简介：AbstractPapillary thyroid carcinoma (PTC) has a high propensity for regional metastases, however, the impact of such metastases on the outcome of the patients is minimal. The central compartment of the neck is considered the first and the most common echelon of metastases from thyroid carcinoma. Physical examination along with ultrasonography are the gold standard pre-operative evaluation of patients with PTC. Ultrasonography is highly sensitive in evaluating lateral neck nodes, however, its value in evaluating the central compartment is limited, resulting in a relatively high rate of occult metastases in this compartment. The main potential complications of para-tracheal neck dissection (PTND) are recurrent laryngeal nerve paralysis and hypocalcemia and these may be higher in patients undergoing PTND compared to thyroidectomy alone. New histological data is available showing no evidence of lymph nodes in the central compartment above a level parallel to the inferior border of the cricoid cartilage. These findings support withholding dissection of the upper para-tracheal region routinely as a part of PTND in patients with well-differentiated thyroid cancer. By doing that, the complications may be lower and identical to thyroidectomy alone, thus may abolish arguments against more common use of elective PTND in patients with thyroid carcinoma.

简介：Iatrogenicaortocoronarydissection(IACD)isararebutpotentiallylife-threateningcomplicationduringcoronarycatheterizations.Althoughtheincidencewasrelativelylow,thedissectionoftenleadstoprocedurefailurewithincreasedriskofmyocardialinfarctionanddeath.IACDismainlycausedbydisruptionofintimaattheostiaofleftorrightcoronaryarteryduringinterventionalprocedures,andappearsasluminalfillingdefectsorpersistenceofcontrast(“extraluminalcap”)orintimaltearoutsidethecoronarylumen.Dissectioncoulddisseminateantegradelyandleadtosubtotalortotalocclusionofthecoronarylumen.Similarly,itcouldextendretrogradelyintothesinusofValsalvaandcusp,oreventheascendingaorta,aorticarch,ordescendingaorta,leadingtohemodynamiccollapse.EarlyidentificationandpromptmanagementiscrucialtotheprognosisofpatientswithIACD.Immediatebail-outstentingshouldbeperformedasrapidlyaspossibleinmostcasesofseveredissection,evenwhensignificantpropagationhasalreadyoccurred.Surgeryshouldonlybeconsideredwhenstentingfailedtosealthedissectionandthepatientshadhemodynamiccompromise.

简介：AbstractBackground:Acute type A aortic dissection (ATAAD) and acute type A intramural hematoma (ATAIMH) are life-threatening diseases with high mortality. To better understand their clinical features in the Chinese population, we analyzed the data from the first Registry of Aortic Dissection in China (Sino-RAD) to promote the understanding and management of the diseases.Methods:All patients with ATAAD and ATAIMH enrolled in Sino-RAD from January 1, 2012 to December 31, 2016 were involved. The data of patients’ selection, history, symptoms, management, outcomes, and postoperation complications were analyzed in the study. The continuous variables were compared using the Student’s t test for normal distributions and the Mann-Whitney U test for non-normal distributions. Categorical variables were compared using the Chi-square test or Fisher exact test.Results:A total of 1582 patients with ATAAD and 130 patients with ATAIMH were included. The mean age of all patients was 48.4 years. Patients with ATAAD were significantly younger than patients with ATAIMH (48.9 years vs. 55.6 years, P < 0.001). For the total cohort, males were dominant, but the male ratio of patients with ATAAD was significantly higher compared to those with ATAIMH (P = 0.01). The time range from the onset of symptom to hospitalization was 2.0 days. More patients of ATAIMH had hypertension than that of ATAAD (82.3% vs. 67.6%, P < 0.05). Chest and back pain were the most common clinical symptoms. Computerized tomography (CT) was the most common initial diagnostic imaging modality. 84.7% received surgical treatment and in-hospital mortality was 5.3%. Patients with ATAAD mainly received surgical treatment (89.6%), while most patients with ATAIMH received medical treatment (39.2%) or endovascular repair (35.4%).Conclusions:Our study suggests that doctors should comprehensively use clinical examination and genetic background screening for patients with ATAAD and ATAIMH and further shorten the time range from symptoms onset to intervention, achieving early diagnosis and treatment, thereby reducing the mortality rate of patients with aortic dissection in China. We should standardize the procedures of aortic dissection treatment and improve people’s understanding. Meanwhile, the curing and transferring efficiency should also be improved.

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简介：BackgroundVocalcordmovementdisorder(VCMD)isalaryngealdisordercharacterizedbyparadoxicaladductionofthevocalcordsduringininspiration,expirationorboth.ThenursingexperienceofpatientswithVCMDafteraorticdissectionsurgeryislimited.MethodsWeretrospectivelyanalyzedtheclinicaldataandnursingrecordsof269patientsafteraorticdissectionsurgeryinGuangdongGeneralHospitalbetweenMay2010andMay2012.Weobservedthepatients’pronunciation,andjudgediftherewasdysphagiaundergoingwaterdrinkingtesttwohoursafterextubation,toconfirmwhetherpatientshadVCMD.ResultsSeventeenpatientshadVCMDafteraorticdissectionsurgery,ofwhom2sufferedhoarseness,3haddysphasiaand12hadbothhoarsenessanddysphasia.Aftertimelytreatmentandcarefullynursing,allthepatientsrecoveredwell.ConclusionsWiththeenhancedcareofpatientswithaorticdissection,observinghoarsenessappearanceanddrinkingexperimentimmediatelyafterextubationcandetectVCMDassoonaspossible.Furtherrehabilitationtrainingandpsychologycarecanpreventbuckingandaspirationeffectively,andpromotingrecoveryandimprovingpatient’slifequality.

简介：Giventhehighincidenceofcervicallymphnodemetastasisindifferentiatedthyroidcancer(DTC)andtherapidlyincreasedimportanceofneckdissectioninDTC,thejournalofGlandSurgeryislaunchingaspecialissueon'NeckDissectioninDifferentiatedThyroidCarcinoma'inNovemberIssueof2013,

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简介：为在米饭的壳硅内容的QTLqHUS6以前位于米饭染色体6的短手臂。由使用在在一个isogenic背景怀有qHUS6的RM587RM19784区域分离的一张F2:3人口，为壳硅内容的二QTL被检测，哪个qHUS6-1在对着丝点近似的区域位于远侧的区域和qHUS6-2。在目标区域带小异质接合的片断的三米饭植物被选择，哪个二盖住qHUS6-1区域，其它盖住qHUS6-2区域。三张F2:3人口分别地从三植物的selfed种子被导出。印射的QTL用在qHUS6-1区域分离的二张人口被执行，并且qHUS6-1被标记RM510和RM19417限定到147.0-kb区域flanked。有在qHUS6-2区域的不同genotypic作文的五组F3线从另外的F2:3人口被选择。二QTL用双向ANOVA，qHUS6-2a位于RM19706RM19795和qHUS6-2b在间隔RM314RM19665定义的间隔被分开。

简介：BackgroundPatientswithacutetypeAaorticdissectionhaveahighincidenceofpostoperativecerebralcomplication.Betterunderstandingoftheriskfactorscouldhelptooptimizepreventionandtreatmentstrategies.MethodAtotalof298patientsofacutetypeAaorticdissectionoperatedinGuangdongCardiacInstitutionfrom2010.10to2014.12wereincluded,253ofthemweremaleandtheother45werefemale.Theiraverageagewas45.8±12.2y.Allthepatientsweredividedintocerebralcomplicationandnocerebralcomplicationgroups.Datacollectedfrombothgroupswereanalyzedbyunivariateandmultivariateanalysestoidentifytheindependentriskfactorsofpostoperativecerebralcomplication.ResultTheincidenceofpostoperativecerebralcomplicationwas37.9%(113/298).Among113patients,temporarynervedamage(TND)groupandpermanentnervedamage(PND)accountedfor93cases(31.2%)and20cases(6.7%)respectively.LogisticRegressmultivariateanalysisshowedthathistoryofhypertension(OR=2.560,95%CI,1.397-4.692,P<0.01),totalarchreplacement(OR=2.315,95%CI,1.386-3.869,P<0.01),timeofaorticarrest(OR=1.008,95%CI,1.004-1.012,P<0.01)andpostoperativehypoxemia(OR=1.858,95%CI,1.122-3.078,P<0.05)weretheindependentriskfactorsofthepostoperativecerebralcomplicationinpatientswithacutetypeAaorticdissection.ConclusionIncidenceofpostoperativecerebralcomplicationishighintheacutetypeAaorticdissectionpatientsitsmajorriskfactorsarehypertensionhistory,totalarchreplacement,andlongdurationofaorticarrestorhypoxemia.

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简介：这研究的目的是为把用不同技术比较修改Nesbit过程的结果神经与血管的捆(NVB)到正确腹的先天的阴茎弯曲(CPC)。捆在21用中间、侧面的解剖技术被动员(组1)并且13(组2)病人分别地。在中间的技术，uck's扁带在阴茎的背面的方面被打开，深背面的静脉在弯曲的最突出的地点被移开，钻石形的tunicaalbuginea(TA)从阴茎的中线被切除。在侧面的技术，捆在5和7o’在尿道上面用uck's扁带的一个纵的侧面的切口被动员；经由一条双边的途径的钟位置。弯曲的本地化和度用联合intracavernous注射刺激测试或从patients’被评估；相片。弯曲的吝啬的耐心的年龄和度在组之间是类似的。吝啬的操作时间为组2是更长的(P=0.01)。在组1，九个病人(42.8%)要求了一钻石切除，(47.6%)10要求了二钻石切除，(9.5%)二要求了超过二切除；在组2，六个病人(46.2%)要求二钻石切除和七个病人(53.8%)要求了超过二钻石切除(P=0.019)。在阴茎弄短的差别，阴茎弄直和龟头的麻木不是统计上重要的。为修改Nesbit过程的捆的中间的解剖减少TA的钻石形的移动的数字并且因此弄短与它的侧面的对应物比较的操作时间。

简介：AbstractBackground:With the wide application of endoscopic submucosal dissection (ESD) for early gastric neoplasms, metachronous gastric neoplasms (MGN) have gradually become a concern. This study aimed to analyze the characteristics of MGN and evaluate the treatment and follow-up outcomes of MGN patients.Methods:A total of 814 patients were retrospectively enrolled. All these patients were treated by ESD for early gastric cancer or gastric dysplasia between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General Hospital. The risk factors for MGN were analyzed using Cox hazard proportional model. Moreover, the cumulative incidence, the correlation of initial lesions and MGN lesions, and the treatment and follow-up outcomes of MGN patients were analyzed.Results:A total of 4.5% (37/814) of patients had MGN after curative ESD. The 3-, 5-, and 7-year cumulative incidences of MGN were 3.5%, 5.1%, and 6.9%, respectively, and ultimately reaching a plateau of 11.3% at 99 months after ESD. There was no significant correlation between initial lesions and MGN lesions in terms of gross type (P = 0.178), location (long axis: P = 0.470; short axis: P = 0.125), and histological type (P = 0.832). Cox multivariable analysis found that initial multiplicity was the only independent risk factor of MGN (hazard ratio: 4.3, 95% confidence interval: 2.0-9.4, P < 0.001). Seventy-three percent of patients with MGN were treated by endoscopic resection. During follow-up, two patients with MGN died of gastric cancer with lymph node metastasis. The disease-specific survival rate was significantly lower in patients with MGN than that in patients without MGN (94.6% vs. 99.6%, P = 0.006).Conclusions:The MGN rate gradually increased with follow-up time within 99 months after curative gastric ESD. Thus, regular and long-term surveillance endoscopy may be helpful, especially for patients with initial multiple neoplasms.

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简介：AbstractBackground:Endoscopic resection bleeding (ERB) classification was proposed by the authors’ team to evaluate the severity of intraoperative bleeding (IB) during endoscopic submucosal dissection (ESD). This study aimed to evaluate the application of ERB classification and to analyze the risk factors of major IB (MIB) and postoperative bleeding (PB) associated with ESD for gastric neoplastic lesions.Methods:We retrospectively enrolled a total of 1334 patients who underwent ESD between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General Hospital. All patients were divided into the non-MIB group (including ERB-0, ERB-controlled 1 [ERB-c1], and ERB-c2) and the MIB group (including ERB-c3 and ERB-uncontrolled [ERB-unc]) according to the ERB classification. Risk factors of major MIB and risk factors of PB were analyzed using a logistic regression model.Results:Among the 1334 patients, 773 (57.95%) had ERB-0, 477 (35.76%) had ERB-c1, 77 (5.77%) had ERB-c2, 7 (0.52%) had ERB-c3, and no patients had ERB-unc. The rate of PB in patients with IB classifications of ERB-0, ERB-c1, ERB-c2, and ERB-c3 were 2.20% (17/773), 3.35% (16/477), 9.09% (7/77), and 2/7, respectively. In multivariate analysis, proximal location (odds ratio [OR]: 1.488; 95% confidence interval [CI]: 1.045-3.645; P = 0.047) was the only significant risk factor of MIB. Chronic kidney disease (CKD) (OR: 7.844; 95% CI: 1.637-37.583; P = 0.010) and MIB (ERB-c3) (OR: 13.932; 95% CI: 2.585-74.794; P = 0.002) were independent risk factors of PB.Conclusions:Proximal location of lesions was a significant risk factor of MIB. Additionally, CKD and MIB (ERB-c3) were independent risk factors of PB. More attention should be paid to these high-risk patients for MIB and PB.

简介：AbstractBackground:Acute mural dissection of the anterior wall of the internal carotid artery which may contribute to the development of blood blister-like aneurysms (BBLAs) was postulated, and stenting or flow diversion treatment across the soi-disant aneurysm was reported in this study.Methods:From December 2016 to December 2018, 8 patients presenting with subarachnoid hemorrhage (SAH) due to BBLA were subjected to endovascular treatment with stent-assisted coiling. Clinical outcomes were evaluated using a clinical outcome score scale.Results:Based on angiograms, pathologic change involving the supraclinoid segments of the internal carotid artery (ICA) adjacent to BBLA was found in all patients. This pathologic change meant a focal dissection of the supraclinoid segment of the ICA which constituted the pathogenesis of BBLAs. Closed-cell, open-cell, and braided stents were used in 1, 1, and 6 patients, respectively. Complete obliteration was achieved following endovascular treatment among all 8 patients harboring BBLA. One re-bleeding successive to a closed-cell stent across the aneurysmal neck was observed. Follow-up angiograms revealed stable complete exclusion of all BBLAs from the parent vessel at 3 to 8 months. All patients had a favorable clinical outcome score of 0-1.Conclusions:Acute dissection of a focal point of the intracranial vessels underlies the development of BBLAs. Open-cell and braided-cell stent-assisted coiling may constitute appropriate treatment due to good apposition against the vascular walls. Adjunctive coils may facilitate immediate complete occlusion of BBLAs.

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