86 results on '"Qian, Chang"'
Search Results
2. Proliferative Vascular Smooth Muscle Cells Stimulate Extracellular Matrix Production via Osteopontin/p38 MAPK Signaling Pathway
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Xiaogang Sun, Xiaobo Guo, Yanhai Meng, Huawei Pei, Xiangyang Qian, Haiyue Zhang, Qian Chang, and Chuan Tian
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Vascular smooth muscle ,p38 mitogen-activated protein kinases ,Myocytes, Smooth Muscle ,Matrix (biology) ,p38 Mitogen-Activated Protein Kinases ,Muscle, Smooth, Vascular ,Extracellular matrix ,Aortic aneurysm ,Western blot ,Humans ,Medicine ,Pharmacology (medical) ,Osteopontin ,Cells, Cultured ,biology ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Molecular biology ,Extracellular Matrix ,cardiovascular system ,biology.protein ,Cardiology and Cardiovascular Medicine ,business ,Elastin ,Signal Transduction - Abstract
Introduction: Extracellular matrix disorder and cellular phenotype transformation are the major histopathological features associated with ascending aortic aneurysms. Rare studies have investigated the relationship between cellular phenotype transformation and the abnormalities of the matrix constituents. In this study, we investigated whether the cellular phenotype transformation resulted in the extracellular matrix disorder. Methods: Aortic samples were obtained from 20 patients undergoing operations for ascending aortic aneurysms. Control aortic samples were obtained from 15 patients who underwent coronary artery bypass graft. The protein levels of osteopontin (OPN), collagen, and elastin were examined using Western blot, and quantitative reverse transcriptase-PCR was used to analyze the mRNA expression of collagen and elastin. In vitro experiment, vascular smooth muscle cells (VSMCs) were treated with recombinant human OPN (rh-OPN) or p38 MAPK inhibitor (SB203580) to investigate whether OPN and p38 MAPK regulated the expression of collagen and elastin. Results: The protein level of OPN and collagen III increased in ascending aortic aneurysm samples, compared with controls (p < 0.05). There was no difference in the protein level of elastin between aneurysm tissues and the controls. VSMCs treated with rh-OPN increased the collagen III and elastin protein level and mRNA expression (p < 0.05). Cells treated with SB203580 decreased the collagen III and elastin protein level and mRNA expression (p < 0.05). Furthermore, VSMCs incubated with SB203580 reduced the rh-OPN-induced production of collagen III and elastin (p < 0.05). Conclusion: OPN, the proliferative VSMCs maker, increased the expression of extracellular matrix. OPN/p38 MAPK signaling pathways may protect against ascending aortic aneurysm progression.
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- 2021
3. Identifying barriers to sustainable apple production: A stakeholder perspective
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Lynn J. Frewer, Shan Jin, Wenjing Li, Jing Chen, Zhenhong Li, Guijun Yang, Qian Chang, Yiying Cao, and Glyn Jones
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Crops, Agricultural ,Environmental Engineering ,Farms ,Lock-in ,Supply chain ,Context (language use) ,Interpretive structural modelling ,Management, Monitoring, Policy and Law ,Article ,Humans ,Waste Management and Disposal ,Farmers ,Policy mix ,Stakeholder ,Agriculture ,General Medicine ,Environmental economics ,Policy ,Sustainability ,Food system ,Malus ,Food systems ,Survey data collection ,Business ,Thematic analysis ,Apple production - Abstract
Apple is one of the most important cash crops in China. However, negative economic, environmental and social impacts are associated with its production. This study aims to apply a holistic systems perspective to understand existing problems associated with apple production in China and use this information to improve its sustainability. A structured survey was administered to farmers (n = 245) in Shandong and Shanxi provinces, combined with semi-structured interviews with apple supply chain stakeholders (n = 25). Themes, dimensions and relationships were identified based on an inductive thematic analysis of interview data, and then triangulated against the survey data. Interpretive Structural Modelling and Cross-Impact Matrix Multiplication Applied to Classification methods were applied to investigate interrelationships and effects of the elicited elements within the system. The results indicated that various environmental, economic and social problems are associated with apple production in China, including environmental and health risks associated with synthetic input applications, yield instability, deterioration of apple quality, farmers’ uncertainty about accessing routes to market, and the ageing farming workforce. The interaction of socio-economic and supply chain issues has contributed to the system “lock-in” to unsustainable practices within the apple production system. Existing agricultural policies were ineffective as they did not include policy leverage to mitigate the multiple factors driving lock-in to unsustainable practices within the system. The research has provided evidence to enable policymakers to develop effective and targeted strategies to facilitate sustainable production within the apple production system. In particular, the future policy mix should consider the entirety of the food system including perspectives and requirements of different stakeholders. The three-stage approach applied has demonstrated its feasibility of investigating sustainability issues facing a particular industry within a specific cultural and policy context., Graphical abstract Image 1, Highlights • 21 barriers to Chinese sustainable apple production were identified. • Vicious circles trap different problems in the apple production system. • There exists socio-technical lock-in around existing tools and practices. • Ineffective agricultural policies strongly hinder upgrading apple production. • A three-stage approach was established for researching agricultural sustainability.
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- 2022
4. The effect of functional mandibular advancement for adolescent patients with skeletal class II malocclusion on the TMJ: a systematic review and meta-analysis
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Lan Ding, Rui Chen, Jiaxin Liu, Yuan Wang, Qian Chang, and Liling Ren
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Adolescent ,Temporomandibular Joint ,Humans ,Malocclusion, Angle Class II ,Temporomandibular Joint Disorders ,General Dentistry ,Mandibular Advancement ,Randomized Controlled Trials as Topic - Abstract
Objectives This study aimed to assess whether functional mandibular advancement (FMA) will cause temporomandibular joint disorders (TMD) or have side effects on temporomandibular joint (TMJ) in adolescent patients. Methods All searched databases, including PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trails and Scopus were searched. Gray literature and unpublished literature was also searched. Randomized controlled trails (RCT) and non-randomized studies of the effects of interventions (NRSI) directly observe the condition of adolescent patients’ TMJ after finishing treatment will be considered to include in our study. According to Cochrane Handbook, Cochrane Collaboration risk of bias tool was used to assess the quality of included RCTs, and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool was used to assess the quality of included NRSIs. Result Finally 18 researches were evaluated as eligible to include in this study. 5 of the studies were RCTs, 8 were NRSIs and 5 were systematic reviews. The data of RCTs and NRSIs were statistically pooled in meta-analysis. The number of samples under investigated among primary studies was 579 individuals,there were 80 patients who developed temporomandibular symptoms during or after treatment. But all the subjective symptoms disappeared during follow-up time. The statistical outcomes proved that patients received FMA didn’t show more tendency to develop temporomandibular symptoms [I2 = 27%, OR = 0.54, 95%CI (0.33,0.87), p = 0.01]. Conclusion (1) TMJ symptoms may occur during the functional oral appliance wearing, but the symptoms will release or disappear after treatment or during the follow-up period. (2) Less convincing evidence indicates that slightly previous TMD and condyle-glenoid fossa relationship will be improved after treatment. (3) There is TMJ disc anterior displacement observed during treatment, but most of them will return to the normal position later. (4) Moderate evidence support that FMA will not have side effects on TMJ of adolescent patients.
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- 2021
5. Determining the Efficiency of the Sponge City Construction Pilots in China Based on the DEA-Malmquist Model
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Heng, Zhang, Qian, Chang, Sui, Li, and Jiandong, Huang
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China ,Pilots ,sponge city construction ,data envelopment analysis ,efficiency evaluation ,water ecological environment ,Ecology ,Health, Toxicology and Mutagenesis ,Public Health, Environmental and Occupational Health ,Humans ,Water ,Efficiency ,Cities - Abstract
Sponge city construction (SCC) has improved the quality of the urban water ecological environment, and the policy implementation effect of SCC pilots is particularly remarkable. Based on the data envelopment analysis (DEA) model, this study employed the related index factors such as economy, ecology, infrastructure, and the population of the pilot city as the input, and the macro factors of SCC as the output, to scientifically evaluate the relative efficiency between the SCC pilots in China. Eleven representative SCC pilots were selected for analysis from the perspectives of static and dynamic approaches, and comparisons based on the horizontal analysis of the efficiency of SCC pilots were conducted and some targeted policy suggestions are put forward, which provide a reliable theoretical model and data support for the efficiency evaluation of SCC. This paper can be used as a reference for construction by providing a DEA model for efficiency evaluation methods and thus helps public sector decision makers choose the appropriate construction scale for SCC pilots.
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- 2022
6. Respiratory diseases are positively associated with PM2.5 concentrations in different areas of Taiwan
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Feifei Wang, Yang Li, Ben-Chang Shia, Tianyi Chen, Mingchih Chen, Yi-Wei Kao, Qian Chang, and Jian Li
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Pulmonology ,Fine particulate ,Epidemiology ,Physiology ,Social Sciences ,Disease ,Geographical Locations ,Habits ,Medical Conditions ,Risk Factors ,Medicine and Health Sciences ,Smoking Habits ,Medicine ,Psychology ,Respiratory system ,education.field_of_study ,Air Pollutants ,Multidisciplinary ,Pollution ,Public attention ,Hospitals ,Hospitalization ,Infectious Diseases ,Research Article ,Asia ,Science ,Chronic Obstructive Pulmonary Disease ,Population ,Taiwan ,Disease Surveillance ,complex mixtures ,Respiratory Disorders ,Environmental health ,Air Pollution ,Humans ,Respiratory Physiology ,education ,Behavior ,Models, Statistical ,business.industry ,Ecology and Environmental Sciences ,Biology and Life Sciences ,Respiration Disorders ,Health Care ,Health Care Facilities ,People and Places ,Respiratory Infections ,Particulate Matter ,business - Abstract
The health effects associated with fine particulate matter (PM2.5) have attracted considerable public attention in recent decades. It has been verified that PM2.5 can damage the respiratory and cardiovascular systems and cause various diseases. While the association between diseases and PM2.5 has been widely studied, this work aims to analyze the association between PM2.5 and hospital visit rates for respiratory diseases in Taiwan. To this end, a disease mapping model that considers spatial effects is applied to estimate the association. The results show that there is a positive association between hospital visit rates and the PM2.5 concentrations in the Taiwanese population in 2012 after controlling for other variables, such as smoking rates and the number of hospitals in each region. This finding indicates that control of PM2.5 could decrease hospital visit rates for respiratory diseases in Taiwan.
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- 2021
7. Different treatment options for Takayasu arteritis patients with moderate-to-severe aortic regurgitation: long-term outcomes
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Guozhang Liu, Xuesen Cheng, Qian Chang, Aimin Dang, Naqiang Lv, Zuozhi Li, and Yunhu Song
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Male ,Aortic valve ,Digoxin ,Takayasu's arteritis ,Myocardial Infarction ,Angiotensin-Converting Enzyme Inhibitors ,030204 cardiovascular system & hematology ,Conservative Treatment ,Severity of Illness Index ,0302 clinical medicine ,Cause of Death ,Pharmacology (medical) ,Myocardial infarction ,Stroke ,Aorta ,Heart Valve Prosthesis Implantation ,Hazard ratio ,Middle Aged ,Calcium Channel Blockers ,Treatment Outcome ,medicine.anatomical_structure ,Cardiology ,Female ,Immunosuppressive Agents ,Adult ,medicine.medical_specialty ,Cardiotonic Agents ,Adrenergic beta-Antagonists ,Aortic Valve Insufficiency ,Angiotensin Receptor Antagonists ,03 medical and health sciences ,Rheumatology ,Internal medicine ,medicine ,Humans ,Mortality ,Propensity Score ,Glucocorticoids ,Survival rate ,Retrospective Studies ,Heart Failure ,030203 arthritis & rheumatology ,business.industry ,medicine.disease ,Takayasu Arteritis ,Case-Control Studies ,Heart failure ,Propensity score matching ,Prednisone ,business ,Platelet Aggregation Inhibitors - Abstract
Objectives To determine the prognosis of Takayasu arteritis (TA) patients with moderate-to-severe aortic regurgitation treated with surgical vs conservative treatment and to identify independent prognostic factors of long-term outcomes. Methods Between January 2002 and January 2017, 101 consecutive TA patients with moderate-to-severe aortic regurgitation treated with either surgical (n = 38) or conservative (n = 63) treatments were investigated in this retrospective observational case–control study. The primary end point was all-cause mortality, and the secondary end point comprised the combined end points of death, non-fatal stroke and cardiac events (non-fatal myocardial infarction and congestive heart failure). Propensity score matching was used to reduce the bias of baseline risk factors. Results The unadjusted all-cause 10-year mortality in the conservative group was increased compared with the surgical group (28.2% vs 7.4%; log-rank P = 0.036), and the combined end points showed the same trend (52.1% vs 25.3%; log-rank P = 0.005). After an adjustment of baseline risk factors, the conservative treatment was associated with reduced survival rates of both all-cause mortality [hazard ratio (HR): 8.243; 95% CI: 1.069, 63.552; P = 0.007] and combined end points (HR: 6.341; 95% CI: 1.469, 27.375; P = 0.002). Conservative treatment (HR: 3.838, 95% CI: 1.333, 11.053; P = 0.013) and left ventricular end-diastolic diameter (HR: 1.036, 95% CI: 1.001, 1.071; P = 0.042) were risk factors for increased combined end points. Conclusion Surgical treatment improves the outcomes of patients with moderate-to-severe aortic regurgitation due to TA. The dilated left ventricle indicated a worse prognosis.
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- 2020
8. [Long-term clinical outcomes of patients with aneurysmal subarachnoid hemorrhage in Yunnan Province]
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Jie, Sun, Zeyi, Wang, Ping, Su, Jun, Liu, Junyan, Li, Gang, Ma, Jianchang, Cen, Qian, Chang, Xinghai, Liu, and Nan, Zhao
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Male ,China ,临床研究 ,Treatment Outcome ,Activities of Daily Living ,Humans ,Female ,Intracranial Aneurysm ,cardiovascular diseases ,Middle Aged ,Subarachnoid Hemorrhage ,Aged ,Retrospective Studies - Abstract
OBJECTIVE: To investigate the clinical outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) after surgeries in Yunnan Province. METHODS: We retrospectively analyzed the demographic features, vascular risk factors, severity at admission, and aneurysm locations in 85 patients with aSAH receiving surgical interventions in Yunnan Province. All the patients were treated by aneurysm clipping or coiling and followed up for clinical outcomes and recovery of daily activities evaluated by modified Rankin Scale (mRS) and Activities of Daily Living (ADL) scale, respectively. RESULTS: Thirty-four of the patients (40.0%) underwent aneurysm clipping and 51 (60.0%) underwent aneurysm coiling. During a median follow- up period of 66.23 months (IOR, 12.03 months), 84.7% of the patients had low mRS scores, and 78.8% lived independently. The WFNS grade at admission was significantly correlated with the follow-up mRS scores (95%CI: 1.48-19.09, P=0.011) and ADL (95%CI: 2.55-28.77, P < 0.001). Multivariate analysis showed that age (95%CI: 1.02-1.23, P=0.017; 95%CI: 1.00-1.15, P=0.038) and a high WFNS grade at admission (95%CI: 2.19-141.48, P=0.007; 95%CI: 2.84-82.61, P=0.002) were independent predictors of both mRS and ADL scores at follow-up. There was no significant difference in clinical outcomes or the length of hospital stay between the two treatment strategies (P > 0.05), but the cost of hospitalization was significantly higher in coiling group than in the clipping group (P < 0.001). CONCLUSIONS: Both aging and a high WFNS grade at admission are associated with a poor prognosis of aSAH, for which aneurysm clipping and coiling have similar long- term outcomes, but for patients with a high WFNS score, aneurysm clipping is favored over coiling in terms of health economics.
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- 2020
9. [Outcomes after Surgical Repair of Thoracoabdominal Aortic Aneurysm with Distal Aortic Dissection:DeBakey Type Ⅰ versus Type Ⅲ]
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Mingxing, Ma, Qian, Chang, Cuntao, Yu, Chang, Shu, Xiangyang, Qian, Xiaogang, Sun, Qiong, Ma, Bo, Wei, and Xiaopeng, Hu
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Aortic Dissection ,Blood Vessel Prosthesis Implantation ,Postoperative Complications ,Treatment Outcome ,Aortic Aneurysm, Thoracic ,Humans ,Hospital Mortality ,Retrospective Studies - Published
- 2020
10. [Risk Factors for Acute Renal Failure after Thoracoabdominal Aortic Aneurysm Surgery]
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Ming-Xing, Ma, Qian, Chang, Cun-Tao, Yu, Chang, Shu, Xiang-Yang, Qian, Xiao-Gang, Sun, Bo, Wei, and Xiao-Peng, Hu
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Adult ,Male ,Reoperation ,Aortic Aneurysm, Thoracic ,Smoking ,Acute Kidney Injury ,Middle Aged ,Blood Vessel Prosthesis Implantation ,Young Adult ,Postoperative Complications ,Treatment Outcome ,Risk Factors ,Humans ,Blood Transfusion ,Female ,Aged ,Retrospective Studies - Published
- 2020
11. Expression of H2S in Gestational Diabetes Mellitus and Correlation Analysis with Inflammatory Markers IL-6 and TNF-α
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Jinjing Tian, Qian Chang, Shuxia Xuan, Li Tian, Ming Jiang, and Yucui Teng
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Blood Glucose ,0301 basic medicine ,Complications of pregnancy ,endocrine system diseases ,Article Subject ,Endocrinology, Diabetes and Metabolism ,Physiology ,030204 cardiovascular system & hematology ,Diseases of the endocrine glands. Clinical endocrinology ,Umbilical vein ,Pathogenesis ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Downregulation and upregulation ,Pregnancy ,medicine ,Humans ,Insulin ,Childbirth ,Hydrogen Sulfide ,Interleukin 6 ,Inflammation ,biology ,Interleukin-6 ,Tumor Necrosis Factor-alpha ,business.industry ,nutritional and metabolic diseases ,Venous blood ,Glucose Tolerance Test ,Fetal Blood ,RC648-665 ,medicine.disease ,equipment and supplies ,female genital diseases and pregnancy complications ,Gestational diabetes ,Diabetes, Gestational ,030104 developmental biology ,biology.protein ,Female ,business ,Biomarkers ,Research Article - Abstract
Background. Gestational diabetes mellitus (GDM) is a severe threat to the health of both mother and child. The pathogenesis of GDM remains unclear, although much research has found that the levels of hydrogen sulfide (H2S) play an important role in complications of pregnancy. Methods. We collected venous blood samples from parturient women and umbilical vein blood (UVB) and peripheral venous blood (PVB) samples one hour after childbirth in the control, GDM-, and GDM+ groups in order to determine the concentration of glucose and H2S in plasma; to measure levels of TNF-α, IL-1β, IL-6, TGF-β1, and ADP in parturient women and the UVB of newborns; and to find the correlation of H2S with regression. Results. We found that, with the elevation of glucose, the level of H2S was decreased in GDM pregnant women and newborns and the concentrations of IL-6 and TNF-α were upregulated. With regression, IL-6 and TNF-α concentrations were positively correlated with the level of blood glucose and negatively correlated with H2S concentration. Conclusion. This study shows that downregulation of H2S participates in the pathogenesis of GDM and is of great significance in understanding the difference of H2S between normal and GDM pregnant women and newborns. This study suggests that IL-6 and TNF-α are correlated with gestational diabetes mellitus. The current study expands the knowledge base regarding H2S and provides new avenues for exploring further the pathogenesis of GDM.
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- 2020
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12. Racial differences in Urinary Bladder Cancer in the United States
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Yu Wang, Qian Chang, and Yang Li
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,030232 urology & nephrology ,lcsh:Medicine ,Article ,White People ,Young Adult ,03 medical and health sciences ,Age Distribution ,0302 clinical medicine ,Epidemiology ,medicine ,Humans ,Young adult ,Child ,lcsh:Science ,Survival analysis ,Aged ,Aged, 80 and over ,Multidisciplinary ,Asian ,business.industry ,Incidence ,Incidence (epidemiology) ,lcsh:R ,Infant, Newborn ,Infant ,Hispanic or Latino ,Middle Aged ,Prognosis ,Survival Analysis ,United States ,Black or African American ,Eastern european ,Urinary Bladder Neoplasms ,Child, Preschool ,030220 oncology & carcinogenesis ,Etiology ,Marital status ,Pacific islanders ,Female ,lcsh:Q ,business ,SEER Program ,Demography - Abstract
Urinary bladder cancer (UBC) has a high incidence rates in many southern and eastern European countries, in parts of Africa and the Middle East, and in North America. It exhibits a wide variety of histological types that goes from less aggressive to rapid-growing ones. In order to compare the different presentations, etiologies, and prognoses among racial groups, including NHW (non-Hispanic white), HW (Hispanic white), blacks, and API (Asian and Pacific Islander), we analyzed the UBC patients diagnosed between 1973 and 2014 using SEER (Surveillance, Epidemiology, and End Results) database. Patient characteristics, age-adjusted incidence rates, and survival were compared across races. There are significant racial differences in patients’ characteristics, including gender, marital status, age at diagnosis, treatment strategies, grade, stage, survival time, and so on. Overall, non-Hispanic whites have the highest incidence rate, followed by blacks, Hispanic whites, and APIs. In the analysis of survival, significant racial differences exist when stratified by gender, age group, histological type, stage, location and treatment strategies. Racial differences exist among UBC patients in the United States in terms of characteristics, incidence, and survival. Future studies may collect and analyze more data for comprehensive description and interpretation of the racial differences.
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- 2018
13. Predictors of Adverse Outcome and Transient Neurological Dysfunction Following Aortic Arch Replacement in 626 Consecutive Patients in China
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Cuntao Yu, Hong Liu, Hai-tao Zhang, and Qian Chang
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Adult ,Male ,Pulmonary and Respiratory Medicine ,China ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Logistic regression ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Humans ,Medicine ,Cerebral perfusion pressure ,Stroke ,Aortic dissection ,business.industry ,Incidence (epidemiology) ,Perioperative ,Middle Aged ,medicine.disease ,Circulatory Arrest, Deep Hypothermia Induced ,030228 respiratory system ,Brain Injuries ,Anesthesia ,Deep hypothermic circulatory arrest ,Female ,Nervous System Diseases ,Cardiology and Cardiovascular Medicine ,business ,Packed red blood cells - Abstract
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.
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- 2017
14. [Early and Midterm Results of Thoracoabdominal Aortic Aneurysm Repair in Patients with Marfan Syndrome]
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Ming Xing, Ma, Qian, Chang, Cun Tao, Yu, Chang, Shu, Xiang Yang, Qian, Xiao Gang, Sun, Bo, Wei, and Xiao Peng, Hu
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Adult ,Male ,Aortic Dissection ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Aortic Aneurysm, Thoracic ,Humans ,Female ,Middle Aged ,Marfan Syndrome ,Retrospective Studies - Abstract
Objective To evaluate the early and midterm results of surgical repair of thoracoabdominal aortic aneurysm(TAAA)in patients with Marfan syndrome(MFS). Methods The clinical data of patients with MFS undergoing TAAA repair in Fuwai Hospital between January 2009 and December 2017 were retrospectively analyzed.These patients were divided into two groups:MFS group(
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- 2019
15. Surgical treatment for Kommerell's diverticulum associated with aortic dissection involving aortic arch
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Qian Chang, Yi Chang, Xiaogang Sun, Cuntao Yu, Xiangyang Qian, and Hongwei Guo
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Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,Elephant trunks ,medicine.medical_treatment ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,medicine ,Humans ,Aortic dissection ,Mechanical ventilation ,business.industry ,medicine.disease ,Surgery ,Aortic Aneurysm ,Aortic Dissection ,Diverticulum ,030228 respiratory system ,Median sternotomy ,Descending aorta ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective Kommerell diverticulum with aortic dissection involving aortic arch is a rare but troublesome condition. The purpose of this study is to summarize the experience and strategy of surgical treatment. Method From November 2015 to January 2018, seven consecutive patients underwent surgical treatment in our institution. Three patients with acute type A aortic dissection and one patient with acute type B aortic dissection received total arch replacement and frozen elephant trunk (FET) implantation through median sternotomy. Three patients with chronic type B aortic dissection underwent total aortic arch and descending aorta replacement through median sternotomy and lateral thoracotomy. Result There were seven male patients whose median age was 42.3 ± 11.7 (from 14 to 54) years old. There was no perioperative death in this study. One patient had postoperative critical illness polyneuropathy and required prolonged mechanical ventilation (485 hours) and recovered finally. Follow up was completed for all seven patients with a median follow-up time of 7 (3-46) months. One patient with type A dissection developed aneurysm of the descending aorta distal to the FET and received reintervention. No clinical events and abnormal computed tomography manifestations were found in the other seven patients. Conclusion Total arch replacement and FET through single median incision is a reliable method for Kommerell diverticulum associated with acute dissection involving arch. For Kommerell diverticulum associated with chronic type A or B aortic dissection involving aortic arch, graft replacement by double or single incision is safe and appropriate.
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- 2019
16. Genetic testing of the FBN1 gene in Chinese patients with Marfan/Marfan-like syndrome
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Zhou Zhou, Jing Zhang, Mingyao Luo, Qianlong Chen, Xiangyang Qian, Xiaogang Sun, Hang Yang, Qian Chang, Yuanyuan Fu, and Yuxin Fan
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Male ,musculoskeletal diseases ,0301 basic medicine ,Marfan syndrome ,Proband ,China ,congenital, hereditary, and neonatal diseases and abnormalities ,Connective Tissue Disorder ,Fibrillin-1 ,Clinical Biochemistry ,030204 cardiovascular system & hematology ,Biology ,medicine.disease_cause ,Biochemistry ,Marfan Syndrome ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,medicine ,Humans ,Genetic Testing ,cardiovascular diseases ,skin and connective tissue diseases ,Gene ,Genetic testing ,Genetics ,Sanger sequencing ,Mutation ,medicine.diagnostic_test ,Biochemistry (medical) ,General Medicine ,Middle Aged ,medicine.disease ,030104 developmental biology ,symbols ,Female ,Fibrillin - Abstract
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.
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- 2016
17. The platelet-to-lymphocyte ratio, superior to the neutrophil-to-lymphocyte ratio, correlates with hepatitis C virus infection
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Peiguo Zheng, Qian Chang, Gaohui Wei, Wanhai Wang, Ruoyu Peng, Xianchun Meng, Guang Shi, Fucheng He, and Liang Ming
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Adult ,Blood Platelets ,Liver Cirrhosis ,Male ,Microbiology (medical) ,medicine.medical_specialty ,Cirrhosis ,Carcinoma, Hepatocellular ,Neutrophils ,Hepatitis C virus ,medicine.disease_cause ,Gastroenterology ,Severity ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,lcsh:RC109-216 ,Lymphocytes ,Neutrophil to lymphocyte ratio ,Neutrophil-to-lymphocyte ratio ,Aged ,Retrospective Studies ,business.industry ,Liver Neoplasms ,Area under the curve ,Retrospective cohort study ,General Medicine ,Virological response ,Hepatitis C, Chronic ,Middle Aged ,medicine.disease ,Platelet-to-lymphocyte ratio ,Confidence interval ,Blood Cell Count ,body regions ,Infectious Diseases ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Immunology ,HCV ,030211 gastroenterology & hepatology ,Female ,business - Abstract
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
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- 2016
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18. Transcatheter arterial chemoembolization (TACE) combined with γ-knife compared to TACE or γ-knife alone for hepatocellular carcinoma
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Zhu Chen, Quan-Liang Shang, En-hua Xiao, Yeyu Cai, and Qian Chang
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Adult ,Male ,γ-ray ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Treatment outcome ,education ,Observational Study ,Radiosurgery ,Stereotactic conformal radiotherapy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Catheterization, Peripheral ,medicine ,Carcinoma ,Combined Modality Therapy ,Humans ,Chemoembolization, Therapeutic ,Transcatheter arterial chemoembolization ,Survival rate ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Liver Neoplasms ,General Medicine ,primary hepatocellular carcinoma ,Middle Aged ,medicine.disease ,Radiation therapy ,Survival Rate ,Treatment Outcome ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Female ,Radiotherapy, Conformal ,business ,Nuclear medicine ,conformal radiotherapy ,Research Article ,transcatheter arterial chemoembolization - Abstract
To compare the clinical efficacies and adverse reactions between transcatheter arterial chemoembolization (TACE), γ-ray 3-dimensional fractionated stereotactic conformal radiotherapy (FSCR), and TACE combined with FSCR for primary hepatocellular carcinoma. The study was approved by the Institutional Review Board, and informed consent was waived due to the retrospective study design. About 121 patients met the inclusion criteria and were included in this study, from March 2008 to January 2010, in the Second Xiangya Hospital. Forty-six patients underwent TACE alone, 36 patients underwent γ-knife alone, and 39 were treated by γ-knife combined with TACE. Short-term effects, overall survival rates, adverse reactions, and survival times were compared between the 3 treatment groups. Short-term effects were observed in 41.3% of the TACE group, 33.3% of the γ-knife group, and 64.1% of the TACE combined γ-knife group (P = .020). Overall survival rates at 6,12, 18, and 24 months were 50%, 34.8%, 28.3%, and 21.7% for the TACE group, 36.1%, 30.6%, 16.7%, and 11.1% for γ-knife group, and 84.6%, 71.8%, 61.5%, and 30.8% for TACE combined γ-knife group, respectively. The differences in the overall survival rates at 6, 12, and 18 months between the 3 groups were statistically significant (P = 0), but the overall survival rates at 24 months in the 3 groups were not significantly different (P = .117). The median survival time was 7 months for the TACE group, 3 months for the γ-knife group, and 20 months for the TACE combined γ-knife group (P = 0). There were statistically significant differences (P = .010) of leukopenia between the 3 groups, and no statistically significant differences of (P > .05) thrombocytopenia, anemia, nausea, vomiting, and liver function lesions. TACE combined with γ-knife for primary hepatocellular carcinoma is superior to TACE or γ-knife alone in short-term and long-term effects. This procedure is a mild, safe, and effective treatment for primary hepatocellular carcinoma.
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- 2018
19. Angiotensin II induces an increase in MMP-2 expression in idiopathic ascending aortic aneurysm via AT1 receptor and JNK pathway
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Xiaogang Sun, Xiangyang Qian, Chunmao Wang, Chuan Tian, and Qian Chang
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Adult ,Male ,medicine.medical_specialty ,Angiotensin receptor ,Biophysics ,Biochemistry ,Receptor, Angiotensin, Type 1 ,Western blot ,Internal medicine ,medicine.artery ,medicine ,Humans ,Phosphorylation ,Receptor ,Aorta ,Angiotensin II receptor type 1 ,medicine.diagnostic_test ,Chemistry ,Angiotensin II ,JNK Mitogen-Activated Protein Kinases ,General Medicine ,Middle Aged ,Candesartan ,Endocrinology ,cardiovascular system ,Matrix Metalloproteinase 2 ,Female ,Ex vivo ,medicine.drug - Abstract
The cellular and molecular mechanisms responsible for human idiopathic ascending aortic aneurysm (IAAA) remain unknown. Matrix metalloproteinase-2 (MMP-2) is a key enzyme for the degradation of extracellular matrix in aneurysmal walls. The aim of this study was to elucidate the role of the angiotensin II (Ang II) pathway in MMP-2 induction in IAAA aortic walls. Quantitative polymerase chain reaction and western blot analysis were used to compare the MMP-2 mRNA and protein levels in ascending aortic specimens with those in IAAA patients (n = 10) and heart transplant donors (n = 5) without any aortopathy. It was found that MMP-2 expression was significantly increased, which was associated with elastic lamellae disruption in IAAA walls. Additionally, the expression levels of angiotensinogen (AGT) and Ang II in the ascending aortic tissues from individuals with and without IAAAs were detected by western blot analysis and radioimmunoassay, respectively. The results demonstrated that the expressions of AGT and Ang II protein were significantly increased in the ascending aortic tissues of IAAA patients. Furthermore, whether Ang II induces MMP-2 expression was investigated using human IAAA walls ex vivo culture. It was found that exogenous Ang II increased the MMP-2 expression in a dose-dependent manner, which was completely inhibited by the Ang II type 1 receptor (AT1R) inhibitor candesartan and was mediated by c-Jun N-terminal kinase (JNK) activation. Taken together, these results indicate that Ang II can induce an increase of MMP-2 expression via AT1R and JNK in ex vivo cultured IAAA aortic walls, and suggest that angiotensin receptor blocker (ARB) drugs and JNK inhibitors have the potential in the prevention or treatment of IAAAs.
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- 2015
20. Angiotensin II increases matrix metalloproteinase 2 expression in human aortic smooth muscle cells via AT1R and ERK1/2
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Chunmao Wang, Xiaogang Sun, Qian Chang, and Xiangyang Qian
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MAPK/ERK pathway ,medicine.medical_specialty ,Angiotensin receptor ,MAP Kinase Signaling System ,Blotting, Western ,Fluorescent Antibody Technique ,Muscle, Smooth, Vascular ,Receptor, Angiotensin, Type 1 ,General Biochemistry, Genetics and Molecular Biology ,Downregulation and upregulation ,Internal medicine ,medicine ,Humans ,Receptor ,Protein kinase A ,Aorta ,Original Research ,Angiotensin II receptor type 1 ,Reverse Transcriptase Polymerase Chain Reaction ,Chemistry ,Angiotensin II ,Molecular biology ,Endocrinology ,cardiovascular system ,Matrix Metalloproteinase 2 ,Signal transduction - Abstract
Increased levels of angiotensin II (Ang II) and activated matrix metalloproteinase 2 (MMP-2) produced by human aortic smooth muscle cells (human ASMCs) have recently been implicated in the pathogenesis of thoracic aortic aneurysm (TAA). Additionally, angiotensin II type 1 receptor (AT1R)-mediated extracellular signal-regulated kinase (ERK)1/2 activation contributes to TAA development in Marfan Syndrome. However, there is scant data regarding the relationship between Ang II and MMP-2 expression in human ASMCs. Therefore, we investigated the effect of Ang II on MMP-2 expression in human ASMCs and used Western blotting to identify the Ang II receptors and intracellular signaling pathways involved. Reverse transcription polymerase chain reaction (RT-PCR) and immunofluorescence data demonstrated that Ang II receptors were expressed on human ASMCs. Additionally, Ang II increased the expression of Ang II type 2 receptor (AT2R) but not AT1R at both the transcriptional and translational levels. Furthermore, Western blotting showed that Ang II increased MMP-2 expression in human ASMCs in a dose- and time-dependent manner. This response was completely inhibited by the AT1R inhibitor candesartan but not by the AT2R blocker PD123319. In addition, Ang II–induced upregulation of MMP-2 was mediated by the activation of ERK1/2, whereas p38 mitogen-activated protein kinase (p38 MAPK) and c-Jun N-terminal kinase (JNK) had no effect on this process. In conclusion, these results indicate that Ang II can increase the expression of MMP-2 via AT1 receptor and ERK1/2 signaling pathways in human ASMCs and suggest that antagonists of AT1R and ERK1/2 may be useful for treating TAAs.
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- 2015
21. Overexpression of MicroRNA-145 Promotes Ascending Aortic Aneurysm Media Remodeling through TGF-β1
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W. Liu, Chuan Tian, Huawei Pei, Penghong Liu, Xiaogang Sun, Qian Chang, and Xiangyang Qian
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Male ,Pathology ,medicine.medical_specialty ,Vascular smooth muscle ,Vascular Remodeling ,Transforming Growth Factor beta1 ,Aortic aneurysm ,stomatognathic system ,TGF-β1 ,Internal medicine ,microRNA ,medicine ,Humans ,Osteopontin ,MicroRNA-145 ,Medicine(all) ,biology ,Ascending aortic aneurysm ,business.industry ,Media remodeling ,Transfection ,Middle Aged ,medicine.disease ,Aortic Aneurysm ,Blot ,MicroRNAs ,Collagen Type III ,medicine.anatomical_structure ,Gene Expression Regulation ,cardiovascular system ,Cardiology ,biology.protein ,Female ,Surgery ,Collagen ,Tunica Media ,Cardiology and Cardiovascular Medicine ,business ,Transforming growth factor ,Artery - Abstract
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
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- 2015
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22. The role of IDO, IL-10, and TGF-β in the HCV-associated chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma
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Xianchun Meng, Wanhai Wang, Nan Gao, Ruonan Yang, and Qian Chang
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Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,Carcinoma, Hepatocellular ,Inflammation ,Enzyme-Linked Immunosorbent Assay ,Chronic liver disease ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Transforming Growth Factor beta ,Virology ,Internal medicine ,medicine ,Humans ,Indoleamine-Pyrrole 2,3,-Dioxygenase ,030212 general & internal medicine ,Aspartate Aminotransferases ,Indoleamine 2,3-dioxygenase ,Aged ,Retrospective Studies ,Hepatitis ,Aged, 80 and over ,business.industry ,Liver Neoplasms ,Alanine Transaminase ,Bilirubin ,Hepatitis C ,Hepatitis C, Chronic ,Middle Aged ,medicine.disease ,digestive system diseases ,Interleukin-10 ,Infectious Diseases ,Hepatocellular carcinoma ,030211 gastroenterology & hepatology ,Female ,medicine.symptom ,business ,TBIL - Abstract
Indoleamine-2,3-dioxygenase (IDO) is an enzyme that catalyzes tryptophan to kynurenine and studies have revealed that IDO play a vital role in regulation of liver immunity and inflammation activities. This study investigated the association between plasma IDO and disease severity and the possible marker role of IDO in the inflammatory process of hepatitis C. In this study, 80 individuals with HCV infection were retrospectively selected. Plasma levels of IDO, IL-10, and TGF-β were assayed by ELISA. Clinical characteristics of patients, including the levels of ALT, AST, and total bilirubin (TBil) were collected from clinical databases. HCV-related liver cirrhosis (HC-Cirr) and HCV-related Hepatocellular carcinoma (HCV-HCC) had significantly high plasma levels of IDO compared to other patient groups and healthy controls. Plasma IL-10 level were significantly greater in all chronic liver disease groups and with respect to TGF-β, the level was high in all the selected patients with HCV infection compare with controls. Moreover, HCV-HCC patients showed highest values for both IL-10 and TGF-β, with significant difference compared with other groups. In addition, plasma IDO was positively correlated with TGF-β among all patients with HCV infection (r = 0.4509, P < 0.0001), with IL-10 in CHC patients (r = 0.4787, P = 0.0047), with TBil in HCV-Cirr patients (r = 0.4671; P = 0.0093). High level of IDO and TGF-β is associated with hepatocyte necrosis and intrahepatic inflammation, and may be used as an index of disease progression for patients with chronic HCV infection.
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- 2017
23. Single Stage Hybrid Repair for DeBakey Type I Aortic Dissection in High Risk Patients
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Cuntao Yu, Mingxing Ma, Xiangyang Qian, Yanhai Meng, Hao Lin, Chuan Tian, Yukui Du, Penghong Liu, Chunmao Wang, Xiaogang Sun, Xiaobo Guo, Qian Chang, and Huawei Pei
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Aortic arch ,Male ,medicine.medical_specialty ,Time Factors ,Computed Tomography Angiography ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Aortography ,Disease-Free Survival ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Postoperative Complications ,Median follow-up ,Risk Factors ,medicine.artery ,Ascending aorta ,medicine ,Odds Ratio ,Humans ,Hospital Mortality ,Adverse effect ,Stroke ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aortic dissection ,Chi-Square Distribution ,business.industry ,Endovascular Procedures ,Odds ratio ,Middle Aged ,medicine.disease ,Surgery ,Aortic Aneurysm ,Aortic Dissection ,Logistic Models ,Treatment Outcome ,030228 respiratory system ,Multivariate Analysis ,Deep hypothermic circulatory arrest ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
To evaluate the efficacy of the less invasive hybrid zone 0 (Z0) total aortic arch repair (HAR, ascending repair + complete debranching + thoracic endovascular aortic repair [TEVAR]) without deep hypothermic circulatory arrest in management of DeBakey type I aortic dissection (IAD). The adverse outcome was defined as a single composite endpoint comprising peri-operative mortality, permanent neurological deficit, and renal failure necessitating haemodialysis at discharge.A retrospective review of prospectively collected data was conducted of 120 consecutive patients (mean EuroSCORE = 11.6%) with IAD undergoing HAR (urgent/emergency, n = 97, 80.8%) involving reconstruction of the ascending aorta (zone 0) and total arch exclusion with TEVAR during a 7.5 year period. Multivariable analysis of 27 potential pre-operative and intra-operative risk factors was performed to examine the early composite endpoint and short and long-term overall mortality.The total early (30 day or in hospital) mortality was 9.2% (n = 11). The incidence of the composite endpoint was 11.7% (n = 14). On multivariable analysis, malperfusion syndromes were predictors of the composite endpoint (odds ratio [OR], 4.789; 95% CI 1.362-16.896; p = .015), and previous cerebrovascular accident (OR, 13.74; 95% CI 2.330-81.039; p = .004) and myocardial ischaemia time (OR, 1.038; 95% CI 1.015-1.061; p = .001) predicted short and long-term overall mortality. The overall survival was 84.7% during a median follow up of 3.4 years. Freedom from late aortic adverse events was 93.1% at 5 years, including secondary aortic intervention and endoleak. The maximum diameters of the true lumen increased significantly in stented thoracic (14.4 ± 6.5 mm to 29.7 ± 5.3 mm, p .001), lower thoracic (14.2 ± 6 mm to 21.6 ± 7.2 mm, p .001) and abdominal (11.7 ± 4.8 mm to 17.4 ± 4.1 mm, p .001) aorta. Complete thrombosis of the peri-stent false lumen was achieved in 88.2% of CT scans (82/93) performed a mean of 12 ± 17 months (median 5 months; 25-75% quartile, 2-12 months) post-operatively.IAD was treated safely and durably by Z0 HAR, and peri-operative mortality and morbidity were not substantially higher despite the older age and high risk of patients.
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- 2017
24. Frozen elephant trunk with total arch replacement for type A aortic dissections: Does acuity affect operative mortality?
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Jun Zheng, Wei-Guo Ma, Jun-Ming Zhu, Wei Zhang, Rui-Dong Qi, John A. Elefteriades, Bulat A. Ziganshin, Long-Fei Wang, Qian Chang, Kai Sun, Yong-Min Liu, and Li-Zhong Sun
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Elephant trunks ,Prosthesis Design ,Risk Assessment ,Blood Vessel Prosthesis Implantation ,Aortic aneurysm ,Risk Factors ,Blood vessel prosthesis ,Odds Ratio ,Humans ,Medicine ,Hospital Mortality ,Risk factor ,Spinal cord injury ,Stroke ,Retrospective Studies ,Aortic dissection ,Chi-Square Distribution ,Aortic Aneurysm, Thoracic ,business.industry ,Middle Aged ,medicine.disease ,Blood Vessel Prosthesis ,Surgery ,Aortic Dissection ,Logistic Models ,Treatment Outcome ,Cardiothoracic surgery ,Anesthesia ,Acute Disease ,Chronic Disease ,Multivariate Analysis ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
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.
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- 2014
25. One-stage repair of extensive aortic aneurysms: mid-term results with total or subtotal aortic replacement
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Xiangyang Qian, Xiaogang Sun, Cuntao Yu, Liang Zhang, and Qian Chang
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Adult ,Male ,Reoperation ,Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,Time Factors ,Aortography ,Risk Assessment ,Blood Vessel Prosthesis Implantation ,Aortic aneurysm ,Postoperative Complications ,Aortic valve replacement ,Risk Factors ,medicine.artery ,Ascending aorta ,medicine ,Humans ,Hospital Mortality ,Retrospective Studies ,Aortic dissection ,Aorta ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Aortic Aneurysm ,Surgery ,Perfusion ,Circulatory Arrest, Deep Hypothermia Induced ,Treatment Outcome ,cardiovascular system ,Female ,ORIGINAL ARTICLES ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Intercostal arteries - Abstract
OBJECTIVES: To retrospectively analyse the mid-term clinical results of one-stage repair of extensive aortic aneurysms with total or subtotal aortic replacement. METHODS: From February 2004 to February 2011, 21 patients with extensive aortic aneurysm underwent one-stage total or subtotal aortic replacement for aortic dissection (95.23%) or aortic aneurysms. Operations were performed under circulatory arrest with profound hypothermia. Patients were opened with a mid-sternotomy and a thoraco-abdominal incision. Extracorporeal circulation was instituted as usual. 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. Staged aortic occlusions allowed for replacement of the descending thoracic and abdominal aorta. T6 to T12 intercostal arteries and L1,L2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8-mm branch for maintaining spinal cord blood perfusion. Visceral arteries were joined into a patch and anastomosed to the end of the main graft. RESULTS: The early mortality was 4.8% (1 of 21); 1 patient died due to renal failure and multiple organ failure. No patient had spinal cord deficits postoperatively. Two patients had postoperative stroke at Day 5 and 7, respectively. Twenty patients were all alive with good life status during the follow-up period ranging from 18 to 84 months postoperatively. One patient was reoperated with aortic valve replacement because of massive valve insufficiency after 2 years. During the follow-up period, reconstructed intercostal arteries were clogged in 3 patients and dilatated in 2 patients with Marfan syndrome. CONCLUSIONS: One-stage repair of extensive aortic aneurysms with total or subtotal aortic replacement is safe and effective. It is feasible with acceptable surgical risks and satisfactory results. It can eliminate the risk of remnant aortic aneurysm rupture in staged total aortic replacement and has satisfactory mid-term results.
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- 2013
26. Total Arch Replacement in Patients With Aortic Dissection With an Isolated Left Vertebral Artery
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Jun Zheng, Yong-Min Liu, RuiDong Qi, Jun-Ming Zhu, ChengNan Li, Li-Zhong Sun, and Qian Chang
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,Elephant trunks ,Dissection (medical) ,Blood Vessel Prosthesis Implantation ,Young Adult ,Aortic aneurysm ,Aneurysm ,medicine.artery ,medicine ,Humans ,Spinal cord injury ,Vertebral Artery ,Retrospective Studies ,Aortic dissection ,Cardiopulmonary Bypass ,Aortic Aneurysm, Thoracic ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Perfusion ,Aortic Dissection ,Treatment Outcome ,Cardiothoracic surgery ,Female ,Stents ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
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.
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- 2013
27. Genetic testing of 248 Chinese aortopathy patients using a panel assay
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Zhou Zhou, Cao Yandong, Yanyun Ma, Yuanyuan Fu, Wenke Li, Chang Shu, Jing Zhang, Chunjie Meng, Hang Yang, Qian Chang, Yuxin Fan, Mingyao Luo, and Kunlun Yin
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0301 basic medicine ,Proband ,Marfan syndrome ,Adult ,Male ,Adolescent ,Aortic Diseases ,030105 genetics & heredity ,Bioinformatics ,Article ,03 medical and health sciences ,Young Adult ,Asian People ,medicine ,Humans ,Genetic Predisposition to Disease ,Genetic Testing ,Young adult ,Child ,Gene ,Genetic testing ,Genetics ,Multidisciplinary ,Polymorphism, Genetic ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,030104 developmental biology ,Child, Preschool ,Cohort ,Mutation (genetic algorithm) ,Mutation ,Female ,False positive rate ,business - Abstract
Inherited aortopathy, which is characterized by a high risk of fatal aortic aneurysms/dissections, can occur secondarily to several syndromes. To identify genetic mutations and help make a precise diagnosis, we designed a gene panel containing 15 genes responsible for inherited aortopathy and tested 248 probands with aortic disease or Marfan syndrome. The results showed that 92 individuals (37.1%) tested positive for a (likely) pathogenic mutation, most of which were FBN1 mutations. We found that patients with a FBN1 truncating or splicing mutation were more prone to developing severe aortic disease or valvular disease. To date, this is the largest reported cohort of Chinese patients with aortic disease who have undergone genetic testing. Therefore, it can serve as a considerable dataset of next generation sequencing data analysis of Chinese population with inherited aortopathy. Additionally, according to the accumulated data, we optimized the analysis pipeline by adding quality control steps and lowering the false positive rate.
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- 2016
28. [Surgical outcomes of off-pump technique in extensive thoracoabdominal aorta replacement]
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Liang, Zhang, Cuntao, Yu, Qian, Chang, Xiaogang, Sun, Xiangyang, Qian, Xinjin, Luo, and Bo, Wei
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Adult ,Survival Rate ,Blood Vessel Prosthesis Implantation ,Cardiopulmonary Bypass ,Aortic Aneurysm, Thoracic ,Heart Arrest, Induced ,Humans ,Length of Stay ,Aorta - Abstract
To assess the safety and efficacy of off-pump technique with normothemia to extend thoracoabdominal aortic aneurysm replacement compared with traditional hypothermic circulatory arrest.From January 2004 to December 2013, 128 consecutive patients underwent surgical repair of thoracoabdominal aortic aneurysm (type Crawford Ⅱ) in Fuwai Hospital. The mean age was (37±11) years. The patients included 74 cases (57.8%) with chronic Stanford A dissection, 34 cases (26.6%) with chronic Stanford B dissection, 20 cases (15.6%) with thoracoabdominal aortic true aneurysm. There were 71 patients who underwent hypothermic circulatory arrest surgery (cardiopulmonary bypass (CPB) group) and 57 patients who underwent off-pump surgery with normothermia (off-pump group). The clinic data was compared between the 2 groups using paired t tests and χ(2) test. Kaplan-Meier survival analysis was used for postoperative survival stays.The mean CPB time in CPB group was (251 ±87) minuets and the circulatory arrest time was (45±24) minuets. Spinal cord ischemia time in the two groups was (21±12) minuets and (18±10) minuets (t=5.68, P=0.51). The operation time, ventilator time, length of ICU stay and length of hospital stay of off-pump group were shorter than CPB group ((408±114) minuets vs.(630±156) minuets, t=-7.67, P=0.05; (18±13) hours vs. (113±89) hours, t=-3.86, P=0.00; (4±2) days vs.(10±9) days, t=-4.19, P=0.00; (15±7) days vs.(25±14) days, t=-4.47, P=0.00). The intraoperative blood loss in off-pump group and CPB group was (900±750) ml and (1 400±400) ml (t=-2.23, P=0.04). The mortality was 1.7% and 9.8% in the off-pump group and CPB groups (χ(2)=3.544, P=0.05). The cerebral complication rate in the normal temperature group was 1.7% vs. 22.6% in extracorporeal group (χ(2)=9.35, P0.05). A total of 113 patients were followed up, with a follow-up rate of 88.2%. Duration of follow-up was (78±54) months. Five patients died during the follow-up period, including 2 who died of cerebral infarction and 3 paraplegia patients who died of infection. Eight patients had phase Ⅱ aortic arch replacement after a mean time of 6 months. The overall postoperative survival rate was 97%, 93% and 87% at 3 years, 5 years and 7 years, respectively.Off-pump technique with normothemia was associated with a lower risk of a composite outcome of mortality and major adverse cardiac and cerebrovascular events during repair of extensive thoracoabdominal aortic aneurysm.
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- 2016
29. A high or a reasonably-reactively elevated platelet-to-lymphocyte ratio, which plays the role?
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Qian Chang, Wanhai Wang, Liang Ming, Gaohui Wei, Fucheng He, and Xianchun Meng
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Blood Platelets ,medicine.medical_specialty ,medicine.medical_treatment ,Lymphocyte ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Platelet ,Lymphocyte Count ,Lymphocytes ,Platelet Count ,business.industry ,Percutaneous coronary intervention ,Hematology ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Cardiology ,business - Abstract
A high or a reasonably-reactively elevated platelet-to-lymphocyte ratio, which plays the role?
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- 2016
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30. Genetic testing of 10 patients with features of Loeys-Dietz syndrome
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Zhou Zhou, Kunlun Yin, Yuxin Fan, Jing Zhang, Hang Yang, Qianlong Chen, Qian Chang, and Mingyao Luo
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0301 basic medicine ,Adult ,Male ,Clinical Biochemistry ,Biology ,medicine.disease_cause ,Biochemistry ,Loeys–Dietz syndrome ,03 medical and health sciences ,Aortic aneurysm ,medicine ,Humans ,Genetic Testing ,Child ,Uncertain significance ,Gene ,Likely pathogenic ,Genetic testing ,Genetics ,Mutation ,Loeys-Dietz Syndrome ,medicine.diagnostic_test ,Biochemistry (medical) ,General Medicine ,Middle Aged ,medicine.disease ,Aortic Aneurysm ,030104 developmental biology ,Wide phenotypic spectrum ,Child, Preschool ,Female - Abstract
Inherited aortopathy, characterized with a high risk of fetal aortic aneurysms/dissections, could occur secondary to several syndromes. To identify genetic mutations and help to give a precise diagnosis, we performed a gene panel testing, involving 15 genes related to inherited aortopathy. Here we reported 10 patients, combining with the genetic testing results, were diagnosed or suspected with Loeys-Dietz syndrome, which would be the largest group of Loeys-Dietz syndrome ever reported in China till now. 10 likely pathogenic mutations or rare variants of uncertain significance were found. These results expanded the mutation spectrum of Loeys-Dietz syndrome and might be implicated in its wide phenotypic spectrum.
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- 2015
31. Early and mid-term results after hybrid total arch repair of DeBakey type I dissection without deep hypothermic circulatory arrest
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Xiaogang Sun, Qian Chang, Penghong Liu, Yan Li, Cuntao Yu, Chuan Tian, Huawei Pei, and Xiangyang Qian
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Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,China ,Time Factors ,Aorta, Thoracic ,Dissection (medical) ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Imaging, Three-Dimensional ,Internal medicine ,medicine.artery ,medicine ,Humans ,Superior mesenteric artery ,Hospital Mortality ,Survival rate ,Aged ,Aortic dissection ,Aorta ,Lung ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,Middle Aged ,medicine.disease ,Thrombosis ,Surgery ,Survival Rate ,Aortic Dissection ,Circulatory Arrest, Deep Hypothermia Induced ,medicine.anatomical_structure ,Treatment Outcome ,030228 respiratory system ,Cardiology ,Deep hypothermic circulatory arrest ,Female ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Echocardiography, Transesophageal ,Follow-Up Studies - Abstract
OBJECTIVES: The purpose of this study was to assess the efficacy of the hybrid total arch procedure for the treatment of DeBakey type I dissection by analyzing mid-term results. METHODS: From November 2009 to September 2014, 56 patients with DeBakey type I dissection underwent hybrid total arch repair without deep hypothermic circulatory arrest. During the follow-up, computed tomographic imaging was performed to evaluate the aortic diameter, true lumen diameter, false lumen diameter and false patency at the following three levels: pulmonary bifurcation, diaphragm and superior mesenteric artery. RESULTS: The hospital mortality rate was 3.6% (2/56 patients). Three patients exhibited type Ia endoleak during the operation and 1 patient demonstrated type II endoleak 5 days after surgery. During the follow-up, false lumen complete thrombosis was observed at the level of the pulmonary bifurcation in 94% of patients (P< 0.001). At the level of the diaphragm and superior mesenteric artery, false lumen thrombosis was observed in 68% (P< 0.001) and 36% (P< 0.001) of patients, respectively. No patient had type I or III endoleak and no reoperation was related to residual dissected aorta. The actuarial 1-, 3- and 5-year survival rates were 96.4% [95% confidence interval (95% CI), 91.5–100], 92.3% (95% CI, 85–99.6) and 89.6% (95% CI, 80.8–98.4), respectively. CONCLUSIONS: For patients with DeBakey type I dissection, the hybrid total arch procedure can be safely adopted with good mid-term results and with low morbidity and mortality. Longer-term follow-up is required to confirm the viability of this technique.
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- 2015
32. Treatment of complex coarctation and coarctation with cardiac lesions using extra-anatomic aortic bypass
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Qian Chang, Li-Zhong Sun, Ren Wang, Xiao-peng Hu, Jun-Ming Zhu, Yong-Min Liu, Wei-Guo Ma, and Cuntao Yu
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Adult ,Heart Septal Defects, Ventricular ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Bentall procedure ,Heart Valve Diseases ,Coarctation of the aorta ,Risk Assessment ,Aortic Coarctation ,Cohort Studies ,Blood Vessel Prosthesis Implantation ,Young Adult ,Aortic aneurysm ,Aortic valve replacement ,medicine.artery ,Internal medicine ,Ascending aorta ,medicine ,Humans ,Aorta, Abdominal ,Child ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Laparotomy ,Aorta ,Cardiopulmonary Bypass ,Aortic Aneurysm, Thoracic ,business.industry ,Cardiovascular Surgical Procedures ,Abdominal aorta ,Mitral valve replacement ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Sternotomy ,Survival Analysis ,Surgery ,Radiography ,Cardiology ,cardiovascular system ,Female ,business ,Cardiology and Cardiovascular Medicine ,Follow-Up Studies - Abstract
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.
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- 2010
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33. Retrospective Analysis of 99 Patients With the Application of Extracorporeal Membrane Oxygenation in Fuwai Hospital
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Feilong Hei, Xu Wang, Cun Long, Ying-long Liu, Zhengyi Feng, Shengshou Hu, Guodong Gao, Jianping Xu, Ju Zhao, Jingwen Li, Kun Yu, Ping Liu, Qian Chang, Jinping Liu, Shuyi Lrou, and Yuan Yuan
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Adult ,Male ,China ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,Activated clotting time ,Bioengineering ,Biomaterials ,Young Adult ,Extracorporeal Membrane Oxygenation ,medicine ,Extracorporeal membrane oxygenation ,Retrospective analysis ,Humans ,Child ,Aged ,Retrospective Studies ,Heart Failure ,Lung ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Infant ,Retrospective cohort study ,General Medicine ,Heparin ,Middle Aged ,medicine.disease ,Cardiac surgery ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,Child, Preschool ,Heart failure ,Anesthesia ,Female ,business ,medicine.drug - Abstract
The purpose of this study was to retrospectively summarize and analyze the data of 99 cases with the application of consecutive extracorporeal membrane oxygenation (ECMO) from December 2004 to August 2008 in Fuwai Hospital. The intersurface of the ECMO equipment system was completely heparin coated. All patients received venoarterial ECMO, and the activated clotting time was maintained between 120 and 180 seconds. The heparin dose was 5-20 U * kg(-1) * h(-1). Mean blood flow was 40-220 ml * kg(-1) * min(-1) during ECMO assisted period. The shortest ECMO time was 12 hours, and the longest was 504 hours (mean time, 119.45 +/- 80.20 hours). Sixty patients (60.6%) weaned from ECMO successfully; 54 of them (84%) were discharged, and six died of postoperative complications. Thirty-nine patients could not wean from ECMO. Total discharge rate was 54.5%. ECMO is an effective mechanical assistant therapy for cardiac and pulmonary failure after cardiac surgery. Earlier use of ECMO for heart lung failure patients and avoidance of irreversible damage to the main organs are still the key points in the success of ECMO.
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- 2009
34. Surgery for Acute Type A Dissection With the Tear in the Descending Aorta Using a Stented Elephant Trunk Procedure
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Jun-Ming Zhu, Chun-Tao Yu, Haitao Zhang, Qian Chang, Jun Zheng, Yong-Min Liu, Li-Zhong Sun, Jin-Guo Lu, RuiDong Qi, Bin Lv, and LiangXin Tian
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Elephant trunks ,medicine.medical_treatment ,Ischemia ,Aorta, Thoracic ,Dissection (medical) ,Prosthesis Design ,Blood Vessel Prosthesis Implantation ,Young Adult ,Aneurysm ,medicine.artery ,Internal medicine ,Humans ,Medicine ,Aged ,Aorta ,business.industry ,Middle Aged ,medicine.disease ,Aortic Aneurysm ,Blood Vessel Prosthesis ,Surgery ,Aortic Dissection ,Mesenteric ischemia ,Median sternotomy ,Descending aorta ,Cardiology ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business - Abstract
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.
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- 2009
35. Surgery for Marfan Patients With Acute Type A Dissection Using a Stented Elephant Trunk Procedure
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Jin-Guo Lu, Bin Lv, Haitao Zhang, Chun-Tao Yu, Jun-Ming Zhu, Qian Chang, Jun Zheng, Yong-Min Liu, RuiDong Qi, Li-Zhong Sun, and LiangXin Tian
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,Adolescent ,Elephant trunks ,Dissection (medical) ,Prosthesis Design ,Risk Assessment ,Marfan Syndrome ,Blood Vessel Prosthesis Implantation ,Young Adult ,Aortic aneurysm ,Axillary artery ,medicine.artery ,medicine ,Humans ,Aged ,Aortic dissection ,Cardiopulmonary Bypass ,Aortic Aneurysm, Thoracic ,business.industry ,Abdominal aorta ,Angiography ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Surgery ,Aortic Dissection ,Treatment Outcome ,Descending aorta ,Acute Disease ,cardiovascular system ,Female ,Stents ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Follow-Up Studies - Abstract
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.
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- 2008
36. Angiotensin II Induces an Increase in Matrix Metalloproteinase 2 Expression in Aortic Smooth Muscle Cells of Ascending Thoracic Aortic Aneurysms Through JNK, ERK1/2, and p38 MAPK Activation
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Xiaogang Sun, Penghong Liu, Xiangyang Qian, Xiaobo Guo, Wenzhi Liu, Chunmao Wang, Huawei Pei, and Qian Chang
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MAPK/ERK pathway ,Adult ,Male ,medicine.medical_specialty ,Angiotensin receptor ,MAP Kinase Kinase 4 ,MAP Kinase Signaling System ,p38 mitogen-activated protein kinases ,Myocytes, Smooth Muscle ,Primary Cell Culture ,p38 Mitogen-Activated Protein Kinases ,Aortic aneurysm ,Downregulation and upregulation ,Internal medicine ,medicine.artery ,medicine ,Humans ,Phosphorylation ,Receptor ,Aorta ,Cells, Cultured ,Aged ,Pharmacology ,Mitogen-Activated Protein Kinase 1 ,Mitogen-Activated Protein Kinase 3 ,Aortic Aneurysm, Thoracic ,Dose-Response Relationship, Drug ,Chemistry ,Angiotensin II ,Middle Aged ,medicine.disease ,Up-Regulation ,Endocrinology ,cardiovascular system ,Cardiology ,Matrix Metalloproteinase 2 ,Female ,Cardiology and Cardiovascular Medicine - Abstract
In this study, we hypothesized that angiotensin II (Ang II) induces matrix metalloproteinase 2 (MMP-2) upregulation in aneurysmal smooth muscle cells (ASMCs) derived from ascending thoracic aortic aneurysms (ATAAs). We compared MMP-2 protein levels in ascending aortic specimens using Western blot and plasma concentrations by enzyme-linked immunosorbent assay between ATAA (n = 40) and coronary heart disease patients (n = 40). Additionally, the protein level of angiotensinogen (AGT) in the ascending aorta and the plasma concentration of Ang II were detected by Western blot and radioimmunoassay, respectively, in ATAA and coronary heart disease patients. In ATAA patients, Ang II and MMP-2 plasma levels were significantly increased (P < 0.05). Additionally, AGT and MMP-2 protein levels in the aorta of ATAA patients were higher (P < 0.01). Enhanced AGT suggested that the amount of Ang II in aneurysmal aorta specimens may be also increased, which was confirmed by immunofluorescent staining for Ang II. Moreover, we investigated the effect of Ang II on MMP-2 upregulation by ASMCs and determined the Ang II receptors and intracellular signaling pathways that are involved. Our results showed that treatment with Ang II significantly increased the expression of MMP-2 through the Ang II type 1 receptor (AT1R) and activated the 3 major mitogen-activated protein kinases (MAPKs), JNK, ERK1/2, and p38 MAPK. In conclusion, these results indicate that Ang II can induce MMP-2 expression elevation through AT1R and MAPK pathways in ASMCs and suggest that there is therapeutic potential for angiotensin receptor blocker drugs and MAPK inhibitors in the prevention and treatment of ATAAs.
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- 2015
37. Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period
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Long-Fei Wang, Paris Charilaou, John A. Rizzo, John A. Elefteriades, Jun Zheng, Wei-Guo Ma, Bulat A. Ziganshin, Jun-Ming Zhu, Wei Zhang, Qian Chang, Xu-Dong Pan, Yong-Min Liu, and Li-Zhong Sun
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Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Elephant trunks ,Adolescent ,Lumen (anatomy) ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Blood vessel prosthesis ,medicine.artery ,medicine ,Humans ,Stroke ,Aged ,Retrospective Studies ,Aortic dissection ,Aorta ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Aortic Aneurysm ,Aortic Dissection ,Treatment Outcome ,030228 respiratory system ,Cardiothoracic surgery ,Anesthesia ,Tears ,Female ,Vascular Grafting ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
To evaluate the efficacy of the frozen elephant trunk (FET) and total arch replacement (TAR) technique (FET + TAR) in the management of type A aortic dissection (TAAD) with arch entry tear.Clinical outcomes were analyzed for 104 TAAD patients with arch entry tear undergoing FET + TAR at 4.7 ± 3.5 days from symptom onset and compared with 728 TAAD patients with entry tears in elsewhere. The mean patient age was 49.3 ± 9.3 years, compared with 45.6 ± 10.8 years in other TAAD patients (P .001). There were 84 men (80.8%). Hypertension was seen in 84.6% (88/104).Operative mortality was 8.6% (9/104). Spinal cord injury occurred in 3 cases (2.9%), stroke in 2 (1.9%), renal failure in 4 (3.8%) and limb ischemia in 2 (1.9%). Follow-up was 100% (95/95) at mean 5.6 ± 2.6 years (range 1.3-11.6). Late death occurred in 2 cases (1.9%). Survival and freedom from late adverse events were 89.2% (95% confidence interval [CI], 81.3%-93.9%) and 85.0% (95% CI, 76.3%-90.8%) at 8 years, respectively. Both the stented and unstented distal aortic segments showed significant trends of false lumen shrinkage and true lumen expansion over time (P .001). Of the 65 CT scans at mean 4.6 ± 2.9 years postoperatively, the false lumen was completely obliterated in 63. Risk factors for arch entry tear were hypertension (odds ratio [OR], 2.091; 95% CI, 1.186-3.687; P = .011) and age (OR, 1.025; 95% CI, 1.002-1.048; P = .032).TAAD with arch entry tear was treated safely and durably by FET + TAR. Although patients with arch entry tear were somewhat older than other patients, operative mortality was not substantially higher despite their older age and arch location of entry tear. These results argue favorably for the use of the FET + TAR technique in the management of TAAD patients with arch entry tears.
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- 2015
38. Intercostal Artery Reconstruction: The Simple and Effective Technique on Spinal Cord Protection during Thoracoabdominal Aortic Replacement
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Liang Zhang, Xiaogang Sun, Xiangyang Qian, Cuntao Yu, and Qian Chang
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Adult ,Male ,medicine.medical_specialty ,Aortography ,Time Factors ,Dissection (medical) ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Aortic aneurysm ,Pseudoaneurysm ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Thoracic Arteries ,Paraparesis ,Risk Factors ,medicine.artery ,medicine ,Humans ,Retrospective Studies ,Aortic dissection ,Paraplegia ,medicine.diagnostic_test ,Aortic Aneurysm, Thoracic ,business.industry ,Spinal Cord Ischemia ,Anastomosis, Surgical ,General Medicine ,Middle Aged ,Plastic Surgery Procedures ,medicine.disease ,Surgery ,Aortic Dissection ,Treatment Outcome ,030228 respiratory system ,Spinal Cord ,Regional Blood Flow ,Anesthesia ,Female ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Intercostal arteries ,Lumbar arteries - Abstract
Background To retrospectively analyze the role of intercostal artery reconstruction in the spinal cord protection for patients undergoing extensive thoracoabdominal aortic aneurysm repair. Methods From August 2007 to 2014, thoracoabdominal aortas (Crawford II) of 81 consecutive patients with mean age 39.4 ± 10.32 years were repaired. Seventy-three of these patients (90.12%) were diagnosed with aortic dissection in our group, 25 (30.86%) with Stanford type A dissection and 48 (59.26%) with Stanford B aortic dissection. All 25 patients with type A dissection have previously undergone surgical procedures which include Bentall's procedures in 11 cases, ascending aortic replacement in 6 cases, and total aortic arch replacement in 8 cases. All procedures were performed under profound hypothermia with interval cardiac arrest after making a thoracoabdominal incision. Extracorporeal circulation was instituted with 2 arterial cannulae and a single venous cannula in the right atrium. T6–T12 intercostal arteries and L1 and L2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8 mm branch for maintaining spinal cord blood perfusion. Visceral arteries were joined into a patch and anastomosed to the end of the main graft. The left renal artery was anastomosed to an 8 mm branch or joined to the patch. The other 10 mm branches were anastomosed to iliac arteries. Results With 100% follow-up, early mortality was 7.4%. Six deaths were recorded; 1 patient died of cerebral hemorrhage, 3 of renal failure, 1 of heart failure because of myocardial infarction, and the last one died from the rupture of celiac artery dissection. The rate of postoperative spinal cord deficits was 3.7%, 2 patients with paraplegia and 1 patient with paraparesis. None had bladder or rectum dysfunction. Neo-intercostal arteries were clogged in 12 patients within follow-up period and formed pseudoaneurysm in 2 patients with Marfan syndrome. The mean survival time in this group was 54.22 ± 3.03 months (95% confidence interval 44.37–59.90 months) with survival rate of 92.37% after 1 year, 89.02% after 2 years, and 85.54% after 5 years. All patients were free from spinal cord deficits. Conclusions Intercostal artery reconstruction is an effective technique for spinal cord protection in patients with the thoracoabdominal aortic repair. It can achieve favorable results and avoid spinal cord deficits with long-term follow-up.
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- 2015
39. Aortic Surgical Emergencies in Young Children With Loeys-Dietz Syndrome
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Fuxia Yan, Haitao Zhang, Xiaogang Sun, Jinping Liu, Qian Chang, Xiangyang Qian, Yan Li, and Lei Chen
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Pediatrics ,Loeys-Dietz Syndrome ,business.industry ,MEDLINE ,medicine.disease ,Aortic repair ,Aortic disease ,Loeys–Dietz syndrome ,Surgery ,Aneurysmal disease ,Child, Preschool ,cardiovascular system ,medicine ,Humans ,Diagnostic Errors ,Emergencies ,Cardiology and Cardiovascular Medicine ,business ,Child - Abstract
Loeys-Dietz syndrome presents early in life with rapidly progressive aortic aneurysmal disease. Aortic emergency in young children with Loeys-Dietz syndrome is an extremely rare occurrence. In this communication we report on 2 young children whose diagnoses were missed and consequently underwent urgent aortic repair due to aortic emergencies. For personalized management of aortic disease in Loeys-Dietz syndrome patients, when and how do we intervene?
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- 2015
40. One-Stage Total or Subtotal Aortic Replacement
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Zhi-Gang Liu, Qian Chang, Xiao-peng Hu, Jun-Ming Zhu, Li-Zhong Sun, and Cuntao Yu
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,Marfan Syndrome ,Blood Vessel Prosthesis Implantation ,Aortic aneurysm ,Aneurysm ,medicine.artery ,Internal medicine ,Ascending aorta ,medicine ,Humans ,Aorta ,Aortic dissection ,Cardiopulmonary Bypass ,business.industry ,Abdominal aorta ,Aortic bifurcation ,Middle Aged ,medicine.disease ,Aortic Aneurysm ,Surgery ,Aortic Dissection ,medicine.anatomical_structure ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
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.
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- 2006
41. Long Non-coding RNA–mRNA Correlation Analysis Reveals the Potential Role of HOTAIR in Pathogenesis of Sporadic Thoracic Aortic Aneurysm
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X. Guo, Xiaohong Qian, Xiaogang Sun, Qian Chang, Huawei Pei, Hao Lin, and Chuan Tian
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0301 basic medicine ,Genetic Markers ,Leukocyte migration ,Time Factors ,Myocytes, Smooth Muscle ,Apoptosis ,Vascular Remodeling ,Muscle, Smooth, Vascular ,Transcriptome ,03 medical and health sciences ,Medicine ,Humans ,Gene Regulatory Networks ,Genetic Predisposition to Disease ,RNA, Messenger ,Hox gene ,Cells, Cultured ,Genetic Association Studies ,Cell Proliferation ,Oligonucleotide Array Sequence Analysis ,Messenger RNA ,Gene knockdown ,Aortic Aneurysm, Thoracic ,Microarray analysis techniques ,business.industry ,Gene Expression Profiling ,HOTAIR ,Anatomy ,Long non-coding RNA ,030104 developmental biology ,Phenotype ,Gene Expression Regulation ,Case-Control Studies ,Cancer research ,RNA Interference ,RNA, Long Noncoding ,Surgery ,business ,Cardiology and Cardiovascular Medicine - Abstract
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.
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- 2017
42. Determinant roles of gender and age on SII, PLR, NLR, LMR and MLR and their reference intervals defining in Henan, China: A posteriori and big-data-based
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Xianchun Meng, Peiguo Zheng, Jingjing Yang, Ling Chen, Wanhai Wang, Yuying Liu, Gaohui Wei, Fucheng He, Liang Ming, and Qian Chang
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Adult ,Blood Platelets ,Male ,0301 basic medicine ,Microbiology (medical) ,China ,medicine.medical_specialty ,Clinical Biochemistry ,Central china ,Age and gender ,03 medical and health sciences ,Health examination ,Sex Factors ,0302 clinical medicine ,Reference Values ,Leukocytes ,Retrospective analysis ,Humans ,Immunology and Allergy ,Medicine ,Research Articles ,Retrospective Studies ,business.industry ,fungi ,Biochemistry (medical) ,Age Factors ,Public Health, Environmental and Occupational Health ,Reproducibility of Results ,Hematology ,Middle Aged ,Blood Cell Count ,Reference intervals ,Surgery ,Medical Laboratory Technology ,030104 developmental biology ,030220 oncology & carcinogenesis ,Cohort ,Female ,business ,Demography - Abstract
OBJECTIVES: By now, there are few data of the reference intervals (RIs) of SII, PLR, NLR, LMR and MLR. We aimed to establish RIs of SII, PLR, NLR, LMR and MLR for healthy persons. METHODS: A retrospective analysis on a cohort of ostensibly healthy, aged no 65 year‐old: [55,179]; NLR: 18‐65 year‐old male: [0.90,2.94]/18‐65 year‐old female: [0.85,3.06]/>65 year‐old male: [0.95,3.57]/aged >65 year‐old female: [0.83,3.30]; LMR: 18‐65 year‐old male: [2.50,7.50]/18‐65 year‐old female: [2.75,8.50]/>65 year‐old male: [2.16,7.41]/>65 year‐old female: [2.40,8.33]; MLR: 18‐65 year‐old male: [0.12,0.35]/18‐65 year‐old female: [0.10,0.32]/>65 year‐old male: [0.12,0.41]/>65 year‐old male: [0.11,0.33]. CONCLUSIONS: RIs of SII, PLR, NLR, LMR and MLR of people in central China were established and validated. It will benefit experimental design of the related studies and lead to better standardizations of SII, PLR, NLR, LMR and MLR for their clinical applications.
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- 2017
43. Aortic root replacement by ministernotomy: technique and potential benefit
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Xiaogang Sun, Yue Tang, Xiaodong Zhu, Lizhong Sun, Jun Zheng, Qian Chang, and Jun Feng
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Aortic valve ,Sternum ,medicine.medical_specialty ,medicine.medical_treatment ,Aortic Valve Insufficiency ,Bentall procedure ,Femoral vein ,Marfan Syndrome ,Blood Vessel Prosthesis Implantation ,Postoperative Complications ,Humans ,Minimally Invasive Surgical Procedures ,Medicine ,Aortic valve regurgitation ,Heart Valve Prosthesis Implantation ,business.industry ,Length of Stay ,Middle Aged ,medicine.disease ,Cardiac surgery ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Great arteries ,Median sternotomy ,Anesthesia ,Female ,Cardiology and Cardiovascular Medicine ,business ,Surgical incision - Abstract
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.
- Published
- 2000
44. Reoperation on aortic disease in patients with previous aortic valve surgery
- Author
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Xiao-Gang, Sun, Liang, Zhang, Cun-Tao, Yu, Xiang-Yang, Qian, and Qian, Chang
- Subjects
Adult ,Heart Defects, Congenital ,Male ,Bicuspid Aortic Valve Disease ,Aortic Valve ,Aortic Diseases ,Heart Valve Diseases ,Humans ,Female ,Middle Aged - Abstract
Aortic valve replacement (AVR) is a safe and effective method in the treatment of aortic valve diseases. This study aimed to increase the understanding on re-treatment of aortic diseases after aortic valve surgery through a retrospective analysis of 47 related cases.Forty-seven patients (38 males and 9 females) with previous aortic valve surgery have received reoperation on aorta from January 2003 to June 2012, and the mean interval time of re-intervention to aortic disease was 6 years ((6.0 ± 3.8) years). The secondary aortic surgery included aortic root replacement (14 cases), ascending aorta replacement (10 cases), aortic root/ascending aorta plus total arch replacement with stented elephant trunk implantation (21 cases), and total thoracoabdominal aorta replacement (2 cases). All these patients have received outpatient re-exams or follow-up by phone calls.After the initial aortic valve replacement, patients suffered from aortic dissection (25 cases, 53%), ascending aortic aneurysm (12 cases, 26%) or aortic root aneurysm (10 cases, 21%). Diameter in ascending aorta increased (5.2 ± 7.1) mm per year and aortic sinus (3.3 ± 3.1) mm per year. The annual growth value of diameter in ascending aorta was higher in patients with rheumatic heart disease than that in Marfan syndrome (P0.05). All 47 patients have received reoperation on aorta. One patient died in operating room because aortic dissection seriously involved right coronary artery. Seven patients had renal insufficiency after operation; neurological complications occurred in 14 patients including 7 patients with stroke and the others with transient brain dysfunction. All patients were followed up, the mean survival time was (97.25 ± 17.63) months, 95% confidence interval was 55.24-73.33 months. Eight cases were died during follow-up and five-year survival rate was 83%.To reduce the aortic adverse events after first aortic valve surgery, it is necessary to actively treat and strictly follow-up patients with previous aortic operation especially patients with Marfan syndrome and rheumatic heart disease.
- Published
- 2013
45. Elevated expression of connective tissue growth factor, osteopontin and increased collagen content in human ascending thoracic aortic aneurysms
- Author
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Lizhong Liu, Qian Chang, Yan-hai Meng, Liang Wang, and Chuan Tian
- Subjects
Male ,Pathology ,medicine.medical_specialty ,Vascular smooth muscle ,medicine.medical_treatment ,Connective tissue ,Real-Time Polymerase Chain Reaction ,Collagen Type I ,Extracellular matrix ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Osteopontin ,Aorta ,Aged ,biology ,Aortic Aneurysm, Thoracic ,business.industry ,Histocytochemistry ,Growth factor ,Connective Tissue Growth Factor ,General Medicine ,Middle Aged ,medicine.disease ,Abdominal aortic aneurysm ,CTGF ,medicine.anatomical_structure ,Case-Control Studies ,cardiovascular system ,biology.protein ,Immunohistochemistry ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Little is known about the molecular mechanisms of ascending thoracic aortic aneurysms (ATAAs). Abnormal extracellular matrix changes and variations of vascular smooth muscle cells (VSMCs) have been implicated in abdominal aortic aneurysm formation. Our objective was to investigate the alterations of collagen, stimulators of collagen synthesis and synthetic VSMCs in patients with ATAA. Surgical samples from ATAA were taken from 20 patients, and 18 control aortas were obtained during coronary artery bypass surgery. All aortic wall specimens were fixed for histology and immunohistochemistry for collagen, connective tissue growth factor (CTGF) and osteopontin. Realtime polymerase chain reaction was used to determine their mRNA expression. Histology and semi-quantitative analysis demonstrated that protein levels of collagen, CTGF and osteopontin significantly increased by 1.9-, 1.4- and 2.2-fold, respectively ( P < 0.01 for all) in the ATAA group than in the control group. Similar results were shown in mRNA levels of type Iα1and IIIα1 collagen, CTGF and osteopontin. The protein levels of CTGF and osteopontin were positively correlated with aortic diameter ( r = 0.67, r = 0.73; P < 0.01 for both). In conclusion, overexpression of aortic CTGF and synthetic VSMCs marker (osteopontin), which is likely to be responsible for elevated aortic collagen content, may provide a potential mechanism for aneurysmal enlargement.
- Published
- 2013
46. [Stented elephant trunk and femoral artery bypass grafting surgery for extended aneurysmal dilation of Stanford A aortic dissection or aortic aneurysm]
- Author
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Yi-zhen, Wei, Cun-tao, Yu, Qian, Chang, Xiang-yang, Qian, and Xiao-gang, Sun
- Subjects
Adult ,Femoral Artery ,Male ,Aortic Dissection ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Humans ,Female ,Stents ,Middle Aged ,Tomography, X-Ray Computed ,Aortic Aneurysm ,Follow-Up Studies - Abstract
To summarize the clinical experience of stented elephant trunk with femoral artery bypass grafting procedure to treat severe aneurysmal dilation of Stanford A aortic dissection or aortic aneurysm. To study the surgical indication and surgical strategy of chronic Stanford A aortic dissection and aneurysmal dilation, also to summarize the early follow-up results.From February 2006 to November 2011, 19 patients with Stanford A aortic dissection or aortic aneurysm with extented aneurysmal dilation (megaaorta) received stented elephant trunk with femoral artery bypass grafting procedure. There were 3 acute cases and 16 chronic cases with 14 male patients and 5 female patients. Average age of this group was (42 ± 8) years and average body weight was (70 ± 15) kg. One patient was aortic aneurysm and all the other were Stanford A aortic dissection. Eight patients were Mafan's syndrome. Ascending aorta replacement or Bentall's operation was done first and total arch replacement and stented elephant trunk operation was done under deep hypothermia and circulatory arrest. After the patient was weaned from cardiopulmonary bypass, bypass from ascending aorta to femoral artery was done subcutaneously using the 10 mm graft in the same femoral incision.There was no operative mortality. One patient had chylothorax which recovered with medical treatment and one patient got paraplegia after surgery. The cardiopulmonary bypass time was (176 ± 42) minutes, aortic cross clamping time was (88 ± 25) minutes and deep hypothermia and low flow rate time was (23 ± 8) minutes. The blood pressure of the lower extremities were normal after operation. Follow-up time was (22 ± 19) months. All patients survived. False lumen closure rate at the stent level was 100%. CT scan at 3 to 6 months after operation showed no obvious dilation of the descending aorta. Two patient successfully received second stage operation of total (subtotal) thoracoabdominal aorta replacement.Stented elephant trunk and aorta to femoral artery bypass is a safe procedure to treat aortic dissection or aortic aneurysm with extended aneurysmal dilation. This procedure can effectively increase the blood supply of the lower extremities due to small true lumen of the descending aorta, and may decrease the speed of dilation of the false lumen. It is also a practical procedure to lay the foundation for the second stage operation of normothemia thoracoabdominal aorta replacement.
- Published
- 2013
47. [Risk analysis for hospital mortality after operations for type A aortic dissection]
- Author
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Liang, Wang, Qian, Chang, Cun-tao, Yu, Xiao-gang, Sun, Xiang-yang, Qian, Chuan, Tian, Lei, Liu, and Yan-hai, Meng
- Subjects
Adult ,Male ,Adolescent ,Aortic Aneurysm, Thoracic ,Middle Aged ,Risk Assessment ,Aortic Dissection ,Young Adult ,Logistic Models ,Humans ,Female ,Hospital Mortality ,Aged ,Follow-Up Studies ,Retrospective Studies - Abstract
To analyze the risk factors for hospital mortality after operations for type A aortic dissection.Totally 766 consecutive patients (586 male and 180 female patient, aged (45±12) years, ranging from 16 to 78 years), who underwent surgery for type A aortic dissection from January 2001 to December 2010, were studied retrospectively. Preoperative and operation related clinic factors were analyzed by univariate analysis, followed by Logistic regression model, to identify the risk factors of hospital mortality.Overall, 37 patients (4.8%) died during hospitalization. On univariate analysis, significant risk factors for hospital mortality were male, acute status, renal dysfunction, cardiac dysfunction, cardiopulmonary bypass time, duration of operation, volume of blood transfusion, re-operation for bleeding (χ2=4.008-27.093, P0.05). On Logistic regression model, independent risk factors were acute status (OR=2.784, 95%CI: 1.166-6.649, P=0.021), renal dysfunction (OR=6.285, 95%CI: 1.738 - 22.723, P=0.005), cardiac dysfunction (OR=3.052, 95%CI: 1.083-8.606, P=0.035), re-operation for bleeding (OR=3.690, 95%CI: 1.262-10.791, P=0.017), volume of blood transfusion (OR=1.033, 95%CI: 1.008-1.058, P=0.010). Additionally, male (OR=0.387, 95%CI: 0.177-0.848, P=0.018) was protective factor, and alternatively, female was indeed one of the independent risk factors for hospital mortality.Female, acute status, renal dysfunction, cardiac dysfunction, re-operation for bleeding, volume of blood transfusion were independent risk factors for hospital mortality after operations for type A aortic dissection.
- Published
- 2012
48. Outcome of surgery for sinus of Valsalva aneurysm with discrete membranous subaortic stenosis
- Author
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Hong-Wei, Guo, Qian, Chang, Cun-Tao, Yu, Xiao-Gang, Sun, Xiang-Yang, Qian, and Sheng-Shou, Hu
- Subjects
Adult ,Male ,Young Adult ,Treatment Outcome ,Adolescent ,Discrete Subaortic Stenosis ,Humans ,Female ,Middle Aged ,Sinus of Valsalva - Abstract
Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly, and SVA with discrete membranous subaortic stenosis is even rarer. The aim of the study was to make sure the incidence of SVA with discrete membraneous subaortic stenosis in SVA and their surgical results. We retrospectively analyzed 234 patients receiving surgical repair of SVA and reported the incidence of ventricular septal defect, aortic regurgitation, and discrete membranous subaortic stenosis. We also reported seven cases of SVA combined with discrete membranous subaortic stenosis and their surgical results.Between January 1999 and December 2009, seven patients of SVA with discrete membranous subaortic stenosis underwent surgical repair of SVA and resection of subaortic discrete membrane. There were six male and one female patients. The mean age was (33.71 ± 13.25) years (range 16 - 52 years). Associated cardiovascular lesions were aortic regurgitation (n = 7), ventricular septal defect (n = 5), coarctation of aorta (n = 1), bicuspid aortic valve (n = 1), patent ductus arteriosus (n = 1), and aortic valve stenosis (n = 1). The aortic valve was replaced in four patients and valvuloplasty was done in three. The other co-existing anomalies were corrected at the same time. All the seven patients were followed up from 18 to 125 months (mean (63.14 ± 39.54) months). Among 234 SVA patients who underwent surgical repair, the number of cases with coexisting ventricular septal defect, aortic regurgitation, and discrete membranous subaortic stenosis was 129, 108, and 7, respectively.There was neither early death after operation nor late death during the follow-up period. All the seven patients were in the New York Heart Association (NYHA) functional classes I and II. There was no recurrence of discrete subaortic membrane during the follow-up period. The incidence of ventricular septal defect, aortic valve incompetence, and discrete membranous subaortic stenosis among 234 SVA patients was 55.13%, 46.15%, and 2.99%, respectively.Surgical repair of SVA with discrete membranous subaortic stenosis showed good mid-term results. Resection of discrete subaortic membrane should be done actively while repairing SVAs. Long-term results need to be followed up.
- Published
- 2012
49. Acute type B aortic dissection and coarctation: open stent-graft elephant trunk
- Author
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Hongtao Sun, Qian Chang, and Xiangyang Qian
- Subjects
Pulmonary and Respiratory Medicine ,Aortic arch ,Adult ,Male ,medicine.medical_specialty ,Aortography ,Coarctation of the aorta ,Dissection (medical) ,Prosthesis Design ,Aortic Coarctation ,Blood Vessel Prosthesis Implantation ,medicine.artery ,medicine ,Humans ,Aortic dissection ,Aorta ,medicine.diagnostic_test ,business.industry ,General Medicine ,Anatomy ,medicine.disease ,Surgery ,Aortic Aneurysm ,Blood Vessel Prosthesis ,Aortic Dissection ,Treatment Outcome ,Thoracotomy ,Descending aorta ,Acute Disease ,cardiovascular system ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Intercostal arteries - Abstract
We describe a case of acute type B dissection associated with coarctation of the aorta. An intimal tear was located just distal to the coarctation. Aortic dilatation started below the coarctation and extended to the level of the diaphragm. We performed descending aorta replacement from the distal aortic arch to the level of the 9th intercostal arteries, and implanted a stent-graft elephant trunk through a left posterior lateral thoracotomy in the 5th intercostal space off-pump.
- Published
- 2012
50. Hybrid total arch repair without deep hypothermic circulatory arrest for acute type A aortic dissection (R1)
- Author
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Cuntao Yu, Xiaogang Sun, Qian Chang, Yi-zhen Wei, Chuan Tian, and Xiangyang Qian
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Time Factors ,Kaplan-Meier Estimate ,Aortography ,Blood Vessel Prosthesis Implantation ,Postoperative Complications ,medicine.artery ,Medicine ,Humans ,Hospital Mortality ,Adverse effect ,Computed tomography angiography ,Aged ,Retrospective Studies ,Aortic dissection ,Surgical repair ,medicine.diagnostic_test ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,Middle Aged ,medicine.disease ,Confidence interval ,Surgery ,Survival Rate ,Aortic Dissection ,Circulatory Arrest, Deep Hypothermia Induced ,Treatment Outcome ,Descending aorta ,Acute Disease ,Deep hypothermic circulatory arrest ,Feasibility Studies ,Female ,Cardiology and Cardiovascular Medicine ,business ,Paraplegia ,Tomography, X-Ray Computed - Abstract
Objective To investigate the surgical outcomes of hybrid total arch repair without deep hypothermic circulatory arrest for patients with acute Stanford type A aortic dissection. Methods Retrospective review of clinical data of patients with acute Stanford type A aortic dissection who underwent surgical repair at our institution between November 2009 and December 2011 identified 21 patients who underwent hybrid total arch repair without deep hypothermic circulatory arrest. The in-hospital and follow-up data were investigated. Postoperative serial computed tomography angiography was used to evaluate the fate of true and false lumen in arch and descending aorta. Results Mean follow-up was 13.8 months (range, 3 to 21 months). The 1- and 12-month survival rates (by Kaplan-Meier analysis) were 95.2% (95% confidence interval, 86.2%-100%) and 90.5% (95% confidence interval, 78.0%-100%), respectively. No endograft caudal migration occurred. One patient with type I endoleak was successfully resolved during operation. There was no late rupture or paraplegia. Conclusions Hybrid total arch repair without deep hypothermic circulatory arrest offers a promising alternative to risk reduction of complications during the postoperative period and late adverse events resulting from false lumen enlargement in the arch and descending aorta.
- Published
- 2012
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