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, Volume 47 Issue 6 Previous Issue    Next Issue
Relative security of health care big data protection
LIU Chunfu,CHEN Hongmin
J Zhejiang Univ (Med Sci), 2018, 47(6): 563-576.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.01
Abstract( 274 )   HTML( 53 )     PDF(1185KB)( 111 )

With China's implementing big data strategy, health care becomes one of the key areas in which the national big data strategy is highly promoted. However, as the health care big data industry grows rapidly, the security risk is increasingly prominent and the internet plus medical care makes the protection of health care big data more complicated. By analyzing the current situation of health care big data security protection, the article proposes the viewpoint of relative security and suggests the strategies and key issues of health care big data protection. From the aspects of legal supervision, talents cultivation, publicity and education, and key data protection, it is necessary to build the prevention and control system for health care big data security, so that the security risk can be reduced and the data utility can be maximized.

Efficacy of integrated minimally invasive treatment for iliac vein compression syndrome with varicose veins of lower extremities
WANG Xiaohui,HE Yangyan,WU Ziheng,ZHANG Hongkun
J Zhejiang Univ (Med Sci), 2018, 47(6): 577-582.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.02
Abstract( 257 )   HTML( 9 )     PDF(1047KB)( 86 )

Objective: To analyze the efficacy of integrated minimally invasive surgery for iliac vein compression syndrome with varicose veins of lower extremities. Methods: From January 2017 to January 2018, 11 patients with iliac vein compression syndrome accompanied by varicose veins of lower extremities underwent left iliac vein stent implantation and radiofrequency thermal ablation of lower extremity veins in the First Affiliated Hospital of Zhejiang University School of Medicine. The left iliac vein stent was implanted through the puncture point approach of the main great saphenous vein, and then radiofrequency thermal ablation of the main saphenous vein was performed. Rivaroxaban and aspirin were administered from the day of surgery for 6 months and 12 months, respectively. After discharge, patients were followed up for more than 6 months. The lower extremity veins, iliac veins were reexamined by Doppler ultrasound or CT angiography at 2 weeks, 2 months and 6 months after surgery. Results: The operations were successfully performed in 11 patients, and no complication was observed during the operation. The rates of soreness and swelling remission, pigmentation and skin quality improvement, and the iliac vein stent patency were 100%. No varicose vein recurrence, iliofemoral vein thrombosis and pulmonary embolism were found. Conclusion: Integrated minimally invasive surgery is safe, effective and less invasive for iliac vein compression syndrome with varicose veins of lower extremities.

Clinical features and surgical treatment of neurilemmoma versus carotid body tumors at bifurcation of carotid artery
SHAO Hua,LIU Fei,ZHANG Wei,WANG Lixin,CHEN Bin,JIANG Junhao,DONG Zhihui,SHI Yun,GUO Daqiao,FU Weiguo
J Zhejiang Univ (Med Sci), 2018, 47(6): 583-587.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.03
Abstract( 151 )   HTML( 16 )     PDF(1033KB)( 46 )

Objective: To analyze clinical features, surgical treatment and outcomes of neurilemmoma and carotid body tumors in bifurcation of carotid artery. Methods: The clinical data of 17 patients with neurilemmomas and 76 patients with carotid body tumors at the bifurcation of carotid artery, who were surgically treated in Zhongshan Hospital of Fudan University from March 2012 to November 2016, were retrospectively analyzed. The clinicopathological characteristics, surgical procedures and outcomes were compared between two groups. Results: No difference of preoperative clinical demographic data was found between two groups. Operation time of the neurilemmoma group was significantly shorter than that of the carotid body tumor group[(93.9±30.8) min vs. (159.3±52.9) min, P < 0.01]. The neurilemmoma group had lower volume of intra-operative blood loss[(110±96) mL vs. (356±239) mL, P < 0.01] and lower rate of external carotid artery resection (11.8% vs. 68.4%, P < 0.01) than the carotid body tumor group. In the neurilemmoma group, 17 tumors were completely resected and no malignant disease was found. In the carotid body tumor group, 76 patients underwent complete surgical resection for the tumor, of which 5 (6.6%) were malignant. Tumor size of the neurilemmoma group was larger than that of the carotid body tumor group[(4.5±1.4) cm vs. (3.1±1.0) cm, P < 0.01]. There was no significant difference in the incidence of peri-operative complications and length of hospital stay between two groups (P>0.05). Conclusions: The clinical manifestations of neurilemmoma and carotid body tumors at carotid artery bifurcation are similar. The carotid body tumor group has a longer operating time, larger intra-operative blood loss, higher external carotid resection rate and relative higher incidence of malignancy. More cautions should be given when carotid body tumors at carotid artery bifurcation are treated.

Comparison of mechanical thrombectomy with transcatheter thrombolysis for acute iliac femoral venous thrombosis
YIN Xiaoliang,LANG Dehai,WANG Di
J Zhejiang Univ (Med Sci), 2018, 47(6): 588-594.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.04
Abstract( 161 )   HTML( 5 )     PDF(1316KB)( 47 )

Objective: To compare the efficacy of mechanical thrombectomy with transcatheter thrombolysis in the treatment of acute iliac femoral venous thrombosis. Methods: The clinical data of 170 patients with acute iliac venous thrombosis treated in Ningbo No.2 Hospital from September 2015 to September 2017 were retrospectively reviewed. Among them, 94 cases were treated with AngioJet mechanical thrombolysis or additional thrombolysis for residual thrombus (PMT group) and 76 cases were treated with catheter-directed thrombolysis(CDT group). After thrombolytic treatment if there was stenosis of iliac vein, the transluminal angioplasty was also performed. The clearance of thrombus and safety were evaluated and compared between two groups. Results: In PMT group there were 86 cases (91.5%) with grade Ⅲ, 5 cases (5.3%) with grade Ⅱ, 3 cases (3.2%) with grade Ⅰ clearance of thrombus; while in CDT group, there were 63 cases (82.9%) with grade Ⅲ, 7 cases (9.2%) with grade Ⅱ and 6 cases (7.9%) with grade Ⅰ clearance of thrombus (P>0.05). The differences of diameter of two lower extremities 15 cm above knee after treatment in PMT and CDT groups were (2.3±0.9) cm and (2.5±1.1) cm, respectively (P>0.05). The time of thrombolysis in group PMT was significantly shorter than that in group CDT[(2.6±1.2) d vs. (5.3±1.5) d, P < 0.05]. The dosage of urokinase in PMT group was significantly lower than that in CDT group[(15.0±5.0)×105 U vs. (26.5±7.5)×105 U, P < 0.05]. Hemoglobin decrease was observed in both groups, which was more significant in PMT group (P < 0.01). During the following period, there was no significant difference in the incidence of recurrence and post-thrombosis syndrome in two groups (all P>0.05). Conclusion: Both PMT and CDT have good thrombus clearance effect in the treatment of acute iliac femoral venous thrombosis, however, PMT has the advantages of short thrombolytic time and less urokinase.

Efficacy of percutaneous mechanical thrombectomy combined with percutaneous transluminal angioplasty in treatment of iliofemoral deep vein thrombosis
LIN Zuodong,LANG Dehai
J Zhejiang Univ (Med Sci), 2018, 47(6): 595-600.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.05
Abstract( 149 )   HTML( 3 )     PDF(1265KB)( 36 )

Objective: To evaluate the clinical efficacy of percutaneous mechanical thrombectomy (PMT) combined with percutaneous transluminal angioplasty (PTA) in the treatment of iliofemoral deep vein thrombosis. Methods: Ninety-four patients with iliofemoral deep vein thrombosis were identified in this retrospective study in our institution from November 2015 through December 2017. Patients were divided into two groups:PMT+PTA group (n=50) and PMT only group (n=44). Clot lysis rates, the retrieving and the embolism of the interior vena cava filter, as well as the incidence of complications were compared between two groups. The changes of serum creatinine, lactate dehydrogenase and hemoglobin were also measured perioperatively. Results: All procedures were completed successfully. The average clot lysis rate was higher and the procedure time was shorter in PMT+PTA group than those in PMT group (both P < 0.01). No significant differences were found in the rates of venous stenosis, catheter-directed thrombolysis and stent placement between two groups (all P>0.05). The interior vena cava filter was taken out in 82.0% (41/50) patients of PMT+PTA group and 81.8% (36/44) patients of PMT group (P>0.05). There were no significant differences of the changes in serum creatinine, lactate dehydrogenase and hemoglobin (all P>0.05). In PMT+PTA group, symptomatic pulmonary embolism and puncture bleeding occurred in 1(2.0%) and 2(4.0%) patients, while in PMT group, it was 0 and 2(4.5%), respectively (P>0.05). Conclusion: PMT combined with PTA is more effective than PMT alone for the treatment of iliofemoral deep vein thrombosis with less procedure time and without more incidence of pulmonary embolism.

One case of hepatosplenic artery aneurysm with hepato-splenomesenteric trunk and literature review
SHEN Yang,ZHANG Ruili,CHEN Guang,LI Fei,CHU Haiwei,HU Bin,ZHAO Wenjun
J Zhejiang Univ (Med Sci), 2018, 47(6): 601-605.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.06
Abstract( 180 )   HTML( 3 )     PDF(1103KB)( 42 )

An asymptomatic 71-year-old woman was admitted to the hospital due to aneurysm of visceral artery. CT angiography revealed that she possessed a hepatosplenic artery aneurysm with hepatosplenomesenteric trunk anomaly. The aneurysm was big with diameter about 28 mm, and is very adjacent to the superior mensenteric artery. The neck of the aneurysm is wide (the diameter of the neck was 5.5-6.0 mm) and short (length of the proximal landing zone was about 2.0 mm). The patient received endovascular reconstruction of the hepatosplenic artery and coil embolization of the aneurysm, and got satisfactory result.

Screening for inherited thrombophilia and genome sequencing
YIN Li,LI Ge,SHEN Jian,LIU Zhenjie
J Zhejiang Univ (Med Sci), 2018, 47(6): 606-611.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.07
Abstract( 382 )   HTML( 10 )     PDF(1125KB)( 87 )

Objective: To screening coagulation and anticoagulation genes and mutations in Chinese patients with venous thromboembolism suspected of inhered thrombophilia. Methods: Patients with venous thromboembolism caused by inherited thrombophilia were collected from the second Affiliated Hospital, Zhejiang University School of Medicine during June 2015 and December 2017. Gene sequencing was conducted to screen the anticoagulant-related genes PROC, PROS1, SERPINC1 and coagulation-related genes F5, F2, F8, CBS, MTHFR. The thousands of human genome database, ESP6500 database, Genoma database, HGMD mutation database were used to compare the mutation sites, and the pathogenic mutation sites were predicted according to SIFT, Polyphen, MutationTaster and CADD databases. Results: Among 25 patients screened, eight patients with PROC mutations, two patients with PROS1 mutations, three patients with SERPINC1 mutations; one patient with F5 mutation, one patient with F2 mutation, one patient with F8 mutation, two patient with CBS mutations, and one patient with MTHFR mutation. Conclusion: The second generation gene sequencing helps to diagnose inherited thrombophilia and guide the decision of anticoagulation duration.

Endovascular treatment of abdominal aortic aneurysm and aortic bifurcation stenosis by unibody bifurcation stent graft
LU Kaiping,LU Weiqing,YANG Guangwei,LAI Jifu,WU Hao,JIANG Jinsong
J Zhejiang Univ (Med Sci), 2018, 47(6): 612-616.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.08
Abstract( 160 )   HTML( 0 )     PDF(1078KB)( 29 )

Objective: To sum up experience in unibody bifurcation stent graft in the treatment of abdominal aortic aneurysm with aortic bifurcation stenosis. Methods: Clinical data of 19 cases of abdominal aortic aneurysm and aortic bifurcation stenosis received endovascular treatment using unibody bifurcation stent graft in Zhejiang Provincial People's Hospital during March 2009 and March 2018 were collected. The clinical characteristics, surgery procedure and follow-up results were reviewed. Results: Stent graft was successful in all patients, and the average operation time was (70.0±2.3) min. Leakage was found in 3 patients, in which 2 patients with type Ⅰ leakage and 1 patient with type Ⅱ leakage. All leakage disappeared 15 days after surgery. The 19 cases were followed-up for 9-48 months with the median follow-up time of 27 months, and no displacement, leakage and lower limb ischemia was observed. Conclusion: Unibody bifurcation stent graft is of satisfactory long-term effect for patients with abdominal aortic aneurysm and aortic bifurcation stenosis, and can avoid displacement of stent graft after operation.

Progress on in situ fenestration during thoracic endovascular aortic repair
XIANG Yilang,WU Ziheng,ZHANG Hongkun
J Zhejiang Univ (Med Sci), 2018, 47(6): 617-622.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.09
Abstract( 191 )   HTML( 5 )     PDF(1043KB)( 80 )

Endovascular aortic arch repair remains challenging due to the complicated anatomy and the involved vital branches. Off-label techniques emerged during the last decade, including endografts with parallel stents (known as Chimney, Periscope, Sandwich), surgeon-modified endografts, and various other reported techniques. In situ fenestration of standard endografts represents another off-label endovascular means to maintain perfusion to aortic side branches located in the excluded area. Its principle is based on fenestration of an endograft following its deployment inside the vascular system. As data are emerging regarding in situ fenestration, the aim of this article is to review recent progress of technical descriptions, in vitro and clinic results of in situ fenestration from the available literature.

Long-term efficacy of percutaneous mechanical thrombectomy combined with stent implantation in treatment of acute iliofemoral venous thrombosis
YU Zuanbiao,LIN Zuodong,LANG Dehai
J Zhejiang Univ (Med Sci), 2018, 47(6): 623-627.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.10
Abstract( 164 )   HTML( 4 )     PDF(1211KB)( 41 )

Objective: To evaluate the long-term efficacy of percutaneous mechanical thrombectomy (PMT) combined with stent implantation in treatment of acute iliofemoral vein thrombosis. Methods: Seventy patients with acute iliac vein thrombosis were treated with PMT combined stent implantation in Ningbo No.2 Hospital from November 2015 to November 2017. During the follow-up, the improvement of blood flow was evaluated, the occurrence of post-thrombotic syndrome was assessed by the Villalta rating scale, and the stent patency was examined with lower extremity ultrasound or angiography. Results: The blood flow was significantly improved after procedure in all 70 patients, including 62 cases (88.6%) of grade Ⅲ clearance, 5 cases (7.1%) of grade Ⅱ clearance, and 3 cases (4.3%) of grade Ⅰ clearance. No significant complications occurred during the treatment. The patients were followed up for (15.0±2.5) months. During the follow-up, 64 patients (91.4%) had unobstructed stents, and 9 patients (12.8%) had post-thrombotic syndrome. Conclusion: PMT combined with stent implantation is effective in the treatment of acute iliac vein thrombosis with a high medium-and long-term stent patency rate.

Effects of Niaoduqing granule on urine metabolic profile in chronic renal failure rats
ZHU Min,WU Yunqiu,SHOU Zhangfei
J Zhejiang Univ (Med Sci), 2018, 47(6): 628-635.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.11
Abstract( 196 )   HTML( 6 )     PDF(1288KB)( 60 )

Objective: To investigate the effects of Niaoduqing granule on the urine metabolic profile in chronic renal failure (CRF) rats. Methods: Thirty six male SD rats were divided into the normal control group, the model group, and the Niaoduqing group with 12 rats in each group. The CRF was induced by gavage of 250 mg·kg-1·d-1 adenine for 21 d. UPLC-Q-TOF-MS/MS technique was used in combination with principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) to analyze the urine metabolic profiles in three groups. The endogenous substances with the variable importance projection (VIP)>1 and P < 0.05 were screened as the potential biomarkers for CRF, and enrichment analysis of metabolic pathways was carried out. Results: Compared with the normal control group, the model group had lower body weight, higher kidney coefficient, higher serum creatinine and urea nitrogen levels (all P < 0.01), while the above indexes in the Niaoduqing group were ameliorated compared with the model group (all P < 0.01). Fifteen potential biomarkers were found in the urine of the model group, which were involved in 9 metabolic pathways including phenylalanine, tyrosine and tryptophan biosynthesis, glyoxylate and dicarboxylate metabolism, valine, leucine and isoleucine biosynthesis, arachidonic acid metabolism, cysteine and methionine metabolism, tricarboxylic acid cycle, glycerophosphatide metabolism, tryptophan metabolism and tyrosine metabolism. Conclusion: Niaoduqing granules has therapeutic effect on rats with CRF, which may be related to the regulation of amino acid metabolism, lipid metabolism and energy metabolism.

Metabonomics studies of urine from APP/PS1 mice with early-stage Alzheimer's disease
ZHENG Yongquan,ZHANG Xiaoqian,CHEN Jiuxia,ZHOU Qi,GAO Hongchang
J Zhejiang Univ (Med Sci), 2018, 47(6): 636-642.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.12
Abstract( 138 )   HTML( 4 )     PDF(1296KB)( 60 )

Objective: To investigate the metabolic profiles of urine from APP/PS1 mice with early-stage Alzheimer's disease (AD). Methods: Urine samples were collected from 13 APP/PS1 mice of 16 weeks and 15 wild-type mice. 1H-NMR spectroscopy was acquired with a one-dimensional NOESY pulse sequence, and the integral values were imported to SIMCA-P+12.0 software for analysis. Results: The metabonomic analysis showed that the metabolic profiles of the APP/PS1 mice were significantly different from that of age-matched wild-type mice. The levels of 3-hydroxybutyrate, 2-hydroxybutyrate, succinic acid, 2-ketoglutaric acid, citric acid, cis-aconitic acid, fumaric acid decreased, and those of acetic acid, trimethylamine, taurine, creatinine, hippuric acid, formic acid, trigonelline, urea increased (all P < 0.05). Conclusion: Metabolic pathways including glucose metabolism and methylamine metabolism may be involved in the pathogenesis of early AD.

Efficacy and safety of digestive tract stent placement under direct visual endoscopy without X-ray monitoring in treatment of digestive tract stricture
SHEN Hong,JI Feng
J Zhejiang Univ (Med Sci), 2018, 47(6): 643-650.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.13
Abstract( 176 )   HTML( 1 )     PDF(1200KB)( 43 )

Objective: To evaluate the efficacy and safety of digestive tract stent implantation under direct visual endoscopy without X-ray monitoring in the treatment of digestive tract stricture. Methods: The clinical data of patients undergoing digestive tract stent placement under direct visual endoscopy without X-ray monitoring in the First Affiliated Hospital of Zhejiang University School of Medicine from March 2003 to November 2017 were retrospectively analyzed. The process of procedures, the postoperative complications and the postoperative follow-up data were documented. The survival time of patients with malignant gastrointestinal stricture was compared between those with and without stent implantation. Results: Among 562 patients, there were 310 cases of esophagus and cardia stricture, 40 cases of gastroduodenus stricture, 212 cases of colorectum stricture, and 63 cases with esophagus-tracheal fistula, esophagus-mediastinal fistula or anastomotic fistula. The stents were implanted successfully in 560 cases (99.64%) and the symptoms were alleviated in all patients after stent implantation (100%). Postoperative substernal discomfort, chest pain or abdominal pain occurred in 26 cases (4.64%), bleeding in 18 cases (3.21%), displacement of esophageal stents in 9 cases (1.61%), and restenosis in 15 cases (2.68%), in whom the stents were successfully placed again. None of the patients died within 7 days after the procedure. The incidence of postoperative abdominal pain, bleeding and stent displacement in esophageal/cardiac stricture patients was higher than that in the colorectal stricture patients (P < 0.05). In 284 cases of malignant stenosis, the median survival time of colorectal stricture patients[(27.5±1.94) months] was significantly higher than that of esophagus/cardia stricture patients[(13.40±0.71) months] and gastroduodenal stricture patients[(11.00±1.78) months]. The survival time of stenting patients with upper gastrointestinal malignant stenosis was significantly longer than that of the non-stenting patients (P < 0.05). Conclusion: Stent implantation under direct visual endoscopy without X-ray monitoring is safe and effective for the treatment of benign and malignant stricture of digestive tract and closure of fistula.

Graft failure in allogeneic hematopoietic stem cell trans-plantation
CAO Liqin,SHI Jimin
J Zhejiang Univ (Med Sci), 2018, 47(6): 651-658.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.14
Abstract( 267 )   HTML( 9 )     PDF(1027KB)( 97 )

With the progress of medical technology, the development of new drugs and the improvement of the therapeutic effect of graft-versus host disease in the last two decades, the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) have been greatly improved. However, graft failure is still a rare but serious complication of allo-HSCT. HLA incompatibility, virus infection, elderly donor, uncontrolled primary disease, damage of bone marrow hematopoietic microenvironment, ABO blood group incompatibility, T cell depletion, reduced intensity conditioning, and low nucleated cell number are all risk factors for graft failure. In recent years, with the implementation of HLA haplo-identical hematopoietic stem cell transplantation, the role of donor-specific antibodies in graft failure has attracted attention increasingly. This article reviews the recent studies involving the mechanism, risk factors and prevention measures of graft failure in allo-HSCT.

Research progress on interleukin-6 in lung cancer
TANG Hexiao,BAI Yuquan,SHEN Wulin,ZHAO Jinping
J Zhejiang Univ (Med Sci), 2018, 47(6): 659-664.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.15
Abstract( 209 )   HTML( 7 )     PDF(1015KB)( 75 )

As the core of cellular immunotherapy, T cells are important aspects of research and treatment of lung cancer. IL-6 is a costimulatory signal factor of T cells that is directly targeted by lung cancer stem cells. As a highly expressed cytokine in lung cancer cells, IL-6 plays an important role in variety of biological activities such as tumor occurrence, development, invasion and metastasis. This article reviews the research progress on IL-6 in lung cancer, including cancer development and progression, and the therapeutic sensitivity of lung cancer.

Research progress on composite animal models of inflammatory bowel disease based on gene knockout
ZHAO Huihui,TANG Huifang
J Zhejiang Univ (Med Sci), 2018, 47(6): 665-670.   https://doi.org/10.3785/j.issn.1008-9292.2018.12.16
Abstract( 202 )   HTML( 8 )     PDF(1015KB)( 80 )

Establishing a suitable animal model is important for studying the mechanism of inflammatory bowel disease (IBD) and exploring new therapeutic approaches. Although a large number of IBD single gene knockout animal models have been established, single knockout of certain genes associated with human IBD susceptibility does not manifest symptoms of IBD or manifest extremely milder symptoms, while composite animal models based on other modeling factors can better simulate the clinical features of IBD. This article mainly introduces three novel composite animal models and elaborates the possible pathogenesis of each composite model:animal models established by gene double knockout have more obvious and earlier symptoms than single-knockout models; single gene knockout model with Helicobacter infection can help to study the role of microbial infections in the pathogenesis of IBD; on the basis of gene knockout, specific deletion of certain immune cells can be used to study the role of the immune cells in the development of IBD. Among the above composite animal models, Muc2/IL-10 double knockout mice may be important animal models for IBD study.

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