目的 探讨经腹部彩色多普勒超声（腹部超声）联合高频超声诊断良性胆囊息肉样病变的价值。 方法 回顾性分析2008年1月－2011年11月121例腹部超声联合高频超声检查提示为良性胆囊息肉样病变、且有手术病理检查结果的患者资料进行对照，以此评价经腹部超声联合高频超声对良性胆囊息肉样病变的诊断准确性。 结果 121例术前经腹部超声联合高频超声诊断为良性胆囊息肉样病变的患者，手术后病理检查结果示胆固醇息肉62例（51.24%），炎性息肉27例（22.31%），腺瘤6例（4.96%），腺癌3例（2.48%），胆囊结石14例（11.57%），腺肌症3例（2.48%），囊壁腺体结构紊乱3例（2.48%），黏膜下层软结节3例（2.48%）。经腹部超声联合高频超声与手术后病理对比检查，其诊断符合率为78.51%（95/121），误诊率为21.49%（26/121）。 结论 经腹部超声联合高频超声检查对良性胆囊息肉样病变诊断准确性较高，可为临床预防胆囊癌前病变提供依据。Objective To investigate the value of abdominal color Doppler ultrasonography (CDU) combined with high-frequency ultrasonography (HFU) diagnosing benign polypoid lesion of gallbladder (B-PLG). Methods A total of 121 patients with B-PLG diagnosed by CDU combined with HFU between January 2008 and November 2011 were randomly selected. All of the patients underwent the surgery and had the record of surgical pathological examination results, which were compared with the results of the ultrasonography in order to evaluate the diagnostic accuracy of CDU combined with HFU for B-PLG. Results In 121 patients with B-PLG diagnosed by CDU combined with HFU before the surgery, cholesterol polyp was found in 62 (51.24%), infective polyp was found in 27 (22.31%), adenoma was found in 6 (4.96%), adenocarcinoma was found in 3 (2.48%), gallstones was found in 14 (11.57%), adenomyosis was found in 3 (2.48%), the wall structure gland disorder was found in 3 (2.48%), and submucosal soft nodules was found in 3 (2.48%) after the surgical pathological examination. Coincidence rate between CDU combined with HFU diagnosis and surgical pathological diagnosiswas 78.51% (95/121), and the misdiagnosis rate of CDU combined with HFU was 21.49% (26/121). Conclusion The accuracy of CDU combined with HFU diagnosing B-PLG is high, which can help to prevent precancerous lesion of gallbladder cancer.
ObjectivesTo compare the clinical features and the effects on cognition, emotion, and prognosis of antiepileptic drugs (AEDs) between occipital lobe epilepsy (OLE) and temporal lobe epilepsy (TLE).MethodsWe collected the clinical data of the patients with OLE and TLE from the Department of Neurology, the First Hospital of Jilin University from January 2016 to May 2018. We measured the patients with Mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), digital span, Auditory verbal memory test (AVMT), Generalized anxiety disorder (GAD-7), Patient health questionnaire-9 (PHQ-9) and Chinese version of the Neurological Disorders Depression Inventory for Epilepsy (c-NDDI-E) and followed up for 1 year.Results① After 1 year’s follow-up, the frequency of the two groups decreased compared with the first visit (Z=3.734, P=0.000) and the extent was similar (Z=−0.290, P=0.772). In group OLE, occipital aura was 45.9% (17 cases) and temporal aura was 37.8% (14 cases). In TLE group, temporal aura was 49.3% (33 cases) and occipital aura 7.5% (5 cases). In OLE group, post-seizure headache was found in 17 cases (45.9%), which was more than the 15 cases (22.4%) in TLE group (χ2=6.210, P=0.013). ② 30 cases (81.1%) in OLE group interictal discharge involved lobes outside occipitotemporal lobe, 4 of which had a wide-lead-involved discharge, and 19 cases (28.4%) in TLE group involved lobes outside temporal lobe, and there was a significant difference between the two groups (χ2=26.592, P=0.000). ③ There was no significant difference in the score of MOCA and AVMT in the group of OLE-A and OLE-B, either the group of TLE-A and TLE-B. The score of AVMT in group OLE-A was higher than that in group TLE-A (t=3.193, P=0.002), and that in group OLE-B was higher than that in group TLE-B (t=2.264, P=0.029). There was no significant difference in GAD-7, PHQ-9, and c-NDDI-E (P>0.05). After follow-up for 1 year, the scores were compared with its initial scales. The score of GAD-7 (Z=−2.561, P=0.010), PHQ-9 (Z=−2.053, P=0.040) and c-NDDI-E (Z=−2.493, P=0.013) all decreased. The score of GAD-7 (r=0.281, P=0.021) and c-NDDI-E (r=0.456, P=0.000) have a positive correlation with the frequency of seizure. Therapeutic effect: In OLE group, the efficiency of carbamazepine or oxcarbazepine group was 58.82% and of levetiracetam group was 83.33%. in TLE group, the efficiency of carbamazepine or oxcarbazepine was 72.50% and of levetiracetam group was 70.00%. There was no significant difference between group OLE and group TLE in the curative effect of carbamazepine or oxcarbazepine group (χ2=1.033, P=0.310) or levetiracetam group (χ2=0.356, P=0.551). After 1 year’s follow-up, the frequency of OLE group was 0.00 (0.000, 2.750) times per month, and the TLE group was 0.00 (0.000, 1.500) times per month. There was no significant difference between the two groups (Z=−0.226, P=0.822). At the follow-up, the frequency of seizure in the two groups was lower than that at the first visit (P=0.000). The frequency of seizure in TLE group was similar to that in OLE group (=−0.648, P=0.517). After 1 year, 5 patients (13.51%) in OLE group were newly diagnosed as refractory epilepsy and 6 patients (9.00%) in TLE group There was no significant difference in the rate of the newly diagnosed refractory epilepsy between the two groups (2=0.524, P=0.469).ConclusionOccipital aura and post-seizure headache are specific to OLE, which can be used as one of the basis for diagnosis of OLE. Epileptiform discharge in OLE is more likely to spread out in multiple cerebral lobes, while epileptiform discharge in TLE is confined to temporal lobe and the area near it. The cognitive impairment in OLE or TLE is not related to the duration of the disease. The degree of depression is positively correlated with the frequency of seizure. The responses to AEDs of OLE and TLE are similar.
Abstract: Objective To study the impact of different kinds of mechanical circulation support devices on plasma free hemoglobin(FHb). Methods From Mar. 2004 to Dec. 2005, 20 patients received mechanical circulation support in Fu Wai Hospital, who were divided into 4 groups according to the different type of supporting devices. 9 got extracorporeal membrane oxygenation (ECMO) treatment, 8 received BVS5000 left ventricular support, 2 got MEDOS left ventricular support and 1 received AB5000 left ventricular support. Random control group included 9 cardiotomy patients after CPB supporting and 9 patients with offpump coronary artery bypass grafting during the same period. Parameters such as FHb, Tbil, Dbil, Cr and BUN were monitored throughout the supporting term. The results were compared according to the different types of mechanical circulation support devices. Results The elevation of FHb caused by CPB could be decreased to normal within 1d. However, in BVS5000 group, the elevated FHb level decreased to normal till 2 days later. The others mechanical circulation support devices such as ECMO, MEDOS, AB5000 elevated the FHb throughout the whole supporting period. Compared with those in ECMO group, the patients in BVS5000 group had obviously lower level of FHb since the third day after the beginning of supporting. In patients who got ECMO treatment, there was a trend that the elevation degree of FHb was lower in those with support flow rate less than 2.5 L/min. For most patients got devices support, there was also an elevation of Tbil and BUN level during the supporting period. Conclusion Mechanical circulation support devices, such as ECMO, BVS5000, MEDOS and AB5000, can cause red cell destruction in acceptable level. BVS5000 has much smaller impact on cell destruction than others do in postoperative patients.
OBJECTIVE: To study the gap junction and phenotype of cultured chondrocyte of rabbit, and the gap junction between the chondrocytes in the same cartilage cavities in human femoral head articular cartilage. METHODS: CFDA-AM was added into the medium of the fifth passage of chondrocyte of rabbit in the 96-well plate. The fluorescent in spherical and fibroblast-like chondrocytes was detected separately. The recurrence of the fluorescent in accordant with time in 16 minutes was recorded after blanching the fluorescent with laser. And the fluorescent after blanching of chondrocyte in the cartilage cavities in the proliferative zone of articular cartilage of adult human femoral head was recorded, too. RESULTS: The average fluorescent of the single layer of the fibroblast-like chondrocyte was 83(ranged from 1 to 274), the highest was found in the spherical shaped cell (averaged 2,057, ranged from 340 to 3,538). The recurrence of the fluorescent after the blanching appeared only in the spherical chondrocyte, the gap junctions reappeared only in the spherical chondrocytes, as well as in the cells in the cartilage cavities in the articular cartilage of the human femoral head. CONCLUSION: The appearance of the gap junction is corresponded with the spherical shape, secretion of the cartilage matrix of the chondrocyte. There are gap junctions in the cells in the same cartilage cavities in the articular cartilage of the human femoral head, while no gap junctions in the isolated chondrocytes in the cartilage.
ObjectiveTo compare the effect on adjacent segment degeneration after cervical disc arthroplasty (CDA) and anterior cervical decompression and fusion (ACDF) for treatment of cervical spondylosis. MethodsBetween August 2009 and February 2012, 60 cases of single segmental cervical spondylosis accorded with the inclusion criteria were included. Of 60 patients, 28 patients underwent CDA (CDA group) and 32 patients underwent ACDF (ACDF group). There was no significant difference in gender, age, disease duration, pathological type, pathological segment, the time of conservation treatment, preoperative neck disability index (NDI), preoperative Japanese Orthopaedic Association (JOA) score, and degeneration of the adjacent segment and disc between 2 groups (P > 0.05). The NDI and JOA score were used to evaluate effectiveness. The range of motion (ROM) of adjacent segment was measured, and degeneration of the adjacent segment and disc was evaluated according to Kellgren grading system based on X-ray and Miyazaki grading system based on T2-weighted MRI, respectively. ResultsThe follow-up time was 24-50 months (mean, 34 months) in 2 groups. All patients had no complication of prosthesis loosening, dislocation, or fracture of plate. The NDI and JOA scores from 12 months after operation were significantly improved compared with preoperative scores in 2 groups (P < 0.05), but no significant difference was found at each time point between 2 groups (P > 0.05). The improvement rate of JOA was 80.68%±4.01% in ACDF group and was 79.44%±3.76% in CDA group at last follow-up, showing no significant difference (t=1.237, P=0.221). And the improvement rate of JOA in 2 groups were excellent. There was no significant difference in ROM and degeneration grading of adjacent segments between at last follow-up and at pre-operation in 2 groups (P > 0.05), and between 2 groups at pre-operation and at last follow-up (P > 0.05). The degeneration grading of disc at last follow-up showed significant difference in 2 groups compared with preoperative ones (P < 0.05), but no significant difference was found between 2 groups (Z=0.132, P=0.895). ConclusionBoth CDA and ACDF can achieve good effectiveness in treating cervical spondylosis, but CDA can not significantly slow down the degeneration of adjacent segment disc.
ObjectiveTo investigate the role of transforming growth factor β1(TGF-β1) and connective tissue growth factor (CTGF) in pathogenesis and progression of human intervertebral disc degeneration by detecting the expressions of these two factors in different degrees of degenerative discs. MethodsThe lumbar intervertebral discs were collected from 33 patients with lumbar disc herniation and 12 patients with lumbar vertebral fracture between November 2012 and April 2013.All samples were observed under the microscope after HE staining,and then were divided into different subgroups according to the degenerative degree.The expressions of TGF-β1 and CTGF were detected by Western blot. ResultsAccording to the pathological features,10 discs were defined as normal discs,10 as mild degenerative discs,9 as moderate degenerative discs,and 16 as severe degenerative discs.The histological observation showed that rounded nucleus pulposus cells with similar size evenly distributed in the cartilage-like matrix,and no hyperplastic collagenous fiber was seen in normal discs;mild degenerative discs characterized by slightly larger nucleus pulposus cells in the matrix,but cells did not decrease,a small quantity of inflammatory cells infiltrated in the matrix,hyperplasia of collagenous fiber was not seen;most of the nucleus pulposus cells became bigger,some showed a bulb form,the number of nucleus pulposus cells was significantly reduced,low grade hyperplasia of collagenous fiber emerged in the matrix,new vessels and inflammatory cells were both found in some specific areas of discs in moderate degenerative discs;there was no nucleus pulposus cells in the matrix of severe degenerative discs,the hyperplasia of collagenous fiber was obvious.The relative expression of TGF-β1 in 3 degeneration discs was significantly higher than that in normal discs (P<0.05),and the expression of TGF-β1 was significantly higher in severe degenerative discs than in moderate and mild degenerative discs (P<0.05),but no significant difference between moderate and mild degenerative discs (P>0.05).The relative expression of CTGF in moderate and severe degeneration discs was significantly higher than that in normal discs (P<0.05);and the expression of CTGF in mild degenerative discs was higher than that in normal discs,but there was no significant difference (P>0.05);and significant difference in CTGF expression was found among 3 degeneration discs (P<0.05). ConclusionThe expressions of TGF-β1 and CTGF are closely related to the degree of human lumbar disc degeneration,these two factors may play an important role in promoting lumbar intervertebral disc degeneration.
Objective To summarize the updates of diagnosis and differential diagnosis for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) for providing evidences for early diagnosis and treatment of PVTT patients. Methods The related literatures on diagnosis and differential diagnosis for HCC with PVTT in recent years were collected and reviewed. Results The serious complications and tumor metastasis are attributed to the PVTT, then it is necessary to make diagnosis accurately according to clinical symptoms, hematological and imaging examinations. The differential diagnosis of PVTT and portal vein thrombosis, portal sponge degeneration and hepatic arteriovenous shunt diseases should be carried out. Conclusions The diagnosis and differential diagnosis of PVTT cannot rely on a single method, and it requires a comprehensive judgment of various diagnostic methods. More accurate and specific diagnostic methods are needed.
Objective To review the progress of total ankle arthroplasty (TAA) in treatment of end-stage ankle osteoarthritis (AOA). Methods The domestic and foreign literatures about TAA in recent years were reviewed. The current status and progress of TAA were summarized from the results of traditional and computer-assisted TAA clinical outcomes. Results End-stage AOA often leads to severe pain and dysfunction, and arthrodesis is still the main selective treatment option. In recent years, with the advancement of surgical techniques and prosthesis design, TAA which can remain joint mobility has increased gradually, and the surgical results also have significant progress. Accurate prosthesis implant and mechanical alignment restoration are critical factors for TAA, and surgery-related malalignment is correlative to the prosthesis failure. Computer assisted patient-specific guide can simplify the TAA procedures and obtain the accuracy of tibia and talus osteotomy. Conclusion The clinical efficiency of preoperative CT based patient-specific guide technology for TAA needs further clinical follow-up. Meanwhile, it is necessary to further develop intraoperative navigation and robotic surgery system suitable for TAA.