Objective To investigate the possibility of differentiation of theisolated and cultured adipose-derived adult stem cells into chondrocytes, which is induced by the recombinant human bone morphogenetic protein 2 (rhBMP-2). Methods The rabbit adipose tissue was minced and digested by collagenase Type Ⅰ. The adposederived adult stem cells were obtained and then they were cultured inthe micropellet condition respectively in the rhBMP-2 group, the rhTGF-β1 group, the combination group, and the control group for 14 days. The differentiation of the adiposederived stem cells into chondrocytes was identifiedby the histological methods including HE, Alcian blue, Von kossa, and immunohistochemical stainings. Results After the continuous induction by rhBMP-2 and continuous culture for 14 days, the HE staining revealed a formation of the cartilage lacuna; Alcian blue indicated that proteoglycan existed in the extracellular matrix; the immunohistochemical staining indicated that collagen Ⅱ was in the cellular matrix; and Von kossa indicated that the adipose-derived stem cells couldnot differentiate into the osteoblasts by an induction of rhBMP-2. Conclusion In the micropellet condition, the adipose-derived adult stemcells can differentiate into the chondrocytes, which is initially induced by rhBMP-2. This differentiation can provide a foundation for the repair of the cartilage injury.
Objective To explore an improved method of treating avascular necrosis of the femoral head in young adults by grafting the sartorius muscle iliac bone flap. Methods From September 1994 to August 2003, 68 patients (57 males, 11 females; age, 16-58 years) underwent of the transplant the sartorius muscle oliac bone flap into the femoral head after decompression of the femoral head medullary core and removal of the dead bone and the fibrous tissue in the femoral head. The transplantation was performed on 31 patients left-unilaterally, on 37 patients rightunilaterally, and on 7 patients bilaterally. The pathological causeswere as follows: alcoholism in 52 patients, prolonged use of hormones in 6, traumain the hip in 6, and undetermined cause in 4. Their illness course ranged from 8 months to 4 years. According the Ficat staging, 10 patients belonged to Stage I (11 sides), 27 patients to Stage Ⅱ (31 sides), and31 patients to Stage Ⅲ (33 sides). Results The follow-up of the 68 patientsfor 2.5-11 years averaged 5.2 years revealed that based on the Harris evaluation for the hip function, 23 patients had an excellent result, 33 had a good result, 10 had a fair result, and 2 had a poor result. The excellent and good resultsaccounted for 82.3%. There was no recurrence after operation. Conclusion Thismethod has the following advantages: the lesion focus can be eradicated; enoughdecompression can be achieved, and the blood circulation for the femoral head can be rebuilt. The grafting of the sartorius muscle iliac bone flap can bring the osteogenesis components to the femoral head, promoting the reconstruction of the bones. This method is suitable and effective for the patients with avascular necrosis of the femoral head (Ficat Grades Ⅰ, Ⅱ and Ⅲ) in young adults.
Objective To explore and implement a systematic, case guided online interactive training course for neurologists to improve their diagnosis and treatment of rare genetic diseases. Methods Doctors who participated in the course investigation of the neurogenetic project of the Department of Neurology of Peking Union Medical College Hospital between January and September 2021 were selected. Based on andragogy theory, a genetics training course for neurologists was developed by applying Kern’s six steps of curriculum development. According to the time of participating in the doctor’s courses, they were divided into three groups: completed all courses (10.7 h group), completed more than 1/2 courses (5.3～10.7 h group) and completed less than 1/2 courses (<5.3 h). According to the length of service, they were divided into groups of less than 10 years, 10-20 years and more than 20 years. Analyze the benefit difference of different doctors’ training time, and collect their feedback scales on the curriculum for the improvement of follow-up courses. Results A total of 54 doctors were included. Among them, 17 (31.5%) completed all courses, 29 (53.7%) completed more than 1/2 courses, and 8 (14.8%) completed less than 1/2 courses. There was a statistically significant difference among the three groups in the self-assessment improvement score (H=12.341, P=0.002). The results of pairwise comparison between groups of self-assessment improvement score showed that the <5.3 h group was lower than that of the 10.7 h group (P=0.007), and the the <5.3 h group was also lower than that of the 5.3～10.7 h group (P=0.002). 33 (61.1%) in the less than 10 years group, 16 (29.6%) in the 10-20 years group, and 5 (9.3%) in the more than 20 years group. There was no correlation between participating in work and course time (rs=0.113, P=0.418). 54 (100.0%) believed that they had more than moderate help (≥3 points). Most doctors (>90%) had a good evaluation of the curriculum. Conclusion The periodic neurogenetic re-education project is helpful for clinical diagnosis and treatment of rare neurogenetic diseases.
Objective To assess the midterm follow-up outcomes of total hip arthroplasty (THA) for the treatment of patients with juvenile-onset ankylosing spondylitis (JAS). Methods The clinical data of 81 patients (127 hips) with JAS (age≤16 years, JAS group) and 267 patients (391 hips) with adult onset ankylosing spondylitis (AAS) (age>16 years, AAS group) between January 2004 and March 2018 were retrospectively analysed. The baseline demographics, clinical, radiographic, and laboratory parameters were collected. Before operation and at last follow-up, the overall disease activity [Bath ankylosing spondylitis disease activity index (BASDAI)] and function status [Bath ankylosing spondylitis functional index (BASFI)], hip subjective score [Harris hip score (HHS)] and objective score [12-item short form health survey (SF-12), including physical component score (PCS) and mental component score (MCS)], and patient satisfaction for THA were reviewed. The major orthopedic complications, including periprosthetic infection, dislocation, periprosthetic fractures, and poor incision healing, were also recorded during the follow-up period. Results The comparison of preoperative baseline parameters showed that the body mass, body mass index, age of onset, age of surgery, disease duration, and the proportion of combined smoking history in the JAS group were significantly lower than those in the AAS group (P<0.05), the proportion of bilateral surgeries, proportion of uveitis, proportion of combined family history, C-reactive protein, albumin, and preoperative BASFI were significantly higher than those in the AAS group (P<0.05). Both groups were followed up. The follow-up time in the JAS group was 29-199 months, with an average of 113 months; in the AAS group was 35-199 months, with an average of 98 months. Incisions in both groups healed by first intention. During the follow-up period, there were 1 case of periprosthetic fracture, 1 case of dislocation, and 1 case of ceramic fragmentation in the JAS group, 1 case of periprosthetic infection and 6 cases of periprosthetic fracture in the AAS group. There was no significant difference in the incidence of complications between the two groups (P>0.05). At last follow-up, the BASDAI, BASFI, SF-12 MCS, SF-12 PCS, and HHS score of the two groups were significantly improved when compared with those before operation (P<0.05); but there was no significan difference in the difference of the above parameters before and after operation and the patient satisfaction between the two groups (P>0.05). Conclusion The midterm follow-up outcomes of THA for the treatment of JAS patients were reliable. A low age at disease onset did not exert a significant negative effect on THA reconstruction for the treatment of ankylosing spondylitis.
Liddle syndrome and Gordon syndrome are two rare single-gene inherited hypertension diseases. In patients≤40 years, the prevalence of Liddle syndrome is about 1% and Gordon syndrome is uncertain all over the word, for which is often misdiagnosed and mistreated. The therapies of those diseases are targeted at gene mutation sites, as well as combined with modified lifestyle, and can achieve satisfactory diseases control. This paper reports a patient who is diagnosed with Liddle syndrome and Gordon syndrome at the same time. We aimed to consolidate and improve the diagnosis and accurate treatment of those two diseases by sharing, studying and discussing together with clinical doctors.
Objective To explore the effects of fibulectomy on lower limb function and gait of adult patients through gait analysis, in order to provide guidance for clinical treatment. Methods A clinical data of 24 patients who underwent fibulectomy and met the selection criteria between January 2017 and December 2022 was retrospectively analyzed. There were 12 males and 12 females with an average age of 25 years (range, 18-68 years). The length of fibulectomy was 10-19 cm, with an average of 15 cm. The patients underwent routine rehabilitation training after operation. The occurrence of postoperative complications was recorded, the pain degree of surgical incision was evaluated by visual analogue scale (VAS) score, and the residual fibular bone was reviewed by imaging. A gait test system was used before operation and at 6 months after operation to collect gait data of healthy and affected sides under slow, medium, and fast velocity conditions, including gait parameters (foot rotation angle, step length, support phase, swing phase, gait line length, single support line, maximum force 1, maximum force 2) and the tripod area parameters (maximum pressure, time maximum force, and contact time of forefoot, midfoot, and hindfoot). Results All incisions healed by first intention after operation. All patients were followed up 1-5 years, with an average of 3 years. The great dorso-extension muscle strength decreased in 3 cases, and the sensory defects in the operative area and distal part occurred in 5 cases. The VAS scores of incisions were 0-6 (mean, 4) at 6 months after operation and 0-5 (mean, 2) at last follow-up. During follow-up, imaging review showed that 5 cases had osteoporotic changes of distal residual bone of the fibula, and the residual segment was shorter and more significant; 3 cases had new bone formation. The results of gait test showed that the gait parameters and the tripod area parameters under the three gait speeds were consistent. There was no significant difference in the gait parameters and the tripod area parameters between the healthy side and the affected side before operation (P>0.05). Compared with the healthy side, the foot rotation angle, the single support line, the maximum force 1, the maximum force 2, and the maximum pressures of the forefoot and midfoot of the affected side significantly decreased after operation (P<0.05), and the step length, the time maximum force of midfoot and hindfoot, and the contact time of the forefoot and midfoot significantly increased (P<0.05). Compared with preoperative conditions on the same side, the foot rotation angle, the gait line length of both sides significantly decreased (P<0.05), and the maximum pressures of the forefoot, midfoot, and hindfoot and the time maximum force of the midfoot significantly increased (P<0.05); the step length on healthy side significantly decreased, while the affected side significantly increased (P<0.05); the maximum force 1 and the maximum force 2 on the healthy side significantly increased, while the affected side significantly decreased (P<0.05); the single support line on the affected side significantly decreased (P<0.05). Conclusion Different degrees of clinical symptoms occurred, gait pattern changes, compensatory gait appears, gait stability decreases, and the risk of tumble increases in adult patients after partial fibulectomy. Therefore, it is recommended to walk slowly after fibulectomy.
ObjectiveTo systematically evaluate the correlation between interpersonal stress and suicidal ideation. MethodsThe PubMed, EMbase, Cochrane Library, CBM, WanFang Data and CNKI databases were searched to collect studies on the correlation between interpersonal pressure and suicidal ideation from database inception to April 27, 2022. Two researchers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 14.0 software. ResultsA total of 42 studies including 3 cohort studies, and 39 cross-sectional studies, with a total sample size of 193 810 participants were included. Meta-analysis showed that the risk of suicidal ideation was higher in people who had experienced interpersonal pressure than in people who had not (OR=2.11, 95%CI 1.99 to 2.23, P<0.01). Subgroup analysis showed that people in the Americas who had experienced interpersonal pressure were more strongly associated with suicidal ideation than people in other regions of the studied area. Young adults in the study who had experienced interpersonal pressure were more strongly associated with suicidal ideation than other studied age groups; People who had experienced partner pressure were more strongly associated with suicidal ideation than those who had experienced other types of interpersonal pressure. ConclusionThis study shows that people who have experienced interpersonal pressure are at greater risk of suicidal ideation, and there are certain differences among study areas, subjects and types of interpersonal pressure. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To summarize the experience of the prevention of early arterial compl ications after hepatic artery (HA) reconstruction in adult-to-adult l iving donor l iver transplantation (A-A LDLT). Methods Between January 2002and March 2008, 127 patients underwent A-A LDLT. Of the 131 donors (127 cases of right lobe graft, 4 cases of left lobe graft), there were 69 males and 62 females with a mean age of 36.2 years (range, 19-65 years); in 127 recipients, there were 109 males and 18 females with a mean age of 41.9 years (range, 18-64 years). All patients underwent microsurgical reconstruction of HA between grafts and recipients. The artery of graft was anastomosed to the right HA in 62 cases, to the proper HA in 34 cases, to the left HA in 7 cases, to the common HA in 6 cases, and aberrant right HA rising from superior mesenteric artery in 8 cases. Interposition bypass using great saphenous vein (GSV) was performed between the donor right HA and recipient common HA in 5 cases. Bypass was performed between the donor right HA and recipient abdominal aorta using GSV in 2 cases, or using cryopreserved cadaveric il iac vessels in 3 cases. Results Of these 127 cases, hepatic artery thrombosis (HAT) occurred in 2 recipients (1.6%) at 1 day and 7 days following A-A LDLT, which were successfully revascularized with GSV between right HA of donor and abdominal aorta of recipient, HAT in 1 patient occurred on the 46th postoperative day with no symptom. No other arterial compl ication such as HA stenosis and aneurysm occurred in recipients. All patients were followed up 9-67 months. At 1, 2, and 3 years, actual survival rateswere 82.2%, 64.7%, and 59.2%. No death was related to HA compl ication in peri-operative period. Conclusion The anatomic structure and variation of HA, the pathological changes, as well as surgical technique in HA reconstruction, have direct impact on the risk of postoperative compl ications of HA reconstruction.
Objective To provide experience for clinical diagnosis and treatment through exploring the perioperative characteristics and short-term treatment outcomes of adult cardiac surgery in patients with prior coronavirus disease-2019 (COVID-19). MethodsA retrospective analysis was performed on patients undergoing coronary artery bypass grafting (CABG) or valve surgery in the Department of Cardiac Surgery of Beijing Anzhen Hospital from December 26, 2022 to December 31, 2022, and previously diagnosed with COVID-19 before surgery. ResultsFinally 108 patients were collected, including 81 males and 27 females, with an average age of 60.73±8.66 years. Two (1.9%) patients received emergency surgery, and the others received elective surgery. The 86.1% of patients had been vaccinated, and the duration of COVID-19 was 5.0 (4.0, 7.0) days. The time from COVID-19 to operation was 15.0 (12.0, 17.8) days. Eighty-nine patients received CABG, of which off-pump CABG was dominant (92.1%). Nineteen patients received valve surgery. The rate of delayed extubation of ventilator was 17.6%. The ICU stay was 21.0 (17.3, 24.0) hours, and the postoperative hospital stay was 7.0 (6.0, 8.0) days. Three (2.8%) patients were treated with intra-aortic balloon pump (IABP), one (0.9%) patient was treated with extracorporeal membrane oxygenation (ECMO), one (0.9%) patient was treated with continuous renal replacement therapy (CRRT) due to acute renal insufficiency, three (2.8%) patients were treated with temporary pacemaker, and one (0.9%) patient underwent rethoracotomy. In terms of postoperative complications, the incidence of cerebrovascular accident, acute renal insufficiency, gastrointestinal bleeding and septicemia was 0.9%, respectively, and the incidence of acute heart failure, lung infection, and liver insufficiency was 1.9%, respectively. All patients recovered and were discharged from hospital, and no in-hospital death occurred. Conclusion The utilization rate of postoperative IABP, ECMO, CRRT, temporary pacemaker and the incidence of serious complications in patients with prior COVID-19 are not higher than those of normal patients, and the short-term treatment outcome is good.
Objective To investigate the myocardial protective effects of Del Nido cardioplegia and analyze its advantages in adult cardiac surgery. Methods We retrospectively analyzed the clinical data of 96 adult patients undergoing cardiac valve surgery who received Del Nido cardioplegia (a DNC group) from June 2016 to January 2017 in our hospital. There were 44 males and 52 females with a mean age of 51.36±13.31 years. Meanwhile 96 patients who received conventional cardioplegia were recruited as a control group (a CTC group) and there were 53 males and 43 females with a mean age of 52.91±10.95 years. Cross-clamping time, cardiopulmonary bypass (CPB) time, total volume of and transfusion frequency of cardioplegia, the rate of spontaneous defibrillation, red blood cell transfusion and vasoactive-inotropic score at postoperative 24 hours (VIS 24) were recorded. Results No significant difference was found in age, body weight, ejection fraction, hematokrit, CPB time and cross-clamping time between the DNC group and CTC group. There was no significant difference in the rate of spontaneous defibrillation, VIS 24, cardiac enzymes and cardiactroponin I and length of ICU stay between the two groups. The total volume and transfusion frequency of cardioplegia, perioperative blood transfusion were lower in the DNC group. There was no new atrial fibrillation or in-hospital death in the two groups. Conclusion Del Nido is a good myocardial protection solution in adult cardiac valve surgery, and requires less static preload volume and reduceshemodilution and perioperative blood transfusion.