthy diet,medication adherence,good lifestyle habits,regular exercise,and timely follow-up,higher scores on the Coronary Heart Disease Self-Management Scale,higher scores for managing adverse habits,symptoms,emotional cognition,emergency response,disease knowledge,general lifestyle,and treatment adherence,higher scores for understanding coronary heart disease,recognizing the importance of medication adherence,understanding selfcare points after CABG surgery,and being aware of post-CABG precautions,higher scores for physical well-being,disease condition,general health,social-psychological well-being,and work-related aspects(P<0.05).CONCLUSION Specialized nursing outpatient case management can enhance patient adherence to medical treatment,knowledge mastery,psychological well-being,and overall quality of life in patients after CABG surgery.展开更多
Since its approval by the Food and Drug Administration in 2011,transcatheter aortic valve implantation(TAVI)has rapidly evolved to become the preferred ultimate intervention for high-and intermediate-risk patients wit...Since its approval by the Food and Drug Administration in 2011,transcatheter aortic valve implantation(TAVI)has rapidly evolved to become the preferred ultimate intervention for high-and intermediate-risk patients with severe symptomatic aortic stenosis.[1]This is due to its non-open-heart,minimally invasive and off-pump advantages.[1]Nevertheless,as a result of the frequent frailty and comorbidity profiles of patients undergoing TAVI,such as advanced cardiac dysfunction and extensive coronary artery disease,or technically difficult anatomy for the procedure itself,[2-4]it is common for these patients to experience critical circulatory collapse perioperatively.These factors are linked to elevated mortality rates,necessitating suitable mechanical circulatory support(MCS)to reverse the disastrous situations.[5]展开更多
Small-break superposed station blackout(SBO)accidents are the basic design accidents of nuclear power plants.Under the condition of a small break in the cold leg,SBO further increases the severity of the accident,and ...Small-break superposed station blackout(SBO)accidents are the basic design accidents of nuclear power plants.Under the condition of a small break in the cold leg,SBO further increases the severity of the accident,and the steam bypass discharg-ing system(GCT)in the second circuit can play an important role in guaranteeing core safety.To explore the influence of the GCT on the thermal-hydraulic characteristics of the primary circuit,RELAP5 software was used to establish a numerical model based on a typical pressurized water reactor nuclear power plant.Five different small breaks in the cold-leg super-posed SBO were selected,and the impact of the GCT operation on the transient response characteristics of the primary and secondary circuit systems was analyzed.The results show that the GCT plays an indispensable role in core heat removal during an accident;otherwise,core safety cannot be guaranteed.The GCT was used in conjunction with the primary safety injection system during the placement process.When the break diameter was greater than a certain critical value,the core cooling rate could not be guaranteed to be less than 100 K/h;however,the core remained in a safe state.展开更多
The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to ass...The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to assess the effect of sevoflurane on cardiac function.Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia(AS)group and a propofolbased total intravenous anesthesia(AA)group.The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T1(after harvesting all grafts and before coronary anastomosis)and T_(2)(30 min after completing all coronary anastomoses)(P<0.05).Moreover,strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group,compared with the AA group at both T1 and T_(2)(P<0.01).The flow of the left internal mammary artery-left anterior descending artery graft was superior,and the postoperative concentration of troponin T decreased rapidly in the AS group,compared with the AA group(P<0.05).Compared with total intravenous anesthesia,sevoflurane resulted in a significantly higher global longitudinal strain,stroke volume,and cardiac output.Sevoflurane also led to an amelioration in the condition of the arterial graft.Furthermore,sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value.The findings need to be replicated in larger studies.展开更多
The mixing effectiveness of the airflow between the inner and outer bypass inlets of a Rear Variable-Area Bypass Injector(RVABI)is the key to the afterburner performance of variable cycle engines.This paper describes ...The mixing effectiveness of the airflow between the inner and outer bypass inlets of a Rear Variable-Area Bypass Injector(RVABI)is the key to the afterburner performance of variable cycle engines.This paper describes an optimized RVABI design based on an alternating area regulator to improve the velocity/temperature uniformity of the incoming flow at the afterburner.Compared with a classical RVABI,numerical simulations show that the proposed alternating RVABI performs better in terms of thermal mixing efficiency and total pressure loss in different variable cycle engine modes.Both the increasing air contact area between the inner and outer bypass of alternating structure RVABI,and a larger streamwise vortex in the inner bypass inlet due to the proposed alternating lobe structure in the RVABI contribute to the significantly increase of mixing effectiveness.Besides,the alternating regulator induces strong streamwise vortex,which helps to improve the airflow mixing with its vortex-induced velocity.The interaction between the streamwise vortex and azimuthal vortex further promises the velocity/temperature uniformity after the RVABI.With the increase of alternating lobe’s height ratio,the covering area of the streamwise vortex and the azimuthal vortex is enlarged,which further enhances the thermal mixing efficiency of the RVABI.This design gives an insight into the future design and optimization of RVABI.展开更多
基金Supported by National Natural Science Foundation of China,No.82360168 and No.81960154Natural Science Foundation of Jiangxi Province,No.20212BAB206020the Foundation of Health Commission of Jiangxi Province,No.SKJP220225830.
文摘BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their glycemic control outcomes.We hypothesize that proximal small intestinal bypass(PSIB)is superior in blood glucose reduction over Roux-en-Y gastric bypass(RYGB)and jejunoileal bypass(JIB).AIM To compare the effectiveness of PSIB,RYGB,and JIB in lowering blood glucose.METHODS Rats with streptozotocin-induced diabetes were randomly divided into PSIB,RYGB,JIB,and sham-operated groups.Body weight,food intake,fasting blood glucose level,oral glucose tolerance test,insulin tolerance test,liver enzymes,and blood lipids were measured.RESULTS Postoperatively,only the JIB group had a lower body weight compared to the sham group.The food intake of the rats in all three surgical groups was significantly less than that in the sham group.Fasting blood glucose was reduced in all surgical groups and was lower in the PSIB group than in the RYGB and JIB groups.Glucose tolerance and insulin sensitivity improved in all three surgical groups compared to the sham group,but the improvement appeared earliest in the PSIB group.At six weeks postsurgery,the PSIB group showed a reduction in alanine transaminase levels and maintained a normal lipid profile.CONCLUSION PSIB demonstrated excellent hypoglycemic effects in the early postoperative period,and had better efficacy than RYGB and JIB.
文摘The incidence of saphenous vein graft aneurysms(SVGAs)after coronary artery bypass grafting(CABG)is approximately 0.07%;[1]however,the true incidence is likely underreported because of their frequent incidental discovery.[2]Due to its rarity,knowledge mainly comes from case reports and small case series,though some decision algorithms have been proposed in systematic reviews.
文摘BACKGROUND Cardiopulmonary bypass(CPB)is a life-support technology widely used in surgery.Review articles reflect research advances in a certain topic or field within a certain period of time.AIM To perform a bibliometric analysis of the review articles that focused on CPB for cardiovascular surgery.METHODS This study was based on a bibliometric analysis.Data were acquired from the Web of Science and basic bibliometric parameters were analyzed and visualized using VOSviewer and Excel.RESULTS We identified 141 review articles on CPB.Generally,the number of publications increased,and most of them were published in the 2010s(n=57,40.4%)and the 2020s(n=45,31.9%).There were 113(80.1%)narrative review articles,21(14.9%)meta-analysis studies and 7(5.0%)systematic review papers.The United States(n=25,17.7%)and China(n=21,14.9%)were the leading countries in terms of publication number.The articles were published in 98 different journals.The Journal of Cardiothoracic and Vascular Anesthesia(n=14,10.0%)and Perfusion-United Kingdom(n=11,7.8%)were preferred by the authors.The high-frequency keywords included inflammatory response,children,acute kidney injury,meta-analysis and off-pump,except for CPB and cardiac surgery.Inflammatory response had the closest relationship with CPB during cardiac surgery.The complications of CPB,including inflammatory response,kidney injury and ischemia,caught lots of concern.CONCLUSION The rapid increase of review papers shows that the research on CPB in cardiac surgery is increasingly being emphasized by scholars and clinical staff worldwide.Meta-analysis has been widely conducted to analyze clinical controversies and further guide clinical practice.Strategies to improving the outcomes of patients undergoing cardiac surgery with CPB are the hot spots in this field.
文摘BACKGROUND The EuroSCORE II is a globally accepted tool for predicting mortality in patients undergoing cardiac surgery.However,the discriminative ability of this tool in non-European populations may be inadequate,limiting its use in other regions.AIM To evaluate the performance of EuroSCORE II in patients undergoing coronary artery bypass graft(CABG)surgery at a hospital in Bogotá,Colombia.METHODS An observational,analytical study of a retrospective cohort was designed.All patients admitted to Hospital Universitario Mayor Méderi who underwent CABG between December 2015 and May 2020 were included.In-hospital mortality was the primary outcome evaluated.Furthermore,the performance of EuroSCORE II was assessed in this population.RESULTS A total of 1009 patients were included[median age 66 years IQR=59-72,78.2%men].The overall in-hospital mortality was 5.5%(n=56).The median mortality predicted using EuroSCORE II was 1.29(IQR=0.92-2.11).Non-ST-segment elevation myocardial infarction was the most common preoperative diagnosis(54.1%),followed by ST-segment elevation myocardial infarction(19.1%)and unstable angina(14.3%).Urgent surgery was performed in 87.3%of the patients(n=881).Mortality rates in each group were as follows:Low risk 6.0%(n=45,observed-to-expected(O/E)ratio,5.6),moderate risk 3.0%(n=5,O/E ratio 1.17),high risk 5.0%(n=4,O/E ratio 0.94),and very high risk 7.6%(n=2,O/E ratio 0.71).The overall O/E ratio was 4.2.The area under the curve of EuroSCORE II was 0.55[95%confidence interval:0.48-0.63]CONCLUSION EuroSCORE II exhibited poor performance in this population owing to its low discriminative ability.This finding may be explained by the fact that the population comprised older individuals with higher ventricular function impairment.Moreover,unlike the population in which this tool was originally developed,most patients were not electively admitted for the surgery.
基金supported by the National Cancer Institute(T32,CA 236621-5).
文摘Annular pancreas is a rare congenital anomaly formed by a thin band of pancreatic tissue that encircles the descending duodenum and leads to partial or complete obstruction.Annular pancreas is estimated to occur in less than 5/100,000 people;however,the true incidence is unknown given that annular pancreas is frequently asymptomatic and only an incidental finding on cross-sectional imaging or autopsy examination.1,2 When symptomatic,patients typically present with abdominal pain,nausea and vomiting,or postprandial fullness due to gastric outlet obstruction.3 Other and less common presentations include peptic ulcer disease,biliary obstruction,or symptoms of acute or chronic pancreatitis.
文摘BACKGROUND Laparoscopic one anastomosis gastric bypass(OAGB)has grown in popularity in recent years for the treatment of morbid obesity.Despite routine practice,the utility of early postoperative upper gastrointestinal(UGI)swallow studies to detect complications following OAGB has been questioned.AIM To evaluate the effectiveness and cost-efficiency of performing routine UGI studies on the first postoperative day(POD)after OAGB.METHODS A retrospective cohort analysis of a prospectively collected database was conducted to identify all consecutive patients who underwent OAGB between January 2019 and July 2022.Patient demographics,operative data,and postoperative complication rates were analyzed.Reports from all imaging studies were retrospectively reviewed,and complications were recorded.The institutional review board waived the requirement for informed consent.RESULTS A total of 385 patients were included.All patients had an iodine-based contrast swallow study on the first POD.Abnormal findings were observed in 4 patients(1%),none of which were correlated with postoperative complications.Two patients(0.5%)required reoperation due to complications although both had normal UGI study results.Sensitivity and positive predictive value of UGI studies for detecting complications were 0%,while specificity and negative predictive value were 99%and 98%,respectively.Based on hospital charges the overall cost of all the UGI swallow studies performed in our study was 95865 USD.CONCLUSION The study findings showed that performing routine UGI swallow studies on the first POD after laparoscopic OAGB is ineffective in detecting complications and is not cost effective.Normal UGI studies might mislead clinicians in the postoperative period and thus should be omitted in favor of close clinical monitoring.
文摘BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous grafts,the safety of transfemoral access via direct graft puncture,especially when performed twice within a short period,remains unclear compared to alternative access methods.We present a case demonstrating the safety and efficacy of direct graft puncture for transfemoral access during balloon aortic valvuloplasty(BAV)and TAVR.CASE SUMMARY An 82-year-old man presented with dyspnea on exertion.Echocardiogram was significant for severe aortic stenosis.Following a heart team discussion,the patient was scheduled for a balloon valvuloplasty followed by staged TAVR.Based on pre-TAVR computed tomography angiogram,the aortobifemoral graft was deemed as an appropriate access site.Micropuncture needle was used to access the right femoral artery graft,and the sheath was upscaled to 10 Fr.He underwent successful intervention to ostial left anterior descending and left circumflex arteries,and BAV with 22 mm Vida BAV balloon.Hemostasis was achieved using Perclose.For TAVR,an 8 Fr sheath was inserted via the right femoral bypass graft.The arteriotomy was pre-closed with two Perclose ProGlides and access was upsized to 18F Gore DrySeal.A 5Fr sheath was used for left femoral bypass graft access.Patient underwent successful TAVR with 29 mm CoreValve.Hemostasis was successfully achieved using 2 Perclose for right access site and one Perclose for left side with no postoperative bleeding complications.CONCLUSION BAV and TAVR are feasible and safe through a direct puncture of the aortofemoral bypass graft with successful hemostasis using Perclose.
基金Supported by National Natural Science Foundation of China,No.81860268 and No.82201000Ningxia Natural Science Foundation,No.2021AAC02025+3 种基金Ningxia Science and Technology Innovation Leading Talent Training ProjectNo.2020GKLRLX06 and No.2020GKLRLX11Ningxia Medical University Research Project,No.XJKF240315Ningxia Key Research and Development Project,No.2023BEG03021 and No.2021BEB04034.
文摘BACKGROUND Diabetes mellitus(DM)is linked to an earlier onset and heightened severity of urinary complications,particularly bladder dysfunction,which profoundly impacts patient quality of life.Overactive bladder(OAB)is a common storage disorder of the lower urinary tract and is characterized by urgency,frequency,and nocturia.Several factors contribute to bladder dysfunction in diabetic individuals,including changes in urothelial signaling,detrusor morphology,and central nervous system regulation.The transient receptor potential vanilloid type 1 channel,expressed by bladder urothelial cells,is upregulated in OAB and plays a crucial role in ATP release during bladder filling.This ATP release subsequently activates purinergic receptor P2X3,further exacerbating OAB symptoms.AIM To clarify the mechanism of Roux-en-Y gastric bypass(RYGB)metabolic surgery to improve OAB in type 2 DM(T2DM).METHODS The model of T2DM was induced by feeding a high-fat diet to mice for 16 weeks.After 16 weeks,sham operation and RYGB operation were performed.The related indexes of glucose metabolism were also detected to evaluate the therapeutic effect,and the recovery degree of bladder function and micturition behavior of mice was assessed by urodynamics and micturition spot analysis.RESULTS Compared with the normal mice in the sham group,T2DM mice had increased urine spot count,uncontrolled urination behavior,shortened urination interval,and reduced bladder capacity.Immunohistochemistry and immunofluorescence costaining showed that Transient receptor potential vanilloid type 1(TRPV1)and purinergic receptor P2X3 were both expressed in mouse bladder epithelial layer,and they had the same localization.In the bladder of T2DM mice,the mRNA and protein expression of TRPV1 and P2X3 were significantly increased.The ATP content in urine of T2DM mice was significantly higher than that of the sham group.After RYGB operation,the glucose metabolism index of the RYGB group was significantly improved compared with the OAB group.Comparing the results of urine spots,urodynamics,and histology,it was found that the function and morphological structure of the bladder in the RYGB group also recovered obviously.Compared with the OAB group,the expression of TRPV1 and P2X3 in the RYGB group was downregulated,and the level of inflammatory factors was significantly decreased.RYGB significantly decreased the content of ATP in urine and activated AMPK signaling.CONCLUSION RYGB downregulated the expression of TRPV1 by inhibiting inflammatory factors,thus inhibiting the enhancement of P2X3 by TRPV1.RYGB directly inhibited the activity of P2X3 by inhibiting ATP synthesis in the bladder epithelium to improve OAB.
文摘Kataveni et al’s meta-analysis offers an important contemporary synthesis of randomized evidence comparing fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass grafting(CABG)in multivessel coronary artery disease(CAD).The pooled analysis found no significant difference in all-cause mortality or stroke,yet CABG was superior in reducing myocardial infarction,major adverse cardiac events,and repeat revascularization.These results confirm CABG’s durability even in the era of physiological lesion assessment and second-generation drug-eluting stents.From a traditional Chinese medicine(TCM)perspective,multivessel CAD corresponds to syndromes such as“heart vessel obstruction”and“Qi and blood stagnation”,in which local blockage is compounded by systemic imbalance.While revascularization addresses the structural impediment to blood flow,TCM approaches,including herbal medicine,acupuncture,and lifestyle therapy,aim to improve microcirculation,reduce inflammation,and support recovery,potentially mitigating recurrent ischemic events.This commentary argues that future research should integrate optimal revascularization strategies with rigorously evaluated TCM interventions to address both the anatomical and systemic dimensions of CAD and improve long-term patient outcomes.
基金supported by the National Science and Technology Major Project of China (No. J2019-II-00070027)the China Academy of Launch Vehicle Technology Funding (No. CALT2023-07)
文摘The Front Variable Area Bypass Injector(FVABI)is a key to bypass ratio adjustment for a Variable Cycle Engine(VCE).In order to study the role of the FVABI with the Core Driven Fan Stage(CDFS)duct,firstly,the engine bypass with the CDFS duct model and the equivalent engine bypass without the CDFS duct model are designed using the concept of a jet boundary line.By comparing the difference between airflow driving forces in the two engine bypass models,the quantitative effects of the injection from the CDFS duct on the mass flow rate of the engine bypass airflow are obtained under different combinations of pressure difference and area ratios.Then,the CDFS duct injection characteristic map is obtained through the typical experiment of the FVABI.Based on this map,the performance model of the FVABI is developed.Finally,the turbofan engine model with the Variable Inlet Guide Vane(VIGV),the First Variable Cycle Engine model(VCE1)with the CDFS duct and without the VIGV,and the Second Variable Cycle Engine model(VCE2)with the CDFS duct and VIGV are built.The gain on the engine bypass ratio adjustment range caused by the injection from the CDFS duct is clarified by comparing the three engine models.It is concluded that the bypass ratio adjustment range of the variable cycle engine with the FVABI is about twice that of the traditional turbofan engine.
文摘Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution was obtained in both cases, confirmed by endoscopic and functional esophageal assessment, together with symptoms questionnaire. Conclusion: The association of Latarjet nerves sectioning or truncal vagotomy with re-sleeve gastrectomy plus gastrointestinal anastomosis (antrojejunal), in a revision for a failed sleeve, can represent a technical approach, to reproduce RYGB results, without exclusions and with duodenum endoscopic accessibility maintenance. It maybe could be applied for primary surgeries. Additional studies are necessary to confirm this hypothesis.
基金the National Natural Science Foundation of China:Mechanism of Protective Effect of Acupoint Preconditioning on Myocardial Mitochondria and Energy Metabolism in Rats with Bupivacaine Toxicity(No.81760892)。
文摘OBJECTIVE:To evaluate the efficacy of electroacupuncture(EA)intervention on myocardial protection and postoperative rehabilitation in patients undergoing cardiac surgery with cardiopulmonary bypass(CPB).METHODS:Eight databases,including Pub Med,Embase,the Cochrane Library,Web of Science,Chinese Bio Medical Literature Database,China National Knowledge Infrastructure Database,Wanfang Data,China Science and Technology Journal Database,and two clinical trial registries,were searched.All randomized controlled trials(RCTs)related to EA intervention in cardiac surgery with CPB were collected.Based on the inclusion and exclusion criteria,two researchers independently screened articles and extracted data.After the quality evaluation,RevMan 5.3 software was used for analysis.RESULTS:Fourteen RCTs involving 836 patients were included.Compared with the control treatment,EA significantly increased the incidence of cardiac automatic rebeat after aortic unclamping[relative risk(RR)=1.15,95%confidence interval(CI)(1.01,1.31),P<0.05;moderate].Twenty-four hours after aortic unclamping,EA significantly increased the superoxide dismutase[standardized mean difference(SMD)=0.96,95%CI(0.32,1.61),P<0.05;low],and interleukin(IL)-2[SMD=1.33,95%CI(0.19,2.47),P<0.05;very low]expression levels and decreased the malondialdehyde[SMD=-1.62,95%CI(-2.15,-1.09),P<0.05;moderate],tumour necrosis factor-α[SMD=-1.28,95%CI(-2.37,-0.19),P<0.05;moderate],and cardiac troponin I[SMD=-1.09,95%CI(-1.85,-0.32),P<0.05;low]expression levels as well as the inotrope scores[SMD=-0.77,95%CI(-1.22,-0.31),P<0.05;high].There was no difference in IL-6 and IL-10 expression levels.The amount of intraoperative sedative[SMD=-0.31,95%CI(-0.54,-0.09),P<0.05;moderate]and opioid analgesic[SMD=-0.96,95%CI(-1.53,-0.38),P<0.05;low]medication was significantly lower in the EA group than in the control group.Moreover,the postoperative tracheal intubation time[SMD=-0.92,95%CI(-1.40,-0.45),P<0.05;low]and intensive care unit stay[SMD=-1.71,95%CI(-3.06,-0.36),P<0.05;low]were significantly shorter in the EA group than in the control group.There were no differences in the time to get out of bed for the first time,total days of antibiotic use after surgery,or postoperative hospital stay.No adverse reactions related to EA were reported in any of the included studies.CONCLUSIONS:In cardiac surgery with CPB,EA may be a safe and effective strategy to reduce myocardial ischaemia-reperfusion injury and speed up the recovery of patients after surgery.These findings must be interpreted with caution,as most of the evidence was of low or moderate quality.More RCTs with larger sample sizes and higher quality are needed to provide more convincing evidence.
基金the continued support of Key Laboratory of Inlet and Exhaust system Technology (Nanjing University of Aeronautics and Astronautics), ChinaMinistry of Education, National Science and Technology Major Project of China (Nos. 2017-V-0004-0054, 2019-II-0007-0027, Y2022II-0005-0008)+6 种基金Defense Industrial Technology Development Program of China (No. JCKY2019605D001)Advanced Jet Propulsion Creativity Center of AEAC of China (No. HKCX2020-02-011)China Postdoctoral Science Foundation (No. 2022M721598)Jiangsu Funding Program for Excellent Postdoctoral Talent of China (No. 2022ZB214)the Youth Fund Project of Natural Science Foundation of Jiangsu Province of China (No. BK20230891)the National Natural Science Foundation of China (No. 12332018)Science Center for Gas Turbine Project, China (P2022-B-I-006-001) and some other related foundations
文摘The Bypass Dual Throat Nozzle(BDTN)is a novel fluidic Thrust Vectoring(TV)nozzle,it switches to TV state by opening the valve in the bypass.To greatly manipulate the BDTN,the dynamic characteristics in the TV starting process should be analyzed.This paper conducts numerical simulations to grasp the variation processes of performances and the flow field evolution of BDTN and Dual Throat Nozzle(DTN).The dynamic responses of TV starting in typical DTN models are investigated at first.Then,the TV starting processes of BDTN in different Nozzle Pressure Ratio(NPR)conditions are simulated,and the valve opening durations(T)are also considered.Before the expected TV direction is achieved in the DTN,the jet is deflected to the opposite direction at the beginning of the dynamic process,which is called the reverse TV phenomenon.However,this phenomenon disappears in the BDTN.The larger injection width of DTN intensifies unsteady oscillations,and the reverse TV phenomenon is strengthened.In the BDTN,T determines the delay degree of performance variations compared to the static results,which is called hysteresis effect.At NPR=10,the hysteresis affects the final stable performance of BDTN.This study analyses the dynamic characteristics in DTN and BDTN,laying a foundation for further design of nozzles and control strategies.
基金Supported by the Natural Science Foundation of China,No.82070856the Science and Technology Development Plan of Shandong Medical and Health Science,No.202102040075+1 种基金Scientific Research Plan of Weifang Health Commission,No.WFWSJK-2022-010 and No.WFWSJK-2022-008Weifang Science and Technology Development Plan,No.2021YX071 and No.2021YX070.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM)is often accompanied by impaired glucose utilization in the brain,leading to oxidative stress,neuronal cell injury and inflammation.Previous studies have shown that duodenal jejunal bypass(DJB)surgery significantly improves brain glucose metabolism in T2DM rats,the role and the metabolism of DJB in improving brain oxidative stress and inflammation condition in T2DM rats remain unclear.AIM To investigate the role and metabolism of DJB in improving hypothalamic oxidative stress and inflammation condition in T2DM rats.METHODS A T2DM rat model was induced via a high-glucose and high-fat diet,combined with a low-dose streptozotocin injection.T2DM rats were divided into DJB operation and Sham operation groups.DJB surgical intervention was carried out on T2DM rats.The differential expression of hypothalamic proteins was analyzed using quantitative proteomics analysis.Proteins related to oxidative stress,inflammation,and neuronal injury in the hypothalamus of T2DM rats were analyzed by flow cytometry,quantitative real-time PCR,Western blotting,and immunofluorescence.RESULTS Quantitative proteomics analysis showed significant differences in proteins related to oxidative stress,inflammation,and neuronal injury in the hypothalamus of rats with T2DM-DJB after DJB surgery,compared to the T2DM-Sham groups of rats.Oxidative stress-related proteins(glucagon-like peptide 1 receptor,Nrf2,and HO-1)were significantly increased(P<0.05)in the hypothalamus of rats with T2DM after DJB surgery.DJB surgery significantly reduced(P<0.05)hypothalamic inflammation in T2DM rats by inhibiting the activation of NF-κB and decreasing the expression of interleukin(IL)-1βand IL-6.DJB surgery significantly reduced(P<0.05)the expression of factors related to neuronal injury(glial fibrillary acidic protein and Caspase-3)in the hypothalamus of T2DM rats and upregulated(P<0.05)the expression of neuroprotective factors(C-fos,Ki67,Bcl-2,and BDNF),thereby reducing hypothalamic injury in T2DM rats.CONCLUSION DJB surgery improve oxidative stress and inflammation in the hypothalamus of T2DM rats and reduce neuronal cell injury by activating the glucagon-like peptide 1 receptor-mediated Nrf2/HO-1 signaling pathway.
文摘BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to patients'unhealthy lifestyles and dietary habits,inadequate understanding of the disease,and poor disease management compliance.Thus,searching for more targeted nursing intervention models that can enhance patients'self-management abilities and reduce the risk of readmission after CABG surgery is significant.AIM To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.METHODS A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample.The patients were divided into two groups using an odd-even number grouping method.The control group received routine nursing care,while the case management group received specialized nursing outpatient case management.The differences in psychological status,adherence to medical treatment,self-care ability,knowledge mastery,quality of life scores,and the occurrence rate of MACE were compared between the two groups.RESULTS After the intervention,the case management group had lower scores on the selfrating depression scale and self-rating anxiety scale and lower MACE rate,as well as higher scores for adherence to a healthy diet,medication adherence,good lifestyle habits,regular exercise,and timely follow-up,higher scores on the Coronary Heart Disease Self-Management Scale,higher scores for managing adverse habits,symptoms,emotional cognition,emergency response,disease knowledge,general lifestyle,and treatment adherence,higher scores for understanding coronary heart disease,recognizing the importance of medication adherence,understanding selfcare points after CABG surgery,and being aware of post-CABG precautions,higher scores for physical well-being,disease condition,general health,social-psychological well-being,and work-related aspects(P<0.05).CONCLUSION Specialized nursing outpatient case management can enhance patient adherence to medical treatment,knowledge mastery,psychological well-being,and overall quality of life in patients after CABG surgery.
基金supported by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support(ZYLX202111,to XTH)Beijing Hospitals Authority“Ascent Plan”(FDL20190601,to XTH)+2 种基金Young Elite Scientists Sponsorship Program by CAST(2022QNRC001,to LSW)National Natural Science Foundation of China(82200433,to LSW)Beijing Hospitals Authority Youth Programme(QML20230602,to LSW).
文摘Since its approval by the Food and Drug Administration in 2011,transcatheter aortic valve implantation(TAVI)has rapidly evolved to become the preferred ultimate intervention for high-and intermediate-risk patients with severe symptomatic aortic stenosis.[1]This is due to its non-open-heart,minimally invasive and off-pump advantages.[1]Nevertheless,as a result of the frequent frailty and comorbidity profiles of patients undergoing TAVI,such as advanced cardiac dysfunction and extensive coronary artery disease,or technically difficult anatomy for the procedure itself,[2-4]it is common for these patients to experience critical circulatory collapse perioperatively.These factors are linked to elevated mortality rates,necessitating suitable mechanical circulatory support(MCS)to reverse the disastrous situations.[5]
文摘Small-break superposed station blackout(SBO)accidents are the basic design accidents of nuclear power plants.Under the condition of a small break in the cold leg,SBO further increases the severity of the accident,and the steam bypass discharg-ing system(GCT)in the second circuit can play an important role in guaranteeing core safety.To explore the influence of the GCT on the thermal-hydraulic characteristics of the primary circuit,RELAP5 software was used to establish a numerical model based on a typical pressurized water reactor nuclear power plant.Five different small breaks in the cold-leg super-posed SBO were selected,and the impact of the GCT operation on the transient response characteristics of the primary and secondary circuit systems was analyzed.The results show that the GCT plays an indispensable role in core heat removal during an accident;otherwise,core safety cannot be guaranteed.The GCT was used in conjunction with the primary safety injection system during the placement process.When the break diameter was greater than a certain critical value,the core cooling rate could not be guaranteed to be less than 100 K/h;however,the core remained in a safe state.
基金supported by Jiangsu Province Hospital(the First Affiliated Hospital of Nanjing Medical University)Clinical Capacity Enhancement and was awarded to the first author,Chanjuan Gong(Grant No.JSPH-MC-2022-4).
文摘The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to assess the effect of sevoflurane on cardiac function.Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia(AS)group and a propofolbased total intravenous anesthesia(AA)group.The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T1(after harvesting all grafts and before coronary anastomosis)and T_(2)(30 min after completing all coronary anastomoses)(P<0.05).Moreover,strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group,compared with the AA group at both T1 and T_(2)(P<0.01).The flow of the left internal mammary artery-left anterior descending artery graft was superior,and the postoperative concentration of troponin T decreased rapidly in the AS group,compared with the AA group(P<0.05).Compared with total intravenous anesthesia,sevoflurane resulted in a significantly higher global longitudinal strain,stroke volume,and cardiac output.Sevoflurane also led to an amelioration in the condition of the arterial graft.Furthermore,sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value.The findings need to be replicated in larger studies.
基金This study was supported by the National Science and Technology Major Project,China(No.J2019-III-0016-0060)。
文摘The mixing effectiveness of the airflow between the inner and outer bypass inlets of a Rear Variable-Area Bypass Injector(RVABI)is the key to the afterburner performance of variable cycle engines.This paper describes an optimized RVABI design based on an alternating area regulator to improve the velocity/temperature uniformity of the incoming flow at the afterburner.Compared with a classical RVABI,numerical simulations show that the proposed alternating RVABI performs better in terms of thermal mixing efficiency and total pressure loss in different variable cycle engine modes.Both the increasing air contact area between the inner and outer bypass of alternating structure RVABI,and a larger streamwise vortex in the inner bypass inlet due to the proposed alternating lobe structure in the RVABI contribute to the significantly increase of mixing effectiveness.Besides,the alternating regulator induces strong streamwise vortex,which helps to improve the airflow mixing with its vortex-induced velocity.The interaction between the streamwise vortex and azimuthal vortex further promises the velocity/temperature uniformity after the RVABI.With the increase of alternating lobe’s height ratio,the covering area of the streamwise vortex and the azimuthal vortex is enlarged,which further enhances the thermal mixing efficiency of the RVABI.This design gives an insight into the future design and optimization of RVABI.
