Objective To compare the effect of conventional and hyperoxia management strategy during deep hypothermia in patients with DeBake type 1 aortic dissection or aortic arch aneurysm undergoing total aortic arch replacement.Methods 32 adult patients undergoing total aortic arch replacement were randomly allocated to one of two groups(n=16 each):conventional(C)and hyperoxia group(H).The patients had no history of cerebral vascular disease.Left radial artery and dorsal artery of left foot were cannulated for monitoring of blood pressure of upper and lower limbs.Right internal jugular vein was cannulated for CVP monitoring and administration of drug and fluid.Anesthesia was induced with etomidate 10-15 mg,fentanyl 5-10 ?g?kg~(-1) and pancuronium 0.1 mg?kg~(-1) and maintained with fentanyl(total amount was＜20 ?g?kg~(-1)),isoflurane and pancuronium after tracheal intubation.Intermittent i.v.boluses of diazepam,sodium thiopental or propofol were given during cardiopulmonary bypass(CPB).Another catheter was inserted into right internal jugular vein eephalad until resistance was met.The tip of the catheter was at the level of mastoid process.The hyperoxia management involved the following steps:FiO_2 was gradually reduced with decreasing body temperature(T_0)from 70%(36～ 37℃)to 60%-40%(35.9-34℃),38%-30%(32-26℃),30%(26-24℃)and finally to 21%.When nasopharyngeal T_0 was reduced to 22℃ or 5-10 min before selective cerebral peffusion(SCP),FiO_2 was raised to 60%-100% to maintain PjvO_2＞20 mm Hg or SjvO_2＞60%.FiO_2 was maintained at 60%-100% during SCP until T_0 was rewarmed to 22℃,then reduced to 30%.FiO_2 was then gradually increased to 40%(when T_0 reached 28℃),to 50%-70% (34-37℃)and finally to 80%(T_0＞37℃).Blood samples were taken from jugular venous bulb and arterial port of oxygenator for determination of PjvO_2,SjvO_2 and PaO_2 before skin incision (T_1),at 15 min of CPB(T_2),10 min of SCP(T_3),5 min after descending aorta unclamping(T_4),5 min after left subclavian artery unclamping(T_5),5 min after left common carotid artery unclamping(T_6),anonymous artery unclamping(T_7),when nasopharyngeal To returned to 35℉(T_8)and 10 min after CPB was terminated(T_9).The awakening time and the duration of ICU stay(days)were recorded.Pre- and postoperative neurological examination and brain CT scan were performed.Results All patients survived the operation and were discharged from hospital.No new brain infarction occurred.Transient neurologic dysfunction occurred in 2 patients in group H and 3 patients in group C.There was a positive linear relationship between PaO_2 and PjvO_2 during deep hypothermia in group H (r=0.541,P＜0.01).The PjvO_2 and SjvO_2 were significantly higher in group H than in group C.The awakening time and the ICU stay were significantly shorter in group H than in group C.Conclusion The hyperoxia management strategy can provide clinical prognosis than the conventional management strategy during deep hypothermia for total aortic arch replacement by supplying more dissolved oxygen.

Animals ; Behavior, Animal ; drug effects ; Depressive Disorder ; drug therapy ; psychology ; Eleutherococcus ; Male ; Plant Extracts ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Stress, Psychological

OBJECTIVEClinical application of autologous fat grafting (AFG) is quickly expanding. Despite the widely acceptance, long-term survival rate (SR) of AFG remains a question not yet solved. Meanwhile, although rare, severe complications related to AFG including vision loss, stroke even death could be seen in the literature.

DATA SOURCESA comprehensive research of PubMed database to June 2013 was performed according to guidelines of the American Society of Plastic Surgeons Fat Graft Task Force Assessment Methodology. Articles were screened using predetermined inclusion and exclusion criteria.

STUDY SELECTIONData collected included patient characteristics, surgical technique, donor site, recipient site, graft amount, and quantified measurement methods. Patient cohorts were pooled, and SR was calculated. All the severe complications were also summarized according to the different clinical characteristics.

RESULTSOf 550 articles, 16 clinical articles and 10 animal studies met the inclusion criteria and provided quantified measurement methods. Totally, 596 patients were included. SR varied from 34% to 82% in breast and 30-83% in the facial area. Nude mice were applied to investigate human fat grafting SR (38.3-52.5% after 15 weeks). Rabbits were commonly used to study animal AFG SR (14.00-14.56% after 1-year). Totally, 21 severe complications were reported, including death (2), stroke (10), vision loss (11, 8 of which accompanied with stroke), sepsis (3), multiple abscess (1) and giant fat necrotic cyst (2). Ten of these complications happened within 10 years.

CONCLUSIONSThere is no unified measurement method to evaluate fat graft SR until now and no clinical evidence to show better SR according to different donor and recipient cite. Body mass index change between pre- and postoperation may be the bias factor in evaluating fat SR. Fat embolisms of the ophthalmic artery and the middle cerebral artery are the most severe complication of AFG and still lack of effective treatment.

Adipose Tissue ; transplantation ; Animals ; Autografts ; Humans ; Survival Rate

OBJECTIVETo analyze the direct economic burden of stroke in rural areas of Hanzhong.

METHODSPlan on primary interview was made after the purpose of the study had been informed to the managers of the 'surveillance field base', heads and members of the monitor assistants and detailed information was collected in the fields. Every single patient of stroke was then interviewed by the above said interviewers,using a self-designed questionnaire. 164 patients with stroke were interviewed in 53 villages with 75,000 persons lived there. The main items involved in the questionnaire would include: costs for inpatient or outpatient, reaching-out fees, fee for accommodation during treatment as outpatient, costs for treatment at home, long term medicine, caregivers and funerals as well as average income.

RESULTSThe median of annual direct economic burden was 3100 Yuan for each patient in Hanzhong rural area. There were no significant differences seen between males and females or among age groups (P > 0.05). The proportion of patients with medians of annual direct economic burden of: 1000 Yuan and below, 1001-5000 Yuan, 5001-10,000 Yuan, 10,001-20,000 Yuan and over 20,001 Yuan, were 29.2%, 36.0%, 18.3%, 9.8% and 6.0% respectively. The median of annual direct economic burden of first episode stroke was 5500 Yuan for each patient, and that of stroke was 1700 Yuan for each chronic patient. The direct economic burden of first episode was significantly higher than that of stroke (P < 0.01). The costs of hospitalization, accommodation of hospitalization and treatment at home of middle-aged patients were significant higher than that of old age patients (P < 0.05).

CONCLUSIONIn this study, the direct economic burden of stroke was 2.9 times of the annual personal average income, which was contrary to the reports from other countries. However, the State Health Bureau bore 87.1% of the direct economic burden for urban patients, but patients in the rural areas had to pay from their own pockets. The direct economic burden of stroke was heavy in Hanzhong rural region, which called for measures to be made to decrease the direct economic burden of stroke in the region.

Age Distribution ; Aged ; China ; Cost of Illness ; Female ; Humans ; Income ; statistics & numerical data ; Male ; Middle Aged ; Rural Population ; statistics & numerical data ; Sex Distribution ; Stroke ; economics

OBJECTIVEUsing the indirect economic burden of stroke in a rural population to develop rational allocation of future health resources, in Hanzhong area.

METHODSCluster sampling which involved 53 natural villages with a total number of 75,000 people selected from the 'stroke monitoring base' of rural population was adopted in this study in the Hanzhong area. All of the 164 stroke cases were studied through a self-designed questionnaire. In calculating disability-adjusted life years (DALYs), fixed value was used in accordance with the value of GBD. The disability assessment was simplified in DALYs calculation and modified Barthel's ADL was used in disability assessment of stroke patients. In indirect economic burden analysis, the human capital method combined with DALYs was adopted with the formula as: indirect economic burden = GNP per capita x DALYs x productivity weight.

RESULTSThe total DALYs were 598.88, with an average DALY of stroke as 3.65 per case. The total indirect economic burden of stroke patients in rural areas was 1,993,977.8 RMB and the average of indirect economic burden of stroke was 12,158.4 RMB per case with the largest seen in the 45-59 age group, accounted for 74.4%.

CONCLUSIONIn our study, the use of method in combining the human capital with DALYs was the first time being adopted in calculation of the indirect economic burden of stroke in rural population in China. The burden seemed to be much lower than literature cited from other countries. It was reasonable to evaluate indirect economic burden of stroke using method in integrating DALYs with human capital, but it was difficult to calculate the DALYs.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; Cost of Illness ; Female ; Humans ; Male ; Middle Aged ; Models, Theoretical ; Quality-Adjusted Life Years ; Stroke ; economics ; epidemiology ; Young Adult

OBJECTIVETo explore the effects of Dangua Recipe (DGR) on glycolipid metabolism, serum reactive oxygen species (ROS) level, nuclear factor kappa B (NF-kappaB) positive expression and its mRNA expression level in the thoracic aorta of diabetic rats with atherosclerosis, thus revealing its partial mechanisms for intervening chronic diabetic complications.

METHODSRecruited 40 Goto-Kakisaki (GK) Wistar rats were fed with high fat forage containing metabolic inhibition Propylthiouracil, and peritoneally injected with endothelial NOS inhibitor N-nitro-L-arginine methyl ester to establish a high fat diabetes model with atherosclerosis. The modeled GK rats were stratified by body weight, and then, by blood glucose level from high to low, randomly divided into the DGR group (at the daily dose of 8 mL/kg), the metformin group (MET, at the daily dose of 150 mg/kg), the simvastatin group (SIM, at the daily dose of 2 mg/kg), and the model group (MOD, fed with pure water, at the daily dose of 8 mL/kg) according to the random number table, 10 in each group. Another 10 Wistar rats of the same ages and comparable body weight level were recruited as the normal control group. All the interventions lasted for 24 weeks by gastrogavage. The fasting blood glucose (FBG) and body weight were monitored. The HbA1c, TC, LDL-C, HDL-C, TG, serum ROS were determined. The aortic NF-kappaB level was analyzed with immunohistochemical assay. The expression of NF-kappaB (P65) mRNA in the aorta was detected with Real-time PCR.

RESULTSThe body weight in the normal control group was eventually heavier than others (P < 0.01). There was no difference among the four groups of GK modeled rats (P > 0.05). The FBG in the four GK modeled groups were higher than that in the normal control group (P < 0.01, P < 0.05). There was no statistical difference in the blood glucose level at the first visit and at the baseline among the GK modeled groups (P > 0.05). The last FBG level was obviously lower in the MET and DGR groups than in the MOD group (P < 0.01) and the SIM group (P < 0.05). Twenty-four weeks after intervention, the level of FBG, HbA1c, TC, LDL-C, HDL-C, and NF-kappaB positive expression rate of the thoracic aorta of the four groups of GK modeled rats, and NF-kappaB mRNA expression in the thoracic aorta in the MOD group, the MET group, and the DGR group were significantly higher than those in the normal control group (P < 0.01, P < 0.05). The TG level, serum ROS in the MET, DGR, and SIM groups, and the NF-kappaB mRNA expression level in the thoracic aorta in the SIM group were significantly lower than those in the normal control group (P < 0.01, P < 0.05). The levels of FBG, TC, LDL-C, serum ROS, NF-kappaB mRNA expression level in the thoracic aorta in three drug intervention groups, and NF-kappaB positive expression rate in the DGR and MET groups, and the levels of HbA1c, TG in the DGR group were significantly lower than those in the MOD group (P < 0.01, P < 0.05). The level of FBG in the MET and DGR groups were lower than that in the SIM group (P < 0.05). The level of NF-kappaB mRNA expression in the thoracic aorta of the SIM and DGR groups, and the levels of TC and LDL-C in the DGR group were significantly lower than those in the MET group (P < 0.01).

CONCLUSIONDGR played a role in preventing and treating chronic diabetic complications by comprehensively regulating blood glucose and serum lipids, as well as down-regulating oxidative stress.

Animals ; Aorta, Thoracic ; metabolism ; Atherosclerosis ; complications ; drug therapy ; metabolism ; Blood Glucose ; analysis ; Diabetic Angiopathies ; drug therapy ; metabolism ; Disease Models, Animal ; Drugs, Chinese Herbal ; therapeutic use ; Lipid Metabolism ; Male ; NF-kappa B ; metabolism ; Oxidative Stress ; Phytotherapy ; Rats ; Rats, Wistar ; Reactive Oxygen Species ; blood

OBJECTIVETo study the toxicity features of high glucose on the endothelial cell cycle and the influence of Dan Gua-Fang, a Chinese herbal compound prescription, on the reproductive cycle of vascular endothelial cells cultivated under a high glucose condition; to reveal the partial mechanisms of Dan Gua-Fang in the prevention and treatment of endothelial injury caused by hyperglycemia in diabetes mellitus (DM); and offer a reference for dealing with the vascular complications of DM patients with long-term high blood glucose.

METHODSBased on the previous 3-(4,5)-dimethylthiahiazo (z-y1)-3-5-diphenytetrazoliumromide (MTT) experiment, under different medium concentrations of glucose and Dangua liquor, the endothelial cells of vein-304 (ECV-304) were divided into 6 groups as follows: standard culture group (Group A, 5.56 mmol/L glucose); 1/300 herb-standard group (Group B); high glucose culture group (Group C, 16.67 mmol/L glucose); 1/150 herb-high glucose group (Group D); 1/300 herb-high glucose group (Group E); and 1/600 herb-high glucose group (Group F). The cell cycle was assayed using flow cytometry after cells were cultivated for 36, 72 and 108 h, respectively.

RESULTS(1) The percentage of cells in the G0/G1 phase was significantly increased in Group C compared with that in Group A (P<0.05), while the percentage of S-phase (S%) cells in Group C was significantly reduced compared with Group A (P<0.05); the latter difference was dynamically related to the length of growing time of the endothelial cells in a high glucose environment. (2) The S% cells in Group A was decreased by 30.25% (from 40.23% to 28.06%) from 36 h to 72 h, and 12.33% (from 28.06% to 24.60%) from 72 h to 108 h; while in Group C, the corresponding decreases were 23.05% and 21.87%, respectively. The difference of S% cells between the two groups reached statistical significance at 108 h (P<0.05). (3) The percentage difference of cells in the G2/M phase between Group C and Group A was statistically significant at 72 h (P<0.01). (4) 1/300 Dan Gua-Fang completely reversed the harmful effect caused by 16.67 mmol/L high glucose on the cell cycle; moreover it did not disturb the cell cycle when the cell was cultivated in a glucose concentration of 5.56 mmol/L.

CONCLUSIONSHigh glucose produces an independent impact on the cell cycle. Persistent blocking of the cell cycle and its arrest at the G0/G1 phase are toxic effects of high glucose on the endothelial cell cycle. The corresponding variation of the arrest appears in the S phase. 1/300 Dan Gua-Fang completely eliminates the blockage of high glucose on the endothelial cell cycle.

Cell Cycle ; drug effects ; physiology ; Cells, Cultured ; Culture Media ; pharmacology ; Cytoprotection ; drug effects ; Dose-Response Relationship, Drug ; Drug Evaluation, Preclinical ; Drugs, Chinese Herbal ; pharmacology ; Endothelial Cells ; drug effects ; physiology ; Flow Cytometry ; Glucose ; adverse effects ; Humans

While overweight and obesity have gradually became global concerns. Bariatric surgery is an effective and safe option for improving quality of life and alleviating psychosocial distress in obese individuals. However,body contouring is required to solve skin problems associated with massive weight loss after bariatric surgery. This article reviews the indications,importance,and postoperative complications of body contouring after bariatric surgery.

Chest wall reconstruction is a key approach to restoring the structure and function of the defective chest wall after tumor excision. While autologous flaps have been ideal materials for soft tissue reconstruction,the optimal skeletal reconstructive material still remains controversial. Currently,besides autologous bones,non-biodegradable materials have been used widely,which offer sufficient strength and stability but with some inevitable complications. Many studies have explored the clinical applications of biodegradable materials and the improvements in their characteristics,and some of these materials may be clinically feasible. This article reviews the recent advances in the applications of reconstructive materials.