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@#Objective To evaluate the data of preoperative aortic root CT angiography (CTA), compare it with two-dimensional transthoracic echocardiography and investigate the correlation of the two measurements with the actual intraoperative measurement data. Methods Clinical data of 53 patients with aortic valve diseases who underwent aortic valve repair in our hospital from January 2018 to August 2020 were retrospectively analyzed, including 38 males and 15 females with an average age of 42.9±18.3 years ranging from 10 to 77 years. Preoperative two-dimensional transthoracic echocardiography (TTE) and aortic root CTA measurements were collected, including aortic valve annulus (AVA), aortic sinus (Sinus) and sino-tubular junction (STJ). In comparison with the intraoperative measurements during the aortic valve repair surgery, the consistency analysis was performed. Results Both the preoperative echocardiography AVA measurements and the CT AVA measurements were positively correlated with the intraoperative AVA measurements (P<0.001). Compared with the echocardiography AVA data [correlation coefficient (ρ)=0.74, mean squared error (MSE)=12.78], the CT AVA data were more accurate and consistent with the intraoperative AVA measurements (ρ=0.95, MSE=2.72). CT AVA data had a higher correlation coefficient with the intraoperative measurements, compared to that of the echocardiography AVA data (P<0.001). Conclusion In comparison with two-dimensional transthoracic echocardiography, preoperative morphological evaluation of aortic root CTA is more consistent with the actual intraoperative measurements during aortic valve repair surgery.
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Objective:To evaluate the cognitive function of elderly inpatients in Qinghai and analyze the influencing factors in this prospective study.Methods:A total of 1077 elderly inpatients were enrolled for general information investigation, including the Mini Nutritional Assessment-Short form(MNA-SF), Geriatric Depression Scale 15(GDS-15), FRAIL Scale, activities of daily living(ADL), instrumental ability of daily living(IADL)and the Mini-Mental State Examination(MMSE).Results:The 1077 elderly inpatients being subjected in this study, included 470 in the cognitive impairment(CI)group and 607 in the normal group.The prevalence of CI in hospitalized elderly patients was 43.64%(470/1077). The results of univariate analysis showed that as compared with the normal group, the proportion of cognitive impairment was higher in female, elder patients, and boiling tea-drinker, otherwise the proportion of CI was lower in patients living with the spouse, normal sleep, often eating beef and mutton( P<0.01 or P<0.05); FRAIL Scale, ADL total score, and IADL total score were higher in the normal group than in the CI group( P<0.01); the elderly depression score and frailty score were higher in the CI group than in the normal group( P<0.01). The results of logistic regression analysis showed that the risk of CI was higher in female and people frequently drinking boiling tea than in male and people not frequently drinking boiling tea( OR=0.740, 1.211, both P<0.05), and that frequent consumption of beef and mutton, and reasonable levels of nutrition, ADL, and IADL were protective factors for CI in elderly hospitalized patients( OR=0.780, 0.938, 0.956, 0.895, all P<0.05). Conclusions:The incidence of cognitive impairment in hospitalized elderly patients in Qinghai is relatively high.Female and often drinking boiling tea may increase the risk of cognitive impairment.Regularly eating beef and mutton, reasonable levels of nutrition, maintaining good daily life ability can delay cognitive impairment.
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Objective:To investigate the prevalence of mild cognitive impairment(MCI)in elderly inpatients in high altitude areas, analyze the influencing factors, and then construct a risk factor model.Methods:A cross-sectional random sampling method was used to conduct a questionnaire survey among elderly patients over 65 years old hospitalized at Qinghai Provincial People's Hospital from October 2018 to February 2019.The survey contents included demographic data, lifestyles, physical activities and cognitive function.The occurrence of MCI was analyzed with descriptive epidemiological measures, a predictive model of influencing factors was established using Logistic regression analysis, and influencing factors were ranked.Results:There were a total of 1412 elderly people aged 65 and above, with 760 males, accounting for 53.8%.The ages of respondents ranged between 65-82 years, with an average age of(72.8±5.8)years.Of the subjects, 600 had MCI, with a prevalence of 42.4%.Male( OR=1.318, P=0.02), junior high school education or above( OR=0.521, P<0.001), bedriddenness( OR=2.658, P=0.002), lifestyle( OR=0.702, P=0.011), abnormal defecation( OR=1.625, P=0.005)and frailty( OR=1.536, P=0.002)were included into the predictive model of influencing factors.The area under the ROC curve in this study was 0.676(95% CI: 0.648-0.704), with sensitivity=0.553, specificity=0.741, and Youden index=0.274.When ordered by importance, the independent risk factors were frailty, male, abnormal defecation, bedriddenness, lifestyle, and education level. Conclusions:Male, frailty, abnormal defecation and long-term bedriddenness are risk factors for cognitive impairment in elderly people, whereas living with a partner and education above junior high school are protective factors.
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Objective:To compare the short-term therapeutic effects of Gamma 3 U-Blade system and Gamma 3 nails in the treatment of elderly patients with osteoporotic unstable intertrochanteric fracture.Methods:The data of 70 elderly patients with osteoporotic unstable intertrochanteric fracture were retrospectively analyzed who had been admitted to the Department of Orthopedics, Wuhan Fourth Hospital from June 2018 to December 2020. They were divided into 2 groups according to their treatments. In the U-Blade group of 35 cases subjected to fixation with Gamma 3 U-Blade system, there were 14 males and 21 females with an age of (77.7 ± 4.8) years; in the Gamma 3 nail group of 35 cases subjected to fixation with Gamma 3 nails, there were 14 males and 21 females with an age of (79.3 ± 5.2) years. The 2 groups were compared in terms of operation time, intraoperative blood loss, apex distance, fracture union time, postoperative complications, timed up and go (TUG) at postoperative 2 weeks, 3 months and 6 months, and hip function at postoperative 9 months.Results:There was no statistically significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There was no significant difference either in operation time, intraoperative blood loss or apex distance between the 2 groups ( P>0.05). The fracture union time [(12.0 ± 0.2) weeks] and Harris hip score at postoperative 9 months [90 (90, 91)] in the U-Blade group were insignificantly different from those in the Gamma 3 nail group [(12.0 ± 0.3) weeks and 91 (89, 91)] ( P>0.05). The rate of implant-related complications in the U-Blade group [0% (0/35)] was significantly lower than that in the Gamma 3 nail group [17.1% (6/35)] and the TUGs at postoperative 2 weeks and 3 months [(80.2 ± 3.6) s and 45 (43, 49) s] in the former were significantly shorter than those in the latter [(89.3 ± 4.2) s and 56 (54, 59) s] ( P<0.05). Conclusion:In the treatment of elderly patients with osteoporotic unstable intertrochanteric fracture, compared with traditional Gamma 3 nails, Gamma 3 U-Blade system can reduce implant-related complications and facilitate early recovery of walking ability.
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Objective:To investigate the clinical efficacy of 3D printed osteotomy guide plate combined with "Jail" screw technique in the treatment of tibial plateau fractures involving external posterior condylar collapse.Methods:From January 2016 to January 2021, 41 patients (22 males and 19 females) with tibial plateau fractures involving external posterior condylar collapse were treated with 3D printed osteotomy guide plate combined with "Jail" screw technique and followed up. The age was 47.4±11.5 years (range, 22-69 years). According to Schatzker fracture type, 18 cases were type IV, 14 cases were type V and 9 cases were type VI. All fractures were closed, and 12 of them were complicated with lateral meniscus injury, but none of them were complicated with nerve and vascular injury. The time from injury to operation was 7.2±3.4 d (range, 4-17 d). All patients underwent 3D CT scanning and digital modeling before operation. According to the modeling results, a 1∶1 solid size fracture model was made by 3D printing, and the osteotomy guide plate and the "Jail" screw preset guide plate were designed. During the operation, the tibial lateral condyle osteotomy was performed with customized osteotomy guide plate. After reduction, the fixation of the fracture was performed with the preset guide plate using "Jail" screw. Postoperative fracture reduction was evaluated according to Rasmussen score, and knee function was evaluated by Hospital for Special Surgery (HSS) score.Results:All the 41 patients were followed up for 15.2±5.8 months (range, 6-26 months). Immediate postoperative radiographs showed good fracture reduction, and the average healing time was 14.1±1.2 weeks (range, 12-17 weeks). One year after operation, the Rasmussen score of knee joint was 17.4±1.6 points (range, 13-19 points), of which 31 cases were excellent, 8 cases were good, and 2 cases were fair, with an excellent/good rate of 95% (39/41). HSS scores was 87.3±5.6 points (range, 68-95 points), including 30 excellent cases, 10 good cases and 1 fair case, with an excellent/good rate of 98% (40/41). The range of motion of knee joint was 126.8°±3.8°. At the last follow-up, no serious complications such as common peroneal nerve injury, popliteal vascular injury, postoperative infection, or internal fixation failure occurred.Conclusion:3D printed osteotomy guide plate combined with "Jail" nail placement technique is an effective method for tibial plateau fractures involving external posterior condylar collapse, and the postoperative treatment results are satisfactory. The use of customized osteotomy guide plate is more accurate and less damaging. The use of "Jail" screw preset guide plate can ensure more accurate screw placement.
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Interprofessional education (IPE) is of great importance to the cultivation of medical students, which can improve their ability of team cooperation in medical work in the future and can also improve the treatment experience of patients. This paper focuses on the general situation of the development of medical IPE and organizational forms, capacity building framework, curriculum development, influencing factors, teaching evaluation, existing problems, and enlightenments on the development of medical IPE in China.
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@#AIM: To observe the characteristics of the dominant eye in the progression of myopia in the proportion and gender distribution of the left eye and the right eye in the dominant eye, the difference in the degree and growth rate of myopia between the dominant eye and the non-dominant eye during the progression of myopia in adolescents.<p>METHODS: In this prospective study, we selected 235 cases of 7-17 years old adolescents with myopia who were treated in our hospital from February to May 2020. The ocular structure was examined to exclude various eye diseases, and the dominant eye(card hole method)was determined and cycloplegic optometry was performed. They were all corrected by wearing monofocal glasses, and the dominant eye(card hole method)and cycloplegic optometry were retested after 1a.<p>RESULTS: Among the subjects, 159 cases were right eyes, accounting for 67.7%, and 76 cases were left eyes, accounting for 32.3%; There was no significant difference in gender distribution between dominant eyes and non-dominant eyes(<i>P</i>>0.05); There was no significant difference in spherical equivalent degree between dominant and non-dominant eyes(<i>P</i>>0.05); There was no significant difference in the degree of myopia growth between dominant and non-dominant eyes(<i>P</i>>0.05); There was no significant difference in the increase of myopia and the increase of myopia between the two eyes whether the right eye was dominant or the left eye was non-dominant(<i>P</i>>0.05); There was a significant correlation between the degree of myopia growth in the dominant eye and in both eyes(<i>P</i><0.01).<p>CONCLUSION: In myopic adolescents, most of the dominant eyes were right eye, and there was no difference between dominant eye and gender; Dominant eyes showed no specificity in the degree and growth of myopia, the dominant eye type do not affect the degree of myopia growth and the degree of anisometropia, but the degree of dominant myopia growth may affect the degree of anisometropia in both eyes.
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Objective:To explore the potential synergistic protective mechanism of Glycyrrhizae Radix et Rhizoma-Granati Pericarpium formula compound by using the methods and tools of network pharmacology，and provide a basis for the modernization of traditional Chinese medicine（TCM） compounds and the discovery of new drugs. Method:Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP） was used to obtain the active components of Glycyrrhizae Radix et Rhizoma-Granati Pericarpium formula and their corresponding targets. The obtained targets were input to the UniProt database to inquire the gene names corresponding to the targets. By searching the CTD database，Genecards database and OMIM database of disease-related websites，the anti-sunburn targets were obtained. The interaction of the active targets was analyzed with online STRING database to screen the predicted core targets. The gene ontolog（GO） gene function enrichment analysis and Kyoto encyclopedia of genes and genomes（KEGG） pathway enrichment analysis of the predictive targets were performed by using DAVID database. Cytoscape 3.6.1 software was used to make "drug-component-target" network diagram，"protein-protein interaction" network diagram and "component-target-pathway" network diagram. Online website Draw Venn Diagram was used to show the relationship between disease targets and drug predicted targets. R Studio software was used to draw the functional enrichment analysis diagram of GO gene and KEGG pathway. Molecular docking between the active ingredients and the core targets was performed using GOLD software. Result:The 16 active compounds were collected，such as liquiritin，glycyrrhizin，kaempferol and quercetin. The active components mainly acted on 5 core targets：protein kinase B1（AKT1），interleukin（IL）-6，vascular endothelial growth factor（VEGFA），tumor necrosis factor（TNF） and tumor suppressor gene （TP53） and played a role in anti-sunburn effect primarily through these pathways such as hepatitis B，pathways in cancer，toxoplasmosis，chagas disease（American trypanosomiasis），and TNF signaling pathway. Conclusion:Based on the method of network pharmacology，the present study has preliminarily explored the anti-sunburn targets and pathways of Glycyrrhizae Radix et Rhizoma-Granati Pericarpium formula，and further verified the characteristics of multi-component and multi-target treatment of diseases in TCM，so as to provide certain scientific ideas for the modernization research of Chinese herbal compound prescriptions.
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Objective To analyze the magnetic resonance imaging (MRI) features of caesarean scar pregnancy (CSP), and to evaluate the diagnosis value of MRI in CSP. Methods The MRI data of 38 patients with clinically and pathologically confirmed CSP were retrospectively analyzed. These patients aged 19 to 50 years old, with one to two previous cesarean sections. The interval between this pregnancy and the last cesarean section was 2 to 11 years, the menopause time was 32 to 90 days, the urine human chorionic gonadotrophin (HCG) were all positive, and the blood β-HCG was 159.7-210 800.0 U/L. Twenty-nine cases were treated due to a small amount of vaginal bleeding after menopause, and nine cases due to abdominal pain. Results On the sagittal T2-weighted image, 38 cases of gestational sacs were clearly showed, of which 28 cases had round or oval morphology, with low signal on T1 and high signal on T2; 10 cases of gestational sacs showed irregular mixed cystic solidity with slightly low signal on T1 and slightly high signal on T2, and the contents were significantly strengthened after the enhancement. In all cases, the cyst wall was intact and located at the scar of the cesarean section of the anterior inferior wall of the uterus. In two cases of MRI grade 0, the gestational sac was located on the scar surface and grew into the uterine cavity without involving the myometrium; in 13 cases of grade 1, the gestational sac slightly invaded the myometrium, but mainly grew in the uterine cavity, with a clear boundary between the gestational sac and the myometrium; in 14 cases of grade 2, the gestational sac was small and completely implanted into the myometrium, the endometrial junction was continuously interrupted, the anterior-inferior wall of the uterus was thin, in the shape of “W” or “U”, without invading the serosa; in nine cases of grade 3, the gestational sac was large, completely implanted into the myometrium and protruded out of the uterine contour, compressing the bladder. Fifteen patients of MRI grade 0 and 1 were mainly treated with methotrexate, mifepristone or misoprostol, and/or ultrasound-guided curettage; 23 patients of grade 2 and 3 were mainly treated with curettage, excision of scar lesions and scar repair. Conclusion The typical MRI features of CSP can guide the clinical treatment decision-making, especially for the choice of operation mode.
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Objective:To evaluate the effect of standardized training for new nurses in the first year based on Kirkpatrick model as a theoretical framework.Methods:A cross-sectional study was conducted. New nurses' satisfaction with training, theoretical and operational assessment, job performance, core competence, turnover rate and other indicators were used, to evaluate the effect of standardized training for 62 new nurses in the first year.Results:At the reaction level, the overall satisfaction score of new nurses was 4.66±0.47; at the learning level, the theoretical assessment score was 95.32±2.38, the operational assessment score was 97.53±1.07, and the performance score was 97.12±1.64; at the behavioral level 88.45±9.75; and at the result level, there were no complaints and errors among new nurses, and the turnover rate was 1.6% (1/62). The theoretical and operational assessment scores were positively correlated with work performance, with r value of 0.424 and 0.399, respectively, and P = 0.001. The theoretical assessment scores were negatively correlated with the behavioral level, with the r value of -0.264 and P= 0.038. There were no correlation with the operational assessment scores and the behavioral level, with the r value of 0.147 and P value of 0.253. Conclusions:Kirkpatrick model validates the standardized training program for new nurses effectively, and provides scientific basis for improving the training program for new nurses. The results level of the training needs to be evaluated in the long term.
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Objective:To investigate the current status of clinical teaching towards postgraduates of master of nursing specialist(MNS) in China.Methods:Objective sampling was used to invest 390 MNS clinical nursing teachers in 36 hospitals across the country. The survey included the admission and evaluation criteria of teachers, the MNS postgraduates′ clinical teaching plan and implementation, and the assessment of MNS postgraduate ′s clinical practice ability, etc. Results:Among the criteria for clinical teachers for MNS postgraduates, 79.49% of departments required bachelor ′s degree or above, and 67.18% of departments requested medium-grade professional title or above; 47.44% of the departments demanded that clinical teachers had the research experience, 58.21% departments asked for the experience of articles publication. The main method of selecting clinical teaching teachers was examination (50%), while 31.28% departments had no definite criteria. The evaluation indicators of clinical teachers mainly depended on the results of students ′ clinical practice capability assessment (81.79%) and students ′ satisfaction (80%). Only 49.23% of the study objects knew the training objectives of MNS. The pivotal abilities of MNS graduate students were the ability of clinical nursing practice (91.79%) and clinical research (82.82%). The MNS postgraduate teaching plan of each department was mainly derived from the requirements of tutors and colleges (87.69%). The mode of clinical teaching was that one student was guided by a fixed clinical teacher (87.18%). Clinical practice assessment methods of MNS mainly included theoretical knowledge assessment (88.46%) and the performance of section lectures (82.56%). The assessment personnel were mainly clinical teachers (95.40%) and head nurses (83.51%). The self-assessment of clinical teachers was rated at the medium level about their performance on the postgraduate MNS students ′ clinical teaching. Conclusions:The homogenization and standardization of the construction of MNS clinical teaching base needs to be improved in China. In the field of defining the criteria of clinical teaching teachers, strengthening the construction of clinical faculty, perfecting the clinical teaching plan and evaluation system according to the cultivation objectives and specialist characteristics, and elevating the comprehensive medical education combined with clinical education and college education, further exploration is indispensable.
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Objective:To predict the anti-inflammatory targets and relevant signaling pathways of Epimedii Folium in the treatment of depression by network pharmacology，in order to explore the potential mechanism of its anti-depression effect. Method:The active constituents of Epimedii Folium were collected and screened out through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP） database. PharmMapper server and TCMSP database were used to predict and screen out protein targets. OMIM database，CTD database and GeneCards database were used to screen out relevant targets and anti-inflammatory targets of depression. Enrichment analysis of the gene ontology （GO） function and Kyoto Encyclopedia of genes and genomes（KEGG） signaling pathway for the key anti-inflammatory targets of Epimedii Folium were carried out by DAVID database. Cytoscape 3.6.0 was used to construct the network diagram of "active component-action target-signal pathway" of Epimedii Folium and analyze the topological structure of the network. GOLD molecular docking software was used to verify the results of active components and key anti-inflammatory targets. Result:A total of 12 active components，30 targets and 5 key anti-inflammatory targets of Epimedii Folium were screened out， 65 biological processes，4 cell components and 1 molecular function were enriched with GO function， and 41 KEGG pathways were enriched and analyzed，including 9 inflammation-related signaling pathways. Molecular docking verified that icariin and key anti-inflammatory targets could form the optimal binding structure. Conclusion:The study preliminarily reveals the molecular mechanism of Epimedii Folium on depression through its anti-inflammatory target and its relevant signaling pathway network，so as to provide a basis for further study on the antidepressant effect of Epimedii Folium.
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Objective: To establish a better near infrared quantitative model for quality control of Glycyrrhizae Radix et Rhizoma of components (moisture,total ash,liquiritin and glycyrrhizic acid) in liquorice,in order to realize rapid detection.Method: The contents of moisture,total ash,liquiritin and glycyrrhizic acid were determined in 97 samples based on the methods set forth in Chinese Pharmacopoeia.Meanwhile,the near infrared spectrum was scanned using near infrared spectroscope.R software was used to screen out the spectral pretreatment and build the quantitative models.Result: The optimum spectral pretreatment method for establishing the near infrared quantitative model of moisture and liquiritin was the first order derivative.For moisture,the correlation coefficients of test and validation were 0.930 0 and 0.929 9,and the root mean square errors were 0.243 2 and 0.203 8,respectively.For liquiritin,the correlation coefficients of test and validation were 0.930 3 and 0.907 6,and the root mean square errors were 0.093 9 and 0.128 9,respectively.The optimum spectral pretreatment method for establishing the near infrared quantitative model of total ash was MSC.The correlation coefficients of test and validation were 0.926 5 and 0.917 7,and the root mean square errors were 0.109 6 and 0.103 7,respectively.The optimum spectral pretreatment method for establishing the near infrared quantitative model of glycyrrhizic acid was SNV.The correlation coefficients of test and validation were 0.918 1 and 0.915 7,and the root mean square errors were 0.274 8 and 0.236 0,respectively.Conclusion: In this study,a better near infrared quantitative models for quality control of components of Glycyrrhizae Radix et Rhizoma were established,with a high accuracy,which laid a foundation for rapid detection of the components in Glycyrrhizae Radix et Rhizoma.
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Objective :To analyze therapeutic effect of different dose of simvastatin on hypertension complicated hy‐perlipidemia and its safety .Methods :A total of 90 patients with hypertension complicated hyperlipidemia treated in our hospital were randomly and equally divided into simvastatin routine dose group (20mg／d simvastatin) and high dose group (40mg／d simvastatin) ,both groups were treated for six months .Therapeutic effect ,levels of blood pressure (BP) and blood lipids before and after treatment ,and incidence of adverse reactions were compared between two groups .Results :Compared with routine dose group after treatment , there were significant rise in total effective rates of hypertension (75.56% vs.93.33%) and hyperlipidemia (71.11% vs.95.56%) in high dose group ,P＝0.020 ,0.002 ;Compared with routine dose group after treatment ,there were significant reductions in levels of serum TC [ (5.68 ± 0.68) mmol／L vs. (4.07 ± 0.62) mmol／L] ,TG [(1.89 ± 0.37) mmol／L vs.(1.03 ± 0.31) mmol／L] ,LDL‐C [ (3.59 ± 0.74) mmol／L vs. (2.12 ± 0.69) mmol／L] and blood pressure [ (134.84 ± 11.92)／(90.96 ± 8.79) mmHg vs.(120.09 ± 11.43)／(81.78 ± 8.57) mmHg] ,and significant rise in serum HDL‐C level [ (1.28 ± 0.41) mmol／L vs.(1.48 ± 0.46) mmol／L] in high dose group , P＜0.05 or ＜0.01. There was no significant difference in incidence rate of adverse reactions between two groups (P＝0.535).Conclusion :High dose simvastatin possesses more significant therapeutic effect on hypertension compli‐cated hyperlipidemia .It can significantly reduce BP and blood lipids with good safety .
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It was aimed at exploring the potential pharmacological effects of alkaloids in Sophora alopecuroides by means of network pharmacology in this study. The main alkaloids in S. alopecuroides were collected for analysis of drug properties, prediction of potential targets and screening of signaling pathways. DAVID analysis tool combined with KEGG database was used to annotate and analyze the signaling pathway. The alkaloids-targets-signaling pathways network was built through Cytoscape software. Results showed that 17 alkaloids in S. alopecuroides involved 49 targets (170 times in all) and 22 important signaling pathways. Three nodes in model of network pharmacology were cross-linked, and the metabolic pathways were coordinated and regulated by each other. It indicated that alkaloids in S. alopecuroides may have therapeutic effect on diseases of cancer, metabolic disorder, endocrine system, digestive system, nervous system and so on.
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Alkaloids , Pharmacology , Phytochemicals , Pharmacology , Signal Transduction , Sophora , ChemistryABSTRACT
The aim of this paper was to investigate the potential pharmacological effect of flavonoids in Sophora alopecuroides by network pharmacology. This study predicted the potential targets of 11 flavonoids of S. alopecuroides with help of reversed pharmacophore matching target recognition service platform (PharmMapper). The pathway information was acquired from DAVID and KEGG databases. Cytoscape software was used to construct the "ingredient-target-pathway" network of flavonoids active components of S. alopecuroides. The flavonoids active components of S. alopecuroides play anti-inflammatory, blood sugar regulating and other pharmacological effects by regulating 62 targets (such as INSR，KDR，MET) and intervening 44 pathways, such as B cell receptor signaling pathway, insulin signaling pathway, neurotrophin signaling pathway, and T cell receptor signaling pathway. In this study, the mechanism of "muti components-multitargets-multiple pathway" of flavonoids was studied. It reflects the multi-components, multi-targets and multiple pathway features of traditional Chinese medicine. Meanwhile, it provides a scientific basis for the elucidation the mechanism of S. alopecuroides as a medicine, and the development and utilization resources of S. alopecuroides.
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BACKGROUND: Precartilaginous stem cells exist in articular cartilage, which may become potential seed cells for cartilage tissue engineering. Transforming growth factor-β3 (TGF-β3) has positive regulation effect on the proliferation and chondrogenic differentiation of precartilagious stem cells. OBJECTIVE: To investigate the effect of TGF-β3 on the chondrogenesis of osteochondroprogenitor cells. METHODS: CD146+chondrocytes were isolated from the patients with advanced osteoarthritis, and were then identified. CD146+chondrocytes were cultured in the normal medium (blank control group), chondrogenic induced medium (control group), chondrogenic induced medium containing 2.5 and 10 μg/L recombinant human TGF-β3, respectively. The immunohistochemistry of collagen Ⅱ and aggrecan was performed, and the related gene expression was tested by real-time quantitative PCR after 4 weeks of culture. RESULTS AND CONCLUSION: When chondrogenic differentiation was performed, the number of cell pellets in the 10 μg/L TGF-β3 group was greater than that in the 2.5 μg/L TGF-β3 group, and the number of cell pellets in the 2.5 μg/L TGF-β3 group was greater than that in the control group. The expression levels of collagen Ⅱ and aggrecan in the 10 μg/L TGF-β3 group was significantly higher than that in the 2.5 μg/L TGF-β3 group (P＜ 0.05). The expression levels of collagen Ⅱ and aggrecan in the 2.5 μg/L TGF-β3 group were significantly higher than those in the control group (P＜ 0.05). Real-time quantitative PCR results showed that the expression levels of collagen Ⅱ and aggrecan mRNA in the 10 μg/L TGF-β3 group were significantly higher than those in the 2.5 μg/L TGF-β3 group (P＜ 0.05), but the expression level of SOX-9 showed insignificant difference between two groups (P ＞ 0.05), and the expression level of SOX-9 in the 10 and 2.5 μg/L TGF-β3 groups was significantly higher than that in the control group (P＜ 0.05); the expression levels of collagen Ⅱ and aggrecan mRNA in the 2.5 μg/L TGF-β3 group were higher than those in the control group (P＜ 0.05). Our findings suggest that osteochondroprogenitor cells with stem cell characteristics exist in the residual articular cartilage of the patients with advanced osteoarthritis. TGF-β3 has the ability of promoting chondrogenic differentiation of osteochondroprogenitor cells, which may be an ideal cytokine for cartilage tissue engineering.
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Objective To investigate the clinical efficacy of 3D printing technique combined with osteotomy in the treatment of complex tibial plateau fractures involving the posterolateral condyle.Methods The clinical data of 47 patients with complicated tibial plateau fractures involving the posterolateral condyle who were treated with 3D printing technology and tibial lateral condyle osteotomy from January 2012 to February 2015 were retrospectively analyzed.There were 19 males and 28 females aged from 21 to 69 years (mean 50.3 years).All of them were closed fractures without neurological and vascular injuries.The time between injury and operation was 4 to 19 days (average,6.7 days).All the patients were treated with tibial lateral condyle osteotomy and bilateral plate fixation with anterolateral approach and posteromedial approach.Three-dimensional CT scans were performed preoperatively and 1 ∶ 1 to mimics model was made by 3D printing technique based on the data after conversion.Refer to the 3D fracture model to accurately design the osteotomy line to improve the operation scheme.During the operation,anterior and lateral anterior combined with posterior medial incision were performed,and the tibia external condyle osteotomy was conducted to accurately expose the external posterior condyle fracture block of the tibia platform,and bilateral plate was applied after reduction.The fracture reduction was evaluated according to the Rasmussen score of the knee joint.The knee joint function was evaluated by the score of the hospital for special surgery (HSS).Results All 47 patients were followed up for 13.2 months (range,7-19 months).Immediate postoperative X-ray showed good fracture reduction.The union time of fracture was 14.3 weeks (range,12-18 weeks).The knee joint Rasmussen score one year after operation was 13-18 (average,15.73),including 33 cases excellent,12 cases good and 2 cases fair.The excellent and good rate was 95.7％ (45/47).HSS score was 67 to 94 (average,82.67),among which 31 cases were excellent,13 cases good,2 cases fair,and 1 case poor (postoperative refusal to rehabilitate exercise resulted in joint stiffness).The excellent and good rate of 89.9％ (44/47).Knee joint activity was-5°-0°-135°,with the average range of 125.5°.No common peroneal nerve injury,important vascular injury,postoperative infection,internal fixation failure and other serious complications was found.Conclusion 3D printing technology can help to accurately display the specific situation of the posterior tibial condyle fractures,which is conducive to the surgeon to develop a more intuitive plan of reduction.The method of tibial lateral condyle osteotomy can clearly reveal the tibial plateau posterolateral condylar fractures.With accurate osteotomy the surgical field can be fully exposed,and ultimately achieve a satisfactory result.Therefore,3D printing combined with tibial lateral condyle osteotomy is an effective method for complex tibial plateau fractures involving the posterolateral condyle.
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Objective To explore the mid-term efficacy of porous titanium trabecular metal ( TTM ) components manufactured by 3D printing for primary total hip arthroplasty ( THA ). Methods Enrolled for this prospective clinical trial were 19 patients ( 20 hips ) who were to receive primary THA from May 2012 to June 2013 at Department of Orthopaedics and Traumatology, Puai Hospital. Of them, 9 patients ( 10 hips) used 3D printing porous TTM for acetabular prosthesis in primary THA while the other 10 patients ( 10 hips ) used Pinnacle acetabular prosthesis. At 5 years after operation, clinical and radiographic evaluations were conducted to assess acetabular component stability, osseointegration in the acetabulum-bone interface, and osteolysis incidence. Harris scores were used to assess the hip functions. Results The follow-up duration for all the patients averaged 5 years. By the Harris scores, 8 cases were excellent and 2 good in the TTM group while 9 excellent and one good in the Pinnacle group. The Harris scores were significantly improved from preoperative 48.2+5.5 to 92.8+3.1 at 5 years after operation in the TTM group and significantly from 46.5 ± 8.7 to 94.6 ± 2.9 in the Pinnacle group ( P ＜0.05 ). There were no significant differences regarding the preoperative Harris scores and those 5 years after operation between the 2 groups ( P ＞ 0.05 ) . Radio-graphic evaluation showed stable acetabular components, fine osseointegration, and no implant loosening or osteolysis. Two hips in the TTM group had a postoperative radiolucent line which disappeared 6 months later. The 5-year survival rate of the acetabular components was 100% for both groups, taking prosthetic loosening or revision as the end point. Conclusion The 3D printing TTM has shown excellent mid-term efficacy but its long-term efficacy needs further follow-up study.
ABSTRACT
Objective To report the operative procedures and clinical outcomes of open reduction and internal fixation for the treatment of tibial plateau fractures involving anteromedial margin caused by hyperextension varus injury.Methods From December 2013 to December 2015,11 patients with tibial plateau fracture involving anteromedial margin caused by hyperextension varus injury were treated at our department.They were 6 males and 5 females with a mean age of 42.3 years (range,from 19 to 65 years).Simple medial column fracture happened in 2,fractures of medial and lateral columns in 4,fractures of medial and posterior columns in 3,and 3-column fractures in 2 cases.The cortical bone fractures of anteromedial margin were fixated by open reduction and internal fixation using self-clipped joint line plating.Bone grafting was conducted if necessary.Results The 9 patients were followed up for an average of 17.6 months (range,from 12 to 30 months).All the fractures healed.The average time for radiographic bony union and full weight bearing was 11.4 weeks (range,from 9 to 14 weeks) and 16.1 weeks (range,from 14 to 19 weeks),respectively.On average,the Rasmussen's radiological grading scored 16.9 (range,from 14 to 18)immediately after operation;the Hospital for Special Surgery scores of all the patients at 12 months postoperatively averaged 89.1 (range,from 75 to 94),yielding an excellent to good rate of 92.3％.The average range of motion of the affected knee was from 2.3° to 125.1°.There were significant differences in both tibial plateau angle and posterior slope angle on radiography between preoperation and postoperation (P ＜ 0.05).There were no significant differences in either tibial plateau angle or posterior slope angle on radiography between immediate postoperation and 12 months postoperation (P ＞ 0.05).Partial incision necrosis occurred postoperatively in one case which was uneventfully healed after wound management.One case complicated with preoperative common peroneal nerve injury reported dorsal sense of numbness which was healed after administration of neurotrophic drugs.No screw loosening,plate breakage or fixation failure was found during follow-ups.Conclusions It is difficult to treat the tibial plateau fractures involving anterumedial margin caused by hyperextension varus injury.Internal fixation with joint line plating is an appropriate treatment for this fracture pattern,leading to satisfactory clinical outcomes.