Objective To explore the effectiveness of one-stage debridement and two-stage Ilizarov bone transport technology in repairing post-traumatic lateral malleolus defect. Methods Between June 2013 and December 2016, 7 patients with bone defect of lateral malleolus were treated. There were 5 males and 2 females with an average age of 45.9 years (range, 35-60 years). There were 6 cases of traffic accident injury and 1 case of strangulation injury. All patients had extensive soft tissue injury and lateral malleolus bone exposure. There were 4 cases of Gustilo type ⅢB and 3 case of Gustilo type ⅢC. The time from injury to admission was 3-10 hours (mean, 6.3 hours). Through one-stage thorough debridement, exploration and repair of vessels and nerves, external fixation of scaffolds and coverage of wounds, free fibulas were removed in 3 cases at one-stage and fibulas were resected in 4 cases after expansion. The bone defects ranged from 4.5 to 15.0 cm in length (mean, 8.2 cm). The Ilizarov circular external fixators were used to transport with fibula osteotomy for repairing bone defect of lateral malleolus when the wound healing. Results During fibular osteotomy, the stents were adjusted 2-4 times (mean, 2.8 times) and the external fixators were removed after 10-16 months (mean, 12.8 months). The nail tract infection occurred in 2 cases during transporting and was controlled after symptomatic treatment. All patients were followed up 24-48 months (mean, 32.9 months). The shape of lateral malleolus was close to normal without obvious varus or valgus deformity. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score was 86-92 (mean, 90.3), and 5 cases were excellent and 2 cases were good. X-ray film showed that there was no obvious widening of the gap between the ankle points and no sign of absorption of the lateral malleolus. Conclusion The one-stage debridement combined with two-stage Ilizarov bone transport technology can maintain the stability of ankle joint structure and obtain better effectiveness in repairing post-traumatic lateral malleolus defect.
Objective To study the intervention effect of ginkgo biloba extract（GBE） on airway and vascular remodeling in rat model of chronic obstructive pulmonary disease(COPD).Methods Forty wistar rats were randomly divided into group A，B，C and D.The rat model of COPD were established by intratracheally injection of lipopolysaccharide and exposure to cigarette smoke in groups B，C and D.Groups C and D were given intraperitoneally injection with 40 mg/kg GBE respectively from day1 to day14 and day29 to day42.Forty-three days later，the rats were sacrificed for lung pathological examination.Results Group B，C and D all showed pathological changes characteristic of COPD to different extent.The average area and standard number of alveoli showed significant difference between each groups（all Plt;0.01）.The structure of bronchiole walls in group C and D show mild changes.The ratio of bronchial smooth muscle thickness to bronchial wall thickness and bronchial wall area to bronchial area of group C and D showed significant difference when compared with group A and B（all Plt;0.01）.The vascular smooth muscle cell of group C and D had mild hyperplasia and the vascular wall had slightly thickened.The ratio of vascular smooth muscle thickness to vascular wall thickness and vascular wall area to vascular area in group C and D showed significant difference when compared with group A and B（all Plt;0.01）.Conclusion GBE has inhibitory effects on airway and vascular remodeling in rats model of COPD.
Gastrointestinal (GI) complications after heart surgery included slight bleeding through fulminant hepatic failure. Although overall rate of these complications is low, it can lead to high mortality after heart surgery. Diagnosis of GI complication is difficult. Risk factors for GI complications are clear. Mechanisms of complications are various. Therefore, we collected the recent prospective and retrospective literatures to sumarize mortality of GI complications, pathogenesis, risk factors, recent progress of prevention and management, to guide clinical practice.
ObjectiveTo discuss the possibility of constructing injectable tissue engineered adipose tissue, and to provide a new approach for repairing soft tissue defects.MethodsHuman adipose-derived stem cells (hADSCs) were extracted from the lipid part of human liposuction aspirate by enzymatic digestion and identified by morphological observation, flow cytometry, and adipogenic induction. The hADSCs underwent transfection by lentivirus vector expressing hepatocyte growth factor and green fluorescent protein (HGF-GFP-LVs) of different multiplicity of infection (MOI, 10, 30, 50, and 100), the transfection efficiency was calculated to determine the optimum MOI. The hADSCs transfected by HGF-GFP-LVs of optimal MOI and being adipogenic inducted were combined with injectable fibrin glue scaffold, and were injected subcutaneously into the right side of the low back of 10 T-cell deficiency BALB/c female nude mice (transfected group); non-HGF-GFP-LVs transfected hADSCs (being adipogenic inducted) combined with injectable fibrin glue scaffold were injected subcutaneously into the left side of the low back (untransfected group); and injectable fibrin glue scaffold were injected subcutaneously into the middle part of the neck (blank control group); 0.4 mL at each point. Twelve weeks later the mice were killed and the implants were taken out. Gross observation, wet weight measurement, HE staining, GFP fluorescence labeling, and immunofluorescence staining were performed to assess the in vivo adipogenic ability of the seed cells and the neovascularization of the grafts.ResultsThe cultured cells were identified as hADSCs. Poor transfection efficiency was observed in MOI of 10 and 30, the transfection efficiency of MOI of 50 and 100 was more than 80%, so the optimum MOI was 50. Adipose tissue-like new-born tissues were found in the injection sites of the transfected and untransfected groups after 12 weeks of injection, and no new-born tissues was found in the blank control group. The wet-weight of new-born tissue in the transfected group [(32.30±4.06) mg] was significantly heavier than that of the untransfected group [(25.27±3.94) mg] (t=3.929, P=0.001). The mature adipose cells in the transfected group [(126.93±5.36) cells/field] were significantly more than that in the untransfected group [(71.36±4.52) cells/field] (t=30.700, P=0.000). Under fluorescence microscopy, some of the single cell adipocytes showed a network of green fluorescence, indicating the presence of GFP labeled exogenous hADSCs in the tissue. The vascular density of new-born tissue of the transfected group [(16.37±2.76)/field] was significantly higher than that of the untransfected group [(9.13±1.68)/field] (t=8.678, P=0.000).ConclusionThe hADSCs extracted from the lipid part after liposuction can be used as seed cells. After HGF-GFP-LVs transfection and adipose induction, the hADSCs combined with injectable fibrin glue scaffold can construct mature adipose tissue in vivo, which may stimulate angiogenesis, and improve retention rate of new-born tissue.
Objective To evaluate clinical efficacy of mFOLFOX6 combined with aspirin in treatment of advanced gastric cancer following perioperative period of laparoscopic distal subtotal gastrectomy. Methods One hundred and seven patients with advanced gastric cancer were assigned to observation group (57 cases) and control group (50 cases). The patients in the observation group received the mFOLFOX6 chemotherapy and regular intake of aspirin (100 mg/d) and the control group received the mFOLFOX6 chemotherapy alone. The recurrence or metastasis rate, rate of disease progress, toxicity, median survival time, and 3-year survival rate were compared between the observation group and the control group. Results ① There were no significant differences in the gender, age, pathological type, and so on between the observation group and the control group (P>0.05). ② The rates of toxicity such as the white blood cell reduction, granulocyte reduction, thrombocytopenia had no significant differences in these two groups (P>0.05). ③ The follow-up time was 4–45 months with an average 3.5 years, the rate of disease progress was lower (P=0.032), the median survival time was longer (P=0.043), the cumulative 3-year overall survival (P=0.015) and the cumulative 3-year disease-free survival (P=0.037) were better in the observation group as compared with the control group. Conclusion Preliminary results in this study show that mFOLFOX6 regimen combined with low-dose aspirin could significantly improve efficacy of advanced gastric cancer following perioperative period of laparoscopic distal subtotal gastrectomy, reduce rate of disease progress, and improve survival rate without increasing side effects.
ObjectiveTo investigate the effect of adipose-derived stem cell derived exosomes (ADSC-Exos) on angiogenesis after skin flap transplantation in rats.MethodsADSCs were isolated and cultured by enzymatic digestion from voluntary donated adipose tissue of patients undergoing liposuction. The 3rd generation cells were observed under microscopy and identified by flow cytometry and oil red O staining at 14 days after induction of adipogenesis. After cells were identified as ADSCs, ADSC-Exos was extracted by density gradient centrifugation. And the morphology was observed by transmission electron microscopy, the surface marker proteins (CD63, TSG101) were detected by Western blot, and particle size distribution was measured by nanoparticle size tracking analyzer. Twenty male Sprague Dawley rats, weighing 250-300 g, were randomly divided into ADSC-Exos group and PBS group with 10 rats in each group. ADSC-Exos (ADSC-Exos group) and PBS (PBS group) were injected into the proximal, middle, and distal regions of the dorsal free flaps with an area of 9 cm×3 cm along the long axis in the two groups. The survival rate of the flap was measured on the 7th day, and then the flap tissue was harvested. The tissue morphology was observed by HE staining, and mean blood vessel density (MVD) was measured by CD31 immunohistochemical staining.ResultsADSCs were identified by microscopy, flow cytometry, and adipogenic induction culture. ADSC-Exos was a round or elliptical membrane vesicle with clear edge and uniform size. It has high expression of CD63 and TSG101, and its size distribution was 30-200 nm, which was in accordance with the size range of Exos. The distal necrosis of the flaps in the ADSC-Exos group was milder than that in the PBS group. On the 7th day, the survival rate of the flaps in the ADSC-Exos group was 64.2%±11.5%, which was significantly higher than that in the PBS group (31.0%±6.6%; t=7.945, P=0.000); the skin appendages in the middle region of the flap in the ADSC-Exos group were more complete, the edema in the proximal region was lighter and the vasodilation was more extensive. MVD of the ADSC-Exos group was (103.3±27.0) /field, which was significantly higher than that of the PBS group [(45.3±16.2)/field; t=3.190, P=0.011].ConclusionADSC-Exos can improve the blood supply of skin flaps by promoting the formation of neovascularization after skin flap transplantation, thereby improve the survival rate of skin flaps in rats.
ObjectiveTo investigate the effects of adipose-derived stem cell released exosomes (ADSC-Exos) on wound healing in diabetic mice.MethodsThe ADSCs were isolated from the adipose tissue donated by the patients and cultured by enzymatic digestion. The supernatant of the 3rd generation ADSCs was used to extract Exos (ADSC-Exos). The morphology of ADSC-Exos was observed by transmission electron microscopy. The membrane-labeled proteins (Alix and CD63) were detected by Western blot, and the particle size distribution was detected by nanoparticle tracking analyzer. The fibroblasts were isolated from the skin tissue donated by the patients and cultured by enzymatic digestion. The 5th generation fibroblasts were cultured with PKH26-labeled ADSC-Exos, and observed by confocal fluorescence microscopy. The effects of ADSC-Exos on proliferation and migration of fibroblasts were observed with cell counting kit 8 (CCK-8) and scratch method. Twenty-four 8-week-old Balb/c male mice were used to prepare a diabetic model. A full-thickness skin defect of 8 mm in diameter was prepared on the back. And 0.2 mL of ADSC-Exos and PBS were injected into the dermis of the experimental group (n=12) and the control group (n=12), respectively. On the 1st, 4th, 7th, 11th, 16th, and 21st days, the wound healing was observed and the wound healing rate was calculated. On the 7th, 14th, and 21st days, the histology (HE and Masson) and CD31 immunohistochemical staining were performed to observe the wound structure, collagen fibers, and neovascularization.ResultsADSC-Exos were the membranous vesicles with clear edges and uniform size; the particle size was 40-200 nm with an average of 102.1 nm; the membrane-labeled proteins (Alix and CD63) were positive. The composite culture observation showed that ADSC-Exos could enter the fibroblasts and promote the proliferation and migration of fibroblasts. Animal experiments showed that the wound healing of the experimental group was significantly faster than that of the control group, and the wound healing rate was significantly different at each time point (P<0.05). Compared with the control group, the wound healing of the experimental group was better. There were more microvessels in the early healing stage, and more deposited collagen fibers in the late healing stage. There were significant differences in the length of wound on the 7th, 14th, and 21st days, the number of microvessels on the 7th and 14th days, and the rate of deposited collagen fibers on the 14th and 21st days between the two groups (P<0.05).ConclusionADSC-Exos can promote the wound healing in diabetic mice by promoting angiogenesis and proliferation and migration of fibroblasts and collagen synthesis.