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γ-aminobutyric acid can be produced by a one-step enzymatic reaction catalyzed by glutamic acid decarboxylase. The reaction system is simple and environmentally friendly. However, the majority of GAD enzymes catalyze the reaction under acidic pH at a relatively narrow range. Thus, inorganic salts are usually needed to maintain the optimal catalytic environment, which adds additional components to the reaction system. In addition, the pH of solution will gradually rise along with the production of γ-aminobutyric acid, which is not conducive for GAD to function continuously. In this study, we cloned the glutamate decarboxylase LpGAD from a Lactobacillus plantarum capable of efficiently producing γ-aminobutyric acid, and rationally engineered the catalytic pH range of LpGAD based on surface charge. A triple point mutant LpGADS24R/D88R/Y309K was obtained from different combinations of 9 point mutations. The enzyme activity at pH 6.0 was 1.68 times of that of the wild type, suggesting the catalytic pH range of the mutant was widened, and the possible mechanism underpinning this increase was discussed through kinetic simulation. Furthermore, we overexpressed the Lpgad and LpgadS24R/D88R/Y309K genes in Corynebacterium glutamicum E01 and optimized the transformation conditions. An optimized whole cell transformation process was conducted under 40 ℃, cell mass (OD600) 20, 100 g/L l-glutamic acid substrate and 100 μmol/L pyridoxal 5-phosphate. The γ-aminobutyric acid titer of the recombinant strain reached 402.8 g/L in a fed-batch reaction carried out in a 5 L fermenter without adjusting pH, which was 1.63 times higher than that of the control. This study expanded the catalytic pH range of and increased the enzyme activity of LpGAD. The improved production efficiency of γ-aminobutyric acid may facilitate its large-scale production.
Subject(s)
Glutamate Decarboxylase/genetics , Lactobacillus plantarum/genetics , Catalysis , gamma-Aminobutyric Acid , Hydrogen-Ion Concentration , Glutamic AcidABSTRACT
Objective@#To predict the prognosis of cervical cancer, we constructed a novel model with 5 specific cell types and identified a potential biomarker. @*Methods@#We employed CIBERSORT and xCell method to evaluate the abundances of 23 cells types in tumor microenvironment. Five specific cell types were filtrated to determine different immunotypes by applying least absolute shrinkage and selection operator (LASSO) Cox regression method. The expression of immune checkpoints (ICPs) and effectors were validated by immunohistochemistry. Correlation analysis was performed to examine the relevance between PIK3CA mutational status and ICPs. @*Results@#Unsupervised clustering of patients on the basis of tumor infiltrating lymphocytes and fibroblasts identified patients with shorter overall survival (OS) (hazard ratio [HR]=3.0729; 95% confidence interval [CI]=1.5103–6.2522; p=0.0118). An immunoscore (IS) signature consisting of 5 immune cell types infiltrating in tumor core (CD8T, activated NK cells, neutrophils, activated mast cells, macrophages) was constructed using LASSO Cox regression analysis. Receiver operating characteristic curves confirmed that the area under the curve of IS was significantly higher to that of International Federation of Gynecology and Obstetrics staging alone (0.637 vs. 0.55). Survival analysis revealed patients in high IS group exhibited a poorer OS (HR=3.0113; 95% CI=1.8746–4.8373; p<0.0001). The multivariate analysis indicated the IS was an independent prognostic factor. In addition, the lower IS related to higher expression of ICPs and neoantigen load. @*Conclusions@#The identification of IS in cervical cancer tissues could facilitate patient risk stratification and selection of immunotherapeutic responses, but more prospective studies are needed to assess its reliability.
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Objective:To summarize the experience and technical difficulties of complete thoracoscopic lobectomy(segmental) in the treatment of congenital pulmonary airway malformation in children.Methods:The clinical data, surgical videos and follow-up results of 38 children suffering from congenital pulmonary airway malformation and underwent complete thoracoscopic lobectomy in Children′s Hospital of Fudan University Xiamen Branch from January 2017 to December 2019 were retrospectively analyzed.A statistical comparisons of operative time, intraoperative blood loss, postoperative pain (the first time of getting out of bed), incision length and postoperative pulmonary complications were made between 28 children who underwent the total thoracoscopic lobectomy and 21 children who accepted open surgical lobectomy before January 2017 in Children′s Hospital of Fudan University Xiamen Branch.Results:Thirty-eight children with congenital pulmonary airway malformation were successfully operated by complete thoracoscopy.There were 28 lobectomies, 6 segmental lobectomies and 4 wedge lobectomies.Postoperative follow-up was conducted for more than 3 months, and no serious surgical complications occurred.Chest radiograph of 2 children with the right lower lobectomy at 48 hours after surgery had the elevation of the right diaphragm (2-3 intercostal), and it returned to normal 3 months after surgery.The CT review of 1 child with pulmonary wedge resection 1 month after surgery displayed a little residual lesion.Thoracoscopic lobectomy was significantly different from open surgery in terms of incision length[(2.0±0.5) cm vs. (10.0±0.5) cm], postoperative pain (the first time of getting out of bed)[(24.0±2.0) h vs. (48.0±1.5) h] and pulmonary complications (0 vs. 5 cases). The operative time of single lung ventilation was remarkably different from that of double lung ventilation in thoracoscopic lobectomy[(96.0±6.0) min vs. (118.0±7.0) min, t=106.501, P<0.001]. Compared with thoracoscopic lobectomy, thoracoscopic pulmonary segmentectomy has a long time and a large amount of blood loss. Conclusions:Complete thoracoscopic lobectomy (segmental) is the first choice for the treatment of congenital pulmonary airway malformation in children, with clear operative field, little trauma, less postoperative pain, quick recovery and fewer respiratory complications.Single-lung ventilation is beneficial for surgical completion.
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Objective:To explore the association of miRNA-146a (miR-146a), miRNA-196a2 (miR-196a2), and miRNA-499 (miR-499) single nucleotide polymorphisms with genetic susceptibility in hepatocellular carcinoma.Methods:A case-control study was designed. A total of 175 patients (hepatocellular carcinoma group) in Affiliated Hospital of Yangzhou University from April 2015 to March 2019 and 302 healthy people undergoing physical examination during the same period (the control group) were selected. The genotype distribution of miR-146a, miR-196a2 and miR-499 in the peripheral blood of the two groups were detected by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Logistic regression model was used to analyze the association of 3 genotypes of miRNA, genotypes of hepatitis virus infectors with genetic susceptibility in hepatocellular carcinoma. The relationship between miR-146a gene polymorphism and demography factor as well as the clinical characteristics was also analyzed by using Spearman correlation analysis.Results:In hepatocellular carcinoma group, miR-146a single nucleotide polymorphism of CC, CG, GG site genotypes had 52 (29.7%) cases, 86 (49.1%) cases, 37 (21.1%) cases, respectively; in the control group, the corresponding genotypes had 137 (45.4%) cases, 135 (44.7%) cases and 30 (9.9%) cases, respectively, and the difference in genotype distribution of both groups was statistically significant ( χ2 = 17.23, P < 0.05). There were no statistical differences in genotype distribution of miR-196a2 and miR-499 ( χ2 = 0.51, P = 0.776; χ2 = 0.05, P = 0.976). Single factor logistic regression analysis showed that in the co-dominant model of miR-146a genotype, genotypes of CG ( OR = 1.96, 95% CI 1.13-3.41, P = 0.017) and GG ( OR = 3.30, 95% CI 1.85-5.89, P<0.01) had elevated risk of hepatocellular carcinoma compared with CC genotype. In the dominant model, the risk of hepatocellular carcinoma in CG+GG genotypes was increased compared with that in CC genotype ( OR=1.97, 95% CI 1.33-2.93, P = 0.001); in the recessive model, the risk of hepatocellular carcinoma in GG genotype was increased compared with that in CG+ GG genotype ( OR=2.43, 95% CI 1.44-4.11, P = 0.001). Single factor logistic regression analysis showed that there was no significant difference in the risk of hepatocellular carcinoma in the co-dominant, dominant and recessive models between miR-196a2 and miR-499 genotypes (all P > 0.05). For hepatocellular carcinoma patients with positive hepatitis B virus (HBV), CG genotype had a 2.02-fold (95% CI 1.06-5.07) risk of hepatocellular carcinoma compared with CC genotype, and GG genotype had a 3.12-fold (95% CI 1.66-10.07) risk of hepatocellular carcinoma compared with CC genotype; CG+GG genotype had a 1.91-fold (95% CI 1.85-3.38) compared with CC genotype, GG genotype had a 1.54-fold (95% CI 1.15-6.08) compared with CG+GG genotype. The increasing risk of hepatocellular carcinoma by miR-146a gene polymorphisms was not found in hepatocellular carcinoma patients with hepatitis C virus (HCV) infection or without HBV and HCV infection. Spearman correlation analysis showed that miR-146a gene polymorphisms was not related with age, gender, smoking, drinking, family history of cancer, alanine transaminase and aspartate aminotransferase (all P>0.05). Conclusions:GG and CG genotypes of miR-146a increase the risk of genetic susceptibility in hepatocellular carcinoma, especially for patients with HBV infection. miR-196a2 and miR-499 single nucleotide polymorphisms don't increase the risk of hepatocellular carcinoma.
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Objective:To analyze and compare difference of ultrasonic blood flow of left internal mammary artery(LIMA) and right internal mammary artery(RIMA)as graft to left anterior descending artery(LAD) in patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods:From October 2017 to October 2019, a total of 363 patients who underwent OPCAB including 329 patients in LIMA-LAD group and 34 patients in RIMA-LAD group, were included in this study. Transthoracic ultrasound examination on IMA was performed before OPCABG. The blood flow , the value of PI(pulsation index) and diastolic flow(DF) of LIMA and RIMA to left anterior descending were measured and recorded by intraoperative TTFM. Patients underwent coronary artery CT examinations at 1 week after OPCABG to discover the patency of grafts.Results:The pre-operative diameter of RIMA was larger and the blood flow and pulsation index of RIMA was better than that of LIMA before OPCABG( P<0.001). But there was no significant difference in the flow, pulsation index and DF value of graft between the two groups after IMA were anastomosed to LAD( P>0.05). In situ skeletonized graft of RIMA did not show the advantage of increased blood flow. Compared with the preoperative parameters of flow of internal mammary artery, both the left and right grafts of IMA were significantly better in blood flow and pulsation index( P<0.001). Considering the remarkable difference in age between the two groups, Flow, PI and DF were compared again after propensity score matching, and there was still no statistical difference between the two groups( P>0.05). A total of 313 patients in LIMA-LAD group completed coronary CTA examination one week after surgery, among which 4 grafts had different degrees of problems. A total of 34 patients in RIMA-LAD group completed coronary CTA examination, one case indicated that the CTA imaging in distal segment was not clear, and the other results had no obvious abnormality. There was no significant difference in postoperative rate of coronary CTA completion( P=0.381) and rate of graft failure( P=0.405) between the two groups. Conclusion:Compared with the preoperative parameters of blood flow of internal mammary artery, both the left and right IMA grafts are significantly better in flow and pulsation index. The pre-operative diameter of RIMA is larger and the blood flow and pulsation index of RIMA is better than that of LIMA before OPCABG. But there is no significant difference in the flow, pulsation index and DF value of graft between the two groups after IMA are anastomosed to LAD. In situ skeletonized graft of RIMA do not show the advantage of increased blood flow.
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Objective:To explore the relationship between residual collateral vessels in uterine arterial embolization (UAE) and the risk of bleeding during the operation of curettage for cesarean scar pregnancy.Methods:A total of 499 patients who underwent preventive UAE before curettage for scar pregnancy in Shandong Provincial Hospital from January 2012 to June 2019 were included. Clinical data of the patients were retrospectively collected and analyzed. In patients with uterine collateral circulation, collateral vessels were embolized as much as possible. Angiography was performed after UAE. All the cases were divided into 3 grades according to residual staining in middle and lower part of corpus uteri as follows, grade A: no or mild staining, grade B: moderate staining, grade C: intense staining. Blood loss of the patients during curettage was recorded, and the incidence rate of minor hemorrhage (<50 ml) and massive hemorrhage (>500 ml) of the 3 grades were calculated respectively. The results of three grades groups were compared with those of control group (patients without collateral circulation) by using Chi-square test or Fischer exact probability.Results:According to angiogram acquired after UAE, collateral vessels were found in 53 patients, with 25 cases in grade A group, 15 cases in grade B group, and 13 cases in grade C group, respectively. Thirty-six patients underwent transcatheter embolization of collateral vessels. The incidence rate of minor hemorrhage in type B and C [60.0% (9/15), 46.2% (6/13)] was lower than that in control group (87.9%, 392/446), with significant difference found (χ2=9.972, P=0.002, χ2=19.090, P<0.001). Significant difference was found in the incidence rate of massive haemorrhage between group C (23.1%, 3/13) and control group (2.2%, 9/446) (χ2=14.480, P=0.001). Conclusion:As for cesarean scar pregnancy cases with uterine collateral vessels, embolization of collateral vessels may reduce the amounts of bleeding during curettage. Residual staining of middle and lower part of corpus uteri may be helpful in predicting the risk of massive haemorrhage during curettage.
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The scalpel is the most practical tool for surgeons. The traditional scalpel is a blade with a split handle, but the length of the blade cannot be adjusted, and it is easy to scratch medical staff. In order to solve the above problems, a retractable scalpel handle was designed by the medical staffs of department of general surgery, Affiliated Hospital of Yangzhou University (Clinical Teaching Hospital of Dalian Medical University), and obtained the National Utility Model Patent of China (ZL 2019 2 0203154.9). The telescopic scalpel adopted the design of rotary telescopic sleeve and threaded column handle to achieve the purpose of built-in blade. By rotating the handle at one end of the handle, the length of the surgical blade extending out of the sleeve could be adjusted according to the actual needs. The structure of the device is simple and easy to operate. The adjustable blade length could also achieve the purpose of accurate operation while effectively avoiding the injury of medical personnel during the operation.
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Objective:To observate the changing trend of flow of in-situ bilateral internal mammary artery as grafts during perioperative period in patients undergoing coronary artery bypass grafting(CABG), and to compare the parameters of flow between LIMA and RIMA.Methods:A total of 57 patients , 50 males and 7 femails, mean aged(57.8±10.1) years, underwent bilateral IMA CABG in our hospital from August 2016 to January 2019. Transthoracic ultrasound of IMA examination was performed before CABG. The blood flow, the PI(pulsation index) and other parameters were measured and recorded by intraoperative TTFM.Results:There was no significant difference of the average diameter and PI between LIMA and RIMA, but the preoperative flow of RIMA is higher( P=0.026) in our study. There was no significant difference of the average flow and PI between LIMA and RIMA recorded by TTFM( P>0.05), but the higher diastolic flow(DF) in LIMA grafts( P=0.022) compared with RIMA grafts may be associated with the different target sites( P<0.05). Compared with the preoperative flow and PI of IMA, the intraoperative flow and PI of both LIMA and RIMA grafts were better( P<0.001). Conclusion:Compared with the preoperative flow of IMA, both flow of LIMA and RIMA are better. In spite of the targets exist difference , there are no significant difference of the average flow and PI between LIMA graft and RIMA graft recorded by TTFM.
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Objective To observe the value of cone-beam CT (CBCT) for identifying whether the suspected responsibility artery found with DSA was the real responsibility artery of massive hemoptysis during emergent arterial embolization. Methods Data of 31 patients with massive hemoptysis underwent emergent arterial embolization were retrospectively analyzed. CBCT was used for qualitative diagnosis of suspected responsibility artery found with DSA. According to whether it was the feeding vessel of the target lesion in lung on CBCT image, the responsibility artery of massive hemoptysis was determined. Embolization was performed on the definite responsibility artery and the indefinite feeding vessel judged with CBCT, while the irresponsible artery judged with CBCT was not embolized. Results In 31 patients, haemoptysis was stopped within 24 h after emergent arterial embolization. There were 37 suspected responsibility arteries found with DSA. A total of 34 (34/37, 91.89%) suspected responsibility arteries in 29 (29/31, 93.55%) patients were definitely judged whether they were responsibility arteries of massive hemoptysis or not with CBCT, including 11 (11/37, 29.73%) of definite responsibility arteries and 23 (23/37, 62.16%) of irresponsible arteries. The other 3 (3/37, 8.11%) suspected responsibility arteries in 2 (2/31, 6.45%) patients were indefinite feeding vessels judged with CBCT which were difficult to determined whether they were responsibility arteries or not. Conclusion CBCT is useful to determine whether a suspected responsibility artery is the real responsibility artery of massive hemoptysis during emergent arterial embolization.
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Objective To evaluate the effects of sevoflurane on microglial polarization after traumatic brain injury (TBI) in rats.Methods Seventy-two healthy adult male Sprague-Dawley rats,weighing 230-250 g,were divided into 3 groups (n=24 each) using a random number table method:sham operation group (group Sham),group TBI,and TBI plus sevoflurane anesthesia group (group TBI+Sevo).TBI models were established by using Feeney's method in TBI and TBI+Sevo groups,30 min later 2.4％sevoflurane was inhaled for 1 h once a day for 3 consecutive days in TBI+Sevo group,while pure oxygen was inhaled instead in Sham and TBI groups.At 1,3,7 and 14 days after establishing the model,6 rats were selected,the neurological function was evaluated with the modified neurologic severity score (mNSS),and tail venous blood samples were taken for determination of tumor necrosis factor-a (TNF-α),interleukin-1beta (IL-1β) and IL-6 concentrations by enzyme-linked immunosorbent assay.The rats were then sacrificed,the limbic cortical tissues of brain contusion lesion were taken for determination of cell apoptosis (by TUNEL) and expression of microglial marker lba-1,microglial M1 phenotypic marker CD86 and microglial M2 phenotypic marker CD206 (by Western blot).Results Compared with group Sham,the mNSS score,apoptosis rate of cortical cells,expression of Iba-1,CD86 and CD206,and concentrations of serum TNF-α,IL-1β and IL-6 were significantly increased in TBI and TBI+Sevo groups (P＜0.05).Compared with TBI group,the mNSS score,apoptosis rate of cortical cells,expression of Iba-1 and CD86 and concentrations of serum TNF-α,IL-1β and IL-6 were significantly decreased,and the expression of CD206 was up-regulated in TBI+Sevo group (P＜0.05).Conclusion The mechanism by which sevoflurane anesthesia reduces TBI may be related to promoting microglial polarization and inhibiting systemic inflammatory response in rats.
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Objective@#To evaluate the effects of sevoflurane on microglial polarization after traumatic brain injury (TBI) in rats.@*Methods@#Seventy-two healthy adult male Sprague-Dawley rats, weighing 230-250 g, were divided into 3 groups (n=24 each) using a random number table method: sham operation group (group Sham), group TBI, and TBI plus sevoflurane anesthesia group (group TBI+ Sevo). TBI models were established by using Feeney′s method in TBI and TBI+ Sevo groups, 30 min later 2.4% sevoflurane was inhaled for 1 h once a day for 3 consecutive days in TBI+ Sevo group, while pure oxygen was inhaled instead in Sham and TBI groups.At 1, 3, 7 and 14 days after establishing the model, 6 rats were selected, the neurological function was evaluated with the modified neurologic severity score (mNSS), and tail venous blood samples were taken for determination of tumor necrosis factor-a (TNF-α), interleukin-1beta (IL-1β) and IL-6 concentrations by enzyme-linked immunosorbent assay.The rats were then sacrificed, the limbic cortical tissues of brain contusion lesion were taken for determination of cell apoptosis (by TUNEL) and expression of microglial marker Iba-1, microglial M1 phenotypic marker CD86 and microglial M2 phenotypic marker CD206 (by Western blot).@*Results@#Compared with group Sham, the mNSS score, apoptosis rate of cortical cells, expression of Iba-1, CD86 and CD206, and concentrations of serum TNF-α, IL-1β and IL-6 were significantly increased in TBI and TBI+ Sevo groups (P<0.05). Compared with TBI group, the mNSS score, apoptosis rate of cortical cells, expression of Iba-1 and CD86 and concentrations of serum TNF-α, IL-1β and IL-6 were significantly decreased, and the expression of CD206 was up-regulated in TBI+ Sevo group (P<0.05).@*Conclusion@#The mechanism by which sevoflurane anesthesia reduces TBI may be related to promoting microglial polarization and inhibiting systemic inflammatory response in rats.
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Objective Toexplorethevalueofdualvolumereconstructionininterventionalembolizationofwideneckedintracranial aneurysms.Methods Theclinicalandimagingdataof30patientswithintracranialwideneckaneurysmrupturedwerecollectedfrom June2016toDecember2017intheMeizhouPeople’sHospital.Thetreatmentoftheintracranialwideneckedaneurysm,theposition andopeningofthestentreleasing,therelatedcomplications,andfollow-upreviewafter6monthswereretrospectivelyanalyzed.Results Ofthe30patients,therewere35aneurysms(4 multipleaneurysms),inwhich26caseswerestentsassisted,with26stentsimplanted, and4caseswereballoonassisted.3D-DSAwasperformedimmediatelyafteroperationandevaluatedbydualvolumereconstructionon AdvantageWorkstation (AW)postprocessing workstation.(1)26casesofdenseembolism ofaneurysmswithouttumorneckor tumorresidual(86.7%),3casesofaneurysmcervicalresidual(10%)and1casesoftumorresidual(0.33%);(2)26stentswithaccurate locationsandcompletereleases(100%).(3)2caseswithvasospasmandstentthrombosisduringoperation,and1casewithsecond aneurysmruptureduringoperation.(4)DSAreexaminationsinhalfayearafteroperations:3casesrecurred (11.5%)inthe26cases ofdenseembolism;theresidualin2casesincreasedin4ofaneurysmalneckresidualand2oftumorresidual,andtherestremained;26stentsstayedinthesamepositionandthestentsin3caseswerenarrowed.2D-DSA,3D-DSAanddualvolumereconstructioncould clearlyshowthedegreeofembolizationofaneurysmsin20cases(66.7%),25cases(83.3%)and30cases(100%),respectively.The degreeofembolizationofaneurysmswassignificantlydifferentinthreeimagingmethods(P＜0.05).Conclusion Intheprocessof interventionalembolizationforintracranialwideneckedaneurysm, doublevolumereconstructioncanbeusedtoshowtheeffectof embolization,thelocationofthestentandtherelationshipwith theneckoftheaneurysm,whichprovidesanassessmentofthe situationofaneurysmembolism,thedevelopmentoftheauxiliarystentandtheobjectivefortheselectionofthesurgicalstrategy.
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A multi-label based level set model for multiple sclerosis lesion segmentation is proposed based on the shape, position and other information of lesions from magnetic resonance image. First, fuzzy c-means model is applied to extract the initial lesion region. Second, an intensity prior information term and a label fusion term are constructed using intensity information of the initial lesion region, the above two terms are integrated into a region-based level set model. The final lesion segmentation is achieved by evolving the level set contour. The experimental results show that the proposed method can accurately and robustly extract brain lesions from magnetic resonance images. The proposed method helps to reduce the work of radiologists significantly, which is useful in clinical application.
Subject(s)
Humans , Algorithms , Magnetic Resonance Imaging , Multiple Sclerosis , Diagnostic ImagingABSTRACT
Objective To explore the guiding role of double volume reconstruction (DVRT) in interventional embolization of intracranial aneurysms. Methods Ninety?six cases of subarachnoid hemorrhage with 115 aneurysms underwent total cerebrovascular angiography and interventional endovascular embolization of intracranial aneurysms in our hospital from January 2017 to December 2017 were retrospectively analyzed. They were randomly divided into observation group (n=48) and control group (n=48) according to random number method. In the control group, guided by the results of 2D?DSA and 3D?DSA 3D reconstruction, the aneurysm neck and tumor were fully exposed with the optimal position. the responsible aneurysms were performed with the interventional endovascular embolization. The operators finished the embolization According to the size and shape of aneurysms and the operative experience. In the observation group, the operators could speculate the embolization density of aneurysms by using the data of 3D reconstruction and digital subtraction reconstruction and adjusted the surgical plan to make the aneurysms had been completely embolized. The baseline data, treatment status, adverse cerebrovascular reaction and recurrence rate of aneurysms were compared between the two groups. All patients in the two groups were operated by Deputy chief surgeons or above of the neurosurgery department. The comparison of the counting data were tested by χ2. The measured data conformed to normal distribution were tested by independent sample t. Results Statistically, There was no significant differences in baseline data including sex, age, blood glucose, blood pressure and cerebral atherosclerosis between the two groups (P>0.05). Comparing the responsible aneurysms in different positions and sizes, the differences was not statistically significant (P>0.05).There was no statistically significant differences in the dosage of contrast media and the cost of operation between the two groups (P>0.05). The radiation dose and operation time in the observation group were smaller and shorter than those in the control group, but there was no statistical differences between the two groups (P<0.05). Statistically, The incidence of rerupture of aneurysm and thrombosis in the observation group was significantly lower than that in the control group (P<0.05). and The incidence of cerebral infarction and the recurrence rate of aneurysm in the observation group were significantly lower than those in the control group (P<0.05). There was no significant difference in sex, age, blood glucose, blood pressure and cerebral atherosclerosis between the two groups (P>0.05).There was no significant difference in the location and size of responsible arterial tumors (χ2=0.148, P=0.929).There was no significant difference in the dosage of contrast agent and the cost of operation between the two groups (t=-0.769, 0.225; P>0.05). The radiation dose and operation time were (479.81 ± 51.21)mGy, (103.52 ± 10.18) minin the observation group and (511.95 ± 53.26)mGy, (114.60 ± 9.51)min in the control group. The difference was statistically significant (t=-1.376,-2.516; P<0.05).There were 1 case of rerupture of aneurysm in the observation group, 4 cases in the control group;There were 0 cases of thrombus, respectively, 3 cases in the control group. The difference was statistically significant (χ2=11.748, 4.256; P<0.05).There were 0 cases postoperative cerebral infarction occurred in the observation group, and aneurysm recurrence in 1 case. Four cases postoperative cerebral infarction occurred in the control group, and aneurysm recurrence in 3 cases, respectively. The difference was statistically significant (χ2=5.719, 10.811; P<0.05). Conclusions The clinical effect of interventional embolization of intracranial aneurysms under the guidance of double volume reconstruction is remarkable, and the effect of interventional embolization and the relationship with the peripheral vessels can be clearly demonstrated. It can reduce the incidence of adverse cerebral vascular reactions and the recurrence rate of aneurysms and reduce the intraoperative risk. It is worthy to be popularized in interventional embolization of intracranial aneurysms and follow?up after operation.
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Objective To evaluate the effectiveness and safety of prostatic arterial embolization as a primary treatment for patients with lower urinary tract symptoms as a result of large benign prostatic hyperplasia.Methods This was a prospective,single-center study enrolling 64 patients with prostates>80 ml from January 2010 to December 2013.Prostatic arterial embolization was carried out using a combination of 50 μm and 100 μm particles.Clinical follow up was carried out using the International Prostate Symptom Score, quality of life, peak urinary flow, postvoid residual volume, International Index of Erectile Function Short Form, prostate-specific antigen, and prostatic volume at 1, 3, 6 month following embolization, the parameters were compared by using t test. Results Prostatic arterial embolization was technically successful in 60 of 64 patients (93.8%). Follow-up data were available for 60 patients with a mean of 18 months,a total of 42 patients had completed the follow up at 24 months after prostatic arterial embolization. A clinical improvement,defined as reduction of International Prostate Symptom Score and increase of peak urinary flow, at 1 month, 3 months, 6 months, 12 months and 24 months, was achieved in 95.0%(57/60), 95.0%(57/60),93.3%(56/60),92.6%(50/54) and 90.5%(38/42), respectively. There was an improvement in terms of mean International Prostate Symptom Score, mean quality of life, mean peak urinary flow, mean post-void residual volume and prostatic volume were significantly different with respect to baseline(all P<0.05).No serious complications occurred.Conclusion Prostatic arterial embolization appears to be a safe and effective treatment method for patients with lower urinary tract symptoms as a result of large benign prostatic hyperplasia.
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Objective To investigate the application of 3D-printing and digital technology in the preoperative design of internal fixation for intra-articular calcaneal fractures.Methods Thin-layer CT images of bilateral calcanei were collected from 12 patients who had been treated for calcaneal fracture of Sanders type Ⅲ from November 2015 to October 2016.They were 7 men and 5 women,aged from 23 to 53 years (average,38.7 years).The images were uploaded into Mimics software for 3D reconstruction,virtual reduction and digital surgical design.Real-size calcaneal models and navigation modules were produced using 3D printing technology for plate preshaping and surgical simulation.The operations were carried out according to preoperative design.The postoperative calcaneal morphological parameters were evaluated.Comparisons were made between postoperative results and preoperative digital design.Results The operating time for the 12 patients ranged from 60 to 90 minutes,averaging 77.9 minutes.Their follow-ups ranged from 4 to 8 months,averaging 6.2 months.No complications affecting their soft tissues happened.The postoperative B(o)hler angle (32.6° ± 3.6°) and Gissane angle (123.9° ± 9.5°) were significantly improved compared with the preoperative values (12.4° ± 2.1° and 143.9° ± 7.8°) (P ＜ 0.001).The shape of postoperative calcaneus was similar to that of the preoperative reduction model.The internal fixation locations and nail directions were in agreement with the preoperative design.Their average Maryland score was 87.8 and excellent to good rate 91.7％.Conclusion This technique can transform a digital design for intra-articular calcanealfracture into real operation tools to help realize a precise surgical design for such fractures.
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In this study, the rapid resolution liquid chromatography-quadrupole time-of-flight mass spectrometry (RRLC-QTOF/MS) was used to profile the metabolites of urine samples from chronic heart failure (CHF) patients and healthy controls to find the differential metabolites which could provide the scientific evidence to explain the pathogenesis of the disease and supply a better therapy plan.Urine samples from 15 CHF patients (age (62.27±3.14) years) and 15 healthy controls (age (65.41±4.63) years) were analyzed by RRLC-QTOF/MS.After processing the data, the multivariate statistical analysis (principal component analysis, PCA) was performed to find the potential biomarkers.Result showed that urine samples of CHF patients were successfully distinguished from those of healthy controls.Two significantly differentially expressed metabolites, uridine and alanyltryptophan, were found and identified as potential biomarkers.The result showed that the LC-MS based metabolomics approach had good performance to identify potential biomarkers, and the disorder of uracil metabolism and Tryptophan metabolism may play an important role in the mechanism of CHF.
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Objective To compare the clinical outcomes between two different femur rotating osteotomy methods for kneeling ability recovery after total knee arthroplasty (TKA).Methods From January 2012 to December 2014,88 patients underwent TKA were selected for a retrospective study and were divided into two groups based on the methods to determine femoral rotation.Forty-eight patients were in measured resection group,while 40 patients in gap balancing group.The patients in both groups underwent fixed-bearing tibia prosthesis.There were no statistical significance between the two groups in gender,age,BMI and knee varus angle (P＞0.05).The knee varus angle,ROM,Oxford knee score (OKS) and American Knee Society (KSS) knee score were collected to assess malformation correction,kneeling ability and functions at pre-operation,one and two years postoperatively.Results The operation duration and blood loss in measured resection group were 80±19 min and 348±121 ml,while these data in gap balancing group were 82±23 min and 315 ± 100 ml respectively (P＞0.05).Patients in measured resection group were followed up 24-59 months (mean 43± 11 months),while the followed-up duration in gap balancing group was 25-58 months (mean 47±10 months).No major complications such as infection loosen and instability were occurred.Varus angles in measured resection group at postoperative 1 year and 2 year postoperative were 1.2°±0.4° and 1.0°±0.2° respectively,while those in gap balancing group were 0.9°±0.2° and 0.8°±0.3° (P＞0.05).The scores of the seventh item of OKS in measured resection group at 1 year and 2year follow-ups were 2.79±1.02 and 2.75± 1.03 respectively,while those in the gap balancing group were 1.90±0.85 and 1.80±0.83 (P＜0.01).ROM in the measured resection group at 1 year and 2 year postoperative were 102.08°± 15.60° and 102.08°±15.60° respectively,while those in the gap balancing group were 112.50°±18.32° and 113.00°±18.09° (P＜0.05).KSS in measured resection group at postoperative 1 year and 2 years were 154.63±31.12 and 154.63±31.26 respectively,while those in the gap balancing group were 170.55±22.67 and 173.45±22.52 (P＜0.05).Conclusion The method of measured resection and gap balancing to confirm femoral rotation during TKA can both achieve favorable kneeling ability and clinical outcomes,while gap balancing show superiority on kneeling ability recovery,ROM and clinical outcomes at 2-year postoperative improvement.
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Objective To investigate the application of 3D-printing and digital technology in the preoperative design of internal fixation for intra-articular calcaneal fractures.Methods Thin-layer CT images of bilateral calcanei were collected from 12 patients who had been treated for calcaneal fracture of Sanders type Ⅲ from November 2015 to October 2016.They were 7 men and 5 women,aged from 23 to 53 years (average,38.7 years).The images were uploaded into Mimics software for 3D reconstruction,virtual reduction and digital surgical design.Real-size calcaneal models and navigation modules were produced using 3D printing technology for plate preshaping and surgical simulation.The operations were carried out according to preoperative design.The postoperative calcaneal morphological parameters were evaluated.Comparisons were made between postoperative results and preoperative digital design.Results The operating time for the 12 patients ranged from 60 to 90 minutes,averaging 77.9 minutes.Their follow-ups ranged from 4 to 8 months,averaging 6.2 months.No complications affecting their soft tissues happened.The postoperative B(o)hler angle (32.6° ± 3.6°) and Gissane angle (123.9° ± 9.5°) were significantly improved compared with the preoperative values (12.4° ± 2.1° and 143.9° ± 7.8°) (P ＜ 0.001).The shape of postoperative calcaneus was similar to that of the preoperative reduction model.The internal fixation locations and nail directions were in agreement with the preoperative design.Their average Maryland score was 87.8 and excellent to good rate 91.7％.Conclusion This technique can transform a digital design for intra-articular calcanealfracture into real operation tools to help realize a precise surgical design for such fractures.
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BACKGROUND:On CT reconstruction of three-dimensional (3D) model, fracture virtual reduction and internal fixation cannot be achieved, and reasonable operation scheme cannot be formulated. Digital design can fuly meet the needs of clinical orthopedics physicians. Standard parts database can provide the possibility to choose the ideal internal fixation. 3D printing makes the reasonable operation scheme accurate in clinical implementation. OBJECTIVE:To discuss the feasibility, accuracy and minimal invasion of internal fixation in treatment of the distal femoral fracture with digital design of standard parts database by 3D printing. METHODS: (1) Nine adult lower extremity specimens were selected to take continuously thin-layer CT scanning. After Dicom images were imported into the mimics software, the model was established. According to the AO classification, they were classified into A1-3, B1-3 and C1-3 types of distal femoral fracture by virtual design. Internal fixation with plate and screw formed standard parts database virtualy. It was printed out the pilot hole of the navigation module design by three-dimensional printing forming technique. Plate and screw were inserted assisted by the module. X-ray and CT scan were taken postoperatively to access the position. (2) 30 patients with distal femoral fracture were subjected to above fixation. The operation time, intraoperative blood loss and postoperative drainage were recorded. Imaging and curative effects were evaluated during folow-up. RESULTS AND CONCLUSION: (1) Nine samples underwent X-ray and CT scan. 3D reconstruction results revealed plate position, screw entry point, nail direction, length and diameter were consistent with presetting data in Mimics software. The navigation models were designed to fit the lateral bony structure of distal femur. There were good fitting degree, good card position and good stability when the navigation was applied. It could guide plant and screw implantation. (2) In 30 cases, the operation time was (104.63±26.12) minutes, intraoperative blood loss was (121.74±11.49) mL, and postoperative drainage volume was (30.29±6.38) mL. Al patients were folowed up. According to Schagzker criterion, the efficiency of 22 cases was excelent, 6 cases good and 2 cases average, and the excelent and good rate was 93%. The parameters of length, diameter, orientation and angle were consistent with that preoperatively. (3) Internal fixation formed by standard parts database assisted by 3D printing navigation model has advantages of high accuracy, short process, lessened blood loss, high safety, less complications, and precise fixation. Digital design of standard parts database via3D printing navigation module is expected to achieve implant navigation and application.