The present study investigated diagnostically the seasonal variation of the bypassing flows caused by the splitting effect of the Tibetan Plateau （TP）. The relationships among the splitting bypassing flows around th...The present study investigated diagnostically the seasonal variation of the bypassing flows caused by the splitting effect of the Tibetan Plateau （TP）. The relationships among the splitting bypassing flows around the TP to precipitation in China, the westerly jet stream, and the thermal status over the TP are revealed. The bypassing flows occur from the 1st to the 22nd pentad and from the 59th to the 73rd pentad, respectively, and they disappear from the 29th to the 58th pentad. They are strongest in winter from the 1st to the 22nd pentad and from the 59th to the 73rd pentad, respectively. During the rebuilding of the bypassing flows from mid-October to mid-February, they are the main cause of precipitation over southeastern China. The enhancement of the bypassing flow intensity in March can cause the precipitation to increase in the early stage of the persistent spring rain over southeastern China. From winter to summer, the seasonal transition of the bypassing flows in the lower troposphere precedes that of the westerly jet stream axis in the upper troposphere to the west of the TP by -4 pentads, while from summer to winter lags by -4 pentads. The seasonal variation of the thermal status over the TP plays an important role in the bypassing flows around the TP. The strengthening of the heating over the cooling over the TP is related to the rebuilding and TP weakens the bypassing flows, and the increase in strengthening of the bypassing flows.展开更多
This paper presents a design method of ByPassing Unit(BPU) in 32-bit Digital Signal Processor(DSP)-MD32. MD32 is realized in 0,18μm technology, 1.8V and 200 MHz working clock. It focuses on the Reduced Instruction Se...This paper presents a design method of ByPassing Unit(BPU) in 32-bit Digital Signal Processor(DSP)-MD32. MD32 is realized in 0,18μm technology, 1.8V and 200 MHz working clock. It focuses on the Reduced Instruction Set Computer(RISC) architecture and DSP computation capability thoroughly, extends DSP with various addressing modes in a customized DSP pipeline stage architecture. The paper also discusses the architecture and circuit design of bypassing logic to fit MD32 architecture. The parallel execution of BPU with instruction decode in architecture level is applied to reduce time delay. The optimization of circuit that serial select with priority is analyzed in detail, and the result shows that about half of time delay is reduced after this optimization. Examples show that BPU is useful for improving the DSP's performance.The forwarding logic in MD32 realizes 8 data channels feedback and meets the working clock limit.展开更多
AIM To investigate whether duodenal lesions induced by major venous occlusions can be attenuated by BPC 157 regardless nitric oxide(NO) system involvement.METHODS Male Wistar rats underwent superior anterior pancreati...AIM To investigate whether duodenal lesions induced by major venous occlusions can be attenuated by BPC 157 regardless nitric oxide(NO) system involvement.METHODS Male Wistar rats underwent superior anterior pancreaticoduodenal vein(SAPDV)-ligation and were treated with a bath at the ligated SAPDV site(BPC 157 10 μg, 10 ng/kg per 1 mL bath/rat; L-NAME 5 mg/kg per 1 m L bath/rat; L-arginine 100 mg/kg per 1 mL bath/rat, alone and/or together; or BPC 157 10 μg/kg instilled into the rat stomach, at 1 min ligation-time). We recorded the vessel presentation(filled/appearance or emptied/disappearance) between the 5 arcade vessels arising from the SAPDV on the ventral duodenum side, the inferior anterior pancreaticoduodenal vein(IAPDV) and superior mesenteric vein(SMV) as bypassing vascular pathway to document the duodenal lesions presentation; increased NO-and oxidative stress [malondialdehyde(MDA)]-levels in duodenum.RESULTS Unlike the severe course in the SAPDV-ligated controls, after BPC 157 application, the rats exhibited strong attenuation of the mucosal lesions and serosal congestion, improved vessel presentation, increased interconnections, increased branching by more than 60% from the initial value, the IAPDV and SMV were not congested. Interestingly, after 5 min and 30 min of L-NAME and L-arginine treatment alone, decreased mucosal and serosal duodenal lesions were observed; their effect was worsened at 24 h, and no effect on the collateral vessels and branching was seen. Together, L-NAME+L-arginine antagonized each other's response, and thus, there was an NO-related effect. With BPC 157, all SAPDV-ligated rats receiving L-NAME and/or L-arginine appeared similar to the rats treated with BPC 157 alone. Also, BPC 157 in SAPDV-ligated rats normalized levels of NO and MDA, two oxidative stress markers, in duodenal tissues.CONCLUSION BPC 157, rapidly bypassing occlusion, rescued the original duodenal flow through IAPDV to SMV flow, aneffect related to the NO system and reduction of free radical formation.展开更多
In coronary artery bypass grafting(CABG),graft’s poor instant patency may lead to an abnormal hemodynamic environment in anastomosis,which could further cause graft failure after the surgery.This paper investigates t...In coronary artery bypass grafting(CABG),graft’s poor instant patency may lead to an abnormal hemodynamic environment in anastomosis,which could further cause graft failure after the surgery.This paper investigates the graft hemodynamics with different instant patency,and explores its effect on graft postoperative efficiency.Six CABG 0D/3D coupling multi-scale models which used left internal mammary artery(LIMA)and saphenous vein(SVG)as grafts were constructed.Different types of grafts were examined in the models,including normal grafts,grafts with competitive flow and grafts with anastomotic stenosis.Simulation results indicated that comparing with SVG grafts,there was a greater difference between normal LIMA graft and non-patent LIMA graft.Also,the backflow occurred even in LIMA systolic flow.The wall shear stress(WSS)in the graft of the competitive flow LIMA model had an appreciable decrease comparing with the normal graft.In addition,the WSS in the stenosis region of the anastomotic stenosis LIMA model was much higher than its adjacent regions.In contrast,the WSS distributions in the SVG models were much smoother than in the LIMA models.For oscillatory shear index(OSI),there was little difference between normal LIMA and SVG.But when the graft had competitive flow or anastomotic stenosis,much higher OSI occurred in some regions in LIMA than SVG.There are significant differences in hemodynamics between normal grafts and non-patent grafts both in LIMA and SVG.The hemodynamic environment in a normal LIMA is better than that in a normal SVG.However,in the situation of the two types of non-patent grafts,the hemodynamics of SVG is better than LIMA.展开更多
Profs.Yang Jun(杨军)and Hu Yongyun(胡永云)at the Department of Atmospheric and Oceanic Sciences,School of Physics,Peking University,and their collaborators recently published a paper in Nature Geoscience(http://www.na...Profs.Yang Jun(杨军)and Hu Yongyun(胡永云)at the Department of Atmospheric and Oceanic Sciences,School of Physics,Peking University,and their collaborators recently published a paper in Nature Geoscience(http://www.nature.com/ngeo/journal/v10/n8/pdf/ngeo2994.pdf).They show展开更多
Nucleotide-binding and oligomerization domain(NOD)-like receptors(NLRs)are evolutionarily conserved intracellular pattern recognition receptors(PRRs)that sense microbial and danger signals,trigger immediate host defen...Nucleotide-binding and oligomerization domain(NOD)-like receptors(NLRs)are evolutionarily conserved intracellular pattern recognition receptors(PRRs)that sense microbial and danger signals,trigger immediate host defenses,and prime the adaptive immune response for long-lasting protection[1].In humans,22 known NLRs exist,and mutations in NLR family genes are associated with a wide range of inflammatory and autoimmune conditions,including hereditary periodic fever syndromes,Crohn’s disease,Blau’s syndrome,infantile enterocolitis,multiple sclerosis,and asthma[2,3].展开更多
To investigate the overall performance of reverse energy bypass scramjet,firstly a variable spe⁃cific heat method combined with a chemical balance calculation module for combustion products were used to es⁃tablish a b...To investigate the overall performance of reverse energy bypass scramjet,firstly a variable spe⁃cific heat method combined with a chemical balance calculation module for combustion products were used to es⁃tablish a benchmark scramjet performance evaluation model.Based on the test data of typical flying point of Mach 7 with the altitude of 29 km,the reliability of the model was verified.The deviations of parameters such as the to⁃tal pressure loss of combustor between the model and the test data were analyzed.Furtherly,an analytical method for post-combustion magnetohydrodynamic power generation was established;by embedding the above method into the overall performance evaluation model,performance prediction considering the power generation effect was realized.Finally,based on the above model,variety regulations of the inlet and the outlet parameters of the power generation channel and performance parameters including the engine specific impulse and the unit thrust under different enthalpy extraction ratios and load factors were analyzed.It could be concluded that the model can reliably predict the variations of key parameters.As the value of the load factor increases,the value of the conduc⁃tivity required to reach the specified enthalpy extraction ratio first decreases and then increases,which is approxi⁃mately parabolic.In order to reduce the demand for the gas conductivity for MHD power generation,the load fac⁃tor should be around 0.5.When the load factor is 0.4 and the magnetic induction intensity is 2.5 T,if the enthalpy extraction ratio reaches 0.5%,the engine specific impulse performance reduces about 3.58%.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 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
BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male pa...BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.展开更多
Metabolic risk factors are a significant cause of global burden among adults and adolescents,especially those with high BMIs.1 The prevalence of obesity in Kazakhstan is rapidly increasing,which reduces life expectanc...Metabolic risk factors are a significant cause of global burden among adults and adolescents,especially those with high BMIs.1 The prevalence of obesity in Kazakhstan is rapidly increasing,which reduces life expectancy.2,3 One common approach for treating obesity and its associated comorbidities is gastric bypass surgery.However,it is not without complications,and one of the most significant postoperative concerns is reflux esophagitis.Gastroesophageal reflux disease(GERD)is a prevalent problem among obese patients,and providing care is a significant factor in bariatric surgery.4 Roux-en-Y gastric bypass(RYGB)is frequently considered the preferable surgical treatment for individuals with GERD because of its efficacy in reducing reflux symptoms.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
Introduction:Pulmonary hypertension(PH)is a hemodynamic and pathophysiological condition characterized by abnormally elevated pressures in the pulmonary vasculature.It is defined by a mean pulmonary arterial pressure...Introduction:Pulmonary hypertension(PH)is a hemodynamic and pathophysiological condition characterized by abnormally elevated pressures in the pulmonary vasculature.It is defined by a mean pulmonary arterial pressure≥25 mmHg at rest by right heart catheterization.He is frequently associated with cardiovascular surgery and is a common complication that has been observed after surgery utilizing cardiopulmonary bypass(CPB).Preoperative PH has been significantly linked to morbidity and is a risk factor for poor outcome post-surgery.Some specific features in sub-Saharan Africa:given the lack of access to cardiac surgery,PAH occurs very frequently in cases of advanced heart disease in patients with congenital heart disease or rheumatic valve disease that has been treated late.Objective:The purpose of this study was to evaluate a protocol for managing PH during cardiac surgery under cardiopulmonary bypass in resource limited settings.Patients and Methods:This is a descriptive and analytical retrospective study that included all patients who underwent cardiopulmonary bypass surgery at the“Le Luxembourg”Mother and Child University Hospital between January 1,2023,and June 30,2024,and who had a preoperative systolic pulmonary artery pressure(SPAP)≥35 mmHg.Preoperatively,all patients included were given Furosemide:1 mg/kg and Sildenafil 5 or 10 mg/8 hours in children and 20 mg/8 hours in adults.In the operating room,a nasogastric tube was inserted to administer sildenafil at the end of surgery,and weaning from CPB was performed using Milrinone at a syringe pump rate of 5μg/kg/min,combined with Norepinephrine as needed depending on hemodynamic status.We analyzed the mean changes in PAPS from the preoperative assessment to discharge from intensive care.Results:During the period,292 patients underwent surgery,142 of whom had PH,representing a prevalence of 48.63%.Our patients had an average age of 11.57±11.There was a female predominance of 51.4%.The average length of preoperative hospitalization was 5 days[3-8].The time between diagnosis and surgical treatment was between 1 and 5 years in 62.8% of cases.It was≤1 year in 29.6%of cases.The clinical signs were dominated by dyspnea in 43.7% of cases.Pulmonary artery systolic pressure was between 51-100 mmHg in 29.58% and>100 mmHg in 19.72% of cases,with a mean preoperative sPAP of 59 mmHg[35-110].Congenital heart disease accounted for 52.11% of surgical indications,and valvular heart disease for 47.89%.Surgical indications for mitral valve disease accounted for 35.92% of cases and those for congenital heart disease for 52.11%.The mean duration of CPB was 110 min±50.There were no intraoperative episodes of pulmonary hypertension.At the end of surgery,the average time to postoperative extubation in intensive care was 3.53 hours±2.2.There was a significant decrease in sPAP between the preoperative and postoperative periods.A comparison of pre-and post-operative sPAP averages using a t-test was significant with a P-value<0.001(t:27.978).The main postoperative complications are:Overall cardiac failure:4.2%;respiratory failure:2.1%;hematological complications:0.7%.We recorded a perioperative mortality rate of 5.6%.Conclusion:PH complicates rheumatic valve disease and certain congenital heart diseases.It is common in our resourcelimited setting,where access to cardiac surgery is insufficient.It is associated with high perioperative morbidity and mortality.Management is well codified,but the therapeutic classes are sometimes unavailable in our countries.The postoperative protocol of furosemide+sildenafil and milrinone appears to give good results.展开更多
Performing endoscopic retrograde cholangiopancreatography (ERCP) in patientswith Roux-en-Y-anatomy is technically challenging and additional techniquesincluding balloon-assisted enteroscopy, endoscopic ultrasound (EUS...Performing endoscopic retrograde cholangiopancreatography (ERCP) in patientswith Roux-en-Y-anatomy is technically challenging and additional techniquesincluding balloon-assisted enteroscopy, endoscopic ultrasound (EUS) guided, andpercutaneous approaches offers only modest success rates. Motorized spiralenteroscopy (MSE)-assisted ERCP (MSE-ERCP) has emerged as a potentialalternative. In a retrospective study by Nennstiel et al, MSE-ERCP achieved highsuccess rates for biliary entry (88%) and therapeutic intervention (83%). However,outcomes varied significantly between bilioenteric anastomosis (93%) and nativepapilla (63%), underscoring the importance of anatomy-driven proceduralselection. Despite encouraging efficacy, the global withdrawal of the MSE platformdue to serious device-related complications highlights the ongoing balancebetween feasibility and safety. Future directions should prioritize refinements indevice engineering, multicenter prospective trials comparing MSE with balloonassistedand EUS-guided techniques, and systematic outcome stratification byanatomical subgroup. Such efforts will be critical to defining the role of MSEwithin the therapeutic algorithm for surgically altered anatomy.展开更多
BACKGROUND Bilateral internal mammary arteries(BIMAs)as the most advanced surgical option for coronary artery bypass grafting(CABG)are usually recommended for younger patients without traditional risk factors.This stu...BACKGROUND Bilateral internal mammary arteries(BIMAs)as the most advanced surgical option for coronary artery bypass grafting(CABG)are usually recommended for younger patients without traditional risk factors.This study compares outcomes in propensity score-matched patients aged over 70 years who received BIMAs versus those who received a single internal mammary artery(SIMA).METHODS From 2013 to 2024,8123 patients underwent primary CABG for multivessel coronary artery disease at our institution.BIMA grafting was performed in 1233 patients(15.17%),with in situ BIMA grafting in 290 patients(3.57%).For in situ BIMA group,the right internal mammary artery was used to revascularize the right coronary artery,while the left internal mammary artery was utilized for the left anterior descending artery.BIMA patients aged over 70 years(n=79)were compared with SIMA patients(n=79)using propensity score matching.Primary outcome was all-cause mortality at 30 days and 8 years.Secondary outcomes included length of hospital stay,incidence of postoperative major adverse cardiovascular and cerebrovascular events,sternal wound infection and the need for subsequent percutaneous revascularization.RESULTS There was no difference in immediate postoperative primary and secondary outcomes.Mean follow-up was 8.3±1.0 years with an 8-year freedom from death of 67.08%±1.1%in the BIMA group versus 58.22%±0.9%in the SIMA group(P<0.05).CONCLUSIONS BIMAs as in situ grafts can be successfully used in CABG for patients aged 70 years and older.Consequently,the refined techniques for constructing internal mammary artery grafts used in this study challenge traditionally accepted limitations regarding the use of BIMAs.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:The neutrophil-lymphocyte ratio(NLR)is a simple,cost-effective marker of systemic inflammation.This study aims to evaluate the association between perioperative NLR and postoperative outcomes in pediatric p...Background:The neutrophil-lymphocyte ratio(NLR)is a simple,cost-effective marker of systemic inflammation.This study aims to evaluate the association between perioperative NLR and postoperative outcomes in pediatric patients undergoing congenital heart surgery with cardiopulmonary bypass(CPB).Methods:We retrospectively reviewed 70 patients under 18 years of age who underwent surgery between 2018 and 2023.NLR was measured preoperatively and on postoperative days(POD)0,1,2,3,and 6.Receiver operating characteristic analysis identified optimal cutoffs,and associations with postoperative outcomes were assessed.Results:The preoperative NLR cutoff of 1.14(AUC=0.75)was associated with prolonged mechanical ventilation(>72 h)(p=0.02),extended intensive care unit(ICU)stay(p=0.004),and longer hospital stay(p=0.006).NLR values on POD3(AUC=0.74)and POD6(AUC=0.78)also demonstrated strong predictive ability for these outcomes.Conclusions:Elevated perioperative NLR-particularly preoperative values≥1.14-is associated with prolonged mechanical ventilation,longer ICU admission,and extended hospitalization in pediatric congenital heart surgery.NLR may serve as a practical biomarker for early risk stratification and postoperative management.展开更多
基金supported by the National Natural Science Foundation of China (Grant No.40921003)the International S&T Cooperation Project of the Ministry of Science and Technology of China under Grant No. 2009DFA21430
文摘The present study investigated diagnostically the seasonal variation of the bypassing flows caused by the splitting effect of the Tibetan Plateau （TP）. The relationships among the splitting bypassing flows around the TP to precipitation in China, the westerly jet stream, and the thermal status over the TP are revealed. The bypassing flows occur from the 1st to the 22nd pentad and from the 59th to the 73rd pentad, respectively, and they disappear from the 29th to the 58th pentad. They are strongest in winter from the 1st to the 22nd pentad and from the 59th to the 73rd pentad, respectively. During the rebuilding of the bypassing flows from mid-October to mid-February, they are the main cause of precipitation over southeastern China. The enhancement of the bypassing flow intensity in March can cause the precipitation to increase in the early stage of the persistent spring rain over southeastern China. From winter to summer, the seasonal transition of the bypassing flows in the lower troposphere precedes that of the westerly jet stream axis in the upper troposphere to the west of the TP by -4 pentads, while from summer to winter lags by -4 pentads. The seasonal variation of the thermal status over the TP plays an important role in the bypassing flows around the TP. The strengthening of the heating over the cooling over the TP is related to the rebuilding and TP weakens the bypassing flows, and the increase in strengthening of the bypassing flows.
基金Supported by the National High Technology Research & Development Program of China (863 Program) (2002AA1Z1140).
文摘This paper presents a design method of ByPassing Unit(BPU) in 32-bit Digital Signal Processor(DSP)-MD32. MD32 is realized in 0,18μm technology, 1.8V and 200 MHz working clock. It focuses on the Reduced Instruction Set Computer(RISC) architecture and DSP computation capability thoroughly, extends DSP with various addressing modes in a customized DSP pipeline stage architecture. The paper also discusses the architecture and circuit design of bypassing logic to fit MD32 architecture. The parallel execution of BPU with instruction decode in architecture level is applied to reduce time delay. The optimization of circuit that serial select with priority is analyzed in detail, and the result shows that about half of time delay is reduced after this optimization. Examples show that BPU is useful for improving the DSP's performance.The forwarding logic in MD32 realizes 8 data channels feedback and meets the working clock limit.
文摘AIM To investigate whether duodenal lesions induced by major venous occlusions can be attenuated by BPC 157 regardless nitric oxide(NO) system involvement.METHODS Male Wistar rats underwent superior anterior pancreaticoduodenal vein(SAPDV)-ligation and were treated with a bath at the ligated SAPDV site(BPC 157 10 μg, 10 ng/kg per 1 mL bath/rat; L-NAME 5 mg/kg per 1 m L bath/rat; L-arginine 100 mg/kg per 1 mL bath/rat, alone and/or together; or BPC 157 10 μg/kg instilled into the rat stomach, at 1 min ligation-time). We recorded the vessel presentation(filled/appearance or emptied/disappearance) between the 5 arcade vessels arising from the SAPDV on the ventral duodenum side, the inferior anterior pancreaticoduodenal vein(IAPDV) and superior mesenteric vein(SMV) as bypassing vascular pathway to document the duodenal lesions presentation; increased NO-and oxidative stress [malondialdehyde(MDA)]-levels in duodenum.RESULTS Unlike the severe course in the SAPDV-ligated controls, after BPC 157 application, the rats exhibited strong attenuation of the mucosal lesions and serosal congestion, improved vessel presentation, increased interconnections, increased branching by more than 60% from the initial value, the IAPDV and SMV were not congested. Interestingly, after 5 min and 30 min of L-NAME and L-arginine treatment alone, decreased mucosal and serosal duodenal lesions were observed; their effect was worsened at 24 h, and no effect on the collateral vessels and branching was seen. Together, L-NAME+L-arginine antagonized each other's response, and thus, there was an NO-related effect. With BPC 157, all SAPDV-ligated rats receiving L-NAME and/or L-arginine appeared similar to the rats treated with BPC 157 alone. Also, BPC 157 in SAPDV-ligated rats normalized levels of NO and MDA, two oxidative stress markers, in duodenal tissues.CONCLUSION BPC 157, rapidly bypassing occlusion, rescued the original duodenal flow through IAPDV to SMV flow, aneffect related to the NO system and reduction of free radical formation.
基金This work is supported by National Natural Science Foundation of China(11832003,11772016,11472022,11702008).
文摘In coronary artery bypass grafting(CABG),graft’s poor instant patency may lead to an abnormal hemodynamic environment in anastomosis,which could further cause graft failure after the surgery.This paper investigates the graft hemodynamics with different instant patency,and explores its effect on graft postoperative efficiency.Six CABG 0D/3D coupling multi-scale models which used left internal mammary artery(LIMA)and saphenous vein(SVG)as grafts were constructed.Different types of grafts were examined in the models,including normal grafts,grafts with competitive flow and grafts with anastomotic stenosis.Simulation results indicated that comparing with SVG grafts,there was a greater difference between normal LIMA graft and non-patent LIMA graft.Also,the backflow occurred even in LIMA systolic flow.The wall shear stress(WSS)in the graft of the competitive flow LIMA model had an appreciable decrease comparing with the normal graft.In addition,the WSS in the stenosis region of the anastomotic stenosis LIMA model was much higher than its adjacent regions.In contrast,the WSS distributions in the SVG models were much smoother than in the LIMA models.For oscillatory shear index(OSI),there was little difference between normal LIMA and SVG.But when the graft had competitive flow or anastomotic stenosis,much higher OSI occurred in some regions in LIMA than SVG.There are significant differences in hemodynamics between normal grafts and non-patent grafts both in LIMA and SVG.The hemodynamic environment in a normal LIMA is better than that in a normal SVG.However,in the situation of the two types of non-patent grafts,the hemodynamics of SVG is better than LIMA.
文摘Profs.Yang Jun(杨军)and Hu Yongyun(胡永云)at the Department of Atmospheric and Oceanic Sciences,School of Physics,Peking University,and their collaborators recently published a paper in Nature Geoscience(http://www.nature.com/ngeo/journal/v10/n8/pdf/ngeo2994.pdf).They show
基金National Natural Science Foundation of China(82388201 to JH,32170751 to Z-HY)Fundamental Research Funds for the Central Universities(226-2024-00015 to XW)+3 种基金National Key R&D Program of China(2020YFA0803500 to JH)CAMS Innovation Fund for Medical Science(2019-I2M-5-062 to JH)Fujian Province Central to Local Science and Technology Development Special Program(No.2022L3079 to JH)Fu-Xia-Quan Zi-Chuang District Cooperation Program(No.3502ZCQXT2022003 to JH).
文摘Nucleotide-binding and oligomerization domain(NOD)-like receptors(NLRs)are evolutionarily conserved intracellular pattern recognition receptors(PRRs)that sense microbial and danger signals,trigger immediate host defenses,and prime the adaptive immune response for long-lasting protection[1].In humans,22 known NLRs exist,and mutations in NLR family genes are associated with a wide range of inflammatory and autoimmune conditions,including hereditary periodic fever syndromes,Crohn’s disease,Blau’s syndrome,infantile enterocolitis,multiple sclerosis,and asthma[2,3].
文摘To investigate the overall performance of reverse energy bypass scramjet,firstly a variable spe⁃cific heat method combined with a chemical balance calculation module for combustion products were used to es⁃tablish a benchmark scramjet performance evaluation model.Based on the test data of typical flying point of Mach 7 with the altitude of 29 km,the reliability of the model was verified.The deviations of parameters such as the to⁃tal pressure loss of combustor between the model and the test data were analyzed.Furtherly,an analytical method for post-combustion magnetohydrodynamic power generation was established;by embedding the above method into the overall performance evaluation model,performance prediction considering the power generation effect was realized.Finally,based on the above model,variety regulations of the inlet and the outlet parameters of the power generation channel and performance parameters including the engine specific impulse and the unit thrust under different enthalpy extraction ratios and load factors were analyzed.It could be concluded that the model can reliably predict the variations of key parameters.As the value of the load factor increases,the value of the conduc⁃tivity required to reach the specified enthalpy extraction ratio first decreases and then increases,which is approxi⁃mately parabolic.In order to reduce the demand for the gas conductivity for MHD power generation,the load fac⁃tor should be around 0.5.When the load factor is 0.4 and the magnetic induction intensity is 2.5 T,if the enthalpy extraction ratio reaches 0.5%,the engine specific impulse performance reduces about 3.58%.
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.
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BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.
基金supported by the Ministry of Education and Science of the Republic of Kazakhstan(Grant No.AP23490186).
文摘Metabolic risk factors are a significant cause of global burden among adults and adolescents,especially those with high BMIs.1 The prevalence of obesity in Kazakhstan is rapidly increasing,which reduces life expectancy.2,3 One common approach for treating obesity and its associated comorbidities is gastric bypass surgery.However,it is not without complications,and one of the most significant postoperative concerns is reflux esophagitis.Gastroesophageal reflux disease(GERD)is a prevalent problem among obese patients,and providing care is a significant factor in bariatric surgery.4 Roux-en-Y gastric bypass(RYGB)is frequently considered the preferable surgical treatment for individuals with GERD because of its efficacy in reducing reflux symptoms.
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Introduction:Pulmonary hypertension(PH)is a hemodynamic and pathophysiological condition characterized by abnormally elevated pressures in the pulmonary vasculature.It is defined by a mean pulmonary arterial pressure≥25 mmHg at rest by right heart catheterization.He is frequently associated with cardiovascular surgery and is a common complication that has been observed after surgery utilizing cardiopulmonary bypass(CPB).Preoperative PH has been significantly linked to morbidity and is a risk factor for poor outcome post-surgery.Some specific features in sub-Saharan Africa:given the lack of access to cardiac surgery,PAH occurs very frequently in cases of advanced heart disease in patients with congenital heart disease or rheumatic valve disease that has been treated late.Objective:The purpose of this study was to evaluate a protocol for managing PH during cardiac surgery under cardiopulmonary bypass in resource limited settings.Patients and Methods:This is a descriptive and analytical retrospective study that included all patients who underwent cardiopulmonary bypass surgery at the“Le Luxembourg”Mother and Child University Hospital between January 1,2023,and June 30,2024,and who had a preoperative systolic pulmonary artery pressure(SPAP)≥35 mmHg.Preoperatively,all patients included were given Furosemide:1 mg/kg and Sildenafil 5 or 10 mg/8 hours in children and 20 mg/8 hours in adults.In the operating room,a nasogastric tube was inserted to administer sildenafil at the end of surgery,and weaning from CPB was performed using Milrinone at a syringe pump rate of 5μg/kg/min,combined with Norepinephrine as needed depending on hemodynamic status.We analyzed the mean changes in PAPS from the preoperative assessment to discharge from intensive care.Results:During the period,292 patients underwent surgery,142 of whom had PH,representing a prevalence of 48.63%.Our patients had an average age of 11.57±11.There was a female predominance of 51.4%.The average length of preoperative hospitalization was 5 days[3-8].The time between diagnosis and surgical treatment was between 1 and 5 years in 62.8% of cases.It was≤1 year in 29.6%of cases.The clinical signs were dominated by dyspnea in 43.7% of cases.Pulmonary artery systolic pressure was between 51-100 mmHg in 29.58% and>100 mmHg in 19.72% of cases,with a mean preoperative sPAP of 59 mmHg[35-110].Congenital heart disease accounted for 52.11% of surgical indications,and valvular heart disease for 47.89%.Surgical indications for mitral valve disease accounted for 35.92% of cases and those for congenital heart disease for 52.11%.The mean duration of CPB was 110 min±50.There were no intraoperative episodes of pulmonary hypertension.At the end of surgery,the average time to postoperative extubation in intensive care was 3.53 hours±2.2.There was a significant decrease in sPAP between the preoperative and postoperative periods.A comparison of pre-and post-operative sPAP averages using a t-test was significant with a P-value<0.001(t:27.978).The main postoperative complications are:Overall cardiac failure:4.2%;respiratory failure:2.1%;hematological complications:0.7%.We recorded a perioperative mortality rate of 5.6%.Conclusion:PH complicates rheumatic valve disease and certain congenital heart diseases.It is common in our resourcelimited setting,where access to cardiac surgery is insufficient.It is associated with high perioperative morbidity and mortality.Management is well codified,but the therapeutic classes are sometimes unavailable in our countries.The postoperative protocol of furosemide+sildenafil and milrinone appears to give good results.
文摘Performing endoscopic retrograde cholangiopancreatography (ERCP) in patientswith Roux-en-Y-anatomy is technically challenging and additional techniquesincluding balloon-assisted enteroscopy, endoscopic ultrasound (EUS) guided, andpercutaneous approaches offers only modest success rates. Motorized spiralenteroscopy (MSE)-assisted ERCP (MSE-ERCP) has emerged as a potentialalternative. In a retrospective study by Nennstiel et al, MSE-ERCP achieved highsuccess rates for biliary entry (88%) and therapeutic intervention (83%). However,outcomes varied significantly between bilioenteric anastomosis (93%) and nativepapilla (63%), underscoring the importance of anatomy-driven proceduralselection. Despite encouraging efficacy, the global withdrawal of the MSE platformdue to serious device-related complications highlights the ongoing balancebetween feasibility and safety. Future directions should prioritize refinements indevice engineering, multicenter prospective trials comparing MSE with balloonassistedand EUS-guided techniques, and systematic outcome stratification byanatomical subgroup. Such efforts will be critical to defining the role of MSEwithin the therapeutic algorithm for surgically altered anatomy.
文摘BACKGROUND Bilateral internal mammary arteries(BIMAs)as the most advanced surgical option for coronary artery bypass grafting(CABG)are usually recommended for younger patients without traditional risk factors.This study compares outcomes in propensity score-matched patients aged over 70 years who received BIMAs versus those who received a single internal mammary artery(SIMA).METHODS From 2013 to 2024,8123 patients underwent primary CABG for multivessel coronary artery disease at our institution.BIMA grafting was performed in 1233 patients(15.17%),with in situ BIMA grafting in 290 patients(3.57%).For in situ BIMA group,the right internal mammary artery was used to revascularize the right coronary artery,while the left internal mammary artery was utilized for the left anterior descending artery.BIMA patients aged over 70 years(n=79)were compared with SIMA patients(n=79)using propensity score matching.Primary outcome was all-cause mortality at 30 days and 8 years.Secondary outcomes included length of hospital stay,incidence of postoperative major adverse cardiovascular and cerebrovascular events,sternal wound infection and the need for subsequent percutaneous revascularization.RESULTS There was no difference in immediate postoperative primary and secondary outcomes.Mean follow-up was 8.3±1.0 years with an 8-year freedom from death of 67.08%±1.1%in the BIMA group versus 58.22%±0.9%in the SIMA group(P<0.05).CONCLUSIONS BIMAs as in situ grafts can be successfully used in CABG for patients aged 70 years and older.Consequently,the refined techniques for constructing internal mammary artery grafts used in this study challenge traditionally accepted limitations regarding the use of BIMAs.
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:The neutrophil-lymphocyte ratio(NLR)is a simple,cost-effective marker of systemic inflammation.This study aims to evaluate the association between perioperative NLR and postoperative outcomes in pediatric patients undergoing congenital heart surgery with cardiopulmonary bypass(CPB).Methods:We retrospectively reviewed 70 patients under 18 years of age who underwent surgery between 2018 and 2023.NLR was measured preoperatively and on postoperative days(POD)0,1,2,3,and 6.Receiver operating characteristic analysis identified optimal cutoffs,and associations with postoperative outcomes were assessed.Results:The preoperative NLR cutoff of 1.14(AUC=0.75)was associated with prolonged mechanical ventilation(>72 h)(p=0.02),extended intensive care unit(ICU)stay(p=0.004),and longer hospital stay(p=0.006).NLR values on POD3(AUC=0.74)and POD6(AUC=0.78)also demonstrated strong predictive ability for these outcomes.Conclusions:Elevated perioperative NLR-particularly preoperative values≥1.14-is associated with prolonged mechanical ventilation,longer ICU admission,and extended hospitalization in pediatric congenital heart surgery.NLR may serve as a practical biomarker for early risk stratification and postoperative management.
