The diagnosis and management of congenital heart disease (CHD), the most common inborn defect, has been a tremendous success of modern medicine. With the development of diagnostic techniques, surgical procedures and interventional techniques, more than 90% of CHD children can survive to adulthood. Consequently, the prevalence of patients with CHD has shifted away from infancy and childhood towards adulthood. Adult CHD cardiology is now encompassing not only young or middle-aged adults but also patients aged above 60 years. Standardized guidelines can provide good theoretical support for the comprehensive management of adult CHD. Ten years after the European Society of Cardiology guidelines for the management of grown-up CHD released in 2010, the new version was officially released in August 2020. The new version of guidelines updated the classification and stratification of diseases, comprehensive intervention methods and intervention timing, and put forward some new concepts, new intervention standards and methods. For adult CHD that has not been repaired or needs to be repaired again, the indication and mode of surgical intervention and perioperative management have a great impact on the prognosis. The new version of the guidelines provides a detailed description of the surgical and intervention indications and methods for different diseases, and clarifies the management methods for high-risk groups. This article attempts to interpret this newly updated guideline from the perspective of a surgeon, sort out several key diseases introduced by the guideline, and strives to provide a concise and actionable guideline for domestic counterparts.
To evaluate the development prevention and treatment of pneumonic injury after operation on aged patients with abdominal infection. We analyzed 77 aged patients (＞60 y) admitted from Jan. 1991 to Dec. 1992: 38 cases of which with abdominal infection (infection group), 39 cases without abdominal infection (non-infection group). All patients were given oxygen therapy and continuous SaO2 monitoring. Results: There were 28 patients with hypoxemia (SaO2＜95%) in infection group, with an occurrence rate of 73.7%. In non-infection group (12 patients), the rate of hyoxemia was 30.8%, which has significant difference between two groups (Ｐ＜0.001). All patients with hypoxemia were given oxygen therapy and 31 patients′ SaO2 was elevated. The efficient rate was 77.5%. Other 9 patients developed ARDS, the rate was 2.5% (9/40). In the infection group 8 patients developed ARDS with an occurrence rate of 21.1%. There was one patient with ARDS in the non-infection group, the rate was 2.6%. There was significant difference between two group (Ｐ＜0.05). Conclusions: The results suggest that hypoxemia is liable to occur in aged patients with abdominal infection after operation and these patients were liable to develop ARDS. Oxygen therapy and SaO2 monitoring is the important managements to these patients in prevention of pneumonic injury.
Objective To study the effects of L-arginine （L-Arg） on cell proliferation, inducible nitric oxide synthase (iNOS) expression and cell cycle in human colon carcinoma cell line LS174 through nitric oxide (NO) pathway. Methods LS174 cells were cultured in medium with L-Arg at different concentrations for different times. MTT method was employed to evaluate the level of the cell proliferation. The production of NO in culture supernatants of LS174 cell was detected with enzyme reduction of nitrate. The distribution of the cell cycle was detected with the flow cytometry (FCM). The expression level of iNOS in the cells was determined by Western blot and SP immunocytochemical staining method. Results The growth of LS174 was promoted by the L-Arg at low concentration (0.125 mmol/L) and inhibited at high concentrations (0.5， 2， 8 and 32 mmol/L). The level of NO was increased with the increasing concentration of L-Arg in culture medium. To compare with the control group, the ratio of cells at S phase was increased after 48 hours’ treatments with high concentrations (0.5, 2, 8 and 32 mmol/L) of L-Arg (P＜0.05, P＜0.01); while there was no obvious difference after treatments with low concentration (0.125 mmol/L) of L-Arg (Pgt;0.05). With the increase of the concentration of L-Arg, the expression of iNOS was increased as compared with control group. The higher the concentration of L-Arg was, the better the effect. Conclusion L-Arg can induce the expression of iNOS resulting in increase the production of nitric oxide (NO). Low concentration of L-Arg can promote the growth of LS174 cells, while high concentration ones can inhibit growth and proliferation. The high concentration of L-Arg could induce S phase arrestion in the cell cycle.
Abstract： Objective To evaluate different shunting flow in varied conditions in a simulated adult cardiopulmonary bypass (CPB) model under normothermia. Methods We established the pseudo adult patient undergoing CPB at four different shunting states with devices of heartlung machine, heatcooler, an adult membrane oxygenator and arterial filter. In state 1, purge line of the arterial filter was open alone; In state 2, purge line combined with 6.5 mm tubing hemoconcentrator shunting was open; In state 3, purge line combined with 5 mm tubing hemoconcentrator was open; In state 4, purge line combined with blood cardioplegia shunting was open. The flow of preoxygenator and postfilter was recorded with ultrasonic flowmeter, and the pressure of purge line and postarterial filter was also detected. Results At state 1, when the pump flow was invariable, the percentage of the shunting flow increased with the increase of postfilter pressure. However, when the postfilter pressure was constant, the percentage of the shunting flow decreased with the increase of the pump flow. The purge line pressure increased with the increase of the postfilter pressure at a constant pump flow under state 1. The shunting flow of state 2 was the largest among all the four states. The shunting flow of state 3 was similar to that of state 4. All the purge line pressure was lower than the postfiler pressure of the circuit in the four states. Conclusion Under states of different shunting opening, different degrees of blood flow are diverted away from the arterial line. The shunting flow increases at a lower pump flow and a higher postfilter pressure. A flow probe located in the postfilter line may be necessary to monitor realtime arterial flow.
