Face ; surgery ; Humans ; Mouth ; surgery ; Reconstructive Surgical Procedures ; Retrospective Studies

Objective To evaluate the feasibility,safety,and efficacy of endovascular repair combined with second-stage surgical debridement for ruptured femoral pseudoaneurysms (RFP).Methods All patients who underwent emergency repair of an RFP in our institution between 2009 and 2013 were identified.Case notes were retrieved for clinical data.Results Seven patients were identified.All the patients were treated with emergent percutaneous stent-graft implantation and secondary surgical debridement.The procedure time was (55 ± 6.32) min,blood loss was (93.33 ± 25.03) ml,hospital stay was (9.5 ± 0.84) d,and no postoperative complications occurred.Conclusions stent graft implantation for the treatment of RFPs is safe and effective in short-or middle-term outcome.It is an alternative for RFPs and may be the better option,which makes the secondary surgical debridement feasible and viable.

Objective To analyze the mutation of PreS-S region in occult hepatitis B virus(OHBV) in HBV infected persons with positive HBsAb and investigate the biological mechanisms of the special infectious model.Methods A total of 38 HB-sAb positive OBI serum samples were amplified by Nested PCR and sequenced,HBV genotype and serotype were determined.The amino acid sequences of OHBV were compared to the corresponding sequence of wild-type strains of similar genotype obtained from the GenBank database.Results PreS-S segment of 11 samples were obtained and 8 samples were sequenced successfully.Among which,5 were genotype C and 3 were genotype B.Genotype B were all serotype adw,while genotype C were 1 adw and 4 adr.The mutation rates of PreS-S region,the immunoreactive area and the major hydrophilic region (MHR) were higher in OHBV than the wild-type strains (2.6％ vs 0.8％,x2 =40.23,3.2％ vs 0.3％,x2 =52.13,3.6％ vs 0.6％,x2 =13.25,all P＜0.01) and the substitutions of I126T,Q129R,M133T,F134I,D144E,G145K in α determinant were found in OBI samples.The mutation rate of amino acids in PreS-S region was higher in genotype C than genotype B (3.5％ vs 1.2％,x2--15.98,P＜0.01),meanwhile,the mutation rates in MHR,α determinant and immunoreactive region were higher in genotype C too,but no statistical significance was attained (4.7％ vs 1.7 ％,x2 =2.96,3.6 ％ vs 2.9％,x2 =0.25,4.1％ vs 2.3％,x2 =3.59,all P ＞0.05).Conclusion Mutations in PreS-S region,especially in immunoepitope,might change the virus'immunogenicity leading to escape from immune response and cause OBI with HBsAb positive.

Objective To investigate the clinical outcome and treatment of portal vein thrombosis (PVT) following partial splenic embolization (PSE).Methods From April 2006 to April 2010,105patients with hypersplenism caused by cirrhotic portal hypertension were treated with PSE.Contrastenhanced abdominal computed tomography or magnetic resonance imaging was performed routinely in 60patients before PSE and 1 -3 months after PSE.PVT was detected in 10 patients on images after the procedures.After PVT was diagnosed,4 patients received anticoagulant therapy immediately,and the other 6 patients did not receive therapy.Clinical data of these 10 PVT patients were analyzed retrospectively.Results 3 of 4 patients who received anticoagulant therapy had complete or partial resolution of the thrombus,and one developed mild ascites without thrombosis progression.Of the 6 patients who did not receive anticoagulant therapy,follow-up studies (6- 48 months,mean 16.9 months) demonstrated partial clot calcification in one,thrombosis progression in 5.Among those 5 patients with thrombosis progression,two experienced hematemesis due to variceal rupture and underwent transjugular intrahepatic portosystemic shunt,2 developed cavernous transformation,extensive collateral circulation,ascites and variceal progression,and one had variceal progression with melena during the follow-up period.Conclusions PVT is a severe complication of PSE.Early diagnosis and prompt anticoagulant therapy is effective in preventing PVT.

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.

Objective: To analyze the current status and equity of mental health resources allocation in Shanghai Municipality, so as to provide data supports to formulate mental health action plans and relevant policies. . Methods: The data pertaining to mental health institutions, actual beds opened, certified or assistant psychiatrists and registered nurses was collected from the Survey of the Current Status on Mental Health Resources in Shanghai Municipality in 2020. The equity of mental health resources allocated by population and geographical area in Shanghai Municipality was evaluated with Lorenz curve and Gini coefficient Results: There were 96 mental health institutions, 15 060 actual beds opened, 257 certified or assistant psychiatrists and 2 887 registered nurses in Shanghai Municipality in 2020, with a physician-to-nurse ratio of 1∶2.30. The greatest numbers of actual beds opened in the department of psychiatrics, the number of certified or assistant psychiatrists and the number of registered nurses per 10 000 residents and per km2 were all found the central urban areas. The numbers of actual beds opened in the department of psychiatrics, the number of certified or assistant psychiatrists and the number of registered nurses per 10 000 residents were 6.06 beds, 0.51 physicians and 1.16 nurses, with Gini coefficients of 0.36, 0.42 and 0.44, respectively, and the numbers of actual beds opened in the department of psychiatrics, the number of certified or assistant psychiatrists and the number of registered nurses per km2 were 2.38 beds, 0.20 physicians and 0.46 nurses, with Gini coefficients of 0.72, 0.76 and 0.75, respectively. Conclusions There was a gross equity in mental health resources allocated by population and geographical area in Shanghai Municipality in 2020, which showed an improvement as compared to 2015. The equity in mental health resources allocated by geographical area was lower than that by population in Shanghai Municipality.

Objective To explore the value of Doppler tissue imaging(DTI) in assessing the left ventricular diastolic function of patients with essential hypertension.Methods Twenty healthy person(group A),35 essential hypertension(EH) patients with normal left ventrecular mass index(LVMI,group B) and 30 EH patients with left ventricular hypertrophy(LVH,group C) were included.The mitral annular velocity in early diastole(Ea) and late diastole(Aa) were detected by DTI,meanwhile the mitral inflow velocity E and A were detected.Results The E,E/A,Ea,Ea/Aa of group B and group C were lower than those of group A(P0.05).The Ea,Ea/Aa of group C were lower than those of group B(P

Objective To explore the danger of lead exposure in newborns who accepted the blood stored in blood bank for blood change treatment.Methods The lead level of blood was examined before and after blood change treatment for 37 neonates with hyperbilirubinemia who accepted 53 cases blood stored in blood bank during Jun.to Dec.2006.The level of blood lead was measured by graphite stove atom absorb spectrum method.Results The average lead level of 53 cases blood stored in blood bank was 101.02 ?g/L,which had attained the level of lead poisoning.There were 15 cases(28.5%) whose blood lead levels was very high(≥100 ?g/L),3 cases whose blood lead level ≥200 ?g/L.After blood change treatment,the percentage of the blood lead level ≥100 ?g/L rose from 2.9% to 19.0%.The average level of blood lead after blood change treatment was higher than before(P

Objective To review the prevention and treatment strategies for complications after carotid artery stenting in a single medical center. Methods From December 2004 to December 2009,clinical data of 118 cases of carotid artery stenting with the use of cerebral protective device were analyzed retrospectively. Results The surgical success rate was 100% with no perioperative 30- day mortality or severe complications such as disabling stroke. The overall perioperative complication rate was 32. 20% (38/118), including carotid artery spasm in 10.17% (10/118), bradycardia in 11.02% (13/118), hypotension in 2.54% (3/118), transient ischemic attack in 5.93% (7/118) and false aneurysm of femoral artery in 2. 54% (3/118) cases. The average follow-up time was (28 ± 15) months. The mortality was 2. 38% (2/84) and the overall complication rate was 10. 71% (9/84) , including ischemic stroke in 3. 57% (3/84) , in-stent restenosis in 1. 19% ( 1/84) , stent deformation in 4. 66% (4/84) and stent fracture in 1. 19% (1/84) cases. Conclusion Death or ischemic stroke and other severe complications after carotid artery stenting under cerebral protective device were low. A careful selection of patients and strict indication for surgery is the key to reduce the complication rate.

BACKGROUND:Currently, limb salvage therapy has become the standard treatment of malignant bone tumors way, but improper treatments wil result in tumor recurrence, secondary infection, internal fixation or prosthesis loosening.
OBJECTIVE:Based on the traditional surgical principle for metastatic bone tumors of the limbs, this study designed a user-friendly, individualized, simplistic pal iative treatment regimen from the actual conditions of patients to observe the reasonability, clinical efficacy and prognosis of bone cement fil ing combined with internal fixation in the treatment of metastatic malignant bone tumors.
METHODS:Thirty-one patients with metastatic malignant bone tumors who required salvage treatment were screened from the Department of Orthopedics, the 421 Hospital of Chinese PLA, and their clinical data were retrospectively analyzed. Al the 31 patients were divided into two groups:tumor removal+internal fixation group (non-chemoradiotherapy group, n=11) treated with bone cement fil ing plus plate internal fixation (pal iative
treatment);tumor removal+internal fixation+chemoradiotherapy group (chemoradiotherapy group, n=20), treated with radiotherapy before internal fixation plus plate internal fixation with limb salvage. The fol ow-up period was 4-38 months, averagely 18 months.
RESULTS AND CONCLUSION:The fol ow-up results showed that in the non-chemoradiotherapy group, al the 11 patients survived, who could live independently and have good motor functions;in the chemoradiotherapy
group, 17 of the 20 patients survived and the rest three patients died of tumor metastasis, their poor conditions and complications at 9 and 13 months after internal fixation. In patients undergoing tumor removal+plate internal fixation with limb salvage, the integrated scores for nerve and motor functions were increased by more than
level 1. These findings confirm that a simple pal iative therapy of bone cement fil ing and internal fixation without chemoradiotherapy is better for metastatic malignant bone tumors patients who require limb salvage.