Objective
To summarize the clinical experience of capture technology in the large diameter of abdominal aortic aneurysm in endovascular repair of abdominal aortic aneurysm(EVAR).
Methods
We retrospectively analyzed clinical data of 6 patients with abdominal aortic aneurysm (maximum diameter of 6.0 cm or bigger) in our hospital between July 2013 and May 2014.There were 3 males and 3 females at age of 76.2(73–81) years. Two patients of ruptured abdominal aortic aneurysm, in EVAR, established orbit using the capture technology successfully.
Results
The capture technology made the thread through the proximal tumor neck smoothly, successful repaired. One patient of rupture of abdominal aortic aneurysm was dead after 10 hours. One patient was lost to follow-up. Four patients were followed up for 3 to 11 months. The four patients had not occurred bracket displacement, internal leakage, thrombosis, or other serious complications.
Conclusion
For the patients with larger abdominal aortic aneurysm, capture technology may be used to the thread through the proximal tumor neck, to build a convey or track easily, to shorten the operation time, to improve the success rate of surgery.
Objective To explore the effectiveness and predictive value of computer simulated thoracic endovascular aortic repair (TEVAR). Methods The clinical data of the patients with Stanford type B aortic dissection who underwent TEVAR from February 2019 to February 2022 in our hospital was collected. According to whether there was residual false cavity around the stent about 1 week after TEVAR, the patients were divided into a false cavity closure group and a false cavity residual group. Based on computer simulation, personalized design and three-dimensional construction of the stent framework and covering were carried out. After the stent framework and membrane were assembled, they were pressed and placed into the reconstructed aortic dissection model. TEVAR computer simulation was performed, and the simulation results were analyzed for hemodynamics to obtain the maximum blood flow velocity and maximum wall shear stress at the false lumen outlet level at the peak systolic velocity of the ventricle, which were compared with the real hemodynamic data of the patient after TEVAR surgery. The impact of hemodynamics on the residual false lumen around the stent in the near future based on computer simulation of hemodynamic data after TEVAR surgery was further explored. Results Finally a total of 28 patients were collected, including 24 males and 4 females aged 53.390±11.020 years. There were 18 patients in the false cavity closure group, and 10 patients in the false cavity residual group. The error rate of shear stress of the distal decompression port of the false cavity after computer simulation TEVAR was 6%-25%, and the error rate of blood flow velocity was 3%-31%. There was no statistical difference in age, proportion of male, history of hypertension, history of diabetes, smoking history, prothrombin time or activated partial thromboplatin time at admission between the two groups (all P>0.05). The blood flow velocity and shear stress after TEVAR were statistically significant (all P<0.05). The maximum shear stress (OR=1.823, P=0.010) of the false cavity at the level of the distal decompression port after simulated TEVAR was an independent risk factor for the residual false cavity around the stent. Receiver operating characteristic curve analysis showed that the area under the curve corresponding to the maximum shear stress of false cavity at the level of distal decompression port after simulated TEVAR was 0.872, the best cross-sectional value was 8.469 Pa, and the sensitivity and specificity were 90.0% and 83.3%, respectively. Conclusion Computers can effectively simulate TEVAR and perform hemodynamic analysis before and after TEVAR surgery through simulation. Maximum shear stress at the decompression port of the distal end of the false cavity is an independent risk factor for the residual false cavity around the stent. When it is greater than 8.469 Pa, the probability of residual false cavity around the stent increases greatly.
Objective
To develop an evaluation tool for the screening of high risk population for oral complications in critically ill patients, which can be performed accurately and scientifically.
Methods
Basing on the related foreign oral assessment scale, combined with the method of brainstorming, expert consultation, method of clinical status and so on, the item pool of the assessment scale was determined. Five nursing experts and two oral experts assessed the content validity and 50 ICU nurses were tested. Then, the screening accuracy of the assessment scale was proved by application in 100 critically ill patients selected randomly.
Results
The Cronbach’s a coefficient of final version of the High Risk Assessment Scale for Oral Complications in Critically Ill Patients (including seven parts contents of oral health assessment and oral pH value test) was 0.815, the content validity index (Sr-CVI/Ave) was 0.932. The results of 50 nurses to the 91.2% assessment items of the assessment scale were very important and important. For screening related indicators of oral complications in high-risk patients, the sensitivity of the assessment scale was 97.53%, the specificity was 94.11%, the positive predictive value was 98.75%, the negative predictive value was 88.89%, and the crude agreement was 95%.
Conclusion
There are good reliability, validity and a high accuracy of screening test in the High Risk Assessment Scale for Oral Complications in Critically Ill Patients. It can be used for screening patients at high risk for oral complications in critically ill patients, and help clinical nurses to complete the oral health status of the critically ill patients quickly.
The aim of this paper is to explore the prevention of rabbit postoperative abdominal cavity adhesion with poly (lactic-co-glycotic acid) (PLGA) membrane and the mechanism of this prevention function. Sixty-six Japanese white rabbits were randomly divided into normal control group, model control group and PLGA membrane group. The rabbits were treated with multifactor methods to establish the postoperative abdominal cavity adhesion models except for those in the normal control group. PLGA membrane was used to cover the wounds of rabbits in the PLGA membrane group and nothing covered the wounds of rabbits in the model control group. The hematologic parameters, liver and kidney functions and fibrinogen contents were detected at different time. The rabbit were sacrificed 1, 2, 4, 6, 12 weeks after the operations, respectively. The adhesions were graded blindly, and Masson staining and immunohistochemistry methods were used to observe the proliferation of collagen fiber and the expression of transforming growth factorβ1 (TGF-β1) on the cecal tissues, respectively. The grade of abdominal cavity adhesion showed that the PLGA membrane-treated group was significant lower than that in the model control group, and it has no influence on liver and kidney function and hematologic parameters. But the fibrinogen content and the number of white blood cell in the PLGA membrane group were significant lower than those of model control group1 week and 2 weeks after operation, respectively. The density of collagen fiber and optical density of TGF-β1 in the PLGA membrane group were significant lower than those of model control group. The results demonstrated that PLGA membrane could be effective in preventing the abdominal adhesions in rabbits, and it was mostly involved in the reducing of fibrinogen exudation, and inhibited the proliferation of collagen fiber and over-expression of TGF-β1.
Regurgitation is an abnormal condition happens when left ventricular assist devices (LVADs) operated at a low speed, which causes LVAD to fail to assist natural blood-pumping by heart and thus affects patients’ health. According to the degree of regurgitation, three LVAD’s regurgitation states were identified in this paper: no regurgitation, slight regurgitation and severe regurgitation. Regurgitation index (RI), which is presented based on the theory of dynamic closed cavity, is used to grade the regurgitation of LVAD. Numerical results showed that when patients are in exercising, resting and sleeping state, the critical speed between slight regurgitation and no regurgitation are 6 650 r/min, 7 000 r/min and 7 250 r/min, respectively, with corresponding RI of 0.401, 0.300 and 0.238, respectively. And the critical speed between slight regurgitation and severe regurgitation are 5 500 r/min, 6 000 r/min and 6 450 r/min, with corresponding RI of 0.488, 0.359 and 0.284 respectively. In addition, there is a negative relation correction between RI and rotational speed, so that grading the LVAD’s regurgitation can be achieved by determining the corresponding critical speed. Therefore, the detective parameter RI based on the signal of flow is proved to be able to grade LVAD’s regurgitation states effectively and contribute to the detection of LVAD’s regurgitation, which provides theoretical basis and technology support for developing a LVADs controlling system with high reliability.
ObjectiveTo observe and analyze the effect of peripore cavity size on visual function of macular area before and after surgery for idiopathic macular hole (IMH). MethodsA retrospective clinical study. From July 2020 to February 2021, a total of 25 patients with 25 eyes with monocular IMH (operation group) diagnosed by ophthalmology examination in Department of ophthalmology, Fourth Hospital of Hebei Medical University were included in the study. The control group was contralateral healthy eyes. All subjects were examined by best corrected visual acuity (BCVA), microfield of vision, frequency domain optical coherence tomography (SD-OCT), and OCT angiography (OCTA). The diameter of macular hole was measured by SD-OCT. The cystic morphology of deep capillary plexus (DCP) was detected by en face OCT, and the cystic area was measured by Image J software. MP-3 microperimeter was used to measure central macular retinal light sensitivity (MS) and mean macular retinal light sensitivity (MMS). Central macular retinal light sensitivity (CMS), MMS and cystic cavity MS were measured in the operation group. MMS was measured in the control group. The microperimetry images were superimposed on the DCP layer of OCTA to identify and calculate the average MS within the lumen and compare it with the control group. Standard three incisions were performed in all affected eyes by vitrectomy of the flat part of the ciliary body + stripping of the inner boundary membrane + intraocular sterile air filling. Three months after the operation, the same equipment and methods were used to perform relevant examinations. Paired sample t test was used to compare MS between operation group and control group. Pearson correlation analysis was used to analyze the correlation between capsular area, macular hole diameter before and after operation and MS before and after operation. The correlation between BCVA and capsular area before and after surgery was analyzed by Spearman correlation analysis. ResultsIn the surgical group, the retinal MS was (4.24±3.07) dB. The MMS of control group was (19.08±6.11) dB. The MS in the surgical group was significantly lower than that in the control group, and the difference was statistically significant (t=10.832, P＜0.01). Before operation, the area of cyst was (1.04±0.55) mm2, and the diameter of macular hole was (564.80±166.59) μm. CMS and MMS were (2.27±2.29) dB and (9.08±3.65) dB, respectively. The diameter of macular hole (r=0.50, P=0.010) and BCVA before operation (r=0.57, P＜0.001) were positively correlated with peripore cavity area. Before operation, CMS and MMS were negatively correlated with peripore cavity area (r=－0.53, －0.47; P=0.010, 0.020). At 3 months after surgery, the capsular area was negatively correlated with CMS and MMS (r=－0.65,－0.76; P=0.020, 0.030). There was no correlation with BCVA (r=0.23, P=0.470). ConclusionsRetinal MS is decreased in the peri-capsular area of IMH pore. There is a positive correlation between capsule area, BCVA and macular hole diameter before operation. The capsular area is negatively correlated with CMS and MMS before operation.
Objective To compare the effects of double-channel core decompression (CD) combined with medullary cavity irrigation with those of simple CD on progression of collapse and clinical outcomes in non-traumatic osteonecrosis of the femoral head (ONFH). Methods A retrospective analysis was conducted on the clinical data of 19 patients (30 hips) with non-traumatic ONFH who underwent double-channel CD combined with medullary cavity irrigation and admitted between January 2024 and October 2024 (CD+irrigation group). According to a 1: 2 ratio, 54 patients (60 hips) who underwent simple CD and were matched in terms of age, gender, and body mass index (BMI) were included as the control (CD group). There was no significant difference in baseline data such as age, gender, BMI, affected side, ONFH type, preoperative Association Research Circulation Osseous (ARCO) stage, bone marrow edema stage, visual analogue scale (VAS) score for pain, and Harris score between the two groups (P>0.05). The postoperative discharge time and occurrence of complications were recorded for both groups. The VAS scores before operation and at discharge after operation were compared, and the differences between pre- and post-operation (change values) were calculated for intergroup comparison. The Harris scores before operation and at discharge and 3 months after operation were also compared. During follow-up, X-ray film, CT, and MRI were performed for reexamination. The ARCO stage and bone marrow edema stage were evaluated at 3 months after operation and compared with those before operation to determine whether there was radiological progression or relief. Results All incisions in both groups healed by first intention after operation, with no infection, femoral neck fracture, or other operation-related complications. All patients were followed up, and the follow-up time of the CD+irrigation group was (146.8±27.7) days, and that of the CD group was (164.3±48.2) days; there was no significant difference between the two groups (t=1.840, P=0.069). There was no significant difference in the length of hospital stay between the two groups (P>0.05). At discharge after operation, the VAS score of the CD+irrigation group was significantly lower than that of the CD group (P<0.05), and the change value was significantly higher than that of the CD group (P<0.05). The Harris scores at discharge and 3 months after operation in the CD+irrigation group were significantly higher than those in the CD group (P<0.05). The Harris score gradually increased with time, and the differences between different time points were significant (P<0.05). Radiological reexamination showed that there was no significant difference in the ARCO stage and the incidence of radiological progression between the two groups at 3 months after operation (P>0.05); however, the bone marrow edema stage and the degree of bone marrow edema relief in the CD+irrigation group were better than those in the CD group, with significant differences (P<0.05).Conclusion Double-channel CD combined with medullary cavity irrigation can significantly alleviate hip joint pain and improve joint function in patients with non-traumatic ONFH, reduce the degree of bone marrow edema in the femoral head, and delay the progression of ONFH.
ObjectiveTo review the advances of lymphocinesia in the abdominal cavity infection.
MethodsDomestic and foreign literatures about the research of lymphocinesia in the abdominal cavity infection were collected and reviewed.
ResultsBacterial translocation occurred when abdominal infection happened. At early phase, bacteria and endotoxin translocation could return and arrive the other tissues or organs through the lymphatic system. The peritoneal lymphatic stomata played an important role in lymphatic circulation, with strong absorption function and immune function.
ConclusionsThe theory of lymphatic channels and lymphatic stomata immune pathway is a beneficial supplement to the theory that bacterial and endotoxin can spread to whole body through portal vein pathway, and combination of the 2 kinds of theories can explain the abdominal infection-related systematic infection better. Research of abdominal infection intervention which embarked on the lymphatic pathways would be a promising field.
Objective To explore the application of medical thoracoscopy in the extraction of intrapleural foreign bodies. Methods The clinical data of 2 cases of adult intrapleural foreign bodies were analyzed and reviewed in combination with related literatures. Results One patient with foreign body located in the right intrapleural cavity was a closed drainage tube with a broken intrapleural cavity, and the foreign body was removed with a cold trap and a thoracoscopic stab card, while in one patient, the foreign body was located in the left intrapleural cavity and was a guide wire of a single lumen central vein. Endoscopic biopsy forceps were used to remove the foreign body. Searching the literature at home and abroad, there were 8 reports of thoracoscopic removal of intrapleural foreign bodies and 9 cases. The main cause of intrapleural foreign bodies was iatrogenic improper operation, accounting for 66.7% of the total number of cases. the most common types of intrapleural foreign bodies are ruptured closed thoracic drainage tubes and puncture needles. Conclusion Medical thoracoscopy can be used to remove foreign bodies in the intrapleural cavity, which has certain application value and prospects.
Objective
To summarize experience and efficacy of multidisciplinary treatment for severe intra-abdominal infection.
Methods
The clinical data of 17 patients with severe intra-abdominal infection underwent multidisciplinary treatment were analyzed retrospectively. There were 5 cases of severe acute pancreatitis, 4 cases of postoperative biliary fistula, 2 cases of intestinal fistula, 2 cases of pancreatic trauma, 1 case after resection for intestinal necrosis, 1 case of abdominal trauma, 1 case after operation for liver abscess, 1 case of unexplained severe intra-abdominal infection. The experiences of multidisciplinary treatment including the intensive care unit (ICU), surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on were summarized.
Results
After multidisciplinary treatment, 13 patients were cured, of which 4 patients treated by non-open operation. Three patients died, including 1 patient died of infectious shock, 1 patient died of pancreatic bed bleeding, 1 patient died of multiple organ failure. There was 1 case of automatic discharge.
Conclusions
Multidisciplinary treatment including ICU, surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on has an exact clinical curative effect in patients with severe intra-abdominal infection. Concept of damage control should be followed by surgical intervention. Abdominal cavity puncture and drainage has some advantages of small trauma and good clinical effect, which is suitable for infection control of patients with severe intra-abdominal infection, it could provide surgical condition and opportunity for patients required further surgical treatment.
