Objective To evaluate the short-term results of sleeve wrapping technique using remnant aortic wall in modified Bentall procedure. Methods The patients undergoing modified Bentall procedure with the remnant aortic wall as a sleeve to cover the sewing area of composite valved graft and the aortic annulus for proximal hemostasis between March 2021 and March 2022 in Shenzhen Fuwai Hospital were enrolled. Short-term results were assessed by cardiopulmonary bypass time, aortic clamping time, mechanical ventilation time, ICU stay, postoperative hospital stay, effusion drainage on the first postoperative day, left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), and follow-up results. Results A total of 14 patients were collected, including 12 males and 2 females, with a mean age of 55.33±10.57 years. There was no postoperative or follow-up death. Cardiopulmonary bypass time was 147.90±21.29 min, aortic clamping time was 115.70±15.23 min, mechanical ventilation time was 19.42±8.98 h, ICU stay was 99.08±49.42 h, and postoperative hospital stay was 16.33±2.74 d. Thoracic drainage volume was 333.33±91.98 mL on the first postoperative day. Only 2 patients required blood transfusion (4.5 U and 2 U, respectively). During the follow-up of 6.17±3.69 months, there was no death, no aortic or valve-related complications. There was statistical difference in the LVEDD between preoperation and before discharge after surgery (P＜0.001), and between half a year after surgery and before discharge after surgery (P＜0.001). There was a little decrease of LVEF before discharge after surgery compared with preoperative LVEF, but there was no statistical difference (P=0.219). There was no statistical difference in the LVEF half a year after operation compared with that before operation (P=1.000). Conclusion Sleeve wrapping technique using remnant aortic wall in modified Bentall procedure has good short-term results. This modification may be a simple, effective way in controlling proximal bleeding.

Outpatient humanistic care refered to providing a full process of caring medical services to outpatients. In order to standardize the human caring services for outpatients in medical institutions, promote the comprehensive service level of outpatient services, and improve the patient′s medical experience, Chinese Association for Life Care issued the group standard of Management Norms for Human caring of Outpatients in April 2023. This standard clarified the relevant terms and definitions of human caring for outpatients, specified the basic requirements for human caring, the humanistic quality and care responsibilities of outpatient staff, the outpatient care environment and facilities, the outpatient care process and measures, and quality management. It designed standardized and personalized full process care service norms, providing references for medical institutions at all levels to promote the development of human caring for outpatients.

Objective:To summarize the relationship between the clinicopathological features and prognosis of immunoglobulin A nephropathy (IgAN) after renal transplantation.Methods:A total of 34 patients with IgAN after renal transplantation confirmed by renal biopsy were enrolled. And another 34 patients with primary IgAN confirmed by initial renal biopsy were adopted as controls. Clinical and pathological features of two groups were compared to explore the relationship between clinicopathological features and prognosis of allograft IgAN.Results:As compared with primary IgAN group, renal function in allograft IgAN group included serum creatinine [(158.5±75.9) vs (84.8±26.8) umol/L], urea nitrogen [(9.7±6.1) vs (5.2±1.4) mmol/L], uric acid [(406.7±87.8) vs (359.0±92.6) umol/L], estimated glomerular filtration rate {(57.4±25.4) vs (91.2±28.6) [ml/(min·1.73m 2)]}. All were statistically significantly higher ( P<0.05) while other parameters showed no differences. Pathologically, the proportion of T1 type (50.0% vs 17.6%) of renal tubular atrophy/interstitial fibrosis was significantly higher in allograft IgAN group than control group ( P<0.05). Furthermore, univariate and multivariate Logistic regression analyses were performed between various pathological parameters and prognosis in allograft IgAN patients. It indicated that the degree of mesangial hyperplasia of patients with transplanted IgAN had a significantly negative impact on the prognosis. Conclusions:The clinicopathological features of patients with allograft IgAN show no difference from those of patients with primary IgAN. And among patients with allograft IgAN, those with severe mesangial hyperplasia often have a worse prognosis.

Objective : To assess the safety and feasibility of incision in the retroauricular sulcus for removal of benign tumors in the lower pole of the parotid gland and to provide some ideas for aesthetic consideration of parotidectomy. Methods: In total, 18 cases with benign tumors of the lower pole regions of the parotid gland were included in this study, including 9 pleomorphic adenomas, 2 myoepitheliomas, 5 Warthin tumors, 1 basal cell adenoma and 1 oncocytoma. Three months after the operation, facial paralysis and salivary fistula were assessed. A visual analog scale was used to score the cosmetic satisfaction of the surgical incision. Tumor recurrence was followed up 6 ~ 12 months after operation. Results: In 18 patients with benign tumors the lower pole regions of the parotid gland, the tumor diameter ranges from 1.0 to 3.1 cm, with an average value of 2.5 cm. All patients experienced successful complete removal of the parotid mass with the minimally invasive retroauricular approach, and all wounds healed in one stage after operation. No serious complications, such as permanent facial paralysis and tumor recurrence, occurred 3 months after the operation. The patients were satisfied with the appearance of the surgical incision (aesthetic score 9.3 ± 0.4), achieving the expected aesthetic effect. Conclusion This approach is feasible and safe for most small benign parotid tumors located in the lower pole region of the parotid gland and in the posterior region of the jaw. The scar is located in the retroauricular sulcus, which significantly meets the aesthetic needs of the concealed incision for patients.

Objective: To investigate the effectiveness and safety of intraoperative sac coiling embolization among patients who are athigh-risk developing type-Ⅱ endoleak after endovascular aortic repair(EVAR). Methods: From Jan 2014 to Jan 2018, one hundred and twelve consecutive patients with infra-renal AAA were enrolled for this study, There were 76 patients undergoing standard EVAR (standard-group)and 36 patients doing aneurysmal sac coiling embolization (embo-group). Baseline characteristics, aneurysmal sac parameters, radiological intervention details and follow up results were recorded. Results: Mean follow-up time was 25.9 m for embo-group. During follow-up period, no coils-related complications were noted and no type-Ⅱ endoleak associated secondary interventions were reported. A mean of (2.72±1.16) coils (range 1-7) was used in the embo-group. The incidence of type Ⅱ endoleak was 30.3%(23/76) in standard-group and 11.1%(4/36) in embo-group(χ²=4.90, P=0.027). Logistic multivariate analysis revealed that the independent risk factors of type Ⅱ endoleak after endovascular aortic repair for high-risk patients were those EVAR without sac embolization and sac volume≥128 cm³. In the subgroup analysis (sac volume≥128 cm³), the incidence of type-Ⅱ endoleak was lower in embo-group compared to standard-group (χ²=6.07, P=0.014). Conclusion Intraoperative sac coiling embolization in high-risk patients is safe and effective in prevention of type Ⅱ endoleak. This preventive effect is more significant with large sac aneurysm compared to small sac aneurysm.

Objective To observe the effect of GLP-1 on HSP70 expression of rabbit thoracic aortic endothelial cells at high glucose level.Methods Rabbit thoracic aortic endothelial cells were isolated and cultured.Tunnel was used to assay endothelial cells apoptosis.Cell proliferation was analyzed with BUDR.The protein level of HSP70 were detected by Western blot.Results The proliferation of rabbit thoracic aortic endothelial cells cultured under high glucose (33 mmol/L) decreased,(0.54 ±0.06 vs 0.78 ±0.04,P ＜ 0.01).The apoptosis and the protein level of HSP70 increased,(36.43％ ± 6.85％ vs 5.25％ ±0.73％) and (0.94 ± 0.11 vs 0.29 ± 0.03,all P ＜ 0.01).The proliferation of rabbit thoracic aortic endothelial cells (0.62 ± 0.06)in the GLP-1 group increased,the apoptosis ratio (10.13％ ± 1.19％) and HSP70 expression (0.76 ± 0.05) decreased significantly (P ＜ 0.05) compared with high glucose group.Conclusion GLP-1 can ameliorate high-glucose-induced rabbit thoracic aortic endothelial cells apoptosis and promote cell proliferation,attenuating high-glucose-induced level of HSP70 expression through the GLP-1 R-dependent pathways.

Objective To investigate the method and effect of endovascular treatment for ilio-femoral venous post-thrombotic syndrome.Methods We retrospectively analyzed the clinical data of 47 patients,who underwent endovascular treatment for ilio-femoral venous post-thrombotic syndrome from January 2010 to December 2013.Patients received transjugular iliofemoral venous thrombectomy,percutaneous angioplasty (PTA) and/or endovascular stent placement after inferior vena cava filter was implanted.Results All patients were successfully treated with angioplasty and stent placement.The ilio-femoral venous were patent after the placement of the stent.Chronic ulcer in 7 patients healed within one month.The patency rate of the affected limb at 6 months was 88.9％,occlusion rate was 11.1％.No reblocked cases were found during venous ultrasound follow-up.After treatment,the circumference difference of low limb between affected and normal limb decreased from (2.46 ± 0.98) cm to (0.70 ± 0.19) cm (P ＜0.05) at the level of 15 cm above knee,and from (3.28 ±0.85) cm to (0.83 ±0.26) cm (P＜0.05) at the level of 15 cm below knee.Villalta score decreased from (12.0 ± 1.9) to (6.9 ±2.2,P ＜ 0.05) and symptoms were significantly improved.Conclusions Ilio-femoral venous stenting provides a safe,effective and minimal invasive approach for the treatment of post-thrombotic syndrome.Acceptable patency rates can be expected through short-term follow-up.

OBJECTIVE: To explore the relationship between activity of plasma heparin cofactor II (HC II) and the incidence of in-stent restenosis aft er the intervention of arteriosclerosis obliterans in lower extremity. METHODS: A total of 62 patients with arteriosclerosis obliterans in lower extremity underwent femoropopliteal stent implantation. They were divided into 2 groups: A high HC II activity group (≥100%, n=40) and a low HC II activity group (<100%, n=22). All patients filled in follow up tables and conducted body examination. Possible risk factors resulting in restenosis were collected. Patients were followed up for 6 months after femoropopliteal stent implantation. RESULTS: Baseline clinical characteristics were not significantly different between the 2 groups. The degree and incidence of angiographic restenosis at the end of the 6th month after the implantation in the high HC II activity group were all significantly lower than those in the low HC II activity group (P<0.05). Multivariate analysis demonstrated that high plasma HC II activity was an independent factor in reducing the incidence of angiographic restenosis (OR=0.982, P=0.048, 95%CI, 0.966, 0.998). CONCLUSION High plasma HC II activity is an independent factor in reducing the degree of in-stent restenosis. The lower the plasma HC II activity, the severer the degree of in-stent restenosis.
Arteriosclerosis Obliterans ; surgery ; Constriction, Pathologic ; Heparin Cofactor II ; metabolism ; Humans ; Incidence ; Lower Extremity ; Risk Factors ; Stents

Objective To explore the clinical significance of retrograde access for the interventional treatment of lower extremity arterial occlusive diseases when the occluded segment of lower extremity artery could not be reached through antegrade access.Methods Twenty-seven cases (male 17,female 10; age range 32-89 years ) were retrospectively investigated, including 18 with lower limb arteriosclerosis obliterans,7 with diabetic foot and 2 with thromboangiitis obliterans.According to the Fontaine staging,6 cases were classified as Fontaine Ⅱ,11were classified as Fontaine Ⅲ and 10 were classified as Fontaine Ⅳ.All cases underwent endovascular operation through antegrade access first with an attempt to cross the occlusive segment,but in vain.So retrograde access was tried via puncture of pedis dorsalis or posterior tibial artery or exposure of lateral branches of posterior tibial artery,peroneal artery or dorsal artery by open surgery,which followed by Percutaneous transluminal angiography and (or) stenting.Results The operation through retrograde access was successful in all cases with obvious improvement of ischemic symptoms.Hematoma at the puncture site occurred in 3 patients,and paresthesia of toes occurred in 1after dorsalis pedis arteriotomy.No severe perioperative complication occurred.The average ankle brachial index increased from 0.37 ± 0.11preoperatively to 0.85 ± 0.12 postoperatively.Conclusions Retrograde access could be used as an alternative strategy in lower extremity arterial occlusive diseases when the occluded segment could not reach through antegrade access.