Objective We designed a simplified total arch reconstruction (s-TAR) technique which could be performed under mild hypothermia (30–32°C) with distal aortic perfusion. This study aimed to compare its efficacy of organ protection with the conventional total arch reconstruction (c-TAR). Methods We reviewed the clinical data of 195 patients who had ascending aortic aneurysm with extended aortic arch dilation and underwent simultaneous ascending aorta replacement and TAR procedure between January 2018 and December 2022 in our center. 105 received c-TAR under moderate hypothermia (25–28°C) with circulatory arrest (c-TAR group); rest 90 received s-TAR under mild hypothermia (30–32°C) with distal aortic perfusion (s-TAR group). Results The s-TAR group demonstrated shorter CPB time, cross-clamp time and lower body circulatory arrest time compared with the c-TAR group. The 30-day mortality was 2.9% for the c-TAR group and 1.1% for the s-TAR group (P = 0.043). The mean duration of mechanical ventilation was shorter in the s-TAR group. Paraplegia was observed in 4 of 105 patients (3.8%) in the c-TAR group, while no such events were observed in the s-TAR group. The incidence of temporary neurologic dysfunction was significantly higher in the c-TAR group. The incidence of permanent neurologic dysfunction also showed a tendency to be higher in the c-TAR group, without statistical significance. Furthermore, the incidence of reoperation for bleeding were significantly lower in the s-TAR group. The rate of postoperative hepatic dysfunction and all grades of AKI was remarkably lower in the s-TAR group. The 3-year survival rate was 95.6% in the s-TAR group and 91.4% in the c-TAR group. Conclusions s-TAR under mild hypothermia (30–32℃) with distal aortic perfusion is associated with lower mortality and morbidity, offering better neurological and visceral organ protection compared with c-TAR.

Background: Leptin is a growth factor for the fetus. The sources for maternal and fetal leptin plasma levels are the adipose tissue and the placenta. Placental leptin release elevates maternal leptin levels only about 15%. We hypothesize that activated adipose tissue is an additional source for the high leptin levels in pregnancy. However it is further not clear if maternal leptin reaches the fetal circulation and supports fetal growth by that way. Aim of the study: (1) Do maternal leptin arrive the fetal circulation and (2) is maternal adipose tissue leptin production activated during pregnancy ? Methods: Placentas and adipose tissue was obtained after written informed consent of the patients. (1) Dual in vitro perfusion of isolated cotyledons (nϭ7) for 3h. Addition of 125-I-leptin and unlabeled leptin (1ϩ3, 22 ng/ml total leptin) to the maternal circulation. Control of vitality and integrity by measurement of glucose consumption, lactate production, creatinine-and antipyrin transfer. (2) Sampling of subcutaneous maternal adipose tissue during cesarean sections (nϭ10, no gestational pathology) and during other gynecological surgery (nϭ10, age matched, no malignancies). Measurement of leptin mRNA using Taqman real time PCR. Results: (1) Materno-fetal transfer rate of the labeled leptin was 4,5 Ϯ 1,4% of the initial concentration. Permeability of 125-I-leptin accounted for 0,04 Ϯ 0,02 ml min-1 g-1, and was 1,3 Ϯ 0,1 ml min-1 g-1 normalized to creatinine transfer. Existence of free 125-iodine was excluded by comparison of dialysated and undialysated fetal perfusion medium. (2) Leptin mRNA was significant higher in adipose tissue of pregnant women than in the control group (1,0 Ϯ 0,5 v. 0,5 Ϯ 0,4 rel. Units; pϽ0,05) Conclusion: (1) We could show first, that leptin from the maternal circulation passes the placenta and enters the fetal blood. There seems to be an active transplacental transport from the maternal to the fetal circulation, due to molecular weight and calculated permeability. (2) Maternal adipose tissue leptin production is activated during pregnancy. A basic leptin supply in the beginning of fetal development seems to be guaranteed by the placenta and maternal adipose tissue and was supplemented by the own leptin production of the fetus during further maturation and growth. X H Liu, H J Huang, C R Li Shenzhen Children's Hospital, Neonatology, Shenzhen, China Objective: Neonatal infants with severe respiratory failure have no response to conventional mechanical ventilation (CMV). Our goal was to evaluate the efficacy of high-frequency oscillatory ventilation (HFOV) for treatment of these infants. EFFICACY OF HIGH-FREQUENCY OSCILLATORY VENTILATION FOR TREATMENT OF SEVERE RESPIRATORY FAILURE IN NEONATESMethods: From December 1998 to December 2003, 66 infants with respiratory failure and not responsive to CMV were treated with HFOV. The primary efficacy variables were improvement in oxygenation, lung function, complications and survival. Gestational age of the studied infants was 38°À 5 wk and birth weig...