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Objective:To investigate the related factors affecting intraoperative blood loss in patients with spinal tumors undergoing preoperative selective arterial embolization.Methods:The clinical data of 90 patients with spinal tumors who underwent preoperative selective arterial embolization in the Affiliated Hospital of Jining Medical College and the Second Affiliated Hospital of Shanxi Medical University from January 2017 to December 2020 were retrospectively analyzed. The influencing factors of intraoperative bleeding were analyzed by using multiple linear regression.Results:There were statistically significant differences in intraoperative blood loss of spinal tumor patients undergoing preoperative selective arterial embolization with different blood supply abundance and the number of tumors involving vertebral body (all P < 0.05). There were no significant differences in age, gender, body mass index, interval after embolization, operation time, pathological type, tumor site, embolization degree, the number of embolized vessels, preoperative Frankel grade among different groups (all P > 0.05). Multiple linear regression analysis showed that the number of tumors involving vertebral body and tumor blood supply abundance were factors affecting intraoperative blood loss, and vertebra number and tumor blood supply were positively correlated with intraoperative blood loss (all P < 0.05). Conclusion:For patients with spinal tumors undergoing preoperative selective arterial embolization, the number of tumors involving vertebral body and the abundance of the tumor blood supply are factors affecting the amount of intraoperative bleeding.
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OBJECTIVES@#Cardiac hypertrophy and fibrosis are major pathological manifestations observed in left ventricular remodeling induced by angiotensin II (AngII). Low-intensity pulsed ultrasound (LIPUS) has been reported to ameliorate cardiac dysfunction and myocardial fibrosis in myocardial infarction (MI) through mechano-transduction and its downstream pathways. In this study, we aimed to investigate whether LIPUS could exert a protective effect by ameliorating AngII-induced cardiac hypertrophy and fibrosis and if so, to further elucidate the underlying molecular mechanisms.@*METHODS@#We used AngII to mimic animal and cell culture models of cardiac hypertrophy and fibrosis. LIPUS irradiation was applied in vivo for 20 min every 2 d from one week before mini-pump implantation to four weeks after mini-pump implantation, and in vitro for 20 min on each of two occasions 6 h apart. Cardiac hypertrophy and fibrosis levels were then evaluated by echocardiographic, histopathological, and molecular biological methods.@*RESULTS@#Our results showed that LIPUS could ameliorate left ventricular remodeling in vivo and cardiac fibrosis in vitro by reducing AngII-induced release of inflammatory cytokines, but the protective effects on cardiac hypertrophy were limited in vitro. Given that LIPUS increased the expression of caveolin-1 in response to mechanical stimulation, we inhibited caveolin-1 activity with pyrazolopyrimidine 2 (pp2) in vivo and in vitro. LIPUS-induced downregulation of inflammation was reversed and the anti-fibrotic effects of LIPUS were absent.@*CONCLUSIONS@#These results indicated that LIPUS could ameliorate AngII-induced cardiac fibrosis by alleviating inflammation via a caveolin-1-dependent pathway, providing new insights for the development of novel therapeutic apparatus in clinical practice.
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Objective@#To evaluate the effect of transcatheter aortic valve replacement(TAVR) using Venus-A valve for treating patients with severe aortic stenosis.@*Methods@#In this prospective study, 101 consecutive severe aortic stenosis patients with high surgical risk(Society of Thoracic Surgeon(STS) score ≥4%) or at prohibitive surgical risk were enrolled from 5 academic cardiovascular centers in China(Fuwai hospital, the second affiliated hospital of Zhejiang university school of medicine, West China hospital of Sichuan university, the first affiliated hospital of Nanjing medical university, Ruijin hospital of Shanghai Jiaotong university school of medicine) from September 2012 to January 2015, and Venus-A valves were used in TAVR for these patients. The primary endpoints were death from any cause and major stroke in 1 year. The secondary endpoints included efficacy and safety of TAVR in 1 year.@*Results@#TAVR success rate was 97.9%(98/101), and 3 patients were transferred to receive surgical AVR. There were 85 patients using 1 Venus-A valve, and 13 patients underwent valve-in-valve implantation using 2 Venus-A valves. There were 1 case(1.0%) of stroke, 2 cases(2.0%)of acute myocardial infarction, 5 cases(5.0%) of pericardial effusion, 6 cases(5.9%) of severe vascular complication, and 2 cases(2.0%) of death after 7 days of TAVR. Meanwhile, aortic pressure gradient derived from echocardiography was significantly reduced when compared with pre-procedure level(11(8, 15) mmHg (1 mmHg=0.133 kPa) vs. 59(45, 71)mmHg, P<0.01), and there was no aortic root rupture or leaflets thrombosis. Rate of NYHA functional class ≤Ⅱ improvements were observed at 6 months follow-up when compared with pre-procedure(94.4%(84/89)vs. 21.3%(21/89), P<0.01). The primary endpoint was 7.9%(8/11), and the incidence of all cause death and stroke was 5.9%(6/101) and 2.0%(2/101) respectively at 1 year after the procedure. Kaplan-Meier survival analysis showed that cumulative survival rate was 94.1% at 1 year after the procedure.@*Conclusion@#TAVR using Venus-A valve for treating patients with severe aortic stenosis is effective and safe in the early and medium term post procedure.
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Objective:To identify the novel HAND 1 mutation associated with congenital ventricular septal defect (VSD) and to perform the functional analysis.Methods:A total of 125 patients with congenital VSD and 210 control individuals were recruited,and their clinical data and blood samples were collected.The genomic DNA from each study subject was isolated,and all the coding exons of HAND1 were amplified.The amplicons from HAND 1 were sequenced to identify a sequence variation.The functional characteristics of the mutant HAND 1 were analyzed by a dual-luciferase reporter assay system.Results:A novel heterozygous HAND1 mutation c.355G＞T,equivalent to E119X,was identified in a patient with sporadic VSD.This nonsense mutation was absent in the 210 control subjects.Functional analysis revealed that the mutant HAND1 lost the ability to transactivate a target gene.Conclusion:A novel HAND1 mutation with VSD is identified in this study.
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A limited number of microRNAs (miRNAs, miRs) have been reported to control postnatal cardiomyocyte proliferation, but their strong regulatory effects suggest a possible therapeutic approach to stimulate regenerative capacity in the diseased myocardium. This study aimed to investigate the miRNAs responsible for postnatal cardiomyocyte proliferation and their downstream targets. Here, we compared miRNA profiles in cardiomyocytes between postnatal day 0 (P0) and day 10 (P10) using miRNA arrays, and found that 21 miRNAs were upregulated at P10, whereas 11 were downregulated. Among them, miR-31a-5p was identified as being able to promote cardiomyocyte proliferation as determined by proliferating cell nuclear antigen (PCNA) expression, double immunofluorescent labeling for α-actinin and 5-ethynyl-2-deoxyuridine (EdU) or Ki-67, and cell number counting, whereas miR-31a-5p inhibition could reduce their levels. RhoBTB1 was identified as a target gene of miR-31a-5p, mediating the regulatory effect of miR-31a-5p in cardiomyocyte proliferation. Importantly, neonatal rats injected with a miR-31a-5p antagomir at day 0 for three consecutive days exhibited reduced expression of markers of cardiomyocyte proliferation including PCNA expression and double immunofluorescent labeling for α-actinin and EdU, Ki-67 or phospho-histone-H3. In conclusion, miR-31a-5p controls postnatal cardiomyocyte proliferation by targeting RhoBTB1, and increasing miR-31a-5p level might be a novel therapeutic strategy for enhancing cardiac reparative processes.
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Animals , Rats , Cell Count , MicroRNAs , Myocardium , Myocytes, Cardiac , Negotiating , Proliferating Cell Nuclear AntigenABSTRACT
Objective To analyze the clinical effect of anterior cervical decompression with double-way connection intervertebral fusion device (ROI-C) implantation for type Ⅱ or type Ⅱ a Hangman fracture.Methods A retrospective study was made on 14 patients with type Ⅱ or type Ⅱ a Hangman fracture treated with anterior cervical ROI-C implantation between February 2011 and March 2014.The patients (11 males and 3 females) were aged between 22 and 46 years (mean,26.4 years).Nine patients sustained traffic injury,4 fall injury and 1 crash injury.Nine patients were classified as type Ⅱ and 5 type Ⅱ a according to the Levine-Edwards classification.All were completed cervical anteroposterior and lateral X-ray,CT scan,three-dimensional CT reconstruction and MRI examination after adnission.American Spinal Injury Association (ASIA) grade E was noted in all before operation.Clinical posttraumatic neck score,visual analogue scale (VAS) as well as angle deformity and displacement of the axis were recorded before operation and at the latest follow-up.Results All patients were operated successfully.Mean operation time was 61 min(range,45-116 min).There were no injuries of superior laryngeal nerve,hypoglossal nerve,throat wall and vessel during operation.Laryngeal edema,dysphagia,paralysis of tongue,hematoma and wound infection were not observed after operation.Mean period of follow-up was 24.2 months (range,4-32 months).All segments and fracture sites showed solid fusion after 3 months.No cages became subsided or displaced,no discs collapsed,and no malunion occurred at the latest follow-up.Data of preoperation and latest follow-up differed significantly with respect to clinical posttraumatic neck score[(53.1 ±7.2) points vs.(91.1 ±5.0)points],VAS[3.38(2.43,4.33)points vs.0.58(0,1.29) points],axis displacement[(4.0 ± 1.5) mm vs.(1.3 ± 1.2) mm],and angle deformityoftheaxis[(9.2±4.7)° vs.(2.1 ±1.9)°] (P＜O.05 or O.01).Conclusion Anterior cervical surgery with ROI-C implantation for type Ⅱ or type Ⅱa Hangman fracture provides good fusion rate and satisfactory clinical effect.
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Objective To analyze the internal fixator remove time in different age patients after non-fusion cross injured vertebral screw of thoracolumbar vertebral fracture. Methods Sixty-eight patients who had underwent non-fusion cross injured vertebral screw were divided into 2 group according to the age:young group (20-44 years, 36 cases) and middle aged group (45-59 years, 32 cases). The numeric rating score (NRS), Oswestry disablility index (ODI), discoideum index (DI) and kyphotic Cobb angle 6, 9, 12 and 15 months after surgery were compared between 2 groups. Results The kyphotic Cobb angle, ODI and NRS 9, 12 and 15 months after surgery in 2 groups were significantly lower than those 6 months after surgery, which was in young group: (37.34 ± 6.86)° , (36.81 ± 6.78)° and (36.90 ± 6.97)° vs. (56.31 ± 3.56)° , (2.45 ± 0.55)%, (2.24 ± 0.53)% and (2.09 ± 0.41)% vs. (3.02 ± 0.89)%, (18.46 ± 2.73), (18.44 ± 3.05) and (18.28 ± 2.98) scores vs. (19.79 ± 2.85) scores, and in middle aged group: (37.11 ± 6.80)° , (35.58 ± 5.48)° and (35.40 ± 5.44)° vs. (56.03 ± 3.68)° , (2.21 ± 0.41)%, (2.08 ± 0.43)%and (1.97 ± 0.39)%vs. (3.04 ± 0.93)%, (19.17 ± 2.99), (18.57 ± 2.98) and (18. 43 ± 2.92) scores vs. (20.95 ± 2.49) scores. There were statistical differences (P<0.05). The DI 12 and 15 months after surgery in young group were significantly lower than that 6 and 9 months after surgery:(50.59 ± 4.60)%and (47.57 ± 4.30)%vs. (56.60 ± 3.98)%and (56.32 ± 3.87)%, and there were statistical differences (P<0.05). The DI 15 months after surgery in middle aged group was significantly lower than that 6, 9 and 12 months after surgery:(47.95 ± 4.87)%vs. (56.34 ± 3.97)%, (56.13 ± 3.88)%and (55.63 ± 3.94)%, and there were statistical differences (P<0.05). Conclusions The internal fixator remove time in the young patients after non-fusion of cross injured vertebral screw of thoracolumbar vertebral fracture is 9 months after surgery, and in the middle aged patients is 12 months after surgery. Intervertebral disc degeneration is one of the risk factors for delayed removal.
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Objective To investigate the preliminary clinical result of thoracolumbar fracture combined with posterior ligamentous complex injuries repaired by posterior transpedicular screw fixation.Methods A retrospective review was performed on 22 patients with thoracolumbar flexion-distraction fracture combined with posterior ligamentous complex injuries treated with transpedicular screw fixation from July 2008 to March 2013.There were 16 males and 6 females with mean age of 39 years (range,23-62 years).After medically stable,posterior pedicle screw fixation was performed under intravenousinhalational anesthesia.According to the degree of fracture displacement and types of ligament injury,posterolateral bone grafting or intervertebral fusion at the level of injury was conducted.Vertebral height restoration,Cobb' s angle and American Spinal Injury Association (ASIA) score were reviewed preoperatively,at postoperative 3 days and at the last follow-up.Results All the patients were operated on smoothly.There were no complications during operation.All the patients were followed up for 5-51 months (mean,26.5 months).Fracture reductions were satisfied with the closure of vertebral posterior element.Mean anterior vertebral height and Cobb' s angle improved by 20.6％ and 10.60°respectively after operation (P ＜0.01).Eight patients with neurological dysfunction showed some recovery after operation with the mean sensory score improved by 20.7％ (P ＜ 0.05) and mean motor function score improved by 30.9％ (P ＜ 0.0l).All bone grafts were healed,without pain,loosening or breakage in the fixation system.Conclusions Posterior pedicular screw fixation attains good short-term outcome for thoracolumbar flexion-distraction fracture combined with posterior ligamentous complex injuries.The surgery provides satisfactory reduction and instant spinal three-column stability for the unstable spine fracture.Sufficient bone graft is the guarantee to permanent stability.
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<p><b>OBJECTIVE</b>To compare the features of patients with pulmonary hypertension due to left heart disease classified according to transpulmonary gradient (TGP) or diastolic pressure difference (DPD).</p><p><b>METHODS</b>Thirty-three patients with pulmonary hypertension due to left heart disease diagnosed by right heart catheterization were enrolled. Patients were divided into two groups according to TPG: 17 patients with TPG ≤ 12 mmHg (1 mmHg = 0.133 kPa) and 16 patients with TPG > 12 mmHg; or divided into two groups according to DPD: 23 patients with DPD < 7 mmHg and 10 patients with DPD ≥ 7 mmHg. McNemar's method was used to test the agreement of the two classification methods.</p><p><b>RESULTS</b>Below are the patients features according to the classification by TPG: central venous pressure ((9.0 ± 2.5) vs. (12.7 ± 5.4) mmHg), mean right atria pressure ((9.1 ± 2.4) vs. (12.8 ± 5.2) mmHg), right heart systolic pressure ((45.5 ± 9.8) vs. (66.8 ± 15.4) mmHg), right heart mean pressure ((22.6 ± 5.2) vs. (33.1 ± 7.5) mmHg), pulmonary systolic pressure ((44.2 ± 10.3) vs. (64.8 ± 14.2) mmHg), pulmonary diastolic pressure ((24.2 ± 4.5) vs. (33.1 ± 8.3) mmHg), pulmonary mean pressure ((32.3 ± 5.7) vs. (45.8 ± 8.6) mmHg), cardiac index ((2.6 ± 1.0) vs. (1.9 ± 0.9) L · min(-1) · m(-2)), right heart EF ((31.2 ± 12.6)% vs. (22.6 ± 7.1) %) and pulmonary vascular resistance ((2.3 ± 0.8) vs. (6.3 ± 2.6) Wood) were significantly different between the two groups (all P < 0.05). According to the classification of DPD, only right heart diastolic pressure ((7.4 ± 3.7) vs. (11.5 ± 5.7) mmHg), pulmonary diastolic pressure ((25.9 ± 6.4) vs. (34.7 ± 8.0) mmHg) and pulmonary vascular resistance ((3.3 ± 2.0) vs. (6.2 ± 3.4) Wood) were significantly different between the two groups (all P < 0.05). These was a weak agreement (κ = 0.386 6, 95% CI: 0.092 2-0.681 0) between the two classification methods.</p><p><b>CONCLUSION</b>TPG classification is superior to DPD classification for pulmonary hypertension patients due to left heart disease on identifying the hemodynamic differences.</p>
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Humans , Blood Pressure , Cardiac Catheterization , Diastole , Heart , Heart Failure , Hemodynamics , Hypertension, Pulmonary , Vascular ResistanceABSTRACT
The principal goal of opening the course of Medical Communication is to develop medical students'basic communication skills which involve three aspects:the proper use of language tools,communication and problem-solving skills in the course of general interper-sonal relationships,information communication skills between doctors and patients in the process of making a diagnosis or treatment,public communication skills on medical education and communication skills in dealing with a medical dispute or crisis between doctors and patients. This paper presents clearly the connotation of medical communication and puts forward specific programs on the organization and implementation of the course.
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@#ObjectiveTo explore the effect of the lateral island flap with neurovascular pedicle of finger on reconstruction of the sensory function of thumb and forefinger pulp.MethodsSensory functions of 9 thumb pulps and 7 forefinger pulps were reconstructed by the lateral island flap with neurovascular pedicle of ring finger and middle finger.ResultsAll 16 island flaps were survived. Follow-up survey was 6 months to 2 years. The appearance and texture of flaps were satisfactory with sensory function being S3-S3+ grade.ConclusionThe lateral island flap with neurovascular pedicle of ring finger and middle finger is a good and reliable method to reconstruct the sensory function of thumb and forefinger pulp.
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Mass education and elite education are two different viewpoints on education.Medical education is a special type of education which involves human beings' health and life,so it can only be elite education.Government,universities and society should perform their duties to maintain the elite characteristics of medical education.
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Objective To evaluate the effect of transcatheter closure of perimembranous ventricular septal defect (PMVSD) with symmetric ventricular septal occluder (SVSO). Methods Sixty-three patients with UCG confirmed PMVSD underwent transcatheter closure with SVSO. Results The implantation was successful in 58 patients (93.0%). The mean PMVSD diameter was 5.1?1.9 mm by angiography. The distance from the aortic valve to the rim of PMVSD was 2.7?1.0 mm and the mean size of SVSO was 7.2?2.1 mm. There was no residual shunt in 55 patients (94.8%) right after the deployment of SVSO. Arrhythmia was recorded in 15 patients (23.8%) during or after the procedure. New aortic regurgitation was observed in one patient after the implantation SVSO. Two patients developed myocardium injury and one patient developed obstruction of right ventricular outflow tract. Dislocation of the device was found in one patient. During the follow-up of 3 to 12 (means 7.4?2.7) months, no residual shunt, displacement or rupture of divices and endocarditis happened. Conclusion Transcatheter closure of PMVSD using SVSO is safe and effective, meanwhite attention should be paid to the complications such as arrhythmias.
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The existent problems of medical insurance specialty core course system currently are tallied up on the foundation of definition of core course system. The strategy and measure for adjustment are put forward,providing a basis for this professional course reform.
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<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of the Amplatzer septal occluder for transcatheter closure in patients with secundum atrial septal defect (ASD II).</p><p><b>METHODS</b>Patients with clinically confirmed ASD II were recommended for transcatheter closure of ASD II.</p><p><b>RESULTS</b>30 ASD II patients (20 females) underwent transcatheter closure at a median age of 18.4 years (5-55 years). Both the stretched diameters of ASDs and the sizes of the devices were from 18 to 34 mm (25 +/- 7 mm). The successful placement rate was 100%. The rest shunt documented by color Doppler, was immediately after implantation in 40% of patients, in 9.9% after 24 hours, and in 3.3% trace at 3 months. No serious complications were observed. There was improvement in symptoms and in cardiac size. Septal motion abnormalities normalized in all patients after 3 months follow-up.</p><p><b>CONCLUSION</b>The Amplatzer septal occluder is a safe and effective device for transcatheter closure of ASD II. Long-term follow-up is still required before widespread clinical use can be recommended.</p>
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Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Follow-Up Studies , Heart Septal Defects, Atrial , General Surgery , Surgical InstrumentsABSTRACT
heparin coating.Conclusion Anti-thrombogenicity in vitro of biomaterials designed for the closure of congenital heart defects can be improved by immobilizing Chi/Hep conjugating onto the surface,but proliferation of HUVEC could be inhibited by Chi/Hep coating.
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Objective To evaluate the effectiveness and safety of transcatheter closure of membranous ventricular septal defect (MVSD) using Amplatzer membranous VSD occluder (AMVSO). Methods The patients, who were clinically diagnosed with VSD were recommended for further transthoracic echocardiographic assessment using multiple standard views. If there were left to right shunts across ventricular septum, the margin of defects to the aortic valve was more than 1mm and that to tricuspid valve was more than 3 mm. If there was an aneurysm, it should not interfere with the function of outlet of right ventricule. Finally, if the diameter of VSDs wasless than 14mm, catheter closure of VSDs was suggested in these patients. The patients, having residual shunt after surgical closure of VSD, were included. All procedures were performed under local or general anesthesia. Transthorac echocardiography and X ray were used continuously to monitor the procedure. Transthoracic echocardiography was performed immediately after the release of devices, 24 hours, and 3 months after the procedure, respectively.Results From June 2002 to March 2003, 32 consecutive patients (15 females), underwent transcatheter closure of MVSD. The mean diameters of VSDs measured by echocardiography was 5.1 mm (3～8 mm) and, while that by angiography was 4.4 mm (3～8 mm). The mean size of the occluder was 7.6 mm(4～12 mm). The successful rate of device implantation was 100% (32/32). The residual shunt immediately after the closure was 11.5%, whereas after 24 hours it was only 7.7%, which was not serious. After 3 months′ follow-up, only 3.8% trivial residual shunt existed. No death occurred during and after the procedure. Atrial tachycardia, ventricular tachycardia, and bundle (right and left bundle) branch block, which was considered to relate to catheter manipulation inside the chamber of ventricle, were common and transient. One aortic regurgitation and tricuspid insufficiency became severe after the procedure, but they were not serious. One patient developed III degree A-V block 24 hours after the procedure, and EKG became LBBB 3 days after the temporary pace making. Hemolysis was observed in one patient, and he recovered 7days after the medication therapy. Conclusion Transthoracic echocardiography was very much effective in catheter closure of MVSD. The asymmetric self-expanding nitinol double-disc Amplatzer device designed for the transcatheter closure of MVSD is implanted easily and stably. Due to low ratio of residual shunt and few serious complications, the Amplatzer device is a good choice for the transcatheter closure of MVSD.
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Objective To discuss the hemodynamics and treatment of silent patent ductus arteriosus (PDA) Methods The heart catheterizations were performed in seven silent PDA patients Results The mean pulmonary artery pressure of seven patients was (16?2 4) mm?Hg The mean Qp/Qs was 1 08?0 02 The mean size of the left right shunt was (0 32?0 08) L/min The proportion of left right shunt size in pulmonary blood flow was 0 098?0 024 on average The mean PDA at its narrowest segment was (0 9?0 2) mm We performed neither surgery nor interventional treatment in all patients In 9 5 months follow up (clinical findings, electrocardiography, echocardiography), no atrioventricular chambers enlargement, pulmonary hypertension, infective endoarteritis and infective endocarditis happened Conclusion In silent PDA patients, there is less size of left right shunt and smaller effect on hemodynamics Its treatment with surgical and interventional closure is under discussion