Objective To evaluate the feasibility of X-ray guided access to the extrahepatic segment of the main portal vein (PV) to create a transjugular extrahepatic portacaval shunt (TEPS). Methods 5F pigtail catheter was inserted into the main PV as target catheter by percutaneous transhepatic path under ultrasound guidance. The RUPS-100 puncture system was inserted into the inferior vena cava (IVC) by transjugular path under ultrasound guidance. Fluency covered stent was deployed to create the extrahepatic portacaval shunt after puncturing the target catheter from the IVC under the X-ray guidance, then shunt venography was performed. Enhanced CT of the abdomen helped identify and quantify the patency of the shunt and the presence of hemoperitoneum. Results The extrahepatic portacaval shunts were created successfully by only 1 puncture in 6 pigs. No extravasation was observed in shunt venography. One pig died of anesthesia on the day of operation. The extrahepatic portacaval shunts were failed in 2 pigs 3 days after the operation (one was occluded and the other one was narrowed by 80%). The extrahepatic portacaval shunts were occluded 2 weeks after the operation in the remaining 3 pigs. The shunts were out of the liver and no hemoperitoneum was identified at necropsy in the 6 pigs. Conclusion TEPS is technically safe and feasible under the X-ray guidance.
With the rapid development of evidence-based medicine during the past two decades, evidence andevidence-based methods were not only used in the field of health care, but also applied to other non-medical fields. Asystematic literature search and a comparative study were conducted to investigate the definition of evidence. We also putforward our own definition of evidence: Evidence is the information from the systematic review process. We also discussedthe development of evidence-based paradigm and hope this will act as a reference for other subjects and industries.
Abstract: Objective To compare the sensitivity and accuracy of autofluorescence bronchoscope (AFB) and white light bronchoscope (WLB) in airway examination for patients with central type lung cancer. Methods From September 2009 to May 2010, 46 patients including 36 males and 10 females with an average age of 62.1 years underwent both AFB and WLB procedures in People’s Hospital of Peking University. Among them, 35 were preliminary diagnostic cases and 11 were postoperative surveillance cases. Local anaesthesia of glottis and airway, and general anaesthesia with continuous intravenous drugs were given before electric bronchoscope was adopted. All patients underwent WLB examination followed by AFB procedure. All suspicious abnormal visual findings were recorded for biopsy and pathological examination. Results All procedures were carried out safely without death or severe complications. We performed bronchoscopy 48 times for all 46 patients and 159 tissues of various sites were taken out for biopsy and pathologic examination which showed 64 malignancies and 95 none malignancies. In 64 malignancies, AFB found all but WLB missed 15 with a missed diagnosis rate of 23.4%. Thirtysix times of examination were performed for the 35 preliminary diagnostic cases and 56 sites of malignancy were found. AFB found all, while WLB missed 12, and 6 sites of malignancy found by AFB were larger in size than those found by WLB. AFB detected 3 cases of multisite malignancy, but WLB missed these diagnoses. The results of AFB and WLB were the same for 26 patients. Twelve times of bronchoscopy were performed for the 11 postoperative surveillance cases and 8 sites of malignancy were found. AFB found them all while WLB missed 3 which were two recurrent cases during the early period after lung cancer surgery. The sensitivity of AFB and WLB was 100.0 % and 76.6%(Plt;0.05) respectively, and the negative predictive value of AFB and WLB was 100.0% and 84.5%(P=0.002) respectively. Conclusion AFB has a better sensitivity and negative predictive value than WLB in detecting mucous canceration lesions in central type lung cancer, and is more accurate in assessment of tumor margins, more sensitive in finding multiple lesions in airway and detecting early cancer recurrence in postoperative surveillance patients.
Abstract: Objective To summarize the clinical experiences of videoassisted thoracoscopic surgery (VATS) lobectomy performed on a series of 300 consecutive patients, and report the results of a 3year followup. Methods We retrospectively analyzed the clinical data of 300 consecutive patients who underwent VATS lobectomy from September 2006 to December 2009 in the Department of Thoracic Surgery, People’s Hospital of Peking University. Of the 300 patients, there were 159 males and 141 females with the age ranged from 18 to 86 years (58.30±13.90 years). Preoperative diagnosis showed that there were 266 patients of mass in the lung, 22 of bronchiectasis, 5 of cyst/abscess in the lung, 3 of pulmonary sequestration, 2 of fungus infection, and 2 of pneumothorax. We assessed the perioperative variables by standard descriptive statistics and estimated the 3year survival rate by KaplanMeier analyses. Results Sixtysix patients were diagnosed to have benign diseases and 234 patients were with malignancies. A percentage of 81.82% (54/66) of the benign patients had infectious diseases, and the majority of the malignancies was nonsmall cell lung cancer (213 patients), especially adenocarcinomas which comprised 73.08% (171/234) of all the malignancies. A total of 273 patients accomplished VATS lobectomy, of whom 27 patients required conversion to thoracotomy at a conversion rate of 9.00%(27/300). In the VATS lobectomy accomplished group, the mean operation time was 317±088 h, and the blood loss was 225.70±195.20 ml. Benign surgery took significantly less time (t=2.280, P=0.0032) and had shorter drainage time(t=1.392, P=0.0304) than those of malignancies. Dense adhesions between lymph nodes and blood vessels was the primary reason for conversion to thoracotomy in 17 patients at a percentage of 62.96%(17/27). Bleeding was the second reason for conversion in 5 patients at a percentage of 1852%. The patients in the upper lobe lobectomy group showed significantly higher risk of conversion compared with those in the nonupper lobe surgery group (χ2=6.131, P=0.013), while gender (χ2=1.182, P=0.277), pathology (χ2=0.210, P=0.647) and the tumor located in left or right side(χ2=2.933, P=0.087) didn’t influence the risk of conversion. The result of the 3year followup showed that there was no reoccurrence of symptoms in patients with benign diseases; Nonsmall cell lung cancer patients had a 3year survival rate of 0.87 with the 95% confidence interval (CI) from 0.77 to 0.96, and pathologic stage I patients at 0.91 with the 95%CI from 0.85 to 0.98. Conclusion VATS lobectomy is safe and effective. This research shows that domestic technologies of VATS lobectomy and its midterm results have reached the international standard.
ObjectiveTo explore the safety and effectiveness of endoscopic treatment for biliary tract complications after liver transplantation.MethodsPatients who underwent endoscopic treatment for biliary tract complications after liver transplantation from January 2009 to December 2018 in West China Hospital were enrolled. Characteristics of patients, types of biliary tract complications, effectiveness of endoscopic treatment and endoscopic related complications were collected and analyzed.ResultsAmong the 57 patients with biliary tract complications, 37 patients had biliary stricture alone, 4 patients had bile leak alone, 15 patients had biliary stricture plus biliary stones or sludge, and 1 patient had biliary stricture combined with biliary leakage. A total of 112 treatments of endoscopic retrograde cholangiopancreatography (ERCP) were performed, among which 100 treatments were accomplished successfully (89.3%), including the improvement of bile duct stenosis, the cure of bile leak and the successful removal of common bile duct stones. The number of total ERCP related complications was 15 (13.4%), among which post ERCP pancreatitis was the most common (9.8%).ConclusionEndoscopic therapy can be considered as an initial treatment for biliary tract complications after liver transplantation as its safety and effectiveness.
To solve the problem of stent malapposition of intravascular stents, explore the design method of intravascular body-fitted stent structure and to establish an objective apposition evaluation method, the support and apposition performance of body-fitted stent in the stenotic vessels with different degrees of calcified plaque were simulated and analyzed. The traditional tube-mesh-like stent model was constructed by using computational aided design tool SolidWorks, and based on this model, the body-fitted stent model was designed by means of projection algorithm. Abaqus was used to simulate the crimping-expansion-recoil process of the two stents in the stenotic vessel with incompletely calcified plaque and completely calcified plaque respectively. A comprehensive method for apposition evaluation was proposed considering three aspects such as separation distance, fraction of non-contact area and residual volume. Compared with the traditional stent, the separation distances of the body-fitted stent in the incompletely calcified plaque model and the completely calcified plaque model were decreased by 21.5% and 22.0% respectively, the fractions of non-contact areas were decreased by 11.3% and 11.1% respectively, and the residual volumes were decreased by 93.1% and 92.5% respectively. The body-fitted stent improved the apposition performance and was effective in both incompletely and completely calcified plaque models. The established apposition performance evaluation method of stent considered more geometric factors, and the results were more comprehensive and objective.
It has been found that the incidence of cardiovascular disease in patients with lower limb amputation is significantly higher than that in normal people, and the risk of developing coronary atherosclerosis is much higher than that in other high-risk groups. Numerous studies have confirmed that high systolic and diastolic blood pressures are potential risk factors for coronary artery disease, and it has been demonstrated that the ascending aortic pressure during diastole increases after amputation. However, the relationship between lower limb amputation and coronary atherosclerosis has not been fully explained from the perspective of hemodynamic environment. Therefore, in this study, a centralized parameter model of the human cardiovascular system and a three-dimensional model of the left coronary artery were established to investigate the effect of amputation on the hemodynamic environment of the coronary artery. The results showed that the abnormal hemodynamic environment induced by amputation, characterized by factors such as increased diastolic pressure in the ascending aorta, led to a significant expansion of the low wall shear stress (WSS) region on the outer lateral aspect of the left coronary artery bifurcation during diastole. The maximum observed increase in the area of low WSS reached up to 50.5%. This abnormal hemodynamic environment elevates the risk of plaque formation in the left coronary artery. Moreover, the more severe the lower limb atrophy, the greater the risk of coronary atherosclerosis in amputees. This study preliminarily revealed the effect of lower limb amputation on the hemodynamic environment of the left coronary artery.
ObjectiveTo systematically review the clinical efficacy and safety of afatinib in the treatment of advanced non-small cell lung cancer (NSCLC).MethodsWe electronically searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and VIP to collect randomized controlled trials (RCTs) about the afatinib for advanced non-small cell lung cancer from inception to October 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsEight RCTs were included. The results of meta-analysis showed that afatinib could significantly prolonged progression-free survival (PFS) for lung adenocarcinoma patients (HR=0.43, 95%CI 0.32 to 0.57, P<0.000 01), but there was no significant difference between the two groups in terms of overall survival (OS) in patients with lung adenocarcinoma (HR=1.03, 95%CI 0.85 to 1.23, P=0.79). In addition, afatinib significantly increased the patient’s adverse reactions including diarrhea, skin rashes, nausea and vomiting.ConclusionAfatinib can improve PFS in patients with lung adenocarcinoma, but it does not prolong OS. Due to the limited quantity and quality of included studies, the above conclusions are still needed to be verified by more high quality studies.
Objective To explore the characteristics of parenting styles of female patients with anorexia nervosa (AN) and bulimia nervosa (BN), to and provide a reference for the clinical treatment of eating disorders. Methods Patients with AN and BN between November 2019 and May 2020 in the Centre for Mental Health, West China Hospital, Sichuan University were retrospectively included. Female teachers and students from Sichuan University were used as normal controls. The general conditions of the subjects in the three groups were collected, and the parenting styles and behaviors of the subjects in the three groups were evaluated using Egna Minnen av Barndoms Uppfostran (Parenting Style Evaluation Scale). Results Finally, 30 subjects were included in the AN group, 44 subjects were included in the BN group, and 33 subjects were included in the healthy control group. There was no significant difference in the course of disease between the AN group and the BN group (P>0.05). There were no significant differences in age, place of residence, education level, parental divorce, parental education level and parental occupation among the three groups (P>0.05). The body mass index of the AN group was lower than that of the BN group and the healthy control group (P<0.05). The parenting style evaluation scale scores showed that in terms of father scores, there was no significant difference in the excessive interference dimension scores among the three groups (P>0.05). The score of preference dimension in AN group (14.60±4.45 vs. 10.18±5.98 vs. 10.36±5.90) was higher than that in BN group and healthy control group, the score of emotional warmth and understanding dimension in BN group (50.55±11.81 vs. 55.33±9.12 vs. 57.03±6.13) was lower than that in the AN group and the healthy control group, and the scores of rejection and denial dimension (7.91±3.65 vs. 10.10±3.85 vs. 10.16±3.83) and overprotection dimension (11.76±2.82 vs. 14.10±3.16 vs. 13.25±2.97) in healthy control group were lower than those of AN group and BN group (P<0.05). In terms of mother scores, the scores of preference dimension (14.40±4.64 vs. 10.59±5.92 vs. 10.94±5.34) in AN group was higher than that in the BN group and the healthy control group, and the scores of emotional warmth and understanding dimension (58.06±7.05 vs. 51.40±11.79 vs. 52.91±11.57) in healthy control group was higher than that in AN group and BN group (P<0.05). Conclusion Compared with healthy controls, the parenting styles of female patients with eating disorders show more negative emotions such as rejection and denial. The parenting styles of female BN patients show more negative emotions than female AN patients. These all suggest that the parenting style, attitude and behavior may be the influencing factors of female AN and BN.
It has been found that the incidence of cardiovascular disease in patients with lower limb amputation is significantly higher than that in normal individuals, but the relationship between lower limb amputation and the episodes of cardiovascular disease has not been studied from the perspective of hemodynamics. In this paper, numerical simulation was used to study the effects of amputation on aortic hemodynamics by changing peripheral impedance and capacitance. The final results showed that after amputation, the aortic blood pressure increased, the time averaged wall shear stress of the infrarenal abdominal aorta decreased and the oscillatory shear index of the left and right sides was asymmetrically distributed, while the time averaged wall shear stress of the iliac artery decreased and the oscillatory shear index increased. The changes above were more significant with the increase of amputation level, which will result in a higher incidence of atherosclerosis and abdominal aortic aneurysm. These findings preliminarily revealed the influence of lower limb amputation on the occurrence of cardiovascular diseases, and provided theoretical guidance for the design of rehabilitation training and the optimization of cardiovascular diseases treatment.