Bacterial biofilm is responsible for a wide variety of nosocomial infections.Many chronic infectious diseases are closely correlated with biofilm formation in the clinic.As the biofilm growth,bacterial clusters detachment and dispersal from mature mixed-species biofilms will result in repeated acute infections.Here reviews three distinct biofilm dispersal strategies: swarming dispersal,clumping dispersal and surface dispersal.Many factors,such as heredity and increased fluid shear in the environment,contribute to this complex and dynamic process.Fundamental investigation upon biofilm will benefit clinical therapy of biofilm-associated infections.

Objective: To prepare curcumin-micelles adopting vitamin E-TPGS (VE-TPGS) and Solutol HS15 (SHS15) as carriers, and study the effect on solubility and oral bioavailability of curcumin (Cur). Methods: Cur was loaded into micelles between VE-TPGS and SHS15 by thin film dispersion method. Particle size, loading efficiency, entrapment efficiency, and in vitro release were carried on to estimate the influence of micelles on Cur; Moreover, oral bioavailability in rats was also evaluated. Results: The particle size was (35.79 ± 1.23) nm with polydispersity index (PDI) of 0.12 ± 0.03 when the optimized micelles ratio was at 3:7 of VE-TPGS and SHS15, which increased the solubility of Cur to 2.03 mg/mL in water. The entrapment efficiency and drug loading were 90.03% and 9.34%, respectively. The in vitro release profile showed a sustained release property compared with that of Cur. In addition, the relative bioavailability of micelles (AUC0~∞) compared with that of Cur (AUC0~∞) was 303.5% (P < 0.01). Conclusion: The Cur-micelles combined use of VE-TPGS and SHS15 shows great potential clinical application.

OBJECTIVETo compare the differences between computer aided identification and ultra-thin layer slicing in measuring the lesions of femoral head necrosis,and to confirm the accuracy and practicability of computer aided method.

METHODSFrom June 2012 to December 2013, the X-ray and MRI of 24 patients (24 hips on unilateral) were reviewed, who had avascular necrosis of the femoral head (ANFA) at late stage (stage III and IV) according to the ARCO international staging system. There were 15 males and 9 females, with an average age of (65.1 ± 8.8) years old, ranged 33 to 74 years old. Based on the software system with seeds point identification, the ragional adaptive search method with computer aid was used to calculate the volume of necrotic lesion in femoral on MRI. Then the pathological slices of those intraoperative femoral heads were made to measure the gross volume of necrotic lesion in femoral head,and the values were compared with the data in the computer.

RESULTSFor 24 hips, by the calculation of computer, the necrotic volume was (20.00 ± 3.04) cm (ranged, 18.72 to 21.29 cm³). Under the pathological section, the necrotic volume of the femoral head was (19.89 ± 3.17) cm³ (ranged, 18.55 to 21.23 cm³). In computer and pathology two kinds of measurement, the two entire femoral head volume had no significant difference using these two measurements (t = -1.227, P = 0.232).

CONCLUSIONComputer aided identification for necrotic area of femoral head adaptive can demonstrate the morphology of femoral head necrosis accurately and reliably, which will help surgeon better understand the morphology and orientation in femoral head.

Adult ; Aged ; Diagnosis, Computer-Assisted ; Female ; Femur Head Necrosis ; pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged

Objective: To investigate the current status of adjuvant therapy compliance in elderly breast cancer patients (≥65 years old) attended the case-management model and to analyze the impact of demographic characteristics and clinical features on adjuvant therapy compliance. Methods: This study enrolled 654 elderly early breast cancer patients who were treated in Ruijin Hospital and subsequently accepted case-management model between March 2013 and August 2016. Data on patients' compliance to adjuvant therapies which were designed by multidisciplinary treatment (MDT) were collected. The correlation of patients' adjuvant therapy compliance with demographic characteristics and clinical features were evaluated using χ2 test. The statistically significant variables were taken and the corresponding impact on adjuvant therapy compliance were further analyzed using multiple Logistic regression model. Results: In this study, 603 (92.20%) elderly breast cancer patients were treated with one or a combination of adjuvant therapies according to MDT discussion/recommendation. Overall patients' compliance to adjuvant therapy was 88.05%. 45.94% patients were required adjuvant chemotherapy, of which 91.34% patients complied in reality; 45.61% patients were required adjuvant radiotherapy, of which 88.73% patients complied in reality; 80.93% patients were required adjuvant endocrine therapy, of which 93.65% (median treatment duration 44.16 months) patients complied in reality; 12.94% patients were required adjuvant targeted therapy, of which 82.05% patients complied in reality. By number of adjuvant therapies that elderly early breast cancer patients were required, patients' compliance to one, two, three and four adjuvant therapies amounted to 94.30%, 83.68%, 87.20% and 60.00% respectively. The results from analysis of demographic characteristics and clinical features revealed that, age and number of adjuvant therapies had significant impact on adjuvant therapy compliance in elderly breast cancer patients (P<0.05). Furthermore, patients' education level showed strong correlation with patients' compliance to adjuvant chemotherapy and adjuvant radiotherapy (P<0.05). Additionally metastasis to lymph nodes impacted on patients' compliance to adjuvant chemotherapy (P<0.05). Conclusion: Case-management model is beneficial to improve adjuvant therapy compliance after surgery in elderly breast cancer patients. To further increase patients' compliance, more efforts should be invested to help patients older than 74 years old, with lower education level, negative lymph nodes and more types of comprehensive treatment.

Objective To report clinical study of diabetic foot with microsurgical treatment.Methods 32 cases basing on physical treatment underwent operation which included reconstruction of vessel under DSA and flap transfer and relaxation of nerves.Results 8 eases were examined with DSA after operation,it showed that the bypass grafts were unobstructed and the distal blood were improved;All flap were lively. Conclusion The ulcer of the patients with diabetic foot was closed early and the blood supply of the limb have been reconstructed by microsurgical treatment,it can not only avoid amputation or lower the limb amputation level,but also improve the life quality of patients and obtain social benefit.

OBJECTIVETo evaluate the technique and the clinical effect of folding roof and rotary pushing in treatment of children with distal radius and ulna fracture of "back to back".

METHODSFrom January 2012 to February 2014,38 children with distal radius and ulna fracture of "back to back" were treated by using the technique of folding roof and rotary pushing to reset and splint fixation including 23 males and 15 females with an average age of 9.5 years old ranging from 6 to 14 years old. Injury time was from 45 min to 3 days (averaged 1.3 days). All cases was unilateral closed fracture without symptoms of nerve injury occurred. The wrist joint anteroposterior and lateral radiographs showed double fracture of radius and ulna, and the broken end of radius was typical "back to back" displacement. The quality of reduction was assessed according to Dienst recommendation on the combination of Aro measurement, and the therapeutic effect was evaluated using standard of Anderson function.

RESULTSAll patients were followed up from 3 to 13 months with an average of 6 months. There were no iatrogenic nerve injury. Thirty cases were treated successfully for the first time, 8 cases were again reset successfully; 28 cases were anatomical reduction, 7 cases were near anatomic reduction, 3 cases were functional reduction. At the second day 7 cases with hand and finger swelling appeared in multiple reset patients. Quality results of reduction were excellent in 33 cases, good in 5 cases. According to the standard of Anderson function evaluation, 35 cases were excellent, 3 cases were good. All fractures were healed with of deformity of wrist.

CONCLUSIONUsing the technique of folding roof and rotary pushing in treatment of children with distal radius and ulna fracture of "back to back" is very successful, the patient's limb function recovered well, the whole operation process is simple.

Adolescent ; Child ; Female ; Fracture Healing ; Humans ; Male ; Radius Fractures ; physiopathology ; surgery ; Ulna Fractures ; physiopathology ; surgery

OBJECTIVETo investigate the characteristics of supracondylar fracture of humerus in children and to explore the effect of closed reduction and internal fixation at radial side on the fracture.

METHODSThe children with fractures of Gartland type II and type III in our hospital from June 2010 to June 2013 were reviewed. There were 28 males and 7 females, ranging in age from 1 year and 1 month to 2 years and 6 months, with an average of 2 years and 1 month. According to Gartland classification, 19 cases were type II, 16 cases were type III. There were 3 patients with radial nerve injuries, and 5 patients with anterior interosseous nerve injuries. There were no vascular injuries. All the patients were treated with closed reduction and three Kirschner fixation at the radial side, followed by the plaster external fixation with elbowed flexion at 90 °. The X-ray examination was performed at the second day after operation. The joint function exercise began about at 2 to 3 weeks after operation when the plaster fixation was removed, and opportune time for removal of Kirschners depends on the situation of fracture healing. The operation time, nerve recovery, and the elbow joint function were observed.

RESULTSAll the children were followed up, and all the fractures had bony union. According to Flynn score system at the final follow-up, 28 patients got an excellent result, 4 good, 1 poor and 2 bad.

CONCLUSIONThree Kirschner fixation at the radial side for the treatment of supracondylar fracture of humerus has advantages of minimally invasive, shorter time of hospitalization, simple removal of the internal fixation and reliable therapeutic effects.

Bone Wires ; Child, Preschool ; Female ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Humeral Fractures ; surgery ; Humerus ; injuries ; surgery ; Infant ; Male ; Treatment Outcome

OBJECTIVETo evaluate the effect of the combined use of Shenmai Injection (SMI) and enteral nutrition on postoperative fatigue syndrome (POFS) in patients with gastric cancer (GC).

METHODSFifty-eight GC patients were randomized into the parenteral nutrition group (PNG, 19 cases), enteral nutrition group (ENG, 19 cases) and combined treatment group (CTG, 20 cases). The post-operative recovery in patients was observed; patients' conditions of fatigue, mood and sleep were evaluated respectively by visual analogue scale of fatigue, profile of mood states (POMS) and Pittsburgh sleep quality index (PSQI). Meanwhile, nutritional variables, such as serum contents of total protein, albumin, pre-albumin, were measured at different time points: before operation (d0) and the 1st, 5th, and 9th day (d1, d5 and d9) after operation. Immune variables such as subsets of lymphocytes (CD3, CD4, CD8), serum immunoglobulins (IgG, IgM, IgA) were also determined.

RESULTSConditions of recovery, POMS and PSQI were better and the postoperative fatigue reduced more significantly in CTG than those in the other two groups (P < 0.05). On d9, levels of pre-albumin, CD3, CD4, CD4/CD8 in CTG were significantly higher than those in the PNG and ENG (P < 0.05), meantime, levels of albumin and IgA were higher in CTG than those in PNG (P < 0.05).

CONCLUSIONCombined treatment of SMI and enteral nutrition can regulate mood and sleep to some extents, and reduce the postoperative fatigue through improving nutritional status and immune function, thus speeding up the recovery of patients.

Adult ; Aged ; Combined Modality Therapy ; Drug Combinations ; Drugs, Chinese Herbal ; therapeutic use ; Enteral Nutrition ; Fatigue ; therapy ; Female ; Gastrectomy ; methods ; Humans ; Male ; Middle Aged ; Parenteral Nutrition ; Phytotherapy ; Postoperative Complications ; therapy ; Stomach Neoplasms ; surgery

BACKGROUNDHypogammaglobulinemia is common in infant humoral immunodeficiencies and has complicated causes and outcomes. We aimed to determine the clinical manifestations, immunological changes and outcomes of Shanghai infants with hypogammaglobulinemia.

METHODSPatients under 2 years old, having one or more warning signs of primary immunodeficiency disorders, serum immunoglobulin levels below the lower limit of reference range per age, and with normal numbers for lymphocyte subsets, were analyzed and followed up for 2 to 3 years.

RESULTSA total of 91 children (male-to-female ratio: 2.25: 1) participated in the study. Initial clinical presentation was recurrent upper respiratory tract infection (46%), invasive infection (3%), atopic disease (32%). IgA reduction (77%) was prevalent; 34% patients had more than one isotype reduced. During follow-up, 51 of 62 patients (82.25%) had immunoglobulins normalized at the age between 12 - 48 months; these were diagnosed as transient hypogammaglobulinemia of infancy (THI). Long-term follow-up may reveal a diagnosis for the remaining 11 infants with persistent lower immunoglobulin levels, who did not have antibody titers measured. Earlier onset was correlated with higher rates of normalization. More patients were diagnosed with isolated hypogammaglobulinemia in 2006 compared with the previous 4 years (2002 - 2005).

CONCLUSIONSThe awareness of immunodeficiency among pediatricians has been greatly improved. Recurrent otitis media was not a major infection in our patients. THI is a relatively common condition associated with infant hypogammaglobulinemia. In the absence of specific antibody titers, the diagnosis of THI can be confirmed retrospectively with Ig levels normalized in follow-up visits. Therefore, long-term follow-up and frequent re-evaluation of these patients are necessary to distinguish them from true primary immunodeficiency.

Agammaglobulinemia ; epidemiology ; metabolism ; pathology ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Follow-Up Studies ; Humans ; Infant ; Male

BACKGROUNDThe lung functional status could be displayed on lung perfusion images. With the images, the radiotherapy plans of lung cancer could be guided to more optimized. This study aimed to assess quantitatively the impact of incorporating functional lung imaging into 3-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiation therapy (IMRT) planning for non-small cell lung cancer (NSCLC).

METHODSTen patients with NSCLC who had undergone radiotherapy were included in this study. Before radiotherapy, each patient underwent CT simulation and lung perfusion imaging with single photon emission computed tomography (SPECT). The SPECT images were registered with simulation planning CT and used to contour functional lung (lung-F) and non-functional lung (lung-NF). Two 3DCRT plans and two IMRT plans were designed and compared in each patient: two anatomic plans using simulation CT alone and two functional plans using SPECT-CT in addition to the simulation CT. Dosimetric parameters of the four types of plans were compared in terms of tumor coverage and avoidance of normal tissues. Total radiation dose was set at 66 Gy (2 Gy x 33 fractions).

RESULTSIn incorporating perfusion information in 3DCRT and IMRT planning, the reductions on average in the mean doses to the functional lung in the functional plan were 168 cGy and 89 cGy, respectively, compared with those in the anatomic plans. The median reductions in the percentage of volume irradiated with > 5 Gy, > 10 Gy, > 20 Gy, > 30 Gy and > 40 Gy for functional lung in the functional plans were 6.50%, 10.21%, 14.02%, 22.30% and 23.46% in 3DCRT planning, respectively, and 3.05%, 15.52%, 14.16%, 4.87%, and 3.33% in IMRT planning, respectively. No greater degree of sparing of the functional lung was achieved in functional IMRT than in 3DCRT.

CONCLUSIONFunction-guided 3DCRT and IMRT plannings both appear to be effective in preserving functional lung in NSCLC patients.

Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; pathology ; radiotherapy ; Humans ; Radiography ; Radiotherapy, Conformal ; methods ; Radiotherapy, Intensity-Modulated ; methods ; Tomography, Emission-Computed, Single-Photon ; methods