Domestically Made WH Co. Patent 300 MW Unit Bypass System Analysis

Summary This paper analyses the turbine bypass system design and operation mode for domestically made 300 MW unit with technology imported, and put forward some suggestions about whether bypass system is needed. 1.0 Introduction The domestically made WH Co, patent 300 MW unit is produced according to the technology of American Westinghouse (WH) Corporation. The original

Extracorporeal membrane oxygenation versus cardiopulmonary bypass during transcatheter aortic valve implantation: a meta-analysis of survival benefits

Since its approval by the Food and Drug Administration in 2011,transcatheter aortic valve implantation(TAVI)has rapidly evolved to become the preferred ultimate intervention for high-and intermediate-risk patients with severe symptomatic aortic stenosis.[1]This is due to its non-open-heart,minimally invasive and off-pump advantages.[1]Nevertheless,as a result of the frequent frailty and comorbidity profiles of patients undergoing TAVI,such as advanced cardiac dysfunction and extensive coronary artery disease,or technically difficult anatomy for the procedure itself,[2-4]it is common for these patients to experience critical circulatory collapse perioperatively.These factors are linked to elevated mortality rates,necessitating suitable mechanical circulatory support(MCS)to reverse the disastrous situations.[5]

Response characteristics of PWR primary circuit under SBLOCAs considering steam bypass discharging

Small-break superposed station blackout(SBO)accidents are the basic design accidents of nuclear power plants.Under the condition of a small break in the cold leg,SBO further increases the severity of the accident,and the steam bypass discharg-ing system(GCT)in the second circuit can play an important role in guaranteeing core safety.To explore the influence of the GCT on the thermal-hydraulic characteristics of the primary circuit,RELAP5 software was used to establish a numerical model based on a typical pressurized water reactor nuclear power plant.Five different small breaks in the cold-leg super-posed SBO were selected,and the impact of the GCT operation on the transient response characteristics of the primary and secondary circuit systems was analyzed.The results show that the GCT plays an indispensable role in core heat removal during an accident;otherwise,core safety cannot be guaranteed.The GCT was used in conjunction with the primary safety injection system during the placement process.When the break diameter was greater than a certain critical value,the core cooling rate could not be guaranteed to be less than 100 K/h;however,the core remained in a safe state.

Effects of sevoflurane on left ventricular function by speckletracking echocardiography in coronary bypass patients: A randomized trial

The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to assess the effect of sevoflurane on cardiac function.Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia(AS)group and a propofolbased total intravenous anesthesia(AA)group.The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T1(after harvesting all grafts and before coronary anastomosis)and T_(2)(30 min after completing all coronary anastomoses)(P<0.05).Moreover,strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group,compared with the AA group at both T1 and T_(2)(P<0.01).The flow of the left internal mammary artery-left anterior descending artery graft was superior,and the postoperative concentration of troponin T decreased rapidly in the AS group,compared with the AA group(P<0.05).Compared with total intravenous anesthesia,sevoflurane resulted in a significantly higher global longitudinal strain,stroke volume,and cardiac output.Sevoflurane also led to an amelioration in the condition of the arterial graft.Furthermore,sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value.The findings need to be replicated in larger studies.

Impact of specialized nursing outpatient case management on postcoronary artery bypass grafting patients

BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to patients'unhealthy lifestyles and dietary habits,inadequate understanding of the disease,and poor disease management compliance.Thus,searching for more targeted nursing intervention models that can enhance patients'self-management abilities and reduce the risk of readmission after CABG surgery is significant.AIM To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.METHODS A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample.The patients were divided into two groups using an odd-even number grouping method.The control group received routine nursing care,while the case management group received specialized nursing outpatient case management.The differences in psychological status,adherence to medical treatment,self-care ability,knowledge mastery,quality of life scores,and the occurrence rate of MACE were compared between the two groups.RESULTS After the intervention,the case management group had lower scores on the selfrating depression scale and self-rating anxiety scale and lower MACE rate,as well as higher scores for adherence to a healthy diet,medication adherence,good lifestyle habits,regular exercise,and timely follow-up,higher scores on the Coronary Heart Disease Self-Management Scale,higher scores for managing adverse habits,symptoms,emotional cognition,emergency response,disease knowledge,general lifestyle,and treatment adherence,higher scores for understanding coronary heart disease,recognizing the importance of medication adherence,understanding selfcare points after CABG surgery,and being aware of post-CABG precautions,higher scores for physical well-being,disease condition,general health,social-psychological well-being,and work-related aspects(P<0.05).CONCLUSION Specialized nursing outpatient case management can enhance patient adherence to medical treatment,knowledge mastery,psychological well-being,and overall quality of life in patients after CABG surgery.

Duodenal-jejunal bypass improves hypothalamic oxidative stress and inflammation in diabetic rats via glucagon-like peptide 1-mediated Nrf2/HO-1 signaling

BACKGROUND Type 2 diabetes mellitus(T2DM)is often accompanied by impaired glucose utilization in the brain,leading to oxidative stress,neuronal cell injury and inflammation.Previous studies have shown that duodenal jejunal bypass(DJB)surgery significantly improves brain glucose metabolism in T2DM rats,the role and the metabolism of DJB in improving brain oxidative stress and inflammation condition in T2DM rats remain unclear.AIM To investigate the role and metabolism of DJB in improving hypothalamic oxidative stress and inflammation condition in T2DM rats.METHODS A T2DM rat model was induced via a high-glucose and high-fat diet,combined with a low-dose streptozotocin injection.T2DM rats were divided into DJB operation and Sham operation groups.DJB surgical intervention was carried out on T2DM rats.The differential expression of hypothalamic proteins was analyzed using quantitative proteomics analysis.Proteins related to oxidative stress,inflammation,and neuronal injury in the hypothalamus of T2DM rats were analyzed by flow cytometry,quantitative real-time PCR,Western blotting,and immunofluorescence.RESULTS Quantitative proteomics analysis showed significant differences in proteins related to oxidative stress,inflammation,and neuronal injury in the hypothalamus of rats with T2DM-DJB after DJB surgery,compared to the T2DM-Sham groups of rats.Oxidative stress-related proteins(glucagon-like peptide 1 receptor,Nrf2,and HO-1)were significantly increased(P<0.05)in the hypothalamus of rats with T2DM after DJB surgery.DJB surgery significantly reduced(P<0.05)hypothalamic inflammation in T2DM rats by inhibiting the activation of NF-κB and decreasing the expression of interleukin(IL)-1βand IL-6.DJB surgery significantly reduced(P<0.05)the expression of factors related to neuronal injury(glial fibrillary acidic protein and Caspase-3)in the hypothalamus of T2DM rats and upregulated(P<0.05)the expression of neuroprotective factors(C-fos,Ki67,Bcl-2,and BDNF),thereby reducing hypothalamic injury in T2DM rats.CONCLUSION DJB surgery improve oxidative stress and inflammation in the hypothalamus of T2DM rats and reduce neuronal cell injury by activating the glucagon-like peptide 1 receptor-mediated Nrf2/HO-1 signaling pathway.

Safety and effectiveness of neuromuscular electrical stimulation in cardiac surgery:A systematic review

BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit(ICU)are major factors resulting in the development of ICU-acquired muscle weakness(ICUAW).ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery,and may be a risk factor for prolonged duration of mechanical ventilation,associated with a higher risk of readmission and higher mortality.Early mobilization in the ICU after cardiac surgery has been found to be low with a significant trend to increase over ICU stay and is also associated with a reduced duration of mechanical ventilation and ICU length of stay.Neuromuscular electrical stimulation(NMES)is an alternative modality of exercise in patients with muscle weakness.A major advantage of NMES is that it can be applied even in sedated patients in the ICU,a fact that might enhance early mobilization in these patients.AIM To evaluate safety,feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery.METHODS We performed a search on Pubmed,Physiotherapy Evidence Database(PEDro),Embase and CINAHL databases,selecting papers published between December 2012 and April 2023 and identified published randomized controlled trials(RCTs)that included implementation of NMES in patients before after cardiac surgery.RCTs were assessed for methodological rigor and risk of bias via the PEDro.The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function.RESULTS Ten studies were included in our systematic review,resulting in 703 participants.Almost half of them performed NMES and the other half were included in the control group,treated with usual care.Nine studies investigated patients after cardiac surgery and 1 study before cardiac surgery.Functional capacity was assessed in 8 studies via 6MWT or other indices,and improved only in 1 study before and in 1 after cardiac surgery.Nine studies explored the effects of NMES on muscle strength and function and,most of them,found increase of muscle strength and improvement in muscle function after NMES.NMES was safe in all studies without any significant complication.CONCLUSION NMES is safe,feasible and has beneficial effects on muscle strength and function in patients after cardiac surgery,but has no significant effect on functional capacity.

Predicting short-term thromboembolic risk following Roux-en-Y gastric bypass using supervised machine learning

BACKGROUND Roux-en-Y gastric bypass(RYGB)is a widely recognized bariatric procedure that is particularly beneficial for patients with class III obesity.It aids in significant weight loss and improves obesity-related medical conditions.Despite its effectiveness,postoperative care still has challenges.Clinical evidence shows that venous thromboembolism(VTE)is a leading cause of 30-d morbidity and mortality after RYGB.Therefore,a clear unmet need exists for a tailored risk assessment tool for VTE in RYGB candidates.AIM To develop and internally validate a scoring system determining the individualized risk of 30-d VTE in patients undergoing RYGB.METHODS Using the 2016–2021 Metabolic and Bariatric Surgery Accreditation Quality Improvement Program,data from 6526 patients(body mass index≥40 kg/m^(2))who underwent RYGB were analyzed.A backward elimination multivariate analysis identified predictors of VTE characterized by pulmonary embolism and/or deep venous thrombosis within 30 d of RYGB.The resultant risk scores were derived from the coefficients of statistically significant variables.The performance of the model was evaluated using receiver operating curves through 5-fold cross-validation.RESULTS Of the 26 initial variables,six predictors were identified.These included a history of chronic obstructive pulmonary disease with a regression coefficient(Coef)of 2.54(P<0.001),length of stay(Coef 0.08,P<0.001),prior deep venous thrombosis(Coef 1.61,P<0.001),hemoglobin A1c>7%(Coef 1.19,P<0.001),venous stasis history(Coef 1.43,P<0.001),and preoperative anticoagulation use(Coef 1.24,P<0.001).These variables were weighted according to their regression coefficients in an algorithm that was generated for the model predicting 30-d VTE risk post-RYGB.The risk model's area under the curve(AUC)was 0.79[95%confidence interval(CI):0.63-0.81],showing good discriminatory power,achieving a sensitivity of 0.60 and a specificity of 0.91.Without training,the same model performed satisfactorily in patients with laparoscopic sleeve gastrectomy with an AUC of 0.63(95%CI:0.62-0.64)and endoscopic sleeve gastroplasty with an AUC of 0.76(95%CI:0.75-0.78).CONCLUSION This simple risk model uses only six variables to assist clinicians in the preoperative risk stratification of RYGB patients,offering insights into factors that heighten the risk of VTE events.

Implications of Elevated Serum Cortisol in the Onset of Postoperative Delirium Following Off-Pump Coronary Artery Bypass Grafting: Insights from a Bangladesh-Based Single Center Experience

Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.

Functional Roux-en-Y Gastric Bypass (F-RYGB), with Preservation of Duodenal Access: Report of Two Revisional Cases of Sleeve Gastrectomy

Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution was obtained in both cases, confirmed by endoscopic and functional esophageal assessment, together with symptoms questionnaire. Conclusion: The association of Latarjet nerves sectioning or truncal vagotomy with re-sleeve gastrectomy plus gastrointestinal anastomosis (antrojejunal), in a revision for a failed sleeve, can represent a technical approach, to reproduce RYGB results, without exclusions and with duodenum endoscopic accessibility maintenance. It maybe could be applied for primary surgeries. Additional studies are necessary to confirm this hypothesis.

Results of the First 10 Cases of Coronary Bypass Surgery in Senegal

This is a review of the first 10 coronary artery bypass surgeries performed by the local team. The mean age was 62 years old [45 - 74]. The patients were predominantly male, with a M/F ratio of 4:1. Cardiovascular risk factors were mainly myocardial infarction (MI) (60%), hypertension (50%), obesity (40%) and diabetes (30%), with at least two risk factors per patient. Angina was the main symptom (80%). The average time from presentation to surgery was 8 months. The mean Euroscore 2 was 2.92 ± 1.65 [1.33 - 6.60]. Coronary angiography revealed an average of 2 lesions per patient, with 3-vessel involvement in 70% of cases: the Interventricular artery (IVA) (100%), the right coronary artery (90%) and the circumflex artery (70%). On echocardiography, the mean Left ventricular ejection fraction (LVEF) was 59% [33% - 76%]. All patients underwent median sternotomy with bypass grafting. The average duration of the cardiopulmonary bypass was 150 min [46 - 275 min];that of aortic clamping, 120 min [43 - 232 min]. The grafts used were internal thoracic artery (ITA) in 100% of cases (80% on the left and 20% on the right), and the great saphenous vein (GSV) in 60% of cases (50% on the left and 10 on the right). Double bypass was performed in 60% of cases, single bypass in 30% and triple bypass in 10%. The bypasses were performed on the IVA (100%), the middle lateral of the circumflex (30%) and the bisector (20%). The average time to extubation was 11 hours and the length of stay in the intensive care unit was 7 days [03 - 17 days]. One patient had a reoperation on Day 0 post-op. The average hospital stay was 13 days [06 - 27 days]. Complications occurred in nine of the patients (90%), with a predominance of infectious and neurological complications. Overall operative mortality was 3%, all in intensive care.

Abnormal ACT in a Patient with Prekallikrein Deficiency Undergoing Cardiopulmonary Bypass

Prekallikrein deficiency is a disorder that often remains undiagnosed. Prekallikrein activates factor XII, which initiates the intrinsic coagulation pathway. Prekallikrein deficiency results in prolonged Partial Thromboplastin Time and Activated Clotting Time in absence of anticoagulants or active bleeding. This case report describes the anesthesia management of a patient with Prekallikrein deficiency who underwent cardiac surgery with Cardiopulmonary Bypass for correction of a congenital cardiac malformation. We highlight the importance of understanding the different tests available for the diagnosis of coagulation factors deficiency during administration of heparin in the setting of cardiovascular procedures under general anesthesia.

Effects of Intraoperative Autologous Blood Donation and Tepid Temperature Cardiopulmonary Bypass on Blood System

The effects of the intraoperative autologous bind donation and tepid temperature cardiopulmonary bypass (CPB) on blood system were investigated. Twenty-four patients with rheumatic heart valve diseases scheduled for open heart surgery were selected and divided randomly into group A (intraoperative autologous blood donation and tepid temperature, nasopharyngeal temperature was at 32-34 ℃ during CPB) and group B (control, nasopharyngeal temperature was at 25-28 ℃ during CPB). The plasmatic concentrations of GMP-140 and D-Dimer and the plasmatic activities of 6- ketoPGF1α and AT- Ⅲ were measured by using ELISA or substrate luminescence techniques before operation, at the end of CPB, after discontinuation of CPB and postoperatively. Red blood cell count, platelet count, hematocrit, the amount of blood drainage and the amount of blood transfusion needed were measured or recorded postoperatively. The results showed the plasmatic concentrations of GMP140 and D-Dimer in group A were significantly less (P<0. 05) than those in group B during and after operation. The activity of 6-keto--PGF1α in group A was higher (P<0. 05) than that in group B during and after operation. The AT- Ⅲ activity in group A was less (P<0. 05) during CPB but higher 30 min after discontinuation of CPB than that in group B. The amount of postoperative blood loss (283± 166 versus 722± 194 ml, P<O. 01) and amount of blood transfusion (816±126 versus 1443± 678 ml, P<0. 01) in group A were significantly less than those in group B, respectively. The red blood cell count, platelet count and hematocrit in group A were significantly higher than those in group B after operation. The results suggests intraoperative autologous blood donation and tepid temperature have a good protection on blood system and can reduce postoperative non-surgical bleeding.

Real-time OHT Dispatching Mechanism for the Interbay Automated Material Handling System with Shortcuts and Bypasses

As a key to improve the performance of the interbay automated material handling system （AMHS） in 300 mm semiconductor wafer fabrication system, the real- time overhead hoist transport （OHT） dispatching problem has received much attention. This problem is first formu- lated as a special form of assignment problem and it is proved that more than one solution will be obtained by Hungarian algorithm simultaneously. Through proposing and strictly proving two propositions related to the char- acteristics of these solutions, a modified Hungarian algo- rithm is designed to distinguish these solutions. Finally, a new real-time OHT dispatching method is carefully designed by implementing the solution obtained by the modified Hungarian algorithm. The experimental results of discrete event simulations show that, compared with con- ventional Hungarian algorithm dispatching method, the proposed dispatching method that chooses the solution with the maximum variance respectively reduces on average 4 s of the average waiting time and average lead time of wafer lots, and its performance is rather stable in multiple dif- ferent scenarios of the interbay AMHS with different quantities of shortcuts. This research provides an efficient real-time OHT dispatching mechanism for the interbay AMHS with shortcuts and bypasses.

Surgical outcome of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass for resolution of type 2 diabetes mellitus:A systematic review and meta-analysis

BACKGROUND Bariatric procedures are considered superior to medical therapies in managing type 2 diabetes mellitus(T2DM).Laparoscopic Roux-en-Y gastric bypass(LRYGB)and laparoscopic sleeve gastrectomy(LSG)are the most commonly used procedures for weight loss and comorbidity resolution worldwide.However,it is not yet known whether the degree of T2DM is influenced by the choice of bariatric procedure.AIM To quantitatively compare T2DM resolution over 1-5 years follow-up by LRYGB and LSG in morbidly obese patients.METHODS We searched the selected databases for full-text English language clinical studies that compared the effectiveness of LRYGB and LSG for T2DM resolution.Review manager 5.3 was used for data analysis,and the overall effect summary was represented in a forest plot.RESULTS From 1,650 titles retrieved by an initial search,we selected nine studies for this research.We found insignificant differences for T2DM resolution by LRYGB and LSG,with an odds ratio of 0.93(95%CI:0.64-1.35,Z statistics=0.38,P=0.71).Additionally,subset analyses for T2DM resolution showed insignificant differences after 24 mo(χ^2=1.24,df=4,P=0.87,overall Z effect=0.23),36 mo(χ^2=0.41,df=2,P=0.81,overall Z effect=0.51),and 60 mo(χ^2=4.75,df=3,P=0.19,overall Z effect=1.20)by LRYGB and LSG.This study reports a T2DM remission rate of 82.3%by LRYGB and 80.7%by LSG.CONCLUSION This study reports similar T2DM resolution rates by both LRYGB and LSG during 1-5 years of follow-up.However,long-term follow-up of 10 years is needed to further substantiate these findings.

Anesthesia with ciprofol in cardiac surgery with cardiopulmonary bypass:A case report

BACKGROUND Ciprofol is a novel agent for intravenous general anesthesia.In February 2022,it was approved by the National Medical Products Administration for general anesthesia induction and maintenance.It has the advantages of fast onset,fast elimination,stable circulation,and few adverse reactions.However,the efficacy and safety of ciprofol in cardiac surgery with cardiopulmonary bypass have not been reported.Here we describe a case where ciprofol was successfully used for anesthesia in cardiac surgery with cardiopulmonary bypass.CASE SUMMARY A 72-year-old man(height 176 cm;weight 70 kg)was diagnosed with coronary atherosclerotic cardiomyopathy requiring coronary artery bypass grafting and left ventricular aneurysmectomy.Ciprofol was administered for induction(0.4 mg/kg)and maintenance(0.6-1.0 mg/kg/h)of general anesthesia.During the entire operation,the bispectral index,hemodynamics,and blood oxygen saturation were maintained at normal levels.The patient recovered well after surgery,with no serious adverse events related to ciprofol.CONCLUSION Ciprofol is safe and effective for anesthesia in cardiac surgery with cardiopulmonary bypass.

Roux-en-Y gastric bypass or sleeve gastrectomy for obstructive sleep apnea:A systematic review and meta-analysis

Objective:Bariatric surgery has been shown to be an effective method of treatment for obstructive sleep apnea(OSA)with long-term benefits,however,the mechanisms of action and the optimum operative procedure remains unclear.The aim of this systemic review was to compare the efficacy of laparoscopic sleeve gastrectomy(LSG)and Roux-en-Y gastric bypass(RYGB)in resolving OSA.Methods:A comprehensive search of MEDLINE,Pubmed,Embase,and OVID was performed.Studies that reported OSA resolution in obese patients with BMI>30 kg/m2 were included in the study.RCTs,comparative prospective and matched cohort studies comparing RYGB with LSG were considered for this study.Results:Five studies(309 participants)were included:4 cohort studies and 1 RCT;all with low risk of bias.At 12 months follow-up,there was a trend towards improved resolution of OSA with LSG(OR 0.47,95%CI[0.20 to 1.06];p=0.07)when compared to RYGB.In contrast,there was a trend to poorer weight loss in the LSG group(SMD 3.83,95%CI[-1.82 to 9.48];p=0.18).Similarly,at 36 months follow-up,there was a trend towards better resolution of OSA with LSG(OR 0.52,95%CI[0.16 to 1.71];p=0.28)and a significantly poorer weight loss in LSG when compared to RYGB(SMD 8.25,95%CI[2.91 to 13.58];p=0.002).Conclusion:Despite poorer weight loss following LSG,there is a trend towards increased resolution of sleep apnea post-LSG.These findings suggest the possibility of weight loss independent factors causing OSA resolution,which should be further investigated.Registration:PROSPERO:CRD42018090367.

Role of Second-Generation Drug-Eluting Stents and Bypass Grafting in Coronary Artery Disease:A Systematic Review and Meta-analysis

Background:The safety and efficacy of coronary artery bypass grafting(CABG)and second-generation drug-eluting stents(DESs)in patients with coronary artery disease(CAD)remain controversial.Therefore we aimed to compare the outcomes of CAD patients treated with CABG and second-generation DESs.Methods:We systematically searched the PubMed,Cochrane Library,Ovid,and Elsevier databases.Studies comparing second-generation DESs with CABG in CAD patients were included.RevMan 5.3 was used to extract and pool the data from the applicable studies.Results:Six trials(N=6604 participants)were included in this meta-analysis.Among all of the CAD patients,second-generation DESs were associated with no differences in the risks of all-cause death[risk ratio(RR)1.18,95% confi dence interval(CI)0.98–1.43,P=0.09],cardiovascular death(RR 1.14,95% CI 0.81–1.59,P=0.45),myocardial infarction(RR 1.22,95% CI 0.98–1.54,P=0.08),and stroke(RR 0.83,95% CI 0.59–1.17,P=0.29),but increased the risks of revascularization(RR 1.95,95% CI 1.66–2.30,P<0.001)and major adverse cardiac and cerebrovascular events(RR 1.72,95% CI:1.31–2.26,P<0.001)when compared with CABG.Conclusions:In the treatment of CAD patients,second-generation DESs was not associated with increased risks of all-cause death,cardiovascular death,myocardial infarction,and stroke,but increased the risks of revascularization and major adverse cardiac and cerebrovascular events when compared with CABG.

Effect of Cardiopulmonary Bypass on Beta Adrenergic Receptor Adenylate Cyclase System on Surfaces of Peripheral Lymphocytes

Summary: The experimental results showed that the level of CAMP, the ratio of cAPM to cGMP, IL-2R expression and IL-2 production in vitro in lymphocytes immediate and 2 weeks after car- diopulmonary bypass (CPB) were significantly lower than those before anesthetics in the patients undergoing cardiac surgery with CPB. These findings suggested that CPB could cause serious damage to adrenergic beta receptor-adenylate cyclase system on circulating lymphocytes surfaces, which might be one of the mechanisms resulting in immunosuppression after open heart surgery with CPB.

Transoral outlet reduction:Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice

BACKGROUND Transoral outlet reduction(TORe)is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass(RYGB)for weight recurrence;however,little has been published on its clinical implementation in the community setting.AIM To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB.METHODS This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022.Patients were provided longitudinal nutritional support via virtual visits.The primary outcome was total body weight loss(TBWL)at twelve months from TORe.Secondary outcomes included TBWL at three months and six months;excess weight loss(EWL)at three,six,and twelve months;twelve-month TBWL by obesity class;predictors of twelve-month TBWL;rates of post-TORe stenosis;and serious adverse events(SAE).Outcomes were reported with descriptive statistics.RESULTS Two hundred eighty-four adults(91.9%female,age 51.3 years,body mass index 39.3 kg/m^(2))underwent TORe an average of 13.3 years after RYGB.Median pre-and post-TORe outlet diameter was 35 mm and 8 mm,respectively.TBWL was 11.7%±4.6%at three months,14.3%±6.3%at six months,and 17.3%±7.9%at twelve months.EWL was 38.4%±28.2%at three months,46.5%±35.4%at six months,and 53.5%±39.2%at twelve months.The number of follow-up visits attended was the strongest predictor of TBWL at twelve months(R^(2)=0.0139,P=0.0005).Outlet stenosis occurred in 11 patients(3.9%)and was successfully managed with endoscopic dilation.There was one instance of post-procedural nausea requiring overnight observation(SAE rate 0.4%).CONCLUSION When performed by an experienced endoscopist and combined with longitudinal nutritional support,purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.