Effect of ferroptosis mediated by glutathione peroxidase 4 in the occurrence and progression of synovitis in knee osteoarthritis / 中国组织工程研究

BACKGROUND:Synovitis plays a leading role in the early progression of knee osteoarthritis and is a potential early therapeutic target.However,the mechanism of synovitis remains unclear.In animal models,increased systemic iron and intracellular iron uptake can induce and exacerbate osteoarthritis,but the association with ferroptosis in synovitis remains unclear.Further studies are needed to investigate the role of ferroptosis in the development and progression of synovitis in osteoarthritis. OBJECTIVE:To investigate the role of ferroptosis mediated by glutathione peroxidase 4(GPX4)in the development of synovitis in knee osteoarthritis. METHODS:The synovial tissues of 43 patients with osteoarthritis who underwent arthroscopic or joint replacement surgery and 10 patients undergoing arthroscopic treatment of meniscal injury or ligament tear were collected and divided into three groups according to the Kellgren-Lawrence grading of X-ray images:normal control group(KLG 0,n=10),early knee osteoarthritis group(KLG 1,2,n=20)and late knee osteoarthritis group(KLG 3,4,n=23).Hematoxylin-eosin staining was used to observe the severity of synovitis in each group,and iron deposition in the synovium in each group was evaluated by Prussian blue staining.The expressions of Acyl-CoA Synthetase Long Chain Family Member 4(ACSL4),GPX4,cyclooxygenase 2 and tumor necrosis factor α in the synovium were detected by immunohistochemical staining.Western blot and immunofluorescence were used to detect the expression of ferroptosis-related proteins ACSL4 and GPX4. RESULTS AND CONCLUSION:Compared with the normal control group,iron content in synovial tissue was increased in the knee osteoarthritis groups,and iron deposition in the late knee osteoarthritis group was higher than that in the early osteoarthritis group.ACSL4 was highly expressed in the synovial tissue of knee osteoarthritis compared with the normal control group(P＜0.01),and GPX4 was lowly expressed in the synovial tissue of knee osteoarthritis(P＜0.01).The expression level of ACSL4 increased with the progression of osteoarthritis,while the expression level of GPX4 decreased with the progression of osteoarthritis.The expression of cyclooxygenase 2 in the synovium of osteoarthritis was significantly higher than that in the normal synovium,and the expression was the highest in the early stage of osteoarthritis,which was significantly different from that in the advanced stage of osteoarthritis(P＜0.01).The expression of tumor necrosis factor α in the synovium of osteoarthritis was significantly higher than that in the normal synovium,but there was no significant difference between early and late osteoarthritis groups(P＞0.05).To conclude,the deposition of iron exists in the synovial tissue of osteoarthritis and ferroptosis is involved in the occurrence and progression of synovitis in knee osteoarthritis.

Myocardial patch:cell sources,improvement strategies,and optimal production methods / 中国组织工程研究

BACKGROUND:Myocardial patches are used as an effective way to repair damaged myocardium,and there is controversy over which cells to use to make myocardial patches and how to maximize the therapeutic effect of myocardial patches in vivo. OBJECTIVE:To find out the best way to make myocardial patches by overviewing the cellular sources of myocardial patches and strategies for perfecting them. METHODS:The first author searched PubMed and Web of Science databases by using"cell sheet,cell patch,cardiomyocytes,cardiac progenitor cells,fibroblasts,embryonic stem cell,mesenchymal stem cells"as English search terms,and searched CNKI and Wanfang databases by using"myocardial patch,biological 3D printing,myocardial"as Chinese search terms.After enrollment screening,94 articles were ultimately included in the result analysis. RESULTS AND CONCLUSION:(1)The cellular sources of myocardial patches are mainly divided into three categories:somatic cells,monoenergetic stem cells,and pluripotent stem cells,respectively.There are rich sources of cells for myocardial patches,but not all of them are suitable for making myocardial patches,e.g.,myocardial patches made from fibroblasts and skeletal myoblasts carry a risk of arrhythmogenicity,and mesenchymal stem cells have a short in vivo duration of action and ethical concerns.With the discovery of induced multifunctional stem cells,a reliable source of cells for making myocardial patches is available.(2)There are two methods of making myocardial patches.One is using cell sheet technology.The other is using biological 3D printing technology.Cell sheet technology can preserve the extracellular matrix components intact and can maximally mimic the cell growth ring in vivo.However,it is still difficult to obtain myocardial patches with three-dimensional structure by cell sheet technology.Biologicasl 3D printing technology,however,can be used to obtain myocardial patches with three-dimensional structures through computerized personalized design.(3)The strategies for perfecting myocardial patches mainly include:making myocardial patches after co-cultivation of multiple cells,improving the ink formulation and scaffold composition in biological 3D printing technology,improving the therapeutic effect of myocardial patches,suppressing immune rejection after transplantation,and perfecting the differentiation and cultivation protocols of stem cells.(4)There is no optimal cell source or method for making myocardial patches,and myocardial patches obtained from a particular cell or technique alone often do not achieve the desired therapeutic effect.Therefore,researchers need to choose the appropriate strategy for making myocardial patches based on the desired therapeutic effect before making them.

Elastase quantitative analysis of elastin effect on mechanical response of anterior cruciate ligament / 中国组织工程研究

BACKGROUND:The anterior cruciate ligament has unique nonlinear mechanical properties under a complex physiological loading environment.Elastin is an important contributor to the mechanical properties of the anterior cruciate ligament,but its mechanical response to the anterior cruciate ligament under axial tension is not clear. OBJECTIVE:To quantitatively analyze the effect of elastin on the tensile mechanical response of the anterior cruciate ligament. METHODS:Elastase solution and control buffer were prepared.The porcine anterior cruciate ligament samples were prepared into small-size samples and randomly soaked in 0,0.1,1.0,2.0,5.0,and 10.0 U/mL elastase solution for 6 hours,and other small samples of the same size were soaked in 2 U/mL elastase solution for 0,1,3,6,9,and 12 hours.To determine suitable soaking conditions for elastin-targeted enzymes and verify the digestive effect,histological staining was used to compare the effects of enzyme treatment on tissue structure and composition.The ligament samples were randomly divided into elastase-treated group and PBS group,and immersed in 2 U/mL elastase solution and PBS buffer for 6 hours,respectively.A mechanical tensile test was performed before and after immersion. RESULTS AND CONCLUSION:(1)The biochemical results showed that being treated in 2 U/mL elastase solution for 6 hours could reduce the elastin content by 31.1%,and had no significant effect on other mechanical-related components in the tissue.(2)The histological results showed that elastase was able to penetrate the tissue,and the loose degree of tissue increased after treatment.(3)In the mechanical results before and after treatment,the mechanical properties of the PBS group decreased significantly,only the low-tension elastic modulus increased significantly and the initial length increased significantly in the elastase-treated group.(4)The intergroup comparison results showed that there was no significant difference between the two groups in pre-treatment,but the low-tension elastic modulus,initial slopes,saturated slopes,and initial length of the elastase-treated group after treatment were significantly higher than those in the PBS group.(5)These results suggest that elastin degradation significantly affects the biomechanical properties of the anterior cruciate ligament and further complements our understanding of the structure-function relationship of the anterior cruciate ligament.

Semen cuscutae in the treatment of osteoarthritis:network pharmacology analysis and experimental validation / 中国组织工程研究

BACKGROUND:Semen cuscutae has the effect of tonifying the liver and kidney system and benefiting the essence.The main pathogenesis of osteoarthritis is deficiency of the liver and kidneys.Therefore,it is hypothesized that there is a link between semen cuscutae and osteoarthritis. OBJECTIVE:To explore the potential relationship between osteoarthritis and semen cuscutae and validate the mechanism of semen cuscutae based on the network pharmacology and molecular docking analysis. METHODS:First,the active ingredients and targets of semen cuscutae were screened in TCMSP,and the genes related to osteoarthritis were collected in the disease databases GeneCard's,OMIM and TTD.The intersected genes were taken and then subjected to a series of analyses and screened for hub genes.Through the enrichment analysis of hub genes,the pathway of semen cuscutae acting on osteoarthritis was selected.The role of hub genes was verified by molecular docking.Therefore,the appropriate active ingredients of semen cuscutae were selected for experimental verification. RESULTS AND CONCLUSION:There were 11 active ingredients of semen cuscutae,66 intersection target genes of semen cuscutae and osteoarthritis,and 12 hub genes,including tumor necrosis factor,interleukin 1B,TP53,RAC-alpha serine/threonine protein kinase(AKT1),vascular endothelial growth factor A,matrix metalloproteinase 9,prostaglandin peroxidase 2,cystatinase 3,epidermal growth factor,peroxisome proliferator-activated receptor gamma,interleukin 10,vascular cell adhesion factor 1.After the enrichment analysis of the hub genes,the classical inflammatory pathway,nuclear factor-κB signaling pathway,was selected for subsequent validation of semen cuscutae to alleviate osteoarthritic inflammation.Through the results obtained after molecular docking of each active ingredient and the hub gene of the pathway prostaglandin peroxidase 2,sesamin with the highest affinity was selected for subsequent cell experiments,and the experimental results confirmed that sesamin,the active ingredient of semen cuscutae,could reduce the expression of cyclooxygenase 2 by inhibiting the nuclear factor-κB signaling pathway induced by interleukin-1β.To conclude,sesamin,the active ingredient of semen cuscutae,reduces the expression of cyclooxygenase 2 by inhibiting the nuclear factor-κB signaling pathway induced by interleukin-1β,thereby improving inflammation in osteoarthritis and expanding the therapeutic effect of semen cuscutae in osteoarthritis.

Embedded 3D printing of porous silicon orbital implants and its surface modification / 南方医科大学学报

OBJECTIVE@#To prepare customized porous silicone orbital implants using embedded 3D printing and assess the effect of surface modification on the properties of the implants.@*METHODS@#The transparency, fluidity and rheological properties of the supporting media were tested to determine the optimal printing parameters of silicone. The morphological changes of silicone after modification were analyzed by scanning electron microscopy, and the hydrophilicity and hydrophobicity of silicone surface were evaluated by measuring the water contact angle. The compression modulus of porous silicone was measured using compression test. Porcine aortic endothelial cells (PAOECs) were co-cultured with porous silicone scaffolds for 1, 3 and 5 days to test the biocompatibility of silicone. The local inflammatory response to subcutaneous porous silicone implants was evaluated in rats.@*RESULTS@#The optimal printing parameters of silicone orbital implants were determined as the following: supporting medium 4% (mass ratio), printing pressure 1.0 bar and printing speed 6 mm/s. Scanning electron microscopy showed that the silicone surface was successfully modified with polydopamine and collagen, which significantly improved hydrophilicity of the silicone surface (P < 0.05) without causing significant changes in the compression modulus (P > 0.05). The modified porous silicone scaffold had no obvious cytotoxicity and obviously promoted adhesion and proliferation of PAOECs (P < 0.05). In rats bearing the subcutaneous implants, no obvious inflammation was observed in the local tissue.@*CONCLUSION@#Poprous silicone orbital implants with uniform pores can be prepared using embedded 3D printing technology, and surface modification obviously improves hydrophilicity and biocompatibility of the silicone implants for potential clinical application.

Repair of finger pulp defect with free thenar perforator flap / 中华显微外科杂志

Objective:To investigate the effect of free thenar perforator flap on repair of finger pulp defect.Methods:From September 2019 to November 2021, 79 cases of finger injuries complicated with defects in the pulp of fingers received free thenar perforator flap transfer surgery for reconstruction of finger pulps in the Department of Hand and Foot Surgery, Taizhou Hospital, Zhejiang Province. The patients were 51 males and 28 females, aged from 17 to 52(37.5±5.2) years old. There were 34 finger-pulp defects of index fingers, 15 of middle fingers, 26 of ring fingers and 4 of little fingers. All patients were treated with free thenar perforator flaps sized 2.0 cm×2.5 cm-3.0 cm×3.5 cm. All thenar perforator flaps were pedicled with the perforator artery and subcutaneous superficial vein in the thenar region, and the vessels were anastomosed with the proper palmar digital artery and dorsal digital vein, respectively. At the same time, subcutaneous nerve and proper palmar digital nerve were sutured to reconstruct the sensation of flaps. During the operation, the dominant perforating branch of thenar was found being originated from the superficial palmar branch of radial artery in 27 cases, from the superficial palmar arch in 21 cases, from the perforating branch of metacarpophalangeal proper artery of thumb in 11 cases, from the radial artery in 10 cases and from the main artery of thumb in 10 cases. The origins of nerves within the flaps were found from the superficial branch of radial nerve(24 cases), the terminal branch of lateral cutaneous nerve of forearm(22 cases) and the palmar branch of median nerve(33 cases). The operation time was (96.7±10.7) minutes. The donor site for the flap was closed directly without skin grafting. Most of the follow-up were conducted through the visit of outpatient clinic and the patients from other regions were reviewed via telephone or WeChat.Results:All perforator flaps survived completely and the flap donor sites healed smoothly. Follow-up lasted for (20.5±3.8) months. The reconstructed finger pulp was not bulky and the texture was satisfactory. TPD of the flaps was (5.6±0.9) mm. Only a linear scar left in the flap donor sites without significant affect on thenar function.Conclusion:The vascular anatomy of thenar perforator flap is constant, which helps to regain sensations of the flap. The texture and thickness of the flap are similar to those of the finger. It is ideal for reconstruction of defect of finger pulp.

Molecular dynamics simulation of force-regulated interaction between talin and Rap1b / 生物医学工程学杂志

The binding of talin-F0 domain to ras-related protein 1b (Rap1b) plays an important role in the formation of thrombosis. However, since talin is a force-sensitive protein, it remains unclear whether and how force regulates the talin-F0/Rap1b interaction. To explore the effect of force on the binding affinity and the dynamics mechanisms of talin-F0/Rap1b, molecular dynamics simulation was used to observe and compare the changes in functional and conformational information of the complex under different forces. Our results showed that when the complex was subjected to tensile forces, there were at least two dissociation pathways with significantly different mechanical strengths. The key event determining the mechanical strength difference between the two pathways was whether the β4 sheet of the F0 domain was pulled away from the original β1-β4 parallel structure. As the force increased, the talin-F0/Rap1b interaction first strengthened and then weakened, exhibiting the signature of a transition from catch bonds to slip bonds. The mechanical load of 20 pN increased the interaction index of two residue pairs, ASP 54-ARG 41 and GLN 18-THR 65, which resulted in a significant increase in the affinity of the complex. This study predicts the regulatory mechanism of the talin-F0/Rap1b interaction by forces in the intracellular environment and provides novel ideas for the treatment of related diseases and drug development.

Frontier hotspots and research progress on 3D bioprinting in organ reconstruction / 器官移植

3D bioprinting is an advanced manufacturing technology that utilizes biomaterials and bioactive components to manufacture artificial tissues and organs. It has been widely applied in multiple medical fields and possesses outstanding advantages in organ reconstruction. In recent years, 3D bioprinted organs have made an array of groundbreaking achievements. Nevertheless, it is still in the exploratory stage of research and development and still has bottleneck problems, which can not be applied in organ transplantation in vivo. In this article, the application of 3D printing technology in medicine, characteristics of 3D bioprinting technology, research hotspots and difficulties in bionic structure, functional reconstruction and immune response of 3D bioprinted organs, and the latest research progress on 3D bioprinting technology were illustrated, and the application prospect of 3D bioprinting technology in the field of organ reconstruction was elucidated, aiming to provide novel ideas for the research and clinical application of organ reconstruction and artificial organ reconstruction, and promote the development of organ transplantation and individualized medicine.

Clinical effect of rhinoplasty with ear cartilage and silicone prosthesis: a three-dimensional scanning study / 中华医学美学美容杂志

Objective:To use three-dimensional (3D) scanning to measure the preoperative and postoperative nasal parameters of the patients received rhinoplasty with ear cartilage and silicone prosthesis, and to evaluate the clinical effect of the surgery.Methods:Sixteen female patients with an average age of 28.3 years, ranged from 21 to 35 years, received rhinoplasty with ear cartilage and silicone prosthesis in Wuhan Tongji Hospital from June 2018 to February 2019. Preoperative and postoperative 3D scanning was performed to measure nasal parameters, including linear length, angle, and proportional index.Results:All patients were satisfied with the postoperative outcomes. The postoperative nasal length, nasal height, and nasal depth increased significantly, and the postoperative nasal width and nasal tip width decreased. The postoperative nasolabial angle and nasofrontal angle were statistically improved, while the preoperative and postoperative data of columellar facial angle, nasal tip angle, and nasal column-lobular angle were not significantly different. The ratios of nasal depth and nasal width, nasal index and nasal tip protrusion were improved after surgery, while the postoperative ratios of nasal columella and nasal lobules length were not statistically improved.Conclusions:The 3D scanning allows for comprehensive and accurate measurement of the nasal parameters. The rhinoplasty with ear cartilage and silicone prosthesis is more effective in improving the overall contour of the nose, but less effective in improving the aesthetics of the nasal tip.

Preparation and Antidepressant Activity Study of β-sitosterol and Its Derivatives from the Fruit of Sorbus pohuashanensis / 中国药房

OBJECTIVE： To prepare β-sitosterol （shorted fo r “Sit”） and its deri vatives from the fruit of Sorbus pohuashanensis，and to investigte their antidepressant activities. METHODS ：Using the fruit of S. pohuashanensis as raw material ， extracted with 75％ ethanol and 20％KOH solution ，Sit was obtained after extraction and crystallization. C 3 hydroxyl group of Sit was used as the structural modification site ，CH2Cl2 was used as the reaction solvent ，DMAP was used as catalyst ，EDCI was used as dehydrating agent ，4 kinds of organic acids （salicylic acid ，2-tetrahydrofuranic acid ，phenylalanine，sorbic acid ）were added to make the carboxylation reaction to produce ester derivatives Sit-S ，Sit-T，Sit-P and Sit-Sr. The chemical structure of its derivatives were elucidated by IR and NMR. The tail suspension test and the forced swimming model were used to preliminarily explore the antidepressant active components of Sit and 4 kinds of derivatives ；tail suspension test and the spontaneous exercise capacity test were used to screen effective dose of the compounds with antidepressant active. The compound was used alone or in combination with agomelatin [ 40 mg/kg，5-hydroxytryptamine（5-HT）and 5-HT 2C receptor antagonist] ，haloperidol [ 0.2 mg/kg，non-selective D2 receptor antagonist] and bicuculline [ 4 mg/kg，competitive γ-aminobutyric acid（GABA）antagonist]，respectively. Sixty minutes after intraperitoneal injection ，tail suspension test was performed. The levels of 5-HT，dopamine（DA）and GABA in brain tissues of mice were detected by ELISA. The blank control group was given intraperitoneal injection of 10％ propylene glycol solution. RESULTS：By spectrum technology ，the corresponding ester compounds were synthesized by the reaction of Sit with four kinds of organic acids. Among Sit and its four derivatives ，the immobility time of Sit-S group was the shortest in tail suspension test and forced swimming test ，which was significantly shorter than that of blank control group （P＜0.05）. Screening results of Sit-S showed that the effective antidepressant dose was 4 mg/kg， ＊ and it did not affect the spontaneous activity of mice compared with the blank control group （P＞0.05）. With this dose ，Sit-S could significantly shorten the immobility time of mice in tail hua1666@163.com suspension test （P＜0.01），and can s ignificantly increase the ·64levels of 5-HT，DA and GABA in the brain tissue of mice （P＜0.05 or P＜0.01），but its effect can be reversed by agomelatine ， haloperidol and bicuculline to different extent. CONCLUSIONS ：Sit salicylate derivatives Sit-S exhibits good antidepressant activity，and its mechanism of action may be mediated by increasing the levels of 5-HT，DA and GABA.

Three-dimensiona navigation template assisted osteotomy for fracture malunion of lateral condyle of humerus in children / 中华实用儿科临床杂志

Objective:To investigate the efficacy and safety of three-dimensional navigation template assisted osteotomy for fracture malunion of lateral condyle of humerus in children.Methods:Eighteen children with ma-lunion of fracture of lateral condyle of humerus were treated in Southern Medical University Third Affiliated Hospital from August 2012 to December 2019 and analyzed retrospectively.Among them, 12 cases were treated with routine ope-ration: according to CT reconstruction and empirical osteotomy during the operation, the location of deformity was analyzed.Six cases were treated with navigation template assisted osteotomy: according to the CT data of bilateral elbow joints, a three-dimensional bone model was established, and the coronal and sagittal deformities of the distal humerus were evaluated by comparing the images of the distal humerus of the affected side with the distal humerus of the healthy side, so as to determine the best plane of osteotomy and the target position of reduction.The preoperative simulation was carried out on the computer, and the osteotomy navigation template and reduction navigation template were designed.The navigation template was printed out with a 3D printer.During the operation, the osteotomy was corrected with the assistance of navigation template, and the broken end of osteotomy was fixed with hollow screw and fixed with 80 degree flexion plaster.The X-ray films of the two groups were reexamined regularly after operation.The amount of intraoperative blood loss, operation time, incidence of postoperative complications (necrosis of humeral head and trochlea, delayed ulnar nerve paralysis, and bone nonunion) and the recovery of flexion and the extension function of elbow joint were observed in the 2 groups.Results:The elbow joint activity of all children basically returned to normal, the orthopedic site of osteotomy achieved bony healing, and the orthopedic effects were satisfactory.All the 18 cases were followed up for 6-24 months (mean 15 months). According to the postoperative Dhillon score, the navigation template group was excellent in 1 case and better in 5 cases, while in the routine group, 11 cases were batter and 1 case was fair.There were no significant differences in Dhillon score between the 2 groups after operation ( P>0.05). There were no significant differences in the range of the motion of elbow joint between the 2 groups ( P>0.05). In the comparison of operation time and intraoperative blood loss, the navigation template group [(200.0±24.2) min, (85.0±10.9) mL]was better than the routine group[(232.0±20.1) min, (139.1±18.3) mL](all P<0.001). Conclusions:The application of three-dimensional humerus reconstruction and mirror image contrast to evaluate the distal humerus deformity of the affected side, and the design of osteotomy and reduction navigation template auxiliary operation can restore the normal anatomical structure of elbow joint to the greatest extent.Accurate correction, and the function of elbow joint recover well after operation, which optimizes the operation procedure, improves the safety and effectiveness of the operation.

Topological optimization of locking plate stiffness for distal radial fracture / 中华创伤骨科杂志

Objective:To optimize the topological design of locking plate for distal radial fracture so that the internal fixation stiffness can be customized.Methods:Models of both the distal radial fracture and the conventional locking plate fixation were constructed using software for three-dimensional modeling and computer-aided design. Based on the data from our previous finite element analysis, a decrease of 33.33% in axial stiffness but retention of more than 90.00% in torsional stiffness were defined as the optimization limits. The conventional plate was redesigned by way of topological optimization iterations. Finite element analysis was done to compare stiffness and interfragmentary strain (IFS) between the new optimized design and conventional design of the locking plate under both compressive and torsional loads.Results:The axial stiffness of the optimized plate was 636.5 N/mm with a downgrading magnitude of 19.7% which was close to the given limit; the torsional stiffness was 634.12 Nmm/° with a downgrading magnitude of 8.8% which remained under the given limit. In the optimized design, a more significant increase was observed in axial IFS than that in shear IFS, leading to a similar effect as the stiffness regulation did.Conclusion:The optimized design of locking plate for distal radial fracture can provide a reliable solution for customized regulation of the internal fixation stiffness.

Progress in clinical application of 3D printed navigational template in orthopedic surgery / 南方医科大学学报

Orthopedic 3D printed surgical navigational template is an instrument that is prepared by 3D reconstruction based on preoperative radiological data of the patient using computer-aided design (CAD) and 3D printing techniques. The 3D printed navigational template allows accurate intra-operative assessment of the relative spatial distance, angular relationship, direction and depth. The application of 3D printed navigational template technique in orthopedics surgeries achieves the conversion of preoperative planning from 2/3D graphics to 3D models, and provides a new method for individualized and precise treatment. Herein we review the evolution, clinical application, and basic classification of 3D printed navigation template technique, analyze its advantages and disadvantages, and discuss the current problems and the future development of this technique.

Differential diagnosis and treatment of intestinal perforation caused by neonatal necrotizing enterocolitis and Hirschsprung′s disease / 中华实用儿科临床杂志

Objective@#To retrospectively analyze the differential diagnosis and treatment strategy of neonatal intestinal perforation caused by neonatal necrotizing enterocolitis (NEC) and Hirschsprung′s disease (HD).@*Methods@#The clinical data of 42 cases with NEC and 22 cases with HD combined with intestinal perforation from Ja-nuary 2012 to January 2017 admitted at Fujian Provincial Maternity and Children′s Hospital were collected, the proportion of premature infants, and the proportion of low birth weight infants, age of onset, preoperative clinical symptoms and surgical treatment was compared between the two groups.@*Results@#The proportion of premature infants[95.23%(40/42 cases) vs.27.27%(6/22 cases)], the proportion of low birth weight infant[90.48%(38/42 cases) vs.45.45%(10/22 cases)]and the age of onset [(14.48± 10.51) d vs.(3.18±3.43) d]were statistically different between the NEC group and the HD group, and the differences were statistically significant(all P<0.05). There were significant differences in the presence of normal defecation before the operation[71.4% (30/42 cases)vs.27.3%(6/22 cases)], and in the the defecation characteristics at the onset[95.2% (40/42 cases)vs.9.1%(2/22 cases)]between the NEC group and HD group(all P<0.05). Among 42 cases of NEC patients, 8 cases underwent intestinal anastomosis, and 34 cases underwent enterostomy because of the high risk of anastomosis.All of 22 patients with HD underwent double-lumen enterostomy.@*Conclusions@#The general conditions, preoperative manifestations and intraoperative fin-dings of the children should be comprehensively analyzed for identification.Enterostomy is recommended for NEC intestinal perforation, but if the risk of anastomosis is high, then fistula should be performed.Double-lumen fistula should be recommended for HD intestinal perforation, and enterostomy should be recommended if the two cannot be clearly distinguished.

Differential diagnosis and treatment of intestinal perforation caused by neonatal necrotizing enterocolitis and Hirschsprung's disease / 中华实用儿科临床杂志

Objective To retrospectively analyze the differential diagnosis and treatment strategy of neonatal intestinal perforation caused by neonatal necrotizing enterocolitis (NEC) and Hirschsprung's disease (HD).Methods The clinical data of 42 cases with NEC and 22 cases with HD combined with intestinal perforation from January 2012 to January 2017 admitted at Fujian Provincial Maternity and Children's Hospital were collected,the proportion of premature infants,and the proportion of low birth weight infants,age of onset,preoperative clinical symptoms and surgical treatment was compared between the two groups.Results The proportion of premature infants[95.23％ (40/ 42 cases) vs.27.27％ (6/22 cases)],the proportion of low birth weight infant [90.48％ (38/42 cases) vs.45.45％ (10/22 cases)] and the age of onset [(14.48 ± 10.51) d vs.(3.18 ± 3.43) d] were statistically different between the NEC group and the HD group,and the differences were statistically significant(all P ＜ 0.05).There were significant differences in the presence of normal defecation before the operation [71.4％ (30/42 cases) vs.27.3％ (6/22 cases)],and in the the defecation characteristics at the onset[95.2％ (40/42 cases)vs.9.1％ (2/22 cases)] between the NEC group and HD group(all P ＜ 0.05).Among 42 cases of NEC patients,8 cases underwent intestinal anastomosis,and 34 cases underwent enterostomy because of the high risk of anastomosis.All of 22 patients with HD underwent double-lumen enterostomy.Conclusions The general conditions,preoperative manifestations and intraoperative findings of the children should be comprehensively analyzed for identification.Enterostomy is recommended for NEC intestinal perforation,but if the risk of anastomosis is high,then fistula should be performed.Double-lumen fistula should be recommended for HD intestinal perforation,and enterostomy should be recommended if the two cannot be clearly distinguished.

Three-dimensional printing in resection of skull base tumors / 中华神经医学杂志

Objective To explore the application value of three-dimensional (3D) printing in skull base tumor resection.Methods Fourteen patients accepted resection of skull base tumors in our hospital from May 2016 to November 2017 were chosen in our study;before surgery,solid models of the tumors,having bones of the skull base,tumor tissues and main blood supply arteries,were established by 3D printing;resection was simulated in these models and the surgical approaches and surgical methods were determined accordingly.The disease history,preoperative and postoperative imaging data were analyzed retrospectively.Results The mean time for making a solid model of the tumors was 18.5 h,and the cost was about 5,000 Yuan.Postoperative CT and MR imaging showed that total excision was achieved in 8 patients,subtotal excision was achieved in 5 patients,and one with tumor of the jugular foramen achieved total excision of the intracranial tumor and subtotal excision of the extracranial tumor.One patient had large hemispheric infarction after operation and decompressive craniectomy was performed;the other 13 patients recovered well without serious complications or death.Conclusion The 3D printing technique can assist the preoperative simulation and formulation of skull base tumor resection,and improve the efficiency and safety of the operation.

Symmetry analysis of a 3D printed model of distal radius / 中华创伤骨科杂志

Objective To investigate whether a 3D printed model of the contrlateral healthy distal radius, especially its articular accuracy, helps anatomical reduction and precise reconstruction of the fractured distal radius. Methods The CT data of bilateral radii were collected from 15 normal volunteers ( 11 males and 4 females with an average age of 22. 8 years ) between November and December 2016. After 3D reconstruction of the bilateral distal 1/3 radii, solid 3D models of left radius were mirrored and generated by 3D printing. The data of right radii ( reference group ) were compared with the data of the solid 3D models of left radius acquired through a 3D scanner ( test group ) using deviation analysis. Results The maximum volume difference between the 3D printed model and the contralateral radius was 6. 86％. The average volume of the reference group was 19, 165. 82 ± 3, 250. 50 mm3 and that of the test group 19, 310. 65 ± 3, 305. 15 mm3, showing no statistically significant difference between the 2 groups ( t= -0. 941, P=0. 363 ) . The maximum surface area difference was 3. 84％ between the 2 groups. The average surface area of the reference group was 5, 075. 80 ± 549. 34 mm2 and that of the test group 5, 139. 43 ± 572. 48 mm2, showing a signifi-cant difference ( t= -2. 451, P=0. 028 ) . The 3D deviation analysis showed a mean positive deviation of 0. 37 ± 0. 10 mm and a mean negative deviation of 0. 30 ± 0. 07 mm. The maximum mean square root was 0. 65. The 3D deviation was distributed mainly within 1 mm interval, with a distribution frequency of 96. 27％. Conclusions A 3D printed model prepared by high precision equipment is accurate enough to guide reconstruction of distal radius fractures in adults. In the treatment of complex fractures of the distal radius, a 3D printed model of the contralateral healthy distal radius can be used as a reference to achieve anatomical reduction and precise reconstruction of the fractured distal radius.

Research on and application of 3D printing technology in orthoses / 中华创伤骨科杂志

Three-dimensional (3D) printing,a key technique of rapid prototyping (RP),is developing rapidly all over the world.As 3D printing has a significant advantage of personalized manufacturing,it has exerted a profound effect on medicine.The high demand for personalized manufacturing in the field of orthosis provides an excellent opportunity for widespread use of 3D printing technique.This review briefly introduces the principles and characteristics of different forming methods of 3D printing,the types and characteristics of 3D printing materials widely used at present,and classification and clinical application of orthoses.We also summarize the domestic and international research on and manufacture oforthoses using 3D printing techniques,and discuss current problems and future development of 3D printing techniques in orthosis.

Review and prospect of using traditional Chinese medicine drugs "supplementing Qi and nourishing Yin, activating blood circulation and detoxifying" for prevention and treatment of diabetes mellitus complicated with acute coronary syndrome / 中国中西医结合急救杂志

At present, the prevalence rate of diabetes presents a rising tendency. The cardiovascular disease is a major complication of diabetes mellitus and acute coronary syndrome (ACS) is a severe form of coronary heart disease. Compared with non-diabetic patients, the disease situation in diabetic ACS patients is more serious with more contradictory problems and difficulty in treatment. Although percutaneous coronary intervention (PCI) plays a certain role in re-canalization of coronary artery, after PCI the problems the patients with diabetic ACS will face are still serious. traditional Chinese medicine (TCM) recognizes that the etiology and pathogenesis of diabetic ACS are deficiency in Qi and Yin, and accumulation of blood stasis and toxin inside the body. Through clinical observation and retrospective analysis, it is found that using "supplementing Qi and nourishing Yin, activating blood circulation and detoxifying"can interfere with the patients' diabetic ACS and simplify the therapeutic regimen, which is an integrated regulatory treatment with multiple links, multiple pathways and multiple targets, and is a sufficient realization of unique superiority of traditional Chinese medicine by using holistic concept, syndrome differentiation and multiple-link interference for comprehensive prevention and treatment of diabetic ACS.

3D-printing in preoperative design of internal fixation for Sanders Ⅲ calcaneal fractures / 中华创伤骨科杂志

Objective To investigate the application of 3D-printing and digital technology in the preoperative design of internal fixation for intra-articular calcaneal fractures.Methods Thin-layer CT images of bilateral calcanei were collected from 12 patients who had been treated for calcaneal fracture of Sanders type Ⅲ from November 2015 to October 2016.They were 7 men and 5 women,aged from 23 to 53 years (average,38.7 years).The images were uploaded into Mimics software for 3D reconstruction,virtual reduction and digital surgical design.Real-size calcaneal models and navigation modules were produced using 3D printing technology for plate preshaping and surgical simulation.The operations were carried out according to preoperative design.The postoperative calcaneal morphological parameters were evaluated.Comparisons were made between postoperative results and preoperative digital design.Results The operating time for the 12 patients ranged from 60 to 90 minutes,averaging 77.9 minutes.Their follow-ups ranged from 4 to 8 months,averaging 6.2 months.No complications affecting their soft tissues happened.The postoperative B(o)hler angle (32.6° ± 3.6°) and Gissane angle (123.9° ± 9.5°) were significantly improved compared with the preoperative values (12.4° ± 2.1° and 143.9° ± 7.8°) (P ＜ 0.001).The shape of postoperative calcaneus was similar to that of the preoperative reduction model.The internal fixation locations and nail directions were in agreement with the preoperative design.Their average Maryland score was 87.8 and excellent to good rate 91.7％.Conclusion This technique can transform a digital design for intra-articular calcanealfracture into real operation tools to help realize a precise surgical design for such fractures.