Objective To explore the feasibility of combining high level Le Fort Ⅰ osteotomy with bone grafting in the same operation for correction of secondary midface deformities in cleft patients. Methods From January 2002 to January 2005, 10 patients suffering from secondary midface deformities were treated. There were 4 males and 6 females, aged from 16 to 32 years. The unilateral cleft was involved in 8 patients and the bilateral cleft in2 patients. All patients received combining high level Le Fort Ⅰ osteotomy with bone grafting in the same operation. The horizontal corticotomy of high level Le Fort Ⅰosteotomy on anterior wall of maxillary bone is higher than that of traditionalLe Fort Ⅰ osteotomy, it is only 5 mm close to infraorbital foramen. Results All 10 patients were satisfied with their appearances after operation. Dental articulation was improved greatly in 9 patients. With an X-ray re-examination, maxillary was returned to normal position in all patients. After a follow up from 6months to 2 years, dental arch had good appearance. The X-ray films showed no obvious bone absorption. The density of grafting bone was approximation to the normal bone.Conclusion High level Le Fort Ⅰ osteotomy can make notonly maxillary advance, but also regions of lateral and floor of nose and partial infraorbital region advance. Combining with bone grafting in the same operation can decrease the frequency of operation, save the treatment expense and obtain an ideal effect. So it is an effective method for correction of the secondary midface deformities in cleft patients.
目的:探讨儿童糖尿病患者的营养治疗方法以提高治疗效果。 方法:随机选择20例胰岛素依赖型儿童糖尿病患者,结合年龄、体重、病情、胰岛素用量、营养状况、生长发育需要设计个体化营养治疗方案。结果:通过营养治疗,除1例患儿家属在病情控制相对稳定,但血糖未有效控制提前出院外,其余19例患者均坚持营养治疗。治疗前后,随机血糖、餐后2 h血糖差异有统计学意义,P＜0.05;糖化血红蛋白差异无统计学意义。结论:个体化的营养治疗有助于儿童糖尿病患者血糖控制,并能促进儿童的生长发育及提高生活质量。
ObjectiveTo explore the biocompatibility of the poly-lactide-co-glycolide (PLGA)/collagen type I scaffold with rat vaginal epithelial cells, and the feasibility of using PLGA/collagen type I as scaffold to reconstruct vagina by the tissue engineering. MethodsPLGA/collagen type I scaffold was prepared with PLGA covered polylysine and collagen type I. The vaginal epithelial cells of Sprague Dawley rat of 10-12 weeks old were cultured by enzyme digestion method. The vaginal epithelial cells of passage 2 were cultured in the leaching liquor of scaffold for 48 hours to detect its cytotoxicity by MTT. The vaginal epithelial cells were inoculated on the PLGA/collagen type I scaffold (experimental group) and PLGA scaffold (control group) to calculate the cell adhesion rate. Epithelial cells-scaffold complexes were implanted subcutaneously on the rat back. At 2, 4, and 8 weeks after implantation, the epithelial cells-scaffold complexes were harvested to observe the cell growth by HE staining and immunohistochemical analysis. The epithelial cells-scaffold complexes were transplanted to reconstruct vagina in 6 rats with vaginal defect. After 3 and 6 months, the vaginal length was measured and the appearance was observed. The neovagina tissues were harvested for histological evaluation after 6 months. ResultsThe epithelial cells grew and proliferated well in the leaching liquor of PLGA/collagen type I scaffold, and the cytotoxicity was at grade 1. The cell adhesion rate on the PLGA/collagen type I scaffold was 71.8%±9.2%, which significantly higher than that on the PLGA scaffold (63.4%±5.7%) (t=2.195, P=0.005). The epithelial cells could grow and adhere to the PLGA/collagen type I scaffolds. At 2 weeks after implanted subcutaneously, the epithelial cells grew and proliferated in the pores of scaffolds, and the fibroblasts were observed. At 4 weeks, 1-3 layers epithelium formed on the surface of scaffold. At 8 weeks, the epithelial cells increased and arranged regularly, which formed the membrane-like layer on the scaffold. The keratin expression of the epithelium was positive. At 3 months after transplantation in situ, the vaginal mucosa showed pink and lustrous epithelialization, and the majority of scaffold degraded. After 6 months, the neovagina length was 1.2 cm, without obvious stenosis; the vaginal mucosa had similar appearance and epithelial layer to normal vagina, but it had less duplicature; there were nail-like processes in the basal layer, but the number was less than that of normal vagina. The immunohistochemistry staining for keratin was positive. ConclusionThe PLGA/collagen type I scaffolds have good cytocompatibility with the epithelial cells, and can be used as the biodegradable polymer scaffold of the vaginal tissue engineering.
Objective To assess clinical value of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter. Methods The clinical data of 75 patients with type Ⅰ substernal goiter in the Department of General Surgery of the Central Hospital of Xiaogan from April 2013 to April 2017 were retrospectively analyzed. These patients received the surgical resection by the meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach. Results There were 12 Hashimoto thyroiditis, 10 thyroid adenoma, 41 nodular goiter, and 12 thyroid carcinoma in the 75 patients with type Ⅰ substernal goiter. Five cases underwent the unilateral total thyroidectomy. Fifty-eight cases underwent the bilateral total thyroidectomy. The bilateral total thyroidectomy plus central lymph node dissection were performed in the 9 patients with thyroid carcinoma, the bilateral total thyroidectomy plus central lymph node dissection plus affected ipsilateral neck lymph node dissection were performed in the 3 patients with thyroid carcinoma. The average operative time was 100 min, the average intraoperative blood loss was 50 mL, the average postoperative hospital stay was 5 d. The rate of parathyroid injury was 2.7% (2/75), the rate of hypocalcemia caused by parathyroid injury was 2.7% (2/75). There were 3 cases (4.0%) of unilateral recurrent laryngeal nerve injury, 1 case (1.3%) of the outer branch of the upper laryngeal nerve injury. There were 2 cases of tracheal partial softening in the 75 patients. None of postoperative bleeding and seroma happened. No death and the tumor recurrence and metastasis of patients happened during follow-up period. Conclusions Preliminary results in this study show that operation of meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach in treatment of type Ⅰ substernal goiter is safe and feasible, it could effectively reduce postoperative complications of thyroidectomy, and protect parathyroid and it’s function, recurrent laryngeal nerve, and superior laryngeal nerve.
ObjectiveTo investigate the changes of fibrinogen and classical markers of collagen metabolism [carboxy-terminal propeptide of type Ⅰ procollagen (PICP) and carboxy-terminal cross-linked peptide of type Ⅰ collagen (ICTP)] in peripheral blood and pericardial drainage after coronary artery bypass grafting (CABG) and/or heart valve replacement (VR), and to evaluate their relationship with postoperative atrial fibrillation (POAF) after cardiac surgery. MethodsPatients who underwent CABG and/or VR in the Heart Center of Beijing Chao-Yang Hospital from March to June 2021 were included. Peripheral blood and pericardial drainage fluid samples were collected before surgery and at 0 h, 6 h, 24 h and 48 h after surgery to detect PICP, ICTP and fibrinogen levels, and preoperative, intraoperative and postoperative confounding factors were also collected. PICP, ICTP and fibrinogen levels were measured by enzyme-linked immunosorbent assay (ELISA). ResultsA total of 26 patients with 125 blood samples and 78 drainage samples were collected. There were 18 males and 8 females with an average age of 64.04±7.27 years. The incidence rate of POAF was 34.6%. Among the factors, the fibrinogen level in pericardial drainage showed two peaks within 48 h after operation (0 hand 24 h after operation) in the POAF group, while it showed a continuous downward trend in the sinus rhythm (SR) group, and the change trend of fibrinogen in pericardial drainage was significantly different over time between the two groups (P=0.022). Fibrinogen in blood, PICP and ICTP in blood and drainage showed an overall decreasing trend, and their trends over time were not significantly different between the two groups of patients (P>0.05). Univariate analysis showed that fibrinogen at 24 h and 48 h after pericardial drainage, fibrinogen in preoperative blood, PICP immediately after surgery and right atrial long axis diameter were significantly higher or longer in the POAF group than those in the SR group. Multiple regression showed that fibrinogen≥11.47 ng/mL in pericardial drainage 24 h after surgery (OR=14.911, 95%CI 1.371-162.122, P=0.026), right atrial long axis diameter≥46 mm (OR=10.801, 95%CI 1.011-115.391, P=0.049) were independent predictors of POAF. ConclusionThis study finds the regularity of changes in fibrinogen and collagen metabolic markers after CABG and/or VR surgery, and to find that fibrinogen in pericardial drainage 24 h after surgery is a potential novel and predictive factor for POAF. The results provide a new idea for exploring the mechanism of POAF, and provide a research basis for the accurate prediction and prevention of clinical POAF.
Objective To study the relation between expressions of transforming growth factor β1 （TGF-β1）, transforming growth factor receptor type Ⅰ (TβRⅠ) and cell proliferation, cell cycle in gallbladder carcinomas, to disclose the mechanism of TGF-β1 and TβRⅠin the gallbladder carcinogenesis，and to evaluate their values in the prognosis of gallbladder carcinomas. Methods Thirty five gallbladder carcinomas 〔age （57.94± 4.61） years, 14 male cases and 21 female cases〕 comprised 32 adenocarcinomas, 2 adenosquamous carcinoma and 1 squamous cell carcinomas. Formalin fixed, paraffin embedded sections from gallbladder carcinomas were immunostained with TGF-β1, TβRⅠ, PCNA, cyclin E antibodies by immunochemical assays. Gallbladder adenoma and chronic cholecystitis were collected as non-malignant controls. Patients of gallbladder carcinomas were followed up. Results Positive immunostaining rate of TGF-β1 was 57.14% in gallbladder carcinomas, which was significantly higher than that in gallbladder adenomas and chronic cholecystitis (P＜0.01, respectively). Expression of TGF-β1 was associated with Nevin stage, lymph nodes and distant metastasis (P＜0.05, P＜0.01, respectively). Expression of TGF-β1 was positively correlated with expression of PCNA LI and cyclin E (r=0.523 2, P=0.001 3; r=0.406 5, P=0.015 4), and 34.29% of gallbladder carcinomas were immunostained positively for TβRⅠ. Expression of TβRⅠwas significantly lower in gallbladder carcinomas than that in gallbladder adenomas and cholecystitis (P＜0.05, respectively). It was significantly lower in gallbladder carcinomas patients with lymph nodes and distant metastases than in those without (P＜0.05). Expression of TβRⅠwas negatively correlated with PCNA LI (r=-0.402 4, P=0.016 6). Patients with negative expression of TGF-β1 and/or positive expression of TβRⅠ had significant longer survival rates than those with positive expression of TGF-β1 and/or negative expression of TβRⅠ(P＜0.01, P＜0.05, respectively). Expressions of TGF-β1 and TβRⅠ correlated with prognosis of gallbladder carcinomas closely. Conclusion TGF-β1 and TβRⅠ have close correlation with cell proliferation, cell cycle of gallbladder carcinomas and are important biological markers of carcinogenesis and progress of gallbladder carcinomas. The escape of growth inhibition of TGF-β1 due to low expression of TβRⅠand carcinogenesis of TGF-β1 may play an important role in gallbladder carcinogenesis. TGF-β1 and TβRⅠare valuable indices for judging the prognosis of gallbladder carcinoma.
Objective To investigate the effect of topical treatment with antisense oligonucleotides（ASON）targeting tumor necrosis factor-alpha;（TNF-alpha;）on the pathological process of experimental herpes simplex virus type-Ⅰ（HSV-Ⅰ）induced chorioretinitis in mouse eye. Methods Fifty BALB/c mice were randomly divided into experimental and control group（twenty five mice in each group）.HSV chorioretinitis model was induced in each mouse by inoculating 1times;105 plaque-forming units （pfu） of HSV-Ⅰ（KOS strain）into anterior chamber of the right eye.In experimental group，Fluorescein isothiocyanate （FITC）-labeled ASON targeting TNF-alpha; 2 mu;l were injected sub-conjunctiva in the left eye1day before and 1 and 4 days after the infection;while phosphate buffer solution was injected in the same way in control group.The inflammation changes of the eyes in the 2 groups were observed and the clinical grades were assessed according to the extends of anterior-chamber inflammation，vasodilatation of cornea and iris，formation of cataract，and vitreous opacity. All of the mice were executed 10 days after the infection and were observed histologically. The contents of TNF-alpha; in retina and choroid were measured by enzyme-linked immunobsorbent assay（ELISA）. Results After the infection，acute inflammation appeared in the right eyes in both groups. The inflammation of the left eyes in experimental group was significantly milder than which in the control group.Twelve left eyes had necrotic chorioretinitis in different degrees in the control group while 2 left eyes had mild chorioretinitis in the experimental group. The difference of the number of inflammatory cells between the 2 groups was statistically significant in retina，choroid，and ciliary body（P＜0.05）and was not obvious in anterior chamber，vitreous cavity，and iris（P＞0.05）.The content of TNF-alpha; in choroid and retina was（60plusmn;1.25）pg in the experimental group and（305plusmn;1.03）pg in the control group（P＜0.05）. Conclusions TNF-alpha; ASON treating HSV-Ⅰinduced chorioretinitis may reduce the content of TNF-alpha; in affected mice eyes and decrease the inflammatory reaction. (Chin J Ocul Fundus Dis, 2006, 22: 245-248)
To investigate the inhibitory effect of Col I A1 antisense ol igodeoxyneucleotide (ASODN) transfection mediated by cationic l iposome on Col I A1 expression in human hypertrophic scar fibroblasts. Methods Scar tissue was obtained from volunteer donor. Human hypertrophic scar fibroblasts were cultured by tissue block method. The cells at passage 4 were seeded in a 6 well cell culture plate at 32.25 × 104 cells/well, and then divided into 4 groups: group A, l iposomeand Col I A1 ASODN; group B, Col I A1 ASODN; group C, l iposome; group D, blank control. At 8 hours, 1, 2, 3 and 4 days after transfection, total RNA of the cells were extracted, the expression level of Col I A1 mRNA was detected by RT-PCR, the Col I A1 protein in ECM was extracted by pepsin-digestion method, its concentration was detected by ELISA method. Results Agarose gel electrophoresis detection of ampl ified products showed clear bands without occurrence of indistinct band, obvious primer dimmer and tailing phenomenon. Relative expression level of Col I A1 mRNA: at 8 hours after transfection, group A was less than groups B, C and D (P lt; 0.05), and groups B and C were less than group D (P lt; 0.05), and no significant difference was evident between group B and group C (Pgt; 0.05); at 1 day after transfection, groups A and B were less than groups C and D (P lt; 0.05), and there was no significant difference between group A and group B, and between group C and group D (P gt; 0.05 ); at 2 days after transfection, there were significant differences among four groups (P lt; 0.05); at 3 and 4 days after transfection, group A was less than groups B, C and D (P lt; 0.05), group B was less than groups C and D (P lt; 0.05), and no significant difference was evident between group C and group D (P gt; 0.05). Concentration of Col I protein: at 8 hours after transfection, group A was less than groups B, C and D (P lt; 0.05), groups B and C were less than group D (P lt; 0.05), and no significant difference was evident between group B and group C (P gt; 0.05); at 1 day after transfection, significant differences were evident among four groups (P lt; 0.05); at 2, 3 and 4 days after tranfection, groups A and B were less than groups C and D (P lt; 0.05), and no significant difference was evident between group A and group B (P gt; 0.05). Conclusion Col I A1 ASODN can inhibit mRNA and protein expression level of Col I A1. Cationic l iposome, as the carrier, can enhance the inhibition by facil itating the entry of ASODN into cells and introducing ASODN into cell nucleus.
目的 探讨Ⅰ型先天性胆总管囊肿的手术治疗。方法 回顾性分析笔者所在医院1987年3月至2011年6月期间收治的42例Ⅰ型先天性胆总管囊肿患者手术治疗后的效果。结果 本组中2例因并发腹膜炎先行囊肿外引流术后4周再行囊肿空肠吻合术；3例直接行囊肿空肠吻合术；35例行囊肿切除肝总管空肠Roux-en-Y吻合术；2例行囊肿切除间置空肠肝总管十二指肠吻合术。手术成功率为100%。5例内引流术（囊肿空肠吻合术）后均有不同程度的胆道感染症状。37例行囊肿根治术（即囊肿切除肝总管空肠Roux-en-Y吻合或间置空肠肝总管十二指肠吻合术）中有2例囊肿切除肝总管空肠Roux-en-Y吻合术后患者偶有右上腹隐痛不适，经X线钡餐检查，诊断为胆管逆行性感染，抗炎治疗有效；其余病例无腹痛、黄疸、发热、再生结石、吻合口狭窄、癌变及其他手术并发症。结论 囊肿外引流术仅作为急诊手术，待患者一般情况改善后再行第二次手术；囊肿根治术是治疗Ⅰ型先天性胆总管囊肿理想的手术方式。