BACKGROUND: Anterior cervical decompression and bone graft fusion is always the standard operation type for the treatment of cervical spondylotic radiculopathy and myelopathy. However, secondary degeneration and new symptoms caused by the stress increase of adjacent segments following anterior cervical spinal fusion have been paid more and more attention. Artificial cervical disc replacement provides a new choice for the treatment of cervical syndrome.OBJECTIVE: To observe the therapeutic effect of BRYAN& artificial cervical disc displacement for the treatment of cervical spondylotic radiculopathy and myelopathy.DESIGN: Self-control experiment.SETTING: Department of Orthopaedics, Sixth Hospital of Ningbo.PARTICIPANTS: Seventeen patients with cervical spondylotic radiculopathy and/or myelopathy admitted to the Department of Orthopaedics, Sixth Hospital of Ningbo were involved between December 2003 and February 2005 were involved in the study. Informed consents were obtained, and all participates were approved by Medical Ethics Committee.There were 9 patients with cervical spondylotic myelopathy, and 8 patients with cervical spondylotic radiculopathy.BRYAN& artificial cervical disc system is an artificial cervical intervertebral disc with composite structure. It is constructed by two titanium alloy end plates and polymer core, which can bear loading and took polyisocyanate as matrix.METHODS: BRYAN& artificial cervical disc system was used in the treatment. All the patients underwent single-segment displacement. Two patients underwent the displacement at C3-4, five at C4-5, 8 at C5-6 and 2 at C6-7. At postoperative 1, 3and 6 months, X-ray lateral position, anteflexion position, posterior extension position, the left and right side dynamic position plains were taken to investigate prosthetic stability. Neurologic function was evaluated according to Japanese Orthopaedic Association (JOA) scoring system.MAIN OUTCOME MEASURES: ① Investigating whether or not prosthesis displaced by means of dynamic position plains.② Investigating the recovery of neurologic function by JOA scoring system.RESULTS: ①JOA average scores were elevated to 15 from preoperative 8.5. Nervous system symptoms had improved to different extents, and the mean improvement rate was 75%. At postoperative 1,3 and 6 months, all the patients were followed up and their X-ray plains of cervical lateral position and flexion-extension position showed good stability,indicating that motor function was not lost obviously. No heterotopic ossification was found around the prothesis. ②Wound infection was not found in any patient. At postoperative 3 months, less than 2 mm slight displacement appeared in the prothesis in one patient, and there were no obvious symptoms. Prothesis abrasion, subsidence, bone bridge formation and other rejections were not found in the other prothesis. Prothesis had good biocompatibility, and could be examined by routine CT and MRI.CONCLUSION: Artificial cervical disc replacement can obviously improve the symptoms of patients, and has good therapeutic effects in the treatment of cervical syndrome.

Surgical resection and radiotherapy have been commonly applied to the treatment of early- and intermediate-stage Merkel cell carcinoma. In recent years, immunotherapy based on immunogenic characteristics of Merkel cell carcinoma has been proved to be effective in the treatment of advanced Merkel cell carcinoma. This review focuses on advances in the treatment of Merkel cell carcinoma, and provides a reference for its clinical diagnosis and treatment.

BACKGROUND:Periprosthetic fracture of the femoral of the knee after total knee arthroplasty is one of the common complications,and there is a lack of biomechanical research on the periprosthetic fractures of the femoral of the knee under different bone strength conditions.The three-dimensional finite element analysis can provide a biomechanical basis for clinical practice. OBJECTIVE:To investigate the biomechanical changes of anterior femoral notching after total knee arthroplasty under different bone strengths,and to provide a mechanical basis for the clinical prevention of supracondylar femoral periprosthetic fractures after knee arthroplasty. METHODS:The femoral CT data of healthy adults were obtained,and the three-dimensional model of femoral lateral replacement of the knee joint was established by Mimics,Geomagic studio,and Solidworks software.Anterior femoral notching models of different depths were constructed,and the models were imported into ANSYS software to analyze the changes of biological stress on the femoral condyle with different bone strengths and different anterior femoral notching depths.The stress changes of the femoral anterior condyle section after and before the filling of anterior femoral notching with bone cement were analyzed. RESULTS AND CONCLUSION:(1)Under any bone strength,the supracondylar stress increased with the depth of anterior femoral notching.In normal bone conditions,there was a stress abrupt change point when the anterior femoral notching depth was between 3 mm and 4 mm.In the case of osteoporosis,there was a stress abrupt point when the anterior femoral notching depth was between 2 mm and 3 mm.(2)When anterior femoral notching occurred during knee arthroplasty and the depth exceeded the thickness of the bone cortex,the supracondylar stress of the femoral gradually increased as the bone strength decreased.(3)The stress of the anterior femoral condyle section decreased when the model with an anterior femoral notching depth of 3 mm was filled with bone cement.(4)The results show that anterior femoral notching should be avoided during knee arthroplasty,especially in patients with osteoporosis.If anterior femoral notching occurs during surgery,bone cement can be used to evenly fill the anterior femoral notching to reduce the supracondylar stress of the femur and reduce the incidence of periprosthetic fractures of the femoral joint

Objective:Discuss the etiological characteristics of pulmonary infection after renal transplantation and the diagnostic value of metagenomics nextgeneration sequencing (mNGS) technique.Methods:A total of 40 patients with pulmonary infection who were admitted to the Department of Renal Transplantation of the First Affiliated Hospital of Medical College, Xi'an Jiaotong University from January, 2018 to January, 2021 were selected, and identification of pathogens through routine pathogen detection methods and mNGS. The routine pathogen detection methods included: blood culture, bronchoalveolar lavage fluid (BALF) and sputum culture and smear staining, lung histopathology, antigen detection and PCR, etc. BALF were used to search for pathogens by mNGS. Combined with the results of the two groups to give accurate anti-infection treatment, the clinical data were retrospectively analyzed.Results:Eventually 36 patients were cured and discharged, and 4 patients deaths. In 40 cases of pulmonary infection, the BALF mNGS pathogens detection of BALF was positive in 37 cases and negative in 3 patients, with a detection sensitivity of 92.5%. In addition, there were 15 cases of single pulmonary infection and 22 cases of mixed pulmonary infection, including 8 cases of bacterial infection, 9 cases of viral infection and 20 cases of fungal infection, among which pneumocystis (20/40, 50%) and cytomegalovirus (10/40, 25%) were the most common. In contrast, the positive rate of pathogens by routine detection were only 30% (12/40), and the difference between the two detection methods was statistically significant ( χ2=32.92, P<0.05). The diagnostic rates of mixed pulmonary infection were 55% and 10% respectively, the difference was statistically significant ( χ2=18.46, P<0.05), the single type pulmonary infection was 30% and 20% respectively, the difference was not statistically significant( χ2=2.99, P>0.05). Conclusions:mNGS has more advantages than routine pathogen detection methods in terms of pathogen species and distribution, detection time, sensitivity, mixed infection diagnosis rate and benefit. Using mNGS can be more efficient to find pathogens of pulmonary infection after renal transplantation, take accurate treatment, reduce costs, and improve cure rate, such as worth wide application..

Objective: To explore the correlation between blood pressure and urinary phthalandione, MMP, MEP, MnBP, MiBP, PAEs. Methods: Three schools were selected from Shenzhen, China for the present study. A total of 765 firstgrade students of Han ethnicity were recruited voluntarily from the selected schools during September 2016 to June 2017. They were divided into normal blood pressure (BP) group (lower than P90 group) and high BP group (BP≥P90). Linear and Logistic regression models were used to analyze the relationships between blood pressure and urine phthalate metabolite levels. Results: Urinary MMP and MnBP in students of high BP group were significantly higher than that of students in normal BP group(t=13.12, 3.97, P<0.05). Linear regression models showed that Z score increased when MMP and MnBP levels increased(P<0.05). Logistic regression model suggested that the risk of high BP increased with the increment of MMP level adjusting creatinine, sex, age and BMI(OR=1.47, P<0.05). There was no statistical significance in the differences after adjusting many factors including family income and education level of parents(P>0.05). Conclusion Urinary phthalate metabolite levels are positively associated with blood pressure in first-grade children.

Humans ; Living Donors ; Tissue and Organ Harvesting ; Nephrectomy ; Printing, Three-Dimensional ; Technology ; Laparoscopy

Kidney Transplantation/adverse effects* ; Magnetics ; Anastomosis, Surgical ; Magnetic Phenomena