Objective To investigate the effects of internal plating with high and low moduli of elasticity on the stress and its distribution on the femoral shaft fracture. Methods A femur from a normal Chinese adult male was scanned by 64-detector row helical CT at 0. 5 mm interval. The CT images were used to establish a finite element model of the femur by software. The mid-femoral fracture was simulated in the model and fixated by eight-hole plates of Ti-6Al-4V (high modulus group, E = 110 GPa) and of Ti2448 (low modulus group, E = 30 GPa). When the femur was in axial compression, flexion and torsion loads, the stress and its distribution on the bone fracture site were analyzed to compare the biomechanics of the plates with high and low moduli. Results Under axial compression load, the contact stress between fracture ends in the low modulus group was larger than that in the high modulus group, while the max stress at the hole (11.47MPa) was smaller than that in the high modulus group (13.89 MPa) . Under four-point bending load, the contact stress in the low modulus group was still larger, while the bending movement was smaller. Under the torsion load, stress on the femur was well-distributed in both groups, but the max stress at the hole in the low modulus group (11.47 MPa) was smaller than that in the high modulus group (31.24 MPa). Conclusions Under internal fixation by plates of low modulus, the stress stimulus at the fracture site may be increased,while the stress concentrated at the hole may be decreased. The stress shielding of the low modulus plate may also be modified.

Objective To analyze the security and effectiveness of the accurate resection and reconstruction of pelvic tumor with computer navigation and to evaluate the feasibility of pelvic ring structure and mechanics reconstruction using finite element analysis.Methors From December 2008 to June 2010,tumor resections assisted by computer navigation technology and pelvic reconstructions with assembly prosthesis designed by finite element analysis were performed in 12 patients with internal hemi-pelvic malignant tumors.There were 8 male and 4 female patients,with the average age of 39.7 years(range,25-53).The malignant tumors involved chondrosarcoma(4 cases),osteosarcoma(2),Ewing sarcoma(2),malignant fibrohistiocytoma(1),and metastatic tumor(3,in which including renal cell carcinoma 1 case,thyroid carcinoma 1,and breast carcinoma 1).According to Enneking staging classification,there were 1 case in Ⅰ A,2 cases in ⅠB,2 cases in Ⅱ A.and 4 cases in Ⅱ B.The local recurrence of tumor and functional results were followed up postoperatively.Results There were no nerves,vessels and pelvic organs injuries intra-operatively.The postoperative X-rays showed that the excised regions were proper to the preoperative schedule and en bloc resections were performed in all patients.All assembly prostheses were in satisfactory position.and the screw fixation was accordance with the finite element biomechanical analysis.All the cases were followed up for average 18.2 months (range,8-26).There were 1 case with local recurrence and pulmonary metastasis,1 case with deep infection,and 1 case with deep vein thrombosis.No prosthesis dislocation,loosening,breaking,and limb length discrepancy occurred in all patients.The average MSTS93 functional score was 70%in all patients at 6 months,and 68 % in 6 patients at 20 months follow.up.Conclusion The resection and reconstruction of pelvic tumor assisted by computer navigation is a safe and effective procedure.The finite element analysis can provide accurate biomechanical guidance to the reconstruction of pelvic ring.

Thymopentin (TP5) and bursopentin (BP5) are both immunopotentiators. To explore whether the TP5-BP5 fusion peptide (TBP5) has adjuvant activity or not, we cloned the TBP5 gene and confirmed that the TBP5 gene in a recombinant prokaryotic expression plasmid was successfully expressed in Escherichia coli BL21. TBP5 significantly promoted the proliferation of thymic and splenic lymphocytes of mice. The potential adjuvant activity of the TBP5 was examined in mice by coinjecting TBP5 and H9N2 avian influenza virus (AIV) inactivated vaccine. HI antibody titers, HA antibodies and cytokines levels (IL-4 and IFN-γ) were determined. We found that TBP5 markedly elevated serum HI titers and HA antibody levels, induced the secretion of both IL-4 and IFN-γ cytokines. Furthermore, virus challenge experiments confirmed that TBP5 contributed to inhibition replication of the virus [H9N2 AIV (A/chicken/Jiangsu/NJ07/05)] from mouse lungs. Altogether, these findings suggest that TBP5 may be an effective adjuvant for avian vaccine and that this study provides a reference for further research on new vaccine adjuvants.
Adjuvants, Immunologic ; pharmacology ; Animals ; Antibodies, Viral ; blood ; Cell Proliferation ; drug effects ; Influenza A Virus, H9N2 Subtype ; drug effects ; physiology ; Influenza Vaccines ; immunology ; Interferon-gamma ; immunology ; Interleukin-4 ; immunology ; Lymphocytes ; drug effects ; Mice ; Oligopeptides ; immunology ; Orthomyxoviridae Infections ; drug therapy ; Recombinant Fusion Proteins ; immunology ; Spleen ; cytology ; Thymopentin ; immunology ; Thymus Gland ; cytology ; Vaccines, Inactivated ; immunology ; Virus Replication

Objective To assess the value of bedside gastrointestinal ultrasound combined with gaswater alternate injection on nasointestinal tube positioning in critically ill patients.Methods A total of 62 critically ill patients requiring post-pyloric enteral nutrition admitted to the intensive care unit in our Hospital from May 1,2017 to December 1,2017 were enrolled.Nasointestinal tubes were blindly inserted in a bedside setting.Then,we evaluated the nasointestinal tube position using both an ultrasound with gas-water alternate injection and the traditional auscultation method after gas perfusion.Abdominal X-ray imaging was also performed in all cases as the gold standard,and the sensitivities,specificities,positive predictive values,negative predictive values,and accuracies of the tested methods were obtained.Results Sixty-two patients were confirmed by X-ray,wherein 55 were successfully catheterized and 7 were ectopic.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of ultrasound-assisted gas-water injection were 90.9％,100％,100％,58.3％,and 91.9％,respectively,which were all higher than those of traditional gas perfusion auscultation (P ＜ 0.05).Conclusion The bedside gastrointestinal ultrasound with gas-water alternate injections for nasointestinal tube positioning in critically ill patients has a certain clinical value.

Objective To evaluate the six scoring systems and four laboratory tests,including pancreatitis outcome prediction (POP),Ranson score,bedside index for severity in acute pancreatitis (BISAP),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),systemic inflammatory response syndrome (SIRS),and Glasgow score as well as four laboratory tests including C-reactive protein (CRP),hematocrit (HCT),blood urea nitrogen (BUN) and serum creatinine (Scr) in the prognostic assessment of severe acute pancreatitis (SAP).Methods From January 2016 to December 2017,at Sir Run Run Shaw Hospital,151 SAP patients who met the enrollment criteria were retrospectively analyzed.According to the time from onset to treatment,the patients were divided into less than three days group (n=102) and over three days group (n=49).The evaluation of six scoring systems and four laboratory tests,including CRP,HCT,BUN and Scr at 0,24 and 48 h after hospitalization in the prognostic assessment of SAP patients was measured by receiver-operating characteristic (ROC) curve.Results The Ranson score had the highest area under curve (AUC) value (0.916) in the evaluation of the prognosis of SAP patients less than three days group followed by BISAP,APACHE Ⅱ,Glasgow and POP score,and their AUC values were 0.832,0.823,0.793,and 0.787,respectively,all of them were statistically significant in the prognostic assessment of SAP patients in less than three days group (all P＜0.05).There were statistically significant of BISAP and APACHE Ⅱ scores in the prognostic evaluation of SAP patients in over three days group (both P＜0.05),and the AUC values were 0.751 and 0.735,respectively,which were less than those of SAP patients in less than three days group.There were statistical significance of BUN and Scr at 24 and 48 h after hospitalization in the prognostic assessment of SAP patients in less than three days group (all P＜0.05),and the AUC values were 0.856,0.853 and 0.793,0.874,respectively.There were statistical significance of BUN at 0,24,48 h and Scr at 48 h after hospitalization in the prognostic assessment of SAP patients in over three days group (all P＜0.05),and the AUC value was 0.709,0.754,0.742 and 0.716,respectively.Conclusions Ranson,POP and Glascow score systems are only suitable for patients with SAP less than three days.APACHE Ⅱ,BISAP score systems,BUN and Scr can be used to evaluate patients with SAP over three days,but are more suitable for patients with SAP less than three days group.

Surgery is the most effective way to cure non-small cell lung cancer currently. Although sleeve lobectomy, with less reduction of respiratory function and a lower mortality rate, would not compromise oncological results in well-selected patients with central lung cancer, pneumonectomy is still necessary when complete resection could not be achieved by other surgical procedures. Cardiopulmonary complications are the most common complication after pneumonectomy. Fully understanding the related complications after pneumonectomy can help surgeons make a diagnosis timely, and further take relevant measures to reduce the adverse effects of postoperative complications on patients. What's more, in order to avoid postoperative complications and improve the prognosis of patients as much as possible, it is necessary to fully understand the risk factors to minimize the risk and to make the patients benefit from pneumonectomy as much as possible.

Common iliac artery ureteral fistula is a rare but potentially life-threatening disease which is difficult to diagnose clinically. This paper reports a case of common iliac artery ureteral fistula. The patient was admitted to our hospital due to ureterostomy bleeding for one day. He underwent radical cystectomy and bilateral ureterostomy for bladder cancer 4 years ago, and also underwent radiotherapy and bilateral ureteral stents indwelling after the operation. Angiography revealed a left common iliac artery pseudoaneurysm, and a left common iliac artery ureteral fistula was considered. The left common iliac artery stent-graft was implanted. The patient recovered well after the operation, and there was no obvious hematuria during follow-up period of 6 months.

Objective:To explore the advantages of the novel individualized 3D printing artificial vertebral body in spine reconstruction and to evaluate its clinical effect.Methods:From January 2017 to December 2018, the 15 patients who underwent total vertebrectomy and spine reconstruction with individualized 3D printing artificial vertebral body were analyzed retrospectively. There were 8 males and 7 females, with the mean age 39.5 years (range: 20-57), including 12 primary tumors and 3 metastatic tumors. According to tumor location and surrounding soft tissue invasion range, simple posterior or combined anterior and posterior approach were used for total vertebral resection, and the defection was reconstructed by 3D printing artificial vertebral body. The operation time, intraoperative bleeding volume, postoperative stability of artificial vertebral body and bone ingrowth of adjacent vertebral body, preoperative and postoperative neurological changes, preoperative and postoperative VAS score, local control and survival of patients were analyzed.Results:The mean operation time was 412.0 min (range: 135-740 min), and the mean blood loss was 4 140.0ml (range: 100-14 000 ml). The mean follow-up time was 23.2 months (range: 12-35 months), and no one loss to follow-up. One case had pleural rupture, one case had cerebrospinal fluid leakage and one case had L5 nerve root palsy. All patients recovered after active symptomatic treatment. Compare with the preoperative VAS score (4.7±1.1), the differences of VAS score at 7 d postoperative and last follow-up (1.6±0.6 and 1.0±0.5) were significantly reduced ( P<0.001). Three patients with Frankel grade C gradually recovered to grade D, and no change were found in grade D and Grade E patients, there was no significant improved at last follow-up. Preliminary bone growth was found between the artificial vertebral body and the adjacent vertebral body 3 months after operation. The bone growth was more obvious at 12 months post-operation, and the artificial vertebral body fused with the adjacent vertebral bodies to form bone integration. At 24 months post-operation, the integration of the artificial vertebral body was more accurate. During the follow-up period, there was no loosening or displacement of the artificial vertebral body and no failure of internal fixation. A case of hemangioendothelioma and a case of epithelioid angiosarcoma died at 33 months and 35 months postoperatively. One patient with chondrosarcoma had local recurrence at16 months post-operation. After treated with arotinib, the tumor did not progress. The other 12 patients had no tumor recurrence or distant metastasis. Conclusion:After spinal tumor resection, individualized 3D printing artificial vertebral body can be used to accurate restoration of spinal continuity, and provide nice interface matching and bone growth between artificial vertebral body and the adjacent vertebral endplates. Moreover, the immediate and long-term stability of the artificial vertebral body can meet the needs of spinal reconstruction.

Pancreatic duct stone is a sequel of chronic pancreatitis and may be found in the main ducts,side branches or parenchyma.These stones obstruct the pancreatic ducts and produce ductal hypertension,which leads to pain,the cardinal feature of CP.Surgical operation has been the preferred treatment of pancreatic duct stones in many domestic and external pancreatic medical centers.Lithotomy by longitudinal pancreatic duct incision and Roux-en-Y anastomosis of pancreatic duct to jejunum is the main and effective surgical procedure,while micro-surgery was also rational for the treatment of pancreatic duct stones.However,further studies with a larger sample size and longer follow-up duration are needed to improve the surgical technique and verify our initial results.

Objective:To evaluate the short-term efficacy and safety of 3D printing patient-matched artificial vertebral body in clinical research and application.Methods:A total of 12 patients with spinal tumors were enrolled 7 males (58.33%) and 5 females (41.67%), aged from 18 to 65 years old in The First Affiliated Hospital of Air Force military Medical University (hereinafter referred to as Xijing Hospital) and Peking University people's Hospital from September 2021 to July 2022. The spinal vertebra defect were restored by using 3D printing patient-matched artificial vertebral body after tumor resection. All patients who accepted TES and 3D printing patient-matched artificial vertebral body implantation were included according to the inclusion and exclusion criteria. The bone interface fusion was evaluated by the imaging fusion criteria of Brantigan and Steffee at 3 and 6 months after operation, the curative effect was evaluated by comparing Japanese Orthopaedic Association (JOA) score at 3 and 6 months after operation, visual analogue scale (VAS) 3 months after operation and intervertebral height at 3 and 6 months after operation with those before operation, and the safety was evaluated by adverse event recording.Results:All 12 patients completed the operation successfully, and the operation sites were thoracic vertebrae in 6 cases (50%), thoracolumbar in 3 cases (25%) and lumbar vertebrae in 3 cases (25%). All patients were followed up. The mean follow-up time was 23.92±3.23 months (range, 19-29 months). No tumor recurrence or metastasis was observed during this period. All patients were followed up at 15 days, 3 months and 6 months after operation. During the 6-month follow-up, X ray results showed that interface of bone and the vertebral body were fused in all of the 12 patients, and the effective rate of fusion was 100%. The 95% confidence interval is calculated to be (75.6%-100%). Six months after operation, the improvement rate of JOA score was excellent in 10 cases, good in 1 case, poor in 1 case, and the excellent and good rate was 91.66%. The preoperative VAS score was 4.08 ±2.47, and during the 3-month follow-up, the VAS score was improved to 1.83 ±1.59. Compared with the preoperative VAS score, the difference was statistically significant ( t=2.635, P=0.023). The intervertebral height before operation, 15 days after operation, 3 months after operation and 6 months after operation were 32.75 (25.94, 68.20), 41.09 (30.55, 70.20), 40.70 (30.23, 67.83) and 40.74 (30.23, 67.08), respectively, and there was no statistically significant difference (χ 2=0.768, P=0.857). No implant-related adverse events occurred after operation. Conclusion:The 3D printing patient-matched artificial vertebral body used in this study has satisfactory short-term efficacy and safety in the reconstruction of spinal stability after spinal tumor resection.