Objective:To analyze the imaging characteristics of Stanford B aortic dissection in aortic CT angiography, in order to explore the possible related factors of aortic dissection combined with renal malperfusion and to analyze the morphological changes in each involved vessel after TEVAR.Methods:From January 2018 to December 2019, totally 148 patients of Stanford B aortic dissection underwent TEVAR in our hospital. The preoperative aortic CTA was analyzed, and all cases complicated with renal malperfusion were determined according to the clinical manifestation, laboratory examination and imaging results. The differences of morphological features between the patients with and without renal malperfusion and the possible correlative factors were analyzed.The different ischemic types of the involved renal arteries were analyzed, and the morphological changes of the involved vessels before and after the operation of TEVAR were compared.Results:The logistic regression analysis showed that the concave configuration of the tear at the renal artery level was the independent risk factor for renal malperfusion (right kidney OR=5.319, P=0.032; left kidney OR=12.879, P=0.007). The diameter of renal artery was the independent protective factor for renal malperfusion (right kidney OR=0.464, P=0.018; left kidney OR=0.685, P=0.016). Compared with preoperative CTA, the diameter of the involved renal artery was significantly enlarged after TEVAR, no matter which type of ischemia. Most of the dynamic ischemia (15/16) was improved after TEVAR; while static and mixed ischemia only partially improved after TEVAR (static 22/36, mixed 11/19) . Conclusion:The concave configuration of the renal artery level, and the diameter of renal artery are associated with renal malperfusion.The malperfusion can be improved in most cases of dynamic ischemia type vessels, while only can be partially improved in static and mixed types vessles.

The efficacy of adaptive immune responses in cancer treatment relies heavily on the state of the T cells. Upon antigen exposure, T cells undergo metabolic reprogramming, leading to the development of functional effectors or memory populations. However, within the tumor microenvironment (TME), metabolic stress impairs CD8 + T cell anti-tumor immunity, resulting in exhausted differentiation. Recent studies suggested that targeting T cell metabolism could offer promising therapeutic opportunities to enhance T cell immunotherapy. In this review, we provide a comprehensive summary of the intrinsic and extrinsic factors necessary for metabolic reprogramming during the development of effector and memory T cells in response to acute and chronic inflammatory conditions. Furthermore, we delved into the different metabolic switches that occur during T cell exhaustion, exploring how prolonged metabolic stress within the TME triggers alterations in cellular metabolism and the epigenetic landscape that contribute to T cell exhaustion, ultimately leading to a persistently exhausted state. Understanding the intricate relationship between T cell metabolism and cancer immunotherapy can lead to the development of novel approaches to improve the efficacy of T cell-based treatments against cancer.

Objective    To evaluate the preoperative risk factors for acute Stanford type A aortic dissection (ASTAAD) patients in our country by collecting multi-center data. Methods    We consecutively enrolled 700 patients who underwent surgery for ASTAAD in the multi-center hospital database from January 2018 to January 2020. According to the ascending aorta size (AAS), the patients were divided into two groups: a group AAS≥55 mm and a group AAS< 55 mm. Univariate and multivariate logistic regression analyses were used to investigate the related preoperative risk factors for the onset of ASTAAD. Results    According to the exclusion criteria, a total of 621 patients were finally enrolled, including 453 males and 168 females with an average age of 48.24±11.51 years, and 509 (81.94%) patients had AAS< 55 mm. Univariate and multivariate statistical analyses showed that smoking, hypertension, preoperative cardiac troponin I, and left ventricular ejection fraction were related to the occurrence of ASTAAD. The mortality rate of the patient during hospitalization was 13.04% (81 patients). Conclusion    In clinical practice, various preoperative risk factors affect ASTAAD patients, which should be paid attention to. Comprehensive evaluation and an individualized analysis of patients and timely prevention and intervention improve patients' survival rate.

Objective:To investigate the preoperative ascending aorta diameter in patients with acute type A aortic dissection in the Chinese population, compares and analyze the differences in preoperative blood biomarkers, and evaluate the impact of the preoperative ascending aorta diameter in this part of patients on the short-term prognosis of patients.Methods:A collection of 641 patients with acute type A aortic dissection who were enrolled in the " Acute Aortic Syndrome High-Risk Early Warning and Intervention Study" project from January 2018 to January 2020 were collected. Divide the patients into two groups (group Ⅰ<55 mm, group Ⅱ≥55 mm) according to the preventive intervention value of ascending aorta diameter recommended by the guideline for studying preoperative ascending aorta diameter difference in blood biomarkers and the influence of ascending aorta diameter on the short-term prognosis of patients. All patients had CT scans to assess the diameter of the ascending aorta before operation.Results:In this study, all patients with acute type A aortic dissection had a mean preoperative ascending aorta diameter of (46.9±9.7)mm. The preoperative ascending aorta diameter of all patients was less than 55 mm, accounted for 84.1%. Male patients were more likely to have aortic dissection than females; most patients' age was less than 60 years old. The preoperative blood inflammatory index counts were higher in the ascending aorta diameter ≥55 mm group. However, the long-term prognosis of patients with different ascending aorta diameters before surgery was not apparent in this study. The preoperative survival rate and short-term survival rate of patients with ascending aorta diameter <55 mm were higher than those of other groups, but the difference was not statistically significant.Conclusion:In patients with acute type A aortic dissection, the diameter of the ascending aorta is usually less than 55 mm. Moreover, the blood inflammatory index counts are high in the preoperative ascending aorta diameter ≥55 mm group. Meanwhile, patients with smaller ascending aorta diameter have better survival rate and short-term prognosis.

Objective:To summarize the experience of 15 cases of balloon endovascular occlusion assisted aortic replacement.Methods:15 patients who needed reoperation after aortic surgery underwent endovascular balloon occlusion assisted aortic replacement by DSA guidance in the hybrid OR. Main inclusion criteria: The target vessel to be blocked cannot be directly blocked. Based on the last CTA before the operation, the diameter of the target vessel was measured, and the appropriate diameter balloon and the appropriate diameter balloon and the amount of contrast agent were selected. The vascular approach was selected according to the CTA.During the operation, the balloon was filled and fixed well, the distal invasive blood pressure waveform showed advection, and the pressure close to hydrostatic pressure as the complete blocking standard.Results:All 15 cases of balloon endovascular occlusion assisted aortic surgery were successful. After the operation, 14 target vessels normally without damage, and there was no vascular complication. One case after surgical three-branch stent surgery underwent the second thoracoabdominal aortic replacement operation. After the stent was blocked by the balloon, the new tissue in the stent fell off, and the celiac trunk and superior mesenteric artery were embolized for reoperation.Conclusion:Balloon endovascular occlusion technology expands the indications of aortic surgery and simplifies the operation, that is a safe and effective occlusion method. Whether the target vessel is suitable for balloon occlusion should be judged before the operation to avoid related complications.

To investigate the effect of multiple propofol anesthesia and operative trauma on neuroinflammation and cognitive function in development rats and its mechanism. A total of 104 13-day-old neonatal Sprague-Dawley rats were randomly divided into 4 groups with 26 rats in each group: control group was treated with saline q.d for propofol group was treated with propofol q.d for surgery group received abdominal surgery under local anesthesia and then treated with saline q.d for surgery with propofol group received propofol anesthesia plus abdominal surgery under local anesthesia with ropivacaine at d1, then treated with propofol q.d for At d2 of experiment, 13 rats from each group were sacrificed and brain tissue samples were taken, the concentration of TNF-α in hippocampus was detected with ELISA, the expression of caspase-3 and c-fos in hippocampal tissue was determined with immunohistochemical method, the number of apoptotic neurons in hippocampus was examined with TUNEL assay. Morris water maze test was used to examine the cognitive function of the rest rats at the age of 60 d, and the TNF-α concentration, caspase-3, c-fos expressions and the number of apoptotic neurons in hippocampus were also detected. Compared with control group, TNF-α concentration, caspase-3, c-fos expression and the neuroapoptosis in hippocampus increased significantly in other three groups (all <0.05). Compared with surgery group, propofol group and surgery with propofol group showed increased TNF-α level, caspase-3 and c-fos expressions and apoptotic cell numbers (all <0.05), but there was no significant difference between last two groups (all >0.05). Morris water maze test showed that there were no significant differences in swimming speed, escape latency, target quadrant residence time and crossing times among groups (all >0.05). TNF-α level, expressions of caspase-3 and c-fos and apoptotic cell numbers in hippocampus had no significant differences among the 4 adult rats groups (all >0.05). Abdominal surgery and multiple propofol treatment can induce neuroinflammation and neuroapoptosis in hippocampus of neonatal rats, however, which may not cause adverse effects on neurodevelopment and cognitive function when they grown up.
Anesthesia ; Animals ; Cognition ; Hippocampus ; Propofol/adverse effects* ; Rats ; Rats, Sprague-Dawley

Objective: To investigate the feasibility and efficacy of percutaneous closure of paravalvuar leak (PVL) in patients after heart valve replacement surgery using Amplatzer vascular plug Ⅲ (AVP Ⅲ). Methods: In this retrospective study, consecutive PVL patients after heart valve replacement surgery receiving percutaneous closure with AVP Ⅲ in Beijing Anzhen hospital between March 2017 and October 2018 (n=21) were enrolled.The preoperative and intraoperative data and short-and mid-term outcome results were analyzed. Results: Theage of patients in this cohort was (54.9±11.7) years, and there were 12 (57.1%) male patients. There were 8 patients (38.1%) post mitral valve replacement, 4 patients (19.0%) post aortic valve replacement and 9 patients (42.9%) post double valves replacements.There were 14 cases (66.7%) of mitral valve PVL,6 cases (28.6%) of aortic valve PVL, and 1 case (4.8%) of double valves PVL.Successful device deployment was accomplished in 18 defects from 17 PVL patients. Technical successful rate of mitral valve PVL closure and aortic valve PVL closure was 12/15 and 6/7,respectively. One patient received surgical repair due to procedure-induced femoral pseudoaneurysm.There were 17 cases of severe PVL and 1 case of moderate PVL before procedure, and there were 2 cases of moderate PVL, 6 cases mild PVL, and PVL disappeared in 10 cases after procedure (P<0.01 vs. pre-procedure). The follow-up time was (8.3±4.7) months. There were 10 cases (58.8%) of New York Heart Association (NYHA) function grade Ⅲ and 7 cases (41.2%) of NYHA function grade Ⅳ before procedure, and there were 12 cases of NYHA function grade Ⅰ(70.6%) and 5 cases (29.4%) of NYHA function grade Ⅱ post procedure (P<0.01). Post procedure, there was no displacement of the occluder and heart valve movement was not affected,and there was no new hemolysis or hemolysis worsening. Conclusion Percutaneous closure of PVL in patients after heart valve replacement surgery with AVP Ⅲ is feasible, and associated with favorable short-and mid-term clinical outcomes.

Objective To retrospectively review our experience of correction of type Ⅰa endoleak after thoracic endovascular aortic repair(TEVAR). Methods From August 2009 to May 2016, 29 patients with type Ⅰa endoleak after TEVAR (25 males, 4 females at mean age of 56±10 years (range, 41–86 years) underwent treatment: open surgery in 15 patients (an open surgery group), hybrid aortic arch repair in 6 patients (a hybrid group) and cuff extension in 8 patients(a cuff group). A history of hypertension was noted in 25 patients, diabetes mellitus in 3 patients, coronary artery disease in 3 patients, lung infection in one patient, aortic root aneurysm in one patient and aberrant right subclavian artery in one patient. Results In the open surgery group, no death was observed. Continuous renal replacement therapy and re-intubation was done in one patient and drainage of pericardial effusion in one patient. No death was noted in the hybrid group and persistent type Ⅰa endoleak in one patient. In the cuff group, thrombosis of the left common artery was noted in one patient and bypass of the left axillary artery to the left axillary artery and the left common carotid artery was done. Unfortunately, he died of cerebral infarction and total in-hospital death rate was 3.4% (1/29). Bypass of the left axillary artery to the left axillary artery was done in one patient with left upper limb ischemia. There were 4 (14.2%) deaths during follow-up: 3 deaths in the open surgical group and one death in the cuff group. Endoleak was observed in one patient in the hybrid group and one in the cuff group. Conclusion The corresponding procedure, including open surgery, hybrid aortic arch repair or cuff extension, is scheduled to be done according to the characteristics of type Ⅰa endoleak. Satisfactory outcomes are achieved in patients with typeⅠa endoleak.

Objective To discuss the discovery of stent graft mis-deployed into false lumen during aortic dissection treatment and re-deployment.Methods Retrospective analysis of the data of deployment of the stent-graft into the false lumen in the initial treatment of aortic dissection between January 2013 to December 2017.Of the five cases,there were three males and two females,range from 28 to 52 year old.Two patients,suffered from acute Stanford type A aortic dissection,with aortic surgical replacement and circulatory elephant trunk technique,displayed the visceral ischemia and internal environment disorder postoperatively.An emergency CT angiography showed that the deployed stent-graft was in the false lumen.Another two cases with sub-acute Stanford type B aortic dissection underwent TEVAR.The stent-grafts were put in the false lumen intra-operatively,one patient with pregnancy-induced hypertension suffered from acute Stanford type B aortic dissection.An emergency endovascular repair was set under general anesthesia to deal with this problem.New stent-graft was utilized to correct the blood flow into true lumen via flap fenestration or secondary intimal tear.Results The successful rate of this operation was 100％.Time of surgery spanned from 45 minutes to 120 minutes,and blood loss was estimated to be from 50 ml to 100 ml.Five stent grafts were placed with 160 mm length and 6 mm taper and one was 120 mm length and 10 mm taper.Patients were observed in ICU for three days and discharged from hospital after seven days.No complications such as paraplegia,visceral ischemia,etc occurred.Postoperative aortic CTA one month later showed no complications,such as endoleak,etc.The stents were in ideal position,with fluent blood flow of aorta and major visceral artery.Conclusions Deployment of the stent-graft in the false lumen is a rare and critical complication in the treatment of aortic dissection.In addition to clinical manifestations and laboratory tests,aortic CTA could identify this complication quickly and accurately.Endovascular repair was recommended as primary treatment of choice,which could re-direct the blood flow into true lumen via flap fenestration or secondary intimal tear technology quickly and effectively.