Objective:To examine the efficacy and experience of staged and segmented two hybrid surgeries for total repair of Debakey type Ⅰ aortic dissection (TIAD).Methods:This study was a retrospective case series. The clinic data of 10 patients with acute TIAD who were admitted to the Department of Cardiac Surgery, Second Hospital of Lanzhou University or the First People′s Hospital of Lanzhou, between January 2016 and August 2022, were retrospectively studied. Ten patients underwent hybrid surgeries in two hospitalizations (stages), including 7 males and 3 females with an age of (60±7) years (range: 49 to 71 years). In stage 1, the first type Ⅱ hybrid arch repair was performed to treat the ascending, total arch, and descending thoracic aorta for acute TIAD without circulatory arrest. In stage 2, the second hybrid surgery including infrarenal abdominal aorta replacement, visceral arteries bypass and endovascular thoracoabdominal aortic repair was performed to treat residual thoracoabdominal aortic dissection after the first hybrid operation (segmented). Basic data, preoperative concomitant diseases, high-risk factors, surgical approaches and postoperative complications of all important organs, as well as CT imaging were analyzed.Results:There was no death in the 20 hybrid surgical procedures. In stage 1 type Ⅱ hybrid surgery, 4 cases underwent reconstruction of the aortic sinutubular junction, while Bentall and David surgery was performed for 3 cases, respectively. A patient received coronary artery bypass grafting. Then all patients were sequentially treated with arch debranching and thoracic aortic endovascular repair. Postoperative complications included renal insufficiency (4/10), hemofiltration (1/10), hypoxemia (4/10), neurologic event (1/10) and type Ⅱ endoleak (1/10). Complete false lumen thrombosis occurred in 9/10 of the patients. All complications recovered successfully at discharge and the average hospital stay was (21±4) days (range: 16 to 28 days) in the first hospitalization. At stage 2, the second hybrid surgery was successfully performed in all patients. No paraplegia, hepatic or renal insufficiency, or endoleak occurred. However, branch graft embolism of the left renal artery was found in one patient 3 days after laparotomy, as well as of superior mesenteric artery in another. Superior mesenteric artery occlusion was successfully treated by endovascular recanalization. Complete false lumen thrombosis occurred in all patients. Although all patients had different degrees of intestinal dysfunction, they were gradually relieved at discharge, and the average hospital stay was (19±2)days (range:16 to 21 days) in the second hospitalization. During follow-up, CT angiography showed aortic remodeling in all patients.Conclusion:Staged and segmented two hybrid surgeries are safe and feasible for total repair of Debakey type Ⅰ aortic dissection and are associated with acceptable early and midterm outcomes.

Objective:To examine the efficacy and experience of staged and segmented two hybrid surgeries for total repair of Debakey type Ⅰ aortic dissection (TIAD).Methods:This study was a retrospective case series. The clinic data of 10 patients with acute TIAD who were admitted to the Department of Cardiac Surgery, Second Hospital of Lanzhou University or the First People′s Hospital of Lanzhou, between January 2016 and August 2022, were retrospectively studied. Ten patients underwent hybrid surgeries in two hospitalizations (stages), including 7 males and 3 females with an age of (60±7) years (range: 49 to 71 years). In stage 1, the first type Ⅱ hybrid arch repair was performed to treat the ascending, total arch, and descending thoracic aorta for acute TIAD without circulatory arrest. In stage 2, the second hybrid surgery including infrarenal abdominal aorta replacement, visceral arteries bypass and endovascular thoracoabdominal aortic repair was performed to treat residual thoracoabdominal aortic dissection after the first hybrid operation (segmented). Basic data, preoperative concomitant diseases, high-risk factors, surgical approaches and postoperative complications of all important organs, as well as CT imaging were analyzed.Results:There was no death in the 20 hybrid surgical procedures. In stage 1 type Ⅱ hybrid surgery, 4 cases underwent reconstruction of the aortic sinutubular junction, while Bentall and David surgery was performed for 3 cases, respectively. A patient received coronary artery bypass grafting. Then all patients were sequentially treated with arch debranching and thoracic aortic endovascular repair. Postoperative complications included renal insufficiency (4/10), hemofiltration (1/10), hypoxemia (4/10), neurologic event (1/10) and type Ⅱ endoleak (1/10). Complete false lumen thrombosis occurred in 9/10 of the patients. All complications recovered successfully at discharge and the average hospital stay was (21±4) days (range: 16 to 28 days) in the first hospitalization. At stage 2, the second hybrid surgery was successfully performed in all patients. No paraplegia, hepatic or renal insufficiency, or endoleak occurred. However, branch graft embolism of the left renal artery was found in one patient 3 days after laparotomy, as well as of superior mesenteric artery in another. Superior mesenteric artery occlusion was successfully treated by endovascular recanalization. Complete false lumen thrombosis occurred in all patients. Although all patients had different degrees of intestinal dysfunction, they were gradually relieved at discharge, and the average hospital stay was (19±2)days (range:16 to 21 days) in the second hospitalization. During follow-up, CT angiography showed aortic remodeling in all patients.Conclusion:Staged and segmented two hybrid surgeries are safe and feasible for total repair of Debakey type Ⅰ aortic dissection and are associated with acceptable early and midterm outcomes.

Objective:To explore the long-term efficacy of virtual reality exposure therapy (VRET) for acrophobia.Method:Sixty patients with acrophobia who visited the Nanjing Brain Hospital Affiliated to Nanjing Medical University from October 2018 to January 2021 were selected and randomly divided into VRET group ( n=30) and imaginary exposure therapy (IET) group ( n=30) using a block random number table method. The VRET group received VRET treatment, while the IET group received IET treatment. Both groups received treatment twice a week for 3 weeks. At baseline and after treatment, the acrophobia questionnaire (AQ) and attitude towards high questionnaire (ATHQ) were used to assess the patients' acrophobia symptoms, and the behavioral avoidance test (BAT) was used to assess the patients' level of avoidance when facing high altitude situations. During the 2-year follow-up after treatment, AQ and ATHQ were used to evaluate the patients' acrophobia symptoms. The repeated measures ANOVA and covariance analysis were used to analyze the data using SPSS 27.0 software. Result:(1) Repeated measures ANOVA showed that there was no significant interaction effect of AQ-anxiety, AQ-avoidance, and ATHQ scores between the two groups before and after treatment ( F=1.37, 1.95, 0.21, all P>0.05), while the time main effect of AQ-anxiety ( F=43.29) and ATHQ score ( F=13.35) was significant (both P<0.05), and the time main effect and group main effect of AQ-avoidance score were significant ( Ftime=62.84, Fgroup=5.65, both P<0.05). The AQ-avoidance scores of the VRET group(6.19±3.60, 8.25±3.80) were significantly lower than those of the IET group (9.60±3.74, 12.00±4.57)after treatment and during the follow-up period (both P<0.05).(2)After controlling for the baseline initial values of BAT in the two groups, the VRET group had a lower corrected BAT score (1.51 ± 0.72) than the IET group (4.39 ± 0.75) ( F=55.81, P<0.001), indicating that the efficacy of the VRET group was significantly better than that of the IET group. Conclusion:VRET significantly reduces acrophobia symptoms and behavioral avoidance level in patients with acrophobia, demonstrating superior efficacy compared to IET in both immediate and long-term effects.

Objective:To explore the long-term efficacy of virtual reality exposure therapy (VRET) for acrophobia.Method:Sixty patients with acrophobia who visited the Nanjing Brain Hospital Affiliated to Nanjing Medical University from October 2018 to January 2021 were selected and randomly divided into VRET group ( n=30) and imaginary exposure therapy (IET) group ( n=30) using a block random number table method. The VRET group received VRET treatment, while the IET group received IET treatment. Both groups received treatment twice a week for 3 weeks. At baseline and after treatment, the acrophobia questionnaire (AQ) and attitude towards high questionnaire (ATHQ) were used to assess the patients' acrophobia symptoms, and the behavioral avoidance test (BAT) was used to assess the patients' level of avoidance when facing high altitude situations. During the 2-year follow-up after treatment, AQ and ATHQ were used to evaluate the patients' acrophobia symptoms. The repeated measures ANOVA and covariance analysis were used to analyze the data using SPSS 27.0 software. Result:(1) Repeated measures ANOVA showed that there was no significant interaction effect of AQ-anxiety, AQ-avoidance, and ATHQ scores between the two groups before and after treatment ( F=1.37, 1.95, 0.21, all P>0.05), while the time main effect of AQ-anxiety ( F=43.29) and ATHQ score ( F=13.35) was significant (both P<0.05), and the time main effect and group main effect of AQ-avoidance score were significant ( Ftime=62.84, Fgroup=5.65, both P<0.05). The AQ-avoidance scores of the VRET group(6.19±3.60, 8.25±3.80) were significantly lower than those of the IET group (9.60±3.74, 12.00±4.57)after treatment and during the follow-up period (both P<0.05).(2)After controlling for the baseline initial values of BAT in the two groups, the VRET group had a lower corrected BAT score (1.51 ± 0.72) than the IET group (4.39 ± 0.75) ( F=55.81, P<0.001), indicating that the efficacy of the VRET group was significantly better than that of the IET group. Conclusion:VRET significantly reduces acrophobia symptoms and behavioral avoidance level in patients with acrophobia, demonstrating superior efficacy compared to IET in both immediate and long-term effects.

Abstract Social withdrawal is a kind of behavioral inhibition in social situations, which may increase the risk for maladjustment, internalizing and externalizing problems, interfering with psychological development and healthy growth. With the deepening understanding in sociology of development, child social withdrawal has gradually received extensive attention from scholars across the world. Understanding the phenomenon of child social withdrawal is important for in depth follow up research. Based on the literature review, the paper aims to summarize the types, mechanisms and influencing factors of social withdrawal in children, in order to provide scientific basis for formulating prevention strategies and early intervention programs in the future.

With the continuous in-depth study of minimally invasive cardiac surgery(MICS), minimally invasive cardiac surgery in children has also been developed in this period, but there is still a certain gap compared with adults. Because of the large difference in body size and the low tolerance of surgery in children, minimally invasive cardiac surgery in children still has a short board on complex cardiac diseases. This article reviews several commonly used minimally invasive techniques: (1) small incision cardiac surgery; (2) thoracoscopic and robot-assisted cardiac surgery; (3) minimally invasive cardiopulmonary bypass(MiECC) and cardiac surgery to avoid cardiopulmonary bypass; (4) hybrid surgery and enhanced cardiac rehabilitation surgery(ERACS) in pediatric cardiac surgery and their application and research progress.

Open surgery is currently the gold standard for the treatment of thoracoabdominal aortic aneurysm(TAAA), while endovascular aortic repair(EVAR) has also been widely carried out. Because it involves important branches supplying internal organs, the technical system for treating TAAA is particularly complex. However, with the advent of newer, low-cost, flexible stent systems, total endovascular repair techniques have become more feasible and attractive. For young and low-risk patients, the choice of open or endovascular treatment remains controversial. Despite the advantages of a minimally invasive procedure, EVAR carries a greater risk of spinal cord injury and may require secondary endovascular intervention to repair endoleak when its unique complication occurs, and the long-term durability after EVAR is not clear. This article reviews the open and endovascular treatment of TAAA, introduces the development of open surgery and endovascular repair, the advantages and disadvantages of various types of stents, and discusses how to select a more suitable surgical method for patients, providing clinicians with a treatment reference.

Objective: To observe the effects of electroacupuncture (EA) with three frequencies (100 Hz, 2 Hz, and 2 Hz/100 Hz) on the apoptosis of neurons and c-Jun N-terminal kinase (JNK) signaling pathway in the hippocampus of rats with vascular dementia (VD), and explore the mechanism of EA intervention for VD. Methods: Fifty male Sprague-Dawley rats were randomly divided into a model group, a sham operation group, a 100 Hz EA group, a 2 Hz EA group, and a 2 Hz/100 Hz EA group, with ten rats in each group. The VD model rats were established by repeated ischemia-reperfusion of bilateral common carotid arteries. The rats in the EA groups received EA intervention at Baihui (GV20), Dazhui (GV14), Geshu (BL17) and Zusanli (ST36), once a day for 14 d. Afterward, Morris water maze was used to examine the learning and memory performances of the rats in each group, hematoxylin-eosin staining to observe the histomorphological changes in the hippocampal CA1 region, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling to test the apoptosis of neurons in the hippocampal CA1 region, and Western blot to detect the protein expression levels of JNK, phosphorylated JNK (p-JNK), Caspase-8, and Caspase-3 in the hippocampus tissue. Results: Compared with the sham operation group, the escape latency of the model group in water maze test was prolonged; the number of crossing the original platform was decreased (P<0.01); the hippocampal neurons were severely damaged and the number of surviving neurons was decreased (P<0.01), whereas the number of apoptotic neurons was increased (P<0.01); the protein expression levels of JNK, p-JNK, Caspase-8, and Caspase-3 in the hippocampus were significantly increased (P<0.01). Compared with the model group, the escape latency of each EA group was significantly shortened; the number of crossing the original platform was significantly increased (P<0.01); the damage of hippocampal neurons was alleviated, the number of surviving neurons was increased (P<0.01), and the number of apoptotic neurons was decreased (P<0.01); the protein expression levels of JNK, p-JNK, Caspase-8, and Caspase-3 in the hippocampus were decreased (P<0.01). The results in the 2 Hz EA group and the 2 Hz/100 Hz EA group were superior to those in the 100 Hz EA group. Conclusion: EA with the three frequencies (100 Hz, 2 Hz, and 2 Hz/100 Hz) can improve the learning and memory performances in VD rats subjected to ischemia-reperfusion, its mechanism may be related to the inhibition of neuronal apoptosis and the regulation of the related protein expression of JNK signaling pathway, and the intervention effects of EA with 2 Hz and 2 Hz/100 Hz are more significant.

Objective:To explore and compare the value of radiomic features based on 18F-fluorodeoxyglucose (FDG) PET and CT in distinguishing epidermal growth factor receptor (EGFR) mutation status in patients with lung adenocarcinoma. Methods:Pretreatment 18F-FDG PET/CT images and EGFR gene status of 114 patients (64 males and 50 females, aged range: 35-84 (average age: 61) years) with primary lung adenocarcinoma between January 2017 and December 2017 were retrospectively collected. The volume of interest was drawn manually slice by slice, then the features were extracted by the LIFEx software. The parameters were screened by least absolute shrinkage and selection operator (LASSO) method for 200 times, and ten-fold cross-validation was used to select the best tuning parameter λ. Three models, namely M PET, M CT, M PET+ CT, were constructed by binary logistic stepwise regression. The receiver operating characteristic (ROC) curve was generated and the corresponding area under the curve (AUC), sensitivity, specificity and accuracy were calculated. The AUCs of three models were compared by Delong test. Results:Totally, 53.51%(61/114) patients were with wild type EGFR and 46.49%(53/114) patients had EGFR mutation. There were 3, 3, 7 parameters selected to form M PET, M CT, M PET+ CT, respectively. The AUCs for M PET, M CT, M PET+ CT were 0.730, 0.752 and 0.866 respectively. When the cut-off values were 0.427, 0.522, 0.378 for M PET, M CT and M PET+ CT, the Youden index were up to the maximum as 0.420, 0.405, 0.630, with sensitivities of 83.0%(44/53), 58.5%(31/53), 92.5%(49/53), specificities of 59.0%(36/61), 82.0%(50/61), 70.5%(43/61) and accuracies of 70.2%(80/114), 71.1%(81/114), 80.7%(92/114), respectively. There was no significant difference between AUC of M PET and M CT ( z=-0.320, P>0.05). The differences of AUCs between M PET+ CT and M PET, M PET+ CT and M CT were statistically significant ( z values: 2.963, 2.523, both P<0.05). Conclusions:PET, CT and PET+ CT radiomic features are all associated with EGFR gene expression in lung adenocarcinoma. M PET+ CT has the highest predictive efficiency.

Objective To explore the risk factors of hidden blood loss after UKA.Methods A retrospec-tive study was conducted on 273 patients who underwent UKA from January 2015 to December 2016,including 79 males and 194 females,age between 46 to 87 years old,mean age(67.21± 8.23)years old. The clinical data were collected and the blood volume was calculated according to the Nadler formula. The Gross equation was used to calculate the blood loss and the amount of occult blood loss at 3 days after operation. The risk factors were analyzed statistically. Results The volume of hidden blood loss after operation was(75.36 ± 10.21)mL,and the volume of total blood lost after operation was(187.35± 60.31)mL.Sex,BMI and type of prosthesis were risk factors for hidden blood loss after UKA. Conclusions The volume of hidden blood loss after UKA was related to sex, BMI,and type of prosthesis. For the obese and male patients,we should actively take bleeding management and choose the type of prosthesis reasonably.