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Objective To compare the efficacy and safety of surgical thrombectomy with those of catheter-directed thrombolysis (CDT) in treating acute lower limb ischemia (ALLI) . Methods The clinical data of 107 patients with ALLI, who underwent CDT or surgical thrombectomy at authors' hospital during the period from January 2012 to December 2017, were retrospectively analyzed. The incidence of complications, mortality, re-intervention rate and amputation rate within 30 days after operation were calculated. Cooley standard of efficacy score was used to assess the clinical curative effect of patients with grade Ⅱ of American Society of Vascular Surgeons (SVS) and International Society of Cardiovascular Surgery (ISCVS) classification of acute limb ischemia. Results A total of 107 patients with ALLI were enrolled in this study. Among them, 59 patients received CDT therapy and 48 patients received surgical thrombectomy. The technical success rate of both groups was 100％. Within 30 days after operation, the incidence of complications in CDT group and surgical thrombectomy group was 11.9％ and 14.6％ respectively, the mortality was 5.1％ and 6.3％respectively, and the re-intervention rate was 17.0％ and 22.9％ respectively, all the differences were not statistically significant (P>0.05) . The amputation rate of patients with grade Ⅱ of SVS/ISCVS ischemia classification in CDT group was 8.9％, which was higher than 2.3％ in surgical thrombectomy group, but the difference between the two groups was not statistically significant (P>0.05) . In patients with grade Ⅱ of ischemia assessed by the ca uses and Cooley curative effect standard at the time of discharge, the cure percentage of embolism-caused ALLI patients in surgical thrombectomy group was 82.5％, which was remarkably higher than 62.8％ in CDT group (P <0.05) . The cure percentage of thrombosis-caused ALLI patients in CDT group was 92.3％, which was strikingly higher than 25.0％ in surgical thrombectomy group (P <0.05) . The difference in the improvement of ischemia, which was assessed by the duration of ischemia and Cooley therapeutic criteria at the time of discharge, between the two groups was not statistically significant (P>0.05) . Conclusion In treating ALLI, no significant differences in curative effect, incidence of postoperative complications and mortality exist between surgical thrombectomy and CDT. The formulation of therapeutic regimen should be based on ischemia grade of SVS/ISCVS, etiology and coexisting underlying diseases.
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Objective To evaluate the efficacy and safety of early endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) in patients of acute biliary pancreatitis (ABP).Methods Databases including PubMed,EMBASE,Cochrane library,CBM,CNKI,WanFang data and VIP data were searched with " Endoscopic retrograde cholangiopancreatography" "Endoscopic sphincterotomy" "ERCP" "Pancreatitis" "Biliary pancreatitis" resection up to September 2017.Randomized controlled trails (RCTs) conternming the comparison of ERCP with EST versus conservative management in ABP patients were enrolled in the study.Two reviewers independently screened literature,extracted data,and assess the risk of bias of the included studies.The Meta-analysis was conducted by RevMan 5.3 software.Results A total of 10 RCTs involving 1 752 cases were included in the Metaanalysis.The results of Meta-analysis showed that compared with the control group,early ERCP with EST reduced the systemic complication rate of ABP (RR =0.66;95％ CI:0.47-0.93;P ＜ 0.05).However,there were no significant differences in overall mortality,local complication rate,and ERCP related complication rate in ABP between early and selected ERCP with EST treat (P ＞ 0.05).Subgroup analyses indicated that early ERCP with EST therapy reduced the mortality of severe acute biliary pancreatitis (SABP),ABP with biliary obstruction and within 24 hours of admission (RR =0.48,0.35,0.25;95％ CI:0.24-0.96,0.17-0.74,0.09-0.73;P ＜ 0.05);decreased the local and systemic complication rate of SABP,ABP with biliary obstruction (RR =0.56,0.54,0.51,0.51;95％ CI:0.37-0.86,0.33-0.91,0.32-0.81,0.32-0.80;P ＜ 0.05);reduced the local and systemic complication rate of SABP (RR =0.42,0.47;95％ CI:0.25-0.70,0.25-0.87;P ＜0.05) and shortened the hospital stay of SABP (MD =-11.22 d;95％ CI:-16.09--6.36;P ＜ 0.01).However,there were no significant differences of overall complication rate in ABP without biliary obstruction and hospital stay in MABP.Conclusion Early ERCP with EST therapy appears to be safe and effective for ABP patients.
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The objectiue was to explore how to improve stem cell derivation from human great saphenous vein. After the saphenous vein was cut into small pieces, the cells of the vessel wall were obtained by tissue adherent method and digestion with type Ⅱ collagenase. The morphological changes of blood vessel wall were observed under inverted microscope. The survival of vascular wall cells was assessed by trypan blue staining. Stem cells doubly positive for CD34 and CD117 were sorted out by immunofluorescent staining and flow cytometry. The cells obtained by tissue adherence method exhibited signs of fibrotic changes and aging at the third passage (P3), while the cells extracted by enzymatic digestion still showed colony-like growth. Survival rates of these two groups of cells were (91.7±1.2)% and (97.2±0.7)%, (P=0.005). The results of flow cytometry showed that the positive rates of CD34 and CD117 double positive cells in these two groups were (0.16± 0.05)% and (0.44±0.07)%, respectively, with statistical significance (P=0.005). Immunofluorescent staining showed that the positive rates of double positive stem cells in the two groups were (89.41±2.06)% and (94.03±1.83)%, P<0.05 one week after the sorted stem cells were cultured. The positive rates of CD31, VEGF2 and SMA in the stem cells determined by flow cytometry were (0.12±0.01)%, (0.19±0.02)% and (0.45±0.01)%, respectively, which were not statistically different from those of the control groups. This could rule out substantial inclusion of mature endothelial cells and smooth muscle cells. Tube forming experiment confirmed that these vascular stem cells had developmental plasticity. More viable and morphologically healthy vascular stem cells can be derived by enzymatic digestion. These cells can be widely used in clinical and basic research.
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Objective To explore the influence of dexmedetomidine on blood gas and inflammation cytokines in patients with one-lung ventilation (OLV).Methods Sixty-two patients undergoing radical resection of pulmonary carcinoma were divided into observation group and control group in sequence,31 cases in each group.All patients treated with intravenous sufentanil 0.3-0.5 μg/kg,propofol 1.5-2.5 mg/kg,midazolam 0.5 mg/kg and rocuronium 0.9 mg/kg for induction of anesthesia;intravenous infusion of propofol 6-8 mg·kg-1 ·h-1 and remifentanil 0.1-0.5 μg·kg-1 ·min-1,intermittent intravenous injection of cisatracurium for anesthesia maintenance.The patients in the observation group were given 1μg/kg loading dose dexmedetomidine 10 min before anesthesia induction (infusion in 10 min),maintaining at 0.5 μg·kg-1 ·h-1 until 30 min before the end of surgery.The patients in the control group were given the same amount of saline as a control.The blood gas analysis index,pH,partial oxygen pressure (PaO2),CO2 partial pressure (PaCO2) and such inflammation cytokines as tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) at OLV (T0),after OLVlh (T1),the end of OLV (T2) were respectively tested,the dosage of propofol in the two groups were recorded.Results The dosage of propofol in observation group was significantly lower than that in the control group (P＜0.05);pH declined in the two groups (P＜0.05),but the difference had no statistical significance;PaO2 was rising then declined in the two groups (P＜0.05),but it was significantly higher in the observation group than in the control group(P＜0.05);PaCO2 in the two groups increased gradually(P＜0.05),it was significantly lower in the observation group than in the control group (P＜0.05);The serum TNF-α,IL-6 in the two groups showed a trend of increasing (P＜0.05),it was significantly lower in the observation group than in the control group (P＜0.05).Conclusion Dexmedetomidine can maintain blood gas stability and reduce inflammation caused by single lung ventilation.
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Objective To discuss the feasibility,safety and validity of ViabahnTM self-expanding covered stent in endovascular repair of femoral pseudoaneurysm caused by intravenous drug injection.Methods The clinical data of 9 patients with femoral pseudoaneurysm caused by intravenous drug injection,who were admitted to authors' hospital during the period from April 2014 to April 2015,were retrospectively analyzed.The pseudoaneurysms were located at the common femoral artery in 6 patients and at the superficial femoral artery in 3 patients.Endovascular repair with ViabahnTM self-expanding covered stent was performed in all the 9 patients.The intraoperative angiographic findings,the sizes of the implanted stents,and the manifestations of the angiography performed immediately after stent implantation were recorded,after operation,the patients were kept under close observation to evaluate the improvement of clinical symptoms,the effect of pseudoaneurysm repair,and the occurrence of endoleak,stent infection,in-stent stenosisand fracture of stent.Anti-infection treatment was employed both before and after the stent implantation;after the stent implantation debridement and/or drainage for soft tissue infection area of inguinal region was adopted.Results Successful implantation of ViabahnTM self-expanding covered stent was accomplished in all 9 patients,with a technical success rate of 100％.Angiography performed immediately after stent implantation showed that complete repair of pseudoaneurysm cavity was obtained in all 9 patients,the distal segment of the parent artery was patent,and no endoleak occurred.The patients were followed up for 6-12 months,and limb salvage was successful in all patients,no intermittent claudication or muscular atrophy occurred.CT angiographyreexamination showed that no endoleak,stent infection,stent fracture or in-stent stenosis occurred.Conclusion Under the conditions of adequate anti-infection,local debridement and drainage,the use of ViabahnTM self-expanding covered stent can promptly close the break of femoral pseudoaneurysm to save the patient's life.Because of the excellent qualities,such as flexibility,adhesion and patency,of ViabahnTM self-expanding covered stent,the postoperative occurrence of intermittent claudication,stent fracture and in-stent stenosis can be effectively reduced.It is expected that ViabahnTM self-expanding covered stent may become one of the vascular reconstruction methods for femoral pseudoaneurysm caused by intravenous drug injection,although its long-term curative effect needs to be further observed and verified.
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Objective To analyze the correlation between seminal plasma α-glucosidase activity and zinc content with sperm morphology parameters in the patients with idiopathic oligozoospermia.Methods One hundred and fifty-two cases of idiopathic oligozoospermia were divided into five groups according to morphological analysis.The quality of semen and sperm morphology were analyzed by using computer assisted sperm analysis (CASA) and Diff-Quik staining.The rate method,PAN method and automatic biochemical analyzer were used to detect the seminal plasma α-glucosidase activity and zinc content.Results The seminal plasma α-glucosidase activity had statistically significant difference between 4 groups of normal sperm morphology 3%-4%,2%-3%,1%-2% and 0%-1% with normal sperm morphology ≥4% (Z=-2.199,-2.685,-2.827,-3.358,P0.05);the seminal plasma zinc content had no statistical difference among various groups (P>0.05).The seminal plasma α-glucosidase activity had a extremely significant positive correlation with percentage of normal morphology sperms (P0.05);there was no significant correlation between the zinc content in seminal plasma with the sperm morphological parameters (P>0.05).Conclusion The seminal plasma α-glucosidase activity in idiopathic oligozoospermia patients with abnormal percentage of normal sperm mophology is significantly lower than that in the patients with normal sperm morphology;seminal plasma α glucosidase activity has significantly positive correlation with the percentage of normal mophology sperms,has a negative correlation with SDI,which may be conducive to in vitro fertilization.
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Objective To realize the utilization of antibacterial drugs in pediatric inpatients in Children's Hospital for clinical reference of rational use of drugs. Methods By a retrospective study, 180 cases in pediatric inpatients were randomly sampled in Children's Hospital from July to December 2012, and were analyzed in utility rate, antibiotics varieties, administrational frequency,single dose,combination use,prophylaxis time,courses of drug use,etc. Results The use of antibacterial drugs in pediatric inpatients was 110 cases (61.1%) and used in combination was 55 cases (50%) . Leading the list in terms of DDDs was cephalosporins,followed byβ-lactam and its enzyme inhibitor complex preparations. The improper medications frequency was 12 cases (10.9%), irrational single dose was 7 cases (6.4%), and irrational course of treatment was 9 cases (8.2%) . Conclusion The utilization of antibacterial drugs in Children's Hospital is basically rational, but there still exist some irrational drug uses,such as antibiotics varieties,no indication, irrational dosage,long duration and irrational combination. So, it is necessary to enhance the administration of antibiotics use and improve the level of clinical reasonable application of antibiotics.
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Objective To sum up the techniques of radiofrequency ablation assisted laparoscopic liver resection .Methods A ret-rospective analysis was done based on the clinical data of 16 patients undergone radiofrequency ablation assisted laparoscopic liver resection from July 1 ,2011 to July 30 ,2012 .Results Sixteen patients were all received successful total laparoscopic liver resection . Anatomical liver resection was carried out on 5 patients including 2 left hemihepatectomy ,2 left lateral segmentectomy ,1 right pos-terior lobectomy ,and 11 patients underwent nonanatomical hepatectomy .None was transected under regional hepatic blood inflow occlusion .The mean operation time was 125 minutes(range 35-335 minutes) ,mean blood loss 310 mL(range 20~1 100 mL) ,and mean hospital stay 9 days(range 5 to 16 days) .No operation death and postoperative complications occurred .The patients were fol-lowed up for 2 to 12 months ,1 recurrence was found in patients with Ⅶ segment hepatocellular carcinoma 60 day after operation . Conclusion The application of radiofrequency ablation assisted laparoscopic liver resection can effectively control the resection mar-gin hepatic blood inflow to ensure the success of operation and reduction of complications .
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Objective To evaluate the clinical efficacy of oral Sarpogrelate hydrochloride in the treatment of chronic arterial ischemia of the lower extremities.Methods In this study 892 patients,who suffered from arteriosclerosis (ASO) or thromboangiitis obliterans ( TAO ) or diabetic foot ( DF ),with symptoms of intermittent claudication, sensation of cold, pain, ulcer, and without a history of vasotransplantation or bypass grafting or interventional therapy, were treated by taking Sarpogrelate hydrochloride tablets 100 mg tid for consecutive 8 weeks.The improvement rate of concomitant symptoms and the total effective rate of ASO, TAO, DF were evaluated.Drug adverse reaction were recorded.Results The improvement rate of intermittent claudication,sensation of cold,pain and ulcer were 96.9％,97.1％,89.0％ and 86.9％ respectively.The total effective rate for ASO,TAO,DF was 83.5％.A total of 81 cases (9.1％) reported mild side effects,including 7 patients with mild rash after 2- 5 days' medication,21 patients with mild nausea and 53 patients with stomach discomfort after 1 - 2 days' medication.Symptoms were managed conservatively without discontinuing taking sarpogrelate hydrochloride.Conclusions Sarpogrelate hydrochloride oral is a safe and effective therapy for chronic arterial ischemia diseases of the lower extremities.
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Case based learning/problem-based learning ( CBL/PBL ) is a new teaching method based on traditional medical education methods.In order to conquer the deficiency of traditional education methods in autonomous study motivation and ability of knowledge integration, CBL/PBL has been introduced into vascular surgery teaching procedure since 2006.The quality and effort of CBL/PBL compared with lecture-based learning ( LBL ) were evaluated and scored. The outcome of this teaching innovation shows CBL can arouse students' desire in autonomous study and enhance their ability in clinical analysis.But, its superiority is difficult to develop in the current medical education system.
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Objective To evaluate the possibility of no-beparin open operation at low costal arch in live donor nephrectomy via retroperitoneal approach. Methods The effects of 134 cases no-beparin operation and 82 eases heparinized operation at low costal arch in live donor nephrectomy via retroperitoneal approach during 2003.5 to 2008.5 in our hospital were retrospective analyzed. Results The kidneys of the donors in two groups were successfully harvested. The operation time varied from 110 rain to 200 rnin, and warm isebemia time varied from lOs to 20s. Delayed graft function (DGF) was oceurred in one ease in each group. There was no signifieant difference in live donor nephreetomy between the two groups(P >0. 05), but the no-beparin group had less bleeding. Conclusion The no-beparin open operation at low eostal arch in live donor nephrectomy via retroperitoneal approach is technieal]y feasible and safe, and has less bleeding, and little influence on the allograft.
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Objective To introduce the current status of clinical research on endoscopic cholecystolithotomy with reservation of gallbladder.Methods Literatures related to the basis,advantage,indication,contraindication,operative method and current controversy were reviewed and summarized.Results The objective evidences were afforded by postoperative complications of cholecystectomy for endoscopic cholecystolithotomy with reservation of gallbladder.The progress of endoscopic technique made it possible for reservation of gallbladder.The controversy in endoscopic cholecystolithotomy with reservation of gallbladder was focused on the choice of indications and operative procedure.Incorrect patient selection and undue pursuit of cholecystolithotomy with reservation of gallbladder would be completely opposite to the treatment of gallstone.Conclusion It is feasible for endoscopic cholecystolithotomy with reservation of gallbladder to remove completely stone and reserve gallbladder function,but further investigation and long-term follow up are required to delineate gallstone recurrence after operation.
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Objective To evaluate the clinical efficacy of transplantation of autologous peripheral blood stem cells(PBSC) for the treatment of toe or heel ulcer and of rest pain in patients with lower limb arterial ischemic diseases.Methods To mobilize patients' own stem cells with G-CSF for 5 days.At the sixth day,PBSC are collected with a blood-cells separator.The PBSC were then intramuscularly injected into ischemic areas of the lower limbs.Results After transplantation,all patients are followed up from 3 to 24 months.The rest pain disappeares in 12 patients,while toe or heel ulcers are cicatrized in 11 cases.However,4 patients lost in following up.ConclusionTransplantation of autologous peripheral blood stem cells is an effective method for the treatment of arterial ischemic disease.
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Objective To assess the effects of treating varicose vein with endovenous laser treatment(EVLT). Methods 810nm wavelength diode laser machine was used to treat 170 patients with varicose veins of the legs. After treatment, leg bandage compression was used for 2 days, and then changed to elastic stockings for 6-8 weeks. Patients were examined with Doppler ultrasound at follow-up. Results Post-operative follow up(1-12 months) of EVLT in 170 patients indicated 100% rate of greater saphenous vein closure on Doppler ultrasound, and no significant complications. All of the symptoms, disappeared or were significantly improved. Conclusions The results of EVLT of varicose veins have been favorable. This minimally invasive technique appears to be safe, and results in very effective closure of great saphenous vein.
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Objective:To explore the possibility of establishment of experimental femoral pseudoaneurysm (PA)and arteriovenous fistula (AVF) models in rabbits and to make the related study.Methods:Experimental PA and AVF models were established in rabbits with microsurgical technique.Models were analyzed by blood gas analysis,checked by color Doppler flow imaging(CDFI),examined by computed tomography angiography(CTA),magnetic resonance angiography (MRA),digital subtraction angiography(DSA) and histological observation.Results:16 of 20 femoral pseudoaneurysms and 20 arteriovenous fistulae were successfully anastomosed and were confirmed by related examination methods.Conclusion:It is possible to establish experimental model in rabbit with microsurgery technique and each of examination methods has its own characteristics.