Objective This retrospective study was perform to assess risk factors of the type A aortic dissection after aortic valve replacement,in order to provide a basis for devising a strategy for future treatment.Methods From 2009 to 2012,23 patients were found type A aortic dissection and 20 patients were found aortic aneurysm after aortic valve replacement in Beijing Anzhen hospital.Analysis the clinical,pathology and surgery procedure characteristics of these patients,and assess the risk factors for type A aortic dissection after aortic valve replacement.Results After aortic valve replacement,There were significant different in age (P =0.012),bicuspid aortic valves (P =0.014),aortic valve regurgitation (P =0.009) and postoperative pathoanatomical characteristics(P =0.001) between type A aortic dissection group and ascending aortic aneurysm group.Multivariate logistic regression analysis indicated that age(P =0.032),aortic valve regurgitation(P =0.046) and pathoanatomical characteristics(P =0.002) were important risk factor for type A aortic dissection after aortic valve replacement,respectively.Conclusion Older age,aortic regurgitation combined and thinned or fragile aortic walls with systemic hypertension in patients with ascending aortic dilatation (≥45 mm diameter) at the time of AVR might be predisposing factors for postsurgical type A aortic dissection.These patients should be considered for concomitant replacement or repair of the ascending aorta unless the patient has a high operative risk.

60 minutes. There were no significant differences in the three groups in age, sex ratio, C/T ratio, or left ventricular function. Blood samples for analysis were collected before skin incision and at time intervals up to 6 days postoperatively. Analysis of creatine kinase MB, LDH and cardiac-specific troponin I was used for the detection of myocardial damage. Meantime, the ECG was checked for myocardial infarction. After the reperfusion, myocardial tissue was obtained from the free wall of right ventricle myocardial structure studies. Results: The level of cTnI was increased significantly when the time of myocardial ischemia was prolonged. The changes of CK-MB and LDH were not significant in these three groups. Electron microscopy demonstrated the mitochondria of myocardial cell swelled, the myofilament shortened and the sarcoplasmic reticulum vacuolated in group III. The ECG was almost normal in all groups. Conclusion: The cTnI was an early and highly sensitive biochemical marker of ischemic and reperfusion injury during correction of cardiac defects in children. The concentration of cTnI was correlated ischemia with the degree of so evaluation of the release of cTnI could be used to assess myocardial protection during cardiac operation.

Aortic dissection is a kind of fatal cardiovascular disease, and the apoptosis of aortic vascular smooth muscle plays an important role in aortic dissection.The new discovered Hippo-YAP signal transduction pathway is significant in regulation of the function of vascular smooth muscle, and it can cause many cardiovascular diseases.This paper aims to review the present studies of the mechanism of the apoptosis of aortic vascular smooth muscle and Hippo-YAP signaling pathway in the pathogenesis of cardiovascular diseases, especially the aortic dissection.

Objective To investigate degenerative changes of auditory functions and age -related expression of phosphorylated extracellular signal -regulated protein kinases1/2(p-ERK1/2) in the cochlea of the senescence accelerated mouse .Methods The 3 ,5 ,7 months old mice were selected for the study and each group had 6 mice . The 8 kHz tone burst auditory thresholds and age -related expression of p -ERK1/2 in the cochlea were studied in the senescence accelerated mouse/prone 8(SAMP8) at 3 ,5 ,7 months .The expression of p -ERK1/2 was analyzed by the optical density of immunohistochemical staining .Results For the auditory function evaluation :The SAMP 8 developed a progressive hearing loss at 8 kHz which showed an age -related significant increase (P< 0 .05) .The ABR thresholds in 3 ,5 ,7 months old groups in the left ear were 31 .817 ± 1 .228 ,54 .329 ± 1 .459 ,58 .330 ± 1 .252 dB SPL ,respectively .In the right ears ,the ABR threshold were 32 .474 ± 1 .041 ,53 .485 ± 1 .385 ,57 .842 ± 1 .173 dB SPL ,respectively .p-ERK1/2 protein expressed in the cochlea of the SAMP8 throughout the development sta‐ges ,which developed an age-related significant decrease (P<0 .05) .The average optical density of p -ERK1/2 in the spiral ganglion cells in the 3 ,5 ,7 months old mice were 0 .699 7 ± 0 .018 8 ,0 .621 5 ± 0 .014 7 ,0 .575 3 ± 0 .015 5 ,respectively .In the hair cells ,they w ere 0 .651 9 ± 0 .025 2 ,0 .591 2 ± 0 .010 2 ,0 .559 3 ± 0 .006 7 respec‐tively .Conclusion The expression level of p -ERK1/2 protein decreases when the SAMP 8 develops a progressive hearing loss .This indicates that p-ERK1/2 protein probably has relationship with maintaining functional status of the cochlea and the auditory formation .

The numbers of application and granted funds for NSFC were analyzed statistically in Capital Medical University Affiliated Beijing Anzhen Hospital from 2009 to 2012.This paper retrospectively analyzed the development recurrent features of scientific research and put forward some suggestions.Meanwhile,it revealed the prospects of scientific research in our hospital.

OBJECTIVE To investigate the characteristics and antibiotics resistance of nosocomial infection caused by Stenotrophomonas maltophilia after open-heart operation.METHODS The clinical data of 324 patients with microbiologically documented nosocomial infection from Jan 2004 to Dec 2006 were retrospectively analyzed.RESULTS There were 34 infected cases caused by S.maltophilia,and accounted for 10.5% of all infections during the same period.All infected patients had serious original heart diseases,and received previous glucocorticoids and broad-spectrum antibiotic therapy.Thirty patients prolonged mechanical ventilation time for over 2 weeks.Results of susceptibility test showed that trimethoprim-sulfamethoxazole,ticarcillin-clavulanic acid and levofloxacin were the most active antibiotics,followed by ceftazidime and ciprofloxacin.S.maltophilia presented high resistantce to carbopenems and aminoglycoside antibiotics.CONCLUSIONS Nosocomial S.maltophilia infection is associated with the severity of preoperative underlying heart diseases,prolonged mechanical ventilation and longer period of broad-spectrum antibiotic therapy,especially carbopenems antibiotics.

Objective:To examine whether the use of moderate hypothermic circulatory arrest in a pig model provides comparable vital organ protection outcomes to the use of deep hypothermic circulatory arrest.Methods:Thirteen pigs were randomly assigned to 30 minutes of hypothermic circulatory arrest without cerebral perfusion at 15℃(n=5), 25℃(n=5) and a control group(n=3). The changes in standard laboratory tests and capacity for protection against apoptosis in different vital organs were monitored with different temperatures of hypothermic circulatory arrest management in pig model to determine which temperature was optimal for hypothermic circulatory arrest.Results:There were no significant differences in the capacity for protection against apoptosis in vital organs between 2 groups( P>0.05, respectively). Compared with the moderate hypothermic circulatory arrest group, the deep hypothermic circulatory arrest group had no significant advantages in terms of the biologic parameters of any other organs( P>0.05). Conclusion:Compared with deep hypothermic circulatory arrest, moderate hypothermic circulatory arrest is a moderate technique that has similar advantages with regard to the levels of biomarkers of injury and capacity for protection against apoptosis in vital organs.

Objective To observe the expression of Cathepsin S in the human abdominal aortic aneurysm (AAA) and angiotensin Ⅱ(AngⅡ) perfusion induced AAA lesions in apolipoprotein E-deficient(ApoE-/-) mice.Methods AAA specimens of clinical diagnosis patients(AAA group) and the normal blood vessels(control group)were collected.The AAA model was established by infused Ang Ⅱ 1 000ng · kg-1 · d-1 to ApoE-/-mice.Elastic fibersfracture was observed by elastic fiber staining and Cathepsin S expression by immunohistochemistry.Results The elastic fiber staining revealed that the elastic fibers fracture of the human and mouse AAA group increased significantly (P ＜ 0.05) ; Cathepsin S expression significantly increased in the human and mouse AAA group than the control group by immunohistochemistry(P ＜ 0.05).Conclusion Cathepsin S is activated in human and murine AAA lesions and may be involved in the pathogenesis of AAA.

A total of 59 untreated asthmatics and 47 healthy control subjects were recruited from Qianfoshan Hospital of Shandong Province from May 2011 to April 2012.Compared with healthy control subjects,the levels of IL-25 in induced sputum and eosinophils,IgE,interleukin-4 (IL-4) and interleukin25 (IL-25) in serum samples of asthmatics were significantly higher while the level of interferon-gamma (IFN-γ) were much lower.However,after inhaled glucocorticoid treatment,the levels of eosinophils,IL-4 and IL-25 decreased and IFN-γ significantly increased,while the level of IgE showed no significant changes.It was also found the expression of IL-25 was markedly positively correlated with the levels of eosinophils and IL-4 in serum and markedly negatively correlated with the levels of IFN-γ and had no relatio.

Objective Investigate the operative techniques and early results of a normal thermic and non-cardiopulmonary bypass fashion to perform total thoracoabdominal aortic aneurysm repair (tTAAAR).Methods Between February 2009 and December 2010,41 patients with extensive Crawford Ⅱ thoracoabdominal aortic aneurysm (TAAA) underwent tTAAAR in our hospital.Among them,27 patients underwent tTAAAR in a normal thermic and non-cardiopulmonary bypass fashion.The mean age of this group of patients is (41.85 ± 10.11 ) years ( range 23-61 years),including 18 male and 9 female.The operation was performed via a combined left thoracoabdominal incision.The intercostal incision was through the left fifth (or sixth) intercostal space and an amputated costal arch.The abdominal incision was from the left linea pararectalis to the level of the pubic symphysis via a retroperitoneal approach.The diaphragm was incised circularly to expose the aorta.After the iliac arteries and proximal descending aorta were dissected and exposed sufficiently,two 10 mm side branches were anastomosed to iliac arteries in an end to side fashion.When this was accomplished,the proximal end of the main graft was anastomosed to the proximal descending aorta in an end to end fashion.Then the bypass from descending aorta to bilateral iliac arteries was established under normal thermia.The reestablishment of intercostal arteries and visceral arteries was followed with subsection circulatory arrest.Results The procedure was succeeded in all 27 patients but 1 patient died during operation because of pulmonary hemorrhage.The mean descending aortic circulatory arrest time was ( 13.78 ± 3.77 ) min,the spinal cord ischemia time was ( 19.19 ± 3.93 ) min,and the visceral organs ischemia time was ( 25.19 ± 5.88 ) min,respectively.Mean intubation time is (24.62 ±21.70) hours.Mean ICU stay time is ( 1.84 ± 1.29) days.Two of the 26 survivors suffered permanent spinal cord injury.The morbidity of pulmonary complication,temporal cerebral complications,renal failure,reoperation for hemorrhage,and delayed healing of incision was 11.54％,3.85％,3.85％,3.85％,7.69％,respectively.One Marfan patient suffered Stanford type A aortic dissection after 9 days of tTAAAR.She was rescued by emergency operation.Mean follow-up time was ( 16.04 ± 5.62 ) months,with a follow-up rate of 100％.No late death was found.Conclusion The normal thermic and noncardiopulmonary bypass tTAAAR is a reliable and effective therapeutic strategy for these patients.But the indication of this procedure is limited.If the thoracoabdominal aortic aneurysm grows too huge,the normal thermic tTAAAR cant be performed.So the TAAA patients in China should be treated in their early stage.