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Objective:To investigate the effect of deviation from the isocenter point on the quality of CT images at the same radiation dose.Methods:A 160-layer CT scanner was used to scan the phantom at isocenter and deviations of 3, 6, 9, 12 and 15 cm. CT was performed with the following parameters: 120 kVp; 400 mAs; slice thickness, 1 mm; and slice increment, 1 mm. Images were reconstructed using the filtered back projection algorithm. Noise power spectrum (NPS), task transfer function (TTF) and detectability index (d′) were measured. NPS peak was used to quantify the noise magnitude and TTF 50% was used to quantify the spatial resolution. NPS, TTF and d′ were compared using one-way ANOVA. Results:The NPS average spatial frequency, spatial resolution and d′ values gradually decreased as the offset distance increased and the amount of noise increased. NPS peak at isocenter and deviations of 3 cm, 6 cm, 9 cm, 12 cm and 15 cm were (94.31±1.48), (104.25±1.46), (131.44±1.96), (171.86±1.91), (224.05±1.37), (286.51±2.09)HU 2·mm 2, respectively ( F=37 241.91, P<0.001). And d′ values of 2 mm low-contrast lesions were 3.51±0.06, 3.31±0.04, 3.01±0.04, 2.59±0.06, 2.21±0.03, 1.88±0.03, respectively. The reduction in spatial resolution was more pronounced for high contrast, and the d′ values decreased to a similar extent for various types of lesions. The noise was increased by about 82%, the high contrast spatial resolution was decreased by about 12%, and the d′ value was decreased by about 26% at 9 cm from the isocenter point (all P<0.05). The noise was increased by about 204%, the high contrast spatial resolution was decreased by about 27%, and the d′ value was decreased by about 45% at 15 cm from the isocenter (all P<0.05). Conclusion:The CT image quality was decreased with the increase of the offset distance from the CT isocenter point. The image quality was severely compromised at offset distances greater than 9 cm.
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Purpose@#To explore the effect of intravesical electrical stimulation (IVES) on urinary adenosine triphosphate (ATP) and nitric oxide (NO) in rats with detrusor underactivity (DU) induced by bilateral pelvic nerve crush (bPNC), and to determine the underlying peripheral mechanism. @*Methods@#Twenty-four female Sprague-Dawley rats were equally divided into 3 groups: sham; bPNC; and IVES. Rats in the IVES group began to receive IVES treatment 10 days after bPNC (20 minutes per day for 14 consecutive days). After the 14th IVES, rat urine was collected and cystometry was performed. The serum creatinine, blood urea nitrogen, and urinary ATP and NO levels were measured, and a routine urinalysis was performed. @*Results@#The maximum cystometric capacity (MCC), maximum changes in bladder pressure during filling (∆FP), and postvoid residual urine (PVR) in the IVES group were significantly lower than the bPNC group, and the maximum changes in bladder pressure during voiding (∆VP) was significantly higher than the bPNC group. Compared with the sham group, the MCC, ∆FP and PVR were significantly increased, and the maximum voiding pressure (MVP) and ∆VP were significantly decreased in the bPNC group. After bPNC, urinary ATP was significantly decreased, and urinary NO was significantly increased. In IVES-treated rats, urinary ATP was significantly higher than the bPNC group, and NO was significantly lower than the bPNC group. In addition, the ATP-to-NO ratio of the rats in the bPNC group was significantly lower than the sham and IVES groups. Correlation analysis showed that the ATP and NO were not correlated with the MCC, ∆FP, MVP, ∆VP, and PVR. @*Conclusions@#Promoting the release of urothelial ATP and inhibiting the release of urothelial NO may be one of the peripheral mechanisms underlying IVES in the treatment of DU. Specifically, IVES may shift the balance between excitation and inhibition toward excitation.
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Objective:To analyze the incidence of human papillomavirus (HPV) infection in 1 902 patients and to evaluate the efficacy of drug treatment in 266 patients, aiming to provide reference for the treatment of HPV infection.Methods:The subtypes of HPV isolated from 1 902 patients aged 15-86 years visiting the venereology outpatient clinic of Tianjin Medical University General Hospital from October 2019 to May 2021 were identified by polymerase chain reaction-reverse dot blot hybridization. Drug treatment efficacy in 266 patients of them was retrospectively analyzed.Results:The overall incidence of HPV infection in the 1 902 patients was as high as 53.84% (1 024/1 902). It was 52.60% (689/1 310) in males and 56.59% (335/592) in females. There was no significant difference in the incidence between males and females ( P>0.05). The most common HPV genotype in males and females was HPV6 [15.27% (200/1 310) and 21.96% (130/592)], followed by HPV16 [10.61% (139/1 310) and 9.46% (56/592)], HPV11 [9.31% (122/1 310) and 8.61% (51/592)], HPV52 [6.79% (89/1 310) and 8.95% (53/592)] and HPV43 [5.64% (87/1 310) and 8.45% (50/592)]. The majority of HPV-positive patients were aged between 20 and 39 years. There were 476 cases (25.03%, 476/1 902) of single-type infection and 548 cases (28.81%, 548/1 902) of multiple infection. The incidence of multiple infection was higher than that of single-type infection ( P<0.05). The incidence of multiple infection in females was higher than that in males ( P<0.05). Among the 266 patients, 106 were treated with Paiteling, a traditional Chinese medicine (TCM) preparation, and 68 of them tested negative (64.15%) after treatment. Fifty-eight patients were treated with recombinant human interferon α2b and 22 of them (37.93%) tested negative after treatment. Twenty out of the 56 subjects treated with imiquimod tested negative after treatment. Eight out of the 46 patients without treatment also turned negative. Conclusions:The incidence of HPV infection in the 1 902 patients visiting the venereology outpatient clinic was very high, and most of them were young adults. Multiple infection was more common than single-type infection. Topical application of drugs such as Paiteling, recombinant human interferon α2b and imiquimod was effective in treating HPV infection.
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OBJECTIVE@#To select variables related to mortality risk of stroke patients in intensive care unit (ICU) through long short-term memory (LSTM) with attention mechanisms and Logistic regression with L1 norm, and to construct mortality risk prediction model based on conventional Logistic regression with important variables selected from the two models and to evaluate the model performance.@*METHODS@#Medical Information Mart for Intensive Care (MIMIC)-Ⅳ database was retrospectively analyzed and the patients who were primarily diagnosed with stroke were selected as study population. The outcome was defined as whether the patient died in hospital after admission. Candidate predictors included demogra-phic information, complications, laboratory tests and vital signs in the initial 48 h after ICU admission. The data were randomly divided into a training set and a test set for ten times at a ratio of 8 ∶2. In training sets, LSTM with attention mechanisms and Logistic regression with L1 norm were constructed to select important variables. In the test sets, the mean importance of variables of ten times was used as a reference to pick out the top 10 variables in each of the two models, and then these variables were included in conventional Logistic regression to build the final prediction model. Model evaluation was based on the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. And the model performance was compared with the forward Logistic regression model which hadn't conducted variable selection previously.@*RESULTS@#A total of 2 755 patients with 2 979 ICU admission records were included in the analysis, of which 526 recorded deaths. The AUC of Logistic regression model with L1 norm was statistically better than that of LSTM with attention mechanisms (0.819±0.031 vs. 0.760±0.018, P < 0.001). Age, blood glucose, and blood urea nitrogen were at the top ten important variables in both of the two models. AUC, sensitivity, specificity, and accuracy of Logistic regression models were 0.85, 85.98%, 71.74% and 74.26%, respectively. And the final prediction model was superior to forward Logistic regression model.@*CONCLUSION@#The variables selected by Logistic regression with L1 norm and LSTM with attention mechanisms had good prediction performance, which showed important implications on the mortality prediction of stroke patients in ICU.
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Humans , Critical Care , Intensive Care Units , Logistic Models , Memory, Short-Term , Prognosis , ROC Curve , Retrospective Studies , StrokeABSTRACT
Purpose@#To determine the risk factors predicting upper urinary tract (UUT) damage using a grading system for upper urinary tract dilation (UUTD) and a descriptive system for all urinary tract dysfunction (AUTD) in patients with myelodysplasia. @*Methods@#Six hundred thirty-seven patients with myelodysplasia were evaluated at our center from January 2008 to November 2019. Clinical data, ultrasonography, magnetic resonance urography, and video-urodynamics (VUDS) parameters were collected. Univariate and multivariate analyses were used to determine the risk factors predicting UUT damage. @*Results@#Three hundred eighty-three males and 254 females were included. The average course of lower urinary tract symptoms (LUTS) was 14.08±7.07 years (range, 3–31 years). The urodynamic diagnoses of all patients were as follows: detrusor overactivity, 26.8%; detrusor underactivity, 6.44%; and acontractile detrusor, 66.72%. UUT damage was determined in 66.56% of the patients. Of the patients, 28.73 % had vesicoureteral reflux (VUR) during filling (bilateral, n=50; unilateral, n=133) on fluoroscopy during VUDS testing. Two hundred thirty-four patients had UUTD (bilateral, n=203; unilateral, n=31). The occurrence of hydronephrosis based on ultrasonography was closely related to ipsilateral VUR (P<0.05). Absent of bladder sensation, long-term course of LUTS, decreased maximum cystometric capacity (MCC) and bladder compliance (BC), and increased postvoid residual urine (PVR) were shown to be independent risk factors in logistic regression analysis. @*Conclusions@#This retrospective study using UUTD and AUTD systems indicated that patients with myelodysplasia have a high incidence of UUT damage. Absence of bladder sensation, long-term course of LUTS, decreased MCC and BC, and increased PVR were independent risk factors predicting UUT damage.
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As a conservative treatment, intravesical electrical stimulation can not only restore bladder sensation, but also improve bladder contraction. Studies in recent decades have shown that intravesical electrical stimulation has a two-way regulating effect on bladder function, and there were few adverse reactions. At present, there was no uniform treatment standard yet, The mechanism of action and curative effect was not clear, so the choice of this treatment method is full of challenges for urologists. This article reviews the research progress in the treatment of lower urinary tract dysfunction by intravesical electrical stimulation.
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Purpose@#To investigate the video-urodynamic and pelvic floor electrophysiological characteristics in patients with traumatic spinal cord injury (SCI). @*Methods@#This retrospective reviewed the clinical records, urodynamic and pelvic floor electrophysiological data of 647 patients with traumatic SCI and out of spinal shock. Patients were classified based on American Spinal Injury Association (ASIA) Impairment Scale and urodynamic findings. @*Results@#Of the 647 patients, detrusor overactivity (DO) with or without detrusor sphincter dyssynergia (DSD) was found in 79.5%, 61%, 35.2%, 35%, and 19.2% of patients with cervical, thoracic (T1–9), thoracic (T10–12), lumbar, and conical cauda injury, respectively. Other patients manifested detrusor areflexia (DA). Patients with DO and/or DSD had a longer duration of SCI at each injury level than patients with DA. In suprasacral injury patients with DA, 63.0% (58 of 92) had a normal bulbocavernosus reflex (BCR) response. Compared with patients without bladder sensation (BS), bladder capacity during urine leakage was far higher in those with BS. The manifestation of BCR and somatosensory-evoked potential (SEP) was associated with the level of injury. @*Conclusions@#This study showed a significant correlation between the level of SCI and video-urodynamic findings, but clinical examination cannot by predict bladder function; urodynamic testing is also necessary. In addition, the role of BCR and SEP for guiding bladder management is limited. Moreover, BS is important for urinary control in patients with traumatic SCI.
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Objective:To explore the efficacy and safety of intravesical electrical stimulation (IVES) combined with a training for bladder motor and sensory dysfunction in the treatment of neurogenic underactive bladder(UAB).Methods:A prospective, single-blind, randomized controlled trial was used to study neurogenic UAB patients admitted to the China Rehabilitation Research Center from October 2019 to May 2021. Inclusive criteria included age≥18 years old, the patients who have been diagnosed as neurogenic UAB and the course of disease being more than 3 months; patients who have been undergone intermittent catheterization to empty the bladder or patients indicated for intermittent catheterization (post-void residual urine accounts for more than 40% of the functional bladder volume), voluntary signing of written informed consent, able to communicate well with researchers and comply with the requirements of the whole trial, and the patient not undergoing any treatment other than oral medication before IVES. Exclusion criteria included patients with low bladder compliance by urodynamic examination(<20 ml/cmH 2O), patients with mechanical outflow obstruction, patients with complete spinal cord injury, the patients with symptomatic urinary tract infection which was not cured, patients with hydronephrosis or bladder-ureteral reflux, patients with renal insufficiency(serum creatinine greater than 1.5 times of the upper limit of normality), patients with malignant tumors of the bladder or prostate, overactive bladder, Alzheimer's disease, brain atrophy, acute cerebrovascular disease, or cognitive impairment, patients who were pregnant or planning to be pregnant, bladder mucosa injury, patients with pacemakers or defibrillators, those who participated in other clinical trials 3 months before the study, and other circumstances that the researcher consider it is not suitable to be involved in this study. The patients were randomly divided into experimental group and control group according to the ratio of 1∶1. The experimental group used conventional transurethral insertion of bipolar catheter electrodes for IVES combined with bladder motor and sensory dysfunction training, and the control group underwent IVES with open circuit combined with bladder motor and sensory dysfunction training. The stimulation parameters of the two groups were two-way square wave, 1-30 mA intensity, 10-20 Hz frequency, 200 μs pulse width, once a day, lasting 30 minutes for each treatment, and for continuous 20 working days. The post-void residual urine, voiding efficiency, 24-hour intermittent catheterization times, first sensation of bladder filling volume and American Urological Association Symptom Index Quality of Life(AUA-SI-QOL) scores were recorded before and at the end of treatment. The adverse events during the treatment were recorded. Results:Fifty-two patients were selected and 50 patients completed the trial, including 26 patients in the experimental group and 24 patients in the control group. Before treatment, there were no significant differences in gender[16(male)/10(female)vs.13(male)/11(female), P=0.598], age [(40.7±13.5)years vs.(38.5±12.3)years, P=0.543], course of disease[0.71(0.42, 1.63)years vs.0.79(0.42, 1.50)years, P=0.695], post-void residual urine[300(193, 400)ml vs.325(178, 380)ml, P=0.724], voiding efficiency[17%(0, 47.8)% vs.21%(0, 38.0)%, P=0.960], 24-hour intermittent catheterization times[4(2, 4)vs.3(2, 4), P=0.692], first sensation volume during bladder filling[(325.8±74.3)ml vs.(307.5±75.0)ml, P=0.391] or AUA-SI-QOL scores[5(4, 5)vs.4(4, 5), P=0.313] between the experimental group and the control group. At the end of treatment, the post-void residual urine, first sensation volume during bladder filling and AUA-SI-QOL scores of the experimental group were significantly lower than those of the control group [250(40, 350)ml vs.300(200, 390)ml, P=0.034; (276.5±68.8)ml vs.(315.4±67.3)ml, P=0.049; 4(2, 4)vs.4(3, 5), P=0.024], and the voiding efficiency was significantly higher than that of the control group[33%(14.5, 84.5)% vs.18%(0, 35.8)%, P=0.041], but there was no significant difference in the number of 24-hour intermittent catheterization between the two groups [3(1, 4)vs.3(2, 4), P=0.174]. In the control group, there were no significant changes in post-void residual urine, voiding efficiency, 24-hour intermittent catheterization times, first sensation volume during bladder filling and AUA-SI-QOL scores before and after treatment [325(178, 380)ml vs.300(200, 390)ml, P=0.832; 21%(0, 38.0)% vs.18%(0, 35.8)%, P=0.943; 3(2, 4)vs.3(2, 4), P=0.239; (307.5±75.0)ml vs.(315.4±67.3)ml, P=0.257; 4(4, 5)vs.4(3, 5), P=0.157]. In the experimental group, there were significant improvements in post-void residual urine, voiding efficiency, 24-hour intermittent catheterization times, first sensation volume during bladder filling and AUA-SI-QOL scores before and after treatment [300(193, 400)ml vs.250(40, 350)ml, P<0.001; 17%(0, 47.8)% vs.33%(14.5, 84.5)%, P<0.001; 4(2, 4)vs.3(1, 4), P=0.011; (325.8±74.3)ml vs.(276.5±68.8)ml, P<0.001; 5(4, 5)vs.4(2, 4), P<0.001]. During the treatment period, 1 case of abdominal discomfort occurred in the experimental group and 1 case of urethral discomfort in the control group. After adjusting the stimulation intensity and catheter position, the discomfort disappeared without other serious adverse events. Conclusions:IVES combined with bladder motor sensory dysfunction training can not only effectively improve the bladder emptying efficiency and bladder sensation in patients with neurogenic UAB, but also be safe and easy to operate.
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Objective:Evaluate the influence of different pressure transmission media of urodynamic water filled catheter(WFC) and air charged catheter(ACC) on the pressure measurement results to determine whether they can be used interchangeably.Methods:The results of 2 147 patients who underwent urodynamic examination in our hospital from January 2014 to December 2020 were retrospectively analyzed. A total of 2 538 times of bladder manometry data were obtained, including 1 299 times in WFC group, 856 times in male and 443 times in female, aged 37(24, 50)years, course of disease 1.2(0.4, 5.0) years, 1 130 times in neurogenic bladder(NB)and 169 times in non-neurogenic bladder(N-NB); In ACC group, there were 1 239 times, 773 times for male and 466 times for female, with age of 37(24, 55)years, course of disease of 1.5(0.5, 6.0)years, 1 040 times for Nb and 199 times for N-NB. There was no significant difference in baseline data of general clinical data between the two groups. The intravesical pressure(Pves), intra-abdominal pressure(Pabd)and detrusor pressure(Pdet) of WFC and ACC patients during filling and urination were analyzed. For traumatic spinal cord injury(SCI) and idiopathic patients, the two sets of pressure measurement data were analyzed separately. Nonparametric test and Chi-square test were used to compare the Pves, Pabd, and Pdet recorded by the two manometry catheters before, at the end and after urination, the maximum detrusor pressure at DO(Pdet.max-DO), and the maximum detrusor pressure during spontaneous urination (Pdet. max) and the detrusor pressure (Pdet.Qmax) corresponding to the maximum urine flow rate, the maximum urethral pressure (MUP) and the maximum urethral closure pressure (MUCP) during resting urethral pressure profile, and the initial cough Pdet signal pattern (typeⅠ, typeⅡand typeⅢ).Results:Regardless of the cause, the Pabd values measured by ACC were significantly higher than WFC before filling, end filling and after voiding[18(10, 26)cmH 2O vs.15(11, 21)cmH 2O; 23(16, 31)cmH 2O vs. 20(14, 26)cmH 2O; 23(15, 31)cmH 2O vs.18(12, 24)cmH 2O], and Pdet were significantly lower than WFC[0(0, 0) cmH 2O vs. 0(0, 1)cmH 2O; 5(1, 13)cmH 2O vs. 9(4, 17)cmH 2O; 6(1, 12)cmH 2O vs. 7(3, 14)cmH 2O]. In the initial cough state, Pves and Pabd increase value were also significantly lower than that of WFC [22(12, 36)cmH 2O vs. 23(14, 38)cmH 2O; 20(10, 33)cmH 2O vs. 21(12, 36)cmH 2O]. The Pves measured by ACC was also significantly higher than WFC before filling and after voiding[18(10, 27)cmH 2O vs. 16(11, 21)cmH 2O; 30(22, 39)cmH 2O vs. 26(20, 36)cmH 2O]. Maximum urethral pressure (MUP) and maximum urethral closure pressure (MUCP) measured by ACC were significantly higher than WFC [91(69, 118)cmH 2O vs.81(64, 106)cmH 2O; 77(55, 103)cmH 2O vs. 68(48, 91)cmH 2O], and there were no significant differences in Pdet.max-DO、Pdet.max和Pdet.Qmax. For patients with traumatic SCI, the Pves measured by ACC was significantly higher than WFC before filling[15(10, 24)cmH 2O vs. 14(10, 20)cmH 2O], and only MUP was significantly higher than WFC in the measurement of urethral pressure[95(71, 119)cmH 2O vs. 85(65, 112)cmH 2O], and there were no significant differences in Pdet.max-DO, Pdet.max, Pdet.Qmax and MUCP. For idiopathic patients, Pves measured by ACC before filling and after urination were significantly higher than WFC[25(20, 29)cmH 2O vs. 18(11, 23)cmH 2O; 35(29, 44)cmH 2O vs. 28(20, 38)cmH 2O], while Pdet.max-DO, Pdet.max, Pdet.Q max, MUP and MUCP were not significantly different in different pressure measurement systems. For the comparison of the initial cough Pdet signal pattern, ACC is easier to detect type Ⅰ, and WFC is easier to detect type Ⅱ and type Ⅲ. Conclusions:Compared with WFC, ACC measured higher Pves and Pabd and lower Pdet in resting state, and lower Pves and Pabd in initial cough state. The pressure values and signal pattern measured by WFC and ACC are not completely consistent, so they cannot be used interchangeably.
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OBJECTIVE@#To compare the clinical outcomes and complications of hip arthroscopic treatment for femoroacetabular impingement (FAI) performed with either Inside-out or Outside-in approach.@*METHODS@#The clinical date of 48 patients with FAI treated by hip arthroscopy surgery and follow-up from June 2016 to June 2019 were retrospectively analyzed. According to the different operative methods, the patients were divided into two groups. Inside-out group, from central compartment to peripheral compartment;Outside-in group, from peripheral compartment to central compartment. There were 14 males and 10 females in Inside-out group with an averageage of (39.8±7.6)years old, 13 males and 11 females in Inside-out group with an average age of (39.5±9.1)years old in Outside-in group. There was no significant difference in age, gender, body mass index, side, impingement type, medical history and follow-up time between the two groups. The complication occurrence rate, modified Harris hip score (mHHS)and nonarthritic hip score (NAHS) were compared between these two groups.@*RESULTS@#The mHHs and NAHS scores of the two groups were significantly higher than those before operation, but there was no significant difference between the two groups (@*CONCLUSION@#Both hip arthroscopic surgery methods can obtain satisfactory clinical efficacy in the treatment of FAI, but the incidence of postoperative complications of Outside-in surgical method is lower. The out-side in method can be preferentially selected for the patients with the indications of operation.
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Adult , Female , Humans , Male , Middle Aged , Arthroscopy , Femoracetabular Impingement/surgery , Follow-Up Studies , Hip Joint/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
Curcumae Longae Rhizoma is a traditional Chinese medicine with the efficacy of activating blood and moving Qi. Curcumin， a polyphenolic substance extracted from the rhizome of plant Curcuma longa， possesses multiple pharmacological activities like anti-tumor， anti-oxidation， anti-bacteria， and anti-inflammation. Laryngeal carcinoma （LC） is a common malignant tumor， whose incidence in recent years has been on the rise， and the 5-year survival rate has continuously decreased. Considering the specific location of larynx， researchers are actively exploring diverse treatment modalities for laryngeal organ preservation. Many studies have shown that curcumin has an inhibitory effect on the development of LC. By virtue of multiple pharmacological effects， curcumin deserves to be thoroughly explored. However， most of the current research is limited to in vitro exploration， and the partial mechanism of curcumin remains unclear， indicating that there is still a long way to go before curcumin becomes a Chinese medicinal preparation for the clinical treatment of LC. This paper reviewed the physicochemical properties of curcumin and the methods for its extraction from plants， the efficacy of curcumin in inducing cell apoptosis and protective autophagy， reversing cell drug resistance， inhibiting cell proliferation， migration， and invasion and tumor angiogenesis， the action mechanism of curcumin in combination with resveratrol， platinum drugs， 3-methyladenine， taxols， and 5-fluorouracil against LC， as well as the bioinformatics analysis concerning curcumin and LC. This paper is expected to provide reference for relevant researchers to clarify the mechanism and important targets of curcumin against LC and promote its clinical application.
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Underactive bladder is the main part of lower urinary tract symptoms. As a conservative treatment, intravesical electrical stimulation can improve the function of bladder sensation, and promote micturition. Intravesical electrical stimulation is effective and safe on underactive bladder, both idiopathic and neurogenic. Rectilinear biphasic waveform, low frequency and short pulse width stimulation was recommended.
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Objective Objective To evaluate the effects of a new type of tibial nerve microstimulator on the micturition reflex in cats.Methods From March to May in 2017,the implantable wireless driver micro-stimulator was implanted around the tibial nerve in 9 α-chloralose anesthetized domestic shorthairs cats (2.5-3.5 kg,6-12 months old).The stimulator was placed near the neurovascular bundle parallel to the tibial nerve and its cathode perpendicular to the cushion.The intensity which can induce toe movement was defined as threshold (T).The ureters were isolated via an abdominal incision.The ureters were cut and drained externally.The bladder was inserted via a double lumen catheter through the urethra.The catheter was then secured by a ligature around the urethra.One lumen of the catheter was used to infuse the bladder with either 0.9％ normal saline (NS) or 0.25％ AA at a rate of 1 to 2 ml/min after connecting to a pump.The other lumen was connected to a pressure transducer to measure the bladder pressure.The bladder capacity was used to test the inhibitory effect of the stimulator.After the appearance of the first large-amplitude (＞ 30 cmH2O) bladder contraction,the bladder infusion was stopped.First,after emptying the bladder,2 or 3 cystometrograms with NS were performed without stimulation to obtain the control bladder capacity.After the bladder was stabilized,TNS (6 Hz,1-2 T) was applied during 2 sequential cystometrograms.Second,after emptying the bladder,0.25 ％ AA was infused into the bladder to irritate and induce bladder overactivity.After the bladder stabilized,TNS (6 Hz,1-2 T) was applied again during 2-3 sequential cystometrograms.If bladder capacity increased significantly,the stimulationhad an inhibitory effect on the micturition reflex.Results During normal saline infusion,the bladder baseline was (17.03 ± 4.10) ml.TNS at 1T did not change the bladder capacity [(18.56 ±0.81)ml] (P ＞0.05).TNS at 2T significantly increased the bladder capacity [(25.05 ± 1.19) ml] (P ＜ 0.05).Compared to normal saline infusion,bladder overactivity was irritated by the intravesical infusion of 0.25％ acetic acid,which significantly reduced the bladder capacity [(9.34 ± 0.75) ml] (P ＜ 0.05).Compared to acetic acid infusion,TNS at 1T did not change the bladder capacity [(11.32 ± 0.82) ml] (P ＞ 0.05).TNS at 2T significantly increased the bladder capacity [(14.82 ± 1.15) ml] (P ＜ 0.05).Conclusions The implantable wireless driver tibial nerve micro-stimulator appears to be effective in inhibiting the micturition reflex during physiologic and pathologic conditions.The implantable wireless driver tibial nerve microstimulator was excepted to be used to treat overactive bladder (OAB).
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PURPOSE: We investigated the effects of different stimulation frequencies on the inhibition of bladder overactivity by sacral neuromodulation (SNM) in pigs. METHODS: Implant-driven stimulators were used to stimulate the S3 spinal nerve in 13 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM (pulse width, 210 µsec) at frequencies ranging from 5 to 50 Hz was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different frequencies on the micturition reflex. RESULTS: AA-induced bladder overactivity significantly reduced the bladder capacity (BC) to 34.4%±4.7% of the NS control level (354.4±35.9 mL) (P0.05), but SNM at 15, 30, and 50 Hz significantly increased the BC to 54.5%±7.1%, 55.2%±6.5%, and 57.2%±6.1% of the NS control level (P0.05). CONCLUSIONS: This study demonstrated that 15 Hz was an appropriate frequency for SNM and that frequencies higher than 15 Hz did not lead to better surgical outcomes.
Subject(s)
Acetic Acid , Reflex , Spinal Nerves , Swine , Tail , Urinary Bladder , Urinary Bladder, Overactive , UrinationABSTRACT
Esophageal variceal bleeding is one of the most serious complications of liver cirrhosis. Upper gastrointestinal endoscopy (UGE) is the gold standard for the diagnosis of esophageal varices, but it is invasive. Recently, several studies have reported some alternative methods for the diagnosis of esophageal varices, including serological model, ultrasound parameters, liver and spleen stiffness measurement, esophageal capsule endoscopy, nuclear magnetic resonance, and computed tomography. This article reviews the accuracy of these methods in the diagnosis of esophageal varices and their clinical significance. Ultrasound parameters (splenoportal index, congestion index of the portal vein, and platelet count/spleen diameter ratio), spleen stiffness measurement, computed tomography, and esophageal capsule endoscopy are accurate in the diagnosis of esophageal varices, and therefore, they can be applied in clinical practice and the application of UGE should be reduced.
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Objective To explore the cause of the thyroid reoperation ,methods,surgical approach ,and the prevention of complications .Methods 39 cases of thyroid reoperation in patients with clinical data were reviewed and analyzed.Results Thyroid papillary carcinoma in 11 cases,follicular carcinoma in 2 cases,nodular 22 cases of thyroid,thyroid adenoma 1 case,3 cases of primary hyperthyroidism .The incidence of transient hypoparathyroidism ac-counted for 2 cases,temporary laryngeal recurrent nerve injury in 2 cases,chyle leakage in 1 case,in total of 12.8%of postoperative complications .Conclusion Improper operation method choice for the first time and the misdiagnosis was the main cause of reoperation , The reoperation of thyroid is difficult and has more complications .Preoperative evaluation and careful operation can prevent the occurrence of complications .
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<p><b>OBJECTIVE</b>To explore the safety and short-term efficacy of laparoscopic transhiatal proximal gastrectomy in patients with adenocarcinoma of the esophagogastric junction.</p><p><b>METHODS</b>From Aug 2008 to May 2011, 98 patients with adenocarcinoma of the esophagogastric junction underwent laparoscopic transhiatal proximal gastrectomy. Clinical data were analyzed retrospectively including operative time, estimated bleeding, length of resection, lymph node dissection, and short-term postoperative complications.</p><p><b>RESULTS</b>Ninety-six patients underwent laparoscopic transhiatal proximal gastrectomy successfully and 2 were converted to open operation (one for combined splenectomy and the other combined splenectomy and resection of the tail of the pancreas). The mean operative time was (224.1±33.7) min and the mean blood loss was (69.4±26.1) ml. The mean length of esophageal resection was (4.0±0.6) cm and the resection margin was negative. The number of lymph node removed was 16.4±5.7. Pleural laceration occurred in 14 cases and spleen injury occurred in 3 case during operation. There was one anastomotic leakage. There were no postoperative mortalities, bleeding, anastomotic stenosis and wound infection. After follow-up ranging from 3 to 30 months, the value of reflux diagnostic questionnaire (RDQ) was 9.9±4.4 at 1 month and 9.3±4.3 at 3 months postoperatively. No incision metastasis was found and 5 patients died.</p><p><b>CONCLUSION</b>Laparoscopic transhiatal proximal gastrectomy is safe for patients with adenocarcinoma of the esophagogastric junction and the short-term clinical outcomes are favorable.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adenocarcinoma , General Surgery , Esophagogastric Junction , Pathology , Follow-Up Studies , Gastrectomy , Methods , Laparoscopy , Methods , Retrospective Studies , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To study the clinical features, diagnosis and therapy of thyroid neoplasm in children.</p><p><b>METHODS</b>A retrospective study was performed on 32 children with thyroid nodular who were underwent operation in Xiangya Hospital between January 2002 and December 2010.</p><p><b>RESULTS</b>Of the 32 cases, there were 23 girls and 9 boys. Six cases were diagnosed as nodular Goiter adenoma and 26 cases were diagnosed as thyroid papillary carcinoma. B-ultrasonic examination showed a 100% accurate rate for the diagnosis of thyroid carcinoma. Fourteen children (44%) were proven to have concurrent Hashimoto's thyroiditis. Twenty-two (69%) children with thyroid carcinoma were found to have lymph metastasis in the lateral neck. The children younger than 10 years showed a high rate of metastasis than those older one (94% vs 56%, P<0.05). All 32 children received a surgical therapy. Subtotal thyroidectomy was performed on the 6 children with nodular Goiter adenoma. Total thyroidectomy (17 cases) or ipsilateral thyroidectomy (9 cases) was performed according to the stage of thyroid carcinoma. The surgical outcomes were followed up for 3 months to 9 years and no recurrence or death occurred. The development and growth were normal in the children.</p><p><b>CONCLUSIONS</b>Childhood thyroid nodular attacks girls more than boys, and the frequency of malignancy is high. Hashimoto's thyroiditis is a common concurrent disease. The incidence of local lymph metastasis is high in those younger than 10 years. The surgical therapy for thyroid neoplasm may lead satisfactory outcomes in children.</p>
Subject(s)
Adolescent , Child , Female , Humans , Male , Follow-Up Studies , Retrospective Studies , Thyroid Neoplasms , Diagnosis , Pathology , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To analyze the patterns of serum soluble CD14 (sCD14) and C-reactive protein (CRP) alterations in patients with chronic heart failure (CHF) and investigate the correlations of sCD14 variation to the etiology, clinical symptoms, and the number of mononuclear cells in these patients.</p><p><b>METHODS</b>This study involved 246 CHF patients stratified according to their etiology and clinical symptoms, with 107 normal individuals serving as the control group. Blood samples were collected from these patients the next day after admission and also from the control subjects for measuring serum sCD14 and CPR levels using enzyme-linked immunosorbent assay (ELISA) and rate nephelometry, respectively.</p><p><b>RESULTS</b>The CHF patients had significantly higher serum levels of sCD14 and CRP than the control subjects (P<0.01). In the CHF patients, serum sCD14 and CRP levels differed significantly in the patients with clinical symptoms of different severities (F=3.787, P=0.024), and those with moderate and severe symptoms had significantly higher levels than the asymptomatic patients (P<0.05). The difference in etiologies also resulted in significant difference in sCD14 levels (P<0.05), which were significantly lower in coronary artery disease group than in hypertension group (P<0.05). Significant positive correlations were found between sCD14 and the CRP levels in the CHF patients (r=0.227, P=0.018) and between sCD14 level and the clinical symptoms (r=0.206, P=0.001), but sCD14 level was not correlated to the absolute or relative number of mononuclear cells.</p><p><b>CONCLUSIONS</b>Serum sCD14 and CRP levels are significantly elevated in CHF patients, but this condition may vary as the etiologies and clinical symptoms differ. Increased mononuclear cells do not contribute to the elevation of serum sCD14.</p>