Objective To explore the value of endovenous laser treatment (EVLT) in treating the variceal ulcer of lower extremities (VULE).Methods Twenty cases of chronic venous insufficiency with VULE were treated with endovenous laser and received regular postoperative follow-up survey.Results No complication,such as burning of skin happened,all superficial varicose veins disappeared,and most of ulcers were healed within 2 -4 weeks after EVLT.Conclusion EVLT is one of the important methods which is minimally invasive and safe to treat VULE.

OBJECTIVE: To analyze the causes of misdiagnosis in patients with familial nasal bleeding and to improve the level of diagnosis and treatment. METHOD: The clinical characteristics of 7 families with nose blood were analyzed retrospectively and 2 typical cases were reported, including their treatment and misdiagnosis in consulting, out-patient and in-patient. RESULT: Typical case 1 was misdiagnosed and mistreated for 42 years, misdiagnosed as blood disease so that the patient was biopsied in bone marrow, misdiagnosed as endometriosis so that the patient was performed uterus resection. Typical case 2 was misdiagnosed and mistreated for 17 years, misdiagnosed as upper digestive tract hemorrhage so that the patient was performed endoscopic sleeve ligation, misdiagnosed as inferior turbinate hemangioma so that the patient was performed nasal endoscopic surgery. CONCLUSION Neglect of family history and the typical signs are the causes of misdiagnosis. So asking about the family history and checking for the typical signs in patients with nose blood can avoid misdiagnosis.
Diagnostic Errors ; Endoscopy ; Epistaxis ; diagnosis ; Female ; Humans ; Nasal Surgical Procedures ; Retrospective Studies ; Turbinates

Objective To evaluate the outcomes achieved by using left internal mammary artery(LIMA) to radial artery (RA) total arterial composite grafts in minimally invasive direct coronary artery bypass grafting (MIDCAB) for patients with multiple vessel disease.Methods From January 2009 to September 2015, 39 patients(24 males) with multiple vessel disease underwent MIDCAB with LIMA-RA total arterial composite grafts without cardiopulmonary bypass in our hospital .MIDCAB was performed through a left anterior minithoracotomy .Results All patients successfully underwent MIDCAB with LIMA-RA total arterial composite grafts.No patient required to convert to strenotomy during the surgery.Mean operation time was(176.1 ± 14.1)min.Revascularization was performed for 2 target vessels in 11 cases, 3 target vessels in 25 cases and 4 target vessels in 3 cases.Mean postoperative ventilation time was(21.9 ±27.9) h.Mean ICU time was(2.8 ±2.1) days, and mean postoper-ative inhosptial time was(11.2 ±3.3)days.There was no early death in perioperation.At a follow-up of 6 to 86 months[aver-age(27.5 ±18.0) months], one patient died.The overall survival at 2 years postoperatively was(96.0 ±3.9)%.The paten-cy rate of LIMA was 100%.The overall patency rate of RA grafts at 2 years postoperatively was(91.8 ±4.0)%.Conclusion MIDCAB with LIMA-RA total arterial composite grafts is a safe and effective procedure with favorable early and mid-term out-comes for patients with multiple vessel disease .

Aim To observe the effects of tetrahydro-biopterin ( BH4 ) on nitric oxide ( NO ) production in the kidney of type 2 diabetic nephropathy ( DN) mice, and to find a new target for the treatment of type 2 DN. Methods The 12 week-old db/db mice developed in-to DN phase were divided into 2 groups:DAHP group, subjected to intraperitoneal injection of 150 mg·kg-1 DAHP (n=8);DN group, subjected to intraperitone-al injection of same dose of normal saline containing 5% DMSO ( n = 6 ) . The age-matched db/m mice ( NS group) were subjected to intraperitoneal injection of same dose of normal saline containing 5% DMSO ( n =6 ) . Three groups of mice were treated for 7 days. Then the fasting blood-glucose, serum creatinine, u-rine protein and activity of iNOS were determined by chemical colorimetry. And the iNOS protein in renal cortex was determined by immunohistochemisty and western blot, respectively. BH4 was measured by HPLC method. NO level was determined by Griess method. Results The levels of fasting blood-glucose, serum creatinine, 24h urine volume, 24h urine pro-tein, BH4 , iNOS and NO in DN group were signifi-cantly higher than those in NS group;The levels of ser-um creatinine, urine volume, urine protein, BH4 , iN-OS and NO in DAHP group were significantly lower than those in DN group. Conclusion In the kidney of type 2 DN mice, the increased BH4 contributes to over-production of NO by the increased iNOS expression, and resultes in the increase of urine volume and urine protein.

Objective To summarize the preliminary experience of early anticoagulant therapy after endovascular stent graft exclusion for Stanford B type aortic dissection.Methods From June 2006 to June 2011,75 patients[ 65 males,10 fe males,mean age (59.1±13.5) years,range 22 -81 years ] under went endovascular stent-graft exclusion for Stafford B type aortic dissection in Shanghai Xinhua Hospital.Computed tomography angiography (CTA) was used to evaluate the lesions of aortic dissection before endovascular stent-graft exchusion.The descending thoracic aortic diameters were 22 mm to 42 mm [ mean (30.3±4.0) mm ].The distance from the breakage of dissection to the left vertebral artery(LSA)was longer than 1.5 mm in 29 cases,and shorter than 1.5cmin 46 cases.During the operation,left subclavian artery revascularization was per formed to patient,whose left vertebral artery was advantage and needs to be fully or partially covered From the second day after operation,asprin was given to patint,whose left subclavian artery was fully or partially coverd by endovascular stent-graft(no endoleak and residual distal tear).Early anticoagulant therapy lasted 3 months.The symptoms or signs about nervous system were observed in the early stage of postoperation,and the CTA was examined at postoperative 3 months.Results The operation succeeded in 75 patients.The diameters of aortic stent were 26mm to 46rmm[ mean(34.3±4.0) mm ].Left subclavian ar tery revascularization was carried out for 2 cases of all patients.The left subclavian artery was fully or partially coverd in 58 patients(fully covered in 19 cases,2/3 covered in 15 cases,1/2 covered in 24 cases),and 56 patints(no endoleak and residualdistal tear) were given anticoagulant therapy to prevent vertebral artery thrombosis.2 patients(2.7％)died in the early stage after operation.1 patient died of renal failure,1 patient died of dissection rupture,The duration of hospitalization was 4 to 19 days [ mean (7.9±3.5)days ].No neurological complications occurred in hospital.The follow-up period was 6 to 66 months.1 patient died during the follow-up,1 patient had recurrence of Stanford A type aortic dissection and was cured by ascending aorta and aortic arch replacement,1 patient had recurrence of Stanford B type aortic dissection and was cured by second endovascular stent-graft exclusion.All patients had no neurological complications,such as cerebral infarction and paraplegia.Concluslon Early anticoagulant therapy could safely and effectively prevent the neurological complications (such as cerebral infarction and paraplegia) related to vertebral artery thrombosis for Stanford B type aortic dissection patients whose left subclavian artery was fully or partially coverd by endovascular stent-graft.

Objective To assess the safety and influence of the stents extended into inferior vena cava in patients with non-thrombotic iliac vein lesions (NIVLs) on the bilateral iliac vein blood flow.Methods We retrospectively reviewed data from July 2008 to June 2017 in 197 patients with NIVLs who underwent iliac vein stenting and complete follow-up was obtained at our institution.Of these patients,stents extended into IVC more than 10 mm in 141 cases,less than 5 mm in 22 cases,and 34 cases were between 5 and 10 mm.Restenosis and thrombosis of bilateral iliac vein and patency of these stents were assessed in the follow-up.The count data were expressed by percentage (％),and the sample comparison rate was analyzed by Fisher exact test formula.The measurement data were first tested for normal distribution and homogeneity of variance,and then corrected t test.Results The two hundred and five iliac vein stents were placed in 197 patients.During a mean follow-up of 58.7 months (6 to 98 months),there were no thrombosis occurred in the contralateral iliac vein,6 patients suffered restenosis or new thrombosis in the stents,the incidence between stenting positions less than 5 mm (13.6％,3/22) and those more than 5 mm (3.43％,6/175) was sighificantly different (P ＜0.001),and 5 of 6 patients had a good patency after endovascular therapy.During the fllow-up,the primary and assisted-primary patency rates were 97.0％ and 99.5％.Conclusions From these data,it appears that there is a very high patency rates of the stenting treatment for the NIVLs,and it is safe for the stents extended into the IVC,stenting across the iliocaval confluence can result in a small number of new contralateral thromboses.Moreover,the risk of stents restenosis or occlusion is high when stents are not extended into IVC.

This study was aimed to explore the feasibility of identification of traditional Chinese medicine (TCM) constitution based on photoplethysmography (PPG) frequency domain analysis,and to establish an automatic identification system (AIS) of TCM constitution with simple operation and good generalization.The Classification and Determination of Constitution in TCM was used to evaluate the subjects' constitutional state.Pulse wave sensor was used to collect the pulse wave signal.Spectral characteristics were analyzed by power spectrum analysis.Eight classification algorithms of data mining were used to establish the model of qi-insufficiency constitution.The results showed that the pulse wave harmonic peak was that qi-insufficiency constitution was higher than health group;the model was optimal when random forest algorithm was used;and the accuracy of 10-CV test was 80.4％.Sensitivity reached 73.2％.Specificity and receiver operator characteristic were all above 0.8.The model has certain reliability.It was concluded that it was feasible to identify qiinsufficiency constitution by means of frequency domain analysis of PPG.It provides preliminary work for the construction of AIS of TCM constitution as well as a simple and quick assistant tool for the constitution identification of subhealth group in family health care.

Objective: To investigate the expression of Apelin and Snail proteins in breast cancer and their relationship with the clinicopathological features and prognosis. Methods: The expression of Apelin and Snail proteins was detected by immunohistochemistry in 89 cases of breast cancer and 50 cases of mammary adenosis collected from January to June in 2008 at Fujian Cancer Hospital; the expression was correlated with the clinicopathological features and outcome of the patients. Results: Apelin and Snail were expressed in 42 cases(47.2%)and 36 cases(40.4%)of breast cancers, respectively, and the expression was higher than that of control group (P<0.01). The expression of Apelin was positively correlated with Snail (r=0.230, P<0.05). Apelin expression was associated with lymph node metastasis and TNM staging(P<0.05). Snail expression was associated with lymph node metastasis(P<0.05). Kaplan-Meier survival curve showed that the prognosis of Apelin positive group was worse than that of Apelin negative group (P<0.01). There was no significant difference in prognosis between Snail negative and positive groups (P>0.05). The prognosis of Apelin and Snail in both positive groups was worse than that of Apelin and Snail both negative groups (P<0.01). Multivariate COX regression analysis showed that Apelin and TNM staging could be used as independent prognostic factors for breast cancer (P<0.05). Conclusions Apelin and Snail are highly expressed in breast cancer, and associated with lymph node metastasis and TNM stage. There is a positive correlation between Apelin and Snail expression, which may suggest a role in breast carcinogenesis. The prognosis of breast cancer with expression of Apelin and co-expression of Apelin and Snail is poor. Therefore, Apelin may be used as an effective indicator to evaluate the prognosis of breast cancer patients.

Objective: To explore the practicability and reproducibility of judgment method and assessment indexes for the end point of double eyelid surgery using 4+ 1 photography in supine position. Methods: From 2017 October to 2018 October, 158 patients were included and randomly divided into 2 groups. Photos were taken by 4 + 1 photography in supine position of 79 patients, while other 79 patients in control group were evaluated by traditional observation. By 4+ 1 photography in supine position, the surgeon stood at the head side of the patient, taking photos with eyes movement: looking straight forward, looking up, looking downward and eye-closed. It was to observe the upper eyelid creases, upper and lower tissues of double eyelid creases, and upper and lower eyelid margo palpebrae. In addition, the surgeon looked from patient′s feet to observe the indexes such as upper margo palpebrae, to make a decision whether the surgery could finish. In control group, the surgeon observed the upper eyelid creases, upper and lower tissues of double eyelid creases and upper and lower eyelid margo palpebrae. The patient has to sit if necessary. Results: All 158 patients were performed double eyelid surgery successfully. Average times of valuating end point was 1.20 by 4+ 1 Photography in supine position, and 1.53 in control group. The operation time of 4+ 1 photography group is (151.65±21.58) s, and control group were (241.53±33.53) s. The satisfaction level was increased to 89.87% in 4+ 1 photography group, compared to 78.48% in control group. Conclusions The 4+ 1 Photography method is simple and easy to practice. The observation indexes are accurate and comprehensive. It is useful in determining the end point of double eyelid plasty in supine position.

Objective    To summarize the clinical data and efficacy of surgical treatment of aortic periannular abscess. Methods    The clinical data of 35 aortic periannular abscess patients admitted to our hospital from January 2009 to June 2019 were retrospectively analyzed, including 21 males and 14 females, aged 36 to 67 (53.0±12.3) years. Among them, there were 14 patients of native aortic valve endocarditis and 21 patients of prosthetic valve endocarditis (16 patients of mechanical valve and 5 patients of biological valve). Preoperative blood cultures were positive in 15 patients, including 8 patients of Staphylococcus aureus, 2 patients of Staphylococcus epidermidis, 3 patients of Streptococcus grass green, 1 patient of Pseudomonas aeruginosa, and 1 patient of Enterococcus. Results    Eleven patients underwent emergency or urgent surgery. Thirty patients underwent aortic valve replacement, and 5 patients underwent modified Cabrol surgery to replace the aortic root. Early postoperative complications included 1 patient of bleeding, 8 patients of low cardiac output syndrome, 5 patients of renal insufficiency, 10 patients of respiratory insufficiency, 3 patients of tracheotomy, 8 patients of pulmonary infection and 1 patient cerebrovascular accident. The postoperative follow-up period was 6 to 120 (53.6±20.8) months. During the follow-up, 4 patients died and 4 patients were lost. No infection recurred during the follow-up. Perivalval leakage occurred in 3 patients, and one patient underwent occlusion 12 months following the procedure. The survival curve indicated that the 1-year survival rate was 85.5%, and the 5-year survival rate was 67.3%. Conclusion    Although the lesions of periannular abscesses are complicated and critical, effective perioperative antibiotic treatment, individualized surgical timing, and appropriate surgical strategies can significantly reduce mortality and achieve better results.