Objective · To evaluate the association between the abnormal maternal serum markers of alpha fetoprotein (AFP), human chorionic gonadotrophin (hCG) and unconjugated estriol (uE3) in the second trimester screening and the adverse obstetric outcomes other than trisomy 21 (T21),trisomy 18 (T18) and open neural tube defects (ONTD), and to provide local data for supporting evidence based clinical managements. Methods · A retrospective cohort study was performed in the women who received second trimester maternal serum screening in the International Peace Maternal and Child Health Hospital between 2012 and 2014, with naturally conceived singleton pregnancies. Obstetric outcomes were followed up by searching electronic medical records within the hospital. Abnormal level of marker was defined as a MOM value ≥ 99th (P99) or ≤ 1st percentile (P1) of the overall screened population. Incidence of an adverse obstetric outcome was compared between the groups with abnormal markers and the control with all markers in normal. Results · ① A total of 25616 pregnancies were included in this study, in which 4526 were identified as having various adverse obstetric outcomes. Among them 4143 pregnancies were with isolated and 383 pregnancies were with co-occurring two or more adverse outcomes. ② When compared to pregnancies with normal levels of all three serum markers, pregnancies with decreased AFP or decreased hCG did not show associations with any adverse obstetric outcomes. However, pregnancies with increased AFP, increased hCG or decreased uE3 were at increased risk for a variety of abnormal pregnancy outcome. In 18 pregnancies with an outcome of fetal chromosomal abnormalities other than T21 and T18, 9 presented with either increased AFP, increased hCG or decreased uE3, with relative risk ratios of 13.33、35.00 and 59.00, respectively. ③ The performance of those markers tended to be improved in a subset of adverse obstetric outcomes, including low birth weight

Adult acquired aortic disease such as aortic dissection,aortic aneurysm,is common,and the treatment is complicated.Furthermore,the specific molecular etiology of this kind of disease is unknown.MicroRNA,which is a short peptide molecule,to some extent,participated in almost every aspect of biological functions.This paper aims to review the role of microRNA in molecular etiology of adult acquired aortic disease.

Objective To investigate the pathogenesis,diagnosis,treatment and prognosis of aort-oesophageal fistula(AEF).Methods Retropective analysis was performed on 6 patients presenting with AEF between January 2002 and December 2014,and relative literature was reviewed on its pathogenesis,di-agnosis,prognosis and treatment.Results Five men and 1 woman with a mean age of 49 (range,27-71 years)were recruited to the study.One case of AEF was caused by esophageal foreign body,2 cases were caused by aneurysm while the other 3 patients presented AEF after aortic surgery.All 6 patients showed he-matemesis,among whom 3 presented sentinel hemorrhage,1 presented exsanguination after sentinel hemor-rhage,2 presented sudden exsanguination.Among 4 patients with sentinel hemorrhage,2 accompanied with chest pain,1 with dysphagia and 1 with fever.Two patients had a history of hypertension.Diagnostic rate was nearly 100% by gastroscopy or CT/CTA.Four patients died from hemorrhagic shock and 2 patients re-covered from surgery.Conclusion AEF should be seriously considered for patients with a history of hyper-tension,aortic disease or esophageal foreign body presenting sentinel hemorrhage,chest pain,dysphagia,fa-tal exsanguination followed by symptom-free interval.Prompt examinations and aggressive surgery are of great significance for survival.

Objective To explore the clinical value of prospective electrocardiography-triggering high-pitch spiral acquisition by dual-source CT (HP mode ) in children with congenital heart diseases (CHD).MethodsThirty-six patients ( mean age:0.67 years,range:1 month to 2 years and 6 months; 25 males;mean weight:7.7 kg)underwent prospective ECG-triggering high-pitch spiral acquisition.The dose length product (DLP) was recorded to calculate effective dose ( ED ).Two experienced radiologists made diagnosis and assessed the overall image quality by a five-point scale independently.The consistency of their judgment was determined by Kappa statistics.Surgeries were performed in 29 patients,and conventional cardiac angiography(CCA) was performed in 7 patients.The accuracy,sensitivity and specificity of HP mode were calculated based on the surgical or CCA findings.ResultsThe DLP was (5.12 ± 1.64) mGy.cm with a range of 2.4 mGy · cm to 9.2 mGy · cm and ED was (0.125 ± 0.027 ) mSv ranging from 0.078 mSv to 0.179 mSv.The average subjective image quality score was 4.2 ± 0.7.All images were diagnosable.Two radiologists made good agreement ( K =0.774,P ＜ 0.05 ).The accuracy,sensitivity and specificity of HP mode were 98.9％,94.2％ and 99.8％,respectively.ConclusionLow radiation dose with the accurate diagnosis of anomalies makes HP mode a new choice for children with CHD.

Objective:To study the effects of LPS and TNF-? on the expression of SSeCKS and morphology as well as cytoskeleton of endothelial cell, so as to explore the role of SSeCKS in cell morphology changes.Methods:The cultured Bovine pulmonary artery endothelial cells(BPAEC) was induced by LPS, TNF-? and the expression of SSeCKS was detected by in situ hybridization,Western blot and immunohistology. Immunofluorescent staining method with confocal laser-scanning fluorescence microscope was used to observe the effects of LPS and TNF-? on the morphology of endothelial cells and the organisation of SSeCKS as well as cytoskeleton.Results:Firstly, we found that TNF-? could induce the expression of SSeCKS in a concentration and time dependent manner , meanwhile LPS had no effects on SSeCKS expression. Secondly, it was observed that LPS and TNF-? induced reorganization of F-actin and SSeCKS in endothelial cell. Thirdly,PKC inhibitor Ro-31-8220 reversed the effect of LPS,TNF-? on F-actin and SSeCKS in endothelial cells.Conclusion:The results demonstrate that TNF-? could induce endothelial cell to express SSeCKS; PKC plays a role in the reorganization of SSeCKS and F-actin in endothelial cells induced by LPS and TNF-?; the results suggest that the mechanism for reorganization of cytoskeleton induced by LPS, TNF-? be partially related to the SSeCKS of ECs.

Objective:To explore the risk factors of intracranial aneurysm interventional embolization for subarachnoid hemorrhage (SAH) perioperative infection.Methods:A retrospective analysis of the clinical data of 236 SAH patients who underwent aneurysm interventional embolization in the Department of Neurosurgery, Huangshan Shoukang Hospital from May 2018 to December 2019, and statistics of the surgical treatment effects and postoperative conditions of all patients, according to the perioperative Infective status in the early stage, the patients were divided into infected group ( n=44) and non-infected group ( n=192) according to the perioperative infection, and the clinical indicators of the patients were recorded, including age, gender, history of drinking, smoking history, history of diabetes, and whether there was any temporary blockade during the operation, aneurysm location, triacylglycerol, lipoprotein type, CT-Fisher classification, history of hypertension, aneurysm diameter, number, albumin, Hunt-Hess classification, Glasgow coma score (GCS) at admission, number of punctures. Measurement data were expressed as the mean ± standard deviation ( Mean± SD), comparison between groups was by t-test; count data comparison between groups was by Chi-square test. Logistic regression was used to analyze the risk factors of infection in SAH patients during perioperative period. Results:The treatment success rate of all SAH patients was 100%; the results of univariate analysis showed that the history of hypertension, aneurysm diameter, number, albumin, Hunt-Hess classification, GCS score at admission, and number of punctures were compared between infected group and non-infected group, the difference was statistically significant ( P<0.05); the results of multivariate Logistic regression analysis showed that history of hypertension, aneurysm diameter ≥8 mm, a large number of aneurysms, albumin ≤35.12 g/L, Hunt-Hess classification Grade Ⅲ to Ⅳ, GCS score> 5 points at admission, and number of punctures>2 times were risk factors for perioperative infection in SAH treated by interventional embolization of intracranial aneurysm; the total score of all factors in the nomogram prediction model was 314.84 points, the corresponding value was 14.96% of the perioperative infection rate of intracranial aneurysm interventional embolization for SAH. Conclusions:Interventional embolization of intracranial aneurysm for SAH can achieve good clinical results. However, history of hypertension, aneurysm diameter ≥ 8 mm, a large number of aneurysms, albumin ≤ 35.12 g/L, Hunt-Hess grade Ⅲ to Ⅳ, GCS score > 5 points at admission, number of punctures> 2 times are all independent risk factors leading to perioperative infection in patients, and clinical attention should be paid to and actively prevented.

Objective:To evaluate the safety and efficacy of the neoadventitia technique for root repair in acute type A aortic dissection(ATAAD).Methods:From January 2019 to February 2022, a total of 94 patients with ATAAD who underwent surgical treatment in Beijing Anzhen Hospital were retrospectively analyzed. According to the different treatment methods for the aortic root, the patients were divided into the neoadventitia technique group(58 cases) and the Bentall group(36 cases). The perioperative data and postoperative follow-up results of the two groups were compared, and the efficacy of the new adventitia technique in acute type A aortic dissection was analyzed.Results:There were no intraoperative deaths. The 30-day mortality was 3.4% and 5.6% in the neoadventitia group and Bentall group, respectively ( P=0.636). The cardiopulmonary bypass time[(154.3±29.8)min, P<0.001] and aortic clamp time[(94.7±20.6)min, P<0.001)]were significantly shorter in the neoadventitia group, compared with the Bentall group. Aortic regurgitation was significantly improved after the operation (0.33±0.50 vs. 1.02±0.80, P<0.001). No aortic root-related secondary intervention occurred during follow-up. There was no significant difference in mortality between the two groups( P=0.248). Conclusion:Neoadventitia root repair is a safe and feasible method for the treatment of ATAAD, which has good short-term and mid-term efficacy.

Objective:To evaluate the efficacy of new arch-clamping technique in Sun’s procedure to repair acute type A aortic dissection.Methods:67 consecutive patients with acute type A aortic dissection who underwent total arch replacement and frozen elephant trunk implantation(TAR+ FET) from Dec 2019 to Dec 2022 with using new arch-clamping technique during operation. Relative intraoperative and postoperative variables and complications were compared.Results:Cardiopulmonary bypass time was(166.66±32.81)min, the aortic occlusion time was(100.49±19.96)min, the circulatory arrest time was(3.97±1.63)min, the lowest nasopharyngeal temperature was(25.716±1.304)℃, and the lowest bladder temperature was(26.209±1.552)℃. The whole group died in hospital in 2 cases(2.98%), cerebral infarction in 3 cases(4.48%), transient neurological dysfunction in 4 cases(5.97%), paraplegia patients in 1 case(1.49%), renal failure requiring continuous dialysis in 4 cases(5.97%).Conclusion:New arch-clamping technique decrease postoperative complication, and is a safe and feasible innovative approach to effectively improve surgical outcome of Sun’s procedure for repair of acute type A aortic dissection.

Objective To explore the mid-term results of the staged total aortic replacement in Stanford type A aortic dissection.Methods During March 2009 to September 2016,a total of 49 patients with Stanford type A aortic dissection in Beijing Anzhen Hospital cardiovascular center underwent total aortic replacement with a median age of 36 (27,41 years),male 36 (73.5％) cases.30 (61.2％) cases of them combined with Marfan syndrome.Results The interval between two stage operation was 23 (10,57) months.In the first stage operation,45 (91.8％) cases underwent Sun's procedure,2 (4.1％) underwent total aortic arch replacement,2 (4.1％) cases underwent classic elephant trunk and total aortic arch replacement.All patients underwent thoracoabdominal aortic repair(TAAAR).Deep hypothermic circulatory arrest surgery was 12(24.5％)cases in the second stage.7 (14.3％)cases dead postoperative.Spinal cord related complications happened in 3 (6.1％) cases with stroke in 2(4.1％) cases,acute renal insufficiency in 7(14.3 ％) cases,respiratory insufficiency in 7 cases (14.3％),re-operation for hemostasis in 3 (6.1％) cases and gastrointestinal bleeding in 3 cases(6.1％).Univariate analysis showed that the interval between two stage operation,operation time,deep hypothermic circulatory arrest surgery are risk factors for in-hospital mortality;multivariate analysis showed that deep hypothermic circulatory arrest surgery and the interval between two stage operation were independent risk factors for in-hospital mortality.3 years,5 years survival rate were 94.4％ and 78.7％.Conclusion For Stanford type A dissection especially the thoracoabdominal aortic expands,staged total aortic replacement shows good mid-term results.Block stentgraft can reduce the use of deep hypothermic circulatory arrests to decrease the mortality.