Clinical features of hepatic myelopathy: An analysis of 562 cases / 临床肝胆病杂志

ObjectiveTo investigate the clinical features of patients with hepatic myelopathy (HM) in China. MethodsThe articles on HM, published in China from January 2009 to December 2018, were collected to analyze the clinical features, laboratory examination results, diagnosis, treatment, and prognosis of HM patients. ResultsA total of 94 articles were included, with 562 patients in total, among whom there were 489 male patients and 73 female patients. Their age ranged from 17-81 years, with a mean age of 46.3±17.5 years. Hepatitis B cirrhosis was the most common etiology (64.4%), followed by alcoholic cirrhosis (10.3%) and hepatitis C cirrhosis (9.2%). The clinical manifestations of HM mainly included decline of muscle strength (89.50%), tendon hyperreflexia (76.87%), ataxia, and movement disorder (76.51%). Laboratory examination showed an increase in blood ammonia by 92.31% and a reduction in albumin by 88.96%. Imaging diagnosis mainly depended on electromyography (64.92%) and spinal cord MRI (22.82%), and abdominal color Doppler ultrasound, CT, or MRI alone has limited clinical value. After comprehensive medical treatment, no patient (0%) was cured, 106 patients (18.86%) were improved, 211 patients (37.54%) had no response, 31 patients (5.52%) worsened, 129 patients (22.95%) died, and 53 patients (9.43%) were not explained. A total of 39 patients underwent liver transplantation, with an improvement rate of 5641%. ConclusionHM is a rare complication of end-stage liver disease and is mainly observed in middle-aged men. It has the main manifestation of chronic and progressive spastic paraplegia of both lower limbs. Currently, there is no effective treatment method, and liver transplantation is feasible for some patients, with poor treatment response and poor prognosis.

Antibacterial properties of biodegradable zinc alloys in vivo / 中国组织工程研究

BACKGROUND: Zinc, an inorganic antibacterial material, has a suitable degradation rate and good antibacterial property. Adding alloying elements can improve the mechanical properties and biocompatibility of the material, which is the development direction of novel medical biodegradable metal materials. There is still lack a comparable research on the antibacterial properties among zinc-based materials. OBJECTIVE: To investigate the antibacterial properties of pure zine and zinc-based alloys in vivo. METHODS: Eighty Sprague-Dawley rats, SPF grade, were randomized into two groups (n=40/group) , and all rats were injected with Staphylococcus aureus or Escherichia coli solution to prepare infection models. Different materials (Zn, ZnAl, ZnSr, Zn3 Mg, Zn3 Ag, Zn3 Ca and Zn4 Cu; five rats for each material) were implanted into the medullary cavity of femur. The control group without any material was set. At 1, 4, 7 and 14 days after implantation, the changes of body temperature, white blood cell count, serum tumor necrosis factor α and serum zinc content in rats were detected. The secretions and tissues of the surgical site were collected to identify the bacterial species. RESULTS AND CONCLUSION: (1) The body temperature in all the rats was increased to different extents after bacterial infection, but the temperature of the rats implanted with zinc and zinc alloys was always lower than that in the control group at 7 and 14 days (P < 0.05) . The temperature in the Zn3 Ag group was significantly lower than that in the other groups at 7 and 14 days (P < 0.05) . (2) The white blood cell count and tumor necrosis factor α level in the zinc and zinc alloys groups were significantly lower than those in the control group at 7 and 14 days after implantation (P < 0.05) . The white blood cell count and tumor necrosis factor α level in the Zn3 Ag group were significantly lower than those in the other groups (P < 0.05) . (3) The serum zinc content in all groups has no significant difference (P> 0.05) . (4) The bacterial culture results showed S.aureus (+) in the Staphylococcus aureus infection group and E.coli (+) in the Escherichia coli infection group. (5) To conclude, degradable zinc-based alloys exert marked antibacterial effects, and Zn3 Ag alloys have the best antibacterial activity.

Comparative clinical study of laparoscopic versus open liver resection in elderly patients with hepatocellular carcinoma / 中华老年医学杂志

Objective To evaluate the feasibility and efficacy of laparoscopic liver resection (LLR) in elderly patients with hepatocellular carcinoma (HCC). Methods Twenty-nine elderly patients undergoing laparoscopic liver resection (LLR) and 58 elderly patients receiving open liver resection (OLR) for HCC were included from January 2013 to December 2015 in our department of Fujian Medical University. Two groups were 1:2 matched for gender ,tumor numbers ,and operative procedure.Besides ,general clinical data ,intraoperative data ,postoperative recovery ,and postoperative survival were compared. Results The postoperative hospital stay was shorter in the LLR group [(9.1±3.8)days]thanintheOLRgroup[(11.8±5.1)days](t= -2.66,P<0.05).Theincidence of portal triad clamping was lower in the LLR group than in the OLR group (34.5％ vs.60.3％ ,χ2 =5.18 ,P<0.05). The removal time of abdominal drainage tube was earlier in the LLR group (4.18 ± 1.94)days than in the OLR group (5.4 ± 2.1)days (t= -2.48 ,P<0.05). The overall survival (OS) showed no difference (37.08 months vs.38.72 months ,t=0.72 ,P=0.789). The disease-free survival (DFS) showed no difference (29.00 months vs.27.49 months ,t=0.53 ,P=0.467). Conclusions LLR in elderly patients with HCC can achieve the same long-term outcome as the conventional open hepatectomy ,and LLR has better short-term outcomes with obvious advantages of minimal invasion.

Clinical efficacy of laparoscopic liver resection versus open liver resection for hepato-cellular carcinoma / 中国肿瘤临床

Objective:To compare the short-and long-term outcomes of laparoscopic liver resection (LLR) with those of open liver re-section (OLR) for hepatocellular carcinoma (HCC). Methods:Clinical data from patients who suffered from HCC and received LLR or OLR from January 2013 to May 2016 in The First Affiliated Hospital of Fujian Medical University were analyzed restrospectively. To over-come selection bias, a 1:1 match was performed via a case-control study. After case-control matching was completed, 105 patients were included in each group. Short-term outcomes of operation and postoperation as well as long-term outcomes, including disease-free survival and overall survival rates, were evaluated. Relevant statistical methods were used for statistical analysis. Results: The postoperative hospital stay of the laparoscopic group was shorter (8.68 ± 2.82 vs. 10.61 ± 2.95 days, P<0.01) and its use of portal triad clamping was less (20.0%vs. 41.0%, P<0.01) than those of the open group. The abdominal drainage tube of the laparoscopic group was also removed at an earlier time than that of the open group (4.45±2.53 vs. 5.40±2.43 days, P<0.01). The 1-, 2-, and 3-year overall survival rates of the laparoscopic group were 96.88%, 87.54%, and 79.50%, respectively. By comparison, the 1-, 2-, and 3-year overall survival rates of the open group were 94.91%, 86.29%, and 76.37%, respectively (P=0.670). The 1-, 2-, and 3-year disease-free survival rates of the laparoscopic group were 72.09%, 60.16%, and 52.08%, respectively, while the 1-, 2-, and 3-year disease-free survival rates of the open group were 69.48%, 56.50%, 48.13%, respectively (P=0.388). Conclusion:LLR is a safe and feasible procedure. LLR in the selected patients with HCC showed similar long-term outcomes to those of OLR. The postoperative hospital stay of these patients who underwent LLR was shorter and their use of portal triad clamping was less than those of the patients who received OLR. The abdomi-nal drainage tube of the former was also removed at an earlier time than that of the latter. Therefore, the short-term outcomes of LLR were better than those of OLR.

Methylcobalamin induces differentiation of rat bone mesenchymal stem cells into neuron-like cells in vitro / 中国组织工程研究

BACKGROUND:Currently, transplantation of bone marrow mesenchymal stem cel s into the spinal cord is very limited to the recovery of animals fol owing spinal cord injury. Methylcobalamin is a common drug for the treatment of neurological diseases and injuries, but its effects on bone marrow mesenchymal stem cel s are unclear. OBJECTIVE:To study the feasibility of bone marrow mesenchymal stem cel s differentiating into neuron-like cel s induced by methylcobalamin in vitro and to observe the cel viability and proliferation of differentiated cel s. Methods:Rat bone marrow mesenchymal stem cel s were isolated, cultured and purified by density gradient centrifugation and adherent culture. The fourth to fifth generation of bone marrow mesenchymal stem cel s were treated for 24, 48 and 72 hours with different concentrations (25, 50 and 100 mg/L) of methylcobalamin. The morphological changes and cel growth were continuously observed under an inverted phase constract microscope. The viability of induced cel s was detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. The expressions of Nestin and neuron-specific enolase were identified by reverse transcription PCR and western blot. RESULTS AND CONCLUSION:Most of bone marrow mesenchymal stem cel s could differentiate into neuron-like cel s after induction with methylcobalamin. The expressions of Nestin and neuron-specific enolase were up-regulated after 48 hours of methylcobalamin treatment at different concentrations, especial y after treatment with 100 mg/L methylcobalamin. Similarly, the expressions of Nestin and neuron-specific enolase could be increased significantly after 100 mg/L methylcobalamin treatment for 24, 48 and 72 hours, especial y for 72 hours. It is indicated that methylcobalamin can induce bone marrow mesenchymal stem cel s differentiating into neuron-like cel s, and the optimal concentration of methylcobalamin is 100 mg/L.

Clinical research of one-stage posterior internal fixation and anterior debridement of bone grafting in the treatment of severe lumbosacral tuberculosis / 重庆医学

Objective To investigate the clinical efficacy of one-stage posterior internal fixation with pedicle screw and anterior debridement of bone grafting through the extraperitoneal approach the medial edge of rectus abdominis in treating severe lumbosa-cral tuberculosis .Methods 17 cases with L4-S1 tuberculosis were treated by internal fixation with pedicle screw ,anterior debride-ment through the extraperitoneal approach the medial edge of rectus abdominis ,and application of allogenic bone from January 2008 to December 2011 .All patients performed X-ray ,CT and MRI examinations before surgery .L5-S1 were involved in 8 cases ,L4-5 were involved in 6 cases ,and L4-S1 were involved in 3 cases;unilateral psoas abscess was found in 6 cases ,while bilateral psoas ab-scess was found in 3 cases ;Among the 17 cases ,8 cases had intraspinal invasion ,and 5 cases were combined with neurological dys-functions ,however ,according to Frankel grade ,4 cases were grade D ,and 1 case was grade C .Regular anti-tuberculosis treatment was given for more than 2 weeks before surgery ,and regular supportive treatment and anti-tuberculosis treatment were given for 9-12 months after surgery .As for regular follow-up(3 ,6 ,9 ,and 12 months after surgery ,and every 6 months later on) ,patients had examinations including ESR and X-ray to evaluate the tuberculosis activity and the condition of bone graft fusion ;while accord-ing to Frankel grade of nerves function ,changes in nerve function before and after surgery were evaluated in patients ,and changes of lumbosacral angle were also comparatively studied before and after surgery .Results There were no great vessel injuries and no nerve injuries except one case who had intraoperative ureteral injury which was repaired in time .The 17 patients were all followed up for 10-36 months(18 months average) ,and all reached clinical healing without complications such as tuberculous peritonitis ,e-rectile dysfunction and retrograde ejaculation .During the follow-up period ,there were no tuberculosis recurrence ,no loosening of in-ternal fixation ,and no break of rod and nail ;the grafted bones were fused in all patients with an average time of 7 .5 months ;accord-ing to Frankel grade of nerves function ,only one patient was grade D ,while the other four cases recovered to grade E .The lumbosa-cral angle of patients was corrected from 23 .8° ± 4 .0°(19 .8°-27 .8°) before surgery to 29 .1° ± 3 .6°(25 .5°-32 .7°) after surgery , and the change was statistical significance(P<0 .05) .Conclusion The one-stage posterior internal fixation with pedicle screw and anterior debridement of bone grafting through the extraperitoneal approach inside of rectus abdominis is a safe and effective meth-od ,which can thoroughly remove the focus ,reconstruct the lumbosacral stability ,and prevent the loosening of bone grafting .

Clinical research progress on reconstruction after sacral tumor resection / 中国矫形外科杂志

Tumors of the sacrum are rare.The valve of adjuvant is uncertain,and en bloc tumor resection remains the primary mode of treatment.But en bloc tumor resectiong often leads to unstability of the pelvic ring.Therefore,the most factor providing the successful outcome in the management of sacral tumor is how to establish stability in the lumbo-sacrai junction.The various spinopelvic reconstruction techniques are reported in the literature.This includes various methods triangular frame reconstruction,or lilac rod or iliac screw fixation,modified galveston,custom-made prosthesis and so on.The authors review the modes of reconstruction after sacral tumor resection and discuss the outcomes.

A comparative study on vascular blockade during hemihepatectomy for primary hepatic carcinoma / 中国普通外科杂志

Objective To compare among three different methods in performing hepatic vascular blockade during hemihepatectomy for primary hepatic carcinoma ( PHC). Methods Between 2000 and 2005, 83 PHC patients underwent the Pringle's maneuver (Group A) , 67 cases in combination Pringle's maneuver and inferior vena cava (IVC) clamping (Group B) , and 32 cases received anatomical blood flow blockade for the half liver for hemihepatectomy ( Group C). Results Operation time in group C was longer than that in group A and B(t =3. 27、2. 74,all P

Effects of liver regeneration on the proliferation of rat fetal hepatocytes after intrasplenical transplantation / 中国病理生理杂志

AIM: To study the effect of environment of liver regeneration on the proliferation of rat fetal hepatocytes after intrasplenical transplantation. METHODS: Fetal hepatocytes isolated from 3-week SD rat fetuses bred were transplanted into the spleens of liver regeneration model rats with 70% partial hepatectomy. The cell cycle of the hepatocytes in the remnants liver was analyzed by flow cytometer and the density dimensions of the donor fetal hepatocytes in spleen were measured by image analysis system 7 and 30 days post-transplantation, respectively. RESULTS: Compared with the control group, the proportions of S and G 2/M cells in the remnants liver were obviously decreased ( P

EFFECTS OF 70% HEPATECTOMY ON THE PROLIFERATION OF RAT FETAL HEPATOCYTES AFTER INTRASPLENICAL TRANSPLANTATION / 解放军医学杂志

To study the effects of 70%Hepatectomy on the proliferation of rat fetal hepatocytes after intrasplenical transplantation, fetal hepatocytes isolated from 3 week SD rat fetuses bred were transplanted into the spleens of liver regeneration model rats with 70% partial hepatectomy. The cell cycle of hepatocytes in the remanent liver was analyzed by flow cytometer and the density dimensions of the donor fetal hepatocytes in spleen were measured by Image Analysis System 7 and 30 days post transplantation respectively. Compared with the control group, the proportions of S state cells in the remanent liver were obviously increased ( P