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Objective:To explore the correlation between intraoperative cooling temperature and postoperative neurological prognosis in aortic arch surgery.Methods:We observed and collected data from 118 patients who underwent open arch replacement surgery by a single surgeon with mild-to-moderate hypothermic circulatory arrest, from January 2017 to December 2020, in Beijing Anzhen Hospital. According to the bladder temperature during the circulation arrest, 118 patients were divided into 3 groups: T1 group[n=39, (25.58±0.64)℃]; T2 group[n=39, (28.21±0.77)℃]; T3 group[n=40, (30.95±0.97)℃]. Clinical data and operative data were analyzed to assess difference between these 3 groups. Analyze the risk factors of postoperative neurological complications, and explore further the correlation between intraoperative core temperature and postoperative neurological prognosis.Results:Among the 118 patients, the average operation, cardiopulmonary bypass (CPB), block, circulatory arrest, and selective cerebral perfusion (SCP) time were 6.64 h, 188.5 min, 104.19 min, 23.93 min, 28.81 min, respectively. The in-hospital death occurred in 8 patients(6.78%), and permanent neurological dysfunction (PND) in 13 patients(11.02%), transient neurological dysfunction (TND) in 25 patients(21.19%). There was no significant difference in the deaths among the three groups. The incidence of TND and PND in the T3 group was significantly reduced ( P=0.042; P=0.045). In addition, the volume of drainage during the first 24 h and the incidence of re-exploration for bleeding had a relatively obvious decreasing trend ( P=0.005; P=0.012). Through multiple regression analysis, under the adjusted model, the core temperature was independently correlated with the incidence of postoperative PND ( OR=0.51; 95% CI: 0.27-0.97; P=0.0389); in group comparison, the relatively higher core temperature was an independent protective factor for postoperative PND ( OR=0.04; 95% CI: 0.00-0.91; P=0.0434). Conclusion:Our research had preliminary proved that in the open arch replacement surgery, mild hypothermia can reduce the incidence of some complications of deep hypothermia, at the same time improve the prognosis of the neurological prognosis, reduce the incidence of postoperative PND.
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As one of the leucine-rich repeat protein family members, leucine-rich α-2 glycoprotein 1 (LRG1) affects many diseases by transforming growth factor (TGF)-β signaling pathway, and is closely associated with angiogenesis, endothelial cell apoptosis and autophagy, inflammatory reaction and blood-brain barrier damage after cerebral ischemia. It is expected to become a new marker and therapeutic target of ischemic stroke. However, at present, there are few studies on investigating the relationship between LRG1 and ischemic stroke, and the understanding of its molecular mechanism is not yet complete, resulting in controversy about the role of LRG1 in ischemic stroke. Therefore, this article reviews the research progress of LRG1-TGF-β signaling pathway and ischemic stroke, hoping to provide new ideas for the early diagnosis, prevention and treatment of ischemic stroke.
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Objective:To explore the application of cannulating the ischemic femoral and right axillary artery in Sun’s procedure for acute type A aortic dissection with lower extremity ischemia.Methods:Twelve patients of acute Stanford type A aortic dissection complicated by lower extremity ischemia were analyzed retrospectively between July 2017 and May 2019, and the right axillary and ischemic femoral artery were used for cardiopulmonary bypass. All the 12 patients were male and categorized as the complicated Stanford type A aortic dissection. The mean age was(48.4±8.4)years, and the median time from symptom onset to emergency operation was 24.00(18.50, 43.25)hours. Eleven patients presented with unilateral extremity ischemia, while bilateral extremity ischemia occurred in one. The prosthetic vessel, with a diameter of 8 mm, was anastomosed to the ischemic femoral artery via an end-to-side way. Both the right axillary artery and the prosthetic vessel were cannulated for CPB. For the proximal dissection in this cohort of patients, we performed Bentall procedure in 5 cases, ascending aortic replacement in 3, and the aortic valve commissure reconstruction with ascending aortic replacement in 4. Total arch replacement with stented elephant trunk implantation were carried out for arch and descending aortic lesion in 12 cases.Results:Early mortality was 8.3%(1/12). The time of CPB, aortic clamp, circulatory arrest, and selective cerebral perfusion averaged(204.6±26.3) min, (114.6±16.6) min, (23.4±8.5) min, and(33.5±11.0) min, respectively. Five patients underwent concomitant bypass procedures, including: ascending aorta-bilateral femoral artery bypass in 1, ascending aorta-right femoral artery bypass in 3, ascending aorta-left femoral artery bypass in 1. Acute renal failure with continuous renal replacement therapy occurred in 4 cases, re-thoratomy for hemaostsis in 1, and re-intubation in 1. One patient developed osteofascial compartment syndrome after aortic repair, and consequent left lower extremity compartment fasciotomy was performed. The mean follow-up time was(17.2±7.6)months, and no aortic-related adverse event was detected during follow up.Conclusion:To acute Stanford type A aortic dissection with lower extremity ischemia, cannulating the ischemic femoral and right axillary artery in Sun’s procedure were associated with lower perioperative mortality and better prognosis.
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Total thoracoabdominal aortic aneurysmrepair is one of the most complex operations in cardiac surgery. Patients may have spinal cord injury, disturbance of consciousness, hypoxemia, arrhythmia, acute renal injury, abdominal organ ischemia and so on after operation. Postoperative complications may occur in patients with neurological, respiratory, circulatory, digestive, urinary and coagulation systems. This paper summarizes the experience of prevention and treatment of postoperative complications based on the medical literature at home and abroad and the experience of diagnosis and therapeutic schedule in our hospital, in order to improve the prognosis.
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Objective:To evaluate the application of moderate hypothermia circulatory arrest(MHCA)with a higher temperature(29℃) and bilateral selective antegrade cerebral perfusion(bSACP) in acute Stanford type A aortic dissection(TAAD] treated by total arch replacement with stented elephant trunk implantation.Methods:From July 2019 to January 2020, fifteen patients of acute TAAD undergoing emergent operations via MHCA with a core temperature of 29℃ and bSACP were analyzed retrospectively(modified group), and 26 patients treated by MHCA(25℃) and unilateral selective antegrade cerebral perfusion(uSACP) during the same period were defined as the traditional group. All cases were complicated type A dissection. The mean age in this cohort was 49 years, and 32 patients(78%) were male. Thirty six patients(87.8%) suffered from arterial hypertension. The proximal manipulations included: aortic sinus repair in 13 cases(31.7%), ascending aortic replacement in 29(70.7%), Bentall in 12(29.3%). Total arch replacement with stented elephant trunk implantation was performed in all cases.Results:The in-hospital death occurred in 2(4.9%), and cerebral infarction in 3(7.3%), transient neurologic deficit in 5(12.2%), paraplegia in 2(4.9%). The ratios of above-mentioned adverse events in the traditional and modified group were[2(7.7%) vs. 0, P=0.524], [3(11.5%)vs. 0, P=0.287], [4(15.4%) vs. 1(6.7%), P=0.636], [1(3.8%) vs. 1(6.7%), P=1.000] respectively. The major adverse events in the modified group were transient neurologic deficit and paraplegia in 1 each. Compared with the traditional group, the time of operation, CPB, cardiac arrest, circulatory arrest of the lower part, anterograde low flow cerebral perfusion, mechanical ventilation and ICU stay was shorter. The drainage of 48 hours after surgery was less also. The differences in new acute renal failure requiring CRRT and re-sternotomy for bleeding between groups were not statistical significance. Conclusion:The early results of MHCA(29℃) and bSACP applied in total arch replacement with stented elephant trunk implantation for acute TAAD were satisfactory. The time of mechanical ventilation and ICU stay was shorter in the modified group, and the drainage of 48 hours after surgery was less also.
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Objective@#To compare the clinical effects of ganciclovir combined with dexamethasone and ganciclovir alone in the treatment of acute idiopathic facial neuritis.@*Methods@#From March 2014 to March 2016, 80 patients with acute idiopathic facial neuritis admitted in the department of neurology of Luzhong Hospital were randomly divided into treatment group and control group according to the admission sequence, with 40 cases in each group.The two groups were given basic treatment (mecobalamine intramuscular injection + clonazepam and continuous application for 15d), and the treatment group was excluded from the corticosteroid application.On this basis, ganciclovir combined with dexamethasone was applied in the treatment group, and ganciclovir was applied in the control group.Both two groups had a course of 15 days.All the patients were graded by Portmann simple scale before treatment and at 7 days and 15 days after treatment, and statistical significance of SPSS13.0 software was adopted.@*Results@#Intra-group comparison: after treatment of 7d, the score of the treatment group was (10.11±3.62)points, which was significantly higher than (2.60±2.22)points before treatment(t=1.432, P<0.05). The score had no statistically significant difference between 7d after treatment[(10.11±3.62)points] and 15d after treatment[(11.82±3.02)points] in the treatment group (t=1.582, P>0.05). In the control group, the score had no statistically significant difference between 7d after treatment[(3.22±3.12)points] and before treatment[(2.70±2.30)points] (t=0.923, P>0.05). Comparison between the two groups: there was no statistically significant difference in pre-treatment score between the two groups (P>0.05). The score of the treatment group at 7d after treatment[(10.11±3.62)points] was significantly different from that of the control group[(3.22±3.12)points](t=1.633, P<0.05). There was no statistically significant difference in scores between the two groups at 15d after treatment (P>0.05).@*Conclusion@#Ganciclovir combined with dexamethasone and ganciclovir alone are effective in the treatment of acute idiopathic facial neuritis.Although the improvement effect of the combined treatment is earlier than that of single use, there is no significant difference in the total effective rate between the two treatments.
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Objective@#To find out what the exact impact of renal malperfusion on short- and long-term postoperative prognosis of ATAAD patietns.@*Methods@#218 patients with ATAAD undergoing surgical repair from June 2009 to May 2012 . Mean age was(47.8±10.7) years and 170 were male(78.0%). Based on computed tomographic angiography and laboratory test, 48 patients were diagnosed with preoperative renal malperfusion(22.0%). Clinical data were compared between two groups and risk factors for short- and long-term mortality identified using Cox regression.@*Results@#Patients with renal malperfusion showed significantly higher incidences of short-term mortality(22.9% vs 8.3%, P=0.023), long-term mortality(87.0% vs 72.9%, P=0.003) and postoperative acute kidney failure(20.8% vs 4.1%, P<0.001). Renal malperfusion was the risk factor for short-term mortality(OR 2.92, 95%CI 1.31-6.63, P=0.009) and long-term mortality(OR 2.56, 95%CI 1.32-4.94, P=0.005).@*Conclusion@#Renal malperfusion significantly increases the postoperative risk of short-term mortality, long-term mortality and incidence of postoperative acute renal failure in patients with ATAAD.
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Objective To find out what the exact impact of renal malperfusion on short- and long-term postoperative prognosis of ATAAD patietns. Methods 218 patients with ATAAD undergoing surgical repair from June 2009 to May 2012 . Mean age was(47.8 ±10.7) years and 170 were male(78.0％). Based on computed tomographic angiography and laboratory test, 48 patients were diagnosed with preoperative renal malperfusion(22. 0％). Clinical data were compared between two groups and risk factors for short-and long-term mortality identified using Cox regression. Results Patients with renal malperfu-sion showed significantly higher incidences of short-term mortality(22. 9％ vs 8. 3％, P =0. 023), long-term mortality (87. 0％ vs 72. 9％, P=0. 003) and postoperative acute kidney failure(20. 8％ vs 4. 1％, P<0. 001). Renal malperfusion wastheriskfactorforshort-termmortality(OR2.92,95％CI1.31-6.63,P=0.009) andlong-termmortality(OR2.56, 95％CI 1. 32-4. 94, P=0. 005). Conclusion Renal malperfusion significantly increases the postoperative risk of short-term mortality, long-term mortality and incidence of postoperative acute renal failure in patients with ATAAD.
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Objective To compare the clinical effects of ganciclovir combined with dexamethasone and ganciclovir alone in the treatment of acute idiopathic facial neuritis.Methods From March 2014 to March 2016,80 patients with acute idiopathic facial neuritis admitted in the department of neurology of Luzhong Hospital were randomly divided into treatment group and control group according to the admission sequence,with 40 cases in each group.The two groups were given basic treatment (mecobalamine intramuscular injection + clonazepam and continuous application for 15d),and the treatment group was excluded from the corticosteroid application.On this basis,ganciclovir combined with dexamethasone was applied in the treatment group,and ganciclovir was applied in the control group.Both two groups had a course of 15 days.All the patients were graded by Portmann simple scale before treatment and at 7 days and 15 days after treatment,and statistical significance of SPSS13.0 software was adopted.Results Intra-group comparison:after treatment of 7d,the score of the treatment group was (10.11 ± 3.62) points,which was significantly higher than (2.60 ± 2.22) points before treatment (t =1.432,P ＜ 0.05).The score had no statistically significant difference between 7d after treatment [(10.11 ± 3.62)points] and 15d after treatment [(11.82 ±3.02) points] in the treatment group (t =1.582,P ＞ 0.05).In the control group,the score had no statistically significant difference between 7 d after treatment [(3.22 ± 3.12) points] and before treatment [(2.70 ± 2.30) points](t =0.923,P ＞0.05).Comparison between the two groups:there was no statistically significant difference in pretreatment score between the two groups (P ＞ 0.05).The score of the treatment group at 7d after treatment [(10.11 ±3.62) points] was significantly different from that of the control group[(3.22 ± 3.12)points] (t =1.633,P ＜ 0.05).There was no statistically significant difference in scores between the two groups at 15d after treatment (P ＞ 0.05).Conclusion Ganciclovir combined with dexamethasone and ganciclovir alone are effective in the treatment of acute idiopathic facial neuritis.Although the improvement effect of the combined treatment is earlier than that of single use,there is no significant difference in the total effective rate between the two treatments.
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Objective To evaluate the safety and efficacy of botulinum toxin type A for injection in the treatment of post-stroke upper limb spasticity (dosage was 200 U,or 240 U if combined with thumb spasticity).Methods The study was a multi-center,stratified block randomized,double-blind,placebocontrolled trial.All the qualificd subjects were from 15 clinical centers from September 2014 to February 2016.They were randomized (2∶1) to injections of botulinum toxin type A made in China (200-240 U;n =118) or placebo (n =60) in pivotal phase after informed consent signed.The study was divided into two stages.The pivotal trial phase included a one-week screening,12-week double-blind treatment,followed by an expanded phase which included six-week open-label treatment.The tone of the wrist,finger,thumb flexors was assessed at baseline and at weeks 0,1,4,6,8,12,16 and 18 using Modified Ashworth Scale (MAS),disability in activities of daily living was rated using the Disability Assessment Scale and impaction on pain,muscle tone and deformity was assessed using the Global Assessment Scale.The primary endpoint was the score difference between botulinum toxin type A and placebo groups in the tone of the wrist flexor using MAS at six weeks compared to baseline.Results Muscle tone MAS score in the wrist flexor of botulinum toxin type A and placebo groups at six weeks changed-1.00 (-2.00,-1.00) and 0.00 (-0.50,0.00) respectively from baseline.Botulinum toxin type A was significantly superior to placebo for the primary endpoint (Z =6.618,P ＜ 0.01).The safety measurement showed 10 subjects who received botulinum toxin type A had 13 adverse reactions,with an incidence of 8.47％ (10/118),and three subjects who received placebo had three adverse reactions,with an incidence of 5.00％ (3/60) during the pivotal trial phase.All adverse reactions were mild to moderate,none serious.There was no significant difference in adverse reactions incidence between the botulinum toxin type A and the placebo groups.During the expanded phase three subjects had four adverse reactions and the incidence was 1.95％.All adverse reactions were mild,none serious.Conclusion Botulinum toxin type A was found to be safe and efficacious for the treatment of post-stroke upper limb spasticity.Clinical Trial Registration:China Drug Trials,CTR20131191
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Objective To confirm the impact of renal malperfusion on early and late outcomes of patients undergoing sur-gery for type A aortic dissection(TAAD). Methods From June 2011 to July 2012,a total of 165 TAAD patients undergoing surgery in hospital were enrolled and divided into 2 groups based on the results:research group(complicated with renal malper-fusion),control group(without renal malperfusion). A cohort follow-up project was conducted among these patients. The pri-mary outcome was all-cause death. Baseline and operative characteristics,early and late outcomes were analyzed to assess difference between 2 groups. Cumlative survival rates within 72 months among the 2 groups was described with Kaplan-Meier curves. Cox proportional hazards model was used to estimate the hazard ratios(HR)and 95％ confidence intervals(95％ CI)of late mortality among the 2 groups. Results Renal malperfusion was detected in 38(23. 0％)of 165 TAAD patients. 30-day mortality was 15. 8％ and 3. 9％ in patients with and without renal malperfusion(P < 0. 05),respectively. The mean follow-up period was(67 ± 3)months,late survival was 68. 4％ in patients with renal malperfusion and 88. 2％ in patients without(P <0. 05). By Cox proportional hazards model,after adjusting forage,sex,group(acute or chronic),presence of cardiac tampon-ade,brachiocephalic vessels involvement,coronary arteries involvement,root replacement,total arch replacement,concomitant coronary artery bypass grafting(CABG)and other organ-malperfusion,when compared to the control group,the HR(95％ CI) of late mortality was 5. 18( 1. 07 - 5. 18)in the research group. Besides renal malperfusion,concomitant coronary artery bypass grafting was presented as an independent risk factor of long-term survival(HR = 10. 08,95％ CI:2. 28 - 44. 62,P = 0. 002). Conclusion Coexistence of renal malperfusion is associated with a substantially increased risk of death in patients undergoing surgery for TAAD. A more exact stratification that weight every malperfusion-affected organ but not base on the number of malp-erfusion-affected organ simply may be more helpful to TAAD patients with malperfusion syndrome.
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Objective To identify the risk factors for acute kidney injury (AKI) in overweight patients who underwent surgery for the treatment of acute type A aortic dissection(TAAD).Methods A retrospective study including 108 consecutive overweight patients(body mass index(BMI) ≥24) between January 2010 and May 2013 in Beijing Anzhen Hospital was performed with Sun's procedure of total aortic arch replacement and frozen elephant trunk implantation.AKI was as defined according to Acute Kidney Injury Network (AKIN) criteria based on serum creatinine(sCr) or urine output.Results The mean age of the patients was(43.69 ± 9.66) years.During the postoperative period seventy-two patients(66.7％) developed AKI.The overall postoperative mortality rate was 7.4％,8.3％ in AKI group and 5.6％ in non-AKI group.There is no statistically significant difference between the two groups(P =0.32).A logistic regression analysis was performed to find out the independent risk factors for AKI:elevated preoperative sCr level and postoperative drainage volume.Renal replacement therapy(RRT) was performed in fifteen patients (13.9 ％).Conclusion A higher incidence of AKI (66.7 ％) in overweight patients following acute TAAD was identified.The logistic regression model found out elevated preoperative sCr level and 72 hour drainage volume as the two independent risk factors for AKI in overweight patients.More attention should be paid to prevent AKI in overweight patients following TAAD.
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ObjectiveTo investigate the effects of oxidized low density lipoprotein (oxLDL) on autophagy and its effect on Akt/mTOR/p70S6K signaling pathway in human umbilical vein endothelial cells (HUVECs).MethodsThe cultured HUVECs were divided into either an oxLDL or a control group, and treated with 100 μg/ml oxLDL and equal volume phosphate buffer solution respectively.The cells were collected after 6 h and 12 h.Transmission electron microscopy was used to observe the autophagosome.Real-time fluorescence quantitative polymerase chain reaction was used to detect expression levels of microtubule associated protein 1 light chain 3 (LC3) and p62 mRNA.Western blot was used to detect the expression levels of LC3, p62, P-Akt/Akt, P-mTOR/mTOR, and p-p70S6K/p70S6K.Results Compared with the control group, the number of intracellular autophagosome increased obviously (P<0.05), LC3 mRNA and protein expression levels increased significantly (all P<0.05), and p62 mRNA and protein expression levels decreased significantly (all P<0.05) in the oxLDL group.In addition, the phosphorylated protein expression levels of Akt, mTOR and p70S6K in the oxLDL group were significantly decreased than those in the control group (all P<0.01).However, total protein levels of Akt, mTOR, and p70S6K were not significantly different between the oxLDL group and the control group.Conclusion oxLDL may induce the autophagy of HUVECs via inhibiting the Akt/mTOR/p70S6K signaling pathway.
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Objective To identify the risk factors for postoperative spinal cord injury in Stanford type A aortic dissection patients.Methods 210 Stanford type A aortic dissection(TAAD) patients underwent Sun's procedure in Beijing Aortic Disease Center during July 2014 to March 2015.14 patients had spinal cord injury after surgery.Clinical data and computed tomography angiography(CTA) imaging of aorta were retrospectively analyzed and multi-logistic regression analysis was performed to identify risk factors for spinal cord injury post operation.Results 14 out of 210(6.7％) patients had transient or permanent spinal cord injury after surgery.Univariate analysis showed only false lumen derived intercostal arteries at eighth thoracic vertebral level (T8) to first lumbar vertebral level (L1) was significantly associated with post-surgery spinal cord injury (P =0.000).Multi-logistic regression analysis showed that false lumen derived intercostal arteries (P =0.000) and age (P =0.016) were significantly associated with postoperative spinal cord injury.Conclusion Major intercostal arteries derived from false lumen and rapid thrombogenesis in false lumen are the major risk factors for postoperative spinal cord injury in Stanford type A aortic dissection patients.
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Objective Continued debates exist regarding optimal surgical approach to acute type A aortic dissection (ATAAD).This study aims to report the early and mid-to long-term outcomes of frozen elephant trunk and total arch replacement (FET + TAR) technique in patients with ATAAD involving the arch and descending aorta.Methods Between April 2003 and September 2012,we performed FET + TAR (the Sun procedure) for 456 patients with ATAAD (376 males,82.5％) at mean (5.0±3.8) days from symptom onset (median 4 days,range 4 hours to 14 days).Mean age was (46 ± 10) years.Concomitant root or valve provcedures were performed in 221 patients (48.5 ％).The outcomes were compared between patients with and without root procedures and risk factors for adverse events identified using multivariate analysis.Results Operative mortality was 8.1％ (37/456).Stroke occurred in 13 eases (2.8％),spinal cord injury in 11 (2.4％),acute renal failure in 18 (3.0％) and reexploration for bleeding in 10 (2.2％).Risk factors for operative mortality were preoperative malperfusion of the brain (odds ratio,OR 7.463,P =0.002) and spinal cord (OR 45.325,P =0.003) and time (min) of cardiopulmonary bypass (OR 1.014,P ＜0.001).Follow-up was complete in 97.6％ (409/419) averaging (5.7 ±2.4) years (range 0.2-12.0).Late death occurred in 32 patients and reoperation in 23.At 5,8 and 10 years,survival 87.7％,83.1％ and 70.5％,and freedom from reoperation was 94.8％,89.3％ and 84.3％,respectively,which did not differ with root procedure and acuity.Postoperative stroke was risk factor for late death (OR 14.452,P =0.014).The time from diagnosis to surgery (days) was risk factor for reoperation (OR 1.188,P =0.024).Patients with concomitant root procedure showed a significant trend towards lower late mortality (OR 0.377,P =0.021) and increased reoperation risk (OR 2.663,P =0.037).Competing risks analysis showed that at 3,5,8 and 10 years,mortality was 2％,5％,10％ and 23％,reoperation was 3％,5％,8％ and 10％,and reoperation-free survival was 95％,90％,82％ and 67％,respectively.Conclusion In this large series of patients with ATAAD,FET + TAR has achieved lower early mortality and morbidity and favorable late survival and freedom from reoperation.A concomitant root procedure could significantly reduce long-term survival without increasing risk for operative mortality.
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Objective Continued debates exist regarding optimal surgical approach to acute type A aortic dissection (ATAAD).This study aims to report the early and mid-to long-term outcomes of frozen elephant trunk and total arch replacement (FET + TAR) technique in patients with ATAAD involving the arch and descending aorta.Methods Between April 2003 and September 2012,we performed FET + TAR (the Sun procedure) for 456 patients with ATAAD (376 males,82.5％) at mean (5.0±3.8) days from symptom onset (median 4 days,range 4 hours to 14 days).Mean age was (46 ± 10) years.Concomitant root or valve provcedures were performed in 221 patients (48.5 ％).The outcomes were compared between patients with and without root procedures and risk factors for adverse events identified using multivariate analysis.Results Operative mortality was 8.1％ (37/456).Stroke occurred in 13 eases (2.8％),spinal cord injury in 11 (2.4％),acute renal failure in 18 (3.0％) and reexploration for bleeding in 10 (2.2％).Risk factors for operative mortality were preoperative malperfusion of the brain (odds ratio,OR 7.463,P =0.002) and spinal cord (OR 45.325,P =0.003) and time (min) of cardiopulmonary bypass (OR 1.014,P ＜0.001).Follow-up was complete in 97.6％ (409/419) averaging (5.7 ±2.4) years (range 0.2-12.0).Late death occurred in 32 patients and reoperation in 23.At 5,8 and 10 years,survival 87.7％,83.1％ and 70.5％,and freedom from reoperation was 94.8％,89.3％ and 84.3％,respectively,which did not differ with root procedure and acuity.Postoperative stroke was risk factor for late death (OR 14.452,P =0.014).The time from diagnosis to surgery (days) was risk factor for reoperation (OR 1.188,P =0.024).Patients with concomitant root procedure showed a significant trend towards lower late mortality (OR 0.377,P =0.021) and increased reoperation risk (OR 2.663,P =0.037).Competing risks analysis showed that at 3,5,8 and 10 years,mortality was 2％,5％,10％ and 23％,reoperation was 3％,5％,8％ and 10％,and reoperation-free survival was 95％,90％,82％ and 67％,respectively.Conclusion In this large series of patients with ATAAD,FET + TAR has achieved lower early mortality and morbidity and favorable late survival and freedom from reoperation.A concomitant root procedure could significantly reduce long-term survival without increasing risk for operative mortality.
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Objective To establish a Chinese expert consensus of the surgical management for type A aortic dissection (TAAD) by using the Delphi method.Methods A systematic review of the previously published literature related to management of TAAD at home and abroad was conducted to formulate a questionnaire of clinical consensus of the surgical treatment for TAAD.This questionnaire including seven aspects of surgical management for TAAD,namely contraindications to operative management,cannulation site,target temperature during circulation arrest,cerebral perfusion strategy,surgical procedure,distal anastomotic technique and surgical management for patients with connective tissue disease such as Marfan syndrome.From October 2015 to April 2016,we performed two rounds Delphi survey in which the current professional opinions from 55 experienced and representative cardiovascular surgeons in China,were gathered and analysed.Results The responses rates of two rounds were 80.0％ (44/55) and 77.27％ (34/44).The scores of authoritative coefficient was 0.87 and 0.83.The coefficient of concordance were 0.31 (P ＜ 0.05) and 0.32 (P ＜ 0.05).After two rounds of consultation,consensus of the surgical management for TAAD was reached on 16 items of seven aspects.Conclusion This Delphi study established an initial Chinese expert consensus concerning the surgical management for TAAD,which drew credible results and reliable conclusions.This study will helo to standardize the surgical management of TAAD in China.
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Objective To investigate the status of medication adherence of secondary prevention after acute ischemic stroke and influence on prognosis in Qingdao area , including antithrombotic drugs , lipid-lowering drugs , antihypertensive drugs and glucose-lowering drugs , to provide the basis for making medical policy.Methods We examined patients with acute cerebral infarction and transient ischemic attack in the Department of Neurology of Affiliated Hospital of Qingdao University from December 2014 to January 2016.Patients′medication status and recurrence of stroke events were registered by using telephone and clinic follow-up within six months after the patients discharged from hospital .The standard of good and bad drug adherence was as follows:good adherence was defined as proportion of days covered ( PDC) ≥80%, bad adherence was defined as PDC <80%.SPSS 19.0 statistical software was used to analyze the influence factors of medication adherence and the influence of medication adherence on prognosis .Results Finally, 444 cases (88.62%) were analyzed.A total of 352 cases (79.28%) had high medication adherence at six months after discharging from hospital .The following factors can improve the adherence of drug treatment:history of diabetes (108 cases (30.68%) in good medication adherence group , 16 cases (17.39%) in poor medication adherence group,χ2 =6.401, P=0.011), having employee health insurance (186 cases (52.84%) in good medication adherence group , 33 cases (35.87%) in poor medication adherence group ,χ2 =8.405, P=0.004), endovascular stent implantation (29 cases(8.24%) in good medication adherence group, 0 case in poor medication adherence group ,χ2 =8.109, P=0.004), staying in hospital more than 10 days ( 230 cases ( 65.34%) in good medication adherence group , 49 cases ( 53.26%) in poor medication adherence group ,χ2 =4.558, P=0.033).Six months later , the modified Rankin Scale ( mRS) score of poor medication adherence group was significantly higher than that in good adherence group ( mRS score≥3,50 cases (14.20%) in good medication adherence group , 22 cases (23.91%) in poor medication adherence group,χ2 =5.060, P=0.024) .After six months, a total of 13 cases had recurrent cerebral infarction, with two cases ( 0.57%) in good adherence group , 11 cases ( 11.96%) in poor adherence group.High medication adherence was an independent protective factor of recurrent stroke ( OR=0.042, 95%CI 0.008 -0.210, P<0.01 ) .At one, three, six months after discharging from hospital , the medication adherence of antihypertensive and glucose-lowering drugs was better than that of antiplatelet agents and lipid-lowering drugs (all P<0.05).Conclusions The persistence and adherence to secondary preventive medication in ischemic stroke patients was generally well at 6th month after discharging from hospital.History of diabetes , having employee health insurance , stent implantation and longer hospital stay are the influencing factors to high medication adherence .High medication adherence is an independent protective factor for ischemic stroke recurrence .The medication adherence of antihypertensive and glucose-lowering drugs is better than that of antithrombotic drugs and lipid-lowering drugs.
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Objective To investigate the relationship between osteoprotegerin ( OPG ) gene polymorphisms and ischemic stroke etiological subtypes, as well as the extent and distribution of cerebral atherosclerosis ( AS) lesions.Methods Patients with ischemic stroke included 285 cases of large-artery atherosclerosis (LAA), 91 cases of small-artery occlusion (SAO) and 42 cases of purely AS, and 165 healthy controls were enrolled in this study.The LAA group was respectively divided into 3 subgroups according to the number and the distribution of stenostic vessels.Genotyping of three single nucleotide polymorphisms (SNPs;rs2073617, rs3134069, and rs3102735) in the promoter region of the OPG gene was performed by polymerase chain reaction-restriction fragment length polymorphism.Results Regarding the three SNPs of OPG gene, the frequence of genotype CC/CT and the prevalence of allele C of rs3102735 were higher in the LAA group contrasting with the control group ( 24.04% vs 14.85%, 44.21% vs 27.88%,χ2 =10.758, 11.804, P =0.001,0.024).However, comparisons of other frequences of genotypes or alleles did not reveal any significant differences among the LAA group, the SAO group, the AS group and the control group, as well as among different subgroups of LAA group.Haplotype analysis revealed that the frequencies of haplotype C-C-T in LAA group and SAO group were significantly lower ( 0.023, 0.017 vs 0.068,χ2 =10.399, 5.841,P=0.001, 0.016), while that of haplotype T-A-C was significantly higher in SAO group(0.043 vs 0.016,χ2 =4.708, P=0.030) compared with controls.Conclusions Our findings indicate that OPG gene polymorphisms might be associated with increased susceptibility to LAA ischemic stroke.But we fail to show association of OPG gene with the extent and distribution of AS.