Application of radial artery in total arterial coronary revascularization in elderly patients / 中华危重病急救医学

OBJECTIVE@#To summarize the application experience and clinical effect of radial artery in total arterial coronary revascularization (TAR) in elderly patients.@*METHODS@#Retrospectively analyzed the clinical data of patients who underwent TAR at the University of Hong Kong Shenzhen Hospital from July 1, 2020 to May 30, 2022. Patients were divided into ≥ 65-year-old group and < 65-year-old group according to age. The radial artery blood flow, diameter, intimal integrity and Allen test were evaluated by ultrasound before operation. The distal ends of radial artery were collected for pathological examination during operation. Coronary artery CT angiography (CTA) was examined postoperatively and follow up. The safety and reliability of ultrasonic assessment of radial artery and application of radial artery in elderly patients with TAR were summarized and analyzed.@*RESULTS@#A total of 101 patients received TAR, including 35 cases aged ≥ 65 years old, 66 cases aged < 65 years old; 78 cases used bilateral radial arteries, and 23 cases used unilateral radial arteries. 4 cases of bilateral internal mammary arteries. All the proximal ends of the radial artery were anastomosed to the proximal end of the ascending aorta, 34 cases were performed of "Y" grafts, and 4 cases were sequential anastomoses. There was no in-hospital death and perioperative cardiovascular events. Perioperative cerebral infarction occurred in 3 patients. 1 patients was reoperated for bleeding. Intra-aortic balloon pump (IABP) assistance was used in 21 patients. Poor wound healing occurred in 2 cases and healed well after debridement. Follow-up of 2 to 20 months after discharge showed no internal mammary artery occlusion and 4 radial artery occlusions; no major adverse cardiovascular and cerebrovascular event (MACCE) occurred, and the survival rate was 100%. There was no significant difference in the above perioperative complications and follow-up endpoints between the two age groups.@*CONCLUSIONS@#By adjusting the order of bypass anastomosis and optimizing the preoperative evaluation method, radial artery combined with internal mammary artery can obtain better outcome early in TAR, and can be safely and reliably applied to elderly patients.

Retrospective review of airway obstruction in 19 infants with pharyngeal cysts / 临床耳鼻咽喉头颈外科杂志

Objective:To discuss the clinical characteristic and treatment of laryngeal cysts in infants. Methods:The clinical data of 19 patients diagnosed with laryngeal cysts in Department of Otolaryngology, Sichuan Provincial Maternity and Child Health Care Hospital from November 2017 to April 2023 were retrospectively analyzed. Results:All of the 19 patients were diagnosed as laryngeal cysts, with clinical manifestations included respiratory distress, inspiratory dyspnea, difficulty in feeding and low and weak crying, etc. All of them were cured after surgical treatment. Conclusion:Misdiagnosis and missed diagnosis of laryngeal cysts are prone to occur in infants and young children. After diagnosis, patients should undergo early surgical treatment to remove airway obstruction and improve ventilation.

Surgery via sylvian fissure-insular approach for 8 patients with invasive thalamus cavernous malformations / 中华神经医学杂志

Objective:To investigate the surgical treatment efficacy and experience of invasive thalamus cavernous malformations (CMs).Methods:A retrospective analysis was performed. The clinical and follow-up data of 8 patients with invasive thalamus CMs, admitted to our hospital from July 2007 to June 2020, were chosen. These patients accepted minimally invasive resection via sylvian fissure-insular approach after the second rapture hemorrhage; follow up was performed for 8 months-10 years. Results:The lesions of these 8 patients were near the lateral thalamus, and the lesions were completely removed during the surgery. Within 24 h of surgery, the lower limb muscle strength of one patient was improved to grading 2, and that of 2 patients was improved to grading 1. Follow up results 6 months after treatment showed that the modified Rankin scale scores were 1-3 in 5 patients and 4 in 3 patients; and there were no recurrence during the follow-up of (49.7±37.8) months.Conclusion:The resection via sylvian fissure-insular approach is safe and effective for patients with invasive thalamus CMs after the second rapture hemorrhage.

Value of inferior petrosal sinus digital substraction angiography analysis in endovascular treatment of carotid cavernous fistulas / 中华神经医学杂志

Objective:To analyze the digital substraction angiography (DSA) features of inferior petrosal sinus (IPS) in patients with carotid cavernous fistulas (CCF), and explore its guiding value in endovascular treatment of CCF.Methods:The surgical process and whole brain DSA images of 76 CCF patients accepted endovascular treatment in our hospital from January 2013 to December 2019 were retrospectively analyzed. These patients were divided into direct CCF group ( n=52) and indirect CCF group ( n=24) according to the Barrow typing. The development of IPS in the affected side of the 2 groups was compared, and the location of IPS entry into the internal jugular vein (IJV) in patients from direct CCF group and indirect CCF group during the whole process of IPS development was compared, and the efficacy of endovascular treatment of CCF by IPS was analyzed. Results:Indirect CCF group had significantly higher proportion of patients with poor visualization (45.8%, 11/24) as compared with direct CCF group (17.3%, 9/52, P<0.05). Except one patient with IPS not connecting to IJV, the proportion of intracranial IPS-IJV junction showed no significant difference between the two groups ( P>0.05). IPS embolization was the first choice for all the 24 indirect CCF patients: 13 patients with IPS whole-process development had a relatively smooth superselecative cathelerization (reperfusion rate=100%), and the time of microcatheter placement was relatively short (32 min on average); in the 11 patients with poor IPS development, 5 were successfully opened by loach guidewire guidance and microguide wire looping technique (reperfusion rate=45%), and microcatheter placement was relatively long (69 min on average). Conclusions:Indirect CCF has a high rate of IPS occlusion. Lateral and 3D images show that IPS is parallel to the petrous bone segment of internal carotid artery. Mastering the course of IPS and the location of its terminal into IJV has very important value for guiding the microcatheter to enter the cavernous sinus through the poorly visualized IPS.

Recent advance in relation between chronic subdural hematoma and intracranial vein circulation / 中华神经医学杂志

Chronic subdural hematoma often has occult onset and acute aggravation of neurological deficits,which has complex pathophysiological processes and complex causality relation with intracranial venous system.This paper reviews the researches on the relation between chronic subdural hematoma and intracranial vein circulation in recent years.

Recent advance in acute subdural hematoma and intracranial vein circulation / 中华神经医学杂志

Acute subdural hematoma will cause a sharp increase in intracranial pressure, which is bound to affect intracranial vein circulation; the latter also has a non-negligible impact on the regulation of intracranial pressure. This paper reviews the researches on the relationship between acute subdural hematoma and intracranial vein circulation in recent years.

Influencing factors of expanding regional brain injury in patients with acute traumatic epidural hematoma after surgical evacuation / 中华神经医学杂志

Objective To investigate the risk factors,mechanism and treatment strategies of expanding regional brain injury (traumatic intracerebral contusion or hematoma) in patients with acute traumatic epidural hematoma (ATEDH) after surgical evacuation.Methods Fifty-nine patients with ATEDH,admired to and accepted surgical evacuation in our hospital from February 2013 to September 2018,were chosen in this study;their clinical data and CT imaging data were retrospectively analyzed.The volume ofintracranial hematoma was measured by 3D Slicer software.According to the progress of local brain injury revealed by first CT examination after surgical evacuation,patients with ATEDH were divided into progressive group and non-progressive group.Risk factors of patients with expanding regional brain injury after surgery were analyzed by univariate and multivariate Logistic regression analyses.Results After surgery,22 showed expanding regional brain injury,accounting for 37.29％:9 occurred expanding intracerebral hematoma,and 2 of them died after conservative treatment;two had both expanding intracerebral contusion and hematoma;11 expanding intracerebral contusion patients developed into hematoma,and three of them occurred delayed intracerebral hematoma adjacent to the area of ATEDH,and two underwent secondary craniotomy with good recovery.As compared with patients from the non-progressive group,progressive group had significantly higher percentages of patients with preoperative hyperglycemia (＞9.1 mmol/L),patients with preoperative abnormal coagulation and patients accepted decompressive craniectomy (P＜0.05).Multivariate Logistic regression analysis revealed that preoperative abnormal coagulation was an independent risk factor for expanding intracerebral contusion or hematoma after surgery (OR=6.498,95％CI:1.076-39.253,P=0.041).Conclusion Expanding regional brain injury has high morbidity in patients with ATEDH after surgery evacuation;preoperative abnormal coagulation is an independent risk factor for its occurrence.

Influencing factors of secondary brain injury adjacent to acute epidural hematoma after surgical evacuation / 中华神经医学杂志

Objective To explore the risk factors,mechanism and treatment strategies of secondary brain injury (cerebral hemorrhage or cerebral infarction/encephaledema) adjacent to acute epidural hematoma after surgical evacuation.Methods Forty-four patients with acute epidural hematoma underwent craniotomy in our hospital from March 2013 to December 2018 were chosen in this study.According to postoperative CT or MR imaging examination results,patients were divided into group of secondary brain injury (n=11) and group of non-secondary brain injury (n=33).The clinical data of the two groups were compared,and the significance of epidural hematoma thickness in assessing secondary brain injury was analyzed by receiver operating characteristic (ROC) curve.Binary Logistic regression analysis was used to analyze the independent risk factors affecting secondary brain injury.Results After surgery,11 showed secondary brain injury:3 occurred cerebral hemorrhage,one of whom was diagnosed as having cerebral venous hemorrhage in the cortical vein drainage area caused by traumatic cerebral venous circulation disorder;6 had cerebral infarction/encephaledema,and 2 occurred hemorrhagic cerebral infarction/encephaledema;two underwent secondary craniotomy and both achieved satisfactory effect.As compared with patients from the non-secondary brain injury group,patients fromsecondary brain injury group had significantly higher percentage of patients with epidural hematoma thickness ≥ 33.5 mm (P＜0.05).ROC curve analysis showed that the thickness of epidural hematoma had predictive value in secondary brain injury after surgery (P＜0.05),and area under the curve was 0.722 and diagnostic threshold was 33.5 mm.Binary Logistic regression analysis revealed that epidural hematoma thickness ≥33.5 mm was an independent risk factor for secondary brain injury adjacent to epidural hematoma after surgery (odds ratio=7.367,P=0.024,95％CI=1.298-41.797).Conclusions Acuteepidural hematoma thickness ≥33.5 mm is a high-risk factor associated with secondary brain injury adjacent to epidural hematoma after surgery.Intracranial venous circulatory disorders have non-negligible effect on occurrence of secondary brain injury.

Morphological features of normal aortic arch / 天津医药

Objective To retrospective study the morphological features of normal aortic arch in population of Tianjin area by computed tomography angiography (CTA). Methods From Jan 2016 to Dec 2016, 142 volunteers undergoing thoracic aorta CTA in our institution were retrospectively reviewed. In each patient, 10 measurements were made in GE AW4.6 workstation, including diameters, distances, and angles of branch vessels of aortic arch. SPSS statistical software was used to analyze data. Results The diameter of the origin of brachiocephalic trunk (BCT) D1 was (15.2 ± 3.0) mm, left common carotid artery (LCCA) D2 was (11.8±2.2) mm and left subclavian artery (LSA) D3 was (13.6±1.9) mm. The distance between the BCT and the LCCA (E1) was (4.0±2.5) mm, between the LCCA and the LSA (E2) was (8.2±3.7) mm. The angle between the BCT and arch (α) was 29.5°±14.4°, between the LCCA and arch (β) was 40.3°±17.5°, between the LSA and archγwas 57.9°±21.6°. The angle formed by BCT, LCCA, and LSA(Φ) was 144.1°±10.1°. The distance between center of LCCA ostia and line between center of ostia of BCT and LSA (L) was (4.5±1.2 )mm. Values of D2 and D3 were larger in male than that in female. In the three age groups of 19-40 y, 41-60 y and ≥61 y, values of D1 increased gradually, while α and γdecreased gradually. When in the two age groups of 41-60 y and≥61 y, values of D2, D3, E2 and L were significantly larger than those in the age group of 19-40 y, whileΦwas smaller (P<0.05). Conclusion The data obtained by this study on the diameter and angle of branching vessels arising from the normal aortic arch may provide support for various studies of endovascular repair of aortic arch.

Subarachnoid hemorrhage secondary to cerebral venous sinus thrombosis: a report of three cases and literature review / 中华神经医学杂志

Objective To investigate the early clinical and imaging features,treatment strategies of subarachnoid hemorrhage secondary to cerebral venous sinus thrombosis.Methods The clinical data of 3 patients with subarachnoid hemorrhage secondary to cerebral venous sinus thrombosis,admitted to our hospital from October 2013 to March 2015,were retrospectively analyzed.One patient underwent anticoagulant therapy singly,and two underwent anticoagulation and thrombolytic therapy.Results One patient was admitted to hospital in gestation period,two patients had unknown etiology.All patients complained of headache;among them,two presented with epilepsy.Two patients with early diagnosis and treatment of anticoagnlation and thrombolysis had favorable prognosis,one patient with secondary intracranial hemorrhage had good outcome after active treatment.Conclusions For those patients with onset of non-aortogenic subarachnoid hemorrhage,we must keep an eye out for underlying cerebral venous sinus thrombosis.Anticoagulant and thrombolytic therapy are the first-line treatment.It is suggested that the appropriate dosage at the appropriate time to prevent cerebral hemorrhage from occurring is necessary.

Associations of JAK1 gene polymorphisms with allergic rhinitis in Chinese Han populations / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The aim of this study was to investigate the association of JAK1 polymorphisms with allergic rhinitis in China Han population.@*METHOD@#A total of 450 patients with AR and 615 healthy subjects as control were genotyped for the presence of three single nucleotide polymorphisms using polymerase chain reaction restriction fragment length polymorphism (PGR-RFLP) analysis of DNA extracted from blood samples.@*RESULT@#All control subjects were in Hardy-Weinberg equilibrium, but high frequencies of JAK1 the homozygous rs310241 CC genotype were observed in AR patients compared to controls (P < 0.05). The results also revealed that there was no association between the rest of two investigated SNPs and AR.@*CONCLUSION@#Our results suggested that JAK1 gene rs310241 CC genotype was associated with patients with AR.

The expression and significance of VIP and its receptor in the cochlea of different degrees of chronic alcoholism rats / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To determine whether chronic alcoholism alters the expression levels of Vasoactive intestinal polypeptide (VIP) and its receptor (VIPR1) in the cochlea of chronic alcoholism rats.@*METHOD@#We measured their expression levels in 30 SD rats, in which we created models of different degrees of chronic alcoholism. We investigated the presence of the mRNA of VIP in the cochlea of chronic alcoholism rats and controls by reverse transcription-polymerase chain reaction (RT-PCR) method. We investigated the presence of proteins of VIPR1 in poisoned rats and controls by western blot. We also evaluated the local distribution of VIP cells by immunohistochemistry.@*RESULT@#We found that the levels of VIP and VIPR1 were downregulated in the chronic alcoholism groups compared to the controls group. The differences in some expression levels were significant different between chronic alcoholism rats and control rats. Moreover, at different degrees of alcohol poisoning in rats, the contents of VIP and VIPR1 differed. Decreased levels of VIP and VIPR1 were detected in the deep chronic alcoholism group compared to the group with low-degree poisoning (P 0.05).@*CONCLUSION@#These results suggest that VIP and VIPR1 play an important role in the auditory function in rats with chronic alcoholism. Chronic alcoholism may cause a peptide hormone secretion imbalance in the auditory system, eventually leading to hearing loss.

A case of the nasal septum pyogenic granuloma and literature / 临床耳鼻咽喉头颈外科杂志

A 56-year-old male had presented with left nasal bleeding repeatedly for 4 days. The pathological examination after resection showed pyogenic granuloma. Its etiology and pathogenesis, clinical features, pathological features and treatments were reviewed.

Diagnosis and treatment of laryngopharyngeal reflux disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the diagnosis and treatment of laryngopharyngeal reflux disease.@*METHOD@#Patients suspect of laryngopharyngeal reflux disease in our out-patient department from Jan 2008 to Jan 2009 were included in this study. All patients were assessed using the reflux symptom index(RSI) and the reflux finding score(RFS). The positive criteria of RSI was score > 13 and that of RFS was score > 7. Fifty-eight double positive patients accepted omeprazole oral administration. After continuous oral administration for three months, all patients received RSI and RFS assessment again.@*RESULT@#After treatment, the symptoms of 41 patients were significantly alleviated. In addition, RSI were positive in 41 cases and RFS were positive in 37 cases. Thirty-seven cases were double positive.@*CONCLUSION@#The RSI and RFS could serve as an effective assessment method and could accurately document treatment efficacy in patients with LPR. Proton pump inhibitor such as omeprazole is an effective treatment for patients with LPR.

Cholesteatoma of external auditory canal among 18 cases / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To improve the diagnosis and treatment of the external auditory canal cholesteatoma (EACC).@*METHOD@#The data of 18 patients caused by EACC were analysed retrospectively.@*RESULT@#In all cases, the cholesteatomas were found in the external auditory canal and the mastoid cavity. CT scanning was using for definition the ranging of lesions and the timm management surgery was completed. There was no recurrence in 10-40 months follow-up.@*CONCLUSION@#EACC is easily misdiagnosed as keratosis obturans (KO). The disease can progress to extensive mastoid destruction. CT of temporal bone and detailed history is necessary in the diagnosis. Early complete surgical treatment is the best method.

Improvement of patients' walking ability with orthosis and functional training / 中国康复理论与实践

@#Objective To observe the influence of the orthosis combined with functional training on patients' walking ability. Methods In different rehabilitation training stages, 36 patients, 11 cases of lumbar enlargement spinal cord injury (SCI), 25 cases of cerebrovascular accident (CVA) and head injury (HI), received strengthened training with ankle-food orthoses (AFO) for 6 weeks. And then, scores of ASIA, FMA and walking function in limited time (including 6 minute walking measures and 10 meters walking time measures) were evaluated respectively at admision, before and after applying AFO for 6 weeks. Results There was a significant difference in patients' walking function scores between before and after AFO training (P<0.01). However, SCI patients' ASIA scores have no significant changes after applying AFO for 6 weeks (P>0.05). In additional, HI patients' walking function scores after applying AFO for 6 weeks were more different from the scores at admision (P<0.01), and before AFO training (P<0.05). Conclusion AFO combined with functional training can obviously recover lumbar enlargement SCI and HI patients' walking ability.

The therapeutic effect of systematic rehabilitation intervention patients with upper limb dysfunction caused by fracture and soft tissue injury / 中华物理医学与康复杂志

Objective To observe the therapeutic effects of systematic rehabilitation treatments on patients with upper limb dysfunction caused by fracture and soft tissue injury. Methods This study observed 45 cases of industrial injuries, with a involvement of 25 shoulder joints, 20 elbow and 23 wrist joints. All the patients were intervened with comprehensive rehabilitation treatments for 2.2?0.9 months, which included physiotherapy( joint mobilization, stretch technique, strength exercise, CPM, physical agent therapy and hydrotherapy), occupational therapy and orthosis. ROM, pain, the muscle strength of main muscle groups and ADL were assessed before and 2 months after treatment, respectively. Results There was significant difference with regard to ROM of the involved joints except for shoulder abduction after treatment when compared with those before the treatment (P

Sequence and analysis of Cyt b gene of Agkistrodon and its adulterants sold in market / 中草药

Objective To differentiate the sequences of Cyt b gene Agkistrodon from its adulterants sold in the market in order to provide molecular evidence for identification of Agkistrodon. Methods Cyt b gene was used to sequence and analyze Agkistrodon and its adulterants sold in the market. Results There was a mixed phenomenon in Agkistrodon species. The differences of Cyt b gene sequence between Agkistrodon and its adulterants sold in the market are significant: the difference rates among the species of Agkistrodon are 0%—0.91%, the difference rates between Agkistrodon and its adulterants are 18.57%—23.78%. Conclusion The characteristics of Cyt b gene sequence can be used as a better molecular marker for authenticating Agkistrodon from its adulterants.