Objective Acute Stanford type A aortic dissection(aTAAD) is often misdiagnosed as acute coronary syndrome(ACS), anti-platelet therapy for ACS will influence the timing and outcome of aTAAD.We reviewed the surgical outcome of these misdiagnosed aTAAD patients.Methods From January 2011 to October 2015, 309 aTAAD patients have received surgical therapy in our department, among them 15 patients had misdiagnosed as ACS and taken oral anti-platelet therapy, 9 male and 6 female, the average age was(60.6±8.7) years.Retrospectively reviewed the data of perioperative and follow-up period.Results 5 patients took orally aspirin, 10 took aspirin and clopidogrel.2 patients had received operation 7 days after stopping the agents, 3 days for 3 patients, 1 day for 1 patient, and the other 5 patients received emergency operation without stopping the agents.The cardiopulmonary bypass time was(259.7±64.8) minutes, aortic cross-clamp time was(181.0±51.7) minutes, and selective cerebral perfusion and lower body arrest time was(34.9±8.1) minutes.There were 2 in-hospital deaths due to circulation failure(mortality 13.3%).The average drainage volume in the first 24 hours after operation was(800.7±598.8)ml.During a mean follow-up period of(20.6±17.4) months, one patient had suddenly death.Conclusion aTAAD misdiagnosed as ACS was not rare, anti-platelet therapy will increase the risk of bleeding.The decision of operation time rely on considering balance between the rupture risk of aortic dissection and the hemorrhage risk of anti-platelet therapy.Emergency operation for these patients will increase the bleeding and transfusion.

Objective To analyze the effect of the false lumenstatus of different methods in a single center.Methods From January 2010 to December 2015,391 cases of acute Stanford A aortic dissection were treated in our center.139 cases(of which 108 malesand 31 females) were finally selected after excluding the cases who died during hospitalization,whose perioperative clinical data were incomplete,follow-up information were incomplete,and DeBakey type Ⅱ aortic dissection and the cases with descending aorta dilatation.The average age was(50.3 ± 11.6) years(22-76 years).According to the methods for aortic arch and descending aorta,139 cases were divided into 5 groups:24 cases in AR(including ascending aorta replacement,ascending aorta + hemi-arch replacement and ascending aorta + island-arch replacement),9 cases in AR + SET (including ascending aorta + hemi-arch replacement + stent elephant trunk and ascending aorta + island-arch replacement + stent elephant trunk),42 cases in Arch + SET(ascending aorta + arch replacement + stent elephant trunk),22 cases in AR + TBS (ascending aorta + triple branched stent) and 42 cases in AR + FS(ascending aorta + arch fenestrated stent).Statistical analysis the size of true lemen and the status of false lumen among these five groups in the level of aortic arch,the distal end of stent,diaphragm,celiac artery,renal artery and iliacartery postoperatively.Results Different levels of descending aorta in each group have showed arying degrees of true lumen open and thrombosisof false lumen during follow-up period.Among them,cases with aortic arch treatment and stent implantation have showed higher ratio of thrombosis of false lumen.Effects of different stents were similar,which all promoted the process of thrombosis of false lumen.Conclusion Three methods for aortrc arch and desc ending aorta repair including Cronus (R),triple branched stent and arch fenstrafed stent had similar clinical aortic false lumen closure rate.Three methods had similar long term effect.

Objective To evaluate the clinical results of free vascularized fibular grafting (FVFG) for the treatment of osteonecrosis of the femoral head (ONFH).Methods From July,2009 to January,2013,85 cases (120 hips) of ONFH were treated with free vascularized fibular grafting.These cases included 61 males (87 hips) and 24 females (33 hips) with an average age of 36.5 years (22-51 years);7 hips (Ⅰ A 2 hips,Ⅰ B 3 hips,Ⅰ C 2 hips) were at stage Ⅰ,98 hips (Ⅱ A 24 hips,ⅡB 39 hips,ⅡC 35 hips) at stage Ⅱ and 15 hips (ⅢA 9 hips,ⅢB 4 hips,Ⅱ C 2 hips) at stage]Ⅲ according to the classification system of Association Research Circulation Osseous (ARCO).The mean preoperative Harris hip score was (60.21±6.85) points (42-71 points),The follow-up items included the X-ray examination,the Harris scores of the hip,and the evaluation of the complications.Results Eighty-three cases (117 hips) were followed up.The average duration of follow-up was 25 months (range from 12 months to 42 months).The mean postoperative Harris hip score was increased to (81.26±5.84) points (67-91 points) by the end of the follow-up,compared with the preoperation,the score improved significantly,the difference was statistically significant (P＜0.05).Comparing with postoperative X-ray,101 hips (86.3％) were improved,12 hips (10.3％) had no significant changes and deterioration occurred in 4 hips (3.4％).Conclusion The free vascularized fibular grafting is an effective method for treating osteonecrosis of and preventing the collapse of the femoral head.

OBJECTIVETo investigate the relationship between subtelomeric rearrangements and idiopathic mental retardation (MR).

METHODSThirty unrelated patients were recruited using strict selection criteria. Patients were screened by multiplex ligation-dependent probe amplification (MLPA) for subtelomeric imbalance.

RESULTSFive subtelomeric deletions/duplications were identified. They were: 4p deletion, 21p duplication, 10p duplication combined with 4p deletion, 15p duplication, and 9p deletion combined with 3p duplication. These subtelomeric rearrangements were previously unidentified by conventional technique.

CONCLUSIONChildren with unexplained mental retardation are related with subtelomeric rearrangements. MLPA is a rapid and an effective technique for detecting genetic abnormalities in patients with idiopathic MR.

Child ; Chromosome Aberrations ; Female ; Gene Deletion ; Gene Duplication ; Humans ; Intellectual Disability ; diagnosis ; genetics ; Ligase Chain Reaction ; methods ; Male

Objective To evaluate the safety and feasibility of extra-anatomic bypass in the treatment of complex aorta coarctation concomitant with cardiac lesions,multiple stenosis of aorta or severe stenosis.Methods Complex aorta coarctation include a combination of heart disease (valve disease,coronary artery disease,ect.),or multiple constrictive lesions of the thoracic abdominal aorta or an aneurysm due to constriction of the arch,which are all difficult by interventional surgery or open thoracotomy surgery.From October 2016 to October 2017,6 patients with complex aorta coarctation have received surgical therapy in our department,including 3 males and 3 females,with the average age(50.0-± 17.9) years old.One-staged extra-anatomic bypass was used to establish an ascending aorta to the distal aorta bypass,4 patients underwent median thoracotomy and bypass surgery with thoracic aorta from the posterior inferior pericardium,1 patient underwent bypass surgery with abdominal aorta through thoracoabdominal incision,and 1 patient underwent bypass surgery with bilateral femoral artery from bilateral inguinal incision and guiding with laparoscopic through peritoneal cavity.Among them,3 patients underwent valve surgery in the same period,and 1 patient underwent coronary artery bypass surgery.Results No patient died.The mean cardiopulmonary bypass time was 273.8 minutes and the average aorta blocking time was 216.0 minutes.Pulse pressure of extremities blood pressure was significantly reduced compared with preoperative,and the clinical symptoms were significantly alleviation.During follow-up,6 patients presented with patent artificial blood vessels and alleviated symptoms.Conclusion Extra-anatomic bypass is a safe and effective method for the treatment of complex vasoconstriction without increasing the risk of surgery.

Objective To evaluate the efficacy and safety of high flow nasal cannula (HFNC) oxygen therapy in preventing postoperative respiratory failure. Methods HFNC, nasal catheter high flow oxygen therapy, high flow nasal catheter oxygen therapy, high-flow nasal humidifiers and oxygen inhalers, and patients with postoperative respiratory failure were used as Chinese terms, and high flow nasal cannulae, high flow nasal cannulae oxygen therapy, nasal high flow, adult, postoperative respiratory failure were used as English terms to retrieve, a computer was used to retrieve already published all available randomized controlled trials (RCTs) about using HFNC therapy to prevent patients from the occurrence of postoperative respiratory failure; the search was carried out from PubMed in literature database of American National Library, the Cochrane Library, Holland Medical Abstract Embase, Web of Science, China National Knowledge Infrastructure (CNKI), VIP database, Wanfang Database, China Biomedicine Database (CBM), and the articles were collected from the creation of various above databases to June 2017. The collected RCTs should be carefully read, and the inclusion or exclusion of an article should strictly follow the respective criteria. Two authors independently extracted data, conducted quality assessments , extract the elevation of respiratory support rate, hospital mortality and hospital length of stay, etc. Revman 5.3 software was used to carry out Meta analysis; funnel plots were applied to analyze the publication bias. Results Finally, after Meta analyses, 6 RCTs were included, involving 935 adult patients with existence of moderate to high risks of respiratory failure after the tube drawn out post-operationally, and there were 467 patients in the experimental group and 468 in control group. Compared with the control group, the escalation of respiratory support rate was reduced in the experimental group [odds ratio (OR) = 0.55, 95% confidence interval (95%CI) = 0.39 - 0.76, P = 0.000 3]; There were no statistical significant differences in improving hospital mortality (OR = 0.77, 95%CI = 0.17 - 3.48, P = 0.73) and shortening hospital length of stay [mean difference (MD) =-0.48, 95%CI = -1.37 - 0.41, P = 0.29] in the comparisons between the two groups, but experimental group tended to be the one with more advantage. The funnel plot analysis suggested that the publication bias was relatively low, because the distribution of the included articles was basically symmetrical. Conclusion Compared with COT, HFNC could reduce the escalation of respiratory support rate in patients with postoperative respiratory failure, although there were no statistical significant differences in hospital mortality and hospital length of stay between HFNC and COT, the advantage tends toward the HFNC.

Objective:To explore the efficacy and correction mechanism of posterior column osteotomy for treatment of "Lenke 5-like" lumbar congenital scoliosis.Methods:From April 2008 to September 2019, 16 patients with lumbar congenital scoliosis underwent posterior column osteotomy were retrospectively reviewed including 6 males and 10 females, aged 23.9±11.7 years (range, 14-48 years). Among them, 8 cases were unsegmentation, 5 malformation and 3 mixed type. The average segments of PCO were 5.3. Posterior column osteotomy was adapted after the insertion of pedicle screws, then removed spinous process, ligaments, superior and inferior facet and corrected the deformity with the rods. The pre- and post-operative and last follow-up radiographic parameters were measured: Cobb angle of lumbar curve, distance between C 7 plumbline and center sacral vertical line (C7PL-CSVL), deformity angle (DA), disc correction angle (DCA) of instrumented segments, disc angle above upper instrumented vertebra (DAAU), lower instrumented vertebra disc angle (LDA), upper instrumented vertebra slope (US), lower instrumented vertebra slope (LS), lower instrumented vertebra offset (LO) and sagittal parameters such as thoracic kyphosis (TK), lumbar lordosis(LL) and thoracic junctional kyphosis (TJK). The Scoliosis Research Society-22 questionnaire (SRS-22) were conducted at preoperation and the final follow up to evaluate the clinical outcomes. Results:The mean follow-up period was 16.69±7.65 months (range, 12-36 months). The coronal DA was 26.74°±10.59° while the sagittal DA was 14.70°±11.63°. The pre- and post-operative Cobb angle were 51.19°±12.91° and 23.25°±12.86° while the correction rate was 57.17%±16.31% and reached 24.26°±13.19° in the last follow-up. The improvement of DAAU, LDA, US, LS, and LO pre- and post-operative had statistical significance ( P<0.001). The pre- and post-operative and the last follow-up C 7PL-CSVL were 27.13±17.08 mm, 21.81±12.80 mm and 20.24±15.02 mm. The pre-operative, postoperative and last follow-up DAAU were -4.35°±2.12°, 1.36°±2.34° and 1.60°±2.45°. The pre- and post-operative LDA were -7.03°±4.40° and 2.42°±3.39°, and the last follow-up LDA was 2.81°±2.98°. US and LS decreased from pre-operative 12.01°±8.33° and 21.46°±5.79° to 2.84°±7.52° and 11.64°±6.06°. The mean US and LS were 4.22°±6.56° and 11.56°±6.02° in the last follow-up. LO decreased after surgery and keep unchanged in the last follow-up, which were 12.71°±6.43°, 6.31°±5.17° and 7.01°±4.73°, respectively. For the sagittal plane parameters, the changes of TK, LL, and TJK reached statistical significance through the surgery. LL increased from 33.69°±14.01° to 44.28°±10.07° through the surgery and reached 41.97°±6.69° at the last follow-up while TK increased from 13.41°±12.37° to 23.52°±8.10°, TJK decreased from 29.02°±20.74° to 16.20°±12.62° after the surgery and reached 16.07°±13.33° at the last follow-up. The pre-operative, post-operative and last follow-up thoracic kyphosis were 13.41°±12.37°, 23.52°± 8.10°, and 24.21°±7.39°. There was no statistical significance of the change of C 7PL-CSVL, SVA, SSA and PI-LL through the surgery ( P>0.05). At the final follow-up, the self-image and psychologic status scores of SRS-22 were significantly higher than that before surgery ( t=15.457, P<0.001; t=14.726, P<0.001), and there was no significant difference in the rest of the domain ( P>0.05). Conclusion:"Lenke5-like" lumbar congenital scoliosis could obtain satisfactory correction of coronal and sagittal deformities with the treatment of posterior column osteotomy, while there was no significant loss of correction during follow-up. The incidence of surgical complications is low.

Objective:To investigate the risk factors of long-term shoulder imbalance in patients presented postoperative shoulder imbalance who underwent single segment hemivertebra resection, and the role of postoperative trunk shift in shoulder imbalance.Methods:All of 30 patients who presented shoulder imbalance after hemivertebrae resection and short fusion from July 2006 to December 2018 were reviewed in this study, including 16 males and 14 females, aged 4.53±2.05 years (range, 2-8 years). Among them, 10 cases were thoracic hemivertebra, 12 thoracolumbar hemivertebra and 8 lumbar hemivertebra. According to the vertical height difference at the highest point of soft tissue shadows on both shoulders in the final follow-up upright posteroanterior radiograph, which was shoulder imbalance (SI), they were divided into two groups: Group B (balance, shoulder imbalance less than 10 mm) and Group IB (imbalance, shoulder imbalance more than 10 mm). Several radiographic parameters were measured preoperatively, 3 months after surgery and at the final follow-up, such as SI, distance between C 7 plumbline and center sacral vertical line (C 7PL-CSVL), Cobb angle of main curve, cobb angle of proximal curve (CAPC), Cobb angle of distal curve (CADC), upper instrumented vertebra offset (UO), lower instrumented vertebra offset (LO), upper instrumented vertebra slope (US), lower instrumented vertebra slope (LS), T1 tilt and sagittal vertical axis (SVA). Results:The mean follow-up period was 54.3±33.7 months (range, 24-132 months). A mean of 3.1 segments were fused. 7 cases (70%) of thoracic, 6 cases (50%) of thoracolumbar and 3 cases of lumbar hemivertebrae (37.5%) with shoulder imbalance at 3 months after surgery remained imbalanced at the last follow-up. Thirteen cases presented coronal imbalance postoperative (C 7PL-CSVL>2 cm), among 6 cases whose trunk shafted to the side of the higher shoulder postoperatively, 5 cases presented aggravated SI at final follow-up, and among 7 cases whose trunk shafted to the side of the lower shoulder postoperatively, 6 cases presented aggravated SI at final follow-up, while the difference had statistical significance ( P=0.029). The static analysis indicated that postoperative and long-term C 7PL-CSVL, long-term lowest instrumented vertebra and long-term T 1 tilt were risk factors of shoulder imbalance at final follow-up. Conclusion:A proportion of congenital scoliosis patients who presented shoulder imbalance after hemivertebra resection plus short fusion are less likely to achieve shoulder balance at the final follow-up. Long-term shoulder imbalance is often presented in the patients whose trunk shafted to the side of the higher shoulder postoperatively.

Objective:To assess the association of time interval with surgical repair effects for patients with ventricular septal defect(VSD) following acute myocardial infarction(AMI).Methods:From January 2010 to December 2017, 14 patients with VSD induced by AMI have received surgical therapy in our department. The age of the entire group was (65.5±3.3) years with male percentage of 78.6%(11/14). VSDs were anterior apical in 10(71.4%) and posterior inferior in 4(28.6%) patients. Average size of VSD was(15.8±5.8)mm. We retrospectively reviewed the patients' clinical manifestations, surgical methods and outcomes. According to the time interval from AMI onset and operation, patients were divided into two groups, Group 1(9 cases) as more than one week and Group 2(5 cases) as less than one week. Comparing study was done and differences were analyzed.Results:All patients underwent concomitant coronary artery bypass graft surgery. The cardiopulmonary bypass time and aortic clamp time was(203.9±52.3)min and(152.4±44.8)min. The mortality rate was 14.3%(2/14), higher in Group 2 but no significant differences(20.0% vs 11.1%, P=1.000). Mechanical support(IABP and ECMO) were more common in Group 2, both in preoperative(IABP 80.0% vs 22.2%, P=0.091; ECMO 20.0% vs. 0, P=0.357) and intraoperative period(IABP 60.0% vs. 0, P=0.027; ECMO 40.0% vs. 0, P=0.110). Compared with Group 1, Group 2 revealed worse left ventricular function(LVEF 0.304±0.023 vs. 0.408±0.103, P=0.035), higher rate of urgent procedure(100% vs. 11.1%, P=0.003). No resistant shunt and death was found during follow-up. Conclusion:Surgery is an effective way to treat AMI with VSD. When the time from onset to surgery exceeds one week, the patient's hemodynamic condition is more stable and the operation is safer. Patients undergoing surgery within one week show more unstable hemodynamic status, and mechanical assistance supports can correct the hemodynamic status and improve perioperative success rate.

Objective: To investigate the current status of professional identity among the undergraduates majoring in public affairs management and the related influence factors. Methods: A stratified cluster sampling method was used to conduct a questionnaire survey among the 115 undergraduates majoring in public affairs management in a medical university in Harbin, China, and the contents of the questionnaires included general status and professional identity. The t-test, one-way analysis of variance, and multiple linear regression analysis were used to analyze the influencing factors of professional identity. In-depth interviews were conducted for some students to explore the profound influencing factors for professional identity among the students majoring in public affairs management. Results: The overall level of professional identity was low among the undergraduates majoring in public affairs management in the medical university in Harbin, and the score of professional identity was 3.25±0.56. The scores of cognitive dimension, emotional dimension, behavioral dimension, and applicable dimension were 3.41±0.69, 3.21±0.78, 3.24±0.71, and 3.13±0.72, respectively. The multivariate analysis showed that grade, academic performance, major selection, and children number in family had significant influence on their professional identity. The students who were at grade four, who had high academic record (b=-0.276, P<0.01), who chose this major independently (b=-0.277, P<0.01), and who were the only child (b=-0.233, P<0.05) had a high score of professional identity. As for the undergraduates at different grades, the undergraduates at grades two and three had a significantly lower score of professional identity than those at grade four (b=-0.296 and -0.369, P<0.05), while there was no significant difference between the undergraduates at grades one and four (b=-0.008, P>0.05). Furthermore, the students with a high score of professional identity had higher possibility to pursue the job related to this major than those with a low score (3.39±0.53 vs. 2.92±0.49, t=4.414, P<0.01). Conclusion Universities should strengthen the publicity of the major of public affairs management, optimize the curriculum, and add job experience, so as to enhance professional identity among students with this major and provide talent for the field of public health management.