Objective To describe the outcomes of extracorporeal membrane oxygenation (ECMO) for patients after aortic surgery and to summarize the experience. Methods The clinical data of patients who received ECMO support after aortic surgery in Fuwai Hospital from 2009 to 2020 were retrospectively analyzed. The patients who received an aortic dissection surgery were allocated into a dissection group, and the other patients were allocated into a non-dissection group. The in-hospital and follow-up survival rates were compared between the two groups, and the causes of death were analyzed. Results A total of 22 patients were enrolled, including 17 patients in the dissection group [13 males and 4 females, with a median age of 54 (46, 61) years] and 5 patients in the non-dissection group [3 males and 2 females, with a median age of 51 (41, 65) years]. There was no statistical difference in the age and gender between the two groups (P>0.05). The in-hospital survival rate (11.8% vs. 100.0%, P=0.001) and follow-up survival rate (11.8% vs. 80.0%, P=0.009) of the patients in the dissection group were significantly lower than those in the non-dissection group. The causes of death in the dissection group included massive bleeding and disseminated intravascular coagulation (3 patients), ventricular thrombosis (1 patient), irreversible brain injury (2 patients), visceral malperfusion syndrome (4 patients) and irreversible heart failure (5 patients). Conclusion ECMO after aortic dissection surgery is associated with high mortality, which is related to the pathological features of aortic dissection and severely disrupted coagulation system after the surgery. For these patients, strict indication selection and optimal management strategy are important.

Working Group on Extracorporeal Life Support, National Center for Cardiovascular Quality Improvement developed guidelines on patient blood management for adult cardiovascular surgery under cardiopulmonary bypass, aiming to standardize patient blood management in adult cardiovascular surgery under cardiopulmonary bypass, reduce blood resource consumption, and improve patients outcomes. Forty-eight domestic experts participated in the development of the guidelines. Based on prior investigation and the PICO (patient, intervention, control, outcome) principles, thirteen clinical questions from four aspects were selected, including priming and fluid management during cardiopulmonary bypass, anticoagulation and monitoring during cardiopulmonary bypass, peri-cardiopulmonary bypass blood product infusion, and autologous blood infusion. Systemic reviews to the thirteen questions were performed through literature search. Recommendations were drafted using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. After five rounds of experts discussions between 2023 and 2024, 19 recommendations were finally formed.

Objective    To evaluate the safety and efficacy of peripheral cannulation for cardiopulmonary bypass (CPB) in patients with reoperation of congenital heart disease. Methods    The perioperative data of patients with congenital heart disease who underwent reoperation in Fuwai Hospital from 2019 to 2020 were retrospectively collected. They were divided into two groups according to the cannulation methods: a central group and a peripheral group. The prognosis of the patients was analyzed. Results     A total of 80 patients were collected, including 43 patients in the central group, and 37 pateints in the peripheral group. In the central group, the median age was 18 (14, 32) years, and 21 patients were male. The median age of the peripheral group was 16 (10, 27 ) years, and 18 patients were male. The CPB time in the peripheral group was 201 (164, 230) min, which was longer than that in the central group [143 (97, 188 ) min, P<0.001]. The lactate after CPB in the peripheral group was statistically higher than that in the central group [2 (1, 2 ) mmol/L vs. 1 (1, 1) mmol/L, P=0.002]. The dosage of albumin use during CPB in the peripheral group was statistically higher than that in the central group [10 (0, 20) g vs. 0 (0, 0) g, P=0.004]. There was no statistical difference in the postoperative dosage of red blood cells use [0 (0, 2) U vs. 0 (0, 0) U, P=0.117], mechanical ventilation time [14 (11, 19) h vs. 13 (10, 15) h, P=0.296], ICU stay time [43 (23, 80) h vs. 40 (20, 67) h, P=0.237] or postoperative hospital stay time [10 (7, 12) d vs. 8 (7, 10) d, P=778] between the two groups. Conclusion    It’s safe and efficient to establish CPB through peripheral cannulation in patients with complex congenital heart disease undergoing reoperation.

Objective    To analyze the safety and efficacy of vacuum-assisted venous drainage (VAVD) in cardiac surgery under cardiopulmonary bypass (CPB). Methods    A total of 180 patients from 3 centers between November 17, 2017 and October 1, 2018 were enrolled and randomly assigned to a VAVD group and a gravity drainage (GD) group by 1∶1 ratio. During the open-heart surgery under CPB, the VAVD group completely relied on VAVD, and the GD group used conventional GD. The primary endpoint was arterial flow before CPB, 15 min after aortic cross-clamping and rewarming to 36 °C of nasopharyngeal temperature. The secondary endpoints included hematocrit, hemoglobin concentration, blood product transfusion, etc. The safety endpoint was free hemoglobin concentration, etc. Results    The full analysis set contained 175 patients, 87 in the VAVD group and 88 in the GD group. Patients in the VAVD group were aged 52.8±12.0 years, and males accounted for 55.2%; patients in the GD group were aged 51.4±12.1 years, and males accounted for 59.1%. The demographic characteristics between the two groups were not statistically different. Compared to the GD group, the VAVD group could provide comparable arterial flow in CPB [average of 3 time points, 2.37±0.22 L/(min·m2) vs. 2.41±0.25 L/(min·m2), P=0.271], while not elevating free hemoglobin concentration. Conclusion    VAVD can provide enough venous drainage, while not elevating free hemoglobin concentration or damaging blood.

Objective    To explore the safety and feasibility of the establishment method and management strategy of prolonged support model with veno-venous extracorporeal membrane oxygenation (V-V ECMO) under dual lumen cannula (DLC) in conscious sheep. Methods    Three adult male sheep were selected. An Avalon Elite DLC was inserted into the superior vena cava, right atrium, and inferior vena cava through the right jugular vein and was connected with centrifugal pump and oxygenator to establish the extracorporeal membrane oxygenation circuit. All the 3 sheep were transferred into the monitoring cage after operation and were ambulatory after anesthesia recovery. Hemodynamic parameters and extracorporeal membrane oxygenation performance were measured every day. Results    All three sheep survived to the end of the experiment (7 days). In the whole process of the experiment, the basic vital signs of the experimental sheep were stable, and no serious bleeding or thrombotic events occurred. During the experiment, hemoglobin concentration and platelet count were relatively stable, plasma free hemoglobin was maintained at a low level, extracorporeal membrane oxygenation flow rate was stable, and oxygenation performance of oxygenator was good. Conclusion    Prolonged V-V ECMO model in conscious sheep under DLC is feasible and stable.

OBJECTIVE To establish a method for simultaneously determining the contents of camphor ，menthol，borneol and methyl salicylate in Compound shexiang xuelian liuzhi plaster . METHODS The test solution was prepared by reflux extraction with ethyl acetate ，and was determined by gas chromatography （GC）. A Shimadzu SH -Rtx-Wax capillary column was used as the chromatographic column ，and a flame ionization detector was used as the detector . The detector temperature and the injector temperature were both set at 200 ℃. The flow rate of carrier gas （nitrogen）was 2.0 mL/min，the separation ratio was 20∶1，and the sample size was 1.0 μL. RESULTS The linear ranges of camphor ，menthol，borneol（calculated by the sum of isoborneol and borneol）and methyl salicylate were 11.5-230.4，10.6-211.6，11.3-225.5，11.0-219.1 μg/mL（r＞0.999）. RSDs of the precision ， repeatability and stability （48 h）tests were all less than 4%. The average recoveries of the four components were 100.7%，99.7%， 98.9% and 100.7%（RSDs were 4.3%，2.9%，2.2%，3.7%，n＝9）. The contents of camphor ，menthol，borneol and methyl salicylate in two specifications of Compound shexiang xuelian liuzhi plaster were 16.8-19.5，4.6-6.0，9.8-11.9，6.9-8.2 mg/piece（7 cm×10 cm/piece），and 8.3-8.6，2.2-2.4，4.7-4.8，3.2-3.6 mg/piece （5 cm×7 cm/piece）. CONCLUSIONS The method is successfully established for simultaneous determination of four volatile components in Compound shexiang xuelian liuzhi plaster .

Breast cancer has become the most commonly diagnosed cancer type in the world. A combination of chemotherapy and photothermal therapy (PTT) has emerged as a promising strategy for breast cancer therapy. However, the intricacy of precise delivery and the ability to initiate drug release in specific tumor sites remains a challenging puzzle. Therefore, to ensure that the therapeutic agents are synchronously delivered to the tumor site for their synergistic effect, a multifunctional nanoparticle system (PCRHNs) is developed, which is grafted onto the prussian blue nanoparticles (PB NPs) by reduction-responsive camptothecin (CPT) prodrug copolymer, and then modified with tumor-targeting peptide cyclo(Asp-d-Phe-Lys-Arg-Gly) (cRGD) and hyaluronic acid (HA). PCRHNs exhibited nano-sized structure with good monodispersity, high load efficiency of CPT, triggered CPT release in response to reduction environment, and excellent photothermal conversion under laser irradiation. Furthermore, PCRHNs can act as a photoacoustic imaging contrast agent-guided PTT. In vivo studies indicate that PCRHNs exhibited excellent biocompatibility, prolonged blood circulation, enhanced tumor accumulation, allow tumor-specific chemo-photothermal therapy to achieve synergistic antitumor effects with reduced systemic toxicity. Moreover, hyperthermia-induced upregulation of heat shock protein 70 in the tumor cells could be inhibited by CPT. Collectively, PCRHNs may be a promising therapeutic way for breast cancer therapy.

Objective To investigate the effect of adjusting tube current time product (mAs) according to head circumference index on head CT image quality and organ-specific-dose level based on Monte Carlo analysis platform.Methods A total of 92 patients including children and adolescents with different clinical symptoms undergoing head CT scan were prospectively selected between September 2017 and June 2018 in the First Hospital of Jilin University.Without limiting the size of the head circumference,there were 22 patients were selected as conventional group by random number table,whose head circumference was 48.1-59.2 cm.Low dose group was divided into following three subgroups according to different head circumferences:A group 54.1-57.0 cm (n=22);B group 51.1-54.0 cm (n=26) and C group 48.1-51.0 cm (n=22).Tube current time product was 250 mAs for conventional group,200 mAs for A group,150 mAs for B group and 100 mAs for C group,respectively.The organ-specific-radiation doses (brain,eye lens and salivary gland) were recorded by Monte Carlo analysis platform and the subjective and objective image quality score was evaluated.Analyses of the differences between four groups were compared with image quality score as well as organ-specific-radiation dose by single factor variance.Results Radiation dose to brain was conventional group (34.37±3.62),A group (25.91±0.99),B group (23.18±6.11) and C group (17.38 ± 3.23) mSv,respectively.The difference was of statistical significance in the four groups (F=54.51,P＜0.05).Dose to eye lens was conventional group (41.54± 1.04),A group (33.03±0.35),B group (26.18±2.72) and C group (20.88±4.45) mSv,with statistical significance in difference between the four groups (F=189.75,P＜0.05).Dose to salivary gland was conventional group (35.04 ± 4.94),A group (25.92 ± 0.99),B group (22.93 ± 6.54) and C (14.96±2.67) mSv,respectively,with statistical significance in difference between the four groups (F=65.74,P＜0.05).Image quality scores were respectively conventional group (4.97±0.13),A group (4.77 ± 0.49),B group (4.60 ± 0.49) and C group (3.98 ± 0.61),respectively,with statistical significance between them (F=3.89,P＜0.05),but without statistical significance in difference between the four groups (P ＞ 0.05).The signal-to-noise ratios of gray matter in A,B and C groups were conventional group (18.69 ± 3.55),A group (16.76 ± 2.87),B group (15.05 ± 2.80) and C group (13.65±2.53),respectively,without statistical significance in difference between the four groups (P＞ 0.05);The signal-to-noise ratios of white matter in conventional group (17.46±3.72),A group (15.54± 2.81),B group (13.71±2.43) and C group (11.77±2.18),respectively,without statistical significance in difference between the four groups (P＞0.05).Conclusions Adjusting the tube current time product (mAs) according to head circumference index of children and adolescents can make scanning program more personalized and reduce organ-specific-radiation doses to sensitive organs without compromise of image quality.

Objective To study the value of endothelin-1 (ET-1) in predicting the outcome of stable coronary artery disease (SCAD) patients.Methods A total of 3154 SCAD patients who were followed up for 24 months were divided into cardiocerebral vascular events group (n=189) and cardiocerebral vascular events-free group (n =2965).Their serum ET-1 level was measured by ELISA.The patients were further divided into ET-1 ＜0.3 pmol/L group (n=1588) and ET-1≥0.3 pmol/L group (n=1566).The value of ET-1 in predicting the end events was assessed by Cox regression analysis.The survival curve was plotted by Kaplan-Meier analysis.Results The serum ET-1 level was signify-cantly higher in cardiocerebral vascular events group than in cardiocerebral vascular events-free group (0.33 pmol/L vs 0.30 pmol/L,P=0.004).The incidence of clinical end events was significantly lower in ET-1 ≥0.3 pmol/L group than in ET-1 ＜0.3 pmol/L group (7.02％ vs 4.97％,P=0.015).Multivariable Cox regression analysis showed that ET-1 was a predictor of clinical end events (HR=1.656,95％CI:1.099-2.496,P=0.016).Kaplan-Meier analysis showed that the events-free survival rate was lower in patients with a higher serum ET-1 level than in those with a lower serum ET-1 level (P=0.016).Conclusion ET-1 is an important risk factor for the outcome of SCAD patients.Further studies are needed to confirm its long-term value in predicting the outcome of SCAD patients.