Objective:To examine the current diagnostic and treatment practices, as well as surgical outcomes, for individuals over the age of 60 diagnosed with acute aortic arch dissection(ATAAD)at Tianjin University Chest Hospital.This analysis evaluates the safety and feasibility of performing open surgical procedures on elderly patients affected by aortic dissection.Methods:A retrospective analysis was conducted on 509 patients diagnosed with ATAAD who were registered in the Chest Pain Center data reporting platform(https: //datacs.chinacpc.org/)at Tianjin Chest Hospital, covering the period from June 2015 to December 2021.The patients were divided into two groups: the elderly group, consisting of individuals aged 60 years or older, and the non-elderly group, comprising those under 60 years of age.Their surgical conditions and short-term outcomes were subsequently examined and compared.Results:A total of 509 patients were included, 311 cases(61.1%)were identified within the non-elderly group, with a mean age of 45.78 ± 8.96 years(range: 21-59 years).In contrast, 198 cases(38.9%)belonged to the elderly group, with a mean age of 65.61 ± 4.13 years(range: 60-81 years).A total of 416 patients(81.7%)received surgical intervention.Among those who underwent surgery, the elderly group exhibited a significantly higher proportion of females(38.1% vs.20.6%, P<0.001), and these patients had smaller body surface areas and lower body mass index values.Furthermore, a greater number of elderly patients presented with comorbid conditions such as hypertension, coronary artery disease, chronic obstructive pulmonary disease, and stroke(all P<0.05).The 30-day all-cause mortality rate, incidence of cerebral infarction, and rate of continuous renal replacement therapy(CRRT)utilization were similar in both groups(20.9% vs.18.8%、15.1% vs.10.5%、19.4% vs.18.1%, all P>0.05).However, elderly patients experienced longer postoperative recovery durations, extended periods of ventilator dependency, and a higher incidence of new-onset atrial fibrillation following surgery(all P<0.05). Conclusions:The surgical rate for elderly patients with ATAAD is low, suggesting that there is significant potential for improvement in clinical diagnosis and treatment.Advanced age should not be viewed as a contraindication for surgery; rather, appropriate case selection and personalized treatment plans can enhance the success rate of surgical interventions.

ObjectiveTo observe the clinical effect of Xiaozhi Hugan capsules in treating patients with non-alcoholic steatohepatitis （NASH） combined with phlegm-dampness and blood stasis syndrome and its effects on serum interleukin-6 （IL-6） and monocyte chemoattractant protein-1 （MCP-1）. MethodsA total of 124 patients with NASH combined with phlegm-dampness and blood stasis syndrome who were admitted to the Department of Spleen， Stomach， and Hepatobiliary Diseases， the First Affiliated Hospital of Henan University of Chinese Medicine from July 2020 to December 2022 were selected. According to the random number table method， patients were randomly divided into an observation group （62 cases） and a control group （62 cases）. The treatment duration was 6 months. The observation group received Xiaozhi Hugan capsules orally， while the control group received polyene phosphatidylcholine capsules. The efficacy indicators included alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， controlled attenuation parameter （CAP）， liver stiffness measurement （LSM）， traditional Chinese medicine （TCM） syndrome scores （discomfort/dull pain/distending pain in liver region， fatigue， etc.）， body mass index （BMI）， waist-to-height ratio （WHtR）， high-density lipoprotein cholesterol （HDL-C）， total cholesterol （TC）， triglycerides （TG）， homeostatic model assessment for insulin resistance （HOMA-IR） ［including fasting blood glucose （FBG） and fasting insulin level （INS）］， free fatty acids （FFA）， IL-6， and MCP-1. Adverse drug reactions were recorded. ResultsAfter treatment， the total effective rate in the observation group was 92.3% （48/52）， while that in the control group was 75.5% （39/49）. The total effective rate in the observation group was higher than that in the control group （χ²=5.339， P<0.05）. After treatment， the TCM syndrome scores in both groups were significantly reduced （P<0.05）， and the post-treatment scores in the observation group were better than those in the control group （P<0.05）. After treatment， the levels of ALT， AST， TC， FFA， fasting insulin （FINS）， HOMA-IR， MCP-1， IL-6， CAP， LSM， BMI， and WHtR were decreased （P<0.05） significantly in both groups， and the observation group showed superior improvement in the above indicators compared to the control group （P<0.05）. The observation group exhibited significant reductions in TG and FBG （P<0.05） and an increase in HDL-C （P<0.05）， while no significant changes were observed in the control group. The observation group was superior to the control group after treatment （P<0.05）. No severe adverse reactions occurred in either group during the treatment. ConclusionXiaozhi Hugan capsules have significant clinical efficacy in treating patients with NASH combined with phlegm-dampness and blood stasis syndrome. It reduces hepatic steatosis， lowers liver stiffness， inhibits the expression of serum inflammatory factors， and alleviates liver inflammation. No obvious adverse reactions occur， suggesting it is suitable for clinical application.

ObjectiveTo observe the clinical effect of Xiaozhi Hugan capsules in treating patients with non-alcoholic steatohepatitis （NASH） combined with phlegm-dampness and blood stasis syndrome and its effects on serum interleukin-6 （IL-6） and monocyte chemoattractant protein-1 （MCP-1）. MethodsA total of 124 patients with NASH combined with phlegm-dampness and blood stasis syndrome who were admitted to the Department of Spleen， Stomach， and Hepatobiliary Diseases， the First Affiliated Hospital of Henan University of Chinese Medicine from July 2020 to December 2022 were selected. According to the random number table method， patients were randomly divided into an observation group （62 cases） and a control group （62 cases）. The treatment duration was 6 months. The observation group received Xiaozhi Hugan capsules orally， while the control group received polyene phosphatidylcholine capsules. The efficacy indicators included alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， controlled attenuation parameter （CAP）， liver stiffness measurement （LSM）， traditional Chinese medicine （TCM） syndrome scores （discomfort/dull pain/distending pain in liver region， fatigue， etc.）， body mass index （BMI）， waist-to-height ratio （WHtR）， high-density lipoprotein cholesterol （HDL-C）， total cholesterol （TC）， triglycerides （TG）， homeostatic model assessment for insulin resistance （HOMA-IR） ［including fasting blood glucose （FBG） and fasting insulin level （INS）］， free fatty acids （FFA）， IL-6， and MCP-1. Adverse drug reactions were recorded. ResultsAfter treatment， the total effective rate in the observation group was 92.3% （48/52）， while that in the control group was 75.5% （39/49）. The total effective rate in the observation group was higher than that in the control group （χ²=5.339， P<0.05）. After treatment， the TCM syndrome scores in both groups were significantly reduced （P<0.05）， and the post-treatment scores in the observation group were better than those in the control group （P<0.05）. After treatment， the levels of ALT， AST， TC， FFA， fasting insulin （FINS）， HOMA-IR， MCP-1， IL-6， CAP， LSM， BMI， and WHtR were decreased （P<0.05） significantly in both groups， and the observation group showed superior improvement in the above indicators compared to the control group （P<0.05）. The observation group exhibited significant reductions in TG and FBG （P<0.05） and an increase in HDL-C （P<0.05）， while no significant changes were observed in the control group. The observation group was superior to the control group after treatment （P<0.05）. No severe adverse reactions occurred in either group during the treatment. ConclusionXiaozhi Hugan capsules have significant clinical efficacy in treating patients with NASH combined with phlegm-dampness and blood stasis syndrome. It reduces hepatic steatosis， lowers liver stiffness， inhibits the expression of serum inflammatory factors， and alleviates liver inflammation. No obvious adverse reactions occur， suggesting it is suitable for clinical application.

Objective:To examine the current diagnostic and treatment practices, as well as surgical outcomes, for individuals over the age of 60 diagnosed with acute aortic arch dissection(ATAAD)at Tianjin University Chest Hospital.This analysis evaluates the safety and feasibility of performing open surgical procedures on elderly patients affected by aortic dissection.Methods:A retrospective analysis was conducted on 509 patients diagnosed with ATAAD who were registered in the Chest Pain Center data reporting platform(https: //datacs.chinacpc.org/)at Tianjin Chest Hospital, covering the period from June 2015 to December 2021.The patients were divided into two groups: the elderly group, consisting of individuals aged 60 years or older, and the non-elderly group, comprising those under 60 years of age.Their surgical conditions and short-term outcomes were subsequently examined and compared.Results:A total of 509 patients were included, 311 cases(61.1%)were identified within the non-elderly group, with a mean age of 45.78 ± 8.96 years(range: 21-59 years).In contrast, 198 cases(38.9%)belonged to the elderly group, with a mean age of 65.61 ± 4.13 years(range: 60-81 years).A total of 416 patients(81.7%)received surgical intervention.Among those who underwent surgery, the elderly group exhibited a significantly higher proportion of females(38.1% vs.20.6%, P<0.001), and these patients had smaller body surface areas and lower body mass index values.Furthermore, a greater number of elderly patients presented with comorbid conditions such as hypertension, coronary artery disease, chronic obstructive pulmonary disease, and stroke(all P<0.05).The 30-day all-cause mortality rate, incidence of cerebral infarction, and rate of continuous renal replacement therapy(CRRT)utilization were similar in both groups(20.9% vs.18.8%、15.1% vs.10.5%、19.4% vs.18.1%, all P>0.05).However, elderly patients experienced longer postoperative recovery durations, extended periods of ventilator dependency, and a higher incidence of new-onset atrial fibrillation following surgery(all P<0.05). Conclusions:The surgical rate for elderly patients with ATAAD is low, suggesting that there is significant potential for improvement in clinical diagnosis and treatment.Advanced age should not be viewed as a contraindication for surgery; rather, appropriate case selection and personalized treatment plans can enhance the success rate of surgical interventions.

Objective To investigate the efficacy of low-dose inhaled nitric oxide (iNO) in the treatment of severe hypoxemia after Sun’s operation. Methods The clinical data of patients undergoing Sun’s operation for acute Type A aortic dissection in our hospital from January 2020 to June 2022 were retrospectively analyzed. Patients who received conventional treatment before November 2021 were enrolled as a control group. After November 2021, iNO was used in our hospital, and the patients who received iNO as an iNO group. The preoperative clinical baseline data, perioperative clinical data and oxygenation index were compared between the two groups. Results A total of 54 patients were included in the control group, including 45 males and 9 females, with an average age of 53.0±10.9 years. A total of 27 patients were included in the iNO group, including 21 males and 6 females, with an average age of 52.0±10.6 years. The preoperative body mass index of the two groups was greater than 25 kg/m2, white blood cell count, C-reactive protein were significantly higher than normal level, but there was no statistical difference between the groups (P＞0.05). There were no statistical differences in intraoperative data between the two groups (P＞0.05). The iNO group had significantly shorter duration of mechanical ventilation, postoperative ICU stay, and postoperative hospital stay than the control group (P<0.001). After 12 h of iNO treatment, hypoxic condition improved obviously, oxygenation indices in 12 h, 24 h, 36 h,48 h, 60 h and 72 h in the iNO group were significantly higher than those in the control group (P<0.05). Conclusion The treatment of severe hypoxemia after Sun’s surgery with low-dose of iNO is safe and effective, can significantly improve oxygenation function, and has significant advantages in shortening ventilator use time, postoperative ICU stay and postoperative hospital stay, but it is not significant in changing postoperative mortality.

Objective:Using different machine learning methods to construct and screen the best prediction model for predicting the risk of death within 30 days after surgery in patients with acute type A aortic dissection.Methods:Five hundred and twenty-one patients with acute type A aortic dissection who underwent surgery between 2015 and 2022 were included, after collecting their perioperative date and screening them, 329 patients were retained. two different groups of predictor variables were generated by using Lasso regression and principal component analysis, after that, logistic regression, support vector machine algorithm, random forest algorithm, gradient boosting algorithm, and super learning algorithm were used to develop prediction models for the risk of death within 30 days after surgery. Finally, we compare the models and select the best one. Results:The AUC values for all models rangrd from 0.791-0.959. The model using Lasso regression to determine the predictor variables and built by the super learning algorithm had the best prediction with an AUC value of 0.959. Conclusion:The super learning algorithm better than other algorithms in predicting death within 30 days after acute type A aortic dissection.

Objective To summarize the results and clinical experience of transcatheter valve-in-valve implantation using domestic self-expanding valve in patients with aortic degenerated bio-prosthesis. Methods From January 2019 to April 2023, the patients who underwent transcatheter valve-in-valve surgery in the Department of Cardiac Surgery of Tianjin Chest Hospital due to surgical bio-prosthesis failure were included. Characteristics of valves, perioperative complications, and hemodynamic manifestations during the early postoperative and follow-up period were analyzed. Results A total of 24 patients were enrolled, including 14 males and 10 females with an average age of 68.17±7.72 years, and the average interval between the two operations was 10.48±4.09 years. All patients were successfully discharged without complications such as coronary artery obstruction and pacemaker implantation, and the average transvalvular pressure gradient was 16.39±6.52 mm Hg before discharge. During the median follow-up time of 16 months, the left ventricular diastolic inner diameter and ejection fraction were continuously improved. Conclusion Transcatheter valve-in-valve using domestic self-expanding valves is safe and feasible to treat aortic bioprosthetic valve failure. Sound patient selection and surgical strategies are critical to achieve good hemodynamics.

Objective:The transjugular or transfemoral approach is used as a common method for hepatic venous pressure gradient (HVPG) measurement in current practice. This study aims to confirm the safety and effectiveness of measuring HVPG via the forearm venous approach.Methods:Prospective recruitment was conducted for patients with cirrhosis who underwent HVPG measurement via the forearm venous approach at six hospitals in China and Japan from September 2020 to December 2020. Patients' clinical baseline information and HVPG measurement data were collected. The right median cubital vein or basilic vein approach for all enrolled patients was selected. The HVPG standard process was used to measure pressure. Research data were analyzed using SPSS 22.0 statistical software. Quantitative data were used to represent medians (interquartile ranges), while qualitative data were used to represent frequency and rates. The correlation between two sets of data was analyzed using Pearson correlation analysis.Results:A total of 43 cases were enrolled in this study. Of these, 41 (95.3%) successfully underwent HVPG measurement via the forearm venous approach. None of the patients had any serious complications. The median operation time for HVPG detection via forearm vein was 18.0 minutes (12.3~38.8 minutes). This study confirmed that HVPG was positively closely related to Child-Pugh score ( r = 0.47, P = 0.002), albumin-bilirubin score ( r = 0.37, P = 0.001), Lok index ( r = 0.36, P = 0.02), liver stiffness ( r = 0.58, P = 0.01), and spleen stiffness ( r = 0.77, P = 0.01), while negatively correlated with albumin ( r = -0.42, P = 0.006). Conclusion:The results of this multi-centre retrospective study suggest that HVPG measurement via the forearm venous approach is safe and feasible.

Objective　To perform the pathogenic and genomics analyses on isolates of Streptococcus suis (Ss) from three human infections in Shenzhen, aiming to provide a basis for the prevention and control of Ss outbreaks. Methods　The suspected bacterial strains from three blood plate cultures of three critically ill patients in three hospitals were subjected to biochemical identification, matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS), and real-time fluorescent PCR identification, resulting in the identification of three strains positive for Streptococcus suis serotype 2(SS2). Pure positive cultures were taken for an antimicrobial susceptibility test and extracted nucleic acids for whole-genome sequencing and analysis. The whole-genome sequencing and analysis included species identification, antibiotic resistance genes alignment, multilocus sequence typing (MLST), virulence genes alignment, and coregene-based phylogenetic tree analysis. Results　The blood agar isolates from three patients were all identified as Ss, the VITEK 2 identified them as SS2, and MALDI-TOF-MS identified them as Ss. Real-time PCR results for the universal gene gdh and serotype 2 cps2 gene of Ss were both positive. The antimicrobial susceptibility test results showed that all three strains were resistant to erythromycin and clindamycin, with variable sensitivity to tetracycline. Whole-genome sequencing results showed that all three strains were identified as Ss, including one ST7 strain and two ST1 strains. The virulence gene prediction results based on the VFDB database showed that all three strains were positive for mrp, sly, and cps, indicating high virulence gene characteristics. The analysis of the phylogenetic tree based on coregene showed that the three strains were in different evolutionary branches, with two ST1 strains having a closer evolutionary distance. Conclusions　The pathogens responsible for these three critically ill patients were SS2, and all three strains were resistant to erythromycin and clindamycin. Genetically, they all carried virulence genes that are found in highly virulent strains, while showed differences in MLST typing and phylogenetic tree analysis, indicating the presence of different genotypes of high pathogenicity SS2 in Shenzhen area and had caused sporadic cases, which requires high attention.

Objective To investigate the characteristics of hemodynamics of proper hepatic artery and portal vein after splenectomy and devascularization. Methods The clinical data of 103 patients with portal hypertension who underwent splenectomy and devascularization in the Capital Medical University-Affiliated You'an Hospital from April 2014 to February 2019 were retrospectively analyzed. Their hemodynamics of the proper hepatic artery and portal vein were recorded before and 1 week-, and 1-, 3-, 6-, 12-, and 24-months after surgery and then statistically analyzed. Continuous data with normal distribution were compared using paired-samples t test. Results Compared with the before surgery data, the portal vein diameter, portal vein flow, maximum velocity, and average velocity of the portal vein were all significantly decreased 1-week-, 1-, 3-, 6-, 12-, and 24-months after splenectomy and devascularization (all P < 0.05). The blood flow and velocity of the proper hepatic artery was significantly increased 1 week and 1 month after surgery (all P < 0.05); however, there was no statistically significant difference at 3-, 6-, 12-, and 24-months after surgery. Conclusion The diameter, flow, and flow velocity of the portal vein after splenectomy and devascularization were significantly lower than those before surgery, whereas the proper hepatic artery flow and flow velocity were increased within 1 month after surgery and then returned back to the pre-surgery levels 3 months after surgery.