BACKGROUND & AIMS: :Only 2 comprehensive surgical series, published in 1977 and 1983, have evaluated clinicopathologic features of the ascending aorta. Retrospective review of medical records and microscopic slides was performed on 513 consecutive patients with surgical resection of ascending aortic tissue (1985 to 1999). Patients were 2 to 89 years old (mean 59 y), and 303 (59%) were men. Aneurysm or dissection was the indication for surgery in 479. Aortic valves were also excised in 360. Systemic hypertension was present in 279, inherited connective tissue disease (ICTD) in 67, arteritis in 33, and acquired connective tissue disease in 16. Microscopy showed cystic medial degeneration (CMD) in 209, aortic dissection (AD) in 109 (with CMD in 56), normal media in 90, aortitis in 57 (with CMD in 14), and other findings in 48. The most significant, independent risk factor of CMD and AD was ICTD (confidence interval=7.61 and 2.26, respectively). Systemic hypertension was more common in patients with AD than without (P=0.0202). Normal media was the most common histologic finding associated with bicuspid aortic valve (P<0.0001). Among 57 patients with aortitis (giant cell in 39), ages ranged from 16 to 85 years (mean 64 y), and 42 (74%) were women; only 8 had Takayasu arteritis, and 11 had temporal or systemic arteritis. In surgically resected ascending aorta, the 3 most common histologic findings were CMD, AD, and normal media. ICTD, systemic hypertension, and bicuspid aortic valve were common comorbid findings. Giant cell aortitis occured predominantly in women, usually without systemic disease.

背景与目标： : 只有2个全面的外科系列，发表于1977年和1983，评估了升主动脉的临床病理特征。对连续513例手术切除升主动脉组织的患者 (1985例1999年) 进行了病历和显微镜切片的回顾性回顾。患者为2至89岁 (平均59岁)，303 (59%) 为男性。动脉瘤或夹层是479手术的指征。主动脉瓣也在360中切除。279存在全身性高血压，遗传性结缔组织病 (ICTD) 67例，动脉炎33例，获得性结缔组织病16例。显微镜检查显示209的囊性内侧变性 (CMD)，109的主动脉夹层 (AD) (CMD为56)，正常介质为90，主动脉炎为57 (CMD为14)，其他发现为48。CMD和AD最重要的独立危险因素是ICTD (置信区间分别为7.61和2.26)。全身性高血压在AD患者中比没有AD患者更常见 (P = 0.0202)。正常介质是与二叶主动脉瓣相关的最常见组织学发现 (P<0.0001)。在57例主动脉炎患者 (巨细胞39例) 中，年龄从16岁到85岁 (平均64岁)，女性42例 (74% 例); 只有8例患有大动脉炎，11例患有颞动脉炎或全身性动脉炎。在手术切除的升主动脉中，最常见的3种组织学发现是CMD，AD和正常介质。ICTD，全身性高血压和二叶主动脉瓣是常见的合并症。巨细胞主动脉炎主要发生在女性，通常没有全身性疾病。

BACKGROUND & AIMS: :Peroxisome proliferator-activated receptors (PPARs) are expressed on vascular tissue. To investigate the direct vasoprotective effects of PPARgamma and PPARalpha ligands, pioglitazone (3 mg/kg/day) and bezafibrate (10 mg/kg/day) were given by gavage to streptozotocin-induced diabetic rats for 4 weeks. Streptozotocin (65 mg/kg, i.p.) significantly increased NADPH oxidase, vascular call adhesion molecule-1 (VCAM-1), and osteopontin mRNA levels in the aorta, as determined by reverse transcription (RT)-polymerase chain reaction (PCR). Immunohistochemical analysis revealed that the expression of osteopontin protein was also enhanced in the streptozotocin-injected rat aorta. Pioglitazone or bezafibrate attenuated the streptozotocin-induced increase in the expression of NADPH oxidase and VCAM-1 mRNA. The enhanced expression of osteopontin gene and protein induced by streptozotocin was suppressed by pioglitazone, whereas treatment with bezafibrate had no effect on the expression of osteopontin. We also demonstrated that pioglitazone or bezafibrate prevented the streptozotocin-induced increase in angiotensin converting enzyme (ACE) gene and protein content, by the means of RT-PCR and Western blotting. On the other hand, the treatment of pioglitazone or bezafibrate in the present study did not affect glucose tolerance, serum insulin or lipid level in streptozotocin-induced diabetic rats. These results suggest that the direct anti-oxidant and anti-inflammatory effects of PPARs ligands in the aorta of streptozotocin-induced diabetic rats were not likely to have been mediated by the normalization of glucose or lipid metabolism, but instead these salutary effects appear to have been associated with the inhibition of the expression of ACE. In addition, pioglitazone appeared to be more effective on the suppression of osteopontin expression compared with bezafibrate.

背景与目标： : 过氧化物酶体增殖物激活受体 (ppar) 在血管组织上表达。为研究PPARgamma和PPARalpha配体的直接血管保护作用，将吡格列酮 (3 mg/kg/天) 和苯扎贝特 (10 mg/kg/天) 灌胃给链脲佐菌素诱导的糖尿病大鼠4周。通过逆转录 (RT)-聚合酶链反应 (PCR) 测定，链脲佐菌素 (65 mg/kg，i.p.) 显着增加主动脉中的NADPH氧化酶，血管呼叫粘附分子-1 (VCAM-1) 和骨桥蛋白mRNA水平。免疫组织化学分析显示，在注射链脲佐菌素的大鼠主动脉中，骨桥蛋白的表达也得到了增强。吡格列酮或苯扎贝特减弱了链脲佐菌素诱导的NADPH氧化酶和VCAM-1 mRNA表达的增加。吡格列酮抑制了链脲佐菌素诱导的骨桥蛋白基因和蛋白的增强表达，而苯扎贝特治疗对骨桥蛋白的表达没有影响。我们还证明，吡格列酮或苯扎贝特通过rt-pcr和Western印迹阻止了链脲佐菌素诱导的血管紧张素转化酶 (ACE) 基因和蛋白质含量的增加。另一方面，本研究中吡格列酮或苯扎贝特的治疗不会影响链脲佐菌素诱导的糖尿病大鼠的葡萄糖耐量，血清胰岛素或脂质水平。这些结果表明，链脲佐菌素诱导的糖尿病大鼠主动脉中ppar配体的直接抗氧化和抗炎作用不太可能由葡萄糖或脂质代谢的正常化介导。但是，这些有益的作用似乎与抑制ACE的表达有关。此外，与苯扎贝特相比，吡格列酮似乎对抑制骨桥蛋白表达更有效。

BACKGROUND & AIMS: :Ascending aorta reinterventions present a challenge for surgeons as the technical difficulties of the procedure and the complex strategic approach can complicate successful treatment. These patients should be treated by surgical teams with ample experience in aortic diseases as they can be at high risk of mortality. The number of interventions on the ascending aorta and aortic arch and the use of biological conducts (lung autograft, homograft, etc.) have increased in recent years; therefore, the number of reinterventions can also be expected to increase, representing 10% of aortic surgical procedures. This article reviews the current status of ascending aorta reinterventions, analyzing the principal aspects of indication and surgical strategy, as well as the results published in the largest studies.

背景与目标： : 升主动脉再干预对外科医生来说是一个挑战，因为手术的技术困难和复杂的战略方法会使成功的治疗复杂化。这些患者应由具有丰富主动脉疾病经验的外科团队进行治疗，因为他们可能具有很高的死亡风险。近年来，对升主动脉和主动脉弓进行干预的数量以及生物学行为 (肺自体移植，同种异体移植等) 的使用有所增加; 因此，可以预期再干预的数量也会增加，这代表了主动脉外科手术的10%。本文回顾了升主动脉再干预的现状，分析了适应症和手术策略的主要方面，以及在最大的研究中发表的结果。

BACKGROUND & AIMS: :We present an unusual case of spinal cord ischemia from an acute type B intramural hematoma that was successfully treated with blood pressure elevation and drainage of cerebral spinal fluid.

背景与目标： : 我们介绍了急性b型壁内血肿引起的不寻常的脊髓缺血病例，该病例已成功通过血压升高和脑脊液引流治疗。

BACKGROUND & AIMS: :Aortic dissection commonly affects the thoracic aorta and is associated with high morbidity and mortality rates. Localized dissections originating from the infrarenal abdominal aorta are extremely rare. We report a rare case of localized dissecting aneurysm originating from the infrarenal abdominal aorta in a 62-year-old man. Open surgical repair was successfully performed without any complications.

背景与目标： : 主动脉夹层通常影响胸主动脉，并与高发病率和死亡率相关。源自肾下腹主动脉的局部解剖极为罕见。我们报告了一名62岁男性中罕见的源自肾下腹主动脉的局部夹层动脉瘤病例。成功进行了开放式手术修复，没有任何并发症。

BACKGROUND & AIMS: :Aneurysms of the abdominal aorta are often diagnosed in the over-75s. Although for many Authors the presence of risk factors such as cardiopathies, cerebrovascular problems, renal or respiratory insufficiency, which are clearly more frequent in elderly patients, represent a contraindication to the intervention of choice, personal experience has shown that surgery remains the best solution. In fact, in a group of patients operated on for aneurysm of the abdominal aorta in a heart, no significant differences in age-related mortality were observed. Surgery therefore remains the treatment of choice in the elderly too for it must also be remembered that the natural history of the disease has shown that, in a comparatively short time, the aneurysm ruptures and operating mortality is markedly higher.

背景与目标： : 腹主动脉的动脉瘤通常在over-75s中被诊断。尽管对于许多作者来说，诸如心脏病，脑血管问题，肾脏或呼吸衰竭等危险因素的存在 (在老年患者中明显更常见) 代表了选择干预的禁忌症，但个人经验表明，手术仍然是最佳解决方案。实际上，在一组接受心脏腹主动脉动脉瘤手术的患者中，未观察到与年龄相关的死亡率的显着差异。因此，手术仍然是老年人的首选治疗方法，因为还必须记住，该疾病的自然病史表明，在相对较短的时间内，动脉瘤破裂和手术死亡率明显更高。

BACKGROUND & AIMS: :This study was designed to analyze flow pattern, velocity, and strain on the aortic wall of a glass aortic model during extracorporeal circulation, and to elucidate the characteristics of flow pattern in four aortic cannulas. Different patterns of large vortices and helical flow were made by each cannula. The high-velocity flow (0.6 m/s) was observed in end-hole cannula, causing high strain rate tensor (0.3~0.4 without unit) on the aortic arch. In dispersion cannula, a decreased strain rate tensor (less than 0.1) was found on the outer curvature of the aortic arch. In Soft-flow cannula (3M Cardiovascular, Ann Arbor, MI, USA), further decreased flow velocity (0.2 m/s) and strain (less than 0.2) were observed. In Select 3D cannula (Medtronic, Inc., Minneapolis, MN, USA), a high strain (0.4~0.5) was observed along the inner curvature of the aortic arch. In conclusion, end-hole cannula should not be used in atherosclerotic aorta. Particular attention should be paid both for selection of cannulas and cannulation site based on this result.

背景与目标： : 本研究旨在分析体外循环过程中玻璃主动脉模型主动脉壁的血流模式，速度和应变，并阐明四个主动脉插管的血流模式特征。每个套管产生不同的大涡旋和螺旋流模式。在端孔套管中观察到高速流 (0.6 m/s)，在主动脉弓上引起高应变率张量 (无单元0.3〜0.4)。在分散套管中，在主动脉弓的外曲率上发现了降低的应变率张量 (小于0.1)。在软流套管 (3m心血管，安阿伯，MI，美国) 中，观察到流速进一步降低 (0.2 M/s) 和应变 (小于0.2)。在选定的3D套管 (Medtronic，inc.，Minneapolis，MN，USA) 中，沿主动脉弓的内曲率观察到高应变 (0.4 ~ 0.5)。总之，端孔套管不应用于动脉粥样硬化的主动脉。根据此结果，应特别注意选择插管和插管部位。

BACKGROUND & AIMS: :Numerical analysis methods including finite element analysis (FEA), computational fluid dynamics (CFD), and fluid-structure interaction (FSI) analysis have been used to study the biomechanics of human tissues and organs, as well as tissue-medical device interactions, and treatment strategies. However, for patient-specific computational analysis, complex procedures are usually required to set-up the models, and long computing time is needed to perform the simulation, preventing fast feedback to clinicians in time-sensitive clinical applications. In this study, by using machine learning techniques, we developed deep neural networks (DNNs) to directly estimate the steady-state distributions of pressure and flow velocity inside the thoracic aorta. After training on hemodynamic data from CFD simulations, the DNNs take as input a shape of the aorta and directly output the hemodynamic distributions in one second. The trained DNNs are capable of predicting the velocity magnitude field with an average error of 1.9608% and the pressure field with an average error of 1.4269%. This study demonstrates the feasibility and great potential of using DNNs as a fast and accurate surrogate model for hemodynamic analysis of large blood vessels.

背景与目标： : 包括有限元分析 (FEA)，计算流体动力学 (CFD) 和流体-结构相互作用 (FSI) 分析在内的数值分析方法已用于研究人体组织和器官以及组织-医疗设备的生物力学相互作用和治疗策略。但是，对于特定于患者的计算分析，通常需要复杂的程序来建立模型，并且需要较长的计算时间来执行模拟，从而阻止了对时间敏感的临床应用中的临床医生的快速反馈。在这项研究中，通过使用机器学习技术，我们开发了深度神经网络 (dnn) 来直接估计胸主动脉内部压力和流速的稳态分布。在对来自CFD模拟的血液动力学数据进行训练之后，dnn将主动脉的形状作为输入，并在一秒钟内直接输出血液动力学分布。训练的dnn能够预测平均误差为1.9608% 的速度幅度场和平均误差为1.4269% 的压力场。这项研究证明了使用DNNs作为大血管血流动力学分析的快速准确替代模型的可行性和巨大潜力。

BACKGROUND & AIMS: BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a viable resuscitation approach for a subdiaphragmatic injury that can regulate arterial blood flow. On the other hand, the evaluation of venous or portal venous blood flow during REBOA remains insufficient because invasive cannulation or exposure of the vessel may affect the blood flow, and Doppler echography is highly operator-dependent. However, phase contrast magnetic resonance imaging has enabled accurate evaluation and noninvasive measurement. This study aimed to investigate the change of venous and portal venous blood flow during REBOA in a porcine model. METHODS:Seven pigs were anesthetized, and a REBOA catheter was placed. The blood flows of the inferior vena cava (IVC), hepatic vein (HV), portal vein (PV), and superior vena cava (SVC) were measured using phase contrast magnetic resonance imaging, in both the balloon deflated (no-REBOA) and fully balloon inflated (REBOA) states. Mean arterial pressure (MAP), central venous pressure, cardiac index, and systemic vascular resistance index were measured. RESULTS:The blood flows of the suprahepatic, infrahepatic, and distal IVC, HV, and PV in the no-REBOA state were 1.40 ± 0.36 L·min, 0.94 ± 0.16 L·min, 0.50 ± 0.19 L·min, 0.060 ± 0.018 L·min, and 0.32 ± 0.091 L·min, respectively. The blood flow of each section in the REBOA condition was significantly decreased at 0.41 ± 0.078 (33% of baseline), 0.15 ± 0.13 (15%), 0.043 ± 0.034 (9%), 0.029 ± 0.017 (37%), and 0.070 ± 0.034 L·min (21%), respectively. The blood flow of the SVC increased significantly in the REBOA condition (1.4 ± 0.63 L·min vs. 0.53 ± 0.14 L·min [257%]). Mean arterial pressure, central venous pressure, cardiac index, and systemic vascular resistance index were significantly increased after REBOA inflation. CONCLUSION:Resuscitative endovascular balloon occlusion of the aorta decreased blood flows of the IVC, HV, and PV and increased blood flow of the SVC. This result could be explained by the collateral flow from the lower body to the SVC. A better understanding of the effect of REBOA on the venous and portal venous systems may help control liver injury.

背景与目标：

BACKGROUND & AIMS: :Blood vessels and neurons grow often side by side. However, the molecular and cellular mechanisms underlying their parallel development remain unclear. Here, we report that a subpopulation of secondary motoneurons extends axons ventrally outside of the neural tubes and rostrocaudally as a fascicle beneath the dorsal aorta (DA) in zebrafish. We tried to clarify the mechanism by which these motoneuron axons grow beneath the DA and found that Vegfc in the DA and Vegfr3 in the motoneurons were essential for the axon growth. Forced expression of either Vegfc in arteries or Vegfr3 in motoneurons resulted in enhanced axon growth of motoneurons over the DA. Both vegfr3 morphants and vegfc morphants lost the alignment of motoneuron axons with DA. In addition, forced expression of two mutant forms of Vegfr3 in motoneurons, potentially trapping endogenous Vegfc, resulted in failure of growth of motoneuron axons beneath the DA. Finally, a vegfr3 mutant fish lacked the motoneuron axons beneath the DA. Collectively, Vegfc from the preformed DA guides the axon growth of secondary motoneurons.

背景与目标： : 血管和神经元经常并排生长。然而，它们平行发展的分子和细胞机制仍不清楚。在这里，我们报告了次级运动神经元的亚群在斑马鱼的背主动脉 (DA) 下方的束中向神经管的腹侧和尾部延伸轴突。我们试图阐明这些运动神经元轴突在DA下生长的机制，并发现DA中的Vegfc和运动神经元中的Vegfr3对于轴突生长至关重要。动脉中Vegfc或运动神经元中Vegfr3的强制表达导致DA上运动神经元的轴突生长增强。vegfr3形变和vegfc形变都失去了运动神经元轴突与DA的排列。此外，在运动神经元中强迫表达两种突变形式的Vegfr3，可能捕获内源性Vegfc，导致DA下方的运动神经元轴突生长失败。最后，vegfr3突变鱼在DA下方缺少运动神经元轴突。总的来说，来自预先形成的DA的Vegfc引导次级运动神经元的轴突生长。

BACKGROUND & AIMS: :Tinnitus is a challenging condition to manage with no effective treatment. We report a case of lifelong tinnitus present in a patient who was cured with the surgical repair of his coarctation of aorta. The patient was a fit 37-year-old with coarctation of aorta, senserineural deafness and intractable tinnitus. He underwent a thoracotomy and tube by-pass of his coarctation of aorta. A complete relief of his tinnitus and improvement in his hearing was noted postoperatively and confirmed on audiograms. This is the first reported case of tinnitus due to coarctation of aorta relieved by surgical correction of the coarctation.

背景与目标： : 耳鸣是一种具有挑战性的疾病，没有有效的治疗方法。我们报告了一例因手术修复主动脉缩窄而治愈的患者终身耳鸣。该患者为37岁，患有主动脉缩窄，神经性耳聋和顽固性耳鸣。他接受了开胸手术，并对主动脉缩窄进行了管旁路。术后发现他的耳鸣完全缓解，听力得到改善，并在听力图上得到证实。这是首例因主动脉缩窄而通过手术矫正缩窄而缓解的耳鸣病例。

BACKGROUND & AIMS: BACKGROUND:Transesophageal echocardiography (TEE) is a key diagnostic modality in patients with acute aortic dissection, yet its sensitivity is limited by a "blind-spot" caused by air in the trachea. After placement of a fluid-filled balloon in the trachea visualization of the thoracic aorta becomes possible. This method, modified TEE, has been shown to be an accurate test for the diagnosis of upper aortic atherosclerosis. In this study we discuss how we use modified TEE for the diagnosis and management of patients with (suspected) acute aortic dissection. NOVEL DIAGNOSTIC APPROACH OF THE DISSECTED AORTA:Modified TEE provides the possibility to obtain a complete echocardiographic overview of the thoracic aorta and its branching vessels with anatomical and functional information. It is a bedside test, and can thus be applied in hemodynamic instable patients who cannot undergo computed tomography. Visualization of the aortic arch allows differentiation between Stanford type A and B dissections and visualization of the proximal cerebral vessels enables a timely identification of impaired cerebral perfusion. During surgery modified TEE can be applied to identify the true lumen for cannulation, and to assure that the true lumen is perfused. Also, the innominate- and carotid arteries can be assessed for structural integrity and adequate perfusion during multiple phases of the surgical repair. CONCLUSIONS:Modified TEE can reveal the "blind-spot" of conventional TEE. In patients with (suspected) aortic dissection it is thus possible to obtain a complete echocardiographic overview of the thoracic aorta and its branches. This is of specific merit in hemodynamically unstable patients who cannot undergo CT. Modified TEE can guide also guide the surgical management and monitor perfusion of the cerebral arteries.

背景与目标：

BACKGROUND & AIMS: BACKGROUNDS:Hemolysis related to a kinked prosthetic graft or inner felt strip is a very rare complication after aortic surgery. We describe herein a case of hemolytic anemia that developed due to aortic flap of the dissection and inversion of an inner felt strip that was applied at the proximal anastomosis of a replaced ascending aorta 10 years previously. CASE PRESENTATION:A 74-year-old woman presented with consistent hemolytic anemia 10 years after replacement of the ascending aorta to treat Stanford type A acute aortic dissection. The cause of hemolysis was attributed to mechanical injury of red blood cells at a site of stenosis caused by aortic flap of the dissection and inversion of the felt strip used for the proximal anastomosis. Repeated resection of the strip and graft replacement of the ascending aorta resolved this problem. CONCLUSIONS:We considered that blood flow disrupted by a jet of blood at the site of the proximal inner felt strip was the cause of severe hemolysis, we describe rare hemolytic anemia at the site of aortic flap and inverted felt strip after replacement of the ascending aorta.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Postcardiac injury syndrome (PCIS) is an inflammatory response syndrome characterized by pericardial effusion with or without pleural effusion; however, serious PCIS with peripheral hematoma of the ascending aorta and acute cerebral infarction after percutaneous coronary intervention (PCI) have not been reported. CASE PRESENTATION:This article reports a very rare case of a 40-year-old patient who developed acute pericardial and pleural effusions (both bloody), acute respiratory distress, peripheral hematoma of the ascending aorta, and acute cerebral infarction after PCI. The patient's ECG showed bow-back downward ST elevation in leads I, II, III, and V4-V6. A blood test showed significant increases in eukaryotic-cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Echocardiography and pulmonary artery computed tomography angiography (CTA) showed a large amount of pericardial effusion and pleural effusion. CTA of the thoracic and abdominal aorta showed a peripheral hematoma of the ascending aorta. A cranial computed tomography (CT) showed cerebral infarction anterior to the anterior horn of the right ventricle. After tracheal intubation, ventilator breathing support, pericardial and pleural drainage, and adrenocortical steroid (prednisone) treatment, he gradually recovered and was discharged 20 days later. CONCLUSION:We report the management of a case of serious PCIS with peripheral hematoma of the ascending aorta and acute cerebral infarction after PCI. Early diagnosis, early differential diagnosis, and early use of steroid therapy are the key in treating PCIS.

背景与目标：

BACKGROUND & AIMS: :Traumatic injury of the abdominal aorta with total interruption of blood flow is uncommon. When there is total obstruction of the artery, the clinical picture is dramatic. The most frequent mechanism is compression due to the safety belt during a car accident. The patients have absent femoral and distal pulses, associated to neuropathy in the lower limbs. We present a case of abdominal aorta injury secondary to closed trauma and review the causes, presentation forms and management of the injury.

背景与目标： : 完全中断血流的腹主动脉外伤并不常见。当动脉完全阻塞时，临床表现是戏剧性的。最常见的机制是在车祸中由于安全带的压缩。患者的股骨和远端脉搏缺失，与下肢神经病变有关。我们介绍了一例继发于闭合性创伤的腹主动脉损伤，并回顾了损伤的原因，表现形式和处理方法。