Application of Different Types of Hybrid Aortic Arch Repair: Toward to Solve Dissection Involving the Aortic Arch.

BACKGROUND: To investigate the outcomes and effectiveness of different types of hybrid aortic arch repair for aortic dissection involving the aortic arch. METHODS: From 2013 to 2020, 168 patients underwent hybrid aortic arch repair for dissection involving the aortic arch. We collected data from our electronic medical records, including the presenting pathology, perioperative details, and postoperative outcomes. We included the following types of hybrid aortic arch repair: classic type I, type II, and type III hybrid aortic arch repair, as well as the new type IV hybrid aortic repair. We defined type IV hybrid aortic arch repair as revascularization of supra-aortic branches through extra-anatomy bypass without sternotomy, followed by stent-graft placement. RESULTS: There were 23, 82, and 63 patients who underwent type I, type II, and type IV hybrid aortic arch repair, respectively. There were no type III hybrid aortic repairs performed. Forty-nine cases were performed urgently. The technical success rate was 99.4%. The early mortality rates of the total group, type I group, type II group, and type IV group were 6.5%, 4.3%, 8.5%, and 4.8%, respectively. Postoperative complications mainly included tracheotomy (8.9%), stroke (6%), wound infection (4.2%), renal insufficiency (8.9%), and endoleak (7.7%). With a mean follow-up of 45.1 ± 28.5 months, the total 1-year and 5-year actual survival rates were 93.5% and 89.0%, respectively. At 6 months, the aortic diameter at the level of the diaphragm decreased significantly (30.8 ± 4.9 mm vs. 28.5 ± 6.3 mm, P = 0.012), and the rate of thrombosis of the false lumen at the level of pulmonary bifurcation and diaphragm were 95.7% and 83.1%. Ten patients underwent reintervention of the aorta, including 7 endovascular reinterventions, 2 total thoracoabdominal aortic aneurysm repairs, and 1 open total arch replacement. For the total group, the free from aorta reintervention rate at 5 years was 91.4%. CONCLUSION: Our results with hybrid aortic arch repair for aortic dissection involving the aortic arch are acceptable. The hybrid aortic arch repair could promote thrombosis of the distal false lumen while excluding intimal tears in the aortic arch.

INSULIN RESISTANCE AND POLYCYSTIC OVARY SYNDROME IN A CHINESE POPULATION.

OBJECTIVE: Our study aimed to investigate glucose and lipid level as well as insulin resistance (IR) in patients with polycystic ovary syndrome (PCOS). METHODS: In a case-control study, 426 patients with PCOS were diagnosed according to Rotterdam criteria, and they were conducted in the morning after a 10-h fast. Participants received standard 75-g oral glucose tolerance test (OGTT). Plasma glucose and insulin levels were obtained at 0, 30, 60, 120, and 180 min. They also received the lipid evaluation; 95 healthy women with normal menstrual cycles served as controls. Thus, by modifying the homeostasis model assessment of insulin resistance (HOMA-IR) with the use of individual time-course values of glucose and insulin plasma levels, we developed a new assessment method, HOMA-Mx. RESULTS: In our study, 23.71% of patients had abnormal glucose metabolism. With further impairment in glucose metabolism, the glucose and lipid level gradually increased (P<0.05), while the impaired glucose regulation (IGR) group showed greater insulin response than a type 2 diabetes mellitus (T2DM) group. Compared with healthy controls, both lean and obese PCOS patients with normal glucose tolerance (NGT) had a higher body mass index (BMI), and higher serum glucose, insulin, and lipid values. Additionally, the insulin value peaked at 30 min and 60 min in the lean and obese groups, respectively. HOMA-M30 proved to be the best predictive parameter (cutoff: 20.36, area under the curve [AUC]: 0.753) for assessment of IR in normal-weight patients and HOMA-IR (cutoff: 32.17, AUC: 0.868) was optimal in obese PCOS patients. CONCLUSIONS: A new assessment method was developed for these groups: HOMA-M30 for lean PCOS patients and HOMA-M60 for obese patients, in order to focus on peak insulin values for early detection of IR.

Effect of Saengmaeksan on Fatigue, Liver Function, and Immunity Combined with High-Intensity Training.

Saengmaeksan (SMS) is a traditional drink that consists of three natural herbs, Lirio platyphlla, Panax ginseng, and Schisandra chinensis, and improves fatigue, liver function, and immunity. Moderate-intensity exercise has a positive effect on fatigue, liver function, and immune function, whereas long-term high-intensity training has a negative effect on these aspects. We hypothesized that SMS intake will improve fatigue (ammonia, lactic acid), liver function (aspartate transaminidase (AST) and alanine aminotransferase (ALT)), and immunity (IgA, IgG, IgM) with high-intensity training. To investigate this hypothesis, 17 male college tennis players were randomly assigned to SMS and placebo groups with high-intensity training. SMS and placebo were consumed in 110 mL doses for a total of 770 mL. High-intensity training was performed at 70%-90% of heart rate reserve, conducted five times weekly for 4 weeks. A significant interaction effect was observed between the SMS and control (CON) groups regarding ammonia, ALT, and IgA levels. Ammonia levels significantly decreased in the SMS group, but there was no difference in the lactic acid levels. AST significantly decreased in the SMS group. IgA significantly increased in the SMS group, IgM significantly decreased in both groups, but there was no change in IgG. The correlation analysis revealed positive correlation in ΔAST vs. ΔALT, ΔALT vs. ΔIgG, and ΔIgA vs. ΔIgG in the SMS group. These findings demonstrate that SMS intake can reduce ammonia, AST, ALT, and IgM levels, while causing an increase in IgA, which has a positive effect on fatigue reduction, liver function, and immunoglobulins in a high-intensity training or related environment.

Towards bio monitoring of toxic (lead) and essential elements in whole blood from 1- to 72-month old children: a cross-sectional study.

OBJECTIVES: Minerals such as zinc, copper, selenium, calcium, and magnesium are essential for normal human development and functioning of the body. They have been found to play important roles in immuno-physiologic functions. The study is to evaluate the distribution and correlation of nonessential (lead) and essential elements in whole blood from 1- to 72-month old children. METHODS: The cross-sectional study was performed in 1551 children. Six element concentrations, including copper (Cu), zinc (Zn), calcium (Ca), magnesium (Mg), iron (Fe) and lead (Pb) in the blood were determined by atomic absorption spectrometry. Distributions and correlations of trace elements in different age groups were analyzed and compared. A Pearson correlation controlled for age and gender was used to assess the relationship of non essential (lead) and essential elements. RESULTS: Levels of copper and magnesium were 18.09 ± 4.42 µmol/L and 1.42 ± 0.12 mmol/L, respectively. 6.04% of all children showed copper levels below the normal threshold, the levels of Magnesium were stable in different age groups. Though the overall mean blood zinc and iron concentrations (61.19 ± 11.30 µmol/L and 8.24 ± 0.59 mmol/L, respectively) gradually increased with age and the overall deficiency levels (24.1% and 36.0%, respectively) decreased with age, zinc and iron deficiencies were still very stable. Controlling for gender and age, significant positive correlations were found when comparing copper to zinc, calcium, magnesium, and iron ((r = 0.333, 0.241, 0.417, 0.314 ,p < 0.01); zinc to magnesium and iron (r = 0.440, 0.497p < 0.01); and magnesium to Calcium and iron (r = 0.349, 0.645, p < 0.01). The overall mean blood lead levels (41.16 ± 16.10) were relatively unstable among different age groups. The prevalence of lead intoxication in all children was 1.3% .Calcium levels decreased gradually with age, with an overall concentration of 1.78 ± 0.13 mmol/L. CONCLUSION: Significant negative correlations were also noted between Pb and Zn, Fe (r = -0.179, -0.124.p < 0.01) .The importance of calcium deficiency and supplementation is well realized, but the severity of iron and zinc deficiency is not well recorded. The degree of lead intoxication in all the children studied was low; The established reference intervals for Cu, Zn, Ca and Mg provide an important guidance for the reasonable supplementation of essential elements during different age groups.