Pulmonary arterial hypertension is a type of malignant pulmonary vascular disease, which is mainly caused by the increase of pulmonary vascular resistance due to the pathological changes of the pulmonary arteriole itself, which eventually leads to right heart failure and death. As one of the diagnostic indicators of hemodynamics, pulmonary vascular resistance plays an irreplaceable role in the pathophysiology, diagnosis and treatment of pulmonary arterial hypertension. It provides more references for the evaluation of pulmonary arterial hypertension patients. This article summarizes the clinical application of pulmonary vascular resistance in patients with pulmonary arterial hypertension.
Coronary microvascular disease is a high-risk factor for many cardiovascular events. However, due to its high concealment and many etiologies, the current understanding of its pathophysiological mechanism is very limited, which greatly limits its clinical diagnosis and treatment. In the process of the occurrence and development of coronary microvascular disease, the damage of coronary microvascular endothelial cell (CMEC) is the core link. CMEC's stress, metabolism, inflammation and other dysfunctions have a causal relationship with coronary microvascular disease, and are also the main features of coronary microvascular disease in the early stage. This article mainly reviews the molecular mechanisms of CMEC damage.
[Abstract] objectives To explore the etologies, surgical methods and outcomes of redo aortic root replacement after cardiac surgery. Methods Between February 2010 and February 2020, 41 patients who had at least one previous cardiac operation received aortic root replacement surgery in our hospita, including 27 males and 14 females with an average age of 49.5±10.2 years. Indications for reoperation include: aortic sinus dilation and ascending aortic aneurysm in 20 cases (48.8%), recurrent aortic dissection in 7 cases (17.0%), aortic pseudoaneurysm in 4 cases (9.8%), prosthetic valve endocarditis in 5 cases (12.2%) and 5 cases (12.2%) had paravalvular leakage. The redo operation was a midline thoracotomy, and Bentall operation was performed. In addition, 3 cases of mitral valve replacement surgery, 4 cases of mitral valvuloplasty, 8 cases of tricuspid valvuloplasty, 4 cases of coronary artery bypass graft surgery, 3 cases of Debakey I aortic dissection patients underwent Sun’s surgery simultaneously. Results The mean cardiopulmonary bypass time was 95~302 (168.1±41.2) min, and the mean aortic crossclamp time was 45~135 (84.5±22.3) min. Six patients (14.6%) died during the postoperative hospitalization. The main causes of death were heart failure in 3 patients and septic shock in 3 patients.The follow-up time was 3~62 (30.3±15.5) months. During the follow-up period, 3 cases died, including 1 case died of septic shock and 2 cases died of cerebral hemorrhage. Conclusions Redo aortic root replacement is difficult to deal with, and the risk is high. Preoperative evaluation is required, appropriate surgical approach, adequate myocardial protection, and a complete surgical plan are essential to ensure the success of the operation.
Robotic repair of the ventricular septal defect was performed mainly for perimembranous type via right thorax approach. Minimally invasive strategies for doubly committed juxta-arterial ventricular septal defect were limited. Here, for the first time, we successfully repaired a doubly committed juxta-arterial ventricular septal defect with Da Vinci robotic system via left thorax approach. The technique could provide excellent exposure of surgical field and accurate repair, with the advantage of reducing trauma and shortening the overall length of stay.congenital heart disease, robotic cardiac surgery, ventricular septal defect | 497 cardiac surgery compared with a standard sternotomy approach, particularly during the early learning phase. We believe that cross-clamp and CPB time will decrease dramatically after overcoming the learning curve.In summary, we described a new totally robotic endoscopic technique for doubly committed juxta-arterial VSD, which is feasible and safe, with the potential of reducing postoperative pain and shortening the overall length of stay.
AUTHOR CONTRIBUTIONSYH is responsible for the operation, collection of images, and writing of initial draft. JD and SZ helped in the collection of images, the writing of the manuscript, radiological description, and involved in the design of the manuscript. QZ has contributed to the conception of the idea, design of the techniques, operation, the writing and critically reviewed the manuscript to its final shape before submission to the journal. All authors were involved in the active management of the patient and have reviewed the final manuscript before submission to the journal. We declare that the manuscript has not been previously published in any form in another publication of any type. All the authors have read and approved the manuscript. All authors have no financial and personal relationships with other persons or organizations that can inappropriately influence our work.
The government’s supervision of new residential building projects’ (NRBPs) energy-saving can promote carbon neutrality policies within its jurisdiction. A scientific and systematic evaluation of NRBPs energy-saving reflects a government’s management performance. However, achieving accurate and reasonable results with unitary evaluation standards without considering regional characteristics is not easy. This study proposes an evaluation method of intelligently evaluating the effectiveness of government energy-saving supervision with regional characteristics weighted in. Consequently, these evaluation indicators can reveal the key issues in carrying out local energy-saving policies and provide concrete guidance for local governments to manage the energy-saving of NRBPs better. The method was tested with ten projects and found to be effective.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.