Adult ; Humans ; Retrospective Studies ; Pneumonia ; Community-Acquired Infections/epidemiology* ; Hospitalization

Objective    To discuss the efficacy of type Ⅱ hybrid aortic arch repair for type A aortic dissection in patients of different age groups. Methods    We retrospectively analyzed the clinical data of 126 patients with type A aortic dissection admitted to the Fuwai Hospital between January 2016 and December 2018, including 78 (61.9%) males and 48 (38.1%) females, with an average age of 61.8±6.9 years. The patients were divided into an elderly group (≥60 years, n=82) and a non-elderly group (<60 years, n=44). The preoperative, intraoperative and postoperative data of patients in the two groups were compared. Results    The age between the elderly and non-elderly group was significantly different (65.9±4.1 years vs. 54.3±4.1 years, P<0.010), and no significant difference was found between the two groups in other preoperative baseline data. There were 6 (4.8%) patients of early death, 3 (2.4%) patients of stroke and 2 (1.6%) patients of paralysis. A total of 194 stents were implanted, and the average dimeter of the stents was 33.6±1.8 mm and the average length was 199.0±6.7 mm. The non-elderly group had shorter mechanical ventilation time (31.9±41.7 h vs. 61.0±89.2 h, P=0.043) and ICU stay time (77.8±51.4 h vs. 143.1±114.4 h, P<0.001) than the elderly group. There was no significant difference in in-hospital mortality rate, reoperation rate or survival rate between the two groups (P>0.05). Follow-up time was 1-43 (22.6±10.8) months, and 3 patients were lost. There were 104 (82.5%) patients of complete thrombus formation of false lumen in stent and endoleak was reported in 11 (9.2%) patients. Conclusion    Type Ⅱ hybrid aortic arch repair offers an alternative approach to acute type A aortic dissection with acceptable early and mid-term clinical effects. The non-elderly patients have a similar early treatment effect to the elderly patients, but have a better mid-term outcome.

Aortic graft infections(AGI) are uncommon complications of aortic surgery, although they carry a high mortality. Due to its special anatomical location, the thoracic aorta has less surrounding covered tissue. Once the graft infection occurs, the condition is often more dangerous. Therefore, the treatment of AGI of thoracic aorta is particularly important. This article reviews the surgical treatment of thoracic aorta graft infections.

Objective     To explore impact of climate change on aortic dissection and to put forward a new way about prediction and prevention of aortic dissection. Methods     We retrospectively analyzed the characteristics of acute aortic dissection patients came from Hebei province in Fuwai Hospital between 2010 and 2016 year. Meanwhile, we collected monthly maximum temperature, minimum temperature, average temperature, average pressure, amount of rainfall, sunshine, humidity and other meteorological data. Generalized model was implied to explore climate change and the incidence of aortic dissection. Results     A total of 1 121 acute aortic dissection patients from Hebei province were admitted in Fuwai Hospital during the period of 6 years. There were 774 patients were type A aortic dissection, and 347 patients were type B aortic dissection. The average age was 51.4±12.0 years. There were 873 males and 248 females. There were 889 (79.3%) patients with hypertension, 99 (8.83%) with Marfan syndrome. It was found that temperature, humidity and air pressure were all statistically significant for indication aortic dissection through single variable analysis (P<0.01). The temperature was only variable by one-way analysis of variance (P<0.01). The lowest temperature has the best predictive effect on the occurrence of aortic dissection. The relative risk was 1.02 with 95% confidence interval 1.02 to 1.03. Conclusion     The change of climatic conditions can affect the occurrence of aortic dissection, and the lowest temperature is an important trigger factor for aortic dissection onset.

Objective: To explore the relationship between the incidence of aortic dissection and climate change. Methods: The characteristics of 345 acute aortic dissection patients came from Beijing in Department of Vascular Surgery, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College from January 2005 to December 2015 were analyzed, retrospectively. There were 266 male and 79 female patients with a mean age of (49±12) years. There were 209 cases of Stanford type A aortic dissection, and 136 cases of type B. According to Fuwai aortic dissection classification: type A 8 cases, type B 95 cases, type Cp 13 cases, type Ct 187 cases, type Cd 40 cases, type D 2 cases. Meanwhile, monthly maximum temperature, minimum temperature, average temperature, average pressure, amount of rainfall, sunshine, relative humidity and other meteorological data were collected. Rank-sum test was used to analyze the difference of onset of aortic dissection in different seasons and months. Generalized additive models were implied to explore climate change and the onset of aortic dissection. Results: The onset of aortic dissection was related to season. Winter had higher morbidity compared to summer (M(Q_R): 3(2) vs. 2(2), Z=1.97, P=0.05). The occurrence of aortic dissection was associated with month.December had the largest quantity, July had the least (2(3) vs. 2(1), Z=2.42, P=0.02). The mean temperature was statistically significant for indicating the change of aortic dissection onset. It meaned that onset probability was increased with the decrease of temperature (RR=1.01, 95%CI: 1.00 to 1.02, P=0.04). Conclusions The onset of aortic dissection had something to do with season and month. The incidence of aortic dissection increases with temperature decreases.

Objective Nowadays, emergency surgery is the most important method to treat acute type A aortic dissec-tion.There are many factors that can affect the prognosis, but the relationship between time period and the prognosis of aortic dissection surgery has not been reported.Therefore, the purpose of this study was to explore the relationship between different time periods and the prognosis of acute type A aortic dissection surgery .Methods We retrospectively analyzed the characteris-tics of acute type A aortic dissection surgery in Fuwai Hospital from 2010 to 2015.All patients were divided into two groups ac-cording to different time period .Propensity matching analysis was used to compare in-hospital mortality and post-operative com-plications of these groups.Results There were 698 cases acute aortic dissection surgery during study period.321 cases were operated in the nighttime(45.98％), the others were operated during daytime(54.02％).After propensity score matching, the operation time, extracorporeal bypass time, and the aortic blocking time of nighttime group were longer than daytime group , and there was a statistical difference(P<0.01).There was a statistical difference between the two groups of postoperative con-tinuous renal replacement therapy.Nighttime group had higher incidence(15.94％ vs.5.64 ％, P<0.01).There was statis-tically significant in 30-day mortality between daytime group and nighttime group(5.26％ vs.10.53％, P=0.03).The mul-tiple-factor risk analysis of 30-day mortality in the whole group found that nighttime surgery was an independent risk factor ( OR 2.13, 95％CI 1.19-3.81, P=0.01).Conclusion For acute type A aortic dissection surgery, nighttime surgery may be the important factor for increasing 30-day mortality.For relatively stable patients, avoiding nighttime surgery may increase survival rate.

Objective To investigate the significance of fibroblast growth factor 23 in metabolic bone disease of prematuriy.Methods 60 patients who had been treated in our hospital from March 2016 to March 2017 were included in this study.Blood biochemistry was examined two weeks after birth,and values of blood phosphorus, serum calcium and alkaline phosphatase were recorded. Serum levels of 25 hydroxyvitamin D3,parathyroid hormone and fibroblast growth factor 23 were detected two weeks after birth. 20 premature infants with metabolic bone disease were selected as a study group. 40 infants without metabolic bone disease were treated as a control group. Two weeks after treatment,the above indicators were measured and compared in the study group. Results Serum levels of 25 hydroxyvitamin D3,parathyroid hormone and fibroblast growth factor 23 were compared between the two groups 2 weeks after birth,the difference was statistically significant(P<0.05).Levels of serum parathyroid hormone and fibroblast growth factor 23 in the study group were not statistically significant after treat-ment(P > 0.05). Levels of 25 hydroxy vitamin D3 in the study group had statistically significant after treatment (P<0.05).Conclusions Early detection of fibroblast growth factor 23 can reflect metabolic bone disease in pre-term infants.It suggests that vitamin D should be adequately supplemented in early.

Objective To compare the early and late outcomes of different techniques of proximal root reconstruction during the repair of acute type A aortic dissection, including aortic valve (AV) resuspension, isolated supracoronary ascending aorta replacement, and aortic root replacement procedure (Bentall). Methods All patients who underwent acute Type A aortic dissection repair between January 2010 and December 2015 in Fuwai Hospital were retrospectively analyzed in our study. There were 673 patients with 512 males and 161 females at mean age of 48.80±11.22 years. There were 403 patients as an AV resuspension group (287 males and 116 females at average age of 50.61±9.95 years), 95 patients as an isolated supracoronary ascending aorta replacement group (76 males and 19 females at average of 49.83±12.21 years), and 175 patients as an AV resuspension group (149 males and 26 females at average of 44.07±11.99 years). The differences of preoperative aortic insufficiency, intraoperative variables and postoperative aortic insufficiency were compared in the three groups. Results Five hundred ninety-one patients (87.8%) had aortic valve commissure involved. The proportion of mild degree, moderate degree, and severe degree among the three groups were statistically significant (31.7%, 52.4%, 15.9%; 87.4%, 12.6%, 0.0%; 23.4%, 56.0%, 20.6%; P < 0.01). The diameter of aortic sinus in the three groups was 39.06±5.11 mm, 38.27±4.41 mm, 50.39±6.22 mm, respectively, with a statistical difference ( P< 0.01). The duration of surgery, cardiopulmonary bypass time, aorta cross-clamp time were also statistically significant (P < 0.01). The in-hospital mortality was 11.73% in the whole group. There was no difference among the three groups (12.2% vs. 13.7% vs. 9.7%, P=0.58). Five-year survival rate was similar (83.06% vs. 81.27% vs. 83.05%, P=0.85). The 5-year free from over moderate aortic insufficiency rate were 95.2%, 98.6% and 100% respectively, with no statistical difference (P=0.07). There was no re-do operation for aortic root diseases in the whole group. Conclusion According to aortic root processing strategy in our center, AV resuspension, isolated supracoronary ascending aorta replacement, and aortic root replacement can achieve satisfactory results. However, there is higher incidence of aortic insufficiency through AV resuspension. Further study is needed to evaluate its efficacy.

Objective This study was designed to evaluate the prognosis of the reconstruction of left subclavian artery (LSA)in thoracic endovascular aortic repair(TEVAR)for patients with aortic arch disease.Methods From January 2010 to August 2016,55 patients with aortic arch disease(left vertebral artery dominance)who had undergone TEVAR including LSA covered in Fuwai Hospital were enrolled.28 patients received concomitant reconstruction of LSA.The study endpoints includ-ed: postoperative death, reoperation, stroke and aorta-related adverse events.Results Follow-up data were obtained from all patients.The mean follow-up time was(30.0 ±17.5)months.All patients were diagnosed with left vertebral artery dominance by preoperative computerized tomography of aorta.The preoperative diameter of left vertebral artery was(4.88 ±0.85)mm while the right vertebral artery was(3.00 ±0.75)mm.There were no in-hospital deaths,reoperations and aorta-related adverse events.Three patients died and 2 patients experienced Type Ⅳ endoleak during the follow up.Conclusion The mid-term prognosis of the reconstruction of left subclavian artery in thoracic endovascular aortic repair for patients with aortic arch disease are good and long-term follow-up is necessary.

Objective To study the antitumor effects of dendritic cell vaccine induced by astragalus polysaccha?rides on S180 tumor-bearing mice, and its possible mechanism. Methods Dendritic cells derived from mouse bone marrow were induced maturation by astragalus polysaccharides and loaded with S180 tumor antigen to prepare tumor vaccine. Tu?mor-bearing mice were divided into four groups and treated on day-5 and day-10 respectively. Group A was injected with NS, Group B with CTX (50 mg/kg), Group C with dendritic cells induced by astragalus polysaccharides and Group D with dendritic cells induced by tumor necrosis factor (TNF)-α. After 12 days of tumor-bearing, the animals were killed. The sub?cutaneous sarcoma, thymus and spleen were separated and weighted. The inhibitory rate, thymus index and spleen index were then calculated. ELISA assay was used to detect the levels of interleukin (IL)-4, interferon (IFN)-γin serum of tumor bearing mice. Results The tumor inhibition rate was higher in astragalus polysaccharide group and cytokine group than that of CTX group (64.25%, 64.10%vs 35.11%). The thymus index was higher in astragalus polysaccharide group and cyto?kine group than that of CTX group (1.69 ± 0.26, 1.74 ± 0.38 vs 1.45 ± 0.22). The spleen index was higher in astragalus poly?saccharide group and cytokine group than that of CTX group (5.44 ± 0.76, 5.31 ± 0.81 vs 3.54 ± 0.52). The level of IL-4 was lower in astragalus polysaccharide group and cytokine group than that of CTX group (15.66±2.57, 14.72 ± 4.84 vs 23.95 ± 6.07). The level of IFN-γwas higher in astragalus polysaccharide group and cytokine group than that of CTX group (16.54 ± 3.71, 17.20 ± 2.03 vs 10.37 ± 2.19). All the differences were statistically significant (P<0.05). Conclusion Dendritic cell vaccine induced by astragalus polysaccharides can effectively inhibit tumor growth. Its mechanism may be associated with the promotion spleen index and thymus index of S180 tumor-bearing mice, the effective correction of Th1/Th2 imbalance in?duced by tumor, and the enhancement of antitumor immune responses.