染料介导光氧化处理去细胞牛颈静脉带瓣管道的细胞毒性研究

目的:评价染料亚甲基蓝介导的光氧化处理去细胞牛颈静脉带瓣管道的细胞毒性.方法:(1)间接接触毒性试验:制备染料介导光氧化处理去细胞牛颈静脉带瓣管道浸提液,培养L929细胞,然后采用MTT比色法测定相对增殖率.(2)直接接触毒性试验:将L929细胞与染料介导光氧化处理去细胞牛颈静脉带瓣管道直接接触培养,在不同时间观察细胞...     

Mid-term experience with valved bovine jugular vein conduits

From June 1999 to January 2004, 43 children underwent implantation of a valved bovine jugular vein conduit and correction of complex congenital heart defects. Median age was 1.98 years (range, 11 days - 13.3 years). There were 7 early deaths (16.3%) unrelated to conduit failure or thrombosis. Median follow-up of 36 survivors was 24 months (range, 1-48 months, quartile range, 12-48 months), total follow-up was 78 patient-years. There were 3 late deaths (8.3%) due to infection, pulmonary thromboembolism, and sudden cardiac arrest after re-operation to repair a right ventricular outflow tract aneurysm. There were 2 conduit explantations due to dysfunction and suspected endocarditis. Three patients underwent balloon dilatation of distal stenoses. The mean peak gradient through the pulmonary anastomosis was 15 mm Hg (range, 3-42 mm Hg) among patients free from re-intervention. No severe valve regurgitation was observed. Freedom from re-intervention was 72% at 48 months. This conduit remains a good alternative to homografts. Causes of distal stenosis must be clarified, guidelines for prophylactic anticoagulation must be created, and the role of percutaneous balloon dilatation established.     

染料介导的光氧化处理去细胞猪主动脉瓣的细胞毒性研究

目的 评价染料亚甲基蓝介导的光氧化处理去细胞猪主动脉瓣膜的细胞毒性。方法 将L929细胞经亚甲基蓝介导光氧化处理去细胞猪主动脉瓣浸提液培养后,用MTT比色法测定其相对增殖率。将L929细胞与染料介导光氧化处理去细胞猪主动脉瓣直接接触培养,于不同时间观察细胞的生长状态。将L929细胞种植于染料介导的光氧化处理去细胞猪主动脉瓣表面,用扫描电镜观察其生长情况。结果 染料亚甲基蓝介导的光氧化处理去细胞猪主动脉瓣的性质稳定,细胞毒性程度为0～Ⅰ级。L929细胞与瓣膜材料直接接触培养生长良好,形态学无明显改变。结论 染料亚甲基蓝介导的光氧化处理去细胞猪主动脉瓣的细胞相容性良好。     

Histological/biological characterization of decellularized bovine jugular vein

Several deficiencies in currently available right ventricular valved conduits make them problematic for use in infants and children. A solution would be to develop a tissue-engineered valved conduit containing autologous cells. A method was devised to produce a decellularized bovine matrix scaffold for developing a tissue-engineered right ventricular valved conduit. Fresh bovine jugular veins were treated with sodium deoxycholate and Triton X-100. The major structural proteins of the fresh and decellularized jugular venous valves and vessel walls were detected by histological methods. Thickness, water absorption rate, water maintenance rate, disruption strength, and extensibility were determined. Circumferential and radial specimens of valves and vessel walls were subjected to tensile testing. Histological analysis showed that no cell fragments were retained within the decellularized matrix scaffold and the major structural proteins had been retained intact. There were no significant differences in thickness, rates of absorption and maintenance of water, disruption strength, and extensibility between the decellularized and fresh veins. It was concluded that this treatment can successfully remove cellular components while maintaining the major structural components and the histological and biological properties of bovine jugular veins.     

环氧氯丙烷处理牛颈静脉带瓣管道生物学特性的研究

目的 评价环氧氯丙烷处理牛颈静脉带瓣管道（BJVC)的生物学特性。方法 分别比较戊二醛处理、环氧氯丙烷处理、戊二醛+环氧氯丙烷联合处理和新鲜BJVC的管壁、瓣膜的厚度、大体形态、组织学特点、含水量、热皱缩温度及断裂强度，并进行可溶性蛋白含量的测定。结果 戊二醛+环氧氯丙烷联合处理组BJVC的管壁、瓣膜厚度、组织含水量与未处理组相比较无明显变化；但管壁、瓣膜断裂强度和热皱缩温度均较新鲜对照组明显提高(P<0.05)，可溶性蛋白的含量明显减少(P<0.05)。结论 戊二醛+环氧氯丙烷联合处理的带瓣管道材料具有较好的生物学特性。     

Varix of the external jugular vein

A case of varix involving the left external jugular vein is presented. The pathogenesis of the unusual condition is discussed and the attention of practising physicians drawn to the new differential diagnosis of swelling in the neck.     

The bovine jugular vein: a totally integrated valved conduit to repair the right ventricular outflow

BACKGROUND AND AIMS OF THE STUDY: Current techniques to correct valvular anomalies of the right ventricular outflow tract (RVOT) include repair and replacement of the pulmonary valve. However, the performance of currently used conduits has been less than ideal because of unfavorable hemodynamics and mid- to long-term complications. An early experience with a totally integrated Contegra valved conduit derived from a bovine jugular vein is reported; this conduit has the advantage that there is no discontinuity between its lumen and the valve it incorporates. METHODS: Between October 1999 and October 2001, a total of 22 Contegra valved conduits (12-22 mm) was implanted in 21 children aged <5 years, and in one patient aged 21 years. Diagnosis included tetralogy of Fallot (n = 13), pulmonary atresia (n = 3), double outlet right ventricle with pulmonary stenosis (PS) (n = 3), transposition of the great arteries, ventricular septal defect and PS (n = 2) and truncus arteriosus (n = 1). In 15 of these patients, distal and proximal anastomoses were performed on the beating heart. RESULTS: There was no mortality and no valved-conduit-related early morbidity. Intraoperative invasive assessment demonstrated excellent hemodynamic characteristics: mean peak pressure increase was 8.5+/-6.3 mmHg (varying between 4 mmHg in the 20-mm conduit and 18 mmHg in the 14-mm conduit). These values were confirmed by pre-discharge transthoracic pulsed-wave Doppler echocardiography. Because of endocarditis, one conduit was explanted after 11 months and replaced with a pulmonary homograft. Two patients required reintervention. CONCLUSION: The Contegra valved conduit is an excellent immediate substitute in the treatment of RVOT lesion when a pulmonary valve has to be inserted. Both systolic and diastolic valve functions are promising. Further data are required to confirm the favorable hemodynamics, as well as the durability and efficacy of this conduit in the long term.     

Unusual complication of internal jugular vein cannulation

Internal jugular cannulation is a common procedure in the hospitals. We report a rare complication where the guide wire was pushed into the internal jugular vein without threading the catheter through. Complications due to central venous cannulation are also discussed.     

Brachial jugular autogenous spiral vein bypass for obstruction of subclavian vein

Recent advances in venous reconstruction allow the surgeon to bypass obstructive lesion of the venous system successfully. Because of low pressure and low velocity flow in the venous system, and adjunct temporary arteriovenous fistula appears to be essential for patency of the venous bypass. The existing data has shown that autogenous vein is superior to prosthetic material for bypassing venous obstruction. We are presenting a 44-year-old patient who has failed medical treatment and successfully been treated by this method.     

带瓣牛颈静脉补片在右室流出道重建中的临床应用

目的 总结带瓣牛颈静脉补片在右室流出道重建中的临床经验和术后早期效果.方法 2006年6月至2008年12月,16例患者应用带瓣牛颈静脉补片进行右室流出道重建.与同期手术行右室流出道重建使用自体心包组术后早期进行对比.结果 全组无死亡,术后3个月超声检查右室流出道通畅,4例有轻度反流.结论 带瓣牛颈静脉作为右室流出道重建的替代材料,具有易于获取、型号齐全、早期临床效果好的特点,但中远期效果仍待随访观察.     

水垫联合压疮贴及静脉导管敷贴预防压疮

压疮长期以来一直是呼吸科护理工作中较为棘手的问题,是护理工作需攻克的顽症.2014年1月至20104年6月我科对96例卧床患者应用水垫联合静脉导管敷贴及压疮贴（泡沫敷料）预防压疮,取得了非常好的效果,现报道如下.     

Doppler sonography measurement of jugular vein blood flow

By multiplying mean cross section determined with a linear array scanner by time averaged mean spatial velocity measured with a single gated pw Doppler device, internal jugular venous volume flow was computed in 50 healthy male and 50 female volunteers aged 21 to 70 years with even age distribution within this range. Right plus left flow was 793 +/- 276 ml/min in males and 799 +/- 288 ml/min in females. There was no correlation between flow and age.     

医用牛颈静脉带瓣管道重建右室流出道临床应用研究

目的应用牛颈静脉带瓣管道（BJVC）进行心脏右室流出道的重建,探讨BJVC对复杂先天性心脏病外科治疗的效果。方法2005年10月至2009年5月共应用BJVC治疗复杂先天性心脏病15例。结果BJVC重建右室流出道15例患者均痊愈出院。随访3～24个月,患者心悸、气促消失,活动耐力明显提高,心功能恢复至I～Ⅱ级,超声检测发现15例置入的管道通畅,无扩张,未见血栓形成,瓣叶活动良好,无明显反流,肺动脉跨瓣压差不大,吻合口无狭窄。结论BJVC用于复杂先天性心脏病右室流出道的重建可获良好的近期治疗效果,但远期效果仍有待进一步观察。     

比较牛颈静脉去细胞处理实验方法

目的比较两种牛颈静脉脱细胞方法。方法改良组对牛颈静脉使用0.25%聚乙二醇辛基苯基醚、2.5g/L脱氧胆酸钠、0.2g/L乙二胺四乙酸、0.1g/LRNA酶和0.2g/LDNA酶作48h脱细胞处理;常规组使用0.5g/L胰蛋白酶和0.2g/L乙二胺四乙酸处理24h,再按以上处理组程序处理24h。血管壁和瓣膜自身细胞脱除和细胞外基质改变在染色后用扫描电镜观察;血管组织强度用生物力学检测。结果改良处理组管壁和瓣膜自身细胞完全脱除而细胞外基质无明显改变,常规组仍有大量固有细胞残留,弹力纤维出现断裂;两组脱细胞血管的生物力学性能无明显变化。结论改良脱细胞处理用聚乙二醇辛基苯基醚、脱氧胆酸钠、乙二胺四乙酸、RNA酶和DNA酶组合,是一种较理想的牛颈静脉脱细胞方法。     

Early results of balloon dilatation of the stenotic bovine jugular vein graft in the right ventricular outflow tract in children

The aim of this study was to evaluate the early results of interventional balloon dilatation of stenotic bovine jugular vein (BJV) grafts implanted for reconstruction of the right ventricular outflow tract (RVOT) in children. METHODS: From May 2001 to December 2005, 153 BJV grafts were implanted in children in our institution. An average of 16.9 (7.6-41.1) months after implantation, 17 balloon dilatations in a significant stenosis proximal (n = 1), distal anastomosis (n = 8), BJV valve (n = 3), or at multiple sites (n = 5) were performed in 15 children (male:female = 9:6) with a mean age of 3.9 (0.8-13.0) years. Balloon diameter was 75-133.3% (mean 100.3) of the original BJV size. Mean follow-up was 8.8 (2 days to 22.8 months) months. RESULTS: In 10 interventions (58.8%) the instantaneous peak gradient was reduced below 50 mmHg. A balloon diameter > or =100% of the original BJV size correlated significantly with a successful intervention. No major complications, two minor (nonobstructive floating membranes at the dilatation site and one septicemia) occurred afterward. Freedom from reintervention after 6 months was 58.2% for all, 77.8% for dilatations of the proximal anastomosis and mixed stenotic lesions, and 33.3% for the distal anastomosis. CONCLUSION: Balloon dilatation of stenotic BJV grafts is safe and can significantly reduce the pressure gradient in two-thirds of interventions. Balloon diameters above the original graft size should be aimed for. The most frequent stenosis of the distal anastomosis tends to renarrow early after dilatation. Nevertheless, balloon dilatation should be considered in nearly every stenotic graft to gain time until a surgical or interventional graft exchange.     

乙醇、丁二醇改性对牛颈静脉的抗钙化作用

目的探讨两种醇类改性对牛颈静脉带瓣管道的抗钙化作用。方法将戊二醛固定的牛颈静脉带瓣管道分别用80%乙醇(A组)和100%2,3-丁二醇(B组)进行化学改性,分别将两组管壁片及瓣膜片植入12只刚离乳的SD大鼠背部两侧皮下,90 d后处死大鼠,取出植入的组织片进行组织钙质量分数、总蛋白水平测定与光镜、电镜检查。结果A组的牛颈静脉管壁及瓣膜组织钙质量分数分别为(173±61)μg/m g和(2.13±0.85)μg/m g,B组钙质量分数分别为(181±29)μg/m g和(1.73±1.20)μg/m g,两组比较,均无显著性差异(P>0.05);组织学观察显示两组改性管壁及瓣膜组织炎性细胞浸润较少,胶原纤维结构保持良好。A组管壁及瓣膜片总蛋白水平分别为(337±293)m g/L和(142±82)m g/L,B组管壁及瓣膜片总蛋白水平分别为(269±230)m g/L和(139±111)m g/L,两组比较,均无显著性差异(P>0.05)。结论两种醇类均可作为牛颈静脉带瓣管道的改性剂;生物材料钙化与蛋白吸附相关;丁二醇及乙醇改性减少了生物材料的蛋白吸附,从而增强其抗钙化性能。