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The widespread application of 3D printing and computer technologies in the medical field has opened up opportunities for digital and automated fabrication of body immobilization tools for radiotherapy, thus making it possible to get rid of the original complex manual fabrication process. As the most widely used technique for body immobilization, body membrane immobilization has always attracted much attention. This review outlines the development of the body membrane immobilization technology in different radiotherapy stages. Moreover, the advances in the application of 3D-printed body membranes were introduced, as a development direction of body immobilization technology, in the field of radiotherapy. This technology can be utilized as a reference for clinical application and research.
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Objective:To explore the method and effect of aesthetic reconstruction of distal segment of finger with modified second toe nail flap while retains the full length of the second toe.Methods:From April 2018 to June 2020, 16 patients with degloving injury of distal segment of fingers were treated. The patients were 11 males and 5 females aged 18 to 45 years in an average of 29 years. All injuries were degloving injury of the distal segment of finger, including 5 index fingers, 7 middle fingers, 3 ring fingers and 1 little finger. The time from injury to operation was 0.5-3.0 hours, with an average of 1.5 hours. The second toe nail flap was used for the reconstruction. After the dorsal flap of the second toe was rotated to the plantar side of the foot, the donor site defect was repaired by a skin graft. The regular follow up reviews were carried out.Results:All 16 flaps survived except 1 flap had necrosis and underwent toe amputation of the distal segment of the second toe. All patients entered follow-up for 4-12 months, with an average of 5.7 months. The blood supply of all flaps was good. After the flaps having atrophied, they were equivalent to the diameter of the body of normal fingers with the TPD at 6.5(4-10) mm; All patients returned to work. According to the Evaluation Standard of Upper Limb Function of Chinese Hand Surgery Society, 13 cases were graded as excellent, 2 were good and 1 was fair.Conclusion:The techniques of modified second toe toenail flap in aesthetic reconstruction of the distal segment of a finger can effectively restore the length and aesthetic appearance of the affected finger, without sacrificing the donor toe. Clinical application of it should be promoted.
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Objective:To explore a surgical procedure of reconstruction finger pulp defect with free toes plantar flap with vascular anastomosis of toe-finger artery and plantar-palmar vein of finger.Methods:From April, 2018 to November, 2019, 15 patients with finger pulp defect were repaired by transplantation of the second toe pulp. In the procedure, the plantar vein of the toe and palmar vein of the finger were anastomosed. The artery and nerve of the toe and finger were anastomosed. The flap size was 0.8 cm×0.5 cm-1.0 cm×1.2 cm. The donor site was primary closed without deformity and other complication.Results:All flaps survived without vascular crisis. The mean followed-up period was 5.7 (range 3-9) months. The flaps had good blood flow, soft texture and good elasticity. Three months after surgery, touch sensation was partly recovered in some patients, and while pain was partly recovered in some patients 4-6 months after surgery. There was no deformity and other complication in the donor site. The donor sites of the foot had good appearance and normal walking function.Conclusion:The free toe plantar flap anastomosed with palmar vein can repair the digital pulp defect without dissecting the dorsal vein of digital (toe), and the donor sites can be primary sutured without deformity and other complications. The surgery operation is simple with satisfactory clinical effect.
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Objective:To evaluate the efficacy of modular flexible ureteroscopy combined with minimally invasive percutaneous nephrolithotomy in patients with complex kidney stones.Methods:From March 2017 to February 2019 in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei Province, 150 patients with complex kidney stones were selected. The patients were divided into group A, group B and group C by sortition method with 50 cases each. Group A was treated with modular flexible ureteroscopy, group B was treated with standard percutaneous nephrolithotomy, and group C was treated with modular flexible ureteroscopy combined with minimally invasive percutaneous nephrolithotomy. The operation time, transoperative bleeding, hospitalization time, calculi clearance 1- and 3-month after operation, procalcitonin (PCT) and C-reactive protein (CRP) 2 h before operation and 1 and 3 d after operation were compared among 3 groups.Results:The operation time, transoperative bleeding and hospitalization time in group C were significantly lower than those in group A and group B: (65.25 ± 7.90) min vs. (99.73 ± 8.52) and (96.11 ± 9.92) min, (33.22 ± 3.70) ml vs. (41.54 ± 3.62) and (45.17 ± 3.30) ml, (3.90 ± 0.90) d vs. (4.77 ± 1.17) and (5.70 ± 1.19) d, the calculi clearance 1- and 3-month after operation was significantly higher than that in group A and group B: 94.00% (47/50) vs. 80.00% (40/50) and 82.00% (41/50), 98.00% (49/50) vs. 84.00% (42/50) and 86.00% (43/50), and there were statistical differences ( P<0.05). There were no statistical differences in PCT and CRP 2 h before operation among 3 groups ( P>0.05); the PCT and CRP 1 and 3 d after operation in group C were significantly lower than those in group A and group B, and there were statistical differences ( P<0.05). There were no statistical differences in all indexes between group A and group B ( P>0.05). Conclusions:Modular flexible ureteroscopy combined with minimally invasive percutaneous nephrolithotomy can effectively improve calculi clearance, reduce surgical trauma, shorten operation time, promote recovery, and have significant therapeutic effects in the treatment of complex kidney stones.
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Objective:To customize the individualized 3D printed head film for patients with head tumors undergoing radiotherapy, and to evaluate the physical properties of the material and the precision of this technology compared with the thermoplastic head film.Methods:The 3D printed head film and thermoplastic head film were placed on the solid water surface, and the depth and surface dose were measured at 5 cm by ionization chamber and film, respectively. Thirty patients with head tumors receiving radiotherapy were randomly divided into the control and experimental groups. The patients were fixed with thermoplastic head film and 3D printed head film. The translational and rotational errors in the x, y and z direction were obtained by CBCT.Results:The radiation attenuation rate of two materials at the depth of 5 cm was less than 1%. The dose of thermoplastic head film in the surface position was increased by 27%, and increased by 18% in the 3D printed head film. In two groups, 116 sets of setup errors were collected. The average translational setup errors in the control and experimental groups were 1.29 mm and 1.16 mm, 1.42 mm and 1.24 mm, 1.38 mm and 1.16 mm, respectively, and the average rotational setup errors were 1.29°and 1.08°, 1.02°and 0.96°, 1.01°and 1.00°, respectively. The translational setup errors in the y and z direction and rotational setup errors in the x direction significantly differed between the control and experimental groups (all P<0.05), but no statistical significance was found in the other direction (all P>0.05). Conclusion:The 3D printed head film fixation meets the precise setup requirements of modern radiotherapy, which deserves further application in clinical trials.
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Objective To investigate the effect of piracoxib sodium on analgesia in patients with upper abdominal surgery,and to provide a reference for the choice of analgesia in these patients.Methods A total of 120 patients with abdominal surgery (stomach,liver,pancreas,spleen,etc.) were enrolled using computer random software,including 81 males and 39 females,37-62 years old,BMI 17.6-24.2kg/m2,ASA grade Ⅰ-Ⅱ.They were randomly divided into parecoxib sodium group (P group) and control group (C group) using computer random software,60 patients in each group.The two groups were treated with midazolam 0.05mg/kg,propofol 1-1.5mg/kg,rocuronium 0.6mg/kg,sufentanil 0.6pg/kg for anesthesia induction.TCI propofol 2-4mg · kg-1 · h-1 and intermittent intravenous injection of sufentanil 0.1-0.2μg/kg,rocuronium 0.15-0.3mg/kg to maintain intraoperative BIS value between 40-60.The visual analogue scale (VAS) was recorded at 2h,4h,6h,8h and 12h after operation.The postoperative analgesia of sufentanil and PCIA bolus times were recorded at 12 hours postoperatively.The incidence of complications such as postoperative sleepiness,skin pruritus,postoperative nausea and vomiting (PONV) and other anesthesia-related complications were recorded.Results The VAS scores of the patients in the P group [(1.41 ± 0.29) points,(1.55 ±0.30) points] were significantly lower than those in the C group [(1.86 ±0.33) points,(1.95 ±0.41) points] both at static state and active state immediately out of the operation room (t =7.934,6.099,all P ＜ O.05).The dosage of sufentanil and the PCIA bolus times in the P group were significantly lower than those in the C group at 12 hours after operation (t =3.732,4.205,all P ＜ 0.05).The incidence rates of lethargy,PONV and skin pruritus in the P group were significantly lower than those in the C group (x2 =8.107,3.927,4.227,all P ＜ 0.05).Conclusion In the patients of upper abdominal surgery,the analgesic effect of parecoxib sodium can significantly reduce the dosage of sufentanil and reduce the risk of postoperative complications at the same time,it is worthy of promotion in clinical use.
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Objective To study on the factors of sheep plasma method detect heparin potency and improved methods.Methods Acorrding to sheep plasma method, to study the bubbles, solids, pH and NaCl concentration on the heparin potency determination.Results The bubbles impact on the heparin potency determination was less.Solids were the main factors on heparin potency determination, containing solids protein hydrolysates heparin potency determination was (2.87 ± 0.01 ) U/mL, after removing solids potency was 24.60 U/mL, raised about 8.5 times.In the removed solids sample, when pH 7.5 to 9.5 had little effect on heparin potency determination, and pH 6.5 and 7.0 had smaller effect on the heparin potency determination.The presence of solids in the sample, as the sample pH rised, heparin potency determination also rised, at potency of sample at pH 9.0 was 3.4 times than that at pH 6.5.Enzymatic hydrolyzate mainly contain: 47.86% protein, 39.16% NaCl, 4.12% fat, wherein the protein was 91.34% of small peptides.NaCl concentration had no effect on the heparin potency determination.The improved method of recovery assay value was 98.92%~101.53%.Conclusion The method is reliable, the heparin output value calculated by measuring value in accordance with the process of practical production output.This method can be used for the determination the production process of each link in heparin potency of heparin.
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Objective To investigate the possibility of transfection of adipose-derived mesenchymal stem cells (ADMSCs) into the insulin-secreting cells in vitro,and assay the secretion of insulin of ADMSCs in high and low glucose environment.Methods The ADMSCs that untransfected were in the control group,the ADMSCs that contained PcDNA3.1 were in the vacant vector group,and the ADMSCs that contained PcDNA3.1-hINS were in the recombinant vector group.After transfection,the recombinant vector group were sub-divided into the 1,6,12,18 days groups.According to the concentrations of glucose,the recombinant vector 18 days group were divided into the high glucose group and low glucose group.Human insulin gene was amplified by RT-PCR,and the eukaryotic expression recombinant vector PcDNA3.1-hINS that contained the human insulin gene was constructed.The ADMSCs were obtained by digestion and centrifugation,and then underwent flow cytometry for identification.The transcription of insulin DNA was assayed by RT-PCR,and the levels of insulin were assayed by ELISA.Glucose test was done in the recombinant vector 18 days group.The measurement data was shown in the format of (x) ± s,the measurement data in multiple groups were compared by randomized analysis of variance,and the comparison among groups was performed by the t test.ResuIts The expressions of CD44,CD90,CD106 were positive,and the expressions of CD34,CD45 and CD11b were negative.No insulin DNA transcription was detected in the control group and vacant vector group.The levels of insulin secreted were (4.7 ± 0.8) mIU/L,(8.8 ± 0.5) mIU/L,(8.9 ± 0.8)mIU/L,(8.6 ± 0.6)mIU/L in the recombinant vector 1,6,12,18 days group,which were significantly higher than (1.3 ± 0.6) mIU/L in the control group and (1.7 ± 0.8) mIU/L in the vacant vector group (t =10.09,32.64,22.20,55.53 ; 9.23,27.56,19.43,51.25,P ＜ 0.05).There were significant differences in the levels of insulin secreted between the recombinant vector 1 day group and the recombinant vector 6,12,18 days groups (t =12.77,12.26,13.93,P ＜0.05).There were no significant difference in the levels of insulin secreted between the recombinant vector 6,12,18 days groups (F =45.67,P ＞ 0.05).There was a significant difference in the level of insulin secreted between the high glucose group and the low glucose group (t =2.03,P ＜ 0.05).The result of the glucose stimulation test was negative.Conclusion The ADMSCs are transfected into insulinsecreting cells in vitro successfully,and the secretion of insulin is stable.Although the secretion of insulin can't change in line with the concentration of glucose,it is a new seed cell for the treatment of diabetes with stem cells.
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The decoy receptor-3 ( DcR3 ) and glutamic acid decarboxylase-65 ( GAD65 ) recombinant adenovirus was construced and transduced into denlritic cells (DC). After the transduced DC were utilized to immunize NOD mice,the CD+8 T cells and blood glucose were analyzed. The results showed that recombinant adenovirus inhibited the proliferation and cytokine release of GAD65 specific T cells,and delayed the incidence of diabetes.Both interferon-γ[ (50.5±7.2)vs(95.4±6.9) and(91.2±6.5) pg/ml] and interleukin-2 [ (46.3±5.1 )vs ( 86.1 ±5.2 ) and ( 80.3 ± 7.3 ) pg/ml ] were decreased compared to those in negative and blank controls ( all P＜0.05 ).The results suggest that DcR3 and GAD65 recombinant adenovirus might provide a promising way for gene therapy of type 1 diabetes.
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Objective To discuss the clinical outcomes of old fracture-dislocation of proximal interphalangeal joint treated with a self-made distraction external fixator which consists of 3 pins and rubbers.Methods From March 2005 to August 2011,8 cases of old fracture-dislocation of proximal interphalangeal joint treated with a pins-rubber distraction external fixator were retrospectively reviewed.There were 6 males and 2 females,aged from 17 to 58 years,averaged 23.2 years.The middle finger was involved in 5 cases and ring finger was involved in 3 cases.The right hand was affected in six patients,and the left hand was affectd in two patients.The mechanism of injury was sports injury in 6 cases,traffic injuries in 1,and sprain in 1.All of the cases were closed injury.The mean time from injury to surgery was 58 d (range,45-90 d).According to Schenck classification of the proximal interphalangeal joint fracture-dislocation,there were 4 cases of type Ⅰ,3 of type Ⅱ,I of type Ⅲ.Based on the Michigan Hand Outcomes Questionnaire (MHQ) for subjective hand function score,the average preoperative score was 56; the range of motion of proximal interphalangeal joint was 0°.Grip strength was 60％-80％ of the contralateral hand.Results The follow-up lasted 6-51 months,with a mean period of 20.5 months.Solid bone healing was eventually achieved in all patients.The average healing period was 3 months (range,2-5 months).The mean normalized MHQ score was 88 (range,84-92).Grip strength was 85％-100％ of the contralateral hand.Extension of proximal interphalangeal joint was -10°-0° (average,-5°).Flexion angle was 75°-100° (average,89.4°).Postoperative complications included slight joint space narrowing (2 cases),joint incongruity (＜ 1 mm) (2 cases) and fusiform arthrocele (2 cases).No infection,pin loosening,and pin breakage was encounted.Conclusion A pins-rubber distraction external fixator is a minimally invasive,reliable and effective treatment for old fracture-dislocation of proximal interphalangeal joint.
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Objective To investigate the analgesic effect of salmon calcitonin(sCT)and its effect on expression of calcitonin receptor(CT-R)in periaqueductal gray(PAG). Methods Rat models of neuropathic pain were prepared by chronic constriction injury(CCI). Thermal withdrawal latency(TWL)and mechanical nociceptive threshold(MNT)were measured using hot plate test and yon Frey monofilaments test. The distribution of CT-R in PAG was detected by immunohistochemical method. CT-R protein was quantitatively determined by western blotting. Fourty male SD rats were randomized into 5 groups: normal group, sham-CCI group, CCI group, CCI plussubcutaneous sCT group, and CCI plus microinjection of sCT into PAG group. Results TWL, MNT, andexpression of CT-R in PAG showed no difference between normal group and sham-CCI group(P＞0. 05). TWL and MNT in CCI group were significantly lower than those in normal group(P＜0.05), and expression of CT-R in CCI group was significantly higher than that in normal group(P＜0.05). TWL, MNT and expression of CT-R in CCI rats increased significantly after sCT therapy(P＜0. 05), and the effect was more marked in PAG injection group than subcutaneous injection group(P＜0.05). Conclusions sCT raises the pain threshold and increase the expression of CT-R in PAG of CCI rats, while PAG injection showed more marked effect than subcutaneous injection.
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Objective To observe the effect of MAC of the isoflurane at the general combined with epidural anesthesia with lidocaine and dicaine.Methods 78 cases of the cholecystectomy patients randomly double-blindly divided Ⅳ groups. General combined with epidural anesthesia were performed at the Ⅰ、Ⅱ、 Ⅲ groups. And general anesthesia were performed at the contronal group. The MAC of the isoflurane are checked with up-and-down method with electronic stimulation at left on C5 leveral. Results The MAC of the three observed groups of the general combined with epidural anaesthesia were 0.67?0.097%、0.68?0.084%、0.61?0.103 % differently. There is no siginificant difference.But the MAC of the general contronl group is 1.15?0.088%.There are siginificant difference with the three observed groups,The MAC of the isoflurane can be reduced with general combined with epidural anesthesia. Coinclousions The MAC the isoflurane can be reduced with general combined with epidural anaesthsia significantly compared with singal general anesthesia. And there are no significant different in the three observed groups.It is the pulsing action with lidocaine combined with dicaine at epidural anesthesia. The mechanism of anaesthesia with lidocaine or dicaine supposed to be the same.
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Objective To study the effect of portal vein blocking on the permeability of the intestinal mucosa in pigs. Methods Healthy Rongchang pigs were divided into 3 groups: ① sham operation group(SO), ② portal vein clamping for 45 min group (PVC-45'), ③ portal vein clamping for 60 min group (PVC-60'). Urine lactulose/mannitol(L/M) ratio was measured after portal vein blocking. Results The L/M ratio was increased significantly (P<0.05) in PVC-45' and 60' groups than in SO group, with that of PVC-60' higher than that of PVC-45' group, but not significantly. Conclusion The increase of intestinal mucosal permeability after portal vein blocking is an early and important index for the damage of the intestinal mucosa barrier.