Aortic dissection (AD) is a condition in which high-velocity, high-pressure blood flow in the aortic lumen enters the mesentery through a tear in the aortic intima, forming a coarctation hematoma that expands and dissociates in the aortic mesentery, resulting in pathological changes in both the true and pseudolumen. Aortic dissection has a high morbidity and mortality rate, especially in acute type A aortic dissection. Once diagnosed, type A aortic dissection should be actively treated surgically. Surgery is still the gold standard of treatment for type A aortic dissection. Despite surgical advances, the postoperative mortality rate for type A aortic dissection remains high. When conventional treatment fails and patients develop postoperative cardiopulmonary dysfunction and circulatory collapse, in severe cases leading to death. The use of mechanical circulatory assist devices for the treatment of postoperative cardiogenic shock after aortic dissection has been reported on a constant schedule, and the latest developments are described in this review.

AIM: To investigate the possible use of anti-FGF-2 nanobody for the treatment of pathological neovascularization. METHODS: SD rats were divided into a sham operation group, a control group (3 mm diameter circular filter paper soaked with 1 mol/L NaOH solution was applied to the central part of the cornea of rats for 30 s to prepare the rat model of alkali-burn angiogenesis) and a treatment group (treated with a drop of 3 mg/mL anti-FGF-2 nanobody 7 days after the operation. Repeat application 3x/day for 14 days). Corneal angiogenesis was measured by stereoscopic microscopy and CD31 immunohistochemical staining. The mRNA and protein expression levels of VEGF and FGF-2 were detected by quantitative fluorescence PCR (qPCR), enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry.RESULTS: (1) Blood vessel: The area of the treatment group was significantly reduced compared with the model group, and the vascular lumen was narrower (P<0.05). The difference was the most significant after 14 days of drug intervention; (2) Expression level of FGF-2 mRNA and protein: the model group had similar results to the treatment group (P>0.05); (3) Expression levels of VEGF mRNA and protein: The treatment group was significantly higher than the model group (P<0.05). In addition, the expression of VEGF also increased significantly in the continuous administration of the sham operation group. CONCLUSION: Anti-FGF-2 nanobody can be used for the treatment of angiogenesis. However, the expressions of VEGF will compensatorily increase after blocking FGF-2 in normal or pathological rats.

Objective To evaluate the efficacy of patients with stage T2 bladder cancer who underwent combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy.Methods The survival data of bladder cancer paients from January 2000 to December 2014 with stage T2N0M0 were retrospectively analyzed.Thirty-five patients of cT2N0M0 receive combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy(group A),and 80 patients of pT2N0M0 underwent radical cystectomy (RC) (group B).The pathological diagnosis of all patients was urothelial carcinoma.In group A,there were 33(94.2％) males and 2 (5.8％) females;20 (57.1％) tumor size less than 3 cm and 15 (42.9％) larger than 3 cm;24 (68.6％) with single tumor and 11 (31.4％) with multiple tumors;11 (31.4％) patients with primary tumors and 24 (68.6％) recurrent tumors.In group B,there were 71 (88.7％) males and 9 (11.3％) females;35 (43.8％) tumor size less than 3 cm and 45(56.2％) larger than 3 cm;44 (55.0％) with single tumors and 36 (45.0％) with multiple tumors;22(27.5％) patients with primary tumors and 58 (72.5％) recurrent tumors.Results Groups A and B consisted of 35 and 80 patients and median follow-up time was 68 (13-157)and 67 (4-198)months,respectively.There was no significantly statistical difference in disease-specific survival (DSS) between the two groups(P =0.888),76.5％ for group A and 60.6％ for group B respectively.In group A,26 (74.3％) patients achieved complete response (CR) to intra-arterial chemotherapy.Additionally,amounts of 21 (60.0％) patients preserve their functional bladder successfully and their median follow-up time was 69 (13-134)months.8 patients receive delayed radical cystectomy when suffered tumor recurrence and none of them had lymph node metastases.Of those pathological stage was presented as stage T2 5 cases,T3 2 cases and T4 1 case.Importantly,the 8 patients who receive delayed RC did not confer worse DSS when compared with those underwent immediate RC in group B (P =0.809).Cox proportional hazards model showed that tumor number and CR to intra-arterial chemotherapy was independent prognostic factor for disease-free survival (HR =0.238,P =0.007) and DSS(HR =0.085,P =0.004) respectively.During the period of intra-arterial chemotherapy,we did not observe hematological toxicity of grade Ⅳ and the hematological toxicity of grade Ⅰ-Ⅲ was 9 (25.7％),6 (17.1％) and 4 (11.4％).Conclusions For patients with T2N0M0,combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy could be a therapy with long-term survival outcome and safety.The therapy could be offered as alternative treatment option for patients who were unsuitable for receiving RC.

Objective To investigate the Mycobacterium tuberculosis infections in 2014 among Beijing army recruits, and evaluate a new method for screening latent tuberculosis infections.Methods A total of 194 army recruits were subjected to chest X-ray examination purified protein derivative(PPD) skin test, antibody detection, and interferon gamma release assay(IGRA) by ELISA combined with recombinant protein CFP10-ESAT6 and latent infection protein Rv2628.Results The positive rates of PPD skin test and antibody test were 49.7% and 15.5%, respectively.The latent infection rate of IGRA test was 22.2% in 194 cases after CFP10-ESAT6 stimulation.After stimulation of latent tuberculosis infection(LTBI) with Rv2628, IFN-γ level was significantly higher than that in healthy control group (P<0.05).The weak positive group of TST (5 mm≤diameter<15 mm) had a significantly higher level of IFN-γ than the strong positive group(diameter≥15 mm)(P<0.05),but after stimulation with CFP10-ESAT6,IFN-γ levels were not significantly different between the two groups(P>0.05).There was no significant difference between antibody negative and positive groups after stimulation by CFP10-ESAT6 and Rv2628 (P>0.05).The area under the ROC curve of Rv2628 diagnosis of tuberculosis infection was 0.84.When Youden index was 0.621,the specificity was 94.7% and sensitivity was 67.4%.ConclusionCombined detection of antigens Rv2628 and CFP10-ESAT6 specific IFN-γ values can be potentially used for differential diagnosis of active or latent tuberculosis infections.

OBJECTIVETo explore the diagnosis, treatment and prognosis of testicular benign tumors in children.

METHODSThe clinical data of 37 boys (aged between 3 months to 12 years) with testicular tumors treated in our center between August 2000 and August 2013 were retrospectively analyzed. The median age was 14 months and 21 boys were less than 2 years old. The tumors were on the left side in 18 cases, on the right side in 15 cases, and on both sides in 4 cases (adrenal residue testis tumor). Thirty-five patients presented with painless scrotal mass; in the other two cases, testicular residue tumor was found in routine medical examination in one case and testicular mature teratoma was found due to perineal pain in the other; both of the boys underwent ultrasound or CT examination. Thirty-three boys had tumor marker detection. Of the 37 boys with benign testicular tumors, 25 underwent radical inguinal orchiectomy and 12 had testis-sparing surgery.

RESULTSThe boys were followed up for 3-107 months (median 46 months). No patients were found to have tumor recurrence, metastasis or such complications as testicular atrophy; 3 boys had natural fertility later in adutthood.

CONCLUSIONSA high proportion of testicular tumors in children are benign. Preoperative ultrasound or CT combined with detection of tumor markers such as serum AFP can be important in the diagnosis of pediatric testicular tumors, for which testis-sparing surgery should be considered.

Biomarkers, Tumor ; Child ; Child, Preschool ; Humans ; Infant ; Male ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Orchiectomy ; Retrospective Studies ; Teratoma ; diagnosis ; pathology ; therapy ; Testicular Neoplasms ; diagnosis ; pathology ; therapy

Background To maintain corneal transparency is important for good visual function.A new treatment concept and the selection of surgical techniques and timing of surgery are critical for stopping the infringement of cornea tissue after alkali burning and other chemical warfare agents.Objective This study was to investigative the ultrastructure and histopathological status following the femtosecond laser-assisted deep lamellar keratoplasty (DLK) for acute alkali burn of cornea.Methods Acute corneal alkali burn models were established in 12 New Zealand rabbits by putting the 6 mm filter paper with 1 mol/L NaOH at the central cornea for 30 seconds.The rabbits were randomly allocated to femtosecond laser-assisted DLK group and model control group according to the randomized number table method.Femtosecond laser-assisted DLK was performed to transplant the corneal grafts of domestic rabbits to the model rabbits 24 hours after burning.The rabbits were sacrificed 1 week,2 weeks and 4 weeks after modeling,and the corneas were extracted for the preparation of corneal section.The cornea were performed with hematoxylin and eosin staining to assess the histopathological status under the optical microscope,and the ultrastructure of grafts and corneas was examined under the transmission electron microscope (TEM).Results Acute corneal alkali bourn models were successfully eatablished.In the fourth week after surgery,corneal graft was clear in the femtosecond laser-assisted DLK group.However,corneal swelling,conjunctival congestion and neovascularization were found in the model control group.Histopathological examination revealed the defect of corneal epithelium,edema of stroma,loose arrangement of collagen fibers,much vacuoles,few neovascularization and infiltration of a large number of inflammatory cells in the model control group,but in the femtosecond laser-assisted DLK group,the inflammatory response was slight.More desmosomes among the endothelial cells were seen,and the nuclei were intact in the grafts.In the fourth week after surgery,the transplanted corneas were transparent with the regular arrangement of collagen fibers and entire fibroblasts in the femtosecond laser-assisted DLK group under the TEM.However,flat surface corneal epithelial cells and shedding of some epithelial cells were exhibited in the modelcontrol group.Conclusions Femtosecond laser-assisted DLK can effectively alleviate the inflammatory response,promote epithelial healing and enhance intercellular tight junction in the cornea with acute alkali burn.

Objective To screen gastric infiltrating carcinoma from gastric high grade intraepithelial neoplasia (HGIEN) checked again by regular gastroscopy and confocal laser endomicroscopy(CLE).Methods From January 2005 to December 2010,82 patients with endoscopic biopsy and the tissue pathological diagnosed HGIEN were collected at Department of Gastroenterology,Ruijin Hospital,Jiaotong University.61 male patients and 21 female patients were collected,of which 38 patients underwent common gastroendoscopy and the other 44 patients were underwent CLE besides common gastroendoscopy.The pathological diagnosis of endoscopic biopsy tissues were compared,and patients with indications were referred to surgery and pathological examination again.Results A total of 82 patients were confirmed by repeated examination,and there were 8 cases of inflammation or benign ulcers (24.4％),12 cases of low grade intraepithelial neoplasia (14.6％),10 cases of HGIEN (12.2％),52 cases of infiltrating carcinoma (63.4％).36 cases of differentiated carcinoma and 16 cases of undifferentiated carcinoma.Of the 21 infiltrating carcinoma cases diagnosed by CLE,17 cases (81.0％) were consistent with the pathological diagnosis.The consistent parameter value of κ between CLE diagnosis and pathological diagnosis was 0.7250.Conclusion It is necessary to make differential diagnosis of infiltrating cancer in patients with endoscopic biopsy and the tissue pathological diagnosed HGIEN.

Objective To investigate the accuracy and the consistency with pathological diagnosis of confocal laser endomicroscopy (CLE) in real-time diagnosis of gastric malignancy and precancerous diseases.MethodsFrom January 2010 to March 2011, the out-patients and hospitalized patients of suspected gastric malignancy or precancerous diseases in Shanghai Ruijin Hospital were screened and undergone confocal laser endomicroscopy.Fluorescein sodium was used as fluorescent agent in the examination.A four-tiered diagnostic system was applied in the real time diagnosis with CLE images, and targeted biopsy was performed accordingly. Surgery was performed in CLE diagnosed or highly malignancy suspected patients.The diagnosis of common endoscopy, CLE and pathology was reviewed.ResultsA total of 160 patients were enrolled in this study, of those one patient withdrew because of fluorescin allergy and the rest 159 patients completed the CLE examination.A total of 194 lesions were inspected, among them, 130 cases each with one lesion, 23 cases each with two lesions and 6 cases each with three lesions.Overall accuracy rate of CLE was 93.3％ (181/194).And the sensitivity and specificity of CLE in gastric malignancy diagnosis was 93.6 ％ and 99.3 ％ respectively.Ideal correlation was identified between confocal laser endomicroscopy and final pathology results (Kappa=0.876).The incidence of marked fluorescin-related adverse events was only 0.6％ (1/160). ConclusionsCLE is consistent with histopathology and is helpful to make accurate diagnosis of gastric malignancy and precancerous diseases.It is important in early diagnosis of gastric malignancy and helps to avoid misdiagnosis and missed diagnosis.

Objective To evaluate the relationship of central aortic pressure (CAP) with atherosclerosis and left ventricular function in elderly patients with essential hypertension. Methods A total of 155 elderly hypertensive patients were divided into two groups: aged 60-79 years group (n = 71) and aged 80-95 years group (n= 84). Central aortic waveforms were generated using pulse wave analysis, then CAP and augmentation index (AI) were determined. Auto-survey atherosclerosis apparatus was applied to examine brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and toe-brachial index (TBI). Interventricular septal thickness at end diastole (IVSd), left ventricular end-diastolic dimension (LVDd), left ventricular posterior wall thickness at end diastole (LVPWd), relative left ventricle thickness (RLVT), left ventricular mass index (LVMI), Ejection fraction(EF) slope, left ventricle ejection fraction (LVEF) and fractional shortening (FS) were measured by the two-dimensional echoeardiography. Results Systolic pressure (SBP), pulse pressure (PP), CAP, AI and baPWV were significantly higher in aged 80-95 years group than in aged 60-79 years group (all P<0.05), ABI and TBI were significantly lower oppositely (both P<0. 01). IVSd, LVPWd, RLVT and LVMI were all significantly higher and EF slope was lower in aged 80-95 years group than in aged 60-79 years group (all P<0. 057. There were no significant differences in LVDd, LVEF and FS between the two groups (both P>0. 05). CAP had positive association with PP, AI and baPWV (r=0. 505,0. 284,all P<0.01). After adjustment for age, gender, smoking, body mass index, fasting blood sugar, creatinine, uric acid, cholesterol, triglyceride, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, there was no significant relationship between CAP and ABI or TBI (both P>0. 05). There was also positive association of CAP with IVSd, LVPWd, RLVT, LVMI, while negative associations of CAP with EF slope (all P<0. 01). There were no significant relationship between CAP and LVEF, FS, LVDd (all P> 0.05). Conclusions CAP and degree of artherosclerosis increase with aging in elderly patients with essential hypertension, which contributes to left ventricular hypertrophy and the decreased diastolic function. CAP helps to make an early diagnosis of or screening arteriosclerosis, and it is an important forecast factor for cardiovascular disease.

Objective To investigate the protective effect of the extract of ginkgo biloba on myocardial tissue in aged rat.Methods The rats aged 20 months were given the extract of ginkgo biloba (EGB) and ALT-711 respectively by garage for 16 weeks.The aged controls and adult rats were infused with the same volume saline.The superoxide dismutase (SOD), glutathione peroxidase (GSH-PX), malonyt diadehyde (MDA) in blood samples and advanced glycation end products (AGEs) in the myocardial tissue were measured .The myocardial histopathological changes under electron microscope and the mitochondrial DNA (mtDNA) deletion rate in myocardial cells were observed.Results Compared with the adult rats, the content of AGEs in myocardial cells in aged rats was significantly increased [(33.5±1.3)AU/mgHYP us.(18.1±1.2)AU/mgHYP, t= 7.18,P<0.05] and the levels of SOD and GSH-PX in blood samples were decreased [(138.4±3.8) U/mlvs.(227.7±13.8)U/ml, (1283.8±28.8) U/ml vs.(2114.1 ±135.9)U/ml, t=-19.59, -18.79;both P<0.01].The MDA level in the serum and mtDNA deletion rate in aged rats were higher than in adult rats[(6.7±0.6) mmol/ml vs.(4.1±1.0) mmol/ml, (0.18054±0.0718) % vs.( 0.0060±0.0001)%, t=7.18,6.98;both P<0.05].Compared with the aged controls, the content of AGEs in myocardial cells, the level of MDA and mtDNA deletion rate were significantly decreased in EGB and ALT-711 treatment adults (all P<0.05).The SOD and GSH-PX in blood samples were increased in EGB and ALT-711 treatment adults (all P<0.05).Conclusions Nonenzymatic glycation may play an important role in myocardial aging, which may be amplified by oxidative stress.EGB and ALT-711 may have the same anti-aging effects by inhibiting nonenzymatic glycation and oxidative stress.