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Objective:To comprehensively understand the operational status and existing problems of the neurosurgery professional training bases for standardized residency training in Guangdong Province.Methods:According to the scoring rules of "Standardized Residency Training Evaluation Indicators—Surgery (Neurosurgery) Professional Base" formulated by the Post-Graduation Medical Education Neurosurgery Professional Committee of the Chinese Medical Doctor Association, 28 training bases were supervised and evaluated. The scoring results of the supervision of 28 neurosurgery training bases were collected, and the training bases were divided into two categories according to the traditional teaching history, 6 affiliated hospitals of traditional medical schools and 22 non-traditional affiliated/teaching hospitals. GraphPad 5.0 software was used for statistical analysis of the 14 core indicators, and t-test, variance analysis and Chi-square test were used for analysis. Results:The results showed that there was a statistically significant difference in the compliance rate of 14 core indicators between traditional teaching hospitals and non-traditional teaching hospitals ( P = 0.003), skill operation and type and number of surgeries ( P = 0.041) and student rotation plan ( P = 0.012). The differences were also statistically significant. Conclusion:This study reveals that the comprehensive management ability of training bases in traditional teaching hospitals is significantly better than that in non-traditional teaching hospitals. Additionally, it's suggested to strengthen the construction of professional bases, enhance the institutionalized management of bases, and thus realize the homogenization training of neurosurgery residents.
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Objective:To evaluate the role of Angiojet thrombus clearance device in the treatment of dialysis access thrombosis.Methods:The clinical data of 37 patients with Angiojet thrombus clearance due to hemodialysis thrombosis from May 2019 to May 2021 were retrospectively analyzed.Results:The clinical success rate was 100%, the mean operation time was (42±21) minutes. The time of aspiration was (35±18) s, and the average length of occlusion was (8±5) cm. All patients were treated with balloon dilation after aspiration. The average postoperative dialysis flow was (270±15) ml/min. The mean length of stay was (2.0±1.5) days. There were no surgically related deaths, no vascular rupture or bleeding, no major complications. Dilated local pseudoaneurysm formation was observed in 5 patients after dilation by angiography without special treatment. The mean follow-up time was 11 months. The primary patency rate was 85% and the secondary patency rate was 87% at 6 months post operatively.Conclusion:Angiojet thrombus removal device has the advantages of minimally invasive, short operation time and repeatability.
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Objective@#A retrospective analysis of audiologic outcome and graft take rate on post-tympanoplasty with different middle ear mucosal conditions in wet ear. @*Method@#According to the characteristics of middle ear mucosal condition and residual eardrum, 80 cases with wet ear of chronic suppurative otitis media were divided into the hydrocele group, the swelling group and the granulation group. The factors in different groups, including gender, age, disease course, sides, size and location of perforations, destruction of ossicular chain and reconstruction methods were analyzed. Moreover, postoperative hearing improvement and graft take rate were compared among the three groups. @*Result@#There was no significant difference in gender, age, disease course, sides, size and location of perforations among the hydrocele group, the swelling group and the granulation group （P>0.05）. Overall, the postoperative average Air-Bone Gaps（ABG） were reduced in all wet ear patients after surgery （P<0.01）. The ABG was decreased from （25.5 ± 10.8） dB to（15.4 ± 9.4） dB in the hydrocele group, and decreased from （27.6 ± 8.7） dB to （15.2 ± 9.6） dB in the swelling group, and from （29.5 ± 7.7） dB to （17.2 ± 17.2） dB in the granulation group. The graft take rates were 90.0% in totally. There were no significant difference in graft take rates among the three groups, and 84.6% in the hydrocele group, 93.3% in the swelling group and 100.0% in the swelling group（P>0.05）. @*Conclusion@#Wet ear is not an absolute contraindication of tympanoplasty for chronic suppurative otitis media. Whether there was effusion, swelling or granulomatous hyperplasia in the tympanoplasty, the patients'hearing improved significantly after tympanoplasty, and the healing rate of the tympanoplasty did not decrease. Further basic and clinical studies are needed to standardize the timing of wet ear surgery, clarify the operative contraindication and elucidate the pathophysiological mechanism of eardrum healing.
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Objective:To observe the clinical effect of TurboHawk plaque excision system combined with drug-coated balloon in the treatment of femoral popliteal artery in-stent restenosis.Methods:The clinical and follow-up data of 13 patients with femoral popliteal artery in-stent restenosis were retrospectively analyzed, ankle-brachial index (ABI) and lower extremity artery CTA before and after surgery were recorded.Results:Surgery was successful in all the 13 patients.There was perioperative death, no major complications. One patient underwent salvage stent implantation due to residual stenosis of more than 30% in the proximal end of the stent after rotary cutting and expansion . The average postoperative ABI was (0.90±0.08), significantly higher than that before the operation ( P<0.05). All patients were followed-up for mean 16.4 months, One patient died of acute heart failure after 13 months, one of the lower extremity vascular CTA confirmed in-stent restenosis was treated by drug-coated balloon. The primary patency rate was 84.6% at one year. Conclusion:The mid-term results of directional atherectomy system combined with drug-coated balloon in the treatment of femoral artery in-stent restenosis is satisfactory.
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A retrospective analysis of audiologic outcome and graft take rate on post-tympanoplasty with different middle ear mucosal conditions in wet ear. According to the characteristics of middle ear mucosal condition and residual eardrum, 80 cases with wet ear of chronic suppurative otitis media were divided into the hydrocele group, the swelling group and the granulation group. The factors in different groups, including gender, age, disease course, sides, size and location of perforations, destruction of ossicular chain and reconstruction methods were analyzed. Moreover, postoperative hearing improvement and graft take rate were compared among the three groups. There was no significant difference in gender, age, disease course, sides, size and location of perforations among the hydrocele group, the swelling group and the granulation group （>0.05）. Overall, the postoperative average Air-Bone Gaps（ABG） were reduced in all wet ear patients after surgery （0.05）. Wet ear is not an absolute contraindication of tympanoplasty for chronic suppurative otitis media. Whether there was effusion, swelling or granulomatous hyperplasia in the tympanoplasty, the patients'hearing improved significantly after tympanoplasty, and the healing rate of the tympanoplasty did not decrease. Further basic and clinical studies are needed to standardize the timing of wet ear surgery, clarify the operative contraindication and elucidate the pathophysiological mechanism of eardrum healing.
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Objective@#To investigate the relationship between V-raf murine sarcoma viral oncogene homologue B1 (BRAF)V600E mutation and metastasis after thyroidectomy in papillary thyroid carcinoma (PTC) with different recurrence risk stratification.@*Methods@#From March 2014 to September 2017, 134 PTC patients (45 males, 89 females; age: 16-72 years) who underwent 131I treatment in the Department of Nuclear Medicine of Liaocheng People′s Hospital and had undergone BRAFV600E mutation detection were retrospectively analyzed. The recurrence risk during surgery was divided into 3 levels: low-, medium- and high-risk. Each recurrence risk group was divided into 3 subgroups according to the postoperative follow-up results: non-metastasis group, cervical lymph node metastasis group and pulmonary metastasis group. BRAFV600E mutation rates in different groups were compared (χ2 test).@*Results@#The BRAFV600E mutation rate was 55.22%(74/134) in 134 PTC patients. The mutation rates were not significantly different in the 3 metastasis subgroups for low-risk patients (n=46; χ2=2.39, P>0.05). In medium-risk patients (n=47), the mutation rate in neck lymph node metastasis group (16/19) was higher than that in pulmonary metastasis group (3/8) and non-metastasis group (25.00%, 5/20; χ2 values: 5.89 and 13.75, both P<0.05), while there was no difference between pulmonary metastasis group and non-metastasis group (χ2=0.44, P>0.05). In high risk patients (n=41), the mutation rate in neck lymph node metastasis group (85.00%, 17/20) was higher than that in the pulmonary metastasis group (5/13) and non-metastasis group (1/8; χ2 values: 7.68 and 13.08, both P<0.01), while there was no difference between pulmonary metastasis group and non-metastasis group (χ2=1.64, P>0.05).@*Conclusion@#The BRAFV600E mutation is closely related to neck lymph node metastasis after operation in middle- and high-risk patients with PTC, but it does not significantly increase the probabilities of neck lymph node metastasis in low-risk patients and pulmonary metastasis in low-, medium- and high-risk patients.
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Objective:To explore the characteristics of prevailing factors and their influence on esophageal cancer in Xinjiang. Meth-ods:Patients diagnosed with esophageal cancer from January 2010 to January 2016 were selected from the Xinjiang Medical Universi-ty First Affiliated Hospital and categorized as the patient group. Patients without cancer admitted to the same period were classified as the control group. Case control study and correlation analysis between esophageal cancer and type 2 diabetes were performed. Re-sults:Type 2 diabetes (≥2 years), as a risk factor, is associated with esophageal cancer. The use of insulin (≥2 years) can increase the risk of esophageal cancer. Smoking, drinking, hyperlipidemia, body mass index≥24, and esophageal diverticulum esophageal cancer are also risk factors. Conclusion:The risk factors for esophageal cancer are prevalent among patients with type 2 diabetes patients. In-sulin use is also correlated with the occurrence of esophageal cancer. Further studies must be performed to develop secondary preven-tion for diabetic patients susceptible to esophageal cancer in high-risk subgroups.
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Objective To evaluate the safety and efficacy of preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty in treating chronic occlusive arterial disorders of lower extrenities under the second time window principle for thrombolysis.Methods From Jan 2001 to Dec 2014,preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty was performed in 206 patients with chronic occlusive arterial disorders of lower extremities.All the patients had a history of chronic ischemia of lower limb for an average of (20 ± 9) months (3-60 months).Anklebrachial index (ABI) was 0.00-0.65 with a mean of (0.33 ± 0.22).Results The mean time of thrombolysis was 72 hours (within a range of 24-120 h).The D-dimer level multiplied next day after thrombolysis.The occluded length of the diseased arteries before the treatment was 60-180 mm,with a mean of (90 ± 27) mm.After catheter-directed thrombolysis,the occluded length decreased to 20-60 mm [mean of (40 ± 15) mm].Thrombolysis was effective in 192 patients (92％).Endovascular angioplasty was successfully completed in all patients after thrombolysis therapy.Postoperative ABI was 0.64-1.0 [mean of (0.86 ± 0.11)].During the perioperative period no complications nor death occurred.Conclusions Under the guidance of the second time window principle for thrombolysis,preparatory catheterdirected thrombolysis together with assisted endovascular angioplasty is an effective and safe treatment for chronic occlusive arterial disorders of the lower extremities.
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Objective To evaluate the value of technetium-99m methoxy isobutyl isonitrile (99Tcm-MIBI)tomography and integrated CT in preoperative localization diagnosis of secondary hyperparathyroidism (SHPT).Methods 28 patients with SHPT were selected.15 minutes and 90 minutes (delayed images)after intravenous administration of 99Tcm-MIBI 370 MBq,static anterior planar images of the neck and chest were obtained.99Tcm-MIBI tomography and integrated CT scan were acquired after the delayed imaging.The imaging findings were compared to the pathological results.Results The detection rate of SHPT lesions by 99Tcm-MIBI dua-phase imaging and 99Tcm-MIBI tomography and registration with integrated CT scan was 53.3％ and 70.7％ respectively.The difference had statistical significance(X2 =5.903,P＜0.05).The fusion imaging with integrated CT can provide detailed anatomy data and more information for surgical doctors.Conclusion 99Tcm-MIBI tomography and registration with integrated CT scan can improve the detection rate of SHPT compared with 99Tcm-MIBI dua-phase imaging,provide more detailed anatomy data,and has high clinical value in preoperative localization and diagnosis of SHPT.
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<p><b>OBJECTIVE</b>To identify the risk factors associated with the severity of pulmonary embolism among patients with deep venous thrombosis of lower extremities.</p><p><b>METHODS</b>This prospective study enrolled 208 patients with acute deep venous thrombosis to screen for pulmonary embolism between July 2010 and July 2012 in Beijing Shijitan Hospital. There were 101 male and 107 female patients, with a mean age of (59 ± 16) years. Gender, age, extension, side of lower extremities of deep venous thrombosis was analyzed by χ² test. Ordinal Logistic regression was used to determine risk factors associated with severity of pulmonary embolism.</p><p><b>RESULTS</b>There were 83 patients with iliofemoral deep venous thrombosis, 102 patients with femoropopliteal and 23 patients with calf deep venous thrombosis. Pulmonary embolism was detected in 70 patients with the incidence of 33.7%. Pulmonary embolism was significantly correlated with extension (χ² = 17.286, P = 0.004) and sides (χ² = 15.602, P = 0.008) of deep venous thrombosis, not with age (χ² = 7.099, P = 0.260), gender (χ² = 7.014, P = 0.067), thrombotic risk factors (χ² = 3.335, P = 0.345) in univariate analysis. Results of multivariate ordinal logistic regression showed that iliofemoral vein thrombosis (OR = 6.172, 95% CI: 1.590 to 23.975, P = 0.009) and bilateral venous thrombosis (OR = 7.140, 95% CI: 2.406 to 24.730, P = 0.001) are associated with more serious pulmonary embolism.</p><p><b>CONCLUSIONS</b>Incidence of pulmonary embolism is still high in patients with deep venous thrombosis. Extensive iliofemoral and bilateral vein thrombosis may increase risk of severity of pulmonary embolism. Clinicians should pay more attention to these high-risk patients.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Acute Disease , Incidence , Logistic Models , Lower Extremity , Pathology , Prospective Studies , Pulmonary Embolism , Diagnosis , Pathology , Risk Factors , Veins , Pathology , Venous Thrombosis , Diagnosis , PathologyABSTRACT
Objective To explore the influence of the protection motivation theory (PMT) on the self-nursing ability of high-risk diabetic foot (DF) patients. Methods The outpatients in our hospital were selected with high-risk DF between January 2013 and May 2014, randomly divided into the control group and PMT group, 52 cases in each group. Guided under the protection motivation theory, PMT group received a six-month health education and management; and the control group accepted conventional health education of diabetes. Before and after the intervention, some observation indexes of the two groups respectively were evaluated including the ability of diabetic foot self-nursing, foot condition, fasting blood sugar, 2 h postprandial blood glucose. Result After six months, the scores of the self-care ability of diabetic foot and foot condition from the patients of PMT group were higher than that of PMT group before the intervention and that of control group after intervention (P<0.05). Conclusion PMT can help patients with high-risk DF enhance their foot self-care ability, improve their foot condition, control their blood sugar, and prevent the DF onset.
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Objective To evaluate the value of technetium-99m methoxy isobutyl isonitrile(99Tcm-MIBI) tomography and integrated CT scan in preoperative localization diagnosis of primary hyperparathyroidism (PHPT). Methods 31 patients with PHPT were selected .15 minutes and 90 minutes ( delayed images ) after intravenous administration of 99 Tcm-MIBI 370 MBq, static anterior planar images of the neck and chest were obtained .99 Tcm-MIBI tomography and integrated CT scan were acquired after the delayed images .All patients received neck ultra-sound scan before surgery .The imaging findings were compared to the pathological results .Results The detec-tion rate of hyperparathyroidism lesions of 99 Tcm-MIBI dual-phase imaging and 99 Tcm-MIBI tomography and regis-tration with integrated CT scan was 87.1%and 93.5%respectively, without statistical significance (P>0.05). However , they were both higher than ultrasound scan which had a detection rate of 64.5%.The differences had statistical significance (χ2 =4.039 and 7.884 respectively , P<0.05 ) .The detection rate of parathyroid hyper-plasia of 99 Tcm-MIBI tomography and registration with integrated CT was both 80.0%, higher than that of the ul-trasound test(40.0%)and 99Tcm-MIBI dual-phase imaging(40.0%).The fusion imaging with integrated CT scan provided detailed anatomy data and more information for surgical doctors .Conclusions 99 Tcm-MIBI tomography and registration with integrated CT scan can improve the detection rate of PHPT compared with 99 Tcm-MIBI dual-phase imaging , provide detailed anatomy data , and has high clinical value in preoperative localization diagnosis of PHPT.
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Long-term medical education program requires that the medical students should ac-quire both professional knowledge and scientific research ability. These students,with heavy task and course,have difficulty in performing the scientific research systematically. It is very important to develop the early scientific research training. Department of pathology in Central South University,took early sci-entific research activities in various forms,such as literature searching,reviews writing,research design-ing,experiment performing,lecture communicating and clinical practicing after combining the discipline characteristic and arranging the overall process. Satisfactory effects were achieved with efforts.
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Objectives To assess outcomes of endovascular treatment for critical limb ischemia in patients with TASC C and D femoropopliteal lesions.Methods Between January 2009 and January 2012,patients with critical limb ischemia for TASC Ⅱ C or D lesions underwent endovascular treatment.Patients demographic,pre-and post- procedure ABI,primary patency rate,limb salvage at 1,3,6,12,24 months were reviewed.Results There were 58 males,38 females, mean age was (76 ± 10 ) years,with Rutherford Ⅳ in 68 limbs,Ⅴ in 23 limbs,Ⅵ in 5 limbs.Successful rate of procedure for target lesions was 94.80％,angioplasty alone was performed in 13 limbs,stent in 80 patients,thromblysis assisted angioplasty and stent in 8 limbs.Stents of popliteal artery were implanted in 47 limbs.Major complication rate was 19.80％,two patients died within 30 days.Mean ABIs were 0.25 ±0.17 and 0.76 ±0.23 before and after procedure.Mean time of follow up was (12 ± 6) months.Primary patency rates and limbs salvage rate were 94.79％ and 95.83％,93.73％ and 95.83％,88.01％ and 93.42％,78.34％ and 93.42％,68.38％ and 83.04％ on 1,3,6,12,24 months respectively.Conclusions Patients with critical limb ischemia caused by TASC C/D lesions often suffer from significant comorbid medical conditions.Endovascular procedure has a high risk of morbidity and restenosis,but short term limb salvage rate is satisfactory.
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Objective To assess the clinical effect of tumor-type prosthesis replacement for treatment of giant cell tumors of bone near the joints. Methods Thirty-seven patients with giant cell tumors of bone near the joints from January 1998 to January 2008 were reviewed. 18 were males and 19 were females. The ages ranged from 19 to 64 and the median age was 32 years old. The anatomic site of the lesions spreaded at distal femur(23 cases) , proximal tibia(10 cases),proximal humerus(3 cases) and proximal femur(1 case). According to Companacci's staging system: 9 patients were classified as grade II and 28 as grade Ⅲ. All patients had been treated with block excision and reconstruction with prosthesis. The functional outcomes were evaluated by MSTS 93 score. Results According to the follow-up for 2 -9 years,1 patient (4. 3% ) had local recurrence and underwent amputation of the diseased limb. As for the complications, periprosthesis infection occurred in 1 patient, prosthesis loosening in 2 patients. The average MSTS 93 score was 22. 49 ±5. 16 in 3 years after surgery. The evaluated functional result revealed excellent or good performance in 89. 2% of the patients. Conclusions Tumor-type prosthesis replacement is an effective procedure to reduce the local recurrence,and to restore joint function.
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Objective To explore differential expression of protiens between patients with esophageal cancer and healthy individuals, and to screen out the tumor biomarkers to construct a dignostic model. Methods From January to August, 2008, the clinical data of 127 patients with esophageal cancer (esophageal cancer group) who had been admitted to the First Affiliated Hospital of Xinjiang Medical University and 63 healthy individuals (control group) were retrospectively analyzed. The serum proteomic profiles of the esophageal cancer pateints and healthy individuals were deteced by weak cation exchange and hydrophobic surface ProteinChip using the surface enhanced laser desorption/ionization-time of flight-mass spectrometry (SELDT-TOF-MS) technique.Serum differentially expressed markers of esophageal cancer were screened out to establish the diagnostic model for esophageal cancer. All data were analyzed using rank sum test. Results Six proteins were high-expressed in the esophageal cancer group, and the mass-to-charge ratios were 4488, 5495, 15964, 3948, 8154, 8166. Four were low-expressed in esophageal cancer group, and the mass-to-charge ratios were 8789, 6682, 8714, 6650. A diagnostic model consisting six proteins was established. A total of 124 patients were correctly diagnosed and three were misdiagnosed in the esophageal cancer group, and 60 were correctly diagnosed and three were misdiagnosed in the control group. The accuracy, sensitivity and specificity of the diagnostic model were 96.8% ( 184/190),97.6% ( 124/127 ) and 95.2% (60/63). Conclusions The diagnostic model established based on the tumor markers screened out by the SELDT-TOF-MS is highly sensitive and specific.
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<p><b>BACKGROUND</b>Reconstruction of carina, bronchoplasty and arterioplasty are widely used to extend the indication of lung cancer operation. Because these procedures preserve as many healthy lung tissues as possible, their therapeutic effect is better than pneumonectomy in many central lung cancer cases with poor cardiopulmonary function. The aim of this study is to explore the feasibility and indication of extended resection in selected patients with centrally located lung cancer.</p><p><b>METHODS</b>From November, 1979 to January, 2003, lobectomy or pneumonectomy combined with extended resection of tracheo-carina, bronchus or vessels were performed in 50 patients with centrally located lung cancer. Tracheo-carinal reconstruction and bronchoplasty were performed in 48 cases, and pulmonary arterioplasty in 2 cases.</p><p><b>RESULTS</b>Postoperative complications occurred in 4 patients (8.0%), and operative death occurred in 2 patients (4.0%). All the 48 patients were followed up from 1 to 10 years. The 1-, 3-, 5- and 10-year survival rate was 89.4% (42/47), 57.1% (20/35), 42.1% (8/19) and 25.0%(2/8) respectively.</p><p><b>CONCLUSIONS</b>Extended pulmonary resection combined with tracheo-carinal reconstruction, bronchoplasty and vascular reconstruction is feasible for selected patients with centrally located lung cancer. It is helpful to prolong the long-term survival of patients with lung cancer.</p>
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Objective To explore the complication s and management of the placement of vena caval filter in patients suffering from deep venous thrombosis (DVT). Methods From 1998 to 2005, 80 DVT patients were treated by vena caval filte r placement. Before the placement 46 cases received CTA, 27 cases did radionucli de imaging(LPS), 16 cases did color Doppler ultrasonography, 5 cases underwen t venography. Result The p rocedure was successful in all 80 cases. New DVT developed in contralateral fem oral vein in 2 patients and vena caval obliteration developed in 3 patients afte r one year. Conclusion The complications of vena caval filter placement could be prevented by correctly de fine indication and good expertise.
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qualitative and quantitative analysis of solid depolymerization products for supercritical methanolysis of ploy(ethylene terephthalate) polyester (PET) were studied by means of reversedphase high performance liquid chromatogr aphy on ZorbaxC8(4.6mm×250mm) with 70%(V/V) methanol as mobile phase. The results showed that the solid depolymerization products were mainly composed of dimethyl terephthalate (DMT), methyl(2hydroxyethyl)terephthalate (MHET), bis(hydroxyethyl)tere phthalate (BHET), dimers and oligomers, which could be separated effectively under the above chromatographic conditions. The calibration curves of DMT and BHET were linear in the range of 1.0～45 mg/L (n=8),r=0.9998～1.0000 and RSD＜2.8%. The determination limits of DMT and BHET were 4.0×10-4μg and 6.0×10-4μg respectively.
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Objective To prevent and manage spinal ischemia caused by cross-clamping the thoracoabdominal aorta often undertaken in clinical surgical practice. Methods Forty-five rabbits were divided for 3 experiments. A variety of vasoactive agents were used to manage spinal ischemia; The effect of cerebrospinal fluid drainage was evaluated; Hypothermia was used to alleviate the spinal ischemia injury. Results Among the above three experiments neuron degeneration was the mildest in hypothermia group though prostaglandin and cerebrospinal fluid drainage do have some positive effects. Conclusion It was suggested that administration of hypothermia and prostaglandin are the most effective for the prevention of spinal ischemic injury during major thoracoabdominal aorta surgery.