Objective:In the reform process, to improve the force, small hospital comprehensive strength, must find a way of hospital development. Methods: the introduction of local funds, powerful combination, common development. Results:At the beginning of 2009, provided by the hospital site, the investment invested 9000000 yuan to build 8400 square meters, medical center, in 2010 invested 80000000 yuan, construction of 52000 square meters, set more than 1000 bed sheets, more than 30 new departments of surgery complex, after 2011, is expected to finance the nearly two hundred million, the purchase of 128 row CT high-grade large and medium-sized equipment and facilities more than 3000 Taiwan (sets), make the hospital more the last step. Conclusion:Hospital development, the talent, technology, capital and many other factors, how to do, only out of bottleneck, the introduction of local funds, strengthen their connotation construction, enabled the hospital to promote a long development.

Objective To observe histomorphology of neo-cartilage obtained with tissue-engineering by combining calcium alginate gel and in vitro cultrue of chondrocytes. Methods Articular chondrocytes from the knee joints of 2-week-old New Zealand white rabbits were harvested, expanded in cell culture, and following the second generation of the culture, the chondrocyte suspension was mixed with calcium alginate gel resulting in a cell density of 5? 10 6/ml. Finally the mixture, which contained 1％ sodium alginate, 40 mmol/L calcium gluconate, 0.135 mol/L NaCl, 0.1 mol/L K 2HPO 4 and 5? 10 6 chondrocytes per milliliter, were injected into the dorsal subcutaneous tissue in rabbits of experimental groups (A and B). Animals of the control groups (C and D) were injected with calcium alginate without chondrocytes or chondrocytes without calcium alginate. Specimens were harvested at the 2nd and 4th week after injection, and stained with HE and toluidine blue. Results In the HE stained specimens in the experimental groups, proliferation of chondrocytes was demonstrated at the 2nd week and the formation of neo-cartilage at the 4th week after injection of calcium alginate chondrocyte-composite. Toluidine blue stained specimens showed positive staining of chondrocytes and cartilage matrix of neo-cartilage. In some animals injected with chondrocytes without calcium alginate, relative small amount of neo-cartilage was also formed and no neo-cartilage was observed in animals injected with calcium alginate without chondrocytes. Conclusion Injectable calcium alginate-chondrocyte-composite can induce tissue engineered neo-cartilage in allogenic animal.

Objective To investigate the effects of different operation methods for the treatment of distal tibial pilon fractures.Methods 40 cases of distal tibial pilon fractures were randomly divided into study group and control group,each of 20 cases.The research group used percutaneous insertion of the distal tibia locking plate internal fixation,the control group used the traditional open reduction and anatomical locking plate fixation.The average healing time,the incidence of complications and high rate of fracture healing were compared between the two group.Results The average healing time of the fracture study group(3.0±0.2)months was significantly shorter than that in the control group(4.0±0.3)months.Complication rate in the study group 5.0％ was significantly lower than that in the control group 35.0％.Fracture healing rate of study group 95.0％ was significantly higher than that of control group 65.0％.There was significant difference(P＜0.05).Conclusion The insertion of percutaneous locking plate fixation in the treatment of distal tibia has less trauma,simple operation,ankle joint function recovery,and the complication rate is low.

Objective:To explore the application of cannulating the ischemic femoral and right axillary artery in Sun’s procedure for acute type A aortic dissection with lower extremity ischemia.Methods:Twelve patients of acute Stanford type A aortic dissection complicated by lower extremity ischemia were analyzed retrospectively between July 2017 and May 2019, and the right axillary and ischemic femoral artery were used for cardiopulmonary bypass. All the 12 patients were male and categorized as the complicated Stanford type A aortic dissection. The mean age was(48.4±8.4)years, and the median time from symptom onset to emergency operation was 24.00(18.50, 43.25)hours. Eleven patients presented with unilateral extremity ischemia, while bilateral extremity ischemia occurred in one. The prosthetic vessel, with a diameter of 8 mm, was anastomosed to the ischemic femoral artery via an end-to-side way. Both the right axillary artery and the prosthetic vessel were cannulated for CPB. For the proximal dissection in this cohort of patients, we performed Bentall procedure in 5 cases, ascending aortic replacement in 3, and the aortic valve commissure reconstruction with ascending aortic replacement in 4. Total arch replacement with stented elephant trunk implantation were carried out for arch and descending aortic lesion in 12 cases.Results:Early mortality was 8.3%(1/12). The time of CPB, aortic clamp, circulatory arrest, and selective cerebral perfusion averaged(204.6±26.3) min, (114.6±16.6) min, (23.4±8.5) min, and(33.5±11.0) min, respectively. Five patients underwent concomitant bypass procedures, including: ascending aorta-bilateral femoral artery bypass in 1, ascending aorta-right femoral artery bypass in 3, ascending aorta-left femoral artery bypass in 1. Acute renal failure with continuous renal replacement therapy occurred in 4 cases, re-thoratomy for hemaostsis in 1, and re-intubation in 1. One patient developed osteofascial compartment syndrome after aortic repair, and consequent left lower extremity compartment fasciotomy was performed. The mean follow-up time was(17.2±7.6)months, and no aortic-related adverse event was detected during follow up.Conclusion:To acute Stanford type A aortic dissection with lower extremity ischemia, cannulating the ischemic femoral and right axillary artery in Sun’s procedure were associated with lower perioperative mortality and better prognosis.

This article summarized the experience of Professor Xiong Jibai,a national TCM master,in treating pulmonary nodules based on the theory of"body fluids and blood stasis mixing"in Huang Di Nei Jing.Professor Xiong Jibai believes that the basic pathogenesis of pulmonary nodules is that"body fluids and blood stasis mixing"accumulate in lung collaterals,and the fundamental pathological factor is phlegm and blood stasis.Xiong's treatment is based on dissipating phlegm and activating qi,activating blood circulation and resolving masses,paying attention to syndrome differentiation and treatment,examining syndromes and seeking causes,flexibly selecting prescriptions and treating both symptoms and root causes;attaching importance to maintaining healthy qi,preventing both illness and change,and preventing recovery after illness.Clinical medical records were attached to prove the clinical thinking and medication characteristics.

Objective To investigate the mechanism of Gastrodiae Rhizoma-Salviae Miltiorrhizae Radix et Rhizoma drug pair in the treatment of hypertension based on the network pharmacology method and animal experiment verification.Methods(1)TCMSP,BATMAN and TCMIP databases were used to screen the active components and targets of Gastrodiae Rhizoma-Salviae Miltiorrhizae Radix et Rhizoma drug pair.The hypertension-related targets were obtained by searching the Drugbank,Genecard,TTD and Disgenet databases.The intersection(common target)of the active component target and the target related to hypertension disease was taken,and the obtained intersection target was the potential target of Gastrodiae Rhizoma-Salviae Miltiorrhizae Radix et Rhizoma drug pair for the treatment of hypertension.The active ingredients and their targets of Gastrodiae Rhizoma-Salviae Miltiorrhizae Radix et Rhizoma drug pair were imported into Cytoscape 3.9.1 software to construct a'Chinese medicines-active ingredients-targets'network and screen key active ingredients.The protein-protein interaction(PPI)network of potential targets was constructed to screen potential core targets.The Metascape platform was used to analyze the GO function and KEGG pathway enrichment of potential targets.The key active components and potential core targets were selected for molecular docking verification.(2)Thirty male spontaneously hypertensive rats(SHR)were randomly divided into model group,western medicine group(Candesartan Cilexetil,0.72 mg·kg-1)and low-,medium-and high-dose groups of Gastrodiae Rhizoma-Salviae Miltiorrhizae Radix et Rhizoma(2.25,4.50,9.00 g·kg-1).Another male WKY rats were selected as blank group,with 6 rats in each group,once a day for 8 weeks.The systolic blood pressure of rat tail artery was detected before administration and 2,4,6 and 8 weeks after drug intervention.The pathological changes of thoracic aorta were observed by HE staining.The protein expression levels of GRP78,CHOP and Caspase-12 in aorta abdominalis were detected by Western Blot.Results(1)A total of 83 active components of Gastrodiae Rhizoma-Salviae Miltiorrhizae Radix et Rhizoma were obtained,and 158 potential targets(intersection targets)for the treatment of hypertension were screened out.Five key active ingredients:p-hydroxybenzoic acid,4-hydroxybenzylamine,tanshinone I,tanshinone,γ-sitosterol;6 potential core targets:IL6,TNF,CASP3,JUN,PTGS2,IL1B;GO functional enrichment analysis obtained 1 826 biological process items,89 cell component items,and 199 molecular function items.KEGG pathway enrichment analysis obtained 186 pathways,mainly involving neuroactive ligand-receptor interaction,calcium signaling pathway,inflammatory response(such as TNF and MAPK signaling pathway),vascular protection(such as HIF-1 and cAMP signaling pathway),oxidative stress(such as PI3K-Akt signaling pathway)and other signaling pathways.Tanshinone I and tanshinone had strong binding force to 6 potential core targets,and γ-sitosterol had strong binding force to IL6,CASP3,JUN,PTGS2 and IL1B.(2)Compared with the blank group,the systolic blood pressure of the model group was significantly increased(P＜0.01).The thoracic aortic endothelial injury was obvious,the endothelial cell morphology was abnormal,swelling and exfoliated cells could be seen,the intima of the tissue was disordered,the intima structure was incomplete,and the intima was thickened.The protein expressions of GRP78,CHOP and Caspase-12 in abdominal aorta were significantly increased(P＜0.01).Compared with the model group,the systolic blood pressure of the rats in the administration group was significantly decreased(P＜0.01);the injury of thoracic aorta was alleviated,and the morphology,intima structure and thickness of endothelial cells were improved to varying degrees.The protein expressions of GRP78,CHOP and Caspase-12 in abdominal aorta were significantly decreased(P＜0.01).Conclusion Gastrodiae Rhizoma-Salviae Miltiorrhizae Radix et Rhizoma drug pair may act on core targets such as IL6,TNF,CASP3,JUN,PTGS2,and IL1B through key active components such as p-hydroxybenzoic acid,tanshinone,and γ-sitosterol,and regulate key signaling pathways such as TNF signaling pathway,MAPK signaling pathway,PI3K-Akt signaling pathway,and PERK signaling pathway to improve vascular endothelial dysfunction,inhibit endoplasmic reticulum stress,and lower blood pressure.

Objective To confirm the impact of renal malperfusion on early and late outcomes of patients undergoing sur-gery for type A aortic dissection(TAAD). Methods From June 2011 to July 2012,a total of 165 TAAD patients undergoing surgery in hospital were enrolled and divided into 2 groups based on the results:research group(complicated with renal malper-fusion),control group(without renal malperfusion). A cohort follow-up project was conducted among these patients. The pri-mary outcome was all-cause death. Baseline and operative characteristics,early and late outcomes were analyzed to assess difference between 2 groups. Cumlative survival rates within 72 months among the 2 groups was described with Kaplan-Meier curves. Cox proportional hazards model was used to estimate the hazard ratios(HR)and 95％ confidence intervals(95％ CI)of late mortality among the 2 groups. Results Renal malperfusion was detected in 38(23. 0％)of 165 TAAD patients. 30-day mortality was 15. 8％ and 3. 9％ in patients with and without renal malperfusion(P < 0. 05),respectively. The mean follow-up period was(67 ± 3)months,late survival was 68. 4％ in patients with renal malperfusion and 88. 2％ in patients without(P <0. 05). By Cox proportional hazards model,after adjusting forage,sex,group(acute or chronic),presence of cardiac tampon-ade,brachiocephalic vessels involvement,coronary arteries involvement,root replacement,total arch replacement,concomitant coronary artery bypass grafting(CABG)and other organ-malperfusion,when compared to the control group,the HR(95％ CI) of late mortality was 5. 18( 1. 07 - 5. 18)in the research group. Besides renal malperfusion,concomitant coronary artery bypass grafting was presented as an independent risk factor of long-term survival(HR = 10. 08,95％ CI:2. 28 - 44. 62,P = 0. 002). Conclusion Coexistence of renal malperfusion is associated with a substantially increased risk of death in patients undergoing surgery for TAAD. A more exact stratification that weight every malperfusion-affected organ but not base on the number of malp-erfusion-affected organ simply may be more helpful to TAAD patients with malperfusion syndrome.

Objective:To evaluate the application of moderate hypothermia circulatory arrest(MHCA)with a higher temperature(29℃) and bilateral selective antegrade cerebral perfusion(bSACP) in acute Stanford type A aortic dissection(TAAD] treated by total arch replacement with stented elephant trunk implantation.Methods:From July 2019 to January 2020, fifteen patients of acute TAAD undergoing emergent operations via MHCA with a core temperature of 29℃ and bSACP were analyzed retrospectively(modified group), and 26 patients treated by MHCA(25℃) and unilateral selective antegrade cerebral perfusion(uSACP) during the same period were defined as the traditional group. All cases were complicated type A dissection. The mean age in this cohort was 49 years, and 32 patients(78%) were male. Thirty six patients(87.8%) suffered from arterial hypertension. The proximal manipulations included: aortic sinus repair in 13 cases(31.7%), ascending aortic replacement in 29(70.7%), Bentall in 12(29.3%). Total arch replacement with stented elephant trunk implantation was performed in all cases.Results:The in-hospital death occurred in 2(4.9%), and cerebral infarction in 3(7.3%), transient neurologic deficit in 5(12.2%), paraplegia in 2(4.9%). The ratios of above-mentioned adverse events in the traditional and modified group were[2(7.7%) vs. 0, P=0.524], [3(11.5%)vs. 0, P=0.287], [4(15.4%) vs. 1(6.7%), P=0.636], [1(3.8%) vs. 1(6.7%), P=1.000] respectively. The major adverse events in the modified group were transient neurologic deficit and paraplegia in 1 each. Compared with the traditional group, the time of operation, CPB, cardiac arrest, circulatory arrest of the lower part, anterograde low flow cerebral perfusion, mechanical ventilation and ICU stay was shorter. The drainage of 48 hours after surgery was less also. The differences in new acute renal failure requiring CRRT and re-sternotomy for bleeding between groups were not statistical significance. Conclusion:The early results of MHCA(29℃) and bSACP applied in total arch replacement with stented elephant trunk implantation for acute TAAD were satisfactory. The time of mechanical ventilation and ICU stay was shorter in the modified group, and the drainage of 48 hours after surgery was less also.

Objective To explore the relationship between single nucleotide polymorphism (SNP) locus rs1058587,rs1059519 and rs1059369 polymorphisms of growth differentiation factor-15 (GDF-15)gene and susceptibility to chronic Keshan disease in Gansu Province.Methods Using the case-control study method,56 individuals with chronic Keshan disease were taken as case group,and 53 individuals without chronic Keshan disease from the same villages were selected as control group in Gansu Keshan disease areas,venous blood samples were collected,and ethylenediamine tetraacetic acid disodium salt (EDTA) was used for anticoagulation,and the samples were sent for gene sequencing.Univariate and multivariate logistic regression analyses were conducted to analyze the influence of genotypes of rs1058587,rs1059519 and rs1059369 on the prevalence of chronic Keshan disease,and the risk factors for disease were expressed as odds ratio (OR).Results The age of the 56 patients in the case group was (60.93 + 21.99) years old,15 males and 41 females;the age of the 53 residents in control group was (47.49-+ 33.61) years old,26 males and 27 females.There was no significant difference in age between the two groups (t =46.16,P ＞ 0.05);the difference in gender was statistically significant (x2=5.76,P ＜ 0.05).The differences of allele frequencies of case group and control group rs1058587 (C:36.6％,32.1％,G:63.4％,67.9％),rs1059369 (A:61.6％,72.6％,T:38.4％,27.4％) between the two groups were not significantly different (x2 =0.50,3.00,P ＞ 0.05);the differences of allele frequencies of GDF-15 rs1059319 (C:25.0％,40.6％,G:75.0％,59.4％) between the two groups were significantly different (x2 =6.01,P ＜ 0.05).The genotype frequency distribution of GDF-15 gene rs1058587,rs1059519 and rs1059369 in the case group and the control group was not significantly different between the groups (P ＞ 0.05).However,in the case group,the mutant GG frequency of rs1059519 locus was higher than wild type CC (x2 =5.33,P ＜ 0.05).In multivariate logistic regression analysis,women were 3.81 times more likely to suffer from chronic Keshan disease than men,and people aged 45 or older were 5.30 times more likely to suffer from chronic Keshan disease than those younger than 45.The heterozygous and mutant types of GDF-15 gene rs1058587 and rs1059369 were compared with wild type,and the difference was not statistically significant (ORrs1058587 =0.46,0.50,ORrs1059369 =1.30,2.59,P ＞ 0.05);there was no significant difference between the heterozygous type of GDF-15 gene rs1059519 and wild type (OR =3.34,P ＞ 0.05),and the difference between the mutant and wild type was statistically significant (OR =8.58,P ＜ 0.05).Conclusions In this study,we find women of the study population are more likely to have chronic Keshan disease than men,and aged≥45 is a risk factor for chronic Keshan disease.Genetic polymorphisms of GDF-15 gene rs1058587,rs1059369 are not associated with susceptibility to chronic Keshan disease,and a certain correlation between genetic polymorphism of rs1059519 locus and susceptibility to chronic Keshan disease.