Objective To assess the technical feasibility and efficacy of the combined application of a flexible,self-expanding neurovascular stent(Neuroform)and Gugliebni detachable coils(GDC)in the management of wide-necked intracranial aneurysms in humans.Methods Sixty-five wide-necked aneurysms which underwent 65 endovascular procedures were performed by using intracranial stent and GDC.There was a total of 30 aneurysms at basilar artery including 16 at the basilar tip,9 at the basilar trunk and 5 at the beginning of the basilar artery.And there were 30 aneurysms located at the posterior communicating artery, and 5 aneurysms located at the vertebral artery.The Neuroform stents were deployed to cover the neck of aneurysms.Another microcatheter was introduced into the aneurysm sac through the stent interstices and then detachable coils were released to embolize the aneurysms.Results The combined procedures were successful in all of the 65 patients with wide-necked aneurysms.The stent could pass smoothly through the intracranial artery and got released.Complete occlusion was achieved in 60 patients and incomplete occlusion in 5 patients.In-stent thrombosis occurred in 2 patients.All patients recovered well.Forty-two patients had followe-up angiography at 3 to 6 months after the procedure.Among them,no filling was found for the 39 aneurysms which were densely packed,and 3 aneurysms had neck remnant.Conclusion The implantation of Neuroform stent as a complimentary device to GDC coiling is easy and safe for embolization of wide-necked intracranial aneurysms.It has great advantage for treatment of wide-necked intracranial aneurysms.

Objective To investigate the methods for reconstructing portal vein in liver transplantation patients with grade Ⅳ portal vein thrombosis.Methods Clinical data of 6 patients with grade Ⅳ portal vein thrombosis who underwent liver transplantations were analyzed retrospectively.Different portal vein reconstructing approaches were applied: 4 patients underwent portal vein anastomosis with internal organ varicosis vein (group A),and 2 patients underwent portal vein arterialization (group B). Portal venous flow was monitored by intraoperative ultrasound and postoperative liver function was tested periodically during follow-up.Results In group A,one patient died of celiac infection 2 months post-transplantation.The remaining three patients were followed up for 14-17 months,and their portal veins remained smooth without thrombosis and with mitigated esophageal varicosity.In group B,one patient,with recurrent upper gastrointestinal bleeding,died of celiac infection 47 days after liver transplantation.The patient was followed up for 33 months with satisfactory liver and kidney functions although stomach esophagus varicosity was aggravated.Portal vein blood flow in groups A and B was 1258 ± 345 and 2275 ± 247 ml/min respectively after anastomosis by intraoperative color Dopplar ultrasound monitoring. Aspertate aminotransferase (AST) in group B was significantly lower on the fourth day after liver transplantation,and alanine aminotransferase (ALT) in group B was significantly lower on the 3rd,4th,5th and 6th day after liver transplantation than in group A (all P＜0.05).Serum total bilirubin (TBIL) had no statistically significant difference during the 10 days post-operation (P＞0.05).Conclusion Patients with grade Ⅳ portal vein thrombosis may achieve a satisfactory clinical effect by reconstructing portal vein through anastomosis of donor portal vein with internal organ? varicosis vein.PVA may be associated with early recovery of graft function and may be an effective remedial measure for patients with grade Ⅳ portal vein thrombosis who undergo liver transplantation.

OBJECTIVETo evaluate breast reconstruction with a combined skin flap of the deep inferior epigastric perforator (DIEP) and the transverse rectus abdominis musculocutaneous (TRAM).

METHODSThe DIEP and TRAM united flap was elevated with the vessel pedicle of the deep inferior epigastric perforator on the affected side and the rectus abdominis muscle pedicle on the intact side. The reconstructive breast was shaped after the deep inferior epigastric vessels were anastomosed to the internal mammary vessels or the thoracodorsal vessels ipsilaterally.

RESULTSWe have used the DIEP and TRAM united flaps for breast reconstruction in 17 cases. All of the flaps survived, and the reconstructed breasts were well-shaped with the follow-up of 6-18 months.

CONCLUSIONSThe DIEP and TRAM united flap possesses of advantages such as rich blood supply, abundant tissue volume and easy shaping. It is especially applicable to the cases who have large chest defect and need large volume tissue.

Adult ; Epigastric Arteries ; transplantation ; Female ; Humans ; Mammaplasty ; methods ; Middle Aged ; Rectus Abdominis ; transplantation ; Skin Transplantation ; Surgical Flaps ; blood supply

OBJECTIVETo find anatomic basis for clinically modifying technique of harvesting superior and inferior gluteal artery perforator flap, in order to avoid muscle lossing in conventional superior and inferior myocutaneous flaps, keep the advantage such as large rich supplied volume soft tissue.

METHODS5 cases 10 sides adult cadaver were used to study the numbers, position, Course of superior and inferior gluteal artery perforators. The position of perforators was located by ultrasound Doppler in 6 cases and 12 sides in patient's superior and inferior gluteal area.

RESULTSSuperior and inferior gluteal artery originated from internal iliac artery. Several main perforators of large caliber were found in the paraischia and central portions of the gluteal muscle, its number was 10 - 15. The length of the vessels varies from 3 to 8 cm and their diameter from 1 - 1.5 mm. These significant perforators pass through the muscle itself and the fascial portion of the muscle to the overlying skin on the gluteal region. The dorsal branches of nervorum lumbalium perforate the deep fascia just above the iliac crest, lateral to the posterior superior iliac spine. If a nerve branch with a substantial diameter crosses the incision line, the nerve can be harvested within the flap. This nerve can be anastomosed to the anterior ramus of the lateral branch of the 4th intercostals nerve. In adult female, 3 - 5 perforators were located by ultrasound Doppler. They distributed in the triangle area among posterior superior iliac crest, the great trochanter and the coccyx.

CONCLUSIONSThe area and diameter of perforators of superior gluteal artery were relatively confirmed. It's possible to harvest the perforator flap without any muscle. It has the advantage of conventional myocutaneous flap with out of its disadvantages. It's easy to detect those perforator by ultrasound Doppler clinically. The nerve can be harvested and anastomosed simultaneously. Because the inferior gluteal area is a weight loading area, we suggested to use superior gluteal artery perforator flap. This flap can be transferred pedicled to treat sacral pressure sores or to be transferred freely for the breast reconstruction.

Adult ; Arteries ; anatomy & histology ; Buttocks ; blood supply ; innervation ; Female ; Humans ; Male ; Skin Transplantation ; Surgical Flaps ; blood supply ; innervation

OBJECTIVETo evaluate the efficacy and safety of Solitaire(TM) AB neurovascular stenting-assisted coil embolization for patients with wide-necked or dissecting aneurysms.

METHODSThe clinical results and prognosis from a consecutive series of 38 patients with 40 wide-necked or dissecting aneurysms aneurysms who treated by Solitaire(TM) AB neurovascular stenting-assisted coil embolization from August 2010 to January 2012 was retrospectively analyzed. There were 12 male and 26 female patients, the age was 21 - 78 years (mean 55 years). Thirty-one cases were confirmed wide-neck aneurysms and 9 cases were dissection aneurysms by DSA. Acute subarachnoed hemorrhage due to the rupture of aneurysms was seen in 28 cases (according Hunt-Hess scale, 1 case of Class I, 20 cases of Class II, 4 cases of Class III, 3 cases of Class IV), 1 case was traumatic intracranial aneurysm, 1 case was misdiagnosed during the operation of pituitary adenoma by the approach of transsphenoid, and unruptured aneurysms were seen in 8 cases. The aneurysms were located at the posterior communicating segment of internal carotid artery (21 cases), the supraclinoid segment of internal carotid artery (6 cases), the cavernous segment of internal carotid artery (3 cases), the anterior communicating artery (1 case), and the vertebral artery (9 cases). The patients were performed DSA and Glasgow outcome score (GOS) to evaluate the prognosis 6 months after surgery.

RESULTSForty stents were used and all remodeling device were achieved successful position. Owing to acute thrombosis in 3 patients, the stents were retrieved successfully. The proportion of patients in whom Raymond class 1 occlusion was obtained in 31 cases (77.5%), Raymond class 2 occlusion in 5 cases (12.5%) and Raymond class 3 occlusion in 4 cases (10.0%). The follow-up was 3 to 12 months (median 6 months). The results of DSA indicated none of the patients' anuerysm was recurred; and GOS was applied to evaluate the prognosis of patients after 3 months. Of 38 patients, 34 recovered well, 3 moderately disabled, 1 patient died.

CONCLUSIONSIt is safe to embolize aneurysms with Solitaire(TM) AB neurovascular stenting-assisted coil; meanwhile, the stents can be retrieved when acute thrombosis to reduce the complications.

Adult ; Aged ; Aneurysm, Dissecting ; therapy ; Cerebral Angiography ; Embolization, Therapeutic ; instrumentation ; Female ; Humans ; Intracranial Aneurysm ; therapy ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Young Adult

OBJECTIVEThe objective of the present study was to investigate the feasibility and reliability of sintering alumina and zirconia-based all-ceramic materials through a recently introduced microwave heating technique. The variation of crystal phases, the growth of grain sizes and microstructural features of these materials were evaluated after sintering.

METHODSFour different groups of powder (l00%Al2O3, 60%Al2O3+40%ZrO2, 40% Al2O3+60%ZrO2, 100% ZrO2) were respectively press-compacted to fabricate green disk samples, 5 specimen of each group were prepared. All the samples were surrounded by refractory materials for heat containment and processed at 1 600 degrees C in a domestic microwave oven (850 W, 2 450 MHz), 1 600 degrees C/5 min for heating rate, 10 min for holding time. After sintering, the phase composition and average grain size of these ceramics were examined using X-ray diffraction (XRD). Their microstructure characteristics were studied by scanning electron microscopy (SEM).

RESULTSAll the specimens were successfully sintered with the application of microwave heating system in combination with a suitable thermal insulator. No phase change was found in alumina while monoclinic-zirconia was found to be transformed to tetragonal-zirconia. A little grain size growth of Al2O3 and ZrO2 has been observed with Al2O3 24.1 nm/before and 51.8 nm/after; ZrO2 25.3 nm/before and 29.7 nm/after. The SEM photos indicated that the microwave-sintered Al2O3-ZrO2 ceramics had a uniform crystal distribution and their crystal sizes could be maintained within the range of nanometers.

CONCLUSIONIt is expected that in the near future microwave heating system could be a promising substitute for conventional processing methods due to its unparalled advantages, including more rapid heating rate, shortened sintering time, superfine grain size, improved microstructure and much less expensive equipment.

Aluminum Oxide ; Ceramics ; Hot Temperature ; Materials Testing ; Microscopy, Electron, Scanning ; Microwaves ; Reproducibility of Results ; Surface Properties ; Zirconium

OBJECTIVETo discuss the avail of balloon and stent-assisted Guglielmi detachable coil (GDC) placement in treatment of wide-necked cerebral aneurysm.

METHODSEighty-seven patients with 92 wide-necked aneurysms undergone endovascular procedures using the balloon and stent-assisted remodeling technique. Respectively, appropriate Neuroform stents delivered with a 5 mm landing zone on either side of the aneurysm neck, the microcatheter entered through the interstice, aneurysms were embolized at one or several times. Two catheters were used in balloon-remodeling technique, balloon were inflated across the neck of the aneurysms after the microcatheter entering the aneurysms, then the GDC were used to embolize the aneurysms.

RESULTSThirty-one aneurysms were completely occluded, 3 subtotally (> 90%) and 1 incompletely (70% - 90%) occluded using stent-assisted technique, all carry arteries were unblocked, 3 patients with mild neurological dysfunction and no mortality. Fifty aneurysms were completely occluded and 4 incompletely occluded using balloon-assisted technique, 1 patients with mild neurological dysfunction and no mortality. Two aneurysms were completely occluded and 1 incompletely occluded using stent-assisted and balloon-assisted technique. The mean period of follow-up was 5.8 months. Rates of recanalization were 16.7% for stent-remodeling group and 12.5% for balloon-remodeling group.

CONCLUSIONSThe stent and balloon-assisted remodeling technique are safe and effective in treating wide-necked aneurysms. Balloon-remodeling technique has more security comparing with stents.

Angioplasty, Balloon ; Embolization, Therapeutic ; methods ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; therapy ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome

OBJECTIVETo understand antibody responses to and RNA sequences of Hantavirus in patients with hemorrhagic fever renal syndrome (HFRS) in Yantai areas and to demonstrate the type of the prevalent viruses caused HFRS.

METHODSSerum specimens collected at acute and convalescent stages from 90 patients with HFRS and IgM and IgG antibodies against Hantavirus were detected with ELISA, and cross plaque reduction neutralizing tests were performed to detect neutralizing antibody. Viral RNA was extracted from the patients? sera by using Trizol method and nested PCR was utilized to amplify the specific segments of the viral cDNA and the products of the PCR were TA cloned and then the nucleotide sequences were determined.

RESULTSThe IgM antibody was positive in 82.2% (88/107) of the patients while the IgG antibody was positive in 85.7% (66/77) of the patients. Both the serologic and sequence analyses demonstrated that the epidemic of HFRS in Yantai areas was caused by mixed types of Hantavirus. The prevalent strains of Hantavirus had higher homology with the strains isolated in Korea than with those isolated previously in China.

CONCLUSIONSThe serologic and sequencing analyses indicated that the epidemic of HFRS in Yantai areas was caused by mixed types of Hantavirus dominated by type SEO.

Antibodies, Viral ; blood ; Base Sequence ; China ; DNA, Viral ; analysis ; Disease Reservoirs ; Hantaan virus ; classification ; genetics ; immunology ; Hemorrhagic Fever with Renal Syndrome ; virology ; Humans ; Immunoglobulin G ; blood ; Immunoglobulin M ; blood ; Molecular Sequence Data ; Sequence Analysis, DNA ; Serotyping

OBJECTIVETo investigate the risk factors for mother-to-child transmission of hepatitis B virus (HBV) and the efficacy of hepatitis B immunoprophylaxis in children at high risk of hepatitis B.

METHODSA questionnaire survey was performed on 539 HBsAg-positive mothers and their 551 children (aged from 6 months to 5 years) at high risk of hepatitis B. Serum markers of hepatitis B in the children at high risk of hepatitis B were measured. Univariate logistic regression analysis was used to investigate the risk factors for mother-to-child transmission of HBV.

RESULTSThe rate of hepatitis B vaccination in the children at high risk of hepatitis B was 100%, and 96.6% received injections of hepatitis B vaccine and hepatitis B immunoglobulin (HBIG). The HBsAg positive rate showed no significant differences between different age groups. The HBsAb positive rate gradually decreased with the increasing age (P<0.01). The children born to HBsAg- and HBeAg-positive mothers had a significantly higher hepatitis B infection rate than those born to HBsAg-positive mothers (15.1% vs 0.2%; P<0.01). The high-risk children who received hepatitis B vaccination alone had a significantly higher hepatitis B infection rate than those who received both hepatitis B vaccine and HBIG injections (28.6% vs 2.8%; P<0.01).

CONCLUSIONSThe HBsAb positive rate gradually decreases with the increasing age in children at high risk of hepatitis B. Maternal HBsAg and HBeAg positivity and the absence of HBIG combined with hepatitis B vaccine injections for children at high risk of hepatitis B are the risk factors for mother-to-child transmission of HBV.

Child, Preschool ; Female ; Hepatitis B ; etiology ; prevention & control ; Hepatitis B Surface Antigens ; analysis ; Hepatitis B Vaccines ; immunology ; Hepatitis B e Antigens ; analysis ; Humans ; Immunoglobulins ; immunology ; Infant ; Infectious Disease Transmission, Vertical ; prevention & control ; Male ; Risk Factors

OBJECTIVETo assess the application value of transrectal ultrasound (TRUS) in the diagnosis of chronic prostatitis.

METHODSTRUS and examination of prostatic secretion (EPS) were used in the diagnosis of 3 500 cases of chronic prostatitis from September, 2000 to May, 2006.

RESULTSLower resonance of the inner gland, low-level echo, uneven echo light spots, incomplete outlines and unsmooth borderlines were found in 2279 cases (65.1%), and the enlarged prostate in 1 084 cases (31.0%), with clear integrated amicula and enhanced echogenic spots at the juncture of the external and inner gland. No obvious changes were noted in 137 cases (4.0%), and in another 391 cases (11.2%) were detected alteration of the acoustic image of cystospermitis and blurred margins and uneven echoes of the seminal vesicle. The WBC count in EPS was < 10/HP in 132 cases (3.8%), 10-19/HP in 2 156 cases (61.6%) and > or =20/HP in 1212 cases (34.6%).

CONCLUSIONTRUS, as a diagnostic means for chronic prostatitis, can be easily performed and causes little pain and therefore is readily accepted by patients. Combined with EPS, TRUS can provide more definite diagnostic evidence, and for those who are afraid of pain and reject EPS, it is a desirable alternative in the diagnosis of chronic prostatitis.

Adult ; Chronic Disease ; Humans ; Male ; Middle Aged ; Prostate ; diagnostic imaging ; pathology ; Prostatitis ; diagnosis ; diagnostic imaging ; Rectum ; Sensitivity and Specificity ; Ultrasonography ; methods