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@#Objective To investigate the clinical effect of in situ fenestration combined with chimney technique in the treatment of aortic dissection involving left common carotid artery. Methods From January 2012 to June 2019, 53 patients with aortic dissection involving left common carotid artery were selected. There were 21 patients in the test group, including 14 males and 7 females, with an average age of 57.2±11.2 years; there were 32 patients in the control group, including 20 males and 12 females, with an average age of 56.7±12.1 years. In the test group, the left subclavian branch was reconstructed by in situ fenestration and the left common carotid artery was reconstructed by chimney technique. In the control group, the left common carotid artery was reconstructed by hybrid operation. The clinical data of the patients were compared. Results The operation time of the test group was significantly longer than that of the control group (151.8±35.2 min vs. 101.3±29.6 min, P=0.00). The patients in the two groups were followed up for 6-20 months. There was no significant difference in the incidence of pulmonary infection, stroke, steal blood syndrome, false lumen thrombosis or internal leakage between the two groups (P>0.05). The diameters of the distal and proximal ends of the true cavity in the test group increased significantly compared with those in the control group (P<0.05). Conclusion In situ fenestration combined with chimney technique is an effective method for the treatment of aortic dissection involving left common carotid artery, which is worthy of further clinical promotion.
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BACKGROUND: Unilateral spinal epidural anesthesia with ropivacaine can reduce the perioperative pain in the elderly undergoing hip or knee arthroplasty, but choosing which concentration of small dose hypobaric ropivacaine is an issue of concern.OBJECTIVE: To explore the anesthetic and analgesic effects of unilateral spinal epidural anesthesia with different concentrations of low dose hypobaric ropivacaine in senile knee or hip replacement.METHODS: Ninety patients undergoing knee or hip replacement in the Henan Province Hospital of TCM from August 2014 to December 2015 were enrolled, and randomized into 0.15%, 0.5% and 0.25% ropivacaine groups (n=30 per group), followed by spinal epidural anesthesia at L3-4 or L2-3 lumbar interspace, respectively.RESULTS AND CONCLUSION: (1) The order of the flat subsided time and motor block recovery time was as follows:0.15% ropivacaine group < 0.25% ropivacaine group < 0.5% ropivacaine group; the onset time of motor block was longest in the 0.25% ropivacaine group, followed by 0.5% ropivacaine group, and shortest in the 0.15% ropivacaine group (all P < 0.05). (2) The order of the visual analogue scale scores at 1, 5, and 10 hours after anesthesia and 24 hours postoperatively was as follows: 0.5% ropivacaine group < 0.25% ropivacaine group < 0.15% ropivacaine group (P < 0.05). (3) The change levels of heart rate and blood pressure were highest in the 0.5% ropivacaine group, followed by 0.15% ropivacaine group, and lowest in the 0.25% ropivacaine group. (4) The incidence of adverse events was highest in the 0.5% ropivacaine group, followed by 0.15% ropivacaine group, and lowest in the 0.25% ropivacaine group (P < 0.05). (5) To conclude, 3 mL of 0.25% ropivacaine exhibits desired anesthetic effect.
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Objective To investigate the distribution and clinical significance of EGFR mutations in phase Ⅰ non-smallcell lung cancer(NSCLC).Methods We examined 272 consecutive phase Ⅰ NSCLC patients' tumor samples for EGFR mutations in exons 18,19,20 and 21 using the Amplification Refractory Mutation System(ARMS).Results 154 patients (56.62％)were identified with mutations in the series of 272.Of all the mutations identified,2 (1.3％) were aminoacidic substitutions (G719 S) in exon 18,53 (34.4 ％) were in frame deletions (19-del) in exon 19,6 (3.9 ％) were insertional mutations (20-ins) in exon 19 and 97 (63.9 ％) were aminoacidic substitutions (L858 R) in exon 21.There were 11 patients with coexisting mutations in other exons.The probability of the coexisting resistance mutations (20-ins) in exon 21 was significantly higher than that in exon 19 (P ＜ 0.05).Mutations in adenocarcinoma samples (148/223,66.4％) were more frequent than that in squamous carcinoma(2/40,5％),while mutations in adeno-squamous carcinoma were highest in all histologic types (P ＜ 0.05).Conclusion EGFR mutations in phase Ⅰ NSCLC in Shanghai and surrounding areas were 56.62％.Mutations were more frequent in particular histologic types,e.g.adenocarcinoma and adeno-squamous carcinoma.Exon 19 deletion mutations and the substitution mutation L858R in exon 21 are the most frequent in NSCLC.And the probability of coexisting 20-ins mutations in exon 21 was significantly higher than which in exon 19.
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Objective The aims of this study were to assess the efficacy of video-assisted thoracoscopic extended thymectomy(VATET) as a treatment for non-thymomatous myasthenia gravis (NTMG) and to identify prognostic factors for thymectomy.Methods Retrospectively analyzed clinical datas of 112 patients received VATET for the treatment of NTMG.Clinical efficacy and variables influencing outcome were evaluated by Kaplan-Meier method and Cox proportional hazards regression analysis.Results At 3.2 years averaged (1.5-6.2 years) of follow-up,none of these patients were lost to follow up.According to the MGFA post-intervention status,54 patients(48.2％) obtained complete stable remission during follow-up,21 patients(18.8％) obtained pharmacologic remission,10 patients (8.9％) obtained minimal manifestations,7 patients (6.3％) improved,20 patients(17.8％) unchanged,and none of these patients were worse or died of MG.By multivariate analysis,the chance of complete stable remission was significantly increased when age ＜ 40 years (P ＜ 0.01,OR =3.468),symptom duration ＜ 12 months(P ＜ 0.01,OR =3.203) and the presence of thymic hyperplasia (P ＜ 0.01,OR =3.064).Conclusion Video-assisted thoracoscopic extended thymectomy achieved satisfactory long-term results in patients with nonthymomatous myasthenia gravis,while age,symptom duration,the presence of thymic hyperplasia correlated with response to operation.
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The aimed of this study was to prepare stabilized thiomers to overcome the poor stability character of traditional thiomers. Poly(acrylic acid)-cysteine (PAA-Cys) was synthesized by conjugating cysteine with poly(acrylic acid) and poly(acrylic acid)-cysteine-6-mercaptonicotinic acid (PAA-Cys-6MNA, stabilized thiomers) was synthesized by grafting a protecting group 6-mercaptonicotinic acid (6MNA) with PAA-Cys. The free thiol of PAA-Cys was determined by Ellmann's reagent method and the ratio of 6MNA coupled was determined by glutathione reduction method. The study of permeation enhancement and stabilized function was conducted by using Franz diffusion cell method, with fluorescein isothiocyanate dextran (FD4) used as model drug. The influence of polymers on tight junctions of Caco-2 cell monolayer was detected with laser scanning confocal fluorescence microscope. The results indicated that both PAA-Cys and PAA-Cys-6MNA could promote the permeation of FD4 across excised rat intestine, and the permeation function of PAA-Cys-6MNA was not influence by the pH of the storage environment and the oxidation of air after the protecting group 6MNA was grafted. The distribution of tight junction protein of Caco-2 cell monolayer F-actin was influenced after incubation with PAA-Cys and PAA-Cys-6MNA. In conclusion, stabilized thiomers (PAA-Cys-6MNA) maintained the permeation function compared with the traditional thiomers (PAA-Cys) and its stability was improved. The mechanism of the permeation enhancement function of the polymers might be related to their influence on tight junction relating proteins of cells.
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Objective To know the problems of reference factors,and then provide evidences for scientific and specific identifying index system for students from poor families.Methods Questionnaires were used among 719 students from poor families.Results There were 86.0％ families whose earnings were lower than 410 RMB per month.57.2％ families depended on agriculture.70.1％ students were from the rural areas.Family member number was 4～6 for the majority ( 70.7％ ).91.2％ ( 94.5％ ) fathers'( mothers' ) education levels were under high middle school.64.0％ ( 67.3％ )fathers ( mothers ) were farmers.The proportion of students having computers was 76.1％.61.2％ students' life was not frugal.There were 80.9％ students who thought campus cards shouldn't be monitored.Conclusion Family economic situation should be the key indicator.Most of the basic family information could be reference factors.Basic situation of students at school was inappropriate to be reference factors.
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1. The frontal sinuses of 250 skulls of Chinese male adults were investigated. Ac-cording to the number of the frontal sinuses, the skulls were classified into five types. Type Ⅰ. no frontal sinus. Type Ⅱ. one frontal sinus (either left or right). Type Ⅲ. two frontal sinuses (one on each side). Type Ⅳ. three frontal sinuses (two left, one right, & vice versa). TyPe Ⅴ. four frontal sinuses (two on each side). 2. The degrees of superior, lateral and posterior extensions of the frontal sinuses inmost cases were grossly symmetrical. 3. It was found that two frontal sinuses were extended posteriorly over the orbitto near the greater and lesser wings of the sphenoid bone. 4. The degree of prominence of the superciliary arches was neither the indicationof the presence of the frontal sinuses nor the estimation of its extension or size. 5. The thickness of the anterior wall of the frontal sinuses was within 0.8--3 mm(89.4% on the left, 84.6% on the right), and the thickness of its septum fluctuated be-tween 0.1--2 mm (70.4%). The septa of all metopic skulls were divided into two partsby the suture. 6. The invading cells and the recesses of the frontal sinuses were studied, classifiedand discussed. 7. The position of the openings of the naso-frontal duct was as follows: 1. drain-age into the ethmoid infundibulum 49.5%. 2. drainage into the frontal recess 26.2%. 3.drainage into the frontal pit 20.5%. 4. drainage into the supra-bulla region 3.8%.
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A total of 30 cats were used in this experiment.The nucleus raphe magnus wasinjected with 0.1～0.3?l of 25～50% HRP solution(RZ:2.4～3.1).Two or three daysafter operation,the animals were killed and then perfused with the fixing fluid.Thebrainstem and spinal cord were sectioned serially on a freezing microtome and treatedaccording to the method of retrograde axonal transport of horseradish peroxidase.Parts of the sections were counterstained with toloidine-blue.The labelled neuronswere examined microscopically under bright-field and dark-field illumination Thelabelled neurons were distributed as follows.After injections of nucleus raphe magnus,a few labelled neurons were foundin the medial part of parafascicular nucleus of the thalamus.A greater numbers oflabelled cells were consistently found in the ventrolateral area of the central greymatter of the midbrain.The dorsal nucleus of the midbrain raphe had a few labelled neurons.The HRPpositive neurons were found in the nucleus Darkschewitsch,mesencephalic reticularformation,nucleus reticularis gigantocellularis,nucleus reticularis paramedianus,nucleus vestibularis medialis and nucleus vestibularis lateralis.In some cases a fewlabelled cells were also seen in the posterior area of hypothalamus,nucleus posteriorcommissure,nucleus tegmentalis dorsalis,superior collicus,nucleus annularis,reticularformation of the pons,nucleus nervi facialis and nucleus gracilis.In summary,the present studies show that the afferent connections of nucleusraphe magnus are widely concerned with the structures of the pain control.Itsuggests that the nucleus raphe magnus is an important relay station for pain control.