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Objective:To summarize the clinical characteristics and investigate risk factors associated with the development of plastic bronchitis(PB)in pediatric patients who have severe pneumonia caused by adenovirus(HAdVs)infections.Methods:We retrospectively reviewed the clinical manifestations, laboratory results, radiological examinations, and treatment courses of 258 children who were diagnosed as HAdVs associated severe pneumonia between 1st January, 2015 and 31st October, 2019 at Shenzhen Children′s Hospital.According to the presence of PB, patients were divided into PB group( n=45)and non-PB group( n=213). Results:In PB group, the male to female ratio was 1.65∶1(including 28 boys and 17 girls)and the median age was 41.0(18.5, 65.5)months.Patients younger than 6 years of age accounted for 80.0%(36/45)and older patients accounted for 20.0%(9/45). The major clinical symptoms of patients in PB group were high fever(95.6%, 43/45), cough(100.0%, 45/45)and conjunctivitis(33.3%, 15/45). Physical examinations revealed that most patients had tachypnea(80.0%, 36/45)and crackles(80.0%, 36/45). Compared to patients in non-PB group, the duration of fever in PB group was significant longer( Z=-13.519, P<0.001). Compared to non-PB group, there was a significant decrease of the lymphocyte count[2.24(1.44, 3.84)×10 9/L vs.1.75(1.21, 3.03)×10 9/L] and a significantly increase of the procalcitonin level[0.46(0.19, 1.73)ng/mL vs.1.54(0.37, 2.96)ng/mL] in PB group( P<0.05). Chest radiological examinations revealed that patients in PB group had higher rates to develop pleural effusion(62.2% vs.42.3%) and atelectasis(57.8% vs.22.1%) of the lungs compared to non-PB group( P<0.05). The majority of patients improved after resolution of symptoms(97.8%, 44/45) in PB group.Only one patient(2.2%, 1/45) died due to discontinuation of treatment.Conjunctivitis( P<0.001, OR=108.514, 95% CI 17.476-673.791), tachypnea( P<0.001, OR=18.788, 95% CI 5.172-68.246), pleural effusion( P=0.007, OR=3.363, 95% CI 1.389-8.139) were independent risk factors associated with the development of PB in children with HAdVs associated severe pneumonia. Conclusion:Pre-school age children are at higher risk to develop HAdVs related severe pneumonia that complicated with PB.Fever and cough remain the main clinical symptoms.The presence of PB is associated with longer period of fever and higher risks to have pleural effusion and atelectasis.Conjunctivitis, tachypnea orpleural effusion are higher risk to develop PB in those with HAdVs associated severe pneumonia.
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Objective:To investigate the middle-aged and elderly people′ willingness for family doctor service contracts and its influencing factors, and to provide feasible suggestions for the implementation and promotion of family doctor services.Methods:Stratified random sampling method was adopted to select middle-aged and elderly people aged 45 in 6 urban areas of Xuzhou city for questionnaire survey to investigate their illness, medical treatment and their willingness to contract a family doctor. The data acquired were analyzed with statistical description, univariate analysis( χ2 test), and multivariate logistic regression analysis. Results:Among the 927 valid questionnaires were recovered, 272(29.34%)of them intended to contract a family doctor, and 655(70.66%)had no such intention. Results of multivariate logistic regression showed that the influencing factors of the middle-aged and elderly people′ willingness of contracting family doctors were age, occupation, self-rated health, treatment status within two weeks, chronic diseases, referral experience and their knowledge of family physician contract system.Conclusions:Middle-aged and elderly people at large are not willing to sign up for family doctors. It is recommended to focus the publicity efforts on those who are relatively younger age, farming and healthier, enhancing their awareness of the service, and encouraging them to support the dual-referral policy. These efforts are expected to promote the coordinated progress of both dual referral and family doctor contract service, hence achieving the national coverage of the family doctor system.
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Objective:To investigate the current status of the employment quality of public health graduates and feedback from employers.Method:s The questionnaires covering employing fields, coherence between major and employment, ways to find job and feedback from employers were used. A total of 309 bachelor graduates majoring in public health from Grade 2011 to Grade 2016 were selected as study objects via random cluster sampling method. In addition, online and offline synchronization survey were adopted to collect employment data; SPSS 22.0 was used for analyzing the data. Employment quality of graduates from different specialties as well as feedback of employers were compared.Result:s Bachelor graduates in public health had an employment rate of 100%; 19.75% (61/309) graduates in public health changed work place, while the most had a stable job; 50.10% (155/309) graduates had work relatively or fully related to their specialties. Bachelor graduates in public affairs management had a relatively high level of satisfaction in salary, welfare insurance and others (χ 2=18.805, P=0.043). Employers were satisfied with the bachelor graduates generally, but also believed that their professional knowledge and innovation ability should be improved. Conclusion:The overall employment quality of bachelor graduates in public health is good, but there is still room to improve the quality. The overall evaluation for graduates is high, and few organizations consider bachelor graduates of poor quality. In summary, schools should optimize course setting, cultivate comprehensive quality, and strengthen students' humanistic education.
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Thioredoxin reductase (TrxR) is one class of the most important antioxidant selenoproteins and is involved in regulating tumor genesis and progression. It has been reported that naphthoquinones can target and inhibit TrxR1 activity therefore produce reactive oxygen species (ROS) mediated by TrxR1, resulting into cellular redox imbalance and making the naphthoquinone compounds to become potential antitumor chemotherapy drugs. The purpose of this work is to explore the interaction between TrxR1 and menadione using biochemical and mass-spectrometric (MS) analyses, to further reveal the detailed mechanisms of TrxR1-mediated naphthoquinone reduction and inhibition of TrxR1 by naphthoquinone compounds. Using the site-directed mutagenesis and recombinantly expressed TrxR1 variants, we measured the steady-state kinetic parameters of menadione reduction mediated by TrxR1 and its variants, performed the inhibition analysis of menadione on TrxR1 activity, and eventually identified the interaction between menadione and TrxR1 through MS analysis. We found that Sec-to-Cys mutation at residue of 498 significantly enhanced the efficiency of TrxR1-mediated menadione reduction, though the Sec⁴⁹⁸ is capable to catalyze the menadione reduction, indicating that TrxR1-mediated menadione reduction is dominantly in a Se-independent manner. Mutation experiments showed that Cys⁴⁹⁸ is mainly responsible for menadione catalysis in comparison to Cys⁴⁹⁷, while the N-terminal Cys⁶⁴ is slightly stronger than Cys⁵⁹ regarding the menadione reduction. LC-MS results detected that TrxR1 was arylated with one molecule of menadione, suggesting that menadione irreversibly modified the hyper-reactive Sec residue at the C-terminus of selenoprotein TrxR1. This study revealed that TrxR1 catalyzes the reduction of menadione in a Se-independent manner meanwhile its activity is irreversibly inhibited by menadione. Hereby it will be useful for the research and development of naphthoquinone anticancer drugs targeting TrxR1.
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Catalysis , Drug Development , Oxidation-Reduction , Thioredoxin Reductase 1/metabolism , Vitamin K 3/metabolismABSTRACT
Objective To report the clinical outcomes of latissimus dorsus flap used to reconstruct severe trauma on lower leg.Methods From May 2011 to September 2016,12 patients were treated for severe trauma on lower leg at Orthopaedic Department,General Hospital of Rocket Force.They were 10 men and 2 women,aged from 22 to 54 years (average,37.5 years).According to the Gustilo classification,their open fractures were of type ⅢA in 2 cases and of type ⅢB in 10.The areas of soft tissue defect ranged from 15 cm × 8 cm to 35 cm × 12 cm.Their wounds were covered with latissimus dorsus flaps;the dorsal expansion of the ankle joint was reconstructed after their bone infection was controlled.Two flaps were anastomosed directly to the anterior tibial vessels and one flap to the femoral vessels.The other 9 flaps were anatomosed to the lateral circumflex femoral artery,bridging with the greater saphenous vein (average length:32 cm).Ten flaps were neuroanatomosed with the motor branch of common peroneal nerve and 2 with the motor branch of vastus lateralis.The therapeutic outcomes were evaluated in terms of repair of soft tissue defects,control of infection and range of active dorsal flexion of the ankle at neutral position.Results The 12 patients were followed up for an average of 3.5 years (from 1 to 6 years).All the 12 flaps survived and infections were eradicated.The fractures were healed with muscle strength of grade 3 to grade 4.Their ankle extension was reconstructed.Their limbs were preserved with satisfactory limb function.The bone exposures of 5 cm × 3 cm and 6 cm × 3 cm in area after debridement respectively in 2 cases of Gustilo type ⅢA were covered with latissimus dorsus flaps.The range of active dorsal flexion of the ankle at neutral position increased from preoperative 10.5° to postoperative 19.1° on average.Conclusion In treatment of severe trauma on lower leg,latissimus dorsus flaps can be used to repair skin wound,control infection and reconstruct ankle function simultaneously,with advantages of reduced operative procedures,a high rate of limb preservation,and better function recovery.
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Objective To evaluate the efficacy of microsurgical techniques combined with bone transportation for osteomyelitis following open fracture on the leg.Methods From April 2007 to April 2016,25 patients with osteomyelitis caused by severe open injury on the leg were treated at Orthopaedic Department,General Hospital of Rocket Force.They were 22 men and 3 women,aged from 19 to 65 years (average,36.5 years).Their open injury was located at upper tibia in 6 cases,at middle tibia in 6 and at lower tibia in 13.Eight patients received internal fixation with plate and 17 unilateral external fixation.By the Cierny-Mader classification,their chronic osteomyelitis was of type Ⅲ in 14 cases and of type Ⅳ in 11.The tibial defects after excision of infectious segment ranged fromn 5 to 14 cm in length (average,8.8 cm).After infectious tissues were removed,antibiotic bone cement chains were inserted into the defects.The open wounds were covered with microsurgical pedicled or free flaps.Bone transportation with unilateral external fixation was used to deal with the bone defects after removal of the infectious bone.Results Bone infection was controlled in the 25 patients.The rate of infection control after one debridement procedure was 76.0％ (19/25),and that after 2 debridement procedures was 24.0％ (6/25).Flap repair led to early closure of the open wounds.The successful rate of wound closure after one operative procedure was 84.0％ (21/25),and that after secondary operation was 16.0％ (6/25).Bony union of tibial defects was achieved in all the 25 patients with no recurrence of osteomyelitis.The patients were followed up for 18 to 36 months (average,24.6 months).Re-fracture happened in one case and was treated with another operation.Bone union time starting from bone transportation ranged from 8 to 18 months (average,10.5 months).Time for external fixation ranged from 12 to 20 months (average,18.4 months).Conclusion For osteomyelitis caused by severe open injury on the leg,microsurgical techniques can be used to repair open wounds and bone transportation to reconstruct bone defects after removal of infectious bone.
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Objective To analyze the influence of NRCMS polices evolutionon residents’utilizationof outpatient serv-ices.Methods Based on the same individual balance panel data in two years of three counties in Ji＇nan city,we build panel dat-amodel and conductrandom effects of binary choice panel data model,random effects Poisson regression model,difference in differences(DID)model to analyze the influence.Results Our study shows that the four-week consultation rate in 2011 in-creased by 4. 1% compared to 2008.Age,self-ratedhealthstatus,suffering from chronic diseases or not,the distance to the nearest medical institution have an influence on outpatient service utilization.The new rural cooperative medical outpatient reimburse-ment policy has an effect on thefour-week consultation rate of middle-income residents and high-income residents.The NCMS policy tends to benefit middle and high-income groups.Conclusion we should increase NCMS outpatient compensation level of low-income residents appropriately.
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Objective To measure and evaluate the construction of hospital safety culture, analyze the present situation and problems of hospital safety culture construction, and put forward strategy of continuous improvement. Methods Based A tertiary hospital in northern Jiangsu province was chosen for the survey. Sampling questionnaire survey was made to 400 staff of the hospital, including directors/vice directors of clinical departments, chief nurses and logistic/administrative staff(10％ of the total staff). These people were subject to a questionnaire survey of Hospital Safety Culture Measurement regarding hospital safety culture status and satisfaction. Likert 5-point scale and assign points, statistical inference, and quality control chart method were used, to analyze the organization structure, medical quality and medical safety, comprehensive evaluation dimensions of hospital safety culture, as well as 31 items involved. Results The agreement/satisfaction scoring of the general evaluation dimension of hospital safety culture was 67. 10％ as in agreement and 23. 20％ as high agreement; the scoring of the organization structure ( management capability of department managers and medical worker staffing) and medical safety( failure to report adverse events and discussion of patient privacy ) for hospital safety culture development was low ( 3. 4167 and 3. 5009 respectively). This calls for improvement. Conclusions The hospital should perform continuous monitoring and improvement, and strengthen the organizational work of safety culture hospital wide ( especially department managers) . It should also enhance the management of medical quality( ensuring drug supply, and service management awareness of logistic departments), and pay attention to medical safety monitoring and management for higher responsiveness of the hospital.
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Objective To investigate the residents' acceptance and the influencing factors of the hierarchical medical system in Xuzhou, and to suggest on effective system implementation. Methods Xuzhou residents free of cognitive impairment and over 18 years old were sampled for questionnaire survey in July-August 2016, to study their acceptance of their basics and acceptance of the system. 1 550 questionnaires were distributed, and 1 473 valid ones were recovered. The count data were expressed as constituent ratio, and χ2test was used for single-factor analysis, with binary logistic regression analysis for multi-factor analysis. Results 71. 0% of the residents embraced this system. Their acceptance varies significantly with their age, place of residence, education, annual average monthly income, self-rated health status, physical examination experience, conditions of chronic diseases, medical visit experience at primary healthcare institutions, and their awareness of the system (P<0.05). Conclusions The acceptance of the system by Xuzhou residents needs to be elevated, by means of greater promotional efforts, capacity building for primary institutions, so as to fully leverage the system to serve the residents.
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Objective To evaluate the effect of retention time of urokinase on hematoma dissipation in the treatment of severe ventricular hemorrhage by lateral ventricle drainage. Methods The clinical data of 62 patients with severe ventricular hemorrhage and having received bilateral ventriculostomy were retrospectively analyzed. These patients was divided into 3 groups according to the retention time of urokinase: A group (20 patients, retention time 1 h), B group (22 patients, retention time 2 h) , and C group (20 patients , retention time 3 h).The number of patients with complete hematoma dissipation at different time in each group were compared. Results At 5-6 d, 7-9 d and 10-12 d after operation, the number of hematoma dissipation in A group was 2, 5, 13 cases, in B group was 5, 13, 4 cases, and in C g group was 3, 13, 4 cases. The number of hematoma dissipation patients in three groups had significant difference (P=0.008), the number of hematoma dissipation patients between A group and B group, and between A group and C group had significant differences (P=0.005, 0.012), but there was no significant difference between B group and C group (P=0.621). The complication rate in three groups had no significant difference (χ2=2.540, P=0.281). Conclusions The 2 h retention time of urokinase is more suitable for the patients with severe ventricular hemorrhage who underwent external drainage.
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Objective To study the diagnosis and treatment of protracted bacterial bronchitis (PBB) in children. Methods Children with PBB conifrmed by bronchoscopy were recruited from May 2013 to April 2015 . The clinical data were retrospectively analyzed. Results All 31 cases include 18 boys and 13 girls were recruited. 28/31 were younger than 6 years old. They all complained of wet cough, some of them were reported with wheeze ( 17/31 ) and with ruttle in the lungs ( 16/31 ). White blood cell were in normal range ( 18/31 ) or slightly elevated ( 13/31 ). The C-reactin protein was in normal range ( 28/31 ). Chest X-ray test of 16 cases were normal. Twenty-four cases taken chest computerized tomograph scan, 5 had a sign of tracheobronchial stenosis. The purulent bronchitis without tracheobronchial stenosis were conifrmed by bronchoscopy. Four cases had tracheomalacia. The medians of proportion of neutrophil were 80% in bronchoalveolar lavage lfuid (BALF). The pathogens were identiifed in BALF in 17 cases, 6 with Streptococcus pneumoniae, 6 with Haemophilus parainfluenzae, 3 with Moraxella catarrhalis, 2 with Staphylococcus aureus and 1 with Haemophilus influenzae. The symptoms were improved in all cases and co-amoxiclav was prescribed to most cases when discharged. The course of antibiotics therapy was 2-4 weeks in 23 cases, and more than 4 weeks in 8 cases. Twenty-three ( 23 ) cases were cured but 8 of them relapsed. Another 8 cases were improved but not completely remitted, 7/8 were cured by further treatment for concomitant diseases such as nasosinusitis and allergic rhinitis. Conclusions Children with PBB are typically younger than six years old, and presented with prolonged wet cough and parent-reported wheeze, normal or with ruttle in the lungs. A conifrmed diagnosis was reached by bronchoscopy. The antibiotics therapy were effective, the course should be more than 2-4 weeks, however, relapse were common. When antibiotics therapy does not lead to complete remission, concomitant diseases should be considered.
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Objective To study the causes, temporal courses, predictors and outcomes of delayed neurological deterioration (DND) after mild traumatic brain injury. Methods In a cohort of 254 patients, the incidence, causes and temporal courses of DND after mild traumatic brain injury were summed up. Univariate and multivariate (Logistic regression) analysis were performed to assess the predictors of DND. The short-term outcomes were compared between patients with and without DND. Results DND occurred in 14.2% (36/254) of the 254 patients. Intracranial causes of DND such as hematoma growth were observed in 91.7%(33/36) of patients with DND. The interval from arrival to DND was 0.5- 59.0 h. Thirty patients (83.3%, 30/36) deteriorated within 24 h. The univariate analysis revealed that dangerous injury mechanism, loss of consciousness, severe headache, more than 1 time vomiting, interval from injury to first CT scanning, first Glasgow coma scale (GCS) scores, basal skull fracture, hypocoagulability, heavy alcohol consumption were the predict factors for DND (P<0.05 or<0.01). The multivariate analysis revealed that interval from injury to first CT scanning (P=0.000, OR=0.169, 95% CI: 0.083- 0.344), first GCS scores (P = 0.004, OR = 0.355, 95%CI: 0.175- 0.721) and hypocoagulability (P=0.001, OR=0.077, 95%CI:0.017-0.354) were the independent predict factors for DND. All of the patients without DND recovered better. But in the patients with DND, 30 patients recovered better, 4 patients had slight disability, 1 patient had severe disability, and 1 patient died. The treatment outcome between two groups had significant difference (Z =-6.088, P = 0.000). Conclusions The causes of DND are mostly intracranial. Most patients deteriorat within 24 h. The interval from injury to first CT scanning, first GCS scores and hypocoagulability appear to be independent predictors of DND. DND is associated with poor short-term outcomes.
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Objective:To investigate the role of sterol regulatory element binding protein-1 (SREBP1) in atorvastatin-induced reduction of nucleotide-binding oligomerization domain-like receptor protein 1 ( NLRP1 ) inflammasome expression. Methods:THP-1 cells were treated with phorbol 12-myristate 13-acetate (160 nmol/L) for 12 h to be differentiated into macrophages. The medium was then replaced with serum-free medium containing lipopolysaccharide and ( or ) atorvastatin. The mRNA expression of NLRP1 and SREBP1 were detected by Real-time PCR. The protein expression of NLRP1 and SREBP1 were determined by Western blot. Furthermore, we observed the effect of SREBP1 siRNA on atorvastatin-induced reduction of NLRP1 expression. Results:Atorvastatin inhibited the mRNA and protein expression of NLRP1 and SREBP1 in the THP-1 macrophages. SREBP1 siRNA showed no significant difference on lowering NLRP1 expression when compared with atorvastatin. Treating cells with SREBP1 siRNA and atorvastatin at the same time resulted in more obvious reduction of NLRP1 expression than single use of SREBP1 siRNA or atorvastatin. Conclusion:Atorvastatin might exert anti-inflammatory effect by repressing NLRP1 expression through the SREBP1 path-way.
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Objective To learn the impact of county-level public hospital reform on the expenditure of medical insurance fund.Methods Using the difference-in-differences model to analyze the differences incurred in both hospitalization expenditure and expenditure of the fund at two county-level public hospitals.Results The reform has reduced both the drug expenditure and examination expenses per hospitalization at such hospitals at 318.5 yuan and 410.2 yuan respectively,yet with an increase of treatment expenditure of 535.6 yuan per hospitalization.No significant growth rate was incurred by the reform to the medical insurance fund.A significant difference of both hospitalization expenditure of patients and the fund was found among patients covered by different medical insurance funds.Conclusions The reform has achieved initial success at such hospitals in reducing inpatients′drug and examination expenditures.However,it is important to prevent from the treatment expenditure from an offset increase;to further reform the payment modes for safety of the fund,to remove the differentiation found in the existing medical insurance system,and leverage the regulating role of various medical insurance funds on medical service behaviors and expenditures.
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Objective To explore the characteristic of sleep disorders in the initial stage of withdrawal and their relationships with alcohol craving levels in alcohol dependence (AD) patients,and provide support for diagnosis and prevention of re-drinking.Methods Thirty-two AD inpatients were assigned to AD group and 20 male healthy volunteers to control group.Alcohol craving was assessed with the Pennsylvania Alcohol Craving Scale (PACS) within the 2nd week after alcohol withdrawal for AD patients,and then the whole-night polysomnogram (PSG) tracings were conducted on the day of the night.Results The five item scores of the PACS were from 3.48 to 4.26 in AD patients.The sleep latency was(42.48±22.42) min,total sleep time was(289.61± 103.22)min,sleep efficiency was(71.45± 19.86) ％,S1 sleep was (23.47± 11.07) ％,arousal frequencies was (8.01 ± 2.77),S3+4 sleep was(6.26±5.35)％ in AD group.Compared with control group((19.65±8.57) min,(407.33±21.29) min,(81.52 ± 6.46) ％,(8.79± 1.83) ％,(2.17 ± 1.04),(15.87 ± 5.24) ％ respectively),the differences had statistical significances(t=2.206-9.082,P＜ 0.05-0.001).Alcohol craving levels were positively related to sleep latency,arousal frequencies and S1 sleep (r=0.424-0.898,P＜0.05-0.01) and negatively to total sleep time,sleep efficiency and S3+4 sleep (r=-0.416--0.662,P＜0.05-0.01) in AD group.Conclusion AD patients have sleep continuity and structure disturbances in the initial stage of alcohol withdrawal,sleep continuity and structure disturbances are related to alcohol craving.Improvements of sleep disorders should be paid during clinical alcohol dependence treatment.
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Objective To investigate the surgical technique,postoperative function and dislocation incidence of proximal humerus reconstruction with metallic endoprostheses and polypropylene knitted nonabsorbable mesh after proximal humeral tumor resection.Methods Twenty patients with proximal humeral tumor were retrospectively reviewed.They were performed proximal humerus reconstruction with proximal humeral prosthesis and polypropylene knitted non-absorbable mesh from February 2006 to January 2009.There were 5 women and 7 men with a mean age of 38 years(range,21-55 years)at the time of surgery,and giant cell tumor in 9 patients(including Campanacci Ⅱ for 3,Campanacci Ⅲ for 6),osteosarcoma in 1(Enneking ⅡB).and chondrosarcoma in 2 (Enneking ⅡA).The operative time,blood loss,and shoulder movement postoperation were analysed.According to the assessment system by MSTS,the function of limb after surgery was assessed.Results Patients were followed clinically and radiographically for a minimum of 24 months (mean,35 months;range,24-52 months).The mean operative time was 172 min(range,150-200min).The mean blood loss was 254 ml (range,150-500 ml).There were no shoulder dislocations at final follow-up.The mean shoulder flexion was 41°(range,20°-60°)and mean shoulder abduction was 42°(range,20°-70°).The mean postoperative functional assessment score of the limb was 66%(range,53%-77%).None of the Datients had a wound infection,traction neuropraxia or died after the surgical procedure.Conclnsion The data suggests that the use of a polypropylene knitted non-absorbable mesh for proximal humerus reconstruction may reduce dislocations and facilitate soft tissue attachment after tumor resection.
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BACKGROUND: Alginic acid has a relatively mild gel condition and good biocompatibility, and it has been widely used in bio-tissue engineering.OBJECTIVE: To construct bone tissue engineering scaffolds using alginate gel composite bone xenograft approach, and to observe the cell biological properties and in vivo osteogenic potential in scaffolds.METHODS: The bone marrow was harvested from two 2-week-old New Zealand rabbits, 1 ×10~(-8)mol/L recombinant human bone morphogenetic protein-2 was used to induce bone marrow mesenchymal stem cells. The induced bone marrow mesenchymal stem cells at the second generation were incubated into 1% sodium alginate gel, after cultured for 4 days, the cell morphology in gel was observed by hematoxylin-eosin staining. Bone marrow mesenchymal stem cells at the second generation were divided into simple DMEM gel group and DMEM containing 1% sodium alginate gel group, followed by a culture of 7 days. Then bone morphogenic protein-2 immunohistochemical staining was performed. A total of 24 nude mice were randomly divided into two groups, both sides of the thigh muscle pockets were implanted with bone marrow-derived mesenchymal stem cells/alginate gel/bovine cancellous bone complex as an experimental group, with bone marrow-derived mesenchymal stem cells/bovine cancellous bone as a control group. At 2 and 4 weeks post-operation, the osteogenesis in the composite was observed by histological examination, the percentage area of new bone or cartilage was determined using image analysis system.RESULTS AND CONCLUSION: The bone marrow-derived mesenchymal stern cells in the sodium alginate gel exhibited a well-stacked morphology, they suspended in a gel, showing cell division and mitosis phase. In the simple DMEM gel group and DMEM gel containing 1% sodium alginate group, the immunohistochemical results showed that, cell division and proliferation were normal, with prominence at a variety of forms, large nucleus, and clear nucleolus. The bone morphogenetic protein-2 expression had no significant difference between the simple DMEM gel group and DMEM gel containing 1% sodium alginate group (P>0.05).Scanning electron microscopy revealed that, the alginate gel evenly composited in bovine cancellous bone micropores, cell grew at different planes. Animal experiments showed that there were significant differences regarding the percentage of new bone or cartilage area between the experimental group and control group at 2 and 4 weeks postoperation (P< 0.05). It is indicated that constructing bone tissue engineering scaffolds by using alginate gel/bovine cancellous bone, complies with the ultra-structural principle of tissue engineering scaffolds, can maximize the cell loads, achieve good bio-performance, without adverse affects on the proliferation, osteogenic phenotype and related biological properties of bone marrow-derived mesenchymal stem calls, the in vivo osteogenic efficiency was high.
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BACKGROUND: The proximal tibia is the second common site for primary bony sarcomas,which lacks adequate soft tissue coverage.Resection and reconstruction by any technique leave the reconstructed area in a subcutaneous position.This has been a major source of necrosis of skin and infections.OBJECTIVE: To observe the effect of gastrocnemius muscle transfer to obtain soft-tissue coverage and extensor mechanism reconstruction for limb-sparing resection of the proximal tibia with endoprosthetic reconstruction.METHODS: From January 2001 to June 2008,27 patients with osteosarcoma of the proximal tibia confirmed by biopsy were selected.All the tumours were assigned to stage IIB based on Enneking's classical staging system.Neoadjuvant chemotherapy(Bacci,IOR/OS-N4)was utilized for the patients.All the patients adopted limb-sparing surgery,i.e.resection of proximal tibia with endoprosthetic reconstruction.A gastrocnemius flap was utilized to improve implant coverage and enhance the patellar tendon repair.MSTS was used to measure the functional status of patients with a sarcoma in the leg.RESULTS AND CONCLUSION: The follow-up was averagely 53.1 months.Of 27 patients,2 cases(7%)died of lung metastasis within 2 years,1(4%)suffered from amputation due to infection and underwent amputation.The others developed no complications or recurrence.The MSTS score was averagely 25.1 points.Results show that resection with endoprosthetic reconstruction utilizing a gastrocnemius muscle flap for osteosarcoma of the proximal tibia is reliable and predictable in combination with neoadjuvant chemotherapy.
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Objective To study the characteristics of intramedullaiy tumors of embryonal origin, surgical treatment and outcome. Methods The data of 26 cases with intramedullary tumors of embryonal origin, including clinical features, pathological types and imaging characters of the tumor, surgical treatment and outcome, were retrospectively summarized. Among the 26 patients, apart from the neurological symptoms, lower-extremity deformities were seen in 7 cases, scoliosis in 1 case, lower midline cutaneous abnormalities in 3 cases. The tumors involving lumber section of the spinal cord (thoracolumbar + lumbar segments + lumbosacral) in 21 cases, account for 80.8% (21/26). The tumor in different kinds had its characteristic MRI appearance. All of the 26 patients underwent surgical treatment. Subtotal resection of the tumor was performed in 19 cases, most partial resection in 5 cases, partial removal in 2 cases. Results Of the 26 patients, 25 patients had improved neurologically when leaving hospital. Twenty-one patients were followed up from 6 to 82 (30.0 ± 8.2) months, 12 patients had a good recovery without any neurological defect, 7 patients could live independently, 1 patient needed care offered by others, 1 patient with malignant teratoma died at 6 months after operation. In the follow-up period, no patient needed the second surgery for recurrent tumor. Conclusions Apart from the neurological symptoms, other abnormalities such as lower-extremity deformities, scoliosis, lower midline cutaneous abnormalities could be appeared in patients with intramedullary tumors of embryonal origin. Most tumors involving lumber section of the spinal cord, could be diagnosed by MRI. Other spinal abnormalities frequently occur with the tumors. It is difficult to remove the tumors totally, while the surgical outcome is satisfactory.
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Objective To study the value of configuration of the fourth ventricle to indicate, surgical treatment in patients with spontaneous cerebellar hemorrhage. Methods The data of 52 patients with spontaneous cerebellar hemorrhage were retrospectively analyzed. The relationship between configuration of the fourth ventricle and consciousness, volume of the hematoma, frequence of hydrocephalus and incidence of deterioration of consciousness was investigated. Results The correlations between the degree of the fourth ventricular compression and the consciousness, the volume of the hematoma were strong (r= -0.881,P <0.01; r=0.808,P < 0.01, respectively). The more the degree of the fourth ventricular compression was severe,the more GCS score was low and the volume of the hematoma was large. The incidence of hydrocephalus in patients with composed the fourth ventricle[57.7%(15/26)] was significantly higher than that in patients with normal configuration of the fourth ventricle [16.7% (3/18)] (χ~2= 7.406, P < 0.01). The incidence of deterioration of consciousness in patients with compressed the fourth ventricle who accepted conservative therapy initially [72.7% (8/11)]was significantly higher than that in patients with normal configuration of the fourth ventricle [12.5%(2/16)] (P= 0.003). Conclusions The configuration of the fourth ventricle is an useful indicator for surgical treatment in patients with spontaneous cerebellar hemorrhage. When making decision whether surgical treatment was used or not in patients with spontaneous cerebellar hemorrhage, the configuration of the fourth ventricle should be take into account.