A novel approach to full-mouth rehabilitation of dentinogenesis imperfecta type II: Case series with review of literature.

RATIONALE: Dentinogenesis imperfecta (DI) is an autosomal-dominant disorder. The most common clinical manifestations, including obliterated tooth tissues and severe tooth wear, usually lead to tooth extractions. It remains a great challenge for dentists to preserve the residual tooth tissue and establish the esthetics and occlusion of dentitions. PATIENTS CONCERNS: 25-year-old twin sisters, who had suffered from dentinogenesis imperfecta type II for more than 10 years, presented with continuous tooth wear and discomfort from wearing a removable partial denture for more than 3 years. DIAGNOSIS: Intraoral examination showed extensive tooth wear with enamel exfoliation and typical amber-brown color with an opalescent discoloration. Their panoramic radiographs revealed completely obliterated tooth tissues and severe tooth wear. INTERVENTIONS AND OUTCOMES: The dentitions were restored with post-and-core crowns and pin lays after preparing root post paths and pin holes guided by computer-aided design/computer-aided manufacturing (CAD/CAM) procedures, resulting in a successful repair. LESSONS: Severe tooth wear and tooth tissue obliteration are typical clinical manifestations in DI-affected dentitions, increasing the complexity and difficulty in dental restorations. Early diagnosis and appropriate treatments are essential to achieve a favorable prognosis. CAD/CAM procedures, permitting accurate and effective treatment, possess promising potential in the treatment of DI-affected dentitions.

Management Of Ectopic Eruption Of Bilateral Mandibular First Permanent Molars: A Case Report And Literature Review.

Ectopic eruption of the first permanent molars is a local eruption disturbance. The frequency of ectopically erupted first permanent molars is predominant in boys and primarily affects the maxilla. Interceptive treatment for irreversible ectopic eruptions should be initiated early to prevent space loss and the impaction of the second premolars. Herein, we report the case of a six-year-old girl with irreversible ectopic eruption of the bilateral mandibular first permanent molarstreated with a modified lingual arch. The mandibular first permanent molars were successfully distalised after six months of treatment, and one year of follow-up showed a satisfactory outcome. The modified lingual arch satisfies not only the clinical aspects of treatment but also the patient's well-being. However, the lingual arch may disturb tooth eruption in the mixed dentition stage.

Curling Leaf 1, Encoding a MYB-Domain Protein, Regulates Leaf Morphology and Affects Plant Yield in Rice.

The leaf is the main site of photosynthesis and is an important component in shaping the ideal rice plant architecture. Research on leaf morphology and development will lay the foundation for high-yield rice breeding. In this study, we isolated and identified a novel curling leaf mutant, designated curling leaf 1 (cl1). The cl1 mutant exhibited an inward curling phenotype because of the defective development of sclerenchymatous cells on the abaxial side. Meanwhile, the cl1 mutant showed significant reductions in grain yield and thousand-grain weight due to abnormal leaf development. Through map-based cloning, we identified the CL1 gene, which encodes a MYB transcription factor that is highly expressed in leaves. Subcellular localization studies confirmed its typical nuclear localization. Transcriptome analysis revealed a significant differential expression of the genes involved in photosynthesis, leaf morphology, yield formation, and hormone metabolism in the cl1 mutant. Yeast two-hybrid assays demonstrated that CL1 interacts with alpha-tubulin protein SRS5 and AP2/ERF protein MFS. These findings provide theoretical foundations for further elucidating the mechanisms of CL1 in regulating leaf morphology and offer genetic resources for practical applications in high-yield rice breeding.

Analysis of CAT Gene Family and Functional Identification of OsCAT3 in Rice.

Catalase (CAT) is an important antioxidant enzyme in plants that plays a key role in plant growth and stress responses. CAT is usually encoded by a small gene family that has been cloned and functionally studied in some species, such as Arabidopsis, wheat and cucumber, but its specific roles in rice are not clear at present. In this study, we identified three CAT family genes (OsCAT1, OsCAT2 and OsCAT3) in the rice genome and performed a systematic bioinformatics analysis. RT-PCR analysis revealed that OsCAT1-OsCAT3 was primarily expressed in vegetative tissues such as roots, stems and leaves. Since OsCAT3 showed the highest expression level among the three OsCAT genes, we then focused on its related functions. OsCAT3 prokaryotic expression protein has an obvious ability to remove H2O2. The OsCAT3crispr plant was short and had a low survival rate, the leaves were small with brown lesions, and the activities of the CAT, POD and SOD enzymes were significantly reduced. A microarray analysis showed that differentially expressed genes were primarily enriched in toxin metabolism and photosynthesis. This study laid a foundation for further understanding the function of the rice OsCAT gene.

Midterm Outcomes of One-Stage Hybrid Aortic Arch Repair for Stanford Type A Aortic Dissection: A Single Center's Experience.

This study sought to identify the midterm outcomes of one-stage hybrid aortic arch repair (HAAR) in patients with Stanford type A aortic dissection (TAAD). Between January 2010 and December 2015, 75 consecutive patients with TAAD involving the aortic arch who underwent one-stage type Ⅱ HAAR at our institution were identified. During this period, 496 consecutive patients with TAAD underwent traditional total aortic arch replacement (TAR) with frozen elephant trunk. The preoperative, perioperative, and postoperative data of all patients were compared. A propensity score-matching analysis was applied to adjust for baseline risk factors. Five hundred and seventy-one patients were included for analysis (428 men; mean age, 48.9 ± 11.1 years). For all patients, the mean follow-up time was 41.1 ± 22.1 months, in-hospital mortality was 4.7%, and the 5-year survival rate was 89.5%. Midterm outcomes between the propensity-matched groups were compared (59 HAAR vs TAR pairs). HAAR group showed shorter cardiopulmonary bypass time (105-159 minutes vs 158-230 minutes, P < 0.001), aortic cross-clamping time, postoperative ventilation time, and intensive care unit stays (33-108 hours vs 45-131 hours, P = 0.010) than the TAR group. There were no significant differences in in-hospital mortality, rate of stroke and rate of paraplegia between the 2 groups, however, better 5-year survival rate was found in HAAR group (94.9% vs 75.8%, Log-rank P = 0.005). As compared to propensity matched cohort of TAR patients, HAAR shows good midterm outcomes for patients with TAAD. Further randomized study was needed to clarify the optimal management strategy of TAAD.

Cytological Analysis and Fine Mapping of paa1 (Post-meiosis Abnormal Anther 1) Mutant with Abnormal Tapetum and Microspore Development.

To further understand the molecular mechanism for rice male reproduction, a rice male sterile mutant paa1 was screened from the rice mutant library generated by treatment with 60Coγ-rays. Genetic analysis revealed that paa1 is controlled by a single- recessive nuclear gene, and the anthers of the paa1 mutant were smaller than those of WT plants with a white color. Histological analysis demonstrated that the anthers of the paa1 mutant began to turn abnormal at the microspore stage after meiosis, with abnormal degradation of tapetum, deformed Ubisch bodies, and defective pollen exine. TUNEL assay results also confirmed the delay of tapetum PCD in paa1. Map-based cloning was performed for the PAA1 location. As a result, PAA1 was located in a 88-kb region at the end of chromosome 10, which comprises a total of seven candidate genes, and no genes related to anther development have been reported in this region. The results indicate that PAA1 is an essential gene in regulating tapetum development and pollen/microspore formation after rice meiosis.

Coexistence of Ferroelectriclike Polarization and Dirac-like Surface State in TaNiTe_{5}.

By combining angle-resolved photoemission spectroscopy, scanning tunneling microscopy, atomic force microscope based piezoresponse force microscopy and first-principles calculations, we have studied the low-energy band structure, atomic structure, and charge polarization on the surface of a topological semimetal candidate TaNiTe_{5}. Dirac-like surface states were observed on the (010) surface by angle-resolved photoemission spectroscopy, consistent with the first-principles calculations. On the other hand, piezoresponse force microscopy reveals a switchable ferroelectriclike polarization on the same surface. We propose that the noncentrosymmetric surface relaxation observed by scanning tunneling microscopy could be the origin of the observed ferroelectriclike state in this novel material. Our findings provide a new platform with the coexistence of a ferroelectriclike surface charge distribution and novel surface states.

A New Aortic Arch Dissection Classification: The Fuwai Classification.

Aims: We describe a new aortic arch dissection (AcD) classification, which we have called the Fuwai classification. We then compare the clinical characteristics and long-term prognoses of different classifications. Methods: All AcD patients who underwent surgical procedures at Fuwai Hospital from 2010 to 2015 were included in the study. AcD procedures are divided into three types: Fuwai type Cp, Ct, and Cd. Type Cp is defined as the innominate artery or combined with the left carotid artery involved. Type Cd is defined as the left subclavian artery or combined with the left carotid artery involved. All other AcD surgeries are defined as type Ct. The Chi-square test was adopted for the pairwise comparison among the three types. Kaplan-Meier was used for the analysis of long-term survival and survival free of reoperation. Results: In total, 1,063 AcD patients were enrolled from 2010 to 2015: 54 patients were type Cp, 832 were type Ct, and 177 were type Cd. The highest operation proportion of Cp, Ct and Cd were partial arch replacement, total arch replacement, and TEVAR. The surgical mortality in type Ct was higher compared to type Cd (Ct vs. Cd = 9.38 vs. 1.69%, p < 0.01) and type Cp (Ct vs. Cp = 9.38 vs. 1.85%, p = 0.06). There was no difference in surgical mortality of type Cp and Cd (p = 0.93). There were no significant differences in the long-term survival rates (p = 0.38) and free of aorta-related re-operations (p = 0.19). Conclusion: The Fuwai classification is used to distinguish different AcDs. Different AcDs have different surgical mortality and use different operation methods, but they have similar long-term results.

Early Outcomes of Three Total Arch Replacement Strategies for DeBakey Type I Aortic Dissection.

Background: This study employed three surgical techniques: total arch replacement (TAR) with frozen elephant trunk (FET), aortic balloon occlusion technique (ABO) and hybrid aortic arch repair (HAR) on patients with type I aortic dissection in Fuwai Hospital, aiming to compare the early outcomes of these surgical armamentariums. Methods: From January 2016 to December 2018, an overall 633 patients (431 of TAR+FET, 122 of HAR, and 80 of ABO) with type I aortic dissection were included in the study. Thirty-day mortality, stroke, paraplegia, re-exploration for bleeding, and renal replacement therapy were compared using the matching weight method (MWM). Results: After MWM process, the baseline characteristics were comparable among three TAR groups. It showed that ABO group had the longest cardiopulmonary bypass (p < 0.001) and aortic cross-clamp time (p < 0.001), while the operation time was longest in the HAR group (p = 0.039). There was no significant difference in 30-day mortality among groups (p = 0.783). Furthermore, the incidence of stroke (p = 0.679), paraplegia (p = 0.104), re-exploration for bleeding (p = 0.313), and CRRT (p = 0.834) demonstrated no significant difference. Of note, no significant differences were found regarding these outcomes even before using MWM. Conclusions: Based on the early outcomes, the three TAR approaches were equally applicable to type I aortic dissection. We may choose the specific procedure relatively flexibly according to patient status and surgeon's expertise. Importantly, long-term investigations are warranted to determine whether above approaches remain to be of equivalent efficacy and safety.

The effect of prime-and-rinse approach using MDP micellar solutions on extrafibrillar demineralization and dentin bond performance.

OBJECTIVE: This study investigated the effects of prime-and-rinse approach using 10-methacryloyloxydecyl dihydrogen phosphate (MDP) micellar solutions on extrafibrillar demineralization and dentin bond performance of etch-and-rinse adhesive. METHODS: The micellar solutions were prepared by adding 15% MDP in two ethanol-aqueous (75:25, 55:45 V/V%) solutions, referring to MDP/EtOH75 and MDP/EtOH55. After mid-coronal dentin surfaces were either etched (control) or conditioned with MDP/EtOH75 and MDP/EtOH55 and rinsed, they were applied with adhesive (Adpter Single Bond 2) in dry- or wet-bonding mode and placed with composite resin (Filtek Z350 XT). They were prepared into multiple micro-beams for micro-tensile bond strengths (MTBS) testing after storage in water for 24 h or subjecting to thermocycling. The other pretreated dentin surfaces were analyzed by TF-XRD, ATR-FTIR, HRTEM, FE-SEM, contact angle measurement and nanoindentation testing. The MTBS data was analyzed with two-way ANOVA followed by LSD post-hoc test. RESULTS: MDP/EtOH75 produced significantly greater MTBS values than MDP/EtOH55 and control after thermocycling aging in dry- or wet-bonding mode (P < 0.05). The ATR-FTIR spectrums shows that ratios of phosphate/monomer (1,034 cm-1/1,716 cm-1) on MDP/EtOH75-, MDP/EtOH55-treated dentin surfaces are 0.51 and 0.23, respectively. This is confirmed by HRTEM images and SAED pattern that intrafibrillar minerals were mostly preserved after treatment with MDP/EtOH75. MDP/EtOH75 produced significantly higher elastic modulus and nanohardness on pretreated dentin surface than MDP/EtOH55 (P < 0.05). TF-XRD pattern shows some MDP-Ca salts remained on the primed dentin surface. SIGNIFICANCE: Prime-and-rinse approach using MDP/EtOH75 micellar solution could produce mostly extrafibrillar demineralization, and greatly increase dentin bond durability in dry- or wet-bonding mode.

Patterning Graphene Films by H2O-Based Magnetic-Assisted UV Photolysis.

Properly cutting graphene into certain high-quality micro-/nanoscale structures in a cost-effective way has a critical role. Here, we report a novel approach to pattern graphene films by H2O-based magnetic-assisted ultraviolet (UV) photolysis under irradiation at 184.9 nm. By virtue of the paramagnetic characteristic, the photo-dissociated hydroxyl [OH(X2Π)] radicals are magnetized and have their oxidation capability highly enhanced through converting into an accelerated directional motion. Meanwhile, the precursor of H2O(X̃1A1) molecules distributes uniformly thanks to its weak diamagnetic characteristic, and there exists no instable diamagnetic intermediate to cause lateral oxidation. Possessing these unique traits, the H2O-based magnetic-assisted UV photolysis has the capability of making graphene microscale patterns with the linewidth down to 8.5 µm under a copper grid shadow mask. Furthermore, it is feasible to pattern graphene films into 40 nm-wide ribbons under ZnO nanowires and realize hybrid graphene/ZnO nanoribbon field-effect transistors with a hole mobility up to 7200 cm2·V-1·s-1. The X-ray photoelectron spectroscopy and time-of-flight secondary ion mass spectrometry analyses reveal that OH(X2Π) radicals act as a strong oxidant and that another product of H(12S) adsorbs weakly on graphene.

Effect of heated humidified ventilation on intraoperative core temperature and prognosis in normothermic thoraco-abdominal aortic aneurysm repair.

BACKGROUND: To evaluate whether the heated humidified ventilation can effectively maintain core temperature and improve prognosis in normothermic thoraco-abdominal aortic aneurysm repair surgery. METHODS: Patients who were scheduled for normothermic thoraco-abdominal aortic aneurysm repair surgery were randomized into the group using heated humidified ventilation combined with water blanket and the group using water blanket only. During the operation, the core temperature will be measured every 30 minutes. We analyzed intraoperative core-temperature, coagulation function and in-hospital mortality. RESULTS: HHV&WB group showed lesser decrease in core temperature than WB groups in the first two hours, while WB group had a higher body temperature at the third to fifth hour (2-hour: 35.45±0.47 vs. 35.24±0.59 °C, P=0.284; 5-hour: 35.38±0.70 vs. 35.51±0.88 °C, P=0.664). There was less blood loss, dosage of coagulation drugs and in-hospital mortality (13.33% vs. 20.00%, P=1) in the HHV&WB group. CONCLUSIONS: Heated humidified ventilation can improve the prognosis of normothermic thoraco-abdominal aortic aneurysm repair surgery to some extent, but it can only maintain the core temperature during the first 2 hours.

Breaking 50 Femtosecond Resolution Barrier in MeV Ultrafast Electron Diffraction with a Double Bend Achromat Compressor.

We propose and demonstrate a novel scheme to produce ultrashort and ultrastable MeV electron beam. In this scheme, the electron beam produced in a photocathode radio frequency (rf) gun first expands under its own Coulomb force with which a positive energy chirp is imprinted in the beam longitudinal phase space. The beam is then sent through a double bend achromat with positive longitudinal dispersion where electrons at the bunch tail with lower energies follow shorter paths and thus catch up with the bunch head, leading to longitudinal bunch compression. We show that with optimized parameter sets, the whole beam path from the electron source to the compression point can be made isochronous such that the time of flight for the electron beam is immune to the fluctuations of rf amplitude. With a laser-driven THz deflector, the bunch length and arrival time jitter for a 20 fC beam after bunch compression are measured to be about 29 fs (FWHM) and 22 fs (FWHM), respectively. Such an ultrashort and ultrastable electron beam allows us to achieve 50 femtosecond (FWHM) resolution in MeV ultrafast electron diffraction where lattice oscillation at 2.6 THz corresponding to Bismuth A_{1g} mode is clearly observed without correcting both the short-term timing jitter and long-term timing drift. Furthermore, oscillating weak diffuse scattering signal related to phonon coupling and decay is also clearly resolved thanks to the improved temporal resolution and increased electron flux. We expect that this technique will have a strong impact in emerging ultrashort electron beam based facilities and applications.

A novel prime-&-rinse mode using MDP and MMPs inhibitors improves the dentin bond durability of self-etch adhesive.

OBJECTIVES: The study investigated the effects of novel prime-&-rinse mode using MDP (10-methacryloyloxydecyl dihydrogenphosphate) and matrix metalloproteinase (MMPs) inhibitors on dentin microtensile bond strengths (MTBS) of self-etch adhesive, resin-dentin interface degradations, and activity of recombinant human (rh) MMP-8, -9. MATERIALS AND METHODS: Eight experimental primers were prepared using 5% and 15% of MDP ethanol-aqueous (1:1) solution in combination with/without MMPs inhibitors (1%benzalkonium chloride (BAC), 1000 µm/mL polyvinylphosphonic acid (PVPA) and 15%proanthocyanidin (PA)). Ninety human mid-coronal dentin surfaces were applied with the experimental primers, water-sprayed and gently air-dried (prime-&-rinse mode), or not (control, self-etch mode). The specimens were bonded with self-etch adhesive (Clearfil S3 Bond) and composite resin (Clearfil Majesty). The resin-bonded specimens were prepared into multiple micro-beams for MTBS tests after 24 h and 1 yr of water storage. The resin-dentin interfaces were analyzed with SEM/TEM. The inhibitory effects of eight primers on rhMMP-8, 9 were determined. The data were analyzed using two-way ANOVA and LSD multiple comparisons tests. RESULTS: Compared with control, all the primers used in prime-&-rinse mode could significantly improve long-term dentin MTBS (P < 0.05), while 5%MDP-BAC, 15%MDP and 15%MDP+MMPs inhibitors could significantly increase the short-term dentin MTBS (P < 0.05). The SEM/TEM findings revealed that the resin-dentin interfaces were stable over time when the prime-&-rinse mode used. Eight primers possessed the high inhibitory ratio of rh MMP-8, 9. CONCLUSIONS: The novel prime-&-rinse mode using 5%MDP-BAC, 15%MDP and 15%MDP+MMPs inhibitors could significantly increase the short- and long-term dentin MTBS of self-etch adhesive. This might be a supplement to contemporary dentin bonding strategies.

Low and high concentrations of butyrate regulate fat accumulation in chicken adipocytes via different mechanisms.

The present study investigated the effects of varying concentrations of sodium butyrate (SB) on fat accumulation and cell proliferation in chicken adipocytes. High and low serial concentrations of SB used significantly reduced adipocytic fat accumulation. However, they were observed to exhibit differences in cell morphology and distinctions in lipogenic genes expression profiles. At lower concentration (0.01 mM), fat accumulation was decreased with an associated downregulation in the expression of lipogenic genes, which was mediated by free fatty acid receptors (FFARs). Contarily, at higher concentration (1 mM), the fat droplets laden in adipocytes were enlarged, and this was accompanied with activation of lipogenic genes expression. However, the total accumulated fat was also decreased largely due to reduction in cell numbers, which was partially attributable to the reduction in histone deacetylase (HDAC) activity. Animal experiments further indicated that dietary supplementation of lower dose coated SB (0.1% wt/wt) inhibited fat deposition in livers and abdominal fat tissues of broilers, suggesting the potential application of sodium butyrate as feed additive in the regulation of fat deposition.

Initial oxidation behavior of a single crystal superalloy during stress at 1150 °C.

Revealing the initial oxidation behavior of single crystal superalloys is significant for a better understanding of the oxidation mechanism of turbine blades during service condition. The purpose of current research was to observe the initial oxidation of a single crystal superalloy. In-situ oxidation experiment during only thermal exposure and thermal-stress pattern were carried out. The mechanism of nucleation and growth of oxide scale was discussed. Results showed that the oxide on the interface of γ/γ' phase was constituted of Al2O3 precipitates and formed by external diffusion of Al atoms or ions. Loading stress enhanced the diffusion of Al atom causing high oxidation rate. A logarithmic model was proposed and fitted well with the oxidation process.

Subacute/chronic type A aortic dissection: a retrospective cohort study.

OBJECTIVES: Our goal was to outline the clinical presentations, surgical treatment and outcomes of subacute/chronic type A aortic dissection (TAAD). METHODS: A total of 1092 patients with TAAD were enrolled retrospectively and divided into 2 groups based on acuity of TAAD (181 subacute/chronic vs 911 acute cases of TAAD). Early and late outcomes were investigated and compared using propensity score matching. RESULTS: The top 3 symptoms for subacute/chronic TAAD were chest tightness (80/181, 44.2%), mild pain (65/181, 35.9%) and sweating (58/181, 32.0). Fifteen (15/181, 8.3%) patients were symptom-free. Typical symptoms of acute TAAD were less common in patients with subacute/chronic TAAD such as intense/sharp pain (48/181, 26.5%), tear-like pain (35/181, 19.3%) and radiating pain (30/181, 16.6%). Patients with subacute/chronic TAAD had better early and late survival rates, with an early mortality rate of 6.1% (11/181) compared to 11.6% (106/911) of those with acute TAAD (P = 0.038). Before propensity score matching, survival at 1, 3 and 5 years was 93.1% [95% confidence interval (CI) 89.4-96.9%], 88.4% (95% CI 83.1-93.9%) and 86.4% (95% CI 80.1-93.1%) for subacute/chronic TAAD and 86.9% (95% CI 84.7-89.2%), 82.6% (95% CI 79.9-85.3%) and 79.0% (95% CI 75.5-82.7%) for acute TAAD, respectively (P = 0.039). The propensity score matching analysis substantiated the foregoing results. CONCLUSIONS: Subacute/chronic TAAD was clearly distinct from acute TAAD in terms of clinical presentations and had better early and late survival rates. Current surgical strategies for acute TAAD are applicable to subacute/chronic TAAD with excellent outcomes.

Surgical Management and Outcomes of the Aortic Root in Acute Type A Aortic Dissection.

BACKGROUND: This study evaluated the short- and middle-term outcomes of different aortic root managements in the setting of acute type A aortic dissection (ATAAD): aortic root repair (ARR group), untouched aortic root (UAR group), and Bentall procedure (Bentall group). METHODS: The study enrolled 673 patients (512 men; age 48.8 ± 11.2 years) between 2010 and 2015. Survival, aortic growth, reintervention, and valve function were compared between the 3 groups. RESULTS: The ages were 50.6 ± 9.9, 49.8 ± 12.2, and 44.0 ± 12.0 years for ARR, UAR, and Bentall groups, respectively (P < .01). The mean follow-up time was 3.0 years (range, 0.5-6.8 years). The aortic root diameters in the groups were 39.0 ± 5.1 mm in ARR, 38.2 ± 4.4 mm in UAR, and 50.3 ± 6.2 mm in Bentall (P < .01). The overall 30-day mortality was 11.7% (79 of 673). There was no difference in 30-day mortality between the 3 groups (P = .58). The estimated aortic root growth rate was 0.60 ± 0.17 mm/y for ARR and 0.50 ± 0.14 mm/y for UAR. During follow-up, 28 patients (4.1%) died. Differences in 5-year survival between the 3 groups did not reach statistical significance (P = .82). Aortic insufficiency greater than grade 2+ developed in 15 patients (2.2%). There was no significant difference between ARR and UAR in freedom from aortic insufficiency greater than grade 2+ (P = .56). None of the patients experienced new dissection or underwent proximal reoperation during the follow-up period. CONCLUSIONS: Conservative techniques (ARR and UAR) and aggressive root replacement can both be performed with excellent short- and middle-term outcomes in ATAAD. Thus, an individualized approach in managing the aortic root for ATAAD is recommended based on the patient's general condition, root pathology, and the surgeon's preference.

Hybrid and frozen elephant trunk for total arch replacement in DeBakey type I dissection.

OBJECTIVE: The study objective was to determine whether hybrid aortic repair yields superior outcomes compared with the conventional surgical approach for DeBakey type I aortic dissection. METHODS: A retrospective analysis of patients with DeBakey type I dissection admitted to Fuwai Hospital between January 2010 and December 2016 showed that 815 patients (86.9%) underwent open total arch replacement with frozen elephant trunk (frozen elephant trunk group) and 122 (13.1%) underwent hybrid aortic arch repair without deep hypothermic circulatory arrest (hybrid group). We selected 109 pairs of patients for propensity score matching. Outcomes included early postoperative death, a composite of complications, dissected aorta remodeling, long-term survival, and freedom from reoperation. RESULTS: Early mortality and complication rates were lower in the hybrid group, but the difference was not statistically significant (9.2% vs 17.4%, P = .073; 15.6% vs 25.7%, P = .066). The rates of postoperative renal insufficiency was significantly lower in the hybrid group than in the frozen elephant trunk group (22.9% vs 38.5%, P = .013); liver insufficiency and paraplegia were significantly lower in the hybrid group than in the frozen elephant trunk group (20.2% vs 33.9%, P = .022; 0% vs 6.4%, P = .014). After matched, the 1-year, 3-year, and 5-year survivals were 87.6%, 86.3%, and 82.2%, respectively, in the hybrid group and 80.7%, 76.5%, and 74.6% (P = .071), respectively, in the frozen elephant trunk group. CONCLUSIONS: Hybrid aortic arch repair is a viable alternative treatment for patients with DeBakey type I aortic dissection, which improves outcomes and promotes remodeling of the dissected thoracic aorta.

Normothermic iliac perfusion improves early outcomes after thoraco-abdominal aortic aneurysm repair.

OBJECTIVES: The aim of this study is to evaluate the safety and efficacy of thoraco-abdominal aortic aneurysm repair with normothermic iliac perfusion. METHODS: One hundred and ninety patients who underwent aortic replacement for the Crawford type II thoraco-abdominal aortic aneurysm between January 2005 and June 2017 were assigned to 2 groups: normothermic iliac perfusion (group A, n = 75) and deep hypothermic circulatory arrest (group B, n = 115). We selected 58 pairs of patients for propensity score matching. We analysed early operative death, a composite of complications and mid-term survival. RESULTS: After propensity score matching, no early operative death occurred in group A (0.0%), and group B had 4 cases of early operative death (6.9%), with a statistically significant difference (P = 0.047). The composite of complications was reported in 11 patients in group A (21.0%) and in 21 patients in group B (36.2%) (P = 0.038). Age >50 years [odds ratio (OR) 6.50, 95% confidence interval (CI) 2.32-16.36; P = 0.020], deep hypothermia (OR 12.13, 95% CI 1.64-23.13; P = 0.003) and chronic renal insufficiency (OR 8.21, 95% CI 2.34-43.33; P < 0.001) were independent risk factors for early operative death. The 3-year, 5-year and 7-year survival rates were 98.3%, 98.3% and 86.9% in group A and 86.9%, 86.9% and 86.9% in group B, respectively (P = 0.471). The 7-year cumulative incidence function rates for reintervention were 0.026% in group A and 0.048% in group B (P = 0.625). CONCLUSIONS: Normothermic iliac perfusion provides a viable alternative for thoraco-abdominal aortic aneurysm repair, which reduced early operative death and composited complications.