阻断子宫动脉的腹腔镜筋膜内子宫切除术60例报告

目的探讨阻断子宫动脉的腹腔镜筋膜内子宫切除术(c lassic intrafasc ial supracervical hysterectomy,C ISH)的临床应用价值。方法子宫良性疾病60例在腹腔镜下分离出子宫动脉后钛夹夹闭,阻断子宫动脉后行筋膜内子宫切除术。结果手术均获成功,无中转开腹,无手术并发症。手术时间72~186 m in,(91.4±26.3)m in;术中出血量50~150 m l,(76.5±20.6)m l;术后肠功能恢复时间18~30 h;(22.7±5.8)h;24 h引流液50~160 m l,(80.5±31.8)m l。术后2例体温38.5℃,术后病率3.3%(2/60)。术后住院4~7 d。60例随访6~18个月,(10.6±4.2)月,3例在1~3个月阴道点滴出血,经抗感染、止血等治疗5~7 d治愈。结论阻断子宫动脉的腹腔镜筋膜内子宫切除术是C ISH的技术改进,并发症少,安全,效果好,值得临床推广。     

输尿管镜治疗输尿管结石185例

目的探讨输尿管镜气压弹道碎石治疗输尿管结石的效果。方法2004年2月～2005年3月，我们对185例输尿管结石（其中伴肾绞痛96例）采用输尿管镜取石或气压弹道碎石进行总结和分析。结果失败12例，其中6例改开放手术，6例术后3d行体外冲击波碎石。一次碎石成功率93．5％（173／185），其中上段结石为75．0％（24／32），中段为95．8％（46／48），下段为98．1％（103／105）。肾绞痛者成功率为100％（96／96）。术中输尿管损伤率2．9％（5／173），其中3例（1．7％）中转开放手术。术后肾绞痛1例。全组随访6～12个月，平均10．2月，无复发。结论输尿管镜气压弹道碎石安全有效，并发症少，是治疗输尿管中下段结石的首选方法，尤其对肾绞痛者疗效更好。     

Portal Setup: the Key Point in the Learning Curve for Hip Arthroscopy Technique

ObjectiveTo analyze the learning curve experience of hip arthroscopy based on patient demographics, surgical time, portal setup time, and postoperative complications and to find the key point in the learning curve.MethodsFrom May 2016 to February 2019, a prospective study on the learning curve experience of hip arthroscopy was performed in our hospital. We evaluated the first 50 consecutive hip arthroscopy procedures performed by a single surgeon. There were nine females and 41 males with a mean age of 30.8 years. We divide the patients into early group and late group according to the date of their operation, with each group including 25 patients. Data on patient demographics, types of procedure, surgical time, portal setup time, and postoperative complications were collected. Functional scores were assessed with the modified Harris Hip Score (mHHS).ResultsPatients were followed up for 16.4 months on average (range, 13–27 months). The early group of patients had a mean age of 35.2 years and the late group a mean age of 26.5 years. The most common procedures performed for the early group were debridement (17 patients, 68%), and in the late group, most patients underwent labral repair (18 patients, 72%). Mean total surgical time was 168 min for the early group and 143 min for the late group, and there was no statistically significant difference between two groups. The portal setup time in the early group and late group was 40.2 ± 12.4 min and 18.5 ± 6.2 min, respectively (P < 0.001), and the portal setup time was significantly longer in the early group. Further analysis of the learning curve of portal setup showed that the average portal setup time was not statistically significant changed after 30 cases. There were six complications including iatrogenic cartilage injury and iatrogenic labrum injury in the early group and five complications including perineal crush injury and nerve stretch injury in the late group. The functional score of patients in the late group was significantly higher than that in the early group during follow‐up.ConclusionThe steep learning curve of hip arthroscopy is mainly caused by the challenge of portal setup and portalrelated complications were more common in the early group than in the late group. Surgical time is not an effective indicator for evaluating progress on the learning curve of hip arthroscopy.     

Nanostructure of collagen fibrils in human nucleus pulposus and its correlation with macroscale tissue mechanics

Collagen fibrils are the main structural components of the nucleus pulposus tissue in the intervertebral discs. The structure–property relationship of the nucleus pulposus (NP) tissues is still unclear. We investigated the structure of individual collagen fibrils of the NP and evaluated its correlation with the bulk mechanical properties of the tissue. Collagen fibrils were extracted from the NP of discs retrieved from adolescents during scoliosis correction surgery, and the extracts were confirmed by SDS‐PAGE. The diameters of the individual collagen fibrils were measured through atomic force microscopy, and the compressive mechanical properties of the tissues were evaluated by confined compression. The correlations between the nanoscale morphology of the collagen fibrils and the macroscale mechanical properties of the tissues were evaluated by linear regression. The SDS‐PAGE results showed that the fibril extracts were largely composed of type II collagen. The mean diameter of the collagen fibrils was 92.1 ± 26.54 nm; the mean swelling pressure and compressive modulus of the tissues were 6.15 ± 4.3 kPa and 1.23 ± 0.7 MPa, respectively. The mean fibril diameter had no linear correlation (R² = 0.30) with the swelling pressure of the tissues. However, it had a mild linear correlation with the compressive modulus (p = 0.023, R² = 0.68). This is the first study, to our knowledge, to evaluate the nanostructure of the individual collagen fibrils of the nucleus pulposus and its relationship with macroscale mechanical properties of the NP tissues. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:497–502, 2010     

Action of IL‐1β during fracture healing

After bone injury, developmental processes such as endochondral and intramembranous ossification are recapitulated as the skeleton regenerates. In contrast to development, skeletal healing involves inflammation. During the early stages of healing a variety of inflammatory cells infiltrate the injured site, debride the wound, and stimulate the repair process. Little is known about the inflammatory process during bone repair. In this work, we examined the effect of a pro‐inflammatory cytokine, Interleukin‐1 beta (IL‐1β), on osteoblast and stem cell differentiation and on intramembranous and endochondral ossification, because IL‐1β exerts effects on skeletal homeostasis and is upregulated in response to fracture. We determined that IL‐1β stimulated proliferation of osteoblasts and production of mineralized bone matrix, but suppressed proliferation and inhibited differentiation of bone marrow derived MSCs. We next performed loss‐ and gain‐of‐function experiments to determine if altering IL‐1β signaling affects fracture healing. We did not detect any differences in callus, cartilage, and bone matrix production during healing of nonstabilized or stabilized fractures in mice that lacked the IL‐1β receptor compared to wild‐type animals. We observed subtle alterations in the healing process after administering IL‐1β during the early phases of repair. At day 10 after injury, the ratio of cartilage to callus was increased, and by day 14, the proportion of cartilage to total callus and to bone was reduced. These changes could reflect a slight acceleration of endochondral ossification, or direct effects on cartilage and bone formation. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:778–784, 2010     

MicroRNA-221 silencing predisposed human bladder cancer cells to undergo apoptosis induced by TRAIL

ObjectivesBladder cancer is the most common type of urologic cancer in Chinese males. The 5-year survival rate of advanced bladder cancer is approximately 20%–40%. There is an obvious urgent need for novel and effective therapies against bladder cancer. MicroRNAs (miRNAs) are a recently discovered class of noncoding RNAs; suppressing miRNA-221 might prove beneficial in several cancers. To explore novel and effective therapies against bladder cancer, we explored the effects of miRNA-221 silencing on the survival of bladder cancer cells.Materials and methodsNorthern blot analysis was used to determine miRNA-221 expression levels in bladder cancer T24 cells, RT4 cells and human normal urothelial cells. miRNA-221 was silenced with antisense oligonucleotides in T24 cells and pro-apoptotic effect of necrosis factor related apoptosis-inducing ligand (TRAIL) on miRNA-221-silenced cells was assessed with flow cytometry. The p27^kip1 protein expression in miRNA-221-silenced cells exposed to TRAIL was detected by Western blotting. The role of miRNA-221 silencing on T24 cell cycle phase distribution was investigated through flow cytometric analysis.ResultsHuman miRNA-221 was significantly up-regulated in bladder cancer T24 cells and RT4 cells compared to human normal urothelial cells. T24 cell was TRAIL-resistant cell line. MiRNA-221 silencing predisposed T24 cells to undergo apoptosis induced by TRAIL and resulted in an up-modulation of cyclin-dependent kinase inhibitor p27Kip1. MiRNA-221 suppression promoted the activation of caspase 3 induced by TRAIL in T24 cells.ConclusionsMiRNA-221 silencing rendered human bladder cancer T24 cells to undergo apoptosis induced by TRAIL. Our findings suggest a potential role of suppressing miRNA-221 in human bladder cancer therapy.     

Anterolateral thigh adipofascial flap for the restoration of facial contour deformities

From January 2000 to May 2008, 50 patients with facial contour deformities underwent soft tissue augmentation with 51 anterolateral thigh (ALT) adipofascial flaps. Fifty flaps survived with no complications; partial fat necrosis occurred in one flap. Mean follow‐up was 16 months. Flaps ranged from 10 × 6 cm to 20 × 12 cm. Perforators were found in 50 flaps, 43 musculocutaneous perforators (84.3%) and 7 septocutaneous perforators (13.7%), with a mean of 2.5 perforators per flap. In one flap (2.0%), no perforator was found. In this case, we used an anteromedial thigh adipofascial flap using the medial branch of the descending branch of lateral circumflex femoral artery as the vascular pedicle. Relatively symmetric facial contour was achieved in 20 cases. In 30 cases, adjunctive procedures including flap debulking, fat injection, and resuspension were necessary, and 23 patients achieved satisfactory outcomes. We conclude that the ALT adipofascial flap can be successfully elevated and transplanted for the correction of soft tissue facial defects. This flap can provide tissue to fill large defects, and posses the qualities of pliability, an excellent blood supply, ease of suspension and fixation, and minimal morbidity at the donor site. © 2010 Wiley‐Liss, Inc. Microsurgery 30:368–375, 2010.     

宏基因组二代测序技术在假体周围感染病原诊断中的应用

目的:探讨基于假体周围组织的宏基因组二代测序技术（metagenomic next-generation sequencing,mNGS）在关节置换术后假体周围感染（periprosthetic joint infection,PJI）的诊断效率和价值。方法:回顾性分析2019年6月至2020年6月接受髋或膝关节翻修术...     

紫外线致皮肤光老化及光癌变机制的研究进展

日光的累计照射可加速皮肤老化与癌变,使皮肤的生物学及临床反应发生改变,包括急性损伤(日晒伤)和慢性损伤(光老化、光癌变或色素沉着等)。文章概述了近年来紫外线对皮肤光老化及光癌变影响的研究进展,揭示光老化和光致癌机制是通过紫外线照射产生活性氧和DNA损伤,以及由此引起的细胞损伤、炎症、免疫抑制、细胞外基质重塑及血管生成改变所致,为临床防治光老化和光癌变提供帮助。