Objective To explore the learning curve of the Tianji orthopedic robot in assisting percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF).Methods A retrospective study was conducted of the consecutive 44 OVCF patients (71 fractured vertebrae) who had been treated with PKP assisted by the Tianji orthopedic robot from May 2018 to March 2019 at Department of Ortbopedics,The First Hospital of China Medical University.They were 2 men and 42 women,aged from 55 to 89 years (average,68.6 years).Their operations were performed by the same surgical team.The patients were divided into 4 even groups (n =11) according to the date of operation.The accuracy of robot-assisted puncture,total operation time,robot operation time,PKP operation time and complications were statistically analyzed and compared between the 4 groups.Natural logarithm regression analysis of total operation time,robot operation time and PKP operation time was conducted to determine the association between operation time and operation number [y =aln(x) + b,x indicating operation number and y operation time].Results The 4 groups were comparable due to insignificant differences in age,gender or operative segment between them (P ＞ 0.05).The total rate of accurate puncture was 95.8％ (68/71).The rates of accurate puncture were 92.9％ (13/14),94.4％ (17/18),94.7％ (18/19) and 100％ (20/20) for groups 1,2,3,and4,respectively,with no significant differences between groups (P ＞ 0.05).The total operation time for the 4 groups was respectively 56.6 ± 6.6 min,46.4 ± 8.5 min,40.2 ± 4.7 min and 40.4 ± 5.7 min and the robot operation time for the 4 groups was respectively 32.1 ±4.9 min,23.8 ±5.1 min,18.9 ±2.7 min and 19.6 ± 5.3 min,showing significant differences between the 4 groups (P ＞ 0.05) and a significant difference between groups 1 and 2 versus groups 3 and 4 (P ＞ 0.05) but no significant difference between group 3 and 4 (P ＞ 0.05).The natural logarithm regression analysis showed that the total operation time [y =-7.2861n(x) + 66.616,R2 =0.4889,P ＜ 0.001] and robot operation time [y =-5.6621n(x) +39.763,R2 =0.5196,P ＜ 0.001] decreased significantly with the increase of operation number but became stable in groups 3 and 4.There was no significant difference in PKP operation time among the 4 groups (P ＞ 0.05).The main intraoperative complication was leakage of bone cement in the anterior vertebral space and intervertebral space,with a total incidence of 8.5％ (6/71),showing no significant difference among the 4 groups (P ＞ 0.05).Conclusions The puncture accuracy of the Tianji orthopedic robot in assisting PKP for OVCF may not change with the increased operation number.The total operation time and robotic operation time decrease with the increased operation number.The learning curve of the Tianji orthopedic robot becomes stable very fast,indicating the surgical technique is easy to learn.

The theory on four seas is a kind of view to explain the longitudinal and horizontal distribution relationship of meridians and collaterals by ancient scholars. The authors were attempted to explore it by taking the theory on sea of marrow as example in terms of literature analysis. In (Chapter 33 of ), it is recorded that sea of marrow flows into two locations, but they are not the acupoint sites for treatment. Based on the comprehensive literature investigation, it is known that such two sites to which sea of marrow flows refer to a kind of boundaries so that the range of sea of marrow is determined, the function of it explored, and the controversy on "heart dominating mind" and "brain governing spirit" solved. It is defined that the function of sea of marrow is the macro-conception of (mind, spirit) that is modulated by vital movement information. Additionally, in association with meridian literature analysis, as well as acupoint textual research, it finally focuses on Naohu (GV 17) that is the critical point in the application of the theory on sea of marrow. In clinical application of such theory, the importance should be attached to the governor vessel, Naohu (GV 17) and their spatial system of bone.
Acupuncture Points ; Acupuncture Therapy ; Bone Marrow ; Humans ; Meridians

BACKGROUND: Gestational diabetes mellitus (GDM) is usually diagnosed between 24th and 28th gestational week using the 75-g oral glucose tolerance test (OGTT). It is difficult to predict GDM before 24th gestational week because fast plasma glucose (FPG) decreases as the gestational age increases. It is controversial that if FPG ≥5.1 mmol/L before 24th gestational week should be intervened or not. The aim of this study was to evaluate the value of FPG to screen GDM before 24th gestational week in women with different pre-pregnancy body mass index (BMI). METHODS: This was a multi-region retrospective cohort study in China. Women who had a singleton live birth between June 20, 2013 and November 30, 2014, resided in Beijing, Guangzhou and Chengdu, and received prenatal care in 21 selected hospitals, were included in this study. Pre-pregnancy BMI, FPG before the 24th gestational week, and one-step GDM screening with 75 g-OGTT at the 24th to 28th gestational weeks were extracted from medical charts and analyzed. The pregnant women were classified into four groups based on pre-pregnancy BMI: Group A (underweight, BMI < 18.5 kg/m), Group B (normal, BMI 18.5-23.9 kg/m), Group C (overweight, BMI 24.0-27.9 kg/m) and Group D (obesity, BMI ≥28.0 kg/m). The trend of FPG before 24th week of gestation was described, and the sensitivity and specificity of using FPG before the 24th gestational week to diagnose GDM among different pre-pregnancy BMI groups were reported. Differences in the means between groups were evaluated using independent sample t-test and analysis of variance. Pearson Chi-square test was used for categorical variables. RESULTS: The prevalence of GDM was 20.0% (6806/34,087) in the study population. FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week. FPG was higher in women with higher pre-pregnancy BMI. FPG before the 24th gestational week and pre-pregnancy BMI could be used to predict GDM. The incidence of GDM in women with FPG ≥5.10 mmol/L in the 19th to 24th gestational weeks and pre-pregnancy overweight or obesity was significantly higher than that in women with FPG ≥5.10 mmol/L and pre-pregnancy BMI <24.0 kg/m (78.5% [62/79] vs. 52.9% [64/121], χ = 13.425, P < 0.001). CONCLUSIONS FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week. Pre-pregnancy overweight or obesity was associated with an increased FPG value before the 24th gestational week. FPG ≥5.10 mmol/L between 19 and 24 gestational weeks should be treated as GDM in women with pre-pregnancy overweight and obesity.
Adult ; Blood Glucose ; analysis ; Body Mass Index ; Diabetes, Gestational ; blood ; diagnosis ; epidemiology ; Fasting ; blood ; Female ; Gestational Age ; Glucose Tolerance Test ; Humans ; Incidence ; Pregnancy ; Prevalence ; ROC Curve ; Retrospective Studies

BACKGROUND: Spinal cord injury (SCI) is a worldwide medical concern. This study aimed to elucidate the mechanism underlying the protective effect of hyperbaric oxygen (HBO) against SCI-induced neurologic defects in rats via exploring the stromal cell-derived factor-1 (SDF-1)/CXC chemokine receptor 4 (CXCR4) axis and expression of brain-derived neurotrophic factor (BDNF). METHODS: An acute SCI rat model was established in Sprague-Dawley rats using the Allen method. Sixty rats were divided into four groups (n = 15 in each group): sham-operated, SCI, SCI treated with HBO (SCI + HBO), and SCI treated with both HBO and AMD3100 (an antagonist of CXCR4; SCI + HBO + AMD) groups. The rats were treated with HBO twice a day for 3 days and thereafter once a day after the surgery for up to 28 days. Following the surgery, neurologic assessments were performed with the Basso-Bettie-Bresnahan (BBB) scoring system on postoperative day (POD) 7, 14, 21, and 28. Spinal cord tissues were harvested to assess the expression of SDF-1, CXCR4, and BDNF at mRNA and protein levels, using quantitative real-time polymerase chain reaction, Western blot analysis, and histopathologic analysis. RESULTS: HBO treatment recovered SCI-induced descent of BBB scores on POD 14, (1.25 ± 0.75 vs. 1.03 ± 0.66, P < 0.05), 21 (5.27 ± 0.89 vs. 2.56 ± 1.24, P < 0.05), and 28 (11.35 ± 0.56 vs. 4.23 ± 1.20, P < 0.05) compared with the SCI group. Significant differences were found in the mRNA levels of SDF-1 (mRNA: day 21, SCI + HBO vs. SCI + HBO + AMD, 2.89 ± 1.60 vs. 1.56 ± 0.98, P < 0.05), CXCR4 (mRNA: day 7, SCI + HBO vs. SCI, 2.99 ± 1.60 vs.1.31 ± 0.98, P < 0.05; day 14, SCI + HBO vs. SCI + HBO + AMD, 4.18 ± 1.60 vs. 0.80 ± 0.34, P < 0.05; day 21, SCI + HBO vs. SCI, 2.10 ± 1.01 vs.1.15 ± 0.03, P < 0.05), and BDNF (mRNA: day 7, SCI + HBO vs. SCI, 3.04 ± 0.41 vs. 2.75 ± 0.31, P < 0.05; day 14, SCI + HBO vs. SCI, 3.88 ± 1.59 vs. 1.11 ± 0.40, P < 0.05), indicating the involvement of SDF-1/CXCR4 axis in the protective effect of HBO. CONCLUSIONS HBO might promote the recovery of neurologic function after SCI in rats via activating the SDF-1/CXCR4 axis and promoting BDNF expression.
Animals ; Blotting, Western ; Brain-Derived Neurotrophic Factor ; metabolism ; Disease Models, Animal ; Hyperbaric Oxygenation ; methods ; Male ; Rats ; Rats, Sprague-Dawley ; Receptors, CXCR4 ; metabolism ; Receptors, Interleukin-8A ; metabolism ; Spinal Cord Injuries ; metabolism ; therapy

Prodrug nanoassemblies, which can refrain from large excipients, achieve higher drug loading and control drug release, have been placed as the priority in drug delivery system. Reasoning that glutathione (GSH) and reactive oxygen species (ROS) are highly upgraded in tumor tissues which makes them attractive targets for drug delivery system, we designed and synthetized a novel prodrug which utilized mono thioether bond as a linker to bridge linoleic acid (LA) and docetaxel (DTX). This mono thioether-linked conjugates (DTX-S-LA) could self-assemble into nanoparticles without the aid of much excipients. The mono thioether endowed the nanoparticles redox sensitivity resulting in specific release at the tumor tissue. Our studies demonstrated that the nanoassemblies had uniform particle size, high stability and fast release behavior. DTX-S-LA nanoassemblies outperformed DTX solution in pharmacokinetic profiles for it had longer circulation time and higher area under curve (AUC). Compared with DTX solution, the redox dual-responsive nanoassemblies had comparable cytotoxic activity. Besides, the antitumor efficacy was evaluated in mice bearing 4T1 xenograft. It turned out this nanoassemblies could enhance anticancer efficacy by increasing the dose because of higher tolerance. Overall, these results indicated that the redox sensitivity nanoassemblies may have a great potential to cancer therapy.

The aim of this study was to investigate the inhibitory effect and the underlying mechanism of ethacrynic acid (EA) on the contraction in mice. BL-420S force measuring system was used to measure the tension of mouse tracheal rings. The whole cell patch clamp technique was utilized to record the channel currents of airway smooth muscle (ASM) cells. The calcium imaging system was used to determine the intracellular Ca concentration ([Ca]) in ASM cells. The results showed that EA significantly inhibited the high K (80 mmol/L) and acetylcholine (ACh, 100 µmol/L)-induced contraction of mouse tracheal rings in a dose-dependent manner. The maximal relaxation percentages were (97.02 ± 1.56)% and (85.21 ± 0.03)%, and the median effective concentrations were (40.28 ± 2.20) μmol/L and (56.22 ± 7.62) μmol/L, respectively. EA decreased the K and ACh-induced elevation of [Ca] from 0.40 ± 0.04 to 0.16 ± 0.01 and from 0.50 ± 0.01 to 0.39 ± 0.01, respectively. In addition, EA inhibited L-type voltage-dependent calcium channel (LVDCC) and store-operated calcium channel (SOCC) currents in ASM cells, and Ca influx. Moreover, EA decreased the resistance of the respiratory system (Rrs) in vivo in mice. These results indicated that EA inhibits LVDCC and SOCC, which results in termination of Ca influx and decreases of [Ca], leading to relaxation of ASM. Taken together, EA might be a potential bronchodilator.
Animals ; Calcium ; metabolism ; Calcium Channels, L-Type ; Enzyme Inhibitors ; pharmacology ; Ethacrynic Acid ; pharmacology ; Mice ; Muscle Contraction ; drug effects ; Muscle, Smooth ; drug effects ; Respiratory System ; cytology ; drug effects

To investigate the normal structures of parotid duct by using magnetic resonance(MR)hydrography. MR three-dimensional heavy T2-weighted imaging was performed in 21 normal subjects.After taking 200 mg of vitamin C orally for 3 minutes,the subjects underwent parotid duct coronal hydro-magnetic resonance imaging.The images were transferred to the GE AW4.5 workstation,on which multi-planner reformation was performed using Functool software.The numbers of the parotid duct,accessory parotid duct,segments,and its branches was counted and the length and diameter of the intra-and extra-parotid ducts were measured. Accessory ducts were found in 24 parotid glands(57.1%,24/42),with the average length being(9.54±9.98)mm and the average diameter being(0.87±0.88)mm.The intra-parotid ducts were found to be with 3 segments were in 3 cases(7.14%,3/42),with 2 segments in 19 cases(45.23%,19/42),and with 1 segment in 20 cases(47.62%,20/42).The average number of the branches of the first,second and third segment was 2.38,0.88,and 0.1,respectively.The average length of the intra-parotid duct was(36.97±7.97)mm,with its average diameter being(2.01±0.76)mm.The average length of extra-parotid duct was(34.98±10.25)mm,with its average diameter being(2.13±0.79)mm.The average length of the whole parotid duct was(71.95±11.47)mm,with its average diameter being(2.07±0.68)mm. The parotid duct,the accessory parotid duct,and the segments and their branches of the intra-parotid duct can be accurately displayed by MR hydrography.
Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Parotid Gland

It has been previously thought that calcification is a feature of the stability of atherosclerotic plaques. However, recent studies have shown that microcalcification in atherosclerotic plaques is significantly associated with plaque vulnerability. The relationship between atherosclerotic plaques and calcification is unclear, and the specific role of calcification in atherosclerotic plaques remains controversial.

Objective: To investigate the expressions of programmed death ligand 1（PD-L1）in triple-negative breast cancer (TNBC) and its correlation with angiogenesis. Methods: 120 cases of TNBC patients who underwent surgery in the Fourth Hospital of Hebei Medical University from March 1, 2011 to June 1, 2012 were collected. The tumor tissues of patients were surgically resected and confirmed by pathology. PD-L1 protein expression in TNBC tissues of 120 patients was detected by tissue microarray combined with immunohistochemistry, and its relationship with various clinical indicators was analyzed. Blood vessels and lymphatic vessels were labeled withCD34andD2-40todetectmicrovesseldensity(MVD)andlymphaticvesseldensity(LVD)inTNBC.Results:Thepositiveexpression rate of PD-L1 in the tumor cells and interstitial infiltrating lymphocytes fromTNBC was 56.7% (68/120); No correlation was found between PD-L1 protein expression and the gender, age, histological grade, clinical stage, or tumor size of patients with TNBC (P>0.05), but related to the lymph node metastasis (P<0.05) and vascular thrombus (P<0.05). TNBC with high PD-L1 expression exhibited high incidence of lymph node metastasis and formation of vascular thrombus, and the expression of PD-L1 was positively correlated with MVD (r=0.500, P=0.02) as well as LVD (r=0.662, P=0.01). Log-Rank test showed that the survival time of TNBC patients with positive PD-L1 protein expression was significantly shorter than that of patients with negative expression (P<0.05). Cox multivariate analysis suggested that PD-L1 protein expression could be an independent prognostic factor for TNBC overall survival. Conclusion: PD-L1 plays an important role in TNBC angiogenesis and lymphangiogenesis, and is closely related to TNBC invasion and metastasis; blocking PD1/PD-L1 signal pathway is expected to be an effective new strategy for TNBC treatment.

Objective: To investigate the surgical treatment strategies for persistent and recurrent parathyroidectomy after total parathyroidectomy plus autotransplantation(tPTX+ AT) in cases of renal hyperparathyroidism. Methods: From Oct 2009 to Oct 2018, 480 patients with renal hyperparathyroidism received tPTX+ AT in our hospital. 32 patients suffered from post-op persistent (31) and recurrent (1) hyperparathyroidism .The high frequency ultrasonography combined with fine needle puncture eluent PTH determination and SPECT/CT co-computed tomography fusion imaging were used as qualitative and localizing diagnostic methods before reoperation. Results: Of the 32 patients, 28 cases underwent reoperation for once, and 4 underwent reoperations fort wice. 36 parathyroid glands and 2 grafts were resected.In 31 patients the bone pain, skin pruritus relieved significantly or disappeared, and muscle strength gradually increased compared with that before operation. Level of iPTH in 31 patients fluctuated between 15 and 90 ng/L. Postoperative parathyroid hormone decreased compared with that before the operation (P<0.05). One patient was still with persistent hyperparathyroidism despite reoperation, whose iPTH fluctuated between 550 and 1 000 ng/L during 6 months to 2 years follow-up. Conclusion Ultrasonography, FNA-iPTH and SPECT/CT co-computed tomography can be used as methods for qualitative and localizing diagnosis of PTPT or PHPT.With accurate preoperative localization, resection of all parathyroid glands is an effective treatment for posto perative persistent and recurrent renal hyper parathyroidism.