To investigate the postoperative complications and mortality after reoperative cardiac surgery: an analysis of 146 cases / 中华胸心血管外科杂志

Objective:To investigate the postoperative complications and in-hospital mortality of reoperative cardiac surgery, and to explore the feasibility and safety of reoperative cardiac surgery.Methods:The baseline data and clinical information of patients undergoing cardiac surgery in Nanjing First Hospital from November 2012 to November 2021 were retrospectively conducted, and they were divided into the reoperative cardiac surgery group and the primary surgery group according to whether they underwent reoperative cardiac surgery using a propensity score analysis. The intraoperative indicators, postoperative complications and in-hospital mortality were compared between the two groups after matching.Results:After propensity score analysis, 146 cases were included in each of the group. In terms of intraoperative indicators, the cardiopulmonary bypass time [(141.48±47.88)min vs.(105.31±33.56)min], aortic occlusion time [87.0(70.5, 113.3)min vs. 71.5(53.0, 92.0)min], ICU stay time[2( 1, 4)days vs. 2(1, 2)days], postoperative drainage volume [750(460, 1300)ml vs. 610(410, 840)ml], postoperative transfusion of red blood cells [0(0, 3.5)U vs. 0(0, 2)U], the reoperative cardiac surgery group increased with statistically significant differences( P<0.05). Postoperative complications, the two groups had postoperative hypoxemia [15(10.3%) vs. 6(4.1%)], acute kidney injury [10(6.8%) vs. 0(0)], postoperative infection [24(16.4%) vs. 4(2.7%)], cerebral complications [7(4.8%) vs. 1(0.7%)] )], the incidence rate in the reoperative cardiac surgery group was higher with statistically significant differences( P<0.05). There was no significant difference in in-hospital mortality[7(4.8%) vs. 4(2.8%)]( P>0.05). Conclusion:The time of reoperative cardiac surgeryis is longer, postoperative recovery is slower, and postoperative complication rate is higher, but does not increase in-hospital mortality.

Cause-of-death analysis in low-risk cardiac surgery patients during postoperative period / 中国胸心血管外科临床杂志

@#Objective    To analyze the cause of death in low-risk cardiac surgery patients during postoperative period and discuss the prevention and treatment methods to increase the survival rate. Methods    We retrospectively analyzed the clinical data of 132 patients dead after cardiac surgery from January 2014 to December 2018, among whom 35 patients had a EuroSCORE Ⅱ score <4% (low-risk cardiac surgery patients), including 20 males and 15 females aged 62.7±13.4 years. The cause of death in these low-risk patients was analyzed. Results    The main causes of death were cardiogenic and brain-derived causes (60.0%), and infections and ogran failure (45.7%). Pulmonary infection and low cardiac output after surgery were the main causes of death. Cerebral infarction, malignant arrhythmia and multiple organ failure were the common causes of death. There were 4 deaths (11.4%) caused by accidents, including gastrointestinal bleeding caused by esophageal ultrasound probe, cough and asphyxia caused by drinking water, postoperative paralytic ileus and multiple perioperative allergic reactions caused by allergic constitution. Conclusion    Postoperative treatment and prevention for low-risk cardiac surgery patients should be focused on postoperative infection, and cardiac and brain function protection. Changes in various organ functions need to be closely monitored for preventing organ failure, accidents should be strictly controlled, and more details of intraoperative and postoperative treatment still need to be further improved.

Efficacy of low dose and short-term rifaximin on irritable bowel syndrome related with small intestinal bacterial overgrowth / 中华消化杂志

Objective@#To investigate the efficacy of low dose and short-term oral rifaximin in patients with small intestinal bacterial overgrowth (SIBO) related irritable bowel syndrome (IBS).@*Methods@#From June 2017 to June 2018, at the Department of Gastroenterology of Huashan Hospital, Fudan University in Shanghai, a total of 37 patients with SIBO related IBS were sequentially enrolled and divided into three groups: diarrhea type, constipation type and mixed type. All the patients received rifaximin 200 mg each time, three times per day for 14 days. The clinical efficacy before and after treatment were compared by the scores of irritable bowel syndrome symptom severity scale (IBS-SSS) and irritable bowel syndrome associated quality of life (IBS-QoL). The efficacy of rifaximin on SIBO clearance and SIBO related chronic low-grade inflammation was evaluated by lactulose breath test (LBT) and exhaled nitric oxide (eNO). T test and variance analysis were used for statistical analysis.@*Results@#Among 39 patients with SIBO related IBS, 24 patients were diarrhea type, seven were constipation type and six were mixed type. Except one patient quitted the study because of chest tightness and palpitation, the IBS-SSS score of the left 36 patients before treatment was (250.83±55.10), and decreased to (151.11±33.96), and the difference was statistically significant (t=13.686, P<0.01). Before treatment the score of IBS-QoL was (28.03±16.16), and decreased to (14.39±9.31) after treatment, and the difference was statistically significant (t=6.867, P<0.01). There was no significant difference in IBS-SSS and IBS-QoL scores among the diarrhea type, constipation type and mixed type groups (all P>0.05). After treated by rifaximin, the negative conversion rate of SIBO was 52.8%(19/36). The negative conversion rate of hydrogen LBT was 54.5%(12/22) and among 11 methane LBT positive patients, six cases turned negative; and one of three patients with both positive hydrogen LBT and methane LBT turned negative. The negative conversion rate of eNO was 41.7%(15/36).@*Conclusions@#Low dose and short term rifaximin treatment can improve the severity of clinical symptoms and quality of life in SIBO-related IBS patients, and the efficacy is not related with the subtypes of IBS.

Efficacy of low dose and short-term rifaximin on irritable bowel syndrome related with small intestinal bacterial overgrowth / 中华消化杂志

Objective To investigate the efficacy of low dose and short-term oral rifaximin in patients with small intestinal bacterial overgrowth (SIBO)related irritable bowel syndrome (IBS). Methods From June 2017 to June 2018,at the Department of Gastroenterology of Huashan Hospital,Fudan University in Shanghai,a total of 37 patients with SIBO related IBS were sequentially enrolled and divided into three groups:diarrhea type,constipation type and mixed type. All the patients received rifaximin 200 mg each time,three times per day for 14 days. The clinical efficacy before and after treatment were compared by the scores of irritable bowel syndrome symptom severity scale (IBS-SSS)and irritable bowel syndrome associated quality of life (IBS-QoL). The efficacy of rifaximin on SIBO clearance and SIBO related chronic low-grade inflammation was evaluated by lactulose breath test (LBT)and exhaled nitric oxide (eNO). T test and variance analysis were used for statistical analysis. Results Among 39 patients with SIBO related IBS,24 patients were diarrhea type,seven were constipation type and six were mixed type. Except one patient quitted the study because of chest tightness and palpitation,the IBS-SSS score of the left 36 patients before treatment was (250. 83 ± 55. 10),and decreased to (151. 11 ± 33. 96),and the difference was statistically significant (t = 13. 686,P <0. 01). Before treatment the score of IBS-QoL was (28. 03 ± 16. 16),and decreased to (14. 39 ± 9. 31)after treatment,and the difference was statistically significant (t = 6. 867,P < 0. 01 ). There was no significant difference in IBS-SSS and IBS-QoL scores among the diarrhea type,constipation type and mixed type groups (all P > 0. 05). After treated by rifaximin,the negative conversion rate of SIBO was 52. 8％(19 / 36). The negative conversion rate of hydrogen LBT was 54. 5％(12 / 22)and among 11 methane LBT positive patients,six cases turned negative;and one of three patients with both positive hydrogen LBT and methane LBT turned negative. The negative conversion rate of eNO was 41. 7％ (15 / 36). Conclusions Low dose and short term rifaximin treatment can improve the severity of clinical symptoms and quality of life in SIBO-related IBS patients,and the efficacy is not related with the subtypes of IBS.

Port-access minimally invasive versus sternotomy approach for aortic valve surgery / 中国医师杂志

Objective To compare early outcomes of the minimally invasive aortic valve surgery (MIAVS) through right parasternal mini-thoracotomy with conventional mitral valve surgery (AVS),and evaluate feasibility and safety of MIAVS.Methods From January 2017 to December 2017,60 patients undergoing elective AVS in Nanjing First Hospital were prospectively enrolled in this study.There were 32 male and 28 female patients with their age of 28-72 (46.5 ± 10.2)years.Using a random number table,all the patients were randomly divided into a port-access MIAVS group (MIAVS group,n =20) and a conventional AVS group (conventional group,n =60).MIAVS group patients received port-access cardiopulmonary bypass (CPB) establishment via femoral artery,femoral vein and right internal jugular vein cannulation through right the 3rd in tercostal space with 5-6 cm right parasternal incision in length.Special MIAVS operative instruments were used for mitral valve repair or replacement.Conventional group patients received mitral valve repair or replacement under conventional CPB through median sternotomy.Perioperative clinical data,morbidity and mortality were compared between the 2 groups.Results There was no death in-hospital or shortly after discharge in this study.CPB time [(106.0 ± 21.0) minutes vs (73.0 ± 15.0) minutes] and aortic cross-clamping time [(78.0 ± 10.0) minutes vs (47.0 ± 7.0) minutes] of MIAVS group were significantly longer than those of conventional group (P ≤ 0.05).Postoperative mechanical ventilation time [(7.0 ±4.2) hours vs (10.2 ±5.3)hours],length of intensive care unit (ICU) stay [(19.0 ± 4.0) hours vs (27.5 ± 8.0) hours] and postoperative hospital stay [(8.5 ± 2.5) days vs (13.0 ± 3.0) days] of MIAVS group were significantly shorter than those of conventional group (P ≤ 0.05).Chest drainage volume within postoperative 12 hours [(100.0 ±40.0)ml vs (410.0 ±80.0)ml] and the percentage of patients receiving blood transfusion (15.0％ vs 55.0％) of MIAVS group were significantly lower than those of conventional group (P ≤0.05).Patients were followed up for 1-12 months,and the follow-up rate was 96.7％.There was no statistical difference in postoperative morbidity or mortality between the 2 groups (P ＞ 0.05).Conclusions Minimally invasive aortic valve surgery through right right parasternal mini-thoracotomy is a safe and feasible procedure for surgical treatment of mitral valve diseases.MIAVS can achieve similar clinical outcomes as conventional AVS,with more quickly recovery and less blood transfusion,and is a good alternative to conventional AVS.

Small intestinal bacterial overgrowth and low-grade systemic inflammation in 50 patients with irritable bowel syndrome / 中华消化杂志

Objective@#To investigate the incidence of small intestinal bacterial overgrowth (SIBO) and systemic low-grade inflammation in patients with irritable bowel syndrome (IBS).@*Methods@#From June to October in 2017, 50 cases of IBS patients who met Rome Ⅳ criteria were consecutively collected at Outpatient Department of Gastroenterology of Shanghai Huashan Hospital. The incidence of SIBO was detected by hydrogen lactulose breath test (LBT) and methane LBT. The incidence of systemic low-grade inflammation in IBS patients was determined by fractional exhaled nitric oxide(FeNO) breath test. Chi-square test was used for statistical analysis.@*Results@#Among 50 IBS patients, the positive rate of FeNO was 70%(35/50), and the number of FeNO positive cases in diarrhea-predominant (n=28), constipation-predominant (n=14) and mix-type (n=8) IBS paitents was 18, 11 and six, respectively, and the difference was not statistically significant among three groups (χ2=1.020, P=0.600). The incidence rate of SIBO was 60% (30/50), with 20 cases (40%) being only positive for hydrogen LBT, seven cases (14%) being methane LBT, and three cases (6%) being both positive. The numbers of hydrogen LBT and methane LBT in diarrhea-predominant, constipation-predominant, and mix-type IBS patents were 17, three, three and two, six, two, respectively. There were statistically significant differences in positive rates of hydrogen LBT and methane LBT among three groups (χ2=6.076 and 6.392, both P<0.05). The positive rate of FeNO in IBS patients with SIBO was higher than that of IBS patients without SIBO (90%, 27/30 vs. 40%, 8/20), and the difference was statistically significant (χ2=14.286, P<0.01).@*Conclusions@#Combination of hydrogen LBT and methane LBT has a higher detection rate of SIBO than traditional single hydrogen LBT. There is a correlation between SIBO and systemic low-grade inflammation in IBS patients.

Small intestinal bacterial overgrowth and low-grade systemic inflammation in 50 patients with irritable bowel syndrome / 中华消化杂志

Objective To investigate the incidence of small intestinal bacterial overgrowth (SIBO) and systemic low-grade inflammation in patients with irritable bowel syndrome (IBS ) .Methods From June to October in 2017 ,50 cases of IBS patients who met Rome Ⅳ criteria were consecutively collected at Outpatient Department of Gastroenterology of Shanghai Huashan Hospital .The incidence of SIBO was detected by hydrogen lactulose breath test (LBT) and methane LBT .The incidence of systemic low-grade inflammation in IBS patients was determined by fractional exhaled nitric oxide (FeNO) breath test .Chi-square test was used for statistical analysis .Results Among 50 IBS patients ,the positive rate of FeNO was 70％ (35/50) ,and the number of FeNO positive cases in diarrhea-predominant (n=28) ,constipation-predominant (n= 14) and mix-type (n= 8) IBS paitents was 18 ,11 and six ,respectively ,and the difference was not statistically significant among three groups (χ2=1 .020 ,P=0 .600) .The incidence rate of SIBO was 60％ (30/50) ,with 20 cases (40％ ) being only positive for hydrogen LBT ,seven cases (14％ ) being methane LBT ,and three cases (6％ ) being both positive .The numbers of hydrogen LBT and methane LBT in diarrhea-predominant ,constipation-predominant ,and mix-type IBS patents were 17 , three ,three and two ,six ,two ,respectively .There were statistically significant differences in positive rates of hydrogen LBT and methane LBT among three groups (χ2 =6 .076 and 6 .392 ,both P<0 .05) . The positive rate of FeNO in IBS patients with SIBO was higher than that of IBS patients without SIBO (90％ ,27/30 vs .40％ ,8/20) ,and the difference was statistically significant (χ2 =14 .286 ,P<0 .01) . Conclusions Combination of hydrogen LBT and methane LBT has a higher detection rate of SIBO than traditional single hydrogen LBT . There is a correlation between SIBO and systemic low-grade inflammation in IBS patients .

Features of clinicopathology and blue laser imaging combined with magnification endoscopy of patients with early gastric cancer / 中华消化内镜杂志

Objective To study the clinical and pathological characteristics of early gastric cancer ( EGC) and to evaluate the value of blue laser imaging combined with magnification endoscopy ( BLI-ME) in the diagnosis of EGC. Methods A retrospective study was conducted on data of 255 patients with EGC diagnosed in Huashan Hospital from January 2014 to January 2017, including 33 cases of preoperative BLI-ME intensive examination. According to the Japanese classification of gastric carcinoma of Japanese Gastric Cancer Association, the EGCs were histopathologically divided into differentiated and undifferentiated subtypes. Clinical characteristics, endoscopic features, pathological type, lymph node metastasis, and lesion characteristics of BLI-ME were analyzed. Results Among the 255 cases of EGC, 164 cases ( 63. 31％) were male, 242 cases ( 94. 90％) were over 40 years old, 182 cases ( 71. 37％) belonged to differentiated type, 93 cases ( 36. 47％) were located in gastric antrum, 92 cases ( 36. 08％) were type 0-Ⅱc under endoscopy, and 37 cases (14. 51％) had lymph node metastasis. Comparative analysis showed that the lymph node metastasis rate was significantly lower in mucosal carcinoma compared to submucosal carcinoma[ 5. 04％(7/139) VS 25. 86％ (30/116),χ2=22. 109, P=0. 000], lower in differentiated carcinoma compared to undifferentiated carcinoma[9. 89％ (18/182) VS 26. 03％ (19/73), χ2=10. 938, P=0. 002], and lower in tumors with maximum diameter of lesion≤2. 0 cm compared to maximum diameter of lesion>2. 0 cm [ 9. 88％ ( 16/162 ) VS 22. 58％ ( 21/93 ) , χ2 =7. 687, P=0. 009 ] . Among the 33 cases undergoing BLI-ME, differentiated EGC was mainly fine-network pattern (13. 64％, 3/22), intralobular loop pattern (ILL)-1 (59. 09％, 13/22) and ILL-2 (22. 73％, 5/22), whereas undifferentiated subtype patients were characterized as ILL-2 ( 45. 45％, 5/11 ) and corkscrew pattern ( 54. 55％, 6/11 ) . Conclusion The incidence of EGC is higher in male with age over 40 years. Gastric lesions occur most frequently in the antrum, and the most common microscopic morphology is 0-Ⅱc type. Tumor>2. 0 cm or invasion of submucous layer, and undifferentiated carcinoma are prone to lymph node metastasis. The assessment of mucosal microvascular pattern and micro surface structure under BLI-ME facilitate to determine the pathological type of EGC.

Late reoperations after repaired Stanford type A aortic dissection / 中华外科杂志

Objective@#To summarize the experience of reoperations on patients who had late complications related to previous aortic surgery for Stanford type A dissection.@*Methods@#From August 2008 to October 2016, 14 patients (10 male and 4 female patients) who underwent previous cardiac surgery for Stanford type A aortic dissection accepted reoperations on the late complications at Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University. The range of age was from 41 to 76 years, the mean age was (57±12) years. In these patients, first time operations were ascending aorta replacement procedure in 3 patients, ascending aorta combined with partial aortic arch replacement in 4 patients, aortic root replacement (Bentall) associated with Marfan syndrome in 3 patients, aortic valve combined with ascending aorta replacement (Wheat) in 1 patient, ascending aorta combined with Sun′s procedure in 1 patient, Wheat combined with Sun′s procedure in 1 patient, Bentall combined with Sun′s procedure in 1 patient. The interval between two operations averaged 0.3 to 10.0 years with a mean of (4.8±3.1) years. The reasons for reoperations included part anastomotic split, aortic valve insufficiency, false aneurysm formation, enlargement of remant aortal and false cavity. The selection of reoperation included anastomotic repair, aortic valve replacement, total arch replacement and Sun′s procedure.@*Results@#Of the 14 patients, the cardiopulmonary bypass times were 107 to 409 minutes with a mean of (204±51) minutes, cross clamp times were 60 to 212 minutes with a mean of (108±35) minutes, selective cerebral perfusion times were 16 to 38 minutes with a mean of (21±11) minutes. All patients survived from the operation, one patient died from severe pulmonary infection 50 days after operation. Three patients had postoperative complications, including acute renal failure of 2 patients and pulmonary infection of 1 patient, and these patients were recovered after treatment. Thirteen patients were finally recovered from hospital. The patients were followed up for 16 to 45 months, and no aortic rupture, paraplegia and death were observed in the follow-up.@*Conclusions@#Patients for residual aortic dissection after initial operations on Stanford type A aortic dissection should be attached great importance and always need emergency surgery, but the technique is demanding and risk is great for surgeons and patients, which need enough specification and accurate on aortic operation. More importantly, the Sun′s procedure also should be performed on the treatment of residual aortic dissection or distal arch expansion, and obtains the short- and long-term results in the future.

Strategies for surgical treatment of ischemic mitral incompetence / 中华外科杂志

Treatment of ischemic mitral incompetence (IMI) is an important problem in cardiovascular surgery, and it is arguing to the best strategies for surgical treatment of IMI. IMI can be quantitative assessment precisely by three-dimensional ultrasonic sound. Perioperative transesophageal echocardiography can acquire detailed information about IMI, but it is possible to underestimate the degree of IMI. The effective mitral regurgitation area at resting are the independently prognosis factor in patients with IMI. So it is necessary to sufficiently evaluate the patients before operation in order to predict the operative effect and risk. It is the choice for the best strategies for surgical treatment of IMI regarding to patients symptom, the degree of IMI, cardiac reconstruction. The therapy strategies should be weighed the operative risk and long-term benefit for moderate IMI, so that combining CABG with concomitant mitral surgery or not would be decided. It is arguing to mitral valve replacement or repair for surgical treatment of severe IMI. The surgical methods should be chosen carefully according to left ventricular remodeling and pathological changes of mitral valve. The effect of mitral valve repair is dependent on correctly perform. The suitable repair technique and plasty ring should be selected actively.

Concomitant atrial fibrillation ablation with valve procedures for / 中国胸心血管外科临床杂志

@#Objective    To explore the operability of concomitant ablation for the patients with valvular heart diseases with left atrium bigger than 60 mm. Methods    We prospectively included 306 patients with concomitant ablation in our hospital between 2013 and 2015 year. Based on diameter of left atrium measured by intra-operative transesophageal echocardiography (TEE), we separated these patients into two groups including a group L (left atrium >60 mm, 93 patients, 55 males and 38 females at age of 57.0±10.1 years) and a group S (left atrium <60 mm, 213 patients, 120 males and 93 females at age of 55.2±9.9 years) and followed them on 4 time points (time on discharge, three months, six months, and one year after surgery). Then, we analyzed the impact of left atrial size on cardioversion outcome of surgical ablation based on the following data. Results    The successful rate of the group S and the group L in the 4 time points was 72.8% vs. 75.3%, 74.2% vs. 75.3%, 78.9% vs. 77.4%, and 77.0% vs. 77.4%, respectively . The result of both univariate logistic regression analysis and receiver operation characteristic(ROC) curve analysis showed that there was no statistical difference in cardioversion rates between the group S and the group L. And there was no evident correlation between size of left atrium and ablation failure. Conclusion    Patients with left atrium enlarged from 60 mm to 70 mm can achieve the same satisfactory results in cardioversion, and should not be the contraindication of concomitant surgical ablation.

The clinical results of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To analyze the clinical effect of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection. Methods    From January 2010 to December 2015, 30 patients (25 males, 5 females) underwent partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection with involvement of aortic root. The range of age was from 27 to 72 years, and the mean age was 51.2±8.0 years. The proximal aortic dissection received partial aortic root remodeling, and the operation procedures included partial aortic root remodeling+ascending aortic replacement in 9 patients, partial aortic root remodeling+ascending aortic replacement+hemi-arch replacement in 6 patients, partial aortic root remodeling+ascending aortic replacement+Sun's procedure in 15 patients. The patients were followed up for 10 to 60 months with a mean of 37.9±3.2 months. Preoperative and postoperative degrees of aortic regurgitation were compared. Results    All patients survived from the operation, and one patient died from severe pulmonary infection 15 days after operation. The overall survival rate was 96.7% (29/30). One patient died during the follow-up. Two patients underwent aortic valve replacement in the 12th and 15th postoperative month respectively because of severe aortic regurgitation (AI). Up to the last follow-up, trivial or no aortic regurgitation was demonstrated in 24 patients, but mild aortic regurgitation occurred in 2 patients. Conclusion    The surgical treatment for aortic root pathology due to Stanford type A aortic dissection is challenging, and partial aortic root remodeling operations could restore valve durability and function, and obtains the early- and mid-term results.

Effects of lentivirus-mediated siRNA interference of USP39 on proliferation and migration of mice vascular smooth muscle cell / 中国生化药物杂志

Objective To investigate the effect of lentivirus-mediated siRNA interference of USP39 on proliferation and migration of mice vascular smooth muscle cell in vitro.Methods Five siRNAs of siControl, siRNAUSP39-70, siRNAUSP39-71, siRNAUSP39-72 and siRNAUSP39-73 were designed and sythezied,mice VSMCs were infected with the lentivirus for delivering siRNAUSP39-73, and the stably transfected cells were selected by puromycin.The interference efficiency of siRNAUSP39-73 was assessed with Western blot.The effect of USP39 interference on the proliferation of VSMCs was determined by cells counting and MTT assay.Transwell assay was used to detect the migration of VSMCs.Results Recombinant lentiviral vector siRNAUSP39-73 was successfully transfected into mice VSMCs.Comparing with siControl group and Normal group, USP39 protein level of siRNAUSP39-73 VSMCs were decreased(P<0.05), and the proliferation and migration ability were all inhibited(P<0.05).Conclusion Targeted down-regulation of USP39 expression can inhibit the proliferation and migration of mice VSMCs in vitro.

The stented elephant trunk transplantation combined with total arch replacement for acute type A aortic dissection / 中华胸心血管外科杂志

Objective To summanrize the operative method and follow-up data of total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta (Sun's procedure) for acute Stanford type A aortic dissection.Methods Between August 2004 and March 2012,73 patients with acute type A aortic dissection underwent this procedure.60 males and 13 females ranging in age from 26 to 79 years (mean age,49,6 years).Right axillary or femoral artery cannulation was routinely used for cardiopulmonary bypass.Cerebral protection was achieved by bilatero-antegrade or selected hrain perfusion.The stented elephant trunk was implanted throuugh the aortic arch under hypothermic circulatory arrest.The stented elephant trunk was a 10cmlong self expandable graft.Patent false lumina were evaluated using computed tomography 3 months and once each year after discharge to evaluate the postoperative time course of the residual false lumen.Results Mean cardiopulmonary bypass time was (248.1±69.8)min,and selected cerebral perfusion time was (38.2±10.5)min.Hospital morality was 6.85 ％ (5/73).Thrombus obliteration of the residual false lumen in the descending thoracic aorta was observed in 9 1.7％ of the aortic dissections 3 months postoperatively.The mean follow-up time was(36.4 ± 31.6)months (range,2 to91 months).Survival at 1,5,7 years was 97％,87％ and 81％,respectively.Conclusion Total aortic arch replacement combined with transaortic stented paft implantation into the descending aorta is an effective treatment and n more promising choice for acute type A aortic dissection.

Identification and Culture of Rat AO Vascular Smooth Muscle Cells by Tissue - piece Inoculation / 医学研究杂志

Objective To obtain a lasting and purified cell line of vascular smooth muscle cells (VSMCs) by primary culture, and to provide these test materials related research. Methods The primary and transfer culture was done by tissue - piece inoculationand trypsin digestion,respectively. The cells were frozen in liquid nitrogen,and cultured cells were identified by phase contrast microscopy and immunohistochemical SP kit. Results 85% of inoculated tissue pieces survived. More than 90% of VSMCs regrew in transfered culture. The frozen cells could recover their proliferation by several culture transfers. The VSMCs showed the typical "peak and valley" characteristics under microscopy. Immunohistochemical staining with antibody against SM - a - actin expression in these cells was positive. Conclusion The tissue - piece inoculation is a simple method for obtaining satisfactory VSMCs in short term.

Acquired Fungal Infection in Cardiosurgery Intensive Care Unit / 中华医院感染学杂志

OBJECTIVE To explore the reason, characteristic,prevention and treatment measures of acquired fungal infection in cardiosurgery intensive care unit(CSICU). METHODS A total of 153 patients who were admitted to our CSICU ward and had perfect microorganism materials from Jan 1999 to Jul 2002 were investigated with retrospective method,in which 34 cases were acquired fungal infection. RESULTS The rate of fungal infection was 21.52%.The most common infection site was lower respiratory tract.The patients after cardiac injury were easy to be infected.The Candida were the main pathogens,especially Candida tropicalis.The cardiopulmonary bypass(CPB) time,the time stayed in ICU,mechanical ventilation time, urinary dwelling tracheal intubation or tracheotomy,fiber bronchoscope and central venous intubation were the risk factors. CONCLUSIONS The reason of acquired fungal infection in CSICU is that CPB decreases patient′s immunity and every invasive exam or treatment can break the normal immunity.