Objective To investigate the diagnostic value of carotid artery ultrasonography,CT angiography (CTA)and digital subtraction angiography (DSA)for carotid artery dissection. Methods The image data of carotid artery ultrasonography,CTA,and DSA of 24 patients with carotid artery dissection were analyzed retrospectively. Results Twenty-four,16,and 21 patients were examined with DSA,CTA,and carotid artery ultrasonography respectively. The detection rates of carotid artery dissection with DSA,CTA, and carotid artery ultrasonography were 95. 8%,75.0%,and 71. 4% respectively. The DSA mostly showed the line-like sign (n=12,50 %). CTA and carotid artery ultrasonography mostly showed the double lumen sign;they were 37. 5%(n=6)and 52. 4%(n=11)respectively. Compared with DSA,the concordance rates of carotid artery ultrasonography and CTA were 66. 7% and 81. 3% respectively. There was no significant difference (Kappa=0. 39,P=0. 08 and Kappa=0. 43,P =0. 22 respectively). The concordance rate of ultrasonography in combination with CTA and DSA reached 87. 5%(n=15,Kappa=0. 67,P =0.047). There was significant difference. Conclusion DSA is a gold standard for the diagnosis of carotid artery dissection,and it is irreplaceable. Carotid artery ultrasonography in combination with CTA can improve the diagnostic rate. Carotid artery ultrasonography can be used as a screening method for carotid artery dissection.

Objective To explore the blood-saving and conservation effect and clinical prognosis of extracorporeal circulation circuits designed individually by using medical polymeric materials for adults and infants in cardiac surgical procedures.Methods A total of 41 new extracorporeal circulation circuits designed based on the operation requirements,including 20 for adults and 21 for infants,were applied on adults and infants (body weight less than 10 kg),and the results were compared with that of the conventional circuits on adults (20) and infants (19)respectively.Total priming volume,priming and intraoperative blood products consumption,pump pressure,intraoperative blood hemoglobin (Hb) level,free Hb (f-Hb),platelet (Plt) count,mixed venous oxygen saturation (SvO2),colloid osmotic pressure (COP),lactate (Lac) level,Hb level after modified ultrafiltration,endotracheal intubation time and ICU time were all collected in two groups.Results Priming volume,priming and intraoperative blood consumption and f-Hb level in the blood-saving and conservation circuits group were significantly lower than that of conventional circuits group (P＜0.05).There were no significant differences (P＞0.05) between the two groups in pump pressure,intraoperative blood Hb level,Plt,SvO2,COP,Lac level,Hb level after modified ultrafiltration,endotracheal intubation time and ICU time.Conclusions The minimized blood conservation extracorporeal circulation circuit plays an important role in reducing priming volume and blood transfusion.It maintains a normal level of hemodynamics,oxygenation and tissue perfusion level during cardiopulmonary bypass in cardiac surgery for adults and infants.Red blood cell destruction can be reduced by improving blood compatibility,and physical data are all stabilized intra and post operation.This new circuit is secure,with its better outcome,expected in application.

Objective To summarize and discuss the diagnostic and treating experiences of chronic pancreatitis with mass in the head. Methods Eight patients of chronic pancreatitis with mass in the head who were misdiagnosised as carcinoma of head of pancreas were analyzed retrospectively in the past 10 years. Results All the patients exhibited abdominal pain,5 of whom were with jaundice and 3 with anorexia. All the patients were misdiagnosised as carcinoma of head of pancreas before the operation,but the pathology after operation indicated chronic pancreatitis. The pancreaticoduodenectomy was performed in 5 patients,the choledochojejunostomy in 2 patients,while the exploratory laparotomy in 1 patient. After the operations,the abdominal pain was relieved in 7 patients, while 2 patients who accepted pancreatoduodenectomy suffered from pancreatic fistula,1 of whom died in the end. Conclusion It’s hard to differentiate the chronic pancreatitis with mass in the head from the carcinoma of head of pancreas before operation. If the carcinoma of head of pancreas can’t be excluded during the operation,the pancreatoduodenectomy should be performed,while the duodenum-preserving total resection of the head of the pancreas or any intra-drainage operations should be done if chronic inflammation is found in the whole pancreas with a negative result of the biopsy of the pancreas through the needle aspiration.

Objective To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE MRA) in infrapopliteal occlusive diseases of diabetic patients.Methods A total of 105 patients with known diabetes and peripheral vascular occlusive disease who underwent both CE MRA and DSA examnations were included in this study.They had no obvious stenosis or with stenosis of less than 75％ in iliac,femoral,and popliteal arteries.Every infra-popliteal artery was anatomically divided into 9 vascular segments as tibiofibular trunk artery,proximal and distal anterior tibial artery,proximal and distal posterior tibial artery,proximal and distal peroneal artery,plantar and dorsalis pedis artery.There were 945 segments.The arterial stenosis was accessed with CE MRA and DSA respectively.The segments were scored in 5 categories as＜30％,≥30％ and＜50％,≥50％ and＜75％,≥75％ and＜100％,and 100％ according to stenostic degrees.The Kappa test was used to compare the diagnostic consistency of CE MRA and DSA.Taken DSA as a gold standard for reference,ROC curve was drawn to calculate the diagnostic accuracy of CE MRA in diagnosis of lower limb arterial disease.Results The ratio of statistically valid segments for both CE MRA and DSA were 97.7％ (923/945) in 945 vessel segments of 105 patients,and 390 of 923 arterial segments were both indicated as occlusion by CE MRA and DSA.The diagnostic consistency for the segments was listed in the decreasing order as follows:proximal peroneal artery,proximal posterior tibial artery,distal posterior tibial artery,proximal anterior tibial artery,distal anterior tibial artery,tibiofibular trunk artery,dorsalis pedis artery,plantar artery,distal peroneal artery,and corresponding Kappa values were 0.88,0.86,0.84,0.84,0.81,0.77,0.75,0.75 and 0.73,P＜ 0.05.The AUC(area under ROC curve) of CE MRA was 0.893 with 95％ confidence interval of 0.882 to 0.904.Conclusion CE MRA is an accurate imaging modality in the diagnosis of infrapopliteal occlusive disease s for diabetes.

Objective:To observe the clinical efficacy of morpholine nidazole in the treatment of infection after radical resection of perianal abscess.Methods:Thirty patients diagnosed with perianal abscess were randomly divided into the observation group(given intravenous infusion of morpholine nidazole) and the control group(given intravenous infusion of ornidazole).Results:There was no significant difference in postoperative wound infection rate between the observation group and the control group ( P>0.05). There was significant difference in wound healing quality between the two groups on the 2 d and 7 d after the operation ( P<0.05). There was no significant difference in WBC and neutrophil counts between the two groups ( P>0.05), and the WBC and neutrophil counts in the two groups were significantly lower on the 7th day after the operation than before the treatment, and the observation group was significantly lower than the control group ( P<0.05). After treatment, there was no significant difference in the clearance rate of escherichia coli, klebsiella pneumoniae, bacteroides fragile and staphylococcus aureus in the observation group ( P>0.05), but there was significant difference in the overall bacterial clearance rate compared with the control group ( P<0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group ( P<0.05). Conclusions:The use of morpholinidazole in patients with perianal abscess is effective and safe.

Objective To evaluate the safety of dynamic anterior plate fixation for cervical distractive flexion injuries and compare its rigidity between different types of plate design. Methods Twelve sets of cadaveric calf spine were used in this test. All the specimens were made into distractive flexion injury models (C4-C5) ac- cording to Allen's method. After discectomy and grafting, they were randomized into three groups in which Orion, Codman, and Window instrumentations were used respectively. The stiffness of each construct was tested in flexion, extension, lateral bending and axial torsion conditions sequentially. Results Compared with an intact cervical spine, the range of motion (ROM) of an injured cervical spine increased whatever plate was applied. Orion in- strumentation presented stiffness the closest to that of the normal control, except for less torsional stiffness. Codman instrumentation provided stiffness close to that for normal and Orion groups only in lateral bending. Window's was the weakest mad not enough in all kinds of movement. Conclusions Static anterior fixation is the first choice for cervical injuries. Dynamic plate fixation may sacrifice stiffness to some extent, especially when a shifting kind of design is to be chosen.

BACKGROUND:Currently, X-ray examination is mainly used for diagnosis of nonunion. However, this method that relies only on the clinician’s experience and degree of calus mineralization has less accuracy because it is vulnerable to projection, processing conditions and subjective factors. OBJECTIVE:To establish an animal model of nonunion and to detect the variation of biochemical markers and bone mineral density. METHODS: Twenty New Zealand white rabbits were randomly divided into two groups, and bone defect and fracture models were made in the midshaft of the forearm radius, respectively. X-ray examination of the forearm, quantitative CT measurement of bone mineral density and serological test were carried out before and at 2, 3, 4, 5, 6, 7, 8, 10, 12 weeks after surgery.RESULTS AND CONCLUSION:Postoperative X-ray films showed that the in the bone defect group, a little calus formed in three rabbits at 2 weeks, the calus formed stably at 5 weeks, but there was stil no healing at 8 weeks; in the fracture group, the fracture line was blurred at 2 weeks and a large number of caluses formed at 6-8 weeks. Compared with the fracture group, the value of bone mineral density in the bone defect group began to decrease significantly at 5 weeks after surgery. Results from the serological test showed that in the bone defect group, the activity of bone-specific alkaline phosphatase increased after surgery, reached peak at 4 weeks, began to decrease at 5 weeks and became stable at 6 weeks; the activity of tartrate-resistant acid phosphatase 5b increased after surgery, peaked at 4 weeks, then decreased and stabilized basicaly; the expression of N-terminal telopeptide of type I colagen decreased significantly at 5 weeks after surgery and became stable at 6 weeks. These findings indicate that the systematic monitoring of changes in bone mineral density and biochemical indicators such as bone-specific alkaline phosphatase, tartrate-resistant acid phosphatase 5b and type I colagen N-terminal telopeptides may help to reflect the early progress of rabbit nonunion.

OBJECTIVE: To investigate the clinical application and efficacy of ¹²⁵Ⅰ radioactive seeds implantation in the treatment of recurrent salivary gland carcinoma after external radiotherapy. METHODS: From July 2004 to July 2016, 43 cases of recurrent salivary gland carcinoma of the neck after external radiotherapy or surgery combined with external radiotherapy were treated. According to the conventional segmentation radiotherapy for head and neck cancer (once a day, 1.8-2.0 Gy each time, 5 days per week), the cumulative radiation dose of the patients in this group was calculated. In the study, 26 patients received 50-60 Gy, 7 patients received less than 50 Gy, 4 patients received 60-70 Gy, and 6 patients received more than 80 Gy (range: 80-120 Gy). The interval between the last external irradiation and local recurrence was 4-204 months, and the median interval was 48 months. Among them, 25 cases were treated with ¹²⁵Ⅰ radioactive seeds implantation only and 18 cases were treated with ¹²⁵Ⅰ radioactive seeds implantation after operation. The prescription dose was 100-140 Gy. The control rate, survival rate and disease-free survival rate were recorded to evaluate the side effects. RESULTS: The median follow-up time was 27 months (ranging from 2.5 to 149.0 months). Among them, the median follow-up time of adenoid cystic carcinoma patients was 31 months (range: 2.5-112.0 months), and the median follow-up time of mucoepidermoid carcinoma patients was 18 months (range: 5-149 months). The local control rates for 1, 3 and 5 years were 66.5%, 48.8% and 42.7%, respectively. The 1-, 3- and 5- year survival rates were 88.0%, 56.7% and 45.8%, respectively. The disease-free survival rates of 1, 3 and 5 years were 58.3%, 45.4% and 38.1%, respectively. There was no statistically significant difference in local control rate, survival rate, and disease-free survival between the radioactive seeds implantation group and the radioactive seeds implantation group after surgical resection. There were 2 cases of acute radiation reaction Ⅰ/Ⅱ and 3 cases of reaction Ⅲ or above. In the late stage of radiotherapy, there were 8 cases with Ⅰ/Ⅱ grade reaction and 3 cases with Ⅲ grade or above reaction. The incidence of radiation reactions of Grade Ⅲ and above was 7%. CONCLUSION ¹²⁵Ⅰ radioactive seeds implantation provides an alternative method for the treatment of recurrent salivary gland carcinoma after external radiotherapy. The local control rate and survival rate are improved on the premise of low incidence of side effects.
Brachytherapy/adverse effects* ; Humans ; Iodine Radioisotopes/therapeutic use* ; Neoplasm Recurrence, Local/radiotherapy* ; Salivary Gland Neoplasms/radiotherapy* ; Salivary Glands

BACKGROUND: When one is in a stress state, some amino acids as neurotransmitter in his brain are of important regulating action to his cerebral functions and his psychic behaviors,and some traditional Chinese drugs can regulate the stress state of the body.OBJECTIVE:To observe the content changes of glutamic acid,aspartic acid, γ-aminobutyric acid and taurine in the hypothalamus and hippocampus of rats under repeatedly psychic stress so as to investigate the effects of tiaogan recipe, jianpi recipe, bushen recipe and ginsenoside on them.DESIGN: A randomized grouping and controlled observation trial.SETTING:Department of Basic Theory of Traditional Chinese Medicine(TCM) of Basic Medical Science College, Guangzhou University of TCM.MATERIALS:The experiment was completed from March 2002 to January 2003 at the Animal Center of Guangzhou University of TCM.Totally60 Wistar rats were randomly divided into 6 groups: normal, model, tiaogan, bushen, jianpi and ginsenoside groups, with 10 in each group. Compositions and doses of tiaogan recipe: radix bupleuri 5 g, fruetus gardeniae 5 g,radix paeoniae alba 15 g,fructus lycii 15 g,fructus aurantii 6 g,radix rehmanniae 18 g, concha haliotidis 30 g. Compositions and doses of shenqi pill: radix rehmanniae 30 g, rhizoma dioscoreae 15 g, fructus corni 15 g,rhizoma alismatis 10 g,poria 10 g,cortex moutan radicis 10 g,ramulus cinnamomi 4 g, radix aconiti praeparata 4 g. Compositions and doses of sijunzi decoction:radix codonopsis pilosulae 20 g,rhizoma atractylodis macrocephalae 15 g, poria 15 g, radix glycyrrhizae preparata 6 g.METHODS:① The traditional Chinese medicines were conventionally decocted; and the tiaogan recipe condensed to the liquid containing1.69 g/mL crude drug, shenqi pill containing 1.76 g/mL crude drug,sijunzi decoction containing 1.01 g/mL crude drug.Ginsenoside was prepared as 7 g/L water solution.The rats in the normal and model groups were by gavage given 2 mL of 9.0 g/L sodium chloride injection.The rats in the tiaogan, bushen, jianpi and ginsenoside groups were respectively by gavage given 2 mL of tiaogan recipe, shenqi pill, sijunzi decoction and ginsenoside solution 1 hour before immobilization stress. ② Except for rats in the normal group, those in the rest groups were all conducted for establishment of psychic stress reaction model.The rats were put into an immobilization tube,their action space was gradually reduced by using a mobile insertion piece,they were regulated to a nervous state without prpduction of intense revolting, which was done once a day, starting with 4 hours immobilization on the first day, and later on increased by 30-60 minutes per day, for consecutive 14 days. ③ The whole brain of the rats in each group was collected by decapitation,OPA high-performance liquid chromatography was used for assays of the contents of glutamic acid, aspartic acid, γaminobutyric acid and taurine in hypothalamus and hippocampus of the rats.MAIN OUTCOME MEASURES: The content changes of glutamic acid,aspartic acid,γ-aminobutyric acid and tanrine in the hypothalamus and hippocampus of rats in each group.RESULTS: Totally 60 rats involved all entered into the result analysis. ①The content changes of glutamic acid in the hypothalamus and hippocampus of rats in each group:Compared with normal group,the contents of glutamic acid in hypothalamus of rats in the tiaogan, jianpi,bushen and ginsenoside groups were markedly decreased [(21.85±8.19), (15.76±1.80),(14.68±7.91), (21.46±5.45), (13.43±7.68) μmoL/g]; compared with model group,the contents in the tiaogan, bushen, jianpi and ginsenoside groups were obviously raised [(11.04±3.65), (11.78±2.17), (18.67±2.98), (20.91 ±3.96),(17.71±1.83) μ moL/g, P ＜ 0.05, P ＜ 0.01, P ＜ 0.01, P ＜ 0.05]. ② The content changes of aspartic acid in the hypothalamus and hippocampus of rats in each group:Compared with model group,the contents of aspartic acid in the hypothalamus in the jianpi and ginsenoside groups were obviously decreased [(8.65±1.18), (5.72±1.32), (4.67±1.88) μmoL/g, P ＜ 0.01,P ＜ 0.01], while the contents in the hippocampus of rats in the jianpi,bushen and ginsenoside groups were markedly raised[(2.58 ±0.87),(3.93±0.49), (4.52±0.98), (3.83±0.41) μmoL/g, P ＜ 0.01, P ＜ 0.01, P ＜ 0.05].③ The content changes of γ-aminobutyric acid in the hypothalamus and hippocampus of rats in each group:Compared with model group,the contents of γ-aminobutyric acid in the hypothalamus of rats in the tiaogan,jianpi,bushen and ginsenoside groups were markedly decreased[(20.92±4.96), (15.87±2.90), (13.84±2.63), (14.94±3.98), (10.94±3.68) μ moL/g,P ＜ 0.05, P ＜ 0.05, P ＜ 0.01, P ＜ 0.01], while the contents in the hypothalamus were obviously raised [(4.12±1.66), (4.18±1.04), (6.67±1.29),(6.11±0.99), (6.37±0.78) μmoL/g, P＜ 0.05, P＜ 0.01, P＜ 0.01, P＜ 0.01].④ The content changes of taurine in the hypothalamus and hippocampus of rats in each group: Compared with model group, the contents of taurine in the hypothalamus of rats in the tiaogan, jianpi, bushen and ginsenoside groups were markedly decreased [(10.24±1.72), (7.82±1.14), (8.00±2.05),(6.42±3.17) μmoL/g, P ＜ 0.05, P ＜ 0.05, P ＜ 0.01], while the contents in the hippocampus in the jianpi and ginsenoside groups were obviously raised [(12.61±3.51), (17.03±2.74), (18.04±2.14) μnoL/g, P＜ 0.01, P＜ 0.01].CONCLUSION:The central acting site of tiaogan recipe may mainly be in the hypothalamus,possibly being related with down-regulating amino acids.While the central acting sites ofjianpi recipe,bushen recipe and ginsenoside may include the hippocampus and hypothalamus, being mainly related with up-regulating amino acids,through enhancing the integration of the hippocampus on stress so as to gain the effect of anti-injury of stress.