BACKGROUND:Wtih hyaluronic acid and col agen by cellautocrine as endogenous scaffolds, cellsheet technology can eliminate the disadvantages of exogenous scaffolds. Human adipose-derived stem cells combined with cellsheet technology used in the study of ful-thickness skin defects have become the current hot spot.
OBJECTIVE:To summarize the research progress in adipose-derived stem cellsheet.
METHODS:Articles related to adipose-derived stem cells, cellsheet technology and tissue-engineered skin were retrieved in VIP information and PubMed database from January 1993 to April 2014. The key words were“adipose-derived stem cell, wound healing, tissue-engineered skin, cellsheet”in English and Chinese, respectively. Total y 27 relevant articles were analyzed.
RESULTS AND CONCLUSION:Adipose-derived stem cells derived from discarded human adipose tissue are immmunocompatible and multi-potent, rendering them ideal for regenerative medicine applications. cellsheet technology seemingly provides several advantages over traditional tissue reconstruction with biodegradeable scaffolds. Adipose-derived stem cells combined with cellsheet technology can enhance tissue vascularization, promote wound healing, the secreted extracellular matrix provides the microenvironment for the celldifferentiation and growth, so it is expected to build a real three-dimensional tissue-engineered skin.

Objective To assess short-time effect of selective head cooling on neonatal hypoxic-ischemic encephalopathy induced by perinatal asphyxia. Methods Twenty-three infants of moderate/severe hypoxic ischemic encephalopathy (HIE) were divided into treatment group ( 14 cases) and control group (9 cases). The head hypothermia in the treatment group [rectal temperature ( 34. 0 ～ 35.0) ℃, nasopharyngeal temperature (34. 0 ± 0. 5 ) ℃]was induced by circulating water cooling cap for up to 72 h. Control group were treated routinely. All newborns were monitored and analyzed for blood pressure, heart rate, neurological function. Neonatal behavioral neurological assessment (NBNA) was conducted for assessment of neurobehavioral development on day 28 after birth. Results Treatment group showed slower hear rate as nasopharyngeal temperature decreased and there was significant difference as compared with the control group ( P ＜ 0.05 ). Apnea and arrhythmia were not found in either group. As compared with the control group, treatment group showed better results in seizure incidence, recovery of neonatal reflex( embracing reflection, sucking reflex and grasp reflex), and improvement of limb muscle tension. The NBNA score on day 28 was much higher in hypothermia group(35.00 ± 1.41 ) than that of control group(30. 67 ± 1.58) and there was significant difference (P ＜ 0.05). Conclusion Selective head cooling is safe for newborns with moderate/severe HIE if the nasopharyngeal temperature maintains at (34 :± 0. 5 ) ℃, rectal temperature at 34 ～ 35 ℃. Selective head cooling can effectively improve the short-term nervous symptoms and the neurobehavioral score,but the long-term efficacy remains to be further studied.

Objective To explore the procedures of breast repair and reconstruction after mastectomy with three methods for optimal appearances of the breast.Methods Three methods were adopted in this study:(1)Two-stage breast reconstruction operation with ampliate latissimus dorsi myocutaneous flap after mastectomy;(2)One stage breast reconstruction operation with transverse rectus adbominis myocutaneous(TRAM)flap after mastectomy;and(3)Two-stage breast reconstruction and nipple repair operation with tissue expander/implant after mastectomy preserving pectoralis major museulus or implants along under pectoralis major musculus.Results All of the flaps survived well and were well-shaped in total 10 patients(10 breasts)with a flap breast reconstruetion,in which the superior ratios were 83.33%.The appearance and volume were not satisfactory in 1 patiant treated with the method of tissue expander/implant,because the volume of tissue inflation was smaller than another one and 100 ml implant was applied.The partial flap necrosis occurred in 1 case with the method of TRAM flap.Conclusions With the development of plastic surgery technique,the appearances and shapes of reconstructed breast achieve the satisfactory effects.After the ampliate latissimus dorsi myocutaneous flap is applied,the appearance and volume of reconstructed breast are similar to the healthy one.The two-stage nipple repair operation is applied with breast reconstruction operation by the tissue expander/implant after mastectomy preserving pectoralis major musculus.According to the different methods of mastectomy to choose suitable procedures of breast reconstruction,the satisfactory appearances and psychotherapy will be achieved.

Objective To study the construction of tissue engineering adipose in vitro with silk fibroin scaffold and human umbilical cord mesenchymal stem cells (hUCMSCs) transfected by recombinant human insulin gene lentivirus.Methods hUCMSCs infected with recombinant lentiviral pLenti6.3-insulin-IRES-EGFP (Group A) by the best MOI=10 were seeded in silk fibroin scaffold; hUCMSCs transfected by EGFP gene (Group B)was regarded as negative control; and then the cell-scaf-fold complexes were cultured in adipogenic differentiation medium. MTT test was used to detect whether recombinant lentiviral affected the growth and proliferation of hUCMSCs and the growth activity of hUCMSCs seeded in silk fibroin.Results After 5-7 days for adipogenic culture,the numbers of fat-like cells in group A were significantly more than those in group B (P =0.007,P＜0.01).RTPCR results showed that the expression of PPARγ-2 in group A was much stronger than that in group B.MTT test showed that there was no significant difference in optical density (A)at each time between transfected group and nontransfected group (P=0.056,P＞0.05).And there was also no significant difference in optical density (A)between cell group and cell-scaffold group (P =0.066,P＞0.05).Conclusions Insulin gene could obviously promote hUCMSCs getting into adipose,and carrying recombinant human insulin gene lentiviral vector transfection of hUCMSCs and silk fibroin scaffolds could effectively construct tissue engineering adipose in vitro.

Objective To study the treatment method of giant neurofibromatosis on body surface.Methods Replantation of the tumor skin,full-thickenss skin grafting and transferring of expanded flap were used to reconstruct the appearance and function after the excision of giant neurofibroma.Results Sixteen cases gained primary healing while other 2 cases with delayed healing after onestage or fractionated resection of giant neurofibroma on body surface.All the 18 patients resumed selfcare and working ability.Conclusions Giant neurofibromatosis has significant damage to the appearance and body shape and also greatly limits the patient's life and work.Patients can resume physical and psychological rehabilitation by surgical resection and plastic surgery treatment.

Our objective is to prevent doctors and nurses who worked on SARS ward from contracting this highly communicable disease through observing strict isolation strategies. The following measures have been taken in our hospitals. The wards for SARS patients were remodeled according to the isolation requirements for infectious diseases. They were separated into three quarters, namely clean area, semi-contamination area and contamination area. Two buffer zones were set up to separate the three quarters. Four specific passages were separately allotted to health care staffs, patients, soiled materials disposal and handling and dispatch of specimens, to avoid cross infection by contact. According to the criteria for isolation of serial A respiratory infectious diseases, every health care worker was strictly requested to wear and take off isolation garments properly when they entered and left the ward. Most importantly, specific garbs for different areas were essential for efficient isolation. Respiratory tract, skin and mucous surfaces should be effectively protected on the ward. In addition, doctors and nurses should wear special masks or helmets and waterproof suit during the performance of intubation, CPR or operation. Direction of air flow in SARS ward was diverted away from the clean area by using ventilator in order to prevent air-borne contamination. The air outlet of SARS ward was efficiently filtered to cut down pollution of the environment. Living quarters of medical staff working on SARS ward were isolated with a safe distance from the ward. Their health condition was closely monitored daily. After working in SARS ward for four weeks, they should enjoy a special vacation to assure their good health condition. In the past spring, 882 SARS patients were admitted to both the 309 hospital and Xiao Tanghan hospital. 1 632 health care workers worked for those SARS paitents by turns. To our satisfaction, none of our staffs was infected by SARS. Our experiences indicated that health care workers on the SARS ward could be effectively protected from contracting SARS infection by taking efficient and strictly observed protective measures.

Objective To investigate the morbidity,clinical feature,diagnosis and therapy of ovarian disease in children.Methods Eighty-two children with ovarian disease were admitted and treated in Nanjing children's hospital from Jan.1992 to Jan.2007,were analyzed retrospectively with age,emergency admissions or not,dwell,pathology and method of operation.Results The age of 82 patients ranged from 1 day to 14 years old and the mean age was 6.7 years old.Thirty-one cases(37.8%) were emergency admissions and 51 cases(62.2%) were routine admissions.Twenty-seven cases(32.9%) were rural patients and 55 cases(67.1%) were urban patients.Forty-five cases(54.8%) were nontumorous disorder,31 cases(37.8%) were benign tumor and only 6 cases(7.4%) were malignant tumor.About the morbidity,12 patients(14.6%)were admitted from 1992 to 1996,24 patients(29.5%) from 1997 to 2001 and 46 patients(55.9%) from 2002 to 2007.Chemotherapy were carried out in 6 cases with malignant tumor in internal medicine,2 cases with sexual precosity kept observation,the others were cured.Conclusions Ovarian disease can occur at any age in children.The clinical manifestation is characterized mainly by acute abdomen.The incidence of ovarian disease of children in urban areas is higher than that children in rural areas.The morbidity continues to show an upward tendency and the pathologic manifestations are mostly benign,laparoscopic operation has obviously superiority.

Objective:To explore whether cigarette smoking extract (CSE) has influence on fluorescence protein ex-pression of thrombomodulin (TM) on surface of African green monkey kidney fibroblast cells (COS-7) or not . Methods:When TM-green fluorescent protein (GFP) plasmid was successfully constructed ,COS-7 cells were trans-fected by it ,then incubated by prepared 5% CSE (5% CSE group) ,PBS of certain volume was added to serum-free minimal essential medium (MEM ,simple medium) ,which was cultured at the same time and treated as control group .Flow cytometry counting method was used to detect change of TM-GFP expression amount on COS-7 surface at different time point .Results:Compare with control group ,there were no significant difference in the expression of TM-GFP on COS-7 surface at 1h and 6h in 5% CSE group [1h :(134.99 ± 18.41) vs .(146.61 ± 12.06) ,6h :(116.89 ± 27.28) vs .(123.89 ± 39.24) ,P>0.05 both] .Conclusion:The 5% cigarette smoking extract has no influ-ence on fluorescence expression of thrombomodulin on surface of African green monkey kidney fibroblast cells .

Objective The aim of this study is to summarize primarily the application range and the clinical effect of the minimally invasive direct cardiac surgery (MIDCS).Methods From April 2010 to August 2011,108 operations had been performed in our centre using MIDCS,among of which 44 males and 64 females,mean age (44.3 ± 16.4 ) years old,mean weight (60.0 ± 12.0 ) kg.These operations included 29 MVR operations (replacement with mechanical valve 19,with tissue valve 10),17 AVR operations( replacement with mechanical valve 11,with tissue valve 6 ),5 MVP operations,6 MVR + AVR operations (replacement with mechanical valve 5,with tissue valve 1 ),12 VSD repair operations and 23 ASD repair operations,9 MIDCAB operations,1 MVR + CABG oparation,2 PECD correction,1 repair of ruptruec chordae tendineae of tricuspid septum and 1 Ebstein deformity correction operation.Concomitant procedures included 19 TVP operations and 11 radiofrequency ablation operations.Except MIDCAB operations,other operations are performed with closed type extracorporeal circulation.Conversion to median sternotomy was necessary in only two patients ( 1.9％ ).Results Mean cardiopulnonary bypass time and aortic eross-clamp time were ( 104.4 ± 59.3 ) minutes and ( 66.7 ± 52.8 ) minutes respectively,74 patients ( 92.5 ％ ) recover to beat automatically after heart ceased operation.Median mechanical ventilation time was ( 14.5 ± 11.9 ) hours,Median intensive care unit stay was ( 18.8 ± 15.3 ) hours,median hospital stay post operative was (6.9 ± 2.9) days.Median incision length was (5.3 ± 1.2 )cm.Median draining volume was( 337.6 ± 240.9 )ml in the first day after operation,No transfusion occurred in 72 patients(66.7％ ).Hospital mortality was 0.No re-exploration for bleeding and sternal wound infection.When leaving hospital,94 being of heart functional class Ⅰ,8 of class Ⅱ,6 of class Ⅲ.Conclusion MIDCS was associated with good operative effect in the near future,superior safety and broad application range.Furthermore MIDCS has minimally invasive,less postoperative bleeding,fewer blood transfusions,good cosmesis,as well as the absence of sternal wound infection.It may be safely performed on selected patients with low postoperative mortality and morbidity.

BACKGROUND:Polyvinyl alcohol is a biocompatible and biodegradable polymer. It is widely used in clinical areas because of its water-soluble, film forming, emulsification, adhesiveness, tasteless, and nontoxic.
OBJECTIVE:To review the applications of polyvinyl alcohol and its composite materials in bone, cartilage, skin, vessels and other tissue engineering scaffolds.
METHODS:A computer-based online search of CNKI database from January 2000 to December 2011, PubMed database and Elsevier (ScienceDirect) database from January 1980 to December 2012, was performed by the first author with key words of“poly(vinyl alcohol), composite material, tissue engineering scaffold”both in Chinese and English. Literatures concerning polyvinyl alcohol and its composite materials in bone, cartilage, skin, vessels and other tissue engineering scaffolds were included, and repetitive research was excluded.
RESULTS AND CONCLUSION:Although there are not enough strength, complications and other shortcomings in vivo, due to its good biocompatibility and biodegradable properties, polyvinyl alcohol and its composite
materials have made great progress in tissue engineering applications from the laboratory to the pre-clinical
research. But its long-term effects need further research. It wil be a main research aim of scaffold materials in the future to improve the interaction of cel s with the scaffold materials by surface modification, to prepare biomimetic materials by cel microenvironment simulation, to improve the hydrophilicity, the adhesion of cel s, and cel
differentiation and proliferation, to bionic the structure and function of the natural extracel ular matrix by building three-dimensional porous structure and control ing the release of cel growth factors, to meet the need of tissue regeneration by congruity or harmony of degradation and mechanical strength.