Objective:To analyze the effective and safety of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (RAAA) at one tertiary center, and to improve the outcomes of RAAA under fast-track protocol.Methods:Nineteen cases of RAAA in the 940th Hospital of Joint Logistic Support Force of PLA from January 2014 to December 2020 were reviewed retrospectively. EVAR-fist strategy was employed from the emergency room to the operating room by using fast-track protocol. Preoperative management, anatomic characteristics, choice of anesthesia, operative procedures and postoperative complications were collected and analyzed. Abdominal compartment syndrome (ACS) and hospital mortality were paid special attention.Results:Nineteen cases were undergone EVAR procedures. The age was (73.4 ± 7.4) years old, and the AAA size was (67.8 ± 13.6) mm. Two cases underwent cardiopulmonary resuscitation at emergency department. General anesthesia was used in 13 patients and local anaesthesia in 6 patients. Successful stent graft deployment was achieved in all cases. The duration from emergency room to operating room was (84.8 ± 22.4) min. The hospital stay time was (9.7 ± 5.7) d. The hospital mortality was 5/19. The 5 deaths were reviewed: 3 died for multiple organ failure, 1 for irreversible shock, and 1 for ongoing bleeding.Conclusions:Excellent results were confirmed by using EVAR-first strategy for RAAA. The management of hemodynamically unstable state, standardized endovascular procedure, fast-track program and multidiscipline team collaboration were the very important determining factors for the implementation of EVAR. Focused efforts to reduce RAAA mortality are warranted.

Reports a case admitted in the Ward I of Department of Surgery of Zhengzhou Renji Hospital in June 2017. A young child who suffered destructive injury of left forearm, wrist and palm with severed 3rd-5th fingers. Tendon and neurovascular repairs of forearm, wrist and palm were performed with pedicled abdomina flap and the 3rd-5th fingers ectopic replantation in Phase I surgery. In the Phase II surgery, the abdomina flap division was carried out. The replantation of severed fingers after ectopic replantation and the reconstruction of foot defect with free anterolateral thigh flap(ALTF) were carried out in Phase III surgery. In Phase IV surgery, fingers functional reconstruction and foot flap thinning were performed. Four years after surgery, the thumb oppositions to middle, ring and little fingers could be completed, with slightly limitations. The appearance and texture of transferred foot flap were good, and the child could walk and run almost normally.

A case of a 3-year-old child suffered with severe crush injury to the right forearm and right hand on June, 2017. A comprehensive treatment was conducted with limb salvage, free flap repair and the repair of nerve, vessel and tendon for functional reconstructions followed by rehabilitation therapies. The function and appearance of the injured limb and hand recovered well 3 years after surgery.

Objective To investigate the application prospect of the most extensive genome engineering pig internationally in preclinical xenotransplantation. Methods Porcine endogenous retrovirus (PERV) knockout combined with 3 major heterologous antigen gene knockouts and 9 humanized genes for inhibition of complement activation, regulation of coagulation disorders, anti-inflammatory and anti-phagocytosis were transferred into a pig (PERV-KO/3-KO/9-TG) as a donor, and the heart, liver and kidney were obtained and transplanted to 3 Rhesus macaque recipients respectively to establish a preclinical research model of pig-to-Rhesus macaque xenotransplantation. The functional status of xenografts after blood flow reconstruction was observed and the survival of recipients was summarized. The hemodynamics of xenografts were monitored. The change of hematological indexes of each recipient was compared. The histopathological manifestation of xenografts was observed. Results After the blood flow was reconstructed, all xenografts showed ruddy color, soft texture and good perfusion. The transplant heart, liver and kidney showed full arterial and venous blood flow and good perfusion at 1 d after operation. The postoperative survival time of heart, liver, and kidney transplant recipients was 7, 26, and 1 d, respectively. The levels of creatine kinase, creatine kinase isoenzyme, and lactate dehydrogenase increased in heart transplant recipient at 1 d after operation, and gradually recovered to near normal levels at 6 d after operation. All indexes increased sharply at 7 d after operation. The level of aspartate aminotransferase increased in liver transplant recipients at 2 d after operation, and the alanine aminotransferase basically returned to normal at 10 d after operation, but the total bilirubin continued to increase. Both aspartate aminotransferase and alanine aminotransferase increased at 12 d after operation, and reached a peak at 15 d after operation. The kidney transplant recipient developed mild proteinuria at 1 d after operation, and died of sudden severe arrhythmia. Histopathology showed that the tissue structure of cardiac and renal xenografts was close to normal, and liver xenografts presented with patchy necrosis, the liver tissue structure was disordered, accompanied by inflammatory damage, interstitial hemorrhage and thrombotic microangiopathy. Conclusions PERV-KO/3-KO/9-TG pig shows advantages in overcoming hyperacute rejection, mitigating humoral rejection and coagulation dysregulation. However, whether it can be used as potential donor for clinical xenotransplantation needs further evaluation.

A great challenge in multi-targeting drug discovery is to identify drug-like lead compounds with therapeutic advantages over single target inhibitors and drug combinations. Inspired by our previous efforts in designing antitumor evodiamine derivatives, herein selective histone deacetylase 1 (HDAC1) and topoisomerase 2 (TOP2) dual inhibitors were successfully identified, which showed potent and antitumor potency. Particularly, compound was orally active and possessed excellent antitumor activity in the HCT116 xenograft model (TGI = 75.2%, 150 mg/kg, .) without significant toxicity, which was more potent than HDAC inhibitor vorinostat, TOP inhibitor evodiamine and their combination. Taken together, this study highlights the therapeutic advantages of evodiamine-based HDAC1/TOP2 dual inhibitors and provides valuable leads for the development of novel multi-targeting antitumor agents.

Objective:To explore the clinical effect of expanded scalp flaps in repconstructing the wounds after resection of frontal and facial nevus and scar.Methods:From May 2014 to May 2019, 28 patients (5 cases of nevus and 11 cases of scar in the frontal part and 2 cases of nevus, 9 cases of scar and 1 case of verrucous nevus in facial part) were repaired with expanded scalp flaps. According to the size of the lesion, the expander was selected and placed under the galea aponeurotica. After tissue expansion, the wound was reconstructed by random designed or pedicled skin flaps. The pedicled skin flaps took the branch of superficial temporal artery as the pedicle. The pedicle was cut off after 3 weeks. Hair removal by laser was performed 3 to 6 times 2 weeks after removing the suture.Results:In all the 28 cases, expansion in the first stage was sufficient, after skin flap transfer in the second stage, all survived without infection or local necrosis. After the pedicle division, 2 cases had small area of distal blood flow disorder, and the wound was healed after skin grafting The follow-up time ranged from 3 to 31 months. After hair removal by laser, the color and texture matched well with the normal skin in the adjacent area. No contracture and pigmentation occurred, and the effect was satisfactory.Conclusions:The scalp is a good donor site for expansion with sufficient tissue and few secondary deformities. The expanded scalp flap has good blood supply for repairing frontal and facial lesions, after hair removal by laser, the effect is good, and it is worth popularizing and applying.

Objective:To explore the clinical effect of expanded scalp flaps in repconstructing the wounds after resection of frontal and facial nevus and scar.Methods:From May 2014 to May 2019, 28 patients (5 cases of nevus and 11 cases of scar in the frontal part and 2 cases of nevus, 9 cases of scar and 1 case of verrucous nevus in facial part) were repaired with expanded scalp flaps. According to the size of the lesion, the expander was selected and placed under the galea aponeurotica. After tissue expansion, the wound was reconstructed by random designed or pedicled skin flaps. The pedicled skin flaps took the branch of superficial temporal artery as the pedicle. The pedicle was cut off after 3 weeks. Hair removal by laser was performed 3 to 6 times 2 weeks after removing the suture.Results:In all the 28 cases, expansion in the first stage was sufficient, after skin flap transfer in the second stage, all survived without infection or local necrosis. After the pedicle division, 2 cases had small area of distal blood flow disorder, and the wound was healed after skin grafting The follow-up time ranged from 3 to 31 months. After hair removal by laser, the color and texture matched well with the normal skin in the adjacent area. No contracture and pigmentation occurred, and the effect was satisfactory.Conclusions:The scalp is a good donor site for expansion with sufficient tissue and few secondary deformities. The expanded scalp flap has good blood supply for repairing frontal and facial lesions, after hair removal by laser, the effect is good, and it is worth popularizing and applying.

Objective: To explore the clinical effects of expanded forehead flaps in repairing midfacial defects. Methods: From January 2003 to December 2018, 19 patients with midfacial defects were admitted to our unit, including 8 males and 11 females, aged 7 to 52 years. One cylindrical expander with rated capacity ranged from 100 to 170 mL was placed in the forehead of patients in the first stage of expansion, and the total water injection volume was about 2 times of the rated capacity of the expander during 1 to 2 months. The area of midfacial defects was 4 cm×2 cm to 9 cm×5 cm after resection in the second stage surgery. Expanded forehead flaps with vascular pedicle of supratrochlear vessels or frontal branch of superficial temporal vessels were used to repair the midfacial defects, with flap size ranging from 5 cm×2 cm to 16 cm×6 cm. The donor sites were closed by direct suturing. Three weeks later, the pedicle was divided. The complications, blood supply after flap transfer and pedicle division, and the treatment effects during follow-up were observed. Results: Among the patients, flaps of 11 patients had vascular pedicle of supratrochlear vessels; flaps of 8 patients had vascular pedicle of frontal branch of superficial temporal vessels. All the flaps survived with no complications and good blood supply after flap transfer and pedicle division. During the follow-up of 6 to 12 months after the third stage surgery of pedicle division of 12 patients, no lower eyelid ectropion occurred, the appearance of the flaps was similar to the surrounding tissue with no swelling. Conclusions The application of expanded forehead flaps can not only repair the defects but also effectively avoid the complication of lower eyelid ectropion, which is a promising method in repairing midfacial defects.

Natural product evodiamine and its derivatives represent a promising class of multi-target antitumor agents. However, the clinical development of these compounds has been hampered by a poor understanding of their antitumor mechanisms. To tackle this obstacle, herein, novel fluorescent probes were designed to elucidate the antitumor mode of action of 10-hydroxyevodiamine. This compound was proven to be distributed in the mitochondria and lysosomes and to act by autophagy and apoptosis mechanisms.

Obstructive sleep apnea (OSA)is a high incidence of potentially dangerous disease,characterized by intermittent hypoxia or hypercapnia.It is an independent risk factor for ischemic stroke.Currently a number of studies have confirmed OSA closely associated with oxidative stress.In this paper,the complex mechanisms of oxidative stress in the OSA and the occurrence of stroke will be reviewed,such as promoting atherosclerosis,damaging the mitochondria,ischemia -reperfusion injury,ischemic preconditioning.To investigate the relationship between OSA,oxidative stress and stroke from molecular mechanisms.