ObjectiveTo comprehensively analyze the recent advancements in the field of mesenchymal stem cells (MSCs) derived exosomes (MSCs-exosomes) in tissue repair. MethodsThe literature about MSCs-exosomes in tissue repair was reviewed and analyzed. ResultsExosomes are biologically active microvesicles released from MSCs which are loaded with functional proteins, RNA, and microRNA. Exosomes can inhibit apoptosis, stimulate proliferation, alter cell phenotype in tissue repair of several diseases through cell-to-cell communication. ConclusionMSCs-exosomes is a novel source for the treatment of tissue repair. Further research of MSCs-exosomes biofunction, paracellular transport, and treatment mechanism will help the transform to clinical application.
ObjectiveTo study the clinical value of changes of serumα-fetoprotein(AFP) and soluble cell adhesion molecule-1(sICAM-1) levels before and after surgical treatment of primary hepatocellular carcinoma(PHC) as predictors of patient survival. MethodsThe clinical data and followed-up results of 86 patients with hepatocellular carcinoma received hepatectomy or radiofrequency ablation(RFA) in Xijing Hospital and the 451st Hospital of PLA were retrospectivly analyzed. The changes of peripheral blood AFP and sICAM-1 levels in patients before and in 1 month after treatment were observed and all patients were divided into different groups according to the changes in both two markers. Then survival rates of each group were analyzed. ResultsThe patients with AFP < 20μg/L or sICAM-1 < 1 000 U/L before treatment had lower tumor recurrence rate and higher survival rate than patients with elevated serum levels of the both markers(AFP:P=0.018, P < 0.001;sICAM-1:P=0.027, P < 0.001). The larger tumor, late TNM stage, and higher rate of recurrence were associated with elevated serum levels of the both markers(AFP:P=0.016, P=0.026 and P=0.025;sICAM-1:P < 0.001, P=0.024 and P=0.032). The better survival situation was closely related with these cases treated with hepatectomy and their levels of both markers were lower than the above cutoff values both before and after treatment, or leves of both markers above the cut-off values returned to within the normal range after treatment (AFP:P=0.006, P=0.001;sICAM-1:P=0.001, P=0.002). The patients who had simultaneous increase of AFP and sICAM-1 after operation showed the worst tumor-free and overall survivals(P=0.007, P < 0.001). ConclusionTo test the changes of serum AFP and sICAM-1 levels in early stage after treatment for patients who received radical resection of hepatocellular carcinoma has good clinical value for monitoring of tumor recurrence and predict prognosis.
ObjectiveTo construct the human small interfering RNA (siRNA) lentiviral vector who targeting inhibitor of differentiation-1 (Id1) gene, and to detect its efficiency of gene silence for the HepG2 cells. MethodsThe most effective RNA interference sequences was screened from 4 kinds of siRNA vectors targeting Id1 gene (included pCGSIL-GFP-Id1-1, pCGSIL-GFP-Id1-2, pCGSIL-GFP-Id1-3, and pCGSIL-GFP-Id1-4), who was transfected to 293T cells. The selected siRNA vector was used to build lentiviral vector (Id1-RNAi-LV) and then infected human HepG2 cells. Then the expression levels of Id1 mRNA and its protein were detected by the real time PCR and Western blot method respectively. ResultsExpression level of Id1 protein in pCGSIL-GFP-Id1-4 group was lower than those of pCGSIL-GFP-Id1-1 group, pCGSIL-GFP-Id1-2 group, and pCGSIL-GFP-Id1-3 group (P < 0.05), who had the best efficiency of gene silence. The Id1-siRNA lentiviral vector (Id1-RNAi-LV) was successfully constructed by using pCGSIL-GFP-Id1-4. The titer of lentiviral was 2.0×109 TU/mL.results of real time-PCR and Western blot showed that, the expression levels of Id1 mRNA and its protein in HepG2 cells of Id1-RNAi-LV group were lower than those of blank control group and negative control group (P < 0.05). ConclusionsThe specific lentiviral can constantly down-regulate the expression of Id1 gene.
ObjectiveTo systematically evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with partial splenic embolization (PSE) for hepatocellular carcinoma (HCC) with hypersplenism. MethodWe searched The Cochrane Library (Issue 11, 2015), PubMed, EMbase, CBM, VIP, CNKI and WanFang Data databases from inception to November 1st 2015, to collect randomized controlled trials (RCTs) about TACE combined with PSE in treating HCC with hypersplenism. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 11 RCTs involving 708 patients were included. The results of meta-analysis showed that: Compared with TACE alone, TACE combined with PSE could significantly improve postoperative CD4 count (MD=6.99, 95%CI 4.60 to 9.38, P<0.00001), CD4/CD8 ratio (MD=0.64, 95% 0.45 to 0.84, P<0.00001), and the rate of half year survival (RR=1.16, 95%CI 1.02 to 1.32, P=0.02), decrease the incidences of spontaneous peritonitis (RR=0.20, 95%CI 0.05 to 0.48, P=0.03) and varices bleeding (RR=0.17, 95%CI 0.04 to 0.68, P=0.01). The two groups had similar incidence of post-embolization syndrome (RR=1.17, 95%CI 0.79 to 1.75, P=0.44). ConclusionTACE combined with PSE is more safe and effective than TACE alone in unresectable HCC with hypersplenism. Due to limited quantity and quality of the included studies, the above conclusion should be further verified by conducting more high quality, large scale RCTs.
ObjectiveTo comprehensively collect quality assessment tools of systematic review/meta-analysis (SR/MA) of randomized controlled trials (RCTs), and compare the differences of numbers and contents of items, in order to provide references for optimizing and using these quality assessment tools. MethodsWe searched PubMed and EMbase databases up to December 31th, 2013 for quality assessment tools of SR/MA of RCTs. EndNote X3 software was used for screening literature and Excel 2010 software was used for data extraction. A descriptive analysis was performed. ResultsA total of 61 studies including 32 quality assessment tools were included. Among them, 30 tools were for methodological quality and 2 tools for reporting quality. These tools were developed by different medical universities or colleges, research institutes, national health institutes, and some famous epidemiologists and methodologists from 1984 to 2007. Among the 32 tools, 4 tools were scales, while 28 were checklists. The numbers of items of these tools ranged from 5 to 101, among them, 9 tools had more than 20 items. ConclusionThere are many quality assessment tools for SR/MA, but none of them is generally acknowledged. The quality, contents of items, and applicability of these tools are different, and some of them are too long to use. In practice and decision-making, most of the tools have the problems of low relevance and applicability. How to regularly use these tools to guide the research, practice and decision-making of SR/MA is still needed to be further researched.
Different generations of biomedical materials are analyzed in this paper. The current clinical uses of plates made of metals, polymers or composite materials are evaluated, and nano hydroxyapatite/polylactic acid composites and carbon/carbon composite plates are introduced as emphasis. It is pointed out that the carbon/carbon composites are of great feasibility and advantage as a new generation of biomedical materials, especially in the field of bone plate. Compared to other biomaterials, carbon/carbon composites have a good biocompatibility and mechanical compatibility because they have similar elastic modulus, porosity and density to that of human bones. With the development of the technology in knitting and material preparation, carbon/carbon composite plates have a good application prospect.
ObjectiveTo compare the cost-effectiveness between endoscopic retrograde cholangio-pancreatography (ERCP) treatment and laparotomy treatment for simple common bile duct stone or common bile duct stone combined with gallbladder benign lesions. MethodsA total of 596 patients with common bile stone received ERCP (ERCP group) and 173 received open choledocholithotomy (surgical group) in our hospital between January 2009 and December 2012. Their clinical data were retrospectively analyzed. The curing rate, postoperative complications, hospital stay, preoperational preparation and total cost were compared between the two groups of patients. Meanwhile, for common bile stone combined with gallbladder benign lesion, 29 patients received ERCP combined with laparoscopic cholecystectomy (LC) (ERCP+LC group), 38 received pure laparoscopy treatment (laparoscopy group) and 129 received open choledocholithotomy combined with cholecystectomy (surgery group). ResultsFor simple common bile stone patients, no significant difference was found in cure rate and post-operative complication between endoscopic and surgical treatment groups (P>0.05). However, total hospitalization expenses[(13.1±6.3) thousand yuan, (20.6±7.5) thousand yuan)], hospital stay[(8.91±4.95), (12.14±5.15) days] and preoperative preparation time[(3.77±3.09), (5.13±3.99) days] were significantly different between the two groups (P<0.05). For patients with common bile stone combined with gallbladder benign lesion, no significant discrepancy was detected among the three groups in curing rate and post-operative complications (P>0.05). Significant differences were detected between ERCP+LC group and surgical group in terms of total hospitalization expense[(18.9±4.6) thousand yuan, (23.2±8.9) thousand yuan] hospital stay[(9.00±3.74), (12.47±4.50) days] and preoperative preparation time[(3.24±1.83), (5.15±2.98) days]. No significant difference was found in total hospitalization expense and hospital stay, while significant difference was detected in preoperative preparation time between ERCP+LC group and simple LC group. ConclusionFor patients with simple common bile stone, ERCP is equivalent to surgery in the curing rate, and has more advantages such as less cost, shorter length of hospital stay, and lower preoperative preparation time. For the treatment of common bile duct stone with gallbladder benign disease, ERCP combined with LC also has more advantages than traditional surgery.
ObjectiveTo assess the safety and efficacy of a new surgical strategy, perventricular device closure, for the treatment of subarterial ventricular septal defect (VSD). MethodsThirty-nine patients younger than 10 years with subarterial VSD who received surgical repair in West China Hospital from November 2010 to May 2012 were included in this study. There were 18 male and 21 female patients with their age of 5.9±3.2 years. Perventricular device closure was performed with eccentric device under the guidance of transesophageal echocardiography (TEE). Residual shunt, valvular regurgitation (including aortic regurgitation)and arrhythmias during perioperative period and follow-up were analyzed. ResultsThirty-three patients successfully received perventricular device closure, and 6 patients received conversion to open surgical repair. Postoperative ICU stay was 2.2±0.8 days, and length of hospital stay was 4.8±1.8 days. Major postoperative complications included residual shunt and mild or less aortic regurgitation. Mean follow-up duration was 7±2 months. No obvious arrhythmia, moderate or severe valvular regurgitation was observed during follow-up. ConclusionPerventricular device closure is safe, efficacious and minimally invasive for the treatment of subarterial VSD in pediatric patients with suitable anatomic characteristics with good mid-term results.
ObjectiveTo investigate the essential healthcare system performance in Xinjin county of Chengdu city from 2009 to 2010, so as to provide baseline data for further study. MethodsThe general information of the essential healthcare, such as the numbers of out and in-patients, service and profits were collected and then analyzed using the software of Microsoft Excel 2003 and SPSS 13.0. Resultsa) The results showed that the numbers of out and in-patients were in the rank of the county, township and community hospital. The numbers of out and emergency patients has been decreased 31.0% and 25.3% in the community hospital from 2009 to 2010, while patients in the county and township hospital has been increased. The numbers of in-patients has been increased by year; b) hospital bed occupancy has been increased by year, and the hospital bed occupancy of county hospitals was 8% lower than national level in 2009, 33.5% higher in 2010, the hospital bed occupancy of township hospitals from 2009 to 2010 was higher than national level, the ones of community hospital was lower than national level; c) there is an annual decreasing tendency for average days for hospitalization in county and community hospital, which were higher than national level; d) it was lower than national average rate; e) the inpatient fee per time was lower than national average rate; f) in the components of the in-patients expense, drug expense, operation expense and diagnose expense were constituted more than 86% in all eight costs; and g) the receipts and expenditure of Xinjin hospital throughout the year increased by years, the income and expenses showed 39.3% and 37.7%. ConclusionThe hospital bed occupancy, average hospitalization days and the inpatient fee per time in Xinjin county of Chengdu city during 2009-2010, were higher than national level. The overall health performance of hospitals in Xinjin county was satisfied. However, there was significant difference between the best and the worst. In order to distribute health resources, both benefit and efficient should be emphasized.
ObjectiveTo comprehensively evaluate the essential public health service in Xinjin county of Chengdu from 2009 to April 2011, so as to provide evidence for improving primary healthcare system reform in Chengdu city. MethodsThe data was collected from the Xinjin county-wide health information system. The electronic health records, chronic disease management, childbirth management and mental health were quantitatively described and compared. Resultsa) In 2010, 88 772 residents had the physical examination and health assessment, among which, 14 497 (16%) were detected with some health problems. The average cost per positive detection was RMB 122.5 yuan. b) Up to April 2011, 98.2% of people in Xinjin county have their health records but the proportions were ranged from 68.08% to 109.02% in different primary healthcare providers. The details of the most health records were incomplete. c) 7 318 patients with hypertension and 2 187 diabetes mellitus were detected, and among them, 90.1% of patients with hypertension and 95.1% of patients with diabetes had their health records for chronic diseases management. d) The rate of stillbirth or neonatal mortality was lower than 4‰. There was no maternal death in the 8 years. But the cesarean section rate was about 61%. e) 97.3% of the patients with mental disorders were supervised in 2010, which was reduced by 2.7% compared to 2009. Conclusionsa) There is low proportion of all the residents in Xinjin having physical examination and health assessment and the rate of diseases detection is low as well. b) There is very wide coverage of health records for residents in Xinjin county, nearly universal coverage. c) The health records for the chronic disease patients were well-established, but the early detection rate of the chronic diseases is low. d) High proportion of the patients with mental disorders is supervised. e) The strategy that only county-level hospitals could provide obstetrical service instead of township hospitals is successful to reduce the neonatal mortality and maternal mortality. However, the cesarean section rate is high. f) It acts, to some extent, as a model to successfully improve the essential public health service and management based on the conuty-wide healthcare information system. However, the data quality, data mining and data utilization should be further improved