Purpose::Shaping and assembling contemporary external fixators rapidly for the severe mandibular fractures remains a challenge, especially in emergency circumstance. We designed a novel external fixator that incorporates universal joints to provide the stabilization for mandibular comminuted fractures. This study aims to confirm the efficacy of this novel external fixator through biomechanical tests in vitro and animal experiments. Methods::In vitro biomechanical tests were conducted using 6 fresh canine with mandibular defect to simulate critical comminuted fractures. Three mandibles were stabilized by the novel external fixator and other mandibles were fixed by 2.5 mm reconstruction plates. All fixed mandibles were subjected to loads of 350 N on the anterior regions of teeth and 550 N on the first molar of the unaffected side. The stability was evaluated based on the maximum displacement and the slope of the load-displacement curve. In animal experiments, 9 beagles with comminuted mandibular fractures were divided into 3 groups, which were treated with the novel external fixation, reconstruction plate, and dental arch bar, respectively. The general observation, the changes in animals’ weight, and the surgical duration were recorded and compared among 3 groups. The CT scans were performed at various intervals of 0 day (immediately after the surgery), 3 days, 7 days, 14 days, 21 days, and 28 days to analyze the displacement of feature points on the canine mandible and situation of fracture healing at 28 days. The statistical significance was assessed by the two-way analysis of variance test followed by the Bonferroni test, enabling multiple comparisons for all tests using GraphPad Prism10.1.0 (GraphPad Inc, USA). Results::The outcomes of the biomechanical tests indicated that no statistically significant differences were found in terms of the maximum displacement ( p = 0.496, 0.079) and the slope of load displacement curves ( p = 0.374, 0.349) under 2 load modes between the external and internal fixation groups. The animal experiment data showed that there were minor displacements of feature points between the external and internal fixation groups without statistic difference, while the arch bar group demonstrated inferior stability. The CT analysis revealed that the best fracture healing happened in the internal fixation group, followed by the external fixation and arch baring at 28 days after fixation. The external fixation group had the shortest fixation duration (25.67 ± 3.79) min compared to internal fixation ((70.67 ± 4.51) min, p < 0.001) and arch baring ((42.00 ± 3.00) min, p = 0.046). Conclusion::The conclusion of this study highlighted the efficacy and reliability of this novel external fixator in managing mandibular fractures rapidly, offering a viable option for the initial stabilization of comminuted mandibular fractures in the setting of emergency rescue.

Objective: To investigate the response characteristics of patients with locally advanced/metastatic non-squamous non-small cell lung cancer (nsq-NSCLC) treated with tislelizumab in combination with chemotherapy in the first line. Methods: Patients with nsq-NSCLC who achieved complete or partial remission after treatment with tislelizumab in combination with chemotherapy or chemotherapy alone in the RATIONALE 304 study, as assessed by an independent review board, were selected to analyze the response characteristics and safety profile of the responders. Time to response (TTR) was defined as the time from randomization to the achievement of first objective response. Depth of response (DpR) was defined as the maximum percentage of tumor shrinkage compared with the sum of the baseline target lesion length diameters. Results: As of January 23, 2020, 128 patients treated with tislelizumab in combination with chemotherapy achieved objective tumor response (responders), representing 57.4%(128/223) of the intention-to-treat population, with a TTR of 5.1 to 33.3 weeks and a median TTR of 7.9 weeks. Of the responders (128), 50.8%(65) achieved first remission at the first efficacy assessment (week 6), 31.3%(40) at the second efficacy assessment (week 12), and 18.0%(23) at the third and subsequent tumor assessments. The percentages of responders who achieved a depth of tumor response of 30% to <50%, 50% to <70% and 70% to 100% were 45.3%(58/128), 28.1%(36/128) and 26.6%(34/128), respectively, with median progression-free survival (PFS) of 9.0 months (95% CI: 7.7 to 9.9 months), 11.5 months (95% CI: 7.7 months to not reached) and not reached (95% CI: 11.8 months to not estimable), respectively. Tislelizumab plus chemotherapy were generally well tolerated in responders with similar safety profile to the overall safety population. Conclusion: Among responders to tislelizumab in combination with chemotherapy for nsq-NSCLC, 82.0%(105/128) achieves response within the first two tumor assessments (12 weeks) and 18.0%(23/128) achieves response at later (18 to 33 weeks) assessments, and there is a trend toward prolonged PFS in responders with deeper tumor response.
Humans ; Antibodies, Monoclonal, Humanized/therapeutic use* ; Antineoplastic Combined Chemotherapy Protocols/adverse effects* ; Carcinoma, Non-Small-Cell Lung/pathology* ; Lung Neoplasms/pathology* ; Treatment Outcome

OBJECTIVE: To compare clinical effects of different postoperative rehabilitation modes on lumbar degenerative diseases, and explore influence of rehabilitation mode and other factors on postoperative effect. METHODS: From June 2013 to July 2016, totally 900 patients were admitted from nine tertiary hospitals in Beijing to perform single segment bone grafting and internal fixation due to lumbar degenerative diseases were prospectively analyzed. There were 428 males and 472 females, the age of patient over 18 years old, with an average of (51.42±12.41) years old;according to patients' subjective wishes and actual residence conditions, all patients were divided into three groups, named as observation group 1 (performed integrated rehabilitation approach and orthopedic treatment model intervention), observation group 2 (performed integrated rehabilitation approach and orthopedic treatment, classified rehabilitation model intervention), and control group(performed routine rehabilitation model intervention). Visual analogue scale(VAS), Oswestry Disability Index(ODI) and Japanese Orthopaedic Association (JOA) were used to evaluate postoperative efficacy among three groups at 24 weeks. Possible factors affecting the postoperative efficacy including age, age grouping, gender, body mass index (BMI), BMI grouping, education level, visiting hospital, payment method of medical expenses, preoperative complications, preoperative JOA score, clinical diagnosis, surgery section, operative method, intraoperative bleeding volume, postoperative complications and rehabilitation mode were listed as independent variables, and postoperative ODI score at 24 weeks as dependent variables. Univariate analysis was used to analyze relationship between influencing factors and postoperative efficacy. Multiple linear regression was used to analyze relationship between influencing factors, rehabilitation mode and postoperative ODI score at 24 weeks, in further to find out the main reasons which affect postoperative efficacy, and to analyze impact of rehabilitation mode on postoperative efficacy. RESULTS: All patients were followed up for 24 weeks after operation. All incisions healed at stage I with stable internal fixation. (1)Evaluation of postoperative efficacy:① There were no statistical differences in preoperative VAS and ODI among three groups( CONCLUSION Preoperative JOA score, gender, age could predict postoperative clinical effects of lumbar degenerative diseases in varying degrees treated with single level bone graft fusion and internal fixation. Different rehabilitation modes could improve clinical effects. Intergrated rehabilitation orthopedic treatment model and integrated rehabilitation approach and orthopedic treatment with classifiedrehabilitation model are superior to conventional rehabilitation model in improving patients' postoperative function and relieving pain, which is worthy of promoting in clinical.
Adolescent ; Adult ; Aged ; Female ; Humans ; Infant ; Lumbar Vertebrae/surgery* ; Lumbosacral Region ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fusion ; Treatment Outcome

Objective To conduct metal elements analysis and risk assessment of carcinogenicity on Particulate Matter 2.5 ( PM2.5) collected from Shenzhen and Taiyuan. Methods PM2.5 samples were collected in Shenzhen and Taiyuan from 2017 to 2018. Ten heavy metal elements in PM2.5 samples were detected by inductively coupled plasma mass spectrometry (ICP-MS). Health risk assessment was conducted using the recommended United States Environmental Protection Agency (EPA) model. Results Metal elements found in PM2.5 samples from Shenzhen included (in decreasing order of concentration) Al, Pb, Mn, Cr, Cu, V, As, Ni, Cd and Co. Their levels were 1 807.67, 31.02, 30.63, 17.37, 17.32, 11.59, 6.98, 4.76, 2.24, 2.20 ng/m3, respectively. Metal elements in PM2.5 samples from Taiyuan included Al, Mn, Pb, Cr, Cu, As, Ni, V, Cd and Co. Their levels were 2 817.64, 91.04, 63.33, 26.56, 24.69, 11.82, 10.39, 4.46, 3.42, 1.01 ng/m3, respectively. There were significant differences among Pb, Mn, As, Ni levels between Shenzhen and Taiyuan (all P<0.05), but remaining metal element levels did not show significant differences between Shenzhen and Taiyuan. Risk assessment data showed that the total risk from five carcinogenic metal elements in Taiyuan and Shenzhen were more than 1.00×10-4 and the total risk from five carcinogenic metal elements of Taiyuan(3.79×10-4) was higher than Shenzhen(2.44×10-4). Among five carcinogenic metal elements, Cr had the highest carcinogenicity risk (>1.00×10-4), then followed by As, Ni and Cd (1.00×10-6-1.00×10-4). Pb had the lowest risk (<1.00×10-6). Conclusion Some of the metal elements in PM2.5 samples collected from Shenzhen and Taiyuan have carcinogenicity risk. Further researches and measures for prevention and control should be considered.

Ganzi Tibetan Autonomous Prefecture is the birthplace of Tibetan medicine of southern school, also rich in natural resources of Chinese and Tibetan medicine (CTM). As the pillar industry of Ganzi prefecture, CTM shows a trend of improvement of overall services, growing of the number of companies and increasing scale of industries. However, the CTM industry in Ganzi prefecture still has some shortcomings. This article reviewed the development and existential problems of CTM industry of Ganzi prefecture. In addition, the article carries on relevant thinking through literature review and discussion and analysis. It is believed that CTM industry of Ganzi prefecture faced with the conflict between environmental protection and the development of CTM industry, small scale of CTM industry, inadequate expertise and insufficient product innovation. This article gave some feasible suggestions, such as coordinated development of cultural tourism and medical industry, establishment of high efficient mode to promote producing-learning-research development, enhancement of quality standardization of CTM industry, with a purpose to guarantee the quality transmission of each step.

BACKGROUNDAutoimmune encephalitis associated with antibodies against γ-aminobutyric acid B receptor (GABA B R) in patients with limbic encephalitis (LE) was first described in 2010. We present a series of Han Chinese patients for further clinical refinement.

METHODSSerum and cerebrospinal fluid (CSF) samples from patients referred to the program of encephalitis and paraneoplastic syndrome of Peking Union Medical College Hospital were tested with indirect immunofluorescence. Clinical information of patients with anti-GABA B R antibody positivity was retrospectively reviewed, and descriptive statistical analysis was performed.

RESULTSAll eighteen anti-GABA B R antibody-positive cases had limbic syndromes, and electroencephalogram (EEG) or neuroimaging evidence fulfilled the diagnostic criteria of LE. Four patients had additional antibodies against Hu in serum and one had anti-N-methyl-d-aspartate receptor antibody in both sera and CSF. Seventeen (17/18) patients presented with new-onset refractory seizure or status epileptics. Twelve (12/18) patients had memory deficits, 11 (11/18) patients had personality change, 7 (7/18) patients had disturbance of consciousness, and 3 (3/18) patients showed cerebellar dysfunction. One patient with LE had progressive motor and sensory polyneuropathy. Lung cancer was detected in 6 (6/18) patients. Ten (10/18) patients showed abnormality in bilateral or unilateral mediotemporal region on magnetic resonance imaging. Ten (10/18) patients had temporal lobe epileptic activity with or without general slowing on EEG. Seventeen patients received immunotherapy and 15 of them showed neurological improvement. Four patients with lung cancer died within 1-12 months due to neoplastic complications.

CONCLUSIONSOur study demonstrates that most Han Chinese patients with anti-GABA B R antibody-associated LE have prominent refractory epilepsy and show neurological improvement on immunotherapy. Patients with underlying lung tumor have a relatively poor prognosis. Testing for anti-GABA B R antibodies is necessary for patients with possible LE or new-onset epilepsy with unknown etiology.

Adult ; Autoantibodies ; immunology ; China ; Electroencephalography ; Epilepsy ; immunology ; pathology ; Female ; Humans ; Limbic Encephalitis ; immunology ; pathology ; Male ; Middle Aged ; Receptors, N-Methyl-D-Aspartate ; immunology ; Retrospective Studies ; gamma-Aminobutyric Acid ; metabolism

OBJECTIVE: To research the toxicokinetics features of ivabradine hydrochloride and the accumulation situation of its products in Beagles, during one month oral administration with it.

OBJECTIVETo investigate the relationship between serum concentration of fluorouracil and therapeutic efficacy as well as adverse reactions in patients with unresectable locally advanced or measurable metastatic colorectal cancer, and to analyze its role in further improving therapeutic efficacy and reducing adverse reactions of fluorouracil-based chemotherapy.

METHODSEighty-six patients were randomly assigned into three groups according to the average plasma concentration of fluorouracil after three cycles of chemotherapy with the initial regimen of two weeks FOLFOX-4 (oxaliplatin + leucovorin + fluorouracil) or FOLFIRI (irinotecan + leucovorin + fluorouracil): group 1 (plasma concentration of fluorouracil < 25 ng/ml), group 2 (25 - 35 ng/ml) and group 3 (> 35 ng/ml). The blood samples were taken at 12 h after continuous infusion of fluorouracil in each cycle and the plasma concentration of fluorouracil was detected by high performance liquid chromatography (HPLC) (about 5 am ± 1 h). The relationship between the drug plasma concentration, therapeutic efficacy and adverse reactions in different fluorouracil plasma concentration arms was analyzed retrospectively.

RESULTSThe average plasma concentrations of fluorouracil of the three groups were (23.48 ± 1.95) ng/ml, (31.47 ± 2.33) ng/ml and (39.89 ± 3.87) ng/ml, respectively (P < 0.01). As for therapeutic efficacy, the median OS of the groups 2 and 3 were 18.0 and 17.5 months, significantly higher than that in the group 1 (13.0 months, P < 0.01). The PFS were 4.5, 7.5 and 8.0 months, respectively (P < 0.01). In terms of adverse reactions, the incidences of bone marrow suppression, mucositis and diarrhea in the group 3 were significantly higher than that in the first two groups (P = 0.02, P = 0.04 and P = 0.02).

CONCLUSIONSThe patients with local advanced and metastatic colorectal cancer, receiving fluorouracil-based chemotherapy, and with an average plasma concentration of fluorouracil between 25 - 35 mg/L have a better prognosis, and lower incidence of adverse reactions such as bone marrow suppression, mucositis and diarrhea.

Adenocarcinoma ; blood ; drug therapy ; pathology ; Adenocarcinoma, Mucinous ; blood ; drug therapy ; pathology ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Bone Marrow Diseases ; chemically induced ; Colonic Neoplasms ; blood ; drug therapy ; pathology ; Diarrhea ; chemically induced ; Disease-Free Survival ; Female ; Fluorouracil ; adverse effects ; blood ; pharmacokinetics ; therapeutic use ; Humans ; Leucovorin ; adverse effects ; therapeutic use ; Male ; Middle Aged ; Mucositis ; chemically induced ; Neoplasm Staging ; Organoplatinum Compounds ; adverse effects ; therapeutic use ; Random Allocation ; Rectal Neoplasms ; blood ; drug therapy ; pathology ; Remission Induction ; Survival Rate

Objective To evaluate the health related quality of life (HRQoL) and to explore the influencing factors related to the prevalence of the essential hypertension,diabetes,coronary heart disease (CHD) and stroke in middle-aged and elderly people from rural communities.Methods A total of 5345 individuals were chosen from a 2010 Health Survey in Fangshan,Beijing.Self-designed questionnaire was applied to collect the information on general health-related behaviors,chronic conditions,self-rated health,blood pressure and HRQoL with the EuroQoL questionnaire (EQ-5D) were measured.Probit regression model was used to identify the influencing factors on HRQoL,adjusting age,marriage status,education level,smoking,alcohol intake,physical activity and control of blood pressure.Population Attributable Risk Proportion (PARP) for estimating the influence of chronic disease on HRQoL was also calculated.Results The average EQ-5D index was 0.923 ±0.145,with 72.1％ of the overall respondents in the status of having chronic diseases.Participants with chronic diseases had significantly lower EQ-5D index (0.907 ± 0.155 ) than those without (0.963 ±0.105 ) (t =15.082,P＜ 0.001 ).Significant relations were found between a lower HRQoL and chronic diseases.Relative risk (RR) and 95％ confidence interval (95％ CI) of poor HRQoL in populations with hypertension,diabetes,CHD and stroke were 1.686 (95％CI: 1.519-1.871),1.725 (95％CI:1.502-1.981 ),1.869 (95％CI: 1.663-2.099),and 1.759 (95％CI: 1.474-2.089) respectively.The most influential disease appeared to be stroke in male (RR=1.929,95％CI: 1.462-2.546),whereas CHD in female individuals (RR=1.926,95％CI: 1.671-2.220).Rates of PARP (PAR％) for poor HRQoL in chronic disease subgroups were as follow: hypertension 31.05％,CHD 23.39％,diabetes 4.84％ and stroke 4.44％,respectively.Conclusion This study suggested that stroke,at individual level,was the major influential factor to HRQoL.However,hypertension remained the leading preventable influential factor to HRQoL at the population level.

BACKGROUNDOsteogenesis imperfecta (OI) is a rare bone disease and its effective treatment is relatively deficient. We tried to assess the effects of new bisphosphonate, ibandronate on children with OI.

METHODSIn this open-label, prospective, controlled study, 30 children with OI were enrolled. They received either infusions of ibandronate (2 mg) in every three months or oral calcitriol 0.25 µg daily for 24 months. All patients took 500 mg calcium plus 200 U vitamin D daily together. The endpoints were the change of annual new fracture rate (observed by case history and X ray films of spine), bone mineral density (BMD, measured by dual energy X-ray absortiometry), serum concentration of carboxy-telopeptide cross-links of type I collagen (CTX, bone resorption marker) and alkaline phosphatase (ALP, bone formation marker) during the follow-up.

RESULTSAfter the cyclic infusions of ibandronate, the annual new fracture rate was significantly decreased from 1.9 to 0.13 time, obviously lower than that of calcitriol group, which decreased from 1.8 to 1.0 time after the treatment (P < 0.001). The significant increase of BMD at the lumbar spine, femoral neck, trochanter, total hip was found in the group of ibandronate by 59.0%, 42.0%, 47.5% and 36.6% in time dependent manner (compared with the baseline, P < 0.001). The increase of BMD in ibandronate group was greater than that of calcitriol group (P < 0.001). The concentrations of ALP and CTX were obviously decreased in ibandronate group, and the reduction of CTX was more significant than that of ALP (P < 0.001). The tolerance of the children to ibandronate was quite well. Mild fever and muscle pain were found in 9 cases within 1 - 3 days after the first infusion of ibandronate, which could relieve after 1 - 2 days without special management.

CONCLUSIONSThe benefits of cyclic infusions of ibandronate to children with OI are significant because ibandronate could significantly reduce annual bone fracture rate, increase lumbar and hip BMD, preserve vertebral morphometry of patients through inhibition of bone resorption.

Bone Density Conservation Agents ; administration & dosage ; Child ; Child, Preschool ; Diphosphonates ; administration & dosage ; Female ; Humans ; Infant ; Infant, Newborn ; Infusions, Intravenous ; Male ; Osteogenesis Imperfecta ; drug therapy ; Prospective Studies