Objective: To analyze the differences of two anchorage ty pe s in closing the space following tooth extraction in maxilla. Methods:By using Spiral CT scanning, image processing and CAD technology, a three -dimensional finite element model of maxilla which could simulate the closing o f space following the extraction of maxillary first bicuspid was established. Ba sed on the model, two loading models were developed, which contained palatal imp lant and transpalatal arch respectively to reinforce the anchorage of molar. Th e two anchorage types were compared and the finite element analysis of closing t he space was performed.Results: The displacement(mm) of the firs t permanent molar in X, Y and Z direction in the model with palatal impl ant was -0.001 162 4,-0.000 901 9 and 0.000 196 2, that in the model with transp alatal arch -0.001 163 7,-0.000 902 2 and 0.000 196 4, respectively(P

Objective To evaluate the efficacy and adverse effects of thalidomide plus melphalan and VAD regimen in the treatment of multiple myeloma(MM). Methods 24 patients in the treatment group were treated with thalidomide plus melphalan and VAD regimen. Two continuous treatment were considered valuable. Observational content included results of serum myeloma protein; liver and renal function; protein-uria of 24-hours; bone marrow and peripheral blood and soon. The side reactions were recorded. The clinical efficacy evaluation was divided into complete response(CR), partial respouse(PR), none response(NR). Results 13 cases in the treatment group achieved CR, 6 cases achieved PR, 5 cases no change, 19 cases achieved overall response. Conclusion The prominent clinical efficacy was achieved with thalidomide plus melphalan and VAD regimen in multiple myeloma. The clinical manifestation was improved significantly.

Objective To explore the indexes change of coagulation and fibrinolysis in APL with ATRA and As2O3.Methods Treatment group 18 eases were undeaaked ATRA 20-30 mg/d until relieved completely.0.1%arsenic trioxide 10 ml with 5%glucose 500 ml for 28 days.Normal control 10 cases were undertaked ATRA 45～60 mg/d until relieved completely.Results The CR rate of treatment group was higher than control group(P＜0.05),the patients of control group showed different reactions such as thirsty mouth,rationale acid syndrome.2 cases reacted strongly and the treatment had to be interrupted,the patients of treatment group had little reaction,but liver function were badly hurt and liver-protection treatment was needed.Fbg,D-dimer recovery time is 7 days,21 days in treatment group,14 days,21 days in control group.Conclusion CR rate is high and has little side effect,and indexes change of coagulation and fibrinolysis were recovered quickly,it has great significance to take D-dimer as early diagnose and observe the indexes change during the treatment.

Objective To investigate the clinical efficacy and safety of high-frequency electric snare for the treatment of main airway neoplasm through bronchoscopy. Methods The clinical datas of 18 patients from July 2013 to April 2016, who had main airway neoplasm and were treated with high-frequency electric snare through bronchoscopy, were retrospectively analyzed. Meanwhile, the interventional bronchoscopic techniques partly included argon plasma coagulation and cryoablation. After operarion, the relief of symptoms and complications were observed. Results After operarion, the clinical symptoms, shortness of breath, dyspnea index score and the degree of airway stenosis were improved significantly. No serious complications such as massive hemoptysis occurred in all patients. Conclusion High-frequency electric snare is an effective and safe approach for the treatment of main airway neoplasm.

Objective:To investigate the feasibility of using anastomotic stoma as a long-term vascular access to maintain hemodialysis in patients who cannot establish an effective vascular access after ACUSEAL graft occlusion.Methods:A rare case of brachial artery-right atrium ACUSEAL artificial blood vessel fistula bypass to establish vascular access occlusion, the use of artificial blood vessel anastomosis stoma to establish buttonhole puncture as a long-term vascular access and the corresponding nursing methods.Results:At present, the patients were treated with regular dialysis for 32 months and blunt needle puncture for 23 months.Conclusions:Brachial artery-right atrium ACUSEAL graft is a rare vascular access surgery. As a new type of access with depleted autologous vascular resources, the efficacy is not certain. Because it is different from the traditional vascular prosthesis surgery, once the thrombotic occlusion of the graft fails, the risk and difficulty of reopening by interventional or surgical methods are great. Therefore, it is a challenging and reasonable method to use the limited residual cavity of the anastomosis as a long-term vascular access after occlusion to prolong the service life of the graft.

Objective To explore the clinical efficacy and safety of hyper-early embolotherapy in treatment of intracranial ruptured aneurysm.Methods A retrospective analysis was made on 33 patients with intracranial ruptured aneurysm.Preoperative Hunt-Hess grade:grade Ⅰ-Ⅱ in 16 patients,gradeⅢin 5 patients,grade Ⅳ in 9 patients,grade Ⅴ in 3 patients.All patients were confirmed with subarachnoid hemorrhage (SAH) by angiography and then underwent embolization under general anesthesia by detachable coils within 6 h from onset.Results After operation,25 patients (75.8％) recovered well,4 patients (12.1％) were with mild disability with paralysis and aphasia,4 patients (12.1％) were dead (1 patient for intraoperative aneurysm rupture,1 patient for postoperative pneumonia,1 patient for infection of hematoma at puncture site and 1 patient for postoperative gastrointestinal bleeding).Followed up 1-6 months,no rebleeding occurred.Conclusions Hyper-early embolotherapy could avoid rebleeding of the aneurysm,and relieve the vasespasm,without increasing the intra-operative rebleeding rate.Moreover hyper-early embolotherapy could greatly decrease the mortality of poor-grade SAH patients.

OBJECTIVETo evaluate the efficacy and safety of mechanical thrombectomy with the Solitaire AB device in recanalization of patients with acute ischemic stroke of posterior circulation.

METHODSThe clinical data of 17 consecutive patients with acute ischemic stroke of posterior circulation, treated with the Solitaire AB device from August 2011 to August 2015 in Department of Neurosurgery, the Military General Hospital of Beijing People's Liberation Army, were extracted and then retrospectively analyzed. There were 12 male and 5 female patients with a median age of 60 years (ranging from 44 to 75 years). Among them, 8 cases occluded in basilar artery, 4 cases occluded in vertebral artery and 5 cases occluded in vertebral plus basilar artery. Recanalization rate as well as complications after treatment were analysized. Also, neurological functions of the patients before and after treatment, measured by National Institute of Health stroke scale (NIHSS) score, were compared via t test and the clinical outcomes were assessed by modified Rankin score (mRS) at 90 days after treatment.

RESULTSFifteen patients resulted in successfully recanalization, and 2 cases failed both of whose onset to sheath time were above 7.5 hours. The NIHSS score at 7 days was 11±10, which was significantly decreased compared to the admission NIHSS score 17±5 (t=2.949, P=0.009). No symptomatic intracranial hemorrhage case was found after thrombectomy. At 90 days, one patient died(mRS 6), one patient seriously disabled (mRS 5), two patients moderately seriously disabled (mRS 4), four patients resulted in moderate outcome (mRS 3) and the other 9 patients achieved good outcome (mRS 0 to 2). The dead and seriously disabled cases were both due to failure in recanalization. Two moderately seriously disabled cases were probably attributed to their severe admission condition (NIHSS >20) and prolonged time (onset to sheath time >6 hours).

CONCLUSIONMechanical thrombectomy with the Solitaire AB device contributes to a high rate of recanalization with a low probability of complication and improves functional outcome in patients with acute ischemic stroke of posterior circulation.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Stroke ; surgery ; Thrombectomy ; Treatment Outcome

Objective:Exploration of epidermal growth factor receptor (EGFR) expression and its clinical significance in pancreatic adenosquamous carcinoma (PASC).Methods:A total of 60 pancreatic cancer tissue samples and 8 normal pancreatic tissue samples were obtained from patients who were surgically treated at Beijing Chao-Yang Hospital, Capital Medical University from January 2016 to December 2021. A retrospective analysis of the clinical and pathological data of these 60 patients was conducted, including 23 males and 37 females with an age of (62.7±10.2) years. Among them, 20 cases were pathologically diagnosed as PASC, and 40 contemporaneous cases of pancreatic ductal adenocarcinoma (PDAC) were selected through propensity score matching. Immunohistochemistry (IHC) staining was used to measure the integrated optical density (IOD) of EGFR expression, and quantitative polymerase chain reaction (qPCR) was employed to detect the expression differences of EGFR mRNA. Based on the median IOD value of EGFR, the 20 PASC samples were divided into two groups, high and low expression groups. Kaplan-Meier survival analysis was performed to compare the impact of EGFR expression on the prognosis of PASC patients.Results:The IOD value of EGFR in PASC group (29.2 [25.7, 35.1]) was significantly higher than that in the PDAC group [9.5 (5.5, 13.0)] and they both exceeded the value in normal tissues [2.4 (1.7, 3.1)], with statistical significances ( all P<0.001 ). The level of EGFR mRNA expression in the PASC group was higher than that in the PDAC group [3.0 (1.8, 3.5) vs 1.2 (0.8, 1.2)], showing statistically significant difference ( P=0.0079). Patients with high EGFR expression had shorter overall survival compared with patients with low expression ( P=0.002). The incidence of vascular invasion in the PASC group [40.0% (8/20)] was higher than that in the PDAC group [17.5% (7/40)], with a significant difference ( P=0.002). The median survival time for the PASC group was 16.00 (9.25, 25.25) months, which was shorter than that of the PDAC group 21.50 (11.25, 40.75) months, showing a statistically significant difference ( P=0.033). The overall survival rate of the PASC group was lower than PDAC group ( P=0.028). Conclusion:EGFR expression is significantly elevated in PASC tissues and PASC patients have poor prognosis.

Objective To investigate the application of percutaneous transluminal balloon dilatation (PTA) in catheter replacement within patients with catheter-related central vein disease (CVD). Methods Thirteen cases of CVD patients from Jan 2015 to Mar 2018 admitted into the First Affiliated Hospital of Zhejiang University were retrospectively analyzed. All of them underwent digital subtraction angiography (DSA) to clarify problem origin. Suitable balloons were chosen to dilate the original catheters or the occlusive veins, and then the original catheters were replaced. PTA was used to help catheter replacement and all patients were followed up for 6 months. Results Four of the 13 patients were found stuck when replacing catheters. All of them successfully had catheters removed with PTA (Hong's techniques). All patients had successfully catheter replacement with blood flow volume>250 ml/min. Among 4 patients with edema, 3 patients showed better within 6 months. Only 3 patients needed warfarin to keep blood flow volume>250 ml/min within 6 months. Conclusions PTA shows advantages of lesser trauma, better tolerance and higher success rate in patients with catheter-related CVD. It can also relieve symptoms resulting from occlusive central vein.

Objective:To investigate the emergency treatment and clinical effect when the guidewire stuck in the right atrium during central vein catheter placement for hemodialysis.Methods:Five cases with guidewire stuck in the right atrium during central vein catheter placement for hemodialysis from January 2011 to July 2018 admitted into the First Affiliated Hospital of Zhejiang University were retrospectively analyzed. In two cases, the guidewires were found completely stuck when the insert depth was about 20 cm. The guidewires were not able to move forward nor backward. In the other three cases, the guidewires could be moved forward but not backward with the insert depth at about 18 cm. All patients received emergent computed tomography angiography (CTA) or digital subtraction angiography (DSA) imaging. Images showed that the guidewires were stuck in the right atrium near the ventricular valve. The guidewire core drawing method, the multipurpose angiography(MPA) catheter capturing method and the manual guidewire adjusting method were used for emergent treatment.Results:One patient with completely stuck guidewire was successfully treated with guidewire core drawing method and the temporary central vein catheter catheterization through the internal jugular vein was performed under DSA. In a completely stuck case and a retrogradely stuck case, the J-shaped ends of the warped guidewires were captured into the MPA catheter, and the guidewires were then withdrawn from right atriums along with the contrast catheter. In the other 2 retrogradely stuck cases, under DSA, the guidewires were repeatedly pushed, the direction of J-shaped ends was manually adjusted, and then the guidewires were repeatedly pushed and pulled until catheters can be pulled out of the right atriums. The later 4 cases had permanent central vein catheter placement with the same guidewire after the stuck guidewires were withdrawn from the right atrium and readjusted.Conclusions:All three methods can successfully solve the emergent situation of the stuck guidewire in the right atrium. For patients with completely stuck guidewires, the MPA catheter capturing method can be simpler, safer, and more effective.