Objective To introduce the possible effects and significances of angiogenesis and antiangiogenic in the development and treatment of hepatocellular carcinoma (HCC). Methods Recently relevant literatures were reviewed. Results Angiogenesis played a significant role in the development and therapy of HCC, and the development and metastasis of HCC could be effectively suppressed by antiangiogenic therapy. This might provide a new approach for the treatment of HCC. Conclusion Comprehending the molecular mechanism of angiogenesis and applying antiangiogenic therapy will contribute a lot for the prevention and treatment of HCC.
Objective To investigate the clinical value of " O”continuous biliary-enteric anastomosis combined with percutaneous transhepatic cholangial drainage (PTCD) in pancreaticoduodenectomy (PD). Methods The clinical data of 35 patients with PD who were admitted to Xinyang Central Hospital from June 2015 to June 2017 were retrospectively analyzed. Results All patients completed the " O” continuous biliary-enteric anastomosis combined with PTCD without perioperative death. ① The preoperative indwelling time of PTCD tube was (13.24±3.39) d, total bilirubin (TBIL) was (363.67±12.26) μmol/L on admission and (155.59±17.63) μmol/L on preoperative after PTCD, respectively. ② The operative time was (231.46±18.69) min, the intraoperative blood loss was (158.30±31.33) mL, the diameter of the hepatic ductal segment was (1.3±0.2) cm, and the duration of the " O” continuous biliary-enteric anastomosis was (7.31±1.52) min. ③ After surgery, the indwelling time of PTCD tube was (8.13±1.49) d, the hospitalization time was (27.31±5.49) d. Biliary leakage occurred in 1 case, pancreatic fistula occurred in 5 cases (3 cases of biochemical sputum and 2 cases of B-stage pancreatic fistula), abdominal infection occurred in 2 cases, pneumonia occurred in 3 cases, wound infection occurred in 2 cases. No postoperative biliary-enteric anastomosis stenosis, biliary tract infection, and intra-abdominal hemorrhage occurred. There was no laparotomy patients in this group and all patients were discharged. ④ All patients were followed-up for 180 days after surgery. No death, bile leakage, biliary-enteric anastomotic stenosis, biliary tract infection, pancreatic fistula, gastro-intestinal leakage, and abdominal infection occurred. One case of delayed gastric emptying and 2 cases of alkaline reflux gastritis were cured after outpatient treatment. Conclusions The preoperative PTCD can improve the preoperative liver function and increase the security of PD. " O” continuous biliary-enteric anastomosis is simple, safe, feasible, and has the function of preventing biliary-enteric anastomosis stenosis. For severe jaundice patients with blood TBIL >170 μmol/L, the " O” continuous biliary-enteric anastomosis combined with PTCD is an alternative surgical procedure for PD.
Over the past 20 years, transcatheter mitral valve edge-to-edge repair (TEER) has become an important treatment option for patients with severe mitral regurgitation (MR) who are at high surgical risk. Initially, several landmark clinical studies established the basis of TEER for primary and secondary MR, but they only involved clinically stable patients with appropriate mitral valve anatomy. With the increasing experience of interventional therapy, the iteration of equipment and the improvement of intraoperative imaging technology, the scope of use of TEER has been continuously expanded, and its indications have been continuously expanded to more complex mitral valve lesions and clinical situations. Therefore, in clinical practice, selecting the appropriate device according to the individual anatomical characteristics of the patient can minimize MR and complications, thereby optimizing immediate and long-term prognosis. This article mainly introduces the pathogenesis and related mechanisms of MR, the main TEER devices and their clinical evidence, the limitations of TEER, and the future development direction.
目的:比較不同麻醉方法在腹腔鏡婦科不孕檢查及治療術中的效果和安全性。方法:選擇不孕擬在腹腔鏡下行檢查及治療術的患者60例,隨機分為三組,每組20人,分別進行連續硬膜外麻醉(簡稱EA組);靜吸復合全身麻醉(簡稱GA組);連續硬膜外麻醉加靜吸復合全身麻醉(簡稱EGA組),觀察比較三種麻醉方法對患者呼吸,循環及麻醉效果的影響。結果:三種麻醉方法均可保證手術完成,EA組術中管理較為麻煩,GA組循環波動大,EGA組麻醉效果更好,各種藥物用量減少,患者血液動力學更穩定,恢復快,管理更輕松。結論:連續硬膜外麻醉加靜吸復合全身麻醉(EGA)可避免其它兩種麻醉方式不足,各取長處,更適用于腹腔鏡婦科不孕檢查及治療術麻醉。
ObjectiveTo study the expression of survivin protein in primary hepatocellular carcinoma(PHC) and its relationship to the proliferation of the tumor cells and prognosis of PHC. MethodsThe expression of survivin protein and the proliferation of tumor cells marked by proliferating cell nuclear antigen (PCNA) in 48 cases of PHC were determined by immunohistochemical method. ResultsThe survivin protein was expressed in 31 of 48 cases of PHC (64.6%). The expression of PCNA was significantly higher in hepatocellular carcinoma (HCC) with positive survivin expression than in HCC with negative survivin expression. The patients with positive survivin expression had the worse prognosis than those with negative survivin expression. ConclusionThe expression of survivin may play an important role in the proliferation of PHC cells and closely associate with the prognosis of PHC, and probably become the prognostic factor and an important target of therapy.
ObjectiveTo preliminary study on the feasibility of constructing three-dimensional (3D) hippocampal neural network in vitro by using microfluidic technology.MethodsA network patterned microfluidic chip was designed and fabricated by standard wet etching process. The primary hippocampal neurons of neonatal Sprague Dawley rats were isolated and cultured, and then inoculated on microfluidic chip for culture. Immunofluorescence staining was used to observe the growth of hippocampal neurons at 3, 5, and 7 days of culture and electrophysiological detection of hippocampal neuron network at 7 days of culture.ResultsThe results showed that the number of hippocampal neurons increased gradually with the prolongation of culture time, and the neurite of neurons increased accordingly, and distributed uniformly and regularly in microfluidic chip channels, suggesting that the 3D hippocampal neuron network was successfully constructed in vitro. Single and multi-channel spontaneous firing signals of hippocampal neuronal networks could be detected at 7 days of culture, suggesting that neuronal networks had preliminary biological functions.ConclusionPatterned microfluidic chips can make hippocampal neurons grow along limited paths and form 3D neuron networks with corresponding biological functions such as signal transduction, which lays a foundation for further exploring the function of neuron networks in vitro.
ObjectiveTo review the research progress on the establishment of prevertebral pathway in the treatment of unilateral total brachial plexus injury, cerebral palsy, stroke, and traumatic brain injury by contralateral C7 nerve root transfer.MethodsThe literature about contralateral C7 nerve root transfer via prevertebral pathway at home and abroad was extensively reviewed, and the development, changes, advantages and disadvantages of various operation methods were analyzed and summarized.ResultsAfter unilateral total brachial plexus injury, cerebral palsy, stroke, and traumatic brain injury, it can be repaired by a variety of surgical methods of the contralateral C7 nerve root transfer via prevertebral pathway, which include the anterior subcutaneous tissue tunnel of the vertebral body, the passage under the sternocleidomastoid muscle, the posterior pharyngeal space and the anterior vertebral fascia passage, the modified posterior esophageal anterior vertebral passage, the anterior vertebral passage that cuts off the bilateral anterior scalene, and Huashan anterior pathway, etc. Among them, how to establish the shortest, safe, and effective way of anterior vertebral canal has been paid more attention and discussed by peripheral nerve repair doctors.ConclusionIt is a safe and effective surgical method to repair unilateral total brachial plexus injury, cerebral palsy, stroke, and traumatic brain injury patients with contralateral C7 nerve root transfer via prevertebral pathway.
ObjectiveTo investigate the effectiveness of modified extensor indicis proprius (EIP) tendon transfer for reconstruction of spontaneously ruptured extensor pollicis longus (EPL) tendon by comparing with the traditional EIP tendon transfer. MethodsBetween January 2009 and December 2011, 11 cases of spontaneously ruptured EPL tendon were treated by modified EIP tendon transfer to reconstruct extension function (modified group). On the base of traditional procedure, the proximal end of EPL tendon was sutured with EIP tendon and the distal end of EIP tendon was crossed round extensor pollicis brevis (EPB) tendon and sutured back with EPL tendon. A specific EI-EPL evaluation method (SEEM) was used to measure the EPL tendon function after transfer. The result was compared with that of the other 18 cases undergoing traditional operation (traditional group). There was no significant difference in gender, age, disease duration, and injury causes between 2 groups (P gt; 0.05). ResultsAll incisions healed by first intention. In traditional group, 5 cases were out of follow-up, and the other 24 cases were followed up 1 year and 6 months on average (range, 8 months-2 years and 6 months). At the last follow-up, according to the evaluation of SEEM, the thumb elevation and flexion deficits of modified group were significantly less than those of traditional group (P lt; 0.05). The independent elevation deficit of the index finger of modified group was similar to that of traditional group (P gt; 0.05). The effectiveness was excellent in 9 cases and good in 2 cases with an excellent and good rate of 100% in modified group, and was excellent in 5 cases, good in 6 cases, and fair in 2 cases with an excellent and good rate of 84.6%. The effectiveness of modified group was significantly better than that of traditional group (χ2=0.03, P=0.03). ConclusionReconstruction of EPL tendon function by modified EIP tendon transfer is effective and easy. It can increase strength of the transferred tendon and obtain satisfactory results, but the long-term effectiveness needs further follow-up.
Objective To access the efficacy and safety of different doses of metoprolol for patients with chronic heart failure. Methods We searched databases such as MEDLINE, EMbase, The Cochrane Library, CBM and CMCC. The search was conducted in March 2006. Randomised controlled trials, systematic reviews, and current guidelines of chronic heart failure were reviewed. The efficacy and safety of the high-dose (≥100 mg/d) and low-dose metoprolol (lt;100 mg/d) were compared. Results Only one small-scale, short-term randomised trial met our inclusion criteria. This found that metoprolol 100 mg/d was more effective than 25 mg/d and 50 mg/d. A sub-group analysis of MERIT-HF recommended individualized titration for drug administration. Most guidelines suggested that the administration of metoprolol CR/XL for chronic left ventricular systolic dysfunction should be performed by titrating up to 200 mg/d or the maximum tolerance dose. Patients receiving 100 mg/d might have more adverse events than those receiving a lower dose than this. However, in the long-term, it’s the benefits of high-dose treatment outweighed its risks. Race-related differences in tolerance or dose-related adverse effects were not found. Conclusion We couldn’t determine an optimal dose based on the existing evidence, but a target dose of metoprolol CR/XL 200 mg/d is safe and effective. We are unable to draw any conclusions about the relationship between dose and adverse effects.
Heritable aortic disease (HAD) is characterized by thoracic aortic aneurysm/dissection with strong genetic predisposition and high clinical phenotypic heterogeneity. HAD is one of the main causes of sudden death. Early diagnosis of this disease is difficult because of atypical clinical symptoms, leading to the deterioration of disease with the development of aortic aneurysm, aortic dissection or sudden death. Genetic testing plays an important role in the early diagnosis, standardized follow-up, screening of family members, genetic counseling and individualized treatment of HAD. This review focused on the application of genetic testing in the standardized diagnosis and treatment of HAD.