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@#Since the advent of coronary artery bypass grafting (CABG), the selection of bypass conduits has always been one of the most controversial topics in this field. Arterial conduits have received extensive attention due to their excellent biological features and high patency. In recent years, the application of arterial grafting and total arterial grafting in China keeps increasing in recent years, but there is still a gap compared to the Europe and America. Previous clinical studies have indicated the benefits of the total arterial grafting in terms of patency and long-term outcomes, but the advantage of multiple arterial grafting over other procedures is still in need to be confirmed with high-quality randomized controlled trials. This article reviews the clinical application and strategy of total-arterial CABG, aiming to provide objective reference for future clinical research and application.
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Objective:To analyze the clinical and pathological features and gene mutations of pancreatic acinar cell carcinoma (PACC).Methods:Clinical data of 34 patients with PACC admitted to the Department of Pancreatic Surgery of the First Affiliated Hospital of Naval Medical University from December 2009 to July 2018 were retrospectively analyzed to summarize its clinical characteristics, and the expressions of α1-ACT, CaM5.2, Syn and CgA in pancreatic tumor tissues were detected by immunohistochemistry. Next-generation gene sequencing technology was used to detect gene mutations in tumor specimens.Results:Among the 34 PACC patients, 23(68%) were males and 11(32%) were females; the age ranged from 25 to 75 years, with an average age of 54 years. The first symptom was abdominal pain or distension in 21 cases (62%), skin or scleral yellow staining in 4 cases(12%), and 9 cases(26%) were found in routine physical examination. BMI was 17.6-34.0 kg/m 2, of which 3 cases (9%) were <18.5 kg/m 2, 23 cases (68%) were 18.5-24.0 kg/m 2, and 8 cases (23%) were >24.0 kg/m 2. Preoperative examination showed elevated CA19-9 in 7 cases (20.6%), elevated CEA in 3 cases (8.8%), and elevated AFP in 7 cases (20.6%). Blood amylase was 16-247 U/L, with an average of 80 U/L. Enhanced CT showed that the lesion was irregular in shape, showing inhomogeneity and slightly low density, with areas of cystic degeneration and necrosis. The tumor was located in the head of the pancreas in 14 cases (41%), the body and tail of the pancreas in 19 cases (56%), and the neck of the pancreas in 1 case (3%). The largest tumor diameter was 1.5-15.5 cm, with an average of 5.4 cm. Postoperative pathologic stage I was confirmed in 4 cases (12%), stage Ⅱ in 14 cases (41%), stage Ⅲ in 14 cases (41%) and stage Ⅳ in 2 cases (6%). Immunohistochemical results showed that both α1-ACT and CaM5.2 were positively expressed (100%). Syn was positive in 8 cases (23.5%) and CgA was positive in 6 cases (17.6%). Ki-67 index was from 9% to 70%, with an average of 41%. Gene sequencing of pancreatic tumor tissue from 6 patients showed BRCA2 mutation in 2 patients (7155C>G), K-ras mutation in 1 patient (35G>T), RET mutation in 1 patient (200G>A), and LKB1 mutation (234G>T) in 1 patient, and one double mutation of K-ras and RET (35G>A, 1 798C>T). 30 patients were followed up, and the median survival was 38.3 months. Conclusions:PACC was a rare pancreatic tumor with no specific clinical manifestations. The positive expression rates of α1-ACT and CAM5.2 in tumor tissues were 100%. BRCA2, K-ras, RET and LKB1 were common gene mutations.
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Objective To study the blood flow in aneurysm and its influence on mechanical properties of vascular walls for two kinds of common aneurysms, so as to improve the diagnosis and treatment of aneurysms and the prognosis of patients. Methods The interaction between the aneurysm-carrying vessels and blood of two common aneurysms was studied by fluid-structure interaction method. The blood flow velocity, wall deformation, stress distribution and damage form of aneurysm-carrying vessels were analyzed. Results The blood flow in both aneurysms were slow and stable, which resulted in better deposition and adhesion conditions. The junction between the aneurysm and the downstream of the blood vessel was a dangerous place for damage. The spindle aneurysm would undergo shear failure on outer wall of the aneurysm, while the cystic aneurysm would undergo stretching failure on inner wall. Under the effect of the same blood flow, a larger stress appeared on the cystic aneurysm, which was more prone to damage, and the tensile failure would lead to a more serious consequences. Conclusions The junction at the aneurysm and blood vessel is prone to damage, and the cystic aneurysm is more dangerous and harmful.
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Objective To study the blood flow in aneurysm and its influence on mechanical properties of vascular walls for two kinds of common aneurysms, so as to improve the diagnosis and treatment of aneurysms and the prognosis of patients. Methods The interaction between the aneurysm-carrying vessels and blood of two common aneurysms was studied by fluid-structure interaction method. The blood flow velocity, wall deformation, stress distribution and damage form of aneurysm-carrying vessels were analyzed. Results The blood flow in both aneurysms were slow and stable, which resulted in better deposition and adhesion conditions. The junction between the aneurysm and the downstream of the blood vessel was a dangerous place for damage. The spindle aneurysm would undergo shear failure on outer wall of the aneurysm, while the cystic aneurysm would undergo stretching failure on inner wall. Under the effect of the same blood flow, a larger stress appeared on the cystic aneurysm, which was more prone to damage, and the tensile failure would lead to a more serious consequences. Conclusions The junction at the aneurysm and blood vessel is prone to damage, and the cystic aneurysm is more dangerous and harmful.