Objective    To evaluate the short-term therapeutic effect of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of acute type A aortic dissection (ATAAD). Methods    From November 2019 to July 2020, 28 patients with ATAAD were treated by extended adventitial inversion with graft eversion anastomosis technique in the Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, including 19 males and 9 females, aged 60.11±11.11 years. The intima of the ascending aorta was trimed to 5 mm above the sinotubular junction. The adventitia of the ascending aorta was longitudinally cut to the reserved intima margin along the junction of the three aortic valves. The extended adventitial inversion was sutured continuously, no coronary sinus was sutured over the aortic annulus, and the left and right coronary sinus was sutured above the coronary ostium. The anastomotic graft was everted and inserted into the aortic lumen, and the everted graft was continuously sutured at the level of sinotubular junction which was 5 mm away from the edge of graft. Results    There was no intraoperative death, intractable root hemorrhage, residual root false lumen, root dilatation, anastomotic hematoma or other complications. There was no recurrence of the pain in the back of all patients, and the results of the CT angiography were not significantly changed. In 22 patients with no regurgitation, only 1 (4.55%) patient had a mild regurgitation. In 6 patients with mild aortic regurgitation, the disappearance rate of regurgitation was 50.0% (3/6). Conclusion    The treatment of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of aortic dissection eliminates the residual dissection at the root. The anastomotic hemorrhage is prevented, the root structure of aortic dissection is reconstructed and strengthened, the root function is restored, and the possible expansion of the root is prevented. The short-term results are satisfactory.

Objective:To explore the current situation of rumination and hope level in stroke patients and to analyze the effect of rumination on their hope level, so as to provide a basis for clinical intervention.Methods:Using the convenient sampling method, stroke patients admitted to Lanling County People's Hospital from March to June 2021 were selected as the research objects. General data questionnaire, Chinese Version of Event Related Rumination Inventory (C-ERRI) and Herth Hope Scale were used to investigate the patients. Multiple linear regression analysis was used to analyze the influencing factors. A total of 100 questionnaires were distributed in this study, and 92 valid questionnaires were recovered, with an effective recovery rate of 92.0%.Results:The total score of C-ERRI in 92 stroke patients was (29.40±7.89) and the total score of Herth Hope Scale was (32.97±6.52) . Pearson correlation analysis showed that purposeful rumination in stroke patients was positively correlated with the total score and each dimension scores of Herth Hope Scale ( P<0.05) . The results of multiple linear regression analysis showed that gender, education level, economic income level, Barthel index and purposeful rumination were influencing factors of the hope level of stroke patients ( P<0.05) . Conclusions:The hope level of stroke patients is not high, and more attention should be paid to stroke patients who are female, have a lower education level, a lower level of economic income and have poor activities of daily living. And certain measures should be taken to improve the level of purposeful rumination of patients, thereby raising its hope level.

Objectives: To propose a novel clinical classification system of gallbladder cancer, and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer. Methods: The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females, aged (62.0±10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type, hepatic type, hepatic hilum type and mixed type, the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage, N stage, vascular invasion, neural invasion, median survival time and surgical procedures were analyzed.Rates were compared by χ² test, survival analysis was carried by Kaplan-Meier and Log-rank test. Results: Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5%).The overall median survival time was 28 months.There were 81 patients in Tis-T1 stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage: 345 cases(35.3%)of peritoneal type, 331 cases(33.8%) of hepatic type, 122 cases(12.5%) of hepatic hilum type and 180 cases(18.4%) of mixed type.T stage(χ²=288.60,P<0.01),N stage(χ²=68.10, P<0.01), vascular invasion(χ²=128.70, P<0.01)and neural invasion(χ²=54.30, P<0.01)were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(χ²=80.60,P<0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P>0.05). Conclusion With application of new clinical classification, different types of gallbladder cancer are proved to be correlated with TNM stage, malignant biological behavior and prognosis, which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.

Objective To investigate the diagnostic value of ultrasonography in radial head subluxation (RHS).Methods The clinical data and ultrasonographic findings of 34 children with RHS were retrospectively analyzed.All patients were routinely treated by bilateral compared and multi-sectional elbow joints ultrasonography.And the X ray results were negative.Results Ultrasonographic manifestations of RHS included increased radiocapitellar distance in 29 cases (29/34,85.29％);widened joint space and enhanced echo in 25 cases (25/34,73.53％);hook sign,supinator muscle above the radial head in 32 cases (32/34,94.12 ％);annular ligament entrapment in 33 cases (33/34,97.06％).Conclusion Ultra sonographic manifestations of RHS have certain characteristics.Comparation of bilateral elbow joints and the application of continuous scanning ultrasound are helpful to make a quick and accurate diagnosis of X-ray negative RHS.

Objective To summarize the puncture indications and the pathological type features of renal allografts biopsies in our center for evaluating its safety and diagnostic value .Methods The data of 773 percutaneous renal allograft biopsies in 629 kid‐ney transplants in the Pearl River Hospital of Southern Medical University from January 2005 to June 2014 were retrospectively an‐alyzed .Results The success rate of renal biopsy was 100% ,9 cases(1 .2% ) were complicated postoperative perirenal small hemato‐ma ,33 cases(4 .3% ) with gross hematuria and 1 case(0 .13% )with abdominal pain .Among the indications of 773 biopsies ,protein urine occured 205 cases(26 .5% ) of patient ,blood Cr increased in 187 cases(24 .2% )of patients ,protein urine simultaneously com‐plicating blood Cr increased ,in 313 cases of patients ,53 cases(6 .9% )had postoperative oliguria urinary ,and 15 cases(1 .9% )were get procedural biopsy .In the pathological types ,21 cases(2 .7% ) were normal ,179 cases (23 .2% ) were acute T cell‐mediated rejec‐tion after transplantation ,51 cases (6 .6% )were acute antibody‐mediated rejection ,205 cases (26 .5% ) were chronic T cell‐mediated rejection and 43 cases(5 .6% ) were chronic antibody‐mediated rejection;41 cases(5 .3% ) were drug toxicity ,29 cases(3 .7% ) were acute tubular necrosis(ATN) ,11 cases(1 .4% ) were relapsed or new nephropathy ;9 cases(1 .2% )were HBV related renal disease;39 cases (5 .0% ) were critical lesion and 145 cases(18 .8% )were others .Conclusion Rrenal allograft biopsy is safe ,it is important to the etiological diagnosis of renal disease after renal transplant ,which can guide the clinical treatment and improve the long term survival of renal graft and should be routinely carried out in clinic .

Objective To observe the expression of MicroRNA-21(miRNA-21)in kidney tissue of unilateral ureteral obstruc-tion (UUO)rats and explore mechanisms of miRNA-21 involved in TGF-β1/Smad3 signaling pathway in renal interstitial fibrosis (RIF).Methods Totally 20 adult male SD rats were divided into UUO group and Sham operation group.The left ureter of rats in UUO group were ligated,and the rats in sham group were dissociated left ureter only,but not to be obstructed.The left kidney tis-sue was collected at the 3rd、7th days after surgery.Real-time quantitative PCR analysed the expression of miRNA-21.Masson stai-ning,HE staining and immunohislochemistry staining were used to evaluate the degree of RIF.The expression of transforming growth factor-β1(TGF-β1)、Smad3,α-smooth muscle actin (α-SMA)、and collagenⅠ(Col-Ⅰ)were examined by immunohislochemis-try staining.Results The expression of miRNA-21 in kidney tissue was higher at 3rd、7th days after surgery in UUO groups than that in Sham group(P <0.01).The expression in UUO group at 7th day was higher than 3rd day after surgery(P <0.01).The fi-brosis score,positive TGF-β1、Smad3、Col-Ⅰ、α-SMA area in UUO group were significantly higher than those of Sham group at 3rd、7th days (P <0.01),Which at 7th day were higher than 3rd day in UUO group(P <0.01).The expressions of miRNA-21 in kidney tissue was positive correlations with the fibrosis score(r=0.888,P <0.01).The expressions of miRNA-21 in kidney tissue was positive correlations with TGF-β1、Smad3、Col-Ⅰ、α-SMA(r=0.799,0.849,0.882,0.896,P <0.01).Conclusion The expres-sion of miRNA-21 was upregulated in UUO kidney tissue after model establishment.The RIF degree might be positive correlations with miRNA-21 expression,and TGF-β1/Smad3 signaling pathway positively regulate miRNA-21 to mediate rats RIF.

Objective To investigate the reference values and Z scores regression equations of newborn undergoing echocardiography. Methods Two hundred and eighty-eight newborns (aged 0-28 days) of Shenzhen Children′s Hospital underwent echocardiography examination, including M-mode, two-dimensional (2D) and real-time three-dimensional (3D) echocardiography, color Doppler lfow imaging (CDFI) and tissue Doppler imaging. The correlation between echocardiography results and weight were analyzed and Z scores were calculated. Results The normal values of right ventricular diameter (RV) and left ventricular end-diastolic diameter (LVEDD) measured by M-mode, the mitral annulus diameter in four chamber view (MV-D1), mitral annulus diameter in two chamber view (MV-D2), mitral annulus diameter in longitudinal view (MV-D3), aortic ring diameter (ARD), aortic sinus diameter (ASD), ascending aorta diameter (AAO), transverse aorta diameter (TA), aortic isthmus diameter (AI), aorta diaphragm diameter (AO-Dia), tricuspid annulus diameter in four chamber view (TV-D1), tricuspid annulus diameter in right ventricular inlfow tract view (TV-D2), right ventricular outlfow tract diameter (RVOT), pulmonary valve diameter (PVD) and main pulmonary artery diameter (PA) measured by 2D echocardiography and the normal values of mitral valve inflow Doppler component during early diastole (MV-E), mitral valve inlfow Doppler component during atrial contraction (MV-A), tricuspid valve inlfow Doppler component during early diastole (TV-E), tricuspid valve inflow Doppler component during atrial contraction (TV-A), aortic valve peak velocity (AV-max), aortic valve velocity-time integral (AV-VTI), pulmonary valve peak velocity (PV-max), pulmonary valve velocity-time integral (PV-VTI) measured by pulse Doppler, the mitral annular tissue Doppler component during systole (MV-s′), mitral annular tissue Doppler component during early diastole (MV-e′), mitral annular tissue Doppler component during atrial contraction (MV-a′), tricuspid annular tissue Doppler component during systole (TV-s′), tricuspid annular tissue Doppler component during early diastole (TV-e′), tricuspid annular tissue Doppler component during atrial contraction (TV-a′), interventricular septum annular tissue Doppler component during systole (IVS-s′), interventricular septum annular tissue Doppler component during early diastole (IVS-e′), interventricular septum annular tissue Doppler component during atrial contraction (IVS-a′) measured by tissue Doppler, the normal values of left atrial volume (LAV), left ventricular end-systolic volume (LVEDV), stroke volume (SV) and cardiac output (CO) measured by bi-plane method and the normal values of LVEDV, SV and CO measured by real-time tri-plane method, together with the normal values of left ventricular (LV) mass, left ventricular mass index [LV mass/BSA, LV mass/H2.7, body surface area (BSA) and height (H)], all showed nonlinear positive correlations with body weight (all P<0.01). The values of MV-E/A, PV-E/A, MV-e′/a′, TV-e′/a′, IVS-e′/a′, MV-E/IVS-e′, LV mass/LVEDV and left ventricular ejection fraction (LVEF) showed no correlations with body weight (all P>0.05). Except for RV, MV-D1, MV-D2, MV-D3, TV-D1, TV-E, MV-s′, IVS-a′, TV-s′and TV-e′, all R2 obtained by nonlinear regression method (lnY=a+bX+cX2+dX3) were larger than those obtained by linear regression method (Y=a+bX). The Z score showed a normal distribution and no correlation with body weight. Conclusions The normal reference values of newborn undergoing echocardiography reflect the variation in weight. The Z scores can be obtained by the predicted nonlinear regression equations and show standard normal distribution. The echocardiography normal reference values have important significance for the diagnosis and treatment of neonatal heart disease.

ObjectiveTo evaluate the value of adenosine-stress myocardial perfusion imaging (MPI)in post-operation follow-up after the percutaneous coronary intervention(PCI) in the elderly.MethodsThere were patients (53 cases) underwent adenosine-stress MPI prior to and 6 months after PCI. Major adverse cardiovascular events (MACE) were followed. Left ventricular ejection fraction (LVEF) was analyzed in 40 cases. The image of the left ventricular myocardium was divided into 16 segments to calculate total defect score using a 4-grade assessment.Myocardial scintigrams were evaluated by calculating the summed adenosine-stress score and coronary angiography assessed by calculating the summed score of coronary artery stenosis.Results There was a significant correlation between the scores of coronary artery stenosis and adenosine-stress MPI scores (r=0.675,P＜0.01). Adenosine-stress MPI scores were obviously lower after PCI than before(2.2± 2.3 vs. 4.5±1.9,t= 7.348, P＜0.01); LVEF was significantly greater after PCI than pre-operation[(58.3±10.5 ) ％ vs. (53.8 ± 10.3) ％, t = 3.497, P＜0.01] and the effective rate for myocardial perfusion were 86.84 ％. Conclusions Adenosine stress MPI is a good noninvasive diagnostic method with high accuracy and plays an important role for evaluating recovery of myocardial perfusion and left ventricle function in the elderly patients after PCI.

Objective To investigate the protective effect and mechanism of pamidronate disodium on calcification in rat vascular smooth muscle cells (RVSMCs) induced by hyperphosphate.Methods RVSMCs were placed in various culture mediam, including normal phosphate medium (Pi 1.4 mmol/L), high phosphate medium (Pi 4.5 mmol/L), different pamidronate disodium concentrations medium (Pi 4.5 mmol/L+pamidronate disodium 10-5, 10-6, 10-7 mmol/L). Calcium content and cell protein content were quantified by the O-cresolphthalein complexone method and BCA protein assay respectively. Calcification was visualized by yon Kossa staining, and cbfα-1,osteocalcin were quantified by Western blotting. Results After culture for 3 days, calcium content in high phosphate group were much higher than that in control group, and pamidronate disodium groups had a lower calcium content compared with high phosphate group (all P＜0.05).Calcium deposit in RVSMCs was greater in high phosphate group, while pamidronate disodium groups revealed obviously decreased deposit (all P＜0.05). Protein expression of cbfα-1 and osteocalcin in pamidronate disodium groups was much lower than that in high phosphate group.Conclusion Pamidronate disodium can protect RVSMCs from phosphate-induced calcification in vitro, which may be associated with the blockage of transformation of RVSMCs into osteoblast.

Combining the functional metabolic imaging and anatomical imaging,PET-CT stands for the highest level of current nuclear medical imaging techniques,and has been applying increasingly in acupuncture studies.However,owning to complexity of the brain function and sensitivity of brain metabolism,the lower reproducibility of cerebral function imaging even may reverse many results.This has been provoked more and more attention by researchers.Its main cause is intimately related to poor experimental methodology.For this reason,the present paper raises the quality control of the research on mechanisms of acupuncture in the process of application of PET-CT techniques from 1) the included standards of participants,2) the preparation of participants during the scanning process of PET-CT,3) the setting of the scanning parameters,4) the used machine and the imaging reagent,5) the analysis of dada,6) the standardization of acupuncture manipulation,and 7) the designs of the acupuncture operation,needling opportunity and scanning opportunity,hoping to offer some beneficial information for the coming researches.