Objective To report the primary experience of open placement of triple-branched stent graft for acute Stanford type A aortic dissection. Methods Between June 2008 and September 2009, 20 well-selected patients with acute Stanford type A aortic dissection underwent open placement of triple-branched stent graft for total arch reconstruction. When core cooling to a 20℃ nasophageal temperature, perfusion to the lower body was discontinued and the ascending aorta was transected at the base of the innominate artery. Through a transverse incision, the triple-branched stent graft was inserted into the true lumen of the arch and descending aorta, and each side arm of the stent graft was positioned one by one into the arch branches.The transected stump of the ascending aorta was reconstructed by inner proximal stent-free dacron tube of the main graft and outer teflon felt, and subsequently continuous anastomosis to the 1-branched dacron tube graft was made. Results Open placement of triple-branched stent graft was technically successful in all patients. The mean cardiopulmonary bypass time, aortic cross-clamp time and lower body arrest time were (163.2 ±19.2) min, (89.4 ±10.0) min and (32. 7 ±6. 6)min, respectively. Transient postoperative neurological dysfunction was observed in 1 patient and acute renal failure in 1 patient. All patients were discharged from the hospital. Their computed tomographic scans at 3 months postoperatively showed that all stent grafts were fully opened without distortion. In the vascular stent implantation site the dissected false lumen was eliminated. The false lumen of the descending aorta distal to the stent graft was closed with thrombus in 16 cases. Conclusion Open placement of triple-branched stent graft is a new effective technique for total arch reconstruction in acute type A aortic dissection. Patients have the indications of the extensive primary repair of the thoracic aorta without primary intimal tears in the arch may be the best candidates for this new technique. The size of the stent graft, the distances between two neighboring side arm grafts and the prevention of the intimal trauma during the placement are crucial for successful open placement of triple-branched stent graft.

Objective To explore whether glutamine can ameliorate oxidative stress injury in mice with sepsis in order to provide an experimental basis for clinical application.Methods Thirty 5-week old Qunming male mice were randomly divided into three groups: control, model and glutamine groups, 10 mice in each group. Lipopolysaccharide (LPS) 5 mL/kg was injected into intraperitoneal cavity to establish septic model in model and glutamine groups, and an equal amount of normal saline was injected into the cavity in control group. After the septic model was successfully established, propylene ammonia acyl-glutamine 0.75 g/kg was immediately injected through tail vein in the glutamine group, and an equal amount of sterile normal saline was injected into the vein in the model and control groups. After 6 hours, the experiment was terminated, the blood was collected from the orbital cavity and the animal was sacrificed; serum, liver and renal tissue homogenates were taken to detect the indexes of oxidative stress, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and lipid metabolite malonaldehyde (MDA).Results Compared with the control group, the levels of SOD activities and GSH-Px of serum and liver, kidney tissue in the model group were significantly lower, and the MDA content was significantly higher. Compared with the model group, the levels of SOD activities and GSH-Px of serum and liver, kidney tissue in the glutamine group were significantly higher, and the MDA content was significantly lower [SOD in the serum (U/mL): 134.78±3.74 vs. 124.60±3.49, SOD in the liver (U/mg): 56.71±1.35 vs. 49.84±0.86, SOD in the kidney (U/mg): 46.22±1.22 vs. 43.22±1.52; GSH-Px in serum (U/mL): 325.15±21.86 vs. 267.04±13.5, GSH-Px in liver (U/mg): 91.35±1.59 vs. 83.40±1.33, GSH-Px in kidney (U/mg): 136.08±0.58 vs. 132.97±0.74; MDA in serum (μmol/L): 9.20±0.32 vs. 13.67±1.24, MDA in liver (nmol/mg): 1.85±0.10 vs. 4.88±0.17, MDA in kidney (nmol/mg): 2.47±0.12 vs. 3.52±0.27, allP < 0.01].Conclusion Sepsis can cause oxidative stress and oxidative damage, glutamine not only can improve the levels of antioxidant enzymes of GSH-Px and SOD, enhance antioxidant capacity, reduce the MDA content of lipid metabolites, but also can reduce the toxic metabolites, so as glutamine has the effect of ameliorating oxidative stress injury.

Objective: To explore the roles of Notch signal pathways in propranolol inhibiting hemangioma-derived pericyte(PCs) in order to improve the therapeutic mechanism of propranolol and provide new targets for its clinical treatment. Methods: The specimens of proliferative hemangioma were obtained from operation. Cell suspension was prepared after incubation and digestion. Then a-SMA positive PCs were sorted out by flow cytometry and sub-cultured. Propranolol in different concentrations (0, 10, 20, 40, 80, 160, 320 μmol/L) was added into PCs solution and cultured for 24, 48 and 72 h respectively. And CCK-8 culture and BrdU labeling solutions were added. Activity and proliferation of PCs before and after intervention of propranolol were respectively tested. The level of mRNA of Notch3 and Hes1 in PCs before and after intervention of propranolol were detected by RT-PCR. All data were analyzed by SPSS 13.0 statistical software. Single factor analysis of variance and paired data t test were used. Results: The rate of a-SMA positive cells was 98.0%. The longer incubation time, the more marked inhibitions of cell activity and proliferation after propranolol dosing. The inhibition of cell activity and proliferation were significant at a propranolol concentration of 40 μmol/L. Experimental group of cell activity(0.17±0.05) is compared to control group(0.53±0.03) with paired data t test, t value=3.502. Similarly, experimental group of cell proliferation(301.66±28.71) is compared to control group(498.66±56.09) with paired data t test, t value=7.425.And significant differences existed between them and those of control group (P<0.05), especially at 72 h. Gene expressions of Notch3 and Hes1 increased with rising propranolol concentrations. Conclusions One therapeutic mechanism of propranolol to infantile hemangioma may be achieved by pericytes. Propranolol can inhibit the growth of infantile hemangioma by inhibiting proliferation of pericytes which is closely related to activated Notch signal pathways.

Objective To explore the role of ultrasound-guided core needle biopsy in diagnosis and treatment of thyroid nodules.Methods 778 cases undergoing ultrasound-guided core needle biopsy in our department from Jan.2012 to Dec.2014 were retrospectively analyzed,and the sensitivity,specificity and accuracy were calculated.Results All the patients were operated successfully.Except for 21 nodules undiagnosed,16.4％ (124/757) were histologically diagnosed as malignant and 83.6％ (633/757) were benign.15 samples of the 124 malignant nodules were less than 10 millimeter in diameter.The sensitivity,specificity and accuracy were 100％,94.8％ and 95.6％,respectively.Of the ultrasound features,blood flow,boundary,internal situation and calcification were statistically significant between benign and malignant nodules,but not so between the groups of different greatest dimentions.Conclusion Ultrasound-guided core needle biopsy is safe and effective for obtaining thyroid nodule tissue,and it is helpful for diagnosis of thyroid diseases.

Objective:To investigate the predictive value of Graeb score for the outcome of high-grade aneurysmal subarachnoid hemorrhage (aSAH) patients with intraventricular hemorrhage (IVH).Methods:Consecutive high-grade aSAH patients with IVH admitted to the No. 1 People's Hospital of Jiujiang from January 2012 to March 2020 were enrolled retrospectively. High-grade aSAH was defined as grade Ⅳ to Ⅴ according to the World Federation of Neurological Surgeons (WFNS) scale. The outcome of patients was evaluated by the modified Rankin Scale (mRS) at 3 months after discharge. A score of ≤2 was defined as a good outcome and a score of >2 were defined as a poor outcome. Multivariate logistic regression model was used to evaluate the correlation between Graeb score and clinical outcome, and the receiver operating characteristic (ROC) curve was used to determine the predictive value of Graeb score for clinical outcome. Results:A total of 86 high-grade aSAH patients with IVH were enrolled. Aneurysm treatment: craniotomy clipping in 42 patients (48.8%), intravascular embolization in 21 (24.4%), and conservative treatment in 23 (26.7%). Twenty-nine patients (33.7%) had a good outcome and 57 (66.3%) had a poor outcome. Multivariate logistic regression analysis showed that the Graeb score >6 (odds ratio [ OR] 26.360, 95% confidence interval [ CI] 4.106-169.235; P<0.001), the modified Fisher grade 3-4 ( OR 11.674, 95% CI 1.540-88.512; P=0.017) and complicated with chronic hydrocephalus ( OR 21.236, 95% CI 2.883-156.431; P=0.003) were the independent risk factors for the poor outcome. ROC curve analysis showed that the area under the curve of the Graeb score predicting for poor outcome was 0.843 (95% CI 0.760-0.926; P<0.001), the best cut-off value was 6.5, and the corresponding sensitivity and specificity were 71.9% and 86.2%, respectively. Conclusion:The Graeb score is an independent influencing factor affecting the clinical outcome of high-grade aSAH patients with IVH. Graeb score >6.5 had higher predictive value for the poor outcome in such patients.

Objective This study aimed to explore the effect of peripheral blood mesenchymal stem cells combined with porous absorbable gelatin sponge/self assembling peptide composite scaffolds on SD rat femoral con-dyle bone defect reconstruction and provide a new strategy for the repair of bone defects. Methods 30 female SD rats,8W age,were randomly divided into 3 groups,10 every group.The group A was blank control group,group B was porous absorbable gelatin sponge/self assembling peptide composite scaffold group,and group C was periph-eral blood mesenchymal stem cells combined with porous absorbable gelatin sponge/self assembling peptide compos-ite scaffold group. The effect of osteogenesis was observed by paraffin section,hematoxylin eosin staining,X-ray examination,and Micro-CT scanning in 3 dimensional reconstruction of femoral condyle defect. Results Imaging examination showed that the experimental group had better osteogenesis effect. Histological examination showed that a lot of new bone tissue was found in group C,while only a small amount of new bone was found in the group of A and B. Conclusions The experiment shows that peripheral blood mesenchymal stem cells as the seed cells for tissue engineering,combined with porous absorbable gelatin sponge-self assembling peptide has better ability to repair bone defects,and has good application prospect,which is worthy of further research.

Objective:To analyze the molecular epidemiology and virulence characteristics of polymyxin-resistant Klebsiella pneumoniae ( K. pneumoniae). Methods:From 2011 to 2016, 1 376 strains of K. pneumoniae were isolated from various clinical specimens of hospitalized patients in First Affiliated Hospital of Wenzhou Medical University. Agar dilution method was used to screen out the polymyxin-resistant strains.Polymerase chain reaction (PCR) was used to detect the genes related to polymyxin resistance, and real-time fluorescence quantitative PCR was used to detect the relative mRNA expression level of drug resistant genes. Pulsed-field gel electrophoresis, multilocus sequence typing and Galleria mellonella larvae infection model were performed to analyze the molecular epidemiological and virulent characteristics. Results:A total of 14 strains (1.02%) of polymyxin-resistant K. pneumoniae were detected among 1 376 K. pneumoniae isolates. Subsequent sequencing identified mutations leading to amino-acid changes (K2E, F28C) in MgrB of 10 isolates and D150G in PhoQ of nine isolates, and genes such as mcr and crrB were not detected in all drug-resistant strains. Compared with standard strains, the relative expression levels of pmrH and pmrD mRNA of these drug resistant strains were increased. Analysis of the molecular epidemiology indicated that the 14 drug-resistant strains were divided into nine clones. Galleria mellonella larvae infection model revealed polymyxin-resistant K. pneumoniae isolates had higher virulence. Conclusions:Polymyxin-resistant K. pneumoniae has mutations in mgrB and phoQ genes, and mgrB mutation may play a key role in the change of virulence profiles. The homology among the polymyxin-resistant K. pneumoniae stains in this study is low.

Objective:To investigate the influencing factors for prognoses of patients with high-grade aneurysmal subarachnoid hemorrhage (aSAH).Methods:A retrospective analysis was performed on clinical data of 104 patients with aSAH, admitted to our hospital from January 2012 to March 2010. According to the modified Rankin scale (mRS) scores 3 months after discharge, these patients were divided into good prognosis group (mRS scores≤2) and poor prognosis group (mRS scores >2). Clinical data of patients from the 2 groups were compared. Multivariate Logistic regression analysis was used to analyze the influencing factors for prognoses.Results:Forty patients (38.5%) were with good prognosis and 64 (61.5%) were with poor prognosis. As compared with patients in the poor prognosis group, patients in the good prognosis group had significantly lower proportion of patients>60 years old, and significantly lower Graeb scores, cast fourth ventricle (CFV) incidence, Fisher grading, blood glucose content, diastolic blood pressure, systolic blood pressure and mean arterial pressure, and statistically higher serum potassium content ( P<0.05). There were significant differences in treatment methods and incidence of complications between the two groups ( P<0.05). Multivariate Logistic regression analysis showed that age>60 years ( OR=13.470, 95%CI: 2.177-83.347, P=0.005), Fisher grading ( OR=6.649, 95%CI: 1.141-38.736, P=0.035), conservative treatment ( OR=6.348, 95%CI: 1.048-38.742, P=0.044), mean arterial pressure at admission ( OR=29.721, 95%CI: 3.177-278.012, P=0.003), serum potassium ( OR=5.296, 95%CI: 1.138-24.653, P=0.034), CFV ( OR=9.855, 95%CI: 1.785-51.456, P=0.008), and chronic hydrocephalus ( OR=19.298, 95%CI: 3.294-113.069, P=0.001) were influencing factors for prognoses of high-grade aSAH patients. Conclusion:Severe aSAH patients with advanced age, high Fisher grading, high mean arterial pressure, low serum potassium content, fourth ventricle casting and chronic hydrocephalus under conservative treatment are more likely to have poor prognosis.

Objective:To explore the influence of prognostic nutritional index (PNI) and controlling nutritional status (CONUT) on the prognosis of patients with multiple myeloma.Methods:Data of 157 patients with multiple myeloma (MM) at the affiliated hospital of Xuzhou medical university from January 2014 to December 2018 were retrospectively evaluated. The operating characteristic (ROC) curve analysis was adopted as the optimal cut-off point. PNI and CONUT were grouped based on the cut-off points of 44.45 and 3.5, respectively, and the differences between age, gender, serum calcium, β 2-microglobulin, serum creatinine, lactate dehydrogenase, and hemoglobin were analyzed. The prognostic factors were analyzed via univariate and Cox multivariate regression analyses. Results:The level of PNI and CONUT is the influencing factor of OS time. The univariate analysis revealed that age, LDH, plasma cell ratio, β 2-microglobulin, ISS stage, PNI, and CONUT were the risk factors for the prognosis of patients with MM. The multivariate analysis revealed that age ( HR=1.636, 95% CI 1.014-2.640) , plasma cell ratio ( HR=1.953, 95% CI 1.232-3.096) , and PNI ( HR=0.513, 95% CI 0.287-0.917) were the independent prognostic risk factors of patients with MM. Conclusion:Low PNI in patients with MM indicates a poor prognosis, which is an independent prognosis risk factor.

Objective To investigate the effects of the third-generation mechanical chest compressor on outcomes of cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest.Methods The patients with out-of-hospital cardiac arrest from October 2015 to September 2017 in the Yuyao peoples' hospital were included and divided randomly into 2 groups:manual chest compression group and mechanical chest compression group.The duration of resuscitation,the rate of restoration of spontaneous circulation (ROSC),4-h survival rate and the rate of survival getting to hospital discharge with favorable neurological status of two groups were analyzed.Results A total of 95 patients with out-of-hospital cardiac arrest were included.The rate of ROSC and 4-h survival was significantly increased in the mechanical chest compression group compared with the manual chest compression group (P＜0.05).There was no remarkable difference in the duration of resuscitation and the rate of survival getting to hospital discharge with favorable neurological status between 2 groups.Conclusions The thirdgeneration mechanical chest compressor significantly improves the rate of ROSC and the shout-term survival in patients with out-of-hospital cardiac arrest.