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[Objective]To discuss the effect of Jiawei Shengji Yuhong Ointment on wound healing of rat model after anal fistula operation and its internal mechanism.[Methods]Seventy SD rats were randomly divided into blank group,Vaseline group(model group),Kangfuxin liquor group(control group),Jiawei Shengji Yuhong Ointment group(experimental group),ammonium pyrrolidine dithiocarbamate(PDTC)+vaseline group(PDTC+model group),PDTC+Kangfuxin liquid group(PDTC+control group),PDTC+Jiawei Shengji Yuhong Ointment group(PDTC+experimental group).The damp-heat wound model of rats after anal fistula operation was established and treated with different drugs.At the same time,PDTC intervention group was given intraperitoneal injection of nuclear factor-κB(NF-κB)signaling pathway inhibitor PDTC for 5 consecutive days on the basis of drug intervention.The wound healing of rats in each group was recorded,and the wound healing rate of rats in each group was calculated.On the 3rd,7th and 14th days,the granulation tissues of rats in each group were taken for Western blot and immunohistochemistry to detect the protein expression of NF-κB p65.The expression of interleukin-1β(IL-1β)and vascular endothelial growth factor(VEGF)was detected by enzyme-linked immunosorbent assay(ELISA).Hematoxylin-eosin(HE)staining was used for histomorphological observation.[Results]Compared with other groups,the experimental group and PDTC+experimental group could significantly shorten the wound healing time,and the wound healing rates of PDTC+experimental group and experimental group were higher(P＜0.05).HE staining results also confirmed that PDTC+experimental group can effectively promote the rapid growth of granulation tissue.The results of immunohistochemistry and Western blot showed that was inhibited significantly in experimental group and PDTC+experimental group the protein expression of NF-κB p65 in rat wound tissue,and the difference was statistically significant compared with the other groups(P＜0.05).The results of ELISA showed that the content of IL-1 β in each group decreased gradually at 3,7 and 14 d after treatment,and the content of IL-1[3 in PDTC+experimental group was the lowest(P＜0.05).The content of VEGF in each group increased gradually,and the content of VEGF in PDTC+experimental group and experimental group was the highest(P＜0.05).[Conclusion]Jiawei Shengji Yuhong Ointment can inhibit the expression of NF-κB p65 and IL-1 β protein and up-regulate the expression of VEGF protein through NF-κB signaling pathway,thereby promoting the angiogenesis of vascular endothelial cells,reducing inflammation,and promoting the wound healing after anal fistula surgery.
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In the study of the mechanism of wound healing after anal fistula surgery, how to scientifically and efficiently promote wound healing is of great significance. At present, modern medical treatment of wounds after anal fistula surgery mostly focuses on physical therapy intervention, new wound dressing and packing, and external application of growth factors. However, these therapies have many problems, and there is still no consensus on their clinical use. Traditional Chinese Medicine (TCM) has several methods to promote wound healing, such as oral administration, rubbing, and fumigation, which have a long history and obvious efficacy, but research in this area is relatively scattered and lacks classification and summarizing. Therefore, this paper analyzes and summarizes the existing research on TCM for promotion of wound healing after anal fistula surgery, carries out targeted analyses according to different clinical syndromes and treatment methods, and analyzes the defects in current research and anticipates future research trends in order to provide theoretical support for the advantages of TCM in promoting wound healing after anal fistula surgery.
Subject(s)
Medicine, Chinese Traditional , Rectal Fistula , Humans , Administration, Oral , Wound Healing , Rectal Fistula/drug therapy , Rectal Fistula/surgeryABSTRACT
Objective:To evaluate the clinical efficacy of modified all-arthroscopic reconstruction of medial patella femoral ligament (MPFL) for the treatment of recurrent patellar dislocation.Methods:A retrospective case series study was conducted to analyze the clinical data of 38 patients (46 knees) with recurrent patellar dislocation, who were treated at First Affiliated Hospital of Shenzhen University from January 2017 to January 2020. The patients included 12 males (12 knees) and 26 females (34 knees), aged 14-40 years [(24.6±5.4)years]. All patients underwent the modified all-arthroscopic MPFL reconstruction procedure. The femoral tunnel locations were assessed by 3D-CT immediately after surgery. The MRI was performed at 6 and 12 months after operation to assess the healing morphology of the reconstructed MPFL. The Lysholm score and Kujala score were used to assess the knee function before operation, at 6 months after operation, at 12 months after operation and at the last follow-up. The time to return to sports as well as complications were observed.Results:All patients were followed up for 26-48 months [(32.4±8.6)months]. Postoperative 3D-CT examination showed that the femoral tunnels were located in the groove area of the medial epicondyle of the femur and the adductor tubercle. At 6 and 12 months after operation, MRI T2 images showed that the reconstructed MPFL had a low signal and well tensioned ligament tissue, indicating that the MPFL was healed well. The Lysholm scores at 6 and 12 months postoperatively and at the last follow-up were (81.1±12.0)points, (91.2±3.8)points, and (92.2±9.8)points, respectively, being significantly higher than the preoperative (52.4±10.6)points (all P<0.01). The Kujala scores at 6 and 12 months postoperatively and at the last follow-up were (85.4±3.9)points, (91.4±3.6)points, and (93.1±8.5)points, respectively, being significantly higher than the preoperative (55.2±6.8)points (all P<0.01). Compared with 6 months postoperatively, the Lysholm score and Kujala score were significantly improved at 12 months postoperatively and at the last follow-up (all P<0.05). All patients returned to sports, with the time to return to sports for 3-12 months [(8.7±2.3)months] after operation. One patient had poor wound healing but was healed after dressing changes. No wound infection, nerve injury, joint stiffness, patella re-dislocation or other complications occurred. Conclusion:For recurrent patellar dislocation, the modified all-arthroscopic MPFL reconstruction has advantages of accurate bone tunnel positioning, good ligament healing, good function recovery, early return to sports, and less postoperative complications.
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Objective:To evaluate the gastric emptying of orally administered enzyme-hydrolyzed rice flour solution before surgery in the patients undergoing laparoscopic cholecystectomy and effect on insulin resistance.Methods:One hundred patients, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-64 yr, with body mass index of 19-30 kg/m 2, scheduled for elective laparoscopic cholecystectomy under general anesthesia, were divided into 2 groups ( n=50 each) using a random number table method: water group (group C) and enzyme-hydrolyzed rice flour group (group M). Routine fasting and water deprivation were executed at 1 day before operation in two groups, and 300 ml water in group C or 300 ml enzyme-hydrolyzed rice flour solution in group M were taken orally at 2-3 h before induction on the day of surgery.Bedside antrum ultrasonography was used to calculate the gastric volume (GV) before oral administration (V 0), immediately after oral administration (V 1), and before induction (V 2), and then the ΔGV (GV 1-GV 0) was calculated.Fasting plasma glucose and insulin CONCENTRATIONS were measured on admission to hospital (T 1) and on an empty stomach on 1st morning after surgery (T 2), and then the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated according to HOMA steady-state model formula.Visual analog scale (VAS) scores for subjective comfort (thirst, hunger, fatigue and anxiety) and grip strength were assessed before anesthesia (T 3) and before leaving PACU (T 4). Reflux and aspiration during induction, nausea and vomiting within 24 h after surgery, and anal exhaust time after surgery were recorded. Results:There was no significant difference in GV at V 0, V 1 and V 2 between the two groups ( P>0.05). Compared with the baseline at V 0, no significant was found in the GV at V 2 in both groups ( P>0.05). The fasting plasma glucose and insulin concentrations and HOMA-IR were significantly increased at T 2 than at T 1 in both groups ( P<0.05 or 0.01). Compared with group C, the fasting plasma glucose and insulin concentrations and HOMA-IR were significantly decreased at T 2, VAS scores for hunger, fatigue and anxiety were decreased at T 3, 4, grip strength was increased at T 3, 4, the postoperative anal exhaust time was shortened, and the incidence of nausea was reduced in group M ( P<0.05). No reflux and aspiration happened during induction in either group. Conclusion:The gastric emptying of 300 ml enzyme-hydrolyzed rice flour solution orally administered at 2 h before surgery is normal in the patients undergoing laparoscopic cholecystectomy, which does not increase the risk of reflux and aspiration during anesthesia induction, reduces postoperative insulin resistance, and increases patient′s subjective comfort, and enhances the postoperative recovery of intestinal function.
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BACKGROUND:Studies have reported that the bone bridge and bone plug for meniscal alograft transplantation show better outcomes than simple soft tissue suture, but there are rare studies concerning the comparison of their fixation effects. OBJECTIVE:To compare the clinical effects of bone bridge and bone plug in meniscal alograft transplantation. METHODS:Eighteen patients undergoing arthroscopy-assisted meniscal alograft transplantation were enroled, including nine cases of bone plug fixation and nine cases of bone bridge fixation. Symptoms, physical examination, visual analog scale, Lysholm and Tegner scores were used to evaluate the clinic outcome. Every 6 months post operation, the signal and morphological changes of alograft meniscus was observed with MRI for each patient. RESULTS AND CONCLUSION:Al of the 18 patients were folowed up for 12-36 months after transplantation. No complications, absence of knee pain and effusion, and disappearance of the discomfort within the meniscectomy compartments after prolonged activity during folow-up period were found in al patients. The patients were competent of daily life and sports activity. The visual analog scale, Lysholm and Tegner scores were significantly increased after transplantation. MRI showed that the vicariousness and livability of the alograft menisci appeared within 1 year post operation. The safety and feasibility of the arthroscopy-assisted meniscal alograft transplantation were approved. Knee pain, knee effusion and joint stability and function were improved after arthroscopic-assisted alograft meniscus transplantation, and there was no difference between the clinical curative effects of the two kinds of fixed methods.