ObjectiveTo retrospectively analysis the role of intercostal artery reconstruction in spinal cord protection for patients with extent thoracoabdominal aotic aneurysm (TAAA) repair.MethodsFrom August 2003 to August 2010,extent Crawford Ⅱ TAAA repair were performed in 81 consecutive patients with mean age (39.4 ± 10.3) years and 61 (75.3％)were males.All the procedures were performed under profound hypothermia with interval cardiac arrest.Patientswere opened with a thoracoabdominal incision.Extracorporeal circulation was instituted with two arterial cannulae and a single venous cannula in the right atrium.T6 to T12 intercostal arteries and L1,2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8mm branch for keeping spinal cord blood perfusion.Visceral arteries were joined into a patch and anastomosed to the end of the main graft.Left renal artery was anastomosed to an 8mm branch or joined to the patch.The other 10mm branches were anastomosed to iliac arteries.ResultsWith 100％ follow-up,early mortality was 7.4％ (6/81),one patient was dead result from cerebral hemorrhage,three from renal failure,one from heart failure because of myocardial infarction and one from rupture of cliac artery dissection.Postoperative spinal cord deficits was 3.7％ (3/81),temporary paraplegia were observed in 2 patients and paraparesis occurred in 1 patient,but all of them were without bladder or rectum deficits.Neo- intercostal arteries were clogged in 12 patients within follow-up,and two of those patients with Marfan syndrome underwent pseudoaneurysm after intercostal arteries reconstruction.The mean survival time in this group is (54.22 ± 3.03 )months (95％ CI:44.37 months,59.90 months)with survival rate 92.37％ after 1 year,89.02％ after 2 years,85.54％ after 5 years.Three patient were dead with long term follow-up,one were resulted from cerebral hemorrhage at 20th month,one from rupture of ascending aorta at 23rd month and the last from rupture of aorta ulcer.ConclusionIntercostal artery reconstruction is a reliable method in spinal cord protection for patients with TAAA repair.It is a feasible method with acceptable surgical risks and satisfactory results.It can achieve long term result with less risk of spinal cord deficits and good quality of daily life.

Objective Retrospectively analyze the mid-term clinical results of single-stage repair of extensive aortic aneurysms with total or subtotal aortic replacement(T/STAR).This study describes our experience in this operation in single center of aortic disease at Fuwai Hospital.Methods From February 2004 to February 2011,21 patients with hypertension or Marfan syndrome underwent one-stage total or subtotal aortic replacement for aortic dissection or aortic aneurysms.16 male and 5 female,aged (34 ±9) years.Operations wore performed under circulatory arrest with profound hypothermia.Patients were opened with a mid-sternotomy and a thoracoabdominal incision.Extracorporeal circulation was instituted with two arterial cannulae and a single venous cannula in the right atrium.During cooling,the ascending aorta or aortic root was replaced.At the nasopharyngeal temperature of 20 ℃,the aortic arch was replaced with selective antegrade cerebral perfusion.Staged aortic occlusions allowed for replacement of descending thoracic and abdominal aorta.T6 to T12 intercostal arteries and L1,2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8 mm branch for keeping spinal cord blood perfusion.Visceral arteries were joined into a patch and anastomosed to the end of the main graft.Left renal artery was anastomosed to an 8mm branch or joined to the patch.The other 10 mm branches were anastomosed to iliac arteries.Results Early mortality was4.8％ ( 1/21 eases),the only one patient was dead result from renal failure and multiple organ failure.There were no postoperative spinal cord deficits occurred,two patients were stroked at day 5th and 7th respectively.Three patients were operated with tracheotomy because of respiratory insufficiency.Operation was undertaken on one patient with splenenctomy result of spleen rupture during first aortic aneurysms repair.All patients were follow-up,ranging from 18 to 84 months postoperatively,all 20 survivors were alive and had good functional status.One patient was reoperated with aortic valve replacement because of massive valve insufficiency after two years.Neo- intercostal arteries were clogged in 3 patients within follow-up,and two of those patients with Marfan syndrome underwent pseudoaneurysm after intercostal arteries reconstruction.Conclusion Single-stage repair of extensive aortic aneurysms with total or subtotal aortic replacement is safely and effectively.It is feasible with acceptable surgical risks and satisfactory results.It can eliminate the risk of remnant aortic aneurysm rupture in staged total aortic replacement and has satisfactory mid-term results.

Objective Retrospectively analyze 47 cases received reoperation with aortic disease after aortic valve replacement to deepen the understanding of aortic valve disease.Methods From January 2003 to June 2012,47 patients with previous aortic valve replacement received aortic root or other aortic operation because of new aortic disease.38 male and 9 female,the interval (6.0 ± 3.8) years. All cases with new aortic disease were diagnosed by cardiac ultrasound and aortic computed tomography.Bentall's procedure were operated on 14 patients,total aortic arch replacement with elephant trunk procedure on 14 patients,aortic root and aortic arch with elephant trunk procedure on 7 patients,ascending aortic replacement on 10patients,total thoracic and abdominal aorta replacement on 2 cases.All patients were followed by clinic interview or telephone.Results Aortic dissection and aneurysmal dilatation were occurred on ascending aorta,each account for 50％,in patients with previous aortic valve replacement because of rheumatic valve disease and bicuspid aortic valve; 3 cases with Marfan syndrome occurred ascending aortic dilatation and 4 cases occurred aortic dissection.Diameter in ascending aorta increased (5.2 + 7.1)mm per year and aortic sinus (3.3 ± 3.1)mm per year.The value of ascending aortic dilatation per year in patients with rheumatic disease was higher than patients with Marfan syndrome(P ＜ 0.05).47 patients were re-operated in fuwai hospital,1 patients died in operating room because aortic dissection seriously involved right coronary artery.7 patients have renal insufficiency after operation and all were cured by hemofiltration; neurological complication occurred in 14 patients including that 7 patients stroked and 7 patients had transient brain dysfunciotn.There were no postoperative spinal cord deficits occurred.All patients were followed up,the mean follow up time were(53.49 +33.79) months.8 cases were died during follow-up and threeyear survival rate was 83％.There were no cases received operation due to aortic disease during follow-up.Conclusion Deepening the understanding of aortic valve disease combine ascending aorta changes,especially pay attention to patients with previous aortic valve replacement because of Marfan syndrome and rheumatic disease during follow-up after first operation,all efforts should decrease the occurrence of aortic adverse events in long term.

Objective To analyze the etiology and surgical results through 17 cases with retrograde aortic dissection after thoracic endovascular repair.Methods From March 2009 to March 2014,17 patients were diagnosed with retrograde type A aortic dissection after thoracic endovascular repair,the mean age was 53 years,13 male and 4 female.Type B aortic dissection as the primary disease were 13 cases,aortic aneurysm and aortic ulcer were 2 cases respectively.All cases with new type A aortic dissection were diagnosed by cardiac ultrasound and aortic computed tomography.All patients were received aortic root and total aortic arch replacement plus elephant trunk procedure.All patients were followed by clinic interview or telephone.Results The interval time was from 1 to 2 200 days,5 patients were diagnosed before discharge,12 patients during clinical follow-up.The primary tear in 12 patients were located the area which were anchored by bare mental stent,in 2 cases were nearby the bare stent,the other 3 cases were located anterior part of ascending aorta.1 patient was died due to cerebral hemorrhage after operation.3 patients had renal insufficiency after operation and all were cured by hemofiltration;neurological complication occurred in 3 patients including that 1 patient stroked,1 patient cerebral hemorrhage and 1 patient had transient brain dysfunction,4 patients had pulmonary complication and 2 patients with intestinal dysfunction.There were no postoperative spinal cord deficits occurred.All patients were followed up,the mean follow up time was(35-±21) months.2 cases were died during follow-up and five-year survival rate was 87.5 ％.One patient was reoperation with total thoracic abdominal aorta replacement,five-year free from reoperation was 85.7％.Conclusion The retrograde type A dissection after thoracic endovascular repair were closely related with proximal bare mental stent,part of cases were silent symptom,the clinical fellow with aortic enhanced computed tomography were necessary to detect the serious complication.Operation scheme was safely and effectively,aortic arch replacement plus elephant trunk procedure was the preferred method to repair retrograde aortic dissection.

Objective:To analyse the degree of equality of New Rural Cooperative Medical Scheme (NRCMS) in different economic regions. We provide a reference for equal development of the NRCMS and the reform of the political system and mechanism under the provincial-controlled county fiscal system. Methods:A typical province was chosen with provincial-controlled county fiscal system was fully implemented several years. We collected data on coverage, financing and compensation for the NRCMS from 2005 to 2011. We used the variable coefficient, uniformity coefficient, Theil Index for comprehensive evaluation. Results:Per capita financing has not reached the bottom line. From 2005 to 2011, inter-re-gional and intra-regional variation coefficient, Theil index of service coverage, financing level and hospital actual compen-sation has declined year by year. The degree of inequality in economically developed regions was greater than in less eco-nomically developed regions and economic medium region. Conclusion:The degree of equalization of the NRCMS in the province continuously improved. Innovation of provincial-controlled county fiscal system and mechanism provides a favora-ble environment and forming conditions for equalizing the development of the NRCMS. The paper suggested exploring and building fiscal classification step transfer payment institution and dynamic prediction model of the NRCMS, further optimi-zing financing mechanism, promoting the provincial management system of the NRCMS as soon as possible in order to pro-mote the equalization development.

Objective To study the different expression of microRNA(miRNA) including mir-29c,mir-200a,mir-145 in the mid-secretary endometrium and its relationship with infertility of endometriosis.Methods From August 2011 to February 2013,36 infertile cases with endometriosis confirmed by laparoscopy and pathology and excluded the other infertile factors in Department of Reproductive Medicine in Peking University Shenzhen Hospital were enrolled in this study,which were divided into 17 cases with stage Ⅰ-Ⅱ,19 cases with stage Ⅲ]-Ⅳ according to the revised classification American Fertility Society.Forty-four healthy women with male factor infertility were chosen as control group.The relative expression levels of mir-29c,mir-200a,mir-145 in the endometrium of women in two groups were detected by using real-time quantitative polymerase chain reaction.Those women were followed up for pregnancy outcome of endometriosis group after assisted reproductive techniques (pregnancy and nonpregnancy group respectively).Results (1) The expression of miRNA between endometriosis and control groups:the average expression level of mir-29c,mir-200a,mir-145 in the endometrium of endometriosis group was 2.46 ± 1.98,3.20 ± 2.45,6.378 ± 3.275,which were significantly higher than 1.36 ± 1.05,2.04 ±1.16,4.548 ± 1.885 in control group (P =0.026,0.027,0.041,respectively).(2) The expression of miRNA between Ⅰ-Ⅱ stage and Ⅲ-Ⅳ:the average expression level of mir-29c,mir-200a,mir-145 in the endometrium was 0.53 ± 0.51,0.33 ± 0.26,0.048 ± 0.021 in patients with of stage Ⅰ-Ⅱ,while 0.26 ±0.18,0.28 ±0.12,0.045 ±0.016 in stage Ⅲ-Ⅳ respectively,there were no statistically significant differences between the two groups(P =0.191,0.661,0.753,respectively).(3) The expression of miRNA between pregnancy and non-pregnancy groups:the average expression level of mir-29c,mir-200a,mir-145 in the endometrium were 0.60 ± 0.30,1.23 ± 0.48,0.886 ± 0.238 in pregnancy group,while 2.64 ± 1.73,4.39 ± 2.58,7.199 ± 3.945 in non pregnancy group,there were statistically significant differences between the two groups(P =0.030,0.039,0.028,respectively).Conclusion Up-regulation of mir-29c,mir-200a,mir-145 in the endometrial tissue might play a role in endometriosis associated infertility.

Scientific research is important for the improvement of the health-care techniques,and is certainly important for the health of women and children of the whole society.With the development of medical science,research ability of maternal and child healthcare professionals is deemed essential.And the evaluation of their research ability,stimulation,and creativity have been important topics to address.Here we introduce an evaluation system for research capacity of maternal and child healthcare professionals established in our hospital,which is the fruit of constant exploration and practice for several years.It is proved to be practical,simple and feasible.The establishment methods,practices and experiences of the evaluation system are presented in this paper.

Objective To investigate the effects of Chinese herbal medication combined with nutrition intervention on perioperative nutrition in patients with colon carcinoma.Methods Ninety-six patients with colon carcinoma were divided according to their odd or even number into the control group and the intervention group.The former were given routine nutrition and the latter Chinese herbal medication combined with nutrition intervention.Then the mini-nutritional assessment(MNA)was used to assess the changes before and after operation and the complications.Results The intervention group was significantly better than the control one in terms of all nutrition factors but hematoglobin(P<0.05).The incidences of complication and dystrophy in the intervention group were lower than in control group(P<0.05).Conclusion The application of Chinese herbal medication combined with nursing intervention is important for the improvement of their nutrition and the reduction of postoperative complications.

Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Heart ; Heart Diseases ; drug therapy ; Humans ; Medicine, Chinese Traditional

Objective To investigate the effects of stellate ganglion block (SGB) on erythrocyte immunity in patients with acute cerebral infarction.Methods Twenty-four patients (13 male, 11 female) who developed acute cerebral infarction for less than 3 days were randomly divided into 2 groups (n=12each): Group A receiving traditional treatment and Group B receiving traditional treatment + SGB.The patients ranged in age from 51 to 64 yr and weighed 52-71 kg. All patients received intravenous 5% glucose 25 ml plus citicoline sodium 1.0 g and sodium ozagrel injectio 250 ml daily for 10 days in addition to dehydration and effective control of complications and intracranial pressure. Group B received SGB on one side alternatively with 1% licocaine 10 mi once a day for 10 days. Fasting venous blood samples were taken in the early mornings of the day before treatment (baseline, T1 ) and the 1st, 5th and 10th day of treatment (T2-4) for determination of the plasma MDA concentration and SOD activity, erythrocyte C3b receptor rosette rate (RBC-C3bRR) and RBC immune complex rosette rate (RBC-ICR) and Ne+-K+-ATPase activity in erythrocyte membrane.Results The plasma MDA concentration and RBC-ICR were significantly decreased during treatment es compared with the baselines at T1 in both groups (P＜0.05 or 0.01), but were significantly lower in Group B than in Group A (P＜0.05 or 0.01 ).The activities of plasma SOD and Na+ -K+ -ATPase in erythrocyte membrane and RBC-C3bRR were significantly increased during treatment as compared with the baselines at T1 and were significantly higher in Group B than in Group A.Conclusion SGB combined with traditional treatment can increase the activities of plasma SOD and Na+ -K+ -ATPase in erythrocyte membrane, inhibit production of oxygen free radicals and enhance RBC immune function in patients with acute cerebral infarction.