OBJECTIVE: To investigate the ability of repairing bone defect with the compound of coralline hydroxyapatite porous (CHAP), fibrin sealant(FS) and staphylococcus aureus injection (SAI), and the feasibility to use the compounds as bone substitute material. METHODS: The animal model of bone defect was made on the bilateral radius of 54 New Zealand white rabbits, which were randomly divided into the experimental group(the defect was repaired with CHAP-FS-SAI), control group(with autograft) and blank control group(the defect was left unrepaired) with 18 rabbits in each group. The ability of bone defect repair was evaluated by gross observation, histopathological study, X-ray and biomechanical analysis 2, 4, 8 and 12 weeks after repair. RESULTS: (1) In the 2nd week, tight fibro-connection could be found between the implant and fracture site and there were many fibroblasts and capillary proliferation with many chondrocytes around CHAP in the experimental group, while only a few callus formed, and chondrocytes, osteoblast and osteoclast existed in the control group. (2) In experimental group and control group, a large quantity of callus was found 4 and 8 weeks; ossification of chondrocytes with weave bone formation were found 4 weeks and many osteocytes and weave bones and laminar bones were found 8 weeks. (3) In the 12th week, the complete ossification of implant with well bone remodeling, a large number of mature osteocytes and laminar were found in experimental group and control group, and CHAP still existed in the experimental group; the defect area filled with fibro-scar tissue and only many fibroblasts could be seen in blank control group. (4) X-ray findings were the following: In experimental and control groups, callus formation could be seen 2 weeks postoperatively, more callus formed 4 weeks, the bone defect area disappeared and CHAP scattered in the callus 8 weeks; the fracture line disappeared and medullary cavity became united (in control group); and in the 12th week, the cortex became continuous, the medullary cavity became united, and remodeling completed, while bone defect was not still united in blank control group. The maximal torque and torsional stiffness in the experimental group is higher than those in the control group 2 weeks (P lt; 0.05), but there was no significant difference (P gt; 0.05) between the two groups 4, 8, 12 weeks after repair. CONCLUSION: The compound of CHAP-FS-SAI has good biological compatibility, and it can be used for one kind of bone substitute material to repair the bone defect.
ObjectiveTo systematically review efficacy application of fibrin glue (FG) after thyroidectomy.MethodsPubMed, EMbase, The Cochrane Library, ClinicalTrials.gov, CBM, CNKI, WanFang Data and VIP databases were searched to collect randomized controlled trials (RCTs) regarding the use of FG after thyroidectomy from inception to October 29th, 2019. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 15 RCTs involving 2 406 patients were included. The results of meta-analysis showed that compared with non-FG group, the use of FG could reduce postoperative drainage amount at the initial 24 hours (MD=?17.98, 95%CI ?28.35 to ?7.60, P=0.000 7), total amount of wound drainage (MD=?40.92, 95%CI ?46.25 to ?35.59, P<0.000 01), and postoperative discomfort (RR=0.48, 95%CI 0.35 to 0.66, P<0.000 01), as well as shorten drainage time (MD=?9.99, 95%CI ?15.74 to ?4.23, P=0.000 7) and stitches removal time (MD=?1.49, 95%CI ?2.1 to ?0.87, P<0.000 01). However, there was no statistically significant difference concerning postoperative short-term complications such as swelling (RR=0.78, 95%CI 0.48 to 1.28, P=0.32), recurrent laryngeal nerve injury (RR=0.83, 95%CI 0.21 to 3.29, P=0.79) and wound infection (RR=0.28, 95%CI 0.07 to 1.21, P=0.09) between two groups.ConclusionsThe current evidence shows that FG can reduce postoperative drainage amount and shorten postoperative recovery time in thyroidectomy. Due to the limited quality and quantity of included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo investigate the predictive factors of portal vein thrombosis (PVT) before and after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension.
MethodsSixty-one cases of liver cirrhosis with portal hypertension who underwent splenectomy and gastroesophageal devascularization were enrolled retrospectively. The patients were divided into PVT group and non-PVT group based on the presence or absence of postoperative PVT on day 7. The clinical factors related with PVT were analyzed.
ResultsThere were 25 cases in the DVT group and 36 cases in the non-DVT group. The results of univariate analysis showed that the preoperative platelet (P=0.006), activated partial thromboplastin time (P=0.048), prothrombin time (P=0.028), and international normalized ratio (P=0.029), postoperative fibrin degradation product (P=0.002) and D-dimer (P=0.014) on day 1, portal venous diameter (P=0.050) had significant differences between the DVT group and non-DVT group. The results of logistic multivariate regression analysis showed that the preoperative platelet (OR=0.966, 95% CI 0.934-1.000, P=0.048) and postoperative fibrin degradation product on day 1(OR=1.055, 95% CI 1.011-1.103, P=0.017) were correlated with the PVT. The PVT might happen when preoperative platelet was less than 34.5×109/L (sensitibity 80.6%, specificity 60.0%) or postoperative fibrin degradation product on day 1 was more than 64.75 mg/L (sensitibity 48.0%, specificity 91.7%).
ConclusionPreoperative platelet and postoperative fibrin degradation product on day 1 might predict PVT after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension.
OBJECTIVE: To evaluate the effect of vascular endothelial growth factor(VEGF) 165 or basic fibroblast growth factor (bFGF), which was slowly-released in fibrin glue patch, on expanded prefabricated flaps in rabbits to facilitate the neoangiogenesis process. METHODS: A total of 53 rabbits were divided randomly into 6 groups. The central auricular vascular bundle of the ear was implanted into the expanded prefabricated flap as the pedicle. Fibrin glue, sandwiched between the expander and the implanted vessels, was adopted for topical delivering and slow-releasing of VEGF(625 ng) or bFGF(2880U). After 14 days, the island flap with the implanted vascular bundles as the pedicle was elevated, sutured back to its original position and then harvested more 3 days later. Neoangiogenesis was measured by digital recording of survival area, laser Doppler flowmetry, PCNA immunohistochemistry, TUNEL, ink and PbO infusions. RESULTS: When compared with the other groups, flap survival improved; neoangiogenesis of flaps increased, together with the blood flow enhanced in the groups applied growth factors. The reduced cellular apoptosis and the increased proliferation were also observed. CONCLUSION: VEGF or bFGF slowly-released by fibrin glue shows the potential to facilitate neoangiogenesis and accelerate maturation of the expanded prefabricated flap.
【
Abstract
】
Objective
To investigate the precautionary effect of fibrin glue on postoperative bleeding and bile leakage when used in partial hepatic resection. Methods House-hold rabbit partial hepatectomy model was prepared and 40 rabbits were divided into sham operation
（
SO) group (n=10), control group (n=10) and protocol group (n=20) randomly. The SO rabbits received laparotomy only, while both the control and protocol group received partial hepatectomy. Fibrin glue was used in the protocol group following electric coagulation therapy while the control group received electric coagulation therapy only. The animals’ diet, weight and adverse effects were observed then, and the celiac drainage volume, levels of hemoglobin (Hg), WBC and TBil in celiac outflow and ALT, AST, LDH and TBil in rabbit serum were checked on schedule after operation. Results The average blood loss volume and operation time in the protocol group were (16.0±2.7) ml and (23.7±2.9) min respectively, which were lower than those in the control group
〔
(20.8
±
3.5) ml and (27.3
±
2.9) min (P
＜
0.01)
〕
. The celiac drainage volume, levels of Hg, WBC and TBil in celiac outflow decreased gradually on postoperative days in protocol groups (P
＜
0.05). The levels of Hg in celiac outflow of the protocol group on the 1st, 2nd and 7th postoperative day were lower than those of the control group (P
＜
0.05), and the result of TBil was the same on the 1st, 2nd, 3rd, 5th and 7th postoperative day (P
＜
0.05). The serum ALT, AST, LDH and TBil levels in the control and protocol groups were higher than those in the SO group significantly (P
＜
0.01), while the serum ALT, AST (except on the 3rd postoperative day) and LDH levels in the protocol group were lower than those in the control group (P
＜
0.05) in significance.All animals had good appetite, normal weight gain and no adverse reaction
and death occurred. Conclusion Application of fibrin glue may effectively prevent and cure the postoperative bleeding and bile leakage in partial hepatectomy without any adverse reaction.
In order to observe the effects of different facing directions of the germinal layer of periosteum on the cartilage regeneration, the human fibrin adhesive agent was used to adhere autogenous periosteum to repair the articular cartilage defect of rabbits. Twentyfour rabbits with 48 knee joints were divided randomly into two groups. A 0.6cm×1.2cm articular cartilage defect was created on the femoral trochlea until there was bleeding from the subchondral bone. A piece of periosteum, sized 0.75cm×1.5cm, was removed from the medial aspect of upper tibia. The periosteum was adhered to the defect by human fibrin adhesive agent. In Group 1 the germinal layer faced the subchondral bone and in Group 2 the germinal layer faced the joint cavity. The cartilage regeneration in both groups was observed by naked eyes and light microscope in 2nd and 6th weeks and by electron microscope after Safronin Ostained in 12th and 20th weeks. The results showed that before the 6th week, the cartilage regeneration was faster in Group 2 than that in Group 1. After that there was no significant difference in regeneration between the two groups. This suggested that the facing direction of the germinal layer was not a critical factor on cartilage regeneration. It was also found that the strength of the adhesive agent was not enough. The regenerated cartilage was proved to be hyaline cartilage.
Objective To evalute the cl inical outcomes of two different surgical treatments for arachnoid cysts in sacral canal.? Methods From January 2004 to March 2009, 55 cases of arachnoid cysts in the sacral canal were treated by traditonal simple sacral laminectomies with resection of the cysts (group A, 25 cases) and novel CT-guided percutaneous fibrin glue therapy of arachnoid cysts (group B, 30 cases). Of them, there were 23 males and 32 females, aging 15-66 years with an average of 42.6 years; the duration of symptoms was 6 months to 15 years with an average of 3.5 years. L5-S1 was involved in 22 cases, S1,2 in 25 cases, S2,3 in 12 cases, S2 in 8 cases, and presacral in 2 cases. The size of cysts was 1.5 cm × 1.0 cm to 6.0 cm × 2.8 cm. The MRI examination showed that all patients had cysts in the sacral canal. There were no significant difference (P gt; 0.05) in sex, ages, disease duration and cysts size between two groups. Preoperative data and postoperative lumbosacral pain and function improvement were analyzed and compared between two groups. Results All operations were performed successfully. The operative time, blood loss and hospital ization days of group B were significantly less than those of group A (P lt; 0.01). All 55 cases were followed up from 9 to 61 months (mean 23 months). In group A, postoperative cerebrospinal fluid leakage (25 cases), intracranial infection (2 cases), nerve injury (3 cases), and nerve root irritation (8 cases) occurred; in group B, mild meningitis (3 cases) and low grade fever (5 cases) occurred. Except for nerve injury, other compl ications were cured after symptomatic management. During the follow-up, 2 recurrent cases were found in group A and 1 case in group B. Of them, 2 recurrent cases were treated with CT-guided percutaneous fibrin glue therapy of arachnoid cysts, and cysts disappeared. For two groups, there were significant differences in Oswestry functional disabil ity index and visual analogue scale score between preoperation and postoperation (P lt; 0.01), and in the rate of score improvement between two groups (P lt; 0.01). According to the rating scale, the excellent and good rates of pain improvement were 64% in group A and 100% in group B; the excellent and good rates of function improvement were 24% in group A and 97% in group B. Conclusion CT-guided percutaneous fibrin glue therapy for arachnoid cysts in the sacral canal is a mini-invasive, safe, effective, and economical method, it may be better choices for the treatment of arachnoid cysts in the sacral canal.
Objective To investigate the effect of the injectable osteoinductive material with fibrin sealant(FS) as a carrier compounded with bone morphogenetic protein (BMP) on the proliferation and differentiation of marrow stromal cells (MSCs) towards osteoblasts and to provide the experimental foundation for the clinical application. Methods MSCs were extracted and cultured from bone marrow of the 3-day-old rabbit, and the third generation culturedMSCs were studied. The experiment included the experimental group(FS,including 1 μg/ml rhBMP-2), FS control group（FS）and blank control group (no material).The proliferation rate, the adhesive rate, the expression of the collagen Ⅰ and alkaline phosphatase, cell growth condition in the material and the ultrastructure of MSCs were investigated by electron microscopy, histochemistry and cell culture. Results The proliferation rate and the adhesive rate of MSCs in experimental group was significantly higher than those in blank control group ,but lower than those in FS control group （P＜0.05）. The expression level of thecollagen Ⅰ and alkaline phosphatase in the experimental group was significantlyhigher than those in all control groups（Marrow stromal cells Fibrin sealant Bone morphogenetic protein Cell culture Rabbits0.05）. Scanning electron microscope showed that the surface of material was rough and had many pores and that celland material mixed. Transmission electron microscope showed that MSCs of the experimental group were mostly of the phenotype of osteoblasts with relatively lowproliferation activity and high differentiation degree toward osteoblasts and with plenty of extracellular matrix and collagen fibers. MSCs of FS control group had low differentiation degree toward osteoblasts with few extracellular matrix and collagen fibers and high proliferation activity. MSCs of blank control group had low differentiation degree toward osteoblasts with few extracellularmatrix and collagen fibers, and low proliferation activity. Conclusion The injectable osteoinductive material with fibrin sealant as a carrier compounded with BMP could significantly accelerate the differentiation of MSCs towards osteoblasts. But it could not significantly accelerate the proliferation activity of MSCs.
【Abstract】 Objective To broaden the cl inical uses of fibrin-based biomaterials and to develop further study incell biology and to comprehensively understand and master related knowledge with regard to the present development status of fibrin. Methods Many relevant domestic and international papers were reviewed to make a summary. Results Recognization was obtained from four aspects, which were structure and function of fibrinogen, cl inical use of fibrin, fibrin scaffold for tissue engineering, and compounding biomaterials of fibrin. It showed that every aspect had great research extension and practical appl ication. Conclusion Besides a surgical hemostat and sealant, fibrin has great potentials in playing roles of tissue engineering scaffold, drug del ivery vehicle, and compounding material.
The fundus lesions caused by high myopia (HM) often lead to irreversible visual impairment or even blindness. However, the pathogenesis of HM and its fundus lesions is still unclear, the intraocular fluid detection technology of micro samples has brought new prospects for the early diagnosis, monitoring and intervention of the fundus lesions. The molecules associated with HM are various and functionally diverse, intermolecular interactions are staggered and the specific mechanism is complex. With the development of intraocular fluid detection technology, while gradually revealing the role of each molecule in the pathogenesis of HM, it is expected to successfully assist clinical work in the future, providing outpost markers for the progress of myopia and targets for early intervention, or providing a new therapy choice for HM fundus lesions at the molecular level targeting pathogenesis, which is expected to provide more accurate and effective treatment for HM patients in the future.
