ABSTRACT
Objective:To summarize the safety and efficacy of aortic banding in the treatment of refractory endoleaks after endovascular abdominal aortic aneurysm repair (EVAR).Methods:The clinical and follow-up data of 10 patients with refractory endoleaks EVAR undergoing aortic banding at Peking University People's Hospital from Jun 2019 to Aprl 2022 were retrospectively analyzed.Results:The aortic banding was indicated for type Ⅰ endoleak in 6 patients, type Ⅱ endoleak in 3 patients and internal tension in 1 patient with persistent aneurysm enlargement or rupture. The surgical procedure was based on laparotomy. The proximal aortic neck was exposed and re-fixation with artificial strip to prevent bleeding. The surgical procedures was successful in all the 10 cases without residual endoleak or re-bleeding. The post-operative contrast-enhanced ultrasonography revealed neither new-onset endoleak nor occlusion of stent-grafts. Perioperative complications included one case of delayed wound healing and one case of incomplete ileus. No perioperative deaths occurred. Midterm follow-up was achieved in 10 patients with a mean follow-up time of 13 months. No recurrence of endoleak was found. One patient underwent endovascular repair for independent thoracic aortic aneurysm 6 months after surgery. There were no other aorta-related secondary surgeries or aortic-related deaths.Conclusion:Aortic banding for refractory endoleaks after EVAR is minimally invasive and reliable. It can effectively eliminate the refractory endoleaks, and reduce the risks of aortic-related secondary surgery or death.
ABSTRACT
Objective:To investigate the safety and efficacy of simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) for patients with concomitant severe carotid and coronary artery disease.Methods:The clinical data of 19 patients with concomitant severe carotid artery stenosis and coronary artery disease undergoing simultaneous CEA and CABG at Peking University People′s Hospital from Jan 2011 to Dec 2019 were retrospectively analyzed.Results:The mean ages was 69 years old.The operation adopted the strategy of CEA first and then CABG. Conventional CEA with carotid arterial shunting was performed. The primary composite end points were perioperative cardiovascular and neurological adverse event rates, as well as the late follow-up outcomes. The technical success rate was 100%. There were no adverse cardiovascular events during the perioperative period. Ischemic stroke occurred in 2 patients. No early death was observed. Seventeen cases were successfully followed up for 1-103 months. One patient developed cerebral infarction after 8 months, one developed acute myocardial infarction 43 months after surgery. No cases suffered from carotid artery restenosis. The 5-year overall survival rate was 91%.Conclusions:Simultaneous CEA and CABG treatment for patients with concomitant carotid and coronary artery disease is safe with few perioperative cardiovascular events and no deaths.
ABSTRACT
Objective@#To investigate the clinical significance of verticalization of frontal P axis on electrocardiagraphy (ECG) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and asthma.@*Methods@#Thirty five COPD patients and 20 asthma patients with acute exacerbation admitted in Jing′an District Central Hospital were enrolled and 20 health subjects served as a control group. The 12 lead ECG examination, pulmonary function test and high resolution CT (HRCT) scan of lung were performed. The P axis in ECG, pulmonary function and CT emphysema score were compared among three groups. The correlation of P axis verticalization with pulmonary function and CT emphysema score was analyzed.@*Results@#There were significant differences in P axis(F=24.36), FEV1/FVC(F=39.36), FEV1(F=28.82), FEV1%(F=30.64), FVC%(F=3.45), PEF%(F=13.22), RV/TLC(F=10.46) and total emphysema score (F=50.60) among the three groups (all P<0.01). P axis was positively correlated with age(r=0.229), total emphysema score(r=0.567), upper lung emphysema score(r=0.542), middle lung emphysema score(r=0.507), lower lung emphysema score(r=0.572)(all P<0.01), and negative correlation with body mass index(r=-0.491), cardiothoracic ratio (r=-0.396), FEV1/FVC(r=-0.609), FEV1(r=-0.389), FEV1%(r=-0.460), and PEF% (r=-0.419)(all P<0.01). Taking P axis>60 ° as cut-off value for screening COPD, the sensitivity was 0.933, specificity was 0.667, positive predictive value was 0.833 and negative predictive value was 0.857.@*Conclusion@#The verticalization of frontal P axis on ECG is significantly associated with obstructive ventilation disorder and CT emphysema score, which can be used as a preliminary screening index for COPD.
ABSTRACT
Objective:To investigate the distribution features of anti-neutrophil cytoplasmic antibody (ANCA) in patients with cardiovascular and cerebrovascular diseases and the clinical characteristics of the patients.Methods:Clinical data of 6 759 patients who were treated in Baoding No.1 Central Hospital for cardiovascular and cerebrovascular diseases during January 2015 to July 2019 were collected and analyzed. ANCA was detected by indirect immunofluorescence (IIF). Antibodies against myeloperoxidase (MPO) and protease 3 (PR3) were detected by enzyme-linked immunosorbent assay (ELISA).Results:IIF showed that 558 out of the 6 759 cases tested positive for ANCA with a positive rate of 8.26%. Among them, 382 (68.46%) were positive for perinuclear ANCA (p-ANCA) and 176 (31.54%) were positive for cytoplasmic ANCA (c-ANCA). Anti-MPO and anti-PR3 antibodies were detected in 69 ANCA-positive cases, while the antibodies against other target antigens were detected in 489 cases. The ratio between the two groups was 1∶7.09. The incidence of recurrent respiratory tract infection and pulmonary interstitial lesions in ANCA-positive cases was 69.35% (387/558) and 64.52% (360/558), respectively, which was significantly higher than that in ANCA-negative patients [40.51% (2 512/6 201) and 33.17% (2 057/6 201)].Conclusions:Anti-MPO and anti-PR3 antibody detection could not replace IIF to detect total ANCA for a high rate of missed diagnosis would be caused. Early detection of ANCA would be of great significance to patients with chronic cardiovascular and cerebrovascular diseases.
ABSTRACT
Objective:To investigate the clinical significance of verticalization of frontal P axis on electrocardiagraphy (ECG) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and asthma.Methods:Thirty five COPD patients and 20 asthma patients with acute exacerbation admitted in Jing′an District Central Hospital were enrolled and 20 health subjects served as a control group. The 12 lead ECG examination, pulmonary function test and high resolution CT (HRCT) scan of lung were performed. The P axis in ECG, pulmonary function and CT emphysema score were compared among three groups. The correlation of P axis verticalization with pulmonary function and CT emphysema score was analyzed.Results:There were significant differences in P axis( F=24.36), FEV 1/FVC( F=39.36), FEV 1( F=28.82), FEV 1%( F=30.64), FVC%( F=3.45), PEF%( F=13.22), RV/TLC( F=10.46) and total emphysema score ( F=50.60) among the three groups (all P<0.01). P axis was positively correlated with age( r=0.229), total emphysema score( r=0.567), upper lung emphysema score( r=0.542), middle lung emphysema score( r=0.507), lower lung emphysema score( r=0.572)(all P<0.01), and negative correlation with body mass index( r=-0.491), cardiothoracic ratio ( r=-0.396), FEV 1/FVC( r=-0.609), FEV 1( r=-0.389), FEV 1%( r=-0.460), and PEF% ( r=-0.419)(all P<0.01). Taking P axis>60 ° as cut-off value for screening COPD, the sensitivity was 0.933, specificity was 0.667, positive predictive value was 0.833 and negative predictive value was 0.857. Conclusion:The verticalization of frontal P axis on ECG is significantly associated with obstructive ventilation disorder and CT emphysema score, which can be used as a preliminary screening index for COPD.
ABSTRACT
Objective To summarize the clinical experience on acute type B aortic intramural hematoma,and to investigate the relation between focal enhancement characteristics on CT angiography (CTA) and the outcome of acute type B aortic intramural hematoma.Methods From Sep 2009 to Mar 2017,a total of 29 patients with acute type B aortic intramural hematoma treated in our department were retrospectively reviewed.After type B aortic intramural hematoma diagnosis by CTA,patients were prescribed anti-hypertension medicine with targeted systolic blood pressure of less than 120 mmHg.Then patients underwent a schemed CT angiography review within 2 weeks if no complications occurred.Surgical indications included recurrent pain,enlarged extent of hematoma and appearance of penetrated ulcer/dissection/aneurysm,and hematoma around the aorta or rupture.Results In the initial CT imagines,lesions of intimal defect were found in 22 patients,intramural blood pool in 16 patients,and ulcer-like projection in 16 patients.15 patients underwent thoracic endovascular aortic repair,with success rate of 100％,no mortality.The median duration of follow-up was 28 months.There was no aortic related complications nor death.Among the 14 patients treated by medicine 1 patient had formation of dissection and 1 patient with new-onset penetrating ulcer lesion and formation of thoracic aortic aneurysm.These two received thoracic endovascular aortic repair successfully.The proportion of deterioration of intramural hematoma in patients with ulcer-like projection lesions in initial CT imagines was higher than that in patients without ulcer-like projection lesions (7％ vs.33％,P =0.047).The proportion of deterioration of intramural hematoma in patients with intimal defect and intramural blood pool lesions in initial CT imagines was 68％ and 69％,respectively.Conclusions Strict anti-hypertension medical treatment with timely surgical repair was effective for acute type B intramural hematoma of the aorta.Intramural hematoma with ulcer-like projection lesions are prone to deterioration.
ABSTRACT
Objective To explore the clinical effect of enhanced recovery after surgery and pain management during the perioperative period in rectal cancer patients.Methods 100 rectal cancer patients after radical resection were divided into ERAS group (50 cases) and routine care group (50 cases).Results Compare with the routine group,the time of ERAS group was shorter in postoperative bowel function recovery [(1.8 ± 0.6) d vs.(3.4 ± 0.6) d,t =-8.1,P ＜ 0.001],oral feeding [(1.3 ± 0.6) d vs.(3.2 ± 0.6) d,t =-10.1,P ＜ 0.001],intraperitoneal catheter drain [(3.6 ± 0.7) d vs.(5.3 ±0.8) d,t=-6.7,P＜0.001] and mobilization[(1.1 ±0.3)d vs.(2.7 ±0.5) d,t=-12.7,P＜0.001].ERAS group was associated with shorter hospital stay [(4.6 ± 0.6) d vs.(6.1 ± 0.6) d,t =-7.7,P ＜ 0.001],lower costs (P =0.014),lower pain score at the time of 6 h,12 h,24 h and 48 h after surgery (P ＜0.001).There was no significant statistical difference in postoperative complication rate 8％ and 10％ (P =1.000).Conclusions ERAS management in rectal cancer patients after radical operation enhanced postoperative recovery.
ABSTRACT
Objective To investigate the potential heart sparing effects of tangential volumetric modulated arc therapy (T-VMAT) by comparing its dosimetric properties with conventional wedged tangential fields (W-TF) technique and 6-field intensity-modulated radiotherapy (6F-IMRT) in the locoregional radiotherapy of left breast cancer after conserving surgery,including internal mammary nodal irradiation.Methods Fifteen patients with left breast cancer were enrolled in this study.Three plans were generated for each patient:W-TF,6F-IMRT and T-VMAT with two arc segments of 50°.The prescription dose to planning tumor volume (PTV) was 50 Gy in 25 fractions.Dose-volume parameters and indices of conformity were calculated and compared for the PTV and organs at risk (OAR).Results Compared with W-TF,T-VMAT not only significantly decreased D D and the high dose areas (above 10 Gy) of the heart and left anterior descending branch (LAD) (P ＜ 0.05),but also had the trend of sparing the V5Gy although there was statistically significant difference (P ＞ 0.05).T-VMAT also significantly decreased Dmean V5Gy,V10Gy and V20Gy of the heart,as well as the D V5Gy and V10 Gy of LAD (P ＜ 0.05),compared to 6F-IMRT.Furthermore,T-VMAT did not result in higher V20Gy of ipsilateral lung and higher V5Gy of contralateral breast compared with W-TF (P ＞ 0.05).T-VMAT achieved distinctly better target coverage and conformity,meanwhile obviously lowered hot volume of V110 compared to W-TF (P ＜ 0.05).Conclusions T-VMAT not only significantly decreased the high dose areas,but also had the trend of sparing the low dose area for the heat and LAD.Moreover,there was no significant difference for V20Gy of ipsilateral lung and V5Gy of contralateral breast between T-VMAT and W-TF.
ABSTRACT
OBJECTIVE@#This paper used plantar pressure analysis equipment to discuss the plantar pressure distribution pattern and balance ability of patients with the knee joint injury under static standing.@*METHODS@#Zebris FDM-S plantar pressure analysis equipment was used to collect plantar pressure data from subjects with the knee joint injury and healthy control subjects. We compared the pressure values in each region of pelma, and then assessing the balance ability of the subjects based on the trajectory of the overall pressure center movement.@*RESULTS@#Compared with the healthy control group, patients with knee joint injury have a significantly lower pressure in the heel areas and a significantly higher pressure in the middle foot area. And the total pressure of the injured limb foot in the patient group is lower than that in the contralateral foot. In addition, there is a significant increase in the parameters of the balance ability index in the patient group.@*CONCLUSIONS@#The plantar pressure distribution pattern of patients with knee joint injury is different from that of normal people in static standing, and the balance ability is poor. Therefore, this method has a positive guiding significance in the evaluation and application of knee joint injury.
Subject(s)
Humans , Biomechanical Phenomena , Equipment Design , Foot , Gait , Knee Joint , PressureABSTRACT
Objective To compare the effect of immediate implantation and delayed implantation on the surrounding tissue.Methods The clinical data of 98 cases of anterior teeth with single implant repair were analyzed retrospectively,and they were divided into study group (n =50) and control group (n =48) according to the method of implantation.The patients in the study group were implanted in the tooth socket immediately after the minimally invasive tooth extraction,and the patients in the control group were implanted after 12-16 weeks of minimally invasive extraction.All the two groups were repaired in coronal at 6 months after implantation.The success rate of implant,implant bone resorption,periodontal probing depth,gingival bleeding index,plaque index and red aesthetic score were compared between the two groups.Results The success rate was 100％ in the two groups after 12 months,the difference was not statistically significant(P ＞ 0.05).The implant surrounding bone absorption in the study group was lower than that in the control group,the differences were statistically significant (t =2.132,2.241,2.421,all P ＜ 0.05).At the end of 3 and 6 months,the depth of probing in the study group were significantly lower than those in the control group (t =2.019,2.307,all P ＜ 0.05),and the red aesthetic score in the study group was significantly higher than that in the control group,the differences were statistically significant [(7.97 ± 1.12) points vs.(6.82 ± 1.03) points,(8.65 ± 1.14) points vs.(7.42 ± 1.07) points,t =2.012,2.137,all P ＜ 0.05].The modified sulcus bleeding index and plaque index had no statistically significant differences between the two groups (all P ＞ 0.05).Conclusion The clinical effect of immediate implant restoration of anterior teeth is better than delayed implantation.
ABSTRACT
Atherosclerotic occlusive disease of the lower extremities (ASO-LE) has the third highest rate among systematic atherosclerosis obliterans, ranking after coronary heart disease and stoke, and the disease burden of ASO-LE has been continuously increasing. Invasive revascularizations, which is presented by endovascular therapy technique, has undergone a dramatic development in the past couples of decades. However, controversy concerned about the surgical management and operative indications has heated up in the meanwhile. Thus Society for Vascular Surgery (SVS) published the practice guidelines for ASO-LE with asymptomatic disease and claudication in March, 2015. At the first time the guideline definitely opposed the aggressive invasive revascularization for ASO-LE patients with asymptomatic disease or claudication under satisfied tolerance. Instead, it posed the extreme emphasis on the pharmacotherapy with risk reduction of atherosclerosis at the core and the exercise therapy with supervised or home-based exercise program at the core for ASO-LE patients with asymptomatic disease and claudication.
Subject(s)
Humans , Asymptomatic Diseases , Therapeutics , Endovascular Procedures , Exercise Therapy , Intermittent Claudication , Therapeutics , Lower Extremity , Practice Guidelines as TopicABSTRACT
Computational fluid dynamics (CFD) technology has the potential to simulate normal or pathologic aortic blood flow changes of mechanical properties and flow field, thereby helping researchers understand and reveal the occurrence, development and prognosis of aortic disease. In aortic diseases research, the initial conditions of CFD numerical simulation has experienced a developed process from idealization (forward engineering), rigid vessel wall, uniform cross-sections, laminar flow and stable blood flow towards personalization (reverse engineering), elastic vessel wall (fluid-solid coupling technique), cone-shaped diminishing cross-sections, turbulent flow, pulsatile blood flow. In this review, the research status, the technical superiority and application prospect of CFD technology were discussed with examples in following three major application areas: (1) dynamics characteristic and mechanical properties in normal thoracic aorta; (2) occurrence, advance and disruptive risk predicting in thoracic aortic aneurysm; (3) therapeutic effect and aneurysmal dilatation simulation in thoracic aortic dissection. For the future, the CFD technology may profoundly put an influence on the awareness to aortic diseases and treatment strategies.
Subject(s)
Humans , Aorta , Pathology , Physiology , Aortic Aneurysm, Thoracic , Computer Simulation , Dilatation , Hemodynamics , Pulsatile Flow , Regional Blood FlowABSTRACT
<p><b>OBJECTIVE</b>To study the treatment strategy and survival of patients with primary leiomyosarcoma of inferior vena cava (PIVCLMS).</p><p><b>METHODS</b>Clinical data of 12 cases with PIVCLMS admitted in Peking University People's Hospital from January 2006 to September 2014 were reviewed retrospectively. All cases were confirmed by pathology examination. Among them, there were 4 male and 8 female patients with a mean age of (54 ± 9) years old. Tumors arose from the inferior vena cava (IVC) upper segment in 5 patients, from the middle in other 7 patients. Cardiac extension was observed in 4 cases. Tumor resection was undertaken in 8 patients, the other 4 patients were inoperable. The series was analyzed to identify clinical outcome of surgical strategy and protective factors for patient survival.</p><p><b>RESULTS</b>In tumor resection group, 6 patients had radical resection and 2 underwent palliative resection. As for IVC reconstruction, caval wall resection with a direct suture was carried out in 6 patients or with prosthetic patch in 1 patient. The other 1 patient underwent a segment caval resection and prosthetic graft replacement in situ. In 4 cases of suprahepatic PIVCLMS cardiopulmonary bypass or perfusion by right atrial intubation was performed to assist bleeding control and maintain circulation stabilization, among them 1 patient survived for more than 101 months with no tumor recurrence or metastasis. Among the patients submitted to tumor resection 2 early postoperative deaths occurred, and another 2 patients had complications. All 4 patients submitted to non-resective operation (only neoplasm biopsy) died of PIVCLMS within 8 months. Except for 2 cases of early death, mean survival after tumor resection was (54 ± 40) months. Two patients presented local recurrence and hepatic metastasis at follow-up of 16 months and 68 months.</p><p><b>CONCLUSIONS</b>Tumor resection is the only therapy for PIVCLMS with an expectation for long-term survival. The applicant of cardiopulmonary bypass makes some inoperable indicated to tumor resection.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Blood Vessel Prosthesis Implantation , Cardiopulmonary Bypass , Leiomyosarcoma , Diagnosis , General Surgery , Neoplasm Recurrence, Local , Retrospective Studies , Vascular Neoplasms , Diagnosis , General Surgery , Vena Cava, Inferior , PathologyABSTRACT
Objective To investigate the expression of cytokeratin 34βE12 in esophageal squamous cell carcinoma (ESCC),and its mechanism of action in the process of occurrence and development of an ESCC.Methods Immunohistochemistry was used to analyze the expression of cytokeratin 34βE12 in 252 ESCC patients,66 patients with esophageal carcinoma in situ,and 106 patients with adjacent normal esophageal mucosa before the relationship between its expression and biological behavior was evaluated on the basis of complete clinical information.In addition,Western blotting was used to determine the expression of cytokeratin 34βE12 in 60 patients with esophageal cancer and adjacent normal esophageal tissues.Results (1)The positive rate of caveolin-1 in ESCC,carcinoma in situ,and adjacent normal tissues was 85.7％,54.5％,and 25.7％,respectively.The difference between them was statistically significant (P ＜0.01).(2)The positive rate of cytokeratin 34βE12 in stages Ⅰ,Ⅱ,Ⅲ of ESCC was 76.5％,84.7％,and 96.3％,respectively.The expression intensity of cytokeratin 34βE12 in carcinoma tissue was gradually increased with the advance of clinical stages with a statistically significant difference (P =0.038).The positive rate of cytokeratin 34βE12 with group of lymph node metastasis was significantly higher than those without lymph node metastasis (P ＜ 0.01).(3)Western blotting results further confirmed that the expression of cytokeratin 34βE12 in ESCC was significantly higher than that in adjacent normal esophageal tissue (P ＜0.01).Conclusions The high expression of caveolin-1 might be involved in the occurrence and development of esophageal cancer.The expression of cytokeratin 34βE12 was correlated with the clinical stage of esophageal cancer.cytokeratin 34βE12 was a potential therapeutic target and a valuable prognostic indicator of esophageal cancer progression.
ABSTRACT
The frequency-domain magnetic resonance spectroscopy (MRS) is achieved by the Fast Fourier Transform (FFT) of the time-domain signals. Usually we are only interested in the portion lying in a frequency band of the whole spectrum. A method based on the singular value decomposition (SVD) and frequency-selection is presented in this article. The method quantifies the spectrum lying in the interested frequency band and reduces the interference of the parts lying out of the band in a computationally efficient way. Comparative experiments with the standard time-domain SVD method indicate that the method introduced in this article is accurate and timesaving in practical situations.
Subject(s)
Humans , Algorithms , Brain , Metabolism , Computer Simulation , Fourier Analysis , Magnetic Resonance Spectroscopy , Methods , Signal Processing, Computer-AssistedABSTRACT
Studies have suggested that human cytomegalovirus-activated infection is closely associated with atherosclerosis. The levels of interleukin-8 increase significantly in human cyto-megalovirus infection-related atherosclerosis, inducing and aggravating inflammatory reaction through the chemokine receptors, and thus plays an important role in the process of atherosclerosis.