Retained or altered expression of major histocompatibility complex class I in patient-derived xenograft models in breast cancer

Immunologic Research - The expression of major histocompatibility complex class I (MHC I) in tumor cells is regulated by interferon signaling, and it is an important factor in the efficacy of...     

Chinese liver fluke Clonorchis sinensis infection changes the gut microbiome and increases probiotic Lactobacillus in mice

Chinese liver fluke Clonorchis sinensis changes the host’s immune system. Recently, it has been reported that helminths including C. sinensis can ameliorate immune-related diseases such as allergy. In addition, recent studies showed that helminth infection can alleviate immune-mediated disorders by altering the gut microbiome. However, changes in the gut microbiome due to C. sinensis have not been reported yet. In this study, changes in the gut microbiome of C57BL/6 mice infected with C. sinensis metacercariae were evaluated over time. Stool was analyzed by 16S rRNA amplicon analysis using high-throughput sequencing technology. There was no apparent difference in species richness and diversity between the infected and control groups. However, the composition of the microbiome was different between the infected and control groups at 20 days and 30 days post-infection, and the difference disappeared at 50 days post-infection. In particular, this microbiome alteration was associated with a change in the relative abundance of genus Lactobacillus and the probiotic Lactobacillus species that are known to have an immune-modulation role in immune-mediated diseases.

     

Residual varus alignment after total knee arthroplasty increases knee adduction moment without improving patient function: A propensity score-matched cohort study

BackgroundTargeting residual varus alignment in total knee arthroplasty may be functionally beneficial to preoperative varus patients.MethodsBilateral TKA patients were enrolled. According to the postoperative hip-knee-ankle axis, patients were allocated into residual varus (3° ± 1°) alignment group or neutral (0° ± 1°) alignment group. Then, 1:2 propensity score matching was used to match preoperative variables. Finally, matched neutral (n = 45) and varus groups (n = 32) were followed-up for two years and compared. The primary outcome was the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were range of motion (ROM), Knee Society knee score and function score, spatiotemporal gait parameters, dynamic alignment, knee flexion angle, knee adduction moment (KAM) and internal knee extension moment.ResultsAt two years after surgery, the mean difference of WOMAC score was 0.3 (95% CI, [? 3.1, 3.7]) between the two groups. All secondary outcomes, except KAM and dynamic alignment, showed no significant difference between the two groups. Residual varus alignment group showed increased KAM and maximum KAM was 19% higher (P = 0.006).ConclusionsResidual varus alignment showed no clinical benefits, and both groups of patients had a functionally identical knee gait biomechanics, except for increased KAM and varus alignment. The authors consider that even in patients with varus alignment, the first principle is still achieving neutral alignment, which is helpful for reducing the KAM.Level of evidenceIII, retrospective cohort study.     

侧方入路腰椎内固定的生物力学研究进展

极外侧椎体融合术（extreme lateral interbody fusion, XLIF）可用于治疗腰椎间盘突出、椎体滑脱、椎管狭窄等腰椎疾病。此术式从侧方腹膜后建立手术通道,与其他手术方式相比,术中出血少,创伤小,康复时间短,并发症少,既可避免前方大血管损伤的风险,也可减少后方肌肉、关节突等组织的破坏,因而受到越来越多的关注和应用。但此术式在临床治疗效果、并发症发生率等方面是否优于其他入路尚无定论。从生物力学角度总结XLIF重建腰椎稳定的效果,并比较XLIF与相关经典术式在生物力学上的特点。     

微创手术机器人机械臂结构设计与工作空间分析

目的现有双平行四边形机构设计的机械臂需要串联一个伸缩自由度机构,导致机械臂体积增大,运动灵活性降低,持镜臂与持器械臂发生干涉。针对这一问题,提出一种新型机械臂结构,增强运动灵活性、减小机械臂的体积。方法采用5连杆机构、滑块与滑轨的低副机构和丝传动机构设计机械臂,实现末端执行器的伸缩运动,建立机械臂的运动学模型,以MATLAB为仿真工具验证零位关节角D-H参数的正确性,求解出机械臂的运动方程;同时运用蒙特卡洛算法,得到末端执行器的三维工作空间范围,并对3条机械臂作术前动物实验规划;最后,在猪体内进行胆囊切除等操作,验证机械臂的双5连杆2自由度设计的合理性和可操作性。结果蒙特卡洛算法在MATLAB环境下得到的工作空间范围为:-650.4 mmx649 mm,163.8 mmy1 202 mm,-254.6 mmz829.8 mm,并成功完成16例猪的胆囊切除实验,平均操作时间为51 min。结论新型设计的双5连杆2自由度机械臂在猪体内成功完成胆囊切除等操作,且猪术后无其他不良症状,机械臂之间的运动无干涉,充分验证了所提出的微创手术机器人机械臂设计方案的可行性。     

外侧半月板后根部损伤不同缝合位置对膝关节生物力学的影响

目的对损伤的外侧半月板后根部进行不同位置的修复固定,比较不同缝合方式时膝胫股关节的生物力学结果,探讨外侧半月板后根部损伤最佳缝合术式。方法使用8例人体尸体膝关节,胫腓骨固定装置维持膝关节在0°位,在1 k N压缩载荷下,采用Tek-scan压力感测片收集膝关节外侧半月板后根部完整、外侧半月板后根部断裂、将外侧半月板后根部分别缝合至中心点、中心点偏后5 mm、中心点偏前5 mm、中心点偏外5 mm位置下的平均接触压力、峰值压力以及接触面积。结果在外侧间室,与完整状态相比半月板后根部损伤断裂后会导致平均接触压力和峰值压力明显增加(P0. 01),接触面积减少(P0. 05)。4种缝合固定方法均可减少平均压力和峰值接触压力,接触面积较根部断裂时均有增加。在半月板后根部中心点偏外5 mm缝合时,生物力学结果更接近完整膝关节(P0. 05)。比较缝合位点在根部中心点和中心点偏后5 mm时,平均接触压力影响差别微小,峰值接触压力、接触面积均无统计学差异(P0. 05)。在内侧间室,生物力学指标各组间均无统计学差异(P0. 05)。结论外侧半月板后根部发生撕裂后会导致膝关节外侧间室的平均接触压力、峰值压力以及接触面积相比正常膝关节发生显著改变;半月板缝合位置在原根部中心点偏外5 mm时,其生物力学功能更接近完整膝关节。     

维持性血液透析患者透析过程中血压变异性的相关探讨

研究终末期肾病患者维持性血液透析中血压变异性（BPV）及其影响因素。选择143例维持性血透患者,根据收缩压均数分为高收缩压血压变异性组（高SBPV组）、低收缩压血压变异性组（低SBPV组）;根据舒张压均数分为高舒张压血压变异性组（高DBPV组）、低舒张压血压变异性组（低DBPV组）。比较两组BPV与各指标的关系。高SBPV组和低SBPV组的年龄、糖尿病患病率、透析前收缩压（透前SBP）、超滤量、透析间期体质量增长率（IDWG%）、白蛋白（Alb）、尿素清除指数（Kt/V）有显著性差异（P＜0.05）。以SBPV为因变量,其余因素作为自变量进行多元线性回归分析,年龄、透前SBP、超滤量、血红蛋白（Hb）、血钙（Ca2+）是SBPV的独立影响因素并呈正相关。Alb是SBPV的独立影响因素并呈负相关。高DBPV组和低DBPV组的血管通路选择、超滤量、IDWG%有显著性差异（P＜0.05）。以DBPV为因变量,其余因素作为自变量进行多元线性回归分析,IDWG%、Alb、Kt/V是DBPV的独立影响因素,前者呈正相关,后两者呈负相关。高龄、高透前SBP、超滤量大、Alb低、高Ca2+是收缩压BPV的独立危险因素。IDWG%大、Alb低、Kt/V低是舒张压BPV的独立危险因素。临床中,控制透析前血压和透析间期体质量增长率,适当减少超滤量、增加血浆Alb,充分透析有助于降低透析中血压波动,进而改善透析患者预后,在老年人群尤应关注以上指标。     

辅助用药临床使用情况的调查与研究

【摘要】 目的：调查我院2014-2016年辅助用药临床使用现状,为临床合理使用辅助用药提供参考。方法：结合我院近3年收集、上报的545例精神科药品不良反应的数据,对2014-2016年期间我院病区辅助用药的使用DDDs、金额排名及B/A值进行统计分析。结果：非注射剂辅助用药DDDs排名居前的是盐酸苯海索、盐酸普萘洛尔、二甲双胍等,主要用以对抗精神科用药引起的ADR为主;注射剂辅助用药金额排名居前的是奥拉西坦、参芎葡萄糖、赖氨酸等,主要以神经营养类、活血化瘀类为主。结论：我院病区非注射剂类辅助用药基本合理,但注射剂类辅助用药存在超适应症、过度治疗等现象,需进一步加强管理,确保患者用药的安全、有效、合理。