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OBJECTIVE@#To investigate the short-term effectiveness of calcaneal lateral displacement osteotomy with lateral ligament repair in the treatment of Takakura stage Ⅱ varus-type ankle arthritis.@*METHODS@#A retrospective analysis was performed on the clinical data of 13 patients with Takakura stage Ⅱ varus-type ankle arthritis treated with calcaneal lateral displacement osteotomy with lateral ligament repair between January 2016 and December 2020. There were 6 males and 7 females aged 31-65 years, with an average age of 53.6 years. The preoperative tibial-ankle surface angle (TASA) was (88.13±1.01)°, medial distal tibial angle (MDTA) was (86.36±1.49)°, tibial talar surface angle (TTSA) was (6.03±1.63)°, talar tilting angle (TTA) was (81.95±2.15)°, and tibiocalcaneal axis angle (TCAA) was (-5.74±6.81)°. The preoperative American Orthopedic Foot and Ankle Society (AOFAS) score was 56.3±7.1 and the pain visual analogue scale (VAS) score was 3.7±0.5. AOFAS scores, VAS scores, TTSA, TTA, and TCAA were compared between pre- and post-operatively.@*RESULTS@#All 13 patients were followed up 14-41 months, with an average of 28.7 months. The osteotomies healed in all patients. The last follow-up revealed TTA, TTSA, and TCAA to be (88.27±1.19)°, (-0.13±1.37)°, and (2.09±5.10)° respectively, the AOFAS score was 84.3±4.2 and the VAS score was 0.7±0.5, all showing significant improvement when compared to preoperative values ( P<0.05).@*CONCLUSION@#For patients with Takakura stage Ⅱ varus-type ankle arthritis, calcaneal lateral displacement osteotomy with lateral ligament repair can correct the lower limb force line, regain ankle stability, and achieving good short-term effectiveness.
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Male , Female , Humans , Middle Aged , Ankle , Retrospective Studies , Ankle Joint/surgery , Osteoarthritis/surgery , Osteotomy , Collateral Ligaments , Treatment OutcomeABSTRACT
Objective:To investigate the correlation between serum concentration of vasohibin-1 (VASH-1) and urinary albumin creatinine ratio (UACR) in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy.Methods:The clinical data of 196 patients with T2DM from February 2017 to December 2020 were analyzed retrospectively. According to whether diabetic nephropathy (DN) was combined, 33 patients without DN of T2DM were divided into the control group,and 163 patients with DN of T2DM were divided into the case group, and the case group was divided into four groups:normal albuminuria group (groupⅠ, UACR <30 mg/g, 21 cases),microalbuminuria group (groupⅡ, UACR ≥30-≤300 mg/g, 50 cases), clinical albuminuria group (group Ⅲ, UACR>300 mg/g, 43 cases), and clinical albuminuria hypertensive group (groupⅣ, UACR >300 mg/g with hypertension, 49 cases). Serum levels of VASH-1,C-reactive protein(CRP), erythrocyte sedimentation rate (ESR) and transforming growth factor β1 (TGF-β1) with other biochemical indicators were measured. T-test was used for comparison between measurement data groups in accordance with normal distribution, one-way ANOVA was used for comparison between multiple groups, q-test was used for pairwise comparison, and χ2 test was used for comparison between counting data groups. The influencing factors were analyzed by multivariate Logistic regression.Pearson correlation analysis was used to analyze the correlation between vash-1 and UACR. Results:UACR((1 175.9±120.4) mg/g), CRP((9.80±2.01) mg/L), ESR((20.61±2.20) mm/h),TGF-β1((16.75±2.05) μg/L), VASH-1((645.3±183.5) ng/L) in case group were higher than that in the control group((11.5±2.0) mg/g, (4.77±1.34) mg/L, (8.33±1.56) mm/h, (10.63±1.97) μg/L, (416.3±162.1) ng/L), and there were significant differences between the two groups ( t=123.39,13.76,30.54,15.75,6.66; all P<0.001). Multivariate logistic regression analysis showed that VASH-1 ( OR=1.881,95% CI 1.146-3.089), UACR( OR=1.511,95% CI 1.064-2.146), TGF-β1( OR=1.846,95% CI 1.135-3.001)were all risk factors for DN of T2DM ( P values were 0.009, 0.022 and 0.012). Serum VASH-1 ((693.5±201.4), (709.8±214.7) ng/L] in group Ⅲ and group Ⅳ were higher than those in group Ⅰ and group Ⅱ ((585.3±162.1), (632.9±165.5) ng/L). There was significant difference between the two groups ( F=129.46, P<0.001). The CRP ((7.08±1.36), (8.99±3.72), (10.58±3.48), (11.64±3.50) mg/L), ESR ((17.36±1.76), (19.05±4.12), (21.45±5.74), (22.69±9.13) mm/h) and TGF- β1 ((14.75±1.97), (16.50±1.90), (17.06±1.23), (18.39±1.46) μg/L) of groupⅠ, groupⅡ, groupⅢ and groupⅣ increased gradually, and there were significant differences between the four groups ( F values were 73.48, 156.61, 25.83; all P<0.001). Pearson correlation analysis showed that there was a significant positive correlation between VASH-1 and UACR ( r=0.532, P=0.008). Conclusion:The concentration of VASH-1 in serum of patients with T2DM complicated with DN increased with the increase of UACR. VASH-1 may become a new marker for predicting early DN of T2DM.
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Objective:To observe the clinical characteristics of esophageal reflux after total gastrectomy (ERATG), and to explore the mechanism of occurrence.Methods:Fourteen gastric cancer patients who underwent total gastrectomy were prospectively enrolled in this study. The postoperative symptoms were observed and recorded and 24 h MII-pH with pH monitoring was performed to investigate the characteristics of postoperative reflux.Results:After total gastrectomy patients were with different degrees of ERATG as heartburn, appetite loss, chest tightness and belching. The overall nature of ERATG is mainly weak acid, with a pH between 4 and 7. ERATG involved esophageal-jejunal anastomosis and a length of esophagus 7 cm above the anastomosis. Patients with typical reflux symptoms had a lower pH minimum in the upright position than those without typical symptoms[(4.76±0.71) vs.(5.68±0.37), t=2.866, P<0.05]. Patients with typical reflux symptoms had a higher frequency of reflux of mixed liquid and liquid-air reflux than those without typical symptoms[liquid(31.25±29.76) vs.(4.50±9.14), t=0.011, P<0.05; liquid-air(19.50±12.99) vs.(2.00±2.61), t=0.004, P<0.05]. Conclusion:ERATG is mainly a upward reflux of weakly acidic gas, with typical symptoms of heartburn, appetite loss, chest tightness and belching. Patients with typical symptoms usually have lower pH in the upright position.
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Background@#Diabetes-related neuropathic pain frequently occurs, and the underpinning mechanism remains elusive. The periaqueductal gray (PAG) exhibits descending inhibitory effects on central pain transmission. The current work aimed to examine whether inflammatory cytokines regulate mechanical allodynia and thermal hyperalgesia induced by diabetes through the phosphoinositide 3-kinase (PI3K)-mammalian target of rapamycin (mTOR) pathway in the PAG. @*Methods@#Streptozotocin (STZ) was administered intraperitoneally to mimic allodynia and hyperalgesia evoked by diabetes in rats. Behavioral assays were carried out for determining mechanical pain and thermal hypersensitivity. Immunoblot and ELISA were performed to examine PAG protein amounts of interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α), as well as their corresponding receptors in STZ rats, and the expression of PI3K/protein kinase B (Akt)/mTOR signaling effectors. @*Results@#Increased PAG p-PI3K/p-Akt/p-mTOR protein amounts were observed in STZ-induced animals, a PI3K-mTOR pathway inhibition in the PAG attenuated neuropathic pain responses. Moreover, the PAG concentrations of IL-1β, IL-6, and TNF-α and their receptors (namely, IL-1R, IL-6R, and tumor necrosis factor receptor [TNFR] subtype TNFR1, respectively) were increased in the STZ rats. Additionally, inhibiting IL-1R, IL-6R, and TNFR1 ameliorated mechanical allodynia and thermal hyperalgesia in STZ rats, alongside the downregulation of PI3K-mTOR signaling. @*Conclusions@#Overall, the current study suggests that upregulated proinflammatory cytokines and their receptors in the PAG activate PI3K-mTOR signaling, thereby producing a de-inhibition effect on descending pathways in modulating pain transmission, and eventually contributing to neuropathic pain.
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Objective:To investigate the safety of endoscopic retrograde cholangiopancreatogra-phy(ERCP)and its associated treatments in the elderly aged 65 years and over, and analyze the related factors leading to postoperative complications.Methods:Totally 512 patients who received ERCP and its associated treatments in the Department of Gastroenterology, Peking University People's Hospital from January 2013 to January 2019 were included retrospectively.The clinical data, operative procedures and postoperative complications were collected.The differences in underlying diseases, operative procedures and postoperative complications between the elderly group(≥65 years old, n=301)and the non-elderly group(n=211)were compared, and the correlations between them were analyzed.Results:The proportion of hypertension, diabetes, heart disease and diverticulum beside the nipple was higher in the elderly group than in the non-elderly group(all P<0.01). The proportion of preoperative medication of anticoagulant and antiplatelet drugs was higher in the elderly group than in the non-elderly group(all P<0.01). There were no significant differences in cholelithiasis, history of biliary surgery, history of ERCP, immunity disease and tumor between the two groups(all P>0.05). Endoscopic sphincterotomy was the most common ERCP-associated treatments in both groups, followed by the order of endoscopic balloon dilation of the nipple, endoscopic biliary stent drainage, pancreatic duct intubation, and pancreatic duct stenting.The proportions of endoscopic papillary balloon dilation and endoscopic biliary stent drainage were 34.6%(104 cases)and 18.9%(57 cases)respectively, in the elderly group, which were statistically significantly higher than 25.6%(54 cases)and 11.4%(24 cases)in the non-elderly group(all P<0.05). The common bile duct diameter and maximum stone diameter were(1.32±0.43)cm and(1.04±0.53)cm, respectively in the elderly group, which were statistically significantly higher than those in the non-elderly group(1.16±0.40)cm and(0.81±0.03)cm respectively, ( t values were -4.23 and -4.76, respectively, all P<0.01). The proportions of endoscopic papillary balloon dilation and biliary stent drainage were statistically significantly higher in elderly patients than in non-elderly patients(all P<0.05). The incidence of intraoperative bleeding was 4.0%(12 cases)and 5.7%(12 cases)in the elderly group and non-elderly group, respectively, with no statistical significance( χ2=0.08, P>0.05). There was no significant difference in the incidence of postoperative pancreatitis, bleeding, perforation, infection and contrast agent-related complications(all P>0.05). Conclusions:Clinically widely used high-risk endoscopic papillary balloon dilation and endoscopic biliary stent drainage(ERCP-associated treatments)are frequently performed in elderly patients, and do not increase intraoperative bleeding and postoperative complications in the elderly.Therefore, ERCP-associated treatments are safe for the elderly.
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Objective:To investigate the current status of satisfaction with training program and loyalty to the university among professional postgraduate students majoring in clinical medicine, as well as the association between satisfaction with training program and loyalty to the university.Methods:The 2017 National Medical Student Satisfaction Survey Database was used. A total of 1 944 professional postgraduate students in the second or third year, as well as those with delayed graduation, from 59 postgraduate training colleges and universities who participated in clinical internship were selected. SPSS 20.0 software was used for analysis; descriptive analysis was used to describe satisfaction with training program and loyalty to the university; factor analysis was adopted to calculate comprehensive satisfaction score to reduce the number of variables; logistic regression analysis was applied to investigate the association of general information and satisfaction with training program with loyalty to the university.Results:The professional postgraduate students majoring in clinical medicine had a degree of 60.44% of loyalty to the university. Satisfaction with training program reflected low satisfaction at each link of the training program. For every 1-point increase in the comprehensive satisfaction scores of the four links of courses, research training, college support, and practice, the loyalty to the university was increased to 2.11, 1.83, 1.77, and 1.75 times as the original, respectively, of the baseline scores.Conclusion:There is still room for further improvement in the satisfaction with training program and the loyalty to the university among professional postgraduate students majoring in clinical medicine, and the satisfaction with training program is closely associated with the loyalty to the university. Colleges and universities need to take measures for courses, practice, research training, and college support, so as to improve satisfaction and thus enhance loyalty to the university.
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Objective:To explore the impact of mentors' behaviors on the professional identity of medical students during the internship.Methods:Based on the data of the China Medical Students Survey in 2020, a research was conducted on 25 557 medical graduates from 104 universities in China. The Wilcoxon rank-sum test and multiple linear regression were used to analyze the impact of mentors' behaviors on the professional identity of medical students during the internship.Results:More than 70% of medical students believed that the clinical mentors they met during their internship had positive medical and teaching behaviors. If students believed that clinical mentors were enthusiastic, responsible for their work, highlighted role modeling and paid attention to their behaviors in teaching, the scores of professional identity would be 3.027, 0.445, 0.840 and 1.234 points greater than if they did not respectively (all P<0.001). Conclusion:The students have generally good evaluation on mentors' behavior during the internship. The positive medical and teaching behaviors of mentors have a positive impact on the professional identity of medical students and the impact of enthusiasm is the greatest. Medical institutions should provide complete institutional support and standardize the behavior of clinical teachers in order to enhance the professional identity of medical students.
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Background@#Diabetes-related neuropathic pain frequently occurs, and the underpinning mechanism remains elusive. The periaqueductal gray (PAG) exhibits descending inhibitory effects on central pain transmission. The current work aimed to examine whether inflammatory cytokines regulate mechanical allodynia and thermal hyperalgesia induced by diabetes through the phosphoinositide 3-kinase (PI3K)-mammalian target of rapamycin (mTOR) pathway in the PAG. @*Methods@#Streptozotocin (STZ) was administered intraperitoneally to mimic allodynia and hyperalgesia evoked by diabetes in rats. Behavioral assays were carried out for determining mechanical pain and thermal hypersensitivity. Immunoblot and ELISA were performed to examine PAG protein amounts of interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α), as well as their corresponding receptors in STZ rats, and the expression of PI3K/protein kinase B (Akt)/mTOR signaling effectors. @*Results@#Increased PAG p-PI3K/p-Akt/p-mTOR protein amounts were observed in STZ-induced animals, a PI3K-mTOR pathway inhibition in the PAG attenuated neuropathic pain responses. Moreover, the PAG concentrations of IL-1β, IL-6, and TNF-α and their receptors (namely, IL-1R, IL-6R, and tumor necrosis factor receptor [TNFR] subtype TNFR1, respectively) were increased in the STZ rats. Additionally, inhibiting IL-1R, IL-6R, and TNFR1 ameliorated mechanical allodynia and thermal hyperalgesia in STZ rats, alongside the downregulation of PI3K-mTOR signaling. @*Conclusions@#Overall, the current study suggests that upregulated proinflammatory cytokines and their receptors in the PAG activate PI3K-mTOR signaling, thereby producing a de-inhibition effect on descending pathways in modulating pain transmission, and eventually contributing to neuropathic pain.
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PURPOSE@#. The aim of this study was to evaluate the clinical performance and reliability of plasma sprayed nanostructured zirconia (NSZ) coating. @*MATERIALS AND METHODS@#. This study consisted of three areas of analysis: (1) Mechanical property: surface roughness of NSZ coating and bond strength between NSZ coating and titanium specimens were measured, and the microstructure of bonding interface was also observed by scanning election microscope (SEM). (2) Biocompatibility: hemolysis tests, cell proliferation tests, and rat subcutaneous implant test were conducted to evaluate the biocompatibility of NSZ coating. (3) Mechanical compatibility: fracture and artificial aging tests were performed to measure the mechanical compatibility of NSZcoated titanium abutments. @*RESULTS@#. In the mechanical study, 400 μm thick NSZ coatings had the highest bond strength (71.22 ± 1.02 MPa), and a compact transition layer could be observed. In addition, NSZ coating showed excellent biocompatibility in both hemolysis tests and cell proliferation tests. In subcutaneous implant test, NSZcoated plates showed similar inflammation elimination and fibrous tissue formation processes with that of titanium specimens. Regarding fatigue tests, all NSZ-coated abutments survived in the five-year fatigue test and showed sufficient fracture strength (407.65-663.7 N) for incisor teeth. @*CONCLUSION@#. In this study, the plasmasprayed NSZ-coated titanium abutments presented sufficient fracture strength and biocompatibility, and it was demonstrated that plasma spray was a reliable method to prepare high-quality zirconia coating.
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Objective@#To setup a custom-made gait simulator, and to provide an efficient tool for biomechanics research of ankle and foot.@*Methods@#From November 2017 to April 2018, a total of 6 fresh frozen specimens of the foot and ankle were collected. The donated specimens, free of diseases in the foot and ankle part, were from the Department of Anatomy, Shanghai Medical College of Fudan University. Donors were 3 males and 3 females, aged from 48 to 69 years old, with an average age of 58.8 years old. The nine tendons in the foot were divided into 4 bundles, including anterior group comprised of tibialis anterior (TA), extensor hallucis longus (EHL) and extensor digitorum longus (EDL). Posterior group comprised of Achilles's tendon (AT). Medial group comprised of tibialis posterior (TP), flexor hallucis longus (FHL), and flexor digitorum longus (FDL). Lateral group comprised of peroneus brevis (PB) and peroneus longus (PL). A custom-made gait simulator was set up by using four independent electro motors to actuate 4 bands of tendons in the foot and another six motors to control tibia to achieve 6 degree-freedom parallel mechanism. And a hydraulic machine was used to provide axial pressure along tibia. Gait cycle of six fresh frozen cadaver feet was reproduced using this machine, and the kinematics data of ankle movement and ground reaction force (GRF) data was collected. By comparing the data above with the normal human gait data, the simulation results were analyzed to explore the clinical usage of this machine.@*Results@#On the sagittal plane, the ankle appeared to plantarflexion at the beginning of gait, and then turned to dorsiflexion after the max plantar flexion (about 10°) at 18% of gait cycle. At the 40% gait cycle, ankle joint was in neutral position and reached its max dorsiflexion (about 22°) at 83% gait cycle. On the coronal plane, ankle joint appeared inversion at the beginning and eversion afterwards with 10° range of change. On the horizontal plane, movement of ankle joint was small. Results showed that the first peak of vertical ground reaction force can reach to 1.1-1.3 times of bodyweight at 25% of gait cycle and the second peak appeared little lower at 70% of gait cycle. The GRF in posterior direction reached its peak at 30%, and then turned to anterior with its peak at 83% gait cycle. The GRF had small variation at the internal to external direction.All of the coefficients of multiple correlations (CMC) of GRF and ankle joint movements were close to or greater than 0.90.@*Conclusion@#This custom-made gait simulator has good gait simulation ability with high intra repeatability in respect of ankle rotation and ground reaction force, and can satisfy the request for ankle and foot biomechanics research.
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Objective@#To study the effects of endoscopic submucosal dissection(ESD) on long-term quality of life (QOL) and gastric function of patients with distal early gastric cancer (EGC), compared with those of surgery.@*Methods@#Patients with EGC who received ESD or surgical resection in Peking Union Medical College Hospital over 1 year ago were selected to be followed up. QLQ-C30, SF-36, EQ-5D and dyspeptic symptom rating scale were used to evaluate QOL. Five-hour gastric emptying rate was used to evaluate distal gastric function. Electronic gastroscopy was used to observe whether the anastomotic stoma was stenotic. According to the age at resection, 1 to 1 matching was performed between the distal 1/3 gastric ESD (EP) group and the distal subtotal gastrectomy (SP) group, and then the QOL and gastric function between the two groups were compared.@*Results@#Twenty-five patients were included in group EP and group SP respectively. According to QLQ-C30, the scores of cognitive function were 83.3 (83.3, 83.3) in group EP and 83.3 (83.3, 100.0) in group SP (P=0.056). The proportion of patients with symptoms (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea and financial difficulties) between the two groups were not statistically different. There was no statistical difference in the scores of EQ-5D and SF-36 between the two groups. According to dyspeptic symptom rating scale, 56.0% patients in group EPhad burning sensation, but only 28.0% in group SP had this symptom (P=0.054). 20.0% of patients in group SPreported nausea, while only 4.0% in group EP had this symptom (P=0.084). Gastric emptying results showed that the proportion of patients with abnormal 5-hour gastric emptying rate was 31.8% in group EP, while there was no abnormal emptying in group SP (P=0.003). Gastroscopy results showed that one patient in group EP had pyloric stenosis, but 5-hour gastric emptying rate was normal. All anastomotic stomas in group Sp were unobstructed.@*Conclusion@#ESD and surgical resection for distal EGC show similar long-term effects on QOL of patients. But the long-term gastric emptying function may decrease after distal gastric ESD.
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Objective To analyze the current status of research competitiveness of medical subjects in China.Methods Analyzing the fund of Natural Science Foundation of China (NSFC) in 2017 and using the Range ratio and Theil Index to describe the dispersion and source of difference.Regional research competitiveness of Chinese medical subjects is measured by the attraction and accumulation capacity of NSFC.Results The research competitiveness of medical subjects in East China and South China are stronger,and those in the Northwest are weaker.The distribution of medical funds mainly originated from the interior (88.88％),among which the East China and North China are the two regions with the largest contribution rate.In terms of provinces,Shanghai and Beijing have a much higher concentration of medical funds than other provinces.Condusions The Research competitiveness in inter-regional medical subjects in China is quite different,and the differences mainly stem from the competition of internal provinces;the degree of advantages of medical subjects in regions is different,and there are medical research centers in ever regions.
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Objective To study the effects of endoscopic submucosal dissection(ESD) on long-term quality of life ( QOL) and gastric function of patients with distal early gastric cancer ( EGC) , compared with those of surgery. Methods Patients with EGC who received ESD or surgical resection in Peking Union Medical College Hospital over 1 year ago were selected to be followed up. QLQ-C30, SF-36, EQ-5D and dyspeptic symptom rating scale were used to evaluate QOL. Five-hour gastric emptying rate was used to evaluate distal gastric function. Electronic gastroscopy was used to observe whether the anastomotic stoma was stenotic. According to the age at resection, 1 to 1 matching was performed between the distal 1/3 gastric ESD ( EP ) group and the distal subtotal gastrectomy ( SP ) group, and then the QOL and gastric function between the two groups were compared. Results Twenty-five patients were included in group EP and group SP respectively. According to QLQ-C30, the scores of cognitive function were 83. 3 (83. 3, 83. 3) in group EP and 83. 3 (83. 3, 100. 0) in group SP(P=0. 056). The proportion of patients with symptoms (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea and financial difficulties) between the two groups were not statistically different. There was no statistical difference in the scores of EQ-5D and SF-36 between the two groups. According to dyspeptic symptom rating scale, 56. 0％patients in group EPhad burning sensation, but only 28.0％ in group SP had this symptom (P=0.054).20. 0％ of patients in group SP reported nausea, while only 4. 0％ in group EP had this symptom ( P=0. 084) . Gastric emptying results showed that the proportion of patients with abnormal 5-hour gastric emptying rate was 31. 8％ in group EP, while there was no abnormal emptying in group SP(P=0. 003). Gastroscopy results showed that one patient in group EP had pyloric stenosis, but 5-hour gastric emptying rate was normal. All anastomotic stomas in group Sp were unobstructed. Conclusion ESD and surgical resection for distal EGC show similar long-term effects on QOL of patients. But the long-term gastric emptying function may decrease after distal gastric ESD.
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Objective To setup a custom?made gait simulator, and to provide an efficient tool for biomechanics research of ankle and foot. Methods From November 2017 to April 2018, a total of 6 fresh frozen specimens of the foot and ankle were collected. The donated specimens, free of diseases in the foot and ankle part, were from the Department of Anatomy, Shanghai Medical College of Fudan University. Donors were 3 males and 3 females, aged from 48 to 69 years old, with an average age of 58.8 years old. The nine tendons in the foot were divided into 4 bundles, including anterior group comprised of tibialis anterior (TA), extensor hallucis longus (EHL) and extensor digitorum longus (EDL). Posterior group comprised of Achilles's tendon (AT). Medial group comprised of tibialis posterior (TP), flexor hallucis longus (FHL), and flexor digitorum longus (FDL). Lateral group comprised of peroneus brevis (PB) and peroneus longus (PL). A custom?made gait simulator was set up by using four independent electro motors to actuate 4 bands of tendons in the foot and another six motors to control tibia to achieve 6 degree?freedom parallel mechanism. And a hydraulic machine was used to provide axial pressure along tibia. Gait cycle of six fresh frozen cadaver feet was reproduced using this machine, and the kinematics data of ankle movement and ground reaction force (GRF) data was collected. By comparing the data above with the normal human gait data, the simulation results were analyzed to explore the clinical usage of this machine. Results On the sagittal plane, the ankle appeared to plantarflexion at the beginning of gait, and then turned to dor?siflexion after the max plantar flexion (about 10°) at 18% of gait cycle. At the 40% gait cycle, ankle joint was in neutral position and reached its max dorsiflexion (about 22°) at 83% gait cycle. On the coronal plane, ankle joint appeared inversion at the begin?ning and eversion afterwards with 10° range of change. On the horizontal plane, movement of ankle joint was small. Results showed that the first peak of vertical ground reaction force can reach to 1.1-1.3 times of bodyweight at 25% of gait cycle and the second peak appeared little lower at 70% of gait cycle. The GRF in posterior direction reached its peak at 30%, and then turned to anterior with its peak at 83% gait cycle. The GRF had small variation at the internal to external direction.All of the coefficients of multiple correlations (CMC) of GRF and ankle joint movements were close to or greater than 0.90. Conclusion This custom?made gait simulator has good gait simulation ability with high intra repeatability in respect of ankle rotation and ground reaction force, and can satisfy the request for ankle and foot biomechanics research.
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BACKGROUND/AIMS: Functional dyspepsia (FD) remains a great clinical challenge since the FD subtypes, defined by Rome III classification, still have heterogeneous pathogenesis. Previous studies have shown notable differences in visceral sensation processing in the CNS in FD compared to healthy subjects (HS). However, the role of CNS in the pathogenesis of each FD subtype has not been recognized. METHODS: Twenty-eight FD patients, including 10 epigastric pain syndrome (EPS), 9 postprandial distress syndrome (PDS), and 9 mixed-type, and 10 HS, were enrolled. All subjects underwent a proximal gastric perfusion water load test and the regional brain activities during resting state and water load test were investigated by functional magnetic resonance imaging. RESULTS: For regional brain activities during the resting state and water load test, each FD subtype was significantly different from HS (P < 0.05). Focusing on EPS and PDS, the regional brain activities of EPS were stronger than PDS in the left paracentral lobule, right inferior frontal gyrus pars opercularis, postcentral gyrus, precuneus, insula, parahippocampal gyrus, caudate nucleus, and bilateral cingulate cortices at the resting state (P < 0.05), and stronger than PDS in the left inferior temporal and fusiform gyri during the water load test (P < 0.05). CONCLUSIONS: Compared to HS, FD subtypes had different regional brain activities at rest and during water load test, whereby the differences displayed distinct manifestations for each subtype. Compared to PDS, EPS presented more significant differences from HS at rest, suggesting that the abnormality of central visceral pain processing could be one of the main pathogenesis mechanisms for EPS.
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Humans , Brain , Broca Area , Caudate Nucleus , Classification , Dyspepsia , Functional Neuroimaging , Healthy Volunteers , Magnetic Resonance Imaging , Parahippocampal Gyrus , Parietal Lobe , Perfusion , Prefrontal Cortex , Sensation , Somatosensory Cortex , Visceral Pain , WaterABSTRACT
Objective@#To investigate the osseointegration of a novel coating-plasma-sprayed zirconia in dental implant.@*Methods@#Zirconia coating on non-thread titanium implant was prepared using plasma spraying, the implant surface morphology, surface roughness and wettability were measured. In vivo, zirconia coated implants were inserted in rabbit tibia and animals were respectively sacrificed at 2, 4, 8 and 12 weeks after implantation. The bond strength between implant and bone was measured by push-out test. The osseointegration was observed by scanning electron microscopy (SEM), micro CT and histological analyses. Quantified parameters including removal torque, and bone-implant contact (BIC) percentage were calculated.@*Results@#The surface roughness (1.6 µm) and wettability (54.6°) of zirconia coated implant was more suitable than those of titanium implant (0.6 µm and 74.4°) for osseointegration. At 12 weeks, the push-out value of zirconia coated implant and titanium implant were (64.9±3.0) and (50.4±2.9) N, and BIC value of these two groups were (54.7±3.6)% and (41.5±3.6)%. All these differences had statistical significance.@*Conclusions@#The surface characters of zirconia coated implant were more suitable for osseointegration and present better osseointegration than smooth titanium implant in vivo, especially at early stage.
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Objective To analyze the consistency between constipated symptoms and the parameters of gastrointestinal transit time (GITT),anorectal manometry (ARM) in elderly patients with functional constipation.Methods Total 111 patients (54 males and 57 females) with an average age of (70.2±6.5) years,who met Rome Ⅲ criteria of functional constipation were enrolled from June 2010 to October 2012.After enrollment,patients took two-week diary,recording the spontaneous bowel movements per week,stool type of Bristol Stool Form,the frequency and severity of defecation straining,sensation of anorectal obstruction,manual maneuvers and sensation of incomplete evacuation.The GITT and ARM tests were performed,and the consistency between symptoms and test results were analyzed.Results Patients with symptoms of slow transit,defecation disorder and mixed symptoms were 19.8％ (22/111),16.2％ (18/ 111) and 59.5％ (66/111) respectively;and 4.5％ (5/111) patients had scattered symptoms.Based on results of GITT,slow transit subtype,defecation disorder subtype and mixed subtype were 54.1％ (59/109),1.8％ (2/ 109) and 29.4％ (32/109) respectively;and 14.7％ (16/109) patients were with normal transit time.ARM results showed that 38.0％ (41/109) of patients had dyssynergic defecation.The percentage of slow transit in GITT test showed no significant difference between patients with slow transit symptoms and mixed symptoms [50.0％ (11/22)vs.57.9％(33/57),x2=0.401,P=0.527].The consistency of predominant symptom with GITI subtype was low (κ=-0.013).The percentage of dyssynergic defecation detected with ARM showed no significant difference between patients with defecation disorder-predominant symptom and with mixed symptom [23.1％ (6/24)vs.38.2％ (21/55),x2=1.813,P=0.178].The consistency of defecation disorderpredominant symptom with dyssynergic defecation in ARM was low (κ=-0.019).Conclusion The mixed subtype symptoms are the most common presentations of elderly patients with functional constipation,and the consistency of predominant constipated symptoms with GITI,ARM test results is poor.
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Objective To analyze the clinical characteristics and endoscopic findings in patients with cirrhosis and upper gastrointestinal variceal bleeding (UGIB) and to evaluate the risk factors of rebleeding after endoscopic therapy.Method Between May 2010 and May 2017,383 patients who diagnosed with cirrhosis and UGIB were enrolled.Results The incidence of rebleeding was 8.88％ (n =34).In the univariate analysis,advanced age (P =0.362,OR =0.662),male (P =0.036,OR =2.975),cause of cirrhosis (P =0.047,OR =2.512),Child-Pugh scores (P =0.026,OR =1.852),prothrombin time (P =0.017,OR =3.746),thrombocytopenia (P =0.445,OR =0.577),severe varices (P =0.314,OR =0.745),red color sign (P =0.016,OR =4.013),portal vein diameter (P =0.365,OR =1.026),portal thrombosis (P =0.027,OR =1.954) were risk factors for rebleeding following endoscopic therapy.In the non-condition multivariate logistic regression analysis,male (P =0.036,OR =2.975),autoimmune liver disease (P =0.047,OR =2.512),Child-Pugh scores (P =0.026,OR =1.852),prothrombin time (P =0.017 OR =3.746),red color sign (P =0.016,OR =4.013),portal thrombosis (P =0.027,OR =1.954) were independent risk factors for rebleeding following endoscopic therapy.Conclusions Esophagogastric variceal rebleeding is common after a successful initial endoscopic therapy.Independent risk factors for rebleeding are male,autoimmune liver disease,elevated Child-Pugh scores,prolonged thrombin time,portal vein thrombosis and red color sign.
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Objective To analyze the clinical characteristics and endoscopic findings in the elderly cirrhotic patients with variceal bleeding.Method In this study,181 cirrhotic patients with variceal bleeding cltnically and endoscopically diagnosed from May 2011 to May 2016 were divided into ≥60 years of age group (58 cases) and control group (＜ 60 years of age,123 cases).Clinical data and endoscopic findings were compared retrospectively.Results The cirrhosis caused by virus and alcohol (15/58,62/123) was less in elderly group,but autoimmune disease and non-alcoholic fatty liver disease was more common (14/58,12/58)(x2 =7.452,P =0.004).The incidence rate of hypertension and coronary artery disease was higher in elderly group (20/58,7/58,x2 =6.124,12.764,P =0.012,0.001).However,there was no difference in the incidence rate of diabetes between the two groups (P ＜ 0.05).Gastric varices bleeding was higher in the elderly group (x2 =3.965,P =0.049).The gastric varices located in cardia were more in the elderly group (37.93％,22/58) than control (34.96％,43/123),(x2 =4.124,P =0.044).The rate of EIS was higher in the elderly group and cyanoacrylate injection was less than control (x2 =3.621,P =0.046).Conclusions Compared with those of ＜ 60 years of age,the causes and endoscopic findings and treatment are different cirrhotic variceal bleeding in patients ≥60 years of age.
ABSTRACT
Objective To evaluate the efficacy and safety of testa triticum tricum purif for the treatment of functional constipatiofi(FC) in the late middle-aged and elderly patients.Methods This study was designed as a multicenter randomized controlled trial.Patients who met Rome Ⅲ diagnostic criteria of FC were enrolled,with age between 55-85 years old.Those with organic diseases were excluded.The patients were randomly allocated to receive testa triticum tricum purif (3.5 g bid) or polyethylene glycol 4000 powder (PEG4000,10g bid) for 8 weeks,followed by single dose of maintenance therapy for 4 weeks.Follow-up visits were at 4 and 12 weeks after treatment discontinuation.The independent investigators in each center evaluated the constipation symptoms scores.The primary endpoints included rates of significant improvement,improvement and overall improvement at the end of 2,4 and 8 weeks of therapy,which were calculated by the reduction of symptom scores ≥ 75 ％,50％-74％,≥ 25 ％ respectively.Results A total of 127 FC subjects were enrolled from 3 centers,and 122 cases valid for final analysis.The mean age was (69.4 ± 6.9) years old,including 62 cases in testa triticum tricum purif group and 60 cases in PEG4000 group.The demographic data,constipated symptoms scores and proportion of FC subtypes at baseline were comparable.The rates of significant improvement,improvement and overall improvement in testa triticum tricum purif and PEG4000 groups at the end of 2,4 and 8 weeks were 37.70％ (23/61) vs 59.32％(35/59) (P=0.018),57.38％ (35/61)vs74.14％ (43/58) (P=0.054),and64.41％ (38/59)vs 79.31％ (46/58) (P =0.073) respectively.Testa triticum tricum purif therapy significantly improved the proportion of spontaneous bowel movement (SBM) ≥ 3 times/week from 43.55％ (27/62) to 80.33％ (49/61),83.61％ (51/61) and 93.22％ (55/59) at 2,4,and 8 weeks respectively (all P＜0.01),which were comparable with PEG4000 group (all P ＞ 0.05).The proportion of normalized stool forms in study group was significant higher than that of control group at the end of 8 weeks [86.44％ (51/59) vs 67.24％ (39/58),P =0.014].Only one patient complained mild abdominal distension during testa triticum tricum purif therapy.Conclusions The efficacy of testa triticum tricum purif for the treatment of FC in late middle-aged and older patients is comparable with osmotic laxatives PEG4000,which has significant effect on normalization of fecal forms and reliable safety.