ObjectiveTo investigate the efficacy and safety of intravenous diltiazem in controlling ventricular rate in elderly patients with atrial fibrillation. MethodWe retrospectively analyzed the clinical data of patients suffering from atrial fibrillation with rapid ventricular rate presented to the Emergency Department between January 2014 and January 2015, and found that 57 elderly patients aged over 70 were treated with intravenous diltiazem for ventricular rate controlling. We analyzed the general situation of this group of patients, the changes of heart rate and mean arterial pressure before and after the treatment, and the adverse reactions to the treatment. ResultsThe total effective rate was 92.9%, and the mean onset time was (13.3±7.3) minutes. The mean arterial pressure showed no significant difference after treatment, and the heart function showed no significant deterioration. Only 4 patients (7.0%) had symptoms of transient hypotension. ConclusionsFor elderly patients with atrial fibrillation with rapid ventricular rate, intravenous diltiazem can control the ventricular rate rapidly, efficiently, safely, and sustainably.
With the development of tissue engineering, a variety of forms of silk fibroin (SF) scaffolds has been applied to research of constructing variety of organization based on cells, which has become scientific focus in recent years. In this paper we introduced the source and structure of SF and the fabrication method of the scaffold, and also address the SF application progress in several relevant fields of tissue engineering, such as bone, cartilage, skin, blood vessel and nerves. Finally, we discuss the future leading prospect of the SF in order to provide reference for subsequent research.
Objective To summarize the clinical characteristics of laparoscopic unexpected gallbladder cancer (UGC), and to explore the impact of TNM stage and secondary surgery timing on postoperative survival. Methods Clinical data of 70 UGC patients who treated in Xianyang Hospital of Yanan University and The First Affiliated Hospital of Xi’an Jiaotong University from January 2008 to January 2014 were retrospectively analyzed. The influencing of TNM staging and secondary surgery timing on the prognosis of UGC patients were analyzed by single factor analysis. Results Of the 70 patients before operation, 68 patients (97.2%) were diagnosed as calculus of gallbladder, 1 patient (1.4%) was diagnosed as gallbladder polyps, 1 patient (1.4%) was diagnosed as intrahepatic and extrahepatic bile duct stone. TNM staging: 2 patients (2.9%) in stage 0, 9 patients (12.9%) in stage Ⅰ, 50 patients (71.4%) in stage Ⅱ, 6 patients (8.6%) in stage Ⅲa, 1 patient (1.4%) in stage Ⅲb, 1 patient (1.4%) in stage Ⅳa, and 1 patient (1.4%) in stage Ⅳb. Fifty-five patients (78.6%) were confirmed by intraoperative frozen section examination, and 15 patients (21.4%) were confirmed after laparoscopic surgery. There were 66 patients were followed-up for 2-79 months, and the median follow-up time was 28-month, the 1-， 3-, and 5-year survival rates were 92.3%, 70.7%, and 53.7% respectively. The survival curves of stage 0, Ⅰ, Ⅱ, and Ⅲ+Ⅳ were differed significantly (P ＜0.01), the survival situation was best in patients in stage 0 and Ⅰ, but worst in patients in stage Ⅲ+Ⅳ. There was no statistical difference between the prognosis of patients underwent one-stage surgery and those underwent two-stage surgery (P=0.73). Conclusions A large proportion of UGC are in stage Ⅱ. For UGC patients, the prognosis is related with the clinical stage, so the surgical approach does not worsen the prognosis, regardless whether the tumor is detected during or after laparoscopic cholecystectomy.
ObjectiveTo evaluate the clinical results of the tibial Inlay technique for the medial collateral ligament (MCL) reconstruction using Achilles tendon allograft in recovery of medial instability of the knee. MethodsBetween January 2011 and December 2012, 21 patients underwent tibial Inlay reconstruction of the MCL using Achilles tendon allograft, and the clinical data were retrospectively analyzed. There were 13 males and 8 females with a mean age of 32 years (range, 19-62 years). Injury was caused by sports in 15 cases and by traffic accident in 6 cases. The disease duration ranged from 15 days to 3 months (mean, 1.5 months). According to International Knee Documentation Committee (IKDC) criteria, 5 cases were classified as degree II and 16 cases as degree III. The results of the valgus stress test were positive in all patients. The complications were observed after operation; IKDC subjective knee score and Lysholm score were used to assess the knee function. ResultsBone block fracture occurred in 1 case during operation. Primary healing of incision was obtained in the other cases except 1 case having unhealing incision who was healed after skin grafting. No complications of knee joint stiffness, vascular nerve injury, and infection occurred. All patients were followed up 7-29 months (mean, 18.5 months). At last follow-up, the results of the valgus stress test were negative in 20 cases, and positive (degree I) in 1 case; the other patients had no knee extension or flexion limitation except 1 patient having 15° flexion limitation. The Lysholm score was significantly improved from 45.4±13.6 to 87.5±9.4, the IKDC 2000 subjective score was significantly improved from 46.5±14.0 to 88.4±9.3 at last follow-up (P<0.05). MRI showed that the reconstructed MCL was continuous. ConclusionThe short-term clinical results of the tibial Inlay technique for MCL reconstruction using Achilles tendon allograft are satisfactory. The Inlay technique for MCL reconstruction can provide good medial stability of the knee, but the lorg-term effectiveness needs further follow-up.
Currently,lung cancer (LC) has one of the highest incidence rates among various malignant tumors worldwide,and the annual mortality rate of LC has ranked first among all malignant tumors. About 80% of LC patients present to the hospital in a late advanced stage and lose the chance of surgical resection. Among all the patients who receive surgical treatment,the 5-year mortality rate of patients with early TNM stages is far lower than that of patients with advanced stage LC. With the advancement of medical equipment and more people who receive routine medical examination,more and more patients with small pulmonary nodules are discovered. Limited lung resection,including wedge resection and segmental resection,can be performed with minimally invasive video-assisted thoracoscopic surgery for these patients to acquire equivalent surgical outcomes as traditional lobectomy and a much better postoperative quality of life. LC screening increases the chances of early detection and diagnosis of LC patients,so these patients can receive reasonable diagnosis and treatment at an early stage. This strategy can greatly reduce treatment cost and mortality,and achieve maximal treatment benefits with minimal economic and medical cost. This review focuses on the necessity,high-risk groups,evaluation criteria and methods of LC screening with some LC screening guidelines and research studies in order to provide reasonable and feasible screening strategies and references for clinical LC screening.
ObjectiveTo investigate the application value of the Ilizarov technique for infection after the limb salvage operation of primary bone tumor. MethodsA retrospective analysis was made on the clinical data of 6 patients with infection treated with Ilizarov technique after limb salvage operation of primary bone tumor between July 2012 and April 2015. There were 4 males and 2 females, aged 18-40 years (mean, 28 years). Tumor types included 3 cases of osteosarcoma and 3 cases of giant cell tumor of bone. Tumor located at the left distal femur in 2 cases, at the right distal femur in 1 case, at the left proximal tibia in 1 case, and at the right proximal tibia in 2 cases. Six cases had recurring infection after debridement. The patients underwent operation 2 to 5 times (mean, 3.5 times). The time from tumor resection to visiting was 8-20 months (mean, 14.3 months). During operation, the internal implant was removed; infection and necrotic tissue was removed thoroughly; and the Ilizarov external fixator was installed. After operation, gentamycin normal saline was used for 2 to 3 weeks, and the sensitive antibiotic intravenous infusion was performed at the same time. After 1 week, the osteotomy lengthening was used. ResultsAll 6 patients were followed up for 6 to 18 months (mean, 12.2 months). Pin tract infection occurred in 1 case after operation; primary healing of incision was obtained in the other patients, and no related complications occurred. The external fixation time ranged from 6 to 16 months (mean, 11.5 months). The healing indexes ranged from 34 to 62 days/cm (mean, 52.0 days/cm). After removal of the external fixator, the knee range of motion ranged from 0 to 5° (mean, 3°) in extension, and from 120 to 130° (mean, 125°) in flexion. The American musculo-skeletal tumor society system (MSTS) function scoring was excellent in 3 patients, good in 2 patients, and fair in 1 patient, with an excellent and good rate of 83.3%. During follow-up period, there was no recurrence of infection; and no recurrence or metastasis was found in 3 patients with osteosarcoma. ConclusionInfection can be cured by Ilizarov technique after limb salvage operation of bone tumor.
ObjectiveTo investigate the short-term effectiveness of balloon vertebroplasty combined with short-segment pedicle screw instrumentation for the treatment of thoracolumbar burst fractures. MethodsBetween June 2011 and December 2013, 22 patients with thoracolumbar burst fractures were included. There were 14 males and 8 females, aged 20-60 years (mean, 42.5 years). The fracture segments included T11 in 1 case, T12 in 4 cases, L1 in 10 cases, L2 in 6 cases, and L3 in 1 case. According to AO classification system, there were 13 cases of type A and 9 cases of type B. Spinal cord injury was classified as grade C in 2 cases, grade D in 3 cases, and grade E in 17 cases according to Frankel scale. The time from injury to operation was 3-10 days (mean, 5.5 days). All patients underwent posterior reduction and fixation via the injured vertebra, transpedicular balloon reduction of the endplate and calcium sulfate cement (CSC) injection. The ratio of anterior vertebral height, the ratio of central vertebral height, the sagittal Cobb angle, the restoration of nervous function, and internal fixation failure were analyzed. ResultsPrimary healing of incision was obtained in the others except 2 cases of poor healing, which was cured after dressing change or debridement. All the patients were followed up 9-40 months (mean, 15 months). CSC leakage occurred in 2 cases. Absorption of CSC was observed at 8 weeks after operation with complete absorption time of 12-16 weeks (mean, 13.2 weeks). The mean fracture healing time was 18.5 weeks (range, 16-20 weeks). The ratio of anterior vertebral height, ratio of central vertebral height, and sagittal Cobb angle were significantly improved at 1 week and 3 months after operation and last follow-up when compared with preoperative values (P<0.01), but no significant difference was found among 3 time points after operation (P>0.01). There was no internal fixation failure or Cobb angle loss more than 10°. Frankel scale was improved with no deterioration of neurologic function injury. ConclusionBalloon vertebroplasty combined with short-segment pedicle screw instrumentation is simple and safe for the treatment of thoracolumbar burst fractures, and it can improve the quality of reduction, restore vertebral mechanical performance effectively, and prevent the loss of correction and internal fixation failure.
ObjectiveTo evaluate the significance of the accessory left hepatic artery during the procedure of laparoscopic radical gastrectomy for gastric cancer. MethodsClinical data and imaging data of 120 patients with gastric cancer who underwent laparoscopic radical gastrectomy between January 2014 and June 2015 were retrospectively collected, to summarize the significance of accessory left hepatic artery in laparoscopic radical gastrectomy for gastric cancer, and to summarize the main points during the operation. ResultsNine patients (7.5%) had the accessory left hepatic artery in the whole group of 120 patients. Ligation was performed at the beginning of the distal left gastric artery or each branch near the stomach. All patients recovered well postoperatively. There was no significant difference in the total bilirubin, glutamic-pyruvic transaminase, and glutamic-oxalacetic transaminase on 3 days before surgery, 1, 3, and 7 days after surgery (P > 0.05). In addition, there was no occurrence of liver abscesses and intrahepatic biloma. ConclusionsThe incidence of accessory left hepatic artery variation is at a high incidence rate in clinical patients. It needs to be paid attention to protect the accessory left hepatic artery during the laparoscopic radical gastrectomy for gastric cancer, in order to avoid the occurrence of liver abscess and intrahepatic biloma.
ObjectiveTo systematically review the clinical effectiveness of continuous lumbar drainage for CSF leakage. MethodsA comprehensive literature search was conducted in PubMed, The Cochrane Library (Issue 1, 2014), EMbase, CNKI, CBM, VIP and WanFang Data from January 1994 to January 2014 for randomized or non-randomized controlled trials on the comparison between lumbar drainage and conventional treatment in the effectiveness of CSF leakage treatment. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. ResultsSeven non-randomized controlled trials were finally included, involving 465 patients. The results of meta-analysis showed that:compared with conventional treatment, lumbar drainage was better in effectiveness (RR=3.78, 95%CI 1.91 to 7.50, P=0.000 1), CNS infection rates (RR=0.48, 95%CI 0.24 to 0.95, P=0.04), and hospital stay (MD=-6.66, 95%CI-10.09 to-3.23, P=0.000 1). However, no significant difference was found in the incidence of headache caused by hypotensive cranial pressure (RR=1.32, 95%CI 0.65 to 2.69, P=0.45). ConclusionCurrent evidence suggests that continuous lumbar drainage is superior to conventional treatment in total effectiveness rates, prevention of CNS infection and in reducing hospital stay, which is an effective treatment intervention of CSF leakage. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality studies.
ObjectiveTo research the effect of chondroitin sulfate (CS) on the proliferation of myoblasts and the formation of myotube. MethodsThe myoblasts at passage 5 were used to prepare the cells suspension (1×108 cells/mL), and the experiment was divided into 4 groups based on CS concentration in the medium:group A (0 μg/mL), group B (50 μg/mL), group C (100 μg/mL), and group D (200 μg/mL). The cell morphology and myotube formation were observed by inverted microscope at 4, 5, and 8 days after treatment; MTT was used to detect the cell proliferation at 6 days, and the number of myotube was calculated by HE staining at 8 days. ResultsCells showed spindle shape after adherent, with ovoid nuclei and dense cytoplasm under inverted microscope. When the cell adherent rate was 90%, cells arranged in whorls swirled and showed long fusiform adherent growth; and then nuclei fusion resulted in formation of multincleated myotubes. At 8 days, most myoblasts fused to form myotube in group A, but less myotube was observed in groups B and C, and the least myotube in group D. The absorbance (A) values of groups A, B, C, and D were 0.045 2±0.004 4, 0.540 4±0.096 7, 0.660 9±0.143 4, and 1.069 0±0.039 0 respectively, showing significant difference between other groups (P<0.05) except between groups B and C P>0.05). HE staining observation showed that most myoblasts fused to form myotube in group A, but less myotube in groups B and C, and the least myotube in group D. The number of myotube of groups A, B, C, and D were 222.01±30.02, 193.13±42.46, 170.26±11.96, and 136.88±16.78 respectively, showing no significant difference among groups (F=1.658, P=0.252). ConclusionCS can significantly promote the proliferation of myoblast, the promotion is the biggest when CS concentration is 200 μg/mL.