Objective To learn the effect of breast removal of polyacrylamide hydrogel by areola incision;and to provide an effective method for removal of polyacrylamide hydrogel.Methods According to the accepted operation,45 cases with breast polyacrylamide hydrogel were divided into 25 cases of observation group and 20 cases of control group.The observation group was treated with areola medial semicircular incision breast removal of polyac-rylamide hydrogel,and the control group was treated with areola small incision suction to remove polyacrylamide hydrogel.The operative time,intraoperative blood loss,postoperative drainage tube extraction time,postoperative 7d breast shape and perioperative complications of the two groups were observed;postoperative follow -up was performed to evaluate the effect of surgery.Results The operation time of the observation group (190.2 ±36.1)min was longer than (119.5 ±44.0)min of the control group,the difference was statistically significant between the two groups (t =5.924,P <0.05);the intraoperative blood loss of the observation group (250.4 ±23.9)mL was higher than (89.7 ± 30.4)mL of the control group,the difference was statistically significant (t =19.865,P <0.05 ).The difference between postoperative 7d breast normal morphology rates of the two groups was not statistically significant (χ2 =2.571,P >0.05);the postoperative drainage tube extraction time of the observation group (3.7 ±0.5)d was more than (2.3 ±0.3)d of the control group,the difference was statistically significant (t =11.021,P <0.05 ).The complication rate of the observation group was 12.0%(3 /25),which of the control group was 10.0%(2 /20),the difference was not statistically significant (χ2 =0.045,P >0.05).All cases of the two groups were followed up;the mean follow -up time was (6.7 ±2.1)months.The good rate of surgery of the observation group was 92.0 % (23 /25),which of the control group was 70.0%(14 /20),the observation group was higher than the control group (χ2 =5.718,P <0.05).Conclusion For patients with complications after polyacrylamide hydrogel injection for augmentation mammoplasty;the breast polyacrylamide hydrogel removal surgery by areola medial semicircular incision is recommen-ded as the preferred.

ObjectiveTo explore the diagnostic and predictive value of troponin Ⅰ,lactic acid and hypersensitive C-reactive protein(hs-CRP) in viral myocarditis.MethodsTroponin Ⅰ,hs-CRP,lactic acid blood levels in different time were measured in 88 patients with acute viral myocarditis(54 cases) or acute upper respiratory infections (34 cases).Troponin Ⅰ leyel in patients with severe 39 cases and mild VMC 15 cases were compared.ResultsTroponin Ⅰ level of VMC group was (0.59 ±0.10) ng/L,and significantly higher than that of acute upper respiratory infection group [ (0.10 ± 0.08 ) ng/L ] ( t =2.79,P ＜ 0.05 ).And higher lactic acid and hs-CRP level were observed at different period ( t =2.71,2.48,all P ＜ 0.05).ConclusionTroponin I could help diagnose VMC predict the severity of myocarditis to some extent.Lactic acid and hs-CRP could also reflect imflammation injury of VMC.

Objective To explore the relation of fat cells factor and insulin resistance in type 2 diabetes.Methods 60 patients were divided into obesity group, non-obese group and normal control group.To detect the FINs, FPG, TG, TC, LDL,HDL,APN,CTRP3,leptin and TNF-α, according to the formula of HOMA,to analyze the correlation between indicators.Results 1).Compared with normal control group, DM group significantly decrease serum APN, CTRP3 level, compared with non-obesity group, obesity group APN, CTRP3 level significantly decreased(P<0.05 or P<0.01).The leptin level elevated (P<0.05).2)APN concentration and age, BMI, FPG, TG, TC, LDL, FINs, HOMA-IR has negative correlation;CTRP3 andFPG,FINs, HOMA-negative correlation IR(P<0.05), TG was positively correlated (P<0.05);TNF-α and FPG and positively correlated (P< 0.05).Conclusions T2DM patients` serum APN, CTRP3 and high Leptin levels are closely associated with obesity, HOMA-IR, FPG and TG as an independent factor can be used as a new sensitive index of evaluating the degree of insulin resistance.

Objective To evaluate the diagnostic value of cardiac magnetic resonance(CMR)in patients with severe connective tissue disease-associated pulmonary hypertension(CTD-PAH).Methods A total of 48 patients diagnosed with CTD-PAH by right heart catheterization(RHC)in Tianjin Medical University General Hospital from June 2018 to July 2021 were retrospectively included.The parameters of right ventricular(RV)morphology,function and ventricular septum(IVS)were obtained by manual delineation on CMR images and corrected by body surface area.The late gadolinium enhancement(LGE)myocardial mass(MM)and its percentage in left ventricular(LV)MM were manually sketched and calculated on LGE images.The patients were divided into the mild-moderate group and the severe group according to mean pulmonary arterial pressure(mPAP).CMR parameters were compared between the two groups.The diagnostic value of CMR for severe CTD-PAH was analyzed by receiver operating characteristic(ROC)curve.Results A total of 48 patients with CTD-PAH were included in this study.The curvature of interventricular septum(CIVS)and RV ejection fraction(EF)were lower in the severe group than those in the mild-moderate group,and the time proportion of IVS deformation,RV end-diastolic volume index(EDVI),RV end-systolic volume index(ESVI)and RV MM were higher than those in the mild-moderate group(P＜0.05).ROC curve analysis showed that RV MM,time proportion of IVS deformation and RV ESVI had better diagnostic efficacy in severe CTD-PAH patients(AUC was 0.792,0.766 and 0.731,respectively).The combined AUC of the three parameters was 0.840,specificity was 85.7%and sensitivity was 79.4%.Conclusion The parameters of RV and IVS measured by CMR can effectively evaluate patients with severe CTD-PAH and directly reflect serverity of cardiac impairment in patients with severe CTD-PAH from the morphological and functional perspective.

Objective To investigate the clinical characteristics and risk factors of mixed connective tissue disease associated with pulmonary arterial hypertension(MCTD-PAH).Methods Twelve MCTD-PAH patients diagnosed by right heart catheterization(RHC)at Tianjin Medical University General Hospital were retrospectively included,and 36 MCTD patients without pulmonary arterial hypertension(MCTD-non-PAH)were randomly selected from the same period of hospitalization based on gender and age.The clinical features and auxiliary examination of the two groups were compared,and the survival status of the two groups was compared.Results The proportion of dyspnea after activity,myositis and pericardial effusion were higher in the MCTD-PAH group than those of the control group.Serum sedimentation rate and immunoglobulin G(IgG)levels were higher in the MCTD-PAH group.Multivariate Logistic regression analysis showed that dyspnea after activity and high level of IgG were risk factors for predicting the occurrence of PAH in MCTD.Three patients(16.7%)died in the MCTD-PAH group,and no patients died in the control group.Conclusion Pulmonary arterial hypertension is one of the serious complications of MCTD.MCTD patients have shortness of breath after activity and high level of IgG should be wary of concomitant PAH.

Objective:To retrospectively assess the occurrence and risk factors in patients with acute gastrointestinal injury (AGI) after polytrauma.Methods:Totally 430 patients with polytrauma admitted to Tongji Hospital from April 2018 to October 2019 were enrolled as the observation group. According to the diagnostic criteria of AGI, all patients were divided into the AGI group (with AGI) or N-AGI group (without AGI). The patients with abdominal injury or previously suffered from gastrointestinal disease were excluded. The patient's clinical characteristics lab tests results, and the first ISS, APACHEⅡ, SOFA and GCS scores were collected. The differences between different groups were statistically analyzed. The independent risk factors of AGI were analyzed by Logistic regression.Results:65.3% of patients with polytrauma were accompanied by AGI (281/430 cases).There were significant differences between the AGI group and N-AGI group in ISS, GCS, APACHE Ⅱ and SOFA score, PCT or IL-6 level, shock index and length of stay in ICU ( P<0.05). Logistic regression analysis showed that shock, ISS≥16, APACHE Ⅱ≥16, SOFA≥5, GCS≤8 and IL-6>50 pg/mL were the early independent risk factors in patients with ACI after polytrauma. Conclusion:The incidence of AGI in patients after polytrauma is higher, which is related to ischemia, hypoxia, abnormal blood coagulation and stress in the early stage after trauma.

OBJECTIVE: To review the development of adult and pediatric liver transplantation in Tianjin First Center Hospital, and to enhance academic exchanges, improve technological innovation, and jointly promote the progress and maturity in the field of liver transplantation. METHODS: The development of liver transplantation in Tianjin First Center Hospital was analyzed. The clinical data of adult and pediatric liver transplantation from September 1998 to September 2018 were collected. The important events and technological innovation achievements of liver transplantation during the 20 years were summarized. RESULTS: The first clinical liver transplantation was attempted in Tianjin First Central Hospital in April 1980. The first long-term survival adult liver transplantation in China was completed in 1994 (11 years survival after the operation). The specialized team of liver transplantation was formally established in September 1998. The 20-year clinical exploration and progress reflected the characteristics of era changes and technological innovation during the rapid development of liver transplantation in China. Our center performed liver re-transplantation in January 1999, reduced-size pediatric liver transplantation in August 2000. In May 2001, we organized the formulation for the preventive and treatment plan for hepatitis B recurrence after liver transplantation. We performed combined liver and kidney transplantation in July 2002, split liver transplantation (SLT) in April 2004, the first domino liver transplantation (DLT) in August 2005. Pediatric living donor liver transplantation (LDLT) was initiated in October 2006, adult LDLT was carried out in August 2007. In September 2007, the first living donor combined liver and kidney transplantation from the same donor in Asia was performed. The first domino+living donor double grafts liver transplantation in the world was performed in January 2009. In March 2011, we performed laparoscopically assisted right hepatic lobe liver transplantation (LDLT) with middle hepatic vein. In May 2014, living donor laparoscopic left lateral lobe procurement was successfully established. In April 2016, simultaneous liver, pancreas and kidney multi-organ transplantation was completed. Domino donor-auxiliary liver transplantation was performed in February 2017. In December 2017, extracorporeal membrane oxygenation (ECMO)-supported liver transplantation in a patient with severe pulmonary hypertension was successfully completed. Liver transplantation combined with partial splenectomy was established in April 2018. Cross-domino liver transplantation (hypersensitive kidney transplantation with auxiliary liver transplantation+pediatric liver transplantation) was performed in May 2018. During the 20 years, the team has performed or assisted other centers in Beijing, Shanghai, Guangzhou and Shenzhen to carry out more than 10 000 cases of liver transplantations. A total of 7 043 cases of various types of liver transplantation were performed in the single center of the hospital (6 005 adult liver transplantations and 1 038 pediatric liver transplantations). Concerning adult liver transplantation, the cumulative 1-year, 3-year and 5-year survival rate from September 1998 to March 2003 were 83.1%, 73.0% and 69.0%, from April 2003 to March 2009 were 85.3%, 76.2% and 72.1% and from April 2009 to September 2018 were 87.5%, 79.2% and 75.1%, respectively. The cumulative 1-year, 3-year and 5-year survival rate for pediatric liver transplantation were 93.5%, 92.2% and 90.2%, respectively. The nucleoside (acid) analogue combined with low dose hepatitis B immunoglobulin (HBIG) was developed to prevent the recurrence of hepatitis B after liver transplantation, this plan has reduced the recurrence rate of hepatitis B and the 5-year re-infection rate of hepatitis B virus (HBV) after liver transplantation significantly. The risk assessment system for tumor recurrence after liver transplantation was established and individual treatment method was established based on this assessment system. Continuous exploration and improvement of liver transplantation for liver cancer, liver re-transplantation, liver transplantation with portal vein thrombosis, SLT, DLT and multi-organ combined transplantation have significantly improved the clinical efficacy of patients and the post-operative survival rate. CONCLUSIONS The liver transplantation team of Tianjin First Center Hospital has carried out a scientific and technological exploration on the key problems and technical difficulties of clinical liver transplantation. This work strongly has initiated and promoted the rapid development of liver transplantation in China. The restrictive barrier of hepatitis B recurrence after liver transplantation has been overcome. The risk prevention and control system of tumor recurrence after liver transplantation has been established. A series of innovative achievements that can be popularized have been achieved in the field of complex liver transplantation and expansion of donor liver source. The iterative progress and sustainable development of liver transplantation have been realized.
China ; Humans ; Liver Transplantation