Objective:To explore the clinical efficacy of a wearable robot for improving the balance and walking function of stroke survivors.Methods:Eighty stroke survivors were randomly divided into an observation group and a control group, each of 40. Both groups were given routine rehabilitation, but the observation group additionally received 20 minutes of training assisted by a wearable robot six days a week for 4 weeks. Before and after the experiment, both groups were evaluated using the Berg Balance Scale (BBS) and functional ambulation categories (FACs). Their movement distance and ellipse area were measured using a Prokin balance instrument, and their step length and pace on the affected side were recorded.Results:Significant improvement in the average BBS and FAC scores, exercise length, ellipse area, and step length and speed on the affected side was observed in both groups. On average, the experimental group′s results were significantly better than those of the control group.Conclusion:Supplementing conventional rehabilitation with wearable robot assistance can significantly improve the balance and walking function of stroke survivors.

OBJECTIVE: To investigate the role of the SIRT1/NF-κB pathway in mediating the effect of puerarin against lipopolysaccharide (LPS)-induced acute kidney injury (AKI). METHODS: Fifteen BALB/C mice were randomized into control group, LPS group and puerarin treatment group, and in the latter two groups, the mice were given an intraperitoneal injection of LPS (5 mg/kg), followed by daily injection of normal saline for 3 days or injection of puerarin (25 mg/kg) given 1 h later and then on a daily basis for 3 days. On day 5 after modeling, the kidney tissues were taken for histological observation and detection of cell apoptosis. The renal function indexes including urea nitrogen (BUN), serum creatinine (Scr) and kidney injury molecule 1 (KIM-1) and the levels of tumor necrosis factor (TNF-α) and interleukin 1β (IL-1β) were measured, and the expressions of SIRT1 and NF-κB-p65(acetyl K310) in the renal tissues were detected. RESULTS: Intraperitoneal injection of LPS caused obvious glomerular capillary dilatation, hyperemia, renal interstitial edema, and renal tubular epithelial cell swelling and deformation in the mice. The mouse models of LPS-induced AKI also showed significantly increased renal tubular injury score and renal cell apoptosis (P < 0.01) with increased serum levels of BUN, Scr, KIM-1, TNF-α and IL-1β (P < 0.01), enhanced renal expressions of TNF-α, IL-1β and NF-κB p65(acetyl K310) (P < 0.01) and lowered renal expression of SIRT1 (P < 0.05). Treatment with puerarin effectively alleviated LPS-induced renal interstitial edema and renal tubular epithelial cell shedding, lowered renal tubular injury score (P < 0.01) and renal cell apoptosis rate (P < 0.01), and decreased serum levels of BUN, Scr, KIM, TNF-α and IL-1β (P < 0.01). Puerarin treatment significantly reduced TNF-α, IL-1β and NF-κB p65 (acetyl K310) expression in the renal tissue (P < 0.05) and increased SIRT1 expression by 17% (P < 0.05) in the mouse models. CONCLUSION Puerarin can effectively alleviate LPS-induced AKI in mice possibly by modulating the SIRT1/NF-κB signaling pathway.
Animals ; Mice ; Mice, Inbred BALB C ; NF-kappa B ; Lipopolysaccharides ; Sirtuin 1 ; Tumor Necrosis Factor-alpha ; Acute Kidney Injury ; Disease Models, Animal ; Edema

Objective:To investigate the safety and effectiveness of robot-assisted total knee arthroplasty (TKA).Methods:From August 2021 to March 2022, the data of 69 patients who received robot-assisted TKA for inflammatory disease of knee in 6 hospitals were collected, including 24 males and 45 females, aged 52±6 years (range, 46-72 years), including 53 cases of knee osteoarthritis,10 cases of rheumatoid arthritis, and 6 cases of traumatic arthritis. Imaging data examination of patients was completed according to the multicenter specification. Preoperatively, the patient's CT data were extracted before surgery and a personalized prosthesis positioning plan was designed by the robotic system to determine the prosthesis size, lower limb force lines, and femoral and tibial osteotomy volumes; intraoperatively, the osteotomy template was robotically controlled to complete the osteotomy according to the prosthesis positioning plan, and the intraoperative osteotomy volumes were measured to verify the accuracy of the robot-assisted TKA osteotomy with the preoperative planning. Postoperatively, the lateral angle of the distal femur, the medial angle of the proximal tibia and the hip-knee-ankle angle were measured in the coronal plane according to radiographs; the postoperative outcome was evaluated 3 months after operation, using the American Knee Society score (KSS), including the KSS knee score and functional score.Results:The operative time was 97.3±2.3 min (range, 80-110 min) and the amount of bleeding was 320.0±6.2 ml (range, 300-350 ml) in 69 patients. Three months after operation, the mean range of motion of knee joint was increased from 82.2°±1.1° before surgery to 119.7°±0.8° after surgery ( t=27.65, P<0.001), and the line of force of lower limb was improved from 160.9°±0.5° before surgery to 178.0°±0.2° after surgery ( t=32.03, P<0.001). KSS-knee score increased from 54.8±0.7 points before operation to 85.0±0.5 points after operation, and KSS-functional score increased from 56.5±0.7 points before operation to 85.9±0.4 points after operation, the difference was statistically significant ( t=35.45, 36.58, P<0.001). The proportion of patients with intraoperative femoral and tibial osteotomies within 2 mm osteotomy error compared with preoperative planning was 97% for the lateral tibial plateau, 100% for the medial tibial plateau, 100% for the lateral distal femur, 99% for the medial distal femur, 93% for the lateral posterior femoral condyle, and 100% for the medial posterior femoral condyle; The proportion of patients with postoperative anteroposterior X-ray measurement angle error within 3° was: 100.0% for the distal lateral femoral angle, 100.0% for the proximal medial tibial angle, and 100% for the hip-knee-ankle angle. No complications occurred in all patients except for one case in which fat liquefaction occurred in the postoperative wound. Conclusion:Robot-assisted TKA is a safe and effective surgical method for the treatment of inflammatory disease of knee with accurate prosthesis installation and good postoperative recovery of lower limb alignment.

As a mature management method, the matrix management model has been embraced by various sectors at large. This article introduced the practice of a tertiary general hospital in combining hospital ethics with medical administration and code of conduct for medical service, leveraging the matrix management mode in hospital ethics construction. By sorting out the risk exposure in hospital ethics, the hospital identified specific responsibilities and departments involved. On such basis, eight stable matrix-based ethics working groups were established, namely hospital ethics training, hospital ethics publicity, hospital ethics interview, prevention against prescription statistics for drug rebate, patient rights protection, management of physician practice in other medical facilities, academic cooperation, and hospital ethics tour inspections. Matrix-based management meets the characteristics of hospital ethics development as it not only enables multi-department management needs, but also improves the efficiency. With the advancement and connotation enrichment of hospital ethics development, matrix management can become a regular management mode.

Based on the requirement of the ongoing healthcare reform on the performance appraisal for public hospitals, Shanghai Tenth People′s Hospital explored the performance appraisal system oriented by clinical ability and cost control from the perspective of medical administration and finance. Performance appraisal programs were made from five aspects: clinical development ability, key efficacy indicators, clinical path, disease-entity structure, cost control, aiming to highlight the functional positioning of tertiary hospitals, change doctors′ behaviors of diagnosis and treatment, lead clinical improvement and maintain healthy economy development.

Objective: To investigate the significance of circulating tumor cells (CTC) in squamous cell carcinoma of the head and neck (HNSCC). Methods: Twenty-four patients with HNSCC treated between October 2016 and July 2017 in our department were selected (experimental group), including 23 males and 1 females, aged 47-81 years. There were 14 cases of squamous cell carcinoma of larynx and 10 cases of hypopharynx, including I-Ⅱ stage (5 cases) and Ⅲ- Ⅳ stage (19 cases). All patients were primary and/or relapsed after treatment. Nine healthy volunteers were selected as control group. A novel in vivo capture technique (CellCellector system) was used to detect CTC. SPSS23.0 was used for statistical analysis. Results: The total capture rate of CTC in patients with HNSCC before treatment was 70.8% (17/24), with 40% (2/5) for patients at I-Ⅱ stage, and 78.9% (15/19) for patients at Ⅲ- Ⅳ stage, and was 0 in patients of control group. The total capture rate of CTC in patients with HNSCC after treatment was 50% (8/16). There was no significant correlation between CTC and age, sex, location of tumor or lymph node metastasis (P>0.05). CTC was related to tumor staging and tumor differentiation (P<0.05). The positive rate of EGFRVⅢ in CTC was 26.3% (5/19). Conclusions The CellCollector system is a very efficient way of detecting CTC, and CTC plays an important role in the occurrence, progression and metastasis of HNSCC.

Objective To explore the relationship between fractional anisotropy (FA) of corticospinal tract (CST) and motor function in stroke patients using diffusion tensor imaging (DTI). Methods From January, 2013 to October, 2016, 36 stroke patients were evaluated with Fugl-Meyer Assessment (FMA), Japan Upper Limb Function Test and DTI before and eight weeks after rehabilitation. FA in posterior limb of internal capsule, cerebral peduncle and pons were obtained, including ipsilesional and contralesional CST. Results The FA values within three sections of CST were significantly lower in the ipsilesional side than in the contralesional side both before and after rehabilitation (t>5.330, P<0.001). In posterior limb of internal capsule, the FA value increased after rehabilitation (t=-3.415, P<0.05), and no significant dif-ference was found in the other two sections (t<1.653, P>0.05) in the ipsilesional side, as well as in all the sections in the contralesional side (t<1.021, P>0.05). The FA values were positively correlated with the scores of FMA and Japan Upper Limb Function Test in all the sections both before and after rehabilitation (r>0.43, P<0.05), especially the relationship between the FA value and the score of Japan Upper Limb Function Test in the posterior limb of internal capsule (r=0.67). Conclusion DTI can be used to evaluate CST injury and the relationship be-tween CST injury and motor function.

Objective To observe the relationship between injury of corticospinal cord tract (CST) in basal ganglia and upper limb func-tion after stroke using diffusion tensor imaging (DTI). Methods 18 stroke inpatients hospitalized from January, 2013 to July, 2015 accepted DTI, and their upper limb function was evaluated with simple Fugl-Meyer Assessment and Japan Upper Limb Function Test. The fractional anisotropy (FA) of CST in basal ganglia of affected and unaffected sides were compared, and the correlation between FA of affected CST and upper limb motor function were analyzed. Results The FA was significantly less in the affected CST than in the unaffected CST (t=-21.09, P<0.001). The FA of the affected CST correlated with the scores of simple Fugl-Meyer Assessment (r=0.570, P<0.05) and Japan Upper Limb Function Test (r=0.509, P<0.05). Conclusion CST is injured after stroke, which may related to the upper limbs motor function impairment.

Objective To detect the gene expressions of phosphatase and tensin homolog on chromosome ten (PTEN) engineered mesenchymal stem cells (MSCs) and observe their effects on DBTRG glioma cells.Methods Primary culture of human umbilical cord MSCs was performed;48 h after PTEN transfection into MSCs by liposomes,transfection results were detected under microscope.(1) Transfected MSCsPTEN were used as experimental group and MSCs as control group.PTEN protein and gene expressions of the cells from the two groups were detected by Western blotting and real time-PCR;soluble PTEN protein in the culture supematants was measured using ELISA.(2) In vitro cultured DBTRG cells were divided into four groups,and MSCs supernatant and 25％,50％ and 100％ MSCsPTEN supernatants were added into the four groups,respectively;24 h after culture,calcein AM/EthD-1 staining was used to detect the activity of DBTRG cells which co-cultured with different percentages of MSCsPTEN medium.(3) In vitro cultured DBTRG cells were divided into three groups,and MSCs supernatant and 25％ and 100％ MSCsPTEN supernatants were added into the three groups;RTCA was used to observe the growth curve of DBTRG cells.Results (1) A large number of red fluorescence masses were noted in the MSCsPTEN cells by microscope;real time-PCR and Western blotting indicated that the gene and protein expressions of PTEN in the experimental group were significantly higher than those in the control group (P＜0.05).PTEN content in the supernatants of the experimental group was significantly higher than that in the control group (P＜0.05).(2) CalceinAM/EthD-1 staining indicated that 25％,50％ and 100％ MSCsPTEN supernatant groups had significantly larger number of death DBTRG cells than MSCs supernatant group (P＜0.05);and with the increase of MSCsPTEN supeenatant percentages,the number of death DBTRG cells became larger (P＜0.05).(3) RTCA indicated that as compared with the MSCs supernatant group,25％ and 100％ MSCsPTEN supernatant groups had decreased DBTRG cell index.Conclusion After MSCsPTEN transfection,MSCsPTEN cells can stablely express targeted gene,and their supernatant can obviously promote the death of DBTRG cells and inhibit the growth of glioma cells;PTEN engineered MSCs may be an effective gene therapy for gliomas.

OBJECTIVE:To observe the clinical efficacy and safety of Shenfu injection combined with Danshen chuanxiongqin injection in the treatment of chronic pulmonary heart disease patients with heart failure. METHODS:Totally 100 chronic pulmonary heart disease patients with heart failure were randomly divided into observation group and control group. Patients in control group were given routine treatment,including antispasmodic asthma,low-flow oxygen therapy,anti-inflammatory,diuretic strong heart, maintaining the body water,electrolyte balance,vasoactive drugs and dopamine,etc. Patients in observation group were given Shenfu injection 50 ml and Danshen chuanxiongqin injection 10 ml adding into 5% glucose injection 250 ml based on the treatment of control group,iv,once a day. The course of both was 14 d. The clinical data was observed,including clinical efficacy,improve-ment time of signs and symptoms,p(O2),p(CO2),SV,LVEF,LVEDD,LVSD and the incidence of adverse reactions before and after treatment. RESULTS:The total effective rate in observation group was significantly higher than control group,the remission time of cyanosis,slowing time of heart rate and subsided time of swelling were significantly shorter than control group,with signif-icant differences(P<0.05). After treatment,the p(O2),p(CO2),SV,LVEF,LVEDD and LVSD in 2 groups were significantly bet-ter than before,and observation group was better than control group,with significant differences(P<0.05). There were no obvious adverse reactions during treatment. CONCLUSIONS:Based on the treatment,Shenfu injection combined with Danshen chuanxion-gqin injection has better clinical efficacy than routine treatment in the treatment of chronic pulmonary heart disease patients with heart failure,with similar safety.