Effects of plasma lipopolysaccharide changes on platelet release of vascular endothelial growth factor and thromobospondin-1 in patients with cirrhotic portal hypertension after TIPS procedure / 中华肝脏病杂志

Objective: To investigate the effects of plasma lipopolysaccharide (LPS) concentration changes on platelet release of vascular endothelial growth factor (VEGF) and thrombospondin (TSP)-1 in patients with decompensated cirrhotic portal hypertension after transjugular intrahepatic portosystemic shunt (TIPS) procedure. Methods: 169 cases with cirrhotic portal hypertension were enrolled, of which 81 cases received TIPS treatment. LPS, VEGF, and TSP-1 concentrations with different Child-Pugh class in peripheral blood plasma of patients were measured. After pre-incubation of normal human platelets with different concentrations of LPS and stimulated by collagen in vitro, platelet PAC-1 expression rate, VEGF, and TSP-1 concentrations were detected. PAC-1 expression rate and the concentrations of LPS, VEGF and TSP-1 in peripheral blood plasma of patients before and after TIPS procedure were detected. The relationship between plasma LPS, VEGF and TSP-1 concentrations and Child-Pugh score changes in patients after TIPS procedure was analyzed. Statistical analysis was performed by t-test, one-way ANOVA or Pearson's rho according to different data. Results: Plasma LPS and TSP-1 concentrations were significantly higher in Child-Pugh class C patients than class A and B, but the concentration of plasma VEGF was significantly lower than class A and B (P < 0.01). In vitro experiments showed that concentration of LPS, TSP-1, and platelet PAC-1 expression rate was higher in the supernatant, but the difference in the concentration of VEGF in the supernatant was not statistically significant. Portal vein pressure and platelet activation were significantly decreased (P < 0.01) in patients after TIPS procedure. Portal venous pressure, platelet activation, plasma LPS, and TSP-1 levels were significantly decreased continuously, while VEGF levels were significantly increased continuously after TIPS procedure. Plasma LPS concentration was positively correlated with TSP-1 concentration (r = 0.506, P < 0.001), and negatively correlated with VEGF concentration (r = -0.167, P = 0.010). Child-Pugh score change range was negatively correlated with change range of plasma VEGF concentration (r = -0.297, P = 0.016), and positively correlated with change range of plasma TSP-1 concentration (r = 0.145, P = 0.031) after TIPS. Conclusion: Portal venous pressure gradient, plasma LPS concentration and corresponding platelet activation was decreased in cirrhotic portal hypertension after TIPS procedure, and with TSP-1 reduction and VEGF elevation it is possible to reduce the liver function injury caused by portal venous shunt.

Transjugular intrahepatic portosystemic shunt with Viatorr stent grafting: report of 3 cases / 南方医科大学学报

We here report 3 cases successfully treated with transjugular intrahepatic portosystemic shunt using Viatorr stent. The 3 patients were had a diagnosis of liver cirrhosis with portal vein hypertension, and presented with black stool and hematemesis. After the treatment, the patients' portal vein pressures were decreased without black stool or hematemesis. Our success demonstrate the feasibility of using Viatorr stent in transjugular intrahepatic portosystemic shunt.

Effect of covered stent length in portal and hepatic veins on long-term clinical efficacy of transjugular intrahepatic portosystemic shunt / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the effect of the length of covered stents in the portal and hepatic veins on long-term clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS).</p><p><b>METHODS</b>We retrospectively reviewed 53 cases receiving TIPSs between January, 2008 and December, 2011. All the shunts were created with Fluency stents (8 mm in diameter). Bare metal grafts of the same diameter were implanted to extend the length in the portal and hepatic veins as deemed necessary according to angiographic images. The primary patency, hepatic encephalopathy and patient survival were evaluated during the follow up. The length of the covered stents within the hepatic vein (X1) and in the portal vein (X2), and the total length of stents placed in the hepatic vein (X3) and the portal vein (X4) were measured and their effects on primary patency and the patients'outcomes were evaluated.</p><p><b>RESULTS</b>The procedures were completed successfully in all the patients and the mean portosystemic pressure decreased from 29.80∓4.83 mmHg to 19.00∓3.92 mmHg (t=13.44, P<0.01) after the procedure. The patients were followed up for a median of 64 months (3 to 89 months, 39 months on average). Hepatic encephalopathy occurred in 23% (12/53) of the patients after TIPS. Shunt dysfunction occurred in 16 cases, and the cumulative primary patency rates at 1 to 5 years were 83%, 75%, 63%, 62%, and 54%, respectively. The cumulative survival rates of the patients at 1 to 5 years were 79%, 72%, 72%, 69%, and 69%, respectively. Cox proportional regression analysis showed a significant association between the length of covered-stent in the hepatic vein and the primary patency (OR=0.42, P<0.01), and there was a significant association between the length of stent in the portal vein and the patient survival. No significant correlation was found between these parameters and hepatic encephalopathy.</p><p><b>CONCLUSION</b>Increasing the length of the covered stent in the hepatic vein and decreasing the stent length in the portal vein can improve the primary patency and the patient survival receiving TIPS.</p>

Clinical features of Chinese children with narcolepsy: a report of 32 cases / 中华神经医学杂志

Objective To raise the awareness of childhood narcolepsy. Methods We analyzed the clinical data of 32 children with narcolepsy and review the literature. Results All the patients manifested as excessive daytime sleepiness with irresistible sleep attacks.Cataplexy appeared in 26 cases (81.3％),hypnagogic hallucination in 11 cases (34.4％),and sleep paralysis in merely 2 cases (6.25％).Daytime sleepiness was the first symptom in most cases.Common features included night sleep disorder,emotional disorder,excessive weight gain,and earlier puberty.Owing to the young age and short duration,a few children could have the false negative multiple sleep latency test (MSLT) results.Conclusion Excessive daytime sleepiness with irresistible sleep attacks and cataplexy are the typical clinical manifestations of Chinese narcoleptic children. A definite diagnosis is established on the comprehensive analysis of symptoms and assistant examination.

5-lipoxygenase is involved in rotenone-induced injury in PC12 cells / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To determine whether 5-lipoxygenase (5-LOX) is involved in rotenone-induced injury in PC12 cells, which is a cell model of Parkinson disease.</p><p><b>METHODS</b>After rotenone treatment for various durations, cell viability was determined by colorimetric MTT reduction assay, and 5-LOX translocation was detected by immunocytochemistry. The effect of 5-LOX inhibitor zileuton was also investigated.</p><p><b>RESULT</b>Rotenone (0.3-30 μmol/L) induced PC12 cell injury, and zileuton (3-100 μmol/L) attenuated this injury. Rotenone also time-and concentration-dependently induced 5-LOX translocation into the nuclear envelope, and zileuton (1-30 μmo/L) significantly inhibited rotenone-induced 5-LOX translocation.</p><p><b>CONCLUSION</b>5-LOX is involved in rotenone-induced injury in PC12 cells, and 5-LOX inhibitor zileuton can reduce rotenone-induced 5-LOX activation and cell injury.</p>

Removal of metallic foreign body in the soft tissue under fluoroscopy: 10 years of experiences / 南方医科大学学报

<p><b>OBJECTIVE</b>To summarize our 10-year experience with percutaneous fluoroscopically guided removal (PFGR) of metallic foreign body (MFB) in the soft tissue.</p><p><b>METHODS</b>PFGR was performed in 65 patients for removing a total of 368 MFBs from the soft tissues. The MFBs ranged from 0.2 to 0.3 cm in length embedded in the soft tissue for 7 days to 8 years. For superficial MFBs, the MFBs were removed directly with curved forceps under real time fluoroscopy. For deep MFBs, trocar technique was applied using the instruments for percutaneous diskectomy, with the outer cannula inserted toward the foreign body under real-time fluoroscopy followed by MFB removal by grasping forceps.</p><p><b>RESULTS</b>A total of 346 MFBs were successfully removed without any serious complications (success rate 94.0%), including 154 removed directly and 192 MFBs with trocal technique. The time of the procedures and radiation exposure for MFB removal was 30 s to 20 min and 1-6 min, respectively.</p><p><b>CONCLUSION</b>PGFR of MFBs in the soft tissue under fluoroscope is safe and effective. Direct removal using curved forceps is suitable for MFBs in superficial soft tissues, while trocal techniques needs to be utilized for deep MFBs.</p>

Endovascular graft exclusion with digital subtraction angiography for treatment of Stanford type B aortic dissection / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess value of endovascular graft exclusion (EVGE) with digital subtraction angiography (DSA) in the treatment of Stanford type B aortic dissection (AD).</p><p><b>METHODS</b>On the basis of diagnosis with multi-slice spiral CT (MSCT), DSA was performed in 20 Stanford B AD cases for further diagnostic confirmation and EVGE was conducted for treatment. The DSA findings of the cases and the therapeutic effect of EVGE were evaluated.</p><p><b>RESULTS</b>In the 20 cases of Stanford type B AD, altogether 22 stents were implanted during EVGF with a stent release success rate of 100%. Postoperative examination revealed no obvious leakage or false lumen in 15 cases, and death occurred in 1 case 6 days after the operation due to right renal hemorrhage and infection, and the rest 19 patients were cured and discharged. Follow-up of the patients demonstrated improvement in the clinical symptoms, and MSCT showed that all the dissections were sealed successfully. No severe complications were observed 3 months after the treatment in these patients.</p><p><b>CONCLUSION</b>DSA can identify the fine anatomy of AD and allowed intraoperative monitoring in EVGE, which is an effective and safe means for treatment of Stanford type B AD.</p>

Percutaneous intradiscal oxygen-ozone injection for lumbar disc herniation: no need of perioperative antibiotic prophylaxis / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the feasibility of no antibiotic administration to prevent infection during the perioperative period of percutaneous intradiscal ozone-injection for treatment of lumbar disc herniation.</p><p><b>METHODS</b>Seventy-two patients with lumbar disc herniation but normal body temperature as well as normal results of three routine tests (blood, urine, stool) and C-reactive protein (CRP) level were randomly divided into two groups. The patients in prophylaxis group were given cephalothin V(2.0 g) intravenous 30 min before the operation, and the control group did not use any antibiotics. All the patients were injected with 6-10 ml ozone (40 microg/ml) for medical use into the discs with 21G needles under fluoroscopic guidance, followed by 10 ml ozone into the paravertebral space. Three days later the general examinations and CRP measurement were repeated.</p><p><b>RESULTS</b>No infection was found in these patients, nor were any significant differences noted in the results of the examinations between the two groups after controlling in patients with above-normal white blood cell count, neutrophil percentage and CRP level.</p><p><b>CONCLUSION</b>Prophylaxis antibiotics is not necessary during the perioperative period of percutaneous intradiscal ozone injection for lumbar disc herniation.</p>

Initial Discussion About How To Improve Orthopedic Clinical Teaching Quality For Externs / 中华医学教育探索杂志

During the orthopedic clinical teaching for interns,such methods as raising high-toned professional ethics,strengthening basic skills of orthopedics developing all-round scientific clinical thought to guide interns to correctly treat employment and taking the entrance exams for postgraduate schools,so as to improve the orthopedic teaching quality and attain the target of orthopedic clinical teaching.

Treatment of orbital venous malformations with intralesional injection of bleomycin lipiodol emulsion / 中华放射学杂志

5 mm and ≤8 mm in 4 cases.The mean value was 4.2 mm. Four patients noticed reduction in their vision and two had diplopia.Those patients were examined by CT or MR.Direct venography was performed in each patient.After the diagnosis of OVM was confirmed, intralesional injection of BLE was performed.The efficacy of the treatment and complications were observed during the following 8 to 42 months(mean 23 months).Results The BLE were successfully injected in all the patients.All patients had resolution of proptosis and diplopia.Three patients gained improvement of visual acuity.The periorbital swelling occurred in all patients after operation and resolved within 1 week without special treatment.Other complications,such as orbital hemorrhage and periorbital scar,were not observed during following-up.Conclusion Intralesional injection with BLE is convenient,safe and efficient for the treatment of OVM.