腹腔镜食管胃吻合肌瓣成形术对于直径>5 cm食管胃结合部肿瘤近端胃切除术后消化道重建安全可行

目的探讨腹腔镜辅助食管胃吻合肌瓣成形术(Kamikawa吻合)在治疗肿瘤最大径>5 cm的食管胃结合部(EGJ)平滑肌瘤或胃肠间质瘤近端胃切除术后消化道重建的安全性及可行性。方法采用描述性病例系列研究方法,回顾性分析广东省中医院胃肠外科2017年9月至2019年3月期间,收治并施行腹腔镜辅助近端胃切除术和Kamikawa吻合的EGJ平滑肌瘤和胃肠间质瘤病例资料。肿瘤均侵犯贲门齿状线,且最大径>5 cm;排除需急诊手术和合并有严重心肺疾病患者后,共4例患者纳入本研究,男性3例,女性1例,年龄29-49岁。患者接受腹腔镜辅助近端胃切除术后,把残胃提出腹腔外,距残胃前壁近端3-4 cm处亚甲蓝标记"H"形,并沿"H"形切开胃壁浆肌层,沿纵行切开线向两侧分离黏膜下层和肌层之间的间隙,制作浆肌瓣;将残胃放回腹腔,腹腔镜下将"H"形上边与食管后壁距断端4-5 cm处间断缝合4针;切开食管残端,在"H"形的下边切开黏膜下层和黏膜层,进入胃腔;腹腔镜下将食管断端后壁与残胃黏膜层和黏膜下层连续缝合,食管断端前壁与残胃全层连续缝合,将胃前壁浆肌瓣缝合包埋食管,完成消化道重建。观察患者术中并发症和术后反流性食管炎和吻合口相关并发症的发生率。结果 4例患者均顺利完成手术,无中转开腹。手术中位时间为239(192-261)min,Kamikawa吻合中位时间为149(102-163)min,术中中位出血量为35(20-200)ml。4例患者均术后第1天拔除腹腔引流管和胃管,并恢复流质饮食,术后住院中位时间为6(6-8)d。术后病理提示,3例平滑肌瘤,1例胃肠间质瘤。术后无吻合口漏及狭窄等并发症,未观察到反流症状。术后中位随访时间22(11-29)个月,4例患者复查胃镜均未见反流性食管炎。结论对于>5 cm的EGJ平滑肌瘤或胃肠间质瘤,近端胃切除术后应用腹腔镜辅助Kamikawa吻合进行消化道重建,安全可行。     

CircCDR1as Suppresses Bone Microvascular Endothelial Cell Activity and Angiogenesis Through Targeting miR‐135b/ FIH‐1 Axis

ObjectiveThe current study investigated the role of CircCDR1as on angiogenesis of bone microvascular endothelial cells (BMECs) isolated from non‐traumatic ONFH.MethodsForty corticosteroid‐induced ONFH patients received THA were enrolled in our study. Expressions of CircCDR1as, miR‐135b, and FIH‐1 were detected by qRT‐PCR in affected necrosis tissue and non‐affected normal tissue. Bone microvascular endothelial cells (BMEC) were isolated from six patients and treated with 0.1 mg/mL hydrocortisone to establish a GC‐damaged model of BMECs. Circ CDR1as plasmid and miR‐135b mimic were transfected into BMECs. BMEC proliferation was assessed using MTT assays. The migration ability of cells was detected by scratch‐wound assays. Matrigel assay was performed to detect angiogenesis in vitro. Western blot assay was used to detect HIF‐1α, VEGF, and FIH‐1 expressions. FISH, RNA pull down, RIP, and luciferase assay were carried out to determine the interaction of CircCDR1as, miR‐135b, and FIH‐1.ResultsCircCDR1as was upregulated(2.02 ± 0.30 vs. 1.00 ± 0.10,P < 0.001) whereas miR‐135b was downregulated (0.55 ± 0.12 vs. 1.00 ± 0.10,P < 0.001) in affected tissues than in non‐affected tissues. Expression of CircCDR1as and FIH‐1 were negatively associated with miR‐135b in affected tissues (CircCDR1as with miR‐135b: r = −0.506, P < 0.001; FIH‐1 with miR‐135b r = −0.510, P < 0.001). Total blood tubule density was increased when CircCDR1as was silenced compared with NC (P < 0.01 vs. NC). The number of migrated BMECs were significantly increased in CircCDR1as silencing group compared with NC group (P < 0.05 vs. NC). In addition, CircCDR1as plasmids transfection increased the protein expressions of FIH‐1 (P < 0.05 vs. NC) and reduced the HIF‐1α as well as VEGF expression compared with NC group (P < 0.05 vs. NC). FISH, RNA pull down, RIP, and luciferase assay identified that FIH‐1 was a target of miR‐135b and could be modulated by CircCDR1as.ConclusionCircCDR1as decreases angiogenesis and proliferation of BMECs by sponging miR‐135b and upregulate FIH‐1.     

Culture-Expanded Autologous Adipose-Derived Mesenchymal Stem Cell Treatment for Osteonecrosis of the Femoral Head

BackgroudOutcomes of traditional treatment for osteonecrosis of the femoral head (ONFH) are not always satisfactory. Hence, cell-supplementation therapy has been attempted to facilitate necrotic-tissue regeneration. Adipose-derived mesenchymal stem cell (ADMSC) transplantation is potentially advantageous over bone marrow-derived MSC implantation, but its outcomes for ONFH remain unclear. The aim of this study was to determine 2-year radiological and clinical outcomes of culture-expanded autologous ADMSC implantation for ONFH.MethodsEighteen hips with necrotic lesions involving ≥ 30% of the femoral head were included. ADMSCs were harvested by liposuction and culture expanded for 3 passages over 3 weeks. With a 6-mm single drilling, ADMSCs were implanted into the necrotic zone. All patients underwent magnetic resonance imaging (MRI), single-photon emission computed tomography/computed tomography (SPECT/CT) at screening and 6 months, 12 months, and 24 months postoperatively. The primary outcome was the change in the size of necrotic area on MRI. Secondary outcomes were changes in clinical scores and radioisotope uptake on SPECT/CT. Conversion total hip arthroplasty (THA) was defined as the endpoint.ResultsPreoperatively, the necrotic lesion extent was 63.0% (38.4%–96.7%) of the femoral head. The mean Harris hip score was 89.2, the University of California at Los Angeles (UCLA) score was 5.6, and Western Ontario and McMaster Universities Arthritis index (WOMAC) was 79.4. Three patients underwent THA and 1 patient died in an accident. Finally, 11 patients (14 hips) were available for ≥ 2-year follow-up. At the last follow-up, no surgery-related complications occurred, and 14 of 17 hips (82%) were able to perform daily activities without THA requirement. There was no significant decrease in lesion size between any 2 intervals on MRI. However, widening of high signal intensity bands on T2-weighted images inside the necrotic lesion was observed in 9 of 14 hips (64%); 11 of 14 hips (79%) showed increased vascularity on SPECT/CT at 2 years postoperatively. No significant differences were observed between preoperative and 24-month mean Harris hip score (89.2 vs. 88.6), WOMAC (79.4 vs. 75.7), and UCLA score (5.6 vs. 6.2).ConclusionsOur outcomes suggest that culture-expanded ADMSC implantation is a viable option for ONFH treatment without adverse events.     

经旋股内侧动脉深支和旋股外侧动脉升支介入治疗股骨头缺血性坏死的应用解剖

对 50例成人下肢标本的旋股内侧动脉深支和旋股外侧动脉升支的起源、起点、外径、走行、分布以及经这二支血管介入有关的结构进行观测 ,为介入治疗股骨头缺血性坏死提供更接近病变部位及可进行插管的血管。结果表明 ,旋股外侧动脉升支与横支共干起自旋股外侧动脉者占 68% ,升支单独起自旋股外侧动脉占 2 6 % ;旋股内侧动脉深支由旋股内侧动脉主干延续而来。旋股内、外侧动脉深支或升支起点外径分别为 3 0± 0 8mm、 2 8± 0 7mm。从股动脉的起点 ,经股深动脉、旋股外侧动脉至其升支长度为 7 1± 1 1cm ;经股深动脉、旋股内侧动脉至其深支长度为 5 6± 1 4cm。旋股内侧动脉与其深支间约呈 90 。 角 ;旋股外侧动脉与其升支间约呈 1 33。 角。旋股内、外侧动脉深支 (升支 )为营养股骨头和颈的血管 ,这二支血管符合导管插入要求     

顺行交锁髓内钉治疗肱骨骨折

目的探讨顺行交锁髓内钉治疗肱骨骨折的手术要点和治疗效果。方法回顾性分析2003年10月～2005年10月23例顺行肱骨交锁髓内钉治疗肱骨干中上段骨折。结果全部病例随访6个月～1年3个月,平均11个月。所有病例均骨性愈合,平均临床愈合时间为2.4个月。所有关节活动度均可。结论顺行交锁髓内钉治疗肱骨中段或中上段骨折,效果良好。     

Urinaryα 1 as an index of proximal tubular function in early infancy

Urinary ₁-microglobulin (U-A₁M) was measured in healthy term infants on days 1, 4, 7, 14, 28, 90 and 180 of life. U-A₁M was high until day 14 and declined thereafter. It was significantly correlated with urinary ₂-microglobulin (U-B₂M) throughout the study, but not with serum A₁M on days 1 or 7. Similar to U-B₂M, U-A₁M in the clinically stable term infants with intrauterine growth retardation (n=4–7) was not elevated on days 1–7. In the sick infants who needed immediate resuscitatio at birth (n=4–8), U-A₁M as well as U-B₂M was high on days 1–7 and then decreased to normal levels, suggesting that U-A₁M can be used as a sensitive marker of acute proximal tubular damage and its recovery. These observations indicate that U-A₁M is a useful index of proximal tubular function in early infancy.     

Embracing fixator for treating periprosthetic femoral fractures

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交锁髓内钉治疗胫骨不稳定性骨折

目的 探讨交锁髓内钉治疗胫骨不稳定骨折的效果。方法 本研究38例中不扩髓法31例,扩髓法7例;闭合穿针33例,开放穿针5例;静力性固定32例,动力性固定6例。结果 平均随访时间10月（3～22月）采用Johner-Wruh评分标准,对治疗的最终结果证定：优31例,良5例,中1例,差1例。骨折平均愈合时间;闭合性骨折16周（11～24周）,开放性骨折18周（12～26周）,2例延迟愈合（闭合性骨折、开放性骨折各1例）。无感染及骨不连。结论 文锁髓内钉是治疗胫骨不稳定骨折的较好方法之一。