Since February 1987, reconstruction of the brest by transposition of the contralateral half-brest with myocutaneous flap of pectoralis major muscle was used in 4 cases with successful results. The operation was suitable for those patients having radical mastectomy for early carcinoma of brest, and it was particularly feasible in those patients having benign lesions, trauma or other disorders causing absence of brest, and especially for those patients who had a huse brest of the contralateral side.
Objective To investigate the accuracy of preoperative three-dimensional reconstruction of tumor in craniotomy for supratentorial convex brain tumors, and to provide an accurate and safe auxiliary method for craniotomy. Methods Patients with supratentorial convexity brain tumors who were admitted to the Department of Neurosurgery, West China Hospital, Yibin Hospital, Sichuan University between April 2018 and November 2020 were prospectively enrolled and randomly divided into reconstruction group and control group. In the reconstruction group, preoperative three-dimensional reconstruction of the tumor was used for craniotomy positioning, while in the control group, traditional two-dimensional tomographic imaging was used. The basic conditions, intraoperative localization and tumor exposure satisfaction rate, maximum diameter of bone window, operation time, cerebral draining vein injury, and postoperative subcutaneous effusion or intracranial infection were compared between the two groups. Results A total of 43 patients were included, 22 in the reconstruction group and 21 in the control group. There was no significant differences in age, gender composition, incidence of midline shift, tumor growth site and tumor size between the two groups (P>0.05). There was no significant difference in the incidence of cerebral drainage vein injury and postoperative subcutaneous effusion or intracranial infection between the two groups (P>0.05). The satisfaction rate of intraoperative positioning and tumor exposure in the reconstruction group (95.5% vs. 66.7%) was higher than that in the control group, the maximum diameter of the bone window [(6.26±1.32) vs. (7.31±1.13) cm] and the operation time [(194.00±22.76) vs. (214.57±26.53) min] were lower than the control group, and the differences were statistically significant (P<0.05). Conclusions Preoperative three-dimensional reconstruction helps to locate the tumor more accurately, improves the satisfaction rate of tumor exposure, reduces the diameter of the craniotomy window, and shortens the operation time. Compared with traditional two-dimensional tomographic positioning, it has more advantages.
Abstract： Objective To evaluate clinical outcomes of pulmonary artery banding for morphologic left ventricular training in corrected transposition of the great arteries.?Methods?A total of 89 patients with corrected transposition of the great arteries underwent surgical repair in Shanghai Children’s Medical Center from January 2007 to December 2011 year. Among them, 11 patients underwent pulmonary artery banding, whose clinical records were retrospectively analyzed. Except that one patient was 12 years, all other patients were 3 to 42 （16.40±11.67） months old and had a body weight of 6 to 32 （11.70±7.20）kg. All the patients were diagnosed by echocardiogram and angiocardiogram.?Results?There was no postoperative death after pulmonary artery banding in 11 patients. The pulmonary arterial pressure/systemic blood pressure ratio （Pp/Ps） was 0.3 to 0.6 （0.44±0.09） preoperatively and 0.6 to 0.8 （0.70±0.04） postoperatively with statistical difference （P＜0.01）. Tricuspid regurgitation was mild in 2 （18.2%） patients, moderate in 5 （45.4%）, severe in 4 （36.4%）preoperatively，and none in 2（18.2%）patients, mild in 7 （63.6%），and mild to moderate in 2 （18.2%）postoperatively. Five patients underwent staged double-switch operation after pulmonary artery banding at 15.20±8.31 months, and 1 patient died. The other 6 patients were followed up for 18.83±3.43 months, and echocardiogram showed tricuspid regurgitation as trivial in 2 （33.3%）, mild in 3 （50.0%）, and moderate in 1 （16.7%）patient.?Conclusions?In patients with corrected transposition of the great arteries, pulmonary artery banding is helpful to reduce tricuspid regurgitation, and morphologic left ventricle can be trained for staged double-switch operation with good clinical outcomes. It is important to follow up these patients regularly to evaluate their morphologic left ventricular function and tricuspid regurgitation after pulmonary artery banding.
ObjectiveTo investigate the factors affecting enteral nutrition tolerance in patients accepting prone position ventilation.MethodsA retrospective study was conducted to analyze the tolerance of enteral nutrition in patients with prone position ventilation from January 2013 to December 2018. The single factor and multiple factors were used to analyze the influencing factors of enteral nutrition tolerance in patients accepting prone position ventilation.ResultsNinety-two patients who met the inclusion criteria were divided into 2 groups according to enteral nutrition tolerance table: 45 patients with good tolerance and 47 patients with poor tolerance. Univariate analysis showed age, use of muscle relaxants, albumin, prealbumin, feeding amount per unit time, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), sequential organ failure assessment (SOFA), nutrition risk in critically ill (NUTRIC) score and gastric residual volume were factors affecting the patient's tolerance (P<0.05). Logistic analysis showed that the factors affecting the patient's tolerance during the prone position were age, use of muscle relaxant, albumin, prealbumin, APACHEⅡ, SOFA, and NUTRIC scores (P<0.05).ConclusionFactors affecting enteral nutrition tolerance in patients accepting prone position ventilation are age, use of muscle relaxants, albumin, prealbumin, APACHEⅡ, SOFA and NUTRIC scores.
Abstract: The complete transposition of the great arteries (TGA) is one of the commonest congenital cardiac anomalies in cyanosis. In untreated patients, death occurs early in infancy. Nowadays arterial switch operation (ASO) has been widely proposed to treat TGA without pulmonary valve stenosis. Meanwhile, surgical risks and mortality will be increased if TGA is accompanied by coronary arterial anomalies. So proper surgical management of abnormal coronary artery has a significant influence on the outcome of ASO. The classification, operation methods and surgical results were reviewed in this article.
ObjectiveTo investigate the safety and feasibility of thoracoscopic surgery of anterior mediastinal tumors via subxiphoid approach under scissors position (SASP) and lateral thoracic approach under lateral position (LALP).MethodsClinical data of 69 patients who received anterior mediastinal tumor excision surgery in our hospital from June 2016 to November 2019 were retrospectively analyzed, including 32 males and 37 females with an average age of 46.38±11.52 years. The clinical effects of the two groups were compared.ResultsThere was no perioperative death or conversion to thoracotomy. There was no statistically significant difference between the two groups in the operative time (123.34±12.64 min vs. 125.05±17.02 min, P=0.642), intraoperative blood loss [50.00 (73.75) mL vs. 50.00 (80.00) mL, P=0.643], tumor diameter (2.75±0.57 cm vs. 2.89±0.45 cm, P=0.787) and total hospital expenses [32.70 (5.30) thousand yuan vs. 32.90 (4.80) thousand yuan, P=0.923]. However, the postoperative catheterization time [2.00 (1.00) d vs. 4.00 (1.50) d, P=0.000], postoperative drainage [260.00 (200.00) mL vs. 400.00 (225.00) mL, P=0.031], postoperative pain index [2.00 (1.00) points vs. 4.00 (2.00) points, P=0.000], postoperative analgesic time [1.50 (1.00) d vs. 3.00 (2.00) d, P=0.000], postoperative fever time [1.50 (1.00) d vs. 2.00 (1.00) d, P=0.000] in the SASP group were better than those in the LALP group.ConclusionThoracoscopic surgery via SASP is more suitable for the treatment of anterior mediastinal tumor with rapid postoperative recovery and reduced pain, and the postoperative curative effect is definite. However, there is a high requirement for the surgical experience and techniques. It can be promoted in the clinic.
Objective To analyze the growth of anastomotic stoma of aortic(AO) and pulmonary artery (PA) after arteries switch operation(ASO) so as to assess the longterm efficacy of ASO . Methods The data of 331 patients who had undergone ASO in Shanghai Children’s Medical Center of Jiaotong University from December 1999 to December 2007 was analysed retrospectively. One hundred eleven patients had complete transposition of great arteries complicated with intact ventricular septum(TGA/IVS), 123 had complete transposition of great arteries complicated with ventricular septal defect(TGA/VSD), 73 had TaussigBing complicated with ventricular septal defect and pulmonary hypertension, and 24 underwent StageSwitch. Of the 331 patients 228 were followedup, and the followup time was 20.4±18.6 months. There were 752 ultrasonic cardiograph reports, 3.3per patient on average. The growth of anastomosis was analysed according to the diameters of AO and PA. Results The AO and PA anastomosis diameters of TGA/IVS patients（before discharge 0.74±0.17 cm and 0.65±0.13 cm, latest followup 1.09±0.31cm and 0.84±0.21 cm）, TGA/VSD patients (before discharge 0.76±0.20 cm and 0.63±0.14 cm, latest followup 1.09±0.24 cm and 0.82±0.22 cm) and TaussigBing patients（before discharge 0.84±0.25 cm and 0.74±0.20 cm, latest followup 1.05±0.30 cm and 0.85±0.24 cm） growed significantly（Plt;0.05）. The AO anastomotic stoma diameters of patients who had underwent StageSwtich (before discharge 0.93±0.19 cm, latest followup 1.19±0.29 cm) growed significantly（Plt;0.05）. The PA anastomotic stoma diameter growed（before discharge 0.90±0.27 cm, latest followup 1.00±0.32 cm）, but had no statistical significance (P＞0.05). Till November 2008, Six patients needed reoperation because of the right or left ventricle outflow tract obstruction. After reoperation, 3 had no residual obstruction, 3 had residual obstruction. Conclusion After the section and suture of ASO, aortic and pulmonary artery can grow with age, but sometimes stenosis happens to some patients. During the followingup, some patients need reoperation.
To better evaluate neuromuscular function of patients with stroke related motor dysfunction, we proposed an effective corticomuscular coherence analysis and coherent significant judgment method. Firstly, the related functional frequency bands in the electroencephalogram (EEG) were extracted via wavelet decomposition. Secondly, coherence were analysed between surface electromyography (sEMG) and sub-bands extracted from EEG. Further more, a coherent significant indicator was defined to quantitatively describe the similarity in certain frequency domain and phase lock activity between EEG and sEMG. Through the analysis of corticomuscular coherence during knee flexion-extension of stroke patients and healthy controls, we found that the stroke patients exhibited significantly lower gamma-band corticomuscular coherence in performing the task with their affected leg, and there was no statistically significant difference between their unaffected lag and the healthy controls, but with the rehabilitation training, the bilateral difference of corticomuscular coherence in patients decreased gradually.
【Abstract】 Objective The present study employed both static and dynamic imaging modal ities to study bothintra- and extravascular events attributing to steroid-associated osteonecrosis (ON) using an experimental protocol with a single low-dose l i ppolysaccharide (LPS) injection and subsequently three injections of high-dose methylprednisolone (MPS). Methods Fourteen 28-week-old male New Zealand white rabbits received one intravenous injection of LPS (10 μg/ kg). After 24 hours, three injections of 20 mg/kg of MPS were given intramuscularly at a time interval of 24 hours. Additional 6 rabbits were used as controls. Dynamic MRI was performed on bilateral femora for local intraosseous perfusion before and after LPS injection. Blood samples were collected for haematological examinations before and after LPS injection. Bilateral femora were dissected and decalcified for microCT-based microangiography. ON lesion, intravascular thrombus and extravascular marrow fat cell size were examined histopathologically. Results Intravascular thrombus was observed in all ON rabbits. Extravascular marrow fat cell size was significantly increased in ON rabbits than that of the controls (P lt; 0.05). Compared to basel ine, a significant decrease in ratio of tissue-type-plasminogen-activator/plasminogen-activator inhibitor 1,activated-partial- thromboplatin-time, and a significant increase in ratio of low-density-l ipoprotein/high-density-l ipoprotein were only found in ON rabbits (P lt; 0.05). Dynamic MRI showed a significant decrease in the perfusion index ‘maximum enhancement’ in the ON rabbits (P lt; 0.05) and microCT-based microangiography showed blocked stem vessels in ON samples.Overall, 93% of the rabbits (13/14) developed ON and no rabbits died throughout the experiment period. Conclusion Bothintra- and extravascular events were found attributing to the steroid- associated ON based on our experimental protocol with a single low-dose LPS injection and subsequent three injections of high-dose MPS. Both high ON incidence and no mortal ity in rabbits treated with this inductive protocol suggested its effectiveness for future studies on evaluation of therapeutic efficacy of interventions developed for prevention of steroid-associated ON.
ObjectiveTo assess the function of left ventricular outlet tract and aortic valve after arterial switch operation (ASO) for patients with transposition of the great arteries (TGA) and left ventricular outlet tract obstruction (LVOTO).
MethodsFrom 2002 to 2013, 549 pediatric TGA patients received ASO in Fu Wai Hospital. Among them, 42 patients had LVOTO, including 31 males and 11 females with their median age of 12 months (range, 7 days to 96 months), median body weight of 6.5(3.5-26.0) kg and percutaneous oxygen saturation of 52%-85%. LVOTO anomalies included pulmonary valve stenosis, subaortic membrane, tunnel-like subaortic stenosis, muscular subaortic stenosis, subvalvular apparatus and combined anomalies. Different surgical procedures were performed according to respective anomalies. Echocardiographic characteristics, intraoperative findings, surgical methods, early and follow-up results were summarized.
ResultsCardiopulmonary bypass time was 147-344 (193.5±73.1) minutes, mean aortic cross-clamping time was 139(109-305) minutes, mean mechanical ventilation time was 36(3-960) hours, and mean length of ICU stay was 5(1-48) days. Three patients received and later successfully weaned from extracorporeal membrane oxygenation. Two patients died postoperatively including 1 patient with multiple organ dysfunction syndrome and another patient with severe infection. One patient died during follow-up for unknown reason, and 3 patients were lost during followup. Thirty-six patients were followed up for 24 (3-116) months. During follow-up, there were 1 patient with LVOTO recurrence, 1 patient with new-onset mild aortic valve stenosis, 11 patients with new-onset mild aortic regurgitation (AR), and 2 patients with new-onset moderate AR. Median systolic left ventricular-aortic pressure gradient[4 (2-49) mm Hg] was significantly lower than preoperative value[37.2 (12.1-70.6) mm Hg] (Z=-5.153). Cardiac event-free rate was 91%±5% at 1 year and 78%±8% at 5 years after discharge.
ConclusionFor TGA patients with LVOTO, ASO can produce satisfactory mid-and long-term results if proper surgical indications and strategies are chosen according to different severity of LVOTO which can be evaluated by anatomic features of TGA and systolic left ventricular-aortic pressure gradient.
