【Abstract】Objective To evaluate the clinical value of photoplethysmography (PPG) in the diagnosis of venous valvular incompetence of lower extremity. Methods Two hundreds and six lower limbs in 181 patients including primary deep venous incompetence(PDVI), simple superficial veins incompetence and simple cross veins incompetence were examined by PPG in the assessment of venous refill time(VRT). All limbs underwent deep vein venography. Results Using venography as control the sensitivity of PPG was 89.8% and the specificity was 83.3 % in the diagnosis of venous valvular incompetence of lower extremity. Conclusion PPG could be taken as clinical diagnostic method for venous valvular incompetence of the lower extremity. The feature of PPG is noninvasive, painless with nonallergic reaction. The authors suggest that PPG can be used as a screening procedure for performing venography and postoperative follow-up.
Objective To summarize the outcome in surgical management and medical therapy of aneurysm involved in Behcet’s disease. Methods From April 1977 to December 2004,7 patients (one female) were admitted. There were 4 false aneurysms in aortic isthmus, and 1 right subclavian artery pseudoaneurysm, and 1 right axillary artery false aneurysm, and 1 thoracicoabdominal multiple pseudoaneurysms. Surgical procedures included 4 aneurysmorrhaphys and patch angioplasties, 1 aneurysmorrhaphy and tube graft replacement, 1 covered stents and axillary to axillary artery bypasses, 1 aneurysmorrhaphy and right subclavian artery ligation. The other 3 cases survived. Results There were no hospital death, but there were 1 anastomotic aneurysm occurrence, 2 new aneurysms formation, 1 femoral artery occlusion at canal insertion site, and 1 bypass graft occlusion. Follow-up from 1 to 12 months, there were death in 4 cases. Conclusions Behcet’s disease could easily result in anastomotic aneurysm and/or new aneurysm or rupture occurrence. Based on location of lesion, selection of proper intervention, and combination with immunosuppression therapy, the satisfactory result could be obtained, therein, prosthetic graft replacement surpasses the patch angioplasty.
ObjectiveTo investigate the expression of growth arrest-specific 5 (GAS5) mRNA and its clinical significance in hepatocellular carcinoma.MethodsThe expression of GAS5 mRNA in the hepatocellular carcinoma tissues and corresponding adjacent tissues were detected by real time-PCR. The relationship between the expression of GAS5 mRNA and clinicopathological characteristics were analyzed by SPSS 19.0 software.ResultsThe expression of GAS5 mRNA in hepatocellular carcinoma tissues was significantly lower than that of the adjacent tissues (P<0.01). The expression of GAS5 mRNA was related to tumor size, tumor number, lymph node metastasis, clinical TNM stage, alpha fetoprotein level, and tumor differentiation (P<0.05). Cox hazard model results showed that low expression of GAS5 mRNA was associated with poor prognosis (P<0.05).ConclusionGAS5 mRNA is expected to be a diagnostic and prognostic marker for patients with hepatocellular carcinoma.
Objective To calculate the recovery rate and enrichment factor and to analyse the correlation by measuring the concentrations of platelets, leukocyte, and growth factors in platelet-rich plasma (PRP) so as to evaluate the feasibil ity and stabil ity of a set of PRP preparation. Methods The peripheral blood (40 mL) was collected from 30 volunteers accorded with the inclusion criteria, and then 4 mL PRP was prepared using the package produced by Shandong Weigao Group Medical Polymer Company Limited. Automatic hematology analyzer was used to count the concentrations of platelets and leukocyte in whole blood and PRP. The enrichment factor and recovery rate of platelets or leukocyte were calculated; the platelet and leukocyte concentrations of male and female volunteers were measured, respectively. The concentrations of platelet-derived growth factor (PDGF), transforming growth factor β (TGF-β), and vascular endothel ial growth factor (VEGF) were assayed by ELISA. Results The platelet concentrations of whole blood and PRP were (131.40 ± 29.44) × 109/L and (819.47 ± 136.32) × 109/L, respectively, showing significant difference (t=—27.020, P=0.000). The recovery rate of platelets was 60.85% ± 8.97%, and the enrichment factor was 6.40 ± 1.06. The leukocyte concentrations of whole blood and PRP were (5.57 ± 1.91) × 1012/L and (32.20 ± 10.42) × 1012/L, respectively, showing significant difference (t=—13.780, P=0.000). The recovery rate of leukocyte was 58.30% ± 19.24%, and the enrichment factor was 6.10 ± 1.93. The concentrations of platelets and leukocyte in PRP were positively correlated with the platelet concentration (r=0.652, P=0.000) and leukocyte concentration (r=0.460, P=0.011) in whole blood. The concentrations of platelet and leukocyte in PRP between male and female were not significantly different (P gt; 0.05). The concentrations of PDGF, TGF-β, and VEGF in PRP were (698.15 ± 64.48), (681.36 ± 65.90), and (1 071.55 ± 106.04) ng/ mL,which were (5.67 ± 1.18), (6.99 ± 0.61), and (5.74 ± 0.83) times higher than those in the whole blood, respectively. PDGF concentration (r=0.832, P=0.020), TGF-β concentration (r=0.835, P=0.019), and VEGF concentration (r=0.824, P=0.023) in PRP were positively correlated with platelet concentration of PRP. Conclusion PRP with high concentrations of platelets, white blood cells and growth factors can be prepared stably by this package.
Objective To investigate the security and efficiency of endovascular repair for Stanford type B aortic dissection (AD) with severe complications. Methods Between January 2003 and December 2009, 60 patients having Stanford type B AD with severe compl ications were treated, including 39 males and 21 females with an average age of 43.7 years (range, 34-71 years). Severe compl ications included 27 cases of huge hemothorax, 1 case of paraplegia, 7 cases of acute renal failure,10 cases of cel iac trunk ischemia, 10 cases of superior mesenteric artery ischemia, and 5 cases of severe limb schemia. Emergency stent-graft deployment were appl ied in all patients, and 64 stent-grafts were successfully implanted. Results All patients survived and were followed up 3-86 months. Hemothorax disappeared after 28 days to 3 months of operation in all hemothorax patients; renal function returned normal after 1 to 9 days; l imb and visceral ischemia disappeared gradually after 1 to 14 days; and muscular strength of lower limb in the paraplegia patient began to recover after 4 hours of operation. The postoperative CT angiography showed enlarged true lumen and thrombosis in the false lumen. Conclusion Emergency endovascular repair is a safe and effective method to treat Stanford type B AD with severe complications.
【摘要】 目的 探讨双水平无创正压通气(BiPAP)对心脏外科术后需要二次机械辅助通气患者的治疗效果。方法 2008年9月—2009年9月，收集心脏外科手术后成功脱离呼吸机辅助通气后心功能衰竭或呼吸功能衰竭需要二次机械通气的患者,符合纳入及排除标准者共53例，进行回顾性分析,根据治疗方案分为无创通气组(32例)和有创通气组(21例),在需要机械通气时(T1),机械通气后30 min(T2),机械通气后2 h(T3)及预计脱离机械通气时(T4),分别统计患者心率、血气分析等情况,比较氧分压、ICU停留时间及术后至出院时间。结果 给予辅助通气前,两组患者的心率及PO2无统计学差异(Pgt;0.05)。给予辅助通气后,无创通气组患者的心率由T1(130.8±21.10)次/min,下降到T2(125.60±21.36)次/min,T3(101.70±13.73)次/min,T4(87.40±9.35)次/min；PO2由T1(64.70±14.12) mm Hg,上升到T2 (121.40±30.19) mm Hg，T3 (140.40±25.29) mm Hg，T4 (132.90±16.33) mm Hg。有创通气组患者的心率由T1 (138.27±21. 39)次/min,下降到T2(118.18±18.03)次/min，T3(100.00±11.73)次/min，T4(87.00±10.70)次/min；PO2由T1 (61.45±13.56) mm Hg上升到T2(122.55±29.50) mm Hg，T3(138.91±24.77) mm Hg，T4(133.55±18.00) mm Hg。两组患者心率及PO2均较辅助通气前降低(Plt;0.05)。两组患者之间各时间点心率及PO2比较无差异(Pgt;0.05)。无创通气组的ICU停留时间及术后至出院时间分别为(1.75±2.97) d及(9.14±4.11) d，均低于有创通气组的(4.38±5.13) d及(14.00±0.82) d,有统计学意义(Plt;005)。结论 双水平无创正压通气可用于心脏外科术后需要二次机械通气的患者。
Objective To explore surgery strategy of reoperation for type Ⅳa congenital choledochal cyst. Methods The patient was a 20-year-old female with repeated right upper abdominal pain and fever for more than 1 year and aggravation for more than 1 month, and the choledochal cyst excison was performed 15 years ago. The MRI revealed that a huge cyst located in the left lobe of liver, with multiple intrahepatic calculus. The patient was diagnosed with a type Ⅳa congenital choledochal cyst and choledochojejunostomy later and the intrahepatic dilated bile duct was untreated. Results The cystic dilatation of the intrahepatic bile duct was confirmed during the reoperation, and the multiple stones with pus formation were seen, the color of the right liver was normal and the anatomical left hemihepatectomy was performed. The original anastomosis had no stenosis then was preserved. An about 1.5 cm length of extrahepatic bile duct was dissociated from the upper of anastomosis, and the extrahepatic bile duct was cut open and explored with a choledochoscope. The T-tube drainage was performed following removing the stone. The patient recovered well and was discharged smoothly following the surgery. The cholangiography 6 weeks later revealed that the biliary tract was patency and there was no residual stone. There was no jaundice or fever afterwards. Conclusion Complete excision of choledochal cyst and hepaticoduodenostomy is widely accepted as a standard surgery for type Ⅳa congenital choledochal cyst.
ObjectiveTo further understand the anatomical characteristics and rules of left upper lingual pulmonary artery.MethodsCT data of 120 patients (82 males, 38 females, median age of 65 years ranging 36-78 years) with pulmonary nodules from December 2018 to August 2020 in our hospital were retrospectively analyzed. The anatomic characteristics of the lingual segment of the upper left lung were analyzed by three-dimensional reconstruction. ResultsMediastinal lingual artery appeared in 34 of the 120 patients, accounting for 28.4%. There were 26 patientsof mixed mediastinal/interlobar type, 8 patients of pure mediastinal lingual artery, and 92.3% (24/26) mixed mediastinal/interlobar type blood vessel contained A4b. Fifty-eight (58/120, 48.3%) patients had interlobar type A4+5 type, the rest were two-branches type. And 22 patients of A4 and A5 type accounted for the most two-branches type (22/28, 78.6%). The single-branch type was located at the distal end of A6 in 54 (54/58, 93.1%) patients, originated from the proximal end of A6 in 4 patients, and originated from the basilar artery in 6 patients. The two-branches type was at the distal end of A6 accounting for 50.0% (14/28).ConclusionMediastinal lingual artery is more common than expected, accounting for 28.4%, among which mixed lingual artery is more prevalent, usually located in the first pulmonary trunk, and mostly follows the principle of proximity to supply relevant lung tissues. The location of the interlobar branches in the pulmonary trunk can be at the distal or proximal end of A6, care should be taken to avoid damaging adjacent structures.
Objective To explore whether interleukin-10 ( IL-10 ) gene single nucleotide polymorphisms are associated with asthma. Methods The frequency of three single nucleotide polymorphisms ( rs1800896, rs3024492, and rs3024496) and haplotypes of IL-10 gene were analysed in 302 adult asthmatic subjects and 275 controls of Han Chinese in Guangzhou using MALDI-TOF-MS and MassARRAY-IPLEX. The genotype and allele frequencies were analyzed by Chi-square test in both groups.Logistic regression analysis with adjustment for age and sex was conducted. Odds ratio ( OR) and 95%confidence interval ( 95% CI) were calculated to analyze the associations between the susceptibility of asthma and genotypes. Results ①Three genotypes GG, GA, and AA of rs1800896 were found in Han Chinese inGuangzhou. The frequencies of GG, GA, and AA genotypes were 2. 12% , 39. 65% , and 58. 23% ,respectively. The relative risk of developing asthma in the carriers of GA was significantly higher than that in the carriers of AA ( OR=4. 827, P lt;0. 001) . ②Two genotypes AA and AT of rs3024492 were found in Han Chinese in Guangzhou. The frequencies of AA and AT genotypes were 1. 22% and 98. 78% , respectively.The rs3024492 polymorphism was not related to susceptibility in asthma. ③Two genotypes TT and CT of rs3024496 were found in Han Chinese in Guangzhou. The frequencies of TT and CT genotypes were 90. 59% and 9. 41% , respectively. The rs3024496 polymorphism was not related to susceptibility in asthma. Conclusion In IL-10 gene single nucleotide polymorphisms, rs1800896 but not rs3024492 and rs3024496 isstatistically related with the development of asthma.
Objective To evaluate the effects of in situ subtalar arthrodesis with bone graft for subtalar traumatic arthritis, and to analyse the plantar pressure distribution so as to provide the evidence for effectiveness evaluation. Methods Between March 2004 and December 2008, 26 patients with unilateral subtalar arthrodesis undergoing bone graft fusion wereenrolled (test group). After operation, the imageology diversity and the effect of subtalar arthrodesis on adjacent joint wereobserved. American Orthopaedic Foot and Ankel Society (AOFAS) ankle and hindfoot score and radiographs were used to assess the foot function before and after operation. Twenty-six normal subjects served as controls. Footscan system was used to test the distribution of maximum plantar pressure and the change of gravity center curve. No significant difference was found in gender, age, height, and weight between 2 groups (P gt; 0.05). Results All patients were followed up 18.2 months on average (range, 14-71 months). The mean subtalar arthrodesis time was 5.6 months (range, 4 months and 15 days to 11 months). The mean AOFAS ankle and hindfoot score improved from 35.18 ± 8.16 preoperatively to 76.36 ± 6.90 postoperatively (t=13.910, P=0.000). Nine (34.6%) patients had satisfactory functional effects, and 13 (50.0%) patients basically satisfactory. The talocalcaneal height, talocalcaneal angle, talar decl ination angle, and calcaneus patch angle were 87.04% ± 6.17%, 76.73% ± 5.13%, 65.86% ± 7.01%, and 70.19% ± 8.33% of the contralateral side, respectively. Osteoarthritis of the adjacent joints occurred in 7 cases. The maximum plantar pressure increased in the third to fifth metatarsal bones and decreased in the first to second metatarsal bones, showing significant differences when compared with normal controls (P lt; 0.05). No significant difference was found in the plantar pressure between arthrodesis foot and contralateral foot of the test group (P gt; 0.05). The plantar pressure was well distributed in patient who was satisfied with the effect, but it was still different from normal controls. In patients who had high plantar pressure n middle foot, mild heel inversion occurred. The gravity center curve of the contralateral foot in the test group was almost the same as that of normal controls; curve medially shifted when forefoot touched down. The curve irregularly and laterally shifted in the subtalar arthrodesis foot; the curve did not medially shift when forefoot touched down. Conclusion In situ subtalar arthrodesis with bone graft has good cl inical results for subtalar traumatic arthritis. Gait analysis can be appl ied to assess the therapeutic effectiveness, and contribute to make a surgical plan. For the adaptive alteration of contralateral side after subtalar arthrodesis, a cohort of normal subjects should be used for comparison in gait analysis.