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Objectives To analyze the risk factors and their predictive value for postoperative hypoxemia in Type-A aortic dissection(TAAD).Methods A single-center retrospective study was conducted among 146 consecutive patients diagnosed as TAAD and undergone aortic arch surgery from January 2018 to June 2021 in Nanfang Hospital of Southern Medical University.According to the lowest postoperative PaO2/FiO2 ratio within 24 hours,the patients were classified into two groups:hypoxemia group(PaO2/FiO2≤200 mmHg)and non-hypoxemia group(PaO2/FiO2>200 mmHg).The difference of preoperative oxygen index,duration of mechanical ventilation and mortality in hospital were analyzed between the two groups.The independent risk factors for postoperative hypoxemia were evaluated by multivariate logistic regression and the predictive value was analyzed by receiver operator character(ROC)curves.Results For TAAD patients,the incidence of postoperative hypoxemia was 45.9%.Compared to non-hypoxemia group,hypoxemia group exhibited longer duration of mechanical ventilation(P<0.001)and longer intensive care unit(ICU)length of stay(P<0.05).Moreover,patients with hypoxemia presented higher mortality during hospital(P=0.011).Multivariate regression analysis identified BMI as independent risk factor(OR=1.701,P<0.001)and preoperation PaO2/FiO2 ratio as protective factors for postoperative hypoxemia in patients with TAAD(OR=0.987,P=0.004).Area under the ROC curve of BMI was 0.848,the optimal cut-off point of BMI was 25.8 kg/m2.Area under the ROC curve of pre-operation PaO2/FiO2 ratio was 0.808,the optimal cut-off point of preoperation PaO2/FiO2 ratio was 265 mmHg.Conclusions BMI higher than 25.8 kg/m2 is an independent risk factor and preoperation PaO2/FiO2 ratio higher than 265 mmHg is a protective factor for postoperative hypoxemia in patients with TAAD.Subjects with hypoxemia had longer duration of mechanical ventilation,ICU stay and higher mortality.
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<p><b>OBJECTIVE</b>To compare the value of apolipoprotein B (apoB) and low-density lipoprotein cholesterol (LDL-C) in assessing the risk of coronary heart disease in patients with inconsistent apoB and LDL-C levels.</p><p><b>METHODS</b>In a total of 603 patients undergoing coronary angiography, apoB and LDL-C levels were categorized into high and low levels relative to the median levels of apoB and LDL-C, based on which the patients were divided into 4 groups with low apoB/low LDL-C, low apoB/high LDL-C, high apoB/low LDL-C, or high apoB/high LDL-C. According to the results of coronary angiography, we evaluated the number of coronary artery branches with lesions and the severity of coronary artery stenosis in the 4 groups to assess the correlation of apoB and LDL-C with cardiovascular risks.</p><p><b>RESULTS</b>We found significant differences in the number of coronary artery branches with lesions and the severity of coronary artery stenosis among the 4 groups (P<0.05). The number of coronary artery branches involved and the severity of stenosis differed significantly between patients with consistently high and low apoB/LDL-C levels (P<0.005). Compared with those with low apoB/low LDL-C levels, the patients with high apoB/low LDL-C levels showed a significantly greater number of coronary artery branches with lesions (P=0.017) and more severe stenosis (P=0.034), but such differences were not found in patients with low apoB/high LDL-C levels. Pearson correlation analysis identified LDL-C and apoB as the risk factors for cardiovascular disease with areas under the ROC curve of 0.579 (P=0.014) and 0.589 (P=0.006), respectively.</p><p><b>CONCLUSIONS</b>In patients with inconsistent levels of apoB and LDL-C, apoB and LDL-C levels are both risk factors of coronary heart disease in close relation with the disease severity. LDL-C and apoB are comparable for their important values in predicting the risk of coronary heart disease.</p>
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Objective To investigate the effect of serous amyloid P (SAP) component on serum paraoxonase 1 (PON1) activity, serum monocyte chemotactic protein 1 (MCP-1) expression and atherosclerosis progression in ApoE-/- mice, and explore the possible mechanisms thereof. Methods Six male C57/BL6 mice were fed with chow diet as normal control group. Twelve male ApoE-/- mice fed with western diet for 12 weeks were used to establish animal models of atherosclerosis, and then randomly divided into two groups (6 each): SAP and PBS group. Mice in SAP group were treated (i.p.) with SAP (6mg/g) every other day from day 0 to day 14. Mice in normal and PBS group were treated (i.p.) with PBS (same volume as SAP group) every other day from day 0 to day 14. The blood specimen and aorta vascular tissues were collected at the 16th week after the first immunization. Serum lipids and PON1 activity were assessed. Enzyme-linked immunosorbent assay (ELISA) was used to detect the expression of serum SAP and MCP-1. Hematoxylin-eosin (HE) staining was used to observe the formation of atherosclerotic plaque. Oil red O staining was performed to observe the lipid accumulation, and immunohistochemical staining was performed to detect the SAP expression in the atherosclerotic plaque. Results Compared with the normal group, the serum PON1 activity reduced significantly while MCP-1 expression increased (P<0.01), and a large number of plaques formed in the blood vessels of mice in SAP and PBS group. Compered with PBS group, SAP treatment markedly improved the PON1 activity (P=0.046) and down-regulated MCP-1 expression (P=0.032). Furthermore, SAP treatment significantly reduced atherosclerotic plaque area (P=0.001) and oil red O positive area (P=0.03). Conclusion SAP could mitigate atherosclerotic lesion through improving the property of PON1 and down-regulating the level of MCP-1.