In February, 2019, a patient with a defect of open dorsal cartilage and bone in the first metatarsal head, including the defects of soft tissue, tendon and joint capsule, was treated in our department. After multiple debridement, the vascularised medial femoral condyle osteochondral chimeric tissue flap was transferred to repair the composite tissue defect in the metatarsal head at the second stage. After 18 months of follow-up, the patient felt no pain in the foot and walking, and there was no sign of lameness and discomfort at donor sites. The postoperative functional recovery was satisfactory.

This study was aimed to investigate the effect of cord blood dendritic cells (DCs) on the in vitro proliferation capability, immunophenotype changes, level of secreted cytokines and activity against leukemia cells of the homologous cytokine-induced killer (CIK) cells. DCs and CIK cells were induced from cord blood mononuclear cells. They were co-cultured at the ratio of 1:5, and CIK cells from cord blood or DC-CIK cells from peripheral blood were cultured as controls. Immunophenotypic changes were analyzed by flow cytometry, increased number of cells were counted by trypan-blue staining, the killing activity to leukemia cells was assayed by MTT, the levels of interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α) and interleukin-12 (IL-12) in the cultured supernatant were detected by ELISA. The results showed that the proliferation capability of cord blood DC-CIK cells was significantly higher than that of cord blood CIK cells and peripheral blood DC-CIK cells (p < 0.05 and p < 0.05). Under the same condition, the rate of double positive cells with CD3(+)CD8(+) and CD3(+)CD56(+) in CIK cells was significantly enhanced by co-culture with cord blood DCs (p < 0.05). The level of IL-12, IFN-γ, and TNF-α in cultured supernatants of cord blood DC-CIK cells increased noticeably on day 3 as compared with CIK cells cultured alone (p < 0.01, p < 0.05, p < 0.05). Within the effector-target ratio range between 2.5:1 to 20:1, the activity of cord blood DC-CIK cells against all subtypes of acute leukemia cells was much higher than that of CIK cells (p < 0.05), and there was no significant difference among all subtypes of acute leukemia cells, which was the same with the killing effect of peripheral blood DC-CIK cells against leukemia cells. It is concluded that the proliferation capability and anti-leukemia effect of the homologous CIK cells can be enhanced by cord blood DCs. The proliferation capability of cord blood DC-CIK cells is stronger than that of peripheral blood DC-CIK cells, but there is no significant differences of cytotoxicity between DCs and CIK cells. As the cord blood is easily gained and does not easily cause a serious graft rejection, the DC-CIK cells should be clinically applied more extensively as novel immune therapy.
Cell Proliferation ; Coculture Techniques ; Cytokine-Induced Killer Cells ; cytology ; Cytotoxicity, Immunologic ; Dendritic Cells ; cytology ; immunology ; Fetal Blood ; cytology ; Humans ; Interferon-gamma ; metabolism ; Interleukin-12 ; metabolism ; Leukemia ; immunology ; Tumor Necrosis Factor-alpha ; metabolism

Objective To investigate the clinical significance and difference in the expression of endostatin and vascular endothelial growth factor (VEGF) in non-small cell lung cancer (NSCLC) patients with different response to recombinant human endostatin (rh-endostatin) combined with chemotherapy.Methods Serum levels of endostatin and VEGF in peripheral blood of 30 patients with stage Ⅳ NSCLC (NSCLC group) and 30 healthy controls (control group) were determined by enzyme-linked immunosorbent assay.Two cycles of chemotherapy combined with rh-endostatin were provided to NSCLC patients to evaluate the efficacy of the regimen.Simultaneously,serum levels of endostatin and VEGF were measured before and after treatment.Results The level of serum endostatin was (37.96 ± 9.01) ng/ml and (40.12 ± 12.11)ng/ml in NSCLC patients and healthy controls,respectively,which was lower in the former than that of the latter,without statistical difference (P ＞ 0.05).Furthermore,the level of serum VEGF was (127.98 ± 33.88) pg/ml and (36.33 ± 15.43) pg/ml in NSCLC patients and healthy controls,respectively,which was higher in the former than that of the latter,with statistical difference (t =13.48,P ＜ 0.05).Besides,levels of endostatin and VEGF in serum were not correlated with the sex,age,tumor pathological type and differentiation of NSCLC patients (P ＞ 0.05).After two cycles of chemotherapy combined with rh-endostatin treatment,the level of serum endostatin in partial response (PR) or stable disease (SD) patients was (76.22 ± 20.41) ng/ml,higher than that of progressive disease (PD) patients,which was (31.24 ± 13.09) ng/ml (t =7.143,P ＜ 0.05).In addition,the level of serum VEGF in PR or SD patients was (93.28 ± 21.33) pg/ml,which was lower than (155.81 ± 48.38) pg/ml of the PD patients (t =3.503,P ＜ 0.05).Conclusions The levels of endostatin and VEGF are associated with the efficacy of anti-angiogenesis combined with chemotherapy in NSCLC patients.

Objective To explore the effect of newly developed XSTAT 30 hemostatic apparatus for US army TCCC. Methods The characteristics and application effects of XSTAT 30 were described from the aspects of design, indication and contraindication, operation and precautions, application safety and etc. Results In tactical echelons XSTAT 30 could be used for the hemostasis of penetrating fragment injuries at groin, armpit and etc. Conclusion XSTAT 30 behaves well in the hemostasis at the junction sites, and is worthy referencing for designing likely devices of the PLA.

Objective To explore the impact of cognitive training on cognitive function of the elderly in a community. Methods Ninety elderly people at and above sixty years old in a community of Shanghai were recruited in the study, and were divided into two groups: the cognitive training group and the control group.The cognitive training group conducted cognitive training for 12 weeks (24 times), a comprehensive training method incorporating cognitive training courses with Lumosity ( a brain functional exercise software) .The two groups were evaluated before and after the intervention with the Montreal Cognitive Assessment Scale ( MoCA) . Results Before the intervention, the scores of four fields ( i.e. visual space and executive function, naming, delayed recall, and directional force) and the total score for the cognitive training group were higher than the control group ( P <0 .05 );there was no statistically significant difference in other three fields ( i.e.attention, language ability and abstract ability) between the two groups (P>0.05).After the intervention, the scores of four fields (i.e.visual space and execu-tive function, attention, abstract, delayed recall) and the total score for the cognitive group improved, compared with the control group ( P<0 .05 ) . Conclusion Cognitive training could improve or maintain cognitive function for the elderly in the community.

OBJECTIVETo summarize the experience of minimally invasive robotic coronary bypass on beating heart using da Vinci S in China.

METHODSFifty-six patients underwent selected robotic coronary bypass on beating heart from April 2007 to December 2008. All the patients had history of angina and the coronary arteriography showed severe stenosis in the left anterior descending artery (LAD), of which 10 cases had right coronary artery or left circumflex coronary (LCX) stenosis. The age was 33 to 74 years old, with a mean of (55.8 +/- 9.4) years old. The weight was (71.4 +/- 13.2) kg. All the patients had good lung function and had no medical history of pleurisy and thoracic surgery. CT scan of double internal thoracic artery (ITA) was routinely checked preoperatively. The procedures included: (1) The robotically assisted endoscopic atraumatic coronary artery bypass surgery. The approach was via a small left anterior thoracotomy (6 to 8 cm) after robotic ITA was taken down. The ITA was manually anastomosed to the LAD or LCX on beating heart. (2) Totally endoscopic coronary bypass graft on beating heart. After ITA harvesting, the endo stabilizer was inserted via the fourth port in the xiphoid area under endoscopic vision. The left ITA to the LAD grafting was done using U-clips on beating heart in a totally endoscopic manner using da Vinci S system through 4 ports. For all patients the ITA flow was checked by the Doppler flowmeter after anastomosis was completed. After the surgery was completed, the thoracic port was checked carefully to avoid bleeding. The operating procedures and a variety of clinical parameters were recorded and analyzed. (3) Stent placement after robotic surgery in a hybrid manner. The graft patency rate was evaluated by CT or arteriography.

RESULTSAll patients successfully accepted robotic minimally invasive coronary bypass on the beating heart using da Vinci S surgical system without complications. The mean graft flow was (23.2 +/- 16.7) ml/min. And there was no surgical conversion and surgical death. Fifty-three patients received ITA to LAD grafts and 3 patients received double coronary artery bypass grafts as well. Ten cases received stent placement in separate session. The CT scan and angiography revealed patent grafts in all patients. There were no post-operative complications. All patients were discharged from hospital.

CONCLUSIONSAs a new advanced approach of revascularization, robotic ITA harvesting and coronary anastomoses can be safely performed with the da Vinci S system. The procedure is minimally invasive and can offer enhanced ability to control precise and stable operative manipulations.

Adult ; Aged ; Coronary Artery Bypass, Off-Pump ; instrumentation ; methods ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Robotics

OBJECTIVETo introduce the experience in coronary artery bypass grafting (CABG) combined with concomitant valve operation.

METHODSFrom 1998 to 2002, forty-five patients (38 men and 7 women) with coronary artery lesion and valve diseases underwent myocardial revascularization combined with concomitant valve operation. The mean age of the patients was 59 years (42 to 75 years). Heart function was Class II (NYHA) in 7 patients, Class III in 30, Class IV in 8. The value of ejection fraction was 0.32 to 0.50. Thirty patients had mitral valve lesion, 7 aortic lesion, and 8 both lesions. Seventeen patients had single-vessel diseases, 20 double-vessel diseases, 8 triple -vessel diseases, and 8 left main artery lesion. After cardiac arrest by cold blood cardioplegia under moderate cardiopulmonary bypass (CPB), distal anastomosis of the saphenous vein (SV) to the target vessels were firstly performed and followed by valve replacement (32 patients) or plasty (2). The left internal mammary artery (LIMA) was grafted to the left anterior descending artery (LAD) before aortic unclamping. Proximal anastomosis of the SV to the aorta was finally finished on beating heart. The mean bypass time was 173.5 min and the mean duration of aortic cross-clamping time was 112.6 min.

RESULTSNo mortality occurred during hospitalization and all patients were discharged 9.2 days after operation. Cardiac function of all patients was improved to Class I-II and no patient died during follow-up.

CONCLUSIONSCABG combined with valve surgery can be safely performed with good results.

Adult ; Aged ; Coronary Artery Bypass ; Coronary Artery Disease ; complications ; surgery ; Female ; Follow-Up Studies ; Heart Valve Diseases ; complications ; surgery ; Heart Valve Prosthesis Implantation ; methods ; Humans ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo summary the first 14 cases undergoing internal mammary artery (IMA) harvest using da Vinci S system and minimally invasive direct coronary artery bypass grafting (MIDCAB) on beating heart.

METHODSThe average age of patients was (60.4 +/- 10.1) years old. One case was female and 13 male. All the patients had a history of angina. The coronary angiography showed severe stenosis of anterior descending branch in all patients, of which 2 cases had diagonal and circumflex branch stenosis. Four case had myocardial infraction history. All the patients had good lung function and had no medical history of pleurisy. Without sternotomy, the camera cannula was placed in the left, 3 cm lateral to nipple in the 4th intercostal space (ICS). Da Vinci instrument arms were inserted through two 1 cm trocar incisions. The right instrument generally was positioned 4 to 6 cm cephalad to camera cannula in the 2nd or 3rd ICS. The left instrument arm was positioned 4 to 6 cm caudal to the camera cannula in the 5th or 6th ICS. Arm trocar sites were maintained 6 cm apart at chest entry. The internal mammary artery was harvested in routine methods. Thirteen cases underwent left internal mammary artery harvest, one case underwent right internal mammary artery harvest, one case underwent double internal mammary harvest. MIDCAB was performed on beating heart in 14 cases and 1 case accepted the totally endoscopic coronary artery bypass (TECAB).

RESULTSAll cases were accomplished successfully without complications. The average time of ICU was 20 hours. Robotic surgery had less draining than the conventional coronary bypass.

CONCLUSIONSTotally robotic internal mammary artery harvest and beating heart coronary artery bypass is less invasive, more precise, safe and efficient.

Adult ; Aged ; Coronary Artery Bypass, Off-Pump ; methods ; Female ; Humans ; Male ; Mammary Arteries ; surgery ; Middle Aged ; Minimally Invasive Surgical Procedures ; Retrospective Studies ; Robotics ; Treatment Outcome

Objective Through determination of selenium content in liver and urine of selenium-induced mice, direct sampling atomic fluorescence spectrometry was established to provide a more accurate and convenient determination method for detection of selenium-related biological samples. Methods Selenium in the sample was released by the electrically heated quartz tube,the selenium in the atomic state was captured by the quartz tube,and the selenium released by the heating quartz tube was carried by the argon-hydrogen mixed gas into the argon-argon flame atomic fluorescence detector for determination; standard curve was established based on selenium content and fluorescence area, and then the content of selenium in the sample was calculated. Results The detection limit of selenium in samples by direct sampling atomic fluorescence spectrometry was 0.28 μg/kg, the correlation coefficient of standard curve was 0.999 3, and the relative standard deviation range was 1.82% - 4.19%. The adding standard recovery of the liver in mice was 87.30%- 100.20%; meanwhile the adding standard recovery of the urine in mice was 93.10% - 96.60%. Conclusions Direct sampling atomic fluorescence method is simple and easy to operate, accuracy and precision are better, the linear range is wide. The samples need not be processed by complex pretreatment,such as acid,etc.,elements loss is avoided and efficiency of detection is improved.The method can be used in a variety of samples for rapid detection of trace selenium.

Objective The nursing treatment ability scale of patients with nuclear radiation damagein the hospital was developed to provide an evaluation basis for improving the nursing ability of nurses with nuclear radiation damage. Methods The scale was prepared by literature review, expert interview and expert consultation, and a total of 330 clinical nurses from a third-class hospital was randomly selected as the research objects. The scales were issued for item analysis and reliability and validity test. Results The scales were divided into 6 dimensions, including basic knowledge of nuclear radiation damage, specialized equipment use ability, specialized ward management ability, basic nursing ability, specialized nursing ability and self-ability recognition, with 51 items. After exploratory factor analysis, there were 6 principal components, and the cumulative interpreted variance was 70.757%. The χ², df, χ²/df, CFI, IFI, TLI, NFI, PNFI, PCFI, RMSEA fitting indexes of confirmatory factor analysis were all acceptable. Cronbach's α coefficient was 0.976, the retest reliability was 0.823, and the S-CVI (S-CVI/UA) was 0.84. The evaluation content validityS-CVI (S-CVI/AVE) was 0.98, and the content validity I-CVI of the item level was 0.78～1.00. Conclusion The items and dimension Settings of this scale have been tested, and all indicators met the requirements. The reliability and validity test results were good. It can be used as a scale for preliminary evaluation of hospital nursing ability of patients with nuclear radiation damage.