Search

Low-strain nanoarchitectures are the precondition for offering a stable electrochemical environment towards high-performance lithium-ion battery anode in the compaction system. Realizing the zero-strain for each particle of high-capacity anode is a scientific challenge, because of huge volume changes arising during the insertion/extraction process of Li+. Herein, we develop a facile and general strategy to construct a freestanding transition metal oxides (TMOs) anode with consecutive nanoarrays of yolk-shell nanorods. By confining the dehydration process in the ion-selective carbon-ene-yne (CEY) nanotubes, free space can be precisely created for alleviating the excessive volume expansion of internal particles. The all-carbon CEY not only conducts the electrons and supports the nanoarchitecture of the anode, but also provides the high-areal-density atomic-level selective channels for Li+ diffusion and prevents the electrolyte from decomposition. The as-obtained strainless anode demonstrates an ultra-stable architecture and interface during cycling, leading to a high specific capacity and enhanced cycling ability. Our result demonstrates the significant advantages to largely produce zero-strain architecture, towards ideally solving the crucial issues confronted in the high-volume-change electrode.

This study was undertaken to establish an integrated quality control method based on the fingerprint of different testing instruments and a four-dimensional antioxidant activity profile. Firstly, the comprehensive ratio quantitative fingerprint method was used to rapidly calculate the similarity of GC fingerprint, UV-vis quantized fingerprint, HPLC fingerprint and ATR-FT-IR quantized fingerprint. In addition, a comprehensive evaluation strategy was proposed using the variation coefficient weighting algorithm, incorporating four complementary inputs, to achieve highly accurate analysis. At the same time, multi-markers assay by monolinear method was used for the first time for the quantitative analysis of multiple components. Based on this, the fingerprint-efficacy relationship was investigated, and substances that might be biologically active and the wavelength range of their distribution were predicted using the online-HPLC-DPPH-FIA method in conjunction with a PLS model built from individual and combined data matrices. The results showed that all 20 batches of samples were within 1-3 grades, with good quality consistency. According to index E, the samples' overall antioxidant capacity was also highly correlated with the year of production. The four-dimensional antioxidant activity profile also led to the conclusion that variations in antioxidant characteristics were caused by differences in the concentration and volatility of particular bioactive chemicals. Finally, mid-level data fusion produced better classification results than a single technique, further demonstrating the synergistic effects that may occur when the four types of data were combined. This study demonstrated that the combination of GC, UV-vis, ATR-FT-IR and HPLC can be used for the consistency control of herbal preparations and can elucidate the potential in predicting the antioxidant capacity of herbal preparations.

Photodynamic therapy (PDT) is an attractive clinical technique for cancer treatment. However, the poor solubility and weak cellular internalization of the molecule-photosensitizers, as well as the exceedingly short lifetime and limited diffusion distance of the generated reactive oxygen species (ROS) in cytoplasm directly restricted the therapeutic efficiency of conventional PDT. In this study, we proposed a facile strategy for improving PDT of cancer based on a mitochondria-targeted nanophotosensitizer. The molecule-photosensitizer chlorin e6 was covalently attached on the internal and external surfaces of the mesoporous silica nanoparticles. Then, the triphenylphosphonium was anchored on the nanoparticles for selectively targeting mitochondria. When irradiated with laser, the nanophotosensitizer can generate a large amount of ROS in mitochondria, thus causing the mitochondrial dysfunction and irreversible cell apoptosis. In vitro and in vivo studies demonstrated that the nanophotosensitizer could boost the treatment efficiency against cancer cells and xenograft tumor models.

The high-voltage spinel LiNi0.5Mn1.5O4 (LNMO) is a potential cathode material for lithium-ion batteries with outstanding energy density and power density. Here, we document a facile approach to prepare Al2O3-modified LNMO cathode materials. The Al2O3-modified LNMO materials were synthesized via a one-step solid-state reaction and then modified with Al2O3 via a wet chemical technique. The impacts of Al2O3 modification on the structure and electrochemical properties of LNMO materials were examined by X-ray diffraction, Fourier-transform infrared spectroscopy, Raman spectroscopy, scanning electron microscopy, transmission electron microscopy, energy-dispersive X-ray spectroscopy, X-ray photoelectron spectroscopy, charge-discharge tests, cyclic voltammetry measurements, electrochemical impedance spectroscopy, and aging tests. Throughout the modification process, several Al3+ were noted to substitute for Ni2+, resulting in a decrease of Mn4+ to Mn3+; this increased the electronic conductivity and lowered the electrochemical polarization of the LNMO material. An amorphous Al2O3 coating layer developed on the surface of the LNMO particles in the modification, and this could alleviate the strike of HF caused by electrolyte decomposition as well as the development of a solid electrolyte interphase. Thus, the 0.5 wt% Al2O3-modified LNMO material had decreased Rsf and Rct and greater DLi values with a rate capability and cycling stability better than LNMO. The rate capability was 105.6 and 83.3 mAh g–1 at high C rates of 5 C and 7 C, as opposed to 83.3 and 54.9 mAh g–1, respectively; the room temperature (25 °C) capacity retention was 92.6% at 1 C after 200 cycles, as opposed to 87.0%. The high-temperature (55 °C) capacity retention was 90.9% at 1 C rate after 200 cycles as opposed to 86.5%. Thus, this is an easy and feasible method to improve the electrochemical performance of LNMO cathode materials for industrialization.

The present study was designed to establish a comprehensive and practical method for the quality evaluation and control of herbal preparation (HEP). The chemical information of belamcandae rhizoma antiviral injection (BRAI) was extracted using a dual-system control system comprised of HPLC chromatography and attenuated total reflection Fourier transform infrared (ATR-FT-IR) spectroscopy. To begin with, a quantitative analysis of six BRAI index components was accomplished. On this basis, HPLC five-wavelength fusion fingerprint was established to control the overall quality of BRAI. Secondly, the quality control system of ATR-FT-IR spectroscopy was constructed, that is, a quantitative analytic model to forecast the total amount of index components. Concurrently, the ATR-FT-IR quantized fingerprint was established for similarity analysis utilizing the Systematic quantified fingerprint method (SQFM). In addition, an integrated evaluation technique based on equal weights was presented to assure the comprehensiveness of chemical information. The 20 samples demonstrated good consistency in terms of quality, with a quality rating of grade 1-3. Notably, the rationality of the average method of Systematic quantified fingerprint method application in BRAI was further verified using PCA and low-level data fusion. Finally, this paper developed a model for intelligent analysis that is both quick and complete. We have redefined the quality standard of belamcandae rhizoma that can be put into production (70% P

International audience; Unsatisfactory crystal quality and deep-level defects are detrimental for Cu(In,Ga)(S,Se)2 (CIGSSe) solar cells. In this work, an in-suit K doping strategy is implemented by introducing KF into the CIGSSe precursor solution to promote crystallization and passivate the deep defects. The effects of K on the solution-processed CIGSSe devices are systematic investigated. It has been discovered that K incorporation results in better crystallization, modified CIGSSe surface and fewer detrimental defects. Benefit from the reduction of the band-tailing effects, suppressed defects density and passivated interface recombination, the solution-processed CIGSSe solar cell achieve systematic improvement in open-circuit voltage and fill factor, enabling a champion efficiency of 16.02%, which is the highest value for alkali metal doped CIGSSe solar cells fabricated by solution-processed method. The effective in-suit K doping tactic opens an avenue for developing highly efficient solution-processed CIGSSe solar cells.

We report a novel oral delivery system based on sodium alginate/κ-carrageenan binary polysaccharide gel bead. β-galactase was selected as a model molecule to evaluate the capacity of the beads as delivery system. After enzyme encapsulation, the hydrogel beads were subsequently coated with κ-carrageenan (κ-CG) and e-polylysine (e-PL). Scanning electron microscope (SEM) images revealed the microstructural differences between the beads synthesized with and without e-PL coating. Fourier transform infrared spectroscopy (FTIR) spectra further proofed the successful coating of e-PL and κ-CG. Releasing studies showed that the enzyme releasing time is significantly prolonged by e-PL coating. In vitro experiments showed that, the hydrogel beads synthesized with 0.6% e-PL were stable and compact in the simulated gastric fluid environment with negligible swelling, which can protect the loaded enzyme effectively. More than 94.6% lactase activity can be retained after treated with simulated gastric fluid (pH 4) for 2 h. After transferred into simulated small intestinal fluid for 14 h (pH 7.4), as much as 89.6% of the enzyme can be released from the beads. It is worthy to note that the activity of the released enzyme retained 76.0% of total enzyme activity. These unique properties of the hydrogel beads enabled the effectively maintenance of enzyme bioactivity and thus enhanced the enzyme delivery and therapeutic efficiency. The reported delivery system is an ideal oral delivery system for bioactive food compounds, especially for compounds that are unstable in gastric environment.

Spinel Li4Ti5O12 doped with F was synthesized via the solid-state reaction of anatase TiO2, Li2CO3, and NH4F. The structural characterization and electrochemical performance evaluation of the prepared materials were carried out utilizing X-ray diffraction, scanning electron microscopy, galvanostatic charge-discharge, electrochemical impedance spectroscopy (EIS), and cyclic voltammetry (CV) tests. The lattice parameters of all samples were calculated using an internal standard and Rietveld refinement method. The results indicate that the F was successfully doped into the lattice structure of Li4Ti5O12, and this process did not influence the crystal structure and superficial morphology. Moreover, the best-performing material, Li4Ti5O11.9F0.1 delivers superior rate capacities of 165, 162.1, 160.0, 142.3, 125.1, and 99.2 mAh g−1, at 0.2 C, 0.5 C, 1 C, 3 C, 5 C, and 10 C, respectively, which is higher than those of Li4Ti5O12 (150.0, 135.0, 123.5, 93.7, 76.4, and 56.8 mAh g−1 at the same C-rates), and the cycling retention is 82.7% after 150 cycles at 5 C. Meanwhile, the charge-transfer resistance (Rct) of Li4Ti5O11.9F0.1 (56.4 Ω) is lower than that of pure Li4Ti5O12 (80.6 Ω), and the lithium-ion diffusion coefficients (DLi+) of Li4Ti5O11.9F0.1 (2.505 × 10−10 cm2 s−1) is higher than that of pure Li4Ti5O12 (1.694 × 10−10 cm2 s−1).

This study focused on hydraulic characteristics around a gear-shaped weir in a straight channel. Systematic experiments were carried out for weirs with two different gear heights and eight groups of geometrical parameters. The impacts of various geometrical parameters of gear-shaped weirs on the discharge capacity were investigated. The following conclusions are drawn from the experimental study: (1) The discharge coefficient ( m c ) was influenced by the size of the gear: at a constant discharge, the weir with larger values of a/b (a is the width of the gear, and b is the width between the two neighboring gears) and a/c (c is the height of the gear) had a smaller value of m c . The discharge capacity of the gear-shaped weir was influenced by the water depth in the weir. (2) For type C1 with a gear height of 0.01 m, when the discharge was less than 60 m3/h and H 1 / P H 1 is the water depth at the low weir crest, and P is the weir height), m c significantly increased with the discharge and H 1 / P ; with further increases of the discharge and H 1 / P , m c showed insignificant decreases and fluctuated within small ranges. For type C2 with a gear height of 0.02 m, when the discharge was less than 60 m3/h and H 1 / P m c significantly increased with the discharge and H 1 / P ; when the discharge was larger than 60 m3/h and H 1 / P > 1.0, m c slowly decreased with the increases of the discharge and H 1 / P for a / b ≤ 1.0 and a / c ≤ 1.0, and slowly increased with the discharge and H 1 / P for a / b > 1.0 and a / c > 1.0. (3) A formula of m c for gear-shaped weirs was established based on the principle of weir flow, with consideration of the water depth in the weir, the weir height and width, and the height of the gear.

Objective American ginseng is a medicinal plant with large market demands, however, its producing areas are shrinking because of the continuous cropping obstacles in China. Therefore, it is urgent to establish a suitable model to determine the new producing areas. Here we evaluated and predicted the suitable areas of American ginseng using the maximum entropy model (MaxEnt). Methods Based on the 37 environmental variables over thirty years from 1970 to 2000 and 226 global distribution points of American ginseng, MaxEnt was used to determine the global ecological suitable areas for American ginseng. The Receiver Operating Curve (ROC) was used to evaluate the model prediction accuracy. Meanwhile, an innovative ecological variable, the precipitation–temperature ratio, was established to indicate the climate characteristic in the American ginseng suitable areas based on the monthly precipitation and temperature. Results The potential ecological suitable areas of American ginseng were primarily in Appalachian Mountain in America and Changbai Mountain in China, about in the range of 35°N–50°N, 60°W–120°W and 35°N–50°N, 110°E–145°E, respectively, including the United States, Canada, China, North Korea, South Korea, Russia and Japan. South Korea and Japan were the potential producing regions. The precipitation–temperature ratios were stable at (0.22, 0.56) of the vigorous growth period (April–October) in the best suitable areas of American ginseng, serving as characteristic parameters to optimize the prediction model. The model showed that the common soil parameters were pH 4.5–7.2, Base Saturation (BS) above 80%, Cation Exchange Capacity (CEC) 10–20 cmol/kg, organic carbon (OC) Conclusion An optimized MaxEnt model was established to predict the producing area for American ginseng that needed to be validated by a field test.

Accurate segmentation of corneal layers depicted on optical coherence tomography (OCT) images is very helpful for quantitatively assessing and diagnosing corneal diseases (e.g., keratoconus and dry eye). In this study, we presented a novel boundary-guided convolutional neural network (CNN) architecture (BG-CNN) to simultaneously extract different corneal layers and delineate their boundaries. The developed BG-CNN architecture used three convolutional blocks to construct two network modules on the basis of the classical U-Net network. We trained and validated the network on a dataset consisting of 1,712 OCT images acquired on 121 subjects using a 10-fold cross-validation method. Our experiments showed an average dice similarity coefficient (DSC) of 0.9691, an intersection over union (IOU) of 0.9411, and a Hausdorff distance (HD) of 7.4423 pixels. Compared with several other classical networks, namely U-Net, Attention U-Net, Asymmetric U-Net, BiO-Net, CE-Net, CPFnte, M-Net, and Deeplabv3, on the same dataset, the developed network demonstrated a promising performance, suggesting its unique strength in segmenting corneal layers depicted on OCT images.

Licorice extract (LE) is widely used in food and medicine fields. The detection of single chemical component cannot describe its overall quality. In this paper, the content of five active components and HPLC fingerprint of LE was determined. Firstly, the dual-standard system calibration method was proposed to correct the differences between different chromatographic systems. Then, the five-dimensional profiling method (FDPM) was established to evaluate LE based on the five parameters. 52 batches of LE were divided into four categories, Cluster analysis and Orthogonal projections on the latent structure - discrimination analysis (OPLS-DA) showed that the quality and quantity of LE can be reflected by FDPM. In addition, the comparison of different chromatographic system conditions showed that FDPM can dig out the potential information and provide strategies for the monitoring and calibration of fingerprint chromatographic systems.

Early mortality and cerebral injury are severe complications of aortic arch surgery, but data from Asian countries are scarce. We reviewed the results of patients who underwent aortic arch replacement with deep hypothermic circulatory arrest (DHCA) and antegrade selective cerebral perfusion (ASCP) at our institution to analyse pre- and intraoperative predictors of early death and neurological complications.Clinical data of adult patients who underwent aortic arch surgery with DHCA plus ASCP between January 2005 and December 2011 were retrospectively analysed. Univariate and multivariate analyses were performed to identify predictors of adverse outcome defined as 30-day mortality and permanent neurological dysfunction (PND), and transient neurological dysfunction (TND).A total of 626 patients were included in the study. The average age of the patients was 45.0±10.7 years with male predominance (77.0%). The incidence of adverse outcome was 5.8%, consisting of 4.6% 30-day mortality and 1.9% PND. Transient neurological dysfunction was found in 13.9% patients. Multiple logistic regression showed that stroke (OR=7.846, 95% CI: 2.737-22.489, p0.001), emergency (OR=2.198, 95% CI: 1.019-4.740, p=0.045), CPB time (OR=1.009, 95% CI: 1.004-1.014, p0.001), CABG (OR=2.613, 95% CI: 1.066-6.405, p=0.036) and packed red blood cells (OR=1.113, 95% CI: 1.038-1.193, p=0.003) were independent predictors of adverse outcome, and acute type A aortic dissection (OR=2.635, 95% CI: 1.535-4.524, p0.001), preoperative neurological deficits (OR=5.326, 95% CI: 1.529-18.548, p=0.009), CPB time (OR=1.004, 95% CI: 1.000-1.007, p=0.026) and cerebral low-flow time (OR=1.034, 95% CI: 1.003-1.066, p=0.033) were associated with TND.A history of stroke was a strong predictor of adverse outcome, and acute type A aortic dissection and preoperative neurological deficits had a high correlation with TND. The predictors identified in this study may help clinicians to optimise the risk evaluation and perioperative clinical management of patients undergoing aortic arch surgery to reduce morbidity and mortality.

Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder typically involving the ocular, skeletal and cardiovascular systems, and aortic aneurysms/dissection mainly contributes to its mortality. Here, we performed genetic testing of the FBN1 gene in 39 Chinese probands with Marfan/Marfan-like syndrome and their related family members by Sanger sequencing. In total, 29 pathogenic/likely pathogenic FBN1 mutations, including 17 novel ones, were identified. In addition, most MFS patients with aortic disease (62%) had a truncating or splicing mutation. These results expand the FBN1 mutation spectrum and enrich our knowledge of genotype-phenotype correlations. Genetic testing for MFS and its related aortic diseases is increasingly important for early intervention and treatment.

Objectives: The platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) have been studied widely in cancer diseases. However, their correlation with hepatitis C virus (HCV) infection is unknown. The aim of this study was to investigate the correlation of PLR and NLR with disease severity in patients with HCV-related liver disease and the virological response in chronic hepatitis C (CHC) patients. Methods: The clinical data of 120 HCV-infected patients and 40 healthy controls were analyzed. The clinical data of 24 CHC patients who had been followed up regularly were collected for the following time points: before treatment (week 0) and weeks 4, 48, and 72 during treatment. These data were also analyzed. All data were collected from the database of the hospital patient electronic medical record system. Results: The HCV-related cirrhosis group and HCV-related hepatocellular carcinoma group were found to have lower PLRs (61 ± 31 and 51 ± 23) than the healthy controls (115 ± 23). The PLR of the HCV cleared group (154 ± 85) was significantly higher than that of the HCV untreated group and HCV uncleared group (90 ± 28 and 88 ± 40, respectively). Receiver operating characteristics curve analysis for the PLR showed an area under the curve of 0.772 (95% confidence interval 0.674–0.869, p

The present study aimed to investigate the metabolic mechanisms of zinc-deficient mice and oligosaccharide-zinc diets intervention by assessing the changes of endogenous metabolites in serum and liver using LC-MS metabolomics approach. Three (3) to four (4) weeks old Kunming mice were divided into three groups: control (normal diet), zinc-deficiency (without zinc diet), oligosaccharide-zinc (without zinc diet + oligosaccharide-zinc at a dose of 3.48 mg Zn/kg·bw). After 16 days treatment of diet with oligosaccharide-zinc complex, metabolites, such as lipid metabolites (fatty acids, phosphatidylcholines (PCs), lysophosphatidylcholines (lysoPCs), lipid metabolism intermediates (betaine), glycerophospholipid, phospholipid, dihydroxyacetone, pyrimidine and aldonic acid were significantly affected. The PLS-DA score plots showed a clear distinction of metabolites between experimental groups in serum and liver markers. Oligosaccharide-zinc treatment recovered the major metabolites changes in serum and liver in zinc-deficiency mice. Those results suggested that oligosaccharide-zinc complex could be regarded as a favourable zinc supplementation.

Mg2+/F− co-doped LiNi0.5Mn1.5O4 cathode material was synthesized by a facile one-step solid-state process. The effect of Mg2+/F− co-doping on grain morphology, phase structure, and electrochemical properties was studied by a series of characterizations. Scanning-electron-microscopy images show that Mg2+/F− co-doped LiNi0.5Mn1.5O4 (denoted LNMO-MF) particles grow larger than pure LiNi0.5Mn1.5O4 particles. X-ray diffraction, Raman spectra, Fourier transformation infrared spectroscopy, X-ray photoelectron spectroscopy, and cyclic-voltammetry tests indicate that all samples mainly display a Fd-3m space group and more Mn3+ ions in the LNMO-MF sample after Mg2+/F− co-doping, which is conducive to increasing the cationic disorder degree and enhancing the electronic conductivity of electrode material. Results show that the LNMO-MF cathode material delivers an excellent rate performance with discharge capacities of 142, 144, 140 136, 132, 124, 115, and 100 mAh g−1 at 0.2, 0.5, 1, 2, 3, 5, 7, and 10C (1C = 140 mAh g−1), respectively. Remarkably, LNMO-MF also shows cycling stability with a capacity retention of 86.2% at 5C after 400 cycles, which is much higher than that of pure LiNi0.5Mn1.5O4 (67.7%). The improvement of LNMO-MF's electrochemical properties could be ascribed to the Mg2+/F− co-doping, delivering a more stable structure, better crystallinity, the highest Li+ diffusion coefficient, and the lowest charge-transfer resistance.

ObjectiveIn this study the role of microRNA-145 expression in ascending aortic aneurysm wall media remodeling was examined.MethodsAortic wall samples were obtained from 10 patients who had undergone surgery for ascending aortic aneurysm. Control aortic tissue samples were obtained from 10 patients who had undergone coronary artery bypass graft. The levels of microRNA-145 were analyzed using real time quantitative reverse transcriptase polymerase chain reaction, and western blots were used to determine the expressions of osteopontin (OPN) and collagen. In vitro cultures of vascular smooth muscle cells (VSMCs) were established from both patient groups. The VSMCs were transfected with either microRNA-145 mimics or microRNA-145 inhibitors to determine the effect of microRNA-145 on the expression of OPN and collagen. Furthermore, cells were co-transfected with microRNA-145 mimics and TGF-β1 siRNA to investigate whether TGF-β1 is involved in the process that microRNA-145 increases the expression of OPN and collagen.ResultsAortic microRNA-145, OPN and collagen III was increased in ascending aortic aneurysm patients compared with controls (p

ObjectiveWe seek to compare the early outcomes of frozen elephant trunk with total aortic arch replacement using a 4-branched graft (the Sun procedure) in patients with acute and chronic type A aortic dissection (TAAD), identify the risk factors for operative mortality, and determine whether the acuity of TAAD significantly affects operative mortality.MethodsWe performed univariate and multivariate analyses of the clinical data from 803 patients with TAAD who underwent the Sun procedure.ResultsThe operative mortality was 6.5% (52 of 803). The overall incidence of stroke and spinal cord injury was 2.0% (16 of 803) and 2.4% (19 of 803), respectively. Patients with acute TAAD had a greater incidence of operative death (8.1% vs 4.3%; P = .031), stroke (2.2% vs 0.6%; P = .046), and respiratory morbidities (20.8% vs 8.6%; P 180 minutes (OR, 1.01; P 180 minutes) were at greater risk of operative mortality.

Background The presence of an isolated left vertebral artery requires changes in the aortic arch reconstruction techniques and cerebral protection methods in patients with total arch replacement. The best method for surgical repair of the isolated left vertebral artery is controversial. We retrospectively reviewed our experience of total arch replacement in patients with aortic dissection with this vessel anomaly. Methods Between August 2003 and December 2008, 21 patients with aortic dissection (type A dissection, n=20; type B dissection, n=1) with an isolated left vertebral artery underwent total arch replacement under hypothermic cardiopulmonary bypass combined with selective cerebral perfusion. Concomitant stented elephant trunk was implanted in 20 patients. Results There was no in-hospital death. Injury to the spinal cord occurred in 2 patients with chronic dissection using stented elephant trunk implantation. One had weakness in the left lower extremity, and the other patient had paraparesis: both recovered during the follow-up period. One patient experienced transient neurologic deficit, and acute renal failure was observed in 1 patient: both recovered completely before hospital discharge. Conclusions Acceptable results were obtained in patients with aortic dissection with an isolated left vertebral artery. Although there was no clear evidence that the spinal cord injury was related to the isolated left vertebral artery using stented elephant trunk implantation, the isolated left vertebral artery was constructed as soon as possible in patients with this vessel anomaly.

A simple, highly effective hydrogenation of chiral BINOL to provide H4-BINOL in multigram scale with good yield (up to 78% yield) was developed. A series of heterogeneous catalysts was tested in the hydrogenation; the best result was obtained with 5% Pd/C in EtOH under the H2 pressure of 50 bar for 2 h. This method is a more useful method for practical synthesis of optically pure H4-BINOL than other available methods.

Background Coarctation of the aorta with cardiac lesions or complex coarctation is a formidable challenge for cardiac surgeons. Extra-anatomic bypass allows simultaneous intracardiac repair or an alternative approach for patients with complex coarctation. Methods Between July 1997 and March 2008, 43 patients with coarctation of the aorta underwent extra-anatomic bypass grafting, including 10 ascending-to-descending aorta bypasses and 33 ascending aorta-to-infrarenal abdominal aorta bypasses. Forty patients had additional cardiovascular disorders and concomitant procedures performed including aortic valve replacement, mitral valve replacement, coronary artery bypass grafting, closure of ventricular septal defect and patent ductus arteriosus, ascending aorta repair, and the Bentall procedure. The other three patients had complex coarctation of the aorta, including a long-segment coarctation in two cases, and descending aortic aneurysm in one. Results Two patients died perioperatively: one due to air embolism during the cardiopulmonary bypass; one due to septic shock. There were no late deaths. Complications included laparotomy for mechanical ileus in one and re-exploration for bleeding in one case. There were no strokes or paraplegia and no grafted-related complication during follow-up period. Systolic blood pressure dropped from 160 ± 27 mm Hg before surgery to 114 ± 16 mm Hg postoperatively. Only two patients with mild hypertension postoperatively needed oral medicine. Conclusions Extra-anatomic aortic bypass via median sternotomy or median sternotomy-laparotomy can be performed with low morbidity and mortality. It is a preferable single-stage approach for patients with concomitant complex coarctation and cardiovascular disorders.

Background Surgical management of acute type A dissection with the tear in the descending aorta is challenging because of the technical difficulty in managing proximal and distal aortic lesions through a median sternotomy or lateral thoracotomy using a single-stage procedure. Methods Thirty-three patients with acute type A dissection with the tear in the descending aorta underwent total arch replacement combined with stented elephant trunk implantation through a median sternotomy from April 2003 to June 2007. Preoperative complications included acute cardiac tamponade (n = 1), acute left heart failure (n = 1), acute myocardial infarction (n = 1), cerebral ischemia (n = 1), acute renal failure (n = 2), chronic renal dysfunction (n = 2), and acute mesenteric ischemia (n = 1) and lower extremity ischemia (n = 3). The residual false lumen was evaluated using postoperative computed tomography. Results Death at 30 days was 6.06% (2 of 33 patients). One patient with preoperative mesenteric ischemia died of postoperative multiple-organ failure. One patient with preoperative acute renal failure ceased treatment after three reoperations owing to uncontrollable bleeding. Left lower-extremity paraparesis occurred in 1 patient, and transient neurologic dysfunction occurred in 1 patient. Severe complications were not observed at a mean follow-up of 25 ± 11 months. Thrombus obliteration of the false lumen was observed at the distal end of the stented graft in 29 patients (96.7%) and at the diaphragmatic level in 20 patients (66.7%) during follow-up. Conclusions Encouraging outcomes favor this technique in patients with acute type A dissection with the tear in the descending aorta. Simultaneous repair of proximal aortic lesions and thrombosis of the false lumen in the descending aorta could be obtained.

Background The purpose of the study was to assess the efficacy of total arch replacement combined with stented elephant trunk implantation for Marfan patients with acute Stanford type A aortic dissection involving the aortic arch. Methods Between January 2004 and April 2006, 13 consecutive Marfan patients (4 female, 9 male) with acute type A aortic dissection involving the aortic arch underwent total arch replacement combined with implantation of a stented elephant trunk. Aortic dissection extending to the iliac artery was seen in 10 patients, and to the abdominal aorta in 3 patients. Ages ranged from 17 to 65 years (mean, 39 ± 13). Computed tomography was done to evaluate the residual false lumen in the descending aorta. Results All patients survived and were discharged from hospital. One patient with thrombosis of the innominate artery suffered cerebral infarction and recovered during follow-up. One patient had ischemia of the left upper limb postoperatively, but recovered after axillary to axillary artery bypass. There was 1 death during the mean follow-up period of 27 ± 10 months. Complete thrombus formation was observed in 84.6% of patients (11 of 13) around the stented elephant trunk, and in 69.2% of patients (9 of 13) at the diaphragmatic level. Conclusions Total arch replacement combined with stented elephant trunk implantation for Marfan patients with acute type A aortic dissection involving the aortic arch results in less late dilatation of the dissected descending aorta. That prolongs the reoperation interval or reduces the number of late thoracoabdominal aortic replacements, unless there is a patent false lumen around the stented elephant trunk.

Background The goal of total aortic resection surgery is to correct the extensive or multiple sites of aortic pathology, which involves the entire length of the vessel. This study describes our experience in this operation at Fuwai Cardiovascular Hospital. Methods From February 2004 to October 2005, thirteen patients with Marfan syndrome underwent one-stage total or subtotal aortic replacement for aortic dissection or aortic aneurysms. Four patients received subtotal aortic replacement (ascending aorta to the abdominal aorta). Nine patients underwent total aortic replacement (ascending aorta to the aortic bifurcation). Operations were performed under circulatory arrest with profound hypothermia. Patients were opened with a mid-sternotomy and a thoracoabdominal incision. Extracorporeal circulation was instituted with two arterial cannulae and a single venous cannula in the right atrium. During cooling, the ascending aorta or aortic root was replaced. At the nasopharyngeal temperature of 20°C, the aortic arch was replaced with selective antegrade cerebral perfusion. After brain reperfusion, staged aortic occlusions allowed for replacement of descending thoracic and abdominal aorta. Intercostal, visceral, and renal arteries were anastomosed to the graft. Results There was no operative or early postoperative death. One case of postoperative complication was noted for cerebral infarction secondary to embolism. Spinal neurologic deficits did not occur. At the last follow-up, ranging from 4 to 24 months postoperatively, all 13 patients were alive and had good functional status. Conclusions One-stage total or subtotal aortic replacement for treatment of extensive aortic disease is feasible with acceptable surgical risks and satisfactory results. It can eliminate the risk of remnant aortic aneurysm rupture in staged total aortic replacement.

Objective/Background Long non-coding RNA (lncRNA) play important roles in many diseases. However, their roles in sporadic thoracic aortic aneurysm (STAA) are unclear. Therefore, the objective of this study was to construct an lncRNA–mRNA network and dissect lncRNAs that might contribute to the pathogenesis of STAA. Methods Differentially expressed lncRNAs and mRNAs between four ascending aortic specimens derived from STAA and four controls from patients who had undergone coronary artery bypass graft (CABG) were identified by microarray analysis. Gene Ontology (GO) enrichment and lncRNA–mRNA correlation analysis were implemented with differentially expressed genes. An lncRNA in the correlation network HOX transcript antisense intergenic RNA (HOTAIR) was selected as a candidate. HOTAIR expression was examined by quantitative real time polymerase chain reaction in STAA ( n = 24) and controls ( n = 24 [CABG, n = 22; heart transplant donors, n = 2]). HOTAIR expression was knocked down with siRNA in order to evaluate its role in apoptosis, cell proliferation, and expression of collagen types I and III. Results Five percent of lncRNAs were significantly differentially expressed in STAA patient samples compared with controls. GO enrichment analysis suggested differentially expressed genes were significantly enriched in the process of extracellular matrix organisation and leukocyte migration. lncRNA–mRNA interaction network revealed HOTAIR was associated with genes involved in extracellular matrix organisation. Moreover, HOTAIR expression was significantly decreased in STAA specimens and it negatively correlated with aortic diameter. HOTAIR knockdown induced early and late apoptosis and reduced cell proliferation. Furthermore, both mRNA and protein levels of collagen types I and III expression were suppressed after HOTAIR knockdown. Conclusion Transcriptomic and lncRNA–mRNA correlation analysis revealed HOTAIR was downregulated in STAA and associated with genes involved in extracellular matrix remodelling. In vitro experiments confirmed that knockdown of HOTAIR could induce apoptosis and suppress collagen types I and III expression in human aortic smooth muscle cells.

Background . Although minimally invasive surgical procedures have aroused much interest in cardiac surgery, difficulty still exists with its application in most of the operations on great arteries. This report summarizes our initial experience of aortic root replacement by a superior ministernotomy in terms of operative indications, operative techniques, and potential benefits. Methods . Between July 1999 and September 1999, 8 patients who were diagnosed with Marfan syndrome with aortic valve regurgitation underwent aortic root replacements with composite grafts. Clinical characteristics, in-hospital outcomes, and postoperative stay of these patients were compared with data of patients who had undergone Bentall procedure by standard median sternotomy from January to September 1999. Results . There was no death in either group of patients. Demographics were similar between the two groups of patients. In the mini-incision group, the mediastinal drainage was significantly less than the standard incision group. The mean operating time was significantly longer than that in the standard incision group. The cardiopulmonary bypass time and aortic cross-clamping time were similar in both groups of patients. The mean intubation time, postoperative blood transfusion amount, duration of intensive care unit stay and postoperative hospital stay were less than that of the standard incision group; however, they all showed no statistical significant difference. Conclusions . Aortic root replacement by a superior ministernotomy in cardiopulmonary bypass with cannulas through the femoral artery and femoral vein or right atrium is a safe, reliable procedure with excellent exposure. The procedure provides a potential benefit of less trauma, quick recovery, and reduction of mediastinal drainage and reduction of blood transfusion.

We give a martingale analogue of Muckenhoupt's A ∞ condition for weights and show a martingale version of his theorem relating this to the A p condition for weights.