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Objective To investigate the effects and possible mechanism of electret and 5-fluorouracil(5-FU)on the growth of scar fibroblasts. Methods The effect of +5000 V electret combined with different concentrations of 5-FU on the proliferation of scar fibroblasts was detected by automatic enzyme labeling instrument. The apoptosis of scar fibroblasts and the mRNA expression of p53 and other apoptotic genes were studied by fluorescence microscopy and RT-PCR technology under the action of electrostatic field. Results ① After the treatment of positive electret and different concentrations of 5-FU for 72 h, the cell proliferation rate decreased, and the inhibition rate of scar cells in the +5000 V electret+160 μg/ml 5-FU group was (0.15±0.051)%. ②+5000 V electret group could promote the apoptosis of scar fibroblasts; The number of apoptotic cells in +5000 V electret and 5-FU group was higher than that in 5-FU group. ③The mRNA expression levels of four apoptotic genes in the +5000 V electret group were increased, and the expression levels of four signature genes in the +5000 V electret and 5-FU group were increased compared with those in the 5-FU group. Conclusion The combination of positive electret and 5-FU had a synergistic effect on inhibiting cell growth. The mechanism of positive electret inhibiting scar cell growth may be through promoting the expression of apoptosis gene, and then affecting the growth state of cells to inhibit cell growth.
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Objective To enhance the standardization of surgical operations,shorten the learning curve,and reduce surgical complications by summarizing common errors and proposing solutions for beginners during pre-study of cavity construction in non-inflatable axillary approach laparoscopic thyroid surgery.Methods A retrospective analysis was made on 210 patients who underwent noninflatable axillary approach luminal thyroid surgery at the Department of Head and Neck Surgery,Zhejiang Provincial People's Hospital,between January 2022 and June 2023.Among them,150 patients were luminalized by the practitioners in the practice group,while 60 patients were luminalized by the practitioners in the skilled group.The occurrence of nine common errors during cavity construction,such as supraclavicular nerve injury and scapulohumeral muscle injury,was assessed and compared between the two groups.Results There was no statistically significant difference in age,gender,tumor diameter,tumor location or pathology type between the two groups(P>0.05).The staff in the practice group had a significant difference in supraclavicular cutaneous nerve injury(19.33%vs.3.33%),scapulohumeral muscle injury or disarticulation(16.00%vs.0),anterior cervical band of free excess(24.00%vs.3.33%),pectoralis major muscle and supraclavicular fascia injury(16.00%vs.5.00%),external jugular vein and genuine branch injury(8.00%vs.0),excessive freeing of the sternoclavicular joint(7.33%vs.0),and incorrect entry of the sternocleidomastoid muscle gap(8.67%vs.0)were significantly higher in incidence than the employees in the skilled group(P<0.05).There was no statistically significant difference between employees in the practice group and those in the skilled group in terms of injury to the internal jugular vein and its geniculate branches(4.00%vs.0),and incorrect entry of the anterior cervical strap muscles into the hierarchy(2.00%vs.0)(P>0.05).Conclusion The incidence of damage to the surrounding tissue was significantly higher in the novice group than in the expert group during endoscopic thyroid surgery for space construction.A solid anatomical foundation and proficient endoscopic surgical technique serve as fundamental prerequisites for achieving a successful space system construction.By summarizing common challenges and providing corresponding solutions encountered during endoscopic thyroid surgery,this study further enhances and refines the learning system for total endoscopic thyroid procedures.
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The payment methods,such as Diagnosis Related Group(DRG)for hospitalization and capitation for outpatient treat-ment,have achieved positive results in protecting the rights and interests of insured persons and improving the efficiency of the use of medical insurance funds.However,for patients with chronic diseases and rehabilitation nursing,the hospitalization period is long and the conditions complicated,and the payment method of DRGs is not reasonable.It analyzes the experiences of paying for long-term hospital cases in the US.and Germany from the aspect of reform process,payment method and regulatory measures.In order to pro-vide references for the reform of per-diem payment in rehabilitation nursing and other long-term hospitalized cases,it puts forward suggestions from aspects of realizing value care,reflecting individual differences,exploring complex payment methods,improving data quality and establishing constraint mechanism.
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Soft tissue defects resulting from head and neck tumor resection seriously impact the physical appearance and psychological well-being of patients. The complex curvature of the human head and neck poses a formidable challenge for maxillofacial surgeons to achieve precise aesthetic and functional restoration after surgery. To this end, a normal head and neck volunteer was selected as the subject of investigation. Employing Gaussian curvature analysis, combined with mechanical constraints and principal curvature analysis methods of soft tissue clinical treatment, a precise developable/non-developable area partition map of the head and neck surface was obtained, and a non-developable surface was constructed. Subsequently, a digital design method was proposed for the repair of head and neck soft tissue defects, and an in vitro simulated surgery experiment was conducted. Clinical verification was performed on a patient with tonsil tumor, and the results demonstrated that digital technology-designed flaps improved the accuracy and aesthetic outcome of head and neck soft tissue defect repair surgery. This study validates the feasibility of digital precision repair technology for soft tissue defects after head and neck tumor resection, which effectively assists surgeons in achieving precise flap transplantation reconstruction and improves patients' postoperative satisfaction.
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Humanos , Procedimientos de Cirugía Plástica , Colgajos Quirúrgicos/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Cabeza/cirugía , Cuello/cirugíaRESUMEN
Objective:To investigate the effectiveness, safety, and advantages of modified radical neck dissection by gasless unilateral axillary approach (GUA-MRND) in the surgical management of selected patients with papillary thyroid cancer.Methods:We retrospectively analyzed patients with papillary thyroid cancer who underwent GUA-MRND (endoscopic group, n=16) versus unilateral open modified radical neck dissection (MRND) (open group, n=32) during the period from Jan. 2019 to Jun. 2021, including the differences in surgical efficiency, complication rate, and incisional satisfaction.Results:Compared MRND with GUA-MRND, the patients were younger ( P<0.05) , operative time and postoperative drainage anterior ( P<0.01) were slightly inferior in the latter, but it had obvious advantages in cervical swallowing discomfort and incision satisfaction evaluation ( P<0.05) . There was no significant difference in the incidence of temporary recurrent laryngeal nerve injury, intraoperative and postoperative bleeding, hematoma, infection, lymphatic or chylous leakage and supraclavicular numbness after surgery ( P>0.05) . The number of dissected lymph nodes in area II in the GUA-MRND was lower ( P<0.05) , but it was significantly higher ( P<0.01) in area III. And the average regional cleaning efficiency in the GUA-MRND was level Ⅲ (35.5%) , level Ⅵ (28.59%) , level Ⅳ (23.21%) , level Ⅱ (7.18%) and level Ⅴ (7.12%) , suggested that GUA-MRND had higher efficacy for level III, level Ⅵ and Level IV. Conclusion:GUA-MRND is safe, effective, and has high cosmetic satisfaction in the treatment of selected patients with lateral cervical lymph node metastases from papillary thyroid cancer.
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Objective:In order to cope with the rising risk pressure on the economic operation of public hospitals,it aims to re-search and construct a comprehensive economic operation evaluation index,and improve the comprehensiveness,scientific and dynamic nature of monitoring and analysis of the economic operation of public hospitals.Methods:Literature research,expert consultation and hierarchical analysis were adopted.Results:A comprehensive evaluation model of public hospitals'economic operation covering 5 dimensions and 25 indexes,including structural optimization,controllable risk,efficiency enhancement,smooth operation and sustain-able development,has been constructed;empirical analyses of the overall index,sub-indexes and monthly indexes have been carried out on the data of some of the tertiary hospitals in Shanghai,which have verified the validity of the above index model in enhancing the monitoring,analysis and evaluation of the hospitals'economic operation,and revealed the role of the above index model in the changes of the economic conditions of the hospitals and the factors.Conclusion:Constructing a comprehensive evaluation index can effectively complement management such as comprehensive assessment and evaluation of public hospitals and traditional financial descriptive analysis.
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Objective:To summarize the prognosis of medullary thyroid carcinoma (MTC) patients with biochemical recurrence (the increase of postoperative calcitonin and no abnormal imaging) and to investigate the optimal cut-off value of calcitonin for postoperative structural recurrence (with imaging abnormality).Methods:Literature retrieval was conducted for PubMed, CNKI, EMbase, Web of Science, Cochrane and other databases, and literatures related to the increase of calcitonin after MTC surgery were included. Review Manager 5.4 software was used for Meta-analysis of the recurrence and death. SPSS 23.0 software was used and receiving operating characteristic (ROC) curve was used to analyze the rising folds of postoperative calcitonin level in comparison with the maximum value of experiment detection, and to predict the outcome of biochemical recurrence transforming to structural recurrence, and then the optimal cut-off value could be worked out.Results:A total of 7 studies including 1 005 MTC patients (276 cases of biochemical recurrence and 542 cases of biochemical cure). Meta-analysis showed that structural recurrence rate in postoperative biochemical recurrence group [40.6% (112/276) vs. 2.2% (12/542); OR = 27.99, 95% CI 14.57-53.78, P < 0.001] and mortality [10.0% (19/190) vs. 0.96% (3/312); OR = 7.26, 95% CI 2.42-21.84, P < 0.001] were higher than those in the biochemical cure group (normal postoperative calcitonin level and no disease state). The data of 89 MTC patients with biochemical recurrence were collected in another 4 studies. ROC curve analysis showed that area under the curve of the rising folds of postoperative calcitonin level in predicting structural recurrence was 0.825; according to the cut-off value at all sections, the optimal cut-off value of the increased postoperative calcitonin was 50 times, the sensitivity was 66. 7%, the specificity was 88.6%. Conclusions:MTC patients with postoperative biochemical recurrence have higher structural recurrence rate and mortality compared with patients with normal postoperative calcitonin. The postoperative elevation of calcitonin more than 50 times the maximum value of the laboratory detection can be taken as the critical diagnostic value, when more than 50 times is prone to structural recurrence.
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Objective:To investigate the feasibility and safety of endoscopic thyroidectomy by gasless unilateral axillary approach.Methods:A matching study was conducted to analyze 21 patients with etgua of Zhejiang Provincial People’s Hospital from Mar. 2019 to Sep. 2021, including 8 cases of bilateral radical thyroidectomy and 13 cases of unilateral radical thyroidectomy + contralateral lobectomy (benign) . At the same time, 23 patients who underwent conventional thyroidectomy were matched as controls, including 8 cases of bilateral radical thyroidectomy and 15 cases of unilateral radical thyroidectomy + contralateral lobectomy (benign) . The operation process was recorded, and the differences in operation safety, postoperative recovery and incision satisfaction between endoscopic group and open group were compared.Results:The operation time in the endoscopy group was longer than that in the open group. The postoperative drainage volume in the endoscopy group was larger than that in the open group. There was no significant difference in the amount of intraoperative bleeding, postoperative stay in hospital or the incidence of complications. The neck pain scores in the endoscopic group were lowter than those in the open group. In terms of postoperative cosmetic satisfaction, the endoscopic group was higher than the open group.Conclusion:Endoscopic bilateral thyroidectomy by gasless unilateral axillary approach is a safe and effective surgical method, and has high cosmetic satisfaction.
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Objective:To compare the postoperative neck pain, discomfort and swallowing difficulty in patients with papillary thyroid cancer (PTC) after conventional open thyroidectomy (COT) and endoscopic thyroidectomy using the gasless unilateral axillary approach (ET-UA) .Methods:The study included 117 female patients with PTC who underwent unilateral thyroid lobectomy plus central neck dissection using COT ( n=68) or ET-UA ( n=48) performed by the same experienced surgeon. Subjective neck pain, discomfort and swallowing alterations were assessed by questionnaire 3 day and 6 months postoperatively. Surgical scar and cosmetic satisfaction evaluation were implemented 6 months postoperatively. SPSS 20.0 was used for statistical analysis, the rate or composition ratio was compared by the χ2 test or the exact probability method, and the significance test of the difference in sample means was tested by analysis of variance. Results:Three days after surgery, the neck pain scores of COT group and ET-UA group were (2.13±1.07) and (2.31±1.07) ( P=0.368) ; the neck injury index was (5.13±3.02) and (5.31±3.00) ( P=0.748) ; the dysphagia index was 5 (0.49±3.47) and (3.77±2.96) ( P=0.006) . At 6 months postoperatively, the neck pain scores in COT group and ET-UA group group were (0.52±0.61) and (0.60±0.74) ( P=0.510) ; the neck injury index was (2.10±1.71) and (2.38±2.35) ( P=0.467) ; the dysphagia index was (2.68±2.36) and (1.81±1.83) ( P=0.034) , respectively. Conclusion:Our preliminary study shows that there is no significant differences in postoperative neck pain or discomfort between COT groups and ET-UA group, whereas the impact of ET-UA on swallow function is relatively small than COT.
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There are abundant and stable circular RNAs in tumor-derived exosomes, which play an important role in the occurrences and developments of tumors. Exosome-circRNAs can be used as the marker of tumors diagnosis and prognosis, and have different roles in regulating tumors immune responses, regulating tumors progressions and mediating tumors drug resistances in different tumors. Exploring and applying the potential value of exosome-circRNAs will provide a new choice for the diagnosis and treatment of tumors.
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Objective:To investigate the efficacy and safety of the modified gasless unilateral axillary approach (MGUAA) endoscopic thyroid surgery in treatment of papillary thyroid microcarcinoma (PTMC) .Methods:From Jan. 2019 to Dec. 2019, 90 patients receiving PTMC (cT1N0M0, cI stage, 8th, 2017 AJCC) therapy by modified gasless unilateral axillary approach endoscopic thyroid surgery (MGUAA group, n=41) , and conventional open thyroid surgery (OS group, n=49) were retrospectively analyzed. Ninety patients were enrolled in the study, including 14 males and 76 females,with the mean age (42.1±12.0) years.The effectiveness of central lymph node dissection (CLND) , the operation time, the types of operation, the amount of drainage, the duration of hospital stay, the related complications, the postoperative pain of neck and axillary and the cosmetic satisfaction were compared between the two groups.SPSS 25.0 statistical software was used for statistical analysis, the measurement data was expressed by ±s, paired t test was used to compare the measurement data between groups, and Chi-square test was used to campare the count date between groups. Results:The mean age (35.0±8.6) years and the amount of surgical bleeding (12.3±7.3) ml in the MGUAA group were significantly lower than those (48.1±11.1) years and (16.1±4.3) ml in the OS group ( P<0.01) , while the mean operation time (99.1±19.5) min, the mean amount of drainage (221.4±67.9) ml and the postoperative drainage tube placement time (5.0±0.8) days were significantly higher than those of (70.6±17.8) min, (98.3±63.7) ml and (3.8±1.0) days in the MGUAA ( P<0.01) . There was no significant difference in the number of lymph nodes of CLND or the duration of hospital stay between the two groups ( P>0.05) . In terms of surgical complications, the transient recurrent laryngeal nerve injury, the postoperative hematoma, the postoperative infection, and the lymphatic leakage had no significant difference between the two groups ( P>0.05) . The MGUAA group had significant advantages in avoiding the postoperative dysphagia in front of neck, the postoperative pain of neck, and cosmetic satisfaction over the OS group [ (0.0% vs 28.6%) , (14.6% vs 71.4%) , (1.1±0.3) score vs (2.4±0.5) score ( P<0.01) ]. Whereas in axillary area pain on the surgical side, the MGUAA group was inferior to the OS group ( P<0.01) . Conclusion:The modified gasless unilateral axillary approach endoscopic thyroid surgery is a feasible, safe and cosmetically operation for PTMC (cT1N0M0, cI stage, 8th, 2017 AJCC) .
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Objective To measure the change of facial volume maintenance rate after autologous fat grafted for repaired progressive facial hemiatrophy by using three-dimensional digital technology.Methods 3D scanner was used to acquire facial data in 10 patients with progressive facial hemiatrophy before operation;Mimics 17.0 software was used to reconstruce patients' facial 3D model and to calculate the volume of facial tissue defect;autologous fat was grafted to repair facial deformity.The facial volume maintenance rate was calculated in all the patients 3 months and 6 months after operation.Results We had performed facial 3D data acquisition and facial repaired with autologus fat grafted in 10 patients;patients' facial morphology was improved.The mean facial volume maintenance rate was (35.80±3.44)% in 3 months and (27.82±3.80)% 6 months after surgery.Conclusions The mean facial volume maintenance rate in postoperative 3 months is inferior to that in 6 months in single autologous fat grafted for repairing progressive facial hemiatrophy.
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Objective@#To present a new method for correction of prominent malar complex via intraoral approach by double support technique osteotomy which can provide a stable support.@*Methods@#According to the anatomical characteristics of malar complex and relevant masseter muscle, we designed a malar reduction technique including anterior and posterior support. The reduction procedure entailed an L-shaped osteotomy ofthemalarbody and oblique osteotomy of malar arch. On the basis of prominence degree, bone fragment was moved inward and upward to form double support, which could reduce malar and zygomatic arch effectively.@*Results@#A total of 76 patients subjected to double support technique for malar reduction between January 2015 and January 2017 were retrospectively reviewed.The follow-up period ranged from 10 to 12 months. All patients were satisfied with aesthetic outcomes without major complications, such as facial nerve damage or bone ununion.@*Conclusions@#Double support technique is an effective method to correct malar prominence andreduce the zygomatic complex which can prevent saggy cheek and bony malunion.
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Objective To find a method to repair nasal deformity of Tessier 3 cleft.Methods Five Tessier 3 cleft patients were treated from June 2010 to June 2015 in our department.Nasolabial groove flap or nasolabial groove flap accompanied by offside ala nasi groove flap were performed to correct the nasal deformity according to the defect of the ala.Results Two cases were treated with simple nasolabial groove glap,and 3 cases were treated with nasolabial groove flap accompanied by offside ala nasi groove flap.All the flaps survived with incisions of donor sites healed primarily.The color,texture and thickness of the flaps were similar to those of recipient sites after 1 year follow up.The scar in donor site was concealed and not obvious.The results showed good healing and good appearance,and the symmetry between the nostrils also seemed to be acceptable.Conclusions Nasolabial groove flap and nasolabial groove flap accompanied by offside ala nasi groove flap are good methods to correct nasal deformity of Tessier 3 cleft.The offside ala can be reduced at the same time and the symmetry between the nostrils can be achieved more easily.The operation is easily performed,the scar is acceptable and the results are good.
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Objective To discuss the correlation between initial malar reduction procedures and the method of revision procedures and the personalized treatment strategies for the second deformity of postoperative prominent malar complex.Methods From January 2003 to December 2017,27 patients underwent personalized revision surgery of malar reduction according to the different second deformity of malar complex.The surgical technique included the double support malar reduction technique,orthotopic malar osteotomy technique,malar bone grinding surgery,and autogenous bone transplantation.Results A total of 27 patients subjected to revision surgery for malar reduction between November 2006 and December 2017 were retrospectively reviewed.22 patients were satisfied with aesthetic outcomes after the first revision procedure,while 5 patients were satisfied after 2 or 3 procedures follow-up for 10 to 12 months.Conclusions The incidence of complications after malar reduction is related to the first surgical method.According to the unsatisfactory results,it can be repaired individually to obtain a better clinical repair effect.
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Based on the holism,the medical and health care model of the Integrated Traditional Chinese Medicine & Western Medicine is referred that the practitioners who work with the TCM & Western medicine,apply the methods combined westem medicine with TCM to treat patients and health educationfrom the "person-centric" holism.Professor Ka-Kit Hui,who is the founder of the East and West Medical Center (CEWM) belonged to the University of California,Los Angeles vigorously advocate,and always adhere to the education and clinical.In this paper,we briefly introduced this model.Taking clinical case discussion of CEWM as an example,we focused on and summarized how the team of CEWM applied this model to train the clinical practitioners who would like to work in the Integrated Traditional Chinese Medicine & Western Medicine.Through this paper,we hope we could get some useful references for the education of Chinese integrated traditional Chinese medicine & westem medicine practitioners.
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Objective To review and investigate the malaria control history of Wuzhou City,Guangxi Zhuang Autonomous Region from 1950 to 2015,so as to provide the evidence for future malaria control and surveillance. Methods The data of ma?laria control in Wuzhou City from 1950 to 2015 were collected and analyzed. Results In 1950 decade,the malaria incidence in Wuzhou City was 1 435.55/100 000,higher than the average level in Guangxi,and the mortality of malaria was 0.95/100 000. The malaria incidence of local residents was reduced to 3.61/100 000 in 1979 and no local malaria case was found since. The im?ported malaria cases were found in Wuzhou City since 1980,and were more than local cases since 1981. In recent five years, 87.50%(7/8)of imported malaria cases were from south?east Asia. Conclusions Wuzhou City has reached the national criteri?on of malaria elimination,but the imported malaria is the recent threat. The surveillance and control work of malaria should be strengthened.
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BACKGROUND: There are currently many cryopreservation methods for the aminotic membrane, which have varying effects on the ultrastructure and biological activity of amniotic membrane, but on no one is effective. OBJECTIVE: To compare the effects of different cryopreservation methods on the ultrastructure and viability of aminotic membrane and to seek the ideal cryopreservation method. METHODS: Aminotic membrane separated from the fresh placenta was preserved respectively with deep-frozen cryopreservation and vitrification, and everyway was run for 3 and 6 months. Fresh aminotic membrane was used as control. The ultrastructure of aminotic membrane was observed by transmission electron microscopy, and the viability of aminotic membrane was assessed by microcomputer analysis system for biological oxygen consumption, and immunohistochemical staining combined with image analysis system was used for lactate dehydrogenase activity. RESULTS AND CONCLUSION:After 3 and 6 months of crypreservation, the damage to the ultrastructure of aminotic membrane by vitreous cryopreservation was slighter than that of amniotic membrane cryopreserved at-80℃. Compared with the fresh aminotic membrane, the gray value of lactate dehydrogenase and partial pressure of oxygen were significantly decreased in the cryopreserved aminotic membrane by deep-frozen cryopreservation at 3 and 6 months (P < 0.05) and by vitreous cryopreservation at 6 months (P < 0.05), but there was no statisticaly significant difference in the change rate of oxygen partial pressure and the gray value of lactate dehydrogenase between the fresh aminotic membrane and the cryopreserved aminotic membrane by vitreous cryopreservation at 3 months. The present study led to the conclusion that vitreous cryopreservation protocol alows to not only maintain the integrity of AM, but also to preserve the viability of the cels. So the vitreous cryopreservation is superior to the deep-frozen cryopreservation for cryopreservation of aminotic membrane.
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Oncogene Pim-1 has a close relationship with the occurrence and development of several tumours.It is involved in a number of signal transduction pathways and regulates the expression of the downstream biological factors or acts synergistically with other oncogenes.Pim-1 plays an important role in the clinical diagnosis,treatment and prognosis of some tumors,and provides a new potential target in the chemotherapy of tumors.Recently,Pim-1-targeting treatment strategy has be a research hotspot and it would be used for cancer clinical treatment hopefully.
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BACKGROUND: Classic isolation method of bone marrow mesenchymal stem cells (BMSCs) is Percoll density gradient centrifugation. Blood cell component was removed. However, this method is complicated. Preparation density was needed when isolating dog bone marrow. Moreover, centrifugation was frequent, which had a great damage to cells. OBJECTIVE: To establish methods of the isolation, proliferation, culture and osteoinduction of canine BMSCs, and observe the in vitro proliferation and ability to osteoinduction differentiation. METHODS: 10 mL bone marrow was extracted from dog posterior superior iliac spine, heparin anticoagulation, diluted using Hanks juice, treated with 1.077 g/mL Ficoll solution 3 mL, and centrifuged at 2 000 r/min for 20 minutes. Karyocytes were absorbed to form white cloudlike layering interface, and then centrifuged twice using DMEM supplemented with fetal bovine serum, incubated at 12×10~4/cm~2 at 37 ℃ in a 5% CO_2 incubator. Following subculture, cells were incubated in DMEM containing dexamethasone, β-sodium phosphoglycerol and ascorbic acid 2-phosphate. Immunocytochemical staining and immunofluorescence staining were utilized to detect osteocalcin, osteopontin and type Ⅰ collagen expression in osteoblasts. Alkaline phosphatase staining and alizarin red staining were performed. RESULTS AND CONCLUSION: 1.077 g/mL Ficoll density gradient centrifugation was used to isolate karyocytes that were significant compared with Percoll solution. Obtained BMSCs had high purity, good growth and the mean doubling time was 24 hours. Following in vitro osteogenic incubation of dog BMSCs, osteocalcin, osteopontin and type Ⅰ collagen showed positive expression. Alkaline phosphatase staining demonstrated bluish-green cytoplasm. Alizarin red staining showed red nodes in extracellular matrix, and could differentiate into osteoblasts in vitro.