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Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.
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OBJECTIVE@#To compare the performance of Clear Cell Likelihood Score (ccLS) v1.0 and v2.0 in diagnosing clear cell renal cell carcinoma (ccRCC) from small renal masses (SRM).@*METHODS@#We retrospectively analyzed the clinical data and MR images of patients with pathologically confirmed solid SRM from the First Medical Center of the Chinese PLA General Hospital between January 1, 2018, and December 31, 2021, and from Beijing Friendship Hospital of Capital Medical University and Peking University First Hospital between January 1, 2019 and May 17, 2021. Six abdominal radiologists were trained for use of the ccLS algorithm and scored independently using ccLS v1.0 and ccLS v2.0. Random- effects logistic regression modeling was used to generate plot receiver operating characteristic curves (ROC) to evaluate the diagnostic performance of ccLS v1.0 and ccLS v2.0 for ccRCC, and the area under curve (AUC) of these two scoring systems were compared using the DeLong's test. Weighted Kappa test was used to evaluate the interobserver agreement of the ccLS score, and differences in the weighted Kappa coefficients was compared using the Gwet consistency coefficient.@*RESULTS@#In total, 691 patients (491 males, 200 females; mean age, 54 ± 12 years) with 700 renal masses were included in this study. The pooled accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ccLS v1.0 for diagnosing ccRCC were 77.1%, 76.8%, 77.7%, 90.2%, and 55.7%, as compared with 80.9%, 79.3%, 85.1%, 93.4%, 60.6% with ccLS v2.0, respectively. The AUC of ccLS v2.0 was significantly higher than that of ccLS v1.0 for diagnosis of ccRCC (0.897 vs 0.859; P < 0.01). The interobserver agreement did not differ significantly between ccLS v1.0 and ccLS v2.0 (0.56 vs 0.60; P > 0.05).@*CONCLUSION@#ccLS v2.0 has better performance for diagnosing ccRCC than ccLS v1.0 and can be considered for use to assist radiologists with their routine diagnostic tasks.
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Female , Male , Humans , Adult , Middle Aged , Aged , Carcinoma, Renal Cell/diagnosis , Retrospective Studies , Kidney , Carcinoma , Kidney Neoplasms/diagnosisABSTRACT
OBJECTIVE To analyze the patents of new target oral drugs for type 2 diabetes mellitus （T2DM）， and to provide references for the research and development direction and patent layout of new domestic diabetes drugs. METHODS Based on global patent data in the HimmPat database， from multiple perspectives such as the number of patent applications and authorization， development trend， regional distribution and main applicants， statistics and analysis were performed for the patents related to 3 types of new target oral drugs for T2DM， such as glucokinase activator （GKA）， protein tyrosine phosphatase 1B inhibitor （PTP-1B-IN）， and 11β-hydroxysteroid dehydrogenase 1 inhibitor （11β-HSD1-IN）. RESULTS & CONCLUSIONS A total of 1 649 patents of GKA， 709 patents of PTP-1B-IN， 592 patents of 11β-HSD1-IN were obtained， the main applicants were well-known pharmaceutical companies， which possessed the core patents of pharmaceutical compounds. The research on GKA drugs was more mature， with a larger number of patent applications and a more comprehensive enterprise layout. Domestic enterprises， universities and research institutions had advantages in the field of PTP-1B-IN. Domestic enterprises and research institutions can leverage the advantages of traditional Chinese medicine and resources to enhance their research capabilities and improve technological competitiveness through core technology exploration， the exploration of process route， patent layout， industry- university-research cooperation and the establishment of patent pool.
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Objective:To evaluate the efficacy of pecto-intercostal fascial block (PIFB)-pectoral nerve block type Ⅱ (PECS Ⅱ block)-general anesthesia for modified radical mastectomy.Methods:Forty-six patients, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, aged 40-65 yr, scheduled for elective modified radical mastectomy, were divided into 2 groups ( n=23 each) using a random number table method: PECS Ⅱ block-general anesthesia group (group P+ G) and PIFB-PECS Ⅱ block-general anesthesia group (group P+ P+ G). The patients received ultrasound-guided PECS Ⅱ block (P+ G group) or PIFB combined with PECS Ⅱ block (P+ P+ G group) in the pre-anesthesia room. Then the patients were admitted to the operating room, and midazolam, propofol, sufentanil and cisatracurium were used for anesthesia induction, and sevoflurane, remifentanil and cisatracurium were used for anesthesia maintenance. The intraoperative consumption of remifentanil, emergence time and extubation time were recorded. Flurbiprofen axetil 50 mg was intravenously injected as rescue analgesic after operation, and visual analog scale score was maintained ≤3 at rest. The requirement for rescue analgesia and occurrence of nausea and vomiting within 24 h after operation were recorded. Results:Compared with group P+ G, the intraoperative consumption of remifentanil was significantly decreased, the emergence time and extubation time were shortened, the rate of rescue analgesia within 24 h after operation was decreased, the time of first rescue analgesia was prolonged ( P<0.05), and no significant change was found in the incidence of nausea and vomiting in group P+ P+ G ( P>0.05). Conclusions:Compared with PECS Ⅱ block-general anesthesia, PIFB-PECS Ⅱ block-general anesthesia can reduce the amount of intraoperative opioids, inhibit postoperative hyperalgesia and promote early postoperative recovery when used for modified radical mastectomy.
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Objective:To evaluate the optimization efficacy of pressure-volume (P-V) curve-based individualized lung-protective ventilation strategy combined with pressure-controlled ventilation-volume guaranteed (PCV-VG) mode (LPVS+ PCV-VG) for one-lung ventilation (OLV) in elderly patients undergoing radical resection of lung cancer.Methods:Seventy American Society of Anesthesiologists Physical Status classificationⅡ-Ⅲ patients, aged 65-74 yr, with body mass index of 18-24 kg/m 2, undergoing elective thoracoscopic radical resection of lung cancer, were divided into 2 groups ( n=35 each) using a random number table method: PCV-VG group and LPVS+ PCV-VG group. Blood samples were collected from the radial artery for blood gas analysis before induction of general anesthesia (T 0), at 5 min of two lung ventilation after endotracheal intubation (T 1), at 30 min of OLV (T 2), at the end of OLV (T 3), and at 5 min of two lung ventilation in supine position (T 4). Ppeak, mean airway pressure (Pmean) and dynamic lung compliance (Cdyn) were recorded. The use of antibiotics, lung-related complications and rehabilitation were recorded within 7 days after operation. Results:Compared with PCV-VG group, PaO 2, PaCO 2 and Cdyn were significantly increased at T 2-4, Ppeak was decreased at T 2, 3, Pmean was increased at T 3, the requirement for antibiotics within 7 days after operation was decreased, the incidence of 1 grade lung-related complications was decreased, and the thoracic drainage tube indwelling time and length of hospital stay were shortened in LPVS+ PCV-VG group ( P<0.05). Conclusions:Individualized LPVS based on P-V curve combined with PCV-VG mode provides better efficacy for OLV in elderly patients undergoing radical resection of lung cancer.
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Objective:To assess the performance of liver and spleen stiffness measured by MR elastography (MRE) and their combined model in diagnosing liver fibrosis.Methods:From November 2018 to November 2019, 104 patients with chronic liver disease were prospectively enrolled in Beijing Friendship Hospital, all patients underwent MRE scans. Liver and spleen stiffness were measured from MRE elastograms. Liver biopsy was used to identify fibrosis stage (F0—F4). The differences among different fibrosis stages were analyzed by one-way ANOVA or independent samples t test. The Spearman rank correlation analysis was used to evaluate the correlation with fibrosis stages. Liver and spleen stiffness combined model was established by logistic regression. The ROC curve was used to evaluate the performance of the liver, spleen stiffness and combined model in staging fibrosis (≥F1), significant fibrosis (≥F2), advanced fibrosis (≥F3), and cirrhosis (F4).The area under the ROC curve(AUC) was compared using Delong test. Results:The liver and spleen stiffness both showed significant differences among the 5 fibrosis stages ( F=64.058, 32.890, both P<0.001). The liver and spleen stiffness were positively associated with fibrosis stage ( r s=0.89, 0.69, both P<0.001). The AUC of liver stiffness in staging ≥F1, ≥F2, ≥F3 were 0. 91, 0.97, 0.93, respectively. The corresponding AUCs of the spleen stiffness were 0.81, 0.82, 0.85, respectively, which were statistically lower than those of liver stiffness ( Z=2.283, 4.085, 2.314, P=0.022,<0.001, 0.021). In diagnosing F4, the AUCs of liver and spleen stiffness were both 0.95. The AUCs of the liver and spleen combined model were 0.92, 0.97, 0.93, 0.96 in diagnosing ≥F1, ≥F2, ≥F3 and F4, with no significantly differences from liver stiffness (all P>0.05). Conclusions:The liver stiffness measured with MRE have better diagnostic performance than spleen stiffness in staging fibrosis. Parameters combined model slightly improves diagnostic value but without significant difference with liver stiffness in staging early fibrosis. Spleen stiffness evaluation is feasible in detecting cirrhosis.
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Objective:To investigate the characteristics of macular perfusion and structures in patients with early stages of diabetic retinopathy (DR) using optical coherence tomography angiography (OCTA).Methods:A cross-sectional study was performed.Forty eyes of 27 diabetic patients without diabetic retinopathy (NDR), forty eyes of 24 patients with mild non-proliferative diabetic retinopathy (NPDR) and forty eyes of 28 patients with moderate NPDR were recruited in Guangdong Provincial People's Hospital from June 2017 to August 2018.RTVue-XR OCTA was used to scan a 6 mm×6 mm area centered in the fovea and the superficial vascular complex (SVC) and deep vascular complex (DVC) vessel density, fovea avascular zone (FAZ) area, FAZ perimeter, acircularity index (AI), and vessel density of a 300 μm wide ring area around FAZ (FD300) were quantified.The associations among stages of DR and macular vessel density, structures were analyzed.This study was approved by the Ethics Committee of the Guangdong Provincial People's Hospital (No.2016232A).Results:The vessel density of SVC and DVC tended to decrease as the progression of DR.The vessel density of SVC was (51.25±3.27)%, (48.81±3.99)%, (47.00±3.49)%, (45.73±3.35)%, and the vessel density of DVC was (53.89±6.30)%, (49.94±6.05)%, (46.69±4.87)% and (44.78±4.30)% in the control group, NDR group, mild NPDR group, and moderate NPDR group, respectively.The vessel densities of SVC and DVC were statistically different among the four groups ( F=18.33, 21.53; both at P<0.01). The vessel density of SVC and DVC in the NDR group, mild NPDR group, moderate NPDR group was significantly lower than that in the control group (all at P<0.01). The vessel densities of FD300 in the mild NPDR group and moderate NPDR group were significantly lower than that in the control group (all at P<0.01). The FAZ area of the control group, NDR group, mild NPDR group, and moderate NPDR group was (0.31±0.11), (0.32±0.09), (0.34±0.13), and (0.37±0.10)mm 2, respectively.There was no significant difference in the FAZ area among the four groups ( F=2.18, P=0.09). The FAZ perimeter and AI were significantly higher in the moderate NPDR group than those in the control group (both at P<0.05). Conclusions:OCTA is able to detect the decrease of vessel density in diabetic patients before the occurrence of visible fundus lesions.The vessel density of SVC and DVC in patients with early stages of DR is decreased.DVC vessel density may be a sensitive marker to indicate DR.FD300 is not significantly decreased until mild NPDR, FAZ area and perimeter are significantly increased in moderate NPDR, indicating a more irregular FAZ.
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Diabetic macular edema is the leading cause of central vision loss and even blindness in diabetic retinopathy.Compared to FFA,OCT can obtain the high-resolution 3D image quickly,easily to reflect the details of the tissue and realize the quantitative measurement.As a novel technology,OCT angiography (OCTA) can display microvascular structure from different layers of retina and choroid,having its advantage of quantifying the vessel density and the lesion area.By detecting fundus morphology,quantifying and quantitating the retinal vessels and vessel density,the combination of OCT and OCTA could play a guiding role in diagnosis,classification,treatment and prognosis of diabetic macular edema.
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Objective To observe the changes of blood flow density in the macular area of normal eyes,and to analyze its correlation with age.Methods A cross-sectional study.Two hundred and fifty normal healthy subjects (125 males and 125 females,aged 44.76± 14.77) in routine ophthalmologic examination at the Department of Ophtalmology of Guangdong Provincial People's Hospital during June 2017 to June 2018 were enrolled.Among them,20 to 29,30 to 39,40 to 49,50 to 59,and ≥ 60 years old were 50 subjects (50 eyes) in each.BCVA,slit lamp microscope,indirect ophthalmoscope,OCT angiography (OCTA) examinations were conducted for all eyes.The subjects were examined by both eyes,and the data of 1 eye was selected by EXCEL to generate random numbers,including 126 right eyes and 124 left eyes.The range of 6 mm × 6 mm in the macular area was scanned using a frequency domain OCTA instrument.The software automatically divides it into three concentric circles centered on the macular fovea,which were foveal area with a diameter of 1 mm,parafoveal area of 1 to 3 mm,and foveal peripheral area of 3 to 6 mm.The blood flow density of superficial capillary vessel,deep capillary vessel and foveal avascular area (FAZ) within a 300 μm width (FD-300),FAZ area,perimeter (PERIM),non-circularity index,center retinal thickness (CRT) were measured.The relationship between the blood flow density in macula,CRT,FAZ and age was analyzed by Pearson correlation analysis.Results The mean blood flow density of superficial capillary vessel and deep capillary vessel were (51.61 ± 2.54)％ and (54.04± 5.46)％,respectively.The average FD-300,CRT,PERIM and non-circularity index were (285.55 ± 12.13) μm,(2.150 ± 0.367) mm,1.10 ± 0.04,respectively.The relevance of the results showed that the age was negatively correlated with the blood flow density of whole area (r=-0.335,-0.279;P＜0.01),parafoveal area (r=-0.255,-0.368;P＜0.01),foveal peripheral area (r=-0.330,-0.269;P＜0.01) in superficial capillary vessel and deep capillary vessel as well as FD-300 (r=-0.311,P＜0.01),but not correlated with the blood flow density of foveal area (r=-0.071,-0.118;P=0.264,0.064).There was no relationship between the age and the FAZ area,PERIM,non-circularity index (r=-0.070,-0.055,0.074;P=-0.267,0.385,0.142).The age was negatively correlated with the average CRT (r=-0.217,P＜0.01),but not correlated with the CRT in foveal area (r=0.115,P=0.068).The CRT was positively correlated with the blood flow density of superficial capillary vessel and deep capillary vessel in foveal area (r=0.715,0.653;P＜0.01),but negatively correlated with the FAZ area (r=-0.669,P＜0.01).Conclusion The capillary blood flow density ofmacular area in the normal eyes decreases with age.
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Objective To investigate the clinical efficacy and safety of Apatinib in treating the advanced esophageal cancer and their prognosis in elderly patients.Methods Totally 52 elderly patients with advanced esophageal cancer who met the inclusion and exclusion criteria at our hospital from March 2015 to August 2017 were retrospectively enrolled.They were treated with Apatinib.The clinical efficacy,adverse reactions and influencing factors for the prognosis were analyzed.Results The partial remission rate(PRR) was 25.0％ and the disease control rate(DCR)was 71.2％ in 52 patients.The main adverse reactions were hypertension,hand-foot syndrome and proteinuria,with the incidence of 50.0％,38.5％ and 36.5％,respectively.The degree of adverse reactions was mainly grade 1 ～ 2.The median progression-free survival(PFS)was 3.8 months,and the median overall survival(OS)was 7.0 months.Univariate analysis (log-rank test) indicated that the degree of adverse reactions(x2 =5.075,P =0.024) and the Eastern Cooperative Oncology Group (ECOG) score (x2 =7.550,P =0.006)were associated with OS in elderly patients with advanced esophageal cancer.Cox multivariate regression analysis showed that the degree of adverse reactions(HR =1.963,P =0.045)and ECOG score(HR =0.458,P =0.015)were the independent influencing factors for OS in elderly patients with advanced esophageal cancer.Conclusions Due to mild adverse reactions and a high safety,Apatinib still has a certain clinical efficacy in the treatment of elderly patients with advanced esophageal cancer.Moreover,patients with the low ECOG score and high degree of adverse reactions have better prognosis.
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Objective To investigate the correlation between the severity of alcoholic fatty liver disease and the amount of fat in the abdominal cavity and the serum inflammatory factor IL-18 and IL-8. Methods From October 2016 to October 2017,one hundred and twenty patients with AFLD in the First Hospital of Hebei Medical University were divided into light,medium,heavy groups according to the severity of fatty lesions by color Doppler Ultrasound. There were 40 mild patients,50 moderate patients and 30 severe patients. Forty healthy subjects were selected as controls. All the participants underwent CT scanning. The intra-abdominal fat area (VAT),abdominal subcutaneous fat area (SAT) and total abdominal fat area (TA) were measured. The liver function was measured by biochemical analyzer and enzyme-linked immunoassay (ELISA). (ELSIA) IL-18 was detected and IL-8 was detected by radioimmunoassay. Results The VAT of the healthy control group and the mild,medium and severe AFLD group were (70. 28±10. 19),(114. 38 ± 9. 97),(146. 73±10. 19),(163. 38±12. 69) cm2. The TA of the healthy control group and the mild, medium and severe AFLD group were ( 256. 72± 34. 56),( 332. 19 ± 33. 28),( 387. 49± 32. 28),( 478. 19 ±31. 02) cm2. The SAT of the healthy control group and the light,medium and severe AFLD group were (156. 23±28. 19),(203. 43±27. 12),(246. 19±26. 89),(271. 19 ±27. 94) cm2,respectively. Aspartate aminotransferase (AST) of the healthy control group and the mild,medium and severe AFLD group were (18. 50±1. 12),(23. 50±1. 21),(25. 50±1. 24),(29. 50± 1. 43) U/L. Alanine aminotransferase (ALT) of the healthy control group and the light, medium and severe AFLD group were ( 18. 50 ± 2. 14), ( 26. 50 ±2. 22),(35. 50±2. 34),(38. 50±2. 11) U/L. γ-glutamyltransferaseof the healthy control group and the light,medium and severe AFLD group were ( 16. 50 ± 2. 11), ( 32. 50 ± 2. 23), ( 47. 50 ± 2. 31), ( 48. 00 ±2. 43) U/L,respectively. Compared with the healthy control group,VAT,TA,SAT,AST,ALT andγ-GT in the light,medium and heavy AFLD group showed statistically significant differences ( P＜0. 05) . Compared with the mild AFLD group, VAT, TA, SAT, AST, ALT and γ-GT in the medium and heavy AFLD group showed statistically significant differences ( P＜0. 05) . Compared with the moderate AFLD group,the VAT, TA,SAT, AST, ALT, and γ-GT of the severe AFLD group showed statistically significant differences ( P＜0. 05). The data of the three AFLD groups showed that the concentration of all indicators were increasing as the severity of fat deepened. IL-18 of the healthy control group and the light,medium and severe AFLD group were (45. 67±4. 51),(52. 18±5. 09),(59. 87±4. 98),(64. 18±5. 12) ng/L; IL-8 of the healthy control group and the light, medium and severe AFLD group were ( 78. 92 ± 5. 07), ( 115. 62 ± 4. 89), ( 223. 76 ± 6. 78),(286. 42±7. 02) g/L. Compared with every group,IL-18 and IL-8 of light,medium and severe AFLD group showed statistically significant differences (F＝1035. 67,2. 93×105,P＜0. 001); compared with mild AFLD group,IL-18 and IL-8 of medium and heavy group showed statistically significant differences;compared with moderate AFLD group,IL-18 and IL-8 of severe group AFLD showed statistically significant differences ( P＜0. 001) . The levels of inflammatory factors IL-18 and IL-8 increased with the severity of steatosis. The severity of AFLD was significantly positively correlated with VAT,TA,SAT,IL-18 and IL-8 ( r 0. 415(P＜0. 001), 0. 435 ( P＜0. 001), 0. 512 ( P＜0. 001), 0. 274 ( P＜0. 001 ), 0. 689 ( P ＜0. 001). Conclusion Fat control is an important measure to prevent AFLD. IL-18 and IL-8 can reflect the severity of liver injury in AFLD and have important significance in judging prognosis.
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Objective To evaluate the effect of multi?plate reconstruction plate in the treatment of partial complex tarsometatarsal joint injury injuries. Methods Seven patients treated complex tarsometatarsal joint injuries with multi?plate reconstruction plate in Nanjing Hospital Affiliated to Nanjing Medical University from September 2014 to July 2016 were selected in this study. According to Myerson classification,3 cases were A type,3 cases were B type,1 case was C type. The therapeutic effects were observed. Results The patients were followed up for 6-12 months,with an average of (8. 6±2. 0) months. According to the foot scoring criteria in American Orthopedic Foot and Ankle Society ( AOFAS) ,the function of the foot was evaluated,3 cases were in excellent condition,4 cases were in good condition. Conclusion In the case of multiple metatarsal fractures of the metatarsal base involved in the joint surface, the use of multiple reconstructive plates for joint fixation reduces the iatrogenic damage of the joint surface. The fixation effect and the functional recovery are satisfactory
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Objective To explore the effects of airway peak pressure (Ppeak)guidance on the minimum laryngeal mask airway (LMA)intracuff pressure (ICP)setting during general anesthesia. Methods Sixty patients,aged 18-65 years,ASA physical status Ⅰ or Ⅱ,scheduled for elective gy-necological laparoscopic operation under general anesthesia were enrolled.The patients were randomly divided into pressure-regulated group (group P)and control group (group C)with 30 cases in each group.Size 4 Supreme LMA was inserted in after general anesthesia induction.Air was injected into the cuff to make ICP achieve 60 cm H2O.Volume-controlled ventilation was selected and Ppeak was recorded.In group P,all the gas in the LMA cuff was sucked out,and then air was injected in during expiration phase to make ICP achieve the level of Ppeak.If air leakage occurred,ICP was increased by 5 cm H2O each time until no gas leaked from the oropharynx.After pneumoperitoneum,the cuff was inflated to make ICP achieve 60 cm H2O and Ppeak was recorded once more.Then all the gas in the LMA cuff was sucked out,and air was injected into the cuff to make ICP achieve the level of Ppeak as the above method till the end of operation.In group C,ICP was maintained at 60 cm H2O.Ppeak, ICP and the intracuff gas volume were recorded before and after pneumoperitoneum.ICP during in-spiratory phase in the two groups was measured.Tidal volume during inspiration(Vti)and expiration (Vte)in the two groups were recorded,and the air leakage fraction (LF)was calculated as [(Vti-Vte)/Vti×100%].Laryngopharyngeal complications of all the patients in 24 hours after surgeries were also recorded.Results The intracuff gas volume before and after pneumoperitoneum and ICP were decreased significantly in group P compared with group C (P<0.05).There was no difference in LF between the two groups.Compared with group C,there were fewer patients with postoperative throat pain and swallow discomfort in group P (P<0.05).Conclusion ICP at the level of Ppeak plus 0-5 cm H2O during LMA ventilation can provide better sealing effect and less laryngopharyngeal com-plications.
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Objective:To observe the process and curative effect of 12 cases of recurrent patellar dislocation treated by double bundle medial patellofemoral ligament (MPFL)reconstruction with anterior half peroneus longus and lateral retinacular release,and to investigate the etiology and treatment method of recurrent patellar dislocation. Methods:A total of 12 patients with recurrent patellar dislocation were enrolled in this study,the MPFL was reconstructed with the anterior half peroneus longus,patellar fixation with suture anchors was completed with 2 parallel 5.0 mm anchors which were spaced 1.0 cm apart at the anatomic insertion site of the native MPFL,the femoral side was secured with a interference screw,and the lateral retinaculum was released at the same time.The Lysholm score,IKDC score,congruence angle,J sign,grind test,and apprehension test of the patients before and after operation were detected.Results:The mean follow-up period was 16.4 months,and the Lysholm score of the patients before operation was lower than the last follow-up (t = 9.03,P < 0.001);the IKDC score of the patients before operation was lower than the last follow-up (t = 9.75,P < 0.001);the congruence angle of the patients before operation was larger than after operation (t = 7.22,P <0.001).All of the patients demonstrated the positive results before operation in J sign,grind test,and apprehension test,and the negative results in J sign, grind test,and apprehension test after operation.No patient appeared pateela fracture and recurrence of patellar dislocation during the follow-up period.Conclusion:The curative effect of reconstruction of the MPFL with anterior half peroneus longus combined with lateral retinacular release is well in the treatment of recurrent patellar dislocation,which is suitable for clinical promotion.
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Objective To observe the safety and clinic effect of umbilical blood stem cell transplantation for the patients with chronic liver failure (CLF).Methods 44 patients with CLF were included in the research and divided into two groups,22 in control group received internal medicine treatment,the other 22 in treatment group received umbilical blood stem cell transplantation in addition to internal medicine treatment.The biochemical index,MELD scores,clinical symptoms,survival situation and adverse reaction of the patients were observed within 2,4,12 and 24 weeks.Results Albumin and prothrombin activity of treatment group were higher than those of control group,the MELD scores of the treatment group was lower than that of control group,the survival rate was higher than the control group,and the difference is significant between the two groups (P ＜ 0.05).There was no significant difference between the two groups in terms of alanine aminotransferase and total bilirubin (P ＞ 0.05).After 4 weeks treatment,fatigue,inappetite,abdominal distention and ascitic fluid of the treatment group were better than that of control group,the difference was statistically significant (P ＜ 0.05).Besides,the patients of the both groups did not have any adverse reaction or hepatocellular carcinoma.Conclusion Umbilical blood stem cell transplantation is safe and effective for the patients with CLF and can improve the survival rate of the patients.
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Objective:To explore the application value of multislice spiral CT scanning on abdomen for the detection of complication of acute pancreatitis.Methods: 120 patients with acute pancreatitis were divided into observation group (70 cases) and control group (50 cases) according to different detection method. The patients of control group were applied basic clinical detections included X-ray radiography and ultrasound imaging, while patients of observation group were supplemented CT detection besides these detections of control group. And situation of complication of patients in two groups were observed.Results: The positive rate of complications, which involved pancreatic pseudocyst, cellulitis, complications of gastrointestinal tract, pancreas hemorrhage and pancreatic ascites, in observation group was 97.14%, that was significant higher than that (62.0%) of control group (x2=24.74,P<0.05). Among 20 patients with pancreatic pseudocysts, there were 9 patients located at tails of pancreases, 6 patients located in bodies of pancreases, 3 patients located in small omental bursas, 2 patients located at heads of pancreases, and the CT images of them showed quasi-circular liquid form density lesions with clear boundaries appeared in lesion field. The CT images of cellulitis showed the volume of pancreas increased and the boundaries were fuzzy, and a larger range of density lesions with irregular soft tissue shape appeared in its periphery. CT detetions of gastrointestinal complications showed fuzzy point-shaped, strip-shaped and flake-shaped soft tissue-styled density shadow appeared in gastrointestinal tracts. The CT image of pancreatic ascites showed intraperitoneal fluid density shadow.Conclusion: Abdominal CT scan applied on patients with acute pancreatitis can increase the positive rate of complications and may be used as preferred detection method for clinical evaluation on the complications of acute pancreatitis.
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Objective To investigate the clinical efficacy of umbilical blood stem cell transplantation (UCBSCT) on the treatment of hepatitis B liver cirrhosis. Methods Forty-eight patients with hepatitis B liver cirrhosis were enrolled and divided into the treatment group and the control group. There were 25 patients in the treatment group , who received UCBSCT treatment based on conventional liver protection treatment and 23 patients in the control group , who received conventional liver protection treatment. The changes of liver function , coagulation function, clinical symptoms, signs and side effects were studied before the treatment and at 2, 4, 12 and 24 weeks post-treatment. Results The levels of albumin, cholinesterase, and prothrombin activity in the treatment group were higher than those before treatment and were higher than those in the control group. The parameters in the control group were not significantly changed before and after the treatment (P > 0.05). The levels of alanine aminotransferase,aspartate aminotransferase,total bilirubin in both two groups were not significantly changed before and after the treatment (P > 0.05). After 4-week treatment,the differences on improvement of appetite , lacking in strength , abdominal distension , ascites were statistically significant in the treatment group compared with the control group (P < 0.05). No adverse reactions were observed in all groups. Conclusion UCBSCT on the treatment of hepatitis B liver cirrhosis is safe and reliable.
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<p><b>OBJECTIVE</b>To investigate the role of p38MAPK and PI3K/AKT pathways in mitomycin (MMC)-induced apoptosis in the liver stem-like cell line WB-F344.</p><p><b>METHODS</b>WB-F344 cells were exposed to MMC and apoptosis was evaluated by flow cytometry and DNA fragmentation. Phospho-MAPK and phospho-PI3K/AKT were detected by western blotting.</p><p><b>RESULTS</b>MMC induced apoptosis in WB-F344 cells at 6h after addition of MMC; the maximum level of apoptosis was reached at 24h after MMC exposure. The apoptosis effects of MMC were concentration dependent and inhibited when the PI3K pathway was abolished by the specific inhibitor LY294002, but not inhibited when the p38MAPK pathway was abolished by inhibitor SB203508.</p><p><b>CONCLUSION</b>Apoptosis of WB-F344 cells can be induced by MMC.Although MMC can activate both the PI3K/AKT and p38MAPK pathways, the apoptosis effect of MMC occurs via a PI3K pathway and is not dependent on the p38MAPK pathway.</p>
Subject(s)
Animals , Rats , Apoptosis , Blotting, Western , Cell Line , Chromones , Flow Cytometry , Mitomycin , Morpholines , Phosphatidylinositol 3-Kinases , Proto-Oncogene Proteins c-akt , Signal Transduction , p38 Mitogen-Activated Protein KinasesABSTRACT
PurposeTo investigate the role of diffusion weighted imaging (DWI) in the detection of focal liver lesions (FLL).Materials and Methods T2WI, dynamic contrast enhancement (DCE) and DWI (b=100 s/mm2 and 600 s/mm2 respectively) were performed in 205 patients with 310 FLLs. All images were read by two reviewers to determine the detection of FLLs and score the confidence. The consistency of the results given by the two reviewers was evaluated. The confidence scores between different sequences and the detection rate of different sequences were also compared.Results The consistency of the two reviewers was excellent or good in T2WI, high b value DWI, low b value DWI, and DCE (Kappa=0.71, 0.85, 0.82 and 0.64,P0.05), but higher than T2WI (P<0.01). The combination of DWI and DCE detected more small malignant lesions than DWI or DCE alone (P<0.01).Conclusion DWI can detect more FLLs than T2WI, and can help DCE detect small malignant FLLs. Therefore DWI is suggested to be included in the routine protocol of liver MRI examination.
ABSTRACT
Objective To study the effect of simvastatin (SIM) on the expression of neuron specific enoalse (NSE) in rat brain and serum after traumatic brain injury (TBI), and therapeutic effects of SIM on TBI thereof. Methods A total of 90 Sprague-Dwalye (SD) rats aged 8 weeks were randomly divided into sham TBI group, control group and treatment group (n=30). The TBI model was established in control group and treatment group by using Feeney method. Rats in treatment group were fed SIM 10 mg/kg in the evening pre-injury and in every evening post-injury while those in control group were fed the same dose of starch at the same time. Blood samples (3 mL) were collected from carotid atrery in three groups, then rats were sacrificed and brains were collected at different time points (3 h, 12 h, 24 h, 3 d, 7 d and 14 d post-injury). The serum ex-pressions of NSE were detected by ELISA method. The NSE expressions in hippocampal area CA3 were detected with immu-nohistochemistry. Results (1) In control group, the serum NSE level was significantly increased at 3 h after injury, reached the peak at 3 d, and was still higher than that of sham injury group at 14 d. In treatment group, the serum NSE level was in-creased 3 h after injury, reached the peak at 24 h, decreased after 3 d, and was near the sham injury group at 14 d after inju-ry, but was significantly lower than that of control group. (2) Immunohistochemical detection showed that the NSE optical density values in hippocampal area CA3 area were decreased at 3 h after injury in control group. The optical density values reached the lowest level between 3 d to 7 d and were still significantly lower than those of sham injury group at 14 d. In treat-ment group the optical density value was decreased at 3 h after injury, reached the lowest level between 12 h to 24 h and re-bounded significantly at 7 d, then at 14 d up to the level of sham injury group. Conclusion SIM can promote the decrease of serum NSE level in TBI rats and increase the NSE expression of hippocampal neurons of injured side, showing protective effects on neuronal damage after traumatic brain injury.