OBJECTIVE: To investigate the incidence and risk factors of hypothermia in patients with acute renal injury (AKI) receiving continuous renal replacement therapy (CRRT), and to compare the effects of different heating methods on the incidence of hypothermia in patients with CRRT. METHODS: A prospective study was conducted. AKI patients with CRRT who were admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from January 2020 to December 2022 were enrolled as the study subjects. Patients were divided into dialysate heating group and reverse-piped heating group according to randomized numerical table method. Both groups were provided with reasonable treatment mode and parameter setting by the bedside physician according to the patient's specific condition. The dialysis heating group used the AsahiKASEI dialysis machine heating panel to heat the dialysis solution at 37 centigrade. The reverse-piped heating group used the Barkey blood heater from the Prismaflex CRRT system to heat the dialysis solution, and the heating line temperature was set at 41 centigrade. The patient's temperature was then continuously monitored. Hypothermia was defined as a temperature lower than 36 centigrade or a drop of more than 1 centigrade from the basal body temperature. The incidence and duration of hypothermia were compared between the two groups. Binary multivariate Logistic regression analysis was used to explore the influencing factors of hypothermia during CRRT in AKI patients. RESULTS: A total of 73 patients with AKI treated with CRRT were eventually enrolled, including 37 in the dialysate heating group and 36 in the reverse-piped heating group. The incidence of hypothermia in the dialysis heating group was significantly lower than that in the reverse-piped heating group [40.5% (15/37) vs. 69.4% (25/36), P < 0.05], and the hypothermia occurred later than that in the reverse-piped heating group (hours: 5.40±0.92 vs. 3.35±0.92, P < 0.01). Patients were divided into hypothermic and non-hypothermic groups based on the presence or absence of hypothermia, and a univariate analysis of all indicators showed a significant decrease in mean arterial pressure (MAP) in hypothermic patients (n = 40) compared with the non-hypothermic patients [n = 33; mmHg (1 mmHg ≈ 0.133 kPa): 77.45±12.47 vs. 94.42±14.51, P < 0.01], shock, administration of medium and high doses of vasoactive drug (medium dose: 0.2-0.5 μg×kg^-1×min^-1, high dose: > 0.5 μg×kg^-1×min^-1) and CRRT treatment were significantly increased [shock: 45.0% (18/40) vs. 6.1% (2/33), administration of medium and high doses of vasoactive drugs: 82.5% (33/40) vs. 18.2% (6/33), administration of CRRT (mL×kg^-1×h^-1): 51.50±9.38 vs. 38.42±10.97, all P < 0.05], there were also significant differences in CRRT heating types between the two groups [in the hypothermia group, the main heating method was the infusion line heating, which was 62.5% (25/40), while in the non-hypothermia group, the main heating method was the dialysate heating, which was 66.7% (22/33), P < 0.05]. Including the above indicators in a binary multivariate Logistic regression analysis, it was found that shock [odds ratio (OR) = 17.633, 95% confidence interval (95%CI) was 1.487-209.064], mid-to-high-dose vasoactive drug (OR = 24.320, 95%CI was 3.076-192.294), CRRT heating type (reverse-piped heating; OR = 13.316, 95%CI was 1.485-119.377), and CRRT treatment dose (OR = 1.130, 95%CI was 1.020-1.251) were risk factors for hypothermia during CRRT in AKI patients (all P < 0.05), while MAP was protective factor (OR = 0.922, 95%CI was 0.861-0.987, P < 0.05). CONCLUSIONS AKI patients have a high incidence of hypothermia during CRRT treatment, and the incidence of hypothermia can be effectively reduced by heating CRRT treatment fluids. Shock, use of medium and high doses of vasoactive drug, CRRT heating type, and CRRT treatment dose are risk factors for hypothermia during CRRT in AKI patients, with MAP is a protective factor.
Humans ; Continuous Renal Replacement Therapy ; Incidence ; Prospective Studies ; Acute Kidney Injury ; Dialysis Solutions

Objective     To provide experience for clinical diagnosis and treatment through exploring the perioperative characteristics and short-term treatment outcomes of adult cardiac surgery in patients with prior coronavirus disease-2019 (COVID-19). Methods    A retrospective analysis was performed on patients undergoing coronary artery bypass grafting (CABG) or valve surgery in the Department of Cardiac Surgery of Beijing Anzhen Hospital from December 26, 2022 to December 31, 2022, and previously diagnosed with COVID-19 before surgery. Results    Finally 108 patients were collected, including 81 males and 27 females, with an average age of 60.73±8.66 years. Two (1.9%) patients received emergency surgery, and the others received elective surgery. The 86.1% of patients had been vaccinated, and the duration of COVID-19 was 5.0 (4.0, 7.0) days. The time from COVID-19 to operation was 15.0 (12.0, 17.8) days. Eighty-nine patients received CABG, of which off-pump CABG was dominant (92.1%). Nineteen patients received valve surgery. The rate of delayed extubation of ventilator was 17.6%. The ICU stay was 21.0 (17.3, 24.0) hours, and the postoperative hospital stay was 7.0 (6.0, 8.0) days. Three (2.8%) patients were treated with intra-aortic balloon  pump (IABP), one (0.9%) patient was treated with extracorporeal membrane oxygenation (ECMO), one (0.9%) patient was treated with continuous renal replacement therapy (CRRT) due to acute renal insufficiency, three (2.8%) patients were treated with temporary pacemaker, and one (0.9%) patient underwent rethoracotomy. In terms of postoperative complications, the incidence of cerebrovascular accident, acute renal insufficiency, gastrointestinal bleeding and septicemia was 0.9%, respectively, and the incidence of acute heart failure, lung infection, and liver insufficiency was 1.9%, respectively. All patients recovered and were discharged from hospital, and no in-hospital death occurred. Conclusion     The utilization rate of postoperative IABP, ECMO, CRRT, temporary pacemaker and the incidence of serious complications in patients with prior COVID-19 are not higher than those of normal patients, and the short-term treatment outcome is good.

Objective:To investigate the expression of LncRNA ANCR in human glioma tissues and its relationship with malignant proliferation of cells.Methods:The samples of 10 normal brain tissue,13 low-grade and 45 high-grade gliomas were regarded as normal group, low-grade group and high-grade group, which were collected from neurosurgery department in Linyi Central Hospital, and the expression of ANCR and potential interaction molecule eIF4B was detected by reverse transcription polymerase chain reaction (RT-PCR) in vitro. Lentivirus transfection in vitro was used to construct the U251 shRNA ANCR and control cell line in human high-grade gliomas as control, test 1 and test 2 group cells in the study. QPCR detect the expression level ANCR, eIF4B and Myc mRNA in cells. Western blot was used to detect the expression of eIF4B and c-Myc protein, CCK-8 assay was used to detect the relative proliferation ability of cells, and the colony formation assay was used to observe the change of cell clone formation. SPSS 21.0 was used for statistical analysis, analysis of variance was used for inter group comparison, and SNK-q pairwise comparison method was used for intra group comparison.Results:The expressions of ANCR mRNA in high-grade glioma tissues, low-grade gliomas and normal brain tissues were 0.710±0.125, 2.033±0.312 and 3.408±0.296. The expressions of eIF4B mRNA in high-grade glioma tissues, low-grade gliomas and normal brain tissues were 0.176±0.019, 0.268±0.022 and 0.426±0.028. The expression of ANCR and eIF4B in high-grade glioma tissues was higher than that in low-grade gliomas and normal brain tissues ( P<0.001). The expression of ANCR in low-grade glioma tissues was higher than that in normal brain tissues ( P=0.013). There was a significant positive correlation between the expression of ANCR and eIF4B in glioma tissues ( P<0.001) ; The expressions of ANCR mRNA in Control, test1 and test2 were 1.000±0.021, 0.202±0.057 and 0.300±0.016. The expressions of eIF4B mRNA were 1.000±0.078, 0.452±0.012 and 0.526±0.037, and the expressions of c-Myc mRNA were 1.000±0.053, 0.688±0.067 and 0.564±0.089. the expressions of ANCR, eIF4B and c-Myc mRNA and protein in test1 and test2 cells were significantly lower than those in the control group ( P<0.01) ; the proliferation of test1 and test2 groups were significantly decreased at 72h and 96h, and the ability of colony formation was significantly decreased ( P<0.001) . Conclusion:The expression of ANCR was significantly up-regulated in high-grade glioma tissues and positively correlated with the expression of eIF4B. Interference with ANCR in vitro could mediate the decrease of the expression of eIF4B and c-Myc mRNA and protein molecules, thereby inhibiting the proliferation of glioma cells.

Objective:To observe the application effect of high-flow nasal canula oxygen therapy (HFNC) after extubation in patients with mechanical ventilation (MV) in the intensive care unit (ICU).Methods:A prospective study was conducted. From January 2018 to June 2020, 163 MV patients admitted to Yijishan Hospital of Wannan Medical College were enrolled, and they were divided into HFNC group (82 cases) and traditional oxygen therapy group (81 cases) according to the oxygen therapy model. The patients included in the study were given conventional treatment according to their condition. In the HFNC group, oxygen was inhaled by a nasal high-flow humidification therapy instrument. The gas flow was gradually increased from 35 L/min to 60 L/min according to the patient's tolerance, and the temperature was set at 34-37 ℃. The fraction of inspiration oxygen (FiO 2) was set according to the patient's pulse oxygen saturation (SpO 2) and SpO 2 was maintained at 0.95-0.98. A disposable oxygen mask or nasal cannula was used to inhale oxygen in the traditional oxygen therapy group, and the oxygen flow was 5-8 L/min, maintaining the patient's SpO 2 at 0.95-0.98. The differences in MV duration before extubation, total MV duration, intubation time, reintubation time, extubation failure rate, ICU mortality, ICU stay, and in-hospital stay were compared between the two groups, and weaning failure were analyzed. Results:There was no significant differences in MV duration before extubation (days: 4.33±3.83 vs. 4.15±3.03), tracheal intubation duration (days: 4.34±1.87 vs. 4.20±3.35), ICU mortality [4.9% (4/82) vs. 3.7% (3/81)] and in-hospital stay [days: 28.93 (15.00, 32.00) vs. 27.69 (15.00, 38.00)] between HFNC group and traditional oxygen therapy group (all P > 0.05). The total MV duration in the HFNC group (days: 4.48±2.43 vs. 5.67±3.84) and ICU stay [days: 6.57 (4.00, 7.00) vs. 7.74 (5.00, 9.00)] were significantly shorter than those in the traditional oxygen therapy group, the reintubation duration of the HFNC group was significantly longer than that of the traditional oxygen therapy group (hours: 35.75±10.15 vs. 19.92±13.12), and the weaning failure rate was significantly lower than that of the traditional oxygen therapy group [4.9% (4/82) vs. 16.0% (13/81), all P < 0.05]. Among the reasons for weaning failure traditional oxygen therapy group had lower ability of airway secretion clearance than that of the HFNC group [8.64% (7/81) vs. 0% (0/82), P < 0.05], there was no statistically differences in the morbidity of heart failure, respiratory muscle weakness, hypoxemia, and change of consciousness between the two groups. Conclusion:For MV patients in the ICU, the sequential application of HFNC after extubation can reduce the rate of weaning failure and the incidence of adverse events, shorten the length of ICU stay.

The treatment of heart failure is a common clinical problem faced by the medical community all over the world. It is also the only cardiovascular disease in the world that is on the rise. Although drug therapy for heart failure has made great progress in recent years, there are still many problems. Therefore, reversing ventricular remodeling, assisting or even replacing the function of the damaged heart and improving the prognosis and quality of life of patients with heart failure through surgical treatment will become the main battlefield for the future treatment of heart failure. As a transitional support therapy or permanent replacement therapy before heart transplantation, ventricular assist device can significantly improve the survival and quality of life of patients with heart failure, and is becoming an important treatment method for patients with end-stage heart failure. This paper aim to review the history and prospect of ventricular assist devices after heart failure.

Objective:To examine the short-term and long-term outcomes of tricuspid valve replacement (TVR) in patients with left ventricular dysfunction.Methods:The clinical data of 24 patients with left ventricular dysfunction who received TVR at Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University from November 1993 to August 2018 were consecutively enrolled. There were 14 males and 10 females, aged (41.9±13.2) years old (range: 19 to 66 years old). The preoperative ejection fraction was (42.9±6.4)% (range: 21% to 49%), while less than 35% in 3 patients. The scores of Charlson comorbidity index were as follows: 5 patients for 0, 6 patients for 1, 7 patients for 2, 1 patient for 3 and 5 patients for 4. The European system for cardiac operative risk evaluation (EuroSCORE) Ⅰ was 3.6±2.1 (range: 1 to 9). The EuroSCORE Ⅱ was (4.91±2.40)% (range: 1.58% to 11.60%). The model for end-staged liver disease score was 1.8±1.2 (range: 0.2 to 7.1). The simplified model for end-staged liver disease score was 5.6±2.5 (range: 1.5 to 13.4). Follow-up was conducted by clinic. The long-term survival rate was calculated by Kaplan-Meier method.Results:In-hospital mortality was 16.7% (4/24), including 1 patient for multiple organ failure and 3 patients for low cardiac output syndrome (LCOS). One patient needed continuous renal replacement therapy and 6 patients suffered from LCOS. The follow-up time was 1 to 19 years, with a median of 8 years. During the follow-up period, 4 patients died, including 2 deaths for cardiogenic cause, 1 death for anticoagulant complications, and 1 death for lung cancer. The 1, 5 and 10-year survival rates were 76.2%, 71.4% and 64.9%, respectively.Conclusion:The short-term and long-term clinical outcomes of TVR in patients with left ventricular dysfunction are acceptable, but the mortality and morbidity are still high.

Objective:To examine the short-term and long-term outcomes of tricuspid valve replacement (TVR) in patients with left ventricular dysfunction.Methods:The clinical data of 24 patients with left ventricular dysfunction who received TVR at Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University from November 1993 to August 2018 were consecutively enrolled. There were 14 males and 10 females, aged (41.9±13.2) years old (range: 19 to 66 years old). The preoperative ejection fraction was (42.9±6.4)% (range: 21% to 49%), while less than 35% in 3 patients. The scores of Charlson comorbidity index were as follows: 5 patients for 0, 6 patients for 1, 7 patients for 2, 1 patient for 3 and 5 patients for 4. The European system for cardiac operative risk evaluation (EuroSCORE) Ⅰ was 3.6±2.1 (range: 1 to 9). The EuroSCORE Ⅱ was (4.91±2.40)% (range: 1.58% to 11.60%). The model for end-staged liver disease score was 1.8±1.2 (range: 0.2 to 7.1). The simplified model for end-staged liver disease score was 5.6±2.5 (range: 1.5 to 13.4). Follow-up was conducted by clinic. The long-term survival rate was calculated by Kaplan-Meier method.Results:In-hospital mortality was 16.7% (4/24), including 1 patient for multiple organ failure and 3 patients for low cardiac output syndrome (LCOS). One patient needed continuous renal replacement therapy and 6 patients suffered from LCOS. The follow-up time was 1 to 19 years, with a median of 8 years. During the follow-up period, 4 patients died, including 2 deaths for cardiogenic cause, 1 death for anticoagulant complications, and 1 death for lung cancer. The 1, 5 and 10-year survival rates were 76.2%, 71.4% and 64.9%, respectively.Conclusion:The short-term and long-term clinical outcomes of TVR in patients with left ventricular dysfunction are acceptable, but the mortality and morbidity are still high.

Objective:To investigate the difference between the short-term and long-term survival rates of patients undergoing tricuspid valve replacement with biological and mechanical valves.Methods:273 patients who received tricuspid valve replacement were selected from our Hospital from November 1993 to August 2018. The mean follow-up time was(8.2±5.6) years. The total follow-up rate was 95%. Kaplan-Meier method was used to make survival curves of the two groups and log rank test was used to compare the differences between the two groups. In addition, this study made the comparison of preoperative, intraoperative and postoperative information and long-term survival rate between these two groups.Results:There was no significant difference in demographic characteristics and baseline between mechanical valve group and biological valve group. 16 patients died in the mechanical valve group and 22 in the biological valve group. In the mechanical valve group, 14 cases died of postoperative low cardiac output syndrome and 2 cases died of gastrointestinal hemorrhage. 22 patients were died of low cardiac output syndrome. The auxiliary time in the mechanical valve group was longer than that in the biological valve group[(151.76±70.30)min vs.(131.62±60.25)min, P=0.013)]. There was no significant difference in long-term survival rate between the two groups in Kaplan- Meier survival curve( P=0.234). Conclusion:There is no difference in short-term and long-term survival rate between mechanical valve and biological valve in tricuspid valve replacement.

Objective:To provide a reference for extracorporeal membrane oxygenation (ECMO) inter-hospital transport during coronavirus disease 2019 (COVID-19), based on the transport experience of 6 patients with severe H1N1 influenza virus pneumonia using ECMO.Methods:Clinical data of patients with severe H1N1 influenza virus pneumonia implemented by ECMO in the First Affiliated Hospital of Wannan Medical College from October 2018 to December 2019 were retrospective analyzed, including general information, ECMO transport distance, time, clinical parameters before and after ECMO, including the patients' oxygenation index (PaO 2/FiO 2), respiratory rate (RR), pulse blood oxygen saturation (SpO 2), arterial blood carbon dioxide partial pressure (PaCO 2), and pH value, various complications during transport, mechanical ventilation time, patients' prognosis and other indicators. Experience from the aspects of personal protection, transport process and equipment, team cooperation, mid-transit monitoring, quality control, etc., was summarized to provide suggestions for patients with severe COVID-19 using ECMO during inter-hospital transport and protection. Results:A total of 6 patients with severe H1N1 influenza virus pneumonia were transported on ECMO. All patients were transported to the intensive care unit (ICU) of the First Affiliated Hospital of Wannan Medical College by the ECMO transport team after the establishment of ECMO in the local hospital. The transfer distance was 11 to 197 km, with an average of (93.8±58.6) km; the transfer time was 30 to 150 minutes, with an average of (79.2±40.6) minutes. Two patients experienced a drop in ECMO flow and SpO 2 during the process, and the main reason was insufficient volume, which was improved after fluid resuscitation and posture adjustment. All patients maintained SpO 2 above 0.93. Six patients survived and were discharged. ECMO assisted time was 4-9 days, with an average of (6.5±1.5) days; mechanical ventilation time was 7-24 days, and median time was 10.0 (8.0, 14.5) days. No H1N1 transmission occurred in medical personnel. To achieve good therapeutic effect, the main experience was to choose the proper timing and mode of ECMO; intact transportation vehicles and equipment to reduce or avoid mechanical complications; the effective management of respiration and circulation during the transportation to avoid ventilation-associated lung injury (VALI) and serious hypoxemia; the appropriate space for the transfer team to quickly handle various critical situations; and personal protection to avoid infection. Conclusion:With an experienced ECMO transport team, good transport equipment, comprehensive protection measures, reasonable transport procedures, and a perfect emergency plan, it is safe to use ECMO transport for COVID-19 patients.

Objective:To investigate short-term and long-term outcomes of off-pump coronary artery bypass grafting(OPCABG)in patients aged 80 years and over.Methods:In this retrospective study, clinical data were collected, from June 2005 to July 2014, of 31 patients aged 80 and over years with left ventricular dysfunction who had received OPCABG in Beijing Anzhen Hospital and a follow-up of 3-12 years after discharge.Results:Ages of the patients ranged from 80 to 88 years with a mean age of(82.0±2.1)years.There were 25 males(80.6%). The mean left ventricular ejection fraction(LVEF)of patients was(42.0±6.5)% before operation, and 15 patients had LVEF less than 35%(48.4%). The average operation time was 4 hours.Three patients died in hospital(9.7%), of whom, one died from acute respiratory failure and the two others from low cardiac output syndrome.Perioperative complications included myocardial infarction(1 case, 3.2%), acute cerebral infarction(2 cases, 6.5%), tracheal intubation(3 cases, 9.7%), secondary thoracotomy and hemostasis(1 case, 3.2%), continuous renal replacement therapy(3 cases, 9.7%)and perioperative intra-aortic balloon pump(IABP)(8 cases, 25.8%). Twenty-eight patients were followed up for 3-12 years(median, 8.0 years), and no one had withdrawn.There were 10 all-cause deaths(35.7%), including 5 cardiogenic deaths(17.9%), 2 lung cancer deaths(7.1%), 2 deaths due to sepsis from systemic infection(7.1%), and 1 death from unknown causes.Besides, 2 patients had re-admission(7.1%), 2 patients suffered angina(7.1%)and 1 patient(3.6%)had recurrent myocardial infarction(3.6%). No patient received re-revascularization.Coronary computed tomography angiography(CTA)was performed on all surviving patients 1 year after surgery, and the patency rate of vascular bridges was 100%.Conclusions:Both short-term and long-term clinical outcomes of OPCABG are fair in patients aged over 80 years with left ventricular dysfunction, but the mortality and risk of complications are still high, and comprehensive preoperative evaluation is needed for these patients.