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Objective:To screen plasma exosomal protein molecular markers in patients with spinal cord injury (SCI) by applying Label-Free quantification and bioinformatics analysis.Methods:Fifty plasma specimens from the First Affiliated Hospital of Nanjing Medical University (from January 2021 to June 2022) were collected from SCI patients and healthy people, respectively. Plasma exosomes were isolated using ultracentrifugation and identified by transmission electron microscopy, nanoparticle tracking analysis and western blot. Plasma exosomal differentially expressed proteins (DEPs) were analyzed using Label-Free quantitative proteomics, and DEPs were characterized, annotated, and enriched based on Gene Ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) databases. The screened DEPs were validated by western blot and enzyme linked immunosorbent assay (ELISA) using plasma exosomal specimens.Results:According to the spinal cord injury classification of the American Spinal Injury Association, 14 cases were grade A, 19 cases were grade B, 12 cases were grade C, and 5 cases were grade D. Plasma exosomes of SCI patients and control groups showed typical cup-like morphology, with diameters mainly ranging from 30-200 nm. A total of 493 exosomal proteins were identified by Label-Free quantification, and 126 proteins were screened for differential expression, of which 38 were up-regulated and 88 were down-regulated. GO annotation revealed that DEPs were mainly involved in functions such as protein activation cascade, complement activation and immune response. KEGG pathway analysis revealed that DEPs were involved in biological pathways such as complement and coagulation cascade reactions, proteasome and neurodegenerative disease pathways. Two candidate proteins, APOB and S100A9, were initially screened based on quantitative results from proteomics and bioinformatics analyses. Western blot results showed that the relative expression of S100A9 protein in plasma exosomes of 30 SCI patients (1.62±0.19) was elevated compared with that of 30 control groups (0.86±0.24), and the difference was statistically significant ( t=8.55, P<0.001), while the relative expression of APOB protein (1.06±0.13 and 1.02±0.23) were not statistically significant ( t=0.46, P=0.653). The results of ELISA analysis showed that the expression of S100A9 in plasma exosomes of patients with different degrees of SCI (grade A 197.7±11.7 pg/ml, grade B 151.7±15.2 pg/ml, grade C 136.3±14.7 pg/ml) had statistical significance ( F=69.94, P<0.001), the higher the severity of SCI, the higher the expression of S100A9 in plasma exosomes (A vs. B, q=13.11, P<0.001; A vs. C, q=15.66, P<0.001; B vs. C, q=4.19, P=0.005). Conclusion:S100A9 is a potentially valid plasma exosomal molecular marker for assessing the severity of SCI.
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Objective:To study the clinical features of the "migration birds" population in Hainan Province in winter presenting with acute cholecystitis.Methods:Patients who were diagnosed to suffer from acute cholecystitis in the winter months from November to February of the following year of 2017, 2018 and 2019 and admitted in Hainan Hospital of Chinese PLA General Hospital were included in this study. The "migration birds" patients who arrived in Hainan Province in less than 30 days were defined as the short-term group ( n=49), 30-89 days as the mid-term group ( n=24), more than 90 days as the long-term group ( n=48). The general information, associated medical diseases, clinical presentations, interventional strategies and in-hospital outcomes were compared, and further analyze the clinical characteristics of patients with purulent cholecystitis and non-purulent cholecystitis in the short-term group. Results:Of 120 patients, there were 49 patients in the short-term group (29 males and 20 females with an average age of 65.18±15.02 years), 24 patients in the mid-term group (13 males and 11 females with an average age of 66.21±11.93 years), and 48 patients in the long-term group (30 males and 18 females with an average of 60.73±12.54 years). The general information, interventional strategies and in-hospital outcomes were similar among the three groups. When compared with patients in the long-term group, patients in the short-term group had higher incidences of hypertension [20.83% (10/48) vs 48.98% (24/49)] and diabetes [10.42% (5/48) vs 30.61% (15/49)]. The gallbladder wall in the short-term group was significantly thicker than that in the long-term group [0.60(0.40, 0.70) cm vs 0.50(0.30, 0.60) cm, P<0.017]. The proportion of purulent cholecystitis in the short-term group was significantly higher than that in the long-term group [48.15% (13/27) vs 17.24% (5/29) , P<0.017] . In the short-term group, the incidences of silt-like stones of purulent cholecystitis [38.46% (5/13) vs 14.29% (2/14)], gallbladder perforation [30.77% (4/13) vs 0], gallbladder gangrene [53.85% (7/13) vs 7.14% (1/14)], perigallbladder effusion [76.92% (10/13) vs 14.29% (2/14)], abdominal effusion [46.15% (6/13) vs 7.14% (1/14)] were significantly higher than that of patients with non-purulent cholecystitis, (all P<0.05). Conclusion:Patients presenting with acute cholecystitis after arrival in Hainan in the short term had more severe inflammation with complications of suppuration, perforation and gangrene. Patients with hypertension and diabetes were the high risk group of patients presenting with acute cholecystitis after short-term arrival in Hainan.
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OBJECTIVE：To e stablish and compare HPLC fingerprints of green Forsythia suspensa and grown F. suspensa ，and to conduct cluster analysis and principle component analysis. METHODS ：HPLC method was adopted. The determination was performed on Hypersil C 18 column with mobile phase consisted of acetonitrile- 0.1％ formic acid （gradient elution ）. The detection wavelength was 235 nm and column temperature was 25 ℃ with the flow rate of 1.0 mL/min. The sample size was 10 μL. HPLC fingerprints of 8 batches of green F. suspensa （Q1-Q8）and 6 batches of grown F. suspensa （L1-L6）were drawn ，with phillyrin as reference；the similarity evaluation was conducted by using Similarity Evaluation System of TCM Chromatographic Fingerprint （2012 edition），and common peak was confirmed. Cluster analysis and principal component analysis were carried out with SPSS 23.0 software. RESULTS ：There were 19 common peaks for green F. suspensa and grown F. suspensa ，among which 6 peaks were identified，i.e. forsythoside A ，rutin，pinoresinol-β-D-glucoside，phillyrin，quercetin and phillygenin ；the similarities of HPLC fingerprints from green F. suspensa and grown F. suspensa were 0.351-0.767；results of cluster analysis showed that green F. suspensa and grown F. suspensa were classified into 4 categories，among which L 1-L6 were clustered into one category ，Q1 was clustered into one category ，Q2-Q6 were clustered into one category ；Q7-Q8 were clustered into one category. The results of principal component analysis showed that the cumulative variance contribution rate of the first three principal components was 83.14％， L1-L6 distribution was close ，Q2-Q6 distribution was close ，Q7-Q8 distribution was close ，and Q 1 distribution was independent ， which was consistent with the results of cluster analysis. CONCLUSIONS ：There were significant differences in the common peaks of fingerprint of green F. suspensa and grown F. suspensa of similarity eraluation ，cluster analysis and principle component analysis，the established HPLC fingerprint can be used for comprehensive evaluation and quality comparison of green F. suspensa and grown F. suspensa .
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In the present experimental study, cecal ligation and puncture significantly increased the myocardial injury assessed in terms of excess release of creative kinase-MB (CK-MB), cardiac troponin I (cTnI), interleukin (IL)-6 and decrease of IL-10 in the blood following 12 h of laparotomy procedure as compared to normal control. Also, a significant increase in protein expression levels of high-mobility group box 1 (HMGB1) and decreased phosphorylation of glycogen synthase kinase-3β (GSK-3β) was observed in the myocardial tissue as compared to normal control. A single independent administration of telmisartan (2 and 4 mg/kg) and AR-A014418 (1 and 2 mg/kg) substantially reduced sepsis-induced myocardial injury in terms of decrease levels of CK-MB, cTnI and IL-6, HMGB1, GSK-3β and increase in IL-10 and p-GSK-3β in the blood in sepsis- subjected rats. The effects of telmisartan at dose 4 mg/kg and AR-A014418 at a dose of 2 mg/kg were significantly higher than the telmisartan at a dose of 2 mg/kg and AR-A014418 1 mg/kg respectively. Further, no significant effects on different parameters were observed in the sham control group in comparison to normal. Therefore it is plausible to suggest that sepsis may increase the levels of angiotensin II to trigger GSK-3β-dependent signaling to activate the HMGB1/receptors for advanced glycation end products, which may promote inflammation and myocardial injury in sepsis-subjected rats.
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Objective:To compair the outcomes of repairing soft tissue defects of hand between a biodegrad- able repair patch—porcine small intestinal submucosa (SIS) and skin grafting.Methods:From December, 2017 to December, 2018, 36 cases of hand soft tissue defect were treated and analyzed retrospectively. According to the defect area and treatment methods, 36 cases were divided into 2 groups: SIS group (21 cases) and grafting group(15 cases). In SIS group, the area of soft tissue defects was 2.0 cm×1.5 cm-9.0 cm×3.5 cm with an average of 5.3 cm×2.1 cm, treat- ed with SIS; In grafting group, the area of soft tissue defects was 9.0 cm×4.0 cm-16.0 cm×9.0 cm with an average of 12.0 cm×8.5 cm, treated with autologous skin grafting after wet dressing. Wound healing was evaluated at 14, 21 and 28 days, and 3 months after the surgery according to the appearance of colour, elasticity, sensory recovery and prog- noses of partial tendon exposure.Results:All patients were followed-up for 3 to 10 months, with an average of 5 months. All wounds in both groups were completely healed; the appearance was normal, and the skin elasticity and sensation had recovered. Sensation recovery in SIS group: 14 cases were good (66.6%), 5 cases were fine (23.8%), and 2 cases were bad (9.6%); in grafting group: 9 cases were good (60.0%), 4 cases were fine (26.0%), and 2 cases were bad (14.0% ). Wound healing effect in SIS group: 14 cases were good, 5 cases were fine, and 2 cases were bad; in grafting group: 9 cases were good, 4 cases were fine, and 2 cases were bad.Conclusion:The SIS patch can be used in the reconstruction of soft tissue defects in hand. There was no significant difference in colour compared to the sur- rounding skin and left no scar. The patch is an ideal repair material for superficial skin defects.
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In the present experimental study, cecal ligation and puncture significantly increased the myocardial injury assessed in terms of excess release of creative kinase-MB (CK-MB), cardiac troponin I (cTnI), interleukin (IL)-6 and decrease of IL-10 in the blood following 12 h of laparotomy procedure as compared to normal control. Also, a significant increase in protein expression levels of high-mobility group box 1 (HMGB1) and decreased phosphorylation of glycogen synthase kinase-3β (GSK-3β) was observed in the myocardial tissue as compared to normal control. A single independent administration of telmisartan (2 and 4 mg/kg) and AR-A014418 (1 and 2 mg/kg) substantially reduced sepsis-induced myocardial injury in terms of decrease levels of CK-MB, cTnI and IL-6, HMGB1, GSK-3β and increase in IL-10 and p-GSK-3β in the blood in sepsis- subjected rats. The effects of telmisartan at dose 4 mg/kg and AR-A014418 at a dose of 2 mg/kg were significantly higher than the telmisartan at a dose of 2 mg/kg and AR-A014418 1 mg/kg respectively. Further, no significant effects on different parameters were observed in the sham control group in comparison to normal. Therefore it is plausible to suggest that sepsis may increase the levels of angiotensin II to trigger GSK-3β-dependent signaling to activate the HMGB1/receptors for advanced glycation end products, which may promote inflammation and myocardial injury in sepsis-subjected rats.
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OBJECTIVE： To provide reference for strengthening the construction of retail pharmacy pharmacists and ensure safe and rational use of drugs. METHODS： A simple random sampling method was used to determine 18 cities （counties） in Guizhou province as survey sites to visits all retail drugstores one by one. According to the Pharmacist Pharmaceutical Care Competency Evaluation Standard（Trail） issued by the Chinese Pharmacists Association， questionnaire survey and face-to-face interviews were conducted with licensed pharmacists in Guizhou province’s retail pharmacies， and multiple linear regressions were conducted on the factors affecting the pharmacy’s pharmaceutical care competency. RESULTS： A total of 943 retail pharmacies in Guizhou province were visited， and 270 licensed pharmacists were investigated. The total self-assessment score of pharmaceutical care competence was （79.62±11.23）， with 11.5％ of undergraduate education and above， and 53.0％ of pharmacy related majors. Among self-assessment score of pharmaceutical care competency， score of basic knowledge item such as foreign language knowledge， statistical knowledge and computer knowledge was the lowest， followed by clinical thinking ability and drug treatment evaluation ability. The results of multiple linear regression showed that age had significant influence on the scores of basic skills and professional knowledge. The influence of academic qualifications on personal accomplishment， basic knowledge， basic skills， professional knowledge and professional skills score was statistically significant； the influence of professional and technical positions on total score， personal accomplishment， basic skills and professional skills score was statistically significant （P＜0.05）. CONCLUSIONS： The overall educational level of licensed pharmacists in Guizhou retail pharmacies is low and their professional level is limited. It is suggested that the supervision of licensed pharmacists should be strengthened and the access conditions of licensed pharmacists should be improved； the education and training of professional competency of licensed pharmacists in pharmaceutical care should be strengthened， the functional orientation of licensed pharmacists in retail pharmacies should be clarified， and public safety and rational drug use should be effectively guaranteed.
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Objective To investigate the feasibility and technique of using the anterolateral thigh perforator flap pedicled with the lateral branch of the lateral circumflex femoral artery (LBLCFA) to repair soft tissue defect of extremities.Methods Eighty-six cases of anterolateral thigh perforator flap transplantation were performed from May,2014 to May,2018.A total of 37 cases of soft tissue defect of extremities were treated by anterolateral thigh perforator flap used the LBLCFA as vascular pedicle,of which there were 19 cases of upper limbs and 18 of lower limbs.There were 27 cases of defects caused by trauma,and 10 by soft tissue tumor resection.The flaps were designed centering around the point proximal to the midpoint of the iliac-patellar line.The dimensions of soft tissue defect were from 9.0 cm×6.0 cm to 26.0 cm×10.0 cm,and the flap were from 10.0 cm×7.0 cm to 27.0 cm×11.0 cm.The length of vascular pedicle ranged of 7.0-13.0 cm,with an average of 11.5 cm.The donor sites were directly sutured.All of the patients were followed-up regularly in the outpatient department.Results All the flaps survived and the donor sites were primarily healed.Of these 37 cases,2 trauma patients and 2 patients treated with local radiotherapy had poor wound healing,but still healed after multiple dressing changes.All the patients were followed-up for 3-26 months,with an average of 13 months.The texture,color and elasticity of the flap were similar to the surrounding tissue of the recipient sites,while only a linear scar remained at the donor sites.Ten tumor patients were treated with routine radiotherapy and chemotherapy after the repairation;there was no tumor recurrence during the follow-up period.Conclusion The LBLCFA gives off a relatively large and thick perforator proximal 5.0-7.0 cm of the iliacpatellar line,which locates in the upper lateral side,travels parallel to the vastus lateralis,and give off the skin and muscular perforators.The lateral branch can be used as pedicle to make into perforator flap or chimeric flap,which provides a novel selection of vascular pedicel for anterolateral thigh perforator flap.When the descending branch does not provide a thick and large perforator,the LBLCFA has important practical value and is worth utilizing in the clinic.
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<p><b>OBJECTIVE</b>To compared the efficacy of laparoscopy- assisted radiofrequency ablation (LRFA) and percutaneous radiofrequency ablation (PRFA) for the treatment of hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Between September, 2013 and September, 2016, a total of 60 HCC patients with 78 tumor nodules underwent LRFA (30 cases with 46 tumor nodules) and PRFA (30 cases with 32 tumor nodules) in our hospital. The patients were followed up for 3 years to compare the complete ablation rate, serious complications, recurrence rate and long-term survival rate between the two groups.</p><p><b>RESULTS</b>The patients receiving LRFA had a complete ablation rate of 95.65% (44/46), significantly higher than the rate of 93.75% (30/32) in PRFA group ( > 0.05). Significant differences were found between LRFA and PRFA groups in the incidence of serious complications [0 6.7% (2/30), < 0.05] and recurrence rate [13.33% (4/30) 23.33% (7/30), < 0.05]. The 1-and 3-year overall survival rates of the patients were 96.15% and 55.12% in LRFA group and 93.73% and 48.54% in PRFA group, respectively ( > 0.05).</p><p><b>CONCLUSIONS</b>Both LRFA and PRFA are effective for HCC treatment, but is associated with a lower recurrence rate, fewer serious complications, a better treatment safety and a better applicability for tumor in difficult locations.</p>
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Objective To study the surgical treatment of hepatic hemangiomas and the timing of surgery.Methods A retrospective study was conducted on 908 patients with giant hemangiomas who underwent surgery between December 1997 and December 2017.The clinical data,surgical indications,surgical outcomes,lesion size,and the effect of TAE were compared.Results The diameter (mean + /-S.D.)of the resected hepatic cavernous hemangiomas was (11.1 ± 6.2) cm (the longest diameter was 60 cm).585 patients (64.4％) underwent enucleation of hepatic hemangiomas and 323 patients (35.6％) underwent anatomical hepatectomy.Six patients died perioperatively (mortality rate 0.7％).The incidence of severe complication (Clavien-Dindo grade 3 ～ 5) was 3.8％.The incidence of severe postoperative complication for enucleation (2.7％) was significantly less than anatomic liver resection (5.6％,P ＜0.05).When the lesion was more than 20 cm,the complication and mortality rates were significantly higher than those less than 20 cm (P ＜ 0.05).The complication and mortality rates in patients who underwent TAE before surgery were significantly higher than those without TAE (P ＜ 0.05).Conclusions Surgical enucleation of hemangiomas was superior to anatomical hepatectomy.With increase in tumor size,the risk of surgery increased.Surgical treatment was safe and effective for giant hepatic hemangiomas.For giant hepatic hemangiomas with significant increase in size,prompt surgical treatment is recommended.
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Objective:To compare the clinical effect of anterior and posterior resection,bone grafting and internal fixation on the spinal tuberculosis.Methods:82 cases of patients with spinal tuberculosis in our hospital from February 2014 to August 2015 were selected and randomly divided into the control group and the observation group with 41 cases in each group.Both groups received conventional anti tuberculosis treament and underwent debridement bone graft and internal fixation treatment,the control group underwent anterior internal fixation,while the observation group underwent posterior internal fixation.The operation time,intraoperative blood loss,low back pain relief time,ambulation time and hospitalization time were compared between two groups.All patients were followed up for 6 months,the Frankel grade and serum Thl7 cell related factors levels were compared between two groups before and after operation.Results:The low back pain relief time,ambulation time and hospitalization time of observation group were significantly shorter than those of the control group(P＜0.01).After operation,the Frankel classification grade A and B ratio of observation group were significantly higher than those of the control group (P＜0.05),the serum IL-10,IL-17,IL-23 and TGF-beta 1 levels were significantly lower than those of the control group (P＜0.01).Conclusion:Anterior resection combined with posterior bone graft inFixation could effectively promote the rehabilitation of spinal tuberculosis,reduce the severity of spinal injury,relieve the inflammatory response and promote the recovery of immune function.
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Objective To investigate the protective effect of aloe polysaccharide on experimental colitis mucosal. Methods The TNBS-induced experimental rat colitis model was successfully established and were treated by aloe polysaccharide, and enteric-coated tablets with sulfasalazine (SASP). Results DAI score, gross morphology score , histopathologic score and MPO in the model group were significantly higher than that in the normal group (P < 0.01), while those indicators were significantly lower after treatment (P < 0.01), IL-12 and IFN-γ mRNA and protein expressions in the model group were significantly higher than that in the normal group (P < 0.01), and IL-12 and IFN-γ expression levels in treatment group were significantly lower than that in the model group (P < 0.01), IL-4 and IL-13 mRNA and protein expression levels in the model group were significantly lower than that in the normal group (P < 0.01), and IL-4 and IL-13 expression in treatment group was significantly higher than that in the model group (P < 0.01). Conclusion Aloe polysaccharide on experimental colitis in rats has a good protective effect , of which mechanism may be reduced by IFN-γ and IL-12 levels, increased IL-4, IL-13 levels, and correct the imbalance of Thl/Th2.
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OBJECTIVE: To explore the effectiveness percutaneous monoaxial screw combined with polyaxial pedical screw for treating thoracolumbar fracture by comparing with simple polyaxial pedicle screw fixation. METHODS: Between January 2012 and June 2014, 56 cases of thoracolumbar fractures were treated by percutaneous pedicle screw fixation, the clinical data were retrospectively analyzed. Of 56 cases, 30 were treated with percutaneous monoaxial screw combined with percutaneous polyaxial pedical screw fixation (group A), 26 patients with only percutaneous polyaxial pedicle screw fixation (group B). There was no significant difference in gender, age, body mass index, injury causes, time from injury to admission, involved segments, fracture type, and preoperative American Spinal Injury Association (ASIA) stage, visual analogue scale (VAS), the anterior height of the injured vertebrae, Cobb angle, and sagittal index between 2 groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the 2 groups. The VAS score was used to evaluate the improvement of the pain. The sagittal kyphosis Cobb angle, the anterior height of the injured vertebrae, sagittal index, and the average correction (difference between 3 days after oeration and preoperation) and loss degrees (difference between last follow-up and 3 days after operation) were measured on the X-ray films at preoperation, 3 days after operation, and last follow-up. RESULTS: Incision healing at stage I was obtained, no related complications occurred. The operation time and intraoperative blood loss showed no significant difference between 2 groups (P>0.05). The patients were followed up 20-42 months (mean, 32 months) in group A and 21-44 months (mean, 30 months) in group B. VAS score of group A was significantly lower than that of group B at 3 days after operation (t=-2.277, P=0.027), but no significant difference was found at last follow-up (t=-0.289, P=0.774). X-ray examination showed good position of internal fixation, with no broken nails or exit of nail. There were significant differences in the anterior height of the injured vertebrae, Cobb angle, and sagittal index between at preoperation and at 3 days and last follow-up, and between at 3 days and last follow-up in 2 groups (P0.05). CONCLUSIONS: Percutaneous monoaxial screw combined with polyaxial pedicle screw fixation is better than simply polyaxial pedicle screw in effects of treating thoracolumbar fracture under the premise of strictly holding indications.
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The clinical data of 91 patients with axillary cystic/solid mass receiving ultrasound-guided mass puncture in Hangzhou Red Cross Hospital and Hangzhou Third Hospital from March 2010 to October 2015 were retrospectively analyzed.The biopsy cytology examination and routain bacteria culture of puncture fluid were applied in 44 cases ( control group); while X-pert examination of puncture fluid was performed in addition to biopsy cytology examination and routain bacteria culture in 47 cases ( study group) . The histopathological examination of surgical specimens were used as gold standard.The overall diagnostic accuracy rates of study and control groups were 93.6% (44/47) and 68.2% (30/44), respectively(P=0.002) .The diagnostic accuracy rates for tuberculous abscess in study and control groups were 100.0%(28/28)and 57.7%(15/26), respectively (P=0.000).However, there were no significant differences in diagnosis of other diseases, including metastatic carcinoma, abscess other than tuberculous and lymphatic hygroma between two groups.The study shows that diagnostic accuracy of multiple examination methods of puncture fluid for axillary cystic/solid mass is high and has clinical application value.
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Contrast-enhanced ultrasound images of tuberculous diaphragmatic muscle abscess of 26 surgically confirmed patients were retrospectively analyzed.The coincidence rate of preoperative diagnosis was 77％.The contrast-enhanced ultrasound images could be divided into three types of homogeneous,uneven and non-enhancement.Contrast-enhanced ultrasonography could decipher the blood supply characteristics and the different extents of tuberculous diaphragmatic muscle abscess.Thus it has important diagnostic values in the diagnosis of tuberculous diaphragmatic muscle abscess.
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BACKGROUND:Pathological mechanism of femoral head necrosis is not fuly known, and high-dose corticosteroids are prone to induce femoral head necrosis. OBJECTIVE:To investigate the clinical effect of bone marrow mesenchymal stem cels combined with theaflavin on steroid-induced avascular necrosis of femoral head in rats. METHODS: Rat bone marrow mesenchymal stem cels were isolated and culturedin vitro and compounded onto gelatin sponge, and then, divided into four groups: model group, decompression group, cel transplantation group and combined group. Models of steroid-induced avascular necrosis of femoral head were established using liquid nitrogen method. In the combined group, gelatin sponge carrying bone marrow mesenchymal stem cels was transplanted and 250 mg theaflavin was given daily after modeling. RESULTS AND CONCLUSION:At 4 weeks after modeling, the femoral head samples in the four groups were round with exfoliation of articular cartilage that was pale in color. Then, the exfoliation of articular cartilage was aggravated in the model group, and some specimens appeared to colapse; the femoral head specimens in the combined group were round and pale. Until the 8th week after modeling, bone necrosis was increased in the model group; osteoblasts were found in the decompression group with fibrous calus formation; a few of empty bone lacunae appeared with irregular medulary cavity in the cel transplantation group; a large amount of new bone tissues formed in the combined group, and intramedulary adiocytes were in regular array. At 4 and 8 weeks after modeling, the number of empty bone lacunae was significantly lower in the combined group than the other groups (P < 0.05). These findings indicate that bone marrow mesenchymal stem cels combined with theaflavin is an ideal therapy for steroid-induced avascular necrosis of femoral head.
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Objective To investigate the etiologic effect of the lumbar facet joint morphology on the occurrence of degener?ative lumbar spondylolisthesis (DLS). Methods From January 2007 to July 2013, 115 patients with DLS treated in our hospi?tal were randomly selected. There were 28 males and 87 females with an average age of 57.3 years (range, 41-76 years). 115 age? and sex? matched people including 31 males and 84 females with an average age of 56.4 years (range, 45-77 years) free from DLS and back or leg pain were selected randomly as control group from a group coming for routine physical examination in our hospital. Both groups received lumbar anteroposterior and lateral X?ray films、CT scanning and multiplanar reformation, the degree of spondylolisthesis (Taillard index) was measured in DLS group on lateral radiographs; at L3,4 and L4,5 level of both groups the facet joint angles on CT scan images were measured and facet tropism was evaluated, the pedicle?facet angle (the P?F angle) was measured in the sagittal plane on multiplanar reformation CT images, and then all angles of corresponding level were compared and analyzed; L4,5 facet joint degeneration in both groups was evaluated and compared in bone window, the de?gree of spondylolisthesis (Taillard index) in DLS group at different degenerative grade of facet joints were analyzed. The corre?lation between L4,5 facet joint angle、P?F angle and degrees of spondylolisthesis were analyzed. Results All L4,5 spondylolisthe?sis in DLS group were grade I, the facet joint angles were more sagittal in DLS group than those in the control group at L 3,4 and L4,5 levels, and the P?F angles were more horizontal in DLS group compared with control group;the facet tropism in DLS group at L 4,5 level were significantly different as compared to the control group, but there was no significant difference at L 3,4 level between the two groups. Significant difference was found in L4,5 facet joint degeneration grade between two groups,but there was no significant difference in degree of spondylolisthesis during different degeneration grades in DLS group. There was no significant correlation between the facet joint angle and the P?F angle and degree of spondylolisthesis at L4,5 level in DLS group. Conclusion The facet joint morphology abnormality (smaller facet joint angle, horizontal P?F angle, the facet tropism) has an important etiologic meaning in the occurrence of degenerative lumbar spondylolisthesis, however its role cannot be excessively exaggerated. The facet joint de?generation is a secondary change with aging,while the development of DLS aggravates the degeneration.
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<p><b>OBJECTIVE</b>To investigate the clinical features, diagnostic and therapeutic methods of primary hepatic neuroendocrine carcinoma.</p><p><b>METHODS</b>The clinicopathological data of fourteen patients with primary hepatic neuroendocrine carcinoma confirmed by pathology were analyzed retrospectively and related literatures were reviewed.</p><p><b>RESULTS</b>The fourteen patients, including eight males and six females, had an age range of 23-58 years (mean 45.9 years). Four tumors were located in the right liver lobe, four in the left liver lobe and six in both. The clinical manifestations were nonspecific and variable. The most common clinical manifestation was abdominal distention or right upper quadrant pain. Radiological findings were not specific and could not distinguish primary hepatic neuroendocrine tumor from hepatocellular carcinoma. Diagnosis of primary hepatic neuroendocrine tumor was confirmed by pathology using immunohistochemical staining and by the absence of extrahepatic primary lesions. Extrahepatic primary neuroendocrine carcinoma was ruled out by ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT), preoperative gastrointestinal endoscopy and long-term postoperative follow up. Three patients received surgical treatment, two cases received surgical resection and radiofrequency ablation (RFA), six patients received transarterial chemoembolization, one case received orthotopic liver transplantation, one case only received exploratory laparotomy, and one case received chemotherapy. All 14 patients were followed up and seven of them are still alive, the others died of liver failure or recurrence.</p><p><b>CONCLUSIONS</b>Primary hepatic neuroendocrine carcinomas are extremely rare. Its diagnosis should be confirmed by pathology. Preoperative fine needle biopsy is strongly recommended. Prognosis is relatively favorable. Surgical resection is treatment of first choice, and TACE, RFA, and chemotherapy can be used for unresectable patients.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Biopsy, Fine-Needle , Carcinoma, Hepatocellular , Pathology , Therapeutics , Carcinoma, Neuroendocrine , Pathology , Therapeutics , Catheter Ablation , Chemoembolization, Therapeutic , Hepatectomy , Liver , Pathology , Liver Neoplasms , Pathology , Therapeutics , Magnetic Resonance Imaging , Positron-Emission Tomography , Prognosis , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Objective To investigate the value of contrast-enhanced ultrasonography (CEUS) in the diagnosis of tuberculous mesenteric lymphadenitis by analyzing its enhancement pattern. Methods The conventional ultrasound and contrast-enhanced ultrasound images of 62 patients with tuberculous mesenteric lymphadenitis confirmed by needle core biopsy or surgery were retrospectively analyzed. The location, size, shape, internal echo and posterior enhancement of mesenteric lymph nodes were recorded. All cases were divided into two groups:the maximum diameter of the lymph node≤20 mm and the maximum diameter of the lymph node >20 mm, and the patterns of enhancement in two groups were analyzed. Results The conventional ultrasound of 62 cases with tuberculous mesenteric lymph nodes showed enlargement. And the echogenicity was hypoechoic or heterogeneity, containing punctate or clusters of calcification in 19 cases (30.6%). After CEUS, there were three forms of enhancements:rim enhancement in 29 cases (46.8%);inhomogeneous enhancement in 21cases (33.9%);non-enhancement in 12 cases (19.3%). Rim enhancement was more common in the≤20 mm group, while inhomogeneous enhancement was more common in the lymph nodes>20 mm. There was statistically significant difference of the enhancement type between the≤20 mm group and the>20 mm group (χ2=6.782, P=0.034). Conclusions Most of tuberculous mesenteric lymph nodes showed rim and inhomogeneous enhancement in CEUS, and the sizes of mesenteric lymph node tuberculosis influenced the CEUS enhancement patterns. CEUS may provide useful information for the diagnosis of the tuberculous mesenteric lymph node.
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Objective To study the risk factors of delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD).Methods Between Ja(n)uary 1st 2013 and December 31st 2013,data from 196 consecutive patients who underwent PD at the Chinese PLA General Hospital were studied retrospectively.17 factors were examined.Univariate analysis and multivariate logistic regression analysis were used to determine the relative risks.Results DGE occurred in 71 patients (36.2％).The incidences of grade A,grade B and grade C DGE were 22.4％ (44/196),6.1％ (12/196) and 7.7％ (15/196) respectively.There were three postoperative deaths.The overall mortality rate was 1.5％.BMI,Braun anastomosis,clinically relevant postoperative pancreatic fistula (CR-POPF) and intra-abdominal collection were significantly correlated with DGE on univariate analyses.BMI ≥25 kg/m2,CR-POPF,and intra-abdominal collection were independent risk factors on univariate and multivariate regression analyses.Conclusions Post-operative complications were associated with DGE.Early diagnosis and timely treatment for pancreatic fistula and abdominal collection were helpful to decrease morbidity and to promote recovery of DGE.