Objective To evaluate the role of three vessels and trachea view (3VT) in diagnosis of fetal heart disease and great artery abnormality.Methods 39 pregnant women undergoing fetal ultrasound scan and diagnosed with great artery abnormality were enrolled in this study.Then the image characteristics and significance of 3VT in these 39 cases were analyzed and evaluated.Results In these 39 cases proved by autopsy,persistent truncus arteriosus(7 cases),transposition of the great arteries(7 cases),coarctation of the aorta(5 cases),tetralogy of Fallot (4 cases),pulmonary stenosis (3 cases),hypoplastic left ventricle syndrome(2 cases),persistent left superior vena cava (2 cases),pulmonary valve stenosis with single ventricle(2 cases),Ebstein anomaly with pulmonary stenosis (1 case),interruption of the aortic arch( 1 case),hypoplastic right ventricle(1 case),dextroaortic arch (1 case),and ductus arteriosus stenosis( 1 case) were detected.All of them had anomalies performance on 3VT.While in the 2 cases of double outlet right ventricle,only one eoncurrenting with pulmonary artery stenosis showed reduced inner diameter of pulmonary artery on 3VT.According to the performance of 3VT in great artery abnormality,it could be divided into 4 categories:abnormal location,abnormal ratio,abnormal amount and abnormal blood direction of great artery.Conclusions 3VT is a useful supplement to the 4-chamber view,and has significant value in diagnosis of fetal heart and great arteries abnormities.

OBJECTIVETo evaluate the clinical results of using end plate rings in preventing subsidence of titanium cage in anterior cervical corpectomy and fusion (ACCF) surgery.

METHODSThe clinical data of 71 patients with cervical spondylotic myelopathy underwent ACCF in single segment from February 2008 to February 2011 were retrospectively analyzed. There were 38 males and 33 females, aged from 39 to 74 years old with a mean of 53.8 years. Thirty-three were used end plate rings and thirty-eight were not used (end plate rings group and no end plate ring group, respectively). The Japanese Orthopaedic Association (JOA) score, Odom's scale, imaging data were used to evaluate the clinical effects. Imaging data including Cobb angle of fusion segment, intervertebral height of anterior border (Da) and posterior border (Dp), the mean intervertebral height (Dm).

RESULTSAll patients were followed up from 13 to 34 months with an average of 19.5 months. Between two groups, there was no significant difference in Cobb angle of fusion segment and the mean intervertebral height (Dm) before surgery and one week after surgery. Whereas, one year after surgery, the Cobb angle of end plate ring group was (9.4 ± 3.8) degrees, and contral group was (7.5 ± 3.9) degrees, which was significantly lower than that of end plate ring group. Meanwhile, the Dm of end plate ring group was (57.3 ± 2.2) mm, and no end ring group was (55.2 ± 2.6) mm which was significantly lower than that of end plate ring group. The subsidence in end plate ring group was 57.6%, and was 78.9% in no end plate ring group. There was no significant difference in JOA score before and after surgery between two groups. At 1 year after operation, 90.9% (30/33) got excellent or good results in end plate ring group, 89.5% (33/38) got excellent or good results in contral group.

CONCLUSIONThe use of end plate rings could not completely prevent the subsidence of titanium cage, however, which can decrease the occurrence rate of the subsidence and lessen its degree.

Adult ; Aged ; Bone Plates ; Cervical Vertebrae ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Orthopedic Fixation Devices ; adverse effects ; Spinal Fusion ; instrumentation ; methods ; Spondylosis ; pathology ; surgery ; Titanium

Objective To analyze the clinical results and prognostic factors of patients with early-stage primary gastric mucosa-associated lymphoid tissue(MALT) lymphoma. Methods Seventy-seven pa-tients with primary gastric MALT lymphoma treated from 1985 to 2006 were retrospectively analyzed. All pa-tients were pathologically confirmed as MALT lymphoma in stage Ⅰ ,Ⅱ and ⅡE (by modified Blackedge staging system). Thirty-seven patients had stage Ⅰ disease,23 stage Ⅱ and 17 stage ⅡE. Sixty patients un-derwent surgical resection and 17 received non-surgical treatment. Survival rates were calculated by the Kap-lan-Meier analysis with the Logrank test. Results With a median follow up of 57 months for the surviving patients(ranging from 1 to 198 months for all patients), the 5-year overall survival rate, disease-free survival rate,loco-regional control rate and distant metastasis free survival rate were 74% ,70% ,76% and 87% ,re-spectively. In univariate analysis, clinical stage was significantly associated with overall survival. Patients with stage Ⅰ or Ⅱ disease had a better overall survival than those with stage ⅡE (P = 0.01). Tumor size and surgical resection were significantly associated with disease-free survival. Patients with primary tumor 8 cm or less in diameter had better disease-free survival than those with primary tumor more than 8 cm in diameter(P =0.03). Patients who underwent complete resection had better disease-free survival than those who under-went incomplete resection or no surgery (P =0.02). Clinical stage, tumor size and surgical resection were significantly associated with loco-regional control. Patients with stage Ⅰ or Ⅱ disease had better loco-regional control than those with stage ⅡE (P = 0. 03). Patients with primary tumor 8 cm or less in diameter had better loco-regional control than those with primary tumor more than 8 cm in diameter(P =0.01). Patients who un-derwent complete resection had better loco-regional control than those who underwent incomplete resection or no surgery(P=0.03). Patients with stage Ⅰ and Ⅱ disease treated with surgery had more local recurrence, and patients treated without surgery tended to recur systematically. Patients with stage ⅡE disease tended to recur locally in spite of surgery or not. Conclusions The efficacy of surgical and non-surgical treatment for primary gastric MALT lymphoma are similar. Surgical resection is no longer a necessary approach in the primary treatment. Clinical stage is an important prognostic factor for primary gastric MALT lymphoma.

BACKGROUNDCisplatin based chemotherapy is a well recognized risk factor for coagulation disorders and thrombosis. The pathophysiological mechanisms by which cisplatin promote thrombosis are not well understood.

METHODSRed blood cells (RBCs) were separated from peripheral blood of patients with breast cancer (n = 10) and healthy adults (n = 6) and treated with cisplatin. Coagulation time of RBCs was assessed by one step recalcification time and the productions of thrombin, intrinsic and extrinsic factor Xa were measured in the presence or absence of various concentrations of lactadherin. Exposed phosphatidylserine was stained with lactadherin and observed by confocal microscopy and flow cytometry.

RESULTSNeither fresh RBCs nor RBCs treated without cisplatin had potent procoagulant activity. Cisplatin treatment increased procoagulant activity of RBCs in a cell number- and concentration-dependent manner. Exposed phosphatidylserine was stained with lactadherin and after cisplatin treatment, strong fluorescence was revealed by confocal microscopy. Lactadherin bound RBCs from patients with breast cancer increased from (1.9 +/- 0.5)% on control RBCs to (68.0 +/- 3.5)% on RBCs treated with 10 micromol/L cisplatin for 24 hours.

CONCLUSIONSCisplatin treatment increases procoagulant activity of RBCs, which have a strong association with exposure of phosphatidylserine. The increased procoagulant activity may contribute to the pathogenesis of thrombophilia during cisplatin based chemotherapy in breast cancer patients.

Antineoplastic Agents ; pharmacology ; Blood Coagulation ; drug effects ; physiology ; Cisplatin ; pharmacology ; Erythrocytes ; drug effects ; physiology ; Humans ; In Vitro Techniques

OBJECTIVETo explore the possibility of using distraction osteogenesis to repair skull defect.

METHODS17 goats with one year age were chosen randomly. The animals were divided to 3 groups. Group A includes 7 goats, a 3.0 cm x 2.2 cm rectangle skull defect is created on both sides of parietal area. Group B includes 5 goats, a 2.2 cm x 2.2 cm square skull defect was created on right side of parietal area. Group C includes 5 goats, a 3 cm x 1 cm rectangle skull defect was created on both sides of parietal area. Accordingly, different size of transport discs were created on right side of skull and the distraction apparatus is implanted. 3-D CT was done to measure the skull defect on group A. Biomechanical test was done on group B. Process of bone formation illustrated by histological stain, scan and transparent electric microscope was observed on group C.

RESULTSGroup A measured by 3-D CT showed that skull defect of experimental side have been repaired by distraction osteogenesis. There was definitely difference between experimental and control side (P < 0.01). Group B measured by biomechanical test showed no definitely difference between experimental and normal side (maximum load P = 0.235 > 0.05, rigidity P = 0.213 > 0.05). Group C showed that the process of bone formation was typical intramembranous.

CONCLUSIONSThe evidence showed that skull defect of goat can be repaired by distraction osteogenesis.

Animals ; Goats ; Osteogenesis, Distraction ; Skull ; pathology ; surgery

BACKGROUNDCathepsin S and its endogenous inhibitor cystatin C are implicated in the pathogenesis of atherosclerosis, especially in the plaque destabilization and rupture leading to acute coronary syndrome. However, whether circulating cathepsin S and cystatin C also change in association with coronary plaque morphology is unknown yet.

METHODSWe recruited 98 patients with unstable angina (UA, n = 6) or stable angina (SA, n = 2) who had a segmental stenosis resulting in > 20% and < 70% diameter reduction in one major coronary artery on coronary angiography. Thirty-one healthy subjects served as controls. Intravascular ultrasound (IVUS) was used to evaluate plaque morphology. Plasma cathepsin S and cystatin C were measured as well.

RESULTSAt the culprit lesion site, plaque area ((7.85 +/- 2.83) mm(2) vs (6.53 +/- 2.92) mm(2), P = 0.027), plaque burden ((60.92 +/- 11.04)% vs (53.87 +/- 17.52)%, P = 0.025), remodeling index (0.93 +/- 0.16 vs 0.86 +/- 0.10, P = 0.004) and eccentricity index (0.74 +/- 0.17 vs 0.66 +/- 0.21, P = 0.038) were bigger in UA group than in SA group. Plasma cathepsin S and cystatin C were significantly higher in patients than in controls (P < 0.01). Plasma cathepsin S was higher in UA group ((0.411 +/- 0.121) nmol/L) than in SA group ((0.355 +/- 0.099) nmol/L, P = 0.007), so did the plasma cystatin C ((0.95 +/- 0.23) mg/L in UA group, (0.84 +/- 0.22) mg/L in SA group; P = 0.009). Plasma cathepsin S positively correlated with remodeling index (r = 0.402, P = 0.002) and eccentricity index (r = 0.441, P = 0.001), and plasma cystatin C positively correlated with plaque area (r = 0.467, P < 0.001) and plaque burden (r = 0.395, P = 0.003) in UA group but not in SA group.

CONCLUSIONSPlasma cathepsin S and cystatin C increased significantly in UA patients. In angina patients, higher plasma cathepsin S may suggest the presence of vulnerable plaque, and higher plasma cystatin C may be a clue for larger atherosclerotic coronary plaque.

Adult ; Aged ; Aged, 80 and over ; Cathepsins ; blood ; Coronary Artery Disease ; blood ; diagnostic imaging ; pathology ; Cystatin C ; blood ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Ultrasonography, Interventional ; methods

The 5th edition of WHO Laboratory Manual for the Examination and Processing of Human Semen (2010) represents a comprehensive revision. This article aims to explore the applicability of this manual to andrology laboratories in China mainland in view of sperm count analysis, sperm motility analysis, sperm morphology analysis, sperm function analysis, anti-sperm antibody and seminal plasma biochemical marker analysis, and quality assurance and quality control of semen analysis. The authors deem that its recommendation to the analysis method and lower reference limit of sperm concentration may be a little arbitrary and lack of evidence-based support, that the revised grading sperm motility, the strict criteria and the very low cut-off value of 4% morphologically normal spermatozoa for the evaluation of sperm morphology are not applicable to andrology laboratories in China mainland, that the sperm function markers need to be supplemented, and that the determination methods of anti-sperm antibody and seminal plasma biochemical markers are incompatible with the status of Chinese andrology laboratories. However, its recommended methods for quality assurance and quality control of semen analysis have a significant directive role in China mainland. It is worth to point out that the WHO manual ignored the data obtained from Chinese which accounts for approximate 20% of the world population. Thus, given the importance of the WHO manual, its general applicability should be evaluated in China.
Andrology ; Clinical Laboratory Techniques ; Humans ; Male ; Manuals as Topic ; Semen ; Semen Analysis ; Sperm Count ; Sperm Motility ; World Health Organization

Adult ; Female ; Femoral Fractures ; surgery ; Fracture Fixation ; methods ; Humans ; Knee Injuries ; surgery ; Male ; Middle Aged ; Tibial Fractures ; surgery

OBJECTIVETo compare the safety and efficacy of RevoLix 120 W 2 µm continuous-wave (cw) laser enucleation of the prostate with transurethral resection of prostate (TURP) in patients with symptomatic benign prostatic hyperplasia (BPH). And to evaluate clinical value of 120 W 2 µm cw laser enucleation.

METHODSAll 168 patients with BPH underwent 2 µm cw laser enucleation (n = 88) or TURP (n = 80) between January 2010 and January 2011. The operative time, drop in hemoglobin, drop in serum sodium, indwelling catheterization time and operative complications were recorded. International prostate symptom score (IPSS), quality of life (QOL), urinary peak flow rate (Qmax) and post-voiding residual urine (PVR) were also compared.

RESULTSThe mean operative time was slightly longer in the 2 µm laser group ((63.2 ± 21.6) min) than the TURP group ((59.4 ± 18.6) min) (P > 0.05). Transfusions were not necessary in 2 µm laser group. Catheter indwelling time were (1.8 ± 0.6) days vs. (3.5 ± 2.6) days in 2 µm laser group than in TURP group (t = 3.912, P < 0.05). All cases were followed up for 3 - 12 months, the IPSS, QOL, Qmax and PVR were 6.1 ± 2.0, 4.4 ± 1.6, (18.8 ± 4.8) ml/s and (21.6 ± 16.5) ml in the 2 µm laser group, and were 6.3 ± 2.4, 1.9 ± 1.1, (18.4 ± 4.2) ml/s, (23.2 ± 14.6) ml in TURP group respectively. All the markers were improved significantly compared with that of preoperative in both groups (t = 12.453 - 26.213, P < 0.01), but no statistical differences could be found between the two groups. Perioperative complications were less in the 2 µm laser group.

CONCLUSIONSThe 120 W 2 µm cw laser enucleation is an novel excellent treatment for BPH as well as TURP, and has the advantage of significantly less blood loss, shorter hospitalization, shorter catheter indwelling time and rapid recovery after surgery.

Aged ; Aged, 80 and over ; Electrosurgery ; Follow-Up Studies ; Humans ; Laser Therapy ; Male ; Middle Aged ; Prostatic Hyperplasia ; surgery ; Transurethral Resection of Prostate ; methods ; Treatment Outcome

BACKGROUND: Proximal femoral nail anti-rotation is widely used to treat various intertrochanteric fractures. Although its operation trauma is small, and the blood loss of perioperative period is still large. Tranexamic acid has been gradually used to reduce the bleeding of intertrochanteric fracture. The effectiveness and safety of reducing blood loss during perioperative period were not reported. OBJECTIVE: To explore the safety and efficacy of tranexamic acid on perioperative blood loss in patients with intertrochanteric fracture undergoing proximal femoral nail anti-rotation. METHODS: One hundred and eight patients with intertrochanteric fracture undergoing proximal femoral nail anti-rotation were selected from First Affiliated Hospital, Guangzhou University of Chinese Medicine between January 2015 and January 2017. Among all the subjects, 52 patients who received the operation before January 2016 served as the control group and 56 patients who received the operation after January 2016 were selected as the treatment group. Half an hour before operation, patients in the treatment group received 1 g tranexamic acid dissolved in 250 mL normal saline by intravenous dropping; patients in the control group just received 250 mL normal saline by intravenous dropping. The bleeding volume, blood transfusion volume, hemoglobin, hematocrit, coagulation index, D-dimer levels and complications were compared between the two groups. RESULTS AND CONCLUSION: (1) During perioperative period, actual blood loss, intraoperative blood loss, dominant blood loss, recessive blood loss, volume of drainage, blood transfusion volume and blood transfusion rate were lower in the treatment group than in the control group (P < 0.05). (2) There was no statistically significant difference in the hemoglobin and hematocrit between the two groups before operation (P > 0.05). The hemoglobin and hematocrit of the two groups gradually decreased after the operation, and there was a slight improvement in the fifth day after surgery. At postoperative 2 hours, 1, 3 and 5 days, the hemoglobin and hematocrit of the treatment group were higher than in the control group (P < 0.05). At preoperation and each time point postoperation, prothrombin time, activated partial thromboplastin time, and fibrinogen levels were not statistically significant between the two groups (P > 0.05). Postoperative D-dimer levels in the two groups were significantly higher than preoperation, and there was a return on the fifth day. There was no statistically significant difference between groups at preoperation and each time point of postoperation (P > 0.05). (3) The results suggest that the tranexamic acid can effectively reduce the dominant and recessive blood loss in patients with the intertrochanteric fracture, and it is safe and effective.