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Objective: To determine the ability of the ratio of platelet to lymphocyte (PLR) for predicting extubation failure in septic patients receiving invasive mechanical ventilation (IMV). Methods: The retrospective cohort study was conducted in ICU at Beijing Chao-Yang Hospital Shijingshan District, Capital Medical University in China from January, 2010 to December, 2019, including patients with sepsis who received IMV. 180 patients were enrolled in the study, including 111 male and 69 female, with the age range of 23-93 years and the median age of 76 years, and with an average age of 71.22 years. The medical records were reviewed, such as age, sex, acute physiology and chronic health evaluation II (APACHEII), sequential organ failure assessment (SOFA), spontaneous breathing trial (SBT) outcome, weaning outcome, complete blood count before SBT. According to weaning outcome, patients were divided into weaning failure and weaning success group. The difference of PLR, white blood cell(WBC), C-reaction protein (CRP) and procalcitonin (PCT) were compared between weaning failure and success group. Receiver-operating characteristics (ROC) curves and multivariate logistical regression analysis were employed to analyze the performance of these inflammatory markers for predicting weaning failure in patients with sepsis. Results: 180 patients with sepsis were included in the study and 37 patients (20.5%) experienced weaning failure (31 SBT failure and 6 extubation failure after successful SBT). PLR was higher in weaning failure group than that in weaning success group (Z=-5.793,P<0.001). Other inflammation biomarkers such as WBC, CRP and PCT were also higher in weaning failure group than that in weaning success group(Z=-4.356, -3.118 and -2.743, P<0.001, 0.002 and 0.006, respectively). According to ROC curves, PLR has a better predictive ability for weaning failure (AUC=0.809,95%CI 0.733-0.885) when compared to WBC (AUC=0.773,95%CI 0.648-0.817), CRP (AUC=0.666,95%CI 0.577-0.755) and PCT (AUC=0.603,95%CI 0.508-0.698). The cutoff value of PLR for predicting weaning failure was 257.69 with sensitivity 78.38%, specificity 76.22%, and diagnostic accuracy 71.66%. According to multivariate logistic regression analyses, PLR>257.69 was an independent risk factor for predicting weaning failure in patients with sepsis. Conclusions: PLR may be a valuable biomarker for predicting weaning failure in septic patients receiving IMV, and the patients with higher PLR should be handled with caution since they are at higher risk of weaning failure, and some more effective treatment should be in consideration after extubation.
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Humans , Male , Female , Aged , Young Adult , Adult , Middle Aged , Aged, 80 and over , Respiration, Artificial , Retrospective Studies , Sepsis/diagnosis , Procalcitonin , C-Reactive Protein , Biomarkers , ROC Curve , LymphocytesABSTRACT
Aim To investigate the effects of YL- IPA08 on the endogenous metabolites of PTSD model rats by metabolomics methods, and to explore the metabolic pathways and possible mechanisms of YL-IPA08 against PTSD. Methods The rats were randomly divided into control group, PTSD model group, and administration group of PTSD rats induced by forced swimming test, and the treatment group was given YL- IPA08 (2 mg • kg"1) by intragastric gavage for 15 consecutive days. High-performance liquid chromatog- raphy-mass spectrometry (HPLC-MS/MS) technology was used to detect the endogenous differential metabolites and the associated metabolic pathways in rat plasma samples. Targeted quantitative technology was simultaneously applied to detect the concentrations of 18 bile acids in rat plasma. Results Compared with control group, 40 kinds of endogenous metabolites including glutamic acid, proline, valine, arginine, leucine , cholic acid, and creatine showed significant difference, and the concentrations of 11 bile acids significantly increased in plasma of model group as well. Compared with model group, after YL-IPA08 intervention , the above-mentioned potential metabolites ap-peared to return to normal levels. Conclusions Metabolomics analysis reveals that YL-IPA08 has intervention effect on PTSD model rats. The mechanism may be related to the regulation of amino acid metabolism and bile acid metabolism.
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OBJECTIVE: To explore the diagnostic value of serum Aspergillus IgG antibody combined with BALF galactoman(GM) in the diagnosis of pulmonary aspergillosis and provide a new scheme for clinical diagnosis of aspergillus infection. METHODS: 97 patients suspected of pulmonary aspergillus infection were selected in our hospital during March 2016 and September 2017. Serum IgG and BALF GM were performed for all, ROC curve analysis was used to compare the diagnostic value. RESULTS: 58 cases diagnosed as pulmonary aspergillosis and 39 non-aspergillus infection patients were enrolled in this study as patient group and control group, respectively. Serum IgG antibody level in patient group is significant higher than control group(P<0.05), and also higher in chronic pulmonary aspergillosis(CPA) patients, compared with invasive pulmonary aspergillosis(IPA) patients. The sensitivity and specificity were 53.4%, 94.9% respectively if the cut-off value of serum IgG test was set as 140 IU/ml. When the cut-off value of BALF GM test was 0.5, the sensitivity and specificity were 75.9%, 76.9%. The ROC curve area of serum IgG antibody, BALF GM was 0.770, 0.813, respectively. When combined serum IgG antibody and BALF GM together, the area under the curve was 0.897. Conclution The combined serum IgG antibody and BALF GM tests improved the diagnostic value of pulmonary aspergillosis, it is recommended to clinical diagnosis.
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Collagen and its hydrolysates are the main functional substances derived from jellyfish, with superior characteristics including the convenient extraction, non-toxicity, high biodegradability and good biocompatibility. As a result, jellyfish collagen and its hydrolysates have become an important material in the field of biomedical research and showed a good application prospect in tissue engineering, biomaterial development and drug delivery. This review focuses on the application of jellyfish collagen and its hydrolysates in the biomedical researches, such as collagen scaffolds for cartilage tissue engineering, vascular grafts, aptamer sensors, hemostatic materials, anti-arthritis, anti-hypertension, so as to provide a reference for further studies on the application of the jellyfish collagen and its hydrolysates.
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Depression has become a serious global public health concern and a prominent social problem.Moreover,the majority of first-line antidepressants that target monoamine neurotransmitter function have significant limitations (ie,low response rates,a time-lag of weeks for a response,cognitive impairment and sexual dysfunction),particularly with the delayed onset of clinical effects which will reduce the patients' clinical compliance and increase the patients' risk of suicide and self-harm.All this highlights a major unmet need for a new generation of antidepressants with fast onset action and low toxic side effects.There has been great progress in the study on pathogenesis of depression and drug targets so far.Recent research has shifted from increasing the level of monoamine neurotransmitter (NE/5-HT) to focusing on regulating the adaptive and plastic change of the nervous system,especially the discovery of new potential fast-onset non-monoaminergic targets including NMDA receptor,AMPA receptor and M choline receptor.This article reviews the investigation into generalized fast antidepressants and their potential targets,in the hope of providing critical information for the development of fastonset antidepressants.
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We investigated the cause of a leukemia patient induced by infect in a strain of Klebsiella oxytoca with hypermucoviscosity (HMV) phenotype.Identification and drug susceptibility of the isolate were carried out with VITEK-2 compact system.HMV phenotype was detected by string-test.The major high virulence capsular serotypes (K1,K2,K5,K20,K54 and K57) and virulence factors (rmpA,wcaG,allS,kfu,aerobactin,fimH,uge,wabG and cf29a) were detected by polymerase chain reaction and DNA sequencing.Molecular typing was performed by multilocus sequence typing (MLST).Results showed that the isolates of blood and lung tissue were Klebsiella oxytoca belonged to ST 19,which were sensitive to the antibiotics used in test,expressing the HMV phenotype.The virulence gene wcaG was found,while other virulence genes and the major high virulence capsular serotypes were negative.It indicates that ST19 Klebsiella oxytoca with wcaG virulence gene is the main reason causing leukemic patient death.
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Objective To explore the anti-post-traumatic-stress-disorder(anti-PTSD)effects of YL-IPA08,a selective 18kDa translocator protein(TSPO)ligand.Methods The time-dependent stress sensitization(TDS)method was used to establish a rat mod?el of PTSD.The open field test(OFT)was used to evaluate the locomotor activity in rats.The contextual freezing(CF)measurement, elevated plus maze(EPM)test and novel objective recognition(NOR)test were used to evaluate the PTSD-like behaviors in rats.The concentration of allopregnanolone in rat hippocampus was detected by ELISA. Results Compared with the control group,neither TDS nor drug treatment affected the locomotor activity in rats(P>0.05).However,PTSD rats showed significant PTSD-like behaviors with enhanced CF time in CF mearsurement,decreased open arm time and open arm entries in EPM test,and dropped object recogni?tion index in NOR test(P<0.05 or 0.01).Moreover,the concentration of hippocampus allopregnanolone was decreased in PTSD rats (P<0.05).YL-IPA08(0.05-0.1mg/kg)or positive drug sertraline(15 mg/kg),administered intragastrically after establishment of PTSD model,significantly reversed the above PTSD-like behavioral changes(P<0.05 or 0.01)and increased the concentration of hip?pocampus allopregnanolone in PTSD rats.Conclusion YL-IPA08 could improve the PTSD-like behavior in rats,and the mechanism may be related to the increased allopregnanolone level in hippocampus.
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Objective To explore the role of 18 ku translocator protein (TSPO) in the anti-post-traumatic-stress-disorder(PTSD) effects of YL-IPA08 and the value of TSPO as a potential pharmacological target using gene knock out mice.Methods The PCR method was used to genotype TSPO wild type (WT) mice and knock out (KO) mice.Foot shock was used to establish a well-accepted mouse model of PTSD,the open field test (OFT) was used to evaluate the locomotor activity in mice,and freezing measurement was used to evaluate the PTSD-like fear behavior in mice.Results Compared with TSPO WT mice,KO mice had no expressible TSPO gene,but showed similar locomotor activity to WT mice after PTSD modeling.On day 1,day 5 and day 16 after PTSD modeling (day-1-day 0),both WT and KO mice showed significant PTSD-like behavior with enhanced freezing time.However,8 d treatment (day 0-day 7) of YL-IPA08 (0.3 mg/kg,once daily) or positive drug sertraline (15 mg/kg,once daily) after PTSD modeling significantly reduced freezing time selectively in WT mice,but not in KO mice.Conclusion It has been found for the first time that TSPO WT and KO mice can show the same sensitivity to PTSD modeling (namely the same PTSD-like behavior performance).Interestingly,TSPO can mediate the anti-PTSD effects of YL-IPA08.Therefore,the present study provides direct evidence for the value of TSPO as an potential pharmacological target for PTSD.
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<p><b>OBJECTIVE</b>To investigate the clinico-pathologic features, treatment and prognosis of Castleman disease.</p><p><b>METHODS</b>The clinico-pathologic data of 16 patients diagnosed as Castleman disease from January 2002 to December 2014 were analyzed retrospectively.</p><p><b>RESULTS</b>The median age was 28.5 (7-73)years old. There were 14 unicentric cases, 92.8% (13/14) of which was diagnosed as hyaline-vascular type. Two multicentric cases was diagnosed as plasmatcyic type. All the patients were treated by surgical resection and their median follow-up was 55.5 (2-150)months. As a result, 13 unicentric cases achieved sustained remission, 1 unicentric case with plasmatocytic type relapsed at 60th month after surgical resection.</p><p><b>CONCLUSION</b>Clinical subtype and histopathogenic type are the dominating progonostic factors in Castleman patients. The clinical presentation of unicentric disease has been found to be benigns and the surgical resection can be used as first-line treatment method in clinic. The clinical presentation of multicentric disease may be stable or advanced, and the prognosis of advanced cases is poor as there are no effective treatments.</p>
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Adolescent , Adult , Aged , Child , Humans , Middle Aged , Young Adult , Castleman Disease , Prognosis , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To prepare the functionalized nano-graphene oxide (nano-GO) particles,and study their targeted fluorescence imaging effects on glioma U251 cells under near infrared (NIR)irradiation.Methods Single-layer nano-GO particles were obtained after ultrasonic oscillation,and then connected with transferrin (Tf) and fluorescein isothiocyanate (FITC) through poly-L-lysine-G3 to prepare functionalized nano-GO-Tf-FITC particles.Sample morphology was observed and the particle sizes were measured under certain transmission electron microscope (TEM).Glioma U251 cells were employed and divided into targeted experimental group (adding functionalized nano-GO-Tf-FITC particles),parallel control group (adding anti-CD71-FITC reagent) and non-targeted experimental group (adding nano-GO-FITC particles).Fluorescence imaging of these groups was determined by fluorescence microscopy.Results Single-layer particles with a range of 20-100 nm were observed under high TEM,and the functionalized nano-GO-Tf-FITC particles were distributed in a pattern of single layer with a diameter smaller than 100 nm.Yellow green color was monitored in the targeted experimental group and parallel control group,and no imaging was monitored in the non-targeted experimental group because of no transferring integration.Conclusion Functionalized nano-GO-Tf-FITC particles are successfully prepared,and show marked targeted imaging effects on glioma U251 cells.
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<p><b>OBJECTIVE</b>To study cultivation of Panax ginseng adventitious roots in bubble bioreactors.</p><p><b>METHOD</b>The adventitious roots were obtained through tissue culture different types of bioreactors. The contents of ginsenosides Re, Rb1 and Rg1 were determined by HPLC while the contents of polysaccharides were determined by ultraviolet spectrophotometry.</p><p><b>RESULT</b>The results showed that of the three types tested, the most efficient bioreactor for cultivation of the ginseng adventitious roots was the cone-type bioreactors (with the 120 degrees ), in which, the growth curve of adventitious roots was S-shaped. The maximum biomass was obtained on the 40th day, with the fresh weight, dry weight and growth rate reaching the maximum, which were 113.15 g, 9.62 g and 63.13 times respectively, and the concomitant contents of polysaccharide and ginsenoside were 2.73% and 2.25 mg x g(-1).</p><p><b>CONCLUSION</b>The results showed that the most efficient bioreactor for cultivation of the ginseng adventitious roots was the cone-type bioreactors (with the 120 degrees). These results provide a theoretical reference for developing an efficient production process of active metabolites of ginseng in the scale-up cultivation.</p>
Subject(s)
Biomass , Bioreactors , Classification , Reference Standards , Chromatography, High Pressure Liquid , Ginsenosides , Metabolism , Panax , Genetics , Metabolism , Plant Roots , Genetics , Metabolism , Polysaccharides , Metabolism , Reproducibility of Results , Spectrophotometry, Ultraviolet , Time Factors , Tissue Culture Techniques , MethodsABSTRACT
<p><b>OBJECTIVE</b>To report the operative techniques and clinical results of specially designed sural neurocutaneous vascular flap pedicled on a dominant perforator (the diameter > or = 0.8 mm) of the peroneal artery for coverage of soft tissue defects overlying the Achilles tendon.</p><p><b>METHODS</b>An approximately rectangular sural neurocutaneous vascular flap pedicled on the lowest dominant perforator arising from the peroneal artery was designed and harvested to repair defects over the Achilles tendon. The pedicle was located at a certain part of the flap, which divided the flap into the distal and the proximal parts. After the tendon was repaired, the flap was rotated 180 degrees based on the perforator and the position of the distal and proximal parts of the flap was changed to cover the defects and part of the donor site respectively. In most cases, skin graft was not needed.</p><p><b>RESULTS</b>The modified flaps were applied in 15 cases. All flaps (ranged from 13 cm x 15 cm - 18 cm x 9 cm ) were transplanted successfully without necrosis, and no vascular problems occurred. Following up for 10-17 months showed both satisfactory functional and cosmetic results.</p><p><b>CONCLUSIONS</b>The modified flap has reliable blood supply and the special design provides nearly normal outline of the ankle which favorites shoe wearing. It' s an excellent option for covering defects overlying the Achilles tendon.</p>
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Achilles Tendon , Wounds and Injuries , General Surgery , Arteries , Transplantation , Skin Transplantation , Methods , Sural Nerve , Surgical Flaps , Wound HealingABSTRACT
ObjectiveTo investigate the arsenic level in saliva and its relationship with arsenic in urine and drinking water in endemic arsenism area in Shanyin county of Shanxi province.MethodsSeventy individuals from four villages in endemic arsenicosis area in Shanyin county Shanxi provence were selected as research subjects.“The National Diagnosis Standard for Endemic Arsenism” (WS/T211-2001 ) was used to identify and categorize the cases of arsenicosis during the survey.Urine,saliva samples from all individuals and water samples from their families were collected.Total arsenic in saliva,urine and drinking water samples were detected by inductively coupled plasma mass spectrometry (ICP-MS) and atomic fluorescence spectrometry-230 (AFS-230).ResnltsThe median of arsenic in drinking water samples was 127.22 μg/L,and 66.67% (28/42) of samples' arsenic levels exceeded the drinking water standard,37 individuals had varying degrees of skin lesions among the 70 residents.There was a significant difference of the arsenic concentration in saliva and urine of the residents exposed to different levels of arsenic in drinking water (F =28.643,10.226,all P< 0.05).Arsenic levels were positively correlated significantly (r =0.674,0.686,all P< 0.05) between water and saliva,urinary.Saliva and urinary arsenic levels were highly correlated (r =0.794,P < 0.05).In addition,arsenic in saliva and urine,water arsenic,skin symptoms were closely related, and the levels of arsenic were significantly different statistically between symptomatic group and asymptomatic group (t =- 3.194,- 4.167,- 4.938,all P < 0.01).ConclusionsSalivary arsenic is significantly correlated with water arsenic and also with skin symptoms of patients with arsenic poisoning,which suggests that salivary arsenic is a potential useful biomarker for assessing human exposure to arsenic.
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Objective To investigate the relations between saliva arsenic levels and serum arsenic and urinary arsenic of rats after exposed to different levels of sodium arsenite.Methods Thirty-two SD rats were randomly divided into four groups(8 rats in each group),namely the control group,the low,the medium,and the high doses of sodium arsenite exposure groups.Rats of the control group were given 0.9% NaCI by gavage,and other three groups were given sodium arsenite of 0.2,2.0,20.0 mg/kg body weight by gavage.All animals were administrated every other day for two weeks,then saliva,blood,urine and tissue organs were collected,organ coefficients were calculated,total arsenic concentrations in blood and urine were detected by Atomic Fluorescence Spectrometry(AFS-230) and total arsenic concentration in saliva was detected by Inductively Coupled Plasma Mass Spectrometer(ICP-MS).Results The weight gain values of rats exposed to sodium arsenite were lower than that of the control group,the difference was statistically significant between the highest dose group[(76.13 ± 17.19)g]and the control group[(103.00 ± 12.31)g,P < 0.05].The liver and kidney organ coefficients in the highest dose group [(3.92 ± 0.54)%,(0.96 ± 0.15)%]were significantly higher than that in the control group[(3.27 ± 0.35)%,(0.76 ± 0.05)%,P < 0.05 or < 0.01].The total arsenic concentrations in saliva[(0.044 ± 0.019),(0.211 ± 0.071),(1.128 ± 0.380)mg/L],blood[(11.832 ± 1.887),(45.032 ± 7.216),(121.839 ± 17.323)mg/L]and urine[(0.138 ± 0.085),(0.874 ± 0.328),(8.843 ± 1.754)mg/L]in the three treatment groups were significantly higher compared with that of the control group [(0.018 ± 0.014),(2.267 ± 0.370),(0.025 ± 0.011)mg/L,all P < 0.05],furthermore,there was a significant difference among the three treatment groups (all P < 0.05).The arsenic contents in saliva were significantly correlated with blood arsenic and urinary arsenic,the correlation coefficient was 0.934 and 0.960,respectively (all P < 0.01).Conclusions High dose of arsenic exposure,with a strong toxicity to liver and kidney,can inhibit the increase of rat body weight.Arsenic dose-response relationship exists in the saliva,and saliva arsenic is significantly correlated with blood arsenic and urinary arsenic,suggesting that salivary arsenic can be used as a new biomarker for assessing human exposure to arsenic.
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<p><b>BACKGROUND</b>Patient safety has been gained much more attention in recent years. The authors reviewed patients who had cardiac arrest in the operating rooms undergoing noncardiac surgery between January 1989 and December 2001 at the University of Pittsburgh Medical Center, USA. The main objectives of the study were to determine the incidence of intraoperative cardiac arrest, to identify possible causes of cardiac arrest and to explore amenable modifications.</p><p><b>METHODS</b>With approval by the University of Pittsburgh Institutional Review Board, patients experienced cardiac arrest during surgery were retrieved from medical records, surgical operation and anesthesia records and pathological reports by searching the Medical Archival Retrieval System (MARS), a hospital electronic searching system. Cases of cardiac arrest were collected over a period of thirteen years from the Presbyterian University Hospital (PUH), USA.</p><p><b>RESULTS</b>We found 23 cases of intraoperative cardiac arrests occurred in 218 274 anesthesia cases (1.1 per 10 000). Fourteen patients (60.8%) died in the operating room, leading to a mortality rate from all causes of 0.64 per 10 000 anesthetics. Immediate overall survival rate after arrest was 39% (9/23). Half of the patients (12/23) were emergency cases with 41% survival rate (5/12). One fourth of the arrests were trauma patients (6/23). Most arrest patients (87%, 20/23) were American Society of Anesthesiologists Physical Status (ASA PS) IV and V, while only three patients were ASA PS-I, II and III, respectively. One case was attributable to an anesthesia-related cardiac arrest and recovered after successful resuscitation.</p><p><b>CONCLUSIONS</b>Most intraoperative cardiac arrests were not due to anesthesia-related causes. Anesthesia-related cardiac arrests might have a higher survival rate when compared to other possible causes of cardiac arrest in the operating room.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Anesthesia , Mortality , Heart Arrest , Mortality , Intraoperative Complications , Mortality , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To report the operative techniques and clinical results of modified distally based superficial peroneal neurocutaneous flap for skin defect of the forefoot.</p><p><b>METHODS</b>A reversed superficial peroneal neurocutaneous flap pedicled with the lateral superamalleolar perforating artery or its descending branch, which vascularized the flap through the nutrient vessel chain of the nerve, which linked vascular territories of superamalleolar perforating artery, cutaneous branches of the anterior tibial artery and superficial peroneal artery, was designed to repair skin defects in the forefoot.</p><p><b>RESULTS</b>The modified flaps were applied in 17 cases. All flaps were survived successfully with no complication. The largest size of the flap was 20 cm x 8 cm. The flap could reach as far as the proximal end of the second and third toes or weight-bearing areas under the fifth metatarsal caput.</p><p><b>CONCLUSIONS</b>The modified flap has reliable blood supply with a relatively large size and long rotation arc. It is a simple and safe for covering medium to large defects in the forefoot.</p>
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Foot Injuries , General Surgery , Peroneal Nerve , General Surgery , Skin Transplantation , Methods , Surgical FlapsABSTRACT
Objective: To investigate the effects of secreted protein acidic and rich in cysteine (SPARC) peptide on ultramicrostructure and extracellular matrix secretion of human mesangial cells cultured in vitro. Methods: Human mesangial cells (HMC) were incubated at the presence of SPARC peptide (50 μg/ml)for 48 h and 96 h separately; HMC cultured without SPARC peptide was taken as control. The cell ultramicrostructure was observed by transmission electron microscope. Real-time fluorescent quantitative PCR (RT-PCR) was used to detect mRNA levels of collagen type I (Col I), collagen type IV (Col IV), fibronectin (FN), and laminin (LN) 96 hours after culture, and the results were compared between the 2 groups. The secreted levels of Col I, Col IV, FN, and LN protein were measured and compared by enzyme-linked immunosorbent assay (ELISA) in the 2 groups. Results: There was no obvious change in HMC in the control group. After cultured for 48 hours, a few HMC in experimental group showed initial appearance of apoptosis; after cultured for 96 h, a great number of HMC had a typical apoptotic appearance and there were typical apoptotic bodies under electron microscope. RT-PCR showed that, compared with the control group, the experimental group had significantly decreased levels of Col I, Col IV and FN mRNA (P<0.05, P<0.0l); ELISA results showed that the secretions of Col I, ColIV, and FN protein in the experimental group were greatly lower than those in the control garoup (P<.05, P<0.01). Conclusion: SPARC peptide can effectively induce apoptosis of human mesangial cells and down regulate the secretion of extracellular matrix in vitro.
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<p><b>OBJECTIVE</b>To study the distribution of the dominant perforators (the diameter > or = 0.8 mm) of the peroneal artery with color Doppler flow imaging (CDFI) for the purpose of anatomical preparations for the perforator sural neurocutaneous flap.</p><p><b>METHODS</b>The dominant perforators of the peroneal artery (DPPA) were studied with CDFI on bilateral legs of 20 healthy volunteers. The numbers, diameters and locations of the perforators were recorded for a statistical analysis. From Jan. 2005 to Jan. 2009, 51 free or pedicled sural neurocutaneous flaps supplied by a single DPPA were designed and harvested to repair the defects near the ankle (n=22), at the leg (n=15) and the forefoot or hand dorsum (n=14). The perforators were located preoperatively with CDFI and accuracy of CDFI was evaluated intraoperatively. The causes of false results were analysed to improve examining techniques.</p><p><b>RESULTS</b>The average number of DPPA was 4.2 with the average diameter of (1.13 +/- 0.24) mm (0.80-1.90 mm). They were located in the second to ninth segment of the line from the fibular caput to the tip of lateral malleolus which was equally divided into nine segments. The largest DPPA was (1.43 +/- 0.29) mm (1.00-1.90 mm) in diameter and most of them were located in the third to fifth segment (80.4%). The average diameter of the lowest DPPA was (1.02 +/- 0.16) mm( 0.80-1.30 mm) and they were located between the sixth to ninth segment. The total 169 DPPA as well as the largest ones mostly appeared in the middle third of the leg. All of the 51 flaps were transplanted successfully without necrosis, and no vascular problems occurred. Preoperative CDFI examination had a 93.6% true-positive rate and an 88.0% positive predictive value. What should be demonstrated was that if just considered the cases after Dec. 2007, the true-positive rate was 97%, and the positive predictive value was 93.9%.</p><p><b>CONCLUSIONS</b>According to the distribution characteristics of DPPA, a sural neurocutaneous flap pedicled with one of this relatively large perforator can be designed and harvested to repair skin defects of leg and around ankle, but can not be utilized for that of forefoot. With anastomosis of the perforator, the flap based on the largest DPPA can be used as a free flap to cover defect anywhere. CDFI is reliable in preoperative location of DPPA, which makes the surgical procedures easier.</p>
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Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Leg , Sural Nerve , Surgical Flaps , Tibial Arteries , Diagnostic Imaging , UltrasonographyABSTRACT
This study was aimed to investigate the anti-angiogenesis of IFN-alpha2b in chronic myeloid leukemia (CML) in vitro by using K562 cell line and human umbilical vein endothelial cells (HUVEC). The levels of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in culture supernatant of K562 cells were determined by ELISA; the expressions of VEGF and bFGF mRNA after treating K562 cells with 10(3), 10(2) and 10 U/ml IFN-alpha2b for 24, 36, 48 hours were detected by real-time RT-PCR; the effects of K562 cell culture supernatant and IFN-alpha2b on proliferation, migration and differentiation of HUVEC in vitro were assayed by MTT, Transwell chamber and tubule formation assay respectively. The results showed that the K562 cells expressed and secreted VEGF and bFGF. The culture supernatant of K562 cells significantly promoted the proliferation, migration and tubule formation of HUVEC in vitro in a concentration-dependent manner. After treating K562 cells with IFN-alpha2b 10 U/ml for 24, 36 and 48 hours, the expression levels of VEGF and bFGF mRNA were 1.64+/-0.18, 1.49+/-0.14, 1.31+/-0.05 and 1.53+/-0.10, 1.29+/-0.15, 0.79+/-0.13 respectively (p=0.002), but the expression levels of VEGF and bFGF mRNA were not significantly different along with increasing of IFN-alpha2b concentration. It is concluded that the angiogenesis exists in CML. The K562 cell expresses and secrets VEGF and bFGF, which promotes the proliferation, migration and differentiation of HUVEC. The IFN-alpha2b displays anti-angiogenesis by inhibiting the proliferation, migration and tubule formation in vitro of HUVEC and down regulating the expression of VEGF and bFGF mRNA.
Subject(s)
Humans , Angiogenesis Inhibitors , Pharmacology , Endothelial Cells , Fibroblast Growth Factor 2 , Metabolism , Interferon-alpha , Pharmacology , K562 Cells , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Metabolism , Pathology , Neovascularization, Pathologic , Recombinant Proteins , Umbilical Veins , Cell Biology , Vascular Endothelial Growth Factor A , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To report the operative techniques and clinical results of the free peroneal artery perforator sural neurocutaneous flaps.</p><p><b>METHODS</b>Free sural neurocutaneous flap with a single unit of perforating veins and artery arising from the peroneal artery was designed to repair skin defects of hand or from the ankle to distal end of the foot. After the flap was transposed to the defect, the perforating artery was anastomosed with a branch of a nearby artery, and the small saphenous vein was anastomosed with the cephalic vein or the great saphenous vein to establish the flap's circulation. An alternative way was to anastomose the perforating vessels only. The sural nerve was anastomosed to innervate the flap.</p><p><b>RESULTS</b>From Jan 2005 to Dec 2007, 12 cases were treated with the flaps with no flap necrosis. The size of the flaps ranged from 12 cm x 7 cm to 18 cm x 11 cm. The follow-up period was 7 to 27 months. Both the cosmetic and functional results were satisfactory. Two point discrimination was 7 to approximately 12 mm.</p><p><b>CONCLUSIONS</b>The flap has all the advantages of the free flap, the perforator flap and the neurocutaneous flap. It is easily performed with reliable blood supply. It's a good choice for repairing the skin defects of hands and feet.</p>