Based on the actual situation of rapid increase in obesity prevalence and the current lack of a professional weight loss and bariatric surgery treatment platform in Macao, coupled with the continouous rise in the obesity population, the further development and refine-ment of obesity treatment methods has become particularly urgent. Against this backdrop, the authors conduct an in-depth discussion to analyze how Macao, leveraging its unqiue geographical location and favorable policy advantages within the broader context of collaborative development in the Guangdong-Hong Kong-Macao greater bay area, can actively explore future development paths and potential challenges in the fields of bariatric and metabolic medicine and surgery, with the aim to provide a robust reference for advancing related medical technologies in Macao, thereby enhancing the overall level of obesity treatment in the region.

Objective:To compare the effects of different automatic normal tissue objective(NTO)weights(WNTO)of Eclipse planning system on intensity modulated radiation therapy(IMRT)of fixed field for abdominal tumor.Methods:Twenty patients with rectal cancer and twenty patients with cervical cancer who received radiotherapy in The Second People's Hospital of Huludao from September 2022 to January 2024 were selected.5 groups of different plans[WNTO20,40,60,80 and 100]were respectively formulated for each patient.Among of them,the WNTO20 plan was control group,and other 4 groups were respectively WNTO40 group,WNTO60 group,WNTO80 group and WNTO100 group.Then,the differences in dosimetry and monitor units(MU)among 5 groups of plans were compared.Results:In the WNTO 80 and 100 groups of patients with rectal cancer,the conformation index(CI)values of target regions of them were respectively 1.02±0.04 and 1.00±0.03,all of which approached to 1,and the CI values of two groups were lower than that of control group,and the differences were statistically significant(t=15.986,18.422,P<0.05).The homogeneity index(HI)of WNTO 80 and 100 groups were respectively 0.09±0.12 and 0.10±0.14,which were higher than that of control group,and the differences were statistically significant(t=-1.371,-1.463,P<0.05).The 52Gy dose volume(Vmax52)of small intestine of the two groups were respectively(4.48±14.49)and(4.77±10.47)cm3,which were higher than that of control group,and the differences were statistically significant(t=-1.360,-2.005,P<0.05).The 30 Gy dose volume percentage(V30 Gy)values of the right femoral heads of the two groups were respectively(12.28±4.57)%and(10.96±4.17)%,which were lower than that of control group,and the differences were statistically significant(t=6.893,6.75,P<0.05).The 30 Gy dose volume percentage(V30 Gy)values of the left femoral head of the two groups were respectively(11.57±4.41)%and(10.17±3.78)%,which were lower than that of control group,and the differences were statistically significant(t=6.782,5.963,P<0.05).The MU value of WNTO100 group was(1254±93)MU,which was higher than that of control group,and the difference was statistically significant(t=-3.741,P<0.05).In the WNTO 80 and 100 groups of patients with cervical cancer,the CI values of target regions of them were respectively 1.03±0.32 and 1.02±0.03,all of which approached to 1,and the CI values of the two groups were lower than those of control group,and the differences were statistically significant(t=20.069,19.475,P<0.05).The HI values of them were respectively 0.07±0.05 and 0.08±0.01,which were higher than that of control group,and the differences were statistically significant(t=-12.445,-19.478,P<0.05).The V30 Gy values of the right femoral heads of the two groups were respectively(16.11±4.71)%and(14.90±4.56)%,which were lower than that of control group,and the differences were statistically significant(t=7.875,8.020,P<0.05).The V30 Gy values of the left femoral head of the two groups were respectively(15.21±3.71)%and(13.93±3.77)%,which were lower than that of control group,and the differences were statistical significance(t=7.617,7.436,P<0.05).The Vmax52 of small intestine of the two groups were respectively(0.82±1.10)and(4.47±8.81)cm3,which were higher than that of control group,and the difference was statistically significant(t=-2.985,-2.388,P<0.05).Conclusion:The WNTO80 is recommended for IMRT plan of radiotherapy on abdominal tumor,which can more quickly and better meet the assessment conditions of IMRT plan.

Objective:To compare the effects of different automatic normal tissue objective(NTO)weights(WNTO)of Eclipse planning system on intensity modulated radiation therapy(IMRT)of fixed field for abdominal tumor.Methods:Twenty patients with rectal cancer and twenty patients with cervical cancer who received radiotherapy in The Second People's Hospital of Huludao from September 2022 to January 2024 were selected.5 groups of different plans[WNTO20,40,60,80 and 100]were respectively formulated for each patient.Among of them,the WNTO20 plan was control group,and other 4 groups were respectively WNTO40 group,WNTO60 group,WNTO80 group and WNTO100 group.Then,the differences in dosimetry and monitor units(MU)among 5 groups of plans were compared.Results:In the WNTO 80 and 100 groups of patients with rectal cancer,the conformation index(CI)values of target regions of them were respectively 1.02±0.04 and 1.00±0.03,all of which approached to 1,and the CI values of two groups were lower than that of control group,and the differences were statistically significant(t=15.986,18.422,P<0.05).The homogeneity index(HI)of WNTO 80 and 100 groups were respectively 0.09±0.12 and 0.10±0.14,which were higher than that of control group,and the differences were statistically significant(t=-1.371,-1.463,P<0.05).The 52Gy dose volume(Vmax52)of small intestine of the two groups were respectively(4.48±14.49)and(4.77±10.47)cm3,which were higher than that of control group,and the differences were statistically significant(t=-1.360,-2.005,P<0.05).The 30 Gy dose volume percentage(V30 Gy)values of the right femoral heads of the two groups were respectively(12.28±4.57)%and(10.96±4.17)%,which were lower than that of control group,and the differences were statistically significant(t=6.893,6.75,P<0.05).The 30 Gy dose volume percentage(V30 Gy)values of the left femoral head of the two groups were respectively(11.57±4.41)%and(10.17±3.78)%,which were lower than that of control group,and the differences were statistically significant(t=6.782,5.963,P<0.05).The MU value of WNTO100 group was(1254±93)MU,which was higher than that of control group,and the difference was statistically significant(t=-3.741,P<0.05).In the WNTO 80 and 100 groups of patients with cervical cancer,the CI values of target regions of them were respectively 1.03±0.32 and 1.02±0.03,all of which approached to 1,and the CI values of the two groups were lower than those of control group,and the differences were statistically significant(t=20.069,19.475,P<0.05).The HI values of them were respectively 0.07±0.05 and 0.08±0.01,which were higher than that of control group,and the differences were statistically significant(t=-12.445,-19.478,P<0.05).The V30 Gy values of the right femoral heads of the two groups were respectively(16.11±4.71)%and(14.90±4.56)%,which were lower than that of control group,and the differences were statistically significant(t=7.875,8.020,P<0.05).The V30 Gy values of the left femoral head of the two groups were respectively(15.21±3.71)%and(13.93±3.77)%,which were lower than that of control group,and the differences were statistical significance(t=7.617,7.436,P<0.05).The Vmax52 of small intestine of the two groups were respectively(0.82±1.10)and(4.47±8.81)cm3,which were higher than that of control group,and the difference was statistically significant(t=-2.985,-2.388,P<0.05).Conclusion:The WNTO80 is recommended for IMRT plan of radiotherapy on abdominal tumor,which can more quickly and better meet the assessment conditions of IMRT plan.

Based on the actual situation of rapid increase in obesity prevalence and the current lack of a professional weight loss and bariatric surgery treatment platform in Macao, coupled with the continouous rise in the obesity population, the further development and refine-ment of obesity treatment methods has become particularly urgent. Against this backdrop, the authors conduct an in-depth discussion to analyze how Macao, leveraging its unqiue geographical location and favorable policy advantages within the broader context of collaborative development in the Guangdong-Hong Kong-Macao greater bay area, can actively explore future development paths and potential challenges in the fields of bariatric and metabolic medicine and surgery, with the aim to provide a robust reference for advancing related medical technologies in Macao, thereby enhancing the overall level of obesity treatment in the region.

Objective:To evaluate the clinical outcomes of right vertical infra-axillary thoracotomy technique (RVIAT) versus traditional median sternotomy (MS) for ventricular septal defect (VSD) repair in infants weighing ≤5 kg.The study further investigates the safety and feasibility of these two surgical approaches.Methods:Retrospective case-series study.Three hundred and fourteen children weighing no more than 5 kg who received VSD repair in Fuwai Central China Cardiovascular Hospital from January 2020 to June 2024 were analysized.Of these children, 252 cases who underwent RVIAT were included in the RVIAT group, and 62 cases who received traditional MS were classified as the MS group.Clinical data such as day age, body mass, the VSD type and diameter were compared between the 2 groups.The operation time, extracorporeal circulation time, block and postoperative mechanical ventilation time, intensive care unit (ICU) treatment time, 24-hour postoperative chest drainage volume and intraoperative bleeding, postoperative secondary intubation, and cardiac arrhythmia of the 2 groups of patients were recorded.Children with unstable blood pressure and active bleeding after taking vasoactive and hemostatic drugs underwent a secondary surgery.The peak airway pressure, oxygenation index, and lung dynamic compliance of the 2 groups of children were recorded before chest opening, immediately after surgery, and 24 hours after surgery. t test, χ2 test and rank sum test were used to compare the clinical data, perioperative results, complications and lung function data of the two groups. Results:(1) No significant differences were observed between the two groups in gender, age, body mass, VSD type and diameter, preoperative pneumonia, and mechanical ventilation rate (all P>0.05).(2) One-stage VSD repair was successfully completed in all cases.In the MS group, 1 infant required a secondary surgery for pericardial tamponade due to excessive bleeding.In the RVIAT group, 1 case necessitated a secondary surgery for third-degree atrioventricular block.Two cases in the MS group and 3 cases in the RVIAT group suffered postoperative arrhythmia, all of who supplemented electrolytes, received a secondary surgery to remove patches and adjust suture positions, and took antiarrhythmic drugs to restore sinus rhythm.(3) The operation time [(137.4±9.1) minutes], hospital stay [(8.2±2.1) days], postoperative mechanical ventilation time [8.0 (6.0, 13.0) hours], postoperative ICU stay [2.9 (2.0, 3.6) days], 24-hour postoperative chest drainage volume [(11.3±1.2) mL], intraoperative bleeding [(11.6±1.2) mL], and hospital costs [(70±7) thousand yuan], the postoperative incidence of incision infection [0.4%(1/252)] and the postoperative incidence of sternal malformation (0) in the RVIAT group were significantly lower than those in the MS group [(151.9±20.2) minutes, (13.1±1.7) days, 12.0 (9.0, 15.0) hours, 2.9 (2.5, 3.7) days, (14.3±1.6) mL, (15.8±2.0) mL, (78±4) thousand yuan, 4.8%(3/62), and 4.8%(3/62), respectively] (all P<0.05).There was no significant difference in extracorporeal circulation time, aortic occlusion time, postoperative arrhythmia rate, residual shunt, and atelectasis between the two groups (all P>0.05).(4) The peak airway pressure, oxygenation index and lung dynamic compliance before chest opening, immediately after surgery, and 24 hours after surgery did not differ significantly between the two groups (all P>0.05). Conclusions:In infants with low body mass (≤5 kg), RVIAT for VSD repair offers good exposure through a small incision, capable of reducing operation time, intraoperative bleeding, postoperative hospital stay, and hospital costs, and facilitating faster recovery.With high safety and effects, RVIAT can be considered as a viable alternative to MS.

Objective To investigate the factors influencing international normalized ratio (INR)>3.0 in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement. Methods A retrospective analysis was performed on the clinical data of patients who underwent mechanical heart valve replacement surgery and received warfarin anticoagulation therapy at West China Hospital of Sichuan University from January 1, 2011 to June 30, 2022. Based on the discharge INR values, patients were divided into two groups: an INR≤3.0 group and an INR>3.0 group. The factors associated with INR>3.0 at the time of discharge were analyzed. Results A total of 8901 patients were enrolled, including 3409 males and 5492 females, with a median age of 49.3 (43.5, 55.6) years. The gender, body mass index (BMI), New York Heart Association (NYHA) cardiac function grading, INR, glutamic oxaloacetic transaminase, and preoperative prothrombin time (PT) were statistically different between the two groups (P<0.05). Multivariate logistic regression analysis revealed that lower BMI, preoperative PT>15 s, and mitral valve replacement were independent risk factors for INR>3.0 at discharge (P<0.05). Conclusion BMI, preoperative PT, and surgical site are factors influencing INR>3.0 at discharge in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement. Special attention should be given to patients with lower BMI, longer preoperative PT, and mitral valve replacement to avoid excessive anticoagulation therapy.

Although metal blocks have been widely used for reconstructing uncontained tibial bone defects, the influence of their elastic modulus on the stability of tibial prosthesis fixation remains unclear. Based on this, a finite element model incorporating constrained condylar knee (CCK) prosthesis, tibia, and metal block was established. Considering the influence of the post-restraint structure of the prosthesis, the effects of variations in the elastic modulus of the block on the von Mises stress distribution in the tibia and the block, as well as on the micromotion at the bone-prosthesis fixation interface, were investigated. Results demonstrated that collision between the insert post and femoral prosthesis during tibial internal rotation increased tibial von Mises stress, significantly influencing the prediction of block elastic modulus variation. A decrease in the elastic modulus of the metal block resulted in increased von Mises stress in the proximal tibia, significantly reduced von Mises stress in the distal tibia, decreased von Mises stress of the block, and increased micromotion at the bone-prosthesis fixation interface. When the elastic modulus of the metal block fell below that of bone cement, inadequate block support substantially increased the risk of stress shielding in the distal tibia and fixation interface loosening. Therefore, this study recommends that biomechanical investigations of CCK prostheses must consider the post-constraint effect, and the elastic modulus of metal blocks for bone reconstruction should not be lower than 3 600 MPa.
Knee Prosthesis ; Humans ; Finite Element Analysis ; Tibia/surgery* ; Elastic Modulus ; Arthroplasty, Replacement, Knee/methods* ; Stress, Mechanical ; Metals ; Prosthesis Design ; Knee Joint/surgery* ; Biomechanical Phenomena

Objective:To evaluate the clinical outcomes of right vertical infra-axillary thoracotomy technique (RVIAT) versus traditional median sternotomy (MS) for ventricular septal defect (VSD) repair in infants weighing ≤5 kg.The study further investigates the safety and feasibility of these two surgical approaches.Methods:Retrospective case-series study.Three hundred and fourteen children weighing no more than 5 kg who received VSD repair in Fuwai Central China Cardiovascular Hospital from January 2020 to June 2024 were analysized.Of these children, 252 cases who underwent RVIAT were included in the RVIAT group, and 62 cases who received traditional MS were classified as the MS group.Clinical data such as day age, body mass, the VSD type and diameter were compared between the 2 groups.The operation time, extracorporeal circulation time, block and postoperative mechanical ventilation time, intensive care unit (ICU) treatment time, 24-hour postoperative chest drainage volume and intraoperative bleeding, postoperative secondary intubation, and cardiac arrhythmia of the 2 groups of patients were recorded.Children with unstable blood pressure and active bleeding after taking vasoactive and hemostatic drugs underwent a secondary surgery.The peak airway pressure, oxygenation index, and lung dynamic compliance of the 2 groups of children were recorded before chest opening, immediately after surgery, and 24 hours after surgery. t test, χ2 test and rank sum test were used to compare the clinical data, perioperative results, complications and lung function data of the two groups. Results:(1) No significant differences were observed between the two groups in gender, age, body mass, VSD type and diameter, preoperative pneumonia, and mechanical ventilation rate (all P>0.05).(2) One-stage VSD repair was successfully completed in all cases.In the MS group, 1 infant required a secondary surgery for pericardial tamponade due to excessive bleeding.In the RVIAT group, 1 case necessitated a secondary surgery for third-degree atrioventricular block.Two cases in the MS group and 3 cases in the RVIAT group suffered postoperative arrhythmia, all of who supplemented electrolytes, received a secondary surgery to remove patches and adjust suture positions, and took antiarrhythmic drugs to restore sinus rhythm.(3) The operation time [(137.4±9.1) minutes], hospital stay [(8.2±2.1) days], postoperative mechanical ventilation time [8.0 (6.0, 13.0) hours], postoperative ICU stay [2.9 (2.0, 3.6) days], 24-hour postoperative chest drainage volume [(11.3±1.2) mL], intraoperative bleeding [(11.6±1.2) mL], and hospital costs [(70±7) thousand yuan], the postoperative incidence of incision infection [0.4%(1/252)] and the postoperative incidence of sternal malformation (0) in the RVIAT group were significantly lower than those in the MS group [(151.9±20.2) minutes, (13.1±1.7) days, 12.0 (9.0, 15.0) hours, 2.9 (2.5, 3.7) days, (14.3±1.6) mL, (15.8±2.0) mL, (78±4) thousand yuan, 4.8%(3/62), and 4.8%(3/62), respectively] (all P<0.05).There was no significant difference in extracorporeal circulation time, aortic occlusion time, postoperative arrhythmia rate, residual shunt, and atelectasis between the two groups (all P>0.05).(4) The peak airway pressure, oxygenation index and lung dynamic compliance before chest opening, immediately after surgery, and 24 hours after surgery did not differ significantly between the two groups (all P>0.05). Conclusions:In infants with low body mass (≤5 kg), RVIAT for VSD repair offers good exposure through a small incision, capable of reducing operation time, intraoperative bleeding, postoperative hospital stay, and hospital costs, and facilitating faster recovery.With high safety and effects, RVIAT can be considered as a viable alternative to MS.

Objective This study prepared gelatin three-dimensional porous microspheres and investigated the feasibility of gelatin three-dimensional porous microspheres loaded with quercetin(G-quercetin)as bone tissue scaffold material.Methods Porous gelatin microspheres were prepared by emulsification and loaded with quercetin by lyophilization.Scanning electron microscopy was used to ob-serve morphology of the microspheres.The cytotoxicity of G-quercetin microspheres and their effects on the adhesion,proliferation and differentiation of mouse embryonic osteoblast precursor cells(MC3T3-E1)were detected by immunofluorescence staining,live/dead cell staining and CCK-8 assay,alkaline phosphatase(ALP)staining and alizarin red staining.RT-PCR was used to detect the tran-scriptional levels of osteoblast-related cytokines such as Runx-2,ALP,OPN and OCN.Results The scanning electron microscopy re-sults showed that the prepared three-dimensional microporous material loaded with quercetin gelatin had a porous structure.Cell adhe-sion showed that the cells could spread well on the surface of the microspheres.Compared with the control group,the results of live/dead cell staining and CCK-8 detection showed that the microspheres had no significant cytotoxicity(P＞0.05).Compared with the con-trol group,G-quercetin microspheres showed an increase in ALP expression and mineralization in vitro.PCR results also showed a sig-nificant increase in Runx-2,ALP,OCN,OPN(P＜0.05).Conclusion The G-quercetin porous microspheres prepared in this experi-ment have good biocompatibility and can promote the osteogenic differentiation of MC3T3-E1 in vitro.It is expected to be used as a new scaffold material for bone tissue engineering.

Objectives:To observe the clinical effect of surgical treatment of suppurative spondylitis after percutaneous vertebroplasty(PVP).Methods:The medical records of 14 patients with suppurative spondylitis after PVP treatment admitted to the Department of Orthopedics of our hospital from March 2017 to February 2022 were retrospectively analyzed.There were 6 males and 8 females,aged 53-83 years,with an average age of 69.3±7.8 years.The patients were followed up for 12 months.The operation time,intraoperative blood loss,postoperative complications,postoperative recurrence rate,postoperative visual analogue scale(VAS)and American Spinal Injury Association(ASIA)improvement,postoperative bone graft fusion rate,and postoperative quality of life(short form-36,SF-36)improvement were analyzed to observe the clinical effect and related risks of surgical treatment of suppurative spondylitis after PVP treatement.Results:The operative time of 14 patients was 123-300min,with an average of 205.1±57.4min.Intraoperative blood loss was 200-900mL,with an average of 517.9±181.5mL.Postoperative incision complications occurred in 2 patients(14.3％),of which,1 case was incision effusion,healed after drainage and dressing change;The other case was delayed healing,which healed after regular dressing change,improving nutritional status and blood sugar control.The VAS scores ranged from 3 to 8 points(6.1±1.6 points)before operation,which was 0-2 points(0.9±0.8 points)at fi-nal follow-up,and the difference was statistically significant(t=11.034,P=0.000).The bone graft fusion rate was 92.8％(13/14),and the fusion time was 3 to 7 months(4.6±1.3 months).Spinal infection recurred at 7 months after surgery in the 1 patient with unfused bone graft,who presented internal fixation loosening and kyphotic deformity and was cured after anti-infection,control of complications,and reoperation.According to the ASIA classification,2 patients were grade D and 12 patients were grade E before surgery,which all im-proved to grade E at final follow-up.At final follow-up,the SF-36 scores of the patients were significantly improved compared with those before surgery,and the comprehensive measurement score of physiological health was 31.4±6.9 before surgery and 79.8±6.0 after surgery,and the difference was with statistical signifi-cance(t=19.721,P=0.000).The comprehensive measurement score of mental health was 46.9±7.2 before surgery and 88.5±6.4 after surgery,and the difference was statistically significant(t=16.027,P=0.000).Conclusions:Surgery can effectively treat suppurative spondylitis after PVP treatment and improve the quality of life of pa-tients.