简介：Myocardialperfusioniswellcontrolledbyadjustmentofvasomotortoneofre-sistancevessels.Thestaticandsamedynamicaspectsofcoronaryflowcontrolcanwellbedescribedbyassumingfeedbackfromtissueoxygenpressuretothecoronaryvessel.Theseresistancevesselsaresmallarteriesfrom400/mandlessinarteriolesdownto10/m.Itisnotclearyethowvesselsofdifferentsizecanbeunderthecon-troloftissuefactorsandhowadaptationoftoneinlargervesselsistunedtothatofsmallerones.

简介：Splanchniccirculationistheprimarymechanismthatregulatesvolumesofcirculatingbloodandsystemicbloodpressureinpatientswithcirrhosisaccompaniedbyportalhypertension.Recently,interesthasbeenexpressedinmodulatingsplanchniccirculationinpatientswithlivercirrhosis,becausethiscapabilitymightproducebeneficialeffectsincirrhoticpatientsundergoingalivertransplant.Pharmacologicmodulationofsplanchniccirculationbyuseofvasoconstrictorsmightminimizevenouscongestion,replenishcentralbloodflow,andthusoptimizemanagementofbloodvolumeduringalivertransplantoperation.Moreover,splanchnicmodulationminimizesanyhighportalbloodflowthatmayoccurfollowingliverresectionandthesubsequentlivertransplant.Thiseffectissignificant,becausehighportalflowimpairsliverregeneration,andthusadverselyaffectsthepostoperativerecoveryofatransplantpatient.Anincreaseinportalbloodflowcanbeminimizedbyeithersurgicalmethods（e.g.,splenicarteryligation,splenectomyorportocavalshunting）oradministrationofsplanchnicvasoconstrictordrugssuchasVasopressinorterlipressin.Finally,modulationofsplanchniccirculationcanhelpmaintainperioperativerenalfunction.Splanchnicvasoconstrictorssuchasterlipressinmayhelpprotectagainstacutekidneyinjuryinpatientsundergoinglivertransplantationbyreducingportalpressureandtheseverityofahyperdynamicstate.Theseeffectsareespeciallyimportantinpatientswhoreceiveatoosmallforsizegraft.TerlipressinselectivelystimulatesV1receptors,andthuscausesarteriolarvasoconstrictioninthesplanchnicregion,withaconsequentshiftofbloodfromsplanchnictosystemiccirculation.Asaresult,terlipressinenhancesrenalperfusionbyincreasingbotheffectivebloodvolumeandmeanarterialpressure.

简介：Sinceitsoriginaldescription,theFontanoperationhasbeenwidelyusedforthepalliationofchildrenwithsingleventriclephysiologyandhasresultedinanincreasingnumberofthesepatientssurvivingtoadulthood.TheFontanoperationisauniqueapproachtocreateacirculationinserieswithouttwodistinctpumpingchambers.AlthoughtheFontanoperationincreasedthesurvivalratesofpatientswithsingleventriclephysiology,itcarriesaninevitableriskoflong-termmorbiditiesthatimpactstheoutcomesandqualityoflifeinthesepatients.Inthisreview,wediscussthechallengesresultingfromtheuniquepathophysiologyofFontancirculationandproposemanagementstrategies.

简介：AIM:Todeterminewhetherretinalcirculatorychangesplayaroleinthepathogenesisofmaculardisordersinpatientswhoareotherwisehealthy.METHODS:Patientswithmaculardisordersthatrequiredangiographicimagingwereincludedinthisprospectivecaseseries.Afteracompleteocularexam,fluoresceinangiographywasperformedusingastandardizedtechniqueontheHRA-II(HeidelbergEngineering,Heidelberg,Germany)withspecialfocusontheposteriorpole.Onlypatientswithgoodqualityimageswereincludedintheanalysis.Circulatoryparametersrecordedincludedthearm-choroidtime,choroid-retinalartery,andfinallytheretinalartery-veintime.Zonalasymmetry(betweentheupperandlowerzonesdividedbyalinepassingthroughthecentreofthefovea)intransittimes,ifanywasalsonoted.Appropriatestatisticalanalysiswasdone.Circulationtimeswerecomparedwithagematchedhistoricalcontrols.Changesinretinaldyetransittimesrelativetohistoricalagematchedcontrols,ifany,werenotedandcomparedbetweenvariousdisorders.RESULTS:Atotalof156eyesof156patients(120males)wereincludedinthestudy.Meanage:49.14±14.93y.Maculardisordersstudiedwereagerelateddegeneration,polypoidalvasculopathy,centralserouschorioretinopathy(CSCR)andparafovealtelangiectasia.DelayedcirculationtimewasnotedinCSCRpatientsonly.CONCLUSION:CSCRpatientsappeartohavedelayedarterialfilling,retinalcirculatorydisturbancesdonotseemtocontributetothepathogenesisofothermaculardisorders.

简介：AbstractBackground:Intracranial aneurysm (IA) is a serious disease. Analyze and review the cases of anterior circulation ruptured IA by supraorbital lateral keyhole approach, and summarize the experiences of this approach.Methods:Retrospective analysis of 16 cases of ruptured anterior circulation IA in our department from January 2019 to June 2020, CT angiography (CTA) was performed before operation. Analyzing the IA's parameters by 3D-CT reconstruction. The IA was clipped by supraorbital lateral keyhole approach combined with the 3D-skull reconstruction. Extraventricular drainage was performed before craniotomy. Intraoperative neurophysiological monitoring was performed during the operation. After operation, fluorescein angiography and vascular ultrasound were performed to check the clipping effect. Intracranial pressure monitor was performed postoperatively. CTA was reexamined one week after operation. The modified Rankin Scale (MRS) was performed 6 months after operation.Results:There were 7 males (43.8%) and 9 females (56.2%), and the average age is 52.31 ± 11.12 years old. Among them, 11 patients (68.8%) were anterior communicating artery aneurysms and 5 (31.2%) were middle cerebral artery aneurysms. All patients were out of hospital within 10 days without any death, without cerebral infarction, cerebrospinal fluid leakage and neurological impairments. About mRS score, after 6 months follow-up, 8 cases (50%) had 0 point, 4 cases (25%) had 1 point, and 4 cases (25%) had 2 points.Conclusions:For ruptured anterior circulation IA, the supraorbital lateral keyhole approach combined with ventricular drainage, intraoperative electrophysiological monitoring, and intraoperative vascular ultrasound is a safe and minimally invasive treatment. The application of reconstruction clipping can reconstruct the diameter of parent vessel and reduce the recurrence rate of IA.

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.

简介：无

简介：BackgroundThecoronarycollateralcirculationhasapositiveeffectontheischemicmyocardium.Butitislimitedforpatientsmissingthetimewindowoftotalocclusionofthecoronaryarteryelectivepercutaneouscoronaryintervention(PCI).Theeffectofcollateralcirculationonleftcardiacfunctionhasbeenlessstudied.MethodsAtotalof34patientswithoneormorecoronaryarteryocclusionwhounderwentcoronaryangiographyandRentrop'smethodweredividedinto2groups:Goodcollateralcirculation(Agroups,Rentropscore2-3,n=19)and(Bgroups,Rentropscore1-2,n=15).Theimprovementofleftventricularenddiastolicvolume(LVEDV)andleftventricularejectionfraction(LVEF)werecomparedbetweenthetwogroupsbeforeandafterPCI.ResultsIngoodcollateralcirculationgroup,leftventricularejectionfraction(LVEF)wassignificantlyhigherafterPCI(P<0.05).Inpoorcollateralcirculationgroup,leftventricularenddiastolicvolumeindex(LVEDV)wassignificantlyincreasedafterPCI(P<0.05).ConclusionsGoodcollateralcirculationhasasignificantprotectiveeffectonleftventricularfunction.PCIoperationcansignificantlyimprovetheprognosisofpatientswithgoodcollateralcirculationofcoronaryarteryocclusion.

简介：AbstractBackground:Early neurologic deterioration (END) may occur in patients with anterior circulation ischemic stroke (ACIS) after receiving endovascular treatment (EVT). Hemodynamic insufficiency, re-occlusion, and post-re-canalization hyper-perfusion are likely to play a critical role in END. We hypothesized that hemodynamic changes can predict END in patients with ACIS post-successful EVT using trans-cranial Doppler (TCD).Methods:We utilized a prospectively maintained database of ACIS patients treated with EVT between September 2016 and June 2018 in the Xuanwu Hospital, Capital Medical University. TCD parameters including peak systolic velocity (PSV), bilateral mean flow velocity (MFV), and pulse index (PI) were determined via the middle cerebral arteries within 72 h post-EVT. A logistic regression model was applied to detect independent predictors for END.Results:Totally, 112 EVT patients were included in this study and 80/112 patients experienced successful re-canalization with <50% residual stenosis, while 17/80 (21.3%) patients suffered END, for which vasogenic cerebral edema (11/17) was considered as a leading role and followed by symptomatic intra-cranial hemorrhage (4/17) and ischemia progression (2/17). For the 80 patients, the PSV (median: 127 cm/s vs. 116 cm/s, P = 0.039), the ratio of ipsilateral-MFV/contra-lateral-MFV (iMFV/cMFV) (median: 1.29 vs. 1.02, P = 0.036) and iMFV/mean blood pressure (MBP) (median: 0.97 vs. 0.79, P = 0.008) in END patients were higher than those of non-END. Using the receiver-operating characteristic curve to obtain cut-off values for PSV, PI, iMFV/cMFV, and iMFV/MBP for END, we found that PI ≥0.85 (odds ratio: 11.03, 95% confidence interval: 1.92-63.46, P = 0.007) and iMFV/MBP ≥0.84 (odds ratio: 9.20, 95% confidence interval: 2.07-40.84, P = 0.004) were independent predictors of END in a multivariate logistic regression model, with a sensitivity of 82.4% and 76.5% and a specificity of 42.9% and 66.7%, respectively, and had the positive predictive values of 29.0% and 38.2%, and negative predictive values of 90.0% and 91.3%, with an area under the receiver-operating characteristic curve of 0.57 and 0.71, respectively.Conclusion:TCD examination of EVT patients may be used as a real-time tool to detect END predictors, such as the higher PI and iMFV/MBP, allowing for better post-thrombectomy management in ACIS patients.

简介：

简介：【摘要】目的：探讨PDCA循环在放射科院感质控中的应用。方法：使用PDCA循环法管理工具，对放射科院感质控工作进行持续改进，并对结果进行分析。结果：PDCA循环法在放射科院感质控工作的开展与改进中效果明显。结论：通过使用PDCA循环法管理工具，放射科的医院感染质量与控制工作明显改善，充分体现出其在放射科院感质控中的应用价值。

简介：无