To explore the method of inducing axial vascularization in a processed bovine cancellous bone scaffold by using an arteriovenous loop, and to evaluate its effect of vascularization. Methods Custom-made processed bovine cancellous bone discs were processed into cyl inder with circular grooves. Thirty male SD rats weighing 300-350 g (3-4 months old) were randomly divided into 2 groups (n=15 per group): experimental group in which the femoral veins in the groin of rats were separated and transplanted to the contralateral femoral artery and vein stump, the processed bovine cancellousbone scaffold was inserted into the arteriovenous loop, which was placed into the annular groove. Control group, in which the blood vessels in the groin of rats were cut, no anastomosis was conducted, and the processed bovine cancellous bone scaffold was planted. At 2, 4 and 8 weeks after operation, gross observation, ink infusion histology observation and microvessel bulk density detection were conducted. Results At each postoperative time point, the samples in the experimental group were fresh red, the circulation of blood vessels were smooth bidirectionally, while the samples in the control group were dark red soft, and flexible. Ink infusion histology observation showed the processed bovine cancellous bone scaffold in the experimental group had obvious vascularization, the blood vessels tended to be mature and integrated into network, and neovascular sprouts originated from arteriovenous loop were evident, especially at 8 weeks after operation; while there was no vascularization in the control group. At 2, 4 and 8 weeks after operation, the bulk density of the microvessels in the experimental group was (3.59 ± 1.84), (16.61 ± 10.23) and (39.04 ± 13.46) μm3/μm3, respectively, and it was (2.43 ± 0.97), (6.79 ± 2.92) and (25.31 ± 10.98) μm3/μm3, respectively, in the control group. Significant differences was noted between two groups at 4 and 8 weeks after operation (P lt; 0.05), and no significant difference was evident at 2 weeks after operation (P gt; 0.05). Conclusion Inducing vascularization in a rocessed bovine cancellous bone using an arteriovenous loop is a new strategy of prevascularization and may provide valuable clues for the preparation of functional artificial bone
【Abstract】 Objective To explore the preventing effects of TGF-β1 antibody (TGF-β1Ab) compounded with fibringlue (FG) on postoperative adhesions of flexor tendon. Methods Seventy-two Leghorn chickens were randomly divided into 4 groups (groups A, B, C and D), 18 chickens for each group, and the long flexor tendons of the 3rd and 4th toes in zone Ⅱ of all chickens were transversed and sutured with the 4-strand cruciate repair technique to make defect models. In group A, 0.2 mL TGF-β1 Ab was appl ied at repair site. In group B, 0.2 mL FG was appl ied at repair site. In group C, 0.2 mL TGF-β1Ab and FG was appl ied at repair site. In group D, 0.2 mL normal sodium was appl ied at repair site. At 1, 3 and 8 weeks after operation, the tendons of 6 chickens in each group were harvested for morphological and histological evaluation. Six specimens of each group were obtained for biomechanical test at 3 and 8 weeks. Results The gross observation showed that the differences ingrading of tendon adhesion were not significant among 4 groups at 1 week after operation (P gt; 0.05), but the differences were significant between groups A, B, D and group C at 3 and 8 weeks after operation (P lt; 0.05). Histological observation showed that collagen fibers arranged irregularly in groups A, B and D, but arranged regularly in group C at 3 and 8 weeks after operation. At 3 weeks after operation the gl iding excursion ratio of the tendon in groups A, B, C and D were 0.45 ± 0.05, 0.40 ± 0.10, 0.79 ± 0.09 and 0.25 ± 0.07 respectively ; the simulated active flexion ratio were 0.61 ± 0.02, 0.67 ± 0.03, 0.91 ± 0.03 and 0.53 ± 0.04 respectively; the work of flexion were(18.00 ± 0.77), (17.80 ± 1.13), (27.60 ± 1.73) and (15.60 ± 1.27)?/N respectively. There were significant differences between group C and other three groups (P lt; 0.05). The tendon anastomosis breaking strengthwere (14.2 ± 1.9), (15.2 ± 2.2), (16.0 ± 2.2) and (14.7 ± 2.7) N, showing no significant differences among 4 groups (P gt; 0.05).At 8 weeks after operation, the gl iding excursion ratio of the tendon in groups A, B, C and D were 0.45 ± 0.07, 0.43 ± 0.08, 0.80 ± 0.09 and 0.29 ± 0.05 respectively; the simulated active flexion ratio were 0.61 ± 0.02, 0.63 ± 0.03, 0.92 ± 0.03 and 0.53 ± 0.03 respectively, the work of flexion were (18.30 ± 0.84), (18.60 ± 0.80), (27.90 ± 1.24) and (15.30 ± 0.75) ?/N respectively. There were significant differences between group C and other three groups (P lt; 0.05). The tendon anastomosis breaking strength were(51.9 ± 3.0), (51.4 ± 1.4), (53.3 ± 1.3) and (52.3 ± 2.2) N, showing no significant differences among 4 groups (P gt; 0.05). Conclusion TGF- β1Ab compounded with FG could significantly prohibit the formation of fibrous adhesions without interfering with the heal ing process.
目的 分析总结严重挤压伤导致四肢创伤性截肢各种生化指标的动态变化及对临床中治疗的指导意义。 方法 2000年3月－2011年3月对23例由于严重挤压导致创伤性截肢的患者各项生化指标检测结果进行实时监控，根据监控结果及时调整治疗方案。 结果 伤后患者电解质，血、尿肌红蛋白，尿比重，尿pH值，血肌酸激酶、肌酸激酶同工酶、羟丁酸脱氢酶、白蛋白、血红蛋白、血小板等指标均有明显改变，据此作为救治的依据进行精细化治疗。术后随访7个月～10年，23例患者均得到康复，肾功能良好。 结论 对于严重挤压伤导致四肢创伤性截肢的各种生化指标实时监控并同步制定精细化治疗，才能确保患者成功救治并得以康复。
ObjectiveTo investigate the value of contrastenhanced ultrasonography in differential diagnosis between benign and malignant breast mass. MethodsTotally 65 patients with 70 breast masses were evaluated by general ultrasonography and contrastenhanced ultrasonography with contrast agent SonoVue. The related indexes, such as the degree and mode of contrast enhancement, the lesion boundaries and dissipation mode, were used to describe the difference between benign and malignant mass, which was also compared with pathological results. ResultsHistopathological examination revealed that benign mass was in 37 cases and malignant in 28 cases. The sensitivity, accuracy, positive predictive value, and negative predictive value of contrastenhanced ultrasonography with contrast agent SonoVue were significantly higher than that of general ultrasonography (Plt;0.05), while no significant difference in diagnostic specificity and misdiagnosis rate was observed between them (Pgt;0.05). All tumors showed contrast enhancement in various degrees. Of 28 patients with enhanced mass, hyperenhancement in 22 cases and nodular inhomogeneous enhancement in 21 cases were observed and the boundaries of malignant tumor were irregular with ill-defined and radial enhancement. Most of benign tumors were represented by weak, homogeneous enhancement, and the shape was regular with smooth and tidy boundary and intact capsule except seven cases with unclear boundary. These imaging characteristics of benign and malignant tumors were obviously different (P=0.000). In the resolution phase, both benign and malignant mass showed heterogeneous or homogeneous dissipation, which was not significantly different (P=0.791). ConclusionCompared with general ultrasonography, contrast enhanced ultrasonography may be more helpful for the differential diagnosis of benign and malignant breast tumors.
Objective To investigate effect of different resuscitation liquids and different resuscitation methods on contents of interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) in early resuscitation process of rats with traumatic hemorrhagic shock. Methods Sixty-four healthy SD rats (450–550 g) were chosen and divided into 4 groups randomly and averagely: crystal liquid limited resuscitation group, colloidal liquid limited resuscitation group, 7.5% NaCl limited resuscitation group, and colloidal liquid non-limited resuscitation group. There were 16 rats in each group. All the experimental rats were weighed before intraperitoneal injection of pentobarbital sodium anesthesia. Animal model was established via Chaudry’s method. The rats were killed and the abdominal aorta bloods were drew on hour 2, 6, 12, and 24 after recovering from anesthesia. The contents of IL-8 and TNF-α in plasmas were detected by enzyme linked immunosorbent assay. Results The contents of IL-8 and TNF-α among three kinds of limited resuscitation groups on hour 6 after resuscitation were significantly higher than those on hour 2 after resuscitation (P<0.05) and reached the peaks, then began to decrease. On hour 12 after resuscitation, the contents of IL-8 and TNF-α were decreased continuously among three kinds of limited resuscitation groups (P<0.05). The contents of IL-8 and TNF-α in the colloidal liquid non-limited resuscitation group at each point time were significantly higher than those among three kinds of limited resuscitation groups (P<0.05), which in the crystal liquid resuscitation group were significantly lower than those in the other limited liquid resuscitation groups (P<0.05). Conclusions In process of liquid resuscitation of rats with traumatic hemorrhagic shock, limited resuscitation method is better than that of non-limited resuscitation method. Among three kinds of limited resuscitation methods, crystal resuscitation liquid is more effective than the other two resuscitation liquids in prohibiting releases of IL-8 and TNF-α in rats with traumatic hemorrhagic shock.
Objective To compare the effect of monopolar and bipolar radiofrequency ablation in patients with atrial fibrillation and concomitant rheumatic heart disease. Methods The clinical data of 261 patients who underwent valve replacement and radiofrequency Maze Ⅲ procedure in Shanghai First People's Hospital from 2010 to 2015 were retrospectively analyzed. According to the radiofrequency ablation system, patients were assigned to a monopolar radiofrequency ablation group (n=209, 129 males, 80 females, aged 59.6±9.7 years) and a bipolar radiofrequency ablation group (n=52, 36 males, 16 females, aged 58.6±11.2 years). After procedures, clinical factors such as patients' basic information, perioperative complication and mortality, the elimination rate of atrial fibrillation were measured. Results There was no statistic difference in perioperative morbidity and mortality between two groups. The ablation time of the monopolar radiofrequency ablation group was longer than that of the bipolar group (29.7±3.3 minvs. 22.3±7.8 min,P=0.035). Postoperative diameter of left atrium was reduced in both groups. Compared with the monopolar radiofrequency ablation group, bipolar group had a better elimination rate of atrial fibrillation at three months and one year follow-up (82.0%vs. 66.3%,P=0.037; 80.0%vs. 59.6%,P=0.008). Conclusion Valve replacement combined with radiofrequency Maze Ⅲ procedure is safe and efficient. Compared with monopolar radiofrequency ablation, bipolar radiofrequency ablation has advantage on elimination rate of atrial fibrillation, ablation time and cardiopulmonary bypass time.
Objective To evaluate the safety and efficacy of the femoral arterial preclosure by purse-string suture for thoracic endovascular aortic repair (TEVAR). Methods From January 2013 to September 2016, TEVAR was performed on 40 patients with Standford type B aortic dissection. There were 34 males and 6 females aged 57.9±10.4 years. According to the surgical procedure, they were divided into a purse-string group (20 patients, 16 males, 4 females, aged 58.1±10.3 years), in which the patients received femoral arterial preclosure by purse-string suture and a convention group (20 patients, 18 males, 2 females, aged 57.7±10.8 years), in which the patients underwent conventional femoral cutdown. The outcomes and complications of two groups were evaluated. Results There was no in-hospital death and no paraplegia event. There was significantly shorter operation time (70.4±24.0 min vs. 100.8±35.6 min, P=0.003) and less blood loss (39.5±29.8 ml vs. 83.5±86.5 ml, P=0.038) in the purse-string group than those in the convention group. Femoral artery stenosis was observed in 3 patients (15.0%) in the convention group and none in the purse-string group during the follow-up of 1-36 (17.2±11.5) months with no statistical difference (P=0.231). Conclusion Using the femoral arterial preclosure by purse-string suture for TEVAR can save operation time, reduce intraoperative bleeding and decrease the approach-associated complications.
Objective To compare the short-term efficacy of Ivor-Lewis via hand-sewn purse-string approach and purse-string forceps approach in minimally invasive esophagectomy for middle and lower esophageal cancer, and to discuss the safety and feasibility of hand-sewn purse-string anastomosis technique for minimally invasive Ivor-Lewis esophagectomy (MIILE). Methods The clinical data of 151 patients undergoing thoracoscopic and laparoscopic esophageal cancer surgery from January 2014 to January 2017 in our hospital were retrospectively analyzed. According to the different methods of purse string making, the patients were divided into a purse-string forceps group including 49 males and 16 females with a mean age of 67.98±7.07 years ranging from 51 to 80 years treated with forceps to make purse-string and a handcraft group including 61 males and 25 females with a mean age of 67.76±8.18 years ranging from 52 to 83 years using hand-sewn way. The perioperative data of two two groups were compared. Results The purse-string making time and postoperative total volume of chest drainage were less in the handcraft group than those in the purse-string forceps group (P<0.05). There was no significant difference between the two groups in hemorrhage during operation, the operation duration or postoperative hospital stay (P>0.05). There was also no statistical difference between the two groups in the rate of anastomotic or gastric tube fistula, anastomotic stenosis, pulmonary infection or incision infection (P>0.05). Conclusion In minimally invasive esophagectomy for middle-lower section, MIILE by hand-sewn purse-string is as safe as purse-string forceps, with no more complications, needing no professional equipments, and easy to learn, master and promote.
Objective To analyze the influencing factors and outcomes of atrial septal defect (ASD) and ventricular septal defect (VSD) occlusion guided by echocardiography. Methods We retrospectively analyzed the clinical data of 188 patients receiving transthoracic and percutaneous transcatheter closure of ASD and VSD from July 2009 to July 2017 in our department, including 74 males and 114 females, aged 13.48±13.53 years ranging from 1 to 65 years. Results Fifty-three ASD patients accepted transthoracic closure surgery, of whom 4 patients were difficult to close and 6 patients failed to close; 24 patients underwent percutaneous transcatheter ASD occlusion surgery, of whom 3 were difficult to close and 1 failed in occlusion; 108 VSD patients implemented transthoracic closure surgery, of whom 10 patients were difficult to close and 5 patients failed in closure; 9 VSD patients underwent percutaneous transcatheter closure, of whom 5 failed and then was converted to transthoracic closure. Our study showed that too large or too small aperture was the independent risk factor. Two kinds of closure surgery had their own advantages and disadvantages. The special type of VSD was the influencing factor of transthoracic closure. Conclusion When the ASD diameter≥25 mm, transthoracic closure is the best choice to avoid the use of large occluder. When the ASD diameter<25 mm, percutaneous closure surgery is the best choice. When the ASD diameter≥35 mm, it is best to give up the closure operation. Technical improvements can significantly raise the closure success rate of the subarterial VSD. For the entry diameter>10 mm and membranous aneurysm with multi-break, occlusion surgery should be avoided in VSD.
ObjectiveTo evaluate the efficacy of thoracoscopic complex segmentectomy for stageⅠnon-small cell lung cancer (NSCLC).MethodsWe retrospectively reviewed the perioperative clinical data of patients with stageⅠNSCLC who underwent thoracoscopic complex segmentectomy (n=58) or simple segmentectomy (n=33) between January 2017 and March 2020 in our hospital. There were 36 males and 55 females with a median age of 57 years (range: 50-66 years). The clinical data of the two groups were compared.ResultsThere were no significant differences between the two groups in characteristics including age, sex, weight, comorbidities, preoperative pulmonary function, dominant composition of tumor, tumor histology and size, overall complications, estimated blood loss, prolonged air leakage, length of hospital stay, length of drainage, surgical margin distance or number of dissected lymph nodes. Only the operation time and number of staples for making intersegmental plane were significantly different between the two groups (P<0.05). There was no perioperative death in both groups.ConclusionThoracoscopic complex segmentectomy is a feasible and safe technique for stageⅠNSCLC.