Objective To investigate the effect of pathoglycemia on the tumor biomarker expression in pancreatic tumor and assess its influence on the diagnostic value of these biomarkers.Methods We recruited 59 patients with malignant pancreatic tumor in total into this study,including 46 cases with pancreatic carcinoma and 13 cases with other pancreatic malignancies.Twenty-seven patients with benign pancreatic diseases were selected as control.All subjects were extracted venous blood and serum samples were separated by centrifugation.Serum levels of CA199,CA125 and CEA were measured by chemiluminescent microparticle immunoassay(CMIA).The positive expression criteria were designated as ＞37 kU/L for CA199;＞35 kU/L for CA125;＞10 μg/L for CEA.Results (1) CA199 showed the highest diagnostic accuracy when the tumor biomarker was used alone.CA199 plus CEA showed the highest diagnostic accuracy when the biomarkers were used pairwisely,even better than three biomarkers used in combination(x2=26.131,P＜0.05).(2)The average rank of all tumor biomarkers were higher in all malignant pancreatic tumor than benign pancreatic diseases,and some of the differences reached statistically significance(CA199,Z=4.682,P=0.000;CA125,Z=1.866,P=0.062;CEA,Z=2.573,P=0.010).(3)When the malignant pancreatic tumor group were further divided into two groups according to their blood sugar level,we found that CA199 were significantly higher in pathoglycemia group than euglycemia group(Z=2.265,P=0.024),while no significant differences were observed in patients with benign pancreatic diseases when compared between patients with different blood sugar levels(Z=4.214,3.224,3.154,Ps＞0.05).Conclusion The combination use of three tumor biomarkers showed no improvements in the diagnosis of pancreatic neoplasm,but with disadvantage of elevated medical expense.CA199 showed the highest diagnostic accuracy when used alone.CA199 plus CEA showed the highest diagnostic accuracy when the biomarkers were used pairwisely.The blood sugar level should be considered when using CA199 in the differential diagnosis of pancreatic neoplasm from benign pancreatic lesions;a new set-point of CA199 should be set by studying the ROC curve and other statistic index to improve the overall accuracy.

Objective To observe the therapeutic effects of muscle energy technique combined with joint mobilization on frozen shoulder.Methods Thirty-six patients with frozen shoulder were randomly assigned to:group A (treated with muscle energy technique plus joint mobilization),group B (treated with passive stretching with joint mobilization),and group C (treated with joint mobilization merely),and each had 12 patients.All the patients were treated accordingly for 3 times a week,totally for 4 weeks.The American Shoulder and Elbow Surgeons evaluation system (ASES) was adopted to evaluate clinical effects before and at the end of treatment.Results After 4 weeks of treatment,all patients' ASES scores were improved significantly (P ＜ 0.05).The improvement in the shoulder score index and shoulder range of motion were to a significantly better extent in group A than in the other two groups.Conclusion Muscle energy technique plus joint mobilization could effectively relieve pain increase the shoulder ROM and improve performance in activities of daily living in patients suffering from frozen shoulder.

Related literature and studies concerning the kinematics in patients after cervical arthrodesis have extensive?ly reviewed and comprehensively analyzed in 4 terms of changes in adjacent segment range of motion, motion segment per?cent contributions, motion pattern of cervical facet joints, and deviated center of rotation at adjacent segments. These report?ed researches of in-vivo kinematics after cervical arthrodesis are almost on the sagittal plane. Few data have been reported on the 6DOF kinematics under physiological loading conditions. Whether adjacent segment pathology caused by hypermobili?ty remains controversial. Long-term follow-up of large sample randomized controlled studies and obtaining the accurate 6DOF kinematics are the best way to resolve controversy.

BACKGROUND:Epidemiologic reports have indicated that excessive weight-bearing exercise is one of important risk factors for lumbar degeneration, but the effects of weight-bearing activity on normal lumbar motion pattern are stil not clear. OBJECTIVE:To measure the changing characteristics and rules of position at the center of rotation of the lower lumbar spine during a weight-lifting activity of normal person. METHODS: Fourteen asymptomatic subjects with a mean age of (25±5) years were recruited for this study. The L4-5 and L5-S1 segments of each subject were CT-scanned to construct 3D models using dual X-ray imaging system and spiral CT examination combined technology in the aid of computer software. The physiological load and lumbar spinal 3D motion under the loading condition were reproduced when matching the flexion, neutrality and extension in the dual X-ray imaging system and on dual oblique lumbar X-ray image. Coordinate systems were established at the vertebral body of L4-S1 to obtain the center of rotation during flexion-to-neutral, neutral-to-extension and the ful flexion-extension motion. RESULTS AND CONCLUSION: (1) Under physiological load, the center of rotation of L4-5 of normal person was located about 1.0 mm anterior to the central axis of the vertebral body, and the center of rotation of L5-S1 was located about 0.7 mm anterior to the central axis of the vertebral body. (2) With weight loading, the center of rotation of both two segments shifted backward about 0.5 mm. There was no statistical difference between these two loading conditions. (3) When the center of rotation in flexion and extension was calculated respectively, the moving range of the center of rotation at both L4-5and L5-S1 became larger due to taking loads of 10 kg (P < 0.05). In flexion, the center of rotation at L5-S1 significantly shifted forward during a weight-lifting activity (P < 0.05). (4) These results confirm that compared with non-weight-bearing condition, the trajectory of the center of rotation was found to be increased when taking loads, especialy during the flexion-to-neutral motion.

Objective To determine the three dimensional motion data of each segment of cervical vertebrae and analyze the characteristics of the intervertebral coupled motion during cervical axial rotation under physiological weight bearing. Methods A total of 16 healthy volunteers (ranging from 22 to 29, median age, 23 years) were recruited to our study. Any cervical spine disorder history, pain or other discomfort and malformations were excluded so as to avoid abnormal neck motion. These subjects underwent CT scans of their cervical segments in a supine position, and 3D models of C1-C7 were constructed. Next, each subject was asked to sit up straight and was positioned in the following sequence:maximal left and right twisting, while double oblique images by DFIS were taken simultaneously at each of the positions. Then, the CT models were matched to the osseous outlines of the images from the two oblique views to quantify the position of cervical vertebraes in 3D at each position. Through local coordinate systems at the center of vertebral bodies, changes of position and angle of each cephalad vertebrae relative to the cauddal one were calculated before and after the axial rotation. Results (1) In the axial rotation of the cervical spine, the contribution of C1/2 accounted for the most of the total cervical rotation range. For the lower levels, axial rotation was found to be maximal at C3/4 and C5/6, minimal at C2/3. (2) In cervical axial motion, C1/2 demonstrated a coupled lateral bending opposite to the axial rotation direction, while each segment of C2-7 demonstrated coupled lateral bending towards the same side of the axial rotation. Among these segments the lateral bending angle of C2/3 was smaller than angles of C3/4, C4/5 and C5/6. Conclusion This study investigated the cervical coupling behavior using the noninvasive 2D-3D matching technique and obtained the motion data at each cervical spinal segment. These findings will help to improve the understanding on physiological cervical spine movement and potential biomechanical mechanism and treatment of cervical spondylosis. Also our data may provide useful reference for the prosthesis design.

Objective: To explore the effect of the new vaginal douche device on vaginal irrigation before ovulation extraction in vitro fertilization-embryo transfer. Methods: From August 2017 to April 2018, 100 cases of infertility patients admitted to the first hospital of reproductive and gynecology of Jilin University who had to undergo ovulectomy were selected and divided into 50 cases in the experimental group and 50 cases in the control group according to the random number table. In the test group, a new type of vaginal irrigator was used for vaginal irrigation one day before the operation, while in the control group, a disposable enema was used for vaginal irrigation. The vaginal cleanliness and comfort of the two groups were compared after washing. Results: Vaginal cleanliness was compared between the two groups. Bacterial culture of vaginal secretions was positive in 2 patients in the experimental group, with a positive rate of 4%. In the control group, bacterial culture of vaginal secretions was positive in 14 patients, with a positive rate of 28%. Vaginal cleanliness was better in the experimental group than in the control group (χ²=10.714, P=0.001). In the experimental group, there were 2 cases of discomfort, 10 cases of discomfort, 29 cases of comfort, and 9 cases of comfort. In the control group, there were 8 cases of discomfort and 17 cases of discomfort. The comfort level of the experimental group was higher than that of the control group, and the difference was statistically significant (Z=-2.271, P=0.023). Conclusions The operation method of the new vaginal douche is simple and soft, which can not only effectively and thoroughly clean the vagina, reduce the incidence of infection, but also increase the comfort level of patients, alleviate psychological fear and improve patient satisfaction.

BACKGROUND:The cervical spine of the human body is an important structure carrying the head and connecting the spine. Its volume is smal, but its flexibility was great. Activity frequency was highest. Simultaneously, cervical spine is the most complicated bony structure of geometric and kinematic characteristics of human body, bears the physiological load of the head, has functions of flexion and extension, lateral bending and rotation. Therefore, the cervical spine has become one of the most vulnerable structures with degenerative diseases of the spine. Analysis of upper cervical spine biomechanics, recognition and understanding of its normal function and mechanical mechanism wil provide a theoretical basis for better treatment of upper cervical spine disorders.
OBJECTIVE:To observe thein vivothree-dimensional kinematics of the upper cervical spine in healthy human beings under physiological load with dual fluorescence X-ray imaging system and spiral CT.
METHODS:Seventeen healthy volunteers were recruited for this study. The vertebral segment motion of each subject was reconstructed with three-dimensional computed tomography and solid modeling software.In vivo cervical vertebral motion during functional postures was observed with dual fluoroscopic imaging. Coordinate systems were established at the vertebral center to obtain the intervertebral range of motion.
RESULTS AND CONCLUSION: (1) During the flexion-extension motion, significant differences in the distance in coronal axis, sagittal axis and angle of rotation were detected in C1-2 and C2-3segments. (2) During the left-right bending motion, the angle of rotation was obviously greater at C1-2 segment than that at C2-3segment. During the left-right twisting motion, significant differences in distance of the vertical axis and the coronal axis, lateral flexion angle and rotation angle were detectable between C1-2and C2-3 segments. (3) These findings confirmed that dual fluorescence X-ray imaging system combined with CT scan can obtain atlanto-axial three-dimensional instantaneous motion of six-DOF data of healthy adults, and found that the main motion of the C1-2 vertebrae is rotating. These data may provide us with some new information about the in vivo kinematics of the upper cervical spine and the non-fixed surgical operation.

Objective To clarify the inhibitory effect of low molecular weight chitosan(LMCTS)on hepatic fibrosis induced by carbon tetrachloride (CCl4 )in the rats, and to investigate its effect on the expression of Toll-like receptor-4(TLR4 )and to lay the foundation for the development of the clinical candidate drug of liver fibrosis. Methods 72 male Wistar rats were randomly divided into blank control group, CCl4 group (model group), glycyrrhizinate (DG)group,50,100 and 150 mg·kg-1 LMCTS groups (low,middle and high doses of LMCTS groups).In addition to blank control group,the rats in the remaining groups were given 40% CCl4-vegetable oil (1.75 mL·kg-1 ),2 times per week for 8 weeks,by intraperitoneal injection to establish the model of rat hepatic fibrosis.And the rats in blank control group were injected with the same amount of 100% vegetable oil agent. From the ninth week, the rats in DG and LMCTS groups were given DG and LMCTS by intragastric administration, 1 time/week for 4 weeks. Then all rats were sacrificed, the activities of serum glutamic acid aminotransferase (ALT),aspartate aminotransferase (AST)and alkaline phosphatase (ALP)were detected with ELISA kit;the pathological changes in liver tissue were observed under light microscope, and the TLR4 expressions were detected by RT-PCR and Western blotting method. Results The serum ALT, AST and ALP activities in middle and high doses of LMCTS groups were lower than those in model group (P<0.05).The serum ALT activity in middle dose of LMCTS group was lower than that in low dose of LMCTS group (P<0.05),but the activities of AST and ALP had no statistically significant change(P>0.05).There were statistically significant differences in the serum ALT, AST and ALP activities between high dose of LMCTS group and middle dose of LMCTS group (P<0.05).There were obvious hepatocyte steatosis,inflammatory cell infiltration,collagen fiber hyperplasia and hepatic lobule damage in the rats in model group.However,all the changes in liver tissue of the rats in LMCTS group were significantly reduced, especially in high dose group. The results of RT-PCR and Western blotting method showed that the expression of TLR4 was declined in LMCTS groups compared with model group (P<0.05,P<0.01),especially in high dose of LMCTS group,and there were statistically significant differences between different doses of LMCTS groups (P<0.05).Conclusion High dose of LMCTS can decrease the serum transaminase activity of liver fibrosis rats and improve liver function,and this process may be related to declining the expression of TLR4 .

This paper summarized the operation cooperation and management of the first case of bilateral lung transplantation assisted with double extracorporeal membrane oxygenation (ECMO) for the recipient with novel coronavirus pneumonia (COVID-19) in the world. The bilateral lung transplantation assisted by double ECMO had been accomplished successfully on a recipient with COVID-19, who was supported by ventilator and ECMO, with other organs function basically normal. The operation took 405 min and went smoothly. The cooperation and management guidelines of the operation room included the following: setting up of COVID-19 emergency operation group quickly; listing and preparing of the detailed operation supplies; transferring of the whole system of lung transplantation operating room in Wuxi People's Hospital to the Wuxi No.5 People's Hospital (isolation hospital); reconstruction of a negative pressure operating room for lung transplantation; formulating and strictly implementing the guidelines and management process for the operation of patient with COVID-19.

Aortic Valve Insufficiency ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Humans ; Transcatheter Aortic Valve Replacement