使用2-辛基-氰基丙烯酸酯粘合剂与自制修复组件进行有缺损血管修复的一种新方法

背景：当今,粘合吻合技术在血管修复领域应用广泛,但针对有缺损的血管修复应用较少。本文的目的正是验证2-辛基-氰基丙烯酸酯类粘合剂与自制修复组件对有缺损血管进行修复的可行性与有效性。 方法：自制组件由可膨胀聚四氟乙烯人工血管、涤纶生物被摸、自制速溶中空支架三部分组成。修复有缺损血管时,粘合剂与此修复组建配合使用,可替代自体移植血管及缝合技术,通过支架的作用可是血管断端良好对位,同时此组件的中空支架不会阻断血流。选用40只成年杂种狗,20只用于生物力学实验20只用于动物体内实验。在生物力学实验中,狗被随机分为两组（n=10）,一组中,狗两侧的颈动脉通过粘合剂与自制修复组件修复,另一组则使用缝合吻合法与ePTFE修复。修复完成后20分钟取标本,10个粘合吻合标本与10个缝合标本用于拉伸强度实验,另10个粘合吻合标本与10个缝合标本用于爆破强度实验。记录标本所能承受的最大拉力强度与最大爆破强度。在动物实验中,狗同样被分为粘合组与缝合组（n=10）,所有动物仅修复左侧颈动脉。记录手术时间,观察术后吻合口出血情况。术前、术后1周、2周、8周使用彩色多普勒超声对血管吻合口进行检测,并在第8周时通过测量内径评估吻合口狭窄情况。第8周是还进行数字减影造影检测对吻合口进行观察。最后对样本进行组织学分析。 结果：粘合吻合组样本所能承受的最大拉伸强度与最大爆破强度分别为23.80±1.51(N)和52.03±2.43(Kpa),缝合组为24.60±1.08(N)和50.04±3.51(Kpa),两组数据差异均没有统计学意义（P>.05）。粘合吻合组平均手术时间为15.20±0.55分钟,缝合组为25.97±0.58分钟,两组差异有统计学意义（P<.05）。术后粘合吻合组仅有1只狗发生漏血现象,而缝合组每只狗均出现不同程度的漏血。每组各有一只狗在第一周的时候发生血管完全栓塞。通过超声测量,除外发生栓塞的两只狗外,其余狗的狭窄度均未超过30%。血管造影检测与组织学检测两组间未见明显不同。 结论：使用2-辛基-氰基丙烯酸酯粘合剂与我们自制修复组件对有缺损血管进行吻合修复,是可行、有效的,且更加的省时、便捷、易于掌握。     

Experimental study on new self and mutual-aiding occlusive dressing for wound

Background Self and mutual-aiding occlusive dressing is a novel method to treat with the wounds in special circumstances.This study aims to prepare a new antimicrobial adhesive for the dressing and evaluate the application effects of the adhesive.Methods The main component of the new antimicrobial adhesive was 5％ triclosan / cyanoacrylate （CA） antimicrobial adhesive.The adhesive was modified with carboxylic multi-walled carbon nanotubes （MWCNTs-COOH）,multi-walled carbon nanotubes （MWCNTs）,hydrophobic nano-silica,nitrile rubber,epoxy resin and polymethyl methacrylate （PMMA） respectively.The bond strength,toughness and viscosity of the modified adhesive in different concentrations were examined to select the optimal modifying material and the best ratio to prepare the new antimicrobial adhesive according to the results.After that,the antimicrobial property of the new antimicrobial adhesive was tested by filter paper method.At last,we disposed the injury models in rats using the new antimicrobial adhesive to examine the application effects.Results In individual tests,the bond strength modification performance of 0.064％ MWCNTS-COOH is the best,the bond strength is （14.71±1.48） Mpa.8％ nano-silica shows the best toughness modification performance,the Tg is （1.10±0.24）℃.The viscosity modification performance of 8％ nano-silica is the best,the viscosity is （15 536.68±28.4） cP.However,consolidating three test results,6％ nano-silica / antimicrobial adhesive has the balanced bond strength,toughness and viscosity.Its bond strength is （14.03±1.92） Mpa,the Tg is （3.60±0.68）℃,and the viscosity is （5 278.87±31.68） cP.The inhibition zone diameter of 6％ nano-silica / antimicrobial adhesive and antimicrobial adhesive group in Day 5 is （28.61±0.91） mm versus （28.24±2.69） mm （P ＞0.05）.In animal studies,both in blood routine test and pathological section,6％ nano-silica / antimicrobial adhesive group shows lower white blood cells count than gauze bandage group （P ＜0.05）.Conclusions 6％ nano-silica has the optimal effect of bond strength modification,toughness modification and viscosity modification,and the antimicrobial adhesive modified with it has a good antimicrobial property （resistant staphylococcus aureus）.     

Retroperitoneal laparoendoscopic single-site ureterolithotomy versus conventional laparoscopic ureterolithotomy

Background Laparoendoscopic single-site （LESS） surgery through the retroperitoneal approach has been seldom reported.We aimed to evaluate the outcomes of LESS and conventional laparoscopic surgery via the retroperitoneal approach in the management of large,impacted ureteral calculi.Methods Between November 2011 and July 2013,retroperitoneal LESS ureterolithotomy was performed in 12 patients using a homemade single-port device comprising a surgical glove and several strips of tape.Another 16 patients underwent conventional retroperitoneal laparoscopic ureterolithotomy.We compared the operative time,complications,and surgical outcomes,retrospectively.Results All patients were completed without conversion to conventional laparoscopic or open surgery.The operative time of the LESS group and of the conventional laparoscopic group were （125.3±12.8） minutes and （116.9±14.4）minutes,respectively （P=0.119）.The intraoperative blood loss was （42.9±8.9） and （43.4±14.7） ml,respectively （P=0.914）.Postoperative radiologic evaluation revealed that the stones had been removed completely.Cosmetic results were superior in the LESS group （P=0.001）.Conclusion Retroperitoneal LESS ureterolithotomy using a homemade single-port device can be considered a feasible and safe alternative to conventional laparoscopic ureterolithotomy.     

Clinical values of intraoperative indocyanine green fluorescence video angiography with Flow 800 software in cerebrovascular surgery

Background Microscope-integrated near-infrared indocyanine green video angiography （ICG-VA） has been used in neurosurgery for a decade. This study aimed to assess the value of intraoperative indocyanine green （ICG） video angiography with Flow 800 software in cerebrovascular surgery and to discover its hemodynamic features and changes of cerebrovascular diseases during surgery. Methods A total of 87 patients who received ICG-VA during various surgical procedures were enrolled in this study. Among them, 45 cases were cerebral aneurysms, 25 were cerebral arteriovenous malformations （AVMs）, and 17 were moyamoya disease （MMD）. A surgical microscope integrating an infrared fluorescence module was used to confirm the residual aneurysms and blocking of perforating arteries in aneurysms. Feeder arteries, draining veins, and normal cortical vessels were identified by the time delay color mode of Flow 800 software. Hemodynamic parameters were recorded. All data were analyzed by SPSS version 18.0 （SPSS Inc., USA）. T-test was used to analyze the hemodynamic features of AVMs and MMDs, the influence on peripheral cortex after resection in AVMs, and superficial temporal artery to middle cerebral artery （STA-MCA） bypass in MMDs. Results The visual delay map obtained by Flow 800 software had more advantages than the traditional playback mode in identifying the feeder arteries, draining veins, and their relations to normal cortex vessels. The maximum fluorescence intensity （MFI） and the slope of ICG fluorescence curve of feeder arteries and draining veins were higher than normal peripheral vessels （MFI： 584.24±85.86 vs. 382.94_±91.50, slope： 144.95±38.08 vs. 69.20±13.08, P 〈0.05）. The arteriovenous transit time in AVM was significantly shorter than in normal cortical vessels （（0.60±0.27） vs. （2.08±1.42） seconds, P 〈0.05）. After resection of AVM, the slope of artery in the cortex increased, which reflected the increased cerebral flow. In patients with MMD, after STA-MCA bypass, cortex perfusion of corresponding branches region increased and local cycle time became shorter. Conclusion Intraoperative ICG video angiography combined with hemodynamic parameter analysis obtained by Flow 800 software appears to be useful for intraoperative monitoring of regional cerebral blood flow in cerebrovascular disease.     

附加钢板在治疗股骨干骨折髓内钉固定后肥大性骨不连中的应用：与更换钢板的比较

Background Augmentation plating has been used successfully to treat hypertrophic non-union after nail fixation.This study compared the efficacy of augmentation plating and exchange plating for treating hypertrophic non-union of femoral shaft fracture after intramedullary nail fixation.Methods A total of 12 patients received augmentation plating and 15 patients received exchange plating as treatment for femoral shaft hypertrophic non-union.The procedures were conducted at our medical centre between January 2005and January 2012.Clinical follow-up was conducted at 2 weeks,1 month and then monthly until union was achieved to compare union time,operation time,bleeding and complications between the two groups.Results All patients underwent follow-up examinations until fracture union was achieved.The average length of followup time after the second treatment was （18.37±3.28） months.The time needed for union was （4.17±0.94） months in the augmentation plating group and （5.33±1.72） months in the exchange plating group.The operation time was （90.00±17.58） minutes in the augmentation plating group and （160.00±25.35） minutes in the exchange plating group.The amount of blood loss during the operation was （270.00±43.32） ml in the augmentation plating group and （530.00±103.65） ml in the exchange plating group.Both groups showed significant difference （P 〈0.05） in their results.No complications were reported after the second operation.Conclusions Augmentation plating after nail fixation could remove local rotation instability,facilitate simple operation,create minimal damage and enable exercise for early functional recovery.Therefore,augmentation plating is excellent for treating hypertrophic non-union after nail fixation in femoral shaft fracture.     

Impact of microbubble enhanced, pulsed, focused ultrasound on tumor circulation of subcutaneous VX2 cancer

Background Intravascular microbubble-enhanced acoustic cavitation is capable of disrupting the vascular walls of capillaries and small vessels. This study was designed to investigate the impact of microbubble-enhanced, pulsed and focused ultrasound （MEUS） on the blood perfusion of subcutaneous VX2 tumors in rabbits. Methods Subcutaneous VX2 cancers in twenty New Zealand rabbits were treated by combining high-pressure amplitude, pulsed and focused therapeutic ultrasound （TUS） and intravenous microbubble injections. The TUS transducer was operated with a peak negative pressure of 4.6 MPa and a duty cycle of 0.41%. Controls were subcutaneous VX2 cancers treated with TUS or microbubbles only. Contrast-enhanced ultrasound （CEUS） and intravenous Evans Blue （EB） perfusion were performed to assess the tumor circulation. The tumor microvascular disruption was assessed by histological examination. Results CEUS showed that the tumor circulation almost vanished after MEUS treatment. The average peak grayscale value （GSV） of tumor CEUS dropped significantly from 84.1±22.4 to 15.8±10.8 in the MEUS-treated tumors but no significant GSV changes were found in tumors in the two control groups. The mean tumor EB content of the MEUS-treated tumors was significantly lower than that of the controls. Histological examination found scattered tumor microvascular disruption with intercellular edema after MEUS treatment. Conclusion The tumor circulation of VX2 cancers can be arrested or significantly reduced by MEUS due to microvascular disruption. Chin M~.cl ,I 2014：127 （14）： 2605-2611     

Transradial artery intervention: an alternative approach for renal artery stent implantation?

Background  Transfemoral artery access is the main approach for the interventional treatment of renal artery stenosis (RAS). This study aimed to investigate the technical feasibility of a transradial interventional (TRI) treatment of renal artery stenosis.

Methods  A series of 23 patients who underwent transradial renal artery stenting from October 2010 to October 2011 were studied. Radial sheath system (Terumo, Japan) was used to get access to the radial artery. Radial tourniquet (Terumo) was used to stop bleeding. A 5Fr MPA (COOK, USA) was used to perform selective renal arteriography. Percutaneous renal artery stent systems were used to perform renal artery stenting. 

Results  Renal artery angiography showed that 15 patients had unilateral renal artery stenosis and eight patients had bilateral renal artery stenosis. The descending aorta could not be catheterized in one patient because of the type III aortic arch. Twenty-two patients successfully underwent transradial renal artery angiography and the technical success rate was 95.7%. There was no puncture site hematoma or pseudoaneurysm. Mean procedure time was (38.4±7.2) minutes, the mean amount of contrast agent used was (93.2±6.3) ml, and the mean postprocedure bleeding time was (3.2±1.9) minutes.

Conclusion  Transradial renal artery intervention is technically reliable with less invasion, rapid recovery, fewer complications and may become an alternative intervention approach for the treatment of renal artery stenosis.

     

Computer-assisted preoperative planning for proximal humeral fractures by minimally invasive plate osteosynthesis

Background Accurate and precise preoperative planning can provide information instrumental for performing less invasive articular fracture surgery. The purpose of this study was to determine that computer-assisted preoperative planning （CAPP） has the potential to improve efficiency and time in the operating room. Methods Sixty-four patients with proximal humeral fractures were treated using locking plates by minimally invasive plate osteosynthesis （MIPO） with CAPP. The time needed for virtual segmentation, reduction, and fixation of the fracture fragments were recorded. Intra and interobserver reliabilities were analyzed using the intraclass correlation coefficient. The clinical function was analyzed using Constant Score and radiology. Results The mean total time required for CAPP of two-part, three-part, and four-part proximal humeral fractures were （13.63±1.38） minutes, （23.14±2.18） minutes, and （39.61±3.01） minutes, respectively. The intra and interobserver reliabilities for all variables were high, ranging from 0.785 to 0.992. The mean operation time was （50.1±6.7） minutes. Fifty- two patients were followed up with an average time of 34.2 months. The mean Constant Score of the injury side was （82.5 ± 9.9）. Three of the fifty-two patients had four complications. Conclusion The application of CAPP was efficient and reliable, and provided excellent clinical and radiographic outcomes for the treatment of proximal humerus fractures by MIPO.     

Clinical results and intramedullary signal changes of posterior decompression with transforaminal interbody fusion for thoracic myelopathy caused by combined ossification of the posterior longitudinal ligament and ligamentum flavum

Background Surgical treatment of thoracic myelopathy caused by ossification of the posterior longitudinal ligament （OPLL） and ossification of the ligamentum flavum （OLF） is technically demanding, and the results tend to be unfavorable. Various operative approaches and treatment strategies have been attempted, and posterior decompression with transforaminal thoracic interbody fusion （PTTIF） may be the optimal method with which the anterior-posterior compression was removed in one step. It is comparatively less traumatic with fewer serious complications.     

Jitter analysis with concentric needle electrodes in the extensor digitorum communis for the diagnosis of myasthenia gravis: a pilot study

Background Single-fiber electromyography is the most sensitive neurophysiological test for the diagnosis of myasthenia gravis （MG）,but its use is limited by the potential risk of transmission of infections.Jitter analysis with disposable concentric needle electrodes （CNEs） is therefore being investigated.This pilot study aimed to evaluate jitter analysis with CNEs for the diagnosis of MG.Methods Forty-two healthy Chinese volunteers and 44 MG patients were prospectively enrolled.MG patients were classified according to the Osserman classification,and acetylcholine receptor antibody titer was measured.Jitter analysis with CNEs in the extensor digitorum communis and repetitive nerve stimulation （RNS） testing were performed.Jitter was expressed as the mean consecutive difference （MCD）,and 20 action potential pairs were analyzed in each subject.The mean MCD in each subject and the mean individual MCD of all action potential pairs were compared between groups.Results The mean MCD and mean individual MCD were higher in MG patients （（42.3±20.0） μs and （42.2±26.0） μs） than in healthy volunteers （（23.0±3.1） μs and （22.8±7.5） μs）.The area under the receiver operating characteristic curve for the mean MCD of MG patients and healthy volunteers combined was 0.85.The mean MCD and mean individual MCDwere higher in generalized MG patients （（64.1±18.5） μs and （63.6±30.0） μs） than in ocular MG patients （（33.1±12.0） μs and （33.2±17.6） μs）,and were higher in MG patients with abnormal RNS results （（57.2±18.3） μs and （57.3±29.2） μs） than in MG patients with normal RNS results （（32.9±14.8） μs and （32.7±18.3） μs）.Abnormal RNS results were observed in 38.60% （17/44） of MG patients and abnormal jitter were observed in 72.70% （32/44） of MG patients.Conclusion Jitter analysis with CNEs is feasible for the diagnosis of MG.     

An anatomical comparison of two minimally invasive pelvic reconstructive surgeries using fresh female cadavers

Background During the past decade, graft materials have been widespread used in the vagina in order to correct pelvic organ prolapse. The aim of this study was to describe and compare the exact anatomical position of the puncture devices and their relations to the relevant anatomical structures in the ProliftTM and a modified pelvic reconstructive surgery with mesh. Methods Twelve fresh cadavers were allocated randomly to either the ProliftTM or the modified pelvic reconstructive surgery group. Each group had six fresh cadavers. Relevant distances between the puncture devices and anatomical structures were recorded in both minimally invasive puncture surgeries. Results The mean distances from the posterior puncture points of the obturator membrane to the posterior branch of obturator arteries were shorter （（0.60＋0.36） cm and （0.78＋0.10） cm） when compared with the distances to the anterior branch of obturator arteries （（1.53＋0.46） cm and （1.86＋0.51） cm） for the reconstruction of the anterior compartment in both surgeries （all P 〈0.05）. The distance from the puncture points of the pelvic floor through the ischiorectal fossa to the coccygeal and inferior gluteal arteries in the ProliftTM technique （（0.88＋0.10） cm） and （（1.59＋0.36） cm））were much shorter than that in the modified pelvic reconstructive surgery （（2.95＋0.09） cm） and （（3.40＋0,36） cm）） for the reconstruction of the middle and posterior compartments （all P 〈0.05）. Conclusions Compared with the ProliftTM technique, the modified pelvic reconstructive surgery with mesh would be safer not to cause great damage to the inferior gluteal arteries and the coccygeal arteries, The posterior branch of obturator arteries would be easier to be injured than the anterior branch of obturator arteries during anterior compartment reconstruction in both surgeries.     

Comparative study of video-assisted thoracoscopic surgery ablation and radiofrequency catheter ablation on treating paroxysmal atrial fibrillation: a randomized, controlled short-term trial

Background It is unclear whether the effect of video-assisted thoracoscopic surgery ablation is better than catheter ablation on paroxysmal atrial fibrillation （PAF） or not. This study aimed to compare the effects of catheter ablation and video-assisted thoracoscopic surgery ablation on PAF. Methods From March 2008 to March 2012, 138 consecutive patients with PAF were randomly assigned to receive either video-assisted thorecoscopic surgery ablation （thoracoscopy group, n=66） or the traditional catheter ablation （catheter group, n=72）. Results No patient died during the study and all were successfully followed and included in analysis. There were no significant differences in clinical and echocardiographic characteristics between the two groups. All patients were evaluated at 1 week, 1 month, 3 months, 6 months, and 12 months after discharge by physical examination and related laboratory tests. Preoperative left atrium dimensions （LADs） of the recurrent AF were （47±4） mm in the thoracoscopy group and （46±8） mm in the catheter group, whereas the LADs were （40±5） and （39±9） mm, respectively, in non-recurrent PAF. Conclusions The short-term outcome of video-assisted thoracoscopic surgery ablation is safe and effective; and the indications are wider than those for catheter ablation. The larger left atrium diameter is related to the recurrence of atrial fibrillation. Chin Med J 2014;127 （14）： 2567-2570     

Pulmonary vein antrum isolation of pre-excited atrial fibrillation

Background Pulmonary vein antrum isolation (PVAI) of pre-excited atrial fibrillation (AF) is controversial. This study aimed to observe the therapeutic effects of PVAI on pre-excited AF.

Methods Twenty-nine patients with pre-excited AF were prospectively divided into a PVAI group (group I, 19 cases) and a control group (group II, 10 cases). To each case in group I, PVAI was performed, and then electroanatomical mapping of accessory pathways (AP) and ablation were constructed on a three-dimensional (3D) map of the valve annulus. Only AP ablation was performed in each case of group II.

Results Of the 29 cases, three were found to have dual APs, two had intermittent APs, and the remaining 24 had single APs. All APs were successfully ablated after the procedure. There were no significant statistical differences in the AP procedure duration ((77.4±21.3) minutes vs. (85.3±13.1) minutes), the AP ablation time ((204±34) seconds vs. (223±62) seconds) and the AP X-ray exposure time ((18.6±4.4) minutes vs. (19.1±4.5) minutes) respectively between groups I and II. As compared with the control group (5 of 10 cases, 50%), the PVAI group had a significantly lower AF recurrence rate (2 of 19 cases, 11%; P <0.05) during follow-up of (20.5±10.0) months. All seven patients who recurred were successfully abolished by a second ablation.

Conclusions In patients with pre-excited AF, PVAI is an effective therapeutic approach with a low AF recurrence rate. 3D electroanatomical maps of AP contributed to the high success rate of ablation without significantly prolonging of operational duration and X-ray exposure time.

     

Long term follow up of clinical outcome between patellar resurfacing and nonresurfacing in total knee arthroplasty: Chinese experience

Background The long term outcome of patellar resurfacing in Chinese has not been well described.This study evaluated more than 10-year clinical outcomes and survivorship of patellar resurfacing or nonresurfacing in total knee arthroplasty.Methods From January 1993 to December 2002,265 patients accepted total knee arthroplasty in Department of Orthopaedic Surgery,Peking Union Medical College Hospital.Among them,226 patients （246 knees） were successfully followed up,with 176 knees for patellar resurfacing and 70 knees for nonresurfacing.The survivorship of total knee arthroplasty between two groups and the hospital for special surgery knee score （HSS）,patellar score,patellar related complication and radiological results were studied at the latest follow-up.Results The HSS knee score increased from 55.9±12.2 preoperatively to 92.0±10.9 postoperatively for patellar resurfacing group and from 56.6±9.9 to 94.2±11.4 for nonresurfacing group after average 11.4-year follow-up.Patellar score increased from 13.93±2.42 preoperatively to 28.33±2.20 for resurfacing group and from 13.55±2.73 to 27.8±2.37 for nonresurfacing group.There was no statistically significant difference for both HSS score,patellar score between the two groups with higher rate of anterior knee pain for nonresurfacing group.Patellar nonresurfacing had higher lateral subluxation than resurfacing group according to radiological evaluation.Patients with rheumatoid arthritis had 5.5 fold patellar related complication than patients with osteoarthritis.The 10-year survival rate was not statistically significant different between the two groups （P=0.12）.Conclusions There was no significant difference of long-term clinical outcome and survivorship between patellar resurfacing and nonresurfacing.Patellar nonresurfacing can be advisable during primary total knee arthroplasty especially in Chinese patients with osteoarthritis.Selective patellar resurfacing for patients with rheumatoid arthritis can achieve lower patella related complication.     

Rotational Alignment in Total Knee Arthroplasty: Nonimage-based Navigation System Versus Conventional Technique

Background  Proper rotational alignment during total knee arthroplasty (TKA) is important for adequate postoperative patellofemoral and tibiofemoral kinematics, as well as for achieving balanced flexion space at 90º. The effects of computer navigation-assisted total knee replacement and conventional total knee arthroplasty on rotational alignment, mechanical axis, component position and clinical outcomes were compared.

Methods  Two methods were used in 82 patients and the rotation of the femoral and tibial components in the transverse plane, the combined rotation of the two components, the mismatch between them, and the mechanical axis of the lower limb were analyzed. All of these parameters were measured from postoperative radiographs and computed tomography images. Functional outcomes were compared at 6 weeks and 6 months postoperatively.

Results  Significant differences were found between the two techniques (P <0.05) in the following parameters: average rotation of the femoral component ((1.51±3.55)º vs. (−0.63±3.04)º); combined rotation of the femoral and tibial components (2.85±4.07)º vs. (0.28±3.43)º); and mismatch between the femoral and tibial components ((1.44±4.55)º vs. (−0.43±2.86)º). Differences in the rotation of the tibial component were not statistically significant. The prevalence of outliers (malalignment >±3° internal/external rotation) of the femoral component (31.7% vs. 12.5%) and the tibial component (36.6% vs. 15%) were significantly reduced when the navigation system was used (P <0.05). In addition, while patients in the navigation group had significantly better mechanical axis and functional outcomes at 6 weeks after surgery (P <0.05), there was no significant difference between the two groups (P >0.05) with respect to functional outcomes at 6 months.

Conclusion  The navigation system exhibited higher accuracy than the conventional technique in the transverse and coronal plane, and provided better early functional outcomes.

     

Radioactive probe-guided parathyroidectomy for secondary hyperparathyroidism

Background The value of gamma probes in the surgical treatment of secondary hyperparathyroidism （sHPT） was determined.The aim of this study was to enhance the rate of successful total parathyroidectomy in patients with sHPT using intraoperative gamma probe investigations.Methods We retrospectively analyzed the clinical data of 48 sHPT patients between May 2007 and September 2011.Preoperative 99Tcm-methoxyisobutyl isonitrile （MIBI） scintigraphy and high-frequency ultrasonography were used for parathyroid localization.Thirty-five patients （group Ⅰ） underwent conventional neck exploration and open parathyroidectomy.Thirteen patients （group Ⅱ） underwent gamma probe-guided total parathyroidectomy and parathyroid transplantation.The two groups were compared in terms of the number of parathyroid resections,operative time,and postoperative changes in the blood levels of parathyroid hormone （PTH）,calcium,and phosphate.Results The clinical manifestations,PTH and calcium levels,age distribution,and clinical characteristics did not differ between the two groups.The accuracy of preoperative 99Tcm-MIBI scintigraphy （89.74％） for the diagnosis of hyperparathyroidism did not differ from that of ultrasonography （81.25％）.However,the accuracy of 99TcmMIBI scintigraphy （66.67％） for localizing hyperfunctioning parathyroids was significantly lower than that of ultrasonography （76.86％）.The operation time was significantly longer in group Ⅰ （（120±25） minutes） than in group Ⅱ （（90±30） minutes）.The accuracy of parathyroid identification was significantly higher in group Ⅱ （92.59％） than in group Ⅰ （80.39％）.On average,significantly fewer parathyroid specimens were obtained in group Ⅰ （2.5±0.5） than in group Ⅱ （3.5±0.5）.Compared with group Ⅰ,group Ⅱ showed a significant increase （15.4％） in the number of parathyroid resections.The PTH,calcium,and phosphate levels significantly decreased postoperatively in all patients.Conclusions Intra     

A recommended technique of renal vein anastomosis in rat kidney transplantation for trainee

Background Various rat kidney transplantation models have been introduced over the decades and the study on the models seems to lack novelty and necessity.However,vascular anastomosis,especially renal vein,is still very difficult for trainees.The aim of this study was to provide the modified renal venous anastomosis of rat kidney transplantation to substitute the currant method for trainees.Methods Male Wistar rats were used as donors and recipients,respectively.Left orthotopic transplantation was performed with a modified technique of renal vein anastomosis,combining the end-to-end sutures with epidural catheter.Meanwhile,the survival rate,warm ischemia time,renal venous anastomosis time,and complications were recorded to evaluate the merits of the modified technique compared with the current recommended technique of rat renal vein.Two trainees took part in the learning of the models in two methods for performing 30 operations,respectively.Results The difference in warm ischemia time （from （57.25±7.30） minutes in the first 10 operations to （30.05±1.85）minutes in the third 10 operations） and renal vein anastomosis time （from （32.80±3.80） minutes in the first 10 operations to （19.30±0.98） minutes in the third 10 operations） was significantly short （P＜0.01） and the survival rate was statistically high （from （25±7）％ in the first 10 operations to 70％ in the third 10 operations） in equal number of operations （P＜0.01） by comparing with the current recommended method （（47.60±7.19） minutes to （22.8±1.85） minutes,（22.40±3.10） minutes to （9.95±1.50） minutes,45％±7％ to 80％±0,respectively）.The intraoperative complications and postoperative complications of renal venous anastomosis were also significantly decreased （P＜0.01）.Conclusions The technique with epidural catheter can shorten the learning curve of the trainee learning rat kidney transplantation.It may replace the currently recommended technique of rat renal vein for trainees.     

Distinct properties and metabolic mechanisms of postresuscitation myocardial injuries in ventricular fibrillation cardiac arrest versus asphyxiation cardiac arrest in a porcine model

Background The two most prevalent causes of sudden cardiac death are ventricular fibrillation cardiac arrest （VFCA） and asphyxiation cardiac arrest （ACA）. Profound postresuscitation myocardial dysfunction has been demonstrated in both VFCA and ACA animal models. Our study aimed to characterize the two porcine models of cardiac arrest and postresuscitation myocardial metabolism dysfunction. Methods Thirty-two pigs were randomized into two groups. The VFCA group （n=16） were subject to programmed electrical stimulation and the ACA group （n=16） underwent endotracheal tube clamping to induce cardiac arrest （CA）. Once induced, CA remained untreated for a period of 8 minutes. Two minutes following initiation of cardiopulmonary resuscitation （CPR）, defibrillation was attempted until return of spontaneous circulation （ROSC） was achieved or animals died. To assess myocardial metabolism, 18F-FluoroDeoxyGlucose Positron Emission Tomography was performed at baseline and 4 hours after ROSC. Results ROSC was 100% successful in VFCA and 50% successful in ACA. VFCA had better mean arterial pressure and cardiac output after ROSC than ACA. Arterial blood gas analysis indicated more detrimental metabolic disturbances in ACA compared with VFCA after ROSC （ROSC 0.5 hours, pH： 7.01±0.06 vs. 7.21±0.03, P〈0.01; HCO3： （15.83±2.31 vs. 20.11±1.83） mmol/L, P〈0.01; lactate： （16.22±1.76 vs. 5.84±1.44） mmol/L, P〈0.01）. Myocardial metabolism imaging using Positron Emission Tomography demonstrated that myocardial injuries after ACA were more severe and widespread than after VFCA at 4 hours after ROSC （the maximum standardized uptake value of the whole left ventricular： 1.00±0.17 vs. 1.93±0.27, P〈0.01）. Lower contents of myocardial energy metabolism enzymes （Na＊-K＊-ATPase enzyme activity, Ca2＊- ATPase enzyme activity, superoxide dismutase and phosphodiesterase） were found in ACA relative to VFCA. Conclusions Compared with VFCA, ACA causes more severe myocardium injury an     

Propofol enhances the field excitatory postsynaptic potentials in CA1 hippocampal slices of young and aged mice

Background Increasing age was shown to decrease the requirements for propfol.However,the mechanisms of ageing-induced potentiation of anesthetic actions have not been clearly explored.The aim of this study is to compare the effects of propofol on the field excitatory postsynaptic potentials （fEPSPs） in hippocampal slices of young and aging mice.Methods Brain slices were prepared from C57BL6 male young （2 months） and aging （＞12 months） mice.The dendritic field excitatory postsynaptic potential was recorded from the CA1 stratum radiatum using patch clamp electrophysiological methods.A bipolar concentric stimulating electrode was placed along the Schaffer collateral for othodromic stimulation.The effects of clinically-relevant concentrations of propofol were studied in the young and ageing mouse tissues.Results Propofol application increased the orthodromically evoked fEPSP produced in slices taken from young and older animals.A striking feature in the I/O relationship was the decreased enhancement of the fEPSPs by propofol in slices from older mice.A clinically relevant concentration of propofol,10 μmol/L,showed more significant enhancement in amplitude and area under the curve （AUC） of fEPSP in young compared to tissues from older mice （amplitude：young （24.9±3.4）％,old （4.6±1.6）％; AUC young （30.6±5.4）％,old （2.1±1.7）％）.There was no statistically significant difference between the paired-pulse facilitation （PPF） ratios calculated for the responses obtained in tissues from young mice.In slices from older mice,in the presence of 10 μmol/L propofol,PPF was decreased and returned to baseline after washout （baseline 1.21±0.01,propofol：1.16±0.01）.Bicuculline （15 μmol/L） blocked the enhancement of propofol on fEPSP in tissues from young and old mice.Conclusion The fEPSP of slices from aging mice demonstrates diminished sensitivity to the enhancing actions of propofol.     

Surgery for sinus of Valsalva aneurysm: 33-year of a single center experience

Background Sinus of Valsalva aneurysm （SVA） is a rare anomaly and few large or long-term series are well established.This study was designed to review 33-year surgical experience of SVA in one center.Methods From August 1980 to December 2013,patients with SVA underwent surgical repair were retrospectively studied.Results A total of 160 patients were identified with mean age of （30±12） years and 112 （70％） of them were males.The right coronary sinus origin of SVA was found in 108 patients （67.5％）,the non-coronary sinus in 51 patients （31.9％）,and the left coronary sinus in one patient （0.6％）.The rupture of 3VA into the right ventricle was identified in 89 （55.6％） cases,the right atrium in 61 （38.1％）,the left ventricle in 2 （1.3％） and no rupture in 8 （5.0％）.Ventricular septal defect （VSD） and aortic regurgitation （AR） were found in 59 （37％） and 45 （28％） patients respectively.An approach via the involved chamber was used in 86 patients （54％）,aortotomy in 8 （5％）,and a combined approach in 66 （41％）.Either direct suture （56,35％） or patch （104,65％） closure were used to repair the SVA.The VSD was closed with a patch （44/59,75％） or direct suture （15/59,25％）.aortic valve replacement （AVR） was performed in 23/45 （51％） and aortic valvuloplasty （AVP） in 9/45 （20％） patients combined with AR.There were 3 hospital deaths （1.9％） and 2 late deaths and 84％ of the patients were followed up for （17.6±4.2） years.New York Heart Association functional class improved significantly after surgery （P＜0.01）.Actuarial survival was 94％ at 10 years,and 88％ at 20 years.Conclusions Surgical treatment of SVA is safe and effective,ruptured SVA or unruptured SVA with VSD and/or AR should be repaired surgically as early as possible.However,late progressive AR is still a risk during long-term follow-up,and early aggressive measures are recommended.These include more use of a combined approach t