Objective To evaluate the early diagnosis value of MRI combined with DSA in cirrhotic nodules (regenerative nodules, dysplastic nodules) becoming small hepatocellular carcinoma. Methods 40 patients diagnosed as cirrhosis and whose liver nodules detected by ultrasound were followed up as MR dynamic study. All patients were followed up by three dynamic contrast-enhanced MR scanning once every 3 months,and the changes of cirrhotic nodules were observed and analyzed in the signal. If MRI suggested cancerous nodules cirrhosis, hepatic artery DSA would be carried out. Results 40 patients were followed up for 1.5 to 3 years,all patients MR nodules were found in liver regeneration. Follow-up process, the dysplastic nodules were founded in 28 cases and the small hepatocellular carcinoma were founded in 18 patients. 16 cases of 18 patients with small hepatocellular carcinoma carried out routine DSA all had typical of hepatic arterial blood supply and angiogenesis, and were given to Integrated Traditional and Western intervention simultaneously. Conclusion Combined use of MRI-DSA in the evaluation of cirrhotic nodules had a definite value, and could find smaller hepatocellular carcinoma,provide the basis for smaller hepatocellular carcinoma therapy.

Blood-brain barrier (BBB) is a kind of important barrier system in the body. It can have a choice to prevent certain substances from entering the brain, in order to maintain the relative stability of internal environment of the central nervous system (CNS). However, it also became an important restriction factor for the treatment of CNS diseases. Traditional Chinese medicine (TCM) had good curative effects on several kinds of CNS diseases, which illustrated that effective composition of TCM can pass through or influence the function of BBB. This paper summarized the research progress of literatures on current pharmacological and clinical trials for the effect of TCM on BBB.

Objective To approach the evaluative effect of respiratory variation of superior vena cava peak flow velocity measured using transthoracic echocardiography (TTE) on fluid responsiveness in patients with mechanical ventilation.Methods A prospective cohort study was conducted.All mechanical ventilated critically ill patients whose fluid therapy was planned due to hypovolemia in Department of Critical Care Medicine of Beijing Tongren Hospital of Capital Medical University from April 2011 to April 2013 were enrolled.Volume expansion was performed with 500 mL Linger solution within 30 minutes.Patients were classified as responders if pulse pressure variation (PPV) increased ≥ 13％ before volume expansion.The respiratory variation in superior vena cava peak velocity was calculated as the difference between maximum and minimum values of velocity in peak A,peak S and peak D over a single respiratory circle,and their variations (ΔA,ΔS,ΔD) were also calculated.The receiver operating characteristic curve (ROC curve) was plotted to assess the evaluative effect of respiratory variation of superior vena cava peak velocity on fluid responsiveness.Results Twenty-seven patients were enrolled in this study.Volume expansion increased PPV ≥ 13％ happened in 14 patients (responders).The velocity of superior vena cava in peak A,peak S,peak D was significantly increased after volume expansion compared with that before volume expansion in responders [peak A (cm/s):34.6 ± 2.2 vs.31.3 ±2.1,t=-2.493,P=0.027; peak S (cm/s):39.1 ± 1.3 vs.35.3 ±2.1,t=-2.564,P=0.024; peak D (cm/s):28.1 ± 1.2 vs.23.3 ± 1.4,t=-4.995,P=0.000],but there was no significant difference in ΔA,ΔS and ΔD between before and after volume expansion.The ΔA,ΔS and ΔD were positively correlated with PPV (r＝0.040,P=0.854; r=0.350,P=0.074; r=0.749,P=0.000).The area under ROC curve (AUC) of peak S was 0.36 [95％ confidence interval (95％CI):0.11-0.52],but the AUC of ΔS was 0.68 (95％CI 0.47-0.89),the AUC of peak D was 0.41 (95％CI 0.19-0.63),but the AUC of ΔD was 0.95 (95％CI 0.86-1.00),so the aberration rate of superior vena cava in respiration was better than the flow rate in superior vena cava.When the cut-off value of ΔS was 20.7％ for predicting fluid responsiveness,the sensitivity was 78.6％ and the specificity was 61.5％.When the cut-off value of ΔD was 12.7％ for predicting fluid responsiveness,the sensitivity was 92.0％ and the specificity was 92.3％.Conclusion Respiratory variations in superior vena cava peak velocity measured by TTE could assess fluid responsiveness in patients with mechanical ventilation.

  Objective  To summarize the clinical manifestations, pathological features and gene mutation diversity of Blau syndrome/early-onset sarcoidosis.  Methods  We collected general data, clinical manifestations, and auxiliary examination results from 8 patients who were diagnosed of Blau syndrome/early-onset sarcoidosis and treated in our hospital from January 2011 to December 2022, and then summarized and analyzed their characteristics and diversity.  Results  Among the 8 patients, 4 were males and 4 were females. The onset age was 3 to 8 months old. Rash was the first symptom in 7 patients(87.5%). 6 patients(75.0%) had papules and erythema.3 cases(37.5%) had arthritis. 2 cases(25.0%) had uveitis and other eye inflammation. 4 cases (50.0%) also showed intermittent fever. 3 cases (37.5%) showed symptoms in nerve and respiratory system, and hypertension respectively. The skin histopathology of 8 patients showed non-caseous granuloma formation. In laboratory detection, CRP and TNF-α were significantly increased before treatment, while IL-6, IL-8, TNF-α and IL-2 receptor(IL-2R) were significantly decreased in 5 patients after glucocorticoid therapy. The results of genetic testing showed that 4 of the 7 patients had p.R334W(c.1000C > T) mutation, 1 had p.H313R(c.938A > G) and p.R471C(c.1411C > T)double mutation, and 1 had p.476_477del (c.1427_1429delcct).  Conclusions  Blau syndrome/early-onset sarcoidosis has significant features in clinical manifestations, histopathology and gene mutation, but it also has diversity.

OBJECTIVETo analyze the infection of human parvovirus B19, human bocavirus (HBoV) and human parvovirus 4 (PARV4) in blood samples among patients with liver disease in Nanjing by molecular detection.

METHODSNested PCR assays were designed and validated to detect B19, HBoV and PARV4, respectively. The assays were used to screen three parvoviruses in blood samples from 95 patients with different liver disease in Nanjing. The parvovirus infection was analyzed statistically.

RESULTSThe detection limits were 10 copies of genomic DNA equivalents per reaction for each assays and the good specificity were observed. The frequency of B19 and HBoV were 2/95 (2.1%) and 9/95 (9.5%) in blood samples respectively. No PARV4 was detected. HBoV was detected in 3/5 patients with drug-induced hepatitis.

CONCLUSIONBoth B19 and HBoV infection were detected in blood from patients with liver disease.

Adolescent ; Adult ; Aged ; Child ; Coinfection ; virology ; Female ; Human bocavirus ; isolation & purification ; Humans ; Liver Diseases ; virology ; Male ; Middle Aged ; Parvovirus ; isolation & purification ; Parvovirus B19, Human ; isolation & purification ; Polymerase Chain Reaction ; Viremia ; virology

OBJECTIVETo evaluate the clinical short-term results of the acellular dermal matrix for guided bone regeneration.

METHODSSixty-four patients with bone defect in anterior maxillary area (average bone width: 3 mm) were included. Ridge-splitting technique with simultaneous placement of implants and artificial bone material implantation was performed in 21 patients (non-membrane group). Forty-three patients received the same procedure but with acellular dermal matrix covering the surgical sites (membrane group). The patients were followed up for three months and the new bone formation was checked in clinic and by X-ray.

RESULTSThree months after operation, the membrane group showed good osseointegration and high bone density over the implant cover screws. In the second operation, the membranes became thinner and the new bone fully covered the implant in the membrane group. The labial bone exhibited slight absorption and labial surface of 7 implants in 7 patients was exposed in non-membrane group. The width and the height of the ridge in the second operation were greater in membrane group than in non-membrane group (P < 0.05).

CONCLUSIONSThe acellular dermal matrix can effectively resist the growth of soft tissue to allow bone regeneration around the implant.

Acellular Dermis ; Bone Regeneration ; Bone Substitutes ; Dental Implants ; Guided Tissue Regeneration, Periodontal ; Humans

OBJECTIVE: To observe the effect of sevoflurane on the induction and maintenance of anaesthesia in children, and to evaluate its safety and effectiveness. METHODS: Forty child patients who conformed to the selection standard were operated under anaesthesia with intubation.Without premedicant, all the patients inhaled 100% oxygen(1L/min) and sevoflurane by mask, and escalated the concentration of sevoflurane (to the maximum concentration 7%) until the lash reflex disappeared, and the maintenance concentration was controlled under 4%. All the patients were intubated, together with vecuronium 0.1mg/kg. RESULTS: With little tract excretion, the achievement ratio of induction by sevoflurane was 100%, and the children tolerated well. With stable hemodynajmics,1% approximately 4.0% maintenance concentration of sevoflurane during the operation showed effective anaesthesia, no decreased heart rate or blood pressure appeared, and all the patients' body temperature was normal. CONCLUSION Sevoflurane for children induction can bring fewer stimuli in the respiratory tract,less cardiac vascular inhibition and palinesthesia time. Anaesthesia in children induced by sevoflurane is safe and effective.
Anesthesia ; methods ; Anesthesia, Inhalation ; Anesthetics, Inhalation ; administration & dosage ; Child ; Child, Preschool ; Female ; Humans ; Male ; Methyl Ethers ; administration & dosage ; Sevoflurane ; Treatment Outcome

With the continuous progress of human assisted reproductive technology （ART）， more genetic diseases have been discovered and the use of innovative technologies is intended to reduce genetic risks， and the reproductive rights of infertile couples have been protected and satisfied to a greater extent. However， in some special genetic cases， offspring rights need to be fully considered. This paper conducted an ethical analysis of an “ectodermal dysplasia” case asking for the implementation of human ART to assist in pregnancy， revealing the ethical dilemmas in the implementation of ART for patients with genetic diseases， which were caused by the contradiction between the protection of the patient’s reproductive rights and the offspring rights， as well as the contradiction between the implementation of ART and the blocking of genetic risk. According to the literature review， it is proposed that in the diagnosis， treatment， and ethical judgment process of genetic cases， informed consent should be fully fulfilled. Based on the ethical foundation of care， narrative medicine methods should be used to form doctor-patient joint decision-making， avoiding paternalism. Meanwhile， sufficient information support should be provided and the ethical supervision mechanism should be improved to effectively solve the ethical dilemmas.

OBJECTIVETo summarize the experience in the treatment of severe pressure sore.

METHODSFrom Aug. 2007 to Jun. 2011, 21 cases of severe pressure sore with 43 III-IV degree lesions were treated with combination treatment, including vacuum sealing drainage technique, local fascia flaps, upper or lower gluteus maximus island myocutaneous flaps, lower gluteus maximus myocutaneous flap, neurocutaneous femoris posterior flaps, tensor fascia lata island myocutaneous flaps, free latissimus dorsi myocutaneous flaps, and skin graft, combined with stryker frame and nursing tracking guidance. 13 of 21 cases had multiple pressure sore. Among them, 5 III degree pressure sores were covered by skin grafting and 3 non-caudal III degree pressure sores (< 2 cm in width) were directly closed after debridement. 8 of 21 cases had single IV degree pressure sore.

RESULTSAll the 43 wounds healed completely. 5 wounds in 3 cases had effusion under flap which healed after re-drainage. The wounds were not healed in 3 cases with flap transposition which were also healed after re-debridement. All the flaps survived completely. 16 cases were followed up for 2-26 months. Recurrence happened in 4 cases after discharge because of not following the required nursing care.

CONCLUSIONSComprehensive application of vacuum sealing drainage technique, multiple myocutaneous flaps and skin grafting, combined with stryker frame and nursing tracking guidance after discharge can be used for the treatment of severe pressure sore with satisfactory results.

Adolescent ; Adult ; Aged ; Combined Modality Therapy ; Debridement ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Pressure Ulcer ; surgery ; therapy ; Skin Transplantation ; Surgical Flaps ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the effect of insular pectoralis major myocutaneous flap on repair of jaw and neck tissue defect as a result of high-voltage electric burn.

METHODSEighteen patients with large area tissue defect in jaw and neck caused by high-voltage electric burn hospitalized from August 2001 to December 2007 were repaired with insular pectoralis major myocutaneous flap. The flaps (from 12 cm x 10 cm to 16 cm x 13 cm) was transplanted in 8 patients after early wound debridement, and in 10 patients on infected wounds.

RESULTSAll flaps survived wells except in 4 patients necrotic area (length 2-5 cm, width 1-2 cm) appeared in the distal wound edge, localized dehiscence of wound edge in 2 cases, which were healed after dressing change or secondary suturing. Patients were followed up from 6 months to 3 years, and the appearance and function were satisfactory.

CONCLUSIONSPectoralis major muscle island myocutaneous flap has the advantage of large tissue mass, with thin and flat muscle belly, and rich blood supply, which is suitable for repair of large deep tissue defect in jaw and neck.

Adolescent ; Adult ; Burns, Electric ; surgery ; Female ; Humans ; Middle Aged ; Muscle, Skeletal ; transplantation ; Neck ; surgery ; Skin Transplantation ; Surgical Flaps ; Young Adult