Objective Study of the effects of hepatocyte growth factor on inhibit Intimal hyperplasia of the anastomotic stoma after carotid artery bypass grafting.Methods Thirty-two New Zealand white rabbits were randomly divided into control group and the experimental group.The veins were pretreated with saline solution(control group)only or pretreated with HGF(experimental group ;100ng/ml).The vein grafts were harvested at 14 days,28days after operation,HE Stain and Elastic fibrin Stain,The thickness of Intima and media in the vein grafts,intima-media ratio(I/M) was calculated by computer image analysis system.PCNA Immunohistochemistry was performed.Results The thickness of Intima and media in the vein grafts of control group surpassed experimental group significantly(P ＜0.01).At 14d I/M in the vein grafts of control group (0.81 ± 0.05) surpassed experimental group (0.47 ± 0.05) (P ＜ 0.01),At 28d I/M in the vein grafts of control group(0.73 ± 0.01)surpassed experimental group (0.65 ± 0.01) (P ＜ 0.01).The vascular smooth muscle cell proliferation in experimental group was significantly lower than that in control group (P ＜ 0.01).Conclusion Treatment of veins grafts with HGF can significantly inhibit intimal hyperplasia in a rabbit carotid artery bypass grafting model.

Objective Discusses the peeling carotid endarterectomy tcchnique(CEA) operation methods and main points,around the time of surgery to reduce the incidence of stroke and postoperative restenosis rate.Methods Retrospectively analyzed and summarized for the CEA 21 cases in vascular surgery in our hospital from March 2006 to November 2011.Conventional Doppler ultrasonography,preoperative CTA.All the patients were under general anesthesia CEA,conventional set neck artery bypass tube surgery and vascular patch for carotid angioplasty.Results Around the time of surgery and postoperative 30 d were no deaths and stroke occurred and the follow-up both not again hair.In 3 6 months after mild carotid artery stenosis (＜40％),patients were no more than the carotid artery stenosis again.Conclusion Carotid endarterectomy exfoliative procedure the routine use carotid artery flow pipe and the blood vessels to patch do artery figuration,which can effectively improve the safety of the procedure and reduce postoperative restenosis happen.

Objective To establish the quality standard of Radix Toddaliae Asiaticae. Methods Thin layer chromatography ( TLC) and high performance liquid chromatography ( HPLC) were used to identify and determine chloride nitidine and toddalolactone in Radix Toddaliae Asiaticae. The moisture and total ash contents were detected according to the methods recorded in appendix of Chinese Pharmacopeia (2010 edition) . Results Toddalolactone and chloride nitidine were detectable by TLC, the spots were clear and the dissociation was good. The established HPLC method was simple and accurate. The linear ranges of toddalolactone and chloride nitidine in Radix Toddaliae Asiaticae were 2.84~42.6 μg/mL and 25.6~385 μg/mL, and their recovery rates were 99.2 % ( RSD=1.12%) and 100 % ( RSD=0.71%) , respectively. The content of moisture was in the range of 75.8~98.9 mg/g and that of total ash was in the range of 12.4~33.6 mg/g. Conclusion The developed method is specific and accurate, and can provide useful reference for establishing quality standard of Radix Toddaliae Asiaticae.

Objective To observe the clinical effect of intravenous thrombolytic therapy for central retinal artery occlusion (CRAO) with poor effect after the treatment of arterial thrombolytic therapy.Methods Twenty-four CRAO patients (24 eyes) with poor effect after the treatment of arterial thrombolytic therapy were enrolled in this study.There were 11 males and 13 females.The age was ranged from 35 to 80 years,with the mean age of (56.7± 15.6) years.There were 11 right eyes and 13 left eyes.The visual acuity was tested by standard visual acuity chart.The arm-retinal circulation time (A-Rct) and the filling time of retinal artery and its branches (FT) were detected by fluorescein fundus angiography (FFA).The visual acuity was ranged from light sensation to 0.5,with the average of 0.04±0.012.The A-Rct was ranged from 18.0 s to 35.0 s,with the mean of (29.7±5.8) s.The FT was ranged from 4.0 s to 16.0 s,with the mean of (12.9±2.3) s.All patients were treated with urokinase intravenous thrombolytic therapy.The dosage ofurokinase was 3000 U/kg,2 times/d,adding 250 ml of 0.9％ sodium chloride intravenous drip,2 times between 8-10 h,and continuous treatment of FFA after 5 days.Comparative analysis was performed on the visual acuity of the patients before and after treatment,and the changes of A-Rct and FT.Results After intravenous thrombolytic therapy,the A-Rct was ranged from 16.0 s to 34.0 s,with the mean of (22.4 ±5.5) s.Among 24 eyes,the A-Rct was 27.0-34.0 s in 4 eyes (16.67％),18.0-26.0 s in 11 eyes (45.83％);16.0-17.0 s in 9 eyes (37.50％).The FT was ranged from 2.4 s to 16.0 s,with the mean of (7.4± 2.6) s.Compared with before intravenous thrombolytic therapy,the A-Rct was shortened by 7.3 s and the FT was shortened by 5.5 s with the significant differences （x2=24.6,24.9;P＜0.01).After intravenous thrombolytic therapy,the visual acuity was ranged from light sensation to 0.6,with the average of 0.08 ± 0.011.There were 1 eye with vision of light perception (4.17％),8 eyes with hand movement/20 cm (33.33％),11 eyes with 0.02-0.05 (45.83％),2 eyes with 0.1-0.2 (8.33％),1 eye with 0.5 (4.17％) and 1 eye with 0.6 (4.17％).The visual acuity was improved in 19 eyes (79.17％).The difference of visual acuity before and after intravenous thrombolytic therapy was significant (x2=7.99,P＜0.05).There was no local and systemic adverse effects during and after treatment.Conclusion Intravenous thrombolytic therapy for CRAO with poor effect after the treatment of arterial thrombolytic therapy can further improve the circulation of retinal artery and visual acuity.

Objective To observe the clinical characteristics of ophthalmic and cerebral artery occlusion after facial cosmetic injection.Methods A retrospective case study. Twenty patients (20 eyes) with ophthalmic and cerebral artery occlusion in Department of Ophtalmology, The Fourth Hospital of Xi'an from February 2014 to December 2016 were enrolled in this study. There were 2 males (2 eyes) and 18 females (18 eyes). They aged from 21 to 41 years, with the mean age of 29.8±1.4 years. The disease courses was ranged from 3.5 hours to 21 days, with the mean of 40 hours. Facial cosmetic injections of all patients were performed at out-of-hospital beauty institutions. The visual impairment was associated with eyelid pain 1 to 10 minutes after injection.There were 12 right eyes and 8 left eyes.The injection materials, 18 patients were hyaluronic acid and 2 patients were autologous fat, respectively. At the injection site, 13 patients were sacral, 4 patients were nasal, and 3 patients were frontal. The concentration and dose of the injected filler were not known. All patients underwent vision, slit lamp microscope, fundus color photography, visual field, FFA, OCT, and brain CT, magnetic resonance angiography (MRA) examination.Results The visual acuity was ranged from no light perception to 1.0. Among the 20 eyes, 3 eyes (15％) were obstructed by simple ophthalmic artery; 5 eyes (25％) were obstructed by ophthalmic artery combined with cerebral artery; 7 eyes (35％) were obstructed by simple retinal artery occlusion (RAO) alone, which including central RAO (CRAO, 4 eyes), hemi-lateral artery obstruction (1 eye) and branch RAO (2 eyes); 1 eye (5％) was CRAO with ciliary artery branch obstruction; 1 eye (5％) was branch artery occlusion with ischemic optic neuropathy; 2 eyes (10％) were CRAO with nasal dorsal artery occlusion; 1 eye (5％) was CRAO, posterior ciliary artery obstruction and right middle cerebral artery occlusion. Among 20 patients, 4 patients (20％) had eye movement disorder and eyelid skin bun; 2 patients (10％) had facial pain and nasal skin ischemic necrosis. MRA revealed 6 patients (30％) of new intracranial ischemic lesions. Among them, 5 patients of hyaluronic acid injection showed asymptomatic small blood vessel embolization; 1 patient of autologous fat injection showed ophthalmary artery occlusion, cerebral artery occlusion, ipsilateral eye blindness, eye movement disorder and contralateral limb hemiplegia.Conclusion Facial cosmetic injection can cause severe iatrogenic complications such as RAO, ciliary artery occlusion, ischemic optic neuropathy, ophthalmic artery occlusion, and cerebral artery occlusion.

Objective:To evaluate the safety and long-term effect of total parathyroidectomy in patients with secondary hyperparathyroidism.Methods:One hundred fifty-four patients with secondary hyperparathyroidism who underwent total parathyroidectomy in Zhongshan Hospital,Dalian University from Mar 2012 to Mar 2018 were followed up for 3-9 years,including the level of iPTH, serum calcium and phosphorus and dosing of calcium supplement.Results:Among the 154 patients, the iPTH level in 149 patients fluctuated within 15-60 pg/ml. After oral calcium carbonate, the blood calcium fluctuated in 1.8-2.4 mg/ml, and serum phosphorus was 0.8-1.6 mg/ml. The level of iPTH in 5 patients was between 80-150 pg/ml, which was higher than the normal value 10-70 pg/ml. The clinical symptoms of all patients were significantly relieved.Conclusion:Total parathyroidectomy is safe and reliable in the treatment of secondary hyperparathyroidism with low recurrence rate and stable long-term effect.

Objective:To comparae the accuracy of imaging examination in preoperative parathyroid localization, and the safety and effect of total parathyroidectomy on secondary hyperparathyroidism complicated by chronic renal failure.Method:A total of 257 patients with secondary hyperparathyroidism who underwent total parathyroidectomy at the Department of General Surgery , Zhongshan Hospital, Dalian University from Mar 2012 to Mar 2022 were analyzed retrospectively.Result:Six hundred fourty parathyroid glands were found by color Doppler ultrasound and 954 parathyroid glands were by enhanced CT before the operation. Among them, the number of patients with accurate location of all 4 parathyroid glands by color Doppler ultrasound was 54, while that by enhanced CT was 216. The parathyroid detection rate by enhanced CT was significantly higher than that of color Doppler ultrasound ( χ2=325.480, P<0.001), and the accuracy rate was significantly higher tnan that of color ultrasound ( χ2=215.146, P<0.001). The average values of iPTH before operation, on the day after operation, on the 1st day and 7th day after operation were (1 880±890), (137±82), (66±46) and (34±23) pg/ml, respectively. The clinical symptoms of all patients were significantly relieved. Conclusions:Enhanced CT is superior to color Doppler ultrasound in the overall detection rate and individual localization accuracy of preoperative parathyroid localization. Total parathyroidectomy is safe and reliable in the treatment of secondary hyperparathyroidism complicated by chronic renal failure.

Objective:To observe the efficacy and safety of urokinase arterial thrombolysis in the treatment of central retinal artery occlusion (CRAO) at different time window.Methods:A retrospective study. From January 2014 to November 2019, 157 eyes (157 CRAO patients) in the Xi’an People's Hospital (Xi’an Fourth Hospital) were included in the study. There were 120 males and 37 females, with the average age of 54.87±12.12 years. The mean onset time was 65.66±67.44 h. All patients were tested with BCVA using international standard visual acuity chart, and the results were converted into logMAR visual acuity record. The arm-retinal circulation time (A-Rct) and the filling time (FT) of retinal arterial trunk-terminal filling time were measured by FFA. The mean logMAR BCVA was 2.44±0.46, the mean A-Rct and FT were 27.72±9.78 and 13.58±14.92 s respectively. According to the time window, the patients were divided into the onset 3-72 h group and the onset 73-240 h group, which were 115 patients and 42 patients respectively. There were no statistically significant difference between the 3-72 h group and the 73-240 h group in age, A-Rct and LogMR BCVA before treatment ( χ2=-0.197, -1.242, -8.990; P=0.844, 0.369, 0.369); the difference was statistically significant in FT comparison ( χ2=-3.652, P=0.000). Urokinase artery thrombolytic therapy was performed at different time window of 3-24 h, 25-72 h, 73-96 h, 97-120 h, 121-240 h after the onset of onset. Age and A-Rct of patients with different treatment time windows were compared, and the differences were not statistically significant ( χ2=6.588, 6.679; P=0.253, 0.246).In comparison of FT and logMAR BCVA, the difference was statistically significant ( χ2 =30.150, 71.378; P=0.000, 0.000). FFA was rechecked 24 hours after treatment, BCVA was rechecked 30 days after treatment. The changes of A-Rct, FT and BCVA before and after treatment were compared and analyzed. The occurrence of adverse reactions during and after treatment were observed. The two groups of measurement data were compared. The t test was used for those with normal distribution and χ2 test was used for those with non-normal distribution. Spearman correlation analysis was used to analyze the correlation between onset time and the difference of A-Rct, FT shortening time and logMAR BCVA after treatment. Results:At 24 h after CRAO treatment, A-Rct and FT of 157 cases were 19.64±6.50 and 6.48±7.36 s respectively, which were significantly shorter than those before treatment, and the differences were statistically significant ( χ2=-16.236, -14.703; P=0.000, 0.000). The logMAR BCVA at 30 d after treatment was 1.72±0.76, which was significantly higher than that before treatment. The difference was statistically significant ( χ2=-14.460, P=0.000). After CRAO urokinase arterial thrombolysis at different time window, there were statistically significant differences in A-Rct shortening time, FT shortening time, and logMAR BCVA difference ( χ2=12.408, 24.200, 104.388; P=0.030, 0.000, 0.000). There was no statistically significant difference between the 3-72 h group and the 73-240 h group ( χ2 =-1.042, P=0.297) in shortening time of A-Rct after treatment. The difference of FT shortening time was statistically significant ( χ2=-3.581, P=0.000). The difference of logMAR BCVA was statistically significant ( χ2=-9.905, P=0.000). The results of Spearman correlation analysis showed that there was no correlation between the onset time and the shortening time of A-Rct and FT after treatment ( rp=-0.040, -0.081; P=0.436, 0.115), and negative correlation with the logMAR BCVA difference ( rp=-0.486, P=0.000). One case of intracranial hemorrhage occurred after treatment, and it improved after dehydration to reduce cerebral edema, scavenging free radicals and brain protection. Conclusions:Urokinase arterial thrombolytic therapy is effective for CRAO within time window of 3-240 h, A-Rct, FT and LogMRA BCVA are all improved. However, with the prolongation of thrombolytic therapy time window, the therapeutic effect of urokinase arterial thrombolytic therapy is decreased. The therapeutic effect of Urokinase arterial thrombolytic therapy was better within 72 h.

Objective: To compare the clinical effects of urokinase thrombolytic therapy for optic artery occlusion (OAO) and retinal artery occlusion (RAO) caused by facial microinjection with hyaluronic acid and spontaneous RAO. Methods: From January 2014 to February 2018, 22 eyes of 22 patients with OAO and RAO caused by facial microinjection of hyaluronic acid who received treatment in Xi'an Fourth Hospital were enrolled in this retrospective study (hyaluronic acid group). Twenty-two eyes of 22 patients with spontaneous RAO were selected as the control group. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. FFA was used to measure arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT). Meanwhile, MRI examination was performed. There were significant differences in age and FT between the two groups (t=14.840, 3.263; P=0.000, 0.003). The differecens of logMAR visual acuity, onset time and A-Rct were not statistically significant between the two groups (t=0.461, 0.107, 1.101; P=0.647, 0.915, 0.277). All patients underwent urokinase thrombolysis after exclusion of thrombolytic therapy. Among the patients in the hyaluronic acid group and control group, there were 6 patients of retrograde ophthalmic thrombolysis via the superior pulchlear artery, 6 patients of retrograde ophthalmic thrombolysis via the internal carotid artery, and 10 patients of intravenous thrombolysis. FFA was reviewed 24 h after treatment, and A-Rct and FT were recorded. Visual acuity was reviewed 30 days after treatment. The occurrence of adverse reactions during and after treatment were observed. The changes of logMAR visual acuity, A-Rct and FT before and after treatment were compared between the two groups using ttest. Results: At 24 h after treatment, the A-Rct and FT of the hyaluronic acid group were 21.05±3.42 s and 5.05±2.52 s, which were significantly shorter than before treatment (t=4.569, 2.730; P=0.000, 0.000); the A-Rct and FT in the control group were 19.55±4.14 s and 2.55±0.91 s, which were significantly shorter than before treatment (t=4.114, 7.601; P=0.000, 0.000). There was no significant difference in A-Rct between the two groups at 24 h after treatment (t=1.311, P=0.197). The FT difference was statistically significant between the two groups at 24 h after treatment (t=4.382, P=0.000). There was no significant difference in the shortening time of A-Rct and FT between the two groups (t=0.330, 0.510; P=0.743, 0.613). At 30 days after treatment, the logMAR visual acuity in the hyaluronic acid group and the control group were 0.62±0.32 and 0.43±0.17, which were significantly higher than those before treatment (t=2.289, 5.169; P=0.029, 0.000). The difference of logMAR visual acuity between the two groups after treatment was statistically significant (t=2.872, P=0.008). The difference in logMAR visual acuity before and after treatment between the two groups was statistically significant (t=2.239, P=0.025). No ocular or systemic adverse reactions occurred during or after treatment in all patients. Conclusions Urokinase thrombolytic therapy for OAO and RAO caused by facial microinjection with hyaluronic acid and spontaneous RAO is safe and effective, with shortening A-Rct, FT and improving visual acuity. However, the improvement of visual acuity after treatment of OAO and RAO caused by facial microinjection with hyaluronic acid is worse than that of spontaneous RAO.