测序技术在结直肠癌研究中的应用

测序技术的出现是分子生物学领域的伟大变革,该技术已经被广泛应用于各类疾病的研究并取得了重大突破。结直肠癌是一种涉及到多种基因表达改变的疾病,高通量测序技术在结直肠癌基因组、转录组、循环肿瘤DNA及表观遗传学研究中发挥了重大作用,为人类从更深层次认识结直肠癌的发生发展机制,更好的指导临床诊疗做出了巨大贡献。本文就测序技术在结直肠癌研究中的应用做简要综述。     

Impact of the human genome project on medical practice

Background: The Human Genome Project is a coordinated effort to define the human genetic blueprint. The goals include construction of a variety of maps of the human genome, including the identification and localization of all genes. The discovery of genes responsible for human diseases has had a significant impact on the practice of medicine. Methods: Methods for defining the human genome include cytogenetic, physical, and genetic mapping techniques. A variety of strategies have been used to identify human genes, especially those genes that are responsible for disease. Once a disease gene has been identified, this information can be used to develop new diagnostic and therapeutic procedures. Results: A number of disease genes have already been identified, leading to improved diagnosis and novel approaches to therapy. A new type of mutation, trinucleotide repeat expansion, has been found to be responsible for at least seven diseases with an unusual inheritance pattern. Conclusions: Materials and technology generated by the Human Genome Project and related research have provided important tools for the diagnosis and treatment of patients afflicted with genetic diseases.     

Extracorporeal bioartificial liver for treating acute liver diseases

Liver is a vital organ of the human body performing myriad of essential functions. Liver-related ailments are often life-threatening and dramatically deteriorate the quality of life of patients. Management of acute liver diseases requires adequate support of various hepatic functions. Thus far, liver transplantation has been proven as the only effective solution for acute liver diseases. However, broader application of liver transplantation is limited by demand for lifelong immunosuppression, shortage of organ donors, relative high morbidity, and high cost. Therefore, research has been focused on attempting to develop alternative support systems to treat liver diseases. Earlier attempts have been made to use nonbiological therapies based on the use of conventional detoxification procedures such as filtration and dialysis. However, the absence of liver cells in such techniques reduced the overall survival rate of the patients and led to inadequate essential liver-specific functions. As a result, there has been growing interest in the development of biological therapy-based extracorporeal liver support systems as a bridge to liver transplantation or to support the ailing liver. A bioartificial liver support is an extracorporeal device through which plasma is circulated over living and functionally active hepatocytes packed in a bioreactor with the aim to aid the diseased liver until it regenerates or until a suitable graft for transplantation is available. This review article gives a brief overview of efficacy of various liver support systems that are currently available. Also, the development of advanced liver support systems, which has been analyzed for improving the important system component such as cell source and other culture and circulation conditions for the maintenance of the liver-specific functions, have been described. Keywords: liver failure, hepatocytes, liver support devices, bioartificial liver, bioreactor.     

腹腔镜部分脾切除术的临床研究进展

腹腔镜部分脾切除术作为一种新式的保脾手术方式,伴随着微创治疗观念的深入及技术设备的进步,在临床上得到了越来越多的应用。相关研究表明这种手术方式主要适用于血液系统疾病、脾脏占位性病变及创伤性脾破裂等疾病的治疗和诊断。综合国内外近年来所开展的相关研究,其在手术的技术方法及手术的治疗效果方面取得了很大进展,但在某些方面还存在着一些争议。本文就腹腔镜部分脾切除术目前的研究动态及其临床进展加以综述。     

LED 技术在皮肤疾病方面的应用进展

发光二极管（LED）光生物调节是皮肤病治疗领域较新的一类非热光疗法，可用于治疗各种皮 肤疾病，例如治疗炎症性痤疮、银屑病、黄褐斑等。随着LED光在皮肤治疗领域的研究逐渐增多，基于 LED技术的设备因其安全性及有效性而受到广大消费者及皮肤科医生的关注。本文简要概述了光对身心健 康和皮肤健康的影响，并回顾了LED技术的发展及其在皮肤疾病中的应用进展。     

Cultured and immediately procured endothelial cells: Current and future clinical applications

Great progress has been made in the last several years in our ability to culture human endothelial cells. In addition, techniques to immediately procure and utilize these cells have also been developed. The purpose of this paper is to present an overview of the current and potential uses of these cells in both vascular and nonvascular conditions. It is likely that endothelial cells will be used in a variety of applications in the near future. Immediately procured and cultured cells will be used to resurface vascular prosthetic grafts. They may also be used on the surface of vessels following procedures such as balloon angioplasty or atherectomy. In addition, they may be placed upon the surface of implantable devices such as expandable stents. Through the mechanism of genetic engineering, these cells may be modified to produce proteins, which may modify thrombogenicity and perhaps decrease the rate of recurrent stenosis by influencing cellular hyperplasia. Genetically modified endothelial cells also have great potential in nonvascular disease. Their contact with circulating blood makes them an ideal cell for production of proteins to correct systemic conditions such as the insulin deficiency found in diabetes mellitus. The application of endothelial cell biology in both vascular and nonvascular science represents one of the most exciting fields of research active today.     

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??Innovative significance and trend of vascular surgery technology CHEN Zhong??YANG Yao-guo. Department of Vascular Surgery, Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China
Corresponding author??CHEN Zhong,E-mail??chenzhong8658@
vip.sina.com
Abstract The development of vascular surgery is closely related to the innovation and development of technology. Vascular diseases mainly include aortic disease, peripheral vascular disease and venous disease. Recently??therapy of vascular surgery have been focused on endovascular treatment. Along with the development of endovascular technology??numerous diseases that were suggested for open surgery such as aortic dissection and aneurysm involving ascending aorta or aortic arch lesion??are treated by in situ fenestration and branch aortic stent.Rebuild main arterial branches of aortic arch and visceral arteries through interventional therapy will become an significant development direction in the future. Interventional therapy and treatment concept of peripheral artery disease are during an improvement stage.The success rate of interventional therapy is increasing attribute to the new generation of recanalized devices??the patency rate is also increasing attribute to the application of drug-coated balloon and atherectomy devices compared with traditional bare metal stent??which accord with the idea of“leave nothing behind”.     

Three-dimensional printed assistive devices for addressing occupational performance issues of the hand: A case report

Study DesignThis is a case report.IntroductionPersons with rheumatoid arthritis frequently use assistive devices as a compensatory strategy to enhance occupational performance when client factors such as hand weakness, pain, and/or limited range of motion interfere with activity performance. Computer-aided design software and 3D printers are increasingly being used to design and make assistive devices.Purpose of the StudyThis case report describes a client-centered approach in the selection, three-dimensional (3D) printing, and evaluation of outcomes for three assistive devices to enhance occupational performance in a subject with rheumatoid arthritis.MethodsOutcome measures used in this study included the Patient-Specific Functional Scale, Numeric Pain Rating Scale, and Quebec User Evaluation of Satisfaction with Assistive Technology V2.0. Activity analysis along with the subject input informed a client-centered approach in the selection, color, and design modifications of 3D printed assistive devices made for the study.ResultsThe subject reported decreased pain, improved occupational performance, and satisfaction with use of 3D printed assistive devices to open plastic beverage bottles, unlock/lock doors, and write.Discussion3D printing offers therapists a means to design and make assistive devices that can be cost-effective, customizable, and client-centered.ConclusionAssistive devices made with 3D printing resulted in positive outcomes in a subject with rheumatoid arthritis.     

相变纳米造影剂联合HIFU应用研究进展

随着医学技术的发展，精准医疗逐渐受到重视。HIFU作为一种无创外科技术，已在实体肿瘤和非肿瘤治疗领域得到应用。相变纳米造影剂作为一种多功能、多模态造影剂，已被证实可用于疾病的早期诊断和治疗。相变纳米造影剂可作为HIFU的有效增效剂，二者联合应用可发挥协同作用，达到更好的治疗效果。本文对相变纳米造影剂联合HIFU应用的研究进展进行综述。     

Advances in ureteroscopy

Ureteroscopy (URS) is a procedure which has been constantly evolving since the development of first generation devices 40 years ago. Progress towards smaller and more sophisticated equipment has been particularly rapid in the last decade. We review the significant steps that have been made toward improving outcomes and limiting morbidity with this procedure which is central to the management of urolithiasis and other upper urinary tract pathology.     

Advancing the management of upper extremity musculoskeletal conditions: Insights from the field of implementation science

IntroductionThe development of effective interventions in hand and upper extremity rehabilitation is critically important; yet even the most promising interventions may not successfully be implemented in practice. Occupational and physical therapists who provide specialized hand and upper extremity rehabilitation services (“hand therapists”) can face extensive, multi-level barriers when attempting to use research findings in real-world settings, widening the long-standing research-to-practice gap. Concepts from the field of implementation science can be leveraged to address this gap and expedite the application of research discoveries that can maximize treatment outcomes of the musculoskeletal upper extremity client. As the intersection of hand and upper extremity rehabilitation and implementation science draws growing attention, there is a great need for researchers and clinicians to infuse implementation science into the hand and upper extremity rehabilitation research and practice contexts.PurposeThe purpose of this article is to define implementation science and synthesize several studies from the hand and upper extremity rehabilitation field that have examined the effect of implementation strategies (eg, chart audit and feedback techniques; implementation teams) on implementation outcomes (eg, acceptability, fidelity). We also present recommendations for how (1) hand and upper extremity rehabilitation researchers can design studies to examine both patient outcomes and implementation outcomes relative to interventions for the musculoskeletal upper extremity and (2) hand and upper extremity rehabilitation specialists and administrators can develop implementation teams to facilitate the use of evidence in practice.ConclusionCollaboration between researchers and clinicians has great potential to advance the entirety of the hand and upper extremity rehabilitation profession, especially when such collaborations are guided by the implementation science field.     

血管外科技术创新的意义与趋势

血管外科的发展与技术的创新发展密切相关。血管外科治疗范围主要包括主动脉疾病、外周动脉疾病及静脉疾病,近年的治疗方法已明显侧重于血管腔内治疗技术,且随着技术的不断创新发展,既往以开放手术治疗为主的许多复杂疑难病例,如累及升主动脉、主动脉弓的主动脉夹层或瘤样扩张疾病,近肾或累及肾动脉等重要内脏动脉分支的腹主动脉瘤等,亦逐渐采用开窗支架、分支支架等新型血管腔内技术治疗,未来内脏动脉及主动脉弓上重要分支动脉的腔内重建将成为血管腔内技术发展的主要方向。外周动脉病变的血管腔内治疗方法与治疗理念均处于改进阶段,各新型开通装置增加了血管腔内治疗成功率,涂药球囊和减容装置较传统支架置入术的远期效果有明显优势,同时能达到不遗留异物的目的,但现阶段还不能完全取代支架置入术。     

数字化技术在儿童口腔医学中的临床应用进展

随着科技发展,口内扫描技术、计算机辅助设计和计算机辅助制造（CAD/CAM）技术等数字化 技术逐渐广泛应用于口腔医学,改变了传统口腔医学的治疗模式,可为患者提供舒适化、个性化治疗,符 合儿童口腔疾病诊治原则。但目前口腔医师对数字化技术在儿童口腔医学的临床应用了解甚少。本文对数 字化技术在儿童口腔医学中的临床检查和治疗中的应用进展作一综述,以期提高口腔医师对相关内容的了 解和认知,为推广数字化技术在儿童口腔医学的临床应用提供一定参考。     

Smart sensor implant technology in total knee arthroplasty

Innovations in computer technology and implant design have paved the way for the development of smart instruments and intelligent implants in trauma and orthopaedics to improve patient-related functional outcomes. Sensor technology uses embedded devices that detect physical, chemical and biological signals and provide a way for these signals to be measured and recorded. Sensor technology applications have been introduced in various fields of medicine in the diagnosis, treatment and monitoring of diseases. Intelligent ‘Smart’ implants are devices that can provide diagnostic capabilities along with therapeutic benefits. In trauma and orthopaedics, applications of sensors is increasing because of the advances in microchip technologies for implant devices and research designs. It offers real-time monitoring from the signals transmitted by the embedded sensors and thus provides early management solutions. Smart orthopaedic implants have applications in total knee arthroplasty, hip arthroplasty, spine surgery, fracture healing, early detection of infection and implant loosening. Here we have explored the role of Smart sensor implant technology in total knee arthroplasty. Smart sensor assisted can be used intraoperatively to provide objective assessment of ligament and soft tissue balancing whilst maintaining the sagittal and coronal alignment to achieve desired kinematic targets following total knee arthroplasty. It can also provide post-implantation data to monitor implant performance in natural conditions and patient's clinical recovery during rehabilitation. The use of Smart Sensor implant technology in total knee arthroplasty appears to provide superior patient satisfaction rates and improved functional outcomes.     

Technical Approaches to Computer-Assisted Orthopedic Surgery

Abstract Surgical navigation systems and medical robotic devices are increasingly being used during trauma and orthopedic surgery. This article tries to present the underlying technology of these devices and to describe different approaches to the various aspects of the methods. To structure the variety of available products and presented research modules, a new categorization for these approaches is proposed. Examples of pre- or intraoperative imaging modalities, of trackers for navigation systems, of different surgical robots, and of methods for registration as well as referencing are discussed. Many applications that have been realized for numerous surgical procedures will be presented and their advantages, disadvantages, and possible implications will be elucidated.     

A novel multimodal platform for assessing surgical technical skills

BackgroundEstablished methods for assessing surgical performance face limitations. Global rating scales and procedure-specific checklists are resource intensive and rely on expert opinions. Alternatives that use technology to track hand movements, such as magnetic and optical tracking systems, are generally expensive and ill suited to the surgical environment.MethodsThe authors present a new platform that integrates a novel, low-cost optical tracking system, magnetic tracking technology and a videographic recording system to quantify surgical performance synchronously across all modalities. The validity of this platform was tested by examining its ability to differentiate between the performance of expert and novice participants on a basic surgical task.ResultsEach modality was able to differentiate between expert and novice participants, and metrics were well correlated across modalities.ConclusionsThe authors have developed a platform for assessing surgical performance. It can operate in the absence of expert raters and has the potential to provide immediate feedback to trainees.     

The use of polyurethane materials in the surgery of the spine: a review

Background contextThe spine contains intervertebral discs and the interspinous and longitudinal ligaments. These structures are elastomeric or viscoelastic in their mechanical properties and serve to allow and control the movement of the bony elements of the spine. The use of metallic or hard polymeric devices to replace the intervertebral discs and the creation of fusion masses to replace discs and/or vertebral bodies changes the load transfer characteristics of the spine and the range of motion of segments of the spine.PurposeThe purpose of the study was to survey the literature, regulatory information available on the Web, and industry-reported device development found on the Web to ascertain the usage and outcomes of the use of polyurethane polymers in the design and clinical use of devices for spine surgery.Study design/settingA systematic review of the available information from all sources concerning the subject materials' usage in spinal devices was conducted.MethodsA search of the peer-reviewed literature combining spinal surgery with polyurethane or specific types and trade names of medical polyurethanes was performed. Additionally, information available on the Food and Drug Administration Web site and for corporate Web sites was reviewed in an attempt to identify pertinent information.ResultsThe review captured devices that are in testing or have entered clinical practice that use elastomeric polyurethane polymers as disc replacements, dynamic stabilization of spinal movement, or motion limitation to relieve nerve root compression and pain and as complete a listing as possible of such devices that have been designed or tested but appear to no longer be pursued. This review summarizes the available information about the uses to which polyurethanes have been tested or are being used in spinal surgery.ConclusionsThe use of polyurethanes in medicine has expanded as modifications to the stability of the polymers in the physiological environment have been improved. The potential for the use of elastomeric materials to more closely match the mechanical properties of the structures being replaced and to maintain motion between spinal segments appears to hold promise. The published results from the use of the devices that are discussed show early success with these applications of elastomeric materials.     

Postmarketing safety of biologics and biological devices

Background contextRegardless of study design, the approval process of biologics and biological devices cannot identify every possible safety concern. Postmarketing safety surveillance can provide information based on real-world use of medical products in heterogeneous populations and is critical for identifying potentially serious adverse events, events that are too rare to be detected during premarketing studies, late complications, and events involving individuals or uses that were not evaluated in clinical trials.PurposeTo review why adverse event reporting is important and how the information is used, with emphasis on the points that are most applicable for surgeons and other spine professionals.MethodsThis is an overview of postmarketing safety surveillance.ResultsReview of adverse event reports has resulted in safety notifications, label changes, and publications regarding the safety of biologics and biological devices, such as the risk of airway compromise after the use of recombinant human bone morphogenetic protein in cervical spine fusion, the occurrence of a fatal air embolism after the use of a fibrin sealant that had been applied with a spray device, and infections after allograft transplantation of human tissues.ConclusionsIn light of the rapid development of new biologics, postmarketing surveillance is imperative for ensuring that these products are as safe as possible. By reporting adverse events, surgeons and other health care professionals play a key role in improving and refining our understanding of the safety of biologics.     

New resorbable bone fixation. Biomaterials in craniomaxillofacial surgery: present and future

Metallic implants have been extensively used for osteofixation in craniomaxillofacial surgery (CMF). Although they are mainly inert, the disadvantage of not being resorbable remains. Advances in biomaterials technology led to the development of resorbable polymers composed by monomeric units that are naturally present in the body. Among them are polylactide (PLA), polyglycolide (PGA) and their copolymers [PLGA and P(L/DL)LA]. After in-depth studies of the structure of these materials, the self-reinforced (SR) technology has merged to solve their mechanical limitations. SR is based on reinforcing elements within the same material, increasing their strength. Ultra-high strength implants were then manufactured by the SR technique. In CMF surgery, SR devices have been used for over 10 years without reported complications. As advantages, SR devices have shown to be biocompatible, reliable, easily handled, and to have favorable degradation properties. At present, copolymeric SR devices [P(L/DL)LA, BioSorb FX, and PLGA, BioSorb PDX] represent an advance in the clinical application of absorbable devices in CMF surgery. The aim of this review is to give an overall understanding of the ultimate advances in biomaterial research for CMF reconstruction, with emphasis in self-reinforced resorbable devices. We also intend to give insight into new devices, such as SR, tacks and their applicability.