Objective To explore the application and management of deep hypothermic extracorporeal circulation (DHECC) in surgical procedures. Methods From Dec. 1997 to Dec. 2007, DHECC was applied in 54 patients suffered from great vessel diseases (34/54), complex congenital heart disease (10/54), giant basilar artery aneurysm (5/54), and abdominal tumor with tumor embolus intruding into right atrium or inferior vena cava (5/54) in the General Hospital of PLA. Extracorporeal circulation was performed with arterial perfusion by ascending aorta (n=25), axillary artery (n=18) and femoral artery (n=11), and venous drainage by superior vena cava and inferior vena cava (n=21), right atrium (n=25), and femoral vein (n=8). Clinical data were analyzed retrospectively including extracorporeal circulation (ECC) time, aortic clamping time, deep hypothermic circulation time, the lowest temperature, and the use of ultrafiltration. Results The ECC time was 63-414 (178.55?74.42)min. Aortic clamping time was 16-259 (123.39?52.21) min in 46 patients. Deep hypothermic circulatory arrest (DHCA) was performed in 43 patients, and the duration was 2-109 (30.00?22.37)min. The lowest nasopharyngeal temperature was 13.6-25.7 (19.61?3.40)℃, and the lowest rectal temperature was 15.2-30.5 (21.58?3.63)℃. Ultrafiltration technique was used in 49 cases. 36 of 54 cases (66.7%) self-awakened. Four cases (7.41%) died in the early post-operation period. Conclusion The DHECC can offer a clear and exsanguinated operating field, and is helpful to execute complicated or major operations which are hard to complete with common techniques.

Objective To analyze and evaluate the effect addition of albumin to the extracorporeal circulation (CPB) in patients undergoing valve replacement. Methods 62 patients under 60 years of age, with the blood level of albumin nearly normal, undergoing mitral valve replacement or aortic valve replacement were randomly divided into two groups. In 34 patients albumin was added to the priming fluid of extraporeal circulation, and in 28 patients it was not. The pre-operative and postoperative serum albumin levels, the duration of assisting ventilation, and the amount of albumin needed between the time of operation to 7 am of the first postoperative day were compared. In both groups the primary priming fluid consisted of balanced electrolyte solution, hydroxyethyl starch, 5% sodium bicarbonate, and 25% mannitol. Results All the indexes, including the preoperative level of albumin, the amount of albumin needed from operation to 7 am of the first postoperative day, and the albumin level at 7 am of the first postoperative day showed no notable differences. Conclusion For patients with no hypoalbuminemia, mitral valve replacement or aortic valve replacement is safe to withhold the addition of albumin to the priming fluid for CPB.

To summarize the experience of application of the cardiopulmonary bypass (CPB) technique in non cardiac surgery in 28 patients, including 22 cases of Budd Chiari syndrome, 2 cases of renal cell carcinoma with cancer cell emboli in the inferior vena cava, 2 cases of tracheal carcinoma, 1 case of intracranial basilar artery aneurysm, and 1 case of leiomyolipoma of the liver with excision and replantation of remaining liver. Different types of CPB were adopted as follows: 10 cases were supplemented by hypothermia and low flow perfusion, 15 cases by deep hypothermia and circulation arrest (DHCA) and 3 cases with vena vena bypass in normothermia, respectively. 2 patients died in early post operative period. It is our opinion that CPB can be used in non cardiac surgery, when it is difficult or almost impossible to carry out with routine surgical technique. The technique can make operations more convenient and safer to perform, even though there are some disadvantages, such as more trauma and higher cost.

Objective: To investigate the role of surfactant associated protein-A (SP-A) in the development and progression of silicosis, and its mechanism. Methods: Homozygous and heterozygous mice of SP-A knockout of specific pathogen free (SPF) grade were selected for mating, and mice with SP-A^-/- genotype were selected for subsequent experiments. SP-A wild-type (SP-A^+/+) and SP-A^-/- mice were divided into SP-A^+/+ control group, SP-A^-/- control group, SP-A^+/+ silicosis group and SP-A^-/- silicosis group with six mice in each group by random number table method. Mice in both silicosis groups were given 20.0 μL 250 g/L silica suspension by tracheal exposure, and mice in both control groups were injected with 0.9% sodium chloride solution at the same volume. On the 28th day after modeling, mice were sacrificed. Lung tissues were used for lung histopathology examination. The apoptosis of alveolar type Ⅱ epithelial cells of mice was detected by TUNEL method. The mRNA expression of B-lymphoblastoma 2 (Bcl-2), Bcl-2 associated X protein (Bax), cysteinyl aspartate specific proteinase (Caspase)-3 and Caspase-9 in lung tissues of mice was detected by quantitative real-time polymerase chain reaction. Results: The histopathological result of mice showed that thickened alveolar septum, scattered silicon nodule and collagen fiber formation were observed in the mice lungs of SP-A^+/+ silicosis group, and a large number of inflammatory cells were observed in silicosis nodule, after exposure to silica dust. SP-A^-/- silicosis group resulted in a more severe pulmonary inflammation and interstitial fibrosis compared to SP-A^+/+ silicosis group. The apoptosis of alveolar type Ⅱ epithelial cells and the mRNA relative expression levels of Bax, Caspase-3 and Caspase-9 in lung tissues of mice in each silicosis groups were increased compared with their control groups (all P<0.05). The above four indexes of mice in SP-A^-/- silicosis group were higher than those in SP-A^+/+ silicosis group (all P<0.05). There was no significant difference in the expression of Bcl-2 mRNA in lung tissues of these four groups (P>0.05). Conclusion: Knockout of SP-A can aggravate inflammation and pulmonary fibrosis in silicosis model mice, and promote apoptosis of alveolar type Ⅱ epithelial cells. The mechanism may be related to the Bcl-2/Bax/Caspase-3 signaling pathway which affects the apoptosis of mitochondrial pathway.

Objective:To investigate the current situation of cardiopulmonary bypass(CPB) in China and analyze the causes, to guide the formulation and implementation of technology standard.Methods:The survey task force sent out a nationwide survey to obtain up-to-date information on perfusion practice by ChSECC(Chinese Society of Extracorporeal Circulation). The unit of analysis for the survey was the medical center performs CPB. The survey consisted 48 questions covering four topics of qualifications, including certification and education, policies and practices, device and equipment, techniques used.Results:There were 540 of the 714 centers for an overall response rate of 76%. According to the annual number of CPB, they were divided into 4 groups: group A(≤50 cases/year), group B(50-100 cases/year), group C(100-500 cases/year) and group D(≥500 cases/year). The response rate of center with more than group D last year was 100%. Most of the perfusionists had certification issued by ChSECC. Although there were more than 80% of group D performed regular training and assessment of perfusionist, the result was still not ideal enough. Low utilization of safety equipment was not depend on the annual operation volume in most of responding centers. Ultrafiltration and blood protection technology had high application rate in group D compared with group A and B.Conclusion:The certification rate of perfusionists are high. Lower the number of annual CPB cases, lower the proportion of regular evaluation and training, and lower rate of standards performance. No matter the amount of CPB, the application rate of safety equipment is not ideal. Higher the number of CPB cases, higher the utilization rate of CPB related technologies.

OBJECTIVE: To explore the effect of ultra-high frequency radiation on psychomotor neurological behavior in workers with exposure. METHODS: A total of 85 workers who exposed to 40.68 MHz radiofrequency were recruited as the exposure group by judgment sampling method. A group of 121 workers without occupational EMR exposure were recruited as the control group. Workers in both groups were from the same shoe factory. The electric field intensity(EFI) of ultra-high frequency radiation of workplace in the exposure group was measured. The computerized neurobehavioral evaluation system in Chinese version 3 was used to evaluate the psychomotor neurobehavioral function which included the neurobehavioral ability index(NAI) of simple visual reaction time(SVRT), digital screening and fit curve and the general NAI(GNAI) of the above 3 indexes. RESULTS: The median of the workplace EFI of ultra-high frequency radiation in the exposure group was 119.0 V/m, and all of them exceeded the national occupational exposure limit. NAI of digital screening in exposure group was lower than that in the control group(P<0.05). There is no statistically significant difference in the NAI of SVRT, fit curve and GNAI(P>0.05). Meanwhile, there is no statistically significant difference in abnormal rate of NAI of SVRT, digital screening, fit curve and GNAI(P>0.05). The results of multiple linear regression analysis showed that the ultra-high frequency radiation EFI exposure was negatively correlated with NAI of digital screening(P<0.05) after eliminating the influence of confounding factors such as age, working age, gender, education level, smoking, drinking and staying up late. CONCLUSION: The digital screening of psychomotor neurobehavioral function in the exposure workers was adversely affected by the ultra-high frequency radiation. The neural behavioral ability of eye-hand coordination and precise movement may be the specific performance.

OBJECTIVE: To evaluate the ability of health emergency drill for sudden poisoning incidents in Guangdong Province. METHODS: A double-blinded method was used to organize 22 teams in Guangdong Province to conduct a health emergency drill which contained preliminary and repeated drill. The preliminaries contained blind sample analysis,theoretical examination and skills assessment. The repeated drills was desktop network exercise carried out for the teams ranked top 10 in the preliminaries. RESULTS: In the preliminary round,the median( M) of total score among the 22 teams was 72. 5. Among them,blind sample analysis,theoretical examination and skills assessment were 71. 0,61. 4 and 76. 5,respectively. The total score of skill assessment was higher than that of theoretical assessment( P < 0. 05). The passing rate of 22 teams was 68. 2%(15/22),and the failure rate was 31. 8%(7/22). The failing teams all came from the nonPearl River Delta region. The total preliminary scores,passing rate,the total scores of blind sample analysis and skills assessment of the teams in Pearl River Delta Region were higher than that in the non-Pearl River Delta region( P < 0. 01).In the theoretical examination,the scores of detection and investigation were both higher than that of medical rescue( P <0. 05). For the skills assessment,the scores of decision-making,personal protection and poisoning detection were in the top three,the scores of the medical rescue and investigation were relatively low( P < 0. 05). In the repeated round,the M of desktop exercise was 55. 0,passing rate was 20. 0%,and the failure rate was 80. 0%. CONCLUSION: The health emergency response capacity for sudden poisoning incidents in Guangdong Province needs to be improved. The construction of emergency response capacity for emergency poisoning in the non-Pearl River Delta region should be strengthened,especially the training on strengthening theoretical and practical knowledge of poisoning medical treatment and poisoning investigation.

OBJECTIVE: To screen the allergens of trichloroethylene-induced occupational medicamentosa-like dermatitis( OMDT) by patch test,and explore methods for OMDT auxiliary diagnosis and trichloroethylene( TCE) allergic population screening. METHODS: A total of 20 subjects diagnosed with OMDT were selected as case group,and 22 nonOMDT healthy workers exposed to TCE≥12 weeks were selected as control group. Different concentrations of TCE and its main metabolites such as chloral hydrate( CH),trichloroethanol( TCOH) and trichloroacetic acid( TCA) were used as allergens in a skin patch test in workers of these two groups. Another 20 new workers exposed to TCE < 12 weeks without OMDT were tested as validation group. They were tested with a patch test at a mass fraction of 15. 00% CH and follow-up observations were performed until 12 weeks of TCE exposure. RESULTS: The patch test of TCE,CH,TCOH and TCA were negative in the control group. In the case group,the patch test positive rate for 50. 00% TCE was 10. 00%,the patch tests were negative in 25. 00%,10. 00% and 5. 00% TCE. The CH patch test positive rate was 100. 00% with the CH mass concentrations of 15. 00%,10. 00% and 5. 00%. The TCOH patch test positive rates were 90. 00%,75. 00% and50. 00%,with the corresponding concentration of 5. 00%,0. 50% and 0. 05%. The TCA patch test positive rates were50. 00% and 0. 00% with the TCA concentrations of 5. 00% and 0. 50% respectively. When the mass concentration was5. 00%,the patch test positive rates in case group from high to low were CH,TCOH,TCA and TCE( P < 0. 01). And the patch test positive rates of CH and TCOH showed no statistical significant difference( P > 0. 05). The patch test positive rate of TCOH increased with increase of TCOH mass concentrations( P < 0. 01). The patch test positive rates for 5. 00%TCA was higher than that of 0. 50% TCA( P < 0. 01). The patch test positive rate in 0. 50% TCOH was higher than that of 0. 50% TCA( P < 0. 01). In the validation group,the patch test of 15. 00% CH was negative,and there was no OMDT case found during the follow-up 12 weeks of TCE exposure. CONCLUSION: The metabolites CH and TCOH of TCE may be the main allergens of OMDT after exposure to TCE. The CH and TCOH patch test can be an auxiliary diagnosis method for OMDT. The CH patch test could be used as a method for screening population allergic to TCE.

OBJECTIVE: To analyze the epidemiologic characteristics of occupational medicamentosa-like dermatitis induced by trichloroethylene( OMDT) in Guangdong Province. METHODS: The data of OMDT cases diagnosed by Guangdong occupational disease diagnosis institutions from 1988 to 2016 was collected and analyzed. The data of OMDT come from medical records,the National Occupational Disease Network Reporting System and literature retrieval. RESULTS: A total of 475 cases of OMDT were diagnosed in Guangdong Province during 1988 to 2016. The recovery rate was 91. 4%( 434/475),and the fatality rate was 8. 6%( 41/475). All cases had a clear history of trichloroethylene( TCE) exposure and had not been exposed to TCE prior to the present exposure. The median incubation period was 30 days. The exceeding standard rate of TCE time weighted average concentration was 80. 7%( 171/212),and the exceeding standard rate of urine trichloroacetic acid was 75. 0%( 123/164). The years that have most OMDT cases were from 1999 to 2006,which accounted for 64. 0%( 304/475); but there was no seasonal aggregation. The enterprises of OMDT cases concentrated in the Pearl River Delta Region,with Shenzhen City and Dongguan City accounting for 62. 9%. The median age of onset was22 years old,81. 9% of cases were 30 years old or below. The male-female ratio was 1. 2 ∶ 1. 0; 57. 7%( 274/475) cases were from southern China. Meanwhile,95. 4%( 453/475) of the cases came from the manufacturing industry such as electronics factory,hardware factory,electroplating factory and others. CONCLUSION: The distribution of OMDT cases on area,age of onset,native place and occupation in Guangdong Province showed a certain aggregation.

OBJECTIVE: To understand the long-term prognosis of patients with occupational medicamentosa-like dermatitis induced by trichloroethylene( OMDT) after recovery. METHODS: A total of 185 patients with OMDT were surveyed through landline and correspondence after recovery. Based on the individual's wishes,19 patients( follow-up examination group)were followed up and arranged for health examination in hospital. RESULTS: Seventy-one cases of OMDT was successfully follow-up. The success rate was 38. 4%( 71/185). Among the 71 cases who were successfully followed up,64. 8%( 46/71)cases complained of physical discomfort. The main complain included skin itching,allergy,upper respiratory tract infection or frequent fever,xerophthalmus,osteonecrosis of femoral head. The 19 cases in the follow-up examination group had different degrees of skin itching,dryness and mild melanosis. The abnormal rates of schirmer I test were 42. 1%( 8/19)and 52. 6%( 10/19) in the left and right eye,respectively. The abnormal rate of tear break-up time in both left and right eyes was 84. 2%( 16/19). The highest positive rate of patch test was chloral hydrate( 100. 0%). There was no abnormality in body temperature,superficial lymph nodes,blood routine,urine routine,liver function and autoimmunity antibody. There was no new rash. CONCLUSION: Different degree of long-term prognosis can occur in OMDT recovery patients. Xerophthalmus and osteonecrosis of femoral head are the major sequelae. Chloral hydrate,which is the main metabolite of trichloroethylene,may be the causative culprit compound for OMDT.