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Objective:To investigate the clinical value of totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization for portal hypertension com-plicated with splenic aneurysm.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 17 patients with portal hypertension complicated with splenic aneurysm who were admitted to 2 medical centers (15 cases in Shenzhen University General Hospital and 2 cases in Wuhan First Hospital) from January 2013 to May 2020 were collected. There were 7 males and 10 females, aged (59±14)years. All patients underwent totally laparoscopic exoclusion of splenic artery aneurysm combined with pericardial devascularization. Observation indicators : (1) surgical and postoperative conditions; (2) complications; (3) follow-up. Follow-up was conducted by out-patient examiantion and telephone interview to detect the effect of exclusion of arterial tumor, and blood re-flow, portal vein thrombosis and survival of patients 3 months after operation. The follow-up was up to December 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Results:(1) Surgical and postoperative conditions. All 17 patients successfully completed the operation, without perioperative death. The operation time, volume of intraoperative blood loss of 17 patients were (181±30)minutes, 187(range, 90?420)mL. The white blood cell count, red blood cell count, hemoglobin, serum albumin were (9±4)×10 9/L, (3.5±0.9)×10 12/L, (86±17)g/L, (36±7)g/L on the postoperative day 3. Time to postoperative abdominal drainage tube removal and duration of post-operative hospital stay were (7±4)days and (11±4)days. (2) Complications. All 17 patients had ascites after surgery, which were improved after oral treatment with diuretics. There was no complication such as intra-abdominal hemorrhage, gastrointestinal fistula, pleural effusion, infection, abscess formation, fever and vascular embolism. (3) Follow-up. All the 17 patients were followed up for 28.6(range, 7.0?84.0)months. During the follow-up, the splenic aneurysm cavity of all patients was completely isolated, no blood re-flow and no portal vein thrombosis was observed, and no patient died. Conclusion:Totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization is safe and feasible in the treatment of portal hypertension complicated with splenic aneurysm.
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Objective: In order to describe the employment status of the first group of targeted admission medical graduates, evaluate the effects of targeted admission medical education program, find out the existing problems and provide relevant policy recommendations.Methods: This study conducted follow-up survey among 305 medical graduates and 315 clinical medical graduates in four medical colleges of the central and western regions.Data analyses of the contract fulfillment, their employment status, and their participation in the standardized residency training are carried out.Results: The contract fulfillment rate of rural-oriented medical graduates is 99.3%, while the percentages of rural-oriented medical graduates and clinical medical graduates are 90.7% and 2.8%, respectively.Their average monthly incomes are respectively 2,011 and 2,774 yuan, and their proportions of participating in standardized residency training are 77.8% and 43.3% respectively.From the findings it can be seen that the employment situation of the first group of targeted admission medical graduates in four medical colleges and universities is quite good, but the policy implementation process in terms of permanent post and income is less satisfactory.However, the way how medical graduates should participate in the standardized residency training is not yet clearly regulated.This paper recommends that medical colleges and universities should well coordinate with local health administrative departments and human resources and social security departments to systematically deploy medical graduates.At the same time, full consultations should be conducted to make appropriate arrangement for medical graduates to participate in standardized residency training.
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Objective:To provide policy recommendations for Beijing public health departments to grasp the dy-namic allocation of healthcare resources and the advantage of medical functional dispersal, and making appropriate health policies to rationally adjust the allocation of health resources. Methods:To study the dynamic function of Bei-jing medical, this study uses the method of accounting of cases summary of the annual report on health finance through the descriptive analysis of the gross fixed capital formation in various regional government-run health facili-ties. Results:The results of this study show that the quality of medical health administrative resources was higher, but effectively dispersed in 2015. By contrast, the basic public health resources allocation was unbalanced. Conclu-sion:This study puts forward the corresponding health policy suggestions. On one hand, it is important to make fur-ther policy to encourage high quality medical resources to be effectively relieved and the regional planning should be done according to market demand by avoiding the blind construction at the early stages. On the other hand, much at-tention should be paid on the balanced development of the basic public health service ability and the coordinated de-velopment of administrative capacity in health, and supporting policies should be formulated, which should rationally allocate the public health resources for a better overall medical functional dispersal.
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Objective To discuss the technical method,safety and clinical efficacy of CT-guided 125I radioactive seed implantation for the treatment of mediastinal lymph node metastases.Methods CT-guided 125I radioactive seed implantation was carried out in 11 patients with mediastinal lymph node metastases.Before 125I seed implantation,the interstitial brachytherapy treatment planning system (TPS) was employed to formulate a treatment plan.The particles with radioactivity of (1.11-2.96) × 107Bq (0.3-0.8 mCi) were used for the implantation.Postoperative complications were recorded.The local lesion control rate and the effective rate of pain relief were evaluated at one,3,6 and 12 months after 125I seed implantation.Results After 125I seed implantation,pneumothorax occurred in 3 patients,tracheal fistula in one patient,and pulmonary infection in one patient.The local lesion control rates at one,3,6 and 12 months were 81.8％,90.9％,72.7％ and 72.7％ respectively;the effective rate of pain relief at one week,one,3,6 and 12 months were 100％,90.9％,90.9％,81.8％ and 72.7％ respectively.Conclusion For the treatment of mediastinal lymph node metastases,CT-guided radioactive 125I seed implantation is less-invasive with less complications,and it carries reliable local lesion control rate.Therefore,this technique is a safe therapeutic means.
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For attracting more social charity funding into the health field, in-depth interviews are conducted into four health foundations in Beijing, presenting three aspects of existing problems and obstacles in the foundations devel-opment in this article. Firstly, the foundations have low effect in fundraising, poor information publication, little com-munication between other facilities and vague mechanism in donation. Secondly, the social public has erroneous views leading to deviant behavior. Finally, some annual inspection standards of the foundation are not suitable for the health field. Based on the above analysis, suggestions about how to improve transparency and fundraising ability in foundations and change the public erroneous views in donation are proposed. The governments might be suggested to get more relax-ed on the annual inspection standards of the foundations, and build an information platform in healthcare field as well.
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Objective To explore the mechanism of 125I seed interstitial implantation-induced apoptosis of liver VX2 tumor cells in experimental rabbits, and to compare the effects of different radioactivity 125I seeds on the apoptosis and on the proliferation of tumor cells. Methods A total of 24 rabbit models with VX2 liver cancer were randomly and equally divided into 3 groups, and 125I seeds with different initial radioactivity were separately implanted into the rabbits of the three groups. 125I seeds of 0 mCi radioactivity were used in the control group (n=8), 125I seeds of 0.7 mCi radioactivity were used in the 0.7 mCi group (n=8) and 125I seeds of 1.0 mCi radioactivity were used in the 1.0 mCi group (n=8). The experimental rabbits were sacrificed at 5 weeks after the implantation; the tumor lesions were removed, and the effects of 125I seeds on the apoptosis and proliferation of tumor cells were determined. The tumor cell apoptosis rate, tumor growth-related factors, tumor growth factor expression protein and the influence of caspase-3 activity were evaluated. Results Regardless of their initial radioactivity, all the 125I seeds could make the tumor cell apoptosis rate increased, make Bcl-2 and VEGF expression level decreased, and make Bax expression increased, which were more obvious in 1.0 mCi group (P0.05). Conclusion The implanted 125I seeds can not only inhibit tumor’s growth through inducing apoptosis of tumor cells, but also inhibit tumor’s angiogenesis through influencing the expression of apoptosis-related gene and coding protein.
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OBJECTIVE To observe the protection of vitamin C on the cardiac injury induced by 50 nm titanium dioxide inmice.METHODS Kunming mice were ad mistered by ig of vitamin C 100,200 and 400 mg·kg -1 for 2 d.And then the mice were ad mistered by ig of nano-TiO2 2 g·kg -1 and vitamin C (100.0,200.0 and 400.0 mg·kg -1 )for 3 d,the interval of treatment with nano-TiO2 and vitamin C was 4 h.The mice were scarified 24 h later after the last ad ministration.Electrocardiogra m (ECG)was determinated by physiological recorder.The myocardial enzy mes activities in serum and superoxide dismutase (SOD)and glutathione peroxidase(GSH-Px)activities in serum and myocardial tissue were determinated by bioche mical method.Cometassay was used to detect the DNA da mage of the heart. Heart tissue was used for histopathological exa mination by HE staining.RESULTS Co mpared with the control,ECG showed higher S-T and T-wave a mplitude of nano-TiO2 2 g·kg -1 (P<0.05).The myocar-dial enzy mes activities significantly increased and activities of SOD and GSH-Px significantly decreased in nano-TiO2 group,compared with the control group(P <0.05).Cometassay showed that olive tail mo ment (OTM)was significantly increased after nano-TiO2 2 g·kg -1 ,compared with the control group (P<0.05).The histopathology showed ede ma of myocardial cells,myofibril disorders and increasing infla mmatory cells.Vita min C 100,200 and 400 mg·kg -1 can decrease S-T in ECG,OTM,myocardial enzy mes activities,increase the SOD and GSH-Px activities in serum and myocardial tissue;reduce myocardial hypertrophy and infla mmatory cells.CONCLUSION nano-TiO2 can induce myocardial injury inmice and vitamin C can alleviate the da mage.The mechanism may be associated with the antioxidant ability of vitamin C inmyocardial tissue.
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Objective To retrospectively analyze the effect of interventional embolization for hepatocelluar carcinoma (HCC) associated with arteriovenous shunting (AVS), and to discuss the factors influencing the therapeutic results. Methods The clinical data of 62 cases with HCC associated with AVS , who were treated with interventional chemoembolization , were retrospectively analyzed. Based on the type and extent of AVS identified by angiographic manifestations, appropriate obstruction of the shunt and Lipiodol chemoembolization of HCC were conducted. The curative effect of the shunt embolization was assessed by DSA at one or two months after the treatment. The relevant factors influencing the prognosis of embolization were analyzed by using univariate and multivariate Cox regression analysis methods. Results Of the 62 patients, arterioportal shunting (APS) was detected in 44, hepatic arterio-venous shunting (HAVS) in 11, APS together with HAVS in 4, and hepatic artery-pulmonary artery shunting (HAPAS) in 3. Re-examination with DSA was carried out in 53 patients at 1 - 2 months after the treatment , which showed that the shunting disappeared in 18 cases, obvious reduction of the shunt flow was seen in 19 cases, the lesion remained stable in 9 cases and the disease became worse in 7 cases. Univariate analysis indicated that the kind of embolic material and the presence of tumor thrombus could affect the obstructive result of the shunt , while multivariate Cox regression analysis showed that portal tumoral thrombus was an independent risk factor. The embolization effect of polyvinyl alcohol (PVA) particles and Lipiodol-ethanol mixture, used as the embolic agents, was better than that of gelatin sponge particles. Conclusion To ensure a successful interventional chemoembolization for HCC combined with AVS the procedure should be individualized according to the type and extent of the arteriovenous shunting. The type of embolic materials used for embolization can affect the results to a certain degree.
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To evaluate the effects of blood pressure levels on prognosis of intracranial trauma patients with cognitive dysfunction. One hundred and twenty intracranial trauma patients enrolled in our hospital from February 2011 to July 2013 were selected, including 40 hypertension and 80 non-hypertension cases. They were investigated by MiniMental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA] scales, and the clinical data were retrospectively analyzed. Compared with the control group, the MoCA, visuospatial executive function, attention, language, delayed recall, MMSE, orientation and memory scores of the hypertension group were significantly lower. Unconditional Logistic regression analysis showed that age, history of cerebrovascular disease and triglyceride level were the independent risk factors of cognitive function. The blood pressure levels of intracranial trauma patients were associated with cognitive function, with age, history of cerebrovascular disease and triglyceride level as the independent risk factors. Therefore, it is necessary to control blood pressure level to improve prognosis
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ObjectiveTo evaluate the technical feasibility of animal model of avascular necrosis of femoral head (ANFH)with transcatheter arterial embolization (TAE).MethodsTwenty experimental pigs were randomly divided into experimental group and control group (each n= 10).Experimental group:A 5F Cobra catheter was inserted into left femoral artery,and the feeding arteries of femoral head were superselectively inserted.The feeding arteries were embolismed through transcatheter arterial injecting the segments of silk measuring about 500μm.Control group:The arterial embolization was not performed,and the other treatment was identical to experimental group.The articulation of hip in all pigs underwent plain X-ray examination,CT and MR scanning 2 weeks and 4 weeks after treatment,respectively.Histological examination was made in 4 weeks to evaluate volume of bone trabecula (TBV) and percentage of bone lacuna (PBL) at unit area under microscope.The data were compared between the two groups.Results In experimental group,CT and MRI showed swolling in hip soft tissue and high T1 in hip joint cavity,while no obvious abnormalities were found in plain X-ray film 2 weeks after feeding arteries were embolized.Four weeks after feeding arteries embolization,plain X-ray film,CT and MR showed typical necrosis of femoral head in the experimental group,while no obvious abnormalities were found in control group.The histology examination revealed there were obvious karyopyknosis and anachromasis in the bone cells.The quantity of bone cells decreased obviously or disappeared.PBL increased and TBV decreased significantly compared with those of control group (P＜0.05).ConclusionThe animal model of ANFH in pigs can be induced by TAE.It can preferably mimic the pathological situation of ANFH.
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Objective To observe the relationship between the expression of GFAP and iNOS the post-traumatic intervals after experimental cerebral contusion,in order to attempt to find out a method of timing wound age of brain contusion in the forensic prediction of injury time.Methods After setting up an model of experimental focal cerebral contusion in rats,immunohistochemical method was applied to observing the changes of inducible nitric oxide synthase (iNOS) and glial fibrillary acidic protein (GFAP) staining combined with histology method in rats.The immunostaining results were measured quantitatively with computer imaging analysis system.Results (1) At 3h after injury,GFAP-positive astrocytes around the wounded area were definitely detected.The intensity and the area of GFAP-positive cells increased following the post-traumatic intervals.The intensity peaked dually at 1d and 5d,respectively,followed by reduction at 3d,which revealed two-peak waveforms,The area of GFAP positive cells enhanced significantly at 3h and gradually increased with prolonging survival time,and reached a peak at 7d after injury.(2) At 12h after injury,the iNOS isoform was present and iNOS positive staining cells were noted.The intensity and the area of iNOS positive cells increased following the post-traumatic intervals.The area of positive reached maximal level at 1-3days,gradually subsided after 5d,and maintain a higher lever up to 7d post-injury;but the intensity of individual positive cell gradually increased with prolonging survival time,reached a peak at 5d and gradually subsided after 5d,but the level was still higher than the initial interval.Conclusions Expression of GFAP and iNOS is correlated with post-traumatic intervals after cerebral contusion in rats,suggesting that the expression of iNOS and GFAP may be served as the markers for timing of brain contusion in forensic practice.
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Three patients with carotid body tumor were treated by surgery in our department from 1994 to 1998. There were 3 females with age from 23 to 40 years old. Among 3 cases, 2 cases were misdiagnosis as neurilemmoma before operation. The size of tumor was 2.5×2.5cm in 1, 3.0×3.0cm in 2. The treatment methods were surgery alone in 2, combined radiotherapy in 1. All patients were cured who had not serious complications. We think that the three symptoms of carotid body tumor are important bases for diagnosis on this disease. However, color B ultrasonography, DSA, CT or MRI also provided informations for useful diagnosis.
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Objective To investigate the selective killing effect of MDA/IL-24 on human hepatocellular carcinoma line HepG2 in vitro and provide a theoretical basis for gene therapy of hepatocellular carcinoma.Methods The MDA-7/IL-24 gene was transfected into human hepatocullular carcinoma cell line HepG2 and normal liver cell line L02 with a replication-incompetent adenovirus vector.The mRNA and protein expression of MDA7/IL-24 in HepG2 and L02 cells was examined by RT-PCR and ELISA assay respectively.MTT assay and flow cytometry were used to study tumor cell proliferation and cell cycle in vitro.Hoechst and Annexin-V and PI staining were studied to indicate the apoptosis.Results RT-PCR confirmed that the exogenous MDA-7/IL-24 gene was expressed in HepG2 and L02 cells.The protein product was confirmed by assay of the supernatant with ELISA.MTT and apoptosis test indicated MDA-7/IL-24 induced growth suppression and cell apoptosis of the HepG2 cell in vitro but not in cell line L02,and cell cycle test revealed MDA-7/IL-24 could block HepG2 cell in G2/M but not in L02.Conclusions MDA-7/IL-24 selectively induces growth suppression and apoptosis in lines HepG2 in vitro but not in L02 cell,which indicates that adenovirus mediated MDA-7/IL-24 can be an excellent tool for gene therapy in hepatocellular carcinoma.
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Objective To explore a new molecular target for HSV-tk/GCV system in human liver cancer therapy.Methods The lactose and poly-L-lysine covalently linked compound(Lac-PLL) were prepared by using reductive amination methods and purified by using Sephadex G10 gel filtration.The value of n was determined by methods of phenol-vitriol colorimetry.The plasmid r-pAs16Dr was mixed with the conjugate to form a gene delivery complex named GlanPLL-r-pAs16Dr.The GlanPLL-r-pAs16Dr was transformed to different cell lines such as HepG2 and A549 to confirm the expression of RFP.The expression of HSV-tk was confirmed by RT-PCR.Cells with various concentrations of GCV were observed at different time points using MTT.Results The PLL modified by 34 Lac was obtained by using chemical synthesis.The RFP was expressed in HepG2 by 48h after transfection,and was not expressed in A549.The expression of HSV-tk was only detected in HepG2 using RT-PCR.The HepG2 transformed with GlanPLL-r-pAs16Dr was sensitive to GCV and the growth inhibiting rate was 70.5% with the treatment of low concentration of GCV(1mg/L) for 3 days.The A549 was not sensitive to GCV.Conclusion Lac-PLL,which is easy to prepare,is an efficient carrier for HSV-tk to be delivered to hepatoma cell lines by binding to ASGPR.
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Objective To evaluate the therapeutic effects and experience of the tracheal stent implantation for the management of severe tracheal stenosis.Materials Thirteen patients with severe tracheal stenosis of various causes underwent high kilovoltage radiography and computed tomography for evaluating the site,form and extent of the stenosis including 10 at the trachea,1 at the right main bronchus and 2 at left main bronchus.The C2 catheter assisted with ultra-slipping guide wire was inserted into the trachea under fluoroscopy and then a replaced high shoring guide wire was pushed through the stenotic segment and retained the stent. Results All stents were implanted successfully with successful rate 100% together with dyspneic improvements.The mean survival time was 6.2 months for patients with malignant neoplasm.One patient with benign tracheal stenosis has been followed-up for 5 years without restenosis. Conclusions The tracheal stent implantation is an effective means for severe tracheal stenosis.