Research progress of EGFRvIII targeted immunotherapy in the treatment of glioblastoma / 药学学报

Glioblastoma (GBM) is the most common primary brain tumor, which is prone to recurrence and metastasis with poor prognosis. In recent years, immunotherapy has prolonged the survival of patients with GBM, providing a new option for the treatment of GBM. Target selection is very important for immunotherapy. Epidermal growth factor receptor variant III (EGFRvIII) is highly expressed on the surface of GBM cells in some patients, and EGFRvIII was not expressed in normal tissues. EGFRvIII are pivotal for the occurrence and progression of GBM, various targeted therapy including immunotherapy is promising to improve the efficacy of GBM. Currently, there are various approaches to target EGFRvIII, including humanized monoclonal antibodies, adoptive cell therapies and therapeutic vaccines. In this review, we focus on the preclinical and clinical findings of targeting EGFRvIII for GBM.

Effect of Salidroside on Proliferation， Migration， Invasion， and Apoptosis of HepG2 Cells / 中国实验方剂学杂志

ObjectiveSalidroside is the most abundant natural active compound in the famous Chinese herbal medicine Rhodiolae Crenulatae Radix et Rhizoma. This study aims to explore the effect of salidroside on the proliferation， migration， invasion， and apoptosis of human hepatoma （HepG2） cells. MethodThe HepG2 cells without any treatment were selected as the blank group， and the HepG2 cells in the salidroside groups were treated with salidroside at final concentrations of 20， 40， 80 μmol·L-1， respectively. A multifunctional cell analyzer， scratch assay， and Transwell assay were employed to determine the proliferation， migration， and invasion of HepG2 cells， respectively. An inverted microscope was used to observe the morphology， and a transmission electron microscope to observe the mitochondria of HepG2 cells. Flow cytometry was employed to determine the apoptosis and cycle distribution of HepG2 cells. Real-time fluorescent quantitative polymerase chain reaction ( Real-time PCR ) and Western blot were employed to determine the expression of apoptosis-associated genes and migration-， invasion-， and apoptosis-associated proteins， respectively， in HepG2 cells. ResultCompared with the blank group， salidroside （20， 40， 80 μmol·L-1） decreased the cell index and increased the healing area in a time- and dose-dependent manner （P<0.05）. Compared with that in the blank group， the HepG2 cells that could pass through Matrigel reduced in the salidroside （20， 80 μmol·L-1） groups. Compared with the blank group， salidroside （20， 40， 80 μmol·L-1） increased the total apoptosis rate in a dose dependence manner and blocked the cells in the G2/M phase （P<0.05）. Compared with the blank group， salidroside up-regulated the expression of epithelial-cadherin （E-cadherin） in a dose-dependent manner （P<0.05） and down-regulated that of nerve-cadherin （N-cadherin） in the 20 and 80 μmol·L-1 groups （P<0.05）. Compared with the blank group， salidroside （20， 40， 80 μmol·L-1） up-regulated the mRNA level of cysteine-containing aspartate-specific protease -3 （Caspase-3） and the protein levels of B-cell lymphoma-2 （Bcl-2） associated X protein （Bax）， Caspase-3， and cysteine-containing aspartate-specific protease-9 （Caspase-9） in a dose-dependent manner （P<0.05）， while it down-regulated the protein levels of the actin-binding protein Girdin and Bcl-2 in a dose-dependent manner （P<0.05）. ConclusionSalidroside inhibited the proliferation， migration， and invasion and induced the apoptosis of HepG2 cells through the mitochondrial pathway. The results suggest that salidroside can be used as a potential chemotherapy candidate for liver cancer.

Traditional Chinese and Western Medicine in Treatment of Postmenopausal Osteoporosis： A Review / 中国实验方剂学杂志

Postmenopausal osteoporosis （PMOP） is a systemic disease characterized by increased bone fragility caused by insufficient estrogen secretion in women after menopause，resulting in decreased bone mass and damage to the microstructure of bone tissues. The main clinical manifestations are low back pain，osteoporotic fractures，spinal deformities，and multiple organ dysfunction. PMOP directly leads to high morbidity， high mortality， and a decline in the quality of life. In addition to miss diagnosis， it is often not treated in time. In recent years， significant progress has been made in the research on factors related to the pathogenesis of PMOP. Based on the previous findings in recent years，this article described three major pathogenesis of PMOP， including intestinal flora imbalance，oxidative stress，and abnormal differentiation of bone marrow mesenchymal stem cells （BMMSCs）， and analyzed the current status of PMOP treatment， such as syndrome differentiation and treatment，acupuncture and moxibustion，exercise therapy， and external treatment in traditional Chinese medicine （TCM）， and basic measures，drug intervention，and physical therapy in western medicine. Among them，drug intervention in western medicine treatment is generally divided into bone resorption inhibitors，bone formation promoters，and other mechanism drugs according to the mechanism of action. This article summarized the specific methods and effects or mechanisms of TCM and western medicine in the clinical treatment of PMOP，which is expected to provide a reference for formulating reasonable health management models and drug treatments in the future.

Yixin Ningshen Tablet Alleviates Comorbidity of Myocardial Infarction and Depression by Enhancing Myocardial Energy Metabolism and Increasing Availability of Monoamine Neurotransmitter / 中国结合医学杂志

OBJECTIVE@#To investigate the therapeutic effect of Yixin Ningshen Tablet (YXNS) on comorbidity of myocardial infarction (MI) and depression in rats and explore the underlying mechanism.@*METHODS@#The Sprague-Dawley rats were randomly divided into 5 groups with 7 rats in each group according to their weights, including control, model, fluoxetine (FLXT, 10 mg/kg), low-dose YXNS (LYXNS, 100 mg/kg), and high-dose YXNS (HYXNS, 300 mg/kg) groups. All rats were pretreated with corresponding drugs for 12 weeks. The rat model of MI and depression was constructed by ligation of left anterior descending coronary artery and chronic mild stress stimulation. The echocardiography, sucrose preference test, open field test, and forced swim test were performed. Myocardial infarction (MI) area and myocardial apoptosis was also detected. Serum levels of interleukin (IL)-6, IL-1β, tumor necrosis factor-α (TNF-α), 5-hydroxytryptamine (5-HT), adrenocorticotrophic hormone (ACTH), corticosterone (CORT), and norepinephrine (NE) were determined by enzyme linked immunosorbent assay. The proteins of adenosine 5'-monophosphate -activated protein kinase (AMPK), p-AMPK, peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α), and nuclear respiratory factor 1 (NRF1) in heart were detected by Western blot analysis. The expression levels of TNF-α, IL-6, indoleamine 2,3-dioxygenase (IDO1), kynurenine 3-monooxygenase (KMO), and kynureninase (KYNU) in hippocampus were detected by real-time quantitative polymerase chain reaction.@*RESULTS@#Compared with the model group, the cardiac function of rats treated with YXNS improved significantly (P<0.01). Meanwhile, YXNS effectively reduced MI size and cardiomyocytes apoptosis of rats (P<0.01 or P<0.05), promoted AMPK phosphorylation, and increased PGC-1α protein expression (P<0.01 or P<0.05). HYXNS significantly increased locomotor activity of rats, decreased the levels of TNF-α, IL-6 and IL-1β, and increased the serum levels of 5-HT, NE, ACTH, and CORT (all P<0.05). Moreover, HYXNS decreased the mRNA expressions of IDO1, KMO and KYNU (P<0.05).@*CONCLUSIONS@#YXNS can relieve MI by enhancing myocardial energy metabolism. Meanwhile, YXNS can alleviate depression by resisting inflammation and increasing availability of monoamine neurotransmitters. It may be used as a potential drug to treat comorbidity of MI and depression.

Acupuncture combined with western medication for ocular myasthenia gravis: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between acupuncture combined with western medication and simple western medication for ocular myasthenia gravis (OMG), and to explore its possible mechanism.@*METHODS@#A total of 60 patients of ocular myasthenia gravis were randomized into an acupuncture combined with western medication group (30 cases, 1 case dropped off) and a western medication group (30 cases, 2 cases dropped off). Oral pyridostigmine bromide tablet and prednisone acetate tablet were given in the western medication group. On the basis of the treatment in the western medication group, Tongdu Tiaoqi acupuncture (acupuncture for unblocking the governor vessel and regulating qi ) was applied at Baihui (GV 20), Fengfu (GV 16), Hegu (LI 4), Zusanli (ST 36), etc. in the acupuncture combined with western medication group, once a day, 6 days a week. The treatment was given 8 weeks in both groups. Before and after treatment, the OMG clinical absolute score was observed, electrophysiological indexes of orbicularis oculi (value of mean jitter, percentage of jitter >55 μs and percentage of blocks) were measured by single-fiber electromyography (SFEMG), serum levels of acetylcholine receptor antibody (AChR-Ab), interferon-gamma (IFN-γ) and interleukin-4 (IL-4) were detected by ELISA method.@*RESULTS@#After treatment, the OMG clinical absolute scores, values of mean jitter, percentages of jitter >55 μs, percentages of blocks and serum levels of AChR-Ab, IFN-γ and IL-4 were decreased compared before treatment in both groups (P<0.05), and those in the acupuncture combined with western medication group were lower than the western medication group (P<0.05).@*CONCLUSION@#Acupuncture combined with western medication can effectively improve ptosis, palpebra superior fatigability, eye movement disorder and neuromuscular junction dysfunction in patients with ocular myasthenia gravis, the therapeutic effect is superior to simple western medication. Its mechanism may be related to down-regulating serum levels of AChR-Ab, IFN-γ and IL-4 and promoting the recovery of orbicularis oculi function.

Effect of Testudinis Carapax et Plastrum Aqueous Extract Regulating NF-κB Inflammation Microenvironment on Osteogenic Differentiation of MC3T3-E1 / 中国实验方剂学杂志

Objective::To investigate the role and mechanism of Testudinis Carapax et Plastrum aqueous extract in promoting osteogenic differentiation of mouse preosteoblast cell line(MC3T3-E1) by regulating nuclear transcription factor-κB(NF-κB) inflammation microenvironment. Method::MC3T3-E1 cells were cultured in vitro, and osteogenic induction (OI) was performed. Testudinis Carapax et Plastrum was prepared and treated the cells. Cells were devided into control group, osteogenic induction group and Testudinis Carapax et Plastrum (20 mg·L-1)with osteogenic induction group. The proliferation of MC3T3-E1 was detected by cell counting kit-8 (CCK-8), and the optimum concentration of intervention was determined. MC3T3-E1 differentiation and osteogenic mineralization were assayed using alkaline phosphatase (ALP) and Alizarin red staining (ARS), respectively. The expressions of NF-κB p65, NF-κB p105, interleukin-6(IL-6), ALP and Collagen-Ⅰ(COL-Ⅰ) mRNA were detected by Real-time PCR. Result::The results of CCK-8 showed that the proliferation of MC3T3-E1 did not change statistically with time, but it showed an upward trend, while the proliferation at 20 mg·L-1 was more obvious than other groups. The ALP and ARS showed that the positive staining rate of osteogenic induction group and Testudinis Carapax et Plastrum with osteogenic induction group were higher than control group.Real-time PCR results showed that on the 7th day in culture, the expression of NF-κB p105 and IL-6 mRNA in Testudinis Carapax et Plastrum with osteogenic induction group was significantly lower than that in control group (P<0.01), and the expression of ALP and COL-Ⅰ mRNA was significantly upregulated(P<0.05), on the 14th day, the expression of NF-κB p65, NF-κB p105 and IL-6 mRNA in Testudinis Carapax et Plastrum with osteogenic induction group was significantly lower than that in control group (P<0.01). The expression of ALP and COL-Ⅰ mRNA was significantly increased (P<0.05, P<0.01). Conclusion::Testudinis Carapax et Plastrum aqueous extract can promote osteogenic differentiation of MC3T3-E1 via a mechanism associated with the regulation of inhibition of NF-κB inflammatory microenvironment.

Preliminary application of CPC/PMMA composite bone cement in kyphoplasty for the elderly / 中国骨伤

OBJECTIVE@#From the perspective of clinical application to analyze the effectiveness and reliability of CPC/PMMA bone cement in percutaneous kyphoplasty (PKP) for the treatment of elderly patients with osteoporotic thoracolumbar fractures.@*METHODS@#A retrospective analysis was performed on 62 patients with osteoporotic compression fracture of single-vertebral thoracic or lumbar segment who underwent PKP surgery and had a bone density less than or equal to -3.0 SD from February 2016 to December 2016. Among them, 23 patients were in CPC/PMMA group, with an average age of (77.6±2.2) years old, 39 patients in PMMA group, with an average age of (77.1±1.1) years old. The indexes between two groups were compared, including the visual analogue scale (VAS), height ratio of anterior vertebra (AVHR), local Cobb angle, cement leakage, new adjacent vertebral fracture(NAVF).@*RESULTS@#There were no significant difference in gender, age, follow-up time and preoperative VAS, AVHR, local Cobb angle between two groups (>0.05), at the 1 day after operation, VAS, AVHR, local Cobb angle in all patients got obvious improvement (0.05). At the same time, there was no statistically significant difference in the incidence of new adjacent vertebral fracture and cement leakage (>0.05). The pain in both groups continued to improve at follow up after operation (<0.05), the local Cobb angle increased (<0.05) and AVHR decreased slightly (<0.05). However, the images of conventional methods (X-ray or CT) could not find signs about CPC degeneration and new bone ingrowth.@*CONCLUSION@#CPC/PMMA composite bone cement is safe and reliablein PKP for treatment of elderly patients with osteoporotic thoracolumbar fractures, which can effectively relieve pain and maintain vertebral body stability. It has the same curative effect as PMMA bone cement. It was worthy to research more in future, although no direct evidences support the CPC/PMMA composite bone cement can reduce the incidence of adjacent vertebral fracture, CPC degeneration or new bone ingrowth.

The clinicalvalue of pancreatic fistula risk scoring system in pancreaticoduodenectomy / 中华肝胆外科杂志

Objective@#To explore the value of pancreatic fistula risk score (FRS) in pancreaticoduodenectomy (PD).@*Methods@#A total of 491 patients undergoing complete pancreaticoduodenectomy in the Department of Biliary Pancreatic Surgery, Affiliated Provincial Hospital of Anhui Medical University from January 1st, 2012 to January 1st, 2017 were included in this retrospective study. Among them, 288 males and 203 females. Univariate and multivariate logistic regression analysis were used to determine the independent risk factors for pancreatic fistula. Receiver operating characteristic (ROC) curve was used to prospectively analyze the value of the FRS in predicting the incidence of postoperative pancreatic fistula in 90 PD patients.@*Results@#A total of 90 patients (18.3%) of 491 patients with PD developed pancreatic fistula, including 56 cases (11.4%) of grade A pancreatic fistula, 26 cases (5.3%) of grade B pancreatic fistula, and 8 cases (1.6%) of grade C pancreatic fistula. Univariate and multivariate logistic regression analysis found that gender male, main pancreatic duct diameter ≤ 3 mm were independent risk factor for pancreatic fistula after PD. FRS scores without pancreatic fistula risk group (0 points) clinical pancreatic fistula incidence rate 0, low pancreatic fistula risk group (1~2 points) clinical pancreatic fistula incidence rate 5.4%, moderate pancreatic risk group (3~6 points) The incidence of clinical pancreatic fistula was 12.1%, and the incidence of clinical pancreatic fistula was 60% in the high pancreatic risk group (7~10 points). The FRS system prospectively predicts the sensitivity of pancreatic fistula after surgery for PD was 80%, specificity was 70.5%, and the area under the curve was 0.852 (95% CI: 0.740~0.963).@*Conclusions@#The FRS has a certain clinical value in predicting pancreatic fistula after PD, which can predict and interfere with pancreatic fistula risk in early postoperative surgery.

The clinicalvalue of pancreatic fistula risk scoring system in pancreaticoduodenectomy / 中华肝胆外科杂志

Objective To explore the value of pancreatic fistula risk score (FRS) in pancreaticoduodenectomy (PD).Methods A total of 491 patients undergoing complete pancreaticoduodenectomy in the Department of Biliary Pancreatic Surgery,Affiliated Provincial Hospital of Anhui Medical University from January 1st,2012 to January 1st,2017 were included in this retrospective study.Among them,288 males and 203 females.Univariate and multivariate logistic regression analysis were used to determine the independent risk factors for pancreatic fistula.Receiver operating characteristic (ROC) curve was used to prospectively analyze the value of the FRS in predicting the incidence of postoperative pancreatic fistula in 90 PD patients.Results A total of 90 patients (18.3％) of 491 patients with PD developed pancreatic fistula,including 56 cases (11.4％) of grade A pancreatic fistula,26 cases (5.3％) of grade B pancreatic fistula,and 8 cases (1.6％) of grade C pancreatic fistula.Univariate and multivariate logistic regression analysis found that gender male,main pancreatic duct diameter ≤ 3 mm were independent risk factor for pancreatic fistula after PD.FRS scores without pancreatic fistula risk group (0 points) clinical pancreatic fistula incidence rate 0,low pancreatic fistula risk group (1 ～ 2 points) clinical pancreatic fistula incidence rate 5.4％,moderate pancreatic risk group (3 ～ 6 points) The incidence of clinical pancreatic fistula was 12.1％,and the incidence of clinical pancreatic fistula was 60％ in the high pancreatic risk group (7 ～ 10points).The FRS system prospectively predicts the sensitivity of pancreatic fistula after surgery for PD was 80％,specificity was 70.5％,and the area under the curve was 0.852 (95％ CI:0.740 ～ 0.963).Conclusions The FRS has a certain clinical value in predicting pancreatic fistula after PD,which can predict and interfere with pancreatic fistula risk in early postoperative surgery.

Long segment fusion for adult degenerative scoliosis: long-term outcomes and sagittal complications / 中华骨科杂志

Objective@#To investigate the long-term outcomes of posterior long segment instrumentation and fusion in adult degenerative scoliosis (ADS), and to explore the correlative factors of sagittal imbalance after long segment instrumentation and fusion, and to summarize the impacts of different lowest instrumented vertebra (LIV) on sagittal complication rates.@*Methods@#ADS patients who underwent long segment instrumentation and fusion between January 2008 and January 2014 were retrospectively reviewed and divided into two groups depended on LIV (L 5 group and S1 group). The follow-up time was at least five years. Radiographic parameters, Visual Analogue Score (VAS), Oswestry Disability Indexscore(ODI), the 12-item Short Form Health Survey-Physical Component Summary (SF-12 PCS)and sagittal complications were analyzed. And the correlation between sagittal imbalance and sagittal complications were calculated. Patients were divided into two groups(sagittal imbalance group and sagittal balance group) to explore the correlative factors of sagittal imbalance.@*Results@#All of 56 patients were included and evaluated in this study, and 35 cases stopped at L 5, 21 cases at S1. The mean follow-up time was 6.6±1.6 years. No significant difference were found in age, gender, follow-up time and surgery method (P>0.05) between two groups. No significant differences were found in Cobb angle(11.8°±7.3° vs 12.6°±6.4°), coronal balance distance(CBD) (0.7±0.6 cm vs 1.0±0.5 cm), sagittal vertebral axis(SVA)(3.0±3.1 cm vs 2.6±5.6 cm), thoracic kyphosis(TK) (21.4°±9.6° vs 22.5°±6.9°), lumbar lordosis(LL) (-32.7°±7.3° vs-34.8°±9.1°), pelvic tilt (PT) (23.4°±9.8° vs 23.3°±8.1°), VAS score(2.0±1.2 vs. 2.2±0.9), ODI score(18.5%±6.4% vs 19.3%±5.2%) and SF-12 PCSscore(45.5±5.2 vs 42.4±7.0) between two groups at final follow-up time(P>0.05). Radiographic parameters including Cobb angle, CBD, SVA and health related quality of life scores including VAS score, ODI score and SF-12 PCS scores were improved significantly at two weeks postoperatively, two-year follow-up time andfinal follow-up time in two groupscompared with those preoperatively (P<0.05). And no significant difference were found in radiographic parameters and health related quality of life scores between those at two years follow-up time and those at final follow-up time; Sagittal complication rates at final follow-up were higher than these at two years follow-up (82.1% vs 33.9%, P=0.000). Sagittal imbalance was related to internal fixation failure in L 5 group (r=0.691, P=0.011), internal fixation failure in S1 group (r=0.691, P=0.001) and pseudoarticulation formation (r=0.499, P=0.021). 10 patients in the sagittal imbalance group were with preoperative sagittal imbalance, 9 with preoperative coronal imbalance, 6 with internal fixation failure, 5 with proximal junctional kyphosis (PJK), 4 with adjacent segment degeneration during the follow-up periods, the incidence rates of which were higher than those in the sagittal balance group. LL in the sagittal imbalance group was lower than that in the sagittal balance group at two years follow-up time and final follow-up time. Compared with the sagittal imbalance group, the sagittal balance group achieved a higher SF-12 PCS (45.4±5.1 vs 41.6±7.4, P<0.05) and lower ODI scores (17.8%±6.1% vs 21.5±4.6%, P<0.05), and no significant difference was found in VAS scores between two groups (1.9±1.2 vs 2.4±0.8, P>0.05). The incidence of adjacent segment degeneration in L 5 group was higher than that in S1 group (P<0.05) at final follow-up time, and the incidence of pseudojoint in S1 group was higher than that in L 5 group (P=0.002) at final follow-up time.@*Conclusion@#Posterior long segment instrumentation and fusion for adult degenerative spinal deformity can obtain satisfying long-term clinical outcomes, and postoperative sagittal imbalance was related to preoperative sagittal/coronal imbalance, postoperativeinternal fixation failure, PJK, pseudoarticulation formation and adjacent segment degeneration. Distal fusion at L 5 or S1 may lead to high risk of adjacent segment degeneration or pseudoarticulation formation respectively.

Effect of Compound Danshen Dropping Pills on Heart of Diabetic Cardiomyopathy Rats by Regulating VEGF/TGF-β1 by miRNA-200b / 中国实验方剂学杂志

Objective: To study the protective effect and mechanism of compound Danshen dropping pills on the heart of rats with type 2 diabetic cardiomyopathy. Method: Seventy-five male SD rats were randomly divided into blank group (15 rats) and model group (60 rats). The model group was fed with high-sugar and high-fat diet, high-sugar and high-fat milk and sucrose water. Six weeks later, rats with foodborne obesity (body mass ≥ the mean body mass of blank control group + 2 times standard deviation) were selected and intraperitoneally injected with 1% streptozotocin (STZ)28 mg·kg-1. After 12 weeks, rats with fasting blood glucose ≥ 11.1 mmol·L-1 and polydipsia, diuresis, polyphagia and weight loss were randomly divided into model group, compound Danshen dropping pills group (0.5 g·kg-1) and metformin group (0.5 g·kg-1) and intervened for 12 weeks. At the end of the experiment, echocardiography was used to evaluate cardiac function. Blood samples were taken to determine the corresponding biochemical indicators of rats. Histopathological changes of myocardium were observed by hematoxylin-eosin (HE) and Masson staining. The ultrastructure of myocardium was observed under electron microscope. Western blot was used to detect the expressions of vascular endothelial growth factor (VEGF), transforming growth factor-beta 1 (TGF-β1) and type Ⅰ collagen (Collagen Ⅰ). Real-time fluorescence quantitative analysis (Real-time PCR) was used to detect the expression of miRNA-200b. Result: Compared with the blank group, the heart weight index (HMI), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterin(LDL-C) levels in the model group were significantly increased (PPPPPβ1 and Collagen I increased (PPPPPPβ1 and Collagen I was decreased (PPConclusion: Compound Danshen dropping pills may play a protective role in the heart of type 2 diabetic cardiomyopathy rats by lowering lipid, up-regulating the expression of miR-200b and inhibiting the expression levels of VEGF, TGF-β1 and Collagen I.

Observation of stand-alone MC+polyether-ether-ketone (PEEK) Cage in anterior cervical double-level fusion for more than 2 years follow-up / 中国修复重建外科杂志

Objective: To investigate the effectiveness of stand-alone MC+polyether-ether-ketone (PEEK) Cage (single blade type) in anterior cervical double-level fusion for more than 2 years follow-up. Methods: A clinical data of 30 patients who were treated with anterior cervical fusion surgery with stand-alone MC+PEEK Cage (single blade type) between January 2013 and December 2016 and followed up for more than 2 years, was retrospectively analyzed. There were 16 males and 14 females, aged from 34 to 72 years with an average of 52.2 years. There were 16 cases of cervical spondylotic myelopathy, 8 cases of cervical spondylotic myelopathy, and 6 cases of traumatic cervical disc herniation. The continuous double segments were C 4, 5, C 5, 6 in 12 cases and C 5, 6, C 6, 7 in 18 cases; and the disease duration ranged from3 days to 24 months (mean, 12 months). Postoperative neck hematoma and wound healing were observed; dysphagia was assessed by Bazaz system; and bone fusion was assessed by Suk method. Before operation, at 1 week after operation, and at last follow-up, the Japanese Orthopaedic Association (JOA) score was used to evaluate the neurological recovery; the cervical X-ray film was performed to record the cervical curvature (C 2-C 7 Cobb angle), the height of the intervertebral space of the fusion segment, and to judge the occurrence of the fusion Cage subsidence. Results: No complication such as neck hematoma, incision infection, or esophageal fistula was found, primary healing of incisions was obtained in all cases. All patients were followed up 24-72 months (mean, 46 months). Neurological symptoms such as limb numbness and pain gradually disappeared after operation; during the follow-up period, the cervical curvature could be effectively maintained; dysphagia and internal fixation related complications such as displacement of Cages were not found. All patients obtained bony fusion from 3 to 8 months with an average time of 4.3 months. Compared with preoperative ones, the JOA score, intervertebral space height, and Cobb angle of cervical spine were significantly improved at 1 week after operation and at last follow-up ( P0.05). Conclusion: The application of stand-alone MC+PEEK Cage (single card type) in anterior cervical fusion can provide early cervical stability, effectively maintain the physiological curvature of cervical spine and the height of fusion intervertebral space.

Long segment fusion for adult degenerative scoliosis: long?term outcomes and sagittal complications / 中华骨科杂志

Objective To investigate the long?term outcomes of posterior long segment instrumentation and fusion in adult degenerative scoliosis (ADS), and to explore the correlative factors of sagittal imbalance after long segment instrumentation and fusion, and to summarize the impacts of different lowest instrumented vertebra (LIV) on sagittal complication rates. Meth?ods ADS patients who underwent long segment instrumentation and fusion between January 2008 and January 2014 were retro?spectively reviewed and divided into two groups depended on LIV (L 5 group and S1 group). The follow?up time was at least five years. Radiographic parameters, Visual Analogue Score (VAS),Oswestry Disability Indexscore(ODI), the 12?item Short Form Health Survey?Physical Component Summary (SF?12 PCS)and sagittal complications were analyzed.And the correlation between sagittal imbalance and sagittal complications were calculated. Patients were divided into two groups(sagittal imbalance group and sagittal balance group) to explore the correlative factors of sagittal imbalance. Results All of 56 patients were included and evaluat? ed in this study, and 35 cases stopped at L 5, 21 cases at S1. The mean follow?up time was 6.6±1.6 years. No significant difference were found in age, gender, follow?up time and surgery method (P>0.05) between two groups.No significant differences were found in Cobb angle(11.8°±7.3°vs 12.6°±6.4°), coronal balance distance(CBD) (0.7±0.6 cm vs 1.0±0.5 cm), sagittal vertebral axis (SVA)(3.0±3.1 cm vs 2.6±5.6 cm), thoracic kyphosis(TK) (21.4°±9.6°vs 22.5°±6.9°), lumbar lordosis(LL) (-32.7°±7.3°vs -34.8°± 9.1°), pelvic tilt (PT) (23.4°±9.8°vs 23.3°±8.1°), VAS score(2.0±1.2 vs. 2.2±0.9), ODI score(18.5%±6.4% vs 19.3%±5.2%) and SF?12 PCSscore(45.5±5.2 vs 42.4±7.0) between two groups at final follow?up time( P>0.05). Radiographic parameters including Cobb angle, CBD, SVA and health related quality of life scores including VAS score, ODI score and SF?12 PCS scores were improved significantly at two weeks postoperatively, two?year follow?up time andfinal follow?up time in two groupscompared with those preop?eratively (P<0.05). And no significant difference were found in radiographic parameters and health related quality of life scores be?tween those at two years follow?up time and those at final follow?up time; Sagittal complication rates at final follow?up were higher than these at two years follow?up (82.1% vs 33.9%, P=0.000). Sagittal imbalance was related to internal fixation failure in L 5 group (r=0.691, P=0.011), internal fixation failure in S1 group (r=0.691, P=0.001) and pseudoarticulation formation (r=0.499, P=0.021). 10 patients in the sagittal imbalance group were with preoperative sagittal imbalance, 9 with preoperative coronal imbalance, 6 with internal fixation failure, 5 with proximal junctional kyphosis (PJK), 4 with adjacent segment degeneration during the follow?up periods, the incidence rates of which were higher than those in the sagittal balance group. LL in the sagittal imbalance group was lower than that in the sagittal balance group at two years follow?up time and final follow?up time. Compared with the sagittal imbal?ance group, the sagittal balance group achieved a higher SF?12 PCS (45.4 ± 5.1 vs 41.6 ± 7.4, P<0.05) and lower ODI scores (17.8%±6.1% vs 21.5±4.6%, P<0.05), and no significant difference was found in VAS scores between two groups (1.9±1.2 vs 2.4± 0.8, P>0.05). The incidence of adjacent segment degeneration in L 5 group was higher than that in S1 group (P<0.05) at final follow?up time, and the incidence of pseudojoint in S1 group was higher than that in L 5 group (P=0.002) at final follow?up time. Conclu?sion Posterior long segment instrumentation and fusion for adult degenerative spinal deformity can obtain satisfying long?term clinical outcomes, and postoperative sagittal imbalance was related to preoperative sagittal/coronal imbalance, postoperativein?ternal fixation failure, PJK, pseudoarticulation formation and adjacent segment degeneration. Distal fusion at L 5 or S1 may lead to high risk of adjacent segment degeneration or pseudoarticulation formation respectively.

Association between maternal dietary patterns during pregnancy and risk of ventricular septal defect in offspring / 上海交通大学学报（医学版）

Objective·To examine the association of maternal dietary patterns during pregnancy with the risk of ventricular septal defect (VSD) in offspring.Methods · Seventy-three children with VSD were selected as cases from June 1,2016 to December 1,2016;another 73 children without congenital heart or other defects were selected as controls during the corresponding period.VSD was diagnosed by clinical examination and echocardiography figure.Both cases and controls were recruited from Shanghai Children's Medical Center.All the children's mothers were interviewed using a structured questionnaire,which includes information on demographic characteristics and food frequency during pregnancy.Dietary patterns were defined by the factor analysis module of SPSS 23.0.The association between dietary patterns during pregnancy and VSD risk was analyzed by Logistic regression model.Results · Four dietary patterns were obtained by the factor analysis,i.e.vegetable-fruit-high-quality protein pattern,animal food pattern,high sodium and high fat pattern and aquatic product pattern.After adjusting for possible confounding factors,it was demonstrated that the vegetablefruit-high-quality protein pattern and aquatic product pattern were negatively associated with VSD risk in offspring (P＜0.05).Conclusion · Maternal dietary patterns during pregnancy that are rich in high-quality protein,vegetables,fruit and aquatic products may be helpful for decreasing VSD risk in offspring.

The primary research for the influence of immobilization baseplate of carbon fiber on dose distribution of radiation field of radiotherapy / 中国医学装备

Objective:To analyze the attenuation of immobilization baseplate of carbon fiber for ray and the change of dose verification results for enhanced radiation field of MatriXX. And to primarily research the influence of this immobilization baseplate for the dose distribution of radiation field of radiotherapy.Methods: 20 patients with cervical cancer were enrolled in the research. The angle of gantry was 180°in the enhanced plan of immobilization field, and the corresponding verification plans were designed. When the verification plan was implemented on the Varian Clinac iX of accelerator, the two-dimensional ionization chamber array (MatriXX) was used to measure dose distributions of the plan. The immobilization baseplate of carbon fiber (ORFIT AIO) was used in the research. The situations of no baseplate (A group), one baseplate (B group), two baseplates (C group)and three baseplates (D group)between the handpiece of accelerator and Matri XX were researched, respectively. The data of the 4 groups were obtained by using software (OminiPro I'mRT), and the largest dose point and passing rate of Gamma in plane of radiation field were counted and analyzed.Results: Compared with A group, the average attenuation factors for ray on the largest dose point of B, C and D group in the plane of radiation field were (1.73±0.11)％, (3.44±0.36)％, and (5.48±0.44)％, respectively. The passing rates of Gamma in the 4 groups were (94.87±2.31)％, (99.18±0.61)％, (99.79±0.27)％ and (96.24±1.99)％, respectively. And the differences of passing rate between each group and A group were statistical significance (t=9.788,t=9.261,t=2.256,P<0.05).Conclusion:The immobilization baseplate of carbon fiber has influence for the attenuation of high-energy X-rays and it can affect the dose distribution of radiation field which has passed baseplate in some degrees. And when physicists calculates the dose, they should consider the effect of immobilization baseplate of carbon fiber for dose distribution of radiation field.

Evaluation of efficacy and safety of biliary metal stent implantation via ERCP in treatment of unresectable malignant extrahepatic biliary obstruction / 中国内镜杂志

Objective To investigate efficacy and safety of biliary metallic stent placement via endoscopic retrograde cholangiopancreatography (ERCP) for malignant extrahepatic biliary obstruction. Methods According to different methods, 40 patients with malignant biliary obstruction were divided into PTCD group and ERCP group. Patients in PTCD group received percutaneous puncture bile duct drainage (PTCD) treatment, patients in ERCP group received placement of metal stents under ERCP. Results The survival time of the two groups were significant difference (P < 0.05). Postoperative biliary patency time in ERCP group was significantly longer than that in PTCD group, the difference was statistically significant (P < 0.05). One week later, the index for liver function of ERCP group was significantly better than that in PTCD group (P < 0.05). Additionally, the incidence of complications of PTCD group amd ERCP group was 30.0% and 10.0%, respectively. The complication rate of ERCP group was significantly lower than PTCD group (P < 0.05). Conclusion The effect of ERCP stent implantation is similar to that of PTCD in the treatment of malignant biliary obstruction. However, after ERCP, the time of biliary tract patency is longer with less complications and the index of liver function is recovered quickier than that after PTCD. Therefore, for the patients with malignant extrahepatic biliary obstruction, ERCP holds better clinical efficacy and safety.

Zuogui pill regulates DKK1 in the prevention and treatment of glucocorticoid-induced osteoporosis / 中国组织工程研究

BACKGROUND: Chinese medicine is effective for preventing and treating glucocorticoid-induced osteoporosis, however, the underlying mechanism remains unclear. DKK1, an inhibitor of Wnt/β-catenin signaling pathway, can be up-regulated by glucocorticoid. Thereafter, DKK1 is an important target in the prevention and treatment of osteoporosis. OBJECTIVE: To explore the regulatory effect of Zuogui pill on DKK1 in the prevention and treatment of glucocorticoid-induced osteoporosis. METHODS: Eighteen three-month-old female Sprague-Dawley rats were randomly divided into three groups: control group, model group and Zuogui pill group. Rats in the model and Zuogui pill groups received the subcutaneous injection of dexamethasone to establish the model of glucocorticoid-induced osteoporosis. The Zuogui pill group rats were administrated Zuogui pill extracts, and the control rats were given the same volume of normal saline. At 1 month after modeling, the lumbar vertebrae were removed to test the bone mass and microstructures by micro-CT scanning. The biomechanical properties were detected by compression test. The mRNA expression levels of DKK1, Runx2 and CTSK were determined by Qpcr. The serum alkaline phosphatase activity was tested. RESULTS AND CONCLUSION: Compared with the control group, in the model group, the volumetric bone mineral density, trabecular bone volume fraction, trabecular number, and trabecular thickness were significantly decreased (P ＜ 0.05), the trabecular separation and structure model index were significantly increased (P ＜ 0.05). The serum alkaline phosphatase activity was on a decline. The mRNA expression level of DKK1 showed a significant up-regulation (P ＜ 0.05). The mRNA expression level of Runx2 showed a down-regulated trend while mRNA expression level of CTSK showed an up-regulated trend. Compared with the model group, the Zuogui pill group showed significantly enhanced volumetric bone mineral density, trabecular bone volume fraction, and trabecular number (P ＜ 0.05); the structure model index was significantly decreased (P ＜ 0.05); the trabecular separation was reduced; the serum alkaline phosphatase activity was enhanced; the mRNA expression level of DKK1 showed a significant down-regulation (P ＜ 0.05); the mRNA expression level of Runx2 showed an up-regulated trend while mRNA expression level of CTSK showed a down-regulated trend. The vertebral compressive strength in the Zuogui pill group was significantly higher than that in the model group (P＜0.05). In summary, Zuogui pill prevents and treats glucocorticoid-induced osteoporosis possibly through the down-regulation of mRNA expression of DKK1.

Effect of cervical rotatory direction on the displacement of cervical disc and the volume of intervertebral foramen in a three-dimensional finite element model / 中国组织工程研究

BACKGROUND: Cervical spondylotic radiculopathy could be effectively treated by cervical rotatory manipulation, but the symptoms may be exacerbated when rotated to the wrong direction. OBJECTIVE: To simulate the cervical rotatory manipulation in left/right rotation by three-dimensional finite element, and then investigate the effect of this manipulation on the displacement of cervical disc and the volume of intervertebral foramen so as to provide a basis for effectiveness and safety of cervical rotatory manipulation in treating cervical spondylotic radiculopathy. METHODS: With Mimics10.01, Geomagic Studio and Solidworks 14.0 software, a three-dimensional geometric CAD model of C5-6was developed from the CT scan images of a 25-year-old normal adult female. The model was imported into Ansys Workbench 14.5, and a three-dimensional finite element model was verified and simulated the cervical rotatory manipulation. The cervical rotatory manipulation was decomposed by principium of manipulation in left lateral flexion and rotated to the left/right side. The parameter of mechanics was analyzed with the finite element system. The change of displacement in cervical disc and volume in intervertebral foramen simultaneously were displayed during simulating the manipulation. RESULTS AND CONCLUSION: In left lateral flexion and rotated to the left side, the posterior part of the left side of annulus fibers was expanded 0.46 mm into posterior, and the posterior part of the right side of annulus fibers was retracted 0.77 mm. The volume of left intervertebral foramen became small and the right side became large. However, in left lateral flexion and rotated to the right side, the posterior part of the left side of annulus fibers was retracted 0.71 mm, and the posterior part of the right side of annulus fibers was expanded 0.43 mm into posterior. The volume of left intervertebral foramen became large and the right side became small. Therefore, the posterior part of the rotated side of cervical disc was expanded into posterior, while the posterior part of the contralateral side of cervical disc was retracted. The volume of intervertebral foramen in rotated side became small, while the volume of intervertebral foramen in contralateral side became large. We should rotate to the contralateral side when cervical spondylotic radiculopathy was treated with cervical rotatory manipulation.

Finite element analysis on the optimal unilateral pedicle screw-implanted angle and cage position for TLIF surgery / 医用生物力学

Objective To compare biomechanical properties of pedicle screw with different axial angles and interbody cage with different positions for unilateral transforaminal lumbar interbody fusion (TLIF) surgery.Methods The normal L3-5 finite element (FE) model was established and validated.Then one bilateral TILF reconstruction FE model and four unilateral TILF reconstruction FE models with different pedicle screw-cage combination types at L4-5 level were constructed,respectively.Namely,Model A (a small axial angle-implanted screw and an ipsilaterally-placed cage),Model B (a small axial angle-implanted screw and a contralaterally-placed cage),Model C (a large axial angle-implanted screw and an ipsilaterally-placed cage),Model D (a large axial angle-implanted screw and a contralaterally-placed cage).The range of motion (ROM) of 4 reconstruction models under various physiological stresses as well as the maximum Von Mises stresses on pedicle screw,cage-L4 inferior endplate were compared.Results The ROMs at fusion segment (L4-5) in 4 unilateral TLIF reconstruction models were significantly decreased compared with the normal model,but they were still larger than bilateral TLIF reconstruc-tion model.For 4 unilateral TLIF reconstruction models,Model C showed the largest decrease in stability,and the ROM of Model C was 50.7％,89.9％,90.3％ of the normal model in flexion-extension,lateral bending,axial rotation,respectively.When comparing the maximum Von Mises stress of posterior pedicle screw and cage-L4 inferior endplate in 4 unilateral TLIF reconstruction models,Model C could bear relatively smaller stress under most loading modes,except in ipsilateral lateral bending and axial rotation.Conclusions The unilateral TLIF reconstruction model with a large axial angle-implanted screw and an ipsilaterally placed-cage can achieve the optimal stability.By narrowing the difference in stability with the bilateral TILF model,the unilateral TLIF reconstruction model can reduce the risk of screw failure and cage subsidence,which is worth of clinical application.

The management of medical consumables in the cost control of hospital / 中国医学装备

Objective: To strengthen the management of medical consumable of hospital, and adapt the public welfare characteristic of hospital, and control the use of medical consumable, and reduce burden of patients, and decrease expenditure of medical healthcare insurance fund so as to establish economic base for realizing the redeveloping of hospital. Methods: Hospital must strengthen internal management, and improve the existed problem in the link of "receive-use-repurchase" of consumables management. Besides, hospital should especially strengthen the management of medical consumables. Results: As above measures, hospital has formulated countermeasures for fortifying the management of medical consumables, and strengthened supervision of purchasing. Besides, hospital has carried out performance assessment of cost from consciousness, and carried out informatization and intelligentialize of materials management system from details. And the management of consumables has be implemented in plan, out-put and in-put of warehouse, application and use management. Conclusion: The strengthening of medical consumable management of hospital can reduce the total cost of medical consumables of patients in treatment and its proportion in the operating cost of hospital. And it can alleviate burden of patients, and it also can reduce the expenditure of medical healthcare insurance fund and operating cost of hospital.