Objective To investigate the effects of cryoanalgesia for post-thoracotomy pain on the intercostal nerves. Methods Two hundred and eight patients suffering from thoracotomy were divided into three groups, according to different analgesia received respectively. Cryoanalgesia group （n = 80）： cryoanalgesia on the intercostal nerves, intercostals nerves was freezed at -55 ℃ for 90 seconds ; patient controlled analgesia by vein （PCA group, n= 80）： patient controlled analgesia was practiced intravenously, and control group （n = 48）： Dolantin given irregularly intra-muscularly and/or tramadol orally. Severity of pain was graded by visual analogue scale. Forced expiratory volume in one second（FEV1.0） was measured and pulmonary complication after operation was compared. Results There was a statistically significant improvement in postoperative pain scores and an improvement in respiratory function tests for patients in cryoanalgesia group（X2 = 74.93,15.04,P〈0. 05）. FEV1.0 in cryoanalgesia group was significantly higher than that in control group（1. 97±0.27L vs. 1. 39±0. 14 L,P〈0. 05）. Pulmonary complication in cryoanalgesia group after operation was lower than that in control group （6. 25% vs. 31. 25%, P〈0. 05 ）, Conclusion Cryoanalgesia on post-thoracotomy pain is very effective and may improve the respiratory function after operation.
Objective Aseptic loosening of prosthesis is associated with peri prosthetical osteolysis caused by osteoclast activation. Receptor activator of nuclear factor kappa B (NF-κB) l igand (RANKL)/receptor activator of NF-κB (RANK) signalpathway is fundamental in osteoclast activation. To determine whether RANKL antibody can inhibit inflammatory osteolysis in a osteolysis model of mouse. Methods Sixty female BALB/c mice (aged 8-10 weeks, weighing 18-20 g) were selected. The skull bone piece was harvested from 20 mice as the donor of bone graft; the subcutaneous air pouches (2 cm × 2 cm) models were established on the back of the other 40 mice and the skull bone piece was inserted into the air pouches. The 40 mice were equally divided into groups A (negative control group), B (positive control group), C (low-dose RANKL antibody group), and D (high-dose RANKL antibody group). At 1 day after bone graft, 0.5 mL PBS was injected into the pouch of group A, 0.5 mL PBS containing titanium particle into groups B, C, and D. At 2 days before the titanium particle was injected, RANKL antibody (0.1 mL) were injected into the pouch of group C (50 μg/mL) and group D (500 μg/mL), respectively every day for 2 days, and 0.1 mL PBS into groups A and B. At 14 days after bone implantation, the pouchmembranes containing implanted bone were harvested for gross observation and histological analyse. Results All mice survived to the end of experiment, and incisions healed well. The gross observation showed that inflammatory responses, exudation, and vascular proliferation were obvious in group B, and were inconspicuous in groups A, C, and D. The histological analysis showed that significantly more infiltration of inflammatory cells, more obvious bone resorption, more bone collagen loss, and more positive staining area were observed in group B than in groups A, C, and D. There were significant differences in inflammatory cell number, pouch membrane thickness, bone collagen loss, and osteoclast content between group B and groups A, C, and D (P lt; 0.05). Conclusion RANKL antibody can directly blockRANKL/RANK signal pathway, which is an efficient therapy to inhibit bone absorption associated with implant wearing particles.
Objective The results related to the role and research progress of Syndecan-1 in breast cancer are systematically reviewed, with the aim of providing new directions for the treatment and prognosis of breast cancer research. Method The unique properties and role of Syndecan-1 in breast cancer patients were analyzed and summarized by searching the relevant literatures in recent years. Results Syndecan-1 was of great significance in the diagnosis and treatment of breast cancer and could be used as a potential prognostic marker of breast cancer. Meanwhile, it could also be used as a potential therapeutic target for breast cancer, which had significant research value for clinical applications. Conclusion Syndecan-1 has been applied in the field of breast cancer research because of its unique properties and effects on the development, treatment and prognosis of breast cancer.
ObjectiveTo assess the effect of microfracture and biomimetic hydrogel scaffold on tendon-to-bone healing in a rabbit rotator cuff tear model.MethodsGelatin and methacrylic anhydride were used to synthesize gelatin methacryloyl (GelMA). Then the GelMA were treated with ultraviolet rays and vacuum freeze-drying method to obtain a biomimetic hydrogel scaffold. The morphology of the scaffold was observed by gross observation and scanning electron microscope. Degradation of the scaffold was determined at different time points. Twenty-four adult New Zealand rabbits, weighting 2.8-3.5 kg and male or female, were surgically created the bilateral acute rotator cuff tear models. One shoulder was treated with microfractures on the footprint and transosseous suture (control group, n=24). The other shoulder was treated with the same way, except for putting the scaffold on the footprint before transosseous suture (experimental group, n=24). The general conditions of rabbits were observed postoperatively. Tendon-to-bone healing was evaluated by gross observation, Micro-CT, HE staining, and bio-mechanical testing at 4 and 8 weeks after operation.ResultsThe scaffold was white and has a porous structure with pore size of 31.7-89.9 μm, which degraded slowly in PBS solution. The degradation rate was about 95% at 18 days. All the rabbits survived to the completion of the experiment. Micro-CT showed that there was no obvious defect and re-tear at the tendon-to-bone interface in both groups. No difference was found in bone mineral density (BMD), tissue mineral density (TMD), and bone volume/total volume (BV/TV) between the two groups at 4 and 8 weeks postoperatively (P>0.05). HE staining showed that the fibrous scar tissue was the main component at the tendon-to-bone interface in the control group at 4 and 8 weeks postoperatively; the disorderly arranged mineralized cartilage and fibrocartilage formation were observed at the tendon-to-bone interface in the experimental group at 4 weeks, and the orderly arranged cartilage formation was observed at 8 weeks. Besides, the tendon maturation scores of the experimental group were significantly higher than those of the control group at 4 and 8 weeks (P<0.05). There was no significant difference in the ultimate load to failure and stiffness between the two groups at 4 weeks (P>0.05); the ultimate load to failure at 8 weeks was significantly higher in the experiment group than in the control group (t=4.162, P=0.009), and no significant difference was found in stiffness between the two groups at 8 weeks (t=2.286, P=0.071).ConclusionCompared with microfracture alone, microfracture combined with biomimetic hydrogel scaffold can enhance tendon-to-bone healing and improve the ultimate load to failure in rabbits.
【摘要】 目的 探讨乳腺癌不同分子亚型腋窝淋巴结转移的状态及预后分析。 方法 对2005年1月－2007年12月收治的125例乳腺癌患者进行分子分型，对腋窝淋巴结转移状态进行分析并结合随访结果进行预后分析。 结果 Luminal A型63例，16例淋巴结转移，转移率为25.4%；Luminal B型19例，7例淋巴结转移，转移率为36.8%；HER-2过表达型26例，11例淋巴结转移，转移率为42.3%；Basal-like 型17例，9例淋巴结转移，转移率为52.9%。其中Luminal A型淋巴结转移率与Basal-like 型比较差异有统计学意义（Plt;0.05），其余型间比较差异无统计学意义（Pgt;0.05）。运用χ2检验各分子亚型在肿瘤大小的差异无统计学意义（Pgt;0.05）。经过2~5年随访，8例患者出现局部复发或远处转移，其中Luminal B型2例，HER-2过表达型5例，Basal-like 型1例。8例中有3例因肝转移死亡，另5例接受治疗现仍生存。 结论 乳腺癌的分子分型可作为腋窝淋巴结转移的预测指标，HER-2过表达型和Basal-like 型预后较差，将为今后制定乳腺癌个体化治疗提供重要依据。【Abstract】 Objective To analyze the axillary lymph nodes metastasis of various breast cancer molecular subtypes and its prognosis. Methods Molecular subtypes of 125 cases of operable breast cancer diagnosed and treated between January 2005 and December 2007 were categorized, and the axillary lymph nodes metastasis of these types was analyzed. At the same time, we analyzed its prognosis status with the results of the follow-up. Results Among the 125 cases, there were 63 luminal A cases in which 16 (25.4%) were found to be axillary lymph nodes metastasis. Among the 19 luminal B cases, there were 7 (36.8%) axillary lymph nodes metastases. There were 11 cases (42.3%) of axillary lymph nodes metastasis in the 26 cases of HER-2 (+) subtype. In the 17 cases of basal-like subtye, 9 (52.9%) were axillary lymph nodes metastases. As for the axillary lymph nodes metastatic rate, only basal-like subtype was higher than luminal A subtype with a statistically significant difference (Plt;0.05). Differences between all other subtypes were not significant (Pgt;0.05). The molecular subtypes did not differ in tumor size (Pgt;0.05) according to the result of chi-square test. During the 2 to 5-year follow-up, 8 of the 125 patients were found to have local tumor recurrence or distant metastatic disease, which included 2 luminal B cases, 5 HER-2 (+) subtype cases, and 1 basal-like subtype case. In those 8 patients, 3 died of liver metastases and 5 survived and are still accepting treatment now. Conclusions Molecular subtyping can provide important information of axillary lymph nodes metastatic status. HER-2 over-expression and basal-like subtype have a poor prognosis, which is an important basis for individual treatment of breast cancer in the future.
ObjectiveTo explore the effects of modified telescopic embedding anastomosis in surgical treatment of esophageal and cardiac carcinoma. MethodsWe retrospectively analyzed the clinical data of 160 patients with esophageal or cardiac cancer undergoing surgery in our group from January 2014 through May 2015. There were 119 males and 41 females with a mean age of 61.6±7.1 years. Sixty-four patients received Sweet esophagectomy and 96 patients underwent minimally invasive Mckeown esophagectomy, and all the patients received end to side mechanical anastomosis. The patients were divided into a modified group and a traditional group according to the embedding types. There were 34 males and 12 females aged 61.7±6.4 years in the modified group undergoing modified telescopic embedding. There were 85 males and 29 females aged 62.2±7.5 years in the traditional group undergoing traditional interrupted horizontal mattress suture embedding. The anastomostic time and postoperative complications were compared between the two groups. ResultsCompared with the traditional group, obviously lower incidence of anastomotic fistula (0.0% vs. 12.3%, χ2=4.478, P=0.013), shorter anastomosis time (28.9±2.9 min vs. 30.0±3.1 min, t=-1.983, P=0.049), but a higher incidence of anastomotic stenosis (30.4% vs. 3.5%, χ2=23.799, P=0.000) in the modified group were found. There were no significant differences in the incidences of pulmonary complications, cardiovascular complications, laryngeal recurrent nerve injury, or perioperative mortality between the two groups (P>0.05). ConclusionModified telescopic embedding anastomosis is safe and feasible in surgical treatment of esophageal and cardiac carcinoma, and can effectively reduce the incidence of anastomotic fistula.
ObjectiveTo standardize the techniques for laparoscopic radical rectal resection and discuss its application prospect. MethodsThe clinical data of 433 patients who underwent laparoscopic radical rectal resections from July 2003 to December 2010 in our hospital were reviewed retrospectively, and the different surgery procedures and the development prospect were explored. ResultsFive cases (1.2%) underwent handassistant laparoscopic procedures, 412 cases (95.2%) were done by laparoscopic-assisted operation, and the specimens were taken out with transanal pull-through technique in 16 cases (3.7%). In all of them, conversion to open procedures occurred in 11 patients (2.5%), and 290 (67.0%) patients were followed-up in 1 to 6 years, average in 2.7 years. Local recurrence occurred in 7 (2.4%) patients, while distant metastasis were diagnosed in 22 （7.6%） cases, and the overall mortality was 15.9% (46/290). There was no port-site metastasis occurred. ConclusionsFour-port laparoscopic rectal resection technique is also the clinical mainstream. Standardized laparoscopic procedure for rectal resections enhances the transformation of laparoscopic skills, and makes the operation predictable. Single incision procedure and natural orifice transluminal endoscopic surgery are future direction to explore.
目的探讨单腔气管内插管保留自主呼吸的静脉全身麻醉下小儿胸腔镜手术的可行性及安全性。 方法选取郑州大学第一附属医院胸外科2012年2～12月采用单腔气管内插管保留自主呼吸行静脉全身麻醉下胸腔镜手术治疗的14例患儿作为试验组，男9例、女5例，年龄4～9岁；选取2010年5月至2011年10月采用常规双腔气管内插管全身麻醉下胸腔镜手术治疗的20例小儿患者作为对照组，男13例、女7例，年龄3～10岁。比较两组手术时间、术中失血量、术毕至拔管时间、住院费用、住院时间及术后并发症发生率等指标。 结果两组患儿手术均顺利，无术中术后死亡。试验组和对照组患儿平均手术时间[（85.7±16.9）min vs.（83.5±16.5）]及术中失血量[（90.0±55.0）ml vs.（85.0±50.0）ml]差异无统计学意义（P>0.05）。试验组的术毕至拔管时间[（0.5±0.1）min vs.（8.3±1.4）min]、住院费用[（24.3±4.7）千元vs.（27.8±5.3）千元]、住院时间[（6.6±0.9）d vs.（12.7±3.2）d]、术后并发症发生率（7.1%vs.25.0%）都显著短或少于对照组（P < 0.05）。 结论单腔气管内插管保留自主呼吸静脉全身麻醉下小儿胸腔镜手术治疗小儿胸部疾病具有一定的安全性及可行性。