ObjectivesTo systematically review the efficacy and safety of catheter-directed thrombolysis (CDT) versus anti-coagulation (AC) for deep vein thrombosis (DVT). MethodsWe searched PubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases to collect randomized clinical trials (RCTs) about CDT versus AC for DVT from inception to March 2018. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs and 989 patients were included. Meta-analysis showed that there was no significant difference between the two group in incidence of post-thrombotic syndrome (RR=0.73, 95%CI 0.49 to 1.09, P=0.13), iliofemoral venous patency rate (RR=2.57, 95%CI 0.59 to 11.24, P=0.21), bleeding (RR=2.03, 95%CI 0.50 to 8.28, P=0.32), severe bleeding (RR=1.77, 95%CI 0.91 to 3.42, P=0.09) and recurrence rate of venous thromboembolism (RR=1.00, 95%CI 0.42 to 2.36, P=0.99). However, the incidence of moderate-severe PTS decreased in CDT group was lower than that in the control group (RR=0.70, 95%CI 0.53 to 0.92, P=0.01). ConclusionsCompared with the control group, catheter-directed thrombolysis does not reduce the incidence of PTS and VTE recurrence rate, cannot improve the long-term patency of the iliofemoral vein, yet can prevent the occurrence of moderate to severe PTS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To study the mortality and prognostic factors of post-operative acute respiratory failure in cancer patients. Methods There were 1632 postoperative cancer patients from2004 to 2006 in the ICU of Cancer Hospital, in which 447 patients were complicated with acute respiratory failure ( intubation or tracheotomy and mechanical ventilation) . The clinical data was retrospectively analyzed. Stepwise logistic regression analysis was used to identify variables associated with mortality for acute respiratory failure. Results In 447 patients with acute respiratory failure ( male 260, female 187) , 106 cases died with a mortality of 6. 5% . Single factor analysis showed that acute morbodities ( shock, infection, organ failure) , intervention ( continuous renal replacement therapy, vasopressor drugs) , the 28-day ICU free days and APACHE scores ( ≥ 20) had significant differences between the survivor and non-survivor. Multiple logistic regression analysis showed that duration of operation( P = 0. 008, OR 1. 032, 95% CI 1. 008-1. 057) , APACHEⅡ≥20 scores( P =0. 000, OR12. 200, 95% CI 2. 896-51. 406) , organ function failure( P =0. 000, OR 13. 344,95% CI 3. 791-7. 395) were associated with mortality of acute respiratory failure. Conclusion Duration of operation, organ function failure, and APACHE Ⅱ scores were risk prognostic factors for postoperative cancer patients with acute respiratory failure.
Objective To evaluate the cl inical effect of percutaneous transluminal angioplasty (PTA) and PTA and stenting (PTAS) in treating multilevel arteriosclerosis obl iterans (ASO) of lower extremities. Methods Between January 2007 and October 2009, 29 cases of multilevel ASO of lower extremities were treated with PTA or PTAS. There were 17 males and 12females with an average age of 71 years (range, 56-83 years). The cl inical manifestations were l imbs numb with cold sensation, intermittent claudication (lt; 100 m), and 19 patients had rest pain. According to Fontaine stages classification, there were 7 cases of stage II, 14 cases of stage III, and 8 cases of stage IV. Concomitant diseases included hyperl ipidemia in 13 cases, diabetes in 6 cases, hypertension in 12 cases, chronic heart failure in 5 cases, chronic obstructive pulmonary disease in 3 cases, cerebral infarction in 5 cases, and toe ulcer in 15 cases. The preoperative ankle/brachial index (ABI) was 0.28 ± 0.13. Results In 3 cases of below knee lesions for the guide wire puncturing through the artery wall, 1 case gave up, and 2 cases continued recanal ized other arteries without serious bleeding compl ications. After operation, cerebral infarction occurred in 1 case, pulmonary infection in 2 cases, and groin puncture site hematoma in 2 cases. All patients were followed up 3 to 36 months. Limb skin temperature was significantly improved, and intermittent claudication disappeared or claudication distance lengthened, rest pain disappeared or significantly reduced in 27 patients (30 l imbs). The wound of amputee achieved good heal ing in 2 cases (2 l imbs). In 27 patients undergoing endovascular treatment, the postoperative ABI was 0.72 ± 0.19, showing significant difference when compared with the preoperative one (P lt; 0.05). Conclusion The PTA and PTAS treatment for multilevel ASO of lower extremities is a safe and effective option, and the short-term effect is good. Different treatments should be chosen according to the location and length of vascular occlusion.
【Abstract】Objective To investigate the surgical technique of orthotopic liver transplantation using two-cuff technique and prevention of operational complications in rats. Methods The model was established with modified cuff technique.Before donor livers were harvested,the portal vein and hepatic artery were interrupted for 10 min,and reflow was initiated for another 10 min.The donor liver was perfused through abdominal aorta and portal vein respectively.The infrahepatic vena vein and portal vein were anastomosed by means of cuff method； the anastomosis of the suprahepatic vena vein was performed with suture method. The anastomosis of the common bile duct was performed with an internal stent. Results One hundred and twenty rats underwent orthotopic liver transplantation using twocuff technique and the successful rate was 90.8%. The average nonhepatic time of recipients was (21.0±3.5) min and the total surgical time was (46.0±4.5) min. The oneweek survival rate of recipients was 87.2%. Conclusion Good exposure of operative field, sophisticated microsurgical technique and delicate surgical manipulation can benefit decreasing nonhepatic and total surgical time of recipients and increasing the survival rate of recipients.
【Abstract】ObjectiveTo investigate the effects of liver transplantation on splenic function in rats with hepatic cirrhosis. MethodsHepatic cirrhosis model was established in rats by subcutaneous injections of carbon tetrachloride. Liver transplantation model was established with twocuff technique. Spleen index, morphological changes of spleen were observed before and after liver transplantation in hepatic cirrhosis rats. Spleen T lymphocyte subgroups before and after liver transplantation were also assayed by immunofluorescence staining and flow cytometry. ResultsBefore liver transplantation, spleen index was increased from (2.42±0.11) mg/g to (3.62±0.14) mg/g， P＜0.01; pathological examination of spleen samples showed that the areas of white pulp were decreased from (23.47±2.30)% to (7.70±2.01)%， P＜0.01， and the areas of spleen trabecula were increased from (1.75±0.61)% to (4.46±0.71)%， P＜0.01. Meanwhile, the ratio of CD4/CD8 of spleen T lymphocyte subgroups was decreased from 2.67±0.15 to 1.18±0.15, P＜0.01. After liver transplantation, spleen index was decreased from (3.62±0.14) mg/g to (2.62±0.11) mg/g， P＜0.01; pathological examination of spleen showed that the areas of white pulp were increased from (7.70±2.01)% to (15.07±1.97)%， P＜0.01, and those of spleen trabecula were decreased from (4.46±0.71)% to (3.11±0.51)%， P＜0.05. Meanwhile, the ratio of CD4/CD8 of spleen T lymphocyte subgroups was increased from 1.18±0.15 to 2.32±0.11, P＜0.01. ConclusionImpaired function of spleen resulting from liver function damage can be improved in rats with hepatic cirrhosis after liver transplantation.