[Risk Factor Analysis of Abdominal Aortic Enlargement after Thoracic Endovascular Aortic Repair Using Two-Stent Graft Implantation for Stanford Type B Aortic Dissection].

Objective: To explore the risk factors of abdominal aortic enlargement (AAE) after thoracic endovascular aortic repair using two-stent graft implantation (TEVAR-TSI) for Stanford type B aortic dissection. Methods: The clinical and imaging data of patients who underwent TEVAR-TSI for Stanford type B aortic dissection in the First Affiliated Hospital of Hebei North University from January 2013 through September 2020 were retrospectively collected and analyzed. CT angiography (CTA) scans were performed before the procedure. Follow-up CTA scans were scheduled and performed in 1, 3, 6, and 12 months after the procedure and annually thereafter. The primary outcome was AAE. The risk factors of AAE after TEVAR-TSI were selected and survival analysis and multivariate logistic regression were conducted accordingly. Results: A total of 146 patients were regularly followed up at our hospital, with the median followup time of the entire cohort being 48 months (ranging from 12 to 84 months). During the followup period after TEVAR-TSI, the incidence of AAE was 19.9% (29/146). A total of 29 patients developed AAE (the AAE group), while 117 patients did not develop AAE (the non-AAE group). There were a total of 27 deaths, including 13 in the non-AAE group versus 14 in the AAE group. Distal aortic reoperation was performed on 10 patients, including 4 in the non-AAE group versus 6 in the AAE group. The cumulative long-term survival and freedom from distal aortic reoperation of the non-AAE group were both significantly better those of the AAE group ( P<0.05). Logistic multivariate regression analysis showed that independent risk factors of AAE after TEVAR-TSI included the following, partial thrombosis of the false lumen (odds ratio [ OR]=4.090, 95% confidence interval [ CI]: 1.539-10.867, P=0.005), the longer cumulative diameter of residual intimal tear above the level of the lowest renal arteries ( OR=1.290, 95% CI: 1.164-1.429, P=0.000), and shorter cumulative diameter of residual intimal tear below the level of the lowest renal arteries ( OR=0.487, 95% CI: 0.270-0.878, P=0.017). Conclusion: The prognosis of patients who developed AAE after TEVAR-TSI was not good. During followup visits, as precautions against the development of AAE, close attention should be paid to partial thrombosis of the false lumen, cumulative diameter of residual intimal tear above the level of the lowest renal arteries, and cumulative diameter of residual intimal tear below the level of the lowest renal arteries.

[The Characteristics of Aortic Remodeling after Thoracic Endovascular Aortic Repair using Two-stent Graft Implantation for Stanford Type B Aortic Dissection].

OBJECTIVE: To investigate the characteristics of aortic remodeling after thoracic endovascular aortic repair using two-stent graft implantation (TEVAR-TSI) for Stanford B aortic dissection. METHODS: The clinical and imaging data of 128 patients who underwent TEVAR-TSI for Stanford B aortic dissection in the First Affiliated Hospital of Hebei North University from January 2013 through May 2019 were retrospectively collected. CT images were obtained before (T 0) TEVAR-TSI and, 1 week (T 1), 3 months (T 2), 6 months (T 3), 1 year (T 4) after TEVAR-TSI. The maximum diameter of the true lumen and false lumen in the short axis view was accessed at five levels: L 1: the level of primary tear entry, L 2: the level of the bronchial bifurcation, L 3: the level of the distal of the first stent-graft, L 4: the level of the celiac trunk, L 5: the level of the lowest renal arteries. The false lumen thrombosis in the thoracic aorta and abdominal aorta were assessed at different times, the false lumen and true lumen changes in diameter were evaluated between the preoperative and postoperative CT scan. RESULTS: The stented segment of the descending thoracic aorta was evaluated (L 1-L 3): The true lumen diameter showed an increasing trend and the false lumen diameter showed an decreasing trend at levels L 1, L 2, and L 3, the change of true lumen diameter was positively correlated with the follow-up time ( r=0.721, 0.827, 0.893, P<0.05), and the change rate of true lumen diameter was positively correlated with the follow-up time ( r=0.763, 0.818, 0.902, P<0.05), and the change of false lumen diameter was negatively correlated with the follow-up time ( r=-0.750, -0.927, -0.934, P<0.05), and the change rate of false lumen diameter was negatively correlated with the follow-up time (-0.774, -0.935, -0.952, P<0.05). When the unstented segment of the abdominal aorta was evaluated (L 4-L 5), the average true lumen diameter at the level of celiac trunk increased significantly at 1 year by 13.7% ( P=0.007), however, the average false lumen diameter did not change over time ( P=0.406). The average true lumen diameter and false lumen diameter at the level of the lowest renal arteries increased over time as well, the average true lumen increased by 10.1%, and the average false lumen increased by 13.6% ( P=0.048, 0.017). Besides, the complete false lumen thrombosis rate of the stented segment of the descending thoracic aorta was higher than that of the unstented segment of the abdominal aorta.e complete false lumen thrombosis rate of the stented segment of the descending thoracic aorta was higher than that of the unstented segment of the abdominal aorta. CONCLUSION: After receiving TEVAR-TSI, Stanford type B aortic dissection patients had high thrombosis absorption rate in the thoracic aortic segment covered by stent, and the aortic remodeling was more ideal. The aortic remodeling effect in the abdominal aortic segment not covered was not ideal, and the inner diameter of the abdominal aorta tended to increase. Therefore, close follow-up monitoring should be conducted.

Propranolol combined with dopamine has a synergistic action in intensifying and prolonging cutaneous analgesia in rats.

BACKGROUND: The purpose of the experiment was to assess interactions of dopamine with propranolol as an infiltrative anesthetic. METHODS: After injecting the rats with four doses of drugs subcutaneously, the cutaneous analgesic effect of propranolol was compared with dopamine through the blockade of cutaneous trunci muscle reflex (CTMR) in response to local skin pinprick. Drug-drug interactions were examined via an isobolographic analysis. RESULTS: We demonstrated that the action of propranolol and dopamine was dose dependent to skin infiltrative analgesia. On the ED(50) (50% effective dose) basis, the rank of drug potency was propranolol (11.3 [10.6-12.2]µmol) > dopamine (195 [188-205]µmol) (p < 0.001). At the equi-anesthetic doses (ED(25), ED(50), ED(75)), the block duration caused by dopamine was equal to that caused by propranolol. Coadministration of dopamine and propranolol exhibited a synergistic effect on infiltrative cutaneous analgesia. CONCLUSIONS: The preclinical data showed that dopamine produced a lesser potency but a comparable duration of cutaneous analgesia compared to propranolol. Adding dopamine to propranolol potentiated and prolonged propranolol's cutaneous analgesic effect.

[Effects of butylphthalide on the apoptosis of PC-12 cells under the induction of ß-amyloid peptide].

OBJECTIVE: To study the protective effects of butylphthalide (NBP) on the Aß(25-35)-induced apoptosis in PC-12 cells. METHODS: The apoptosis of PC-12 cell was analyzed by MTT assay, transmission electron microscope and PI method at different concentrations of NBP (0.1, 1.0, 10, 100 µmol/L) with the addition of Aß or not. The expressions of Bcl-2 and cytochrome C (Cyt-C) were detected by Western blot. RESULTS: As demonstrated by the MTT assay, the values of cell viability were 76.5% ± 1.1%, 84.2% ± 1.3%, 89.5% ± 1.3% and 81.9% ± 1.9% at various concentration (0.1, 1.0, 10, 100 µmol/L) of NBP respectively. The model group was 71.7% ± 1.4%. It was revealed that the former could significantly prevent the cell viability under the induction of Aß(25-35) (P < 0.05). A pretreatment with 10 µmol/L NBP could significantly inhibit the decrease of viability under the induction of Aß(25-35) (P < 0.05). PI showed that the apoptosis rate of the 10 µmol/L NBP treatment group was significantly lower than that of the model group. Under electron microscope, the characteristics of cell apoptosis were significant in the model group. And the cell morphology of the 10 µmol/L NBP treatment group was normal. The expression rate of Bcl-2 protein in the 10 µmol/L NBP treatment group was obviously higher than that in the model group. Cyt-C was weakly expressed in nerve cells of the normal and the 10 µmol/L NBP groups. But it had a strong expression in the model group. CONCLUSION: NBP prevents the injury of PC12 cells by Aß. And the mechanism may be related to the elevated level of Bcl-2 and the inhibited mitochondrial release of Cyt-C.