Objective To analyze the influence factors of complications in CT-guided percutaneous pulmonary biopsy,and to explore the optimal methods of operation.Methods Totally 410 patients who underwent CT-guided percutaneous pulmonary biopsy were retrospectively analyzed,and the complications of biopsy were observed.Results Pulmo-related complications occurred in 54 patients (54/410,13.17%) ,including pneumothorax in 18 patients (18/410,4.39%) ,1 of them had pneumothorax and pulmonary bleeding around the needles in 35 patients (35/410,8.54%) ,15 of which with haemoptysis (15/410,3.66%) ,and 1 patient had acute pleura reaction.No severe complications such as infection.excessive bleeding,hemothorax,aeroembolism,needle track implantation metastasis occurred.Conclusion Accurate and skillful CT-guiding techniques and appropriate operation methods are important to improve the success rate and to reduce complications of CT-guided percutaneous pulmonary biopsy.

Objective To look for an ideal substance to repair large gap of nerve defect after injuries by culture,population of Schwann cells(Scs)and preparation of acellular allogenous nerve grafts with chemical extraction. Method The double adhesion culture and Arab c to prohibit the fibroblast growth were used to achieve high purified Scs;detergents:Triton X 100 and sodium deoxycholate were used to achieve acellural nerve grafts (ANG);and finally the Scs were micro injected into the acellural nerve grafts and the consequence studied Result By the way above,high purified Scs and the ANG was acquired,which can integrated each other well Scs can survived and transformed to aline in vitro Conclusion ANG populated isogenous Scs may be an ideal substance to repair the large gap of nerve defect after injuries

Objective To identify the risk factors associated with intraoperative acute cardiac decompensation in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods From November 2007 to February 2009, 2379 OPCABGs were performed in our hospital. The possible risk factors associated with intraoperative cardiac decompensation were retrospectively analyzed. The preoperative patient demographics and intraoperative characteristics were correlated with intraoperative acute cardiac decompensation.The possible risk factors included sex, age, body weight, cardiac function (NYHA classification), the associated diseases (hypertension, diabetes mellitus, liver-kidney dysfunction), history of myocardial infarct, ventricular aneurysm, preoperative treatment with β-blocker and/or calcium channel blocking agent, ventricular extrasystole,atrial fibrillation, duration of operation, etc. Results Three hundred and sixty-eight patients developed acute cardiac decompensation during OPCABG (15.5%). No patient died during operation. Multivariate analysis indicated that the risk factors for acute cardiac decompensation during OPCABG included left ventricular aneurysm valvular dysfunction, left main disease, history of myocardial infarct, preoperative ventricular premature beat,preoperative ejection fraction (EF) ＜ 40%, intraoperative atrial fibrillation, intraoperative frequent ventricular premature beat, tachycardia before anesthesia and emergency OPCABG. Conclusion The risk factors for acute cardiac decompensation during OPCABG includ left ventricular aneurysm valvular dysfunction, left main disease,history of myocardial infarct, preoperative ventricular premature beat, preoperative EF ＜ 40%, intraoperative atrial fibrillation, intraoperative frequent ventricular premature beat, tachycardia before anesthesia and emergency OPCABG.

Objective To evaluate the efficacy of the renal arterial embolization with lipidol and absolute alcohol emulsion in the treatment of renal tumors. Methods The superselective renal arterial embolization by using coaxial-cathaterization with infusion of lipiodol and absolute alcohol (in proportion of 2 ∶ 1) emulsion was performed in twenty patients with malignant and benign kidney tumors. 4 weeks later, the renal arteriography was taken routinely and repeated embolization was performed in case of necessary; and follow up was carried out periodically. Results The imaging findings showed thorough tumor necrosis and feeding vessel abruption in 18 cases after one session of treatment. The volume of tumors decreased more than a half in 13 patients (82.25%, 13 / 18) associated with a well-distributed lipidol inside the tumors. The second session of treatment was performed in other 2 patients and the clinical symptoms relieved obviously. Conclusions The superselective renal artery embolization with lipidol and absolute alcohol emulsion can permanently embolize all tumor feeding arteries in capillary vessel level with maximum reservation of renal function, providing definitively efficacy and worthwhile to be recommended widely.

BACKGROUND: Schwann cell derived neurotrophic factor, which is isolated and purified from the kytoplasm of Schwann cell with the relative molecular mass of 58000, is a kind of neurotrophic substance possessing obvious neurotrophic activity. It can be against neurovirulent substance of nitrogen monoxidum.OBJECTIVE:To create root avulsion animal models and observe the protective effects of Schwann cell derived neurotrophic factor (SDNF) on motoneurons of spinal anterior horn from spinal root avulsion induced cell death.DESIGN: Repeated observation and measure.SETTING: Third Department of Orthopaedics, Second People's Hospital of Shenzhen; Department of Micro-surgery , First Hospital Affiliated to Sun Yat-sen University.MATERIALS: This experiment was conducted at the Experimental Animal Center of Medical College of Sun Yat-sen University from March to May 2003. Twenty Sprague-Dawley rats with the age of 3-4 months, of clean degree, were selected and divided randomly into experimental group of Schwann cell derived neurotrophic factor and control group of normal saline with 10 rats in each group. The right side was injured, and the left side was intact served as normal control side.METHODS : ①A rat model of C6,7 spinal root avulsion induced motoneuron degeneration was established. ② A small piece of gelfoam presoaked in 40 μL SDNF solutions (1 g/L) was placed in contact with the injured spinal cord in the animals of the experimental group. Normal saline was added as the same way as above in the animals of the control group. ③ A silica pipe was put on the surface of gleform, one end of the silica was sutured to the glefoam , and the other end wasfixed subcutaneously with vaselinum. Local intramuscular injection of penicillinum was performed on the wound following closing the incision. All rats received an injection (20 μL) of either SDNF or normal saline solution at the lesion site through the silica pipe sutured to the glefoam once a week after the surgery. All the animals were killed by the end of the third weeks. ④The spinal region of C6,7 level was dissected out for observing survival rate and morphological change of motoneurons of spinal anterior horn as well as the expression of nitricoxide synthase(NOS).MAIN OUTCOME MEASURES: ① Survival and morphological change of spinal motor neurons. ②Change of nitricoxide synthase expression of spinal motor neurons.RESULTS: Totally 20 rats were enrolled in the experiment, and all of them entered the stage of result analysis. ① Survival and morphological changeof spinal motor neurons: 68.6% motoneurons of injured side of the control group died at 3 weeks after surgery. The survival rate was 31.4%,which was significantly lower than that of the intact side (P ＜ 0.01), and the survived neurons was shrinked significantly; the death rate of spinal motor neurons of injured side of experimental group was decreased by 35%as compared with control group (P＞ 0.05). The survival rate was 66.4%,and the survived neuron body was increased, similar to the intact side (P ＞ 0.05). ② Change of nitricoxide synthase expression of spinal motor neurons: In normal spinal cord, NOS positive neurons were shown in dorsal horn, surrounding the central canal and in the intermediolateral column.NOS was not seen in the anterior horn motonurons. At the end of the third week after C6,7 spinal root avulsion, increased NOS expression was not found at the injured side in the Schwann cell derived neurotrophic factor group and the intact side in the control side, while the significantly increased NOS expression of spinal motoneurons was found at the injured side of the control group.CONCLUSION: Degeneration of spinal motoneuron and increased expression of NOS can be induced by spinal root avulsion. SDNF has a significant effect in protecting spinal motoneurons from spinal root avulsion induced cell death and inhibiting the expression of NOS. These results suggest that the effects .of SDNF on motoneuron survival may be achieved by modifying the expression of certain cellular molecule such as NOS.

Objective To review computed tomographic angiography (CTA) signs and its potential use in the diagnose of blunt thoracic aortic injury Methods We reviewed 37 cases with blunt thoracic aortic injury (TAI) confirmed by surgery or aortography in Chinese PLA General Hospital emergency department from June 2004 to June 2014.CTA were performed on these patients,and CTA images were analyzed retrospectively to obtain characteristic CTA signs of blunt thoracic aortic injury.Results Of the 37 cases,the blunt injury in aortic isthmus were 83.8％ (31/37),aortic arch 5.4％ (2/37),descending aorta 8.1％ (3/37),and ascending aorta 2.7％ (1/37),respectively.CTA signs of thoracic aortic injury manifested as intimal flap in 34 patients (91.8％),abnormal aortic contour or cavity in 37 cases (100％),arterial contraction in 17 cases (45.9％),aortic dissection in 10 cases (27.0％),pseudoaneurysm in 21 cases (56.7％),thrombosis in 1 case (2.7％).Conclusions CTA signs could be used to facilitate the diagnosis of blunt thoracic aortic injury with a qualitative diagnostic value.

BACKGROUND: Schwann cell-derived neurotrophic factor is a bioactive protein isolated and purified from the kytoplasm of Schwann cell. It can obviously maintain the survival of spinal cord anterior horn motor neuron and promote the regeneration of peripheral nerve.OBJECTIVE: To observe the protective effect of Schwann cell-derived neurotrophic factor on the high injury of peripheral nerve-induced apoptosis of sensory neurons in spinal dorsal root ganglia.DESIGN: Randomized and controlled animal experiment.SETTING: Shenzhen Second People's Hospital.MATERIALS: Totally 30 3-week-old SD infant rats, of clean grade and either gender, were used in this experiment. They were randomly divided into neurotrophic factor group and control group with 15 rats in each one.Left sides of the animals in both two groups were set as normal sides and right sides as injured sides.METHODS: This experiment was carried out at the Experimental Animal Center, Medical College of Sun Yat-sen University from May 2003 to July 2003. ① L4.5 nerve root high-mutilation animal models were developed on the rats in two groups. Proximal nerve stump was connected with silicone tube. According to grouping, 60 mg/L Schwann cell-derived neurotrophic factors and 20 μL normal saline were injected into the silicone tubes respectively. Two ends of silicone tube were enveloped with vaseline.② Sample collecting was conducted at postoperative 4 weeks, survival rate and morphological change of sensory neurons in dorsal root ganglia of injured nerve was observed.MAIN OUTCOME MEASURES: ① Gross observation of sciatic nerve regeneration at injured side of the rats in two groups ② Survival of sensory neurons in dorsal root ganglia ③ Morphological change of sensory neurons in dorsal root ganglia.RESULTS: All the 30 rats entered the stage of result analysis. ① Gross observation of sciatic nerve regeneration: In the neurotrophic factor group,nerve new born axon grew along silicone tube, with 1cm in length; there were few and thin newborn axons in control group with 0.8 cm in length.② Survival of neuron in dorsal root ganglia of the rats in two groups: There was little fibrous tissue proliferation in the dorsal root ganglion in neurotrophic factor group. The loss of neurons was not obvious and the survival rate was 91.8%. Obvious fibrous tissue proliferation appeared in the dorsal root ganglia in control group, and a great many neurons were lost with the survival rate of 58.6%. Survival rate of neurons was 33.2% higher in neurotrophic factor group than in control group (P ＜ 0.01 ). ③ Morphological change of neurons in dorsal root ganglia: The diameter and area of neurons in dorsal root ganglia were significantly lower in control group than in neu rotrophic factor group and normal side [(21.8±1.4) μm,(373.1±50.9) μm2 vs (24.8±1.1) μm, (482.8±42.2) μm2 and (24.5±1.3) μm, (471.5±51.4) μm2,P ＜ 0.01], while there were no significant difference in diameter and area of neurons between neurotrophic factor group and normal side(P ＞ 0.05).CONCLUSION: Schwann cell-derived neurotrophic factors have obvious neurotrophic bioactivity for sensory neurons in the injured dorsal root ganglia.

Objective To study the relationship between serum high-sensitive cardiac troponin I (hs-Tnl) level and prognosis at 9 d in patients with acute ischemic stroke. Methods A total of 1 717 consecutive patients with acute ischemic stroke treated at the Department of Neurology, the First Affiliated Hospital of Harbin Medical University from September to November 2017 were enrolled retrospectively. The clinical data of all patients were collected,including vital signs at admission,laboratory indicators,and past medical history. The levels of hs-Tnl were determined by chemiluminescent particle immunoassay. The severity of stroke at admission was assessed by the National Institutes of Health Stroke Scale (NIHSS) ,and the prognosis at 90 d was evaluated by the modified Rankin scale (MRS). They were divided into good prognosis (MRS 0 -2) group and poor prognosis (MRS 3 -6) group according to the MRS score at 90 d follow-up. Multivariate logistic regression was used to analyze the relationship between hs-Tnl and prognosis at 90 d. Results Follow-up 90 days after discharge, of the 1 717 patients,! 322 had good prognosis, 395 had poor prognosis, the MRS score was 0 - 6[2(1,3)]. Compared with the good prognosis group, female (44.6% [n=176] vs. 32. 3% [n=427],∗2 =20. 05),age (67 [58,75] years vs. 62 [54,69] years,∗2 = 50. 22) , NIHSS score at admission (7 [5,10] vs. 3 [2,4],∗2 =348. 35],and hs-Tnl levels (0.01 [0,0.01] p.g/L vs.0 [0,0.01] ixg/L,∗2 = 29. 44),white blood cell count (8.43 [6.79,10.42] x 10VLt.7.51 [6.21,9. 13] x lO'/L,∗2 = 32.42),systolic blood pressure (150 [140,170] mmHg vs. 150 [135,165] mmHg,∗2 =4. 22) .hospital stay (8 [6,9] d vs. 1 [6,8] d,∗2 =49. 06) , the proportion of patients with previous stroke history (54. 2% [n =214] ts. 42. 3% [n =559] j(2 = 17. 38] ,and increased hs-Tnl (16. 7% [n = 66] vs. 8. 9% [n = 118] ,∗2 = 19. 25) and the proportion of patients in clinical deterioration (18. 5% [n = 73] vs. 2. 7% [n = 36] ,∗2 = 127. 02) were all higher than the those of the good prognosis group. The proportions of patients with smoking history (34. 7% [n = 137] w.44.0% [n = 582] ,x2 = 10. 90] .creatinine (67. 4 [56. 4,84. 7]u.mol/L vs. 70. 9 [60.8, 81. 2]u,mol/L,∗2 = 4. 26),hemoglobin (140 [126,149]g/L vs. 142 [131 ,153] g/L,∗2 = 14. 95) , and hematocrit (42. 2 [38. 6 , 44. 7%] vs. 42. 8 [39. 8 , 45. 6%] ,∗2 = 13. 16) were lower than those of the good prognosis group. The differences were statistically significant (P < 0. 05). Multivariate logistic regression analysis showed that female (OR, 1. 33,95 % CI 1. 01 -1. 77) , age > 60 years (Oft, 1.59,95% CI 1.18-2. 14), history of previous stroke (Oft,1.46,95% CI 1. 11 -1. 92) , NIHSS score 3s 5 at admission (Oft, 11. 49,95% CI 8. 57-15. 4) ,elevated hs-Tnl (Oft,1.56,95% CI 1. 05 -2. 32) ,and clinical deterioration (Oft,14. 71,95% CI 8. 89-24. 33) were the independent risk factors for poor prognosis at 90 d,and elevated hemoglobin (Oft, 0. 62 , 95% CI 0. 43 -0. 88) was a protective factor of good prognosis at 90 d (all P < 0. 05). Conclusion Elevated serum hs-Tnl in patients with acute ischemic stroke was an independent risk factor of poor prognosis at 90 d.

Objective　To observe the changes of the microvascular permeability after blunt chest trauma (BCT), endotoxemia and their combined injury in rats. Methods　After the establishment of the rat models of BCT, endotoxemia and their combined injury in the right lungs, the fluorescein sodium (FINa) content was measured with flurospectrophotometer in lungs 0.5, 1, 4 and 8 h after injury. Results　There was an early obvious increase of the microvascular permeability in the impact lateral (peak at half an hour after injury), and a delayed increase in the contralateral lung (peak at the 8th h) in the BCT group. The FINa content was higher in endotoxemia group than in the BCT group(P<0.05), and lower than that in the combined injury group(P<0.05) in the contralateral lung. Conclusion　Results indicate that there were different pathophysiologic processes among the 3 kinds of injury and the FINa content is a useful index to manifest the changes of microvascular permeability in tissues.

Objective To determine if the cardiac index (CI) measured with arterial pressure-based cardiac output (APCO) agrees with that measured with pulmonary artery catheter (PAC) during cesarean section in parturients with congenital heart disease and severe pulmonary hypertension.Methods Thirty parturients with congenital heart disease and severe pulmonary hypertension,scheduled for elective cesarean section,were enrolled in the study.APCO and PAC were used for cardiac output and other parameters of hemodynamics monitoring during operation in all patients.Continuous epidural anesthesia was performed.CI was recorded immediately before epidural administration (T1),at 5 and 10 min after epidural administration (T2-3),immediately before delivery (T4),and at 2 and 5 min after delivery (T5-6).The correlation was tested by Pearsone correlation analysis.CI derived from APCO and PAC was compared by Bland-Altman analysis for agreement.Results CI measured with PAC was significantly higher than that measured with APCO (P ＜ 0.05).Compared with the baseline value at T1,no significant difference in CI measured with PAC and APCO was found at T11-T4 and T6 (P ＞ 0.05),and CI measured with PAC and APCO was significantly increased at T5 (P ＜ 0.05).Bland-Ahman analysis showed poor agreement between CI measured with the two methods.The correlation analysis showed that there was positive correlation between CI derived from the two methods at T1-6 (the correlation coefficient was 0.93,0.95,0.94,0.89,0.96 and 0.91 at T1-6,respectively,P ＜ 0.05).Conclusion CI value obtained with APCO agrees poorly with that obtained with PAC during cesarean section in parturients with congenital heart disease and severe pulmonary hypertension,but agrees well in monitoring the changing trend of CI.