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Objective:To evaluate the efficacy of a calf tissue flap combined with antibiotic-loaded calcium sulfate (artificial bone or mixed iliac bone graft) in the treatment of foot and ankle osteomyelitis.Methods:A retrospective study was conducted to analyze the 11 cases of foot and ankle osteomyelitis which had been treated at Department of Hand and Microsurgery, The Third Hospital of Baoji from October 2018 to October 2021. There were 8 males and 3 females, aged (42.3±23.7) years. The chronic hypotoxic osteomyelitis was repaired and reconstructed after thorough debridement at one stage with a calf tissue flap combined with antibiotic-loaded calcium sulfate artificial bone to fill the cavity and cover the wound. The acute infected trauma was repaired and reconstructed after thorough debridement at the second stage with a calf tissue flap combined with antibiotic-loaded calcium sulfate artificial bone to fill the cavity and cover the wound only after the acute infection was controlled by local dressing, drainage or negative pressure therapy and systemic anti-infection treatment at the primary stage. The flap size ranged from 3.5 cm × 2.0 cm to 12.0 cm × 6.0 cm. Four cases were treated by a peroneal artery perforator flap combined with antibiotic-loaded calcium sulfate artificial bone, 3 cases by a flap with peroneal artery perforator and peroneal nerve trophic vessel combined with antibiotic-loaded calcium sulfate artificial bone, 3 cases by a posterior tibial artery perforator flap combined with antibiotic-loaded calcium sulfate artificial bone, and one by a peroneus longus muscle flap combined with antibiotic-loaded calcium sulfate artificial bone. Postoperatively, the flap survival, bone union time, ankle function and complications were observed; the therapeutic efficacy was evaluated by comparing infection control indexes at the final follow-up [clinical manifestations like local redness, swelling, pain, ulceration, and exudation, and white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and calcitoninogen (PCT)].Results:All the flaps survived except for one which developed necrosis at the distal 1/3 of the flap but responded to dressing change. All the patients were followed up for (22.6±11.5) months. The 6-month follow-up revealed that all the flaps were fine in shape and texture. Re-examinations showed that WBC, CRP, ESR and PCT were normal or close to normal, the local skin was free of redness, swelling or ulceration, and protective sensation was restored to varying degrees. X-ray at (12.1±2.3) months showed that lesions disappeared, bony union was achieved, the ankle joint regained basic flexion and extension, and the affected limb also regained weight-bearing and walking functions in all the patients but one whose X-ray at 18 months showed poor bony union but no other symptoms or signs.Conclusion:In the treatment of foot and ankle osteomyelitis, a calf tissue flap combined with antibiotic-loaded calcium sulfate artificial bone can promote bone healing and restore the function of the foot and ankle because it not only fills the cavity and covers the wound but also effectively controls the infection.
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Objective:To observe the surgical method and clinical efficacy of applying calf tissue flap combined with artificial bone of antibiotics loaded calcium sulphate in treatment of tibia osteomyelitis.Methods:From July 2018 to January 2021, calf tissue flaps combined with artificial bone of antibiotics loaded calcium sulphate (or mixed with iliac bone) were applied to treat 16 cases with tibia osteomyelitis in the Department of Hand and Microsurgery of Baoji Third Hospital. There were 10 males and 6 females, aged 15 to 64 years old, with a mean age of 41 years old. For the 5 cases with acute osteomyelitis caused by wound infection, local dressing changes and drainage or VSD wound management were applied after debridement, together with primary systemic anti-infection treatment. After the acute infection period had been under control and stabilised, the wounds were then thoroughly exposed and cavities were filled and covered with the surgical reconstruction procedure with antibiotics-loaded artificial bone of calcium sulphate in combination with calf tissue flaps. For the 11 cases with chronic and hypotoxicity osteomyelitis, calf tissue flaps combined with antibiotics-blended artificial bone of calcium sulphate were applied to fill the cavity and cover the wound in phase I surgical reconstruction after thorough debridement. For the 7 cases with large bone defects or larger cavities after debridement, a mixed bone grafts of antibiotics-loaded artificial bone of calcium sulphate and autologous iliac bone were employed, with muscle flaps or myocutaneous flaps for an embedding repair. Sizes of the tissue flaps were 2.0 cm×3.5 cm to 12.0 cm×23.0 cm. Clinical outcomes were evaluated through follow-ups at outpatient clinic. The therapeutic effect was evaluated by the method described by McKee et al.Results:Except for 1 case of distal necrosis of tissue flap and survived after dressing change, the other tissue flap survived successfully. Postoperative follow-ups lasted for 12 to 40(mean 18) months. All the osteomyelitis were successfully cured, except 1 that had recurrence of osteomyelitis 1 year later, and treated with antibiotics-loaded artificial bone of calcium sulphate combined with autologous iliac bone implants after thorough debridement, and then healed well. The shape and texture of flaps were good. Protective sensations were restored to vary levels after 6 months. The calf regained weight-bearing and walking functions at 1 year after surgery. According to McKee et al., the therapeutic effect was evaluated: 11 cases were cured, 4 cases were improved, and 1 case relapsed, with an effective rate of 93.8%.Conclusion:Application of calf tissue flap combined with antibiotics-loaded artificial bone of calcium sulphate in the treatment of tibia osteomyelitis has a high cure rate and remarkable efficacy. It can significantly reduce the number of surgeries and shorten the course of disease.
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Objective:To investigate the clinical effect of propeller flap pedicled with perforating branch of peroneal artery in repairing soft tissue defects of ankle and foot.Methods:From August 2018 to August 2021, 15 cases of soft tissue defect of ankle and foot were repaired with propeller flap pedicled with perforating branch of peroneal artery in the Department of Hand and Microsurgery, Baoji Third Hospital. Among them, there were 7 cases with soft tissue defect in heel, 6 cases in lateral ankle and 2 cases in front of ankle. The size of defects was 3.0 cm×3.5 cm-5.5 cm×4.0 cm, and the size of flaps was 5.0 cm×4.5 cm-12.0 cm×6.0 cm. In 7 cases, the donor sites were closed directly with the aid of small paddle. The donor sites in other cases were covered with medium thickness skin graft after the wounds were narrowed by pull-up suture. The clinical efficacy was evaluated by follow-up at outpatient clinic and via telephone or WeChat interviews. Functional recovery was evaluated according to the American Orthopedic Foot Ankle Society (AOFAS) -Marylad.Results:Among the 15 flaps, 2 had distal necrosis and healed after dressing change; One flap was swelling and had venous osculation, but relived 2 weeks later. The rest of the 12 flaps survived smoothly. At the final follow-up: the shape and texture of the flap were good, and the protective feeling was restored; The ankle also recovered the normal flexion, extension and weight-bearing. According to the AOFAS-Marylad, function recovery were excellent in 9 cases, good in 4 cases, and fair in 2 cases.Conclusion:It is simple, safe and reliable to repair the soft tissue defect of foot and ankle with propeller flap pedicled with perforating branch of peroneal artery. It does not sacrifice the main blood vessels of limb, and the blood supply of the flap is reliable. It is an ideal operation for repairing the soft tissue defects of ankle and foot.
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Objective:To investigate the surgical technique and clinical effect of the island flap of dorsal branch of proper palmar digital artery in repair of the soft tissue defect of digits.Methods:From March 2013 to March 2021, 22 cases of digit soft tissue defects were repaired with dorsal branch of proper palmar digital artery island flap. The digit defects involved: 9 thumbs, 5 index fingers, 3 middle fingers, 3 ring fingers and 2 little fingers. The repair of defects covered 8 digit-tips, 7 pulps and 7 dorsal and nail beds. The defected area of soft tissue was 0.8 cm×0.5 cm-1.5 cm×8.0 cm, and the size of flap was 1.0 cm×0.7 cm-1.8 cm×1.0 cm. The donor site in 6 cases was closed directly. The other 16 cases were covered with medium thickness skin graft and pressurised bandaging. The follow-up reviews were carried out via the outpatient clinic visit, telephone or WeChat interview. Results:After operation, 1 flap had cyanosis due to a tight suture and it was relieved after the removal of intermittent suture; Tension blisters appeared in 2 cases and disappeared after 1 week; One case had necrosis at distal flap and healed after dressing change. Other flaps survived successfully and the incision and donor site healed in the first stage. All patients were entered to 6 to 18(mean 10) months of follow-up. At the final follow-up, the appearance and texture of the flaps were good and the protective sensation was restored. The flexion and extension function of the affected digit was normal with the TPD at 7-11 mm. The original shape and function of the digit body were basically reconstructed, except the failure in reconstruction of the special structure of digit body, such as nail, finger pulp thread and fine sensation. According to the Evaluation Standard of Upper Limb Function of Chinese Hand Surgery Society, 11 cases were in excellent, 9 in good and 2 in fair. The excellent and good rate was 91%. The function at donor sites was not affected.Conclusion:Repair of digit soft tissue defect with dorsal branch of proper palmar digital artery island flap is easy to operate, and with a low risk, high success rate and satisfactory curative effect.
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Objective:To summarise the clinical efficacy and surgical indications for free hallux toe nail flap and adjacent island flap of the middle and ring fingers in repair of distal thumb degloving injuries.Methods:From May 2009 to May 2021, a total of 24 patients (24 digits) with degloving injury of distal thumbs were treated in the Department of Hand and Microsurgery of Baoji Third Hospital. The flap was selected according to the patient's wishes and occupation. Of the 24 patients, 13 were repaired by free hallux toe nail flap transfer (group of hallux toe nail flap), and 11 were repaired by combining the proper palmar digital artery island flap of middle (ulnar side) and ring (radial side) fingers with the same volar common digital artery vascular pedicle (group of tile combined flap). Follow-up was performed at the 1st, 3rd, 6th,12th and 18th months after surgery respectively through outpatient clinic and telephone or WeChat interviews. The follow-ups focused on the appearance, colour, texture and two-point discrimination (TPD) of the flap, as well as thumb flexion, extension, opposition and grasping functions. Functional recovery evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results:All the 24 flaps survived and all were included in the follow-up. The follow-up lasted 12-60 and 6-18 months, with an average of (18.5±0.5) months and (6.8±0.3) months in group of hallux toe nail flap and group of tile combined flap, respectively. Appearance of thumb body and function at the last follow-up showed: in the group of hallux toe nail flap, the nails, thumbtips and fine sensations were restored, with the TPD at 5-8 mm. The thumb flexion, extension, opposition and grasping functions were good. Apart from without nails and fingerprint, the flaps in the group of tile combined flap had good appearance and texture, and the protective feeling was restored with the TPD at 6-11 mm. The affected thumbs also recovered the basic functions of flexion, extension, opposition and grasping. According to the Trial Standard of Upper Limb Function Evaluation of the Chinese Medical Association Hand Surgery Society, 7 cases were excellent, 5 cases were good, and 1 case was poor in the group of hallux toe nail flap. In the group of tile combined flap, 3 cases were in excellent, 5 in good, and 3 in poor. Appearance of flaps (such as nails and thumbtip fingerprint), fine sensory recovery, and the accuracy and stability of the grasping function, the group of hallux toe nail flap was significantly better than that of the group of tile combined flap. There was no functional impact on the donor site.Conclusion:Both types of flap are classic surgical procedures for repair of distal thumb degloving injury. In order to meet the individual requirement and to improve the efficacy of the treatment, such as for those who have high expectation for digit restoration, especially those who are young with aesthetical or professional requirement, free hallux toe nail flap repair is used to restore the perfect shape and function. And for those who are reluctant to sacrifice their toes or for the middle-aged and elderly people who do not have high expectation for the shape of thumb, a tile combined flap repair is used to restore thumb function.
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Objective:To study the expression of Resistin protein in breast cancer and to evaluate its significance to clinicopathology.Methods:The immunohistochemical technique, EnVision method, was used to evaluate the expression of Resistinin in 42 cases of normal breast tissues and 145 cases of breast cancer, and to analyze the relationship between Resistin protein expression and clinicopathological characteristics and molecular typing of invasive breast cancer patients.Results:The positive rate and strong positive rate of Resistin protein in normal breast tissue were 23.8% (10/42) and 0.0% (0/42) , respectively, while the positive rate and strong positive rate in invasive breast cancer were 88.3% (128/145) and 24.8% (36/145) . The positive rate and strong positive rate of Resistin protein in invasive breast cancer tissues were significantly higher than those in normal breast tissues (both P=0.000) . The positive rate of Resistin protein in invasive breast cancer was significantly higher in estrogen receptor (ER) -negative patients than in ER-positive patients ( P=0.006) , and it was higher in histological grade III and progesterone receptor (PR) -negative subjects than that of I-II and PR-positive, but the difference was not statistically significant ( P=0.053 and P=0.058, respectively) . The strong positive rate of Resistin protein in histological grade III, ER negative, PR negative and human epidermal growth factor receptor 2 (HER2) positive was significantly higher than that in histological grade I-II, ER positive, PR positive and HER2 negative ( P=0.001, P=0.001, P=0.001, and P=0.015, respectively) .The positive rate and strong positive rate of Resistin protein in triple negative breast cancer (TNBC) were significantly higher than those in other breast cancer subtypes ( P=0.048 and P=0.003, respectively) . Conclusion:Resistin plays an important role in the development of breast cancer and is expected to be a potential anti-cancer therapy biologic marker.
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Objective: To establish the aortic regurgitation model in Chinese miniature pigs under echocardiography guidance. Methods: The animal models were established by following steps: general anesthesia, measuring body weight and then receiving echocardiography examination to exclude aortic valve lesions; carotid artery was exposured by surgery, catheter was sent to aortic sinus with stiff guide wire penetrates and the position of catheter was adjusted to obtain aortic valve damage. The aortic valve injury and regurgitation were evaluated by ultrasound; then the pigs were killed and the heart was taken to observe aortic valve damage. Results: A total of 7 pigs were used including 4 male and 3 female with the mean body weight of (24.7 ± 3.6) kg. Aortic regurgitation model was successfully established in 5 pigs including 1 mild, 1 mild-moderate, 2 moderate, 1 severe aortic valve regurgitation, and 4 were with valve lealfets perforation and 1 with lealfets tearing. Conclusion:①Echocardiography can smoothly guide wire go through aortic valve and make valve damage at different degrees, it is reliable to establish aortic valve regurgitation model in experimental pigs.②Echocardiography may clearly identify the position and degree for aortic valve injury.
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BACKGROUND:Menstrual blood-derived mesenchymal stem cels are proved to be a new type of adult stem cels. To date, little is reported on the methods of establishing this kind of cel lines systematicaly. OBJECTIVE:To isolate, culture, identify and finaly establish menstrual blood-derived mesenchymal stem cel lines. METHODS:Menstrual blood-derived mesenchymal stem cels were isolated from the menstrual blood of healthy female donors and cultured accordingly using density gradient centrifugation method. Cel morphology and proliferation characteristics were observed, and proliferative ability was detected by cel counting kit-8 assay. Cels were colected periodicaly for karyotype analysis. Expressions of cel surface antigens such as CD34, CD38, CD44, CD45, CD73, CD90, CD105 and Oct-4 were analyzed using flow cytometry. Cel pluripotency were identified by inducing adipogenesis and osteogenesis in vitro. RESULTS AND CONCLUSION:We successfuly established four menstrual blood-derived mesenchymal stem cel lines from the menstrual blood of six healthy volunteers. The cultured cel lines had a typical spindle shape and kept normal 46, XX karyotype. The cels grew rapidly and entered into the logarithmic growth phase at 48 hours after passaging. The results of flow cytometry showed that menstrual blood-derived mesenchymal stem cels were positive for CD44, CD73, CD90, CD105 and Oct-4, while negative for CD38, CD34 and CD45. Menstrual blood-derived mesenchymal stem cels were positive for oil red O staining at 22 days after adipogenic induction and also positive for alizarin red staining at 2 weeks after osteogenetic induction. In conclusion, our study suggests that menstrual blood-derived mesenchymal stem cels with stable karyotype and pluripotency can proliferate quickly, and we can provide a new resource for stem cel therapy and regenerative medicine through establishing the menstrual blood-derived mesenchymal stem cel lines.
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Objective To investigate the characteristics of vena cava connection in patients with asplenia syndrome diagnosed by ultrasound. Methods From October 2009 to February 2014, 49 patients with asplenia syndrome diagnosed in Fuwai Hospital by ultrasound were included in this study. The characteristics and percentage of varied types of anomalous connection of vena cava and pulmonary vena were analyzed. Results Thirty patients (61.2%) had bilateral superior vena cavies. In these cases, right vena cava was drainage into right atrium (or the right side of the single atrium), while left superior vena cava into left atrium (or the left side of the single atrium). For hepatic vein, drainage into inferior vena cava were found in 25 patients (53.2%), into left atrium (or the left single of the single atrium) in 1 patient (2.1%), into right atrium (or the right side of the single atrium) in 3 patients (6.3%), into both right and left atrium in 5 patients (10.2%) and into the middle of the single atrium in 1 patient (2.1%). For inferior vena cava, drainage into left atrium (or left side of the single atrium) were found in18 patients (36.2%), into right atrium (or right side of the single atrium) in 24 patients (51.1%) and into the middle of the single atrium in 1patient (2%). Total anomalous pulmonary venous drainage occurred in 20 patients (40.2%) and partially anomalous pulmonary venous drainage in 8 patients (16.3%). Conclusion Asplenia syndrome is frequently accompanied with anomalous vena cava and pulmonary venous drainage.
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Objective To explore the characteristics of vena cava and pulmonary vena connection in patients with polysplenia syndrome ,and to improve the diagnosis of the polysplenia syndrome by echocardiography .Methods Forty‐five patients with polysplenia syndrome diagnosed by echocardiography were reviewed retrospectively .The characteristics and the frequency of the various types of anomalous connection of vena cava and pulmonary vena were analyzed .Results In 45 patients with polysplenia ,27 cases (60% ) had anomalous connection of superior vena cava ,anomalous inferior vena cava was found in 24 cases (53 3.% ) ,while 22 cases (48 8.% ) were diagnosed with hepatic vein anomalous drainage .Nineteen patients (42 2.% ) had anomalous pulmonary venous ,which partially anomalous venous drainage in 4 (8 9.% ) and total anomalous pulmonary venous drainage occurred in 15 patients (33 3.% ) .Conclusions Polysplenia syndrome often accompanied with anomalous vena cava and pulmonary venous drainage .Echocardiography can effectively diagnose polysplenia syndrome .
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Objective To evaluate the clinical application value of epicardial transesophageal echocardiography (ETE) in cardiac surgeries. Methods Using the transesophageal multi-plane ultrasonic probe of GE company, ETE were performed for a total of 53 patients undergoing cardiac surgeries with extracorporeal circulation and heart re-beat, evaluating valvular function, left ventricular systolic function and residual shunts. Results Qualiifed ETE images were obtained in all of the 53 cases without complications of infection, bleeding and serious arrhythmia. Intraoperative regional left ventricular systolic dysfunction happened in 5 cases and was promptly handled. Residual mitral regurgitation after valvular replacement was found in one case, which was reduced by valvuloplasty. One case showed moderate tricuspid regurgitation and another two cases indicated residual shunt. All the problems in the above cases were corrected in immediate surgeries. Moreover, the pressure gradient of one hypertrophic obstructive cardiomyopathic patient fell significantly to 8 mmHg after successful myectomy (the blood flow velocity fell from 3.2 m/s to 1.4 m/s). Conclusion Epicardial transesophageal echocardiogramphic examination is easy to handle and useful in monitoring abnormalities in cardiac surgery by providing hemodynamic and anatomic information.
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Objective To screen the active component from Fructus Citri Sarcodactylis which have aortic vascular relaxant effect. Methods The active components from Fructus Citri Sarcodactylis were screened by combining vascular smooth muscle/cell membrane chromatography (VSM/CMC) and liquid chromatography/mass spectrometry (LC/MS) with pharmacological assay in vitro. Results Bergapten was the active component of Fructus Citri Sarcodactylis that functions in vascular. The pharmacological experiment showed that bergapten had vasodilating effect. The capacity factor of this compound on the VSM/CMC model was found to be significantly correlated with its pharmacological effect. Conclusion Association between compound and membrane protein (receptor) can be reflected by using the VSM/CMC model. VSM/CMC-offline-LC/MS technology can be used to quickly screening new active components from natural medicine.
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Medical research contracts including the state-funded research contracts and enterprises-funded research contract,The application of law and dispute resolution approach depends on the legal nature of two contracts.Therefore,the legal nature of the medical research contracts and contract risk prevention is the focus of this study.
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A simple and reliable high performance liquid chromatography (HPLC) method has been developed for the simultaneous quantification of five major bioactive components in ‘Shu-Jin-Zhi-Tong' capsules (SJZTC), for the purposes of quality control of this commonly prescribed traditional Chinese medicine. Under the optimum conditions, excellent separation was achieved, and the assay was fully validated in terms of linearity, precision, repeatability, stability and accuracy. The validated method was applied successfully to the determination of the five compounds in SJZTC samples from different production batches. The HPLC method can be used as a valid analytical method to evaluate the intrinsic quality of SJZTC.