简介：Coronaryarterybypassgrafting(CABG)isenteringaneweraasminimallyinvasivetechniques,off-pumpsurgeryandtotal'arterialrevascularizationhavefotmdrolesinthesurgicaltreatmentofpatientswithcoronaryarterydisease.Thecontinueddevelopmentofthetechniquesofpercutaneouscoronaryintervention(PCI)isalsohavinganimpactonthetypeofpatientreferredforCABG.

简介：Adynamicexperimentalapparatustomeasuretheinstantaneousvelocityandpressureinthemultibypasspulsetuberefrigerator(MPTR)wasdesignedandconstructed.SomeimportantexperimentalresultsoftheinstantaneousmeasurementsofthevelocityandthepressureintheMPTRwithtwobypasstubesduringactualoperationareprsented.Theeffectsofthemiddle-bypassversiononthedynamicpressureandmassflowrateatthecoldendofthepulsetubeareevaluatedfromexperimentalmeasurements.DC-flowphenomenaareobservedinthisMPTR.Thereasonsofthemulti-bypassversionimprovedtheperformanceofpulsetuberefrigertoraregiven.

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简介：BackgroundThroughaministernotomy'J'shapedapproach,leftinternalmammaryartery(LIMA)bypassgraftingtotheleftanteriordescendingartery(LAD)canbeperformedsafelyoff-pump.Toachieveacompleterevascularization,percutaneouscoronaryinterventions(PCI)withdrugelutingstentimplantationtoothercoronaryarterieswasused.Wereportedoutcomesofthetreatmentofmultivesselcoronaryarterydiseasewithminimallyinvasivecoronaryarterybypass(MICAB)andPCI.MethodsBetweenJanuary2009andDec2012,14patients(11males,3females,meanagewas64.8±10.1years.Two-vesseldiseaseaccountfor35.7%(5/14)ofthesepatients,three-vesseldisease64.2%(9/14)(Table1).Allpatientsunderwentaminimallyinvasivecoronaryarterybypassgraftingviamini-sternotomy'J'shapedapproach.SevenpatientswerefollowedbyPCI,7forobtusemarginalcircumflex,5forrightcoronaryartery(RCA).AngiographicassessmentofgraftpatencywasperformedinallpatientsduringthePCIprocedure.Theclinicalfollow-upperiodlastsfrom11-24months.ResultsThein-hospitalmortalitywas0%.Therewasneitherconversiontoafullmediansternotomynorintraoperativecomplications.Ventilationtimewas6.6±4.1h.Bloodlossranged341±78.8mL.ICUstayranged22.3±12.8h.Hospitalpostoperativestaylastedfor6.5±1.6days.PriortoPCIpatientsshowed100%patentleftinternalmammaryartery.Onepatienthadmediastinitis(Tables2-3).Rateoffreedomfromcardiacreinterventionduringthefollow-upperiodwas92.8%(13/14).ConclusionsTheinferiorJ-shapedsternotomyissimple,reproducible,andthesafesttechniqueforperformingminimallyinvasivecoronarybypasssurgery.MICAB+PCIisalsosafe,feasibleandefficacious.

简介：Theconventionalbypassdesignistoimplantagraftonthestenosedhostarteryallowingbloodtoflowbypassthestenoticartery.However,restenosisisachallengingproblemwhichfinallyresultsinreoperation.Thepurposeofthispaperistoproposeanewbypassgraftdesignofcoronaryarterywithanassistantgraftforthetreatmentofcoronaryarterystenosis.AnadditionalassistantgraftwasemployedinthenewdesigncomparedwiththeconventionalETSanastomosis.Numericalsimulationswereperformedbymeansoffinitevolumemethodusingcomputationalfluiddynamics(CFD)solver.ResultsdemonstratedthatthenewanastomosesmodelprovidedamoresmoothflowatthedistalETSanastomosiswithoutanystagnationpointonanastomoticbedandvortexformationintheheelregion.Oscillatoryshearindex(OSI)andtime-averagedwallshearstressgradient(TAWSSG)atthearterybedofthedistalETSanastomosiswerereduced.Thecoronaryarterybypassgraftwithanassistantgraftisfeasibletoimprovethelocalhemodynamicsanddiminishtheprobabilityofrestenosisinthetreatmentofcoronaryarterystenosis.

简介：Objective:Toestablishagoodrecoverableratmodelofcardiopulmonarybypass(CPB)tolaythefoundationforstudyingthepathophysiologyofCPB.Methods:TwentyadultmaleSprague-Dawleyratsweighing480g±20gwererandomlydividedintoCPBgroup(n=10)andShamgroup(n=10).Allratswereanaesthetized,intubatedandventilated.Thecarotidarteryandjugularveinwerecannulated.Thebloodwasdrainedfromtherightatriumviatherightjugularveinandfurthertransferredbyaminiaturizedrollerpumptoahollowfiberoxgenatorandbacktotheratviatheleftcarotidartery.Primingconsistedof8mlofhomologousbloodand6mlofcolloid.Thesurfaceofthehollowfiberoxgenatorwas0.075m~2.Ratswerecatheterizedandbroughtinbypassfor120minataflowrateof100-120ml/kg/min.Oxygenflow/perfusionflowwas0.8to1.0,themeanarterialpressure(MAP)keptin60-80mmHg.Bloodgasanalysis,lactatedehydrogenase(LDH),andsurvivalratewereexaminedsubsequently.Resnits:AllCPBratsrecoveredfromtheoperativeprocesswithoutincidentandremaineduneventfulwithinoneweek.Normalcardiacfunctionaftersuccessfulweaningwasconfirmedbyelectrocardiographyandbloodpressuremeasurements.MAPremainedstable.Theresultsofbloodgasanalysisatdifferenttimepointswerewithinanormalrange.NosignificanthaemolysiscouldbedetectedinthegiventimeframeunderbypassconditionbyusingLDH.Conclusions:TheratmodelofCPBcanprincipallysimulatetheclinicalsettingofhumanCPB.Thenon-transthoracicmodeliseasytoestablishandisassociatedwithexcellentrecovery.ThiswellreproduciblemodelmayopenthefieldforvariousstudiesonpathophysiologicalprocessofCPBandalsoofsystemicischemia-reperfusioninjuryinvivo.

简介：BackgroundTheconventionalextra-anatomicbypassisoriginatedfromtheaxillary'sarteryandthegraftsizeisoftenlimitedduetothesmalldiameterofaxillary'sartery.Extra-anatomicbypassgraftoriginatingfromascendingaortacanimprovethegraftsizeanddistalperfusion,butneedsternotomywhichmighthavehigheroperativeriskscomparedwithaxillo-femeralbypass.Wesummarizeourexperiencesofextra-anatomicbypassfromascendingaortaforatypicalaorticcoarctation.MethodsBetweenJanuary2005andFebruary2008,5womenagedfrom18to64yearsunderwentextra-anatomicbypassfromascendingaortatoabdominalaortaoriliacarterybypassfortreatmentofatypicalaorticcoarctation.Preoperatively,allpatientshadhypertensionandneededanti-hypertensivemedications.Systolicbloodpressurewas151±9mmHg.Anklepressureindex(API)were0.60±0.23inleftand0.56±0.23inright.Averagesystolicpressuregradientofaorticstenosiswas76±18mmHg.Threepatientsunderwentconcomitantcardiacoperation,includingcoronaryarterybypassgrafting,Bentallprocedureandatrialseptaldefectrepair.ResultsTherewasnohospitalandlatemortalityduring58±15monthsfollow-up(rangefrom44to81months).Postoperativesystolicbloodpressurewasreducedto126±11mmHgatthetimeofdischarge.Allpatientsmaintainednormalbloodpressurewithoutmedicationduringfollow-up.APIwasimprovedto1.12±0.24inleftand1.17±0.25inright(comparedwithpreoperativedata,P<0.05).Follow-upcomputertomographyshowedpatencyinallgrafts.ConclusionsSurgicaltreatmentofatypicalaorticcoarctationwithextra-anatomicbypassoriginatingfromascendingaortaalleviateshypertensionandlowlimbischemia.

简介：AbstractObesity has become a global health problem. Lifestyle modification and medical treatment only appear to yield short-term weight loss. Roux-en-Y gastric bypass (RYGB) is the most popular bariatric procedure, and it sustains weight reduction and results in the remission of obesity-associated comorbidities for obese individuals. However, patients who undergo this surgery may develop hypoglycemia. To date, the diagnosis is challenging and the prevalence of post-RYGB hypoglycemia (PRH) is unclear. RYGB alters the anatomy of the upper gastrointestinal tract and has a combined effect of caloric intake restriction and nutrient malabsorption. Nevertheless, the physiologic changes after RYGB are complex. Although hyperinsulinemia, incretin effects, dysfunction of β-cells and α-cells, and some other factors have been widely investigated and are reported to be possible mediators of PRH, the pathogenesis is still not completely understood. In light of the important role of the gut microbiome in metabolism, we hypothesized that the gut microbiome might also be a critical link between RYGB and hypoglycemia. In this review, we mainly highlight the current possible factors predisposing individuals to PRH, particularly related to the gut microbiota, which may yield significant insights into the intestinal regulation of glucose metabolic homeostasis and provide novel clues to improve the treatment of type 2 diabetes mellitus.

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简介：BackgroundComparedwiththeopensaphenousveinharvesting(OVH),thereisalargerdecreaseinincisioncomplicationsofendoscopicveinharvesting(EVH).Fewerstudieswereconductedtoevaluatethequalityofgreatsaphenousvein(SVG)harvestingbythesetwomethods.Toapplytransittimeflowmeasurement(TTFM)toSVGgraftsincoronaryarterybypassgrafting(CABG),weproperlyevaluatethequalityofSVGandsurgicaleffect.MethodsFromJanuary2012toAugust2012,38casesunderwentEVHand16casesunderwentOVH.Werecordedpulsatilityindex(PI),meangraftflow(MGF)anddiastolicflow(DF)ofSVGgraftsforstatisticalanalysis.ThedysfunctionalgraftsdiagnosticcriteriaisPI>5,MGF<10mL/minorDF<50%.ResultIntermsofSVGgrafts,nosignificantdifferenceexistedinthelengthoftwogroups(P=0.2395).EVHgroupharvestingtimewaslongerthanOVHgroup(P=0.0113),buttheincisionlengthofEVHgroupwasshorter(P=0.0000)anditneededlesssuturetime.EVHgrouppresentednosignificantdifferencesinincisioncomplicationratefromOVHgroup(P=0.7055)within1monthaftersurgery.TTFMdataofwellfunctioninggraftshadnosignificantdifferenceinthetwogroups(PI3.2±1.0vs.2.9±0.9,MGF34.7±20.4vs.36.3±19.2mL/min,DF66.3%±10.6%vs.68.5%±10.3%).Therewasnosignificantdifferenceintherateofdysfunctionalgraftsintwogroups(P=0.7954)aswell.Thecausefordysfunctionalgraftsisanastomoticstricture.Were-anastomosedthegraftswithsatisfactoryeffect.ConclusionEVHisasafeandrecommendableoptionalSVGharvestingmethods.ThesurgicaleffectandthequalityofSVGgraftscanbereasonablyevaluatedbyTTFM.

简介：Theetiologyofvasoplegicsyndrome(VS)isnotcompletelyelucidatedandtheclinicalimportanceremainsspeculative.MethodsTwenty-fourpatientswhounderwentcoronaryarterybypassgraftinganddevelopedVSwerecomparedwith48controlpatientswithoutVSina2:1casecontrolstudy.Casesandcontrolswerematchedbygender,age(±5yearsold)andoperationdate(±1week).ResultsTheindependentpredictorsofVSwerelowerejectionfraction(OR10.75,95%CI2.93-39.44,whenLVEF<0.45)anddiureticuse(OR8.98,95%CI2.59-31.10)inlogisticregressionanalysis.Conclusionlowerejectionfraction(<0.45)anddiureticuseareindependentriskfactorsforVSoccurrence.

简介：有电磁的领域的不同安排的一个MHD生成器将带在三个模式工作的生成器。quasi-one-dimensional近似被用于MHD发电机的模型分析操作模式的内部机制。为有一个一致经常的磁场的MHD发电机，特定的批评电场E<潜水艇class=“a-plus-plus”>cr被要求速度超声的入口流动进亚声的出口流动。否则，发电机比E与一个更大的电场在一个稳定的模式工作稳定的超声的流动在出口在被提供的cr，或发电机比E与一个更小的电场在一个窒息的模式工作超声的入口流动在隧道在被窒息的cr。在不同操作模式的详细流动地特征被讨论，表明有电磁的地的操作模式的关系。

简介：ObjectivesTotestthefeasibilityoftheuseofhighthoracicepiduralanesthesiaasasoleanestheticinpatientsundergoingoffpumpcoronaryarterybypasssurgery,avoidinggeneralanesthesia.MethodsBetweenOctober2002toApril2003,twentyfivecasesunderwentbeatingheartcoronaryarteryrevascularizationwithoutendotrachealgeneralanesthesia,usinghighthoracicepiduralanesthesiaandanalgesia.Allthepatientsunderwentepiduralcatheterizationontheeveningbeforethesurgery.ResuitsThepatientsinallreceived71grafts(singlen=11,doublen=5,triplen=6,quadruplen=3).Sixpatientsunderwentrepeatcoronaryarterybypass.Exceptonewasconvertedtogeneralanesthesiaandcardiopulmonarybypass,theotherpatientsunderwentoff-pumpcoronaryarterybypassgraftsurgery,2patientsunderwentgraftingvialeftthoracotomy(MIDCAB)andtherestthroughmidsternotomy.Therewasnomortality.Meanlengthofstayintheintensivecareunitwas16.2(4.2hoursandhospitalwas3.0(1.2days.ConclusionsOurexperienceconfirmsthefeasibilityofperformingmuhiplecoronaryarterybypassesinconsciouspatientswithoutendotrachealgeneralanesthesia.

简介：Therestenosisaftercoronaryarterybypassgraft(CABG)isattributedtotheformationofintimalhyperplasia(IH)attheanastomosis,whichiscloselyrelatedtohemodynamicdependonthegeometricmodel.Inordertogiveareasonableassessmentofthesurgeryeffectandjudgethelong-termpatencyrate,thehemodynamicofCABGsurgeryprogramiscomparedwiththatofsurgerydesignofthejunctionanglechanged.Basedonin-vivoCTcoronaryangiographydatasets,theindividualgeometricmodelofCABGreconstructedinsteadofidealizedgeometricmodelsareappliedtosimulatetherealphysiologicalbloodflowutilizingpulsatileflowboundarywaveformsinthepresentstudy.Thesimulationresultsshowthatthemaximumwallshearrate(WSS)valueisatthebottomofanastomosis.Moreover,thestagnationzonegrowinggraduallywiththegreaterangledownstreamtheanastomosisispronetoformtheIH,whichisconsistentwithclinicalobservation.Itisprovedthatthesurgerybeingbettersuitedtomaintaingraftpatencyissuccessful.

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简介：为了描述创造登陆的一种新奇技术，在trabecular网状组织以内脱衣指导trabecular微绕过stent(iStent)在经历了phacoemulsification.METHODSThirty的病人的培植--从从2014年5月在phacoemulsification以后经历了iStent培植到2015年2月的30个病人的四只眼睛在我们的回顾的学习被包括。所有iStents经由登陆长带技术被植入。A25计量器microvitreoretinal片被用来切分trabecular网状组织到不到1钟小时，有效地创造登陆脱衣。iStent棉棍沿着登陆长带被压然后stent被释放进34与iStent培植看的trabecularmeshwork.RESULTSOf，(79.4%)27看有的主要开角度的绿内障，(17.6%)6看有的pseudoexfoliation绿内障，并且(2.9%)1看有的眼睛的高血压。在6月的后续(n=17)，低血压患者药的吝啬的数字从2.2减少了

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简介：SummaryThispaperanalysestheturbinebypasssystemdesignandoperationmodefordomesticallymade300MWunitwithtechnologyimported,andputforwardsomesuggestionsaboutwhetherbypasssystemisneeded.1.0IntroductionThedomesticallymadeWHCo,patent300MWunitisproducedaccordingtothetechnologyofAmericanWestinghouse(WH)Corporation.Theoriginalimported

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简介：BackgroundTherequisitetechniquesforsafefetalcardiacarrestduringcardiacinterventionsneedtobefurtherdeveloped.Furthermore,littleisknownaboutthepathophysiologiceffectofcardiopulmonarybypass(CPB)atdifferentlevelsoftemperaturewithcardioplegicarrestonthedevelopingfetus.MethodsTwelvepregnantgoatswererandomlydividedintohypothermicCPBgroup(Hgroup):cardiopulmonarybypasswithperfusionat30-32℃(n=6)andnormothermicCPBgroup(Ngroup):cardiopulmonarybypasswithperfusionat36℃-38℃(n=6).Fetalcardiopulmonarybypasswasmaintainedincluding30minutesofcardiacarrest.Fetalmeanarterialbloodpressure(MAP)andheartrate(HR)weremonitored.Fetalarterialbloodsampleswereanalyzed.Thepulseindex(PI)andresistanceindex(RI)ofthefetalumbilicalarterywererecorded.ResultsThematernalweight,fetalweightandpumpflowhadnosignificantdifferencebetweenthe2groups.Afterclampremoval,twofetalheartsdidnotauto-beatinHgroup.ThefetalHRandMAPbweresignificantlydifferent(P<0.05)etweenthe2groups.Therewasremarkabledecreasinginpost-CPBfetalHRandMAPinHgroup.AstabledecreaseinpartialpressureofoxygenwithaconcomitantstableincreaseofcarbondioxidepartialpressureinHgroupwasnoted.ThelacticacidinHgroupwassignificantlyhigherthanthatintheNgroup(P<0.05).ThePIandRIinHgroupweresignificantlyelevated1hourafteroffCPBandfurthermarkedlyincreased2hoursafteroffbypass.ConclusionsFetalCPBcouldbeperformedunderbothhypothermicandnormothermicconditions.However,normothermicbypassmayprovidebetterdeliveryofoxygentofetaltissue.