Background/Purpose: Complications of open conversion, hypercarbia, and intestinal injury have plaguedminimally invasive approaches to congenital diaphragmatic hernia (CDH) repair in neonates. To safely begin using min...Background/Purpose: Complications of open conversion, hypercarbia, and intestinal injury have plaguedminimally invasive approaches to congenital diaphragmatic hernia (CDH) repair in neonates. To safely begin using minimally invasive techniques for neonatal CDH repair, we formulated preoperative selection criteria and operative techniques that would enhance chances for successful thoracoscopic primary diaphragm repair and uncomplicated outcome. Methods: During the period from January 2003 to October 2004, neonates were selected for thoracoscopic CDH repair using anatomic and physiologic criteria. Anatomically, all patients were required to have stomach in the abdomen by radiography. Physiologically, all patients were required to be on minimal ventilator support with preoperative ventilator peak inspiratory pressures in the low 20 mm Hg. No patient could have clinical evidence of pulmonary hypertension at the time of surgery. Thoracoscopic CDH repair was performed using 3 trocars (3 and 5 mm). The hernia contents were reduced into the abdomen using 5-mm Hg insufflation, and the diaphragms were repaired primarily using interrupted 3-0 Ethibond simple sutures (Ethicon, Inc, Piscataway, NJ). Posterolateral diaphragm stitches were passed around the posterolateral ribs and tied extracorporeally. Results: Thirty neonates with CDH were admitted to Children’ s Hospital Boston and Vanderbilt Children’ s Hospital during the study period. Eight patients (27% ) met selection criteria and 7 underwent thoracoscopic CDH repair. Primary diaphragmatic repair was successfully accomplished thoracoscopically in all neonates without perioperative complication. Preoperative anatomic criteria correlated accurately with intact esophageal hiatus and primary diaphragm repair. Physiologically, each patient tolerated intrathoracic insufflation and CDH repair without clinical pulmonary hypertension or blood pressure lability. Three patients had intraoperative respiratory acidosis that was reversed with ventilator changes. Operative times averaged 152 minutes and ranged from 212 to 106 minutes. Postoperative mechanical ventilation ranged from 0 to 7 days, and the length of hospitalization ranged from 5 to 32 days. Longest follow-up has been 17 months. One patient required reoperation for recurrent CDH at 10 months after repair, but there have been no other long-term complications. Conclusions: Neonatal thoracoscopic CDH repair is safe in selected patients who have good preoperative pulmonary function and anatomy amenable to primary diaphragmatic repair. A wider range of neonates may be acceptable for thoracoscopic CDH repair with increasing surgical experience.展开更多
Personal ethics are strongly influenced by emotions, particularly secondary emotions, because these emotions expand ethical reasoning and development as the child matures. A well-developed consciousness profoundly inf...Personal ethics are strongly influenced by emotions, particularly secondary emotions, because these emotions expand ethical reasoning and development as the child matures. A well-developed consciousness profoundly influences a person＇s actions and conduct when solving problems of what is thought, or taught to be, right or wrong Compelling neurological evidence supports the claim that children begin to develop enduring ethical standards at an early age and that these standards are largely based on the experiences of early childhood. Essentially, the innate sense of ethics requires nurturing during infancy before it can be cognitively understood and practiced in maturity. In biological terms, the development of neural networks that regulate emotional growth, and subsequently, the capacity for ethical discrimination, depends on the infant＇s early social environment. Thus, the toddler＇s early epigenetic experiences enhance, or impede, its innate still dormant genetic potential. Importantly, personal character development and ethical discrimination begins long before the child＇s formal educational years. As a consequence, early learning has to discover ways of conserving adaptive thinking which can be applied to the choices that may confront future generations. Early ethics education, including accurate access to scientific, medical, and technological knowledge, is thus critical. Future generations will increasingly require education from a global perspective when making major ethical decisions in areas, such as nuclear technology, disposal of wastes, preservation of biodiversity, global warming, and unregulated human population growth. As long as our culture continues to reflect advances in science and technology, there is an obligation to make science education overlap with crucial periods in the advancement of ethical consciousness. Significantly, when considering the human capacity for excess at times of conflict, it is incumbent on the scientific community to integrate research-based knowledge with wide-ranging learning and problem-solving skills. Bioscience ethics, the established interface bridging applied science and applied bioethics, can assist in this process of integration. To become fully responsible adults, we must share our extraordinary cognitive talents and respect life on earth in all its rich diversity. In biological terms, human uniqueness resides primarily in our brains with its products being co-operation in family and ancestral units, long education, sophisticated language and culture, and importantly, ethical consciousness-all attributes held in trust by knowledge and wisdom for future generations.展开更多
Introduced the technology and application of treating the gasification effluent offertilizer with the physical-chemistry and biochemistry united technology.The technology issimple and viable, and occupies less land.Wh...Introduced the technology and application of treating the gasification effluent offertilizer with the physical-chemistry and biochemistry united technology.The technology issimple and viable, and occupies less land.When the main equipment runs normally, thegasification effluent of fertilizer treated with the united technology reached the requirementby second-degree discharge standard of the'Discharge standard of water pollutants forsynthesize ammonia industry'.展开更多
文摘Background/Purpose: Complications of open conversion, hypercarbia, and intestinal injury have plaguedminimally invasive approaches to congenital diaphragmatic hernia (CDH) repair in neonates. To safely begin using minimally invasive techniques for neonatal CDH repair, we formulated preoperative selection criteria and operative techniques that would enhance chances for successful thoracoscopic primary diaphragm repair and uncomplicated outcome. Methods: During the period from January 2003 to October 2004, neonates were selected for thoracoscopic CDH repair using anatomic and physiologic criteria. Anatomically, all patients were required to have stomach in the abdomen by radiography. Physiologically, all patients were required to be on minimal ventilator support with preoperative ventilator peak inspiratory pressures in the low 20 mm Hg. No patient could have clinical evidence of pulmonary hypertension at the time of surgery. Thoracoscopic CDH repair was performed using 3 trocars (3 and 5 mm). The hernia contents were reduced into the abdomen using 5-mm Hg insufflation, and the diaphragms were repaired primarily using interrupted 3-0 Ethibond simple sutures (Ethicon, Inc, Piscataway, NJ). Posterolateral diaphragm stitches were passed around the posterolateral ribs and tied extracorporeally. Results: Thirty neonates with CDH were admitted to Children’ s Hospital Boston and Vanderbilt Children’ s Hospital during the study period. Eight patients (27% ) met selection criteria and 7 underwent thoracoscopic CDH repair. Primary diaphragmatic repair was successfully accomplished thoracoscopically in all neonates without perioperative complication. Preoperative anatomic criteria correlated accurately with intact esophageal hiatus and primary diaphragm repair. Physiologically, each patient tolerated intrathoracic insufflation and CDH repair without clinical pulmonary hypertension or blood pressure lability. Three patients had intraoperative respiratory acidosis that was reversed with ventilator changes. Operative times averaged 152 minutes and ranged from 212 to 106 minutes. Postoperative mechanical ventilation ranged from 0 to 7 days, and the length of hospitalization ranged from 5 to 32 days. Longest follow-up has been 17 months. One patient required reoperation for recurrent CDH at 10 months after repair, but there have been no other long-term complications. Conclusions: Neonatal thoracoscopic CDH repair is safe in selected patients who have good preoperative pulmonary function and anatomy amenable to primary diaphragmatic repair. A wider range of neonates may be acceptable for thoracoscopic CDH repair with increasing surgical experience.
文摘Personal ethics are strongly influenced by emotions, particularly secondary emotions, because these emotions expand ethical reasoning and development as the child matures. A well-developed consciousness profoundly influences a person＇s actions and conduct when solving problems of what is thought, or taught to be, right or wrong Compelling neurological evidence supports the claim that children begin to develop enduring ethical standards at an early age and that these standards are largely based on the experiences of early childhood. Essentially, the innate sense of ethics requires nurturing during infancy before it can be cognitively understood and practiced in maturity. In biological terms, the development of neural networks that regulate emotional growth, and subsequently, the capacity for ethical discrimination, depends on the infant＇s early social environment. Thus, the toddler＇s early epigenetic experiences enhance, or impede, its innate still dormant genetic potential. Importantly, personal character development and ethical discrimination begins long before the child＇s formal educational years. As a consequence, early learning has to discover ways of conserving adaptive thinking which can be applied to the choices that may confront future generations. Early ethics education, including accurate access to scientific, medical, and technological knowledge, is thus critical. Future generations will increasingly require education from a global perspective when making major ethical decisions in areas, such as nuclear technology, disposal of wastes, preservation of biodiversity, global warming, and unregulated human population growth. As long as our culture continues to reflect advances in science and technology, there is an obligation to make science education overlap with crucial periods in the advancement of ethical consciousness. Significantly, when considering the human capacity for excess at times of conflict, it is incumbent on the scientific community to integrate research-based knowledge with wide-ranging learning and problem-solving skills. Bioscience ethics, the established interface bridging applied science and applied bioethics, can assist in this process of integration. To become fully responsible adults, we must share our extraordinary cognitive talents and respect life on earth in all its rich diversity. In biological terms, human uniqueness resides primarily in our brains with its products being co-operation in family and ancestral units, long education, sophisticated language and culture, and importantly, ethical consciousness-all attributes held in trust by knowledge and wisdom for future generations.
文摘Introduced the technology and application of treating the gasification effluent offertilizer with the physical-chemistry and biochemistry united technology.The technology issimple and viable, and occupies less land.When the main equipment runs normally, thegasification effluent of fertilizer treated with the united technology reached the requirementby second-degree discharge standard of the'Discharge standard of water pollutants forsynthesize ammonia industry'.
