OBJECTIVETo investigate the clinical effects of laparoscopic tension-free repair of umbilical hernia using mesh.

METHODSForm August 2006 to April 2009, 26 patients with umbilical hernia were repaired with mesh under laparoscopy. After the tissues surrounding umbilical perforation were separated by using ultrasonic scalpel, the mesh was stapled to the hernia edge with under laparoscopy. The efficacy of this procedures was analyzed in this study.

RESULTSThe tension-free repairing operations were completed successfully in the 26 patients under laparoscopy. The patients felt slight pain and began eating normally on the second day after the operation. The mean operation time was 35 min (30 - 45 min) and the mean blood loss was 8 ml (5 - 15 ml). No operative death and infection occurred postoperatively. The mean postoperative hospital stay was 5 days (3 - 7 days). The patients were followed up for 3 - 25 months (mean 14 months), no recurrence of the hernia occurred in this group.Patients were satisfied with the operation.

CONCLUSIONSTension-free repairing of umbilical hernia with mesh under laparoscopy is a minimally invasive operation with fast recovery, few complications, it's in line with the principle of tension-free repair for hernia.

Adult ; Aged ; Female ; Hernia, Umbilical ; surgery ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Surgical Mesh ; Treatment Outcome

Objective To observe the efficacy and safety of applying sirolimus-eluting stents in emergency percutaneous coronary intervention (PCI) for the patients with acute myocardial infarction (AMI).Methods In total,220 patients with AMI were enrolled in this study at Shanghai Tongji Hospital, divided into two groups,one with bare-metal stent and the other with sirolimus-eluting stent.Cardiovascular fatality,major adverse cardiac events (MACE) and target vessel revascularization (TVR) were observed one and six months after PCI in the two groups.Results There was no significant difference in overall fatality and MACE in the 1~(st) or 6~(th) months after PCI between the two groups.Three cardiogenic deaths occurred in bare-metal stent group with a fatality of 2.8 percent,and five deaths in sirolimus-eluting stent group with a fatality of 4.5 percent in six months after PCI.However,rate of restenosis in those with sirolimus-eluting stents was significantly lower than that of bare-metal stents (6.0 percent vs 16.1 percent,P

Objective To observe the effect of limited laminectomy combined with foraminal stenosis decompression on preventing C5nerve root palsy and improving neurological function. Methods From March,2014 to May,2016,69 patients with multi-segment cervical spondylotic myelopathy underwent surgical treatment in our hospital were included.Thirty-eight patients(group A)were treated with limited lami-nectomy combined with foraminal stenosis decompression and internal fixation,and 31 patients(group B)under-went routine laminectomy and internal fixation.The postoperative neurological recovery rate,cervical curvature index(CCI)and C5palsy rate were recorded and analyzed. Results No spinal cord and nerve injury occurred during the operation.The width of laminectomy was(16.8±2.1)mm in group A,and was significantly less than(21.7±2.5)mm in group B(t=8.849,P<0.001).There was no significant difference in operation time and intraoperative blood loss between two groups(t<0.439,P>0.05).The Japanese Orthopaedic Association (JOA) score increased continuously after surgery in both groups (F>42.996, P<0.05), and no significant difference was found between them at each time point(t<1.021,P>0.05).The cervical curva-ture index improved after surgery(F>86.379,P<0.05),and no significant difference was found between them at each time point(t<0.943,P>0.05).The spinal cord drift distance was(3.6±0.7)mm in group A,and ws signifi-cantly shorter than(2.5±0.5)mm in group B(t=7.602,P<0.001).There was no significantly difference in the neu-rological recovery rate between two groups(t=0.724,P=0.471).The C5palsy rate was lower in group A(5.2%,2/38)than in group B(22.5%,7/31)(χ2=4.514,P=0.034). Conclusion Limited laminectomy combined with foraminal stenosis decompression could relieve the spinal cord com-pression and restrict the excessive back drift, promote the neurological function recovery and reduce the inci-dence of C5palsy.

OBJECTIVETo explore the role of monitoring sex chromosome chimeric status by fluorescence in situ hybridization (FISH) in the identification of leukemic extramedullary relapse and post-transplant lymphoproliferative disease (PTLD) in acute lymphocytic leukemia (ALL) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODSSix ALL patients who received sex-mismatched allo-HSCT and manifested extravisceral lymphadenectasis or local lump were investigated. The sex chromosome chimeric status in tumor tissues and bone marrows (BM) were monitored by FISH, and EBV-RNA in the tumor tissues were detected by in situ hybridization (ISH).

RESULTSThe sex chromosomes in BM of all 6 patients were 100% donor-derived. Among the sex chromosome chimeric status of tumor tissues, three patients were mainly recipient-derived, and the percentage of sex chromosomes derived from recipients were 100%, 100% and 98.0%, respectively, and then they were diagnosed leukemic extramedullary relapse. The other 3 patients were donor-derived, the percentage was 98.5%, 96.0% and 91.5%, respectively, and were diagnosed PTLD. EBV-RNA and latent membrane protein (LMP-1) were positive in 2 patients with PTLD and negative in the other 4 patients. One patient with extramedullary relapse obtained partial remission, one with PTLD gained complete remission, and the others died eventually after therapy.

CONCLUSIONMonitoring the sex chromosome chimeric status by FISH is an effective method to distinguish leukemic extramedullary relapse from PTLD in ALL received sex-mismatched donor HSCT.

Adolescent ; Adult ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; In Situ Hybridization, Fluorescence ; methods ; Lymphoproliferative Disorders ; pathology ; surgery ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; pathology ; physiopathology ; surgery ; Recurrence ; Sex Chromosomes ; genetics ; physiology ; Transplantation Conditioning ; Young Adult

The aim of this study was to investigate the feasibility of the human cord blood adult stem cells (ASCs) to differentiate into hepatocytes in vitro induced by combined stimulation with hepatocyte growth factor (HGF), stem cell factor (SCF) and leukemia inhibitory factor (LIF). The adult stem cells were obtained through density gradient centrifugation and magnetic activated cell sorting (MACS). The adult stem cells were cultured in DMEM with HGF (10 ng/ml)+SCF (10 ng/ml)+LIF (10 ng/ml) in induced group I. In induced group II the enriched cells were cultured in DMEM with SCF (10 ng/ml)+LIF (10 ng/ml) and the undifferentiated cells acted as the control group without the factors. The morphology of cells was observed by the inverted phase contrast microscopy; the expression of albumin (Alb), human hepatocyte cytokeratin (CK18) and alpha-fetoprotein (AFP) were detected by immunofluorescence, immunohistochemistry and RT-PCR assay in the 21-day culture. Alb secreted by hepatocytes in the medium was determined by radioimmunoassay (RIA) at day 7, 14, 21, 23 and 25. The results showed that the shapes of ASCs changed and their sizes and number increased in the course of culture in group I. After being induced for three weeks, the cells turned round and resembled hepatocyte-like cells. The mRNA for Alb could be detected by RT-PCR in the differentiated adult stem cells in group I, and the mRNA for AFP was poorly detected by RT-PCR at day 21. Alb and CK18 were positive through immunofluorescence and immunohistochemistry at day 21, compared with group II and the control group. In group I, Alb in the medium significantly increased, compared with control group, and reached the highest level at day 21, then decreased at day 23. It is concluded that under some definite inducing conditions, human cord blood adult stem cells can differentiate into hepatocyte-like cells and HGF plays a critical role during the course.
Adult Stem Cells ; cytology ; Cell Differentiation ; physiology ; Cells, Cultured ; Fetal Blood ; cytology ; Hepatocyte Growth Factor ; pharmacology ; Hepatocytes ; cytology ; Humans ; Leukemia Inhibitory Factor ; pharmacology

Objective To compare the clinical effect of minimally invasive surgery transforaminal lumbar interbody fu-sion(MIS-TLIF)and posterior lumbar interbody fusion(PLIF)in the treatment of recurrent lumbar intervertebral disc hernia-tion(LIDH). Methods Twenty-nine patients with recurrent LIDP were selected from May 2014 to May 2016 in Weifang Peo-ple's Hospital and the clinical data were analyzed retrospectively. Thirteen patients were given MIS-TLIF(MIS-TLIF group) and sixteen patients were given PLIF(PLIF)group. The operative incision length,intraoperative bleeding volume,postoperative drainage volume,hospitalization time and complications were compared between the two groups. The lumbar function was evalu-ated with the Japanese Orthopaedic Association(JOA)score standard,and the clinical effect was compared between the two groups according to the modified Macnab standard one year after treatment. Results The operativeincision length,intraopera-tive bleeding volume,postoperative drainage volumeand hospitalization time in MIS-TLIF group were significantly less than tho-sein PLIF group (P < 0. 05). The preoperative JOA score of lumbar function in PLIF group and MIS-TLIF group was 7. 9 ± 1. 9 and 8. 0 ± 1. 6 respectively,it was 24. 0 ± 2. 7 and 24. 2 ± 2. 5 respectively at one year after treatment,there was no significant-difference in the JOA score between the two groups before and one year after operation (P > 0. 05). The JOA score atone year after operation was significantly higher than that before operation in the two groups (P < 0. 05). According to the modified Macnab standard one year after treatment,the fineness rate of the patients in PLIF group was 87. 50％(14 / 16),the fineness rate of the patients in the MIS-TLIF group was 84. 62％(11 / 13). There was no significant difference in the fineness rate be-tweenthe two groups (χ2 = 1. 380,P > 0. 05). The incidence of postoperative complications in the MIS-TLIF group and PLIF group was 7. 7％(1/ 13)and 6. 3％ (1/ 16)respectively,there was no significant difference in the incidence of postoperative complications between the two groups (χ2 = 0. 020,P > 0. 05). There were 8 cases (61. 5％)with gradeⅠfusion and 5 cases (38. 5％)with gradeⅡfusion in MIS-TLIF group,there were 9(56. 3％)with gradeⅠfusion and 7(43. 8％)with gradeⅡfu-sion,there was no significant difference in the constituent ratio with gradeⅠandⅡfusion between the two groups (χ2 = 0. 080, P >0. 05). Conclusion MIS-TLIF in treatment of recurrent LIDH has the advantages of less incision,less intraoperative bleed-ing,less postoperative drainage and shorter hospitalization time;and the clinical effect of MIS-TLIF is similar to that of PLIF.

To investigate the effect of S-nitrosoglutathione (GSNO), a nitric oxide donor, on platelet production from megakaryocytes differentiated from cord blood CD34(+) cells in vitro, the CD34 (+) cells from eight fresh umbilical cord blood samples by a high-gradient magnetic cell sorting (MACS) system were cultured in serum-free medium for 14 d with thrombopoietin (TPO) 50 ng/ml, IL-3 10 ng/ml, stem cell factor (SCF) 50 ng/ml and rHuGM-CSF 20 ng/ml. Then, CD61 (+) cells were purified by MACS system from these CD34 (+) cells, and were cultured in serum-free medium supplemented with TPO 50 ng/ml, IL-3 10 ng/ml and SCF 50 ng/ml in the presence (treatment group) and absence (control group) of GSNO for 30 min or 2 h. Platelet-sized particles were counted by flow cytometry; megakaryocyte structure was detected by scanning electron microscope. Aggregation of the thrombin-induced platelet particle was observed under inversion microscope. cGMP was assessed by commercial ELISA kit. The results showed that, compared with the control group, the number of platelet-sized particles significantly increased (P<0.05) in the treatment group, in which megakaryocytes presented significant pseudopod formation and extensive membrane blebbing. The platelet particle aggregation could be observed under microscope after thrombin induction. cGMP activity was significantly increased after treatment with GSNO (P<0.05). These results propose that GSNO can facilitate platelet production from megakaryocyte, and it may be partly through cGMP pathway.
Antigens, CD34 ; analysis ; Blood Platelets ; cytology ; Cell Differentiation ; drug effects ; Cyclic GMP ; blood ; Female ; Fetal Blood ; cytology ; Hematopoiesis ; drug effects ; Hematopoietic Stem Cells ; cytology ; Humans ; Megakaryocytes ; cytology ; Nitric Oxide ; physiology ; Platelet Aggregation ; drug effects ; Pregnancy ; S-Nitrosoglutathione ; pharmacology

OBJECTIVETo investigate the protective effect of Heme oxygenase-1 (HO-1) gene transfer on rat renal autograft against ischemia/reperfusion injury.

METHODSHO-1 recombinant adenovirus vectors were constructed and transduced into rat renal autograft by renal arterial perfusion. The renal autografts were transplanted orthotopically after store at 4 degrees C for 24 h, followed by contralateral native nephrectomy 5 d after transplantation. There were 25 rats in the control group. 5 h and 3 d after transplantation, reverse transcriptase polymerase chain reaction (RT-PCR) and immunohistochemistry were used to detect the expression of HO-1 gene; enzyme-labeled immunosorbent (ELISA) was used to measure HO-1 protein content in the homogenate of renal autograft.

RESULTSThe intensity of HO-1mRNA expression at 3 h and 3 d after transplantation were 0.65 +/- 0.11, 0.86 +/- 0.17 in the experimental group and 0.09 +/- 0.01, 0.15 +/- 0.02 in the control group respectively. The differences between the two groups were significant (t = 14.38, 11.73, P < 0.05). HO-1 protein content at 3 h and 3 d after transplantation were significantly increased in the experimental group, as compared with the control group [(297 +/- 61) ng/g and (468 +/- 51) ng/g versus (98 +/- 30) ng/g and (155 +/- 31) ng/g; t = 8.27, 14.83, P < 0.05]. HO-1 transduced autografts had less renal ischemic injury and lower serum creatinine level compared with control animals (P < 0.05).

CONCLUSIONAdenoviral vector can successfully transduce rat kidneys with the HO-1cDNA, which can protect rat renal autografts from ischemia/reperfusion injury.

Adenoviridae ; genetics ; Animals ; Female ; Genetic Vectors ; Heme Oxygenase-1 ; biosynthesis ; genetics ; Kidney ; blood supply ; metabolism ; Kidney Transplantation ; Male ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; prevention & control ; Transfection ; Transplantation, Autologous

This study was aimed to investigate the effect of angiotensin II on differentiation of cord blood CD34+ cells into megakaryocytes in vitro. The CD34+ cells from eight fresh umbilical cord blood samples sorted by a high-gradient magnetic cell sorting system (MACS) were cultured in serum-free culture medium containing thrombopoietin (TPO) 50 ng/ml, IL-3 10 ng/ml, stem cell factor (SCF) 50 ng/ml and different concentrations of angiotensin II (0, 50, 100, 1000 microg/ml) for 14 days. Mononuclear cells (MNC) were counted by automatic cell analyzer. Cultured CD41+ cell and platelet counts in cultured system, and cell cycle were analyzed by flow cytometry. CD41 specific monoclonal antibody staining was observed by immunofluorescence microscopy. The results showed that as compared with the control group, the number of MNC not increased significantly (P > 0.05), but the number of CD41+ cells and platelets increased significantly in treatment group (P < 0.05). Cell cycle analysis revealed that the amounts of 4N cells increased and apoptosis cells obviously existed in treatment group (P < 0.05). After fluorescence staining, more CD41+ cells of different sizes were observed by means of fluorescence microscopy in both groups. It is concluded that angiotensin II can induce the cord blood CD34+ cells to differentiate towards megakaryocyte, and enhance the function of megakaryocyte to produce platelet.
Angiotensin II ; pharmacology ; Antigens, CD34 ; analysis ; Cell Differentiation ; drug effects ; Cells, Cultured ; Culture Media, Serum-Free ; Fetal Blood ; cytology ; Humans ; Megakaryocytes ; cytology ; Stem Cell Factor ; pharmacology ; Thrombopoietin ; pharmacology

OBJECTIVETo design transoralpharyngeal atlantoaxial reduction plate (TARP), evaluate its biomechanical performance and observe its preliminary clinical effect.

METHODSA brand-new TARP system was designed, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operation instruments. Twelve fresh occipital bone-C(3) specimen were designed for biomechanical test including range of motion (ROM) (n = 6) and screw pull-out strength (n = 12). Preliminary clinical application of TARP was reported.

RESULTSThe reduction mechanism of the TARP system was designed cleverly. TARP had equal effect with Magerl + Brooks and it was more stable than the other three clinically widely used atlantoaxial fixators: Magerl, Brooks and anterior transarticular screw fixation through C(2) vertebral body. TARP's C(1) and C(2) screws were strong enough for atlantoaxial arthrodesis and their antipull-out performance was excellent. Clinical application on irreducible atlantoaxial dislocation proved that TARP had the function of instant reduction, the operation was feasible and the operation effect was significant.

CONCLUSIONTARP's design is novel and it has excellent biomechanical performance. The operation procedure is simple and reasonable. Furthermore, instant reduction could be completed during the operation and the fixation is strong. Above all, TARP is creative and will have excellent prospect.

Adolescent ; Adult ; Atlanto-Axial Joint ; surgery ; Equipment Design ; standards ; Equipment and Supplies ; adverse effects ; standards ; Female ; Humans ; Joint Dislocations ; etiology ; surgery ; Male ; Orthopedic Procedures ; methods ; Pharynx ; surgery ; Treatment Outcome