Objective To report the experience of the arterial switch operation(ASO) for Taussig-Bing anomaly and late outcomes.Methods From January 2001 to December 2015,57 patients were underwent arterial switch operation for Taussig-Bing anomaly in Fudan university affiliated children's hospital cardiac center,Median age and weight at operation was 63(37.5-88.5)days, 4.1(3.4-5.0)kg, respectively.29 patients with Arch anomalies(50.9%), 23 patients with unusual coronaries(40.3%),according to have arch anomaly or not and surgery time, dividing the patients into two groups, group A(have, n=29)and group B(not have, n=28), earlier experience into group 1(2001-2008, n=27), later experience into group 2(2009-2015, n=30), respectively.Results The Mortality was12.3%, the mortality of group A and group B was 13.8%, 10.7%(P>0.05),group 1 and group 2 was 22.2%, 3.3%(P<0.05) respectively, follow up was complete in 47 patients with a mean follow-up of(6.2±3.5) years , three patients lost, there was no late mortality, the actual survival at 1, 5year was 87%, 87%, respectively.Reintervention was required in 10 patients(21.3%), the aorta-PA valve diameter ratio was a risk factor for reintervention(group A P=0.02, group B P=0.04) ,and 1,2,5year free of reintervention was 95.6%, 86.6%, 77.2%, respectively.Conclusion The ASO approach can be applied to Taussig-Bing anomaly with acceptable mortality , and it is the procedure of choice at our institution.One stage to repair TBA with aortic arch abnormalities did not influence outcomes.The aorta-PA valve diameter ratio<0.5 was a risk factor for reintervention.

Background and purpose: Radiofrequency ablation (RFA) is one of the effective treatment methods for primary liver cancer and metastatic liver cancer. The purpose of this study was to investigate the risk factors of residual tumor after RFA for hepatic malignancies. Methods:A total number of 302 hepatic malignancies cases with 691 tumors after ultrasound-guided RFA from Jan. 2010 to Mar. 2013 were retrospectively analyzed. Single factor and multi-factor Logistic regression model were used to analyze the risk factors of residual tumor after RFA. Results:Complete ablation cases were 90.07%(272/302) for patients and 91.46%(632/691) for tumors, and the ablation residual rate was 8.54%. Ablation residual rates for tumor ≤3 cm, 3-5 cm and >5 cm in diameter were 6.30%, 9.57% and 28.57%, for tumor close to the intrahepatic vascular and gallbladder were 17.14%and 18.52%, for with and without combination with other local treatments were 7.02%and 13.41%, respectively. Multivariate analysis showed that tumor size>5 cm (P=0.044), proximity to large vessel (P=0.039) and without combination with other local treatments (P=0.001) were independent risk factors for ablation residual. Multivariate analysis showed that tumor near the intrahepatic vascular (P=0.014), single needle RFA (P=0.047) and without combination with other local treatments (P=0.023) were independent ablation residua risk factors for tumors between 3-5 cm in maximum diameter. Conclusion:Ultrasound-guided RFA can achieve satisfactory ablation effect. Tumor close to the intrahepatic vascular, tumor diameter>5 cm and without combination with other local treatment act as the independent risk factors for ablation residual. For tumors between 3-5 cm in diameter, in addition to close to intrahepatic blood vessels and without combination with other local treatment, single needle RFA is also another independent risk factor for ablation residual, and double-needle or multi-needle treatment can improve the ablation efifciency and reduce residual rate.

Objective:To establish and apply the intervention model of professional attitude for nursing undergraduates in universities of Traditional Chinese Medicine (TCM), and to explore its effect on the professional attitude of the nursing undergraduates.Methods:The study started in August 2018 included two steps. The first step was to develop intervention model of professional attitude for nursing undergraduates in universities of TCM based on the three-stage theory of Kelman ′s attitude formation and with Delphi method. After two rounds of expert consultation, the intervention model of professional attitude for nursing undergraduates in universities of TCM was finally formed, including three intervention stages, a total of 41 intervention measurements. The second step was to use the historical control research method. Grade 2016 nursing undergraduate (the year 2016—2020) in Beijing University of Chinese Medicine was taken as the experimental group ( n=86) and adopted the intervention model. Grade 2012 nursing undergraduate (the year 2012—2016) in the same university was taken as the control group ( n=56) and did not adopted the intervention model during their university study. The two groups were continuously evaluated by "Scale for Nurse ′s Professional Attitude" during their four years in the university. The measurement time was within one week of admission and the 16th week of the second semester of each academic year, with a total of 5 times of measurement. Results:Repeated measurement design showed that the scores of Scale for Nurse′s Professional Attitude of the two groups changed with time. At the end of the first year, the score of the scale in the experimental group was (6.06±0.95) points, higher than (5.41±1.08) points of the control group ( t value was 3.765, P<0.001). There was no difference between the two groups at other time points ( P>0.05). Conclusions:The intervention model of professional attitude for nursing undergraduates in universities of TCM has good operability and can improve the professional attitude of nursing undergraduates in universities of TCM during their freshman year. The intervention model needs to be further adjusted to improve the professional attitude in the subsequent learning stage.

BACKGROUNDGastrodin, as one of the major components extracted from the Chinese herb Gastrodia elata Bl., has many biologic effects, one of which is anti-apoptosis. Apoptosis is considered to be one of the pathogenetic mechanisms in steroid-induced osteonecrosis of the femoral head (ONFH). Therefore, we performed this study to investigate whether gastrodin has the potential to prevent steroid-induced ONFH.

METHODSAll 18 male adult Wistar rats were divided equally into three groups: the steroid group, the gastrodin+steroid group, and the control group. Osteonecrosis was induced by low-dose lipopolysaccharide and subsequent high-dose methylprednisolone. Histomorphometric method was used to determine the incidence of osteonecrosis. Terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay was performed to detect apoptotic index of osteocytes and osteoblasts. Real-time PCR and Western blotting were performed to detect mRNA and protein expression of Bax, Bcl-2, and Caspase-3. Fisher's exact probability test and one-way analysis of variance (ANOVA) with Turkey's post hoc test were used to examine significant differences between groups.

RESULTSThe incidence of osteonecrosis in the gastrodin+steroid group (16.7%) was significantly lower than that in the steroid group (83.3%). According to TUNEL assay, the apoptotic indices in the steroid group, the gastrodin+steroid group, and the control group were 91.1%, 27.1%, and 5.4%, respectively, and the differences were significant between groups. Compared with the control group and the gastrodin+steroid group, the mRNA and protein expression levels of Bax and Caspase-3 were significantly higher in the steroid group, but the Bcl-2 mRNA and protein expression levels were significantly lower.

CONCLUSIONGastrodin could prevent steroid-induced ONFH by anti-apoptosis.

Animals ; Apoptosis ; drug effects ; Benzyl Alcohols ; therapeutic use ; Femur Head Necrosis ; drug therapy ; prevention & control ; Glucosides ; therapeutic use ; Lipopolysaccharides ; pharmacology ; Male ; Rats ; Rats, Wistar ; Steroids ; pharmacology

Objective: To explore the subunit strategy for perineal defect reconstruction and flap selection. Methods: This is a respective study of 21 patients, with perineal defect, during January 2008 to December 2018. All patients were admitted to the fifth section of Burn and Plastic Surgery in the Fourth Medical Center of the People′s Liberation Army General Hospital. There were 10 males and 11 females, aged from 4 to 68 years old, with the mean age of 26.4 years. The causes of injury included burn (n=11), trauma (n=2), Paget′s disease (n=2), Brown′s disease (n=2), perineal squamous cell carcinoma (n=3)and hemangioma (n=1). The perineum is divided into 4 subunits, according to the anatomical structure: a front area monsveneris or pubic symphysis, 2 middle areas (labia or scrotum) and a posterior area (anal). The defects ranged 23 cm×11 cm-5 cm×3 cm after perineal lesions were removed. Appropriate flaps were selected based on tissue defect. Results: Nine patients were repaired with superficial inferior epigastric artery flap, 3 patients were repaired with superficial circumflex iliac artery flap, and 2 patients were repaired with combined superficial inferior epigastric artery flap and superficial circumflex iliac artery island flap. Internal pudendal arterial perforator flap was performed in 5 patients, and anterolateral thigh perforator flap in 2 patients. The size of flap was 25 cm×12 cm-6 cm×3 cm. All flaps survived, and incisions were primary healing. Patients were followed up for 6 months to 9 years, with an average of 13 months. The patients were satisfied with the appearances and functions of the recipient and doner sites. Scars were concealed well. Conclusions Appropriate flap can be chosen to repair perineal defects, based on the subunit principle in perineum, in order to restore function and appearance, and achieve satisfactory clinical outcomes.

Objective: To evaluate the effect of modified basin-forming anastomosis for recurrent stones after choledochojejunostomy. Methods: A total of 83 patients suffering from recurrent choledocholithiasis undergoing re-operation at our department from Jan 2013 to Dec 2017 were divided into two groups. 46 patients treated by routine choledochojejunostomy(controls), and 37 patients by modified basin-forming biliary-intestinal anastomosis(study group). Results: Control vs study group: intraoperative blood loss were(262±86)ml vs(121±77)ml, blood transfusion: (139±256)ml vs(22±92)ml , and operative time: (316±75)min vs(245±73)min , the number of patients with liver resection were 8 vs 3(all P<0.05). The number of patients with fever, biliary tract infection, abdominal infection, anemia, and postoperative hospital stay were 14 vs 4, 12 vs 3, 7 vs 0, 11 vs 1, (11.5±1.8) d vs (8.5±1.9) d (all P<0.05). Conclusions The modified basin-forming biliary-intestinal anastomosis is a simple, safe and effective surgical method for recurrent choledocholithiasis after choledochojejunostomy.

Migraine is one of the most prevalent and disabling neurological disease, but the current pharmacotherapies show limited efficacy and often accompanied by adverse effects. Acupuncture is a promising complementary therapy, but further clinical evidence is needed. The influence of acupuncture on migraine is not an immediate effect, and its mechanism remains unclear. This study aims to provide further clinical evidence for the anti-migraine effects of acupuncture and explore the mechanism involved. A randomized controlled trial was performed among 10 normal controls and 38 migraineurs. The migraineurs were divided into blank control, sham acupuncture, and acupuncture groups. Patients were subjected to two courses of treatment, and each treatment lasted for 5 days, with an interval of 1 day between the two courses. The effectiveness of treatment was evaluated using pain questionnaire. The functional magnetic resonance imaging (fMRI) data were analyzed for investigating brain changes induced by treatments. Blood plasma was collected for metabolomics and proteomics studies. Correlation and mediation analyses were performed to investigate the interaction between clinical, fMRI and omics changes. Results showed that acupuncture effectively relieved migraine symptoms in a way different from sham acupuncture in terms of curative effect, affected brain regions, and signaling pathways. The anti-migraine mechanism involves a complex network related to the regulation of the response to hypoxic stress, reversal of brain energy imbalance, and regulation of inflammation. The brain regions of migraineurs affected by acupuncture include the lingual gyrus, default mode network, and cerebellum. The effect of acupuncture on patients' metabolites/proteins may precede that of the brain.
Humans ; Migraine Disorders/etiology* ; Brain/diagnostic imaging* ; Acupuncture Therapy/methods* ; Magnetic Resonance Imaging