The aim of the study was to investigate surgical modalities and outcomes in patients with type A aortic dissection involving arch anomalies.Patients with type A aortic dissection who underwent surgical treatment at our center between January 2017 and 31 December 2020 were selected for this retrospective analysis. Data including computed tomography (CT), surgical records, and cardiopulmonary bypass records were analyzed. Perioperatively survived patients were followed up, and long-term mortality and aortic re-interventions were recorded.A total of 81 patients with arch anomalies were included, 35 with "bovine" anomalies, 23 with an aberrant right subclavian artery, 22 with an isolated left vertebral artery, and one with a right-sided arch + aberrant left subclavian artery. The strategies of arch management and cannulation differed according to the anatomic variation of the aortic arch. In total, seven patients (9%) died after surgery. Patients with "bovine" anomalies had a higher perioperative mortality rate (14%) and incidence of neurological complications (16%). Overall, four patients died during the follow-up period, with a 6-year survival rate of 94.6% (70/74). A total of four patients underwent aortic re-intervention during the follow-up period; before the re-intervention, three received the en bloc technique (13.6% 3/22) and one received hybrid therapy (11.1% 1/9).With complete preservation and reconstruction of the supra-arch vessels, patients with type A aortic dissection combining arch anomalies can achieve a favorable perioperative prognostic outcome. Patients who received the en bloc technique are more likely to require aortic re-intervention than patients who underwent total arch replacement with a four-branched graft vessel. Cannulation strategies should be tailored according to the variation of anatomy, but routine cannulation with the right axillary artery can still be performed in most patients with arch anomalies, even for patients with an aberrant right subclavian artery.
Abstract Background Adjuvant therapy for T3N0 rectal cancer was controversial with respect to both radiation and the use of a combined regimen of chemotherapy. We evaluated both clinical features and biomarkers and sought to determine risk factors for those patients retrospectively. Methods A total of 122 patients with T3N0 rectal cancer were analyzed in this study from January 2000 to December 2005. Clinicopathologic and biomarkers were used to predict local recurrence (LR), disease-free survival (DFS), and overall survival (OS). Results The median follow-up interval was 45.4 months. Five-year LR, DFS, and OS rates were 10.4%, 68.3%, and 88.7%. Having a lower tumor location and showing low P21 and high CD44v6 expression were identified as risk factors for LR: patients with two or three of these risk factors had a higher 5-year LR rate (19.3%) than did patients with none or one of these risk factors (6.8%) (p = 0.05). A poorer DFS was related to low P21 nor high CD44v6 expression but not to tumor location: the 5-year DFS rates were 79.3% for those with neither, 65.9% for those with either one or the other, and 16.9% for those with both (p = 0.00). Conclusions The prognostic model including tumor location, P21 and CD44v6 expressions could help to distinguish these patients with high risk T3N0 patients and determine whether adjuvant therapy was beneficial.
<p>Details on inclusion and exclusion criteria, and supplementary table showing the frequency of patients with discriminatory taxa in fecal samples.</p>
The present study was designed to develop an activable, dual‑targeted theranostic platform combining fluorescent and cytotoxic templates to provide a novel strategy for specific drug delivery and cellular imaging in ovarian cancer cells. Two compounds of a folic acid‑prodrug‑doxorubicin (Dox) scaffold were synthesized, and their antiproliferative activities were evaluated using 3‑(4,5‑dimethylthiazol‑2‑yl)‑2,5‑diphenyltetrazolium bromide and flow cytometric analysis. The process of drug release was investigated using fluorescence emission spectra assay and confocal laser scanning microscopy. The results showed that the synthesized compounds exhibited potent antitumor activities against ovarian cell lines. Among them, compound 1e exhibited the most potent activity demonstrating half maximal inhibitory concentration values of 0.85±0.10, 8.64±0.37 and 0.81±0.03 µM against A2780, A2780/Dox and A2780/cisplatin cell lines. The fluorescence imaging of live cell lines also provided an easy and reliable method to monitor site‑specific drug activities through turn‑on systems induced by drug release. The results of the present study may assist in the treatment of ovarian cancer cells with strengthened efficiency and real‑time imaging, which may be used as a multifunctional system for the optimization of anticancer drugs.
Objective
To explore the clinical efficacy and safety of Hydromorphone combined with Propofol therapy in painless gastroscopy combined with colonoscopy examination in elder patients.
Methods
Sixty-one patients aged 65-80 years underwent a painless gastroscopy combined with colonoscopy examination in the Affiliated Tumor Hospital of Zhengzhou University from June 2015 to January 2016.The patients were randomly divided into the Hydromorphone combined with Propofol group (Group H, n=31) and the Fentanyl combined with propofol group (Group F, n=30).
Results
The levels (H vs F group) of VAS at 5, 15, 30 min after anesthetic recovery were lower in H group than in F group〔(2.4±0.5) vs (3.4±0.6), (2.0±0.5) vs (3.2±0.6), (1.6±0.4) vs (2.6±0.7) respectively, (all P 0.05).
Conclusions
The clinical efficiency of hydromorphone combined with propofol used in painless gastroscopy combined colonoscopy examination is favourable and safe without increasing postoperative adverse reactions in elder patients.Hydromorphone combined with propofol is superior to fentanyl combined with propofol as a general intravenous anesthesia.
Key words:
Hydromorphone; Propofol; Gastroscopes; Colonoscopes; Sedation
Abstract Introduction: Hyperparathyroid crisis is a rare and potentially life-threatening complication of severe calcium intoxication. Parathyroidectomy is the only curative method for hyperparathyroid crisis. Several case reports and case series have been published on the medical and surgical treatments for hyperparathyroid crisis, however, few reports have focused on the associated perioperative anesthetic management. Patient concerns: A 48-year-old Chinese woman presented with a 2-week history of nausea and vomiting and complained of mental status alteration including confusion and agitation in the 24 hours prior to her admission. She denied any history of past illness. Laboratory tests showed severe hypercalcemia crisis with a serum calcium level of 5.21 mmol/L and a serum intact parathyroid hormone level of > 5000 pg/mL. Diagnosis: The diagnosis was hyperparathyroid crisis, acute kidney injury, acute liver injury, rhabdomyolysis, infection, and shock. Interventions: She underwent initial management with aggressive intravenous fluid resuscitation, loop diuretic treatment, vitamin D supplement, intravenous bisphosphonates, and calcitonin therapy. However, her condition worsened, and she was transferred to the operating theater for a parathyroidectomy under general anesthesia. She was under general anesthesia and monitored with electrocardiogram, pulse oxygen saturation, continuous arterial blood pressure, central venous pressure and nasopharyngeal temperature. Cardiac output and stroke volume variation were monitored from the FloTrac system. After liberal fluid rehydration, circulatory support, cooling treatment and calcium supplement after tumor removal, her unstable vital signs gradually improved. Outcomes: After meticulous anesthetic management by the anesthesiologist and complete tumor resection by the surgeon, she survived this fatal disease. The patients was discharged on postoperative day 37 without any sequelae. Lessons: Patients with hyperparathyroid crisis should undergo a thorough preoperative evaluation. Difficult airway, fluid depletion, multiple organ dysfunction, hypercoagulability, and concomitant diseases are the primary challenges in anesthetic management. After tumor removal, the serum calcium level should be monitored closely and calcium should be supplemented in a timely manner to prevent serious complications.
Objective To search the relative factors for occurence of the colon cancer.Metheds 269 cases in 1∶1 paired case control were studied.the data was input the computer and handled by EPI software and SAS software.Results History of intesttional disease,over intake of fish and eggs are correlative risk factors of colon cancer,ample intake of regetables is a correlative protection factor.Single factor analysis showed that abnormality of defecation,over cooking of regetable,psychological trauma,medication history of digestive duct are probably correlative with colon cancer.There is not or not strongly correlative between incidence of colon cancer and following factor:family history of cancer,smoking,consumption of alchohol,tea,fruits and milkproducts,over intake of fat and fried food.Concusions Reducing the occurrance of intestinal disease,intake less protein,and enough fresh vegetable can profit to prevent colon cancer.
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