ObjectiveTo explore the effect of snapshot freeze (SSF) on the image quality of coronary artery in 64 multislice spiral CT for patients with high heart rate. MethodsWe retrospectively analyzed the clinical data of 98 patients with an mean heart rate of ≥ 70 beats/min who underwent coronary CT angiography examination between August 2013 and February 2014. According to the inclusion criteria, 60 patients were included in our study. The image quality of standard reconstruction (STD) and motion-corrected (MC) reconstruction based on SSF platform were analyzed. The image quality was classified into 4 grades, and the image quality of coronary segments named according to AHA standard was evaluated. Then, we compared the image quality between the two different reconstruction methods. ResultsAltogether 180 coronary arteries and 795 coronary segments were evaluated. Before MC reconstruction, there were 133 (73.89%) arteries and 287 (36.10%) segments had pseudomorph, while after MC reconstruction, those two numbers were 89 (49.44%) and 150 (18.87%) (P<0.05). The right coronary artery (RCA) had a higher rate of pseudomorph and a lower image quality score[91.67% (55/60), 3.32±0.40] than left anterior descending artery[60.00% (36/60), 3.69±0.42] and left circumflex artery[70.00% (42/60), 3.44±0.55], especially the S2[90.00% (54/60), 2.45±0.85]. Overall image quality was higher with the use of MC reconstruction on per-artery level (P<0.05) and most of the per-segment level (P<0.05) compared with STD, especially for RCA and its segments (P<0.05). ConclusionSSF improves image quality of coronary artery in patients with high heart rate, especially for RCA.
ObjectiveTo explore the risk factors for and preventive measures of orthopedic perioperative surgical site infection. MethodsWe retrospectively analyzed the clinical data of 2 752 cases of orthopedic surgery performed from January 2010 to December 2012. The risk factors for such infection were analyzed and certain preventive measures were put forward. ResultsA total of 97 patients were infected with a surgical site infection rate of 3.52%. The surgical site infection was closely related to ages, basic diseases, surgical site, types of incision, preoperative hospital stay, operative time, urgent elective surgery, the use of antibiotics, medical staff hand hygiene and other factors, of which the rate of infection after amputation was the highest, reaching 23.81% (20/84). ConclusionMaking full preparations before operation, strengthening medical staff's hand disinfection, prophylactic antibiotics, good precautions and regulations in operation, and nursing meticulously after operation can be taken to prevent and reduce surgical site infection in orthopedic operation patients effectively.
ObjectiveTo explore a standardized model for cardiothoracic surgery resident training program based on a combined clinical and research oriented team approach. Methods We conducted this study in a nationally ranked Class AAA hospital among the eleven residents who were accepted into the program. Throughout their training periods, clinical surgical skills were taught by one-on-one mentoring by individually assigned doctoral degree advisors, other attending surgeons and doctoral degree candidates in the program. To foster their scientific curiosity and research skills, regular didactic lectures in basic science and statistical skills by the doctoral thesis advisors, supplemented by monthly journal clubs during which trainees were required to present and discuss a previously assigned topics based on recent clinical cases within the department, thus combining acquisition of clinical skills and theory/research at the same setting. ResultsEleven physicians were selected for this training path. With respect to clinical surgical skills, 4 residents were judged to be sufficient at the end of the first cycle. The other seven residents at the end of the second cycle. One trainee won the third prize in the Medical Skill Competition in the hospital. As for scientific research skills, the team produced 11 scientific articles, one of which was accepted by the annual national conference in cardiothoracic surgery and the first author was invited to present the article. The team submitted four research projects, one won funding at the provincial competition and three within the medical school. ConclusionOur proposed standardized model of cardiothoracic surgery resident training based on a combined clinical and research oriented approach appears to be practical with moderate success. Adaptation of this model by other cardiothoracic surgery training programs in the nation will further attest to its value and functionality.
ObjectiveTo investigate the influence of semi-mechanical and hand-sewn esophagogastric anastomoses on postoperative anastomostic complications in patients undergoing esophagectomy. MethodsA systematic, computer-aided literature search was performed in PubMed, OVID, CNKI and BioMed databases for studies which were published from database establishment to December 2013. A manual literature search was also performed. We included randomized controlled trials (RCT)and observational studies which investigated the influence of semi-mechanical and conventional hand-sewn esophagogastric anastomoses on postoperative anastomostic complications. Quality assessment and data extraction were performed, and RevMan 5.2 was used for meta-analysis. ResultsTwelve relevant studies with 1 271 patients were included (3 RCTs and 9 observational studies).No significant heterogeneity among the 12 trials was found, so fixed effects model was used for meta-analysis.There was statistical difference in the incidence of postoperative anastomotic leak between hand-sewn and semi-mechanical esophagogastric anastomoses[RCT RR=0.34, 95%CI (0.12, 0.97), P < 0.05;observational studies OR=0.40, 95%CI (0.26, 0.62), P < 0.05]. Postoperative incidence of anastomostic stricture was reported in all 12 studies. There was statistical difference in the incidence of postoperative anastomotic stricture between hand-sewn and semi-mechanical esophagogastric anastomoses[RCT RR=0.14, 95%CI (0.04, 0.47), P < 0.05;observational studies OR=0.22, 95%CI (0.15, 0.34), P < 0.000 1]. ConclusionsCompared with conventional hand-sewn anastomosis, semi-mechanical esophagogastric anastomosis can significantly reduce the incidence of postoperative anastomostic leak and stricture. Due to limited quantity and quality of included studies, more high-quality studies with larger sample size including RCT and non-randomized studies are needed to confirm these findings.
ObjectiveTo observe effect of echinococcus cyst fluid on proliferation and cell cycle progression of rat hepatic stellate cells (HSC-T6), and to preliminarily reveal a new mechanisms of pro-fibrogenic effect of alveolar echinococcosis. MethodsHSC-T6 cells were treated with different concentrations (0.00-0.90 mg/mL) of echinococcus cyst fluid. Then, the morphological changes were observed under the inverted microscope, the impacts on proliferation and cell cycle were tested by the CCK-8 assay and flow cytometry respectively. ResultsAfter treated by echinococcus cyst fluids with different concentrations (0.00-0.90 mg/mL) for 24 h, the most cells shrinked fusiform shape with more slender synapses, and the proliferation activities were increased with the concentration of echinococcus cyst fluid increasing when it was higher than 0.05 mg/mL (P<0.05), the proportion of G0/G1 was decreased (P<0.05) and those of S and G2/M were increased (P<0.05) with the concentration of echinococcus cyst fluid increasing. ConclusionsEchinococcus cyst fluid could promote proliferation of HSC-T6 cells in a dose-dependent manner, which might due to its impact on cell cycle progression. Therefore, alveolar echinococcosis might promote hepatic fibrosis through regulating hepatic stellate cells, but further research on detail needs to be done in future.
ObjectiveTo explore potential value of three-dimensional reconstruction technique for preoperative evaluation of hepatic alveolar echinococcosis. MethodsTwenty-one cases of hepatic alveolar echinococcosis proved by postoperative pathological examination in Affiliated Hospital of Qinghai University from October 2013 to March 2014 were analyzed retrospectively. The three periods of patients’ liver dynamic thin layerCTscan images were collected and imported in three-dimensional reconstruction software by DICOM format. The volume of the virtual resected liver tissue was calculated by software, and then was compared with the actual resected liver tissue volume. ResultsThe resected liver volume was (761.94±505.77) mL and (756.19±501.78) mL in the virtual surgery and in the veritable surgery, respectively. The proportion of resected liver in the total liver was (39.27±18.75)% and (38.95±16.99)% in the virtual surgery and in the veritable surgery, respectively. The resected liver volume had no significant difference between the virtual surgery and veritable surgery (P>0.05), which a positive relation (r=0.989, P<0.001). ConclusionThe limited preliminary data in this study show that three-dimensional reconstruction technique and virtual planning system for surgery could accurately guide resection of lesion and provide preoperative guidance of accurate liver resection for hepatic alveolar echinococcosis.
ObjectiveTo summarize clinical treatments of hepatic alveolar echinococcosis in recent years and provide a new basis for guiding clinical practice. MethodsThe relevant literatures about treating hepatic alveolar echinococcosis at home and abroad were reviewed. The clinical curative effect and advantages or disadvantages among various treatments were analyzed. ResultsThe radical surgery was still the primary treatment of hepatic alveolar echinococcosis, liver transplantation was more used in the treatment of the late hepatic alveolar echinococcosis. surgery combined with chemical therapy had an obvously clinical curative effect. ConclusionsWith a high incidence and poor prognosis of hepatic alveolar echinococcosis, it is difficult to cure. Radical surgery, liver transplantation, chemotherapy and radiation therapy have been used in clinical treatment of hepatic alveolar echinococcosis. It is essential to fully acknowledge indications of various treatments. At the same time, if occurrence and development of this disease could be further researched, it might bring us a new hope of curing hepatic alveolar echinococcosis.
ObjectiveTo detect expressions of interleukin-17 (IL-17) and interleukin-27 (IL-27) proteins in liver tissue of hepatic alveolar echinococcosis. MethodsThe edge liver tissues (from the lesion edge 0.5 cm) and the normal liver tissues (from the lesion edge 5 cm) of 20 patients with hepatic alveolar echinococcosis in the Affiliated Hospital of Qinghai University were collected and stored at-80℃ freezer. The immunohistochemical method was used to detect the expressions of IL-17 and IL-27 proteins in these two tissues. ResultThe positive rates of IL-17 and IL-27 protein expressions in the edge liver tissues were significantly higher than those in the normal liver tissues[IL-17:80.0% (16/20) versus 10.0% (2/20), χ2=12.36, P < 0.01; IL-27:85.0% (17/20) versus 20.0% (4/20), χ2=12.36, P < 0.01]. ConclusionHigh expressions of IL-17 and IL-27 protein in edge liver tissue might participate in progress of hepatic alveolar echinococcosis.
ObjectiveTo systematically review the quality of evidence-based guidelines (EBGs) on medication therapy for children with vitamin D deficiency, and to compare differences and similarities of the drugs recommended, in order to provide guidance for clinical practice. MethodsDatabases such as the TRIP, PubMed, EMbase, CNKI, VIP, WanFang Data, CBM, National Guideline Clearinghouse and Guidelines International Network were searched to collect EBGs on medication therapy for children with vitamin D deficiency. The methodological quality of the guideline was evaluated according to the AGREE Ⅱ instrument, and the differences between recommendations were compared. ResultsA total of 9 EBGs were included. Among them, 3 guidelines were developed by America, 1 by Europe, 1 by France, 1 by China, 1 by Poland, 1 by Canadian and 1 guideline was by Australia and New Zealand. Seven guidelines were developed specially for children, while others were for people of different ages. According to the AGREE Ⅱ instrument, only "Scope and purpose" and "clarity and presentation" were scored more than 60%. The recommendations of different guidelines were of large different. ConclusionThe quality of included guidelines concerning children with vitamin D deficiency is vary. Although only the America 2011 guideline is of high quality, the strength of recommendation is not high. Thus, the development of national guidelines is urgently needed.
ObjectiveTo investigate the expressions of type Ⅰ and type Ⅲ collagen protein in hepatic alveolar echinococcosis tissues, and to explore its relationship with the biological behavior in progress of hepatic alveolar echinococcosis (HAE). MethodsTwenty samples of normal liver tissues and liver tissues at the edge of the lesion with HAE in our hospital from Jan. 2012 to Dec. 2014 were collected, and HE and Masson staining were performed. The pathological changes and the degree of fibrosis of liver tissues around HAE lesion were observed under light microscope. The expressions of type Ⅰ and type Ⅲ collagen protein in liver tissues were detected by immunohistochemical staining. ResultsThe degree of liver fibrosis of liver tissues at the edge of the lesion with HAE was grade Ⅱ, and the degree of fibrosis of normal liver tissues was grade 0, the difference between the two was statistically significant (P < 0.05). The color index of type Ⅰand type Ⅲ collagen protein in the liver tissues at the edge of the lesion with HAE was 7.45±1.85 and 8.00±1.62, respectively, which were higher than those of normal liver tissues (3.10±1.02 and 3.50±0.89), the difference were statistically significant (t=-9.21, P=0.001;t=-10.88, P=0.001). ConclusionsThere is liver fibrosis around the lesion in the patients with HAE. HAE may promote the expressions of type Ⅰ and type Ⅲ collagen and then induce the occurrence of liver fibrosis.