Objective:To evaluate the curative effects of 3D printed microporous titanium (tantalum) prosthesis in reconstruction of large segmental bone defects caused by lower extremity osteomyelitis.Methods:A retrospective study was conducted to analyze the clinical data of 18 patients who had been treated for large segmental bone defects caused by lower extremity osteomyelitis between January 2020 to May 2022 at Department of Orthopaedics, The 920th Hospital of Joint Logistics Support Force. There were 10 males and 8 females with an age of (45.3±14.1) years. The defects were at the left side in 13 cases and at the right side in 5 cases, at the femur in 11 cases and at the tibia in 7 cases. The duration of osteomyelitis was 1.0 (1.0, 3.5) years. The length of bone defects was 8.35 (6.50, 9.84) cm. Their bone defects were repaired by an individually 3D printed microporous titanium (tantalum) prosthesis after operative removal of osteomyelitis lesions. The wound healing was observed after surgery. The clinical efficacy was comprehensively evaluated by the Paley grading for bone defect healing, visual analog scale (VAS), lower extremity functional scale (LEFS), and imaging examination.Results:The postoperative follow-up period for the 18 patients was (12.2±0.3) months. Wound infection occurred 2 months after surgery in one patient who was treated with Ilizarov bone transfer after removal of the microporous titanium prosthesis. The remaining 17 patients had good postoperative wound healing. At the last follow-up, the 18 patients had a VAS pain score of 2.0(1.0, 4.0) points, significantly lower than the preoperative one [(6.1±2.3) points], and a LEFS score of 54.00(34.50, 69.25) points, significantly higher than the preoperative one [18.50(9.00, 26.50) points] ( P<0.05). At the last follow-up, according to the Paley grading, the bone union was rated as excellent in 16 patients, as good in 1 patient and as poor in 1 patient. The integration of femoral fractures with 3D printed microporous titanium prostheses was fine. Conclusion:In reconstruction of large segmental bone defects caused by lower extremity osteomyelitis, implantation of a 3D printed microporous titanium (tantalum) prosthesis is feasible and effective, not only reducing pain but also restoring the limb function.

BACKGROUND: Endocrine therapy (ET) and ET-based regimens are the preferred first-line treatment options for hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (HR+/HER2- MBC), while chemotherapy (CT) is commonly used in clinical practice. The aim of this study was to investigate the efficacy and clinical outcome of ET and CT as first-line treatment in Chinese patients with HR+/HER2- MBC. METHODS: Patients diagnosed with HR+/HER2-MBC between January 1st, 1996 and September 30th, 2018 were screened from the Chinese Society of Clinical Oncology Breast Cancer database. The initial and maintenance first-line treatment, progression-free survival (PFS), and overall survival (OS) were analyzed. RESULTS: Among the 1877 included patients, 1215 (64.7%) received CT and 662 (35.3%) received ET as initial first-line treatment. There were no statistically significant differences in PFS and OS between patients receiving ET and CT as initial first-line treatment in the total population (PFS: 12.0 vs. 11.0 months, P = 0.22; OS: 54.0 vs . 49.0 months, P =0.09) and propensity score matched population. For patients without disease progression after at least 3 months of initial therapy, maintenance ET following initial CT (CT-ET cohort, n = 449) and continuous schedule of ET (ET cohort, n = 527) had longer PFS than continuous schedule of CT (CT cohort, n = 406) in the total population (CT-ET cohort vs. CT cohort: 17.0 vs . 8.5 months; P <0.01; ET cohort vs . CT cohort: 14.0 vs . 8.5 months; P <0.01) and propensity score matched population. OS in the three cohorts yielded the same results as PFS. CONCLUSIONS ET was associated with similar clinical outcome to CT as initial first-line treatment. For patients without disease progression after initial CT, switching to maintenance ET showed superiority in clinical outcome over continuous schedule of CT.
Humans ; Female ; Breast Neoplasms/metabolism* ; Receptor, ErbB-2/metabolism* ; Progression-Free Survival ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Disease Progression ; Treatment Outcome

Data sharing is the fundamental work for building a " Healthy China" and a technical support for improving China′s healthcare service system. It is of great significance to the government, society, and individuals. In the digital era, public health data could be referred to various data collected, connected, read, and stored on digital platforms for research, monitoring, prevention, and control of diseases, health events, and the operation of health systems. China′s public health data sharing has initially formed a development pattern of " four modernizations", providing basic conditions and practical preparations for vigorously promoting data sharing. In the process of data sharing, the risk prevention principle should be fully considered and established, including establishing a series of measures to balance legal protection and interest protection for different entities and situations, that is, data information typing to limit data access rights, building a unified public health data sharing platform, and continuously improving public health data sharing mechanisms. At the same time, appropriate data use policies and security measures should be formulated to ensure data privacy and security.

AIM: To observe the effects of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), myeloperoxidase (MPO) and transforming growth factor-β1 (TGF-β1) of radiation-induced lung injury rats by Kiwi fruit essence (unsaturated fatty acid of actinidia chinesis planch seed oil). METHODS: According to random number table, 90 Sprague-Dawley rats were divided into the control group, model group, 60 mg/kg unsaturated fatty acid of actinidia chinesis planch seed oil intervention group, 120 mg/kg unsaturated fatty acid of actinidia chinesis planch seed oil intervention group, 240 mg/kg unsaturated fatty acid of actinidia chinesis planch seed oil intervention group, 18 animals were included in each group. Except for the control group, rats in the remaining groups were constructed by 6MV-X-ray 18Gy full chest radiation, one week before modeling, the rats in the last 3 groups were given (60, 120, 240) mg/kg unsaturated fatty acid of actinidia chinesis planch seed oil. The first two groups were given 0.9% sodium chloride solution by gavage, once a day in each rat. 14 days, 28 days, and 56 days after radiation, the rats were randomly sacrificed and their chests were cut, and ave lung tissue was saved. HE and Masson staining were performed to observe the pathological changes, and the content of SOD, GSH-Px, MPO was determined. The expression of TGF-β1 was analyzed by immunohistochemical staining. RESULTS: Compared with the model group, (60, 120, 240) mg/kg unsaturated fatty acid of actinidia chinesis planch seed oil significantly reduced the degree of lung alveolitis and radiation pulmonary fibrosis, reduced the content of hydroxyproline (HYP), MPO, increased the antioxidant enzymes SOD and GSH-Px content, down-regulated the expression of TGF-β1.There were significant differences in the above-mentioned indicators among the intervention groups of (60, 120, 240) mg/kg unsaturated fatty acid of actinidia chinesis planch seed oil group, and it was positively correlated with dosage. CONCLUSION: Unsaturated fatty acid of actinidia chinesis planch seed oil has a preventive effect on radiation-induced lung injury, and its mechanism may be related to the reduction of oxidative stress damage and down-regulation of TGF-β1 expression.

AIM:To compare the effects of atorvastatin at different doses on the function of endothelial proge-nitor cells (EPCs) in the patients with ST-segment elevation myocardial infarction (STEMI).METHODS:The patients of STEMI (n=40) were chosen.According to treatment with different doses of atorvastatin calcium tablet, they were randomly divided into a group of 20 mg and a group of 40 mg (20 cases in each group).The EPCs isolated from the patients were identified and quantitatively analyzed at different time points (before the treatment and on days 5, 10, 15, 20, 30, 60, 90 and 120 after the treatment) by flow cytometry.The surface markers of the EPCs, CXC chemokine receptor 4 (CXCR4), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and silent information regulator 1 (SIRT1), were also detected.RESULTS:On the 5th day, the group of 40 mg demonstrated stronger cell proliferation capability and higher expression levels of CXCR4, VEGF and bFGF than the group of 20 mg (P<0.05).From the 10th day to 120th day, the group of 20 mg revealed stronger cell proliferation capability and higher expression levels of CXCR4, VEGF and bFGF than the group of 40 mg (P<0.05).Within 30 d, the expression of SIRT1 showed no significant diffe-rence between the 2 groups, yet it witnessed a marked change after that and peaked on the 60th day with a drop afterwards.At each time point, the SIRT1 expression level in the group 20 mg was observed higher than that in the group of 40 mg (P<0.05).CONCLUSION:In the acute phase, the repair function of the body treated with atorvastatin at dose of 40 mg is better than that with 20 mg.However, in a long term the low concentration of statin therapy works better in improving the vascular intima and promoting the angiogenesis than high concentration.

Objective To explore the role of 3D venous-fusion models in the resection of meningiomas.Methods The study included 19 patients with meningiomas,admitted to our hospital from March 2015 to July 2015.The preoperative and postoperative contrast enhancement MR venography (CE-MRV) data were imported into the neuronavigator system.The establishment of 3D venous-fusion models was performed;reconstruction,cropping,fusion of the intracranial venae and tumors were performed.3D venous-fusion models were used to evaluate the intracranial venous circulation,and the positions of venae and tumors were navigated in real-time.Results 3D venous-fusion models showed good results.The position relationship of tumors and their surrounding venous was perfectly assessed in operation.Nineteen patients underwent craniotomy using neuronavigator to locate venous position,and no postoperative venous complications occurred.The contrast of preoperative and postoperative 3D venous-fusion models prompted that the venous protection was in line with expectations.Conclusions The 3D venous-fusion models established by neuronavigator can accurately evaluate the relationship between cerebral venous and the tumors.These models help the operator making a better understanding of tumors and their peripheral venous imaging data from 3D perspective.It is benefit for the operator to make a more reasonable venous protect strategy.

Objective To compare the clinical effects of percutaneous foramen rotundum and percutaneous foramen ovale radiofrequency thermocoagulation (PRT) on maxillary neuralgia.Methods Eighty patients with primary maxillary neuralgia were randomly divided into puncture foramen (group A) and foramen rotundum through pterygopalatine fossa (group B).Visual analogue scale (VAS) scores,puncture time,surgical side effects,and complications were recorded before surgery,one week,and one,3,6 and 12 months after operation.Recurrent rate and excellent and good results were calculated one week,and one,3,6 and 12 months after operation.Results The operation time of group A was significantly shorter than that of group B (P＜0.05),however,complications (involved V1 and V3 branches) of group A were significantly higher than those of group B (P＜0.05).VAS scores of two groups showed no significant differences at each time points (P＞0.05).Recurrence rate of group A 3,6 and 12 months after surgery was 5.1％(2/39),7.8％(3/39) and 15.4％(6/39),respectively,which showed no significant differences as compared with that of group B (2.8％[1/36],11.1％[4/36] and 11.1％[4/36],P＞ 0.05).Rate excellent and good results showed no significant differences between each two groups one week,and 3,6 and 12 months after operation (P＞0.05).Conclusion Percutaneous punctures of the foramen ovale and foramen rotundum approach radiofrequency therrnocoagulation for the treatment of maxillary neuralgia are safe and effective operation methods;surgical complications in foramen rotundum approach are less than those in the foramen ovale approach.

Based on an observation of the evolution in rural cooperative medical system,the author proposed the concepts and legal nature of the system.He held that the system is a non-voluntary social insurance,with the country and society as the subjects of liability and oriented to peasants at large.With focused reference of legislation experiences in the USA,Japan and Germany,and summary of local experiments,the author recommended to draft laws and decrees of the system without delay,regulating the conception,goal,legal nature,functionality,regulators,fund raising,and supervision of the system.

ObjectiveTo measure the displacement of solitary pulmonary lesion (SPL) using fourdimensional CT (4DCT), and to compare the planning target volume using 4D maximum intensity projection (MIPMIP) ( PTV4DMIP ) with the empirical PTV3D.Methods Data were acquired from 24 consecutive patients with SPL. For each patient, respiration-synchronized 4DCT images and standard axial CT scans were obtained during free breathing.In lung window setting,the 4D technique was used to measure the displacement of SPL in three dimensions. We compared an PTV created using the MIP (PTV4DMIP) to the PTV created from the gross tumor volume (GTV) enlarged isotropically for each spatial direction by 1.0 cm and 1. 5 cm in the PTV3D1.0cm and PTV3D1.5cm. Results The SPL located in the lower lobe showed significant difference with the upper and middle lobe in y axis (0. 44 cm,0. 92 cm, t =2. 87, P =0. 000),but there was no difference in both x and z axis (0. 27 cm,0. 39 cm,t =1.44 ,P =0. 116 and 0. 29 cm,0. 40 cm,t =1.51, P =0. 227). SPL showed significantly greater displacement in y axis than in both x and z axis [0.60 cm and0. 31 cm (t =4.23,P=0.000) ,0.60 cm and 0.32 cm (t =4.65,P=0. 000)], but there was no significant difference between x and z axis (0. 31 cm,0. 32 cm,t =0. 33 ,P =0. 741 ). There was no statistically difference between the peripheral lung cancer and the pulmonary metastasis tumor in three directions ( x axis : 0. 37 cm,0. 32 cm, t =0. 52, P =0. 223 ; y axis : 0. 54 cm, 0. 95 cm, t =- 1.38, P =0.061;z axis:0.42 cm,0.37 cm, t=0.29, P=0.859).Both PTV3D1.0cm and PTV3D1.5cm showed significantly greater volume than PTV4DMIP(46. 73 cm3 ,86. 52 cm3 and 30. 02 cm3 ,t =- 11.35, - 12. 09,P =0. 000,0. 000). ConclusionsThe displacement of SPL in y axis is much greater than x and z axis. The empirical PTV3D is much bigger than PTV4DMIP, which suggests that 4DMIP provide adequate coverage of the moving target and minimize dose to normal tissues.

Objective To enlarge the scan width of cone-beam computed tomograpby(CBCT) and offer the integrity of structures( including tumor targets and organs at risk) on CBCT images by pasting the CBCT images together without gap or data lost. Methods Patients received CBCT scan twice at different longitude position. The two CBCT image series were then imported to TPS and fused with the planning CT. The same layer of two CBCT series was found by analyzing the two fusion results and recording their sequence numbers. The CBCT image series and the sequence numbers were sent to" CBCT Pasting", a special software we developed for this investigation. Then the software merged the CBCT series into the same reference flame. To validate the feasibility of CBCT Pasting,we observed its geometric characteristics by patients and phantoms. Results On the images of phantom, the difference was 0.26% (28.34 cm3) of the total body volume,and 1.87% (12.82cm3) and 1.47%(10.07cm3) of the two lungs between CT and CBCT images. On the images of patients, the difference was 1.97% (64.53cm3) ,2.30%(33.32cm3) and 1.75%(31.21cm3) for the total-lung,the left lung and the right lung. Conclusions The CBCT scan and pasting can enlarge the scan width without image data lost. This technique can provide a chance to observe the whole target and OAR and help physicists to evaluate the treatment plan.