Clinical study on relationship between renal artery involvement and renal function in acute Stanford A aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To evaluate the involvement of renal artery in acute Stanford type A aortic dissection (TAAD) using CT angiography (CTA) and to analyze the difference of renal function among different types of renal artery involvement. Methods    From January 2016 to November 2017, 151 patients of acute TAAD with renal artery involvement were included in the study. There were 118 males and 33 females, with an average age of 47.93±10.53 years. All patients underwent aortic CTA to confirm the TAAD. According to CTA，involvement of one side of renal artery can be divided into four types: type A, large tear near renal artery orifice, difficult to distinguish true or false lumen; type B, the orifice of the renal artery originates entirely from the false lumen; type C, the orifice of the renal artery originates entirely from the true lumen; type D, renal artery dissection is observed, renal artery intima can be seen. The levels of serum creatinine (sCr) and creatinine clearance (CC) in all groups were analyzed and compared. Results    The results of one-way ANOVA analysis showed that there was no significant difference in sCr or CC among the groups (P>0.05). There was no significant difference in age, sex, proportion of hypertension history and onset time among the above groups (P>0.05). Conclusion    The three most common types of renal artery involvement were BC type, CC type, and AC type. The types of renal artery involvement do not affect renal function.

Surgical treatment of distal aortic arch lesions using stented elephant trunk implantation combined with transposition of left subclavian artery to left common carotid artery / 中国胸心血管外科临床杂志

@#Objective    To evaluate the short- and middle-term outcomes of surgical treatment for distal aortic arch lesions using stented elephant trunk implantation combined with transposition of left subclavian artery to left common carotid artery. Methods    The clinical data of 14 patients with distal aortic arch lesions undergoing stented elephant trunk procedure with left subclavain artery transposition under hypothermic cardiopulmonary bypass (CPB) with antegrade selective cerebral perfusion from May 2009 to November 2015 in our hospital were retrospectively reviewed. All of them were males with a mean age of 52±14 years ranging from 20 to 69 years. Hypertension was observed in nine patients, coronary artery disease in five and prior cerebral infarction in one. History of percutaneous coronary intervention was noted in one patient, history of Bentall operation in one, ligation of patent ductus arteriosus in one and endovascular aneurysm repair in one. Results    There was no hospital death. Concomitant procedures included coronary artery bypass grafting in two patients and plasty of the ascending aorta replacement in one. Mean duration of mechanical ventilation and ICU stay was 21±7 h and 43±19 h, respectively. All patients survived and were discharged. One patient was lost to follow-up and no patient died during the follow-up. Postoperative computed tomography revealed good patency of  the anastomotic site between the left subclavian artery and the left common carotid artery. Conclusion    Stented elephant trunk procedure with left subclavain artery transposition obtains satisfactory surgical results in patients with distal aortic arch lesions.

Application and analysis of abdominal aortic branch malperfusion pattern in thoracic endovascular aortic repair for Stanford B aortic dissection / 北京大学学报(医学版)

Objective:To evaluate the efficiency of thoracic endovascular aortic repair (TEVAR) in dealing with abdominal aortic branch malperfusion based on the analysis of aortic computed tomography angiography (CTA) images in pre-and post-TEVAR.Methods:Retrospective analysis from September 2015 to March 2016 in single institution to 32 patients,diagnosed as Stanford B aortic dissection with abdominal aortic branch malperfusion,CTA images in pre-and post-TEVAR were collected.Based on the aortic branch malperfusion pattern redefined by Nagamine,we identified and characterized branch malperfusion pattern for four abdominal aortic branches (celiac trunk,superior mesenteric artery,bilateral renal artery) in statistical analysis.Results:In the four abdominal aortic branches (total 128 branches),86 branches (67.2％) expressed with Class Ⅰ patterns,in which subtype Ⅰ-b presented with 0.8％,subtype Ⅰ-c with 5.5％;14 branches (10.9％) expressed with Class Ⅱ patterns,in which subtype Ⅱ-b-1 with 3.9％,subtype Ⅱ-b-2 with 3.1％;16 branches (12.5％) expressed with Class Ⅲ patterns,all with subtype Ⅲ-a,no subtype Ⅲ-b and Ⅲ-c presented.The remaining 12 branches were normal.The 100％ successful rate of TEVAR obtained in 32 patients performed.The mean following-up was 4 months.Aortic CTA showed that among the 14 "high-risk" abdominal aortic branch malperfusion,13 (92.9％) with obvious branch malperfusion in post-TEVAR were observed to improve,and the remaining one branch malperfusion (7.1％) was observed to change from subtype Ⅰ-b to Ⅰ-c.Conclusion:Few ratios in abdominal aortic branches suffered with obvious malperfusion complicated by Stanford B aortic dissection.For branches with "high-risk" malperfusion pattern,optimal changes were observed in abdominal aortic branch without revascularization in post-TEVAR,as well other branches with non-" high-risk" pattern perfusion were mostly stable in post-TEVAR.It could be of profound benefit to extend branch malperfusion patterns redefined by Nagamine in clinical practice to assess aortic dissection and in further guide for revascularization or not.

Onychogryphosis in tuberous sclerosis complex: an unusual feature

Abstract Onychogryphosis is an acquired nail plate change. It often affects the toenail and is characterized by an opaque, yellow-brownish nail plate that is distorted, grossly thickened, elongated, and partly curved resembling a ram's horn. Tuberous sclerosis complex is a multisystem disorder associated with high rates of mental retardation, autism, cognitive impairment, behavioral problems, or seizures. Nail disease can also be associated, which is a concern to patients due to pain and nail distortion. We reported a typical tuberous sclerosis complex patient with distinctive clinical features of a ram's horn nails, which presented a great challenge to surgical treatment and nail restoration.

EFFECT OF FORTIFIED FOOD ON THE NUTRITIONAL STATUS OF PRESCHOOL CHILDREN / 营养学报

Three kinds of fortified biscuits and bread were given as breakfast for 5 months to 106 preschool children 4-6 years old lodged in a kindergarten, with a control group taking common biscuits and bread without fortification. 6 g protein and 160 kcal were supplied by 50 g of fortifed foods in which 0.25 g lysine, 0.25 g lysine and 0.8 mg riboflavin, and cod liver oil and calcium in addition to lysine and riboflavin were fortified respectively. The results showed that a diet with intake of 2.1 g protein and 71 kcal/kg body weight fortified on the average by 228 mg lysine or 228 mg lysine and 1.1 mg riboflavin increased the monthly increment of body weights, heights, and urinary excretions of creatinine per day. There was also a tendency of improvement, in nitrogen retention. The urinary excretion of riboflavin in load test was increased in the group taking the second kind of fortified foods.