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Objective:To investigate the feasibility of using anastomotic stoma as a long-term vascular access to maintain hemodialysis in patients who cannot establish an effective vascular access after ACUSEAL graft occlusion.Methods:A rare case of brachial artery-right atrium ACUSEAL artificial blood vessel fistula bypass to establish vascular access occlusion, the use of artificial blood vessel anastomosis stoma to establish buttonhole puncture as a long-term vascular access and the corresponding nursing methods.Results:At present, the patients were treated with regular dialysis for 32 months and blunt needle puncture for 23 months.Conclusions:Brachial artery-right atrium ACUSEAL graft is a rare vascular access surgery. As a new type of access with depleted autologous vascular resources, the efficacy is not certain. Because it is different from the traditional vascular prosthesis surgery, once the thrombotic occlusion of the graft fails, the risk and difficulty of reopening by interventional or surgical methods are great. Therefore, it is a challenging and reasonable method to use the limited residual cavity of the anastomosis as a long-term vascular access after occlusion to prolong the service life of the graft.
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Objective:To investigate the emergency treatment and clinical effect when the guidewire stuck in the right atrium during central vein catheter placement for hemodialysis.Methods:Five cases with guidewire stuck in the right atrium during central vein catheter placement for hemodialysis from January 2011 to July 2018 admitted into the First Affiliated Hospital of Zhejiang University were retrospectively analyzed. In two cases, the guidewires were found completely stuck when the insert depth was about 20 cm. The guidewires were not able to move forward nor backward. In the other three cases, the guidewires could be moved forward but not backward with the insert depth at about 18 cm. All patients received emergent computed tomography angiography (CTA) or digital subtraction angiography (DSA) imaging. Images showed that the guidewires were stuck in the right atrium near the ventricular valve. The guidewire core drawing method, the multipurpose angiography(MPA) catheter capturing method and the manual guidewire adjusting method were used for emergent treatment.Results:One patient with completely stuck guidewire was successfully treated with guidewire core drawing method and the temporary central vein catheter catheterization through the internal jugular vein was performed under DSA. In a completely stuck case and a retrogradely stuck case, the J-shaped ends of the warped guidewires were captured into the MPA catheter, and the guidewires were then withdrawn from right atriums along with the contrast catheter. In the other 2 retrogradely stuck cases, under DSA, the guidewires were repeatedly pushed, the direction of J-shaped ends was manually adjusted, and then the guidewires were repeatedly pushed and pulled until catheters can be pulled out of the right atriums. The later 4 cases had permanent central vein catheter placement with the same guidewire after the stuck guidewires were withdrawn from the right atrium and readjusted.Conclusions:All three methods can successfully solve the emergent situation of the stuck guidewire in the right atrium. For patients with completely stuck guidewires, the MPA catheter capturing method can be simpler, safer, and more effective.
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Objective To investigate the application of percutaneous transluminal balloon dilatation (PTA) in catheter replacement within patients with catheter-related central vein disease (CVD). Methods Thirteen cases of CVD patients from Jan 2015 to Mar 2018 admitted into the First Affiliated Hospital of Zhejiang University were retrospectively analyzed. All of them underwent digital subtraction angiography (DSA) to clarify problem origin. Suitable balloons were chosen to dilate the original catheters or the occlusive veins, and then the original catheters were replaced. PTA was used to help catheter replacement and all patients were followed up for 6 months. Results Four of the 13 patients were found stuck when replacing catheters. All of them successfully had catheters removed with PTA (Hong's techniques). All patients had successfully catheter replacement with blood flow volume>250 ml/min. Among 4 patients with edema, 3 patients showed better within 6 months. Only 3 patients needed warfarin to keep blood flow volume>250 ml/min within 6 months. Conclusions PTA shows advantages of lesser trauma, better tolerance and higher success rate in patients with catheter-related CVD. It can also relieve symptoms resulting from occlusive central vein.
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Objective To investigate the effect of recombinant human interleukin 11(rhlL-11)in the treatment of idiopathic thrombocytopenic purpura(ITP)on the levels of Th1,Th2 and the expression of their transcription factors T-bet mRNA,GATA-3 mRNA.Methods Fifty-six cases adult ITP patients hospitalized in the department of hematology of the Second People's Hospital of Datong from May 2015 to December 2016 were collected,including 21 males and 35 females,aged 29~73 years; 10 healthy people in the same period were enrolled as control group,4 males and 6 females,aged 20~52 years.Th1 and Th2 cell ratio and Th1/Th2 ratio of ITP patients were detected by flow cytometry before and after treatment.The expression levels of transcription factor T-bet and GATA-3 were measured using real-time fluorescence quantitative reverse transcription polymerase chain reaction(RT-PCR)before and after treatment.Results The effective rate of rhlL-11 in ITP treatment was 76.8%(43/56).For the effective patients,the median PLT after treatment increased(25.0(15. 0,36.0)×109/L vs.68.0(49.0,108.0)×109/L,Z=-5.712,P<0.001); Th1 cells decreased,compared with that before the treatment(14.8 %(12.6%,17.6%)vs.10.6 %(9.8%,12.6%),Z=-4.825,P<0.001);Th2 cell increased,compared with that before the treatment(0.4%(0.3%,0.5%)vs.1.2%(0.9%,1.4%), Z=-5.720,P<0.001); Th1/Th2 decreased,compared with that before the treatment(40(30,49)vs.10.6(7.8,12.0),Z=-5.711,P<0.001];the expression level of T-bet mRNA decreased(0.36(0.18,0.51)vs 0.09(0.05,0.13),Z=-2.668,P=0.008);the expression level of GATA-3 mRNA increased,compared with that before treatment(0.04(0.03,0.05)vs.0.12(0.09,0.15),Z=-2.366,P=0.018).For ineffective patients,the median PLT before treatment was(11.0(8.0,15.5)×109/L),and the median PLT after treatment was(15.0(10.0,19.5)×109/L)(Z=-3.027,P=0.002); there was no significant difference in Th1,Th2, ratio of Th1/Th2 and T-bet and GATA-3 mRNA expression level before and after treatment in patients with ITP (P>0.05).Conclusion rhIL-11 can effectively correct the imbalance in Th1 and Th2 cells and the imbalance of T-bet and GATA-3 in ITP patients,but it has no obvious therapeutic effect on a small number of patients
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Objective To evaluate the efficacy and adverse effects of thalidomide plus melphalan and VAD regimen in the treatment of multiple myeloma(MM). Methods 24 patients in the treatment group were treated with thalidomide plus melphalan and VAD regimen. Two continuous treatment were considered valuable. Observational content included results of serum myeloma protein; liver and renal function; protein-uria of 24-hours; bone marrow and peripheral blood and soon. The side reactions were recorded. The clinical efficacy evaluation was divided into complete response(CR), partial respouse(PR), none response(NR). Results 13 cases in the treatment group achieved CR, 6 cases achieved PR, 5 cases no change, 19 cases achieved overall response. Conclusion The prominent clinical efficacy was achieved with thalidomide plus melphalan and VAD regimen in multiple myeloma. The clinical manifestation was improved significantly.
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Objective To explore the indexes change of coagulation and fibrinolysis in APL with ATRA and As2O3.Methods Treatment group 18 eases were undeaaked ATRA 20-30 mg/d until relieved completely.0.1%arsenic trioxide 10 ml with 5%glucose 500 ml for 28 days.Normal control 10 cases were undertaked ATRA 45～60 mg/d until relieved completely.Results The CR rate of treatment group was higher than control group(P＜0.05),the patients of control group showed different reactions such as thirsty mouth,rationale acid syndrome.2 cases reacted strongly and the treatment had to be interrupted,the patients of treatment group had little reaction,but liver function were badly hurt and liver-protection treatment was needed.Fbg,D-dimer recovery time is 7 days,21 days in treatment group,14 days,21 days in control group.Conclusion CR rate is high and has little side effect,and indexes change of coagulation and fibrinolysis were recovered quickly,it has great significance to take D-dimer as early diagnose and observe the indexes change during the treatment.
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Objective: To analyze the differences of two anchorage ty pe s in closing the space following tooth extraction in maxilla. Methods:By using Spiral CT scanning, image processing and CAD technology, a three -dimensional finite element model of maxilla which could simulate the closing o f space following the extraction of maxillary first bicuspid was established. Ba sed on the model, two loading models were developed, which contained palatal imp lant and transpalatal arch respectively to reinforce the anchorage of molar. Th e two anchorage types were compared and the finite element analysis of closing t he space was performed.Results: The displacement(mm) of the firs t permanent molar in X, Y and Z direction in the model with palatal impl ant was -0.001 162 4,-0.000 901 9 and 0.000 196 2, that in the model with transp alatal arch -0.001 163 7,-0.000 902 2 and 0.000 196 4, respectively(P