Epidemiological characteristics of all-cause mortality reviewing out-hospital death under the clouds of COVID-19

TotheEditor:Coronavirus disease2019(COVID-19)has rapidly become a great global infection and broughtabout a wide range of health consequences,including a high number of deaths due to continuous spread.

A Novel Perspective on Histopathology Provides Novel Insights into Surgical Effects in Pulmonary Atresia,Ventricular Septal Defect,and Major Aortopulmonary Collateral Arteries:A Case-Series Study

Background:Never had literatures characterized the relationship between the property of major aortopulmonary collateral arteries(MAPCAs)and outcomes of selective unifocalization of pulmonary atresia with ventricular septal defects and MAPCAs.Methods:This is a case-series study.Thirteen patients were included.Angiographybased assessment was conducted to determine whether collateral arteries should be unifocalized or treated with intraoperative ligature.Specimens were collected and stained by HE and ET+VG.Results:Twelve patients underwent one-stage unifocalization at a median age of 37 months(range:6–228 months)and a median weight of 14.0 kg(range:5.0–49.0 kg),which produced a favorable right ventricle to aortic systolic pressure ratio of no more than 0.5 except in one patient who died.Patients were divided into three groups:Group 1(n=6),had no native pulmonary arteries,and collateral arteries supplied all pulmonary blood;Group 2(n=6)presented dysplastic native pulmonary arteries on one or both sides,and in some lung lobes or segments,blood was supplied only by collateral arteries;Group 3(n=1)had well-developed left and right pulmonary arteries,and collateral arteries,and pulmonary arteries provided blood flow to the same segments.Pathological reports demonstrated two types of collateral arteries:Elastic arteries presented an arborization distribution similar to native pulmonary artery walls,while muscular arteries showed high resistance and distortion.We selectively unifocalized single-supply collateral arteries with morphologic features based on the arborization distribution.Conclusions:We found that there were two kinds of MAPCAs with different histology,and we performed selective UF for MAPCAs that might belong to the elastic artery.Selective unifocalization achieved a low right ventricle to aortic systolic pressure ratio and favorable surgical effects.

Expert consensus on the use of human serum albumin in adult cardiac surgery

Introduction Albumin,which is a 65-kDa liver-synthesized protein,accounts for nearly 50%of total plasma protein and contributes to approximately 80%of intravascular oncotic pressure.Albumin helps maintain microvascular integrity,functions as an antioxidant,and transports hormones,fatty acid,bile salts,bilirubin,electrolytes(e.g.,calcium,magnesium,copper,zinc,et al.),and drugs.[1–3]Human serum albumin(HSA)is a sterile,liquid albumin product derived from large pools of human plasma by fractionation and pasteurization.The medical use of HAS could date back to approximately the time of World War II.

Veno-arterial extracorporeal membrane oxygenation as a bridge in patients with advanced heart failure:Initial experience in China

To the Editor:Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)has been used as a bridge in patients with advanced heart failure(AdHF)while waiting for heart transplantation(HTx).Many studies reported by developed countries have confirmed the advantages of VA-ECMO in terms of bridge to left ventricular assist device(LVAD)or HTx,with stabilizing the condition and improving the possibility of further treatment of patients.[1-3]Recent data from the Extracorporeal Life Support Organization(ELSO)[4]indicated that ECMO used as a bridge has increased by 20.5%over a decade.However,to date,there are few studies on the bridge experience of VA-ECMO in the mainland of China.

Cerebral Metabolic Profiling of Hypothermic Circulatory Arrest with and Without Antegrade Selective Cerebral Perfusion： Evidence from Nontargeted Tissue Metabolomics in a Rabbit Model

Background： Antegrade selective cerebral perfusion （ASCP） is regarded to perform cerebral protection during the thoracic aorta surgery as an adjunctive technique to deep hypothermic circulatory arrest （DHCA）. However, brain metabolism profile after ASCP has not been systematically investigated by metabolomics technology. Methods： To clarify the metabolomics profiling of ASCP, 12 New Zealand white rabbits were randomly assigned into 60 min DHCA with （DHCA＋ASCP [DA] group, n = 6） and without （ DHCA [D] group, n = 6） ASCP according to the random number table. ASCP was conducted by cannulation on the right subclavian artery and cross-clamping of the innominate artery. Rabbits were sacrificed 60 min after weaning off cardiopulmonary bypass. The metabolic features of the cerebral cortex were analyzed by a nontargeted metabolic profiling strategy based on gas chromatography-mass spectrometry. Variable importance projection values exceeding 1.0 were selected as potentially changed metabolites, and then Student＇s t-test was applied to test for statistical significance between the two groups. Results： Metabolic profiling of brain was distinctive significantly between the two groups （Q2y = 0.88 for partial least squares-DA model）. In comparing to group D, 62 definable metabolites were varied significantly after ASCP, which were mainly related to amino acid metabolism, carbohydrate metabolism, and lipid metabolism. Kyoto Encyclopedia of Genes and Genomes analysis revealed that metabolic pathways after DHCA with ASCP were mainly involved in the activated glycolytic pathway, subdued anaerobic metabolism, and oxidative stress. In addition, L-kynurenine （P = 0.0019）, 5-methoxyindole-3-acetic acid （P = 0.0499）, and 5-hydroxyindole-3-acetic acid （P = 0.0495） in tryptophan metabolism pathways were decreased, and citrulline （P - 0.0158） in urea cycle was increased in group DA comparing to group D. Conclusions： The present study applied metabolomics analysis to identify the cerebral metabolic profiling in rabbits with ASCP, and the results may shed new lights that cerebral metabolism is better preserved by ASCP compared with DHCA alone.

A novel and feasible way to cultivate and purify endothelial progenitor cells from bone marrow of children with congenital heart diseases

Background Endothelial progenitor cells （EPCs） are used in vascular tissue engineering and clinic therapy. Some investigators get EPCs from the peripheral blood for clinic treatment, but the number of EPCs is seldom enough. We have developed the cultivation and purification of EPCs from the bone marrow of children with congenital heart disease, to provide enough seed cells for a small calibre vascular tissue engineering study. Methods The 0.5-ml of bone marrow was separated from the sternum bone, and 5-ml of peripheral blood was collected from children with congenital heart diseases who had undergone open thoracic surgery. CD34＋ and CD34＋NEGFR＋ cells in the bone marrow and peripheral blood were quantified by flow cytometry. CD34＋/VEGFR＋ cells were defined as EPCs. Mononuclear cells in the bone marrow were isolated by Ficoll density gradient centrifugation and cultured by the EndoCult Liquid Medium KitTM. Colony forming endothelial cells was detected. Immunohistochemistry staining for Dil-ac-LDL and FITC-UEA-1 confirmed the endothelial lineage of these cells. Results CD34＋ and CD34＋NEGFR＋ cells in peripheral blood were （0.07±0.05）% and （0.05±0.02）%, respectively. The number of CD34＋ and CD34＋/VEGFR＋ cells in bone marrow were significantly higher than in blood, （4.41±1.47）% and （0.98±0.65）%, respectively （P 〈0.0001）. Many colony forming units formed in the culture. These cells also expressed high levels of Dil-ac-LDL and FITC-UEA-I. Conclusion This is a novel and feasible approach that can cultivate and purify EPCs from the bone marrow of children with congenital heart disease, and provide seed cells for small calibre vascular tissue engineering.

Bridging fulminant myocarditis patients to recovery or advanced therapies with veno-arterial extracorporeal membrane oxygenation:a single-center retrospective study

Fulminant myocarditis(FM)is a severe inflammatory cardiac disease,typically triggered by viral pathogens or autoimmune disorders.[1,2]Early symptoms of the disease can be mild and nonspecific,but in certain cases,patients may experience sudden and severe heart failure,arrhythmias,refractory cardiogenic shock,or even death.

Comparable prognosis in different neonatal histidine-tryptophan-ketoglutarate dosage management

Background:Histidine-tryptophan-ketoglutarate(HTK)is a solution commonly used for organ transplantation.However,there is no certified fixed regimen for on-pump heart surgery in neonates.We aimed to retrospectively evaluate the outcomes related to different HTK dosages and to analyze the safety of high-dosage perfusion.Methods:A total of 146 neonates who underwent on-pump heart surgery with single-shot HTK perfusion were divided into two groups according to HTK dosages:a standard-dose(SD)group(n=63,40 mL/kg<HTK≤60 mL/kg)and a high-dose(HD)group(n=83,HTK>60 mL/kg).Propensity score matching(PSM)was performed to control confounding bias.Results:The SD group had a higher weight(3.7±0.4 vs.3.4±0.4 kg,P<0.0001),a lower proportion of complete transposition of the great artery(69.8%vs.85.5%,P=0.022),a lower cardiopulmonary bypass(CPB)time(123.5[108.0,136.0]vs.132.5[114.8,152.5]min,P=0.034),and a lower aortic x-clamp time(82.9±27.1 vs.95.5±26.0 min,P=0.005).After PSM,44 patients were assigned to each group;baseline characteristics and CPB parameters between the two groups were comparable.There were no significant differences in peri-CPB blood product consumption after PSM(P>0.05).The incidences of post-operative complications were not significantly different between the two groups.There were no significant differences in ventilation time,intensive care unit stay,and post-operative hospital stay(P>0.05).Follow-up echocardiography outcomes at 1 month,3 to 6 months,and 1 year showed that left ventricular ejection fraction and end-diastolic dimension were comparable between the two groups.Conclusions:In neonatal on-pump cardiac surgery patients,single-shot HD(>60 mL/kg)HTK perfusion had a comparable heart protection effect and short-term post-operative prognosis as standard dosage perfusion of 40 to 60 mL/kg.Thus,this study provides supporting evidence of the safety of HD HTK perfusion.

Airway Management in a Child with Goldenhar Syndrome

Goldenhar syndrome, also known as oculo-auriculo-vertebral dysplasia, is characterized by a wide range of congenital anomalies, such as micrognathia, oral cavity malformations, and vertebral anomalies and always causes difficult airway. Awake intubation often cannot be used on children because of inadequate cooperation. In addition, children have higher rates of oxygen consumption, significantly shortening the period of apnea that can be safely tolerated. This study reported a successful orotracheal intubation using the McGrath？ video laryngoscope combined with a fiberoptic bronchoscope （FOB） in a pediatric patient with Goldenhar syndrome.