Volume 87  ·   Issue 43  ·  2007

Primary deep venous valve insufficiency is an important cause of chronic venous insufficiency (CVI) of lower limbs. According to most domestic and foreign literature reports, 60% ~70% of CVI affected limbs have deep venous valve insufficiency, and various valve repair and functional reconstruction operations have been applied in clinical practice.

With the increasing maturity of computer technology and automatic control technology of precision machinery, the quality of medical imaging equipment is constantly improved, and the combination of computer medical image processing, three-dimensional visualization, three-dimensional positioning and navigation system and clinical surgery makes computer assisted surgery (CAS) system become the hotspot of orthopedic clinical surgery at present, especially in joint replacement surgery, computer assisted navigation surgery has been widely paid attention to.

Objective to evaluate the accuracy and clinical feasibility of a newly designed orthopedic robot system module. Methods the total length of tibia on the spliced images was measured in 9 cases of plastic tibia models, and compared with the actual length of the model, the difference was recorded, and the splicing accuracy was statistically analyzed. The tibia fracture (accompanied by shortened angular deformity) was artificially manufactured in one case of tibia specimens of both lower limbs of a cadaver, the whole tibia image after fracture was spliced, the whole process was planned on the spliced images, the fracture traction distance was determined, and the automatic quantitative closure traction was carried out by tibia traction bracket. The accuracy and effectiveness of the module were analyzed. At the same time, the length change of tibia during traction was tracked by video camera to ensure the safety of traction process. The splicing, planning and traction were carried out in one case of tibia fracture to verify the clinical feasibility of this module. Results 7~10 C-arm images were collected during operation to splice a complete tibia image, and the image splicing accuracy was 1.5 mm. The average operation time of image acquisition is 1.5 min, the time of splicing and planning is about 3 min, and the average time of traction bracket installation and traction operation is 4 min. Both cadaver specimens and clinical trials achieve accurate reduction of fracture end after traction, which meets the requirements of surgery. Conclusion The whole process planning module of the department robot system can provide effective and accurate traction reduction information for the treatment of long bone fractures.

Objective to summarize the differences in the efficacy of computer navigation and conventional localization surgery in the treatment of knee ankylosis in two groups. Methods to compare the force line, soft tissue balance, complicated fat embolism, bleeding volume and operation time of the two groups after artificial knee surface replacement with computer navigation and conventional localization. Results All cases were followed up for 5~12 months, with an average of 9 months. The error of force line detection data of 11 knees in the navigation group was significantly smaller than that of 11 knees in the conventional localization group, and the angle variables and distance variables of soft tissue balance data in the navigation group were significantly smaller than those in the conventional localization group.

Objective to study the preliminary clinical application of navigation technique in the surgical treatment of pelvic and acetabular fractures, and to explore the surgical indications and methods.Methods 22 cases of pelvic and acetabular fractures under navigation were fixed with C-arm fluoroscopic navigation equipment, including 36 fractures, including 15 pubic branch fractures, 12 acetabular fractures and 9 sacroiliac joint fractures. The average deviation distance and the average deviation angle were (2.9±1.2) mm, (2.2±0.3) °, less intraoperative bleeding (<21.7 ml/piece), 1 case (2.4%) had screw deviation during operation, and no postoperative complications such as infection and failure of endoservation occurred. Conclusion The use of fluoroscopic navigation technique in the surgical treatment of pelvic fracture can make the surgery more accurate, safe and effective, and can reduce the operation time and X-ray exposure time, so it is more suitable for use in trauma orthopedics.

Objective to investigate the type and cause of abdominal aortic variation.Methods A patient with congenital abdominal aortic rupture detected by digital subtraction angiography (DSA) was studied by gadolinium-enhanced magnetic resonance angiography (MRA) abdominal angiography combined with maximum intensity projection and volumetric reconstruction. Results MRA clearly showed the disconnected abdominal aortic variation: the abdominal aorta ruptured immediately after bilateral renal arteries emerged; The lower abdominal aorta starts at the level of L3-4 intervertebral space and emits the inferior mesenteric artery. The ruptured abdominal aorta is connected to each other by the collateral branches of the superior and inferior mesenteric arteries that compensate for the thickening. Conclusion This asymptomatic rupture variation of the abdominal aorta is caused by unknown external force during embryonic development.

Objective to explore a new method for preventing intimal hyperplasia (IH) restenosis after peripheral artery artificial vessel bypass grafting (VGB). Methods Five large mongrel dogs were subjected to bilateral iliofemoral artery VGB after general anesthesia, and the autologous arteries between artificial vessel bridges were ligated and severed. One artificial vessel (VG) and distal and proximal anastomosis were randomly selected from the same dog, and paclitaxel-bioprotein glue (FG) mixture was sprayed on the other side, and FG was sprayed on the other side as control. Four weeks later, the VG on both sides including distal and proximal anastomosis was removed, and the anastomosis was examined by macroscopic, histopathological and electron microscopic examination. The intimal thickness and intimal area were measured, and immunohistochemical examination was performed. Results The VG on both sides of the five experimental dogs was unobstructed, and the neointimal thickness and intimal area of the anastomosis on the experimental side were significantly smaller than those on the control side (P<0.05). Scanning electron microscopy examination showed that the anastomosis on the experimental side was covered with an intact layer of endothelial cells (EC), and the EC were arranged neatly, with less blood formation on its surface The transmission electron microscopy examination of the neointima of the anastomosis showed that the control side was rich in cells, and the cell type was single, mainly typical smooth muscle cells (VSMC); The matrix is regular and densely arranged collagen fibers. Many types of cells can be seen on the experimental side; The collagen fibers in the matrix are sparse, and a large number of foreign particles can be seen. Conclusion Local application of small dose of paclitaxel outside the anastomosis of VG can inhibit the anastomotic IH by using FG as carrier. Paclitaxel can penetrate from outside the anastomosis into the anastomosis and stay in the intima for at least 4 weeks. It is safe and effective in the near term.

Objective to study the morphological, phenotypic and functional changes of human cavernous hemangioma endothelial cells. Methods the cells were isolated and purified from human cavernous hemangioma tissues, and compared with normal human sinusoidal endothelial cells by transmission electron microscopy, flow cytometry, reverse transcription polymerase chain reaction (RT-PCR), gelatin zymography and laser confocal microscopy. Results Compared with normal human sinusoidal endothelial cells, the ultrastructure of human cavernous hemangioma endothelial cells showed abnormally enlarged endoplasmic reticulum and vacuolate-like structure; Phenotypically, integrin α v β 3 is highly expressed, and functionally, vascular-like network structure is abnormal in vitro, which may be related to its high expression of endogenous vascular endothelial growth factor, angiopoietin-1 and matrix metalloproteinase-2. Conclusion Human cavernous hemangioma endothelial cells are different from normal hepatic sinusoidal endothelial cells in morphology, phenotype and function.

Objective to evaluate the technical feasibility and short-term clinical effect of subintimal angioplasty (SIA) in the treatment of arteriosclerosis obliterans of lower limbs. Methods From December 2003 to December 2005, 36 limbs with arteriosclerosis obliterans were treated with subintimal angioplasty. The average length of arterial occlusion was 11.5 cm (4.5~28.0 cm), of which 13 limbs were intermittent claudication due to lifestyle restriction, and 23 limbs were severe ischemia threatening limb survival. The main parameters of analysis and evaluation were the technical success rate of subintimal angioplasty, the patency rate of recanalization channel, clinical efficiency and complications. Results The technical success rate of subintimal angioplasty was 80%, and 4 of the 7 limbs with technical failure were successfully performed vascular bypass surgery. At an average follow-up of 13.2 months, the patency rate of recanalization channel was 70%, the clinical efficiency rate was 81%, and there were no serious related complications. Conclusion SIA is a good alternative treatment for atherosclerosis obliterans of lower limbs, with high technical success rate, The short-term results are still satisfactory, but there is still a lack of convincing clinical data on the long-term results after SIA.

Objective to evaluate the therapeutic effect of laser cauterization (EVLT) and traditional dissection of varicose saphenous veins. Methods 80 patients (80 limbs) with varicose saphenous veins were randomly divided into two groups. The EVLT group underwent EVLT of great saphenous vein, and the vein dissection group underwent traditional high ligation and dissection of great saphenous vein. The operative time, bleeding volume, complications, pain degree, mean hospital stay and vascular Doppler ultrasound and air volume scanning results at 6 and 12 months after operation were compared between the two groups. Results the intraoperative blood loss (P<0.01), hospital stay (P<0.05) and postoperative pain degree (P<0.05) in EVLT group were significantly reduced compared with the vein dissection group. However, there was no significant difference in the operative time and total complication rate between the two groups (P>0.05). Conclusion EVLT is a safe and effective minimally invasive surgical method for varicose saphenous veins, and its short-term efficacy is similar to that of traditional high ligation and stripping of saphenous veins.

Objective to investigate the effect of different methods under microscopic discoscopy on the prevention of intraspinal scar adhesion after intervertebral discectomy. Methods 165 patients with lumbar disc herniation were randomly divided into 3 groups: Group A was sodium hyaluronate group; Group B was the ligamentum flavum-preserving group; In group C, ligamentum flavum was preserved and sodium hyaluronate was used for minimally invasive microdiscoscopic discectomy. In group A, ligamentum flavum was removed, and sodium hyaluronate was sprayed uniformly on the interlaminar space before the incision was closed after nucleus pulposus was removed. Group B preserved ligamentum flavum; Group C was followed up at 2, 4, 8 weeks, 1 year and 2 years after surgery. Japanese (JOA) standard was used to score, and the improvement rate was calculated, and CT examination was performed. Results There was no significant difference in the improvement rate between the three groups at 2 weeks after surgery. The improvement rate between Group B and Group C at 4 weeks after surgery, 8 weeks after surgery, 1 year after surgery, and 2 years after surgery was statistically significant (t values were 0.602, 0.701, 0.623, 0.654 and 0.833, 0.759, 0.714, 0.771, respectively, P<0.05), which were better than those of Group A. However, there was no significant difference in the improvement rate between Group B and Group C (t values were 0.041, 0.135, 0.980, 0.530, 0.103, respectively, P>0.05). In Group A, the improvement rate at 2 weeks after surgery and the improvement rate at other times after surgery were statistically significant (P<0.05), and the average improvement rate at 1 and 2 years after surgery was slightly higher than that at 4 and 8 weeks after surgery, but there was no significant difference in the improvement rate between Group B and Group C at different time after surgery And the long-term preventive effect is good. Sodium hyaluronate can better prevent intraspinal scar adhesion in the short term, but the long-term effect is not good. Adding sodium hyaluronate on the basis of preserving ligamentum flavum does not play a better preventive effect.

Methods 32 cases of gynecomastia were treated with modified liposuction combined with glandectomy. The surgical areas were divided into central and peripheral regions, the peripheral adipose tissue and the central deep glandular tissue were aspirated, the central subcutaneous layer and superficial glands were not aspirated, and the superficial layer was kept intact; Results 32 patients were followed up for 3.0~18.5 months. There were no complications such as local collapse deformity, nipple and areola blood supply disorder, and the appearance was similar to that of normal male.The patients were satisfied. Conclusion Modified liposuction combined with glandectomy is a good and effective method for the treatment of gynecomastia.

Objective to investigate the risk factors and dynamic changes of middle cerebral artery (MCA) stenosis in asymptomatic community in Foshan, Guangdong Province, and to provide epidemiological help for the prevention of stroke in the community. Methods In 2002, 2500 community residents were randomly selected to collect data from epidemiological questionnaire, anthropometry, transcranial Doppler ultrasound (TCD) and plasma homocysteine (Hcy) level, and 1068 observation subjects met the inclusion criteria. Four years later, the observation subjects were re-examined with the same index, and 844 valid samples were kept. According to the results of TCD examination of middle cerebral artery, they were divided into stenosis group and non-stenosis group. Each index was processed by SPSS 13.0. Results The prevalence of middle cerebral artery in asymptomatic community in 2002 and 2006 was 2.73% and 4.62%, respectively. The prevalence of stenosis in non-stenosis group in 2002 was 1.9% in 2006. The Logistic regression analysis of 2002 data showed that diabetes history and hyperHcyemia were the risk factors of middle cerebral artery. The data after 4 years showed that the history of diabetes, high Hcy, hypertension and coronary heart disease were the risk factors of middle cerebral artery, and marital status may also have an influence on middle cerebral artery stenosis. Longitudinal dynamic analysis confirmed that the dynamic changes of coronary heart disease, diabetes history and body mass index also played an important role in the occurrence of middle cerebral artery stenosis (all P<0.05). Conclusion Middle cerebral artery stenosis existed in asymptomatic people in the community, and the history of diabetes, hypertension, coronary heart disease and hyperHcyemia were the risk factors.

Objective to investigate the changes of coagulation and fibrinolysis system and vascular endothelial function in patients with acute pulmonary embolism (PTE) after onset of disease and after anticoagulation or thrombolysis therapy. Methods 37 patients with PTE were divided into anticoagulation group (20 cases) and thrombolysis group (17 cases), and 40 cases were set up as normal control group. The contents of plasma D-dimer (D-D), tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), protein-S (PS), protein-C (PC) and thrombin regulatory protein (TM) were detected by ELISA, and the activity of antithrombin-Ⅲ (AT-Ⅲ) was detected by chromogenic substrate method. The above indexes were re-examined AT the sixth maximum of anticoagulation therapy and 24 h after the end of thrombolysis, respectively. Patients with anticoagulation could be treated with intravenous injection of unfractionated heparin or subcutaneous injection of low molecular weight heparin. After 24~48 h of unfractionated heparin or low molecular weight heparin, warfarin was added as an oral anticoagulant for 4~5 days. When the international standard ratio (INR) of prothrombin time (PT) reached 2.0~3.0 for 2 consecutive days, it was stopped The patients in the thrombolytic treatment group were treated with urokinase or rtPA for thrombolysis. After 24~48 h of application of low molecular weight heparin, oral anticoagulant warfarin was added for 4~5 days. When PT INR reached 2.0~3.0 for 2 consecutive days, low molecular weight heparin was stopped and oral warfarin alone was treated. Results Before treatment, the contents of D-D, t-PA, PS, TM in the anticoagulant treatment group were significantly higher than those in the normal control group, and the AT-Ⅲ activity was significantly lower than that in the normal control group (all P<0.05); The contents of D-D, t-PA, PAI-1, PS and TM in PTE patients in the thrombolytic treatment group were significantly higher than those in the normal control group, and the activity of AT-Ⅲ was significantly lower than that in the normal control group (all P<0.05). The contents of D-D, t-PA, PAI-1, PS, PC and TM in the anticoagulant treatment group were significantly lower than that before treatment (all P<0.05), while the contents of PAI-1, TM and AT-Ⅲ activity were not statistically significant.

Objective to establish a model to predict the clinical efficacy of gefitinib in the treatment of advanced non-small cell lung cancer (NSCLC). Methods the clinical results of 262 patients with advanced NSCLC treated with gefitinib in the Cancer Hospital of Chinese Academy of Medical Sciences in the past 4 years (July 2002 to March 2007) were retrospectively analyzed, and the EGFR gene mutation (DNA sequencing) was detected in 55 cases with sufficient tumor tissue. Median time to disease progression (PFS) and median survival were 6 months and 16 months, respectively; The 1-, 2-and 3-year survival rates were 60.8%, 35.6% and 18.3%, respectively. The efficacy rate of 24 patients (47.3%) with EGFR gene mutation (50.0%) was significantly higher than that of those without mutation (16.1%), and the difference was statistically significant (χ 2=7.27, P =0.009). Gefitinib was well tolerated, and the main adverse reactions were rash and diarrhea. Univariate analysis showed that women, age<65 years, adenocarcinoma, non-smokers, non-resistant to taxans and patients with gene mutation were more sensitive to gefitinib treatment. However, COX multivariate regression analysis showed that only age, pathological type, smoking status and gene mutation affected the efficacy of gefitinib. The efficacy prediction model was established with these four factors as basic elements, and with 2 points as the boundary value, the efficacy rate of patients with>2 points (34.2%) was significantly higher than that of patients with ≤2 points (9.3%), and the difference was statistically significant (χ 2=10.619,P =0.001); Conclusion A model was established to predict the clinical efficacy of gefitinib in the treatment of NSCLC, which has certain reference value for selecting suitable patients.

Objective to investigate the relationship between the metabolic activating enzyme cytochrome P4501A1 (CYP1A1), 2D6 (CYP2D6), 2E1 (CYP2E1) and the metabolic detoxification enzyme glutathione sulfur transferase (GSTM1) and lung cancer susceptibility. Methods PCR and PCR-RFLP were used to detect the metabolic enzyme genotypes of CYP1A1, CYP2D6, CYP2E1 and GSTM1 in primary lung cancer group (279 cases) and control group (684 cases). The difference of OR values in the distribution frequency of different genotypes in the two groups was analyzed statistically. Results CYP1A1 mutant allele (m) and GSTM1 function deficient type (-) increased the risk of lung cancer by 1.64 (OR =1.64, 95% CI 1.21-2.22, P =0.001) and 1.58 (OR =1.58, 95% CI 1.19-2.11, P =0.002), respectively.

Objective to explore the mechanism of low molecular weight heparin sodium improving the blood circulation of skin flaps.Methods 48 Wistar rats were randomly divided into experimental group (topical low molecular weight heparin sodium cream) and control group (topical petrolatum jelly), 24 rats in each group.Random skin flaps (pedicle width 2 cm, length 8 cm) were designed on the back of the rats, and the skin flaps of each group were applied with corresponding drugs externally to observe the survival of the skin flaps.Blood was taken at different times (24, 48, 72 h and 7 d) to detect nitric oxide, and histomorphological examination of the skin flaps was performed. Results (1) Changes of nitric oxide content: 7 d after operation, the content of nitric oxide in the experimental group (53 ± 15) μ mol/L was higher than that in the control group (27 ± 20) μ mol/L (P<0.05); (2) The survival rate of skin flap in the experimental group (66%±18%) was higher than that in the control group (22%±16%), and the difference was statistically significant (t =18.19, P<0.01); (3) The histological results showed that a large number of new blood vessels formed in the flap of the experimental group, and the capillary intima was intact, the cell swelling was light, and the mitochondrial structure was stable. Conclusion Low molecular weight heparin sodium cream can increase the content of nitric oxide in the blood circulation of the flap and promote the survival of the flap.

Objective to investigate the effects of medium wave ultraviolet (UVB) radiation on nuclear factor kappa B (NF-κ B) and p53 signaling pathways in epidermal keratinocytes and the interaction between NF-κ B and p53 signaling pathways. Methods Normal human epidermal keratinocytes (NHEK) (containing wild type p53) and immortalized human keratinocyte line HaCaT (containing mutant p53) were cultured in 2 groups at 37℃ and 5% CO2. When the cells fused to 85%, they were irradiated with UVB (60mJ/cm2). One group was added with BAY11-7082 at a final concentration of 5 μ mol/L with anti-NF-κ B activation 1 h before irradiation. The cellular proteins and nuclear proteins of NHEK and HaCaT were extracted before and after irradiation, respectively, and the expression levels of NF-κ B, p53 and P21 were detected by Western blot, and the transcription of NF-κ B was detected by electrophoretic migration change analysis (EMSA). Results UVB radiation could activate the expression of NF-κ B, p53 and P21 in NHEK and HaCaT and the transcriptional activity of NF-κ B Conclusion UVB radiation activates the NF-κ B and P53 signaling pathway in epidermal keratinocytes, and this interaction is related to the functional status of P53.

Computer image navigation refers to the use of computer technology to combine the preoperative or intraoperative patient image data, the patient's lesion position and the coordinate system of the surgical tool in the actual surgical process. According to the needs of actual surgery, the tissue around the surgical tool is displayed correspondingly, and the operation is navigated in real time.

Both acute and chronic viral infection can cause immune suppression in the body, and the immune suppression in the acute infection stage is generally transient, while chronic infection can lead to long-term immune suppression and finally lead to the persistence of the virus in the body. This is also the most headache for virologists all along.

At present, anti-hepatitis B virus (HBV) drugs mainly include interferon, lamivudine, adefovir, entecavir, telbivudine and other nucleoside (acid) analogues, but these drugs have their own advantages and disadvantages, and they have not been able to completely effectively and durably inhibit virus replication.