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Objective:To study the efficacy of different surgical methods in treatment of hilar cholangiocarcinoma (HCCA), and to analyze the factors affecting long-term prognosis of HCCA patients after surgical treatment.Methods:The clinical data of 105 patients who underwent surgical treatment for HCCA at the First Affiliated Hospital of Soochow University from April 2010 to October 2021 were retrospectively analysed. There were 58 males and 47 females, with age (64.2±10.6) years old. Data analysed included surgical treatments, postoperative pathological data, perioperative complications and survival on follow-up. The Kaplan Meier survival curve was plotted, and the log-rank test and Cox proportional hazard model were performed to analyze the key factors affecting long-term prognosis.Results:Of 105 patients, 4 (3.8%) patients died during the perioperative period, and 58 patients (55.2%) developed complications with included 32 (30.5%) patients with pleural effusion and 12 (11.4%) patients with biliary leakage. The follow-up data was available in 85 patients with the overall median survival time of 19 months, and the 1-, 3-, 5-year cumulative survival rates of 58.1%, 27.0% and 24.8% respectively. The 1-, 3-, and 5-year cumulative survival rates for the R 0 resection patients ( n=59) were 69.4%, 36.2%, 27.4%, respectively, which were significantly better than 49.4%, 12.3%, 0% for the R 1/2 resection patients ( n=20), and 0% for the palliative drainage patients ( n=6) (all P<0.05). Univariate analysis and Cox multivariate analysis showed that age ≥70 years ( HR=2.158, 95% CI: 1.175-3.965), preoperative CA19-9 level ≥1 015 U/ml ( HR=1.981, 95% CI: 1.009-3.894), resection margin ( HR=2.587, 95% CI: 1.371-4.881), and lymph node metastasis ( HR=2.308, 95% CI: 1.167-4.567) were independent risk factors for long-term prognosis of HCCA patients (all P<0.05). Conclusions:R 0 resection was an effective way to prolong survival of patients with HCCA. Age, preoperative CA19-9 level, resection margin and lymph node metastasis were related to long-term survival of HCCA patients.
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In recent years, society has gradually shifted from a "fearful" approach of unscientific plan design, unbalanced resource protection and inadequate management experience leading to the spread of public panic and negative emotions to a "comfortable" approach of proactive prevention, precise control, information symmetry, scientific response and systematic treatment in the face of public health emergencies. College students are increasingly becoming the "key minority" to participate in crisis management. This is mainly due to their values in line with social ideals, their mobility in line with disciplinary practice and volunteerism, their knowledge accumulation in multi-disciplinary cross-fertilization, and their good cognitive thinking literacy, high information media literacy and perfect social support system. Therefore, this group has a strong comprehensive advantage in public health emergencies. Based on this background, combined with on-site investigation and interview feedback, this paper considered that this group can play an active role in normal prevention and early warning beforehand, information transmission and communication at the moment the event occur, corrective cognitive implementation and disposal in the event, and scientific research innovation and popularization afterwards, so as to better play an increasingly important leading demonstration effect in public health emergencies. At the same time, it can also encourage universities to take the initiative in the process of talent training to teach people according to the concept of "change according to the matter, advance according to the time and new according to the situation", and lead college students of different majors to maximize the pioneering effect of role models in public health emergencies.
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Objective:To investigate the application of anterolateral thigh chimeric perforator flap in repairing complex soft tissue defects in lower extremities.Methods:From January, 2015 to June, 2019, 76 cases of complex soft tissue defects in lower extremities were repaired with free anterolateral thigh chimeric perforator flap pedicled with the descending branch of lateral circumflex femoral artery, including 29 cases in shank and 47 cases in ankle, and all had various tissue necrosis, infection, deep tissue defect and orthopaedic implant exposure. The size of the wound ranged from 15 cm×8 cm to 35 cm×20 cm, in which 45 cases associated with dead cavity formation, 62 cases with combined fractures at the same site, and 38 cases with combined fractures or other system injuries in other sites. After debridement, VSD treatment, good wound granulation and infection control, the chimeric perforator flap pedicled with the descending branch of the circumflex lateral femoral artery was designed and harvested. The perforator flap was used to repair most of the wounds with deep tissue exposures, the muscle flap was used to fill the dead cavity and (or) cover the wound around the flap, and free skin was grafted of the muscle flap at the first or second stage. Scheduled follow-up was conducted after the operation.Results:All 76 flaps survived, including vascular crisis occurred in 2 cases within 72 hours after surgery and ceased after immediate surgical exploration. One case had a further surgical operation due to excessive bleeding. Partial necrosis occurred at the distal end of the flap or the skin graft area of the muscle flap in 4 cases, of which 2 cases were treated with grafted skin again and the other 2 cases completely eliminated the wound after active dressing change. Other 16 cases of post-traumatic osteomyelitis with bone defect were repaired respectively with bone grafting, bone transportation or Masquelet technique in 3 to 6 months after wound healing. Among the 76 cases, 68 cases had primary wound healing while 8 cases delayed. Seventy-one cases were followed-up from 9 to 24 months, with an average of 16 months, while 5 cases lost. The appearance and function of the affected limbs recovered satisfactorily without recurrence of infection.Conclusion:With the anterolateral thigh chimeric perforator flap transplantation, the perforators flap can be conveniently used to repair the wound, and the muscle flap can be used to fill dead cavity and(or) deep wounds with free skin graft. Only the descending branch of lateral circumflex femoral artery is required to be anastomosed. It achieves a 3-dimensional effective reconstruction of the complex wound in extremities. It is a safe and effective technique to repair and reconstruct the complex wound in lower extremities and ideal in clinical applications.
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Objective: To review the research progress of medicine biomaterials in prevention and treatment of adhesion after tendon injury, and to provide reference for clinical treatment. Methods: The literature on the application of medical biomaterials in the prevention and treatment of tendon adhesions in recent years was reviewed, and the biological process, treatment methods, and current status of tendon adhesions were summarized. Results: Tendon adhesion as part of the healing process of the tendon is the biological response of the tendon to the injury and is also a common complication of joint dysfunction. Application of medical biomaterials can achieve better biological function of postoperative tendon by reducing the adhesion of peritendon tissues as far as possible without adversely affecting the tendon healing process. Conclusion: The use of medical biomaterials is conducive to reduce the adhesion of tendon after operation, and the appropriate anti-adhesion material should be selected according to the patients' condition and surgical needs.
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Objective To evaluate the feasibility and clinical efficacy of our self-designed simple skin stretching device combined with collagen sponge for management of severe soft tissue wounds.Methods From September 2015 to October 2017,a consecutive series of 43 patients whose soft tissue wounds could not be closed primarily were enrolled for a therapy using a simple skin stretching device made of round osseous pins and wire combined with collagen sponge.They were 27 males and 16 females,with a mean age of 31.5 years (from 5 to 56 years).There were 18 fresh wounds and 25 old ones.Their skin defects ranged from 5.5 cm × 3.0 cm to 18.0 cm × 7.5 cm.After debridement and vacuum sealing drainage,2 round osseous pins with a diameter of 2.0 mm or 2.5 mm were driven through the dermis about 1 to 2 cm from both edges of the wound,in parallel with the longitudinal axis of the wound.After the parts of 2 pins exposed outside the skin were bent,they were fixed respectively with a fine wire with 2 twisted strands.The wounds were continuously stitched with eversion suture.The wires and sutures were gradually tightened to contract the wounds until the skin color changed and capillary filling reaction started.Then medical collagen sponge was used to cover the wounds.Next,the wires and sutures were tightened continuously until the wound edges were pulled together.Details of this therapy and its complications were recorded.Follow-up visits were paid until wound healing.Results Of the 43 cases,the wounds were directly closed immediately after primary stretching procedure in 8,closed after skin stretching for 4 to 12 days (average,7.5 days) in 30,and significantly reduced in 5 which were cured following skin graft.Eventually,40 cases were followed up for an average of 6.8 months (from 3 to 18 months) and 3 were lost.Aesthetic reoperation was performed in 3 patients who were inflicted with postoperative scar formation after skin graft.Linear healing of the wound edges was achieved in 37 patients without complications like skin necrosis,pathological hyperplasia scar,skin sensation deletion or wound infection,leading to fine appearance and functional recovery.Conclusion Our self-designed simple skin stretching device combined with collagen sponge provides a cost-effective and practical technique for clinical treatment of soft tissue defects,with an advantage of reducing or even avoiding secondary repair with skin graft or skin flap.
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Objective To develop a rapid kit applied to the field for detection of antibody to schistosome in human sera. Methods A new kit for rapid detection of antibody to schistosome was developed through improving the dot immunogold filtration assay (DIGFA). A total of 100 cases of sera from chronic schistosomiasis patients and 140 from healthy people, HBV patients and the people infected with other parasites were detected by the kit. The sensitivity, specificity, Youden's index and Kappa value were utilized as the evaluation standard. Results The sensitivity of detecting antibody to schistosome, specificity, Youden's index and Kappa value were 92% , 95.08% , 0.87 and 0.87, respectively. The cross reaction to patients with clonorchiasis was 5%. Conclusion DICFA kit is practical for antibody to schistosome detection in the field because of its advantages such as smaller serum needed and faster in reaction.
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In order to observe the effect of Bushenantai recipe on the expression of endometrial leukemia-inhibitory factor (LIF) in mice with embryonic implantation dysfunction (EID), 120 Kunming mice post coition were randomized into three groups: normal control group, model group and traditional Chinese medicine group (TCM group) (n=40 in each group). Uterus was collected on the pregnancy day (Pd) 4, 5, 6 after an intravenous injection of Evan's blue. The endometrium was dyed by Evan's blue and the mean points of response were observed on Pd 5. The expression of LIF mRNA and protein was detected by RT-PCR and immunohistochemistry respectively and analyzed statistically by image system. The results showed that the number of implantation sites in model group was remarkably less than in normal control group and TCM group. There was no significant difference between normal control group and TCM group. The expression of LIF mRNA and protein in model group was delayed. Bushenantai recipe could increase the expression of LIF mRNA and protein in endometria of mice with EID. It was suggested that Bushenantai recipe could improve embryo implantation of mice with EID by promoting the endometrial LIF expression and endometrial decidualization.
Subject(s)
Blastocyst/cytology , Embryo Implantation , Endometrium/metabolism , Gene Expression , Gene Expression Regulation, Developmental , Leukemia Inhibitory Factor/biosynthesis , Leukemia Inhibitory Factor/genetics , Medicine, Chinese Traditional , Models, Biological , Plant Extracts/pharmacology , RNA, Messenger/metabolism , Time FactorsABSTRACT
The effect of triptolide (TP) on the expression of receptor activator of nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) was explored in rat adjuvant induced arthritis (AA). AA was induced in Wistar rats. Arthritis rats were treated with TP and methotrexate (MTX) at the onset (day 9) of arthritis. On the peak of arthritis (day 24), the expression of RANKL and OPG protein in the joints and RANKL mRNA in peripheral blood mononuclear cells (PBMC) was detected. TNF-alpha and IL-1beta levels in peripheral blood were determined. Bone erosion scores were also evaluated. The results showed that bone erosion scores in TP and MTX groups were lower than in AA group (P < 0.01); The expression levels of RANKL in the synovium (P < 0.01) and bone (P < 0.05), and OPG level in synovium (P < 0.05) were lower in TP group than in AA group (P < 0.05). In TP group, the expression levels of RANKL mRNA and TNF-alpha, IL-1beta in PBMC were lower than in AA group (all P < 0.01). It was concluded that TP could inhibit rat adjuvant arthritis bone erosion by suppressing the expression of RANKL.
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The effect of triptolide (TP) on the expression of receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) was explored in rat adjuvant induced arthritis (AA).AA was induced in Wistar rats. Arthritis rats were treated with TP and methotrexate (MTX) at the onset (day 9) of arthritis. On the peak of arthritis (day 24), the expression of RANKL and OPG protein in the joints and RANKL mRNA in peripheral blood mononuclear cells (PBMC) was detected. TNF-α and IL-1β levels in peripheral blood were determined, Bone erosion scores were also evaluated. The results showed that bone erosion scores in TP and MTX groups were lower than in AA group (P＜0.01); The expression levels of RANKL in the synovium (P＜0.01) and bone (P＜0.05), and OPG level in synovium (P＜0. 05) were lower in TP group than in AA group (P ＜0.05). In TP group, the expression levels of RANKL mRNA and TNF-α, IL-1β in PBMC were lower than in AA group (all P＜0.01). It was concluded that TP could inhibit rat adjuvant arthritis bone erosion by suppressing the expression of RANKL.
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AIM: To determine whether triptolide induce apoptosis of synovial cells in collagen - induced arthritis(CIA) in rats. METHODS: The male Wistar rats were used to make CIA models by immunized with Bovine collagen Ⅱ ( BC Ⅱ )in Freund's complete adjuvant (FCA). A total of 20 CIA rats were randomly divided into 2 groups, triptolide group (10 rats) and CIA control group (10 rats). Triptolide group were administered with triptolide at 40 μg/kg body weight intramuscularly every three days. CIA control group andanother 10 age - matched normal rats were given normal saline instead. The rats were sacrificed on the 31st day after the triptolide administration. The pieces of synovium of the rat knee joints were harvested. The synovium was examined by HE staining and electron microscope. The apoptosis was tested by TUNEL and flow cytometer. RESULTS: The earlier phase of apoptotic synoviocytes were observed under the electron microscope. The flow cytometry showed that the percentage of the apoptotic cells was (3.98 ± 1.16)% in the triptolide group, (1.83 ± 0.82)% in the CIA control group, and (0.87 ±0.24)% in the normal group (P＜0.01: triptolide vs control group). While the percentage of the cells in DNA synthesis phase was (3.3± 1.2)% in the triptolide goup, (8.0± 1.4)% in the CIA control group, and (3.4 ± 0.7)% in the normal group.There is significantly different in the apoptosis changes between the triptolide group and the CIA control group ( P ＜ 0.01: triptolide vs CIA control group). The TUNEL labeling demonstrated that the percentage of the apoptotic cells was (4.5 ± 1.0)% in the triptolide group, (2.2 ± 1.0) % in the CIA control group, and ( 1.0 ± 0.4) % in the normal group. The difference of apoptotic rate between the triptolide group and the CIA control group is significant ( P ＜ 0.01). CONCLUSION: This study demonstrates that triptolide can induce apoptosis in CIA rats, which may be one of the mechanisms that triptolide treats the rheumatoid arthritis.
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The expression and activity of NF-κB in the synovium of collagen-induced arthritis (CIA)rats was detected in order to investigate the possible therapeutic effects of triptolide on rheumatoid arthritis (RA). The experimental Wistar rat model of CIA was set up by intradermal injection of emulsion of bovine collagen Ⅱ and the successful rate of setting-up models was evaluated by arthritis index (AI). Rats were grouped randomly into three groups: normal, model and treatment group.The expression of TNF-α and IL-6 in synovial fluid was detected by ELISA, and the expression and activity of NF-κB in synovium by immunohistochemistry method and by electrophoretic mobility shift assay (EMSA) respectively. As compared with normal group, the expression of TNF-α and IL-6 in synovia (P＜0.05), and the expression and activity of NF-κB (P＜0.05) in synovium were increased in model group. There was statistical difference in above-mentioned indexes between model group and treatment group. Triptolide may play a protective role in RA via downregulating the expression and activity of NF-κB in synovium.
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The clinical effects of acupuncture on idiopathic male infertility in sperm parameter and on therapeutic results in assisted reproductive technology were investigated. 22 patients failed in intracytoplasmic sperm injection (ICSI) with idiopathic male infertility were treated with acupuncture twice weekly for 8 weeks, followed by ICSI treatment again. The sperm concentration, motility, morphology, fertilization rates and embryo quality were observed. Quick sperm motility after acupuncture (18.3% +/- 9.6%) was significantly improved as compared with that before treatment (11.0% +/- 7.5%, P < 0.01). The normal sperm ratio was increased after acupuncture (21.1% +/- 10.4% vs 16.2% +/- 8.2%, P < 0.05). The fertilization rates after acupuncture (66.2%) were obviously higher than that before treatment (40.2%, P < 0.01). There was no significant difference in sperm concentration and general sperm motility between before and after acupuncture. The embryo quality after acupuncture was improved, but the difference between them was not significant (P > 0.05). Acupuncture can improve sperm quality and fertilization rates in assisted reproductive technology.
Subject(s)
Adult , Humans , Male , Acupuncture Therapy , Combined Modality Therapy , Infertility, Male , Therapeutics , Semen , Sperm Injections, Intracytoplasmic , Sperm Motility , Spermatozoa , PhysiologyABSTRACT
The clinical effects of acupuncture on idiopathic male infertility in sperm parameter and on therapeutic results in assisted reproductive technology were investigated. 22 patients failed in intracytoplasmic sperm injection (ICSI) with idiopathic male infertility were treated with acupuncture twice weekly for 8 weeks, followed by ICSI treatment again. The sperm concentration, motility, morphology, fertilization rates and embryo quality were observed. Quick sperm motility after acupuncture (18.3% +/- 9.6%) was significantly improved as compared with that before treatment (11.0% +/- 7.5%, P 0.05). Acupuncture can improve sperm quality and fertilization rates in assisted reproductive technology.
Subject(s)
Acupuncture Therapy , Combined Modality Therapy , Infertility, Male/therapy , Semen , Sperm Injections, Intracytoplasmic , Sperm Motility , Spermatozoa/physiologyABSTRACT
AIM: To determine whether triptolide induce apoptosis of synovial cells in collagen-induced arthritis (CIA) in rats. METHODS: The male Wistar rats were used to make CIA models by immunized with Bovine collagen Ⅱ (BCⅡ) in Freund's complete adjuvant (FCA). A total of 20 CIA rats were randomly divided into 2 groups, triptolide group (10 rats) and CIA control group (10 rats). Triptolide group were administered with triptolide at 40 ?g/kg body weight intramuscularly every three days. CIA control group and another 10 age-matched normal rats were given normal saline instead. The rats were sacrificed on the 31st day after the triptolide administration. The pieces of synovium of the rat knee joints were harvested. The synovium was examined by HE staining and electron microscope. The apoptosis was tested by TUNEL and flow cytometer. RESULTS: The earlier phase of apoptotic synoviocytes were observed under the electron microscope. The flow cytometry showed that the percentage of the apoptotic cells was (3.98?1.16)% in the triptolide group, (1.83?0.82)% in the CIA control group, and (0.87?0.24)% in the normal group (P