Usefulness of a Three‐Dimensional‐Printed Model in the Treatment of Irreducible Atlantoaxial Dislocation with Transoral Atlantoaxial Reduction Plate

ObjectiveTo evaluate the usefulness of a 3D‐printed model for transoral atlantoaxial reduction plate (TARP) surgery in the treatment of irreducible atlantoaxial dislocation (IAAD).MethodsA retrospective review was conducted of 23 patients (13 men, 10 women; mean age 58.17 ± 5.27 years) with IAAD who underwent TARP from January 2015 to July 2017. Patients were divided into a 3D group (12 patients) and a non‐3D group (11 patients). A preoperative simulation process was undertaken for the patients in the 3D group, with preselection of the TARP system using a 3D‐printed 1:1 scale model, while only imaging data was used for the non‐3D group. Complications, clinical outcomes (Japanese Orthopaedic Association [JOA] and visual analogue score [VAS]), and image measurements (atlas–dens interval [ADI], cervicomedullary angle [CMA], and clivus‐canal angle [CCA]) were noted preoperatively and at the last follow up.ResultsA total of 23 patients with a follow‐up time of 16.26 ± 4.27 months were included in the present study. The surgery duration, intraoperative blood loss, and fluoroscopy times in the 3D group were found to be shorter than those in non‐3D group, with statistical significance. The surgery duration was 3.29 ± 0.45 h in the 3D group and 4.68 ± 0.90 h in the non‐3D group, and the estimated intraoperative blood loss was 131.67 ± 43.03 mL in the 3D group and 185.45 ± 42.28 mL in the non‐3D group. No patients received blood transfusions. The intraoperative fluoroscopy times were 5.67 ± 0.89 in the 3D group and 7.91 ± 1.45 in the non‐3D group. Preoperatively and at last follow up, JOA and VAS scores and ADI, CCA, and CMA were improved significantly within the two groups. However, no statistical difference was observed between the two groups. However, surgical site infection occurred in 1 patient in the 3D group, who underwent an emergency revision operation of the removal of TARP device and posterior occipitocervical fixation; the patient recovered 2 weeks after the surgery. In 2 patients in the traditional group, a mistake occurred in the placement of screws, with no neurological symptoms related to the misplacement.ConclusionPreoperative surgical simulation using a 3D‐printed real‐size model is an intuitive and effective aid for TARP surgery for treating IAAD. The 3D‐printed biomodel precisely replicated patient‐specific anatomy for use in complicated craniovertebral junction surgery. The information was more useful than that available with 3D reconstructed images.     

产力异常产妇62例临床护理

目的探讨产力异常产妇的临床护理。方法对62例产力异常产妇进行护理评估,并针对性采取护理措施。结果 62例产力异常产妇经过精心细致的治疗和护理,均成功分娩,无并发症发生。结论对产力异常产妇在围生期进行密切观测,并有针对性地采取护理干预措施,能够提高分娩成功率,保证产妇及胎儿安全度过分娩期。     

Serum‐Level Changes of Vascular Endothelial Growth Factor in Children with Infantile Hemangioma after Oral Propranolol Therapy

Oral propranolol is the first‐line therapy for infantile hemangioma (IH), but its mechanism of action remains unclear. The aim of this study was to evaluate the change in serum vascular endothelial growth factor (VEGF) levels in patients with IH who underwent propranolol treatment. The study included 22 patients with IH receiving propranolol treatment. At three time points—before treatment and 1 and 3 months after treatment—blood samples were examined by enzyme‐linked immunosorbent assay for serum VEGF expression. The mean serum VEGF concentration in children with proliferative hemangiomas was 395.0 ± 176.7 pg/mL, approximately twice as high as in patients with venous malformations (mean 170.7 pg/mL) and in healthy controls (204.8 pg/mL, p = 0.006). After 1 month of propranolol treatment, the level had fallen 21.6% (p = 0.003), although the downward trend was less obvious after 3 months of treatment (18.0%, p = 0.63). VEGF expression correlated significantly with the lesion size (correlation coefficient [R] = 0.43, p = 0.046), whereas no correlation was observed with age (R = 0.13, p = 0.56). Serum VEGF levels were higher in patients with IH and fell after 1 month of oral propranolol treatment. Similar results, although less pronounced, were found after 3 months of treatment. Lesion volume and serum level of VEGF were significantly correlated.     

Albiflorin Attenuates Mood Disorders Under Neuropathic Pain State by Suppressing the Hippocampal NLRP3 Inflammasome Activation During Chronic Constriction Injury

BackgroundNeuropathic pain is a multifaceted and ubiquitous disease across the globe. Mood disorders, such as anxiety and depression, are frequently observed in patients suffering from neuropathic pain. Both neuropathic pain and comorbid mood disorders seriously impact quality of life. Accumulated evidence shows that activation of the NOD-like receptor protein 3 (NLRP3) inflammasome is involved in the neuroinflammatory pathogenesis of neuropathic pain, anxiety, and depression. However, the role of the NLRP3 inflammasome in the pathological process of anxiety and depression under the neuropathic pain state has not been fully described. Albiflorin, a monoterpene glycoside, may be a potential regulator of the NLRP3 inflammasome, but it is not clear whether albiflorin relates to NLRP3 inflammasome activation.MethodsWe used a systematic pharmacological method to confirm whether the activation of the NLRP3 inflammasome in the hippocampus was involved in the development of neuropathic pain associated with mood disorders and whether albiflorin could be an effective treatment for these symptoms.ResultsThe NLRP3 inflammasome contributed to the neuropathic pain and comorbid anxiety and depression-like behaviors induced by chronic constriction injury of the sciatic nerve, and albiflorin may relieve these symptoms via inhibition of the NLRP3 inflammasome activity. Moreover, albiflorin enhanced the translocation of the nuclear factor erythroid 2-related factor 2 into the nucleus and suppressed nuclear factor-kappa B activity in the hippocampus.ConclusionsAlbiflorin, as a potential therapeutic agent, might greatly improve the overall symptoms of neuropathic pain.     

中国胰腺癌发病趋势分析和预测

目的利用中国肿瘤登记地区1998-2007年胰腺癌发病登记数据分析胰腺癌发病趋势，并预测2008--2015年中国胰腺癌的发病情况。方法计算各年份胰腺癌的粗发病率，直接法计算中国人口标准化率，采用JoinPoint软件对中国肿瘤登记地区1998-2007年胰腺癌发病数据进行趋势分析，计算年度平均变化率。应用贝叶斯年龄一时期一队列模型对数据进行拟合，估计年龄、时期、队列参数效应并预测2008-2015年全国胰腺癌发病情况。结果1998-2007年城市男性粗发病率每年以1．86%的比例上升，中国人口标准化率上升趋势不明显；女性粗发病率每年上升2．1%，中国人口标准化率上升趋势不明显。农村男性粗发病率每年上升7．54%，中国人口标准化率每年上升4．82%；女性分别上升7．83%和5．48%。预测模型显示年龄效应、时期效应和队列效应均在胰腺癌发病中起重要作用。估计2015年新发胰腺癌103 428例，其中男性60 500例，女性42 928例，较2008年增加15 277例。结论中国胰腺癌发病率呈上升趋势，其中农村地区上升明显，城市地区上升速度略缓，到2015年总体上升趋势有所减缓，但短期内胰腺癌仍然是主要癌症。     

基于德尔菲法和层次分析法的硕士研究生生源质量评价指标体系研究

目的构建准确、有效、易操作的研究生生源质量评价体系，促进研究生教育健康发展。 方法在利益相关者调查、文献研究及专家访谈的基础上，初步确定硕士研究生生源质量评价指标体系的一级、二级指标，运用德尔菲法进行两轮专家咨询最终确定硕士研究生生源质量评价指标，运用层次分析法计算评价指标权重。 结果专家熟悉程度为0.8657、0.8648，判断依据为 0.7457、0.7484，权威系数为 0.8057、0.8314，Kendall协调系数为 0.125、0.406（ P<0.001）。确定硕士研究生生源质量评价指标包括 4项一级指标、14项二级指标。一级指标为成绩指标、背景结构、专业适配、综合素质，权重分别为 0.42、0.23、0.23、0.12，判断矩阵的一致性比例（CR）为 0.004，二级指标判断矩阵的（CR）分别为0.017、0.018、0.018、0。 结论运用德尔菲法和层次分析法构建的硕士研究生生源质量评价指标体系及其权重较为科学，结果可信，可对研究生生源质量进行科学的诊断性评估，为研究生教育的培养、就业跟踪评价奠定了重要的基础作用。     

Deletion of Krüppel-like factor-4 promotes axonal regeneration in mammals

Axonal regeneration plays an important role in functional recovery after nervous system damage. However, after axonal injury in mammals, regeneration is often poor. The deletion of Krüppel-like factor-4 (Klf4) has been shown to promote axonal regeneration in retinal ganglion cells. However, the effects of Klf4 deletion on the corticospinal tract and peripheral nervous system are unknown. In this study, using a mouse model of sciatic nerve injury, we show that the expression of Klf4 in dorsal root ganglion sensory neurons was significantly reduced after peripheral axotomy, suggesting that the regeneration of the sciatic nerve is associated with Klf4. In vitro, dorsal root ganglion sensory neurons with Klf4 knockout exhibited significantly enhanced axonal regeneration. Furthermore, the regeneration of the sciatic nerve was enhanced in vivo following Klf4 knockout. Finally, AAV-Cre virus was used to knockout the Klf4 gene in the cortex. The deletion of Klf4 enhanced regeneration of the corticospinal tract in mice with spinal cord injury. Together, our findings suggest that regulating KLF4 activity in neurons is a potential strategy for promoting axonal regeneration and functional recovery after nervous system injury. This study was approved by the Animal Ethics Committee at Soochow University, China (approval No. SUDA20200316A01).

Chinese Library Classification No.R456; R741; Q344+.14