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Liu Q, Guan Y, Yang X, Jiang Y, Hei F. Perioperative oxygenation impairment related to type a aortic dissection. Perfusion 2024:2676591231224997. [PMID: 38174389 DOI: 10.1177/02676591231224997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Type A aortic dissection (TAAD) is a life-threatening disease with high mortality and poor prognosis, usually treated by surgery. There are many complications in its perioperative period, one of which is oxygenation impairment (OI). As a common complication of TAAD, OI usually occurs throughout the perioperative period of TAAD and requires prolonged mechanical ventilation (MV) and other supportive measures. The purpose of this article is to review the risk factors, mechanisms, and treatments of type A aortic dissection-related oxygenation impairment (TAAD-OI) so as to improve clinicians' knowledge about it. Among risk factors, elevated body mass index (BMI), prolonged extracorporeal circulation (ECC) duration, higher inflammatory cells and stored blood transfusion stand out. A reduced occurrence of TAAD-OI can be achieved by controlling these risk factors such as suppressing inflammatory response by drugs. As for its mechanism, it is currently believed that inflammatory signaling pathways play a major role in this process, including the HMGB1/RAGE signaling pathway, gut-lung axis and macrophage, which have been gradually explored and are expected to provide evidences revealing the specific mechanism of TAAD-OI. Numerous treatments have been investigated for TAAD-OI, such as nitric oxide (NO), continuous pulmonary perfusion/inflation, ulinastatin and sivelestat sodium, immunomodulation intervention and mechanical support. However, these measures are all aimed at postoperative TAAD-OI, and not all of the therapies have shown satisfactory effects. Treatments for preoperative TAAD-OI are not currently available because it is difficult to correct OI without correcting the dissection. Therefore, the best solution for preoperative TAAD-OI is to operate as soon as possible. At present, there is no specific method for clinical application, and it relies more on the experience of clinicians or learns from treatments of other diseases related to oxygenation disorders. More efforts should be made to understand its pathogenesis to better improve its treatments in the future.
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Affiliation(s)
- Qindong Liu
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yulong Guan
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofang Yang
- Department of Extracorporeal Circulation and Mechanical Circulation Assistants, Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu Jiang
- Department of Extracorporeal Circulation and Mechanical Circulation Assistants, Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Feilong Hei
- Department of Extracorporeal Circulation and Mechanical Circulation Assistants, Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Huang PF, Zhang YJ, Lou XZ, Ma D, Wu YY, Zhao YB. Predictive value of admission CO 2 combining power combined with serum sodium for the prognosis in acute Stanford type A aortic dissection patients. Sci Rep 2023; 13:1048. [PMID: 36658204 PMCID: PMC9852255 DOI: 10.1038/s41598-022-27099-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/26/2022] [Indexed: 01/20/2023] Open
Abstract
Acute Stanford type A aortic dissection (ATAAD) with sudden onset and high mortality requiries a standard Bentall operation and a accurate prognosis in common, together with alteration of CO2 combining power (CO2CP) and serum sodium rase concern, hence, we evaluated the prognostic value of CO2CP combined with serum sodium in ATAAD patients. This retrospective study included 183 patients who underwent Bentall operation for ATAAD from 2015 to 2021 in the Fourth Hospital of Hebei Medical University, subsequently followed grouping by the levels of CO2CP and serum sodium. The study endpoint was 30-day all-cause mortality, and the prognostic value of CO2CP combined with serum sodium levels in ATAAD patients were evaluated with multivariate logistic regression method. The postoperative incidence of in-hospital death and adverse events in patients with ATAAD were 18% and 25.7%, respectively. Combination of CO2CP and serum sodium for predicting ATAAD death and adverse events presented a higher predictive value than each single indicator with ROC curve analysis (the AUC of CO2CP combined with serum sodium was 0.786, 95% CI 0.706-0.869, P < 0.001), along with CO2CP < 22.5 mmol/L + serum sodium > 138.5 mmol/L group had the worst prognostic. Multivariate regression analyse showed that CO2CP < 22.5 mmol/L combined with serum sodium > 138.5 mmol/L preferably predicted the prognosis of ATAAD (OR =6.073, 95% CI 2.557-14.425, P < 0.001). Consistently, the cumulative 30-day survival after surgery in ATAAD patients with the low CO2CP and high serum sodium simultaneously was the worst (log-rank P < 0.05). The combination of CO2CP and serum sodium increases the predictive value of prognosis, which is conducive to risk stratification of patients with ATAAD.
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Affiliation(s)
- Peng-Fei Huang
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China
| | - Yun-Jing Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China
| | - Xian-Zhe Lou
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China
| | - Dong Ma
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China. .,Department of Biochemistry and Molecular Biology, Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China.
| | - Yun-Yan Wu
- Cardiac Surgery Department, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Yong-Bo Zhao
- Cardiac Surgery Department, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China.
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Liu L, Yang Y. Nutritional Management Mode of Early Cardiac Rehabilitation in Patients with Stanford Type A Aortic Dissection. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2124636. [PMID: 36035298 PMCID: PMC9410849 DOI: 10.1155/2022/2124636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/07/2022] [Accepted: 08/08/2022] [Indexed: 12/01/2022]
Abstract
Malnutrition and metabolic disorders are common problems faced by patients with Stanford type A aortic dissection after surgery. Some patients have dietary problems such as malnutrition, unbalanced diet, and poor eating habits before surgery. Therefore, the nutritional management of early heart health can improve the nutritional support for perioperative recovery, to improve the pertinence. Therefore, active nutritional support after surgery will help to change malnutrition and metabolism and is of great significance to postoperative recovery and quality of life. This paper is aimed at studying the nutritional management mode of early cardiac rehabilitation in patients with Stanford type A aortic dissection. Based on the analysis of the pathogenesis of aortic dissection and the diagnosis of aortic dissection, two groups of patients were given individualized nutritional management scheme and routine nutritional scheme, respectively, and the nutritional risk differences between the two groups under different schemes were compared. The results showed that there was a statistical difference between the two groups at discharge. The NRS-2002 score of 14 cases in the observation group was less than 3 after nutritional intervention, indicating that there was no nutritional risk at discharge.
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Affiliation(s)
- Lu Liu
- School of Public Health, Anhui Medical University, Hefei 230032, China
- Department of Cardiovascular Surgery, First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital, Hefei 230001, China
| | - Yongjian Yang
- School of Public Health, Anhui Medical University, Hefei 230032, China
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Pan X, Xing Z, Yang G, Ding N, Zhou Y, Chai X. Obesity Increases In-Hospital Mortality of Acute Type A Aortic Dissection Patients Undergoing Open Surgical Repair: A Retrospective Study in the Chinese Population. Front Cardiovasc Med 2022; 9:899050. [PMID: 35903673 PMCID: PMC9315262 DOI: 10.3389/fcvm.2022.899050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The prevalence of obesity is increasing worldwide, and the role of the obesity paradox in cardiovascular surgery remains controversial. In this study, we redefined obesity according to the Chinese criteria and examined the relationship between obesity and in-hospital mortality in patients with acute type A aortic dissection (AAD) undergoing open surgical repair. Materials and Methods A total of 289 patients with AAD (between 2014 and 2016) were divided into the non-obese group and obese group for correlation analysis, general information, demographic factors, blood biochemistry, surgical details, and complications, which were used as covariates. Survival was estimated by the Kaplan–Meier method, and any differences in survival were evaluated with a stratified log-rank test. Least Absolute Shrinkage and Selection Operator (LASSO) regression and logistic regression were used to evaluate the effect and interaction of obesity on surgical mortality. Results All the 289 patients had a mean age of 48.64 (IQR 44.00–55.00) and 74.39% were men. Of the 289 patients, 228 were non-obese (78.89%) and 61 were obese (21.11%). Patients with obesity were younger and more prone to unstable blood pressure [systolic blood pressure (SBP) and diastolic blood pressure (DBP)], preoperative hypoxemia and delirium, prolonged operative time, and surgical wound deep infection (p < 0.05). In the fully adjusted model, we observed an increased risk of in-hospital mortality in patients with obesity after fine-tuning other covariates including age and sex (HR = 2.65; 95% CI = 1.03 to 6.80; p = 0.042). The interaction suggested that obesity was more likely to cause death in elderly patients (age ≥ 60), although it was more common in younger patients (test for interaction, p = 0.012). Conclusion Obesity, interacting with age, increases the risk of in-hospital mortality in patients with AAD undergoing open surgical repair. Although more verification is needed, we believe these findings provide further evidence for the treatment of AAD.
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Affiliation(s)
- Xiaogao Pan
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenhua Xing
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Guifang Yang
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Ning Ding
- Emergency Department, Changsha Central Hospital, University of South China, Changsha, China
| | - Yang Zhou
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiangping Chai
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Xiangping Chai,
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Differential expression profile of plasma exosomal microRNAs in acute type A aortic dissection with acute lung injury. Sci Rep 2022; 12:11667. [PMID: 35804020 PMCID: PMC9270349 DOI: 10.1038/s41598-022-15859-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/30/2022] [Indexed: 11/08/2022] Open
Abstract
MicroRNAs (miRNAs) packaged into exosomes mediate cell communication and contribute to the pathogenesis of acute type A aortic dissection (ATAAD) with acute lung injury (ALI). The expression profile of plasma exosomal miRNAs in ATAAD patients with ALI hasn’t been identified. We performed a miRNA-sequencing to analyze the differentially expressed miRNAs (DE-miRNAs) of circulating exosomes in ATAAD patients with ALI compared to patients without ALI, founding 283 specific miRNAs in two groups. We respectively selected the top 10 downregulated and upregulated DE-miRNAs for further studies. The predicted transcription factors (TFs) of these DE-miRNAs were SMAD2, SRSF1, USF1, etc. The Gene Ontology (GO) and Kyoto Encyclopedia Genes and Genomes (KEGG) analysis predicted their target genes mainly involved acute inflammatory response, cell junction, cytoskeleton, NF-κB signaling pathway, etc. Construction and analysis of the PPI network revealed that RHOA and INSR were considered hub genes with the highest connectivity degrees. Moreover, we confirmed two exosomal miRNAs (hsa-miR-485-5p and hsa-miR-206) by real-time quantitative polymerase chain reaction (RT-qPCR) in a validation cohort. Our study identified a plasma exosomal miRNAs signature related to ATAAD with ALI. Certain DE-miRNAs may contribute to the progression of this disease, which help us better understand the pathogenesis of ATAAD with ALI.
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Fu R, Cheng Z. Letter to the Editor: Prediction model for postoperative severe acute lung injury in patients undergoing acute type A aortic dissection surgery. J Card Surg 2022; 37:2486. [PMID: 35415907 DOI: 10.1111/jocs.16506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Ruihong Fu
- Department of Neurology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Zeyi Cheng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
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Zhao X, Bie M. Preoperative acute lung injury and oxygenation impairment occurred in the patients with acute aortic dissection. BMC Cardiovasc Disord 2022; 22:129. [PMID: 35346059 PMCID: PMC8958762 DOI: 10.1186/s12872-022-02579-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractAcute lung injury (ALI) and oxygenation impairment (OI) frequently occur in the patients with acute aortic dissection (AAD), which may necessitate mechanical ventilation and result in adverse outcomes. This paper aims to increase clinicians’ awareness of the severe respiratory complications in the patients with AAD, and provide the overview of the epidemiology, adverse outcomes, pathogenesis, predictive markers and therapeutic modalities of the concurrent conditions. Currently, it is considered that inflammatory response plays a great role in the pathogenesis of ALI and OI in the patients with AAD, but the definite pathogenesis remains unclear. Given the great importance of the prediction of the occurrence of the severe respiratory complication at a very early stage, some inflammatory biomarkers have been investigated to predict the occurrence of ALI and OI in several studies. C-reactive protein was found to have a significant predictive effect for the development of ALI and OI. Early use of beta-blockers and the use of bindarit could prevent the occurrence of OI and ALI. Ulinastatin could also improve oxygenation in the patients with type-A AAD. Prevention and management of ALI and OI in AAD remain a great challenge. The definite pathogenesis should be clearly clarified and further studies should be performed to look for potential effective way to predict and manage the severe respiratory conditions.
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8
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Wang W, Satti DI, Harky A, Mayhew D. Clinical assessment or scoring model for acute lung injury: A crossing path? J Card Surg 2022; 37:1611-1612. [PMID: 35338717 DOI: 10.1111/jocs.16444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- William Wang
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Danish Iltaf Satti
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - David Mayhew
- Department of Anaesthesia and Critical Care, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, UK
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9
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Zhang C, Shi R, Zhang G, Bai H, Zhang Y, Zhang L, Chen X, Fu Z, Lin G, Xu Q. The association between body mass index and risk of preoperative oxygenation impairment in patients with the acute aortic syndrome. Front Endocrinol (Lausanne) 2022; 13:1018369. [PMID: 36465611 PMCID: PMC9712723 DOI: 10.3389/fendo.2022.1018369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The study aimed to determine the relationship between body mass index (BMI) and the risk of acute aortic syndrome (AAS) with preoperative oxygenation impairment. METHODS A meta-analysis of published observational studies involving BMI and AAS with preoperative oxygenation impairment was conducted. A total of 230 patients with AAS were enrolled for retrospective analysis. All patients were divided into 2 groups (Non-oxygenation impairment group and Oxygenation impairment group). Logistic regression analysis was performed to assess the relation between BMI and the risk of preoperative oxygenation impairment after the onset of AAS. Dose-response relationship curve and subgroup analysis were conducted to test the reliability of BMI as an independent factor of it. RESULTS For the meta-analysis, the quantitative synthesis indicated that excessive BMI increased the risk of preoperative oxygenation impairment (OR: 1.30, 95% CI: 1.05-1.60, P heterogeneity = 0.001). For the retrospective analysis, a significant association was observed after adjusting for a series of variables. BMI was significantly related to preoperative oxygenation impairment after the onset of AAS (OR: 1.34, 95% CI: 1.15-1.56, p <0.001), and compared with normal weight group (18.5 kg/m2 ≤ BMI < 23.0 kg/m2), the individuals with excessive BMI were at higher risk of preoperative oxygenation impairment for the obese group (BMI ≥ 25 kg/m2) (OR: 17.32, 95% CI: 4.03-74.48, p <0.001). A J-shape curve in dose-response relationship analysis further confirmed their positive correlation. Subgroup analysis showed that diastolic blood pressure (DBP) ≥ 90mmHg carried an excess risk of preoperative oxygenation impairment in obese patients. CONCLUSION Excessive BMI was an independent risk factor for AAS with preoperative oxygenation impairment.
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Affiliation(s)
- Chiyuan Zhang
- Department of Cardiovascular Medicine, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ruizheng Shi
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guogang Zhang
- Department of Cardiovascular Medicine, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hui Bai
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanfeng Zhang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lei Zhang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuliang Chen
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zuli Fu
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guoqiang Lin
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Guoqiang Lin, ; Qian Xu,
| | - Qian Xu
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Guoqiang Lin, ; Qian Xu,
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Zeng Z, Zhang K, Cai J, Wu H, Yue J. Associations of high-mobility group box 1 and receptor for advanced glycation end products with acute lung injury in patient with acute aortic dissection. Rev Assoc Med Bras (1992) 2021; 67:1251-1255. [DOI: 10.1590/1806-9282.20210395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/20/2021] [Indexed: 08/30/2023] Open
Affiliation(s)
- Zhaofan Zeng
- Hainan Affiliated Hospital of Hainan Medical University, China
| | - Kun Zhang
- Hainan Affiliated Hospital of Hainan Medical University, China
| | - Junhong Cai
- Hainan Affiliated Hospital of Hainan Medical University, China
| | - Hongfei Wu
- Hainan Affiliated Hospital of Hainan Medical University, China
| | - Jie Yue
- The First Affiliated Hospital of Guangzhou Medical University, China
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Ke C, Wu H, Xi M, Shi W, Huang Q, Lu G. Clinical features and risk factors of postoperative in-hospital mortality following surgical repair of Stanford type A acute aortic dissection. BMC Cardiovasc Disord 2021; 21:392. [PMID: 34384373 PMCID: PMC8359018 DOI: 10.1186/s12872-021-02107-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background To investigate the clinical features of patients with Stanford type A acute aortic dissection (AAD) and analyze the risk factors affecting postoperative in-hospital mortality rate. Methods
The demographic and clinical data were retrospectively collected and analyzed from 118 AAD patients admitted to the Affiliated Hospital of Hangzhou Normal University from June 2016 to April 2019. All patients underwent surgical treatment and were grouped into death and survival groups. The risk factors affecting postoperative in-hospital death were analyzed using multivariate logistic regression analysis. Results The male to female ratio in the patients was 3.8:1 and the mean age was 50.11 ± 9.91 years. The patient’s main comorbidities were hypertension (70.33%) and coronary heart disease (10.17%). The main symptoms included chest pain and back pain (72.89%). The highest incidence of complications was pericardial effusion (48.31%), followed by pleural effusion (22.88%). The mean systolic blood pressure, white blood cell count and D-dimer in the patients were over the ranges of normal people. The incidences of cardiac and renal insufficiency were 18.64% and 16.95% respectively, and the postoperative in-hospital mortality rate was 12.71%. Univariable analysis showed that age, renal insufficiency, cardiac insufficiency, D-dimer level, cardiopulmonary bypass time, operation time, blood transfusion volume and postoperative hemostasis were significant factors leading to the death (P < 0.05). Multivariate logistic regression analysis showed that age > 65, renal insufficiency, cardiopulmonary bypass time ≥ 250 min and postoperative hemostasis were independent risk factors for the death (P < 0.05). Conclusions AAD patients frequently have underlying diseases with pain as the main symptom. Age > 65 years, renal insufficiency, cardiopulmonary bypass time ≥ 250 min and postoperative hemostasis are significantly risk factors for postoperative mortality.
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Affiliation(s)
- Chen Ke
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310029, China
| | - Hao Wu
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310029, China.
| | - Min Xi
- General Ward of Internal Medicine, Dingqiao Hospital, Hangzhou, China
| | - Wei Shi
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310029, China
| | - Qihong Huang
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310029, China
| | - Guirong Lu
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310029, China
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12
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Leng X, Onaitis MW, Zhao Y, Xuan Y, Leng S, Jiao W, Sun X, Qin Y, Liu D, Wang M, Yang R. Risk of Acute Lung Injury after Esophagectomy. Semin Thorac Cardiovasc Surg 2021; 34:737-746. [PMID: 33984482 DOI: 10.1053/j.semtcvs.2021.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/04/2021] [Indexed: 12/25/2022]
Abstract
To develop a new approach for identifying acute lung injury (ALI) in surgical ward setting and to assess incidence rate, clinical outcomes, and risk factors for ALI cases after esophagectomy. We also compare the degree of lung injury between operative and non-operative sides. Consecutive esophageal cancer patients (n=1022) who underwent esophagectomy from Dec 2012 to Nov 2018 in our hospital were studied. An approach for identifying ALI was proposed that integrated radiographic assessment of lung edema (RALE) score to quantify degree of lung edema. Stepwise logistic regression identified risk factors for postoperative ALI incidence. The degree of bilateral lung injury was compared using the RALE score. The approach for identifying ALI in surgical ward setting was defined as acute onset, PaO2/FiO2≤300 mmHg, bilateral opacities on bedside chest radiograph with a RALE score≥16, and exclusion of cardiogenic pulmonary edema. Incidence rate of ALI was estimated to be 9.7%. ALI diagnosis was associated with multiple clinical complications, prolonged hospital stay, higher medical bills, and higher perioperative mortality. Nine risk factors including BMI, ASA class, DLCO%, duration of surgery, neutrophil percentage, high-density lipoprotein, and electrolyte disorders were identified. The RALE score of the lung lobes of the operative side was higher than the non-operative side. A new approach for identifying ALI in esophageal cancer patients receiving esophagectomy was proposed and several risk factors were identified. ALI is common and has severe outcomes. The lung lobes on the operative side are more likely to be affected than the non-operative side.
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Affiliation(s)
- Xiaoliang Leng
- Division of Thoracic Surgery, Department of Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mark W Onaitis
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Yandong Zhao
- Division of Thoracic Surgery, Department of Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yunpeng Xuan
- Division of Thoracic Surgery, Department of Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shuguang Leng
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA; Cancer Control and Population Sciences, Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA; Division of Occupational and Environmental Health, School of Public Health, Qingdao University, Qingdao, China.
| | - Wenjie Jiao
- Division of Thoracic Surgery, Department of Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
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- Division of Thoracic Surgery, Department of Surgery, Affiliated Hospital of Qingdao University, Qingdao, China; Surgery, Health management center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao Sun
- Division of Thoracic Surgery, Department of Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi Qin
- Division of Thoracic Surgery, Department of Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dahai Liu
- Surgery, Health management center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Maolong Wang
- Division of Thoracic Surgery, Department of Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ronghua Yang
- Division of Thoracic Surgery, Department of Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
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13
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Yang Y, Xue J, Li H, Tong J, Jin M. Perioperative risk factors predict one-year mortality in patients with acute type-A aortic dissection. J Cardiothorac Surg 2020; 15:249. [PMID: 32917250 PMCID: PMC7488853 DOI: 10.1186/s13019-020-01296-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022] Open
Abstract
Objective The goal of this study was to analyze perioperative risk factors to predict one- year mortality after operation for acute type A aortic dissection (AAD). Methods A total of 121 consecutive patients undergoing Stanford type A AAD surgery in Beijing Anzhen Hospital were enrolled. Preoperative clinical and laboratory data from patients were collected. Results Multivariable Cox regression analysis showed that significant factors associated with increased one-year mortality were elder age (year) (hazard ratio (HR) 1.0985; 95% confidence interval (CI) 1.0334–1.1677), intraoperative blood transfusion ≥2000 mL (HR 8.8081; 95% CI 2.3319–33.2709), a higher level of serum creatinine (μmol/L) at postoperative one day (HR 1.0122; 95% CI 1.0035–1.0190) and oxygenation index (OI) < 200 (mmHg) at the end of surgery (HR 5.7575; 95% CI 1.1695–28.3458). Conclusion In this study, perioperative risk factors to predict one-year prognosis are age, intraoperative blood transfusion ≥2000 mL, postoperative OI < 200 mmHg and level of postoperative serum creatinine. The results aid in the comprehension of surgical outcomes and assist in the optimization of treatment strategies for those with perioperative risk factors to decrease one-year mortality.
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Affiliation(s)
- Yanwei Yang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.,Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, 100029, China
| | - Jiayi Xue
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, 100029, China.,Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Huixian Li
- Department of Anesthesiology, The First Hospital of Tsinghua University, Beijing, China
| | - Jiaqi Tong
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Mu Jin
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China. .,Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, 100029, China.
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14
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Guo Z, Yang Y, Zhao M, Zhang B, Lu J, Jin M, Cheng W. Preoperative hypoxemia in patients with type A acute aortic dissection: a retrospective study on incidence, related factors and clinical significance. J Thorac Dis 2019; 11:5390-5397. [PMID: 32030257 DOI: 10.21037/jtd.2019.11.68] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Pre-operative hypoxemia (HO) is a serious complication occurring in acute type A aortic dissection (AAD) patients. Methods This was a retrospective study of 505 patients who underwent Stanford type A acute aortic dissection surgery in Anzhen hospital, Beijing, China, between January 2015 to February 2018. Patients were divided into a HO(+) group (PaO2/FiO2 ≤300) and a HO(-) group (PaO2/FiO2 >300) according to preoperative arterial blood gas (ABG) analysis. The incidence of preoperative hypoxemia in patients undergoing surgery for AAD was calculated as the main outcome. Multivariable binary logistic regression analysis was used to identify independent prognostic factors of HO. Results Preoperative HO occurred in 46.5% (235/505) of patients. Mean patient age was 47.8±9.6 years, and 189 (80.4%) were male. Multivariable logistic regression analysis showed a correlation between preoperative serum level of fibrinogen [95% confidence interval (CI), 0.95-0.99], white blood cell count (WBC) (95% CI, 1.07-1.18), systolic blood pressure (95% CI, 0.98-1.00), history of smoking (95% CI, 1.05-2.11) and pleural effusion (95% CI, 1.14-2.71) with preoperative HO. The HO(+) group had a significantly higher mortality than the HO(-) group (8.1% vs. 5.9%, P=0.38). The median of intubation time (P<0.01), the length of stay in the intensive care unit (P<0.01) and the length of hospital stay (P<0.01) were significantly longer in patients with HO. The activity of daily living scale score was significantly lower in the HO(+) group (P<0.01). Conclusions AAD patients were easy to have pre-operative HO, which had a higher morbidity than those without HO. Altered fibrinogen, WBC, systolic blood pressure levels, positive smoking history, and pleural effusion were associated with the presence of HO. More monitoring and treatment should be given to these patients.
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Affiliation(s)
- Zijian Guo
- Department of Anesthesiology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Yanwei Yang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Mingming Zhao
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Bo Zhang
- Department of Mathematics, University of Essex, Colchester, UK
| | - Jiakai Lu
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Mu Jin
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Weiping Cheng
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
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15
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Moskowitzova K, Orfany A, Liu K, Ramirez-Barbieri G, Thedsanamoorthy JK, Yao R, Guariento A, Doulamis IP, Blitzer D, Shin B, Snay ER, Inkster JAH, Iken K, Packard AB, Cowan DB, Visner GA, Del Nido PJ, McCully JD. Mitochondrial transplantation enhances murine lung viability and recovery after ischemia-reperfusion injury. Am J Physiol Lung Cell Mol Physiol 2019; 318:L78-L88. [PMID: 31693391 PMCID: PMC6985877 DOI: 10.1152/ajplung.00221.2019] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The most common cause of acute lung injury is ischemia-reperfusion injury (IRI), during which mitochondrial damage occurs. We have previously demonstrated that mitochondrial transplantation is an efficacious therapy to replace or augment mitochondria damaged by IRI, allowing for enhanced muscle viability and function in cardiac tissue. Here, we investigate the efficacy of mitochondrial transplantation in a murine lung IRI model using male C57BL/6J mice. Transient ischemia was induced by applying a microvascular clamp on the left hilum for 2 h. Upon reperfusion mice received either vehicle or vehicle-containing mitochondria either by vascular delivery (Mito V) through the pulmonary artery or by aerosol delivery (Mito Neb) via the trachea (nebulization). Sham control mice underwent thoracotomy without hilar clamping and were ventilated for 2 h before returning to the cage. After 24 h recovery, lung mechanics were assessed and lungs were collected for analysis. Our results demonstrated that at 24 h of reperfusion, dynamic compliance and inspiratory capacity were significantly increased and resistance, tissue damping, elastance, and peak inspiratory pressure (Mito V only) were significantly decreased (P < 0.05) in Mito groups as compared with their respective vehicle groups. Neutrophil infiltration, interstitial edema, and apoptosis were significantly decreased (P < 0.05) in Mito groups as compared with vehicles. No significant differences in cytokines and chemokines between groups were shown. All lung mechanics results in Mito groups except peak inspiratory pressure in Mito Neb showed no significant differences (P > 0.05) as compared with Sham. These results conclude that mitochondrial transplantation by vascular delivery or nebulization improves lung mechanics and decreases lung tissue injury.
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Affiliation(s)
- Kamila Moskowitzova
- Department of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Arzoo Orfany
- Department of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Kaifeng Liu
- Department of Pulmonary and Respiratory Diseases, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Giovanna Ramirez-Barbieri
- Department of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jerusha K Thedsanamoorthy
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rouan Yao
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, Massachusetts
| | - Alvise Guariento
- Department of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Ilias P Doulamis
- Department of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - David Blitzer
- Department of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Borami Shin
- Department of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Erin R Snay
- Department of Radiology, Division of Nuclear Medicine and Molecular imaging, Boston Children's Hospital, Boston, Massachusetts
| | - James A H Inkster
- Department of Radiology, Division of Nuclear Medicine and Molecular imaging, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Khadija Iken
- Department of Pulmonary and Respiratory Diseases, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Alan B Packard
- Department of Radiology, Division of Nuclear Medicine and Molecular imaging, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Douglas B Cowan
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Gary A Visner
- Department of Pulmonary and Respiratory Diseases, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - James D McCully
- Department of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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16
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Gao Z, Pei X, He C, Wang Y, Lu J, Jin M, Cheng W. Oxygenation impairment in patients with acute aortic dissection is associated with disorders of coagulation and fibrinolysis: a prospective observational study. J Thorac Dis 2019; 11:1190-1201. [PMID: 31179061 DOI: 10.21037/jtd.2019.04.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Stanford type-A acute aortic dissection (AAD) is typically accompanied by oxygenation impairment before surgery. In addition, inflammation, coagulation and fibrinolysis also impair blood oxygenation. However, our understanding of the concentration of these factors in bronchoalveolar lavage fluid (BALF) has not been reported. The objective of the study was to investigate the impact of preoperative acute lung injury (ALI) on postoperative oxygenation impairment and to explore the effect of coagulation and fibrinolysis in blood and BALF. Methods This investigation utilized a prospective observational study design, which was registered at www.clinicaltrials.gov (identifier NCT01894334). The study included 53 patients undergoing surgery for Stanford type-A AAD at an academic hospital in China between October 2013 and July 2014. Preoperative ALI was identified according to the oxygenation index calculated by the PaO2/FiO2 ratio. The subjects were divided into the ALI group (oxygenation index ≤300 mmHg) or the control group (oxygenation index >300 mmHg). The primary outcome was patient oxygenation index, while secondary outcomes were concentrations of tissue factor (TF), tissue factor pathway inhibitor (TFPI), and plasminogen activator inhibitor-1 (PAI-1) in serum and BALF. Results The incidence of preoperative ALI for Stanford type-A AAD patients was 41.5%. Stanford type-A AAD patients with preoperative ALI had a lower postoperative oxygenation index (104.6±31.7 vs. 248.7±48.0 mmHg, P<0.001), higher concentrations of TF in serum and BALF (F=133.67, P<0.001; F=68.14, P<0.001), higher concentrations of TFPI in serum and BALF (F=31.98, P<0.001; F=45.58, P<0.001), and higher concentrations of PAI-1 in serum and BALF (F=213.88, P<0.001; F=107.95, P<0.001) when compared with those without preoperative ALI. Type-A AAD patients also showed a greater loss of blood (1,524±458 vs. 1,175±327 mL, P=0.040), longer mechanical ventilation time in the ICU (27.24±8.37 vs. 17.33±7.36 h, P<0.001), longer total stay in the ICU (42.27±10.85 vs. 33.45±9.05 h, P=0.002), and longer total hospital stay (17.77±5.00 vs. 13.48±3.97 days, P=0.001). Multivariate linear regression analysis indicated that preoperative PAI-1 in BALF, and TF in both serum and BALF were significantly associated with preoperative oxygenation impairment in patients with Stanford type-A AAD. Conclusions Preoperative ALI caused more serious postoperative oxygenation impairment for Stanford type-A AAD, and coagulation and fibrinolysis appear to play critical roles in this process. Preoperative PAI-1 in BALF and TF in both serum and BALF were significant factors related to the occurrence of preoperative oxygenation impairment for Stanford type-A AAD.
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Affiliation(s)
- Zhifeng Gao
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China.,Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Xin Pei
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Chen He
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Yuefeng Wang
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Jiakai Lu
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Mu Jin
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Weiping Cheng
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
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17
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Lou X, Jin J, Gong J, Zhao L, Li Y, He Q. Comparison of the Effects of Indobufen and Warfarin in a Rat Model of Adenine-Induced Chronic Kidney Disease. Med Sci Monit 2019; 25:3566-3572. [PMID: 31086128 PMCID: PMC6530882 DOI: 10.12659/msm.915590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Worldwide, the treatment of patients with chronic kidney disease (CKD) remains a challenge as warfarin treatment can be associated with severe adverse events related to bleeding. Alternative anticoagulants that can be used in CKD remain to be identified. This study aimed to compare the effects of indobufen, a new antiplatelet agent, with warfarin in a rat model of adenine-induced CKD. Material/Methods Forty-eight male Wistar rats were treated with intragastric adenine to create the rat model of CKD and were divided into four groups: an untreated control group (N=12), a group treated with dimethyl sulfoxide (DMSO) (N=12), a group treated with indobufen, (N=12) and a group treated with warfarin (N-12). Treatment was given for 4 weeks and 8 weeks. Kidney histology was performed, and the degree of fibrosis was quantified using Masson trichrome staining. Results In the rat model of adenine-induced CKD, Masson trichrome staining showed that the degree of kidney fibrosis in the indobufen group (26%) was significantly reduced (p<0.05) when compared the DMSO group (58%) and the warfarin group (49%). Kidney fibrosis was associated with upregulation of 6-keto-PGI2/TXB2 in the rat kidney tissue. Conclusions In a rat model of adenine-induced CKD, preliminary findings showed that indobufen was associated with reduced kidney fibrosis when compared with warfarin.
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Affiliation(s)
- Xiaowei Lou
- Department of Nephrology, Zhejiang Provincial Peoples' Hospital, Hangzhou, Zhejiang, China (mainland).,Peoples' Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China (mainland).,Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| | - Juan Jin
- Department of Nephrology, Zhejiang Provincial Peoples' Hospital, Hangzhou, Zhejiang, China (mainland).,Peoples' Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China (mainland).,Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| | - Jianguang Gong
- Department of Nephrology, Zhejiang Provincial Peoples' Hospital, Hangzhou, Zhejiang, China (mainland).,Peoples' Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China (mainland).,Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| | - Li Zhao
- Department of Nephrology, Zhejiang Provincial Peoples' Hospital, Hangzhou, Zhejiang, China (mainland).,Peoples' Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China (mainland).,Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| | - Yiwen Li
- Department of Nephrology, Zhejiang Provincial Peoples' Hospital, Hangzhou, Zhejiang, China (mainland).,Peoples' Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China (mainland).,Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| | - Qiang He
- Department of Nephrology, Zhejiang Provincial Peoples' Hospital, Hangzhou, Zhejiang, China (mainland).,Peoples' Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China (mainland).,Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
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