Objective To investigate and discuss the feasibility and clinical outcome of the minimally invasive two-incision total hip arthroplasty. Methods From February to June 2004, 17 cases of the minimally invasive two-incision total hip arthroplasty were performed. There were 7 males and 10 females with an average age of 69 years from 58 to 75 years. Preoperative diagnosis of the patients included 5 of osteoarthritis, 4 of osteonecrosis and 8 of femoral neck fracture. The operations were performed with Versys cementless prosthesis and minimally invasive instruments provided by Zimmer Company. Operation time, blood loss, length of incisions, average postoperative hospitalization, and operation related complications were analyzed. Blood transfusion was performed while hemoglobin of the patients was less than 8 g. Results The patients were followed up from 6 to 12 months with an average of 8 months. The average operation time was 95 mins (85 to 170 mins). The average blood loss was 280 ml (190 to 450 ml) and blood transfusion was carried out in 4 cases of femoral neck fracture (average, 400 ml). The average length of anterior incision was 5.0 cm (4.6 to 6.5 cm) and that of posterior incision was 3.7 cm (3.0 to 4.2 cm). All the patients were ambulatory the day after surgery. 11 cases were discharged 5 days and 6 cases discharged 7 days after operation. Postoperative measurement on X-ray film showed that the average angles of abduction and anteversion of acetabular cup were 46?(43? to 55?) and 21?(17? to 23?) respectively. Proximal femoral split fracture occurred in one case, in which the fluoroscopy demonstrated the femoral component was stable and well positioned, and the patient walked without weight-wear for 2 months and was found with stable prosthesis evaluated at 3 and 6 months postoperatively. None of infection, dislocation or injury of vessel and nerve happened. Conclusion Anterior and posterior two-incision total hip arthroplasty has the advantages of muscle sparing, minimally invasive, less blood loss, rapid recovery; however, this technique is time consuming, special instruments and fluoroscopy are needed.

Objective To investigate the effect of trimetazidine postconditoning on myocardial cell apoptosis in acute ischemia-reperfusion injury in rats.Methods 40 healthy adult Wistar rats were randomly assigned to Sham-operated group,MIRI group(I/R group),trimetazidine group and ischemic postconditioning group(IPOC group).The left anterior descending coronary artery of rat was ligated and the acute myocardial ischemia-reperfusion injury model was established.After that,ultrastructural changes of apoptotic myocardial cells were observed under electron microscope,and apoptotic cells were detected under optical microscope.The expressions of the Bcl-2,caspase-3 apoptosis related proteins were determined.Results ① The degree of ultrastructural injury of apoptotic myocardial cells was mild and basically the same in trimetazidine group versus IPOC group,and had a significant improvement as compared with I/R group.② The degree of myocardial apoptosis was basically the same in trimetazidine versus IPOC group,and lighter than in I/R group.③ Bcl-2 protein expression levels were(61.9 ± 2.9) ％,(21.4 ± 3.2) ％,(46.8 ± 3.5) ％ and (49.7 ± 3.1) ％,and caspase-3 protein expression levels were(38.1±4.5) ％,(72.8±5.7) ％,(47.2±5.1) ％ and(39.8 ±4.6)％ in Sham-operated group,I/R group,trimetazidine group and IPOC group respectively.Compared with I/R group,the expression of Bcl-2 protein was increased obviously,while the expression of easpase-3 protein was decreased in trimetazidine group and IPOC group.But there were no significant differences in the protein levels of Bcl-2 and caspase-3 between trimetazidine group and IPOC group(both P＞0.05).Conclusions Trimetazidine postconditoning can inhibit the myocardial cell apoptosis in acute ischemia-reperfusion injury in rats,and has a protective effect on myocardial cells.

Objective To compare the efficacy and safety of Etomidate-Dexmedetomidine and Propofol-Dexmedetomidine sedation in patients undergoing endoscopic radiofrequency ablation of gastroesophageal relfux disease (GERD).Methods Sixty adult patients, scheduled for elective endoluminal radiofrequency ablation for GERD under sedation were prospectively randomized into Etomidate-Dexmedetomidine (Group-E,n = 30) or Propofol-Dexmedetomidine (Group-P,n = 30) group. A bolus of 0.2 μg/kg of intravenous Dexmedetomidine was followed by intermittent Etomidate or Propofol injection during the procedure in order to maintain a proper depth of sedation with a Ramsay sedation scores of 5~6. Heart rates, mean blood pressure, oxygen saturation, respiratory rates and Ramsay sedation scores were recorded before sedation (T0), at the beginning of the examination (T1), during radiofrequency energy delivery (T2), at the time of gastroscopy (T3) and at the end of therapy (T4). Inter-group differences in sedation proifles (duration, time to recovery, incidence of body movement, Ramsay sedation scores and satisfaction of patient and endoscopist) and cardio-respiratory responses (heart rate, mean arterial pressure, oxygen saturation) were determined during and after radiofrequency ablation.Results No difference was found for therapy duration, anesthesia time or the time to recovery between Group-P and Group-E. Patients receiving Propofol experienced more bradycardia (Ρ = 0.032) and had higher incidences of vasoactives used (Ρ = 0.002) compared with that receiving Etomidate. Oxygen saturation in T1 (Ρ = 0.023) and T2 (Ρ = 0.009) was lower in the Group-P. No significant difference was found for other indicators.Conclusion Etomidate-Dexmedetomidine sedation was superior to Propofol-Dexmedetomidine sedation for GERD radiofrequency therapy with more stable cardio-respiratory responses.

BACKGROUND: During spinal orthopedic repair, the main difficulty is to maximize the correction of the deformity, simultaneously, to reduce the incidence of trauma and complications, especial y to avoid the corresponding spinal nerve injury. OBJECTIVE: To evaluate the curative effect of one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation in the treatment of rigid angular kyphosis of thoracolumbar spine. METHODS: We retrospectively analyzed the data of 42 cases of rigid angular kyphosis of thoracolumbar spine that were treated by one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation. Al patients received detailed imaging examination before and after operation. Kyphosis angle, Frankel grading and perioperative complications were recorded in al patients. X-ray films or CT films showed the bone graft fusion during fol ow-up. RESULTS AND CONCLUSION: Patients were fol owed up for 10-36 months after treatment. The average time of bone graft fusion was 5.1 months. Cobb’s angle of kyphosis was corrected from 78.4° (38°-110°) preoperatively to 7°(-8°-24°) at 10 days after treatment. The correction rate was 90%. The average angle during final fol ow-up was 7.9°, with an average loss of 0.9°. In 16 paresis patients, Frankel grading results showed grade B in 0 case, grade C in 3 cases, grade D in 5 cases, and grade E in 8 cases during final fol ow-up, showing significant improvement as compared with that pre-treatment (P < 0.05). Among 42 patients, 5 cases had complications. At 7 months after treatment, there were screw and titanium rod loosening at the distal end of the fusion segment in 1 case, cerebrospinal fluid leakage in 2 cases, transient double lower limb weakness in 1 case, pain in one side of lower limb in 1 case, and no severe complications appeared. These results verified that one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation could achieve satisfactory clinical outcomes in rigid angular kyphosis of thoracolumbar spine. The internal fixation was stable and with a high fusion rate and few complications. The medium-term effect was satisfactory.

Objective To explore the application value of magnetic resonance molecular functional imaging diffusion weighted imaging(DWI) in the identification of pancreatic carcinoma and mass-type pancreatitis of animal model.Methods Each 8 cases of laboratory pancreatic head transplantation tumor model,chronic mass-type pancreatitis model and normal rabbits were selected and performed the MR DWI molecular functional imaging,the b values were 333,667,1 000 s/mm2 respectively.The apparent diffusion coefficients(ADC) of pancreatic carcinoma model,mass-type pancreatitis model and normal pancreas under different b values were observed.Then the change situation of ADC values of pancreatic carcinoma model,mass-type pancreatitis model and normal pancreas under different b values and difference of ADC(DADC) was analyzed.Moreover the differences in molecular diffusion,tissue perfusion among various groups were observed.Results Throughout the study period,the mortality rate of pancreatic head transplantation tumor model was 50%;the mass-type pancreatitis model and 8 normal rabbits were normally survival.The ADC value of pancreatic carcinoma under the same b value was significantly lower than that of chronic inflammation and normal pancreas area.The ADC value in each group was decreased with the increase of b value,and there was significant difference in ADC value when the b value was 333 s/mm2(F=6.662,P=0.014),in the pairwise comparison among groups,the difference between pancreatic cancer and pancreatitis (t=6.773,P=0.003) and between pancreatic cancer and normal pancreas(t=5.883,P=0.016) had statistical significance (P<0.05).The b value was increased,DADC was smaller,the difference change of DADC between pancreatic cancer area and chronic pancreatitis mass area,between pancreatic cancer area and normal pancreatic head area had statistical significance (P<0.05).Conclusion Rationally selecting the molecular functional imaging DWI technology of b value can better distinguish pancreatic cancer from mass-type pancreatitis,which may be promoted and applied in the evaluation of animal pancreatic head cancer model.

In recent years,the application of machine learning in the field of radiotherapy has been gradually increased along with the development of big data and artificial intelligence technology.Through the training of previous plans,machine learning can predict the results of plan quality and dose verification.It can also predict the multi-leaf collimator (MLC) positioning error and linear accelerator performance.In addition,machine learning can be applied in the quality assurance of intensity-modulated radiotherapy to improve the quality and efficiency of treatment plan and implementation,increase the benefits to the patients and reduce the risk.However,there are many problems,such as difficulty in the selection,extraction and calculation of characteristic value,requirement for large training sample size and insufficient prediction accuracy,which impede its clinical translation and application.In this article,research progress on the application of machine learning in the quality assurance of IMRT was reviewed.

In order to find a method suitable for purifying large amount of CD34(+) cells, from 5 cases who accepted autologous peripheral blood stem cell transplantation, CD34(+) cells were collected and enriched by using Isolex 300i (Nexell). Phenotypes were detected by flow cytometry and the biological viability were assayed by the colony-forming experiments and cell expansion experiment in vitro. The results showed that the number of mononuclear cells first collected was about (3.5 - 6.0) x 10(10) and (0.55 - 1.2)% of cells were CD34 positive. The number of positive production was about (2.0 - 3.0) x 10(8); the CD34(+) cells purity was (75 - 85)% and the yield was (40 - 65)%. The CD34(+) cells of positive production could expand up to 2 - 3 times when cultured with SCF + IL3 + FL + TPO + EPO in vitro. The results of colony-forming experiments demonstrated that the CD34(+) cells collected has enough colony-forming ability. All results showed the enriched CD34(+) cells with biological viability. In conclusion, the CD34(+) immunomagnetic isolation apparatus Isolex300i is suitable to clinical application for a large amount of CD34(+) cell enrichment.
Antigens, CD34 ; immunology ; Colony-Forming Units Assay ; Flow Cytometry ; Hematopoietic Stem Cells ; cytology ; immunology ; Humans ; Immunomagnetic Separation ; instrumentation ; methods ; standards ; Neoplasms ; blood

Clinical data of patients underwent pancreaticoduodenectomy due to malignant ampullary tumors from January 2013 and December 2016 in our hospital with full access to medical records were collected,and 144 patients were enrolled in total.Surgical Apgar Score (SAS) was calculated based on the intraoperative lowest mean arterial pressure,lowest heart rate and blood loss.The patients were divided into 2 groups depending on whether postoperative delirium developed or not within 7 days after surgery.The receiver operating characteristic curve of SAS in predicting postoperative delirium was drawn.The area under the curve,optimal cut-off value and sensitivity and specificity were calculated.Thirty-six patients developed postoperative delirium,and the incidence was 25.0％.The area under the curve of SAS in predicting postoperative delirium was 0.86 (95％ confidence interval 0.79-0.91).The optimal cut-off value was 6 with a sensitivity of 86％ and a specificity of 83％.In conclusion,intraoperative SAS can predict the development of postoperative delirium in patients undergoing pancreaticoduodenectomy.

Machine learning has developed rapidly in recent years.Using machine learning to predict the radiotherapy outcomes and complications can more accurately evaluate the patients' conditions and take appropriate treatment measures as soon as possible.The non-dose and dose related factors generated during radiotherapy are filtered and input into the algorithm model,then corresponding prediction result can be obtained.There are many algorithm models to predict survival rate,tumor control rate and radiotherapy complications,and the predicted result are more accurate now.However,the algorithm model also has various problems,and it needs constant exploration and improvement.

Objective:Anatomical study of the cross-donor flap pedicled with the peroneal artery and the discussion of the effect of clinical application, so as to describe a new method for the repair of large-area soft tissue defects in the foot and ankle.Methods:From June 2016 to August 2019, 12 specimens of adult lower limbs were studied. The popliteal arteries were perfused with perchloroethylene-ethyl acetate-lead oxide and red perchloroethylene-ethyl acetate. The origin, number, outer diameter, course and distribution of perforating branches of the peroneal artery were anatomically observed. The source, distribution and anastomosis of the skin nutrient vessels in the posterolateral area of the calf were also studied. Relationship of the blood supply between the peroneal arteries and veins and the nutritional vessels of the sural nerve were observed. In 9 patients, the peroneal artery and vein were designed as the pedicle of cross-donor flap in the repair of large soft tissue defects of foot and ankle. The patients were entered follow-up through outpatient visits and telephone interviews.Results:Among the 12 adult specimens of lower limbs, there were 65 perforating branches from the peroneal artery, 4-7 branches on each side, with an average of (5.41±1.00) branches. The diameter of the penetrating deep fascia was(1.07±0.36) mm. The perforator branches were mostly distributed in 3 sections of 4.0-11.0 cm, 16.0-21.0 cm and 24.0-27.0 cm away from the lateral malleolus, accounting for 48%, 24% and 17% of the total number of perforators, respectively. The outer diameters of the perforator vessels were (0.92±0.26)(0.56-1.68) mm, (1.32±0.38)(0.60-2.14) mm, and (0.98±0.28)(0.62-1.36) mm. The length of the pedicle of the perforator vessels were (3.91±0.96)(2.15-5.78) cm, (5.34±0.50)(4.01-5.85) cm, and (3.31±1.15)(2.16-5.66) cm. The perforating branches in the 3 sections appeared constantly. The diameter of the vessels was≥0.5 mm with an average length of at(4.19±1.16)(2.15-5.85) cm. The vascular network of the flap in the posterolateral area of the calf was mainly composed of subdermal vascular network and deep fascial vascular network. The deep fascia vascular network in the posterolateral area of the calf had 3 obvious longitudinal chains, including the medial sural neurotrophic vascular chain, the small saphenous vein-sural nerve communicating branch vascular chain and the lateral sural neurotrophic vascular chain, which took the nutrient blood supply from the perforating branches of the peroneal artery also formed a longitudinal and transverse anastomosis between the perforating branches of the peroneal artery. In the clinical trials performed on 9 patients, all soft tissue defects of foot and ankle were repaired. The composite tissue flap survived without infection or necrosis. The follow-up was lasted for 12 months to 3 years. The postoperative function and the donor site appearance were good and the patients walked normally. According to the American Orthopaedic Foot and Ankle Association(AOFAS) foot scoring standard, the function of affected feet were evaluated. Five patients were excellent and 4 were good.Conclusion:The cross-donor flaps pedicled with peroneal arteries and veins has sufficient blood supply and a large area. It provides a method for the repair of large-area soft tissue defects in the foot and ankle.