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Objective: To analyze the early outcome of one-stage hybrid technique in the treatment of Stanford type-A aortic dissection involving the arch and compare its therapeutic efficacy with the classical frozen elephant trunk technique (FET). Methods: A total of 106 patients with Stanford type-A aortic dissection involving the arch in Department of Cardiac and Vascular Surgery, 1st Affiliated Hospital of Soochow University from October 2015 to October 2019 was collected. All patients in this group were treated with one-stage hybrid technique (modified arch debranching technique) without deep hypothermia circulation. Meanwhile, 30 patients with Stanford type A dissection involving the arch who underwent FET from January 2014 to September 2015 were collected. The therapeutic effects of the two surgical methods were analyzed and compared. Results: The age [ M ( Q 1 , Q 3 )] of 106 patients in hybrid group was 49.0 (40.0, 55.0) years, including 89 males and 17 females. The age [ M ( Q 1 , Q 3 )] of 30 patients in FET group was 49.5 (41.5, 65.3) years, including 24 males and 6 females. The time [ M ( Q 1 , Q 3 )] of using ventilator in hybrid group was 56.0 (38.0, 72.0) h, which was shorter than 127.0 (92.0, 145.0) h in FET group ( P <0.001). The incidence of cerebral infarction in hybrid group was 2.8% (3 cases), which was lower than 13.3% (4 cases) in FET group ( P =0.042); the incidence of postoperative renal insufficiency in hybrid group was 7.5% (8 cases), which was lower than 23.3% (7 cases) in FET group ( P =0.023); the ICU time [ M ( Q 1 , Q 3 )] in hybrid group was 8.0 (6.0, 10.0) d, which was shorter than 14.0 (8.3, 24.0) d in FET group ( P <0.001). Conclusion: Compared with FET, one-stage hybrid technology is safer and more effective in the treatment of Stanford type A aortic dissection involving the arch. Its short-term therapeutic efficacy appears good.

Objective: By retrospectively analyzing the clinical data of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with respiratory failure, to find the associated factors for failure of invasive-noninvasive sequential ventilation therapy. Methods: We conducted a cohort study of 64 patients with AECOPD complicated with respiratory failure, who were treated by invasive-noninvasive sequential ventilation. We took re-intubation, death or spontaneous discharge within 7 days following extubation as the endpoints. By comparing the APACHE Ⅱ score at admission into RICU, the ABCD grouping for COPD, the ratio of the diameter of the pulmonary artery to the diameter of the ascending aorta in chest CT(PA: A ratio), the levels of NT-proBNP, PaCO(2), PaO(2), the total number of leukocytes and the level of procalcitonin, we analyzed the differences between the success group(43 cases) and the failure group(21 cases). Results: The APACHE Ⅱ score at admission to RICU, the PA: A ratio, the level of NT-proBNP, the total leukocytes and the level of procalcitonin at admission to RICU showed significant differences in the univariate analysis( P <0.05). The average APACHE Ⅱ score was 23±4 in the success group and 27±6 in the failure group. The average PA: A ratio was 0.88±0.09 in the success group and 1.03±0.10 in the failure group. In the multivariate regression analysis, there were significant differences only in the APACHE Ⅱ score( P =0.02)and the PA: A ratio( P =0.012). The area under the ROC curve of the PA: A ratio for all patients was 0.894 and the cut-off value of the PA: A ratio was 0.98. Conclusion: The APACHE Ⅱ score and the PA: A ratio in CT are independent risk factors for failure of sequential ventilation in AECOPD patients complicated with respiratory failure. In particular, patients with a PA: A ratio greater than 0.98 have a higher risk of treatment failure.

Cryptococcal meningitis is a common and refractory central nervous system infection, with high rates of mortality and disability. The experts of the Society of Infectious Diseases of Chinese Medical Association have reached this consensus after a thorough discussion. Based on the current situation of cryptococcal meningitis in China, the management of cryptococcal meningitis includes 6 aspects: introduction, microorganism identification, clinical manifestations and diagnosis, principles of antifungal therapy, treatment of refractory and recurrent meningitis, treatment of intracranial hypertension. There is not a separate consensus on human immunodeficiency virus (HIV) infection in patients with cryptococcal meningitis. This article focuses on different antifungal regimens and reducing intracranial pressure by reference to Infectious Disease Society of America (IDSA) guidelines. The importance of early diagnosis, combined long-term antifungal therapy, control of intracranial hypertension are emphasized.

Objective: To study the in vitro activity of fosfomycin to extended-spectrum β-lactamases (ESBLs)-producing Escherichia coli and Klebsiella pneumoniae and to explore the mechanisms of fosfomycin resistance. Methods: A total of 1 052 ESBLs-producing E . coli (ESBL-EC) and K . pneumoniae (ESBL-KP) isolates were collected from bloodstream infections of 28 hospitals of 22 provinces and municipalities, which were stored by our laboratory.Minimum inhibitory concentrations (MICs) of fosfomycin against these clinical isolates were determined by agar dilution methods according to the Clinical and Laboratory Standards Institute (CLSI)(2015). The genes related to fosfomycin resistance were confirmed by Polymerase Chain Reaction (PCR) and sequencing. Results: The susceptibility rates of ESBL-EC and ESBL-KP isolates to fosfomycin were 91.3% (818/896) and 91.7% (143/156), respectively. A total of 91 fosfomycin-non-susceptible isolates were detected, of which 73 (80.2%) isolates carried fosA3 genes.Amongst 18 fosA3-negative isolates, 16 isolates were detected to have chromosomal mutations or insertion inactivation, while the rest two isolates had not been detected any resistant mechanisms. Conclusions: Fosfomycin shows great in vitro antimicrobial activity to ESBL-EC and ESBL-KP. The primary mechanism of fosfomycin-non-susceptible isolates is fosA3 gene.Chromosomal mutations may also involve in the fosfomycin resistance.

Objective: To observe the antibacterial activity of moxalactam against Enterobacteriaceae bacteria and anaerobic bacteria in vitro, and to compare with other antibacterial drugs, for providing experimental basis for the clinical application of moxalactam., Methods: Minimum inhibitory concentrations (MICs) of moxalactam and other antibacterial agents against 491 Enterobacteriaceae spp. and anaerobic spp.collecting from clinical settings were determined by agar dilution methods and E-test strips according to the Clinical and Laboratory Standards Institute (CLSI)(2014)., Results: Moxalactam showed great antibacterial activity to Enterobacteriaceae spp., including ESBLs-producing Escherichia coli, Klebsiella pneumoniae, and Proteus spp., with the MIC(50), MIC(90), and susceptibility rates of 0.25-4 mg/L, 0.5-8 mg/L, and >90%, respectively. The susceptibility rates of Enterobacteriaceae with ESBLs-producing or non-ESBLs-producing to imipenem and meropenem were both higher than 90%. The susceptibility rates of ESBLs-producing Escherichia coli, Klebsiella pneumoniae, and Proteus spp.to piperacillin/tazobactam and cefoperazone/sulbactam were 90%, 68%, 53% and 76%, 66%, 76.6%, respectively, while the susceptibility rates of non-ESBLs-producing Escherichia coli, Klebsiella pneumoniae, and Proteus spp.were all more than 95%. The susceptibility rates of Enterobacter spp. and other Enterobacter to piperacillin/tazobactam were 80%, 80%and that to cefoperazone/sulbactam were 80%, 76.7%, respectively.The MICs range of moxalactam on anaerobic spp.was from ≤0.064 to >256 mg/L, while MIC(50) was 2 mg/L and MIC(90) was 64 mg/L., Conclusions: Moxalactam showed well activity against ESBLs-producing and non-ESBLs-producing Enterobacteriaceae and anaerobia.

The mtDNA hypervariable segment I sequences (HVS I) were sequenced in 64 Shuis from Guizhou Province. 73 sites were polymorphic in the 495 bp fragment that sequenced, identified 48 different haplotypes. Phylogenetic analysis of the haplotypes suggested that there were some ancestral haplotypes in current Shuis, and these haplotypes were also present in Eurasia populations as well as in other ethnic groups. Demographic analysis of the Shuis demonstrated a unimodal distribution that is typical for a population undergone expansion in the past and with a high Tau value, which suggested that the Shui group might be a ancestral population. Combined with the analysis of the reported data, the Shui ethnic group showed a generally similar genetic component with the Zhuang from Guangxi, but it is also different from these typical south populations as Zhuang, Cantonese.

Objective: The purpose of this study was to find the best material for valvular wrapping operation of deep vein of lower limb and to study the diagnostic value of colored Ultrasonic-Doppler for valvular incompetency of the deep vein and the function of the popliteal valve., Methods: Strips of autogenous saphenous vein, autogenous fascia lata and pieces of polytetrafluroethylene artificial vessel were used respectively as the wrapping material for narrowing the valve in 30 dogs. The results of three different wrapping material were obtained by colored Ultrasonic-Doppler and transpopliteal venography in 78 patients. The hemokinetics of the popliteal valve was examined in 20 normal persons., Results: In the saphenous vein and fascia lata groups, diffuse fibrosis and marked narrowing of the femoral vein were found, while in the group of artificial vein graft, the graft was intact without prominent fibrosis and narrowing of the vein. In comparing with the result of venography, the accuracy of diagnosis by colored Ultrasonic-Doppler was 91.86%. The femoral and popliteal venous valves closed at the same time when holding the breath, but the popliteal venous valve opened more widely than the femoral venous valve when the calf muscles of the leg contracted., Conclusion: It was suggested that the graft was the best material for valvular wrapping operation, and colored Ultrasonic-Doppler was an important and non-invasive method for the diagnosis of incompetency of deep vein. The popliteal venous valve was the important barrier for protection of the function of deep vein.

Since 1983, we have used free dorsal pedal flaps with m. extensor hallucis brevis for two patients with serious thenar defects to restore their thumb function. The results were satisfactory, as most of oponens function was restored, however the power of the thumbs was inadequate. Functional restoration of the thumb after the loss of thenar muscles involves many aspects of microsurgery. This article discusses only the dissection of the muscle, the orientation of transferred muscle, etc.