The rotary left ventricular assist device (LVAD) has been an effective option for end-stage heart failure. However, while clinically using the LVAD, patients are often at significant risk for ventricular collapse, called suction, mainly due to higher LVAD speeds required for adequate cardiac output. Some proposed suction detection algorithms required the external implantation of sensors, which were not reliable in long-term use due to baseline drift and short lifespan. Therefore, this study presents a new suction detection system only using the LVAD intrinsic blood pump parameter (pump speed) without using any external sensor. Three feature indices are derived from the pump speed and considered as the inputs to four different classifiers to classify the pumping states as no suction or suction. The in-silico results using a combined human circulatory system and LVAD model show that the proposed method can detect ventricular suction effectively, demonstrating that it has high classification accuracy, stability, and robustness. The proposed suction detection system could be an important part in the LVAD for detecting and avoiding suction, while at the same time making the LVAD meet the cardiac output demand for the patients. It could also provide theoretical basis and technology support for designing and optimizing the control system of the LVAD.
Patients with locally advanced thyroid cancer often face challenges in achieving radical surgery during initial diagnosis. This has become a significant hurdle in the treatment of thyroid cancer. With the continuous development of systemic therapy for thyroid cancer, several studies have demonstrated that neoadjuvant therapy can shrink tumors in some patients, thereby increasing the chances of complete resection and improving prognosis. Targeted therapy plays a crucial role as a core component of neoadjuvant treatment. Simultaneously, the potential efficacy of immunotherapy has gained attention, showing promising prospects. We aim to summarize the research progress and existing issues regarding neoadjuvant therapy for locally advanced thyroid cancer. We look forward to more high-quality clinical studies providing robust evidence for neoadjuvant therapy in locally advanced thyroid cancer, expanding the breadth of treatment options.
【摘要】 目的 探讨腰硬联合麻醉复合丙泊酚恒速输注清醒镇静的可行性、理想的药物剂量、术中知晓情况以及麻醉质量和效果。 方法 收集2009年3-12月480例美国麻醉医师协会（ASA）Ⅰ～Ⅲ级拟在腰硬联合麻醉下行下腹部、会阴部、下肢手术的患者480例，随机分为咪达唑仑组（M组）、丙泊酚Ⅰ组（PA组）、丙泊酚Ⅱ组（PB组）、丙泊酚Ⅲ组（PC组），每组各120例。四组患者均于腰2-3或腰3-4行腰硬联合麻醉，蛛网膜下腔注入轻比重0.2 %布比卡因12～15 mg，麻醉平面确切后，M组予以咪达唑仑0.04~0.06 mg/kg，PA组先予以负荷量丙泊酚0.50 mg/kg再以2.00 mg/（kg•h）剂量持续泵注，PB组予以负荷量丙泊酚0.75 mg/kg再以3.00 mg/（kg•h）剂量持续泵注，PC组予以负荷量丙泊酚1.00 mg/kg再以3.75 mg/（kg•h）剂量持续泵注。观察患者给药前（T0）、给药1（T1）、3（T2）、5（T3）、10（T4）、30（T5）、60 min（T6）各时点血流动力学平均动脉血压（MAP）、心率（HR）的变化、脑电双频指数（BIS）值及镇静评分、术中所看到的图片的回忆及不良反应。 结果 各组在给予镇静药后MAP、HR均有所下降，但测量值的变化在正常范围内；在T3时间点，各组BIS值及镇静/警醒OAA/S评分降低，与T0比较，差异有统计学意义（Plt;0.05）；与其他3组比较，在T4、T5、T6时点PC组BIS值与OAA/S评分降低，差异有统计学意义（Plt;0.05），PC组的镇静遗忘满意率高于其他3组；各组间未见发生严重的舌后坠、呼吸暂停和血氧饱和度（SpO2）lt;90%。 结论 在下腹部、下肢手术中，应用腰硬联合麻醉复合1.00 mg/kg负荷量的丙泊酚继而以3.75 mg/（kg•h）剂量持续泵注，可取得良好的镇静效果，不良反应小。【Abstract】 Objective To investigate the feasibility, ideal dose, intra-operative awareness as well as the quality and effectiveness of constant infusion of propofol under combined spinal-epidural anesthesia (CSEA) for conscious sedation. Methods A total of 480 patients at ASA grade Ⅰ-Ⅲ to be operated in the lower abdomen, perineum and lower limbs under CSEA from March to December 2009 were randomly divided into four groups: midazolam group (M group), propofol group Ⅰ (PA group), propofol group Ⅱ (PB group), and propofol group Ⅲ (PC group), with 120 patients in each group. All four groups of patients underwent CSEA at L2-3 or L3-4 and accepted pinal injection of 12-15 mg of 0.2% hypobaric bupivacaine. After the anesthetic plane was confirmed, patients in M group accepted 0.04-0.06 mg/kg of midazolam; patients in PA group accepted propofol at a loading dose of 0.50 mg/kg followed by continuous infusion at a dose of 2.00 mg/(kg•h); patients in PB group accepted propofol at a loading dose of 0.75 mg/kg followed by continuous infusion at a dose of 3.00 mg/(kg•h); patients in PC group accepted propofol at a loading dose of 1.00 mg/kg followed by continuous infusion at a dose of 3.75 mg/(kg•h). The change of hemodynamics including the mean arterial pressure (MAP) and the heart rate (HR), bispectral index (BIS) values, sedation scores, memory of pictures seen during operation and adverse effects before drug administration (T0), at minute 1 (T1), 3 (T2), 5 (T3), 10 (T4), 30 (T5) and 60 (T6) after drug administration were observed. Results MAP and HR decreased in all the four groups after administration of sedatives, but the changes of measured values were within normal ranges. BIS value and the Observer’s Assessment of Alertness and Sedation (OAA/S) scale decreased in all groups at T3, compared with those at T0 (Plt;0.05). Compared with the other 3 groups, BIS valueand OAA/S scale were significantly lower in PC group at T4, T5 and T6 (Plt;0.05), and the satisfaction rate of sedation and amnesia was much higher. No serious glossocoma, apnea and SpO2 below 90% was observed in all the four groups. Conclusion During the surgery of lower abdomen and lower limbs, application of CSEA combined with propofol at a loading dose of 1.00 mg/kg followed by continuous infusion at a dose of 3.75 mg/(kg•h) can achieve a good sedative effect, with little side effect.
ObjectiveTo explore the utility and advantage of same-day surgery mode of Mammotome minimally invasive operation (MMT) in ambulatory surgery center, and summarize the key points of clinical management.MethodsFemale patients who underwent MMT in West China Hospital of Sichuan University between June and December 2019 were included. According to the operation mode, the patients were divided into same-day surgery group and routine group (routine day operation). The perioperative data were analyzed.ResultsA total of 1 297 female patients were included. Among them, 571 cases were in the same-day surgery group and 726 cases were in the routine group. There was no significant difference in baseline data, intra-operative bleeding volume, operation time, or complication rate between the two groups (P>0.05). There were significant differences in the number of masses (χ2=13.384, P<0.001), pathological type (χ2=11.990, P=0.007) and operation method (χ2=89.185, P<0.001). The length of hospital stay in the same-day surgery group was significantly shorter than that in the routine group (Z=–29.746, P<0.001); the cost of biopsy (Z=–8.549, P<0.001), the cost of surgical instruments (Z=–9.564, P<0.001), and the total cost of hospitalization (Z=–10.378, P<0.001) in the same-day surgery group were less than those in the routine group. In addition, the result of generalized estimating equation showed that the postoperative pain scores of patients in the same-day surgery group were lower than those in the routine group (P<0.001).ConclusionsThe same-day surgery mode of MMT is safe and feasible with high time economic benefits, which is worthy promoting in ambulatory surgery center. Cautions should addressed with patients’ safe and high-quality health education.
ObjectiveTo explore the effect of gastric bypass (GBP) on metabolic syndrome (MS) and the related mechanisms. MethodsThe literatures addressed the effect of GBP on glucose metabolism and blood pressure were retrospectively analyzed. ResultsIt showed that GBP achieved durable level of blood glucose, remission of dylipidemia and hypertension, however, which occurred before significant weight loss. The changes of many factors such as food intake, gastrointestinal hormones, adipocytokines, fat distribution might be involved in GBP to improve MS. ConclusionGBP seems to achieve the control of MS as a primary and independent effect, rather than secondary to the treatment of overweight.
【摘要】 目的 探讨高频彩色多普勒超声对浅表软组织肿物的诊断价值。 方法 回顾性分析2008年1-11月70例经手术、活检病理证实的浅表软组织肿物的声像图特征，包括肿物的部位、形态大小、内部回声、边界及其与周边组织的关系、长径与厚度比值（L/T）及病变周边与内部血流分布情况。 结果 超声对浅表肿块病灶的显示率为100%，良性肿瘤有脂肪瘤、表皮囊肿、滑膜囊肿、神经鞘瘤，血管瘤、异物肉芽肿等，恶性肿物包括皮肤纤维肉瘤，转移性腺癌。 结论 彩色多普勒超声对浅表肿块的检出、定位及物理性质可做出准确的诊断，综合分析肿物的边界、形态、内部回声及血流分布等特点对肿物的良恶性诊断具有重要价值。【Abstract】 Objective To evaluate the value of high-frequency color Doppler ultrasonography in diagnosing the superficial soft tissue masses. Methods The clinical data of 70 patients with superficial soft tissue masses from January to November 2008 were retrospectively analyzed. Superficial soft tissue masses was diagnosed by the surgery and biopsy. The sonographic features, including the location, morphology, size, internal echo, boundary, relationship with peripheral tissues, longitude to transverse ratio (L/T), and the vascularity, were observed. Results The results of sonographic examination showed that 100% superficial masses could be found. Benign masses included lipoma, sebaceous cysts, synovial cysts, nerve sheath tumors, haemangioma, foreign body granulomas, etc. Malignant soft tissue tumors included fibrous sarcoma and metastatic neoplasms. Conclusion Color Doppler ultrasonography can precisely diagnose the presence, localization and the physical characters of superficial soft tissue masses. It is an excellent modality to diagnose the benign or malignant masses by analyzing the boundary, configuration, internal echo and vascularity of the masses.
Objective To review the research progress of C terminal propeptide of collagen type II (CTX-II), a osteoarthritis (OA) biomarker. Methods Domestic and international l iterature about CTX-II was reviewed extensively and summarized. Results CTX-II is investigated broadly and has the best performance of all currently available biomarkers. CTX-II is a truly useful biomarker for early diagnosis, prognosis, and measurement of treatment response in OA. Conclusion Single CTX-II may be not sufficient for early diagnosis and prognosis of OA, so a combination of CTX-II and other biomarkers or diagnosis methods is needed.
Objective To discuss the effectiveness and the safety of accurate decompression via foraminoplasty in treating lumbar lateral recess stenosis patients who accompanied by disk-flavum ligamentum space and bony lateral recess stenosis, and to analysis the short-term effectiveness of the surgical procedures. Methods Forty-five lumbar lateral recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis were treated by accurate decompression via foraminoplasty between January 2013 and January 2016. There were 29 males and 16 females with a median age of 58 years (range, 42-82 years). The disease duration was 3-96 months (mean, 24.4 months). The lesion segment included L4, 5 in 36 cases and L5, S1 in 9 cases. The visual analogue scale (VAS) score of low back pain and leg pain at preoperation and last follow-up were recorded, and the modified Macnab criteria was used to evaluate the effectiveness at last follow-up. Postoperative CT and MRI were reviewed to evaluate the stability and decompression of the lumbar spine. Results All operations were successfully completed. All the 45 patients were followed up 3-18 months (median, 11 months). Dural tear occurred in 2 cases during operation, bone graft removed into the spinal canal in 1 case, postoperative low back pain occurred in 5 cases, and there was no nerve root injury, hematoma formation, or other complications. The leg pain VAS score at last follow-up (0.6±1.2) was significantly improved when compared with preoperative score (5.7±1.4) (t=8.981, P=0.001); and the low back pain VAS scores showed no significant difference between preoperation and last follow-up (1.5±1.3vs. 1.7±1.4;t=0.535, P=0.585). According to the modified Macnab criteria, the results were excellent in 20 cases, good in 22 cases, fair in 2 cases, and poor in 1 case at last follow-up, and the excellent and good rate was 93.3%. Conclusion Accurate decompression via foraminoplasty is an effective, safe, and less invasive way for treating lumbar recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis.