Objective To analyze the risk factors of hypoxemia after coronary artery bypasses grafting (CABG) along with cardiopulmonary bypasses and to understand the regular pattern and characteristics of hypoxemia after CABG. Methods The risk factors of hypoxemia were studied by one way analysis and multivariate logistic regression analysis in 86 patients with hypoxemia after CABG along with cardiopulmonary bypass. Results One way analysis indicated that hypoxemia after CABG along with cardiopulmonary bypass was related to senility ( ≥ 65 years ), smoking history, diabetes mellitus, chronic obstructive pulmonary disease ( COPD), left ventricular ejection fraction ( LVEF ＜ 45 % ), obesity before operation, transfusion ( ≥ 1000 ml );multivariate analysis indicated that pulmonary dysfunction before operation, longer extracorporeal circulation time ( ≥2 h), hypoalbuminemia and pulmonary infection were independent risk factors of hypoxemia after CABG along with cardiopulmonary bypass. Conclusion Multiple risk factors contributed to hypoxemia after CABG along with cardiopulmonary bypass. Increase the awareness of risk factors of perioperative hypoxemia may guide the prevention and treatment, even alleviate or avoid the hypoxemia postoperatively.

Objective To evaluate the safety and efficacy of FW-Ⅱ axial blood pump short term assistance for treating acute heart failure.Methods We selected 5 patients who were difficult to remove cardiopulmonary bypass,and implanted FW-Ⅱ axial blood pump by left atrium-pump-femoral artery.Perioperative hemodynamics,circulating markers of myocardial injury,vW factor levels in plasma and white blood cell-platelet aggregates in different rotational speed were observed and analyzed.Results All patients were assisted for(24.0 ± 2.6) h by FW-Ⅱ axial blood pump with speed of 7 000-9 000 r/min,flow of 1.9-3.0 L/min,and no mechanical dysfunction.Compared with mean artery pressure(MAP),cardiac index(CI) and systemic vascular resistance index (SVRI) before implantation of FW-Ⅱ axial pump was (50.29 ± 6.98) mmHg (1 mmHg=0.133kPa),(1.70±0.23)L· min-1 · m-2 and (2 009.86 ±129.46) dyn· s · cm-5,MAP and CI significantly increased,while SVRI significantly reduced at 8 000 r/min after pump assistance [(65.43 ± 6.90) mmHg,(2.53 ± 0.27) L · min-1 · m-2,(1 578.14 ± 356.70) dyn · s · cm-5,P ＜ 0.01).CK-MB and cTnI levels reached significant decrease after 12 hours of pump assistance and maintained low level [(66 ± 11) IU/L and (8.4 ± 3.8) μg/L,P ＜ 0.01].Compared with 7 000 r/min,vW factor levels significantly increased at 8 500 r/min [(2.59 ± 0.57) U/L vs (1.26 ± 0.43) U/L,P ＜0.01].Platelet activation and white blood cell-platelet aggregation was the lowest at 8 000 r/min,and reached the most high level at 7 000 and 9 000 r/min [(15 ± 3) ％,(33 ± 3) ％ and (31 ± 5) ％)].Conclusion FW-Ⅱ axial flow pump can be effectively used for short-term treatment of acute ischemic left ventricular failure,8 000 r/min is optimum speed to balance hemodynamics and biocompatility.

Objective: To evaluate short-term effect and risk factors for the timing of intra-aortic balloon pump (IABP) implantation with coronary artery bypass grafting (CABG) in high risk coronary artery disease (CAD) patients. Methods: A total of 197 high risk CAD patients received IABP with CABG in our hospital from 2010-01 to 2015-12 were retrospectively analyzed. There were 91 (46.2%) male and the mean arterial pressure (MAP) was (70.3±8.2) mmHg. Based on IABP implantation time, the patients were divided into 2groups: Pre-operative IABP group,n=89 and Intra- , post-operative IABP group,n=108. Peri-operative condition, durations of mechanical ventilation and ICU stay were compared between 2 groups; survival condition was studied by Kaplan-Meier analysis; risk factors causing 30-day mortality was assessed by Logistic regression analysis and its sensitivity and specialty was measured by ROC curve. Results: The mean durations for aortic clamping and cardiopulmonary bypass were (86.7±37.3) min and (147.3±18.4) min in all 197 patients. The age, gender, blood levels of CK-MB c-TnI, creatinine, MAP and European cardiac surgery system scoring were similar between 2 groups, allP>0.05. Compared with Intra- , post-operative IABP group, Pre-operative IABP group had decreased CK-MB (130.6±25.4) mmol/L vs (149.7±18.2) mmol/L at 48h post-operation and mechanical ventilation time (81.5±10.3) h vs (107.9±11.5) h, less in-hospital stay (21.3±4.1) d vs (27.7±9.4) d, reduced acute kidney injury (3.4% vs 23.1%), brain complication (5.6% vs 19.4%) and 30-day mortality (4.5% vs 36.1%), allP<0.05. Kaplan-Meier analysis indicated that the median survival time was longer in Pre-operative IABP group, (27.9±1.2 vs 16.5±2.2) dP<0.05; Logistic regression analysis and ROC curve demonstrated that IABP re-implantation (OR=2.37, 95% CI 1.42-5.72,P=0.01) was an important risk factor for 30-day mortality with the sensitivity of 75.3% and specialty of 67.4%. Conclusion: Pre-operative IABP implantation was helpful for decreasing post-operative level of CK-MB, reducing mechanical ventilation, in-hospital time and short-term mortality in high risk CAD patients; IABP re-implantation was the risk factor for short-term mortality.

Objective To study the impact of the off-pump coronary artery bypass compared to the on-pump coronary artery bypass technique on the rate of acute kidney injury.Methods A retrospective analysis of 824 patients accepted coronary artery bypass surgery in FuWai Hospital Surgical ICU from March 2011 to January 2013.Patients were divided into two groups according to the surgical approach,597 patients in on-pump group and 227 patients in off-pump group.Then compared the difference of acute kidney injury incidence in the two groups.Results 92 patients in the on-pump group occurred AKI,the incidence of AKI was 15.4％.32 patients in the off-pump group occurred AKI,the incidence of AKI was 14.1％.Two groups of patients had no statistical difference in the incidence of AKI,x2 =0.222,P =0.638.Based on the preoperative baseline creatinine clearance levels.We defined normal creatinine clearance (SCR ≥ 60 ml/min),mild renal insufficiency (45 ml/min ＜ SCR ＜60 ml/min),moderate renal dysfunction group(31 ml/min ＜ SCR ＜45 ml/min).Decline with the preoperative creatinine clearance rate,the AKI incidence was elevated significantly,P ＜0.05.Patients with moderate renal insufficiency,offpump patients had lower incidence of AKI than those in on-pump group,P ＜ 0.05.The incidence of renal replacement in the two group patients had no statistical differences.Conclusion The incidence of AKI after coronary artery bypass surgery had no statistical differences with or without pump.In the patients with preoperative moderate renal insufficiency,off-pump can reduce the incidence of AKI,but could not change the kidney the incidence of renal replacement treatment.

Objective:To analyze the risk factors for postoperative delirium in cardiac surgery through an observational cohort study.Methods:Data of postoperative cardiac surgery patients (1 562 cases)who underwent median open-heart extracorporeal circulation between January 2020 and April 2021 at Fuwai Hospital were prospectively included, and patients were divided into delirium group(503 cases, 32.2%) and non-delirium group(1 059 cases, 67.8%) according to whether delirium occurred after surgery, and clinical indicators of the two groups were compared preoperatively, intraoperatively and postoperatively to determine the risk factors for postoperative delirium.Results:The first 48 h after surgery was the high incidence of delirium, accounting for 87.2% of the total incidence of delirium. The incidence of postoperative delirium varied widely among patients with different types of cardiac surgery. The percentage of unemployment and joblessness was higher in delirium group (7.3% vs. 4.8%, P<0.05), and the percentage of hypertension and carotid stenosis were higher than those in non-delirium group( P<0.05). Statistical differences existed between the type of surgery, intraoperative extracorporeal circulation time and block time, and intraoperative hypotensive events (MAP<40 mmHg, 1 mmHg=0.133 kPa), P<0.05. The first postoperative blood glucose was higher in delirium group , and the first blood gas partial pressure of oxygen and the first postoperative ultrasound left ventricular ejection fraction were lower than those in non-delirium group( P<0.05). There was no statistical difference in the duration of postoperative mechanical ventilation between the two groups( P>0.05), but the mean ICU stay was higher in delirium group ( P<0.05). The in-hospital mortality rate , the incidence of postoperative respiratory complications, and the mean hospitalization cost were also higher in delirium group than those in non-delirium group ( P<0.05). Multifactorial logistic regression analysis showed that carotid stenosis, preoperative hypertension, intraoperative block time >120 min and first postoperative blood glucose were independent risk factors for postoperative cardiac delirium. Conclusion:Carotid stenosis, preoperative hypertension, intraoperative block time >120 min and first postoperative blood glucose were independent risk factors for postoperative cardiac delirium.

Objective:To analyze the epidemiological and clinical characteristics of human brucellosis in Enshi Tujia and Miao Autonomous Prefecture (Enshi Prefecture) of Hubei Province, and to provide a basis for prevention and control of local brucellosis.Methods:Using descriptive epidemiological methods, the data of reported cases of brucellosis in Enshi Prefecture from 2012 to 2019 (from the "Enshi Infectious Disease Reporting Information Management System" and the medical record system of hospitals in counties and cities within the jurisdiction of Enshi Prefecture) were collected, and the three distributions (population, time, region distributions) and clinical manifestations of human brucellosis cases were statistically described and analyzed.Results:A total of 78 brucellosis cases were reported in Enshi Prefecture from 2012 to 2019, with an average annual incidence rate of 0.193 5/100 000. Among the 78 cases of brucellosis reported, the sex ratio of men to women was 2.12∶1.00 (53∶25); the age of onset was mainly from 30 to 59 years old, accounting for 75.64% (59/78); the occupation was mainly farmer, accounting for 88.46% (69/78); the main contact animal was sheep, accounting for 80.77% (63/78). There were reported cases of brucellosis throughout the year, and the main onset months were May, June, September, November, and December, accounting for 55.13% (43/78) of the total number. From 2012 to 2019, all counties and cities in Enshi Prefecture except Xianfeng County and Hefeng County had reported cases. Among them, Lichuan City had the most cases, with 55 cases (70.51%). The main clinical manifestations of reported cases of brucellosis were fever, fatigue, hyperhidrosis, and muscle and joint pain, which accounted for 98.72% (77 cases), 89.74% (70 cases), 79.49% (62 cases), and 69.23% (54 cases), respectively.Conclusions:The majority of patients with brucellosis in Enshi Prefecture are young and middle-aged male farmers, with the highest incidence in Lichuan City. Relevant departments should increase the propaganda of brucellosis, increase the people's awareness of disease prevention, and strengthen the prevention and control measures of high-risk groups and regions to reduce the incidence of brucellosis.

Objective To explore the clinical efficacy and safety of off-clamping in robotic-assisted partial nephrectomy (RAPN) for the treatment of renal tumors.Methods From January 2015 to March 2017,the data of 48 patients who underwent off-clamping RAPN were reviewed retrospectively.There were 31 males and 17 females,and the mean age was 57 years (range:23-84 years).The mean tumor size was 3.1 cm (range:1.2-6.4 cm),with the upper,middle,and lower polar tumors account for 35.4％,27.1％,and 37.5％,respectively.The clinical tumor stage was T1N0M0 in all 48 cases,according to the AJCC tumor staging system for renal cancer.Results RAPNs were performed successfully in all 48 cases,without conversion to open surgery.In those patients,the application of off-clamping in robotic-assisted partial nephrectomy was performed in 44 cases.The renal artery and vein was exposed,dissected,isolated and then clamped in 4 cases due to bleeding.The mean surgical time was 85 min (range:75-185 min).The mean estimated blood loss was 134 ml (range:60-270 ml),and no blood transfusion was needed.The wound surface was closed using interrupted suture with Hem-o-lok clips securing each needle point.The mean time for renorrhaphy was 22 min (rang:11-31 min).No intraoperative severe complications such as vascular injury,trauma of abdominal organ occurred.There were 5 complications,including 2 cases of hematuria,2 cases of delayed healing of incision,and 1 case of pneumohypoderma.The pathological diagnosis included 40 cases of renal clear cell carcinoma,3 cases of papillary renal cell carcinoma,and 5 cases of angiomyolipomas.No tumor recurrence or distant metastasis was observed during the average follow-up of 17 months (range 3-27 months).Conclusions Off-clamping RAPN is safe and feasible approach to excise certain kidney tumors.It carries the benefits of less complication,quick recovery,and less ischemia reperfusion renal injury.Off-clamping RAPN would be suitable for those patients with solitary kidneys,renal insufficiency,and bilateral tumors.

Objective To observe the incidence of spinal cord injury (SCI) following aortic surgery in Fuwai Hospital of Chinese Academy of Medical Sciences, and evaluate the effect of standardized multidisciplinary spinal cord protection strategies, to summarize the experience in the prevention and treatment of SCI at perioperative period of aortic surgery. Methods The clinical data of patients underwent aortic surgery admitted to vascular center of Fuwai Hospital from January 2011 to December 2018 were retrospectively analyzed. The patients receiving traditional spinal cord protection strategies from January 2011 to December 2016 were defined as the control group, while the patients receiving standardized multidisciplinary spinal cord protection strategies from January 2017 to December 2018 were defined as the standardized treatment group. The standardized multidisciplinary treatment included preoperative cerebrospinal fluid drainage (CSFD), respiratory tract management, and maintenance of effective circulation of the lowest venous pressure; at the same time, anticoagulation, glucocorticoid, improve microcirculation, scavenge oxygen free radicals and other adjuvant treatments were started, and nerve function was monitored to prevent complications. The changes in SCI incidence after aortic surgery between the two groups were observed in order to evaluate the effect of standardized multidisciplinary spinal cord protection strategies. Meanwhile, the types of SCI after operation and the safety of CSFD were analyzed. Results During the 8-year period, 7 724 patients underwent aortic surgery at vascular center of Fuwai Hospital, 64 of which suffered from SCI after aortic surgery with total incidence of 0.83%. The onset of SCI was immediate in 39 patients (60.94%) and was delayed in 25 patients (39.06%), more than half of patients were immediate SCI. Of 64 patients with SCI, 52 patients (81.25%) underwent paraplegia and 12 (18.75%) underwent paraparesis. SCI persisted beyond discharge in 38 patients (59.38%) and 25 patients (39.06%) fully or partly recovered form SCI. One patient (1.56%) died. Compared with the control group, the incidence of SCI was decreased significantly after application of standardized multidisciplinary spinal cord protection strategies. The total incidence of SCI after aortic surgery was decreased from 1.06% (52/4 893) to 0.42% (12/2 831), the incidence after aortic arch replacement under deep hypothermic circulatory arrest was decreased from 3.66% (40/1 092) to 1.11% (5/450), and the incidence after thoraco-abdominal aortic replacement was decreased from 9.40% (11/117) to 2.47% (2/81) with statistically significant difference (all P < 0.05). Perioperative CSFD analysis showed that the incidence of CSFD-related complications was low, the overall incidence was 5.45% (3/55), including 1 patient of cerebrospinal fluid leakage, 2 patients of blood cerebrospinal fluid. No serious complications such as hemorrhage and infection of central nervous system occurred. Conclusions The main type of SCI after aortic surgery was immediate, about 39% SCI patients fully or partly recovered. Standardized multidisciplinary spinal cord protection strategies which included preoperative CSFD, reduced incidence of SCI after aortic surgery. The incidence of CSFD-related complications was low, which was safe and effective.

Objective:To assess the efficacy and safety of 100 units of botulinum toxin A (BTX-A) intradetrusor injection in patients with overactive bladder.Methods:From April 2016 to December 2018, 17 tertiary hospitals were selected to participate in this prospective, multicenter, randomized, double-blind, placebo-controlled study. Two phases of study were conducted: the primary phase and the extended phase. This study enrolled patients aged 18 to 75 years who had been inadequately managed by anticholinergic therapy (insufficient efficacy or intolerable side effects) and had spontaneous voiding with overactive bladder. Exclusion criteria included patients with severe cardiac, renal and hepatic disorders, patients with previous botulinum toxin treatment for 6 months or allergic to BTX-A, patients with urinary tract infections, patients with urinary stones, urinary tract tumors, diabetes mellitus, and bleeding tendency. Eligible patients were randomly assigned to BTX-A group and placebo control group in a ratio of 2∶1. Two groups of patients received 20 intradetrusor injections of BTX-A 100U or placebo at the depth of the submucosal muscle layer respectively under cystoscope, including 5 injections at the base of the bladder, 3 injections to the bladder triangle, 5 injections each to the left and right walls and 2 injections to the top, sparing the bladder neck. As a placebo control group, patients received same volume of placebo containing no BTX-A and only adjuvant freeze-dried preparations for injection with the same method. A combination of gelatin, sucrose, and dextran served as adjuvants. Average micturition times per 24 hours, urinary incontinence (UI) episodes per day, average micturition volume per day, OAB symptom score(OABSS), and quality of life (QOL) score were recorded at baseline and the 2nd, 6th and 12th week after treatment. The primary efficacy endpoint was the change from baseline in the average micturition times per 24 hours at the 6th week after treatment. The secondary efficacy endpoints included the change from baseline in the average micturition times per 24 hours at 2nd and 12th week, as well as the change from baseline in the OABSS, QOL score, average frequency of urgency and UI episodes per day, urgency score, average micturition volume per day at 2nd, 6th and 12th week after treatment. Patients were followed for 12 weeks to assess adverse events (AEs). After assessed at week 12, if the micturition times has decreased less than 50% compared to baseline and the patient is willing to receive retreatment, then patients could enter the extended trial phase. In that phase, patients in both groups were injected with 100 units BTX-A from 12th week onwards and then followed up the same indicators for 12 weeks.Results:216 patients were enrolled in this trial (144 cases in the BTX-A group and 72 cases in the placebo control group). Baseline characteristics such as age (47.75±14.20 in the BTX-A group and 46.39±15.55 in the control group), sex (25 male/117 female in the BTX-A group and 10/61 in the control group), and disease duration (0.51 years in the BTX-A group and 0.60 years in the control group) were balanced between the two groups( P>0.05). A marked reduction from baseline in average micturition times per 24 hours was observed in all treatment groups at the 6th week and the reduction of the two groups was statistically different ( P<0.001 and P=0.008 respectively). Compared with the baseline, the average micturition times per 24 hours at the 6th week decreased from baseline by 2.40(0.70, 4.60)times for the BTX-A group and 0.70(-1.00, 3.30) times for the placebo control group respectively, and the difference between the two groups was considered to be statistically significant ( P=0.003). The change rates of average micturition times per 24 hours from baseline at the 6th week of the two groups were (16±22)% and (8±25)% respectively, and the difference between the two groups was statistically significant ( P=0.014). Compared with the baseline, the average micturition times per 24 hours at 2nd and 12th week decreased by 2.00(0.00, 4.00)and 3.30(0.60, 5.03)for the BTX-A group, 1.00(-1.00, 3.00)and 1.70(-1.45, 3.85)for the placebo control group respectively. The difference between two groups was considered to be statistically significant ( P=0.038 and P=0.012); the changes of average urgency times per day for the BTX-A group and the control group at the 2nd, 6th and 12th week were 2.00(0.00, 4.30)and 2.40(0.30, 5.00), 3.00(0.30, 5.70)and 0.70(-1.30, 2.70), 0.70(-1.30, 3.00) and 1.35(-1.15, 3.50), respectively. There were significant differences between two groups at the 2nd, 6th and 12th week, ( P=0.010, P=0.003 and P=0.025, respectively). The OABSS of the BTX-A group and the control group at the 6th week decreased by 1.00(0.00, 4.00)and 0.50(-1.00, 2.00) compared with the baseline, and the difference between the two groups was statistically significant ( P=0.003). 47 cases of BTX-A group and 34 cases of placebo control group entered the extended trial phase, and 40 and 28 cases completed the extended trial phase, respectively. The average micturition volume per 24 hours changed by -16.60(-41.60, -0.60)ml and -6.40(-22.40, 13.30)ml, (-35.67±54.41)ml and(-1.76±48.69)ml, (-36.14±41.51)ml and (-9.28±44.59)ml, (-35.85±43.35)ml and(-10.41±40.29)ml for two groups at the 12th, 14th, 18th and 24th week, and the difference between two groups was statistically significant at each follow-up time ( P=0.01, 0.006, 0.012 and 0.016, respectively). There was no significant difference in other parameters( P>0.05). However, adverse reactions after intradetrusor injection included increased residual urine volume (27 in the BTX-A group and 3 in the control group), dysuria (21 in the BTX-A group and 6 in the control group), urinary infection (19 in the BTX-A group and 6 in the control group), bladder neck obstruction (3 in the BTX-A group and 0 in the control group), hematuria (3 in the BTX-A group and 1 in the control group), elevated alanine aminotransferase (3 in the BTX-A group and 0 in the control group), etc. During the follow-up period, there was no significant difference in the other adverse events between two groups except the increase of residual urine volume( P<0.05). In the primary trial phase, among the 27 cases with increased residual urine volume in BTA group, only 1 case (3.70%) with PVR more than 300 ml; the PVR of 3 patients in the placebo group was less than 100 ml. The increase of residual urine volume caused by the injection could be improved or disappeared with the passage of time. Conclusions:Intradetrusor injection of Chinese BTX-A improved the average micturition times per 24 hours, the average daily urgent micturition times, OABSS, and average micturition volume per time, and reduced the adverse effects in patients with overactive bladder.Chinese BTX-A at dose of 100U demonstrated durable efficacy and safety in the management of overactive bladder.

OBJECTIVE：To provide reference for the quality control of the leaves of Toricellia angulata . METHODS ：HPLC method was adopted. The determination was performed on Agela Promosil C 18 column with 0.2％ phosphoric acid solution-acetonitrile（gradient elution ）as mobile phase at the flow rate of 1.0 mL/min. The detection wavelength was set at 210 nm，and column temperature was 35 ℃. The sample size was 10 μL. HPLC fingerprint of 10 batches of the leaves of T. angulata was established and similarity evaluation was conducted by using Similarity Evaluation System of TCM Chromatographic Fingerprint（2004 edition）. The chromatographic peak was identified by comparing with the chromatogram of reference substance. Cluster analysis ，PCA and PLS-DA were used to identify chemical patterns ，and the quality differential markers were screened. The contents of hyperoside and isoquercitrin were determined by the same HPLC. RESULTS ：The similarities of HPLC fingerprint of 10 batches of the leaves of T. angulata with control fingerprint were 0.923-0.983. A total of 11 common peaks were identified ，and the peaks 4 and 5 were hyperoside and isoquercitrin ，respectively. Results of cluster analysis ，PCA and PLS-DA showed that 10 batches of leaves of T. angulata could be divided into two categories ，Y10 was clustered into one category ，and others were clustered into one category. PLS-DA analysis showed that 6 common peaks （peaks 4，3，10，2，6 and 11） with variable importance projection （VIP）greater than 1 were selected. Average contents of hyperoside and isoquercitrin in 10 batches of the leaves of T. angulata were 0.47-6.97，0.21-1.87 mg/g，respectively. CONCLUSIONS ：Established HPLC fingerprint and the method for content determination are stable and reliable ，and can be used for the quality control of the leaves of T. angulata from different areas. Six quality differential markers including hyperoside in the leaves of T. angulata from different areas are qnyz202034） preliminarily screened.