BACKGROUND:Silk fibroin/mesoporous glass ceramic composites have been reported to exert satisfactory repair outcomes in bone defects and hold good biocompatibility. However, the biosafety and preparation methods are rarely reported. OBJECTIVE:To investigate the preparation method and treatment outcomes of silk fibroin/mesoporous bioactive glass ceramic in skul repair. METHODS:Thirty-two Sprague-Dawley rats were enrol ed to establish the skul defect models and were thenrandomized into two groups:fibroin/mesoporous glass ceramic materials and silk fibroin were respectively implanted into the defect region in experimental and control groups. At 4 and 8 weeks after implantation, the CT examination and histological observation were performed. RESULTS AND CONCLUSION:CT examination showed that at 4 weeks after implantation, the defect area in the experimental group diminished in size, showing more dense new bones. The defect area of the control group was reduced, and a smal amount of new bones were observed. At 8 weeks after implantation, bone defect repair was completed in the experimental group, but not in the control group. The bone volume in the experimental group was significantly larger than that in the control group at different time points after implantation (P<0.05). Hematoxylin-eosin staining found that at 4 weeks after implantation, in the experimental group, there was new bone between the implant and the bone, which did not cause inflammation;there were few new bones and fibrous tissues in the control group. At 8 weeks after implantation, many new bones formed in the experimental group, with similar morphology to the host bone and the scaffold was degraded completely. Conversely, the implant material stil existed in the control group. In conclusion, the silk fibroin/mesoporous glass ceramic composite can promote bone repair.

OBJECTIVE:To observe the effects of different routes of administration of tranexamic acid on coagulation function and amount of bleeding in patients with one stage posterior surgery of thoracic tuberculosis. METHODS:40 patients suffered from thoracic tuberculosis in our hospital from Jan. 2011 to Dec. 2013 were randomly divided into intravenous group(5% Glucose injec-tion 100 ml+tranexamic acid 10 mg/kg,through an intravenous drip at 30 min before closing the wound) and topical application group(5% Glucose injection 10 ml and tranexamic acid 10 mg/kg,through soaking the wound before closing the wound)with 20 cases in each group. Other 15 cases suffered from the thoracic tuberculosis in our hospital from Jan. 2009 to Dec. 2010 were includ-ed in control group. 3 groups received one stage posterior surgery of thoracic tuberculosis,interbody fusion and internal fixation. The difference of hemoglobin,coagulation function and the amount of suction drainage were observed before and after surgery, and followed up. Bone graft fusion and therapeutic condition of tuberculosis were observed in the study. RESULTS:There was no statistical significance in postoperative suction drainage between intravenous group and topical application group (P>0.05),but their decrease was more significant than control group,with statistical significance(P<0.05). There was no statistically difference in fiber protease,prothrombin time or activated partial thromboplastin time among 3 groups(P>0.05). The difference value of he-moglobin in control group before and after operation was significantly higher than in intravenous group and topical application group,with statistical significance (P<0.05);there was no statistical significance between intravenous group and topical applica-tion group(P>0.05). 55 patients were all followed up and bone graft of all cases were fused,and all patients were cured and no case recurred. CONCLUSIONS:Tranexamic acid by intravenous application or topical application can reduce hemorrhage and ane-mia after operation of thoracic tuberculosis,and has no effect on blood coagulative system.

Objective:To evaluate the efficacy and outcomes of early removal of lumen-apposing metal stent (LAMS) in the treatment of pancreatic wall-off necrosis (WON).Methods:A retrospective analysis was performed on 51 patients with WON who underwent endoscopic ultrasound (EUS)-guided transluminal drainage (ETD) and direct endoscopic necrosectomy (DEN) using LAMS at Nanjing Drum Tower Hospital from January 2018 to December 2022. Patients were divided into the early removal group (within two weeks, n=24) and the traditional removal group (after two weeks, n=27) based on the timing of LAMS removal. The short-term effects, safety and long-term outcomes of WON were compared between the two groups. Results:The technical success rate of LAMS placement in 51 patients reached 100%, and all patients underwent ETD and DEN. The median number of necrosectomy sessions in the early removal group was significantly lower than in the traditional removal group, 2.0 sessions vs 3.0 sessions and the difference was statistically significant ( P<0.05). Postoperatively, 15.7% of patients required percutaneous catheter drainage (PCD) and 5.9% required surgery, with no significant difference between the two groups. The clinical success rate and mortality rate in the early removal group were 79.2% and 8.3%, respectively, compared to 81.5% and 3.7% in the traditional removal group, with no statistically significant difference. In terms of safety, the early removal group exhibited a significantly lower rate of adverse events during stent retention with statistically significant difference (12.5% vs 37.0%, P<0.05) compared to the traditional removal group. A total of 46 patients were followed up for six months. In the early removal group, the rates of disease recurrence, need for endoscopic reintervention and occurrence of long-term complications were 20.0%, 10.0% and 20.0%, respectively. These rates did not show a significant increase compared to the traditional removal group, which were 7.7%, 3.8% and 38.5%, respectively, without significant differences between the groups. Conclusions:In the treatment of WON, early removal of LAMS is safe and effective to a certain extent. In comparison to the traditional practice of removing LAMS after two weeks, early removal does not reduce clinical success rates, nor does it increase the rates of disease-related mortality, recurrence, or long-term complications. On the contrary, it may reduce the occurrence of adverse events during stent retention and decrease the number of necrosectomy procedures subsequently.

Objective:To compare the efficacy of endoscopic submucosal dissection (ESD) and modified-endoscopic mucosal resection (M-EMR) for G1 rectal neuroendocrine tumors (RNETs) .Methods:Data of 121 patients with pathologically confirmed G1 RNETs treated with ESD ( n=105) or M-EMR ( n=16) in Nanjing Drum Tower Hospital from January 2017 to September 2020 were retrospectively analyzed. The complete resection rate, complication incidence, hospital stay, treatment cost and other indicators of the two groups were compared by using inverse probability of treatment weighting (IPTW). Results:There were significant differences in tumor number ( χ2=8.76, P=0.003), tumor invasion depth ( χ2=6.96, P=0.008), utilization of metal clips [82.9% (87/105) VS 93.8% (15/16), χ2=8.78, P=0.003], number of metal clips ( χ2=8.41, P=0.016), hemostasis using hot clamp [78.1% (82/105) VS 18.7% (3/16), χ2=20.64, P<0.001], traction procedure [2.9% (3/105) VS 18.7% (3/16), χ2=4.45, P=0.035] and treatment cost (17 568.6 ± 8 911.0 yuan VS 8 120.8±1 528.2 yuan, t=3.65, P<0.001) between the ESD group and the M-EMR group. After verifying the stability of the results using IPTW sensitivity analysis, there was still significant difference in the treatment cost ( t=2.07, P<0.001). Conclusion:Both ESD and M-EMR demonstrate comparable efficacy in treating G1 RNETs; however, M-EMR exhibites lower treatment costs.