Objective To improve the quality of thyroid surgery though the special surgical instruments and operating skill.Method Sub-total thyroidectomy for 504 pafients with primary hyperthyroidism were done through MPBS illuminating instruments and dissection,scrape absorption and electric coagulation skills of PMOD.Results Five hundred and four eases of sub-total thyroidectomy were successfully performed.The operation time was(50±20)minutes.The blood loss volume Was(60±30)ml.The hospital duration was(54±1)days.The incisions were short and the sears wore even.There was 1 case recurrence of hyperthyroidism and 2 cases of hypothyroidism after(5±3)years follow-up in 482 patients.There were no postoperative complications of hypoparathyroidism and injury of nerve.Conclusion The MPBS and PMOD instruments can be safely applied in thyroid surgery with the advantage of less blood loss,shorter operation time,smaller incision and less side-injuries.

Objective To investigate the distribution of vancomycin-resistant genes and virulence genes in vancomycin-resistant Enterococcus (VRE) isolates from intensive care unit (ICU).Methods A total of 180 anal swabs were collected from patients in ICU in Tianjin Medical University General Hospital during September 2012 and May 2013.VRE strains were screened by ChromID agar method.Vitek 2 Compact system was used in drug sensitivity test,and the sensitivities to vancomycin and teicoplanin were further determined using Kirby-Bauer disk diffusion method.Vancomycin resistant genes vanA,vanB,vanC1 and virulence genes esp,hyl were detected by polymerase chain reaction(PCR).Results Nineteen strains of vancomycin resistant Enterococcusfaecium were isolated from 180 anal swabs.All 19 VRE isolates were resistant to both vancomycin and teicoplanin,while they were susceptible to linezolid and tigecycline.All VRE isolates carried vanA and esp genes,and hyl gene was positive in 10 isolates.Conclusions VRE isolates from ICU are highly resistant to commonly used antibacterial agents,and most isolates carry vancomycin-resistant genes and virulence genes.Linezolid and tigecycline may be recommended for VRE infection in ICU.

Objective To study the therapeutic effects and mechanisms of Astragaloside-Ⅳ (ASG-Ⅳ) on diabetic cardiomyopathy (DCM) in the rat diabetic model. Methods Forty SD(Sprague-Dawley)healthy rats were used. The diabetic retinopathy rats model were induced by STZ, 45 mg/kg, 3d. Another 10 were injected the same amount of citrate buffer as a control group. Fasting blood glucose was measured with SureStep Plus detector 72 h later. The blood glucose of the diabetes model was ≥16.7 mmol/L. And 12 weeks later, DCM rats were divided into 4 groups randomly in the experiment, includes: DCM, ASG-Ⅳ-L (10 mg/kg), ASG-Ⅳ-M (30 mg/kg), ASG-Ⅳ-H (60 mg/kg)groups. After give dugs 4 weeks, the phosphokinase isoenzyme (CK-MB) and LDH level were tested, the cardiac hypertrophy was evaluated by HW/BW and LVW/BW. Activity of Na+-K+-ATPase and Ca2+-ATPase were determined in left ventricular tissues by ATPase ELISA Assay Kit. The content of FFA was measured and myocardial pathological examination was performed. Results Compared with the control group, blood and urine glucose were higher than experimental animal in diabetic model group, were significantly increased (P<0.05). LDH and Phosphokinase isoenzyme (CK-MB) level were significantly increased, the HWI and LVWI ratio were enhanced in DCM group (P<0.05). ASG-Ⅳ could reduce the ratio of HWI and LVWI, decrease the level of CK-MB and LDH, improve the pathomorphological changing of DCM rat model (P<0.05). Moreover, compared with DCM group, ASG-Ⅳ could restore the Na+-K+-ATPase and Ca2+-ATPase activity, reduced the content of FFA (P<0.05). Conclusion ASG-Ⅳ plays therapeutic effect on diabetic cardiomyopathy might via restore the Na+-K+-ATPase and Ca2+-ATPase activity, reduce the content of FFA, protect the myocardial energy metabolism in DCM.

Objective To evaluate the CT image features of urinary tract inflammatory myofibroblastic tumor (IMT) for use in clinical and differential diagnosis.Methods Eight pathologically proven IMT cases were retrospectively analyzed in this study.There were six female patients and two male patients.Patient average age was 35 (13-62) years.The main clinical manifestations were hematuria and urination pain.Tumors were found in the bladder in 5 cases,in ureter in 2 cases and in urethra in 1 case.All the 8 cases accepted CT scan five of which had contrast enhanced CT scan.The imaging features were then analyzed.Results Of the IMT in bladder,CT scan showed a cauliflower like bladder tumor or round soft tissue mass with even or uneven density of 11.5-36.0 HU.Three tunors were accompanied with necrosis.Four cases had associated adjacent bladder wall thickening and two cases were found with fuzzy surrounding fat space.Ureteral lesions in two cases showed a solid mass with smooth edges and even density of 40.3 HU compared to the surrounding muscle.The urethral lesions had clear mass realm of 17.5-22.6 HU accompanied with calcification.Enhanced CT scan showed that homogeneous or heterogeneous mild to moderate enhancement was found in the tumor.Delayed phase showed consistant enhancement of 102.7-118.6 HU.Conclusion Tumor CT imaging features,particularly the significant and consistant enhancement in delayed phase,provide important information for diagnosis and differential diagnosis of the urinary tract IMT.

Objective To compare the effect of allograft and autograft of bone-patellar tendon- bone (B-PT-B) under arthroscopy in reconstruction of anterior cruciate ligament (ACL).Methods The injured ACL was reconstructed under arthroscopy by using autograft of B-PT-B in 30 cases and al- lograft of B-PT-B in 28 cases from January 2000 to August 2003.After over twelve months follow up,a comparison was done on rehabilitation of quadriceps femoris,knee stability,the Lysholm's score of knee and the enlargement of tunnel in both groups.Results Both groups obtained marked improvement of knee stability and symptoms after operation.But in the early time,the rehabilitation of quadriceps femoris in the ailograft group is faster than that in the autograft group.The rehabilitation of quadriceps femoris, knee stability and the Lysholm's score of knee were similar at 12th month (P＞0.05).There could be seen enlargement of tunnel in both groups,with more in the allograft group (P＞0.05).Conclusion For arthroscopic reconstruction of anterior crucial ligament (ACL),allograft of B-PT-B is good substitute, for it is characterized by effectiveness,convenience and minor side effect.

Objective To evaluate the safety,biocompatibility and efficacy of transcatheter closure of atrial septal defect(ASD)with no stainless-steel-screw occluder in canine model.Methods The device was constructed from superelastic Nitinol wires tightly woven into two flat disks and sewed with polyester fibers inside,with a pliable loop on the right-atrial-disk of the device,connecting to the delivery cable.ASD was created by transcatheter puncture and balloon dilatation and then closed by occluder under fluoroscopy in the catheterization laboratory.The location and the influence of the implanted device on function of tricuspid valve and mitral valve were evaluated by echocardiography.At 1,2,3 and 6 months after the operation,the animals were killed and autopsy was conducted.Results Eight dogs with puncture-produced ASD underwent ASD closing procedure successfully.The occluder showed no influence on the function of MV and AV demonstrated by echocardiogram.The two disks of the implanted device were covered with a smooth intact neogenesis layer in all dogs.Endocardial cells fully covered the surface of the two disk without inflammating reaction 3 months later. There was no evidence of corrosion on the surface of the nitinol wire removed from the dog after 6 months.Light microscopic examination of the liver,kidney,lung and spleen showed no evidence of embolization and inflammation.Conclusion Transcatheter ASD occlusion with new-type occluder is safe,feasible,effective and good biocompatibility with a good prospective clinical application.

Objective The purpose of this study was to assess the incidence,treatment and prognosis of silent pulmonary embolism (PE) after off-pump coronary artery bypass graft (CABG).Methods From December 2009 to September 2012,582 consecutive patients underwent off-pump CABG by a same surgeon.Their age ranged from 16 to 86 years with a mean age of (61.4 ± 9.3) years.Left internal mammary artery and saphenous vein were harvested routinely.A dose of 20 mg unfractionated heparin was given intravenously every 6 hours on the operative day after postoperative pleural fluid less than 50 ml per hour.All patients received aspirin 100 mg daily starting on postoperative day 1.The 64-slice coronary MDCT was performed to assess the graft patency on postoperative day 5 ～ 7.Results There were no in-hospital death.PE,which involved the lobar or more proximal arteries,was detected on the CT images of 10 patients (1.7％).In these 10 patients,there were no significant dyspnea or hypoxemia postoperatively ; echocardiography and ECG showed no specific signs of PE ; all bypass grafts were patent in CT images except a LIMA to LAD graft with LAD endarterectomy.PE involved both lungs in 6 patients,and only the right lung in 4 patients.All patients received anticoagulation with warfarin for 3 to 6 months except one.All patients were with good quality of life during 6 to 18 months of follow-up.Three to six months after discharge,8 patients received repeated MDCT,which showed diminish of PE.Conclusion Acute PE after off-pump CABG was an uncommon complication and was difficult to diagnose.MDCT played an important role in examining the patency of graft vessels and helped detect silent PE in CABG patients.The prognosis of acute PE after off-pump CABG was acceptable.PE diminished after 3 months of anticoagulation with warfarin.

OBJECTIVETo study on the reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in total knee arthroplasty (TKA) the rotational alignment reference bony landmarks of the proximal tibial component on magnetic resonance image (MRI) were measured.

METHODSFrom January 2010 to December 2013, 80 normal knees of Chinese volunteers including 35 males and 45 females with an average age of (35.4±6.1) years were reviewed. The images of the knees were obtained by MRI. The surgical epicondylar axis (STEA) was identified in the femoral transverse sections and then was projected to the side of tibia, forming the SETA'. A line connecting the medial border of the patellar tendon and the middle of the posterior cruciate ligament insertion (Akagi line) and its vertical line (AK), as well as a line connecting the medial 1/3 of the patellar tendon and the middle of the posterior cruciate ligament insertion and its vertical line (AP), were identified in the tibial transverse sections. The angles were measured between the AK, AP and STEA'.

RESULTSThe angle between AK and STEA' was (0.59±2.07)°, and there was no significant difference between the two lines (t=-2.54, P=0.13). The mean angle between AP and STEA' was (3.21±2.04)°, and there was a significant difference between the two lines (t=14.05, P<0.05). There was a significant difference between the AK and AP (t=-11.68, P<0.05).

CONCLUSIONThe reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in TKA is good.

Adolescent ; Adult ; Arthroplasty, Replacement, Knee ; methods ; Female ; Humans ; Male ; Middle Aged ; Reproducibility of Results ; Rotation ; Tibia ; surgery

Objective To investigate the feasibility of setting mAs in liver enhanced CT scan according to plain scan noise with fixed mA CT scanner,in order to reduce the radiation dose.Methods One hundred continuous patients underwent liver enhanced CT scan (group A) prospectively.Two hundred and fifty mAs was used in plain and enhanced CT scans.Noises of plain and venous phase CT images were measured,and the image quality was evaluated.The equation between mAs of enhanced scan and noise of plain scan image was derived.Another 100 continuous patients underwent liver enhanced CT scan (group B).Enhanced scan mAs was calculated from noise on plain scan by using the equation above.Noises on venous phase images were measured and the image quality was measured.Based on body mass index (BMI),patients in groups A and B were divided into three subgroups respectively:BMI ＜ 18.5 kg/m2,18.5 kg/m2 ≤ BMI ＜ 25.0 kg/m2 and BMI ≥ 25.0 kg/m2.Image quality score was compared with nonparametric rank sum test,CT dose index (CTDI) and effective dose (ED) were measured and compared between each subgroup with 2 independent samples t or t' test.Results The equation between enhanced scan mAs (mAsX) and plain scan noise (SDp) was as follows:mAsX =mAs1 × [(0.989 × SDp + 1.06) /SDx]2,mAs1 =250 mAs,SDx =13.In patients with BMI ＜ 18.5 kg/m2,ED of group A [(6.86 ±0.38) mSv,n =12] was significantly higher than group B [(2.66 ±0.46) mSv,n =10)] (t =18.52,P ＜0.01).In patients with 18.5 kg/m2 ≤ BMI ＜ 25.0 kg/m2,ED of group A [(7.08 ± 0.91) mSy,n =66] was significantly higher than group B [(4.50 ± 1.41) mSv,n =73] (t' =10.57,P ＜ 0.01).In patients with BMI ≥25.0 kg/m2,there was no significant difference between EDs of group A (7.54 ± 0.62 mSv,n =22) and group B [(8.19 ±3.16) mSv,n =17] (t' =0.89,P =0.39).Image quality of 5 patients in group A and none in group B did not meet the diagnostic requirement.Conclusion Setting mAs of enhanced scan according to plain scan noise could reduce the radiation dose with maintainence of image quality.

Objective The aim of this study was to explore the clinical value of dual-source CT(DSCT)in the diagnosis of coronary artery fistula(CAF)before and after surgery. Methods A retrospective analysis was performed in 15 cases of patients with CAF,11 cases of which was treated by surgery during extracorporeal circulation. Results CAF arose from right coronary artery in 8 cases and left coronary artery in 7 cases,with the latter including 3 cases of ramus nodi sinuatrialis fistula,2 cases of anterior descending branch fistula,and 2 cases of left circumflex fistula. CAF entered into right atrium(6 cases),right ventricle(5 cases),left ventricle(4 cases)and left atrium(1 case). There were dilatation of coronary artery in 8 cases,localized aneurysm in 4 cases,normal coronary artery in 3 cases,single fistula orifice in 11 cases,and multiple fistula orifice in 4 cases. 11 patients underwent surgery under cardiopulmonary bypass(CPB).The postoperative imaging revealed fistula has been sutured in 10 patients with no residual fistula,including fistula vascular ligation in 3 cases,the proximal imaging and distal occlusion in right coronary artery angioplasty in 1 case,and pseudo diverticulum in 2 cases. Conclusion DSCT examination has significant value in preoperative diagnosis and postoperative follow-up for CAF.