[Clinical effect of modified vertical rectus abdominis myocutaneous flap in repairing skin and soft tissue defects after abdominoperineal resection for rectal cancer].

Objective: To investigate the clinical effect of the modified vertical rectus abdominis myocutaneous flap in repairing the skin and soft tissue defect after abdominoperineal resection for rectal cancer. Methods: This study was a retrospective observational study. From June 2019 to July 2022, five male patients with low rectal cancer who were conformed to the inclusion criteria were admitted to the Department of Basic Surgery of Xiangya Hospital of Central South University, with ages ranging from 65 to 70 years and the sizes of the perianal skin ulcers ranging from 5 cm×4 cm to 11 cm×9 cm, and all of them underwent abdominoperineal resection. The secondary skin and soft tissue defects in the perineum with an area of 8 cm×6 cm-14 cm×12 cm (with the depth of pelvic floor dead space being 10-15 cm) were repaired intraoperatively with transplantation of modified vertical rectus abdominis myocutaneous flaps with the skin area being 9 cm×7 cm-16 cm×12 cm, the volume of the muscle being 18 cm×10 cm×5 cm-20 cm×12 cm×5 cm, and the vessel pedicle being 18-20 cm in length. During the operation, most of the anterior sheath of the rectus abdominis muscle was retained, the flap was transferred to the recipient area through the abdominal cavity, the remaining anterior sheaths of the rectus abdominis muscle on both sides of the donor area were repeatedly folded and sutured, the free edge of the transverse fascia of the abdomen was sutured with the anterior sheath of the rectus abdominis muscle, and the donor area skin was directly sutured. After the operation, the survival of the transplanted myocutaneous flap was observed. The occurrence of complications in the perineal recipient area was recorded within 2 weeks after the operation. The recovery of the perineal recipient area and the abdominal donor area was observed during follow-up, and the occurrence of complications in the donor area of the abdomen as well as the recurrence of tumors and metastasis were recorded. Results: All transplanted myocutaneous flaps in 5 patients survived after surgery. One patient had dehiscence of the incision in the perineal recipient area 2 days after surgery, which healed after 7 d with intermittent dressing changes and routine vacuum sealing drainage treatment. In the other 4 patients, no complications such as incisional rupture, incisional infection, or fat liquefaction occurred in the perineal recipient area within 2 weeks after surgery. Follow-up for 6-12 months after discharge showed that the skin of the perineal recipient area had good color, texture, and elasticity, and was not bloated in appearance; linear scars were left in the perineal recipient area and the abdominal donor area without obvious scar hyperplasia or hyperpigmentation; no complications such as incisional rupture, incisional infection, intestinal adhesion, intestinal obstruction, or weakening of the abdominal wall strength occurred in the abdominal donor area, and the abdominal appearance was good with no localized bulge or formation of abdominal hernia; there was no local recurrence of tumor or metastasis in any patient. Conclusions: The surgical approach of using the modified vertical rectus abdominis myocutaneous flap to repair the skin and soft tissue defects after abdominoperineal resection for rectal cancer is relatively simple in operation, can achieve good postoperative appearances of the donor and recipient areas with few complications, and is worthy of clinical promotion.

The Effects of ß-Pinene, a Pine Needle Oil Monoterpene, on Adenovirus Type 3.

The mechanisms of the inhibitory action of ß-pinene, a pine needle oil monoterpene, on human adenovirus type 3 were studied using cytopathic inhibition test, MTT test, atomic force and laser confocal microscopy. ß-Pinene inhibited the viruses stronger that the reference antiviral medication ribavirin (p<0.05). Inhibition of viral cytopathic effect (CPE) increased with increasing the concentration of ß-pinene, which attested to direct elimination of adenovirus type 3. During viral reproduction phase, ß-pinene significantly inhibited proliferation of adenovirus type 3. Typical signs of adenoviral CPE as cell swelling and rounding were less pronounced in comparison with the control (ribavirin treatment). In addition, elevation of ß-pinene concentration significantly increased the cell survival rate (p<0.05). Laser confocal microscopy showed that fluorescence intensity in the ß-pinene group was significantly lower than in the control group (p<0.01), which was consistent with the results of MTT test, thereby providing additional arguments that ß-pinene affects the virus during the absorption phase. Thus, ß-pinene directly inactivates adenovirus type 3 and impedes its invasion into the cells, but produces no protective effects on cells. Understanding the mode of action of such monoterpenes as ß-pinene is of great importance for the development of new antiviral drugs.

Feasibility and advantages of endoscope-assisted parotidectomy: a systematic review and meta-analysis.

The object of this paper was to explore the feasibility and advantages of endoscope-assisted parotid tumour resection. Three databases (PubMed, Web of Science, and Cochrane) were used to search for all related randomised controlled trials or controlled trials (up to November 2019). The key parameters for assessment included 'Endoscope', 'Endoscopes', 'Cancer of Parotid', and 'Parotid Cancer'. To evaluate the feasibility and advantages of endoscope-assisted resection of parotid tumours, the data for each parameter were pooled, based on patients who received endoscope-assisted surgery and those who received conventional surgery. This meta-analysis included seven studies, involving 170 patients in the endoscopy group and 270 patients in the control group. The analysis using the pooled data showed that there were no significant differences in the operating times between the two groups; however, the endoscopy group had significantly shorter incisions and less intraoperative bleeding. In addition, the patients who received endoscope-assisted surgery had lower incidences of temporary facial paralysis and Frey's syndrome after surgery. Patients in the endoscopy group had greater postoperative satisfaction. Endoscope-assisted parotid tumour resection results in only a small, concealed incision wound and fewer postoperative complications. Therefore, it is promising for the surgical treatment of parotid tumours.

[Risk factors of permanent stoma in rectal cancer patients undergoing transabdominal anterior resection with temporary stoma].

Objective: To investigate the risk factors of turning temporary stoma into permanent stoma in rectal cancer patients undergoing transabdominal anterior resection with temporary stoma. Methods: A case-control study was carried out. Data of rectal cancer patients who underwent transabdominal anterior resection with temporary stoma and completed follow-up in Department of General Surgery of Xiangya Hospital of Central South University from June 2008 to June 2018 were collected and analyzed. In this study, temporary stoma included defunctioning stoma (ostomy was made during operation) and salvage stoma (ostomy was made within one month after operation due to anastomotic leakage or severe complications). Cases of multiple intestinal tumors were excluded. A total of 308 rectal cancer patients were enrolled in the study, including 198 males and 110 females with a median age of 56 (48-65) years. Ninety-four patients received intraperitoneal chemotherapy during operation. Among 308 patients, upper rectal cancer was observed in 64 cases, middle rectal cancer in 89 cases and low rectal cancer in 155 cases. Twenty patients underwent transverse colostomy and 288 underwent ileostomy. Phone call following-up was conducted from August to September 2019 to investigate whether stoma was reversed, causes of reversal failure, and tumor relapsed or not in detail. Permanent stoma was defined as that the stoma was still not reversed by the latest follow-up. The univariate analysis was performed with chi-square test or Fisher's exact test, and variables with P value < 0.10 were included in the non-conditional logistic regression model for multivariate analysis. Results: The median follow-up time was 54.3 (32.4-73.8) months. During follow-up, 8 cases had local recurrence and 37 cases had distant metastasis. Among the 308 patients with temporary ostomy, 247 (80.2%) patients had stomas reversed and the median interval time was 4.5 (3.5-6.1) months. The median interval time in 65 patients with salvage stoma was significantly longer that in 182 patients with defunctioning stoma [5.5 (4.3-7.5) vs. 4.2 (3.4-5.5) months; Z=-4.387, P<0.001]. The temporary ostomy was confirmed to become permanent stoma in 61 patients (19.8%), including 45 cases of defunctioning stoma and 16 cases of salvage stoma. Univariate analysis showed that preoperative anemia, intraperitoneal chemotherapy during operation, middle rectal cancer, transverse colostomy, pathological stage, postoperative local recurrence and distant metastasis were associated with permanent stoma (all P<0.10). Multivariate analysis revealed that the intraperitoneal chemotherapy during operation (OR=1.961, 95% CI: 1.029-3.738, P=0.041), middle rectal cancer (OR=2.401, 95% CI: 1.195-4.826, P=0.014), transverse colostomy (OR=3.433, 95% CI: 1.234-9.553, P=0.018), and distant metastasis (OR=8.282, 95% CI:3.820-17.954, P<0.001) were independent risk factors of permanent stoma. Conclusions: There is high risk of turning temporary stoma into permanent stoma among rectal cancer patients undergoing transabdominal anterior resection who receive intraperitoneal chemotherapy during operation, present as the middle rectal cancer, undergo transverse colostomy or develop distant metastasis. Surgeons need to evaluate and balance the risks and benefits thoroughly, and then inform the patients in order to avoid potential conflicts.

[Isolated biceps tenodesis by double row for pulley lesions].

Objective: To explore clinical outcome of isolated arthroscopic biceps tenodesis by double row for pulley lesions. Methods: Forty-nine patients with pulley lesions were treated from July 2017 to June 2018 in the Department of Sport Medicine, the Affiliated Zhongshan Hospital of Dalian University by isolated arthroscopic biceps tenodesis by double row. Patients were divided into 2 groups according to the intraoperative damage of the pulley system. In group A, there were 16 patients with isolated superior glenohumeral ligament/coracohumeral ligament (SGHL/CHL) complex lesions, including 9 males and 7 females, aged (55±6) years. In group B, there were 33 patients (15 males and 18 females, aged (57±8) years) with SGHL/CHL complex and adjacent supraspinatus tendon and/or subscapularis tendon articular-side partly tears. Patients in two groups were treated with different isolated arthroscopic biceps tenodesis by double row. Constant-Murley shoulder score and pain visual analogue scale (VAS) score were assessed before operation and 3, 6, 12 months after the operation. Postoperative complications were also recorded in two groups. The t test was used to compare the quantitative data within and between two groups. Results: All 49 patients were followed up for 12 to 24 months with an average of (17±6) months. The first-stage healing was achieved in all incisions in the two groups. No surgical complications related to revision, infection, Popeye syndrome and cramping pain were observed in either group. There was 1 case treated by secondary arthroscopy for retrauma in group B. The Constant-Murley shoulder score in group A before the operation was 46±10, and it was increased to 89±9 at the 12 months post operation(t=-22.637, P<0.05); and it was 39±10 and 87±8 before and 12 months after the operation respectively in group B (t=-44.849, P<0.05). The VAS scores in the two groups were both decreased significantly at the 12 months post operation when compared with those before the operation (0.68±0.70 vs 5.25±0.27 and 0.72±0.83 vs 5.69±0.84, respectively) (t=29.007, 37.079, both P<0.05). Conclusion: Isolated arthroscopic biceps tenodesis by double row can relieve pain, recover functions of shoulder joint effectively, and achieve a satisfactory outcome in the treatment of pulley lesions.

Management of cN0 papillary thyroid microcarcinoma patients according to risk-scoring model for central lymph node metastasis and predictors of recurrence.

BACKGROUND: The role of routine prophylactic central neck dissection (pCND) in clinically lymph node-negative (cN0) papillary thyroid microcarcinoma (PTMC) patients remains controversial. This retrospective study aimed to identify the clinical and pathologic factors of central lymph node metastasis (CLNM) and recurrence in PTMC patients. METHODS: A total of 371 cN0 PTMC patients from two hospitals were retrospectively analyzed. All patients underwent thyroidectomy plus pCND between January 2010 and January 2018. Clinicopathological features were collected, univariate and multivariate analyses were performed to determine the risk factors of CLNM. A scoring model was constructed on the basis of the results of independent risk factors of CLNM. The Cox proportional hazards model was used to analyze the risk factors of recurrence. RESULTS: CLNM occurred in 123 (33.2%) patients. Multivariate analysis showed male, tumor size > 0.75 cm, multifocality, extrathyroidal extension (ETE) and tumor in the middle/lower pole were independent risk predictors of CLNM (P < 0.05). A seven-point risk-scoring model was established to predict the stratified CLNM in cN0 PTMC patients. Multivariate Cox regression model showed ETE, vascular invasion and CLNM were independent risk predictors of recurrence (P < 0.05). CONCLUSION: Our study suggested that routine pCND should be performed for cN0 PTMC patients with score ≥ 3 according to the risk-scoring model. Moreover, patients with risk factors of recurrence should consider more complete treatment and more frequent follow-up.

[Comparison of graft vessel versus native vessel strategies for late saphenous vein graft disease after coronary artery bypass grafting].

Objective: To compare clinical efficacy of interventional treatment with graft vessel and native coronary artery for patients with late saphenous vein grafts disease(SVGD) after coronary artery bypass grafting (CABG). Methods: A total of 1 608 patients underwent CABG in Tianjin Chest from March 2014 to December 2017 were screened. During the follow-up period, 165 hospitalized patients with recurrence of angina pectoris within one year after CABG, who had at least one narrow vein graft(≥50%) confirmed by the coronary angiography were enrolled. According to the results of angiography and surgeon's clinical experiences, the patients received interventional treatment to vein grafts(grafts group, n=53) or native coronary vessels(native group, n=112). The operation success rate, mortality and incidence of serious complications after interventional treatment in two groups at the time of hospitalization were compared.And the incidence of major adverse cardiovascular events(MACE) in two groups at one year after discharge were also compared. Kaplan-Meier survival curve was used to compare the cumulative event-free survival rates. The risk factors for the MACE in the patients with late SVGD and treated by interventional therapy were analyzed by Cox regression analysis. Results: A total of 165 patients were included for analysis, including 98 males(59.4%). The age was (64.2±7.1) years old. The follow-up time was 12 (8, 12) months. In the grafts group, operation success rate was 90.57%(48/53), and 3 cases(5.66%) suffered from serious complications after interventional treatment, 2 cases(3.77%) died. For native group the operation success rate was 88.39%(99/112), and 7(6.25%) cases suffered from serious complications after interventional treatment, and no deaths. The operation success rate and the incidences of serious complications after interventional treatment in two groups had no statistically significant difference(both P>0.05). The mortality in hospital of native group was lower than that in grafts group(P<0.05). Within 12 months after discharge, there was no statistically significant difference in incidence of MACE of two groups (11.32%(6/53) vs. 10.71%(12/112), P>0.05). Survival analysis showed that the cumulative event-free survival rates in two groups were 73.58% (39/53) and 66.13%(74/112), and there was no statistically significant difference (P>0.05). Cox regression analysis showed acute coronary syndrome (HR=41.203, 95%CI 4.859-349.361, P<0.01), and peripheral vascular diseases (HR=2.808, 95%CI 1.067-7.393, P<0.05) were the risk factors of the MACE for the patients treated by interventional therapy with late SVGD. Conclusion: For the patients with late SVGD after CABG, the success rate of intervention with vein grafts and own coronary vessels are both high with satisfactory safety.The in-hospital mortality of interventional therapy in own coronary vessels is lower than in graft vessel. Patients with acute coronary syndrome and peripheral vascular disease have a poor prognosis.

[Analysis of misdiagnosis causes of suprasellar arachnoid cysts].

Objective: To investigate the causes of misdiagnosis of suprasellar arachnoid cysts, analyze its characteristics and put forward the diagnostic basis and differential points. Methods: The clinical data fo 97 cases of suprasellar arachnoid cysts diagnosed and treated in the neurosurgery department of Beijing Tiantan Hospital and Hebei General Hospital from March 2015 to March 2019 were analyzed retrospectively. All patients underwent CT and MRI scans with obstructive hydrocephalus. 13 cases were misdiagnosed, including 7 males and 6 females. First visit age 1-31 years old, with an average age of 6.3 years. There were 10 patients younger than 6 years old. The remaining 15-year-old patients, 31-year-old patients and 26-year-old patients each have one case. 11 cases were misdiagnosed as obstructive hydrocephalus, 2 cases as cystic craniopharyngioma. Results: 13 cases were misdiagnosed and mistreated, 11 cases were treated with intraventricular and abdominal shunt, 9 cases were treated with neuroendoscopy and recovered well. One cases of intracranial hematomas underwent craniotomy again, the hematomas were removed again and the bone slise were decompressed. One case had fissured stable after shunt. There were no operative deaths and no complications in this group. After endoscopic reoperation, CT and/or MRI scans showed that the ventricle narrowed in varying degrees, some of them returned to normal size and the flow of cerebrospinal fluid (cerebrospinal fluid) was unobstruct at the end of magnetic resonance cerebrospinal fluid angiography (MRI) fistula after endoscopic reoperation. Conclusions: The incidence of suprasellar arachnoid cysts is low, it is rare in clinic and it is easy to misdiagnose and mistreate. At present, it is recognized that the best treatment methods are partial resection of endoscope cyst wall, cyst ventricle fistula and third ventricle floor fisthla.

Total tumor diameter: the neglected value in papillary thyroid microcarcinoma.

BACKGROUND: Tumor multifocality is not uncommon in papillary thyroid carcinoma (PTC), especially in micro-PTC. However, assessing the size of the largest tumor may underestimate effect of additional foci. We aimed to investigate the effect of total tumor diameter (TTD) on clinicopathological features of micro-PTC. METHODS: Data from 442 patients who underwent thyroidectomy with cervical lymph node dissection for PTC were retrospectively analyzed. Patients were classified into subgroups according to multifocality and TTD. The relationships of clinicopathological features among these groups were analyzed. RESULTS: Multifocality was observed in 119 patients (26.9%). TTD > 1 cm and presence of extrathyroidal extension (ETE) were significantly higher in multifocal tumors compared to unifocal tumor (P < 0.001, P = 0.016, respectively). When comparing multifocal micro-PTC with TTD > 1 cm to those with unifocal micro-PTC or multifocal micro-PTC with TTD ≤ 1 cm, the proportions of cases with ETE, central lymph node metastasis (CLNM), and lateral lymph node metastasis (LLNM) were significantly higher (all P < 0.05). There was no significant difference in terms of these parameters between multifocal micro-PTC with TTD > 1 cm and macro-PTC or multifocal macro-PTC. The risk of CLNM was 2.056 (P = 0.044) times higher in multifocal micro-PTC with TTD > 1 cm than in unifocal micro-PTC. CONCLUSION: For multifocal micro-PTC, TTD can better assess the aggressiveness of the tumor. Multifocal micro-PTC with TTD > 1 cm was more aggressive than unifocal micro-PTC or multifocal micro-PTC with TTD ≤ 1 cm.

[Interpretation of clinical practice guideline for anorectal day surgery 2019 edition].

As the rapid development of minimally invasive techniques, anesthesia, and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow-up, for the convenience of various medical centers.

[Changes of BK(Ca) on vascular striaepericytes of D-galactose-induced aging model in guinea pigs].

Objective: The aging model of guinea pigs induced by D-galactose was set up to investigate the changes of BK(Ca) expression and function on cochlear pericytes and their relationship with age-related hearing loss. Methods: Thirty healthy 8-week-old guinea pigs were randomly divided into three groups, with 10 in each group: D-galactose aging model group, subcutaneous injection of D-galactose (500 mg/kg) daily for 6 weeks; saline control group, the same amount of saline was injected into the neck of the aging model group for 6 weeks; the blank control group, no treatment was performed. The threshold of auditory brainstem response (ABR) was detected. The content of BK(Ca) in the perivascular cells of the guinea pig cochlear cells was detected by immunofluorescence technique. The changes of peripheral current density and BK(Ca) current were detected by patch clamp technique. The data were analyzed by GraphPad Prism software. Results: Compared with the saline group and the control group, the ABR threshold and the amplitude of the wave I were significantly decreased in the aging model group, and the difference was statistically significant (P<0.01). Compared with the control group, the expression of BK(Ca) in the vascular pericytes of guinea pigs in the aging model group was significantly reduced (1.00±0.08 vs 0.27±0.03,the difference was statistically significant P<0.01), and the cell current density and BK(Ca) net current value were also significantly reduced with statistically significant (P<0.01). Conclusions: D-galactose can successfully induce guinea pig aging model, in which BK(Ca) expression decreases and net current value decreases in pericytes of cochlear striavascularis, and changes in BK(Ca) expression and function may be related to age-related hearing loss.

Fractional Deletion of Compound Kushen Injection Indicates Cytokine Signaling Pathways are Critical for its Perturbation of the Cell Cycle.

We used computational and experimental biology approaches to identify candidate mechanisms of action of aTraditional Chinese Medicine, Compound Kushen Injection (CKI), in a breast cancer cell line (MDA-MB-231). Because CKI is a complex mixture of plant secondary metabolites, we used a high-performance liquid chromatography (HPLC) fractionation and reconstitution approach to define chemical fractions required for CKI to induce apoptosis. The initial fractionation separated major from minor compounds, and it showed that major compounds accounted for little of the activity of CKI. Furthermore, removal of no single major compound altered the effect of CKI on cell viability and apoptosis. However, simultaneous removal of two major compounds identified oxymatrine and oxysophocarpine as critical with respect to CKI activity. Transcriptome analysis was used to correlate compound removal with gene expression and phenotype data. Many compounds in CKI are required to trigger apoptosis but significant modulation of its activity is conferred by a small number of compounds. In conclusion, CKI may be typical of many plant based extracts that contain many compounds in that no single compound is responsible for all of the bioactivity of the mixture and that many compounds interact in a complex fashion to influence a network containing many targets.

Decreased expression of miR-551b predicts poor prognosis and promotes tumorigenesis by targeting PTP4A3 in human colorectal cancer.

OBJECTIVE: MiR-551b has been reported to display tumor-suppressive and oncogenic potential in several cancers, but there has been no study on the roles of miR-551b in colorectal cancer (CRC). In this work, we aimed to explore the potential functions and mechanisms of miR-551b in the modulation of the CRC progression. PATIENTS AND METHODS: The expressions of miR-551b were examined in 122 pairs of CRC cancer tissues and adjacent non-tumor samples by Real Time-Polymerase Chain Reaction (RT-PCR). The clinical significance of miR-551b in CRC patients was explored using a Chi-square test, Kaplan-Meier assays, and multivariate analysis. MiR-551b mimics and inhibitors were used to establish miR-551b upregulation and downregulation models in CRC cells to examine the functions of miR-551b on cells proliferation, migration, invasion, and apoptosis. Dual-luciferase reporter assays were conducted for the validation of the possible modulation of a putative target of miR-551b. RESULTS: We showed that miR-551b was significantly down-regulated in CRC tissues and cell lines. It was observed that miR-551b expressions were correlated with lymph nodes metastasis, TNM stage, and poor prognosis. Multivariate analysis identifies low level of miR-551b expressions as an independent predictor for a shorter overall survival. The functional assessment suggested that forced miR-551b expression distinctly suppressed CRC cells growth, invasion, and migration, while the suppression of miR-551b displayed the opposite trend. Mechanistic studies confirmed that PTP4A3 was identified as a direct target of miR-551b in CRC. Interesting observations revealed that the cells capacities were higher in miR-551b +PTP4A3 group, when compared with those in miR-551b group, indicating that up-regulation of PTP4A3 rescued the repressive functions of miR-551b overexpression on CRC cells growth and migration. CONCLUSIONS: The findings of our study first showed that miR-551b, a potential tumor suppressor, may be used as a promising prognostic predictor and therapeutic target for CRC.

Protective effect of remifentanil on myocardial ischemia-reperfusion injury through Fas apoptosis signaling pathway.

OBJECTIVE: The aim of this study was to investigate the protective effect of remifentanil (RFT) on myocardial ischemia-reperfusion (IR) injury through Fas apoptosis signaling pathway. MATERIALS AND METHODS: A total of 36 Sprague-Dawley (SD) rats were randomly divided into 3 groups, including the sham operation (Sham) group, IR model (IR) group and RFT pretreatment (RFT) group, with 12 rats in each group. Myocardial tissues of rats in each group were collected. Hematoxylin and eosin (H&E) staining was used to examine the pathological differences of the myocardium in the three groups. The levels of lactate dehydrogenase (LDH), creatine kinase (CK), superoxide dismutase (SOD) and malondialdehyde (MDA) in the serum of rats in each group were detected by enzyme-linked immunosorbent assay (ELISA). Meanwhile, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was adopted to detect the apoptosis level of myocardial cells in each group. Furthermore, Reverse Transcription-Polymerase Chain Reaction (RT-PCR) and Western blotting were applied to measure the mRNA and protein expression levels of Fas and its pathway indexes, respectively. RESULTS: Compared with the Sham group, LDH and CK activities and MDA level in the IR group were significantly increased, whereas the level of SOD was remarkably decreased (p<0.05). Compared with the IR group, RFT pretreatment could significantly reduce the release of LDH and CK-muscle/brain (CK-MB), increase SOD level and decrease MDA level (p<0.05). TUNEL results manifested that the apoptosis rate of myocardial cells in the IR group was markedly increased than that of the Sham group (p<0.05). Meanwhile, the apoptosis rate of myocardial cells in the RFT group was notably decreased when compared with that of the IR group (p<0.05). ELISA results demonstrated that the levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) proteins in the RTF group were significantly lower than those of the IR group (p<0.05). RT-PCR and Western blotting results indicated that the expressions of Fas, Fas ligand (FasL), and Fas-associated protein with death domain (FADD) in IR and RFT groups were significantly higher than those of the Sham group (p<0.05). However, RTF pretreatment could markedly reduce the levels of Fas, FasL, and FADD (p<0.05). CONCLUSIONS: RFT can reduce the apoptosis of myocardial cells as well as IR-induced oxidative stress and inflammation by inhibiting the Fas/FasL signal transduction pathway.

Predictive factors for central lymph node and lateral cervical lymph node metastases in papillary thyroid carcinoma.

BACKGROUND: Central lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) is common. But the association between primary tumor characteristics and specific features of metastatic lymph nodes in PTC has not been fully identified. Determining risk factors for LNM may help surgeons determine rational extent of lymph node dissection. METHODS: Data from 432 patients who underwent thyroidectomy with cervical lymph node dissection for PTC were retrospectively analyzed. The relationships between LNM to central compartment or lateral compartment and clinicopathologic factors were analyzed. Cox regression model was used to determine the risk factors for recurrence-free survival (RFS). RESULTS: Central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) were found in 216 (50.0%) and 65 (15.0%) patients, respectively. In the multivariate analysis for CLNM, patients < 45 years of age (OR 2.037, 95% CI 1.388-2.988, P < 0.001), extrathyroidal invasion (OR: 2.144, 95% CI 0.824-5.457, P = 0.011), vascular invasion (OR 13.817, 95% CI 1.694-112.693, P = 0.014), LLNM (OR 2.851, 95% CI 1.196-6.797, P = 0.014) and TNM Stage III-IV (OR 465.307, 95% CI 113.903-1900.826, P < 0.001) were independent predictors for high prevalence of CLNM. In the multivariate analysis for LLNM, tumor size more than 1cm (OR 3.474, 95% CI 1.728-6.985, P < 0.001) and CLNM (OR 5.532, 95% CI 2.679-11.425, P < 0.001) were independent predictors for high prevalence of LLNM. Moreover, tumor with T3-T4 stage, extrathyroidal invasion and CLNM were the significant factors related to the RFS. CONCLUSION: For patients with pre-operative risk factors of LNM, an accurate preoperative evaluation of central compartment or lateral compartment is needed to find suspicious lymph nodes. And prophylactic lymph node dissection should be performed in patients with high risk of CLNM. Moreover, we suggest performing close follow-up for patients with high risk of RFS.

Effects of l-carnitine in the distillers dried grains with solubles diet of sows on reproductive performance and antioxidant status of sows and their offspring.

Distillers dried grains with solubles (DDGS) are highly susceptible to lipid oxidation because DDGS contain about 10% crude fat, which is largely composed of polyunsaturated fatty acids. l-carnitine serves an important function in fatty acids ß-oxidation, and also has antioxidant properties. The objective of this study was to examine the effects of l-carnitine in the DDGS diet of gestating and lactating sows on reproductive performance, milk composition and antioxidant status of sows and their offspring. One hundred and twenty sows (Landrace×Large white, mean parity 4.2, initial BW 230 kg) were randomly allotted to 1 of 4 dietary treatments (n=30 sows/treatment). Treatments were arranged as a 2×2 factorial with two levels of dietary DDGS (0 v. 250 g/kg in gestating diets and 400 g/kg in lactating diets) and two levels of dietary l-carnitine (0 v. 100 mg/kg in gestating diets and 0 v. 200 mg/kg in lactating diets). Distillers dried grains with solubles had no significant effect on litter size but significantly reduced the birth weights and weaning weights of piglets (P0.05). Supplementing the diets with l-carnitine had no significant effect of total litter size (P>0.05) but increased the number of piglets born alive and piglets weaned, birth weight and weaning weight of piglets and litter weight at birth and weaning (P<0.05). l-carnitine supplementation also increased the concentration of l-carnitine in milk and l-carnitine status of piglets (P<0.05). The antioxidant enzyme activities of new born and weaning piglets were increased (P<0.05) by maternal dietary l-carnitine but this did not extend to finishing pigs. In conclusion, including DDGS in the sows diet could induce oxidative stress, which may be associated with the reduced individual birth and weaning weight of piglets. Dietary l-carnitine supplementation improved the antioxidant and l-carnitine status of sows, which may be associated with the improved reproduction and piglet performance and the antioxidant status of piglets at birth and weaning. There were no interactions between DDGS and l-carnitine.

[Virtual planning and 3D printing modeling for mandibular reconstruction with fibula free flap].

Objective: To evaluate the use of virtual planning and 3D printing modeling in mandibular reconstruction and compare the operation time and surgical outcome of this technique with conventional method. Methods: Between June 2013 and June 2017, A total of 18 patients underwent the mandibular reconstruction with fibula free flap in the Affiliated Hospital of Qingdao University.Among 18 patients, there were 11 males and 7 females with an average age of 36.5 years (21-73 years). Nine patients underwent vascularized fibula flap mandibular reconstruction using virtual planning and 3D printing modeling.Titanium plates were pre-bent using the models and cutting guides which were used for osteotomies.Another 9 patients who underwent mandibular reconstruction using fibula flap without aid of virtual planning and 3D printing models were selected as control group. The operation time was recorded and compared in two groups. Accuracy of reconstruction was measured by superimposing the preoperative image onto the postoperative image of mandible. The selected bony landmark, distance and angle were measured. Results: The mean total operation time were 4.7-6.2(5.5±0.5) h in computer-assisted group and 5.6-7.5(6.6±0.7) h in conventional group, respectively. The operation time was shorter in computer-assisted group. The difference between the preoperative and postoperative intercondylar distances, intergonial angle distances, anteroposterior distances were(2.6±1.4)vs(4.4±1.6)mm, (2.9±1.2)vs(4.7±1.7)mm, (4.2±1.4) vs(5.9±1.8)mm in the computer-assisted and conventional group, respectively. The differences between the preoperative and postoperative mandible were smaller in the computer-assisted group. Conclusions: Virtual planning and 3D printing modeling have the potential to increase mandibular reconstruction accuracy and reduce operation time. We believe that this technology for mandibular reconstruction in selected patients can significantly improve the quality of reconstruction.

LPS at low concentration promotes the fracture healing through regulating the autophagy of osteoblasts via NF-κB signal pathway.

OBJECTIVE: To investigate the effect of low-concentration lipopolysaccharide (LPS) on proliferation and apoptosis of osteoblasts and to discover the mechanism of low-concentration LPS in facilitating the proliferation of osteoblasts. MATERIALS AND METHODS: MC3T3-E1 osteoblasts were treated with LPS, 3-methyladenine (3-MA, autophagy inhibitor), and BAY11-7082 (inhibitor of nuclear factor-kappa b, NF-κB), respectively. The cell cycles were detected using a flow cytometer. Cell proliferation and activity of MC3T3-E1 osteoblasts were explored by cell counting kit-8. Western blotting and immunofluorescence assay were performed to detect the protein level. RNA expression was measured through polymerase chain reaction (PCR) and immunofluorescence assay. RESULTS: At the third day after cell culture, cell infusion reached 80%, and cells were taken as the subjects. At 6 h after treatment with low-concentration LPS, the proliferation and activity of cells were higher than those at 1 h and 12 h after treatment, and the apoptotic level was significantly lower than that in cells at 12 h after treatment. The proliferation and activity of cells in the low-concentration LPS group were significantly higher than those in the control group, 3-MA group and BAY11-7082 group, and the apoptotic level was lower than those in these groups. Compared with those of cells in control group and BAY11-7082 group, the messenger RNA (mRNA) and protein expressions and nuclear transfer of cells in low-concentration LPS group were significantly elevated, but there were no statistically significant differences in comparisons with the 3-MA group. In the experiment of cell autophagy, the autophagic level in cells in low-concentration LPS group was higher than those in the control group, 3-MA group and BAY11-7082 group. CONCLUSIONS: Through the NF-κB signaling pathway in osteoblasts, low-concentration LPS can activate the autophagy and promote cell proliferation, thereby inhibiting cell apoptosis and accelerating the fracture healing.

[Efficacy and safety of ultrasound-guided or neurostimulator-guided bilateral axillary brachial plexus block].

Objective: To explore the efficacy and safety of bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator. Methods: From February 2012 to April 2014, 120 patients undergoing bilateral hand/forearm surgery in Beijing Jishuitan Hospital were enrolled and anaesthetized with bilateral axillary brachial plexus block. All patients were divided into two groups randomly using random number table: the ultrasound-guided group (group U, n=60) and the neurostimulator-guidedgroup (group N, n=60). The block was performed with 0.5% ropivacaine. Patients' age, sex and operation duration were recorded. Moreover, success rate, performance time, onset of sensor and motor block, performance pain, patient satisfaction degree and the incidence of related complications were also documented. Venous samples were collected at selected time points and the total and the plasma concentrations of ropivacaine were analyzed with HPLC. Results: The performance time, the onset of sensor block and the onset of motor block of group U were (8.2±1.5), (14.2± 2.2)and (24.0±3.5)min respectively, which were markedly shorter than those in group N( (14.6±3.9), (19.9±3.8), (28.8±4.2)min, respectively), and the differences were statistically significant(t=11.74, 10.09, 6.73, respectively, all P<0.01). The performance pain score of group N was (25.5± 13.2), which was obviously more serious than group U (31.7± 11.2) and a significant statistical difference was detected (t=2.856, P<0.05). The patient satisfaction degree of group U was 95.0%, which was significantly higher than group N (83.3%) and a markedly statistical difference was detected (χ(2)=4.227, P<0.05). Fifty min after performance, the total plasma concentration of ropivacaine of group U was(1.76±0.48)mg/L, which was significantly lower than group N (1.88±0.53)mg/L and a significant statistical difference was detected (t=2.43, P<0.05), while no significant differences were detected at the other time points between two groups (P>0.05). No analgesic was superadded and no other anesthesia methods were applied. No complications were detected perioperatively. Conclusions: The bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator are both effective and safe for bilateral hand/forearm surgery. However, the ultrasound-guided block may be more clinically beneficial because of its shorter performance time, rapid onset and higher patient satisfaction degree.