Patients with bicuspid aortic valve (BAV) are characterized by asymmetric anatomy, severe calcification and combined aortic dilatation. Compared with tricuspid aortic valve stenosis patients, patients with BAV stenosis confront with greater surgical risks in transcatheter aortic valve replacement (TAVR), including paravalvular leak, aortic valve rupture, coronary artery obstruction, atrioventricular block and so on. However, with the advent of new generation of prosthetic valves and optimization of surgical strategies, several studies have shown that TAVR is safe and effective in the treatment of BAV stenosis. Therefore, we aim to provide an overview of the use of TAVR in patients with BAV stenosis.

OBJECTIVE: To investigate the classification of idiopathic inflammatory myopathies (IIM) based on clinical manifestations and myositis- specific antibodies using cluster analysis. METHODS: We retrospectively analyzed the data of patients with IIM admitted in Nanfang Hospital in 2015-2019. The clinical data of the patients including serum creatine kinase (CK), interstitial lung disease (ILD), cancer, and myositis-specific antibodies were collected for two-step cluster analysis to identify the distinct clusters of patients, whose clinical characteristics were subsequently analysed. RESULTS: A total of 71 patients with IIM were included in this study, including 30 (42.3%) with polymyositis (PM), 20 (28.2%) with classic dermatomyositis (DM), 16 (22.5%) with amyopathic dermatomyositis (CADM), and 5 (7.0%) with immune-mediated necrotizing myopathy (IMNM). Two-step cluster analysis identified 3 distinctive subgroups: Cluster 1 of 15 (51.7%) patients characterized by rash, positive anti-MDA5 antibody and hypoproteinemia ( < 0.05) with normal or slightly elevated CK level, mainly corresponding to CADM; Cluster 2 of 4 (57.1%) patients with significantly elevated CK and positive anti-SRP antibody ( < 0.001) corresponding to IMNM; and Cluster 3 of 17 (48.6%) patients consisting primarily of patients with PM, characterized by positivity for anti- aminoacyl transfer RNA synthetases antibodies (=0.022) corresponding to antisynthetase syndrome (ASS). CONCLUSIONS Patients with IIM can be divided into 3 subgroups based on their clinical and serological characteristics (especially myositis-specific antibodies), and among them ASS may represent an independent IIM subgroup with unique clinical characteristics.
Antibodies ; metabolism ; Humans ; Myositis ; classification ; physiopathology ; Retrospective Studies

OBJECTIVE: To investigate the classification of idiopathic inflammatory myopathies (IIM) based on clinical manifestations and myositis- specific antibodies using cluster analysis. METHODS: We retrospectively analyzed the data of patients with IIM admitted in Nanfang Hospital in 2015-2019. The clinical data of the patients including serum creatine kinase (CK), interstitial lung disease (ILD), cancer, and myositis-specific antibodies were collected for two-step cluster analysis to identify the distinct clusters of patients, whose clinical characteristics were subsequently analysed. RESULTS: A total of 71 patients with IIM were included in this study, including 30 (42.3%) with polymyositis (PM), 20 (28.2%) with classic dermatomyositis (DM), 16 (22.5%) with amyopathic dermatomyositis (CADM), and 5 (7.0%) with immune-mediated necrotizing myopathy (IMNM). Two-step cluster analysis identified 3 distinctive subgroups: Cluster 1 of 15 (51.7%) patients characterized by rash, positive anti-MDA5 antibody and hypoproteinemia ( < 0.05) with normal or slightly elevated CK level, mainly corresponding to CADM; Cluster 2 of 4 (57.1%) patients with significantly elevated CK and positive anti-SRP antibody ( < 0.001) corresponding to IMNM; and Cluster 3 of 17 (48.6%) patients consisting primarily of patients with PM, characterized by positivity for anti- aminoacyl transfer RNA synthetases antibodies (=0.022) corresponding to antisynthetase syndrome (ASS). CONCLUSIONS Patients with IIM can be divided into 3 subgroups based on their clinical and serological characteristics (especially myositis-specific antibodies), and among them ASS may represent an independent IIM subgroup with unique clinical characteristics.
Antibodies ; Autoantibodies ; Dermatomyositis ; Humans ; Lung Diseases, Interstitial ; Myositis ; Retrospective Studies

Objective: To improve the recognition of ectopic adrenocorticotropic hormone syndrome. Methods: The diagnosis and treatment of a 43 years old female patient with multiorgan involvement mimic dermatomyositis was analyzed and discussed. Results: The patient presented with fatigue, edema, skin pigmentation, neuropsychiatric abnormalities, hypertension, hypokalemia, hyperglycemia and other systemic involvement, was finally diagnosed with ectopic adrenocorticotropic hormone syndrome caused by paraganglioma of the anterior mediastinum. After surgical removal of the tumor, her clinical symptoms immediately relieved, meanwhile related hormone levels returned to normal. Conclusion Although paraganglioma-induced ectopic adrenocorticotropic hormone syndrome is rare in clinical practice, more attention should be paid to this specific situation.

Objective To explore the role of TLR4/NF-kB signal pathway in rat nerve injury after traumatic brain injury coupled with seawater drowning.Methods A total of 96 male Sprague-Dawley rats were randomly divided into 3 groups:the sham surgery group(n =12),the traumatic brain injury (TBI) group(n =42) and the traumatic brain injury coupled with seawater drowning group (or the TBI + SWD group) (n =42).At the timepoints of 3,6,12,24,72 and 168 hours after the establishment of the TBI model,immunohistochemistry was used to detect the expression of TLR4 and NF-kB cells in the rat brain tissue.Real time PCR (rt-PCR) was applied to detect the expression levels of TLR4 and NF-kB mRNA in the hippocampus of the brain tissue,and enzyme-linked immunosorbent assay (ELISA) was employed to detect the content of TNF-α in the rat brain tissue.Results The number of TLR4 and NF-kB positive cells in the brain tissue of the TBI group and the TBI + searwater drowning group increased.The expressions of TLR4 and NF-kB mRNA in the hippocampus of the brain tissue of the TBI group and the TBI + SWD group significantly increased 3 hours after establishment of the TBI model.For the TBI group,the expressions of TLR4 and NF-kB were respectively (1.63 ±0.52) and (1.52 ±0.41),while in the the TBI + SWD group,the expressions of the above 2 substantce were respectively (4 1.87 ± 0.93) and (1.87 ± 0.93).At hour 24,the expression reached peak.For the TBI group,the expressions of TLR4 and NF-kB were respectively (49.61 ± 0.34) and (4.60 ± 0.51),while for the the TBI + SWD group,the expressions of the above 2 substantces were respectively (16.11 ±0.49) and (5.80 ± 0.52),then they decreased gradually.The expression levels of TNF-α in the TBI group and the TBI + SWD group were found to elevate 3 hours after establishment of the model.TNF-α expression level for the TBI group was (53.68 ± 1.48) ng/L),while the expression level of the same substance for the TBI + SWD group was (60.14 ± 2.06) ng/L.Wave peak appeared at hour 12,and the wave peak for the TBI group was (79.28 ± 2.46) ng/L,while for the TBI + SWD group,it displayed at (103.51 ± 5.53) ng/L.Conclusion Seawater drowning could aggravate nerve inflammatory response mediated by TLR4/NF-kB signal pathway,which might play an important role in the rat brain injury induced by trauma.

Objective To explore the role of TLR4/NF-kB signal pathway in rat nerve injury after traumatic brain injury coupled with seawater drowning.Methods A total of 96 male Sprague-Dawley rats were randomly divided into 3 groups:the sham surgery group(n =12),the traumatic brain injury (TBI) group(n =42) and the traumatic brain injury coupled with seawater drowning group (or the TBI + SWD group) (n =42).At the timepoints of 3,6,12,24,72 and 168 hours after the establishment of the TBI model,immunohistochemistry was used to detect the expression of TLR4 and NF-kB cells in the rat brain tissue.Real time PCR (rt-PCR) was applied to detect the expression levels of TLR4 and NF-kB mRNA in the hippocampus of the brain tissue,and enzyme-linked immunosorbent assay (ELISA) was employed to detect the content of TNF-α in the rat brain tissue.Results The number of TLR4 and NF-kB positive cells in the brain tissue of the TBI group and the TBI + searwater drowning group increased.The expressions of TLR4 and NF-kB mRNA in the hippocampus of the brain tissue of the TBI group and the TBI + SWD group significantly increased 3 hours after establishment of the TBI model.For the TBI group,the expressions of TLR4 and NF-kB were respectively (1.63 ±0.52) and (1.52 ±0.41),while in the the TBI + SWD group,the expressions of the above 2 substantce were respectively (4 1.87 ± 0.93) and (1.87 ± 0.93).At hour 24,the expression reached peak.For the TBI group,the expressions of TLR4 and NF-kB were respectively (49.61 ± 0.34) and (4.60 ± 0.51),while for the the TBI + SWD group,the expressions of the above 2 substantces were respectively (16.11 ±0.49) and (5.80 ± 0.52),then they decreased gradually.The expression levels of TNF-α in the TBI group and the TBI + SWD group were found to elevate 3 hours after establishment of the model.TNF-α expression level for the TBI group was (53.68 ± 1.48) ng/L),while the expression level of the same substance for the TBI + SWD group was (60.14 ± 2.06) ng/L.Wave peak appeared at hour 12,and the wave peak for the TBI group was (79.28 ± 2.46) ng/L,while for the TBI + SWD group,it displayed at (103.51 ± 5.53) ng/L.Conclusion Seawater drowning could aggravate nerve inflammatory response mediated by TLR4/NF-kB signal pathway,which might play an important role in the rat brain injury induced by trauma.

Objective To study the benefit of prophylactic antibiotics (PA) in totally percutaneous aortic endovascular repair (PEVAR) in the catheterization laboratory for reducing stent-graft infection and postimplantation syndrome (PIS). Methods The clinical data were analyzed of patients undergoing thoracic endovascular aortic repairs. The patients were divided into non-PA group and PA group according to the use of prophylactic antibiotics before PEVAR. The diagnosis of infection was made by two senior physicians with reference to Hospital Acquired Infection Diagnostic Criteria Assessment released by the Ministry of Health of China. Results The 95 enrolled patients included 35 with PA and 60 without PA group, who were comparable for baseline characteristics. Infection-related deaths occurred in 1 case in non-PA group and retrograde Stanford type A dissection and death occurred in 1 case in PA group (1.67%vs 2.85%, P=1.00). The PA and non-PA groups showed no significant difference in the incidence of postoperative infection (5%vs 2.86%, P=1.000), hospital stay (9.30±7.21 vs 10.06±5.69, P=0.094), infection-related mortality (1.67% vs 0%, P=1.00), or postoperative fever (70.90% vs 91.43%, P=0.20). The body temperature showed significant variations at different time points after procedure (F=19.831, P<0.001) irrelevant to the use of prophylactic antibiotics (F=0.978, P=0.326). Conclusion The current data do not support the benefit of PA in reducing postoperative infection and PIS in patients undergoing PEVAR, but the patients without PA may have worse clinical outcomes in the event of postoperative infections.

Objective To study the benefit of prophylactic antibiotics (PA) in totally percutaneous aortic endovascular repair (PEVAR) in the catheterization laboratory for reducing stent-graft infection and postimplantation syndrome (PIS). Methods The clinical data were analyzed of patients undergoing thoracic endovascular aortic repairs. The patients were divided into non-PA group and PA group according to the use of prophylactic antibiotics before PEVAR. The diagnosis of infection was made by two senior physicians with reference to Hospital Acquired Infection Diagnostic Criteria Assessment released by the Ministry of Health of China. Results The 95 enrolled patients included 35 with PA and 60 without PA group, who were comparable for baseline characteristics. Infection-related deaths occurred in 1 case in non-PA group and retrograde Stanford type A dissection and death occurred in 1 case in PA group (1.67%vs 2.85%, P=1.00). The PA and non-PA groups showed no significant difference in the incidence of postoperative infection (5%vs 2.86%, P=1.000), hospital stay (9.30±7.21 vs 10.06±5.69, P=0.094), infection-related mortality (1.67% vs 0%, P=1.00), or postoperative fever (70.90% vs 91.43%, P=0.20). The body temperature showed significant variations at different time points after procedure (F=19.831, P<0.001) irrelevant to the use of prophylactic antibiotics (F=0.978, P=0.326). Conclusion The current data do not support the benefit of PA in reducing postoperative infection and PIS in patients undergoing PEVAR, but the patients without PA may have worse clinical outcomes in the event of postoperative infections.

BACKGROUNDThoracic endovascular aortic repair (TEVAR) is an emerging treatment modality, which has been rapidly embraced by clinicians treating thoracic aortic disease. However, the clinical manifestations of systemic inflammatory response after TEVAR as post-implantation syndrome (PIS) resemble the perioperative infection. This study aimed to evaluate changes and diagnostic value of procalcitonin (PCT) and other traditional inflammatory markers for infections after TEVAR.

METHODSWe conducted a prospective clinical study that enrolled 162 consecutive aortic dissection cases, who underwent TEVAR in our institution between July 2011 and November 2012. The PCT, C-response protein (CRP), erythrocyte sedimentation rate (ESR) and blood routine examination were monitored before the operation and on days 1, 2, 3 and 5 after the operation. The diagnosis of infection was confirmed by the infection control committee with reference to Hospital Acquired Infection Diagnostic Criteria Assessment, released by the Ministry of Health of the People's Republic of China.

RESULTSPost endovascular repair of thoracic aorta, PCT changes significantly at different time points (χ(2) = 13.225, P = 0.021), without significant difference between the PIS group and the control group (0.24 ± 0.04 vs.0.26 ± 0.10, P = 0.804). PCT values were significantly higher in the first day after TEVAR than the preoperative levels (0.18 ± 0.03 vs. 0.11 ± 0.02, P < 0.001). Compared with PIS patients, the level of PCT, CRP, White blood cell (WBC) and neutrophil (NEU) in the infection patients elevated significantly (relatively χ(2) = 6.062, P = 0.048; χ(2) = 6.081, P = 0.048; χ(2) = 11.030, P = 0.004; χ(2) = 14.632, P = 0.001). According to the ROC analysis, the PCT levels in the first day after TEVAR (AUC = 0.785, P = 0.012) had better predictive values of infection than WBC, NEU CRP and ESR (AUC = 0.720, P = 0.040; AUC = 0.715, P = 0.045; AUC = 0.663, P = 0.274; AUC = 0.502, P = 0.991). The best predictive index was the changes of PCT between preoperative and postoperative (PCT), which possess AUC as 0.803 (P = 0.014). And PCT = 0.055 could be considered as an infection diagnosis cutoff value with a sensitivity of 83.3% and specificity 69.0%.

CONCLUSIONSPCT provides better diagnostic value of infection compared with other inflammatory markers. The potential applications of PCT in differential diagnosis of PIS and infection after percutaneous TEVAR deserve further studies.

Adult ; Aged ; Blood Sedimentation ; C-Reactive Protein ; metabolism ; Calcitonin ; metabolism ; Calcitonin Gene-Related Peptide ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Protein Precursors ; metabolism ; Vascular Surgical Procedures

Objective To evaluate the prevalence and impact of coronary artery disease (CAD) in aged patients with Stanford type B aortic dissection(AD).Methods From January 2008 to December 2011,CAG was routinely performed before aortography and thoracic aortic repair(TEVAR) to determine the prevalence of concomitant CAD in 200 consecutive Stanford type B AD patients who were older than 50 years.All patients received 1 year follow-up.Adverse events were compared between patients with and without concomitant CAD.Data analysis by SPSS 17.0 statistical software,using Student t test,Chi-square test and Fisher exact test.Results CAG showed 53 patients (26.5％) had CAD.Multivariate logistic regression analysis showed that male gender(OR =4.415,95％ CI:1.131-17.237,P =0.033) and age (OR =1.061,95％ CI:1.017-1.108,P =0.006) were independent predictors of Stanford type BAD coexisted with CAD.Age was also independent predictor of multi-vessel disease(MVD) and/or left main disease(LMD) (OR =1.096,95％ CI:1.009-1.191,P =0.023).At 30-day follow-up,there was no difference in the incidence of adverse events between patients with and without concomitant CAD.Patients with concomitant CAD showed higher incidence of myocardial infarction[3 (5.66％) vs.0(0),P =0.018] and stroke [4 (7.55 ％) vs.1 (0.68 ％),P =0.018].Conclusion The prevalence of CAD in aged patients with Stanford type BAD is relatively high.Concomitant CAD is associated with higher risk of cardio-cerebrovascular ischemic events while dose not increase the risk of adverse aorta related events.