Objective:To evaluate the outcomes of minimally invasive therapy for aortic arch pathology after ascending aortic replacement.Methods:A retrospective analysis was conducted at the Department of Cardiovascular Surgery, West China Hospital of Sichuan University from 2016 to 2024. After multidisciplinary discussion, these included patients were evaluated to be at high risk for traditional open surgery. Various minimally invasive repair techniques were employed, including Ⅳb hybrid technique, physician-modified endograft and novel unibody endograft. The study outcomes were technical success, in-hospital and follow-up mortality, stroke, endoleak, and the patency of the supra-aortic vessels.Results:A total of 40 patients(32 males and 8 females) with a median age of 60 years old were included in this study. The technique success rate was 100%, with no deaths or strokes reported. The patency of the supra-aortic vessels was 100%. 10 patients underwent Type Ⅳb hybrid surgery without any endoleaks occurring. Among the 22 patients who received physician-modified endograft, endoleaks were observed in 2 cases. One of these type Ⅰc endoleaks persisted and underwent reintervention. One patient underwent femoral artery replacement due to vascular injury. For the 8 patients who received novel unibody endograft, one case required reintervention due to persistent type Ⅰc endoleaks.Conclusion:With the development of different endovascular techniques and novel branched endograft, patients with aortic arch pathology who are at high risk for redo open surgery can achieve favorable outcomes with various minimal invasive techniques. However, long-term and large-sample follow-up studies are needed for further evaluation.

Objective To investigate the clinical efficacy of Zhikang Capsules plus Compound Huangbai Lotion for retention enema in the treatment of patients with mild to moderate distal ulcerative colitis(UC)of damp-heat in large intestine type,and to observe their effects on the serum levels of pro-inflammatory cytokines of tumor necrosis factor α(TNF-α),interleukin 6(IL-6)and C-reactive protein(CRP).Methods A total of 110 patients with mild to moderate distal UC of damp-heat in large intestine type who were treated in the Outpatient Clinics and Wards of the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine from October 2022 to December 2023 were randomly divided into an observation group and a control group according to random number table method,with 55 patients in each group.The control group was given retention enema with 1 g of Xilei Powder and 50 mL of Compound Huangbai Lotion before going to bed every night,while the observation group was given retention enema with 2.4 g of Zhikang Capsules and 50 mL of Compound Huangbai Lotion before going to bed every night The course of treatment for the two groups covered 14 days.The changes in the serum inflammation factors,coagulation function indicators,traditional Chinese medicine(TCM)syndrome scores,and the Inflammatory Bowel Disease Quality of Life Questionnaire(IBDQ)scores in the two groups were observed before and after treatment.After treatment,the clinical efficacy and drug safety in the two groups were evaluated.Results(1)After 14 days of treatment,the total effective rate of the observation group was 90.91％(50/55)and that of the control group was 80.00％(44/55),and the intergroup comparison(tested by rank sum test)showed that the therapeutic efficacy of the observation group was significantly superior to that of the control group(P＜0.01).(2)After treatment,the serum levels of inflammation factors of TNF-α,IL-6,and CRP patients in the two groups were decreased compared with those before treatment(P＜0.05),and the decrease in the observation group was significantly superior to that in the control group(P＜0.05 or P＜0.01).(3)After treatment,the prothrombin time(PT)and fibrinogen(FIB)of the two groups of patients were improved compared with those before treatment(P＜0.05),while the improvement of thrombin time(TT)and activated partial thromboplastin time(APTT)were not obvious when compared with those before treatment(P＞0.05);the comparison between the two groups showed that the improvement of PT and FIB in the observation group was significantly superior to that in the control group(P＜0.05 or P＜0.01).(4)After treatment,the scores of TCM symptoms of diarrhea,mucous-purulent and bloody stool,tenesmus,scorching sensation of the anus in the two groups were decreased compared with those before treatment(P＜0.05),and the decrease in the observation group was significantly superior to that in the control group(P＜0.05 or P＜0.01).(5)After treatment,the scores of IBDQ items of general symptoms,intestinal symptoms,social functioning,emotional role functioning in the two groups were increased compared with those before treatment(P＜0.05),and the increase in the observation group was significantly superior to that in the control group(P＜0.01).(6)During the treatment,no obvious adverse reactions occurred in the two groups,with higher safety.Conclusion Zhikang Capsules plus Compound Huangbai Lotion for retention enema are effective and safe in treating mild to moderate distal UC of damp-heat in large intestine type.The therapy can effectively control the illness of UC,alleviate the clinical symptoms and negative emotions,improve the inflammatory response and coagulation function,and enhance the quality of life of the patients.

Objective:To evaluate the outcomes of minimally invasive therapy for aortic arch pathology after ascending aortic replacement.Methods:A retrospective analysis was conducted at the Department of Cardiovascular Surgery, West China Hospital of Sichuan University from 2016 to 2024. After multidisciplinary discussion, these included patients were evaluated to be at high risk for traditional open surgery. Various minimally invasive repair techniques were employed, including Ⅳb hybrid technique, physician-modified endograft and novel unibody endograft. The study outcomes were technical success, in-hospital and follow-up mortality, stroke, endoleak, and the patency of the supra-aortic vessels.Results:A total of 40 patients(32 males and 8 females) with a median age of 60 years old were included in this study. The technique success rate was 100%, with no deaths or strokes reported. The patency of the supra-aortic vessels was 100%. 10 patients underwent Type Ⅳb hybrid surgery without any endoleaks occurring. Among the 22 patients who received physician-modified endograft, endoleaks were observed in 2 cases. One of these type Ⅰc endoleaks persisted and underwent reintervention. One patient underwent femoral artery replacement due to vascular injury. For the 8 patients who received novel unibody endograft, one case required reintervention due to persistent type Ⅰc endoleaks.Conclusion:With the development of different endovascular techniques and novel branched endograft, patients with aortic arch pathology who are at high risk for redo open surgery can achieve favorable outcomes with various minimal invasive techniques. However, long-term and large-sample follow-up studies are needed for further evaluation.

Objective To evaluate the clinical efficacy of two-stage retrograde hybrid repair for acute aortic dissection involving the aortic arch complicated with distal malperfusion syndrome. Methods From May 2019 to December 2022, the patients presented with acute aortic dissection involving the aortic arch complicated with distal malperfusion syndrome treated in the Department of Cardiovascular Surgery of West China Hospital, Sichuan University were enrolled. After preoperative evaluation, all patients underwent priority emergency interventional surgery to improve distal malperfusion, and then underwent two-stage hybrid surgery to repair proximal aortic lesions. The perioperative clinical and imaging data were retrospectively analyzed. Results Five patients were collected, including 4 males and 1 female, with a median age of 58 years. The main manifestations were lower limb ischemia and renal insufficiency in 3 patients, and poor intestinal perfusion in 2 patients. All patients were given priority to interventional surgery to implant graft stents or bare stents and necessary branch artery intervention, and then successfully performed two-stage hybrid surgery, including type Ⅰhybrid surgery for 2 patients, type Ⅱ hybrid surgery for 1 patient and type Ⅲ hybrid surgery for the other 2 patients, with a success rate of 100.0%. All patients were discharged successfully, and the function of the organs with poor perfusion returned to normal. Only 1 patient recovered to grade 4 muscle strength of the diseased lower limbs upon discharge. No adverse events such as amputation, exploratory laparotomy and intestinal resection or long-term hemodialysis occurred. Conclusion The application of two-stage retrograde hybrid repair in the surgical treatment of acute aortic dissection involving the aortic arch complicated with distal malperfusion syndrome is safe and effective, and is helpful to improve the perioperative survival rate, and clinical outcomes of such patients.

Objective:To evaluate the efficacy of esketamine combined with different doses of remimazolam for induction of general anesthesia in pediatric patients.Methods:One hundred and sixty pediatric patients of either sex, aged 3-6 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, with body mass index of 13-20 kg/m 2, undergoing elective general anesthesia under a laryngeal mask, were divided into 4 groups ( n=40 each) by the random number table method: esketamine combined with propofol group (KP group) and esketamine combined with different doses of remimazolam group (0.2, 0.3, 0.4 mg/kg) groups (KR1 group, KR2 group, KR3 group). Esketamine 0.8 mg/kg was intravenously injected in the preanesthesia room. After entering the operating room, propofol 2.5 mg/kg was intravenously injected in KP group, and remimazolam 0.2, 0.3 and 0.4 mg/kg were intravenously injected in KR1, KR2 and KR3 groups, respectively. When the child lost consciousness and the Modified Observer′s Assessment of Alertness/Sedation Scale score<1, sufentanil and mevacurium were intravenously injected. When the Modified Observer′s Assessment of Alertness/Sedation Scale score≥1, rescue sedation was performed, and 3 min later the laryngeal mask airway was inserted. The onset time of sedation, response to laryngeal mask airway placement, rescue sedation, hypotension, tachycardia, bradycardia, bucking, hiccup, injection pain and apnea were recorded, and the increase rate of perfusion index (PI) was calculated. Results:No response to laryngeal mask implantation occurred in the four groups. Compared with KP group, the onset time of sedation was significantly prolonged, the incidence of hypotension, bradycardia, injection pain and apnea was decreased, the incidence of tachycardia was increased, and the increase rate of PI was decreased in KR1, KR2 and KR3 groups, and the rate of rescue sedation and incidence of bucking were increased in KR1 and KR2 groups ( P<0.05). Compared with KR1 group, the onset time of sedation was significantly shortened in KR2 group and KR3 group, and the rate of rescue sedation and incidence of bucking were decreased in KR3 group ( P<0.05). Compared with KR2 group, the onset time of sedation was significantly shortened, and the rate of rescue sedation was decreased in KR3 group ( P<0.05). There was no significant difference in the increase rate of PI, hypotension, bradycardia, tachycardia, injection pain and apnea among KR1, KR2 and KR3 groups ( P>0.05). There was no significant difference in the incidence of hiccup among the four groups ( P>0.05). Conclusions:Esketamine 0.8 mg/kg combined with remimazolam 0.4 mg/kg can be safely and effectively used for anesthesia induction and has milder inhibition of respiration and circulation as compared with esketamine combined with propofol in pediatric patients.

Objective To investigate the clinical efficacy of transjugular intrahepatic portosystemic shunt(TIPS)combined with indwelling catheter-directed thrombolysis for the treatment of portal vein thrombosis(PVT).Methods The clinical efficacy of 307 patients with portal hypertension complicated by PVT,who received successful TIPS combined with indwelling catheter-directed thrombolysis at the Affiliated Beijing Shijitan Hospital of Capital Medical University of China between January 2016 and December 2019,were retrospectively analyzed.Before and after TIPS,the inferior vena cava pressure(IVCP)and portal vein pressure(PVP)were measured,and the pre-TIPS,post-TIPS(before thrombolysis),and post-thrombolysis portal pressure gradient(PPG,PPG=PVP-IVCP)was separately calculated.Reexamination of portal venography DSA was performed to determine the degree of PVT disappearance and whether the shunt was unobstructed.All patients were followed up for one year.Results The pre-TIPS,post-TIPS(before thrombolysis),and post-thrombolysis mean PPG was(24.50±6.91)mmHg,(18.51±5.11)mmHg,and(10.17±3.97)mmHg,respectively.The post-thrombolysis mean PPG was strikingly lower than the pre-thrombolysis values,the differences were statistically significant(P＜0.001).Among the 307 patients,complete disappearance of PVT was observed in 221(72.3%),remarkable reduction of PVT in 86(27.7%),and no invalid result was seen.The patients having complete patency of the shunt flow accounted for 85.7%of the 307 patients(261/307),and the patients having partial patency of the shunt flow accounted for 14.3%of the 307 patients(46/307).Forty-two patients developed complications,and no death occurred.All patients were followed up for one year,and the main clinical symptoms were improved or completely disappeared.Among the 307 patients,an increase in thrombus volume was found in 17(5.5%)when compared to their postoperative values,which returned to the first-time postoperative level after local treatment of the thrombus via the TIPS shunt combined with catheter-directed thrombolysis.Within one year after TIPS and thrombolysis,overt hepatic encephalopathy(OHE)occurred in 54 patients(17.6%,54/307).One patient died of hepatic failure 9 months after TIPS,another patient died of cerebral hemorrhage 11 months after TIPS,and all the remaining patients were alive.Conclusion For patients with portal hypertension complicated by PVT,TIPS combined with indwelling catheter-directed thrombolysis is clinically safe and effective.The standardized,systematic management of the whole therapeutic process should be strengthened.(J Intervent Radiol,2024,32:22-27)

Background::There is a need for effective and safe therapies for psoriasis that provide sustained benefits. The aim of this study was to assess the efficacy and safety of tildrakizumab, an anti-interleukin-23p19 monoclonal antibody, for treating moderate-to-severe plaque psoriasis in Chinese patients.Methods::In this multi-center, double-blind, phase III trial, patients with moderate-to-severe plaque psoriasis were enrolled and randomly assigned (1:1) to receive subcutaneous tildrakizumab 100 mg or placebo at weeks 0 and 4. Patients initially assigned to placebo were switched to receive tildrakizumab at weeks 12, 16, and every 12 weeks thereafter. Patients in the tildrakizumab group continued with tildrakizumab at week 16, and every 12 weeks until week 52. The primary endpoint was the Psoriasis Area and Severity Index (PASI 75) response rate at week 12.Results::At week 12, tildrakizumab demonstrated significantly higher PASI 75 response rates (66.4% [73/110] vs. 12.7% [14/110]; difference, 51.4% [95% confidence interval (CI), 40.72, 62.13]; P <0.001) and Physician’s Global Assessment (60.9% [67/110] vs. 10.0% [11/110]; difference, 49.1% [95% CI, 38.64, 59.62]; P <0.001) compared to placebo. PASI 75 response continued to improve over time in both tildrakizumab and placebo-switching to tildrakizumab groups, reaching maximal efficacy after 28 weeks (86.8% [92/106] vs. 82.4% [89/108]) and maintained up to 52 weeks (91.3% [95/104] vs. 87.4% [90/103]). Most treatment-emergent adverse events were mild and not related to tildrakizumab. Conclusion::Tildrakizumab demonstrated durable efficacy through week 52 and was well tolerated in Chinese patients with moderate-to-severe plaque psoriasis.Trial registration::ClinicalTrials.gov, NCT05108766.

Objective:To evaluate the influence of age factors on dose-effect relationship of oxycodone inhibiting responses to tracheal intubation during induction of general anesthesia in pediatric patients.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ pediatric patients of both sexes, aged 6 months-6 yr, with body mass index of 12-22 kg/m 2, scheduled for elective surgery under general anesthesia with tracheal intubation, were divided into 3 groups: infant group (group I, 6-12 months), young children group (group Y, >1-3 yr) and preschooler group (group P, >3-6 yr). Oxycodone was slowly injected intravenously, 2 min later etomidate 0.3 mg/kg and cisatracurium 0.15 mg/kg were intravenously injected, and 3 min later endotracheal intubation was carried out with a visual laryngoscope in all the children. Mean arterial pressure(MAP) and heart rate (HR) immediately before intubation and peak MAP and HR within 3 min after intubation were recorded. The modified Dixon′s sequential method was used. The initial dose of oxycodone was 0.3 mg/kg in each group. If the response to tracheal intubation was positive, the dose of oxycodone was increased by 0.02 mg/kg in the next child; if the response to tracheal intubation was negative, the dose of oxycodone was decreased by 0.02 mg/kg in the next child. Positive response to tracheal intubation was defined as increase in MAP and/or HR and increase in the peak value exceeding 20% of the pre-intubation level within 3 min after tracheal intubation. The aforementioned process was repeated until 7 negative and positive reactions crossed, and then the test was stopped. The median effective dose (ED 50) and 95% confidence interval of oxycodone were calculated by Probit method. Results:The ED 50 (95% confidence interval) of oxycodone inhibiting responses to the tracheal intubation were 0.280 (0.247-0.301) mg/kg, 0.321 (0.304-0.342) mg/kg and 0.354 (0.342-0.368) mg/kg in I, Y and P groups, respectively. The ED 50 of oxycodone inhibiting responses to the tracheal intubation was gradually increased during induction of general anesthesia with increasing age ( P<0.05). Conclusions:For children aged 6 months to 6 yr, the potency of oxycodone in inhibiting responses to the tracheal intubation during general anesthesia induction gradually decreases with increasing age.

Objective:To investigate the early and mid-term outcomes of aortic endovascular remodeling device (AERD) for Stanford type A aortic dissection (TAAD) in type Ⅱhybrid surgery, and to evaluate its clinical efficacy.Methods:46 patients with TAAD, including 14 females and 32 males, participated in the single-center clinical trial of West China Hospital of Sichuan University and underwent type II hybrid surgery (Bentall / ascending aorta replacement + AERD implantation) from February 2021 to October 2023. The safety and efficacy of AERD in type Ⅱ hybrid surgery for TAAD were estimated by clinical indicators (postoperative mortality, cardiovascular and cerebrovascular accidents, paraplegia, ischemia), and blood flow condition (volume of the true and false lumen, and suprachial branches).Results:Three patients (6.52%) died during the follow-up period, and the operation-related mortality was 4.35% (2/46). The remaining 43 patients were followed up for an average of (25.53±9.60) months. There were two cases (4.35%) of stroke after the operation, and paraplegia, acute renal insufficiency, and other severe complications were not noticed. The blood flow of the superior branch of the aortic arch was unobstructed, and there was no significant difference in the blood flow of the branch before the operation and at each follow-up time point. Compared to the pre-operation, the true lumen volume of the stent part increased by 59.0% and the false lumen volume decreased by 82.4%.Conclusion:AERD is a safe and effective alternative in type II hybrid surgery for acute TAAD, which is helpful in improving perioperative and short- and long-term survival rates and clinical outcomes.

Objective:To analyzed the 3-year follow-up results in a single center to evaluate the mid-term clinical efficacy of aortic endovascular remodeling device(AERD).Methods:From January 2019 to June 2019, 18 patients with residual aortic dissection after proximal repair of acute aortic dissection were treated with AERD in our heart center of West China Hospital of Sichuan University. They were followed up for 3 years after surgery and underwent vascular enhanced CT review. The primary outcome of our study included all-cause mortality and stent-related mortality. Secondary outcome included branch patency rate, reoperation rate and the incidence of serious adverse events. Morphological measures assessed the effectiveness of AERD in treating residual distal dissection.Results:17 patients completed the 3-year follow-up, and 1 was lost to follow-up. There was no stent-related death, branch artery occlusion, or new serious adverse events. 12 patients completed vascular enhanced CT review, the true lumen was significantly expanded and the false lumen was reduced considerably at 3-year follow-up, true lumen volume, (52.39±22.32)cm 3 vs. (74.34±14.64) cm 3( P<0.01), false lumen volume(50.42±25.44) cm 3 vs. (32.32±31.75)cm 3( P<0.01). Increased true lumen diameter and area ( P<0.001) and decreased false lumen diameter( P<0.001) were significantly different from those before operation, especially in the level below the renal artery and 5 cm below the renal artery. Conclusion:The mid-term effect of AERD in treating distal residual dissection is satisfactory, and it promoted positive distal aorta remodeling with safety and effectiveness.