CTICU is a place in which many patients with critical cardiothoracic and vascular disease are centered. Owning skillful medical underwent complex and dangerous cardiopulmonary operation and the patients underwent complex and dangerous cardiopulmonary operation and the dying can get immediately effective treatment and intensive care as well as good effects. HOwever, We often face some new ethical challenge in which ethical conflicts about use of high-new technology and abandoning treatment or surgery are the most typical while we hae gotten interests in CTICU. This paper is to do somw discussion about the ethical problem and the ethical criterions according to clinical characteristics in CTICU.

Objective To clarify the role of protein kinase A (PKA),protein kinase C (PKC) and cyclin dependent kinase5 (CDK5) in the alterations of neurofialments (NFs) in 2,5-hexanedione (HD) induced toxic peripheral neuropathies. Methods HD was administrated to male Wistar rats by intraperitoneal injection at doses of 200 or 400 mg/kg,once a day,for 8 consecutive weeks. The relative contents of PKA,PKC,p35 precursor and CDK5 in spinal cord were determined by using SDS-PAGE and Western Blotting. Results In the cytosolic fraction of spinal cord,the levels of PKA and PKC in 400 mg/kg group significantly increased (P

Background Corneal blindness is one of the major blinding eye diseases in China.With the development and progress of tissue engineering technology,tissue-engineered corneas offers a new approach to the treatment of corneal diseases.To select and cultivate ideal seed cells is a foundation of construction of tissueengineered corneas.Objective This study was to evaluate the efficiency of stripe off the Descemet membrane with endothelium plus enzymic digestion in the isolation of corneal endothelial cells and analyze the bionomics of rabbit corneal endothelial cells (CECs) in vitro.Methods Descemet membrane was stripped from fresh cornea of New Zealand rabbit under the dissection microscope.Descemet membrane with endothelium was incubated in trypsin and EDTA solution at 37 ℃ and then purified for CECs subculture in vitro.The morphology of the cultured cells was observed under the inverted microscope and marked by CM-Dil dye solution.Then the shape of the cells was observed by hematoxylin and eosin staining and the cells were identified for the expression of neuron specific enolase (NSE) using immunochemistry.The viability of the cells were evaluated by trypan blue staining.The surface structure of the cells were examined under the scanning electron microscope.Intercellular zonula occludens-1 (ZO-1) was identified by immunofluorecsence staining.Results A large number of purified CECs were obtained from Descemet membrane with endothelium through enzymic digestion.Cultured cells grew well and formed monolayer 5-7 days later with the cobblestone stone-like arrangement.The survival rate of the cells was 95％.CECs presented with the red annular fluorescence for CM-Dil with the labeling rate ＞90％.NSE was positively expressed in the cytoplasm.Polygon CECs were seen by hematoxylin and eosin staining and showed the brown staining.Abundant microvilli on the cellular surface and interconnected foot process were seen under the scanning electron microscope.ZO-1 showed the green fluorescence.Conclusions The method of striping off the corneal Descemet membrane with endothelium plus enzymic digestion can obtain abundant CECs.Cultured cells have good biological properties.This study may offer a feasible application in the engineering of corneal transplant membrane.

OBJECTIVE:To compare the efficacy and safety of low molecular weight heparin and rivaroxaban in the preven-tion of deep venous thrombosis after spinal surgery. METHODS:Totally 276 patients with high risk factors after spinal surgery were randomly divided into control group and observation group. The patients in the two groups were used elastic stockings to physi-cally prevent deep venous thrombosis from the postoperative first day to continue 3 months;based on it,control group was subcuta-neously injected with 1 low molecular weight heparin from the postoperative first day,once a day. Observation group was orally treated with 1 Rivaroxaban tablet,once every night. The treatment course for 2 groups was 2 weeks. The clinic data was observed, including clinical efficacy,superficial femoral vein diameter(FSV),popliteal vein diameter(POPV),prothrombin time(PT),fi-brinogen degradation products(FIB)and D- dimer(DD)before and after treatment,incidence of deep venous thrombosis and ad-verse reactions. RESULTS:There were no significant differences in the total effective rate and deep venous thrombosis and inci-dence of ADR between 2 groups(P>0.05). After 3 months,compared with before,there were no significant differences in the FSV and POPV between 2 groups (P>0.05);POPV in control group was significantly lower than before and observation group, there was statistical significance(P<0.05). After 1 week,compared with before,there was no significant difference in the PT be-tween 2 groups(P>0.05);the FIB and D-D were significantly higher than before,there was statistical significance(P<0.05), however,there were no significant differences between 2 groups(P>0.05);after 4 weeks,PT in 2 groups was significantly high-er than before,there was statistical significance(P<0.05),however,there were no significant differences between 2 groups(P>0.05);FIB and D-D were significantly higher than before,and observation group was lower than control group,there was statisti-cal significance(P<0.05). CONCLUSIONS:Both efficacy and safety of low molecular weight heparin and rivaroxaban in the pre-vention of deep venous thrombosis after spinal surgery are good. However,rivaroxaban is better than low molecular weight heparin in improving blood coagulation function.

Objective:To compare the efficacy of pars plana vitrectomy (PPV) and nonvitrectomizing vitreous surgery (NVS) in the treatment of idiopathic epimacular membrane (IMEM).Methods:A prospective , randomized and comparative clinical study. From April 2019 to May 2020, 21 eyes of 21 patients with IMEM diagnosed in Chongqing Aier Eye Hospital were included in the study. Among them, 11 males had 11 eyes, and 10 females had 10 eyes. Best-corrected visual acuity (BCVA), optical coherence tomography angiography (OCTA), and corneal, intraocular, and global aberration measurements were performed in all eyes. The international standard logarithmic visual acuity chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The iTrace visual function analyzer was used to measure the corneal, intraocular and whole ocular aberrations, and the dysfunction lens index (DLI) was calculated. Lens density in Scheimpflug images was calculated using Pentacam three-dimensional anterior segment analysis and diagnosis system. The 6 mm×6 mm area of the macular area was scanned by OCTA, which was divided by the software automatically into three concentric circles with the fovea as the center, namely the central area with a diameter of 1 mm, the inner ring area with a diameter of 1-3 mm, The outer ring area of 3-6 mm was used to measure the superficial vessel density (SVD) and superficial perfusion density (SPD) of the entire macular area, the central area, the inner ring area, and the outer ring area. The patients were divided into PPV combined with epimacular membrane (MEM) peeling group (PPV group) and NVS direct peeling MEM group (NVS group) by random number table method, 10 cases with 10 eyes and 11 cases with 11 eyes, respectively. The age of the two groups ( t=-0.72), logMAR BCVA ( t=-0.98), lens density ( t=-1.10), DLI ( t=1.15), SVD ( t=0.82) and SPD ( t=1.19) of entire macular area, corneal aberration ( t=0.45), intraocular aberration ( t=-0.22), and whole eye aberration ( t=0.83), there was no significant difference ( P>0.05). All eyes were operated on with a 27G vitrectomy system. The MEM was removed from the eyes of the NVS group under NVS condition, and the MEM was removed from the eyes of the PPV group under the condition of PPV, and the operation time was recorded at the same time. The follow-up period after surgery was 12 months. Relevant examinations were performed using the same equipment and methods before surgery. Taking the last follow-up as the time point for efficacy judgment, the BCVA, lens opacity, DLI, visual quality, SVD, SPD and MEM recurrence in the macula were compared between the two groups. The two groups were compared by paired t test. Results:The operation time of eyes in PPV group and NVS group was 20.81±3.52 and 5.70±1.30 min, respectively, and the difference was statistically significant ( t=7.23, P<0.001). At the last follow-up, the logMAR BCVA of PPV group and NVS group were 0.65±0.25 and 0.44±0.20, respectively, and the difference was statistically significant ( t=-2.16, P=0.04); compared with before operation, the BCVA of eyes of the two groups was significantly improved, and the difference was statistically significant. ( t=2.52, 4.41; P=0.033, P<0.001). The lens density and DLI of the affected eyes in the PPV group and NVS group were 10.64±1.58, 6.24±3.99 and 5.77±1.63, 7.74±1.55, respectively, and the differences were statistically significant ( t=-3.90, 2.85; P<0.05). The macular area SVD ( t=1.03), SPD ( t=1.77), corneal aberration ( t=-0.42), intraocular aberration ( t=-1.10), and whole-eye aberration ( t=-1.17) of eyes of the two groups, the difference was not statistically significant ( P>0.05). During the follow-up period, there were 2 eyes with MEM recurrence, 1 eye in the PPV group and 1 eye in the NVS group; there was no significant difference in the recurrence rate of MEM between the two groups ( χ2=0.005, P=0.94). Conclusion:Compared with PPV combined with MEM stripping, the BCVA after NVS surgery increases more, has a better protective effect on the lens, and has a shorter operation time.