OBJECTIVETo investigate the efficacy of the application of transosseous osteosynthesis with annular external fixator for the treatment of traumatic large bone defects of the tibia.

METHODSFrom 2002 to 2011,17 cases of traumatic tibial long bone defect were treated by transosseous osteosynthesis with annular external fixator including 11 males and 6 females with an average age of (31.00+/-2.35) years old ranging from 22 to 45 years. The length of defect was from 5 to 13.1 cm with an average of (7.50+/-1.01) cm. The fixed time,bone healing time and the extend length of the affected limb were observed, and the degree of recovery of limb function after surgery were assessed ccording to the Paley's limb function evaluation.

RESULTSAll patients were followed up from 12 to 48 months with an average of (30.00+/-2.35) months, the bone defects of 17 patients achieved bone healing. The average bone healing time was (10.10+/-0.59) months (8 to 15 months); the average time of fixed time was (14.10+/-0.65) months (12 to 16 months); the average extend length of the affected limb was (7.50+/-1.01) cm. The results of Paley's functional evaluation was excellent in 9 cases,good in 6,fair in 2.

CONCLUSIONTransosseous osteosynthesis with annular external fixator is an effective method for treatment of large bone defects of the tibia. It is successful reconstruction of limb length, simple operation, less soft tissue injury,and is clinical worthy of promotion.

Adult ; External Fixators ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Tibia ; injuries ; surgery ; Wound Healing

OBJECTIVE: To explore the applicability of integration between three-dimensional (3D) facial and dental data to evaluate the nasolabial morphology variation before and after the cross-arch fixed restoration of the maxillary implant-supported prostheses. METHODS: Twelve patients (4 women and 8 men), mean age (54.82±5.50) years (from 45 to 62 years) referred to the Department of Oral Implan-tology, Peking University School and Hospital of Stomatology, were selected and diagnosed with edentulous maxilla. For all the patients, 4 to 6 implants were inserted into the maxilla. Six months later, the final cross-arch fixed prostheses were delivered. The 3D facial images were collected before and after the final restoration. The 3D data of prostheses were also captured. All the 3D data were registered and measured in the same coordinate system. Then the displacement of all the landmarks [cheilion left (CHL), cheilion right (CHR), crista philtri left (CPHL), crista philtri right (CPHR), labrale supe-rius (LS), subnasale (SN), stomion (STO), upper incisor (UI), upper flange border of the prostheses (F-point, F)], and the variation of the distances between these landmarks (SN-LS, CPHR-CPHL, CHR-CHL, LS-STO) were analyzed and compared. RESULTS: The consistency test among three measurements of the length of F-SN indicated that the integration method of the dental prostheses and soft tissue had the good repetitiveness, ICC=0.983 (95%CI: 0.957-0.995). After wearing the final cross-arch maxillary implant-supported prostheses, all the landmarks on the soft tissue moved forward. The nasal base area changed minimally, and the shift of SN in the sagittal direction was only (0.61±0.44) mm. But the sagittal shift of LS was (3.12±1.38) mm. In the vertical direction, SN, LS, CPHL, and CPHR moved upward. But STO, CHL, and CHR moved downward a little. Except for the slight decrease of the length of philtrum (SN-LS), the length of CHL-CHR, CPHL-CPHR, and the height of upper lip were increased together (P < 0.01). In the direction of Z axis, the strong correlations were found not only between the movements of SN and F (r=0.904 3) but also between the movements of LS and UI (r=0.958 4). CONCLUSION The integration method of 3D facial and dental data showed good repetitiveness. And the strong correlations between the landmarks of prostheses and nasolabial soft tissue in the sagittal direction were found by this new method.
Female ; Humans ; Incisor ; Lip ; Male ; Maxilla/surgery* ; Middle Aged ; Mouth, Edentulous ; Prostheses and Implants

OBJECTIVE: To explore the molecular mechanism of proliferation inhibition of human breast cancer cell MCF-7 regulated by E1A gene. METHODS: E1A gene was transfected into MCF-7 cells by liposome reagents. RT-PCR and Western blot were used to detect E1A mRNA and protein expression and HER-2 mRNA in MCF-7. The proliferation and colony formation of MCF-7 were measured by 3-(4,5-dinmethylthiahiazo-z-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and soft agar formation assay. The apoptosis of MCF-7 cells regulated by E1A expression was examined by flow cytometry. RESULTS: E1A was not endogenously expressed in MCF-7. E1A expression in MCF-7 could significantly decrease HER-2 mRNA and protein expression. Flow cytometry indicated that the apoptosis of MCF-7 could be induced by E1A. Meanwhile, E1A gene could significantly inhibit MCF-7 proliferation and colony formation in soft agar. CONCLUSION E1A gene can decrease HER-2 expression and induce the apoptosis of human breast cancer cell MCF-7, and inhibit the proliferation and colony formation of MCF-7.
Adenovirus E1A Proteins ; biosynthesis ; genetics ; Apoptosis ; genetics ; Breast Neoplasms ; genetics ; metabolism ; Cell Proliferation ; Female ; Genes, erbB-2 ; genetics ; Humans ; RNA, Messenger ; biosynthesis ; genetics ; Receptor, ErbB-2 ; biosynthesis ; genetics ; Transfection ; Tumor Cells, Cultured

Objective To investigate the value of 18F-FDG/99Tcm-MIBI SPECT myocardial imaging for the detection of myocardial viability and prognosis in patients with AMI. Methods 18F-FDG/99Tcm-MIBI SPECT myocardial imaging was performed in 98 consecutive patients [man 87, women 11; average age (58 ±11)y] with AMI. The myocardium was scored individually for nine segments: mildly decreased uptake = 1,significantly decreased uptake = 2, and no uptake = 3. Perfusion defect but preserved 18 F-FDG uptake was defined as perfusion-metabolism mismatch, indicating jeopardized but viable myocardium. Perfusion defect and decreased 18 F-FDG uptake were defined as match, indicating myocardial necrosis. Echocardiogram was performed before and after treatment for evaluating the LVEF. All patients were followed after treatment.The rate of cardiac events was calculated and compared between patients with medication and revascularization. Paired t test, Chi-square test and log-rank test were used for statistical analysis. Results In the group with viable myocardium, 27 patients received revascularization and 10 received medication. In the group with infarcted myocardium, 26 patients received medication and 35 received revascularization. Patients underwent revascularization and with medication had no significant difference in improvement of LVEF between both groups (viable myocardium group: χ2 = 0.509, P > 0. 05; infarcted myocardium group: χ2 =0.035, P > 0.05). In viable myocardium group, cardiac event rate was significantly higher in patients with medication than in those who had undergone revascularization (50.0% vs 14.8%, χ2 =4.91, P<0.05).In the infarcted myocardium group, cardiac event rate was also significantly higher in patients with medication (30.7% vs5.7% ,χ2 =6.83, P<0.05). Conclusions 18F-FDG/ -MIBI SPECT myocardial imaging may well be of value but limited for the detection of myocardial viability and prediction of improvement in cardiac function as well as prognosis. However, more prospective data are needed for final evaluation.

OBJECTIVETo evaluate the early and midterm outcomes of endovascular repair of aortic dissection (AD).

METHODSBetween January 2001 and December 2006, 165 patients (145 male and 20 female) with AD were treated with endovascular repairing. The mean age of the patients was 52.8 years (range, 30-82 years). Among them, 36 patients had Stanford type A dissection, 121 had type B dissection and 8 had aortic ulcer. Among the dissection patients, 47 were acute AD (the interval between onset and surgery was < or = 7 days), 69 were subacute AD (the interval between onset and surgery was 8-30 days) and 41 were chronic AD (the interval between onset and surgery was > 30 days).

RESULTSThe stents were placed technically successfully in 164 patients (99.4%). The rate of endoleak within 30 days after placement of stents was 7.3% (12/165) and neurologic complication rate was 2.5% (4/165). The mortality rate within 30 days was 6.1% (10/165), and the mortality of acute, subacute and chronic AD was 12.8%, 1.4% and 7.3%, respectively. One hundred and forty-five cases were followed up for 6 to 75 months (median, 28.2 months). Complete thrombosis in false lumen was achieved in 62 patients (42.8%), while partial thrombosis was achieved in 83 patients (57.2%). Nine patients died during fellow-up.

CONCLUSIONIt's indicated that endovascular repair of AD is a microinvasive, safe and effective methods for aortic dissection. However, the long-term efficacy needs to be evaluated further.

Adult ; Aged ; Aged, 80 and over ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm ; surgery ; Blood Vessel Prosthesis Implantation ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome

BACKGROUND: Human placental mesenchymal stem cells can improve the blood glucose level of diabetes mellitus rats and gestational diabetes rats, but little is reported on its effect on glucagon, adiponectin, and tumor necrosis factor-α in the serum and placental tissues. OBJECTIVE: To investigate the effects of human placental mesenchymal stem cells on the levels of glucagon, adiponectin and tumor necrosis factor-α in the serum and placental tissues in gestational diabetes rats. METHODS: A rat model of gestational diabetes was made by high-fat and high-sugar diet plus low-dose injection of streptozotocin. Passage 3 human placental mesenchymal stem cell suspension (1×1010 cells/L, 0.5 mL) was injected into gestational diabetes rats at gestational days 4 and 11 (4- and 11-day intervention groups). Meanwhile, control rats were given the same amount of normal saline. At 20 days of gestation, blood samples from the abdominal aorta were extracted, and then cesarean section was made to remove the placenta in the gestational diabetes rats. ELISA and real-time PCR were used to detect the levels of glucagon, adiponectin and tumor necrosis factor-α in the serum and placental tissues, respectively. RESULTS AND CONCLUSION: (1) The serum and placental levels of glucagon, adiponectin and tumor necrosis factor-α showed no differences between the 4- and 11-day intervention groups (P > 0.05). (2) Compared with the control group, significantly increased serum adiponectin level and significantly decreased placental glucagon mRNA expression were found in the 4-day intervention group (P < 0.05). (3) Compared with the control group, the serum adiponectin level and the placental glucagon level both had a significant decrease in the 11-day intervention group (P < 0.01), while the serum level of tumor necrosis factor-α was significantly decreased (P < 0.01). To conclude, transplantation of human placental mesenchymal stem cells can vary the adiponectin and glucagon levels, which provides a new research idea and basis for the further study on the possible mechanism of placental mesenchymal stem cells to improve blood glucose level in gestational diabetes rats. Additionally, it is worthy while to notice that gestational diabetes rats given placental mesenchymal stem cells in the early or late pregnancy show no effects on the above indicators.

UNLABELLEDOBJECTIVE To evaluate the effects of endovascular stent-graft repair for Stanford type A aortic dissection combined with extra-anatomic bypass.

METHODSTo perform endovascular repair for Stanford type A aortic dissection, we tried to extend the landing zone by extra-anatomic bypass to reconstruct the innominate artery, the left common carotid artery or the left subclavian artery, and then achieved the process immediately or at a secondary stage via either the carotid or the femoral approach.

RESULTSThirty-four patients with ascending aortic dissection (n=8) and aortic arch dissection (n=26) were treated with this technique. Thirty three patients were successfully done aortic endovascular repair, only one died during the operation. The thirty-day mortality rate was 8.8% (3/34), endoleak incidence rate was 11.8% (4/34) and incidence rate of cerebral infarction was 5.9% (2/34). Twenty-nine patients were followed-up for 6-70 months (mean, 24. 5 months). Complete (n=16) and partial (n=13) thrombosis of the false lumen were showed with CT angiography and/or vascular color Doppler ultrasound scanning.

CONCLUSIONSEndovascular stent-graft repair combined with extra-anatomic bypass can be a novel option for Stanford type A aortic dissection; it is safe, less invasive, and with fewer complications. Nevertheless, indications need further consideration.

Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm ; surgery ; Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome

OBJECTIVETo study endovascular treatment of DeBakey type I aortic dissecting aneurysm.

METHODSSeven patients with DeBakey I aortic dissecting aneurysms were treated. Diagnoses were confirmed by MRA, CT and angiography. The intimal tear entry was in the ascending aorta, 2.5 approximately 6.0 cm from the ostia of the coronary arteries, and 0.5 approximately 4.0 cm from the brachiocephalic trunk opening. Endovascular stent-grafts were deployed via a left common carotid artery (LCCA) approach in 2 cases and right femoral artery (RFA) approach in 5 cases. Prior to treatment, a left subclavicular artery (LSA)-LCCA shunt was established to ensure blood supply to the LCCA during surgery in 2 cases via LCCA approach, and a LSA-LCCA-right common carotid artery (RCCA) synthetic bypass was established to ensure blood supply to the brain in 2 cases in RFA approach.

RESULTSThe operative success rate was 100%. In 3 cases, endoleak persisted after the first stent was placed, but this was eliminated by placement of a second stent. All patients survived except one who died of acute massive hemorrhage from the upper gastrointestinal tract one month postoperatively. The false lumen in all 6 cases became thrombosed and no endoleak or new aortic dissecting aneurysms developed.

CONCLUSIONSEndovascular treatment of DeBakey type I aortic dissecting aneurysm is feasible, minimally invasive, and effective. Case selection depends on the distance of the coronary artery ostia from the tear entry.

Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm ; surgery ; Blood Vessel Prosthesis Implantation ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Stents ; Treatment Outcome

Objective To investigate the clinical effect of posterior femoral composite tissue flap pedicled with inferior gluteal artery for repair of huge sacrococcygeal pressure injuries.Methods The clinical data of 11 patients with huge sacrococcygeal pressure injuries admitted to our hospital were retrospectively analyzed,with a mean wounds area of(205.3±15.3)cm2,and the depth of the wounds all reached the sacrococcygeal bone surface with partial sacrococcygeal necrosis.The inferior gluteal artery and its perforating branch were investigated with ultrasonic Doppler flow detector before operation,the posterior femoral composite tissue flap pedicled with inferior gluteal artery was designed according to the wound surface,and then the chronic sacrococcygeal wound was repaired.The operation time,intraoperative blood loss,wound healing,postoperative skin flap survival and occurrence of complications were recorded.The skin flap color,temperature and two-point discernability were monitored to evaluate skin flap sensory sensitivity.The visual analog scale(VAS)was used to evaluate the satisfaction of appearance.Results The operation time of patients was(2.8±0.1)hours and the intraoperative blood loss was(235.4±10.2)mL.The posterior femoral composite tissue flap pedicled with inferior gluteal artery of all the 11 patients survived.The distal part of the flap was necrotic in 1 case,which healed well after local debridement and suturing by amplification;other wounds healed well in the first stage without complications such as infection,fat liquefaction or hematoma.The skin flap has good color,soft texture,and good elasticity,with good healing in the donor area.There were significant differences in the skin flap temperature,two-point discernability and VAS score of appearance satisfaction between 12 months after operation and other time points(P＜0.05).Conclusion The posterior femoral composite tissue flap pedicled with inferior gluteal artery has a constant blood supply,without damage to the main blood vessels.It can be transposed at anterograde or retrograde direction,with simple operation and less damage,which can reconstruct flap sense,and has significant clinical efficacy in repairing huge sacrococcygeal pressure injuries.

OBJECTIVE: To investigate the clinical features and outcome of neonatal acute respiratory distress syndrome (ARDS) in southwest Hubei, China. METHODS: According to the Montreux definition of neonatal ARDS, a retrospective clinical epidemiological investigation was performed on the medical data of neonates with ARDS who were admitted to Department of Neonatology/Pediatrics in 17 level 2 or level 3 hospitals in southwest Hubei from January to December, 2017. RESULTS: A total of 7 150 neonates were admitted to the 17 hospitals in southwest Hubei during 2017 and 66 (0.92%) were diagnosed with ARDS. Among the 66 neonates with ARDS, 23 (35%) had mild ARDS, 28 (42%) had moderate ARDS, and 15 (23%) had severe ARDS. The main primary diseases for neonatal ARDS were perinatal asphyxia in 23 neonates (35%), pneumonia in 18 neonates (27%), sepsis in 12 neonates (18%), and meconium aspiration syndrome in 10 neonates (15%). Among the 66 neonates with ARDS, 10 neonates (15%) were born to the mothers with an age of ≥35 years, 30 neonates (45%) suffered from intrauterine distress, 32 neonates (49%) had a 1-minute Apgar score of 0 to 7 points, 24 neonates (36%) had abnormal fetal heart monitoring results, and 21 neonates (32%) experienced meconium staining of amniotic fluid. Intraventricular hemorrhage was the most common comorbidity (12 neonates), followed by neonatal shock (9 neonates) and patent ductus arteriosus (8 neonates). All 66 neonates with ARDS were treated with mechanical ventilation in addition to the treatment for primary diseases. Among the 66 neonates with ARDS, 10 died, with a mortality rate of 15% (10/66), and 56 neonates were improved or cured, with a survival rate of 85% (56/66). CONCLUSIONS Neonatal ARDS in southwest Hubei is mostly mild or moderate. Perinatal asphyxia and infection may be the main causes of neonatal ARDS in this area. Intraventricular hemorrhage is the most common comorbidity. Neonates with ARDS tend to have a high survival rate after multimodality treatment.
China ; Female ; Humans ; Infant, Newborn ; Meconium Aspiration Syndrome ; Pregnancy ; Respiratory Distress Syndrome, Newborn ; Retrospective Studies