Objective To investigate the surgical treatment of coronary malperfusion due to acute type A aortic dissection.Methods The clinical data of 305 consecutive patients with type A aortic dissection, who were hospitalized and underwent operation between 2004 and 2015, were analyzed retrospectively.Among that, there were 37 cases with coronary malperfusion due to aortic dissection.Results The right coronary artery was involved in 33 cases, the left in 2 cases, and both coronary arteries in 2 cases.There were 22 coronary bypass grafting using saphenous vein in 21 patients, including 20 patients with the right coronary bypass grafting and 1 patient with the left.Six patients died postoperatively, with the mortality of 16.22％.Conclusion Acute type A aortic dissection with coronary involvement is associated with high mortality rate, which is necessary to restore the coronary revascularization as soon as we can.The methods to reconstruct the involved coronary is depend on the patients' condition and experience of surgeon.

OBJECTIVE:To study the targeting of folic acid(FA)-modified docetaxel(DOC)nano-liposome(L-DOC-FA)to hepatocellular carcinoma Bel-7402 cells in vivo and in vitro. METHODS:The cell viability and survival rate of Bel-7402 cells was tested by CCK-8 kit after treated with 0,1,2,5,10 and 20 μg/ml DOC,L-DOC and L-DOC-FA for 24 h. And then,the fluores-cein isothiocyanate was used to label L-DOC and L-DOC-FA nano-liposome,and the rate of L-DOC and L-DOC-FA absorbed by hepatocellular carcinoma Bel-7402 cells were detected. 125I was used to label L-DOC and L-DOC-FA nano-liposome,and then the contents of them in the subcutaneous tumor tissues were detected. 28 Balb/c naked mice were selected and given liver cell suspen-sion via back ih to induce tumor model. After modeling,naked mice were divided into blank control group(normal saline),DOC group(3 mg/kg),L-DOC(3 mg/kg,by DOC)and L-DOC-FA(3 mg/kg,by DOC). They were given relevant medicine intrave-nously once a day for consecutive 30 d. The relative tumor volume in naked mice was detected. RESULTS:DOC,L-DOC and L-DOC-FA all inhibited the cell viability of Bel-7402 cells,the survival rate of cells decreased in concentration-dependant manner;compared with DOC and L-DOC,the cell viability decreased after treated with L-DOC-FA,the survival rate of cells decreased (P<0.01). The rate of L-DOC and L-DOC-FA absorbed by Bel-7402 cells in descending order as L-DOC-FA(69.5%)>L-DOC (31.2%),with statistical significance (P<0.01). The content of L-DOC-FA in tumor was significantly more than that of L-DOC (P<0.01). In addition,3 mg/kg L-DOC-FA showed better inhibitory effect than 3 mg/kg L-DOC and DOC on tumor,and the rela-tive tumor volume was smaller(P<0.01). CONCLUSIONS:L-DOC-FA has obvious targeting to Bel-7402 cells in vivo and in vi-tro,and shows good inhibitory effect on tumor in vivo and in vitro.

Objective This report is to compare the difference outcome between total arch replacement and hemi-arch replacement for Stanford type A aortic dissection.Methods The subjects were 208 consecutive patients,including 121 who received total arch replacement(group A) and 87 who had hemi-arch replacement(group B) for Stanford type A aortic dissection from August 2001 to July 2013 in Nanjing Hospital Affiliated to Nanjing Medical University.The cardiopulmonary bypass (CPB) time,average cross-clamping time,selective cerebral perfusion(SCP) time,complications,in-hospital mortality and follow-up after surgery were retrospectively compared between the A and B groups.Results The age,sex ratio,preoperative complications do not show a significant difference between the A and B groups.The CPB time [(247.68± 58.65) min vs (212.68±60.75) min,P =0.000],cross-clamping time[(154.85±45.96) min vs(137.83± 38.91) min,P =0.000] and SCP time [(36.98± 10.62) min vs(29.85± 13.46) min,P =0.000] of group A are all longer than group B.The incidence of postoperative complications(14.0％ vs 10.3％,P =0.619) and in-hospital mortality(9.1％ vs 8.0％,P =0.791) between the A and B groups do not have a significant difference.The mean time of follow-up differed significantly between two groups [(21.86± 18.89) months vs(61.23± 38.57) months,P =0.000] and did not differ in the rate of follow-up(94.5％ vs 96.3％,P =0.585).The rate of false lumen thrombosed at the proximal descending aorta showed a significant difference between the twogroups(91.8％ vs 23.8％,P =0.000),but the rate of secondary surgical intervention (0 vs 2.3 ％,P =0.095) and follow-up death (6.4％ vs 6.3 ％,P =0.975) do not.Conclusion For the Stanford type A aortic dissection patients,surgery is the only treatment that can save lives.Total arch replacement need more time in CPB,cross-clamping and SCP,but the complications,in-hospital mortality and follow-up death do not show a significant difference compared with hemi-arch replacement,and higher rate of false lumen thrombosed have been showed in total arch replacement.

Objective To compare the effects of moderate and deep hypothermic circulatory arrest (DHCA) during aortic arch surgery in the adult patients,to offer the evidence for the detection of which temperature provides best brain protection in the subjects who accept the great aortic surgery.Methods A total of 109 patients undergoing the surgery of aortic arch were divided into the moderate hypothermic circulatory arrest group and deep hypothermic circulatory arrest group.We recorded the characters of the patients and their cardiopulmonary bypass time,aortic clamping time,cerebral perfusion time and postoperative recovery time,tracheal intubation time,time of intensive care unit (ICU) and postoperative cognitive dysfunction.Results Patients' characteristics were similar in two groups.All the patients were cured.There were no significant differences in aortic clamping time of each group [(111.4 ± 58.4) min vs.(115.9 ± 16.2) min];selective cerebral perfusion time [(27.4 ± 5.9) min vs.(23.5 ±6.1) min] of the moderate hypothermic circulatory arrest group and deep hypothermic circulatory arrest group.There were significant differences in the cardiopulmonary bypass time[(207.4 ± 20.9) min vs.(263.8 ± 22.6) min],the postoperative recovery time [(19.0 ± 11.1) h vs.(36.8 ± 25.3) h],intubation time [(46.4 ± 15.1) h vs.(64.4 ± 6.0)h];length of ICU [(4.7 ± 1.7) d vs.(8.± 2.3) d],and postoperative cognitive dysfunction of the two groups.Conclusion Compared to the deep hypothermic circulatory arrest,the moderate hypothermic circulatory arrest can provide better brain protection and achieve good clinical results.

OBJECTIVE:To prepare Diacerein (DCR)-loaded (poly lactic-co-glycolic acid) PLGA microspheres for intra-articular injection and investigate its related properties. METHODS:PLGA was used as microspheres material,and the microsphere was prepared by emulsification solvent evaporation method. The contents of DCR-PLGA microspheres were determined by HPLC,and drug-loading amount and entrapment efficiency were also calculated. Using entrapment efficiency as evaluation index,the preparation technology was optimized by orthogonal test. The morphology and particle size of microspheres were observed by optical microscope and SEM. Accumulative release rate was investigated by using in vitro release test. RESULTS:The linear range of DCR was 2.1-105.0 μg/mL(r＝0.999 9). RSDs of precision,stability,reproducibility and recovery tests were all lower than 2.0%. The optimal technology was PLGA concentration of 200 mg/mL,volume ratio of oil-water 1∶50,polyvinyl alcohol concentration of 1%. The prepared DCR-PLGA microspheres were spherical,average particle size was(11.2±4.7)μm, drug-loading amount was(4.25 ± 0.26)% and encapsulation rate was(92.30 ± 1.93)%,respectively. The drug release rate of DCR-PLGA microspheres within 360 h was about(73.08 ± 5.33)%. CONCLUSIONS:DCR-PLGA microspheres are prepared successfully with good morphology,suitable particle size and obvious sustained release effect,which are suitable for intra-articular injection.

Objective To determine the solubility of rhein in different vehicles and its partition coefficients in the n-octanol-water system for designing new formulations. Methods High performance liquid chromatography(HPLC) method was established to determine the concentration of rhein in water,different pH solutions and different solvents;the partition coefficients for the n-octanol- buffer solution systems were determined by shaking flask method. Results The equilibrium solubility of Rhein was 3.89 μg·mL-1and the lgP was 2.79 in water at 37 ℃.The solubility of rhein was increased with the raise of pH, which could reach 362.20 and 431.65 μg·mL-1in phosphate buffer solution at pH 6.8 and 7.4,respectively.Solubility of rhein in the semi polar solvent was relatively good,which can up to 2 971.74 μg·mL-1in PEG400.The oil-water partition coefficients of rhein were decreased with the increase of pH,and were 0.83 and 0.54 in phosphate buffer solution at pH 6.8 and 7.4,respectively. Conclusion Rhein is almost not soluble in water.With the raise of pH,the solubility is increased but the oil-water partition coefficient is decreased.

Cryptococcus gattii is a kind of Cryptococcus that infects the lungs and central nervous system through the inhalation of infectious particles such as spores or Cryptococcus yeast cells. The development of clinical disease of Cryptococcus gattii may be determined by the sex, immunity and genetics of the host factors, in which immune system factors play an important role in host injury. Their defects will have serious clinical consequences. Cryptococcus gattii mainly infects the population with normal immune, and the infection of immunosuppressed population is rare. The infection mechanism, molecular types, clinical characteristics, treatment and prognosis of Cryptococcus gattii meningitis were different between the two populations. This article reviews the main differences in different immune status with Cryptococcus gattii meningitis.

Cryptococcal meningitis is a common fungal meningitis that may present with an abnormal immune response during effective antifungal therapy and is called immune reconstitution inflammatory syndrome in human immunodeficiency virus (HIV)-infected patients. Similar phenomenon can also be seen in non-HIV patients with normal immune function in the past. Paradoxical clinical and/or imaging deterioration occurs due to strong immune response during treatment, which is called post-infectious inflammatory response syndrome. At present, it has not attracted attention. This complication is an important cause of poor prognosis in non-HIV patients. Early identification and treatment of post-infectious inflammatory response syndrome is of great significance. This article will review its possible pathogenesis, clinical manifestations, imaging characteristics, risk prediction, diagnosis, treatment and prognosis.

Objective:To explore the optimal monochromatic level for the observation of coronary in-stent lumen by dual-layer spectral CT (DLCT).Methods:Forty-nine patients with 74 stents after percutaneous coronary intervention (PCI) who underwent coronary CTA (CCTA) examinations by a DLCT between January 2016 and September 2017 were retrospectively enrolled. A total of 12 groups of images including 60-120 keV (kilo electron voltage) images with 10 keV interval, 140-200 keV images with 20 keV interval and conventional images. In-stent lumen diameter of proximal, mid and distal portion was measured. Difference of CT values between in-stent lumen and ascending aorta was used to describe as blooming artifact, and noise of in-stent lumen as image noise. Then Likert 5-point scale was performed to evaluate images noise, enhancement of in-stent lumen, blooming artifact and diagnostic confidence. Differences of objective and subjective parameters among conventional and various monochromatic images were compared by Friedman test.Results:In the diameter measurement of the proximal, middle and distal segments of the stent, the difference between the images of each group was statistically significant (χ 2 = 427.270, 426.375, 400.981, P< 0.001). The diameter of the lumen measured by 120-200 keV single-level image was larger than that measured by 60-100 keV single-level image, and the difference was statistically significant ( P< 0.05). In the comparison of CT difference between the stent lumen and ascending aorta, the difference between the images of each group was statistically significant (χ 2 = 242.193, P< 0.001), and 100-200 keV single-level images were lower than the conventional images, the difference was statistically significant ( P< 0.05). In the comparison of noise values, the difference between the images of each group was statistically significant (χ 2 = 420.161, P< 0.001), and the difference was statistically significant ( P< 0.05). In the subjective scores of noise, enhancement, halo artifact and diagnostic confidence, there were statistically significant differences among the groups (χ2= 333.827, 455.989, 276.824, 399.497, P< 0.001). The noise score of 100-200 keV single-level image was higher than that of conventional image, the difference was statistically significant ( P< 0.05). The enhancement score of 60 keV was significantly higher than that of other images ( P< 0.05). The halo artifact score of 100-200 keV single level image was higher than that of 60-90 keV image, the difference was statistically significant ( P<0.05). The scores of 90-120 keV single-level images were higher than those of other single-level images, and the difference was statistically significant ( P< 0.05). Conclusions:CCTA examinations can be effectively performed by DLCT in patients after PCI in clinical settings, and 120 keV is recommended as the optimal monochromatic image for the observation of in-stent lumen.

Objective:To summarize the surgical treatment and it’s results of patients with acute type A aortic dissection with cerebral malperfusion.Methods:We collected and analyzed the clinical date of 16 patients, who were hospitalized and underwent operation Between January 2010 to June 2019, presented cerebral malperfusion due to acute type A aortic dissection. All of them showed preoperative newly developed neurologic deficits, left hemiplegia in 8 cases, left paraparesis in 5 cases and right paraparesis in 3 cases.Results:Aortic valve was involved in 5 patients, 2 of whom underwent AVR surgery, 2 cases of CABG and 2 cases of artificial graft bypass were performed at the same time, 1 case underwent left leg amputation postoperatively. Seven patients died after surgery.Conclusion:The results of surgical management of acute type A aortic dissection with cerebral malperfusion demonstrated high hospital mortality, which needs us to restore the cerebral perfusion as soon as possible. The specific method should be decided according to the patients' condition.