[Analysis of clinical effect of arthroscopic release at different time in treating knee adhesion after arthroscopic surgery]

Objective: To explore the efficacy of arthroscopic release in treating postoperative knee adhesion and investigate the influence of release timing on the treatment outcomes. Methods: A total of 50 patients who accepted arthroscopic release in Peking University Third Hospital from February 2017 to December 2021 were included in the retrospective cohort. The study cohort comprised 28 men and 22 women, with a mean age of (30.8±11.9) years. All the primary surgeries were manipulated under arthroscopes. A comparison was made between pre-and postoperative range of motion (ROM), visual analog scale (VAS), International Knee Documentation Committee (IKDC) scores, and Tegner activity scale scores for the patients. According to the interval between the appearance of adhesion and arthroscopic release, the patients were divided into four groups:<3 months group (n=12), 3-6 months group (n=16),>6-12 months group (n=14), and>12 months group (n=8). Inter-group comparisons on postoperative ROM, IKDC scores, and Tegner activity scale scores and improvement values of each outcome were conducted. Results: All the patients were followed up for (36.4±19.7) months. Patients gained significant improvement in flexion, extension, IKDC scores, and Tegner scores (125.0°±20.0° vs 75.7°±27.5°, 2.3°±4.8° vs 7.4°±7.3°, 69.8±17.7 vs 51.4±12.8, 4.1±2.1 vs 2.2±1.1) (all P<0.05), while the VAS scores did not show significant improvement. There were no significant differences among different groups in postoperative extension, IKDC scores or Tegner scores, nor in their improvements. However, patients in the ≤6 months group could gain better postoperative flexion and improvement in flexion than those in the >6 months group (129.9°±20.0° vs 118.8°±17.4°, 58.6°±32.8° vs 37.3°±23.1°) (P<0.05). Conclusions: Arthroscopic release presents a great effect in treating knee adhesion after arthroscopic operation. Once the symptoms of adhesion appear and physical rehabilitation fails to improve the ROM, one should accept early surgical intervention (less than 6 months) for a better outcome.

[The development and future of sports medicine in China]

This article mainly introduces the development history and current situation of sports medicine in China, and deeply analyzes the problems that have emerged during the current development process, and proposes corresponding solutions. Based on this, the article proposes five key directions for the development of sports medicine, which are: developing arthroscopic minimally invasive techniques, ensuring the guarantee work for competitive sports, attaching great importance to the development of sports rehabilitation, vigorously carrying out exercise prescription and exercise assessment work, and emphasizing the training and education of sports medicine professionals. Finally, the article looks forward to the future development of sports medicine from three aspects: popularizing and expanding the influence of sports medicine through popular science promotion, improving the quality and safety of sports through health management and disease prevention, and achieving precise diagnosis and treatment through scientific research and innovation. It is hoped that this article will provide reference for the development of sports medicine in China.

[Association between vitamin D level and grip strength in adults aged 50 and older in Shanghai]

Objective: To understand the association between vitamin D level and grip strength in people aged ≥50 years in Shanghai. Methods: Data were obtained from the WHO's Study on Global Ageing and Adult Health in Shanghai during 2018-2019. Logistic regression model was used to analyze the association between vitamin D level and grip strength, and a stratified analysis was conducted for different gender, age and dairy product intake groups. Restricted cubic spline was used to evaluate the dose-response association between vitamin D level and low grip strength. Results: A total of 4 391 participants were included in the study, including 2 054 men (46.8%), with an average age of (67.02±8.81) years. And 1 421 individuals (32.4%) had low grip strength; 1 533 individuals (34.9%) had vitamin D deficiency, and 401 individuals (9.1%) had vitamin D deficiency. After adjusted for confounding factors, the logistic regression results analysis showed that individuals with vitamin D deficiency had a higher risk for low grip strength (OR=1.41, 95%CI: 1.09-1.83). In men, after adjusting for confounding factors, vitamin D deficiency was positively associated with the risk for low grip strength (OR=1.67, 95%CI: 1.12-2.50), but there was no significant association between vitamin D level and grip strength in women (OR=1.30, 95%CI: 0.97-1.74). In age group 60-69 years and ≥80 years, there was significant association between vitamin D deficiency and low grip strength after adjusting for confounding factors (OR=1.57, 95%CI: 1.05-2.35; OR=2.40, 95%CI: 1.08-5.31). In people who had daily intake of dairy product <250 ml, there was positive association between vitamin D deficiency and low grip strength, but there was no significant association in people who had daily dairy product ≥250 ml after adjusting for confounding factors. The restrictive cubic spline demonstrated that risk of low grip strength might decreased with the increase of vitamin D levels, however, the difference was not significant (P>0.05). Conclusions: This study demonstrated that there is association between vitamin D level and grip strength. People with vitamin D deficiency have higher risk for low grip strength.

[Association between dietary pattern and frailty among people aged 50 years and over in Shanghai]

Objective: To investigate dietary patterns of individuals aged ≥50 in Shanghai and analyze their association with frailty. Methods: Using data from the third wave of the Study on Global Ageing and Adult Health in Shanghai conducted between 2018 and 2019. We collected the frequency and average intake of food by the food frequency questionnaire. Factor analysis was used to extract dietary patterns, and a frailty index was constructed using the ratio of the cumulative total score of health deficits to 35 health-related variables considered. We used an ordinal multinomial logistic regression model to analyze the association between dietary patterns and frailty. Results: A total of 3 274 participants aged (67.9±9.2) years were included in the study, including 1 971 (60.2%) men and 1 303 (39.8%) women. We extracted four dietary patterns: high-protein-nuts pattern, potato-bean-vegetable-fruit pattern, poultry-meat pattern, and high-oil-salt pattern. After adjusting for confounding factors, the logistic regression analysis showed that compared with the high-oil-salt pattern, the high-protein-nuts pattern was negatively associated with the risk of higher frailty (OR=0.743, 95%CI: 0.580-0.951). We did not find an association between dietary patterns and frailty between the different gender groups. In the age group 50-64, the high-protein-nuts and potato-bean-vegetable-fruit patterns were negatively correlated with a higher degree of frailty than the high-oil-salt pattern. In the low-level physical activity group, the high-protein-nuts pattern was negatively correlated with a higher degree of frailty than the high-oil-salt pattern (OR=0.509, 95%CI: 0.361-0.720). However, we found no significant effect of the high-protein nuts pattern, potato-bean-vegetable-fruit pattern, and poultry-meat pattern on the risk of higher frailty compared to the high-oil-salt pattern in the moderate to high level of physical activity group. Conclusions: Compared to the high-oil-salt pattern, dietary patterns with a higher intake of high-protein nuts, potatoes, legumes, and fruits and vegetables might be associated with a lower risk of higher frailty in residents aged 50-64 years of age than with a high oil and salt pattern. At the same time, it may have a more significant protective effect in people with lower physical activity levels. It is suggested that a diet rich in high-protein foods, nuts, potatoes, beans, vegetables, and fruits may help reduce and delay the risk of frailty.

[Study on the Correlation between Elevated Serum Free Light Chain and Inferior Clinical Features or Hematological Parameters of Lymphoma Patients in Chengdu Area]

OBJECTIVE

To analyze the correlation of the serum free light chain elevated (sFLC) and clinical characteristics and hematological parameters of lymphoma in Chengdu area.

METHODS

249 cases of non-Hodgkin lymphoma （NHL） out of 274 patients with lymphoma diagnosed in Sichuan People's Hospital from April 2019 to July 2021 were selected, the sFLC, clinical features and hematological parameters of the patients were analyzed retrospectively. The difference of clinical features between the patients with normal sFLC and elevated sFLC was examined by chi-square test. The difference of hematological parameters between patients with normal sFLC and elevated sFLC were examined by chi-square test and nonparametric Mann-Whitney U test.

RESULTS

Among the 249 NHL patients, 55.42% （138/249） patients had an elevated sFLC, of which 9.24% （23/138） were being monoclonal and 46.18% （115/138） were polyclonal. The sFLC elevation was common in NHL, but varied according to the types of sFLC secretion （monoclonal or polyclonal）, and types of lymphoma. Furthermore, there were no significant statistical differences in clinical characteristics, including age, sex, stage disease, International Prognostic Index （IPI）, B symptoms, and bone marrow invasion between elevated sFLC and normal sFLC of the NHL patients （P＞0.05）. However, the patients with elevated sFLC had adverse hematological parameters more frequently, including higher WBC, ANC, AMC, hsCRP, Cr, Glb, LDH, and lower Hb, Alb.

CONCLUSION

Elevated sFLC is associated with inferior hematological parameters, revealing the uniqueness of the diagnostic and prognostic value of sFLC in lymphoma in chengdu area.

[Classification system of radical surgery for rectal cancer based on membrane anatomy]

Because the classification system of radical surgery for rectal cancer has not been established, it is impossible to select the appropriate surgical method according to the clinical stage of the tumor. In this paper, we explained the theory of " four fasciae and three spaces " of pelvic membrane anatomy and then combined this theory with the membrane anatomical basis of Querleu-Morrow classification for radical cervical cancer resection. Based on this theory and the membrane anatomy of Querleu-Morrow classification of radical cervical cancer resection, we proposed a new classification system of radical rectal cancer surgery based on membrane anatomy according to the lateral lymph node dissection range of the rectum. This system classifies the surgery into four types (ABCD) and defines corresponding subtypes based on whether the autonomic nerve was preserved. Among them, type A surgery is total mesorectal excision (TME) with urogenital fascia preservation, type B surgery is classical TME, type C surgery is extended TME, and type D surgery is lateral extended resection. This classification system unifies the anatomical terminology of the pelvic membrane, validates the feasibility of using the " four fasciae and three fascial spaces " theory to classify rectal cancer surgery, and lays the theoretical foundation for the future development of a unified and standardized classification of radical pelvic tumor surgery.

[Relationship between respiratory event-related arousal and increased pulse rate in patients with obstructive sleep apnea]

Objective: To investigate the relationship between respiratory event-related arousal and increased pulse rate in patients with obstructive sleep apnea (OSA), and to evaluate whether elevated pulse rate can be used as a surrogate marker of arousal. Methods: A total of 80 patients [40 males and 40 females, age range (18-63 years), mean age (37±13) years] who attended the Sleep Center of the Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital for polysomnography (PSG) from January 2021 to August 2022 were enrolled. Stable PSG recordings of non-rapid eye movement (NREM) sleep to compare the mean pulse rate (PR), the lowest PR 10 seconds before the onset of arousal, and the highest PR within 10 seconds after the end of arousal associated with each respiratory event. At the same time, the correlation between the arousal index and the pulse rate increase index (PRRI), as well as ΔPR₁ (highest PR-lowest PR) and ΔPR₂ (highest PR-mean PR), respectively, with the duration of respiratory events, the duration of arousal, the magnitude of pulse oximetry (SpO₂) decline, and the lowest SpO₂ was analyzed. Among the 53 patients, 10 events without arousal and 10 events with arousal (matched for the magnitude of SpO₂ decline) were selected for NREM in each of the 53 patients, and ΔPR before and after termination of respiratory events in the two groups was compared. In addition, 50 patients were simultaneously subjected to portable sleep monitoring (PM) and divided into non-severe OSA group (n=22) and severe OSA group (n=28), and ΔPR≥3 times,≥6 times,≥9 times, and≥12 times after respiratory events were used as surrogate markers of arousal, and ΔPR was scored manually and integrated into the respiratory event index (REI) of PM. Then, we compared the agreement between REI calculated from the four PR cut-off points and the apnea-hypopnea index (AHI_PSG) calculated by the gold standard PSG. Results: ΔPR₁ [(13±7)times/min] and ΔPR₂ [(11±6)times/min] were significantly higher in patients with severe OSA than in patients with non-OSA,mild and moderate OSA. The arousal index was positively correlated with the four PRRIs (r 0.968, 0.886, 0.773, 0.687, P<0.001, respectively), and the highest PR [(77±12) times/min] within 10 s after the end of arousal was significantly higher than the lowest PR [(65±10) times/min, t=113.24, P<0.001] and the mean PR [(67±11) times/min, t=103.02, P<0.001]. ΔPR₁ and ΔPR₂ were moderately correlated with the decrease in SpO₂ (r=0.490, 0.469, P<0.001). After matching the magnitude of SpO₂ decline, the ΔPR[(9±6)/min] before and after the termination of respiratory events with arousal was significantly higher than that of respiratory events without arousal [(6±5)/min, t=7.72, P<0.001]. The differences between REI+PRRI₃ and REI+PRRI₆ and AHI_PSG in the non-severe OSA group were not statistically significant (P values 0.055 and 0.442, respectively), and REI+PRRI₆ and AHI_PSG showed good agreement (the mean difference was 0.7 times/h, 95%CI 8.3-7.0 times/h). The four indicators of PM in the severe OSA group were statistically different from AHI_PSG (all P<0.05), and the agreement was poor. Conclusions: Respiratory event-related arousal in OSA patients is independently associated with increased PR, and frequent arousal may lead to increased frequency of PR fluctuations, and elevated PR may be used as a surrogate marker of arousal, especially in patients with non-severe OSA, where elevated PR≥6 times significantly improves the diagnostic agreement between PM and PSG.

[Correlation between Serum Free Light Chain and Blood Routine Parameters in Patients with Multiple Myeloma]

OBJECTIVE

To investigate the correlation between serum free light chain (sFLC) and blood routine parameters in patients with multiple myeloma (MM).

METHODS

347 patients with multiple myeloma diagnosed in Sichuan people's Hospital from April 2019 to July 2021 were selected. sFLC, serum total light chain (sTLC), peripheral blood routine, coagulation and biochemical parameters were analyzed retrospectively. The correlation analysis between sFLC and blood routine parameters were calculated by Pearson or Spearman correlation coefficients. Multiple stepwise linear regression was used to screen the combined blood routine parameters related to sFLC. The efficacy of the selected blood routine parameters eflecting sFLC level was evaluated, the Kruskal Wallis test of independent samples was used for inter group comparison, and the receiver operating characteristic (ROC) curve was drawn at the same time.

RESULTS

In MM patients, sFLC was positively related with sTLCκ, sTLCλ, sTLCκ/λ, Cr, Urea, Cr and Cys_C significantly, while negatively correlated with eGFR markedly (｜r｜≥0.3). Multivariate stepwise linear regression showed that the influence factors of sFLCκ were Cr and sTLCκ (P=0.000, P=0.003), the influence factors of sFLCλ were eGFR and sTLCλ(P=0.000, P=0.000), the sFLCκ/λ influence factor was sTLCκ/λ (P=0.032). Kruskal Wallis test of independent samples showed that Cr and sTLCκ, eGFR and sTLCλ, TLCκ/λ were good or better parameters to reflect the level of sFLCκ, sFLCλ and sFLCκ/λ in MM patients(P＜0.05), respectively. ROC curve analysis shows that Cr, sTLCκ, eGFR, sTLCλ and sTLCκ/λ had the ability to judge the abnormality of sFLC in MM patients (AUC=0.684-0.875, P＜0.05).

CONCLUSION

In MM patients, sTLCκ and sTLCλ with renal function parameters could evaluate sFLCκ or sFLCλ level respectively, while sFLC κ/λ was estimated by sTLCκ/λ.

[Characteristics of overnight obstructive apnea events in patients with obstructive sleep apnea hypopnea syndrome]

Objective: To compare the overnight variation trends in the duration of obstructive apnea events, and to explore the adaptive capacity to the pathophysiological consequences of periodic sleep disordered-breathing and its underlying mechanism in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: A retrospective analysis were performed of the polysomnographic (PSG) results of 89 snoring patients including 10 non-OSAHS, 15 mild, 29 moderate and 35 severe OSAHS. The total record time was divided into four equal phases, and the variation trends of the mean apnea duration (MAD) and the longest apnea duration (LAD) were compared with the progression of sleep phases in different groups. Correlation analysis was conducted with demographic indicators, pulse oxygen saturation (SpO₂) and sleep related indicators. In addition, the number of apneas-time variability curve was plotted for fitting analysis. Results: In patients with severe OSAHS, both MAD [26.1(20.9, 31.4) s] and LAD [56.5(46.5, 82.0) s] were significantly higher than those of non-OSAHS, mild and moderate OSAHS (P<0.001). In addition, the MAD in the third and fourth quartiles were significantly higher than that in the first quartile [(28.4±9.0) s, (27.3±9.8) s, (22.3±9.9) s, respectively, P=0.046], and the LAD in the third quartile was significantly higher than that in the first quartile [56.5(38.5, 71.0) s, 41.0(28.0, 53.0) s, respectively, P=0.018]. In all subjects, the MAD and LAD in the third and fourth quartiles were significantly higher than those in the first quartile [MAD: 20.3(10.3, 29.2) s, 18.5(11.3, 24.2) s, 12.9(0.0, 21.8) s, respectively, P<0.001; LAD: 28.0(10.3, 50.5) s, 28.0(12.0, 44.5) s, 14.5(0.0, 32.3) s, respectively, P<0.001]. There was no statistical difference in the lowest SpO₂ (LSpO₂), the mean SpO₂ (MSpO₂), and the percent of sleep time oxygen saturation below 90% (T90%) of all subjects in different sleep phases (P>0.05). The LAD was positively correlated with obstructive apnea index (OAI, OR=1.660, P=0.025), but no correlation was observed with other indicators (P>0.05). The MAD increased 0.22 s per episode at the onset of sleep (1-31 apnea events), then dropped to 0.04 s of increase per episode, with a dynamics change of 5.5-fold slower. Conclusions: The MAD and LAD show a gradual prolongation trend with the progression of sleep phases, and the prolongation trend is the most obvious in patients with severe OSAHS, while the dynamic change trend of SpO₂ is not obvious. There may be multiple adaptation mechanisms for recurrent hypoxic episodes, and the adaptation occurr in stages, with a rapid increase in MAD at the onset of sleep, follow by a markedly slower increase. Patients with severe OSAHS express the most complete pattern, suggesting the most severe pathophysiological outcomes.

[Clinical analysis of pulmonary nocardiosis associated with bronchiectasis]

Objective: To better understand the clinical characteristics of pulmonary nocardiosis associated with bronchiectasis. Methods: Patients diagnosed as bronchiectasis complicated with pulmonary nocardiosis in 9 tertiary general hospitals in China were enrolled from March 2016 to March 2020, with the record of general data, imaging performance and pathogen. The literature was reviewed. Results: Totally 17 patients were included. There were 12 females and 5 males. The ages ranged from 45 to 79 years, with an average of (63±9) years. There were 15 nonsmokers and 2 smokers, all of whom with chronic course. The clinical manifestations were mostly cough, expectoration, hemoptysis, fever, and dyspnea. The imaging manifestation was bronchiectasis in both lungs, with the most common involvement in the left lower lung, right middle lobe and left lingual lobe. Sputum cultures were positive in 10 cases, bronchoalveolar lavage fluid (BALF) cultures were positive in 6 cases, and next generation gene sequencings were positive in 4 cases, including 2 cases of Nocardia gelsenkii, 2 cases of Nocardia abscess, 2 cases of Nocardia stellate, 1 case of Nocardia mexicana, 1 case of Nocardia otitis caviae, and 9 cases of undetermined Nocardia. There were 3 cases of Klebsiella pneumoniae, 2 cases of Pseudomonas aeruginosa and 2 cases of Aspergillus. The symptoms and imaging of all patients were improved after anti Nocardia therapy. Conclusions: Bronchiectasis combined with nocardiosis is more common in middle-aged and elderly women without smoking, which is similar to the clinical manifestations of Lady Windermere syndrome. Bronchiectasis often involves the left lower lobe, right middle lobe and left lingual lobe. Nocardia infection might further precipitate the initiation and progression of bronchiectasis.

[Analysis of influencing factors on surgical outcome and exploration of technical principles during pancreaticojejunostomy]

Pancreaticojejunostomy is the most common anastomosis following pancreaticoduodenectomy and middle pancreatectomy. The detailed surgical technics of pancreaticojejunostomy vary dramatically, but none of them can achieve zero fistula rate. In recent years,with the development of new surgical concept,application of new surgical technology, high-tech materials and instruments,the incidence of pancreatic fistula has decreased. At the same time,researches on investigating the risk factors of pancreaticojejunostomy are gradually deepening. Based on years of surgical experience on pancreaticojejunostomy and current literatures, this paper analyzes the factors affecting the effect of pancreaticojejunostomy, such as the patient's basic physical state,pancreatic texture and diameter of the pancreatic duct,pathology and course of the disease,surgical technology and perioperative management,and summarizes six technical principles for pancreaticojejunostomy to be shared with surgical comrades:appropriate tension,protection of blood supply,hermetic closure of pancreatic section,accurate connection of pancreatic duct and intestinal mucosa,individualization,learning and accumulation of experience.

[Molecular characteristics of Legionella pneumophila in shower water of public places in Ma'anshan city from 2019 to 2020]

Objective: To understand the epidemiological and pathogenic characteristics of Legionella pneumophila in shower water of public places in Ma'anshan City from 2019 to 2020, and to provide scientific basis for further prevention and control of legionellosis. Methods: From 2019 to 2020, according to population density distribution and business scale of bathing places in the main urban area of Ma'anshan City (Huashan District and Yushan District), 8 public bathing places (including 3 large, 3 medium and 2 small) were selected to collect 308 shower water and water storage pool water samples (294 shower water samples and 14 water storage pool water samples). After the collected water samples were treated, cultured, isolated and identified, the type characteristics of Legionella pneumophila were analyzed. Results: Legionella pneumophila were detected in 120 water samples among 308 shower water and water storage pool water samples, with an overall positive rate of 39.0% (120/308). A total of 154 Legionella pneumophila strains were detected, including 10 different serotypes, predominated by serotype 1 (LP1) and serotype 3 (LP3), accounting for 40.9% (63/154) and 22.7% (35/154). Among 154 strains of Legionella pneumophila, 23 strains of Legionella pneumophila were positive for all 14 virulence genes, accounting for 14.9% (23/154), including 19 serotype 1 (LP1) and 4 serotype 8 (LP8). Pulsed field gel electrophoresis (PFGE) cluster analysis of 154 Legionella pneumophila strains showed 60 different patterns. Conclusion: Legionella pneumophila was seriously polluted in the shower water environment of public places in Ma^, anshan City. The serotypes are widely distributed and the virulence of the strains is strong. The results of molecular typing show that these strains have genetic diversity.

[Research progress of human coronaviruses and associated eye diseases]

Coronaviruses are RNA viruses. We should be alerted from the outbreak of the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003, the discovery of the human coronavirus NL63 (HCoV-NL63) in 2004 and the pneumonia outbreak caused by the novel coronavirus in 2019 (2019-nCoV). Coronaviruses can adhere to mucous membranes of the eye, nose, mouth, respiratory tract and digestive tract through various media, which leads to inflammatory reaction, pulmonary fibrosis, kidney failure and death in severe cases. As an exposed organ, the eye can also be infected. With the progress of molecular technology and the in-depth research of coronaviruses, there have been seven known coronaviruses that can infect humans, among which HCoV-NL63, SARS-CoV and 2019-nCoV can cause eye diseases. This article summarizes and analyzes the latest research results at home and abroad concerning the structural characteristics, transmission routes, ocular pathogenic characteristics and treatment of HCoV-NL63, SARS-CoV and 2019-nCoV, in order to provide reference for clinical diagnosis and treatment. (Chin J Ophthalmol, 2021, 57: 871-875).

[Classification and reconstruction of complex defects after lateral facial tumor surgery]

Objective: To explore the classification and reconstruction strategy of defects in lateral face region after operation of malignant tumors. Methods: Eighteen cases with the reconstruction of complicated defects after resection of tumors in the region of lateral face from January 2015 to January 2018 in Hunan Cancer Hospital were retrospectively reviewed. There were 14 males and 4 females, aged from 32 to 68 years. According to the presence or absence of bony scaffold, complicated defects were divided into two main categories: soft tissue perforating defects and soft tissue defects combined with bony scaffold defects. All soft tissue perforating defects in 5 cases were repaired with free anterolateral femoral flaps. Among 13 cases with soft tissue plus bony scaffold defects, 3 were repaired with free fibular flaps, 6 with free fibular flaps combined with free anterolateral femoral flaps, and 4 with chimeric deep circumflex iliac artery perforator flaps combined with anterolateral femoral flaps. Results: All flaps survived well. Two patients complicated with fistula in floor of mouth, but the wound healed after dressing change. Transoral feeding was resumed within 2 weeks after surgery in all patients. One year follow-up evaluation showed that 14 cases had symmetrical face and 10 cases had mouth opening more than 3 transverse fingers. After 36-50 months of follow-up, 6 patients died, with an overall 3-year survival rate of 66.7%. Conclusion: The classification of defects with or without bony stent loss is conducive to the overall repair design, the recovery of facial contour stent, the effective fill of dead space and the maintain of residual occlusal relationship. Good reconstruction results require a multi flap combination of osteocutaneous and soft tissue flaps.

[The history and influence of Losheng Sanatorium in Taiwan area]

Losheng Sanatorium, as a prophylactic-therapeutic institution for isolation, treatment, rehabilitation and social control of leprosy patients, was established by the Japanese colonial government in Taiwan in 1930. Losheng Sanatorium effectively carried out the compulsory isolation of leprosy patients, under the assistance of the public medical system with the help of police and the Bao-Jia management in the Japanese colonial period in Taiwan. Losheng sanatorium imported DDS, a therapeutic drug for leprosy, popularised an outpatient treatment model of leprosy, and developed mobile medical services after the Second World War. Losheng detected and treated leprosy patients successfully through the support of special skin clinics in public hospitals and missionary hospitals after Multi-drug Therapy was introduced in Taiwan in 1984. The Department of Health, Executive Yuan of the Taiwan area in commenced administration of Losheng Sanatorium in 1999 transformed it into a community-based general hospital. Losheng sanatorium adopted different control strategies in different historical periods based on the requirements of health, epidemic prevention systems and leprology developments to achieve its goals of leprosy control. The Sanatorium provides an example to understand and further study epidemical control and public health practice in the Taiwan area.

Inhibitory effects of lactoferrin on pulmonary inflammatory processes induced by lipopolysaccharide by modulating the TLR4-related pathway

This study tested the ability of lactoferrin to modulate pulmonary inflammation. To construct in vitro and in vivo inflammatory lung models, cells from the human lung adenocarcinoma cell line (A549) were exposed to lipopolysaccharide (LPS, 1 µg/mL), and mice (CD-1) were intratracheally administered LPS [10 mg/kg of body weight (BW), tracheal lumen injection], respectively. The A549 cells were preincubated with lactoferrin (10 mg/mL), and the mice were intraperitoneally injected with lactoferrin (100 mg/kg of BW), followed by LPS treatment. The concentrations of proinflammatory cytokines (IL-1β and TNF-α) in culture medium of A549 cells and in bronchoalveolar lavage fluid of the mice were determined using enzyme-linked immunosorbent assays. The toll-like receptor 4-related pathway (TLR4/MyD88/IRAK1/TRAF6/NFκB) was determined at gene and protein expression levels in A549 cells and mouse lung tissue. Results showed that LPS treatment significantly elevated the concentrations of IL-1β and TNF-α in the A549 cell culture medium and in bronchoalveolar lavage fluid of the mice; it also elevated both the mRNA and protein expressions of TLR4 and the TLR4 downstream factors in A549 cells and mouse lung tissue. Nevertheless, lactoferrin apparently depressed the releases of IL-1β and TNF-α from A549 cells and lung tissues stimulated by LPS, and significantly suppressed the TLR4 signaling pathway. Lactoferrin also promoted the enhancement of miR-146a expression in A549 cells and mouse lung tissue. Moreover, 100°C heating for 3 min caused total loss of the previously listed bioactivity of lactoferrin. Collectively, we proved that lactoferrin intervened in LPS-induced inflammation in the pulmonary cell model and in the mouse model, through inhibiting the TLR4-related pathway.

Clinical Efficacy of Cortex Daphnes (Zushima) Patch in Patients With Symptomatic Knee Osteoarthritis: A Multicenter Non-Inferiority Randomized Controlled Clinical Trial

Background: Osteoarthritis (OA) is imposing substantial burdens on individuals and society with the aging population. Cortex Daphnes patch is widely used for symptomatic knee OA in China with a satisfying clinical efficacy; however, there is scant clinical evidence supporting its use. To evaluate its efficacy, we conducted a multicenter, non-inferiority, randomized, parallel-group study comparing Cortex Daphnes patch with topical nonsteroidal anti-inflammatory drugs in patients with knee OA (NCT02770950).

Methods: A total of 264 symptomatic knee OA patients were treated with Cortex Daphnes or indomethacin cataplasms applied to affected sites once daily for 2 weeks. The primary outcome was improvement in knee pain on walking as assessed using a visual analog scale (VAS). The non-inferiority margin based on the full analysis population was set as –5 mm on the pain VAS. The secondary outcomes were changes of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, WOMAC scores for pain, function and stiffness, the 36-item Short Form Health Survey (SF-36), and global assessment of knees by the patients. Responder rates for pain VAS, WOMAC total score, and WOMAC pain were also included in the secondary outcomes.

Results: The Cortex Daphnes patch was non-inferior to indomethacin cataplasms for the primary outcome with a group difference (Cortex Daphnes patch–indomethacin cataplasm) of 2.1 mm (95% confidence interval: 2.1–6.4); similar results were found in the per-protocol population. For all other outcomes, no significant differences were found in the full analysis set or in the per-protocol analysis set, except the responder rates for WOMAC pain was higher in the Cortex Daphnes patch group than in the indomethacin cataplasm group (78.4 vs. 64.7%, p = 0.022) in the per-protocol analysis set. Overall, 28.8% patients in the Cortex Daphnes patch group and 9.8% in the indomethacin cataplasm group reported treatment-related adverse events, the vast majority of which were mild-to-moderate skin irritation, resulting in only 3.8 and 0.8% of patients dropping out, respectively.

Conclusion: The Cortex Daphnes patch, which provides satisfactory analgesic efficacy and enhances the physical function of the knee, as well as improving quality of life, may be a promising alternative to knee OA.

Hepatic transcriptome perturbations in dairy cows fed different forage resources

Background

Forage plays critical roles in milk performance of dairy. However, domestic high-quality forage such as alfalfa hay is far from being sufficient in China. Thus, more than 1 million tons of alfalfa hay were imported in China annually in recent years. At the same time, more than 10 million tons of corn stover are generated annually in China. Thus, taking full advantage of corn stover to meet the demand of forage and reduce dependence on imported alfalfa hay has been a strategic policy for the Chinese dairy industry. Changes in liver metabolism under different forage resources are not well known. Thus, the objective of the present study was to investigate the effect of different forage resources on liver metabolism using RNAseq and bioinformatics analyses.

Results

The results of this study showed that the cows fed a diet with corn stover (CS) as the main forage had lower milk yield, DMI, milk protein content and yield, milk fat yield, and lactose yield than cows fed a mixed forage (MF) diet (P <  0.01). KEGG analysis for differently expressed genes (DEG) in liver (81 up-regulated and 423 down-DEG, Padj ≤0.05) showed that pathways associated with glycan biosynthesis and metabolism and amino acid metabolism was inhibited by the CS diet. In addition, results from DAVID and ClueGO indicated that biological processes related to cell-cell adhesion, multicellular organism growth, and amino acid and protein metabolism also were downregulated by feeding CS. Co-expression network analysis indicated that FAM210A, SLC26A6, FBXW5, EIF6, ZSCAN10, FPGS, and ARMCX2 played critical roles in the network. Bioinformatics analysis showed that genes within the co-expression network were enriched to “pyruvate metabolic process”, “complement activation, classical pathway”, and “retrograde transport, endosome to Golgi”.

Conclusions

Results of the present study indicated that feeding a low-quality forage diet inhibits important biological functions of the liver at least in part due to a reduction in DMI. In addition, the results of the present study provide an insight into the metabolic response in the liver to different-quality forage resources. As such, the data can help develop favorable strategies to improve the utilization of corn stover in China.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12864-020-07332-0.

Deep small RNA-Seq reveals microRNAs expression profiles in lactating mammary gland of 2 sheep breeds with different milk performance

Micro ribonucleic acid (miRNA) is a type of noncoding RNA, and it has been revealed to play important roles in the activity of the mammary gland (MG) in some species. However, the function of miRNAs in MG of sheep is poorly understood. In the study, Gansu Alpine Merino (GAM; n = 9) and Small-tailed Han sheep (STH; n = 9) with different milk production traits were investigated. Microstructures and the expression profile of miRNAs of MG tissues at peak lactation were studied. Mature alveolar lumens of MG in appearance were larger in STH than GAM. The expression levels of CSN2 and the content of rough endoplasmic reticulum were also higher in STH ewes than GAM ewes. A total of 124 mature miRNAs were expressed, and 18 of these were differentially expressed between the 2 breeds. The KEGG analysis results showed that the targeted genes of differentially expressed miRNAs were mainly involved in some metabolic pathways and signaling pathways related to MG development, milk protein, and fat synthesis. The findings in the study can improve our understanding of the roles of miRNAs in the development and lactation of MG in sheep.

[Investigation on the status of monotherapy for newly diagnosed tic disorders and its comorbidity in children]

Objective: To investigate the status of monotherapy for newly diagnosed tic disorders and its comorbidity in children, so as to provide a reference for clinical medication. Methods: A questionnaire survey was conducted to collect the application experience of monotherapy for newly diagnosed tic disorders and comorbidities in 110 pediatric neurologists and psychiatrists from Chinese Tic Disorders Study Consortium from February to August in 2019. Doctors were asked to rate treatment options based on a rank 5-point scale with "1" least appropriate and "5" most appropriate. The drug evaluation index was based on the comparison of the median score of a single drug with the overall scores of all drugs in this disease (M (Q₁, Q₃)), single drug M ≥ overall Q₃ was recommended as preferred drugs; overall Q₁≤ single drug M < overall Q₃ was considered as secondary drugs; single drug M < overall Q₁ was considered as unsuitable drugs. Results: Among 110 electronic questionnaires, 94 (86%) were availably responded, responding doctors included 37 (39%) males and 57 (61%) females, the age of responding doctors was (48±10) years, and their working year was (17±10) years. In the investigation of the first and second monotherapy for newly diagnosed tic disorders in children without comorbidities, there were no preferred drugs for mild transient tic disorders. The scores of clonidine, aripiprazole and tiapride were 4 (3, 4), 4 (3, 4), 4 (4, 5) scores respectively, and were greater than overall scores (3 (2, 4) scores), so they could be recommended as the preferred drugs for moderate chronic tic disorders, the recommendation for initial mild Tourette syndrome (TS) treatment was the same as preferred drugs for moderate chronic tic disorders. Similarly, clonidine, aripiprazole, tiapride and haloperidol could be recommended as the preferred drugs for other kinds of tic disorders. As for the second monotherapy, the preferred drugs for moderate transient tic disorders, mild chronic tic disorders and severe TS were all aripiprazole, tiapride, haloperidol, sulpiride, clonidine and topiramate. While clonidine, aripiprazole, tiapride could be considered as preferred drugs for severe transient tic disorders, moderate to severe chronic tic disorders and mild to moderate tic disorders. In the investigation of monotherapy for newly diagnosed tic disorders in children with comorbidities, for moderate chronic tic disorders and TS comorbid with obsessive-compulsive disorder, aripiprazole (4 (3, 5) scores) and sertraline (4 (3, 4) scores) were preferred drugs,the median scores of which were all greater than overall scores (3 (3, 4) scores), they were also the preferred treatment for severe transient tic disorders and mild chronic tic disorders. For mild and moderate transient tic disorders, severe chronic tic disorders and TS comorbid with obsessive-compulsive disorder, aripiprazole, fluvoxamine, fluoxetine, haloperidol and sertraline were preferred drugs. When comorbid with attention deficit hyperactivity disorder (ADHD), severe transient tic disorders, moderate chronic tic disorders and TS, tomoxetine and clonidine were recommended as preferred drugs (both 4 (4, 5) scores), and tomoxetine and clonidine were also the preferred treatment for severe TS. For severe chronic tic disorders comorbid with ADHD, clonidine (5(4, 5) scores) was preferred drug, greater than overall scores (4 (3, 5) scores), while for mild and moderate transient tic disorders clonidine, tomoxetine, guanidine and methylphenidate were recommended as preferred drugs. For mild chronic tic disorders and TS comorbid with ADHD tomoxetine was preferred drug. When comorbid with sleep disorders, there were no preferred drugs for mild transient tic disorders; estazolam (3 (2, 3) scores) was the preferred drug for mild chronic tic disorders and TS comorbid with sleep disorders. For othe kind of tic disorders comorbid with sleep disorders, estazolam, melatonin and clonazepam were preferred drugs. When comorbid with anxiety and depressive disorders, for all kinds of tic disorders sertraline was recommended as preferred drugs, the median scores of sertraline were all (4 (3, 5) scores) in severe transient tic disorders, moderate to severe chronic tic disorders and moderate TS, and greater than overall scores (3 (3, 4) scores). While severe chronic tic disorders comorbid with anxiety and depressive disorders, fluvoxamine could also be chosen as preferred drugs. Conclusions: Drug therapy is not recommended for mild transient tic disorders, while tiapride, aripiprazole, clonidine, and haloperidol are mainly preferred drugs for the other kinds of tic disorders. Corresponding drugs should be selected when tic disorders are combined with obsessive-compulsive disorder, ADHD, sleep disorders, anxiety, depression, etc.

Metallic Glacial Glass Formation by a First-Order Liquid-Liquid Transition

The glacial phase, with an apparently glassy structure, can be formed by a first-order transition in some molecular-glass-forming supercooled liquids. Here we report the formation of metallic glacial glass (MGG) from the precursor of a rare-earth-element-based metallic glass via the first-order phase transition in its supercooled liquid. The excellent glass-forming ability of the precursor ensures the MGG to be successfully fabricated into bulk samples (with a minimal critical diameter exceeding 3 mm). Distinct enthalpy, structure, and property changes are detected between MGG and metallic glass, and the reversed "melting-like" transition from the glacial phase to the supercooled liquid is observed in fast differential scanning calorimetry. The kinetics of MGG formation is reflected by a continuous heating transformation diagram, with the phase transition pathways measured at different heating rates taken into account. The finding supports the scenario of liquid-liquid transition in metallic-glass-forming liquids.

Overcoming Intrinsic H3K27me3 Imprinting Barriers Improves Post-implantation Development after Somatic Cell Nuclear Transfer

Successful cloning by somatic cell nuclear transfer (SCNT) requires overcoming significant epigenetic barriers. Genomic imprinting is not generally regarded as such a barrier, although H3K27me3-dependent imprinting is differentially distributed in E6.5 epiblast and extraembryonic tissues. Here we report significant enhancement of SCNT efficiency by deriving somatic donor cells carrying simultaneous monoallelic deletion of four H3K27me3-imprinted genes from haploid mouse embryonic stem cells. Quadruple monoallelic deletion of Sfmbt2, Jade1, Gab1, and Smoc1 normalized H3K27me3-imprinted expression patterns and increased fibroblast cloning efficiency to 14% compared with a 0% birth rate from wild-type fibroblasts while preventing the placental and body overgrowth defects frequently observed in cloned animals. Sfmbt2 deletion was the most effective of the four individual gene deletions in improving SCNT. These results show that lack of H3K27me3 imprinting in somatic cells is an epigenetic barrier that impedes post-implantation development of SCNT embryos and can be overcome by monoallelic imprinting gene deletions in donor cells.

Safety and Efficacy of Chemotherapy Combined with Anlotinib Plus Anlotinib Maintenance in Chinese Patients with Advanced/Metastatic Soft Tissue Sarcoma

Purpose

Anlotinib, a newly developed oral small-molecule receptor tyrosine kinase inhibitor (TKI), has been shown to have encouraging activity against sarcoma. The purpose of this study was to retrospectively evaluate the safety and clinical efficacy of chemotherapy combined with anlotinib plus anlotinib maintenance in advanced/metastatic soft tissue sarcoma (STS) patients in a real-world setting in China.

Patients and Methods

We retrospectively collected the medical data of thirty-two patients with advanced/metastatic STS who received chemotherapy combined with anlotinib plus anlotinib maintenance therapy. The objective response rate (ORR) and disease control rate (DCR) were calculated according to the RECIST 1.1 criteria. The progression-free rates (PFRs) at three and six months, the progression-free survival (PFS) time, and adverse events were recorded.

Results

On the basis of investigator assessments, two patients (6%) achieved CR (complete response) and nine patients (28%) achieved PR (partial response), with an ORR of 34%. Eleven patients (34%) achieved SD (stable disease), and ten patients (31%) achieved PD (progression disease), with a DCR of 69%. The progression-free rates (PFRs) at three and six months were 81% and 69%, respectively. The median PFS time was 8.2 months. The hematologic and non-hematologic toxicities were manageable. The most common grade 3 and 4 adverse events were febrile neutropenia (9%), leukopenia (19%), thrombocytopenia (3%), anemia (6%), anorexia (6%), vomiting (3%), and hypertension (6%). The combination therapy was generally well tolerated.

Conclusion

Our study suggests that chemotherapy combined with anlotinib plus anlotinib maintenance therapy had good efficacy and resulted in more favorable survival with good tolerance among patients with advanced/metastatic STS.

[Expression of HLA-DP in patients with neuromyelitis optica spectrum disorders]

Objective: To investigate the effect of HLA-DP gene expression on the susceptibility and disease status of neuromyelitis optica spectrum disorders (NMOSD). Methods: A total of 86 NMOSD patients (52 in acute phase and 34 in remission phase), 52 multiple sclerosis (MS) patients (20 in acute phase and 32 in remission phase) diagnosed in Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University and 29 healthy controls were enrolled prospectively. Genotyping of HLA-DP was performed. The expression levels of HLA-DP molecules in peripheral blood B cells and monocytes were measured by flow cytometry. The transcription levels of HLA-DPB1 mRNA in peripheral blood mononuclear cells (PBMC) were measured by real time-PCR. The results were compared among different groups Results: There was no statistically significant difference of the distributions of HLA-DPB1*0501/HLA-DPB1*0501, HLA-DPB1*0501/X and X/X genotypes and the frequencies of allele of HLA-DPB1*0501 among NMOSD, MS patients and healthy controls (P=0.96 and 0.71, respectively). The expression levels of HLA-DP on the surface of B cells in NMOSD patients, especially in remission phase patients, were significantly higher than those in healthy controls(212±328 and 374±394 vs 55±57, P=0.049 and 0.002, respectively). The expression levels of HLA-DP on the surface of monocytes in NMOSD patients in acute phase were significantly higher than those in healthy controls(158±175 vs 65±90, P=0.025). The transcription levels of PMBC HLA-DPB1 mRNA in acute phase and remission phase of NMOSD patients were significantly higher than those in healthy controls (3.0±1.4 and 2.9±1.3 vs 1.5±1.4, P=0.000 and 0.003, respectively). The expression levels of HLA-DP molecules on the surface of peripheral blood B cells and monocytes and the transcription levels of PMBC HLA-DPB1 mRNA in MS patients at the acute and remission stages were not significantly different from those in healthy controls. The expression levels of HLA-DP molecules on the surface of B cells in patients with HLA-DPB1*0501/HLA-DPB1*0501, HLA-DPB1*0501/X and X/X genotypes were statistically different (P=0.017). Conclusion: HLA-DP gene transcription and molecular expression levels in antigen presenting cells may affect the susceptibility and disease status of NMOSD patients, while HLA-DPB1*0501 allele may affect the transcription and molecular expression levels of HLA-DP gene in antigen presenting cells.

Short communication: Decrease of lipid profiles in cow milk by ultra-high-temperature treatment but not by pasteurization

Triglyceride (TG) and fatty acid profiles of raw (RM), pasteurized (PM, 85°C for 15 s), and indirect UHT-treated (UM, 135°C for 15 s) cow milk were investigated by a lipidomics approach. Ninety-four TG were identified and all were present at significantly lower concentrations in UM than in RM or PM, and free fatty acid contents were significantly higher in UM than in RM and PM, indicating that TG lipolysis occurred to a greater degree in UM than in RM and PM. In addition, UM contained significantly fewer unsaturated fatty acids (14 types) than those in RM and PM, including C14:1n-5, C15:1n-5, C16:1n-7, C17:1n-7, C18:1n9 cis, C18:2n-6 cis, C18:3n-3, C18:3n-6, C20:1, C20:2, C20:3n-6, C20:3n-3, C20:4n-6, and C20:5n-3. However, we detected no significant differences between RM and PM in these fatty acids. In conclusion, UHT treatment, but not pasteurization, caused loss of the nutritional quality and bioactivity of cow milk lipid profiles.

[Comparison of stratification methods for malignant risk of thyroid nodules]

Objective: To compare the diagnostic value of the 2015 American Thyroid Association(ATA) guidelines and the American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS) classification for thyroid nodules. Method: Retrospective analysis of 340 cases of 386 thyroid nodules confirmed by surgery or pathology from November 2016 to November 2018 in Yan' an University Hospital was conducted, using 2015 ATA, ACR TI-RADS for classification. Histopathology or cytology was the gold standard, The receiver operating characteristic(ROC) curve was plotted, using χ test to compare the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the two methods. Result: Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ACR TI-RADS were 961%, 741%, 645%, 974%, 813%, respectively, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the 2015 ATA guidelines was 937%, 733%, 632%, 960%, 801%,respectively. There was no statistically significant difference between the two groups. The area under ACR TI-RADS and 2015 ATA guide curve is 0851 and 0839, respectively. Conclusion: Both ACR TI-RADS and 2015 ATA guidelines have high diagnostic value. The two classification methods are equally effective in assessing the benign and malignant thyroid nodules.

[The efficacy and safety of salvage surgery for local recurrent nasopharyngeal carcinoma: a systematic review and Meta-analysis]

Objective: To assess the current evidence regarding the efficacy, safety, and potential advantages of endoscopic compared with open salvage surgery for patients with local recurrent nasopharyngeal carcinoma. Methods: A systematic search of Pubmed/Medline, Embase, and Cochrane databases ranged between 2000 and 2017 was conducted. Included studies reported specific residual or local recurrent nasopharyngeal cancer survival data. Proportional Meta-analysis was performed on both outcomes with a random-effects model and the 95% confidential intervals were calculated by Stata 12.0 software. Results: A total of 24 case series studies were included in the Meta-analysis.The pooled 2-year overall survival rates of endoscopic and open group were 84% (95%CI:72%-93%), 68%(95%CI:59%-77%),respectively.The pooled 2-year disease-free survival rates of endoscopic and open group were 68%(95%CI:53%-81%), 65%(95%CI:54%-75%),respectively. The pooled 5-year overall survival rates of endoscopic and open group were 72%(95%CI:37%-97%), 48% (95%CI:40%-56%),respectively.The pooled 5-year disease-free survival rates of endoscopic and open group were 65%(95%CI:29%-93%), 50%(95%CI:43%-57%),respectively.The combined outcome of endoscopic was higher than open procedure. In addition, less severe complications, lower local recurrence rates(27%vs32%).The 2-year overall survival rates of endoscopic was higher than open procedure in the staging of rT1, rT2, and rT3 (93%vs87%; 77%vs63%; 67%vs53%) , but was equal to open in the staging for rT4 (35%vs35%) .Meta-regression showed that the heterogeneity was correlated with advanced tumor ratio. Conclusions: The present Meta-analysis reveals that endoscopic approach offers a safe and efficient alternative to open approach with better short-term outcome and fewer postoperative complications in selecting patients strictly.

Tetramethylpyrazine supplementation reduced Salmonella Typhimurium load and inflammatory response in broilers

The present study tested whether tetramethylpyrazine (TMP) supplementation could influence the growth performance, Salmonella Typhimurium (S. Typhimurium) load, inflammasomes, cytokines, and chemokines in broilers. Treatments were a 2 × 2 factorial design, including negative control (NC), S. Typhimurium challenge (SC), and NC/SC + TMP (150 mg/kg of diet). The trial lasted for 28 D, and S. Typhimurium subclinical challenge was occurred on day 8. The results showed that S. Typhimurium challenge worsened (P < 0.05) growth performance, S. Typhimurium load in intestinal digesta and visceral tissues, intestinal inflammatory responses, and permeability compared to the NC treatment. TMP supplementation increased (P < 0.05) feed intake, weight gain, and feed efficiency by 4.3 to 12.0%, but decreased (P < 0.05) S. Typhimurium load by 5.4 to 45.8%, inflammasomes (caspase-1/3/9, gasdermin A/E, and nod-like receptor protein 3) by 25.0 to 59.0%, chemokines (C-C motif ligand 2 and C-X-C motif 10) by 40.2 to 47.2%, intestinal permeability by 28.2% compared to the SC treatment. The TMP also reduced inflammatory response by influencing tumor necrosis factor α, interleukin 1β/4/6. Factorial analysis indicated that TMP and SC were interactive (P < 0.05) on most parameters due to the more pronounced TMP effect in S. Typhimurium challenge groups. It is concluded that TMP can promote growth and mitigate S. Typhimurium infection by reducing the S. Typhimurium load and inflammatory response in broilers.

Investigation and comparison of the anti-tumor activities of lactoferrin, α-lactalbumin, and β-lactoglobulin in A549, HT29, HepG2, and MDA231-LM2 tumor models

To investigate the anti-tumor activities of lactoferrin, α-lactalbumin, and β-lactoglobulin, 4 types of human tumor cells (lung tumor cell A549, intestinal epithelial tumor cell HT29, hepatocellular cell HepG2, and breast cancer cell MDA231-LM2) were exposed to 3 proteins, respectively. The effects on cell proliferation, migration, and apoptosis were detected in vitro, and nude mice bearing tumors were administered the 3 proteins in vivo. Results showed that the 3 proteins (20 g/L) inhibited viability and migration, as well as induced apoptosis, in 4 tumor cells to different degrees (compared with the control). In vivo, tumor weights in the HT29 group (0.84 ± 0.22 g vs. control 2.05 ± 0.49 g) and MDA231-LM2 group (1.11 ± 0.25 g vs. control 2.49 ± 0.57 g) were significantly reduced by lactoferrin; tumor weights in the A549 group (1.07 ± 0.19 g vs. control 3.11 ± 0.73 g) and HepG2 group (2.32 ± 0.46 g vs. control 3.50 ± 0.74 g) were significantly reduced by α-lactalbumin. Moreover, the roles of lactoferrin, α-lactalbumin, and β-lactoglobulin in regulating apoptotic proteins were validated. In summary, lactoferrin, α-lactalbumin, and β-lactoglobulin were proven to inhibit growth and development of A549, HT29, HepG2, and MDA231-LM2 tumors to different degrees via induction of cell apoptosis.

Determination of sulbactam in raw bovine milk by isotope dilution-ultra-high-performance liquid chromatography-tandem mass spectrometry

We developed a sensitive and selective isotope dilution ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for the determination of sulbactam residue in raw bovine milk. Sulbactam and internal standard, sulbactam-d₅, were extracted from raw bovine milk via liquid-liquid extraction and enriched with strong anion exchange solid-phase extraction cartridges and finally analyzed by using UPLC-MS/MS with multiple reaction monitoring mode. The method was validated according to European regulations. The calibration curve showed good linearity, with a correlation coefficient of 0.9998. Decision limit and detection capability of sulbactam were determined by matrix calibration curve and were 0.0445 and 0.0517 μg/L, respectively. The recoveries of sulbactam in fortified raw bovine milk ranged from 72.1 to 91.5%, with the intra- and interday relative standard deviations ranging from 3.0 to 18.9%. Furthermore, the developed method was applied to analyzing real raw bovine milk samples collected from dairy farms in Beijing, China. Sulbactam was not determined in all samples. The proposed method could ultimately serve as a methodological foundation for the determination of sulbactam in different types of raw milk and dairy products.

[A preliminary study on resting-state functional magnetic resonance imaging of brain after anterior cruciate ligament preservation reconstruction with autologous tendon]

Objective: To preliminarily study on the possible mechanism of cerebral cortical dysfunction pattern after anterior cruciate ligament (ACL) preservation reconstruction with autologous tendon through resting-state functional magnetic resonance imaging (fMRI). Methods: From June 2015 to February 2019, 18 patients (10 males and 8 females with an average age of (36±10) years) with left anterior cruciate ligament rupture and treated with arthroscopic preservation reconstruction with autologous tendon were enrolled in this study, and 17 comparable healthy controls were included in Tongji Hospital of Tongji University. fMRI was performed after the postoperative period (2 to 12 weeks). The fMRI data were preprocessed by SPM8 software package and RESTplus software. The amplitude of low-frequency fluctuation (ALFF) and the fractional amplitude of low-frequency fluctuation (fALFF) in those two groups were calculated. Two-sample t-test was performed on ALFF and fALFF of the two groups, and multiple test corrections were performed by using AlphaSim. These methods were used for contrast studies on the characteristic activities of the brain dysfunction. Results: Compared with those in the control, ALFF in the central cingulate gyrus (cingulum_mid_bilateral), involving the auxiliary movement zone (supp_motor_ area) were significantly higher in the patients (P<0.01 before correction, P<0.05 after AlphaSim correction). The fALFF in activation cluster 1 was significantly higher in the right central gyrus (postcentral_R), the right lower lobule (parietal_inf_R), and the right upper margin (supramarginal_R) in the patients than that in the normal control group, respectively (P<0.01 before correction, P<0.05 after AlphaSim correction); the fALFF in activation cluster 2 in the right central cingulate gyrus (cingulum_mid_R), involving the right auxiliary movement zone (supp_motor_area_R) was significantly higher in the patients than that in the normal control group, respectively (P<0.01 before correction, P<0.05 after AlphaSim correction). Conclusion: The patients' cerebrum cortical function associated with the kinesthesis and their regulations are abnormally changed after anterior cruciate ligament preservation reconstruction with autologous tendon.

Transcriptome analysis revealed that aflatoxin M1 could cause cell cycle arrest in differentiated Caco-2 cells

Being a hydroxylated metabolite of aflatoxin B1 (AFB1) and the most threatening aspect of AFB1 contamination, aflatoxin M1 (AFM1) can lead to hepatotoxicity and hepato-carcinogenicity, and possess intestinal cytotoxicity. However, little is known about the potential mechanisms of the extrahepatic effect. The aim of this study was to investigate intestinal dysfunction induced by AFM1 via transcriptome analysis. Gene expression profiling was analyzed to comparatively characterize the differentially expressed genes (DEGs) after differentiated Caco-2 cells were exposed to different concentrations of AFM1 for 48 h. A total of 165 DEGs were significantly clustered into two down-regulated patterns. Protein-protein interaction (PPI) network analysis based on Search Tool for Retrieval of Interacting Genes (STRING)suggested that 23 key enzymes mainly participated in the regulation of the cell cycle. Q-PCR analysis was performed to validate that key 12 genes (BUB1, BUB1B, MAD2L1, CCNA2, RB1, CDK1, ANAPC4, ATM, KITLG, PRKAA2, SIRT1, and SOS1) were involved. This study firstly revealed that the toxicity of AFM1 to intestinal functions may be partly due to the occurrence of cell cycle arrest, which is linked to changes in CDK1, SOS1/Akt, and AMPK signaling molecules.

[Extirpation of primary malignancies in the pterygopalatine and infratemporal fossa via modified maxillary swing approach]

Five patients with primary malignancies in the pterygopalatine fossa (PPF) and infra temporal fossa (ITF) were enrolled in this retrospective study between January 2012 and January 2018. After malignancies proven by biopsy and evaluation with CT and MRI scan, all patients received modified maxillary swing (MMS) approach for extirpation of malignant tumors in the PPF and ITF under general anesthesia. En bloc resection with wide surgical margins was successfully performed in all cases. Negative margins were observed in 4 cases and positive margins were found in one patient with adenoid cystic carcinoma who received postoperative radiotherapy. The most common complication was facial numbness. During the follow-up period (range 12 to 57 months), one patient suffered from recurrence while others did not. The advantages of MMS include wide surgical field, full exposure and easy manipulation. The MMS approach is expected to become an standard method for monobloc resection of malignancies in the PPF and ITF.

Three new sesquiterpenes from the stems of Nicotiana tabacum and their bioactivities

Three new sesquiterpenes, methyl 4-isopropyl-7-methoxy-6-methylnaphthalene-1-carboxylate (1), methyl 2-hydroxy-4-isopropyl-7-methoxy-6-methylnaphthalene-1-carboxylate (2), and methyl 2-hydroxy-6-(hydroxymethyl)-4-isopropyl-7-methoxynaphthalene-1-carboxylate (3), together with three known sesquiterpenes (4-6), were isolated from the stems of Nicotiana tabacum. Their structures were determined by means of HRESIMS and extensive 1D and 2D NMR spectroscopic studies. The results showed that compounds 2, 3, and 5 exhibited high anti-TMV activity with inhibition rates of 33.6, 35.8, and 36.7%. Compounds 1-6 showed weak inhibitory activities against some tested human tumor cell lines (NB4, A549, SHSY5Y, PC3, and MCF7) with IC50 values in the range of 6.7-9.6 μM.

Meta-analysis of the association of IGFBP3 and IGF1 polymorphisms with susceptibility to colorectal cancer

The aim of this study is to comprehensively evaluate the associations of IGFBP3 and IGF1 polymorphisms with susceptibility to colorectal cancer (CRC). We searched the English and Chinese databases and recruited case-control studies based on strict inclusion and exclusion criteria. The statistical analysis was performed by the Comprehensive Meta-analysis 2.0 (CMA 2.0) software and this initially identified 251 studies. We then recruited 10 English studies to this meta-analysis detailed review which includes 9,415 CRC patients and 14,179 healthy controls. Our results demonstrated that IGFBP3 rs2854746 C>G polymorphism increases susceptibility to the CRC (allele model: OR=1.167, 95% CI=1.095~1.244, p<0.001 and to the dominant gene model: OR=1.226, 95% CI=1.113~1.350, p<0.001); but IGFBP3 rs2854744 A>C has no significant association with the CRC susceptibility (allele model: OR=0.970, 95% CI=0.932~1.010, p=0.138; dominant gene model: OR=0.995, 95% CI=0.936~1.057, p=0.874). Also, IGF1 rs35767 C>T polymorphism decreases susceptibility to CRC (allele model: OR=0.785, 95% CI=0.726~0.850, p<0.001 and also the dominant model: OR=0.730, 95% CI=0.661~0.806, p<0.001). However, IGFBP3 rs2854746 C>G is considered the susceptible CRC polymorphism and IGF1 rs35767 C>T is CRC protective.

[Rethinking on ethics and principle of surgery]

Surgery is an important part of medicine, it has undergone huge changes in recent decades in China.The concepts of damage control surgery, minimally invasive surgery, and enhanced recovery after surgery are all new with the date, laparoscopic surgery, robotic surgery, natural orifice transluminalendoscopic surgery are not new words to all of us. Surgical operations are becoming more and more specialized, surgical technique is becoming more and more mature, and surgeons are becoming more and more specialized. Medical ethical issues, as the common language of surgeons and basic principle of surgery, should be recognized and understood more stronger than ever, which will enable surgeons to retrieve original intention of surgery. This paper takes this as starting point and explore the common principles of surgery, aims to arouse some mutual encouragement to growing youth surgeons.

Effect of cysteamine hydrochloride supplementation on the growth performance, enterotoxic status, and glutathione turnover of broilers fed aflatoxin B1 contaminated diets

This study aimed to investigate the effect of cysteamine hydrochloride (CSH) supplementation on the growth performance, opportunistic bacteria and enterotoxic markers, visceral lesions, glutathione turnover, and inflammatory factors of broilers fed diets contaminated with aflatoxin B1 (AFB1). One-day-old Arbor Acres broilers (n = 480) were randomly allocated to 4 treatments with 6 replicates of 20 chicks each for a 2 × 2 design with CSH (0 or 200 mg/kg) and AFB1 (0 or 40 μg/kg). The trial lasted for 42 d. Results showed that AFB1 negatively affected (P < 0.05) growth performance, opportunistic bacteria and enterotoxic markers, intestinal lesions, glutathione turnover, and inflammatory factors. The CSH increased (P < 0.05) feed intake and body weight gain. The enterotoxic status was relieved in the CSH treatments by reducing (P < 0.05) the populations of gut Escherichia coli, Gram-negative bacteria, serum diamine oxidase, and intestinal lesions. The CSH also increased (P < 0.05) serum reduced glutathione, glutathione s-transferases, and glutathione reductase, and decreased (P < 0.05) the mRNA levels of tumor necrosis factor-α, interleukin-6, and interleukin-1β. Significant interactions (P < 0.05) were found on Gram-negative bacteria, diamine oxidase, and glutathione s-transferases. The results suggest that the CSH can improve glutathione turnover and reduce the risk of enterotoxic disease induced by AFB1 in broilers.

Furosine induces DNA damage and cell death in selected human cell lines: a strong toxicant to kidney Hek-293 cells

Ne-(2-furoylmethyl)-l-lysine (furosine) is well-known indicator of early stage of Maillard reaction in processed food. Yet the toxicological aspects associated with its exposure remain rarely studied. Here, we investigated the effects of furosine exposure on cell viability, DNA damage, and its mutagenic potential by using MTT assay (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide), TUNEL assay (Terminal deoxynucleotidyl transferase mediated dUTP Nick End Labeling assay), and Ames assay techniques on human cell lines, i.e., liver HepG-2, kidney Hek-293, neuronal SK-N-SH, and intestinal Caco-2, respectively. Our results showed that kidney Hek-293 cell line was the most sensitive to furosine exposure as significant reduction in cell viability and induction of DNA damage were observed at 50 mg/L concentration. In contrast, intestinal Caco-2 cell lines showed resistance to furosine exposure as DNA damage was only observed at 800 mg/L concentration of furosine. Ames assay indicated that furosine has no mutagenic effects on TA 100 and TA 1535 strains. Hence, this study suggests that furosine is a strong toxicant for kidney cells.

Effect of yeast cell wall on the growth performance and gut health of broilers challenged with aflatoxin B1 and necrotic enteritis

This study aimed to investigate the effect of yeast cell walls (YCW) on the growth performance, visceral lesions, intestinal integrity, enterotoxicity, and bacteria of broilers challenged with aflatoxin B1 (AF) and necrotic enteritis (NE) from 1 to 21 d of age. A total of 576 one-day-old broilers were assigned to a 2 × 2 × 2 design for diets containing AFB1 (0 or 40 μg/kg), NE (challenged or unchallenged), or YCW (0 or 500 mg/kg). The main effect analysis showed that AF depressed (P < 0.01) average daily feed intake (ADFI), average daily body weight gain (ADG), the mRNA profiles of polymeric Ig receptor (pIgR), claudin-1, and occludin, but increased (P < 0.001) liver lesion scores, serum endotoxin, and diamine oxidase (DAO). The NE challenge depressed (P < 0.01) ADFI, ADG, secretory IgA (sIgA), pIgR, claudin-1, occludin, and the populations of Lactobacilli and Bifidobacteria, but increased (P < 0.001) visceral lesions, endotoxins, and DAO. The main effect of YCW on growth performance, visceral lesions, and intestinal integrity was not significant, but decreased (P < 0.01) mortality, endotoxin, DAO, and C. perfringens, and increased (P < 0.05) the populations of Lactobacilli and Bifidobacteria. There were 3-way interactions (P < 0.05) on growth performance, intestinal lesions, integrity, and gut bacteria. Compared with the treatment with the dual challenges, there were pronounced effects (P < 0.05) of YCW on ADFI, ADG, lesions, DAO, pIgR, and Bifidobacteria. The results suggest that with the concurrent challenges of AF and NE, the YCW can partially protect the growth performance and intestinal health of broilers.

Detoxification, metabolism, and glutathione pathway activity of aflatoxin B1 by dietary lactic acid bacteria in broiler chickens

Lactic acid bacteria (LAB) and the glutathione (GSH) pathway are protective against aflatoxin, but information on the effect of LAB on aflatoxin metabolism and GSH activity in farm animals is scarce. This study aimed to investigate the effects of LAB and aflatoxin B (AFB) on growth performance, aflatoxin metabolism, and GSH pathway activity using 480 male Arbor Acres broiler chickens from d 1 to 35 of age. Diets were arranged in a 2 × 2 factorial design, including AFB at 0 or 40 µg/kg of feed and LAB at 0 or 3 × 10 cfu/kg of feed, and the LAB was a mixture of equal amounts of , , and . The results showed that there were highly significant ( < 0.01) effects of AFB toxicity, LAB protection, and their interaction on ADFI, ADG, and G:F of broilers during d 1 to 35. Compared with the AFB diet, the LAB diet reduced ( < 0.05) the residues of AFB in the liver, kidney, serum, ileal digesta, and excreta on d 14 by 121.5, 80.6, 43.7, 47.0, and 26.5%, respectively, and on d 35 by 40.6, 60.2, 131.7, 37.9, and 32.9%, respectively, whereas the LAB diet increased ( < 0.05) the contents of aflatoxin M, a metabolite of AFB, in the liver, kidney, serum, and ileal digesta on d 14 by 98.2, 154.2, 168.6, 19.1, and 34.1%, respectively, and in the kidney and serum on d 35 by 32.6 and 142.2%, respectively. For the activity of the GSH pathway in the liver and duodenal mucosa, there were significant ( ≤ 0.01) effects of LAB and AFB on reduced GSH, glutathione S-transferases (GST), and glutathione reductase (GR) on d 14 and 35; compared with the control diet, the LAB diet increased ( < 0.05) GSH, GST, and GR by a range of 11.6 to 86.1%, and compared with the AFB diet, the LAB diet increased ( < 0.05) GSH, GST, and GR by a range of 24.1 to 146.9%. In the liver, there were interactions ( < 0.05) on GSH and GST on d 14 and on GSH on d 35; in the mucosa, interactions were significant ( ≤ 0.01) on GSH and GR on d 14 and on GST on d 35. It can be concluded that LAB is effective in the detoxification of AFB by modulating toxin metabolism and activating the GSH pathway in animals.

d-Glucose and amino acid deficiency inhibits casein synthesis through JAK2/STAT5 and AMPK/mTOR signaling pathways in mammary epithelial cells of dairy cows

Amino acids and energy deficiency lead to lower milk protein content in dairy cows. However, the known mechanisms involved in this process do not adequately explain the variability of milk protein concentration in the mammary gland. We hypothesized that a deficiency in d-glucose (d-Glc) or AA would inhibit casein synthesis by regulating signaling pathways in mammary epithelial cells. Cow mammary epithelial cells (CMEC) were subjected to combinations of 1 of 3 concentrations of d-Glc (0, 2.50, or 17.5 mM) and 1 of 3 concentrations of AA (0, 1.03, or 7.20 mM). The effect of each mixture on cell cycle stage was assessed by flow cytometry. The expression levels of β-casein and κ-casein (encoded by CSN2 and CSN3) were measured by quantitative real-time PCR and Western blotting. Phosphorylation of Janus kinase 2 (Jak2), signal transducer and activator of transcription 5a (Stat5a), AMP-activated protein kinase (AMPK), mammalian target of rapamycin (mTOR), ribosomal protein S6 kinase 1 (S6K1), and eukaryotic factor 4E-binding protein 1 (4EBP1) were analyzed by Western blotting. The percentages of cells in the DNA postsynthetic (G2) and DNA synthesis (S) phases would decrease, with the level of d-Glc or AA declining individually, but no interaction was observed between the d-Glc and AA effects. The CSN2 and CSN3 mRNA and protein were downregulated when d-Glc or AA decreased individually from 17.5 to 2.50 mM or from 7.20 to 1.03 mM, but d-Glc deficiency had a greater effect according to the regression analysis. The phosphorylation ratio of Jak2 (Tyr^1007/1008), Stat5a (Tyr⁶⁹⁴), mTOR (Ser²⁴⁴⁸), S6K1 (Thr³⁸⁹), and 4EBP1 (Thr³⁷) was downregulated with the level of d-Glc or AA decline, whereas the phosphorylation ratio of AMPK (Thr^183/172) was upregulated. And the change of d-Glc level had a more marked effect than AA in regulating the activity of these signaling protein above according to the regression analysis. Thus, d-Glc or AA deficiency likely reduced casein transcription via inhibition of the Jak2/Stat5 pathway, and reduced translation via suppression of the mTOR pathway by activation of AMPK, but d-Glc deficiency had a more marked effect. These indicated that deficiency of AA, and especially Glc, suppressed proliferation of CMEC and casein gene and protein expression, associated with inhibition of JAK2/STAT5 and AMPK/mTOR signaling pathways.

A novel swine model for evaluation of dyslipidemia and atherosclerosis induced by human CETP overexpression

Background

The mechanism of cholesteryl ester transfer protein (CETP) in lipid metabolism is still unclear. Furthermore, the relationship of CETP and atherosclerosis (AS) has been controversial. As pigs are a good model for both lipid and AS research, we investigated the lipid metabolism of human CETP (hCETP) transgenic pigs and explored the mechanism of CETP in lipid modulation.

Methods

Plasmids expressing the hCETP gene were designed, successfully constructed, and transfected into porcine fetal fibroblasts by liposomes. Using somatic cell nuclear transfer technology and embryonic transfer, hCETP transgenic pigs were generated. After the DNA, RNA, and protein levels were identified, positive hCETP transgenic pigs were selected. Blood samples were collected at different ages to evaluate the phenotypes of biochemical markers, and the metabolomes of plasma samples were analyzed by liquid mass spectrometry.

Results

Eight positive hCETP transgenic pigs and five negative cloned pigs were generated by transgenic technology. Finally, five hCETP transgenic and five cloned pigs were grown healthily. After feeding with a normal diet, hCETP transgenic pigs compared with unmodified pigs had no significant differences in body weight, liver function, kidney function, or plasma ions, while total cholesterol and low-density lipoprotein were higher than in unmodified pigs, and high-density lipoprotein was significantly decreased. Metabolomics analysis showed that there were differences in metabolic components between hCETP transgenic pigs, cloned pigs, and unmodified pigs.

Conclusions

In this study, we created hCETP transgenic pigs that could serve as an excellent model for lipid disorders and atherosclerosis.

Electronic supplementary material

The online version of this article (10.1186/s12944-017-0563-x) contains supplementary material, which is available to authorized users.

Melt fluxing to elevate the forming ability of Al-based bulk metallic glasses

Salt-fluxing treatment is an effective technique to improve the glass-forming ability (GFA) of bulk metallic glass (BMG)-forming melts, as demonstrated before in Pd- and Fe-based systems. However, it has been challenging to develop similar fluxing protocol for more reactive melts, such as Al-rich BMG-forming systems. Here we design new fluxing agents, from a thermodynamics perspective that takes into account combined effects of physical absorption and chemical absorption (reaction) between the fluxing agents and oxide inclusions. MgCl₂-CaCl₂ composite salts were selected, and their fluxing effects were systematically studied on an Al₈₆Ni_6.75Co_2.25Y_3.25La_1.75 alloy, the best BMG-forming composition reported thus far for Al-rich alloy systems. The oxygen content was found to continuously decrease in the master alloy with increasing cycles of salt-fluxing treatment, with chlorate products on the surface suggesting concurrent physical absorption and chemical reaction. The fluxing treatment developed has enabled a record critical size (diameter) of 2.5 mm for Al-based BMGs. Our finding is thus an advance in developing highly desirable Al-based BMGs, and also provides guidance for designing processing protocol to produce larger-sized BMGs in other reactive systems.

Short communication: Microbiological quality of raw cow milk and its association with herd management practices in Northern China

Contamination of raw milk with bacterial pathogens is potentially hazardous to human health. The aim of this study was to evaluate the total bacteria count (TBC) and presence of pathogens in raw milk in Northern China along with the associated herd management practices. A total of 160 raw milk samples were collected from 80 dairy herds in Northern China. All raw milk samples were analyzed for TBC and pathogens by culturing. The results showed that the number of raw milk samples with TBC <2 × 10⁶ cfu/mL and <1 × 10⁵ cfu/mL was 146 (91.25%) and 70 (43.75%), respectively. A total of 84 (52.50%) raw milk samples were Staphylococcus aureus positive, 72 (45.00%) were Escherichia coli positive, 2 (1.25%) were Salmonella positive, 2 (1.25%) were Listeria monocytogenes positive, and 3 (1.88%) were Campylobacter positive. The prevalence of S. aureus was influenced by season, herd size, milking frequency, disinfection frequency, and use of a Dairy Herd Improvement program. The TBC was influenced by season and milk frequency. The correlation between TBC and prevalence of S. aureus or E. coli is significant. The effect size statistical analysis showed that season and herd (but not Dairy Herd Improvement, herd size, milking frequency, disinfection frequency, and area) were the most important factors affecting TBC in raw milk. In conclusion, the presence of bacteria in raw milk was associated with season and herd management practices, and further comprehensive study will be powerful for effectively characterizing various factors affecting milk microbial quality in bulk tanks in China.

[Clinical research on robot-assisted percutaneous pelvic and acetabular screws surgery]

OBJECTIVE

To evaluate the security and efficiency of a surgical robotic assisted percutaneous screw fixation for the treatment of pelvic and acetabular fractures.

METHODS

In the study, 12 patients with pelvic and acetabular fractures who were treated in Beijing Jishuitan Hospital from January to April in 2016 were involved in this research. The research subjects were randomly divided into two groups: the experimental group and the control group. Robotic-assisted percutaneous sacroiliac screw internal fixations were performed under the guidance of fluoroscopy navigation in the experimental group; in the control group, doctors operated manually guided by fluoroscopy. Statistical analysis was performed on the total operation time, the intraoperative fluoroscopy time, the adjustment numbers of intraoperative guide wires, the excellent rate of screw placement and the incidence of adverse events in order to evaluate the security and efficiency of a surgical robotic assisted percutaneous screw fixation for the treatment of pelvic and acetabular fractures.

RESULTS

Eleven screws were placed in 7 patients from the experimental group, while 7 screws were placed in 5 patients from the control group in total. All the screw placement positions were satisfactory according to postoperative CT images. The excellent rates of screw placement position were 100% in both groups. However, the P value was 0.016 based on the comparison between the screws' distribution in the two groups which meant that the screw distribution of the experimental group was better than that of the control group. The average fluoroscopy time needed for screw insertion was (7.36±2.63) s in the experimental group while (41.80±13.99) s in the control group (P<0.001). This suggested that the difference between the two groups had statistical significances. Intra-operative fluoroscopy time of the experimental group was significantly smaller than that of the control group. The number of the average screw adjustment was (0.36±0.48) times in the experimental group while (9.00±3.06) times in the control group (P=0.003). This suggested that the difference of the number of the guide needle adjustment between the two groups had statistical significances, and the number of the experimental group was smaller than that of the control group. The average operation time was (43.86±49.06) min in the experimental group while only (29.00±12.14) min were needed in the control group (P=0.528). This suggested that the difference between the two groups had no statistical significance. That is, the total operation time of the two groups was equal. All the screws were in satisfactory positions according to validation results of CT scans. No complications such as screw breaking out the bone cortex and entering into the knee joint cavity, wound infection occurred.

CONCLUSION

Surgical robots are suitable for robot-assisted percutaneous screw fixation in pelvic and acetabular fractures. Robot-assisted treatment of pelvic and acetabular fractures has significant advantages over manual operations including high accuracy, small perspective radiation, safety and efficiency.