目的:评价外用盐酸氨酮戊酸散光动力疗法治疗尖锐湿疣的临床疗效。方法:采用开放、高频电离子平行对照的临床研究方法。治疗组28例患者,采用外用盐酸氨酮戊酸散光动力疗法,一周治疗一次,连续治疗三周;对照组37例患者,采用高频电离子切割治疗。两组患者均在末次治疗后第一周进行疗效评价及不良反应观察,第4、8、12周观察复发率。结果:1例患者因三次外用盐酸氨酮戊酸散光动力疗法后疣体脱落而提前终止试验,64例患者完成了全部的随访。在末次治疗后1周时疣体清除率:治疗组为96.4%,对照组为100%,其中尿道口的疣体清除率:两组均为100%;非尿道口的疣体清除率:治疗组为91.67%,对照组100%,无论是尿道口还是非尿道口尖锐湿疣,两组的疗效无统计学差异(Pgt;0.05)。治疗后随访12周的复发率:治疗组为 6.86%,对照组24.32%, Plt;0.05;其中尿道口的复发率:治疗组为 5.88%,对照组42.86%,Plt;0.05;非尿道口的疣体清除率:治疗组为8.33%,对照组为20%,Plt;0.05。两组均具有统计学差异。两组均没有出现系统不良反应,局部不良反应率:治疗组为7.14%,主要为轻度糜烂、疼痛、渗液;对照组为4865%,主要为溃疡、疼痛、疤痕等,治疗组不良反应发生率均明显低于对照组,差异有统计学意义。结论：ALA-PDT清除率高，复发率低，安全，耐受性好，无明显副作用，可作为尿道口CA治疗首选。
Objective To assess the clinical outcome of thelimb salvage surgery and complications occurring in the lower extremities after a wide resection of sarcoma. 〖WTHZ〗Methods A total of 167 patients underwent a limb-sparing procedure by means of the implantation of a custom-made or modular tumor endoprosthesis from July 1997 to July 2004. Of the 167 patients, 100 were followed up, including 56 males and 44 females, with their ages ranging from 13 to 57 years at surgery.In 5 patients, a proximal femur prosthesis was implanted; in 57 patients, a distal femur prosthesis was implanted; and in 38 patients, a proximal tibia prosthesis was implanted. According to the Enneking staging, 3 patients were grouped in the stage of ⅡA, 85 in ⅡB, and 12 in Ⅲ. Seventy-one patients used a domestic prosthesis, and 29 patients used a prosthesis made in Link Company, Germany. For the reconstruction, 17 patients used an autograft prosthesis composite, 21 patients used the allograft prosthesis composite, and the remaining 62 patients used an artificial prosthesis. All the patients received chemotherapy for 1-2 courses and 3-5 courses before operation and after operation, respectively. After operation, The Musculoskeletal Tumor Society(MSTS) score was used to evaluate the recovery of their corresponding functions. Results According to the follow-up for 1-8 years, with a median of 3.5 years, and the assessment by the Kaplan-Meier estimate, the 3-year survival rate of the prostheses was 81.8%, and the 5year survival rate was 65%. As for the complications, prosthesis breakage occurred in 6 patients, periprosthesis infection in 13 patients, aseptic loosening in 2 patients, non-union between the host bone and graft bone in 5 patients, allograft absorption in 2 patients, prosthesis sinking in 2 patient, and periprosthesis fracture in 1 patient. Local recurrence developed in 7 patients within 6 months to 2 years after operation. Of the 7 patients, 4 had a recurrence of the softtissue tumor for which resection was performed; the other 3 patients underwent amputation of the diseased limb. The mean MSTS score was 23.30±5.17, with an excellent limb function in 62 patients, good in 27 patients, fair in 7 patients, and poor in 4 patients. The overall excellent and good function was obtained in 89% of the patients. Conclusion We conclude that tumor prostheses can give a satisfactory functional outcome after the tumor around the knee is removed; however, the tumor prostheses still need to be further improved because of a high complication rate.
OBJECTIVE: To investigate the effect of electroacupuncture on mRNA expression of NGF and IGF-1 in injured nerve. METHODS: Sciatic nerve injury model was established by transection of right side sciatic nerve in 90 male SD rats, which were randomly divided into two groups. The experimental group was treated with electroacupuncture, no treatment in the control group. The distal part of the injured nerve was harvested after 1, 2, 4, 6 and 10 weeks of operation and stored in the liquid nitrogen. The total RNA was extracted by the TRIzol reagent. Reverse transcriptase-polymerase chain reaction(RT-PCR) was used to detected the mRNA expression of NGF and IGF-1. RESULTS: The mRNA expression of NGF in the experimental group was increased quickly from the second week, and reached to highest level in the fourth week. It was much higher than that of the control group (P lt; 0.05). Then it began to decline in following time and approximately reached to the level of the first week after 10 weeks of operation. The mRNA expression of IGF-1 in the experimental group was remarkably increased in the second and fourth week, and which was much higher than that of the control group respectively(P lt; 0.05). Although the mRNA expression of IGF-1 after 10 weeks of operation in the experimental group was higher than that of the control group, but there was no significant difference between the two groups(P gt; 0.05). There was linear correlation in the fourth week between mRNA expression of NGF and IGF-1 in the experimental group. CONCLUSION: The mRNA expression of NGF and IGF-1 can be elevated in injured nerve at early stage interfered with electroacupuncture.
Objective To evaluate the effectiveness of bipolar prosthetic replacement for proximal femoral tumors from the perspectives of patient survival, prosthesis survival, functional outcomes, and complication rates. Methods Between July 2001 and July 2010, 96 patients with proximal femoral tumors underwent wide resection and bipolar prosthetic replacement, including 83 cases of primary femoral tumors and 13 cases of soft tissue sarcomas involving the proximal femur. There were 50 male and 46 female patients with a mean age of 43.2 years (range, 15-69 years). Prosthetic replacement for proximal femoral tumors was used in 85 patients and deactivated bone-prosthetic complex was used in 11 patients. According to Enneking staging, the patients were divided into 3 groups: group A, 24 patients at stages IA, IB, and benign lesion; group B, 56 patients at stages IIA and IIB; and group C, 16 patients at stage III, myeloma, and lymphoma. The American Musculoskeletal Tumor Society 1993 version (MSTS93) functional score was used to evaluate the lower limb function. Results Primary healing of incision was obtained in 93 patients; 3 patients had poor healing, which was cured after debridement. Of the patients, 89 were followed up 6.5 years on average (range, 1-10 years). During follow-up, 28 patients died of tumor. The 5- and 10-year survival rates of patients were 100% in group A, and were 56.5% and 41.5% in group B respectively, and the 5-year survival rate was 18.4% in group C; there was significant difference among 3 groups (P lt; 0.01). The 5- and 10-year survival rates of prosthesis were 74.4% and 62.5%, which were significantly higher than those of patients in groups B and C (P lt; 0.01). Sixty-one patients were followed up 1-10 years (mean, 4.7 years) for functional evaluation. The mean MSTS93 score of the survival patients was 79% (range, 63%-95%) at last follow-up. Complications were observed in 15 patients (16.9%): hip dislocation in 2, delayed infection in 2, aseptic loosening in 8, severe acetabulum wear in 1, and hip pain in 2. Conclusion Bipolar proximal femoral prosthetic replacement for proximal femoral tumors can provide a satisfactory functional outcome, especially for tumors at stage II or III and myeloma and lymphorma patients. Revision is needed because of main late complications of aseptic loosening, hip pain, and acetabulum wear.
Objective To investigate the effectiveness of subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip (DDH). Methods Between January 2004 and December 2010, 37 patients (44 hips) with Crowe type IV DDH underwent subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty with cementless prosthesis. There were 15 males (18 hips) and 22 females (26 hips) with an average age of 42 years (range, 24-46 years). Unilateral hip was involved in 30 cases and bilateral hips in 7 cases. Preoperative X-ray films showed complete dislocation of the femoral head and hypoplasia of the acetabulum and proximal femur. Before operation, the leg discrepancy was (5.5 ± 1.1) cm, and the Harris score was 32.1 ± 5.2. Results The mean operation time was 4.3 hours (range, 3-6 hours); the mean blood loss was 760 mL (range, 600-1 000 mL). All patients obtained primary healing of incision. The patients were followed up 1-8 years (mean, 6.7 years). Pain relief was achieved; 6 cases had mild claudication; 3 cases had femoral nerve palsy; and no stretch injury of sciatic nerve was observed. X-ray films showed that acetabular cups were in normal position. The healing time of fracture was 3-6 months (mean, 3.7 months). The leg discrepancy was (1.5 ± 1.0) cm at 1 day after operation, showing significant difference when compared with preoperative one (t=16.45, P=0.00). The Harris score was 94.3 ± 3.8 at 3 months after operation, showing significant difference when compared with preoperative score (t=59.15, P=0.00). No revision of acetabular and femoral prostheses was performed during follow-up. Conclusion Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty is a safe method of restoring the anatomic hip center in Crowe type IV DDH in adults. It can avoid reduction difficulty caused by soft tissue contracture and injuries of sciatic nerve and femoral nerve caused by limb lengthening.
Objective To study biological rule of recombinant human bone morphogenetic protein 2 (rhBMP-2) in regulating the expression of vascular endothelial growth factor (VEGF) of adipose-derived stem cells (ADSCs) at different induced concentrations and time points at gene level and protein level. Methods ADSCs were separated from adult human adipose tissues and cultured until passage 3. After ADSCs were induced by rhBMP-2 in concentrations of 0, 50, 100, and 200 ng/ mL respectively for 24 hours, and by 100 ng/mL rhBMP-2 for 3, 6, 12, 18, 24, 36, and 48 hours (ADSCs were not induced at corresponding time point as controls) respectively, the VEGF mRNA and protein expressions were detected by RT-PCR and ELISA. Results The VEGF mRNA and protein expressions induced by rhBMP-2 were concentration-dependent; the expressions were highest in a concentration of 100 ng/mL. The VEGF mRNA expression in concentrations of 50, 100, and 200 ng/mL were significantly higher than that in a concentration of 0 ng/mL (P lt; 0.05); and the expression in concentration of 100 ng/ mL was significantly higher than that in concentrations of 50 and 200 ng/mL (P lt; 0.05). The VEGF protein expression in a concentration of 100 ng/mL was significantly higher than that in the other concentrations (P lt; 0.05). The VEGF mRNA and protein expressions induced by rhBMP-2 were time-dependent. The VEGF mRNA and protein expressions at 3 and 6 hours after induction were significantly lower than those of non-induced ADSCs (P lt; 0.05); the expressions were lower at 12 hours after induction, showing no significant difference when compared with those of non-induced ADSCs (P gt; 0.05); the expressions reached peak at 18 and 24 hours after induction, and were significantly higher than those of non-induced ADSCs (P lt; 0.05); the expressions decreased in induced and non-induced ADSCs at 36 and 48 hours, showing no significant difference between induced and non-induced ADSCs (P gt; 0.05). Conclusion rhBMP-2 adjusts VEGF expression of ADSCs in a concentration- and time-dependent manner. The optimum inductive concentration of rhBMP-2 is 100 ng/mL, induced to 18-24 hours is a key period when rhBMP-2 is used to promote tissue engineering bone vascularization.
目的 探讨Oddi括约肌松弛症（SOR）的原因，总结其临床特点及处理经验，观察横断胆管＋胆肠Roux-en-Y吻合术治疗SOR的效果。方法 回顾性分析我院2001年1月至2011年1月期间收治的76例SOR患者的临床资料，将患者分为3组，分别采用横断胆管＋胆肠Roux-en-Y吻合术（39例）、胆道探查T管引流术（28例）及不横断胆管仅行胆肠Roux-en-Y吻合术（9例）治疗。结果 76例病例均经手术治疗，无手术死亡。手术并发症为：横断胆管＋胆肠Roux-en-Y吻合术组胆瘘1例，胸腔积液1例，切口脂肪液化2例；胆肠Roux-en-Y吻合术组胆瘘1例，胸腔积液1例，切口脂肪液化2例；胆道探查T管引流术组胸腔积液2例，切口脂肪液化1例。均经保守治疗好转。76例均获随访，随访时间3～83个月，平均45个月。因本研究是回顾性研究，考虑到胆肠Roux-en-Y吻合术组例数较少（仅9例），因此在分析其疗效时合并到胆道探查T管引流术组与横断胆管＋胆肠Roux-en-Y吻合术组进行比较。横断胆管＋胆肠Roux-en-Y吻合术组术后治愈34例，好转3例，无效2例，有效率为94.9% （37/39）；胆道探查T管引流术组和胆肠Roux-en-Y吻合术组术后治愈5例（2组分别为4例和1例），好转11例（2组分别为4例和7例），无效21例（2组分别为1例和20例），有效率为43.2% （17/37）。横断胆管＋胆肠Roux-en-Y吻合术组术后有效率明显高于胆道探查T管引流术组和胆肠Roux-en-Y吻合术组（P＜0.05）。结论 横断胆管＋胆肠Roux-en-Y吻合术是治疗SOR较有效的手术方式。
Objective To investigate the surgical characteristics and preliminary effectiveness of Orthofix unilateral external fixator in the treatment of musculoskeletal tumors. Methods Twenty-two patients received Orthofix unilateral external fixator treatment for bone defect after tumor excision or complications after limb salvage surgery between June 2011 and March 2016. There were 11 males and 11 females with a median age of 23.5 years (range, 4-57 years). The bone defect or limb length discrepancy after tumor resection was at proximal femur in 6 cases, distal femur in 8 cases, diaphysis of femur in 3 cases, proximal tibia in 2 cases, and diaphysis of tibia in 3 cases. The external fixation was used for temporary fixation after reconstruction of bone defect in 10 cases [the length of bone defect was 6-19 cm (mean, 12.3 cm); using vascularized fibular graft in 2 cases, allograft bone and free fibular graft in 2 cases, allograft bone and autogenous bone graft in 5 cases, allograft bone reconstruction in 1 case]; bone distraction lengthening for limb length discrepancy in 5 cases [the length of shortening was 6.5-8.5 cm (mean, 7.5 cm)]; temporary fixation after open biopsy in 3 cases; bone transportation over locking plate in 1 case (the length of bone defect was 7.5 cm); fixation for preoperatively pathology fracture in 1 case; and joint distraction for dislocation after tumor ablation in 2 cases. Results All the patients were followed up 12-72 months (mean, 36 months). In 10 patients with bone defect reconstruction, the wearing external fixator time was 3-8 months (mean, 4.8 months); all got bone union with the healing time of 3-16 months (mean, 6.4 months); the Musculoskeletal Tumor Society 93 (MSTS 93) score was 73.3-93.3 (mean, 87.2); and no complication occurred during wearing external fixator. In 5 patients with bone distraction lengthening for limb length discrepancy, the wearing external fixator time was 7-15 months; 2 patients had axial deviation during distraction and2 had greenstick fracture after apparatus removal; pin site infection was observed in 2 cases with grade 1 and 1 case with grade 2 according to Checketts-Otterburn classification system; the MSTS 93 score was 80.0-96.7 (mean, 89.2). The remaining patients had no complications, the knee and ankle joint movement was normal. Conclusion Orthofix unilateral external fixator can be used in fixation for complex bone defect after tumor resection and to correct limb length discrepancy after limb salvage surgery.
ObjectiveTo investigate the effect of perioperative allogeneic blood transfusion on the prognosis of patients with non-small cell lung cancer (NSCLC).MethodsThe databases including PubMed, The Cochrane Library, EMbase, CNKI, Wanfang Data, VIP and CBM were searched for literature about the effects of perioperative allogeneic blood transfusion on the prognosis of patients with NSCLC from the inception to May 2020. Two authors independently screened the literature, extracted and cross-checked data, and negotiated to resolve differences in opinions. Review Manager V5.3 (Cochrane Collaboration, Oxford, UK) software was used for data analysis.ResultsA total of 15 articles were included, including 5 897 patients. There were 1 649 patients in the trial group and 4 248 patients in the control group. The results of meta-analysis showed that the overall survival of the control group was significantly higher than that of the trial group (OR=0.58, 95%CI 0.47-0.70, P<0.000 01). The disease-free survival of the control group was significantly higher than that of the trial group (OR=0.43, 95%CI 0.36-0.52, P<0.000 01). The recurrence rate of the control group was significantly lower than that of the trial group (OR=1.85, 95%CI 1.34-2.55, P=0.000 2).ConclusionPerioperative allogeneic blood transfusion has adverse effects on the recurrence and survival of patients with NSCLC.