单纯后路多个全脊椎切除矫治严重脊柱侧、后凸畸形

目的评价严重脊柱侧、后凸畸形单纯后路多节段全脊椎切除,侧后凸畸形矫正技术的手术矫治效果和临床风险性。方法2003年1月~2001年1月,本院骨科收治38例严重脊柱侧、后凸畸形患者,全部病例均采用单纯后路多节段全脊椎切除的方法。全部病例手术前均行站立位X线脊柱全长片、核磁共振和三维CT重建等辅助检查,计算手术时间、出血量,观察手术前后侧后凸的矫正率、术中脊柱短缩,手术后整体平衡情况。结果本组患者均进行1.5~3个椎体的全脊椎切除,术中测量脊柱短缩42 mm(31~62 mm),手术平均用时348 m in(280~510 m in),手术中平均出血量2010 m l(1400~3200 m l)。全部病例经过1~2.5年的随访,侧凸畸形cobb角平均矫正率为56.3%(51.2%~64.2%);后凸畸形平均矫正率为75.6%(67.8%~81.4%)。所有患者躯干平衡良好,未发现失代偿现象。手术并发症包括3例出现一过性的脊髓损伤症状(1例一过性双侧下肢不全瘫、2例一过性单侧下肢不全瘫)和6例神经根性疼痛,未经特殊处理恢复正常,4例肠系膜上动脉综合症,经胃肠减压处理症愈。结论对于严重成人脊柱侧、后凸畸形患者,单纯后路顶椎附近多个椎体全脊椎切除技术三维矫正效果满意,安全有效。     

Efficacy of negative pressure therapy to enhance take of 1-stage allodermis and a split-thickness graft

Negative pressure therapy has been used in various conditions to promote wound healing. It has also been used to secure a skin graft by improving microcirculation and providing tight adhesion between the graft and the recipient bed. The authors coupled the idea of negative pressure therapy for 1-stage allodermis and a split-thickness skin graft. This prospective study presents 47 cases of skin defects treated by 1-stage allodermis and a split-thickness skin graft. The patients were divided into 2 groups either treated with simultaneous aid of negative pressure therapy for 5 days (group 1, n = 37) or a classic tieover dressing (group 2, n = 10). In group 1, 97.8% graft take was noted at day 5 and the mean time until complete healing was 5.8 days. In group 2, 84% graft take was noted at day 5 and mean time until complete healing was 8.9 days with an average number of 3.2 dressings. Statistically significant graft take (day 5) and time until complete healing was noted (P < 0.05). Good aesthetic and functional result mimicking a full-thickness skin graft was achieved in both groups. However, frequent dressings, longer time to heal, and more restriction to the graft site were needed for group 2. Split-thickness skin added to allodermis provided a sufficient amount of dermis to prevent contracture, and the negative pressure therapy ensured fast and complete take of the 2-layered composite graft. This option can be used to achieve healing mimicking a full-thickness skin graft without requiring large full-thickness donor sites.     

Maximizing the benefits of antiretroviral therapy for key affected populations

Introduction

Scientific research has demonstrated the clinical benefits of earlier initiation of antiretroviral treatment (ART), and that ART can markedly reduce HIV transmission to sexual partners. Ensuring universal access to ART for those who need it has long been a core principle of the HIV response, and extending the benefits of ART to key populations is critical to increasing the impact of ART and the overall effectiveness of the HIV response. However, this can only be achieved through coordinated efforts to address political, social, legal and economic barriers that key populations face in accessing HIV services.

Discussion

Recent analyses show that HIV prevalence levels among key populations are far higher than among the general population, and they experience a range of biological and behavioural factors, and social, legal and economic barriers that increase their vulnerability to HIV and have resulted in alarmingly low ART coverage. World Health Organization 2014 consolidated guidance on HIV among key populations offers the potential for increased access to ART by key populations, following the same principles as for the general adult population. However, it should not be assumed that key populations will achieve greater access to ART unless stigma, discrimination and punitive laws, policies and practices that limit access to ART and other HIV interventions in many countries are addressed.

Conclusions

Rights-based approaches and investments in critical enablers, such as supportive legal and policy environments, are essential to enable wider access to ART and other HIV interventions for key populations. The primary objective of ART should always be to treat the person living with HIV; prevention is an important, additional benefit. ART should be provided only with informed consent. The preventive benefits of treatment must not be used as a pretext for failure to provide other necessary HIV programming for key populations, including comprehensive harm reduction and other prevention interventions tailored to meet the needs of key populations. An end to AIDS is only possible if we overcome the barriers of criminalization, stigma and discrimination that remain key drivers of the HIV epidemics among key populations.     

Pancreaticoduodenectomy with En Bloc Portal Vein Resection for Pancreatic Carcinoma with Suspected Portal Vein Involvement

Pancreaticoduodenectomy combined with portal vein resection is increasingly accepted as a viable treatment option for pancreatic carcinoma with suspected involvement of the portal vein.However, its clinical benefit remains controversial. This study evaluated the outcomes of pancreaticoduodenectomy with portal vein resection for pancreatic carcinoma in a group of Chinese patients operated on by a specialized team in a center with a low case volume of pancreatic cancer. The perioperative and long-term outcomes of 12 patients with portal vein resection for suspected involvement of the portal vein and 38 patients who underwent pancreaticoduodenectomy without portal vein resection during the same period were compared. In the former group, eight patients underwent segmental resection, and four patients underwent wedge resection of the portal vein. There were no significant differences in operative blood loss (median 0.8 vs. 0.8 liter, p = 0.313), hospital mortality (0% vs. 2.6%, p = 1.000), or operative morbidity (41.7% vs. 42.1%, p = 0.979) between the two groups. Patients who required portal vein resection had higher frequencies of microscopic lymphatic permeation (58.3% vs. 18.4%, p = 0.023) and vascular invasion (50.0% vs. 15.8%, p = 0.025). Long-term survival was comparable between patients with portal vein resection and those without it (median 19.5 vs. 20.7 months, p = 0.769). These findings suggest that pancreaticoduodenectomy combined with portal vein resection can be performed safely by a specialized team in a center with a low case volume of pancreatic carcinoma and that it may offer survival benefit in patients with suspected portal vein involvement.     

Monitoring systemic donor lymphocyte macrochimerism to aid the diagnosis of graft-versus-host disease after liver transplantation

BACKGROUND: The diagnosis of graft-versus-host disease (GvHD) after liver transplantation can be difficult because early symptoms are often nonspecific. In this study, the presence of donor lymphocyte macrochimerism in recipient peripheral blood was examined as a diagnostic aid for GvHD after cadaveric donor liver transplantation. METHODS: Between 1996 and 2002, 33 liver transplant recipients with a clinical suspicion of GvHD (skin rash, diarrhea, pyrexia, pancytopenia, or anemia, without an obvious alternative cause) were investigated for peripheral blood donor lymphocyte macrochimerism. Donor macrochimerism was determined at the time of first clinical presentation by a low-sensitivity polymerase chain reaction (PCR) to detect donor human leukocyte antigen (HLA) alleles using genomic DNA extracted from recipient peripheral blood. Where donor HLA alleles were detected, the percentage of donor T cells was quantified by two-color flow cytometric analysis using antibodies specific for mismatched donor and recipient HLA alleles. The relationship between the presence or absence of donor lymphocyte macrochimerism and final diagnoses based on clinical and histological criteria was examined. RESULTS: Seven of the 33 patients were PCR positive for donor HLA alleles. All had macrochimerism, with donor T lymphocyte levels ranging from 4% to 50% of circulating lymphocytes. All seven patients had normal liver function tests, skin rash, and diagnosis of GvHD histologically confirmed by skin or gut biopsies. Twenty-six patients were PCR negative, and, in 23, an alternative diagnosis was eventually established. The remaining three patients made a rapid and spontaneous recovery with no further symptoms suggestive of GvHD. CONCLUSIONS: Donor lymphocyte macrochimerism was present in all patients in whom the diagnosis of GvHD was confirmed. In patients with symptoms consistent with GvHD and a negative PCR for donor HLA, an alternative diagnosis was eventually established or the patients recovered spontaneously. Detection of donor HLA alleles in recipient peripheral blood by PCR is a useful diagnostic tool for GvHD after liver transplantation.     

Methodical placement of mesh during endoscopic extraperitoneal inguinal hernioplasty

Endoscopic extraperitoneal inguinal hernioplasty has been gaining in popularity worldwide recently. Placement of mesh remains a technically challenging part of the procedure. This paper describes a systematic method for the placement of mesh during endoscopic inguinal hernioplasty. To broaden the endoscopic view and maximize working space, the mesh should be kept far from the telescope within the limited extraperitoneal space. Unfolding the mesh requires prior stabilization of the mesh at one point, to avoid uncontrolled migration of the whole mesh and subsequent loss of mesh orientation. Mastering the skill of two‐handed technique is essential for coordinated manipulation and expeditious mesh placement. Before concluding the procedure, a trial of deflation can help to ensure appropriate repositioning of the peritoneum without displacement of the mesh. Chinese Abstract

Figure Chinese Abstract Open in figure viewer PowerPoint

Volume 6 , Issue 1 February 2002

Pages 18-21     

新型定位板在经椎间孔腰骶神经根封闭术术前定位中的应用

目的 :探讨新型定位板应用在腰椎后外侧经椎间孔腰骶神经根封闭术的术前定位中的有效性、可靠性。方法:2015年3月~2016年3月收治腰椎退行性疾病患者102例,其中单节段腰椎间盘突出症51例,单节段腰椎管狭窄症42例,经皮内窥镜下腰椎间盘切除术后症状复发9例,采用随机数字表随机分入两组后行腰椎后外侧经椎间孔腰骶神经根封闭术。A组54例,手术节段为L3/4 8例、L4/5 28例、L5/S1 18例,采用新型定位板术前定位;B组48例,手术节段为L3/4 8例、L4/5 26例、L5/S1 14例,采用金属定位针术前定位。两组患者年龄、性别、手术节段、保守治疗时间均无统计学差异(P0.05)。记录两组术前的透视次数和准备时间、穿刺时间、穿刺期透视次数、手术并发症、穿刺术后1h穿刺区疼痛VAS评分,并进行统计学分析。结果:A组术前的准备时间为5.2±1.0min、透视次数为1.1±0.3次,穿刺时间9.6±2.2min,穿刺期透视次数3.1±1.0次;B组术前的准备时间为10.7±2.3min、透视次数为3.8±1.2次,穿刺时间16.3±3.3min,穿刺期透视次数4.6±0.6次,两组比较均有统计学差异(P0.05),A组均优于B组。两组均未出现椎管内血肿、腹腔脏器损伤、下肢感觉和运动功能异常,B组出现硬膜刺裂1例(1/48)、穿刺区域皮下血肿4例(4/48),两组并发症发生率无统计学差异(P0.05);术后1h穿刺区域疼痛VAS评分,A组为3.4±0.5分,B组为5.0±0.9分,有统计学差异(P0.05)。结论:对于经椎间孔腰骶神经根封闭术,使用新型定位板术前定位,并进行穿刺路径设计,可减少术前透视次数、术前准备时间,有助于缩短穿刺时间及穿刺期透视次数,定位板具有使用方便、可靠、有效等优点。     

髓样相关蛋白14真核表达载体的构建及其细胞内定位研究

目的:构建小鼠髓样相关蛋白14(MRP14)的真核表达载体,观察其在NIH3T3细胞中的表达定位情况。方法:提取BALB/c小鼠肝脏组织的总RNA,通过逆转录-聚合酶链反应(RT-PCR)扩增得到MRP14编码序列。然后将该编码序列克隆到带有血凝素(HA)标记的载体pcDNA3-HA上,随后转染NIH3T3细胞,在荧光显微镜下观察结果。结果:重组质粒经聚合酶链反应(PCR)、酶切和测序鉴定证明构建正确。转染实验发现,该质粒能够在NIH3T3细胞中表达,表达产物主要定位在细胞质中。结论:成功构建带HA标签的MRP14真核表达载体。该载体能在哺乳动物细胞中有效表达并正确定位,为下一步深入研究MRP14作用细胞的信号通路提供了一个重要工具。     

巨噬细胞对内皮细胞系同源盒B2基因和血管内皮生长因子受体mRNA及整合素αvβ3表达的影响

目的　体外观察巨噬细胞(M)对血管内皮细胞同源盒(HOX)B2基因mRNA和血管内皮生长因子(VEGF)受体KDRmRNA及整合素ανβ3表达的影响。　方法　体外培养人脐静脉血管内皮细胞系ECV304,分为(1)ECV304组; (2)ECV304 伴刀豆球蛋白A(conA,终浓度25mg/L)组; (3)ECV304 人M系U937组:ECV304细胞中加入1×105 /mlU937细胞; (4)ECV304 U937 conA组:ECV304中加入1×105 /mlU937细胞及终浓度25mg/L的conA.反应48h后,用免疫荧光技术检测各组ECV304细胞整合素ανβ3的表达情况,并用逆转录聚合酶链反应(RT PCR)技术检测细胞KDRmRNA和HOXB2基因mRNA的表达水平。　结果　ECV304组细胞的整合素ανβ3、KDRmRNA及HOXB2基因mRNA的表达水平分别为6. 7±1. 5、0. 633±0. 012、0. 674±0. 004。ECV304 U937 conA组细胞上述指标较ECV304组均明显上调(P<0. 01 ),分别为10. 2±1. 7、0. 879±0 003、0. 947±0 003。其余两组细胞上述指标与ECV304组比较,差异均无统计学意义(P>0. 05).结论　被conA活化的M通过影响内皮细胞的KDRmRNA、HOXB2mRNA基因及整合素ανβ3的表达,来促进内皮细胞增殖、迁移及与基质黏附,从而调节血管生成。     

Effective component from verbena officinalis L.inhibits proliferation and induces apoptosis of human choriocarcinoma JAR cells

<正> Objective:To examine the action of the effective component,4'-methylether-scutellarein,from Verbena officinalis L.(VOL)on the proliferation and apoptosis of human choriocarcinomaJAR cells.Methods:Cell proliferation was measured by MTT[3-(4,5-dimethylthiazol-2-yl)-2,5-di-phenyl tetrasodium bromide,MTT]assay and the incorporation of tritiated thymidine(~3H-TdR).Apoptosis of cell was evaluated by flow cytometry(FCM)and the characteristic apoptoticDNA ladder by agarose gel electrophoresis,and the morphological changes of apoptotic JAR cellswere observed under fluorescence microscopy and electron microscopy(EM).Expressions of ap-optosis proteins,poly(ADP-ribose)polymerase(PARP)and caspase-3,-8,and -9 were deter-mined with Western blot.Results:The effective component from VOL inhibited the proliferation of JAR cells in a dose-and time-dependent manner.The treated cell cycle was arrested in S phase and an apoptotic peakwas found in S phase using FCM analysis.A typical DNA ladder appeared in the treatment groupwhen analyzed by agarose gel electrophoresis.Using fluorescence microscopy,the percentage ofapoptotic cell was 0.9%,6%,and 14% after treatments of 10,20,and 40 mg·L~(-1) of the effec-tive component,respectively,for 48 h.Typical apoptotic changes,such as condensed chromatinand presence of apoptotic bodies,were observed under EM.Treatment with effective componentfor 48 h and 72 h also induced protein expression of PARP and caspase-3,-8,and -9 as seen byWestern blot.Conclusions:The effective component from VOL inhibits cell proliferation and induces apop-tosis in human choriocarcinoma JAR cells.