ObjectiveTo determine the prognostic significance of change of systemic immune inflammation index (SII) before and after neoadjuvant chemotherapy (NCT) in advanced pancreatic cancer.MethodsThe patients with advanced pancreatic cancer who received the NCT before pancreatectomy and met the inclusion and exclusion criteria of this study from January 2013 to December 2016 in the Panjin Liao-Oil Gem Flower Hospital were retrospectively collected. The patients were designed into an increased SII group (SII before NCT was lower than after NCT) and decreased SII group (SII before NCT was higher than after NCT) according to the change of SII before and after NCT. The laboratory data before and after NCT were collected to calculate the SII and to analyze the relationship between the change of SII before and after NCT and the clinical outcomes. The clinicopathologic characteristics and postoperative 3-year survival rate of the two groups were compared. The Cox regression was used to evaluate the influencing factors of postoperative survival of advanced pancreatic cancer.ResultsAll of 103 patients were included, 42 of whom in the increased SII group and 61 in the decreased SII group. The proportions of the intraoperative tumor size >3 cm, CA19-9>37 U/mL after NCT, and postoperative complications in the increased SII group were significantly higher than those in the decreased SII group (P<0.05). All 103 patients were followed up from 9 to 81 months with median 13 months, the 3-year cumulative survival rate of patients in the increased SII group was significantly lower than that of patients in the decreased SII group (19.0% versus 42.6%, P=0.012). The results of the multivariate analysis showed that the CA19-9>37 U/mL after NCT [HR=2.084, 95%CI (1.140, 3.809), P=0.017], postoperative complications [HR=1.657, 95%CI (1.009, 2.722), P=0.046], the absent of postoperative adjuvant chemotherapy [HR=1.795, 95%CI (1.085, 2.970), P=0.023], and the elevated SII after NCT [HR=1.849, 95%CI (1.111, 3.075), P=0.018] were the independent risk factors affecting postoperative 3-year survival rate of patients with advanced pancreatic cancer.ConclusionsThe change value of SII before and after NCT is an independent risk factor for the prognosis of patient with advanced pancreatic cancer, the elevated SII after NCT is a poor prognosis index in patient with advanced pancreatic cancer. However, the evaluations of larger controlled trials are necessary at multiple institutions before introduction of SII as a prognostic indicator in clinical practice.
The purpose of this study was to investigate the arterial supply of the pisiform bone. Fifty upper extremities from adult human cadavers of both sexes were studied. The observations showed that there was a small branch(named the main artery of pisiform) arising from the lower part of the ulnar artery in each cases. The mean value of the length of the main artery of the pisiform was 23.89±8.68mm, the diameter of the artery was 0.79±0.21mm. The length, width and thickness of the pisiform were 11. 61±1.98mm, 11.40±1.87mm and 10.30±1.26mm, respectively. The length and width of the space accupied by the lunate on the X-ray films were measured, they were 16.38±1.96mm and 12.03±1.17mm, respectively.
ObjectiveTo design the channels of parallel screws and cross screws for fixation of symphysis pubis diastasis through a small sample anatomic study on pubic symphysis and its neighbor structures so as to provide anatomical basis for minimally invasive fixation of symphysis pubis diastasis. MethodsEight cadaveric pelvic specimens (6 men and 2 women) were transected along L5 and the proximal 1/3 of bilateral thighs, with intact lumbar spines. The spermatic cord, womb round ligament, and corona mortis were dissected; the distance to the ipsilateral pubic tubercle was measured and subsequently the distance between pubic tubercles, the height of pubic symphysis, the diameter of outer edge of pubic tubercle, the thickness of pubic symphysis and 2 cm outside the pubic symphysis (upper, central, and lower 1/3 thickness of pubic symphysis) were measured to provide anatomical basis for the design of channels of parallel screws and cross screws. ResultsParallel screw fixation: the entry point of first screw was on the outer edge of pubic tubercle, and its exit point was on the outer edge of contralateral pubic tubercle; a cannulated screw with a diameter of 4.5 mm or 6.5 mm can be suitable for this channel. The entry point of second screw was 20 mm outside the pubic symphysis and 23 mm beneath the pubic symphysis, and its exit point was symmetrical with entry point; a cannulated screw with a diameter of 4.5 mm can be appropriate for the second channel. The direction of two screws was perpendicular to the pubic symphysis. Cross screw fixation: the entry point of cross screws was on one side of the pubic tubercle, and its exit point was 20 mm outside the contralateral pubic symphysis and 23 mm beneath the contralateral pubic symphysis; two cannulated screws with a diameter of 4.5 mm can be chosen for cross screws channels. The direction of two cross screws was intersected with the horizontal line of two pubic tubercles at an angle of 25° respectively; besides, two cross screws formed an anteversion angle and retroversion angle of 5-10° with pubic body plane, respectively. ConclusionThe channels of parallel screws and cross screws are feasible for fixation of symphysis pubis diastasis by analyzing the anatomical data of the pubic symphysis and its neighbor structures, but further biomechanical research is need to confirm the stability of two fixation methods.
ObjectiveTo summarize the progress in treatment of pubic symphysis diastasis. MethodsRelated literature concerning treatment of pubic symphysis diastasis was extensively reviewed and comprehensively analyzed in terms of anatomy, biomechanics, and treatment. ResultsThere are many fixation methods for treatment of pubic symphysis diastasis, which aims at restoring the stability of the anterior pelvic ring. External fixator is often used as a temporary fixation; tension band wire has been abandoned due to its poor biomechanical stability; screw loosening and plate breakage often appears when a single reconstruction plate is used; box plate significantly increases the biomechanical stability of anterior pelvic ring but it leads to a considerable surgical trauma; locking plate has been used for pubic symphysis diastasis recently, especially for osteoporotic fractures; percutaneous cannulated screw has the advantages of less trauma, less bleeding, and good stability, so it is good choice for treatment of pubic symphysis diastasis. ConclusionThere is no uniform standards about the treatment of pubic symphysis diastasis, but the minimally invasive treatment is an undeniable trend. Percutaneous cannulated screw has achieved satisfactory effectiveness, however, its biomechanical stability and anatomic channels need to be further studied.
ObjectiveTo investigate the biological characteristics of bone marrow mesenchymal stem cells (BMSCs) in microenvironment of premature senescence of nucleus pulposus cells (NPCs) so as to lay a foundation for the repair of intervertebral disc degeneration by BMSCs transplantation. MethodsHuman degenerative nucleus pulposus and normal bone marrow were collected, and then NPCs and BMSCs were isolated, cultured, and identified. The 3rd passage BMSCs and the 1st passage NPCs with premature senescence were co-cultured without contact in the Transwell culture system. NPCs to BMSCs ratio was 75%:25% (group A), 50%:50% (group B), and 0:100% (group C). The morphological changes of BMSCs were observed by inverted phase contrast microscopy and transmission electron microscopy. At 3 and 6 days after co-culture, cell counting kit 8 was used to detect cell viability, flow cytometry was used to observe the cell cycle and detect DNA metabolism after BrdU labeling. Cell senescence was also evaluated by detecting senescence associated β-galactosidase (SA-β-gal) activity. ResultsThe typical morphology of cell senescence was seen in groups A and B, especially in group A. At 3 and 6 days after co-culture, the cell survival rate of group A was significantly lower than that of group B (P<0.05). At 3 days after co-culture, the proportion of cells in G1 phase in group A was significantly higher than that in groups B and C (P<0.05), the proportion of cells in S phase in group A was significantly lower than that in groups B and C (P<0.05). At 6 days, the proportion of cells in G1 phase in group A was about 81.0%, and the proportion of cells in S phase and G2 phase decreased, showing significant difference when compared with groups B and C (P<0.05); the proportion of cells in G1 phase in group B was about 74.4%, showing significant difference when compared with group C (P<0.05). BrdU content in group A was significantly lower than that in groups B and C at 3 and 6 days after co-culture (P<0.05), but no significant difference was found between groups B and C at 3 days (P>0.05); Brdu content in group B was also significantly reduced when compared with group C (P<0.05) at 6 days. At 6 days, SA-β-gal activity was significantly increased in groups A and B, and significant difference was shown in SA-β-gal positive cell number between groups (P <0.05). ConclusionPremature senescence of NPCs can down-regulate the proliferation capacity of co-cultured BMSCs by the paracrine effect. The greater proportion of NPCs with premature senescence is, the earlier senescence of BMSCs will be induced.
Objective To investigate the management strategies of external fixation combined with microsurgical techniques for repairing complex foot and ankle wounds in children. MethodsThe clinical data of 9 children with complex foot and ankle wounds who met the selection criteria between June 2017 and December 2021 was retrospectively analyzed. There were 6 boys and 3 girls, aged 3-13 years, with an average of 7.4 years. The causes of injury included crush injury in 5 cases and traffic accident injury in 4 cases. The wound size ranged from 6 cm×5 cm to 25 cm×18 cm. The time from injury to surgery ranged from 3 to 8 hours, with an average of 5 hours. All cases underwent staged surgical treatment. Among the 3 cases requiring deformity correction, 2 cases initially underwent free anterolateral thigh flap transplantation for wound coverage and limb salvage, followed by circular external fixation combined with osteotomy to address postoperative limb deformity, while 1 case received osteotomy for tibial fracture realignment prior to local pedicled flap reconstruction. All the 6 cases with non-deformity correction underwent initial external fixation followed by secondary flap reconstruction for wound management. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate the foot and ankle function of children. Results All children successfully achieved limb salvage postoperatively. Among the 6 non-deformity correction cases, all flaps survived with satisfactory wound healing and no infection was observed; fractures healed within 2.5-4.5 months, after which external fixators were removed for functional rehabilitation with favorable recovery. One case treated with circular external fixation combined with osteotomy achieved bone union at 4 months postoperatively, followed by fixator removal. One case undergoing osteotomy for tibial fracture realignment showed bone healing at 2.5 months post-correction, with subsequent fixator removal. One patient receiving bone lengthening developed infection at 1 week postoperatively, which was managed with multiple debridements, ultimately achieving bone union at 16 months postoperatively and followed by fixator removal. At last follow-up, all patients demonstrated satisfactory ankle-hindfoot functional recovery, with AOFAS ankle-hindfoot scores ranging from 80 to 90 (mean, 84.2). Conclusion The combination of external fixation and microsurgical techniques demonstrates significant advantages in reconstructing complex foot and ankle wounds in children. The synergistic interaction provides both mechanical stability and biological repair, enabling early functional rehabilitation while reducing infection risks.
ObjectiveTo investigate the predictive value of diaphragm rapid shallow breathing index (D-RBSI) in weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD).MethodsSeventy-six patients with COPD who were undergoing mechanical ventilation were enrolled in department of critical care medicine of our hospital from March 2016 to March 2017. The patient underwent spontaneous breathing test (SBT) using CPAP mode after weaning screening. When the SBT had started 10 min or the SBT failed, the patients' respiratory rate (RR) and tidal volume were recorded, and the diaphragmatic displacement (DD) of patients was measured by bedside ultrasound. The ratio of RR to DD (RR/DD) was calculated as D-RBSI, and the predictive value of D-RBSI on weaning results in mechanically ventilated patients with COPD was analyzed by receiver operating characteristic (ROC) curve.ResultsTwenty-eight patients failed weaning procedure. There were no significant differences in age and acute physiology and chronic health evaluation II scores between the successful group and the failed group. The DD of the patients in the successful group was greater than that of the failed group [(22±6) mm vs. (13±5) mm, P<0.001]. RBSI and D-RBSI of the successful group were lower than those of the failure group [RBSI: (40±14) breaths/(min·L)vs. (52±20) breaths/(min·L), P=0.003; D-RBSI: (0.95±0.51) breaths/(min·mm) vs. (1.79±0.83) breaths/(min·mm), P<0.001)]. There was a good correlation between the RBSI and D-RBSI in the two groups (R2=0.778, P<0.001). The area under the ROC curve predicted the weaning result by D-RBSI was higher than RBSI (0.85vs. 0.75, P<0 001="" the="" cutoff="" value="" of="" d-rbsi="">1.13 breaths/(min·mm) to predict weaning failure had a sensitivity of 0.82, and a specificity of 0.81.ConclusionThe rapid shallow breathing index of diaphragm can be effectively used to predict the weaning result of COPD patients during mechanical ventilation.