Objective To investigate the effect of tissue engineering bone compounded in vitro by nanohydroxyapatite/collagen/ polylactic acid (nHAC/PLA) and recombinant human bone morphogenetic protein 2 (rhBMP-2) in repairing rabbit critical calvarial defects. Methods Forty eight New Zealand rabbits, weighting 2.0-2.5 kg, were made the models of critical cranial defects(15 mm in diameter) and divided into 4 groups randomly. Defects were repaired with autoflank bone in the positive control group; with no implant in the blank control group; with nHAC/PLA in the negative control; and with active nHAC/PLA(AnHAC/PLA) in the experimental group(the average quality of each AnHAC/PLA absorbed rhBMP-2 was 1.431 mg). The reapir results were observed through X-ray,HE dyeing and Masson’s trichrism dyeing after 8 and 16 weeks. Results The difference of bone formation was observed by X-ray block degree of skull defect area at 8 and 16 weeks. In the 8 th week and 16 th week, the radiopacities on cranial defect were 67.21%±2.06% and 86.48%±1.73% in the positive control group； 5.84%±1.92% and 9.48%±2.72% in the blank control group; 19.13%±2.51% and 35.67%±3.28% in the negative control group; and 58.84%±2.55% and 8561%±3.36% in the experimental group. There were significant differences between the negative control and the positive control group, and between the experimental group and the positive control group at 8 weeks(Plt;0.05) . There were significant differences between the negative control and blank group, and between the experiment and the blank group at 8 and 16 weeks(P＜0.05). The histology observation showed that the width of bone trabecula at 16 weeks was more than that at 8 weeks and bone defectwas full of bone tissue in positive control group. The bone defect was full of fibrous tissue at 8 and 16 weeks, and there was no new bone in the blank group. The bone defect was full of remnant material and fibrous tissue in the negative control group. The implanted area was replaced by the new bone at 8 weeks and the new bone was lamellar at 16 weeks in the experimental group; the residual material was less in defect area and there were more osteoblasts surrounding. Conclusion The nHAC/PLA is a good scaffoldmaterial of rhBMP-2 and AnHAC/PLA has agood ability in repairing bone defect. So it is hopeful to be applied in the clnical repair of large bone defect.
Objective To analyze the safety of surgical treatment and optimal surgical procedure for lung cancer patients with prior history of lung resection. Methods The medical records of 69 lung cancer patients with history of lung resection was retrospectively collected. There were 53 males and 16 females with a median age of 68 years ranging from 45 to 80 years. The risk factors for postoperative complications were analyzed using one-way ANOVA and logistic regression analysis. By comparing the data between the lobectomy and sublobectomy groups, the best surgical procedure was chosen. Results The 90-day mortality rate was 4.3%. Postoperative complication rate was 24.6%. Results of one-way ANOVA showed that blood loss during operation (P=0.020), tumor size (P=0.007), smoking (P=0.028) and FEV1%pre (P=0.018) were associated with increased major postoperative complications. Logistic regression analysis showed that FEV1%pre<77.0% (OR=0.935, 95%CI 0.888 to 0.984, P=0.010) and tumor size≥2 cm (OR=4.288, 95%CI 1.375 to 13.373, P=0.012) were independent risk factors for major postoperative complications. Lobectomy and sublobectomy groups had similar postoperative mortality and complication rate (P=0.063). Conclusion Surgical resection for selected lung cancer patients with history of lung resection is safe with low postoperative mortality and complication rate. Lobectomy with lymph node resection is the first choice if cardiopulmonary function permits. Pneumonectomy is not recommended.
ObjectiveTo evaluate the expression level of histone deacetylase 9 (HDAC9) in lung squamous cell carcinoma (LUSC) tissues, to analyze its correlations with clinicopathological characteristics and prognosis of LUSC patients, and to explore the effect it exerts on the proliferation of LUSC cells.MethodsThe expression level of HDAC9 was detected by immunohistochemistry staining (IHC), and its correlations with clinicopathological characteristics were analyzed by χ2 test. Survival analysis was performed using Kaplan-Meier method. Univariate and multivariate Cox proportional hazards model were employed to analyze independent predictors for overall survival (OS) of LUSC patients. CRISPR/dCas9 activation system was used to activate the transcription of HDAC9 gene in LUSC cell line EBC-1. CCK8 cell proliferation assay and colony formation test were performed to investigate the effect that transcriptional activation of HDAC9 exerts on the proliferation of LUSC cells.ResultsOf the 129 LUSC patients, 39 (30.2%) were in the HDAC9 low expression group and 90 (69.8%) were in the HDAC9 high expression group. The OS of the patients with HDAC9 high expression was shorter than that of patients with HDAC9 low expression (P=0.032). The expression level of HDAC9 was associated with tumor grade (P=0.035), primary tumor size (P=0.041), and lymph node metastasis (P=0.013). The expression level of HDAC9 (P=0.023), tumor grade (P=0.003), primary tumor size (P=0.003), and lymph node metastasis (P=0.002) were independent predictors for OS of LUSC patients. Transcriptional activation of HDAC9 promoted colony formation of LUSC cells and cell proliferating curves showed that LUSC cells with HDAC9 transcriptional activation proliferated faster than non-targeting cells (F=52.7, P=0.002).ConclusionLUSC patients with HDAC9 high expression have poorer prognosis than HDAC9 low expression ones. The expression level of HDAC9 is associated with tumor grade, primary tumor size, and lymph node metastasis, and is identified as an independent predictor for prognosis of LUSC. Transcriptional activation of HDAC9 promotes cell proliferation in LUSC. These results suggest that HDAC9 may serve as a promising biomarker for prognosis in LUSC.
ObjectiveTo introduce the method and preliminary experience of robot-assisted bilateral internal mammary arteries (BIMA) harvesting for off-pump coronary artery bypass grafting (OPCAB) with 5 grafts via left anterolateral minithoracotomy.MethodsBIMA were harvested using the da Vinci robotic surgical system, and the right internal mammary artery (RIMA) was pulled out of the thoracic cavity through right second intercostal space. Intercepting the distal part of the RIMA for the BIMA composite Lima-Rima Y graft and anastomosing the great saphenous vein with remaining RIMA end to end. The Y graft anastomosed with left anterior descending (LAD) branch and diagonal branches (DIAG), artery-vein graft sequentially anastomosed with blunt round branch, left ventricular posterior branch and posterior descending branch.ResultsThe operation succeeded without hemodynamic instability and intra aortic balloon pump (IABP) implantation or cardiopulmonary bypass. The blood flow of Y graft was 24 mL/min, and the blood flow of artery-vein graft was 30 mL/min. Ventilator assistance time was 35 hours, ICU staying time was 62 hours, and postoperative myocardial enzymes increased temporarily. Postoperative coronary CTA showed that all the grafts were patency, and cardiac ultrasound indicated that the heart function was normal. The patient cured and discharged from hospital 7 days after operation.ConclusionRobot-assisted bilateral internal mammary artery harvesting for OPCAB with 5 grafts via left anterolateral minithoracotomy is feasible, which can achieve complete revascularization.
Objective To summarize recent research advancement on gene therapy for hepatic ischemia-reperfusion injury (IRI). Methods Relevant references about basic and clinical researches of hepatic IRI were collected and reviewed. Results Recent experimental researches indicated that the expression of several genes and cytokines could protect hepatic cells by suppressing cell apoptosis, decreasing the production of oxyradical, remaining and improving portal venous flow, promoting bilifaction, self immunoloregulation and decreasing inflammatory reaction, so that it could decrease IRI. Conclusion IRI could be decreased by regulating the expressing of target genes or transducing relative genes in vivo, but the path of gene transfer and the selection and optimization of gene carrier still need more basic and clinical researches to prove.
目的 探讨腹主动脉瘤破裂的诊断和治疗方法。方法 我院从1999年10月至2004年1月期间经手术治疗腹主动脉瘤破裂6例。结果 1例患者因术后失血性休克而死亡； 5例患者随访4年，1例术后2年死于心肌梗死，余4例存活。结论 腹主动脉瘤应早期诊断、早期治疗，一旦破裂应迅速诊断、急诊手术，手术时应注意阻断腹主动脉的方法以及防止术后下肢缺血。
目的 探讨 2 cm 单孔胸腔镜肺叶切除术的可行性及安全性。 方法 回顾性分析 2016 年 3～8 月我院胸外科行 2 cm 单孔胸腔镜下解剖性肺叶切除术 8 例肺癌患者的临床资料，其中男 5 例、女 3 例，年龄41～75（58.5±10.1）岁。在腋前线第 3 肋间做 2 cm 切口置入胸腔镜及手术器械行解剖性肺叶切除术。 结果 8 例均顺利完成手术，无中转开胸。手术时间（191.6±41.9）min，术中出血量（186.3±175.0）ml，术后胸腔引流时间（4.5±1.7）d，术后住院时间（5.5±1.7）d。术后病理均为 ⅠA 期非小细胞肺癌。 结论 2 cm 单孔胸腔镜下解剖性肺叶切除术治疗早期肺癌安全、可行，减小了胸腔镜手术对患者的创伤，其进一步的推广应用需更多研究的支持。
目的 探讨肝脏局灶性增生结节(FNH)的诊断和治疗。 方法 回顾性分析哈尔滨医科大学第一临床医学院1993年1月至2004年12月12年间收治并经病理检查证实的9例FNH的临床、影像学和病理学资料。结果 FNH术前正确诊断率较低，该病多见于中、青年，多无乙型肝炎病毒感染，AFP检查正常，彩色多普勒检查多发现病灶有血管通过，CT动态扫描增强后早期有显著强化，MRI检查也有明显强化。结论 FNH在临床和影像学上均有一定特征，综合分析临床表现、实验室检查与多种影像学资料可提高正确诊断率。
Objective To present method and experiences in using the buccal mucosa with the Snodgrass procedure for repair of hypospadias. Methods Between August 2012 and April 2015, 55 boys with hypospadias were treated with Snodgrass procedure combined with buccal mucosa. The age ranged from 1 to 7 years (mean, 4 years). There were 32 cases of distal penile type, 14 cases of proximal penile type, and 9 cases of coronal sulcus type. The buccal mucosa taking from inner cheek was fixed into the incised urethral plate. The urethral plate was tubularized over a catheter. Results All the patients were followed up 3-25 months (mean, 11 months). After operation, 1 patient had urethral stricture and fistula after repaired urethra was infected, and 5 patients had fistula. For the others, the urination was smooth, the appearance of penis was satisfying, the urethral stricture did not occur, and the penis was straightened completely. Conclusion Compared with traditional Snodgrass procedure, the application of buccal mucosa can increase the reconstruction material of urethral and reduce the stricture of the repaired urethra after operation.