Aim To investigate the clinical characteristics and related factors of post-implantation syndrome(PIS)following the prophylactic application of non-steroidal anti-inflammatory drugs(NSAID)after thoracic endovascular aortic repair(TEVAR).Methods A total of 510 adult patients who had received prophylactic NSAID after TEVAR at General Hospital of Northern Theater Command from September 2013 to April 2024 were consecutively included in the study.The patients were divided into two groups based on the occurrence of PIS postoperatively:the PIS group(34 pa-tients,6.67％)and the non-PIS group(476 patients,93.33％).General information,past medical history and surgical features were compared between the two groups.Univariate and multivariate Logistic regression analysis were used to i-dentify predictors of PIS.The ROC curve was used to assess the overall diagnostic performance of the risk factors.Results The baseline data and clinical characteristics of PIS group and non-PIS group were compared.The rate of gen-der as male,chest and back pain on adimission,limb ischaemia on admission,systolic blood pressure on admission,use of angiotensin converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)drugs during hospitalization,preop-erative white blood cell(WBC)count and surgical approach involving an incision in PIS group were higher than those in non-PIS group,and the age,preoperative estimated glomerular filtration rate(eGFR)level and use of statin drugs during hospitalization were lower than those in non-PIS group,all differences were statistically significant.Postoperative C-reac-tive protein level,incidence of clinical adverse events during postoperative hospitalization,and time of postoperative hospi-talization were increased in PIS group compared with those in non-PIS group.There was no significant difference in the incidence of aortic adverse events between the two groups(P＜0.05).Univariate and multivariate Logistic regression a-nalysis identified patients' age＜60 years(OR=4.671,95％CI:1.348～16.188,P=0.015),increased preoperative WBC count(OR=3.582,95％CI:1.469～8.735,P=0.005),and surgical approach involving an incision(OR=8.339,95％CI:1.849～37.610,P=0.006)as independent predictors for PIS.The results of the ROC curve analysis showed that the area under the curve of patients' age＜60 years,increased preoperative WBC count,femoral arteriotomy ac-cess,and the three combined diagnoses in predicting the occurrence of PIS after TEVAR were 0.653(95％CI:0.573～0.733),0.686(95％CI:0.600～0.771),0.699(95％CI:0.627～0.770),0.826(95％CI:0.765～0.887).Conclusion Despite the prophylactic use of NSAID,some patients develop PIS after TEVAR.Patients' age＜60 years,elevated preoperative WBC count,and femoral artery incision approach are independent risk factors for PIS after preventive medication.Additionally,the incidence of PIS increased with the number of independent risk factors present.

Aim To investigate the clinical characteristics and related factors of post-implantation syndrome(PIS)following the prophylactic application of non-steroidal anti-inflammatory drugs(NSAID)after thoracic endovascular aortic repair(TEVAR).Methods A total of 510 adult patients who had received prophylactic NSAID after TEVAR at General Hospital of Northern Theater Command from September 2013 to April 2024 were consecutively included in the study.The patients were divided into two groups based on the occurrence of PIS postoperatively:the PIS group(34 pa-tients,6.67％)and the non-PIS group(476 patients,93.33％).General information,past medical history and surgical features were compared between the two groups.Univariate and multivariate Logistic regression analysis were used to i-dentify predictors of PIS.The ROC curve was used to assess the overall diagnostic performance of the risk factors.Results The baseline data and clinical characteristics of PIS group and non-PIS group were compared.The rate of gen-der as male,chest and back pain on adimission,limb ischaemia on admission,systolic blood pressure on admission,use of angiotensin converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)drugs during hospitalization,preop-erative white blood cell(WBC)count and surgical approach involving an incision in PIS group were higher than those in non-PIS group,and the age,preoperative estimated glomerular filtration rate(eGFR)level and use of statin drugs during hospitalization were lower than those in non-PIS group,all differences were statistically significant.Postoperative C-reac-tive protein level,incidence of clinical adverse events during postoperative hospitalization,and time of postoperative hospi-talization were increased in PIS group compared with those in non-PIS group.There was no significant difference in the incidence of aortic adverse events between the two groups(P＜0.05).Univariate and multivariate Logistic regression a-nalysis identified patients' age＜60 years(OR=4.671,95％CI:1.348～16.188,P=0.015),increased preoperative WBC count(OR=3.582,95％CI:1.469～8.735,P=0.005),and surgical approach involving an incision(OR=8.339,95％CI:1.849～37.610,P=0.006)as independent predictors for PIS.The results of the ROC curve analysis showed that the area under the curve of patients' age＜60 years,increased preoperative WBC count,femoral arteriotomy ac-cess,and the three combined diagnoses in predicting the occurrence of PIS after TEVAR were 0.653(95％CI:0.573～0.733),0.686(95％CI:0.600～0.771),0.699(95％CI:0.627～0.770),0.826(95％CI:0.765～0.887).Conclusion Despite the prophylactic use of NSAID,some patients develop PIS after TEVAR.Patients' age＜60 years,elevated preoperative WBC count,and femoral artery incision approach are independent risk factors for PIS after preventive medication.Additionally,the incidence of PIS increased with the number of independent risk factors present.

OBJECTIVE To study the toxicokinetics and tissue distribution characteristics of alpha-amanitin in rats.METHODS The tail venous blood was collected from SD rats before and 5,10,20,30 and 45 min,1,1.5,2.5,4 and 8 h after intraperitoneal injection of alpha-amanitin(1.5 mg·kg-1),and the concentration of alpha-amanitin in blood was determined by liquid chromatography-mass spectrometry(LC-MS/MS).DAS 2.0 software was used to analyze and plot the drug-time curve with toxicokinetic parame-ters.Based on the toxicokinetics results,18 SD rats were randomly divided into three groups.The rats were sacrificed,and left ventricular arterial(LVA)blood and 9 types of tissue samples involving the heart,liver,spleen,lung,kidney,whole brain,small intestine,stomach wall and testis were collected 15 min,40 min and 2.5 h after dosing,and the concentrations of alpha-amanitin were measured by LC-MS/MS to obtain the tissue distribution results of alpha-amanitin in SD rats.RESULTS Toxicokinetics studies revealed that the peak blood concentration(Cmax)was(633±121)μg·L-1,the elimination half-life(T1/2)was(0.72±0.37)h,and the peak time(Tmax)was(0.52±0.16)h.The total clearance rate(CLz)was(1.62±0.26)L·h·kg-1,the area under the curve(AUC0-t)was(946±183)μg·h·L-1,and the mean reten-tion time(MRT0-t)was(1.18±0.17)h.The apparent volume of distribution(Vz)was(1.65±0.86)L·kg-1.The results of tissue distribution study showed that alpha-amanitin was widely distributed in SD rats with the highest concentration in the kidney,followed by the lung,small intestines,stomach wall,LVA blood and liver,but was low in the heart,spleen,testicles and other tissues,and very low in the brain.Alpha-amanitin was absorbed and eliminated quickly,peaked at 40 min in each tissue,and the concen-tration was minimized after 2.5 h.CONCLUSION The absorption and elimination of alpha-amanitin by intraperitoneal injection are rapid in SD rats,and the blood concentration reaches the peak about 31 min after administration,but can not be detected 4 h later.Alpha-amanitin is mainly distributed in the kidney,followed by the tissues and metabolic organs with rich blood flow,such as the lung,small intestines,stomach wall,LVA blood and liver.The content of alpha-amanitin is low in the heart,spleen,testicles and other tissues,and very low in the brain.It is speculated that it may have toxic targeting effect on the kidney and low blood-brain barrier permeability.