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    30 April 2013, Volume 17 Issue 18 Previous Issue    Next Issue
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    Expression of transforming growth factor beta 1 of cryopreserved skin allograft
    Cao Li-ying, Ding Xuan-xi, Yang Sheng-ping, Wang Guan, Jiang Ming-jing
    2013, 17 (18):  3231-3238.  doi: 10.3969/j.issn.2095-4344.2013.18.001
    Abstract ( 414 )   PDF (1878KB) ( 463 )   Save

    BACKGROUND: Skin transplantation and wound surface coverage are the most important measures for the treatment of wound and burn. At present, allogenic skin still is the best available wound coverage.
    OBJECTIVE: To evaluate the application of allogeneic skin in the wound by detecting the expression of transforming growth factor-β1 in rat skin allograft under cryopreservation.
    METHODS: The skin specimens of rats were preserved at -20 ℃ (low temperature preservation group) or at
    -80℃ (cryopreservation group) for 1 week, 1 month and 2 months, respectively. Then skin pieces in each group were transplanted into the back of rats. Autologous skin grafting rats were as control group.
    RESULTS AND CONCLUSION: Compared with low temperature preservation group, the expression of transforming growth factor-β1 in the cryopreservation group was inhibited, rejection of skin allograft was delayed and survival time was prolonged. Histology score of skin rejection was also lower in the cryopreservation group. Compared with low temperature preservation, cryopreservation could reduce expression of antigen of transforming growth factor-β1 in skin allograft. The results show that cryopreserved allograft skin as a kind of wound temporary coverage has wide application prospect in case that skin tissue is inadequate or insufficient.

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    Inter-alpha-trypsin inhibitor level reflects the chronic renal allograft rejection
    Huang Jin-qiu, Zhang Jian-qiang, Hu Jian-min, Chen Chuan-bao, Hu Yu-xiang, Chen Hua, Li Liu-yang, Fan Li-pei, Zhao Ming
    2013, 17 (18):  3239-3246.  doi: 10.3969/j.issn.2095-4344.2013.18.002
    Abstract ( 512 )   PDF (859KB) ( 482 )   Save

    BACKGROUND: Currently, the pathological examination of renal transplantation is still the “gold standard” for chronic renal allograft rejection. But the procedural biopsy for renal transplantation is still difficult to spread in China, and there exists a certain risk. Due to various reasons, the patients with chronic rejection miss the timing of treatment as timely detection fails.
    OBJECTIVE: To detect the inter-alpha-trypsin inhibitor level in the serum of rats with chronic renal allograft rejection.
    METHODS: Normal male Wistar rats were used as donors and normal male Sprague Dawley rats were used as recipients to perform renal transplantation. After transplantation, the rats were divided into chronic rejection group and normal renal transplantation group. Recipents in the chronic rejection group were intraperitoneally injected with cyclosporine A microemulsion 2 mg/kg once a day from 3 days before transplantation, and those in the normal renal transplantation group were intraperitoneally injected with cyclosporine A microemulsion 2 mg/kg daily.
    RESULTS AND CONCLUSION: Western blot results showed that the inter-alpha-trypsin inhibitor levels in two groups at 4, 6, 8, 10 and 12 weeks after transplantation were significantly decreased when compared with those at 1 week before transplantation (P < 0.01). At 4 and 6 weeks after transplantation, the inter-alpha-trypsin inhibitor level in the chronic rejection group was higher than that in the normal renal transplantation group (P < 0.01), but lower than that in the normal renal transplantation group at 8, 10 and 12 weeks after transplantation. The inter-alpha-trypsin inhibitor level in the chronic rejection group was decreased in a time-dependent manner (P < 0.01). The results show that the inter-alpha-trypsin inhibitor level is significantly decreased when chronic rejection appears after renal transplantation. The change of inter-alpha-trypsin inhibitor level is closely related with the chronic renal allograft rejection, which can provide basis for the prediction of chronic rejection after renal transplantation.

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    Serum cystatin C is considered to monitor the renal function of urinary tract obstruction patients after renal transplantation
    Zhang Xin-tao, Dai Cheng, Zhang Qing
    2013, 17 (18):  3247-3254.  doi: 10.3969/j.issn.2095-4344.2013.18.003
    Abstract ( 537 )   PDF (877KB) ( 647 )   Save

    BACKGROUND: As cystatin C cannot be secreted and reabsorbed by the renal tubule, it is considered as an ideal indicator to evaluate the glomerular filtration rate in recent years.
    OBJECTIVE: To assess the change of serum cystatin C level in ureteral stenosis patients after renal transplantation and to investigate the effect on the diagnosis of renal function impairment.
    METHODS: Eighteen renal transplantation patients with ureteral stenosis and renal insufficiency after renal transplantation were selected from the Department of Urology, Shenzhen Second People’s Hospital and Guangzhou Overseas Chinese Hospital as the case group, while there were 63 healthy cases in the control group whose age and gender were matched with those in the case group. The levels of serum cystatin C, serum creatinine and urea nitrogen were tested before and at 1 month after the treatment of ureteral stenosis, and the correlation was analyzed. 
    RESULTS AND CONCLUSION: Compared with the control group, the levels of serum cystatin C, serum creatinine and urea nitrogen in the case group were increased significantly before the treatment of ureteral stenosis (P < 0.01); at 1 month after treatment, the levels of serum cystatin C, serum creatinine and urea nitrogen in the case group were decreased significantly when compared with those before treatment (P < 0.01). The relative analysis results showed that the serum cystatin C level of the ureteral stenosis patients was positively correlated with the levels of serum creatinine and urea nitrogen. It suggests that serum cystatin C can be regarded as one of the monitoring indicators of renal function recovery after renal transplantation.

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    Femoral head necrosis after renal transplantation
    Wang Xiao-bo, Wang Yue, Feng Gui-wen, Li Jin-feng, Shang Wen-jun, Pang Xin-lu
    2013, 17 (18):  3255-3262.  doi: 10.3969/j.issn.2095-4344.2013.18.004
    Abstract ( 1597 )   PDF (633KB) ( 732 )   Save

    BACKGROUND: Femoral head necrosis is a serious complication after renal transplantation which will seriously affect the quality of life of patients. Therefore, its prevention is particularly important.
    OBJECTIVE: To explore the clinical features, related risk factors, diagnosis, prevention and treatment measure of avascular necrosis of femoral head after renal transplantation, and to provide the basis for clinical treatment.
    METHODS: We retrospectively analyzed the clinical data of 486 patients with femoral head necrosis after renal transplantation selected from the First Affiliated Hospital of Zhengzhou University from January 2008 to July 2012. The dialysis method and duration before transplantation, dose and duration of corticoid administration after transplantation, changes of body mass of the patients, lipids situation, and the time from transplantation to onset of femoral head necrosis were observed.
    RESULTS AND CONCLUSION: 454 out of 486 patients were followed-up (averaged for 22.7 months) and four patients were diagnosed with femoral head necrosis. The incidence rate was 0.8%, and the mean duration of occurrence was 8.25 months. The mean dose of methylprednisolone for 5 days after transplantation was          (2 707.5±154.45) mg, and the mean dose of prednisone for the first month after transplantation was (617.5±   180.76) mg. All the four patients above received hemodialysis, and the lipids and body mass were increased after renal transplantation; the amount of corticoid was decreased or stopped after diagnosis and then treated with blood circulation drugs and conservative treatment. Three cases were improved, and the other one case was newly diagnosed with femoral head necrosis. Application of corticoid is the main reason for femoral head necrosis after renal transplantation, while to stop hormone therapy and give the blood circulation drugs after the onset can get better effect.

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    Clinical management of vascular variations in renal transplantation
    Li Cheng, Fang Chi-hua, Shen Sheng, Wu Jia-qing, Meng Shan-dong, Zhou Jie-xue, Liu Dong
    2013, 17 (18):  3263-3266.  doi: 10.3969/j.issn.2095-4344.2013.18.005
    Abstract ( 390 )   PDF (414KB) ( 473 )   Save

    BACKGROUND: The vascular anastomosis technique is directly related to the success or failure of the renal transplantation.
    OBJECTIVE: To improve the techniques of variable vascular anastomosis in renal transplantation.
    METHODS: 878 cases received renal transplantation in the Department of Organ Transplantation, Guangdong No.2 Provincial People’s Hospital from September 1999 to December 2010 were selected, and the donor renal vascular variation including renal artery and renal vein were treated with trim, merge, extend and other reconstruction processes for renal transplantation, and the accessory renal arteries were anastomosed to inferior epigastric arteries by a modified stereotaxic method.
    RESULTS AND CONCLUSION: Among the 878 renal transplantation cases, 55 donor kidneys had renal artery variation and 22 donor kidneys had renal vein variation. All the variable vessels were anastomosed to the internal iliac or external iliac vessels successfully after vascular reconstruction. Twenty-three cases of accessory renal arteries with the diameter of more than 1 mm were anastomosed to inferior epigastric arteries successfully. Color Doppler ultrasound image showed that blood stream was smooth in all anastomosed vessels. Transplant renal vascular variation and accessory renal arteries can be transplanted safely and effectively by correct vascular rebuilding or vascular anastomosis.

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    Liver transplantation for the treatment of hepatolenticular degeneration  
    Yu Xiu-tao, Jiang Yi, Zhang Kun, Yang Fang, Cai Qiu-cheng
    2013, 17 (18):  3267-3274.  doi: 10.3969/j.issn.2095-4344.2013.18.006
    Abstract ( 923 )   PDF (672KB) ( 583 )   Save

    BACKGROUND: In recent years, the treatment of hepatolenticular degeneration with liver transplantation has achieved great improvement, and a small amount of researches also optimistic reminder that the improvement can be sustained stably. Because of the patients, doctors, and other uncontrollable factors, the recovery of the patients after transplantation is different.
    OBJECTIVE: To review the cases with liver transplantation in Department of Hepatobiliary Surgery, Fuzhou General Hospital of Nanjing Military Command, and to long-term follow-up the patients with nerves system damage before transplantation. 
    METHODS: From July 2005 to May 2010, nine cases (four males and five females) with a mean age of 24.5 years (14-44 years) undergoing liver transplantation for hepatolenticular degeneration were selected from Fuzhou General Hospital of Nanjing Military Command, and the clinical data of the nine patients were retrospective analyzed. All the recipients had low serum levels of ceruloplasmin (200-600 mg/L) before transplantation, and five of them demonstrated the neurological manifestations.
    RESULTS AND CONCLUSION: There were eight patients underwent orthotopic liver transplantation and one patient received living donor liver transplantation in this study. Eight recipients recovered satisfactorily with excellent liver functions, while one patient died of multiple organ failure during perioperative period. Compared to the levels before transplantationthe, total bilirubin levels of the eight patients were significantly declined (P < 0.05), the serum levels of albumin, ceruloplasmin and platelet were obviously increased (P < 0.05); the serum copper levels were increased, but the difference was not significant (P > 0.05); the neurological manifestations were also partly relieved or disappeared after liver transplantation. K-P loop was receded in five patients at 1 month after transpantation, and K-P loop was disappeared in two patients at 7 and 11 months after transplantation. Orthotopic liver transplantation or living donor liver transplantation cannot only improve the copper metabolism of the patients with hepatolenticular degeneration, but also can significantly relieve the severe neurological manifestations.

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    Complications after liver transplantation
    Yu Zhong-shan, Jiang Yi, Cai Qiu-cheng, Yang Fang, Lü Li-zhi
    2013, 17 (18):  3275-3282.  doi: 10.3969/j.issn.2095-4344.2013.18.007
    Abstract ( 1380 )   PDF (657KB) ( 805 )   Save

    BACKGROUND: The complicated operation process and easy production of complications of orthotropic liver transplantation limit the successful rate of liver transplantation.
    OBJECTIVE: To investigate the common reasons and prevention and treatment of complications after liver transplantation.
    METHODS: Clinical data of 59 cases (53 males and six females) with complications in 176 liver transplantation patients were analyzed retrospectively, the age of the 59 patients were 25-74 years, averaged in (46.41±12.02) years. Ten cases had the parimary disease of hepatitis B cirrhosis (hepatitis B merger renal failure in one case), seven cases had cirrhosis complicated hepatocellular carcinoma, four cases had biliary cirrhosis, one case had alcoholic cirrhosis, 13 patient had hepatocellular carcinoma, one case had cholangiocarcinoma, three cases had hepatolenticular degeneration, 13 patients had liver failure and 47 patients had severe hepatitis B (severe hepatitis B combined with renal failure in one case). All the donors and recipients were in line with the principle of blood type matching.
    RESULTS AND CONCLUSION:
    A total of 102 cases of complications occurred, including abdominal cavity bleeding (15 cases), upper gastrointestinal bleeding (five cases), pulmonary infection (21 cases), abdominaI infection (five cases), biliary complications (21 cases), chronic rejection (three cases), acute rejection (ten cases), acute renal insufficiency (seven cases), hepatitis B virus recurrence (three cases), neuropsychopathic complications (six cases), primary nonfunction (four cases), inferior vena cava thrombosis (one case), graft-versus-host reaction (one case). A total of 24 patients died during perioperative period, abdominal cavity bleeding (six cases), pulmonary infection (six cases), primary nonfunction (four cases), multiple organ dysfunction syndrome (three cases), abdominaI infection (one case), graft-versus-host reaction (one case), crdiac arrest (one case), biliary necrosis (one case), subarachnoid hemorrhage (one case). Emphasis on perioperative period management of liver transplantation patients, to improve the liver function, to correct the coagulation, to improve the nutrition and the infection control, as well as the improvement of surgical techniques and timely diagnosis and treatment of the complications are the keys to improve the success rate of liver transplantation.

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    Pathological changes and clinical application standards of brain-death donor lung
    Nong Jiang, Sun Xu-yong, Qin Ke, Lai Yan-hua, Nie Feng, Dong Jian-hui, Wen Hai-tao, Li Zhuang-jiang, Ding Qi, Yang Jian-jun, He Chang-huan
    2013, 17 (18):  3283-3286.  doi: 10.3969/j.issn.2095-4344.2013.18.008
    Abstract ( 547 )   PDF (454KB) ( 564 )   Save

    BACKGROUND: Some scholars believe that many factors can lead to pathological changes of the lung in the process of brain-death
    OBJECTIVE: To observe the pathological changes of brain-death donor lung, and to investigate the feasibility of its clinical transplantation.
    METHODS: Twenty-three cases of brain-death donor lung received pathological biopsy, and hematoxylin-eosin staining, silver staining and PAS staining were used to observe the pathological changes of lung, and the microstructure of lung tissues was observed under electron microscope.
    RESULTS AND CONCLUSION: Under the light microscope, bronchial and alveolar structure was complete, and edema, necrosis and defluxion could be observed in part of epithelial cells by hematoxylin-eosin staining, silver staining and PAS staining; alveolar interval was not widened obviously, but hyperemia was visible; small amount of bleeding and scattered lymphocytes could be seen around the vessels. Under the electron microscope, the slightly edema were observed in the brain-death alveolar cells, the cell nuclear chromatin condensed along the caryotheca, some nucleus appeared abnormity, mitochondria were engorgement, but no cell necrosis could be observed. Brain-death donor lung is suitable for clinical transplantation.

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    Rapamycin for the treatment of refractory extensive chronic graft-versus-host disease
    Li Xu-dong, He Yi, Wang Dong-ning, Hu Yuan, Wang Wen-wen, Zhang Xiang-zhong,
    2013, 17 (18):  3287-3294.  doi: 10.3969/j.issn.2095-4344.2013.18.009
    Abstract ( 634 )   PDF (588KB) ( 458 )   Save

    BACKGROUND: Refractory extensive chronic graft-versus-host disease is the mainly late complication of allogeneic hematopoietic stem cell transplantation and glucocorticoid is the first choice for the therapy. But now, there are few effective and less side effect methods for glucocorticoid-resistant or hormone-dependent patients.
    OBJECTIVE: To observe clinical effects and side effects of rapamycin on patients suffering from refractory extensive chronic graft-versus-host disease that resistant or dependent on glucocorticoid.
    METHODS: Seventy-two cases received allogenic hematopoietic stem cells transplantation in the Department of Hematology, the Third Affiliated Hospital of Sun Yat-sen University between January 1998 and June 2012. Among them, five patients with refractory extensive chronic graft-versus-host disease were resistant to glucocorticoid or dependent on hormone, and these five patients were treated with rapamycin. The treatment effects and side effects were observed.
    RESULTS AND CONCLUSION: Among the five cases treated with rapamycin, one case received complete remission, three cases improved obviously, and the last one case received stable condition. The longest and median time for taking rapamycin was 14 and 9.4 (4-14) months respectively. The median follow-up time was 18 months, and five patients were all alive during the follow-up. The rapamycin had fewer side effects, hyperlipidemia and mild anemia were observed in one case separately, and the hepatic dysfunction and hyperglycemia were not observed. The results show that rapamycin has better effect on refractory extensive chronic graft-versus-host disease that resistant or dependent on glucocorticoid, and results in fewer side effects. Hematologic toxicity, hepatic dysfunction and high cholesterolcan can be tolerant well for patients.

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    Biological metabolic function of the human liver cell line-1 used in bioartificial liver
    Rao Xiao-hui, Jian Guo-deng, Zhang Zhi, Wang Yan, Pan Ming-xin, Gao Yi
    2013, 17 (18):  3295-3302.  doi: 10.3969/j.issn.2095-4344.2013.18.010
    Abstract ( 635 )   PDF (706KB) ( 736 )   Save

    BACKGROUND: Our preliminary study found that Chinese human liver cell line-1 has high differentiation ability and good biological metabolic functions, and the human liver cell lines are separated from normal liver tissue on a cell histology which are safer than the tumor-derived liver cell line.
    OBJECTIVE: To investigate the biological metabolic functions of Chinese human liver cell line-1 cells in a hybrid bioartificial liver.
    METHODS: Fifteen cynomolgus monkeys were randomly divided into the control group (n=5) and the treatment group (n=10), and all the monkeys were used to establish the acute liver failure models. The models in the treatment group were implanted with Chinese human liver cell line-1 established hybrid bioartificial liver through the contact perfusion bioreactor inoculation under micro carrier microgravity.
    RESULTS AND CONCLUSION: The serum alanine aminotransferase, total bilirubin, total bile acid, urea nitrogen, creatinine and blood ammonia levels of the cynomolgus monkeys with acute liver failure were increased, while the albumin level and Fischer index were decreased; after treated with hybrid bioartificial liver, serum alanine aminotransferase, total bilirubin, total bile acid, urea nitrogen, creatinine and blood ammonia levels of the cynomolgus monkeys with acute liver failure were recovered to the normal levels. It suggests that Chinese human liver cell line-1 cells in hybrid bioartificial liver have good biological metabolic function with good liver-specific biosynthesis and biological metabolic functions.

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    Tissue engineering bovine pericardium patch in repair of heart defects
    Li Bo, Wang Hui-shan, Fang Min-hua, Hang Hong-guang, Wang Zhen-long, Li Xiao-mi
    2013, 17 (18):  3303-3310.  doi: 10.3969/j.issn.2095-4344.2013.18.011
    Abstract ( 4943 )   PDF (749KB) ( 1379 )   Save

    BACKGROUND: Terylene mesh has been routinely used for cardiac surgery because of its thin texture, light weight and good biocompatibility, but in recent years, we have found that ventricular septal defect repaired with terylene mesh can cause postoperative residual leakage which is prone to cause hemolysis, bacterial or fungal infection.  
    OBJECTIVE: To explore the effect of bovine pericardium patch in repairing of congenital heart septal defect.
    METHODS: A total of 152 cases of heart septal defects were treated with glutaraldehyde-fixed bovine pericardium patch, including 56 cases of atrial septal defect, 78 cases of ventricular septal defect, 18 cases of partialatrioventricular septal defect., The early illness status, hemodynamic and cardiac functions were observed by re-examining electrocardiogram, chest radiography, cardiac ultrasound and laboratory examination after surgery.
    RESULTS AND CONCLUSION: All the 152 cases received the repair surgery without postoperative death, and the patients were followed-up for 2-6 months. No bleeding, hemolysis, thrombus, infection or rejection were observed when using the bovine pericardium patch and at early postoperative period. There was only one patient with pulmonary hypertension caused hypertensive crisis on the first postoperative day and recovered after the emergency treatment. Re-examining electrocardiogram, chest radiography and cardiac ultrasound showed the heart septal defects were repaired completely without residual shunt, the pulmonary artery pressure was decreased significantly, the valve was closed without shunt, the cardiac function was in the normal level. The results indicate that bovine pericardium patch can repair heart septal defects effectively, improve the hemodynamics and cardiac function with satisfactory short-term effect, it is a favorable material used for repairing the heart septal defects.

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    Allogeneic fibular implantation for the treatment of femoral head necrosis:  Clinical observation of 132 hips during 2.5 years follow-up
    Yao Hao, Hu Wen-hai, Li Hui-jie, Liu Si-yuan
    2013, 17 (18):  3311-3317.  doi: 10.3969/j.issn.2095-4344.2013.18.012
    Abstract ( 485 )   PDF (680KB) ( 610 )   Save

    BACKGROUND: Many treatment methods that keep their joints have been used to treat femoral head necrosis. Blood vessel free fibular grafting induces need long-term bed rest, larger damage, blood loss and complications during rehabilitation. Tantalum rod was difficult to artificial hip joint replacement in later.
    OBJECTIVE: To evaluate the recent clinical effect and indications of allogeneic fibula implantation with core for the treatment of femoral head necrosis.
    METHODS: A total of 103 patients (132 hips) with femoral head necrosis were involved, aged 43.2 (20-70) years. According to Steinberg stage, 13 hips at stageⅠ, 53 hips at stage Ⅲ, and 40 hips at stage Ⅲa, 26 hips at stage Ⅲb. The combination of core decompression and allogeneic fibular implantation with hole was used to treat the femoral head necrosis. Harris scores were used to evaluate hip function pre-operation and post-operation. The X-ray films were taken at 3, 6, 12 and 24 months after implantation to observe the repair progress of femoral head necrosis and to analyze the results.
    RESULTS AND CONCLUSION: All patients were followed-up for 2.0-2.5 years (means 2.3 years). Preoperative Harris score was (64.7±7.8) points, 68.5 points on average, and postoperative score was (91.0±2.6) points, 91.4 points on average. There was significant difference between preoperative and postoperative Harris scores (P < 0.05). After 24 months, the X-ray film of all patients showed 106 hips improved, 7 hips unchanged, 10 hips deterioration and 9 hips failed, the total effective rate was 85.6%, and all the deterioration and failed patients were at stage IIIb. All patients had no any complications. The curative effect of core decompression and allogeneic fibula implantation with hole for the treatment of femoral head necrosis is confirmed, especially for Steinberg Ⅰ period, Ⅱ period and Ⅲ a period of young patients.

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    Insulin promotes the microvessel formation in fat grafts  
    Deng Ying, Zeng Ling-huan, Li Wei, Wu Yi
    2013, 17 (18):  3318-3324.  doi: 10.3969/j.issn.2095-4344.2013.18.013
    Abstract ( 429 )   PDF (1632KB) ( 504 )   Save

    BACKGROUND: Currently, the in vitro cell culture experiment shows that insulin can not only promote the proliferation and repairing of vascular endothelia cells, but also can increase the proliferation and differentiation of preadipocytes. However, there are a few papers about the effect of insulin on revascularization in fat grafts through in vivo experiment.
    OBJECTIVE: To investigate the influence of insulin on the microvessel formation in fat grafts of rats.
    METHODS: Forty-eight Sprague Dawley female rats were used in this study, and then the rats were randomly divided into insulin group and control group. 1 mL fat graft was obtained from the side of fallopian tubes of the rats to make fat particles and then transplanted to the dorsal of the rats to establish the granule fat graft models. In the insulin group, granule fat grafts were pre-treated with insulin with the concentration of 300 mU/L before transplantation; the fat grafts in the control group without any treatment. The samples of fat grafts were harvested at 10, 20 and 28 days after the transplantation and treated with hematoxylin-eosin staining and CD34 vascular staining respectively. The changes of grafted adipocytes and the growth of microvessel were observed.
    RESULTS AND CONCLUSION: Mature adipocytes could be observed in the hematoxylin-eosin staining sections, the size of adipocytes was smaller than that before transplantation, and part of the adipocytes were ruptured and shrinked. Hyperplasia of fibrous tissue was observed in two groups, and the number of fibrous tissue around the adipocytes in the insulin group was smaller than that in the control group. At 10 and 20 days after transplantation, the microvessel densities were (3.92±0.12) microvessels/high power field and (6.96±0.42) microvessels/high power field in the insulin group, (2.05±0.21) microvessels/high power field and (4.40±0.36) microvessels/high power field in the control group, respectively. Microvessel density in insulin group was higher than that in the control group, and there was a significant difference between two groups (P < 0.01). The result shows that insulin can improve the survival rate of autogenous fat grafts by promoting the microvessel formation.

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    Chemically extracted acellular allogenic nerve and accompanying peripheral vein for repair of facial nerve defects
    Ma Hong-bin, Zhang Rong-ming
    2013, 17 (18):  3325-3332.  doi: 10.3969/j.issn.2095-4344.2013.18.014
    Abstract ( 413 )   PDF (2600KB) ( 498 )   Save

    BACKGROUND: Studies have showed that repair of facial nerve defect in rabbit with chemically extracted acellular allogenic nerve can achieve good effect.
    OBJECTIVE: To explore a more effective operation means to repair facial nerve defects on the basis of chemically extracted acellular allogenic nerve.
    METHODS: New Zealand rabbits were randomly divided into the experimental group and the control group. The experimental group received chemically extracted acellular allogenic sural nerve transplantation and then received adventitial suture with accompanying peripheral vein to prepare the animal models of defects of buccal branches of facial nerve; the control group received the autologous facial nerve in situ anastomosis. The rabbits in the control group were treated with facial nerve cutting on the proximal and distal part of the same position that did not damage the normal anatomy relations between the cut nerve and the surrounding tissues, then the adventitia suture bridge was performed at the cutting site. 
    RESULTS AND CONCLUSION: At 3 months after operation, the animals of both groups survived well with basically symmetrical facial expression and normal moustache swinging, no formation of obvious scars and neuroma could be seen at the neural transplantation site. The microscope observation results showed that there were no significant differences in the conduction velocity of right facial nerve buccal branch, number of myelinated nerve fibers in the 5.0 mm segment of graft distal anastomosis and the count of target muscle motor endplate between two groups (P > 0.05). Repairing of rabbit facial nerve defects with chemically extracted acellular allogenic nerve and accompanying peripheral vein shows a postoperative result similar to that of autologous facial nerve in situ anastomosis. 

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    Autologous tendon graft with preserved distal insertions for the treatment of old patellar tendon rupture
    Zhu Hua-qiang, Liu Yun, Chen Fa, Liu De-huai
    2013, 17 (18):  3333-3340.  doi: 10.3969/j.issn.2095-4344.2013.18.015
    Abstract ( 746 )   PDF (621KB) ( 716 )   Save

    BACKGROUND: Patellar tendon plays a very important role in the movement of knee joint. Patellar tendon rupture is relatively rare in clinic, so the misdiagnosis rate is high. There are many ways for patellar ligament reconstruction and the therapeutic effect is very different. Improper treatment can lead to patella malposition that would seriously affect the function of the knee joint.
    OBJECCTIVE: To explore the clinical efficacy of autologous tendon graft with preserved distal insertions on the treatment of old patellar tendon rupture.
    METHODS: Eight patients with unilateral old patellar tendon rupture underwent reconstruction using semitendinosus-gracilis tendons with preserved distal insertions. After patellar ligament reconstruction, semi-circular gypsum was used for fixation and the knee joint was kept in flexion of 15° for 1 week. At 2 weeks after patellar ligament reconstruction, surgical incision suture was removed, and 2 weeks later, gypsum was removed for quadriceps isometric and isotonic exercises. At 6 weeks after reconstruction, adjustable knee brace was used for the range of motion exercise, three times per day, and the flexion angle was increased for 10° every week. The patients had fully weight-bearing walking at 3 months after patellar ligament reconstruction.
    RESULTS AND CONCLUSION: All patients had no complications after patellar ligament reconstruction, and X-ray film showed that the patella returned to normal height. Function of knee joint had generally returned to normal. No patient had knee discomfort after walking for two kilometers in 24 months. Compared with that before patellar ligament reconstruction, Lysholm score of the patients at 24 months after reconstruction was increased significantly (P < 0.05). The results indicate that semitendinosus-gracilis tendons with preserved distal insertions used for patellar ligament reconstruction can reconstruct and treat old patellar tendon rupture.

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    Long-term effect of the single-bundle versus reverse “Y”-plasty reconstruction method for the anterior cruciate ligament reconstruction
    Wang Li-hui, Li Wei-ping, Song Bin, Yang Rui, Chen Zhong
    2013, 17 (18):  3341-3348.  doi: 10.3969/j.issn.2095-4344.2013.18.016
    Abstract ( 536 )   PDF (952KB) ( 806 )   Save

    BACKGROUND: The single-bundle or double-bundle reconstruction methods are commonly used to reconstruct the anterior cruciate ligament at present, while reverse “Y”-plasty reconstruction method is rarely used in clinic.
    OBJECTIVE: To compare the long-term clinical curative effect of single-bundle and reverse “Y”-plasty reconstruction method for anterior cruciate ligament reconstruction.
    METHODS: From November 2005 to December 2007, the clinical data of 59 patients with anterior cruciate ligament injury who received anterior cruciate ligament reconstruction under arthroscopic were retrospectively analyzed. All patients received the autogenous hamstring tendon as the graft material; the femoral end and the tibial end were fixed with absorbable interference screw. Among them, 31 patients adopted single bundle reconstruction method, and 28 patients adopted reverse “Y”-plasty reconstruction method.
    RESULTS AND CONCLUSION: Totally, 59 patients were followed-up for 5 to 7 years. No patient had ligament rerupture, joint pain and limited mobility during follow-up period. The Lysholm score, Larson score and international knee documentation committee knee score in the final follow-up period were significantly higher than those before reconstruction (P < 0.05); there were no significant differences in the Lysholm score, Larson score and international knee documentation committee knee score between follow-up period and preoperation (P > 0.05). In single-bundle group, anterior drawer test results of six cases were mild-positive, Lachman test results of five cases were mild-positive, pivot shift test of nine cases were mild-positive, and seven cases had bone tunnel expansion during X-ray examination. In reverse “Y”-plasty group, anterior drawer test results of seven cases were mild-positive, Lachman test results of four cases were mild-positive, pivot shift test results of two cases were mild-positive, and six cases had bone tunnel expansion during X-ray examination. There was significant difference in the positive rate of pivot shift test between two groups (P < 0.05). The results indicate that both single-bundle and reverse “Y”-plasty reconstruction method can obtain the satisfactory long-term curative effect in anterior cruciate ligament reconstruction, and there are no significant differences in the stability and activity of the knee joint between two methods, but the reverse “Y”-plasty reconstruction method can obtain better rotary stability of knee joint after reconstruction.

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    Vascularized tissue-engineered adipose established via the adipose-derived stem cells-attached scaffolds encapsulated in muscular fasciae with axial pattern blood vessel pedicle
    Wang He-geng1, Li Hong-mian1, Cui Shi-en2, Xu Kun-ming1
    2013, 17 (18):  3349-3357.  doi: 10.3969/j.issn.2095-4344.2013.18.017
    Abstract ( 306 )   PDF (639KB) ( 467 )   Save

    BACKGROUND: Revascularization mechanism is the decisive factor for the successful construction of tissue-engineered adipose tissue.
    OBJECTIVE: To observe the difference of in vivo adipogenic efficacy of adipose-derived stem cells and collagen protein scaffold encapsulated in three muscular fasciae.
    METHODS: The rabbit right vascularized latissimus dorsi muscular fasciae was separated and encapsulated with type Ⅰ collagen protein and adipogenic differentiated adipose-derived stem cells complexes as the differentiation group with axial pattern blood vessel pedicle. The rabbit left vascularized latissimus dorsi muscular fasciae was separated and encapsulated with type Ⅰ collagen protein and undifferentiated adipose-derived stem cells complexes as the undifferentiation group with axial pattern blood vessel pedicle. The rabbit gluteus maximus muscular fasciae without specific vascular pedicle was separated and encapsulated with type Ⅰ collagen protein and undifferentiated adipose-derived stem cells complexes as the control group.
    RESULTS AND CONCLUSION: Eight weeks after transplantation, hematoxylin-eosin staining and immunohistochemical staining showed that there was new adipose tissue formation in all groups. The mean humid weight of the neonatal fat tissue and the microvessel density in the differentiation group was higher than those in the undifferentiation group and the control group (P < 0.01, P < 0.05). It indicated that the vascularized tissue-engineered adipose was successfully established via adipose-derived stem cells-attached scaffolds encapsulated in muscular fasciae with axial pattern blood vessel pedicle with good in vivo adipogenic efficiency and strong ability to promote angiogenesis.

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    Heparin anchored to the surface of islet by avidin-biotin technique
    Tian Xiao-hui, Li Yang, Ding Xiao-ming, Song Huan-jin, Feng Xin-shun, Xue Wu-jun
    2013, 17 (18):  3358-3365.  doi: 10.3969/j.issn.2095-4344.2013.18.018
    Abstract ( 287 )   PDF (2168KB) ( 444 )   Save

    BACKGROUND: Islet capillaries are damaged in the process of islet isolation, thereby affecting the nutrient supply of islets after transplantation. Heparin has a very important significance for the regeneration of blood vessels; meanwhile, heparin is commonly used in the clinical islet transplantation to inhibit thrombosis. But systemic heparin can increase the risk of bleeding. The avidin has two strong binding sites of biotin and heparin respectively.
    OBJECTIVE: To improve islet revascularization and decrease risk of bleeding resulting from heparin systemic application through anchoring the heparin on the surface of islet with avidin-biotin technique based on the characteristics of avidin. 
    METHODS: Adult human pancreas were isolated and purified with Ricordi automation method, then the islets were incubated and cultured with 0, 0.5, 1, 1.5, 2 g/L biotin (including biotin-N-hydroxysuccinimide ester, N-hydroxy-succinimido-6-biotinyl amido hexanoate, biocytin hydrazine, biotin hydrazide and TFP-biotin), 1 g/L avidin, and 0.5, 1.0, 1.5 and 2.0 g/L heparin, the change of heparin was observed.
    RESULTS AND CONCLUSION: TFP-biotin had the best effect to mediate the islet surface heparinization, and there was no significant difference in the activity of islet before and after heparinization (P > 0.05); the heparinized and unheparinized heparin islets had the similar insulin release reaction (P > 0.05). Biotin-avidin technique is a safe and effective islet surface heparinization treatment method.

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    Streptozocin affects the hepatorenal function of type 1 diabetes mini-pigs
    Tian Zhong, Cui Yong-chun, Li Kai, Li Ju-bo, Wang Kun, Tang Yue
    2013, 17 (18):  3366-3373.  doi: 10.3969/j.issn.2095-4344.2013.18.019
    Abstract ( 597 )   PDF (837KB) ( 584 )   Save

    BACKGROUND: It is an acknowledged method to establish type 1 diabetes models in mini-pigs with high doses of streptozocin, but there are few reports about its influence on hepatorenal function of animals.
    OBJECTIVE: To explore the effect of high-dose streptozocin on hepatorenal function in type 1 diabetes mini-pigs.
    METHODS: Obama mini-pigs were randomly divided into control group and model group. Before and 10 and 30 minutes, 1, 2 and 4 hours, 1, 3 and 7 days after ear vein administration of sodium citrate or streptozocin, the blood samples were obtained respectively, and used to dynamically monitor the fasting blood-glucose, C peptide and insulin levels, and the hepatorenal function was examined. Glucose transporter protein 2 expression levels in pancreas, liver and kidney were determined by Western blot.
    RESULTS AND CONCLUSION: Since 24 hours after administration, fasting blood-glucose was increased significantly in the model group and maintained at 17.7-20.1 mmol/L, while the C peptide and insulin levels were decreased significantly. Compared with pre-administration, the total protein, alanine aminotransferase, aspartic acid transaminase and creatinine levels were not changed significantly in the model group; urea nitrogen and albumin levels were slightly decreased, but did not reach significant difference level; the blood uric acid was significantly reduced (P < 0.05). Western blot results showed that the expressions of glucose transporter-2 of pancreas, liver and renal basilar membrane cells in the model group were significantly lower than those in the control group. One-time high-dose streptozocin injection can establish the mini-pig model of type 1 diabetes successfully, and has no significant influence on the hepatorenal function.

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    Systematic evaluation of extracorporeal bioartificial liver support system for the treatment of liver failure
    Gu Jin-yang, Shi Xiao-lei, Ren Hao-zhen, Xiao Jiang-qiang, Ding Yi-tao
    2013, 17 (18):  3374-3380.  doi: 10.3969/j.issn.2095-4344.2013.18.020
    Abstract ( 429 )   PDF (507KB) ( 698 )   Save

    BACKGROUND: Bioartificial liver support system is composed of the bioreactors and the cellular materials, which could partially replace the major liver functions, including detoxification, synthesis, secretion and biotransformation.
    OBJECTIVE: To overview and evaluate the current clinical effect of extracorporeal bioartificial liver support system for the treatment of liver failure over the past 15 years.
    METHODS: Relevant clinical studies from 1995 to 2009 were retrieved from PubMed database and Cochrane Library database. Enrolled studies included randomized controlled trials, controlled clinical trials and case reports.
    RESU LTS AND CONCLUSIONS: Thirty-one studies were included. There was a trend of falling into the normal ranges with the clinical and biochemical parameters after bioartificial liver support system treatment. The neurological status of most patients was improved or stabilized during bioartificial liver support system treatment as well. No significant effect on survival rate could be seen after bioartificial liver support system treatment. Although, bioartificial liver support system has proved to be a success in some clinical cases, it still needs to be improved greatly in many aspects.

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    Cryoprotectant used in tissue cryopreservation
    Zhang Zhe-ping, Zhang Shu-ming
    2013, 17 (18):  3381-3388.  doi: 10.3969/j.issn.2095-4344.2013.18.021
    Abstract ( 599 )   PDF (645KB) ( 893 )   Save

    BACKGROUND: Cryopreservation can preserve the activity and function of the in vitro tissues in the greatest degree, which create the enormous push and facilitation effect in medical research and clinical treatment. But in the composite tissue cryopreservation, there also has many problems in the application of cryoprotectant waiting for solve.
    OBJECTIVE: To review the domestic and foreign research progress in the application of cryoprotectant in tissue cryopreservation
    METHODS: The PubMed database, Chinese journal full-text database and Wanfang database were searched by the first author for the literatures published from January 2003 to December 2012. The key words were “cryopreservation, cryoprotectant, composite tissues, vitrification, transplantation” in Chinese and English. Totally 143 relevant literatures were collected, and 56 of them were in accordance with the inclusion criteria.
    RESULTS AND CONCLUSION: Since the beginning of the last century, domestic and overseas experts have made great efforts on the research of tissue cryopreservation through a lot of fundamental experimental researches of animal cells and tissues, and variety of cryopreservation techniques and various cryoprotectants were applied and obtained a certain achievements, it found that the application of cryoprotectant played a crucial role in tissue cryopreservation. Cryopreservation is widely applied in some domains, such as tissue engineering, reproductive medicine and transplantation field. But at present, the application of cryoprotectant in composite tissue cryopreservation is still under studying in laboratory. The types and concentrations of cryoprotectant, as well as the addition and elution process can directly determine the ultimate success of cryopreservation.

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    From islet cell transplantation to pancreatic stem cell transplantation in the treatment of diabetes
    Wang Hong, Li Jin-cheng, Li Zheng, Sun Hai-feng, Yin Hui
    2013, 17 (18):  3389-3396.  doi: 10.3969/j.issn.2095-4344.2013.18.022
    Abstract ( 1151 )   PDF (777KB) ( 761 )   Save

    BACKGROUND: Islet cell transplantation and pancreatic stem cell transplantation are the research focus in the treatment of diabetes, and they are the most promising approaches.
    OBJECTIVE: To explore the feasibility, advantages, problems and solution methods of islet cell transplantation and pancreatic stem cell transplantation in the treatment of diabetes.
    METHODS: Relative experiments and clinical researches on islet cell transplantation and pancreatic stem cell transplantation for the treatment of diabetes were collected to analyze the experimental data. The influencing factors of islet cell transplantation and pancreatic stem cell transplantation in the treatment of diabetes were analyzed, and the advantages and disadvantages of islet cell transplantation and pancreatic stem cell transplantation in the treatment of diabetes were studied from the cell levels and molecular biology.   
    RESUTLS AND CONCLUSION: Islet cell transplantation for the treatment of diabetes is limited with donor shortage, while pancreatic stem cell transplantation can solve the donor shortage, but the research on pancreatic stem cell transplantation is limited in animal experiments. Extensive clinical study can be conducted on the basis of the identification of specific markers of pancreatic stem cells, as well as the methods and techniques that can induce the relative stem cells to differentiate into pancreatic stem cells.

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    Cell transplantation for the treatment of neurodegenerative diseases: “Transdifferentiation” appears?
    Zhou Yu-feng, Zhang Fan-xi, Zhang Jian-min
    2013, 17 (18):  3397-3404.  doi: 10.3969/j.issn.2095-4344.2013.18.023
    Abstract ( 434 )   PDF (976KB) ( 718 )   Save

    BACKGROUND: Neurodegenerative disease is a kind of disease with slow onset, progressive duration and poor prognosis, so far, there is no effective treatment method. Cell transplantation provides a new idea for the treatment of neurodegenerative disease.
    OBJECTIVE: To observe the trasplated cells, modifiers and methods used in cell transplantation for the treatment of neurodegenerative disease, and to explore whether “transdifferentiation” appeared after cell transplantation.
    METHODS: Articles related to cell transplantation for the treatment of neurodegenerative disease were collected, and the transplanted cells and modifiers used in cell transplantation for the treatment of neurodegenerative disease were analyzed, as well as the method of cell transplantation for the treatment of Parkinson’s disease, Alzheimer’s disease and amyotrophic lateral sclerosis.
    RESULTS AND CONCLUSION : At present, the research on the treatment of neurodegenerative disease are mainly focus on bone marrow stem cells, embryonic stem cells, umbilical cord blood stem cells, neural stem cells and allogeneic cells. The modifiers used in cell transplantation for the treatment of neurodegenerative disease includs tyrosine hydroxylase, orphan nuclear receptor, neurotrophic factor, Von Hippel-Lindau gene, interleukin-1 and melatonin. Cell transplantation can treat Parkinson’s disease by transplanting the cells into rat striatum, and cell transplantation can treat Alzheimer’s disease and amyotrophic lateral sclerosis by transplanting the cells into the hippocampus region and subarachnoid space. Cell transplantation for the treatment of neurodegenerative disease is becoming more mature, but there is no clear conclusion on whether “transdifferentiation” appears after transplantation.

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    Autologous muscle transplantation for reconstruction of artificial anal sphincter
    Zhang Qin-liang
    2013, 17 (18):  3405-3412.  doi: 10.3969/j.issn.2095-4344.2013.18.024
    Abstract ( 564 )   PDF (696KB) ( 600 )   Save

    BACKGROUND: Effective artificial anal sphincter reconstruction can improve the survival and quality of life of patients with anal incontinence.
    OBJECTIVE: To evaluate the effect of autologous muscle transplantation on the reconstruction of artificial anal sphincter.
    METHODS: The anatomical basis of autologous gluteus maximus and gracilis transplantation for artificial anal sphincter reconstruction was analyzed, and the patients received artificial anal sphincter reconstruction with autologous gluteus maximus and gracilis transplantation were follow-up observed. The effect of autologous gluteus maximus and gracilis transplantation on artificial anal sphincter reconstruction was identified through evaluating the recovery of bowel control of artificial anus and the incidence of complications.
    RESULTS AND CONCLUSION: Both gluteus maximus and gracilis had the rich blood supply, and the arteries used to provide nutrition to the muscles had the corresponding veins and nerves accompanied. The patients received artificial anal sphincter reconstruction with autologous gluteus maximus and gracilis transplantation were follow-up observed and showed that the patients were mostly suffered colorectal cancer or anal cancer. After artificial anal sphincter reconstruction with autologous muscle transplantation, all the patients obtained good bowel control and defecation function with less anal stenosis, perianal infection or other complications, and no rejection was observed.

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    Recurrent patellar dislocation in children treated with different soft tissue transplantation: A comparative study
    Zhu Jun, Zhu Yun-li, Wu Hai-shan, Wu Yu-li, Fu Pei-liang
    2013, 17 (18):  3413-3420.  doi: 10.3969/j.issn.2095-4344.2013.18.025
    Abstract ( 581 )   PDF (1047KB) ( 457 )   Save

    BACKGROUND: Adult recurrent patellar dislocation is commonly treated with bone transplantation as it will not consider the damage to the epiphysis, but it is not suitable for child recurrent patellar dislocation, and most scholars choose the soft tissue transplantation to treat child recurrent patellar dislocation.
    OBJECTIVE: To retrospectively evaluate the clinical treatment effect of soft tissue transplantation for the treatment of child recurrent patellar dislocation with unclosed epiphysis in 22 cases.
    METHODS: Twenty-two patients (29 knees) with children recurrent patellar dislocation selected from the Department of Joint Surgery, Shanghai Changzheng Hospital during May 2006 and April 2009 were retrospectively analyzed. The patients were treated with soft tissue transplantation, and followed-up at 3 and 6 weeks, 3 months and 1 year after transplantation, and every year thereafter. The patellar stability, subjective symptoms and knee rehabilitation were evaluated.
    RESULTS AND CONCLUSION: Among the 22 patients, one case had recurrent patellar dislocation, one case had medial patellar dislocation, and the other cases obtained satisfactory effects. The subjective scoring of knee function before and after the soft tissue transplantation were 46.99±5.91 and 94.40±9.70, respectively (P < 0.01), comprehensive Lysholm knee function score before and after soft tissue transplantation were (44.37±4.49) and (90.10±11.00) respectively (P < 0.01), and the patella-tackle congruence angle was changed from preoperative (16.27±6.74)° to postoperative (5.33±8.78)° (P< 0.01), the lateral patellofemoral angle was changed from preoperative (-1.92±7.64)° to postoperative (11.95±3.99)° (P < 0.01). Soft tissue transplantation for the treatment of child recurrent patellar dislocation with unclosed epiphysis has the advantages of easy to operation, strong operability and satisfactory effect, and it is beneficial to relief symptoms and to improve knee function.

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