Objective:To evaluate the short-term efficacy and safety of 3D printing patient-matched artificial vertebral body in clinical research and application.Methods:A total of 12 patients with spinal tumors were enrolled 7 males (58.33%) and 5 females (41.67%), aged from 18 to 65 years old in The First Affiliated Hospital of Air Force military Medical University (hereinafter referred to as Xijing Hospital) and Peking University people's Hospital from September 2021 to July 2022. The spinal vertebra defect were restored by using 3D printing patient-matched artificial vertebral body after tumor resection. All patients who accepted TES and 3D printing patient-matched artificial vertebral body implantation were included according to the inclusion and exclusion criteria. The bone interface fusion was evaluated by the imaging fusion criteria of Brantigan and Steffee at 3 and 6 months after operation, the curative effect was evaluated by comparing Japanese Orthopaedic Association (JOA) score at 3 and 6 months after operation, visual analogue scale (VAS) 3 months after operation and intervertebral height at 3 and 6 months after operation with those before operation, and the safety was evaluated by adverse event recording.Results:All 12 patients completed the operation successfully, and the operation sites were thoracic vertebrae in 6 cases (50%), thoracolumbar in 3 cases (25%) and lumbar vertebrae in 3 cases (25%). All patients were followed up. The mean follow-up time was 23.92±3.23 months (range, 19-29 months). No tumor recurrence or metastasis was observed during this period. All patients were followed up at 15 days, 3 months and 6 months after operation. During the 6-month follow-up, X ray results showed that interface of bone and the vertebral body were fused in all of the 12 patients, and the effective rate of fusion was 100%. The 95% confidence interval is calculated to be (75.6%-100%). Six months after operation, the improvement rate of JOA score was excellent in 10 cases, good in 1 case, poor in 1 case, and the excellent and good rate was 91.66%. The preoperative VAS score was 4.08 ±2.47, and during the 3-month follow-up, the VAS score was improved to 1.83 ±1.59. Compared with the preoperative VAS score, the difference was statistically significant ( t=2.635, P=0.023). The intervertebral height before operation, 15 days after operation, 3 months after operation and 6 months after operation were 32.75 (25.94, 68.20), 41.09 (30.55, 70.20), 40.70 (30.23, 67.83) and 40.74 (30.23, 67.08), respectively, and there was no statistically significant difference (χ 2=0.768, P=0.857). No implant-related adverse events occurred after operation. Conclusion:The 3D printing patient-matched artificial vertebral body used in this study has satisfactory short-term efficacy and safety in the reconstruction of spinal stability after spinal tumor resection.

Objective:To investigate the association between congenital hypothyroidism (CH) and the adverse outcomes during hospitalization in very low birth weight infants (VLBWI).Methods:This prospective, multicenter observational cohort study was conducted based on the data from the Sino-northern Neonatal Network (SNN). Data of 5 818 VLBWI with birth weight <1 500 g and gestational age between 24-<37 weeks that were admitted to the 37 neonatal intensive care units from January 1 st, 2019 to December 31 st, 2022 were collected and analyzed. Thyroid function was first screened at 7 to 10 days after birth, followed by weekly tests within the first 4 weeks, and retested at 36 weeks of corrected gestational age or before discharge. The VLBWI were assigned to the CH group or non-CH group. Chi-square test, Fisher exact probability method, Wilcoxon rank sum test, univariate and multivariate Logistic regression were used to analyze the relationship between CH and poor prognosis during hospitalization in VLBWI. Results:A total of 5 818 eligible VLBWI were enrolled, with 2 982 (51.3%) males and the gestational age of 30 (29, 31) weeks. The incidence of CH was 5.5% (319 VLBWI). Among the CH group, only 121 VLBWI (37.9%) were diagnosed at the first screening. Univariate Logistic regression analysis showed that CH was associated with increased incidence of extrauterine growth retardation (EUGR) ( OR=1.31(1.04-1.64), P<0.05) and retinopathy of prematurity (ROP) of stage Ⅲ and above ( OR=1.74(1.11-2.75), P<0.05). However, multivariate Logistic regression analysis showed no significant correlation between CH and EUGR, moderate to severe bronchopulmonary dysplasia, grade Ⅲ to Ⅳ intraventricular hemorrhage, neonatal necrotizing enterocolitis in stage Ⅱ or above, and ROP in stage Ⅲ or above ( OR=1.04 (0.81-1.33), 0.79 (0.54-1.15), 1.15 (0.58-2.26), 1.43 (0.81-2.53), 1.12 (0.70-1.80), all P>0.05). Conclusion:There is no significant correlation between CH and in-hospital adverse outcomes, possibly due to timely diagnosis and active replacement therapy.

Ankle Injuries ; Fractures, Compression ; Humans ; Knee Injuries

Objective:To evaluate the prediction value of preoperative Fibrinogen(FIB) in combination with neutrophil-lymphocyte ratio(NLR)for the prognosis of operable pancreatic cancer patients.Methods:The clinical data of 124 patients who underwent radical resection for pancreatic cancer in our hospital from Jan 2010 to Dec 2018 were retrospectively analyzed.The patients were divided into three groups according the high and low NLR, FIB value which defined by the receiver operating characteristic curve (ROC). The clinicopathological data and overall median survival time were compared between the three groups.Results:Univarate analysis showed that age, tumor stage, NLR, FIB and F-NLR score were associated with the prognosis( P<0.05), while multivariate analysis showed that high F-NLR score was the independent prognostic factor. The median survival time of patients with F-NLR scores 0, 1 and 2 group was 30.6, 20.3 and 13.9 months( P<0.05). The prognosis of high F-NLR score was significantly worse than that of low F-NLR score( P<0.05). Conclusions:A high preoperative F-NLR score was a promising predictor for the prognosis of pancreatic cancer patients after radical resection.

Objective:To explore the advantages of the novel individualized 3D printing artificial vertebral body in spine reconstruction and to evaluate its clinical effect.Methods:From January 2017 to December 2018, the 15 patients who underwent total vertebrectomy and spine reconstruction with individualized 3D printing artificial vertebral body were analyzed retrospectively. There were 8 males and 7 females, with the mean age 39.5 years (range: 20-57), including 12 primary tumors and 3 metastatic tumors. According to tumor location and surrounding soft tissue invasion range, simple posterior or combined anterior and posterior approach were used for total vertebral resection, and the defection was reconstructed by 3D printing artificial vertebral body. The operation time, intraoperative bleeding volume, postoperative stability of artificial vertebral body and bone ingrowth of adjacent vertebral body, preoperative and postoperative neurological changes, preoperative and postoperative VAS score, local control and survival of patients were analyzed.Results:The mean operation time was 412.0 min (range: 135-740 min), and the mean blood loss was 4 140.0ml (range: 100-14 000 ml). The mean follow-up time was 23.2 months (range: 12-35 months), and no one loss to follow-up. One case had pleural rupture, one case had cerebrospinal fluid leakage and one case had L5 nerve root palsy. All patients recovered after active symptomatic treatment. Compare with the preoperative VAS score (4.7±1.1), the differences of VAS score at 7 d postoperative and last follow-up (1.6±0.6 and 1.0±0.5) were significantly reduced ( P<0.001). Three patients with Frankel grade C gradually recovered to grade D, and no change were found in grade D and Grade E patients, there was no significant improved at last follow-up. Preliminary bone growth was found between the artificial vertebral body and the adjacent vertebral body 3 months after operation. The bone growth was more obvious at 12 months post-operation, and the artificial vertebral body fused with the adjacent vertebral bodies to form bone integration. At 24 months post-operation, the integration of the artificial vertebral body was more accurate. During the follow-up period, there was no loosening or displacement of the artificial vertebral body and no failure of internal fixation. A case of hemangioendothelioma and a case of epithelioid angiosarcoma died at 33 months and 35 months postoperatively. One patient with chondrosarcoma had local recurrence at16 months post-operation. After treated with arotinib, the tumor did not progress. The other 12 patients had no tumor recurrence or distant metastasis. Conclusion:After spinal tumor resection, individualized 3D printing artificial vertebral body can be used to accurate restoration of spinal continuity, and provide nice interface matching and bone growth between artificial vertebral body and the adjacent vertebral endplates. Moreover, the immediate and long-term stability of the artificial vertebral body can meet the needs of spinal reconstruction.

Objective: To compare the short-term and long-term results of thoracoscopic and open pneumonectomy for non-small cell lung cancer. Methods: The clinical data of patients with non-small cell lung cancer who underwent pneumonectomy in the Department of Thoracic Surgery, Qingdao University Hospital from January 2008 to December 2016 were collected. Totally 142 patients (55 in the thoracoscopic group and 87 in the open group) were included in the study. A total of 29 pairs of patients were successfully matched by propensity score matching (PSM). Perioperative outcomes and overall survival were compared between the two groups using t test, χ² test, Kaplan-Meier curve and Log-rank test, respectively. Results: Camparion with open group, the thoracoscopic group had longer operative time ((209.7±70.2) minutes vs. (171.3±43.5) minutes, t=2.50, P=0.02), more mediastinal lymph node dissection (M(Q_R): 17(9) vs. 11(10), W=388, P=0.02) and shorter postoperative hospital stay (7.0(3.5) vs. 9.0(3.0), W=285, P=0.03). There was no significant difference in estimated blood loss, postoperative drainage time, dissected lymph node number, dissected lymph node station and perioperative complications. After PSM, there were no signifificant differences found in 3-year survival (71.4% vs. 48.1%, P=0.10) and 3-year disease-free survival (67.4% vs. 47.2%, P=0.13) between the two groups. Conclusion Thoracoscopic pneumonectomy is safe and feasible for the treatment of non-small cell lung cancer with more mediastinal lymph node dissection and accelerating recovery, and equivalent long-term prognosis when compared with open approach.

Objective:To compare the short-term results of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy in periampullary carcinoma patients.Methods:The clinical data of patients with periampullary carcinoma who underwent laparoscopic pancreaticoduodenectomy or open pancreaticoduodenectomy at Department of Hepatopancreatobiliary Surgery, Jinhua Hospital, Affiliated to Zhejiang University School of Medicine from January 2013 to February 2018 were collected. Totally 127 patients were included in the study. There were 73 males and 54 females, aged (61.2±9.4) years (range: 37-80 years). Propensity score matching method was used to perform 1∶1 matching between laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy. Perioperative outcomes and overall survival were compared between the two groups using t test, χ 2 test, Fisher exact probability, Kaplan-Meier curve and Log-rank test, respectively. Results:A total of 32 pairs of patients were successfully matched by propensity score matching. There were 21 males and 11 females in open pancreaticoduodenectomy group, aged (62.1±9.3)years, 21 males and 11 females in laparoscopic group, aged (63.7±9.4)years. Comparion with open pancreaticoduodenectomy, the laparoscopic group had longer operative time (381(47)minutes vs. 249(92)minutes)( t=-5.949, P=0.000), higher hospitalization cost ((64.8±7.2) thousand yuan vs. (56.0±9.2)thousand yuan, t=-3.464, P=0.001), but less in estimated blood loss ((249.38±91.40)ml vs.(329.69±120.26)ml) ( t=3.008, P=0.004), shorter in the time to first flatus ((3.39± 1.1)days vs. (5.03±1.65)days, t=5.316, P=0.000) and preoperative hospital stay((18.6±5.59)days vs. (21.9±5.5)days) ( t=2.242, P=0.018). There was no significant difference in vascular invasion, nerve invasion, number of lymph nodes dissected, perioperative complications and pathology (all P>0.05). After PSM, there was no significant difference found in 1-year overall survival rate (60.0% vs. 62.0%, P=0.729). Conclusions:Laparoscopic pancreaticoduodenectomy is safe and feasible for the treatment of periampullary carcinoma. It not only has advantages of less trauma and faster recovery, but also achieves similar of lymph node dissection and equivalent short-term prognosis when compared with open approach.

Objective:To compare the short-term results of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy in periampullary carcinoma patients.Methods:The clinical data of patients with periampullary carcinoma who underwent laparoscopic pancreaticoduodenectomy or open pancreaticoduodenectomy at Department of Hepatopancreatobiliary Surgery, Jinhua Hospital, Affiliated to Zhejiang University School of Medicine from January 2013 to February 2018 were collected. Totally 127 patients were included in the study. There were 73 males and 54 females, aged (61.2±9.4) years (range: 37-80 years). Propensity score matching method was used to perform 1∶1 matching between laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy. Perioperative outcomes and overall survival were compared between the two groups using t test, χ 2 test, Fisher exact probability, Kaplan-Meier curve and Log-rank test, respectively. Results:A total of 32 pairs of patients were successfully matched by propensity score matching. There were 21 males and 11 females in open pancreaticoduodenectomy group, aged (62.1±9.3)years, 21 males and 11 females in laparoscopic group, aged (63.7±9.4)years. Comparion with open pancreaticoduodenectomy, the laparoscopic group had longer operative time (381(47)minutes vs. 249(92)minutes)( t=-5.949, P=0.000), higher hospitalization cost ((64.8±7.2) thousand yuan vs. (56.0±9.2)thousand yuan, t=-3.464, P=0.001), but less in estimated blood loss ((249.38±91.40)ml vs.(329.69±120.26)ml) ( t=3.008, P=0.004), shorter in the time to first flatus ((3.39± 1.1)days vs. (5.03±1.65)days, t=5.316, P=0.000) and preoperative hospital stay((18.6±5.59)days vs. (21.9±5.5)days) ( t=2.242, P=0.018). There was no significant difference in vascular invasion, nerve invasion, number of lymph nodes dissected, perioperative complications and pathology (all P>0.05). After PSM, there was no significant difference found in 1-year overall survival rate (60.0% vs. 62.0%, P=0.729). Conclusions:Laparoscopic pancreaticoduodenectomy is safe and feasible for the treatment of periampullary carcinoma. It not only has advantages of less trauma and faster recovery, but also achieves similar of lymph node dissection and equivalent short-term prognosis when compared with open approach.

Objective: To compare instrumentation with 3D-printed patient-specific guides versus conventional techniques in supramalleolar osteotomy for varus ankle osteoarthritis. Methods: A retrospective analysis was done of the 21 patients with varus ankle osteoarthritis who had been treated at Department of Orthopaedics, Shanghai JiaoTong University Affiliated Sixth People's Hospital from January 2017 to December 2018. They were divided into 2 groups by their treatment methods. In the 9 patients treated by instrumentation with 3D-printed patient-specific guides, there were 6 males and 3 females with an age of 54.6±8.6 years, 4 left and 5 right sides involved, and one case of Takakura stage 1, 3 cases of Takakura stage 2 and 5 cases of Takakura stage 3a. In the 12 patients treated by conventional techniques, there were 7 males and 5 females with an age of 53.0±6.5 years, 7 left and 5 right sides involved, and one case of Takakura stage 1, 5 cases of Takakura stage 2 and 6 cases of Takakura stage 3a. The 3D printed guide group and the conventional group were compared in terms of operation time, intraoperative blood loss and frequency of intraoperative fluoroscopy, tibial anterior surface angle (TAS), talar tilt angle (TT), and tibial lateral surface angle (TLS). The differences in TAS, TT and TLS between pre- and post-operation in the 3D printed guide group were also evaluated. Results: There were no significant differences in the preoperative general data between the 2 groups (P>0.05), indicating they were comparable. All the patients were available for follow-up for an average of 7.8 months (from 3 to 15 months). The 3D printed guide group incurred significantly shorter operation time (106.2±10.6 min), less intraoperative blood loss (207.2±16.0 mL) and lower fluoroscopy frequency (2±0) than the conventional osteotomy group (all P<0.01). The post-operative TAS (94.3°±3.2°) and TT (3.8°±0.8°) angles in the 3D guide group were significantly different from their preoperative values (84.6°±3.5° and 7.6°±1.6°) (P<0.01). The 3D printed guide group was not significantly different from the conventional group in postoperative TAS (94.3°±3.2° versus 92.4°±5.9°), TT (3.8°±0.8° versus 4.2°±1.1°) or TLS (83.7°±3.4° versus 84.2°±2.2°) angles (P>0.05). Conclusions Compared with conventional techniques, instrumentation with 3D-printed patient-specific guides can shorten operation time and reduce intraoperative blood loss and fluoroscopy frequency. The 3D printed patient-specific guides in osteotomy can facilitate accurate correction of varus deformity, leading to similar efficacy compared with conventional osteotomy.

Objective To analyze the effectiveness and safety of percutaneous screw fixation assisted by an orthopedic robot for treatment of pelvic and acetabular fractures.Methods Fifteen patients with fresh closed pelvic or acetabular fracture were hospitalized from September to December 2017 at Department of Orthopaedics,Foshan Hospital of Traditional Chinese Medicine.They were 10 men and 5 women,from 22 to 69 years of age (average,65.2 years).There were 9 pelvic fractures (5 cases of Tile type B and 4 ones of Tile type C) and 6 acetabular fractures (3 anterior column fractures,2 posterior column fractures and one transverse fracture).All patients underwent percutaneous transpedicular screw fixation with the assistance of an orthopaedic robot.Fluoroscopic frequency,number of guide needle adjustment and deviation between initial planning and the final screw position were recorded intraoperatively.Postoperative CT was performed to evaluate screw positions and incidence of adverse events.Functional recovery in the patients was evaluated in regular follow-ups.Results A total of 26 screws were implanted in the operation.The fluoroscopic frequency ranged from 12 to 49 times,with a mean value of 17.3 times per screw;the number of needle adjustment ranged from 0 to 2 times(mean,0.3 times);the deviation of the actual path from its initial planning ranged from 0.82 to 1.42 mm (mean,1.06 mm).No surgery-related neurovascular injury occurred in any patient.Postoperative CT examination revealed that no screws cut out of cortical bone,yielding a 100％ rate of excellent and good screw positions.Two patients were lost to the follow-up,and the remaining 13 patients were followed up for 12 to 14 months (mean,12.6 months).Their Majeed functional scores at the final follow-up averaged 88.6 points (from 68 to 96 points).No neurological symptoms were observed during follow-up.Conclusion Since percutaneous screw fixation assisted by an orthopaedic robot is accurate and safe and needs less fluoroscopic frequency,it will became a major minimally invasive surgical technique for pelvic and acetabular fractures.