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Objective@#To probe the feasibility of decitabine (DAC) combined with micro-transplantation as consolidation treatment for older patients with acute myeloid leukemia (AML).@*Methods@#Between November 2012 and September 2015, 37 consecutive patients with AML ≥60 years of age were analyzed. Of them, 19 patients received consolidation therapy with DAC followed by micro-transplantation (microtransplant group). Another 18 ones (chemo group) were treated with DAC plus priming regimen as consolidation chemotherapy in the same period.@*Results@#There were no significant differences in terms of age, WBC count, and disease status of onset between the microtransplant and chemo groups (P>0.05). The two regimens were well tolerated. There was no difference of CTC grade 3-4 nonhematologic toxicities between the microtransplant and chemo groups (36.8% vs 27.8%, χ2=0.347, P=0.728). The median recovery durations for neutrophil and platelet in the microtransplant group were similar to those in the chemo group (12 vs 13 days, z=1.599, P=0.110; 14 vs 12 days, z=-1.314, P=0.189, respectively). No graft-versus-host disease was observed in the microtransplant group. The 2-year leukemia-free survival and overall survival were better in microtransplant group (50.7% and 54.9%, respectively) than in chemo group (24.3% and 30.0%, respectively) (P=0.047 and P=0.071, respectively).@*Conclusion@#DAC combined with micro-transplantation as a consolidation regimen may be a safe and promising option for older patients with AML.
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Objective To investigate the application of the frontal branch of superficial temporal vessels pedicled flap in repairing lower eyelid ectropion.Methods Eight cases were collected from patients diagnosed with lower eyelid ectropion in our hospital from April 2012 to April 2015.In phase 1 of operation,the dilators were implanted into the frontal branch of superficial temporal vessels and fully expanded by normal saline injection;In phase 2,the scar of lower eyelid was incised,and the expanded forehead flaps were transferred to cover the wound after the lower eyelid released back to normal anatomy location;In phase 3,the flap delay operation was manipulated 3 weeks after phase 2,and the left wound after scar excision was finished by pedicle division 1 week later.Results All patients in the study showed a good appearance and function of lower eyelid.There were no complications such as flap congestion and necrosis occurred.Meantime there were no relapses observed according to the follow-ups ranging from 6 months to 1 year.Conclusions The application of the frontal branch of superficial temporal vessels pedicled flap shows a promising procedure in treatment of lower eyelid ectropion.
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Objective To explore the clinical results of repairing frontal lesions with the combination of the expanded scalp flaps and postoperative laser hair removal.Methods There were 10 patients involved between May 2014 through May 2016 in our department.In the first stage,the expanders were implanted to the pockets under the scalp.In the second stage,the wounds,after lesion removal,were covered by the expanded scalp flaps.In the third stage,laser hair removal was performed 2 weeks postoperatively for 4 to 6 times until complete removing the hair.Results All the lesions were repaired with good results.The incisions healed primarily.The scalp flaps survived without nec rosis.The hair on the flap was removed completely.The color and texture of the flap were similar to these of the adjacent skin.The satisfactory results of the appearance were achieved in all the patients.Conclusions The combination of the expanded scalp flap and laser hair removal is an effective method for the repairing of the frontal lesion.
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Objective To discuss the repairing methods of the wound after upper lip lesion excision.Methods The wound after upper lip lesion excision was repaired by expanded pedicled submental flap.The 3 cm-long incision was located in 1 cm to sub-mandible.The 100 ml expander was placed beneath the platysma,and the aqueducts and spigots of the expanders were laid out of the skin.After complete expansion,the spastic scars of the upper lip and nasal bottom were resolved,the nasal columella and upper lip were put back to the normal position.The pedicled submental flap was transferred to the wound after upperlip excision according to the size of the wound.The pedicle was severed after 3 weeks.Results There were 5 cases of the expanded pedicled submental flap to repair the wound after upper lip excision.The flap survived without complications.The appearances were satisfied by the patients.Conclusions The method of the expanded submental flap is suitable for the wound after upper lip excision.
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Objective To analyze the effect of EVAR in the treatment of octogenarian patients with abdomi-nal aortic aneurysm.Methods 16 octogenarian patients aged over 80 years who treated with EVAR were collected. Mean age was (87.0 ±6.2)years and included 11 cases in male,2 cases in emergency.All the cases were infrarenal abdominal aortic aneurysm and 11 cases (69%)were the complex aortic anatomy.According to ASA classification, 11 cases (69%)were class Ⅲ and 5 cases (31%)were class Ⅳ.All patients were followed up with CT for 1 month to 3 years.We evaluated technical success rate,perioperative complications and the application characteristics of EVAR in the treatment of octogenarian patients with abdominal aortic aneurysm were analyzed.Results All the patients were operated with EVAR,the success rate was 100%,12 Endurant endografts and 4 Talent endografts were used.Mean operation time was (92 ±25)min and mean hospital stay length was (17 ±9.5)days.1 patient died with heart failure in 3 days after operation.1 patient died due to the Ⅰ endoleak and 4 patients died due to other fators. Conclusion For the octogenarian abdominal aortic aneurysm patients,EVAR is the preferred treatment with accepta-ble procedural success and perioperative morbidity.Those patients have characteristics in the physiological function and anatomy,so we should take measures to prevent the complications.The medium and long -term results suggest that EVAR may be of limited in some patients who are aged over 80 years.
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Objective:The aim of this study was to investigate the mechanism underlying transforming growth factor-β1 ( TGF-β1 ) induced differentiation of bone marrow-derived mesenchymal stem cells (BMSCs)into myofibroblasts.Methods:Primary mouse BMSCs were isolated from bone marrow by flushing the tibias and femurs of mice , and passage 3 to passage 5 of BMSCs were used in the experiments . BMSCs differentiation into myofibroblast was induced by different doses of TGF-β1.In addition, reactive oxygen species (ROS) inhibitor (N-acetylcysteine, NAC) was added to test its effect on the action of TGF-β1.Expressions of BMSCs differentiation parameters , α-smooth muscle actin (α-SMA), collagenα1(Ⅰ) [Col α1(Ⅰ)] and collagen α1(Ⅲ) [Col α1(Ⅲ)] were measured by real-time quantitative PCR (RT-qPCR) and Western blot analysis.BMSCs were preloaded for 15 min with 2’, 7’-dichlorohydro-fluorescein diacetate ( DCFH-DA) , then stimulated with TGF-β1 for different times , and fluorescence of ROS was measured using high content analysis .Results:TGF-β1 stimulated differentiation of BMSCs into myofibroblasts and up-regulated expression of α-SMA, Col α1(Ⅰ) and Col α1(Ⅲ) in a dose-dependent manner , which blocked by ROS inhibitor NAC .In addition , TGF-β1 could induce a significant rapid and transient increase in ROS production in BMSCs , and the effect of TGF-β1 on ROS production was peaked at 30 min.Conclusion:TGF-β1 induced differentiation of BMSCs into myofibroblasts via production of ROS.
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Objective To assess the efficacy and clinical resuhs of thoracic endovascular aortic repair (TEVAR) in Stanford type B aortic dissection,and to explore the therapentic strategy and prevention of complication.Methods Fifty-eight patients with Stanford type B aortic dissection underwent TEVAR were enrolled,and were followed up regularly.Results The technical feasibility and success with deployment proximal to the entry tear was 100.0％(58/58),requiring partial coverage of the left subclavian artery in 20 patients and total coverage in 4 patients,and 2 patients used chimney stents.Hospital mortality was 5.2％ (3/58).Type Ⅰ endoleak was found in 11 patients (19.0％,11/58).In 55 survival patients,48 patients occurred thrombosis in pseudocoele and 2 patients' endoleak disappeared.Seven patients' endoleak appeared blood flow.Forty-eight patients(87.3 ％,48/55) were followed up for 3-68 months.Two patients died,and 2 patients' endoleak disappeared,with total suberization in pseudocoele.Other 5 patients' endoleak relieved,with partial suberization in pseudocoele.One patient had new intimal tear at the distal end of the stent-graft and required a second stent implantation.Conclusion TEVAR is safe and effective for the treatment of Stanford type B aortic dissection.
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Objective To investigate the treatment methods of tissue defects in nose and lower eyelid area.Methods Based on the impaired area,combined pre-expansion of forehead and facial region was adopted.The volume of soft tissue expander was determined.150-170 ml expander was implanted between frontalis muscle and periosteum of forehead,while at the facial region,and the volume of expander should be determined by the normal skin area as large as possible.The excision of impaired tissue was performed after sufficient expansion,and then skin flap or transposition skin flap were advanced at the facial region.At forehead,ortho-position skin flap based on supratrochlear vessels was designed for repairing the nose and palpebra inferior region.Three weeks later division of the ortho-position skin flap was carried out.With the flattened pedicle,the rest part of impaired area was replaced.Results Six cases were performed with this method.For all the cases,the survival rate of flap was 100％.Esthetic appearance and satisfying color-match were achieved,without appearance of lower eyelid ectropion.Conclusions Combined pre-expansion of forehead and facial region is an ideal method in treatment of the defects in nose and lower eyelid area.
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Objective To explore the repair method for wounds after excision of facial benign tumors.Methods Unilateral or bilateral deltopectoral skin flaps were expanded depending on the area of the facial benign tumor.Expander was implanted underneath deltopectoral flap region through an incision inferior to the clavicle.When expansion was completed,all or part of the benign tumor was excised before designing the flap according to the area of the skin defect.The area of the skin flap should be more than that of skin defect with 10％ to 15％.The pedicle wound could be sealed by rolling it around to form a tube or a hinge using the benign tumor and pedicle.The flap was delayed three weeks later and the pedicle was divided one week after flap delaying.Results All 20 cases got the satisfactory results with treatment of pedicled expanded deltopectoral skin flaps for repair of wounds after excision of facial benign tumor.Conclusions It is a better option to repair a large area wound after excision of facial benign tumor with an expanded deltopectoral skin flap.
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Objective To explore the method of total nasal reconstruction when the forehead skin for expanding is unavailable.Methods According to the principle of total nasal reconstruction,total nasal scar and deformity were repaired with expanded random forearm falp.All the expanders were placed in flexor side of forearm.The incision sides were placed in proximal,distal,or lateral part of the forearm according to different pedicles.After expansion,the nares were enlarged,eversion of ala nasi corrected,the contracture scars sufficiently released,and the size and shape of the reconstructive nose designed according to face size.The scar of nasal dorsum and capsule of the expanded flap could be used for reconstructing nasal dorsum.Donor sides could be sutured directly,the pedicle could be cut 3 weeks later.Results All the flaps survived with good appearances,and 3 of the 15 cases with proximal,11 with distal,and 1 with lateral pedicle.The effect of distal pedicle group was better than that in proximal and lateral pedicle group because of comfortable posture longer pedicle,and providing more tissue for reconstruction.Conclusions Total nasal reconstruction with expanded random forearm flap is an option when the forehead skin for expanding is unavailable.
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Objective To observe the clinical role of Qiliqiangxin capsules uniting conventional western medicine interfering with chronic heart failure(CHF).Methods 61 cases of CHF were randomly recruited into a control group(31 cases)and a treatment group(30 cases).The control group was treated with conventional anti-hean failure treatment,and the treatment group was added Qiliqiangxin capsules on the treatment of the control group.After having been treated for 2 courses (fonr weeks),such indexes as clinical efficacy,body weigbt,urine volume,6 min walking distance(6MWD),electrocardiogram,and cardiac ultrasound were measured for both groups.Results The overall efficiency of cardiac function was 93.33%for the treatment group and 74.19%for the control group.There was significant difierence between the two groups(χ~2=4.07985,P＜0.05).The enhance rate of left ventricular ejection fraction(LVEF)was(16±4)%in the treatment group as compared to(11±3)%in the control group,also showing statistical difierence between the two groups(t=5.509,P＜0.001).Conclusion Qiliqiangxin capsules combined with conventional western medicine could effectively improve the cardiac function,LVEE clinical symptoms,and quality of life in the patients with ehronic heart failure.
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Objective To summarize the experience of surgical treatment of venous drug-induced infective endocarditis(IE). Methods The 17 cases of drug-induced IE were found to have valvular vegetations,16 patients had involvement of tricuspid valve, 1 mitral valve associated with ventrieular septal defect. Preoperative blood culture was positive in 8 patients. The operations included tricuspid valve repair (6 cases),tricuspid valve replacement(8 cases), mitral valve replacement and VSD closure(1 cases). Results All patients were alive and discharges. After follow-up of 6 months to 6 years, 1 case had severd tricuspid alve regurgitation, 1 had haemoptysis because of incorrect anticoagulation. Conclusions This study indicated surgical intervention is effective treatment of venous drug-induced infective endocarditis.
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With the human development and social progress,the task of reform in educa-tion and teaching has become more urgent and increasingly heavy. The article discusses the education reform of clinical medicine in the content of courses,construction of teaching materials, teaching methods,teaching assessment and teaching management areas,in combination with the pracice of the current clinical teaching reform in medical school.