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Objective:To evaluate the role of Nod-like receptor family pyrin domain-containing 2 (NLRP2) in the dorsal root ganglion (DRG) in neuropathic pain (NP) in rats.Methods:Thirty-two male Sprague-Dawley rats in which intrathecal catheters were successfully implanted, aged 2-3 months, weighing 200-250 g, were divided into 4 groups ( n=8 each) using a random number table method: sham operation group (S group), NP group, NP plus NLRP2-siRNA group (NP+ siRNA group) and NP plus NLRP2-scrRNA group (NP+ scrRNA group). The right sciatic nerve was only exposed but not ligated in group S. NP was induced by chronic constriction injury (CCI) to the sciatic nerve in anesthetized rats in group NP, group NP+ siRNA and group NP+ scrRNA.NLRP2-siRNA and NLRP2-scrRNA were intrathecally injected at 3 days before CCI in group NP+ siRNA and group NP+ scrRNA, respectively.The mechanical paw withdrawal threshold (MWT) was measured at 1 day before CCI (T 0) and 1, 3, 7 and 10 days after CCI (T 1-4). The rats were sacrificed after the last measurement of pain threshold, and the L 4, 5 segments of the DRG on the operated side were removed for determination of the expression of NLRP2 and caspase-1 (by Western blot), the expression of NLRP2 mRNA (by real-time polymerase chain reaction) and interleukin-1beta (IL-1β) content (by enzyme-linked immunosorbent assay). Results:The MWT was significantly lower at T 2-4 than at T 0 in group NP, group NP+ siRNA and group NP+ scrRNA ( P<0.05). Compared with group S, the MWT was significantly decreased at T 2-4, the expression of NLRP2 protein and mRNA and caspase-1 was up-regulated, and the content of IL-1β was increased in group NP ( P<0.05). Compared with group NP, the MWT was significantly increased at T 2-4, the expression of NLRP2 protein and mRNA and caspase-1 was down-regulated, and the content IL-1β was decreased in group NP+ siRNA ( P<0.05), and no significant change was found in the parameters mentioned above in group NP+ scrRNA ( P>0.05). Conclusion:NLRP2 in DRG is involved in the development of NP, and the mechanism is related to NLPR2 inflammasomes-induced peripheral neuroinflammation in rats.
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Despite the extremely high mortality and disability rates of intracerebral hemorrhage, there are currently no effective interventions to improve the outcomes. More and more research shows that statins may be a new method for treating intracerebral hemorrhage. However, there is still much controversy about the relationship between statins therapy and intracerebral hemorrhage. This article reviews the recent studies on the relationship between statins and intracerebral hemorrhage.
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Objective To investigate the clinical characteristics and risk factors of secondary infection in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV).Methods One hundred and eighteen patients newly diagnosed with AAV at the institute of nephrology,Tongji hospital affiliated to Huazhong university of science and technology,from 2012 to 2017,were analyzed retrospectively.Induction therapy included single corticosteroids,combination of corticosteroids with cyclophosphamide and combination of corticosteroids with other immunosuppressive agents.End point was defined as moderate to severe infection which was diagnosed by the clinical and radiological manifestation as well as microbiological evidences.The infection-related survival curve was drawn to reflect the time when the infection occurred.The clinical baseline variables in patients with and without infection were compared.Multivariate Logistic regression model was used to determine the independent predictors of infection.Receiver-operating characteristic curve (ROC) was plotted for evaluating the predictive value of lymphocyte on moderate to severe infection.Results During followup of median 3 months (1-30 months),88 infection episodes were found in 63 (53.4％) patients,of which 54 times (61.4％) occurred within 6 months after treatment,46 times (52.3％) happened within 3 months after treatment.The most common organ of infection was lung (62.5％),and the most common pathogen was bacteria (51.1％).Multivariate Logistic regression model showed that lung involvement (OR=4.44,95％ CI 1.59-12.41),moderate reduction of lymphocyte in follow-up (OR=5.69,95％ CI 2.05-15.85) and severe lymphocyte reduction (OR=36.28,95％CI 3.45-381.17) were independent risk factors of secondary infection in AAV patients (all P ＜ 0.05).ROC curve showed that the area under the curve of lymphocyte as a predictor of severe infection was 0.767 (95％ CI 0.64-0.89,P ＜ 0.05).Based on lymphocyte less than 0.49× 109/L which was the cut-off value for predicting severe infection,the sensitivity and the specificity were 83.9％ and 71.9％,respectively.Conclusions Lung involvement and moderate-severe lymphopenia during follow-up are independent risk factors of secondary infection in AAV patients.Hence,physician should pay more attention to those patients,and adjust treatment in time to avoid the occurrence of infection.
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Despite the extremely high mortality and disability rates of intracerebral hemorrhage,there are currently no effective interventions to improve the outcomes.More and more research shows that statins may be a new method for treating intracerebral hemorrhage.However,there is still much controversy about the relationship between statins therapy and intracerebral hemorrhage.This article reviews the recent studies on the relationship between statins and intracerebral hemorrhage.
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PURPOSE: Hepatocellular carcinoma (HCC) is a highly aggressive malignant tumor, the prognosis of which remains poor. Recently, microRNAs have been reported to play crucial functions in multiple tumors, including HCC. However, the molecular mechanisms of miR-370 in HCC still remain largely unknown. The present study focused on the effects of miR-370 on HCC migration, invasion, and epithelial-mesenchymal transition (EMT). MATERIALS AND METHODS: We investigated the key roles and possible regulatory mechanism of miR-370 in regulating HCC metastasis with functional assays, such as transwell assay. Quantitative real-time PCR (qRT-PCR) was used to detect miR-370 and guanylylcyclase domain containing 1 (GUCD1) expression in HCC tissues and cells. Subsequently, we performed transwell assays to determine the functions of miR-370 in HCC cell invasion and migration. Western blot was used to determine protein expressions of relevant genes. Luciferase reporter assays were conducted to confirm the target gene of miR-370. RESULTS: qRT-PCR analysis demonstrated that miR-370 was dramatically downregulated in HCC. Moreover, downregulated miR-370 was found to be associated with poor survival and adverse clinicopathologic characteristics of HCC patients. Transwell assays revealed that miR-370 overexpression dramatically suppressed HCC invasion and migration. Meanwhile, miR-370 restoration prominently inhibited EMT progression in HCC cells. Luciferase reporter assays confirmed GUCD1 as a downstream target gene of miR-370. GUCD1 expression in HCC tissues was prominently increased and inversely correlated with miR-370 expression. Furthermore, GUCD1 was verified as mediating the suppressive influence of miR-370 on cell metastasis and EMT in HCC. CONCLUSION: Taken together, our study confirmed that miR-370 suppressed HCC cell metastasis and EMT via regulating GUCD1. Accordingly, the miR-370/GUCD1 axis may potentially acts as attractive therapeutic targets and novel biomarkers for HCC treatment.
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Humans , Biomarkers , Blotting, Western , Carcinoma, Hepatocellular , Epithelial-Mesenchymal Transition , Luciferases , MicroRNAs , Negotiating , Neoplasm Metastasis , Prognosis , Real-Time Polymerase Chain ReactionABSTRACT
Objective To identify the significance of serum phospholipase A2 receptor antibody (PLA2R-Ab) in idiopathic membranous nephropathy (IMN) patients.Methods A total of 108 patients diagnosed as IMN by medical history,physical examination,laboratory examination and renal biopsy in Tongji Hospital affiliated to Tongji Medical College,Huazhong University of Science and Technology between Dec 1,2014 and Aug 31,2017 were enrolled,and all related data were recorded.According to the results of serum PLA2R-Ab test,patients were divided to positive group and negative group,and the data were compared with the independent sample t test and the chi-square test.Kaplan-Meier survival analysis was performed to compare remission rates between groups,and the Logrank method was used to evaluate the significance of differences.Univariate and multivariate Cox regression analysis were used to verify predicting factors for achieving remission.Results Overall,67.6％(73/108) patients had detectable serum PLA2R-Ab.Compared with patients in negative group,patients in positive group exhibited higher proportion of male patients (P=0.002),lower level of serum albumin (P ＜ 0.001),higher level of cholesterol (P ＜ 0.001),lower level of immunoglobulin G (P ＜0.001),higher level of proteinuria (P=0.003),a lower of chance of remission (P=0.049),longer time needed to achieve partial remission (P=0.001) and complete remission (P=0.002).The 1-and 2-year cumulative renal partial remission rates were 72.4％,86.1％,and the cumulative renal complete remission rates were 43.8％,54.0％,respectively.Patients in negative group had higher partial remission (x2=9.84,P=0.002) and complete remission (x2=15.50,P＜0.001) than those in positive group.Multivariate Cox regression model indicated that serum positive PLA2R-Ab was a significant independent risk factor.Conclusions IMN patients with serum PLA2R-Ab show more severe condition and lower remission rates than those without serum PLA2R-Ab.Serum positive PLA2R-Ab is an independent remission-related predictor for IMN patients.
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Objective To investigate the complications caused by CT-guided percutaneous radiofrequency ablations (RFA) for lung cancer and analyze the prevention approach. Methods A total of 125 lung cancer patients (142 RFA treatments) in our hospital were enrolled in this study between July 2015 and June 2017. This retrospective study analyzed the reasons and the strategies for preventing the complications. Results One hundred and twenty?five patients underwent RFA treatment for lung lesions. All the operations were successfully completed. During the treatment, 18 patients showed hemorrhage (3 of CTCAE grade 3 hemorrhage); 16 patients showed pneumothorax, among which, 15 patients have chronic obstructive pulmonary disease; 28 patients showed chest pain (23 cases were located under the pleura); 3 patients showed pneumonia;1 patient showed pulmonary abscess, which located in the subpleural space with a maximum diameter of ＞3 cm; 1 patient showed pulmonary embolism, and 1 patient with scald. Complications were attenuated after symptomatic treatment. Conclusion The main reasons of complications of RFA in treating lung cancer were direct injuries caused by punctures, tumors with abundant blood supplement, tumors adjacent to pleura, low scores of lung function, coagulation disorders, and diabetes. The key points for avoiding and reducing complications are preoperative evaluation of patients' basic situations, exclusion of intraoperative avoidable technical risk factors.
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Objective To investigate the CT-guided percutaneous irreversible electroporation (IRE) in treating locally advanced pancreatic cancer (LAPC) and providing guidance for its prevention and treatment. Methods We retrospectively analyzed the clinical and imaging data of 17 patients (17 lesions) of LAPC treated with CT-guided IRE in our hospital from July 2015 to June 2016. Complications were documented and reviewed at day 7,30 and 90 follow up as well as during the procedure. The Clavien?Dindo was used for classification. The reasons that induced complications were summarized and to further discuss the prevention and treatment approaches. Results Of 17 patients, 2 patients suffered a transient tachycardia during the procedure. Eleven patients (65%) showed complications at day 7, of which gradeⅠcomplications occurred in 6 cases, including abdominal pain, nausea, vomiting, or a few of inflammatory exudations around the pancreas; four patients have grade Ⅱ complications, along with portal vein thrombosis;one patient showed grade Ⅲ a complications for retroperitoneal infection. With 30 days follow up, the grade Ⅰ complications disappeared, gradeⅡcomplications have not getting better, while grade Ⅲ a complications have been improved. With 90 days follow up,patients with grade Ⅲ a complications getting better; two patients with grade Ⅱ complications didn't show any changes;2 cases progressed to grade Ⅴ, and died of digestive tract bleeding at 82 days and 98 days after procedure. Conclusion CT-guided irreversible electroporation for treating LAPC is a safe ablation approach. Strict patient selection before procedure and make a reasonable prevention and treatment measures can reduce the complications.
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Acute lung injury after thoracic surgery is the main cause of perioperative death.Acute lung injury is a complex pathophysiological process involving inflammation,characterized by non cardiogenic hypoxemia and acute exudation of the lungs in imaging.Intraoperative ventilation strategy is the most important factor of postoperative acute lung injury.The core of treatment for postoperative acute lung injury is symptomatic support,and prevention is still the most effective strategy for the management of acute lung injury.In this review,the diagnosis,pathogenesis,risk factors and treatment of post-thoracic acute lung injury are introduced,and the progress of prevention strategy and treatment are discussed and summarized.
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Objective To evaluate the effect of hydrogen sulfide on myocardial exogenous apoptotic pathway in a rat model of hemorrhagic shock and resuscitation.Methods Sixty clean-grade healthy male Sprague-Dawley rats,aged 8 weeks,weighing 250-300 g,were divided into 4 groups (n =15 each) using a random number table method:sham operation group (group S),sham operation plus sodium sulphid (NaHS) group (group S+NaHS),hemorrhagic shock group (HS group),and hemorrhagic shock plus sodium sulphid group (group HS+NaHS).Rats only underwent arterial and intravenous puncture in group S.Hemorrhagic shock was induced by withdrawing blood from the femoral artery until mean arterial pressure (MAP) was reduced to 35-40 mmHg within 10 min and maintained for 1.5 h.NaHS 28 μmol/kg was intraperitoneally injected at 10 min before resuscitation in group HS+NaHS.The equal volume of NaHS was administered at the same time in group S+NaHS.Immediately before blood letting and at 0,1.5,2,3,4 and 6 h after blood letting (T1-5),MAP was recorded and blood samples were collected from the femoral vein for determination of serum creatine kinase (CK) and lactate dehydrogenase (LDH) concentrations by chemical colorimetry.Rats were then sacrificed and hearts were removed for examination of the pathological changes of myocardial tissues (with a light microscope) and for determination of cell apoptosis (by TUNEL),expression of caspase-3 and caspase-8 (by Western blot) and expression of Fas and FasL (by immunohistochemistry).Apoptosis index was calculated.Results Compared with group S,MAP was significantly decreased at T1-5,the serum CK and LDH concentrations at T1-5 and apoptosis index at T5 were increased,and the expression of Fas,FasL,caspase-3 and caspase-8 was up-regulated in group HS (P＜ 0.05).Compared with group HS,MAP was significantly increased at T1-3,the serum CK and LDH concentrations at T3-5 and apoptosis index at T5 were decreased,and the expression of Fas,FasL,caspase-3 and caspase-8 was down-regulated in group HS+NaHS (P＜0.05).The pathological changes of myocardial tissues were significantly attenuated in group HS+NaHS when compared with group HS.Concclusion The mechanism by which hydrogen sulfide attenuates myocardial injury induced by hemorrhagic shock and resuscitation is associated with inhibiting the exogenous apoptotic pathway in rats.
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<p><b>OBJECTIVE</b>To explore the impact of the gastric tube diameter on quality of life of esophagus cancer patients after Ivor-Lewis esophagectomy.</p><p><b>METHODS</b>Clinical and follow-up data of 188 esophageal cancer patients who underwent Ivor-Lewis esophagectomy at Department of Cardio-Thoracic Surgery, Drum Tower Clinical Medicine College, Nanjing Medical University from January 2015 to June 2016 were retrospectively analyzed. Inclusion criteria included age <75 years old, good foundation health situation, no distant metastasis, complete follow-up data for one-year after surgery, and middle-lower esophageal squamous cell carcinoma (ESCC). According to the diameter of gastric tube formed during operation, 92 patients were assigned to narrow gastric tube group (NGT group, ≥2 cm to <4 cm), which were further divided into narrower group (≥2 cm to <3 cm, n=44) and medium narrow group (≥3 cm to <4 cm, n=48); 96 patients were assigned to wide gastric tube group(WGT group, ≥4 cm), which were further divided into medium wide group(≥4 cm to <5 cm, n=50) and wider group(≥5 cm, n=46). Postoperative patients were followed up by telephone or outpatient service for one year and then re-hospitalized to receive associated examinations, including lung function test, esophageal pressure measurement, 24-hour esophageal dynamic pH monitoring (total number of pH<4, number of pH<4 lasting more than 5 minutes, maximum duration of pH<4 and time percentage of pH<4) and dilatation measurement of gastric tube (the diameter measured by CT minus the diameter measured in surgery). During follow-up, postoperative quality of life(QoL) was assessed by questionnaire. These contents were compared and plotted as a chart.</p><p><b>RESULTS</b>There were no statistically significant differences between NGT group and WGT group regard to preoperative baseline information, postoperative pathology and postoperative complications (residual gastric leakage, anastomotic leakage, anastomotic stenosis, pulmonary complications, atrial fibrillation and chylothorax) (all P>0.05). Compared with WGT group, the NGT group had better postoperative lung function, including percentage of vital capacity [(76.4±6.8)% vs. (73.2±7.7)%, t=2.168, P=0.033], percentage of maximal voluntary ventilation [(72.7±6.4)% vs. (69.3±6.8)%, t=2.409, P=0.018] and percentage of forced expiratory volume in the first second [(69.2±5.0)% vs. (66.7±6.2)%, t=2.033, P=0.045], higher plane pressure of anastomotic stoma [(5.4±3.1) mmHg vs. (4.2±2.4) mmHg, t=2.083, P=0.038], greater dilatation of gastric tube [(1.0±0.4) cm vs. (0.5±0.3) cm, t=5.888, P=0.000], milder gastroesophageal reflux according to the indices of 24-hour esophageal dynamic pH monitoring, including the total number of pH<4 (228.3±65.3 vs. 280.8±103.9, t=-2.920,P=0.004), the number of pH<4 lasting more than 5 minutes (19.9±8.5 vs. 30.6±15.6, t=-4.127,P=0.000), the maximum duration of pH<4[(32.5±9.4) minutes vs. (37.9±13.6) minutes, t=-2.232,P=0.028] and the time percentage of pH<4 [(23.4±10.2)% vs. (28.4±10.6)%, t=-2.303, P=0.024]. However, no significant difference was found in the scores of postoperative QoL between the two groups(P=0.051). According to the pairwise comparisons among the four subgroups, narrower group showed better performance on postoperative lung function, plane pressure of anastomotic stoma, the dilatation of gastric tube, indices of 24-hour esophageal dynamic pH monitoring and scores of postoperative QoL as compared to wider group (all P<0.05). There were no statistically significant differences among medium narrow group, medium wide group and wider group. Line charts showed that the larger of the gastric tube diameter, the worse of the postoperative lung function, the more severe of gastroesophageal reflux and the smaller degree of gastric tube dilatation.</p><p><b>CONCLUSION</b>Narrow gastric tube with a diameter of 2-4 cm can improve the postoperative QoL of esophagus cancer patients after Ivor-Lewis esophagectomy without increasing the risk of postoperative complications.</p>
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Aged , Humans , Middle Aged , Enteral Nutrition , Esophageal Neoplasms , General Surgery , Esophagectomy , Postoperative Complications , Quality of Life , Retrospective StudiesABSTRACT
Objective To discuss the safety and efficacy of using ExoSealTM vascular closure device to obtain rapid hemostasis of puncture site in interventional procedure via retrograde femoral artery access.Methods The clinical data of 124 patients,who were admitted to authors' hospital during the period from March 2016 to April 2016 to receive interventional procedure via retrograde femoral artery access,were retrospectively analyzed.During the performance of intervention,ExoSealTM vascular closure device (ExoSealTM group,n=52) or manual compression (MC group,n=72) was employed to make femoral artery puncture point hemostasis.The time spent for hemostasis,the manual compression time,the limb immobilization time,the amount of blood loss during compression process,and the procedure-related complications were recorded and the results were compared between the two groups.Results Technical success rate in ExoSealTM group was 98.1％(51/52).In ExoSealTM group and MC group,the time spent for hemostasis was (0.28±0.08) min and (5.83±1.46) min respectively,the manual compression time was (2.65 ±0.57) min and (7.70± 1.88) min respectively,the limb immobilization time was (2.72±0.43) h and (6.15±0.69) h respectively;all the differences between the two groups were statistically significant (P＜0.01).In ExoSealTM group subcutaneous hemotoma occurred in one patient,while in MC group subcutaneous hemotoma occurred in 3 patients and pseudoaneurysm in one patient;the complication rates were 1.92％ (1/52) and 5.56％ (4/72) respectively,but the difference was not statistically significant (P＞0.05).In MC group the amount of blood loss during compression process was (1.11±0.86) ml,which was remarkably less than (7.83±2.08) ml in ExoSealTM group,the difference between the two groups was statistically significant (P＜0.01).Conclusion For hemostasis of puncture site in interventional management via retrograde femoral artery access,the use of ExoSealTM vascular closure device is safe and effective.
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Nanoknife (irreversible electroporation) has demonstrated to be a safe and effective approach to tumor ablation,and plays a prominent role in application of treatment of pancreatic carcinoma,specifically locally advanced pancreatic carcinoma (LAPC).The complicated parameters of Nanoknife comparatively is still difficult.The advantage,optimal selection,adequate parameters regarding Nanoknife were reviewed in this article.
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Objective To investigate the short-term efficacy of plasma exchange(PE),PE combined with double plasma molecule absorption system(PE+DPMAS) for treating severe hepatitis B(SHB).Methods The clinical data in 70 patients with SHB were retrospectively analyzed.The patients were divided into the PE group and PE+-DPMAS group according to different treatment modes.The clinical symptoms,liver function,coagulation function,blood routine,renal function and electrolytes changes,score decrease of model for end-stage liver disease(MELD) before and after treatment were compared between the two groups.Results After treatment,the alimentary tract symptoms were improved,the grade of hepatic encephalopathy was reduced and MELD score was decreased,but there was no statistically significant difference in the short-term effective rate between the two groups(P＞0.05).After treatment ALT,TBIL,RBC,Hb and PLT in the two groups were decreased significantly(P＜0.05);the ALB level in the PE+DPMAS group was decreased,while K+ and C1 were increased(P＜0.05);the PTA and ALB levels in the PE group were increased,while WBC was decreased in the PE group(P＜0.05).Conclusion The two kinds of treatment method PE and PE-+DP-MAS are effective in treating SHB.PE+-DPMAS can reduce the plasma usage and improve serum K+,Cl-levels;PE is superior to PE+DPMAS in the aspects of improving coagulation function and ALB level.
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Objective To investigate the nursing points of pancreatic leakage after upper abdominal multiple organ transplantation. Methods A retrospective study was conducted on the nursing experience of two patients with end-stage liver disease and type 2 diabetes mellitus who were complicated with pancreatic leakage after upper abdominal multiple organ transplantation from March 2009 to July 2015. Results The blood glucose of these patients returned to normal level within 1 week after operation and insulin was discontinued. Pancreatic leakage was occurred in the two patients at 14 and 21 days after operation, respectively. They were both successfully discharged after active treatments and nursing cares including completely drainage, the application of drugs that inhibited the secretion of pancreatic enzymes and digestive tract glands, strengthening infection control, nutritional support and other conservative treatments. Conclusions It is the key to improve the recovery of pancreatic leakage after upper abdominal multiple organ transplantation with careful observation of abdominal signs and abdominal drainage tube, accurate use of somatostatin, nutritional support, maintenance of water and electrolyte balance, and psychological intervention.
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Objective To develop a kind of gelatin microspheres which is capable of being visualized on radiography,CT and MR examinations.Methods Emulsion chemical cross-linking method was used to prepare gelatin microspheres that carried only solid Fe3O4 nanoparticles.Optical microscope was adopted to observe the morphology,particle diameter and the dispersity of the gelatin microspheres.Using thermogravimetric analysis method,the loading rate of Fe3O4 nanoparticles encapsulated in the gelatin microspheres was calculated.The multimodal visualization ability of the gelatin microspheres was evaluated by radiography,CT and MR examinations.The blood in rabbit heart and human vascular endothelial cells were used to make microsphere hemolysis test and in vitro cytotoxicity test.The elastic characteristics and the swelling characteristics of the gelatin microspheres were determined,and the sterile technique was tested.Results The optimal synthesis condition of microspheres was to use 2:1 of Fe3O4-to-gelatin quality ratio,under this situation,the microspheres showed a roundness appearance with satisfactory dispersion,the spherulization rate was high (up to 77％),the drug loading rate was very high (up to 73.27％),the particle diameter was moderate (199.78±142.90 μm),and the microspheres had multimodal visualization ability for radiography,CT and MR examinations.The optimization CT value of microspheres could be up to (1 028.0± 69.5) Hu (when concentration=25 mg/ml).Hemolysis test and in vitro cytotoxicity test showed that no statistically significant differences in the hemolysis rate and absorption value existed between the study group and the control group (P＞0.05).In acid solution,the microspheres exhibited swelling characteristics,while in ethanol the microspheres showed no swelling phenomenon.Conclusion Using solid Fe3O4 nanoparticles as visualization material as well as gelatin as polymer materials,a special gelatin microspheres can be prepared with emulsion chemical cross-linking method.This kind of microspheres carries the following features:high drug loading,regular in shape,smooth surface,not easy to agglomerate,stronger multimodal visualization ability (radiography,CT and MR),high biological safety and convenient disinfection.
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Objective To analyze the learning curve of an experienced interventional radiologist engaged in thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection.Methods The clinical data of 70 patients with Stanford type B aortic dissection,who received TEVAR that was carried out by the same group of interventional physicians over the past 10 years,were retrospectively analyzed.According to the sequence of operation date,the patients were equally divided into group A,B,C,D and E with 14 patients in each group.The operation time,procedure-related complications,postoperative hospitalization days were compared among the 5 groups,and the curative effects at different stages were evaluated.Results No statistically significant differences in the age,sex,classification,concurrent hypertension,concurrent diabetes,active smoking,maximum diameter of false lumen,viscera artery supplied by the false lumen,etc.existed between each other among the 5 groups (P＞0.05).The operation time of group A and group B was (3.29±0.61) hours and (2.87±0.37) respectively (P＜0.05),while the operation time of group C,group D and group E was (1.80±0.62) hours (1.74±0.34) hours and (1.52±0.39) hours respectively (P＞0.05).The operation time of group A and group B was significantly longer than that of group C,D,and E (P＜0.001).The difference in the occurrence of complications was not statistically significant between each other among the 5 groups (P＞0.05).The hospitalization time was gradually shortened from group A to group E,although the difference was not statistically significant (P＞0.05).The surgeries of 28 patients in group A and group B were completed within 2 years and 6.2 years respectively,with an operation frequency being 3.3 patients per year and 7 patients per year respectively;while the surgeries of 42 patients in group C,group D and group E were completed within 2.2 years,1.2 years and 0.5 years respectively,with an operation frequency being 6.4 patients per year,11.7 patients per year and 17.5 patients per year respectively.Conclusion The learning curve of performing TEVAR for type B aortic dissection is approximately 28 cases;after completing 28 TEVAR procedures for type B aortic dissection at the yearly frequency of 4.6 cases by one interventional radiologist,the operation time becomes significantly shortened,and the surgical skills of theinterventional physician team can been significantly improved.
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Objective To compare the curative effect of thoracic endovascular repair (TEVAR) plus medication with that of pure medication in treating uncomplicated type B aortic dissection,and to discuss the treatment strategy for uncomplicated type B aortic dissection.Methods The clinical data of 118 patients with definitely confirmed uncomplicated type B aortic dissection,who were admitted to authors' hospital during the period from 2004 to 2015,were retrospectively analyzed.Among the 118 patients,57 patients received TEVAR plus medication (TEVAR group) and 61 patients were treated with pure medication (drug group).The complications and mortality within one month and during follow-up period in both groups were calculated respectively,and Kaplan-Meier survival curves were used to compare the survival rate between the two groups.Results The incidences of complications and morbidity during hospitalization and within one month after treatment in TEVAR group were 5.2％ and 0％ respectively,which in the drug group were 0％ and 0％ respectively.The patients were followed up for 1-110 months,with a mean of (43.3±36.7) months.The incidence of main complications and the mortality in TEVAR group were 7.0％ and 5.3％ respectively,which in the drug group were 6.6％ and 8.1％ respectively.The one-,2-,4-and 7-year cumulative survival rates in TEVAR group were 100％,97.1％,93.5％ and 78.0％ respectively,which in the drug group were 98.4％,96.4％,90.8％ and 72.7％ respectively,the differences between the two groups were not statistically significant (~=0.019,P=0.890).Conclusion For the treatment of uncomplicated type B aortic dissection,TEVAR plus medication is superior to pure drug therapy in reducing expansion rate of false cavity,but TEVAR carries some procedure-related complications,besides,TEVAR can not improve the survival rate.(J Intervent Radiol,2017,26:266-269)
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OBJECTIVE To investigate the protective effect of Sika deer velvet antler protein (SVPr) against renal toxicity in mice and its mechanism.METHODS Forty ICR mice were randomly divided into 5 groups:normal control group (ig distilled water),model group (ig distilled water for 7 d,on the 7th day,ip cisplatin 25 mg·kg-1 to establish the model,afterwards ig distilled water for 3 d) and SVPr 5,10 and 20 mg· kg-1 groups (ig SVPr for 7 d,cisplatin 25 mg· kg-1 was provided 2 h after the last administration,then ig SVPr for 3 d).Testing kits were adopted for the measurement of renal indexes in mice,such as blood urea nitrogen (BUN) and serum creatinine (SCr);oxidative stress indictors of super oxide dismutase (SOD),catalase (CAT),glutathione (GSH) and malondialdehyde (MDA);inflammation indictor levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).Caspase 3,Bax and Bcl-2 were detected via Western blotting,and renal pathological changes were observed by HE staining.RESULTS SVPr (5,10 and 20 mg·kg-1) significantly reduced the levels of SCr,BUN,MDA,TNF-α and IL-6,and the expressions of caspase 3 and Bax (P＜0.05),but increased the activities of SOD,CAT and GSH,and the expression of Bcl-2 (P＜0.05).The renal pathological changes were improved.CONCLUSION SVPr can reduce renal toxicity induced by cisplatin in mice,and the mechanism is probably related to inhibiting oxidative stress or inflammatory reaction and improving cell apoptosis.
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Objective To investigate the success rate of fluoroscopy-guided subclavian vein catheter implantation (SVCI) in children with hematologic diseases,to improve the visualization of the position of the catheter head,and to reduce the incidence of procedure-related complications.Methods Fluoroscopyguided SVCI was performed in 183 sick children (aged 1-16 years) with confirmed hematologic disease.The success rate of the catheter implantation,the number of needle puncturing,the operation time,the fluoroscopy time and the occurrence of procedure-related complications were recorded.Results Successful fluoroscopy-guided SVCI was accomplished in all 183 sick children,with a success rate being 100％.Successful SVCI was obtained with ＜3 times of puncturing in 151 sick children (82.5％),with 4-6 times of puncturing in 25 sick children,and with 7-10 times of puncturing in 7 sick children.The catheter tip was successfully positioned at the junction of the superior vena cava with the right atrium in all sick children.The operation time ranged from 5 min to 25 min with a mean of (10.38±4.04) min.The fluoroscopy time varied from 16 seconds to 607 seconds with a mean of (65.46±55.86) seconds.During the procedure,artery was wrongly punctured two times in two sick children.The mean follow-up time was 35 days.Cather-related infection occurred in 2 sick children.No local hematoma at puncture point,nor hemopneumothorax or catheter-related thrombosis occurred.Conclusion Fluoroscopy-guided SVCI has high technical success rate in children with hematologic diseases.For a successful procedure of SVCI,less number of needle puncturing is needed by using this technique.The satisfaction rate for the placement of catheter tip is high and the incidence of complications is low.Therefore,fluoroscopy-guided SVCI is a safe and effective method.