The Effect of Long-Term External Counterpulsation Combined with Exercise Therapy on the Establishment of Collateral Circulation in Patients with Coronary Artery Occlusive Disease.

Objective: By detecting the levels of external counterpulsation combined with exercise therapy on the levels of moesin, angiopoietin-like protein2 (Angptl 2), angiopoietin-like protein (Angptl 3), hypoxia inducible factor-1α (HIF-1α), and RNA-34a (miR-34a) in patients with coronary artery occlusive disease, the effect of external counterpulsation combined with exercise therapy on the establishment of occluded coronary collateral circulation was studied. Methods: A retrospective analysis of 166 patients with coronary heart disease was confirmed by coronary angiography results that at least one coronary artery (anterior descending branch, circumflex branch, and right coronary artery) was completely occluded and was classified into the control group (routine medication) and the treatment group (routine drug therapy plus exercise therapy and external counterpulsation) according to the treatment plan of the patient. The serum levels of moesin, Angptl 2, Angptl 3, and HIF-1α were detected by enzyme-linked immunosorbent assay (ELISA) test. The index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) of the two groups of patients were measured before and after 2 weeks of treatment. The formation of collateral circulation was analyzed according to the Rentrop classification method. Results: After treatment, the IMR levels of the two groups were significantly decreased, and the CFR levels were significantly increased. The decrease of IMR level and the increase of CFR level in the experimental group were better than those in the control group (P < 0.05). There was no significant difference in the positive detection rate of moesin antibody between the two groups, but the OD detection value of the treatment group decreased significantly (P < 0.05). The levels of Angptl 2, Angptl 3, and miR-34a in the treatment group were lower than those in the control group, while the relative expression of HIF-1α was higher than that in the control group. The difference was statistically significant (P < 0.05). External counterpulsation combined with exercise therapy improved the formation rate of collateral circulation (P < 0.05). Conclusions: External counterpulsation combined with exercise therapy can reduce moesin antibody, Angptl 2, Angptl 3, and miR-34a levels increase HIF-1α levels, and promote the establishment of occluded coronary collateral circulation.

The Preventive Effect of Computed Tomography Image-Guided Electroacupuncture Combined with Continuous Femoral Nerve Block on Deep Vein Thrombosis After Total Knee Arthroplasty Based on an Adaptive Algorithm.

Based on an adaptive algorithm model, this study proposed 2 special model structures of randomized fusion and an optimized convolution kernel and use it for image recognition. The adaptive algorithm model combined image-guided electroacupuncture with a continuous femoral nerve block to prevent deep vein thrombosis after total knee arthroplasty. A total of 200 patients after total knee arthroplasty were randomly divided into 4 groups. We assessed the incidence of postoperative lower limb deep vein thrombosis and platelet count before and after surgery. Electroacupuncture combined with continuous femoral nerve block can reduce the incidence of deep vein thrombosis and has obvious advantages in multimode prevention. The effective analgesia provided by electroacupuncture combined with continuous femoral nerve block relieved postoperative pain. It also enabled patients to participate in joint movement and lower limb muscle strength training as soon as possible, which not only is conducive to postoperative functional recovery, but also reduces the body stress response triggered by pain and the hypercoagulable state. Moreover, electroacupuncture stimulation of electroacupuncture points can reduce the inflammatory edema associated with surgery, improve blood circulation at the surgical site, and activate the body's anticoagulation mechanism. This study provides new ideas and references for formulating multimode prevention and control strategies.

A pilot study on thoracoscopic internal mammary lymphatic chain dissection for breast cancer.

PURPOSE: To evaluate the feasibility of internal mammary lymphatic chain dissection by thoracoscopic surgery. MATERIAL AND METHODS: Thirty-two breast cancer women were involved in this pilot study, who were with lesion located at central area or internal quadrant, or with cN2 or cN3 ALNs, or with T4 tumor, or indicating IMNs drainage by preoperative lymphoscintigraphy, but without distant metastasis. Subareolar injection and peritumoral injection of 5 ml methylene blue were done before operation. Double cavity intubation was used to permit collapse of the homolateral lung and set-up the endoscopic operation space. Trocars were introduced through three thoracic incisions of less than 15 mm at the third, the fifth and the seventh intercostal spaces along the midaxillary line. Dissection of internal mammary lymphatic chain was performed by a thoracoscopic grasper and ultrasonically activated scalpel. RESULTS: Thoracoscopic internal mammary lymphatic chain dissection was successfully finished in 28 patients. The procedure time was 30-70 min (45.2+/-9.6 min). A total of 128 internal mammary nodes were removed. Among the 28 patients, 11 had internal mammary node metastasis. Only one patient had internal mammary node metastasis without axillary node metastasis. All internal mammary nodes were located at the first rib to the fourth intercostal space. Thoracoscopic internal mammary lymphatic chain dissection in four patients was impossible because of unfavorable local anatomic conditions. There was no damage on great vessels or the lungs, nor pulmonary atelectasis or pulmonary infection. CONCLUSIONS: Thoracoscopic internal mammary lymphatic chain dissection is feasible, and it is easy to perform without serious additional complications. It may improve nodal staging of breast cancer with internal mammary node.

Contribution of minute axillary lymph nodes to accurate staging for patients with breast cancer.

BACKGROUND: Axillary lymph node metastasis is a very important metastatic pathway in breast cancer and its accurate detection is important for staging tumour and guiding therapy. However, neither the accuracy of routine detection of lymph node in surgical specimens nor the significance of minute lymph node with metastases in breast cancer is clear. A modified method for conveniently detecting minute lymph node in specimens of axillary dissections in patients with breast cancer was used to analyze their influence on staging breast cancer. METHODS: Lymph nodes in fresh, unfixed, specimens of axillary dissections from 127 cases of breast cancer were detected routinely. Then the axillary fatty tissues were cut into 1 cm thick pieces, soaked in Carnoy's solution for 6 to 12 hours, taken out and put on a glass plate. Minute lymph nodes were detected by light of bottom lamp and examined by routine pathology. RESULTS: Lymph nodes (n = 2483, 19.6 +/- 8.0 per case) were found by routine method. A further 879 lymph nodes up to 6 mm (781 < 3 mm, 6.9 +/- 5.3 per case, increasing mean to 26.5 +/- 9.7) were found from the axillary tissues after soaking in Carnoy's solution. By detection of minute lymph nodes, the stages of lymph node metastasis in 7 cases were changed from pathological node (pN) stage pN(0) to pN(1) in 4 cases, from pN(1) to pN(2) in 2 and from pN(2) to pN(3) in 1. CONCLUSIONS: The accurate staging of axillary lymph node metastasis can be obtained routinely with number of axillary lymph nodes in most cases of breast cancer. To avoid neglecting minute lymph nodes with metastases, small axillary nodes should be searched carefully in the cases of earlier breast cancer with no swollen axillary nodes. Treatment with Carnoy's solution can expediently detect minute axillary nodes and improve the accurate staging of lymph nodes in breast cancer.

[Technique investigation of endoscopic axillary lymph node dissection by liposuction].

OBJECTIVE: To study the technique of endoscopic axillary lymph node dissection by liposuction. METHODS: Endoscopic axillary lymph node dissection (E-ALND) after liposuction (group A) were performed on 45 patients with breast cancer from Dec. 2004 to Oct. 2005. It was compared with traditional ALND (group B). RESULTS: The average operation time of E-ALND was 108 min (60 - 190 min), it was longer than that in group B (P < 0.05). The total blood loss in group A was 152.82 ml (80 - 220 ml), it was less than that in group B significantly (P < 0.01). In group A, the mean lymph nodes harvested by endoscopy were 18 (8 - 34), the total postoperative lymph flow was 140.38 ml (60 - 180 ml), the duration of drainage was 6.91 d (6 - 15 d). The postoperation complication included axillary seromas 7 cases, epidermic blister 5 cases, operation area phlegmon 2 cases were found in group A. There was no significant difference between two groups in the total postoperative lymph flow, the duration of drainage and the number of dissected lymph nodes and postoperation complication. The incision of chest wall was smaller in group A, and patients by this surgery were satisfied with the cosmetic results. CONCLUSIONS: Endoscopic axillary lymph node dissection by liposuction could match the traditional lymphadenectomy. The technique should be further standardized.