Objective To investigate the changed rules of the cardiac functions in rabbits and to provide theoretical gists for clinical diagnosis and treatment after blunt chest trauma(BCT). Methods Using the models of moderate to severe BCT with BIM-Ⅱ Bio-impactor in 20 rabbits to examinate the cardiac functions with cardiac catheterization, the single photonemission computed tomography(SPECT) and the Doppler echocardiography at preinjury and 1h, 2h, 4h, 6h, 8h, 12h and 24h after BCT. Results Central venous pressure( CVP）, left ventricular enddiastolic pressure (LVEDP) and the decreasing time constant of left intraventricular pressure (T) at 24h after trauma were higher obviously than those before trauma (Plt;0.05,0.01). The -dp/dtmax at 24h after trauma was lower markedly than that before trauma (Plt;0.05 ). The ejection fraction(EF),1/3 EF, 1/3 ejection rate（1/3ER） and the ratio of 1/3 filling rate (1/3FR) to 1/3ER of the right ventricle at 24h after impacted were lower markedly than those before impacted (Plt;0.05). The peak filling rate, 1/3 filling fraction, 1/3 filling rate, the ratio of peak filling rate to peak ejection rate and the ratio of 1/3FR to 1/3ER of the left ventricular at 24h after impacted were lower obviously than those before impacted (Plt;0.05, 0.01). Conclusion The cardiac functions are changed significantly after BCT. The expressions of the right ventricular dysfunctions mainly are systolic dysfunction while the left ventricular dysfunctions are mainly diastolic dysfunction after BCT. All the cardiac catheterization, SPECT and the Doppler echocardiography are beneficial to the diagnosis of cardiac dysfunction after BCT. The SPECT is more exactitude and the Doppler echocardiography is more cheaper.
ObjectiveTo investigate the clinical value of cervical vascular color Doppler ultrasound for dignosis of nonrecurrent laryngeal nerve before thyroid surgery.
MethodsThere were 1931 cases of thyroid patients treated between January 2010 to Jule 2014, group these patients according to the results of preoperative chest radiograph examination, the chest radiograph shows abnormal vessels image were group A (45 cases), no abnormalities were group B (1886 cases). Before operaton, made patients of group A to have routine carotid duplex ultrasound to identify whether the right subclavian artery abnormalities. All patients were exposed to conventional methods of recurrent laryngeal nerve during surgery.
ResultsThe 45 patients of group A, chest angiography showed 17 cases with right subclavian artery abnormalities, they were confirmed that all the 17 patients were nonrecurrent laryngeal nerve by surgery, no damage cases. The other 28 cases showed a normal right subclavian artery and no cases of nonrecurrent laryngeal nerve. The 1886 patients in group B, surgical exploration found four cases with nonrecurrent laryngeal nerve, injury in 1 case. The 21 patients whose nonrecurrent laryngeal nerve were on the right side, there were no left side with nonrecurrent laryngeal nerve and no co-exist cases of nonrecurrent and recurrent laryngeal nerve. The average exposure time of nonrecurrent laryngeal nerve in patients of group A (17 cases) was significantly shorter than that group B[(4.28±1.08) min vs. (15.50±2.08) min, t=-15.978, P=0.000].
ConclusionsThe cervical vascular color Doppler ultrasound examination before thyroid surgery can be adjuvant used, if there is the right subclavian artery abnormalities, it showes that there is the right side nonrecurrent laryngeal nerve. So as to effectively prevent the damage of nonrecurrent laryngeal nerve during thyroid surgery.
The experience of the treatment of 5 thoracic ulcers and 1 large and deep neck ulcer was reported. Vascularized latissimus dorsi and rectus abdominis myocutaneous flaps were used to treat the ulcers with one failure. No recurrence was foundduring the followup from one to five years. In the early stage of acute inflammatory necrosis, treatment was focused on debridement. In order to remove the necrotic tissue and provide good drainage, it was not appropriate to cover the wound immediately. In the chronic stage, the radiation ulcers with their adjacent tissues should be excised. Island myocutaneous flap and axial pattern skin flap were selected to repair the wound. If the wound was too large, two flaps may be combined to cover it. No matter what kind of flap was chosen, the donor site should be far away from the ulcer.
ObjectiveTo evaluate the timing of chest tube removal after resection of lung or esophageal cancer.MethodsA prospective randomized controlled study was performed. From June 2014 to February 2016, 150 patients suspected with the cancer of lung or esophagus undergoing neoplasm resection and lymph node dissection in our single medical unit were classified into 3 groups according to the random number generated by SPSS17.0 with 50 patients in the each group. The drainage volume for chest tube removal was ≤100 mL/d in the group Ⅰ, 101–200 mL/d in the group Ⅱ, and 201–300 mL/d in the group Ⅲ. Chest radiography was performed 48 hours following chest tube removal. ResultsThe 127 patients (108 males and 19 females, with an average age of 59.0±8.7 years) eligible for analysis consisted of 45 patients in the group Ⅰ, 41 in the group Ⅱ, and 41 in the group Ⅲ respectively after the 23 patients were excluded from this study who were diagnosed as benign lesions through intraoperative frozen pathology (n=20) and postoperative complications (empyema in 2 patients and chylothorax in 1 patient). Age, sex, types of neoplasm, and comorbidities except procedures via video-assisted thoracic surgery (and laparoscopy) showed no significant difference among the three groups (P>0.05). No mortality was observed in this study. There were postoperative complications in 6 patients and its distribution had no statistical differences among the three groups (P>0.05). The mean postoperative duration of chest tube was 181.0±68.2 h, 111.0±63.1 h, 76.0±37.2 h, the mean drainage volume was 1 413.0±500.9 mL, 1 005.0±686.4 mL, 776.0±505.8 mL, and the mean hospital stay time following chest tube removal was 19.0±9.7 d, 14.0±8.0 d, 9.0±4.8 d in the group Ⅰ,Ⅱ and Ⅲ, respectively; there was a significant difference among the three groups (P=0.000). The 13 patients required reintervention after chest tube removal due to pleural effusion accumulation and there was no difference among the three groups (P>0.05). Chest pain relieved essentially after chest tube removal in all patients.ConclusionA drainage volume of ≤300 mL/d as a threshold for chest tube removal after resection of lung or esophageal cancer can shorten postoperative hospital stay and accelerate early recovery of the patients.
Objective To explore the early diagnostic value of single photon emission computed tomography(SPECT), thoracic computed tomography(CT),and chest X-ray for closed chest trauma. Methods To establish the animal model of unilateral chest impact trauma,to adopt SPECT, thoracic CT, and chest X-ray for early diagnosis of closed chest trauma,and to compare these findings with postmortem examination. Results Thirty minutes after blunt chest trauma, the region of interesting (ROI) between traumatized lung and the heart (ROI2/ROI1) immediately increased to the peak six hours after trauma; on the contralateral lung, the ratio (ROI3/ROI1) increased slowly and reached the peak after six hours, these ratio was still smaller than that of the traumatized lung. These differences were significant (Plt;0.01). Conclusions Chest X-ray is still the most fundamental diagnostic method of chest trauma,but it was thought that the patients of severe chest trauma and multiple injuries should be examined early by thoracic CT. Radionuclide imaging have more diagnostic value than chest X-ray on pulmonary contusion. The diagnostic sensibility to pulmonary contusion of thoracic CT is superior to conventional radiograph,but thoracic CT is inferior to SPECT on exploring exudation and edema of pulmonary contusion. Thoracic CT is superior to conventional radiograph on diagnosis of chest trauma,therefore patients of severe chest trauma and multiple injuries should be adopted to thoracic CT examination at emergency room in order to be diagnosed as soon as possible.
On account of the mechanical disturbance of external chest pressing to electrocardiogram (ECG) signal, the ECG rhythm cannot be identified reliably during the cardio-pulmonary resuscitation period. Whereas the possibility of successful resuscitation will be lowered due to interrupted external chest pressing, a new filtering algorithm, enhanced leastmean-square (eLMS) algorithm, was proposed and developed in our laboratory. The algorithm can filter the disturbance of external chest pressing without the support of hardware reference signal and correctly identify ventricular fibrillation (VF) rhythm and normal sinus rhythm in case of uninterrupted external chest pressing. Without other reference signals, this algorithm realizes filtering only through the interrupted electrocardiograma (cECG) signal. It was verified with ECG signal and disturbance signal under different signal to noise ratios and contrasted with other mature algorithms. The verification results showed that the identification effect of eLMS was superior to those of others under different signal to noise ratios. Furthermore, ECG rhythm can be correctly identified only through cECG signal. This algorithm not only reduces the research and development(R & D)costs of automated external defibrillator but also raises the identification accuracy of ECG rhythm and the possibility of successful resuscitation.
Objective To search, evaluate and summarize the relevant evidence of the treatment and management of patients with acute myocardial infarction (AMI) under the chest pain center mode by using the evidence-based medicine method, so as to provide references for optimizing the clinical pathway, improving the medical quality and improving the prognosis of patients. Methods Relevant evidence on the treatment and management of AMI patients in relevant databases and websites at home and abroad was retrieved, and the retrieval time limit was from the establishment of databases to January 1, 2025. The quality of the included literature was evaluated, and the evidence was extracted and summarized. Results A total of 15 articles were included, including 2 clinical decisions, 2 systematic reviews, 8 guidelines, and 3 expert consensuses. Finally, 23 pieces of best evidence were extracted, including the basic conditions of chest pain center, the evaluation and treatment of patients with acute chest pain, the integration of pre-hospital emergency system and hospital green channel, and training and education. Conclusions The best evidence for the treatment and management of AMI under the chest pain center mode can provide evidence-based basis for clinical practice. It is necessary to combine the situation of the chest pain center, fully consider the validity and feasibility of the evidence, and help the chest pain center improve the medical quality and improve the prognosis of patients in a standardized and scientific way.
Objective To compare the therapeutic effects between endoscopic thyroidectomy by anterior chest approach and modified Miccoli thyroidectomy. Methods Sixty patients with thyroid goiter were performed endoscopic thyroidectomy by anterior chest approach (endoscopic thyroidectomy by anterior chest approach group, n=30) and modified Miccoli thyroidectomy (modified Miccoli group, n=30) respectively. The operative time, the drainage volume, cosmetic benefit, the postoperative hospitalization time, the expenses of hospitalization and postoperative complications of two groups were compared. Results The operative time and the drainage volume after operation of endoscopic thyoidectomy by anterior chest approach group were significantly more than modified Miccoli group 〔(99.9±23.4) min vs. (74.0±29.6) min; (68.6±8.7) ml vs. (40.9±6.1) ml, respectively〕, Plt;0.05. The cosmetic benefit score of endoscopic thyoidectomy by anterior chest approach group was higher than that of modified Miccoli group 〔(4.7±0.2) points vs. (3.7±0.1) points〕, Plt;0.05. The postoperative hospitalization time and expenses of hospitalization were no significant differences between the two groups 〔(6.5±1.7) d vs. (5.5±0.9) d; (9 328.3±1 107.1) yuan vs. (8 568.2±1 032.3) yuan, respectively〕, Pgt;0.05. One case had transient hoarseness in 2 groups respectively, no other complications happened. Conclusions Modified Miccoli operation is both minimally invasive and cosmetic, but endoscopic thyroidectomy by anterior chest approach has better cosmetic benefit, which can release patients’ psychological trauma. The patients with specific cosmetic demand may choose endoscopic thyroidectomy by anterior chest approach.
In this study, a closed-loop controller for chest compression which adjusts chest compression depth according to the coronary perfusion pressure (CPP) was proposed. An effective and personalized chest compression method for automatic mechanical compression devices was provided, and the traditional and uniform chest compression standard neglecting individual difference was improved. This study rebuilds Charles F. Babbs human circulation model with CPP simulation module and proposes a closed-loop controller based on a fuzzy control algorithm. The performance of the fuzzy controller was evaluated and compared to that of a traditional PID controller in computer simulation studies. The simulation results demonstrated that the fuzzy closed-loop controller produced shorter regulation time, fewer oscillations and smaller overshoot than those of the traditional PID controller and outperforms the traditional PID controller in CPP regulation and maintenance.
Objective To evaluate the application value of repairing the defects of the chest wall with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis. Methods From January 2002 to June 2005, five patients with defects in the chest wall underwent the prothesis with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis under general anesthesia. Focal cleaning was performed first; then, the skin flap was designed and taken (15 cm ×10 cm); and finally, the defects of the chest wall were repaired with the muscle flap of the musculus rectus abdominis. Results Of the 5patients, 4 had the flap healing by the first intention, and 1 had the delayed healing, with no complication. The skin flap had a good appearance, without edema orpigmentation. The X-ray examination showed that the shadow of the sternal sequestrum disappeared. There was no recurrence or complication during the follow-upfor 1-3 years (average, 18 mon). Conclusion The repairing of the defects in the chest wall with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis is a simple and effective surgical treatment for defects of the chest wall around the sternum, and this kind of treatment is worth applying extensively in clinical practice.
