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 imporve the service level of integrated outpatient department for cardio-oncology in healthcare facilities,and to improve and optimize pharmaceutical management within cardio-oncology integrated outpatient department.Methods Clinical issues were identified using the Delphi method.Relevant problems and existing evidence were collected and organized through systematic research.The evidence grading and recommendation intensity standards developed by the Center for Evidence-Based Medicine at Oxford University were applied to complete the evidence grading.Through questionnaire consultations with 38 experts.Results A total of 11 clinical questions were identified as consensus items.Based on these issues,expert consensus recommendations for pharmaceutical management in combined cardio-oncology outpatient departments were formulated through evidence retrieval,synthesis,and grading.Ultimately,an expert consensus on pharmaceutical management in combined cardio-oncology outpatient clinics was established.Conclusion The expert consensus serves as a reference for managing combined clinical cardio-oncology outpatient clinics,significantly contributing to offering more professional and comprehensive diagnosis and treatment services for cancer patients.

Objective:To investigate imaging characteristics of papulopustular rosacea (PPR) by high-frequency ultrasound combined with color Doppler flow imaging.Methods:From August 2021 to August 2022, 30 patients with PPR were enrolled from the Department of Dermatology, the First Affiliated Hospital of Baotou Medical College in the Inner Mongolia Autonomous Region, and 30 healthy volunteers served as controls. The 22-MHz high-frequency ultrasound combined with color Doppler blood flow imaging was performed to measure the skin thickness, echo and blood flow parameters at the cheek, and the ultrasound results were compared between the two groups. Comparisons between groups were conducted by using t test or chi-square test. The diagnostic value was analyzed using the area under the curve (AUC) in the receiver operating characteristic (ROC) curve. Results:In the case group, there were 12 males and 18 females, and their ages ranged from 22 to 65 years (42.3 ± 12.8 years) ; in the control group, there were 10 males and 20 females, and their ages ranged from 24 to 62 years (41.0 ± 8.4 years) . The epidermal and dermal thicknesses at the cheek were significantly higher in the case group (132.64 ± 12.29 μm, 1 812.29 ± 85.52 μm, respectively) than in the control group (104.34 ± 14.45 μm, 1 671.77 ± 146.55 μm, respectively, both P < 0.05) . High-frequency ultrasound images showed that the case group was mainly characterized by irregular hypoechoic areas in the cheek dermis (80%) , while banded moderately echoic areas were common in the cheek dermis in the control group (90%) ; subepidermal low-echogenic bands and dermal irregular hypoechoic areas were more likely to appear in the case group than in the control group (93.33% vs. 43.33%, 80% vs. 10%, respectively, both P < 0.001) . Compared with the control group, the case group showed a significantly increased proportion of patients with abundant blood flow signals (93.3% vs. 10%, P < 0.05) , and significantly increased blood vessel diameters (1.60 ± 0.42 mm vs. 0.95 ± 0.32 mm, P < 0.05) ; there was no significant difference in peak systolic blood flow velocity and vascular resistance index between the two groups (both P > 0.05) . The AUC of high-frequency ultrasound combined with color Doppler flow imaging quantitative parameters (including epidermal thicknesses, dermal thicknesses, and blood vessel diameters) was 0.989 (95% CI: 0.970 - 1.000) for the diagnosis of PPR, and the sensitivity and specificity were both 96.7%, which were higher than those of single parameter-based diagnostic model. Conclusion:High-frequency ultrasound combined with color Doppler flow imaging can help improve the accuracy of the diagnosis of PPR, by accurately and non-invasively measuring skin thickness and blood flow parameters.

Objective:To study the feasibility of preserving the subvalvular structure during mitral valve replacement and whether it is more conducive to the recovery of cardiac function.Methods:The clinical data of 205 patients who underwent mitral valve replacement due to mitral insufficiency in Enshi Central Hospital from January 2017 to December 2020 were analyzed retrospectively. According to whether the subvalvular structure of mitral valve was preserved during operation, they were divided into three groups: group A was to preserve all the subvalvular structures of anterior and posterior mitral valve, group B retained all or part of the subvalvular structure of the posterior valve, in group C, all anterior and posterior subvalvular structures were removed. The operation time, cardiopulmonary bypass time and aortic occlusion time of patients in each group were counted. Postoperative ventilator use time, ICU stay time and incidence of complications; mitral flow velocities (MVE), left ventricular end diastolic dimension (LVED), left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were rechecked by echocardiography at 1 week, 3 months and 6 months after operation.Results:There were no significant differences in operation time, cardiopulmonary bypass time, aortic occlusion time, ventilator use time and ICU stay time among the three groups before surgery ( P>0.05). There were no death cases in perioperative period, and all patients were cured and discharged from hospital. The results of cardiac color ultrasound showed that MVE, LVED, LVEF and LVFS were improved compared with those before operation. Postoperative ultrasound results showed no significant difference in MVE at 1 week, 3 months and 6 months ( P>0.05). At 1 week after surgery, LVED in group A was lower than that in group B and C: (44.90 ± 5.59) mm vs. (46.13 ± 6.15) mm, (48.33 ± 5.59) mm. The difference was statistically significant ( P<0.05). Three months after operation, LVED and LVFS in group A were higher than those in group B and group C: (43.37 ± 5.61) mm vs. (44.69 ± 5.45) mm and (53.42 ± 5.35) mm, (33.92 ± 3.34)% vs. (31.67 ± 3.20)% and (30.37 ± 6.96)%, respectively. The differences were statistically significant ( P<0.05). At 6 months after operation, LVED in group A was lower than that in group B and group C: (41.86 ± 3.27) mm vs. (47.85 ± 6.93) mm and (53.42 ± 8.17) mm. LVFS was higher than that in group B and group C: (33.42 ± 2.64) % vs. (32.18 ± 5.98) % and (32.28 ± 2.58) %, and the differences were statistically significant ( P<0.05). Conclusions:Preserving the whole subvalvular structure of mitral valve will not lead to prosthetic valve dysfunction and increase surgical complications. After operation, it showed better reduction of left ventricular end diastolic diameter and better left ventricular shortening rate, which was more conducive to the recovery of cardiac function.

Objective To investigate the relationships between the pathology classification, Masaoka clinical stage and postoperation myasthenic crisis in patients of myasthenia gravis with thymoma undergoing thymectomy. Methods Clinical records of 56 patients of myasthenia gravis with thymoma from January 2006 to December 2015 who had underwent thymectomy were reviewed retrospectively. The following factors were analyzed to find the relation to the occurrence of myasthenic crisis after thymectomy: WHO pathology classification, Masaoka clinical stage and tumor size. Results Sixteen patients experienced postoperative myasthenic crisis after thymectomy. Statistical analysis revealed that the incidence of postoperative myasthenic crisis in patients with Masaoka Ⅲ stage was significantly higher than that in patients with Masaoka Ⅰ and Ⅱ stage: 39.39% (13/33) vs. 13.04% (3/23), the incidence of postoperative myasthenic crisis in patients with WHO pathology classification B3 and C type was significantly higher than patients with WHO pathology classification B2 type: 50.00% (12/24) vs. 14.29% (4/28), the incidence of postoperative myasthenic crisis in patients with tumor size more than 5 cm was significantly lower than patients with tumor size less than 5 cm: 10/17 vs. 15.38% (6/39), and there were statistical differences (P＜0.05 or＜0.01). Conclusions WHO pathology classification and Masaoka clinical stage are significantly correlated with the occurrence of myasthenia crisis after thymectomy. The patients with MasaokaⅢstage, WHO pathology classification B3 and C type and tumor size more than 5 cm have the risk of postoperative myasthenic crisis after thymectomy. The comprehensive intervention before and after operation can prevent myasthenia crisis.

OBJECTIVE: To study the mechanism of tumor necrosis factor( TNF)-α and its receptor( TNFR) signal transduction pathways in regulating cell apoptosis of alveolar macrophage( AM) in coal workers' pneumoconiosis( CWP).METHODS: Twenty-four coal workers with pneumoconiosis at stage Ⅰ were selected as CWP group and four observation subjects exposed to coal were chosen as observation group by using simple random sampling method. The bronchoalveolar lavage fluids of whole-lung lavage of two groups were collected. AMs were separated and purified. Then they were divided into 6 groups: a control group,a superoxide dismutase( SOD) group,a TNF/TNFR group,an anti-TNF-α antibody group,a Caspase-8 suppression group and a nuclear factor-κB( NF-κB) suppression group. The AMs of 6 groups with corresponding treatment were cultivated. After 24 hours,the cells were harvested and proteins extracted. The relative expression of TNF-α,TNFR1,TNFR2,Caspase-8,Caspase-3,NF-κB P50 and NF-κB P65 protein was detected by Western blotting. RESULTS: The protein relative expression of TNF-α,TNFR2,Caspase-8,Caspase-3,NF-κB P50 and NF-κB P65 in CWP group was significantly higher than those in the observation group( P < 0. 05). The protein relative expression of TNF-α,TNFR1,Caspase-8,Caspase-3 and NF-κB P50 in the TNF/TNFR group and the anti-TNF-αantibody group was lower than that of the control group( P < 0. 05). The above indexes in the anti-TNF-α antibody group were lower than that of the NF-κB suppression group( P < 0. 05). The protein relative expression of TNFR1,Caspase-8and Caspase-3 in the TNF/TNFR group was higher than that of the SOD group and the Caspase-8 suppression group( P <0. 05). The protein relative expression of TNFR1,Caspase-8 and NF-κB P50 in the TNF/TNFR group was lower than that of the NF-κB suppression group( P < 0. 05). Among the CWP patients,the relative expression of TNFR2 and NF-κB P65 in the TNF/TNFR group was lower than that of the control group( P < 0. 05),and higher than that of the SOD group( P <0. 05). CONCLUSION: AM apoptosis mediated by TNF-α/TNFR/NF-κB signal transduction pathway plays an important role in the occurrence and development of CWP. The TNF-α/TNFR/NF-κB signal transduction pathways inhibited or blocked at different stages can affect the expression of proteins related to AM apoptosis.

Objective To analyze the clinical value of iron protein succinylate combined with erythropoietin (EPO) on the prevention and treatment of anemia in high-risk premature infants.Methods The clinical data of 100 high-risk premature infants with anemia treated in our hospital were analyzed retrospectively,and were divided into combined group (iron protein succinylate combined with EPO,n =58) and control group (EPO,n =42) according to different medication methods.Changes of serum iron,serum ferritin (SF),hemoglobin (Hb),red blood cell count (RBC) and hematocrit (HCT) before and after treatment were compared between the two groups.The rate and times of blood transfusion in the two groups were statistically analyzed.The incidence rates of adverse reactions and anemia were compared between the two groups.Results After treatment,the serum iron,SF,Hb,RBC,HCT and body weight in the combined group,Hb,RBC,HCT and weight in the control group were increased (P ＜ 0.05),but the serum iron,SF,Hb,RBC,HCT and weight in the combined group were higher than those in the control group (P ＜ 0.05).The rate and times of blood transfusion and the incidence rates of anemia at different times in the combined group were lower than those in the control group (P ＜ 0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P ＞ 0.05).Conclusion Iron protein succinylate combined with EPO can effectively prevent anemia in high-risk premature infants,reduce the rate of blood transfusion and improve their hematopoietic function.

Objective To analyze the clinical value of iron protein succinylate combined with erythropoietin (EPO) on the prevention and treatment of anemia in high-risk premature infants.Methods The clinical data of 100 high-risk premature infants with anemia treated in our hospital were analyzed retrospectively,and were divided into combined group (iron protein succinylate combined with EPO,n =58) and control group (EPO,n =42) according to different medication methods.Changes of serum iron,serum ferritin (SF),hemoglobin (Hb),red blood cell count (RBC) and hematocrit (HCT) before and after treatment were compared between the two groups.The rate and times of blood transfusion in the two groups were statistically analyzed.The incidence rates of adverse reactions and anemia were compared between the two groups.Results After treatment,the serum iron,SF,Hb,RBC,HCT and body weight in the combined group,Hb,RBC,HCT and weight in the control group were increased (P ＜ 0.05),but the serum iron,SF,Hb,RBC,HCT and weight in the combined group were higher than those in the control group (P ＜ 0.05).The rate and times of blood transfusion and the incidence rates of anemia at different times in the combined group were lower than those in the control group (P ＜ 0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P ＞ 0.05).Conclusion Iron protein succinylate combined with EPO can effectively prevent anemia in high-risk premature infants,reduce the rate of blood transfusion and improve their hematopoietic function.

Objective To analyze the molecular characteristics and prognosis in acute myeloid leukemia patients with AML1/ETO.Methods The clinical data of 63 cases of acute myeloid leukemia (AML) patients with AML1/ETO positive were analyzed retrospectively.56 cases of AML patients with AML1/ETO negative in the same period were analyzed as control.Characteristics in morphology,immunology,cytogenetics,molecular biology and the clinical effects of treatment were studied and analyzed.Results M2a was 57.12 ％ (36/63),M2b was 33.33 ％ (21/63) in AML with AML1/ETO.The percent of initial marrow blasts was 0.46±0.16.The positive rate of CD34,CD13,CD33,CD19,CD7 and CD56 was 67.21％,52.46 ％,40.98 ％,63.93 ％,4.92 ％ and 50.82 ％,respectively.The rate of t(8;21) translocation was 82.54 ％.There was 4.76 ％ with additional chromosome abnormality,three cases with EV1 1and one case with MLL/AT9.The overall CR rate,the relapse rate,the 3-year and the 5-year overall survival rate was 71.43 ％,51.11％,(43.01±5.31) ％ and (32.79±3.81) ％,respectively.There was no significant difference compared with the control group (P ＞ 0.05).But extramedullary infiltration,the expression of CD56 and additional chromosome abnormality had statistical effects on overall survival (P ＜ 0.05).Conclusions There has unique characteristics in AML with AML1/ETO.The effects of treatment and the prognosis are affected by many factors,so the efficacy and prognosis of AML with AML1/ETO couldn' t just depend on AML1/ETO.