Pregnancy with Marfan syndrome complicated by acute Stanford type A aortic dissection carries extremely high maternal and fetal mortality, and no standardized management protocol exists. A 30-year-old primigravida at 37⁺³ weeks’ gestation presented with acute type A aortic dissection extending from the aortic root (sinus diameter 55 mm; Z-score > 2) and fetal distress. A one-stop hybrid procedure was performed under a single anesthetic: cesarean section followed by subtotal hysterectomy, then Bentall procedure, total arch replacement, and frozen elephant trunk implantation. The core innovation was maintaining cardiopulmonary bypass in “wet standby” with combined sterile draping before cesarean delivery, enabling immediate circulatory support if hemodynamic collapse occurred. Total surgery time was 11 h 25 min, with cardiopulmonary bypass 244 min, aortic cross-clamp 184 min, and deep hypothermic circulatory arrest 22 min. Bilateral selective antegrade cerebral perfusion guided by near-infrared spectroscopy was employed. Postoperatively, the patient developed transient spinal cord ischemia (grade I), successfully reversed by emergency lumbar drainage (cerebrospinal fluid pressure maintained < 15 mmHg for 5 days) and systolic blood pressure elevation to 130–150 mmHg. Genetic testing confirmed a pathogenic FBN1 mutation (c.6410G > C; p.Cys2137Ser), fulfilling revised Ghent criteria. The patient was discharged on postoperative day 14. At 3-month follow-up, she remained asymptomatic (NYHA class I) with patent graft and full motor recovery. A one-stop hybrid procedure integrating pre-prepared cardiopulmonary bypass, meticulous surgical planning, and proactive complication management can achieve favorable maternal and fetal outcomes in this life-threatening condition. The detailed technical specifications provide a replicable framework for other centers.

Abdominal aortic aneurysm (AAA) is a life-threatening cardiovascular disease that has been linked to gut microbiome dysbiosis. Therefore, this study aims to investigate the effects of Akkermansia muciniphila (Am) on AAA mice and the biomolecules involved. AAA mice were generated using angiotensin II (Ang II), and 16sRNA sequencing was used to identify an altered abundance of microbiota in the feces of AAA mice. Vascular smooth muscle cell (VSMC) markers and apoptosis, and macrophage infiltration in mouse aortic tissues were examined. The abundance of Am was reduced in AAA mouse feces, and endothelial PAS domain-containing protein 1 (EPAS1) was downregulated in AAA mice and VSMC induced with Ang II. Am delayed AAA progression in mice, which was blunted by knockdown of EPAS1. EPAS1 was bound to the Cbp/p300-interacting transactivator 2 (CITED2) promoter and promoted CITED2 transcription. CITED2 reduced VSMC apoptosis and delayed AAA progression. Moreover, EPAS1 inhibited macrophage inflammatory response by promoting CITED2 transcription. In conclusion, gut microbiome dysbiosis in AAA induces EPAS1-mediated dysregulation of CITED2 to promote macrophage inflammatory response and VSMC apoptosis.

目的:应用三维斑点追踪技术联合左心腔声学造影评价冠状动脉搭桥术后左心室扭动的变化,探讨其评价治疗效果的临床应用价值.方法:(1)选择本院心脏外科接受择期冠状动脉搭桥术的患者30例,男19例,女11例,左室射血分数≥50％.排除急性及陈旧性心肌梗死病史、其他器质性心脏疾病.另外选择30名行冠状动脉造影或冠状动脉CT成像结果正常的人做为对照组,血生化、心电图检查结果正常.同时排除其它器质性疾病.(2)分别于搭桥术前1-3天、术后早期(7-15)天及术后3个月进行超声心动图检查,同时进行左心腔超声造影.开启4D模式,获取左室扭动参数,并进行手术前后对比分析.结果:左心腔造影可以提高设备自动描记的准确性.术前病例组的左室整体扭动幅度明显减低,与正常对照组相比差异具有显著性(P＜0.05).术后早期左室扭动角度略高于术前,仅中间段增高幅度与术前相比有显著性差异(P＜0.05).而手术后三个月左室扭动逐渐增强,接近正常对照组,与术后早期相比差异有显著性(P＜0.05).结论:三维斑点追踪显像联合左心腔造影可以准确检测冠状动脉搭桥手术前、后左心室扭动的变化.左室扭动可以敏感地反映术后左室心肌收缩功能的变化.

目的 研究黑龙江地区Stanford A型主动脉夹层(Stanford type A aortic dissection,TAAD)撕裂患者术后血流感染的相关危险因素.方法 回顾性分析哈尔滨医科大学附属第四医院2018年1月至2019年8月收治的TAAD撕裂患者240例,检测患者术后血液标本,根据是否出现血流感染将纳入患者分为阳性组(49例)和阴性组(191例).详细记录患者的临床资料,采用多因素Logistic回归分析探讨TAAD撕裂患者术后血流感染的危险因素.结果 240例TAAD撕裂患者术后发生血流感染49例,感染率为20.42％,其中革兰氏阳性菌感染32例,占比65.31％,革兰氏阴性菌感染15例,占比30.61％,真菌感染2例,占比4.08％.多因素Logistic回归分析显示高龄、二次气管插管、不合理应用抗生素、心包纵隔管保留时间及深静脉置管时间过长均为影响TAAD撕裂患者术后血流感染的危险因素(均P<0.05).结论 TAAD撕裂患者术后血流感染发生率较高,应加强临床监护,规范无菌操作,以降低血流感染的发生风险.

For three patients with isolated right coronary artery disease who had drug resistance and were intolerant to interventional therapy, simple transabdominal small incision bypass grafting of the right gastroepiploic artery and the posterior descending branch of the right coronary artery was conducted without cardiopulmonary. All three patients were discharged smoothly without complications, and were followed up for three months, during which time the myocardial bridges were unobstructed and the cardiac functions were good. The surgery needs no thoracotomy and the injury is small, and avoids influences of sternum and pericardium adhesion on other cardiac surgery in the future. The risk of median sternotomy can be avoided for patients undergoing reoperation for coronary artery bypass surgery.

BACKGROUND Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound infection compared with conventional coronary artery bypass surgery (CABG), in which the left internal mammary artery (LIMA) is typically grafted to the left anterior descending artery with additional saphenous vein grafts often used. This study determined whether these favorable clinical results could be realized at the authors’ institute. AIM To summarize the early efficacy and clinical experience of individualized total arterial coronary artery bypass grafting surgery. METHODS CABG was performed on 35 patients with non-single-vessel coronary artery disease by adopting total arterial grafts at Fourth Affiliated Hospital of Harbin Medical University between April 2016 and December 2019. LIMA was used in 35 patients, radial artery (RA) was used in 35 patients, and right gastroepiploic artery (RGEA) was used in 9 patients. Perioperative complications were observed, short-term graft patency rate was followed-up, and quality of life was assessed. RESULTS All patients underwent off-pump coronary artery bypass and the surgeries were successful. All of them were discharged without any complications or deaths. During the follow-up, it was found that patients’ angina symptoms were relieved and New York Heart Association classification for cardiac function was class I to class II. A total of 90 vessels were grafted with no occlusion for internal mammary artery, three occlusions for RA, and one occlusion for RGEA. CONCLUSION The individualized total arterial strategy based on the vessels targeting individual anatomic characteristics can achieve complete revascularization with satisfactory short-term grafting patency rate.

目的 分析本地区导致冠状动脉搭桥(coronary artery bypass grafting,CABG)术后近、中期桥血管病变的影响因素.方法 收集90例CABG患者围手术期临床检测指标,随访术后3个月和1年的桥血管通畅率,统计分析其各组间的关系.结果 CABG术后3个月及1年桥血管通畅率分别为91.0％和81.7％.统计学分析显示患者的主动脉壁厚度(aortic wall thickness,AWT)、性别、病变桥血管的靶血管位置及材料与桥血管近、中期通畅率之间差异存在统计学意义(均P＜0.05).结论 AWT、病变桥血管的靶血管位置及病变桥血管材料是影响桥血管近、中期通畅率的独立危险因素.

目的 研究患者主动脉-桡动脉压力逆变的危险因素及机制.方法 根据术后是否出现压力逆变将患者分为两组,统计分析采用SAS 9.4软件,多重检验采用Bonferroni法校正.统计图采用GraphPad Prism 5软件制作.结果 两组患者在有无糖尿病、复杂手术、体外循环时间、主动脉阻断时间上有统计学差异(P均＜0.01).结论 体外循环的应用是导致患者压力逆变的根本原因.其中有无糖尿病、手术复杂程度、体外循环时间、主动脉阻断时间是出现压力逆变的危险因素.压力逆变的机制是桡动脉血管阻力指数升高、桡动脉血管扩张.

目的 研究杂交手术治疗累及弓部的急性主动脉综合征的临床疗效.方法 回顾性分析2016年1月～2019年6月我院收治的23例累及弓部病变的急性主动脉综合征患者的临床资料,所有患者均实施腔内修复术并杂交手术治疗,对患者进行跟踪随访并观察治疗效果.结果 23例患者均成功完成腔内修复术并杂交手术,置入覆膜支架;术后未出现脑卒中、截瘫等并发症,术后随访提示人工血管通畅,吻合口无狭窄.截止到目前无死亡病例,恢复良好,无不良事件发生.结论 对累及弓部的急性主动脉综合征患者实施杂交手术,扩大腔内修复术手术适应证,临床疗效好,手术成功率高,具有较好的近、中期疗效.

目的 研究二尖瓣置换同期行房颤射频消融术的疗效及其相关的影响因素.方法 回顾性分析2015～2018年间收入我院二尖瓣病变合并房颤的患者70例为研究对象,在进行二尖瓣置换手术的同时,应用Atricure双极笔式射频消融装置进行房颤的射频消融术,收集患者围手术期的临床参数,随访3个月评价房颤的治疗效果,并根据术后是否转复为窦性心律分成2组,分别为转复组和未转复组,评价影响治疗效果的相关因素.结果 在70例房颤患者中,术后3个月房颤转复为窦性心律的占75.7％,术后转复组与未转复组两组患者体外循环时间、术中出血量、术后引流量、呼吸机辅助时间、ICU时间比较无统计学差异(P>0.05).两组患者不同房颤类型,术前EF值、左房大小、年龄,心功能级别比较有明显统计学差异(P<0.05).结论 二尖瓣置换同期房颤射频消融的早期效果良好,房颤的转复效果与患者的房颤类型、EF值、术前心功能、左房大小以及年龄相关.

目的 观察茯苓酸在BALB/c鼠病毒性心肌炎动物模型中的疗效以及对Caspase_3和Akt表达水平的影响.方法 选择BALB/c小鼠150只,随机分为正常对照组、模型对照组、茯苓酸组共三组,每组50只.制备小鼠病毒性心肌炎模型后茯苓酸组腹腔注射茯苓酸提取液0.1mL/g,正常对照组及模型对照组分别给予腹腔注射0.9％ 氯化钠注射液0.1mL/g,每日1次,连用15d.在第4、8、15d取出心脏,并进行病理学检查、Caspase_3及Akt蛋白表达检测.结果 模型对照组小鼠心肌病理积分、心肌组织Caspase_3蛋白活性较正常对照组显著升高,与模型对照组相比,茯苓酸组心肌病理积分显著降低(P<0.05);茯苓酸组Caspase_3表达活性相对较低,但与模型组比较差异无统计学意义(P>0.05);模型对照组Akt蛋白表达较正常对照组显著降低(P<0.05),茯苓酸组Akt蛋白表达显著高于模型组(P<0.05).结论 茯苓酸可能是通过上调Akt蛋白的表达,激活PI3_K/Akt信号传导通路来改善病毒性心肌炎小鼠的心肌炎性和损伤.

目的 研究急性心力衰竭患者血清前白蛋白水平与心因性短期死亡率和再住院率的关系.方法 入选194例符合条件的急性心力衰竭患者,分为正常前白蛋白组(＞0.2 g/L)和低前白蛋白组(≤0.2 g/L).分析两组间60天的死亡率和再入院率.结果 194例患者中,低前白蛋白组81例(42％),正常前白蛋白组1 13例(42％),平均年龄65.6岁(58.9 ～ 70.32,P=0.415),男性77例(40％,P =0.482).平均随访60天后,33例(17％,P=0.032)死亡,69例(47.9％,P=0.476)再次入院.低前白蛋白组死亡率较高.此外,高龄、心力衰竭病史、NT-proBNP升高、出现合并症、心功能降低和住院时间延长等因素也与死亡风险升高有关.结论 前白蛋白水平降低在急性心力衰竭患者中常见,与较高的短期死亡率有关.

Objective Study on expression changes in TGF-β1 signal pathway in atrial myocardium of patients with rheumatic heart disease and atrial ftbrillation (AF),to reveal the underlying mechanism of TGF-β1 signaling pathway downstream signal molecules in atrial fibrillation evolution.Methods Atrial tissue samples from 90 patients undergoing open-heart surgery were collected.Fifty patients had rheumatic heart disease and chronic persistent AF,and 40 patients had rheumatic heart disease but sinus rhythm.We detected the expression level of mRNA and protein of the signal factors in the TGF-β signaling pathway by real-time quantitative PCR and Western blot.Results Realtime-PCR results showed that compared with sinus rhythm group,the expression of ERK1/2 (P =0.007),P38 (P =0.028),connexin 43 (P =0.040) and N-cadherin (P =0.003) mRNA were up-regulated in AF group.JNK (P =0.210),Rac1 (P =0.463) atrial fibrillation group and sinus rhythm group had no significant difference.Western blot showed that the expression of Col Ⅰ (P ＜0.001),ERK1/2 (P =0.015),P38 (P=0.013),connexin 43 (P =0.036) and N-cadherin (P =0.003) were up-regulated in AF group compared with sinus rhythm group.JNK (P =0.081),Rac1 (P =0.753) atrial fibrillation group and sinus rhythm group were not significantly different.The results are consistent with mRNA expression.In addition,correlation analysis showed that the expression of the six detection factors were positively correlated with the expression of Col Ⅰ protein.The correlation coefficients were (0.578,0.353,0.568,0.345,0.488,0.490) and P values were (0.009,0.024,0.015,0.038,0.036,0.044),respectively.Conclusion Collagen Ⅰ fibers obviously accumulate in atrial tissue among those with rheumatic AF,which may correlate with the occurrence of AF.Overexpression of ERK1/2,P38 in non-Smad signal pathway and connexin 43.N-cadherin in CTGF downstream signal molecules in atria of patients with rheumatic heart disease and AF may be related to the occurrence and development of rheumatic heart disease AF.

Objective To investigate the mechanism of a disintegrin and metalloprotease(ADAM10) influence on coronary heart disease(CHD) by detecting the aortic diameters and the expression of interleukin 6 receptor(IL-6R) and Chemokine(C-X3-Cmotif) ligand 1 (CX3CL1) in CHD mice treated with G1254023X.Methods The CHD mouse model was prepared by ApoE-/-mice with high fat and high glucose diet;Type-Bsonicraphy was used to measure the aortic diameters among the G1254023X group,the model group and the control group;The concentrations of IL-6R and CX3CL1 in the peripheral blood among the three groups were detected by enzyme-linked immunosorbent assay (ELISA);Hematoxylin and eosin (HE) were used to detect the pathological changes of aorta in mice;The expression differences of IL-6R and CX3CL1 in aorta among the three groups were detected by Western Blot(WB) and immunohistochemical(IHC) methods.Results The aortic diameters of model group mice were significantly larger than those of G1254023X group.The histopathological changes of the aorta in the model group were greater than those in the G1254023X group.For the concentration of IL-6R and CX3CL1 in both peripheral blood and aorta,the model group mice were significantly higher than G1254023X group mice.For all the three detected,no significantly differences were witnessed between G1254023X group and control group.Conclusions Specific ADAM10-inhibitor G1254023X can effectively inhibit shrinkage of the aortic diameters and the expression of immunalinflammatory factors (IL-6R and CX3CL1)in CHD mice,which delays the development of CHD.

We present a case in which extracorporeal life support treatment of a 6-year-old girl asphyxiated by aspiration of an elliptic plastic ball is described. The attempts for extraction of the foreign body by conventional bronchoscopy under critically ill conditions had failed. Thus, a skin incision was made in the midline, and an emergency open-chest cardiopulmonary bypass (CPB) with aortic, superior vena cava and inferior vena cava cannulation was performed for circulatory support. Following tracheal extubation, a video-assisted rigid bronchoscope was inserted to clear the airway and remove the foreign body. The CPB lasted for 68 min, and the endotracheal tube was pulled out 6 h after the surgery. On the 10th day, the patient was discharged and followed up for 3 months when no neurological symptoms or other complications were documented. The removal of the aspirated bronchial foreign body under extracorporeal life support has been rarely reported. Here, we review the indication, cannulation method, support mode, surgical procedure, and patient outcome in the 8 papers retrieved from the PubMed database and compare their clinical characteristics with those of our case to justify the safe and effective use of CPB for critically ill patients with bronchial foreign body aspiration.

本科在体外循环下成功实施了一例支气管异物导致二氧化碳潴留、窒息昏迷病情危重患儿的异物取出术，现报告如下。<br>　　1资料与方法<br>　　1．1临床资料患儿，女，5岁，25 kg，因玩耍时不慎将一大小约2 cm ×1 cm塑料圆球吸入气管内，立即出现呼吸困难，烦躁伴口唇发绀，急诊送入医院， X线显示：支气管右移，右肺不张，听诊右肺呼吸音弱，结合病史考虑异物在右侧，因患儿呼吸困难、窒息，给予气管插管呼吸机辅助通气，但症状未缓解，后因无纤支镜转入我院。入院后患儿病情危重，意识模糊，呼吸机辅助通气下血氧饱和度难以维持，最低降至40％～50％，经耳鼻喉科、胸外科、麻醉科等科室会诊后认为无法安全取出异物，后转入我科，入科后患儿昏迷状态，血气 pH 6．90， PCO2高至测不出，立即急诊手术，紧急建立体外循环，心脏跳动下并行循环，拔出气管插管，纤支镜下见气管内大量脓性分泌物，给予清除后发现异物位于右主支气管内，镜下钳夹取出，大小约为1 cm×0．8 cm，吸痰后重新插管。体外循环采用儿童用氧合器、管道，中号微栓，预充液为勃脉力500 ml，菲克血浓500 ml，白蛋白20 g，红细胞1 U，5％碳酸氢钠30 ml，转中根据血气情况，调节内环境稳定，流量80～100 ml／（ kg · min），转机开始降温至34℃，头部加带冰帽，进行脑保护，同时给予甲泼尼龙（30 mg／kg），乌司他丁（1万 U／kg），速尿10 mg ，25％甘露醇（3 ml／kg）等，转中行平衡超滤，停机行改良超滤，改良超滤后红细胞比容（ Hct）为0．35。

Background: It has been demonstrated that circulating muscle-enriched miR-1 and the cardiac-specific miR-208 andmiR-499 might leak out of the necrotic myocardium and release into the circulation during the early stages of acute myocardial infarction (AMI). This study aims to investigate potential predictive value of the three miRNAs in AMI.Methods: Plasma samples were taken from 70 AMI patients and 72 healthy controls. The expression levels of target miRNAs were measured by qRT-PCR. Student's t test and chi(2) test were applied to test the significance of the differences between AMI patients and controls. Additionally, a meta-analysis about the prediction accuracy of the three miRNAs in AMI was performed to summarize all the results from available studies.Results: The expression of plasma miR-1, miR-208 and miR-499 were all significantly elevated in AMI patients compared with controls. By receiver operating characteristic (ROC) curve analysis, plasma miR-1, miR-208 and miR-499 were demonstrated to be potential biomarkers for the prediction of AMI with AUC values of 0.81, 0.72, and 0.88, respectively. The meta-analysis consisted of nine studies for miR-1, eight studies for miR-208 and eight studies for miR-499. The summary estimates of miR-1, miR-208 and miR-499 were 0.73, 0.80 and 0.83 for sensitivity, 0.82, 0.95 and 0.90 for specificity, 0.84, 0.89 and 0.91 for AUC, respectively.Conclusion: In summary, we confirmed the predictive values of plasma miR-1, miR-208 and miR-499 in AMI. In contrast to miR-1, the cardiac-specific miR-208 and miR-499 were supposed to be more reliable as biomarkers in AMI screening and prediction. (C) 2015 Elsevier Inc. All rights reserved.

Focal adhesion kinase (FAK) expression has been identified as associated with cancer development and metastasis. Autophosphorylation of FAK at tyrosine (Y) 397 (pY397) performs a critical role in tumor cell signaling. However, few studies have evaluated the expression of pY397 FAK in non-small cell lung cancer (NSCLC). In the present study, pY397 FAK expression in NSCLC was investigated using immunohistochemistry. pY397 FAK staining scores were compared between various groups of specimens and the associations between clinical and pathological characteristics were investigated. A Kaplan-Meier survival curve was used to determine the association between pY397 FAK expression and the prognosis of NSCLC patients. The results of the present study revealed that pY397 FAK expression was localized to the cytoplasm of lung cells, and that pY397 FAK was overexpressed in NSCLC tissues, as well as associated metastatic tissues, when compared with the corresponding non-tumor tissues. However, no significant difference was identified between the pY397 FAK expression in primary lesions and lymph node metastases. Furthermore, pY397 FAK staining scores were not found to be associated with the tumor size, gender, degree of differentiation, histotypes, presence of lymph node metastases or survival rate of NSCLC patients. These results indicate that pY397 FAK is involved with the development of NSCLC, but is not a prognostic marker for the disease.

Transforming growth factor-βsignal pathway is believed to be the most important extra-cellular matrix regulator , which is also the most closely related to growth factor in the process of tissue fi-brosis currently , playing its biological function through Smad and non -Smad signaling pathway . Recent studies suggest that TGF-βsignal pathway is closely related with atrial fibrosis , and further studies will sup-ply a new approach for the treatment of atrial fibrosis in atrial fibrallition .Here is to make a review on the relationship between TGF-βsignal pathway and atrial fibrosis in atrial fibrallition .

Background:Although dobutamine stress myocardial contrast echocardiography (DSMCE) has been widely used for the prediction of myocardial functional recovery, dynamic changes that occur at the microcirculatory level during stress have been studied limitedly. The objective of the present study was to use low-dose DSMCE to assess microvascular damage and predict myocardial functional recovery in coronary artery disease (CAD) patients receiving coronary artery bypass grafting. Methods:Forty-six CAD patients were subjected to low-dose DSMCE, as well as echocardiography and coronary computed tomography angiography before revascularization, 1 year after coronary artery bypass grafting. Dynamic changes occurring at the microcirculatory level during stress were analyzed for the ability to predict functional recovery. Quantitative assessment of functional recovery was determined using myocardial blood flow (MBF) via receiver operating characteristic curve analyses. Results:Patients who failed to recover had fewer changes in MBF (&Dgr;MBF) at rest and with stress compared with the segments showing functional recovery. Semiquantitative changes (enhanced or reduced) of the myocardial perfusion score (&Dgr;MPS) and quantitative changes in &Dgr;MBF of stress myocardial contrast echocardiography enhanced the specificity of resting MPS and the sensitivity of wall motion scores (P < 0.05) for the prediction of functional recovery. Conclusions:Specific stress &Dgr;MBF more accurately reflected the extent of microvascular damage compared with wall motion scores and resting MPS. &Dgr;MBF and &Dgr;MPS under stress myocardial contrast echocardiography provided higher accuracy than wall motion scores and resting MPS in predicting functional recovery in CAD patients after revascularization.