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Objective:To evaluate the association between preoperative thyroid hormones and the postoperative acute kidney injury (AKI) in acute Standford type A aortic dissection (ASTAAD) patients.Methods:The patients with ASTAAD, who underwent surgeries in Beijing Anzhen Hospital from July 2016 to December 2016, were included in this retrospective cohort study. Multivariable regression and stratification analyses were used to examine the association of preoperative thyroid hormone with postoperative AKI.Results:The overall occurrence of postoperative AKI was 42.0%. Multivariate regression revealed that low level of TT3 ( OR=0.08, 95% CI: 0.01-0.94, P=0.04) and TT4 ( OR=0.97, 95% CI: 0.94-1.00, P=0.04) was independently associated with postoperative AKI. Subgroup analyses showed that the relation between TT3 and AKI was significantly noticed in patients with normal TSH levels ( OR=0.004, 95% CI: 0.001-0.16, P<0.01) other than in patients with lower TSH levels ( P=0.26). Conclusion:The present study showed that a low level of TT3 or TT4 was a predictor of postoperative AKI in ASTAAD patients, especially in patients with normal TSH. The thyroid function should be checked before surgical intervention of patients with ASTAAD, and patients with low T3 might be at higher risk of postoperative AKI.
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Objective:This study investigated the association between Yes-associated protein and WW domain-containing transcription regulator protein 1(YAP/TAZ) and the in-hospital surgical mortality rate of STAAD patients.Methods:The mouse β-aminopropionitrile monofumarate(BAPN) model was used to test the level of YAP/TAZ. From July 2016 to December 2016, the blood samples of 139 people who received routine physical examinations consecutively Beijing Anzhen Hospital were included as the control group.According to the inclusion and exclusion requiement, 95 consecutive patients with STAAD who underwent surgery in Beijing Anzhen Hospital during the same period, were involved in the final cohort study. The main outcome measure was in-hospital death. Their blood samples were regarded as the test group. The predictors of postoperative in-hospital death were confirmed by univariate regression analysis. Multivariable logistic regressions were used to analyze the association of the preoperative plasma level of TAZ and the postoperative in-hospital mortality of STAAD patients.Results:The YAP level showed less change in blood samples of both STAAD patients and the BAPN-induced STAAD mice compared to that of the sham control, while TAZ concentration experienced a significant increase. In the crude model, TAZ showed a positive correlation with in-hospital death( OR=1.327, 95% CI: 1.014-1.737, P=0.0392). In adjusted model Ⅰ and adjusted modelⅡ, similar results were found( OR=1.348, 95% CI: 1.010-1.803, P=0.0429; OR=1.353, 95% CI: 1.008-1.816, P=0.0442). Conclusion:The high level of TAZ in the blood suggested poor surgical prognosis for STAAD patients, and patients with a TAZ level ≥13 ng/ml had much higher mortality.
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Objective To summarize the treatment experience and strategies of patients with acute type A aortic dissection involving coronary arteries in order to improve the efficacy of such patients.Methods Between March 2013 and April 2016,we recruited 37 patients with coronary involvement caused by acute type A aortic dissection,26 men,11 women;mean age (49.7 ± 10.4) years.All procedures were done on an emergency basis within 24 hours after the patient's arrival.Results Acute type A aortic dissection with coronary involvement is a more complex operation associated with high in-hospital mortality(18.9％,7/37) and low short-term survival(64.9％,13/37).There were 9 patients underwent coronary artery bypass graft after completion of the root procedure because of ventricular wall motion abnormality(7 patients) and new ST-segment elevation (2 patients) during weaning from cardiopulmonary bypass.Four of them were survival during follow-up due to the success from rescue coronary artery bypass graft.Conclusion Acute type A aortic dissection with coronary involvement is associated with high in-hospital mortality and low short-term survival.If patients suffered abnormal ventricular wall motion or new ST-segment elevation during weaning from cardiopulmonary bypass,rescue coronary artery bypass graft is essential to salvage these critically ill patients.
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Objective To explore the genetic mutation spectrum of patients with hypertrophic cardiomyopathy (HCM) and analysis the correlation of genotype phenotype.Methods Collect peripheral venous blood of the 51 cases unrelated HCM patients(35 male and 16 female) in the Beijing Anzhen Hospital of Capital Medical University from 2013 to 2016.Sequence whole exons of human and analysis seven major mutations of HCM including:MYBPC3、MYH7 、TNNT2、TNNI3 、MYL2 、TPM1 and ACTC1.Then compare the results with clinical characteristics.Results 24 patients(47.1％) had 22 kinds of pathogenicity or possibly pathogenicity mutations.The 90.9％ (20/22) of mutations only occurred one time,except MYH7 gene's 663 amino acid and the TNND gene's 157 amino acid which had twice.The mutations of MYBPC3,MYH7,TNNT2,TNNI3,MYL2,TPM1 and ACTC1 accounted for 45.8％ (11/24),20.8％ (5/24),12.5％ (3/24),8.3％ (2/24),8.3％ (2/24),4.2％ (1/24),and 0 respectively.No amphimutation had been found that causes illness or possibly.Through the comparison of clinical features between Genotype positive(24 cases) and negative(27 cases) patients:the incidence of syncope(19.6％ vs.7.8％,P ＜ 0.05),the largest left ventricular wall thickness[(22.8 ± 2.6) mm vs.(20.0 ± 3.4) mm,P ＜ 0.05],family history of HCM(20.8％ vs.0,P ＜0.05),percentage of apical hypertrophy(25.5％ vs.11.8％,P ＜ 0.05);The ratio of left ventricular outflow tract obstruction in MYH7 group was higher than MYBPC3 group (80.0％ vs.18.2％,P ＜ 0.05).Conclusion MYBPC3 is the most common mutation gene in HCM patients.Phenotype is more severe in geuotype positive patients than in genotype negative patients.Relationship between specific gene mutations and clinical phenotype requires further study.
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Aortic dissection is a kind of fatal cardiovascular disease, and the apoptosis of aortic vascular smooth muscle plays an important role in aortic dissection.The new discovered Hippo-YAP signal transduction pathway is significant in regulation of the function of vascular smooth muscle, and it can cause many cardiovascular diseases.This paper aims to review the present studies of the mechanism of the apoptosis of aortic vascular smooth muscle and Hippo-YAP signaling pathway in the pathogenesis of cardiovascular diseases, especially the aortic dissection.
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Objective To investigate the association between CYP11 B2 gene polymo-rphism and left ventricle hypertrophy with meta analysis.Methods Literatures about the association of CYP11 B2 gene polymorphism and left ventricle hypertrophy from January 1992 to December 2011 were searched.The electronic databases retrieved from Pubmed,Embase,China national knowledge intemet,Chinese biological medicine disk,VIP fulltext database and Wanfang fulltext database.Odds ratio of CYP11 B2 genotype distributions in left ventricle hypertrophy patients comparing with healthy control were analyzed.RevMan5.1 software was applied for investigating hereogeneity among individual studies and summarizing effects with proper statistical methods.Six case control studies were enrolled.Results A total of 541 cases and 553 controls were enrolled for the study.The pooled OR of CC vs TT + TC genotype was 1.15 (95％ CI:0.74 ～ 1.80) (Z =0.63,P =0.53) in the subgroup of hypertension,and the pooled OR of CC vs TT + TC genotype was 1.15 (95 ％ CI:0.74 ～ 1.80) (Z =0.63,P =0.53) in the subgroup of race.The pooled OR of C vs T allele was 1.15 (95％ CI:0.76 ～ 1.74) vs 0.87 (95％ CI:0.58 ～ 1.31) (Z =0.67,P =O.50).Conclusion Whether the hypertension or the race,the genotype of CYP11 B2 polymorphism has no association with an increased risk of left ventricle hypertrophy.