OBJECTIVETo compare the differences in intrapulmonary shunt (Qs/Qt) and arterial oxygenation between selective left lower lobar blockade by Coopdech endobronchial blocker tubes (BB) and one lung ventilation (OLV) by left-sided double-lumen endobronchial tubes (DLT) in patients with normal pulmonary function.

METHODSThirty-six patients (aged 32-64 years) scheduled for lower esophageal surgery were allocated randomly into BB and DLT groups (n=18). Anesthesia was induced and maintained with Propofol by target controlled infusion with intravenous administration of sufentanil and cisatracurium if needed. A 35 to 39 French tube was placed in the DLT group, and an 8.0-mm (internal diameter) single-lumen endotracheal tube was used in the BB group where a 9 French Coopdech BB was advanced into the left lower lobar bronchus guided by a fiberoptic bronchoscope. The variables recorded were blood gas analysis data from the venous and arterial blood samples at 20 min after two-lung ventilation in supine position (T(1)), 20 min after initiation of one-lung ventilation or selective left lower lobar blockade by inflating BB balloons in the right lateral decubitus position (T(2)), total collapse of the left lung or the left lower lobe after the pleura was opened (T(3)), and before tracheal extubation (T(4)). Qs/Qt was calculated using a standard formula based on the three-compartment model. Upon pleura opening, the effectiveness of lung collapse was evaluated by the surgeon who performed the surgery. Chest radiograph and arterial blood gas analyses were performed the day after the operation.

RESULTSBoth of the groups were similar with regard to rank of the surgical exposure, pH, PaCO(2), hemoglobin from T(1) to T(4), Qs/Qt, PaO(2), PO(2), and oxygenation index at T1. In BB group, a significant reduction of Qs/Qt and greater improvements in PaO(2), PO(2), oxygenation index at T(2), T(3) and T(4) were observed in comparison with those in DLT group (P<0.05 or <0.01). No lobe collapse was observed postoperatively in BB group, but 2 patients in DLT group showed left lower lobe atelectasis. The patients in BB group showed better postoperative arterial oxygenation and shorter postoperative hospital stay (P<0.01).

CONCLUSIONSelective left lower lobar blockade by Coopdech endobronchial blocker tube during lower esophageal surgery provides a lower intraoperative intrapulmonary shunt and a better intra- and postoperative arterial oxygenation..

Adult ; Blood Gas Analysis ; Bronchoscopes ; Continuous Positive Airway Pressure ; instrumentation ; methods ; Esophageal Neoplasms ; surgery ; Female ; Fiber Optic Technology ; Humans ; Intubation, Intratracheal ; methods ; Lung ; physiology ; Male ; Middle Aged ; Oxygen ; administration & dosage ; blood ; pharmacology ; Pulmonary Ventilation ; Thoracic Surgical Procedures ; methods

OBJECTIVETo study the durability of expanded polytetrafluoroethylene artificial heart valve (ePTFE AHV).

METHODSSix ePTFE AHVs were tested for 400 million times against accelerated fatigue using TH-2200 artificial heart valve exosomatic accelerated fatigue instrument. Hydromechanical parameters of fore-and-aft accelerated fatigue test of the 6 AHVs were obtained by TH-1200 artificial heart valve exosomatic pulsatile stream instrument.

RESULTS AND CONCLUSIONThe mean gradient pressure spanning the valve and the effective orific area of ePTFE AHVs did not undergo significant changes after fore-and-aft the fatigue test, but the regurgitation volume and regurgitation rate of ePTFE AHVs were reduced after the accelerated fatigue test, suggesting good durability of ePTFE AHV.

Biocompatible Materials ; chemistry ; Heart Valve Prosthesis ; standards ; Materials Testing ; methods ; Polytetrafluoroethylene ; chemistry ; Tensile Strength

OBJECTIVETo design a device for direct vision intracardiac operation without cardiopulmonary bypass, and assess its applicability preliminarily.

METHODSThe device was designed according to the clinical needs of intracardiac operation and used in operations for repairing atrial septal defect in 5 ex vivo porcine heart models. The practical applicability of this device was thoroughly tested and the results of the operations were evaluated.

RESULTS AND CONCLUSIONDirect vision operation for repairing atrial septal defect was successfully performed using this device, which can be a well applicable in some intracardiac operations, but its clinical effects need further evaluation.

Animals ; Cardiac Surgical Procedures ; instrumentation ; methods ; Cardiopulmonary Bypass ; Heart Septal Defects, Atrial ; surgery ; In Vitro Techniques ; Swine

OBJECTIVETo test 25# and 27# ultramicroporous expanded polytetrafluo-roethylene mitral valve (UPMV) under pulsatile flow condition in vitro.

METHODSSix 25# and six 27#UPMV were tested using TH-1200 HV Prosthesis Pulsatile Flow Tester in vitro at the cycling rate of 70 cycle/min, with the systolic pressure maintained at about 16 kPa (120 mmHg), diastolic pressure at 10.7 kPa (80 mmHg), and the percentage of mean forward flow at 35%. The stimulant cardiac output was maintained at 2, 3, 4, 5 and 6 L/min, respectively, for the testing.

RESULTSThe mean pressure difference for the 25#UPMV under stimulant cardiac output of 2, 3, 4, 5 and 6 L/min was 2.488-/+0.378, 4.427-/+0.240, 5.460-/+0.449, 6.776-/+0.391 and 8.327-/+0.490 mmHg, and its effective valvular orifice was 1.430-/+0.333, 1.993-/+0.208, 2.260-/+0.477, 3.204-/+0.174 and 3.652-/+0.158 cm(2), respectively. The regurgitant fraction of the 25#UPMV under each stimulant cardiac output was (5.731-/+0.643) %, (5.431-/+0.312) %, (5.059-/+0.708) %, (3.545-/+0.097) % and (2.615-/+0.125) %, respectively. The mean pressure difference of the 27#UPMV under each stimulant cardiac output was 1.618-/+0.497, 3.448-/+0.440, 4.825-/+0.434, 5.494-/+0.446 and 7.482-/+0.455 mmHg, effective valvular orifice was 1.773-/+0.364, 2.113-/+0.305, 2.409-/+0.295, 3.326-/+0.417 and 4.522-/+0.445 cm(2), and regurgitant fraction was (5.357-/+0.509) %, (5.407-/+0.110) %, (4.999-/+0.182) %, (4.010-/+0.254) % and (2.584-/+0.114)%, respectively.

CONCLUSIONThe mean pressure difference, effective valvular orifice and regurgitant fraction of the UPMVs can measure up to the national criteria for artificial heart valve prosthesis of China.

Biocompatible Materials ; chemistry ; Cardiac Output ; Heart Valve Prosthesis ; standards ; Heart Valve Prosthesis Implantation ; methods ; Heart-Assist Devices ; standards ; Humans ; Materials Testing ; methods ; Mitral Valve ; Polytetrafluoroethylene ; chemistry ; Porosity ; Pulsatile Flow

OBJECTIVETo assess the clinical outcomes of brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique for treatment of Stanford type A aortic dissection.

METHODSTwenty-three patients with Stanford type A aortic dissection requiring arch replacement underwent brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique. The operations were performed within 72 h (20 cases) or 3-14 days (3 cases) after the onset of aortic dissection.

RESULTSThere was no perioperative death in these cases. The mean extracorporeal circulation time was 209∓52 min, the aortic cross clamp time was 85∓21 min, and the mean chest tube output within the first 24 h after the operation was 570∓263 mL; none of the patients required chest reopening for management of bleeding. Postoperative acute renal failure requiring hemodialysis occurred in 3 cases, transient neurologic dysfunction in 2 cases, paraplegia in case and hematosepsis in 1 case. No such complications as permanent neurologic deficit or postoperative visceral malperfusion occurred in these cases. All the patients survived and were discharged from hospital without experiencing severe complications in the follow-up for 6-18 months.

CONCLUSIONBrachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique is a safe and simple procedure with controllable bleeding and can serve as an optional procedure for aortic arch replacement.

OBJECTIVETo observe the effect of one lung ventilation (OLV) preconditioning on perioperative oxygenation during pediatric video-assisted thoracoscopic surgeries (VATS).

METHODSA total of 171 children aged 5 days to 11 years underwent VATS for empyema dissection and abscess excisions (n=55), mediastinal tumor resection (n=34), repair of the diaphragmatic hernia or diaphragmatic plication (n=21), pulmonary lobectomy or biopsy (n=43), or esophageal disease (n=18). Of these patients, 127 were younger than 3 years of age. A 5-Fr pediatric endobronchial blocker was used for OLV with a delivered inspired oxygen fraction (FiO(2)) of 1.0. After lateral decubitus, a sequential protocol of a 5- to 8-min OLV preconditioning and a 5-min two lung ventilation (TLV) was performed followed by OLV again before incision for VATS. In cases of a SpO(2)<95% without malposition of the blocker during OLV, a 5 cm H(2)O positive end expiratory pressure was applied; TLV was maintained for a SpO(2)<90%.

RESULTSOLV provided good surgical conditions in 160 cases. Acceptable saturations were achieved in 166 cases during OLV. In 2 cases in empyema group and 3 in esophageal disease group, the ventilation protocol was converted to intermittent TLV during the operation due to hypoxemia. In esophageal disease group, the procedure and OLV duration, postoperative ventilation time and length of stay (LOS) were the longest among the groups, and the number of cases developing postoperative atelectasis was greater than that in diaphragmatic hernia and pulmonary disease groups. In empyema and esophageal disease groups, the oxygenation index (PaO(2)/FiO(2)) after total collapse of the lung in OLV and after extubation were lower than that in mediastinal tumor group (P<0.05 or 0.01).

CONCLUSIONA OLV preconditioning can maintain an acceptable oxygenation during pediatric OLV. A longer procedure and OLV duration is associated with a prolonged postoperative length of ventilation and LOS.

Blood Gas Analysis ; Child ; Child, Preschool ; Humans ; Hypoxia ; Infant ; Infant, Newborn ; Lung ; One-Lung Ventilation ; Positive-Pressure Respiration ; Respiration, Artificial ; Thoracic Surgery, Video-Assisted

OBJECTIVETo explore the therapeutical effects through investigating the results of multiple traumas treated by means of damage control surgery (DCS) or early total care (ETC).

METHODSThe clinical data of 90 patients with severe multiple traumas admitted from June 2001 to June 2007 were analyzed retrospectively. Forty-five patients were classified to the DCS group, 45 patients to the ETC group as a control. These severely injured patients were selected with an ISS > 25 points.

RESULTSBetween the two groups, the recovery time of clearance of lactic acid, body temperature, prothrombin time (PT) and activated partial thromboplastin time (APTT) of DCS group was significantly shorter than that of ETC group (P < 0.05). Incidence of complications and mortality in DCS group was significant less than that in ETC group (P < 0.05). No significant differences existed in the volume of bleeding and duration of surgery (P > 0.05).

CONCLUSIONSThe concept of DCS could reduce multiple traumas patients' mortality rate and incidence of complications. The indication of DCS should be the combination of physical feature, mechanism and severity of injuries.

Female ; Humans ; Injury Severity Score ; Male ; Multiple Trauma ; therapy ; Treatment Outcome

OBJECTIVETo investigate the potential of siRNAs targeting sphingomyelin phosphodiesterase 1 (SMPD1) in protecting the oocytes from apoptosis, and explore new approaches to female fertility preservation.

METHODSChemically synthesized siRNA targeting SMPD1 were introduced into mouse oocytes retrieved by hyperstimulation, and the cell apoptosis was analyzed by comic assay 48 and 72 h later.

RESULTSIn the oocytes without any siRNA injection, oocyte DNA damage occurred after 24 h, and large amount of DNA fragments migrated from the cells 48 h later. In oocytes injected with siRNA003, DNA migration decreased significantly as compared with the control and the other two groups injected with siRNA001 and siRNA002 (P<0.01).

CONCLUSIONsiRNA targeting SMPD1 may protect the oocytes from apoptosis, and has the potential for use in future female fertility preservation.

Animals ; Apoptosis ; drug effects ; genetics ; Comet Assay ; Female ; Mice ; Oocytes ; cytology ; RNA Interference ; RNA, Small Interfering ; genetics ; Sphingomyelin Phosphodiesterase ; genetics ; physiology ; Transfection