OBJECTIVE To introduce the clinical application of the expanded graft from scalp in the repair of cicatricial baldness in children. METHODS 45 cases with baldness following burn from 1988 to 1998 were reported. All of these patients (age ranged from 5-11 years) were treated by soft tissue expander. RESULTS 5 cases were followed up for 1-2 years, the clinical results showed that the result from the graft of scalp expansion was satisfactory, and the long-term follow-up revealed that the hair in expended area and that in normal area was almost the same except the orientation of hair distribution had some difference. CONCLUSION The head scalp expansion might be the first choice in the repair of cicatricial baldness following burn.
ObjectiveTo compare short- and medium-term effects of Leonardo da Vinci robot-assisted and traditional mitral valvuloplasty.MethodsWe conducted a retrospective analysis of 74 patients who underwent mitral valvuloplasty in our hospital from January 2015 to March 2017. The patients were divided into two groups according to the mode of operation: a da Vinci group (n=29, 13 males, 16 females at an average age of 52 years) and a routine group (n=45, 18 males, 27 females at an average age of 53 years). The perioperative data of patients in the two groups were compared and analyzed.ResultsThere was no significant difference in sex, age, weight, height, body mass index (BMI), cardiac function (NYHA), hypertension, diabetes, postoperative blood transfusion and postoperative complications between the two groups (P>0.05). The tracheal intubation time, ICU retention time, hospital stay time, blood loss and postoperative drainage in the da Vinci group were shorter or less than those in the routine group (P<0.05). The operation time, cardiopulmonary bypass time and aortic clamping time in the da Vinci group were longer than those in the routine group (P<0.05). Different surgical procedures had no significant effect on left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and mitral regurgitation (MR) 3 years after operation. There was no interaction between the mode of operation and the time of follow-up. There was no significant difference in echocardiographic evaluation in the same period (P>0.05).ConclusionDa Vinci operation shortens the rehabilitation process of patients compared with traditional surgery. For short- and medium-term follow-up results, there is no difference between Leonardo da Vinci and traditional mitral valve surgeries, and the clinical effect of da Vinci robot-assisted mitral valvuloplasty is satisfactory, which is worthy of further clinical promotion.
ObjectiveTo summarize the causes, clinical manifestations, diagnosis and treatment methods for the intestinoseminal vesicle fistula. MethodLiteratures about intestinoseminal vesicle fistula at home and abroad were retrieved, the causes, clinical manifestations, diagnosis and treatment methods were analyzed. ResultsThe clinical reports of 19 patients with intestinoseminal vesicle fistula were searched.The intestinoseminal vesicle fistula occurred after the rectal low anterior resection with stomal leak, sigmoid diverticulum, inflammatory bowel disease, prostatectomy or radiotherapy.The main clinical symptoms were pneumaturia, fecaluria, fever, scrotal swelling and pain, orchitis, epididymitis and so on.Imaging methods such as enhanced CT or CT with rectal contrast and so on could confirm the diagnosis.The conservative treatment such as indwelling catheter, antibiotics, parenteral nutrition, and the operation methods such as sinus incision and drainage, mucosa/skeletal muscle flap repairment, urine/stool bypass could cure majority of cases. ConclusionsThe intestinoseminal vesicle fistula is a rare and independent disease.Through the discussion of the intestinoseminal vesicle fistula, it could improve the knowledge, and avoid misdiagnosis and mistreatment of the intestinoseminal vesicle fistula.
Objective To assess the anal sphincteric function after intersphincteric resection for low rectal cancer by vectorial manometry. Methods Maximal anal pressure, vector volume, vector symmetric index and rectal anal inhibitory reflex were assessed in 16 patients underwent intersphincteric resection for low rectal cancer from 1999 to 2006. Thirty patients with low anterior resection for rectal cancer and another 30 healthy individuals were selected as control. Results The patients in intersphincteric resection group were subdivided into soiling group and defecation function good group. Maximal pressure, vector volume and vector symmetric index of the patients in soiling group and defecation function good group were significantly lower than those of the healthy and low anterior resection controls (P＜0.001). The maximal systole pressure, systole vector volume and vector symmetric index in soiling group were significantly lower than those in function good group (P＜0.001). The 25.0% patients in intersphincteric resection group had rectal anal inhibitory reflex， was significantly lower than that of the low anterior resection control group (93.3%, P＜0.001). Conclusion The maximal pressure and vector volume are compromised in patients underwent intersphincteric resection . The vectorial manometry can be an objective comprehensive tool for the evaluation of anal sphincter function in patients with intersphincteric resection.
Mammography imaging is one of the most demanding imaging modalities from the point of view of the balance between image quality (the visibility of small size and/or low contrast structures) and dose (screening of many asymptomatic people). Therefore, since the introduction of the first dedicated mammographic units, many efforts have been directed to seek the best possible image quality while minimizing patient dose. The performance of automatic exposure control (AEC) is the manifestation of this demand. The theory of AEC includes exposure detection and optimization and also involves some accomplished methodology. This review presents the development and present situation of spectrum optimization, detector evolution, and the way how to accomplish and evaluate AEC methods.
Objective To examine the effects of TGF-β1 on epithelial-myofibroblast transition ( EMT) of A549 cells and its relationship with extracellular regulating kinase1/2 ( ERK1/2) signaling system. Methods Cultured A549 cells were divided into one negative control group and four groups incubated with TGF-β1 for 48 hours at different concentration ( 0.05, 0. 5, 5, 10 μg/L, respectively) . The protein expressions of E-cadherin, α-smooth muscle actin ( α-SMA) , vimentin and fibronectin were assessed by indirect immunofluorescence and Western blot. In the other experiment, cultured A549 cells were incubated with TGF-β1 for different time. The protein and mRNA expressions of E-cadherin and α-SMA were assessed by Western blot and RT-PCR. The protein expressions of vimentin, fibronectin, ERK1 /2, and p-ERK1 /2 were detected by Western blot. Results By indirect immunofluorescence, Western blot, and RT-PCR analysis, E-cadherin expression significantly decreased and α-SMA expression significantly increased in A549 cells treated with TGF-β1 compared with negative controls in a time- and concentrationdependent manner ( Plt;0.05 ) . Vimentin and fibronectin protein expressions significantly increased simultaneously ( Plt;0.05) . The concentration of 5 ng/mL of TGF-β1 was most effective. The ratio of p-ERK1 /2 and ERK1/2 was significantly increased in the TGF-β1 treated cells in a time-dependent manner ( P lt;0. 05) . Conclusions TGF-β1 can induced EMT in A549 cells in vitro in a time- and concentrationdependant manner. This effect may involve in upregulation of ERK1/2 signaling system.
目的 探讨低位直肠癌双吻合器保肛手术后吻合口漏的预防。 方法 回顾性分析2000年5月至2005年5月我院肛肠外科行双吻合器保肛手术的78例低位直肠癌患者的资料。结果 所有病例应用双吻合器进行直肠闭合并吻合成功,术后切缘病理检查均未见癌细胞浸润,无吻合口漏及手术死亡。随访73例(93.6%),随访时间9~65个月，平均35个月。盆腔复发2例(2.6%),腹腔广泛转移1例(1.3%),肝脏转移7例(9.0%),吻合口局部复发1例（1.3%,术后11个月再次行Miles术）。结论 双吻合技术为低位直肠癌患者提供更多的保肛机会,使用得当可有效预防吻合口漏的发生。
Objective To investigate short-term clinical outcomes of double-modified Limberg flap transplantation in treatment of sacrococcygeal pilonidal sinus. Methods One hundred patients with sacrococcygeal pilonidal sinus from October 2010 to May 2015 in this hospital were included, and subsequently were divided into double-modified Limberg flap transplantation group (double-modified flap group,n=30), classical Limberg flap transplantation (classical flap group,n=30), and interrupted suture after resection group (interrupted suture group,n=40). The duration of operation, intraoperative bleeding, hospital stay, duration of return to work, recurrence rate, and incision complications rate were compared among these three groups. Results ① The age, gender, body mass index, and preoperative complications had no significant differences among these three groups (P>0.05). ② The intraoperative bleeding and the hospital stay had no significant differences among these three groups (P>0.05). Compared with the interrupted suture group, the durations of operation were significantly longer (P<0.05), the durations of return to work were significantly shorter (P<0.05), the recurrence rates were significantly lower (P<0.05) in the double-modified flap group and the classical flap group. The above indicators had no significant differences between the double-modified flap group and the classical flap group (P>0.05). ③ The incision hematoma and the part disruption of incision had no significant differences among these three groups (P>0.05). Compared with the interrupted suture group, the rates of incision infection and incision complete disruption were significantly lower (P<0.05) in the double-modified flap group and in the classical flap group. The incision maceration of the classical flap group was significantly higher than that of the interrupted suture group (P<0.05) or the double-modified flap group (P<0.05). No skin flap necrosis occurred in the double-modified flap group and the classical flap group. Conclusions Double-modified Limberg flap transplantation and classical Limberg flap transplantation have less complications and lower recurrence rate than interrupted suture after resection. Compare with classical Limberg flap transplantation, double-modified Limberg flap transplantation has a lower incision maceration rate. Because of limitation of sample size in this study, long-term clinical efficacy of double-modified Limberg flap transplantation needs to be confirmed by multicenter randomized controlled trials.
ObjectiveTo compare the curative effects and complications between endoscope-assisted treatment and scalp coronal incision for zygomatic complex fractures. MethodFifty zygomatic complex fracture patients treated between January 2008 to May 2014 were randomly divided into trial group (n=30) treated through endoscope-assisted procedure and control group (n=20) treated through scalp coronal incision. In the trial group, functional reduction and fixation of the fractures under endoscope were performed, and the control group was treated with coronal incision and internal fixation of the fractures. After the operation, all the patients were evaluated on the effects and complications through physical examination and CT review. ResultsThe number of grade-Ⅰ, -Ⅱ and-Ⅲ curative effects were respectively 24 (80.0%), 5 (16.7%), and 1 (3.3%) in the trial group, while those numbers in the control group were respectively 16 (80.0%), 3 (15.0%), and 1 (5.0%). There was no significant difference in the curative effects between the two groups (P>0.05). There were no cases of complications in the trial group, but there were 4 cases (20.0%) of facial nerve injury, 5 cases (25.0%) of hair loss, 4 cases (20.0%) of temporal sag, and 5 cases (25.0%) of scalp hematoma in the control group. The complication rate in the control group was significantly higher than that in the trial group (P<0.05). ConclusionsWhile the curative effects between endoscope-assisted treatment and scalp coronal incision for zygomatic complex fractures are not significantly different, endoscope-assisted technology can reduce the complications of the operation, which is a minimally invasive surgery and can promote good aesthetic appearance.
ObjectiveTo analyze the effect of carotid artery stenosis degree and intervention for carotid artery stenosis on the incidence of central nervous system complications after off-pump coronary artery bypass grafting (OPCABG) and explore the influencing factors. MethodsA total of 1 150 patients undergoing OPCABG in our hospital from June 2018 to June 2021 were selected and divided into two groups according to whether there were central nervous system complications, including a central nervous system complication group [n=61, 43 males and 18 females with a median age of 68.0 (63.0, 74.0) years] and a non-central nervous system complication group [n=1 089, 796 males and 293 females with a median age of 65.5 (59.0, 70.0) years]. The risk factors for central nervous system complications after OPCABG were analyzed. ResultsUnivariate analysis showed that age, smoking, hyperlipidemia, preoperative left ventricular ejection fraction, intra-aortic ballon pump (IABP), postoperative arrhythmia, postoperative thoracotomy and blood transfusion volume were associated with central nervous system complications. The incidence of central nervous system complications in patients with severe carotid artery stenosis or occlusion (11.63%) was higher than that in the non-stenosis and mild stenosis patients (4.80%) and moderate stenosis patients (4.76%) with a statistical difference (P=0.038). The intervention for carotid artery stenosis before or during the operation did not reduce the incidence of central nervous system complications after the operation (42.11% vs. 2.99%, P<0.001). Age, postoperative arrhythmia, severe unilateral or bilateral carotid artery stenosis and occlusion were independent risk factors for postoperative central nervous system complications (P<0.05). Conclusion The age, smoking, hyperlipidemia, preoperative left ventricular ejection fraction, intraoperative use of IABP, postoperative arrhythmia, secondary thoracotomy after surgery, blood transfusion volume and OPCABG are associated with the incidence of postoperative central nervous system complications in patients. Age, postoperative arrhythmia, severe unilateral or bilateral carotid artery stenosis and occlusion are independent risk factors for postoperative central nervous system complications. In patients with severe carotid artery stenosis, preoperative treatment of the carotid artery will not reduce the incidence of central nervous system complications.