Abstract： Objective To assess the effects of simultaneous antegrade/retrograde cardioplegia (SARC) on myocardial perfusion and energy metabolism in ischemic myocardium using magnetic resonance imaging (MRI). Methods After the hearts were harvested from 18 domestic pigs, left anterior descending artery, aorta, anterior ascending cardiac vein and coronary sinus were cannulated to establish the perfusion routes. 6 hearts were used to assess the effects of SARC on myocardial perfusion. Energy metabolism was observed in the other 12 pig hearts. MRI was used to monitor the distribution of contrast agent (gadoliniumdiethylenetriamine penlaacetic acid, Gd-DTPA) in the myocardium after its injection through arterial and retrograde perfusion routes. The efficacies in sustaining myocardial perfusion and energy metabolism were evaluated by using phosphorus-31 magnetic resonance spectroscopy (31P MRS) during antegrade cardioplegia (AC) and SARC respectively. Results It was found that injection of Gd-DTPA into the aorta during AC did not result in signal increase in the ischemic myocardium on MRI. During SARC, however, Gd-DTPA was found in the ischemic region as well as in the other regions, no matter if it was given into the aorta or into the coronary sinus. Moreover,31P spectra showed that occlusion of LAD during AC resulted in severe decrease of the levels of phosphocreatine (PCr) and adenosine triphosphate (ATP), while the level of inorganic phosphate (Pi) increased in LAD-support myocardium. The abnormal metabolic changes were completely abolished by use of SARC. Conclusion It is concluded that SARC can deliver cardioplegic solution to the myocardium distal to a coronary occlusion and can sustain normal energy metabolism in the jeopardized myocardium.
Objective\ In order to assess and evaluate the clinical results of cold blood cardioplegia and intermittent cross clamping as myocardial preservation in coronary artery bypass grafting(CABG).\ Methods\ According to the management methods, 2 013 cases for elective, isolated CABG were divided into two groups at St.George’s Hospital, London.Cold blood cardioplegia group: 596 patients treated with cold blood cardioplegia, and hypothermic ventricular fibrillation group: 1 417 patients treated with intermitt...
ObjectiveTo summarize the research progress of severed limb preservation by perfusion and to analyze difference in effect of severed limb preservation by different perfusate. MethodsThe domestic and foreign related literature about severed limb preservation by perfusion was extensively reviewed and analyzed. ResultsCurrently the main perfusate includes organ perfusate,free radical scavengers,energy mixture,blood substitutes,and whole blood.They can reduce the skeletal muscle's ischemia-reperfusion injury in different degrees. ConclusionDifferent perfusate can reduce the skeletal muscle's ischemia-reperfusion injury in different degrees,but the best effect of perfusate and personalized preservation method need further study.
Objective To observe the long-term effectiveness of tendon allograft to repair tendon defect. Methods Between October 1996 and September 1999, 24 patients with tendon defect were treated with tendon allograft which was cultured with deoxyguanosine and preserved at low-temperature or ultra-deep-low-temperature. There were 19 males and 5 females, aged from 12 to 46 years with an average of 25.9 years. These patients included 7 cases of total extensor tendon defect of 2nd-5th fingers, 7 cases of index finger extensor tendon defect, 3 cases of deep flexor tendon defect of 2nd- 5th fingers, 1 case of ring finger deep flexor tendon defect, 3 cases of long extensor tendon defect of 2nd-5th toes, 2 cases of long extensor hallucis tendon defect, and 1 case of shoulder adduction missing. The sizes of tendon defect ranged from 5 to 15 cm. The mean time from injury to operation was 1.3 months (range, 2 hours to 3 months). Results Incisions healed by first intention. No deep infection, infectious diseases, and obvious immune rejection occurred. All patients were followed up from 10 to 12 years with an average of 10.8 years. When compared with contralateral sides, at 10 years of follow-up, 1 patient lost 6-10° flexion function; after 10.6 years, flexion tendon releasing was performed; allografted tendon had normal color and elasticity with decreased diameter and with mild and moderate adherence; and after releasing, function was improved. According to Hand Surgery Association assessment standard, the results were excellent in 12 cases, good in 6, and poor in 6; the excellent and good rate was 75%. Conclusion Tendon allograft which is cultured with deoxyguanosine and preserved at low-temperature or ultra-deep-low-temperature is safe to use in cl inical, which has good long-term effectiveness in treating tendon defect.
ObjectiveBased on the latest version of the Database from Colorectal Cancer(DACCA), this study analyzed the long-term effect of neoadjuvant therapy combined with intersphincteric resection (ISR) in patients with rectal cancer. MethodsAccording to the established screening criteria, clinical data of 944 patients with rectal cancer admitted from January 2009 to December 2020 were collected from the DACCA updated on March 21, 2022, to explore the influencing factors for overall survival (OS) and disease specific survival (DSS) of rectal cancer treated with neoadjuvant therapy combined with ISR, by Cox proportional hazard regression model. Results① The 3-year OS and DSS survival rates of neoadjuvant therapy combined with ISR for rectal cancer were 89.2% and 90.4%, respectively, and the 5-year OS and DSS survival rates were 83.9% and 85.4%, respectively. ② For different ISR surgical methods and neoadjuvant therapy plans, there were no significant differences in OS and DSS (P>0.05), but there were significant differences in OS and DSS among different ypTNM stage groups (P<0.001), patients with ypTNM 0–Ⅱ had better OS and DSS. ③ BMI, ypTNM stage and R0 resection were influencing factors for OS and DSS (P<0.05). ④ The overall incidence of postoperative complications was low, including 6.4% (60/944) within 30 days, 7.5% (71/944) within half a year and 3.3% (31/944) over half a year after operation. ConclusionsIn the comprehensive treatment of patients with low/ultra-low rectal cancer, neoadjuvant therapy combined with ISR can achieve relatively stable and good long-term oncological efficacy, and the incidence of short-term postoperative complications is not high, which is one of the options.
ObjectiveTo evaluate the safety and advantages of modified Bacon one-time operation in laparoscopic radical resection for ultra-low rectal cancer.MethodsThe medical records of all patients who underwent laparoscopic modified Bacon procedure for ultra-low rectal cancer treated by Professor SONG Junmin Medical Group of our department from August 2018 to June 2020 were analyzed retrospectively. According to the different methods during the operation, the patients were divided into a modified Bacon one-time operation group (modified Bacon group, n=26) and a Bacon secondary operation group (traditional Bacon group, n=33). The perioperative period data and follow-up results were observed and compared.ResultsA total of 59 ptients were collected, including 26 cases in the modified Bacon group and 33 cases in the traditional Bacon group. There were no significant differences in gender composition, age, etc. baseline data between the two groups (P>0.05). All surgery were successfully completed. There were no conversion to laparotomy, intraoperative or postoperative massive bleeding, severe infection and other serious complications and perioperative period death. The incidence of anastomotic leakage in the modified Bacon group was lower than that of the traditional Bacon group [0.0% (0/26) versus 18.2% (6/33), P=0.030]. There were no significant differences in the incidences of postoperative anastomotic bleeding, anastomotic stricture, rectal irritation, and external intestinal necrosis between the two groups (P>0.05). And the number of dissected lymph nodes, operation time, intraoperative blood loss, the first exhaust time, and postoperative hospital stay had no significant differences between the two groups (P>0.05). There were no significant differences in the severity degree and total score of low anterior rectectomy syndrome (LARS) between the two groups at 3 and 6 months after operation (P>0.05). However, the total LARS score at 6 months after operation was lower than that at 3 months in the same group (P<0.001). By the end of the last follow-up (January 2021), there was no obvious difference in the anal shape between the two kinds of surgery. There was no recurrence or death during the follow-up period.ConclusionModified Bacon one-time operation for ultra-low rectal cancer is safe and feasible, which could achieve natural orififice specimen extraction surgery and ultra-low limit sphincter preservation, reduce occurrence of postoperative anastomotic leakage and external intestinal necrosis, times of operation, and shorten total length of stay and reduce total cost of hospitalization.
Ankle arthritis affects approximately 1% of the adult population worldwide and represents a serious global disease burden. However, compared with hip arthritis and knee arthritis, the clinical understanding and treatment of ankle arthritis are still in their infancy. For end-stage ankle arthritis, ankle arthrodesis was considered as the “gold standard” in the past. However, ankle arthrodesis will result in loss of joint mobility, altered gait, limited daily activities, and accelerated degeneration of adjacent joints. Therefore, how to preserve the range of motion of the ankle joint while relieving pain is the key to the treatment of ankle arthritis. Currently, the surgical treatment of ankle arthritis includes arthroscopic debridement, periarticular osteotomies, osteochondral transplantation, ankle distraction arthroplasty, ankle arthrodesis, and total ankle arthroplasty. The choice of treatment should be individualized and based on various factors such as the patient’s symptoms, signs, imaging performance, complaints, and financial situation. However, there are no guidelines that give clear treatment recommendations. Therefore, it is necessary to conduct extensive and in-depth discussions on the diagnosis and treatment of ankle arthritis.
PURPOSE:To establish methods for cryopreservation of human retinal pigment epithelial cells (RPEs)and cell culture from thawing of frozen cells. METHODS:Primary cultured RPEs or its first or second passages,added with 10 dimetbylsulfoxide,were kept in --20℃ for 1 to 2 hours,and then further froze to -40~C over night before being placed in liquid nitrogen. The frozen cells were thawed in 60℃ within 2 minutes. Trypan blue staining and immunocytochemical staining with anti-human keratin were performed for cell viability and differentiation. The growth curve was also determined by calculating the total number of cells/well/day. RESULTS:The viable rate from frozen RPEs was 90%. No differences were observed for growth activity between cultures from frozen cells and controls. The cells were positive with anti-human keratin staining. The logarithmic growth phase was during I to 4 days and the doubling time yeas 1.55 days. CONCLUSION: Cryopreservation of RPEs in liquid nitrogen can maintain biological activities of cells with normal growth and features after thaw- ing. This will provide cell lines for in vitro experiments and possibly for cell banks for RPE transplantation for some fundus diseases. （Chin J Ocul Fundus Dis,1997,13:157-159）
OBJECTIVE: To investigate a cryophylactic agent (CPA) to protect tissue engineered tendon (TET) in deep low temperature. METHODS: Sixty-four BALB/C inbred nude mice were chosen, which included 4 as blank control group, left sides of 60 as experimental group and their right sides as control group. Transformed human embryonic tendon cells of the 54th passage and artificial materials of carbon fiber (CF) and polyglycolic acid (PGA) were co-cultured in vitro to construct TET. TET was frozen in liquid nitrogen with four kinds of CPA (groups A, B, C, and D) for 2 months. They were thawed quickly and transplanted into hind limbs of nude mice to repair the defects of Achilles tendon, which was 5 mm in length and 65.7% of total Achilles tendon. In control group, no cryopreservation treatment was taken. The morphological, histological, ultrastructure, and immunohistochemistry examinations were made and short tandem repeat loci were detected 2, 4, 6, 8, and 12 weeks later. RESULTS: In the experimental group, the morphological properties of tendon cells resumed gradually and the capability of synthesizing collagen enhanced by degrees. Tendon cells survived and could secret type I collagen and there was less difference between experimental and control groups 12 weeks after transplantation. In group A, vacuole in mitochondrion of tendon cell decreased, tendon cell arranged in order and abundant collagen fibers were found and linked. CONCLUSION: The cryopreservation agent in group A can protect TET in deep low temperature.
Objective To investigate the effectiveness of posterior cruciate ligament (PCL) reconstruction with remnant preservation and autogenous quadrupled hamstring tendons under arthroscopy. Methods Between October 2007 and August 2012, 32 patients with PCL rupture were treated and followed up for more than 1 year. There were 24 males and 8 females, aged 20-53 years (mean, 35.6 years). The causes of injury included traffic accident injury in 21 cases, sports injury in 8 cases, and falling injury from height in 3 cases. The disease duration ranged 1 week to 2 years (median, 6.3 weeks). Nine patients had simple PCL rupture, 23 patients complicated by ligament injury, including 10 cases of anterior cruciate ligament rupture, 11 cases of posterolateral corner injury, and 2 cases of posteromedial corner injury. Preoperative Lysholm score was 53.8 ± 7.1. According to the International Knee Documentation Committee (IKDC) rating criteria, 10 cases were classified as grade C and 22 cases as grade D. PCL was reconstructed with autogenous quadrupled hamstring tendons, the tendons were fixed with EndoButton at the femoral side and with interference screw at the tibial side; floats of stump were cleaned up, and the structural stability and continuity ligament remnants were preserved. Results Primary healing was obtained in all incisions; no early complication occurred after operation. Thirty-two patients were followed up 23.4 months on average (range, 12-36 months). All patients had no symptom of knee instability; the results of tibia sags sign, posterior drawer test, and Lachman test were negative. At last follow-up, the knee range of motion (ROM) returned to normal in all cases. The Lysholm score was 92.3 ± 2.0, showing significant difference when compared with preoperative score (t= — 34.32, P=0.00). According to the IKDC rating criteria, 26 cases were classified as grade A and 6 cases as grade B at last follow-up, showing significant difference when compared with preoperative grade (Z= — 5.57, P=0.00). Conclusion Arthroscopic single-bundle reconstruction of PCL with remnant preservation and quadrupled hamstring tendons has advantages of minimal trauma, simple operation, and good knee function recovery.