Objective To summarize the clinical results of the surgical treatment for Stanford B aortic dissection patients with proximal aortic aneurysm(including aortic root,ascending,arch) by enblock technique.Methods From Jun.2011 to Oct.2015,20 patients with Stanford type B aortic dissection and proximal aortic aneurysm underwent open surgery by enbloc technique in our center.Among them,there were 15 male and 5 female.Average age of patients was(40.65 ± 13.55) years (range:22-65 years).The comorbidities of proximal aortic diseases are ascending aortic aneurysm in 10,aortic root aneurysm in 8,and aortic arch aneurysm in 2.All the surgeries were accomplished by hypothermic cardiopulmonary bypass assist.The combined surgery includes:extra-anatomy bypass grafting in 16,Bentall procedure in 15,ascending aortic repair in 5.Before surgery and discharged from hospital computed tomography angiography(CTA) was performed in each patient.All patients except 2 were followed.During the follow-up,CTA was performed and recorded.Results The average operation time,cardiopulmonary bypass time,aortic clamping time and selective cerebral perfusion (SCP) time are (6.47 ± 1.01)h (4.5-9 h),(173.60 ± 43.39) min (109-303 min),(91.25 ± 28.63) min (51-165 min),(27.25 ± 6.80) min (17-43 min),respectively.The mean nasopharyngeal temperature during SCP is(23.77 ± 1.27)℃ (21.6-26℃).There were no operative deaths.The mean follow-up time is (32.44 ± 17.27)months (range:8-60 months).Two patients underwent aortic re-intervention during follow-up.And 2 patients were lost follow-up(The follow-up rate is 90％).One late death was found.The patient succumbed to sudden distal aortic rupture.Other patients are survived without any complications.Conclusion Enblock technique is a relatively simple procedure in total aortic arch repair surgery.And it can be a safely surgical treatment for type B aortic dissection patients with proximal aortic aneurysm.The indications of enblock technique for Stanford B aortic dissection patients are those who combined with proximal aortic aneurysm.

Objective To summarize our experience of surgical repair for cervical aortic arch(CAA) aneurysm and eval-uate early and midterm results of these patients.Methods From January 2010 to December 2014, 22 patients with left-sided CAA aneurysm admitted in our center.There were 6 male and 16 female patients with a mean age of(34.09 ±13.14) years. Comorbidities included pseudocoarctation in 9 patients, hypertension in 4 patients, and aortic valve insufficiency, Stanford type B aortic dissection and middle cerebral artery aneurysm each had 1 patient.All of the patients underwent surgical aortic arch re-construction using artificial graft replacement.Among them, 4(4/22, 18.18%) were performed under moderate hypothermic circulatory arrest(MHCA) combined with selective antegrade cerebral perfusion(SACP) via a median sternotomy, and concom-itant aortic valve replacement(AVR) was implemented in 1 patient.18(18/22, 81.82%) were performed via posterolateral left thoracotomy through the 4th intercostal space, and adjunct methods applied included partial CPB and “simple clamping” in 10 and 8 of these patients respectively.Results The average mechanical ventilation time and ICU stay time was (13.05 ± 4.73)h and(19.14 ±8.08) h respectively.1 patient required repeat thoracotomy for bleeding, 1 patient with delayed wound healing and 1 patient suffered transient liver dysfunction.There were no in-hospital deaths.Mean follow-up time was 34.73 months, and 3 patients were lost during follow-up.There were no late deaths during follow-up.Conclusion Repair of CAA is indicated for the patients with arch aneurysm formation .According to the locations and types of aneurysms and other concomi-tant proximal cardiovascular diseases, performing one-stage surgical aortic arch reconstruction with individualized incisions , ad-junct methods and operative procedures can obtain satisfactory clinical outcomes in patients with CAA aneurysm .

Objective To summarize surgical treatment of Takayasu arteritis,and analysis the drug treatment effect during the perioperative period.Methods Retrospective analysis 46 patients with Takayasu's arteritis disease and received cardiovascular surgery between January 2010 to December 2015,in Anzhen Hospital.By collecting their clinical characteristics,preoperative drug therapy,surgical treatment,pathological examination results to analyze operation conditions,effect of drugs and preoperative conditions.Results The perioperative mortality rate was 2.2％ and the complication rate was 23.9％ in 46 patients.There were 34 patients with symptomatic relief in the perioperative period,11 patients didn't take hormone drugs before operation.There were 11 cases of complications during the perioperative period,of which 7 patients were in active stage and 10 patients had not been used before operation.Conclusion The surgical treatment of patients with Takayasu's arteritis disease can effectively improve symptoms.The patients in Takayasu's arteritis active stage will affect the outcome of the surgery.Rational use of hormone drugs before surgery,can effectively control the patient's condition,improve the rate of remission of symptoms,and effectively reduce the incidence of perioperative complications.

Objective:To summarize the surgical treatment strategy for aortic injury caused by trauma.Methods:From January 2009 to January 2018, 34 patients with TAI were treated in Beijing Anzhen Hospital. 10 had hypertension. 23 cases were males. There were 31 cases caused by traffic accidents, 2 cases were fall injuries, and 1 case was bruise. 9 cases were thoracic aortic pseudoaneurysm, 6 cases were thoracic aorta, and 19 cases were aortic dissection. 29 patients underwent TEVAR and 5 patients underwent OR (2 patients with type A aortic dissection undergoing Bentall + Sun's procedure, 1 patient with type B aortic dissection and 2 patients with thoracic aortic pseudoaneurysm undergoing stented elephant trunk procedure).Results:The follow-up time was (45.09±23.10) months. The mean age of patients undergoing OR or TEVAR was (44.80±20.57) years old, (45.93±11.01) years old; the mean operation time was(403.20±30.30) minutes, (105.72±27.76) minutes; the mean hospitalization (19.00±6.04), (5.76±3.08) days. There were no deaths in the two groups. 2 patients uundergoing TEVAR had left upper limb numbness.Conclusion:The treatment of patients with TAI should be based on the general condition, the classification of injury, the involving regions and anatomical features to choose different treatments. In addition, the long-term prognosis of patients remains to be determined.

Objective To elucidate the mechanism underlying eletroacupuncture's (EA's) amply-documented analgesic effect.To observe its effect on the pain threshold and on the expression of P2X4 receptor and microglia activation in the spinal cords of rats with neuropathic pain.To demonstrate whether or not interfering with A1 receptors and P2X4 receptors at the same time could enhance the analgesic effect.Methods A total of 40 SpragueDawley rats weighing 150 to 180 g were randomly divided into a sham group,a CCI group,an EA group,a 2-chloroN(6)-cyclopentyladenosine (CCPA) group and a CCPA+EA group,each of 8.Chronic constriction injury (CCI)was induced successfully in the rats of all groups except the sham group.Five days later,EA and 20 μL injections of 0.1 mm/L CCPA were applied to the rat analogues of the Zusanli (ST36) and Yanglingquan (GB34) acupoints once a day for 15 days for the rats in the appropriate groups.The mechanical withdrawal threshold (MWT) and the thermal withdrawal latency (TWL) were measured before the CCI operation and 20 days afterward.L4-L6 spinal cord tissue was then resected and the fluorescence intensity of P2X4 and OX42 receptors was detected using double label immunohistochemical staining.The correlation between the mean fluorescence intensity and the pain threshold gap was analyzed.Results The average MWT and TWL of the CCI group were significantly lower than in the other four groups.The expression of P2X4 receptor and OX42 in the spinal cord increased significantly in the CCI group compared to the other four groups.There was significant correlation between the mean fluorescence intensity of P2X4 and OX42 receptors and the gap in pain threshold,with correlation coefficients of 0.907 and 0.717 respectively.Conclusion P2X4 receptor and microglia activation might be involved in the development of neuropathic pain.CCPA and EA can inhibit the activation of microglia and reduce the activity of P2X4 receptors.The interaction between A1 receptors and P2X4 receptors can strengthen the analgesic effect of EA.

Objective:To evaluate the reliability and validity of the Chinese version of the Orebro musculoskeletal pain questionnaire (OMPQ-CHN) using patients with non-specific lower back pain.Methods:The OMPQ was translated into simplified Chinese according to the Beaton cross-cultural translation guidelines, and then 186 patients with acute or subacute lower back pain were asked to respond to its questions. Based on the results, the internal consistency and test-retest reliability were quantified, and its validity was assessed using content, criterion-related and predictive validity.Results:The Cronbach′s α for the instrument was 0.804. Its ICC was 0.833 (95% CI: 0.683-0.915). I-CVI ranged from 0.86 to 1, S-CVI/Ave=0.99. The correlation between the OMPQ-CHN and other questionnaires ranged from r=0.419 to r=0.646. The AUCs predicting pain, dysfunction and sick leave ranged from 0.723 to 0.810. Conclusions:The OMPQ-CHN has good reliability and validity, and suitably assesses the psychosocial risk factors of Chinese patients with low back pain.

Objective To observe the influence of spinal cord injury (SCI) in hypothalamus AMP-activated protein kinase (AMPK) expression,and explore the mechanism of SCI-induced type 2 diabetes or insulin resistance.Methods Eighteen SD rats were randomly divided into model group,High Fat/High Sucrose/High Cholesterol Diet group and SCI group (n=6).The animals in the model group and High Fat/High Sucrose/High Cholesterol Diet group underwent a T10 laminectomy without weight-drop injury,and SCI models were induced by MASCIS Impactor method.Blood glucose and glucose tolerance tests were performed before experiment and 8 weeks after the experiment.At 8 weeks,the levels of serum inflammatory factors,tumor necrosis factor (TNF)-α,interleukin (IL)-1β,and IL-6,were observed by ELISA;Western blotting was used to detect the expression of phosphorylated (p) -AMPK in the hypothalamus.Results Blood glucose levels in the rats of High Fat/High Sucrose/High Cholesterol Diet group and SCI group were significantly higher than that in the model group (P＜0.05).Blood glucose levels 15 and 60 min after SCI in rats of SCI group were significantly higher than those in the model group (P＜0.05);Blood glucose levels 15,30,60 and 120 min after SCI in rats of High Fat/High Sucrose/High Cholesterol Diet group were significantly higher than those in the model group (P＜0.05).As compared with those in the model group,the expression of p-AMPK in the hypothalamus were significantly decreased,and the TNF-α,IL-1β and IL-6 levels were statistically increased in rats of High Fat/High Sucrose/High Cholesterol Diet group and SCI group (P＜0.05).Conclusion SCI could inhibit AMPK expression in the hypothalamus,activate inflammatory signaling pathway and enhance chronic systemic inflammation,and therefore,insulin resistance is induced.

Objective To investigate the effect of acupuncture on fatigue improvement and gut microbiota in mice with cancer-related fatigue(CRF),and explore its possible mechanism of action.Methods The mice model of CRF of breast cancer after chemotherapy was established by tumor bearing and chemotherapy.After acupuncture intervention,fatigue was evaluated by general condition,forced swimming and open field experiment.Then 16S rDNA sequencing was used to analyze the structural abundance of gut microbiota in mice.Results Acupuncture could significantly improve the fatigue degree and general condition of the mice model of CRF of breast cancer after chemotherapy.At the same time,acupuncture could adjust the abundance of gut microbiota structure,up-regulate the abundance levels of Lactobacillus,Bacteroides,firmicutes,actinobacteria,and down-regulate the abundance levels of Proteobacteria and Staphylococcus.There were also differences in the abundance of flora structure among the groups,but the abundance of beneficial bacteria was relatively high in the acupuncture group,and the abundance of pathogenic bacteria was relatively high in the other two groups.Conclusion Acupuncture may play a role in the treatment of CRF by regulating the abundance of gut microbiota structure,increasing intestinal beneficial bacteria,inhibiting pathogenic bacteria,improving body immunity,and alleviating adverse reactions caused by chemotherapy for breast cancer.

Objective:Acute type A dissection with mitral regurgitation was very rare. To sum up our experience of surgical treatment of acute type A dissection with mitral regurgitation.Methods:From October 2010 to January 2017, 17 patients with acute type A dissection with mitral regurgitation underwent surgical treatment. There were 12 males, 5 females; mean age, (38±11) years(range, 18-59 years). Hypertension was noted in 9 patients, Marfan syndrome in 2 patients, renal dysfuction in 3 patients, cardiac dysfunction in 3 patients, lower limb ischemia was observed in 2 patients and dilated cardiomyopathy in one patient. Preoperative abdominal aortic replacement was observed in one case.Results:Concomitant procedures included Bentall procedure in 16 patients, aortic arch operation in 15 patients, tricuspid valve plasty in 3 patients, coronary artery bypass grafting in 2 patients and asceding aorta - femoral artery bypass in one patient. 11 patients required mechanical ventilation for <24 hours, 3 cases for <48 hours and 3 subjects for > 48 hours. Continuous renal replacement therapy was required in 3 patients, re-operation in one patient and partial pericardial excision in one patient. One patient was out of follow-up. The remaining had a normal life during follow-up.Conclusion:Repair of acute type A dissection with mitral regurgitation carried with a relatively high mortality and morbidity. Under better protection of heart and cerebrum, it obtained accepted surgical results in patients with this lesion

Objective To investigate the efficacy of blood purification for acute lymphoblastic leukemia pediatric patients with high-dose methotrexate (MTX)-induced hypermethotrexemia and acute kidney injury (AKI). Methods The clinical data of 50 acute lymphoblastic leukemia pediatric patients with hypermethotrexemia (the 45th hour MTX blood concentration ＞20 μmol/L) and AKI who were admitted to Beijing Children's Hospital Capital Medical University from May 2010 to August 2018 were collected. After the treatment of blood purification, the declining rate of MTX concentration, the incidence of drug-related side effects and the clinical transition were analyzed retrospectively. Results The median MTX blood concentration at the 45th hour after high-dose MTX chemotherapy was 31.5 μmol/L (20.0-80.3 μmol/L). After blood purification treatment, 48 patients (96%) survived, 1 patient (2%) died, and 1 patient (2%) gave up treatment. It costed 10.0 days (7.0-15.0 days) to decline the MTX concentration to the normal level by using blood purification. The median time of purification was 32.5 hours (2.0-168.0 hours), and the days of dialysis were 3.0 days (1.0-9.0 days). The AKI occurred in approximately 96% (48/50) of patients, which was the main side effect. The time of declining the high MTX concentration to the normal was positively correlated with the increase times of serum creatinine (r ＝ 0.371, P＝ 0.009) and urea nitrogen (r ＝ 0.486, P＝ 0.001), and the value of the alanine aminotransferase (r ＝0.364, P＝0.010) and gamma glutamyl transpeptidase (r ＝ 0.344, P＝ 0.010), and the days of dialysis (r ＝ 0.532, P < 0.01), but there was no relationship with the 45th hour MTX blood concentration (r＝0.110, P＝0.248). The reduction of MTX blood concentration from the 45th hour to the 69th hour after high-dose MTX chemotherapy was negatively correlated with the increase times of urea nitrogen (r ＝ -0.336, P＝ 0.009) and serum creatinine (r ＝ -0.260, P＝ 0.035). Conclusion When the MTX blood concentration of patients with hypermethotrexemia and AKI couldn't be declined to the normal level by using high-dose leucovorin, hydration and alkalization, and without the effective detoxification drug (carboxypeptidase G2), they should be offered blood purification, especially continuous renal replacement therapy as soon as possible, which can reduce the blood concentration of MTX quickly and decrease the incidence of side effects effectively.