@@

Objective To develop a new system of computer-aided design(CAD) for individual metacarpophalangeal joint prosthesis based on rapid prototyping technique. Methods A hand of cadaver was scanned with PLUS-4 spiral computed tomography (CT).Then the transaxial 2D image data of digitus metacarpophalangeal joint were reconstructed into 3D digitized contour data by 3DMSR that was designed by ourselves. Then,the intramedullary stem was designed in software of Surface 9.0. Results The 3D contour image of metacarpophalangeal joint presented was reconstructed by 3DMSR and edited by Surface 9.0 easily for CAD of individual metacarpophalangeal joint.The intramedullary cavity was like choanoid. The intramedullary stem longitude of articular head and fossa were 47.31 and 35.20 mm.The intramedullary stem fit cavity.The model fit anatomical shape. Conclusion The 3D contour image of metacarpophalangeal joint can be obtained by spiral CT scanning,and the digitized data can be applied directly to CAD of individual artificial joint and subsequently rapid prototyping fabricating.In addition,the reconstruction method is simple and can be applied widely to clinical implant fabricating practice of orthopaedics.

Objective To analyze the clinical results of surgical treatment of nerve compression of the upper limb.Methods The clinical characterisitcs treatment methods and prognosis of nerve compres sion of the upper Iimbs in 646 padents were analyzed.Results Four hundred and of them were followed up for from 6 months to 3 years.The numbness disappcared and the function five of the nerve innervation area became normal or near normal after operation in 252 cases(62.2%),improved in 124 cases(30.6%),no change or worse in 29 cases(7.2%).The excellent rate of nerve funcfion recovery were 93%after rehabilitation teatment.Conclusions The loss degree of sensorimotor function of the effected limbs provides reference for operating mode and iS closely related to nerve functional restoration.The evaluation of the loss degree of sensorimotor function of the affected limbs before the operation should be taken into account.Rehabilitation teatment after operation can promote functional restoration and prevent teratogencsis.

Objective To investigate the time-effect relationship of angiogenesis induced by ultrasound.mediated microbubble destruction in the skeletal muscle of rats.Methods Forty-eight healthy SD rats were divided into 4 groups:ultrasound-mediated microbubble destruction group,ultrasound only group,microbubble only group and control group.In ultrasound-mediated mierobubble destruction group, microbubbles were inj ected by vein at a dose of 0.5 ml and the target skeletal muscle was radiated at 2.0W/cm2.In ultrasound only group,the target skeletal muscle was radiated at 2.0 W/cm2.In microbubble only group.microbubbles were injected by vein at a dose of 0.5 ml.The control rats were without ultrasound radiation and microbubbles.On the 3rd,7th,10th,14th,21st and 28th day after the ultrasound radiation,two rats in each group were sacrificed and the target skeletal muscle was harvested for HE staining to observe the microstructure of tissue,immunohistochemistry staining was used to count the microvessel density (MVD),enzyme 1inked inmmunosorbent assay(ELISA)was used to detect the expression of vascular endothelial grouth factor(VEGF).Results Angiogenesis was significant in ultrasound-mediated mierobubhle destruction group,but a little in ultrasound only group.There was not any angiogenesis in either microbubble only group or control group.MVD and VEGF expression of ultrasound-mediated microbubble destruction group arrived at a peak on the 1Oth day as well as on the 14th day of ultrasound group.Conclusions Ultrasound-mediated microbubble destruction can facilliate the endogenous secretion of VEGF quickly and more,and accelerate the angiogenesis in the skeletal muscle.

Objective:To investigate the regulatory mechanism of PESV on tumor-infiltrating natural killer ( NK) cells in a mice model with H22 orthotopic transplantation tumor .Methods:Suspensions of H22 cells were injected into the lobe of liver on C 57BL/6 mice for establishing liver orthotopic transplantation tumor model ,then the mice were randomly divided into four groups:normal group , control group ,PESV low dose group ( PESV-L ) and PESV high dose group ( PESV-H ) .Mice were either sacrificed for mechanistic studies or survival followed 14 days of therapy.The volume and weight of the tumor were measured .The proportion of infiltrating NK cells was measured by flow cytometry and the expression of NK 1.1(NK) cells was investigated by immunohistochemistry method .The expression of perforin and granzyme B were further investigated by real-time PCR.Results: In contrast to control group , the tumor inhibition rate was 15.38%and 30.77% in PESV-L group and PESV-H group respectively.The survival showed that PESV-H could significantly prolong the survival time of mice ,and life extension rate was 34.06%,(P<0.05).Histological analysis revealed significant pleomorphism of the neoplastic cells and invasive extendion in control group ,while there were more necrosis and less degree of atypia in PESV-L and PESV-H.The level of tumor-infiltrating NK cell was significantly higher in PESV-H than in tumor-bearing control group [(5.91±0.49)%vs.(3.69±0.50)%,P<0.05],and NK cells were infiltrating in peritumoral lesions.The mRNA of perforin and granzyme B in PESV-H were respectively 3.62 and 5.82 times than that of control group ( P<0.05 ) .Conclusion: These findings suggest that the treatment of PESV might increase the infiltration of natural killer cells in the orthotopic transplantation tumor and contribute to NK cells migration to the tumor , which induct and maintain the activities of natural killer cells against tumor cells by expressing perforin and granzyme B in vivo .

Objective To investigate the effects and the mechanism of sorafenib on hepatocellular car-cinoma growth and vasculogenic mimicry (VM)in mice.Methods A subcutaneous implantation mouse model of human hepatocellular carcinoma (HCC)HepG2 cells were established.Mice inoculated with HepG2 cells were randomly divided into the treatment group (sorafenib 30 mg·kg -1 ·d -1 )and the control group by using of paired comparison method.Growth of established tumor xenografts was monitored at least twice weekly by vernier caliper measurements.VMwas assessed by immunohistochemical assay and periodic acid schiff reaction (PAS)histochemical double-staining.The expressions of HIF-1 α,VEGFA,VEGFR-1 and MMP-2 in tumor tissues were also assessed by immunohistochemical assay,Western blotting and real-time quantitative PCR. Results The tumor volume in the sorafenib group was obviously decreased compared with the control group (809.69 mm3 ±208.71 mm3 vs 1 678.00 mm3 ±31 3.29 mm3 ),with a statistically significant difference (t =6.1 03,P =0.030).Haematoxylin and eosin (HE)staining showed that tumor tissues treated with sorafenib were characterized by obvious necrosis,but there were not the same cases in the control group.Sorafenib group significantly reduced the number of tumor functional vessel in HepG2 xenografts compared with the control group,as assessed by tumor vasculature uptake of DiOC7 (4.77 ±0.1 5 vs 8.44 ±0.68,t =9.1 92,P =0.01 3).The number of VMwas significantly decreased by sorafenib (1 .04 ±0.46 vs 2.66 ±0.42,t =4.51 0, P =0.041 ).Relative to controls,CD31 -positive vessels decreased after treatments (3.42 ±0.1 0 vs 1 .26 ± 0.1 4),with a statistically significant difference (t =21 .580,P =0.002).Compared with the control group, the protein levels of HIF-1 α(0.65 ±0.03 vs 1 .00 ±0.00),VEGFA (0.51 ±0.02 vs 1 .00 ±0.00), VEGFR-1 (0.45 ±0.04 vs 1 .00 ±0.00)and MMP-2 (0.69 ±0.02 vs 1 .00 ±0.00)were significantly decreased in the sorafenib group (t =1 9.650,P =0.003;t =40.493,P =0.000;t =23.429,P =0.002;t =26.071 ,P =0.002).Compared with the control group,the mRNA levels of HIF-1 α(0.78 ±0.05 vs 1 .00 ±0.00),VEGFA (0.52 ±0.05 vs 1 .00 ±0.00),VEGFR-1 (0.45 ±0.02 vs 1 .00 ±0.00)and MMP-2 (0.71 ±0.02 vs 1 .00 ±0.00)were also significantly decreased in sorafenib group (t =6.840,P =0.021 ;t =27.71 0,P =0.001 ;t =62.740,P =0.000;t =23.850,P =0.002).Conclusion Sorafenib can inhibit the tumor growth and VMchannels formation,which may be related with the HIF-1 αand VEGFA /VEGFR-1 signa-ling pathway.

Background and purpose:The most clearly recognized benefit of neoadjuvant chemotherapy (NAC) is that it can increase the proportion of patients who can be treated with breast-conserving therapy (BCT). However, the shrinkage modes of the primary breast tumor after NAC have been conifrmed as a predictor of BCT rate and prognosis. This study is to evaluate the accuracy of MRI predicting the shrinkage mode of the primary breast tumor after NAC with three-dimensional reconstruction technique.Methods:Sixty-one women with pathologically proven solitary invasive ductal carcinoma (ⅡA-ⅢC) were recruited. Breast specimens were prepared with PMSS, and residual tumors were microscopically outlined, scanned and registered by PHOTOSHOP software. The 3D model of residual tumors was reconstructed with 3D-DOCTOR software based on pathology and MRI imaging characteristics to evaluate the shrinkage mode. We devided the pathological shrinkage modes into surgical pCR (no residual tumors), solitary lesions without surrounding lesions, multinodular lesions, solitary lesions with adjacent spotty lesions and diffuse lesions. Further, the clinical-pathological shrinkage modes were divided into 2 categories: distinct shrinkage mode (DSM, the longest diameter of the pathological residual tumors was less than 50% and ≤2 cm in comparison with the primary tumor before NAC) and non-distinct shrinkage mode (NDSM, the longest diameter of the pathological residual tumors was more than 50% and/or >2 cm in comparison with the primary tumor before NAC).Results:The surgical pCR, solitary lesions without surrounding lesions, multinodular lesions, solitary lesions with adjacent spotty lesions and diffuse lesions were observed in 23, 17, 5, 9, 7 and 18, 3, 13, 20, 7 patients by MRI and pathology, respectively (P=0.001). The accuracy, sensitivity and speciifcity of MRI for predicting pathological shrinkage modes were 86.2%, 65.6% and 91.4%, respectively. The DSM was observed in 36 (59.0%) patients by pathology, and 38 (62.3%) patients by MRI. Two methods had a high consistency in clinical-pathological shrinkage modes (κ=0.863,P=0.000). The accuracy, sensitivity and speciifcity of MRI for predicting clinical-pathological shrinkage modes were 91.0%, 64.0% and 94.8%, respectively. There was not a statistic difference in prediction between DSM and NDSM by MRI (P>0.05). Receiver operating characteristic (ROC) curve analysis showed an AUC of 0.928 (P=0.000) for MRI to predict the clinical-pathological shrinkage mode.Conclusion:Three-dimensional MRI reconstruction after NAC could simulate and predict spatial location of residual tumors, and can be helpful in selecting patients who received BCT after NAC with tumor downstaging.

OBJECTIVE: To analyze the differences of sleep respiratory parameters recorded by PSG and synchronous blood pressure measured by ambulatory blood pressure monitor between obstructive sleep apnea (OSA) patients with hypertension (HT) and simple OSA and simple HT; To determine the characteristics of sleep respiratory parameters and blood pressure changes in patient with OSA accompanied HT. METHOD: We chose the patients who were diagnosed simple HT (n=45) and simple OSA (n=50) and OSA with HT (n=56), Compared the sleep respiratory parameters and blood pressure changes between the three groups. Meanwhile the correlations about the sleep respiratory parameters and synchronization blood pressure were analyzed. RESULT: Compared with simple HT and simple OSA, OSA with HT has higher apnea hyponea Index (AHI) (P<0. 001), oxygen desaturation index (ODI), awake index (AI), wake after sleep onset (WASO) and the proportion of non-rapid eyemovement sleepl (N1) in total sleep time(TST), has lower mean arterial oxygen saturation (MSaO2), lowest arterial saturation oxygen (LSaO2), the proportion of slow wave sleep (SWS) and rapid eyemovement sleep (REM) in TST (P<0. 05). There were positive correlations between the systolic/diastolic blood pressure (SBP/ DBP) and AHI, ODI, AI, WASO and N1/TST (P<0. 05). Compared with simple OSA, the mean day systolic blood pressure (dMSP), mean night systolic blood pressure (nMSP), mean day diastolic blood pressure (dMDP), mean night diastolic blood pressure (nMDP) and mean night diastolic blood pressure (nMDP) were significantly decre- sed, meanwhile the difference between the average systolic/diastolic blood pressure day and night were significantly increased after continuous positive airway pressure (CPAP) treatment. OSA with HT has higher There were negative correlations between the SBP/DBP and MSaO2, LSaO2 (P<0. 05). Blood pressure mainly changed in the later sleep stage when the REM phase was increased. Blood pressure changes were characteristic of increasing DBP and decreasing SaO2. CONCLUSION There are significant differences between simple OSA and OSA with HT in the sleep respiratory parameters, which are closely related with changes of blood pressure in sleep stage; AHI is the high risk factor of the OSA with HT. PSG is a effective factor in estimating the OSA accompanied HT course of development and prognosis.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Continuous Positive Airway Pressure ; Humans ; Hypertension ; complications ; Polysomnography ; Sleep ; Sleep Apnea, Obstructive ; complications ; diagnosis ; Sleep Stages

Objective To explore the effect and safety of enhanced recovery after surgery (ERAS) in the surgical treatment of common bile duct stones.Methods According to random number table,48 patients with common bile duct stones were randomly divided into the ERAS group and the control group.The patients of the control group received the traditional perioperative management and laparotomy exploration of common bile duct.The patients of the ERAS group received the ERAS perioperative management and laparoscopic exploration of common bile duct.The preoperative and postoperative level of C reactive protein (CRP),time to out-of-bed activity,time to food taking,time to anal exsufflation,postoperative hospital stay,hospitalization cost and postoperative complications between the two groups were compared.Results Compared with the control group,the ERAS group had lower levels of CRP on the postoperative 1 day and 3 days[d1:(102.6±13.5) mg/L vs.(81.3±17.3)mg/L;d3:(71.8±15.3)mg/L vs.(41.2±11.2)mg/L,t=2.553,3.287,all P<0.05],had shorter time to out-of-bed activity[(3.2±1.8)d vs.(0.9±0.4)d],time to food taking[(4.3±1.9)d vs.(1.8±1.2)d] and time to anal exsufflation[(2.5±0.7)d vs.(1.2±0.3)d],and had shorter operative hospital stay[(7.3±3.2)d vs.(3.8±1.4)d]and less hospitalization cost[(7 200±800)RMB vs.(5 900±700)RMB] (t=5.561,4.319,3.765,2.351,1.671,all P<0.05).The incidence rate of postoperative complications of the ERAS group decreased markedly (61.91% vs.18.52%,x2=25.82,P<0.05).Conclusion ERAS management in the surgical treatment of common bile duct stones is safe and effective,which can enhance the recovery of the patients.

This paper briefly introduces the working procedure of in vitro diagnostic products (IVD) industrial standards, and elaborates the importance of professional standards for production and supervision. Based on the analysis of working progress during the past 10 years, some problems and countermeasures on project setting, participation, standard material, personnel training, work cycle are put forward, which are helpful for the future development of the IVD.
Diagnostic Techniques and Procedures ; standards ; Humans ; Reference Standards