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Research Progress of Protective Effects and Mechanism of Mangiferin on Myocardial Remodeling

Myocardial remodeling is one of the important pathological basis when myocardial infarction or pressure overload occurs, whereas mangiferin which is a naturally occurring xanthone has a broad range of therapeutic effect on postinfarction myocardial remodeling. Mangiferin attenuates myocardial infarction by preventing the accumulation of myocardial collagen and the development of intercellular fibrosis. Mangiferin's inhibition to p38 mitogen activated protein kinases plays an important role in the cardioprotective effect. Inhibition of p38 mitogen activated protein kinases significantly decreases TNF-α and then brings the cardioprotective effect. Similarly, p38 mitogen activated protein kinases in pressure overload disease also play a very important role. Understanding of these has direct implications for clinical therapy.

先天性心脏病心脏不停跳心内直视手术

摘要 目的　介绍体外循环心脏不停跳下心内直视手术治疗先天性心脏病心内畸形的应用体会。　方法　327例先天性心脏病心内畸形行浅低温体外循环心脏不停跳心内直视手术。常规建立体外循环，置左心房引流管，降温至32±1℃并维持，仅阻断上、下腔静脉，不阻断升主动脉，维持灌注压在60mmHg左右，在心脏不停跳下施行心脏畸形矫正术，方法同心脏停搏手术。　结果　死亡7例，死亡率2.1%，其余均痊愈出院，随访1～13个月，恢复良好。　结论　心脏不停跳下心内直视手术有较好的心肌保护作用，能减少并发症的发生，并简化操作，缩短体外循环时间。

血液透析患者合并退缩人综合征并发骨折护理一例

嗜酸性粒细胞与慢性阻塞性肺疾病的临床研究进展

7262例体外循环管理经验总结

目的总结体外循环（CPB）管理的经验及教训，为更安全的CPB方式提供参考。方法回顾性分析我院1964年2月～2004年12月施行的CPB心内直视手术7262例患者的临床资料，并对硬件设备、转流技术、灌注师经验、术中监测及心肌保护等方面进行分析，其中3748例患者采用心脏不停跳CPB。结果全组死亡248例，总死亡率3．4％（248／7262）。1964年2月～1983年12月施行CPB手术464例，死亡52例，死亡率11．2％；1984年1月～1996年12月施行CPB手术1709例，死亡78例，死亡率4．6％；1997年1月～2004年12月施行CPB手术5089例，死亡118例，死亡率2．3％；1997年3月～2004年12月，对3748例患者采用心脏不停跳CPB，手术顺利，未发生与CPg相关的并发症及死亡。结论灌注师的经验和硬件设备的完善、使用高质量的人工心肺机和氧合器、多种转流技术的应用、完善的监测系统等可明显提高CPB的安全性。心脏不停跳下CPB是安全且易于管理的一种方式。

Efficacy of Clinical Use of Different Dialyzer Reprocessing Machines

目的:观察W-F168-B型和RENATRONⅡ型透析器复用机临床应用对患者透析质量的影响。方法:符合纳入标准的受试者随机分为2组,试验组和对照组的透析器分别用W-F168-B和RENATRONⅡ复用。测定受试者透析前后血红蛋白、白蛋白、肌酐、尿素氮,计算尿素清除率除以分布容积(Kt/V,K为尿素清除率,t为透析时间,V为分布容积)。结果用均数±标准差表示,采用成组设计的t检验,spss13.0统计软件包分析。结果:试验组和对照组Kt/V值分别为1.25±0.26和1.24±0.19,透析前后血红蛋白差值分别为(1.32±0.14)g/L和(1.34±0.27)g/L,白蛋白差值分别为(0.86±0.05)g/L和(0.79±0.18)g/L。t 检验示两组以上各值比较差异无统计学意义(Pgt;0.05)。结论:两种透析器复用机对受试者透析充分性的影响无明显差异,能达到较好的透析质量。

体重小于10 kg婴幼儿心内直视术后早期心律失常的防治

目的 分析体重lt;10 kg行心内直视手术后早期发生心律失常婴幼儿的临床特点，探讨其防治措施。 方法 回顾性分析2007年6月～2009年6月第三军医大学附属新桥医院收治的88例体重lt;10 kg行心内直视手术后早期发生心律失常婴幼儿患者的临床资料，其中男49例，女39例；年龄1.0个月～25岁（12.4±5.5个月）；体重2.5~9.7 kg（6.4±2.8 kg）。术后对发生窦性心动过速和室上性心动过速患者给予对症处理，如无效，给予西地兰或普罗帕酮或胺碘酮治疗；对Ⅱ°和Ⅲ°房室传导阻滞合并心率缓慢患者，给予异丙肾上腺素、激素，临时/永久心脏起搏器；对室性心律失常患者给予利多卡因或胺碘酮治疗。 结果 围术期共死亡4例，病死率45%。死于低心排血量综合征2例，多器官功能衰竭1例，室性心动过速1例。术后发生窦性心动过速58例，室上性心动过速18例（心率200~300次/分)；房室传导阻滞6例（Ⅰ°1例、Ⅱ°4例、Ⅲ°1例）；室性心律失常6例；均经给予对症处理、抗心律失常药物或安置临时/永久心脏起搏器治疗好转或治愈。随访76例，随访时间6~40个月（20.4±11.5个月），所有患者健康状况良好，无严重心律失常发生。失访8例。 结论 体重lt;10 kg的婴幼儿行心内直视手术后早期心律失常发生率高，应加强监护，慎重选择抗心律失常药物；复杂型心内畸形，体重lt;6 kg、年龄lt;6个月的婴幼儿术后早期更易出现室性心律失常，应加强防治。

Measurement and clinical validation of safe distance for LC-Ⅱ screw placement using iliac oblique view

Objective To define a safe distance range from the LC-Ⅱ screw trajectory to the apex of the greater sciatic notch based on pelvic CT measurements, and to clinically assess the feasibility of using this range under iliac oblique view combined with iliac tangential view fluoroscopy to guide screw insertion. Methods CT scans of 104 normal pelvises collected between January 2022 and February 2025 were analyzed. There were 52 males and 52 females, with a median age of 45.8 years (range, 19-76 years). The RadiAnt DICOM Viewer software was used to reconstruct coronal, sagittal, and axial sections of the potential LC-Ⅱ screw trajectory. The maximum safety distance (Dmax) and the optimal safety distance (Dopt) from this trajectory to the greater sciatic notch were measured on the coronal and sagittal views. A retrospective analysis was conducted on 21 patients with LC-Ⅱ type pelvic fractures treated with the LC-Ⅱ screws fixation. And the screws were placed within the pre-defined safe distance under guidance from the iliac oblique view and iliac tangential view. Postoperative CT scans were obtained to evaluate the accuracy of screw placement. Results Radiographic measurements from the 104 cases showed that Dmax ranged from 1.87 to 3.87 cm (mean, 2.79 cm), and Dopt ranged from 1.01 to 2.92 cm (mean, 1.84 cm). Both Dmax and Dopt were significantly greater in the males than in the females (P>0.05). No significant difference was found between the left and right sides within the same gender (P>0.05). All 21 patients successfully underwent fracture reduction and fixation, with a total of 23 LC-Ⅱscrews implanted. According to the Lonstein grading system, the screw placement accuracy was rated as excellent in 16 screws, good in 3, fair in 3, and poor in 1, with an excellent and good rate of 82.6%. ConclusionUtilizing a CT-defined safe distance range from the screw trajectory to the greater sciatic notch, and adhering to this range under iliac oblique view combined with iliac tangential view fluoroscopy, enables the accurate and precise placement of LC-Ⅱ screws.

Application of local citrate anticoagulation and heparin-free dialysis in hemodialysis of patients with high risk of bleeding tendency

ObjectiveTo evaluate the safety and efficacy of local sodium citrate anticoagulation for routine hemodialysis in high-risk patients with hemorrhage.MethodsA total of 150 patients who were admitted to West China Hospital from October 2018 to March 2019 for routine hemodialysis treatment with high-risk bleeding were selected as study objects. The patients were divided into without heparin anticoagulation group (group A) and with 4% sodium citrate anticoagulation group (group B) by random number table method, with 75 cases in each group. Biochemical indicators, serum calcium ion concentration, local anticoagulation safety index of citrate and dialysis adequacy index, blood coagulation in dialyzer and tube during dialysis wre observed in the two groups.ResultsThe coagulation events in group B were significantly lower than those in group A (Z=–4.889, P<0.001), and the urea clearance index in group B was higher than that in group A [(1.26±0.12) vs. (0.73±0.13) L/(min·1.73 m2); t=22.418, P<0.05]. There was a significant difference in the changes of urea nitrogen [(3.53±1.05) vs.(3.12±1.11) mmol/L; t=2.323, P=0.021] 24 hours after dialysis; other indicators showed no statistically significant difference (P>0.05). After the filter, serum calcium ion concentrations in group B at different time points were lower than those in group A [2 hours: (0.52±0.07) vs. (0.64±0.08) mmol/L; 4 hours: (0.56±0.09) vs.(0.63±0.09) mmol/L; t=5.198, 0.525, P<0.001], and the coagulation time was higher in group B than that in group A [2 hours: (172.56±14.78) vs. (151.45±19.81) s; 4 hours: (168.45±16.48) vs. (152.88±16.54) s; t=7.396, 5.775, P<0.001]. None of the patients had dialysis-related adverse events.ConclusionFour percent sodium citrate is effective and safe in anticoagulation therapy for hemodialysis patients, and it can reduce the risk of coagulation in dialyzer and ensure the adequacy of maintenance hemodialysis.

Nursing Experience of Continuous Renal Replacement Therapy for Senile Patients with Diabetic Nephropathy

目的　总结老年糖尿病肾病（DN）连续性肾脏替代治疗（CRRT）临床护理措施。 方法　2010年2月－2012年3月对15例老年DN患者CRRT治疗中，采取相应的通路与抗凝、饮食、并发症及心理护理。 结果　患者经CRRT 治疗82 h后水肿明显消退，治疗中发生5例低血糖，3例低血压，3例高血压，各种并发症在相应的对症处置和护理后很快缓解，且无感染病例。 结论　老年DN患者行CRRT治疗中容易出现各种并发症，护理人员需要采取相应的护理措施，确保治疗顺利进行及安全。