Objective:To compare the mid-term clinical effects of AngioJet rheolytic thrombectomy assisted catheter-directed thrombolysis (ART+CDT) with catheter-directed thrombolysis (CDT) in the treatment of acute deep venous thrombosis of lower extremities.Methods:Ninety-one patients admitted to the Department from Jan 2016 to Dec 2017 were placed with inferior vena cava filters and divided into ART+CDT group (30 cases)and CDT group (61 cases). Total urokinase dosge, thrombolytic time, operative cost, length of hospital stay, detumescence rate, thrombus clearance rate, cumulative patency rate of lower limb veins, Villalta score at 2 years and 5 years, thrombosis recurrence rate and chronic venous insufficiency quality of life questionnaire were compared between the two groups.Results:The success rate of surgery was 100% in both groups, there was no mortality. There were significant differences in the short-term postoperative outcomes between the two groups in terms of total dosage of urokinase, thrombolysis time, total cost of surgery, length of hospital stay, detumescence rate, venous patency scores before and after treatment, and venous patency rate (all P<0.05). For the mid- and long-term postoperative outcomes of 2 and 5 years, there were no significant differences in the incidence of PTS, recurrence rate of thrombus, chronic venous function scale, and cumulative patency rate at 2 years (all P>0.05). Conclusions:ART+CDT has a significant advantage over CDT alone in terms of early efficacy and early reopening of blood flow in patients. Both ART+CDT and CDT have a low incidence of PTS and a low recurrence rate of thrombus in the mid-term follow-up, and both have satisfactory performance in the mid- and long-term efficacy of interventional treatment of deep venous thrombosis of lower limbs.

Objective To summarize the effect of the timing of lung transplantation and related treatment measures on clinical prognosis of patients with paraquat poisoning. Methods Clinical data of a patient with paraquat poisoning undergoing bilateral lung transplantation were retrospectively analyzed. Clinical manifestations, auxiliary examination, diagnosis and treatment of this patient were summarized and analyzed. Results A 17-year-old adolescent was admitted to hospital due to nausea, vomiting, cough and systemic fatigue after oral intake of 20-30 mL of 25% paraquat. After symptomatic support treatment, the oxygen saturation was not improved, and pulmonary fibrosis continued to progress. Therefore, sequential bilateral lung transplantation was performed under extracorporeal membrane oxygenation (ECMO). After postoperative rehabilitation and active prevention and treatment for postoperative complications, the patient was discharged at postoperative 50 d. Conclusions The timing of lung transplantation after paraquat poisoning may be selected when the liver and kidney function start to recover. Active and targeted prevention of potential pathogen infection in perioperative period and early rehabilitation training contribute to improving clinical prognosis of lung transplant recipients.

Objective To compare the clinical efficacy between Clamshell incision and bilateral posterolateral incision in the sequential double lung transplantation for end-stage lung disease. Methods Clinical data of 120 recipients undergoing double lung transplantation were retrospectively analyzed. All recipients were divided into bilateral posterolateral incision group (n=108) and Clamshell incision group (n=12) according to different surgical methods. Intraoperative parameters were collected and statistically compared between two groups, including operation time, amount of blood loss, amount of blood transfusion, use of extracorporeal membrane oxygenation (ECMO) or not, cold ischemia time on the first side, and cold ischemia time on the second side. Postoperative parameters were also compared between two groups, including the length of hospital stay, length of intensive care unit (ICU) stay, tracheal intubation duration, ECMO duration, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), incidence of anastomotic stenosis, incidence of bronchopleural fistula, perioperative fatality, and 6-minute walk test for the first time after operation. Results In the Clamshell incision group, the amount of blood loss and blood transfusion was significantly higher than those in the bilateral posterolateral incision group (both P < 0.05). The proportion of ECMO and cold ischemia time on the second side in the Clamshell incision group were significantly lower or shorter than those in the bilateral posterolateral incision group (both P < 0.05). In the Clamshell incision group, the tracheal intubation duration and ECMO duration were significantly shorter compared with those in bilateral posterolateral incision group (both P < 0.05). Conclusions Both Clamshell incision and bilateral posterolateral incision are safe and effective in sequential double lung transplantation. Bilateral posterolateral incision approach can significantly reduce the amount of blood loss and blood transfusion of the recipients without significantly prolonging the operation time. Compared with bilateral posterolateral incision approach, the cold ischemia time of lung graft, tracheal intubation duration and ECMO duration are significantly shortened via the Clamshell incision.

Objective:To investigate the short-term effect of Cinobufacin injection combined with chemotherapy on elderly patients with colorectal cancer and its influence on tumor markers and immune function.Methods:Sixty-two elderly patients with colorectal cancer admitted to Xinchang Branch of Zhejiang Hospital of Traditional Chinese Medicine from January 2015 to December 2017 were randomly divided into observation group (31 cases) and control group (31 cases). Patients in the control group were treated with chemotherapy, while those in the observation group were treated with Cinobufacin injection on the basis of the control group. Two treatment of 21 d was as a cycle, continuous chemotherapy 2-4 cycles. The short-term therapeutic effect, Karnofsky function state score (KPS score), serum tumor markers, immune function and side effects of the two groups were compared before and after treatment.Results:After treatment, the total effective rate of the observation group was 77.42%(24/31), and was higher than that of the control group 48.39%(15/31), there was significant difference ( χ2=5.599, P<0.05). The KPS scores of the observation group was higher than that of the control group [(87.48 ± 6.57) scores vs. (80.20 ± 6.12) scores], there was significant difference ( t=4.514, P<0.05). The levels of serum cancer antigen 19-9(CA19-9), carbohydrate antigen 724(CA724) and carcino-embryonic antigen (CEA) in the observation group were lower than those in the control group [(3.59 ± 1.02) kU/L vs. (6.98 ± 1.37) kU/L, (7.38 ± 1.87) μg/L vs.(9.82 ± 1.42) μg/L, (12.27 ± 2.36) μg/L vs.(16.57 ± 3.24) μg/L], there were significant differences ( t=11.051, 9.042, 10.624, P<0.05). The levels of CD 3+, CD 4+ and CD 4+/CD 8+ in the observation group were higher than those in the control group [(58.97 ± 3.72)% vs. (47.31 ± 2.98)%, (38.85 ± 3.25)% vs. (30.19 ± 2.71)%, 1.59 ± 0.18 vs. 0.89 ± 0.14], there were significant differences ( t=13.620, 11.394, 17.091, P<0.05). The incidence of side effects in the observation group was lower than that in the control group ( P<0.05). Conclusions:Cinobufacin injection combined with chemotherapy can improve the quality of life of elderly patients with colorectal cancer in the near future, reduce the levels of serum CA19-9, CA724 and CEA, improve the immune function of patients, and have fewer side effects.

Objective To analyze the clinical value of low molecular heparin calcium combined with early rehabilitation intervention in the prevention of deep vein thrombosis after internal fixation of intertrochanteric fractures.Methods 100 patients with internal fixation for treatment of femoral intertrochanteric fracture from January 2014 and October 2015 were selected and randomly divided into two groups:the control group of 50 cases, treated with low molecular weight heparin low molecular weight heparin by abdominal subcutaneous injection of drug therapy and routine nursing intervention service, observation group of 50 cases, in the control group based on the use of early rehabilitation intervention.The incidence of deep venous thrombosis after operation in two groups was recorded, and the changes of platelet count and coagulation markers were observed before and after intervention in the two groups.Results The observation group of patients with postoperative deep venous thrombosis incidence rate of 4%, significantly lower than the control group 16%, the difference was statistically significant (P<0.05), the two groups after the intervention each time the platelet count was higher than that of before intervention, four weeks after the intervention, the observation group of platelet count (239.51 ±34.62) ×109/L, significantly higher than the control group (235.23 ±28.87) ×109/L, the difference was statistically significant (P<0.05), the two groups before the intervention of each marker concentration, the difference was not statistically significant, patients in the observation group after the intervention, the blood coagulation markers concentrations were significantly lower than before treatment, and were significantly lower than the control group after the intervention.The comparison between the two groups, the difference was statistically significant (P<0.05).There was no chest pain, chest tightness, dyspnea and other symptoms of pulmonary embolism in the two groups , and no adverse reactions were found.Conclusion The application of low molecular weight heparin calcium combined with early rehabilitation intervention can effectively reduce the incidence of deep venous thrombosis after intertrochanteric fracture fixation.

Objective To investigate the effects of penehyclidine hydrochloride (PHCD)on cerebral ischemia-reperfusion injury induced by intrauterine distress in fetal rats.Methods Eighty mature fetal rats weighing 4.52-4.81 g were randomly divided into four groups (n =20):sham opera-tion group(group S),PHCD control group (group S+ P),cerebral IR group (group IR),PHCD treatment group(group IR+P).Fetal rat intrauterine distress model was set up by clamping bilateral uterine horn vessels of pregnant rats.PHCD 2 mg/kg was injected in pregnant rat’s gluteus at 30 min before intrauterine distress model was set up in group IR+P,the same volume saline was injected in pregnant rat’s gluteus before shame operation in group S,the same volume PHCD was injected in pregnant rat’s gluteus before shame operation in group S+P.Fetal rats were decapitated at 12 h after the reperfusion,the peripheral blood of fetal rats was detected by blood gas analysis (including PH, PaO 2 ,PaCO 2 ,Lac);the infarct volume and the infarct volume fraction were detected by TTC stai-ning;pathological changes in lung tissue were observed by HE staining;the TNF-α,IL-6 content in the brain were detected by ELISA;the expression of NF-κB mRNA was detected by quantitative Real-time PCR,the expression of NF-κB p65 protein was detected by Western-blotting.Results The blood PH,PaO 2 in group IR and IR+P were lower than group S and S+P,the blood PH,PaO 2 in group IR+P was higher than group IR.Compared with group S and group S+P,the blood PaCO 2 , Lac,the infarct volume and the infarct volume fraction,the concentration of TNF-αand IL-6,the ex-pression of NF-κB mRNA and protein were significantly increased in group IR and IR+P (P <0.05), and those in group IR+P were lower than group IR (P <0.05 ).The pathological changes in brain tissue were significantly attenuated in group IR + P (P < 0.05 ).Conclusion Pretreatment with PHCDcouldattenuatecerebralischemia-reperfusioninjuryoffetalratsinducedbyintrauterinedistress. ThemechanismscouldrelatetotheinhibitionofNF-κBsignalingpathwayinbraintissues.

Objective To investigate the molecular mechanisms of PLCεin regulating the invasion and migration of human bladder cancer cells in vitro.Methods After cells treated with recombinant adenovirus , the migratory/in-vasive abilities of T24 cells were explored by wound healing and Transwell chamber cell migration and invasion as -say;RT-PCR was used to detect the mRNA levels of PLCε;The protein levels of PLCε,PKCα,PKCβ, TBX3 and E-cadherin were determined by Western blot;QRT-PCR was used to detect the mRNA levels of TBX3 and E-cad-herin.Results It was confirmed by digesting and sequencing that the recombinant adenovirus had been constructed successfully .The expression of PLCε mRNA and PLCε protein were both decreased after the infection of Ad-shPLCε.Wound healing and Transwell chamber cell migration/invasion assay showed that Ad-shPLCε treatment could inhibit the migratory and invasive activity of bladder cancer cells(P<0.05).The results of Western blot indicated that the expression of PKCα/βin membrane decreased ( P<0.05 ) , and phosphorylation level of PKCαand PKCβwas reduced .QRT-PCR and Western blot analysis demonstrated that the expression level of TBX 3 de-creased , but the expression level of E-cadherin increased .Conclusions PLCε shRNA can inhibit migratory and invasive ability of bladder cancer cells through PKCα/β/TBX3/E-cadherin pathway .

Objective To perform modification study of cyanoacrylate (CA) medical adhesive and to select the optimal mo-difying material and the best ratio.Methods Carboxylic multi-walled carbon nanotubes (MWCNTs-COOH), multi-walled carbon nanotubes (MWCNTs), hydrophobic nano-silica, nitrile rubber, epoxy resin and polymethyl methacrylate (PMMA) were used to modify 5% triclosan/cyanoacrylate antimicrobial adhesive respectively. The bond strength, toughness and viscosity of the modified adhesive were examined in different concentrations.Results 0.064% MWCNTs-COOH, 6% nano-silica, 4% nitrile rubber and 6.4% epoxy resin all had good effects in strength modification. The bond strength were (14.71±1.48)MPa, (14.03±1.92)MPa, (14.6±1.78)MPa and (14.05±1.46)MPa respectively. 8% nano-silica had the lowest Tg of (1.1±0.24)℃ and the strongest viscosity of (15 536.68±28.4)cP. When the nano-silica concentration was 8%, the compound was very viscous and sticky. When the antimicrobial adhesive modified with 6% nano-silica, the bond strength was (14.03±1.92)MPa, the Tg was (3.6±0.68)℃, and the viscosity was (5 278.87±31.68)cP.Conclusion 6% nano-silica is the best modifying material, and has the optimal effect of modification.

BACKGROUNDCurrently, adhesive technique is popular in vascular repair but not widely used for defective vessels. This study aimed to determine the feasibility and effectiveness of repairing defective vessels with 2-octyl-cyanoacrylate and a homemade prosthetic component.

METHODSHomemade prosthetic component consisting of expanded polytetrofluoroethylene (ePTFE), terylene film, and homemade soluble hollow stent mixed with adhesive can replace autologous graft and suture in repairing defective vessels, can fix vessels better using the stent without occlusive bleeding. Forty male mongrel dogs were used, 20 for biomechanical tests and 20 for animal experiments. In the biomechanical test, dogs were randomly divided into two groups (n = 10 each), one group repaired on the two sides of the carotid arteries with 2-octyl-cyanoacrylate and homemade component and another group repaired with suture and ePTFE. Of the 40 specimens, 10 were used for adhesive and 10 for suture specimens for tension strength test, whereas the remaining specimens were used for bursting pressure test. In animal experiments, dogs were also divided into adhesive and suture groups (n = 10), only of the left carotid artery. Recording the operational time, bleeding or not. Vessels were tested using color Doppler ultrasound, the inner diameter was measured, and the degree of stenosis at 8 weeks was evaluated digital subtraction angiography (DSA) were also performed. Specimens were then analyzed histologically.

RESULTSIn the adhesive and suture groups, the specimens could afford atension strength of (23.80 ± 1.51) N versus (24.60 ± 1.08) N (P > 0.05), the bursting pressure was (52.03 ± 2.43) kPa versus (50.04 ± 3.51) kPa (P > 0.05), and the mean time of anastomosis was (15.20 ± 0.55) minutes versus (25.97 ± 0.58) minutes (P < 0.05). One dog in the adhesive group was bleeding from the suture. One dog from each group presented with thrombosis at 1 week. After measuring using ultrasound, the stenosis degree of all dogs were no more than 30% except the two thromboses. DSA and histological observation showed no obvious difference between the two groups.

CONCLUSIONDefective vascular anastomosis with 2-octyl-cyanoacrylate and our homemade prosthetic component is feasible, effective, timesaving, and easy to master.

Anastomosis, Surgical ; methods ; Animals ; Carotid Arteries ; surgery ; Cyanoacrylates ; therapeutic use ; Dogs ; Male ; Reconstructive Surgical Procedures ; methods ; Vascular Surgical Procedures ; methods

BACKGROUNDSelf and mutual-aiding occlusive dressing is a novel method to treat with the wounds in special circumstances. This study aims to prepare a new antimicrobial adhesive for the dressing and evaluate the application effects of the adhesive.

METHODSThe main component of the new antimicrobial adhesive was 5% triclosan / cyanoacrylate (CA) antimicrobial adhesive. The adhesive was modified with carboxylic multi-walled carbon nanotubes (MWCNTs-COOH), multi-walled carbon nanotubes (MWCNTs), hydrophobic nano-silica, nitrile rubber, epoxy resin and polymethyl methacrylate (PMMA) respectively. The bond strength, toughness and viscosity of the modified adhesive in different concentrations were examined to select the optimal modifying material and the best ratio to prepare the new antimicrobial adhesive according to the results. After that, the antimicrobial property of the new antimicrobial adhesive was tested by filter paper method. At last, we disposed the injury models in rats using the new antimicrobial adhesive to examine the application effects.

RESULTSIn individual tests, the bond strength modification performance of 0.064% MWCNTS-COOH is the best, the bond strength is (14.71 ± 1.48) Mpa. 8% nano-silica shows the best toughness modification performance, the Tg is (1.10 ± 0.24)°C. The viscosity modification performance of 8% nano-silica is the best, the viscosity is (15 536.68 ± 28.4) cP. However, consolidating three test results, 6% nano-silica/antimicrobial adhesive has the balanced bond strength, toughness and viscosity. Its bond strength is (14.03±1.92) Mpa, the Tg is (3.60 ± 0.68)°C, and the viscosity is (5 278.87 ± 31.68) cP. The inhibition zone diameter of 6% nano-silica/antimicrobial adhesive and antimicrobial adhesive group in Day 5 is (28.61 ± 0.91) mm versus (28.24 ± 2.69) mm (P > 0.05). In animal studies, both in blood routine test and pathological section, 6% nano-silica/antimicrobial adhesive group shows lower white blood cells count than gauze bandage group (P < 0.05).

CONCLUSIONS6% nano-silica has the optimal effect of bond strength modification, toughness modification and viscosity modification, and the antimicrobial adhesive modified with it has a good antimicrobial property (resistant staphylococcus aureus).

Animals ; Anti-Bacterial Agents ; chemistry ; therapeutic use ; Cyanoacrylates ; chemistry ; therapeutic use ; Male ; Nanostructures ; chemistry ; therapeutic use ; Occlusive Dressings ; Rats ; Rats, Sprague-Dawley ; Triclosan ; chemistry ; therapeutic use