Ilizarov technique in treatment of Gustilo type Ⅲ B and C of large tibia bone defect combined with soft tissue defect / 局解手术学杂志

Objective To investigate the efficacy of Ilizarov technique in treatment of Gustilo type Ⅲ B and C of large tibia bone defect combined with soft tissue defect. Methods Thirty cases with large tibia bone defect combined with soft tissue defect in our hospital from January 2016 to December 2018 were selected including 25 cases with type Ⅲ B and 5 cases with type Ⅲ C,who were all open tibia fractures and treated with Ilizarov technique. Results All patients were followed up for 10 to 18 months with an average of 15 months. The bone defects were reconstructed, the difference between the length of the affected limb and the healthy side was less than 2 cm. The fracture was healed and the wound was closed. One case was with paralysis of common peroneal nerve and recoveried after 3 months. Twenty-two cases recovered without extra surgery, five cases restored with skin graft and three cases covered the wound by rotating skin flap. Conclusion Ilizarov technique is one of effective ways to treat Gustilo Ⅲ type B and type C of large defect combined with soft tissue defect.

Flap transplantation combined with Masquelet technique in the treatment of bone and soft defect / 中华显微外科杂志

Objective To explore the effect of the use of flap transplantation combined with Masquelet tech-nique in the repair of long bone accompanied with soft tissue defect. Methods The retrospective study includes 16 cases of bone defects over 6.0 cm combined with soft tissue defect from March,2013 to March,2016,13 males and 3 females, of which the ages range from 16 to 65 years. The length of bone defect ranged from 6.0 to 12.0 cm, with an average of 8.5 cm,while the wound defect ranged from 5.2 cm×3.5 cm to 16.0 cm×7.5 cm. There were 8 cases out of 16 involve an infection:3 cases of Staphylococcus aureus(including 1 MRSA),2 cases of Staphylococcus epidermidis, 2 cases of Enterobacter cloacae, and 1 case of Acinetobacter baumannii. The 1 stage surgery in all patients admitted to hospital after complete debridement and external fixation, the clean wounds with bone defect received antibiotic-impregnated bone cement filling operation and a flap transplantation or transposition directly after the debridement, but the infected wounds received vacuum sealing drainage treatment firstly, associated with adequate use of antibi-otics for 1-2 weeks and then the bone cement filling and flap transplantation with infection totally controlled.After 8-12 weeks, we conducted the secondary internal fixation surgery replacing antibiotic-impregnated bone cement with autogenic cancellous bone, vancomycin artificial bone as well as rhBMP-2. All the cases were followed for 6 to 18 months. Results All patients with primary surgery are effectively controlled after 1-4 weeks of anti-infection treat-ment exclusive of the case with MRSA.As the condition of the patient with MRSA relapse,we changed to convention-al treatment: placed a continuous irrigation and suction equipment instead of the bone cement filling, the wound healed completely without fistula formation of osteomyelitis in 6 months after the treatment of Ilizarov technique. All transplantation and transposition flaps survived. As for those who received a secondary bone graft operation, all achieved a bony union in a period of 4-6 months. Conclusion The combination of flap transplantation and Masquelet technique is an effective method to repair limb long bone and soft tissue defect currently.

Value of the laparoscopy combined with double-balloon enteroscopy in diagnosis and treatment of intestinal diseases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of laparoscopy combined with double-balloon enteroscopy (DBE) for the diagnosis and treatment of intestinal diseases.</p><p><b>METHODS</b>Clinical data of 69 cases with suspected small bowel diseases undergoing laparoscopic and DBE for the diagnosis and treatment were retrospectively analyzed.</p><p><b>RESULTS</b>The lesions were found in 48 cases by laparoscopy. DBE was required in the remaining 21 patients to identify the underlying condition. All the operations were successfully completed using the laparoscopic approach, including totally laparoscopic bowel resection (n=11), and laparoscopic-assisted bowel resection (n=58). There were no anastomotic leakage, postoperative bleeding, intestinal obstruction, or wound infection. All the patients were discharged within 7 to 9 days after surgery. Postoperative pathological examination showed vascular abnormally (n=10), gastrointestinal stromal tumor (n=20), intestinal adenocarcinoma (n=5), intestinal neurofibroma (n=2), diverticulum (n=5), intestinal mucosal ulceration (n=8), intestinal tuberculosis (n=3), postoperative pouch bleeding (n=1), intestinal polyp (n=6), Crohn's disease (n=5), Meckel diverticulum (n=2), metastatic kidney cancer (n=1), and metastatic lung cancer (n=1). Length of follow up ranged from 3 months to 4 years, during which no re-bleeding occurred, 2 patients with gastrointestinal stromal tumor died of local recurrence and liver metastasis, 1 patient with adenocarcinoma died of local recurrence involving pancreatic head, duodenum, and mesenteric vessels, 2 patients with metastatic disease died of peritoneal recurrence and liver metastasis.</p><p><b>CONCLUSION</b>Laparoscopic combined with DBE has a high detection rate for small intestinal disease with accurate localization, less trauma, and quicker recovery.</p>

Cellular immunotoxicity of rAAV gene medicine and possible solutions / 药学学报

Gene medicine based on recombinant adeno-associated virus (rAAV) vector has rapidly become the prior-choose reagent for gene therapy, since it had been shown that the rAAV was able to stably express many genes in vivo without detectable side-effect. However, recent findings of CTL immune responses to AAV capsid in a clinical trial highlighted a new issue regarding safety that previously was not identified in animal studies. Obviously it is so important to understand the interaction of rAAV with the immune system in details for the safety and success of rAAV gene medicine. In this review we evaluate several current hypotheses aiming to explain the cellular immunotoxicity, also analysis the current findings including the presentation kinetics of the capsid antigen and the activation of CTL. Focusing on the key steps of the immune response several solutions are proposed, including immunosuppression, optimization of vector and improvement of purity, in order to insure clinical safety and efficacy of rAAV.

Sensory and sympathetic innervation of cervical facet joint in rats / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore the patterns of innervation of cervical facet joints and determine the pathways from facet joints to dorsal root ganglions (DRGs) in order to clarify the causes of diffuse neck pain, headache, and shoulder pain.</p><p><b>METHODS</b>Forty-two male-Sprague-Dawley rats, weighing 250-300 g, were randomly divided into three groups: Group A (n=18), Group B (n=18), and Group C (n=6). Under anesthesia with intraperitoneal pentobarbital sodium (45 mg/kg body weight), a midline dorsal longitudinal incision was made over the cervical spine to expose the left cervical facet joint capsule of all the rats under a microscope. The rats in Group A underwent sympathectomy, but the rats in Group B and Group C did not undergo sympathectomy. Then 0.6 microlitre 5% bisbenzimide (Bb) were injected into the C1-2, C3-4 and C5-6 facet joints of 6 rats respectively in Group A and Group B. The holes were immediately sealed with mineral wax to prevent leakage of Bb and the fascia and skin were closed. But in Group C, 0.9% normal saline was injected into the corresponding joint capsules. Then under deep re-anesthesia with intraperitoneal pentobarbital sodium (45 mg/kg body weight), C1-C8 left DRGs in all rats and the sympathetic ganglions in Group B were obtained and the number of the labeled neurons was determined.</p><p><b>RESULTS</b>Neurons labeled with Bb were present in C1-C8 DRGs in both Group A and Group B, and sympathetic ganglions in Group B. In the C1-2 and C3-4 subgroups, labeled neurons were present from C1 to C8 DRGs, while in C5-6 subgroups they were from C3 to C8. The number of Bb(+) neurons after sympathectomy was not significantly different in the injected level from that without sympathectomy. But in the other levels, the number of Bb(+) neurons after sympathectomy was significantly less than that without sympathectomy.</p><p><b>CONCLUSIONS</b>The innervation of the cervical facet joints is derived from both sensory and sympathetic nervous system, and DRGs are associated with sympathetic ganglions through nerve fibers outside the central nerve system.</p>