The learning curve of MAKO-assisted total knee arthroplasty / 中华骨科杂志

Objective:To explore the learning curve of MAKO-assisted total knee arthroplasty.Methods:From May 2021 to September 2022, 136 patients were conducted MAKO-assisted total knee arthroplasty in the PLA General Hospital, including 37 males and 99 females, 65.53±7.01 years old (range 54-80 years). All cases were patients with unilateral knee osteoarthritis. The operations were performed by three surgeons, respectively. Sixty-one cases were performed by surgeon 1, 47 cases were performed by surgeon 2, and 28 cases were performed by surgeon 3. Record the time of each step during the operation, and measure the limb alignment in X-ray. The statistical difference between the two groups was compared by t test by SPSS. The cumulative sum control chart (CUSUM) learning curve was modeled by curve fitting and R2 was used to testify the goodness. Results:The total operation time of the three surgeons was 114.3±25.1 min, 109.8±10.9 min, and 118.6±15.1 min, respectively. The time of each step in the first 10 cases and the last 10 cases of operator 1-3 was counted. The osteotomy time of surgeons 1, 2 and 3 in the final 10 cases was less than that in the initial 10 cases (surgeon 1: 13.5 ± 3.41 min vs. 8.0±1.58 min, t=4.30, P=0.001; surgeon 2: 13.7±3.02 min vs. 8.0± 2.58 min, t=4.77, P=0.001; surgeon 3: 15.3±3.97 min vs. 11.0±2.38 min, t=2.87, P=0.010), and the difference was statistically significant. The CUSUM of osteotomy was calculated and the curve was fitted. The highest point of the curve of the three surgeons was in the 16th, 18th and 12th patients, respectively, and the time of osteotomy continued to decline after passing the peak. No statistical differences were found in surgery time for the remaining steps. Comparing the lower alignment angles of intraoperative planning and postoperative X-ray films, the overall difference was greater than 1 degree. The difference was 1.41°±1.32° for operator 1, 1.34°±1.22° for operator 2, and 1.04°±0.88° for operator 3. The percentages of fully accurate implant size planning were 85.2%(52/61), 76.7%(36/47), and 85.7%(24/28), respectively. Conclusion:For MAKO-assisted total knee arthroplasty, the operator can decrease the operation time by practice, which is mainly reflected in the shortening of the osteotomy time. The learning curve threshold is around in the 15th case. The increase in the number of surgeries did not bring about changes in the accuracy of lower extremity alignment.

Progress in research into the wedge effect during cephalomedullary nailing for intertrochanteric fractures / 中华创伤骨科杂志

Surgical intervention is the first choice treatment for intertrochanteric fractures that are common in clinical practice. Cephalomedullary nailing with two parts inserted respectively into the femoral medullary cavity and femoral head has been the mainstream protocols for the elderly patients with intertrochanteric fracture, but insertion of the cephalomedullary nail may likely lead to the outward displacement of the femoral shaft and the inversion and rotation of the head and neck bone mass, namely the so-called wedge effect. However, few reports have dealt with how to prevent the wedge effect and reduce the complications it may cause such as coxa vara deformity. The present review expounds and analyzes the concept, biomechanical mechanism, influencing factors, measurements, and prevention methods of the wedge effect, hoping to help the surgeons who try to avoid the wedge effect in surgical treatment.

Analysis on Biomechanical Relationship Between Calcaneal Cyst Lesion Size and Pathological Fracture / 医用生物力学

Objective To investigate the relationship between lesion size of solitary bone cyst ( SBC) and pathological fracture of calcaneus, so as to provide references for the treatment of SBC. Methods The three dimensional (3D) finite element model of foot and ankle was established based on CT images. Four models with gradient spherical bone defects were constructed in the focal area to simulate different SBC lesion sizes, and the biomechanical characteristics of calcaneus in different gait phases were analyzed. Results With the increasement of SBC size, the kinematics of calcaneus did not change significantly, but the peak stress of calcaneus increased gradually. When the SBC size exceeded 75% of the calcaneal width, the stress in calcaneal sulcus and cortical bone below SBC increased by 1. 48 times and 7. 74 times, respectively. Conclusions The risk of pathological fracture increases when the SBC diameter exceeds 75% of the calcaneal width, and early surgical intervention should be recommended. The calcaneal sulcus and the cortex bone below SBC are stress concentration regions and can be used as important areas to evaluate pathological fractures.

Biomechanical analysis of four internal fixations for Pauwels Ⅲ femoral neck fractures with defects / 中国骨伤

OBJECTIVE@#To investigate the biomechanical characteristics of different internal fixations for Pauwels type Ⅲ femoral neck fracture with defect, and provide reference for the treatment of femoral neck fracture.@*METHODS@#Three-dimensional (3D) finite element models of femoral neck fractures were established based on CT images, including fracture and fracture with defects. Four internal fixations were simulated, namely, inverted cannulated screw(ICS), ICS combined with medial buttress plate, the femoral neck system (FNS) and FNS combined with medial buttress plate. The von Mises stress, model stiffness and fracture displacements of fracture models under 2 100 N axial loads were measured and compared.@*RESULTS@#When femoral neck fracture was fixed by ICS and FNS, the peak stress was mainly concentrated on the surface of the screw near the fracture line, and the peak stress of FNS is higher than that of ICS;When the medial buttress plate was combined, the peak stress was increased and transferred to medial buttress plate, with more obvious of ICS fixation. For the same fracture model, the stiffness of FNS was higher than that of ICS. Compared with femoral neck fracture with defects, fracture model showed higher stiffness in the same internal fixation. The use of medial buttress plate increased model stiffness, but ICS increased more than FNS. The fracture displacement of ICS model exceeded that of FNS.@*CONCLUSION@#For Pauwels type Ⅲ femoral neck fracture with defects, FNS had better biomechanical properties than ICS. ICS combined with medial buttress plate can better enhance fixation stability and non-locking plate is recommended. FNS had the capability of shear resistance and needn't combine with medial buttress plate.

Tiaoshen Jieyu acupuncture combined with sertraline hydrochloride tablet for post-stoke depression: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between Tiaoshen Jieyu acupuncture (acupuncture for regulating mind and relieving depression) combined with sertraline hydrochloride tablet and simple sertraline hydrochloride tablet for post-stroke depression (PSD).@*METHODS@#A total of 76 patients with PSD were randomized into an observation group (38 cases, 6 cases dropped off) and a control group (38 cases, 4 cases dropped off). Both groups were treated with conventional treatment i.e. controlling blood pressure and anti-inflammation. Sertraline hydrochloride tablet was given orally in the control group, 20 mg a time, once a day. On the basis of the treatment in the control group, Tiaoshen Jieyu acupuncture was applied at Baihui (GV 20), Yintang (GV 24+), Neiguan (PC 6), Taichong (LR 3), etc. in the observation group, Baihui (GV 20) and Yintang (GV 24+) were connected to electroacupuncture, with disperse-dense wave, 2 Hz/100 Hz in frequency, 30 min a time, once a day, 6 times a week. Treatment of 8 weeks was required in both groups. Before and after treatment, the scores of Hamilton depression scale (HAMD), National Institutes of Health stroke scale (NIHSS), Barthel index (BI) and Pittsburgh sleep quality index (PSQI) were observed respectively, the therapeutic efficacy and rate of adverse reactions were evaluated in the two groups.@*RESULTS@#After treatment, the scores of HAMD, NIHSS and PSQI were lower while BI scores were higher than those before treatment in both groups (P<0.05); the scores of HAMD, NIHSS and PSQI in the observation group were lower while BI score was higher than those in the control group (P<0.05). The total effective rate was 93.8% (30/32) in the observation group, which was higher than 70.6% (24/34) in the control group (P<0.05). The rate of adverse reactions was 9.4% (3/32) in the observation group, which was lower than 32.4% (11/34) in the control group (P<0.05).@*CONCLUSION@#Tiaoshen Jieyu acupuncture combined with sertraline hydrochloride tablet can improve the depression degree, neurological function, activity of daily living and sleep quality in patients with post-stroke depression, the clinical efficacy is superior to simple sertraline hydrochloride, and can alleviate the adverse reactions caused by medication.

Value of 18F-FDG PET/CT Imaging in Secondary Extramedullary Infiltration of Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To investigate the characteristics of 18F-FDG PET/CT images of multiple myeloma secondary extramedullary infiltration in order to improve recognition.@*METHODS@#Twenty-one patients with multiple myeloma secondary extramedullary infiltration confirmed by pathology or follow-up from January 2012 to October 2020 in the First Affiliated Hospital of University of Science and Technology of China were retrospectively analyzed. All the patients underwent 18F-FDG PET/CT imaging before treatment, and the PET/CT characteristics of extramedullary infiltration and bone marrow were analyzed.@*RESULTS@#Twenty-one patients included 12 males and 9 females, aged from 41 to 77 years old, with an average of 58.3±10.0; 9 cases of extramedullary infiltration involving lymph nodes; lung, stomach, spleen, and kidney were involved respectively in 2 cases; retroperitoneal, right auricle, subcutaneous nodule, and spinal meninges involvement were reported in each one case respectively. The maximum SUVmax value of extra-medullary lesions was 21.2, the minimum value was 2.1, and mean was 7.7±5.3. The maximum SUVmax value of bone marrow was 33.5, the minimum was 2.4, and mean was 6.6±3.6. There was no statistically significant difference in SUVmax value between extra-medullary lesions and bone marrow (Z=-1.195, P=0.232).@*CONCLUSION@#18F-FDG PET/CT not only has a good diagnostic value for multiple myeloma, but also a good evaluation value for secondary extramedullary infiltration, which provides reference for clinical treatment and prognosis.

Leg length discrepancy after total hip arthroplasty: a comparison between robotic-assisted and coventional implantation / 中华骨科杂志

Objective:To compare the difference of LLD (leg length discrepancy) between robot-assisted and conventional methods of total hip arthroplasty (THA).Methods:Data of 38 patients who had THA performed by robot-assisted or conventional methods from January 2019 to May 2020 were retrospectively analyzed. There were 38 cases (54 hips) in robot-assisted THA group (robot group) with 18 males and 20 females (age 53.5±13.6 years, BMI 26.2±3.4 kg/m 2), and there were 21 cases (32 hips) with osteonecrosis of the femoral head, 17 cases (22 hips) with Crown typeⅠandⅡdevelopmental dysplasia of the hip. There were 38 cases (54 hips) in conventional THA group (conventional group), with 19 males and 19 females, (age 52.3±14.7 years old, BMI 25.7±2.9 kg/m 2), and there were 19 cases (30 hips) with developmental dysplasia of the hip, and 19 cases (24 hips) with osteonecrosis of the femoral head. The operative time, postoperative LLD, Harris score, forgotten joint score-12 (FJS-12) and the difference between preoperative and postoperative LLD between the two groups were compared, and the correlation between surgical methods and the change of hip length was also evaluated. Results:The operation time of the robot group was 73.3±14.1 min and which was 59.3±12.6 min in conventional THA group ( t=2.732, P=0.003). In the robot group, the postoperative LLD was 2.3±3.4 mm, which was less than that of the conventional group 6.7±5.4 mm ( t=3.521, P < 0.001). When the absolute value of LLD was larger than 5 mm as an abnormal value, it was 2.6% (1/38) in the robot group and 47.3% (18/38) in the conventional group. The difference of hip length (HL) in planning and post-operation in the robot group was 2.8±2.2 mm, which was smaller than that in the conventional THA group 7.9±5.3 mm ( t=2.357, P < 0.001). In addition, there was a correlation between the change of hip length results and the postoperative measurement of hip length in the robot group ( r=0.983, P < 0.001). At the last follow-up, Harris score and FJS-12 were recorded in the robot group and coventional group. The scores were 83.1±5.3 and 32.5±4.9 respectively in the robot group, 82.9±7.2 and 31.9±6.7 in the conventional group, respectively. There was no significant difference between the two groups ( t=0.221, 0.356; P=0.819, 0.731). Postoperative bleeding occurred in 1 case in the robot group with postoperative suture healed well. The fracture of the posterior wall of the acetabulum was found in the conventional group and the patient avoids weight bearing 4 weeks after operation. The postoperative recovery was good and no other related complications were found. Conclusion:Robot-assisted THA can accurately restore the length of both legs and reduce LLD compared with conventional THA. The real-time monitoring of LLD during robot operation can give the operator an accurate reference.

Research progress concerning intramedullary nail fixation for calcaneal fractures / 中华创伤骨科杂志

Calcaneal fractures, common injury to foot, usually require surgery if complicated with an obvious displacement. Since open reduction and internal plate fixation often leads to wound infection, more and more minimally invasive surgery has been adopted for calcaneal fractures. As a minimal invasive treatment, intramedullary fixation can be used to treat calcaneal fractures of Sanders types Ⅰ-Ⅳ. Calcanail and C-Nail are 2 major types of intramedullary nails that have been used to treat calcaneal fractures in Europe and the United States since 2011. This article reviews the basic structural features, biomechanical properties, surgical procedures and clinical efficacy of these intramedullary nails.

Application evaluation of a rapid fluorescence quantitative PCR method for the detection of SARS-CoV-2 / 中华微生物学和免疫学杂志

Objective:To establish and evaluate a rapid nucleic acid detection method for SARS-CoV-2 based on COYOTE ? Flash20 real-time fluorescent quantitative PCR instrument. Methods:A rapid reaction system was constructed by using specific primer and probe sets targeting ORF1ab and N gene of SARS-CoV-2, and the sensitivity and specificity of the system were verified. At the same time, 108 clinical samples of COVID-19 were used to evaluate the application of this method.Results:The detection method did not require nucleic acid extraction, and the manual operation time was only one minute. After the sample was sent to the system, the test could be completed in 30 minutes. The detection limit of this method was 4×10 2 copies/ml. It had no cross-reactivity with other human coronaviruses (including HCoV-229E, HCoV-NL63, HCoV-OC43, HCoV-HKU1, SARS-CoV and MERS-CoV) and other respiratory viruses. The evaluation of clinical sample application showed that the total coincidence rate with the conventional RT-qPCR which required nucleic acid extraction was 98.15%. Conclusions:Through the application evaluation of the rapid fluorescent quantitative PCR method of SARS-CoV-2, it was found that the method was simple, fast, specific and sensitive, and it was suitable for real-time and rapid detection needs in varieties of situations.

Effect of Danggui Buxuetang on Functional Activity of Endothelial Progenitor Cells Exposed to Shear Stress / 中国实验方剂学杂志

Objective:To investigate the effect of Danggui Buxuetang（DGBX）on the functional activity of rat endothelial progenitor cells（EPCs）exposed to different luminar shear stress （SS）. Method:EPCs isolated from rat bone marrow were incubated on a parallel plate flow chamber at a steady SS of 0， 0.12， 1.2， 2.4 Pa for 6 h，then the cells exposed to different SS were randomly divided into 8 groups： control group （perfused with serum free medium），simvastatin group（0.1 μmol·L^-1simvastatin），3 DGBX groups（low，medium，high-dose DGBX）and 3 inhibitor groups（3 DGBX groups with LY294002）. After 12 h，the samples were collected for the detection of cell proliferation ，migration，tubule formation ，the secretion of nitric oxide （NO） ，and the expressions of endothelial nitric oxide synthase（eNOS） mRNA and protein kinase B（Akt），respectively. Result:Compared with the control group，simvastatin and DGBX（high-dose）could both promote the functional activities and NO secretion，and up-regulate the expressions of eNOS mRNA and Akt protein in EPCs exposed to different SS（<italic>P</italic><0.05），while DGBX（mid-dose）could do these only at 0 Pa. However，LY294002 could inhibit all effects of DGBX on EPCs. Conclusion:SS seems to play an important role in the effect of DGBX on EPCs，and DGBX could promote the functional activity of EPCs exposed to SS by up-regulating the expressions of NO/eNOS/Akt.

Biomechanical Comparison of Two-Point and Three-Point Fixation for Treating SandersⅢ Calcaneal Fracture / 医用生物力学

Objective To analyze the biomechanical feasibility of two-point fixation by distal radius plate for the treatment of SandersⅢ calcaneal fractures. Methods The three-dimensional (3D) finite element musculoskeletal foot model was established based on CT and MRI images, which comprised bones, muscles, plantar fascia, ligaments and soft tissues. After validation, the SandersⅢ calcaneal fracture models fixed by distal radial plate (two-point fixation) and calcaneal plate (three-point fixation) were established, so as to compare the biomechanical characteristics of two calcaneal models. Results The maximum stress of the two-point fixation and three-point fixation model was 324.70 and 407.90 MPa, respectively. The maximum displacements of the two models were 2.498 and 2.541 mm, respectively. There was no significant difference in the posterior articular surface displacement between the two models. In both models, the Bohler’s angle and Gissane’s angle were within the normal range. Conclusions The two-point fixation by distal radial plate can satisfy the biomechanical stability of calcaneal fracture treatment. Compared with traditional steel plate, the two-point fixation shows the advantage of smaller surgical trauma, more uniform overall stress distribution, early weight-bearing rehabilitation after surgery, which is a novel treatment recommended for treating calcaneal fractures.

Research progress of medial buttress plate assisted fixation for femoral neck fractures in young adults / 中国修复重建外科杂志

Objective: To summarize the research progress of medial buttress plate assisted fixation for femoral neck fractures in young adults. Methods: The literature about buttress plate assisted fixation for femoral neck fractures in young adults was widely reviewed and analyzed. The design principle, background, biomechanical characteristics, and clinical results of buttress plate were summarized. Results: Medial buttress plate assisted fixation is the latest treatment of femoral neck fractures in young adults, which can convert the shear force at the fracture sides into compression force and promote fracture healing. Medial buttress plate can improve the biomechanical stability of femoral neck fractures and reduce the maximum stress of fixation implants. In clinical, the medial buttress plate can maintain fracture reduction, reduce the incidences of nonunion and surgical failure, and improve hip joint function. Conclusion: Medial buttress plate assisted fixation can achieve good effectiveness for femoral neck fractures in young adults. However, due to the preliminary application, its indications, fixation implants, and long-term effectiveness need to be further studied and improved.

Spinal P2X7R contributes to streptozotocin-induced mechanical allodynia in mice / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Painful diabetic neuropathy (PDN) is a diabetes mellitus complication. Unfortunately, the mechanisms underlying PDN are still poorly understood. Adenosine triphosphate (ATP)-gated P2X7 receptor (P2X7R) plays a pivotal role in non-diabetic neuropathic pain, but little is known about its effects on streptozotocin (STZ)-induced peripheral neuropathy. Here, we explored whether spinal cord P2X7R was correlated with the generation of mechanical allodynia (MA) in STZ-induced type 1 diabetic neuropathy in mice. MA was assessed by measuring paw withdrawal thresholds and western blotting. Immunohistochemistry was applied to analyze the protein expression levels and localization of P2X7R. STZ-induced mice expressed increased P2X7R in the dorsal horn of the lumbar spinal cord during MA. Mice injected intrathecally with a selective antagonist of P2X7R and P2X7R knockout (KO) mice both presented attenuated progression of MA. Double-immunofluorescent labeling demonstrated that P2X7R-positive cells were mostly co-expressed with Iba1 (a microglia marker). Our results suggest that P2X7R plays an important role in the development of MA and could be used as a cellular target for treating PDN.

Short-term clinical outcomes of robotic-assisted total hip arthroplasty in osteonecrosis of the femoral head patients / 中华骨科杂志

Objective:To explore the radiology and short-term clinical outcomes of MAKO robotic-assisted total hip arthroplasty (THA).Methods:The present study retrospectively reviewed the medical records of 23 patients (32 hips) who diagnosed as osteonecrosis of the femoral head and underwent MAKO THA from August 1st to December 31st, 2018 as MAKO THA group. A total of 23 patients (32 hips) with the same diagnosis underwent manual THA at the same time as conventional THA group. There was no statistical difference between the two groups in terms of gender, affected side, age, height, weight, Body Mass Index (BMI), stage of the Association Research Circulation Osseous (ARCO), preoperative Harris hip score, WOMAC Osteoarthritis Index and limb length discrepancy. The patients in both groups were operated by the same doctors. The MAKO THA group underwent the acetabular preparation and the acetabular shell impaction with the assistance of the robotic arm. The leg length and offset were adjusted under the feedback of the MAKO system. Other intraoperative procedures and postoperative interventions of MAKO THA group were similar as conventional THA group. The operation duration, incidence of complications, the radiograph parameters (version, leg length discrepancy and offset), consistency of acetabular prosthesis position in MAKO operation plan, position in postoperative X-ray, the consistency of acetabular prosthesis inclination, version in MAKO operation plan, angles in postoperative CT and functional scores (Harris hip score, WOMAC Osteoarthritis Index and forgotten joint score) at 6 months and 12 months after operation were compared between the two groups.Results:The operation duration of the MAKO THA group was longer than that of the conventional THA group (101.2±19.9 min, 65.5±5.6 min, t=7.659, P<0.001). In terms of radiograph parameters, the different of version (22.63°±5.58°, 15.98°±7.13°, t=4.156, P<0.001) and limb length discrepancy (0.35±0.30 cm, 0.87±0.43 cm, t=4.775, P<0.001) and offset (0.27±0.19 cm, 0.49±0.16 cm, t=4.155, P<0.001) between the two groups were statistically significant. The MAKO operative plan and postoperative radiographs were measured. The difference of inclination/version were 1.18°±2.52°/2.06°±2.79° ( r=0.846, P<0.001; r=0.810, P<0.001), respectively. The horizontal/vertical directions of the joint rotation center were 2.25±1.08 mm and 2.20±1.28 mm ( r=0.975, P<0.001; r=0.974, P<0.001), respectively. In terms of functional results at 6 months and 12 months after operation, Harris hip score in MAKO THA group and in conventional THA group was 90.2±5.40/89.9±5.23 ( t=0.188, P=0.851) and 93.9±2.31/94.0±2.61 ( t=0.254, P=0.801), respectively. The WOMAC index was 27.3±10.36/29.1±12.03 ( t=0.623, P=0.535) and 16.4±8.39/15.2±8.35 ( t=0.597, P=0.552). The forgotten joint score was 76.3±6.11/73.7±6.84 ( t=1.560, P=0.124) and 81.7±4.52/80.7±5.11 ( t=0.816, P=0.418), respectively. Transient bleeding in the anterior superior iliac spine pin holes were reported in 4 hips after discharge in MAKO THA group, which were healed after dressing change. No other intraoperative or postoperative complication was reported. Conclusion:Robotic-assisted THA were more accurate and stable than conventional THA. The version of robot-assisted THA was closer to the target of 20° with similar discrepancy in leg length and hip offset. The short-term functional outcomes were similar in the two groups. However, the operation duration of robot-assisted THA was prolonged.

Factors affecting the outcome of surgical treatment for intertrochanteric fractures / 中华创伤杂志

Objective:To investigate the factors affecting the outcome of surgical treatment for femoral intertrochanteric fractures.Methods:A retrospective case series study was conducted for 424 patients with intertrochanteric fractures admitted to four hospitals in Shanghai from January 2014 to December 2016. There were 200 males and 224 females, aged 45-98 years [(77.8±10.5)years]. Normal union was observed in 326 patients (normal union group), and abnormal union was founded in 98 patients including nonunion in 2 patients (abnormal union group). Data were recorded including the age, gender, injury side, AO classification, Evans-Jesen classification, thickness of femoral lateral wall, medial support, tip-apex distance, and screw position within the femoral head. Fracture healing was assessed. Univariate analysis was conducted to examine differences of the above factors between two groups, and Logistic regression was used to screen the main factors affecting fracture union. At the latest follow-up, the hip joint function was estimated according to the Oxford score system.Results:All patients were followed up for 1-3 years [(2.2±0.3)years]. Univariate analysis showed significant differences between two groups regarding the AO classification, Evans-Jesen classification, medial support, tip-apex distance, and screw position within the femoral head ( P<0.05). Multivariate regression analysis revealed that the simple fracture ( OR=1.030), medial support ( OR=0.395), tip-apex distance ≤25 mm ( OR=0.266) and inferior screw position ( OR=0.986) were significantly related to fracture union. The hip function in normal union group was (42.6±4.5)points, better than (35.4±3.2)points in abnormal union group ( P<0.05). Conclusion:The stability of intertrochanteric fracture is the most important factor for fracture union. The medial support, tip-apex distance ≤25 mm and inferior screw position are helpful to promote fracture healing and recovery of hip joint function.

Expert consensus on microbiome sequencing and analysis / 生物工程学报

In the past ten years, the research and application of microbiome has continued to increase. The microbiome has gradually become the research focus in the fields of life science, environmental science, and medicine. Meanwhile, many countries and organizations around the world are launching their own microbiome projects and conducting a multi-faceted layout, striving to gain a strategic position in this promising field. In addition, whether it is scientific research or industrial applications, there has been a climax of research and a wave of investment and financing, accordingly, products and services related to the microbiome are constantly emerging. However, due to the rapid development of microbiome sequencing and analysis related technologies and methods, the research and application from various countries have not yet unified on the standards of technology, programs, and data. Domestic industry participants also have insufficient understanding of the microbiome. New methods, technologies, and theories have not yet been fully accepted and used. In addition, some of the existing standards and guidelines are too general with poor practicality. This not only causes obstacles in the integration of scientific research data and waste of resources, but also gives related companies unfair competition opportunity. More importantly, China still lacks national standards related to the microbiome, and the national microbiome project is still in the process of preparation. In this context, the experts and practitioners of the microbiome worked together and developed the consensus of experts. It can not only guide domestic scientific research and industrial institutions to regulate the production, learning and research of the microbiome, the application can also provide reference technical basis for the relevant national functional departments, protect the scale and standardized corporate company's interests, strengthen industry self-discipline, avoid unregulated enterprises from disrupting the market, and ultimately promote the benign development of microbiome-related industries.

Aapplication and clinical value of total pancreatectomy that combined vascular reconstruction with en bloc resection through both left and right pathways in pancreatic neck tumor / 中国实用外科杂志

OBJECTIVE: To investigate the application and clinical value of total pancreatectomy that combined vascular reconstruction with en bloc resection through both left and right pathways in pancreatic neck tumor. METHODS: The clinical data concerned about 12 patients of pancreatic neck tumor accepted total pancreatectomy combined vascular reconstruction with en bloc resection through both left and right pathways in Changhai Hospital,Naval Military Medical University between March 2015 and March 2017 were analyzed retrospectively. The clinical data especially the data in general situation,operation,hospital stay,perioperative complications,postoperative pathology,condition of surgical margin,postoperative survival time and prognosis were analyzed. RESULTS: All of the 12 patients were diagnosed with pancreatic neck tumor infringing the peripancreatic arteriovenous vein and had accepted total pancreatectomy joint with intravenous resection and reconstruction. The median age of patients was 58 years,whose median BMI reached 23.41,and the number of males was up to 6,equal as females. The information about the operation was as follows:no intraoperative death case,median surgery time being 235 min,median intraoperative blood loss being 800 m L,median plasma-reduced blood transfusion volume being 600 mL,median resection length of vessel being 4.10 cm,median time of portal vein blocking being 15 min. After the operation,9 cases were conducted to large tissue biopsy examination with R0 resection rate of 91.7%. Besides,all the patients were managed with ERAS technique with the postoperative pain relief rate of 100%. Only one case suffered from gastric emptying disorder(Grade A)and two cases had infection. No patients died 30 days after operation,whose median postoperative hospital stay was 12 days and median survival time was 19.8 months. CONCLUSION: The total pancreatectomy combined vascular reconstruction with en bloc resection through both left and right pathways is safe and efficient to treat pancreatic neck tumor,improving operation security and living quality of patients. However,the surgery is so difficult that it could only be applied in certain pancreatic surgery centers with high levels.

Landscape of PD-1/PD-L1 Regulation and Targeted Immunotherapy / 中国医学科学杂志(英文版)

Programmed cell death protein 1 (PD-1)/programmed death ligand 1 (PD-L1) is a significant immune checkpoint, and the dysfunction of this axis contributes to tumor metastasis and immune escape. PI3K/Akt/mTOR and MAPK signal network induces PD-1/PD-L1 expression and facilitates tumor progression. Transcriptional factors such as hypoxia induced factors, PTEN, p53, CDK5, BRD4, STAT modulate PD-1/PD-L1 expression. PD-1/PD-L1 level is also regulated via epigenetic and post-translational manner. The underlying mechanisms mentioned above may provide potential targets for tumor treatment. At present, the combination therapy of PD-1/PD-L1 monoclonal antibodies plus small molecular inhibitors has achieved good outcomes in tumor treatment.

Research progress of regulation mechanism of innate immunity in malaria / 中国药理学通报

Malaria is a kind of disease detrimental to human health and plasmodium is a critical pathogen in it. The immunity against foreign antigens including plasmodium could be divided into two categories, namely, adaptive immunity and innate im-munity. Innate immunity induces non-specific immune response, and is composed of monocyte,macrophage,γδT cell,DC,NK, and cytokines etc. Innate immunity cooperates with adaptive im-munity efficiently to protect against malaria. Meanwhile,autoph-agy is not only the cellular degrading process, but also gets in-volved in regulating immune system and defending against plas-modium infection. Therefore, elucidation of corresponding mechanism could provide proof for efficiently controlling and cu-ring malaria,developing related medicine and vaccine,and clin-ical treatment as well. This article reviews the constitution of in-nate immunity in malaria,related regulation mechanism and rel-evant therapeutic targets for it.

Comparison of patient-specific distal femoral cutting guide and conventional instruments in total knee arthroplasty / 中华骨科杂志

Objective To design a patient-specific distal femoral cutting guide for total knee arthroplasty using rapid prototyping and 3D printing technology and compare with conventional instrumentation.Methods A prospective self-control study was performed in 32 patients who underwent bilateral total knee arthroplasty between March 2015 and November 2015 in our department.The bilateral knee joints were randomly divided into patient-specific guide group and traditional surgery group.The patient-specific guide group obtained CT data of the lower extremities preoperatively.Patient-specific distal femoral cutting guides were designed and manufactured using rapid prototyping and 3D printing techniques.The traditional surgery group were performed using conventional instrumentation.The operation time of the two groups was recorded,and the amount of distal femoral osteotomy was measured.Postoperative alignments were measured including the angle of the lower limb mechanical axis angle (hipknee-ankle Angle,HKA),the mechanical lateral distal femoral angle (mLDFA),and the mechanical proximal tibial angle (mMPTA).In different follow-up points Hospital for Specific Surgery scores of the knee were recorded.Results In the coronal position,the postoperative mLDFA was 90.34°± 1.6° in the patient-specific guide group and 91.37°± 1.8° in the conventional surgery group.The difference between the two groups was statistically significant (t=-2.452,P=0.020).In the patient-specific guide group,the HKA angle was 0.36°±2.35°,and the conventional surgery group was 0.87°±1.85°.The difference between the two groups was statistically significant (t=-2.332,P=0.043).If preoperative mLDFA≤93°,there was no significant difference in postoperative mLDFA between the two groups (t=-1.409,P ＞ 0.05).If preoperative mLDFA ＞ 93°,there was a significant difference in postoperative mLDFA between the two groups (t=-4.145,P=0.004).In addition,the operation time of the patient-specific guide group was significantly shorter (t=-2.425,P ＜ 0.05),but the two groups did not have significant functional differences in the early postoperative period.Conclusion The 3D-printed patient-specific distal femoral cutting guide can significantly shorten the operation time and improve postoperative alignments.It is simple to operate.However,large sample sizes and long-term follow-up studies are still needed to verify their long-term effects.