Objective:To examine the efficacy and experience of staged and segmented two hybrid surgeries for total repair of Debakey type Ⅰ aortic dissection (TIAD).Methods:This study was a retrospective case series. The clinic data of 10 patients with acute TIAD who were admitted to the Department of Cardiac Surgery, Second Hospital of Lanzhou University or the First People′s Hospital of Lanzhou, between January 2016 and August 2022, were retrospectively studied. Ten patients underwent hybrid surgeries in two hospitalizations (stages), including 7 males and 3 females with an age of (60±7) years (range: 49 to 71 years). In stage 1, the first type Ⅱ hybrid arch repair was performed to treat the ascending, total arch, and descending thoracic aorta for acute TIAD without circulatory arrest. In stage 2, the second hybrid surgery including infrarenal abdominal aorta replacement, visceral arteries bypass and endovascular thoracoabdominal aortic repair was performed to treat residual thoracoabdominal aortic dissection after the first hybrid operation (segmented). Basic data, preoperative concomitant diseases, high-risk factors, surgical approaches and postoperative complications of all important organs, as well as CT imaging were analyzed.Results:There was no death in the 20 hybrid surgical procedures. In stage 1 type Ⅱ hybrid surgery, 4 cases underwent reconstruction of the aortic sinutubular junction, while Bentall and David surgery was performed for 3 cases, respectively. A patient received coronary artery bypass grafting. Then all patients were sequentially treated with arch debranching and thoracic aortic endovascular repair. Postoperative complications included renal insufficiency (4/10), hemofiltration (1/10), hypoxemia (4/10), neurologic event (1/10) and type Ⅱ endoleak (1/10). Complete false lumen thrombosis occurred in 9/10 of the patients. All complications recovered successfully at discharge and the average hospital stay was (21±4) days (range: 16 to 28 days) in the first hospitalization. At stage 2, the second hybrid surgery was successfully performed in all patients. No paraplegia, hepatic or renal insufficiency, or endoleak occurred. However, branch graft embolism of the left renal artery was found in one patient 3 days after laparotomy, as well as of superior mesenteric artery in another. Superior mesenteric artery occlusion was successfully treated by endovascular recanalization. Complete false lumen thrombosis occurred in all patients. Although all patients had different degrees of intestinal dysfunction, they were gradually relieved at discharge, and the average hospital stay was (19±2)days (range:16 to 21 days) in the second hospitalization. During follow-up, CT angiography showed aortic remodeling in all patients.Conclusion:Staged and segmented two hybrid surgeries are safe and feasible for total repair of Debakey type Ⅰ aortic dissection and are associated with acceptable early and midterm outcomes.

Objective:To examine the efficacy and experience of staged and segmented two hybrid surgeries for total repair of Debakey type Ⅰ aortic dissection (TIAD).Methods:This study was a retrospective case series. The clinic data of 10 patients with acute TIAD who were admitted to the Department of Cardiac Surgery, Second Hospital of Lanzhou University or the First People′s Hospital of Lanzhou, between January 2016 and August 2022, were retrospectively studied. Ten patients underwent hybrid surgeries in two hospitalizations (stages), including 7 males and 3 females with an age of (60±7) years (range: 49 to 71 years). In stage 1, the first type Ⅱ hybrid arch repair was performed to treat the ascending, total arch, and descending thoracic aorta for acute TIAD without circulatory arrest. In stage 2, the second hybrid surgery including infrarenal abdominal aorta replacement, visceral arteries bypass and endovascular thoracoabdominal aortic repair was performed to treat residual thoracoabdominal aortic dissection after the first hybrid operation (segmented). Basic data, preoperative concomitant diseases, high-risk factors, surgical approaches and postoperative complications of all important organs, as well as CT imaging were analyzed.Results:There was no death in the 20 hybrid surgical procedures. In stage 1 type Ⅱ hybrid surgery, 4 cases underwent reconstruction of the aortic sinutubular junction, while Bentall and David surgery was performed for 3 cases, respectively. A patient received coronary artery bypass grafting. Then all patients were sequentially treated with arch debranching and thoracic aortic endovascular repair. Postoperative complications included renal insufficiency (4/10), hemofiltration (1/10), hypoxemia (4/10), neurologic event (1/10) and type Ⅱ endoleak (1/10). Complete false lumen thrombosis occurred in 9/10 of the patients. All complications recovered successfully at discharge and the average hospital stay was (21±4) days (range: 16 to 28 days) in the first hospitalization. At stage 2, the second hybrid surgery was successfully performed in all patients. No paraplegia, hepatic or renal insufficiency, or endoleak occurred. However, branch graft embolism of the left renal artery was found in one patient 3 days after laparotomy, as well as of superior mesenteric artery in another. Superior mesenteric artery occlusion was successfully treated by endovascular recanalization. Complete false lumen thrombosis occurred in all patients. Although all patients had different degrees of intestinal dysfunction, they were gradually relieved at discharge, and the average hospital stay was (19±2)days (range:16 to 21 days) in the second hospitalization. During follow-up, CT angiography showed aortic remodeling in all patients.Conclusion:Staged and segmented two hybrid surgeries are safe and feasible for total repair of Debakey type Ⅰ aortic dissection and are associated with acceptable early and midterm outcomes.

Objective:To explore the mediating effect of children's effortful control on the relationship between home environment and children's behavioral emotional problems in preschool children with malignant tumors and to provide evidences for family intervention on behavioral emotional problems in children.Methods:Totally 353 preschool children with malignant tumors were investigated with family adaptation and cohesion evaluation scales II (FACES II), child behavior questionnaire-very short form(CBQ-VSF) and strengths and difficulties questionnaire (SDQ), AMOS 22.0 software was used to construct a structural equation model in data analysis and the Bootstrap method was used to test the mediation effect.Results:The scores of family adaptation and cohesion, children's effortful control, difficulty questionnaire were(51.63±12.41), (55.43±10.16), (3.23±0.80) and (13.75±3.66). The scores of dimensions including emotion, conduct, hyperactivity, peer problems, prosocial of difficulty questionnaire were(2.83±0.90), (2.73±0.96), (2.67±0.93), (2.76±0.85), (2.67±0.85), respectively. Family adaptation and cohesion were positively correlated with children's effortful control ( r=0.244, 0.289, P<0.01). Children's effortful control was negatively correlated with children's behavioral emotional problems ( r=-0.365--0.302, all P<0.05). Family adaptation and cohesion were negatively correlated with children's behavioral/emotional problems ( r=-0.323--0.124, r=-0.342--0.181, all P<0.05). The direct effect value was -0.469, indirect effect value was -0.102, accounting for 17.86% of the total effect. Conclusion:Children's effortful control exert a significant mediating effect on the relationship between home environment and children's behavioral/emotional problems in preschool children with malignant tumors, suggesting that medical staff should pay attention to the level of effortful control of preschool children with malignant tumors in order to take effective actions to reduce children's behavioral/emotional problems and improve social applicability.

Objective:To study the differences in clinical characteristics between children and adults with ocular roundworm disease (OT) and analyze its prognosis.Methods:This study was a retrospective cohort study, which included 37 patients (37 eyes) with ocular toxocariasis disease admitted to the Department of Ophthalmology, Peking Union Medical College Hospital from September 2017 to September 2023, including 12 adult patients (12 eyes) and 25 pediatric patients (25 eyes). We compared the clinical differences and prognosis between pediatric and adult patients.Results:16% (4/25) of the affected eyes in the child group had high intraocular pressure, while the adult group had no affected eyes with high intraocular pressure. All affected eyes showed vitreous inflammation, and there was a statistically significant difference in the level of vitreous inflammation between the two groups ( P<0.05). The majority of OT types in the adult group were atypical phenotype OT, with a statistically significant difference compared to the child group ( P<0.05). The proportion of retinal vasculitis, macular edema, and proliferative membrane on the retinal surface in the adult group was higher than that in the child group (all P<0.05). After oral treatment with albendazole and corticosteroids, the thickness of the macular fovea and anterior segment inflammation in both groups were significantly improved (all P<0.05). The proportion of local use of steroid drugs in the children′s group was higher than that in the adult group ( P<0.05). Conclusions:Compared with pediatric OT, adult OT mostly has no characteristic signs, and adult OT is mainly characterized by atypical phenotype OT. Adult OT has a better prognosis and is less prone to recurrent inflammation. In most cases, antiparasitic and anti-inflammatory treatments are safe and effective.

AIM: To summarize 10 surgical pearls for managing proliferative diabetic retinopathy(PDR)adapted from the ancient Chinese allusions and analyze the application of these pearls in a real-world fashion.METHODS: Retrospective, noncomparative, interventional study. Ten surgical pearls were summarized and adapted from the ancient Chinese philosophy. Totally 346 cases(443 eyes)that underwent pars plana vitrectomy(PPV)at our hospial from January 2016 to February 2024 were selected. Flexible combinations of these pearls were applied according to the specific condition of each patient during surgeries. The efficacy and safety were analyzed, as well as the application frequencies according to the existence of tractional retinal detachment or not.RESULTS: A total of 473 times of surgeries were performed on all the patients. According to ancient Chinese allusions, ten surgical pearls were summarized from these surgeries. All PPVs went smoothly with the application of different combinations. Finally, almost all proliferative membranes were successfully peeled except for 10 patients(11 eyes), who went through strategy No.10(minimal membranectomy)that, only necessary relaxation incisions were made with most of the proliferative membranes left on purpose. The final visual acuities were mostly improved or stable(1.92±0.83 LogMAR preoperatively vs 1.16±0.85 LogMAR postoperatively, P<0.01). Postoperative complications mainly included early inflammatory responses in the anterior chamber and nuclear sclerosis. Recurrent vitreous hemorrhage, retinal detachment, and hyphema or neovascular glaucoma occurred in 1.9%(9/473), 3.2%(15/473), 0.4%(2/473)and 0.4%(2/473)times of PPVs, respectively. After 12/473(2.5%)times of PPVs, retinal detachment at the macular area still existed, and multiple times of subsequent PPVs were conducted. Final retinal attachment at the macular area was realized in 98.9% eyes. Those 5 unattached eyes were with heavily reproliferated membranes and subsequent tractional retinal detachment recurrence under the oil, and three of them were scleral buckled additionally.CONCLUSION:These 10 surgical strategies and technique pearls were mostly effective and safe in the management of severe PDR patients. They were relatively easy to be memorized and applicated once the meaning of each Chinese idiom was understood. One can use different combinations flexibly according to a patient's specific condition.