Since 1979, nine children had been treated by free fibular graft in our hospital. Five of them were males, and 4 were females, with a mean age of eight years. The average length of the skeletal defects was 7 cm. The average length of the fibula that was removed for reconstruction was 12.3 cm. The blood circulation of the donor bone was re-established by direct anastomosis of one peroneal artery and vein of the transfer with the appropriate artery and vein of the host region. Nine patients had been followed from 1 year to 9 years,avereged 5.5 years. S even grafts which were substituted in the tibia defects took the same shape and caliber as that of the normal tibia with canalization of the marrow cavity . From the roentgenographic examination of the side where the fibular graft was removed, there was definite caudal migration of the upper fibular in 5 cases,averged 5.2mm,while in 7 cases there was cephalic migration of the distal fibular segments,averaged 4.3mm. The breadth of ankle mortise where increased in 7 cases,The tibio-talus angle was averaged 7 degrees,in 3 cases. In 3 of the 9 cases during follow-up,alaterl wedging of the distal tibia epiphysis with lateral tilting of the talus invarably associated with instability of the ankle was evident. We believed that the elevation of the lateral malleolus and latral wedging of the distal tibia epiphysis were responsible for instability of the ankle.
Objective To study the progressive development of the retinas through an observation on the histological changes of the retinas from neonatal mice of different day-ages. Methods The retinas from the mice of 1 to 20 days of age were examined by light microscopy,and from 1 to 3 days,by autoradiography. Results The retinas of the mice below 3 days of age only had the RPE cells layer,the neuroblast layer and the ganglion cell layer.With the increase in dayage,the retinas developed gradually and would be mature in the 20th day. Conclusions The retinas of mice is a kind of immature tissue before the 20th days,so it can be considered as transplantation donors. (Chin J Ocul Fundus Dis, 1999, 15: 174-176)
Objective To observe the retinal ultrastructure of the human fetal at the age of 9 months, and to investigate the clinical significance of the observation on retinal neuron development during the prenatal period.Methods Four human fetal eyes of 2 fetus at the gestational age of 9 months, including 1 at 35 and the other at 36 weeks, were obtained after termination of pregnancy due to trauma. The gestational ages of the fetus were estimated according to both last menstrual period (LMP) of the pregnant women and the weight/crownheel length of fetus at the delivery. From each eyeball, 4 pieces of retina at the posterior pole were obtained and observed after specimens handling according to the procedure of routine electron microscopy. Eight pieces of retina which were randomly selected from total of 16 pieces of retina in each group were processed and observed by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Permissions from pregnant women and family members were guaranteed.Results At the gestational age of 9 months, the outer nuclear layer of fetal retina contained 5 to 6 layers of photoreceptor cells (PRC), and sphericallike membrane structures were found outside of the outer limiting membrane (OLM). Among many tightaligned inner segments of PRCs there was zonula adherens of OLM, mitochondrias at inner side of OLM, and cilium at outer side of OLM. Outer segment of PRCs were short and contained a few irregularly arranged disc membrane. Some PRC had a multishaped nucleus in which equal amount of euchromatin and heterochromatin. There were only few and thin axon branches from photoreceptor cells, and very few axons contacted with inner nuclear layer (INL) and no typical synapse was found. The INL contained 4 to 5 layers of cell bodies, in which many cellular nuclear had uneven density of euchromatin and heterochromatin; some were lobulated nucleus with clear karyotheca. In inner plexiform layer (IPL), the nerve cells had small branches, and only little connection among the synapses and few synapse structures were found. Although not many retinal ganglion cells (RGC) existed,RGC had both intact cell membrane and some rough endoplasmic reticulum (RER).The karyotheca of RGC had double-layers structures, and the nucleus was mainly consisted of euchromatin. Internal limiting membrane (ILM) had doublelayer membrane structures, and the wellarranged nerve fiber layer was located at the outer side of ILM, with some micropores on the surface. Conclusions At the gestational age of 9 months, all layers of the human retinal has been formed, but some cell structure and cell connections are not yet mature, suggesting that at this time of period, human retina is still at an important stage of developing and remodeling.
Objective To summarize the research progress of pathogenetic and development mechanism of phyllodes tumor of breast (PTB). Method Summarizing the studies on pathogenetic and development mechanism of PTB by searching PubMed, Web of Science, CNKI, and Wanfang databases, and then make a review. Results Currently, there was no uniform conclusion on the pathogenetic and development mechanism of PTB, though many factors may involve in the pathogenesis of PTB. PTB may be derived from fibroadenoma, and some studies suggested that it was closely related to hormonal receptor disorders, epithelial mesenchymal transition mechanism, gene mutation, and so on. Conclusion The pathogenetic and development mechanism of PTB is not clear yet and more researches are needed to confirm it.
【Abstract】 Objective Through a retrospective study, to observe the cl inical therapeutic effect for closed reductiontreatment of developmental dislocation of the hip (DDH), and to dynamically analyze characteristics of acetabular development after closed reduction in DDH. Methods A total of 100 single side DDH children who were treated by “the treatment mode of closed reduction” from January 2002 to December 2005 were followed up, including 18 males and 82 females, with the average age of 19.4 months (ranging from 7 months to 36 months). Sixty-eight patients had left side dislocation, while 32 had right side dislocation. According to Zionts dislocation grades, 15 cases were degree I, 50 degree II, 26 degree III and 9 degree IV. Adductor tenotomies and skeletal traction were carried out in 74 cases, while direct closed reduction was performed in 26 cases. The four-level functional evaluation criterion was used to assess the cl inical therapeutic effect. Lesional and homeochronous normal hips were paired, and acetabular index (AI) and AI (D/W) of lesional and normal hips, before the reduction and in the 3rd, 6th, 9th and 12th month, respectively, after the reduction, were dynamically measured. Results The total choiceness rate of 100 children was 88.00%. Twelve months after the reduction, lesional AI decreased from (37.17 ± 2.17) º to (27.02 ± 3.54) º, while lesional AI(D/W) increased from 22.06% ± 1.65% to 29.80% ± 3.56%, and the differences among each time-point had statistical significance (P lt; 0.01). Both rates of lesional AI decrease and AI(D/W) increase were obviously faster than those of normal side physiological development (P lt; 0.01). In all durations after 12 months reduction, the rates of lesional AI were (3.22 ± 1.42) º and (3.41 ± 2.03) º in 1 - 3 months and 10 - 12 months , respectively, and the rates of AI(D/W) were 2.69% ± 1.83%and 2.33% ± 1.13%, respectively, and they were obviously faster than the other durations (P lt; 0.01). Both rates of lesional AI decrease and AI(D/W) increase were obviously faster than the homeochronous rate of normal side physiological development in each duration (P lt; 0.01). The rates of lesional AI were (13.71 ± 3.96) º and (11.48 ± 4.15) º in 7 - 12 age group and 13 - 18 age group, respectively, and the rates of AI(D/W) were 9.95% ± 3.81% and 8.28% ± 3.58%, respectively, and they wereobviously faster than the other age groups (P lt; 0.05). Both changes of lesional AI and AI(D/W) were obviously faster than the homeochronous changes of normal side in each age group(P lt; 0.01). Conclusion There are simple operating requirements and fine therapeutic effect of “the treatment mode of closed reduction” . Within 12-month after the closed reduction treatment, the rate of lesional acetabular development is obviously faster than that of normal side physiological development. The cresttime of lesional acetabular development is during 1 - 3 months and 10 - 12 months, and the best treatment time of closed reduction is the age before 18 months.
Objective To investigate the role of Notch signaling pathway in pancreas development and pancreatic cancer. Methods The related literatures were reviewed and analyzed. Results Notch signaling played a role early in development by maintaining pancreatic epithelial cells in a progenitor state and delaying their differentiation until timely appropriate. Notch signaling was reactivated in the initiation and progression of pancreatic cancer. Conclusion Notch signaling pathway plays an important role in the pancreas development. Sustained Notch signaling activity promotes the progression of pancreatic cancer, and may be one of major factors in the initiation of pancreatic cancer.
Under the background of high-quality development of public hospitals and from the perspective of medical technology management, this paper discusses the high-quality development path of medical technology management in West China Hospital, Sichuan University. By sorting out the development context of restricted medical technology management in this medical institution, it concludes that there are four problems in restricted medical technology management at present: lack of standardized management system, non-unified surgery grading management, technology management information level to be improved, and the after-effect evaluation and transformation mechanism of medical technology being not perfect. It is proposed that establishing standardized management system, unifying surgical grading catalogue, constructing intelligent information system and establishing achievement transformation mechanism are important ways to strengthen medical technology management.
ObjectiveTo explore the efficacy and safety of ketogenic diet (KD) in the treatment of drug-resistant epilepsy in children with malformations of cortical development (MCD). MethodsThe clinical data of 10 children with drug-resistant epilepsy caused by MCD treated in the Epilepsy Center of Children's Hospital affiliated to Shandong University from May 2021 to February 2023 were analyzed retrospectively. All of them received classical KD treatment for the first time. The patients were followed up at 1, 3, 6 and 12 months after KD treatment. The clinical efficacy was evaluated by Engel grade and the adverse reactions were recorded at the same time. ResultsThere were 10 patients in this study, including 5 males and 5 females. The age of onset was 0.2~36.0 (10.3±11.1) months, 2.0~31.0 (9.7±8.5) months, and the age of starting KD was 3.0~50.0 (20.0±15.7) months. Cranial imaging showed that there were 2 cases of hemimegalencephaly, 1case of lissencephaly, 1 case of pachygyria combine polymicrogyria, and 6 cases of FCD,3 had gene abnormality (2 cases of DEPDC5 gene, 1 case of ARX gene). All children had different degrees of developmental retardation before KD treatment. The antiseizure medications taken before KD treatment were 2.0~5.0 (3.2±0.9). 5/10 (50%) children had a >50% reduction in seizure frequency at 3 months on the diet, 2/10 (20%) children had a seizure free response. The rate of development improvement was 50.0% (5/10) at 3 months. 5 cases had mild adverse reactions (50%), including 1 case of hypokalemia and 4 cases of gastrointestinal reactions, all of which were relieved after the reduction of the proportion of KD diet. None of the children stopped using KD. ConclusionKD therapy is a safe and effective method for the treatment of drug-resistant epilepsy in children caused by MCD, and some children can improve their developmental level.
Based-on retrieval and reviewing information of evidence-based clinical practice guidelines from the literature, this paper introduced the key components of assessment guideline quality, including the process of development and reporting of guideline.
The Second People’s Hospital of Yibin was taken over by West China Hospital of Sichuan University into its close hospital alliance, and simultaneously undertook the task of construction of regional hospital alliance in Yibin city. The article introduces the experiences of the Second People’s Hospital of Yibin in the high-quality development of novel healthcare system. Led by West China Hospital of Sichuan University and based on all-level medical institutions in Yibin, the Second People’s Hospital of Yibin preliminarily established a four-level hierarchical medical system as “province, city, county, village” model, according to the guide of governments within the whole region. It aims to propose a “Yibin model exploration” in hospital alliance construction based on the western regional situation.