Risk factors for infections after arthroscopic rotator cuff repair / 中国骨伤

OBJECTIVE@#To explore risk factors for infections after arthroscopic rotator cuff repair, and improve the under standing for reducing infection.@*METHODS@#Clinical data of 2 591 patients who underwent arthroscopic rotator cuff repair from January 2019 to January 2022 were retrospectively analyzed, including 1 265 males and 1 326 females, aged from 25 to 82 years old with an average age of (51.5±15.6) years old. They were divided into infection group(n=18) and uninfected group(n=2 573) according to whether or not patients had postoperative infection. Gender, age, smoking, diabetes, body mass index, local closure within 1 month before operation, operation time, preventive use of antibiotics, and internal fixation implantation between two groups were recorded. Univariate Logistic regression analysis screened factors associated with infections after arthroscopic rotator cuff repair. Theresultswere entered into the multivariate logistic regression analysis, screening the high risk factors for infections after arthroscopic rotator cuff repair.@*RESULTS@#In 2 591 patients, 18 patients were infected after operation, infection rate was 0.69%. Univariate Logistic regression analysis showed that gender, age, operation time, antibiotic prophylaxis, internal fixation implantation were risk factors for infections after arthroscopic rotator cuff repair. Multivariate Logistic regression analysis showed male(OR=14.227), age≥65 years(OR=34.313), operation time≥2 h (OR=15.616), without antibiotic prophylaxis(OR=4.891), and internal fixation implantation(OR=5.103) were major risk factors for infection after arthroscopic rotator cuff repair(P<0.05).@*CONCLUSION@#Male, age≥65 years, operation time≥2 h, without antibiotic prophylaxis and internal fixation implantation were independent risk factors for infection after arthroscopic rotator cuff repair. Early diagnosis and timely treatment should be carried out to reduce the incidence of infection.

Analysis of risk factors of healthy side fracture after hip fracture surgery in the elderly / 中国骨伤

OBJECTIVE@#To investigate the incidence and related risk factors of healthy side fracture after hip fracture surgery in the elderly, so as to provide basis for the prevention of re-fracture.@*METHODS@#The data of 452 patients over 65 years old with femoral neck fracture or intertrochanteric fracture treated with hip arthroplasty or proximal femoral intramedullary nailing from June 2012 to June 2017 were analyzed, including 168 males and 284 females, the age ranged from 65 to 97(75.5±7.5) years. There were 191 cases of femoral neck fracture and 261 cases of femoral intertrochanteric fracture. According to whether there was a fracture in the healthy hip after operation, the patients were divided into fracture group and no fracture group. The gender, age, body mass index, fracture type, initial treatment method, bone mineral density, bed time, medical compliance, postoperative short-term delirium, whether there were medical diseases before injury and Harris score of hip joint in the final follow-up were recorded. Univariate Logistic regression analysis was used to screen out the risk factors of healthy side fracture after operation, and then statistically significant risk factors were included in multi factor Logistic regression analysis to screen out the independent risk factors of healthy side fracture after operation of hip fracture in the elderly.@*RESULTS@#Among them, 42 of the 452 patients had hip fractures on the healthy side with an incidence of 9.3%. The average interval between the two fractures was (2.9±2.1) years. Univariate Logistic regression analysis showed that there were significant differences in age, bone mineral density, medical compliance, short-term postoperative deliriun, pre-injury complicated with medical diseases and Harris score of hip joint in the final follow-up (P<0.05). Multivariate Logistic analysis showed that age(OR=4.227), bone mineral density(OR=4.313), combined with medical diseases (OR=5.616) and low hip Harris score at the final follow-up (OR=3.891) were independent risk factors for healthy side fractures after hip fracture surgery in elderly(P<0.05).@*CONCLUSION@#The age, bone mineral density, combined with medical diseases and low Harris score of hip joint in the final follow-up are the main risk factors of healthy side fracture after hip fracture in the elderly. It is necessary to strengthen the treatment of medical diseases, anti osteoporosis and improve hip joint function within 3 years after operation, so as to prevent the occurrence of healthy side hip fracture.

Establishment of 3D finite element model of meniscus and its mechanical analysis / 中国骨伤

OBJECTIVE@#To establish a 3D finite element model of normal knee joint involved its meniscus, which can be used to simulate the anatomical morphology and characteristics of human knee joint, to verify the validity of the model by preliminary FEA mechanical analysis, and explain partially biomechanical mechanisms of meniscus.@*METHODS@#CT and MRI data were harvested by scanning the knee joint of a healthy male volunteer, and then these data were imported into Mimics 10.01 software and Geomagic Studio software to constructed the 3D models of tissue structures of knee joint. These models were combined to constructed the 3D model of intact knee joint and meshed in ANSA software. Therefore the finite element model of intact knee joint was established. Finally, after the definitionof its material behavior, boundary conditions and loading. The finite element model of knee joint was analyzed and verified using ANSYS software. Meanwhile The biomechanical properties of meniscus were analyzed.@*RESULTS@#The complete knee finite element model composed of bone, meniscus, articular cartilage, and major ligaments was established. It could effectively simulate the anatomical morphology and characteristics of knee joint and its meniscus. The contact area of medial meniscus was 771.05 mm, while the contact area of lateral meniscus was 634.31 mm, and the ratio was 1.216. The stress distribution was uniform, but the stress of the medial meniscus was higher than that of the lateral meniscus, and the peak stress located in the posterior horn of the medial meniscus and the anterior horn of the lateral meniscus, respectively, and the peak stress value was 4.11 MPa. The maximum displacement of the meniscus was located in body, and the displacement of the medial meniscus was more remarkable than that of the lateral meniscus, and the maximum displacement value is 0.33 mm. The obtained finite element analysis results corresponded to that reported in the literature, which mean the model's reliability.@*CONCLUSION@#The established finite element model of knee joint are proved to be have validity, and is a useful model for finite element analysis of meniscus tear and menisectomy. The results of finite element analysis can explain partially biomechanical mechanisms of meniscus which can provide theoretical guidance for clinical treatment of meniscus injury.

Ureteroscopic holmium laser incision versus ureteroscopic cold knife incision in the treatment of ureteral stricture / 医学研究生学报

Objective　The aim of this study was to compared the clinical effect of ureteroscopic holmium laser incision (USHLI) with that of ureteroscopic cold knife incision (USCKI) in the treatment of ureteral stricture.　Methods　Seventy-eight patients with ureteral stricture underwent USHLI (n = 40) or USCKI (n = 38) in the Armed Police Corps Hospital of Jiangsu Province from January 2010 to December 2016. Comparisons were made between the two surgical strategies in the operation time, postoperative complications, hospital days, short-term effect and long-term effect.Results　Mild postoperative hematuria occurred in all the patients of the USHLI group, which lasted 1-2 days before it disappeared without intervention, but with no other severe complications as adjacent organ injury, ureteral avulsion, or massive hemorrhage. Moderate postoperative hematuria was observed in all the patients of the USCKI group, which was stopped at 2-3 days by administration of hemostatics. Compared with USCKI, USHLI achieved a significantly shorter operation time ([43.4 ± 5.8] vs [35.3 ± 3.8] min, P < 0.05) and postoperative hospital stay ([5.0 ± 1.4] vs [4.0 ± 0.8] d, P < 0.05), lower incidence of postoperative infection (27.3% vs 7.7%, P < 0.05), and higher cure rate (57.6% vs 87.2%, P < 0.05).　Conclusion　USHLI, with its advantages of less damage, lower recurrence rate and fewer complications, is obviously superior to USCKI in the treatment of ureteral stricture.

Comparison of long Gamma 3 nail and proximal femur locking plate for the treatment of femoral subtrochanteric fractures / 中国骨伤

OBJECTIVE@#To compare clinical efficacy of long Gamma 3 nail and proximal femur locking plate (PFLP) in treating femoral subtrochanteric fractures.@*METHODS@#From January 2010 to January 2017, clinical data of 58 patients with subtrochanteric fractures followed more than 12 months were retrospective analyzed. Among them, 35 patients were treated with long Gamma 3 nail including 18 males and 17 females aged from 25 to 78 years old with an average of(66.5±23.5) years old;Causes of injury included fall on the ground in 18 cases, traffic accidents in 7 cases, and fall from height in 10 cases. The other 23 patients were treated with PFLP fixation including 8 males and 15 females aged from 31 to 81 years old with an average of (63.4±22.4) years old;Causes of injury included fall on the ground in 12 cases, traffic accidents in 6 cases, and fall from height in 5 cases. Operative time, blood loss (intraoperative and hidden blood loss), hospital stays, bone healing and complications were observed and compared. Harris hip score after 1-year following-up was used to evaluate postoperative clinical effect.@*RESULTS@#Fifty-one patients were followed up from 14 to 36 months with an average of 24.8 months, including 31 patients were treated with long Gamma 3 and 20 patients were treated with PFLP. Blood loss(intraoperative and hidden blood loss) in PFLP group was less than that of long Gamma 3 nail group(0.05). There was no significant differences in healing time of fractures between long Gamma 3 nail group (17.2±2.4) weeks and PFLP group (18.1±2.6) weeks(<0.05). At 1-year following-up, there was no significant differences in Harris hip score between long Gamma 3 nail group(80.29±10.28) and PFLP group (76.49±12.28)(<0.05). No complications such as pulmonary embolism and nonunion occurred. Two patients were treated with fitler whose occurred deep vein thrombosis. Postoperative pulmonary infection curred in 4 cases and was cured by anti-infection therapy.@*CONCLUSIONS@#Both of long Gamma 3 nail and PFLP in treating patients with femoral subtrochanteric fractures can receive good clinical effects, long Gamma 3 nail is not suitable for the patients of the narrow medullary cavity and prominent anterior arch. PFLP is eccentric fixation, so early weight-bearing was not stress.

Progress in finite element analysis of meniscus / 中国骨伤

The meniscus biomechanics is one of the hottest areas in medical research. Finite element analysis(FEA) provides a new method for biomechanical studies. Using the FEA, the stress force and strain distribution characteristics of the normal meniscus can be analysed by establishing the finite element model of the meniscus and utilizing finite element softwares. In addition, the finite simulation of the meniscus tears, meniscectomy, and knee tissue injury can assess the changes of meniscus biomechanical properties. These research results provide theoretical basis of biomechanics to prevent and treat knee joint injuries. However, the finite element analysis method has its limitations, future research will be aimed at establishing high quality finite element models, making the models offer more authentic simulations of the meniscus anatomy, and ensuring the FEA could be applied to research a variety of knee injuries.

A single-team experience with robotic pancreatic surgery in 1010 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the safety and advantages of robotic pancreatic surgery (RPS) based on the single-team experience with 1010 cases.</p><p><b>METHODS</b>The clinical data of 1010 cases of RPS performed by a single team from November, 2011 to September, 2017 in our hospital were collected prospectively and analyzed. In most of cases the surgeries were performed using the third-generation da Vinci robotic surgical system.</p><p><b>RESULTS</b>The 1010 cases receiving RPS included 417 cases of robotic pancreatoduodenectomy (RPD), 428 cases of robotic distal pancreatectomy, 60 cases of robotic central pancreatectomy, 53 cases of robotic pancreatic tumor enucleation, 3 cases of Appleby procedure, and 49 cases of other operations (including 4 cases of innovative robotic retroperitoneal laparoscopic surgery, 4 cases of robotic pancreatic tumor enucleation combined with main pancreatic duct bridging repair, 1 case of single incision robotic pancreatic tumor enucleation, and 2 cases of robotic central pancreatectomy combined with end-to-end anastomosis reconstruction). The median operative time was 210 min (30-720 min) with a median intraoperative blood loss of 80 mL (10-2000 mL), a conversion rate of 4.06% (41/1010), a blood transfusion rate of 6.7% (68/1010), a mean post-operative stay of 10.87∓6.70 days, a complication rate (beyond grade III according to Clavien-Dindo scoring system) of 8.0% (81/1010), and a pancreatic fistula rate (beyond) grade B of 9.21% (93/1010). The mortality rate of the patients was 0.69% (7/1010) in 30 days and 1.31% (12//934) in 90 days. The application of RPS in total pancreatectomy increased steadily from the rate of 10.44% in 2012 to 72.06% in 2017.</p><p><b>CONCLUSION</b>This represents to our knowledge the world largest series of robotic pancreatic resections. RPS is expected to gradually replace open procedure and laparoscopic procedure to become the primary choice of approach for pancreatectomy. After the learning curve, RPS procedure including distal pancreatectomy, robotic Appleby procedure and other operations can be safely performed, and the experiences from other centers can be beneficial to reduce severe complications in the early stage of learning.</p>

Effect of 1,25(OH)2D3on type Ⅰ collagen secretion in adipose-derived mesenchymal stem cells and its mechanism / 中国组织工程研究

BACKGROUND: Adipose-derived mesenchymal stem cells (ADMSCs) have been reported to improve wound healing. However, type I collagen secreted by ADMSCs will contribute to scar formation. Therefore, inhibiting type I collagen secretion from ADMSCs will strengthen its clinical application. OBJECTIVE: To investigate the effect of 1,25(OH)2D3on secretion of type I collagen by ADMSCs and its mechanism. METHODS: Human ADMSCs were isolated by collagenase digestion, and identified by flow cytometry. ADMSCs at passage 4 were cultured in DMEM/F12 medium containing different concentrations of 1,25(OH)2D3(10-7, 10-8, 10-9, 10-10and 0 mol/L) respectively for 4 days. Then, the concentration of type I collagen in cell supernatant was measured by ELISA. Real-time PCR and western blot were used to detect the expression of Smad3 at mRNA and protein levels and phosphorylated protein Smad3 level in ADMSCs cultured with and without 1,25(OH)2D3. To analyze the contribution of Smad3 to the effect of 1,25(OH)2D3, Smad3 inhibitor was added to culture medium 30 minutes before adding 1,25(OH)2D3, and type I collagen in cell supernatant was detected by ELISA at 4 days after addition of SMAD3 inhibitor. RESULTS AND CONCLUSION: 1,25(OH)2D3inhibited the secretion of type I collagen by ADMSCs in a dose-dependent manner. The results of real-time PCR and western blot showed that the expression of Smad3 was upregulated by 1,25(OH)2D3, and the results of western blot showed that the phosphorylated Smad3 protein level in ADMSCs was significantly increased by 1,25(OH)2D3. Moreover, the inhibition of type I collagen secretion by 1,25(OH)2D3could be blocked by Smad3 inhibitor. These results indicate that 1,25(OH)2D3can inhibit the secretion of type I collagen from ADMSCs by up-regulating the expression of Smad3.

Advanced progress on the treatment of anterior approach to the thoracolumbar vertebral fractures / 中国骨伤

Thoracolumbar fractures are common and severe traumas. Anterior approaches can achieve adirect spinal cord decompression and reconstruct anterior column height what load bearing the major load distribution of the spine. Therefore, anterior approach is an important method in the treatment of thoracolumbar fractures. With the application of pedicle screw, most of the patients were treated with posterior approaches.Because of the unique advantages of anterior approach, the posterior approach can not be replaced it.The review summarizes the biomechanical characteristics? indications? fixation devices? bone grafting method and technique of the anterior approach and in order to provide better evidence for clinical treatment of thoracolumbar fractures.

Inversive LISS plate in treating intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical effects of inversive LISS(less invasive stabilization system, LISS) plate for the treatment of intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures.</p><p><b>METHODS</b>From January 2012 to January 2015, 24 patients with intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures were treated with inversive LISS plate, included 16 males and 8 females with an average age of 62.5 years old ranged from 35 to 81 years old. There were 8 cases of traffic accident injuries, 3 cases of falling from high place, and 13 cases of falls injuries. The time from injury to operation was ranged from 2 to 12 days with an average of 5.2 days. The operation time, intraoperative blood loss and the length of hospitalization were analyzed. The fracture union was assessed by follow-up radiographs and hip functional recovery by Harris hip scoring.</p><p><b>RESULTS</b>All patients were followed up for 16.2 months (ranged, 18 to 36 months). The mean operative time was (68.22±48.36) min;the mean blood loss was (256.28±182.46) ml;the mean time of hospitalization was(14.8±5.2) days. There were no complications such as deep infection, deep vein thrombosis, pulmonary embolism and bone nonunion during the follow up period. The bone healing was ranged from 3 to 8 months with an average of 4.8 months. The mean Harris score was 76.49±12.28 at the final follow-up, 15 cases were classified as excellent, 6 as good and 3 as fair.</p><p><b>CONCLUSIONS</b>Inversive LISS plate can be used in treating with intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures, and should not emphasis on premature loading.</p>

A medium term therapeutic effects of anatomic locking plate for femoral intertrochanteric with lateral femoral wall fractures / 中国骨伤

<p><b>OBJECTIVE</b>To retrospectively study medium term follow-up outcomes of the femoral intertrochanteric with lateral femoral wall fractures using anatomic locking plate fixation.</p><p><b>METHODS</b>From June 2010 to January 2013, 18 cases of the unstable femoral intertrochanteric with lateral femoral wall fractures were treated with the anatomic locking plate, included 8 males and 10 females with an average age of 75.5 years ranging from 19 to 83 years old. There were 8 cases of traffic accident injuries, 6 cases of falls injuries, and 4 cases of falling from high place. The time from injury to operation was ranged from 1 to 14 days with an average of 4.5 days. The operation time, intraoperative blood loss and the length of hospitalization were recorded and analyzed. The fracture union was assessed by follow-up radiographs and hip functional recovery by PPMS and Harris hip scoring.</p><p><b>RESULTS</b>All patients were followed up from 36 to 68 months with a mean of(44.8±8.8) months. The mean operative time was (61.02±38.28) min;the mean blood loss was (226.00±162.52) ml;the mean length of hospitalization was (10.8±9.2) days. During the follow-up period, no infection, deep veintllrombosis, screwed cut-out and implant failure occurred in all patients. Coxa vara with shortening deformity was noted in 2 cases. Bone union was found in all the cases. The bone healing time was ranged from 4 to 10 months with an average of 6.2 months. The mean PPMS score at the final follow-up was 7.22±2.36. The Harris score was 79.46±11.02, 5 cases were classified as excellent, 9 as good and 2 as fair.</p><p><b>CONCLUSIONS</b>Proximal femoral anatomic locking plate can be used in treating intertrochanteric fractures with compromised lateral wall, which has a satisfied medium term follow-up outcomes, especially for complex fractures patterns in which intramedullary nailing may be difficult, and should not emphasis on premature loading.</p>

Expression of CD133 and CD44 proteins in gastric stromal tumors and their clinical significances / 肿瘤研究与临床

Objective To investigate the expression of CD133 and CD44 proteins in gastric stromal tumors (GST) and their clinical significances. Methods The expression of CD44 and CD133 proteins in the GST tissues of 112 patients was detected by immunohistochemical staining. The relation between the expression of CD44 and CD133 proteins and the clinicopathological characters was analyzed. The survival and prognosis of GST were also analyzed. Results Both CD44 and CD133 were expressed on the cell membranes. The expression rates of CD44 and CD133 were 58.04 % (65/112) and 42.86 % (48/112) separately; the co-expression rate of CD44 and CD133 was 27.68 % (31/112). CD44 and CD133 were negative in normal peritumoral tissues. No correlation was found between CD44 and CD133 and the clinicopathological parameters including gender, age and lymphatic vessel invasion (all P>0.05), but the expression levels of CD44 and CD133 in patients with the mitotic count ≥ 5/50 high-power field, large diameter and vascular invasion were significantly higher (all P0.05), but the co-expression level of CD44 and CD133 in patients with tumor diameter ≥5 cm was significantly higher than that in patients with tumor diameter < 5 cm (χ2=5.040, P=0.025). The overall survival rate of the patients with co-expression of CD44 and CD133 was shorter than that in other groups (χ2 = 8.758, P= 0.001). No correlation was found between CD44 and CD133 expression (r=0.126, P=0.210). Multivariate analysis with the Cox regression models showed that the tumor diameter ≥5 cm (P=0.042) and co-expression of CD44 and CD133 (P=0.003) were significantly associated with poor prognosis. Conclusion CD44 and CD133 as robust cancer stem cell markers in GST might be the prognostic factors.

Comparison of anatomical locking plate and Gamma nail for the treatment of intertrochanteric fracture with external wall fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical efficacy of anatomic locking plate and Gamma nail in treating unstable femoral intertrochanteric fractures with external wall fractures.</p><p><b>METHODS</b>From June 2010 to June 2014,clinical data of 44 patients with intertroehanteric fractures associated with lateral wall fractures (type 31A2.2-3.3) followed more than 12 months,which treated with Gamma nail or anatomic locking plate,were retrospective analyzed. Sixteen patients were treated with anatomic locking plate, including 6 males and 10 females aged from 32 to 83 years old with an average of 56.5 years old. Twenty-eight patients were treated with Gamma nail including 17 males and 11 females aged from 26 to 87 years old with an average of 60.4 years old. Operative time, intraoperative fluoroscopy times, blood loss (intraoperative and hidden blood loss), hospital stays were observed and compared. PPMS and HHS scoring were used to evaluate postoperative clinical effect.</p><p><b>RESULTS</b>All patients were followed up from 12 to 24 months with an average of 16.2 months. Operative time in Gamma nail was shorter than anatomic locking plate; while blood loss( intraoperative and hidden blood loss) and intraoperative fluoroscopy times in anatomic locking plate were less than that of in Gamma nail. There was no significant meaning in hospital stays between two groups. Postoperative full weight-bearing time in anatomic locking plate was prolonged than Gamma nail. At the final following-up, PPMS in Gamma nail was 7.50 ± 1.78 and 6.82 ± 1.38 in anatomic locking plate, and there was no obvious meaning between two groups (t = 2.341, P = 0.132); there was no significant differences in HHS score between Gamma nail (83.25 ± 11.18) and anatomic locking plate (86.14 ± 12.36) (t = 1.923, P = 0.243). The incidence of complications in Gamma nail was less than anatomic lock-ing plate (P = 0.005).</p><p><b>CONCLUSION</b>Anatomic locking plate for intertrochanteric fractures with external wall fractures could avoid re-injury of external wall, especially for severe comminuted fractures, difficult for intramedullary nailing, and there was no significant meaning in hip joint function compared with Gamma nail, while postoperative incidence of complications was higher than Gamma nail, so early weight-bearing was not stress.</p>

Transumbilical single-incision laparoscopic hepatectomy: an initial report / 中华医学杂志(英文版)

Transumbilical single-incision laparoscopic surgeries have attracted the attention of surgeon. Here we report a patient with multiple hepatic hemagiomas and symptomatic cholelithiasis who underwent laparoscopic left lateral hepatecomy and left hepatic hemangioma enucleation with single incision followed by cholecystectomy. The duration of the operation was 155 minutes and the blood loss was 100 ml. There were no complications during or after the treatment. This surgical treatment yields a good cosmetic effect and rapid recovery.

A modeling method for laparoscopic left lateral segment liver resection: report of 71 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To summarize the experience with a modeling method for laparoscopic left lateral segment liver resection (LLLR).</p><p><b>METHODS</b>The surgical procedures of LLLR were carried out with the patient placed in a supine position and 4 trocars placed on the abdomen. After complete dissociation of the left lobe, the segment II and III vascular pedicles were freed with a harmonic scalpel and transected with a linear cutter stapler. The left hepatic vein (LHV) was dissociated with a harmonic scalpel with a slightly left direction of liver dissection, followed by complete resection of the LHV and finally by wound surface management, specimen removal, wound drainage, and abdominal incision closure.</p><p><b>RESULTS</b>Between July, 2003 and August, 2010, this modeling method for LLLR was performed successfully in 48 cases without conversion to laparotomy. The mean operation time was 75∓30.8 min, blood loss was 58∓36.4 ml, and length of postoperative hospital stay was 4.8∓1.5 days. Postoperative complications occurred in 3 cases, including ascites in 2 cases and mild biliary leakage 1 case, all cured conservatively.</p><p><b>CONCLUSION</b>This modeling method can simplify the surgical procedure of LLLR, reduce blood loss, and avoid air embolism due to vein injury. Being less technically demanding, this method can be safely performed in hospitals at various levels.</p>

A comparative study of laparoscopic fistal pancreatectomy and open distal pancreatectomy / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the clinical results of laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP), confirm the potential advantages of LDP.</p><p><b>METHODS</b>The medical records of 30 consecutive patients who underwent LDP were reviewed and compared with those of 42 patients who underwent ODP.</p><p><b>RESULTS</b>Operation time was longer for LDP than for ODP [(186.33±58.98 min) vs (149.29±29.00 min), P=0.001], but blood loss [(223.33±143.68 ml) vs(251.19±103.29 ml), P=0.341] and spleen-saving rate(42.3% vs 61.8%, P=0.192) were no significant difference between the 2 groups. Decreased postoperative bowel recovery time [(2.37±0.85 d) vs (2.81±0.67 d), P=0.016], oral intake time [(2.37±0.85 d) vs (2.81±0.67 d), P=0.016] and length of stay [(7.43±1.57 d) vs (9.67±1.41 d), P=0.000] were seen in LDP group. However, the rate of postoperative pancreatic fistula (16.67% vs 21.43%, P=0.619) was no significant difference between the 2 groups. 3 cases of wound infection and 2 cases of lung related complication were occurred in ODP group, but none in LDP group.</p><p><b>CONCLUSION</b>LDP is a safe and effective surgical approach, providing the same surgical results comparable to that of ODP, and substantially faster recovery. However, high requirement of laparoscopic technique and equipments limited its further clinical application.</p>

siRNA knocks down Bax gene and inhibits TNF-α induced apoptosis in A549 cells / 中国病理生理杂志

AIM: To investigate the influence of tumor necrosis factor-α (TNF-α) induced apoptosis through knocking down Bax gene by RNA interference (RNAi) in human alveolar type II epithelial cells (A549). METHODS: A549 cells were cultured in vitro and divided into 4 groups according to RNAi treatment: control group, TNF-α treated group, Bax siRNA group and control siRNA group. Chemically synthesized small interfering RNA (siRNA) directed against human Bax gene was transfected into A549 cells by cationic liposome. The effect of RNAi was investigated by reverse transcription PCR, Western blotting and immunohistochemisty, and the rate of apoptosis was investigated by flow cytometry. RESULTS: Bax gene was knocked down effectively in Bax siRNA group (P<0.05). Apoptosis was induced by TNF-α in TNF-α treated group and control siRNA group. However, it was abolished in Bax siRNA group by the downregulation of Bax gene compared to TNF-α treated group and control siRNA group (P<0.05). CONCLUSION: This result suggests that Bax gene has a significant role of pro-apoptosis in A549 cells and knocking down Bax gene by RNAi can effectively inhibit TNF-α-induced apoptosis in A549 cells.

Comprehensive surgical approaches to management of various facial nevi / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the effects of the flexible surgical approaches on therapeutic and cosmetic outcomes of facial nevi.</p><p><b>METHODS</b>From August 2002 to January 2008, 16 cases with facial nevi had been treated in our wards with the selected approaches. Surgical approaches including serial excision or one-time radical excision, free skin graft, and expanded flap were adopted in accordance with the individual size and location of the facial nevi.</p><p><b>RESULTS</b>All cases experienced complete excision and had satisfactory cosmetic appearance in the end.</p><p><b>CONCLUSION</b>The flexible surgical measures help to minimize the risk of malignant transformation and achieve good cosmetic results.</p>

Clinical application of three methods for total ear reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the indication and results of three methods for total ear reconstruction.</p><p><b>METHODS</b>960 cases of total ear defect were treated with skin expansion and autogenous rib cartilage framework (n = 786), or skin expansion and Medpor framework (n = 150), or ear prosthesis (n = 24). The indication and results of the three methods were analysed.</p><p><b>RESULTS</b>Good cosmetic results were achieved with all three methods. Autogenous rib cartilage framework was suitable for patients under 30 years old with unaffected skin at mastoid region. Medpor framework was good for grown-up, especially over 30 years old, or with mild infection at mastoid region. Patients with severe skin injury at mastoid region or unwilling to accept surgery should choose ear prosthesis.</p><p><b>CONCLUSIONS</b>Satisfactory results can be achieved with suitable methods for total ear reconstruction.</p>

Laparoscopic resection of pancreatic islet cell tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the surgical technique and clinical experience of total laparoscopic resection of the pancreatic islet cell tumors.</p><p><b>METHODS</b>From July 2002 to December 2007, 30 cases including 12 males and 18 females were diagnosed as pancreatic islet cell tumor. There were at least one positive imaging examination of each patient preoperatively. The location of the tumors included 4 in proximal pancreas and 26 in distal pancreas.</p><p><b>RESULTS</b>The tumors were successfully found and removed in 28 cases and unsuccessfully located in the other 2 cases. The procedures included local resections in 13 cases and distal pancreatectomies in 15 cases (spleen reserved in 7 cases). The mean operation time was 165 min (range, 65 - 465 min). The mean blood loss was 145 ml (range, 50 - 800 ml). Pancreatic leakage occurred in 3 cases, 2 of which were cured conservatively. And the other one were cured by endoscopic retrograde cannulation of the pancreatic duct. The mean postoperative hospital stay was 5.6 days (range, 2 - 17 d). There were no conversions and death. After follow up of (14.3 +/- 16.7) months (range, 4 - 62 months), there were no recurrences.</p><p><b>CONCLUSION</b>Total laparoscopic resection is a safe and effective method for pancreatic islet cell tumors.</p>