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Objective:To investigate the clinical effect of a 3D reconstruction assisted preoperative optimal design of anterolateral abdomen cross-region free perforator flaps for repair of soft tissue defects of limbs.Methods:Twenty patients who were treated for soft tissue defects of hand, forearm, foot and ankle in the Department of Hand Surgery, the Sixth Hospital of Ningbo from October 2017 to January 2020 were included in this study. Among the patients,17 had soft tissue defects in hand and forearm and 3 with composite tissue defects including ankle and soft tissue defect of foot. The sizes of soft tissue defects in limbs ranged from 6 cm × 8 cm - 36 cm × 18 cm. Twenty free cross-area perforator flaps were optimal designed with CTA and 3D assisted reconstruction before surgery. Following combinations of flaps were designed: (1) Free perforator flap with inferior abdominal artery and superior abdominal artery; (2) Free perforator flap with superficial iliac circumflex artery and deep iliac circumflex artery; (3) Free perforator flap with superficial iliac circumflex artery and inferior abdominal wall perforator artery; (4) Free perforator flap with perforators of superficial iliac circumflex artery plus superficial abdominal artery; (5) Free perforator flap with perforating artery of lower abdominal wall and superficial artery of abdominal wall. The overall nutritional area of a combined flap were 272.3 cm 2± 12.5 cm 2, 107.4 cm 2± 9.3 cm 2, 193.6 cm 2± 24.2 cm 2, 155.2 cm 2± 20.1 cm 2 and 203.7 cm 2± 16.3 cm 2, respectively. All the donor sites were sutured directly in one stage. The appearance, texture, blood supply, colour, joint movement of affected limbs, recovery and function of donor sites were observed through postoperative follow-up visits at the outpatient clinic. Results:Among the 20 anterolateral transventral perforator flaps, 18 flaps survived successfully; One had partial necrosis after surgery, and healed after dressing change. Subcutaneous haematoma occurred in 1 flap, and survived after drainage. In this study, there was no postoperative infection of flap. A total of 19 flaps healed in one stage, except 1 that had a delayed healing and the flap wound was closed after dressing change for 1 week. According to Disability of Arm, Shouder and Hand (DASH) questionnaire evaluation, which is widely used in the world to evaluate the therapeutic effect after limb injury, combined with the 6-12 months of follow-up, the functional recovery of 17 patients with upper limbs iniury was 7 in excellent, 9 in good and 1 in poor. The overall excellent and good rate achieved 94.1%. All the 3 patients with foot injury recovered well, and the walking and jumping were not significantly affected. The results were all excellent according to the Maryland Foot Function Scoring. Sensation of flaps was evaluated according to the British Sensory Function Evaluation, it showed: 3 in S 2, 15 in S 3 and 2 in S 3+. All 20 flaps had good blood supply, in soft texture, good colour, feeling, thickness and movement. The donor sites all healed well. Conclusion:Combined with an optimal preoperative design, the perforator flap of anterior lateral wall cross-region can obtain a satisfactory clinical efficacy in repair of large area soft tissue defects. It is a feasible treatment method.
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Radial head fracture accounts for one third of the elbow joint fracture.At present,for fractures without obvious displacement,non operative treatment can achieve good results.In the case of complicated comminuted fracture of the radial head,open reduction with internal fixation and the radial head replacement have their own advantages and disadvantages.There is no exact reference for the selection of surgical procedures,and the best treatment regimen remains controversial.No matter which method is adopted,it is necessary to repair accompanied injuries.Meanwhile,postoperative standard rehabilitation exercise is also essential for the recovery of elbow function.The typing of radial head comminuted fracture and the status quo of its treatment is reviewed in this paper,so as to provide reference for better clinical treatment.
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The Essex-Lopresti lesion is characterized by a fracture of the radial head with concomitant rupture of the interosseous membrane and disruption of the distal radioulnar joint. The EssexLopresti lesion is rare and serious, easily subject to missed diagnosis. However, all sorts of therapeutic methods can only yield poor results for chronic Essex-Lopresti lesion. Therefore, early and accurate diagnosis is crucial. The key to treat acute Essex-Lopresti lesion is the reconstruction of radial head and restoration of radius length, preventing the proximal move of radius. At the same time, the distal radioulnar joint should be reset and stablized, and the triangular fibrocartilage complex(TFCC) repaired, so as to restore the normal anatomic relation between radiu and ulna and to reconstruct forearm longitudinal stability. Further studies are needed on whether the forearm interosseous membrane needs repair as well as on repair method selection. The author reviews the Essex-Lopresti injury treatment methods in order to facilitate better clinical treatment.
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<p><b>OBJECTIVE</b>To photoelastically investigate the difference in load distribution of Tension More (TM) implants with different conical angle designs.</p><p><b>METHODS</b>The following five groups of implants of different conical angles were designed: cylinder implant, upper 1/3 TM implant (taper length of 3 mm); 1/2 TM implant (taper length of 5 mm); lower 1/3 TM implant (taper length of 7 mm); and bottom TM implant (taper length of 10 mm). The implants were centrally located in individually photoelastic models consisting of a simulated trabecular bone and a 1 mm-thick layer of cortical bone. Vertical and 45° oblique static loads were applied at the center of the superstructures. The resulting stresses were monitored photoelastically and recorded photographically. RESULTS With vertical loading, the cylinder implant showed higher stress levels in the cortical bone and trabecular bone than the upper 1/3 TM implant, 1/2 TM implant, and lower 1/3 TM implant. The four groups of TM implants showed lower stress levels in the cortical bone than the cylinder implant under oblique loads. The least favorable stress concentration in cortical bone was observed in the upper 1/3 TM implant under vertical and oblique loads.</p><p><b>CONCLUSION</b>TM implants of rational conical angle designs seem to be effective in stress distribution. For all designs and load directions, the upper 1/3 TM implant is the most favorable around the crest.</p>
Subject(s)
Bone and Bones , Dental Implants , Stress, MechanicalABSTRACT
Interferon beta (IFN-beta) and TNF-related apoptosis-inducing ligand (TRAIL) are effective anticancer agents. Adeno-associated virus (AAV) is one of the current most promising gene delivery vectors. Previously, we constructed tumor-targeting AAV-hTERT-IFN-beta and AAV-hTERT-TRAIL by inserting IFN-beta or TRAIL gene into AAV controlled by hTERT promoter. The studies showed that either single IFN-beta or TRAIL gene therapy exhibited a certain extent anticancer effect. Here, we report their inhibitory effects on A549 lung cancer cell growth in vitro and in vivo by combined AAV-hTERT-IFN-beta and AAV-hTERT-TRAIL. Expression of secreted IFN-beta in lung cancer A549 cells infected by AAV-hTERT-IFN-beta was detected by enzyme-linked immunosorbent assay (ELISA). The growth-suppressing effect of AAV-hTERT-IFN-beta in combination with AAV-hTERT-TRAIL on several cancer cell lines was assessed by MTT assay. Apoptosis of A549 cancer cells infected by AAV-hTERT-IFN-beta alone, AAV-hTERT-TRAIL alone, and their combination was evaluated by apoptotic cell staining and flow cytometry (FCM), respectively. The antitumor effect of the combination of AAV-hTERT-IFN-beta with AAV-hTERT-TRAIL in vivo was further evaluated through A549 lung cancer xenograft in nude mice. The results showed that the combinational treatment was superior to any alone and presented intensified tumor cytotoxic and apoptotic effect on A549 cancer cells. Most importantly, the combination of AAV-hTERT-IFN-beta with AAV-hTERT-TRAIL exhibited significant antitumor effect and eliminated all tumor masses in nude mice, which lay a foundation for exploring the molecular mechanisms of combined IFN-beta and TRAIL anti-tumor activity.
Subject(s)
Animals , Humans , Mice , Antineoplastic Agents , Metabolism , Pharmacology , Cell Line, Tumor , Dependovirus , Genetics , Metabolism , Genetic Therapy , Genetic Vectors , Genetics , Interferon-beta , Genetics , Pharmacology , Lung Neoplasms , Pathology , Therapeutics , Mice, Nude , Neoplasm Transplantation , Recombinant Fusion Proteins , Genetics , Pharmacology , TNF-Related Apoptosis-Inducing Ligand , Genetics , PharmacologyABSTRACT
Objective To investigate The effect of Heat shock protein 70(HSP70) antisense oligonucleotides (ASO)to bladder carcinoma in mouse loaded with tumor.Methods The 40 mice loaded with tumor subcutaneously were established by cultured BIU-87 cells,and divided into 4 groups randomly when the subcutaneous neoplasms grew to about 100 mm3,namely,HSP70 mRNA ASO plus mitomycin C(MMC)group;HSP70 mRNA ASO group;MMC and blank control.HSP70 mRNA ASO were injected into neoplasms,10mmg/kg weight,twice every week,and MMC 0.1mg/kg weight,twice every week,and the above schemes were replaced with normal saline to blank.The neoplasms were peeled off,photograghed and weighed in 30 days.HSP70 expressions were examined with reverse transcription polymerase chain reaction (RT-PCR),mierovaseular density(MVD)was evaluated by immunohis to chemical staining and the tumor cells apoptosis was detected by terrainal deoxynucleotidyl transferase(TdT)-mediated dUTP-biotin nick end labeling technique (TUNEL).Results The tumor inhibition rate in ASO+MMC surpassed 50%.more than ASO or MMC respectively,and the differences were significantly(P＜0.05).The ASO and MMC exceeded blank group respectively(P＜0.05).The ASO was the same as the MMC(P＞0.05).The apoptotic index(AI)in ASO+MMC surpassed the other three groups (P＜0.05).The difference between ASO and MMC was not significant (P＞0.05),while the A1 of ASO or MMC was more than blank respectively(P＜0.05).The results of MVD were in accordance with the above results.Conclusion The injection of HSP70 mRNA ASO in tumor locally can inhibit neoplasm growth,and this effect might correlate with the inhibition of apoptosis and microvascular forming resulting from the ASO.
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Objective To investigate the expression of HSP 70 mRNA in transitional cell carcinoma of bladder and association of HSP 70 mRNA with cell apoptosis. Methods In situ hybridization histochemistry(ISHH) was applied to detect HSP 70 mRNA expression in 60 patients with transitional cell carcinoma of bladder,and cell apoptosis was evaluated by means of terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labeling technique(TUNEL). Results Of 60 cases of bladder transitional cell carcinoma,HSP 70 mRNA expression was 56.7%(34/60),and it increased with grade and stage progressing( P
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Objective To construct directional expressing cDNA library from normal testes in Chinese males for further studying the structure and functions of spermatogenesis related genes. Methods mRNA of normal testes from a Chinese male was isolated and the cDNA synthesized by reverse transcription.After being digested by SalI and NotI ,dscDNA was subcloned into expressing plasmid pSPORT1 directionally.Finally,the directional expressing cDNA library from normal testes in Chinese males was constructed. Results The transformation rate of the library was 7?10 5.Ten clones were chosen and analysed. Digested by SalI and NotI ,the fragments of 0.5～2.0 kb were obtained with cDNA inserted. Conclusions The present study indicates that the directional expressing cDNA library from normal testes in Chinese males is qualified to screen genes and is considered to be helpful for studying the structure and functions of spermatogenesis related genes.