Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with transurethral resection of bladder tumor (TURBT) for muscle-invasive bladder cancer (MIBC). Methods China National Knowledge Infrastructure, Chongqing VIP, Wanfang, SinoMed, PubMed, Web of Science, and Cochrane Library were searched from the establishment of databases until December 2023. All randomized controlled trials of TACE combined with TURBT for MIBC were collected and subjected to meta-analysis using RevMan 5.4 software. Results A total of 7 studies were included, involving 490 patients, with 246 in the TACE+TURBT group and 244 in the TURBT group. The meta-analysis results showed that compared with TURBT, TACE+TURBT had certain advantages in reducing recurrence rate [relative risk (RR)=0.49, 95% confidence interval (CI) (0.35, 0.68)], improving survival rate [RR=1.16, 95%CI (1.07, 1.27)], shortening surgical time [standardized mean difference (SMD)=?4.97, 95%CI (?7.54, ?2.40)], reducing intraoperative bleeding [SMD=?4.19, 95%CI (?5.78, ?2.60)], and improving quality of life [SMD=4.51, 95%CI (2.15, 6.86)]. The adverse reactions of the two groups were similar. Conclusions Existing evidence suggests that TACE may reduce intraoperative bleeding and shorten surgical time to help achieve maximum TURBT. TACE combined with TURBT may be superior to simple TURBT in terms of tumor recurrence rate and survival rate. TACE combined with TURBT can benefit MIBC patients in bladder-preserving treatment plans.
The rectus femoris muscles of rabbits were used as muscle model. The electrical stimulation which resembled the normal motor-unit activity was used to observe its effects on free transferred muscle. After three months, the moist muscle weight (MW), its maximum cross-section area, its contractility and its histochemical characteristics were examined. The results showed that the function and morphology of the muscles were well preserved. These findings might encourage its clinical application.
Objective To investigate the effect of the neuromuscular pedicle transplantation in prevention against atrophy in the denervated muscle. Methods Fortyeight SD rats were used to establish the right side tibialis anterior muscle denervation model. The long peroneal muscle neuromuscular pedicle was made as a treatment in 12 rats (Group A); the nerve shaft embedding was used in 12 rats (Group B); no treatment was used in 12 rats(Group C); the remaining 12 rats were used as normal controls (Group D). The gait analysis, electromyogram，muscle wet weight, and muscle fiber crosssectional area were used to determine and compare the effect of the operation at 6 and 12 weeks postoperatively. ResultsAt 6 weeks postoperatively, the parameters tested in Group A about the gait analysis (peroneal function index, PFI, －47.20±12.30), electromyogram, muscle wet weight (0.384 0±0.024 6 g)and muscle fiber cross-sectional area (1 040.98±120.54 μm2) were significantly better than those in Group C (PFI, -114.40±14.84; muscle wet weight, 0.173 0±0.019 1 g; muscle fiber cross-sectional area, 585.08±182.93 μm2,Plt;0.05), and the final two parameters were significantly better than those in Group B (0.294 0±0.056 4 g,763.92±82.68 μm2,Plt;0.05). At 12 weeks postoperatively, the musclefiber crosssectional area in Group A(1 360.10±261.45 μm2) had no significant difference from that in Group D (1 544.57±266.92 μm2，Pgt;0.05)，and most of the parameters tested in Group A were better than those in Groups B and C. Conclusion Neuromuscular pedicle transplantation has an excellent effect in prevention against atrophy in the denervated muscle, and the effect of neuromuscular pedicle transplantation is better than that of the nerve shaft embedding.
Twenty-three patients (28 extremities) suffering secondary ulcer after high ligation and stripping of great saphenous vein were chosen to receive muscle flap formation of potiteal vein. Of which, 21 patients (25 extremities) ulcer scabbed within one week and healed in 2 weeks after operation. The other s were cured in 5 weeks. All patients were followed up 6-12 months with no recurrence and satisfactory results.
Objective To evaluate the application value of repairing the defects of the chest wall with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis. Methods From January 2002 to June 2005, five patients with defects in the chest wall underwent the prothesis with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis under general anesthesia. Focal cleaning was performed first; then, the skin flap was designed and taken (15 cm ×10 cm); and finally, the defects of the chest wall were repaired with the muscle flap of the musculus rectus abdominis. Results Of the 5patients, 4 had the flap healing by the first intention, and 1 had the delayed healing, with no complication. The skin flap had a good appearance, without edema orpigmentation. The X-ray examination showed that the shadow of the sternal sequestrum disappeared. There was no recurrence or complication during the follow-upfor 1-3 years (average, 18 mon). Conclusion The repairing of the defects in the chest wall with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis is a simple and effective surgical treatment for defects of the chest wall around the sternum, and this kind of treatment is worth applying extensively in clinical practice.
ObjectiveTo evaluate the effects of nerve growth factor (NGF) on angiogenesis and skeletal muscle fiber remodeling in ischemic hindlimbs, and study the relationship of NGF and vascular endothelial growth factor (VEGF) to angiogenesis.
MethodsEighteen mice were randomly allocated to normal control group (n=6), blank control group (n=6), and NGF gene transfection group (n=6). The left hindlimb ischemia model was established by ligating the femoral artery. NGF plasmid (125μg) was injected into the mouse ischemic gastrocnemius in the NGF gene transfection group. The same volume of normal saline (200μL) was injected into the mouse ischemic gastrocnemius in the blank control group. The gastrocnemius of left hindlimb was harvested under the condition of peritoneal cavity anesthesia on the 21th day after operation, and then the mice were sacrificed. The gastrocnemius of three groups were tested by hematoxylin-eosin staining, proliferating cell nuclear antigen (PCNA) and CD34 were determined by immunohistochemistry staining. Skeletal muscle fiber type was tested by myosin ATPase staining. NGF and VEGF protein expression were detected by enzyme linked immunosorbent assay.
ResultsOn the 21th day after surgery, compared with the blank control group, the skeletal muscle atrophy degree was weaker, the functional assessment score was significantly lower (P < 0.05), the endothelial cell proliferation index, capillary density, the typeⅠskeletal muscle fiber proportion, NGF and VEGF expression were significantly higher (P < 0.05) in the NGF gene transfection group.
ConclusionsNGF gene transfection could promote NGF and VEGF expression and angiogenesis in ischemic hindlimbs, and induce typeⅠskeletal muscle fibers formation in ischemic hindlimbs. The molecular regulation mechanism still needs to be further studied.
Objective To investigate the therapeutic effect of repairing postoperative soft tissue defects of tibia and ankle open fractures with muscle flap pedicled with medial half of soleus. Methods From February 1998 to January 2009, 15male patients with postoperative soft tissue defects of internal fixation for tibia and ankle open fractures were treated. Their age was 18-54 years old (average 32 years old). The injury was caused by traffic accident in 13 cases and hit of heavy objects in 2 cases. The injury was in the left side in 9 cases and the right side in 6 cases. The soft tissue was necrotic and combined with purulent secretion. All patients presented with exposure of bone and steel plate. The soft tissue defect was located on the upper-segment of tibia in 2 cases, the middle and lower-segments of tibia in 9 cases, and the ankle in 4 cases. The size of the defect was 5 cm × 4 cm- 13 cm × 6 cm. The time from the internal fixation to the operation was 3-6 months (average 4 months). The method of anterograde transposition of muscle flap pedicled with medial half of soleus was used to repair the defects in 2 cases, and the method of retrograde transposition was appl ied to repair the defects in 13 cases. The muscle flap harvested during operation was 5 cm × 4 cm- 13 cm × 5 cm in size. The muscle flap was covered with spl it thickness skin graft (2.5 cm × 1.5 cm-10.0 cm × 5.0 cm) of femoribusinternus in 14 cases, and island flap with nutritional vessel pedicle of sural nerve (7 cm × 6 cm) in 1 case. Results One case had skin graft necrosis 5 days after operation and healed after re-debridement, vacuum seal ing drainage, and dermatoplasty. For the rest 14 patients, the incision all healed by first intention, and the skin graft, skin flaps, and muscle flaps were all survived. All wounds of the donor sites healed by first intention. Thirteen patients were followed up for 6 months to 8 years (average 3 years). The grafted skin presented with good wearabil ity and without ulceration and overstaffed appearance. At the final follow-up, the activity range of ankle was 5-10° in extension and 10-15° in flexion, and the gait was abnormal. Conclusion Muscle flap pedicled with medial half of soleus transposition is easy to be operated with a big rotating arc, can fill the narrow cavity and repair the soft tissue defect simultaneously, and provide flat and non-bloated postoperative incision with minor donor-site injury. It is one of the effective methods of repairing the postoperative soft tissue defect after internal fixation of tibia and ankle open fractures.
Objective To reveal morphologic features and physiological function in compartments of human forearm muscles, and investigate the possibil ity of transplantation of neuromuscular compartments. Methods Sihler’ s neural staining technique was used to study the nerve branches distribution of forearm skeletal muscles in 5 human cadavers (aging26-39 years), including flexor carpi radial is, flexor carpi ulnaris (FCU), extensor carpi radial is brevis, extensor carpi ulnaris, palmaris longus (PL), flexor poll icis longus, pronator teres (PT). According to Wickiewicz’s methods, Ulnar compartment and radial compartment of forearm skeletal muscles above mentioned from 10 human cadvers were used to study the muscle architectural features. Results Each nerve branches run into the ulnar compartment and radial compartment respectively. There was statistically significant difference between the two physiological cross section areas (PSCA) of each neuromuscular compartment from forearm muscles(P lt; 0.05). Among them, PSCA of ulnar compartment of FCU was the largest. The PSCA of ulnar compartment of PT was the smallest. There was no statistically difference between the ratio (PSCA/muscle wet weight) of each neuromuscular compartment from forearm muscles (P gt; 0.05). As the ratio of PSCA to the muscle fiber length, the ulnar compartment of PT and the two compartments of PL had the highest one while the ulnar compartment of FCU had the smallest; and there was no statistically difference among the other neuromuscular compartments (P gt; 0.05). Conclusion Each of forearm muscles be divided into ulnar compartment and radial compartment and they have their own nerve supply. And there are significant differences in the physiological function in compartments of forearm muscles, which can be references in muscular compartment transplantation.
Objective To introduce the current situation and prospect of the tissue-autografting, such as the flaps, muscle flaps, and bone(periosteum) flaps, andits application in reparative and reconstructive surgery. Methods Based on our own experiences and combined with the review of the literature at home and abroad, the latest development of the tissue autografting was analyzed. Results The femoral anterolateral flap, latissimus dorsi muscle flap, upper arm lateral flap, scap flap, temporal fascial flap and perforator flap are the frequently used in clinic. Of all the perforator flap had such advantages as better repair of the recipient sites and less damage of the donor site. Beacause of more advantages of the free myocutaneous flap transplantation, it substituted thefree muscle transplantation. The atissimus dorsi muscle myocutaneous flap was the most frequently used in the transplant of the vessels, with preserved function of the thoracodorsal nerve or with repair of the defected tissues by the bridge. The most common donor sites of the bone were ribs，iliac bone，fibula andscapula, so the severe bone defects or the bone nonunion, femoral head ischemic necrosis, and the bone graft from the tumor removal could be managed with the bones from those sites. Conclusion The autografting in repairing the tissue defect has become one of the most important surgical techniques in reparative and reconstructive surgery.
ObjectiveTo study the differences in body composition between maintenance hemodialysis (MHD) patients with reduced muscle mass and the ones with normal muscle mass by bioelectrical impedance analysis, and explore the influencing factors.MethodsA total of 122 patients undergoing MHD in the hemodialysis center of a general hospital between September 2018 and May 2019 were selected as the research subjects. According to the relative skeletal muscle mass index, they were divided into the muscle loss group and the normal muscle mass group. Their general conditions, post-dialysis body composition, and serum albumin were collected to analyze the differences between the two groups, and a multiple stepwise logistic regression analysis was carried out.ResultsAmong the included subjects, 53 patients had normal muscle mass and 69 patients had muscle mass loss. The post-dialysis body weight, muscle-related indexes, intracellular water, extracellular water (ECW), total body water (TBW), protein, minerals, body cell mass, bone mineral content, body mass index, arm circumference, and arm muscle circumference in the normal muscle mass group were higher than those in the muscle loss group (P<0.05); the percentage of ECW/TBW in the normal muscle mass group was lower than that in the muscle loss group (P<0.05). The multiple stepwise logistic regression analysis showed that the post-dialysis weight [odds ratio (OR)=0.679, 95% confidence interval (CI) (0.535, 0.862), P=0.001] was a protective factor from losing muscle in MHD patients, and the high ECW/TBW [OR=6.926, 95%CI (1.014, 47.280), P=0.048], low body cell mass [OR=57.707, 95%CI (6.927, 480.761), P<0.001], low bone mineral content [OR=9.743, 95%CI (1.220, 77.831, P=0.032], and arm circumference [OR=2.183, 95%CI (1.004, 4.749), P=0.049] were risk factors for muscle loss in MHD patients.ConclusionsMHD patients have a high incidence of muscle loss. It is necessary to monitor the changes of their body composition, especially those who with low post-dialysis body weight, lack of bone minerals and body cells, excessive ECW/TBW, and increased arm circumference after hemodialysis. Both nutritional interventions and exercise interventions should be performed timely and routinely to prevent the occurrence of sarcopenia.
