This article comments on the research by Zhang et al on the role of advanced heart failure and transplant teams in extracorporeal membrane oxygenation(ECMO)management.The study by Zhang et al indicates that direct adv...This article comments on the research by Zhang et al on the role of advanced heart failure and transplant teams in extracorporeal membrane oxygenation(ECMO)management.The study by Zhang et al indicates that direct advanced heart failure and transplant involvement improves survival in ECMO patients,especially those on veno-arterial ECMO.However,the optimal approach varies due to multiple factors.This article discusses the clinical implications,research design limitations,and future directions to enhance ECMO care.展开更多
Extracorporeal membrane oxygenation(ECMO)has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies.ECMO allows blood to b...Extracorporeal membrane oxygenation(ECMO)has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies.ECMO allows blood to be extracted from a patient and introduced to a machine that oxygenates blood and removes carbon dioxide.This blood is then reintroduced into the patient’s circulatory system.This process makes ECMO essential for treating various medical conditions,both as a standalone therapy and as adjuvant therapy.Veno-venous(VV)ECMO primarily supports respiratory function and indicates respiratory distress.Simultaneously,veno-arterial(VA)ECMO provides hemodynamic and respiratory support and is suitable for cardiac-related complications.This study reviews recent literature to elucidate the evolving role of ECMO in trauma care,considering its procedural intricacies,indications,contraindications,and associated complications.Notably,the use of ECMO in trauma patients,particularly for acute respiratory distress syndrome and cardiogenic shock,has demonstrated promising outcomes despite challenges such as anticoagulation management and complications such as acute kidney injury,bleeding,thrombosis,and hemolysis.Some studies have shown that VV ECMO was associated with significantly higher survival rates than conventional mechanical ventilation,whereas other studies have reported that VA ECMO was associated with lower survival rates than VV ECMO.ECMO plays a critical role in managing trauma patients,particularly those with acute respiratory failure.Further research is necessary to explore the full potential of ECMO in trauma care.Clinicians should have a clear understanding of the indications and contraindications for the use of ECMO to maximize its benefits in treating trauma patients.展开更多
BACKGROUND Veno-venous extracorporeal membrane oxygenation(V-V ECMO)is a lifesaving intervention for severe respiratory failure;however,its effectiveness depends on accurate cannulation-patients with anatomical variat...BACKGROUND Veno-venous extracorporeal membrane oxygenation(V-V ECMO)is a lifesaving intervention for severe respiratory failure;however,its effectiveness depends on accurate cannulation-patients with anatomical variations present with significant challenges during the procedure.CASE SUMMARY We describe the case of a 56-year-old woman with severe pulmonary infection and acute respiratory failure managed with V-V ECMO.During the initial cannulation,a 23Fr venous drainage cannula was inadvertently inserted into the middle hepatic vein(HV)instead of the inferior vena cava(IVC)owing to the enlargement of the HV(1.02 cm diameter)and its acute angle(77.78°)relative to the IVC.This misplacement led to extracorporeal membrane oxygenation(ECMO)flow issues which were resolved after repositioning the cannula under real-time ultrasonographic and fluoroscopic guidance.This correction stabilized the patient’s condition and restored effective ECMO function,preventing severe complications such as liver injury and liver failure.CONCLUSION In clinical practice,real-time ultrasonography and fluoroscopy are critical in preventing cannulation errors in patients with anatomical variations.Vigilant imaging and precise techniques are essential for optimizing ECMO management and effectively addressing complications.展开更多
BACKGROUND:Extracorporeal membrane oxygenation(ECMO)is an effective measure for saving the lives of critically ill patients.Prompt identification of the risk factors for mortality among patients receiving ECMO and com...BACKGROUND:Extracorporeal membrane oxygenation(ECMO)is an effective measure for saving the lives of critically ill patients.Prompt identification of the risk factors for mortality among patients receiving ECMO and comprehensive analysis of the long-term prognosis of survivors are vital.This scoping review summarized the representative prognostic scoring systems,aiming to help clinicians in selecting an appropriate scoring system to avoid unnecessary medical resource consumption and reduce ECMO-associated mortality.METHODS:A comprehensive search of multiple databases,including PubMed,Embase,and the Cochrane Library,was conducted.After removing duplicate studies,a full-text review was performed,and all studies that reported score systems before and/or after ECMO support were included.This protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews(PRISMA-ScR)and has been registered with the Open Science Framework(osf.io/zp4ge).RESULTS:Among the 114 studies included,we identified three scores for patients receiving veno-venous ECMO(VV-ECMO),five scores for patients receiving veno-arterial ECMO(VA-ECMO),and three critical illness scores,which apply to both VV-and VA-ECMO conditions.All characteristics of these scoring systems,their advantages,and their limitations were summarized.CONCLUSION:The implementation of an ECMO scoring system helps to assess the condition of critically ill patients,predict outcome,and provide objective indicators to determine the optimal timing for ECMO intervention.Due to the limitations of the currently available scores,further efforts in improving and validating the ECMO scoring system are needed to achieve the goals of minimizing unnecessary consumption of medical resources and reducing mortality rates.展开更多
BACKGROUND Venlafaxine,a serotonin-norepinephrine reuptake inhibitor,is widely prescribed for the treatment of major depressive disorder.At therapeutic dose,it is generally safe,with a low incidence of adverse effects...BACKGROUND Venlafaxine,a serotonin-norepinephrine reuptake inhibitor,is widely prescribed for the treatment of major depressive disorder.At therapeutic dose,it is generally safe,with a low incidence of adverse effects.However,massive venlafaxine inge-stion can cause serious cardiotoxicity,leading to life-threatening arrhythmias.CASE SUMMARY A 31-year-old woman with a history of depression ingested 14.8 g of venlafaxine along with 6 mg of estazolam and 6 mg of flunitrazepam.On admission,2 hours post-ingestion,she presented only with mild QTc prolongation.At 4 hours post-ingestion,she developed a generalized tonic-clonic seizure.Following endo-tracheal intubation,intravenous midazolam infusion was initiated and 50 g of activated charcoal was administered via a nasogastric tube.At 15 hours post-ingestion,she developed ventricular tachycardia that rapidly progressed to refr-actory ventricular fibrillation,which was successfully treated with veno-arterial extracorporeal membrane oxygenation.Toxicological analysis revealed serum ve-nlafaxine and O-desmethylvenlafaxine concentrations 17µg/mL and 10µg/mL,respectively,at 15 hours post-ingestion.CONCLUSION In cases of massive venlafaxine ingestion,continuous intensive monitoring,particularly of QTc,is essential for at least 24 hours,even when initial clinical signs are mild.If refractory ventricular arrhythmias occur,prompt ini-tiation of veno-arterial extracorporeal membrane oxygenation should be considered.展开更多
BACKGROUND Extracorporeal membrane oxygenation(ECMO)is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments.Patients that are supported with veno...BACKGROUND Extracorporeal membrane oxygenation(ECMO)is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments.Patients that are supported with veno-arterial ECMO(VA-ECMO)are considered very-high risk patients to participate in any type of physical therapy(PT)or mobilization.However,cumulative evidence suggests that early mobilization of critically ill patients is feasible,safe,and efficient under certain circumstances.AIM To summarize the existing evidence on the impact of early mobilization and physiotherapy on VA-ECMO patients.METHODS This is a scoping review that used systematic electronic literature searches(from inception until January 2025)on MEDLINE(PubMed),PEDro,DynaMed,CINAHL,Scopus,Science direct and Hellenic Academic Libraries.Snowball searching method was also applied.Eligible studies included those reporting patients on VA-ECMO who participated in early mobilization or PT,published in English and utilized any primary evidence study design.Studies on children,animals and patients placed on any other ECMO,secondary evidence,and‘grey’literature were excluded.RESULTS A total of 316 articles were retrieved and 13 were included in the study.Of those,1 study was a randomized control trial,4 retrospective studies,4 retrospective cohort studies,1 case series and 3 case reports.The sample size of the included studies ranged from 1 to 104 VA-ECMO patients,who were ambulated or received PT inter-ventions,and mobilization frequency ranged from 2 per day to 4 per week.Mobilization of VA-ECMO patients seems to be safe regardless the cannula’s position.PT and early mobilization were associated with better weaning from mechanical ventilation,gradual reduction of inotropes and functional capacity improvement after ECMO discharge.CONCLUSION Early mobilization in VA-ECMO seems to be safe and can potentially help reduce vasoconstrictors and speed up rehabilitation times.High quality research on early mobilization in VA-ECMO patients is warranted.展开更多
BACKGROUND:Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology.We aimed to investigate the relationships between liver fu...BACKGROUND:Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology.We aimed to investigate the relationships between liver function indicators at hospital admission and mortality in children receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO)support following cardiac surgery.METHODS:We retrospectively analysed the clinical data of pediatric patients who received postcardiotomy VA-ECMO support at Fuwai Hospital between January 2010 and June 2020.Univariable and multivariable-adjusted Cox proportional hazard models were constructed to evaluate the risk factors associated with 30-day and 180-day mortality.The cut-off values for the liver function variables measured at hospital admission were categorized into high and low groups and then compared using Kaplan-Meier survival curves and log-rank tests.RESULTS:Our study included 96 pediatric patients who received VA-ECMO support after cardiotomy.Among the patients receiving VA-ECMO,the 30-day and 180-day mortality rates were 37.5% and 52.1%,respectively.The level of aspartate aminotransferase(AST)at admission was associated with 30-day mortality(hazard ratios[HRs]=1.852,95%CI 1.010-3.398,P=0.046).The AST and alkaline phosphatase(ALP)levels were predictors of 180-day mortality,with adjusted HRs of 1.799(95%CI 1.074-3.014;P=0.025)and 1.384(95%CI 1.050-1.825;P=0.021),respectively.The cut-off value for AST to predict mortality at 30 d was 77 U/L,and that for ALP to predict mortality at 180 d was 269 U/L.CONCLUSION:Liver function indicators,including AST and ALP,at hospital admission are associated with mortality risk in children with congenital heart disease receiving VA-ECMO after cardiac surgery.展开更多
This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support....This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support.Advanced heart failure and transplant cardiology(AHFTC)teams play an essential role in managing patients in cardiogenic shock.To determine whether ECMO patient management outcomes differ based on whether AHFTC physicians assume a direct or consultative role,a retrospective cohort study of 51 patients placed on veno-venous and veno-arterial(VA)ECMO between January 2015 and February 2023 was conducted.Results demonstrated a significantly higher 30-day postdischarge survival rate in the AHFTC direct involvement cohort compared to the consultative group(67%vs 30%)for all ECMO patients.This survival benefit was primarily attributable to VA ECMO patients(64%vs 20%).Direct involvement of AHFTC teams in patient selection and management may enhance survival in patients requiring VA ECMO for cardiogenic shock;however,further research is necessary to confirm these findings.展开更多
BACKGROUND Pheochromocytoma(PHEO)is a type of tumor that originates from chromaffin cells in the adrenal medulla and is classified as an adrenal paraganglioma.PHEOs can secrete catecholamines,leading to a variety of s...BACKGROUND Pheochromocytoma(PHEO)is a type of tumor that originates from chromaffin cells in the adrenal medulla and is classified as an adrenal paraganglioma.PHEOs can secrete catecholamines,leading to a variety of symptoms.Accurate diagnosis and appropriate treatment selection are crucial for favorable outcomes in these cases.CASE SUMMARY The patient presented with unexplained chest tightness,palpitations,and pink sputum.Upon examination and analysis of laboratory results,a diagnosis of adrenal PHEO was established.The PHEO secreted high levels of catecholamines,causing sudden fluctuations in blood pressure and heart rate,leading to extre-mely unstable hemodynamics.Treatment with extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation helped stabilize the patient’s vital signs,allowing for timely surgical intervention.CONCLUSION The combination of extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation can enhance tissue perfusion,thus providing a solid foundation for the accurate diagnosis and effective surgical treatment of PHEO.展开更多
BACKGROUND Data on adsorptive extracorporeal membrane oxygenation(ECMO)(combined with HA380 hemoperfusion column)on the inflammatory factors in patients with cardiogenic shock(CS)remains limited.AIM To investigate the...BACKGROUND Data on adsorptive extracorporeal membrane oxygenation(ECMO)(combined with HA380 hemoperfusion column)on the inflammatory factors in patients with cardiogenic shock(CS)remains limited.AIM To investigate the effects of adsorptive ECMO on the inflammatory factors in patients with CS.METHODS A retrospective analysis was performed on 81 patients with CS caused by acute myocardial infarction,fulminant myocarditis,or cardiac surgery who required venoarterial ECMO support at TEDA International Cardiovascular Hospital from December 2020 to December 2024.Patients were divided into the conventional ECMO group(42 cases)and the adsorptive ECMO group(ECMO combined with hemoperfusion,39 cases).The adsorptive ECMO group received 2 columns of HA380 initiation on the first day(the first column connected within 2 hours of ECMO and the second after 12 hours of ECMO),followed by 1 column each day,with each column used for 4–6 hours,totaling 24–30 hours of treatment.Baseline data were compared between the two groups:Inflammatory factor levels(at 0,6,12,24,48,and 72 hours after ECMO or hemoperfusion initiation);ECMO support duration;successful weaning rate;continuous renal replacement therapy(CRRT)utilization;Sequential Organ Failure Assessment(SOFA)score;Vasoactive-Inotropic Score(VIS);systemic inflammatory response syndrome(SIRS)incidence;and in-hospital survival and 30-/90-day survival after discharge.RESULTS The adsorptive ECMO group showed significantly lower levels of C-reactive protein,interleukin(IL)-6,tumor necrosis factor(TNF)-α,and lactate from 6 to 72 hours compared with the conventional ECMO group(all P<0.05),with IL-6 decreasing by 94.4%and tumour necrosis factor alpha by 70.1%from baseline at 72 hours.The adsorptive ECMO group had a significantly shorter ECMO duration[114.0(75.0–139.0)hours vs 135.0(73.0–199.3)hours,P=0.032];higher successful weaning rate(66.7%vs 42.9%,P=0.032);a trend toward lower CRRT utilization(54.8%vs 38.5%,P=0.070);lower post-weaning SOFA score[7(6–8)vs 9(8–10),P<0.001];significantly reduced VIS(8.4±1.3 vs 9.8±1.6,P<0.001);and a trend toward lower SIRS incidence(10.3%vs 26.2%,P=0.065).There were no significant differences in complications,in-hospital survival(64.1%vs 52.4%,P=0.285);or 30-/90-day survival between the two groups(all P>0.05).CONCLUSION Adsorptive ECMO efficiently clears IL-6 and TNF-α,significantly improving ECMO weaning success rate and hemodynamics.However,it has no significant impact on survival,and its efficacy requires validation through prospective studies.展开更多
BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extraco...BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.展开更多
BACKGROUND:Intracranial hemorrhage (ICH),a severe complication among adults receiving extracorporeal membrane oxygenation (ECMO),is often related to poor outcomes.This study aimed to establish a predictive model for I...BACKGROUND:Intracranial hemorrhage (ICH),a severe complication among adults receiving extracorporeal membrane oxygenation (ECMO),is often related to poor outcomes.This study aimed to establish a predictive model for ICH in adults receiving ECMO treatment.METHODS:Adults who received ECMO between January 2017 and June 2022 were the subjects of a single-center retrospective study.Patients under the age of 18 years old,with acute ICH before ECMO,with less than 24 h of ECMO support,and with incomplete data were excluded.ICH was diagnosed by a head computed tomography scan.The outcomes included the incidence of ICH,in-hosptial mortality and 28-day mortality.Multivariate logistic regression analysis was used to identify relevant risk factors of ICH,and a predictive model of ICH with a nomogram was constructed.RESULTS:Among the 227 patients included,22 developed ICH during ECMO.Patients with ICH had higher in-hospital mortality (90.9%vs.47.8%,P=0.001) and higher 28-day mortality (81.8%vs.47.3%,P=0.001) than patients with non-ICH.ICH was associated with decreased grey-white-matter ratio (GWR)(OR=0.894,95%CI:0.841–0.951,P<0.001),stroke history (OR=4.265,95%CI:1.052–17.291,P=0.042),fresh frozen plasma (FFP) transfusion (OR=1.208,95%CI:1.037–1.408,P=0.015)and minimum platelet (PLT) count during ECMO support (OR=0.977,95%CI:0.958–0.996,P=0.019).The area under the receiver operating characteristic curve of the ICH predictive model was 0.843 (95%CI:0.762–0.924,P<0.001).CONCLUSION:ECMO-treated patients with ICH had a higher risk of death.GWR,stroke history,FFP transfusion,and the minimum PLT count were independently associated with ICH,and the ICH predictive model showed that these parameters performed well as diagnostic tools.展开更多
Human herpesvirus 6(HHV-6)is a common childhood infection but rarely causes severe complications.In immunocompetent children,conditions such as febrile convulsions and roseola infantum are typical,with occasional seve...Human herpesvirus 6(HHV-6)is a common childhood infection but rarely causes severe complications.In immunocompetent children,conditions such as febrile convulsions and roseola infantum are typical,with occasional severe manifestations like meningoencephalitis and myocarditis.展开更多
Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)is a life support intervention for patients with refractory cardiogenic shock or severe cardiopulmonary failure.However,the choice of cannulation strategy rema...Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)is a life support intervention for patients with refractory cardiogenic shock or severe cardiopulmonary failure.However,the choice of cannulation strategy remains contentious,partly due to insufficient understanding of hemodynamic characteristics associated with the site of arterial cannulation.In this study,a geometrical multiscale model was built to offer a mathematical tool for addressing the issue.The outflow cannula of ECMO was inserted into the ascending aorta in the case of central cannulation,whereas it was inserted into the right subclavian artery(RSA)or the left iliac artery(LIA)in the case of peripheral cannulation.Numerical simulations conducted on three patient-specific aortas demonstrated that the central cannulation outperformed the two types of peripheral cannulation in evenly delivering ECMO flow to branch arteries.Both the central and RSA cannulations could maintain an approximately normal hemodynamic state in the aortas,although the area of aortic walls exposed to abnormal wall shear stress(WSS)was considerably enlarged in comparison with the normal physiological condition.In contrast,the LIA cannulation not only led to insufficient delivery of ECMO flow to the right upper body(with ECMO flow fractions<0.5),but also induced marked flow disturbance in the aorta,causing about 40%of the abdominal aortic wall and over 65%of the resting aortic wall to suffer from high time-averaged WSS(>5 Pa)and low time-averaged WSS(<0.4 Pa),respectively.The LIA cannulation also resulted in significantly prolonged blood residence time(>40 s)in the ascending aorta,which,along with abnormal WSS,may considerably increase the risk of thrombosis.In summary,our numerical study elucidated the impact of arterial cannulation site in VA-ECMO intervention on aortic hemodynamics and ECMO flow distribution.The findings provide compensatory biomechanical information for traditional clinical studies and may serve as a theoretical reference for guiding the evaluation and selection of cannulation strategies in clinical practice.展开更多
MANTA vascular closure device is an alternative vascular access closure device that is predominantly designed for large bore arteriotomy procedures.Its implementation to reduce morbidity and mortality following percut...MANTA vascular closure device is an alternative vascular access closure device that is predominantly designed for large bore arteriotomy procedures.Its implementation to reduce morbidity and mortality following percutaneous procedures including peripheral veno-arterial(VA)-extracorporeal membrane oxygenation(ECMO)in critically ill patients with various severe clinical conditions such as refractory cardiogenic shock remains to be under scientific discussion.The use of the MANTA vascular closure device leads to a sufficient reduction in a number of post-decannulation complications such as bleeding,vascular complications,inflammatory reactions and major amputation.Furthermore,the technical success of percutaneous decannulation of VA-ECMO with the MANTA vascular closure device appears to be safe and effective.It has been reported that MANTA vascular closure device exerted a strict similarity with other vascular surgical systems in safe profile regardless of the indication for its utilization.Overall,the immobilized patients achieved a favorable recovery outcome with MANTA including safe decannulation and low risk of vascular complications.The authors suggest the use of pulse wave distal Doppler technology for early detection of these clinically relevant complications.In conclusion,MANTA vascular closure device seems to be safe and effective technical approach to provide low-risk vascular assess for a long time for severe sick individuals.展开更多
BACKGROUND Acute pulmonary thromboembolism is a complication of venous thrombosis.Extracorporeal membrane oxygenation(ECMO),an effective rescue measure for rapid hemodynamic recovery,can be used in patients for whom t...BACKGROUND Acute pulmonary thromboembolism is a complication of venous thrombosis.Extracorporeal membrane oxygenation(ECMO),an effective rescue measure for rapid hemodynamic recovery,can be used in patients for whom thrombolysis therapy has failed.CASE SUMMARY This case report describes an extreme rescue process for a patient with a preset inferior vena cava(IVC)filter in a relatively economically underdeveloped area with an insufficient supply of consumables.In an emergency,veno-arterial ECMO was successfully initiated by intubation through the IVC filter to the right atrial opening without displacement of the filter during the entire process.CONCLUSION This study demonstrates that in resource-limited settings,femoral vein cannulation for veno-arterial ECMO is a feasible and safe option for patients with preimplanted IVC filters.展开更多
A case of surgical nursing cooperation during extracorporeal membrane oxygenation(ECMO)-assisted hybrid sleeve left pneumonectomy,which included a right open carinal resection,tracheal bronchial anastomosis,and thorac...A case of surgical nursing cooperation during extracorporeal membrane oxygenation(ECMO)-assisted hybrid sleeve left pneumonectomy,which included a right open carinal resection,tracheal bronchial anastomosis,and thoracoscopic left pneumonectomy,has been documented.A thorough nursing intervention focused on patient safety and proactive measures to address potential complications was implemented throughout the surgical process.The procedure was completed without incident,and no postoperative complications were reported.展开更多
Central retinal artery occlusion(CRAO)is an acute ophthalmic emergency,characterized by sudden vision loss due to retinal ischemia in areas corresponding to arterial occlusion sites.Diagnosis primarily relies on fundu...Central retinal artery occlusion(CRAO)is an acute ophthalmic emergency,characterized by sudden vision loss due to retinal ischemia in areas corresponding to arterial occlusion sites.Diagnosis primarily relies on fundus fluorescein angiography(FFA)and optical coherence tomography(OCT),which show delayed retinal artery filling time hours to days after occlusion and increased hyperreflectivity of the inner retina.展开更多
In recent years,studies focusing on the conversion of renewable lignin-derived oxygenates(LDOs)have emphasized their potential as alternatives to fossil-based products.However,LDOs,existing as complex aromatic mixture...In recent years,studies focusing on the conversion of renewable lignin-derived oxygenates(LDOs)have emphasized their potential as alternatives to fossil-based products.However,LDOs,existing as complex aromatic mixtures with diverse oxygen-containing functional groups,pose a challenge as they cannot be easily separated via distillation for direct utilization.A promising solution to this challenge lies in the efficient removal of oxygen-containing functional groups from LDOs through hydrodeoxygenation(HDO),aiming to yield biomass products with singular components.However,the high dissociation energy of the carbon-oxygen bond,coupled with its similarity to the hydrogenation energy of the benzene ring,creates a competition between deoxygenation and benzene ring hydrogenation.Considering hydrogen consumption and lignin properties,the preference is directed towards generating aromatic hydrocarbons rather than saturated components.Thus,the goal is to selectively remove oxygen-containing functional groups while preserving the benzene ring structure.Studies on LDOs conversion have indicated that the design of active components and optimization of reaction conditions play pivotal roles in achieving selective deoxygenation,but a summary of the correlation between these factors and the reaction mechanism is lacking.This review addresses this gap in knowledge by firstly summarizing the various reaction pathways for HDO of LDOs.It explores the impact of catalyst design strategies,including morphology modulation,elemental doping,and surface modification,on the adsorption-desorption dynamics between reactants and catalysts.Secondly,we delve into the application of advanced techniques such as spectroscopic techniques and computational modeling,aiding in uncovering the true active sites in HDO reactions and understanding the interaction of reactive reactants with catalyst surface-interfaces.Additionally,fundamental insights into selective deoxygenation obtained through these techniques are highlighted.Finally,we outline the challenges that lie ahead in the design of highly active and selective HDO catalysts.These challenges include the development of detection tools for reactive species with high activity at low concentrations,the study of reaction medium-catalyst interactions,and the development of theoretical models that more closely approximate real reaction situations.Addressing these challenges will pave the way for the development of efficient and selective HDO catalysts,thus advancing the field of renewable LDOs conversion.展开更多
BACKGROUND Accurate condition assessment is critical for improving the prognosis of neonatal respiratory distress syndrome(RDS),but current assessment methods for RDS pose a cumulative risk of harm to neonates.Thus,a ...BACKGROUND Accurate condition assessment is critical for improving the prognosis of neonatal respiratory distress syndrome(RDS),but current assessment methods for RDS pose a cumulative risk of harm to neonates.Thus,a less harmful method for assessing the health of neonates with RDS is needed.AIM To analyze the relationships between pulmonary ultrasonography and respiratory distress scores,oxygenation index,and chest X-ray grade of neonatal RDS to identify predictors of neonatal RDS severity.METHODS This retrospective study analyzed the medical information of 73 neonates with RDS admitted to the neonatal intensive care unit of Liupanshui Maternal and Child Care Service Center between April and December 2022.The pulmonary ultrasonography score,respiratory distress score,oxygenation index,and chest Xray grade of each newborn before and after treatment were collected.Spearman correlation analysis was performed to determine the relationships among these values and neonatal RDS severity.RESULTS The pulmonary ultrasonography score,respiratory distress score,oxygenation index,and chest X-ray RDS grade of the neonates were significantly lower after treatment than before treatment(P<0.05).Spearman correlation analysis showed that before and after treatment,the pulmonary ultrasonography score of neonates with RDS was positively correlated with the respiratory distress score,oxygenation index,and chest X-ray grade(ρ=0.429–0.859,P<0.05).Receiver operating characteristic curve analysis indicated that pulmonary ultrasonography screening effectively predicted the severity of neonatal RDS(area under the curve=0.805–1.000,P<0.05).CONCLUSION The pulmonary ultrasonography score was significantly associated with the neonatal RDS score,oxygenation index,and chest X-ray grade.The pulmonary ultrasonography score was an effective predictor of neonatal RDS severity.展开更多
基金Supported by National Natural Science Foundation of China,No.82200353Jiangsu Province Double Innovation Doctoral Program,No.JSSCBS20221948+3 种基金Suzhou Gusu Health Talent Program,No.(2022)043Suzhou Gusu Health Talent Plan Talent Research Project,No.GSWS2022014Jiangsu Province College Students’Innovation and Entrepreneurship Training Program Project,No.202410285087Zand“Boxi”Talent Casting Plan of the First Affiliated Hospital of Soochow University。
文摘This article comments on the research by Zhang et al on the role of advanced heart failure and transplant teams in extracorporeal membrane oxygenation(ECMO)management.The study by Zhang et al indicates that direct advanced heart failure and transplant involvement improves survival in ECMO patients,especially those on veno-arterial ECMO.However,the optimal approach varies due to multiple factors.This article discusses the clinical implications,research design limitations,and future directions to enhance ECMO care.
文摘Extracorporeal membrane oxygenation(ECMO)has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies.ECMO allows blood to be extracted from a patient and introduced to a machine that oxygenates blood and removes carbon dioxide.This blood is then reintroduced into the patient’s circulatory system.This process makes ECMO essential for treating various medical conditions,both as a standalone therapy and as adjuvant therapy.Veno-venous(VV)ECMO primarily supports respiratory function and indicates respiratory distress.Simultaneously,veno-arterial(VA)ECMO provides hemodynamic and respiratory support and is suitable for cardiac-related complications.This study reviews recent literature to elucidate the evolving role of ECMO in trauma care,considering its procedural intricacies,indications,contraindications,and associated complications.Notably,the use of ECMO in trauma patients,particularly for acute respiratory distress syndrome and cardiogenic shock,has demonstrated promising outcomes despite challenges such as anticoagulation management and complications such as acute kidney injury,bleeding,thrombosis,and hemolysis.Some studies have shown that VV ECMO was associated with significantly higher survival rates than conventional mechanical ventilation,whereas other studies have reported that VA ECMO was associated with lower survival rates than VV ECMO.ECMO plays a critical role in managing trauma patients,particularly those with acute respiratory failure.Further research is necessary to explore the full potential of ECMO in trauma care.Clinicians should have a clear understanding of the indications and contraindications for the use of ECMO to maximize its benefits in treating trauma patients.
基金Supported by General Scientific Research Project of the Zhejiang Provincial Department of Education,No.Y201941857the Medical Science and Technology Project of Zhejiang Province,No.2019RC170.
文摘BACKGROUND Veno-venous extracorporeal membrane oxygenation(V-V ECMO)is a lifesaving intervention for severe respiratory failure;however,its effectiveness depends on accurate cannulation-patients with anatomical variations present with significant challenges during the procedure.CASE SUMMARY We describe the case of a 56-year-old woman with severe pulmonary infection and acute respiratory failure managed with V-V ECMO.During the initial cannulation,a 23Fr venous drainage cannula was inadvertently inserted into the middle hepatic vein(HV)instead of the inferior vena cava(IVC)owing to the enlargement of the HV(1.02 cm diameter)and its acute angle(77.78°)relative to the IVC.This misplacement led to extracorporeal membrane oxygenation(ECMO)flow issues which were resolved after repositioning the cannula under real-time ultrasonographic and fluoroscopic guidance.This correction stabilized the patient’s condition and restored effective ECMO function,preventing severe complications such as liver injury and liver failure.CONCLUSION In clinical practice,real-time ultrasonography and fluoroscopy are critical in preventing cannulation errors in patients with anatomical variations.Vigilant imaging and precise techniques are essential for optimizing ECMO management and effectively addressing complications.
基金Natural Sciences Foundation of Gansu(No.23JRRA0972No.25RCKA013)+4 种基金Natural Sciences Foundation of Fujian(No.2022J05105)Science and Technology Planning Project of Chengguan District(No.2022RCCX0023)Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital(No.CY2022-MS-A03)Talent Introduction Plan of the Lanzhou University Second Hospital(No.YJRCKYQDJ-2021-02)Major Scientific Research Project on Health and Medical Science and Technology Innovation in Gansu Province(No.GSWSQNPY2024-13).
文摘BACKGROUND:Extracorporeal membrane oxygenation(ECMO)is an effective measure for saving the lives of critically ill patients.Prompt identification of the risk factors for mortality among patients receiving ECMO and comprehensive analysis of the long-term prognosis of survivors are vital.This scoping review summarized the representative prognostic scoring systems,aiming to help clinicians in selecting an appropriate scoring system to avoid unnecessary medical resource consumption and reduce ECMO-associated mortality.METHODS:A comprehensive search of multiple databases,including PubMed,Embase,and the Cochrane Library,was conducted.After removing duplicate studies,a full-text review was performed,and all studies that reported score systems before and/or after ECMO support were included.This protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews(PRISMA-ScR)and has been registered with the Open Science Framework(osf.io/zp4ge).RESULTS:Among the 114 studies included,we identified three scores for patients receiving veno-venous ECMO(VV-ECMO),five scores for patients receiving veno-arterial ECMO(VA-ECMO),and three critical illness scores,which apply to both VV-and VA-ECMO conditions.All characteristics of these scoring systems,their advantages,and their limitations were summarized.CONCLUSION:The implementation of an ECMO scoring system helps to assess the condition of critically ill patients,predict outcome,and provide objective indicators to determine the optimal timing for ECMO intervention.Due to the limitations of the currently available scores,further efforts in improving and validating the ECMO scoring system are needed to achieve the goals of minimizing unnecessary consumption of medical resources and reducing mortality rates.
文摘BACKGROUND Venlafaxine,a serotonin-norepinephrine reuptake inhibitor,is widely prescribed for the treatment of major depressive disorder.At therapeutic dose,it is generally safe,with a low incidence of adverse effects.However,massive venlafaxine inge-stion can cause serious cardiotoxicity,leading to life-threatening arrhythmias.CASE SUMMARY A 31-year-old woman with a history of depression ingested 14.8 g of venlafaxine along with 6 mg of estazolam and 6 mg of flunitrazepam.On admission,2 hours post-ingestion,she presented only with mild QTc prolongation.At 4 hours post-ingestion,she developed a generalized tonic-clonic seizure.Following endo-tracheal intubation,intravenous midazolam infusion was initiated and 50 g of activated charcoal was administered via a nasogastric tube.At 15 hours post-ingestion,she developed ventricular tachycardia that rapidly progressed to refr-actory ventricular fibrillation,which was successfully treated with veno-arterial extracorporeal membrane oxygenation.Toxicological analysis revealed serum ve-nlafaxine and O-desmethylvenlafaxine concentrations 17µg/mL and 10µg/mL,respectively,at 15 hours post-ingestion.CONCLUSION In cases of massive venlafaxine ingestion,continuous intensive monitoring,particularly of QTc,is essential for at least 24 hours,even when initial clinical signs are mild.If refractory ventricular arrhythmias occur,prompt ini-tiation of veno-arterial extracorporeal membrane oxygenation should be considered.
文摘BACKGROUND Extracorporeal membrane oxygenation(ECMO)is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments.Patients that are supported with veno-arterial ECMO(VA-ECMO)are considered very-high risk patients to participate in any type of physical therapy(PT)or mobilization.However,cumulative evidence suggests that early mobilization of critically ill patients is feasible,safe,and efficient under certain circumstances.AIM To summarize the existing evidence on the impact of early mobilization and physiotherapy on VA-ECMO patients.METHODS This is a scoping review that used systematic electronic literature searches(from inception until January 2025)on MEDLINE(PubMed),PEDro,DynaMed,CINAHL,Scopus,Science direct and Hellenic Academic Libraries.Snowball searching method was also applied.Eligible studies included those reporting patients on VA-ECMO who participated in early mobilization or PT,published in English and utilized any primary evidence study design.Studies on children,animals and patients placed on any other ECMO,secondary evidence,and‘grey’literature were excluded.RESULTS A total of 316 articles were retrieved and 13 were included in the study.Of those,1 study was a randomized control trial,4 retrospective studies,4 retrospective cohort studies,1 case series and 3 case reports.The sample size of the included studies ranged from 1 to 104 VA-ECMO patients,who were ambulated or received PT inter-ventions,and mobilization frequency ranged from 2 per day to 4 per week.Mobilization of VA-ECMO patients seems to be safe regardless the cannula’s position.PT and early mobilization were associated with better weaning from mechanical ventilation,gradual reduction of inotropes and functional capacity improvement after ECMO discharge.CONCLUSION Early mobilization in VA-ECMO seems to be safe and can potentially help reduce vasoconstrictors and speed up rehabilitation times.High quality research on early mobilization in VA-ECMO patients is warranted.
基金supported by the CAMS Innovation Fund for Medical Sciences(2024-12M-C&T-B-045).
文摘BACKGROUND:Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology.We aimed to investigate the relationships between liver function indicators at hospital admission and mortality in children receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO)support following cardiac surgery.METHODS:We retrospectively analysed the clinical data of pediatric patients who received postcardiotomy VA-ECMO support at Fuwai Hospital between January 2010 and June 2020.Univariable and multivariable-adjusted Cox proportional hazard models were constructed to evaluate the risk factors associated with 30-day and 180-day mortality.The cut-off values for the liver function variables measured at hospital admission were categorized into high and low groups and then compared using Kaplan-Meier survival curves and log-rank tests.RESULTS:Our study included 96 pediatric patients who received VA-ECMO support after cardiotomy.Among the patients receiving VA-ECMO,the 30-day and 180-day mortality rates were 37.5% and 52.1%,respectively.The level of aspartate aminotransferase(AST)at admission was associated with 30-day mortality(hazard ratios[HRs]=1.852,95%CI 1.010-3.398,P=0.046).The AST and alkaline phosphatase(ALP)levels were predictors of 180-day mortality,with adjusted HRs of 1.799(95%CI 1.074-3.014;P=0.025)and 1.384(95%CI 1.050-1.825;P=0.021),respectively.The cut-off value for AST to predict mortality at 30 d was 77 U/L,and that for ALP to predict mortality at 180 d was 269 U/L.CONCLUSION:Liver function indicators,including AST and ALP,at hospital admission are associated with mortality risk in children with congenital heart disease receiving VA-ECMO after cardiac surgery.
文摘This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support.Advanced heart failure and transplant cardiology(AHFTC)teams play an essential role in managing patients in cardiogenic shock.To determine whether ECMO patient management outcomes differ based on whether AHFTC physicians assume a direct or consultative role,a retrospective cohort study of 51 patients placed on veno-venous and veno-arterial(VA)ECMO between January 2015 and February 2023 was conducted.Results demonstrated a significantly higher 30-day postdischarge survival rate in the AHFTC direct involvement cohort compared to the consultative group(67%vs 30%)for all ECMO patients.This survival benefit was primarily attributable to VA ECMO patients(64%vs 20%).Direct involvement of AHFTC teams in patient selection and management may enhance survival in patients requiring VA ECMO for cardiogenic shock;however,further research is necessary to confirm these findings.
文摘BACKGROUND Pheochromocytoma(PHEO)is a type of tumor that originates from chromaffin cells in the adrenal medulla and is classified as an adrenal paraganglioma.PHEOs can secrete catecholamines,leading to a variety of symptoms.Accurate diagnosis and appropriate treatment selection are crucial for favorable outcomes in these cases.CASE SUMMARY The patient presented with unexplained chest tightness,palpitations,and pink sputum.Upon examination and analysis of laboratory results,a diagnosis of adrenal PHEO was established.The PHEO secreted high levels of catecholamines,causing sudden fluctuations in blood pressure and heart rate,leading to extre-mely unstable hemodynamics.Treatment with extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation helped stabilize the patient’s vital signs,allowing for timely surgical intervention.CONCLUSION The combination of extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation can enhance tissue perfusion,thus providing a solid foundation for the accurate diagnosis and effective surgical treatment of PHEO.
基金Supported by the Priority Project of the Multi-Source Investment Fund Program,China,No.S21DYZD3172the Tianjin Key Medical Discipline(Specialty)Construction Project,China,No.TJYXZDXK-020A.
文摘BACKGROUND Data on adsorptive extracorporeal membrane oxygenation(ECMO)(combined with HA380 hemoperfusion column)on the inflammatory factors in patients with cardiogenic shock(CS)remains limited.AIM To investigate the effects of adsorptive ECMO on the inflammatory factors in patients with CS.METHODS A retrospective analysis was performed on 81 patients with CS caused by acute myocardial infarction,fulminant myocarditis,or cardiac surgery who required venoarterial ECMO support at TEDA International Cardiovascular Hospital from December 2020 to December 2024.Patients were divided into the conventional ECMO group(42 cases)and the adsorptive ECMO group(ECMO combined with hemoperfusion,39 cases).The adsorptive ECMO group received 2 columns of HA380 initiation on the first day(the first column connected within 2 hours of ECMO and the second after 12 hours of ECMO),followed by 1 column each day,with each column used for 4–6 hours,totaling 24–30 hours of treatment.Baseline data were compared between the two groups:Inflammatory factor levels(at 0,6,12,24,48,and 72 hours after ECMO or hemoperfusion initiation);ECMO support duration;successful weaning rate;continuous renal replacement therapy(CRRT)utilization;Sequential Organ Failure Assessment(SOFA)score;Vasoactive-Inotropic Score(VIS);systemic inflammatory response syndrome(SIRS)incidence;and in-hospital survival and 30-/90-day survival after discharge.RESULTS The adsorptive ECMO group showed significantly lower levels of C-reactive protein,interleukin(IL)-6,tumor necrosis factor(TNF)-α,and lactate from 6 to 72 hours compared with the conventional ECMO group(all P<0.05),with IL-6 decreasing by 94.4%and tumour necrosis factor alpha by 70.1%from baseline at 72 hours.The adsorptive ECMO group had a significantly shorter ECMO duration[114.0(75.0–139.0)hours vs 135.0(73.0–199.3)hours,P=0.032];higher successful weaning rate(66.7%vs 42.9%,P=0.032);a trend toward lower CRRT utilization(54.8%vs 38.5%,P=0.070);lower post-weaning SOFA score[7(6–8)vs 9(8–10),P<0.001];significantly reduced VIS(8.4±1.3 vs 9.8±1.6,P<0.001);and a trend toward lower SIRS incidence(10.3%vs 26.2%,P=0.065).There were no significant differences in complications,in-hospital survival(64.1%vs 52.4%,P=0.285);or 30-/90-day survival between the two groups(all P>0.05).CONCLUSION Adsorptive ECMO efficiently clears IL-6 and TNF-α,significantly improving ECMO weaning success rate and hemodynamics.However,it has no significant impact on survival,and its efficacy requires validation through prospective studies.
文摘BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.
基金supported by the National Natural Science Foundation of China (82072159)。
文摘BACKGROUND:Intracranial hemorrhage (ICH),a severe complication among adults receiving extracorporeal membrane oxygenation (ECMO),is often related to poor outcomes.This study aimed to establish a predictive model for ICH in adults receiving ECMO treatment.METHODS:Adults who received ECMO between January 2017 and June 2022 were the subjects of a single-center retrospective study.Patients under the age of 18 years old,with acute ICH before ECMO,with less than 24 h of ECMO support,and with incomplete data were excluded.ICH was diagnosed by a head computed tomography scan.The outcomes included the incidence of ICH,in-hosptial mortality and 28-day mortality.Multivariate logistic regression analysis was used to identify relevant risk factors of ICH,and a predictive model of ICH with a nomogram was constructed.RESULTS:Among the 227 patients included,22 developed ICH during ECMO.Patients with ICH had higher in-hospital mortality (90.9%vs.47.8%,P=0.001) and higher 28-day mortality (81.8%vs.47.3%,P=0.001) than patients with non-ICH.ICH was associated with decreased grey-white-matter ratio (GWR)(OR=0.894,95%CI:0.841–0.951,P<0.001),stroke history (OR=4.265,95%CI:1.052–17.291,P=0.042),fresh frozen plasma (FFP) transfusion (OR=1.208,95%CI:1.037–1.408,P=0.015)and minimum platelet (PLT) count during ECMO support (OR=0.977,95%CI:0.958–0.996,P=0.019).The area under the receiver operating characteristic curve of the ICH predictive model was 0.843 (95%CI:0.762–0.924,P<0.001).CONCLUSION:ECMO-treated patients with ICH had a higher risk of death.GWR,stroke history,FFP transfusion,and the minimum PLT count were independently associated with ICH,and the ICH predictive model showed that these parameters performed well as diagnostic tools.
文摘Human herpesvirus 6(HHV-6)is a common childhood infection but rarely causes severe complications.In immunocompetent children,conditions such as febrile convulsions and roseola infantum are typical,with occasional severe manifestations like meningoencephalitis and myocarditis.
基金supported by the National Natural Science Foundation of China(Grant Nos.12372309,12061131015).
文摘Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)is a life support intervention for patients with refractory cardiogenic shock or severe cardiopulmonary failure.However,the choice of cannulation strategy remains contentious,partly due to insufficient understanding of hemodynamic characteristics associated with the site of arterial cannulation.In this study,a geometrical multiscale model was built to offer a mathematical tool for addressing the issue.The outflow cannula of ECMO was inserted into the ascending aorta in the case of central cannulation,whereas it was inserted into the right subclavian artery(RSA)or the left iliac artery(LIA)in the case of peripheral cannulation.Numerical simulations conducted on three patient-specific aortas demonstrated that the central cannulation outperformed the two types of peripheral cannulation in evenly delivering ECMO flow to branch arteries.Both the central and RSA cannulations could maintain an approximately normal hemodynamic state in the aortas,although the area of aortic walls exposed to abnormal wall shear stress(WSS)was considerably enlarged in comparison with the normal physiological condition.In contrast,the LIA cannulation not only led to insufficient delivery of ECMO flow to the right upper body(with ECMO flow fractions<0.5),but also induced marked flow disturbance in the aorta,causing about 40%of the abdominal aortic wall and over 65%of the resting aortic wall to suffer from high time-averaged WSS(>5 Pa)and low time-averaged WSS(<0.4 Pa),respectively.The LIA cannulation also resulted in significantly prolonged blood residence time(>40 s)in the ascending aorta,which,along with abnormal WSS,may considerably increase the risk of thrombosis.In summary,our numerical study elucidated the impact of arterial cannulation site in VA-ECMO intervention on aortic hemodynamics and ECMO flow distribution.The findings provide compensatory biomechanical information for traditional clinical studies and may serve as a theoretical reference for guiding the evaluation and selection of cannulation strategies in clinical practice.
文摘MANTA vascular closure device is an alternative vascular access closure device that is predominantly designed for large bore arteriotomy procedures.Its implementation to reduce morbidity and mortality following percutaneous procedures including peripheral veno-arterial(VA)-extracorporeal membrane oxygenation(ECMO)in critically ill patients with various severe clinical conditions such as refractory cardiogenic shock remains to be under scientific discussion.The use of the MANTA vascular closure device leads to a sufficient reduction in a number of post-decannulation complications such as bleeding,vascular complications,inflammatory reactions and major amputation.Furthermore,the technical success of percutaneous decannulation of VA-ECMO with the MANTA vascular closure device appears to be safe and effective.It has been reported that MANTA vascular closure device exerted a strict similarity with other vascular surgical systems in safe profile regardless of the indication for its utilization.Overall,the immobilized patients achieved a favorable recovery outcome with MANTA including safe decannulation and low risk of vascular complications.The authors suggest the use of pulse wave distal Doppler technology for early detection of these clinically relevant complications.In conclusion,MANTA vascular closure device seems to be safe and effective technical approach to provide low-risk vascular assess for a long time for severe sick individuals.
文摘BACKGROUND Acute pulmonary thromboembolism is a complication of venous thrombosis.Extracorporeal membrane oxygenation(ECMO),an effective rescue measure for rapid hemodynamic recovery,can be used in patients for whom thrombolysis therapy has failed.CASE SUMMARY This case report describes an extreme rescue process for a patient with a preset inferior vena cava(IVC)filter in a relatively economically underdeveloped area with an insufficient supply of consumables.In an emergency,veno-arterial ECMO was successfully initiated by intubation through the IVC filter to the right atrial opening without displacement of the filter during the entire process.CONCLUSION This study demonstrates that in resource-limited settings,femoral vein cannulation for veno-arterial ECMO is a feasible and safe option for patients with preimplanted IVC filters.
文摘A case of surgical nursing cooperation during extracorporeal membrane oxygenation(ECMO)-assisted hybrid sleeve left pneumonectomy,which included a right open carinal resection,tracheal bronchial anastomosis,and thoracoscopic left pneumonectomy,has been documented.A thorough nursing intervention focused on patient safety and proactive measures to address potential complications was implemented throughout the surgical process.The procedure was completed without incident,and no postoperative complications were reported.
基金Supported by National Natural Science Foundation of China(No.82070991).
文摘Central retinal artery occlusion(CRAO)is an acute ophthalmic emergency,characterized by sudden vision loss due to retinal ischemia in areas corresponding to arterial occlusion sites.Diagnosis primarily relies on fundus fluorescein angiography(FFA)and optical coherence tomography(OCT),which show delayed retinal artery filling time hours to days after occlusion and increased hyperreflectivity of the inner retina.
基金supported by the National Natural Science Foundation of China,Pilot Group Program of the Research Fund for International Senior Scientists(22250710676)National Natural Science Foundation of China(22078064,22378062,22304028)+1 种基金Natural Science Foundation of Fujian Province(2021J02009)Tianjin University-Fuzhou University Independent Innovation Fund Cooperation Project(TF2023-1,TF2023-8).
文摘In recent years,studies focusing on the conversion of renewable lignin-derived oxygenates(LDOs)have emphasized their potential as alternatives to fossil-based products.However,LDOs,existing as complex aromatic mixtures with diverse oxygen-containing functional groups,pose a challenge as they cannot be easily separated via distillation for direct utilization.A promising solution to this challenge lies in the efficient removal of oxygen-containing functional groups from LDOs through hydrodeoxygenation(HDO),aiming to yield biomass products with singular components.However,the high dissociation energy of the carbon-oxygen bond,coupled with its similarity to the hydrogenation energy of the benzene ring,creates a competition between deoxygenation and benzene ring hydrogenation.Considering hydrogen consumption and lignin properties,the preference is directed towards generating aromatic hydrocarbons rather than saturated components.Thus,the goal is to selectively remove oxygen-containing functional groups while preserving the benzene ring structure.Studies on LDOs conversion have indicated that the design of active components and optimization of reaction conditions play pivotal roles in achieving selective deoxygenation,but a summary of the correlation between these factors and the reaction mechanism is lacking.This review addresses this gap in knowledge by firstly summarizing the various reaction pathways for HDO of LDOs.It explores the impact of catalyst design strategies,including morphology modulation,elemental doping,and surface modification,on the adsorption-desorption dynamics between reactants and catalysts.Secondly,we delve into the application of advanced techniques such as spectroscopic techniques and computational modeling,aiding in uncovering the true active sites in HDO reactions and understanding the interaction of reactive reactants with catalyst surface-interfaces.Additionally,fundamental insights into selective deoxygenation obtained through these techniques are highlighted.Finally,we outline the challenges that lie ahead in the design of highly active and selective HDO catalysts.These challenges include the development of detection tools for reactive species with high activity at low concentrations,the study of reaction medium-catalyst interactions,and the development of theoretical models that more closely approximate real reaction situations.Addressing these challenges will pave the way for the development of efficient and selective HDO catalysts,thus advancing the field of renewable LDOs conversion.
基金Guizhou Provincial Science and Technology Department,Technology Achievement Application and Industrialization Plan,Applied Fundamental Research,No.Qianke Synthetic Fruit[2022]004.
文摘BACKGROUND Accurate condition assessment is critical for improving the prognosis of neonatal respiratory distress syndrome(RDS),but current assessment methods for RDS pose a cumulative risk of harm to neonates.Thus,a less harmful method for assessing the health of neonates with RDS is needed.AIM To analyze the relationships between pulmonary ultrasonography and respiratory distress scores,oxygenation index,and chest X-ray grade of neonatal RDS to identify predictors of neonatal RDS severity.METHODS This retrospective study analyzed the medical information of 73 neonates with RDS admitted to the neonatal intensive care unit of Liupanshui Maternal and Child Care Service Center between April and December 2022.The pulmonary ultrasonography score,respiratory distress score,oxygenation index,and chest Xray grade of each newborn before and after treatment were collected.Spearman correlation analysis was performed to determine the relationships among these values and neonatal RDS severity.RESULTS The pulmonary ultrasonography score,respiratory distress score,oxygenation index,and chest X-ray RDS grade of the neonates were significantly lower after treatment than before treatment(P<0.05).Spearman correlation analysis showed that before and after treatment,the pulmonary ultrasonography score of neonates with RDS was positively correlated with the respiratory distress score,oxygenation index,and chest X-ray grade(ρ=0.429–0.859,P<0.05).Receiver operating characteristic curve analysis indicated that pulmonary ultrasonography screening effectively predicted the severity of neonatal RDS(area under the curve=0.805–1.000,P<0.05).CONCLUSION The pulmonary ultrasonography score was significantly associated with the neonatal RDS score,oxygenation index,and chest X-ray grade.The pulmonary ultrasonography score was an effective predictor of neonatal RDS severity.
