直血管钳背侧撬拨辅助掌侧入路内固定治疗桡骨远端C型骨折的临床疗效

目的探讨直血管钳背侧撬拨辅助掌侧入路内固定治疗桡骨远端C型骨折的临床疗效。方法回顾性分析2019年6月-2021年1月收治的桡骨远端粉碎性骨折手术患者32例病例资料,纳入病例经腕关节DR及CT检查提示桡骨远端骨折,国际内固定研究协会(AO)分型为C型骨折,且为外伤导致,并为单侧损伤。术后采用Gartland-Werley腕关节功能评分对患侧腕关节功能进行评估。结果术后均随访10~16个月,平均13.2个月,未出现切口感染、骨髓炎等并发症,患侧桡骨远端掌倾角、尺偏角及桡骨高度未发生改变。末次随访Gartland-Werley腕关节功能评分标准显示:优23例,良7例,可2例,优良率93%。结论直血管钳背侧撬拨辅助掌侧入路内固定治疗桡骨远端粉碎性骨折在恢复桡骨高度、掌倾角和尺偏角中有很大优势,临床效果满意,有利于患者快速康复。

长直血管钳辅助下袖套式包皮环切术

目的介绍长直血管钳辅助下袖套式包皮环切术的优点。方法2003年9月～2007年3月对621例包皮过长患者行长直血管钳辅助袖套式包皮环切术。本组患者年龄6～52岁,平均24岁,其中包皮过长558例,包茎63例。本法长直血管钳的辅助作用有两方面:(1)辅助下环切外板;(2)辅助下环剥皮瓣。结果手术时间9～30min,平均15min。术中出血1～10ml,平均3ml。术后随访7天～3年。术后6～48h出血6例,迟发性血肿1例,无切口裂开,无切口感染。切口均一期愈合,切口整齐、两侧对称,切口美观。结论直血管钳辅助下袖套式包皮环切术环切外板、剥离袖套皮瓣迅速,术后切口美观,是一种术式较好的袖套式包皮环切术。

重组腺病毒介导的血管内皮生长因子165基因增强大鼠横形腹直肌肌皮瓣活力的研究

目的探讨重组腺病毒介导的血管内皮生长因子165(adenovirusmediatedvascularendothelialgrowthfactor165,Ad-VEGF165)基因,增强大鼠横形腹直肌肌皮瓣(transverserectusabdominismusculocutaneousflap,TRAM)局部缺血区域活力的基因治疗。方法SD大鼠30只,制备30mm×80mm以下腹部血管作为血管蒂的右侧矩形TRAM皮瓣,随机平均分成5组,分别在大鼠TRAM皮瓣皮下、皮下+腹直肌及腹直肌局部注射Ad-VEGF165(1～3组:治疗组),同时在TRAM皮瓣皮下+腹直肌局部注射重组腺病毒载体介导的绿色荧光蛋白(adenovirusmediatedgreenfluorescentprotein,Ad-GFP,4组:重组腺病毒自身对照组)和DMEM培养液(5组:空白对照组),于注射后第7天手术,术后第7天检测各组大鼠TRAM皮瓣成活面积、CD34微血管密度(microvasculardensity,MVD)、VEGF免疫组织化学染色和原位杂交组织化学(insituhybridizationhistochemistry,ISHH)。结果11～3组TRAM皮瓣成活面积分别为14.19±2.77、15.18±2.18、8.30±1.28cm2,均较4、5组4.12±1.86、3.60±1.95cm2明显增加,且差异有统计学意义(P<0.05);21～3组TRAM皮瓣CD34MVD均高于4、5组,差异有统计学意义(P<0.05);31～3组VEGF免疫组织化学染色和ISHH呈阳性表达。结论重组腺病毒载体介导的VEGF165基因局部注射,能增加大鼠TRAM皮瓣局部缺血区域成活面积。

基于三维CTA血管拉直的腹主动脉瘤自动定位方法

目的:腹主动脉瘤越来越严重地威胁着人类健康,CTA成像设备已经成为该疾病的重要诊断工具,从海量的三维CTA影像数据中自动定位腹主动脉瘤位置对疾病辅助诊断系统有重要意义。方法:首先,对分割出的腹主动脉及其分支血管进行三维拓扑细化,提取血管骨架线;其次,利用A-Star最优路径算法确定主动脉中心线,并进行平滑处理;再次,沿主动脉中心线重建血管切面,拉直主动脉;最后,计算主动脉横截面积,定位瘤体位置。结果:经过4例由GE 16层螺旋CT采集的腹主动脉瘤CTA数据的验证,本方法能够100%检测到瘤体,自动定位的瘤体所在原图像中的层数与人工标注的重合率达到90%以上。结论:本文方法可以从海量的腹主动脉CTA数据中自动定位瘤体位置,具有较强的临床应用价值。

腹直肌带血管蒂胸骨翻转术治疗漏斗胸

目的:探讨腹直肌带血管蒂胸骨翻转术治疗漏斗胸的理论依据、方法及其临床效果。方法:总结手术治疗10例漏斗胸的经验,回顾性分析其手术方法、注意事项和术后管理要点。结果:10例全部治愈,无并发症发生,畸形矫正满意。结论:腹直肌带血管蒂胸骨翻转术治疗漏斗胸是一种安全满意的术式。

静脉输液采用45～50°角直进血管穿刺法的临床研究

目的探讨降低对组织和血管损伤、减轻患者痛苦的新穿刺法。方法门诊输液患者260例随机分为对照组及实验组,每组130例,实验组采用增大穿刺角度至45~50°角经皮肤直入血管的穿刺法,与对照组用传统的15~20°角穿刺的方法进行比较,观察两组患者穿刺时疼痛程度、成功率和穿刺局部的复原情况。结果实验组疼痛明显减轻,83.08%的患者自诉穿刺点周围无明显的触痛和压痛,且一次成功率93.8%高于对照组71.5%（P〈0.05）。实验组瘀斑发生率低于对照组（P〈0.05）。结论采用45~50°角直进血管穿刺法可减轻静脉穿刺时的疼痛,提高穿刺成功率,利于血管和组织的快速修复。

犬肾血管构筑及血管和肾小管相互关系——扫描电镜观察

使用同时显示肾血管和肾小管扫描电镜法及肾血管铸型扫描电镜法,观察研究了犬肾血管构筑及肾血管和肾小管相互关系。血管球内存在亚小叶微循环单位;血管球内存在直捷通路;迷路部血管和肾小管无明显的逆流配置;球后血管在肾皮质内有广泛吻合;肾髓质次级血管束内一些降直血管具有门静脉特点;直血管在乳头部肾盂上皮下形成致密血管丛,它是升、降直血管间的主要连接通道;内髓升、降直血管间还有毛细血管及少量血管襻连接。本文还讨论了上述结构特点的功能意义。

左结肠动脉的应用解剖

在88例左半结肠标本上,观察了左结肠动脉。根据其行走位置不同,分为内侧型和外侧型。按左结肠动脉分叉点的高度不同又分为高位组、中位组和低位组。左结肠动脉分支中有一种直血管,向左连于降结肠的缘动脉,这些血管在作肠修复时,对促进左半结肠的血供有重要意义。根据左结肠动脉的解剖特点,提出了裁剪左半结肠时,切断左结肠动脉的要点。

Treatment of metastatic colorectal carcinomas by systemic inhibition of vascular endothelial growth factor signaling in mice

AIM： Tumor angiogenesis has been shown to be promoted by vascular endothelial growth factor （VEGF） via stimulating endothelial cell proliferation, migration, and survival. Blockade of VEGF signaling by different means has been demonstrated to result in reduced tumor growth and suppression of tumor angiogenesis in distinct tumor entities. Here, we tested a recombinant adenovirus, AdsFItl-3, that encodes an antagonistically acting fragment of the VEGF receptor 1 （Fit-l）, for systemic antitumor effects in pre-established subcutaneous CRC tumors in mice.METHODS： Murine colorectal carcinoma cells （CT26） were inoculated subcutaneously into Balb/c mice for in vivo studies. Tumor size and survival were determined. 293 cell line was used for propagation of the adenoviral vectors. Human lung cancer line A549 and human umbilical vein endothelial cells were transfected for in vitro experiments.RESULTS： Infection of tumor cells with AdsFlt1-3 resulted in protein secretion into cell supernatant, demonstrating correct vector function. As expected, the secreted sFlt1-3 protein had no direct effect on CT26 tumor cell proliferation in vitro, but endothelial cell function was inhibited by about 46% as compared to the AdLacZ control in a tube formation assay. When AdsFlt1-3 （5×10^9 PFU/animal） was applied to tumor bearing mice, we found a tumor inhibition by 72% at d 12 after treatment initiation, in spite of these antitumoral effects, the survival time was not improved. According to reduced intratumoral microvessel density in AdsFlt1-3-treated mice, the antitumor mechanism can be attributed to angiostatic vector effects. We did not detect increased systemic VEGF levels after AdsFlt1-3 treatment and liver toxicity was low as judged by serum alanine aminotransferase determination.CONCLUSION： In this study we confirmed the value of a systemic administration of AdsFItl-3 to block VEGF signaling as antitumor therapy in an experimental metastatic colorectal carcinoma model in mice.

Expression of NOS and HIF-1αin human colorectal carcinoma and implication in tumor angiogenesis

AIM: To study CD34, CD105, inducible nitric oxide synthase (iNOS), endogenous nitric oxide synthase (eNOS), and hypoxia-inducible factor 1 (HIF-1)αexpression in human colorectal carcinomas. METHODS: The tissue microarrays (TMAs) were made up of 80 cases of colorectal carcinoma and 80 cases of non-neoplasm colorectal mucosa. The expression of CD34, CD105, NOS and HIF-1αwas detected by immunohistochemistry (S-P). RESULTS: iNOS and HIF-1αexpression in colorectal carcinoma was significantly higher than in non-neoplasm colorectal mucosa (X2 = 43.166, P < 0.01; X2 = 10.4278, P < 0.01); eNOS expression in colorectal carcinoma was significantly lower than in non-neoplasm colorectal mucosa (X2 = 11.354, P < 0.01). The expression of iNOS correlated with differentiation (X2 = 18.141, P < 0.01), invasive depth (X2 = 4.748, P < 0.01), and Micro vessel density (MVD) (t = 2.327, P < 0.05). The expression of HIF-1αwas correlated with infiltrating depth (X2 = 4.397, P < 0.05), Duke's staging (X2= 4.255, P < 0.05), and MVD (t = 2.272, P < 0.05). No correlation was found in eNOS expression. CONCLUSION: Over-expression of iNOS and HIF-1αin colorectal carcinoma is correlated with the biological character MVD.

Successful treatment of giant rectal varices by modified percutaneous transhepatic obliteration with sclerosant:Report of a case

We present a female patient with continuous melena, diagnosed with rectal variceal bleeding. She had a history of esophageal varices, which were treated with endoscopic therapy. Five years after the treatment of esophageal varices, continuous melena occurred. Since colonoscopy showed that the melena was caused by giant rectal varices, we thought that they were not suitable to receive endoscopic treatment. We chose the modified percutaneous transhepatic obliteration with sclerosant, which is one of the interventional radiology techniques but a new clinical procedure for rectal varices. After the patient received this therapy, her condition of rectal varices was markedly improved.

Management of ischemic proctitis with severe rectal haemorrhage: A case report

Acute ischemic proctitis is a rare pathological condition. We report here a patient presented with massive rectal haemorrhage from a bleeding vessel superimposed on an underlying pathology of ischemic proctitis. This case report illustrates the difficulties in making the clinical distinction between ischemic proctitis and other pathological entities. We also discussed the beneficial role of arteriogram with embolotherapy as an effective therapeutic measure in the management of lower gastrointestinal bleeding. The literature on the subject is reviewed.

Rectal angiolipoma:A case report and review of literature

Angiolipoma is a rare vascular variant of the benign lipomatous tumors and is generally seen in subcutaneous tissues. We report a 70-year-old female with abdominal distension not related to rectal small polypoid mass with peduncule described as angiolipoma by histologically, and review the literature.

Tumor angiogenesis and dynamic CT in colorectal carcinoma: Radiologic-pathologic correlation

AIM: To investigate the correlation between microvessel density and spiral CT perfusion imaging in colorectal carcinoma. METHODS: Thirty-seven patients, with histologically proven colorectal carcinoma, underwent water enema spiral CT scan. The largest axial surface of the primary tumor was searched on unenhanced spiral CT images. At this level, the enhanced dynamic scan series was acquired. Time-density curves (TDC) were created from the region of interest drawn over the tumor, target artery by Toshiba Xpress/SX spiral CT with perfusion functional software. Then the perfusion was calculated. Microvessel density (MVD) was evaluated using immunohistochemical staining of surgical specimens with anti-CD34, and then MVD was correlated with perfusion. RESULTS: MVD of colorectal carcinomas was 33.11-173.44, mean 87.28, and perfusion was 15.60-64.80 mL/min/ 100 g, mean 39.74 mL/min/100 g. MVD and perfusion were not associated with invasive depth, metastasis and disease stage, and they all decreased with increasing Dukes' stage, but no significant correlation was found between them (r=0.18, P=0.29). CONCLUSION: There is no significant correlation between MVD and perfusion. Neovascularizaton and perfusion are highly presented in early colorectal carcinoma. CT perfusion imaging may be more suited for assessing tumorigenesis in colorectal carcinoma than histological MVD technique.

Interleukin-24 is correlated with differentiation and lymph node numbers in rectal cancer

AIM:To assess the significance of interleukin(IL)-24 and vascular endothelial growth factor(VEGF)expression in lymph-node-positive rectal cancer. METHODS:Between 1998 and 2005,90 rectal adenocarcinoma patients with lymph node involvement were enrolled.All patients received radical surgery and postoperative pelvic chemoradiotherapy of 50.4-54.0 Gy.Chemotherapy of 5-fluorouracil and leucovorin or levamisole was given intravenously during the first and last week of radiotherapy,and then monthly for about 6 mo.Expression of IL-24 and VEGF was evaluated by immunohistochemical staining of surgical specimens, and their relations with patient characteristics and survival were analyzed.The median follow-up of surviving patients was 73 mo(range:52-122 mo). RESULTS:IL-24 expression was found in 81 out of 90 patients;31 showed weak intensity and 50 showedstrong intensity.VEGF expression was found in 64 out of 90 patients.Negative and weak intensities of IL-24 expression were classified as negative expression for analysis.IL-24 expression was significantly reduced in poorly differentiated tumors in comparison with well or moderately differentiated tumors(P=0.004),N2b to earlier N stages(P=0.016),and stageⅢc to stageⅢ a orⅢb(P=0.028).The number of involved lymph nodes was also significantly reduced in IL-24-positive patients in comparison with IL-24-negative ones. There was no correlation between VEGF expression and patient characteristics.Expression of IL-24 and VEGF was not correlated with survival,but N stage and stages were significantly correlated with survival. CONCLUSION:IL-24 expression was significantly correlated with histological differentiation,and inversely correlated with the degree of lymph node involvement in stageⅢrectal cancer.

Mechanical Properties of Small-diameter Superfine Silk Powder/Polyurethane Vascular Graft Reinforced by Tubular Knitted Fabric

In this paper,a kind of composite microtube,which is made from superfine silk powder and polyurethane,reinforced by polyster and spandex tubular fabrics,was examined.The cross-section of composite microtubes were microporous,and micropores were uniform distributed,the inner surface was relatively smooth.The results showed that the wall thickness of composite microtubes increased,which led to the strength,the breaking work and the initial modulus incresead;that the spandex content increased brought about the initial modulus and the breaking work decreased,but the breaking extension and the breaking load were firstly increased and then decreased;and all the mechanical properties decreased as the SFSP content increased.

The predictive value of vascular endothelial growth factor and Ki-67 expression on neoadjuvant therapy in rectal cancer

Objective： To investigate the expressions of vascular endothelial growth factor （VEGF） and proliferating cell nuclear antigen （Ki-67） in patients with rectal adenocarcinoma and their associations with neoadjuvant therapy. Methods： The expressions of Ki-67 and VEGF in 32 cases of rectal adenocarcinoma, including both pretreatment tumor biopsies and postoperative specimen, were detected by immunohistochemistry using specific antibodies, and were correlated with clinicopathological factors. Results： The intensity of VEGF staining was significantly correlated with lymph nodal metastasis （P =0.033）, depth of tumor invasion （P =0.007） and tumor stage （P= 0.016）, but not with histological types, tumor sizes, patients＇ ages and genders （P 〉 0.05）. Low level of VEGF expression had significant correlation with the high sensitivity of response to neoadjuvant therapy （P = 0.016）. The transient increase of VEGF expression could be seen after neoadjuvant therapy （P = 0.035）. Ki-67 labeling index （Ki-67-LI） was significantly correlated with lymph node metastasis （P = 0.028）, but not correlated to tumor sizes, patients＇ ages and genders （P 〉 0.05）. Tumors with lower Ki-67-LI were more sensitive to neoadjuvant therapy （P = 0.032）. The Ki-67 level decreased after neoadjuvant therapy, but no statistical significance was found （P 〉 0.05）. Conclusion： Our results demonstrate that the expression of VEGF and Ki-67 in pretreatment rectal adenocarcinoma biopsies may be predictive of tumor response to neoadjuvant therapy.

VEGF-D expression correlates with colorectal cancer aggressiveness and is downregulated by cetuximab

AIM:To gain mechanistic insights into the role played by epidermal growth factor receptor (EGFR) in the regulation of vascular endothelial growth factors (VEGFs) in colorectal cancer (CRC). METHODS:The impact of high-level expression of the growth factor receptors EGFR and VEGF receptor (VEGFR)3 and the VEGFR3 ligands VEGF-C and VEGF-D on disease progression and prognosis in human CRC was investigated in 108 patients using immunohistochemistry. Furthermore, the expression of the lymphangiogenic factors in response to the modulation of EGFR signalling by the EGFR-targeted monoclonal antibody cetuximab was investigated at the mRNA and protein level in human SW480 and SW620 CRC cell lines and a mouse xenograft model. RESULTS: Human CRC specimens and cell lines displayed EGFR, VEGF-C and VEGF-D expression with varying intensities. VEGF-C expression was associated with histological grade. Strong expression of VEGF-D was significantly associated with lymph node metastases and linked to a trend for decreased survival in lymph node-positive patients. EGFR blockade with cetuximab resulted in a significant decrease of VEGF-D expression in vitro and in vivo. CONCLUSION:In conclusion, the expression of VEGF-D in colorectal tumours is significantly associated with lymphatic involvement in CRC patients and such expression might be blocked effectively by cetuximab.