微创经椎间孔入路腰椎椎间融合术中横突定位法置钉治疗腰椎退行性疾病

目的 探讨微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)中横突定位法置钉治疗腰椎退行性疾病的可行性.方法 回顾性分析2017年1月—2019年5月在新华医疗集团新华医院接受MIS-TLIF治疗的70例腰椎退行性疾病患者的临床资料,其中采用横突定位法置钉33例(观察组),采用传统人字嵴定位法置钉37例(对照组).记录并比较2组术中出血量、透视次数、置钉时间、一次置钉成功率、置钉优良率、关节突关节破坏率,在术前、术后3个月和末次随访时采用Oswestry功能障碍指数(ODI)、疼痛视觉模拟量表(VAS)评分评价患者腰椎功能及疼痛程度.结果 所有手术顺利完成,患者随访16～36(23.18±3.91)个月.观察组置钉时间、透视次数、关节突关节破坏率显著低于对照组,一次置钉成功率、置钉优良率显著高于对照组,差异均有统计学意义(P<0.05);术中出血量组间差异无统计学意义(P>0.05).2组术后3个月、末次随访时VAS评分和ODI均较术前显著改善,差异均有统计学意义(P<0.05),组间比较差异无统计学意义(P>0.05).结论 MIS-TLIF术中采用横突定位法置钉治疗腰椎退行性疾病近期疗效良好,可减少置钉时间,提高置钉成功率与准确率.     

介入治疗内脏动脉瘤的远期疗效

目的观察介入治疗内脏动脉瘤(VAA)的远期疗效。方法回顾性分析30例接受介入治疗VAA患者(41个瘤灶),术后随访时间均12个月,观察治疗效果及并发症。结果对12个肾动脉瘤、8个脾动脉瘤行动脉瘤填塞术,其中5个脾动脉瘤、5个肾动脉瘤采用裸支架辅助填塞;对13个脾动脉瘤、1个肝动脉瘤行动脉瘤栓塞术;对4个肾动脉瘤行载瘤动脉支架植入术,其中3个采用多层裸支架植入术、1个采用覆膜支架植入术;对2个肾动脉瘤、1个腹腔干动脉瘤行保守治疗;均获得成功。1个脾动脉瘤栓塞术后出现部分脾梗死,1个左肾多发动脉瘤植入支架后瘤腔小部分显影。术后随访12～55个月,平均(23.44±12.48)个月,期间脾梗死者梗死面积未增大、未见脓肿形成,瘤腔部分显影病变显影面积未增大。30例患者中,1例因心力衰竭死亡,余均存活,无VAA复发及其他并发症。结论介入治疗VAA远期疗效较好,且安全性较高。     

Mid‐ to Long‐Term Outcomes of Cementless Modular,Fluted, Tapered Stem for Massive Femoral Bone Loss in Revision Total Hip Arthroplasty

ObjectiveTo evaluate mid‐ to long‐term results of revision total hip arthroplasty for massive femoral bone loss using a cementless modular, fluted, tapered stem.MethodsThis is a retrospective study performed at a single hospital. During the period of January 2007 to January 2015, 33 patients (34 hips) underwent primary revision surgery with cementless modular, fluted, tapered stems due to femoral bone loss. Sixteen men and 17 women were included in the study, with an average age of 63.9 ± 11.7 years (range, 27 to 88 years). Operative data including operative duration, length of incision, drainage volume and duration, blood loss and transfusion, cases of bone graft and extended trochanteric osteotomy were recorded. Clinical evaluation was performed using Harris hip score (HHS), visual analogue scale (VAS), and patients'' satisfaction. Radiographic data including femoral stem fixation, subsidence, integrin of allograft bone, and leg length discrepancy were assessed. Complications and survivorship were evaluated using Kaplan–Meier survival rate.ResultsThe mean follow‐up was 9.1 ± 2.5 years (range, 5–13 years). The Harris hip score was 43.6 ± 11.5 preoperatively and maintained at 86.5 ± 6.6 at the time of latest follow‐up (P < 0. 05). The X‐ray showed bone ingrowth fixation in 30 hips (88%), fibrous stable fixation in three hips (9%), and instability in one hip (3%). The average stem subsidence was 3.9 ± 2.2 mm (range, 1 to 10 mm). The mean difference in leg length in our study was 3.3 ± 2.7 mm (range, 0 to 10 mm), and the leg length discrepancy in 28 (82%) patients was within 5 mm. No case of junction fracture was observed. Seven (21%) intraoperative fractures occurred in our study. Three (9%) cases with infection were observed after revision. Six (18%) patients had lower limb vein thrombosis. The survivorship of prostheses with re‐revision for any reason was 95% (95% CI, 12.0 to 13.0) at the 10‐year follow‐up. Three (9%) re‐revisions were needed, including one for aseptic loosening, one for dislocation, and one for infection.ConclusionThe mid‐ to long‐term results of revision total hip arthroplasty with the cementless modular, fluted, tapered stems are encouraging for massive femoral bone loss.     

Mutation profile and its correlation with clinicopathology in Chinese hepatocellular carcinoma patients

BackgroundHepatocellular carcinoma (HCC) is one of the most common causes of cancer worldwide. Although many studies have focused on oncogene characteristics, the genomic landscape of Chinese HCC patients has not been fully clarified.MethodsA total of 165 HCC patients, including 146 males and 19 females, were enrolled. The median age was 55 years (range, 27–78 years). Corresponding clinical and pathological information was collected for further analysis. A total of 168 tumor tissues from these patients were selected for next-generation sequencing (NGS)-based 450 panel gene sequencing. Genomic alterations including single nucleotide variations (SNV), short and long insertions and deletions (InDels), copy number variations, and gene rearrangements were analyzed. Tumor mutational burden (TMB) was measured by an algorithm developed in-house. The top quartile of HCC was classified as TMB high.ResultsA total of 1,004 genomic alterations were detected from 258 genes in 168 HCC tissues. TMB values were identified in 160 HCC specimens, with a median TMB of 5.4 Muts/Mb (range, 0–28.4 Muts/Mb) and a 75% TMB of 7.7 Muts/Mb. The most commonly mutated genes were TP53, TERT, CTNNB1, AXIN1, RB1, TSC2, CCND1, ARID1A, and FGF19. SNV was the most common mutation type and C:G>T:A and guanine transformation were the most common SNVs. Compared to wild-type patients, the proportion of Edmondson grade III–IV and microvascular invasion was significantly higher in TP53 mutated patients (P<0.05). The proportion of tumors invading the hepatic capsule was significantly higher in TERT mutated patients (P<0.05). The proportion of Edmondson grade I-II, alpha fetoprotein (AFP) <25 µmg/L, and those without a history of hepatitis B was significantly higher in CTNNB1 mutated patients (P<0.05). CTNNB1 mutations were associated with TMB high in HCC patients (P<0.05). Based on correlation analysis, the mutation of TP53 was independently correlated with microvascular invasion (P=0.002, OR =3.096) and Edmondson grade III–IV (P=0.008, OR =2.613). The mutation of TERT was independently correlated with tumor invasion of the liver capsule (P=0.001, OR =3.030), and the mutation of CTNNB1 was independently correlated with AFP (<25 µmg/L) (P=0.009, OR =3.414).ConclusionsThe most frequently mutated genes of HCC patients in China were TP53, TERT, and CTNNB1, which mainly lead to the occurrence and development of HCC by regulating the P53 pathway, Wnt pathway, and telomere repair pathway. There were more patients with microvascular invasion and Edmondson III–IV grade in TP53 mutated patients and more patients with hepatic capsule invasion in TERT mutated patients, while in CTNNB1 mutated patients, there were more patients with Edmondson I–II grade, AFP <25 µmg/L, and a non-hepatitis B background. Also, the TMB values were significantly higher in CTNNB1 mutated patients than in wild type patients.     

Neoadjuvant combination of pazopanib or axitinib and programmed cell death protein-1-activated dendritic cell-cytokine-induced killer cells immunotherapy may facilitate surgery in patients with renal cell carcinoma

BackgroundRadical/cytoreductive nephrectomy or nephron-sparing surgery may be thought to be not safe or unfeasible in some renal cell carcinoma (RCC) patients in which tumor is locally advanced or highly complicated. Neoadjuvant therapy may reduce the volume of the tumor, thus facilitates surgery. The aim the study is to evaluate the efficacy and safety of neoadjuvant combination of pazopanib or axitinib and PD-1-activated dendritic cell-cytokine-induced killer (PD-1/DC-CIK) cell immunotherapy in those patients.MethodsData from 16 RCC patients who received neoadjuvant pazopanib (Group P, n=9) or axitinib (Group A, n=7) plus PD-1/DC-CIK cells immunotherapy were reviewed retrospectively. A total of 9 participants that were potential candidates for radical/cytoreductive nephrectomy (RN/CN) had locally advanced tumor and 5 participants with partial nephrectomy (PN) absolute indications had highly complicated tumors. The efficacy outcomes were based on volume changes of the primary tumor, lymph nodes, and tumor thrombus in 13 participants with complete computed tomography (CT) imaging. The treatment-related toxicities and surgical complications were also reported.ResultsWith a median of 2.1 months treatment, the overall volume of the tumors decreased by a median of 42.30% [interquartile range (IQR): 19.37–66.78%]. Specifically, the median reduction of tumor volume was 88.77 and 15.50 cm³ in group P and group A, respectively (P=0.014). However, participants in Group P were more likely to experience grade 3 or 4 treatment-related adverse events (AEs) than those in Group A (44.4% vs. 0). Finally, all participants were candidates for appropriate surgery after neoadjuvant therapy (as assessed by the surgeon), and 10 participants accepted surgery, including 5 PN, 4 RN/CN, and 1 lymph node dissection. A solitary participant had Clavien grade IV acute renal failure required dialysis and another had grade II lymphatic leakage.ConclusionsNeoadjuvant combination of pazopanib or axitinib and PD-1/DC-CIK cells immunotherapy was well-tolerated and could effectively reduce the volume of tumors in locally advanced or highly complicated RCC patients.     

牛磺酸对大鼠心脏模拟缺血再灌注损伤的保护作用

在离体大鼠心脏模拟缺血再灌注(I/R)损伤的模型上观察了牛磺酸的心肌保护作用。实验结果发现预先给大鼠牛磺酸灌胃(300mg/kg)三日或再灌注同时给药(20mmol/L),对心肌均有保护作用,明显减少心肌细胞内的Mb、LDH的漏出,降低心肌MDA的生成,减轻细胞内钙的聚集,促进心肌ATP含量的恢复。在本实验条件下预防应用牛磺酸较再灌注的同时应用更为有效,表现为更大程度地减少LDH漏出,抑制心肌MDA生成和钙聚集。结果证明牛磺酸具有心肌保护作用,对于防治心肌I/R损伤可能具有临床应用价值。     

X-ray scatter correction algorithm for cone beam CT imaging

Developing and optimizing an x-ray scatter control and reduction technique is one of the major challenges for cone beam computed tomography (CBCT) because CBCT will be much less immune to scatter than fan-beam CT. X-ray scatter reduces image contrast, increases image noise and introduces reconstruction error into CBCT. To reduce scatter interference, a practical algorithm that is based upon the beam stop array technique and image sequence processing has been developed on a flat panel detector-based CBCT prototype scanner. This paper presents a beam stop array-based scatter correction algorithm and the evaluation results through phantom studies. The results indicate that the beam stop array-based scatter correction algorithm is practical and effective to reduce and correct x-ray scatter for a CBCT imaging task.     

VITEK ESBL实验在检测产超广谱β-内酰胺酶细菌中的临床应用

目的 :评价VITEKESBL试验和双纸片试验 ( 2 -disk)检测产超广谱β -内酰胺酶细菌 (ESBLs)的能力。 方法 :对 5 9株细菌进行敏感性和特异性检测。结果 :所测得细菌都具有典型的ESBLs的特征。VITEKESBL和 2 -disk检测ESBLs的敏感性和特异性结果分别为 98 3%和 10 0 %、96 6 1%和 96 6 1%。结论 :VITEKESBL试验比 2 -disk法易于操作。 2 -disk法对结果判读会产生主观影响 ,VITEKESBL试验可正确检测ESBLs。     

利用PCR技术构建GM-CSF/Fc_(γ2)~-融合蛋白真核表达载体

目的　对融合基因GM -CSF Fcγ2 进行定点突变 ,去除其补体结合位点 ,构建GM -CSF Fcγ2-融合蛋白真核表达载体。方法　通过设计突变引物 ,利用PCR定点突变技术扩增融合基因GM -CSF Fcγ2-。并通过T -A克隆策略 ,把突变后的融合基因GM -CSF Fcγ2-重组到真核表达载体pRc CMV2中 ,构建真核表达质粒pRc CMV2 GM -CSF Fcγ2-并经过酶切和测序确证。结果　成功对融合基因GM -CSF Fcγ2-进行了突变 ,构建了真核表达载体pRc CMV2 GM -CSF Fcγ2-。结论　利用该PCR方法进行基因定点突变可行     

严重退变性膝关节骨关节病联合手术疗法

目的 采用多种手术方式的综合治疗严重膝骨关节病。方法 对68例80膝）严重膝骨关节病采用膝关节腔清理术、硬化骨切除钻孔减压术、胫骨高位截骨术、胫骨结节前移术等多种术式组合的方法进行了治疗。其中55例（62膝）经5年1个月的随诊,对其疗效进行了评价。结果 优：40膝,占64.5%;良：16膝,占25.9%;可：6膝,占9.6%,无差级,优良率达90.4%。结论 多种术式的联合应用治疗严重膝骨关节病具有缓解疼痛,提高步行能力及恢复关节活动的明显效果。