ObjectiveTo explore the advantages and disadvantages of preoperative biliary drainage, the timing of preoperative biliary drainage, and the characteristics of various drainage methods for resectable hilar cholangiocarcinoma.MethodsBy reviewing relevant literatures at home and abroad in the past 20 years, the controversies related to the preoperative biliary drainage, surgical biliary drainage, and various drainage methods for resectable hilar cholangiocarcinoma were reviewed.ResultsThere is still a great deal of controversy about whether preoperative bile duct drainage is required for resectable hilar cholangiocarcinoma routinely, but there is a consensus on the timing of preoperative biliary drainage, and various drainage methods have their own characteristics.ConclusionsThe main treatment for hilar cholangiocarcinoma is radical surgical resection, but cholestasis is often caused by malignant biliary obstruction, which makes it difficult to manage perioperatively. A large number of prospective studies are needed to provide more evidence for the need for routine preoperative biliary drainage in patients with hilar cholangiocarcinoma who can undergo resection.
OBJECTIVE: To build the trestle of tissue engineering for skin with the collagen. METHODS: The collagen was obtained from the baby cattle hide pretreated by Na2S and elastinase and Protease M, then the collagen was dissolved in 0.5 mol/L acetic acid solution. The collagen was treated with Protease N to minimize its immunogenicity. The resulting collagen could be used to build the trestle of tissue engineering for skin because of good biocompatibility. The collagen molecular weight and structure were analyzed by SDS-PAGE. The bioactivity of trestle was tested in the experiment of the mice wound healing and the cell implantation. RESULTS: The SDS-PAGE result of the collagen treated by Protease M showed the typical spectrum of type I collagen. The built trestle was a collagen sponge matrix in which micropore size was 50-200 microns. It could accelerate wound healing and the implanted fibroblasts could proliferate well. CONCLUSION: The collagen treated by Protease N can get good biocompatibilily and is suitable for building the trestles of tissue engineering for skin with good bioactivity.
Objective To investigate the method and clinical effect of free iliac flap grafting in repairing the tibia traumatic osteomyelitis complicated withboneskin defect. Methods From June 2001 to February 2006，28 patients with tibia traumatic osteomyelitis complicated with boneskin defect were treated with free iliac flap grafting at stageⅠ. There were 18 males and 10 females, with an average of 32.5 years(1868 years). There were traffic injury in 11 cases, bruise in 6 cases, explosive injury in 5 cases, machinery injury in 4 cases, and falling injury in 2 cases. The disease courses of patients were 1-6 months. All patients had been treated by 26 operations. The wounds located at the mid and upper tibia in 13 cases, and the inferior tibia in 15 cases. The length of free iliac was0.5-6.0 cm and the size of the flap ranged from 4.5 cm×3.5 cm to 28.0 cm×16.0 cm.The external fixation were applied in 18 cases, and steel plate were applied in 10 cases. The donor sites were sutured directly. Results All of the flaps survived completely. The wounds healed by first intention in 26 cases and by second intention in 2 cases. The donorsites healed by first intention. Twentyeight patients were followed up for 6 to 56 months(mean, 30 months).The appearances of the flaps were satisfactory and the colour was similar to recipient site. All grafted bone united 2-14 months (mean，4.6 months) after operation according to X-ray examination. In 20 patients who did not achieved union before operation, fracture healed 2 to 6 months after operation(mean, 3.2 months). Osteomyelitis recurred 12 months after operation in 2 cases and healed by nidus clearing. Conclusion Free iliac flap which used to repair tibia traumatic osteomyelitis complicated with boneskin defect, can repair the defect at stageⅠand enhance the antiinfectious ability. It isone of appropriate and effective clinical methods.
Objective To build artificial dermis by using the acellular dermis matrix(ADM), collagen membrane and collagen gel as scaffolds. Methods The fibroblasts were isolated by enzyme from infant skin and were cultivated in the DMEM medium. After 14 days when the fibroblasts were seeded into 3 different scaffolds, the autografts were detected by HE staining, transmission electron microscope and scanning electron microscope. Results ①The fibroblasts obtained from the fullskin by enzyme could be passaged in the Dulbecco’s modified Eagle’s medium 2high gluco se w ith 10% calf bovine serum. ②A layer of fibroblastsw ere found on the surface of th ree different scaffo lds, the fibroblasts could grow into the co llagen membrane and the co llagengel, but could no t be found in the inner of ADM. ③A rt ificial derm is cont racted slightly by inoculat ing fabricat ion on collagen membrane and ADM , and the fibroblasts on them w ere no t act ive in proliferat ing; but the art ificial derm is built by the collagen gel cont racted obviously. Conclus ion The art ificial dermis built by ADM , collagen membrane and collagen gel as scaffolds have a preferable structure for an ideal subst itute of sk n, and can beused as the graft in the next experiments.
OBJECTIVE: To fabricate artificial human skin with the tissue engineering methods. METHODS: The artificial epidermis and dermis were fabricated based on the successful achievements of culturing human keratinocytes(Kc) and fibroblasts (Fb) as well as fabrication of collagen lattice. It included: 1. Culture of epidermal keratinocytes and dermal fibroblasts: Kc isolated from adult foreskin by digestion of trypsin-dispase. Followed by comparison from aspects of proliferation, differentiation of the Kc, overgrowth of Fb and cost-benefits. 2. Fabrication of extracellular matrix sponge: collagen was extracted from skin by limited pepsin digestion, purified with primary and step salt fraction, and identified by SDS-PAGE. The matrix lattice was fabricated by freeze-dryer and cross-linked with glutaraldehyde, in which the collagen appeared white, fibrous, connected and formed pores with average dimension of 180 to 260 microns. 3. Fabrication artificial human skin: The artificial skin was fabricated by plating subcultured Kc and Fb separately into the lattice with certain cell density, cultured for one week or so under culture medium, then changed to air-liquid interface, and cultured for intervals. RESULTS: The artificial skin was composed of dermis and epidermis under light microscope. Epidermis of the skin consisted of Kc at various proliferation and differentiation stages, which proliferated and differentiated into basal cell layer, prickle cell layer, granular layer, and cornified layer. Conifilament not only increased in number, but also gathered into bundles. Keratohyalin granules at different development stages increased and became typical. The kinetic process of biochemistry of the skin was coincide with the changes on morphology. CONCLUSION: Tissue engineered skin equivalent has potential prospects in application of repairing skin defect with advantages of safe, effective and practical alternatives.
Objective To review the latest research progress of full-thickness tissue engineered skin (FTTES), to thoroughly understand its current state of research and appl ication so as to lay a sol id foundation for developing new type FTTES and improving the qual ity of skin substitutes. Methods Domestical and international l iterature concerning FTTES in recent years was extensively reviewed and comprehensively analyzed. Results Some progress of FTTES had made in seedcells, scaffold materials and construction, and some therapeutic efficacy had also been achieved in cl inical appl ication. ButFTTES grafting successful rate was lower, and it had no complete skin structure and had not reached the requirements of cl inicalappl ication. Conclusion FTTES is an ideal skin substitute and has great development prospects. However, in seed cells, scaffold materials, construction and appl ications of FTTES, further studied is still needed.
Objective To compare the attachment and growth of fibroblasts on the different porcine accellular dermal matrix (ADM) so as to find the suitable scaffold for tissue engineering skin. Methods Fibroblasts (5×10 5) were seeded on 4 kinds of ADMs which were crosslinked with glutaraldehyde, uncrosslinked, crosslinked with glutaraldehyde and removed basement membrane, corsslinked with glutaraldehyde and then meshed. The same density fibroblasts were seeded on petri dish as a control. Cell count was done on the 1st, 3rd, 5th days after seeding. The at tachment of fibroblasts on ADM sw as observed by HE staining. Results The grow th and at tachment of fibroblasts on cro sslinked and non2meshed ADM increasedmarkedly w hen compared w ith the o thers. There w as no obvious difference betw een the group s of w ith o r w ithout basement membrane. Conclus ion The above results indicate that non2meshed and co rsslinked w ith glutaraldehyde ADM ismo re suitable fo r the at tachment and grow th of fibroblasts than the o thers and that the modified ADM can be used fo r the scaffo ld of t issue engineering skin.
From April 1984 to March 1994, 31 reconstructive thumbs or fingers were followedup, including 16 cases with free neurovascular big toe nail skin flap and frozen preserved phalanxjointtendon composite allografts as well as 15 cases withfree second toe transfer. The method had the advantage of more fingers could bereconstructed and fewer toes would be lost. The decision of the site of reconstruction of finger, the augmentation of narrow web space between the thumb and the index finger, the prevention and treatment of vascular crisis and the degeneration of allogenic joint were discussed. It had been found that preserving the allogenic finger below -30℃ may lower the immunoreaction of the allogenic tissues. It was emphasized that the viable tissues should be preserved during the emergency debridement, so as to facilitate the following reconstruction procedure.
摘要:目的:调查呼和浩特市地区变应性疾病患者常见变应原的分布情况。方法:以720例变应性疾病的患者为研究对象,进行11种吸入性变应原皮肤点刺试验,测定致敏变应原。结果:720例变应性疾病患者中577例(80.1％)变应原测试有阳性反应。577例阳性病例中艾蒿阳性率最高,315例(54.6％),其次是螨虫254例(44.0％)。结论:艾蒿、螨虫是呼和浩特市地区变应性疾病的最常见变应原。Abstract: Objective: To study the distribution of common allergens among patients of allergic diseases in Hohhot area.Method: Seven hundred and twenty cases of allergic disease were selected and 11 items of inhaled allergen skin prick tests were carried out to determine the allergens.Results:Five hundred and seventyseven patients out of the 720 (801％) reacted positively to allergen tests.Three hundreds aned fifty cases (546％) were positive in the mugwort,254 cases (440％) were positive in the mites.Conclusion: Mugwort and mites are the most common allergens in Hohhot area.
【Abstract】 Objective To investigate the effectiveness of the vacuum sealing drainage (VSD) technique with split middle thickness skin replantation for the treatment of severe skin closed internal degloving injury (CIDI). Methods Between July 2008 and April 2011, 16 patients with severe skin CIDI were treated. There were 11 males and 5 females, aged 17-56 years (mean, 28 years). Injury was caused by traffic accident in all cases. The time between injury and operation was 2-8 hours (mean, 5 hours). Peeling skin parts included the upper limb in 3 cases and the lower limb in 13 cases. The range of skin exfoliation was 5%-12% (mean, 7%) of the body surface area with different degree of skin contamination. After thorough debridement, exfoliative skin was made split middle thickness skin graft for in situ replantation, and then VSD was performed. Results After 7 days of VSD therapy, graft skin survived successfully in 14 cases; partial necrosis of graft skin occurred in 2 cases, and was cured after thorough debridement combined with antibiotics for 7 days. All patients were followed up 6-18 months (mean, 12 months). The appearance of the limb was satisfactory without obvious scar formation, and the blood supply and sensation were normal.The joint function was normal. Conclusion For patients with severe skin CIDI, VSD treatment combined with split middle thickness skin replantation can improve the local blood circulation of the limb, promote replantation skin survival, and shorten healing time of wound. The clinical effectiveness is satisfactory.