A finite element analysis of biomechanical performance of Proximal Humeral Internal Locking Plate System in treatment of femoral periprosthetic fracture of Vancouver type B1 / 中华创伤骨科杂志

Objective:To explore mechanical stability of Proximal Humeral Internal Locking Plate System (PHILOS) in the treatment of Vancouver B1 femoral periprosthetic fractures by three-dimensional finite element analysis.Methods:A three-dimensional finite element model of the femur was established by digital medical software (Mimics 21.0, 3-matic12.0, Geomagic12.0 and Hypermesh 2017.0) using the CT data of a femur from a volunteer (male, 34 years old, 173 cm in height and 65 kg in weight). After the femoral trochanter was cut in the femoral models, a femoral stem was implanted. PHILOS fixation (PHILOS group) and Cable-Ready GTR fixation (Cable group) were applied respectively. Loads of 700 N, 1,400 N and 2,100 N were applied to the 2 groups of finite element models. Distributions of Von Mises stress and deformation were investigated in the finite element models of 2 internal fixations; the mechanical stability was compared between the 2 groups of models.Results:The maximum deformation occurred on the femoral ball head in the 2 groups of models. At the load of 2,100 N, the maximum deformation was 3.77 mm in the PHILOS group, larger than 3.58 mm in the Cable group, and the maximum stress peak value in the PHILOS group was 491.54 MPa, about 49.2% lower than that in the Cable group (733.61 MPa). The peak stress in the PHILOS group was mainly distributed on the 4th and 5th fixation ends at the bone plate while the peak stress in the Cable group was mainly distributed on the second titanium cable under the fracture line.Conclusions:Under various loads, both PHILOS fixation and Cable-Ready GTR fixation can provide sufficient mechanical stability. As the peak stress of PHILOS fixation is much lower than that of Cable-Ready GTR fixation, PHILOS can be used as an effective fixation method for Vancouver B1 femoral periprosthetic fractures.

Expression and clinical significance of serum exosomal microRNA-221-3p in hepatocellular carcinoma / 临床肝胆病杂志

ObjectiveTo investigate the expression and clinical significance of serum exosomal microRNA(miRNA)-221-3p in hepatocellular carcinoma (HCC). MethodsA total of 66 patients who underwent surgery in Nanjing Drum Tower Hospital, Nanjing University Medical School, from February 2010 to December 2014 and were diagnosed with HCC were enrolled as HCC group, and 25 individuals who underwent physical examination in our hospital during the same period of time were enrolled as control group. The exosome extraction kit was used to isolate the exosomes in serum; Western blotting was used to measure the expression of exosome markers; a transmission electron microscope was used to observe the morphology of serum exosomes; quantitative real-time PCR was used to measure the expression of serum exosomal miRNA-221-3p. The Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method and the log-rank test were used to analyze the association of the expression of serum exosomal miRNA-221-3p with prognosis, and the Cox proportional hazards regression model was used to analyze the influencing factors for prognosis. ResultsSerum exosomes were small membranous vesicles with a diameter of about 40-100 nm, and HSP70, Alix, and CD63 were expressed in the exosomes. The HCC group had significantly higher expression of serum exosomal miRNA-221-3p than the control group (U=354.00, P＜0.001). In the patients with HCC, the high expression of serum exosomal miRNA-221-3p was associated with tumor size (χ2=6.016, P=0.014), capsular invasion (χ2=7.580, P=0.006), and TNM stage (χ2=6.340, P=0012). In addition, the HCC patients with high expression of serum exosomal miRNA-221-3p had a significantly lower overall survival rate than those with low expression (χ2=17.105, P＜0.001). The multivariate analysis showed that the expression of serum exosomal miRNA-221-3p (hazard ratio ［HR］=2.434, 95% confidence interval ［CI］: 1.178-5.027, P=0.016) and tumor stage (HR=2.653, 95% CI: 1.222-5.760, P=0.014) were independent risk factors for the prognosis of patients with HCC. ConclusionThere is a significant increase in the expression of serum exosomal miRNA-221-3p in HCC patients, which provides a reference for the diagnosis and prognostic evaluation of HCC.

Feasibility study on the combination of elderly-care and medical care offered by community health centers / 中华医院管理杂志

Based on literature review and on-site investigation, this paper analyzed the current policies, regulations, supply and demand dilemma and practical mode of such a combination, as well as the feasibility from the views of current policies, service offering and the practice. It is recommended to build a service system centering on " public health services + basic medical care + community elderly/medical support" , with services enriched and supportive mechanisms supplemented, thus transforming community health centers.

Risk factors for recurrence after 5-year endocrine therapy in postoperative breast cancer patients / 中华普通外科杂志

Objective To evaluate recurrence risk factors in postoperative breast cancer patients after 5-year adjuvant endocrine therapy.Methods From Jan 2006 to Dec 2011,a total of 327 patients were enrolled for this study.Kaplan-Meier curves were applied to estimate survival rates and COX's proportional hazards model to identify prognostic variables.Results Among these 327 eligible patients,42 (12.8％) patients suffered from distant metastasis and 34 (10.4％) patients experienced locoregional recurrence after 5-year adjuvant endocrine therapy.Survival analysis showed that patients with histologic grade 3 disease,lymph node metastasis,Ki-67 high expression,high TNM stage and radiotherapy were statistically significant with poorer relapse-free survival (RFS,P =0.000,0.003,0.000,0.003,0.034)and poorer distant metastasis-free survival (DMFS,P =0.000,0.002,0.000,0.002,0.023),respectively.In multivariate analysis,patients with histological grade 3 disease (P =0.002) and more than 3 positive nodes (P =0.032) were risk factors for lower RFS.However,only histological grade 3 (P =0.015) was risk factor for DMFS.Conclusions Late relapse after completion of 5-year adjuvant endocrine therapy was still common,patients with grade 3 disease and more than 3 positive nodes may benefit from extended endocrine therapy.

Evaluation of Clinical Efficacy of Heart and Spleen Deficiency Type Insomnia Treated by Acupuncture for Regulating Governor Vessel and Tranquilizing Spirit / 广州中医药大学学报

Objective To evaluate the clinical effect of acupuncture combined with estazolam for the treatment of primary insomnia with heart and spleen deficiency type. Methods Seventy qualified patients were randomized into treatment group and control group, 35 in each group. Both groups received oral use of estazolam before bed time for 6 continuous weeks, and acupuncture group was additionally given acupuncture for regulating governor vessel and tranquilizing spirit on acupoints of Baihui(GV20), Yintang(GV29), Shenting(GV25), Anmian (EX-HN22), Shenmen(H7), Sanyinjiao(SP6), 3 times a week and lasting for 6 continuous weeks. The sleep state of the patients was estimated according to Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Athens Insomnia Scale(AIS) before treatment, on the third and the sixth week of treatment, and one month after the completion of treatment. Results (1) Five cases in the treatment group and 3 cases in the control group were dropped out for not completing the treatment timely. In the end , 30 cases in the treatment group and 32 cases in the control group finished the trial. (2) The total effective rate in the treatment group was up to 90.0%, and was 71.9% in control group, the difference being significant(P<0.01).(3) Compared to the control group, the scores of PSQI, ESS and AIS were much decreased in treatment group on the third and the sixth week of treatment , and one month after treatment(P<0 . 05 or P<0 . 01). Conclusion Acupuncture for regulating governor vessel and tranquilizing mind combined with oral use of estazolam exerts certain therapeutic effect for the treatment of heart and spleen deficiency type insomnia, and the effect was superior to that of estazolam alone.

The research progress of acupuncture for insomnia after stroke / 国际中医中药杂志

The treatments for insomnia after stroke were various in recent years, including acupuncture with its distinguishing feature. It’s reviewed and summarized that experimental researches on Chinese and English databases about acupuncture treatment of insomnia after stroke in recent 10 years. Clinicians had chosen different acupuncture therapies for insomnia after stroke according to yinyang, zangfu, meridians, opening and closing of qi activity. Although those acupuncture therapies had achieved obvious clinical effects, they were deficient in experimental design and methodology.

Observation on the effect of previous analgesia of acupuncture on the patients with the mixed hemorrhoid surgery pain / 国际中医中药杂志

Objective To study the effects of previous analgesia of acupuncture on patients with the mixed hemorrhoid surgery pain.MethodsA total of 70 patients with mixed hemorrhoid treated with “Milligan-morgan hemorrhoids” were randomly divided into treatment group and control group, 35 patients in each group. The treatment group was treated 30 min prior to the surgery with needling and manipulating Baliao, Chengshan, Hegu every five minutes until the operation, while the control group was not treated before the operation. The patients were assessed by Visual Aualogue Scale and self-reporting Inventory.ResultsAfter the operation, the treatment group was significantly better than the control group in the outcome index of beginning time of pain (14.3 ± 4.9 hvs. 4.2 ± 2.3 h, Z=-5.666,P<0.01) and peak time of pain (17.3 ± 4.5 hvs. 6.0 ± 2.9 h,Z=-5.581,P<0.01). The treatment group was significantly better than the control group in decreasing the pain beginning VAS score (3.3 ± 1.7vs. 4.6 ± 1.7,Z=-2.820, P<0.01) and pain peak VAS score (4.5 ± 2.0vs. 6.5 ± 1.2,Z=-4.025,P<0.05). After surgery, the treatment group was significantly better than the control group in decreasing the score of Self-reporting Inventory scale at the 1stday (1.8 ± 1.3vs. 3.0 ± 1.3),Z=-3.472,P<0.01) and 2ndday (1.2 ± 0.9vs. 1.9 ± 1.2,Z=-2.464,P<0.05). And the treatment group was significantly better than the control group inreducing the quantities of compound aminopyrine phenacetin tablet (0.5 ± 0.9vs.1.5 ± 1.7,t=3.167,P=0.002).ConclusionAcupuncture analgesia 30 minutes prior to the mixed hemorrhoid surgery can significantly reduce the postoperative pain.

Correlations between P53 expression and clinicopathologic factors and the prognosis of Luminal breast cancer / 国际肿瘤学杂志

Objective To investigate the correlations between P53 expression and clinicopathologic factors and prognosis of Luminal breast cancer.Methods From January 2009 to December 2012,a total of 283 patients with Luminal breast cancer in the Shanghai General Hospital Affiliated to Shanghai Jiaotong Univer-sity were included.P53 expressions of them were assayed by immunohistochemistry.Survival analysis was applied using Kaplan-Meier curve and Log-rank test.Single factor analysis and mutiple-factor analysis were applied using Cox proportional hazard regression model.Results The rate of P53 expression was associated with tumor size (χ2 =6.285,P =0.043),lymph node metastasis (χ2 =15.881,P =0.000),histological grade (χ2 =8.132,P =0.043)and Ki-67 (χ2 =6.476,P =0.039),but it was not associated with age (χ2 =0.955,P =0.328),menopausal status (χ2 =3.808,P =0.051),pathological pattern (χ2 =0.847,P =0.655),estrogen receptor (χ2 =1.867,P =0.172),progesterone receptor (χ2 =0.937,P =0.333)and human epidermal growth factor receptor-2 (χ2 =0.110,P =0.741 ).In all the 283 patients,the 5-year relapse-free survival rates for P53-positive group and P53-negative group were 66.7% and 90.7% respectively (χ2 =12.609,P =0.000),while the 5-year overall survival rates were 84.4% and 93.4% respectively (χ2 =4.153,P =0.042),with significant differences.In Cox mutiple-factor analysis,lymph node metastasis (HR =2.484,95%CI:1.393-4.431,χ2 =9.497,P =0.002)and P53 over-expression (HR =3.627,95%CI:1.061-12.401,χ2 =4.220,P =0.040)were independent prognostic factors for the relapse-free survival of patients with Luminal breast cancer,and lymph node metastasis (HR =3.451,95%CI:1.891-6.297,χ2 =16.290,P =0.000)and higher histological grade (HR =2.806,95%CI:1.091-7.219,χ2 =4.582,P =0.032)were independent prognostic factors for overall survival.Conclusion P53 over-expression of patients with Luminal breast cancer is associated with prognostic factors such as lymph node metastasis and histological grade,which indicates the worse prognosis.

Therapeutic Observation of Surround Electroacupuncture in Relieving Pain After Operation for Mixed Hemorrhoids / 上海针灸杂志

Objective To observe the clinical efficacy of surround electroacupuncture in relieving pain after operation for mixed hemorrhoids. Method Seventy-two patients with mixed hemorrhoids were randomized into a treatment group and a control group, 36 cases in each group. The two groups both received the corresponding interventions once in 15 min after the operation: the treatment group received electroacupuncture treatment, and the control group was only placed in a simulated environment of electroacupuncture but without receivimg any needling treatment. The pain intensity was evaluated by using Verbal Rating Scale (VRS), Wong-Baker Faces Pain Rating Scale, and Visual Analogue Scale (VAS) at 11 different time points after the treatment: once every 1 h in 8 h after the treatment, once at the first defecation, once respectively 24 h and 48 h after the treatment. The data were statistically analyzed afterwards. Result At 3 h and 4 h after the treatment and at the first defecation after the treatment, the VRS scores of the treatment group were significantly lower than that of the control group (P<0.05); respectively at 4 h, 5 h, 6 h, 7 h, and 8 h after the treatment and at the first defecation, the Wong-Baker scores of the treatment group were significantly lower than that of the control group (P<0.05); respectively at 2 h, 3 h, 4 h, 5 h, 6 h, 7 h, and 8 h after the treatment, at the first defecation, as well as at 24 h after the treatment, the VAS scores of the treatment group were significantly lower than that of the control group (P<0.05); it indicates that the pain intensity of the treatment group should be lower than that of the control group at the above time points, and the analgesic effect in the treatment group lasts a longer time, running a lower risk of losing effectiveness compared to the control group (P<0.05). Conclusion Real-time acupuncture treatment after the operation is significantly effective in relieving pain after operation for hemorrhoids.

Clinical research on acupuncture analgesia in perioperative period / 国际中医中药杂志

Acupuncture analgesia, as a non-drug analgesic therapy, is widely used in the perioperative period clinically. In recent years, acupuncture analgesia in perioperative period is mainly used for preoperative sedation, intraoperative auxiliary anesthesia and postoperative analgesia, prevention of nausea and vomiting after surgery and perioperative complications, etc. This paper summarized its application law, influence factors, and the existing problems.

Clinical Study of the Effect of Electroacupuncture on Rehabilitation and TCD in Convalescent Stroke Patients / 上海针灸杂志

Objective To investigate the clinical therapeutic effect of electroacupuncture on ischemic stroke by recording the therapeutic effect score and performing transcranial Doppler (TCD) detection in electroacupuncture-treated convalescent stroke patients before and after treatment.Methods Sixty convalescent patients with ischemic stroke were randomly allocated to treatment and control groups, 30 cases each. The control group received routine medication and the treatment group, electroacupuncture in addition. In the two groups, pre- and post-treatment neurological defect scores were recorded and the clinical therapeutic effects were observed after four weeks of treatment. Pre- and post-treatment middle cerebral artery (MCA) pulsation indices (RI), resistance indices (RI) and ratios of systolic to end-diastolic (S/D) blood flow velocity detected by TCD were compared between the two groups. Results The total efficacy rate was 80.0% in the treatment group and 50.0% in the control group; there was a statistically significant difference between the two groups (P<0.01). There was a statistically significant pre-/post-treatment difference in the MESSS score in the two groups (P<0.01). There was a statistically significant post-treatment difference in the MESSS score between the treatment and control groups (P<0.05). There were statistically significant pre-/post-treatment differences in TCD indices (PI, RI and S/D) on the affected side in the two groups (P<0.05). There were statistically significant post-treatment differences in TCD indices on the affected side between the treatment and control groups (P<0.05).Conclusion Electro- acupuncture can promote rehabilitation in convalescent stroke patients.

A single center experience: post-transplantation adjuvant chemotherapy impacts the prognosis of hepatocellular carcinoma patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The aim of this research was to investigate the impact of post-transplantation adjuvant chemotherapy in the prevention of tumor recurrence and metastasis for hepatocellular carcinoma (HCC) exceeding Milan criteria after liver transplantation.</p><p><b>METHODS</b>A total of 117 patients with HCC exceeding the Milan criteria who had undergone orthotopic liver transplantation (OLT) from August 2002 to February 2009 were enrolled and retrospectively analyzed. The patients were divided into four groups according to chemotherapy regimens and the impact of different chemotherapy regimens on survival, disease-free survival, and adverse effects were compared.</p><p><b>RESULTS</b>One year survival rates for the gemicitabine, conventional chemotherapy, oxaliplatin plus capecitabine and the best supportive care (BSC) group were 87.5%, 84.2%, 81.6%, and 67.5%. The 3-year survival rates were 48.1%, 25.9%, 31.6%, and 33.7%, respectively for the four groups. One year disease free survival rates for the four groups were 69.8%, 47.4%, 53.8%, and 45.7% respectively. And 3-year disease free survival rates were 43.2%, 23.7%, 23.6%, and 25.1% for the four groups. Stratification analysis showed that the gemcitabine regimen and conventional chemotherapy could significantly improve the survival rate and disease free survival rate for HCC patients who had major vascular invasion and/or microvascular invasion after liver transplantation compared with BSC group.</p><p><b>CONCLUSIONS</b>For HCC patients beyond Milan criteria, especially who had vascular invasion and/or micorvascular invasion, post-transplantation adjuvant chemotherapy can significantly improve survival. Gemcitabine is a proper regimen for postoperative adjuvant chemotherapy. Conventional chemotherapy can also benefit patients, but the adverse effects are not satisfactory.</p>

Genetic recombinant prokaryotic expression of augmenter of liver regeneration and preparation of polyclonal antibodies in rats / 中国组织工程研究

BACKGROUND:An abroad study repoRed the distribution and expression of augmenter of liver regeneration(ALR)in the central nervous system.There are few literatures on how to prepare and evaluate ALR protein polyclonal antibody in recombinant rats,and how to construct prokaryotic expression vector.There are no repots concerning ALR in the central nervous system in China.OBJECTIVE:TO express ALR fusion protein in E coli BL21 and prepare and identify polyclonal antibody.METHODS:RNA was extracted from the hippocampus of Sprague Dawley rats.The prokaryotic expression plasmid pET28a-ALR was constructed and the positive recombinant plasmid was transformed into BL21.Protein ALR was expressed by inducing transformed BL21 with Isopropyl-β-D-thiogalactopyranoside(IPTG)and purified by Ni~(2+)affinity chromatography column after immune the rabbit for 4 times.the serum of rabbits was extracted from hear as polyclonal antibody.The titer and specificity of the rabbit's antiserum was respectively measured by ELISA and Western blotting The following parameters were measured:construction of prokaryotic expression plasmid pET26a-ALR;pET28a-ALR recombinant enzyme digestion evaluation;results of ELISA and Western-blotting.RESULTS AND CONCLUSION:Expecting bands were obtained by double enzyme digestion electrophoresis,respectively 5.3 kb and 0.4 kb.Nucleotide sequence analysis verified that prokaryotic expression vector pET28a-ALR was successfully constructed.The 19 ku fusion protein was successfuIly expressed.The titer of the antiserum measured by ELlSA could achieve 1:2 000 This indicated that antibody and purified recombinant ALR had a good reaction.and high titer.could meet the experimental require.Western blotting analysis proved that the antibody could identify the prokaryotic expression product of ALR.Prokaryotic expression system expressed ALR fusion protein,prepared and purified polyclonal antibody of ALR protein,and could meet the experimental require of ALR immunoblotting.

Adjuvant chemotherapy in hepatocellular carcinoma after liver transplantation / 国际外科学杂志

Liver transplantation may be the best curative treatment for patients with cirrhosis and primary hepatocellular carcinoma. However, tumor recurrence and metastasis is still a difficult problem of liver trans-plantation. Postoperative adjuvant chemotherapy has been employed in an attempt to eliminate micrometasta-ses, and could improve long-term survival after LT for hepatocellular carcinoma. Although the specific chem-otherapy and its efficacy remain controversial, it has been widely used as a safe, feasible and effective meth-od in several clincial institutions.