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Nanocarriers prepared from organic or inorganic materials are widely used in drug targeting system and diagnosis and treatment of disease. However, there are some problems, such as poor targeting, short circulation time in vivo and improvement in the biocompatibility. Biomimetic nanocarriers has carried out research on the issues, which based on different kinds of cell membrane for the nanocarriers modification, endogenous biofilm improving the biocompatibility of carriers in vivo, more accurate targeting, and even producing immunotherapeutic effect. The principle, method, targeting mechanism and therapeutic effect of biomimetic nano carrier technology of cell membrane have been reviewed in this paper, which provide a new direction for the research of new drug delivery system.
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Objective To prepare a biomimetic nano carrier macrophage membrane hybrid liposome by heterozygous macrophage membrane and liposome, which could be used for the clearance and toxicity inhibition of Vibrio vulnificus hemolysin A (VvhA). Methods Macrophage membrane was extracted and hybridized with liposome by thin-film evaporation combined extrusion method. The hybridized liposome of macrophage membrane was constructed and characterized. The in vitro detoxification ability of the hybridized vector was evaluated by hemolysis test and cytotoxicity test. The detoxification ability of the vector was evaluated by mouse skin infection model. Results Anti toxoid studies in vivo and in vitro showed that the anti-hemolysis rate of macrophage membrane heterozygous liposomes in vitro reached 97.03%, which could effectively inhibit the skin ulceration in subcutaneous infected mice and make the survival rate of abdominal infected mice reach 80%. Conclusion The constructed macrophage membrane hybrid liposome had high detoxification ability, which could provide a potential solution and research basis for the prevention and treatment of Vibrio vulnificus infection.
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Objective:To analyze the characteristics of the circular cases violating the " nine prohibitions" in recent years, so as to provide a basis for further strengthening the moral culture construction of the healthcare industry.Methods:Data came from the reported cases released on official websites of the discipline inspection committees, supervision committees and health committees at all levels in China from December 2013 to August 2021, which were identified by searching the keyword " case or report or moral culture and nine prohibitions" . Descriptive analysis and frequency analysis were conducted on the reported time, region and province, as well as the involved units, departments, persons, punishment results and case classification data of all the cases.Results:A total of 102 cases violating the " nine prohibitions" were included, of which the cases from 2014 to 2015 topped the rest, accounting for 51.96%(53 cases). Top three regions of these cases were central China, east China and southwest China, with 31 cases, 27 cases and 18 cases respectively. The units involved were mainly tertiary medical institutions, accounting for 44.12%(45 cases). More medical staff(134 people) than administrative staff(85 people) were involved in the cases. The largest number of cases was receiving kickbacks, with 52 cases(50.98%). The punishment results of cases included judicial procedures(76 people), Party discipline and government discipline punishment(67 people) and organizational punishment(76 people).Conclusions:Moral culture problem in China′s healthcare sector is characterized in wide coverage, complexity, comprehensiveness and long-term. Relevant authorities should keep up their efforts in enhancing the awareness of medical workers, improving the synergy mechanism in this regard, and strengthening the internal management of medical institutions.
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Objective:To explore the safety of inactivating coronavirus disease 2019(covid-19)vaccine in liver transplantation(LT)recipients.Methods:Retrospective analysis was performed for clinical data of 151 LT recipients from March 2003 to October 2019.They had stable conditions and completed the course of covid-19 vaccine.Frequencies of pain at injection site, fatigue, headache and pruritus after vaccination were recorded.The safety profiles were compared between recipients with and without local and general adverse reactions after vaccination.At the same time, recipients completing two doses of covid-19 vaccines were grouped.According to vaccine companies, they were classified into Sinovac Biotech Ltd and Beijing Biological.Based upon more than or less than 60 years, they were grouped into <60 years and ≥60 years.The safety profiles of inactivating COVID-19 vaccine were compared in subgroups.Results:Among 151 eligible LT recipients, 98 of them were in group of age <60 years and 53 in group of age >60 years.The median period between vaccination and LT was 8.44(4.37, 12.39)years and the median concentration of tacrolimus 2.5(1.8, 3.9)ng/L.Eighty-three cases completed two doses of Sinovac Biotech Ltd(Sinovac Biotech Ltd group)and 40 cases Beijing Biological(Beijing Biological group); 14 cases had combined course of Sinovac Biotech Ltd and Beijing Biological, four recipients were vaccinated with inactivated vaccine from other companies and ten recipients did not know their inactivated vaccine' companies.After immunization, 24/151(15.9%)recipients had a local and general adverse reaction.The prevalence of pain at injection site, fatigue, headache and pruritus was 9.9%( n=15), 5.2%( n=8), 1.3%( n=2)and 0.7%( n=1)respectively.No significant differences existed in age( P=0.602), gender( P=0.752), period after LT( P=0.890), trough concentration of tacrolimus( P=0.377)or versions of covid-19 vaccine( P=0.582)between 24 cases with general adverse reaction and 127 without.Local and general reactions occurred in 16/83(19.3%)in Sinovac group and 5/40(12.5%)in Beijing Biological.There was no significant inter-group difference( P=0.769). There were 98 cases(64.9%)in <60 years group, 17 cases(17.3%)had local and general reaction, 53 cases(35.1%)in ≥60 years group and 7 cases(13.2%)had a local and systemic reaction.There was no significant inter-group difference( P=0.507). Conclusions:Covid-19 vaccine is safe for long-term survival LT recipients with normal liver function.Few participants present with mild fatigue and pain at injection site.
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Because the work of administrative and logistics personnel in public hospitals is difficult to quantify and evaluate, its performance reform is difficult. A large public hospital in Wuhan has explored and established a distribution incentive mechanism that combines department performance appraisal, individual classification and grading, and secondary distribution within the department. Taking into account the completion of performance appraisal indicators of the national tertiary public hospital in the department, the results of the institutional " Excellent Management Team Ranking" , personal job grades, working years and other factors, a relatively mature and operable system has been formed, which could provide reference for the performance reform of other hospitals.
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Objective:To study the risk factors and treatment of portal vein thrombosis (PVT) in patients after liver transplantation.Methods:The clinical data of 290 recipients who underwent liver transplantation at the Department of Hepatology, the Fifth Medical Center of PLA General Hospital from July 2015 to April 2019 were retrospectively analyzed. There were 245 males and 45 females, with a median age of 51(44, 56) years old. The liver transplantation recipients were divided into two groups according to whether PVT occurred or not after operation: the PVT group ( n=16) and the non-PVT group ( n=274). Gender, age and other clinical data of the recipients were compared between the two groups. Outpatient and inpatient follow-up were performed. The risk factors of postoperative PVT were analysed in the liver transplantation recipients. Results:The median follow-up of these 290 liver transplant recipients was 59(42, 73) months, and 16 patients were confirmed to have PVT after operation, with an incidence of 5.5%(16/290). Multivariate logistic regression analysis showed that preoperative PVT ( OR=12.773, 95% CI: 3.887-41.973) was an independent risk factor for PVT after liver transplantation. For the 16 patients with postoperative PVT, 10 were treated with portal vein intervention, and the remaining 6 patients were treated with oral aspirin or rivaroxaban anticoagulation due to mild symptoms. The 3-year survival rate of the PVT group was 93.8% (15/16), while that of the non-PVT group was 90.1% (247/274). There was no significant difference in the 3-year survival rates between the two groups (χ 2<0.01, P=0.969). Conclusions:Preoperative PVT in recipients was an independent risk factor for PVT after liver transplantation. For patients with postoperative PVT, appropriate treatment resulted in good results without affecting the long-term prognosis of these patients.
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Objective:To study the impact of simultaneous ligation of splenic artery on prognosis of patients with severe hypersplenism in liver transplantation.Methods:A retrospective analysis was performed on the clinical data of 206 patients who underwent liver transplantation in the Fifth Medical Center of PLA General Hospital from December 2016 to February 2019. There were 180 males and 26 females, aged (51.0±9.0) years old. Fifty-one patients underwent splenic artery ligation during liver transplantation and they were enrolled into the observation group, and 155 patients without splenic artery ligation were enrolled into the control group. The changes in white blood cells (WBC), platelets, alanine aminotransferase, total bilirubin and serum creatinine as well as the incidence of postoperative complications were compared between the two groups.Results:The platelet count of the observation group was significantly lower than those of the control group before operation and on days 1, 3, 7, 30 and 90 after operation, (all P<0.05). The WBC counts in the observation group were significantly lower than those in the control group before operation and on days 1 and 3 after operation (all P<0.05). However, there were no significant differences in the WBC counts between the two groups on days 5, 7, 30 and 90 after operation (all P>0.05). There were also no significant differences in alanine aminotransferase and total bilirubin indexes between the two groups after surgery (all P>0.05), but the serum creatinine levels in the observation group were significantly lower than those in the control group on days 3, 5, 7 and 30 after surgery (all P<0.05). There were no significant differences in the rates of infection, severe acute rejection, biliary tract complications, arterial/portal thrombosis and mental complications between the two groups (all P>0.05). The rate of renal replacement therapy for acute kidney injury in the observation group (9.8%, 5/55) was significantly higher than that in the control group (1.3%, 2/155) ( P<0.05). Conclusion:Ligation of splenic artery during liver transplantation was safe and it had a significant advantage in the early postoperative recovery of WBC count and creatinine without increasing the incidence of complications in patients with severe hypersplenism.
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Talent evaluation is the premise of development management and the use of human resources. The establishment of the talent classification and evaluation mechanism of university affiliated hospitals plays an important role in setting up the correct employment orientation, stimulating the career development of talents and promoting the high-quality development of public hospitals. The authors took the perspective of university affiliated hospitals, summed up the construction process of talent evaluation system in China, analyzed the existing problems in evaluation indicators, evaluation methods and operation mechanism of talent evaluation system, and came out with suggestions that the national level should strengthen the top-level design and collaborative management of talent evaluation, the hospital level should refine the evaluation indicators, improve the evaluation methods and establish the concept of developmental evaluation, at meanwhile, schools should improve the talent management mechanism and strengthen the function of audit and supervision.
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Objective@#Meta-analysis was conducted on the tetanus antibody protection rate of healthy population born after 1978 in China (data from Hong Kong, Macao and Taiwan was excluded, the same below).@*Methods@#Search the data on China′s tetanus antibody level which were published in China National Knowledge Infrastructure, Wanfang data, VIP, SinoMed database, PubMed and the Cochrane Library. The Chinese search keywords were "Tetanus Antitoxin", "Tetanus Antibody", "Healthy Population" and "Mainland China". English search terms include "tetanus antitoxin", "tetanus vaccine", "tetanus vaccine", "general population" and "mainland of China". The time limit for inclusion in literature research was 2010-2019. Stata software was used to conduct meta-analysis on the protection rate of tetanus antibody.@*Results@#A total of 24 articles were included. There was no obvious publication bias in the included articles. The total number of respondents was 23 530, the antibody protection rate was 49.5%-99.0%. A total of 20 817 people got effective antibody protection, which meant the antibody level reached and exceeded 0.1 IU/ml, and the combined protection rate was 78.6% (95%CI: 75.0%-88.2%). The combined protection rates of antibody in 0-7 years old and 8-15 years old groups were 88.9% (95%CI: 86.9%-91.0%) and 79.3% (95%CI: 72.9%-86.2%) respectively. The combined protection rates of antibodies in 16-20 years old, 21-30 years old and 31-40 years old groups were 58.9% (95%CI: 46.5%-71.2%), 47.7% (95%CI: 16.8%-78.7%) and 63.8% (95%CI:32.6%-95.1%) respectively. The combined protection rate of tetanus antibody for 0-15 years old people was 85.6% (95%CI: 83.1%-88.1%), and the combined protection rate of antibody for 16-40 years old people was 52.9% (95%CI: 39.3%-66.6%).@*Conclusion@#With the increase of age, the protection rate of tetanus antibody among the healthy population aged 16-40 years in our country decreases. An individualized vaccination plan should be formulated according to the previous tetanus vaccination history and the tetanus antibody level when necessary.
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Gliomas are the most common primary intracranial neoplasms among all brain malignancies, and the microtubule affinity regulating kinases (MARKs) have become potential drug targets for glioma. Here, we report a novel dual small-molecule inhibitor of MARK3 and MARK4, designated as PCC0208017. PCC0208017 strongly inhibited kinase activity against MARK3 and MARK4, and strongly reduced proliferation in three glioma cell lines. This compound attenuated glioma cell migration, glioma cell invasion, and angiogenesis. Molecular mechanism studies revealed that PCC0208017 decreased the phosphorylation of Tau, disrupted microtubule dynamics, and induced a G2/M phase cell cycle arrest. In an glioma model, PCC0208017 showed robust anti-tumor activity, blood-brain barrier permeability, and a good oral pharmacokinetic profile. Molecular docking studies showed that PCC0208017 exhibited high binding affinity to MARK3 and MARK4. Taken together, our study describes for the first time that PCC0208017, a novel MARK3/MARK4 inhibitor, might be a promising lead compound for treatment of glioma.
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Objective:To compare the effect of the new anterior cervical spine memory compression fixation device (GYZ memory alloy plate) and traditional titanium plate on the range of motion (ROM) and stress of the adjacent segment after anterior cervical discectomy and fusion.Methods:An adult male volunteer was recruited for a fee. After excluding cervical malformations, fractures, infections and other diseases, C 3-C 7 thin-layer CT scans were performed. Import the scanned data into the finite element modeling software to establish the finite element model of the physiological group and verify itseffectiveness. After C 5,6 discectomy, the intervertebral fusion device was inserted, and the anterior fixation was assisted by a conventional titanium plate or a new type of fixator. Thus, the finite element model of the traditional titanium plate group and the new fixer group was established. The three models were imported into the finite element analysis software ANSYS 16.0, and a vertical downward axial load of 73.6 N was loaded to simulate the head weight and the torque of 1.0 N·m to simulate the cervical spine flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation.Compare the changes of intervertebral disc ROM and stress in adjacent segments of physiological group, traditional titanium plate group and new type fixator group. Results:The intervertebral disc ROM under six conditions was basically similar to the results of previous studies, and the model was effective. In the adjacent segment C 4,5, the three groups of activities in the flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation conditions were: physiological group 3.9°, 4.2°, 3.7°, 3.7°, 2.2° and 2.2°, traditional titanium plate group 4.6°, 4.7°, 4.3°, 4.4°, 3.3° and 3.1°, and new fixture group 4.4°, 4.3°, 4.0°, 4.2°, 2.8° and 2.7°. The maximum stresses of the intervertebral discs under three different working conditions were: physiological group 1.81, 1.60, 3.99, 2.06, 3.63 and 3.41 MPa, traditional titanium plate group 1.86, 1.67, 4.21, 2.16, 3.82 and 3.63 MPa, and new fixture group 1.84, 1.64, 4.17, 2.14, 3.78 and 3.58 MPa. In the adjacent segment C 6,7, the activities of the three groups in six working conditions were: physiological group 3.1°, 3.2°, 2.5°, 2.5°, 1.2° and 1.3°, traditional titanium plate group 4.2°, 3.7°, 3.4°, 3.0°, 2.1° and 2.2°, and new fixture group 3.5°, 3.3°, 2.5°, 2.7°, 1.8° and 1.9°.The maximum stress of the intervertebral disc under three different working conditions was: physiological group 0.45, 0.66, 1.12, 0.85, 0.84 and 0.82 MPa, traditional titanium plate group 0.62, 0.93, 1.55, 1.24, 1.44 and 1.27 MPa, and new fixture group 0.61, 0.92, 1.54, 1.22, 1.07 and 1.24 MPa. The ROM and disc pressure of adjacent segments in the conventional titanium plate group were higher than those of the new fixator group. Conclusion:Compared with the traditional titanium plate, the new type of anterior cervical memory compression fixator has less effect on the ROM and stress of adjacent segments, which may slow down the process of adjacent segments degeneration to a certain extent.
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Objective:To investigate the processing accuracy and biomechanical properties of 3D printed artificial bone trabeculae with different porosity generated by the Voronoi Tessellation algorithm, and to provide a reference for improving the biomechanical properties of titanium alloy implants in orthopedics.Methods:A healthy adult male volunteer (aged: 30 years, tall: 175 cm and weight: 70 kg) was selected to collect CT scan data of the lumbar spine. Five kinds of biomimetic artificial bone trabeculae with different porosity were generated using the Voronoi Tessellation algorithm, and divided into Tra_A (73.7%), Tra_B (74.1%), Tra_C (80.0%), Tra_D (80.2%) and Tra_E (85.7%) groups according to the porosity. Selective laser melting (SLM) 3D printing technology was used to process trabecular bone structures with different porosity into titanium alloy prosthesis with a diameter of 18 mm and a height of 20 mm. Each group had 3 samples. The internal structure of each sample was observed by industrial microscope, and the actual porosity of artificial bone trabecular of each group was calculated and compared with the theoretical porosity to evaluate the machining accuracy of artificial bone trabecular with different porosity. Finally, the ultimate load, yield strength and elastic modulus of each sample were evaluated by in vitro mechanical test, and the biomechanical properties of artificial bone trabeculae with different porosity were evaluated.Results:There were no cracks, fracture of connecting rod or accumulation of titanium alloy powder in all specimens. The average actual porosity of the five groups of artificial bone trabecular specimens was 66.0%, 65.5%, 71.8%, 72.5% and 78.1%, respectively. Compared with the theoretical porosity, it was smaller by 10.5%, 11.6%, 10.2%, 9.7% and 8.8%, respectively. In the in vitro mechanical tests for the five groups of artificial bone trabecular specimens, the mean value of ultimate load was 23.6 kN, 18.9 kN, 17.0 kN, 16.3 kN, 10.7 kN, respectively; the mean value of yield strength was 72.2 MPa, 58.7 MPa, 54.9 MPa, 52.2 MPa, and 36.1 MPa, respectively; the mean value of the actual elastic modulus was 7.5 GPa, 6.3 GPa, 4.5 GPa, 4.3 GPa and 2.4 GPa, respectively. With the increase of the porosity of artificial bone trabeculae, all three indicators above showed a decreasing trend. Conclusions:The artificial bone trabeculae generated by the Voronoi Tessellation algorithm and printed by SLM 3D have better machining quality. With the increase of porosity, the processing precision of the titanium alloy artificial bone tray specimens is better. Limit load, yield light and elastic modulus of artificial bone trabecula decrease with the increase of porosity.
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Objective:To investigate the clinical efficacy of locking proximal femur plates (LPFP) revision and artificial hip joint revision after failure of proximal femoral nail antirotation (PFNA) internal fixation in elderly patients with intertrochanteric fracture.Methods:A retrospective case control study was conducted on the clinical data of 43 patients with PFNA internal fixation failure in the elderly admitted to Henan Provincial People's Hospital between March 2014 and October 2018. There were 23 males and 20 females, aged 65-83 years [(71.2±2.0)years]. The course of disease was 60-267 days [(83.1±3.6)days]. According to Evans classification, there were 11 patients with type II fractures, 13 with type III and 19 with type IV. There were 23 patients in artificial hip joint revision group and 20 patients in LPFP revision group. The operation time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, Harris score and complications were recorded and evaluated in two groups.Results:All patients were followed up for 12-28 months, with an average of 13.6 months. Between artificial joint revision group and LPFP revision group, the operation time and intraoperative blood loss were similar ( P>0.05), but there were significant difference in postoperative hospitalization time [(7.1±3.2)days vs. (13.2±2.9)days] and total hospitalization time [(10.2±2.8)days vs. (16.4±3.4)days] ( P<0.05). In artificial joint revision group, the Harris hip score was (21.1±3.7)points preoperatively, and was respective (70.7±4.8)points, (74.6±4.1)points, (78.6±3.3)points, (82.9±5.2)points, (83.8±5.8)points and (84.9±6.4)points at postoperative 1, 2, 3, 6, 9, 12 months. In LPFP revision group, the Harris score was (21.7±3.2)points preoperatively, and was respective (59.9±2.1)points, (64.79±3.4)points, (70.1±4.2)points, (73.9±4.2)points, (76.2±6.3)points and (77.9±6.8)points at postoperative 1, 2, 3, 6, 9, 12 months. The Harris score in artificial joint revision group was gradually improved compared with LPFP revision group ( P<0.05). One patient with superficial wound infection occurred in each group, and the wound healed after frequent dressing changes. Distal femoral fractures occurred in one patient of artificial joint revision group and distal femoral fractures in three patients of LPFP revision group, but all patients were healed after being fixed with wire. Conclusion:For elderly patients with PFNA internal fixation failure of intertrochanteric fracture, artificial hip revision has shorter hospital stay and better hip joint function recovery than LPFP internal fixation, although the effect in operation time and intraoperative blood loss are similar.
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Objective@#To investigate the relationship between different physical activity pattern and trajectories of anxiety and depression scores in college students, and to provide evidence for exploring the influence of physical activity on the development of anxiety and depression.@*Methods@#A total of 1 265 college students from grade 2017 in a comprehensive university were investigated longitudinally for five times through stratified cluster sampling. Physical Activity Rank Scale-3(PARS-3), Self-rating Anxiety Scale(SAS), and Self-rating Depression Scale(SDS) were used, and latent class linear mixed models(LCLMM) were used to identify the trajectories of anxiety and depression scores and multinomial Logistic regression models were used for exploring the relationship between small persistent status of physical activity among the five surveys and subgroups of trajectory and anxiety and depression scores.@*Results@#A total of 940(74.3%) college students were indentified as low persistent physical activity group and 325(25.7%) of them were identified as moderatre-to-high persistent physical activity group. The trajectories of anxiety score were classified into three groups:low level group, high level-decreasing group, and high level group. The number and proportion of the three groups were 686(54.2%), 144(11.4%), 435(34.4%), respectively. The trajectories of depression score were classified into four groups:low level group, moderate level-decreasing group, moderate level-increasing group, and high level group. The number and proportion of the five groups were 604(47.8%), 170(13.4%), 177(14.0%), 314(24.8%), respectively. Compared to the students with moderate-to-high persistent physical activity, higher persistent physical activity was associated with higher risk of keeping anxiety score at a high level(OR=1.78), and higher odds of decreasing depression score at moderate level(OR=0.67), as well as with higher risk of increasing depression score from a moderate level(OR=1.79), and increase the risk of keeping depression score at a high level(OR=1.97)(P<0.05).@*Conclusion@#Low persistent physical activity of college students could increase the risk of anxiety and depression at a high level. Relevant departments in universities should encourage students to take part in physical activity,with special focus given to individuals with less amount of physical activity and take effective interventional measures to modify the development of anxiety and depression.
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General hospitals play an important role in the prevention and control of emerging infectious diseases, making it imperative to stand by for outbreaks of epidemics in peacetime. This study analyzed the necessity of the mechanism of adapting these hospitals to both peacetime and wartime against emerging infectious diseases. In addition, the authors identified existing problems in dealing with emerging infectious diseases, and put forward corresponding suggestions: readiness in the conversion into epidemic-control; strengthened comprehensive prevention and control of nosocomial infection; strengthened construction of epidemic prevention teambuilding; an emergency material supply guarantee mechanism; an optimized monitoring and early warning mechanism; enhanced risk management and joint prevention and control.
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Objective:To analyze the current situation and characteristics of online public sentiments faced by public hospitals since the outbreak of COVID-19, and provide suggestions for coping strategies for such hospitals.Methods:The data of " trending topic" or " Trending hash tag" of " Wuhan Union Hospital" and " anti-epidemic" were captured on three mainstream new media platforms, namely Sina Microblog, Tik Tok and Headline Today with the help of data analysis tools of Sina and online data statistical software from December 2019 to February 2020. Content analysis method was used to analyze the occurrence frequency, time distribution and development trend of public sentiment on Internet.Results:Under the epidemic of COVID-19, public hospitals faced an exponential growth of online public sentiment. The cumulative total number of searches was 72 119 802 tens of thousands of that before the epidemic. The transmission showed fragmentation of content, instantaneous speed and higher attention to negative information, which brought great challenges for public hospitals.Conclusions:The high participation of online discussion of COVID-19 is unprecedented. Thus public hospitals should attach importance to the work related to online public sentiment, and establish corresponding coping mechanism for response.
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Objective To develop a new type of lumbar prosthesis,movable artificial lumbar vertebral body (MALV) and evaluate the stability and activity of the prosthesis by in vitro biomechanical test.Methods Fifteen adult fresh lumbar spine specimens were randomly divided into three groups:intact group,fusion group and non-fusion group.The anatomical parameters of L2 vertebral body and adjacent intervertebral discs were collected by software (Mimics 16.0,Materialise Company,USA) and the new prosthesis was personalized by 3D printing and mechanical processing.All specimens in fusion group and in non-fusion group were implanted with titanium cage,titanium plate and MALV respectively after partial resection of L2 vertebra and adjacent intervertebral disc.No other intervention was conducted on physiological specimens.All specimens were examined by imaging to determine the position of the prosthesis and the condition of the spinal cord.Specimens in all groups were subjected to a 7.5 N · m load biomechanical test in flexion,extension,left and right lateral bending,left and right rotation aiming to evaluate the mobility of operative site and adjacent discs.Results The new prosthesis consists of three parts,vertebral body,intervertebral disc and composite material ball.All 15 cadavers were free of spinal deformity,fracture and osteoporosis.Postoperative radiographic examination indicated no prosthesis displacement and spinal compression without adverse phenomena.The results in vitro mechanical test were as followed.There was no statistical difference in ROM of the T12L1 intervertebral in non-fusion group (3.68°±0.86°,3.52°± 0.86°,2.64°±0.93°,2.58°±0.76° respectively) and in intact group (3.98°±0.90°,3.74°±0.91°,2.94°±1.10°,2.96°±0.86° respectively) in flexion,extension,left and right lateral bending (P＞0.05).The ROM of the T12L1 intervertebral in fusion group (5.28°±0.83°,5.32°±0.42°,4.72°±1.10°,4.94°±1.17° respectively) was significantly larger than that in intact group and non-fusion group (P＜0.05).There was no statistically significant difference between the ROM of L1.2 and L2.3 intervertebral in flexion,extension and left and rightlateral bending in the non-fusion group (ROM of L1.2 were 4.62°±0.51 °,4.34°±0.67°,3.16°±0.55°,3.28°±0.41 ° respectively;ROM of L2.3 were 4.54°±0.58°,4.36°±0.65°,3.26°±0.21°,3.42°±0.37° respectively) and the intact group (ROM of L1.2 were 4.10°±0.53°,3.72°±0.42°,2.74°±0.50°,3.04°±0.40° respectively;ROM of L2.3 were 4.26°±0.72°,4.08°±0.77°,3.00°±0.36°,3.20°±0.31° respectively) (P＞0.05).The ROM of L1.2 and L2.3 in intact group and in non-fusion group were significantly greater than those in the fusion group (ROM of L1.2 were 1.10°± 0.35°,1.28°±0.31°,0.84°±0.34°,0.80°± 0.43° respectively;ROM of L2.3 were 1.14°±0.30°,1.18°±0.28°,0.94°± 0.36°,1.06°±0.32°) (P＜0.05).There was no statistically significant difference in the ROM of the T12-L3 full segment in the left and right rotation of the three groups (Intact group:4.47°± 0.99°,4.40°±0.70°;Non-fusion group:4.60°±0.90°,4.50°±0.77°;Fusion group:3.85°±0.50°,3.72°±0.70°)(P＞0.05).Conclusion The MALV can retain the mobility of the operative site in flexion,extension,lateral bending and rotation.Furthermore,it can effectively avoid the increased mobility of adjacent segment intervertebral.After implantation,the prosthesis can obtain satisfied immediate stability.
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Objective To compare the effects of movable artificial lumbar vertebra implantation and traditional vertebral excision and fusion on the stress of adjacent intervertebral discs,so as to provide reference for the biomechanical safety of new prosthesis implantation.Methods The total lumbar vertebra CT scan data of a healthy adult were imported into the compute r-aided software Mimics 16.0 for three dimensional reconstruction.The reconstructed three dimensional model was smoothed using computer-aided software Geomagic Studio 12.0.Subsequently,meshing,parameter setting and ligaments reconstructing were completed using computer-aided software Hypermesh 13.0 and Solidworks 2013,successfully constructing the finite element model of lumbar vertebral physiology group.On the basis of the finite element model of physiological group,three vertebral bodies and two intervertebral spaces were fused and fixed,and a simplified finite element model of fusion group was constructed.The partitioned prosthesis model was inserted into the established finite element model of physiological group,replacing the L 3 vertebral body and the adjacent two intervertebral discs in the model,constructing the finite element model of non fusion group.Three finite element models were imported into computer-aided software Abaqus/Explict and loaded under six motion modes including anteflexion,dorsiflexion,left and right rotation,and left and right bending.The stress changes of adjacent intervertebral discs were calculated.Results The maximum Mises stress of the adjacent intervertebral disc in the direction of forward flexure,dorsal extension,left and right rotation and left and right lateral bending of the three finite element models was located at the site of loading and increased with the increase of loading.Under the maximum loading,the Mises stress of adjacent intervertebral discs in the above directions in the fusion group (L1-2 respectively were 0.79,0.96,1.26,1.92,1.34,1.57 MPa while L4-5 respectively were 0.52,1.13,1.50,1.74,0.94,0.87 MPa) was significantly higher than that in the physiological group (L1-2 respectively were 0.42,0.53,0.57,0.66,0.64,0.72 MPa while L4-5 respectively were 0.23,0.29,0.68,0.63,0.37,0.34 MPa).The Mises stress of adjacent intervertebral disc in the non-fusion group (L1-2 respectively were 0.38,0.57,0.75,1.02,0.87,0.90 MPa while L4-5 respectively were 0.18,0.26,0.81,0.98,0.30,0.27 MPa) was similar to that in the physiological group,although there was some difference.Conclusion Movable artificial lumbar disc prosthesis implantation can better avoid the stress increase of adjacent intervertebral discs,and its long-term implantation in the human body is expected to reduce the incidence of degeneration of adjacent intervertebral discs.
ABSTRACT
Gastric cancer is one of the most common clinical malignant tumors; surgery is an important treatment for it. The postoper-ative 5-year survival rate of patients with advanced gastric cancer is low; postoperative tumor recurrence is an important factor influ-encing the prognosis of patients. With the continuous development of domestic medicine, the technology of intraperitoneal hyper-thermic perfusion chemotherapy is improved continuously, and is widely used in postoperative adjuvant therapy for patients with ad-vanced gastric cancer. Long-term clinical practice shows that prophylactic use of hyperthermic intraperitoneal chemotherapy for ad-vanced gastric cancer could significantly reduce the recurrence rate of gastric cancer and improve the 5-year survival rate of patients. It plays a positive role in improving the quality of life of patients and overall clinical curative effect. In this review, the clinical applica-tion of hyperthermic intraperitoneal chemotherapy for advanced gastric cancer in China was summarized.
ABSTRACT
Objective To investgate risk factors of delayed bleeding after endoscopic submucosal dissec-tion(ESD)for early colorectal tumor and precancerrous lesions. Methods We retrospectively reviewed clinical date of 138 patients with early colorectal tumor and precancerrous lesions who received ESD in Hubei Cancer Hos-pital from October 2012 to October 2016. Risk factors of delayed bleeding were analysed by univariate and multi-variable logistic regression analysis. Results Ten(7.2%)of 138 patients occurred delayed bleeding after ESD. Univariate analysis showed that there was significent difference between the bleeding group and the non-bleeding group in location of the lesion(P = 0.022),severe fibrosis of submucosa(P = 0.016),Obvious intraoperative bleeding(P = 0.032)and inadequate endosopic experience of endoscopist(P = 0.045). Multivariate Logistic re-gression analysis showed that location of lesion(P = 0.003,OR = 4.64,95%CI:1.71~12.58),severe fibrosis of submucosa(P = 0.009,OR = 4.83,95% CI:1.49~15.60)were independent risk factors of delayed bleeding after ESD for early colorectal tumor and precancerrous lesions. Conclusion Patients with early colorectal tumor and precancerrous lesions in the rectum and severe fibrosis of submucosa are prone to delayed bleeding after ESD.