Thoracic aortic dissection was a catastrophic disease with change quickly,and the characteristic of thoracic aortic dissection was acute onset,complex,progress rapidly,difficult to diagnosis,and highly misdiagnosis rate.So the fatality rate of thoracic aortic dissection was high,which easy caused medical disputes.Even so,the cause of the formation of thoracic aortic dissection in detail is not clear,and many risk factors associated with the occurrence of thoracic aortic dissection.These including high blood pressure,gender (male),aortic normal aging,drug using,atherosclerosis,genetic disease and inflammatory diseases,etc.

Objective To investigate the expression pattern of Nrf2 in the lung of septic rat and preliminary analysis of the role of Nrf2 in the development of sepsis. Methods Wistar rats were used in this study, it was divided into 4 groups, including normal control group, pure burn group, burn with staphylococcus sepsis group, burn with pseudomonas sepsis group. According to the different time intervals such as 2 hours, 8 hours, and 24 hours, it was divided into three sub-group after injection of bacteria. The expression of Nrf2 in the lung at different time intervals was determined. Results Nrf2 mRNA in the lungs of normal rats was high expression （74.0±7.0）, Nrf2 mRNA in the lungs of pure burns rats obviously down-regulated, respectively as 34.5±1.9,50.4±2.2,32.1±1.4, （t＝5.69～14.63,P＜0.01）. Nrf2 mRNA in burn sepsis caused by Staphylococcus aureus in lung tissue of rats down-regulated expression, respectively as 53.1±5.0,14.4±1.6,48.5±1.9,and reached peak at 8 h（t＝5.59～29.3,P＜0.01）. Pseudomonas aeruginosa burn sepsis didn't induced Nrf2 mRNA in the lung tissue, but it showed a downward trend at 2h（71.0±8.1,P＞0.05）and markedly reduced after 8, 24 h（24.8±2.1,4.1±2.0,t＝21.33,68.1,P＜0.01）.Conclusions The distribution of Nrf2 mainly localized in immune organ, and it directly took part in the post burn immune response.

Objective To investigate the role of nuclear factor-kappa B(NF-κB) in preterm birth with subclinical chorioamnionitis.Methods From October 2005 to October 2006,111 cases including 36 cases of preterm birth in labor,37 cases of full term gravida with spontaneous labor and 38 cases of full term gravida without threatened labor in the Hunan Province People's Hospital,third Xiangya Hospital of Central South University and Changsha Maternal and Child Care Service Center were enrolled in the study.After delivery,by pathology results of fetal membrane they were divided into two groups:subclinical chorioamnionitis group(subclinical infectious group ) and non-infectious group. Immunohistochemical staining and RT-PCR were used to observe the change of the p65 subunit of NF-κB family in maternal blood and fetal membrane in subclinical infectious group and non-infectious group.Results (1) The incidence of subclinical chorioamnionitis:there were 24 cases of subclinical chofioamnionitis in the 36 cases of preterm birth in labor(67% ),7 cases in the 37 cases of full term gravida with spontaneous labor group (19%)and 3 cases in the 38 cases of full term gravida without threatened labor group(8%).There was a significant difference among the three groups (P＜0.01). In the totally 111 cases,34 eases were classified as subclinical infectious group and 77 cases as non-infectious group.(2) In fetal membrane,the median of the average staining intensity of NF-κB p65 protein was higher in the subclinical chorioamnionitis group (8.0)than those in non-infectious group(4.0).Similarly,the average staining intensity of NF-κB p65 mRNA was higher in the subclinical infectious group (47.5±17.2) than those in non-infectious group(31.3±13.6).There was a significant difference between the two groups (P＜0.01).(3)In maternal blood,the expression of NF-KB p65 protein and mRNA was higher in subclinical chorioamnionitis group (8.0 and 42.6) than these in non-infectious group(4.0 and 23.6).There was a significant difference between the two groups (P＜0.01).(4) The concentration of NF-κB p65 protein in fetal membrane was positively correlated with that of maternal blood(r=0.581,P＜0.01 ) and the concentration of NF-KB p65 mRNA in fetal membrane was positively correlated with that of maternal blood (r=0.571,P＜0.01 ).Condusion The expression of NF-KB in maternal blood and fetal membrane in preterm birth with subclinical chorioamnionitis is higher and the two are correlated with each other.NF-KB p65 could be an accurate biochemical marker in predicting subclinical chorioamnionitis in preterm birth. NF-KB p65 plays an important role in the pathogenesis of subclinical chorioamnionitis in preterm birth.

Objective: To investigate the clinical efifcacy of thoracic endovascular aortic repair (TEVAR) for treating the patients with complicated thoracic aortic dissection and to report the relevant clinical experiences. Methods: We retrospectively analyzed the records of 56 patients with complicated thoracic aortic dissection who received the operation of TEVAR in our hospital from 2011-02 to 2015-10 in order to analyze their operation methods with reasons. Results: There were 21 patients with complex anatomic conditions for aortic arch, 7 of them received TEVAR and 14 received TEVAR with covered left subclavian artery; 16 patients with complex shape of aortic dissection, 5 of them received TEVAR and 11 received TEVAR with covered left subclavian artery; 19 patients with aortic dissection involving aortic arch, 17 of them received hybrid procedures of aortic arch branch bypass surgery + TEVAR and 2 received TEVAR with fenestrated stent grafts. All operations were successful and no severe complications occurred. Conclusion: TEVAR is a fast and effective method for treating complicated thoracic aortic dissection, which may expand the application ranges as covering left subclavian artery, branch vessel bypass and modiifed stent grafting.

Objective This study aims to analysis in the clinical features of Stanford type B thoracic aortic dissection with multiple tears,and to explore the clinical methods of thoracic endovascular aortic repair (TEVAR) treating this disease.Methods From February 2011 to May 2015,the cases that diagnosed with multiple tears (≥ two tears) Stanford type B thoracic aortic dissection and accepted operations with TEVAR at department of Thoracic Cardiovascular Surgery,Wuhan General Hospital of Guangzhou Command,were retrospective analyzed their clinical data.Except the first tear of proximal,cases were named for the treatment group whom used surgical methods treating distal aortic dissection tears.Otherwise,the cases were named non-treatment group.We compared the incidence of chest and back pain,the progress of distal aortic dissection,the changes of false lumen with aortic dissection,and the benefit of distal tears in two groups after 6 months after TEVAR.Results A total of 67 cases were recruited this retrospective study,successful operations with TEVAR were conducted in all patients,and no serious complications occurred postoperatively in all patients.7 cases with treatment group,60 cases with non-treatment group,no deaths within two groups in 6 months after TEVAR.There were no significance statistically in complained of the incidence of chest and back pain,and the rate of progress with distal aortic dissection (P ＞ 0.05).There was statistically significant in the rate of changes with false lumen with aortic dissection false lumen (P ＜ 0.05).Some cases with abdominal visceral artery blood flow from the distal tears of aortic dissection in the non-treatment (n =19).Conclusions TEVAR is an effective method for treating multiple tears Stanford type B thoracic aortic dissection.Distal tears should be individualized treatment according to the characteristics of Stanford type B thoracic aortic dissection or try not to deal with.

Objective To explore the effects of the motivational interview on medication adherence and control level of asthma in adult patients with asthma. Methods A total of 100 asthma patients who were hospitalized in the Respiration Department of Putuo People's Hospital in 2016 were selected in the study using convenience sampling. According to the random number table, the participants were divided into the observation group (n=50) and the control group (n=50). Two cases from the observation group withdrew from the study due to personal reasons, leaving 48 patients in the observation group. Three cases from the control group withdrew from the study (i.e. two for disease changes and one for personal reasons), leaving 47 cases in the control group. The control group received conventional health education while the observation group received education based on motivational interview. The asthma medication compliance scale (Chinese version) (MARS-A) and asthma control test (ACT) questionnaire were used to evaluate the medication compliance and asthma control level before the intervention and 1, 2 and 3 months after the intervention. Results None of the patients had good medication compliance before the intervention. However, patients in the observation group had significantly better adherence at 1, 2, and 3 months after the intervention compared with the control group (P<0.05). There were no significant differences in asthma control level between two groups before intervention (P>0.05). But after the intervention, the repeated variance analysis showed that there were significant differences in both intervention effect and time effect for asthma control score, and the interaction effects existed between intervention and time (P< 0.05). Conclusions The health education based on motivational interview can effectively improve the medication adherence and the control level of asthma in adult patients with asthma.

Objective To explore the differences in autophagic expression levels between hypertrophic scar (HS) tissue and normal skin tissue,and further investigate the relationship between hypertrophic scar formation and autophagy protein expression through the rabbit ear hypertrophic scar model.Methods 30 patients with hypertrophic scar were collected.One hypertrophic scar tissue and one normal skin tissue were harvested.The relative expressions of LC3,P62 and Beclin-1 in each tissue specimen were detected by immunohistochemistry and Western blot.Western blot was used to detect the autophagic-associated protein LC3 (MAPLC3),P62 and Beclin-1 in the hypertrophic scar tissue of rabbit ear and the corresponding normal tissue of rabbit ears at 4 weeks,8 weeks,12 weeks,and 24 weeks,and further explore their clinical significance.Results In vivo,the expression of hypertrophic scar tissue protein LC3 and Beclin-1 was significantly stronger than that in normal skin tissue (P ＜ 0.05).The expression of P62 was significantly weaker than that in normal skin tissue (P ＜ 0.05).In animal experiments,during the process of HS formation,the protein expression of LC3 gradually increased,while the protein expression of P62 gradually decreased;the protein expression of Beclin-1 was higher than that of normal rabbit ears tissue,with statistically significant differences (P ＜ 0.05).Conclusions The expression of LC3 and Beclin-1 in human hypertrophic scar tissues is higher than that in normal tissues.While the expression of P62 is lower than that in normal tissues.That is,the expression of autophagy in human hypertrophic scar tissue showed an upward trend in a certain period of time,and was significantly higher than that in normal tissue.