[Diagnosis and treatment of vascular diseases in the era of precise, intelligent and minimally invasive surgery].

The diagnosis and treatment of vascular diseases has experienced the era of open surgery and endovascular minimally invasive surgery. With the breakthrough of endovascular interventional robot, the rapid development of digitalization and informatization and the application of artificial intelligence, it will enter the era of precise, intelligent and minimally invasive surgery. This paper describes and provides new insights into the blueprint of diagnosis and treatment for vascular diseases in such era including three aspects: diagnosis and evaluation, endovascular treatment and postoperative treatment as well as follow-up.

[Efficacy of endovascular treatment of distal aortic dissection involving abdominal visceral segment with bare-metal stents related technique].

Objective: To investigate the effect of bare-metal stent related technique on distal aortic dissection involving abdominal visceral segment. Methods: A retrospective analysis was performed on clinical data of 33 patients with distal aortic dissection involved abdominal visceral segment, who hospitalized in the Vascular Surgery Department of Shanghai Changhai Hospital from July 2012 to September 2019. The effect of the treatment was evaluated according to the clinical and preoperative, intraoperative and follow-up imaging data derived from (aorta computed tomography angiography (CTA) and digital subtraction angiography (DSA)) as well as the changes of the maximal diameter of the aorta and the thrombosis of the false lumen of the dissection. The criteria were as follows: the maximum diameter change of aortic dissection<5 mm was defined as stable; the maximum diameter decrease of aortic dissection≥5 mm was defined as effective reduction; the maximum diameter increase of aortic dissection≥5 mm was defined as expansion; the definition of diameter change of false lumen was the same as above. The hospital complications, clinical symptoms and survival were recorded. Results: There were 28 male patients in this cohort, the mean age was (57.6±4.9) years old. Twenty-one patients were treated with bare-metal stent and coils technique, of which 8 patients were jointly treated with stent grafts. Twelve patients were treated with multi-layer bare-metal stent technique, of which 4 patients were jointly treated with stent grafts. Intraoperative DSA image results showed that the visceral arteries were patent during the treatment, and the blood flow velocity of the false lumen was reduced in all 33 patients. There were no adverse events such as distal outflow tract embolism and coil displacement during the operation. During the period of hospitalization, one patient developed intimal rupture of subrenal abdominal aortic dissection on the fourth day after operation and emergency endovascular graft exclusion was performed for abdominal aortic dissection, and the patient recovered well from the emergency operation. The follow-up time was (16.7±14.0) months. One patient died 1 year after surgery due to non-disease-related factors. Follow-up CTA imaging results showed that the maximum diameter of the aorta in abdominal visceral segment tended to be smaller ((39.1±13.4) mm vs. (41.3±11.9) mm, P=0.469), and the maximum diameter of the false lumen was significantly reduced ((16.2±12.9) mm vs. (23.5±10.7) mm, P=0.014). The maximum diameter of the aortic dissection was reduced in 12 cases, stable in 19 cases, expanded in 2 cases. The maximum diameter of the false lumen was effectively reduced in 22 cases, stable in 10 cases, and expanded in 1 case. Four patients developed small endoleak in the false lumen, one of them was nearby the renal artery stent, and the remaining patients experienced complete thrombosis of the false lumen. Conclusions: Endovascular treatment of distal aortic dissection involving abdominal visceral segment with bare-metal stents related technique could promote the shrink and the thrombosis of the false lumen, and slow down the blood flow from the tear into the false lumen in the setting of patency of visceral arteries.

[Thoracic stent graft sizing for endovascular repair in Stanford type B aortic dissection].

Endovascular treatment for Stanford type B aortic dissection uses thoracic aortic stent-graft system, which consists of covered stent and delivery system. The system is different in the configuration of the stent, the delivery system and the mode of release. The principle of endovascular treatment for Stanford type B aortic dissection is different from aortic aneurysm, so there are differences in stent selection. On the basis of preoperative assessment and measurement, it is suggested that the proximal diameter oversize of the stent is 0 to 5%, at 160 to 200 millimeters in length. The distal end of the stent should pass through the bend of the descending aorta to accommodate the descending aorta blood flow, and the oversize is 0. The postoperative complications and mortality including reverse dissection of proximal part and intima rupture of distal part induced by the stent will be effectively reduced with familiarity with the characteristics of stent-graft, understanding of the possible side effects of stent-graft, combining with the actual conditions and mastering the above principles.

[Expression and clinical significance of Ser10 phosphorylated p27(kip1) protein in human breast carcinoma].

Objective: To explore the expression and clinicopathological significance of Ser10 phosphorylated p27(kip1)(P-p27Ser10) protein in human breast carcinoma tissue. Methods: Tissue specimens were obtained from 111 cases with breast carcinoma from January 2004 to December 2005. And the expression of P-p27Ser10 protein for each specimen was detected by immunohistochemical (EnVision) analysis. Six representative paired samples of cancerous and paired adjacent normal tissues were collected and detected by Western blot. The relationships between the expression levels of P-p27Ser10 protein and its clinicopathological characteristics in primary breast carcinoma were retrospectively analyzed.The association of P-p27Ser10 and Jab1 protein was detected by co-immunoprecipitation method. Results: A high-level expression of P-p27Ser10 was present in cancerous tissues but not in paired adjacent normal tissues. The positive expression rate of P-p27Ser10 protein was as high as 88.3% (98/111) and 7.2% (8/111) in cancerous and paired adjacent normal tissues respectively (P<0.05). P-p27Ser10 expression was correlated with tumor size, lymph node metastasis and TNM stage (all P<0.05). P-p27Ser10 expression was significantly correlated with Ki-67 (r=0.582, P<0.05), and inversely correlated with p27 (r=-0.426, P<0.05). Co-immunoprecipitation revealed that the association of P-p27Ser10 and Jab1 protein was increased in breast carcinoma. Conclusion: Over-expression of P-p27Ser10 protein might play an important role in the pathogenesis of breast carcinoma. P-p27Ser10 protein therefore represents a novel diagnostic marker and therapeutic target in patients with breast carcinoma.

[Clinical characteristics and prognosis of 35 patients with therapy-related hematological neoplasms].

OBJECTIVE: To investigate the morbidity, treatment outcomes and prognosis of 35 therapy-related hematological neoplasms patients. METHODS: A total of 35 cases of therapy-related hematological neoplasms were examined genetically and immunologically using flow cytometry, karyotype analysis and FISH, and their clinical data were retrospective analyzed and literatures were reviewed. RESULTS: Among 35 patients, there were 20 cases of therapy-related acute myeloid leukemia (t-AML), 4 cases of therapy-related acute lymphoblastic leukemia (t-ALL), 1 case of acute mixed leukemia, therapy-related non-hodgkin' s lymphoma (t-NHL) in 8 cases and myelodysplastic syndrome (t-MDS) in 2 cases. The median onset of t-HN was 29(16-90) months, the median OS of t-HN was 14(1-60) months, and 3 years of OS was 17.1%. Among therapy-related acute leukemia (t-AL) patients, 40% (10/25) patients had combined complex karyotype, 36% (9/25) patients with MLL gene rearrangement, 12% (3/25) patients with combined AML/ETO fusion gene, 1 case with NPM1 point mutation and 1 case with P16 gene deletion. CONCLUSIONS: Therapy-related hematological neoplasms had a worse prognosis.

Chip-integrated nearly perfect absorber at telecom wavelengths by graphene coupled with nanobeam cavity.

We exploit the concept of critical coupling to graphene based chip-integrated applications and numerically demonstrate that a chip-integrated nearly perfect graphene absorber at wavelengths around 1.55 µm can be obtained by graphene nearly critical coupling with a nanobeam cavity. The key points are reducing the radiation loss and transmission possibly, together with controlling the coupling rate of the cavity to the input waveguide to be equal to the absorption rate of the cavity caused by graphene. Simulation results show that the absorption of monolayer graphene with a total length of only a few microns is raised up to 97%. Our study may have potential applications in chip-integrated photodetectors.

Toward integrated electrically controllable directional coupling based on dielectric loaded graphene plasmonic waveguide.

We propose and numerically analyze a mid-infrared electrically controllable plasmonic waveguide directional coupler that is composed of two parallel identical straight dielectric loaded graphene plasmonic waveguide and S-shaped waveguide bends. By varying the Fermi energy level of the graphene sheet, the maximum power coupled from the input waveguide to the cross-waveguide and the corresponding coupling length could be effectively tuned. Under different Fermi energy level, this directional coupler could serve as an electrically controlled optical switch or a 3-dB splitter around the wavelength of 10.5 µm. Moreover, the size of the entire device is really in sub-wavelength scale making it very facilitative for high density integration.

Dielectric loaded graphene plasmon waveguide.

Dielectric loaded graphene plasmon waveguide (DLGPW) is proposed and investigated. An analytical model based on effective-index method is presented and verified by the finite element method simulations. The mode effective index, propagation loss, cutoff wavelength of higher order modes and single-mode operation region were derived at mid-infrared spectral region. By changing Fermi energy level, the propagation properties of fundamental mode could be tuned flexibly. The structure of the DLGPW is simple and easy for fabrication. It provided a new freedom to manipulate the graphene surface plasmons, which may led to new applications in actively tunable integrated optical devices.

Bacterial contamination of surgical scrub suits worn outside the operating theatre: a randomised crossover study.

In this study, we aimed to evaluate the bacterial contamination of surgical scrub suits worn outside the operating theatre. We randomised 16 anaesthetists on separate occasions into one of 3 groups: restricted to the operating theatre only; theatre and surgical wards; and theatre and departmental office. For each group, sample fabric pieces attached to the chest, waist and hip areas of each suit were removed at 150 min intervals between 08:30 and 16:00 on the day of study, and sent for microbiological assessment. Mean bacterial counts increased significantly over the course of the working day (p = 0.036), and were lower in the chest compared to the hip (p = 0.007) and waist areas (p = 0.016). The mean (SD) bacterial counts, expressed as colony-forming units per cm(2) at 16:00 on the day of study, were 25.2 (43.5) for those restricted to theatre and 18.5 (25.9) and 17.9 (31.0) for those allowed out to visit the ward and office, respectively (p = 0.370). We conclude that visits to ward and office did not significantly increase bacterial contamination of scrub suits.

Study on the effect of different oxygen therapies on rats with acute carbon dioxide poisoning.

OBJECTIVE: To study the effect of different oxygen therapies on the rats with carbon dioxide poisoning for screening out the best on-the-spot oxygen-therapy technology for treating acute carbon dioxide poisoning. METHODS: The 60 healthy male Sprague Dawley rats were randomly divided into normal control group (A group), carbon dioxide poisoning group (B group), low-concentration oxygen inhalation treatment group (C group), high-concentration oxygen inhalation treatment group (D group) and hyperbaric oxygen-therapy group (E group). Various kinds of oxygen therapies were given after the contamination. The pH, partial pressure of oxygen (PO(2)) and partial pressure of carbon dioxide (PCO(2)) of arterial blood, serum troponin I (CTNI), creatine kinase (CK), glutamic-oxaloacetic transaminase (AST), γ-glutamyl transpeptidase (GGT), blood urea nitrogen (BUN), potassium (K), sodium (Na) and chlorine (Cl) for the rats of each group were inspected. The lung and the brain tissues were taken for observing the pathological changes. RESULTS: There is no significant difference in pH, PO(2) and PCO(2) among all oxygen-therapy groups (p > 0.05). The levels of CTNI, CK and AST in E group are obviously lower than that in B, C and D groups (p < 0.05). The level of serum K in E group is obviously lower than that in B, C and D groups (p < 0.05). The levels of serum Na and Cl in E group are obviously higher than that in B, C and D groups (p < 0.05). The pathological change of lungs in E group is significantly better than that in C and D groups. CONCLUSIONS: We recommend that the medical units with related conditions can give the hyperbaric oxygen therapy to patients as soon as possible.

Comparable efficacy of self-monitoring of quantitative urine glucose with self-monitoring of blood glucose on glycaemic control in non-insulin-treated type 2 diabetes.

AIM: To assess whether self-monitoring of quantitative urine glucose or blood glucose is effective, convenient and safe for glycaemic control in non-insulin treated type 2 diabetes. METHODS: Adults with non-insulin treated type 2 diabetes were recruited and randomized into three groups: Group A, self-monitoring with a quantitative urine glucose meter (n = 38); Group B, self monitoring with a blood glucose meter (n=35); Group C, the control group without self monitoring (n=35). All patients were followed up for six months, during which identical diabetes care was provided. RESULTS: There was a significant decrease in HbA1c within each group (p < 0.05). At the study conclusion, mean changes in HbA1c from baseline were -1.9% for Group A, -1.5% for Group B and -1.0% for Group C, and the proportion of patients achieving HbA1c ≤ 6.5% were 38.9%, 35.3% and 20.0% respectively. However, no significant differences between the groups were found. The average monitoring frequency was significantly higher in Group A than in Group B. The incidence of hypoglycaemia and quality of life scores were similar between the groups. CONCLUSIONS: This study suggests that self-monitoring of urine glucose has comparable efficacy on glycaemic control, and facilitates better compliance than blood self monitoring, without influencing the quality of life or risk of hypoglycaemia.

[Application of degree of complexity in heart rate variability analysis during orthostatic (correction of orthosatic) standing].

Objective. To introduce the degree of complexity in characterizing heart rate variability (HRV), and to discuss the changes in complexity of the cardiovascular system during orthostatic standing posture. Method. ECG of 8 subjects were recorded during supine and orthostatic standing postures. Degree of complexity was used to analyze the HRV. Result. Compared to supine before orthostatic standing posture, R-R intervals and its standard deviation at 0-5 min, 5-10 min, 10-15 min and 15-20 min during orthostatic standing posture were decreased significantly; the degree of complexity of HRV at 0-5 min and 15-20 min during orthostatic standing posture were decreased significantly; the approximate entropy of 0-5 min and 15-20 min were decreased significantly. Conclusion. The results showed that HRV and complexity of cardiovascular system was decreased during orthostatic standing. It was feasible that the degree of complexity can be used to analyze HRV.

Wavelet filter: pure-intensity spatial filters that implement wavelet transforms.

Saloma [Opt. Lett. 20, 1943 (1995)] proposed the concept of mirrors with point-spread functions that exhibit wavelet-related characteristics. We propose novel filters with wavelet point-spread functions. The mirrors are suggested to reform not only the phases of optical waves, but also the filters for amplitude. The transmittance functions of the filters, which are real and positive under some conditions, are given. Optical wavelet transforms can easily be made with these filters, and computer simulations for edge and corner extractions are given.

Significance of various classes of anti-HBc in individuals with chronic asymptomatic HBV infection.

Among 108 individuals with chronic asymptomatic hepatitis B virus infection, liver biopsies and serological investigation were performed simultaneously to determine the correlations of anti-HBc with the infection level of the liver pathology. The results showed that the prevalence of IgA and IgM anti-HBc, and the titers of IgA, IgM, and total anti-HBc, correlated with the liver damage. IgA anti-HBc was most prominent, being present in the whole group of patients with chronic active hepatitis with cirrhosis, and was absent in the whole group of asymptomatic carriers with normal histology. There were no linkages of IgA and IgM anti-HBc with the infectivity; in addition, the titer of total anti-HBc correlated inversely with the viral replication.