Objective To evaluate and compare the relation of the cl inical results of expansion of open-door cervical laminoplasty (EOLP), C5 nerve root palsy in hinge side, and reclose of the opened laminae with different angles in lamina opendoor.Methods Between July 2006 and January 2009, 198 patients with cervical myelopathy were treated by EOLP. Accordingto different opening angles which were measured by CT scan after operation, the patients were divided into group A (gt; 30°, 76 patients including 44 males and 32 females) and group B (15-30°, 122 patients including 71 males and 51 females). There was no significant difference in gender, age, disease duration, and segmental lesions between 2 groups (P gt; 0.05). The Japanese Orthopaedic Association (JOA) score before and after operation was used for neurological assessment and improvement rate, and the postoperative C5 nerve root palsy and reclose of the opened laminae were recorded. Results There was no significant difference in operation time, bleeding volume, and hospital ization days between 2 groups (P gt; 0.05). After 3 weeks of operation, C5 nerve root palsy in the hinge side occurred in 7 patients (9.2%) of group A, and in 2 patients (1.6%) of group B, were restored after symptomatic treatment, showing significant difference between 2 groups (χ2= 4.568, P= 0.033). All patients were followed up 24 to 48 months. Between group A and group B, no significant difference was found in JOA improvement rate at 24 months after operation (P gt; 0.05), and in JOA score at preoperation and at 24 months after operation (P gt; 0.05), but JOA score was significantly improved at 24 months after operation when compared with preoperative score in the same group (P lt; 0.05). The function of l imb l ifting restored in 9 cases of C5 nerve root palsy at 24 months after operation; CT examination revealed that no reclose occured in group A and reclose occurred in 4 cases (3.3%) of group B, but no persistent symptoms or worsen situationwere found during follow-up. Conclusion Different angles in lamina open-door have the same cl inical result; C5 nerve palsy has good prognosis. The opening angle between 15° and 30° will reduce the incidence of C5 nerve root palsy in the hinge side, but the open side should be firmly fixed to prevent further reclose of the opened laminae.
To explore the effects of tissue expansion on the anastomoses and the survival of the axial pattern flap with a crossing area supply so as to improve the survival of crossing area axial pattern flap and to provide a new idea for the development of original crossing area axial flap. Methods The experiment included two parts. Experiment A was divided into expansion group and control group. Square flaps were randomly designed on own control bilaterally in each animal with a boundary of midl ine. Experiment B was divided into expansion group and delay group. The flaps were also randomly designed on own control bilaterally. Angiographic analysis and gross survival observation were carried on. Results ExperimentA: Angiography showed that there were abundant anastomoses with big cal iber between deep il iac circumflex artery and superior epigastric artery in expansion group and there were only 3-4 anastomoses in control group. Experiment B: Angiography showed that there were abundant anastomoses with big cal iber in expansion group and there were two arterial systems with relatively less anastomoses and smaller cal iber in delay group. The survival rates in expansion group was significantly higher than that in the control group (90.16% ± 3.61% vs 72.67% ± 5.35%) in experiment A, and in experiment B the survival rate was 92.08% ± 3.30% in the expansion group and 80.79% ± 4.52% in the delay group, showing significant difference (P lt; 0.01). Conclusion Expansi on prefabrication can and improve the survival of the crossing area supply axial pattern flap. The mechanism is the bridging effect.
OBJECTIVETo study the repairing method of facial nerve defect using nerve elongation, and the biomechanical properties of peripheral nerves. METHODS A novel device for peripheral nerve elongation was designed and manufactured. With the device, facial nerves of rabbits were expanded acutely and chronically by string-type loading. The facial nerves were studied with histological and electrophysiological examinations before and after elongation. RESULTS There were no considerable necrosis, degeneration, and infection in the facial nerves after elongation. The experimental animals took food normally and their body temperature were stable. Histological examinations showed dispersing Sunderland degree III injury and occasionally broken capillary blood vessels in the acute group, thicker nerve and fibroblasts hyperplasia between nerve bundles in the chronic group. The electromyogram(EMG) of buccal muscle and nerve conductive velocity(NCV) showed the maximal range was (18.7 +/- 2.4)% in the acute group, and (30.8 +/- 2.4)% in the chronic group. CONCLUSION It suggests that the novel nerve elongation method is feasible, and it can be used to study the nerve elongation basically and clinically.
OBJECTIVE: To evaluate the application of skin and soft tissue expansion in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound. METHODS: From 1988, 83 cases of application of skin and soft tissue expansion were reported. In those patients with deformity due to severe burn of large area and with whole nasal defect, soft tissue expander was used under the forehead skin graft and venter frontalis, followed by reconstruction of nose with the expanded vascularized skin flap and carved cartilago costalis as nasal frame. In patients of severe deep electrical burned scalp and skull with fresh wound, skin and soft tissue expansion were used to repair the wound simultaneously with scalp burn alopecia, anesthetics and antibiotics injected into the extracapsular space of the expander in case of pain and infection. RESULTS: All of the cases were successfully treated with little pain and minimized infection. CONCLUSION: Skin and soft tissue expansion in a safe and reliable measure in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound.
Abstract An animal experiment had been conducted for the purpose to find out the possibility of application of instantaneous sustained limited expansion (ISLE). A total of 54 skin defects in 9 pigs were obtained and were divided into two groups. One group of the pigs were subjected to instantaneous sustained limited expansion, the others, as the control group, just received the tension suture. At the same time the blood supply of the skin was measured by laser doppler flowmeter (LDF). It was showed that microcirculatory perfusion of the ISLE group was considerably better than that of the control. Inaddition, the correlation between the blood flow of the skin and the expanding pressure, as well as the pathologic changes of the skin were discussed.
Transcatheter aortic valve replacement (TAVR) is an emerging alternative for the treatment of aortic stenosis (AS). Evidence from clinical trials sprang up continuously, and guidelines have listed TAVR as an alternative for part of AS patients. Although old guidelines only recommended TAVR for surgical high-risk or in-operable AS patients, the latest guidelines have expanded its indications enormously. Moreover, there are ongoing TAVR studies on low-risk patients, asymptomatic patients, pure aortic regurgitation patients, bicuspid aortic valve patients,etc. It is believed that the indication of TAVR will continue to expand. More and more patients will benefit from TAVR in the foreseeable future.
Regulatory T cells (Treg) are critical for regulation of tolerance, control immune responses to self-antigens thereby preventing autoimmunity, and limiting responses to foreign antigens thereby minimizing T cell-mediated immunopathology. Recent data indicate that suppression of organ-specific autoimmunity is dependent on the antigen specificity of Treg. An emerging model of Treg action is that organ-specific Treg acquire suppressive activity through activation by dendritic cells expressing specific antigens. Thus, the efficacy of Treg-based therapy should be increased by using antigen-specific Treg rather than polyclonal Treg. It is necessary to identify relevant antigens and to expand antigen-specific Treg from polyclonal populations. Here, we discuss recent techniques for expansion of antigen-specific Treg, function and antigen specificity of Treg and the therapeutic potential of Treg in controlling autoimmune disease and inducing transplant tolerance.