Objective To observe the inhibition effect of selective cyclooxygenase2 inhibitor（celecoxib）on the experimental choroidal neovascularization（CNV）. Methods Thirty 8-10 weeks old healthy male Brown-Norway（BN）rats were randomly divided into the control, laser and celecoxib group,with 10 rats in each group. At the dosage of 50 mg/kg, celecoxib was gavaged twice per day. After 7 days, experimental CNV was induced by Krypon laser on laser group and celecoxib group. Fundus fluorescein angiography (FFA) was performed on days 3, 7,14,21,30 after laser photocoagulation.On days 21 after photocoagulation, 5 rats in each group were sacrificed and the relative thickness of CNV membranes, the expression of COX-2, vascular endothelial growth factor(VEGF) and matrix metalloproteinase-2(MMP-2) were studied by histopathologic or immunohistochemistry examination.Results On days 21 after photocoagulation, the incidence of CNV in the celecoxib group is significantly lower than that in the laser group (chi;2=7.1068,P=0.0077); the relative thickness of the CNV membranes in the celecoxib group is reduced 41.38% compared to the laser group, the difference is statistically significant (t=16.760 0，P=0.0000).COX-2,VEGF and MMP-2 expression in the CNV membrane of celecoxib group were significantly lower than in control group (t=5.710 0,5.840 0, 8.020 0; P=0.000 0); the COX-2, VEGF and MMP-2 expressions in choroid and retina of control group were weak. Conclusion Prophylactic celecoxib can reduce the expression of VEGF and MMP-2 by inhibiting COX-2, and prevent the CNV induced by laser photocoagulation.
目的探讨多排螺旋CT（MSCT）诊断胡桃夹现象的价值及临床意义。 方法对40例正常者（对照组）和12例胡桃夹现象患者（病例组）的腹部MSCT动脉期及延迟期图像进行后处理，测量腹主动脉与肠系膜上动脉（SMA）的夹角、左肾静脉层面腹主动脉前壁与SMA后壁的距离以及左肾静脉最小前后径，并观测左侧精索或卵巢静脉或左侧腰静脉是否扩张。 结果对照组及病例组所有观察对象MSCT均清晰显示左肾静脉、SMA及腹主动脉之间的立体解剖关系。对照组中无一例出现左肾静脉近段及左侧精索静脉或卵巢静脉或左侧腰静脉扩张；腹主动脉与SMA的平均夹角为71.4°，左肾静脉层面腹主动脉前壁与SMA后壁的平均距离为13.7 mm，左肾静脉平均最小前后径为6.9 mm。病例组中左肾静脉近段及左侧精索静脉或卵巢静脉扩张12例，左侧腰静脉扩张5例；腹主动脉与SMA的平均夹角为27.4°，左肾静脉层面腹主动脉前壁与SMA后壁的平均距离为3.8 mm，左肾静脉平均最小前后径为2.7 mm，近端肾静脉扩张。经两独立样本均数t检验，病例组腹主动脉与SMA的夹角、左肾静脉层面腹主动脉前壁与SMA后壁的距离及左肾静脉最小前后径均明显小于对照组（P＜0.05）。 结论MSCT可清晰显示SMA、腹主动脉和左肾静脉之间的解剖关系，对诊断胡桃夹现象具有很高的价值。
Moral education and professional quality training remain important part of medical education and talent training. This article aimed to conduct a questionnaire survey on medical college students about their professional ethics status and school education in professional ethics, so as to explore the paths and measures of medical students' professional ethics education. College education bears the primary responsibility for the medical students' professional ethics education, thus reasonable curriculum should be set up and teaching methods should be innovated; Industry environment and social ethos also have important implications on medical students' professional ethics cognition and behavior, so it is necessary to regulate the behavior of the medical industry according to law; Information age requires correct public opinion by means of network guidance, and under the impact of the pluralistic culture and values, doctors need to adapt themselves to our excellent traditional culture.
ObjectiveTo analyze the causes and prevention principles of hepatic venous hemorrhage during laparoscopic hepatectomy.MethodLiteratures about the causes and prevention of hepatic venous hemorrhage during laparoscopic hepatectomy were collected, and then made an review with our own clinical experience.ResultsIntraoperative hepatic venous hemorrhage was one of the most dangerous complications during laparoscopic hepatectomy. The main reasons for its occurrence included subjective and objective factors. Through accurate preoperative assessment, rigorous attitude during operation and superb surgical skills, intraoperative control of the prsessure difference between the internal and external veins, could significantly reduce the incidence of intraoperative venous bleeding. For the hepatic vein bleeding that had occurred, the correct evaluation and treatment during the operation could reduce the adverse effect on the surgical efficacy.ConclusionCorrectly understand the causes of hepatic venous hemorrhage during laparoscopic hepatectomy, prevent and manage various techniques before and during operation can carry out laparoscopic hepatectomy more safely.
Targeted initiatives of West China Hospital of Sichuan University to cope with coronavirus disease 2019 epidemic in three stages were summarized, including “three reconstructions” to mobilize in pre-epidemic stage, “three earlies” strategy to precisely treat critically ill patients in epidemic stage, and “three orderlies” to resume hospital operation in post-epidemic stage. The development of comprehensive hospitals in China after the epidemic was also discussed. It’s recommended to continuously strengthen the role of emergency response, early warning, comprehensive treatment, high-level talent training, international exchange, regional leadership, and collaborative innovation, in response to the shortcomings exposed in the epidemic.
ObjectiveTo explore the safety and feasibility of mixed approach laparoscopic anatomical left hepatectomy for left hepatolithiasis.MethodThe clinical data and follow-up results of 23 patients with left hepatolithiasis admitted to the Department of Hepatobiliary Pancreatic Surgery in Leshan People’s Hospital from June 2018 to June 2020 were retrospectively analyzed.ResultsAll 23 patients underwent anatomical left hepatectomy under laparoscopy. The median of total operation time was 185 min (153–460 min), the median of operation time of liver dissection was 110 min (90–125 min), the median of total blood loss during operation was 175 mL (100–800 mL), the median of blood loss from liver dissection was 120 mL (60–560 mL), blood transfusion was performed in 2 patients during operation. Postoperative day 1: median of AST was 75 U/L (32–437 U/L), median of ALT was 83 U/L (25–537 U/L),median of TBIL was 24 μmol/L (15.6–42.7 μmol/L); postoperative day 3: median of AST was 31 U/L (23–129 U/L),median of ALT was 27 U/L (14–108 U/L), median of TBIL was 13.5 μmol/L (10.4–24.3 μmol/L). Postoperative blood transfusion was performed in 1 patient, and the median of postoperative hospital stay was 7 days (5–20 days), median of postoperative extubation time was 2.5 days (2–5 days). Postoperative complications occurred in 3 patients. All 23 patients were followed up after the operation for median of 12 months (6–18 months). During the follow-up period, the patients had no special discomfort, no stone recurrence, reoperation, and death.ConclusionMixed approach laparoscopic anatomical left hepatectomy is safe and feasible in the treatment of left hepatolithiasis.
Hospital incident command system is a series of management systems for emergencies response of hospitals from the United States. Some hospitals in many countries have applied this system, but it has not yet been applied in China. In the process of responding to the coronavirus disease 2019 epidemic, West China Hospital of Sichuan University managed coronavirus disease 2019 patients through a standardized and programmatic model using the concept and framework of hospital incident command system, which included organizing hospital incident management team, carrying out incident action plan, space management, personnel management, material management and information management, in order to carry out standardized and procedural crisis response. This article introduces these management measures of West China Hospital of Sichuan University, aiming to provide a reference for establishing a more complete hospital emergency management system in line with China’s system in the future.
Objective?To compare the double dorsal phalangeal flap (DDPF) with the combination of digital neurovascular island flap (NVIF) and first dorsal metacarpal artery flap (FDMA) in terms of repairing digit degloving injury.?Methods?From October 2005 to March 2008, DDPF was used to repair 9 patients (9 fingers) with degloving injury of the thumb and index finger and completely amputated thumb and index finger (group A). From August 1996 to June 2007, NVIF and FDMA were used to repair 13 patients (13 fingers) with the thumb degloving injury and completely amputated or necrotic thumb (group B). In group A, there were 7 males and 2 females aged 19-48 years old, there were 4 cases of thumb and index finger degloving injury repair and 5 cases of completely amputated thumb and index finger reconstruction, the skin defect ranged from 6.0 cm × 3.5 cm to 7.0 cm × 4.5 cm, and the interval between injury and operation was 3-10 hours. The size of DDPF harvested during operation was 4.0 cm × 3.5 cm-5.0 cm × 4.0 cm. In group B, there were 10 males and 3 females aged 18-50 years old, there were 5 cases of thumb degloving injury repair and 8 cases of completely amputated or necrotic thumb reconstruction, the skin defect ranged from 6.0 cm × 3.0 cm to 7.0 cm × 4.5 cm, and the interval between injury and operation was 3 hours-5 days, and the size of NVIF and FDMA harvested during operation was 3.5 cm × 3.0 cm-5.0 cm × 4.0 cm. The donor site was repaired with the full-thickness skin graft.?Results?All the flaps survived uneventfully except for 1 case in group A suffering from venous crisis 1 day after operation and 2 cases in group B suffering from FDMA artery crisis 4-12 hours after operation. Those flaps survived after symptomatic treatment. All the wounds healed by first intention. All patients in two groups were followed up for 1-12 years (average 3.2 years). All the donor sites were normal except for 3 cases in group B suffering from flexion contracture deformity of the proximal interphalangeal joint due to the scar contracture in the margin of NVIF donor site. According to Allen test, the skin temperature and color of the donor fingers in two groups were normal under room temperature; 1 case of group A and 6 NVIF donor fingers of group B were pale and cold under ice water. According to sensory recovery evaluation system, 16 fingers in group A were graded as S4, 1 as S3+, and 1 as S2; while in group B, 3 NVIF fingers were graded as S3, 6 NVIF fingers as S2, 4 NVIF fingers as S1, and 13 FDMA fingers as S4. The appearance of the recipient flap was satisfactory and the color was similar to the surrounding skin. The skin temperature and color of the flaps in two groups were normal under room temperature; 2 cases of group A and 4 recipient fingers of group B were pale and cold under ice water. In group A, all the palmar flap of the recipient finger achieved the reorientation of the recipient flap sensation; while in group B, 8 cases achieved the reorientation of the recipient flap sensation, and 5 cases had double sensation. For the two-point discrimination of the flap, group B was superior to that of group A in terms of the palmar aspect (P lt; 0.05), no significant difference was evident between two groups in terms of the dorsal aspect (P gt; 0.05), and the palmar aspect of each group was superior to the dorsal flap (P lt; 0.05).?Conclusion?DDPF is less invasive to donor finger, easy to be operated, able to partially restore the sensory of the injured finger, and suitable for the repair of the degloving injury of the thumb and the index finger. Combination of NVIF and FDMA can restore the fine sensory of recipient palmar flap better and is applicable for those patients suffering from digital nerve defects from the proximal phalanx and with high demand for the recovery of thumb sensory.
Objective To evaluate the diagnostic value of analyzing the pattern of gallbladder wall enhancement on MDCT to identify the different causes of acute cholecystitis. Methods In January 2009 to December 2012， 169 patients diagnosed with acute cholecystitis caused by various pathologic conditions were performed MDCT scans， the images of portal venous phase and clinical data were retrospectively reviewed by two blinded radiologists. There were 146 cases in non-hepatopathy cholecystitis group and 23 cases in hepatopathy cholecystitis group. The other 5 normal gallbladder cases diagnosed by MDCT scans were retrospectively reviewed as contrast group. Using five patterns according to the enhancement pattern of flat gallbladder wall thickening on MDCT. The study cases were then divided into five patterns and the thickness of the mucous membrane were measured. The occurrence rate of each pattern and the thickness of the mucous membrane between the groups were compared respectively. Results In the non-hepatopathy cholecystitis group， there were typeⅡin 102 cases （69.9%）， typeⅢin 5 cases （3.4%）， typeⅣ in 30 cases （20.5%）， and typeⅤ in 9 cases （6.2%）. In the hepatopathy cholecystitis group， there were typeⅡin 2 cases （8.7%）， typeⅢ in 11 cases （47.9%）， typeⅣin 5 cases （21.7%）， and typeⅤin 5 cases （21.7%）. The occurrence rate of typeⅡin the non-hepatopathy cholecystitis group was significialtly higher than that in the hepatopathy cholecystitis group （P＜0.005）. The occurrence rate of typeⅢ and typeⅤ in the hepatopathy cholecystitis group were significialtly higher than those in the non-hepatopathy cholecystitis group（P＜0.005， P＜0.05）. The occurrence rate of type Ⅳ between the two groups had no significant difference （P＞0.05）. TypeⅠonly present in the contrast group. The non-hepatopathy group’s mean mucous membrane thickness was （2.61±1.30） mm ， which was thicker than the hepatopathy group’s （2.02±0.52） mm（t=2.22， P＜0.05）. Conclusion Analyzing the enhancement pattern of a thickened gallbladder wall on MDCT is helpful in identifying the causes of acute cholecystitis， and the gallbladder perforation or not.