1. The Clinical Study Of Vasopressin In Preoperative Left Ventricular Insufficiency And Postoperative Vasoparalytic Shock 2. Acute Stanford A Type Aortic Dissection Plasma HCMV-miRNAs Expression Profile Analysis

Part one: Clinical study of vasopressin in patients with preoperative left ventricular dysfunction and vasoplegic shock postcardiac surgeryObjective: Vasopressin is used as an adjunct to catecholamines to support blood pressure in postcardiac surgery vasoplegic shock,but its effect among patients with preoperative Left Ventricular Dysfunction(p LVD)is unknown.The aim of this study was to assess whether vasopressin is superior to norepinephrine to improve postoperative outcomes in patients with p LVD.Methods: We retrospectively analyzed 1156 patients with p LVD who underwent cardiac surgery in two centers from January,2007 to June,2017.Patients with postoperative vasoplegic shock received vasopressin(0.02-0.07 U/min)or norepinephrine(10-60 μg/min)to maintain a target blood pressure.The propensity score matching methodology was used to obtain risk-adjusted outcome.The primary endpoint was a composite of mortality or severe complications(stroke,mechanical ventilation > 48 h,cardiac reoperation,ECMO or acute kidney injury)within 30 days.Results: A total of 338 patients(169 patients received vasopressin,and 169 norepinephrine)were included in propensity-score matched cohort.The primary endpoint was similar(50.89% vs 58.58%,P = 0.155)and there was no significant difference between the vasopressin and norepinephrine groups in the rate of 30-day mortality(5.92% and 1.77%,P = 0.052),stroke(3.55% vs 1.77%,P = 0.311),mechanical-ventilation > 48hours(22.48% vs 21.30%,P = 0.574),cardiac reoperation(1.77% vs 5.32%,P =0.078),ECMO(5.32% vs 1.77%,P = 0.124)and acute kidney injury(43.19% vs 48.52%,P = 0.326).Conclusion : Vasopressin did not improve the postoperative outcomes as compared with norepinephrine among postoperative vasoplegic shock patients with p LVD after cardiac surgery.Part two: Analysis of HCMV-micro RNAs expression profile in acute Stanford A aortic dissectionObjective: Analysis the serum HCMV-micro RNAs(miRNAs)expression profile of patients with Stanford type A aortic dissection(TAD)to identify important HCMV-miRNAs that might play an important role in contributing to TAD and evaluate its potential clinical value.Methods: We collected the serum samples of the TAD patients(n = 20)and donors without TAD(non-TAD,n = 20).Quantitative reverse transcription polymerase chain reaction(qRT-PCR)was used to screen the expression profiles of 25 HCMV-micro RNAs.The differential expression of HCMV-micro RNAs was further validated by increasing the number of samples in each group by 12 cases.Its diagnostic performance for TAD was evaluated by receiver operating characteristic curve(ROC)analysis.Results: qRT-PCR revealed that nine HCMV-miRNAs were found to be differentially expressed between two groups,of which eight were up-regulated(hcmv-mi R-UL112-5p,hcmv-mi R-US33-3p,hcmv-mi R-US25-2-5p,hcmv-mi R-US5-1,hcmv-mi R-UL36-3p,hcmv-mi R-US25-2-3p,hcmv-mi R-US4-3p,and hcmv-mi R-US5-2-3p)and one was down-regulated(hcmv-mi R-US25-1-5p)in TAD patients(all P(27)0.05).One differential expression HCMV-mi RNA(hcmv-mi R-UL112-5p)was further validated by increasing samples.ROC analysis showed that HCMV-mi R-UL112-5p had better diagnostic performance for dissection.(AUC = 0.950,95% CI = 0.8584 ~ 1.042,Sensitivity: 90.2%,Specificity: 81.0%).Conclusion : The serum HCMV-miRNAs expression profiles from TAD were significantly changed.These miRNAs might be potential new diagnostic biomarkers for TAD.It needs to be confirmed in larger studies.