Varicose veins of the lower extremities (VVs) is a common chronic vascular disease, with high prevalence rates in some countries; however, their pathogenesis remains unclear. Some studies have identified associations between changes in specific plasma lipid molecules, such as phosphatidylethanolamine (PE), phosphatidylcholine (PC), and sphingomyelin (SM), and the onset of VVs, but due to confounders and reverse causality, the causal relationship remains unclear. Meanwhile, studies on the potential link between other plasma lipids beyond PE, PC, and SM and the risk of VVs in the lower extremities are lacking. This study aimed to explore the potential causal relationship between VVs and plasma lipid levels to provide theoretical insights into the interrelation of plasma lipids and VVs in their occurrence and progression. We conducted a two-sample Mendelian randomization (MR) analysis to assess the potential connection between genetically predicted levels of individual plasma lipids and the risk of developing VVs. We utilized data from a large-scale genome-wide association study involving 7174 Finnish individuals for 179 plasma lipidomes along with VVs genome-wide association study data from 408,455 UK individuals. MR analysis employed methods, such as inverse-variance weighting, weighted median, Bayesian Weighted Mendelian Randomization, and MR-Egger regression. The inverse-variance weighting method was primarily used to assess causality. The validity of the results was demonstrated through sensitivity analysis. In total, 12 lipids were found to have their plasma levels associated with an increased risk of VVs. This includes 3 types of PE, 7 types of PC, and 2 types of phosphatidylinositol. However, no significant causal relationship was found between the plasma levels of 11 types of SM and VVs. These results support the existence of a potential causal relationship between specific types of lipid levels and the risk of VVs, which can provide clues for further studies on biological mechanisms and the exploration of potential therapeutic targets.

Background This study aims to compare the clinical effects of two distinct surgical approaches, namely 3D printing-assisted extracorporeal pre-fenestration and Castor integrated branch stent techniques, in treating patients with Stanford type B aortic dissections (TBAD) characterized by inadequate proximal landing zones. Methods A retrospective analysis was conducted on 84 patients with type B aortic dissection (TBAD) who underwent thoracic endovascular aortic repair (TEVAR) with left subclavian artery (LSA) reconstruction at our center from January 2022 to July 2023. Based on the different surgical approaches, the patients were divided into two groups: the group assisted by 3D printing for extracorporeal pre-fenestration ( n = 44) and the group using the castor integrated branch stent ( n = 40). Clinical indicators: including general patient information, operative time, surgical success rate, intraoperative and postoperative complication rates, re-intervention rate, and mortality, as well as postoperative aortic remodeling, were compared between the two groups. The endpoint of this study is the post-TEVAR mortality rate in patients. Results The surgical success rate and device deployment success rate were 100% in both groups, with no statistically significant difference ( P > 0.05). However, the group assisted by 3D printing for extracorporeal pre-fenestration had a significantly longer operative time (184.20 ± 54.857 min) compared to the group using the castor integrated branch stent (152.75 ± 33.068 min), with a statistically significant difference (t = 3.215, p = 0.002, P < 0.05). Moreover, the incidence of postoperative cerebral infarction and beak sign was significantly lower in the group assisted by 3D printing for extracorporeal pre-fenestration compared to the castor-integrated branch stent group, demonstrating statistical significance. There were no significant differences between the two groups in terms of other postoperative complication rates and aortic remodeling ( P > 0.05). Notably, computed tomography angiography images revealed the expansion of the vascular true lumen and the reduction of the false lumen at three specified levels of the thoracic aorta. The follow-up duration did not show any statistically significant difference between the two groups (10.59 ± 4.52 vs. 9.08 ± 4.35 months, t = 1.561, p = 0.122 > 0.05). Throughout the follow-up period, neither group experienced new endoleaks, spinal cord injuries, nor limb ischemia. In the castor-integrated branch stent group, one patient developed a new distal dissection, prompting further follow-up. Additionally, there was one case of mortality due to COVID-19 in each group. There were no statistically significant differences between the two groups in terms of re-intervention rate and survival rate ( P > 0.05). Conclusion Both 3D printing-assisted extracorporeal pre-fenestration TEVAR and castor-integrated branch stent techniques demonstrate good safety and efficacy in treating Stanford type B aortic dissection with inadequate proximal anchoring. The 3D printing-assisted extracorporeal pre-fenestration TEVAR technique has a lower incidence of postoperative cerebral infarction and beak sign, while the castor-integrated branch stent technique has advantages in operative time.

Background: To compare the outcomes of two Thoracic Endovascular Aortic Repair (TEVAR) techniques of Left Subclavian Artery (LSA) reconstruction for Stanford Type B Aortic Dissection (TBAD) patients with undesirable proximal anchoring zone. Methods: We retrospectively reviewed 57 patients with TBAD who underwent either three dimensional (3D)-printing-assisted extracorporeal fenestration (n = 32) or conventional extracorporeal fenestration (n = 25) from December 2021 to January 2023. We compared their demographic characteristics, operative time, technical success rate, complication rate, secondary intervention rate, mortality rate, and aortic remodeling. Results: Compared with the conventional group, the 3D-printing-assisted group had a significantly shorter operative time (147.84 ± 33.94 min vs. 223.40 ± 65.93 min, p < 0.001), a significantly lower rate of immediate endoleak (3.1% vs. 24%, p = 0.048) and a significantly higher rate of true lumen diameter expansion in the stent-graft segment (all p < 0.05), but a significantly longer stent graft modification time (37.63 ± 2.99 min vs. 28.4 ± 2.12 min, p < 0.001). There were no significant differences in other outcomes between the two groups (p > 0.05). The degree of false lumen thrombosis was higher in the stent-graft segment than in the non-stent-graft segment in both groups and the difference was statistically significant (X2 = 5.390, 4.878; p = 0.02, 0.027). Conclusions: Both techniques are safe and effective for TBAD with an undesirable proximal landing zone. The 3D-printing-assisted extracorporeal fenestration TEVAR technique has advantages in operative time, endoleak risk, and aortic remodeling, while the traditional extracorporeal fenestration TEVAR technique has advantages in stent modification.

Objective: The preoperative aortic hemodynamic data of patients with Stanford type B aortic dissection were obtained by computer fluid dynamics (CFD). Then we explored the relationship between hemodynamic data and short-term residual pseudolumen after thoracic endovascular aortic repair (TEVAR) and predict the latter through the former. Methods: We collected the relevant data of 53 patients who underwent TEVAR in our hospital. They were divided into the A group (residual false lumen group) and B group (closed false lumen group), according to whether there was a residual false cavity around the stent recently after TEVAR. Three-dimensional reconstruction and CFD analysis of the thoracic and abdominal aorta was performed by DSCTA before the operation to obtain the aortic wall shear stress (WSS) and maximum blood flow velocity of the true and false lumen at the entrance, middle point of the long axis, and distal decompression port at the peak time of ventricular systolic velocity. Through the statistical analysis, we further studied the predictive value of hemodynamic data for residual pseudolumen. Results: There was no significant difference in age, male, preoperative and postoperative thoracic and abdominal aorta DSCTA interval, history of hypertension, history of diabetes, smoking, Pt and APTT at admission between the two groups (P > 0.05). The blood flow velocity and shear stress at the entrance of the false lumen and the distal decompression port in the two groups were statistically significant (P < 0.05), while the other hemodynamic indexes were not statistically significant (P > 0.05). Binary logistic regression analysis fur-ther showed that the shear stress of the false lumen at the level of the distal decompression port (OR = 1.73, P = 0.01) was an independent risk factor for the residual false lumen around the stent in the early stage after TEVAR. The ROC curve analysis showed that the AUC area of the ROC curve corresponding to the shear stress of the false cavity at the level of the distal decompression port was 0.83, the best cross-sectional value was 9.49pa, and the sensitivity and specificity were 84.60% and 72.50%. Conclusions: The residual pseudolumen after TEVAR is related to the hemodynamic factors in the aorta before TEVAR. Preoperative hemodynamic data also have good predictive value. When the shear stress of the false lumen at the level of the distal decompression port is greater than 9.49pa, the probability of residual false lumen around the stent during the perioperative period significantly increases.

The purpose of this study is to observe the potential value and underlying mechanism of the metastasis-associated lung adenocarcinoma transcript 1 (MALAT1)/miR-143 axis in ISR. A total of 150 participants were enrolled, including 100 patients (observation group) with coronary heart disease who underwent stent implantation in the Department of Cardiology of our hospital between January 2018 and January 2020, and 50 healthy people (control group) concurrently underwent a physical examination. Serum MALAT1 and miR-143 levels were detected by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Tumor necrosis factor-α (TNF-α; 10 ng/mL) induced human vascular smooth muscle cells (HVSMCs). MALAT1 increased while miR-143 decreased in the observation group versus the control group (P < 0.001). The non-restenosis group had significantly elevated MALAT1 expression while decreased miR-143 expression than the restenosis group (P < 0.001). The areas under the curves of the expression of MALAT1 and miR-143 in predicting restenosis were 0.917 and 0.881, respectively. Following si-MALAT1 transfection, HVSMC multiplication and invasiveness decreased significantly (P < 0.05). miR-143-inhibitor was observed to upregulate the luciferase activity of MALAT1-WT (P < 0.05). MALAT1 is highly expressed in patients with ISR while miR-143 is decreased, and the MALAT1/miR-143 axis is a potential pathway to modulate the multiplication and invasiveness of HVSMCs.

Objective:To study the role of microRNA (miRNA, miR)-29a-5p in myocardial fibrosis after myocardial infarction, and further study the mechanism of miR-29a-5p regulating myocardial fibrosis after myocardial infarction through target gene Endoglin.Methods:Thirty patients with myocardial infarction and 20 patients with non acute coronary syndrome were recruited. Blood samples were collected to detect miR-29a-5p and NTpro-brain natriuretic peptide (BNP). In vivo, the myocardial infarction model of mice was established, and the tail vein was injected with miR-29a-5p agomir and negative control reagent respectively. Four weeks later, After the mice were killed, some of the myocardial tissues were detected by real-time quantitative polymerase chain reaction (Real-time PCR) and Western blotting for miR-29a-5p, Endoglin and BNP respectively. In vitro experiments, 1-day-old mice were killed, myocardial fibroblasts were isolated and cultured. The cultured cells were transfected with miR-29a-5p MICs and negative control reagent with liposome 2000. After transfection, 50 μmol/L angiotensin Ⅱ (Ang Ⅱ) or phosphate buffer (PBS) of equal volume were added for 48 hours. The surface area of each fiber cell was measured by Image J software. The cells were co transfected with miR-29a-5p mimics or antigomir, pRL-tk-endoglin-3’untranslated regions (3’UTR) vector and pGL3 basic plasmid. After 48 hours of transfection, the cells were obtained, and the relative luciferase activity was detected by double Luciferase Report System. The expression of Endoglin in each group was detected by Real-time PCR and Western blotting respectively. Results:The content of miR-29a-5p [(3.57±0.53) ng/ml] in serum of acute myocardial infarct (AMI) patients was significantly reduced ( F=935.899, P<0.01), and the content of NTPRO-BNP [(9.47±5.06) ng/ml] was significantly increased ( F=65.440, P<0.01). The expression level of miR-29a-5p (0.51±0.12) in the MI group of rats was significantly reduced ( t=4.315, P<0.01), and the expression level of miR-29a-5p (0.65±0.26) was also found to be significantly reduced in the Ang Ⅱ-induced myocardial fibrosis model ( t=4.511, P<0.01). The content of Endoglin protein and mRNA expression (0.49±0.09) in cardiac fibroblasts treated by miR-29a-5p mimics decreased ( t=352.312, P<0.01). Endoglin protein in cardiac fibroblasts treated with miR-29a-5p antagomir The content and mRNA expression level (2.15±0.14) increased ( t=7.814, P<0.05). Conclusion:MiR-29a-5p is an important regulator of myocardial fibrosis.

Objective: To investigate the protective effect of erythropoietin (EPO) on myocardial infarction in rats with cardiac injury and its mechanism. Methods: 60 healthy female Sprague Dawley rats aged 8 weeks were randomly divided into mock surgical (MS) group, myocardial infarction (MI) group and EPO group, with 20 in each group. 4 weeks after modeling, among the three groups of rats, the left ventricular ejection fraction (LVEF), fractional shuotening (FS), LDH and CK-MB expression of related biochemical indicators, infarct size, cardiomyocytes apoptosis, and the expression of p-Akt protein in myocardial tissues were detected. Among the myocardial infarction rats, the correlation between myocardial apoptosis index and p-Akt protein expression in myocardial tissues was analyzed. Results: The LVEF value, FS value, and expression of LDH and CK-MB in the MS group were better than those in MI and EPO group (P<0.05). The indicators in the EPO group were better than those in the MI group (P<0.05); the myocardial infarct size and cardiomyocyte apoptosis in the MS group were smaller than those in the MI group and the EPO group (P<0.05). However, the myocardial infarct size and cardiomyocyte apoptosis in the EPO group were lower than those in the MI group (P<0.05). The p-Akt protein in the MS group was higher than that in the MI group and EPO group. The p-Akt protein in the EPO group was increased than that in the MI group (P<0.05). Among the myocardial infarction rats, there was a negative correlation between myocardial apoptosis index and p-Akt protein expression in myocardial tissues (r=-0.623, P<0.05). Conclusion: For rats with myocardial infarction, EPO can effectively improve their cardiac function, and reduce myocardial infarct size and myocardial apoptosis. The mechanism of protective effect on cardiomyocytes may be relied on the regulation of Akt anti-apoptotic signaling pathway.

Objective:To investigate the protective effect and molecular mechanism of trimetazidine preconditioning on myocardial ischemia reperfusion injury in rats.Methods:Thirty healthy adult male sprague-dawley (SD) rats weighing 280-300 g were randomly divided into sham operation group, model group and trimetazidine pretreatment group. In addition to the sham group, all models of myocardial ischemia-reperfusion injury were established in vivo. The rats were sacrificed and their hearts were removed after 120min of reperfusion, and the levels of creatine kinase (CK), creatine kinase isoenzyme (CK-MB) and lactate dehydrogenase (LDH) in serum were detected, and the expression levels of factor associated suicide (Fas), FasL, B cell lymphoma/leukemia-2 (bcl-2) and cysteinyl aspartate-specific protease (Caspase)-3 in myocardial tissue were measured. Statisticalanalysis of data using the statistical product and service solutions 19.0 software. Results:Compared with the sham operation group, the serum contents of CK [ (248.52±7.35), (177.93±5.11) U/L], CK-MB [ (68.54±2.95), (50.92±2.94) U/L], LDH [ (763.96±21.56), (310.06±28.33) U/L] in the model and the trimetazidine pretreatment groupgroup were significantly increased ( F=3 275.866, 675.844, 555.003, P<0.01), and the mRNA expressions of Fas (3.22±0.36, 1.80±0.21), FasL (2.85±0.34, 1.69±0.16), bcl-2 (1.45±0.09, 3.12±1.86) and Caspase-3 (4.46±0.27, 2.34±0.23) in the myocardial tissue were significantly increased ( F=218.549, 187.601, 351.196, 730.616, P<0.01). Compared with the model group, the serum contents of CK, CK-MB and LDH in the trimetazidine pretreatment group were significantly reduced ( t=24.944, 13.375, 11.218, P<0.01), the mRNA expressions of Fas, FasL and Caspase-3 in the myocardial tissue were significantly decreased ( t=10.213, 8.975, 19.004, P<0.01), and the mRNA expressions of bcl-2 were significantly increased ( t=16.141, P<0.01). Conclusion:The mechanism by which trimetazidine preconditioning can alleviate myocardial ischemia-reperfusion injury is related to inhibiting overactivation of the Fas/FasL pathway and inhibiting myocardial apoptosis.

Purpose: To study the effect of Jun N-terminal kinase (JNK) signaling pathway on hepatocyte apoptosis in vivo and in vitro, and to elucidate the mechanism of action. Methods: TdT-mediated dUTP Nick-End Labeling (TUNEL) method was used to determine apoptosis in control and cardiopulmonary bypass (CPB) groups at 0, 3 and 6 hours after rat surgery. The expressions of JNK and p-c-Jun in liver tissues at 0, 3 and 6 h after surgery, and the levels of p-c-Jun, Bcl-2 and Bim following overexpression of JNK, were determined using Western blot assay. Human liver cell line HL-7702 was cultured and transfected with over-expressed JNK plasmid and empty plasmid. Proliferation of HL-7702 cells after JNK over-expression was assessed by Cell Counting Kit-8 (CCK-8), while quantitative real-time polymerase chain reaction (RT-qPCR) was employed to evaluate mRNA expression levels of caspase-3 and caspase-9 mRNA after JNK over-expression. Apoptosis of the cells was determined by flow cytometry (FC) after JNK over-expression. Results: FC results showed that the number of apoptotic hepatocytes increased after JNK overexpression in hepatocytes while TUNEL assay results demonstrated that hepatocyte apoptosis increased in CPB group, when compared to control group; furthermore, the number of apoptotic cells gradually increased within 6 h after surgery. The expressions of JNK and p-c-Jun were higher in CPB group than in control group, and increased gradually in both groups within 6 h after surgery. Overexpression of JNK decreased the proliferation of hepatocytes, and also lowered protein expression levels of p-c-Jun and Bim; on the other hand, the protein expression levels of Bcl-2 fell, while mRNA expression levels of caspase-3 and caspase-9 mRNA increased. Conclusion: JNK pathway promotes hepatocyte apoptosis after cardiopulmonary bypass by inhibiting Bcl-2 pathway and promoting the expressions of Bim caspase-3 and caspase-9. Keywords: Cardiopulmonary bypass, Apoptosis, JNK pathway, Bim, caspase-3 and caspase-9

Objective: To identify the risk factors of prolonged Intensive Care Unit stay after surgery in patients with the type A acute aortic dissection. Methods: Retrospective analysis of 80 patients, 54 males (67.5%) and 26 females (32.5%) who underwent surgery for the treatment of Stanford type A acute aortic dissection in the cardiovascular department of 2nd affiliated hospital of Zhengzhou university through December 2014 to July 2016 were done. The mean age of the patients was 48.9 ± 12.5 years. The patients were divided into two groups, group A, prolonged (n=13) and group B, nonprolonged (n=67) based on the duration of ICU stay time either above or below 5 days. Univariate and multivariate analysis were done to find out the predictive risk factors. Results: The mean length of ICU stay time was 206.9 ± 25.4 hours in group A and 63.2 ± 17.4 hours in group B respectively. Mortality rate was 15.4% in group A and 3.0% in group B while overall mortality was 5%. ICU stay time was significantly influenced by the following factors; age (P=0.013), EuroSCORE (P=0.017), preoperative D- dimer (P=0.006], Deep hypothermic circulatory arrest (P=0.026), postoperative stroke (P=0.016), CPB time (P=0.002), postoperative stroke (P=0.009), postoperative acute respiratory failure (P=0.041) and postoperative acute renal failure (P=0.002). Conclusion: Age, Euro SCORE, preoperative D- dimer level, CPB time, Deep hypothermic circulatory arrest, postoperative stroke, postoperative acute respiratory failure and postoperative acute renal failure are independent risk factors of prolonged ICU stay in the patients after operation for Stanford type A acute aortic dissection.

The development of sensitive detection method for human apolipoprotein A (Apo-A) that is an important marker for coronary artery disease is highly demanded. In this study, a uniform composite composed of chemically reduced graphene (GR) and multi-walled carbon nanotubes (MWCT) was prepared via layer-by-layer assembly method. Cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS) were employed for investigating the electrochemical performance of GR-MWCT modified electrode. The content of Apo-A could be determined according to the change of reductive current after the electrode was functionalized with HRP-labeled Apo-A antibody. The current response of proposed immunosensor fabricated with GR-MWCT modified electrode was related linearly with the logarithm of human Apo-A concentration within the range of 0.51000.0 ng/mL. The detection limit of Apo-A immunosensor was 0.2 ng/mL (S/N=3). In addition, the proposed immunosensor showed excellent specificity for the detection of human Apo-A. In general, the Apo-A immunosensor with remarkable performance demonstrated huge potential use in the clinic diagnosis of coronary artery disease.

A teratoma is a type of germ cell tumor with tissue or organ components resembling normal derivatives of more than one germ layer which is actually present at birth. A 9-years-old boy was admitted with symptoms of breathlessness, fatigue, swelling in right upper parasternal region and slight chest pain on exertion. A large tumor was revealed by thoracic computed tomography with slight displacement of heart and pericardial effusion. The tumor was successfully resected surgically. Histopathology examination confirmed the diagnosis of an intrapericardial mature teratoma. The patient had an uneventful recovery and he is normal after one year follow up. Rarity of the lesion makes this case worthy of documentation.

Objective: To explore the protective role of exogenous Creatine Phosphate (PCr) in the postoperative cardiac muscle recovery in children undergoing open heart surgery. Material and methods: 63 cases of congenital heart disease were randomly divided into 3 groups; A, B and C; 21 cases in each group. Myocardial perfusion fluids were made of the same amount of blood in the St, Thomas Hospital cardioplegic solution type 2 (STH 2). In B and C group, intraoperative myocardial perfusion solution added with exogenous CP. All the groups were postoperatively treated with general fluid therapy, while group C was given postoperative intravenous exogenous CP. Trends of myocardial enzyme at different time points were monitored. Results: At the end of surgery (T2), enzyme levels in the plasma were significantly increased, no difference between the groups B and C but were significantly lower than that in group A (P<0.05); after surgery myocardial enzyme levels recovered fastest in Group C, slowest in A group, the differences between each group were significant (P<0.05). Conclusions: Perioperative and postoperative exogenous PCr have myocardial protective effect and accelerate the repair of injured myocardium due to ischemia during open heart surgery in children.

With average [S] of 0.033%(in the range of 0.028%～0.039%),and average [P] of 0.133%(in the range of 0.129%～0.138%) in molten iron to be fed into converter,X65 pipeline steel was successfully produced through dephosphorization by double slag process in converter,modification of ladle slag during tapping,application of double-deck high alkalinity covering agent in tundish,control of LF slag composition,and casting protection with argon.The average [N],T and [P] in the strands were controlled at 0.0035%,0.001 4%,0.002 3%,and 0.009 8% respectively.Inclusions in the strand were rated below 0.5 with total amounts of 0.004 4%.These globular inclusions were small in size and number,exhibiting satisfied internal quality.The mechanical properties of the trial-produced steel achieved the desired effect,and could fully meet the requirements of standards and users.

The hot metal fed converter in Panzhihua Steel Company is characterized by high sulfur content of 0.085% and high phosphorus content of 0.133%. Under this condition, some technologies like control of sulfur and T[O] content, ladle slag optimization, calcium treatment and protective casting were used in practice, and the desired result of T[O] as low as 0.0014% and sulfur content of 0.0023% was achieved, which met the cleanness requirements by anti-HIC X65 tube steel. With the help of inclusion control technology, grade of inclusions in as-cast steel was less than 0.5. In addition, total amount of inclusions was only 0.0044% which dispersed in slab in form of small spherical particle.

Double-slag process is used to steelmaking of vanadium-titanium containing molton iron at Chengdu steel and vanadium company of Panghang.The results show that both converter operating ratio and dephosphorization rate of a converter is improved,the end [P] content of liquid steel is achieved less than 0.005%,the technical support is provided for development of ultra-low phosphorus steel.Furthermore,blowing loss and steel material consumption could be effectively reduced.