Abstract Thoracic aortic aneurysm (TAA) is a life‐threatening cardiovascular disorder characterized by progressive aortic dilation that often culminates in dissection or rupture, with few effective pharmacological interventions currently available. Vascular smooth muscle cells (VSMCs)‐the predominant cellular component of the aortic media‐undergo extensive phenotypic modulation during TAA development. However, the heterogeneity of VSMC populations and the molecular mechanisms regulating their fate decisions remained poorly understood until the emergence of single‐cell technologies. Single‐cell RNA sequencing, single‐nucleus assay for transposase‐accessible chromatin sequencing, and spatial transcriptomics have revolutionized the understanding of VSMC diversity at an unprecedented resolution. These approaches have revealed a complex spectrum of VSMC phenotypic states that extend beyond the classical contractile–synthetic dichotomy, including fibroblast‐like, macrophage‐like, and chondrocyte‐like subpopulations that arise through distinct differentiation trajectories. This review systematically summarizes recent progress in elucidating VSMC phenotypic switching in TAA, emphasizing developmental trajectories reconstructed through pseudotime analyses, the gene regulatory networks controlling fate decisions, and the spatial microenvironmental cues influencing VSMC behaviour. Furthermore, it discusses the translational implications of these insights for identifying novel diagnostic biomarkers and developing therapeutic strategies aimed at stabilizing VSMC phenotypes.

Background and Objective: Acute type A aortic dissection (ATAAD) represents a critical and life-threatening condition requiring urgent surgical intervention, which is often life-saving. However, postoperative acute lung injury (ALI) has emerged as a prominent complication that significantly impacts patient outcomes and prognosis. This study aims to systematically analyze the risk factors associated with the development of severe ALI following ATAAD surgery, providing insights to improve postoperative management strategies. Methods: A retrospective analysis was conducted using a comprehensive database comprising 483 patients diagnosed with ATAAD. Patients were stratified into two groups based on the severity of postoperative ALI: severe ALI group (n = 182) and non-severe ALI group (n = 301). Clinical data were systematically collected and compared between the two cohorts. Binary logistic regression analysis was employed to identify independent predictors of severe ALI following ATAAD surgery. The diagnostic accuracy of these risk factors was assessed using receiver operating characteristic (ROC) curve analysis, with the area under the curve (AUC) serving as the metric for prognostic performance. Results: The severe ALI group exhibited a higher prevalence of preoperative oxygenation index (OI) ≤ 200 mmHg, smoking history, and coronary artery disease compared to the non-severe ALI group (P < 0.001, P = 0.032, and P = 0.039, respectively), while the prevalence of Marfan syndrome was lower (P = 0.033). Moreover, significant differences were observed in several clinical and intraoperative parameters, including body mass index (BMI), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, white blood cell count (WBC), aortic cross-clamp time, moderate hypothermic circulatory arrest (MHCA) time, cardiopulmonary bypass (CPB) duration, and ICU length of stay (all P < 0.05). Multivariate logistic regression identified preoperative OI [P = 0.008, OR (95% CI): 0.002 (0.000-0.183)], BMI [P = 0.037, OR (95% CI): 1.569 (1.027-2.397)], CRP [P = 0.022, OR (95% CI): 1.292 (1.037-1.609)], D-dimer [P < 0.001, OR (95% CI): 3.841 (1.820-8.108)], MHCA time [P = 0.001, OR (95% CI): 3.306 (1.670-6.544)], and CPB duration [P = 0.017, OR (95% CI): 1.117 (1.020-1.223)] as independent predictors of severe ALI. ROC curve analysis revealed the diagnostic performance of preoperative OI, BMI, CRP, D-dimer, MHCA time, and CPB duration, with AUC values of 0.715, 0.844, 0.871, 0.955, 0.944, and 0.833, respectively (all P < 0.001). Conclusion: Preoperative oxygenation index, BMI, CRP, D-dimer levels, MHCA time, and CPB duration are independent risk factors for the development of severe ALI following ATAAD surgery. These findings underscore the importance of preoperative risk assessment and perioperative optimization to mitigate the risk of severe ALI and improve patient outcomes.

Background:Isolated left vertebral artery (ILVA) may pose additional difficulties during aortic arch surgical repairs. This study aimed to present our experience in managing ILVA in type A aortic dissection (TAAD) treated with total aortic arch replacement combined with frozen elephant trunk implantation (Sun's procedure) or type II hybrid aortic arch repair. Methods:This was a single-center, retrospective, observational cohort study. A total of 672 patients with TAAD underwent open surgery at the Department of Aortic Surgery, Central China Fuwai Hospital between February 2019 and August 2023. Of these, 5.06% (n=34) had ILVA. The demographics, comorbidities, imaging characteristics, operational intricacies, perioperative outcomes, and follow-up data of these patients were collected and retrospectively analyzed. Results:Out of the 34 patients (25 male, mean age 52.47±12.31 years), 32 underwent the Sun's procedure under moderate hypothermia circulatory arrest, while two patients underwent type II hybrid aortic arch repair under mild hypothermia cardiopulmonary bypass (CPB). ILVA transposition was performed in all cases, resulting in a primary technical success rate of 100%. The average CPB time was 209.79±70.73 min, with an aortic cross-clamping time of 110.65±42.21 min. Unfortunately, three patients died during the perioperative period, of which two died due to gastrointestinal hemorrhage and multiple organ failure and one due to low cardiac output syndrome. No instances of vagus/recurrent laryngeal nerve palsy, Horner syndrome, chylothorax, nor vertebral artery thrombosis were reported. The median follow-up period was 31.69±17.68 (range, 3-56) months. One patient died of colon cancer 3 months postoperatively, while the remaining patients were still alive. All transposed ILVAs remained patent without anastomotic stenosis nor pseudoaneurysm. No aorta-related deaths nor the necessity for aorta-related reintervention arose throughout the follow-up period. Conclusions:Though further cases and extended follow-up periods are necessary, our current data underscore the feasibility, safety, and efficacy of ILVA transposition during the Sun's procedure or type II hybrid aortic arch repair for TAAD.

Methylene blue (MB) has antioxidant properties, yet its role in acute lung injury (ALI) induced by hypothermic circulatory arrest (HCA) remains unexplored. This study investigates MB's effects and underlying regulatory mechanisms in an HCA rat model. Rats received an intravenous bolus of MB (1 mg/kg) 15 min before HCA induction. Physiological parameters were monitored, and bronchoalveolar lavage fluid (BALF) was collected 2 h postoperatively to assess total protein levels, inflammatory cells, and cytokines. Histopathological lung damage was evaluated using hematoxylin-eosin (H&E) and TUNEL staining. Inflammatory markers and oxidative stress indicators were measured via ELISA and dihydroethidium (DHE) staining. Alveolar macrophages (AMs) were isolated to analyze polarization using flow cytometry and immunofluorescence double staining. Pyroptosis in AMs was detected with Yo-Pro-1 and Hoechst 33342 staining. Additionally, Western blotting was performed to examine the nuclear factor erythroid-2 related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) pathway, Nod-like receptor protein 3 (NLRP3) inflammasome, and pyroptosis-related proteins. Following HCA, rats exhibited significant blood gas abnormalities, structural lung damage, increased pathological scores, and higher apoptosis rates. However, MB mitigated these effects, improving physiological parameters and reducing lung histopathology scores. MB also lowered proinflammatory cytokine levels, increased SOD and GSH-Px activity, promoted AM polarization toward the M2 phenotype, and decreased pyroptosis. Mechanistically, MB activated the Nrf2/HO-1 pathway while inhibiting NLRP3 inflammasome activation. Notably, Nrf2 inhibitors and NLRP3 agonists weakened MB's protective effects by promoting inflammasome activation and pyroptosis, whereas Nrf2 agonists and NLRP3 inhibitors enhanced MB's beneficial impact. In conclusion, MB attenuates HCA-induced ALI by modulating AM polarization and pyroptosis via Nrf2/HO-1 pathway activation and NLRP3 inflammasome inhibition.

Background: Atherosclerosis is a progressive and complex vascular pathology characterized by cellular heterogeneity, metabolic dysregulation, and chronic inflammation. Despite extensive research, the intricate molecular mechanisms underlying its development and progression remain incompletely understood. Methods: Single-cell RNA sequencing (scRNA-seq) was employed to conduct a comprehensive mapping of immune cell enrichment and interactions within atherosclerotic plaques, aiming to investigate the cellular and molecular complexities of these structures. This approach facilitated a deeper understanding of the heterogeneities present in smooth muscle cells, which were subsequently analyzed using pseudotime trajectory analysis to monitor the developmental trajectories of smooth muscle cell (SMC) subpopulations. An integrative bioinformatics approach, primarily utilizing Weighted Gene Co-expression Network Analysis (WGCNA) and machine learning techniques, identified Cathepsin C (CTSC), transforming growth factor beta-induced protein (TGFBI), and glia maturation factor-γ (GMFG) as critical biomarkers. A diagnostic risk score model was developed and rigorously tested through Receiver Operating Characteristic analysis. To illustrate the functional impact of CTSC on the regulation of plaque formation and SMC viability, both in vitro and in vivo experimental investigations were conducted. Results: An analysis revealed SMCs identified as the most prominent cellular type, exhibiting the highest density of disulfidptosis. Pseudotime trajectory analysis illuminated the dynamic activation pathways in SMCs, highlighting their significant role in plaque development and instability. Further characterization of macrophage subtypes demonstrated intercellular communication with SMCs, which exhibited specific signaling pathways, particularly between the proximal and core areas of plaques. The integrated diagnostic risk score model, which incorporates CTSC, TGFBI, and GMFG, proved to be highly accurate in distinguishing high-risk patients with elevated immune responses and systemic inflammation. Knockdown experiments of CTSC conducted in vitro revealed enhanced SMC survival rates, reduced oxidative stress, and inhibited apoptosis, while in vivo experiments confirmed a decrease in plaque burden and improvement in lipid profiles. Conclusions: This study emphasizes the significance of disulfidptosis in the development of atherosclerosis and identifies CTSC as a potential therapeutic target for stabilizing plaques by inhibiting SMC apoptosis and oxidative damage. Additionally, the risk score model serves as a valuable diagnostic tool for identifying high-risk patients and guiding precision treatment strategies.

OBJECTIVE:To analyze the efficacy of early prone position ventilation in the treatment of severe hypoxemia after surgery for acute type A aortic dissection (TAAD). METHODS:The patients were divided into a control group and a treatment group. Parameters assessed included blood gas analysis indicators [arterial oxygen partial pressure (PaO2). RESULTS:(1) Blood gas analysis: Before treatment, there was no significant difference in PaO2, SpO2, and OI levels between the two groups; after treatment, the PaO2, SpO2, and OI levels in both groups significantly increased compared to pre-treatment, with a more pronounced improvement in the treatment group than in the control group (p < 0.05). (2) Hemodynamics: Before treatment, there was no significant difference in MAP and HR levels between the two groups; after treatment, the MAP levels increased significantly in both groups compared to pre-treatment, while HR levels decreased significantly, with no significant difference between the groups. (3) Prognosis recovery: MV time, ICU stay, and total hospital stay were significantly lower in the treatment group than in the control group; the 30-day mortality rate was 14.58% in the control group and 12.50% in the treatment group, with no significant difference in 30-day mortality rate between the groups. CONCLUSION:Early prone position ventilation has shown promising application in the treatment of severe hypoxemia after TAAD surgery. Compared to traditional supine position ventilation, the use of early prone position ventilation can further improve blood gas analysis indicators in patients, and shorten MV time, ICU stay, and total hospital stay, thereby accelerating patient recovery.

BackgroundInvestigation into the immune heterogeneity linked with atherosclerosis remains understudied. This knowledge gap hinders the creation of a robust theoretical framework essential for devising personalized immunotherapies aimed at combating this disease.MethodsSingle-cell RNA sequencing (scRNA-seq) analysis was employed to delineate the immune cell-type landscape within atherosclerotic plaques, followed by assessments of cell-cell interactions and phenotype characteristics using scRNA-seq datasets. Subsequently, pseudotime trajectory analysis was utilized to elucidate the heterogeneity in cell fate and differentiation among macrophages. Through integrated approaches, including single-cell sequencing, Weighted Gene Co-expression Network Analysis (WGCNA), and machine learning techniques, we identified hallmark genes. A risk score model and a corresponding nomogram were developed and validated using these genes, confirmed through Receiver Operating Characteristic (ROC) curve analysis. Additionally, enrichment and immune characteristic analyses were conducted based on the risk score model. The model’s applicability was further corroborated by in vitro and in vivo validation of specific genes implicated in atherosclerosis.ResultThis comprehensive scRNA-seq analysis has shed new light on the intricate immune landscape and the role of macrophages in atherosclerotic plaques. The presence of diverse immune cell populations, with a particularly enriched macrophage population, was highlighted by the results. Macrophage heterogeneity was intricately characterized, revealing four distinct subtypes with varying functional attributes that underscore their complex roles in atherosclerotic pathology. Intercellular communication analysis revealed robust macrophage interactions with multiple cell types and detailed pathways differing between proximal adjacent and atherosclerotic core groups. Furthermore, pseudotime trajectories charted the developmental course of macrophage subpopulations, offering insights into their differentiation fates within the plaque microenvironment. The use of machine learning identified potential diagnostic markers, culminating in the identification of RNASE1 and CD14. The risk score model based on these biomarkers exhibited high accuracy in diagnosing atherosclerosis. Immune characteristic analysis validated the risk score model’s efficacy in defining patient profiles, distinguishing high-risk individuals with pronounced immune cell activities. Finally, experimental validation affirmed RNASE1’s involvement in atherosclerotic progression, suggesting its potential as a therapeutic target.ConclusionOur findings have advanced our understanding of atherosclerosis immunopathology and paved the way for novel diagnostic and therapeutic strategies.

目的 对比分析新型闭合式股静脉-股动脉体外循环(closed-CPB)与开放式体外循环(open-CPB)在全胸腹主动脉置换术中的应用效果.方法 2018年11月至2023年5月阜外华中心血管病医院在股静脉-股动脉体外循环辅助下共完成46例全胸腹主动脉置换术.为了更好应对"分段阻断"带来的血流动力学紊乱,我们改进回路连接方式:在开放式回路的基础上,将静脉引流管用3/8英寸"Y"型接头分出管路直接连于离心泵入血口;储血器出血口连接滚压泵,滚压泵后管路用3/8英寸"Y"型接头连接于离心泵出血口和膜肺入血口之间;钳闭储血器入血口,可以隔离储血器实现闭合式转流.在closed-CPB辅助下共完成15例全胸腹主动脉置换术(closed-CPB组),我们将其与先前应用open-CPB完成的病例(open-CPB组)进行对比分析,收集两组患者围术期临床资料,首要观察指标为术中和术后24 h血压、血制品用量、血液回收量、乳酸水平和缩血管药物用量,次要观察指标为并发症和临床结局等.计量资料、计数资料比较分别采用t检验、U检验、x2检验或Fisher确切概率法.结果 closed-CPB组的血制品用量少于open-CPB组,其中在术中和术后24 h红细胞用量、冷沉淀用量方面差异有统计学意义[2.0(0.0,4.0)比4.5(2.3,8),Z=2.563,P＜0.05;3.0(0.0,3.8)比 4.0(3.8,8.0),Z=2.950,P＜0.01;0(0,0)比 6(0,10.0),Z=2.973,P＜0.01].closed-CPB 组的血液回收量明显少于 open-CPB 组[800(670,855)比 1 500(811,1 950),Z=2.977,P＜0.01].open-CPB组的缩血管药物用量明显多于closed-CPB组,其中多巴胺泵入药量和去氧肾上腺素单次给药量分别为[(19.4±5.6)比(37.5±9.9),t=-6.576,P＜0.01]和[(0.6± 0.1)比(1.4±0.3),t=-8.836,P＜0.01],然而,其 SBP(Systolic Blood Pressure)低于 80 mmHg 的时间却明显长于 closed-CPB 组[(47.6±9.5)比(32.7±8.9),t=-5.105,P＜0.01],open-CPB 组的最高 Lac 水平亦显著高于 closed-CPB 组[(10.2±3.6)比(4.6±2.4),t=-5.488,P＜0.01].open-CPB 组 30 d 内死亡率明显高于 closed-CPB 组[7(22.6％)比 0(0),x2=2.437,P＜0.01].结论 新型回路连接方式可以安全地实现闭合式体外转流,通过调节滚压泵能够更为方便和有效地调控有效循环血量,及时回输失血,维持血流动力学稳定和良好的组织灌注.

总结成人心脏直视手术中出现急性Stanford A型主动脉夹层的原因及不同紧急治疗措施的效果。2017年12月至2022年5月，行成人心脏直视手术9 307例，术中出现急性Stanford A型主动脉夹层(ATAAD)6例，其中冠心病2例，冠心病合并二尖瓣关闭不全2例，主动脉瓣狭窄合并升主动脉扩张1例，二尖瓣关闭不全及主动脉关闭不全和三尖瓣关闭不全1例；男3例，女3例；年龄47~76岁，均合并高血压。成人心脏直视手术中出现ATAAD发生率0.064%，紧急行升主动脉置换术3例，升主动脉置换和主动脉窦部成形术1例，升主动脉置换和孙氏手术2例。紧急手术死亡1例。临床实践初步表明，心脏直视手术中出现ATAAD，尽快保障重要器官灌注，采用个体化的手术方案可行有效。

Objectives: Recent studies validated the expression of extraoral bitter taste receptors and established the importance of regulatory functions that are associated with various cellular biological processes of these re-ceptors. However, the importance of bitter taste receptors' activity in neointimal hyperplasia has not yet been recognized. The bitter taste receptors activator amarogentin (AMA) is known to regulate a variety of cellular signals, including AMP-activated protein kinase (AMPK), STAT3, Akt, ERK, and p53, which are associated with neointimal hyperplasia.Materials and methods: The present study assessed the effects of AMA on neointimal hyperplasia and explored the potential underlying mechanisms.Results: No cytotoxic concentration of AMA significantly inhibited the proliferation and migration of VSMCs induced by serum (15 % FBS) and PDGF-BB. In addition, AMA significantly inhibited neointimal hyperplasia of the cultured great saphenous vein in vitro and ligated mouse left carotid arteries in vivo, while the inhibitory effect of AMA on the proliferation and migration of VSMCs was mediated via the activation of AMPK-dependent signaling, which could be blocked via AMPK inhibition.Conclusion: The present study revealed that AMA inhibited the proliferation and migration of VSMCs and attenuated neointimal hyperplasia, both in ligated mice carotid artery and cultured saphenous vein, which was mediated via a mechanism that involved AMPK activation. Importantly, the study highlighted the potential of AMA to be explored as a new drug candidate for neointimal hyperplasia.

Objective:To evaluate the effects of different doses of sivelestat sodium on perioperative acute lung injury (ALI) in the patients undergoing emergency surgery for acute Stanford type A aortic dissection (AAAD).Methods:A total of 120 patients of both sexes, aged 30-64 yr, with body mass index of 18.5-24.9 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅲ or Ⅳ, scheduled for emergency AAAD surgery, were divided into 3 groups using a random number table method: low-dose sivelestat sodium group (SL group), medium-dose sivelestat sodium group (SM group)and high-dose sivelestat sodium group (SH group), with 40 patients in each group. Sivelestat sodium 4.8, 6.0 and 7.2 mg/kg were intravenously infused starting from 10 min before anesthesia until 24 h after surgery in SL, SM and SH groups, respectively. Blood samples from the radial artery were collected for blood gas analysis after anesthesia induction and before skin incision (T 1), immediately after the end of surgery (T 2), at 24 h after surgery (T 3), and 72 h after surgery (T 4), the alveolar-arterial oxygen tension difference (PA-aDO 2), oxygenation index (OI)and respiratory index (RI) were calculated. The duration of postoperative mechanical ventilation, length of stay in the intensive care unit (ICU) and length of postoperative hospital stay were recorded. Central venous blood samples were collected at T 1-T 4 to measure serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6)and IL-8. Peripheral venous blood samples were collected on preoperative day 1 and postoperative days 1 and 3 to measure white blood cell (WBC) count, neutrophil (NEUT) count, neutrophil percentage (NEUT%), and C-reactive protein (CRP) concentration. The occurrence of postoperative pulmonary complications (PPCs)and 90-day all-cause mortality were recorded. Results:Compared with the baseline at T 1, PA-aDO 2 and RI were significantly increased, OI was decreased, and the serum concentrations of TNF-α, IL-6 and IL-8 were increased at T 2-T 4 in all the three groups ( P<0.05). WBC, NEUT, NEUT% and concentrations of CRP were significantly higher on postoperative days 1 and 3 than on 1 day before surgery in the three groups ( P<0.05). Compared with SL and SM groups, PA-aDO 2 and RI were significantly decreased, OI was increased, and the serum concentrations of TNF-α, IL-6 and IL-8 were decreased, the WBC count, NEUT count, NEUT% and concentrations of CRP were decreased, the incidence of postoperative hypercapnia, hypoxemia, emerging lung rales and bronchospasm was decreased, and the duration of postoperative mechanical ventilation and length of intensive care unit stay were shortened( P<0.05), and no significant change was found in the postoperative length of hospital stay and 90-day all-cause mortality rate in SH group ( P>0.05). Conclusions:Sivelestat sodium 7.2 mg/kg can significantly inhibit the inflammatory responses, alleviate perioperative ALI, and improve early prognosis in the patients undergoing AAAD surgery.

急性Stanford A型主动脉夹层术中支架误入假腔是孙氏手术少见的严重并发症。我院孙氏手术中出现1例术中支架进入假腔患者，女，54岁，合并高血压，经主动脉CTA确诊为Stanford A型主动脉夹层。急诊行升主动脉置换及全主动脉弓人工血管替换并支架象鼻术。术中发现下肢血压异常，经食管超声确诊术中支架进入降主动脉假腔，遂行胸主动脉腔内修复术，患者顺利康复。

Background Herein, we aimed to analyze cardiac metabolic reprogramming in patients with tetralogy of Fallot (ToF). Methods Cardiac metabolic reprogramming was analyzed through comprehensive bioinformatics analysis, which included gene set enrichment, gene set variation, and consensus clustering analyses, so as to assess changes in metabolic pathways. In addition, full-spectrum metabolomics analysis was performed using right atrial biopsy samples obtained from patients with ToF and atrial septal defect (ASD) before cardiopulmonary bypass; ultrahigh performance liquid chromatography–tandem mass spectrometry (UPLC–MS/MS) was used to construct a metabolic map of cardiac metabolic reprogramming in cyanotic congenital heart disease. Results The metabolic maps of carbohydrate metabolic process and heme metabolism were significantly activated, while bile acid metabolism, lipid droplet, and lipid binding were primarily restrained in ToF samples as compared with that in ASD samples. The reprogramming of butanoate metabolism was identified basing on the UPLC–MS/MS detection and analysis in myocardial hypoxia damage in cyanotic heart disease. Finally, the butanoate metabolism–related hub regulators ALDH5A1 and EHHADH were identified and they were significantly downregulated in ToF samples. Conclusions The metabolic network of butanoate metabolism involved ALDH5A1 and EHHADH, which could contribute to myocardial tissue damage in cyanotic congenital heart of ToF. Our results provide further insights into the mechanisms underlying metabolic reprogramming in cyanotic congenital heart disease and could lead to the identification of potential therapeutic targets.

OBJECTIVES:To study the impact of a balloon occlusion (BO) technique in stented elephant trunk implantation in Sun's procedure for acute Stanford type A aortic dissection (AAAD) on important postoperative organ complications and patient rehabilitation.METHODS:Eighty-five patients with AAAD who underwent Sun's procedure from January 2019 to January 2020 were selected. Cases were divided into two groups based on whether the aortic BO technique was used in stented elephant trunk implantation: the BO group and the nonballoon occlusion (NBO) group. The collected data included the patients' clinical characteristics, operative data, postoperative complications and recovery. We applied statistical software to study the impact of a BO technique in stented elephant trunk implantation in Sun's procedure.RESULTS:A total of 85 patients with AAAD underwent Sun's procedure. A total of 29 used BO technique, 56 did not use. The circulatory arrest time in the BO group was controlled within 8.07 ± 2.33 min, and the nasopharyngeal temperature dropped to 28°C. Overall postoperative complications were less frequent in BO group than NBO group (52% vs. 75%; p = .030). Using BO technique, we reduced the 24-h drainage volume, and lowered the occurrence of hypoxemia (48%), liver dysfunction (10%), and median tracheal intubation time was 37 h (range: 12.5-106 h), median intensive care unit (ICU) time was 65 h (range: 17-207 h).CONCLUSIONS:During total aortic arch replacement and stented elephant trunk surgery for AAAD, we used the aortic BO technique, which avoids deeper hypothermia and effectively shortens circulatory arrest times. This approach is helpful for reducing the incidence of postoperative complications and shortening the intensive care unit time. This method also reduces the patient's medical burden and facilitates faster recovery.

Objective:To investigate the role and potential mechanism of exosomal microRNA (miR)-25 from cancer-associated fibroblasts (CAFs) promoting the proliferation and metastasis of esophageal carcinoma cells.Methods:CAFs and normal fibroblasts (NFs) were isolated from cancer tissues and adjacent tissues of esophageal carcinoma patients, respectively, and immunofluorescence was used to identify α-smooth muscle actin (α-SMA) and Vimentin expression in CAFs and NFs. After centrifugation, exosomal RNA was extracted and exosomes was identified by Western blotting and transmission electron microscopy. The quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) was used to detect the expression of miR-25 in esophageal cancer issues and para-canceresophagus tissues. The results were statistically analyzed by paired sample t test, and the miR-25 level in cell lines of esophageal cancer, CAFs, NFs and exosomes was detecd by RT-qPCR. The influence of CAFs-derived exosomes containing miR-25 on the invasion of esophageal cancer cells was evaluated. The confirmation of target gene of miR-25 was performed with luciferase assay and Western blotting. The results were statistically analyzed by unpaired sample t test. Results:RT-qPCR indicated that miR-25 was highly expressed in esophageal cancer tissues as compared with para-canceresophagus tissues ( n=30, t=3.46, P<0.05). Compared with NFs, α-SMA and Vimentin were highly expressed in CAFs. Western blotting indicated that CD9 and TSG101 proteins were expressed in exosomes. The relative expression of miR-25 in CAFs-derived exosomes was higher than that in NFs-derived exosomes ( t=5.45, P<0.05). Transwell assay indicated that the number of TE-1 migrating cells per field was (202.700±17.840) in the NFs-derived exosomes and TE-1 co-culture group, and (558.000±19.430) in the CAFs-derived exosomes and TE-1 co-culture group ( t=13.47, P<0.01, n=3). The number of TE-1 invasion cells per field was (174.000±10.070) in the NFs-derived exosomes and TE-1 co-culture group, and (428.000±8.888) in the CAFs-derived exosomes and TE-1 co-culture group ( t=18.91, P<0.01, n=3). The number of TE-1 migrating cells per field was (68.000±2.082) in TE-1 cells containing miR-NC, and (379.000±6.083) in the TE-1 cells containing miR-25 mimics ( t=48.37, P<0.01, n=3). The number of TE-1 invasive cells per field was (40.000±2.082) in the TE-1 cells containing miR-NC, and (254.000±2.000) in the TE-1 cells containing miR-25 mimics ( t=74.13, P<0.01, n=3). Luciferase reporter gene detection showed that overexpression of miR-25 reduced luciferase activity of PTEN 3′UTR wild-type by 58% (wild-type: t=7.19, P<0.05). Conclusion:Exosomal miR-25 could regulate the process of CAFs promoting the invasion of esophageal cancer cells.

Objective:To summarize the clinical experience and effect of applying 3D printing assisted with the technology of extracorporeal pre-fenestration in the treatment of thoracic/abdominal aortic aneurysm.Methods:From August 2019 to November 2020, 15 patients with thoracic/abdominal aneurysm involving visceral arteries were admitted to our center, including 11 males and 4 females, with mean age of 57-82(68.26 ±4.73) years old. According to diameters of visceral artery, thoracic aorta, abdominal aorta, and bilateral iliac arteries measured by CTA, we selected suitable stents and made a 3D printing model by professional software to guide the position of intraoperative external fenestration and the fenestration diameter to implement full cavity repair.Results:All operations were completed and one case was converted to laparotomy. The average time of operations was(200.67±41.00)min and hospital stay was(13.47±4.16)days without any death, organ failure, endoleak, paraplegia, graft infection and other complications.Conclusion:The application of 3D printing assisted with the technology of extracorporeal pre-fenestration in the treatment of thoracic/abdominal aortic aneurysm is feasible and effective, and the short-term results are satisfactory.

Objective:To investigate the effects of intraoperative somatosensory evoked potential and cerebrospinal fluid biochemical indexes on postoperative complications of thoracoabdominal aortic replacement.Methods:The clinical data of 56 patients who underwent thoracoabdominal active replacement in Fuwai Huazhong Cardiovascular Hospital Heart Center, Henan Provincial People’s Hospital from August 2018 to August 2021 were analyzed retrospectively. The changes of somatosensory evoked potential during operation were monitored in all patients, and cerebrospinal fluid was collected after operation. The expression levels of glial fibrillary acid protein (GFAP), neurofilament subunit (NFL) and S100B protein in cerebrospinal fluid were detected. Totally, 76 patients were divided into injury group and no injury group according to whether there was spinal cord injury. T-test was used for comparison between normal distribution groups. Results:The operation time of 56 patients was (697.35±139.52) min, the cardiopulmonary bypass time was (192.87±75.56) min, the circulatory arrest time was (17±4) min, and the stay time in the postoperative monitoring room was (9.51±3.85) d. Postoperative cerebrospinal fluid pressure was (12.89±4.25) mmHg (1 mmHg=0.133 kPa). Spinal cord injury occurred in 7 cases after operation, including 2 cases of immediate paralysis and 5 cases of delayed paralysis. The incidence of spinal cord injury was 12.5%. The positive rate of intraoperative somatosensory evoked potential in patients with spinal cord injury [85.71% (6/7)] was significantly higher than that in patients with non-invasive injury [22.45% (11/49), χ2=12.901, P>0.05]. The levels of GFAP, NFL and S100B in cerebrospinal fluid [(0.41±0.15), (4.36±0.59), (1.23±0.18) ng/ml respectively] in patients with spinal cord injury were significantly lower than those in the patients without spinal cord injury [(0.79±0.11), (6.69±0.79), (2.24±0.27) ng/ml, t=3.109, 2.901, 3.328, P<0.05]. Conclusion:The changes of somatosensory evoked potential and cerebrospinal fluid indexes are closely related to spinal cord injury after thoracoabdominal aortic replacement, which can be used as clinical evaluation indexes.

目的 探讨降主动脉置换术中采用左心转流结合回收式自体血输入体外循环支持的临床效果及意义.方法 行降主动脉置换术患者36例,其中术中采用股动脉、静脉插管常规体外循环支持者20例为对照组,术中采用左心转流结合回收式自体血输入体外循环支持者16例为观察组.比较2组体外循环时间、降主动脉阻断时间、术后第1天引流量、气管插管时间、ICU住院时间及降主动脉阻断时、开放时桡动脉、股动脉平均压,观察术后1周监护室恢复期间苏醒延迟、低氧血症、急性肾功能衰竭等并发症发生情况.结果 观察组体外循环时间[(75.0±12.0)min]、降主动脉阻断时间[(62.0±13.0)min]、气管插管时间[(24.1±6.9)h]、ICU 住院时间[(2.6±1.2)d]均短于对照组[(107.0±13.0)min、(89.0±10.0)min、(44.6±7.7)h、(4.1±2.7)d](P＜0.05),术后第 1 天引流量[(270.0±68.8)mL]少于对照组[(350.0±50.7)mL](t=13.765,P＜0.001).观察组降主动脉阻断时、开放时股动脉平均压[(57.2±5.6)、(64.5±4.8)mm Hg]均高于对照组[(32.5±4.6)、(52.5±4.6)mm Hg](t=14.538,P＜0.001;t=7.630,P＜0.001),桡动脉平均压与对照组比较差异无统计学意义(P＞0.05).对照组术后发生苏醒延迟3例,低氧血症3例,急性肾功能衰竭2例,偏瘫1例,截瘫3例;观察组术后发生苏醒延迟1例,低氧血症1例,急性肾功能衰竭1例,无偏瘫、截瘫发生;对照组术后并发症发生率(60.0％)高于观察组(18.8％)(x2=6.223,P=0.013).结论 左心转流结合回收式自体血输入体外循环可维持降主动脉置换术中循环稳定,缩短体外循环时间,降低术后并发症发生率.

Objective:To evaluate the efficacy and safety of total aortic arch replacement in elderly patients with Stanford type A aortic dissection(TAAD).Methods:In this retrospective study, a total of 481 TAAD patients treated with total arch replacement in our hospital from January 2016 to January 2020 were divided into three groups: aged≤59 years, 60-69 years and ≥70 years.The differences between three groups in surgical method, extracorporeal circulation time, blocking time, circulatory time, stopping time, surgical time, ventilator use time, ICU time, hospitalization time, treatment rate of continued renal replacement, fatality rate, and cause of death were statistically analyzed and compared.Results:There were statistically significant differences in the stopping time between any two groups of the three groups(all P<0.05). The older the age, the shorter the circulatory arrest time.The difference of ventilator time and ICU time between ≤59 and 60-69 years was statistically significant( P<0.01). Patients with continuous renal replacement(CRRT)were 19.0%(71/373)in ≤59 years, 23.1%(18/78)in 60~69 years, and 26.7%(8/30)over 70 years.In-hospital mortality was 35/373(9.4%)in the group of ≤59 years old, 11/78(14.1%)in the group of 60~69 years old, and 5/30(16.7%)in the group of ≥70 years old.There was no death in patients undergoing type Ⅱ hybrid surgery. Conclusions:Age is one of the important death factors after total aortic arch replacement in TAAD patients.Total aortic arch replacement is an acceptable surgical method for elderly patients with TAAD.Hybridization may reduce hospitalization death in elderly patients.

Objective:To investigate the treatment strategies for the thoracic endovascular aortic repair (TEVAR) of Stanford type B aortic dissection (TBAD) accompanied with intra-or post-operational retrograde type A aortic dissection (RAAD).Methods:TBAD patients who underwent TEVAR in Henan Provincial People′s Hospital from February 2004 to January 2020 were retrospectively analyzed. Among 1 176 cases, 14 cases (1.2%) were accompanied with RAAD. Another 9 patients who received TEVAR at other hospitals with TBAD accompanied with RAAD were also collected. In total 23 patients [18 males and 5 females, age as (54±12) years old , ranging from 38 to 79] were included in this study. There were 15 cases of typical dissection, 7 cases of intramural haematoma, and 1 case of penetrating aortic ulcer. Sixteen patients received surgical operation, 1 received hybrid surgery, and the remaining 6 patients underwent conventional therapies. The clinical data and followed up data were collected and analyzed.Results:Among 23 cases, 2 RAAD cases were discovered during the TEVAR, 8 cases were discovered during the perioperative period, 5 cases were discovered within 3 months after discharge, and 8 cases were discovered at more than 1 year after TEVAR, with the longest time point of 120 months after TEVAR. The RAAD rupture was located on the greater curvature side of the aorta in 21 cases, and on the minor curvature side in 2 cases. In 13 cases, the rupture was close to the stent head, and in 10 cases, the rupture was located on the ascending aorta and more than 2 cm from the stent head. Followed up data were collected in 21 cases, with the mean follow-up time as (59±40) months, ranging from 1 to 134 months. Six patients died, with 3 cases of all-reason death and 3 cases of cardiac-reason death. Among the 16 patients receiving surgical operation, one patient died during the perioperative period, and 1 patient suffered from the cerebral infarction and mediastinal infection. Well recovery was found in 1 patient received the hybrid operation. Five of 6 patients who received the conventional treatment died.Conclusions:RAAD is a serious complication related to TEVAR, with low incidence and high mortality rate. RAAD can occur in the early or late stages of TEVAR. TEVAR-associated RAAD has poor therapeutic outcomes, and the surgical operation should be recommended as the preferred treatment for RAAD in clinical practice.