ObjectivesTo systematically review the safety and effectiveness of uterine artery embolization (UAE), surgery and high intensity focused ultrasound (HIFU) in the treatment of uterine fibroids.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases were electronically searched to collect relevant studies on comparing the safety and effectiveness of UAE, surgery and HIFU in the treatment of uterine fibroids from January 2000 to August 2019. Two reviewers independently screened the literature, extracted the data and evaluated the risk of bias of included studies, network meta-analysis was performed by ADDIS 1.16.8 software and Stata 14.0 software.ResultsA total of 11 trials (22 references) involving 3469 patients were included. Compared with surgery, UAE and HIFU patients had higher quality of life (1-year follow-up) improvement, and UAE was higher than HIFU. Network meta-analysis showed that patients treated with HIFU had the lowest incidence of major complications within 1 year, followed by UAE, and surgery. Patients treated with HIFU and UAE had shorter hospitalization and quicker recovery time than surgery. The rate of further intervention after surgery treatment might be lower than that of UAE and HIFU.ConclusionsUAE has the highest quality of life improvement (1-year follow-up) for uterine fibroids. HIFU and UAE are safer with shorter hospital stays and quicker recovery time compared with surgery. However, both UAE and HIFU have the risk of re-treatment. However, limited by the number and quality of included studies, the above conclusions are needed to be verified by more high-quality studies.
Objective To investigate the relationship between diabetic retinopathy (DR) and coronary atherosclerosis (CAS) in type 2 diabetes patients and other risk factors of DR. Methods A total of 118 patients of type 2 diabetes with DR (DR group), 120 patients of type 2 diabetes without DR matched in age and sex (non-DR group), and 86 normal controls (control group) were enrolled in this study. The body mass index (BMI), blood pressure (BP), fasting blood-glucose (FPG), glycosylated haemoglobin (HbA1C), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterin (LDL-C), creatinine, estimate glomerular filtration rate (eGFR) and urinary albumin excretion rate(UAER) in all the subjects were measured. Meanwhile, the incidence of CAS in the three groups was detected by 64slice multidetector computed tomography angiography (MDCTA). Assume concurrent DR as dependent variable, clinical indicators and laboratory parameters as independent variable, the risk factors were determined by Logistic regression analysis. In addition, CAS as dependent variable, DR as fixed factor, analysis of covariance was used to investigate the relationship between CAS and DR. Results The incidence of CAS in DR group was higher than that in nonDR group and control group, the differences were statistically significant (chi;2=26.9,35.5;P＜0.05). The results of Logistic regression analysis showed that systolic BP, BMI, CAS, myocardial infarction and UAER were key risk factors for DR ［odds ratio (OR)=1.02, 0.89, 4.50, 3.89, 1.34;P＜0.05］. There was a negative relationship between BMI and DR. The results of analysis of covariance showed that there was significant correlation between CAS and DR (OR=5.31, 95% confidence interval=2.62-10.60; P＜0.05). Conclusion CAS is independently associated with DR in type 2 diabetes patients. In addition, the other risk factors for DR include systolic BP, BMI, myocardial infarction and UAER.
Objective To evaluate the curative effect of the lateral nasal artery pedicled nasolabial flap for reconstruction of nasal defects. Methods From August 2005 to March 2009, 12 cases of large nasal tip and alar defects were repaired with the lateral nasal artery pedicled nasolabial flap. There were 5 male patients and 7 female patients with a mean ageof 48.6 years (range, 35-60 years). Five cases of nasal defects were caused by trauma and other defects were caused by excision of carcinoma or hemangioma; the courses of disease were 1 to 10 years and 3 months to 40 years, respectively. The nasal defect size ranged from 2.0 cm × 1.5 cm to 4.5 cm × 2.5 cm. All defects were reconstructed with lateral nasal artery pedicled nasolabial flap in 9 cases and with island flap in 3 cases. The flap size ranged from 2.5 cm × 2.0 cm to 7.0 cm × 3.0 cm. Five patients required cartilage grafts for alar rim support and the distal end of the nasolabial flap was thinned and folded to repair the nasal l ining. The donor sites were sutured directly. Results The mild venous stasis at the distal end of three island flaps occurred at 5-24 hours postoperatively and alleviated spontaneously. All flaps survived. Incision at donor and accepted sites healed by first intention. Flap revision was performed in 5 cases after 6-15 months because of mild swell ing at the pedicles of skin flaps. All patients were followed up 8-24 months, with an average of 13 months. All patients achieved satisfactory results in nasal appearance, flap texture and color, and ventilatory function. No obvious scar was found at donor sites. Conclusion The nasolabial flap is an excellent choice for reconstruction of defects of nasal tip and ala.
ObjectiveTo study the learning curve of minimal invasive coronary artery bypass grafting (MICS CABG) and the influence on the perioperative clinical effects by analyzing operation time.MethodsFrom March 2012 to November 2020, 212 patients underwent MICS CABG by the same surgeon. Among them, 59 patients (52 males and average age of 62.89±8.27 years) with single vessel bypass grafting were as a single-vessel group and 153 patients (138 males, average age of 59.80±9.22 years) with multi-vessel bypass grafting were as a multi-vessel group. Two sets of operation time-operation sequence scatter plots were made and learning curve was analyzed by cumulative summation (CUSUM) and regression method of operation time. The surgical data of each group before and after the inflection point of the learning curve were compared with the main clinical outcome events within 30 days after surgery.ResultsThere was no death, perioperative myocardial infarction and stroke in 212 MICS CABG patients and no transfer to cardiopulmonary bypass or redo thoracotomy. The learning curve conformed to the cubic fitting formula. In the single-vessel group, CUSUM (x operation number)=–1.93+93.45×x–2.33×x2+0.01×x3, P=0.000, R2=0.986, the tipping point was 27 patients. In the multi-vessel group, CUSUM (x)=y=2.87+1.15×x–1.29× x2+3.463×x3, P=0.000, R2=0.993, and the tipping point was 59 patients. The two sets of case data were compared before and after the learning curve and there was no statistical difference in main clinical outcomes within 30 days (mortality, acute myocardial infarction, stroke, perioperative blood transfusion rate), ventilator tube, and intensive care unit retention.ConclusionThe learning curve of MICS CABG conforms to the cubic formula, and the process transitions from single to multiple vessels bypass. To enter the mature stage of the learning phase, a certain number of patients need to be done. Reasonable surgical procedures and quality control measures can ensure the safety during the learning phase.
ObjectiveTo investigate the feasibility of the free descending branch of lateral circumflex femoral artery perforator tissue flap (fascia flap plus skin flap) to repair large soft tissue defects of the extremities and its impact on the donor site.
MethodsBetween January 2013 and February 2015, 9 cases of large tissue defects of the extremities were repaired with the free descending branch of lateral circumflex femoral artery perforator tissue flap. There were 8 males and 1 female, aged from 13 to 56 years (median, 36 years). The causes included traffic accident injury in 6 cases and crushing injury by heavy object in 3 cases. Soft tissue defect located at the lower limbs in 7 cases and at the upper limbs in 2 cases, including 2 cases of simple tendon exposure, 2 cases of simple bone exposure, and 5 cases of tendon and bone exposure. After debridement, the soft tissue defect area ranged from 13 cm×7 cm to 20 cm×18 cm. The tissue flaps ranged from 14 cm×8 cm to 23 cm×19 cm. The donor site was directly sutured, scalp graft was used to cover the fascia flap.
ResultsAfter operation, partial necrosis of the skin grafting on the fascia flap occurred in 2 cases and healed after dressing change. Arterial crisis occurred in 1 case and the flap survived after anastomosis. The other tissue flaps survived and wounds healed by first intention. The skin grafting healed by first intention in 7 cases, by second intention in 2 cases. The patients were followed up 4-24 months (mean, 10 months). The appearance and function of the tissue flaps were satisfactory, only linear scar was observed at the donor site, which had less damage and no effect on walking.
ConclusionFree descending branch of lateral circumflex femoral artery perforator tissue flap can repair large soft tissue defect of the extremities. The donor site can be sutured directly, which reduces damage to donor site and is accord with the principle of plastic surgery.
ObjectiveTo observe the changes of central visual acuity and extracentral visual acuity in eyes with non-arteritic central retinal artery occlusion (NA-CRAO). MethodsA retrospective clinical study. From January 1, 2017 to December 31, 2024, 140 patients (140 eyes) diagnosed with NA-CRAO through ophthalmic examination at Department of Ophthalmology of First People's Hospital of Xianyang City were included in the study. All affected eyes underwent best corrected visual acuity (BCVA), visual field, intraocular pressure, fundus color photography, optical coherence tomography (OCT), and fluorescein angiography (FFA) examinations. After a clear diagnosis, conservative treatment such as reducing intraocular pressure, relieving spasms, and dilating blood vessels should be given immediately. Simultaneously, intravenous and/or arterial thrombolysis therapy should be administered based on the patient's overall condition. Under the same treatment conditions as other treatments, 33 eyes were treated with hyperbaric oxygen therapy within 24 hours after seeking medical attention. The changes in central visual acuity (BCVA) and peripheral visual acuity of the affected eye one month after treatment were observed. BCVA improvement of ≥ 1 line was defined as the increase of no light sensitivity to light sensitivity or above, and the increase of light sensitivity to 0.01 or above. The visual acuity outside the center was determined by the 0 ° axis in front of the eyeball at eye level, and was 10 ° outside visual acuity on the temporal side. Multivariate analysis using logistic regression analysis. ResultsAmong the 140 cases (140 eyes), there were 84 males (84 eyes) and 56 females (56 eyes). The mean age was (63.89±10.78) years. The duration of illness from the onset of symptoms to the time of diagnosis was 48 (2-720) hours. 6, 1, 14, 47, 41, 16, and 15 eyes were diagnosed with BCVA without light perception, uncertain light perception, manual/anterior, digital/anterior, 0.01-0.10, and ≥ 0.10, respectively. FFA examination revealed delayed arm retinal circulation time and filling of the retinal artery trunk to the peak, with changes in the "arterial front" observed in 126 eyes. OCT examination showed extensive edema and unclear structure in the inner layer of the retina in all patients. Out of 140 eyes, 122 were treated with intravenous thrombolysis and 4 with arterial thrombolysis; 14 eyes did not receive thrombolytic therapy. After treatment, 38 eyes (27.1%) showed an improvement of BCVA ≥ 1; 67 eyes (47.9%) did not show an improvement in BCVA, and the affected eye had a BCVA of approximately 0.6 without light perception; 17 eyes (12.1%) showed improvement in peripheral vision, and the peripheral vision of the affected eyes ranged from 0.01 to 0.1, all of whom were patients undergoing intravenous thrombolysis, and prior to treatment, this group of patients had complete blindness in the coarse side visual field of the Amsler grid, and their out of center visual acuity could not be measured. Among the 33 eyes treated with hyperbaric oxygen therapy, 24 eyes (72.7%) showed an increase in BCVA after treatment; 9 eyes did not improve, among which 4 eyes (12.1%) showed improvement in out of center visual acuity. Among the 107 eyes that did not receive hyperbaric oxygen therapy, 49 eyes (45.8%) showed an increase in BCVA after treatment. There was no improvement in 58 eyes (54.2%), among which 13 eyes (12.1%) showed an improvement in out of center visual acuity. The results of logistic regression analysis showed that intravenous thrombolysis and hyperbaric oxygen therapy were independent predictive factors for the improvement of central and extra central visual acuity (P＜0.05). ConclusionsHyperbaric oxygen therapy within 24 hours of seeking medical attention for patients with NA-CRAO disease course ≤ 1 month has a significant effect on the recovery of central and extra central vision. Intravenous thrombolysis and hyperbaric oxygen therapy are independent predictive factors for the improvement of central and extra central vision.
ObjectiveTo investigate the clinical application of the forearm interosseous dorsal artery perforator sublobe flaps in repairing two wounds in dorsal hand or wrist.
MethodsBetween October 2009 and October 2012, 12 patients with two wounds in the dorsal hand or wrist were included in the study. There were 4 cases of skin defects (grade IV) and bone exposure caused by machine injury, 3 cases of skin defects with bone and tendon exposure caused by traffic accident, and 3 cases of skin defect and tendon exposure caused by crash injury of heavy object, with a duration of 3-12 hours (mean, 6 hours) between injury and admission; defects in the wrist and tendon exposure were caused by tumor resection in 2 cases. Four cases had metacarpal fractures. The size of larger skin and soft tissue defects ranged from 4.0 cm×3.5 cm to 5.0 cm×3.0 cm, and the size of smaller defects was from 2.5 cm×2.0 cm to 4.0 cm×3.0 cm. The flap size was from 6 cm×4 cm to 8 cm×3 cm and 3.0 cm×2.5 cm to 5.0 cm×3.0 cm. The donor sites were directly sutured or repaired with free skin graft.
ResultsAll the flaps survived, and wound healed in first stage. All the cases were followed up 6-36 months (mean, 20 months). The flaps had good color and texture. Three cases underwent secondary surgery of thinning the flaps. At last follow-up, two-point discrimination of flaps was 10-14 mm, 12 mm on average. According to function standard for evaluation of upper extremity with total active motion of the fingers from the Hand Surgery Society of Chinese Medical Association, the results were excellent in 10 cases, and good in 2 cases.
ConclusionForearm interosseous dorsal artery perforators sublobe flaps can be used to repair two wounds in the dorsal hand or wrist simultaneously, and it has the advantages of simple operation, less injury at donor site, and reliable blood supply.
Objective To evaluate the applicating value of transit time flow meter（TTFM） in determing the status of coronary grafting and analyze the correlation factors of the measuring results. Methods Three hundred and one patients underwent CAB（3 in this hospital from March 2002 to January 2004. Seven hundred and ninety-one grafts were measured with TTFM. One hundred and sixty-five patients whose left internal mammary artery （LIMA） were grafted to left anterior descending branch （LAD） were included in this retrospective study according to inclusion criteria, the graft flow and pulsatility index（P1） as dependent and the other 17 factors as independent factors which were analyzed by muhilinear regression analysis. Results According to TTFM technique, technical errors of 5 grafts had been detected and corrected intraoperatively among 791 grafts. The graft flow of LIMA-LAD related strictly to LAD distal diameter, LIMA diameter, anterior myocardial infraction, stenosis degree of proximal LAD, percentage of insufficiency （% insufficiency）, left ventricle end-diastole diameter and different surgical technique （on- pump, off-pump）. PI was influenced by LAD distal diameter, different surgical technique （on-pump, off-pump） and %insufficiency. Conclusions Evaluation of TTFM is valuable in determining the status of a coronary graft after CAB（3. Multiple factors could influence the grafts flow and the PI. The intraoperative technical control of anastomoses should be considered together with major influential factors and cardiac performances.
Two hundred and twenty-two toes to hands free transfers have been performed in our clinic from January 1973 to May 1992 with a 100 percent successful results obtained. The authors developed the extended toe free transfer technique,and this technique was used in 40 cases.Six types of extended toe transfer can be designed to carry out complicated thumb or other finger reconstructions.Keys to successful toe-to-hand transfers are as followings: Evaluation of a three-points and one line pulsation on the donor foot can be used to localize the course of the first dorsal metatarsal artery . The first dorsal metaltarsal artery is best dissected and exposed in the retrograde direction. The toe must obtain good blood perfusion before its transplantation and close postoperative monitor.
ObjectiveTo systematically review the efficacy and safety of endoscopic radial artery harvesting for coronary artery bypass grafting (CABG).
MethodsDatabases including The Cochrane Library (Issue2, 2015), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from inception to August 2015 to collect randomized controlled trials (RCTs) and cohort studies about endoscopic radial artery harvesting technique versus traditional incision technique for CABG. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software.
ResultsA total of 12 studies involving 1359 patients were included. The results of meta-analysis showed that no significant differences were found between the two groups in perioperative mortality (OR=0.66, 95%CI 0.17 to 2.57, P=0.55), the incidence of postoperative myocardial infarction (OR=0.78, 95%CI 0.30 to 2.06, P=0.62), vascular graft patency rate (OR=1.40, 95%CI 0.80 to 2.45, P=0.24) and the incidence of wound infection (OR=0.59, 95%CI 0.33 to 1.07, P=0.08). The endoscopic group showed significantly lower incidence of hematoma formation (OR=0.39, 95%CI 0.20 to 0.74, P=0.004) and paresthesia (OR=0.44, 95%CI 0.22 to 0.88, P=0.02) than that of the incision group.
ConclusionCurrent evidence shows that, compared with the incision technique, the endoscopic radial artery harvesting could significantly reduce the incidence of hematoma formation and paresthesia in patients underwent CABG. Due to the limited quantity and quality of the included studies, the above conclusions still need to be verified by carrying out more high-quality studies.
