BACKGROUND:Hip’s anatomy structure is complex, and the traditional two-dimensional imaging, such as X-ray film or CT scan, is susceptible to image overlap and other soft tissue. As a result, there are some limitations in the diagnosis of hip disease. The digital model is built based on reverse engineering and rapid prototyping. It is comprehensive, intuitive and accurate of the stereo configuration of the hip and the spatial relations of other parts’ anatomical structures. This study has a broad application prospect. OBJECTIVE:To reconstruct the personalized three-dimensional entity model of the hip bone with computer aided technology. METHODS: The human hips were scanned with a portable three-dimensional laser scanner, and then the point cloud data of the hips were gotten. The point cloud was processed and the three-dimensional model reconstruction was carried out by using the engineering software Geomagic and the computer aided software CimatronE. Three-dimensional print of hip was completed and the model was gotten, which was consistent with the geometry of hip bone, through the rapid prototyping machine. RESULTS AND CONCLUSION:A model with good geometric similarity and biomechanical characteristics was built by digital modeling method based on reverse engineering and rapid prototyping. This way of digital modeling provided the basis for digital manufacturing of artificial hip, virtual assembly, stress analysis and surgical simulation.

Objective To investigate the relationship between negative acute phase proteins and chronic urticaria (CU).Methods Fifty patients with CU were enrolled into this study,and divided into three grades,i.e.,mild (grade 1),moderate (grade 2) and severe (grade 3) according to symptoms.Twenty-eight health checkup examinees served as the control group.Immunoturbidimetry was performed to determine serum levels of prealbumin (PA) and transferrin (TRF).Enzyme-linked immunosorbent assay was conducted to measure serum levels of insulinlike growth factor-1 (IGF-1) and tumor necrosis factor-α (TNF-α).Statistical analysis was carried out to assess differences in these indices between these two groups,the relationship among these indices and between these indices and disease severity.Results Compared with the control group,the patients with CU showed reduced serum levels of PA ((229.99 ± 54.16) vs.(272.06 ± 36.42) mg/L,t =3.667,P ＜ 0.05) and IGF-1 ((177.23 ± 46.48) vs.(239.88 ± 45.16) μg/L,t =5.748,P＜ 0.05),but higher serum levels of TNF-α ((25.39 ± 11.01) vs.(14.13 ± 6.12) ng/L,t =4.989,P＜ 0.05),and similar serum levels of TRF ((2.48 ± 0.49) vs.(2.48 ± 0.25) g/L,P＞ 0.05).The serum level of PA showed a significant negative correlation with that of TNF-α (r =-0.312,P ＜ 0.05),as well as with disease severity (r =-0.635,P ＜ 0.01),whereas the serum level of TNF-α showed a significant positive correlation with disease severity (r =0.409,P ＜ 0.01),and no statistical correlation was found between the remaining indices (all P ＞ 0.05) in the patients with CU.Conclusions Serum levels of some negative acute phase proteins decrease and negatively correlate with disease severity in patients with CU.Acute phase response may be involved in the occurrence of CU.

Objective:To explore the clinical effect of simultaneous whole-course hyperfractionated intensity-modulated radiation therapy combined with chemotherapy and nimotuzumab in the treatment of advanced nasopharyngeal carcinoma.Methods:A total of 64 patients with advanced nasopharyngeal carcinoma who were admitted to Kaiping Central Hospital of Guangdong Province from June 2017 to January 2019 were selected and divided into the observation group and control group according to the random number table method, with 32 cases in each group. Both groups were given chemotherapy and nimotuzumab on the basis of radiotherapy. The observation group received simultaneous whole-course hyperfractionated intensity-modulated radiation therapy, and the control group received conventional fractionated intensity-modulated radiation therapy. The short-term efficacy, Karnofsky score, overall survival rate, progression-free survival rate, acute radiation reaction, and late radiation injury in the two groups were observed.Results:Six months after radiotherapy, the efficient rate of the observation group was higher than that of the control group [96.9% (31/32) vs. 75.0% (24/32), χ2 = 6.335, P < 0.05]. At the end of radiotherapy and 3 months after the end of radiotherapy, the Karnofsky scores of the observation group were higher than those of the control group, and the differences were statistically significant [(75±3) points vs. (71±3) points, t = 5.891, P < 0.05; (80±4) points vs.(77±4) points, t = 3.201, P = 0.002]. All patients were well tolerated, no grade 4 acute radiation reaction was observed, and radiotherapy was completed as planned. The incidence rate of oral mucosal reaction in the observation group was lower than that in the control group [21.9% (7/32) vs. 50.0% (16/32), χ2 = 5.497, P < 0.05]. The incidence rates of severe dry mouth and neck soft tissue fibrosis in the observation group were lower than those in the control group [6.2% (2/32) vs. 28.1% (9/32), χ2 = 5.379, P = 0.043; 3.1% (1/32) vs. 21.9% (7/32), χ2 = 5.143, P < 0.05]. The follow-up time was 14-20 months, and the median follow-up time was 17 months. There was no statistical difference in overall survival time between the two groups ( χ2 = 0.553, P = 0.557). The progression-free survival time of the observation group was better than that of the control group ( χ2 = 3.954, P = 0.044). Conclusion:The simultaneous whole-course hyperfractionated intensity-modulated radiation therapy combined with chemotherapy and nimotuzumab are effective in the treatment of advanced nasopharyngeal carcinoma, and the adverse reactions can be tolerated.

Objective To study the feasibility and timing of early laparoscopic cholecystectomy (LC) for the patients with mild-to-moderate acute pancreatitis with gallbladder stone.Methods 26 patients with mild-to-moderate acute pancreatitis with gallbladder stone underwent early laparoscopic cholecystectomy.The patients were initially treated with conservative treatment.When the diagnosis was confirmed and the patients were stable,LC was carried out within 48 hours of hospitalization.The results were compared with a delayed group of patients who received delayed LC for acute pancreatitis.Results All the LC operations were successfully carried out.There were no significant differences between the two groups in alkaline phosphatase,alanine aminotransferase,aspartate aminotransferase,blood amylase and urine armylase on postoperative day 1,3,5,7.Patients who received early laparoscopic cholecystectomy had a shorter hospital stay.There were no significant differences between the two groups in the operation time,intraoperative blood loss,postoperative complication rates and recurrence of acute pancreatifis.Conclusion After CBD stones have been ruled out,it is safe and feasible to carry out early laparoscopic cholecystectomy within 48 hours of hospital admission for patients with mild-to-moderate acute pancreatitis with gallbladder stone.

BACKGROUND:Notch singling pathway is very important for cellproliferation and differentiation, but its role is stil unknown during chondrogenesis of human umbilical cord mesenchymal stem cells. OBJECTIVE:To investigate the effect of N-[N-(3,5-difluorophenacetyl-L-alanyl)]-(S)-phenylglycinet-butyl ester (DAPT) on inducing human umbilical cord mesenchymal stem celldifferentiation into chondrocytes. METHODS:Human umbilical cord mesenchymal stem cells were isolated from human umbilical cord, then were induced to differentiate into chondrocytes. There were four experimental groups:non-induced group, high-glucose Dulbecco’s modified Eagle’s medium containing 5%fetal bovine serum and 1%double antibody;induced group, induced medium containing 6.25 mg/L insulin, 6.25 mg/L transferrin, 10μg/L transforming growth factor beta 1, 0.1μmol/L dexamethasone, 50 mg/L vitamin C, 5%fetal bovine serum and 1%double antibody;dimethyl sulfoxide group, induced medium containing 0.1%dimethyl sulfoxide;DAPT group, induced medium containing 5μmol/L DAPT. RESULTS AND CONCLUSION:After chondrogenic induction, the morphology of human umbilical cord mesenchymal stem cells became polygon and positive for toluidine blue and immunofluorescence staining;the expression of Jag-1, PS-1, Notch-1 and Hes-1 decreased significantly (P<0.01). After the addition of DAPT, compared with the induced group, the relative gene expression of Jag-1, PS-1 and Hes-1 decreased markedly (P<0.01), the relative gene expression of Notch-1 decreased obviously as wel (P<0.05), and the contents of proteoglycan and col agen type II proteins decreased significantly (P<0.01). At the same time, the relative gene expression of proteoglycan decreased obviously (P<0.05), and the relative gene expression of col agen type II decreased in part. Notch signaling pathway exists in human umbilical cord mesenchymal stem cells, once chondrogenesis begins, the signaling strength wil decline rapidly. DAPT may prevent human umbilical cord mesenchymal stem cells from differentiating into chondrocytes by Jag-1-Notch-1-Hes-1 pathway.

Objective To establish mouse model of type 2 diabetes peripheral neuropathy and measure its intra-epidermal nerve fiber density (IENFD).Methods Male C57BL6 mouse were ran-domly divided into four groups:group HS (n =6):high-fat diet+single streptozotocin intraperitoneal injection (120 mg/kg);group H (n =6):high fat diet+buffer injection;group S (n =6):standard chow diet+single streptozotocin intraperitoneal injection (120 mg/kg);group C (n = 6 ):standard chow diet+buffer injection.The 24th week was the end point of the experiment,and random glucose, homeostasis model assessment of insulin resistance (HOMA-IR),mechanical threshold,and IENFD were measured.Results Group HS had significantly higher random glucose and HOMA-IR than other groups (P <0.01),had significantly lower mechanical threshold than other groups (P <0.05), had significantly lower IENFD than groups S and C at 24th week (P <0.05 );group H had signifi-cantly higher random glucose and HOMA-IR than group C at 24th week (P <0.01),had no signifi-cant difference in mechanical threshold compared with group S and group C,and had no significant difference in IENFD compared with group HS.Conclusion A mouse model of type 2 diabetes periph-eral neuropathy was successfully established,and the IENFD was found to be decreased significantly.

A complete hospital security system is essential for the life and property safety of medical workers, patients and their families alike. The successful operation of the system depends on a reasonable staffing of the security department.From 2019, a tertiary hospital has explored and practiced the staffing management of security guards based on the actual needs of the hospital. The first job was to classify its security posts setup, and determine the staffing requirements of front-line security posts based on such indicators as scale, risk and people flow. The management range theory was called into play, to set the staffing coefficient of front-line security posts and their corresponding frontline administrators as 7∶1, and set that each management post needs one middle manager. The next job was to calculate the number of security guards per workload/post. The calculations estimated that the number of guards required for the four front-line security posts, namely, gate keeper post, public area patrol post, security and fire control post, and emergency response unit post, was 37, 46, 26 and 26 respectively. The corresponding management posts, namely, the office of the security department, the security management team, the fire management team, and the order maintenance team, required 7, 8, 5 and 5 management personnel respectively, totaling 160. Based on the calculations, the hospital optimized its staffing, and increased its total security personnel from 150 to 160, including the number of gate keeper posts were reduced by 17, and the number of emergency response unit posts was increased by 22. This optimization has effectively empowered the security department in dealing with medical disputes and emergencies, as well as identifying fire hazards, which serves a reference for the rational staffing of hospital security human resources.

Objective:To compare the efficacy and safety of unilateral biportal endoscopy (UBE) and microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis by Meta-analysis.Methods:PubMed, Web of Science, CNKI and Wanfang Data were searched from their establishment to January 2021 for all the studies on UBE and MED in the treatment of lumbar spinal stenosis. The data extracted were authors, year of publication, study design, subject characteristics, sample size, surgical protocol, age, sex ratio, duration of surgery, length of hospital stay, complications, visual analogue scale (VAS), and Oswestry Disability Index (ODI). The Meta-analysis was conducted with software Revman 5.3 to analyze the operation time, hospital stay, complication rate, waist and lower extremity VAS scores and ODI scores at preoperation, early postoperation and the last follow-up. The quality of the case-control studies included was evaluated using the Newcastle Ottawa Scale (NOS) while the methodological quality and risk of bias of the randomized controlled studies (RCT) included were evaluated using the Cochrane Bias Risk Assessment Tool.Results:Finally, 7 studies were included, 6 in English and one in Chinese. There were 2 RCTs and 5 case-control studies. There were 251 patients in the UBE group and 224 patients in the MED group. Compared with the MED group, the UBE group had a significantly shorter hospital stay ( MD=-2.28, 95% CI: -3.42 to -1.14, P<0.001), and a significantly lower VAS score for early postoperative low back pain ( MD=-0.80, 95% CI:-1.44 to -0.16, P=0.01). There were no significant differences between the 2 groups in operation time, complication rate, waist VAS scores at preoperation or the last follow-up, lower extremity VAS or ODI scores at preoperation, early postoperation or the last follow-up, or dural dilatation area ( P>0.05). Conclusions:In the treatment of lumbar spinal stenosis, compared with MED, UBE is superior in early relief of low back pain and hospital stay after operation, but shows no significant difference in long-term efficacy or safety.

Objective:To observe the clinical and multimodal imaging features of eyes with acute macular neuroretinopathy (AMN) associated with the coronavirus disease 2019 (COVID-19).Methods:A retrospective study. From December 20, 2022 to January 17, 2023, a total of 29 patients (58 eyes) with COVID-19-associated AMN admitted to Department of Ophthalmology of Eye and ENT Hospital, Shanghai Medical College were included in the study. All the affected eyes underwent the best corrected visual acuity, color fundus photography, infrared fundus photography (IR), short-wavelength autofluorescence (SW-AF), near-infrared autofluorescence (NIL-AF), optical coherence tomography (OCT), and OCT angiography (OCTA). All patients were administered microcirculation-improving oral medication with 12 cases receiving adjunctive low-dose corticosteroid therapy. Follow-ups were conducted 1 to 3 months after the initial diagnosis, with a total of 19 cases (38 eyes) completing the one-month follow-up.Results:Out of the 29 cases, there were 9 males (18 eyes) and 20 females (40 eyes), all of whom experienced bilateral eye involvement. The age of the patients ranged from 12 to 47 years, with an average age of (29.9±9.5) years. The time from the onset of fever to the appearance of ocular symptoms was (2.52±2.01) days. Among the 58 affected eyes, there were 5 cases with retinal cotton wool spots, 2 cases with optic disc edema, and 1 case with parafoveal branch retinal vein occlusion. All affected eyes exhibited deep reddish-brown macular dark spots. IR revealed wedge-shaped, wedge-like, or "petaloid-like" dark areas involving the fovea and parafovea. SW-AF examination showed no obvious abnormality in 39 eyes. Weak autofluorescence dark area were consistent with IR in 19 eyes. NIR-AF examination showed spot-like or flaky self-fluorescent dark areas. OCT examination showed strong reflex lesions spreading vertically upward from the retinal pigment epithelium (RPE) layer in the macular area in the acute stage, showing typical "bean seedling" sign. OCTA revealed reduced blood flow density in the deep capillary plexus (DCP) of 50 eyes. Enface OCT displayed lesion areas that corresponded to the dark areas seen in IR. One month after the initial diagnosis, the condition improved in 18 eyes (47.4%, 18/38). Among the 5 eyes with cotton wool spots, regression of these spots was accompanied by loss of nerve fiber layer in 4 eyes. In cases with optic disc edema, the edema subsided. The "bean sprout" sign disappeared in all affected eyes, and the lesions became localized. The ellipsoid zone and/or interdigitation zone in the lesion areas were discontinuous.Conclusions:COVID-19-related AMN is characterized by distinctive features. IR fundus reveals wedge-shaped, wedge-like, or petaloid dark areas involving the fovea and parafovea. OCT displays strongly reflective lesions with vertical spread above the RPE. OCTA shows reduced blood flow density in the DCP of the retina.

Objective:To investigate the clinical significance of autologous platelet separation (APS) in different time courses of cardiovascular surgery.Methods:The relevant data of 75 patients with cardiovascular surgery from September 2019 to August 2021 in Hunan Provincial Peoples′ Hospital were collected retrospectively. They were divided into two groups according to whether APS was used during the operation: group A used APS (37 cases) and group B did not use APS (38 cases). The two groups were divided into subgroups according to the length of cardiopulmonary bypass (CPB): A1 and B1 were medium and short-term groups (CPB bypass time ≤200 min), and A2 and B2 were long-term groups (CPB bypass time >200 min). Blood routine, postoperative drainage volume, postoperative blood product infusion volume and thromboelastogram at different time points were recorded and compared.Results:The postoperative drainage volume, red blood cell infusion volume and ventilator assisted time in group A were less than those in group B (all P<0.05); The postoperative drainage volume [(645.79±205.25)ml vs (886.67±360.96)ml, P=0.006], erythrocyte infusion volume [(3.24±2.53)U vs (4.77±1.97)U, P=0.016], platelet infusion volume [0.00(0.00, 0.00)U vs 1.00(0.125, 2.00)U, P=0.002] and thromboelastogram coagulation reaction time [(7.38±1.74)min vs (9.09±3.57)min, P=0.047] in group A2 were significantly better than those in group B2 (all P<0.05); There were no significant difference in the above indexes between A1 and B1 group (all P>0.05). Conclusions:APS can improve the coagulation function of patients undergoing cardiopulmonary bypass and reduce the amount of bleeding and blood products. Its protective effect is more prominent in high-risk cardiovascular surgery with long cardiopulmonary bypass and complex operation.