Research on the deposition of inhaled particles in human pulmonary acinus region is important to the pathogenesis investigation, prevention and treatment of lung diseases. Most of the current research focus on the final deposition fraction of inhaled particles in human acinar region, but little is involved in their dynamic deposition characteristics. In this paper, five multi-alveolar models, G3−G7, were built. The evaluation parameter 1/4 deposition time was introduced to study the particle deposition speed. The deposition characteristics of particles in the diameter ranging 0.1−5 μm were numerically simulated and summarized under the influence of factors such as the generation and structure of model, particle diameter and respiratory mode, shedding some new light on the further research of transport of inhaled particles. The results showed that the generation and structure of model had a significance effect on the deposition of particles. 0.1 μm particles were dominated by Brownian diffusion, which experienced a high deposition fraction, a fast deposition speed and a logarithmic deposition curve, while 5 μm particles were dominated by gravitational sedimentation, with a high deposition fraction, a fast deposition speed and an S-shaped deposition curve. The deposition of 0.3−1 μm particles were influenced greatly by convention and varied with the change of respiratory mode. The research methods and results in this paper can provide theoretical basis and data support for the further exploration of the mechanism, prevention and treatment of lung diseases.
Objective To analyze the effect of inner diameter of pancreatic duct following pancreaticoduodenectomy on pancreatic fistula. Methods From January 1995 to December 2008, 256 patients underwent pancreaticoduodenectomy were divided into four groups based on the types of pancreaticojejunostomy: end-to-side “mucosa-to-mucosa” anastomosis group (n=115), end-to-end “mucosa-to-mucosa” anastomosis group (n=71), end-to-end invaginated pancreaticojejunostomy group (n=43) and pancreaticogastrostomy group (n=27). Alternatively, 238 patients were divided into two groups according to drainage ways: stenting tube for internal drainage group (n=132) and stenting tube for external drainage group (n=106). Furthermore, 233 cases were divided into three groups on the basis of inner diameter of pancreatic duct: ≤0.2 cm group (n=54), 0.2-0.4 cm group (n=93) and ≥0.4 cm group (n=76). Then, the incidence rate of pancreatic fistula of each group was compared. Results The incidence of pancreatic fistula was 8.20% (21/256). The incidence of pancreatic fistula for different types of pancreaticojejunostomy was as follow: end-to-side “mucosa-to-mucosa” anastomosis group (7.83%， 9/115), end-to-end “mucosa-to-mucosa” anastomosis group (7.04%, 5/71), end-to-end pancreaticogastrostomy invaginated group (13.95%, 6/43) and pancreaticogastrostomy group (3.70%, 1/27), in which there wasn’t significant difference in 4 groups （χ2=2.763，P=0.430）. There was no significant difference of the incidence of pancreatic fistula between stenting tube for internal drainage group (9.10%, 12/132) and stenting tube for external drainage group (8.49%, 9/106), χ2=0.126, P=0.722. The incidence of pancreatic fistula in ≥0.4 cm group, 0.2-0.4 cm group and ≤0.2 cm group was respectively 0, 15.05% (14/93) and 11.11%(6/54), and the difference was significant (χ2=12.009, P=0.002). No correlation was found between the incidence of pancreatic fistula of different inner diameter of pancreatic duct and the types of pancreaticojejunostomy (χ2=1.878， P=0.598). Conclusion The inner diameter of pancreatic duct is an important factor for postoperative pancreatic fistula. No relationship is found between the types of pancreaticojejunostomy and pancreatic fistula in this study.
Objective We probed how to predict left ventricular ejection fraction (LVEF) of the ischaemic cardiomyopathy (ICM) patients would be improved apparently after revascularization. Methods Between July 2010 and December 2015, 245 ICM patients (30%≤LVEF≤40%) with coronary bypass grafting (CABG) were retrospectively observed. Among them, 146 patients were accompanied by ischemic mitral regurgitation (IMR) (146/245, 59.6%), and 41 patients underwent mitral valvuloplasty or replacement because of more than moderate IMR. There were 13 patients early death, and other 232 patients who were followed up over 6 months were divided into two groups based on whether or not post-operative LVEF increased by 10%: a LVEF recovered group (group A, 124 patients) and a non-recovered group (group B, 108 patients). Results Preoperative NT-proBNP in the group A was significantly higher than that in the group B (P=0.036). There were less patients with myocardial infarction in the group A than that in the group B (P=0.047), and more with angina pectoris in the group A than that in the group B (P=0.024). There was no significant difference in the extent of mitral regurgitation or mitral surgery between the groups A and B (P>0.05). There were lower left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic volume (LVEDV) in the group A than those in the group B (P<0.05). Multivariate analysis revealed that preoperative LVEDD dilated apparently and no angina pectoris existed before surgery were independent risk factors for LVEF with no recovery in the ICM patients (30%≤LVEF≤40%) after revascularization. The LVEDD of 245 patients (including 13 early deaths) was 41-71 mm. We found that the ICM patients with LVEDD ≥60 mm were more likely to signify the unfavourable prognosis (χ2=8.63, P=0.003, OR=2.21, 95% confidence interval 1.25 to 3.91). Conclusion Preoperative LVEDD dilated and no angina pectoris before surgery are independent risk factors for LVEF with no recovery in the ICM patients (30%≤LVEF≤40%) after revascularization. LVEDD≥60 mm can be regarded as the preoperative forecasting factors for the unfavourable prognosis in the ICM patients (30%≤LVEF≤40%) after revascularization.
ObjectiveTo analyze risk factors of early outcomes of mitral valvuloplasty (MVP)for the treatment of degenerative mitral regurgitation (DMR). MethodsClinical data of 132 DMR patients who underwent MVP in Fu Wai Hospital between January 1, 2011 and November 1, 2011 were retrospectively analyzed. A total of 114 patients (86.4%)were followed up after discharge with their mean age of 51.21±12.78 years, including 76 males (66.7%). Preoperative risk factors of early outcomes of MVP were analyzed. ResultsAmong those patients, there were 25 patients with atrial fibri-llation (AF)(21.9%). Preoperative ejection fraction was 63.88%±6.93%. Preoperative echocardiography showed left ventricular end-diastolic diameter (LVEDD)was 31.61±5.51 mm/m2. There were 66 patients (57.9%)with tricuspid regurg-itation, and 34 patients (29.8%)underwent concomitant tricuspid valvuloplasty including 10 patients (8.8%)who received tricuspid annuloplasty rings. Two patients died postoperatively, 2 patients underwent re-operation of mitral valve replacement or MVP respectively. Postoperative echocardiography showed moderate or severe mitral regurgitation in 15 patients. Preoperative risk factors of early outcomes of MVP included AF (36.8% vs. 18.9%, P=0.035), large LVEDD (34.02±3.76 mm/m2 vs. 31.15±5.68 mm/m2, P=0.042)and functional mitral regurgitation (15.8% vs. 1.1%, P=0.007). Multivariate analysis showed greater postoperative LVEDD reduction significantly lowered the incidence of postoperative events (HR 0.002, 95% CI < 0.001-0.570, P=0.031). ConclusionsEnlargement of the left ventricle is an independent preoperative risk factor for early outcomes of MVP for DMR patients. Greater postoperative LVEDD reduction significantly lowers the incidence of postoperative events.
ObjectiveTo establish the Z-score reference ranges of fetal arterial ductus (DA) inner diameter of normal fetus at 20 to 40 weeks’ gestation.MethodsA cross-sectional study was conducted in 781 normal singleton pregnancies with 20-40 weeks of gestation who underwent fetal echocardiography in the Third Affiliated Hospital of Henan University of Chinese Medicine from November 2018 to September 2019. The DA diameter, biparietal diameter (BPD), and femoral diaphysis length (FL) were measured and used to estimate gestational age (GA). With BPD, FL, and GA as independent variables and DA as dependent variables, linear regression analyses were conducted on the mean and standard deviation of each parameter to construct the best Z-score models.ResultsThe linear regression equations reflected strong positive correlations between the fetal biological growth parameter BPD, FL, GA, and fetal DA inner diameter. The heteroscedasticity of standard deviations was eliminated by the weighted regression of absolute stagger, and the best Z-score models were constructed. The linear regression equations of GA (week), BPD (mm), FL (mm), and DA inner diameter (mm) were as follows: Y=−2.661+0.217×GA, Y=−2.505+0.084×BPD, Y=−1.734+0.100×FL; the linear regression equations of GA (week), BPD (mm), FL (mm), and the standard deviation of DA inner diameter (mm) were as follows:Y=−0.273+0.025×GA, Y=−0.440+0.013×BPD, Y=−0.180+0.012×FL. According to the models, Z-score normal range reference values of fetal DA inner diameter were calculated.ConclusionsThere are good linear relationships between fetal DA inner diameter and GA, BPD and FL. The Z-score reference ranges of fetal DA diameter during mid- and late-pregnancy are constructed, which are helpful to quantitatively evaluate the normal development of fetal DA and provide a reference for clinical diagnosis of fetal DA abnormality.
Objective To explore the strategy of intrathoracic anastomosis in patients with esophageal squamous cell carcinoma when the proximal esophagus is dilated to different degrees and explore its mechanism. Methods We retrospectively reviewed the clinical data of patients who underwent esophagectomy between 2014 and 2017 in West China Hospital. The patients were divided into two groups including a significant dilatation group with inner mucosal phase diameter (IMPD)≥17.9 mm and a non-significant dilatation group with IMPD<17.9 mm. And the patients were divided into two groups (a layered manual anastomosis group and a stapled anastomosis group) according to anastomosis method and propensity score matching was applied to adjust for potential confounders. Results We finally included 654 patients. There were 206 patients with 158 males and 48 females at average age of 62.21±7.72 years in the layerd manual analstomosis group and 448 patietns with 377 males and 71 females at average age of 62.57±8.42 years in the stapled anastomosis group. We also used Masson trichrome staining to assess the collagen fiber content in the esophagus. Compared with layered manual anastomosis, the incidence of anastomotic leakage was higher in the significant dilatation group than that in the stapled anastomosis group (original cohort: 3.8% vs. 10.7%, P=0.093; propensity score-matched cohort: 1.4% vs. 15.3%, P=0.004). And there was no significant difference in anastomotic leakage b etween layered manual anastomosis and stapled anastomosis in the non-significant dilatation group (original cohort: 4.7% vs. 4.2%, P=0.830; propensity score-matched cohort: 4.8% vs. 4.0%, P=0.206). Moreover, the average collagen fiber area ratio was significantly lower in the significant dilation group than that in the non-significant dilatation group (P=0.045). Conclusion There is a significant reduction in collagen fibers in the proximal esophageal wall tissue of esophageal squamous cell carcinoma patients with a IMPD≥17.9 mm. Intrathoracic layered manual anastomosis effectively reduces postoperative anastomotic leakage in these patients.
Retinal blood vessels are the only circulatory system that can be observed under non-invasive conditions. By observing the morphological changes of retinal blood vessels, the changes of blood circulation can be indirectly reflected. The occurrence, development and evolution of different diseases can be discovered. With the development of new detection technologies, especially the wide application of fundus photography and optical coherence tomography, a more intuitive and non-invasive quantitative index is provided for retinal vascular measurement. It is important for the diagnosis, guiding treatment and follow-up of related vascular diseases. This article reviews the development of retinal vessel diameter measurement methods and related applications in clinical diagnosis and treatment.
Objective To evaluate the effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early oeteonecrosis of the femoral head (ONFH). Methods Between March 2010 and December 2013, 91 patients with early ONFH were treated with the operation of multiple small-diameter drilling decompression combined with hip arthroscopy in 39 cases (53 hips, group A) or with drilling decompression alone in 52 cases (74 hips, group B). The patients in 2 groups had obvious hip pain and limited motion before operation. There was no significant difference in gender, age, etiology, effected side, stage of osteonecrosis, and preoperative Harris score between 2 groups (P>0.05). Results All operations succeeded and all incisions healed by first intention. The operation time was significantly longer in group A [(73.3±10.6) minutes] than in group B [(41.5±7.2) minutes] (t=8.726, P=0.000). Temporary of sciatic nerve apraxia after operation occurred in 2 patients of group A, and no complication occurred in other patients. Patients were followed up 24-52 months (mean, 39.3 months) in group A and 24-48 months (mean, 34.6 months) in group B. At last follow-up, the Harris scores were 83.34±8.76 in group A and 76.61±9.22 in group B, showing significant differences when compared between 2 groups (t=–4.247, P=0.029) and when compared with preoperative values in 2 groups (t=–10.327, P=0.001; t=–8.216, P=0.008). X-ray films showed that the collapse of the femoral head was observed in 6 hips (1 hip at stage Ⅰand 5 hips at stage Ⅱ) in group A, and in 16 hips (4 hips at stageⅠand 12 hips at stage Ⅱ) in group B; and hip arthroplasty was performed. The total effective rates were 88.68% (47/53) in group A and 78.38% (58/74) in group B, respectively; showing significant difference between 2 groups (χ2=5.241, P=0.041). Conclusion Multiple small-diameter drilling decompression combined with hip arthroscopy is effective in pain relief, improvement of hip function, slowing-down the process of femoral head necrosis, delaying the need for total hip arthroplasty in patients with early ONFH.
Objective To observe whether the adoptation of tricuspid annulus diameter as surgical indication for tricuspid annuloplasty will reduce the occurrence of moderate-severe tricuspid regurgitation(TR) in patients after mitral valve replacement (MVR). Methods Between April 2005 and June 2006, MVR was performed in 56 patients with no or mild TR in our Department. The patients were divided into two groups according to tricuspid annulus diameter(TAD)/body surface area (BSA)≥21mm/m2. Tricuspid annuloplasty group(TA group): 22 cases, male 8, female 14, age 45.0±7.7 years, TAD 36.8±3.8mm, BSA 1.57±0.15m2, New York Heart Association(NYHA) functional class Ⅲ/Ⅲ-Ⅳ 18/4, sinus rhythm(SR)/atrial fibrillation (AF) 2/20. Notricuspid annuloplasty group (NTA group): 34 cases, male 9, female 25, age 42.9±11.0 years, TAD 28.5±4.4mm, BSA 1.58±0.13m2, NYHA Ⅲ/Ⅲ-Ⅳ 28/6, SR/AF 9/25. Kay annuloplasty was performed for TA group patients. The patients were followed in outpatient clinical regularly and evaluated by echocardiography at 6 months after operation. Results All patients recovered and were discharged from hospital. The duration of follow-up was 11.0±2.4 months. Except 2 cases, all patients received echocardiography evaluation at 6 months after operation. There were no significantly differences between two groups patients in general clinical characteristics (Pgt;0.05). Compared with NTA group before operation, right atrial diameter (RAD, 49.3±7.0mm) and TAD(36.8±3.8mm) were bigger and more mild TR in TA group (Plt;0.05). RAD(44.1±8.9mm) and TAD(28.9±6.1mm) reduced and the proportion of TR degree improved (Plt;0.05) in TA group but did not occur in NTA group after surgery (Pgt;0.05). There were three cases of moderate TR in NTA group. Conclusion Tricuspid annuloplasty adopting TAD as surgical indication may reduce the occurrences of postoperative moderate-severe TR for patients of MVR with no or mild preoperative TR.
ObjectiveTo investigate the feature of the angulation between left pulmonary artery (LPA) and main pulmonary artery (MPA) and its relationship to pulmonary artery development in patients with tetralogy of Fallot (TOF).MethodsA total of 101 TOF patients in West China Hospital from 2014 to 2018 were enrolled in a TOF group, including 62 males and 39 females, aged 6.8 (0.3-45.8) years, and another 20 patients without basic cardiac diseases at the same stage were enrolled in a control group, including 10 males and 10 females, aged 6.9 (0.3-54.0) years. Diameters of LPA, right pulmonary artery (RPA) and MPA, the angulation between LPA and MPA (MPA-LPA), McGoon ratio, and Nakata index were measured and compared between the two groups. The relationship between the above data and MPA-LPA angulation was also analyzed.ResultsThe average MPA-LPA angulation was smaller in the TOF group than that in the control group (113.63° vs. 128.45°, P=0.001 8). The MPA Z score was also smaller in the TOF group than that in the control group (0.46 vs. 2.75, P=0.000 4). No relationship was found by correlation analysis between the MPA-LPA angulation and MPA Z score or LPA Z score in the control group (P=0.239 6, 0.114 7) and the TOF group (P=0.759 3, 0.242 7). The McGoon ratios (2.22±0.72, 2.43±0.94, P=0.340 0) and Nakata index (359.3±294.24, 395.52±329.31, P=0.650 0) were not significantly different between the two groups.ConclusionThe angulation of LPA-MPA and MPA Z score are smaller in the TOF group than those in the control group. There is no relationship between MPA-LPA angulation and pulmonary artery diameters. The LPA-MPA angulation should not be considered as an influence factor for LPA development and trans-annular patch surgery.