China ; Death ; Humans ; Tissue and Organ Procurement

Objective To evaluate the safety and efficacy of transrectal ultrasound guided prostatic nerve blockade for pain control during transrectal prostate biopsy.Methods Seventy-three patients requiring systematic 13 cores biopsy of the prostate were randomized into two groups.Group A(37 cases) received an injection of 5 ml 1% lidocaine into the prostatic neurovascular bundles on each side at the base of the prostate under ultrasound guidance,and group B(36 cases) received 5 ml saline ( 0.9% sodium chloride) at the same way.Pain during biopsy was assessed using a 10-point linear visual analog pain scale immediately after this procedure.Results The mean pain scores during transrectal prostate biopsy were significantly lower in group A than that in group B( 1.1? 0.6 vs 5.9? 3.1,t= 4.81,P

Objective To explore the prenatal ultrasonographic features of fetuses diagnosed as echogenic bowel and chromosomal abnormalities. Methods From September 2009 to June 2013, eighty cases diagnosed as echogenic bowel by prenatal ultrasound screening in our hospitals underwent chromosomal karyotype analysis and were followed up till fetal birth. The prenatal ultrasonographic features were carefully correlated with the postnatal findings. Results Prenatal ultrasoundand chromosomal findings of the 80 cases were:(1) Fifty-eight cases of fetuses with echogenic bowel alone (72.5%, 58/80, without chromosomal karyotype abnormalities). (2) Eleven cases of fetuses with additional ultrasound soft markers (13.8%, 11/80, without chromosomal karyotype abnormalities). The ultrasound examination revealed 8 cases of choroid plexus cysts, 1 case of single umbilical artery, 1 case of shorter nasal bone, and 1 case of echogenic intracardiac focus. (3) Five cases of fetuses with severe functional abnormalities or complex structural malformations and normal chromosomal karyotype. The ultrasound examination revealed 3 cases of structural cardiac malformations, 1 case of heart failure and 2 cases of central nervous system malformations. Of them,one case showed complex malformations (right ventricular dysplasia syndrome, cerebellar dysplasia and single umbilical artery), whereas the remaining 4 cases only involve single malformation. (4)Six cases had chromosomal abnormalities (7.5%, 6/80), including 3 cases of abnormal chromosome microdeletions, and 3 cases of abnormal chromosome numbers (1 21-trisomy syndrome, 1 18-trisomy syndrome, and 1 triploid syndrome). All of them had severe structural malformations and abnormal soft markers. The ultrasound examination revealed 2 cases of severe cardiac malformations, 2 cases of central nervous system malformations, 1 case of pericardial/peritoneal effusion, and 1 case of placental chorionic multiple hemangioma. One case of holoprosencephaly (donor of the twins) ended with intrauterine death. The associated abnormal soft markers include nuchal fold (NF) thickening, choroid plexus cysts, umbilical cord cysts, single umbilical artery, and placental chorionic hemangioma. Conclusions The fetuses with echogenic bowelaloneusualyhaveagoodprognosis.Insomecases,echogenicbowelmaydisappearduringvfolow-up.The fetuses complicated with severe structural malformations and chromosomal abnormalities have poor prognosis. For the fetuses diagnosed of echogenic bowel by prenatal ultrasound screening, systematic ultrasound examination should be carried out and clinical chromosomal karyotype analysis was suggested.

Skeletal muscle has high regenerative capability. It is able to regenerate completely after acute traumatic damage, while the repairing process often accompanied by fibrosis in the chronic degenerative conditions such as muscular dystrophy and repeated muscle fiber damage. Through in-depth study on the mechanisms of skeletal muscle fibrosis in the past decade, it has been found that a variety of cells and regulatory molecules involved in the process, especially muscle satellite cells-derived myofibroblasts, transforming growth factor β (TGF-β) and other fibrosis promoting growth factors. This review focused on the cellular and molecular mechanisms of the skeletal muscle fibrosis and relevant antagonistic strategies.

Objective To investigate the useful parameters of transthoracic echocardiography (TTE) for the diagnosis of stroke subtypes in patients with acute cerebral infarction.Methods One hundred and one acute ischemic stroke patients met all of the following criteria including ≥50 years of age,normal sinus rhythm on admission,and transesophageal echocardiography (TEE) within 7 days from the onset.The clinical significance of the TEE parameters on admission was examined for identifying intracardiac thrombus formation as follows; left atrial dimension,left ventricular end-diastolic dimension,percentage fractional shortening,left ventricular mass index,ratio of the transmitral inflow velocities (E/A),and the deceleration time of the E wave.Results There were 28 patients with E/A ≥ 1.0 (70 ± 12) years old and 73 with E/A ＜ 1.0 (73 ± 10) years old.No patients showed pulmonary congestion on chest radiography.There were no significant differences in age,TTE parameters,and plasma levels of brain natriuretic peptide between the two groups.Patients with E/A≥ 1.0 had higher incidence of left atrial appendage (LAA)thrombus formation and/or spontaneous echograhic contrast than those with ＜ 1.0 (25.0％ vs 5.5％,x2 =7.95,P ＜0.01).A significant relationship was found between E/A and emptying flow velocity of the LAA (r =-0.569,P ＜0.01).Multivariate logistic regression analysis showed E/A was an independent predictor for LAA thrombus (risk ratio 1.531 per0.1 increase,95％ confidence interval 1.129-2.076,P =0.0002).Conclusions Increased level of E/A on admission was associated with the occurrence of left atrial appendage thrombus formation in patients with acute ischemic stroke.

This thesis mainly expounds the design ideas and the realization methods of medical statistics question database management system.Specifically speaking,the function modules,data structure and business processes of the system are designed based on the analysis of questions,test papers and the needs of system functions.We choose Visual Basic 6.0 to develop the system interface,establish the question database with Access 2003,and make use of Word 2003 to output documents.This system can achieve the separation of teaching and testing effectively which can make examinations more normal and scientific.

ObjectiveTo evaluate axillofemoral bypass(AxFB) for the treatment of chronic severe lower limb ischemia. Method Consecutive AxFB performed in Anzhen Hospital from January 1995 to November 2002 was retrospectively analysed, with 31 patients of aortoiliac occlusive disease undergoing axillobifemoral bypass (AxBFB) and 32 axillounifemoral bypass(AxUFB) respectively. Result On discharge, rest pain disappeared in 44 cases and intermittent claudication in 19 cases, with average ankle/brachial index changing from preoperative 0.18(0～0.49) to postoperative 0.68(0.29～1.04). Rate of limbs salvage was 87.4%, amputation rate was 7.9%. Three cases died with a perioperative mortality of 4.8%. The patency rate of 1,3,5 years were 93.2%,79.8% and 64.1%, respectively. Conclusion AxFB for aortoiliac occlusive disease is considered to be acceptable procedure in high-risk patients with poor femoral run-off and chronic critical lower limb ischemia.

Objective To assess the efficiency,safety and indications of permanent inferior vena cava filters (VCF) placement for prevention of pulmonary embolism in cases of deep vein thrombosis (DVT). Method In this study 71 cases were treated with permanent inferior vena cava filters by way of the internal jugular vein and the common femoral vein. Cavography was performed routinely before inserting the VCF to confirm no thrombosis in IVC and access veins. The insertion site for filters is the subrenal vena cava. Results The procedure was successful in all cases. There was no case of symptomatic PE occurred during 1～41 months of follow-up. There were 2 cases of IVC thrombosis at the site of insertion and 5 cases of filter tilting less than 15?. There were no other complications. Conclusion Permanent IVC filter placement is an effective method for preventing fatal PE due to DVT. Imaging of the vena cava and access vein by venous ultrasound and cavography, strict anticoagulation therapy after VCF insertion are key to perform VCF placement, provide protection from recurrent life-threatening PE and reduce complications. The filter placement indications should be strict.

Objective To evaluate the role of fetal brainstem-vermis (BV) and brainstem-tentorium (BT) angles in differential diagnosis of fetal cereballar vermis anomalies by three-dimensional ultrasonography. Methods A total of 335 normally developed fetuses at 18-34 gestational weeks were examined prospectively in Prenatal Ultrasound Center of Suzhou Municipal Hospital from July 2013 to July 2014 by three-dimensional ultrasonography scanning. The BV angles and BT angles were measured at the mid-sagittal sections of fetal heads which were obtained by three-dimensional ultrasonography. Sixteen fetuses with abnormal cerebellar vermis were selected. The BV angles and BT angles were measured and compared with the measurements of normal group. Results In normal fetuses, the mean of BV angles was (3.3±1.7)° , ranging from1.0 to 10.0°;the mean BT angle was (31.5±6.9)° , and ranging from 16.6 to 57.8° . In 16 cases of abnormal cerebellar vermis, 4 cases of Dandy-Walker Malformation (DWM) showed significantly upward rotated cerebellar vermises, the BV angles increased significantly (88.9±18.1)° , the cerebellar tentoriums were superior displaced, the BT angles increased remarkably (89.0±12.8) ° ;6 cases of Dandy-Walker variant (DWV) showed upward rotated cerebellar vermises, with increased BV angles (23.7±5.2) ° , and slightly increased BT angles (54.5±12.0)°;6 cases of Blake′s pouch cyst (BPC) showed upward rotated cerebellar vermises were, mildly increased BV angles (16.7±1.8)° , and slightly increased BT angles (50.3±8.2)° . The comparison results showed:BV angles increased with increasing severity of the condition in BPC, DWV and DWM;BT angles increased significantly in DWM. Conclusions The measurements of BV angles and BT angles are valuable in the differential diagnosis of fetal cereballar vermis anomalies. From 19 gestational weeks, a BV angle>60° is strongly suggestive of a Dandy-Walker malformation, while a measurement>10.0° and<20° favors the diagnosis of Blake′s pouch cyst.

Objective To evaluate the treatment for acute embolism in the extremities and define the primary factors affecting the prognosis. Methods From December 1984 to December 2006,536 patients with acute embolism of extremities were treated. Embolectomy with Forgarty catheters were performed in 507 cases, including salvage surgery in 34 cases and conservative therapy in 29 cases. Results The cure rate, mortality and amputation rate were 76.68%,9.51% and 10.26% respectively. Embolism recurred in 11.7% cases. Cardiopulmonary (27.5% ) and renal failure ( 25.5% ) were main causes of death during perioperative period. No bleeding nor other major complications occurred in 221 patients with atrial fibrillation who routinely received wafarine under proper monitoring. About 25.6% patients underwent heart valves surgery during hospitalization or within one year after discharge. Conclusions Patients suffering from acute embolism of the extremities should receive combination treatment. The main factors affecting the prognosis include time and degree of ischemia, and ischemia-reperfusion injury. Anticoagulant and etiologic treatment should be adopted in those with cardiogenic embolus and atrial fibrillation.