The Association Between Ascending Aortic and Left Ventricular Dimensions in Patients After Aortic Valve Replacement

ABSTRACT Introduction: Aortic valve replacement (AVR) is often recommended for patients with severe aortic stenosis or chronic aortic regurgitation. These conditions result in remodeling of the left ventricle, including increased interstitial fibrosis that may persist even after AVR. These structural changes impact left ventricular (LV) mechanics, causing compromised LV diameter to occur earlier than reduced LV ejection fraction (LVEF). The aim of this study was to examine the effect of left ventricular end-diastolic diameter (LVEDD) and its role in aortic expansion one year after AVR. Methods: Sixty-three patients who underwent AVR were evaluated. All patients underwent standard transthoracic echocardiography, which included measurements of the ascending aorta, aortic root, LVEF, and LVEDD before the surgery and one year postoperatively. Correlations between these variables were calculated. Results: All patients underwent AVR with either a mechanical or biological prosthetic aortic valve. Following AVR, there was a significant decrease in the dimensions of the ascending aorta and aortic root (both P=0.001). However, no significant changes were observed in LVEDD and LVEF. Correlations were found between the preoperative ascending aortic size and the preoperative and one-year postoperative LVEDD (r=0.419, P=0.001 and r=0.320, P=0.314, respectively). Additionally, there was a correlation between the postoperative ascending aortic size and the preoperative and one-year postoperative LVEDD (r=0.320, P=0.003 and r=0.136, P=0.335, respectively). Conclusion: The study findings demonstrate a significant correlation between the size of the aortic root and ascending aorta, before and after AVR. Additionally, a notable correlation was observed between postoperative LVEDD and the size of the aortic root.

Doble revisión de colon derecho vs revisión simple durante lacolonoscopia para la detección de pólipos y adenomas de colon: revisión sistemática de la literatura

El tamizaje por colonoscopia es un método efectivo para prevenir cáncer de colon a traves de la detección de pólipos sobre los cuales se desarrolla en un mayor porcentaje el cáncer de colon; sin embargo la detección de estas lesiones varía en los diferentes segmentos del colon y de ellos en colon derecho su tasa detección suele ser menor. Objetivo: El objetivo de este estudio es evaluar si la doble revisión endoscópica de colon derecho durante la colonoscopia es un mecanismo para mejorar su rendimiento en cuanto a la tasa de detección de pólipos (TDP) y la tasa de detección de adenomas (TDA). Materiales y métodos: Revisión sistemática y metaanálisis de la literatura de estudios clínicos aleatorizados que realizaron una doble revisión del colon derecho por colonoscopia comparado con una revisión simple para mejorar la detección de pólipos y adenomas. El protocolo de esta revisión se publicó en PROSPERO bajo el código CRD42022356509. Resultados: Se incluyeron 5 estudios que incluyeron 2729 participantes. Se informó la detección de pólipos en 585/1197 pacientes (48,87%) después de la segunda revisión, en comparación con 537/1206 (44,52%) de los pacientes que recibieron una única examinación (p < 0,05), para un RR combinado de 1,09 (IC 95%: 0,97-1,23) (I2 fue de 44%). Se informó la detección de adenomas en 830/1513 pacientes (54,75%) después de la segunda revisión, en comparación con 779/1509 (51,62%) de los pacientes que recibieron una única examinación (p < 0,05), para un RR combinado de 1,06 (IC 95%: 1,00-1,13) (I2 fue de 0%). Conclusión: La segunda examinación del colon derecho por colonoscopia puede tener una modesta mejoría en la detección de pólipos y adenomas.

Colonoscopy screening is an effective method to prevent colon cancer through the detection of polyps on which colon cancer develops in a higher percentage; however, the detection of these lesions varies in the different segments of the colon and the detection rate of them in the right colon is usually lower. Objective: The objective of this study is to evaluate whether double endoscopic revision of the right colon during colonoscopy is a mechanism to improve its performance in terms of polyp detection rate (TDP) and adenoma detection rate (ADR). Materials and methods: Systematic review and meta-analysis of the literature including randomized clinical trials that evaluated repeat right-sight examination by colonoscopy compared to standard view to improve detection of polyps and adenomas. The protocol for this decision was published in PROSPERO under the code CRD42022356509. Results: Five studies involving 2729 participants were included. Polyp detection was reported in 585/1197 patients (48.87%) after the second review, compared with 537/1206 (44.52%) of patients who received a single examination (p< 0.05), for a combined RR of 1.09 (95% CI: 0.97-1.23) (I2 was 44%). Detection of adenomas was reported in 830/1513 patients (54.75%) after the second review, compared with 779/1509 (51.62%) of patients who received a single examination (p < 0.05), for a combined RR of 1.06 (95% CI: 1.00-1.13) (I2 was 0%). Conclusion: Second examination of the right colon by colonoscopy may have a modest improvement in the detection of polyps and adenomas.

Urinary tract infection with renal abscess

Renal abscess is very rare among intra-abdominal abscesses in children. Ascending infection is the most common cause in children compared to hematogenous spread in adults and Escherichia coli is the main pathogen. Persisting high-grade fever is an alarming sign to intervene and has to be taken care of. Here, we are presenting the case of a 3-year-old boy with Klebsiella urinary tract infection and E. coli renal abscess of 4 cm size. Contrast-enhanced computed tomography abdomen helped in early intervention and management. The child responded very well to parenteral antibiotics and ultrasound-guided percutaneous aspiration.

A Rare Catastrophe: Three Cases of Aortic Root Dehiscence after Surgery

Abstract Ascending aortic pathologies may be life-threatening. Postoperative aortic root dehiscence is a very rare but extremely dangerous complication with a high mortality rate, and redo surgery is mandatory due to high risk of spontaneous rupture. We present three cases that had undergone Bentall procedure and had postoperative aortic root dehiscence. One of the patients presented with hemiplegia caused by septic embolus while the others had mild symptoms. Dr. Yakut's modified Bentall procedure, the flanged technique, was performed for each patient in redo surgery. Two patients were successfully discharged from the hospital, but one died due to intracranial hemorrhage and multiple organ failure.

Early efficacy of water sac blocking versus Heartstring for proximal anastomosis during off-pump coronary artery bypass grafting / 中华胸心血管外科杂志

Objective:To compare the early effect of water sac blocking and Heartstring for proximal anastomosis of the calcific ascending aorta.Methods:The data of 400 consecutive patients undergoing elective off-pump coronary artery bypass grafting(OPCABG) in Beijing Anzhen Hospital from January 2022 to June 2022 were retrospectively analyzed. 46 patients with calcific ascending aorta including 40 males and 6 females, with the age ranged from 53 to 73 years and an average of(65.2±5.1) years, who were revealed by preoperative chest CT scan and intraoperative palpation. According to the method of proximal anastomosis, the patients were divided into 2 groups: water sac blocking group(n=19) and Heartstring group(n=27). The effect of preventing postoperative stroke was compared by counting the incidence of postoperative stroke. The efficacy of the 2 methods was compared by detecting the flow and pulsatility fraction of the saphenous vein trunk during surgery, observing the dynamic changes of the electrocardiogram and cTnI level within 48h after the surgery, and reviewing the coronary CTA 3 months after discharge.Results:There was no perioperative death, and all the patients were discharged 4-13 days postoperatively. No adverse events such as stroke and malignant ventricular arrhythmia occurred during perioperative period. 1 patient in each group developed low cardiac output syndrome postoperatively, and both improved after IABP placement. 1 patient in Heartstring group developed acute inferior myocardial infarction, which was improved after IABP placement. Coronary CTA 3 months after operation showed that there was no proximal anastomotic stenosis in both groups.Conclusion:There is no significant difference between the 2 proximal anastomosis methods in preventing stroke after OPCABG in patients with ascending aortic calcification. Compared with Heartstring, water sac blocking does not increase the risk of proximal anastomotic stenosis. In addition, water sac blocking does not require expensive consumables, which is especially suitable for patients with limited funds and can be generalized.

Reduction ascending aortoplasty in adult patients undergoing aortic valve replacement: Aorta diameter change, mid- and long-term clinical results / 中国胸心血管外科临床杂志

@#Objective    To assess mid- and long-term outcomes and share our clinical method of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR). Methods    We retrospectively analyzed clinical data of 41 adult patients with aortic valve disease and ascending aortic dilatation before and after operation of RAA+AVR in Fuwai Hospital from January 2010 to July 2017. There were 28 male and 13 female patients aged 28-76 (53.34±12.06) years. Twenty-three patients received AVR+RAA using the sandwich technique (a sandwich technique group), while other 18 patients received AVR+ascending aorta wrap (a wrapping technique group). Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results    There was no perioperative death. The mean preoperative AAD in the sandwich technique group and the wrapping technique group (47.04±3.44 mm vs. 46.67±2.83 mm, P=0.709) was not statistically different. The mean postoperative AAD (35.87±3.81 mm vs. 35.50±5.67 mm, P=0.804), and the mean AAD at the end of follow-up (41.26±6.54 mm vs. 38.28±4.79 mm, P=0.113) were also not statistically different between the two groups. There were statistical differences in AAD before, after operation and at follow-up in each group. All 41 patients were followed up for 23-108 (57.07±28.60) months, with a median follow-up of 51.00 months. Compared with that before discharge, the AAD growth rate at the last follow-up was –1.50-6.78 mm/year, with a median growth rate of 0.70 mm/year, and only 3 patients had an annual growth rate of above 3 mm/year. Conclusion    Mid- and long-term outcomes of RAA in adult patients undergoing AVR with both methods are satisfying and encouraging.

Successful Use of a Stent-Graft for Treating a Pseudoaneurysm Located at the Anastomosis of the Ascending Aorta and the Great Saphenous Vein / 日本心臓血管外科学会雑誌

Takayasu Arteritis causes annuloaortic ectasia and coronary ostial stenosis, which may necessitate open heart surgery. However, pseudoaneurysms are sometimes observed postoperatively, making subsequent treatment difficult. We report thoracic endovascular aortic repair of a pseudoaneurysm of the ascending aorta with an anastomosis of the great saphenous vein in a 61-year-old female with a history of multiple open-heart procedures. Thirty years earlier, she underwent aortic valve replacement and coronary artery bypass surgery for aortic regurgitation, and right coronary ostial stenosis. Eleven years after surgery, an ascending aortic aneurysm was found and Bentall's surgery was performed. Multiple open thoracotomies were subsequently performed. Postoperatively, a pseudoaneurysm was found at the anastomosis between the ascending aorta and the great saphenous vein. The patient was transferred to the emergency room owing to hemoptysis and was diagnosed with a ruptured pseudoaneurysm at the anastomosis of the ascending aorta and the great saphenous vein. By inserting a stent graft into the ascending aorta, we avoided further complications and her prognosis was good. She was discharged on postoperative day 18 and did not experience any end leak for a year. Thoracic endovascular aortic repair in the ascending aorta is a minimally invasive procedure that may be useful for high-risk patients.

In Situ Replacement for a Mycotic Aneurysm on the Porcelain Aorta Using the Superficial Femoral Artery as a Vascular Graft / 日本心臓血管外科学会雑誌

Infected thoracic aortic aneurysms are rare. Standard treatment methods have not yet been established for medical treatment, timing of surgery, or surgical techniques. In this study, we report a case in which an ascending aortic reconstruction using an autologous superficial femoral artery was successfully performed for an infected pseudoaneurysm of the thoracic aorta without the use of artificial materials. The patient was a 78-year-old man with bacteremia caused by Staphylococcus aureus and an infected pseudoaneurysm of the thoracic aorta. The patient underwent replacement of the ascending aorta and coronary artery bypass grafting. The patient was discharged from the hospital with no recurrence of infection and no abnormality of the reconstructed aorta.

Surgical Management of Aortic Stenosis and Regurgitation and Ascending Aortic Aneurysm in a Patient with Thalassemia / 日本心臓血管外科学会雑誌

Thalassemia is an inherited hemoglobin disorder characterized by hemolytic anemia. Reportedly, cardiopulmonary bypass (CPB) causes hemolysis; therefore, extreme caution is warranted during CPB. However, few studies have reported open heart surgery in patients with thalassemia. We report successful surgery for aortic stenosis and regurgitation (ASR) and an ascending aortic aneurysm (AsAA) in a patient with thalassemia. A 69-year-old woman was referred to our hospital for surgical management of ASR and AsAA. Comprehensive evaluation of microcytic anemia led to diagnosis of beta-thalassemia minor. We performed aortic valve and ascending aorta replacement; we used a biologic valve and performed open distal anastomosis under hypothermic circulatory arrest (25°) combined with retrograde cerebral perfusion. Non-pulsatile flow circulation was maintained using a centrifugal pump during CPB. The suction and ventilatory pressures were decreased, and we performed dilutional ultrafiltration. A spare artificial lung was connected to the CPB to avoid complications in the event of artificial lung blockage. We did not observe any hemolysis-induced adverse event during the clinical course, and the patient was discharged 20 days postoperatively. Careful preoperative evaluation is essential to confirm thalassemia before cardiovascular surgery to establish an optimal surgical strategy and avoid the risk of CPB-induced hemolysis in patients with the hematological disorder.

Discussion on the Four-Season Pathogenesis and Treatment of Insomnia Based on the “Circular Movement of Yang Qi Ascending and Descending” / 中医杂志

In the perspective of the theory of “circular movement of yang qi ascending and descending”， the author explores the four-season pathogenesis and treatment of insomnia based on the seasonal changes of the body's yin-yang balance. It is believed that the core pathogenesis of insomnia lies in the spleen and stomach deficiency and the internal buildup of dampness. The four-season pathogenesis of insomnia focuses can be categorized into four aspects： abnormal ascending of yang qi in the spring， leading to the liver fire inflammation or the liver qi stagnation； Predominance of yang qi in the upper side of the heart and gallbladder fire in the summer； Lung disorder and abnormal descent of yang qi， resulting in yang-heat conversion into dryness or disharmony between nutrient qi and defensive qi； Abnormal hiding of yang qi， manifesting as floating yang or deficiency in both yin and yang in the winter. It is advocated to dynamically grasp the pathogenesis of insomnia in accordance with the changes in time. A treatment framework called “restoring ascending and descending of yang qi” is proposed， with the core focus on resolving dampness and strengthening the spleen， while also addressing the liver and strengthen the spleen， clearing and descending the heart and gallbladder， purifing and descending the lung qi， and suppressing hyperactive the yang and invigorating the kidneys in different seasons. This enrichment of the traditional Chinese medicine time medicine research in insomnia treatment， based on the characteristics of seasonal rhythmic time， aims to better serve clinical practice and provide ideas for the clinical diagnosis and treatment of insomnia.

Predictive value of preoperative liver function for perioperative massive blood transfusion in patients undergoing ascending aorta surgery / 中国输血杂志

【Objective】 To explore the predictive value of preoperative liver function for massive blood transfusion (MBT) in patients undergoing ascending aorta surgery. 【Methods】 Data from 238 patients undergoing ascending aorta surgery in the Department of Cardiovascular Surgery at The Affiliated Lihuili Hospital of Ningbo University were collected. Preoperative liver function tests were performed for all patients. Based on the perioperative transfusion volumes of red blood cell suspension, patients were divided into the MBT group, non-MBT group, and no blood transfusion (NBT) group. Clinical data during the perioperative period were compared among different groups. Receiver operating characteristic curve (ROC curve) analysis was used to assess the predictive value of liver function indicators for MBT and determine cut-off values. 【Results】 Compared with the non-MBT group and NBT group, the MBT group showed statistically significant differences in preoperative levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), direct bilirubin (DBIL), and serum albumin (SA) (P28.50 U/L, ALT >40.00 U/L, SA ≤34.55 g/L, and DBIL >4.25 μmol/L, there was a significant increase in the transfusion volume of various blood components and the incidence of MBT. 【Conclusion】 Preoperative liver function indicators (AST, ALT, SA, DBIL) have a moderate predictive value for MBT in patients undergoing ascending aorta surgery.

Treatment of Psoriasis Based on Theory of Ascending and Descending of Center Qi / 中医杂志

Based on the theory of ascending and descending of center qi， it is believed that yang deficiency and water dampness， as well as abnormal circulation of center qi， are the core pathogenesis of psoriasis. The common pathogenic evolution of psoriasis includes wood constraint and blood stagnation， lung metal fluid exhaustion. In the later stage of psoriasis， a mixture of deficiency and excess patterns， as well as cold and heat in complexity， are often observed. Treatment focuses on warming yang and resolving dampness to restore proper qi ascending and descending， and the therapeutic formulas such as Ganjiang Lingzhu Decoction （甘姜苓术汤）， Zexie Decoction （泽泻汤）， Zhenwu Decoction （真武汤）， and Linggui Zhugan Decoction （苓桂术甘汤） are suggested based on the nature and location of the disease. To unblock the qi movement through discharging the liver and rectifying the lung， Xiaochaihu Decoction （小柴胡汤） and Danzhi Xiaoyao Powder （丹栀逍遥散） are commonly used as the foundation with modifications. To balance yin and yang through clearing the heart and nourishing the kidneys， a self-designed Changzhong Decoction （畅中汤） is utilized. Following the theory of ascending and descending of center qi， it is suggested to combine cold and warm medicinals and mediate the center earth， so as to promote the circulation of the center qi， restore the clear and the turbid， and keep four-dimensional smooth flow of qi， providing a reference for traditional Chinese medicine treatment for psoriasis.

Management of Iatrogenic Aortic Dissections During Percutaneous Right Coronary Artery Interventions

ABSTRACT Iatrogenic acute aortic dissections during percutaneous coronary interventions are an extremely rare but potentially life-threatening complication, occurring in less than 0.02% of transcatheter procedures. We report three patients with different characteristics suffering from iatrogenic aortic dissection during percutaneous coronary intervention successfully treated with an emergency open-heart surgery. A conservative strategy should be pursuit only in small, localized lesions.

Hallazgos posoperatorios esperables en cirugías de aorta torácica ascendente con angiotomografía computada multicorte: todo lo que un médico radiólogo debe conocer / Expected postoperative findings in ascending thoracic aortic surgeries with multislice angiotomography: Everything a radiologist should know

Resumen Para la reconstrucción y el tratamiento de anomalías que comprometen la aorta torácica pueden emplearse diversas técnicas quirúrgicas abiertas, las cuales estarán determinadas por la patología que presente el paciente. La angiotomografía computada multicorte (ATCMC) es el método de elección para su control y seguimiento. El médico radiólogo debe estar familiarizado con las técnicas quirúrgicas empleadas (Wheat, Bentall de Bono, Cabrol, entre otras), con las reparaciones estructurales que se realizan y con los materiales protésicos utilizados con el fin de evitar una interpretación errónea de las imágenes. El fieltro espontáneamente hiperdenso, los conductos protésicos y sus anastomosis, tanto con la aorta como con los grandes vasos, puede generar errores en el informe final y en el diagnóstico.

Abstract Multiple surgical techniques can be used for the reconstruction and treatment of abnormalities that compromise the thoracic aorta, which will be determined by the patient’s pathology. Multislice computed tomography angiography is the method of choice for their control and monitoring. The radiologist should be familiar with the surgical techniques used (Wheat, Bentall de Bono, and Cabrol, among others), as well as with the structural repairs that are performed and the prosthetic materials used in order to avoid an erroneous interpretation of the images. Spontaneously hyperdense felt, the prosthetic ducts and their anastomosis, both with the aorta and the large vessels, can generate pitfalls in the final report and error in the diagnosis.

Remodeling+Ring (modified Yacoub) technique for the treatment of bicuspid aortic valve regurgitation with ascending aortic aneurysm: A case report / 中国胸心血管外科临床杂志

@#Patients with bicuspid aortic valve are often complicated with aortic dilatation. If the aortic valve is of good quality, aortic root replacement with aortic valve preservation is feasible. A 35-year-old male patient with bicuspid aortic regurgitation complicated with ascending aortic aneurysm underwent Remodeling+Ring (modified Yacoub) operation. Echocardiography showed that there was no aortic regurgitation on the 3rd day after operation, and the patient was discharged satisfactorily on the 6th day after operation. Remodeling+Ring surgery ensures the physiological movement of the aortic valve, solves the enlarged annulus, avoids the problems caused by valve replacement, and significantly improves the quality of life of patients, which is worth popularizing.

Expression of virulence genes in Group B Streptococcus isolated from symptomatic pregnant women with term and preterm delivery

Aims@#Maternal vaginal Group B Streptococcus (GBS) colonization is considered a risk factor for preterm delivery and, consequently, neonatal infections. Previous studies have portrayed the important roles of these virulence factors, including hemolytic pigment, hyaluronidase (HylB), serine-rich protein (Srr) and bacterial surface adhesion of GBS (BsaB) in mediating GBS colonization and intrauterine ascending infection, causing preterm delivery. This study aimed to investigate the association between mRNA expression of virulence genes in GBS isolates obtained from symptomatic pregnant women and preterm delivery.@*Methodology and results@#GBS isolates were obtained from high vaginal swabs of 40 symptomatic pregnant women of gestational age of less than 37 weeks. RNA was extracted from these GBS isolates and RT-qPCR was performed to determine the relative mRNA expression of GBS virulence genes, including CylE (encode enzyme required for the biosynthesis of the hemolytic pigment), HylB, Srr-1 and BsaB. Socio-demographic details and obstetric history were not found to be associated with the delivery outcomes of these women. The GBS isolates from symptomatic pregnant women who delivered prematurely showed a higher expression of CylE gene and a trend towards an elevated expression of HylB gene compared to women with term delivery. Meanwhile the expression of both Srr-1 and BsaB genes was similar between symptomatic pregnant women who had term or preterm delivery.@*Conclusion, significance and impact of study@#The results suggest that following vaginal colonization, both CylE and HylB genes are likely to contribute to intrauterine ascending infection and inflammation, leading to preterm delivery in humans. These virulence factors may be targeted for the pre-clinical stages of vaccine development or therapeutic intervention.

Clinical efficacy of reduction ascending aortoplasty with wedge resection in adult patients undergoing aortic valve replacement: A single-center retrospective study / 中国胸心血管外科临床杂志

@#Objective    To assess mid-term outcomes of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR). Methods    We retrospecctively analyzed clinical data of 30 adult patients with aortic valve diseases and ascending aortic dilatation in Fuwai Hospital from 2010 to 2019. There were 20 males and 10 females with an age of 38-72 (55.73±9.95) years. All patients received AVR+RAA using the wedge resection technique. Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results    There was no perioperative death. The mean preoperative and postoperative AAD in all patients were 48.23±3.69 mm and 37.60±5.02 mm, respectively. And the mean AAD of follow-up was 40.53±4.65 mm. There was a statistical difference in AAD between preoperation and postoperation, postoperation and final follow-up, preoperation and final follow-up. The median follow-up time was 28.50 (12-114) months. The median rate of increase in AAD postoperatively was 0.76 mm per year. And the rate of increase was ≥3 mm per year in 5 patients, while ≥5 mm per year in 4 patients with indications for reoperation. Conclusion    Mid-term outcomes of RAA in adult patients undergoing aortic valve replacement using the wedge resection technique are satisfying and encouraging. However, some patients still need surgical re-intervention.

Changes of ascending aortic diameter after transcatheter aortic valve replacement / 中国胸心血管外科临床杂志

@#Objective    To evaluate the changes of ascending aortic (AA) diameter after transcatheter aortic valve replacement (TAVR), and evaluate the safety and efficacy of TAVR in patients with AA dilation. Methods    We retrospectively included 87 patients who underwent TAVR at our center from 2016 to 2019. These patients were divided into 2 groups based on the preoperative AA diameter. There were 17 patients in the AA diameter≥45 mm group (including 10 males, aged 74.4±5.6 years), and 70 patients in the AA diameter<45 mm group (including 39 males, aged 75.9±7.0 years). Results     The baseline variables were similar between two groups (P>0.05). The overall device success rate was 97.7% (85/87). The median computed tomography (CT) follow-up time was 24.2±11.8 months in patients with AA diameter≥45 mm and 23.0±10.7 months in patients with AA diameter<45 mm, and the median annual dilation rate of AA were 0.36 mm/year and 0.00 mm/year, respectively. No statistical significance was observed between two groups (P>0.05). No adverse aortic events occurred during the follow-up period. Conclusion    TAVR is safe and effective in patients with preoperative AA diameter≥45 mm, and the AA diameter remains stable after the procedure. Patients with preoperative AA diameter≥45 mm and AA diameter<45 mm have similar annual dilation rates.

Preoperative ascending aorta diameter and prognosis analysis of patients with acute type A aortic dissection / 中华胸心血管外科杂志

Objective:To investigate the preoperative ascending aorta diameter in patients with acute type A aortic dissection in the Chinese population, compares and analyze the differences in preoperative blood biomarkers, and evaluate the impact of the preoperative ascending aorta diameter in this part of patients on the short-term prognosis of patients.Methods:A collection of 641 patients with acute type A aortic dissection who were enrolled in the " Acute Aortic Syndrome High-Risk Early Warning and Intervention Study" project from January 2018 to January 2020 were collected. Divide the patients into two groups (group Ⅰ<55 mm, group Ⅱ≥55 mm) according to the preventive intervention value of ascending aorta diameter recommended by the guideline for studying preoperative ascending aorta diameter difference in blood biomarkers and the influence of ascending aorta diameter on the short-term prognosis of patients. All patients had CT scans to assess the diameter of the ascending aorta before operation.Results:In this study, all patients with acute type A aortic dissection had a mean preoperative ascending aorta diameter of (46.9±9.7)mm. The preoperative ascending aorta diameter of all patients was less than 55 mm, accounted for 84.1%. Male patients were more likely to have aortic dissection than females; most patients' age was less than 60 years old. The preoperative blood inflammatory index counts were higher in the ascending aorta diameter ≥55 mm group. However, the long-term prognosis of patients with different ascending aorta diameters before surgery was not apparent in this study. The preoperative survival rate and short-term survival rate of patients with ascending aorta diameter <55 mm were higher than those of other groups, but the difference was not statistically significant.Conclusion:In patients with acute type A aortic dissection, the diameter of the ascending aorta is usually less than 55 mm. Moreover, the blood inflammatory index counts are high in the preoperative ascending aorta diameter ≥55 mm group. Meanwhile, patients with smaller ascending aorta diameter have better survival rate and short-term prognosis.

Ascending， Descending， Floating and Sinking Properties of Descurainiae Semen Lepidii Semen Based on Pulmonary Edema Model / 中国实验方剂学杂志

ObjectiveThe pulmonary edema （PE） model where the disease was located in the viscera was established according to the treatment principle that patients with the disease location inside should be treated with descending and sinking medicine， combined with changes in the disease tendency， to verify the scientificity of descending and sinking properties of Descurainiae Semen Lepidii Semen （SD）， and to preliminarily elucidate the scientific connotation of descending， ascending， floating and sinking of Chinese medicine. MethodSixty male SD rats were randomly divided into normal control group， model group （20 mg·kg-1）， positive drug group （dexamethasone， 0.075 mg·kg-1） and SD low （1.167 g·kg-1）， medium （2.334 g·kg-1）and high （4.668 g·kg-1） dose groups. The PE model was established by intrapleural injection of 1% carrageenan （2 mL·kg-1）. The evaluation indexes （lung autopsy， amount of pleural effusion， number of white blood cells， lung wet/dry weight ratio， lung water content and lung permeability） were tested to determine the optimal dose of SD decoction for intervention of PE. The relevant indexes of the five major systems （central nervous system， respiratory system， circulatory system， digestive system and urinary system） closely related to the body's Qi movement were detected and changes in the disease tendency in PE rats were analyzed， to determine the descending， ascending， floating and sinking properties of SD. In addition， histopathological changes were investigated by hematoxylin-eosin （HE） staining， and types and numbers of inflammatory cells and mediators were detected to preliminarily explore the mechanism of SD in improving PE. ResultCompared with the conditions in the normal control group， the amount of pleural effusion， number of white blood cells in pleural effusion， lung wet/dry weight ratio， lung water content and lung permeability were increased （P<0.01） in the model group， where the rats presented cough， dyspnea， shortness of breath and arched back， and a small number of them had wet nose and bubble liquid in nostrils. In the autopsy of the rats in the model group， the lungs were enlarged or accompanied by congestion and plenty of pink bubble liquid appeared at the trachea. Compared with the conditions in the model group， SD reduced the amount of pleural effusion， number of white blood cells in pleural effusion， lung coefficient， lung wet/dry weight ratio and lung water content （P<0.01）， and improved pulmonary edema symptoms such as damage， inflammation and infiltration around the lumen， thickening of the trachea， and accumulation of edema fluid， and the SD medium dose group had the best effect on the treatment of PE. In terms of respiratory system， compared with the normal control group， the model group had reduced latent time of cough and asthma （P<0.05， P<0.01） and elevated number of cough and wheezing （P<0.01）. The three SD groups had increased latent time of cough and asthma and decreased number of cough and wheezing （P<0.01）. In terms of urinary system， compared with the normal control group， the model group presented decreased urine volume. The SD low， medium and high dose groups had increased urine volume （P<0.05， P<0.01）， but they had no effect on perspiration. In terms of digestive system， compared with the conditions in the normal control group， the gastric residual rate and gastrin （GT） level were increased （P<0.05， P<0.01）， and the gastric emptying rate and small intestine transit rate were decreased （P<0.01）. The SD low dose group had elevated small intestine transit rate （P<0.01）， and the SD high and medium groups had enhanced gastric emptying rate and small intestine transit rate （P<0.01）， reduced gastric residual rate， lowered GT level to promote gastrointestinal movement and transportation （P<0.01）， and increased motilin （MTL） level to promote gastric emptying in rats （P<0.05， P<0.01）. In terms of circulatory system， compared with the normal control group， the model group displayed reduced left ventricular ejection fraction （LVEF）， left ventricular short axis shortening rate （LVFS） and cardiac output （CO） （P<0.01）， and elevated tendency of heart rate， systolic blood pressure （SBP， P<0.01） and diastolic blood pressure （DBP， P<0.05）. Compared with the model group， the SD low dose group increased LVEF and decreased DBP （P<0.05）， while the SD medium dose group increased LVEF， LVFS， CO and SBP （P<0.01） and decreased DBP （P<0.05）， and the SD high dose group increased LVFS （P<0.01） and decreased SBP （P<0.01） and DBP （P<0.05）. In terms of central nervous system， compared with the conditions in the normal control group， the standing times dropped in the model group （P<0.01）. SD reduced the movement distance， movement time， standing times and activity time in the center of the open field， and increased the rest time and activity time at the edge of the open field （P<0.05， P<0.01）. Moreover， compared with the normal control group， the model group had serious inflammatory infiltration around the lung lumen， thickened trachea with accumulated edema fluid， seriously damaged lung tissue， increased number of white blood cells and percentage of neutrophils in blood （P<0.01）， elevated percentage of monocytes， interleukin-4 （IL-4）， immunoglobulin E （IgE） level and reactive oxygen species （ROS） level in lung tissue （P<0.05，P<0.01）， and decreased IFN-γ in alveolar lavage fluid （P<0.01）. Compared with the model group， SD decreased the number of white blood cells， neutrophil accumulation， pulmonary congestion and interstitial edema， IFN-γ and IL-4 levels in alveolar lavage fluid and ROS level in lung tissue， and increased IgE level （P<0.05， P<0.01）. ConclusionSD had a significant improvement effect on PE model where the disease was located in the viscera. It could regulate the excretion of water by purgation， regulate Qi movement and expel Qi stagnation by descending and sinking lung Qi， and promote purification and descent of lung qi to make Qi movement downward. This indicated SD had the descending and sinking properties. The medium dose of SD decoction exerted the best effect， and its mechanism of action might be through regulating the neutrophil inflammatory response.