OBJECTIVE: Injuries and pathological changes of hard tissue(bone, tooth,etc.) are common clinical affairs. If the injuries or pathological changes are too serious to be treated with medication, they should be repaired or replaced by hard tissue replacement implants. Researches of hard tissue replacement implants have become an important research direction in biomaterial field at present. This paper is aimed to summarize the type, mechanical feature and biological properties of human hard tissue replacement implants for the indication of the direction in its development.STUDY SOURCES: Time of the search was from January 1998 to July 2004. Search range: 30 types of periodicals from CNKI digital library (Chinese Periodical Full Text database) and Science Direct digital library. Search words were hard tissue replacement implants, artificial bone,artificial root of tooth, bioceramic, and biological coat, etc. Search methods included electronic search and manual search, etc.STUDY SELECTION: Totally 200 corresponding literatures on human hard tissue replacement implants were selected for analysing and summarizing.DATA EXTRACTION: To summarize the corresponding information in the obtained research articles regarding hard tissue replacement implant.DATA SYNTHESIS: To comparatively analyze the mechanical and biological properties of each hard tissue replacement implant as well as their effects in practical application. The existing hard tissue replacement implants including metal materials, macromolecular materials, ceramics and their composite materials have been widely applied in clinics; however, their mechanical and biological properties have not been perfectly combined.CONCLUSION: It is always a key point(key point in researches) in biomedical material academia to find a replacement implant, of which the mechanical and biological properties perfectly suitable for the human hard tissues. The new generation of hard tissue replacement implants established by the application of biomimetic process, nano-technology, composite materisls and tissue engineering could hopefully satisfy the increasingly elevated demand of human beings.

Objective To compare the clinical values of impedance method,optical method and microscopy when used to detect platelet abnormal results.Methods Platelet re-examinations by optical method and microscopy were carried out in case of low confidence degree in platelet test with impedance method by XE-2100 automatic hematology analyzer,and then the results by the three methods were compared.Results Most of the low-confidence-degree results by impedance method could be corrected by re-examination by optical method,and the remained had to turn to microscopy due to unsatisfied requirements of the instrument.Conclusion Optical method has to be involved to correct the platelet abnormal results by XE2100 automatic hematology analyzer,and microscopy should be applied in case optical method doesn't work.The three methods gains advantages and disadvantages of themselves,and can be supplementaries for one another.

In the practice of building its humanistic environment of a research hospital,Nanjing Drum Tower hospital adheres to such humanistic characteristics of the hospital as humanistic concept,planning, environment,management,service,and quality.Furthermore,the hospital upholds such keys as learning, innovation, cooperation, undertaking, competition and development. High focus, high starting point planning,persistence,and down-to-earth efforts,effectively promoting hospital development.

OBJECTIVE: To analyze the correlation of methylation status of dachshund homolog 1 (DACH1) gene in tumor tissues with clinicopathological characteristics and prognosis of patients of esophageal cancer. METHODS: Tumor tissue, paracancerous tissue and normal esophageal mucosal specimens of 104 patients with esophageal cancer were collected. Methylation-specific PCR was used to determine the methylation status of the DACH1 gene. Univariate analysis and multivariate Logistic regression model were used to analyze the correlation between DACH1 methylation status and clinical pathological characteristics of the patients. Kaplan-Meier survival curve was used to analyze the relationship between DACH1 methylation status and prognostic survival of patients. RESULTS: The methylation rate of the DACH1 gene in esophageal cancer tumor tissue was 30.77% (32/104), which was higher than those in adjacent tissues (1.92%) and normal esophageal mucosa (0%) (P< 0.05). The methylation status of the DACH1gene in tumor tissues of patients did not correlate with the patient's age, gender, and pathological type (P> 0.05) but tumor differentiation, TNM staging, and lymph node metastasis(P< 0.05). The degree of tumor differentiation, TNM stage, and lymph node metastasis of patients are independent risk factors for the methylation status of the DACH1 gene. By March 2020, 89 of the 104 patients had died. Among them, the median survival foresophageal cancer patients with DACH1 gene methylation was 22 months, which was lower than 34 months of those without DACH1 methylation (P< 0.05). CONCLUSION Methylation of the DACH1 gene may be involved in the occurrence and progress of esophageal cancer. The degree of tumor differentiation, TNM stage, and lymph node metastasis of patients are independent risk factors for the methylation status of the DACH1 gene. Patients with esophageal cancer but unmethylated DACH1 gene have a longer prognostic survival.
Esophageal Neoplasms/pathology* ; Eye Proteins/genetics* ; Humans ; Lymphatic Metastasis ; Methylation ; Neoplasm Staging ; Prognosis ; Transcription Factors

Objectives:To evaluate the strategy and clinical outcomes of reimplanting biventricular cardiac resynchronization therapy (Biv-CRT) devices after transvenous removal of coronary sinus left ventricular leads due to device-related infections. Methods:A retrospective analysis was conducted on the clinical data and surgical outcomes of all patients who underwent transvenous removal of infectious coronary sinus left ventricular leads and subsequent reimplantation of Biv-CRT devices at Peking University People's Hospital from January 2013 to December 2022.Follow-up was performed to assess the incidence of complications and all-cause mortality. Results:A total of 167 patients underwent coronary sinus left ventricular lead removal due to infection,removal was successful in 161 cases (96.4％) and failed in 6 cases (3.6％).Among the patients with successful removal,109 cases (67.7％) were scheduled for Biv-CRT device reimplantation.After a median time of 7 (5,7) days,6 cases (5.5％) of reimplantation failed,while 103 reimplantations (94.5％) were successful.Among these successful reimplantation cases,102 patients (99.0％) were through the right-side approach,and 1 case (1.0％) through the left-side approach due to bilateral pocket infections.Of the 161 patients with successful removal,58 cases (36.0％) did not undergo left ventricular lead reimplantation,including 39 cases (24.2％) where the initial indications for Biv-CRT were questionable or had resolved.During the one-year postoperative follow-up,among the 103 patients who had undergone Biv-CRT device reimplantation,7 patients (6.8％) died,1 patient (1.0％) experienced pocket infection,and 1 patient (1.0％) had right atrial lead dislodgment. Conclusions:Reimplantation of Biv-CRT devices after removal of coronary sinus left ventricular leads due to infections is feasible,with a high success rate,low complication rate,and low mortality rate for right-side approach implantation.Therefore,for patients re-evaluated to have indications for repeated Biv-CRT after lead removal,right-side reimplantation of the coronary sinus left ventricular lead should be recommended.

Objective:To evaluate the safety of leadless pacemaker implantation in super-elderly patients.Methods:Eleven patients with average age of 90 (86, 92) years who underwent leadless pacemaker implantation in the Department of Cardiology, Peking University People′s Hospital from March 2021 to May 2022 were included. The clinical data and implantation information were collected. The complications (cardiac tamponade, myocardial infarction, cerebral infarction, pulmonary embolism, pacemaker reinfection, femoral vein hematoma) and death of patients were documented at 24 h, 3 d, and 1, 3, 6 months after pacemaker implantation.Results:There were 9 males and 2 females with the body mass index of 21(19, 23)kg/m 2. The underlying diseases were hypertension, diabetes, coronary heart disease, chronic kidney disease, chronic obstructive pulmonary disease, previous cerebral infarction and moderate to severe tricuspid regurgitation in 9, 9, 9, 6, 4, 4, 4 patients, respectively. The left ventricular ejection fraction was 49% (45%, 52%), the hemoglobin concentration was 118 (114, 122)g/L, 4 patients were taking anticoagulant drugs, and 6 patients were taking antiplatelet drugs. Eight patients were newly implanted with a leadless pacemaker, 2 patients were implanted after removal the old ones, and 1 case was implanted at the same time as removal. The implantation time was 45(40, 47) minutes, the X-ray exposure time was 14 (13, 15) minutes, the release time was 1 (1, 2), the threshold value was 0.50(0.38, 0.75)V/0.24 ms, the impedance was 730 (700, 770) Ω, and the perceived R-wave amplitude 8.2(6.7, 12.8) mV. During the follow-up period of 8 (6, 10) months, no patient had pacemaker dysfunction; and the threshold, R wave sensing, and impedance were stable and maintained within the normal range. No cardiac tamponade, myocardial infarction, cerebral infarction, pulmonary embolism, pacemaker reinfection or death occurred perioperatively and during the follow-up period; 1 patient had hematoma after femoral vein puncture, which improved after compression treatment. Conclusion:This single-center and small-sample study shows that leadless pacemaker implantation is safe for super-elderly patients.

Objective:To understand the spectrum of pathogens and epidemic characteristics of respiratory infectious diseases in influenza virus-negative influenza-like cases in Yantai, and provide reference for disease prevention and control and clinical diagnosis and treatment.Methods:From March 2020 to February 2021, nasopharyngeal swab samples of 233 influenza virus-negative influenza like cases were collected in all sentinel hospitals monitored by Yantai National Influenza Network Laboratory, and 22 respiratory pathogens were detected by multiple fluorescence quantitative polymerase chain reaction to analyze epidemiological characteristics.Results:The total pathogen detection rate of 233 samples was 69.96% (163/233). A total of 17 respiratory pathogens were detected. The top three pathogens were human coronavirus (HCoV, 32.62%), rhinovirus/enterovirus (RhV/EV, 17.17%) and Legionella pneumophila (LP, 16.74%). The detection rates in different age groups were 80.28% (57/71) in the 0-15 years old group, 62.65% (52/83) in the 16-30 years old group, 68.18% (30/44) in the 31-45 years old group, 64.28% (9/14) in the 46-60 years old group, and 71.43% (15/21) in the >60 years old group. There was no significant difference among the groups. Respiratory pathogens were detected throughout the year, mainly in a single pathogen carrying mode (44.21%), and there was no significant difference in the physical examination rate of respiratory pathogens in different seasons. The seasonal prevalence of various pathogens was different, and the detection rate of HCoV 229E was the highest in spring (68.75%); the detection rate of rhinovirus/enterovirus was higher in autumn (26.98%) and winter (23.08%); the detection rate of LP was high in spring (19.05%) and summer (27.27%); the detection rate of human parainfluenza virus (HPIV) in spring (22.22%) was significantly higher than that in summer (3.64%). The number of HPIV and Bordetella pertussis (Bp) detected in the 0-15 year old group was the highest, and the detection rate was statistically significant among different age groups. Conclusions:The continuous monitoring of respiratory pathogens such as HCoV, RhV, EV, LP, HPIV should be strengthened to understand their epidemiologic characteristics and the standardization of pathogenicity, which provides data support and reference for epidemiological investigation of outbreaks that may be caused by other pathogens.

Objectives:To evaluate the safety and efficacy of implantation of subcutaneous implantable cardioverter defibrillator(S-ICD)after transvenous lead extraction(TLE)in ICD patients without pacing indications. Methods:All patients who underwent TLE at Peking University People's Hospital from June 2018 to October 2023 were consecutively included.TLE indication,S-ICD implantation indication,defibrillation threshold(DFT)test,complications and postoperative follow-up were collected and analyzed. Results:A total of 11 patients with TV-ICD underwent S-ICD implantation after TLE,eight patients were males and median age were 56(44,65)years.The indications for TLE were infection and lead dysfunction.Nine patients were implanted with S-ICD for secondary prevention,and the most common cause of implantation was ion channelopathies(5 cases).The operative time for S-ICD was 51(48,58)minutes and no perioperative complications were noted.Eight patients underwent DFT testing,and 100%were successful.During a median follow up of 30(9,39)months,a total of six appropriate treatments occurred in two patients,and no complications occurred,including inappropriate treatment,ineffective treatment,infection,lead malfunction and death. Conclusions:Our study provides evidence for S-ICD implantation as a replacement after TV-ICD removal.The S-ICD implantation after TLE is safe and effective.

Objectives:To assess the clinical characteristics and lead extraction in patients with venous occlusion related to infection of cardiovascular implantable electronic devices. Methods:Clinical data of 405 patients(147 men,mean age[62.4±13.2]years)who underwent lead extraction from January 2020 to January 2024 in Peking University People's Hospital were reviewed.Contrast venography of the access vein was retrospectively analyzed.The patients were divided into venous occlusion group(n=119)and non-venous occlusion group(n=286)according to the presence or absence of venous occlusion.The clinical characteristics and lead extraction of patients in two groups were analyzed. Results:Occlusion of the access vein occurred in 119 patients(29.4%).The subclavian vein was occluded in 48 cases(40.3%),brachiocephalic vein was occluded in 37 cases(31.1%),axillary vein was occluded in 30 cases(25.2%),superior vena cava was occluded in 4 cases(3.4%).There were no significant differences between venous occlusion group and non-venous occlusion group in terms of age,sex,device type,number of leads,or anticoagulation therapy(all P>0.05).Time from implant of the initial leads was significantly longer in the venous occlusion group than in the non-venous occlusion group([10.4±3.8]years vs.[5.9±4.1]years,P=0.042).Clinical extraction success rate and complications were similar between the venous occlusion group and the non-venous occlusion group(both P>0.05).Procedural duration and fluoroscopy exposure time were significantly lower in non-venous occlusion group than in the venous occlusion group(both P<0.05).Patients in the venous occlusion group required more advanced tools(such as laser sheaths,evolution sheaths,and needle's eye snares)for lead extraction compared to patients in the non-venous occlusion group(84.0%vs.67.1%,P=0.001). Conclusions:The incidence of venous occlusion related to infection of cardiovascular implantable electronic devices is 29.4%.Time from implant of the initial leads is significantly longer and lead extraction is more difficult in patients with venous occlusion,and requires more advanced tools and more time to achieve the successful lead extraction.

BACKGROUNDCardiac resynchronization therapy (CRT) on patients with advanced and refractory heart failure has made remarkable progress. Clinically, notched QRS (nQRS) is commonly seen on electrocardiographs (ECGs) with bundle branch block morphology and on paced ECGs after implantation of a CRT device, which may reflect the heterogeneity of ventricular myocardial depolarization and electrical activity. The aim of this study was to determine whether patients with more nQRS myocardial segments on paced ECGs had a worse response to CRT than patients with fewer nQRS myocardial segments.

METHODSWe prospectively enrolled 56 patients of CRT with chronic heart failure from People's Hospital affiliated to Peking University from January 2007 to October 2013. Based on nQRS segments on ECGs before CRT, we allocated them to two groups: fewer nQRS (<2) myocardial segments (lateral, inferior, anterior segments) group (F-nQRS, G1, n = 23) and more nQRS (≥2) myocardial segments group (M-nQRS, G2, n = 33). Then according to nQRS segments on ECGs after CRT, we divided them into two groups similarly: fewer nQRS (<2) myocardial segments group (G3, n = 24) and more nQRS (≥2) myocardial segments group (G4, n = 32). This study was approved by the ethics committee of People's Hospital.

RESULTSAt 6 months in the baseline-ECG group, there was a greater absolute increase in left ventricular ejection fraction (LVEF) in G2 than in G1 ((11.5±8.9)% vs. (5.5±10.4)%, P = 0.023), with the incidence of nonresponse lower in G2 than in G1 (9.1% vs. 39.1%, P = 0.018). In the paced-ECG group, the absolute increase in LVEF was less in G4 than in G3 ((6.4±8.8)% vs. (12.5±10.4)%, P = 0.024) and the incidence of nonresponse was higher in G4 than in G3 (31.3% vs. 8.3%, P = 0.039). Multivariate analysis showed that fewer nQRS (<2) myocardial segments on paced ECGs (odds ratio 13.920) was a predictor of positive response to CRT.

CONCLUSIONnQRS ≥2 myocardial segments (lateral, inferior, anterior) on paced ECGs may predict a poor response to CRT.

Aged ; Cardiac Resynchronization Therapy ; Electrocardiography ; Female ; Heart Failure ; therapy ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies