[Summary] The paper reported 9 cases of external type cesarean scar pregnancy treated with transvaginal local lesion resection between January 2013 and March 2014 in this hospital .The surgical exposure was established by using vaginal tractors .The cervical front lip was pulled below outwards by using cervical clamp to expose the front vaginal fornix .Hemostatic water was injected into the cervix vaginal clearance (epinephrine 0.5 mg +NS 500 ml).The vaginal mucosa was opened at bladder cervix groove level for entering the bladder cervix clearance .The bladder was seperated upwards and to the side with fingers to expose uterine isthmus lesions . After cutting the thin muscle , the embryos and part of necrotic tissues were extracted for pathological examination .The incision scar around tissues were trimed and a drainage tube was placed in the uterine .A myometrium full-thickness continuous suture was performed with 1-0 absorbable sutures ( paying attention to avoid endometrial tissues ) , and the vaginal wall was continuously sutured with 1-0 absorbable thread .The drainage tube was removed 5 days after operation .The operations were successfully accomplished in all the 9 cases.The average operation time was 65 min (40-90 min), and the average blood lose was 60 ml (40-80 ml).Cervical tube adhesion occurred in 1 case, and no complications were observed in the remaining cases .The average hospitalization time was 7.5 days (5-10 days).The postoperative time of menstruous restoration was 28-40 days.We deem that transvaginal resection of cesarean scar pregnancy lesion is simple and deserves clinical popularization .

Objective:To explore surgical strategies for acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries.Methods:From January 2019 to March 2023, a total of 29 patients with acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries were included in the study. All patients underwent emergency surgery, with simultaneous intraoperative neck incision and replacement of the unilateral or bilateral carotid arteries. Among them, there were 19 males with a mean age of(49.57±2.14)years old. Preoperative brain CT indicated abnormalities in 15 cases, transient neurological dysfunction occurred in 5 cases, and syncope in 1 case.Results:Procedures included ascending aorta replacement in 10 cases, Bentall procedure in 18 cases, and Wheat procedure in 1 case. Arch operations involved partial arch replacement in 3 cases and Sun’s procedure in 26 cases. Simple left carotid artery replacement was performed in 6 cases, simple right carotid artery replacement in 19 cases, and bilateral carotid artery replacement in 4 cases. Cerebral protection measures during circulatory arrest included unilateral cerebral perfusion in 24 cases and bilateral cerebral perfusion in 5 cases. The mean operation time was(7. 6±0. 3) h, with a mean cardiopulmonary bypass time of(196. 3±8. 7) min, aortic cross-clamp time of(113.2±6.4) min, ischemic time 12(5-16.5) min, and lowest temperature of(26.3±0.4)°C. One patient experienced in-hospital mortality. Postoperatively, new neurological dysfunction occurred in 2 cases, including 1 case with coma and permanent neurological deficit.Conclusion:In patients with acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries, simultaneous carotid artery replacement via neck incision during aortic surgery is a safe and reliable surgical approach.

Interleukin (IL)-17A, a pro-inflammatory cytokine, is a fundamental function in the onset and advancement of multiple immune diseases. To uncover the primary compounds with IL-17A inhibitory activity, a large-scale screening of the library of traditional Chinese medicine constituents and microbial secondary metabolites was conducted using splenic cells from IL-17A-GFP reporter mice cultured under Th17-priming conditions. Our results indicated that some aureane-type sesquiterpene tetraketides isolated from a wetland mud-derived fungus, Myrothecium gramineum, showed remarkable IL-17A inhibitory activity. Nine new aureane-type sesquiterpene tetraketides, myrogramins A-I ( 1, 4- 11), and two known ones ( 2 and 3) were isolated and identified from the strain. Compounds 1, 3, 4, 10, and 11 exhibited significant IL-17A inhibitory activity. Among them, compound 3, with a high fermentation yield dose-dependently inhibited the generation of IL-17A and suppressed glycolysis in splenic cells under Th17-priming conditions. Strikingly, compound 3 suppressed immunopathology in both IL-17A-mediated animal models of experimental autoimmune encephalomyelitis and pulmonary hypertension. Our results revealed that aureane-type sesquiterpene tetraketides are a novel class of immunomodulators with IL-17A inhibitory activity, and hold great promise applications in treating IL-17A-mediated immune diseases.