[Clinical application of enlarging greater ischiatic notch by ilium osteotomy to expose the sacral plexus via the gluteal approach].

Objectives: To observe the possibility of enlarging the greater sciatic notch by illium osteotomy through the posterior gluteal approach for reaching the intrapelvic upper sacral plexus as well as the covergence level of sacral plexus,and performing the nerve graft for surgical repairing the sacral plexus ruptured injuries or sacral plexus nerve tumor resection. Methods: The clinical data of 10 patients with sacral plexus injury or sacral plexus nerve tumor underwent the surgical operation via the expanded greater sciatic notch at Department of Hand Surgery,Beijing Jishuitan Hospital from July 2016 to November 2020 were retrospectively analyzed.There were 4 male and 6 female patients,with an age of (38.0±9.3)years (range:26 to 56 years).There were 8 cases with sacral plexus injury at the intrapelvic or covergence level (deep to the piriformis). Out of this 8 cases,4 cases with intrapelvic pan-sacral plexus injury,1 case with upper sacral plexus injury and 3 cases with convergence level pan sacral plexus injury.Another 2 cases were sacral plexus neoplasm.The average time from injury or onset to operation was 10.4 months (range:1.5 to 60.0 months). All cases were performed surgery for reaching the intrapelvic upper sacral plexus as well as the covergence level of sacral plexus with enlarging the greater sciatic notch by illium osteotomy through the posterior gluteal approach.Intraoperation the sacral plexus ruptured injurie was repaired and the sacral plexus nerve tumor was resected.Intraoperative findings,postoperative complications and healing of patients were recorded. Results: All the 10 patients underwent the sacral plexus surgical exploration and cutaneous nerve graft for sacral plexus nerve repairing or neurolysis or neoplasm resection through the posterior gluteal approach successfully.The length and width of illium osteotomy mass were (2.9±0.4)cm (range:2.5 to 3.8 cm) and (2.5±0.5)cm (range:1.5 to 3.4 cm) respectively.The median intraoperative bleeding volume was (M(QR))800(800)ml (range:400 to 2 000 ml).There were no complication with major vascular injury and hematoma formation,and all incisions healed.The postoperative follow-up was 29.8 months (range:1.5 to 54.0 months).Nine cases of iliac osteotomy were healed,and 1 case was not healed because the follow-up was only 1.5 months. Conclusions: The intrapelvic upper sacral plexus and the convergence level of sacral plexus deep to the piriformis can be exposed clearly through this posterior gluteal approach via illium osteotomy for enlarging the greater sciatic notch,and there was enough operative space that surgical exploration and nerve graft or nerve transfer or neoplasm resection can be performed.

[Developmental characteristics of various types of hand bones of Poland's syndrome].

OBJECTIVE: To explore development status in different types of the hand bone and its developmental characteristics with Poland syndrome. METHODS: There were 32 cases with Poland's syndrome who accepted bilateral hand X-ray examination in Department of Hand Surgery, Beijing Jishuitan Hospital from February 2013 to August 2014.There were 24 male and 8 female patients aged from 1.0 to 15.0 years with median age of 2.4 years. Right hand deformity was 23 cases and left hand deformity was 9 cases. According to Tanner-Whitehouse skeletal age scoring system, 20 bones (radius and ulna, 7 carpal bones, 11 metacarpal and phalangeal bones) selected from the affected and contralateral limb respectively, were evaluated. Besides, hand deformity of the cases was classified into 5 types based on relevant literature. Each bone was given an individual age using the references of Greulich-Pyle chart. The average of all individual ages was taken as gross bone age, the average of individual ages of radius and ulna was taken as bone age of long bones, the average of individual ages of carpal bone was taken as bone age of carpal bones, and the average of individual age of metacarpal and phalangeal bones was taken as bone age of short bones.The delay of bone age was evaluated by correlation test, while the curve of cubic equation was used for analyzing the variance of skeletal development with age. RESULTS: The delay of long bone age of patients with Poland's syndrome in this study were 0-1.9 years ((0.5±0.5) years), 0-2.2 years ((0.7±0.5)years) for carpal bone, 0.5-2.0 years((0.6±0.4) years)for short bone and 0.1-1.7 years((0.6±0.4)years) for gross bone.Twelve cases in type Ⅱ hand deformity, 15 cases in type Ⅲ and 5 cases in type Ⅳ. The delay of bone ages, including long bone age, carpal bone age, short bone age and gross bone age, was not related with gender and side(all P>0.05), but related with degree of deformity(F=3.663-12.971, P=0.000-0.038). CONCLUSION: Compared with normal upper limb, the bone age in the affected limb in Poland's syndrome is delayed and it is correlated with gender, age and the extent of hand deformity and negative with side.

Interleukin-17A activation on bronchial epithelium and basophils: a novel inflammatory mechanism.

Basophils are the accessory cell type for T-helper (Th)2 induction and initiators in immunoglobulin E-mediated chronic allergic inflammation. Basophils and Th17 cells accumulate at the inflammatory sites, such as the airways of allergic asthmatic patients. We investigated the activation of interleukin (IL)-17A on the primary human basophils/KU812 basophilic cells and primary human bronchial epithelial cells/BEAS-2B bronchial epithelial cells. Cytokines, chemokines, adhesion molecules and intracellular signalling molecules were assayed by ELISA or flow cytometry. Co-culture of bronchial epithelial cells and basophils could significantly induce the release of IL-6, an epithelial inflammatory cytokine, and CCL2, a chemokine for basophils, esosinophils and monocytes. Such induction was synergistically enhanced by IL-17A, and direct interaction between these two cells was necessary for IL-17A-induced IL-6 and CCL2 release. Surface expression of intercellular adhesion molecule-1 on bronchial epithelial cells was also upregulated upon their interaction. The interaction of basophils and bronchial epithelial cells under IL-17A stimulation was differentially regulated by extracellular signal-regulated kinase, c-Jun N-terminal protein kinase, p38 mitogen-activated protein kinase and nuclear factor-kappaB pathways. These findings suggest a novel immunopathological role of Th17 cells and basophils in allergic asthma through the activation of granulocyte-mediated inflammation initiated by the direct interaction between basophils and bronchial epithelial cells.

Distribution and clinical significance of human papillomavirus subtypes in Shenzhen city, People's Republic of China.

This study investigated the subtype distribution of the human papillomavirus (HPV) in the patients with condyloma accuminatum (CA) in Shenzhen city, China, and assessed the relationship between different HPV subtypes and cervical neoplasia. Type-specific prevalence and extent of multiple infections were assessed in the genital tract. CA samples collected from the 352 patients in the departments of dermatology and gynecology from the People's Hospital in Shenzhen during 2004-2006, using MY09/11 PCR and reverse dot blot hybridization for genotyping of 9-20 kinds of HPV subtypes. HPV status was studied in relation to the pathologic findings. HPV type diversity was wide. The low-risk HPV subtype 11 and 6 were the main subtypes, and multiple HPV infection rate was about 37% in HPV-positive samples. High-risk HPV (HR-HPV) types (16, 18, 58, 52, and 33) were the main subtypes in the CA of cervix, especially in the advanced stage cervical intraepithelial neoplasia (cervical intraepithelial neoplasia II(+) or above), multiple HR-HPV infection was found in 87% of HPV-positive samples. We conclude that HPV type 6 and 11 were the main subtypes in patients with CA in Shenzhen region, while HPV type 16 and 18 may be one of the main reasons for malignant changes of cervix, but this study cannot prove the association between multiple HPV infection and severity of cervix lesions.

Microarray analysis of microRNA expression in peripheral blood cells of systemic lupus erythematosus patients.

MicroRNAs (miRNAs) are noncoding RNA molecules of 21-24 nt that regulate the expression of target genes in a post-transcriptional manner. Evidence indicates that miRNAs play essential roles in embryogenesis, cell differentiation and pathogenesis of human diseases. This study describes a comparison between the miRNA profile of the systemic lupus erythematosus (SLE) patients and the controls to develop further understanding of the pathogenesis of SLE. Peripheral blood mononuclear cells were isolated from blood samples of 23 SLE patients, 10 idiopathic thrombocytopenic purpura patients and 10 healthy controls. The miRNA microarray chip analysis identified 16 miRNAs differentially expressed in SLE. The chip results were confirmed by northern blot analysis. This work indicates that miRNAs are potential diagnosis biomarkers and probable factors involved in the pathogenesis of SLE.

Real-time quantitative assay of HCV RNA using the duplex scorpion primer.

A novel real-time quantitative method for detecting HCV in serum was established in which the duplex scorpion primer was used to provide a unimolecular probing mechanism for hybridizing the highly conserved 5' noncoding region (5' NCR) of the HCV genome specifically. Through methodological evaluation, we found this new method had a wide linearity, high sensitivity, repeatability and specificity. Compared to the commercial TaqMan method, this method was found to be more sensitive and less costly, and the final results were obtained more quickly. Therefore, it could be applied to diagnose and monitor HCV infection in clinical practice.

Genetic identification of exported proteins in Streptococcus pneumoniae.

A strategy was developed to mutate and genetically identify exported proteins in Streptococcus pneumoniae. Vectors were created and used to screen pneumococcal DNA in Escherichia coli and S. pneumoniae for translational gene fusions to alkaline phosphatase (PhoA). Twenty five PhoA+ pneumococcal mutants were isolated and the loci from eight of these mutants showed similarity to known exported or membrane-associated proteins. Homologues were found to: (i) protein-dependent peptide permeases, (ii) penicillin-binding proteins, (iii) Clp proteases, (iv) two-component sensor regulators, (v) the phosphoenolpyruvate: carbohydrate phosphotransferases permeases, (vi) membrane-associated dehydrogenases, (vii) P-type (E1E2-type) cation transport ATPases, (viii) ABC transporters responsible for the translocation of the RTX class of bacterial toxins. Unexpectedly one PhoA+ mutant contained a fusion to a member of the DEAD protein family of ATP-dependent RNA helicases suggesting export of these proteins.