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Objective:To investigate the effect of berberine on immune regulation and phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signal pathway in lung cancer rats.Methods:The lung cancer rat model was established by perfusing a carcinogenic lipiodol solution. The 36 male Wistar rats were randomly divided into the model group ( n = 12), the berberine group ( n = 12), and the normal group ( n = 12). The rats in the berberine group were ig berberine 15 mg/kg, once daily. The rats in the model group and the normal group were ig the same dose of normal saline, once daily. The intervention was conducted continuously for 16 weeks for each group. The spleen index and lung index, tumor inhibition rate, T lymphocyte subgroup level, PI3K, and Akt protein expression of rats in each group were compared. Results:The spleen index of the model group and berberine group was lower than that of the normal group, while the lung index was higher than that of the normal group (all P < 0.05). The spleen index of the berberine group was higher than that of the model group, while the lung index was lower than that of the model group (all P < 0.05). The tumor weight of the berberine group was lower than that of the model group ( P < 0.05). The tumor inhibition rate of the berberine group was 43.12%. The CD3 +, CD4 +, and CD4 +/CD8 + levels of the model group and berberine group were lower than those of the normal group, CD8 + level was higher than that of the normal group (all P < 0.05), and the CD3 +, CD4 + and CD4 +/CD8 + levels of the berberine group higher than those of the model group, while CD8 + level was opposite (all P < 0.05). The gray values of PI3K and Akt protein of the model group and berberine group were higher than those of the normal group (all P < 0.05), and this value of the berberine group was lower than that of the model group (all P < 0.05). Conclusions:Berberine can effectively inhibit tumor growth in lung cancer rats, promote spleen development and differentiation, regulate immune function, and downregulate the expression of PI3K/Akt signaling pathway.
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Objective:To explore the uptake characteristics and temporal changes of 68Ga-fibroblast activation protein inhibitors (FAPIs) and 18F-FDG in the anastomotic site of reconstructed digestive tracts after radical surgery for gastrointestinal adenocarcinoma. Methods:A cohort of 43 patients (28 males, 15 females; age range 28-79 years) who underwent radical surgery for gastrointestinal adenocarcinoma and underwent 18F-FDG PET/CT follow-up between November 2020 and June 2022 in the First Affiliated Hospital of the Air Force Medical University was prospectively included. One week after the 18F-FDG PET/CT examination, 68Ga-FAPI-04 PET/CT imaging was performed. ROIs were drawn on the PET images at the highest uptake level of anastomotic sites of reconstructed digestive tract and abdominal wall incisions, and SUV max and target-to-background ratio (TBR) were determined. χ2 test, one-way analysis of variance, Kruskal-Wallis rank sum test (Bonferroni correction) and Wilcoxon signed-rank test were supplied. Results:There were 86 surgical wounds (13 gastric-intestinal anastomotic sites, 14 esophagus-intestinal anastomotic sites, 16 intestinal-intestinal anastomotic sites, and 43 abdominal wall incisions) included. In 68Ga-FAPI-04 PET imaging, SUV max of gastric-intestinal anastomotic sites was higher than that of abdominal wall incisions, with a statistically significant difference (adjusted P=0.014). The TBR did not show statistically significant differences among different types of surgical wounds ( H=3.88, P=0.275). In 18F-FDG PET imaging, SUV max of gastric-intestinal, esophagus-intestinal, and intestinal-intestinal anastomotic sites were all higher than that of abdominal wall incisions, with statistically significant differences (adjusted all P<0.001). There were no statistically significant differences in TBR among different types of surgical wounds ( H=3.02, P=0.388). In 68Ga-FAPI-04 PET imaging, the TBR of all types of anastomotic sites exhibited a decreasing trend with increasing postoperative time. Except for intestinal-intestinal anastomotic sites, the differences in TBR between < 0.5-year and ≥ 1.5-year groups were statistically significant for other types of surgical wounds (adjusted P<0.05). In 18F-FDG PET imaging, the TBR of abdominal wall incisions showed a decreasing trend with increasing postoperative time. However, the TBR of other types of surgical wounds did not show a decreasing trend, and the differences in TBR among different time groups were not statistically significant ( H values: 0.53-2.75, P values: 0.252-0.768). In comparing the two PET imaging agents, for all surgical wounds within the <0.5-year and 0.5-1.5-year groups, the 68Ga-FAPI-04 TBR was consistently higher than the 18F-FDG TBR ( z values: -3.17 and -2.55, P values: 0.002 and 0.011). However, in the ≥1.5-year group, the TBR values tended to be consistent, and the differences were not statistically significant ( z=-0.70, P=0.485). Conclusions:The 18F-FDG uptake in the anastomotic sites of reconstructed digestive tracts reaches a low level under half a year after surgery and does not significantly change over time, while the 68Ga-FAPIs uptake remains relatively high within the first 1.5 years after surgery but decreases over time. These patterns suggest that clinical attention should be paid to the differential diagnosis of anastomotic inflammation or fibrosis, which resulting in agent uptake and local tumor recurrence.
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Objective:To evaluate the auxiliary role of the Python-based handover database in online teaching activities for medical clerks and to complete the teaching tasks during the COVID-19 epidemic.Method:Sixteen teachers were randomized into two groups, experimental group and control group, with 8 ones in each group. The experimental group used the self-built handover database, while the control group used the hospital's HIS system. To make multimedia courseware for medical students, suitable cases were screened. The time to acquire cases and picture data, and the index like numbers were statistically analyzed, and the quality of multimedia courseware was scored. All the data were analyzed by SPSS 25.0 statistical software.Results:The time for the two groups of teachers to acquire target cases during making multimedia coursewares were (8.88±3.48) min and (43.50±5.26) min respectively; the time to obtain the pictures were (5.62±1.92) min and (30.25±5.39) min; the numbers of obtained pictures were (11.12±2.17) and (6.12±2.80); and the scores of coursewares were (92.62 ± 4.93) points and (84.75 ± 6.20) points respectively, all with significant differences.Conclusion:The application of the self-made handover database can significantly improve the speed of teachers' access to related teaching data, and also can improve the quality of multimedia courseware.
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Objective:To investigate the effects of sodium butyrate (NaB) on long-term anxiety like behavior and inflammatory activation of microglia in the hippocampus of sepsis-associated encephalopathy (SAE) mice.Methods:① Animal experiment: fifty C57BL/6 mice aged 6-8 weeks were randomly divided into Sham group (only the cecum was found by laparotomy without perforation or ligation), and SAE model group caused by cecal ligation and puncture (CLP; SAE model group, the cecum was found by laparotomy and perforated after ligation. The open field test indicated that the ability of independent exploration decreased and showed anxiety like behavior, which proved that the SAE model was successfully replicated) and NaB pretreatment group was established (NaB was administered at a dose of 500 mg·kg -1·d -1 for 3 days before modeling, and the same dose once a day for 3 days after modeling). Open field test was used to detect the anxiety like behavior of mice at 7 days. The protein expressions and content changes of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in hippocampus of mice at 1 day and 3 days after operation were detected by Western blotting and enzyme linked immunosorbent assay (ELISA). Immunofluorescence staining was used to observe microglia labeled protein ionized calcium bindingadaptor molecule-1 (Iba-1) and TNF-α protein co localization. ② Cell experiment: mouse microglia cell line BV-2 microglia were divided into blank control group, lipopolysaccharide (LPS) group (cells were treated with 1 mg/L LPS), and NaB treatment group (cells were treated with 1 mg/L LPS+5 mmol/L NaB). The protein expressions of IL-1β, TNF-α, Toll-like receptor 4 (TLR4), phosphorylated nuclear factor-κB p65 (p-NF-κB p65), nuclear factor-κB p65 (NF-κB p65) and NF-κB inhibitor protein-α (IκB-α) were detected by Western blotting. The expressions of Iba-1 and TNF-α in each group were observed by immunofluorescence. Results:① Animal experiment: compared with the Sham group, the distance and duration of movement in the central area, the total distance moved of mice decreased 7 days after the establishment of SAE model group were decreased [distance of movement in the central area (mm): 13.45±3.97 vs. 161.44±27.00, duration of movement in the central area (s): 1.82±0.58 vs. 13.45±2.17, the total distance moved (mm): 835.01±669.67 vs. 2 254.51±213.45, all P < 0.05]. In the hippocampus tissues of mice, a large number of nerve nuclei were pyknotic and deeply stained, and the arrangement of nerve cells was disordered. The cell bodies of microglia in mouse hippocampus increased significantly. The number of positive cells of Iba-1/TNF-α (Iba-1 +/TNF-α +) increased significantly. The contents and protein expression of proinflammatory factors TNF-α, IL-1β in hippocampal homogenate supernatant 3 days after operation in SAE model group were significantly higher than those in Sham group [TNF-α (ng/L): 119.17±18.40 vs. 90.18±21.17, IL-1β (ng/L): 407.89±70.64 vs. 313.69±34.63; TNF-α/GAPDH: 1.42±0.50 vs. 0.80±0.08, IL-1β/GAPDH: 1.27±0.22 vs. 0.85±0.25, all P < 0.05]. After intragastric administration of NaB, the distance and duration of movement in the central area of mice were significantly higher than those in SAE model group [distance of movement in the central area (mm): 47.39±15.63 vs. 13.45±3.97, duration of movement in the central area (s): 6.12±1.87 vs. 1.82±0.58, all P < 0.05]. There was no significant change in the total distance moved (mm: 1 550.59±1 004.10 vs. 835.01±669.67, P > 0.05). The pyknosis and deep staining of nerve nuclei in mice were significantly less than those in SAE model group. The number of Iba-1 +/TNF-α + positive cells decreased significantly. The contents and protein expression levels of proinflammatory factors TNF-α, IL-1β in hippocampal homogenate supernatant 3 days after operation were significantly lower than those in SAE model group [TNF-α (ng/L): 64.95±9.10 vs. 119.17±18.40, IL-1β (ng/L): 311.94±69.92 vs. 407.89±70.64; TNF-α/GAPDH: 1.02±0.36 vs. 1.42±0.50, IL-1β/GAPDH: 0.86±0.20 vs. 1.27±0.22, all P < 0.05]. ② Cell experiment: after LPS intervention, the fluorescence intensity of TNF-α in BV-2 cells was significantly enhanced, the protein expression levels of TNF-α, IL-1β, TLR4 and p-NF-κB p65 protein increased (TNF-α/GAPDH: 0.39±0.06 vs. 0.20±0.02, IL-1β/GAPDH: 0.27±0.03 vs. 0.19±0.01, TLR4/GAPDH: 0.55±0.12 vs. 0.33±0.09, p-NF-κB p65/NF-κB p65: 0.55±0.05 vs. 0.29±0.04, all P < 0.05), the expression level of IκB-α was lower than that in the control group(IκB-α/GAPDH: 0.54±0.06 vs. 0.81±0.03, P < 0.05). After NaB treatment, the fluorescence intensity of TNF-α in BV-2 cells was decreased. The protein expression levels of TNF-α, IL-1β, TLR4 and p-NF-κB p65 protein were significantly lower than that of LPS model group (TNF-α/GAPDH: 0.26±0.02 vs. 0.39±0.06, IL-1β/GAPDH: 0.11±0.04 vs. 0.27±0.03, TLR4/GAPDH: 0.28±0.14 vs. 0.55±0.12, p-NF-κB p65/NF-κB p65: 0.29±0.01 vs. 0.55±0.05, all P < 0.05), the protein expression level of IκB-α was significantly higher than that in the LPS group (IκB-α/GAPDH: 0.75±0.01 vs. 0.54±0.06, P < 0.05). Conclusion:NaB could antagonism the TLR4 activation induced by LPS, thus inhibiting p-NF-κB p65 nuclear transcription and IκB-α degradation. It can reduce microglia activation and secretion of inflammatory factors, and finally improve the inflammation in the hippocampus of septic mice and long-term anxiety like behavior.
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Objective:To exploring the uptake of fibroblast activation protein (FAP) inhibitor (FAPI) in pancreatic cancer through 68Ga-FAPI-04 PET/CT imaging, and provide a basis for the FAP-targeted imaging of pancreatic cancer. Methods:Pancreatic cancer-patient-derived tumor xenograft (PDX) mouse models ( n=8) were developed, then 68Ga-FAPI-04 and 18F-FDG microPET/CT imaging were performed (4 in each group). The differences of percentage activity of injection dose per gram of tissue (%ID/g) of 68Ga-FAPI-04 and 18F-FDG were analyzed by independent-sample t test. 68Ga-FAPI-04 and 18F-FDG PET/CT imaging were performed in 5 patients (4 males, 1 female, age: 46-74 (63.0±11.9) years) with pancreatic cancer, and the maximum standardized uptake value (SUV max) of 68Ga-FAPI-04 and 18F-FDG in primary pancreatic cancer and the SUV max ratio of liver metastases to liver tissue were compared by paired t test. Results:MicroPET/CT imaging showed that 68Ga-FAPI-04 was obviously uptaken at all time points in the tumor of PDX mice. The uptake of 68Ga-FAPI-04 in PDX mice 60 min after injection was significantly higher than that of 18F-FDG ((6.58±0.44) and (4.29±0.13) %ID/g; t=4.152, P=0.008 9). PET/CT showed that the SUV max of 68Ga-FAPI-04 in pancreatic cancer was significantly higher than that of 18F-FDG (16.82±3.08 and 5.14±2.20; t=6.893, P=0.000 1) and the SUV max ratio of liver metastases to liver tissue of 68Ga-FAPI-04 was also significantly higher than that of 18F-FDG (4.57±1.47 and 1.30±0.16; t=3.803, P=0.019 1). Conclusion:68Ga-FAPI-04 can be highly uptaken in pancreatic cancer, suggesting that FAP can be a potential target for PET/CT imaging of pancreatic cancer.
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OBJECTIVE: To evaluate the effectiveness of using artificial tears and eye exercise for intervention of dry eye disease in aircrew members. METHODS: A accidental sampling method was used and 86 patients diagnosed with dry eye disease were selected as study subjects. Artificial tears or artificial tears plus eye exercise were used in patients. Symptoms of dry eye disease were investigated. RESULTS: of break up time( BUT) and schirmer I test( SIT) were recorded.RESULTS: The main symptoms of these 86 aviators diagnosed with dry eye disease were visual fatigue( 82. 6%),dry feeling( 60. 5%),and itchy eyes( 29. 1%). Among them,28 patients( 32. 6%) were treated with artificial tears only( artificial tears group) and 58 patients( 67. 4%) were treated with artificial tears plus eye exercise( combined treatment group). The duration of treatment of less than 4 weeks,4-weeks,and 6-9 weeks were 25,36 and 25 cases,respectively.After treatment,the symptoms improved in 71 patients( 82. 6%). All patients of these two groups showed improved SIT and BUT compared with the same group before treatment( P < 0. 01). There was no significant difference in the change of SIT and BUT between the artificial tears group and the combined treatment group after treatment( P > 0. 05). There was statistical significance in the change of SIT in the main effect of treatment time( P < 0. 01),but no significant difference in the main effect of treatment measures and the interaction effect( P > 0. 05). There was no statistical significance in the change of BUT in the main effect of treatment measures,treatment time and the interaction effect( P > 0. 05).CONCLUSION: The intervention using artificial tears or artificial tears combined with eye exercise improved the subjective symptoms of dry eye disease in aircrew members. The SIT and BUT also improved after intervention.
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Perimenopausal syndrome affects women 's work and life. This paper summarized the recent clinical researches of perimenopausal in the fields of the etiology and pathogenesis including the balance of yin and yang and regulating the Chong and Ren meridian, the traditional Chinese medicine treatment of acupuncture and herbs, in order to show the advantages of Chinese medicine.
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Although methyltransferase has been recognized as a major element that governs the epigenetic regulation of the genome during temozolomide (TMZ) chemotherapy in glioblastoma multiforme (GBM) patients, its regulatory effect on glioblastoma chemoresistance has not been well defined. This study investigated whether DNA methyltransferase (DNMT) expression was associated with TMZ sensitivity in glioma cells and elucidated the underlying mechanism. DNMT expression was analyzed by western blotting. miR-20a promoter methylation was evaluated by methylation-specific PCR. Cell viability and apoptosis were assessed using the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) and TdT-mediated dUTP-biotin nick end labeling assays, respectively. The results showed that compared with parental U251 cells, DNMT1 expression was downregulated, miR-20a promoter methylation was attenuated and miR-20a levels were elevated in TMZ-resistant U251 cells. Methyltransferase inhibition by 5-aza-2\'-deoxycytidine treatment reduced TMZ sensitivity in U251 cells. In U251/TM cells, DNMT1 expression was negatively correlated with miR-20a expression and positively correlated with TMZ sensitivity and leucine-rich repeats and immunoglobulin-like domains 1 expression; these effects were reversed by changes in miR-20a expression. DNMT1 overexpression induced an increase in U251/TM cell apoptosis that was inhibited by the miR-20a mimic, whereas DNMT1 silencing attenuated U251/TM cell apoptosis in a manner that was abrogated by miR-20a inhibitor treatment. Tumor growth of the U251/TM xenograft was inhibited by pcDNA-DNMT1 pretreatment and boosted by DNMT1-small hairpin RNA pretreatment. In summary, DNMT1 mediated chemosensitivity by reducing methylation of the microRNA-20a promoter in glioma cells.
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Animals , Female , Humans , Antineoplastic Agents, Alkylating/pharmacology , Apoptosis/drug effects , Brain/drug effects , Brain Neoplasms/drug therapy , DNA (Cytosine-5-)-Methyltransferases/antagonists & inhibitors , DNA Methylation , Dacarbazine/analogs & derivatives , Drug Resistance, Neoplasm , Gene Expression Regulation, Neoplastic , Glioma/drug therapy , Mice, Inbred C57BL , MicroRNAs/genetics , Promoter Regions, GeneticABSTRACT
Objective To analyze factors of volume maintenance percentage after autologous fat grafting breast augmentation.Methods From March 2011 to December 2014,39 patients were included.Age,BMI,donor site,breast preoperative volume,whether or not application of Brava and water-jet-assisted liposuction were collected as variables.We performed multivariate regression and univariate regression analyses in a general linear regression model and multilevel linear regression model to identify significant factors.Results The mean percentage of volume maintenance was (34± 12) ％.In univariate regression analysis,rate of volume maintenace was decreased 3.3％ as increase of age per 5 years;Brava application increased volume maintenace,compared with donor sites of the back and abdomen 8.4％ (40.7％ vs 32.3％,P＜0.05),application of leg fat increased by 9.6％ of volume maintenace (39.1％ vs 29.5％,P＜0.05).In the multivariate regression analysis,Brava use increased volume maintenance of 6.2％ (P＜0.05);use of leg fat increased by 6.0 ％ of volume maintenace as compared with donor sites of the back and abdomen (P＜0.05).Conclusions The age,Brava,and donor site are significant impact factors to percentage volume maintenance in autologous fat graft breast augmentation.
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BACKGROUND:Ion channel analytical technique has verified that huwentoxin is an N-type Ca2+channel blocker affecting on presynaptic membrane. OBJECTIVE:To observe the effects of N-type Ca2+channel blocker huwentoxin on expressions of tumor necrosis factorα, tumor necrosis factor receptor I, tumor necrosis factor receptor-related death domain, Fas-related death domain protein and Caspase 8 in the hippocampi of rat models of global cerebral ischemia reperfusion injury. METHODS:Rat models of global cerebral ischemia and subarachnoid catheter were established using Pulsinel i 4-vessel occlusion and then received infusion of huwentoxin or normal saline via a PE10 tube. Morphological changes in the mitochondria and ultrastructure of pyramidal neurons in the hippocampal CA1 region of rats with global cerebral ischemia reperfusion injury were observed using electron microscope. The expressions of tumor necrosis factorα, tumor necrosis factor receptor I, tumor necrosis factor receptor-related death domain, Fas-related death domain protein and Caspase 8 were measured using RT-PCR. RESULTS AND CONCLUSION:Huwentoxin could maintain the basic morphology of mitochondria of rats with global cerebral ischemia reperfusion injury and decrease the expressions of tumor necrosis factorα, tumor necrosis factor receptor I, tumor necrosis factor receptor-related death domain, Fas-related death domain protein and Caspase 8 mRNA. Results suggested that huwentoxin as a novel N-type Ca2+channel blocker could block extracellular Ca2+influx, reduce intracellular Ca2+concentration, diminish a series of pathological lesion induced by intracellular Ca2+overload, protect nerve cells, and lessen the injury to nerve cells of hippocampus after ischemia and hypoxia.
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Chiari Ⅰ malformation is a congenital anomaly of posterior brain.There has been many theories for its pathogenesis.Recent years,researchers have sunmarized new theories about the pathogenesis of syringomyelia associated Chiari Ⅰ malformation.However,the exact pathogenesis of Chiari Ⅰ malformation has not been clarified.There are a lot of surgical treatments of Chiari Ⅰ malformation.Importantly,there remains no consensus about the best and generally applicable treatment.
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Objective Adhesion or too highly located folds upper eyelid and even hlepharoptosis are common complications after double eyelid operation. The method was designed to correct these de-formities. Methods The incision of upper eyelid was designed under the scar. Skin was resected between the former and the new double line, if there was excessive skin. Completely relieve the adhesion until nor-mal tissue was exposed. Expose lateral extension of retro-orbicularis oculi fat pad. An upper pedicle fat flap was formed after cutting tissues off along bilateral borders. Appropriately and transversely cutting lateral portion of the pedicle made it rotate inside downward with enough blood supply. The fat flap was fixed with released orbital fat and the lower edge of fat flat fixed with upper border of supratarsal to restorate the volume. For severe condition, fat granule injection could be used after the skin was sutured. Results 42 cases (80 eyes) were treated in the past two years. The deformities of 32 cases were corrected by the application of retro-orbicularis oculi fat pad. Fat granule injection was applied for the other 10 pa-tients meanwhile. 30 cases (60 eyes) were followed up for 6 to 24 months. The results were satisfactory. Conclusion The methods are performed easily and the results are satisfied. It is worth of recommenda-tion.
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Objective To study the mechanism of arachnoidal fibrosis after subarachnoid hemor- rhage. Methods Rats were divided into control group, experiment group and treatment group. Radioim- munoassay (RIA) was employed to detect the levels of hyaluronic acid, laminin,type Ⅲ precollagen and type Ⅳ collagen in the arachnoid membrane. In the meantime, arachnoid cell's morphology and collagen distribution in the subarachnoid space were investigated by electron microscope. Results Results of RIA detection showed increase of Type Ⅲ precollagen level (peak at the second week), obvious higher levels of LN and HA but insignificant change of type IV collagen after subarachnoid hemorrhage. However, dexam- ethasone treatment decreased type Ⅲ precollagen level. Electron microscope found that arachnoid cells pres- ented accentruated bioactivity after subarachnoid hemorrhage, with significant increase of arachnoidal colla- gen fibers from one week after suharachnoid hemorrhage, continuing for 3 weeks. Dexamethasone treatment resulted in low density of mitochondria and sparsed arachnoidal collagen fibers. Conclusions Extracellu- lar matrix (ECM) increases in arachnoid membrane after subarachnoid hemorrhage and participates in a- rachnoid fibrosis. Dexamethasoue can relieve arachnoidal fibrosis after subarachnoid hemorrhage, as pro- rides fresh way for prevention and treatment of post hemorrhagic hydrocephalus.
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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>