Aortic dissection has been remained highly lethal by far,especially for those involving the aortic arch.Many ways have been tried to tackle with aortic arch lesions including open surgery,endovascular therapy and hybrid procedure.Among them,surgical replacement of aortic arch seems to be the most promising on account of its long-term follow-up.However,there is still no uniform surgical procedure for aortic arch replacement.And surgical complications often occur due to its complex anatomical structures.Accordingly,many surgical procedures aiming at simplifying the procedure and lowering the risk of the operation have been raised.This article will introduce these new ways by reviewing related literatures and making brief comments.

There are a variety of inherited metabolic diseases (IMD), the incidence is low and clinical manifestations are not char-acteristic. IMD primarily affect not only the nervous system, but also the blood system, which characterized by the abnormalities of blood cells and bone marrow. Because of some clinician's lack of this knowledge, some patients are prone to be misdiagnosed. To pro-mote early diagnosis, this article reviews five groups of IMD (lysosomal storage disease, vitaminopathies, organic aciduria, amino-acidopathies and others) and different hematological abnormal manifestations.

Based on the language problem and cultural background difference of foreign medical students,we applied Problem-based Learning in their pediatric clinic probation teaching. This method could raise students learning activeness,enhance self-teaching ability and cultivate individual clinical thinking,which is a beneficial trial in medical foreign students educational practice.

In the clinical practice of foreign students in neonatal department,the experimental group followed PBL method,while the control group took traditional "master and disciple" way. The performance records of the clinical examination and questionnaire findings are significantly different between the two groups,which confirms that PBL is a good method to be widely used in the foreign students'pediatric clinical practice.

Objective To study the prevalence of perinatal chlamydia trachomatis infection in the city of Chongqing. Methods First void urine (FVU) samples and cervical smear from 512 pregnant women (gestational age≥28 weeks) were collected. According to the “expanded gold standard”, the methodologic indices were compared between Gap LCR ELISA using plasmid probes and omp1 probes on FVU and cervical smear, respectively. Results (1) CT infection in pregnancy is usually asymptomatic. Forty two CT positive cases were confirmed by “expanded gold standard” indicating a prevalence of CT infection in pregnant women in Chongqing was 8.20%(42/512). Among these 42 women, 37 (88.1%) were detected from both FVU and cervical smear, while positive results were shown in 4 cases (9.5%) from cervical smear and only one case (1/42) 2.4% from FVU . (2) The sensitivity of Gap LCR ELISA using plasmid probes and ompl probes were 90.48% and 71.43% ( P 0.05). The specificity of all Gap LCR ELISA tests were 100%. Conclusions FVU plasmid Gap LCR ELISA is a noninvasive, highly sensitive and specific method which is suitable for large scale screening for perinatal CT infections in pregnant women in developing countries and regions.

Objective:To investigate and analysis the distribution situations of Rh blood group system from voluntary blood donors in Foshan area.Methods:Anti-D,anti-C,anti-c,anti-E and anti-e reagents were used to identify Rh blood group system and the RhD(-) was confirmed.The phenotypes,haplotypes and corresponding genotypes frequencies were calculated and the datas were analyzed based on Hardy-Weinberg law.Results:The characteristics of phenotype frequencies in the voluntary blood donors in Foshan area was CCDee＞CcDEe＞CcDee＞ccDEE＞ccDEe＞CCDEe＞CcDEE＞ccdee＞ccDee,Ccdee＞CCdee,ccdEe＞CCDEE,CCdEE,CCdEe,CcdEE,CcdEe and ccdEE.The characteristics of haplotypes frequencies was CDe＞cDE＞cDe＞CDE,de＞Cde＞cdE＞CdE.The characteristics of genes frequencies was D＞d,C＞c,e＞E.The frequency of RhD(-)phenotype was 0.379%.The gene frequency of d was 0.061.The observed value and desired value of the haplotypes and corresponding genotypes were not statistically significant(P>0.05).The data were analyzed well based on Hardy-Weinberg law.Conclusion:The result is reliable according to Hardy-Weinberg law.The distribution of Rh blood group system from voluntary blood donors in Foshan area has geographic and general characteristics.The result is important in guiding the recruitment of voluntary blood donors and banking blood reasonably and enhancing the abilitiy of offering blood for the recipients of rare blood group.

Objective To evaluate the efficacy of narrow-band imaging (NBI) in diagnosis of color-ectal neoplasm. Methods A total of 96 colorectal neoplasm from 78 patients were observed under NBI, and the findings were compared with those from magnifying chromo-endoscopy and pathologic examinations. Re-suits The sensitivity of conventional colonoscopy in diagnosis of polyps was 78. 7%, which was increased to 99% (P < 0. 05) under NBI, with the clear identification of the shape and boundary of the lesions. Magnif-ying NBI colonoscopy provided images of pit patterns similar to those from chromo-endoscopy in diagnosis of type Ⅱ , ⅢL, Ⅳ and ⅤN, which showed better recognition than conventional colonoscopy, but less sensitiv-ity than chromo-endoscopy. Superficial vascular morphologic features could be better classified with NBI, with sensitivity of 100% and specificity at 87. 8%, which was superior to conventional colonoscopy but infe-rior to chromo-endoscopy. Conclusion Both chromo-endoscopy and NBI colonoscopy have better sensitivity and specificity in detection of colon polyps, while chromo-endoscopy reveals clear superficial structure of le-sion and pit pattern, and NBI demenstrates capillary morphology, which can distinguish neoplasm from non-neoplasm colorectal lesions. NBI, easy and convenient to switch, is an effective technique to make early di-agnosis of colorectal neoplasm.

To investigate the plasma thioredoxin-interacting protein ( TXNIP ) levels in different glucose tolerance groups and discuss the relationship between TXNIP and insulin resistance/β-cell dysfunction in diabetes and prediabetes, and to investigate the potential relationship between TXNIP and interleukin-1β( IL-1β) . According to oral glucose tolerance test, 93 participants were divided into 3 groups:diabetes mellitus group, prediabetes group, and normal glucose tolerance group. Plasma TXNIP, IL-1β, and other biochemical indices were measured. The relationship between TXNIP and glucose, IL-1β, homeostasis model assessment for insulin resistance ( HOMA-IR) , and homeostasis model assessment forβcell function ( HOMA-β) were analyzed by using multiple linear regression techniques and Pearson’s linear correlation analysis. Plasma TXNIP level was higher in prediabetes group compared with normal glucose tolerance group, but lower in prediabetes group compared with diabetes mellitus group[(355. 35±31. 88 vs 274. 36±33. 86, 426. 16±63. 15)pg/ml, P<0. 01 or P<0. 05]. TXNIP was positively correlated with IL-1βand HOMA-IR, but negatively correlated with HOMA-β. Multiple linear regression analysis indicated that IL-1βexerted significant influence on TXNIP ( P<0. 05 ). Plasma TXNIP level is affected by blood glucose concentration. There is a close relationship between TXNIP and IL-1β. In prediabetes patient, the TXNIP levels have already been raised.

ObjectiveTo establish a practical and effective clinical pathway (CP) for the etiological diagnosis of acute biliary pancreatitis.MethodsA total of 2216 patients enrolled were randomly divided into control group (n =1120) and CP group (n =1096) according to different etiological diagnosis methods including following doctor's established experiences and habits and the designed CP in our study.ResultsThere was no significant difference in baseline data between the two groups.The etiology of acute pancreatitis was determined in 91.1％ (999/1096) of cases in the CP group which was significantly higher than the control group (65.5 ％,734/1120),P ＜ 0.05.The enhanced etiological determination of CP group was mainly consisted of the increased detection of biliary stones,duodenal diseases as well as pancreas divisum,P ＜ 0.05.The positive etiological determination of magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography in the CP group were 59.1％ (273/462) and 86.0％ (98/114),respectively.ConclusionsThe CP established in this study significantly enhances the biliary etiological determination of acute pancreatitis. It is easy to be conducted and may be of importance to improve the quality of etiological diagnosis of acute pancreatitis.

Objective To analyse the risk factors for lymph node metastasis of early colorectal cancer and the therapeutic indication for endoscopy.Methods The clinical data of the 269 early colorectal cancer patients who underwent surgical treatments between January 2009 and December 2013 in the West China hospital of Sichuan University were analyzed retrospectively.Pathologic features were compared between different histological types and investigated by univariate and multivariate analysis of their possible risk factors for lymph node metastasis.Results Univariate analysis showed that tumor size (P =0.029),depth of tumor invasion (P =0.006),histological type (P =0.000) and lymphatic involvement (P =0.035) were correlated with lymph node metastasis.Multivariate analysis revealed that tumor size (OR =5.385,95％ CI:1.156-25.075,P =0.032)and histological type (OR =5.145,95％ CI:1.553-17.053,P =0.007) were independent risk factorsfor lymph node metastasis.Comprehensive analysis showed that lymph node metastasis could not be found in patients with tumor invading the mucous layer.However,lymph node metastasis occurred if the tumor invaded the submucous layer.The larger and less differentiated tumor was,the higher occurrence of lymph node matastasis would be (P ＜ 0.05).Conclusion Endoscopic resection is recommended for those with early colorectal cancer localized in the mucous layer and without lymph node metastasis.It is recommended that patients with submucosal carcinomas undergo a preoperative endoscopic ultrasonography or pathological screening for the most appropriate surgical treatment,as the larger and the lower differentiated the tumor is,the higher chance the lymphatic metastasis is.