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@#Objective To evaluate the clinical efficacy of two-stage retrograde hybrid repair for acute aortic dissection involving the aortic arch complicated with distal malperfusion syndrome. Methods From May 2019 to December 2022, the patients presented with acute aortic dissection involving the aortic arch complicated with distal malperfusion syndrome treated in the Department of Cardiovascular Surgery of West China Hospital, Sichuan University were enrolled. After preoperative evaluation, all patients underwent priority emergency interventional surgery to improve distal malperfusion, and then underwent two-stage hybrid surgery to repair proximal aortic lesions. The perioperative clinical and imaging data were retrospectively analyzed. Results Five patients were collected, including 4 males and 1 female, with a median age of 58 years. The main manifestations were lower limb ischemia and renal insufficiency in 3 patients, and poor intestinal perfusion in 2 patients. All patients were given priority to interventional surgery to implant graft stents or bare stents and necessary branch artery intervention, and then successfully performed two-stage hybrid surgery, including type Ⅰhybrid surgery for 2 patients, type Ⅱ hybrid surgery for 1 patient and type Ⅲ hybrid surgery for the other 2 patients, with a success rate of 100.0%. All patients were discharged successfully, and the function of the organs with poor perfusion returned to normal. Only 1 patient recovered to grade 4 muscle strength of the diseased lower limbs upon discharge. No adverse events such as amputation, exploratory laparotomy and intestinal resection or long-term hemodialysis occurred. Conclusion The application of two-stage retrograde hybrid repair in the surgical treatment of acute aortic dissection involving the aortic arch complicated with distal malperfusion syndrome is safe and effective, and is helpful to improve the perioperative survival rate, and clinical outcomes of such patients.
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ObjectiveTo investigate the possible mechanism of Fugan Huaxian Decoction (扶肝化纤汤, FHD) against hepatic fibrosis (HF) from the perspective of immunity. MethodsForty-eight SD rats were randomly divided into blank group, model group, colchicine group, FHD high-, medium- and low-dose group, with eight rats in each group. Except for the blank group, the disease-syndrome combined model of HF with healthy qi deficiency and toxin accumulation pattern was established during six weeks in the other five groups. After successful modeling, the high-, medium- and low-dose FHD groups were respectively given 37.5, 18.75 and 9.38 g/(kg·d) of FHD granules by gavage, while the colchicine group received 2 mg/ (kg·d) of colchicine tablets by gavage, and the blank group and the model group were given 10 ml/(kg·d) of purified water, all for 3 weeks. The general condition of the rats was recorded. After the treatment, the histopathological morphology of the liver was observed by HE staining, and the levels of interleukin 10 (IL-10) and interleukin 17 (IL-17) in serum were determined by enzyme-linked immunosorbent assay (ELISA). The expression of helper T cells 17 (Th17) and regulatory T cells (Treg) in peripheral blood were detected by flow cytometry, and the Th17/Treg value was calculated. The mRNA expression of retinoic acid-related nuclear orphan receptor γ (RORγt) and fork-head/wing-like helix transcription factor (FoxP3) in liver tissue were detected by qRT-PCR. ResultsCompared to the general condition of rats in the blank group, those in the model group were listless, less active, stretched and pushed, arched and prone, having no resistance to gavage, significantly reduced food intake, loose stools, dirty anus, slow weight gain, dry and dull hair, purple and darkening skin of the limbs with ecchymoses, purple and black spots with varying degrees of the skin of the tail; hepatic fibrosis and hyperplasia of rats in model group were more obvious; serum IL-17, peripheral blood Th17 expression and Th17/Treg value, RORγt mRNA expression in the liver tissue significantly increased in the model group, while expression of IL-10, Treg and FoxP3 mRNA significantly decreased (P<0.05 or P<0.01). Compared to those in the model group, the general condition of the rats and the liver fibrosis of HE stained liver tissue were improved in all the medication groups; the expression of IL-17 and Th17, Th17/Treg, and RORγt mRNA expression significantly decreased, while expression of IL-10, Treg, and FoxP3 mRNA increased in the high- and medium-dose FHD groups and the colchicine group; the expression of IL-17, Th17, and RORγt mRNA decreased, while the expression of IL-10 and FoxP3 mRNA increased in the low-dose FHD group (P<0.05 or P<0.01). And more improvements were found in the FHD high-dose group than FHD medium- and low-dose groups and colchicine group (P<0.05 or P<0.01). ConclusionFHD can may regulate immune balance and act against fibrosis by regulating the expression of specific transcription factors FoxP3 and RORγt, affecting the differentiation of Th17 and Treg cells and Th17/Treg balance, and regulating the secretion of IL-10 and IL-17.
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@#Patients with bicuspid aortic valve are often complicated with aortic dilatation. If the aortic valve is of good quality, aortic root replacement with aortic valve preservation is feasible. A 35-year-old male patient with bicuspid aortic regurgitation complicated with ascending aortic aneurysm underwent Remodeling+Ring (modified Yacoub) operation. Echocardiography showed that there was no aortic regurgitation on the 3rd day after operation, and the patient was discharged satisfactorily on the 6th day after operation. Remodeling+Ring surgery ensures the physiological movement of the aortic valve, solves the enlarged annulus, avoids the problems caused by valve replacement, and significantly improves the quality of life of patients, which is worth popularizing.
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@#Due to the abnormal structure and function of the cardiac valves, cardiac valve disease gradually appears the expansion of left ventricular inner diameter and volume. When the left ventricular end-diastolic dimension and volume expand severely, it becomes a giant left ventricle. Surgical valve replacement is still one of the main treatment methods for this disease. The degree of postoperative ventricular recovery is closely related to perioperative mortality and long-term prognosis. However, the existing clinical preoperative assessment methods still cannot accurately predict the degree of postoperative left ventricular recovery and long-term prognosis of such patients, so it is difficult to determine the optimal operation timing and surgical methods for patients. Therefore, we reviewed the existing literature and discussed different evaluation methods of the giant left ventricle associated with valvular disease before surgery, so as to optimize the perioperative treatment of such patients, clarify the timing of surgery and improve the prognosis.
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@#The conventional total arch replacement (cTAR) with frozen elephant trunk implantation is commonly regarded as the gold standard for aortic pathologies involving ascending aorta and proximal aortic arch. By combining open supra-aortic vessels debranching and emerging endovascular technologies, hybrid arch repair (HAR) has been increasingly performed as a promising alternative in risky patients with comorbidities and frailties. Nevertheless, the advantages or disadvantages of hybrid arch procedures and cTAR in terms of survival and related outcomes remain controversial. This study is aimed to briefly review the role and results of HAR in the management of aortic arch pathology in comparison of contemporary cTAR.
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Objective To compare the effect of electro-acupuncture(EA) and warm-needle moxibustion(WNM) on the foot three-dimensional gait time-space parameters and surface electromyography of post-stroke patients with flaccid paralysis. Methods A total of 61 patients were randomly divided into EA group (N=30) and WNM group(N=31). Both groups were given post-stroke conventional treatment, and additionally EA group received EA while WNM group was given WNM. Before treatment and after 2 treatment courses, we detected the foot three-dimensional gait time-space parameters of pace race, stance phase, swing phase, bilateral stance phase, and step length, and surface electromyography parameters of root mean square(RMS), integrated electromyogram (iEMG) and co-contraction ratio(CR) of tibialis anterior muscle and gastrocnemius at the state of maximal isometric voluntary contraction(MIVC). Results(1) After treatment, the foot three-dimensional gait time-space parameters of the two groups were improved in various degrees (P<0.05 or P<0.01 compared with those before treatment) , and the improvement of EA group was superior to that of WNM group (P < 0.05). (2) After treatment, the RMS and iEMG of the gastrocnemius and tibialis anterior muscle as well as CR of dorsal extensor at MIVC state were improved in various degrees (P < 0.05 or P < 0.01 compared with those before treatment) , and the improvement of EA group was superior to that of WNM group(P < 0.05 or P < 0.01). Conclusion WNM exerts better effect on improving the parameters of three-dimensional gait time-space parameters and surface electromyography of post-stroke patients with flaccid paralysis than EA.
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Objective To improve the teaching methods for doctor-patient communication skill of medical interns.Methods The present situation and the importance of doctor-patient communication were analyzed.The training model of doctor-patient communication was designed including the aspects of effective training content,training methods and assessment tools,etc.Totally 178 interns in our hospital between June and August 2013 were selected and were divided into two groups.The newly designed training model was applied in students in group A while routine training was applied in students in group B.Doctor-patient communication ability of interns was tested through writing instruments and on-the-spot communicating and investigating satisfaction degree of patients.SPSS 13.0 was applied to do statistical analysis and t test and Wilcoxon were used.Results Score of instrument writing and on-the-spot communication were higher in group A than in group B [Group A:(20.36 ±2.85),(21.18 ± 2.93) ; Group B:(14.79 ± 2.61) and (13.94 ± 3.07)],with statistically significant differences(P=0.000).In addition,according to a survey of 406 patients of group A,367 patients of group B,group A students' satisfaction degree after the training was significantly higher than that group B(59.85% vs.11.99%)(P=0.000).Conclusion The newly designed doctor-patient communication training model can enhance the doctor-patient communication skills.
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Objective To explore the clinical efficacy and side effects of paclitaxel combined with cisplatin chemotherapy for patients with locally advanced cervical cancer. Methods From May 2008 to May 2009,78 patients with locally advanced cervical cancer in our hos-pital were randomly divided into PF group (39 cases) and Taxol group (39 cases). Patients from PF group were treated with cisplatin com-bined 5-Fu while patients in Taxol group were cured with paclitaxel combined with cisplatin. After chemotherapy,all patients were given anes-thesia extensive hysterectomy and pelvic lymph node dissection. The clinical efficacy,side effects and three-year survival of 2 groups were as-sessed and compared. Results The main adverse reactions of PF group were gastrointestinal reactions,oral mucositis and bone marrow sup-pression;the major side effects of Taxol group were bone marrow suppression,oral mucositis and renal toxicity. After chemotherapy,the com-plete remission rate of Taxol group reached 30. 77%,which was higher than that of PF group 10. 26% (χ2 =5. 032,P=0. 025). The average survival time of PF group and Taxol group were 33. 5 months and 34. 7 months,the three-year survival were 59. 6% and 70. 2%,respectively (χ2 =1. 859,P=0. 173),and the difference was not statistically significant. Conclusion The adverse effects of different chemotherapy were observed in 2 groups. The clinical efficacy of Taxol group were better than that of PF group.
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Objective To explore the relationship between apolipoprotein E ( ApoE ) genotype and diabetic nephropathy (DN) in Chinese Han population of Guangdong province. Methods 63 cases of DN patients were selected as group A; 57 diabetes patients without complications as group B; 55 healthy persons as group C. ApoE genotype of all objects were measured. Results ApoE2 in the group A was the highest, while the differences in other groups were not obvious. Detection of ApoE3 and ApoE4 was not obvious in three groups. The Level of triglyceride (TG) was highest inε2 group, and the level of total cholesterol (TC) and low density lipoprotein LDL-C were highest in ε4 groups. Conclusions In Chinese Han population of Guangdong province , ApoE gene polymorphism and DN are closely interrelated , and the occurrence ofε2 is proportionate to DN.
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Browning of white adipose tissue(WAT) is expected to become a possible new therapeutic means for diabetes mellitus and other metabolic diseases in future,because brown adipose tissue (BAT) has attracted scientific interest as an anti-diabetic tissue owning to its ability to dissipate energy as heat.In this article,we reviewed the characteristics of brown fat cells,the major transcription factor and the stimulating factor during browning of WAT,as well as their potential mechanisms and research directions.
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Objective To analyze the epidemic situation of HPV among gynecology clinical cases and provide scientific support for control and prevention of squamous cell carcinoma .Methods Clinical cases with symptom of increased vaginal secretions and obscure vaginal bleeding and cases diagnosed with cervical squamous cell carcinoma or vaginitis and cervicitis were collected as ob-jectives for HPV testing .Samples were collected by maternity doctors for HPV DNA testing by using the reverse hybrid membrane technology gene chip .All data were analyzed by chi-square test and trend analysis(Z) method .Results 24 .64% of the 4 347 cases were positive for 23 kinds of HPV subtypes .Of the 23 subtypes ,the leading four detection rates were 16th ,43th ,58th and 52th sub-types ,which were 8 .10% (352/4 347) ,3 .93% ,3 .52% and 3 .31% respectively ,and shown significant higher than that of the other 19 subtypes .The detection rates of 6th ,11th ,18th ,33th and 56th subtypes were between 1% to 3% ,whereas the rates of other 14 subtypes were lower than 1% .The detection rates of all the age groups were between 16 .00% ~36 .72% ,and rose with the age in-creasing(Z=3 .32 ,P3 .83/6 .63 ,P< 0 .05/0 .01) .Conclusion The detection rate of 16th subtypes HPV was the highest for gynecology clinical cases ,secondly were the 43th ,58th and 52th subtypes .The detection rate of HPV was the highest in symptoms of increased vaginal secretions ,obscure vaginal bleeding and vaginitis .The detection rate rose with the age increasing .It was concluded that elderly cases with increased vaginal secretions ,obscure vaginal bleeding and vagi-nitis were the biggest targets for control and prevention of HPV and cervical squamous cell carcinoma .
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As the curriculum was unreasonable and teaching approac h was simple in the course of pharmaceutical analysis,the course curriculum was reconstructed and optimized to be more advanced and more scientific.Reasonable teaching approaches will be adopted according to different teaching contents and diverse teaching model which is benefit to the cultivation of students' innovative capability will be constructed.
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This study was aimed to compare the differences of adhesion properties of endothelial cells (EC) from arteries (AEC), veins (VEC) and capillaries (MVEC) under shear stress condition, and to explore whether they can get the same adhesive ability as graft in similar shear stress conditions. With mended parallel plate flow apparatus and peristalsis pump providing fluid shear stress used, endothelial culture models were established in vitro with the same environmental factors as steady culture. To compare the adhesion among three kinds of endothelial cells under dynamic condition and static condition, the dynamic change of cytoskeletal actin filaments and the effects of different adhesive proteins coated on the adhesion of EC to the glass were studied. The cultured endothelial cells under flow conditions were extended and arranged along the direction of flow. The adhesive ability from high to low under static condition were AEC, MVEC and VEC (VEC compared with AEC or MVEC, P < 0.05), sequentially. The adhesion of endothelial cells from variety sources under dynamic culture condition was significantly increased than that of the static groups. The ratio of cell retention was not significantly different between AEC and MVEC. But VEC was significantly different (P < 0.05) compared with AEC or MVEC. The actin filaments (F-actin) were bundled together and arranged along the direction of flow after fluid culture. Dense peripheral band (DPB) gradually disappeared and distinct stress fibers were formed, which even interconnected to form a whole in the MVEC. The adhesion of AEC, VEC and MVEC under shear stress conditions are more significantly increased than those under the static culture conditions, and the MVEC can achieve the same adhesion as AEC.
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Humanos , Arterias , Biología Celular , Capilares , Biología Celular , Adhesión Celular , Técnicas de Cultivo de Célula , Métodos , Células Cultivadas , Citoesqueleto , Fisiología , Células Endoteliales , Biología Celular , Fisiología , Resistencia al Corte , Estrés Mecánico , Venas , Biología CelularRESUMEN
Objectives To investigate the epidemiological and clinical characteristics of dyslipidemia as well as its treatment and influence on accompanying diseases in impaired glucose status among inpatients. Methods A cross-sectional survey was conducted among the inpatients registered in ten university hospitals of Guangdong, China during the week before the Diabetes Day in 2004. The fasting blood glucose (FBG), lipid profiles, BMI, waist to hip ratio (WHR) and concomitant disorders of the first screen during the hospitalization period were recorded. Those who had FBG level from 5.6 to 6. 9 mmol/L and not been previously diagnosed diabetes (PDM) underwent oral glucose tolerance test (OGTF). Results Of the 8753 inpatients investigated, 1067 eases had complete medical records(CMR case) including PDM cases and previously non-diagnosed diabetes ones with FBG ≥ 5. 6 mmol/L. Of the previously non-diagnosed diabetes cases with FBG levels from 5.6 to 6.9 mmmol/L, 65.8% accepted OGTT. Of the CMR cases, 41.9% had PDM, 21.7% was newly diagnosed diabetes mellitus (NDM), 29. 1% had impaired glucose regulation (IGR) and only 7.3% had normal glucose tolerance (NGT). The TG levels in NDM and PDM group were higher than those in IGR and NGT group (P < 0.05, respectively). The HDL-C levels in IGR, NDM and PDM group were lower than those in NGT group (P < 0.05, respectively). Sixty-nine point six percent of the diabetes mellitus (DM) inpatients was accompanied with dyslipidemia and the rate was higher than those in NGT (56.4%) and IGR inpatients (52.5%, P <0.05, respectively). Only 22. 8% of the PDM inpatients underwent treatment of dyslipidaemia and just 3.4% achieved the target suggested by the guideline of ATP-Ⅲ. BMI was higher and waistline longer in the PDM and NDM inpatients than those in the NGT cases (P <0.05, respectively). Seventy-two point eight percent of the PDM inpatients was complicated with more than one type of vascular diseases. Nine point seven percent and 0. 2% of the NDM inpatients were tormented by diabetic nephropathy and diabetic retinopathy respectively. Conclusions More inpatients with accompany DM or IGR had concomitant dyslipidemia than those with NGT, which included hypertriglyccridemia, hypo-high-density lipoproteinemia and metabolic syndrome. Concomitant vascular diseases were more frequently found in PDM inpatients than in the others. Some of the NDM and IGT inpatients were complicated with microvascular diseases.
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Objective To investigate whether the combination of glipizide-XL with glucophage was more rational in insulin resistance and insulin secretion in patients with type 2 diabetes mellitus(T2DM).Methods The changes of insulin resistance and insulin secretion were evaluated from variations of IAI(insulin sensitivity index),IR(insulin resistance index.),IS(insulin secretion index)and HBCI(B-ce1l function index)in cases treated with glipigide-XL and glucophage or either for 18 weeks.Results IAI\IR standing for insulin resistance were higher significantly,and IS & HBCI standing for insulin secretion were lower significantly in patients with T2DM than in normal group(P
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The resting cells of Citrobacter freundii 48003 3 expressing high tyrosine phenol lyase activity under the inducing of L tyrosine were used for L DOPA synthesis from catechol, pyruvate and ammonia In this paper, the effects of temperature, pH and substrate concentrations on the synthesis of L DOPA were studied At the optimal conditions of reaction, 9 5g/L of L DOPA was obtained in 12h