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Objective To evaluate the rupture risk of carotid atherosclerotic plaque under cervical rotatory manipulation. Methods The fluid-structure interaction (FSI) model of carotid atherosclerotic plaque was established, and tensile deformation of the plaque and lumen under cervical rotatory manipulation was simulated.Mechanical parameters such as the maximum flow shear stress(FSS), the maximum wall shear stress (WSS), the maximum plaque wall stress (PWS), wall tensile stress (WTS) and wall pressure (WP) of the plaque and lumen were recorded. Results Under 16% carotid tensile deformation, the maximum WSS of the plaque was 40.54 Pa. The maximum PWS was 66.16 kPa, which was far smaller than the threshold of plaque rupture.The maximum WTS of fiber cap and the maximum strain were 156.75 kPa and 0.56, which were larger than the fracture strain range. The maximum WTS of the lumen was 1 040.30 kPa, which approached the threshold of medial membrane rupture and might cause vascular injury. Conclusions When the cervical spine rotates to the end range of motion, large carotid artery stretch may cause damage to epidermal tissues of the plaque, leading to abscission. Lesions, ulcers, bleeding and vascular damage may form inside the plaque, which will affect stability of the plaque. Cervical rotatory manipulation should be performed cautiously in patients with cervical diseases who also have carotid atherosclerotic plaques.The finite element assessment of plaques before manipulation may be an effective safety screening method.
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BACKGROUND: Cervical rotation manipulation is a non-surgical method of cervical spondylosis, showing significant treatment efficacy. But the safety for patients with carotid artery atherosclerosis remains obscure. OBJECTIVE: To analyze the hemodynamic changes of atherosclerotic carotid arteries treated by cervical rotatory manipulation, and to explore the effect of cervical rotatory manipulation on the hemodynamics of atherosclerotic plaque. METHODS: Eight cases of stenosis of ramification of the carotid artery with plaque on MRI. The hemodynamic model of carotid artery atherosclerosis was established, assigned with general boundary conditions and simulated the cervical stretch during cervical rotatory manipulation. All models were grouped and stretched into 0％ (control group), 7％ and 16％ stretch to simulate the hemodynamic changes of atherosclerotic plaque. The hemodynamic parameters, including average wall shear stress, the maximum wall shear stress, the average maximum wall shear stress, the blood velocity of the plaque, and blood flow vectorgraph were compared among groups. RESULTS AND CONCLUSION: (1) All hemodynamic parameters had no significant differences between 7％ stretch and control groups (P＞ 0.05). Compared with the control group, the wall shear stress, the maximum wall shear stress, and the maximum wall shear stress in the 16％ stretch group were significantly increased (P ＜ 0.05), and other indexes showed no significant differences. (2) In summary, different stretches by cervical rotatory manipulation possess different effects on plaque, and a 16％ stretch may affect the hemodynamics of plaque.
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Objective To analyze the influence of ligaments surrounding sacroiliac joints (SIJs) on stability of SIJs by finite element method. Methods The finite element lumbar spine-pelvis-femur model was established. Based on this normal model, all SIJ ligaments in both sides were removed in turn, to establish models without iliolumbar ligaments, sacroiliac anterior ligaments, sacroiliac posterior ligament, sacrotuberous ligaments, sacrospinous ligaments, sacroiliac interosseous ligaments, respectively. The models were used to simulate physiological motions of the spine. The range of motion (ROM) and average stress on the left and right SIJs were analyzed and compared with the normal models. Results Compared with the normal SIJ model, no significant differences in the ROM of bilateral SIJs were found in the models without sacrotuberous ligaments, sacrospinous ligaments and sacroiliac posterior ligaments; for the model without acroiliacinterosseous ligaments, there was no significant difference in the ROM of the left SIJs under spinal right rotation and ROM of the right SIJs under spinal extension, but the ROM of bilateral SIJs increased significantly under the other spinal physiological activities. Under the physiological activities of the spine, the average stress of the SIJ surface in the left and right sides of the model without acroiliacinterosseous ligaments significantly decreased. Conclusions Of all the sacroiliac ligaments, the sacroiliac interosseous ligaments showed the maximum influences on the stability of SIJs. The research findings are helpful to investigate the mechanism of SIJ subluxation and provide certain theoretical basis for clinical treatment of SIJ subluxation.
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Objective To explore the effect of cervical rotatory manipulation on tensile mechanical properties of carotid artery with atherosclerotic plaque.Methods Thirty healthy male New Zealand rabbits were selected and randomly divided into experimental group,model control group and blank control group.Carotid atherosclerosis models were made in the experimental group and model control group.The experimental group received the intervention of cervical rotatory manipulation,but the model control group did not.The blank control group did not receive any intervention.After 3 groups received different interventions,their differences in tensile mechanical properties of rabbit carotid artery were observed.Results The ultimate strain,ultimate load and physiological elastic modulus of rabbit carotid arteries in 3 groups were statistically significant (P ＜0.05);The ultimate strain in the experimental group was 24.87％ and 52.09％ lower than that in the model control group and blank control group,respectively;the ultimate load in the experimental group was 2.21 and 3.47 times of the model control group and blank control group,respectively;the physiological elastic modulus in the experimental group was 1.60 and 1.89 times of the model control group and blank control group,respectively.Conclusions Compared with normal carotid artery,the presence of carotid atherosclerotic plaque will reduce tensile mechanical properties of the carotid artery,and cervical rotatory manipulation will further reduce tensile mechanical properties of the carotid artery with carotid atherosclerotic plaque.Therefore,for patients with carotid atherosclerotic plaque,it is better to avoid cervical manipulation.
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A 61-year-old female presented with 4 years history of left-sided hemifacial spasm. Head MRI and angiography indicated left vertebral artery dissecting aneurysm which compressed ipsilateral cranial nerves Ⅶ and Ⅷ. Microvascular decompression was performed. The dissecting aneurysm was pushed apart and the distal part of the parent artery was adhered to the dura on the petrosum. The compressed nerves were totally decompressed. The symptom of facial spasm was completely resolved immediately after surgery and did not recur during 6 months of follow up.
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Female , Humans , Middle Aged , Cerebral Angiography , Facial Nerve , Pathology , Hemifacial Spasm , General Surgery , Magnetic Resonance Imaging , Microvascular Decompression Surgery , Nerve Compression Syndromes , Diagnosis , General Surgery , Vertebral Artery Dissection , Diagnostic Imaging , General Surgery , Vestibulocochlear Nerve , PathologyABSTRACT
OBJECTIVE To understand pathogen distribution and drug sensitive rate of urinary system infection in our hospital,in order to avoid the clinic to use antibiotics blindly,make the resistant strains decreasing in number,and improve efficacy.METHODS The distribution and drug sensitivity of the pathogens causing urinary infection among the patients with urinary system infection were rectrospectively analyzed.RESULTS Totally 549 strains were isolated,G-bacteria were 333 strains,accounted for 60.66%,from them E.coli was 293 strains,accounted for 87.99%;and G+bacteria were 216 strains,accounted for 39.34%,from them Enterococcus,and Staphylococcus were the main ones.Of E.coli strains,the ESBLs(+) were 36.86%.The MRCNS accounted for 81.91%.The result of drug sensitivity showed that the sensitive rate of E.coli to meropenem and imipenem was 100.0%.The sensitive rate of ESBLs(+) E.coli to cefepime,cefotaxime and aztreonam was all lower than 50%,but that of ESBLs(-) to the above drugs was much higher than ESBLs(+).The sensitive rate of Enterococcus to vancomycin and teicoplanin was 100%.The sensitive rate of CNS to Vancomycin was 100%.CONCLUSIONS In order to decrease the produceing bacteria resistance and the disseminating the resistance genes,it′s necessary to enhance the monitoring and study of bacteria resistance,normlalize the clinical medicine application,and enhance the infection control measures.
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<p><b>OBJECTIVE</b>To present the authors' experience with percutaneous dilatational tracheostomy (PDT), with special attention to early and late complications, outcomes, and primary disease influence.</p><p><b>METHODS</b>Between November 2000 and May 2001, 22 PDTs were performed with the aid of dilatating forceps in 21 neurosurgical coma patients. A Seldinger wire was introduced through a cannula into the trachea serving as a guide. The guidewire was threaded through the clamped guidewire dilating forceps and the forceps was advanced through the tracheal wall. The trachea was dilated by opening forceps. The guidewire was then threaded through the obturator of the tracheostomy tube and both were advanced into the trachea. Demographic data, patient disease variables and patient anatomical features, as well as perioperative and late complications were recorded prospectively.</p><p><b>RESULTS</b>Completion of the procedure consumed 4 - 16 minutes (mean, 12 minutes). The procedure caused complications in 3 operations: 2 cases of stomal bleeding, 1 of intratracheal bleeding, but there was no severe tracheal injury or mediastinal emphysema. Furthermore, none of the cases required intervention due to complications. All patients were followed up for 1 to 6 months. Tracheostomy tubes were removed in 16 patients. All cervical incisions were closed with cosmetic demand. Two patients with tracheostomy tubes were retained for primary diseases. Causes of death in 3 others were unrelated to the PDT. No patient developed tracheomalacia or tracheal stenosis as a late complication.</p><p><b>CONCLUSIONS</b>Percutaneous dilatational tracheostomy is a fast, safe and simple procedure for neurosurgical coma patients and can be safely performed by neurosurgeons.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Coma , General Surgery , Neurosurgical Procedures , Tracheostomy , MethodsABSTRACT
Objective To provide a description of clinical manifestations, special imaging features and treatment of diffuse axonal injury(DAI).Methods Retrospective analysis of 32 cases of diffuse axonal injury.Result 87.5% patients were involved in traffic accident. All patients came into persistent comatose state immediately. 75% patients had abnormal CT scan findings. MRI showed more sensitive. It could reveal injury appearance of corpus callosum and brain stem clearly. Hypothermic therapy and calcium ion antagonist were used. Conclusions combination of clinical manifestations and special imaging features helped to diagnosis of DAI in early stage. Intensive care and preventing secondary brain injury were the important treatment points.
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Aimed to cure dental anxiety,we summarized its clinical features,and also analyzed the etiological factors from therapeutic tools,medical treatment and patients.We adopted kinds of mental interventions,such as promoting patients' vulnerable mental state,eliminating their anxiety,providing therapeutic information,raising their confidence in recovery.By the above countermeasures,we have got satisfactory therapeutic effects in clinical practice.