Objective To evaluate the effectiveness, safety, cost and optimal dosing regimen of bone morphogenetic protein (BMP) used in the lumbar spine arthrodesis. Methods We formulated the clinical questions according to the PICO principle. We searched the ACP Journal Club (1991 to February 2008), The Cochrane Library (Issue 4, 2007) and PubMed (1990 to February 2008) as well as other relevant databases. The evidence retrieved was critically appraised. Results Current evidence showed that BMP was a satisfactory and safe behavior in lumbar arthrodesis. Its cost was equal to that of autogenous iliac bone graft. The types of BMP currently used in clinical practice are BMP-2 and BMP-7. Finished product of fixed composition ratio was recommended in anterior lumbar inter-body fusion, while in posterolateral fusion, 20mg of BMP-2 or 3.5mg of BMP-7 for each side was recommended, with proper carrier according to the place where it was used. Conclusion BMP may be introduced to China for lumbar spine arthrodesis. Before it is applied extensively, further large-scale, high-quality randomized controlled trials are needed. Meanwhile, more research is necessary to determine the proper dosage and preparation form for the dominant Chinese population.
Objective To understand status of technical realization, present development, faced problems, and application prospects of reduced-port laparoscopic surgery for rectal cancer, and to analyze safety and feasibility so as to provide theoretical and practical basis for clinical application and promotion. Method By searching the databases such as Medline, Embase, and Wanfang, etc., the relevant literatures about reduced-port laparoscopic surgery for rectal cancer were collected and reviewed. Results At present, the most common reduced-port laparoscopic surgery was the 1-port laparoscopic surgery, 2-port laparoscopic surgery, and 3-port laparoscopic surgery. The 1-port laparoscopic surgery had the effects of minimal invasiveness and cosmesis, but it was difficult to perform. The 2-port laparoscopic surgery for rectal cancer preserved as far as possible the effect of minimal invasiveness, the difficulty of procedure was reduced greatly, which was easy to be learnt and promoted. The experience of the 3-port laparoscopic surgery for rectal cancer contributed to the technical development of the 1-port laparoscopic surgery, with no need for the assisted incision for intraoperative specimen. The reduced-port laparoscopic surgery for rectal cancer was technically feasible and safe, which possessed the equal or better short-term outcomes as compared with the conventional 5-port laparoscopic or open surgery beside the radical resection for rectal cancer. However, the stringent technique for the laparoscopic surgery was necessary and it needed to overcome the learning curve. Conclusions Reduced-port laparoscopic surgery has some obvious advantages in minimal invasiveness, cosmesis, and enhanced recovery. More large-sample, multi-center, randomized controlled trials are eager to further confirm safety, effectiveness, and feasibility of reduced-port laparoscopic surgery for rectal cancer.
In this paper, we established magnetic fluid hyperthermia (MFH) model for rat tumor using the finite element software COMSOL based on the linear response theory. By analyzing four kinds of magnetic medium within relaxation mechanism, such as Fe3O4、FeCo、fccFePt and L10FePt, we studied the influence of the change of magnetic medium radius on dissipation power and temperature field, respectively. At the same time, the optimization method for the parameters of several magnetic medium is proposed, and the applications of four kinds of magnetic medium are given as well. By increasing the dissipation power of the magnetic medium as much as possible, the dose of magnetic medium used in the treatment can be reduced, meanwhile, the adverse effects on health tissue surrounding the tumor will be minimized. The conclusions of this paper can provide reference for magnetic medium preparation applied to MFH.
ObjectiveTo quantitatively determine the levels of type Ⅰ and type Ⅱ collagen mRNA in the intervertebral disc cartilage endplate of injured animal model, and to clarify the cytological function of intervertebral disc chondrocytes during fibrosis repair after intervertebral disc injury.MethodsForty healthy New Zealand rabbits were randomly divided into fibrosus puncture group, upper cartilage endplate single puncture group, upper and lower cartilage endplate multiple puncture group, and sham group. Two experimental animals were randomly selected from each group on the 2nd day, and the 2nd, 8th, 12th, and 24th week after the animal modeling operation to obtain intervertebral disc specimens. The levels of type Ⅰ collagen and type Ⅱ collagen in cartilage endplate cells of the intervertebral disc were determined by reverse transcriptase polymerase chain reaction (PCR). RNA was extracted from the endplate of the intervertebral disc, and the RNA concentration and the ratio of RNA concentration to protein concentration were determined by nucleic acid analyzer. Reverse transcription was performed by Revertaid M-Mulv reverse transcriptase, type Ⅰ and type Ⅱ collagen primers were designed to establish a PCR reaction system, 2% agarose gel electrophoresis (120 V, 40 min) was prepared by using 0.5×TBE electrophoresis buffer. The amplification results were observed under ultraviolet light, and the gray values of different electrophoresis bands were determined.ResultsThe level of type Ⅰ collagen mRNA in each operation group showed a progressive increase after 8 weeks, and the magnitude of the increase was related to the degree of injury. The level of type Ⅱ collagen mRNA showed a transient increase in the fibrosis puncture group and the upper endplate single-puncture group in the first two weeks after the endplate punctures were completed, and then began to decline progressively; in the multiple puncture group, it showed a downward trend from the beginning of the operation. ConclusionsThe synthesis of type Ⅰ collagen in chondrocytes of the injured nucleus pulposus tissue continues to increase with time, while the synthesis of type Ⅱ collagen begin to decrease progressively after a small increase. The formation and change of type Ⅰ and type Ⅱ collagen in injured intervertebral disc chondrocytes are different from natural degeneration.
Objective To verify the predictive value of Sino System for Coronary Operative Risk Evaluation（SinoSCORE） on quality of life in patients undergoing coronary artery bypass graft （CABG） surgery. Method A total of 234 patients in Peking University People’s Hospital undergoing CABG between November 2008 and September 2010 hadcompleted the preoperative and 6-month postoperative Short Form-36 （SF-36）. There were 172 （73.5%） male patients and63 （26.5%） female patients. The average age was 63.0±10.1 years. According to the SinoSCORE， 234 patients were dividedinto three groups：low risk （SinoSCORE score less than 1 point，n=67）， medium risk （SinoSCORE score 2-5 points，n=77） and high risk （SinoSCORE score more than 6 points，n=90） group. Clinical information of the 234 patients was collected， andthe score values of all patients were calculated according to the SinoSCORE model. Statistic methods were performed toevaluate the relationship between quality of life and SinoSCORE. Results The postoperative quality of life have improvedsignificantly， but the improvement of quality of life have no significantly different between groups. There was statisticallysignificant correlation between quality of life and SinoSCORE （P＜0.05， r value at-0.150 to 0.255）.Linear regression analysis showed that SinoSCORE was significantly collected with quality of life in multiple subgroups （P＜0.05， r 2＜0.1） .Conclusion SinoSCORE have statistically correlated with quality of life， and have certain but limited predictive value on quality of life in CABG patients.
Objective The rel iable animal model of intervertebral disc degeneration, can provide important experimental carrier to research pathogenesis and treatment of intervertebral disc degeneration. To establ ish three kinds of injury induced rabbit intervertebral disc degeneration models and to compare the characteristics among them by using biochemical and radiological methods. Methods Twenty-five healthy New Zealand white rabbits (weighing 2.0-2.5 kg) were randomly divided into 5 groups (n=5). The L3, 4, L4, 5 and L5, 6 discs in each rabbit were used for study. Groups A and B were forannulus puncture with an 18-gauge needle and a 22-gauge needle, respectively; group C was for nucleus aspiration; group D was for endplate injury and group E was used as a control. The lumbar spinal plain radiographs and magnetic resonance images (MRI) were evaluated, the raltive height of intervertebral disc was measured and the grades of disc degeneration were recorded 2, 4, 8, 16, and 32 weeks after operation. The water and the sulfated-glycosaminoglycan (s-GAG) contents of the nucleus were measured after sacrifice (randomly choose one rabbit from each group at each time point). Results In groups A, B, C and D, the height of intervertebral space in plain radiograph gradually decreased after operation. The anterior bony excrescences of vertebral body and varying degrees of calcification of endplate were also observed. The signal intensity of disc in T2-weighted magnetic resonance imaging decreased with time too. Compared with group E, the significant changes of height of intervertebral discs and grades of disc degeneration in MRI occurred at different time points within 4 weeks in groups A-D (P lt; 0.05). The significant change in groups C and D occured earl ier than in groups A and B. The water and s-GAG contents of discs decreased gradually in groups A-D after operation, while the significant change occurred at varying time points within 8 weeks compared with group E (P lt; 0.05). The apparent downward trend in groups C and D occured earl ier than in groups A and B. Conclusion All three methods are successful in inducing intervertebral disc degeneration. The degenerative process induced by endplate injury and nucleus aspiration is faster and more severe than that induced by annulus puncture.
ObjectivesTo develop an orthotopic xenografts model that can dynamically observe the growth of rectal cancer and lymphatic metastasis, and to preliminarily explore the feasibility of monitoring the growth and metastasis of rectal cancer by in vivo imaging system.MethodsAn orthotopic xenografts model was developed in nude mouse by rectal submucosal injection of red fluorescent protein-labeled human colorectal adenocarcinoma cell line HCT 116. Then, the fluorescence signal from cancer cells was collected at different time points by means of in vivo imaging system, and the growth and metastasis of cancer cells in the rectum of nude mice was observed in real time. Finally, the model was evaluated by pathology.ResultsFifty visualized nude mouse models of orthotopic implantation and lymphatic metastasis were successfully constructed. At 2-7 weeks after implantation, the fluorescent protein of tumor were observed in all nude mouse with in vivo imaging system. After the orthotopic implantation, the volume of the transplanted tumor grew with the extension of time, and the integrated density expanded gradually. The number of caudal mesenteric lymph node metastases, para-aortic lymph node metastases, liver metastases and lung metastases increased time-dependent. The results of histological study was consistent with depending on lymph nodes to express fluorescent proteins to determine metastasis.ConclusionsIt is reliable and feasible to visualize the orthotopic implantation and lymphatic metastasis model of nude mice. The in vivo imaging system is simple and effective for real-time, non-invasive and dynamic observation of the growth of orthotopic xenografts and lymphatic metastasis in nude mice.
Objective To investigate surgical outcomes and prognostic factors for patients with coronary heart disease and low left ventricular ejection fraction （LVEF≤40%） undergoing off-pump coronary artery bypass grafting （OPCAB）. Methods We retrospectively analyzed clinical records of 63 discharged patients with coronary heart disease and low LVEF who underwent OPCAB in Peking University People’s Hospital from 2001 to 2004 year. There were 48 males and 15 females with mean age of 65.1±9.2 years and mean LVEF of 33.8%±5.0%. Regular follow-up evaluation was completed. We investigated risk factors for long-term survival of the patients by Kapalan-Meier survival curve, log-rank test and Cox regression model.?Results?Follow-up time was 3-107 （71.3±24.4） months, and six patients were lost during the follow-up. Nineteen patients （30.2%） died during follow-up including 10 patients （15.9%） who had cardiac-related death. The survival rate at 1, 3, 5 and 8 year was 96.7% （61）, 94.9% （60）, 85.9% （55）, 77.2% （53） respectively. Univariate analysis shows LVEF≤30% and acute myocardial infarction within 30 days are risk factors for long-term survival（P＜0.05）. Cox regression analysis showed that LVEF≤30%（RR=4.662, P＜0.05）and acute myocardial infarction within 30 days（RR=5.544, P＜0.05）were two independent risk factors for cardiac-related death after discharge. Conclusion Patients with coronary heart disease and low LVEF can have satisfactory surgical outcomes after OPCAB. LVEF≤30% and acute myocardial infarction within 30 days are the two independent risk factors for cardiac-related death after discharge.
Objective To evaluate the safety of conversion from external fixation to internal fixation for open tibia fractures. Methods Between January 2010 and December 2014, 94 patients (98 limbs) with open tibia fractures were initially treated with external fixators at the first stage, and the clinical data were retrospectively analyzed. In 29 cases (31 limbs), the external fixators were changed to internal fixation for discomfort, pin tract response, Schantz pin loosening, delayed union or non-union after complete wound healing and normal or close to normal levels of erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and the leucocyte count as well as the neutrophil ratio (trial group); in 65 cases (67 limbs), the external fixators were used as the ultimate treatment in the control group. There was no significant difference in gender, age, side of the limbs, interval from injury to the first debridement, initial pathogenic bacteria, the limbs that skin grafting or flap transferring for skin and soft tissue defect between the two groups ( P>0.05). The incidence of Gustilo type III fractures in the control group was significantly higher than that in the trial group (P=0.000). The overall incidence of infection was calculated respectively in the two groups. The incidence of infection according to different fracture types and whether skin grafting or flap transferring was compared between the two groups. The information of the pathogenic bacteria was recorded in the infected patients, and it was compared with the results of the initial culture. The incidence of infection in the patients of the trial group using different internal fixation instruments was recorded. Results The overall incidences of infection for the trial and control groups were 9.7% (3/31) and 9.0% (6/67) respectively, showing no significant difference (χ2=0.013, P=0.909). No infection occurred in Gustilo type I and type II patients. The incidence of infection for Gustilo type IIIA patients in the trial group and the control group were 14.3% (1/7) and 6.3% (2/32) respectively, showing no significant difference (χ2=0.509, P=0.476); the incidence of infection for type IIIB patients in the two groups were 50.0% (2/4) and 14.3% (2/14) respectively, showing no significant difference (χ2=2.168, P=0.141); and the incidence of infection for type IIIC patients in the two groups were 0 and 16.7% (2/12) respectively, showing no significant difference (χ2=0.361, P=0.548). Of all the infected limbs, only 1 limb in the trial group had the same Staphylococcus Aureus as the result of the initial culture. In the patients who underwent skin grafting or flap transferring, the incidence of infection in the trial and control groups were 33.3% (2/6) and 13.3% (2/15) respectively, showing no significant difference (χ2=1.059, P=0.303). After conversion to internal fixation, no infection occurred in the cases that fixed with nails (11 limbs), and infection occurred in 4 of 20 limbs that fixed with plates, with an incidence of infection of 20%. Conclusion Conversion from external fixation to internal fixation for open tibia fractures is safe in most cases. However, for open tibia fractures with extensive and severe soft tissue injury, especially Gustilo type III patients who achieved wound heal after flap transfer or skin grafting, the choice of secondary conversion to internal fixation should carried out cautiously. Careful pre-operative evaluation of soft tissue status, cautious choice of fixation instrument and meticulous intra-operative soft tissue protection are essential for its safety.
ObjectiveTo compare the short-term outcome of 3-port and 5-port laparoscopic assisted radical resection for middle and high rectal cancer.MethodsWe retrospectively analyzed the clinical characteristics of 67 patients with middle and high rectal cancer who were treated in the Gastrointestinal Ward of Center of General Surgery in General Hospital of Western Theater Command of the Chinese People’s Liberation Army from January 2018 to December 2018. The operative, pathological, recent postoperative related indicators, and follow-up results of the two groups were compared and analyzed.ResultsAmong all the enrolled patients, 33 cases received 3-port laparoscopic surgery (3-port group) and 34 cases received 5-port laparoscopic surgery (5-port group). The total length of incision and the pain score of the Visual Analog Scale (VAS) on the 3rd postoperative day of the 3-port group were significantly better than those of the 5-port group (P<0.05). Peripheral incisal margins were negative in both two groups. However, there were no statistically significant differences in indicators such as operative time, intraoperative blood loss, operative conversion rate, hospitalization expenses, length of the distal margins, number of positive lymph nodes, number of lymph nodes harvested, time to the first flatus, time to the first ambulation, time to urinary catheter removal, time to drainage tube removal, time to the first oral intake, postoperative hospital stay, and postoperative complication rate (P>0.05). Thirty cases of the 3-port group were followed up for 12–24 months (median of 19 months), as well as 29 cases of 5-port group were followed up for 12–24 months (median of 19.5 months). There were no significant differences on the incidences of intestinal obstruction, local recurrence, distant metastasis, and death between the two groups (P>0.05).ConclusionCompared with the conventional 5-port laparoscopic surgery, the 3-port laparoscopic surgery could shorten the total length of incision and reduce the surgical trauma, suggesting that it is safe and effective.