Objective To evaluate the effect of composite (bFGF/PDPB) of basic fibroblast growth factor（bFGF） and partially deproteinized bone (PDPB) on the repair of femoral head defect. Methods Forty-eight femoral heads with defect derived from 24 New Zealand rabbits were divided into 3 groups at random, which were implanted with bFGF/PDPB(group A), PDPB(group B) and nothing(group C) respectively.The rabbits were sacrificed at 2,4,and8 weeks after operation, and then the femoral heads were obtained. The specimens injected with Chinese ink were created. Then X-ray examination, histopathological and morphological examination of blood vessel, and image analysis were made. Results The bone defects healed completely 8 weeks after operation in group A. The implants in the repaired tissue were not substituted completely in group B. The bone defects did not heal completely in group C. Two weeks after operation, affluent newly formed vessels were seen in repaired areas in groupA. No significant difference between group A and group B was observed 8 weeks after operation. In group C, newly formed vessels were scarce 2, 4, and 8 weeks after operation. There were 3 sides rated excellent, 2 good and 1 fair in group A; 1 excellent, 2 good, 2 fair and 1 poor in group B; and 1 fair and 5 poor in group C according to the X-ray evaluation 8 weeks after operation. Eight weeks after operation, the volume fraction of bone trabecula in repaired tissue was higher in group A than that in group B (Plt;0.05), and the fraction in group C was thelowest among the 3 groups (Plt;0.05). Conclusion The composite ofbFGF and PDPB can effectively promote the repair of femoral head defect of rabbit.
ObjectiveTo study the clinical characteristics of patients with partial and transitional atrioventricular septal defects (P/TAVSDs) in our hospital, and to evaluate the early follow-up outcomes from a real-world research perspective.MethodsThe clinical data of all patients diagnosed with P/TAVSDs from January 1, 2018 to July 12, 2020, in our hospital were collected, and all patients' examination results were used as the real-world follow-up data, univariable Cox risk proportional model was used to analyze the outcomes. A total of 93 patients were finally included in the analysis, 72 with partial and 21 with transitional AVSD. There were 38 males and 55 females at age of 182.0 months (20.0 d to 779.5 months).ResultsUnivariable Cox proportional risk model suggested that at least one cardiac malformation (HR=15.00, 95%CI 3.00 to 75.00, P=0.001), preoperative moderate or greater mitral regurgitation (HR=6.60, 95%CI 1.70 to 26.00, P=0.007), and preoperative moderate or greater tricuspid regurgitation (HR=13.00, 95%CI 3.10 to 51.00, P<0.0001) were risk factors for moderate or greater postoperative atrioventricular valve regurgitation.ConclusionChildren with coarctation of the aorta or partial pulmonary vein connection, moderate or greater preoperative mitral regurgitation, and moderate or greater preoperative tricuspid regurgitation need to be alerted to the risk of moderate or greater postoperative atrioventricular valve regurgitation. Real-world data, with relaxed statistical P values and combined expertise, can suggest clinical conclusions that are close to those of high-quality retrospective studies.
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.
Objective To evaluate the surgical technique and effectiveness of arthroscopic treatment for lateral discoid meniscus injury. Methods Between January 2010 and May 2011, 38 patients (42 knees) with lateral discoid meniscus injuries underwent arthroscopic treatment. There were 23 males (24 knees) and 15 females (18 knees), aged 7-62 years (median, 32.8 years). The disease duration was 7 days to 40 years (median, 8.6 months). According to Watanabe’s classification of discoid meniscus, 22 knees were classified as complete type, 19 knees as incomplete type, and 1 knee as Wrisberg type. Meniscus plasty combined with suture was performed in 25 patients (28 knees), partial meniscectomy in 12 patients (13 knees), and complete meniscectomy in 1 patient (1 knee). After operation, the rehabilitation training programs (including straight-leg-raising exercise and range of motion exercise) were carried out. Results All incisions healed primarily. The patients basically had normal activities after 3-4 weeks. All the patient were followed up 12-18 months (mean, 14.3 months). No joint locked or clicking symptom occurred; no tear or revision was noted during follow-up. At 3 months, 6 months, and 1 year after operation, the range of flexion and extension were significantly improved when compared with ones at preoperation (P lt; 0.05). Based on Ikeuchi’s grading, the results were excellent in 22 knees, good in 16 knees, and fair in 4 knees with an excellent and good rate of 90.4%. The Lysholm score was significantly increased to 88.57 ± 2.95 at immediate, 91.02 ± 4.17 at 3 months, 92.90 ± 3.36 at 6 months, and 94.74 ± 3.52 at 12 months after operation from 69.38 ± 4.59 before operation (P lt; 0.05). C onclusion Treatment of lateral discoid meniscus injury under arthroscopy has the advantages of minor trauma, precise resection or repair meniscus, preservation of more meniscus function, and low incidence of osteoarthritis. If the operation is combined with standard rehabilitation training, the short-term effectiveness can be enhanced.
ObjectiveTo investigate the effect of external dissection and internal ligation, plus partial internal sphincterotomy in the treatment of mixed hemorrhoids. MethodsDuring January 2010 to January 2012, 364 patients with mixed hemorrhoids selected for surgery were divided into two groups based on whether the patients should accept the treatment of partial internal sphincterotomy. We observed the curative effect of the two groups, including anal pain, bleeding, edema, average healing days and the anorectal stenosis after operation. ResultsThere were statistical differences between the two groups in terms of anal pain, complication rate and hospital stay (P<0.01). The curative effect of the group treated with partial internal sphincterotomy was better than that of the other group. ConclustionExternal dissection and internal ligation, plus partial internal sphincterotomy is a better choice in the treatment of mixed hemorrhoids, which can relieve postoperative symptoms, reduce complications and shorten treatment course.
Constrained spherical deconvolution can quantify white matter fiber orientation distribution information from diffusion magnetic resonance imaging data. But this method is only applicable to single shell diffusion magnetic resonance imaging data and will provide wrong fiber orientation information in white matter tissue which contains isotropic diffusion signals. To solve these problems, this paper proposes a constrained spherical deconvolution method based on multi-model response function. Multi-shell data can improve the stability of fiber orientation, and multi-model response function can attenuate isotropic diffusion signals in white matter, providing more accurate fiber orientation information. Synthetic data and real brain data from public database were used to verify the effectiveness of this algorithm. The results demonstrate that the proposed algorithm can attenuate isotropic diffusion signals in white matter and overcome the influence of partial volume effect on fiber direction estimation, thus estimate fiber direction more accurately. The reconstructed fiber direction distribution is stable, the false peaks are less, and the recognition ability of cross fiber is stronger, which lays a foundation for the further research of fiber bundle tracking technology.
Objective To summarize experiences of surgical treatment and long-term results of myasthenia gravis (MG). Methods Two hundred thirty-six patients underwent thymectomy for MG in our department from Jan.1978 to Dec. 2002. The perioperative management, relative factors of postoperative crisis and long-term results were analysed. Results In 236 patients postoperative crisis took place in 44 cases accounted for 18.6%. The occurrence of postoperative crisis was related to preoperative management, modified Osserman clinical classification and combination with thymoma. Three cases died in the postoperative periods. Among them, one died of acute respiratory distress syndrome induced by aspiration and the other died of crisis. The effective rate in 1, 3, 5 years was 84.6%, 91.0% and 89.0% respectively. Conclusions Thymectomy for MG is safe and effective. Delayed extubation could decrease the needs of tracheotomy in patients with high risk factors for postoperative crisis. The partial sternotomy approach is less traumatic but the long-term effects of surgery are identical to those reported by the most authors.
ObjectiveTo understand the effect of nitric oxide (NO) on the formation of hyperdynamic circulatory syndrome (HCS) and the influence of level of NO on HCS. MethodsAfter establishment of stable HCS in partial portal vein ligated rats,the quantity of NO in blood of portal vein and the activity of nitric oxide synthase (NOS) in liver were determined by pre and post injection of inhabitor of NOS (NGmethylLarginine) and hemodynamics was supervised simultaneously.ResultsThe quantity of NO was paralleled with the activity of NOS and was elevated markedly by 24 hours after operation and reached the top by 48 hours after surgery. These sequential changes were coincided with the dilation of general vascularture. There was a close relation between this changes and the formation of HCS.The quantity of NO and the activity of NOS were decreased significantly to the level of the control group after injection of NGmethylLarginine (LNMMA). LNMMA inhabited the activity of NOS and blocked the production of NO. HCS ameliorated obviously. ConclusionNO plays an important role in initiating the dilation of general vascularture and plays a critical role in the formation of HCS. HCS will be ameliorated obviously or be blocked completely by eliminating the effect of NO and the portal pressure will decreased significantly or recover to normal range.
ObjectiveTo objectively evaluate the effectiveness of the ventricular fold pull-down combined with strip myofascial flap to repair laryngeal defect after early glottic carcinoma operation with glottic morphological parameters and voice parameters. MethodsBetween January 2008 and December 2012, 47 patients with early glottic carcinoma and anterior commissure involvement underwent partial laryngectomy. All patients were male, aged from 60 to 75 years (mean, 68.5 years). The disease duration was 4-11 months (mean, 7.2 months). According to American Joint Committee on Cancer (AJCC) TNM criteria, 28 cases were classified as T1aN0M0, 14 cases as T1bN0M0, and 5 cases as T2N0M0. Laryngeal defect after resection of tumor was repaired by ventricular fold pull-down combined with strip myofascial flap. At 1 day before operation and at 1 year after operation, multilayer spiral CT was used to scan larynx, to measure and compare the anteroposterior diameter of vocal area, the distance between both sides of the vocal process, and the thickness of soft tissue of vocal area, and the effect of combined soft tissue flap was objectively assessed in laryngeal morphology reconstruction. The actual voice parameters[including F0, Jitter, Shimmer, normalized noise energy (NNE), and maximum phonatory time (MPT)] were tested and compared, and the effect of the combined soft tissue flap on postoperative laryngeal pronunciation was evaluated. ResultsPostoperative pathological examination revealed well-differentiated squamous cell carcinoma in 38 cases, and moderately-differentiated squamous cell carcinoma in 9 cases; no tumor was found in the resection margin. Healing of neck incision was obtained in all patients at 7-9 days after operation. Forty-four cases were decannulated at 9-11 days after operation and the remaining 3 cases were decannulated at 3 weeks after operation. Oral feeding usually started in all cases at 3-4 days after operation. All patients were followed up 1 year. At 1 year after operation, the anteroposterior diameter of vocal area was significantly reduced when compared with preoperative one (t=15.161, P=0.000); the distance between both sides of the vocal process and the thickness of soft tissue of vocal area had no significant changes (P > 0.05). Compared with preoperative ones, there were significant differences in Shimmer, NNE, and MPT (P < 0.05), but no significant difference was found in F0 and Jitter (P > 0.05) at 1 year after operation. ConclusionVentricular fold pull-down combined with strip myofascial flap can repair laryngeal defect effectively after partial laryngectomy and maintain the effective airway after operation. It not only has no effect on postoperative laryngeal morphology, but also can be used as new laryngeal voice vibration body.
Objective To analyze the clinical effect of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection. Methods From January 2010 to December 2015, 30 patients (25 males, 5 females) underwent partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection with involvement of aortic root. The range of age was from 27 to 72 years, and the mean age was 51.2±8.0 years. The proximal aortic dissection received partial aortic root remodeling, and the operation procedures included partial aortic root remodeling+ascending aortic replacement in 9 patients, partial aortic root remodeling+ascending aortic replacement+hemi-arch replacement in 6 patients, partial aortic root remodeling+ascending aortic replacement+Sun's procedure in 15 patients. The patients were followed up for 10 to 60 months with a mean of 37.9±3.2 months. Preoperative and postoperative degrees of aortic regurgitation were compared. Results All patients survived from the operation, and one patient died from severe pulmonary infection 15 days after operation. The overall survival rate was 96.7% (29/30). One patient died during the follow-up. Two patients underwent aortic valve replacement in the 12th and 15th postoperative month respectively because of severe aortic regurgitation (AI). Up to the last follow-up, trivial or no aortic regurgitation was demonstrated in 24 patients, but mild aortic regurgitation occurred in 2 patients. Conclusion The surgical treatment for aortic root pathology due to Stanford type A aortic dissection is challenging, and partial aortic root remodeling operations could restore valve durability and function, and obtains the early- and mid-term results.