Objective To explore the correlation between the pulmonary artery diameter(PAD),PAD/aortic diameter(AOD),right ventricular diameter(RVD),RVD/left ventricular diameter(LVD)measured on pulmonary artery CT angiography(CTPA)cross-sectional images and the degree of embolism,cardiac biomarkers in patients with medium-to-high risk acute pulmonary embolism(APE).Methods The clinical data of 53 patients with medium-to-high risk APE,who received interventional treatment at the Putian Municipal First Hospital of China From January 2021 to December 2023,were retrospectively analyzed.The PAD,PAD/AOD,RVD,and RVD/LVD were measured on CTPA cross-sectional images.The correlations of the above indexes with CT embolism index(CTEI),N terminal pro B type natriuretic peptide(NT-proBNP),and cardiac troponin Ⅰ(cTnⅠ)were analyzed.Results A weak-moderate positive correlation existed between PAD,RVD,RVD/LVD and CTEI(r=0.506,r=0.310,r=0.452 respectively,P＜0.001,P=0.024,P=0.001 respectively),while no correlation existed between PAD/AOD and CTEI(r=0.247,P=0.075).Compared with the NT-proBNP negative group,in the NT-proBNP positive group the values of PAD,PAD/AOD and RVD/LVD were higher(all P＜0.05),and there was no statistically significant difference in RVD value between the two groups(P＞0.05).A weak-moderate positive correlation existed between NT-proBNP and PAD,PAD/AOD,RVD,RVD/LVD(r=0.454,r=0.326,r=0.302,r=0.405 respectively,P=0.001,P=0.017,P=0.028,P=0.003 respectively).There were no statistically significant differences in PAD,PAD/AOD,RVD and RVD/LVD values between the cTnⅠ negative group and the cTnI positive group(all P＞0.05).No correlation existed between cTnⅠ and PAD,PAD/AOD,RVD,RVD/LVD(r=0.188,r=0.042,r=-0.021,r=0.139 respectively,and P=0.195,P=0.772,P=0.884,P=0.342 respectively).Conclusion CTPA cross-sectional quantitative indicators are helpful in evaluating the embolism degree of APE and right heart function,but it cannot be used to assess myocardial injury.

Objective To investigate the feasibility,safety and efficacy of transcatheter drug-loaded microsphere embolization(DLME)in treating patients with advanced bladder cancer with bleeding(ABCB).Methods A total of 26 ABCB patients who underwent DLME for tumor supply arteries were retrospectively selected.The postoperative efficacy and related complications were observed.The recurrence of hematuria and survival situation were followed up.Results All 26 surgeries achieved success with a technical success rate of 100.0％.There were 21 cases(80.8％)of bilateral bladder artery embolism and 5 cases(19.2％)of unilateral bladder artery embolism.Three days after the operation,24 patients(92.3％)had hematuria remission.And the other two patients(7.7％)had no hematuria remission,they were relieved after interventional embolization again.Compared with that before operation,the blood transfusion rate,blood transfusion volume,hematocrit and hemoglobin at one week after operation were significantly improved(P＜0.05).One month after the last intervention,there were 2 cases of complete response,19 cases of partial response,3 cases of stable disease,and 2 cases of progressive disease.The objective remission rate was 80.8％,and the disease control rate was 92.3％.Compared with that before operation,the T stage was significantly improved at one month after operation(P＜0.05).No patients had severe complications such as ectopic embolism.After follow-up for 3-36 months,5 cases(19.2％)had a recurrence of hematuria.Conclusion Transcatheter DLME is feasible,safe,and effective in the treatment of patients with ABCB.It is an optional,minimally invasive palliative measure.

Objective To explore the clinical effect of endovascular stent-graft exclusion in the treatment of acute Stanford B-type aortic dissection(AD)with distal left subclavian artery(LSA)rupture accompanied by arch intramural hematoma.Methods A total of 12 patients with acute AD treated by the endovascular stent-graft exclusion alone were retrospectively selected.All patients had primary rupture at the distal end of LSA with arch intramural hematoma and received endovascular treatment after 2 to 3 weeks of conservative treatment.The technique success rate and related complications were observed.Postoperative computed tomography angiography(CTA)of the aorta was reviewed to evaluate the remodeling of the true and false lumen,the absorption of the arch intramural hematoma,to observe whether there was a new rupture and endoleak,and to understand the position and shape of the stent and the blood supply of the branch arteries.Results All patients completed the operation with a technical success rate of 100％.Two patients partially blocked the opening of LSA,and one patient had type Ⅰ internal leakage after the operation,but the amount of internal leakage was small and was not treated.Other patients did not had serious complications such as aortic rupture,new rupture,paraplegia,stent displacement,stroke,upper limb ischemia or vertebral artery ischemia,internal leakage,and abdominal organ ischemia during and after the operation.The patients were followed up for 19 to 66 months,with an average follow-up of(36.7±13.9)months.During the follow-up period,no patient died.The aortic remodeling was satisfactory in all patients,the arch intramural hematoma was absorbed,and there were no new rupture,internal leakage,upper limb ischemia or vertebral artery ischemia,or other serious complications.One patient with type Ⅰ internal leakage showed no significant change in internal leakage after regular postoperative reexamination.Conclusion Endovascular stent-graft exclusion is safe and feasible in the treatment of acute AD patients with distal LSA rupture accompanied by arch intramural hematoma,and it is worth promoting and applying clinically.

Objective:To explore the effect of cholesterol on the expression of genes for matrix synthesis and degradation of human meniscal fibrochondrocytes and its mechanism.Methods:Meniscal tissue was taken from patients undergoing arthroscopic surgery to extract fibrochondrocytes. The cells were divided into a control group in which the normal cells were not processed, a positive control group in which interleukin-1 β was used to create a degeneration model, and 2 treatment groups which were subjected to treatment with 15 and 30 μg/mL cholesterol respectively. Safranin O staining, β-galactosidase staining and enzymic kits were used to detect the morphology and total cholesterol (TCH) content of meniscal fibrochondrocytes in the 4 groups. Immunofluorescence and western blot were used to detect the protein expression of type Ⅰcollagen precursor α1 (COL1A1) and type Ⅱ collagen precursor α1 (COL2A1). RT-qPCR was used to detect the mRNA expression of COL1A1, COL2A1, matrix metalloproteinase (MMP) 3, MMP9, MMP13, and genes related to cholesterol efflux pathways [like liver X receptor α (LXR α), ATP binding cassette transporter A1 (ABCA1) and ABCG1]. Results:There was no significant difference between the control and the positive control groups in the TCH content in human meniscal fibrochondrocytes ( P>0.05). The treatments with 15 and 30 μg/mL cholesterol resulted in significantly increased TCH contents in human meniscal fibrochondrocytes in the treatment groups ( P<0.05). Compared with the control group, the mRNA expression of LXR α, ABCA1 and ABCG1 was significantly decreased in the treatment groups ( P<0.05), and the meniscal fibrochondrocytes in the positive group and the treatment groups presented with a lower density, chaotic distribution and obvious signs of degradation. Compared with the control groups, the mRNA expression of matrix synthesis genes (COL1A1 and COL2A1) in the meniscal fibrochondrocytes was significantly inhibited while the mRNA expression of matrix degradation metalloenzymes (MMP3, MMP9 and MMP13) was significantly promoted ( P<0.05). Conclusion:Cholesterol may inhibit the cholesterol efflux pathways of meniscal fibrochondrocytes, and thus cause accumulation of cholesterol in the meniscal fibrochondrocytes, eventually leading to degeneration of meniscus.

Objective To investigate the clinical characteristics, curative effect and prognosis of myeloid sarcoma. Methods The clinical data of 12 patients with MS diagnosed at Xijing Hospital of Air Force Medical University from August 2008 to May 2018 were retrospectively analyzed. Their clinical manifestations, diagnosis, treatment and survival were analyzed. Results Twelve patients were 17 to 62 years old. The initial site included lymph node, external auditory canal, eye, buttock, lung, liver, pancreas, breast,skin, vertebra and its surroundings,and cervix. Among 11 patients with peripheral blood classification, bone marrow aspiration and bone marrow biopsy, 6 cases were isolated MS [one of which developed acute myeloid leukemia (AML)], 1 case was chronic myeloid leukemia in chronic phase, 2 cases were AML-M2, and 1 case was myelodysplastic syndrome (MDS), and 1 case was after aplastic anemia (AA) with no infiltration of bone marrow. Immunohistochemical results showed that LCA(+) (7/7), MPO(+) (12/12), CD43(+) (9/9), lysozyme(+) (5/7), CD3(-) (8/8), CD20(-) (9/9), CD34(+) (5/6), CD117(+) (7/7), and Ki-67(+) 30%-90%. Four patients were examined for bone marrow chromosomes, 2 patients with AML had t (8;21), 1 patient with MDS was 47, XX, +8, del(11)(q21), and 1 patient with CML was t(9;22). Two of the 12 patients were lost to follow-up. Among the 10 patients who were followed up, 6 died and 4 survived, and the median survival time was 21 months (2-27 months). Conclusions AA in stable phase with MS and CML in chronic phase with MS are rarely reported. The clinical manifestations of MS patients are varied, of which the common incidence sites are superficial lymph nodes, the infrequent sites are vertebra and its surrounding areas, and the rare sites are eye, pancreas, lung, liver, etc. The median survival time of MS patient is short and the curative effect is poor.

Objective To investigate the expression of bone marrow γ-H2AX in the patients with multiple myeloma(MM) and its correlation with the prognosis.Methods The patients with newly diagnosed MM in this hospital were selected as the case group,and the patients with non-hemopoietic system tumor without obvious morphological abnormalities by bone marrow smear and biopsy served as the control group.The immunohistochemistry was adopted to detect the expression level of bone marrow γ-H2AX in the cases group and control group,the image-Pro Plus(IPP) semiquantitative analysis was performed.The expression differences were compared between the two groups,moreover the case group was re-divided into the strong expression group and weak expression group according to γ-H2AX expression level.Then the relation ship between γ-H2AX expression level and the prognosis in the patients with MM.Results The bone marrow γ-H2AX expression level in the case group was significantly higher than that in the control group (P＜0.05);the level of γ-H2AX expression in the strong expression group was significantly stronger than that in the weak expression group (P＜0.05).Conclusion The level of γ-H2AX expression was higher among MM patients,and the over expression of γ-H2AX predicts the shorter survival time.

Objective To explore the application values and the effect of myocardial preservation of right stellate ganglion block in off-pump coronary artery bypass grafting (OPCABG). Methods Sixty-two patients with ASA Ⅱ or Ⅲ,aged 50-75 years,scheduled for OPCABG were randomly divided into stellate ganglion block group (group SGB)and control group (group C)with 31 cases each.The patients in group SGB received right-lateral SGB before anesthesia induction.The medications and methods of anesthesia induction in the two groups were identical.Hemodynamics be-fore start of anethesia (T0 ),after induction (T1 ),after intubation tube (T2 ),after sternotomy (T3 ),at the beginning of bypass surgery for interrupted coronary artery (T4 ),at the end of coronary bypass grafting (T5 )were observed.Meanwhile,changes of serum cardiac troponin I (cTnI)and cre-atine phosphokinase MB (CK-MB)at T0 ,6 h (T6 ),12 h (T7 ),24 h (T8 )after operation were also observed.The operative time,the amount of drugs used and postoperative recovery were recored. Results MAP,HR of group SGB increased at T2-T5 compared with T0 ,and MAP,HR of group C significantly increased at T2-T5 comparing with T0 (P <0.05).Compared with those in group SGB, MAP,HR significantly increased at T2-T5 in group C (P <0.05 ).The Concentrations of cTnI and CK-MB of group C increased more obviously than those in group SGB at T6-T8 (P <0.05).Compared with group C,patients in group SGB needed less medication,less hospitalization time in ICU and had faster postoperative recovery.Conclusion SGB for patients during OPCABG stabilizes hemodynamy stability,further reduces myocardial injury,thus protecting myocardium.

Objective To explore the value of applying multiple disciplinary team (MDT) in the clinical practice teaching of lymphoma. Methods 5-year program clinical medicine undergraduate students of 2012 were divided into experimental and control group randomly, with 30 cases in each group. The ex-perimental group received MDT in clinical teaching through MDT conference and cases analysis. The control group received conventional teaching mainly by smal class presentation and ward round . The effect of teaching was evaluated by examination and questionnaire. The data were analyzed through t-test and chi-square test by SPSS 20.0 software. Results The results showed the students' scores of the theory knowledge test of two groups were similar to each other, but the scores of discussional topic and clinical cases analysis were higher in experimental group than control group and statistically difference [(16.5 ±2.3)vs. (10.5 ±1.8);(37.5±2.5) vs.(27.5±1.8)], (P=0.000), and the final score of two groups showed statistically difference (93.5± 5.2 vs. 76.0 ±6.2) (P=0.000). Meanwhile, questionnaire survey of satisfaction showed that 27 students of experimental group (90.0%) were interested in this new teaching model, 29 students (96.7%) believed it im-proved understanding and memory to the process of lymphoma diagnosis and treatment, 25 students (83.3%) believed it could improved the ablility to diagnose and differential diagnose lymphoma and expanded their clinical view. 28 students (93.3%) had consolidated clinical thinking, and 26 students (86.7%) improved negotiation with patients. All issues were significantly better than control group (P<0.05). Conclusions The clinical teaching model innovation based on MDT could help medical students use the cross-discipinary interviewing and make optimal treatment plan for patients. It is conducive to the cultivation of their diagnosis, differential diagnosis and clinical thinking ability, which is worthy of promotion in hematological clinical teaching.

SUMMARY This case report concerns a 23-year-old woman with chronic periodontitis who had been pre-viously diagnosed with Takayasu arteritis ( TA ) .Her erythrocyte sedimentation rate ( ESR ) and C-reactive protein ( CRP) level were decreased before and 3 months after non-surgical periodontal therapy with no change in her prescribed medications (ESR from 31.00 mm/h to 23.0 mm/h, CRP from 21.40 mg/L to 18.46 mm/h).Through the occasional findings , we raised a hypothetical analysis about the po-tential relationship between periodontitis and TA with respect to inflammatory factors , bacteria and medi-cation.Further studies of large samples are needed to verify the findings .