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PROGRESS OF MESENCHYMAL STEM CELL-DERIVED Exosomes IN TISSUE REPAIR

ObjectiveTo comprehensively analyze the recent advancements in the field of mesenchymal stem cells (MSCs) derived exosomes (MSCs-exosomes) in tissue repair. MethodsThe literature about MSCs-exosomes in tissue repair was reviewed and analyzed. ResultsExosomes are biologically active microvesicles released from MSCs which are loaded with functional proteins, RNA, and microRNA. Exosomes can inhibit apoptosis, stimulate proliferation, alter cell phenotype in tissue repair of several diseases through cell-to-cell communication. ConclusionMSCs-exosomes is a novel source for the treatment of tissue repair. Further research of MSCs-exosomes biofunction, paracellular transport, and treatment mechanism will help the transform to clinical application.

Definition of Evidence and Evidence-based Paradigm in Health Research

With the rapid development of evidence-based medicine during the past two decades, evidence andevidence-based methods were not only used in the field of health care, but also applied to other non-medical fields. Asystematic literature search and a comparative study were conducted to investigate the definition of evidence. We also putforward our own definition of evidence: Evidence is the information from the systematic review process. We also discussedthe development of evidence-based paradigm and hope this will act as a reference for other subjects and industries.

胰腺结石的诊断和外科治疗

Comparison of Autofluorescence Bronchoscope and White Light Bronchoscope in Airway Examination for Patients with Central Type Lung Cancer

Abstract: Objective To compare the sensitivity and accuracy of autofluorescence bronchoscope (AFB) and white light bronchoscope (WLB) in airway examination for patients with central type lung cancer. Methods From September 2009 to May 2010, 46 patients including 36 males and 10 females with an average age of 62.1 years underwent both AFB and WLB procedures in People’s Hospital of Peking University. Among them, 35 were preliminary diagnostic cases and 11 were postoperative surveillance cases. Local anaesthesia of glottis and airway, and general anaesthesia with continuous intravenous drugs were given before electric bronchoscope was adopted. All patients underwent WLB examination followed by AFB procedure. All suspicious abnormal visual findings were recorded for biopsy and pathological examination. Results All procedures were carried out safely without death or severe complications. We performed bronchoscopy 48 times for all 46 patients and 159 tissues of various sites were taken out for biopsy and pathologic examination which showed 64 malignancies and 95 none malignancies. In 64 malignancies, AFB found all but WLB missed 15 with a missed diagnosis rate of 23.4%. Thirtysix times of examination were performed for the 35 preliminary diagnostic cases and 56 sites of malignancy were found. AFB found all, while WLB missed 12, and 6 sites of malignancy found by AFB were larger in size than those found by WLB. AFB detected 3 cases of multisite malignancy, but WLB missed these diagnoses. The results of AFB and WLB were the same for 26 patients. Twelve times of bronchoscopy were performed for the 11 postoperative surveillance cases and 8 sites of malignancy were found. AFB found them all while WLB missed 3 which were two recurrent cases during the early period after lung cancer surgery. The sensitivity of AFB and WLB was 100.0 % and 76.6%(Plt;0.05) respectively, and the negative predictive value of AFB and WLB was 100.0% and 84.5%(P=0.002) respectively. Conclusion AFB has a better sensitivity and negative predictive value than WLB in detecting mucous canceration lesions in central type lung cancer, and is more accurate in assessment of tumor margins, more sensitive in finding multiple lesions in airway and detecting early cancer recurrence in postoperative surveillance patients.

Videoassisted Thoracoscopic Surgery Lobectomy: a Series of Consecutive 300 Patients and a 3year Follow-up

Abstract: Objective To summarize the clinical experiences of videoassisted thoracoscopic surgery (VATS) lobectomy performed on a series of 300 consecutive patients, and report the results of a 3year followup. Methods We retrospectively analyzed the clinical data of 300 consecutive patients who underwent VATS lobectomy from September 2006 to December 2009 in the Department of Thoracic Surgery, People’s Hospital of Peking University. Of the 300 patients, there were 159 males and 141 females with the age ranged from 18 to 86 years (58.30±13.90 years). Preoperative diagnosis showed that there were 266 patients of mass in the lung, 22 of bronchiectasis, 5 of cyst/abscess in the lung, 3 of pulmonary sequestration, 2 of fungus infection, and 2 of pneumothorax. We assessed the perioperative variables by standard descriptive statistics and estimated the 3year survival rate by KaplanMeier analyses. Results Sixtysix patients were diagnosed to have benign diseases and 234 patients were with malignancies. A percentage of 81.82% (54/66) of the benign patients had infectious diseases, and the majority of the malignancies was nonsmall cell lung cancer (213 patients), especially adenocarcinomas which comprised 73.08% (171/234) of all the malignancies. A total of 273 patients accomplished VATS lobectomy, of whom 27 patients required conversion to thoracotomy at a conversion rate of 9.00%(27/300). In the VATS lobectomy accomplished group, the mean operation time was 317±088 h, and the blood loss was 225.70±195.20 ml. Benign surgery took significantly less time (t=2.280, P=0.0032) and had shorter drainage time(t=1.392, P=0.0304) than those of malignancies. Dense adhesions between lymph nodes and blood vessels was the primary reason for conversion to thoracotomy in 17 patients at a percentage of 62.96%(17/27). Bleeding was the second reason for conversion in 5 patients at a percentage of 1852%. The patients in the upper lobe lobectomy group showed significantly higher risk of conversion compared with those in the nonupper lobe surgery group (χ2=6.131, P=0.013), while gender (χ2=1.182, P=0.277), pathology (χ2=0.210, P=0.647) and the tumor located in left or right side(χ2=2.933, P=0.087) didn’t influence the risk of conversion. The result of the 3year followup showed that there was no reoccurrence of symptoms in patients with benign diseases; Nonsmall cell lung cancer patients had a 3year survival rate of 0.87 with the 95% confidence interval (CI) from 0.77 to 0.96, and pathologic stage I patients at 0.91 with the 95%CI from 0.85 to 0.98. Conclusion VATS lobectomy is safe and effective. This research shows that domestic technologies of VATS lobectomy and its midterm results have reached the international standard.

Clinical Study of Nedaplatin plus 5Fluorouracil/Folinic Acid for the Treatment of Advanced Esophageal Cancer

目的:评价奈达铂联合氟脲嘧啶/四氢叶酸治疗晚期复发耐药食管癌的疗效及不良反应。方法:30例晚期复发耐药食管癌均经病理学或细胞学确诊。奈达铂100mg/㎡,静脉滴注,第1天;氟脲嘧啶500mg/㎡,静脉滴注,维持6～8小时,第1～5天; 四氢叶酸200mg,静脉滴注,第1～5天,21天为一周期,连续用2周期后评价疗效及不良反应。结果:30例均完成2个周期以上化疗,共接受86周期化疗,全部病例均可评价疗效及不良反应。无CR病例,PR 13例(43.3%),SD 7例(23.3%),PD 10例(33.3%),有效率为43.3%,TTP 4.0月,MST8.3月。不良反应主要是骨髓抑制,恶心、呕吐,全组无IV度不良反应。结论:奈达铂联合氟脲嘧啶/四氢叶酸治疗晚期复发耐药食管癌有确切疗效,不良反应轻,耐受性好,值得临床进一步推广应用。

应用经气管镜冷冻活检诊断弥漫性肺疾病

目的 探讨经气管镜进行冷冻肺组织活检于弥漫性肺疾病诊断的应用价值。 方法 选择河南省人民医院呼吸与危重症医学科自 2016 年 5 月至 2017 年 4 月收治的弥漫性肺疾病患者 53 例行经支气管镜肺活检，其中采用冷冻活检者 17 例（冷冻组），采用常规活检钳活检者 36 例（常规组）。全身麻醉后置入喉罩，常规检查气管镜后，术前据胸部影像选定支气管，冷冻组患者经支气管镜活检孔道送入冷冻探头至肺部病变，冷冻 3～5 s 后冷冻探头随支气管镜一同取出。比较冷冻活检标本与常规活检标本的组织面积、人工伪差、临床诊断率及出血和气胸并发症等的发生率。 结果 经气管镜冷冻活检标本的组织面积［（44.2±17.2）mm2 比（7.5±6.1）mm2］、临床诊断率（88.2% 比 36.1%）明显高于常规活检标本（均 P<0.05），而人工伪差（11.8% 比 52.8%）明显降低（P<0.05），患者出血和气胸发生率却未明显增多。 结论 在弥漫性肺疾病经气管镜进行冷冻活检是一个安全有效的诊断方法。

Structural design and biomechanical numerical analysis of body-fitted stent in stenotic vessels

To solve the problem of stent malapposition of intravascular stents, explore the design method of intravascular body-fitted stent structure and to establish an objective apposition evaluation method, the support and apposition performance of body-fitted stent in the stenotic vessels with different degrees of calcified plaque were simulated and analyzed. The traditional tube-mesh-like stent model was constructed by using computational aided design tool SolidWorks, and based on this model, the body-fitted stent model was designed by means of projection algorithm. Abaqus was used to simulate the crimping-expansion-recoil process of the two stents in the stenotic vessel with incompletely calcified plaque and completely calcified plaque respectively. A comprehensive method for apposition evaluation was proposed considering three aspects such as separation distance, fraction of non-contact area and residual volume. Compared with the traditional stent, the separation distances of the body-fitted stent in the incompletely calcified plaque model and the completely calcified plaque model were decreased by 21.5% and 22.0% respectively, the fractions of non-contact areas were decreased by 11.3% and 11.1% respectively, and the residual volumes were decreased by 93.1% and 92.5% respectively. The body-fitted stent improved the apposition performance and was effective in both incompletely and completely calcified plaque models. The established apposition performance evaluation method of stent considered more geometric factors, and the results were more comprehensive and objective.

Processing Strategy and Etiological Analysis of Relapsed Biliary Calculi after Endoscopic Sphincterotomy

Objective To investigate the best management in treating relapsed biliary calculi after endoscopic sphincterotomy (EST).Methods The clinical data of 96 patients with relapsed biliary calculi after EST in our hospital from February 1999 to February 2009 were retrospectively analysed. The patients were grouped into two groups by the size of calculi under magnetic resonance cholangiopancreatography: surgical group (the size of calculi was bigger than 1.0 cm) in 79 cases and non-surgical group (the size of stone was smaller than 1.0 cm and the patients were performed EST again) in 17 cases. The relapsed biliary calculi rate between two groups were compared. Results In the surgical group, the 79 patients (82.29%) were performed common bile duct exploration, transected common bile duct and choledochojejunostomy with Roux-en-Y anastomosis. In the non-surgical group, the 17 patients (17.17%) were performed EST again. The relapsed biliary calculi rate was 2.63% in the surgical group, 70.59% in the non-surgical group. There was marked difference in the relapsed biliary calculi rate between surgical group and non-surgical group (Plt;0.05). Conclusion The operation treatment is the best way for relapsed biliary calculi after EST, and has good curative effect. The best manner of operation treatment is common bile duct exploration, transected common bile duct and choledochojejunostomy with Roux-en-Y anastomosis.

Serum vitamin B12 and folic acid in exudative age-related macular degeneration patients

Objective　To investigate the serum levels of vitamin B12 and folic acid (FA) of exudative agerelated macular degeneration (AMD).Methods　A total of 84 patients with exudative AMD（AMD group）and 78 patients with non-exudative AMD （control group） diagnosed at Xijing Hospital between June 2008 and September 2009 were assessed in this study. Serum vitamin B12 and FA levels were measured by chemiluminescence immunoassay. The statistical information of epidemiology and risk factors exposure histories were collected and compared.Results　AMD group had significantly lower serum vitamin B12 levels ［（247.51plusmn;93.92）ng/ml］ compared with the control group ［（312.52plusmn;143.08） ng/ml］，the difference was statistical significance (t=5.013, P＜0.001). Serum FA levels in AMD group ［（5.64plusmn;3.72）ng/ml］ were slightly lower than the control group ［（10.14plusmn;4.48） ng/ml］, the difference was not statistical significance (t=0.780, P=0.437).Conclusion　People with lower serum vitamin B12have higher risk of exudative AMD. Low levels of serum vitamin B12 may relate with the occurrence of exudative AMD.