BACKGROUND:Bone marrow stromal stem cels have a strong osteogenic potential, which are currently the most ideal seed cels for tissue engineering. However, there is no clinical report on the treatment of benign bone tumors and tumor-like lesions using bone marrow stromal stem cel transplantation.
OBJECTIVE: To investigate thein vivo perfusion method of inducing bone marrow stromal stem cels, and the clinical effects of bone marrow stromal stem cels on benign bone tumors and tumor-like lesions.
METHODS: Sixty-five cases of benign bone tumors and tumor-like lesions were divided into three groups according to the different treatments: bone graft group (n=30) and bone marrow stromal stem cels group (n=35). In the bone graft group, alogeneic bone was soaked in normal saline for 30 minutes, and then implanted into the bone defect site. In the bone marrow stromal stem cels group, 20-40 mL of bone marrow from each patient was extracted to isolate, purify and culture bone marrow stromal stem cels that were then perfused into the bone defect site.
RESULTS AND CONCLUSION:Under the inverted phase contrast microscope, the perfused cels appeared as a spherical shape, with different sizes. Initialy, there were more hematopoietic cels in the perfusion cel culture. With the extension of the culture time, adherent spindle cels and suspended red blood cels appeared, which were mostly round and triangular. Al the patients were folowed up for 1-12 months and healed wel after surgery. Compared with the bone graft group, infection rate and healing time were both lower in the bone marrow stromal cel group. To conclude, in vivo perfusion of bone marrow stromal stem cels used for construction of tissue-engineered bone promotes blood supply reconstruction and bone healing in patients with benign bone tumors and tumor-like lesions, which is of high clinical values.

Objective To investigate the changes of plasma levels of homocysteine (Hcy) and monocyte chemoattract protein 1 (MCP 1) in coronary artery disease (CAD) patients and to analyze the effect of Hcy on the expression of MCP 1. Methods The CAD diagnosis of all the studied subjects was confirmed by coronary angiography. A total of 70 patients with CAD and 50 control subjects were recruited in the study. Plasma Hcy concentration, plasma malondialdehyde (MDA) and plasma MCP 1 were determined by high performance liquid chromatography (HPLC), standard protocols and ELISA, respectively. Results Plasma levels of Hcy, MDA and MCP 1 in patients with CAD were significantly higher than those in the control subjects ( P

Objective To explore the causation,diagnosis and management of iatrogenic bile duct injury(BDI) of laparoscopic cholecystectomy(LC).Methods A total of 1 656 patients undergoing laparoscopic cholecystectomy in our department during the last 7 years were included in this study for retrospective analysis.Results There were 274 patients with gallbladder polyps,168 patients with acute calculous cholecystitis and 1214 patients with chronic calculous cholecystitis.There were 15 BDIs associated with LC(0.91%).A total of 8 BDI patients were diagnosed during cholecystectomy.The remaining 7 BDI patients were diagnosed postoperatively.The intraoperative diagnosis of BDI was made on the discovery of bile leakage or double biliary stump during cholecystectomy.Clinical features,diagnostic abdominocentesis and imaging findings formed the basis of diagnosis of BDI postoperatively.One BDI patient was treated by repairing the injuried common bile duct with a T-tube drinage.Four BDI patients were treated by end-to-end anastomosis of injuried bile duct,and one of the four patients was reoperated with Roux-en-Y hepaticojejunostomy because of bile leakage.The remaining 10 BDI patients were treated by Roux-en-Y hepaticojejunostomy,and good results were achieved in all of these patients.Conclusions There is no relationship between the etiology of gallbladder disease and BDI during laparoscopic cholecystectomy.Good results can be achieved if BDI is diagnosed early and treated properly during or after operation.Roux-en-Y hepaticojejunostomy is the primary operation method for treating BDI.

Objective To investigate the relationship between intracranial atherosclerotic plaque stability and stroke recurrence risk.Methods Forty-eight patients with acute ischemic stroke caused by intracranial atherosclerosis in Guangdong Province Hospital of TCM were analyzed retrospectively.After the Essen Stroke Risk Scale (ESRS) was used to assess the risk factors for the patients,they were divided into either an ESRS ≥3 group (n=21 in the high-risk recurrence group) or an ESRS <3 group (n=27 in the low-risk recurrence group).Both groups of patients underwent high-resolution MR imaging (HR-MRI) examinations of the intracranial guilty vessels (basilar artery or unilateral middle cerebral artery).According to the signal intensity of HR-MRI on the T1-weighted imaging,T2-weighted imaging,and T1 fat suppression sequences,the intracranial atherosclerotic stable plaques and unstable plaques were distinguished.The stabilization of intracranial atherosclerotic plaques was compared in patients of both groups.Results There were significant differences in the age and incidences of hypertension,diabetes mellitus,and unstable plaques in patients of both groups (P<0.05).Further multivariate logistic regression analysis of the four factors showed that the age,hypertension,diabetes,and intracranial atherosclerotic unstable plaques were the high-risk factors for recurrent ischemic stroke (ORs,87.114,159.423,8.942,and 11.551,respectively;95%CIs 4.218-1 799.078,3.235-7 855.957,1.054-75.857,and 1.011-132.043,respectively;all P<0.05).Conclusion In addition to the traditional risk factors such as age,hypertension,and diabetes,the intracranial atherosclerotic unstable plaque is an independent risk factor for high-risk recurrence of ischemic stroke.

Objective To investigate the roles of Xenon-CT cerebral blood flow perfusion imaging in cerebral revascularization before surgery and efficacy evaluation.Methods The clinical data of 15 patients with symptomatic cerebral artery stenosis/occlusion of anterior circulation were analyzed retrospectively.Eight patients were treated with endovascular stenting,1 was treated with internal carotid endarterectomy,and 6 were treated with superficial temporal artery-middle cerebral artery bypass grafting.The regional cerebral blood flow (rCBF) detected by Xenon CT within 2 weeks before and after procedure and the modified Ranking scale (mRS) scores at 6 months after procedure were compared.Results (1) The mean rCBF value of 12 patients with abnormal blood perfusion of target vessels before procedure was 30±10 ml/(100 g·min) and that was 32±14 ml/(100 g·min) after procedure.Compared with before procedure,the difference was statistically significant (P<0.05).The mean rCBF value of 3 patients with normal blood perfusion of target vessels before procedure was 48±6 ml/(100 g·min) and that was 50±7 ml/(100 g·min) after procedure.Compared with before procedure,the difference was not statistically significant (P>0.05).(2) The postoperative mRS score was decreased in 8 cases and stable in 7 cases.Compared with before procedure,there were significant differences in mRS scores after procedure in 15 cases (P<0.05).During the follow-up period,none of the patients had new neurological impairment.Conclusion Revascularization can improve the presence of hemodynamic disorders in patients with symptomatic anterior circulation cerebral artery stenosis or occlusion of the target blood vessels in the distal local cerebral perfusion and neurological deficit symptoms.The patients with abnormal perfusion of preoperative Xenon-CT cerebral blood flow perfusion imaging may be more beneficial than those with normal perfusion.

Objetive To investigate the effect of Fasudil on the hepatic ischemia repeffusion injury on rats of obstructive jaundice.Methods 160 mature SD rats were randomly assigned into 2 large groups,namely experimental group (Group A) and control group (Group B).While each large group was subdivided into 4 subgroups,including sham operation subgroups(Group A1 and B1),obstructive jaundice model subgroups(Group A2 and B2),ischemia reperfusion model subgroups (Group A3 and B3)and obstructive jaundice plus ischemia reperfusion model subgroups (Group A4 and B4).In Group A2 and B2,obstructive jaundice models were made on rats by double ligating and cutting the common bile ducts.In Group A3 and B3,the ischemia reperfusion injury models were built by blocking the hepatic portal vessel for 30 minutes before reperfusion.In Group A4 and B4,the ischemia reperfusion injury models were built in 1 week after building the obstructive jaundice models.For Group A,10 mg/kg fasudil was intraperitoneally injected at 30 minutes before ischemia.For Group B,equal amount of physiological saline was injected.Samples were gained on zero hour,1 hour,2 hour and 6 hour post reperfusion.The serum indexes for liver function and serum Endothelin 1 level were tested and analyzed through SPSS.Pathological changes of liver were viewed correspondingly.Results Compared to control groups (Group Bs),experimental groups (Groups As) have better liver function,lower Endothelin 1 level (P ＜ 0.05),as well as less severe microscopic histological damage.Conclusion Fasudil can effectively protect rats of obstructive jaundice from hepatic ischemia reperfusion injury.

Objective To study the diagnosis and management of Pendred's syndrome. Methods The clinical data of 5 patients with Pendred's syndrome were analysed retrospectively. Results All patients had congenital sensorineural hearing loss and gradeⅡ-Ⅲ goiter,and 4 patients compained with thyroid nodure. Of the 5 cases, the results of perchlorate discharge test were 10%-52%. One case underwent subtotal thyroidectomy owing to misdiagnosis before the operation. All the 5 cases received thyroxine and were followed up for 4-7 years.All the patients goiter shrank and the compression symptoms relieved. Conclusions The perchlorate discharge test is the important diagnostic method and may detect the healthy carriers in the patients' relatives.Conservative treatment should be used in most patients. Patients undergoing operation owing to serious compression symptoms should be managed with thyroxine after surgery.

Objective To investigate the effect of doxapram on inhibition of medullary respiratory center excitability by sevoflurane in rats.Methods Neonatal Sprague-Dawley rats of both sexes,aged 1-4 days,were used in this study.Isolated medulla oblongata-spinal cord specimens were made according to the method described by Suzue and perfused with the artificial cerebrospinal fluid saturated with 95％O2-5％CO2.The specimens were randomly divided into 3 groups ( n =9 each):control group (group C),sevoflurane group (group S) and sevoflurane + doxapram group (group S + D).Respiratory rhythmical discharge activity of the hypoglossal nerve rootlets was recorded using suction electrode.After 10 min of equilibration,the specimens were perfused with the artificial cerebrospinal fluid,5％ sevoflurane and the mixture of 5％ sevoflurane and 5 μmol/L doxapram for 10 min in groups C,S,and S + D respectively.The respiratory cycle,inspiratory time and integral amplitude of inspiratory discharge were recorded.Results Compared with group C,the respiratory cycle was significantly prolonged,the inspiratory time was significantly shortened,and the integral amplitude of inspiratory discharge was significantly decreased in group S (P ＜ 0.05),and no significant change was found in the parameters mentioned above in group S + D (P ＞ 0.05).Compared with group S,the respiratory cycle was significantly shortened,the inspiratory time was significantly prolonged,the integral amplitude of inspiratory discharge was significantly increased in group S + D ( P ＜ 0.05).Conclusion Doxapram antagonizes sevoflurane-induced inhibition of excitability of medullary respiratory center in rats.

Objective To investigate the effect of mixed-skin grafting with autologous microskin and allogenetic acellular dermal matrix microskin on wound healing in rats,and to make a further study on the related mechanism.Methods Wistar rats were served as a allogenetic acellular dermal matrix donor rats,and SD rats as acceptors with mould of full thickness skin defects on their back.The ninety SD rats were divided into 5 groups with 18 rats in each group.Group 1 was transplanted with autologous microskin,and group 2 with allogenetic acellular dermal matrix microskin.Groups 3,4 and 5 were grafted with mixed-skin ratio between autologous microskin and allogenetic acellular dermal matrix microskin 1 ∶ 1,1 ∶ 0.5 and 1 ∶ 0.25,repectively.The rate of wound healing was measured,wound samples collected,hematoxylin and eosin stain carried out,fibronectin (FN) and laminin (LN)detected,and intergroup comparison made,respectively,2,3 and 4 weeks after skin grafting.Results The wound healing rates and FN and LN expression of mixed-skin grafting groups were higher than those of the group with autologous microskin grafting.The group of 1 ∶ 0.25 obviously increased (P＜0.05 or P＜0.01).Conclusions The wound healing rate with mixed-skin grafting is higher than that with autologous microskin grafting.The best effect is achieved when the skin ratio between autologous microskin and allogenetic acellular dermal matrix microskin is 1 ∶ 0.25.It is possibly due to the increase of FN and LN on wound skin surface.

Objective To evaluate the role of laparoscopic staging for the resectability of gallbladder cancer. Methods From Jan 2007 to Mar 2010,60 gallbladder cancer patients without of metastatic disease or main hepatic portal vessel invasion as assessed by preoperative imaging underwent staging laparoscopy for tumor resectability evaluation. Peritoneal and liver surface metastases were looked for and assessment of local spread was done if possible. Assessment was based on visual impression and biopsies were obtained routinely. T test and x2 test were used. Results At laparoscopy, 27 (45%) patients were found with disseminated disease on peritoneal cavity or the surface of liver, hence, senseless open surgery was avoided. The other 33 patients were converted to open laparotomy, among those 1 patient was found with disseminated metastasis in the liver and 12 patients with the invasion of main hepatic portal vessel,pancreatic head, duodenum did not undergo any further surgery. Finally 7 patients received surgical bypass procedure and 13 patients underwent radical resection. During the same period, 192 clinically diagnosed gallbladder cancer patients undergoing open laparotomy without laparoscopic pre-assessment served as control. Among those in control group 79 patients received radical or palliative resection. The resectability rate was significantly different between the two groups ( P ＜ 0. 05). Conclusion Staging laparoscopy in patients with gallbladder cancer is helpful in detecting liver and peritoneal metastases overlooked by preoperative imaging, avoiding unnecessary open explorations.