Summary: The effects of angiotensin Ⅱ receptor antagonist losartan on elastic properties of aorta in patients with mild to moderate essential hypertension were assessed. The ascending aortic distensibility in 26 pat...Summary: The effects of angiotensin Ⅱ receptor antagonist losartan on elastic properties of aorta in patients with mild to moderate essential hypertension were assessed. The ascending aortic distensibility in 26 patients (48±3 years) with mild to moderate essential hypertension before and after 12 weeks of treatment with losartan (50 mg/day) was evaluated by using two-dimensional echocardiography. M-mode measurements of aortic systolic (D s) and diastolic diameter (D d) were taken at a level approximately 3 cm above the aortic valve. Simultaneously, cuff brachial artery systolic (SBP) and diastolic(DBP) pressures were measured. Aortic pressure-strain elastic modulus (E p) was calculated as D d×(SBP-DBP)/(D s-D d)×1333 and stiffness index beta (β) was defined as D d×Ln (SBP/DBP)/(D s-D d). Blood pressure significantly decreased from 148±13/95±9 mmHg to 138±12/88±8 mmHg (systolic blood pressure, P=0.001; diastolic blood pressure, P=0.003). There was no significant difference in pulse pressure before and after treatment with losartan (53±10 mmHg vs 50±7 mmHg). The distensibility of ascending aorta increased significantly as showed by the significant decrease in pressure-strain elastic modulus from 4.42±5.79×10 6 dynes/cm 2 to 1.99±1.49×10 6 dynes/cm 2 (P=0.02) and stiffness index beta from 27.4±32.9 to 13.3±9.9 (P=0.02). Although there was a weak correlation between the percent changes in pressure-strain elastic modulus and stiffness index beta and that in diastolic blood pressure after losartan treatment(r=0.40, P=0.04 and r=0.55, P=0.004, respectively), no correlation was found between the percent changes in pressure-strain elastic modulus and stiffness index beta and that in systolic blood pressure (r=0.04, P=0.8 and r=0.24, P=0.2, respectively). Our study demonstrated that angiotensin Ⅱ receptor antagonist losartan has a beneficial effect on aortic distensibility in patients with mild to moderate essential hypertension and this effect is partly independent of blood pressure reduction.展开更多
Purpose: During catheter angiogram (CA) there is momentary increase in intravascular volume and pressure due to intra-arterial injection that can potentially cause vascular distention at the stenotic site, whereas on ...Purpose: During catheter angiogram (CA) there is momentary increase in intravascular volume and pressure due to intra-arterial injection that can potentially cause vascular distention at the stenotic site, whereas on CT angiogram (CTA) is unlikely due to intravenous administration. Methods: CA and CTA of the carotid artery from 29 patients were retrospectively studied. CA and CTA were obtained for each patient. Curved sagittal MPRs mirroring the carotid artery on CA were used to measure the diameter at stenosis and at the distal lumen. Mural plaque calcium content was graded on axial CTAs. Results: Accounting for repeated measurements, the likelihood that the lumen diameter from CA will be larger than CTA was higher at stenosis than distal to it but the difference in lumen diameters at stenosis was similar to CTA. There is insufficient evidence that intra-arterial hand-injection during CA leads to underestimation of the degree of stenosis. Percentage stenosis using the NASCET criteria differed between the 3 measurements, post hoc analysis showed significant difference between CA and axial CTA (p p > 0.99). The difference in lumen diameter did not depend on our calcium grading (p = 0.484). Conclusions: There is insufficient evidence to suggest that intra-arterial hand-injection contributes to vessel distention and underestimation of percent stenosis during CA in this study. Mural plaque calcium does not affect the degree of stenosis on CTA.展开更多
BACKGROUND Rehabilitation of elderly patients with a high body mass index(BMI)after cholecystectomy carries risks and requires the adoption of effective perioperative management strategies.The enhanced recovery after ...BACKGROUND Rehabilitation of elderly patients with a high body mass index(BMI)after cholecystectomy carries risks and requires the adoption of effective perioperative management strategies.The enhanced recovery after surgery(ERAS)protocol is a comprehensive treatment approach that facilitates early patient recovery and reduces postoperative complications.AIM To compare the effectiveness of traditional perioperative management methods with the ERAS protocol in elderly patients with gallbladder stones and a high BMI.METHODS This retrospective cohort study examined data from 198 elderly patients with a high BMI who underwent cholecystectomy at the Shanghai Fourth People's Hospital from August 2019 to August 2022.Among them,99 patients were managed using the traditional perioperative care approach(non-ERAS protocol),while the remaining 99 patients were managed using the ERAS protocol.Relevant indicator data were collected for patients preoperatively,intraoperatively,and postoperatively,and surgical outcomes were compared between the two groups.RESULTS The comparison results between the two groups of patients in terms of age,sex,BMI,underlying diseases,surgical type,and preoperative hospital stay showed no statistically significant differences.However,the ERAS group had a significantly shorter preoperative fasting time than the non-ERAS group(4.0±0.9 h vs 7.6±0.9 h).Regarding intraoperative indicators,there were no significant differences between the two groups of patients.However,in terms of postoperative recovery,the ERAS protocol group exhibited significant advantages over the non-ERAS group,including a shorter hospital stay,lower postoperative pain scores and postoperative hunger scores,and higher satisfaction levels.The readmission rate was lower in the ERAS protocol group than in the non-ERAS group(3.0%vs 8.1%),although the difference was not significant.Furthermore,there were significant differences between the two groups in terms of postoperative nausea and vomiting severity,postoperative abdominal distention at 24 h,and daily life ability scores.CONCLUSION The findings of this study demonstrate that the ERAS protocol confers significant advantages in postoperative outcomes following cholecystectomy,including reduced readmission rates,decreased postoperative nausea and vomiting,alleviated abdominal distension,and enhanced functional capacity.While the protocol may not exhibit significant improvement in early postoperative symptoms,it does exhibit advantages in long-term postoperative symptoms and recovery.These findings underscore the importance of implementing the ERAS protocol in the postoperative management of cholecystectomy patients,as it contributes to improving patients'recovery and quality of life while reducing health care resource utilization.展开更多
Yolk sac tumors of the ovary are rare entities that account for 2% - 5% of all ovarian tumors. They represent the second most common histological variant of malignant germ cell tumors of the ovary after dysgerminomas....Yolk sac tumors of the ovary are rare entities that account for 2% - 5% of all ovarian tumors. They represent the second most common histological variant of malignant germ cell tumors of the ovary after dysgerminomas. Yolk sac tumors are most commonly encountered in women in the second and third decades. Microscopically, they are highly polymorphic and can present in a pure form or associated with another contingent of germ cell tumor. We report the case of a 26-year-old woman, who underwent surgery for a large right ovarian tumor rupturing into the peritoneal cavity. The ovarian tumor was revealed by ascites of great abundance and abdomino-pelvic pain. On histological examination, the diagnosis of yolk sac tumor in its pure and polyvesicular vitelline pattern was made. Through this observation, we propose to discuss the anatomoclinical particularities of these tumors by emphasizing the importance of histology for the diagnosis as well as the need of an early and appropriate management.展开更多
Frozen shoulder is a common disease which causes significant morbidity. Despite over a hundred years of treating this condition the definition, diagnosis, pathology and most efficacious treatments are still largely un...Frozen shoulder is a common disease which causes significant morbidity. Despite over a hundred years of treating this condition the definition, diagnosis, pathology and most efficacious treatments are still largely unclear. This systematic review of current treatments for frozen shoulder reviews the evidence base behind physiotherapy, both oral and intra articular steroid, hydrodilatation, manipulation under anaesthesia and arthroscopic capsular release. Key areas in which future research could be directed are identified, in particular with regard to the increasing role of arthroscopic capsular release as a treatment.展开更多
Both sensorimotor and autonomic dysfunctions often occur after spinal cord injury(SCI). Particularly, a high thoracic or cervical SCI interrupts supraspinal vasomotor pathways and results in disordered hemodynamics ...Both sensorimotor and autonomic dysfunctions often occur after spinal cord injury(SCI). Particularly, a high thoracic or cervical SCI interrupts supraspinal vasomotor pathways and results in disordered hemodynamics due to deregulated sympathetic outflow. As a result of the reduced sympathetic activity, patients with SCI may experience hypotension, cardiac dysrhythmias, and hypothermia post-injury. In the chronic phase, changes within the CNS and blood vessels lead to orthostatic hypotension and life-threatening autonomic dysreflexia(AD). AD is characterized by an episodic, massive sympathetic discharge that causes severe hypertension associated with bradycardia. The syndrome is often triggered by unpleasant visceral or sensory stimuli below the injury level. Currently the only treatments are palliative - once a stimulus elicits AD, pharmacological vasodilators are administered to help reduce the spike in arterial blood pressure. However, a more effective means would be to mitigate AD development by attenuating contributing mechanisms, such as the reorganization of intraspinal circuits below the level of injury. A better understanding of the neuropathophysiology underlying cardiovascular dysfunction after SCI is essential to better develop novel therapeutic approaches to restore hemodynamic performance.展开更多
Cystic lymphangiomas are rare benign tumors.Most frequently occurring in children and involving the neck or axilla,these tumors are much less common in adults and very rarely involve the abdomen.The known congenital a...Cystic lymphangiomas are rare benign tumors.Most frequently occurring in children and involving the neck or axilla,these tumors are much less common in adults and very rarely involve the abdomen.The known congenital and acquired(traumatic)etiologies result in failure of the lymphatic channels and consequent proliferation of lymphatic spaces.This case report describes a very rare case of a giant mesenteric cystic lymphangioma in an adult male with no clear etiology and successful resolution by standard radical resection.A previously healthy 44-year-old male presented with a 6-wk history of progressive upper abdominal pain,vomiting,anorexia and unintentional weight loss accompanied by rapid abdominal distension.A palpable mass was detected upon physical examination of the distended abdomen and abdominal computed tomography scan showed a giant multilobulated cystic process,measuring 40 cm in diameter.Exploratory laparotomy revealed an enormous cystic mass containing 6 L of serous fluid.The process appeared to originate from the lesser omentum and the lesser curvature of the stomach.Radical resection of the tumor was performed along with a partial gastrectomy to address potential invasion into the adjacent tissues.Histological analysis confirmed the diagnosis of a multicystic lymphangioma.The postoperative recovery was uneventful and the patient was discharged after 6 d.At 3-mo follow-up,the patient was in good health with no signs of recurrence.展开更多
This study tested the effects of the gastrointestinal pulse train electrical stimulation with different parameters and at different locations on the neuronal activities of the lateral hypothalamus area(LHA) in obese...This study tested the effects of the gastrointestinal pulse train electrical stimulation with different parameters and at different locations on the neuronal activities of the lateral hypothalamus area(LHA) in obese rats in order to find the optimal stimulation parameter and location. Eight gastric electrical stimulations(GES) with different parameters were performed and the neuronal activities of gastric-distension responsive(GD-R) neurons in LHA were observed. The effects of stimulations with 8 parameters were compared to find the optimal parameter. Then the optimal parameter was used to perform electrical stimulation at duodenum and ileum, and the effects of the duodenal and ileac stimulation on the GD-R neurons in LHA were compared with the gastric stimulation of optimal parameter. The results showed that GES with the lowest energy parameter(0.3 ms, 3 mA, 20 Hz, 2 s on, 3 s off) activated the least neurons. The effects of GES with other parameters whose pulse width was 0.3 ms were not significantly different from those of the lowest energy parameter. Most gastric stimulations whose pulse width was 3 ms activated more LHA neurons than the smallest energy parameter stimulation, and the effects of those 3 ms gastric stimulations were similar. Accordingly, the lowest energy parameter was recognized as the optimal parameter. The effects of stimulations with the optimal parameter at stomach, duodenum and ileum on the LHA neuronal activities were not different. Collectively, gastrointestinal electrical stimulation(GIES) with relatively large pulse width might have stronger effects to the neuronal activities of GD-R neurons in LHA of obese rats. The effects of the GIES at different locations(stomach, duodenum and ileum) on those neurons are similar, and GES is preferential because of its easy clinical performance and safety.展开更多
Objective:To explore the effect of auricular point pressing combined with thunder-fire moxibustion in the treatment of abdominal distension and constipation after thoracic compression fracture.Methods:Totally 100 pati...Objective:To explore the effect of auricular point pressing combined with thunder-fire moxibustion in the treatment of abdominal distension and constipation after thoracic compression fracture.Methods:Totally 100 patients were randomly divided into 4 groups,the observation group 1(n=25)which were treated with conventional nursing combined with auricular piont pressing,observation group 2(n=25)treated with conventional nursing combined with thunder-fire moxibustion,observation group 3(n=25)treated with conventional nursing combined with auricular point pressing and thunder-fire moxibustion,and the control group(n=25)which adopted conventional nursing.First exhaust and defecation time after fracture in 4 groups were observed and compared.Results:The effect of observation group 3 was better than that of observation group 2,observation group 1 and control group(P<0.05).Conclusion:It is obvious that auricular point pressing combined with thunder-fire moxibustion has better result in treating abdominal distension and constipation after thoracic compression fracture.展开更多
BACKGROUND Malignant peritoneal mesothelioma(MPM)originates from the mesothelial and subcutaneous cells of the abdominal cavity.Its diagnose is difficult due to its nonspecific and vague symptoms,and it should be diff...BACKGROUND Malignant peritoneal mesothelioma(MPM)originates from the mesothelial and subcutaneous cells of the abdominal cavity.Its diagnose is difficult due to its nonspecific and vague symptoms,and it should be differentiated from alcoholic cirrhosis and liver and pancreatic cancers.Misdiagnosis and missed diagnosis can easily occur when MPM presents with other diseases.To the best of our knowledge,no case of MPM concurrent with alcoholic cirrhosis has been reported.CASE SUMMARY A 63-year-old man presented to our hospital with abdominal distension for 20days.He had a history of alcohol consumption for nearly 30 years and no history of special drug use or toxic exposure.After treatment for alcoholic cirrhosis in a community hospital,his symptoms did not improve significantly.The patient underwent exploratory laparotomy and surgical resection.Pathologic examination showed an epithelioid MPM.He was treated with chemotherapy and intraperitoneal hyperthermic perfusion after surgery.Currently,he is in a stable condition and tumor recurrence has not occurred.CONCLUSION Misdiagnosis and missed diagnosis of MPM can easily occur because of its insidious onset.Therefore,there is a need to understand.MPM in clinical practice,make the correct diagnosis,and provide timely and effective treatment.展开更多
AIM: To investigate anti-hypersensitive effects of α2δ-1 ligands in non-inflammatory and inflammationassociated colonic hypersensitivity(CHS) mouse models.METHODS: To induce an inflammation-associated CHS, 1% dextra...AIM: To investigate anti-hypersensitive effects of α2δ-1 ligands in non-inflammatory and inflammationassociated colonic hypersensitivity(CHS) mouse models.METHODS: To induce an inflammation-associated CHS, 1% dextran sulfate sodium(DSS) was administered to C57Bl/6J male mice, in drinking water, for 14 d. Regarding the non-inflammatory neonatal maternal separation(NMS)-induced CHS model, wild-type C57BI/6J pups were isolated from their mother from day 2 to day 14(P2 to P14), three hours per day(from 9:00 a.m. to 12:00 p.m.). Colorectal distension was performed by inflating distension probe from 20 μL to 100 μL by 20 μL increment step every 10 s. After a first colorectal distension(CRD), drugs were administered subcutaneously, in a cumulative manner,(Gabapentin at 30 mg/kg and 100 mg/kg; Pregabalin at 10 mg/kg and 30 mg/kg; Carbamazepine at 10 mg/kg and 30 mg/kg) and a second CRD was performed one hour after each injection.RESULTS: The visceromotor response(VMR) to CRD was increased by our NMS paradigm protocol in comparison to non-handled(NH) mice, considering the highest distension volumes(80 μL: 0.783 ± 0.056 mV /s vs 0.531 ± 0.034 m V/s, P < 0.05 and 100 μL: 1.087 ± 0.056 m V/s vs 0.634 ± 0.038 m V/s, P < 0.05 for NMS and NH mice, respectively). In the inflammationassociated CHS, DSS-treated mice showed a dramatic and significant increase in VMR at 60 and 80 μL distension volumes when compared to control mice(60 μL: 0.920 ± 0.079 m V/s vs 0.426 ± 0.100 m V/s P < 0.05 and 80 μL: 1.193 ± 0.097 mV /s vs 0.681 ± 0.094 mV /s P < 0.05 for DSS- and Water-treated mice, respectively). Carbamazepine failed to significantly reduce CHS in both models. Gabapentin significantly reduced CHS in the DSS-induced model for both subcutaneous injections at 30 or 100 mg/kg. Pregabalin s i g n i f i c a n t l y r e d u c e d V M R t o C R D i n t h e n o n-inflammatory NMS-induced CHS model for the acute subcutaneous administration of the highest cumulative dose(30 mg/kg) and significantly reduced CHS in lowdose DSS-treated mice in a dose-dependent manner. Finally, the percent decrease of AUC induced by acute GBP or Pregabalin treatment were higher in the inflammatory DSS-induced CHS model in comparison to the non-inflammatory NMS-induced CHS model.CONCLUSION: This preclinical study demonstrates α2δ-1 ligands efficacy on inflammation-associated CHS, highlighting their potential clinical interest in patients with chronic abdominal pain and moderate intestinal inflammation.展开更多
Ultrasound technology is widely used to make assessments of arterial function. The delicate nature of these measurements requires that sources of errors are limited. Therefore, the aim of this study was to assess vari...Ultrasound technology is widely used to make assessments of arterial function. The delicate nature of these measurements requires that sources of errors are limited. Therefore, the aim of this study was to assess variability due to probe selection and optimization settings. Methods: Ten healthy 20 - 26 year old male and female subjects were tested. Brachial artery size (diameter) was measured thirty times a second using a B-mode Ultrasound unit equipped with a high-resolution video capture device. Distension was calculated using systolic and diastolic diameters. To assess intersession variability, we made recordings over twelve minutes;with the probe being removed and re-positioned every four minutes. To assess variability due to probe selection and optimization, we manipulated four parameters: 1) Probe selection (7 - 13 MHz, 5 - 10 MHz, 6 - 9 MHz). 2) Probe frequency (11 MHZ, 9.6 MHZ, 8 MHz). 3) Measurement location (near, center or middle field). And, 4) Image mode (B-mode, duplex-mode). To assess inter-session variability, three sets of recordings were made for each probe selection and optimization setting. Results: Mean diameter ICC’s for inter-session variability, probe frequency, measurement location, image display size, and probe selection were 0.99, 0.98, 0.97, 0.99, and 0.90 respectively. Distension ICC’s for intersession variability, probe frequency, measurement location, image display size, and probe selection were 0.66, 0.26, 0.62, 0.60, and 0.51 respectively. Conclusions: Altering probe selection increases measurement variability to the greatest extent. However, as long as probe selection and optimization settings are kept constant, our inter-session variability shows that reliable measurements can be made.展开更多
he incidence and mortality of colorectal cancer(CRC)are on the rise in China and rank the fifth in all malignant cancers,which may result from the increasingly aging population and unhealthy lifestyles.At present,the ...he incidence and mortality of colorectal cancer(CRC)are on the rise in China and rank the fifth in all malignant cancers,which may result from the increasingly aging population and unhealthy lifestyles.At present,the major treatment methods for CRC include laparoscopic surgery,radiotherapy and neoadjuvant and palliative chemotherapies,but they all have the limited impact on cure rates and long-term survival.Traditional Chinese medicine(TCM)plays important roles in preventing recurrence and metastasis,improving the quality of life and prolonging the survival of patients with advanced CRC after radical operations.Thereby,this article mainly explored the key points of common syndromes,TCM nursing methods and health guidance of CRC in order to further develop the advantages of TCM,improve its efficacy and standardized its nursing behavior.展开更多
A 42 years old woman suffering from repeated events of intensive vaginal bleeding during the week off birth control pills was referred for diagnostic hysteroscopy. The patient underwent hysterohy drosonoscopy, a 3-ste...A 42 years old woman suffering from repeated events of intensive vaginal bleeding during the week off birth control pills was referred for diagnostic hysteroscopy. The patient underwent hysterohy drosonoscopy, a 3-step procedure, including a transvaginal ultrasound scan, a diagnostic hysteroscopy and immediate hydrosonography. A3 cmintramural myoma was detected by the ultrasound scan without impinging onto the uterine cavity as visualized by diagnostic hysteroscopy. However, continuous hydrosonographic evaluation of the uterus, performed immediately afterwards, unveiled a fibroid with a significant intracavitary portion. A falsely normal cavity could be appreciated by high pressured hysteroscopy, while during the gradual fall of the intracavitary pressure a significant lesion could be revealed encroaching into the lumen. In the absence of an agreed distention pressure range during hysteroscopy, an immediate hydrosonography may serve as an auxiliary tool to follow the uterine wall contour as distention pressure declines during the eventual escape of the distention fluid from the lumen. Uterine wall contour is heavily dependent on the distension pressure and guidelines for intrcavitary pressure during hysteroscopy are evidently needed.展开更多
Acute gastric dilation leading to ischemia of the stomach is an underdiagnosed condition and can be potentially fatal. It can occur in various medical and surgical conditions such as post operative state, trauma, anor...Acute gastric dilation leading to ischemia of the stomach is an underdiagnosed condition and can be potentially fatal. It can occur in various medical and surgical conditions such as post operative state, trauma, anorexia, spinal abnormalities, diabetes mellitus and electrolyte imbalance. Without proper and timely diagnosis and treatment, gastric perforation and hemorrhage can occur. In this report, we present a case of acute massive gastric dilation in a settling of type II diabetes mellitus and urosepsis. We will also present a review of literature and management options for such condition. Our report highlights the need for high index of suspicion and early intervention to avoid life threatening complications.展开更多
Varicocele is a common disease in male urology clinic,mainly manifested as testicular pendent distension discomfort,scrotal moisture,less weak semen and other symptoms.There is no specific drug in clinical treatment o...Varicocele is a common disease in male urology clinic,mainly manifested as testicular pendent distension discomfort,scrotal moisture,less weak semen and other symptoms.There is no specific drug in clinical treatment of modern medicine and traditional Chinese medicine.Mailuo Shutong Pills was created by TANG Zuxuan,a Chinese medical master,for the treatment of damp and heat stasis type thrombotic superficial phlebitis and other vascular diseases.In clinical application,it was found to have a good clinical effect on the treatment of symptoms caused by varicose vein.This paper analyzed the formulation mechanism of Mailuo Shutong Pills in the treatment of varicocele from the perspective of traditional Chinese and western medicine,and provides theoretical basis for clinical application.展开更多
Prolonged cardiorespiratory support can be achieved with ECMO that may provide time for myocardial recovery, prevent multiorgan dysfunction and reduce mortality. Left ventricle (LV) distension can worsen already diste...Prolonged cardiorespiratory support can be achieved with ECMO that may provide time for myocardial recovery, prevent multiorgan dysfunction and reduce mortality. Left ventricle (LV) distension can worsen already distended and hypocontractile heart. Early recognition and aggressive management of LV distension are essential for the treatment of patients with low cardiac output. The case report presented intends to show advantages of left ventricular venting on ECMO after post-cardiotomy shock. With direct flow measurements on bypass-grafts before and after the vent implantation, it was possible to clearly demonstrate the importance of venting for myocardial perfusion.展开更多
We report a 24-year-old male who presented with abdominal distension, constipation and left sided groin pain. CT and MRI of the abdomen/spine were performed which showed a large anterior sacral meningocele occupying m...We report a 24-year-old male who presented with abdominal distension, constipation and left sided groin pain. CT and MRI of the abdomen/spine were performed which showed a large anterior sacral meningocele occupying most of the pelvic and abdominal cavity and displacement of their respective contents. Initially a posterior approach with lumbosacral laminectomy (L5 - S4) was performed. The ostium of the meningocele was identified with several nerve roots identified passing through, adjacent and into the defect. As nerve roots traversed the ostium, watertight closure was not feasible without sacrificing nerve roots. Subsequent MRI demonstrated recurrence of approximately 60% of the anterior sacral meningocele. We therefore opted to approach the ASM anteriorly via an anterior approach with the help of colorectal surgical colleague. The ASM was completely embedded within the sigmoid and upper to mid rectal mesentry, with its own vascular supply to the thick walled capsule. This case highlights the need for a combined approach due to the incorporation of the pseudomeningocele into the omentum with the development of its own blood supply.展开更多
Objective:To explore the application value of moxibustion and acupoint application in the treatment of postoperative abdominal distention in patients undergoing gynecological surgery.Methods:Seventy-two patients who u...Objective:To explore the application value of moxibustion and acupoint application in the treatment of postoperative abdominal distention in patients undergoing gynecological surgery.Methods:Seventy-two patients who underwent gynecological surgery in our hospital from May 2020 to May 2021 were randomly divided into two groups.Group A was treated with moxibustion and acupoint application,and group B was treated with routine treatment.The incidence of postoperative abdominal distention,therapeutic effect of abdominal distention,defecation time,exhaust time,recovery time of bowel sounds and the changes of patients’quality of life were analyzed.Results:The incidence of abdominal distension in group A was 22.22%,which was lower than 41.47%in group B(P<0.05).The therapeutic effect of abdominal distension in group A was 87.50%,which was higher than 66.67%in group B(P<0.05).The recovery time of first defecation,first exhaust and bowel sound in group A was shorter than that in group B(P<0.05).All postoperative quality of life scores of group A were higher than that of group B(P<0.05).Conclusion:On the basis of routine postoperative intervention,moxibustion and acupoint application can reduce the risk of postoperative abdominal distention,reduce the degree of abdominal distention,promote the recovery of intestinal function,shorten the first postoperative exhaust and defecation time,and then improve the quality of life of patients.展开更多
文摘Summary: The effects of angiotensin Ⅱ receptor antagonist losartan on elastic properties of aorta in patients with mild to moderate essential hypertension were assessed. The ascending aortic distensibility in 26 patients (48±3 years) with mild to moderate essential hypertension before and after 12 weeks of treatment with losartan (50 mg/day) was evaluated by using two-dimensional echocardiography. M-mode measurements of aortic systolic (D s) and diastolic diameter (D d) were taken at a level approximately 3 cm above the aortic valve. Simultaneously, cuff brachial artery systolic (SBP) and diastolic(DBP) pressures were measured. Aortic pressure-strain elastic modulus (E p) was calculated as D d×(SBP-DBP)/(D s-D d)×1333 and stiffness index beta (β) was defined as D d×Ln (SBP/DBP)/(D s-D d). Blood pressure significantly decreased from 148±13/95±9 mmHg to 138±12/88±8 mmHg (systolic blood pressure, P=0.001; diastolic blood pressure, P=0.003). There was no significant difference in pulse pressure before and after treatment with losartan (53±10 mmHg vs 50±7 mmHg). The distensibility of ascending aorta increased significantly as showed by the significant decrease in pressure-strain elastic modulus from 4.42±5.79×10 6 dynes/cm 2 to 1.99±1.49×10 6 dynes/cm 2 (P=0.02) and stiffness index beta from 27.4±32.9 to 13.3±9.9 (P=0.02). Although there was a weak correlation between the percent changes in pressure-strain elastic modulus and stiffness index beta and that in diastolic blood pressure after losartan treatment(r=0.40, P=0.04 and r=0.55, P=0.004, respectively), no correlation was found between the percent changes in pressure-strain elastic modulus and stiffness index beta and that in systolic blood pressure (r=0.04, P=0.8 and r=0.24, P=0.2, respectively). Our study demonstrated that angiotensin Ⅱ receptor antagonist losartan has a beneficial effect on aortic distensibility in patients with mild to moderate essential hypertension and this effect is partly independent of blood pressure reduction.
文摘Purpose: During catheter angiogram (CA) there is momentary increase in intravascular volume and pressure due to intra-arterial injection that can potentially cause vascular distention at the stenotic site, whereas on CT angiogram (CTA) is unlikely due to intravenous administration. Methods: CA and CTA of the carotid artery from 29 patients were retrospectively studied. CA and CTA were obtained for each patient. Curved sagittal MPRs mirroring the carotid artery on CA were used to measure the diameter at stenosis and at the distal lumen. Mural plaque calcium content was graded on axial CTAs. Results: Accounting for repeated measurements, the likelihood that the lumen diameter from CA will be larger than CTA was higher at stenosis than distal to it but the difference in lumen diameters at stenosis was similar to CTA. There is insufficient evidence that intra-arterial hand-injection during CA leads to underestimation of the degree of stenosis. Percentage stenosis using the NASCET criteria differed between the 3 measurements, post hoc analysis showed significant difference between CA and axial CTA (p p > 0.99). The difference in lumen diameter did not depend on our calcium grading (p = 0.484). Conclusions: There is insufficient evidence to suggest that intra-arterial hand-injection contributes to vessel distention and underestimation of percent stenosis during CA in this study. Mural plaque calcium does not affect the degree of stenosis on CTA.
基金the Hongkou District Health Committee,No.Hong Wei 2002-08and Discipline Promotion Program of Shanghai Fourth People's Hospital,No.SY-XKZT-2020-1021.
文摘BACKGROUND Rehabilitation of elderly patients with a high body mass index(BMI)after cholecystectomy carries risks and requires the adoption of effective perioperative management strategies.The enhanced recovery after surgery(ERAS)protocol is a comprehensive treatment approach that facilitates early patient recovery and reduces postoperative complications.AIM To compare the effectiveness of traditional perioperative management methods with the ERAS protocol in elderly patients with gallbladder stones and a high BMI.METHODS This retrospective cohort study examined data from 198 elderly patients with a high BMI who underwent cholecystectomy at the Shanghai Fourth People's Hospital from August 2019 to August 2022.Among them,99 patients were managed using the traditional perioperative care approach(non-ERAS protocol),while the remaining 99 patients were managed using the ERAS protocol.Relevant indicator data were collected for patients preoperatively,intraoperatively,and postoperatively,and surgical outcomes were compared between the two groups.RESULTS The comparison results between the two groups of patients in terms of age,sex,BMI,underlying diseases,surgical type,and preoperative hospital stay showed no statistically significant differences.However,the ERAS group had a significantly shorter preoperative fasting time than the non-ERAS group(4.0±0.9 h vs 7.6±0.9 h).Regarding intraoperative indicators,there were no significant differences between the two groups of patients.However,in terms of postoperative recovery,the ERAS protocol group exhibited significant advantages over the non-ERAS group,including a shorter hospital stay,lower postoperative pain scores and postoperative hunger scores,and higher satisfaction levels.The readmission rate was lower in the ERAS protocol group than in the non-ERAS group(3.0%vs 8.1%),although the difference was not significant.Furthermore,there were significant differences between the two groups in terms of postoperative nausea and vomiting severity,postoperative abdominal distention at 24 h,and daily life ability scores.CONCLUSION The findings of this study demonstrate that the ERAS protocol confers significant advantages in postoperative outcomes following cholecystectomy,including reduced readmission rates,decreased postoperative nausea and vomiting,alleviated abdominal distension,and enhanced functional capacity.While the protocol may not exhibit significant improvement in early postoperative symptoms,it does exhibit advantages in long-term postoperative symptoms and recovery.These findings underscore the importance of implementing the ERAS protocol in the postoperative management of cholecystectomy patients,as it contributes to improving patients'recovery and quality of life while reducing health care resource utilization.
文摘Yolk sac tumors of the ovary are rare entities that account for 2% - 5% of all ovarian tumors. They represent the second most common histological variant of malignant germ cell tumors of the ovary after dysgerminomas. Yolk sac tumors are most commonly encountered in women in the second and third decades. Microscopically, they are highly polymorphic and can present in a pure form or associated with another contingent of germ cell tumor. We report the case of a 26-year-old woman, who underwent surgery for a large right ovarian tumor rupturing into the peritoneal cavity. The ovarian tumor was revealed by ascites of great abundance and abdomino-pelvic pain. On histological examination, the diagnosis of yolk sac tumor in its pure and polyvesicular vitelline pattern was made. Through this observation, we propose to discuss the anatomoclinical particularities of these tumors by emphasizing the importance of histology for the diagnosis as well as the need of an early and appropriate management.
文摘Frozen shoulder is a common disease which causes significant morbidity. Despite over a hundred years of treating this condition the definition, diagnosis, pathology and most efficacious treatments are still largely unclear. This systematic review of current treatments for frozen shoulder reviews the evidence base behind physiotherapy, both oral and intra articular steroid, hydrodilatation, manipulation under anaesthesia and arthroscopic capsular release. Key areas in which future research could be directed are identified, in particular with regard to the increasing role of arthroscopic capsular release as a treatment.
基金supported by research grants to VJT from the National Institutes of Health(R01 NS085426)the Department of Defense(W81XWH-14-1-060)
文摘Both sensorimotor and autonomic dysfunctions often occur after spinal cord injury(SCI). Particularly, a high thoracic or cervical SCI interrupts supraspinal vasomotor pathways and results in disordered hemodynamics due to deregulated sympathetic outflow. As a result of the reduced sympathetic activity, patients with SCI may experience hypotension, cardiac dysrhythmias, and hypothermia post-injury. In the chronic phase, changes within the CNS and blood vessels lead to orthostatic hypotension and life-threatening autonomic dysreflexia(AD). AD is characterized by an episodic, massive sympathetic discharge that causes severe hypertension associated with bradycardia. The syndrome is often triggered by unpleasant visceral or sensory stimuli below the injury level. Currently the only treatments are palliative - once a stimulus elicits AD, pharmacological vasodilators are administered to help reduce the spike in arterial blood pressure. However, a more effective means would be to mitigate AD development by attenuating contributing mechanisms, such as the reorganization of intraspinal circuits below the level of injury. A better understanding of the neuropathophysiology underlying cardiovascular dysfunction after SCI is essential to better develop novel therapeutic approaches to restore hemodynamic performance.
文摘Cystic lymphangiomas are rare benign tumors.Most frequently occurring in children and involving the neck or axilla,these tumors are much less common in adults and very rarely involve the abdomen.The known congenital and acquired(traumatic)etiologies result in failure of the lymphatic channels and consequent proliferation of lymphatic spaces.This case report describes a very rare case of a giant mesenteric cystic lymphangioma in an adult male with no clear etiology and successful resolution by standard radical resection.A previously healthy 44-year-old male presented with a 6-wk history of progressive upper abdominal pain,vomiting,anorexia and unintentional weight loss accompanied by rapid abdominal distension.A palpable mass was detected upon physical examination of the distended abdomen and abdominal computed tomography scan showed a giant multilobulated cystic process,measuring 40 cm in diameter.Exploratory laparotomy revealed an enormous cystic mass containing 6 L of serous fluid.The process appeared to originate from the lesser omentum and the lesser curvature of the stomach.Radical resection of the tumor was performed along with a partial gastrectomy to address potential invasion into the adjacent tissues.Histological analysis confirmed the diagnosis of a multicystic lymphangioma.The postoperative recovery was uneventful and the patient was discharged after 6 d.At 3-mo follow-up,the patient was in good health with no signs of recurrence.
基金financially supported by National Natural Science Foundation of China(No.30870927)
文摘This study tested the effects of the gastrointestinal pulse train electrical stimulation with different parameters and at different locations on the neuronal activities of the lateral hypothalamus area(LHA) in obese rats in order to find the optimal stimulation parameter and location. Eight gastric electrical stimulations(GES) with different parameters were performed and the neuronal activities of gastric-distension responsive(GD-R) neurons in LHA were observed. The effects of stimulations with 8 parameters were compared to find the optimal parameter. Then the optimal parameter was used to perform electrical stimulation at duodenum and ileum, and the effects of the duodenal and ileac stimulation on the GD-R neurons in LHA were compared with the gastric stimulation of optimal parameter. The results showed that GES with the lowest energy parameter(0.3 ms, 3 mA, 20 Hz, 2 s on, 3 s off) activated the least neurons. The effects of GES with other parameters whose pulse width was 0.3 ms were not significantly different from those of the lowest energy parameter. Most gastric stimulations whose pulse width was 3 ms activated more LHA neurons than the smallest energy parameter stimulation, and the effects of those 3 ms gastric stimulations were similar. Accordingly, the lowest energy parameter was recognized as the optimal parameter. The effects of stimulations with the optimal parameter at stomach, duodenum and ileum on the LHA neuronal activities were not different. Collectively, gastrointestinal electrical stimulation(GIES) with relatively large pulse width might have stronger effects to the neuronal activities of GD-R neurons in LHA of obese rats. The effects of the GIES at different locations(stomach, duodenum and ileum) on those neurons are similar, and GES is preferential because of its easy clinical performance and safety.
文摘Objective:To explore the effect of auricular point pressing combined with thunder-fire moxibustion in the treatment of abdominal distension and constipation after thoracic compression fracture.Methods:Totally 100 patients were randomly divided into 4 groups,the observation group 1(n=25)which were treated with conventional nursing combined with auricular piont pressing,observation group 2(n=25)treated with conventional nursing combined with thunder-fire moxibustion,observation group 3(n=25)treated with conventional nursing combined with auricular point pressing and thunder-fire moxibustion,and the control group(n=25)which adopted conventional nursing.First exhaust and defecation time after fracture in 4 groups were observed and compared.Results:The effect of observation group 3 was better than that of observation group 2,observation group 1 and control group(P<0.05).Conclusion:It is obvious that auricular point pressing combined with thunder-fire moxibustion has better result in treating abdominal distension and constipation after thoracic compression fracture.
基金Shandong Province Medical and Health Science and Technology Development Plan,No.202003030878.
文摘BACKGROUND Malignant peritoneal mesothelioma(MPM)originates from the mesothelial and subcutaneous cells of the abdominal cavity.Its diagnose is difficult due to its nonspecific and vague symptoms,and it should be differentiated from alcoholic cirrhosis and liver and pancreatic cancers.Misdiagnosis and missed diagnosis can easily occur when MPM presents with other diseases.To the best of our knowledge,no case of MPM concurrent with alcoholic cirrhosis has been reported.CASE SUMMARY A 63-year-old man presented to our hospital with abdominal distension for 20days.He had a history of alcohol consumption for nearly 30 years and no history of special drug use or toxic exposure.After treatment for alcoholic cirrhosis in a community hospital,his symptoms did not improve significantly.The patient underwent exploratory laparotomy and surgical resection.Pathologic examination showed an epithelioid MPM.He was treated with chemotherapy and intraperitoneal hyperthermic perfusion after surgery.Currently,he is in a stable condition and tumor recurrence has not occurred.CONCLUSION Misdiagnosis and missed diagnosis of MPM can easily occur because of its insidious onset.Therefore,there is a need to understand.MPM in clinical practice,make the correct diagnosis,and provide timely and effective treatment.
文摘AIM: To investigate anti-hypersensitive effects of α2δ-1 ligands in non-inflammatory and inflammationassociated colonic hypersensitivity(CHS) mouse models.METHODS: To induce an inflammation-associated CHS, 1% dextran sulfate sodium(DSS) was administered to C57Bl/6J male mice, in drinking water, for 14 d. Regarding the non-inflammatory neonatal maternal separation(NMS)-induced CHS model, wild-type C57BI/6J pups were isolated from their mother from day 2 to day 14(P2 to P14), three hours per day(from 9:00 a.m. to 12:00 p.m.). Colorectal distension was performed by inflating distension probe from 20 μL to 100 μL by 20 μL increment step every 10 s. After a first colorectal distension(CRD), drugs were administered subcutaneously, in a cumulative manner,(Gabapentin at 30 mg/kg and 100 mg/kg; Pregabalin at 10 mg/kg and 30 mg/kg; Carbamazepine at 10 mg/kg and 30 mg/kg) and a second CRD was performed one hour after each injection.RESULTS: The visceromotor response(VMR) to CRD was increased by our NMS paradigm protocol in comparison to non-handled(NH) mice, considering the highest distension volumes(80 μL: 0.783 ± 0.056 mV /s vs 0.531 ± 0.034 m V/s, P < 0.05 and 100 μL: 1.087 ± 0.056 m V/s vs 0.634 ± 0.038 m V/s, P < 0.05 for NMS and NH mice, respectively). In the inflammationassociated CHS, DSS-treated mice showed a dramatic and significant increase in VMR at 60 and 80 μL distension volumes when compared to control mice(60 μL: 0.920 ± 0.079 m V/s vs 0.426 ± 0.100 m V/s P < 0.05 and 80 μL: 1.193 ± 0.097 mV /s vs 0.681 ± 0.094 mV /s P < 0.05 for DSS- and Water-treated mice, respectively). Carbamazepine failed to significantly reduce CHS in both models. Gabapentin significantly reduced CHS in the DSS-induced model for both subcutaneous injections at 30 or 100 mg/kg. Pregabalin s i g n i f i c a n t l y r e d u c e d V M R t o C R D i n t h e n o n-inflammatory NMS-induced CHS model for the acute subcutaneous administration of the highest cumulative dose(30 mg/kg) and significantly reduced CHS in lowdose DSS-treated mice in a dose-dependent manner. Finally, the percent decrease of AUC induced by acute GBP or Pregabalin treatment were higher in the inflammatory DSS-induced CHS model in comparison to the non-inflammatory NMS-induced CHS model.CONCLUSION: This preclinical study demonstrates α2δ-1 ligands efficacy on inflammation-associated CHS, highlighting their potential clinical interest in patients with chronic abdominal pain and moderate intestinal inflammation.
文摘Ultrasound technology is widely used to make assessments of arterial function. The delicate nature of these measurements requires that sources of errors are limited. Therefore, the aim of this study was to assess variability due to probe selection and optimization settings. Methods: Ten healthy 20 - 26 year old male and female subjects were tested. Brachial artery size (diameter) was measured thirty times a second using a B-mode Ultrasound unit equipped with a high-resolution video capture device. Distension was calculated using systolic and diastolic diameters. To assess intersession variability, we made recordings over twelve minutes;with the probe being removed and re-positioned every four minutes. To assess variability due to probe selection and optimization, we manipulated four parameters: 1) Probe selection (7 - 13 MHz, 5 - 10 MHz, 6 - 9 MHz). 2) Probe frequency (11 MHZ, 9.6 MHZ, 8 MHz). 3) Measurement location (near, center or middle field). And, 4) Image mode (B-mode, duplex-mode). To assess inter-session variability, three sets of recordings were made for each probe selection and optimization setting. Results: Mean diameter ICC’s for inter-session variability, probe frequency, measurement location, image display size, and probe selection were 0.99, 0.98, 0.97, 0.99, and 0.90 respectively. Distension ICC’s for intersession variability, probe frequency, measurement location, image display size, and probe selection were 0.66, 0.26, 0.62, 0.60, and 0.51 respectively. Conclusions: Altering probe selection increases measurement variability to the greatest extent. However, as long as probe selection and optimization settings are kept constant, our inter-session variability shows that reliable measurements can be made.
文摘he incidence and mortality of colorectal cancer(CRC)are on the rise in China and rank the fifth in all malignant cancers,which may result from the increasingly aging population and unhealthy lifestyles.At present,the major treatment methods for CRC include laparoscopic surgery,radiotherapy and neoadjuvant and palliative chemotherapies,but they all have the limited impact on cure rates and long-term survival.Traditional Chinese medicine(TCM)plays important roles in preventing recurrence and metastasis,improving the quality of life and prolonging the survival of patients with advanced CRC after radical operations.Thereby,this article mainly explored the key points of common syndromes,TCM nursing methods and health guidance of CRC in order to further develop the advantages of TCM,improve its efficacy and standardized its nursing behavior.
文摘A 42 years old woman suffering from repeated events of intensive vaginal bleeding during the week off birth control pills was referred for diagnostic hysteroscopy. The patient underwent hysterohy drosonoscopy, a 3-step procedure, including a transvaginal ultrasound scan, a diagnostic hysteroscopy and immediate hydrosonography. A3 cmintramural myoma was detected by the ultrasound scan without impinging onto the uterine cavity as visualized by diagnostic hysteroscopy. However, continuous hydrosonographic evaluation of the uterus, performed immediately afterwards, unveiled a fibroid with a significant intracavitary portion. A falsely normal cavity could be appreciated by high pressured hysteroscopy, while during the gradual fall of the intracavitary pressure a significant lesion could be revealed encroaching into the lumen. In the absence of an agreed distention pressure range during hysteroscopy, an immediate hydrosonography may serve as an auxiliary tool to follow the uterine wall contour as distention pressure declines during the eventual escape of the distention fluid from the lumen. Uterine wall contour is heavily dependent on the distension pressure and guidelines for intrcavitary pressure during hysteroscopy are evidently needed.
文摘Acute gastric dilation leading to ischemia of the stomach is an underdiagnosed condition and can be potentially fatal. It can occur in various medical and surgical conditions such as post operative state, trauma, anorexia, spinal abnormalities, diabetes mellitus and electrolyte imbalance. Without proper and timely diagnosis and treatment, gastric perforation and hemorrhage can occur. In this report, we present a case of acute massive gastric dilation in a settling of type II diabetes mellitus and urosepsis. We will also present a review of literature and management options for such condition. Our report highlights the need for high index of suspicion and early intervention to avoid life threatening complications.
基金Supported by Traditional Chinese Medicine Science and Technology Development Program of Shandong Province(2015-108)Horizontal Project of The Affiliated Hospital of Shandong University of Traditional Chinese Medicine(H20210201-01).
文摘Varicocele is a common disease in male urology clinic,mainly manifested as testicular pendent distension discomfort,scrotal moisture,less weak semen and other symptoms.There is no specific drug in clinical treatment of modern medicine and traditional Chinese medicine.Mailuo Shutong Pills was created by TANG Zuxuan,a Chinese medical master,for the treatment of damp and heat stasis type thrombotic superficial phlebitis and other vascular diseases.In clinical application,it was found to have a good clinical effect on the treatment of symptoms caused by varicose vein.This paper analyzed the formulation mechanism of Mailuo Shutong Pills in the treatment of varicocele from the perspective of traditional Chinese and western medicine,and provides theoretical basis for clinical application.
文摘Prolonged cardiorespiratory support can be achieved with ECMO that may provide time for myocardial recovery, prevent multiorgan dysfunction and reduce mortality. Left ventricle (LV) distension can worsen already distended and hypocontractile heart. Early recognition and aggressive management of LV distension are essential for the treatment of patients with low cardiac output. The case report presented intends to show advantages of left ventricular venting on ECMO after post-cardiotomy shock. With direct flow measurements on bypass-grafts before and after the vent implantation, it was possible to clearly demonstrate the importance of venting for myocardial perfusion.
文摘We report a 24-year-old male who presented with abdominal distension, constipation and left sided groin pain. CT and MRI of the abdomen/spine were performed which showed a large anterior sacral meningocele occupying most of the pelvic and abdominal cavity and displacement of their respective contents. Initially a posterior approach with lumbosacral laminectomy (L5 - S4) was performed. The ostium of the meningocele was identified with several nerve roots identified passing through, adjacent and into the defect. As nerve roots traversed the ostium, watertight closure was not feasible without sacrificing nerve roots. Subsequent MRI demonstrated recurrence of approximately 60% of the anterior sacral meningocele. We therefore opted to approach the ASM anteriorly via an anterior approach with the help of colorectal surgical colleague. The ASM was completely embedded within the sigmoid and upper to mid rectal mesentry, with its own vascular supply to the thick walled capsule. This case highlights the need for a combined approach due to the incorporation of the pseudomeningocele into the omentum with the development of its own blood supply.
文摘Objective:To explore the application value of moxibustion and acupoint application in the treatment of postoperative abdominal distention in patients undergoing gynecological surgery.Methods:Seventy-two patients who underwent gynecological surgery in our hospital from May 2020 to May 2021 were randomly divided into two groups.Group A was treated with moxibustion and acupoint application,and group B was treated with routine treatment.The incidence of postoperative abdominal distention,therapeutic effect of abdominal distention,defecation time,exhaust time,recovery time of bowel sounds and the changes of patients’quality of life were analyzed.Results:The incidence of abdominal distension in group A was 22.22%,which was lower than 41.47%in group B(P<0.05).The therapeutic effect of abdominal distension in group A was 87.50%,which was higher than 66.67%in group B(P<0.05).The recovery time of first defecation,first exhaust and bowel sound in group A was shorter than that in group B(P<0.05).All postoperative quality of life scores of group A were higher than that of group B(P<0.05).Conclusion:On the basis of routine postoperative intervention,moxibustion and acupoint application can reduce the risk of postoperative abdominal distention,reduce the degree of abdominal distention,promote the recovery of intestinal function,shorten the first postoperative exhaust and defecation time,and then improve the quality of life of patients.