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Objective:Bioinformatics method was used to screen out prognostic model constructed by the tumor microenvironment (TME)- related genes of adrenocortical carcinoma (ACC), and the prognostic model was verified to provide clinical guidances and related biomarkers for the diagnosis and treatment of ACC.Methods:Transcriptome and clinicopathological data of 79 ACC patients were collected from the Cancer Genome Atlas (TCGA) database. ESTIMATE algorithm was used to calculate immune score, stromal score (both reflect TME) and ESTIMATE score; VennDiagram was used to select differentially expressed genes among immune score, high and low stromal score groups (grouped by median value); Gene Ontology (GO) database and Kyoto Encyclopedia of Genes and Genome (KEGG) database were used to perform functional enrichment analysis on selected genes and to explore the potential function and pathway of genes. Univariate Cox analysis, lasso regression analysis and multivariate Cox analysis were used to screen out genes related to ACC TME and to establish risk score (RS) model for ACC patients. The receiver operating characteristic (ROC) curve was used to evaluate the prognostic value of RS. The data sets GSE33371 and GSE19750 of Gene Expression Omnibus (GEO) were used as external validation sets to validate the prognostic model. The data of 79 ACC patients were extracted from the TCGA database, and the clinicopathological factors and the RS of the established prognostic model were included in the Cox regression analysis to obtain the prognostic factors of ACC patients.Results:According to the immune score and stromal score, 1 205 differentially expressed genes from intersection of both scores were screened out by using VennDiagram, including 833 up-regulated genes and 372 down-regulated genes. After continuing the regression analysis and screening of differentially expressed genes, the ACC prognostic model containing 9 TME-related genes (GREB1, POU4F1, HIC1, HOXC9, CACNB2, RAB27B, ZIC2, C3, CYP2D6) was finally constructed, that was, RS = GREB1×0.223 6+POU4F1×0.671 7+HIC1×0.167 5+HOXC9×0.211 3+CACNB2×0.156 0+RAB27B×0.956 5+ZIC2×0.582 7+C3×(-0.003 1)+CYP2D6×0.819 3. The area under the curve (AUC) of ROC for the 1, 3, and 5-year overall survival of 79 ACC patients predicted by the model in the TCGA database was 0.876, 0.919, 0.917, respectively. In the GEO validation set, the AUC of the 1, 3, and 5-year overall survival for 45 ACC patients predicted by the model was 0.689, 0.704, and 0.708, respectively, indicating that the model had a high prediction accuracy for survival results of ACC patients. Cox regression analysis on the data of 79 ACC patients in the TCGA database showed that the TME-related gene prognostic model RS was an independent factor influencing the prognosis of ACC patients ( HR = 1.011, 95% CI 1.005-1.016, P < 0.01). Conclusions:The established ACC TME-related gene prognostic model can be used to predict the prognosis of ACC patients. The model including 9 genes may become a new target for studying the pathogenesis and immunotherapy of ACC, and it is worthy of further research.
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Objective To investigate the influence of Tai Chi posture on knee joint load and the strategy of coordinated muscle contraction. Methods Twenty Tai Chi practitioners with more than 3 years of Tai Chi practice was recruited. By using high-speed motion capture system andthree-dimensional force plate, the adduction angle, tibial angle, joint force, joint torque of the supporting leg during the Tai Chi step lunge movement were collected, and the quadriceps and gastrocnemius muscle strength were obtained through simulation method. The muscle strength performance, recruitment mode and activation method of baseline step, toe-out step and toe-in step were compared. ResultsThe tibial angle and adduction force increased in the toe-out step but those parameters in the toe-in step remained unchanged; the strength of the medial femoris, semimembranosus, semitendinosus and lateral gastrocnemius muscle increased in the toe-out step; the external femoral muscle and medial gastrocnemius muscle increased in the toe-in step. The gastrocnemius muscle was preferentially activated than the quadriceps muscle, and the way of muscle recruitment changed. Conclusions Tai Chi posture will change the way of muscle force recruitment and affect the knee joint function. Standardized movements can be used as the reference for osteoarthritis exercise therapy and have some significance in clinical application.
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Objective To investigate the clinical efficacy of semi-open cancellous bone grafting for infected bone defect combined with soft tissue defect of lower limb.Methods A retrospective case control study was conducted to analyze the clinical data of 26 patients with infected bone defect combined with soft tissue defect of lower limb admitted to the Third Hospital of Hebei Medical University from March 2010 to August 2017.There were 16 males and 10 females,aged 16-65 years [(39.6 ± 12.8)years].The bone defect area before bone grafting was 1.4-6.0 cm [(3.3 ± 1.2) cm].The surface soft tissue defect of bone graft granules was 2.3 cm × 1.1 cm-8.5 cm × 5.0 cm after bone grafting.If the defect was segmental defect of more than 6 cm,the defect was firstly reduced by bone transport.When the defect was near the docking point,the bone defect was repaired by open bone grafting.If the defect was located at the metaphyseal end of the calcaneus or tibia,stage Ⅰ or stage Ⅱ open bone grafting was performed after debridement.After bone grafting,antibiotic-containing cement sheets were used to cover the wound in 14 patients (semi-open group),and vacuum sealing drainage (VSD) devices were used to cover the wound in 12 patients (VSD group).The time of granulation tissue covering bone graft granules,wound healing time,bone defect healing time,material cost and complications (wound infection and necrosis of bone graft granules) were compared between the two groups.The limb function was evaluated according to Paley score.Results All patients were followed up for 12-40 months [(19.3 ±7.2) months].In the semi-open group and VSD group,the time of granulation tissue coverage was 22.2 days (15.0-44.0) days and 20.2 days (15.0-44.0) days (P ＞ 0.05);wound healing time was 3.1 months (1.5-5.5) months and 3.1 months (1.5-6.5) months (P ＞ 0.05);bone defect healing time was (5.5 ± 2.2) months and (5.9 ± 2.4) months (P ＞ 0.05);the cost of covering wound materials was (2 056.1 ± 23.4) yuan and (5 555.3 ± 1 105.5) yuan respectively (P ＜ 0.05).No wound infection occurred in either group.Two patients in the semi-open group and one patient in the VSD group had bone graft granules surface necrosis (P ＞0.05).According to Paley's functional score,the results were excellent in 12 patients and good in two in the semiopen group,compared with excellent in 11 and good in one in the VSD group (P ＞ 0.05).Conclusion For infected bone defect combined with soft tissue defect of lower limb,semi-open bone grafting can simplify the nursing of wound,prevent wound infection,promote wound healing and fracture healing.It has similar therapeutic effect with VSD,but its treatment cost is significantly reduced.
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Objective To investigate the supernatant of umbilical cord-derived mesenchymal stem cells (UCMSCs) on tumor necrosis factor-α(TNF-α) and apoptosis protein caspase-3 in diabetic rats model with skin ulcer. Methods 45 Sprague-Dawley rats were randomly divided into control group (acute wounds group), phosphate buffered saline (PBS) group and UCMSCs supernatant group. The diabetic rat model was constructed by injecting with alloxan by tail vein and feeding with high-fat diet. Diabetic skin ulcer (DSU) rat model was constructed by scratching a wound and infusing suspension of Staphylococcus aureus. In the control group, the diabetic rats (n=15) were scratched to form a wound and treated by tail vein injection of 100μl PBS. In the PBS group, DSU rats (n=15) were treated by tail vein injection of 100μl PBS, and then 100μl PBS was dropped at the ulcer site. In the UCMSCs supernatant group, freeze-dried powder of UCMSCs supernatant was dissolved in 200μl PBS, 100μl of which was injected into the tail vein of DSU rats (n=15), and other 100μl was dropped at the ulcer site. After 5 days of the treatments, the levels of serum TNF-αwere detected by radioimmunoassay method, and the expression of TNF-αand caspase-3 in the ulcer tissues of rats was detected by polymerase chain reaction and Western Blot. Results The levels of TNF-αin the PBS group [(35.9±3.7)μg/L] were significantly higher than that of the control group [(11.4±4.9)μg/L] and the UCMSCs group [(14.7±6.6)μg/L] (all P<0.05). The levels of mRNA and protein expression of TNF-αand caspase-3 in the UCMSCs group were significantly lower than those of the PBS group (all P<0.05), and have no significant differences with respect to those of the control group (all P>0.05). Conclusions UCMSCs supernatant treatments can effectively down-regulate the expression of TNF-αand caspase-3 in ulcer tissue of DSU rats, and play an anti-inflammatory and anti-apoptotic effect.
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Objective To assess the efficacy of using reaming and antibiotic cement beads/rod for intramedullary nail associated infection.Methods Data of 12 patients with intramedullary infection of tibia or femur following intramedullary nailing from October 2014 to April 2016 were retrospectively analyzed.There were 10 men and 2 women aged from 19 to 63 years old with an average age of 39.2 years.In 5 cases the disease was localized in the femur with one case of nonunion,and in other 7 cases the disease was localizedin the tibia with two cases of nonunion.The initial injury included closed fracture in 8 patients and open fracture in 4 patients which were all Gustilo-Anderson Ⅱ.According to the Cierny-Mader classification of adult osteomyelitis,6 cases were type Ⅰ (medullary osteomyelitis),4 cases were type Ⅰ combined with type Ⅲ (medullary.and localized osteomyelitis),and 2 cases were type Ⅰ combined with type Ⅳ (medullary and diffuse osteomyelitis).Surgical technique included removal of the intramedullary nailand reaming and irrigation of the medullary canal to remove intramedullary debris.The drainage sinus and soft tissues abscess were excised if existed.An local or enbloc resection for the infected or necrotic bone was performed if there was local or diffuse infection in the fracture sites.Ilizarov technique was performed for segment bone defect.The bone union was observed in nine patients and stable nonunion in one.Antibiotic PMMA beads were inserted into intramedullary canal for these ten cases after debridement,and the antibiotic beads were removed approximately 12-14 days after implantation.The antibiotic cement rod was inserted into the medullary canal to provide stabilization in the other 2 cases.All the patients received intravenous antibiotics systemically for three weeks,and followed by three weeks of oral antibiotics.Results At a mean follow-up period of 23.5 months (range,15-33 months),no recurrence of infection was observed.There were 3 cases of nonunions.One case of tibial nonunion had been achieved union 10 months after insertion of an antibiotic cement rod.One with stable nonunion of tibia was treated with antibiotic PMMA beads,and enbloc resection for the infected bone was performed after the extension of infection had been narrowed at the nonunion.6 cm of bone defect was treated with bone transport and then union was obtained 16 months after operation.The third case was infected nonunion in the femur with 4 cm bone defect after debridement.The femur was shortened and temporarily stabilized with the intramedullary antibiotic cement rod.The rod was removed three months after the operation,and then the femur was lengthened.The docking site and the regeneration area were healed 12 months after the lengthening operation.Conclusion The clinical results shows that reaming and antibiotic cement beads/rod appears an effective and safe alternative for management of intramedullary nail associated infection of the tibia and femur.
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Objective To investigate the clinical effect of total hip arthroplasty ( THA) in the treatment of hip osteoarthritis ( HOA) and its effect on the quality of life of the patients. Methods Thirty?seven patients ( 42 hips) who underwent THA surgery in the Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from November 2011 to December 2015 were enrolled in this study. The function of hip joint, hip joint activity and the quality of life of the patients and other indicators were observed before operation,at 3 months,6 months after operation. Results The Harris scores of 37 patients before operation, at 3 months, 6 months after operation were (72.0±7.4) points,(86.1±8.3) points,(45.8±9.5)points respectively,the difference was statistically significant among the three groups ( F=71. 302,P<0. 05) . At 3 months and 6 months after operation,the score significantly improved compared to that before operation ( P<0. 05);At 3 months and 6 months after operation,the angles of the hips in 37 patients were significantly improved ( F=144. 921,41. 195, 351. 648,372. 766, 317. 518, 226. 381, P<0. 05 ) . The hip function was evaluated at 6 months after the operation,and 37 patients (42 hips) were evaluated,26 hips (61. 90％) were excellent. 12 hips (28. 57％) were good,4 hips ( 9. 52％) were fine,and 0 poor hips. At 6 months after operation,the SF?36 scale evaluation of quality of life, body pain, emotional restrictions, mental health, physical limitations, activities, social activities, vitality,general health, physical health, mental health scores were significantly improved compared with the preoperative ones ( F=19. 731, 19. 142, 11. 303, 22. 63821. 563, 20. 936, 13. 372, 14. 985, 6. 773, 13. 028, P<0. 05) . Conclusion THA treatment for patients with HOA can significantly improve the function of the hip joint and improve the quality of life of the patients.
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Objective To investigate the protective effect of umbilical cord mesenchymal stem cells (UCMSCs) on traumatic brain injury (TBI) in rats.Methods Thirty healthy Sprague-Dawley rats (10 rats for each group) were randomly divided into normal control group (normal),model group (injection of saline after TBI) and UCMSCs transplantation group (injection of UCMSCs after TBI).The rats in experimental groups were sacrificed on the 10th day after UCMSCs transplantation.The percentage of UCMSCs in brain tissue was detected by flow cytometry.The pathological changes of brain tissue were observed by hematoxylin-eosin (HE) staining method.The expressions of vascular endothelial growth factor (VEGF),glial fibrillary acidic protein (GFAP) and brain-derived neurotrophic factor (BDNF) in brain tissue were measured by immunohistochemistry and immunofluorescence double staining.The neurological deficit was evaluated by neurological deficit degree.Results The percentage of CD90,CD73 and CD105 cells in the UCMSCs transplantation group was significandtly higher than that in the model group (0.4％ vs 0.1％,P＜0.05).The results of HE staining showed that the brain injury of the transplanted group was alleviated compared with the model group (P＜0.05).The VEGF of the brain tissue in injury area in the UCMSCs transplantation group was higher than that in the model group (P＜0.05).The number of GFAP and BDNF positive cells in the UCMSCs transplantation group was higher than that in the model group (P＜0.05),and the neurological deficit score was also higher than that in the model group (P＜0.05).Conclusions UCMSCs transplantation for the treatment of TBI rats can effectively reduce the vascular damage in the injury area and promote nerve recovery.
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Objective To assess the efficacy of using the Ilizarov bone transport combined with open bone grafting and vacuum sealing drainage (VSD) to treat infected tibial bone defect.Methods A retrospective case series study was made on 8 patients sustaining posttraumatic infectious tibial bone defect treated between March 2010 and May 2015.There were 7 male and 1 female patients between 22 and 51 years (mean,39.4 years).All patients underwent radical resection of the infected/necrotic bone and debridement of the soft tissue.Length of bone defects after debridement averaged 8 cm (range,3.5-13.5 cm) and wound size averaged 4.8 cm ×2.5 cm (range,2.3 cm× 1.1 cm-8.5 cm ×6.0 cm).Stabilization was finished with Ilizarov circular external frame in all patients.Six patients were candidates for single-or double-level bone transport,and the cancellous bone autograft was placed openly within the butterfly defect after docking.Other 2 patients were treated with one-stage shortening of the fracture ends and open cancellous bone grafting,and the bone lengthening was performed.Then the grafted wounds were covered by VSD.Data were recorded including the bone transport or lengthening time,wound healing time,union time of docking sites,consolidation time of regenerate zones,external fixation time and external fixation index.Bone results and functional results were evaluated according to the criteria given by association for the study and application of the method of Ilizarov (ASAMI).Results Duration of follow-up was 10.2-36.4 months (mean,12.2 months).All the wounds achieved successful healing and eradication of infection.Mean bone transport time was 50 days (range,30-69 days).Seven patients showed selfhealing wounds,and mean healing time was 3.4 months (range,1.2-6 months).One patient experienced wound closure by skin grafting.Union and consolidation were achieved in all docking sites and regenerate zones.Mean union time of docking sites after bone grafting was 6.8 months (range,5.3-10 months).Mean consolidation time of regenerate zones was 6.2 months (range,4.8-8.5 months).Mean external fixation time was 8.6 months (range,6.5-11.5 months) with a mean external fixation index of 1.2 months/cm(range,0.7-1.9 months/cm).According to the criterion of ASAMI,bony results were excellent in 7 patients and poor in 1 patient,and functional results were excellent in 4 patients and good in 4 patients.Conclusion Ilizarov bone transport technique combined with open bone grafting and VSD for infectious tibial bone defect can accelerate bone union and wound healing at docking sites and reduce external fixation time.
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Objective To explore the clinical efficacy of rectangle advancement flaps used in the reconstruction of skin defects around the Achilles tendon in children.Methods From May 2014 to June 2015,7 children with skin defects around the Achilles tendon were admitted to our trauma center.The areas of skin defect ranged from 3.4 cm × 2.7 cm to 5.5 cm × 4.0 cm.The integrity of Achilles tendon was preserved in 6 cases but the tendon insertion was partly disrupted in one case.The skin defects were reconstructed with self-designed rectangle advancement flaps after debridement.In the one case with the Achilles tendon partly disrupted,the contaminated tendon ends were excised before wound closure.The injured ankles were immobilized in plantar flexion with one 1.5 mm K-wire and plaster splint to decrease the postoperative tension of the flap.Results All the flaps survived completely by primary intention but local infection occurred in 2 wounds which was cured by second intention of dressing change.The follow-up periods ranged from 8 to 12 months (average,11.5 months).The scar around the flap was remarkable in 2 cases,but the flaps in the other cases appeared normal in terms of color and texture.The ankle function was satisfactorily normal in all the cases.Conclusion Our self-designed rectangle advancement flaps provide a simple,safe and reliable way to repair skin defects around the Achilles tendon in children.
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Objective To assess the efficacy of double-level bone transport for treatment of extensive post-infectious tibial bone defects.Methods From January 2010 to May 2014,12 consecutive patients suffering from massive postinfectious tibial bone defects were treated by the Ilizarov technique of double-level bone lengthening.The study population included 8 males and 4 females,with mean 40.9 years (range,16-65 years).Mechanisms of initial injury included motor-vehicle injury in eight patients,explosive injury in two and crush-related injury in two.After bony resection for infection,skin defect was 8.7 cm ×5.8 cm (range,4.5 cm × 2.0 cm-20.0 cm × 10.0 cm) and bone defect averaged 11.0 cm (range,6.0-20.0 cm).All patients were treated with a double-level transport (three distal-to-proximal,six both-ends-to-center and three proximal-to-distal).Three patients were candidates for flap coverage before bone transport because of large wounds,one patient had direct closure of the wound after tibial partly shortening,and the remaining patients kept the wound open during bone transport.Bone and functional results were evaluated according to the criteria given by Association for the Study and Application of the Method of Ilizarov (ASAMI).Results After removal of the apparatus,follow-up was (30.0 ±5.6) months (range,12-36 months).All patients achieved complete union and successful eradication of infection.Mean bone transport time was (55.4 ± 26.2)d (range,30-125 d),with the lengthening index of (5.0 ± 0.6) d/cm (range,3.9-6.3 d/cm).Wound union time was (3.6 ± 1.4) months (range,1.5-6.0 months).Mean consolidation time of the distraction gap was (10.9 ± 3.8)d (range,4.0-18.0 d).Mean union time of the docking site was (8.4 ± 3.8)months (range,3-16.5 months).Mean external fixation time was (12.5 ±4.1)months (range,5-18 months),and mean external fixation index was (1.2 ± 0.3) months/cm(rang,0.8-2 months/cm).According to the ASAMI,bony results were excellent in seven patients (58％) and poor in five (42％);functional results were excellent in nine patients (75％) and good in three (25％).Conclusion Double-level bone transport is an effective method that can reduce bone transport time and external fixation time.
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Objective To determine the curative effect of stabilizing unstable pelvic ring fracture using the anterior subcutaneous internal fixator (INFIX).Methods From July 2013 to June 2014,15 cases who suffered from anterior pelvic ring fracture were treated with the device.There were 11 males and 4 females,with mean age of 38.5 years (range,23-65 years).Eight cases sustained fracture in traffic accidents,4 in high falls,and 3 in crush injury.According to the Young-Burgess and AO/OTA classification systems,type APC2 or 61-B1 was noted in one case,LC1 or 61-B2.1 in 4 cases,LC2 or 61-B2.2/61-B2.3 in 6 cases,and VS or 61-C1/61-C2 in 4 cases.Basic method in anterior ring fixation was one pedicle screw was respectively inserted into the area between the anterior superior iliac spine and anterior inferior iliac spine of both sides.The precontoured rod was then tunneled subcutaneously from one screw to the other.For the stable posterior injury in pelvic ring fracture,the anterior pelvic ring was stabilized only using the technique.For the unstable posterior injury in pelvic ring fracture,the anterior and posterior ring were both fixed using the technique.During follow-up visits,patients' tolerance to the device,wound infection,myositis ossificans,internal fixation lessening,and lateral femoral cutaneous nerve injury were evaluated.Results Follow-up ranged from 6-12 months (mean,7.5 months).The device was well tolerated by the patients for comfort.None had surgical site infection and internal fixation loosening.Injuries healed without loss of reduction at the 3-month follow-up.Injury of the lateral femoral cutaneous nerve at the both side was reported in 4 cases and at one side in 2 cases,but all restored 3 month after operation.Conclusion The reported technique is minimally invasive with few complications and reliable results,hinting an ideal method to stabilize the anterior pelvic ring fracture.
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Objective To improve the current method of spermatogonial cells transplantation, and make the new method become more operative and easy to carry out. Methods The spermatogonial cells in rC57BL6/tg14 (act-EGFO-Osb Y01) mice that expresse GFP protein were collected as the donor cells, and by using a modified syringe, and then were injected into the seminiferous tubules of pretreated wild type GFP-null mice through testicular efferent duct. The transplantation outcome was evaluated by trypan blue stainting and fluorescent microscopic examination and pathohistological analysis of transplanted testis. Results The transplanted testis of recipient mice showed green fluorescence signal, and the signal of seminiferous tubules was found significantly higher than that of the surrounding tissues. The transplanted GFP-positive cells generated colonies and spermatogenesis but pretreated wild type GFP-null mice were not found. Conclusion The expressed GFP protein spermatogonial cells in rC57BL6/tg14 mice were successfully transplanted in the wild type GFP-null recipient mice, fourthermore the improved transplantation method simplified the triditional one and achieved the same transplantation results.
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This article is mainly about the application of wavefront aberration technology in clinical ophthalmology, including refractive surgery, cataract, retinal disease, ophthalmoxerosis, diplopia, keratoconus, etc. The wavefront aberration technology can not only be used to estimate the surgery method of cataract, but estimate the influence of IOL materials and designs on the human eye's image quality, all of which are intend to find the optimal treatment method, and to further decrease the impact that the glare disability and low visual acuity at night produce on the human eyes. Now, the prospect of wavefront aberration application on ophthalmology is cheerful, however, the specifical application technology of wavefront aberration is still in its infancy. The basic research about the accommodation, age and chromatic aberration needs to be intensified. So there is still a bunch of tasks that inferred the clinical ophthalmology application of wavefront aberration for us to process.
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Objective To study the chemical components from Dryopteris fragrans and their biological activities.Methods By means of HPLC and other column chromatography,the chemical components were isolated from D.fragrans and their chemical structures were identified by spectral and chemical tests in accordance with their physicochemical characteristics.Furthermore,the cytotoxicity of the chemical components for Bel-7402,HCT-8,and A-549 cells was measured by MTT method.Results Four compounds,geniposide(Ⅰ),3S,5R,6R,7E,9S-megastigman-7-ene-3,5,6,9-tetrol-3-O-?-D-glucopyranoside(Ⅱ),(6S,9R)-3-oxo-?-ionol-9-O-?-D-glucopyranoside(Ⅲ),and fragranoside a(Ⅳ) were iso-lated and identified.Conclusion Compound Ⅳ is a new compound.And all the other three compounds Ⅰ-Ⅲ are found in plants of Dryopteris Adanson for the first time.The results of pharmacological experiments indicate that compounds Ⅰ and Ⅲ show strong cytotoxicity.