Objective To observe the effect of in situ needle fenestration thoracic endovascular aortic repair(TEVAR)for treating aortic dissection(AD)involving aortic arch.Methods Data of 16 patients with AD involving aortic arch who underwent in situ needle fenestration TEVAR for reconstruction of aortic arch branches were retrospectively analyzed,and the number of fenestration,technical success rate and TEVAR related complications were recorded.Regular follow-up was conducted after TEVAR,the repair of dissection and the patency of fenestrated branch blood vessels were evaluated,the endoleak was assessed,and the survival of patients were recorded.Results The main aortic stent was successfully implanted in all 16 cases.Among them,4 received triple fenestration stent implantation in zones Z0,Z1 and Z2,6 received double fenestration stent implantation in zones Z1 and Z2,2 received double fenestration stent implantation in zones Z0 and Z1 and 4 received single fenestration stent implantation in zone Z2.The success rate of brachiocephalic trunk(BCT)fenestration was 83.33%(5/6).Left common carotid artery(LCCA)-right common carotid artery bypass was performed in 1 case without successful fenestration.The success rate of LCCA fenestration was 100%(12/12).The success rate of left subclavian artery(LSA)fenestration was 87.50%(14/16),2 cases with not successful fenestration were treated with axillar-axillary artery artificial vascular bypass.The technical success rate of intervention was 100%(16/16).Type Ⅰa endoleak occurred in 1 case during TEVAR process and improved after embolization with spring coil.One patient died of pericardial tamponade at the end of TEVAR.Fifteen patients were followed up for a median follow-up time of 20 months.During this period,transient ischemic attack and local small dissection at the proximal beginning of the main stent occurred each in 1 case,which improved after no special treatment.Type Ⅰ endoleak occurred in 1 case,type Ⅲ endoleak occurred in 2 cases,all improved after proximal fenestrated membrane stent implantation or spring coil embolization treatment.One case died of coronary heart disease.Conclusion In situ needle fenestration TEVAR was effective and safe for treating AD involving aortic arch.

The ultimate goal of cardiac arrest-cardiopulmonary resuscitation (CA-CPR) is to reduce brain damage and promote neurological recovery. Although the return of spontaneous circulation (ROSC) has improved, the proportion of patients who survive to discharge is very low, so how to evaluate the recovery of brain function after resuscitation is particularly important in clinical work. From a clinical perspective, although early prognostic indicators are not perfect, identifying high-risk features may help clinicians determine the severity of brain injury caused by a patient's potential course of disease. This review, based on recent literature, selects several commonly used clinical brain function evaluation indicators to provide theoretical and practical support for assessing brain function recovery in patients after CPR.
Humans ; Cardiopulmonary Resuscitation/methods* ; Heart Arrest/physiopathology* ; Brain/physiopathology* ; Recovery of Function ; Prognosis

ObjectiveTo determine the pathogen and phylogenetic characteristics of an uncommon outbreak of recombinant norovirus infection in Daishan County in February 2022. MethodsFluorescence quantitative PCR was used to detect the norovirus in the eight anal swabs collected in the outbreak. In the positive samples， reverse transcription PCR were used to amplify the norovirus. Norovirus sequences were characterized by MEGA7 and Simplot. ResultsNorovirus GⅠ was identified in all eight anal samples. It was further determined to be recombinant norovirus GⅠ.6 ［P11］， with the recombination site at the ORF1-ORF2 junction. The sequence had the highest nucleotide identity （98.75%） to a GⅠ.6［P11］ strain collected in 2018 （GenBank accession number MT357995）. ConclusionAccording to the etiological identification and phylogenetic analysis， this outbreak is confirmed to be caused by the uncommon recombinant norovirus GⅠ.6 ［P11］ in China.

Objective To explore the molecular mechanism of dipeptidyl peptidase-4 ( DPP4) in the calcification of human vascular smooth muscle cells(HVSMCs). Methods The osteogenic differentiation of HVSMCs was induced by 200 ng/ ml DPP4 as calcification model. The differentially expressed long non-coding RNAs (lncRNAs) between DPP4 group and control group were analyzed by microarray, and the microarray results of LincRNA ENST00000540293 were validated by real-time PCR. After HVSMCs were incubated with LincRNA ENST00000540293 silencing positive reagent for 48 h, the expressions of calcification-related proteins osteoprotegerin (OPG) and bone morphogenetic protein 2(BMP-2) were detected by Western blotting and the formation of calcified nodules was observed by Alizarin red staining. Results The protein expressions of OPG and BMP-2 in HVSMCs were significantly increased after DPP4 intervention (P <0.05), with the increased formation of calcified nodules. RTqPCR showed that LincRNA ENST00000540293 expression was significantly decreased in DPP4 group as compared with the control group(P<0.05). The expressions of calcification-related proteins OPG and BMP-2 were significantly increased after LincRNA ENST00000540293 silence(P<0.05). Conclusion DPP4 may promote the calcification of HVSMC through inhibiting LincRNA ENST00000540293 expression.