ObjectiveTo explore the role of interleukin-6 (IL-6) in cervical cancer cell C-33A.MethodsThe cervical cancer cells C-33A were divided into the IL-6 group and the control group after culture. The IL-6 group were treated with 50 ng/mL of recombinant IL-6 protein, and the control group were without IL-6. Then cell viability and cell migration were detected by MTT assay and wound-healing assay, respectively. The mRNA and protein expressions of epithelial-cadherin (E-Cad), neural-cadherin (N-Cad), vimentin and transcription factors-snail1 (TFs-SNAIL1) were analyzed by real time quantitative polymerase chain reaction and Western blotting, respectively.ResultsCompared with the control group, in the IL-6 group the proliferation of cervical cancer cells C-33A was promoted (12 h: 0.388±0.025 vs. 0.597±0.057; 24 h: 0.547±0.021 vs. 0.798±0.036; 48 h: 0.745±0.056 vs. 1.296±0.122; 72 h: 1.074±0.053 vs. 1.805±0.113; P<0.05), and the relative migration ability of cervical cancer cell was promoted (12 h: 1.057±0.029vs. 1.200±0.045; 24 h: 1.189±0.036 vs. 1.428±0.181; 48 h: 1.273±0.059 vs. 1.569±0.143; 72 h: 1.409±0.047 vs. 1.623±0.170; P<0.05); meanwhile, compared with the control group, in the IL-6 group, the expression of E-Cad mRNA (1.012±0.098vs. 0.483±0.171, P<0.01) and E-Cad protein (1.032±0.015vs. 0.395±0.119; P<0.01) decreased, the expression of N-Cad mRNA (1.054±0.106vs. 1.465±0.230, P<0.01) and N-Cad protein (1.040±0.043vs. 1.605±0.128, P<0.01) increased, the expression of vimentin mRNA (1.050±0.083vs. 1.340±0.099, P<0.05) and vimentin protein (1.043±0.062vs. 1.430±0.077, P<0.05) increased, and the expression of TFs-SNAIL1 mRNA (1.058±0.176vs. 1.510±0.229, P<0.01) and Fs-SNAIL1 protein (1.022±0.015vs. 1.470±0.139, P<0.01) increased.ConclusionIL-6 may promote the proliferation, migration, and epithelial-mesenchymal transition of cervical cancer cell C-33A.
Objective To summarize the research progress of anterior cutaneous nerve injury and repair in knee arthroplasty. Methods The relevant literature at home and abroad in recent years was reviewed and summarized from the anatomy of anterior cutaneous nerve, nerve injury grade, clinical manifestations, prevention and treatment of anterior cutaneous nerve. Results The anterior cutaneous nerve injury is a common complication of knee arthroplasty. Because the anterior cutaneous nerve branches are many and thin, and mainly run between the first and second layers of fascia, this level is often ignored during surgical exposure. In addition, the knee arthroplasty does not routinely perform the exploration and repair of the cutaneous nerve. So the anterior cutaneous nerve injury is difficult to avoid, and can lead to postoperative skin numbness and knee pain. At present, studies have explored the feasibility of preventing its occurrence from the aspects of improved incision and intraoperative separation of protective nerve. There is no effective prevention and treatment measures for this complication. For patients with skin numbness after knee arthroplasty, the effectiveness of drug treatment is not clear. Local nerve block or nerve excision can be used to treat patients with painful symptoms after knee arthroplasty considering cutaneous pseudoneuroma. ConclusionKnee arthroplasty is widely used and anterior cutaneous nerve injury is common in clinic. In the future, more high-quality clinical studies are needed to further explore the prevention and treatment measures of this complication and evaluate the clinical benefits obtained.
Objective To investigate the clinical outcome of sensory reconstruction about the functional perforator flap for repairing the complex defects on the limbs. Methods A retrospective analysis was conducted on 21 patients with limb complex defects admitted between March 2018 and January 2023. There were 12 males and 9 females, with a median age of 36 years (range, 19-62 years). The wounds were on the upper limbs (hands) in 13 cases and the lower limbs (feet) in 8 cases. Five patients with tumor/scar, and the left defects after en-bloc resection of the tumor lesion and scar were repaired immediately. The remaining 16 cases were acute/chronic wounds, undergoing the emergent debridement and vacuum sealing drainage placement, and the left defects were repaired with flaps during second-stage operation. The size of the defects ranged from 5.5 cm×4.5 cm to 17.0 cm×12.0 cm. The donor sites were located on the thoracic and back in 4 cases, the anterior lateral thigh in 6 cases, and the feet in 11 cases. All flaps were functional perforator flaps with sensory nerve. The donor sites were closed directly or repaired with skin grafting. At last follow-up, the sensation of flap and the muscle strength of recipient site were evaluated according to the British Medical Research Council (BMRC) sensory grading (S0-S4) and muscle strength grading (M0-M5) criteria. Results Twenty flaps survived completely without significant complication, and partial edge necrosis was observed in 1 flap, which healed after the debridement and skin grafting. The donor and recipient sites healed by first intention. All patients were followed up 10-18 months (mean, 12 months). At last follow-up, the flaps with satisfactory shape and soft texture were observed, and no abnormal hair growth or pigmentation occurred. The sensation of flap was evaluated as S1 in 2 cases, S2 in 7, S3 in 9, and S4 in 3. The muscle strength of recipient site was evaluated as M2 in 4 cases, M3 in 9, M4 in 5, and M5 in 3. Only linear scars were left at the donor site. Conclusion The functional perforator flap with sensory nerve is beneficial for early sensation reconstruction for repairing the complex defects on the limbs, and could reconstruct the functional subunit structure defect in one stage. The short-term functional follow-up results are satisfactory.
ObjectiveTo explore the effectiveness of iliac myocutaneous flap pedicled with deep circumflex iliac artery (DCIA) on the repair of lower limb composite defect wounds with cavity. MethodsA retrospective analysis of 7 patients with lower limb composite defect wounds treated between March 2017 and September 2020 was conducted, including 4 males and 3 females, aged 24-58 years, with a median age of 37 years. The causes of injury were machine twisting injury in 2 cases, fall from height injury in 2 cases, and traffic accident injury in 3 cases. According to Gustilo-Anderson classification, there were 1 case of type Ⅲa, 4 cases of type Ⅲb, and 2 cases of type Ⅲc (combined with anterior tibial artery rupture); according to AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 2 cases of type 42-C3, 2 cases of type 43-A2, and 3 cases of type 43-B1. The time from injury to admission ranged from 2 to 10 hours, with an average of 6 hours. Tibial bone defect and surrounding soft tissue defect with deep cavity were left after primary emergency debridement. In the second stage, according to the characteristics of the wound, the three-dimensional repair of the composite defect was designed with DCIA embedded iliac myocutaneous flap. The size of the iliac flap was 2.0 cm×2.0 cm×2.0 cm to 7.0 cm×3.0 cm×2.5 cm, and the size of the flap was 12.0 cm×8.0 cm to 21.0 cm×13.0 cm. The internal oblique muscle flap was harvested in size of 3.0 cm×2.0 cm×2.0 cm to 5.5 cm×4.0 cm×4.0 cm. The donor site was primarily closed. ResultsAll the flaps survived after operation, except for 1 case of partial necrosis of the flap edge, which healed after secondary skin grafting, and the donor and recipient wounds healed by first intention. All patients were followed up 16-24 months, with an average of 18 months. The broken end of the bone defect healed well, and the healing time was 8-10 months, with an average of 7.3 months. At last follow-up, the shape of the flap was satisfactory, the texture was soft, and there was no abnormal hair growth, pigmentation, and so on. Only linear scar was left in the donor site, and no complication such as abdominal hernia occurred. According to Paley fracture healing scoring system, bone healing was rated as excellent in 5 cases and good in 2 cases. The limb function was satisfactory, and full weight bearing was achieved at 12-16 months after operation. According to the lower extremity functional scale (LEFS), 6 cases were excellent and 1 case was good. Conclusion The iliac myocutaneous flap pedicled with DCIA is flexible in design and highly free in tissue composition, which can repair the composite defect wound of lower limbs with deep cavity in a three-dimensional way, and repair the limb shape and reconstruct weight-bearing function to the greatest extent.
Objective To evaluate the efficacy of anti-oxidative treatment in cats with pancreaticobiliary maljunction. Methods Thirteen healthy cats as control group were made a model that resembling the common channel of pancreaticobiliary maljunction as in humans，and were divided randomly into two groups：7 cats in untreated group were not treated，6 cats in anti-oxidative group were treated with melatonin，vitamin C， and vitamin E. Six months later， the gallbladders of these animals were removed and histopathological changes were evaluated by pathological and electron microscopic examination. The level of MDA，amylase concentration in the gallbladder bile，and percentage of proliferating cell nuclear antigen （PNCA） positive cells were also test. Results All cats had survived for 6 months after operation. The wall of gallbladder and the bile became thicker in untreated group than that in normal control group， and there were no significant differences between untreated group and anti-oxidative group. The gallbladder epithelium became villous in appearance in untreated group，although the epithelium of that in normal control group was flat with few folds. The epithelial cells of gallbladder arranged tightly in normal control group， while a significant change such as endoplasmic reticulum expanding， intercellular space broadening， and cellular nucleus deforming were observed in untreated group. The things in anti-oxidative group were better than untreated group. The amylase concentration in the gallbladder bile was （203.02±65.04）U in normal control group，（9 368.09±2 204.42） U in untreated group， and（8 746.25±2 077.95） U in anti-oxidative group， respectively. The amylase concentration in untreated group and anti-oxidative group were higher than that in normal control group （P=0.003），and there was no significant difference between the untreated group and anti-oxidative group （P=0.642）. The percentage of PNCA positive cells was （7.29±2.70）% in normal control group，（54.71±10.90）% in untreated group, and （48.17±13.06）% in anti-oxidative group， respectively （F=48.11，P=0.001），and the percentage of PNCA positive cells in untreated group was higher than that in anti-oxidative group （P=0.001）. The level of MDA was （1.095±0.653） nmol/mg prot in normal control group，（2.745±1.533） nmol/mg prot in untreated group, and （1.302±0.771） nmol/mg prot in anti-oxidative group， respectively （F=5.17，P=0.017）, and the level of MDA in untreated group was higher than that in anti-oxidative group （P=0.017）. Conclusion The anti-oxidative treatment is effective to pancreaticobiliary maljunction.
ObjectiveTo compare the effectiveness of lateral approach minimally invasive plate osteosynthesis (MIPO) and helical plate MIPO in the treatment of proximal humeral shaft fractures. Methods The clinical data of patients with proximal humeral shaft fractures who underwent MIPO via lateral approach (group A, 25 cases) and MIPO with helical plate (group B, 30 cases) between December 2009 and April 2021 were retrospectively analyzed. There was no significant difference in gender, age, injured side, cause of injury, American Orthopaedic Trauma Association (OTA) fracture classification, and time from fracture to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, fluoroscopy times, and complications were compared between two groups. The angular deformity and the fracture healing were evaluated according to anteroposterior and lateral X-ray films postoperatively. The modified University of California Los Angeles (UCLA) score for shoulder and the Mayo Elbow Performance (MEP) score for elbow were analyzed at last follow-up. Results The operation time in group A was significantly shorter than that in group B (P<0.05). However, the intraoperative blood loss and fluoroscopy times presented no significant difference between the two groups (P>0.05). All patients were followed up 12-90 months, with an average of 19.4 months. There was no significant difference in follow-up time between the two groups (P>0.05). In terms of the quality of postoperative fracture reduction, there were 4 (16.0%) and 11 (36.7%) patients with angulation deformity in group A and group B, respectively, and there was no significant difference in the incidence of angulation deformity (χ2=2.936, P=0.087). All fractures achieved bony union, there was no significant difference in fracture healing time between group A and group B (P>0.05); delayed union occurred in 2 cases and 1 case in group A and group B, respectively (healing time was 30, 42, and 36 weeks after operation, respectively). In group A and group B, 1 patient had superficial infection of incision, respectively; 2 patients and 1 patient had subacromial impact after operation, respectively; and 3 patients in group A had symptoms of radial nerve paralysis of different degrees; all of them were cured after symptomatic treatment. The overall complication incidence of group A (32%) was significantly higher than that of group B (10%) (χ2=4.125, P=0.042). At last follow-up, there was no significant difference in the modified UCLA score and MEPs score between the two groups (P>0.05). Conclusion Both lateral approach MIPO and helical plate MIPO can achieve satisfied effectiveness in the treatment of proximal humeral shaft fractures. Lateral approach MIPO may be beneficial to shorten the operation time, while the overall complication incidence of helical plate MIPO is lower.
Objective To investigate the influence of tibial component posterior slope angle (TCPSA) on the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA). MethodsThe clinical data of the patients with anterior medial knee osteoarthritis (KOA) treated by UKA between May 2014 and May 2019 were retrospectively analysed. There were 10 males and 45 females with a median age of 68 years (range, 49-83 years). The body mass index (BMI) was 27.63-52.26 kg/m2, with an average of 40.04 kg/m2. There were 28 cases of left knee, 21 cases of right knee, and 6 cases of double knees. The disease duration was from 7 months to 12 years, with an average of 4.33 years. Measurements of posterior tibial slope (PTS) and TCPSA were performed on the knee joint X-ray films of patients before operation and at last follow-up, respectively. According to the postoperative TCPSA, patients were divided into TCPSA<4° group (group A), 4°≤TCPSA<9° group (group B), and TCPSA>9° group (group C) with the quartile method. Baseline data such as age, gender, BMI, and affected side were compared among the 3 groups, as well as the Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, and range of motion (ROM) before and after operation. ResultsAll 55 patients were followed up 17-72 months, with an average of 36 months. No complication such as prosthesis loosening, infection, tibial plateau collapse, and dislocation of the meniscus pad occurred. The preoperative PTS was (7.38±3.37)°, and the postoperative TCPSA was (6.25±3.22)°, showing no significant difference (t=1.815, P=0.074). According to postoperative TCPSA, there were 12 knees in group A, 32 in group B, and 17 in group C. There was no significant difference in age, gender, BMI, affected side, and preoperative HSS scores, ROM, and VAS scores among the 3 groups (P>0.05). At last follow-up, the HSS scores, ROM, and VAS scores of the 3 groups significantly improved when compared with preoperative ones (P<0.05). There was no significant difference in the difference of the above indicators before and after operation among 3 groups (P>0.05). ConclusionThe patients with anterior medial KOA may have good short- and mid-term effectiveness after UKA. Among the recommended range of TCPSA, there is no significant influence on the postoperative short- and mid-term effectiveness. Long-term effectiveness need to extend the follow-up time and expand the sample size for research verification.
Objective To investigate the effectiveness of groin flap combined with medial plantar artery perforator flap (MPAP) for degree Ⅲ-Ⅳ defects of multiple fingers. Methods Between January 2018 and June 2019, 12 patients with degree Ⅲ-Ⅳ defects of multiple fingers caused by crushing were admitted. There were 9 males and 3 females with a median age of 29 years (range, 16-42 years). The mean interval between the injury and admission was 3 hours (range, 1-9 hours). The injured fingers of 7 cases were index and middle fingers, 4 cases were middle and ring fingers, and 1 case was index, middle, and ring fingers. All fingers were taken thorough debridement and covered by the vacuum sealing drainage device during the emergency operation. The mean interval between the debridement and flap repairing was 18 hours (range, 12-36 hours). During the first-stage operation, the iliac bone graft was used to reconstruct bone frame, and the proximal interphalangeal (PIP) joint from the foot was transferred as the digital PIP joint, then the thin groin flap and MPAP were tailored to cover the dorsal and palmar defects, respectively. The size of the groin flap was 7.0 cm×4.5 cm-14.0 cm×9.0 cm, and the size of the MPAP was 8.0 cm×4.5 cm-14.0 cm×6.5 cm. The abdominal donor site was directly sutured, and the foot was repaired with full-thickness skin grafting. The flaps were separated into the finger shape at the second-stage. Results All the flaps survived, and the wounds healed by first intention; the incisions in the donor site healed by first intention, and the skin grafts survived completely. All patients were followed up 12-18 months (mean, 16 months). At last follow-up, the injured finger was similar to the contralateral one in terms of texture, appearance, and color. The mean two-point discrimination was 8 mm (range, 6-10 mm), and the sensate level recovered to the S3-S4. According to the Michigan Hand Outcomes Questionnaire (MHQ), the reconstructed hand function was excellent in 8 cases and good in 4 cases. There was no complication in the donor sites. Conclusion The degree Ⅲ-Ⅳ defects of multiple fingers were repaired by the groin flap and MPAP, and the reconstructed fingers can perform good texture and motion with being sensate, with less sacrifice on the foot.
ObjectiveTo explore the risk factors influenced postoperative complications of colon cancer. MethodsIn this study, 114 patients diagnosed definitely as colon cancer were enrolled from January 2009 to April 2010 in this hospital. The patients were divided into the complication group and non-complication group according to the occurrence of postoperative complications during hospital day. Furthermore, clinicopathological features and operative parameters of patients were compared in two groups, and independent factors for postoperative complications were identified by multiple regression analysis. ResultsThere were statistical differences between two groups in operation time (t=2.034, P=0.032), diabetes mellitus (χ2=5.920, P=0.015), differentiation degree of tumor (χ2=7.163, P=0.028), hospital stay (χ2=0.411, P=0.026), and ASA grades (χ2=11.585, P=0.009). The morbidity of patients with operative time gt;200 min was significant higher than that ≤100 min (χ2=8.884, P=0.003) and 100-200 min (χ2=7.318, P=0.007). The morbidity of patients with ASA Ⅳ grade was higher than that with ASA Ⅰ grade (χ2=13.426, P=0.000). For tumor differentiation, the morbidity of patients with well-differentiated tumor was higher than that with moderately differentiated tumor (χ2=4.950, P=0.026) and poorly differentiated tumor (χ2=7.476, P=0.006). The hospital stay (P=0.009), age (P=0.024), diabetes mellitus (P=0.018), and ASA grade (P=0.001) were the independent factors for postoperative complications by multivariate regression analysis. ConclusionThe physical quality indexes are the mostly common risk factors of postoperative complications for colon cancer, emphasizing on the high-risk factors and making a targeted and individual treatment plan for each patient are of great important to improve the prognosis.
Objective To investigate the effectiveness of the wrap-around great toe flap combined with medial plantar artery perforator flap (MPAP) for repairing the completely degloved fingers. Methods Between February 2018 and December 2019, 12 patients with the completely degloved fingers caused by machine strangulation were admitted. There were 9 males and 3 females with a median age of 32 years (range, 18-42 years). The injured finger was index finger in 7 cases, middle finger in 3 cases, and ring finger in 2 cases. The skin was avulsed from the metacarpophalangeal joint level, with the intact tendon and joint. The interval between injury and admission was 1-8 hours (mean, 5 hours). All fingers were taken debridement during the emergency operation. The size of the skin defect ranged from 8.0 cm×5.0 cm to 12.0 cm×7.5 cm. After flap thinning, the wrap-around great toe flap (8.0 m×2.0 cm-12.0 cm×3.5 cm) and MPAP (8.0 cm×4.0 cm-12.0 cm×5.5 cm) were used to repair the degloved finger. The donor sites were repaired with the full-thickness skin graft or the flap. Results All flaps and skin grafts survived completely without significant complications and the wounds at recipient and donor sites healed by first intention. All patients were followed up 12-16 months (mean, 14 months). The texture, appearance, and color of the affected fingers were close to those of normal fingers, and the nails grew normally. At last follow-up, the mean two-point discrimination of the flap was 9 mm (range, 8-10 mm), and the sensation of the injured finger recovered to S3-S4. And 10 cases were rated as excellent and 2 cases as good according to the Michigan Hand Outcomes Questionnaire (MHQ). There was no complication such as pain from walking or skin ulceration at the donor site. The American Orthopaedic Foot and Ankle Society (AOFAS) score was excellent in 9 cases and good in 3 cases. Conclusion Treating for the completely degloved fingers, the wrap-around great toe flap combined with MPAP can obtain good effectiveness in the respect of the sensation, function, and appearance.