【Abstract】ObjectiveTo summarize the study on the feasibility of celiac axis ligation. Methods Literatures about celiac axis ligation were reviewed retrospectively. ResultsCeliac axis branches included common hepatic artery， splenic artery， left gastric artery which had many variation and collateral flow between celiac and mesenteric vessels by gastroduodenal artery and pancreaticoduodenal artery. Celiac axis could be possibly ligated without obvious complications in patients who had celiac axis injuries, celiac artery aneurysms, upper gastrointestinal haemorrhage, excision of carcinoma around the celiac axis and portal hypertension. However, gallbladder necrosis or perforation, focal infarction of the liver even higher mortality had also been reported. ConclusionCeliac axis ligation should not be performed routinely, but it is surgically possible and may be a life saving approach in certain circumstances.
OBJECTIVE: To modify the surface of poly(D,L-lactide) film by anhydrous ammonia gaseous plasma treatment. METHODS: The changes of contact angles were measured and surface energy were calculated. Mouse 3T3 fibroblast cells were cultured on plasma modified and control poly(D,L-lactide) films. RESULTS: It was found that the hydrophilicity and surface energy of the materials have been increased after plasma treatment. Cell culture results showed that ammonia plasma treatment could promote the cell attachment and cells growth. After 4 days culture, the cells on the plasma treated films were 2-folds quantitatively compared with that of the control films. CONCLUSION: Ammonia plasma treatment can improve the cell affinity to poly(D,L-lactide).
Objective To summarize the relationship of diabetes and its complications with microRNA. Methods Domestic and international researches were collected by searching to summarize the role of microRNA in diabetes and its complications. Results MicroRNA could affect the secretion of insulin and interfer metabolism of gulcose in fat cells， muscle cells， and liver cells， which resulting in insulin resistance. At the same time， the microRNA also played an role in damage of vascular endothelial cells and myocardial cell in diabetes. Conclusion MicroRNA acts an important role in the process of diabetes and its complications.
摘要:目的:探討改良De Vega環縮術與經典De Vega環縮術相比對于治療重度三尖瓣返流是否具有更好的成形效果。方法: 2007年12月至2009年3月對29例重度三尖瓣返流的患者行De Vega環縮術。其中16例行改良De Vega環縮術,13例行經典De Vega環縮術,隨訪比較兩組患者三尖瓣返流程度,右心室舒張期末內徑,EF值及心功能分級。以秩和檢驗分析研究兩組患者三尖瓣返流程度和心功能分級的差異,以t檢驗研究兩組患者右心室舒張末期內徑及EF值變化。結果:術前兩組患者一般指標無顯著差異。兩組患者隨訪時間無顯著差異。隨訪經典De Vega組重度返流1例,中度返流5例,輕度返流5例,微量及無返流2例;改良De Vega組無中、重度返流,輕度返流8例,微量及無返流8例。經分析顯示兩組患者三尖瓣返流程度結果差異有統計學意義(Plt;0.05)。經典De Vega組心功能分級I級5例,II級7例,III級1例;改良De Vega組I級7例,II級8例,III級1例,兩組患者心功能差異無統計學意義(Pgt;0.05)。兩組患者右室舒張期末內徑及EF值組內比較隨訪與術前差異均有統計學意義(Plt;0.05),隨訪時組間比較差異有統計學意義(Plt;0.05), 改良De Vega環縮術隨訪時右室舒張期末內徑縮小更顯著,射血分數改善更明顯。結論:改良De Vega環縮術治療重度三尖瓣返流效果優于經典De Vega環縮術。Abstract: Objective: To compare the efficacy of one kind of modified De Vega technique and traditional De Vega technique for the correction of severe tricuspid regurgitation. Methods: From December 2007 to March 2009, 29 patients were treated with tricuspid valve annuloplasty. These were 16 patients in modified De Vega annuloplasty group and the others (13 patients) in traditional De Vega annuloplasty group. The grade of tricuspid regurgitation、New York Heart Association (NYHA) functional class、ejection fraction (EF) and the right ventricular enddiastolic dimension of two groups were followed and reviewed. Results: There was no statistically difference between two groups about preoperative characteristics and followup time. There was 1 patient with severe TR, 5 patients with moderate TR, 5 patients with mild TR and 2 patients without TR in traditional De Vega annuloplasty group after the operations. In modified De Vega annuloplasty group, no patient was observed with severe or moderate TR, 8 patients with mild TR, and 8 patients without TR. At interval time, there was significant difference in the grade of tricuspid regurgitation between two groups (Plt;0. 05). Both tricuspid valve plasty techniques could reduce the right ventricular enddiastolic dimension and improve ejection fraction significantly (Plt; 0. 05), and there was significant difference in the right ventricular enddiastolic dimension and ejection fraction at interval time between two groups (Plt;0.05). Conclusions: The outcome of modified tricuspid De Vega technique is superior to that of traditional De Vega technique in correcting severe tricuspid regurgitation.
Objective To summarize the experience of surgical treatment for 84 patients with aortic dissection, investigate the surgical technique and perioperative treatment, and to improve surgical results. Methods The operations were performed in 50 patients with aortic dissection of Stanford A， Bentall or Cabrol operations were performed in 24 patients, graft replacement of ascending aorta in 8 patients, Trusler operation in 5 patients, Wheat operation in 5patients, operation of ascending aorta and aortic arch in 8 patients.Stentgraft were used in 34 patients with aortic dissection of Stanford B. Results There were 11 hospital death,the hospital mortality was 13.1%.There were 3 operative deaths.One patient with ascending aortic and hemiarch grafting died of aortic root bleeding;one patient with replacement of ascending aorta died of failure to restart heart beating；one patient with ascending aortic and hemiarch grafting died of rapture of aortic dissection. There were 8 postoperative deaths, including low cardiac output syndrome in 2 patients, lung infection in 2 patients, renal failure in 2 patients， respiratory failure in 1 patient and permanent mental anomaly in 1 patient. The complications were occurred in 16 patients. The followup period was 3 months to 10 years, and carried out in 62 patients（84.9%，62/73).One died of endocarditis, another one died of sudden death. Conclusion The surgicaltreatment of aortic dissection could be carried out safely based on the accurate diagnosis， specific surgical strategy and fine surgical technique.
Objective To verify the feasibility and effectiveness of the modified fast-track surgery (FTS) in the perioperative period of open liver resection. Methods A prospective randomized controlled trial was carried out in 188 consecutive patients undergoing open liver resection between March and December 2014 in the Department of Liver Surgery of West China Hospital. The modified fast recovery procedure and standard rehabilitation procedure were compared in terms of length of hospital stay after operation, hospitalization cost, complications and readmission rate. Results A total of 188 consecutive patients were enrolled in the trial. The analysis included 87 patients in the modified fast recovery group and 89 in the standard rehabilitation group. Compared with the standard rehabilitation group, the modified fast recovery group had a shorter length of hospital stay [(5.70±1.47)vs. (7.26±1.96) days] and a lower cost [(42.7±6.7)vs. (47.3±12.5) thousand yuan], and the differences were statistically significant (P<0.05). There were 20 complication cases in the modified group and 39 in the standard group with significant difference (P=0.003). There was no significant difference in the rate of readmission between the two groups (P=1.000). Compared with the standard group, patients in the modified group had less pain 8 hours, the 1st and 2nd days after surgery, better postoperative activities of daily living, more initiative cough times and off-bed activity times, longer duration of movement, and earlier bowel recovery and exhausting, and all the above differences were significantly different (P<0.05). Stepwise regression analysis showed that postoperative complications and bowel recovery and exhausting time were independent related factors for postoperative hospital stay (P<0.001). Conclusions Multimodal analgesia-based fast recovery procedure is feasible and effective in the perioperative period of partial hepatectomy. It can shorten the time of hospitalization and reduce the cost of hospitalization.
Abstract: Percutaneous balloon pulmonary valvuloplasty (PBPV) has become the first choice for the treatment of pulmonary valve stenosis (PS). PBPV is used not only in the independent way to relieve Milo-Ⅰ amp; Ⅱ type of PS as an alteration of surgery, but also in the combination way with surgical treatment to some multiple or complex congenital heart defect,where it plays a part as a pre-operative appeasement or a co-operative procedure, even a supplementary expedience to some failed surgery post-operatively. In this paper, the anatomic classification of PS, the usage of ultrasounic examination, the indication and contraindication, the method and skill during operation, and the effect evaluation of PBPV are reviewed.
Leukemia is a common, multiple and dangerous blood disease, whose early diagnosis and treatment are very important. At present, the diagnosis of leukemia heavily relies on morphological examination of blood cell images by pathologists, which is tedious and time-consuming. Meanwhile, the diagnostic results are highly subjective, which may lead to misdiagnosis and missed diagnosis. To address the gap above, we proposed an improved Vision Transformer model for blood cell recognition. First, a faster R-CNN network was used to locate and extract individual blood cell slices from original images. Then, we split the single-cell image into multiple image patches and put them into the encoder layer for feature extraction. Based on the self-attention mechanism of the Transformer, we proposed a sparse attention module which could focus on the discriminative parts of blood cell images and improve the fine-grained feature representation ability of the model. Finally, a contrastive loss function was adopted to further increase the inter-class difference and intra-class consistency of the extracted features. Experimental results showed that the proposed module outperformed the other approaches and significantly improved the accuracy to 91.96% on the Munich single-cell morphological dataset of leukocytes, which is expected to provide a reference for physicians’ clinical diagnosis.
Objective To design a novel stentless porcine aortic bioprosthesis and test the feasibility and its function in vitro after the valve was implanted by a modified method. Methods Six stentless porcine aortic bioprosthesis were divided into two groups according to different implantation, single layer suture group: new improvement stentless porcine aortic bioprosthesis sutured with single layer was implanted; double layer suture group: stentless porcine aortic bioprosthesis developmented by our laboratory used double layer suture was implanted. Each group contained three scales: 23 mm ,25 mm and 27 mm. Analogue ex vivo aortic valve replacement was performed , the feasibility of the new implantation was detected. Effective orifice area, transvalvular pressure gradient and regurgitation ratio were recorded at the cardiac output of 2.0 L/min, 3.5 L/min, 5.0 L/min and 7.0 L/min under the guideline of International Organization for tandardization （ISO）5840. Results The average aortic valve implantation time used for single layer suture and tradition double layer suture were 50 min and 70 min respectively. The transvalvular pressure gradient in the single layer suture group were significantly lower than those in double layer suture group under the flow of 5.0 L/min in 23 mm valve and 27 mm valve （13.51±0.51 mm Hg vs. 14.44±0.99 mm Hg, 7.36±0.19 mm Hg vs. 7.53±0.28 mm Hg；P＜0.01）;and the effective orifice area in the single layer suture group were larger than those in double layer suture group in the same case(1.87±0.06 cm2 vs. 1.76±0.08 cm2, 2.26±0.07 cm2 vs. 2.16±0.05 cm2；P＜0.01). There was no statistically difference in other parameters between both groups. Conclusion The novel design of new improvement stentless porcine aortic bioprosthesis used single layer suture has good hemodynamic characteristics as the nature structure . The modified suture method decrease the implantation time.Nemerical data of the evaluation in vitro show that the difference between single layer suture group and double layer suture group in effective orifice area,transvalvular pressure gradient and regurgitation ratio haveno statistical significance. This experiment is the foundation of the animal and clinical experiment in the future.
目的:探討帶膜支架腔內隔絕術治療B型主動脈夾層的技術方法及療效。方法:對近年我院收治的40例主動脈夾層進行分析。40例患者均行股動脈穿刺插管至升主動脈造影，了解主動脈真假腔、夾層裂口及其與重要血管分支位置關系。切開右或左側股動脈置入覆膜血管內支架，封堵原發破口，置入支架后重復造影檢查。觀察真假腔血流變化、主動脈分支供血的情況。結果:40例患者支架置入定位準確，術后即刻造影顯示真腔血流恢復正常。手術成功率100%，無術中轉開胸手術，無截癱及瘤體破裂等嚴重并發癥，無圍手術期死亡。所有患者術后3～6個月復查增強CT，假腔不再顯影，支架通暢，無扭曲、移位。結論:帶膜支架腔內隔絕術治療B型主動脈夾層具有創傷小，術后恢復快，手術死亡率低，手術成功率高的優點，但遠期效果有待進一步觀察。