ObjectiveTo investigate the role of amygdala volume index(AVI) in surgcial evaluation in patients with mesial temporal lobe epilepsy (mTLE), including clinical features, etiologies and surgical outcome. MethodsThirty six patients were diagnosed as mTLE after surgical evaluation including clinical manifestations, video-electroencephalogram (VEEG) and magnetic resonance imaging (MRI) at the Second Affiliated Hospital of Zhejiang University between March 2013 and March 2016. Bilateral amygdala AVI was then calculated from amygdala volumes on MRI, which were measured with region of interest (ROI) analysis. All patients were treated surgically. Etiologies of mTLE were further confirmed by the histopathology of the resected tissue. ResultsAmong the 35 patients, there is a strong correlation between AVI on the lesion side and age of onset (R =-0.389, P = 0.019) as well as age of surgery (R =-0.357, P = 0.032). No obvious relation can be seen between AVI and gender, history of febrile convulsion, duration of epilepsy, secondary generalized seizure, side of lesion, presurgical seizure frequency and electrode implantation. There is no significant difference in AVI among the five etiologies. At follow-up, thirty patients (80.5%) reached seizure-free, AVI on the lesion side is nota predictor of surgical failure (P > 0.05). ConclusionAVI plays a role in etiology evaluation in patients with mesial temporal lobe epilepsy. Moreover, a larger AVI on the lesion side is correlated with an earlier age of onset. There is limited value of amygdala volume insurgical outcome prediction of patients with mTLE.
ObjectiveTo investigate the effect of pressure control ventilation-volume guaranteed (PCV-VG) for patients undergoing da Vinci robotic-assisted pulmonary lobotomy. MethodA total of 40 patients undergoing Da Vinci robotic-assisted pulmonary lobotomy were randomly divided into two groups:a PCV-VG group (G group) and a volume-controlled ventilation (VCV) group (V group). There were 20 patients in each group with 13 males and 7 females at age of 49.0±5.5 years in the G group, 16 males and 4 females at age of 51.0±3.9 years in the V group. Haemodynamics indexes and oxygenation parameters were recorded at different times and compared between the two groups. ResultsDuring one-lung ventilation (OLV) period, the peak inspiratory pressure (Ppeak), respiratory index (RI) and arterial partial pressure of carbon dioxide (PaCO2) in the G group were statistically lower than those in the V group (P<0.05). While the Cdyn and inspired oxygen fraction(OI) were higher in the G group than those in the V group (P<0.05). ConclusionCompared with the traditional VCV ventilation mode, the PCV-VG ventilation mode improves Ppeak, Cdyn, OI, and RI of the patients undergoing da Vinci robotic-assisted pulmonary lobotomy.
Objective To investigate the effect of bilevel ventilation mode on blood gas and hemodynamics of patients with acute lung injury (ALI) by pulse indicator continuous cardiac output(PiCCO), and the clinical effect of this new ventilation mode on patients with ALI as well as its influence degree of circulatory system so that the cure rate of ALI can be improved. Methods There were 42 patients with ALI, 27 male and 15 female aged 15-75 years. According to the order of hospitalization, 40 patients (2 patients did not complete the study) were divided into two groups with 20 patients in each group. Bilevel ventilation group included the first 20 admitted patients. They were given bilevel ventilation support, using Support/Time(S/T) mode. The initial set of end inspiratory pressure (IPAP) was 8-10 cm H2O gradually increased to 14-20 cm H2O, which should be comfortable and appropriate for patients. The initial set of end expiratory pressure (EPAP) was 3-5 cm H2O gradually increased to 8-12 cm H2O. Fraction of inspired oxygen(FiO2) unchanged. Control group included the rest 20 admitted patients. They were given respiratory support, using Auxiliary/Control(A/C) mode followed by an increased positive endexpiratory pressure (PEEP) of 5 cm H2O,10 cm H2O,15 cm H2O,20 cm H2O. Each pressure kept 30 min. FiO2 unchanged. Indexes such as cardiac output (CO), systemic vascular resistance (SVR) etc were observed in both groups. Results There were 13 deaths in two groups, including 5 in bilevel ventilation group and 8 in control group. Seven cases died of multiple organ failure, 3 died of septic shock and 3 died of circulatory failure. Endotracheal intubation time (2.9±0.8 d vs. 4.2±0.9 d, t=7.737, P=0.006) and hospital stay (17.2±4.5 d vs. 18.5±3.6 d, t=2.558, P=0.039) in bilevel ventilation group were significantly shorter than those in control group. In control group, when PEEP ranged from 5 cm H2O to 15 cm H2O, arterial partial pressure of oxygen (PaO2) and oxygenation index (PaO2/FiO2) gradually increased as PEEP increased (Plt;0.05); when PEEP increased to 20 cm H2O, CO decreased, SVR, pulmonary vascular resistance (PVR) and airway peak pressure (PIP) increased than those in range of 515 cm H2O (Plt;0.05). In bilevel ventilation group, PaO2 and PaO2/FiO2 gradually increased as EPAP increased. When EPAP increased to 10 cm H2O, PaO2 and PaO2/FiO2 increased to the maximum (Plt;0.05); PIP was significantly lower than that in control group (t=7.831, .P.=.0.000). Conclusion Giving bilevel ventilation treatment to patients with ALI/acute respiratory distress syndrome(ARDS) can reduce the effects on respiratory and hemodynamic. PIP and the time of endotracheal intubation and hospital stay can be reduced without affecting hemodynamics.
ObjectiveTo explore the mechanism of volume-related mitral regurgitation (MR) from the anatomy of mitral valve.MethodsA total of 32 patients with ventricular septal defect (VSD) combined MR meeting inclusion criteria in West China Hospital from September 2018 to November 2019 were enrolled in this study. The direction relative to the cardiac axis: the deviation of the MR bundle along the left atrial wall was eccentric, otherwises it was central. There were 23 patients of VSD and eccentric MR (EMR, a VSD-EMR group), including 10 males and 13 females aged 21 (10, 56) months, and 9 patients of VSD and central MR (CMR, a VSD-CMR group), including 4 males and 5 females aged 26 (12, 87) months. Besides, 9 healthy children were enrolled in a control group, including 4 males and 5 females aged 49 (15, 72) months. All patients underwent transthoracic echocardiography (TTE) examination at 2 weeks before surgery and 6 months after surgery, respectively, The MR degree, end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), antero-posterior diameter (AP), annulus circumference (AC), commissural diameter (CD) were assessed.ResultsBefore operation, EDV, ESV, SV, AP, AC and CD in the VSD-EMR and VSD-CMR groups were significantly larger or longer than those in the control group (P<0.05); after operation, EDV, ESV, SV, AP and CD decreased compared with those before operation (P<0.05), but there was no significant difference compared with the control group (P>0.05). Compared with the control group, AC was slightly decreased (P<0.05). There was no significant difference in EF between and within groups before and after operation (P>0.05). The improvement rate of MR was 78.9% (15/19) in the VSD-EMR group and 100.0% (9/9) in the VSD-CMR group.ConclusionAfter unloading of volume, the valve structure is back to normal except AC. The improvement rate of MR in the VSD-EMR group is lower than that in the VSD-CMR group, which may indicate that the mechanism of VSD-EMR is more complicated.
Simulation of the human biological lung is a crucial method for medical professionals to learn and practice the use of new pulmonary interventional diagnostic and therapeutic devices. The study on ventilation effects of the simulation under positive pressure ventilation mode provide valuable guidance for clinical ventilation treatment. This study focused on establishing an electrical simulation ventilation model, which aims to address the complexities in parameter configuration and slow display of air pressure and airflow waveforms in simulating the human biological lung under positive pressure ventilation mode. A simulated ventilation experiment was conducted under pressure-regulated volume control (PRVC) positive pressure ventilation mode, and the resulting ventilation waveform was compared with that of normal adults. The experimental findings indicated that the average error of the main reference index moisture value was 9.8% under PRVC positive pressure ventilation mode, effectively simulating the ventilatory effect observed in normal adults. So the established electrical simulation ventilation model is feasible, and provides a foundation for further research on the simulation of human biological lung positive pressure ventilation experimental platform.
Objective To investigate the dynamic changes of postoperative liver reserve function and laboratory liver function as well as liver volume regeneration, and their potential relationship with short-term clinical outcomes after adult-to-adult living donor liver transplantation (LDLT). Methods The data of 30 recipients underwent LDLT were prospectively collected. The plasma clearance (K) by indocyanine green (ICG) excretive test, liver function test by laboratory methods, liver volume by CT and shortterm (lt;3 months) complications were analyzed. Results The graft recipient body weight ratio (GRBW) was 0.63%-1.43%. The hepatic volume of the recipients in the operation was (638±103) ml, which was smaller than that day 7, 30, and 90 after operation (Plt;0.001), but the hepatic volume at subsequent time point was not different from that at the former time point (Pgt;0.05). The KICG values of recipients among the day 3 〔(0.177±0.056)/min〕, 7 〔(0.183±0.061)/min〕, 30 〔(0.200±0.049)/min〕, and 90 〔(0.209±0.050)/min〕 after operation gradually increased, which was respectively higher than that of recipients before operation (P=0.006, P=0.002, Plt;0.001, and Plt;0.001). Compared with the baseline KICG 〔(0.228±0.036)/min〕 of the donors, the KICG of recipients showed significant variation on day 3 and 7 after operation (P=0.004 and P=0.015), and the KICG of recipients on day 30 and 90 after operation approached the baseline KICG (P=0.355 and P=0.915). The recipients were divided into good liver function group (n=23) and poor liver function group (n=7) according to total serum bilirubin on day 14 after operation. The KICG significantly dropped compared with the recipients of good liver function group on day 3 after operation (P=0.001). Conclusions The liver volume regenerates dramatically on day 7 after operation for the recipients. The ICG excretivetest shows that volume recovery occurs much more gradually than the recovery of function in the recipients. The ICG excretive test is a more reliable indicator of graft function and subsequent graft outcome early after LDLT.
ObjectiveTo study the model to predict thymus volume with two-dimensional section diameters among fetuses. MethodsFrom September 2010 to March 2012, 210 singleton pregnant women suspected with fetal abnormality by prenatal ultrasonic testing were confirmed using MRI technology. Three two-dimensional section diameters of thymus were measured and the volume was calculated. No abnormal fetuses regarded as the standard, theoretical normal volume of fetal thymus was calculated. Paired t-test was used to compare the actual thymus volume with its corresponding theoretical normal value, and thus the fetuses were divided into two groups of normal and dysplasia so as to establish predictive model respectively. With two-dimensional section diameters as independent variables and thymus volume as dependent variable, the linear regression model was established. According to the model, the thymus volume was predicted and the error rate was calculated by formula: error rate=(predicted value-actual value) /actual value×100%. The Pearson correlation coefficient of error rate and fetal gestational age was calculated. ResultsThe models of normal and dysplasia groups to predict thymus volume were lnV=0.016d1+0.030d2+0.086d3+5.707+ε (R2=0.510) and lnV=0.048d1+0.036d2+0.016d3+6.011+ε (R2=0.447). The average absolute values of predicted error rate were 4.34% and 5.34% and decreased with fetal gestational age (normal r=-0.264, P=0.007; dysplasia r=-0.182, P=0.060). ConclusionThe prediction effects of above models are not so good and the model accuracy increases with fetal gestational age. Normal fetuses' model of different gestational age should be established to predict thymus volume by conducting large sample size study in the future. The modeling approach has certain practicability and clinical value and can be applied in ultrasonic technique.
ObjectiveCompare the two-degrade collimator (MLC) angle selection's impact on plan quality and operational efficiency for volumetric intensity-modulated radiotherapy (VMAT) in the treatment planning system, and to explore the scheme for treatment plan optimization. MethodsTwenty patients with nasopharyngeal carcinoma underwent the treatment between March and December 2013 were randomly selected and planned for SIBVMAT treatment with different parameters set in the range of 0-60°with 15°interval for collimator angles. Planned dose distribution to the target volumes, organs at risk, and monitor units were compared. ResultsAs the MLC angle increased, target conformal index and homogeneity index had a trend to became deteriorated. The optimal plans were 0°and 15°, while 45°and 60°plans gave poor protection for the organ at risk compare to other angle plans and the monitor units were significantly increased. ConclusionChange the MLC angle had visible impact on treatment plans,there was a trend to deteriorate with the MLC angle increased, but small changes in MLC angle range can theoretically reduce the influence from leakage radiation on the human body.
ObjectiveTo evaluate the predictive value of mini-fluid challenge for volume responsiveness in patients under shock.MethodsSixty patients diagnosed as shock were included in the study. A 50 mL infusion of physiological saline over 10 seconds and a further 450 mL over 15 minutes were conducted through the central venous catheter. Cardiac output (CO), global end-diastolic volume index (GEDVI), central venous pressure (CVP) and extravascular pulmonary water index (EVLWI) were monitored by the pulse indicator continuous cardiac output monitoring. If the increase of CO after 500 mL volume expansion (ΔCO500) ≥10%, the patient was considered to be with volume responsiveness. The relevance between ΔCO50 and ΔCO500 was analyzed, and the sensitivity and specificity of the ΔCO50 were analyzed by receiver operating characteristic (ROC) curve.ResultsAfter 50 mL volume injection, the heart rate and systolic blood pressure of the two groups did not change obviously. The CVP of non-responders changed slightly higher than that of responders, but neither of them had obviously difference (P>0.05). The CO of responders had increased significantly (P<0.05) which was in accord with that after a further 450 mL volume injection. GEDVI and EVLWI did not change significantly (P>0.05). ΔCO50 and ΔCO500 were strongly correlated (r=0.706, 95%CI 0.677 - 0.891, P>0.05). The area under ROC curve for ΔCO50 was 0.814 (95%CI 0.707 - 0.922).ConclusionThe volume responsiveness of patients under shock can be predicted by mini-fluid challenge study which is related to normal volume expansion and it does not increase the risk of pulmonary edema.
ObjectiveTo investigate the risk factors of cement leakage in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). MethodsBetween March 2011 and March 2012, 98 patients with single level OVCF were treated by PVP, and the cl inical data were analyzed retrospectively. There were 13 males and 85 females, with a mean age of 77.2 years (range, 54-95 years). The mean disease duration was 43 days (range, 15-120 days), and the mean T score of bone mineral density (BMD) was-3.8 (range, -6.7--2.5). Bilateral transpedicular approach was used in all the patients. The patients were divided into cement leakage group and no cement leakage group by occurrence of cement leakage based on postoperative CT. Single factor analysis was used to analyze the difference between 2 groups in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, preoperative vertebral body wall incompetence, cement volume, and volume ratio of intravertebral bone cement to vertebral body. All relevant factors were introduced to logistic regression analysis to analyze the risk factors of cement leakage. ResultsAll procedures were performed successfully. The mean operation time was 40 minutes (range, 30-50 minutes), and the mean volume ratio of intravertebral bone cement to vertebral body was 24.88% (range, 7.84%-38.99%). Back pain was alleviated significantly in all the patients postoperatively. All patients were followed up with a mean time of 8 months (range, 6-12 months). Cement leakage occurred in 49 patients. Single factor analysis showed that there were significant differences in the volume ratio of intravertebral bone cement to vertebral body and preoperative vertebral body wall incompetence between 2 groups (P < 0.05), while no significant difference in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, and cement volume (P > 0.05). The logistic regression analysis showed that the volume ratio of intravertebral bone cement to vertebral body (P < 0.05) and vertebral body wall incompetence (P < 0.05) were the risk factors for occurrence of cement leakage. ConclusionThe volume ratio of intravertebral bone cement to vertebral body and vertebral body wall incompetence are risk factors of cement leakage in PVP for OVCF. Cement leakage is easy to occur in operative level with vertebral body wall incompetence and high volume ratio of intravertebral bone cement to vertebral body.