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Abernethy malformation， also known as congenital portosystemic shunts， is rare in clinical practice， with less than 300 cases reported in the global literature up to 2019. The disease can have serious complications such as pulmonary hypertension， liver tumor， and liver failure and tends to have an extremely poor prognosis， and early diagnosis and active and effective treatment can reduce and delay the onset of complications. In this case， portography combined with balloon occlusion helped to display the underdeveloped slender portal vein with dysplasia， so that the child who was formerly misdiagnosed with type Ⅰ Abernethy malformation was diagnosed with type Ⅱ Abernethy malformation， and then the child was successfully treated by transcatheter closure. This article gives a detailed report of this case.
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BACKGROUND: A skull defect is inevitable after decompression treatment for traumatic brain injury. Titanium mesh as the most recognized skull repair material has good biocompatibility and has been widely used in clinical practice. However, the timing for skull repair after brain injury is still in dispute.OBJECTIVE: To compare the changes of brain perfusion and the recovery of neurological function in patients with skull defects before and after early and late-stage titanium mesh repair based on CT perfusion technique.METHODS: This was a single-center, prospective, observational clinical trial that was completed at the Taihe Hospital,Hubei University of Medicine in Hubei Province, China. Eighty-six patients with craniocerebral injury who had undergone decompression with removal of bone flap from January 2013 to January 2016 were recruited and subjected to skull repair using titanium mesh. All the patients were randomized into two groups: test group (n=40) with early skull repair within 1-3 months after decompression and control group (n=46) with late-stage skull repair within 6-12 months after decompression. CT perfusion technology was used to observe changes of brain perfusion at 3 days operatively and at 10 days postoperatively. The Barthel index was evaluated at 30 days postoperatively. The trial was registered with ClinicalTrial.gov (identifier: NCT03222297) on July 12th, 2017. The study protocol was approved by the Ethics Committee of Taihe Hospital with the approval No. 2012 (08), and performed in accordance with the Declaration of Helsinki,formulated by the World Health Organization and the hospital's ethical requirements for human research. All the patients and their families were voluntary to participate in the trial, were fully informed of the trial process, and then signed the informed consent prior to the initialization of the trial.RESULTS AND CONCLUSION: The postoperative cerebral blood volume and cerebral blood flow at the parietal cortex on the side of skull defect and at the cortex in the defect region were significantly higher in the two group than the baseline (P < 0.05), while the time to peak was lower than the baseline (P < 0.05). Compared with the control group,significantly higher cerebral blood volume and cerebral blood flow as well as shorter time to peak were observed in the test group (P < 0.05). The Barthel index of the test group was also significantly higher than that of the control group at 30 days postoepratively (P < 0.05). Overall, early skull repair with titanium mesh is helpful to improve the cerebral blood perfusion at the affected side and the recovery of neurological function. In addition, CT perfusion technology is a safe and effective method to monitor hemodynamic changes in the brain.
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ObjectiveTo investigate the effect of intrathecal injection of TRPV3-siRNA lentivirus on bone cancer pain(BCP) behaviors in rats.Methods40 female SD rats successfully received intrathecal catheter implantation and without motor dysfunction were randomly divided into 4 groups (n=10 in each group):Sham group (S),BCP group (B),negative control lentivirus group (C) and TRPV3-siRNA lentivirus group (T).Group B,C and T were induced bone cancer pain by intra-right-femur inoculation of Wallker 256 cells,while rats in group S were injected of inactivated cell.Rats in group T were intrathecally treated with 5 μl TRPV3-siRNA lentivirus while rats in group C received 5 μl negative lentivirus on 1~6 d after surgery.All the rats received pain behaviors including paw withdrawal thermal latency(PWTL) and paw withdrawal mechanical threshold (PWMT) at 1 d before BCP and 1,3,6,9,12,15,18 and 21 d after BCP.L4~L6 spinal cords were reserved for RT-PCR and Western Blot.ResultsCompared with group S,PWTL and PWMT of group B were decreased (P0.05).The results of RT-PCR and Western blot demonstrated that the expression of TPPV3 in group T was decreased compared with that in group C(P<0.05).ConclusionIntrathecal injection of TRPV3-siRNA lentivirus can inhibit the expression of TRPV3 and thus alleviate symptom of PWTL,but not PWMT.
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Objective:To observe therapeutic effects of dexmedetomidine combined metoprolol on subarachnoid hemorrhage (SAH) complicated myocardial injury (MI) .Methods:According to random number table , a total of 131 SAH + MI pa‐tients were divided into control group (n=31) ,metoprolol group (n=34) ,dexmedetomidine group (n=32) and combined treatment group (n=34 ,received metoprolol combined dexmedetomidine ) .Plasma levels of norepinephrine (NE) ,epi‐nephrine (E) ,brain natriuretic peptide (BNP) and cardiac troponin I (cTnI ) were measured ,echocardiography etc .were used to assess MI recovery condition before and after treatment in all groups .Results:Compared with before operation , there was significant rise in LVEDd on 1d after operation ,significantly reduced on 3d after operation and recovered to nor‐mal on 7d after operation ( P<0.05 all);significant reduction in LVEF on 1d after operation ,significantly rose on 3d after operation and recovered to normal on 7d after operation ( P<0.05 all);significant rise in levels of cTnI ,BNP ,NE and E on 1d after operation ,started to reduce on 3d after operation and recovered to normal on 7d after operation in metoprolol group ,dexmedetomidine group and combined treatment group , P< 0.05 all;compared with control group ,metoprolol group and dexmedetomidine group on 7d after operation ,there was significant reduction in LVEDd ,and significant rise in LVEF and significant improvement in cardiac function ;significant reductions in plasma levels of NE [ (1.37 ± 0.08) pmol/L ,(1.05 ± 0.09) pmol/L ,(1.19 ± 0.07) pmol/L vs .(1.01 ± 0.06) pmol/L] ,E [ (6.17 ± 0.41) pmol/L ,(6.02 ± 0.34) pmol/L ,(6.06 ± 0.29) pmol/L vs .(5.26 ± 0.26) pmol/L] ,cTnI [ (0.22 ± 0.02)μg/L ,(0.11 ± 0.03)μg/L ,(0.17 ± 0.02)μg/L vs .(0.09 ± 0.01)μg/L] and BNP [ (1126.81 ± 11.27) ng/L ,(1014.09 ± 14.29) ng/L ,(1154.09 ± 16.52) ng/L vs .(954.09 ± 9.31) ng/L] in combined treatment group ,P<0.05 all .Conclusion:Either dexmedetomidine or meto‐prolol ,or their combination can effectively inhibit SAH complicated myocardial injury ,improve cardiac function ,but com‐bined treatment possesses the best effective effect .
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Objective:To explore causes of complicated acute lung injury (ALI) after percutaneous coronary interven-tion (PCI) .Methods:According to blood gas analysis and chest imaging examination ,a total of 175 patients under-going PCI were divided into ALI group (n=62) and non-ALI group (n=113) .High performance liquid chromatog-raphy was used to measure plasma concentrations of epinephrine (E) and norepinephrine (NE) during perioperative period .Plasma levels of interleukin-6 (IL-6) and procalcitonin (PCT) and chest CT imaging changes were meas-ured .Fluorescent immunoassay was used to measure plasma level of brain natriuretic peptide (BNP) to assess impact of cardiac function on ALI .Results:Compared with non-ALI group on 1d after PCI ,there were significant rise in plasma levels of NE [ (2.51 ± 0.31) nmol/L vs .(6.91 ± 0.39) nmol/L] and E [ (1.23 ± 0.11) nmol/L vs .(6.03 ± 0.37) nmol/L] ,P<0.01 all;and significant rise in plasma levels of IL-6 [ (119.81 ± 17.23) pg/ml vs .(252.28 ± 34.23) pg/ml] ,PCT [ (0.88 ± 0.01) pg/ml vs .(4.99 ± 0.87) pg/ml] and BNP [ (927.82 ± 89.72) pg/ml vs . (3936.55 ± 131.78) pg/ml] in ALI group (P<0.01 all) .Chest CT indicated that lung tissue inflammation was seri-ous .Conclusion:In patients undergoing percutaneous coronary intervention ,complicated acute lung injury is related to hyperactive sympathetic activity ,postoperative inflammation and heart function status etc .
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Objective: To observe the therapeutic effect of peritoneal dialysis on low cardiac output syndrome (LCOS) after surgery in children with congenital heart disease (CHD). Methods: A total of 61 CHD children complicated with LCOS after surgery were selected. Echocardiography was used to measure heart chamber diameter, left ventricular ejection fraction (LVEF) and pulmonary artery pressure etc. before and after peritoneal dialysis; and central venous pressure (CVP), urine volume, blood gas analysis indexes，plasma brain natriuretic peptide (BNP) concentration were measured to evaluate influence of peritoneal dialysis. Results: Compared with before treatment, there were significant increase in urine volume [(203.28±15.81) ml vs. (989.11± 54.72) ml], LVEF [(32.94±2.29)% vs. (51.93±2.79)%]；and significant reduction in pulmonary artery pressure [(46.72±3.84) mmHg vs. (34.82±2.92) mmHg], CVP [(17.27±1.47) cm H2O vs. (10.41±1.01) cm H2O] and plasma BNP level [(5928.71±158.27) ng/ml vs. (3851.83± 128.81) ng/ml], P<0.001 all. Conclusion: Peritoneal dialysis may effectively treat low cardiac output syndrome after surgery in children with congenital heart disease, related with its effect of ultrafiltration and relieve cardiac burden.