BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology imp...BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology improves.This study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body injury.METHODS:Twelve cases who met the criteria were enrolled in this study.The demographic and clinical data were reviewed for evaluating the characteristics of EFB.RESULTS:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 years.The distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 mm.Eleven cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without TEVAR.In group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE treatment.EFB of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with TEVAR.The mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe complications.CONCLUSION:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.展开更多
AIM:To investigating the relationship between thoracic and cardiac 18F-Natrium-Fluoride(18F-Na F)uptake,as a marker of ongoing calcification and cardiovascular risk factors.METHODS:Seventy-eight patients(44 females,me...AIM:To investigating the relationship between thoracic and cardiac 18F-Natrium-Fluoride(18F-Na F)uptake,as a marker of ongoing calcification and cardiovascular risk factors.METHODS:Seventy-eight patients(44 females,mean age 63,range 44-83)underwent whole body 18F-Na F positron emission tomography/computed tomography.Cardiovascular risk(CVR)was used to divide these patients in three categories:Low(LR),medium(MR)and high risk(HR).18F-Na F uptake was measured by manually drawing volumes of interest on the ascendingaorta,on the aortic arch,on the descending aorta and on the myocardium;average standardized uptake value was normalized for blood-pool,to obtain target-tobackground ratio(TBR).Values from the three aortic segments were then averaged to obtain an index of the whole thoracic aorta.RESULTS:A significant difference in whole thoracic aorta TBR was detected between HR and LR(1.84±0.76 vs 1.07±0.3,P<0.001),but also between MR and HR-LR(1.4±0.4,P<0.02 and P<0.01,respectively).Significance of this TBR stratification strongly varied among thoracic aorta subsegments and the lowest P values were reached in the descending aorta(P<0.01).Myocardial uptake provided an effective CVR classes stratification(P<0.001).Correlation between TBR and CVR was appreciable when the whole thoracic aorta was considered(R=0.67),but it peaked when correlating the descending thoracic segment(R=0.75),in comparison with the aortic arch and the ascending segment(R=0.55 and 0.53,respectively).CONCLUSION:Fluoride uptake within the thoracic aorta wall effectively depicts patients'risk class and correlates with cardiovascular risk.Descending aorta is the most effective in CVR determination.展开更多
Background Rupture of descending thoracic aorta is a rare but lethal disease. Compared with open surgery,thoracic endovascular aortic repair(TEVAR)becomes a less invasive procedure in emergent management of patients w...Background Rupture of descending thoracic aorta is a rare but lethal disease. Compared with open surgery,thoracic endovascular aortic repair(TEVAR)becomes a less invasive procedure in emergent management of patients with feasible anatomy. Nevertheless,mortality remains high as well as morbidity despite successful operation. The purpose of this study was to compare TEVAR with conservative therapy on the 30-day mortality of patients with ruptured descending thoracic aorta. Methods Retrospective analysis of patients admitted to our hospital with descending thoracic aortic rupture was performed. Patients presented with rupture of descending thoracic aorta with feasible anatomy for TEVAR between Jan 2014 and June 2019 were included. Patients were divided into operative and conservative group depending on which therapy they received. Patients received TEVAR were defined as the operative group,while those received conservative therapy were defined as conservative treatment group. Results There were twenty-six patients in total,including fifteen aortic dissections,nine were thoracic aneurysms,and two were traumatic injuries. Theie mean age was 60±13 years with only two female. Seven patients(27%)presented with shock and twenty-two(85%)was accompanied with hemothorax on admission. Nineteen patients(73%)accepted emergent TEVAR with 100% primary technical success,and the other seven received conservative treatment. In operative group,infection(89%)and respiratory failure(63%)occurred after TEVAR. The in-hospital mortality for operative and conservative treatment group was 26% and 57% respectively(P=0.18). Operative group had lower 30-day mortality(26% vs. 86%,P=0.021). Conclusions TEVAR is associated with improved early outcome in patients with ruptured descending thoracic aorta.[S Chin J Cardiol 2019;20(3):140-145]展开更多
<strong>Objectives:</strong> To describe our technique for the implantation of the Thoraflex Hybrid prosthesis for replacement of the aortic arch in a safe and reproducible way. <strong>Materials:<...<strong>Objectives:</strong> To describe our technique for the implantation of the Thoraflex Hybrid prosthesis for replacement of the aortic arch in a safe and reproducible way. <strong>Materials:</strong> Thoraflex<span style="font-size:12.0pt;line-height:107%;font-family:;" "="">™</span> Hybrid Plexus Device (Terumo Aortic).<strong> Design:</strong> Drawing on our own experience over the past 4 years in the management of acute type A aortic dissection, we have distilled the essentials of our “Frozen Elephant Trunk” technique which have led us through our own learning curve to the improved management of this taxing condition. <strong>Method/ Results:</strong> Small extension of the median sternotomy incision along the medial border of sternocleidomastoid muscle. End to side graft anastomosis near the origin of the left subclavian artery during cooling on bypass towards 20 degrees. Attention to cardiac protection and maintenance of cerebral perfusion during the shortened corporeal arrest period. Excellent results in 24 consecutive AAAD patients with just one hospital mortality. <strong>Conclusions:</strong> We believe we are entering a new phase in the treatment of AAAD, facilitated by the availability of a hybrid prosthesis which combines expanding stent technology with familiar surgical graft material. Our particular management of the left subclavian artery and of the cerebral circulation during implantation has contributed to an expeditious and reproducible method of treating dissection within the arch of the aorta and beyond.展开更多
In order to study the effect of and mechanism of lysophosphatidylcholine (LysoPC) on proliferation of the calf thoracic aorta smooth muscle cells (ASMCs), the ASMCs were used to observe the effects of LysoPC induced ...In order to study the effect of and mechanism of lysophosphatidylcholine (LysoPC) on proliferation of the calf thoracic aorta smooth muscle cells (ASMCs), the ASMCs were used to observe the effects of LysoPC induced endothelial cell conditioned medium on the DNA content and proliferating cell nuclear antigen (PCNA) expression in the calf thoracic ASMCs by flow cytometry and Western Blot technique. It was found that LysoPC induced endothelial cell conditioned medium could significantly promote PCNA expression of the calf ASMCs, induce the converting of ASMCs from G 0 /G 1 phase to S phase of DNA synthesis, and increase the tyrosine phosphorylation protein expression. Tyrosine protein kinase inhibitor (TPKi) RG50864 could obviously inhibit proliferation of LysoPC induced ASMCs in a dose dependence manner. The results indicated that the effect of LysoPC promoting the proliferation of ASMCs is partly evoked by endothelial cell derived growth factors such as PDGF and so on.展开更多
Objective:To investigate the expression of phosphorylated peroxisome proliferators-activated receptor y(p-PPARY) in the aging thoracic aorta of spontaneously hypertensive rat(SHR) and the inhibitory effect of rosiglit...Objective:To investigate the expression of phosphorylated peroxisome proliferators-activated receptor y(p-PPARY) in the aging thoracic aorta of spontaneously hypertensive rat(SHR) and the inhibitory effect of rosiglitazone on the phosphorylation of PPART.Methods:16,32 and 64 week-old Wistar-Kyoto rats(WKY) and SHR were randomly and respectively divided into WKY,SHR and SHR+rosiglitazone group(9 in each group).The rats in SHR+rosiglitazone group were treated with rosiglitazone(5 mg/kg,intragastrically) for 56 d,whereas normal saline was applied in WKY and SHR groups.Systolic blood pressure(SBP)of rats was measured by tail cuff method.Histopathological damage of thoracic aorta was analyzed using Hematoxylin-Eosin(HE) staining.Immunohistochemical staining and western blot were performed to test the level of p-PPARY protein in the thoracic aorta arising from each group.Results:The SBP in 16,32 and 64 week-old SHR were significantly higher as compared with those in matched WKY rats(P【0.05,respectively).HE staining showed increased content of smooth muscle cell,wrinkled lining endothelium and increased thickness of internal elastic lamina in the thoracic aorta of SHR.Immunohistochemical staining and western blot indicated that the levels of p-PPARY in the thoracic aorta arising from SHR were obviously higher than those in the thoracic aorta arising from WKY rats(P【0.05,respectively).Importantly,the high SBP,histopathological abnormalities of the thoracic aorta and elevated p-PPARY expression were prominently abrogated by rosiglitazone treatment in SHR(P【0.05,respectively).Furthermore,the SBP,histopathological abnormalities of the thoracic aorta and p-PPARY expression were positively correlated with age in SHR(P【0.05,respectively).Conclusions:The PPARY phosphorylation was observed in the thoracic aorta of SHR and its expression was increased by the increase of age.Furthermore,rosiglitazone inhibited the PPARY phosphorylation and suppressed vascular aging in SHR.展开更多
Object To elucidate the physiological significance of the spiral flow in the arterial system from the viewpoint of atherogenic lipid transport,an ex vivo experimental comparative
Background:Extracellular matrix (ECM) plays a very important role in the development ofrestenosis after PTCA The MMPs,enymes specialized in degradation of ECM,probably partciptesin extracelular matrix remodeling after...Background:Extracellular matrix (ECM) plays a very important role in the development ofrestenosis after PTCA The MMPs,enymes specialized in degradation of ECM,probably partciptesin extracelular matrix remodeling after balloon injury,but the factors that regulates MMPs activity arenot completely understood Basic fibroblast growth factor (bFGF),as a mitogen for a variety of cellstypes,influences metabolism of ECM.However,if effects on MMPs are not known.Methodsand Results:24 male Wistar rats were divided randomly into control group,balloon-injuried group andbFGF-treated group.The rats of control group were not treated.The rats in balloon-injuried group weredamaged by balloon and the thoracic aortas were harvested after two weeks.In the bFGF-treated grorp,balloon injury and the injuried vessels were collected after two weeks.The northern blot was used toinvestigate the MMP1,MMP2 and MMP9 mRNA expression of vesss.At the same time,the effectsof differet dose bFGF (0ng/ml,40ng/ml,80ng/ml and 120ng/ml) on the MMPs expression of culturedVSMCs were examined The results showed the bFGF can selectively increase the expression ofMMP1 and MMP9 mRNA without effect on the MMP2 on the injuried rat thoracic aorta,and dosedependently increase the MMP1 mRNA expression of cultured VSMCs without MMP2 and MMP9expression Conclusion:bFGF selectively increased MMPs mRNA expression on both injuried ratthoracic aorta and cultured VSMCs.This effect may be related to the degradation of ECM,remodelingof vessel after injuty.展开更多
The inhibitory effect of astilbin on transplant arteriosclerosis in murine model of thoracic aorta transplantation was examined. Model of rat thoracic aorta transplantation was established. Ninety rats were divided in...The inhibitory effect of astilbin on transplant arteriosclerosis in murine model of thoracic aorta transplantation was examined. Model of rat thoracic aorta transplantation was established. Ninety rats were divided into three groups. In isograft group, the thoracic aorta of Brown Norway （BN） rat was anastomosed with the abdominal aorta of another BN rat. In allograft group, the thoracic aorta of BN rat was anastomosed with the abdominal aorta of Lewis rat. In astilbin group, the rats receiving allo-transplantation were given astilbin 5 mg/kg per day for a time of 28 days. The donor thoracic aorta and the recipient abdominal aorta were anastomosed by means of a polyethylene can- nula （inner diameter： 1.5 mm, length： 3 mm length）. The grafts were histologically examined for structural changes. The areas of arterial lumen and endatrium were calculated. Our results showed that, in the allograft group, 28 days after allografting, conspicuous proliferation of smooth muscles and infiltration with a great number of inflammatory cells were found in the tunica intima and tunica media. Astilbin significantly inhibited the proliferation of smooth muscles and ameliorated the infiltration of inflammatory cells thereyby prevent against the development of transplant arteriosclerosis. It is concluded that asltilbin can effectively prevent the development of arteriosclerosis in allotransplant by inhibiting the proliferation of smooth muscles and inhibit the proliferation of smooth muscles in tunica of intima and media and reducing infiltration of the inflammatory cells.展开更多
Background: Increasing workload in consultant-led clinics often means patients to wait a long time for clinic appointments. To address this, there is an increasing trend in developing nurse-led clinics across many spe...Background: Increasing workload in consultant-led clinics often means patients to wait a long time for clinic appointments. To address this, there is an increasing trend in developing nurse-led clinics across many specialities in the National Health Service. This study aims to assess whether the implementation of a nurse-led clinic in thoracic aortic surgery will optimise the utilisation of health care services and improve overall patient satisfaction. Methods: 80 follow-up patients were asked to complete a questionnaire following their appointment in an aortic clinic, which was led either by a consultant (n = 40) or an aortic specialist nurse (n = 40). All patients seen by a nurse in the clinic were assessed by a consultant surgeon prior to the clinic for suitability. No new patients were seen by a nurse. Any patient with an aortic dimension of 5 cm or greater was seen by the consultant. If there were any complicated clinical features, the patient was seen in the consultant-led clinic. Patients were asked questions about their time spent with the respective health care professionals across 12 categories (punctuality, preparedness, understanding of concerns, clarity of speech, listening, respect, explaining, letting you talk, putting you at ease, emotional support, advice and advice for next follow-up). Patients rated each category using an ordinal scale from 0 - 10. Results: Patient scores were greater in nurse-led clinics compared to consultant-led clinics across a number of categories although only punctuality reached significance (mean 9.2 vs. 6.8, p 0.05). Conclusion: Patients were highly satisfied with the nurse-led clinic across all categories, with greater satisfaction for punctuality. These findings suggest that a nurse-led clinic can be implemented for the management of carefully selected thoracic aortic surgery patient without reduction in patient satisfaction.展开更多
Clonidine is a classically categorized α2-adrenoceptor (α2-AR) agonist that produces vascular contractions by stimulating arterial smooth muscle α2-ARs. However, clonidine inhibits α1-AR-mediated arterial contract...Clonidine is a classically categorized α2-adrenoceptor (α2-AR) agonist that produces vascular contractions by stimulating arterial smooth muscle α2-ARs. However, clonidine inhibits α1-AR-mediated arterial contractions. Recently, it was suggested that repeated stimulation with clonidine induces desensitization of α2-ARs, thus inhibiting noradrenaline-induced smooth muscle contractions. In the present study, we examined whether clonidine-mediated inhibition of α1-AR contractions involves interactions with α2-ARs in rat thoracic aortae. 1) Clonidine and guanfacine inhibited electrical field stimulation-induced contractions in a concentration-dependent, yohimbine-sensitive manner in isolated rat vas deferens preparations. 2) Clonidine almost completely suppressed phenylephrine-induced sustained contractions of rat thoracic aortae. 3) Clonidine competitively inhibited phenylephrine-induced contractions with a pA2 value of 6.77 at concentrations between 10-7 and 10-6 M. At 10-5 M, clonidine inhibited phenylephrine-induced contractions and dramatically reduced maximum contractions. 4) In contrast, clonidine did not inhibit contractions produced by high KCl or prostaglandin F2α. 5) Inhibition of phenylephrine-induced sustained contractions by clonidine was also produced in the presence of yohimbine. However, guanfacine did not inhibit phenylephrine-induced sustained contractions. These findings suggest that clonidine inhibits phenylephrine-induced contraction of rat thoracic aortae by competitive antagonism of α1-ARs, which is mediated through a mechanism independent of α2-AR stimulation.展开更多
To oonstruct a canine thoracic aortic dissection （TAD） model for later studying. Methods： we opened the thorax of the dog and exposed the aorta. The descending aorta right below the left innominated artery was damp...To oonstruct a canine thoracic aortic dissection （TAD） model for later studying. Methods： we opened the thorax of the dog and exposed the aorta. The descending aorta right below the left innominated artery was damped. The median was cut 1/3 in depth and 1/3 in circumference. Then the head of the ballcon was put into the interspace of the median, the balloon was dilated after putting forward the tube, the normal saline was instilled into the interspace and a suit pressure was kept. The balloon proceeded alongside the separation of the median. After that the elasticity Protease was instilled into the separation maintained for 2 hours. The balloon was put out, the other 2/3 of the median in depth and the intima were cut. The external 1/3 part of the median and the adventitia were sutured. At last the chest wall was dosed. Results： TAD model was established instantly, proved by angiography, MRI and autopsy. Conclusion： it is applicable to construction of a canine TAD model by this procedure.展开更多
Traumatic rupture of the ascending aorta is rare. We report the case of a 23-year-old man who suffered a service accident by crushing the thorax between two tanks during army maneuvers that resulted in an adventitial ...Traumatic rupture of the ascending aorta is rare. We report the case of a 23-year-old man who suffered a service accident by crushing the thorax between two tanks during army maneuvers that resulted in an adventitial rupture of the ascending thoracic aorta extending to the Crosse. Treatment consisted of replacement of the ascending aorta with a 24 mm Hemashield straight tube and re-implantation of supra-aortic vessels at the dome of the prosthesis.展开更多
BACKGROUND Descending thoracic aortic aneurysms are dangerous and have to be treated quickly.The primary treatment methods are thoracic endovascular aortic repair(TEVAR)and open surgical repair(OSR).The comparative ef...BACKGROUND Descending thoracic aortic aneurysms are dangerous and have to be treated quickly.The primary treatment methods are thoracic endovascular aortic repair(TEVAR)and open surgical repair(OSR).The comparative effectiveness and safety of TEVAR and OSR were evaluated in this meta-analysis,focusing on perioperative and long-term outcomes.AIM To compare and contrast the efficacy and safety of TEVAR vs OSR in the treatment of descending thoracic aortic aneurysms.This study aims to assess both perioperative and long-term outcomes through a systematic review and metaanalysis.METHODS A comprehensive search of PubMed,EMBASE,and Cochrane was conducted from inception to January 2025.Baseline characteristics and outcomes were evaluated.Odds ratios(OR)for dichotomous data and mean differences for continuous data with 95%confidence intervals(CI)were analyzed using random-effects models.RESULTS A meta-analysis of 21 studies involving 29465 patients(8261 TEVAR;21204 OR)showed TEVAR associated with lower operative mortality(OR=0.60,95%CI:0.42-0.85,P=0.004),shorter intensive care unit(-2.94 days,95%CI:-4.76 to-1.12,P=0.002)and hospital stays(-7.35 days,95%CI:-10.54 to-4.17,P<0.00001),and reduced rates of paraplegia(OR=0.44,95%CI:0.27-0.73,P=0.002),spinal ischemia(OR=0.30,95%CI:0.16-0.56,P=0.0002),renal failure(OR=0.29,95%CI:0.14-0.61,P=0.001),and wound infections(OR=0.28,95%CI:0.13-0.61,P=0.001).However,TEVAR had higher rates of vascular complications.No significant differences were noted in 1-year and 5-year mortality rates,the rate of non-elective surgery,neurological complications,or stroke rates.CONCLUSION Compared to EVAR,TEVAR revealed lower operative mortality and better perioperative outcomes across all indicators,including hospital and intensive care unit stays,as well as fewer complications,except for those related to vascular problems.Mortality results were also similar in the long run;consequently,more research is required concerning the long-term durability.展开更多
The present study assessed the efficacy and safety of thoracic radiotherapy(TRT)following first-line chemotherapy or chemoimmunotherapy in patients with extensive-stage small cell lung cancer(ES-SCLC),focusing on the ...The present study assessed the efficacy and safety of thoracic radiotherapy(TRT)following first-line chemotherapy or chemoimmunotherapy in patients with extensive-stage small cell lung cancer(ES-SCLC),focusing on the influence of different TRT timing strategies(consolidative vs.salvage)on survival rates.We retrospectively analyzed a total of 54 patients with ES-SCLC treated between January 2019 and July 2022.Patients receiving consolidative TRT(cTRT)within three months after completion of first-line treatment were compared with those receiving salvage TRT(sTRT)after disease progression.The primary endpoints were overall survival(OS),progression-free survival(PFS),locoregional-free survival(LRFS),and distant metastasis-free survival(DMFS);the secondary endpoint included safety.The cTRT group(n=41)showed significantly longer median OS(26.6 vs.14.8 months,P=0.048),PFS(12.9 vs.3.5 months,P<0.0001),and DMFS(10.7 vs.3.4 months,P=0.0044)than the sTRT group(n=13).Multivariate analysis revealed that cTRT was an independent,favorable prognostic factor.No significant differences in OS or LRFS were observed between high-dose(≥50 Gy)and low-dose(<50 Gy)TRT.Hematologic and respiratory toxicities were the most frequently reported adverse events,with acceptable tolerability.In conclusion,cTRT after chemoimmunotherapy significantly improves survival outcomes for ES-SCLC patients,and low-dose TRT may be a suitable option.展开更多
Objective To investigate the structural changes of rat thoracic aorta and changes in expression levels of Bmal1 and cyclins in thoracic aorta endothelial cells following heat stress.Methods Twenty male SD rats were ra...Objective To investigate the structural changes of rat thoracic aorta and changes in expression levels of Bmal1 and cyclins in thoracic aorta endothelial cells following heat stress.Methods Twenty male SD rats were randomized equally into control group and heat stress group.After exposure to 32℃for 2 weeks in the latter group,the rats were examined for histopathological changes and Bmal1 expression in the thoracic aorta using HE staining and immunohistochemistry.In the cell experiments,cultured rat thoracic aortic endothelial cells(RTAECs)were incubated at 40℃for 12 h with or without prior transfection with a Bmal1-specific small interfering RNA(si-Bmal1)or a negative sequence.In both rat thoracic aorta and RTAECs,the expressions of Bmal1,the cell cycle proteins CDK1,CDK4,CDK6,and cyclin B1,and apoptosis-related proteins Bax and Bcl-2 were detected using Western blotting.TUNEL staining was used to detect cell apoptosis in rat thoracic aorta,and the changes in cell cycle distribution and apoptosis in RTAECs were analyzed with flow cytometry.Results Compared with the control rats,the rats exposed to heat stress showed significantly increased blood pressures and lowered heart rate with elastic fiber disruption and increased expressions of Bmal1,cyclin B1 and CDK1 in the thoracic aorta(P<0.05).In cultured RTAECs,heat stress caused significant increase of Bmal1,cyclin B1 and CDK1 protein expression levels,which were obviously lowered in cells with prior si-Bmal1 transfection.Bmal1 knockdown also inhibited heat stress-induced increase of apoptosis in RTAECs as evidenced by decreased expression of Bax and increased expression of Bcl-2.Conclusion Heat stress upregulates Bmal1 expression and causes alterations in expressions of cyclins to trigger apoptosis of rat thoracic aorta endothelial cells,which can be partly alleviated by suppressing Bmal1 expression.展开更多
Objective: Erector spinae plane block is a novel regional anaesthetic intervention that is said to have an effective analgesic profile in the upper abdominal region. We compared its analgesic efficacy with thoracic ep...Objective: Erector spinae plane block is a novel regional anaesthetic intervention that is said to have an effective analgesic profile in the upper abdominal region. We compared its analgesic efficacy with thoracic epidural block for upper abdominal cancer surgeries. Methods: This prospective study included 60 patients, 18 to 65 years old with ASA class II who underwent gastrectomy and Whipple’s procedures under general anesthesia. Patients were assigned into two groups: Thoracic epidural group, with injection of 0.1 ml/kg of bupivacaine 0.25% in epidural catheter followed by 0.1 ml/kg/h of 0.125% bupivacaine infusion for 48 hrs., and Erector spinae group, with insertion of bilateral erector spinae catheters to inject 0.1 ml/kg of bupivacaine 0.25% followed by bilateral infusion of 0.1 ml/kg/h of bupivacaine 0.125% for 48 hrs. The primary endpoint was postoperative VAS scores at rest and movement. Secondary endpoint included postoperative total opioid consumption, 1st request for analgesia, hemodynamic changes and satisfaction scores. Results: Pain scores and needed rescue analgesia in both groups were comparable. However, 1st request for opioid was significantly longer in TEPI compared to ESI group. Hemodynamics were significantly lower in TEPI group with no differences in the incidence of postoperative complications except for hypotension. Patient satisfaction scores were arbitrarily higher in ESI group without significance. Conclusion: Erector spinae infusion is a highly promising regional technique with comparable effects to thoracic epidural blockade in reducing pain and opioid needs while causing minimal hemodynamic consequences.展开更多
The present study investigates the infiuences of aorta geometry on hemodynamics and material transport.Based on the observation of the human aorta.two geometric paramelers are examined for a model aorta,savine the ane...The present study investigates the infiuences of aorta geometry on hemodynamics and material transport.Based on the observation of the human aorta.two geometric paramelers are examined for a model aorta,savine the anele spanned by the main aorticarc and the diameter of the descending aorta.irect numerical simulations are conducted for nine model aortas with difierencombinations of aorta arc and outlet diameter.Results reveal that the outlet diameter has a sienificant impact on aorta hemodynamics.A smaller outlet diameter compared to the inlet leads to accelerated blood fow in the descending segment,affecting fiowmorphology including the vortex structures,and increasing peak pressure gradient and wall shear stress.However,it reducesthe oscillatory shear index,indicating a more organized fow.Analyses show faster particle transport and reduced accumulativeresidence time for smaller outlet diameters,The arc anele has less sieniicant efiects on these properties.except for delaying thetime to reach the maximum pressure gradient during cjection.The research results may suggest that the diameter of the aorticoutlet has a greater impact on the fiow structures,while the arc angle has a relatively less efiect.These findings provide insightsinto the relation between hemodynamics and aorta geometry,with potential clinical implications.展开更多
Objective:To evaluate the efficacy of scenario-based participatory teaching methods in thoracic surgery nursing education.Methods:Sixty undergraduate nursing students were randomly assigned to two groups:a traditional...Objective:To evaluate the efficacy of scenario-based participatory teaching methods in thoracic surgery nursing education.Methods:Sixty undergraduate nursing students were randomly assigned to two groups:a traditional teaching group and a scenario-based participatory teaching group,with 30 students each.The teaching outcomes of both groups were assessed.Results:The clinical reasoning assessment scores of the scenario-based participatory teaching group were significantly higher than those of the traditional group(P<0.05).Additionally,the scenario group demonstrated higher satisfaction levels,superior theoretical and practical skills,improved patient education effectiveness during admission and discharge,and enhanced emergency response coordination(P<0.05).Conclusion:Scenario-based participatory teaching effectively enhances the comprehensive competencies of nursing students in thoracic surgery,demonstrating favorable educational outcomes.展开更多
基金the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine (2017-XK-A36)the Key Research and Development Program of Zhejiang Province (2019C03076).
文摘BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology improves.This study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body injury.METHODS:Twelve cases who met the criteria were enrolled in this study.The demographic and clinical data were reviewed for evaluating the characteristics of EFB.RESULTS:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 years.The distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 mm.Eleven cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without TEVAR.In group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE treatment.EFB of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with TEVAR.The mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe complications.CONCLUSION:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.
文摘AIM:To investigating the relationship between thoracic and cardiac 18F-Natrium-Fluoride(18F-Na F)uptake,as a marker of ongoing calcification and cardiovascular risk factors.METHODS:Seventy-eight patients(44 females,mean age 63,range 44-83)underwent whole body 18F-Na F positron emission tomography/computed tomography.Cardiovascular risk(CVR)was used to divide these patients in three categories:Low(LR),medium(MR)and high risk(HR).18F-Na F uptake was measured by manually drawing volumes of interest on the ascendingaorta,on the aortic arch,on the descending aorta and on the myocardium;average standardized uptake value was normalized for blood-pool,to obtain target-tobackground ratio(TBR).Values from the three aortic segments were then averaged to obtain an index of the whole thoracic aorta.RESULTS:A significant difference in whole thoracic aorta TBR was detected between HR and LR(1.84±0.76 vs 1.07±0.3,P<0.001),but also between MR and HR-LR(1.4±0.4,P<0.02 and P<0.01,respectively).Significance of this TBR stratification strongly varied among thoracic aorta subsegments and the lowest P values were reached in the descending aorta(P<0.01).Myocardial uptake provided an effective CVR classes stratification(P<0.001).Correlation between TBR and CVR was appreciable when the whole thoracic aorta was considered(R=0.67),but it peaked when correlating the descending thoracic segment(R=0.75),in comparison with the aortic arch and the ascending segment(R=0.55 and 0.53,respectively).CONCLUSION:Fluoride uptake within the thoracic aorta wall effectively depicts patients'risk class and correlates with cardiovascular risk.Descending aorta is the most effective in CVR determination.
基金supported by the National Natural Science Fund(No.81602848)
文摘Background Rupture of descending thoracic aorta is a rare but lethal disease. Compared with open surgery,thoracic endovascular aortic repair(TEVAR)becomes a less invasive procedure in emergent management of patients with feasible anatomy. Nevertheless,mortality remains high as well as morbidity despite successful operation. The purpose of this study was to compare TEVAR with conservative therapy on the 30-day mortality of patients with ruptured descending thoracic aorta. Methods Retrospective analysis of patients admitted to our hospital with descending thoracic aortic rupture was performed. Patients presented with rupture of descending thoracic aorta with feasible anatomy for TEVAR between Jan 2014 and June 2019 were included. Patients were divided into operative and conservative group depending on which therapy they received. Patients received TEVAR were defined as the operative group,while those received conservative therapy were defined as conservative treatment group. Results There were twenty-six patients in total,including fifteen aortic dissections,nine were thoracic aneurysms,and two were traumatic injuries. Theie mean age was 60±13 years with only two female. Seven patients(27%)presented with shock and twenty-two(85%)was accompanied with hemothorax on admission. Nineteen patients(73%)accepted emergent TEVAR with 100% primary technical success,and the other seven received conservative treatment. In operative group,infection(89%)and respiratory failure(63%)occurred after TEVAR. The in-hospital mortality for operative and conservative treatment group was 26% and 57% respectively(P=0.18). Operative group had lower 30-day mortality(26% vs. 86%,P=0.021). Conclusions TEVAR is associated with improved early outcome in patients with ruptured descending thoracic aorta.[S Chin J Cardiol 2019;20(3):140-145]
文摘<strong>Objectives:</strong> To describe our technique for the implantation of the Thoraflex Hybrid prosthesis for replacement of the aortic arch in a safe and reproducible way. <strong>Materials:</strong> Thoraflex<span style="font-size:12.0pt;line-height:107%;font-family:;" "="">™</span> Hybrid Plexus Device (Terumo Aortic).<strong> Design:</strong> Drawing on our own experience over the past 4 years in the management of acute type A aortic dissection, we have distilled the essentials of our “Frozen Elephant Trunk” technique which have led us through our own learning curve to the improved management of this taxing condition. <strong>Method/ Results:</strong> Small extension of the median sternotomy incision along the medial border of sternocleidomastoid muscle. End to side graft anastomosis near the origin of the left subclavian artery during cooling on bypass towards 20 degrees. Attention to cardiac protection and maintenance of cerebral perfusion during the shortened corporeal arrest period. Excellent results in 24 consecutive AAAD patients with just one hospital mortality. <strong>Conclusions:</strong> We believe we are entering a new phase in the treatment of AAAD, facilitated by the availability of a hybrid prosthesis which combines expanding stent technology with familiar surgical graft material. Our particular management of the left subclavian artery and of the cerebral circulation during implantation has contributed to an expeditious and reproducible method of treating dissection within the arch of the aorta and beyond.
基金This project was supported by a grant from Hubei Scien-tific and Technological Comm ittee (No. 96 2 9110 1)
文摘In order to study the effect of and mechanism of lysophosphatidylcholine (LysoPC) on proliferation of the calf thoracic aorta smooth muscle cells (ASMCs), the ASMCs were used to observe the effects of LysoPC induced endothelial cell conditioned medium on the DNA content and proliferating cell nuclear antigen (PCNA) expression in the calf thoracic ASMCs by flow cytometry and Western Blot technique. It was found that LysoPC induced endothelial cell conditioned medium could significantly promote PCNA expression of the calf ASMCs, induce the converting of ASMCs from G 0 /G 1 phase to S phase of DNA synthesis, and increase the tyrosine phosphorylation protein expression. Tyrosine protein kinase inhibitor (TPKi) RG50864 could obviously inhibit proliferation of LysoPC induced ASMCs in a dose dependence manner. The results indicated that the effect of LysoPC promoting the proliferation of ASMCs is partly evoked by endothelial cell derived growth factors such as PDGF and so on.
基金Supported by a grant from the National Natural Science Foundation of China(Grant No.81070219)
文摘Objective:To investigate the expression of phosphorylated peroxisome proliferators-activated receptor y(p-PPARY) in the aging thoracic aorta of spontaneously hypertensive rat(SHR) and the inhibitory effect of rosiglitazone on the phosphorylation of PPART.Methods:16,32 and 64 week-old Wistar-Kyoto rats(WKY) and SHR were randomly and respectively divided into WKY,SHR and SHR+rosiglitazone group(9 in each group).The rats in SHR+rosiglitazone group were treated with rosiglitazone(5 mg/kg,intragastrically) for 56 d,whereas normal saline was applied in WKY and SHR groups.Systolic blood pressure(SBP)of rats was measured by tail cuff method.Histopathological damage of thoracic aorta was analyzed using Hematoxylin-Eosin(HE) staining.Immunohistochemical staining and western blot were performed to test the level of p-PPARY protein in the thoracic aorta arising from each group.Results:The SBP in 16,32 and 64 week-old SHR were significantly higher as compared with those in matched WKY rats(P【0.05,respectively).HE staining showed increased content of smooth muscle cell,wrinkled lining endothelium and increased thickness of internal elastic lamina in the thoracic aorta of SHR.Immunohistochemical staining and western blot indicated that the levels of p-PPARY in the thoracic aorta arising from SHR were obviously higher than those in the thoracic aorta arising from WKY rats(P【0.05,respectively).Importantly,the high SBP,histopathological abnormalities of the thoracic aorta and elevated p-PPARY expression were prominently abrogated by rosiglitazone treatment in SHR(P【0.05,respectively).Furthermore,the SBP,histopathological abnormalities of the thoracic aorta and p-PPARY expression were positively correlated with age in SHR(P【0.05,respectively).Conclusions:The PPARY phosphorylation was observed in the thoracic aorta of SHR and its expression was increased by the increase of age.Furthermore,rosiglitazone inhibited the PPARY phosphorylation and suppressed vascular aging in SHR.
基金supported by Grants-in-Aid from the National Natural Science Research Foundation of China,No.30670517,10632010
文摘Object To elucidate the physiological significance of the spiral flow in the arterial system from the viewpoint of atherogenic lipid transport,an ex vivo experimental comparative
文摘Background:Extracellular matrix (ECM) plays a very important role in the development ofrestenosis after PTCA The MMPs,enymes specialized in degradation of ECM,probably partciptesin extracelular matrix remodeling after balloon injury,but the factors that regulates MMPs activity arenot completely understood Basic fibroblast growth factor (bFGF),as a mitogen for a variety of cellstypes,influences metabolism of ECM.However,if effects on MMPs are not known.Methodsand Results:24 male Wistar rats were divided randomly into control group,balloon-injuried group andbFGF-treated group.The rats of control group were not treated.The rats in balloon-injuried group weredamaged by balloon and the thoracic aortas were harvested after two weeks.In the bFGF-treated grorp,balloon injury and the injuried vessels were collected after two weeks.The northern blot was used toinvestigate the MMP1,MMP2 and MMP9 mRNA expression of vesss.At the same time,the effectsof differet dose bFGF (0ng/ml,40ng/ml,80ng/ml and 120ng/ml) on the MMPs expression of culturedVSMCs were examined The results showed the bFGF can selectively increase the expression ofMMP1 and MMP9 mRNA without effect on the MMP2 on the injuried rat thoracic aorta,and dosedependently increase the MMP1 mRNA expression of cultured VSMCs without MMP2 and MMP9expression Conclusion:bFGF selectively increased MMPs mRNA expression on both injuried ratthoracic aorta and cultured VSMCs.This effect may be related to the degradation of ECM,remodelingof vessel after injuty.
基金supported by a grant from the National Natural Sciences Foundation of China (No.30500656)
文摘The inhibitory effect of astilbin on transplant arteriosclerosis in murine model of thoracic aorta transplantation was examined. Model of rat thoracic aorta transplantation was established. Ninety rats were divided into three groups. In isograft group, the thoracic aorta of Brown Norway （BN） rat was anastomosed with the abdominal aorta of another BN rat. In allograft group, the thoracic aorta of BN rat was anastomosed with the abdominal aorta of Lewis rat. In astilbin group, the rats receiving allo-transplantation were given astilbin 5 mg/kg per day for a time of 28 days. The donor thoracic aorta and the recipient abdominal aorta were anastomosed by means of a polyethylene can- nula （inner diameter： 1.5 mm, length： 3 mm length）. The grafts were histologically examined for structural changes. The areas of arterial lumen and endatrium were calculated. Our results showed that, in the allograft group, 28 days after allografting, conspicuous proliferation of smooth muscles and infiltration with a great number of inflammatory cells were found in the tunica intima and tunica media. Astilbin significantly inhibited the proliferation of smooth muscles and ameliorated the infiltration of inflammatory cells thereyby prevent against the development of transplant arteriosclerosis. It is concluded that asltilbin can effectively prevent the development of arteriosclerosis in allotransplant by inhibiting the proliferation of smooth muscles and inhibit the proliferation of smooth muscles in tunica of intima and media and reducing infiltration of the inflammatory cells.
文摘Background: Increasing workload in consultant-led clinics often means patients to wait a long time for clinic appointments. To address this, there is an increasing trend in developing nurse-led clinics across many specialities in the National Health Service. This study aims to assess whether the implementation of a nurse-led clinic in thoracic aortic surgery will optimise the utilisation of health care services and improve overall patient satisfaction. Methods: 80 follow-up patients were asked to complete a questionnaire following their appointment in an aortic clinic, which was led either by a consultant (n = 40) or an aortic specialist nurse (n = 40). All patients seen by a nurse in the clinic were assessed by a consultant surgeon prior to the clinic for suitability. No new patients were seen by a nurse. Any patient with an aortic dimension of 5 cm or greater was seen by the consultant. If there were any complicated clinical features, the patient was seen in the consultant-led clinic. Patients were asked questions about their time spent with the respective health care professionals across 12 categories (punctuality, preparedness, understanding of concerns, clarity of speech, listening, respect, explaining, letting you talk, putting you at ease, emotional support, advice and advice for next follow-up). Patients rated each category using an ordinal scale from 0 - 10. Results: Patient scores were greater in nurse-led clinics compared to consultant-led clinics across a number of categories although only punctuality reached significance (mean 9.2 vs. 6.8, p 0.05). Conclusion: Patients were highly satisfied with the nurse-led clinic across all categories, with greater satisfaction for punctuality. These findings suggest that a nurse-led clinic can be implemented for the management of carefully selected thoracic aortic surgery patient without reduction in patient satisfaction.
文摘Clonidine is a classically categorized α2-adrenoceptor (α2-AR) agonist that produces vascular contractions by stimulating arterial smooth muscle α2-ARs. However, clonidine inhibits α1-AR-mediated arterial contractions. Recently, it was suggested that repeated stimulation with clonidine induces desensitization of α2-ARs, thus inhibiting noradrenaline-induced smooth muscle contractions. In the present study, we examined whether clonidine-mediated inhibition of α1-AR contractions involves interactions with α2-ARs in rat thoracic aortae. 1) Clonidine and guanfacine inhibited electrical field stimulation-induced contractions in a concentration-dependent, yohimbine-sensitive manner in isolated rat vas deferens preparations. 2) Clonidine almost completely suppressed phenylephrine-induced sustained contractions of rat thoracic aortae. 3) Clonidine competitively inhibited phenylephrine-induced contractions with a pA2 value of 6.77 at concentrations between 10-7 and 10-6 M. At 10-5 M, clonidine inhibited phenylephrine-induced contractions and dramatically reduced maximum contractions. 4) In contrast, clonidine did not inhibit contractions produced by high KCl or prostaglandin F2α. 5) Inhibition of phenylephrine-induced sustained contractions by clonidine was also produced in the presence of yohimbine. However, guanfacine did not inhibit phenylephrine-induced sustained contractions. These findings suggest that clonidine inhibits phenylephrine-induced contraction of rat thoracic aortae by competitive antagonism of α1-ARs, which is mediated through a mechanism independent of α2-AR stimulation.
文摘To oonstruct a canine thoracic aortic dissection （TAD） model for later studying. Methods： we opened the thorax of the dog and exposed the aorta. The descending aorta right below the left innominated artery was damped. The median was cut 1/3 in depth and 1/3 in circumference. Then the head of the ballcon was put into the interspace of the median, the balloon was dilated after putting forward the tube, the normal saline was instilled into the interspace and a suit pressure was kept. The balloon proceeded alongside the separation of the median. After that the elasticity Protease was instilled into the separation maintained for 2 hours. The balloon was put out, the other 2/3 of the median in depth and the intima were cut. The external 1/3 part of the median and the adventitia were sutured. At last the chest wall was dosed. Results： TAD model was established instantly, proved by angiography, MRI and autopsy. Conclusion： it is applicable to construction of a canine TAD model by this procedure.
文摘Traumatic rupture of the ascending aorta is rare. We report the case of a 23-year-old man who suffered a service accident by crushing the thorax between two tanks during army maneuvers that resulted in an adventitial rupture of the ascending thoracic aorta extending to the Crosse. Treatment consisted of replacement of the ascending aorta with a 24 mm Hemashield straight tube and re-implantation of supra-aortic vessels at the dome of the prosthesis.
文摘BACKGROUND Descending thoracic aortic aneurysms are dangerous and have to be treated quickly.The primary treatment methods are thoracic endovascular aortic repair(TEVAR)and open surgical repair(OSR).The comparative effectiveness and safety of TEVAR and OSR were evaluated in this meta-analysis,focusing on perioperative and long-term outcomes.AIM To compare and contrast the efficacy and safety of TEVAR vs OSR in the treatment of descending thoracic aortic aneurysms.This study aims to assess both perioperative and long-term outcomes through a systematic review and metaanalysis.METHODS A comprehensive search of PubMed,EMBASE,and Cochrane was conducted from inception to January 2025.Baseline characteristics and outcomes were evaluated.Odds ratios(OR)for dichotomous data and mean differences for continuous data with 95%confidence intervals(CI)were analyzed using random-effects models.RESULTS A meta-analysis of 21 studies involving 29465 patients(8261 TEVAR;21204 OR)showed TEVAR associated with lower operative mortality(OR=0.60,95%CI:0.42-0.85,P=0.004),shorter intensive care unit(-2.94 days,95%CI:-4.76 to-1.12,P=0.002)and hospital stays(-7.35 days,95%CI:-10.54 to-4.17,P<0.00001),and reduced rates of paraplegia(OR=0.44,95%CI:0.27-0.73,P=0.002),spinal ischemia(OR=0.30,95%CI:0.16-0.56,P=0.0002),renal failure(OR=0.29,95%CI:0.14-0.61,P=0.001),and wound infections(OR=0.28,95%CI:0.13-0.61,P=0.001).However,TEVAR had higher rates of vascular complications.No significant differences were noted in 1-year and 5-year mortality rates,the rate of non-elective surgery,neurological complications,or stroke rates.CONCLUSION Compared to EVAR,TEVAR revealed lower operative mortality and better perioperative outcomes across all indicators,including hospital and intensive care unit stays,as well as fewer complications,except for those related to vascular problems.Mortality results were also similar in the long run;consequently,more research is required concerning the long-term durability.
基金supported by the Young Talents Program of Jiangsu Cancer Hospital(Grant No.QL201802)the Science and Technology Development Fund of Jiangsu Cancer Hospital(Grant No.ZL202105).
文摘The present study assessed the efficacy and safety of thoracic radiotherapy(TRT)following first-line chemotherapy or chemoimmunotherapy in patients with extensive-stage small cell lung cancer(ES-SCLC),focusing on the influence of different TRT timing strategies(consolidative vs.salvage)on survival rates.We retrospectively analyzed a total of 54 patients with ES-SCLC treated between January 2019 and July 2022.Patients receiving consolidative TRT(cTRT)within three months after completion of first-line treatment were compared with those receiving salvage TRT(sTRT)after disease progression.The primary endpoints were overall survival(OS),progression-free survival(PFS),locoregional-free survival(LRFS),and distant metastasis-free survival(DMFS);the secondary endpoint included safety.The cTRT group(n=41)showed significantly longer median OS(26.6 vs.14.8 months,P=0.048),PFS(12.9 vs.3.5 months,P<0.0001),and DMFS(10.7 vs.3.4 months,P=0.0044)than the sTRT group(n=13).Multivariate analysis revealed that cTRT was an independent,favorable prognostic factor.No significant differences in OS or LRFS were observed between high-dose(≥50 Gy)and low-dose(<50 Gy)TRT.Hematologic and respiratory toxicities were the most frequently reported adverse events,with acceptable tolerability.In conclusion,cTRT after chemoimmunotherapy significantly improves survival outcomes for ES-SCLC patients,and low-dose TRT may be a suitable option.
文摘Objective To investigate the structural changes of rat thoracic aorta and changes in expression levels of Bmal1 and cyclins in thoracic aorta endothelial cells following heat stress.Methods Twenty male SD rats were randomized equally into control group and heat stress group.After exposure to 32℃for 2 weeks in the latter group,the rats were examined for histopathological changes and Bmal1 expression in the thoracic aorta using HE staining and immunohistochemistry.In the cell experiments,cultured rat thoracic aortic endothelial cells(RTAECs)were incubated at 40℃for 12 h with or without prior transfection with a Bmal1-specific small interfering RNA(si-Bmal1)or a negative sequence.In both rat thoracic aorta and RTAECs,the expressions of Bmal1,the cell cycle proteins CDK1,CDK4,CDK6,and cyclin B1,and apoptosis-related proteins Bax and Bcl-2 were detected using Western blotting.TUNEL staining was used to detect cell apoptosis in rat thoracic aorta,and the changes in cell cycle distribution and apoptosis in RTAECs were analyzed with flow cytometry.Results Compared with the control rats,the rats exposed to heat stress showed significantly increased blood pressures and lowered heart rate with elastic fiber disruption and increased expressions of Bmal1,cyclin B1 and CDK1 in the thoracic aorta(P<0.05).In cultured RTAECs,heat stress caused significant increase of Bmal1,cyclin B1 and CDK1 protein expression levels,which were obviously lowered in cells with prior si-Bmal1 transfection.Bmal1 knockdown also inhibited heat stress-induced increase of apoptosis in RTAECs as evidenced by decreased expression of Bax and increased expression of Bcl-2.Conclusion Heat stress upregulates Bmal1 expression and causes alterations in expressions of cyclins to trigger apoptosis of rat thoracic aorta endothelial cells,which can be partly alleviated by suppressing Bmal1 expression.
文摘Objective: Erector spinae plane block is a novel regional anaesthetic intervention that is said to have an effective analgesic profile in the upper abdominal region. We compared its analgesic efficacy with thoracic epidural block for upper abdominal cancer surgeries. Methods: This prospective study included 60 patients, 18 to 65 years old with ASA class II who underwent gastrectomy and Whipple’s procedures under general anesthesia. Patients were assigned into two groups: Thoracic epidural group, with injection of 0.1 ml/kg of bupivacaine 0.25% in epidural catheter followed by 0.1 ml/kg/h of 0.125% bupivacaine infusion for 48 hrs., and Erector spinae group, with insertion of bilateral erector spinae catheters to inject 0.1 ml/kg of bupivacaine 0.25% followed by bilateral infusion of 0.1 ml/kg/h of bupivacaine 0.125% for 48 hrs. The primary endpoint was postoperative VAS scores at rest and movement. Secondary endpoint included postoperative total opioid consumption, 1st request for analgesia, hemodynamic changes and satisfaction scores. Results: Pain scores and needed rescue analgesia in both groups were comparable. However, 1st request for opioid was significantly longer in TEPI compared to ESI group. Hemodynamics were significantly lower in TEPI group with no differences in the incidence of postoperative complications except for hypotension. Patient satisfaction scores were arbitrarily higher in ESI group without significance. Conclusion: Erector spinae infusion is a highly promising regional technique with comparable effects to thoracic epidural blockade in reducing pain and opioid needs while causing minimal hemodynamic consequences.
基金the support of the Clinical Medicine Plus X-Young Scholars Project at Peking University for thiswork.
文摘The present study investigates the infiuences of aorta geometry on hemodynamics and material transport.Based on the observation of the human aorta.two geometric paramelers are examined for a model aorta,savine the anele spanned by the main aorticarc and the diameter of the descending aorta.irect numerical simulations are conducted for nine model aortas with difierencombinations of aorta arc and outlet diameter.Results reveal that the outlet diameter has a sienificant impact on aorta hemodynamics.A smaller outlet diameter compared to the inlet leads to accelerated blood fow in the descending segment,affecting fiowmorphology including the vortex structures,and increasing peak pressure gradient and wall shear stress.However,it reducesthe oscillatory shear index,indicating a more organized fow.Analyses show faster particle transport and reduced accumulativeresidence time for smaller outlet diameters,The arc anele has less sieniicant efiects on these properties.except for delaying thetime to reach the maximum pressure gradient during cjection.The research results may suggest that the diameter of the aorticoutlet has a greater impact on the fiow structures,while the arc angle has a relatively less efiect.These findings provide insightsinto the relation between hemodynamics and aorta geometry,with potential clinical implications.
文摘Objective:To evaluate the efficacy of scenario-based participatory teaching methods in thoracic surgery nursing education.Methods:Sixty undergraduate nursing students were randomly assigned to two groups:a traditional teaching group and a scenario-based participatory teaching group,with 30 students each.The teaching outcomes of both groups were assessed.Results:The clinical reasoning assessment scores of the scenario-based participatory teaching group were significantly higher than those of the traditional group(P<0.05).Additionally,the scenario group demonstrated higher satisfaction levels,superior theoretical and practical skills,improved patient education effectiveness during admission and discharge,and enhanced emergency response coordination(P<0.05).Conclusion:Scenario-based participatory teaching effectively enhances the comprehensive competencies of nursing students in thoracic surgery,demonstrating favorable educational outcomes.
