Objective To explore the relations between physiological retrogressive auricular fibrillation and organical pathological auricular fibrillation in elderly patients.Methods 36 cases paroxysmal auricular fibrillation in elderly patients without organical pathogeny were monitored for 24 hours using dynamic electrocardiogram.The attack time and frequency of paroxysmal auricular fibrillation,the change of heart rate,and other type arrhythmia complexing were analyzed.Results Most cases of paroxysmal auricular fibrillation in elderly patients were companied with arrhythmia,supraventricular arrhythmia occupy in the first place especially.The ventricle rate was slow in most cases.The attack had different rhythm in day and night,there were two flows and one edd in one day.Conclusion The elderly auricular fibrillation is associated with the physiological anaplasia of auricular muscle and artro-ventricular junction area directly.It also relates to the heighten excitability of pneumogastric nerve and secretive conduction.

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.

Purpose: To apply staged arteriovenous reversal in the treatment of extensive and diffuse arterial occlusive disease of the limb. To avoid amputation of the limb or to limit it to necrosed segments.
Methods: Exactly 138 patients (a total of 153 severely ischemic limbs) were applied staged arteriovenous reversal (AVR) from January 1984 to December 1995. Generic-specific involvement totaled 106 men and 32 women. Their ages ranged from 24 to 71, averaging 48.7 years. The duration of symptoms ranged from 15 days to 17 years. A total of 112 patients were diagnosed as having Buerger's disease, and 25 had arteriosclerosis. In one patient, the popliteal artery was completely obstructed by acute emboli of atheromatous plaques. Three patients with Buerger's disease had not benefited from lumbar sympathectomy or partial adrenalectomy done several years ago. According to different levels of extensive and diffuse arterial occlusion, arteriovenous reversal was formed at three different sites: (1) high-deep reversal, produced between the external iliac, common femoral, or superficial femoral artery and the superficial femoral vein; (2) low-deep reversal between the distal popliteal artery and tibioperoneal venous trunk; (3) superficial reversal, established between the distal popliteal artery and distal portion of the long saphenous vein.
Results: Until June 1996, a total of 132 patients were followed up for 0.5-12 years, averaging 6.5 years. The postoperative results of all limbs except 12 in this series are excellent or good. Cardiac dysfunction does not occur, nor does the marked elevation of venous pressure of the limb.
Conclusion: We consider that if the deep venous trunks are patent, the limbs with extensive arterial occlusion are indicated for staged AVR if severe ischemia is present and all other therapeutic methods have failed. Even with necrotic limbs, this operation may lower the level of amputation. The authors suggest that staged arteriovenous reversal is a new and effective approach in the treatment of extensive arterial occlusive disease of the limb.

Objective To analyze the epidemic characteristics of the hand-foot-mouth disease (HFMD) in four years before and after EV71 vaccine inoculation, and to provide a basis for better EV71 vaccination and prevention and control of HFMD. Methods The descriptive epidemiology method was used to analyze the monitoring data of HFMD from 2013 to 2020 and EV71 vaccination from 2017 to 2020 in Xinwu District of Wuxi City. Results A total of 9 589 HFMD cases including 104 severe cases (accounting for 1.08%) were reported in four years before EV71 vaccination, and the reported average annual incidence rate was 431.15/100 000. A total of 7 396 HFMD cases including 21 severe cases (accounting for 0.28%) were reported in four years after vaccine inoculation, and the reported average annual incidence rate was 325.28/100,000. Annual incidence rate and severe illness rate decreased significantly before and after vaccine inoculation. The HFMD incidences displayed two epidemic peaks, from May to June and from October to November. The three streets with the highest average annual incidence were Jiangxi, Meicun, and Shuofang. The HFMD cases were mainly children under 5 years old, and there were more men than women. A total of 394 samples were sent for examination from 2013-2020, and 231 were positive, with a total positive rate of 58.63%. There were significant changes in the etiological composition before and after vaccine inoculation. The composition of EV71 virus decreased significantly (χ²=69.70, P<0.05), while CA16 and CA6 increased significantly (χ²=22.35, P<0. 05). From 2017 to 2020, a total of 12 472 people were inoculated with EV71 vaccine in Xinwu District of Wuxi City, with estimated annual vaccination rates of 3.78%, 10.96%, 8.40% and 7.63%, respectively. Conclusion There is no significant change in time, region and population distribution of HFMD before and after EV71 vaccination in Xinwu District of Wuxi City, but the annual incidence rate and severe illness rate show a decreasing trend, and the dominant intestinal pathogens have changed. It is suggested to strengthen the use of EV71 vaccine and the development of multivalent HFMD-related vaccine.

Objective The purpose of this study was to assess the technical feasibility, safety and effectiveness of percutaneous transluminal angioplasty (PTA)for the treatment of severe limb ischemia caused by tibioperoneal arteries occlusion. Methods From June 2004 to May 2007,35 patients with critical limb ischemia (CLI)were treated on an intention-to-treat basis with tibioperoneal arterial PTA. Main outcome measures were technical success rate, primary patency rate, limb salvage rate and complications. Results The technical success rate of tibioperoneal arterial PTA Was 83%.Mean follow-up time was 11.5 months, primary patency rate and limb salvage rate were 57%and 82%,respectively.Mean length of tibioperoneal arterial PTA was 9.5 cm(4.5～14 cm),concurrent treatment of iliac artery or femoral-popliteal artery was carried out in 19 patients via either angioplasty or combined with stenting.There were three complications including arterial spasm and thrombosis in one, which Was relieved by thrombolysis and antispasmodics, and artery perforation in 2 cases, which was treated conservatively. Conclusion In tibioperoneal arterial occlusions in CLI patients, PTA is feasible with a high initial technical success rate and high limb salrage rate,tibioperoneal arterial PTA carries a lower morbidity and less severe complications. PTA is a safe, effective and good treatment alternative for CLI patients of tibioperoneal arterial occlusions.

Objective To investigate the effects of acitretin on T helper cell (Th) 1/Th2 balance and Th17 cells in psoriasis vulgaris (PV) patients. Methods A total of 13 men and 17 women with PV were investigated. 10 mg of acitretin was administered twice a day for 8 weeks for intervention therapy. Serum levels of interferon-gamma (IFN-γ), interleukin (IL)-4 and IL-17 were measured by enzyme-linked immunosorbent assay. T, Th1, Th2 and Th17 cells in skin biopsies were counted with double-labeled immunofluorescence. Psoriasis Area and Severity Index (PASI) score was calculated before and 8 weeks after treatment. Results Before treatment PV patients had higher serum levels of IFN-γ and IL-17, and increased T, Th1 and Th17 cells in skin biopsies. After treatment, both serum levels of IFN-γ and IL-17, and T, Th1 and Th17 cells infiltrating in PV skin decreased significantly. Th1/Th2 balance was restored to normal. However, their IL-4 and Th2 cells showed no significant change throughout the therapy. Conclusion Acitretin exerts influence on dermal Th1/Th2 balance and Th17 cell infiltration, so does it on production of systematic inflammatory cytokines IFN-γ and IL-17 in PV patients. However, Th2 cells and its derivative cytokine-IL-4 are not affected.

Objective To select omeprazole content changes smaller with dispensing method and to seek for rationality of off-label uses.Methods To measure content change of omeprazole sodium for injection mixed by different subscriptions at different time through HPLC, and compared effect of different dispensing methods on content of omeprazole sodium for injection.Results 10 mL 0.9%sodium chloride injection was chosed as dissolvent,the change of omeprazole sodium for injection content would be minor, and stability of drug solution was superior.Conclusion Dispensing methods of drug impact on its'security and validity, which is part of discuss category about medicine rational use as well.Off-label uses could not vest in unreasonable use, which should contingent on specific document,data and actual environment of medical treatment.

Objective To assess reconstructive options for critical limb ischaemia in infrapopliteal arteries. Methods A retrospective review of all CLI patients who underwent infrapopliteal reconstruction was carried out. Patient history, demographics, procedure details, complications, and follow-up information were collected and analyzed. Patency, limb salvage rate was determined by Kaplan-Meier analysis. Results During the period (from December 2003 to January 2008 ), 123 CLI patients with arteriosclerosis occlusions were treated on an intention-to-treat basis with infrapopliteal percutaneous transluminal angioplasty (PTA).Thirty-three thromboangiitis obliterans and twenty-three arteriosclerosis occlusions suffering CLI were treated by infrapopliteal bypass procedures. Primary patency and limb salvage rate of infrapopliteal PTA at 6, 12 and 24 months was 67%, 54%, 49% and 91%, 85%, 78% respectively, Primary patency and limb salvage rate of infrapopliteal surgical bypass at 6, 12 and 24 months was 90%, 83%, 79% and 92%,87%, 80% respectively, the patency of infrapopliteal PTA was lower than infrapopliteal surgical bypass (P ＜0. 01 ), but the limb salvage rate of infrapopliteal PTA and open surgery was no significant difference (P ＞ 0. 05 ). Conclusion Endovascular treatment (PTA) in patients with infrapopliteal arteriosclerosis occlusions and critical ischaemia is safe, effective. Infrapopliteal PTA can be used as the choice of therapy and surgical bypass reserved in those endovascular treatment failed. While in CLI patients with thromboangiitis obliterans infrapopliteal artery bypass remains the best treatment option.

Objective To determine the occurrence and clinical characteristics of ectopic pituitary adenoma (EPA) in China.Methods The study are done by searching systematically and comprehensively on major Chinese and English medical literature databases and conference papers before 2015,which are only limited to collected,summarized,sorted and analyzed EPA cases that reported by Chinese authors in English or Chinese occurred in China.Results ① Among the 86 Chinese articles and 27 English articles related to ectopic pituitary adenoma (EPA) gathered by the author,except for cases that have been confirmed as repeated reports,a total of 73 EPA cases were found.Of 70 cases with complete data,31 were male cases,accounting for 44.29％;39 were female cases,accounting for 55.71％;the ratio is 1:1.3.The frequency of EPA occurrence according to the location of the lesion,from high to low in turn,was sphenoid sinus (31 cases,42.47％),nasopharynx (7 cases,9.59％),suprasellar region (7 cases,9.59％),clivus (5 cases,6.85％),followed by the third ventricle,sphenoid sinus/clivus,nasal cavity,and the temporal lobe of the brain,with the same incidence of 4.11％.According to the functional properties of EPA,the frequency of different secreting hormones adenoma was PRL-ma(21 cases,28.77％),NF-ma (21 cases,28.77％),ACTH-ma (15 cases,20.55％),GH-ma (10 cases,13.70％),TSH-ma (2 cases,2.74％) and FSH-ma (1 cases.1.37％).Three cases of EPA were uncertain in their property due to lack of information.The incidence of PRL and nonfunctional tumors was the highest,which was different from what was reported in other countries.Among them,one case of EPA was in pineal region and one in parapharyngeal space,which was even more rare and were never reported abroad.(② Except for 3 cases with incomplete medical records,15 out of 70 cases of EPA were accompanied by empty sella,accounting for 21.43％,among which 11 (73.33％) cases involved the sphenoid sinus,and 3 (20％) cases involved clivus.The sphenoid sinus and clivus cases together accounted for 93.33％.(③ 29 out of the 69 cases of EPA with complete record were invasive pituitary adenomas,accounting for 42.03％ and including 1 case of pituitary adenocarcinoma,which accounted for 1.45％.(④ All cases were treated with surgery as the first choice,and some of them were treated with radiotherapy or drug therapy.Conc lusion Ectopic pituitary adenoma is extremely rare.By the end of 2015,the total number of cases reported in China is only 73,which are mostly located in the sphenoid sinus,suprasellar region and nasopharynx.In the functional classification,the most common types are still PRL adenoma and nonfunctional adenoma as in situ pituitary adenoma.42.03％ of EPA adenomas are invasive.Surgical resection of EPA is the first choice and some cases can be treated with radiotherapy and drug therapy.

Objective:To evaluate the safety and efficacy of 3D printing-assisted pre-fenestration and branch stent endovascular repair (F/b EVAR) in the treatment of thoracoabdominal aortic aneurysms.Methods:The clinical data of 26 patients treated with 3D printing-assisted F/b EVAR for complicated thoracic and abdominal aortic diseases at the Department of Vascular Surgery, the Ninth People's Hospital,Shanghai Jiaotong University School of Medicine from May 2019 to Sep 2022 were retrospectively analyzed.Results:The success rate in these 26 cases of TAAA with 3D printing combined with F/b EVAR was 97.89%, and the mean follow-up time was (8.03±4.15) months. Four cases had Ⅲc internal leakage and disappeared during the follow-up. One case of type Ⅲ leakage were narrowed during follow-up. Ic type internal leakage occurred in 1 patient and disappeared after the addition of a stent at the distal end. During the follow-up period, aortic CTA indicated that 1 patient had renal artery stent occlusion and smooth blood in other visceral branches. No complications such as organ ischemia, lower limb ischemia and all-cause death occurred during follow-up.Conclusion:3D printing-assisted F/b EVAR minimally invasive repair of TAAA is a feasible, effective and safe technique, with high success rate and low complication rate of visceral branch artery reconstruction.