Purpose:Thalamic hemorrhage breaking into ventricles (THBIV) is a devastating disease with high morbidity and mortality rates.Endoscopic surgery (ES) may improve outcomes,although there is no consensus on its superiority.We investigated the efficacy and safety of ES and compared the outcomes of different management strategies by ES,hematoma puncture and drainage (HPD),and external ventricular drainage (EVD) in patients with THBIV.Methods:We retrospectively analyzed patients with THBIV treated by ES,HPD,or EVD at our hospital from June 2015 to June 2018.Patients were categorized into anteromedial and posterolateral groups based on THBIV location,and then the two groups were further divided into ES,HPD,and EVD subgroups.Individualized surgical approach was adopted according to the location of the hematoma in the ES subgroups.Patient characteristics and surgical outcomes were investigated.Results:We analyzed 211 consecutive patients.There were no significant differences in clinical characteristics or incidence of perioperative procedure-related complications (postoperative rebleeding and intracranial infection) in either anteromedial or posterolateral groups.Compared with other therapeutic methods,the ES subgroups had the highest hematoma evacuation rate,shortest drainage time,and lowest incidence of chronic ventricular dilatation (all p ＜ 0.05).Among the three anteromedial subgroups,ES subgroup had the best clinical outcomes which was assessed by the modified Rankin Scale,followed by HPD and EVD subgroups (p ＜ 0.01);while in the posterolateral subgroups,clinical outcomes in the ES and HPD subgroups were similar and better than that in the EVD subgroup (p =0.037).Conclusion:Individualized surgical ES approach for removal of thalamic and ventricular hematomas is a minimally invasive,safe,and effective strategy for the treatment of THBIV with a thalamic hematoma volume of 10-30 mL.

Objective To discuss how to protect the intracranial vertebral artery and posterior inferior cerebellar artery by observing and measuring the intracranial vertebral artery in the surgery adopt far lateral approach. Methods Mimicking far lateral approach, 20 adult cadaveric heads connected to neck fixed with 10% formalin were dissected. Intracranial segment of the vertebral arteries and their main branches were exposed and measured under operating microscope. Results The intracranial vertebral artery joined with the contralateral one into the basilar artery after traveling through the atlanto-occipital sulcus. The relationship between the vertebral artery and the hypoglossal nerve is close. Thirty sides (75%) of the vertebral arteries traveled to pons medulla sulcus in front of the hypoglossal nerve roots and 2 sides (5%) behind the hypoglossal nerve roots, while 8 sides (20%) traveled among the hypoglossal nerve roots; 70% of the vertebral arteries were contacted to the hypoglossal nerve roots, 30% of which compressed the hypoglossal nerve. The main branches of intracranial segment of the vertebral arteries were the posterior inferior cerebellar arteries, the anterior spinal arteries, the posterior meningeal arteries,and some perforating arteries. Posterior inferior cerebellar arteries all originated from the intracranial vertebral artery were the largest vertebral artery's branches; their trip was mostly loop-shaped and they had close relationship with Ⅸ, Ⅹ, Ⅺ cranial nerves. The starting points of the posterior inferior cerebellar arteries were different, even in the same specimen, but most of them originated from the upper 1/3intracranial vertebral artery. No anterior inferior cerebellar artery was noted originated from the vertebral artery in our specimen. Anterior spinal arteries originated from the vertebral arteries joined with the branches of the bilateral vertebral arteries and traveled down through the tortuous anterior median fissure to supply the spinal cord. Conclusion Being familiar with the characteristics and anatomic vertebral arteries variations of the intracranial vertebral artery and its branches can contribute to identify and protect the intracranial segment of the vertebral artery and its main branches in the surgery adopt far-lateral approach.

OBJECTIVETo observe the different mRNA levels of Candida albicans ALS gene family between planktonic and biofilm-grown cells.

METHODSATCC 90038 and a wild strain of Candida albicans, biofilm models in vitro were formed on glass slides. After 48 hours' incubation, the biofilm-grown cells were harvested. Half-quantification of ALS1 and ALS4 mRNA was based on the amplification by one-step RT-PCR.

RESULTSThe amounts of ALS1 and ALS4 mRNA of the wild strain in biofilm increased comparing with planktonic cells, while ATCC 90038 didn't.

CONCLUSIONThe members of ALS gene family may play important roles in the course of Candida albicans biofilm formation.

Biofilms ; Candida albicans ; Fungal Proteins ; Humans ; Mouth ; microbiology ; RNA, Messenger

In recent 10 years, using radiofrequency catheter ablation, our medical center has treated 4865 cases of paroxysmal supraventricular tachycardia (PSVT). To improve clinical practice, a retrospective analysis of this group was made. In this group, 2092 cases were atrioventricular reentry tachycardia (AVRT), including 1415 left accesory pathway and 677 right accesory pathway, and 2773 cases were atrioventricular nodal reentry tachycardia (AVNRT). The total success rate of radiofrequency treatment is 99.71%; the recurrence rate after half a year 1.73%; the total complication rate 1.25%. In conclusion, radiofrequency ablation is a safe and effective treatment for tachycardia with high rate of success and low rate of complication.
Adult ; Catheter Ablation ; Female ; Humans ; Male ; Retrospective Studies ; Tachycardia, Paroxysmal ; surgery ; Tachycardia, Supraventricular ; surgery ; Young Adult

OBJECTIVETo observe the clinical effect of Sizi Zhongwang Capsule (SZC) combined with Western medicine (WM) in treating male sterility.

METHODSTwo hundred and sixty-one male patients with sterility were assigned to 3 groups, 64 in the WM group were treated with conventional Western medical therapy alone, 87 in the SZC group were treated with SZC alone, and 110 in the combined group were treated with SZC combined Western medical therapy. The treatment lasted for 90 days in total. Changes of semen related parameters before and after treatment were observed, and the conditions of pregnancy in patients' spouse were followed-up.

RESULTSThe difference in semen related parameters before and after treatment showed insignificant in the WM group (P > 0.05), but it did show statistical significance in the SZC group and the combined group (P < 0.05, P < 0.01). Moreover, the best effect was shown in the combined group, showing significant difference to the other two groups (P < 0.01, P < 0.05). The pregnancy rate of patients' spouse in the combined treated group was higher than that in the other two groups (P < 0.01, P < 0.05).

CONCLUSIONSZC combined with Western medical therapy could effectively improve the quality of semen in males with infertility and enhance the pregnancy rate in their spouse.

Combined Modality Therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Infertility, Male ; drug therapy ; Male ; Pregnancy ; Pregnancy Rate ; Semen Analysis

OBJECTIVETo explore and evaluate the feasibility, safety, radicality and the short-term outcome of minimally invasive esophagectomy versus open esophagectomy for esophageal cancer.

METHODSFrom July 2007 to October 2009, 67 patients with esophageal cancer received minimally invasive esophagectomy (MIE group), while 38 patients underwent conventional open esophagectomy (OE group: via right thorax, abdomen, left neck). The operative procedures, clinicopathological data and short-term outcome were collected and compared between the two groups.

RESULTSThe clinical data of the two groups were comparable. No significant differences was found in demographics between the two groups. Median blood loss in MIE group was less than that in OE group (chest: 112.3 ml vs. 175.3 ml, P = 0.035, abdominal: 31.4 ml vs. 100.5 ml, P = 0.026). More patients in OE group were transferred to ICU (P = 0.042) and more obvious pain (P = 0.005). The rate of pulmonary infection and intestinal obstruction in OE group were higher than MIE group (P = 0.046 and 0.045). There were no differences in the number of lymph node dissection for two groups, the average was 20.9 and lymph node metastasis rate was 26.9% in MIE group. Mean follow up was (14.0 ± 2.2) months (range, 2 to 29 months). Recurrence rate and survival rate were no differences.

CONCLUSIONThe Minimally invasive esophagectomy for esophageal cancer is feasible, safe, and reliable short-term effect, and can achieve radical tumor resection, which may lead to better future of surgical treatment for esophageal carcinoma.

Aged ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Thoracoscopy ; Treatment Outcome

Objective To study the variants of S gene of hepatitis B virus among the breakthrough infection children immunized with hepatitis B vaccine in Huzhou city.Methods HBV DNA S gene regions were amplified and sequenced in 29 children with HBsAg-positive/HBV DNA-positive after immunized with hepatitis B vaccine.Results The sequencing results showed that 26 cases were B genotypes,3 were C genotypes.The amino acids mutations were presented in 9 children serum HBV DNA.The major amino acid mutations were in the "a" determinant of HBV DNA S gene.Conclusion Different S gene variants maybe cause HBV vaccination failure in some children in Huzhou city.No predominant variant was found.

Objective To observe the clinical efficacy and safety of rituximab injection in the treatment of patients with phospholipase A2 receptor-associated membranous nephropathy(PLA2R-MN).Methods The PLA2R-MN patients were randomly divided into control group and treatment group.The control group received oral prednisone tablets,initial dose of 40-60 mg·d-1,gradually reduced the dose according to the patients'condition after 2 months,cyclophosphamide injection 0.6 g per time,intravenous infusion,once every 2 weeks,for 6 consecutive times,then adjusted to 1.0 g per time,intravenous infusion,once a month;the treatment group received 375 mg·m-2 rituximab injection intravenous infusion,once a week,for 4 consecutive weeks,on the basis of the control group treatment.Both groups of patients were treated for 6 months.The clinical efficacy,24 h urine protein quantification,serum creatinine(SCr),glomerular filtration rate(eGFR),urinary microalbumin(UAlb),urinary creatinine(UCr)and adverse drug reactions were compared between two groups.Results Fifty-three patients were enrolled in the treatment group,2 cases dropped out,and 51 cases were finally included in the statistical analysis.Fifty-three patients were enrolled in the control group,2 cases dropped out,and 51 cases were finally included in the statistical analysis.After treatment,the total effective rate of the treatment group and the control group were 92.16％(47 cases/51 cases)and 76.47％(39 cases/51 cases),and the difference was statistically significant(P＜0.05).After treatment,the 24 h urine protein quantification of the treatment and control groups were(0.86±0.30)and(1.04±0.27)g·24 h-1;SCr levels were(103.37±18.80)and(120.55±19.94)μmol·L-1;eGFR levels were(65.89±8.17)and(55.87±9.36)mL·min-1·1.73 m-2;UAlb levels were(47.45±13.52)and(98.21±25.50)mg·L-1;UCr were(1.55±0.42)and(1.96±0.51)mg·g-1,respectively,and the differences were all statistically significant(all P＜0.05).The adverse drug reactions of two groups were mainly nausea,vomiting,liver function damage,skin itching,infection,hair loss,etc.The total incidences of adverse drug reactions in the treatment and control groups were 43.14％and 37.25％,without significant difference(P＞0.05).Conclusion Rituximab injection has a definite clinical efficacy in the treatment of PLA2R-MN patients,which can significantly improve the renal function of patients,and does not increase the incidence of adverse drug reactions.

OBJECTIVETo investigate the feasibility and efficacy of neoadjuvant chemoradiotherapy followed by combined thoracoscopic and laparoscopic esophagectomy (CTLE) in the treatment of advanced esophageal carcinoma.

METHODSFrom June 2011 to February 2012, 11 patients with locally advanced esophageal carcinoma underwent neoadjuvant chemoradiotherapy followed by CTLE (clinical stage IIB-IIIA). NP (vinorelbine pin and cisplatin) or TP (program paclitaxel-pin and cisplatin) were applied as preoperative chemotherapy. During the same period, conventional fractionated radiotherapy was used with the radiation dose of 40 Gy/20 F. At four to six weeks after CRT, 11 patients received three-incision CTLE.

RESULTSDuring chemoradiation, 9 patients developed bone marrow suppression. The interval between completion of chemoradiation and surgery was (49.6±15.4) d. Intraoperative findings revealed local fibrosis in one patient (75 days after chemoradiation) while operative difficulty was not increased in the remaining 10 patients. Compared to 15 patients who received surgery alone, operative time was shorter [(242.3±27.0) min vs.(280.5±27.2) min, P=0.002] and intraoperative blood loss was less [(168.2±95.6) ml vs. (244.5±84.8) ml, P=0.042], the number of removal lymph nodes was similar [(19.5±5.8) vs. (20.5±7.1), P=0.683], postoperative hospital stay was prolonged [(18.9±10.3) d vs. (12.5±4.6) d, P=0.020]. The postoperative complication rate was 36.4% including cervical anastomotic leak with pulmonary infection (n=1), cervical anastomotic fistula and hoarseness (n=1), pulmonary infection with pleural effusion (n=2). Follow up ranged from 1 to 9 months, and no recurrence was found.

CONCLUSIONThe neoadjuvant chemoradiotherapy followed by combined thoracoscopic and laparoscopic esophagectomy in the treatment of locally advanced esophageal carcinoma is safe, feasible, and the short-term outcomes are favorable.

Adult ; Aged ; Esophageal Neoplasms ; surgery ; therapy ; Esophagectomy ; methods ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Male ; Middle Aged ; Neoadjuvant Therapy ; Preoperative Care ; Thoracoscopy ; Treatment Outcome

BACKGROUNDN-terminal pro beta-type natriuretic peptide (NT pro BNP) has been shown to predict the prognosis and could guide the treatment of heart failure. We aimed to investigate the values of NT pro BNP in predicting the clinical response to cardiac resynchronization therapy (CRT).

METHODSA total of 44 patients with chronic heart failure (34 male and 10 female, mean age of (58 +/- 13) years, New York Heart Association (NYHA) class 3.3 +/- 0.5, QRS duration (150 +/- 14) milliseconds) who underwent successful implantation of a CRT system were enrolled in this study. Pharmacotherapy remained stable during the first 3 months of follow-up. Plasma levels of NT pro BNP were evaluated before and 3 months after implantation. Clinical, echocardiographic and exercise parameters were monitored at each clinical visit after CRT implantation. Receiver operating characteristic analysis and a paired t test were performed to analyze the data.

RESULTSAfter a mean of (16.3 +/- 5.5) months of follow-up, 11 nonresponders were identified. CRT resulted in a significant reduction in NT pro BNP ((1.70 +/- 1.28) vs (1.07 +/- 0.88) pmol/ml, P < 0.001) in responders. Percentage change in NT pro BNP level (DeltaBNP%) was a statistically significant predictor of long term clinical improvement at 3 months of follow-up.

CONCLUSIONSDeltaBNP% from baseline to 3 months of follow-up is a predictor of long term response to CRT. NT pro BNP may be a simple method for monitoring the effects of CRT.

Aged ; Cardiac Pacing, Artificial ; methods ; Female ; Heart Failure ; blood ; therapy ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Prognosis ; Time Factors