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??Objective    The diabetic pig model was established by intravenous injection of streptozocin in order to investigate whether direct laser metal sintering??DLMS??could improve osseointegration in diabetic animal models. Methods    A diabetes model in mini-pigs was established by intravenous injection of streptozotocin??STZ????150 mg/kg????and a total of 36 implants were inserted into the mandibular region. Micro-computed tomography??micro-CT??and histologic evaluations were performed three and six months after implantation. Results     The blood glucose level remained at high level??≥  10 mmol/L?? after the induction of diabetes??reaching the diabetic level??≥ 7 mmol/L??. Obvious improvement in osseointegration was observed in the micro-CT and Van Gieson??VG??staining analyses of DLMS implants compared with MAO at three months??P < 0.05???? although this difference disappeared by six months??P > 0.05??. Conclusion    The rough surface of DLMS implants can accelerate the progress of osseointegration.     

5590例临床血清标本抗核抗体检测结果分析

目的探讨抗核抗体(ANA)和ENA抗体谱在就诊患者中的阳性分布趋势及对自身免疫性疾病(AID)的临床意义。方法采用间接免疫荧光法(IIF)和欧蒙印迹法检测5 590例患者血清标本中的ANA和ENA抗体谱,并对检测结果进行回顾性分析。结果 5 590例患者血清标本中,检出ANA阳性1 256例,阳性率为22.47%。女性阳性率为(1 030/3 645)28.26%,男性阳性率为11.62%(226/1 945),差异有统计学意义(P0.01)。不同年龄组间ANA阳性率,21~50岁组(23.77%)和50岁年龄组(23.87%),与≤20岁年龄组(11.95%)相比较,差异有统计学意义(P0.01)。ANA单一型荧光模式以核颗粒型(46.50%)、核均质型(17.83%)等为主,混合型荧光模式以核颗粒型/核均质型(5.25%)为主。5 590例患者血清标本中ENA抗体谱检测阳性者1 288例,阳性率23.04%,大多数为二种或二种以上抗体同时阳性。阳性抗体中阳性率最高的是抗SS-A(45.89%)、抗Ro-52(40.30%)、抗nRNP/Sm(19.33%)等。结论 ANA和ENA抗体谱联合检测具有互补性,可提高自身抗体检出率,对AID的诊断和治疗有重要意义。     

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??Establishment of a prognostic nomogram in peritoneally metastasized colorectal cancer patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy SI Bao-cai??LIU Lu-guang??Hao Hong-bo??et al. Department of Gastrointestinal Surgery??Shandong Provincial Hospital Affiliated to Shandong University??Jinan 250022??China
Corresponding author??SI Bao-cai??E-mail??sbc_sdsl@163.com
Abstract Objective To analyze the prognostic factors in peritoneally metastasized colorectal cancer (PMCRC) patients treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) to establish a prognostic nomogram and validate its accuracy. Methods Clinical characteristics of 146 PMCRC patients treated with CRS and HIPEC at Shandong Provincial Hospital affiliated to Shandong University from January 2006 to December 2015 were retrospectively analyzed. All the patients were peritoneally metastasis confirmed by histological examination. COX proportional regression model was used to conduct the univariate and multivariate analyses to determine the prognostic factors. Then the R software was adopted to establish a nomogram prognostic model. Bootstrap method was used to validate the nomogram model which was also compared with Peritoneal Surface Disease Severity Score (PSDSS). Results (1) Three-year disease free survival (DFS) was 30.8% in this study. Age??pN status??peritoneal cancer index (PCI) and histology were independent prognostic factors of DFS (P<0.05). (2) The nomogram model showed a C-index of 0.712 higher than that of PSDSS 0.683??and had good agreement with actual DFS. Conclusion The nomogram established based on age??pN status??PCI and histology was accurate in predicting DFS of patients undergoing CRS and HIPEC??with a higher C-index than PSDSS??which showed a good agreement with the actual DFS. It would be useful for guiding the strategy of clinical treatment.     

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??First discovered: How to identify the surgical indication line of Denovilliers’fascial HUANG Jiang-long, FANG Jia-feng, ZENG Zong-heng, et al. Department of Gastrointestinal Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
Corresponding author:WEI Hong-bo, E-mail??drweihb@126.com
Abstract The high incidence of postoperative urogenital dysfunction after traditional total mesorectal excision (TME) surgery has led to worldwide controversy and query on TME surgery. More and more scholars agree with the view on necessity of preserving Denonvilliers’ fascia during rectal cancer resection. However, how to figure out the exact location of Denonvilliers’ fascia is still elusive. Through repeated clinical practice and studies on the anatomy of cadaver specimens, we first discovered that the roof of Denonvilliers’ fascia is located in the lowest level of peritoneal reflex (rectovesical ponch or Douglas' Pouch), and presented as a white thick line. This white thick line (as we call Wei’s line) is the best surgical marker to identify Denonvilliers’ fascia. Dissection in front of Wei’s line can enter into the front plane of Denonvilliers’ fascia, while dissection behind the line helps to enter into the back plane of Denonvilliers’ fascia and thus preserve Denonvilliers’ fascia entirely, as well as protect postoperative urogenital function. Wei’s line helps to provide standardized surgical procedure and surgical plan for preservation of Denonvilliers’ fascia in improved TME surgery and is also useful for surgeons majored in pelvic surgery.     

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??Controversy and expectation on preservation or excision of Denonvilliers fascia during radical rectal cancer resection FANG Jia-feng??WEI Hong-bo. Department of Gastrointestinal Surgery??the Third Affiliated Hospital of Sun Yat-sen University??Guangzhou 510630??China
Corresponding author??WEI Hong-bo??E-mail: drweihb@126.com
Abstract Total mesorectal excision (TME) is the golden standard of surgery for mid-low rectal cancer. Traditional TME surgery requires dissection in front of the Denonvilliers’ fascia??as well as excision of Denonvilliers’ fascia. However??the high incidence of postoperative urogenital dysfunction has led to worldwide controversy and query on TME surgery. Individualized treatment should be applied to patients with middle and low rectal cancer. For patients whose tumors are not located in the anterior and lateral walls of rectum or local stages are early??TME should be performed at the back of Denonvilliers fascia to preserve the integrity of Denonvilliers fascia as far as possible??so as to protect the pelvic autonomic nerve??avoid postoperative urination and sexual dysfunction??improve postoperative life quality of patients.     

新型压疮防护系统对压疮高危风险病人的防护作用的研究

[目的]探讨新型压疮防护系统对压疮高风险病人的压疮预防性作用。[方法]选取吉林省人民医院2015年2月—2017年2月具有压疮高风险(Braden评分12分)的住院病人126例,首先给予常规压疮预防护理45例作为对照组,后81例病人给予新型压疮防护系统作为预防性的措施为实验组,通过观察两组的皮肤情况,统计病人的压疮发生率和评价病人的舒适度。[结果]实验组病人住院第2天、住院第7天压疮发生率低于对照组,差异有统计学意义。[结论]新型压疮防护系统能降低压疮高风险病人的压疮发生率。     

老年慢性阻塞性肺疾病并发自发性气胸25例临床分析

老年慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者自身肺功能较差,易并发自发性气胸,并发气胸后肺功能进一步受损,加之回心血量减少及纵隔摆动,易引起心肺功能衰竭,若不及时诊断或处理不当,可危及生命。     

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??Objective    To invesigate the combined effect of bioactive hyaluronic acid??B-HA?? with minocycline hydrochloride on the antibacterial function of Porphyromonas gingivalis??P.gingivalis????to provide a therory to the clinical of periodontal medicine. Methods    Agar dilution method with medicine to measure the survive rate of P.gingivalis??divided into four groups??B-HA separately??minocycline hydrochloride separately??B-HA combined minocycline hydrochloride??control group accordingly. Quantitated the ability of P.gingivalis is growth by counting the number of the visible bacterial colony??and computed the survival rate of P.gingivalis. Results    Five different density of B-HA combined the minocycline hydrochloride in a density of 0.05 μg/L ??the result showed as the increase of B-HA??the survival rate is decrease gradually??P < 0.05????the survival rate is 82.57%??71.56% seperately when the density is 35 mg/L and 45 mg/L respectively. The survival rate is 50.46% when the density is 55 mg/L. Compared to the B-HA alone??it has improved at 22.93%??P < 0.05??. Conclusion    Our research show that the combination between B-HA and minocycline hydrochloride has signifiant effect on the anti-bacterial of P.gingivalis.