Influential factors and interventions of aortic remodeling in residual aortic dissection after surgical repairs / 中华胸心血管外科杂志

The aortic dissection is a critical emergency in cardiovascular surgery and can be classified as Stanford type A and type B aortic dissection depending on whether the ascending aorta is involved. Currently, the mainstream treatment option for type A aortic dissection is open surgery, while type B dissection can be treated by interventional therapy, open surgery, or optimal medical therapy depending on the situation. However, regardless of the treatment option, it is difficult to resolve all the problems at once. As a result, residual aortic dissection is commonly found in patients with aortic dissection. This article will review the hot issues of aortic remodeling in terms of the definition, prognosis, and risk factors.

Gender-related differences of clinical features and perioperative treatment outcomes in patients with type A aortic dissection / 中华胸心血管外科杂志

Objective:To retrospectively analyze the gender differences in the clinical characteristics and perioperative outcomes of patients with type A aortic dissection in our institution.Methods:From January 2019 to January 2020, total 405 patients underwent surgical treatment for type A aortic dissection at Beijing Anzhen Hospital, including extensive aortic repair (total aortic arch replacement combined with stenting elephant trunk implantation) and limited aortic repair. In the entire cohort, male 295 cases, female 110 cases. All measures in this study were expressed as ± s or median(quartiles) and analyzed by Student t test for variables or non- parametric tests; count data were expressed as frequencies and percentages and analyzed by χ2 test and Fisher exact probability test. Independent risk factors were analyzed by logistic multivariate regression. Results:Females were older than males[(53.3 ± 12.4)years old vs. (47.1 ± 11.0)years old, P<0.001] and had significantly higher proportion of diabetes(9.1% vs. 4.1%, P=0.047) and previous cerebrovascular disease (11.8% vs. 5.8%, P=0.038). Females had a lower proportion of total aortic arch replacement combined with elephant trunk implantation (64.5% vs. 82.7%, P<0.001), while aortic cross-clamp time[168.0(144.8, 201.5) minutes vs. 190.0 (163.0, 217.0) minutes, P<0.001] and CPB time[99.0 (79.8, 118.0) min vs. 107.0 (91.0, 126.0) min, P=0.006] were significantly shorter than males. Females had significantly higher rates of pulmonary infection (14.5% vs. 5.8%, P=0.004) and stroke than males (15.5% vs. 8.1%, P=0.030). The difference in the proportion of postoperative deaths between female and male TAAD patients was not statistically significant (3.6% vs. 7.8%). Logistics multivariable regression analysis found that female was an independent risk factor for postoperative stroke ( OR=2.574, 95% CI: 1.198-5.531, P=0.015) and pulmonary infection ( OR=2.610, 95% CI: 1.180-5.772, P=0.018). Conclusion:Gender did not affect mortality after TAAD repair significantly, but females increased the risk of stroke and pulmonary infection after TAAD surgery.

The influence of COVID-19 infection on treatments of patients with acute type A aortic dissection / 中华胸心血管外科杂志

Objective:To investigate the differences in outcomes of surgical strategies and prognosis of patients with acute type A aortic dissection(ATAAD) during the period of COVID-19 Omicron variant epidemic compared with the non-epidemic period.Methods:Clinical data were retrospectively collected from ATAAD patients during the COVID-19 Omicron variant epidemic(December 7, 2022 to January 10, 2023) and during the non-epidemic period(December 7, 2019 to January 10, 2020) to compare the differences in surgical strategies, perioperative mortality, and perioperative complication rates in ATAAD patients during the two different periods.Results:There were 14 patients in the COVID-19 infected group and 43 patients in the control group. Patients in the infected group had a shorter mean aortic clamp time[(89.71±16.27)min vs.(110.09±28.99)min, P<0.01], a significantly higher postoperative mortality rate relative to the control group(21.43% vs. 2.33%, P=0.02), a significantly longer length of stay in the ICU(3 days vs. 2 days, P=0.04) and the duration of intubation time(34 h vs. 14 h, P<0.01), and the incidence of adverse events, mainly cerebral infarction, was higher in infected group(28.57% vs. 6.98%, P=0.03). Conclusion:During the COVID-19 Omicron variant strain epidemic, our center preferred a more conservative surgical strategy in COVID-19 infected patients. Although the COVID-19 infection increased the postoperative mortality and complication rate of ATAAD, patients still achieve a more satisfactory outcome. Therefore, surgical treatment should be timely performed for ATAAD patients.

Research on the signal pathway of hydrogen sulfide regulating autophagy to protect intestinal injury in sepsis / 中华危重病急救医学

Sepsis is one of the main causes of death in critically ill patients. The intestinal tract is not only the organ easily involved in sepsis, but also the initial organ in the progression of sepsis, so the improvement of intestinal barrier function is the key of the treatment of sepsis. In recent years, it has been found that autophagy is involved in the pathological process of sepsis, maintaining mitochondrial function by clearing damaged organelles, inhibiting inflammation, oxidative stress and apoptosis, regulating immunity, maintaining intestinal homeostasis, and improving the condition and prognosis of sepsis. It is an effective target for the treatment of sepsis. As a new type of medical gas signal molecule, hydrogen sulfide (H 2S) can regulate autophagy by regulating multiple signal pathways, which has become a new target in the treatment of sepsis. This article reviews the signal pathway regulation mechanism of H 2S regulating autophagy in septic intestinal dysfunction.

Research progress of melatonin and pancreatic diseases / 中国临床药理学与治疗学

Melatonin is an indoleamine secreted by the pineal gland and plays a key role in a variety of physiological activities, including the regulation of circadian rhythm, immune response, oxidative process and apoptosis. In recent years, the anti-tumor properties of melatonin have attracted more and more attention. A large number of studies have found that melatonin plays a protective role in the early process of acute pancreatitis and can inhibit the production of pancreatic adenocarcinoma cells through apoptosis; moreover, it can regulate the synthesis and secretion of pancreatic endocrine hormones through autophagy and affect the development of pancreatic endocrine tumors. Therefore, melatonin may affect the development of pancreatic disease, but the mechanism of its action on pancreatic diseases has not been fully understood. This paper reviews the research progress of melatonin and pancreatic diseases in recent years, analyzes the role of melatonin in pancreatic diseases and the therapeutic effect of melatonin combined with chemotherapy drugs on pancreatic cancer.