Aortic dissection is a common acute aortic syndrome. Its incidence and detection rate have been increasing in recent years, and it has received clinical attention. The treatment of aortic dissection is primarily based on the morphological characteristics and complications of the lesion. The main treatment methods include drug conservative treatment, open surgery, and intracavitary interventional therapy. With the continuous development of endovascular treatment technology and instruments, hybrid technology, windowing technology, chimney technology, branch technology, and other derivative technologies have emerged. This paper reviews the current status and progress of the treatment of Stanford type B aortic dissection, and provides a reference for clinical surgical selection.

Inducing the degradation of KRAS represents a novel strategy to combat cancers with KRAS mutation. In this study, we identify ubiquitin-specific protease 2 (USP2) as a novel deubiquitinating enzyme of KRAS in multiple myeloma (MM). Specifically, we demonstrate that gambogic acid (GA) forms a covalent bond with the cysteine 284 residue of USP2 through an allosteric pocket, inhibiting its deubiquitinating activity. Inactivation or knockdown of USP2 leads to the degradation of KRAS, resulting in the suppression of MM cell proliferation in vitro and in vivo. Conversely, overexpressing USP2 stabilizes KRAS and partially abrogates GA-induced apoptosis in MM cells. Furthermore, elevated USP2 levels may be associated with poorer prognoses in MM patients. These findings highlight the potential of the USP2/KRAS axis as a therapeutic target in MM, suggesting that strategically inducing KRAS degradation via USP2 inhibition could be a promising approach for treating cancers with KRAS mutations.

Maintenance hemodialysis can improve many symptoms of patients with end-stage renal disease, but long-term dialysis can cause various physiological symptoms and psychological negative emotions. As a positive psychological change, post-traumatic growth plays a role in relieving patients' psychological pressure and reducing their pain. However, the post-traumatic growth of patients with maintenance hemodialysis needs to be improved. This article reviewed the status, influencing factors and interventions of post-traumatic growth in maintenance hemodialysis patients in order to provide reference for psychological care of such patients.

Objective To investigate the effect of Yangxue Rougan pills on a rat model of liver fibrosis induced by multiple factors and the mechanism of action of Yangxue Rougan pills in the treatment of liver fibrosis. Methods A total of 50 male rats were randomly divided into blank control group, multi-factor model group, Fuzheng Huayu capsule group, and high-, middle-, and low-dose Yangxue Rougan pill groups. The rats in the blank control group were given normal water and feed, and those in the other groups were given modified high-fat low-protein diet and 5% alcohol, as well as subcutaneous injection of olive oil solution containing 40% carbon tetrachloride and intraperitoneal injection of pig serum 0.5 mL per rat, twice a week for 12 consecutive weeks. Since week 7, the rats in the high-, middle-, and low-dose Yangxue Rougan pill groups were given Yangxue Rougan pills at a dose of 9.5, 4.75, and 2.38 g/kg, respectively, those in the Fuzheng Huayu capsule group were given Fuzheng Huayu capsules at a dose of 0.75 g/kg, and those in the blank control group and the multi-factor model group were given an equal volume of distilled water by gavage every day for 6 consecutive weeks. The rats were treated at week 12. HE staining and Masson staining were used to observe the degree of liver fibrosis in rats, and PCR and Western blot were used to measure the expression of TGF-β1, Smad3, and Smad7 in the liver. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the Dunnett's t -test was used for further comparison between two groups. Results Compared with the blank control group, the multi-factor model group had a severely damaged lobular structure and a significantly higher degree of liver fibrosis, with the formation of pseudolobules with different sizes; compared with the multi-factor model group, the Yangxue Rougan pill groups had a significant improvement in the degree of liver fibrosis, with the most significant therapeutic effect in the high- and middle-dose Yangxue Rougan pill groups. Compared with the blank control group, the multi-factor model group had significant increases in the expression of TGF-β1 and Smad3 and a significant reduction in the expression of Smad7 in liver tissue (all P < 0.05); compared with the multi-factor model group, the Yangxue Rougan pill groups had a significant reduction in the expression of TGF-β1 and a significant increase in the expression of Smad7 (all P < 0.05); compared with the multi-factor model group, the high- and middle-dose Yangxue Rougan pill groups had a significant reduction in the expression of Smad3 (both P < 0.05). Conclusion Yangxue Rougan pills can significantly inhibit liver fibrosis in rats by downregulating the expression of TGF-β1 and Smad3 and upregulating the expression of Smad7, and therefore, the TGF-β1/Smad signaling pathway is one of the mechanisms of action of Yangxue Rougan pills in improving liver fibrosis.

Objective:To investigate the clinical effect of laparoscopic assisted removal of greater omentum free transplantation combined with skin grafting for the repair of large area refractory wounds.Methods:From June 2013 to June 2018, 18 cases of lower extremity skin and soft tissue defects with multiple bone, joint, tendon and internal plants exposure were admitted to Hanzhong Central Hospital, including 12 males and 6 females, aged from 15 to 50 years old, with an average age of 32.6 years old. The area of skin and soft tissue defect: 30 cm×12 cm-53 cm×21 cm. The operation was divided into two stages. In the first stage, the greater omentum was acquired with the assist of laparoscope and free transplanted to cover the wound. After the greater omentum free transplantation was confirmed to survive, the split-thickness skin graft was applied for wound repair.Postoperative survival of the greater omentum and skin grafting, complications, appearance and function of lower limbs were observed and followed up.Results:The 18 operations were performed successfully, the area of omentum resection was 25 cm×10 cm-35 cm×15 cm, all the greater omentums survived after operation without complications such as intestinal adhesion, volvulus and peritonitis. The area of the skin grafting was 36 cm×8 cm-45 cm×22 cm. 16 cases skin grafting survived completely, 2 cases skin grafting were necrosis just local small area, and scar healed after dressing change. Postoperative follow-up of 6-12 months showed good appearance and function of lower limbs and satisfactory results.Conclusions:For the large area soft tissue defect wound of lower extremity, complicated with multiple deep tissues such as bone, joint and internal materials exposed, the greater omentum free transplantation under laparoscope combined with medium thick skin graft second stage has the advantages of good appearance and function after wound healing, less donor injury and fewer postoperative complications.

Objective:To investigate the clinical effect of laparoscopic assisted removal of greater omentum free transplantation combined with skin grafting for the repair of large area refractory wounds.Methods:From June 2013 to June 2018, 18 cases of lower extremity skin and soft tissue defects with multiple bone, joint, tendon and internal plants exposure were admitted to Hanzhong Central Hospital, including 12 males and 6 females, aged from 15 to 50 years old, with an average age of 32.6 years old. The area of skin and soft tissue defect: 30 cm×12 cm-53 cm×21 cm. The operation was divided into two stages. In the first stage, the greater omentum was acquired with the assist of laparoscope and free transplanted to cover the wound. After the greater omentum free transplantation was confirmed to survive, the split-thickness skin graft was applied for wound repair.Postoperative survival of the greater omentum and skin grafting, complications, appearance and function of lower limbs were observed and followed up.Results:The 18 operations were performed successfully, the area of omentum resection was 25 cm×10 cm-35 cm×15 cm, all the greater omentums survived after operation without complications such as intestinal adhesion, volvulus and peritonitis. The area of the skin grafting was 36 cm×8 cm-45 cm×22 cm. 16 cases skin grafting survived completely, 2 cases skin grafting were necrosis just local small area, and scar healed after dressing change. Postoperative follow-up of 6-12 months showed good appearance and function of lower limbs and satisfactory results.Conclusions:For the large area soft tissue defect wound of lower extremity, complicated with multiple deep tissues such as bone, joint and internal materials exposed, the greater omentum free transplantation under laparoscope combined with medium thick skin graft second stage has the advantages of good appearance and function after wound healing, less donor injury and fewer postoperative complications.

Objective To investigate the effects of Dingkoulizhong decoction on cellular immune factors and adverse reactions in patients with advanced gastric cancer treated with chemotherapy.Methods One hundred and thirty-eight patients with advanced gastric cancer were enrolled in our hospital from October 2014to December 2016,and were randomly divided into control group (n =69) and observation group (n =69) by using the random number table.The patients of the control group were treated with FOLFOX4 chemotherapy (oxaliplatin + calcium folinate + fluorouracil),while the patients of the observation group were given by the treatment of Dingkoulizhong decoction on the basis of the control group.The peripheral blood samples of the patients were collected before and after the treatment.The levels of cellular immune factors CD3 +,CD4 +,CD8 + and CD4 +/CD8 + were detected,and the clinical efficacy and adverse reactions of the patients of the two groups were observed.Results After the treatment,the number of complete remission (CR),partial remission (PR),stable disease (SD) and progressive disease (PD) in the observation group were 16,25,16 and 12 cases respectively,while the control group were 9,20,19 and 21 cases respectively,and there was a statistically significant difference in the distribution of clinical efficacy between the two groups (Z =4.381,P =0.036).Compared with the control group,the clinical benefit rate (CBR) of the observation group was significantly improved (59.42％ vs.42.03％),with a statistically significant difference (x2 =4.175,P =0.041).The cellular immune factors CD3 + [(52.67 ±6.21)％ vs.(53.45 ±6.54)％],CD4 + [(23.56 ±3.85)％ vs.(24.09±2.91)％],CD8 +[(28.16±3.49)％ vs.(27.87±3.26)％] and CD4 +/CD8+(1.13 ± 0.27 vs.1.19 ±± 0.31) of the patients of the observation group showed no statistically significant difference (t=0.718,P=0.474;t=0.912,P=0.363;t=0.504,P=0.615;t=1.212,P=0.227) beforeand after the treatment,but the cellular immune factor CD3 + [(50.36 ± 3.74)％ vs.(53.13 ± 6.12)％],CD4 +[(21.26±2.37)％ vs.(23.44 ±3.96)％] andCD4+/CD8*(0.96±0.26vs.1.15±0.25) of the patients of the control group after the treatment were significantly lower than those before the treatment,and CD8 +[(31.64 ± 4.05) ％ vs.(27.98 ± 3.52) ％] after the treatment was significantly higher than that before the treatment,all with statistically significant differences (t =3.208,P ＜ 0.001;t =3.924,P ＜ 0.001;t =4.289P ＜ 0.001,t =5.666,P ＜ 0.001).Compared with the control group,the level of CD3 + [(53.45 ± 6.54) ％ vs.(50.36±±3.74)％],CD4+[(24.09±±2.91)％ vs.(21.26±2.37)％] andCD4+/CD8+(1.19±0.31vs.0.96 ± 0.26) of the patients of the observation group after the treatment were significantly improved,and CD8 +[(27.87 ± 3.26) ％ vs.(31.64 ± 4.05) ％] was significantly decreased,all with statistically significant differences (t=3.407,P=0.001;t =6.264,P＜0.001;t =4.722,P＜0.001;t =6.023,P＜0.001).Compared with the control group,the total adverse reaction rate of the observation group was significantly decreased (36.23％ vs.55.07％),with a statistically significant difference (x2 =4.936,P =0.026).Conclusion Dingkoulizhong decoction can significantly improve the clinical efficacy in patients with advanced gastric cancer treated with chemotherapy,alleviate the immune function damage caused by chemotherapy,and it can reduce the occurrence of adverse reactions.

Objective:To explore the expression and clinical significance of ubiquitin-like with PHID and ring finger domains 2 (UHRF2) in intrahepatic cholangiocarcinoma (ICC).Methods:The expression of UHRF2 in 138 ICC was determined by immunohistochemistry,and the relationships between UHRF2 expression with prognosis and clinicopathological features of ICC were analyzed:Results:UHRF2 was highly expressed in ICC compared with paratumorous tissues.Level of UHRF2 was associated with high AFP level (P=0.010),poor tunor differentiation (P=0.026),lymph node metastasis (P=0.001),and advanced TNM stage (P=0.019).Hevated UHRF2 expression was suggested to be associated with poor prognosis and high recurrence rate in ICC patients (P＜ 0.001),and multivariable analysis indicated that UHRF2 was of theprognostic indicators of ICC (P＜0.05).Conclusions:High level of UHRF2 is related to the malignant phenotype of ICC,and can be a prognostic and recurrent indicator of postoperative patients.

Objective To investigate clinical, imaging features, and long-term outcomes in patients with isolated anterior cerebral artery (ACA) territory infarction due to ACA atherosclerosis, and compare with isolated ACA territory infarction due to other etiologies. Methods The consecutive patients with acute isolated ACA territory infarction confirmed by diffusion-weighted imaging were enrolled prospectively. According to their stroke etiology, they were divided into ACA atherosclerotic stroke and non-ACA atherosclerotic stroke. The infarction patterns were classified as single infarction including perforating artery infarction (PAI), small branch infarction (SBI) and cortical branch infarction(CBI), and multiple infarctions (a combination of PAI,SBI or CBI).The clinical,imaging features and long-term outcomes were compared between the ACA atherosclerotic stroke group and the non-ACA atherosclerotic stroke group. Results A total of 86 patients (47 males) were enrolled, ages ranging from 39 to 88 years (mean 67.5 ± 12.5 years). There were 56 patients in the ACA atherosclerotic stroke group, and 30 patients in the non-ACA atherosclerotic stroke group (12 carotid atherosclerosis, 6 cardioembolism, 2 internal carotid artery dissection, 10 undetermined etiology). The proportions of females (53.6% vs. 30.0%; P= 0.043), progressive onset of stroke(58.9% vs. 20.0%;P=0.001),SBI alone(21.4% vs. 3.3%;P=0.029)and infarction involving small branches(80.4% vs. 46.7%;P=0.001)in the ACA atherosclerotic stroke group were higher than those in the non-ACA atherosclerotic stroke group, and CBI alone (17.9% vs. 55.3%, P=0.001) was lower. The follow-up times in the ACA atherosclerotic stroke group and the non-ACA atherosclerotic stroke group were 29.8 ± 16.5 months and 30.4 ± 18.5 months, respectively (P=0.534). Five-year cumulative incidence of adverse events (stroke, cardiovascular events and death) in the ACA atherosclerotic stroke group and the non-ACA atherosclerotic stroke group were 36.3% and 69.9% respectively(log rank test,P=0.021).Conclusions ACA atherosclerosis is the common etiology for isolated ACA territory infarction. The isolated ACA territory infarction due to ACA atherosclerosis had distinctive infarction patterns and a lower long-term incidence of adverse events compared with those due to non-ACA atherosclerosis.

Objective To investigate the risk and predictors of stroke recurrence in patients with symptomatic intracranial internal carotid artery(IICA)stenosis.Methods Consecutive patients with first-ever ischemic stroke or transient ischemic attack (TIA) caused by IICA atherosclerotic stenosis were enrolled prospectively. The patients were regularly followed up to assess stroke recurrence. Results A total of 70 patients were enrolled, 49 patients were males, and the mean age was 68.2 ± 12.3 years. The mean follow-up time was 34 ± 17 months (median, 33 months). Twenty-seven patients (38.6%) experienced recurrent events during the follow-up period (5 TIAs and 22 ischemic strokes);92.6% of recurrent events occurred in the original symptomatic stenotic IICA territory. Internal watershed infarction in patients with recurrent stroke was more common than those without stroke recurrence(74.1% vs. 44.2%,P=0.025). Kaplan-Meier survival analysis showed that the risks of stroke recurrence at 1,3 and 5 years were 26.8%, 42.5%, and 46.9%, respectively in patients with symptomatic IICA stenosis. Multivariate Cox proportional risk regression analysis showed that the predictors for stroke recurrence in patients with symptomatic IICA stenosis included diabetes (hazard risk [HR] 3.68,95% confidence interval[CI] 1.43-9.46; P=0.007), combined asymptomatic intracranial artery occlusive disease(HR 2.95,95% CI 1.16-7.50;P=0.023),and internal watershed infarction (HR 4.50, 95% CI 1.43-14.17; P=0.010) after adjusting for sex, age and traditional vascular risk factors. Conclusions The risk of long-term stroke recurrence in patients with symptomatic IICA stenosis is still high under the current drug treatment. Diabetes, combined asymptomatic intracranial arterial occlusive disease, and internal watershed infarction are closely associated with stroke recurrence.