ObjectiveTo investigate the main influence factors of microbubble-enhanced sono-thrombolysis by an orthogonal array experimental design (OAD) and to confirm the optimal parameters of microbubble-enhanced sono-thrombolysis in vitro. Methods The peripheral blood was collected from 50 female Sprague Dawley rats to prepare the standard plasma, and then 100 μL standard plasma and 25 μL thrombin (0.15 U/μL) were mixed and incubated in 37℃ water bath for 3, 6, 12, and 24 hours respectively to prepare corresponding standardized thrombus. The physical parameters for the designed experiments included transmit powers of ultrasound (factor A: 5%, 25%, 50%, and 100%), microbubble volume (factor B: 50, 100, 200, and 400 μL), urokinase (UK) concentration (factor C: 100, 200, 400, and 800 U/mL), and thrombolysis time (factor D: 10, 20, 30, and 40 minutes), respectively. Then an OAD based on four parameters and four levels [L16(45)] was employed to optimize the thrombolysis conditions. The ultrasound frequency was 1.82 MHz. HE staining and scanning electron microscope (SEM) were used to observe the clots before and after thrombolysis. The thrombolysis rate was measured. ResultsHE staining and SEM observation showed that the fibrin was dissolved after thrombolysis. According to the OAD, the optimal parameter combination was C4-D4-A1-B4, indicating UK concentration 800 U/mL, thrombolysis time 40 minutes, transmit power of ultrasound 5%, and microbubble volume 400 μL, respectively. The four factors above had significant influence on thrombolysis (P lt; 0.05), and UK concentration was the most significant. There were significant differences in thrombolysis between different thrombolysis time (P lt; 0.05). ConclusionUnder the condition of fixed ultrasound frequency, microbubble-enhanced sono-thrombolysis efficiency is better in lower transmit power of ultrasound, higher UK concentration, longer thrombolysis time, higher microbubble volume, and shorter thrombolysis time
ObjectiveTo assess the effect of short-axis and long-axis punctures of thyroid nodules on the diagnostic rate of ultrasound guided aspiration biopsy (US-FNAB). MethodsWe retrospectively analyzed the clinical data of 2 686 thyroid nodule patients who underwent US-FNAB between March 2011 and November 2014. The US-FNAB was performed by 5 beginners (571 each for Dr1-Dr4 and 402 for Dr5). Yields of US-FNAB were divided into two levels according to the classification standard of the Bethesda system:adequacy and inadequacy. Short-axis puncture technique was used by Dr2 and long-axis puncture was performed by the others. According to chronological sequence of thyroid nodules examined, we compared the inadequate diagnostic rate between Dr2 and the others for the first 200 cases and the last 200 cases, respectively. The inadequate diagnostic rate was compared among the 4 doctors who used long-axis punctures for the first 200 cases and the last 200 cases, respectively. ResultsThe inadequacy rate of US-FNAB for Dr2 was higher than that for Dr1, Dr3, Dr4 and Dr5 in the first 200 cases, with statistical significance (P=0.036,<0.001,=0.007 and <0.001, respectively). There was no significant difference in inadequate diagnostic rate among the 4 doctors who used long-axis punctures for the first 200 cases (P=0.033, 0.551, 0.011, 0.122, 0.672 and 0.050). The inadequacy rate of US-FNAB for Dr2 was higher than that for Dr5 and lower than that for Dr4 in the last 200 cases with statistical significance (P=0.027 and 0.003, respectively). The inadequacy rate of US-FNAB for Dr5 was lower than that for Dr3 (P=0.005) and Dr4 (P<0.001) among the 4 doctors who used long-axis punctures for the last 200 cases. ConclusionFor beginners, the inadequacy rate of short-axis puncture is higher than long-axis puncture. We suggest beginners learn long-axis puncture method. There is no significant difference in inadequate diagnostic rate among short-axis and long-axis punctures, when the number of operated cases reaches 200. At this point, the operator can choose either way to puncture according to the disease condition or personal interests.
ObjectiveTo explore the key points and difficulties of intraoperative frozen section diagnosis of pulmonary diseases. MethodsThe intraoperative frozen section and postoperative paraffin section results of pulmonary nodule patients in Beijing Chaoyang Hospital, Capital Medical University from January 2021 to January 2022 were collected. The main causes of misdiagnosis in frozen section diagnosis were analyzed, and the main points of diagnosis and differential diagnosis were summarized. ResultsAccording to the inclusion criteria, a total of 1 263 frozen section diagnosis results of 1 178 patients were included in the study, including 475 males and 703 females, with an average age of 58.7 (23-86) years. In 1 263 frozen section diagnosis results, the correct diagnosis rate was 95.65%, and the misdiagnosis rate was 4.35%. There were 55 misdiagnoses, including 18 (3.44%) invasive adenocarcinoma, 17 (5.82%) adenocarcinoma in situ, 7 (35.00%) mucinous adenocarcinoma, 4 (2.09%) minimally invasive adenocarcinoma, 3 (100.00%) IgG4 related diseases, 2 (66.67%) mucinous adenocarcinoma in situ, 1 (16.67%) atypical adenomatous hyperplasia, 1 (14.29%) sclerosing pulmonary cell tumor, 1 (33.33%) bronchiolar adenoma, and 1 (100.00%) papillary adenoma. ConclusionIntraoperative frozen section diagnosis still has its limitations. Clinicians need to make a comprehensive judgment based on imaging examination and clinical experience.
Objective To investigate the feasibility of establishing the visualization models of intraneural microvessels of sciatic nerves in Sprague Dawley (SD) rats by systemic infusion of Evan’s blue (EB) or lead oxide and to compare the advantages and disadvantages. Methods Fifteen healthy adult SD rats of either gender, weighing 200-250 g, were randomly divided into traditional group (group A, n=5), fluorescence group (group B, n=5), and radiography group (group C, n=5). Ink, EB, and lead oxide, all mixed with gelatin solution, were injected in groups A, B, and C, respectively. After 2 hours of cryopreservation under 4°C, all sciatic nerves were harvested and observed through stereomicroscope to make sure the filling condition. The two-dimentional (2D) images were then collected via reflexion fluorescent microscope in group B and via micro-CT scan in group C. All images were imported into computer to establish three-dimentional (3D) reconstruction models by Mimics 15.0. Results All groups could show the outline of intraneural microvessels of sciatic nerves under stereomicroscope. Diameters of them were measured under fluorescent microscope, ranging from 10 µm to 30 µm. Both groups B and C could establish 3D reconstruction models from 2D images. These models could clearly reproduce the structure of microvessels. Conclusion Both EB and lead oxide can be used to establish 3D reconstruction models to observe structure of the intraneural vessels. However, EB has some disadvantages, such as predisposition to infiltration, grainy 2D images and time-consuming procedure; it is not suitable for researches of large specimen. Though 2D pictures from lead oxide have lower resolution than EB, it is easier to be manipulated and appropriate for experiments of large specimen.
Objective To study the hemodynamic characteristics of concealed perforator flap in mini-pigs by ultrasonic Doppler technique. Methods Seven 7-month-old mini-pigs, weighing 20-25 kg, were included in the study. The saphenous artery perforator flap (group A, n=4), saphenous artery concealed perforator flap (group B, n=5), and saphenous artery concealed perforator flap combined with sarcolemma (group C, n=5) models were established randomly on both hind limbs of pigs. The pigs and flap survival conditions were observed after operation. The percentage of flap survival area was calculated by Photoshop CS5 software at 5 days after operation. Ultrasonic Doppler technique was performed on the flaps before operation and at immediate, 3 days, and 5 days after operation to record the hemodynamic changes of the flaps. The hemodynamic indicators of saphenous artery (inner diameter, peak systoli velocity, resistance index, and blood flow) and saphenous vein (inner diameter, maximum velocity, and blood flow) were recorded. Results At 1 day after operation, 1 pig died of infection, and the rest survived until the experiment was completed. Finally, the 3 flaps of group A, 4 of group B, and 5 of group C were included in the study. The flaps of the 3 groups all showed swelling after operation, which was most significant at 3 days. At 3 days after operation, the flaps in group B showed partial bruising and necrosis. At 5 days after operation, the flaps in groups A and C were basically alive, and the necrosis area of flap in group B increased further. The percentage of flap survival area in groups A, B, and C were 99.7%±0.5%, 74.8%±26.4%, and 100%, respectively. The percentage of flap was significantly lower in group B than in groups A and C (P<0.05). There was no significant difference between groups A and C (P>0.05). There were significant differences in the hemodynamic indicators of saphenous artery and vein between different time points in 3 groups (P<0.05). There was no significant difference in each indicator between groups at each time point (P>0.05). Conclusion Both the saphenous artery concealed perforator flap and the flap combined with sarcolemma have stable blood flow, but the survival area of the latter was better than the former.
Objective To summarize the application of double valve ring enlargement combined with mitral Chimney technique (Chimney Commando) in the secondary valve replacement and to analyze the efficacy in the near and medium term. Methods Patients who underwent the secondary aortic valve and mitral valve (double valve) replacement by Chimney Commando in Wuhan Asia Heart Hospital from 2019 to 2022 were included, and their clinical data were retrospectively collected to analyze the safety and feasibility of this procedure in secondary valve replacement of small aortic root patients. Results A total of 49 patients (44 females and 5 males) were included. The body surface area was 1.64±0.17 m2. The time from the first operation was 13.10±5.90 years. Except for 4 patients whose first operation was valvuloplasty, the remaining 45 patients were all patients after valve replacement, 41 patients of double valves replacement, including 39 patients with mechanical valve and 2 patients with biological valve. The majority of the aortic valves were St.Jude regent 19 mm or St.Jude regent 21 mm, accounting for 30.61% and 34.69%, respectively. The mitral valves were predominantly St.Jude 25 mm mechanical valves, making up 65.31%. All patients underwent Chimney Commando double valve ring enlargement, and the mean time of aortic occlusion was 154.00±45.40 min. The mean size of the aortic valve was 23.90±1.40 mm and that of the mitral valve was 28.20±1.20 mm, and the transvalvular pressure difference across the aortic valve was 20.16±5.76 mm Hg at 6 months postoperatively. There was one death during hospitalization due to multi-organ failure. The follow-up time ranged from 1 to 24 months with a median time of 8 months. Two patients were implanted with permanent pacemakers during the follow-up period and 1 patient died due to massive stroke and malignant arrhythmia. Conclusion Chimney Commando is safe and effective in patients with secondary double valve replacement, and the postoperative prosthetic valves have good hemodynamics, and can achieve good clinical results in the near and medium term.