Adult ; Cardiac Catheterization ; adverse effects ; Female ; Heart Septal Defects, Ventricular ; surgery ; Hemolysis ; Humans ; Postoperative Complications ; etiology

Objective To explore the efficacy of nasal septal perferation with three layers of grafts under nasal endoscope. Methods From June 2002 to June 2007,15 cases of nasal septal perforation were repaired by three laryers of grafts using the perpendicular plate of the ethmoid bone or quadrangular cartilage covered by fascia lata of the thigh. The course of the disease ranged from 6 months to 5 years (mean,1.8 years) and the diameter of the perforation ranged from 0.8 to 1.6 cm (mean,1.2 cm). A 1-2 mm new surface was made along the margin of the perforation,and then the nasal septum was separated by means of submucos correction. Afterwards,a perpendicular plate of the ethmoid bone or quadrangular cartilage covered by fascia lata of the thigh was used to form a three-layer graft for seal of the perforation. Then,the nasal cavities were filled with expansive sponge,which was expanded by injecting lyophilized recombinant bovine basic fibroblast growth factor for external use. Results The surface of the graft was completely covered by nasal mucosa in 6 to 12 weeks after the surgery.Afterwords,the patients were followed up for 6 to 12 months (mean,8.2 months),during which no recurrence occurred. Conclusions It is effective to repair nasal septal perforation with three-layer graft under nasal endoscope.

Objective To investigate the preoperative biliary drainage on the effect of surgical treatment for hilar cholangiocarcinoma patients.Methods A total of 52 hilar cholangiocarcinoma patients who underwent resection operation in Renmin Hospital of Wuhan University from January 2005 to December 2015 were divided into preoperative biliary drainage group (24 cases) and non-preoperative biliary drainage group (28 cases).To compare the operation time,intraoperative blood loss,hospital stay,perioperative changes in liver function,and incidence of postoperative complications,tumor recurrence rate,1-,3-,and 5-year survival rate and some other indicators.The data was analyzed using SPSS 19.0 software.The patients of two groups were followed up by telephone,out-patient review and hospital examination.Patients were followed up for 8-60 monthes.Results The hospital stay for biliary drainage group was longer than that in non-preoperative biliary drainage group and the difference was statistically significant (P ＜ 0.05).The differences of operation time,intraoperative blood loss,postoperative tumor recurrence rate,postoperative complications (including bile leakage,blooding,fever,pleural effusion,abdominal infection,wound infection,pulmonary infection,liver failure and some others) and 1-,3-,and 5-year survival rate were not statistically significant (P ＞ 0.05).Alanine aminotransferase,aspartate aminotransferase,total bilirubin and direct bilirubin in preoperative biliary drainage group before biliary drainage were(98.0 ± 51.7) U/L,(94.2 ± 44.2) U/L,(177.5 ± 64.1) μmol/L and (160.2 ± 61.9) μmol/L,respectively,and after biliary drainage were (71.2 ± 13.8) μmol/L,(60.0 ± 12.1) μmol/L,(93.5 ± 20.7) μmol/L and (76.3 ± 18.1) μmol/L,respectively.The differences of the above parameters before and after biliary drainage were statistically significant (P ＜ 0.05).However,the changes of albumin before and after biliary drainage were not significant (P ＞ 0.05).The follow-up patients of biliary drainage group were 21 cases and the follow-up patients of non-preoperative biliary drainage group were 25 cases.The differences of 1-,3-,and 5-year survival rate between the two groups were not statistically significant (P ＞ 0.05).Conclusions Preoperative biliary drainage for hilar cholangiocarcinoma patients may improve the liver function to a certain extent.However,preoperative biliary drainage cannot improve the prognosis of the hilar cholangiocarcinoma patients.Therefore preoperative biliary drainage is not suggested for patients with good general conditions.

Objective To investigate the wake-promoting action of median nerve electrical stimulation(MNES) in coma rats induced by traumatic brain injury(TBI) and its influence on the expression of α1-adrenergic receptor(α1 R) in the prefrontal contex (PFC).Methods Seventy-two healthy Sprague Dawley(SD) rats were randomly divided into the control group,sham-stimulated group(TBI),stimulated group (TBI+ MNES) and antagonist group(TBI+ OX1R antagonist +MNES).The control group had no any treatment.The TBI coma rat models were prepared in the other 3 groups.The sham stimulated group had no treatment.The antagonist group was injected with orexin receptor-l(OX1R) antagonist SB334867 into lateral ventricle,and both the antagonist group and stimulated group received MNES treatment.Then the behavior changes of rats in each group were observed and the α1 R expression level in PFC was detected by using the immunohistochemistry technique.Results Thirteen rats in the stimulated group and 8 rats in the antagonist group revived,while only 4 rats in the TBI group.The α1R levels from low to high were the blank control group,sham-stimulated group,antagonist group and stimulated group,showing the increasing trend,and the difference was statistically significant(P＜0.05).Conclusion MNES can improve the rat consciousness level after TBI coma,and its mechanism may be related with up-regulating the α1 R expression level in PFC area,moreover Orexin-A participates in this regulation process.

Objective To develop a virtual endoscopy system which can be integrated into PACS.Methods Key techniques on virtual endoscopy were researched and we implemented a virtual endoscopy system with the help of the Visualization Toolkit VTK.Results The Virtual endoscopy system was integrated into PACS and the post-processing function of PACS was advanced.Conclusion As a novel medical image post-processing technology,virtual endoscopy provides a completely non-invaded inspection,so it has broad application prospects in the computer-aided medical teaching,surgical navigation,surgical planning and clinical diagnosis.

Objective To evaluate the value of endoscopic endonasal approach in the surgical treatment of skull base lesions. Methods From May 2002 to December 2006, 112 patients with skull base lesions were treated by endoscopic endonasal surgery. Among them, 39 cases had cerebrospinal fluid (CSF) leak, 4 pituitary adenoma, 3 meningoencephalocele, 9 sphenoethmoidal cyst, 2 sphenoiditis complicated with ploypi, 12 fungal sphenoiditis, 11 inverted papilloma, 6 nasopharyngeal fibroangioma, 2 ossifying fibroma, 2 fibrous dysplasia, 7 chordoma, 2 craniopharyngioma, 10 squamous cell carcinoma, 1 undifferentiated carcinoma, and 2 papillomatous change. Results Follow-up ranged from 6 to 60 months. All the operations were completed under an endoscope. In 20 cases including 8 patients with squamous cell carcinoma, 1 undifferentiated carcinoma, 7 chordoma, 2 craniopharyngioma, and 2 fibrous dysplasia, the lesion was removed subtotally. In the 39 patients with CSF leak, the lesion was cured after the first operation in 31 patients (79.5%), after the second operation in 4, and the third in 4; the final success rate was 100%. One of the patients with meningoencephalocele showed recurrence complicated CSF leakage 2 months after the operation, and then was cured by re-operation using endoscopy. In the 11 patients with inverted papilloma, 1 had recurrence 11 months after the operation, and was re-treated by lateral rhinotomy. One of the patients who had fungal sphenoiditis developed recurrence 4 month after the operation and received endoscopic endonasal surgery for the second time. One patient who had CSF leak before the operation developed intracranial infections after the endoscopic surgery. Conclusion Endoscopic endonasal surgery is a safe, effective, and minimally invasive approach to treat skull base lesions. Clinicians should understand the operation indications precisely, especially for malignant tumors.

Objective To study the technique and clinical effect of naso-endoscopic surgery for cerebrospinal fluid(CSF)rhinorrhea.Methods From June 2002 to May 2007,14 patients with spontaneous CSF rhinorrhea and 28 patients with traumatic or iatrogenic CSF rhinorrhea were treated by naso-endoscopy.The CSF fistula was exposed via different surgical routes by naso-endoscopy according the sites of the lesions(including the cribriform plate or fovea ethmoidalis,sphenoid sinus,and frontal recess).Middle turbinate mucosa,fascia lata,and abdominal fat were used to repair the fistulae by using multilayer "underlay","overlay" or "Bath-plug" techniques.Results Thirty-four cases(81.0%)were cured at the first operation,4 were healed at the second attempt,and 4 were treated successfully at the third attempt.The success rate of the first operation in the patients with a fistula orifice larger than 10 mm in diameter was significantly lower than that in the patients who had a fistula orifice less than 10 mm in diameter(53.8%,7/13 vs 93.1%,27/29;?2=6.606,P=0.010).Two patients developed complications after the endoscopy(intracerebral infection in one,and hydrocephalus another),and were cured afterwards.Totally 42 patients achieved a 6-to 36-month(mean,14 months)follow-up,none of them had recurrence during this period.Conclusions Naso-endoscopic surgery is a safe,effective,and microinvasive treatment for patients with CSF rhinorrhea.Measures should be done to prevent and control the complications of the surgery.The outcomes of the treatment depend on the size of the fistula orifice.Autologous fat tissues are recommended for the repair of the fistulae larger than 10 mm in diameter.

Objective To investigate the wake-promoting effect of vagus nerve stimulation (VNS) on coma rats after traumatic brain in-jury (TBI), and the related mechanism. Methods A total of 168 healthy Sprague-Dawley rats were randomly divided into blank group, TBI group, antagonist group and VNS group, 42 rats in each group. The latter three groups were established TBI model with impact, and the rats in coma at least 30 minutes were included. VNS group accepted VNS, the antagonist group were injected intralateroventricularly Orexin A receptor 1 (OXR1) antagonist SB334867, and TBI group accepted sham VNS. Their behaviors were observed to determine the level of con-sciousness six, twelve and 24 hours after intervention, while the expression ofγ-aminobutyric acid b1 receptor (GABAb1R) in prefrontal cortex was detected with immunohistochemistry and Western blotting. Results There were 42 rats in the blank group, 11 rats in TBI group, 13 rats in the antagonist group, and 28 rats in VNS group awakened finally. The expression of GABAb1R in prefrontal cortex ranged as TBI group, antagonist group, blank group and VNS group from more to less twelve and 24 hours after intervention under Western blotting (F>60.412, P<0.001), and it ranged as TBI group, antagonist group, VNS group and blank group under immunohistochemistry (H=15.121, P=0.002), with no significant difference among time points (H=3.028, P=0.220). Conclusion VNS can promote waking from coma in rats after TBI, which may relate with the decrease of GABAb1R in prefrontal cortex that induced by Orexin A.

Objective:To explore the clinical regularities in acupuncture-moxibustion treatment of cancer pain by reviewing the relevant studies published between 1985 and 2017.Methods:Based on the Chinese Medicine Acupuncture-moxibustion Information Database,quantitative analysis,correlation analysis and Chi-square test were applied to analyze the commonly used acupoints,meridian affiliations and body region distributions,commonly used methods and acupoint correlations,treatment method correlations,the efficacy of acupuncture-moxibustion plus the three-step analgesic ladder for cancer pain,and indicators.Results:Zusanli (ST 36),Ashi point and Sanyinjiao (SP 6) ranked the top on the list of frequency;points from Bladder Meridian of Foot Taiyang and Stomach Meridian of Foot Yangming were often used;points from the lower limbs and back had high frequencies.The most commonly used treatment method was acupuncture-moxibustion plus medication.Acupuncture-moxibustion plus the three-step analgesic ladder showed certain advantage compared with the two methods used separately,and among the integrated methods,acupoint application plus the three-step analgesic ladder produced the most significant efficacy.It took (44.77±55.54) min for the analgesic effect to act and the effect lasted for (12.81±14.59) h.Numerical rating scale (NRS),visual analog scale (VAS) and Karnofsky performance status (KPS) scores all showed significant changes after interventions (all P＜0.01);there was no significant change in the score of quality of life (QOL) after interventions (P＞0.05).Conclusion:Zusanli (ST 36),Ashi point and Sanyinjiao (SP 6) are commonly selected in acupuncture-moxibustion treatment of cancer pain;acupuncture and acupoint application are often used;acupuncture-moxibustion plus the three-step analgesic ladder can boost the treatment efficacy.