Objective To evaluate the ability of 64-slice spiral CT(64-MSCT) in demonstrating the coronary collateral circulation(CCC).Methods Patients undergoing 64- MSCT coronary angiography with relatively good image quality from August 2005 to April 2007 were entered into the study according to following requirements: patients underwent a traditional coronary artery angiography (CAG) after the coronary CT imaging; the CAG showed there was stenosis greater than 90% in at least one major coronary artery.The CCCs were assessed in CAG by the Rentrop grading, and the CAG served as the gold standard to determine the accuracy of 64-MSCT angiography in detecting collateral circulations.All CCCs were grouped angiographieally into three groups of CC0, CC1 ,and CC2 by Werner collateral collection(CC) grading.In the 64-MSCT coronary angiography imaging, a new grading(MSCT-CC) was used to evaluate CCCs.The consistency between these two grading standards was analyzed by Kappa test.Resalts A total of 97 patients were entered into the study, among whom at least one CCC was found by CAG in 37 patients and at least one CCC was detected by 64-MSCT angiography.Taken the CAG results as the reference standard, the sensitivity and specificity of the 64-MSCT angiography in detecting patients with the CCCs were 89.2% (33/37) and 93.8% (60/64) respectively.The sensitivity of the 64-MSCT angiography detecting the CCCs was 75.8% (47/62). All the CCCs detected by CAG and 64-MSCT angiography were grouped into three groups according to Werner grading: 4 in CC0 group, 24 in CC1 group and 19 in CC2 group.The CCCs were grouped into three groups according to MSCT-CC: 7 in MSCT-CC0 group, 22 in MSCT-CC1 group and 18 in MSCT-CC3 group.The consistency of the two grading criteria was relatively high (Kappa = 0.857, P < 0.01).Conclusion 64-MSCT angiography can accurately evaluate the coronary collateral circulation.

AIM and METHOD:To determine the production of nitric oxide(NO) and change of NO synthase(NOS) activity in mitochondria isolated from the rat brains of the ischemia/reperfusion rat model produced by transient occlusion of middle cerebral artery on the following the points: 2 h after occlusion of artery and 30 min, 2h, 4h after reperfusion. RESULTS: After the occlusion of middle cerebral artery, the respiratory control rate(RCR) of mitochondria significantly decreased and slightly increased at 4h after reperfusion. Meantime, the production of NO in mitochondria increased significantly. But with the increase of perfusion, production of NO gradually decreased and reached normal level as in the control group. It also shows that cerebral ischemia increased NOS's activity significantly in the mitochondria and still kept a higher level than the control group although it decreased gradually after reperfusion. But the iNOS's activity did not show obvious change. The change of total NOS's activity depends on the change of cNOS's activity. CONCLUSION: The activation of NO/NOS system in the mitochondria might play an important role in the reperfusion injury during reperfusion of ischemic brain.

Objective To evaluate the accuracy of 16-detector row computed tomography coronary angiography in detection of hemodynamically relevant stenosis(≥50%) of the coronary artery. Methods Twenty-six patients undergoing both multi-detector row CT and conventional coronary angiography were included in this retrospective study. CT scan were obtained with collimation of 16 and rotation time of 500 ms. Retrospective electrocardiographic(ECG) gating was used for image reconstrution. The stenosis degree was detected with axial scanning and three-dimensional reformation. Results With the results of conventional coronary angiography as golden standard, the sensitivity, specificity, accuracy, positive predicted value and negative predicted value of the CT angiography in detection of hemodynamically relevant stenosis(≥50%) were 90.0%, 95.5%, 94.7%, 77.6%, and 98.2% respectively. Conclusion Sixteen-detector row computed tomography coronary angiography has high clinical value with evaluating hemodynamically relevant stenosis(≥50%) of coronary artery,and could be a significant guide for diagnosis and therapy of coronary heart disease.

Objective To investigate the safety, feasibility and results of laparoscopic assisted distal radical gastrectomy for gastric cancer. Methods Twenty-three cases of gastric cancer were subjected to laparoscopic assisted distal radical gastrectomy, D_(1+α)/D_(1+β) lymphadenectomy on 3 cases and D_2 lymphadenectomy on 20 cases. All cases received Billroth I reconstruction. Results Laparoscopic assisted distal radical gastrectomy was carried out in all cases successfully. The mean operative time was (205 ±38 )min, mean blood loss was (105 ± 66) ml and mean number of lymph nodes dissected was 19.7 ± 6.2 each case. The mean postoperative time of recovery of bowel function was (3.5 ±1.2) d,mean postoperative time of liquid intake was (4.9 ±0.9) d and mean hospitalization was (10.2 ± 2.7) d. No postoperative death or anastomotic fistula was found. Postoperative upper gastrointestinal bleeding occurred in 1 case and was cured by conservative treatment. Follow-up for 1-12 months revealed no recurrence or metastasis. Conclusions Laparoscopic assisted distal radical gastrectomy is a safe and feasible procedure with satisfactory short-term outcomes.Moreover,the short-term outcomes may be improved if the patients are treated under the notion of fast track surgery.

Objective To improvethe control of infection source by improving the continuous quality of sputum disposal management. Methods PDCA method based on the management of tuberculosis sputum disposal of the hospital quality improvement. The cross-sectional survey of tuberculosis ward in 32 cases of hospital patients, as control group.PDCA first round of "sputum cup distribution and use of work flow" for quality improvement,the reason leading the work flow of workers to nurse led work flow,the improved cross-sectional survey in 36 cases of hospital patients as experimental group 1.Aiming at the problem of low utilization rate of special sputum cup in the improvement of the first round of PDCA,the improvement of the sputum cup was carried out,On this basis, the "special sputum disposal Cup" was designed to obtain the national patent authorization. After the second round of improvement, the cross-sectional investigation in 35 patients in the hospital,as the experimental group 2.Results After two rounds of PDCA improvement,experimental group 2 groups compared with control,bedside sputum cup configuration was not in place rate decreased from 53.1% (17/32)to 0,the difference was statistically significant(Χ2=24.916,P<0.05);configuration after the sputum cup unused rate from 53.1%(17/32)down to 8.6%(3/35),the difference was statistically significant(Χ2=15.846,P<0.05).Conclusion PDCA method can improve the quality of management standard sputum disposal. Ward sputum cup ration is standardized sputum disinfection ward-based nurse intervention and leading sputum cup release, ward can improve the sputum cup ration, improved sputum containers (sputum cup) can improve patient compliance standard of spitting.

Objective: To summarize our preliminary clinical experience of ultrasound-guided needle-perc combined with standard percutaneous nephrolithotomy (PCNL) in the treatment of staghorn stones, and to analyze its safety and efficacy. Methods: The clinical data of 65 patients with staghorn stones treated by ultrasound-guided needle-perc combined with standard PCNL under general anesthesia with the patient in prone position from December 2017 to June 2019 were retrospectively reviewed. A total of 41 males and 24 females were included. The mean age was (53.5+ 8.9) years. The mean body mass index (BMI) was (25.1±2.9) kg/m², and the mean stone diameter was (10.9±3.1) cm. Among them, there were 3 cases with bilateral staghorn stones, 38 cases with complete staghorn calculi, 36 cases with non- or mild preoperative hydronephrosis, 12 cases with previous ipsilateral renal surgery, and 9 cases with solitary kidneys. Ultrasound-guided renal access and tract dilation were used to establish F24 standard channel. Pneumatic combined with ultrasonic lithotripsy with suction system was used to treat staghorn stones under nephroscope. Needle-perc consists of F4.2 needle-like metal sheath connected with a three-way tube. A 0.6 mm diameter video fiber, 200 um holmium laser fiber and liquid perfusion device can be connected through the three-way tube respectively. The residual stone in the parallel calyx after standard PCNL were punctured by needle-perc under ultrasound guidance, and then the holmium laser fiber was used for lithotripsy. Results: In this study, a total of 68 renal units were included. The median operative time was 79.8 minutes, ranging 45-129 minutes. The median decrease of hemoglobin on postoperative day 1 was 10.6 g/L, ranging 0-25.9 g/L. The median length of postoperative hospital stay was 5.5 days, ranging 4-7 days and the median time of tract establishment was 4.8 minutes, ranging 2.5-9.6 minutes. The median number of standard tract established was 1.5, ranging 1-3 and the median number of needle-perc punctured was 1.0, ranging 1-3. The total complication rate was 10.3% (7 cases), including 5 cases of Clavien grade Ⅰ, 2 cases of postoperative fever, 3 cases of analgesic use. There were 2 cases of Clavien grade Ⅱ. All of them were blood transfusion. The initial stone free rate was 79.4%(54/68). Of the 14 patients with residual stones, 9 patients underwent second-stage operation, 7 patients were stone free, and the final stone free rate was 89.7%(61/68). Conclusions Ultrasound-guided needle-perc combined with standard PCNL is safe and effective in the treatment of staghorn stone.

Objective To describe and introduce the initial clinical application of a novel instrument needle-perc for percutaneous nephrolithotomy (PCNL) in upper urinary tract stones.Methods 24 patients with upper urinary stone treated by PCNL were collected retrospectively between August 2017 and January 2018.Sixteen patients were male and 8 were female.Average age was 41.2 years,ranging 26-65 years.Eight cases had upper pole stones,6 cases had pelvic stones,8 cases had lower pole stones and 4 cases had the stone in UPJ.The mean calculus size was 1.2 cm,ranging 0.5-1.4 cm.All patients were punctured under total ultrasound with needle-perc.Six cases had upper calyceal puncture,10 cases had middle calyceal puncture and 8 cases had lower calyceal puncture.The needle-shaped nephroscope consists of a puncture sheath and a needle handle.The puncture sheath is a hollow metal sheath with an outer diameter of F4.2,an inner diameter of F3.6,and a length of 15 cm.The tip of the sheath is beveled to facilitate puncture.The outer end of sheath is connected to the needle handle through a screw interface.And the three interfaces of the three-way tube can be respectively connected with a liquid irrigation device,a video optical fiber and a 200 μm holmium laser fiber.The needle-perc integrated image system,the irrigation system,and the nephroscope channel are integrated.The tissue passing through the needle can be simultaneously observed through video optical fiber during puncturing.After the tip of the sheath is inserted into the target calyx,the holmium laser fiber is connected for fragmenting or dusting.Results Needle-perc was successful in 22 cases,2 patients were converted to larger tract(F16).The mean opeartive time was 49.2 min,ranging 22-75 min and the mean hemoglobin loss was 5.2 g/L,ranging 0-13.8 g/L.Mean postoperative hospital stay was 3 days,ranging 1 to 6 days.No Double-J stents or nephrostomy tube was placed in the 22 patients.Complications (Clavien Ⅱ) occurred in 4 cases,including fever in 2 cases and renal colic in 2 cases.Plain film of KUB or CT scan was done and stone free rate at 1 month was 90.9％ (20/22),2 patients needed ESWL to remove the residual stones.Conclusions Needle-perc is efficient and safe for small renal stones (size ＜ 1.5 cm) from our initial experience,with high stone-free rate and low complication rate in early follow-up.

Objective To explore the safety and efficacy of fusion imaging technique and traditional ultrasound guidance in percutaneous nephrolithotomy,and to compare the difference of two methods for PCNL.Methods Patients with renal calculus,who underwent percutaneous nephrolithotomy from January 2016 to August 2016,were enrolled in the study.The patients were randomly divided into two groups by SAS software.The control group was treated with traditional ultrasound guided puncture technique (Ultrasound group).Experimental group was treated with fusion imaging method (CT-US group).Preoperative patient CT image data was uploaded to the image fusion ultrasound machine for data synchronization.Both groups used the same way to establish a standard channel (F24).Lithoclast system from EMS was used to remove stones.Intraoperative parameters (time to define the target calyx,access establishment time,operative duration) and postoperative perioperative data (estimated blood loss,stone-free rate,severe complications) were compared between the two groups.Results 65 cases of patients were enrolled into the study.There was no significant difference in age (P =0.72),body mass index (P =0.78),stone size (P =0.53) and so on.Compared with the control group,the time duration to define the target calyx in CT-US group is significantly decreased in experiment group(50.4 ± 18.1) s vs.(82.1 ± 37.7) s,(P =0.02).The time to establish the access and fulfill the procedure shows no significant difference between the two groups,respectvely(P =0.45,0.61).Also,significant differences can be found in the hemoglobin loss during and after the surgery(1.1 ± 0.5) g/L vs.(1.4 ± 0.4) g/L (P =0.04).The difference in severe complications (Clavien Ⅲ and above),stone-free rate (P =0.60) and transfusion rate (P =1.00) was not significant.Conclusions Our primary study shows CT-altrasound image fusion guide PCNL is a safe and reliable technology.The time duration to define the target calyx was decreased compared with traditional US guidance method.The target calyx chosen was more accurate,with lower blood loss during the perioperative period.

Objective:To study the risk factors of intra-abdominal infection after hepatectomy in patients with primary liver neoplasms.Methods:The clinical data of patients with primary liver neoplasms who underwent hepatectomy at the Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2019 to December 2021 were retrospectively analyzed. Of 1 229 patients who were enrolled, 48 patients developed postoperative abdominal infection. There were 45 males and 3 females, with age of 58.0 (45.0, 66.0) years old in the infected group. Forth-eight patients without postoperative abdominal infection were selected based on the random number formula to be allocated to the uninfected group to include 44 males and 4 females with age of 58.5 (48.5, 64.8) years old. The general data, preoperative and postoperative laboratory test results, types of liver neoplasms and hepatectomy, pathogenic infective microorganisms and their drug sensitivity tests were collected. Univariate analysis was used to analyze the related factors of intra-abdominal infection after hepatectomy, and significant factors were included in logistic multivariate regression analysis.Results:Of 24 pathogenic strains which were detected in the 143 samples of abdominal infection, the positive rate of culture was 16.78%(24/143). Multivariate logistic regression analysis showed that prealbumin <180 mg/L ( OR=3.757, 95% CI: 1.117-12.634), intraoperative blood transfusion ( OR=6.363, 95% CI: 1.301-31.113) and the time of drainage tube placement ≥7 d ( OR=31.098, 95% CI: 6.906~140.029) were independent risk factors of intra-abdominal infection after hepatectomy. Conclusion:Prealbumin <180 mg/L, intraoperative blood transfusion and the time of drainage tube placement ≥7 d were independent risk factors of intra-abdominal infection after hepatectomy for primary liver neoplasms.

Objective To investigate the feasibility of tract dilation monitored by ultrasound in percutaneous nephrolithotomy (PCNL),and the risk factors for its failure.Methods A retrospective study was conducted on patients underwent PCNL with only one access (F24) using balloon dilator and sequential dilators (Amplatz and telescopic metal dilators) from December 2014 to December 2018 in Beijing Tsinghua Changgung Hospital.A total of 231 patients (130 males and 101 females) underwent ultrasound-guided PCNL with a mean age of (52.3 ± 9.8) years were included in our study.Mean BMI was (25.8 ± 3.1) kg/m2.Mean size of stone was (3.9 ± 1.1)cm,51.1％ (118/231) of which were staghorn stones.Under ultrasound guidance,after puncture of the target calyx,the balloon dilator was advanced through the guide wire,and inflated to establish the F24 standard renal access.Patients' clinical parameters such as age,gender,BMI,stone diameter,history of open nephrolithotomy were collected.Risk factors for the failure of ultrasound guided balloon dilation were analyzed by logistic regression analysis.Results Tract dilation succeed in 89.2 ％ cases (206 succeed,25 failed) at first attempt.Median tract dilation time was 4.2 min (2.2-8.0 min).Mean operation time was 85.5 min(45.0-120.0 min).Median hemoglobin drop at the first postoperative day was 16.0 g/L (5.0-25.8 g/L).The total rate of complication was 9.1％ (21 cases),including 18 cases Clavien Ⅰ and 3 cases Clavien Ⅱ.The stone free rate was 89.6％ (207/231).Logistic regression analysis revealed that lower pole access (P =0.014) was a risk factor for the failure of access establishment,while the presence of hydronephrosis of target calyx (P ＜ 0.001) would significantly increase the success rate.Conclusions Tract dilation using balloon catheter can be safely monitored by ultrasound with high success rate and low complication rate.Lower pole puncture will make tract establishment difficulty.Patients with a hydronephrotic target calyx are more suitable for this procedure.