Objective To analyze the clinical efficacy of left subclavian artery (LSA) revascularization combined with thoracic endovascular repair (TEVAR) in the treatment of Stanford type B aortic dissection (AD). MethodsA retrospective analysis was conducted on patients treated with TEVAR combined with LAS reconstruction surgery at Wuhan Central Hospital in Hubei Province from 2017 to 2021. The patients were divided into a reconstruction group and a simple stent group. The reconstruction group was subdivided into a hybrid reconstruction group and a chimney reconstruction group according to the different methods of reconstruction surgery. Perioperative data of different groups were compared. A total of 144 patients were included, including 108 males and 36 females. There were 113 patients in the simple group and 31 patients in the reconstruction group. There were statistically significant differences in surgical time, hospital stay, preoperative lesion area diameter, and postoperative right vertebral artery diameter between the reconstruction group and the simple group (P<0.05). There was no statistically significant difference in postoperative complications between the simple group and the reconstruction group within 1 year (P>0.05). There was no statistically significant difference in surgical time between different surgical procedures in the reconstruction group (P>0.05). During the follow-up period, there were no deaths. A total of 12 (10.6%) patients in the simple group experienced complications, which was lower than that in the reconstruction group (8 patients, 25.8%). Among them, the most common complication in the follow-up of patients in the simple group was internal leakage (5 patients), and there was no statistical difference compared to patients in the reconstruction group (2 patients). The most common complication in the follow-up of patients in the reconstruction group was hoarseness (2 patients), while in the simple group, 1 patient occurred. Conclusion Both different surgeries have good effects on the treatment of type B aortic dissection, and multi center, large sample, and long-term studies are needed.
目的 比较使用流式细胞仪355 nm和407 nm激光器激发Hochest33342检测细胞凋亡。 方法 通过ATO药物诱导急性早幼粒白血病细胞（NB4）及血清饥饿法诱导人肺癌细胞（NCl-H292）细胞凋亡，取24、48 h时间点收集细胞，进行Hoechst33342-碘化丙啶（PI）双染，分别在配置有两种激光器的流式细胞仪上检测细胞凋亡。 结果 细胞经处理后24 h，355 nm激光器检测NB4细胞凋亡率Hoechst33342+/PI-：（28.20 ± 4.80）%；NCl-H292细胞凋亡率Hoechst33342+/PI-：（22.47 ± 2.78）%。407 nm激光器检测NB4细胞凋亡率Hoechst33342+/PI-：（25.10 ± 6.19）%。NCl-H292细胞凋亡率Hoechst33342+/PI-：20.47 ± 1.46%。处理后48 h，355 nm激光器检测NB4细胞凋亡率Hoechst33342+/PI-：（33.60 ± 3.75）%。NCl-H292细胞凋亡率Hoechst33342+/PI-：（26.77 ± 1.16）%。407 nm激光器检测NB4细胞凋亡率Hoechst33342+/PI-：（29.47 ± 2.33）%。NCl-H292细胞凋亡率Hoechst33342+/PI-：（31.47 ± 3.05）%。两种细胞处理后比处理前凋亡率明显升高，但355 nm激光器与407 nm激光器检测的凋亡结果差异不明显（P＞0.05）。 结论 407 nm激光器激发Hoechst33342可检测细胞凋亡。
ObjectiveTo summarize the research progress of osteonecrosis of femoral head (ONFH) following femoral intertrochanteric fractures in adults.MethodsRelevant literature at home and abroad was extensively reviewed to summarize the pathogenesis, high-risk factors, and treatment of ONFH after femoral intertrochanteric fracture in adults.ResultsONFH after femoral intertrochanteric fracture mostly occurs within 2 years after operation, with a lower incidence. At present, it is believed that comminuted and large displacement fractures caused by high-energy injuries, fracture line close to the base of neck, excessive external rotation deformity, improper intramedullary nail entry points, and rough intraoperative manipulating may injury the deep branch of the medial circumflex femoral artery, causing ONFH. Hip replacement is the main treatment for necrosis, which can achieve good results.ConclusionAddressing the above risks, excessive external rotation, overstretching, and rough manipulating should be avoided. Anatomical reduction should be performed during the operation, the nail entry point should be accurate and avoid repeated drilling and thermally bone necrosis.
ObjectiveTo investigate the feasibility and clinical outcomes of bilateral endoscopic thoracic sympathectomy (ETS) through single hole for palmar hyperhidrosis (PHH). MethodsFrom August 2012 to April 2013, 19 PHH patients were admitted in the Department of Thoracic Surgery, The Third People's Hospital of Chengdu. There were 7 male and 12 female patients with their age of 24.7(15-33) years. All the patients underwent bilateral ETS through single hole under general anesthesia. ResultsAll the operations were successfully performed. Average operation time was 28.4 minutes, and postoperative hospital stay was 1.6 days. Seventeen patients were followed up for 2 to 10 months. PHH symptoms all disappeared without Horner's syndrome or hemopneumothorax. ConclusionBilateral ETS through single hole is a minimally invasive, reliable and safe procedure for PHH with low morbidity.
Objective To analysis the safety of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids and provide references for clinical practice and prevention of complications of gynecological diseases. Methods Databases including PubMed, The Cochrane Library (Issue 2, 2016), EMbase, CBM, CNKI, and VIP were searched to collect studies concerning the complications of HIFU for uterine fibroids from March 1st 2005 to February 15th 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using R software. Results A total of twenty studies involving 2 405 patients were included. The results of meta-analysis showed that complications rate of gynecological system induced by HIFU was 6.63% (95%CI 3.58% to 12.28%); among them, the incidence of vaginal bleeding was 5.82% (95%CI 3.22% to 10.53%), and the incidence of abdominal pain was 10.02% (95%CI 4.77% to 21.05%). Conclusion The current evidence shows that there is a certain amount of complications of HIFU for uterine fibroids. Due to the limited quantity and quality of included studies, the above results are needed to be validated by more studies.
Objective To explore the components of passive movement resistance in the wrist flexor in subjects after stroke, and investigate the correlations between these components and clinical scales such as Modified Ashworth Scale (MAS) and Fugl-Meyer Assessment (FMA). Methods From March to August 2017, a cross-sectional study was performed in 15 stroke survivors in the Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University. MAS and FMA were assessed by an experienced physical therapist. Components of passive movement resistance in the flexors of wrist and finger were recorded by NeuroFlexor (Aggro MedTech AB, Solna, Sweden), then the average resisting force in one second ensued the passive stretch at 5°/s was took as peak resisting force (PRF). The PRF between paretic side and non-paretic side was compared. Spearman’s rank correlation was used to test the relation between the components and clinical scales. Results The PRF of the paretic side during the slow passive stretch (5°/s) was significantly higher than that of the non-paretic side [(10.49±1.65) vs. (8.98±1.11) N, P<0.05]. Correlations between MAS and the components/PRF were insignificant (P>0.05). FMA had a significant correlation with neural component of the paretic side (rs=–0.645, P=0.009). Conclusions The higher PRF of slow passive stretch in the paretic side may be attributed to the higher muscle stiffness. Neural component of the paretic wrist is correlated with FMA. These findings could be applied in clinical evaluation of functional performance of the wrist muscle of stroke survivors.
ObjectiveTo investigate the effect of Yttrium-90 selective internal radiotherapy (90Y-SIRT) on tumor control and compensatory hyperplasia of left hepatic lobe in the treatment of right hepatic malignant tumor. MethodsThe clinical data of 134 patients with liver malignant tumor (primary or secondary) who were treated with 90Y-SIRT in the Department of Hepatobiliary and Pancreatic Surgery, Beijing Tsinghua Changgung Hospital from September 2022 to November 2023 were collected, and 29 patients who met the inclusion and exclusion criteria were analyzed retrospectively. The liver volume, tumor volume, postoperative future liver remnant (FLR) and the percentage of FLR proliferation before and after treatment were measured by CT or MRI, and the surgical resection rate and pathological necrosis rate of tumor focus after 90Y-SIRT treatment were analyzed. The liver volume, tumor volume, postoperative future liver remnant (FLR) and the percentage of FLR hyperplasia were measured by CT or MRI before and 1 and 3 months after 90Y-SIRT, and the surgical resection rate and pathological necrosis rate of tumor lesions after 90Y-SIRT treatment were analyzed. ResultsOf the 29 patients, 22 patients with hepatocellular carcinoma, 2 patients with cholangiocarcinoma and 5 patients with liver metastases from colorectal cancer received 90Y-SIRT of the right liver. At 1 and 3 months after treatment, the tumor volume average decreased by 149.2 mL (P=0.124) and 228.2 mL (P=0.012), the right liver volume was average reduced by 197.4 mL (P=0.026) and 318.6 mL (P=0.023), the left liver volume average increased by 64.9 mL (P=0.261) and 144.7 mL (P=0.124), and the percentage of FLR increased by 6.6% (P=0.018) and 13.4% (P＜0.001) of 29 patients, respectively. Three months after operation, mRECIST standard was used to evaluate the curative effect of tumor imaging. The results showed that the objective response rate of tumor was 79.3% and the disease control rate was 93.1%. Conclusions90Y-SIRT can effectively control the growth of malignant tumors in the right lobe of the liver and induce compensatory hyperplasia of the left liver. At the same time, high objective response rate and pathological necrosis rate of tumor lesions can be obtained.
ObjectiveTo investigate the effectiveness of three-dimensional (3D) printed total scapula for reverse shoulder arthroplasty in the treatment of scapular tumors. MethodsBetween November 2017 and December 2021, 5 patients with scapular tumors were treated by reverse shoulder arthroplasty with 3D printed total scapula. There was 1 male and 4 females. The age ranged from 44 to 59 years, with an average of 50.4 years. There were 2 cases of chondro sarcoma, 1 case of high-grade osteosarcoma, 1 case of lung cancer with scapular metastasis, and 1 case of ligamentoid fibromatosis recurrence. The disease duration was 4-8 months, with an average of 5.8 months. According to the Musculoskeletal Tumor Society (MSTS) scapular girdle classification criteria, 4 cases of tumors involved both S1 and S2 zones, and 1 case involved S2 zone. The tumor diameters ranged from 4.2 to 11.2 cm, with an average of 6.1 cm. The operation time, intraoperative blood loss, and blood transfusion were recorded. During follow-up, the MSTS score was used to evaluate the recovery of limb function of the patients. The sink depth of the affected shoulder, complications, and oncological outcomes were observed. The position of the prosthesis was reviewed by imaging. ResultsThe operation time ranged from 155 to 230 minutes, with an average of 189 minutes. The intraoperative blood loss was 100-1 500 mL, with a median of 600 mL. Two patients were received blood transfusion of 800 mL and 1 850 mL respectively during operation. All incisions healed by first intention, and no complications such as infection occurred. All patients were followed up 4-22 months, with an average of 13 months. Two patients died at 8 and 15 months after operation respectively due to multiple metastases and organ failure. At last follow-up, the MSTS score of all patients was 73%-83%, with an average of 77.4%. The affected shoulder was 2-4 cm lower than the contralateral side, with an average of 3 cm. Imaging examinations showed that no prosthesis loosening, dislocation, or fracture occurred during follow-up. Conclusion Reverse shoulder arthroplasty with 3D printed total scapula can obtain good shoulder function and appearance. Patients have high acceptance and satisfaction with this surgical method.