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author:("Pan, pudong")
1.  Mechanism and early intervention research on ALI during emergence surgery of Stanford type-A AAD 
Medicine  2016;95(42):e5164.
Stanford type-A acute aortic dissection (AAD) is a severe cardiovascular disease demonstrating the characteristics of acute onset and rapid development, with high morbidity and mortality. The available evidence shows that preoperative acute lung injury (ALI) induced by Stanford type-A AAD is a frequent and important cause for a number of untoward consequences. However, there is no study assessing the incidence of preoperative ALI and its independent determinants before Standford type-A AAD surgery in Chinese adult patients.
This is a prospective, double-blind, signal-center clinical trial. We will recruit 130 adult patients undergoing Stanford type-A AAD surgery. The incidence of preoperative ALI will be evaluated. Perioperative clinical baselines and serum variables including coagulation, fibrinolysis, inflammatory, reactive oxygen species, and endothelial cell function will be assayed. The independent factors affecting the occurrence of preoperative ALI will be identified by multiple logistic regression analysis.
Trial registration: (, Registration number NCT01894334.
PMCID: PMC5079332  PMID: 27759648
acute lung injury; coagulation/fibrinolysis; inflammatory; Stanford type-A acute aortic dissection
2.  Long-term clinical outcome and risk of catheter ablation in elderly with non-paroxysmal atrial fibrillation 
Background: Catheter ablation of atrial fibrillation (AF) became an effective therapy for patients with drug-refractory AF and Catheter ablation of Non-Paroxysmal AF for elderly remains a challenging task. The outcome of AF ablation in Elderly is not clear. Objective: The aim of the present study was to investigate the long-term outcomes of catheter ablation in patients with non-paroxysmal AF and the predictors of AF termination, and the clinical outcomes associated with termination and non-termination. Methods: A total of 95 non-paroxysmal AF patients who received a stepwise catheter ablation were enrolled. There were 46 patients (48.4%) suffering from recurrences (37 patients with AF and 9 patients with atrial flutter/atrial tachycardia) after single procedure during a median follow-up period of 25.6 months. AF termination by ablation was achieved in 73 of the 95 patients Results: The AF non-termination after procedure and CHA2DS2-VASc scores ≥3 were significant predictors of recurrences in the multivariable analysis. In AF termination group: for a CHA2DS2-VASc scores of 0, 1-2, and ≥3 the recurrence rates were 29% (8/28), 39% (12/31) and 64% (9/14) respectively. Similarly, In AF non-termination group: for a CHA2DS2-VASc scores of 0, 1-2, and ≥3 the recurrence rates were 63% (5/8), 75% (6/8), and 100% (6/6), respectively. Of the patients with CHA2DS2-VASc scores of ≥3 in AF non-termination group all experienced recurrences within 2 year after the single procedure. Conclusions: The catheter ablation may be effective in eliminating part of non-paroxysmal AF for elderly. In addition, the present study demonstrated that CHA2DS2-VASc scores and non-termination after procedure were useful predictors of AF recurrence.
PMCID: PMC4659000  PMID: 26629111
Catheter ablation; recurrence; long-term outcome; non-paroxysmal atrial fibrillation
3.  Association of TRAIL and Its Receptors with Large-Artery Atherosclerotic Stroke 
PLoS ONE  2015;10(9):e0136414.
To investigate the association of the tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and its receptors, osteoprotegerin (OPG) and death receptor 5 (DR5) with large-artery atherosclerosis (LAA) stroke and its prognosis.
We included patients with LAA stroke (n = 132) according to the TOAST classification system and controls (n = 60). To evaluate the extent and severity of cerebral atherosclerosis, the LAA stroke group was subdivided into 3 subgroups by number of cerebral arteries with atherosclerotic stenosis (≥50%): single, double and multiple (≥3). Plasma levels of TRAIL, OPG and DR5 were measured by ELISA. Ordinal logistic regression was used to analyze the association between the plasma levels of TRAIL, OPG, DR5 and the severity of cerebral atherosclerosis. Prognosis was determined by the Modified Rankin Scale at 3 months after stroke. Receiver operating characteristic (ROC) curve was used to evaluated TRAIL as a predictor of prognosis.
Plasma TRAIL level was significantly lower for LAA patients than controls (P<0.001), while plasma OPG and DR5 levels were higher (both P<0.001). Logistic regression analysis revealed that risk of severe cerebral atherosclerosis was reduced significantly with increased plasma level of TRAIL (OR 0.438; 95% CI 0.282–0.681; P<0.001), whereas increased with high plasma levels of OPG and DR5 (OR 2.707; 95% CI 1.702–4.302, P <0.001; OR 3.593; 95% CI 1.878–6.869, P <0.001). Plasma TRAIL level was negatively correlated with the prognosis (r = - 0.372, P <0.001). The optimal cut-off value of TRAIL for prognosis was 848.63 pg/mL. The sensitivity and specificity at this cut-off value were 63.1% and 86.2%, respectively. After adding the plasma TRAIL level into the multivariate model of ROC, the area under the ROC curve was increased from 0.639 to 0.785, but the change was not statistical significant (P = 0.146).
TRAIL and its receptors OPG and DR5 may be involved in LAA stroke and the plasma level of TRAIL may be a biomarker predicting the severity of cerebral atherosclerosis and the prognosis of LAA stroke.
PMCID: PMC4559459  PMID: 26334877
4.  Risk factors for acute kidney injury in overweight patients with acute type A aortic dissection: a retrospective study 
Journal of Thoracic Disease  2015;7(8):1385-1390.
To identify risk factors for acute kidney injury (AKI) in overweight patients who underwent surgery for acute type A aortic dissection (TAAD).
A retrospective study including 108 consecutive overweight patients [body mass index (BMI) ≥24] between December 2009 and April 2013 in Beijing Anzhen Hospital has been performed. AKI was defined by Acute Kidney Injury Network (AKIN) criteria, which is based on serum creatinine (sCr) or urine output.
The mean age of the patients was 43.69±9.66 years. Seventy-two patients (66.7%) developed AKI during the postoperative period. A logistic regression analysis was performed to identify two independent risk factors for AKI: elevated preoperative sCr level and 72-h drainage volume. Renal replacement therapy (RRT) was required in 15 patients (13.9%). The overall postoperative mortality rate was 7.4%, 8.3% in AKI group and 5.6% in non-AKI group. There is no statistically significant difference between the two groups (P=0.32).
A higher incidence of AKI (66.7%) in overweight patients with acute TAAD was confirmed. The logistic regression model identified elevated preoperative sCr level and 72-h drainage volume as independent risk factors for AKI in overweight patients. We should pay more attention to prevent AKI in overweight patients with TAAD.
PMCID: PMC4561257  PMID: 26380764
Acute kidney injury (AKI); body mass index (BMI); type A aortic dissection (TAAD); risk factors; Sun’s procedure
5.  Diagnostic Performance of Echocardiography for the Detection of Acute Cardiac Allograft Rejection: A Systematic Review and Meta-Analysis 
PLoS ONE  2015;10(3):e0121228.
Many studies have addressed the diagnostic performance of echocardiography to evaluate acute cardiac allograft rejection compared with endomyocardial biopsy. But the existence of heterogeneity limited its clinical application. Thus, we conducted a comprehensive, systematic literature review and meta-analysis for the purpose.
Studies prior to September 1, 2014 identified by Medline/PubMed, EMBASE and Cochrance were examined by two independent reviews. We conducted meta-analysis by using Meta-DiSc 1.4 software. An assessment tool of QUADAS-2 was applied to evaluate the risk of bias and applicability of the studies.
Thirty studies met the inclusion criteria of meta-analysis. The four parameters of pressure half time, isovolumic relaxation time, index of myocardial performance and late diastolic mitral annular motion velocity were included in the meta-analysis, with a pooled diagnostic odds ratio of 10.43, 6.89, 15.95 and 5.68 respectively, and the area under the summary receiver operating characteristic curves value of 0.829, 0.599, 0.871 and 0.685 respectively.
The meta-analysis and systematic review demonstrate that no single parameter of echocardiography showed a reliable diagnostic performance for acute cardiac allograft rejection. A result of echocardiography for ACAR should be comprehensively considered by physicians in the context of clinical presentations and imaging feature.
PMCID: PMC4378940  PMID: 25822627
6.  Elevation of serum CXCL16 level correlates well with atherosclerotic ischemic stroke 
Currently there are no reliable biological markers for ischemic stroke. The novel chemokine CXCL16 is known to be involved in the development of atherosclerosis. Nevertheless, the real role of CXCL16 in atherosclerotic disorders remains uncertain. The goal of our study was to investigate the associations between serum-soluble CXCL16 level and atherosclerotic ischemic stroke, including large artery atherosclerosis (LAA) and small artery occlusion (SAO) subtypes, and to explore whether elevation in CXCL16 levels is correlated with the severity of large arterial stenosis.
Material and methods
The study recruited 227 subjects, including 74 controls and 153 consecutive patients with acute ischemic stroke from atherosclerosis of the carotid artery. The etiology of the acute ischemic strokes was classified into LAA (n = 86) subtype and SAO (n = 67) subtype according to the TOAST criteria, and the severity of carotid artery stenosis was assessed by the NASCET criteria. Serum-soluble CXCL16 concentration was measured by enzyme-linked immunosorbent assay.
Serum CXCL16 concentrations were significantly increased in both LAA (2.36 ng/ml) and SAO subtypes (2.13 ng/ml) when compared to that of the controls (2.04 ng/ml, p < 0.01 and p < 0.05, respectively), and it was significantly elevated in LAA subtype than in SAO subtype (p < 0.05). However, significant differences in CXCL16 levels between the high-grade stenosis group (2.36 ng/ml) and moderate-grade stenosis group (2.24 ng/ml) of LAA subtype were not found (p > 0.05). A correlation of serum levels of CXCL16 with serum levels of hs-CRP, fibrinogen and lipid parameters was not observed (p > 0.05).
Increased serum level of soluble CXCL16 was independently associated with atherosclerotic ischemic stroke, particularly LAA subtype.
PMCID: PMC3953970  PMID: 24701213
CXCL16; chemokine; atherosclerosis; ischemic stroke; inflammation
7.  Vertebral artery dissection associated with viral meningitis 
BMC Neurology  2012;12:79.
Vertebral artery dissection (VAD) is often associated with trauma or occurs spontaneously, inevitably causing some neurological deficits. Even though acute infection can be related to the development of spontaneous VAD (sVAD), VAD associated with viral meningitis has never been reported in the literature.
Case presentation
A 42-year-old man with fever, sore throat, and runny nose developed sudden onset of occipital headache, vertigo, transient confusion, diplopia, and ataxia. Brain stem encephalitis was diagnosed initially because the cerebrospinal fluid (CSF) study showed inflammatory changes. However, subsequent diffusion-weighted (DWI) magnetic resonance imaging of his brain demonstrated left lateral medullary infarction, and the digital subtraction angiography (DSA) confirmed VAD involving left V4 segment of the artery. Consequently, the patient was diagnosed as VAD accompanied by viral meningitis.
This case suggests that viral meningitis might lead to inflammatory injury of the vertebral arterial wall, even sVAD with multiple neurological symptoms.
PMCID: PMC3466159  PMID: 22909191
Vertebral artery dissection; Cerebral ischemia; Viral meningitis; Infection

Results 1-7 (7)