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Objective:To establish a motion planning method for avoiding singularities for manipulator-assisted puncture surgery navigation, and design the corresponding computer program.Methods:According to the actual operation and the need of clinicians, the puncture needle sleeve installed at the end of the UR3 robotic arm was designed, and the kinematics analysis and simulation verification of the robotic arm were performed. A calculation program for solving the movement pose when the puncture needle at the end of the robotic arm reaches the target position, and a motion planning program for avoiding singularities through small-angle rotation were programmed.Results:Six groups of joint angles were randomly selected, and the theoretical coordinates calculated by the program were compared with the actual coordinates. The result showed that the error between the theoretical value and the actual value was small, which proved the correctness of the kinematics model. In the verification experiment, 3 sets of initial poses at random were simulated, the best pose was obtained by the program. Then the pose was transmitted into the control system to control the movement of the robotic arm. The verification experiment results showed that the puncture needle can reach the target point, and the singularity can be effectively avoid by the small-angle rotation of the fixed central axis.Conclusions:The singular point avoidance method based on end posture rotation can effectively avoid the failure of initial target posture motion planning, and it has reference value for the application of manipulator in puncture surgery.
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OBJECTIVE@#To explore the methods and efficacy of unilateral extra-pedicle precision puncture percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty(PKP) by digital subtraction angiography (DSA) for the treatment of osteoporotic vertebral compression fractures (OVCFs).@*METHODS@#The clinical data of 68 patients with osteoporotic vertebral compression fractures treated from August 2015 to December 2018 were retrospectively analyzed. There were 20 males and 48 females, aged 56 to 90(73.5±8.0) years, 40 cases of double segments, 28 cases of three segments, a total of 168 vertebrae. All the patients were performed PVP orPKP through unilateral extra pedicle precision puncture under the guidance of DSA. The vertebrae were distributed in T@*RESULTS@#All the punctures were successful in 68 patients. All the puncture needles reached the midline of vertebral body, and the bone cement was well dispersed in the vertebral body with symmetrical distribution. The operation time was 35 to 60 (41.6±3.2) minutes, and there was no puncture complications. The injection volume of bone cement was 3 to 5 (3.6±0.5) ml in each vertebra. There were 8 cases of bone cement leakage, with a leakage rate of 11.76%. All 68 patients were followed up from 12 to 27 (14.3±3.5) months in the study. VAS score and ODI at 3 days after surgery and at final follow-up time were significantly improved (@*CONCLUSION@#PVP or PKP under the guidance of DSA via a unilateral extrapedicular approach with precision puncture can effectively relieve pain, restore vertebral body height and spinal function, which is a safe, fast and effective method in the treatment of osteoporotic vertebral compression fractures.
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Female , Humans , Male , Angiography, Digital Subtraction , Fractures, Compression/surgery , Kyphoplasty , Osteoporotic Fractures/surgery , Retrospective Studies , Spinal Fractures/surgery , VertebroplastyABSTRACT
OBJECTIVE： To evaluate the efficacy and safety of nalbuphine for postoperative analgesia systematically， and to provide evidence-based reference in clinic. METHODS： Retrieved from Embase， Medline， PubMed， CNKI， VIP and Wanfang database， RCTs about nalbuphine hydrochloride （trial group） vs. other analgesics （control group） for postoperative analgesia were collected. After literature screening， data extraction and literature quality evaluation with modified Jadad scale， Meta-analysis was performed by using Rev Man 5.3 statistical software. RESULTS： A total of 10 RCTs were included， involving 796 patients. Results of Meta-analysis showed that there was no statistical significance in satisfaction rate of analgesia [OR＝1.11，95％CI（0.70，1.74），P＝0.66]， the incidence of nausea [OR＝1.20，95％CI（0.79，1.83），P＝0.39]， vomiting [OR＝1.02，95％CI（0.69，1.50），P＝0.92] or narcolepsy [OR＝1.32，95％CI（0.47，3.76），P＝0.06] between 2 groups. The incidence of pruritus [OR＝0.29，95％CI（0.14，0.58），P＝0.000 6]， respiratory depression [OR＝0.21，95％CI（0.08，0.58），P＝0.003] and uroschesis [OR＝0.05，95％CI（0.01，0.37），P＝0.004] in trial group were significantly lower than control group. CONCLUSIONS： Nalbuphine has better efficacy and safety for postoperative analgesia.
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Objective:New approach and new methods on measuring disability weights of disease burden was developed and disability weights of diseases and injuries were calculated based on the sample of inpatient expenditure data in Beijing.Methods:Based on the inpatient medical records data of tertiary hospitals in Beijing from 2015-2017,diseases and injuries were classified according to the diagnosis and personal characteristics.Average expenditure of different diseases and injuries was calculated and relative disability weights were computed using the highest inpatient cost as the reference benchmark.The new methodology was developed for computing the relative weights of different diseases and injuries in burden of disease.Pearson correlation analysis was performed to test the consistency of the results.Results:The samples of 6.36 million inpatient medical records were analyzed and disability weights of 385 diseases and injuries were calculated with the results ranging from 0.020 to 0.995.The correlation coefficient between the results of 2012-2014 was 0.90.The results were consistent with the findings in other disability weights research,which made the classification of diseases and injuries more refined,reached to the most detailed classification level of diseases and injuries.Conclusions:The new approach was objective,simple,stable and repeatable with the low cost.It provided an innovative method for disability weights measurement.This was the first research to achieve the disability weights table of different diseases and injuries and it presented the key parameters for the research of burden of disease not only for China but also the other countries and regions.Furthermore,the new approach could be served as the significant reference for other countries and regions around the world to develop localized disability weights.
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Objective To investigate the roles and mechanisms of hepatocyte nuclear factor 4α (HNF4α) in chenodeoxycholic acid (CDCA) induced gastric intestinal metaplasia (IM).Methods After the immortalized gastric mucosal epithelial cells GES-1 were stimulated with CDCA at different concentration,the changes of HNF4α,caudal-related homeobox 2 (CDX2) and trefoil factor family 3 (TFF3) expressions at mRNA and protein levels in GES-1 cells and gastric cancer cell lines (AGS,SGC7901 and BGC823) were detected by real time-polymerase chain reaction (RT-PCR) and Western blotting.After GES-1 were transfected with HNF4α short hairpin RNA (shRNA) or control shRNA,and followed by CDCA stimulation,the expressions of HNF4α,CDX2 and TFF3 at protein level were determined by Western blotting.HNF4α was overexpressed in GES-1 cells and SGC7901 cells,and HNF4α was silenced in BGC823 cell line and AGS by lentiviral vector system.The expressions of HNF4α,CDX2 and TFF3 at mRNA and protein levels were tested by RT-PCR and Western blotting.Luciferase reporter assay was used to analyze the regulation role of HNF4α on CDX2.T test was performed for statistical analysis.Results The expressions of HNF4α in GES-1,SGC7901,BGC823 and AGS cells at mRNA level were 1.00 ± 0.12,263.01±10.23,848.01±18.13 and 3 049.86±91.75,respectively.The mRNAlevels of HNF4α in AGS,BGC823 and SGC7901 cells were all higher than that of GES-1 cells,and the differences were statistically significant (t=33.23,46.72 and 25.62,all P＜0.01).The expressions of HNF4α in GES-1,SGC7901,BGC823 and AGS at protein level were consistent with mRNA level.The expressions of CDX2 and TFF3 at protein level of HNF4α shRNA transfected group were lower than those of non-HNF4α shRNA transfected group.In GES-1 cells,the expressions of HNF4α,CDX2 and TFF3 of HNF4α overexpressed group at mRNA level were 16 281.839 ± 1 843.017,6.275 ± 0.137 and 17.310± 1.533,respectively;which were all higher than those of overexpressed control group (1.000 ± 0.048,1.000 ± 0.012 and 1.000±0.108,respectively),and the differences were statistically significant (t =8.83,38.29 and 10.61,all P＜0.01).In AGS cells,the expressions of HNF4α,CDX2 and TFF3 of HNF4α silenced group at mRNA level were 0.021 ± 0.001,0.088 ± 0.007 and 0.074 ± 0.002,respectively,which were lower than those of silenced control group (1.000 ± 0.108,1.000 ± 0.131 and 1.000 ± 0.122),and the differences were statistically significant (t=9.09,6.93 and 7.57,all P＜0.01).In GES-1 overexpressed cells and AGS silenced cells,the expressions of HNF4α,CDX2,TFF3 at protein level were consistent with mRNA level.In double reporter plasmid containing the CDX2 promoter CDX2 1 (-2 000～-1 bp) and CDX2-2 (-1 510～1 bp),after transfected with HNF4α shRNA,the activities were 0.387 ± 0.013 and 0.533 ± 0.040,respectively,which were lower than those of HNF4α shRNA transfected control group (0.605 ± 0.012 and 0.882 ± 0.019),and the differences were statistically significant (t =21.49 and 13.53,both P＜0.01).Conclusion HNF4α may be involved in bile acid induced intestinal metaplasia by upregulating the expression of CDX2.
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Objective To assess the efficacy and safety of berberine, amoxicillin, lansoprazole, bismuth quadruple therapy for Helicobacter pylori (H.pylori)eradication.Methods From December 2015 to April 2016,566 patients with initial treatment of H.pylori infection were prospectively enrolled.Patients were divided into observation group (berberine, amoxicillin, lansoprazole, bismuth) and control group (clarithromycin, amoxicillin, lansoprazole, bismuth), 283 cases in each group, and the treatment courses in two groups were both 14 days.Four weeks after completion of the treatment, the eradication rate of H.pylori and adverse effect rate of the two groups were compared.Student t test and Chi square test were performed for comparison between the two groups.Results There was no statistically significant difference in the baseline demographic data including gender,age, body mass index (BMI), symptom score between patients of the two groups (all P>0.05).Four weeks after completion of the treatment, the eradication rates of observation group and control group were 87.5%(244/279) and 87.1%(242/278) according to per-protocol analysis, and which were 86.2%(244/283) and 85.5 %(242/283) according to intention-to-treat analysis.There was no statistically significant difference between the two groups (x2=0.021,0.058;both P>0.05).The adverse effect rates of the two groups were 12.5%(35/279) and 16.5%(46/278), and there was no statistically significant difference (x2=1.795,P=0.180).Conclusions Both the new quadruple regimen containing berberine, amoxicillin and bismuth, and the standard quadruple regimen containing clarithromycin, amoxicillin and bismuth both can effectively eradicate H.pylori infection.The new regimen might be recommended as first-line eradication regimen in Xi′an district or area with high clarithromycin resistance.
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Objective To obtain the ratcheting strain of articular cartilage under different loading conditions, and construct the theoretical model so as to predict the ratcheting strain of cartilage. Methods The fresh articular cartilage obtained from the trochlear of distal femur was used as experimental subject. The ratcheting strain of articular cartilage was tested under cyclic compressive loads by applying the non-contact digital image correlation technique. The theoretical model was constructed to predict the ratcheting strain of articular cartilage with different stress amplitudes and stress rates. The results from predictions were compared with the experimental results. Results The ratcheting strain of cartilage increased rapidly at initial stage and then showed the slower increase with cycles increasing. The ratcheting strain increased with stress amplitude increasing when the stress rate was constant. However, the ratcheting strain decreased with stress rate increasing when the stress amplitude was constant. When the stress rate increased, the ratcheting stain decreased. The prediction results of the established theoretical model were in good agreement with experimental results. Conclusions The ratcheting strain of articular cartilage is proportional to the stress amplitude, and inversely proportional to the stress rate. The established theoretical model can predict the ratcheting strain of articular cartilage and provide guidance for the construction of tissue engineered artificial cartilage.
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Objective To investigate the correlation between clinical features and prognosis of patients with neurofibromatosis type 2(NF2)after operation.Methods The clinical features and prognosis of sixty patients with neurofibromatosis type 2(NF2)from 2000 to 2013 in Xi′an No.1 Hospital were analyzed.Cox proportional hazards regression model was used for variable analysis.Results The patients were followed up for 1-188 months,53 patients survived(88.3%,53/60),and 7 patients died(11.7%,7/60).Single factor analysis showed that the first symptom age,age of diagnosis,intracranial meningioma and spinal cord tumor were related to the prognosis of the patients(P<0.05).However,gender,genetic factors,skin lesions,eye diseases, postoperative hearing improvement and relief of dizziness after surgery were not correlated with the prognosis of patients(P>0.05).Spinal cord tumors or intracranial meningiomas were the independent risk factors for the prognosis of NF2 patients(P=0.042,0.037,95%CI=0.021-2.069,0.587-2.543,RR=2.475,3.663).The first symptoms age,age of diagnosis,ocular lesions were the risk factors for the occurrence of spinal cord tumors and intracranial meningiomas(P<0.05).Conclusion NF2 has many clinical symptoms,accompanied by spinal cord tumor and intracranial meningioma,which are the important prognostic factors in patients with poor prognosis.
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Objective To investigate the correlation between clinical features and prognosis of patients with neurofibromatosis type 2(NF2)after operation.Methods The clinical features and prognosis of sixty patients with neurofibromatosis type 2(NF2)from 2000 to 2013 in Xi′an No.1 Hospital were analyzed.Cox proportional hazards regression model was used for variable analysis.Results The patients were followed up for 1-188 months,53 patients survived(88.3%,53/60),and 7 patients died(11.7%,7/60).Single factor analysis showed that the first symptom age,age of diagnosis,intracranial meningioma and spinal cord tumor were related to the prognosis of the patients(P<0.05).However,gender,genetic factors,skin lesions,eye diseases, postoperative hearing improvement and relief of dizziness after surgery were not correlated with the prognosis of patients(P>0.05).Spinal cord tumors or intracranial meningiomas were the independent risk factors for the prognosis of NF2 patients(P=0.042,0.037,95%CI=0.021-2.069,0.587-2.543,RR=2.475,3.663).The first symptoms age,age of diagnosis,ocular lesions were the risk factors for the occurrence of spinal cord tumors and intracranial meningiomas(P<0.05).Conclusion NF2 has many clinical symptoms,accompanied by spinal cord tumor and intracranial meningioma,which are the important prognostic factors in patients with poor prognosis.
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Objective:To analyze the change of bone mineral density (BMD) in postmenopausal women,and to study the relationship between BMD and the estrogen,cytokines,and serum levels of bone metabolism.Methods: 135 postmenopausal women were divided into the OP group (n=54),Osteopenia group (n=43) and normal group (n=38) according to the results of lumbar spine bone mineral density (BMD) scan.To detected the concentration of serum estradiol (E2),bone alkaline phosphatase (BALP) and osteocalcin (BGP),tartrate resistant acid phosphatase-5b (TRAP-5b),interleukin-6 (IL-6),tumor necrosis factor alpha (TNF-α),transforming growth factor beta (TGF-β1) and IL-10 of research objects in the three groups.And to analyze the relationship between BMD and the levels of E2,BALP,BGP,TRAP-5b,IL-6,TNF-α,TGF-β1 and IL-10.Results: In the OP group and the Osteopenia group,BMD and the levels of E2,TGF-β1 and IL-10 were obviously lower than that in the normal group (P0.05).The low serum E2 levels and high serum levels of BALP,BGP,TRAP-5b,IL-6 and TNF-α were the independent factors affecting the reduction of BMD (P<0.05).Conclusion: The E2 level in patients with PMOP decreased obviously,which caused the imbalance of bone remodeling and inflammatory reaction,and which was related to the decrease of BMD.
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Objective To obtain the ratcheting strain of articular cartilage under different loading conditions,and construct the theoretical model so as to predict the ratcheting strain of cartilage.Methods The fresh articular cartilage obtained from the trochlear of distal femur was used as experimental subject.The ratcheting strain of articular cartilage was tested under cyclic compressive loads by applying the non-contact digital image correlation technique.The theoretical model was constructed to predict the ratcheting strain of articular cartilage with different stress amplitudes and stress rates.The results from predictions were compared with the experimental results.Results The ratcheting strain of cartilage increased rapidly at initial stage and then showed the slower increase with cycles increasing.The ratcheting strain increased with stress amplitude increasing when the stress rate was constant.However,the ratcheting strain decreased with stress rate increasing when the stress amplitude was constant.When the stress rate increased,the ratcheting stain decreased.The prediction results of the established theoretical model were in good agreement with experimental results.Conclusions The ratcheting strain of articular cartilage is proportional to the stress amplitude,and inversely proportional to the stress rate.The established theoretical model can predict the ratcheting strain of articular cartilage and provide guidance for the construction of tissue engineered artificial cartilage.
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Objective To obtain the ratcheting strain of articular cartilage under different loading conditions,and construct the theoretical model so as to predict the ratcheting strain of cartilage.Methods The fresh articular cartilage obtained from the trochlear of distal femur was used as experimental subject.The ratcheting strain of articular cartilage was tested under cyclic compressive loads by applying the non-contact digital image correlation technique.The theoretical model was constructed to predict the ratcheting strain of articular cartilage with different stress amplitudes and stress rates.The results from predictions were compared with the experimental results.Results The ratcheting strain of cartilage increased rapidly at initial stage and then showed the slower increase with cycles increasing.The ratcheting strain increased with stress amplitude increasing when the stress rate was constant.However,the ratcheting strain decreased with stress rate increasing when the stress amplitude was constant.When the stress rate increased,the ratcheting stain decreased.The prediction results of the established theoretical model were in good agreement with experimental results.Conclusions The ratcheting strain of articular cartilage is proportional to the stress amplitude,and inversely proportional to the stress rate.The established theoretical model can predict the ratcheting strain of articular cartilage and provide guidance for the construction of tissue engineered artificial cartilage.
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Objective:To explore the effect on sex hormone functional of extracts of Herba Epimedii /Fructus Ligustri Lucidi in osteoporosis rats.Methods:50 cases of 3 months Wistar rats were rando mly divided into normal group ,model group,extract low dose group(extract-L),extract middle dose group(extract-M),extract high dose group(extract-H),10 cases in each group,in addition to the normal group,other 4 groups were bulided OP model by filling and feeding retinoic acid for 15 d,then normal group and model group were filling physiological saline;extract-L,extract-M,extract-H were respectively feeding extracts of Herba Epimedii /Fructus Ligustri Lucidi at 50 mg/kg,100 mg/kg,200 mg/kg,both for 3 weeks.Measured the bone mineral density (BMD),observed the femoral pathology change of left femur with hematoxylin and eosin ( HE ) staining, measured trabecular bone tissue morphology related parameters ,analyzed the hormone receptor protein expression with immunohistochemistry .Results:The BMD of the whole femur ,femur head,and femur neck in normal group were all significantly higher than that of model group ,the BMD of the whole femur ,femur head, and femur neck in extract-M and extract-H group were all significantly higher than that of model group ,the BMD of the whole femur in extract-L group was significantly higher than that of model group ,the differences were statistically significant (P<0.05 or P<0.01).The bone trabecular number had significantly increased ,integrity,continuity improved significantly ,bone histomorphometry such as Tb.Ar, Tb.Th,and Tb.N in model group were decreased ,and Tb.Sp was increased,extract-M and extract-H group had remarkable effect on each index ,while extract-L group only had a remarkable effect on Tb .Ar and Tb.Th ( P<0.05 or P<0.01 ) , compared with model group.The expression of AR , ER in normal groups were significantly higher than that of model group , the expression of AR , ER in extract-H group was significantly higher than that of model group , the differences were statistically significant ( P<0.05 or P<0.01 ) . Conclusion:This study demonstrated that the combination with TFE and TIFL had potential protective effects on osteoporosis rats induced by retinoic acid .The combination with TFE and TIFL is able to increase BMD ,reverse pathological changes of bone tissue ,co-ordinate hormones of the hypothalamic-pituitary-gonadal axis ,and upregulate the expression of sex hormone receptors .
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The present study was designed to determine the taxonomic diversity and metabolic activity of the actinomycetes community, including 13 traditional medicinal plants collected in Sichuan province, China, using multiple approaches such as morphological and molecular identification methods, bioactivity assays, and PCR screening for genes involved in antibiotics biosynthesis. 119 endophytic actinomycetes were recovered; 80 representative strains were chosen for 16S rRNA gene partial sequence analyses, with 66 of them being affiliated to genus Streptomyces and the remaining 14 strains being rare actinomycetes. Antimicrobial tests showed that 12 (15%) of the 80 endophytic actinomycetes displayed inhibitory effects against at least one indicator pathogens, which were all assigned to the genus Streptomyces. In addition, 87.5% and 58.8% of the isolates showed anticancer and anti-diabetic activities, respectively. Meanwhile, the anticancer activities of the isolates negatively correlated with their anti-diabetic activities. Based on the results of PCR screening, five genes, PKS-I, PKS-II, NRPS, ANSA, and oxyB, were detected in 55.0%, 58.8%, 90.0%, 18.8% and 8.8% of the 80 actinomycetes, respectively. In conclusion, the PCR screening method employed in the present study was conducive for screening and selection of potential actinomycetes and predicting potential secondary metabolites, which could overcome the limitations of traditional activity screening models.
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Actinobacteria , Chemistry , Classification , Metabolism , Biodiversity , China , Endophytes , Chemistry , Classification , Metabolism , Molecular Sequence Data , Phylogeny , Plants, Medicinal , Classification , Microbiology , Secondary MetabolismABSTRACT
<p><b>OBJECTIVE</b>To explore therapeutic effects of cannulated screw fixation through posteromedial approach for the treatment of tibial avulsion fracture of the tibial attachment of the posterior cruciate ligament.</p><p><b>METHODS</b>From February 2007 to March 2012, 36 patients with tibial avulsion fracture of the tibial attachment of the posterior cruciate ligament were reviewed. Among the patients, 28 patients were male and 8 patients were female, ranging in age from 16 to 57 years old,averaged 35 years old. All fractures were fresh closed fracture. The posterior drawer test and heavy sign were positive in all patients. AP X-ray of knee joints of all patients showed avulsion fracture flaps at the posterior tibia platform. All the patients were treated with cannulated screw fixation through posteromedial approach, and function exercise performed after operation. The Lysholm criterion was used to evaluate clinical effects.</p><p><b>RESULTS</b>All the patients had successful operation, and were followed up. The duration of follow-up ranged from 6 to 36 months, with an average of 12 months. The fractures healed at 3 months after operation. According to Lysholm knee joint evaluation criteria, 30 patients got an excellent result, 4 good and 2 poor,the average score was 92.2 +/- 3.8.</p><p><b>CONCLUSION</b>Cannulated screw fixation through posteromedial approach for the treatment of tibial avulsion fracture of the tibial attachment of the posterior cruciate ligament is effective to recover joint function to large extent, which is a safe, simple and effective surgical method.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Bone Screws , Fracture Fixation, Internal , Methods , Posterior Cruciate Ligament , Wounds and Injuries , General Surgery , Tibial Fractures , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To explore the influence of fiberform on the defecation condition after surgery for benign anorectal lesion.</p><p><b>METHODS</b>A total of 121 cases undergoing surgery for benign anorectal lesion at the Third Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from October 2009 to February 2010 were randomly divided into the treatment group (n=61) and the control group (n=60) according to random number table. Patients in the treatment group received fiberform granule for 2 weeks while patients in the control group did not receive any medication to promote defecation. Postoperative defecation symptom scores and patient satisfaction were compared between the two groups.</p><p><b>RESULTS</b>On postoperative day 7, patients in the treatment group had a lower defecation smoothness score (62.1% decrease), lower fecal character score (74.3% decrease), lower defecation interval score (80.2% decrease), lower defecation pain score (77.5% decrease), the differences were statistically significant. On postoperative day 14, the degree of decrease of the abovementioned score were 58.3%, 88.5%, 82.8% and 83.1%, respectively. Postoperative patient satisfaction rate in the treatment group was significantly higher than that in the control group(P<0.05). No patient in the treatment group experienced any adverse events such as abdominal pain, diarrhea, and drug dependence.</p><p><b>CONCLUSION</b>Fiberform can effectively prevent defecation disorders such as dry stool, unsmooth defecation, and anorectal pain.</p>