Objective To study the relationship between heart rate and failure of biological valve,and whether reduce the heart rate could delay the failure of biological valve.Methods Retrospective analysis of 92 bioprosthetic valve replacement cases in our institution from April 1996 to March 2001.The follow-up was carried out through the outpatient service,telephone and letter.The patients were divided into two groups based on the heart rate:Group A:basic heart rate no more than 75 beats per minute;Group B:basic heart rate greater than 75 beats per minute.Blood pressure,heart function,echocardiogram and reoperation rate was collected.Results In group A,the average follow-up time and the longest follow-up time was better than the patients in group B but has no significant difference.Echocardiographic data showed that the proportion of valve leaflets stiffness and calcification in group A was significantly lower than group B(7.7％ vs.17.9％,P ＜0.05).Redo operation rate in group A was lower than those in group B (7.7％ vs.22.6％,P ＜ 0.05).There were only 1 case(1.5 ％) suffering from the tearing in all three valve leaflets in group A while it was 8 cases(8.7％) in group B (2.6％ vs.15.1％,P ＜ 0.05).Conclusion Basic heart rate has a significant effect on the failure of the mitral bioprosthesis.To decrease the basic heart rate can delay the failure of the mitral bioprosthesis and improve the durability.

Objective The aim of this study was to evaluate of adilty of two acute renal failure-specific scoring systenms (the classification by Bellome et al and the AKIN criteria) for predicting hospital mortality after cardiac surgery in adult patients. Methods Between October 1 st 2006 to Decemjber 31 st 2006, 509 adult patients who ungerwent coronary artery bypass grafting (CABG) and/ or valve operation were enrolled in this study. The medical data collection included gender, age, types of operation, perioperative he- modynamic parameters, urine output, biochemical parameters and outcome. Renal function was assessed daily according to the classi- ficatinn by Bellomo and the AKIN criteria, respectively. As references, Acure Physiology and Chronic Health Evaluation(APACHE) Ⅱ and Sepsis-related Organ Failure Assessment (SOFA) score were also calculated. Resuits Three hundred and forty-one patients were male (67.0%), and 168 were female (33.0%), mean age was (56.2±12.0) years old. Tnree hundred and nine patieats un- derwent CABG, 182 underwent valve operation and 18 underwent CABG plus valve operation, Mean duration of ventilation support was (20.4±17.7) houra, and the ICU stay was (1.4±1.0) days. Postoperative hospital stay was (13.8±9.1) days. According to the classification by Bellomo., the highest in-hospital mortality was 52.9% in ARFS group. Mahiplicatinn of in-hospital morality rate was abserved (X2 for trend, P<0.01) in 0.4% (non-ARF), 1.2% (stage 1), 12.0% (stal～ 2) and 32.4% (stage 3) of pa- tients based on the AKIN criteria. By applying the area under the receiver operating characteristic ourve, the classification by Bellomo and the AKIN criteria had good discriminative power. Furthering, multivariate logistic regression analysis verified that the Odds Ratio of the AKIN criteria was 5.478 (P =0.028, 95% Confidence Interval 1.027- 24.856), after adjusting for gender and age. Con- clusion Analytical data confinned good discriminative power of both the AKIN criteria and the classification by Bellomo for predicting hospital mortality of adult postoperative patient with ARF.

Objective To evaluate the value of acute kidney injury network (AKIN) criteria for predicting hospital mortality in post-cardiosurgery elderly patients. Methods From October 2006 to January 2007, the elderly patients who underwent coronary artery bypass grafting or valve replacement operation were enrolled in this study. The medical data included gender, age, operation type, perioperative hemodynamic parameters, urine output, biochemical parameters and outcome. Renal function was assessed according to the AKIN criteria, and severity of illness was determined after surgery by calculating Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ ) score. Results A total of 225 patients underwent cardiac surgery during this period, 169 patients were male (75. 1%), while 56 were female (24. 9%), mean age was (66. 7±5. 0) years old. The overall hospital mortality rate was 5.8% (13/225). According to AKIN criteria, there were 125 patients with acute kidney injury (55.6%), and the hospital mortality of stage 1, 2 and 3 patients were 2. l%(2/96), 9. 1% (1/11) and 50. 0% (9/18) respectively. A significant increase was observed in mortality based on AKIN criteria (P<0. 01). By applying the area under the receiver operating characteristic curve, the AKIN criteria had a good discriminative power. Conclusions Both the incidence and mortality rate of acute kidney injury in the post-cardiosurgery elderly patients are high, the AKIN criteria is a simple and valuable method with a good prognostic capability for evaluating acute kidney injury.

Objective The incidence of post-operative hyperbilimbinemia, which is associated with poor outcomes in patients, was reported to be increased in recent years though it has been a rare complication for cardiac operations. Post-opera-tive impairment of liver function is highlighted. We evaluated the incidence and prognosis of post-operative hyperbiliruhinemia in adult patients who underwent cardiotomy with extracorporeal membrane oxygenation (ECMO) support. Methods Sixty-five adult patients who had received ECMO support after cardiac surgery from 2004 to 2008 were enrolled and evaluated retrospec-tively. Post-oporative hypethilirubinemia was defined as the serum level of the total bilirubin more than 51.3 μmol/L during postoperative period. Demographic and clinical data included gender, age, types of surgery, perioperative hemodynamic param-eters, biochemical variables, duration of the ventilation support, ICU stay and outcomes. Results The mean age of the pa-tients was (50.1 ± 13.9) years, forty-six patients(70.8%) were male. The main cardiac procedures were heart transplanta-tion for 9 patients, coronary artery bypass grafting and/or valve operations for 47 patients, congenital heart disease correction for 4 patients and other operations for 5 patients. Among all patients, fifty-one patients(78.5%) were weaned from ECMO succeas-fully and thirty-thrce patients were discharged from hospital. The overall mortality rate was 49.2%. Overall incidence of post-operative hyperbilirubinemia was 55.4%. In patients with postoperative hyperbilirubinemia, the mean peak value for serum to-tal bilirubin was 104.8 (68.5-156.7) μmol/l. The hospital mortality in the hyperbilirubinemia group was significantly higher than that in the non-hyperbilirubinemia group(66.7% vs. 27.6%, P <0.01). Moreover, postoperative hypethilirubinemia (adds ratio = 3. 895, 95% confidence interval, 1.088 - 13.947 ; P = 0.037) and SOFA score (odds ratio = 1.214, 95% confidence interval, 0.987 - 1.494, P = 0.047) and APACHE Ⅲ score (odds ratio = 1.096, 95% confidence interval, 1.028 - 1.169 ; P = 0.004) were associated with hospital mortality after adjusting for preoperative levels of the total bilirubin, direct bilirubin, gender and age. Conclusion Postoperative hyperbilirubinemia is one of the complications in adult patients who undergo cardiotomy with ECMO support, and is associated with increased hospital mortality.

Objective Extracorporeal membrane oxygenation (ECMO) provides a treatment for patients with acute heart-lung failure. However, as an invasive procedure, it associated with high incidence of complications. It is important to a-vert and reduce the complications for improving the success rate in critically ill patients. We investigate the complications associated with ECMO after cardiac surgery and their management. Methods Clinical data from 117 postoperative patients[32 male, mean age (48.7 ± 16.5) years]supported with ECMO in the cardiovascular intensive care unit( ICU) from March 2005 to June 2008 were analyzed retrospectively. The cardiac operations they had undergone included coronary artery bypass grafting (n = 20), coronary artery bypass grafting and remodeling of left ventricle(n =9), coronary artery bypass grafting and valvular operation(n =5), repair of ventricular septal perforation following acute myocardial infarction(n =2), valvular operation( n = 46), heart/lung transplantation (n = 20/1), correction of congenital heart defects ( n = 10), and aortic operations ( n = 4). Venoarterial bypass was established in 110 patients by cannulation of the right atrium and femoral artery, and that of the right atrium and ascending aorta in 5 cases. Left atrial drainage to ECMO was added in 2 cases. Venovenous bypass was established in 2 patients with hypoxemia following cardiac surgery. Heparin was infused for maintaining the activated coagulation time (ACT) at 160 to 200 seconds for centrifugal pump(114 cases),and 200 to 250 seconds for roller pump(3 cases) to avoid thrombotic events until decannulation was achieved. Results The mean ECMO duration was 61 hours (range 3 to 225 hours). 48(41.0% ) patients died, 18 of them died of complications after weaning from circulatory assistant successfully. Complications occurred in 74 (63.2% ) patients included reoperation for hemostasis (n = 24), renal failure requiring renal replacement therapy (n =29), nosocomial infections ( n = 32) , ischemia in the extremities(n = 5), plasma leakage of oxygenators ( n = 29), gastroenteral hemorrhage ( n = 14), hemolysis ( n = 7 ), neurological complications ( n = 4) and centrifugal pump failure (n =1). Conclusion Bleeding is an early complication associated with ECMO support. The risk of nosocomial infection, renal failure and plasma leakage of oxygenators increases with the duration of ECMO support.

Objective: To study the biocompatibility of CFR/PEEK composite in bone tissue after implanted in lumbar intervertebral space and to evaluate its role in the interbody fusion compared to the allograft bone. Methods: Thirteen beagles were chosen among which 7 were implanted with the disk-like CFR/PEEK composite in the lumbar intervertebral space and the other 6 were implanted with allograft bone. X-ray, QCT and histological examination were employed at 6, 12 and 24 months postoperatively. Results: The X-ray results of fusion segment were in conformity with the QCT's as well as that of histological results. All animals obtained a complete fusion at 24 months. Histological examination revealed that the anterior soft tissue to the implant exhibited a nonspecific foreign body reaction with connective tissue embed the biomaterials. Carbon fragment were seen in the surrounding tissue and some of the debric were phagocytosed by foreign body giant cell. Histological examination of bone and material revealed that new bone grew along the hole of CFR/PEEK implant. Conclusion: CFR/PEEK has an excellent biocompatibility to bone tissue.

Objective To investigate the nosocomial infection status in adult patients after cardiac surgery , who suffered cardiac shock and were supported with extracorporeal membrane oxygenation(ECMO).Methods The data of this retrospec-tive analysis were collected from adult patients of postoperative cardiac shock supported with veno-arterial( VA) ECMO from January 2011 to December 2013 in the Center for Cardiac Intensive Care, Beijing Anzhen Hospital.Results 125 patients were enrolled and nosocomial infection occured in 44 patients(51 episodes), infection rate was 35.2% or 71.8 episodes per 1 000 ECMO day.Respiratory tract infection occured most(27.2%), and then bloodstream infection(12.8%).The infection increased in the extension of time.The cultivation of the phlegm and blood specimen showed that the major pathogens were gram-negative bacteria.The patients were divided into the infection and the non-infection groups, the incidence of remedially continuous renal replacement therapy were significantly higher in the infection group than that in the non-infection group and the duration of ECMO support, the lenth of postoperative hospital stay, and the lenth of ICU stay were significantly longer in the in-fection group than those in the non-infection group[40.9% vs.22.2%, P<0.05; (7.2 ±4.6) d vs.(4.9 ±2.1) d, P<0.01;(12.5 ±6.2) d vs.(9.1 ±4.9) d, P<0.01和24(13, 36) d vs.15(11,20) d, P<0.01; respectively].The pa-tients in the infection group had higher mortality compared with the patients in the non-infection group(53.5% vs.17.1%, P<0.01).Conclusion Nosocomial infection is one of the common complications of the ECMO treatment and affects the prognosis of patients.The strict aseptic technique and rational application of antibiotics may reduce the mortality .

Objective:To study the relationship between dynamic Hoffmann's sign(DHS) and the early diagnosis of cervical spondylotic myelopathy. Methods:Patients with neck, shoulder and back pain (218 cases) were employed in this investigation. Among them, 96 cases had positive reaction to DHS test and they received 3 7 years follow up as study group. The other 122 cases negative to DHS test were taken as control group. The clinical data included the patient's symptoms and signs, sagittal diameter of cervical spinal canal, Pavlov rate, angular displacement and horizontal displacement between cervical vertebral, etc . Results:There were 72 cases in study group developed cervical spondylotic myelopathy and needed operation during follow up. Meanwhile, 11 cases in control group received surgical treatment. The incidence of stenosis of cervical spinal canal, herniation of cervical intervertebral disc and instability of cervical spine in DHS group were significantly higher than that of the control group. Conclusion:DHS is closely related to the onset of cervical spondylotic myelopathy. The patients should be followed up closely if they present positive reaction to DHS, and should be operated on early when their neurological symptom is progressing.

0.05). X ray film revealed that there was no loosening and displacement of internal fixation device in the test group 3 days after operation. In control group, there were 2 cases of slight graft bone displacement. Both groups exhibited a stiff bone fusion at operative level 3 months later. The intervertebral disc height of fusion level increased by (1.2?0.7) mm in the test group while decreased by (1.5?0.8) mm in the control group. CT scan revealed that there was tight contact between the internal fixation device and bone 3 days after operation. Both groups had obtained bone fusion in CT image 3 months later. Conclusion:Threaded cervical interbody fusion device made from carbon fiber reinforced PEEK has an excellent biocompatibility and can restore the intervertebral disc hight effectively with satisfactory fusion rate.

Objective: To conduct a scoping review on prognostic prediction models for patients with comorbidity of chronic diseases, and understand modeling methods, predictive factors and predictive effect of the models, so as to provide the reference for prognostic evaluation on patients with comorbidity of chronic diseases. Methods: Literature on prognostic prediction models for patients with comorbidity of chronic diseases was collected through SinoMed, CNKI, Wanfang Data, VIP, PubMed, Embase, Cochrane Library and Web of Science published from the time of their establishment to November 1, 2023. The quality of literature was assessed using prediction model risk of bias assessment tool (PROBAST), then modeling methods, predictive factors and predictive effects were reviewed. Results: Totally 2 130 publications were retrieved, and nine publications were finally enrolled, with an overall high risk of bias. Thirteen models were involved, with three established using machine learning methods and ten established using logistic regression. The prediction results of four models were death, with main predictive factors being age, gender, body mass index (BMI), Barthel index and pressure ulcers; the prediction results of nine models were rehospitalization, with main predictive factors being age, BMI, hospitalization frequency, duration of hospital stay and hospitalization costs. Eleven models reported the area under the receiver operating characteristic curve (AUC), ranging from 0.663 to 0.991 6; two models reported the C-index, ranging from 0.64 to 0.70. Eight models performed internal validation, one model performed external validation, and four models did not reported verification methods. Conclusions The prognostic prediction models for patients with comorbidity of chronic diseases are established by logistic regression and machine learning methods with common nursing evaluation indicators, and perform well. Laboratory indicators should be considered to add in the models to further improve the predictive effects.