Development of Dynamic Ankle Prosthesis (review) / 中国康复理论与实践

Mechanism design and control theory of dynamic ankle prosthesis are important research directions of active lower limb prosthesis. This paper started from the research status at home and abroad, reviewed the background, purpose and significance of dynamic ankle prosthesis, pointed out the shortcomings of passive ankle prosthesis design and kinematics, provided opinions and suggestions for the design and development of powered ankle prosthesis. According to the different driving modes, the research progress of pneumatic, hydraulic and motor driven ankle prosthesis mechanism design was systematically described, and the timeliness and energy dissipation of prosthesis under different driving modes were discussed. According to the different feedback accuracy and real-time of finite-state machine, trajectory tracking and direct volitional control, an optimization scheme was proposed to improve the function of dynamic ankle prosthesis control mode.

Bibliometric analysis of hotspots and frontiers in international translational medicine research / 基础医学与临床

Translational medicine research, as a bridge of basic medicine and clinical medicine, has become the foci of medicine and developed rapidly. To study the research hotspots and frontiers of translational medicine in re-cent 20 years,Web of Science data sources,bibliometrics methods and visualization techniques were used to study the translational medicine from the aspects of time and space and subjects, which may support the translational medicine research of China.

Biomechanical study on the personalized orthopedic insoles for flatfoot / 医用生物力学

Objective To study the effect from different structures and material hardness of orthopedic insoles on flatfoot correction. Methods The contours of flatfoot under weight-bearing and non-weight-bearing conditions were scanned by Infoot system. The 3 kinds of medial longitudinal arch height (typeⅠ, Ⅱ, Ⅲ) and 3 kinds of material hardness (30°, 35°, 42°) from orthopedic insoles were used to compare their effects on flatfoot by the embedded insole test system. Results TypeⅠorthopedic insoles could significantly restore the anatomical position by improving the height of navicular bone, and redistribute the concentrated plantar pressure and increase the loading area of medial longitudinal arch with material hardness of 35°. Conclusions The appropriate insole shows a favorable orthopedic effect to ameliorate the foot deformity of flatfoot patients. The research findings lay a theoretical basis on design of the personalized orthopedic insoles.

The role of perioperative enteral and parenteral nutrition treatment in pancreatic cancer: a multicenter, prospective randomized controlled trial / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the two different nutritional supports, enteral nutrition and parenteral nutrition in the aspects of nutritional conditions, immune status, the incidence of perioperative complications and quality of life impacts in pancreatic cancer.</p><p><b>METHODS</b>For the pancreatic cancer patients which pancreaticoduodenectomy were performed from January 2007 to December 2008 in five high-volume medical centres, prospective, randomized controlled study was carried out. The enrolled patients were randomly divided into enteral nutritional group (EN group) and parenteral nutritional group (PN group). Related indicators, such as nutritional conditions, immune status, incidence of complications, general status and quality of life were assessed.</p><p><b>RESULTS</b>The 200 patients were enrolled, while 178 cases which 90 patients in EN group and 88 patients in PN group were qualified to evaluate. The 22 cases were dropped out. For the mean hospital stay ((23 ± 13) days and (27 ± 24) days respcectively), Karnofsky score and the life quality scoring, there are no statistical differences between the two groups. In post-operation day 7 and day 10, the prealbumin was (69 ± 16) mg/L and (80 ± 22) mg/L in EN group and it was (67 ± 19) mg/L and (70 ± 11) mg/L in PN group, which are all significantly decreased than preoperational levels ((186 ± 38) mg/L for enteral group and (179 ± 37) mg/L for parenteral group, t = -2.24, -2.13, -2.23, -2.20, all P < 0.05), but there was no statistically significant between the 2 groups (P > 0.05). Other general indicators such as the albumin, hemoglobin, total bilirubin, blood urea nitrogen, serum creatinine, serum potassium and serum sodium, revealed no statistical differences in the 2 groups (P > 0.05); The total lymphocytes, CD(+)3CD(+)4 and CD(+)3CD(+)8 lymphocytes in PN group was (0.687 ± 0.065)×10(9)/L, (0.363 ± 0.029)×10(9)/L, and (0.183 ± 0.018)×10(9)/L respectively in post-operation day 10, which they are significantly decreased than in preoperational levels of PN group and the respective counterpart of EN group in post-operation day10 (t = -2.04-2.83, P < 0.05). The 35 patients were suffered from different complications in the 2 groups, but there was no statistical differences among them (P > 0.05).</p><p><b>CONCLUSIONS</b>Enteral nutritional support could not decrease the incidence of perioperative complications in pancreatic cancer patient, but it can improve the immunonutrition status in comparison with parenteral nutrition.</p>

Expression of mitogen activated protein kinase phosphatase-1 in pancreatic cancer / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the expression of mitogen activated protein kinase phosphatase-1(MKP-1)in pancreatic cancer.</p><p><b>METHODS</b>Totally 60 cases of normal pancreas, chronic pancreatitis(CP), and pancreatic cancer tissues were collected by operation in our hospital. Pancreatic tissues were analyzed by Northern blot analysis and Western blot analysis. Meanwhile, MKP-1 expression was detected in 6 pancreatic cancer cell lines by Western blot analysis.</p><p><b>RESULTS</b>Northern blot analysis of total RNA revealed relatively low MKP-1 mRNA expression in 7 of 20(35%)normal pancreatic samples. In the remaining 13 samples, the MKP-1 mRNA was absent to faint detectable. In 7 of the 20 CP samples, MKP-1 was demonstrated moderate to high expression. In contrast, 12 of 20(60%)pancreatic cancer samples MKP-1 mRNA was expressed at high levels, whereas in the remaining 8 cancer tissues this mRNA moiety was present at low to moderate levels. Densitometric analysis with normalization to 7S revealed that the median level of MKP-1 mRNA in CP and cancerous tissues was increased by 6.2 folds(P=0.035)and 8.1 folds(P=0.016)in comparison with the median level in the normal pancreatic samples, respectively. Overexpression of MKP-1 was also found in 6 pancreatic cancer cell lines, in which the expression of MKP-1 was slightly lower in one pancreatic cancer cell line but high in the remaining 5 cell lines.</p><p><b>CONCLUSIONS</b>MKP-1 is over-expressed in pancreatic cancer, CP tissues, and pancreatic cell lines. It is speculated that MKP-1 may play an important role in tumorigenesis of pancreatic cancer.</p>

Pancreatic acinar cell carcinoma: diagnostic and surgical treatment strategy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features, diagnostic and therapeutic strategy of pancreatic acinar cell carcinoma.</p><p><b>METHODS</b>The data of pancreatic acinar cell carcinoma patients who underwent surgical operations from January 2002 to January 2012 were retrospectively reviewed.</p><p><b>RESULTS</b>Six cases of pancreatic acinar cell carcinoma, identified with pathology were collected, including 3 males and 3 females with the average of 47.8 yeas old. Upper abdominal pain was present in 5 cases, weight loss was present in 4 cases with the average of 12.5 kg. Other symptoms included nausea/vomiting, back pain and obstructive jaundice. The serum CA19-9 and CA24-2 level were significantly elevated in 2 cases. CT scan, MRI and DSA were the main imaging methods to diagnose this disease. However, no case was diagnosed as pancreatic acinar cell carcinoma before operation. All cases were confirmed by the pathological examination. Relatively high rates of surgical resection, long operative time, more blood loss and combined multi-organ resection were the characteristics of this disease's operative surgical procedures. The average period of postoperative follow-up process was 60 months, and the mean survival time was (32 ± 8) months.</p><p><b>CONCLUSIONS</b>The clinical features and biological behavior of pancreatic acinar cell carcinoma are different from those of ductal adenocarcinoma, while the relatively specific clinical manifestations and imaging changes will be helpful for qualitative diagnosis before operation. As it has high rate of resection and better prognosis, more radical surgical strategies should be carried out for patients of this disease.</p>

Noninvasive examinations for localization of insulinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the value of the noninvasive examinations for localization of insulinoma.</p><p><b>METHODS</b>The clinical materials of 88 cases of insulinoma treated in Peking Union Medical College Hospital between January 2005 and November 2008 were analyzed retrospectively. There were 40 males and 48 females aged from 15 to 74 years old (averaged, 46.5 years old).</p><p><b>RESULTS</b>The positive rates for localization were 19.3% (17/88), 52.4% (11/21), 95.5% (64/67), 1/6, 30.0% (6/20), 83.9% (26/31), 8/8 and 5/5 respectively in transabdominal ultrasound, enhanced CT, multislice spiral CT pancreatic perfusion, MRI, somatostatin receptor scintigraphy, endoscopic ultrasound, laparoscopic ultrasound and intraoperative ultrasound. Thirty-one multiple tumors in 8 patients were resected. The positive rates of locating the multiple insulinomas of multislice spiral CT pancreatic perfusion and Intraoperative Ultrasound were 48.4% (15/31) and 100% (14/14) respectively.</p><p><b>CONCLUSIONS</b>The locating diagnosis of insulinoma has came to noninvasive examination era. Multislice spiral CT pancreatic perfusion is the first choice for localization. Intraoperative ultrasound might play an important role in locating tumors for patients with multiple insulinomas.</p>

The utility of stapler in distal pancreatectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the influence of hand-sewn and stapler in distal pancreatectomy on the postoperative complication.</p><p><b>METHODS</b>Clinical data of 109 patients after distal pancreatectomy from January 2003 to December 2006 were analyzed retrospectively.</p><p><b>RESULTS</b>The surgical techniques used for closure of the pancreatic stump after distal pancreatectomy were categorized into hand-sewn closure group (n = 53) and stapler closure group (n = 56). In stapler closure group, 25 patients accepted laparoscopic operation. The incidences of abdominal infection and pancreatic fistulae in stapler closure group were lower than hand-sewn closure group. The operation time, blood infusion, postoperative bleeding and medical costs were similar between two groups.</p><p><b>CONCLUSION</b>Stapler closure in distal pancreatectomy could decrease the incidence of pancreatic fistula and abdominal infections.</p>

Significance and reversal of MDR1/P-gp in pancreatic cancer chemotherapy / 中华外科杂志

<p><b>OBJECTIVE</b>To delineate the mechanism of primary drug resistance in pancreatic cancer cell lines by investigating multidrug resistant gene 1 and its protein (P-gp).</p><p><b>METHODS</b>Reverse transcription PCR (RT-PCR) and immunocytochemistry (ICC) were carried out to investigate the expression of the MDR1 and P-gp in 8 pancreatic cancer cell lines. Flow cytometry was performed to detect P-gp function in SW1990 and HL60 cell lines. In addition, verapamil, combined with chemotherapeutic agents was carried out to evaluate its potential effect in pancreatic cancer cells.</p><p><b>RESULTS</b>The highest expression level of MDR1 mRNA was proven in SW1990 cell line by RT-PCR, while the absent expression was found in PCT-2. Weak MDR1 mRNA expression were found in PCT-3, PCT-4, ASPC, Cap-1, Mia-PaCa-2 and Panc-1 cell lines. ICC showed that P-gp was localized mainly in the membrane and partly in the plasma. P-gp overexpression was also present in SW1990. The accumulation of Rhodamin123 in SW1990 was significantly decreased (57.9% +/- 5.4%) compared with its expression in HL60 (99.5% +/- 3.3%) (P < 0.05). Verapamil (VPM), combined with ADM or E-ADM showed a potential effect on reversing drug resistance mediated by P-gp in pancreatic cancer chemotherapy.</p><p><b>CONCLUSIONS</b>MDR1 and its protein P-gp are indeed expressed in some extent in pancreatic cancer cell lines. VPM combined with ADM might imply a new strategy in pancreatic cancer chemotherapy.</p>

Diagnosis and management of isolated pancreatic tuberculosis: experience of 13 cases / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To analyze the diagnosis and treatment of pancreatic tuberculosis.</p><p><b>METHODS</b>Retrospectively reviewed and summarized 13 pancreatic tuberculosis patients' clinical information, presentation, diagnostic methods, therapeutic approaches, and prognosis from 1958 to 2004 at Peking Union Medical College Hospital.</p><p><b>RESULTS</b>All cases presented a wide series of symptoms, including fever in 6 cases, upper abdominal tenderness in 13, epigastric mass in 4, obstructive jaundice in 3, night sweat in 4, weight loss in 7, hypersplenotrophy and hypersplenism in 1, and being complicated with tuberculosis of other organs in 3. One case was diagnosed by clinical symptoms and biopsy of lymph node, and only received anti-tubercular treatment Others were diagnosed by intra-operative biopsy and anti-tubercular treatment, and got well without recurrent tuberculosis in pancreas and other organs during 6 months to 2 years of follow-up. The non-operative case presented extrahepatic portal hypertension.</p><p><b>CONCLUSIONS</b>Pancreatic tuberculosis may be considered in the patients with fever, abdominal tenderness, weight loss, and imaging evidence of regional pancreatic lesion. Efficacy of anti-tubercular agents and laparotomy for pancreatic tuberculosis is evident.</p>

Surgical treatment of pancreatic insulinoma by laparoscopy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and outcome of laparoscopic insulinoma resection.</p><p><b>METHODS</b>Twenty-five patients with insulinoma were admitted and divided into two groups: laparoscopic group (10 patients) and laparotomy group (15 patients). All tumors of two groups were located at the body or tail of pancreas preoperatively by abdominal CT and digital subtraction angiography (DSA). Laparoscopic enucleation was performed for patients in laparoscopic group, open enucleation was performed for patients in laparotomy group. There were no differences in preoperative location and size of tumors between two groups. Statistical method was used to compare the discrepancy from operation time, the volume of blood loss, hospital stay and morbidity of complication between two groups.</p><p><b>RESULTS</b>There were no discrepancies from operation time, blood loss, hospital stay after operation between two groups (P > 0.05). However, one case of pancreatic leakage developed in laparoscopic group, comparably, 3 cases of pancreatic leakage, 2 cases of celiac sepsis and 5 cases of fluid accumulation in thoracic cavity developed in laparotomy group. There were significant discrepancies in morbidity of complication between two groups.</p><p><b>CONCLUSIONS</b>Laparoscopic resection of pancreatic insulinoma is safe and feasible for tumors located at the body or tail of the pancreas. Its application for tumors located at the pancreatic head needs further evaluation.</p>

A pilot study on the impact of the drug resistance on the radioresistance in human pancreatic cancer cell lines / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the impact of the drug resistance on the radioresistance in human pancreatic cancer cell lines.</p><p><b>METHODS</b>Three drug resistant pancreatic cancer cell sublines induced by fluorouracil (5-FU), adriamycin (ADM) and gemcitabine respectively, SW1990/FU, SW1990/ADM and SW1990/Gz, were tested for the cell cycle and radio-sensitivity with flow cytometry and clonogenic assay.</p><p><b>RESULTS</b>Compared with SW1990, the cell cycle assay indicated higher G(0)/G(1) period percentage in SW1990/FU and SW1990/Gz, but the G(2)/M period percentage decreased; SW1990/FU had the same while SW1990/Gz had lower S period percentage. SW1990/ADM almost had a similar cell cycle with SW1990. Clonogenic assay showed both SW1990/FU and SW1990/Gz had greater survival fraction (SF(2)) than SW1990, but SW1990/ADM had seemingly similar SF(2) as SW1990.</p><p><b>CONCLUSION</b>Drug resistant pancreatic cancer cell lines have reduced G(2)/M period percentage and increased radioresistance.</p>

Laparoscopic distal pancreatectomy: current indications and surgical results / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety, feasibility indications, prognosis and follow-up of laparoscopic distal pancreatectomy.</p><p><b>METHODS</b>Retrospective study was employed on 10 patients collected from Feb. to Oct. 2005 with diagnosis of masses located at pancreatic body/tail. The mean age was 43 years and ratio between male and female was 1:9. Preoperative diagnosis: nine patients with cystic lesion located at pancreatic body and tail, one patient with pancreatic endocrine tumor with liver metastasis, which located at pancreatic tail. The mean size of the tumor was 4.0 cm. All patients received adjuvant examinations including CT contrast scan, abdominal ultrasound or endoscopic ultrasound. The serum levels of tumor markers (including CA19-9, CA242, CA50 and CEA) of the patients were all normal.</p><p><b>RESULTS</b>All patients received distal pancreatectomy by laparoscope successfully. Among them, seven procedures were spleen-preserved and three with splenectomy. Mean operative time was 228 +/- 26 min, and mean blood lose volume was 173 +/- 100 ml. One patient suffered with pancreatic fistula after operation but was successfully managed by conservative therapy in one month, pancreatic pseudocyst was detected in one patient and disappeared spontaneously in one month, no other morbidity occurred. The postoperative hospital stay was 12 - 16 d (mean, 13.5 d). The serum glucoses of 10 patients after operation were normal. The mean time of follow-up was 8 months (2 - 22 months). During the follow-up, nine patients with benign cystic lesions did not relapse. And the other one patient with malignant metastasis kept stable, not recurrence was detected in one year after operation.</p><p><b>CONCLUSIONS</b>Laparoscopic distal pancreatectomy was safe and feasible for benign cystic tumors located at the body or tail of the pancreas.</p>

Risk factors for postoperative gastroparesis syndrome after pancreaticoduodenectomy with binary logistic regression / 中华外科杂志

<p><b>OBJECTIVE</b>To study the risk factors of postoperative gastroparesis syndrome after pancreaticoduodenectomy.</p><p><b>METHOD</b>Clinical data of 166 patients who underwent pancreaticoduodenectomy from January 2002 to April 2006 were analyzed with binary logistic regression in order to explore the risk factors of postoperative gastroparesis syndrome after pancreaticoduodenectomy.</p><p><b>RESULTS</b>There were 60 patients occurred postoperative gastroparesis syndrome after pancreaticoduodenectomy. Among 15 factors, 6 factors were proved to be the risk factors of postoperative gastroparesis syndrome after pancreaticoduodenectomy by unitary anylasis; 7 factors were proved related factors of postoperative gastroparesis syndrome after pancreaticoduodenectomy by analyzed with binary logistic regression.</p><p><b>CONCLUSIONS</b>The risk factors are preoperative gastro-intestinal obstruction syndrome, extensive lymphadenectomy, postoperative abdominal cavity infection, starting time of postoperative enteral nutrition, postoperative blood glucose level; The protective factors are preoperative percutaneous transhepatic cholangial drainage (PTCD) and postoperative blood terminal protein (TP) level.</p>

Down regulation of mitogen activated protein kinase phosphatase-1 mediate acquired multidrug resistance in pancreatic adenocarcinoma cell line SW1990/Fu / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the role of mitogen activated protein kinase phosphatase-1 (MKP-1) in mediating acquired multidrug resistance in pancreatic adenocarcinoma cell line SW1990/Fu.</p><p><b>METHODS</b>To detect MKP-1 mRNA expression, Northern blot analysis was carried out in well established drug resistant pancreatic adenocarcinoma cell line SW1990/Fu, SW1990 and MiaPaCa-2 cell lines. To further elucidate the exact role of MKP-1, Western blot hybridization was performed in these three cell lines.</p><p><b>RESULTS</b>Northern blot analysis of total RNA isolated from SW1990/Fu, SW1990 and MiaPaCa-2 cell lines revealed the presence of the 2400 bp MKP-1 transcript 7 at relatively high levels in pancreatic cancer cell lines SW1990 and MiaPaCa-2. In the SW1990/Fu, the MKP-1 transcript was detectable at very low level. Densitometric analysis with normalization to 7S indicated that MKP-1 mRNA expression level was significantly decreased in SW1990/Fu in comparison with the parental and MiaPaCa-2 cell lines. MKP-1 protein expression level in SW1990/Fu detected by Western blot was coincident with mRNA level.</p><p><b>CONCLUSIONS</b>MKP-1 may be involved in acquired multidrug resistance in pancreatic adenocarcinoma, and we could hypothesized that alterations of intra-cellular transduction signal system acts as an important role in multidrug resistance of tumor cells.</p>

Establishment, characterization, and biological analysis of pancreatic adenocarcinoma cell strain SW1990/FU / 中国医学科学院学报

<p><b>OBJECTIVE</b>To establish a 5-fluorouracil (5-FU)-resistant pancreatic adenocarcinoma (PAC) cell strain, and to investigate its biological characteristics.</p><p><b>METHODS</b>The PAC cell strain SW1990 was selected into a multidrug-resistant cell strain stepwise with 5-FU, one of the most common drugs used in PAC chemotherapy, for 12 months and subsequently named SW1990/FU. The cell strain was characterized in terms of morphology, biology, and cross-resistance to adriamycin(ADM), mitomycin-C (MMC), and gemcitabine. BHLB/c-m nude mice tumor growth and CEA and CA19-9 levels were analyzed. In addition, karyotyping and FACS analysis were performed in SW1990/FU and SW1990.</p><p><b>RESULTS</b>The SW1990/FU cell strain was 132.7 times more resistant to 5-FU than the parental SW1990 cells, and exhibited cross-resistance to other agents. Compared to the parental cells, SW1990/FU cells exhibited a smaller growth rate, delayed cell-doubling time, and specific changes in chromosomes 18. Tumor diameters in multidrug resistance and parental cells inoculated in in vivo experiments were (1.5 +/- 0.30) cm and (0.8 +/- 0.15) cm, respectively.</p><p><b>CONCLUSIONS</b>Morphological adaptation and intracellular changes can be induced by drug challenge in PAC cells. SW1990/FU may be used as an experimental system for the search to overcome drug resistance and to elucidate possible mechanisms of acquired drug resistance in human pancreatic cancer.</p>