Objective:To evaluate the value of CT findings in the diagnosis of laryngeal carcinoma infiltration extent.Method:The data of comparison of CT findings and clinico-pathologic stages on 61 patients with laryngeal carcinoma were analyzed from 1995 to 1999.There were 58 males and 3 females ,ranging in age from 37 to 83 years old which stages were T1N0M0 in 11,T2N0M0 in 21,T2N1M0 in 9,T2N2M0 in 1,T2N3M0 in 1,T3N0M0 in 10,T3N1M0 in 2,T4N0M0 in 4 and T4N1M0 in 2,respectively.And the supraglottic cancer was 11(18.0%,11/61),glottic cancer 47(77.1%,47/61),transglottic cancer 3(4.9%,3/61),respectively.The CT examination and surgical treatment were made in all 61 patients.Results:The correct rate at CT findings was 91.8%(56/61),and the accurate rate of clinical stage was 73.8%(45/61).These results showed different significance (P＜0.05).Conclusion:The CT findings showed valuable in the diagnosis to infiltration extent of laryngeal carcinoma and clinical significance for surgical treatment of patients with laryngeal carcinoma.

Objective Summarizing single clinical experience with extracorpomreal membrane oxygenation(ECMO) as a supplement to extracorporeal cardiopulmonary resuscitation(ECPR) in adult patients with cardiac arrest to explore new ideas.Methods We retrospectively analyzed the characteristics of 17 patients who underwent ECMO as part of ECPR from July 2005 to September 2014 at Fuwai Hospital,and analyzed the differences between the survival group(n =6) and the in-hospital death group.Results The mean CPR time was(44.53 ± 21.39) min.The support duration of ECMO was(106.38-± 70.43) h.12 patients of all were successfully weaned from ECMO,and 6 patients survived to hospital discharge.There were significant differences between the two groups in terms of the last serum creatinine and blood lactate acid level before ECMO,and the time to lactate normalization.11 patients died,7 patients developed bleeding,and 8 cases developed infection.Conclusion Single-center data showed that applying ECMO as a means of ECPR improved the survival rate in cardiac arrest patients.Additionally,creatinine and lactic acid were good indicators for assessing prognosis.Refractory circulatory dysfunction and neurologic complications have an adverse impact on the survival of cardiac arrest patients.

Objective: To investigate the technical method for harvesting and application of the descending branch of the lateral circumflex femoral artery (DBLCFA) in the coronary artery bypass grafting (CABG) operation. Methods: Between December 2016 and April 2017, 19 patients were arranged to use DBLCFA and got CT angiography (CTA) of pelvic and femoral arteries pre-operative at Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Finally, DBLCFA was harvested in 16 patients (including 2 female patients, with a mean age of (47.4±8.5) years) through the anterior thigh incision (13 cases on the left side, 3 cases on the right side). The CABG operations were performed under the cardiopulmonary bypass support (in 10 cases) or under the beating heart condition (in 6 cases), and the DBLCFA conduit was used combining with bilateral internal thoracic artery (in 12 cases), radial artery (in 7 cases) and saphenpous vein (in 3 cases). Results: Due to anatomical variations such as short length and anomalous branch, or due to silent atherosclerosis stenosis of femoral artery, DBLCFA in 3 patients was considered inappropriate for use and was not harvested after CTA examination. In another 16 patients, DBLCFA was safely and quickly harvested and successfully used. On average, 3.4±0.6 anastomosis was built up in CBAG, no adverse effects were exhibited. The length of the harvested DBLCFA was (10.3±1.8) cm, with average lumen diameter of (1.9±0.5) mm. DBLCFA was used as free graft in 15 patients (7 to the first diagonal branch, 6 to the ramus intermedius branch, 1 to the left anterior descending branch and 1 to the second obtuse marginal branch). In 1 patient, the DBLCFA was firstly implanted end-to-side to the internal thoracic artery as a "Y" type composite graft, and then anastomosed to the third obtuse marginal branch. Conclusions The descending branch of the lateral circumflex femoral artery is an option conduit in CABG. It can be harvested easily and safely. However, pre-operative CTA examination is necessary to exclude the variation and appropriate strategy for graft establishment should be considered during the operation.

The professional title evaluation of health professionals needs to highlight the clinical performance and actual contribution, and make full use of the information system of medical and health institutions to collect relevant data as an important basis for such evaluation.Based on this, the project team innovatively developed a " clinical work data extraction system" , to extract and calculate the performance indexes of clinicians using data from homepages of medical records. Meanwhile, the team established a reference scale based on the data in the hospital quality monitoring system; developed a " health workers evaluation data platform" , visually presenting the comparison results between the clinical work performance evaluation data of a clinician, and the reference scale and the data of other applicants. In the 2021 annual evaluation of senior professional titles among some medical institutions directly under the National Health Commission and such provinces as Sichuan, Shandong and Chongqing, this method was used to extract homepage data of medical records of 7 833 applicants from 39 medical specialties in 1 416 medical institutions, and finally 6 093 people (77.79%) completed the calculation of clinical work evaluation index data. The initial application results showed that the evaluation of senior clinicians′ professional competence based on homepage data of the medical record was feasible in the senior professional title evaluation of various medical institutions at all levels equipped with the electronic medical record database system, and could effectively present the performance level and actual contribution of the applicant.

Objective: To investigate theperiodic changes in onset of aortic dissection. Methods: The clinical data of 1 121 patients with acute aortic dissection from Hebei province, treated at Fuwai hospital from January 1, 2010 to December 31, 2016, were collected and analyzed retrospectively. The regularity for the onset of aortic dissection was analyzed according to daytime (1:00 to 6:00, 7:00 to 12:00, 13:00 to 18:00, and 19:00 to 24:00), weekday, month, and quarter. Meanwhile,the differences in various type of aortic dissection patient were also compared. Results: The patients were (51.4±12.0) years old,77.88% (873 cases)were male and 69.05% (774 cases) were type A aortic dissection.The peak period for the onset of the disease in a day was from 13:00 to 18:00 (401 cases. 35.77%),and disease onset was less frequent from 1:00 to 6:00 (196 cases, 17.48%).The peak weekday of disease onset was Monday (173 cases, 15.43%) , and disease onset was less frequent on Friday (153 cases, 13.65%) . The peak month of disease onset was January (135 cases, 12.04%), and disease onset was less frequent in July(54 cases, 4.82%). The peak season of disease onset was winter (349 cases, 31.13%), and disease onset was less frequent in summer (184 cases, 16.41%). Number of disease onset was similar between ≥65 years old and<65 years old groups, with or without hypertension groups, with or without Marfan syndrome groups at different periods of a day, each weekday, and seasons(all P>0.05). Conclusion There are periodic changes in the onset of acute aortic dissection,which is higher in winter than in summer, higher in the afternoon than in the morning.

Objective:To understand the current state of renal replacement therapy (RRT) in intensive care unit (ICU) of Tianjin public hospital, and to provide scientific evidence and direction for homogenized management and overall level improvement of RRT in Tianjin.Methods:The questionnaires were distributed to the chief or key staff of 33 ICUs from 32 public hospitals in Tianjin by clinical quality control center for critical care medicine of Tianjin and ICU of Tianjin Third Central Hospital. The RRT data of ICUs from January 2020 to December 2021 was collected, including the type and size of ICU, the number of patients undergoing RRT, reasons for initiating RRT, the RRT modes, the anticoagulation and the complications of RRT and so on.Results:A total of 33 valid questionnaires were obtained, with a recovery rate of 100%. The result showed that there were 38 803 patients admitted to the selected ICUs during investigation, and 5 456 of them (14.06%) received RRT. In most ICUs, the reasons of initiating RRT were renal failure, sepsis and volume overload. The mode of RRT was mainly continuous venovenous hemofiltration (CVVH), which was followed by continuous venovenous hemodiafiltration (CVVHDF). Carbonate replacement fluid was the first choice. Heparin was the dominant anticoagulant, and there was an increasing trend in the use of citrate anticoagulation simultaneously. However, heparin-free anticoagulation used mostly in bleeding patients. Overall, the RRT modes and anticoagulation methods were single. Thrombosis was the main iatrogenic factor interrupting RRT in most ICUs, and also the reasons for complications related to catheter or circulation pipeline. It still showed an ineffective anticoagulation of RRT even after increasing the dosage of anticoagulants.Conclusions:RRT is an important organ support method in ICU, which has been widely carried out in ICUs of Tianjin and continues to expand. Despite the positive performance, it still needs to be improved and standarized in some aspects, such as the diversification of RRT modes, anticoagulation, and the complication prevention.

OBJECTIVETo investigate the role of Wnt signaling pathway on paraquat (PQ)induced PC12 cells damage.

METHODSUsing PC12 cells, in this study CCK8 assay was used to detect the effect of cell viability. The cell apoptosis and cell cycle was detected by flow cytometry. The real-time polymerase chain reaction (RT-PCR) was used to measure the mRNA expression of Wnt pathway key genes including Fzd1, Dvl2 and β-catenin and downstream genes including Bax, Bcl2, Survivin, Cyclin D1 and C-myc.

RESULTCompared with the control, PC12 cells viability in 50.00 and 100.00 µmol/L PQ treatment groups were obviously decreased, the cell cycle S phase arrest, and cell apoptosis increased (P<0.05). The 25.00, 50.00 and 100.00 µmol/L PQ treatment groups mRNA expression of Wnt pathway key genes including Fzd1, Dvl2 and β-catenin and downstream genes including apoptosis suppressor genes (Bcl-2 and survivin)and cyclin gene (Cyclin D1) were downregulated (P<0.05). The mRNA expression of pro-apoptosis gene (Bax) and cyclin gene (C-myc) were upregulated (P<0.05).

CONCLUSIONIt suggested that PQ can activate Wnt pathway to regulate downsteam genes expression, resulting in PC12 cell cycle arrest and apoptosis.

Adaptor Proteins, Signal Transducing ; metabolism ; Animals ; Apoptosis ; Apoptosis Regulatory Proteins ; metabolism ; Cell Cycle ; Cell Survival ; Dishevelled Proteins ; Down-Regulation ; Flow Cytometry ; Frizzled Receptors ; metabolism ; Gene Expression ; drug effects ; PC12 Cells ; Paraquat ; toxicity ; Phosphoproteins ; metabolism ; Rats ; Receptors, Neurotransmitter ; metabolism ; Wnt Signaling Pathway

Objective    To assess outcomes of transcatheter aortic valve replacement (TAVR) for pure native aortic valve regurgitation. Methods    A total of 129 patients underwent transfemoral TAVR in Fuwai Hospital from May 2019 to October 2020 were retrospectively analyzed. There were 83 males and 46 females with an average age of 72.26±8.97 years. The patients were divided into a pure native aortic valve regurgitation group (17 patients) and an aortic valve stenosis group (112 patients). Results    The incidence of valve in valve was higher in the pure native aortic valve regurgitation group (47.0% vs. 16.1%, P<0.01). There was no statistical difference between the two groups in conversion to surgery, intraoperative use of extracorporeal circulation, intraoperative left ventricular rupture, postoperative use of extracorporeal membrane oxygenation (ECMO), peripheral vascular complications, disabled stroke, death, or pacemaker implantation. There was no statistical difference in the diameter of annulus (25.75±2.21 mm vs. 24.70±2.90 mm, P=0.068) or diameter of outflow tract (25.82±3.75 mm vs. 25.37±3.92 mm, P=0.514) between the pure native aortic valve regurgitation group and the aortic valve stenosis group. Conclusion    Transfemoral TAVR is a feasible method for patients with pure native aortic valve regurgitation. The diameter of annulus plane, the diameter of outflow tract and the shape of outflow tract should be evaluated.