Objective To observe whether apoptosis was involved in cells of aspiration fluid from vitrectomy for proliferative vitreoretinopathy(PVR),and whether there was an association with expression of Fas antigen(Fas )and Fas ligand (FasL). Methods Cytocentrifuge slides of 11 fresh vitreous specimenｓ of PVR were prepared to be stained by TUNEL met hod for detection of apoptosis and by immunohistochemical technique for detection of Fas,FasL，and cytokeratin (CK),a cell-type specific antigen. Results Fas and FasL were expressed in normal human retina.Fas,FasL,CK，and apoptosis were found in all preparations.TUNEL-positive cells were 20.53% in total cells.70.35%,51.58%，and 82.97% of cells highly expressed Fas,FasL，and CK,respectively.The linear correlation coefficient of Fas and apoptosis was 0.99(Plt;0．001). Conclusion Vitrectomy specimens of PVR showed expression of Fas，FasL，and apoptosis.Prominent Fas and FasL expressions may be associated with apoptosis of proliferating retinal pigment epithelial cells in the vitreous of PVR. (Chin J Ocul Fundus Dis,1999,15:78-80)
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.
目的 探讨在Sprague-Dawley大鼠右心房注射缓激肽对呼吸的影响。 方法 7～9 d和21～23 d大鼠在迷走神经完整和迷走神经切断的情况下从右心房注射缓激肽，观察呼吸指标的变化。 结果 ① 右心房注射缓激肽后，7～9 d大鼠出现呼吸暂停，而在21～23 d大鼠仅出现呼吸抑制（P＜0.05）；② 切断迷走神经后，右心房注射缓激肽在两组大鼠均不再出现呼吸暂停。 结论 右心房注射缓激肽在7～9 d大鼠产生呼吸暂停，且依赖于迷走神经的完整性。
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.
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.
Objective To evaluate the effect and significance of PBL in clinical skills experiment teaching center (CSETC). Methods A total of 60 undergraduates in major of clinical medicine were divided into two groups according to their student ID. The control group (n=30) was set in an ordinary small classroom, while the experimental group (n=30) was in CSETC for fully using the teaching resources there. Both groups were taught with PBL method by same teachers, and the integrated final examination and questionnaire were adopted to evaluate the teaching effect. SPSS was used for statistical analysis. Results All 8 participated teachers believed that carrying out PBL in CSETC could promote teachers’ professional development, alleviate the shortage of teachers and classroom, increase the utilization ratio of CSETC, and improve the teaching quality. The results of survey on students showed that, compared with the control group, information management ability and clinical skills of students were improved obviously (Plt;0.01). Although there was no difference in total score of final exam, the experimental group was markedly higher than the control group in the score of clinical skill subject (Plt;0.01). Conclusion Carrying out PBL in CSETC can improve teaching quality, and clinical skills and information management ability of students. It is helpful to alleviate the shortage of teachers and classroom, and promote the teaching standards of CSETC.
ObjectiveTo explore technical essentials and safety of laparoscopic cholecystectomy (LC) guided by gallbladder ampulla localization on an imaginary clock for cholecystitis.MethodsA retrospective study of 8 707 continuous patients with mild cholecystitis who underwent LC from July 1998 to February 2018 at a single institution was conducted. Among them, 3 168 patients were treated by the traditional LC from July 1998 to February 2007 (a traditional LC group), 5 539 patients were treated by the LC with the guidance of the gallbladder ampulla localization on an imaginary clock from March 2007 to February 2018 (a gallbladder ampulla localization group). The conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury, operative time, intraoperative blood loss, and postoperative hospital stays were compared between the traditional LC group and the gallbladder ampulla localization group.ResultsThere were no significant differences in the gender, age, course of disease, and type of cholecystitis between these two groups (P>0.050). The rates of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury and the operative time, intraoperative blood loss and postoperative hospital stays in the traditional LC group were 3.00% (95/3 168), 0.13% (4/3 168), 0.09% (3/3 168), 0.03% (1/3 168), (43.6±12.6) min, (18.7±3.3) mL, (3.6±2.7) d, respectively, which in the gallbladder ampulla localization group were 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), (32.2±10.5) min, (12.4±3.5) mL, (3.5±2.8) d, respectively. The differences of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding rates, and the operative time and intraoperative blood loss were statistically significant between these two groups (P<0.050). The differences of the bile leakage without bile duct injury rate and postoperative hospital stays were not statistically significant between the two groups (P>0.050).ConclusionThis study shows that gallbladder ampulla localization on an imaginary clock is useful for ductal identification so as to reduce bile duct injury and improve safety of LC in case of no conversion to open surgery.