BACKGROUND:Preparation of titanium/hydroxyapatite composite by conventional methods has the deficiency of simple structure, low degree of automation and difficulty in porosity and pore size control, which limits the diverse process and manufacture. OBJECTIVE:To evaluate the feasibility of three-dimensional printing technology for the preparation of titanium/hydroxyapatite composite and titanium/hydroxyapatite functional y graded material molding. METHODS:A CAD model of titanium/hydroxyapatite composite was designed to be the cylinder (diameter 25 mm, height 20 mm), while the titanium/hydroxyapatite functional y graded implant designed as a CAD model of the cylinder with 25 mm in diameter asnd 10 mm in height with two layers, the upper layer with titanium powder and the lower layer with titanium/hydroxyapatite powder. The composite and functional y graded implant were processed by the three-dimensional printing and sintered. The sintered titanium/hydroxyapatite composite and titanium/hydroxyapatite functional y graded implant were observed for their microstructures, and the X-ray diffraction analysis and compressive strength testing were performed. RESULTS AND CONCLUSION:The sintered titanium/hydroxyapatite composite and titanium/hydroxyapatite functional y graded implant had uniform contraction and no obvious distortion. The sintered titanium/hydroxyapatite composite had the aperture size from 50 to 150μm. There occurred a chemical reaction between titanium and hydroxyapatite during the sintering process, obtaining the new creations of Ca3(PO4)2, CaTiO3, TiO2 and CaO. Its compressive strength was (184.3±27.1) MPa. The microstructure of titanium/hydroxyapatite functional y graded implant had graded structures with a visible line between the two layers. The results of the microstructure and mechanical properties of titanium/hydroxyapatite composite and titanium/hydroxyapatite functional y graded implant can meet the requirements of medical biological implant materials.

Objective To evaluate the clinical effectiveness of 5-aminolaevulinic acid (ALA)-based photodynamic therapy (PDT) for the treatment of moderate to severe acne vulgaris.Methods From January to June 2013,a total of 43 patients with moderate to severe acne vulgaris were treated by 5 aminolaevulinic acid based PDT with red light.All patients were received three times of treatment at 2-week intervals.Clinical assessment was conducted before and at 2,4,6 and 8 weeks after treatment.Results The lesion counts of both inflammatory and non-inflammatory lesions were reduced significantly after treatment.The mean percentage reduction in inflammatory lesions was 88.9 ％ at 8 weeks after the treatment,meanwhile that in non-inflammatory lesions was 73.4％.After 8 weeks of treatment,55.8％ patients (24/43)showed clinical cure,and 41.9％ patients (18/43)showed excellent response and 2.3％ patient (1/43) showed good response.Only 4.7％ patients (2/43)showed signs of recurrence after 4 months after ALA-PDT.After one course of ALA-PDT,the symptoms in this recurrent case were significant improvement.The common adverse effects included pain,edema and transient hyperpigmentation.They could gradually disappear without a need of special intervention.Conclusions ALA-PDT is a safe and effective therapeutic option for the treatment of moderate to severe acne vulgaris.

Objective:To prepare compound Xiaoshangtong spray films and establish an HPLC method for quality control. Meth-ods:Chitosan hydrochloride and PVP as the main film-forming materials, and HPMC as the film-forming assitant agent, the com-pound Xiaoshangtong spray films were prepared. Lidocaine and mupirocin were simultaneously determined by HPLC. A Hypersil ODS2 column(250 mm × 4. 6 mm, 5 μm)was used. The mobile phase was composed of 0. 5% ammonium dihydrogen phosphate-methanol (40∶60, adjusting pH to 6. 0 ± 0. 5 with sodium hydroxide). The flow rate of mobile phase was 1. 0 ml·min-1 and the temperature of the column was 30 ℃. The detection wavelength was 222nm and the injection volume was 20 μl. Results: The linear range of lido-caine was 25. 0-400. 0 μg·ml-1(r=0. 999 7) and the average recovery was 100. 14% (RSD=1. 21%,n=9). The linear range of mupirocin was 25.0-400.0 μg·ml-1(r=0.999 9)and the average recovery was 101.13%(RSD=0.57%,n=9). Conclusion:The preparation process is reasonable. The established determination method is accurate and reliable, and suitable for the quality con-trol of the compound Xiaoshangtong spray films.

Objective To explore the related risk factors for diabetic nephropathy(DN) and discuss the value of diabetic dermopathy (DD) screening for DN.Methods A total of 188 patients with type 2 diabetes mellitus (T2DM) were studied,which included 78 patients with DN (DN group) and 110 cases without DN (non-DN group).The sex,age,duration of diabetes mellitus,smoking,DD,body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),fasting blood glucose (FBG),2hours postpradial glucose(2 h PG),triglyceride (TG),total cholesterol (TC),glycosylated hemoglobin A1c (HbA1c),fasting C-peptide(FC-P) were recorded.Multiple factor Logistic regression was applied in patients with DN and non-DN.Results The incidence of DD and DN in T2DM patients was 47.34％(89/188) and 41.49％ (78/188) respectively.The ratio of DD in DN group was 79.49％(62/78),in non-DN group was 24.55％ (27/110),and the difference was significant (P ＜ 0.05).The age,duration of diabetes mellitus,SBP,FBG,2 h PG,HbA1c in DN group was higher than that in non-DN group [(52.83 ± 6.43) years old vs.(50.35 ±6.48) years old,(10.51 ±4.36) years vs.(6.48 ±3.25) years,(137.42 ± 14.17) mmHg(1mmHg =0.133 kPa) vs.(132.57 ± 15.38) mmHg,(11.95 ±2.83) mmol/L vs.(10.28 ± 1.98) mmol/L,(15.07 ± 3.16) mmol/L vs.(13.51 ± 2.75) mmol/L,(9.62±2.17)％ vs.(8.63 ± 2.08) ％],FC-P was lower than that in non-DN group [(1.76 ± 0.89) μ g/L vs.(2.01 ± 0.72) μ g/L],and the difference was significant (P ＜ 0.05).Multiple factor Logistic regression analysis showed that duration of diabetes mellitus,DD and FPG were still related to DN in T2DM (OR =4.841,3.209,3.368,P ＜0.01).Conclusions DD is correlated with DN in T2DM.DN should be screened in T2DM patients with DD.

Objective To evaluate the diagnostic yield and the etiological accuracy of double balloon endoscopy and capsule endoscopy in patients with.Methods Seventy-three patients with OGIB received double balloon endoscopy.The route of enteroscopy could be either via mouth or via anus.Negative result of initial route was required afterwards for another via mouth or via anus examination.Sixty-one patients with OGIB received capsule endoscopy.Results The overall diagnostic yield for double balloon enteroscopy was 94.5%,and for capsule endoscopy it was 81.8%.The etiological diagnostic accuracy of double-balloon enteroscopy was 80.8%,and for capsule endoscopy,50.0%.Double-balloon enteroscopy and capsule endoscopy were both well tolerated.Conclusion Double balloon enteroscopy is superior to capsule endoscopy in the diagnostic yield and the etiological diagnosis of obscure gastrointestinal bleeding.

Objective To sum up the experiences in liver transplantations from donation after brain death (DBD),and compare the clinical effect,complications and influential factors with international situation.Methods The retrospective descriptive study was adopted.All the data of 66 DBD liver donors and the matched recipients from authors' affiliations during June 2010 and June 2013 were collected.Original articles,meta-analysis and data reports with high academic influence were read and data were analyzed with SPSS 22.0.Results The incidence of serious complications,vascular complications and biliary complications during the first year among 66 recipients was 21.2％,10.6％,and 6.1％,respectively.Compared to international situation,graft 1-,3-,and 5-year survival rate was similar (P＞0.05) (83％,80％ and 73％ respectively),similar to that of recipients.There was no statistically significant difference in primary nonfunction and vascular complications between our center and other centers.As for biliary complications,morbidity was lower in our center (P＜0.05).The 3-and 5-year survival rate of recipients was also similar (P＞0.05),though the 1-year survival rate was slightly lower (P＜ 0.05).Conclusion These findings provide evidence that patient's prognosis under DBD liver transplantation in our center is acceptable,and long-term survival rate has reached international level.Still,1-year survival rate of recipients is unsatisfactory.In order to achieve a good clinical efficacy,we need to find out disadvantages during donor maintenance,recipient selection,surgical procedure and postoperative management.

Objective To explore the application of body mass index(BMI)and the increased value of postpradial 2h C peptide [2hCP minus fasting C-peptide(FCP), ΔCP]as indexes to adjust the antidiabetic plan after intensive blood glucose control in poorly controlled patients with type 2 diabetes mellitus(T2DM).Methods The insulin intensive therapy with injections of insulin four times a day was applied to 156 type 2 diabetic in-patients with poorly glycemic control.Islet function was evaluated after glucostasis in all patients.According to FCP≥1 ng/ml, addition of basal insulin to oral antidiabetic drugs was applied(as plan A, A group).The insulin intensive therapy was continued if FCP<1ng/ml(as plan B,B group).The treatment plan was adjusted from plan A to B when plasma glucose was poorly controlled after a week(as B group).The baseline data of sex, age, diabetes duration, BMI, fasting plasma glucose(FPG), 2 hours postpradial plasma glucose(2hPG), HbA1C, triglyceride(TG), total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, FCP, 2hCP, 2hCP/FCP, and ΔCP were analyzed.Insulin dose, the incidence of hypoglycemia, and the targeted rate of glucose control were compared between two groups before grouping and one month after treatment.Results The results showed that BMI, TG, FCP, 2hCP, 2hCP/FCP, and ΔCP in A group were higher than those in B group(P<0.01), while FPG, 2hPG and HbA1C were lower(P<0.01).There were no differences in insulin dose, the incidence of hypoglycemia, the targeted rate of FPG and 2hPG between two groups when grouping.After one-month treatment, insulin dose and the incidence of hypoglycemia in group A were lower than those in group B, while the targeted rates of FPG and 2hPG in group A were better than group B(P<0.05 or P<0.01).The results of binary logistic regression analysis showed that BMI and ΔCP were independent factors for choosing antidiabetic plan A(β=0.26, 0.90,P<0.01).The areas under receiver operator characteristic curve of BMI and ΔCP were 0.72 and 0.84, respectively(P<0.01), and their cut-off points to choose antidiabetic plan A were 23.14 kg/m2 and 1.32 ng/ml.Conclusions BMI and ΔCP can be used as the predictive indexes for choosing an antidiabetic plan for poorly controlled type 2 diabetic patients.

Objective To study the intraoperative and postoperative complications of autologous liver transplantation (ALT),and their prevention and treatment.Methods From October 2005 to December 2011,our center carried out 36 cases of ALT for malignant (n=23) and benign diseases (n=13).Intraoperative and postoperative complications and treatment methods were analysed.Results Of the 36 patients,2 patients developed small liver syndrome in the perioperative period.Allogeneic liver transplantation was carried out for 1 of these two patients for acute liver failure.Another patient died of lung infection 16 days after the surgery.Among 36 ALT recipients and 23 patients suffering from malignant tumor,1,2,3-year survival rates were.75％,71％,68％ and 65％,59％,54％ respectively.Conclusions With adequate preoperative assessment,the incidence of serious complications after ALT should be low.Prompt prevention and treatment of intraoperative and postoperative serious complications could cut down perioperative mortality,and provide long-term survival after ALT.

[Summary] A total of 165 type 2 diabetic patients were divided into two groups with pigmented pretibial pathes(PPP group) and no PPP( NPPP group). 50 subjects with normal glucose regulation were used as a control group(NGR group). The records of sex, age, diabetes duration, body mass index( BMI), systolic blood pressure (SBP), diastolic blood pressure, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, fasting blood glucose(FBG), 2 h postpradial plasma glucose(2hPG), triglyceride(TG), total cholesterol, HbA1C , retinol binding protein 4(RBP4), cystatin C(Cys C)were analyzed. The results showed that BMI,FBG, 2hPG, TG, and Cys C levels in NPPP group were higher than those in NGR group(all P<0. 01). The levels of BMI, SBP, FBG, 2hPG, TG, Cys C, and RBP4 in PPP group were higher than those in NGR group(P<0. 01 or P<0. 05), while diabetes duration, FBG, 2hPG, HbA1C , Cys C, and RBP4 in PPP group were higher than those in NPPP group ( P <0. 01). Pearson correlation analysis revealed that serum RBP4 and Cys C were in linear positive correlation(r=0. 77, P< 0. 01). The areas under receiver operating characteristic curve of RBP4 and Cys C were 0. 81 and 0. 78, respectively(P<0. 01). The results of binary logistic regression analysis showed that diabetes duration, HbA1C , RBP4 were related to PPP(r=0. 37, 0. 26, 0. 22, P<0. 05 or P<0. 01).

Objective To investigate the clinical efficacy of vena cava-atrium anastomosis liver transplantation (VCAALT) for Budd-Chiari syndrome (BCS).Methods The retrospective descriptive study was conducted.The clinicopathological data of 18 BCS patients who underwent VCAALT in the Zhongnan Hospital of Wuhan University (6 cases),the Third Xiangya Hospital of Central South University (8 cases) and Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (4 cases) from May 1996 to December 2012 were collected.All the 18 patients were males,aged from 29 to 61 years,with an average age of 42 years.According to characteristics and invasion extent of hepatic vein and vena cava after preoperative examinations,patients were performed different surgical procedures of VCAALT,including bridge piggyback liver transplantation (BPBLT),hanging atrium liver transplantation (HALT) and cava vena resection bridge liver transplantation (CVRBLT).Observation indicators:(1) surgical and postoperative situations;(2) typical case analysis;(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival up to December 2018.Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were described as M (range).Results (1) Surgical and postoperative situations:of 18 patients,11 underwent BPBLT,3 underwent HALT,4 underwent CVRBLT.The operation time and volume of intraoperative blood loss were (6.0± 1.3)hours and (1 264±435)mL.One patient died of bilateral pulmonary diffuse inflammation and sepsis due to severe infection.The duration of postoperative hospital stay was (18±5) days.(2) Typical case analysis:one 47-year-old male BCS patient was detected retrohepatic vena cava plaques and thrombus and hepatic venous thrombus by exploratory laparotomy,and underwent BPBLT.A 43-year-old male BCS patient was detected hepatic and retrohepatic vena cava plaques,thrombus,concomitant cavernous transformation,and underwent HALT.A 32-year-old male BCS patient was detected plaques and thrombus with red thrombus in the hepatic vein,from right renal vein to right atrium,and underwent CVRBLT.All the 3 patients underwent VCAALT successfully with a satisfactory recovery.(3) Followup situations:18 patients were followed up for 3.0-60.0 months,with a median time of 51.7 months.During the follow-up,3 patients died of acute rejection,biliary complications and chronic graft dysfunction at 1,3,5 years postoperatively.The 1-,3-,5-year survival rates were 16/18,15/18,14/18,respectively.Conclusion Different surgical procedures of VCAALT for BCS are selected according to different situations of patients,which are safe and feasible with a satisfactory efficacy and beneficial to long-term survival of patients.