Objective:To explore the clinical efficacy of Masquelet technique combined with tissue flap transfer in the treatment of infectious composite bone and soft tissue defects in the early and middle stages after internal fixation for tibial fractures.Methods:From October 2017 to November 2020, 12 patients (13 tibial fractures) with infectious bone and soft tissue defects in the early and middle stages after internal fixation were treated in the Department of Orthopaedics, 988th Hospital of the Joint Logistics Support Force of CPLA by two-phased surgery with retaining internal fixation. Phase I procedures were thoroughly removal of the infected lesions and failed screws, preserving internal implants as many as possible, implantation of absorbable calcium sulphate and an antibiotics blended string of beads into the distal and proximal medullary cavity of the fractured bones, filling the bone defect and wrapping the internal implants with antibiotics loaded bone cement. The size of defects was 3.5 cm × 5.0 cm-7.5 cm × 14.5 cm, and the flaps for wound coverage sized 4.0 cm × 5.5 cm-8.0 cm × 15.0 cm. As for the repair of donor site, 8 limbs were sutured directly, 5 limbs could not be closed completely, and the remaining wounds were covered by skin grafting after suture. Based on well control of infection and stable clinical signs, fillings of bone cement were then removed in Phase II surgery, or 6-9 weeks after primary surgery. Autologous cancellous bone pieces or composite allogeneic bone were fully implanted around the induction membrane formed by Masquelet technique, and auxiliary steel plates were implanted for internal fixation of unstable fractures. After discharge, the patients visited the outpatient clinic regularly, and combined with Wechat follow-up. The texture, colour and bone healing were observed. At the last follow-up, the function of the affected limbs were assessed according to Johner-Wruhs evaluation standard.Results:After Phase I surgery, 13 flaps survived smoothly without vascular compromise. The wounds healed in Phase I. Two patients (2 sides) had recurrent infections. Re-debridement was performed and external fixation was applied after removal of internal fixation. After Phase II surgery, all patients were included in 12-26 months of follow-up, with an average of 18 months. Thirteen lower leg fractures healed well, and the time of bone healing was 16-25 (average 19.5) weeks. The Johner Wruhs criteria was used in evaluation of the function of affected limbs, and it was found that 6 patients were in excellent, 5 in good and 2 in fair.Conclusion:It is feasible while preserving the internal implants, to use membrane induction technique (Masquelet technique) combined with flap transfer, together with the absorbable calcium sulphate antibiotic sustained-release beads as a carrier in the phased treatment of infectious bone defects and bone exposure in the early and middle stages after the surgery of tibial internal fixation. It also gives a higher rate of excellence in surgical outcome. This study explores a treatment procedure for traumatic bone infection combined with composite soft tissue defects.

Objective:To investigate the efficacy of the nutrient vessel of medial and lateral sural subcutaneous nerve chimeric tissue flap based on posterior perforating branch of peroneal artery to repair the composite tissue defect in the Achilles tendon area.Methods:From January 2016 to June 2021, 12 patients suffering from infectious wound with defect of Achilles tendon were treated in the Department of Trauma and Microscopic Orthopaedics, 988th Hospital of the Joint Logistics Support Force of PLA. The area of soft tissue defect around Achilles tendon was 2.5 cm× 4.5 cm-8.0 cm×12.5 cm, and the length of the defect of Achilles tendon was 3.0-7.0 cm. The defect around the Achilles tendon were repaired with the nutrient vessel of medial and lateral sural subcutaneous nerve chimeric Achilles tendon flap (ATF) and the posterior perforating branch of peroneal artery was used as the vessel of blood supply. The size of flap was 3.0 cm×5.0 cm-9.0 cm×13.0 cm, and the size of the ATF was 3.0 cm×4.0 cm-3.0 cm×8.0 cm. The donor sites were sutured directly (8 cases) or repaired with skin graft (4 cases). External fixation were put on for 6 weeks after surgery. Then the external fixation was removed and the functional exercise gradually started. Outpatient clinic follow-ups were carried out regularly. Thermann Achilles tendon function assessment system was used to evaluate the last follow-up.Results:The chimeric ATF was harvested and the blood supply of each flap was good during the operation. There was no vascular crisis after surgery. The flaps survived smoothly and the wound achieved grade A healing. All patients were entered follow-up that lasted for 10-24 months. There was good appearance of flaps with minor bloating, and the colour of flaps was similar to the skin around the receiving site. The texture was soft with normal function of the lower legs and ankle. Tendon function was evaluated by Thermann Achilles tendon function assessment system, the result were 8 cases in excellent and 4 cases in good.Conclusion:The nutrient vessel of medial and lateral sural subcutaneous nerve chimeric tissue flap based on posterior perforating branch of peroneal artery can accurately repair a composite tissue defect in the Achilles tendon area, and it is one of the effective methods for the repair of a composite soft tissue wound with Achilles tendon defect.

OBJECTIVETo explore the clinical and prognostic features as well as treatment response of childhood B-cell non-Hodgkin's lymphoma/acute lymphoblastic leukemia (B-NHL/B-ALL), so as to better modify the treatment for further improving the prognosis.

METHODSThe clinical data of 43 patients with newly-diagnosed childhood B-NHL/B-ALL from July 2005 to December 2013 in West China Second Hospital of Sichuan University were retrospectively analyzed with particular focus on clinical presentations, laboratory findings and histology. Among them 26 patients received B-NHL-2010 protocol and 17 patients received LMB-89 protocol treatment. Kaplan-Meier method was used to compare the survival rates between groups, while multiple factor logistic regression was used to identify the prognostic factors.

RESULTS(1) The median age at diagnosis was 7.58 (2.42-13.67) years. The male-to-female ratio was 2.9 : 1. No significant difference was found in the median age at diagnosis between male and female children with B-NHL/B-ALL (P = 0.837). (2) Burkitt's lymphoma was the most common (34/43, 79.07%), followed by diffuse large B cell lymphoma (4/43, 9.3%), ALL-L3 (3/43, 6.98%) and others (2/43, 4.65%) in decreasing frequency. (3) According to St. Jude staging classification, 4 patients (9.30%) were divided into stage I, 9 patients (20.93%) into stage II, 23 patients (53.49%) into stage III and 7 patients (16.28%) into stage IV; (4) Clinically, the common predilection sites were as following: ileocecus (11/43, 25.58%), nasopharynx (10/43, 23.26%), faciomaxillary (9/43, 20.93%), superficial lymphadenopathy (8/43, 18.60%), other sites such as mediastinum and bone marrow (5/43, 11.63%). (5) With a median follow up of 24 months (0.7-105 months), the 2-year overall survival (OS) rate and event-free survival (EFS) rate were 79.8% ± 6.5%% and 71.0% ± 7.2%, respectively. The 2-year OS and EFS rates in patients treated with B-NHL-2010 protocol were 79.1% ± 8.4% and 74.1% ± 8.4%, while those in patients treated with LMB-89 protocol were 87.5% ± 8.3% and 66.7% ± 12.4%, respectively, but there was no significant difference between them (P > 0.05). The 2-year EFS rate in patients with LDH > 2N and bone marrow infiltration were significantly lower than that of other groups (P < 0.05). (6) 8 patients (18.6%) relapsed. The median relapsed time was 6 months (2-9 months). 1 patient suffered progressive disease. Male, systemic symptom, elevated LDH, bone marrow and CNS infiltration and advanced stage (stage III and stage IV) were associated with relapse /progressive disease. Logistic regression analysis showed that LDH > 2N was an independent unfavorable prognostic factors (OR = 31.129, P = 0.02).

CONCLUSIONOutcome of B-NHL/B-ALL is greatly improved by current intensive and short-time chemotherapy regimen. The 2-year event-free survival (EFS) rate is 71.0% ± 7.2%. There is no significant difference in EFS rate between patients treated with B-NHL-2010 protocol and LMB89 protocol. The long-term survival rate in patient with advanced disease need to be further improved.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Burkitt Lymphoma ; diagnosis ; drug therapy ; Child ; Cyclophosphamide ; therapeutic use ; Cytarabine ; therapeutic use ; Disease-Free Survival ; Doxorubicin ; therapeutic use ; Etoposide ; therapeutic use ; Female ; Humans ; Hydrocortisone ; therapeutic use ; Leucovorin ; therapeutic use ; Logistic Models ; Lymphoma, B-Cell ; diagnosis ; drug therapy ; Lymphoma, Large B-Cell, Diffuse ; diagnosis ; drug therapy ; Male ; Methotrexate ; therapeutic use ; Multivariate Analysis ; Neoplasm Staging ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; diagnosis ; drug therapy ; Prednisone ; therapeutic use ; Prognosis ; Retrospective Studies ; Survival Rate ; Vincristine ; therapeutic use

OBJECTIVETo determine the safety and efficacy of robotic mitral valve repair using da Vinci S Surgical system. Method From January 2007 to April 2011, over 400 cases of robotic cardiac surgery have been performed, in which 60 patients with isolated mitral valve insufficiency underwent robotic mitral valve repair, including 42 male and 18 female patients with a mean age of (44 ± 13) years (ranging from 14 to 70 years). Forty-eight patients were in NYHA class I-II and 12 patients in class III. Fourteen patients were concomitant with atrial fibrillation. Surgery approach was achieved through 4 right chest ports with femoral perfusion and Chitwood aortic occlusion. Antegrade cold blood cardioplegia was administered directly via chest for myocardial protection. The transesophageal echocardiography was used intraoperatively to estimate the surgical results.

RESULTSAll patients had successful valve repair including quadrangular resections, sliding plasties and chordal replacement. There was no conversion to median sternotomy. The mean cardiopulmonary bypass and arrested heart time were (132 ± 30) min and (88 ± 22) min. One patient had hemolysis after operation, and required mitral valve replacement. Echocardiographic follow-up revealed trace to mild regurgitation in 2 patients with a mean of (16 ± 9) months.

CONCLUSIONRobotic mitral valve repair is safe and efficacious in the patients with isolated mitral valve insufficiency.

Adolescent ; Adult ; Aged ; Cardiac Surgical Procedures ; methods ; Female ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery ; Robotics ; methods ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the safety and efficacy of robotic mitral valve surgery using da Vinci S system.

METHODSWe conducted a retrospective review of 60 robotic mitral surgeries from March 2007 to December 2010. Of the 60 patients, 44 underwent mitral valve repair and 16 received mitral valve replacement. The surgical approach was through 4 right chest ports with femoral and internal jugular vein cannulations. Transesophageal echocardiography was used intraoperatively to estimate the surgical results.

RESULTSNone of the cases required a conversion to a median sternotomy. The mean cardiopulmonary bypass and cardiac arrest time was 132.2∓29.6 min and 88.1∓22.3 min for robotic mitral valve repair, and was 137.1∓21.9 min and 99.3∓17.4 min for robotic mitral valve replacement. Echocardiographic follow-up of all the patients revealed 3 cases of slight regurgitation in mitral valve repair group.

CONCLUSIONIn selected patients with mitral valve disease, robotic mitral surgery can be performed safely.

Adolescent ; Adult ; Aged ; Female ; Heart Valve Prosthesis Implantation ; methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Mitral Valve ; surgery ; Mitral Valve Annuloplasty ; methods ; Mitral Valve Insufficiency ; surgery ; Retrospective Studies ; Robotics ; methods ; Surgery, Computer-Assisted ; methods ; Young Adult

Objective To establish an SD rats animal model for preventive nursing of pressure ulcer.Methods 30 healthy male SD rats were randomly and averagely divided into 6 groups, which were put in simple compression devices supinely after anesthesia, with their hind limb joints regarded as oppressed points.The pressure of each group was: 70, 64, 58, 53, 48 and 44mmHg, respectively. By observing skin color change after two hours of compression and then calculating LD50, the pressure that made half animals' compression skin red was obtained. Results No group had visible skin damages and other serious changes, but compression local skin redness was found. Under the experimental conditions, the pressure of the skin redness among half of the animals was 55.08 mmHg. Conclusions In this model, the most appropriate pressure was 55.08 mmHg. The SD rats pressure ulcer animal model is feasible and could be applied to animal studies on preventive nursing of pressure ulcer.

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

Objective To identify the differentially expressed gene profiles in myocardium of patients with heart failure using human whole genomic oligonucleotide microarray-assisted pathway analysis. Methods Phalanx whole genomic oligonucleotide microarrays were used to detect the gene expression profiles of myocardium in four patients died of heart failure and 4 brain died patients without heart diseases. The microarray findings were confirmed by real-time quantitative reverse transcriptase-polymerase chain reaction. The genes with a threshold of 1.2 times fold-change were selected and BioCarta Pathway and KEGG ( Kyoto Encyclopaedia of Genes and Genomes) pathway databases were used to identify functionally related gene pathways. Results A total of 2806 genes with differentially expression were detected between the failing and non-failing heart samples, expression changes of 399 genes were more than 2-folds. Eleven pathways were identified by BioCarta pathway database and sixteen athways were identified by KEGG PATHWAY Database. Conclusion Genomic microarray-assisted pathway analysis could help to identify gene expression profiles in failing heart.

OBJECTIVETo investigate the relationship between mTOR signaling pathway and ALK-positive lymphoid cell lines.

METHODSThe expression of the downstream effector proteins of mTOR were analyzed by Western blot before and after Karpas299, BaF3/NPM-ALK and BaF3 cell lines treated with rapamycin. Effect of rapamycin on cell proliferation was detected by MTT assay. FACS was used to analyze apoptosis and cell cycles.

RESULTSmTOR signaling phosphoproteins, p-p70S6K and p-4E-BP1 were highly expressed in ALK(+) Karpas299, BaF3/NPM-ALK and parental BaF3 cell lines, and they were dephosphorylated after 1 h withdrawal of IL-3 in BaF3 cells. After 48 h exposure to 10 nmol/L rapamycin, p-p70S6K and p-4E-BP1 proteins expression were decreased, and mainly for the former. The relative inhibitory rate to its control cells was 24.4% in Karpas299, 37.8% in BaF3/NPM-ALK and 61.6% in BaF3. The apoptotic ratio was increased from (11.97 +/- 0.11)% to (15.87 +/- 0.62)% in Karpas299 (P < 0.05), from (3.23 +/- 0.11)% to (7.67 +/- 0.49)% in BaF3 (P < 0.05) and from (1.90 +/- 0.47)% to (2.80 +/- 0.27)% in BaF3/NPM-ALK (P > 0.05). The fraction of G(1) phase cells increased from (37.63 +/- 1.91)% to (69.77 +/- 5.44)% in BaF3/NPM-ALK, from (31.13 +/- 2.51)% to (40.70 +/- 1.47)% in Karpas299 and (53.57 +/- 2.22)% to (63.70 +/- 1.20)% in BaF3 (P < 0.05).

CONCLUSIONNPM-ALK kinase can activate mTOR signaling pathway. Rapamycin can inhibit the proliferation of ALK(+) lymphoid cells by blocking mTOR signaling pathway and inducing cell cycling arrest at G(1) phase.

Animals ; Apoptosis ; drug effects ; Cell Cycle ; drug effects ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Humans ; Intracellular Signaling Peptides and Proteins ; metabolism ; Lymphoma ; metabolism ; pathology ; Mice ; Protein-Serine-Threonine Kinases ; metabolism ; Protein-Tyrosine Kinases ; metabolism ; Receptor Protein-Tyrosine Kinases ; Ribosomal Protein S6 Kinases, 70-kDa ; metabolism ; Signal Transduction ; drug effects ; Sirolimus ; pharmacology ; TOR Serine-Threonine Kinases

Child ; Female ; Humans ; Lymphomatoid Papulosis ; Skin Neoplasms