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Assessing dry weight accurately is crucial in providing effective and safe haemodialysis. Biases towards dry weight assessment may bring a series of dialysis complications. This study introduces an online detection technique of relative blood volume (RBV) based on ultrasound, which analyzes the correlation between changes in blood density and sound speed. By measuring the attenuation in sound velocity, this method was employed to calculate RBV, and then to evaluate the dry weight of patients on dialysis. TDC-GP2 time measurement chip and MSP430 Single-chip Microcontroller (SCM) were used in the system to measure the ultrasonic travel time. In the clinical trials, RBV values range between 71.3% and 108.1%, showing consistent result with Fresenius 4008S blood volume monitor (BVM). This detection method possesses several advantages, such as real time, convenient, reproducible, non-invasive, and etc.
Blood Volume ; Body Weight ; Humans ; Monitoring, Physiologic ; Renal Dialysis ; Ultrasonics

Objective To evaluate the feasibility, safety, and efficacy of Y-shaped jogged stent in patients with malignant hilar biliary obstruction. Methods During the period of January 2010 to June 2015,We retrospectively reviewed 98 cases of malignant hilar biliary obstruction who were received implantation of biliary tract stent. 17 consecutive patients who were treated with Y-shaped jogged stent were identified (group A) during January 2012 to June 2015. Group A was carefully matched according to patients' age, sex, type of tumor, stage, type of biliary obstruction, level of bilirubin at diagnosis, presence of metastasis and treatment, and 17 patients who were underwent unilateral stent placement alone with PTCD were chosen as control group (group B). Patients' baseline characteristics, stenting strategy, complications, stent patency time and survival rates were analyzed, and continuous variables of the two groups were compared using Student's t-test. Categorical variables were analyzed using the Fisher exact test. Results Y-shaped jogged stent implantation group and control groups were closely matched in terms of patients' age, sex, type of tumor, stage, type of biliary obstruction, level of bilirubin at diagnosis, presence of metastasis and treatment ( P>0.05). The bilirubin decreased rate in the two groups was 88.2%and 53.0%respectively (P<0.05). The median time of stent patency after stent implantation was(7.3 ± 1.0)months and(5.7 ± 0.9) months respectively (χ2=4.04,P=0.044), and the median survival time was(9.1 ± 1.5)months and(7.2 ± 1.1)months (χ2=4.60,P=0.032), with significant difference according to Kaplan-Meier analysis. There were no severe complications such as massive hemorrhage, perforation, biliary fistula and severe pancreatitis, which were associated with stent implantation. Conclusions The application of Y-shaped jogged stent is safe, feasible and effective in patients with malignant hilar biliary obstruction. It can relieve the clinical symptoms of biliary obstruction effectively with prolongation of stent patency time and survival rate significantly.

Objective To identify predictors of prescription initiation and persistence of warfarin in non-valvular atrial fibrillation ( NVAF ) patients with high risk of stroke ( CHA2 DS2-VASc≥2 ) . Methods NVAF patients consulted in our hospital from Aug , 2011 to Apr, 2015 were enrolled.Patients who underwent radiofrequency catheter ablation were excluded . Patients were divided into two groups (warfarin group and non-warfarin group).Logistic regression was used to estimate the predictors of initiation warfarin prescription.Kaplan-Meier survival and Cox proportional hazards model was performed to determine rate of warfarin persistence and its associated factors .Results A total of 622 AF patients were enrolled and 490 patients with CHA2DS2-VASc≥2.Ten patients lost follow up and 480 patients were followed up with a mean follow-up period of ( 40.0 ±11.55 ) months.Of which 245 NVAF patients ( 51%) had a warfarin prescription.Patients with ischemic stroke ( OR 2.447 , 95%CI 1.435-4.171 , P=0.001 ) , heart failure ( OR 2.009 , 95%CI 1.084-3.724 , P=0.027 ) and persistent AF ( OR 2.231 , 95%CI 1.448-3.437 , P=0.0001 ) had a higher likelihood of warfarin prescription .Anemia ( OR 0.479 , 95%CI 0.238-0.964 , P=0.039), concommitant Traditional Chinese Medicine (TCM) use (OR 0.638, 95%CI 0.456-0.891, P=0.008 ) and longer distance to hospital ( OR 0.759 , 95%CI 0.610-0.945 , P=0.014 ) decreased the likelihood of warfarin prescription . One hundred and seventy-six ( 71.8%) warfarin users continued persistent therapy and the overall proportion of warfarin persistence was 78.3% for one year , 71.0% for 3 years.Seventy-six existing warfarin users continued the warfarin therapy (80%, 76/95),one hundred new users showed persistence to therapy ( 66.7%, 100/150 ) .Warfarin use before enrollment significantly increased warfarin persistence than new prescription ( P =0.008 ) .Variables associated with higher discontinuation were new prescription ( HR 1.786 , 95% CI 1.029-3.100 , P=0.039 ) , TCM use ( HR 1.687 , 95%CI 1.201-2.37 , P=0.003 ) and longer distance to hospital ( HR 1.446 , 95% CI 1.121-1.865, P=0.005).Conclusions In anticoagulation clinic, concommitant TCM use, distance to hospital and other factors were associated with warfarin initiation prescription and persistence .Identifying factors associated with warfarin treatment could help in developing adherence of patients .

Objective To explore the CT features of renal epithelioid angiomyolipoma (EAML), and to improve the diagnosis of this disease.Methods The clinical materials and image findings of 15 cases (8 female, 7 male) with renal EAML proved by pathologies were retrospectively studied.Plain and enhancement CT scan were performed in all 15 patients.Nine of the 15 cases were correctly diagnosed and the other were misdiagnosed as renal cell carcinoma (RCC) (n=5), renal oncocytoma (n=1).Results There were some distinctive findings of EAML: (1) Little hypodense or iso-high-density, well defined, round lesion with diameter of 2 to 5 cm.(2) The tumor may involve the medulla of kidney or grow out without haematuria.(3) Most lesions showed obviously uniformity enhancement at artery phase, with a few of them showed inhomogeneous enhancement There were thickening and circuitous vessels in a few lesions.(4) Enhancement mode was quick-in and quick-out.Conclusions CT findings combined with clinical materials have important value in making a correct diagnosis of EAML preoperatively.

BACKGROUND: Currently, the widely used intervertebral disc degeneration models are induced by altering intervertebral disc biomechanics, damaging intervertebral disc structure or changing hereditary features with genetic technique. All these methods are vades from natural duration of intervertebral disc degeneration. OBJECTIVE: To evaluate the feasibility of the establishment of rabbit model of ischemic lumbar vertebrae adjacent to endplate by percutaneous puncture followed by pingyangmycin injection. METHODS: A total of 46 New Zealand white rabbits were selected and two vertebraes were divided as experimental group (L_5) and control group (L_4) in every rabbit. Vertebrae adjacent to endplate was punctured. Pingyangmycin (2 g/L) 1 mL was injected into rabbits in the experimental group. And 1 mL normal sodium was injected into the control group. Lumbar artery angiography was performed in 4 rabbits before operation. Six rabbits were randomly performed MRI and then were executed for vertebral histology at weeks 1,2, 3, 4, 5 and months 2, 3 after operation. Ischemic areas of L_5 were measured by the MRI and histological section at week 4 after operation. RESULTS AND CONCLUSION: MRI and histology of control group had not specific changes. MRI had not significant signal intensity changes in the first 2 weeks in the experimental group. At week 3 after operation, it demonstrated slightly hyperintense signal on T_2-weighted image (T_2WI) and fat-suppression T_2-weighted image (FS T_2WI), while fat-suppression T_1-weighted image (FS T_1WI) was hypointense signal. The signal changed more obviously at week 4. Histology of experimental group had not specific changes in the first 2 weeks. From weeks 3-4, bone trabecula arranged confusedly and disorderly, with gradually decreased osteocyte and marrow haemocytes, while adipocytes increased and coalesced. Cartilage corpuscle of endplate decreased and architecture became disorder. But the anulus fibrosus and nucleus pulposus had no obviously changes. The intervertebral disk of the experimental group degenerated at week 5, and the ischemia of lumbar vertebrae still existed and intervertebral disk degenerated more obviously at months 2-3 after operation. There was significant positive correlation of ischemic areas of experimental group between MRI and histology at week 4 (t-=0.965, P < 0.001). The rabbit model of ischemic lumbar vertebrae adjacent to endplate can be established successfully by peroutaneous puncture vertebrae adjacent to endplate followed by pingyangmycin injection. The operation is minimally invasive, simple and reproducible, with high success rate. This is a fairly ideal animal model to study the degeneration of the lumbar spine and intervertebral disc.

Objective To investigate CT findings of concealed rupture of intestine following abdominal trauma.Methods CT findings of 11 cases with concealed rupture of intestine following abdominal trauma proved by surgery were identified retrospectively.Results The main special signs included:(1)Free air in 4 cases,mainly around injured small bowel or under the diaphragnl,or in the retroperhoneal space or and in the lump.(2)High density hematoma between the intestines or in the bowel wall(4 cases).(3)Bowel wall injury sign,demonstrated as low density of the injured intestinal wall,anenuated locally but relatively enhanced in neiighbor wall on enhanced CT.(4)Lump around the injured bowel wall with obvious ring.shaped enhancement(4 cases).Other signs included:(1)Free fluid in the abdominal cavity or between the intestines with blurred borders.(2)Bowel obstruction.Conclusion CT is valuable in diagnosing concealed rupture of intestine following abdominal trauma.

BACKGROUND: Hip-preserving treatment is advocated in the treatment of early avascular necrosis of the femoral head.OBJECTIVE: To compare the clinical efficacy of simple core decompression and three-dimensional porous core decompression combined with autologous bone marrow transplantation on early avascular necrosis of the femoral head.METHODS: Thirty patients (39 hips) with early avascular necrosis of the femoral head at phase I-II according to the staging criteria of the Association Research Circulation Osseuse (ARCO) who had been admitted to the First Affiliated Hospital of Luzhou Medical University between March 2011 and May 2016 were surgically treated and followed up.Seventeen patients (22 hips, trial group) were treated with three-dimensional porous core decompression combined with autologous bone marrow transplantation, including 10 cases of ARCO stage I and 12 cases of ARCO stage II; the other 13 patients (17 hips, control group) were treated with simple core decompression, including 7 cases of ARCO stage I and 10 cases of ARCO stage II. Harris scores, X-ray and magnetic resonance imaging were used to evaluate the surgical efficacy at 1, 3, 6, 9, 12, 18, 24, 30, 36 months after the operation.RESULTS AND CONCLUSION: The incision healed primarily in all patients, and no infection occurred. The follow-up lasted for 1-3 years (average 2.5 years). At the last follow-up, the Harris scores in both trial group and control group were significantly improved compared with the baseline (P < 0.05); moreover, the Harris scores of ARCO stage I and II patients were significantly higher in the trial group than the control group (P < 0.05). Collapse of the femoral head was observed in one hip (stage I) and one hip (stage II) of the trial group, and in three hips (stage I) and five hips (stage II) of the control group, and then hip arthroplasty was performed. The number of the patients developing collapse of the femoral head in the trial group was significantly less than that in the control group (P < 0.05). Compared with simple core decompression, three-dimensional porous core decompression combined with autologous bone marrow transplantation is more adept to improve patient's function and delay disease progression in the treatment of ARCO stage I and II early avascular necrosis of the femoral head.

BACKGROUND:Considering the risk of lack of bone in revision and the bone coverage of component,it is advisable to use bone grafting to increase bone stock in patients with adult Crowe type Ⅲ developmental dysplasia of the hip (DDH) in the first total hip arthroplasty (THA).OBJECTIVE:To investigate the effectiveness of impaction bone grafting with morselized bone and bone paste for acetabular defects of adult Crowe type Ⅲ DDH in THA.METHODS:Forty cases (45 hips) of Crowe type Ⅲ DDH were enrolled,including 8 males and 32 females,aged 31-68 years.All the components were reconstructed at the anatomic acetabulum combined with deepening acetabulum and putting the centre of rotation medially and distally during THA procedures.The patients were all followed up and evaluated with Harris score,limp length,displacement of the centre of rotation,cup coverage,and postoperative complications.RESULTS AND CONCLUSION:The average follow-up was 32.7 months.Acetabular rotation centers of all the cases were recovered (near) to normal.The incisions healed by first intention and there was no complication such as infection,dislocation,prosthesis loosening.The acetabular cup prosthesis did not displace and was covered well by bone at the last follow-up,the grafted bone particles got radiological osseointegration and the bone sclerosis zone disappeared.No radiolucent lines and screw fracture were detected.The Harris scores of affected hips at the last follow-up were significantly higher than those before surgery(P=0).The average leg length was increased (2.31 ±0.18) cm.The mean cup coverage was 78.1％.The postoperative horizontal and vertical distance of the hip center were shorter than those before surgery (P=0).Reconstructing the acetabulum with autogenous morselized bone graft impaction can effectively restore the acetabular coverage,maintain the stability of acetabular cup and provide better relative bone stock in THA for Crowe type Ⅲ DDH in adult,and moreover,the short-term effect is satisfactory.

BACKGROUND:Legacy posterior stabilized prosthesis has advantages in theoretic design,in vitro kinematics and abrasion, but it remains unclear whether its clinical outcomes for vaglus knee deformity are better than Legacy constrained condylar knee prosthesis. OBJECTIVE:To explore the midterm folow-up effect of Legacy posterior stabilized prosthesis in total knee arthroplasty in patients with valgus knee deformity. METHODS: From February 2006 to November 2013 in Department of Bone and Joint Surgery, Affiliated Hospital of Luzhou Medical Colege, total knee arthroplasty was used to treat valgus knee deformity in 33 cases (35 knees). Parapatelar medial approach was used. Precise osteotomy was utilized to correct limb alignment. Lateral soft tissue received selective release. Finaly, an equal type of Legacy posterior stabilized prosthesis (Zimmer, USA) was implanted and fixed with antibiotic bone cement. The differences in hospital for special surgery knee score, range of motion of knee, femoral tibial angle, and maximum flexion and extension angle, as wel as X-ray film results were compared and analyzed before and after replacement. The complications including deep vein thrombosis, peri-prosthetic infection, patelar clicking, unstable knee, and common peroneal nerve injury were recorded after surgery. RESULTS AND CONCLUSION: Al patients were folowed up for 24-50 months. The incision was healed in one-stage. No complications such as peri-prosthetic infection appeared. Three patients suffered from common peroneal nerve palsy, which was cured at half a year after surgery by expectant treatment such as trophic nerve. Two cases suffered from knee instability after replacement, which was improved at 1 month after external fixation with a brace. One case experienced deep vein thrombosis in the lower extremity, which was improved after treatment with low molecular weight heparin anticoagulation. During final folow-up, hospital for special surgery knee score increased from (51.85±4.15) preoperatively to (85.77±2.50) postoperatively (P < 0.01). There were excelent in 20 knees, good in 11 knees, with an excelent and good rate of 89%. X-ray films showed that hindlimb alignment was apparently corrected, prosthetic position was good, no loosening occurred. These data indicate that total knee arthroplasty, using parapatelar medial approach, obtained good correction outcomes through the accurate amputation to correct hindlimb alignment and selective release of the soft tissue with Legacy posterior stabilized prosthesis in the treatment of valgus knee deformity.