Objective To retrospective study the morphological features of normal aortic arch in population of Tianjin area by computed tomography angiography (CTA). Methods From Jan 2016 to Dec 2016, 142 volunteers undergoing thoracic aorta CTA in our institution were retrospectively reviewed. In each patient, 10 measurements were made in GE AW4.6 workstation, including diameters, distances, and angles of branch vessels of aortic arch. SPSS statistical software was used to analyze data. Results The diameter of the origin of brachiocephalic trunk (BCT) D1 was (15.2 ± 3.0) mm, left common carotid artery (LCCA) D2 was (11.8±2.2) mm and left subclavian artery (LSA) D3 was (13.6±1.9) mm. The distance between the BCT and the LCCA (E1) was (4.0±2.5) mm, between the LCCA and the LSA (E2) was (8.2±3.7) mm. The angle between the BCT and arch (α) was 29.5°±14.4°, between the LCCA and arch (β) was 40.3°±17.5°, between the LSA and archγwas 57.9°±21.6°. The angle formed by BCT, LCCA, and LSA(Φ) was 144.1°±10.1°. The distance between center of LCCA ostia and line between center of ostia of BCT and LSA (L) was (4.5±1.2 )mm. Values of D2 and D3 were larger in male than that in female. In the three age groups of 19-40 y, 41-60 y and ≥61 y, values of D1 increased gradually, while α and γdecreased gradually. When in the two age groups of 41-60 y and≥61 y, values of D2, D3, E2 and L were significantly larger than those in the age group of 19-40 y, whileΦwas smaller (P<0.05). Conclusion The data obtained by this study on the diameter and angle of branching vessels arising from the normal aortic arch may provide support for various studies of endovascular repair of aortic arch.

Objective To investigate the correlation between the variations of mitochondrial gene ATP6 and type 2 diabetes mellitus ( T2DM ) and chronic complications. Methods Genomic DNA were extracted from 254 T2DM patients and 165 age-matched controls. After amplification of ATP6 by PCR and direct sequencing, all sequences were compared with the reference sequence (rCRS) to find out the variations. Bioinformatics and statistic method were used to analyze these variations. Results Many variations were detected respectively in T2DM patients and controls, a part of them only appeared in T2DM patients in low frequency, which has not been reported previously. Most of these variations are located in thethird and forth transmembrane helix of ATP synthase subunit 6 (ATPase6). Interestingly, these variationsalmost were detected in the non-obese T2DM patients with hypotension, including G8557A, A8563G,T8594C, C8609T, A8689G, G8998A and G9139A. Conclusions There were many variations in geneATP6 and must of them are mitochondrial SNP, while variations A8689G, T8825C, G8920A, G8998A andG9139A may be mild mutations which my increase the susceptibility of T2DM. G8557A, A8563G,T8594C, C8609T, A8689G, G8998A and G9139A may be associated with the biogenetics diseases suchdiabetes and hypertension.

Objective To analyze the risk factors and prognosis of carotid artery stenosis (CAS) in patients who under?went off-pump coronary artery bypass grafting (OPCAB). Methods A total of 342 patients scheduled for OPCAB between June 2013 and June 2015 were included in this study. According to results of preoperative duplex ultrasound examination of carotid arteries, patients were divided into CAS group (≥50%stenosis) and control group (<50%stenosis or no stenosis). The risk factors of CAS, death rate and the postoperative complications were compared between two groups. Results There were significant differences in age, smoking history, hypertension and chronic obstructive pulmonary disease (COPD) between two groups (P<0.05). Multivariate logistic regression analysis showed that advanced age (OR=1.050, 95%CI:1.014-1.086, P<0.01), hypertension (OR=2.566, 95%CI:1.299-5.071, P < 0.01) and COPD (OR=7.573, 95%CI:1.106-51.834, P < 0.05) were independent risk factors for CAS in OPCAB surgery. CAS (OR=4.530, 95%CI:1.361-15.078, P<0.05) and the history of percutaneous coronary intervention (OR=7.685, 95%CI:2.289-25.800, P<0.01) were independent risk factors for postop?erative death. Conclusion Risk factors for CAS in patients undergoing OPCAB include advanced age, hypertension and COPD. There is higher risk of death in CAS patients with OPCAB.

Objective To explore the optimal treatment options of Stanford type B aortic dissection. Methods A to?tal of 51 patients with Stanford type B aortic dissection who visited the General Hospital of Tianjin Medical University from May 2008 to March 2013 were analyzed retrospectively. Survival and recovery of patients were evaluated by follow ups. Pa?tients were divided to TEVAR group(40 cases)and conservative group(11 cases)according to the treatment they recieved. Results Operations were successful in all 40 patients. There were two cases of perioperative death(5%). And none of pa?tients died in TEVAR group during follow-up. One case among 11 patients who received conservative treatment dead in hos?pital(9.1%)while other 7 cases died during follow-up(63.6%). Kaplan-Meier survival curve showed that two-year survival rate of TEVAR group was significantly higher than that of conservative group. In TEVAR group, the maximum diameter of the aorta presented a decreasing trend and thrombosis was seen in artificial lumen with time going after operation. Conclu?sion For patients with Stanford type B aortic dissection, TEVAR presented a high success rate and promoted remodeling of the aortic genuine and aritificial lumen. What’s more, it can significantly improve patient’s survival rate and recovery in short or mid-term period compared with effect of traditional conservative treatment.

Objective To evaluate the feasibility of strent-graft with Chimney technique in thoracic endovascular aortic repair (TEVAR) of thoracic aortic dissection left subclavian artery (LSA) disease and left common carotid artery (LCCA) disease without good landing zone. Methods A total of 21 patients with thoracic aortic diseases complicated by in-sufficient proximal anchoring area,who were presented in our hospital in recent years,were selected in this study. The clini-cal data were retrospectively analyzed. The thoracic aortic diseases included aortic dissection ( n=11), aortic pseudoaneurysm (n=2), aortic aneurysm(n=1) and penetrating ulcer(n=7). Among all 21 patients,lesion was located in distal to LSA in 18 pa-tients with distance to LSA anchoring less than15 mm,and the lesion was located between the LSA and LCCA in the rest 3 patients.Thoracic aortic stent-graft placement was carried out.The ostium of LSA was intentionally and completely cov-ered by thoracic aortic stent-graft and left subclavian artery or left internal carotid artery stent-graft placement was subse-quently performed. The patients were observed for symptoms of cerebral and upper limb ischemia. The postoperative com-plications such as endoleak and the patency of LSA were assessed with angiography. Results Thoracic aortic stent-graft placement was suceessfully carried out in all 21 patients. In addition,one“Chimney”stent was properly implanted in LSA or LICA in each patient. After the procedure,no complications of nervous system or severe ischemia of upper extremity was observed. Follow-up examinations between to 38 months after the treatment revealed that the aortic stent-graft remained in stable condition without type I endoleak. Meanwhile the blood flow in“chinney”stent was unobstructed. Conclusion Chimney technique can expand the applicability of TSGP with high tolerance. Chimney technique expand the applicability of TEVAR for patients with challenging anatomy. It is a safe,effective and microinvasive method to treat thoracic aortic lesions.

ObjectiveThe present study was designed evaluate the aspirin effectiveness in the inhibition of platelet aggregation in patients after OPCAB.Methods290 patients were recruited.145 patients underwent first time OPCAB (surgery group).Arachidonic acid induced platelet aggregation and urine 11-dehydro thromboxane B2 (11-dehydroTxB2) were measured before operation and on aspirin re-administered days 1,4, 10, and 6 months after surgery.The same tests were also detected in 145 patients from the cardiology department (non-surgery group) received medicine therapy as controls.Results Ninety-nine patients were defined as aspirin sensitive after OPCAB (AS Group).Postoperative aspirin resistance was identified in 46 (32％) patients at the first day after aspirin treatment started (AR Group).19 (13％) and 5 (3％) patients remained as AR at day 4 and 10 after aspirin re-administration, respectively.Patients in the AR group had higher 11-dehydroTxB2 levels than those in the AS group (P = 0.049).Six months follow-up showed ARA-induced platelet aggregation was (11.5 ± 3.4) ％.Urine level of 11-dehydroTxB2 was (50.3 ± 15.4) ng/L.No resistance was found.All cardiologic patients were identified as aspirin sensitive, the change of platelet aggregation and 11-dehydroTxB2 were similar as those in the AS group.Weight ＞75 kg and postoperative drainage ＞500 ml were risk factors of aspirin resistance after OPCAB.ConclusionAnti-platelet effect of aspirin was reduced during the early postoperative period in certain patients undergoing OPCAB.In case of resistance,antiplatelet treatment strategy should be intensified or modified.

Objective: To investigate the effect of ischemic postconditioning on myocardial infarction and myocardial apoptosis in ischemia-reperfusion injury of rats, and the protective mechanisms thereof. Methods:Thirty-six healthy male Wistar rats(230-280 g) were randomly divided into three groups, ischemia-reperfusion group(Group I-R), ischemia 30 min and reperfusion 120 min without additional intervention; myocardial ischemic postconditioning group(Group Post), after 30 min ischemia, the rats were comprised 3 cycles of 10 seconds reperfusion followed by 10 seconds ischemia, and then the rats were reperfused 120 min; myocardial ischemic postconditioning+AG490(JAK2-STAT3 pathway inhibitor) group(Group Post+AG490), rats were treated with AG490 5 minutes before reperfusion, followed by myocardial ischemic postconditioning and 120 min reperfusion. The myocardial infarct size was measured by TTC staining. Apoptotic index of cardiomyocyte was detected by TUNEL. Results: Myocardial infarct size and myocardium apoptotic index were significantly reduced in Group Post compared to those in Group I-R(P ＜ 0.05). AG490 inhibited cardioprotective effect of ischemic postconditioning. Conclusion: Ischemic postconditioning provides potent cardioprotective effect. JAK2-STAT3 pathway mediates the cardioprotective effects of ischemic postconditioning.

Objective:To assess aspirin efficacy in the early postoperative period following off-pump coronary artery bypass(OPCAB)surgery.Methods:Sixty patients undergoing OPCAB surgery were enrolled in the study.Previous aspirin treatment Was terminated 5-7 days before OPCAB and continued to take at the day with food intake after surgery.The functional and biochemical responses to aspirin were evaluated by arachidonie acid (ARA)-induced platelet aggregation.Samples were collected before and on days 1,4 and 10 after aspirin intake(100 mg/d).Results:There were 17 patients(28.3%),9 patients (15%)and 2 patients(3.3%)with aspirin resistance on day 1,4 and 10 of aspirin intake.The overall levels of platelet aggregation(%)were 63(52,70),13(11,22),12(10,14),and 12(11,14)before the surgery and on day 1,4 and 10 of aspirin intake.The level was stable from the 4th day after aspirin intake.It was found that aspirin resistance was not an independent risk factor for the operation.Conclusion:Aspirin did not sufficiently inhibit platelet aggregation at the early stage after OPCAB.It is important to keep potential anti-coagulation therapy in the early postoperative period.

Objective The surgery time for patients with infective endocarditis (IE) has been transformed.It has been supported that,for the patients with surgical indications,the surgery time should be as early as possible to improve the clinical outcome.The purpose of the research is to identify whether the patients with IE could get further benefit from early surgery.Methods Between June 1996 and July 2011,135 IE patients'data has been collected retrospectively,all of whom were verified through the modified Duke categories.The patients were devided into group A( the new therapeutic schedule group after 2008 ) and group B( the traditional therapeutic schedule group before 2008 ) by the year of 2008.The end points of observation were death associated with IE,cardiac failure,embolism,and re-infection.The comparison between the groups was by means of non-parameter rank and inspection test,variance analysis,t test,chi-square test,fisher exact test.The outcome comparison between the groups was via the Kaplan-Meier survival analysis.Results There were no significant differences in baseline data between the groups.No survival differences could be observed via the Kaplan-Meier analysis( Log Rank P =0.189).During the following-up visit,compared with the patients in group B,the mortality in group A is lower(9.4％ vs.23.0％,P=0.016),the incidence of heart failu re was less in group A (5.4％ vs.26.2％,P ＜0.001 ).No differences could be found in re-infection between the two groups(0 vs.4.9％,P =0.112 ). More patients in group A underwent surgery (67.6％ vs.32.8％,P ＜0.001 ).Conclusion The new therapeutic sehedule of IE coull reduce the mortality rate and promote the cardiae funetion.The incidence of re-infeetion didn't increase.

Objective To observe the change of interleukin-8(IL-8) during perioperative period, and to define whether the increase of IL-8 in response to cardiac surgery is related to the presence of a certain allele in a functional polymorphism. To explore the relationship between postoperative inflammation and clinical outcome. Methods One hundred and forty-five patients undergoing selective off-pump coronary artery bypass (OPCAB) for the first time were enrolled. The IL-8 (-251A >T) polymorphisms were analyzed by using polymerase chain reaction (PCR) and gene sequencing. The plasma levels of cytokine, troponin T (TnT). creatine kinase-MB (CK-MB) and creatinine (Cr) were measured before and 4, 24 and 72 hours after operation by suspension array system. Results After surgery, the IL-8 concentration increased and reached the highest level at 4 hours after surgery [18.0 (8.4, 37.1) ng/L, P = 0.000], and then it decreased to the preoperative level at 3 days after surgery. Four hours after surgery, the patients with IL-8-251 AA homozygous genotype had higher concentration of IL-8 C33.1 (16.6, 49.5) ng/L, P =0.0353. They had higher TnT and CK-MB levels than patients homozygous for AT and TT genotype 4 hours after surgery [TnT:0.53 (0.43, 4.92) ng/ml, P = 0.037; CK-MB: 41.5 (28.8, 65.5) U/L, P=0.025], and patients homozygous for AT genotype had higher Cr level 24 hours after surgery C93.1 (76.4, 121.5) μmol/L, P = 0. 021]. The patients who underwent ventilation for more than 1 day or post-operative hospital stay for more than 14 days had higher IL-8 levels (P=0.036, 0.038). IL-8-251AA genotype was an independent risk factor for patients undergoing ventilation for more than 1 day (OR=11.80, 95% CI: 1.87-74.48) and post-operative hospital stay for more than 14 days (OR=38.00, 95% CI:4.15-347. 87) . Conclusions OPCAB results in postoperative inflammatory response. IL-8-251AA genotype is associated with longer mechanical ventilation and hospital staying. Genetic background might alter the extent of inflammatory response and relate to postoperative prognosis. 、