OBJECTIVE: The success of joint prosthesis greatly depends on the materials, which should be a perfect combination of physics, chemistry, biomechanics and clinical sciences in choice of them. In addition, the effect of manufacture technology can not be neglected. So, it is significant to probe into the systematic basis in materials selection of joint prosthesis.DATA SOURCES: A computer-based search was conducted in Pubmed database for articles about joint prosthesis published before April 2006 with the key words of "artificial joint materials, biomaterial", and the language was limited to English. Meanwhile, Chinese Journal Full-text Database (CJFD) and Wanfang database were looked for relevant literatures published before April 2006 with the key words of "artificial joint material, biomedical material", and the language was limited to Chinese. Besides,the standards for materials were searched in Chinese service net for standard consultation with the key words of "implants for surgery" in both Chinese and English. At the same time, relevant books were also manually searched.STUDY SELECTION: Data were checked in the first trial, and related articles according to the criteria of research were looked for the full text.Inclusion criteria: ① Requirements for artificial joint material. ② Relevant standards for artificial joint of surgical implants. Exclusion criteria: Repetitive studies were excluded.DATA EXTRACTION: A total of 390 domestic and overseas articles,which were in relation to the mechanical properties of artificial joint material and bone and measurement of the overall dimensions of knee joint,were collected. There were still 242 relevant standards, while the repetitive studies and similar researches were excluded. Ten typical articles and 25 standards in collection were summed up and reviewed.DATA SYNTHESIS: ①Close combination of physics, chemistry, biomechanics and clinical sciences is sufficiently embodied in the selection of the materials. ② Two aspects must be taken into consideration: Requirements for function of the implant and the responses inside the human body.③ Main types of materials for joint prosthesis: biomedical metallic material, biomedical inorganic material of nonmetal, bioceramic, biomedical compound materials and so on. All kinds of materials that have been adopted should accord with the international or state or trade standards.④ The final determination of materials should meet the comprehensive requirements of standards, laws and regulations, as well as strategic targeting. CONCLUSION: Based on engineering, the fundamental principles of materials selection for joint prosthesis are illustrated from the following angles: clinical requirements for materials of replacement, attentions in joint prosthesis design, commonly used biomedicine materials performance, requirements of product registration and laws & regulations related to the materials, the strategy in the choice of material standard etc. As a result, a valuable system approach is provided for joint-prosthesis designers to select materials.

Objective To evaluate the efficacy and safety of levosimendan applied in patients with chronic heart failure combined with acute ST -elevation myocardium after direct percutaneous coronary intervention (PCI). Methods Using the random number table method,95 patients with heart failure combined with acute ST -elevation myocardium after direct PCI were randomly divided into two groups:the general treatment group and the levosimendan group.The levels of serum NT -proBNP,LVSD,LVEF before and after 24h,one week treatment were examined.After the experiment,clinical assessment was performed to evaluate the efficacy and safety of levosimendan.Results The resuits of NT -proBNP,LVEF and LVSD in the general group before treatment were (5 908.1 ±33.2)ng/L, (36.7 ±4.3)% and (6.1 ±0.6)cm,while those were (3 478.5 ±19.3)ng/L,(45.0 ±6.3)%,(5.9 ±0.3)cm, (3 375.2 ±32.1)ng/L,(48.3 ±5.4)% and (5.8 ±1.1)cm after 24h and 1 week treatment.The level of serum NT-proBNP decreased,while the LVEF increased in general treatment group after 24h treatment(t =3.86,4.11,P =0.021,0.015).The same results happened after 1 week treatment(compared with before treatment,t =4.13,5.06, P =0.016,0.013,compared with 24 hours after treatment,t =3.96,4.77,P =0.021,0.015).But the level of the LVSD had no differences before and after 24h,1 week treatment(P >0.05).The results of NT -proBNP,LVEF and LVSD in the levosimendan group before treatment were (3 340.5 ±19.2)ng/L,(43.3 ±3.9)%,(5.3 ±0.7)cm, (2 938.3 ±12.8)ng/L,(52.7 ±8.2)% and (4.6 ±0.2)cm after 24h and 1 week treatment.The levels of serum NT -proBNP,LVSD decreased,while the LVEF increased in the levosimendan group after 24h,1 week treatment(t =6.07,6.49,5.73,P =0.010,0.008,0.011.t =6.55,7.05,5.33,P =0.009,0.007,0.012).Compared with the general treatment group,the levels of serum NT -proBNP,LVEF showed no differences(all P >0.05),but the level of the LVSD decreased after 24h treatment(t =4.84,P =0.015)in the levosimendan group.The levels of serum NT -proBNP,LVSD decreased,while the LVEF increased in the levosimendan group after 1 week treatment compared with the general treatment group(t =6.60,7.01,5.40,P =0.007,0.007,0.011 ).After one week treatment,the effective and beneficial rates of the levosimendan group were 66.6% and 95.6%,while those were 59.6% and 89.5% in the general treatment group.The therapeutic effects of levosimendan group were more effective than the general treatment group after 1 week treatment(χ2 =9.72,15.63,P =0.015,0.008),but had no statistical differ-ences between the two groups after 24h treatment(P >0.05).There was no statistical differences between the two groups in the rate of adverse reactions.Conclusion Levosimendan has very favorable efficacy and safety for patients with chronic heart failure combined with acute ST -elevation myocardium infarction after direct PCI.

Objective To evaluate the plasma levels of D‐dimer in lung cancer and pulmonary tuberculosis (PTB) patients and their clinical significances .Methods The plasma of 130 patients with lung cancer ,126 patients with PTB and 50 healthy controls were collected .All the patients were enrolled in Beijing Affiliated to Chest Hospital Capital Medical University ,from July 2014 to October 2014 .Full‐automatic analyzer was used to examine the level of plasma D‐dimer .Results The levels of plasma D‐dimer in patients with lung cancer were significantly higher than patients with PTB and healthy controls (Z=2 .704 ,P<0 .01);The levels of plasma D‐dimer in patients with PTB were significantly higher than healthy controls (Z=2 .54 ,P<0 .05);The levels of plasma D‐dimer were significantly higher in stages Ⅲ and Ⅳ than stages Ⅰ and Ⅱ(Z=2 .195 ,P<0 .05);The positive rate in patients with lung cancer was significantly higher than patients with PTB (χ2 =10 .525 ,P<0 .01) .Conclusion Activation of coagulation and fi‐brinolysis exist in lung cancer and PTB patients ,the level of plasma D‐dimer is related to the clinical stage of lung cancer .

Objective:To study the effects of ~(125)I-(α_v)ASODN on the in vitro invasive ability of heptocellular carcino-ma cell line(HepG2) through PEI-RGD-mediated receptor process. Methods: Intergrin α_v-specific antisense oligonucle-otide was labeled with ~(125)I, and PEI-RGD/~(125)I-(α_v)ASODN complex was prepared by combining ~(125)I-(α_v)ASODN with polyethyleneimine derivative PEI-RGD. PEI-RGD/~(125)I-(α_v)ASODN complex was transferred into HepG2 cells through the receptor-mediated process. The effect of PEI-RGD/~(125)I-(α_v)ASODN complex on the invasive ability of HepG2 cells was examined by Boyden chamber invasive assay. Results: (1) The labeling yield and radiochemical purity of ~(125)I-(α_v) ASODN were(73.78±4.09)% and(96.68±1.38)%, respectively, and the labeled compound had a good stability in vitro after 48 h at 37℃; (2) The ability of HepG2 cells to uptake PEI-RGD/~(125)I-(α_v)ASODN reached its peek ([12.77±0.85] % ) when PEI-RGD/~(125)I-(α_v)ASODN was at 4 μl/2 μg ([12.77±0.85] %), and then gredually decreased thereafter. So the dosage of PEI-RGD/~(125)I-(α_v)ASODN for the following experiment was chosen as 2 μl/1 μg; (3) The invasive capacity of HepG2 cells was significantly reduced in PEI-RGD/~(125)I-(α_v)ASODN group compared with those in other experiment and control groups (P <0.01 ). Conclusion: ~(125)I-(α_v)ASODN mediated by PEI-RGD can effectively inhibit the invasive capacity of HepG2 cells.

Objective: To investigate the factors related to cardiac dysfunctions during the percutaneous coronary intervention (PCI) in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Methods: Patients diagnosed as NSTEACS receiving PCI from September 2007 to June 2018 were collected in the data base of medical record management system in Qingdao Eighth People′s Hospital. Patients with cardiac dysfunctions (≥ Killip Ⅱ grade) within 1 week after PCI were included into the case group, while patients with normal cardiac function (Killip Ⅰ grade) within 1 week after PCI were included into the control group. Firstly, baseline data of age, gender, histories of hypertension, histories of type 2 diabetes, histories of high cholesterol, histories of smoking, histories of drinking, histories of myocardial infarction, NSTEACS risk stratifications, the application of platelet glycoprotein (GP)Ⅱb/Ⅲa receptor antagonists, coronary artery SYNTAX scores, the dose of contrast agent during PCI, the peak cardiac troponin (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) within 24 h after admission was compared between the two groups; then, factors with statistical differences (P < 0.05) were analyzed by the multivariate logistic regression; at last, variables screening was performed through the backward method and likelihood ratio test. Results: A total of 3927 patients with NSTEACS receiving PCI were enrolled. After patients with incomplete information were eliminated, 313 patients were admitted to the case group and 2 906 patients were admitted to the controlled group. After the analysis of multivariate logistic regression and variables screening, it showed that >80 years old (OR = 1.758, 95% CI 1.129 to 2.367, P = 0.014), increased dose of contrast agent (OR = 1.083, 95% CI 1.007 to 1.274, P = 0.020), the peak cTnT>0.2 μg/L (OR = 2.102, 95% CI 1.703 to 3.104, P = 0.031) and NT-proBNP>450 ng/L (OR = 2.243, 95% CI 1.863 to 3.257, P = 0.015) after admission were the risk factors of cardiac dysfunctions. Conclusions Advanced age (>80 years old), increased dose of contrast agent during PCI, the peak cTnT>0.2 μg/L and NT-proBNP>450 ng/L within 24 h after admission could raise the risk of cardiac dysfunctions in patients with NSTEACS after PCI.

Objective To investigate the factors related to slow-flow (SF) or no-reflow (NR) during the percutaneous coronary intervention (PCI) in patients with non-ST segment elevation acute coronary sydrome (NSTEACS). Methods Patients diagnosed as NSTEACS who received PCI from September 2007 to June 2018 were collected through the data base of medical record management system in Qingdao Eighth People′s Hospital.The blood flow≤TIMI 2 grade during PCI was defined as slow-flow (SF) or no-reflow(NR). Patients with SF or NR were included into the case group and patients without SF or NR were included into the controlled group. Factors of age, gender, history of hypertension, history of type 2 diabetes, history of high cholesterol, history of smoking, history of drinking, NSTEACS risk stratification, the application of platelet glycoprotein (GP) ⅡB/ⅢA receptor antagonist, coronary artery SYNTAX score, culprit blood vessels, times of balloon dilatation, the burden of thrombus and the preoperative TIMI grade of blood flow were analyzed by multivariate Logistic regression. Then, variables screening was performed through backward method and likelihood ratio test. Results A total of 3 927 patients with NSTEACS receiving PCI were enrolled. After patients with incomplete information were eliminated, 143 patients were admitted to the case group and 3 588 patients were admitted to the control group. After the analysis of multivariate Logistic regression and variables screening, it was showed that times of balloon dilatation ≥ 3 ( OR＝1.725, 95% CI 1.211－2.358, P＝0.014) and high burden of thrombus ( OR＝1.821, 95% CI 1.322-2.511, P＜0.01) were the risk factors of SF or NR, while the application of GPⅡB/ⅢA receptor antagonist ( OR＝0.623, 95% CI 0.382-0.855, P＝0.012) was the protective factor of SF or NR. Conclusions Multiple balloon dilatation and high burden of thrombus increased the risk of SF or NR, while the application of GPⅡB/ⅢA receptor antagonists could inhibit the occurrence of SF or NR.

Aberrant expression of annexin A2-S100A10 heterotetramer (AIIt) associated with PML/RARα fusion protein causes lethal hyperfibrinolysis in acute promyelocytic leukemia (APL),but the mechanism is unclear.To facilitate the investigation of regulatory association between ANXA2 and promyelocytic leukemia/retinoic acid receptor α (PML/RARα) fusion protein,this work was performed to determine the transcription start site of ANXA2 promoter with rapid amplification of S'-cDNA ends analysis.Zinc-induced U937/PR9 cells expressed PML/RARα fusion protein,and resultant increases in ANXA2 transcripts and translational expressions of both ANXA2 and S100A10,while S100A10 transcripts remained constitutive.The transactivation of ANXA2 promoter by PML/RARα fusion protein was 3.29 ± 0.13 fold higher than that by control pSG5 vector or wild-type RARα.The overexpression of ANXA2 in U937 transfected with full-length ANXA2 eDNA was associated with increased S100A10 subunit,although S100A10 transcripts remained constitutive.The tPA-dependent initial rate of plasmin generation (IRPG) in zinc-treated U937/PR9 increased by 2.13-fold,and cell invasiveness increased by 27.6％.Antibodies against ANXA2,S100A10,or combination of both all remarkably inhibited the IRPG and invasiveness in U937/PR9 and NB4.Treatment of zinc-induced U937/PR9 or circulating APL blasts with all-trans retinoic acid (ATRA) significantly reduced cell surface ANXA2 and S100A10 and associated reductions in IRPG and invasiveness.Thus,PML/RARα fusion protein transactivated the ANXA2 promoter to upregulate ANXA2 and accumulate S100A10.Increased AIIt promoted IRPG and invasiveness,both of which were partly abolished by antibodies against ANXA2 and S100A10 or by ATRA.

Objective To analyze the clinical and imaging characteristics of pediatric neuromyelitis optica spectrum disorders(NMOSD)in children. Methods The clinical data,imaging manifestations and follow - up data of 16 NMOSD patients at Department of Pediatric Neurology,Shandong Provincial Hospital Affiliated to Shandong Univer-sity between July 2013 and September 2017 were respectively analyzed. Results In 16 patients,initial presentations included optica neuritis(ON)in 5 cases,longitudinally extensive transverse myelitis(LETM)in 6 cases,and among them there were 2 cases with acute disseminated encephalomyelitis and 3 cases with both ON and LETM. Eleven cases received aquaporin - 4(AQP4)antibody examination and 4 cases were found seropositive. One case out of 7 detected cases was found AQP4 antibody positive in cerebrospinal fluid. Eleven cases received optica magnetic resonance imaging (MRI),and 8 cases were found abnormal signals in optic nerve and optica chiasma. The spinal cord MRI showed 13 ca-ses with LETM manifestations,and abnormal signals were found in vertebral segments(5 - 13),and among them 1 case had cervical cord,3 cases were thoracic cord and 9 cases were both of the above. Lesions in the cervical cord in 2 cases were extended upward to the medulla. Fifteen cases received brain MRI and all of them had brain lesions,which were mainly involved in the central and subcortical white matter,thalamus,corpus callosum,brainstem,the junction of spinal cord and medulla,cerebellum,and so on. All patients received treatment for acute attacks with high - dose Methylpred-nisolone and/ or gamma globulin and got obvious relief. Two cases with recurrent ON received treatment of Rituximab and their vision became improved. Fifteen patients were followed up,and 2 cases had limb disorders and 4 cases had visual impairment,other patients had no clinical symptoms. Conclusions Pediatric NMOSD has a diverse clinical pre-sentation at the onset disease. Those who are initial diagnosed acute myelitis,ON and acute disseminated encephalomye-litis should be considered the possibility of NMOSD. Antibody to AQP4 testing can assist the diagnosis. The typical ima-ging characters of NMOSD children are abnormal signals in the high expression area of AQP4. Intracranial lesions are more common in children. The acute treatment includes the high - dose Methylprednisolone and gamma globulin. Rituximab can be used for the recurrent patients.

Objective To analyse the risk factors associated with spontaneous intestinal perforation (SIP) in extremely premature infants/extremely low birth weight infants. Method From January 2015 to December 2018, infants with gestational age (GA)<28 weeks or birth weight (BW)<1000 g admitted to our neonatal intensive care unit were enrolled to the retrospective nested case-control study.The clinical data of SIP infants (SIP group) and infants with the same GA but without SIP (control group) were randomly selected and compared. Multivariable Logistic regression was used to analyse the risk factors of SIP. Result A total of 409 extremely premature infants/extremely low birth weight infants were born during the study period. Among them, 25 SIP infants and 55 controls were enrolled. The incidence of SIP in infants with GA 22～25 weeks was 11.8％(16/136), which is higher than infants with GA 26～27 weeks (2.0％, 5/247) (χ2=16.057, P<0.001). The incidence of SIP in infants with BW 400～749 g was 13.0％(14/108), which is higher than infants with BW 750～999 g (3.4％, 8/236) (χ2=11.343, P=0.001). Multivariate Logistic regression analysis showed that twins (OR=4.153, 95％CI 1.392～12.384, P=0.011), umbilical veins catheterization (OR=15.942, 95％CI 1.026～247.789, P=0.048) and ibuprofen use within 3 days after birth (OR=15.387, 95％CI 1.519～155.883, P=0.021) were independent risk factors of SIP. Conclusion The smaller the GA and BW, the higher the incidence of SIP. Twins,umbilical veins catheterization and ibuprofen use early after birth may be independent risk factors of SIP.

Objective To analysis the clinical pathway management efficiency under different DRG groups, for a basis for further optimizing clinical pathway management. Methods The retrospective analysis method was used to compare the average length of stay, sub-average costs, and drug proportions of patients with different DRGs in the same clinical pathway. Shapiro-Wilk was used to detect the normality of the samples, t test was used to analyze measurement data conformed to the normal distribution, non-parametric test was used to analyze the abnormal distribution data, and enumeration data was detected by using chi-square test. Results For patients with a clinical pathway of bronchial pneumonia, patients with severe complications and concomitant symptoms had no significant difference in mean hospitalization and sub-costs, regardless of whether they completed or entered the clinical pathway ( P >0.05). For the other two DRG patients, the difference between the average length of stay, sub-average costs, and the proportion of medications for patients who completed the clinical pathway and withdrew from or did not complete the clinical pathway was significant(P<0.05). In the severe surgical group, the length of stay and average cost for patients who completed the clinical pathway were lower than those who exited or did not enter the clinical pathway(P<0.05). Conclusions Patients with different severity of DRGs should be cautious when they are enrolled in the clinical pathway.