Objective To compare the results of Danielson procedure with and without prosthetic valve ring in treating Ebstein anomaly and to define the effect of prosthetic valve ring on the procedure.Methods From January 2006 to December 2009,31 cases of Ebstein anomaly over 10 years old were classified as type A or type B according the Carpentier＇s classification scheme.Patients were treated by Danielson procedure or Danielson procedure plus prosthetic valve ring at Anzhen hospital.They were retrospectively classified as Danielson procedure group (group A,n =19) and Danielson procedure plus prosthetic valve ring group (group B,n =12 ).Results There was 1 early in-hospital death due to lung infection and hypoxemia in group A,and no early death in group B ( Fisher exact test,P =0.51 ).The mean follow-up time was ( 23.0 ± 18.5 ) months (5 -41 months).The cumulative follow-up time was 59.42 patient-years.There was one late death in group A due to the redo tricuspid valve plastic procedure because of severe tricuspid regurgitation,and no late death in group B.With echocardiography inspection,11 patients had mild and 7 had moderate to severe tricuspid regurgitation in group A,and only 2 mild tricuspid regurgitation in group B.The tricuspid valve competence after surgery in group B was better than in group A ( Fisher exact test,P=0.024).The 6-minute walk distance test (6MWD) in group B was significantly better than in group A(415 ±41 )m vs ( 382 ± 46 ) m( t test,P =0.047 ).The New York heart functional class in group B was statistically better than in Group A ( P =0.024).Conclusion Although there was no significant difference in the early and late mortality rate between the two groups after surgery,Danielson procedure plus prosthetic valve ring was better than pure Danielson procedure in prevention of late tricuspid regurgitation recurrence,heart function and 6MWD test during follow-up.

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.

ObjectiveTo explore the experiences of treatment of aortic root aneurysm and mitral valve disease through the incision of aorta.MethodsFrom Mar.2009 to Dec.2010, sixteen patients with aortic root aneurysm and mitral valve disease were operated by transaortic incision.After the leaflets of aortic valve were excised, mitral valve replacement or plasty was performed.There were 13 males and 3 females.The age ranged from 18 to 75 years old with a mean of (40 ± 10) years.The operation procedures included Bentall plus mitral valve replacement in 12 patients, Bentall plus mitral valve plasty in 1,Bentall + total arch replacement + stent elephant trunk + mitral valve plasty in 1, Bentall plus mitral valve plasty and CABG in 1.In 12 patients underwent mitral valve replacement, 11 were using continuous suture and interrupt mattress suture in 1.Four patients underwent mitral valve plasty, the procedure of banding mitral valve leaflets junctions was used.All patients were followed up through telephone and out-patient service.Transthoracic echocardiogram was performed before discharge and 3-, 6-,12-months after operation.Follow-up including cardiac function, valvular and perioperative complications.Results There were 2 re-thoractomy because of bleeding.One patient with pulmonary infection was cured by antibiotics.No death occurred in hospital.Patients were followed-up for 1 to 19 months with a mean of (7 ±5) months.No death occurred during follow-up period.There were no valve-related complications (embolism, bleeding, mitral valve dysfunction).Heart function was improved in all patients and graded as class Ⅰ to Ⅱ (NYHA).Two patients had trace regurgitation after mitral valve plasty when discharged.One patient had mild mitral valve regurgitation was found after mitral valve replacement.There was no further valve exacerbation for above 3 patients during follow-up period.ConclusionTransanrtic mitral valve operation is feasible in patients with aortic root aneurysm and mitral valve disease.

Objective:To retrospectively analyze the characteristics and influencing factors of liver function changes in 111 elderly patients with COVID-19 pneumonia.Methods:111 elderly patients with COVID-19 admitted to the Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from February 5 to March 3, 2020 were enrolled. According to the severity of disease and liver function condition, they were divided into severe group ( n=40), normal group ( n=71), abnormal liver function group ( n=86) and normal liver function group ( n=25). The indexes related to liver function changes [total bilirubin (TBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and γ-glutamyl transferase (GGT)] and related influencing factors were analyzed. Results:Among 111 cases, 86 (77.5%) had abnormal liver function of varying degrees, and 28 (25.2%) had liver injury. The abnormal rates of TBil, AST, ALP and GGT were significantly higher in the severe group than normal group ( P<0.05). There were no significant differences in age, ribavirin, glucocorticoid and the application of lopinavir-ritonavir tablets between the abnormal liver function and the normal group ( P>0.05). The proportion of male was significantly higher in the abnormal liver function than normal liver function group ( P<0.05). Conclusion:Elderly COVID-19 patients have a higher proportion of abnormal liver function, and patients in the severe group are more likely to have higher level of TB, AST, ALP and GGT. The abnormal liver function may be related to the direct viral infection of the liver and the inflammatory immune response of the body after infection in elderly patients.

Objective To study the relationship between renal failure and severe postoperative hypoxemia of patients received surgical procedure for Stanford A aortic dissection.Methods Clinical data of 411 consecutive patients from January 2014 to April 2015,who received surgical procedure for Stanford A aortic dissection in Department of Cardiovascular Surgery of Beijing Anzhen Hospital,were collected retrospectively.The appearance of severe postoperative hypoxemia was recorded in all the cases.All the data about potential prognostic factors was put into the database and analyzed by univariate and multivariate Logistic regression respectively.Results Severe postoperative hypoxemia(PO2/FiO2＜100 mmHg,1 mmHg=0.133 kPa)happened on 69 cases within 48 hours after procedures,with the incidence rate of 17.1％.Both univariate and multivariate Logistic regression indicated the influence that preoperative creatinine clearance rate had on severe postoperative hypoxemia showed no statistical significance.However,the influence of preoperative serum creatinine showed statistical significance(OR=1.009,95％CI:1.000 to 1.018,P=0.048).Conclusions The preoperative creatinine clearance rate of patients has no direct relationship with severe postoperative hypoxemia.But the preoperative serum creatinine could be regarded as an independent predictor of severe postoperative hypoxemia.

Objective To study the relationship between renal failure and severe postoperative hypoxemia of patients received surgical procedure for Stanford A aortic dissection.Methods Clinical data of 411 consecutive patients from January 2014 to April 2015,who received surgical procedure for Stanford A aortic dissection in Department of Cardiovascular Surgery of Beijing Anzhen Hospital,were collected retrospectively.The appearance of severe postoperative hypoxemia was recorded in all the cases.All the data about potential prognostic factors was put into the database and analyzed by univariate and multivariate Logistic regression respectively.Results Severe postoperative hypoxemia(PO2/FiO2＜100 mmHg,1 mmHg=0.133 kPa)happened on 69 cases within 48 hours after procedures,with the incidence rate of 17.1％.Both univariate and multivariate Logistic regression indicated the influence that preoperative creatinine clearance rate had on severe postoperative hypoxemia showed no statistical significance.However,the influence of preoperative serum creatinine showed statistical significance(OR=1.009,95％CI:1.000 to 1.018,P=0.048).Conclusions The preoperative creatinine clearance rate of patients has no direct relationship with severe postoperative hypoxemia.But the preoperative serum creatinine could be regarded as an independent predictor of severe postoperative hypoxemia.

Background::Dual-energy computed tomography (DECT) is purported to accurately distinguish uric acid stones from non-uric acid stones. However, whether DECT can accurately discriminate ammonium urate stones from uric acid stones remains unknown. Therefore, we aimed to explore whether they can be accurately identified by DECT and to develop a radiomics model to assist in distinguishing them.Methods::This research included two steps. For the first purpose to evaluate the accuracy of DECT in the diagnosis of uric acid stones, 178 urolithiasis patients who underwent preoperative DECT between September 2016 and December 2019 were enrolled. For model construction, 93, 40, and 109 eligible urolithiasis patients treated between February 2013 and October 2022 were assigned to the training, internal validation, and external validation sets, respectively. Radiomics features were extracted from non-contrast CT images, and the least absolute shrinkage and selection operator (LASSO) algorithm was used to develop a radiomics signature. Then, a radiomics model incorporating the radiomics signature and clinical predictors was constructed. The performance of the model (discrimination, calibration, and clinical usefulness) was evaluated.Results::When patients with ammonium urate stones were included in the analysis, the accuracy of DECT in the diagnosis of uric acid stones was significantly decreased. Sixty-two percent of ammonium urate stones were mistakenly diagnosed as uric acid stones by DECT. A radiomics model incorporating the radiomics signature, urine pH value, and urine white blood cell count was constructed. The model achieved good calibration and discrimination {area under the receiver operating characteristic curve (AUC; 95% confidence interval [CI]), 0.944 (0.899–0.989)}, which was internally and externally validated with AUCs of 0.895 (95% CI, 0.796–0.995) and 0.870 (95% CI, 0.769–0.972), respectively. Decision curve analysis revealed the clinical usefulness of the model.Conclusions::DECT cannot accurately differentiate ammonium urate stones from uric acid stones. Our proposed radiomics model can serve as a complementary diagnostic tool for distinguishing them in vivo.

Objective:To explore the correlation between intraoperative cooling temperature and postoperative neurological prognosis in aortic arch surgery.Methods:We observed and collected data from 118 patients who underwent open arch replacement surgery by a single surgeon with mild-to-moderate hypothermic circulatory arrest, from January 2017 to December 2020, in Beijing Anzhen Hospital. According to the bladder temperature during the circulation arrest, 118 patients were divided into 3 groups: T1 group[n=39, (25.58±0.64)℃]; T2 group[n=39, (28.21±0.77)℃]; T3 group[n=40, (30.95±0.97)℃]. Clinical data and operative data were analyzed to assess difference between these 3 groups. Analyze the risk factors of postoperative neurological complications, and explore further the correlation between intraoperative core temperature and postoperative neurological prognosis.Results:Among the 118 patients, the average operation, cardiopulmonary bypass (CPB), block, circulatory arrest, and selective cerebral perfusion (SCP) time were 6.64 h, 188.5 min, 104.19 min, 23.93 min, 28.81 min, respectively. The in-hospital death occurred in 8 patients(6.78%), and permanent neurological dysfunction (PND) in 13 patients(11.02%), transient neurological dysfunction (TND) in 25 patients(21.19%). There was no significant difference in the deaths among the three groups. The incidence of TND and PND in the T3 group was significantly reduced ( P=0.042; P=0.045). In addition, the volume of drainage during the first 24 h and the incidence of re-exploration for bleeding had a relatively obvious decreasing trend ( P=0.005; P=0.012). Through multiple regression analysis, under the adjusted model, the core temperature was independently correlated with the incidence of postoperative PND ( OR=0.51; 95% CI: 0.27-0.97; P=0.0389); in group comparison, the relatively higher core temperature was an independent protective factor for postoperative PND ( OR=0.04; 95% CI: 0.00-0.91; P=0.0434). Conclusion:Our research had preliminary proved that in the open arch replacement surgery, mild hypothermia can reduce the incidence of some complications of deep hypothermia, at the same time improve the prognosis of the neurological prognosis, reduce the incidence of postoperative PND.

Taohe Chengqitang is a classical prescription published in The Catalogue of Ancient Classic Recipes (The First Batch). This study systematically summarized traditional Chinese medicine (TCM) ancient books and modern clinical reports on Taohe Chengqitang and investigated its origin， composition， basis, and historical evolution in processing requirements， dosage， preparation and administration， and functions. The findings indicated different opinions on drug basis， preparation of decoction pieces, and drug dosage conversion. Based on sufficient literature review, the actual development needs of classical prescriptions, and the usage habits of modern clinical practice， this study recommended dried mature seeds of Prunus persica or P. davidiana for Persicae Semen， dried twigs of Cinnamomum cassia for Cinnamomi Ramulus， honey-fried Glycyrrhiza uralensis for Glycyrrhizae Radix et Rhizoma, raw Rheum palmatum, R. tanguticum, or R. offìcinale for Rhei Radix et Rhizoma, and mirabilite for Natrii Sulfas. In terms of drug dosage， the doses directed converted from weights and measures in the Han dynasty were large. According to the common doses in modern clinical practice, conversion was carried out based on 6 g of Cinnamomi Ramulus, 6 g of Natrii Sulfas, 6 g of Glycyrrhizae Radix et Rhizoma, and 12 g of Rhei Radix et Rhizoma. The weight of Persicae Semen should be determined according to the actual measurement. In terms of preparation and administration, the drugs in the pot were decocted with 1 400 mL of water to obtain 500 mL of decoction, which was filtered and slightly boiled in the presence of Natrii Sulfas. About 100 mL of warm decoction was taken before meals， three times a day. It was recorded in the ancient books that Taohe Chengqitang was indicated for the syndromes of heat invading the bladder and accumulating inside in the case of released exterior syndrome in Taiyang. After symptom-based flexible application by doctors, it is currently commonly used in the treatment of diabetic nephropathy， constipation， chronic renal failure, and other diseases.