BACKGROUND:The use of 3D-printed patient-specific instruments in opening wedge high tibial osteotomy has advantages such as shorter operative time,fewer fluoroscopic exposures,and higher correction accuracy.However,previous studies have reported issues such as significant damage to surrounding soft tissues and improper fixation of the plates. OBJECTIVE:To investigate the clinical efficacy of using 3D-printed patient-specific instruments combined with customized locking plate in opening wedge high tibial osteotomy for the treatment of knee osteoarthritis. METHODS:A total of 20 patients diagnosed with knee osteoarthritis were divided into the 3D group(n=10)and the conventional group(n=10)according to surgical methods.The 3D group underwent opening wedge high tibial osteotomy using 3D-printed patient-specific instruments combined with customized locking plate,while the conventional group underwent opening wedge high tibial osteotomy using conventional methods.The operative time,fluoroscopic exposures,incision length,pre-and postoperative hip-knee-ankle angle,medial proximal tibial angle,posterior tibial slope,the difference between the planned and actual correction angle,preoperative and 1,3,6 months postoperative knee range of motion and Lysholm score,and incidence of complications were analyzed and compared between the two groups. RESULTS AND CONCLUSION:(1)The operative time and fluoroscopic exposures were significantly shorter in the 3D group compared to the conventional group,with a statistically significant difference(P<0.001).(2)Both groups showed a significant improvement in postoperative hip-knee-ankle angle and medial proximal tibial angle compared to preoperative values,with a statistically significant difference(P<0.001),while there was no significant change in posterior tibial slope.In the 3D group,the postoperative hip-knee-ankle angle,medial proximal tibial angle,and posterior tibial slope differed from their respective preoperative planned values by(-0.22±0.72)°,(-0.20±0.73)°,and(0.23±0.37)°,but the differences were not statistically significant.The difference between the planned and actual correction angle of 3D group was significantly smaller than that of conventional group(P<0.05).(3)Both groups showed a gradual increase in knee range of motion and Lysholm scores after surgery(P<0.001).Compared to the conventional group,the 3D group had superior knee range of motion at 1 and 3 months postoperatively,as well as a higher Lysholm score at 1 month postoperatively,with statistically significant differences(P<0.05).There were no statistically significant differences in Lysholm score at 3 months and knee range of motion and Lysholm score at 6 months between the two groups(P>0.05).(4)Complications occurred in neither groups.(5)The above results indicate that both 3D-printed patient-specific instruments combined with customized locking plate and conventional methods have good clinical efficacy.However,the former has a shorter operative time,fewer fluoroscopic exposures,and faster postoperative recovery of knee joint function.Additionally,3D-printed patient-specific instruments can achieve preoperative planning accurately.

ObjectiveTo observe the clinical efficacy and relative mechanism of the Modified Wenshen Yixin Formula （温肾益心方加减， MWYF） as an auxiliary treatment of coronary heart disease （CHD） complicated with hypothyroidism of spleen-kidney yang deficiency. MethodsA total of 135 CHD patients complicated with hypothyroidism and spleen-kidney yang deficiency were included and divided into control group （67 cases） and experimental group （68 cases） according to the patients' wishes of herbal medicine administration. The control group was given conventional western medicine， while the treatment group was additionally given MWYF， 1 dose per day； both groups were treated for 8 weeks. The traditional Chinese medicine （TCM） syndrome scores， angina scores， SF-36 scores， thyroid function indicators including thyroid stimulating hormone （TSH）， thyroxine （T4） and triiodothyronine （T3）， as well as serum cyclic adenosine monophosphate （cAMP）， cyclic guanosine monophosphate （cGMP）， monocyte chemoattractant ligand 2 （CCL2）， and tumor necrosis factor-related activator protein （CD40L） levels before and after treatment were compared between the two groups. The dosage and reduction and discontinuation rate of thyroid hormone preparations after treatment were compared between the two groups. The effectiveness regarding TCM syndrome and angina pectoris was evaluated， and the safety was assessed. ResultsBias was adjusted by matching on propensity score， and 102 cases were finally included in the statistical analysis， with 51 cases in each group. The total effective rate regarding TCM syndrome ［94.12% （48/51） versus 64.71% （33/51）］， the total effective rate regarding angina pectoris ［80.39% （41/51） versus 62.75% （32/51）］， and the reduction and discontinuation rate of thyroid hormone preparation ［39.21% （20/51） versus 5.88% （3/51）］ were significantly higher in the experimental group than those in the control group （P＜0.05 or P＜0.01）. After treatment， the total TCM syndrome score， individual scores of major symptoms ， the major symptoms score， the secondary symptoms score， angina pectoris score， and TSH level were significantly reduced （P＜0.01）， while all dimensions of SF-36 scores， T4， T3， and cAMP levels significantly increased in both groups （P＜0.05 or P＜0.01）. The dosage of thyroid hormone preparations and the levels of cGMP， CCL2， and CD40L in the experimental group significantly decreased after treatment （P＜0.01）. When compared between the two groups after treatment， the total TCM syndrome score， the major symptoms score， the scores of individual major symptom （chest tightness， chest pain， fear of cold， cold limbs， waist and kness soreness and weakness）， the secondary symptoms score， angina pectoris score， TSH， cGMP， CCL2， and CD40L levels of the experimental group were significantly lower than those of the control group （P＜0.05 or P＜0.01）， while all dimension scores of SF-36， T4， T3， and cAMP levels were significantly higher （P＜0.01）. A total of three adverse events occurred during treatment， none of which were judged to be related to the interventions of this study. ConclusionMWYF can significantly ameliorate the TCM syndrome， angina pectoris， quality of life and thyroid function in CHD patients complicated with hypothyroidism and spleen-kidney yang deficiency， and can promote the reduction and disconti-nuation of thyroid hormone preparations. The mechanism may be related to the regulation of cAMP/cGMP balance， the regulation of hypothalamic-pituitary-thyroid metabolic axis and the reduction of immune inflammation.

Ophthalmic drug-device combination products are a new method of ophthalmic disease treatment,which is characterized by high bioavailability,strong targeting and good compliance.However,it is difficult for products to be developed and regulated due to the complexity of the human eye structure,drug-device interactions,and other factors.To provide a basis for guaranteeing the safety and efficacy of products development and management,the related regulations,current research,and evaluation of the quality of products are summarized in this paper.

OBJECTIVE To study the role of phosphatidylinositol-3-kinase （PI3K） on sunitinib-induced myocardial systolic dysfunction. METHODS Using human-induced pluripotent stem cell-derived cardiomyocytes （hiPSC-CMS） as objects， the contractile force of cardiomyocytes was measured by CardioExcyte 96 system， and IC50 of sunitinib was calculated after hiPSC- CMS were treated with sunitinib at different concentrations [0 （control）， 0.5， 1， 3， 5， 10 μmol/L] for 24 hours. The effects of sunitinib （3.14 μmol/L） on the contractile frequency of cardiomyocytes， calcium transient amplitude and calcium transient recovery time course， mRNA expression of myocardial injury markers atrial natriuretic peptide （ANP）， brain natriuretic peptide （BNP） and β-myosin heavy chain （β-MHC） were detected. PI3K activator 3，4，5-triphosphate phos-phatidylinositol （PIP3， 1 μmol/L） and sunitinib were used to intervene in hiPSC-CMs jointly， so as to investigate the role of PI3K in the myocardial systolic dysfunction induced by sunitinib. RESULTS Sunitinib inhibited the contractile force of hiPSC-CMs in a concentration-dependent manner. IC50 of sunitinib was 3.14 μmol/L. After intervention with 3.14 μmol/L sunitinib， the contractile frequency of hiPSC-CMs and calcium transient amplitude were decreased significantly （P＜0.05 or P＜0.01）； the duration of calcium transient recovery was prolonged significantly （P＜0.05）， and mRNA expressions of ANP， BNP and β-MHC were significantly increased （P＜0.01）. After PI3K was activated with PIP3， the contractile force of hiPSC-CMs was increased significantly （P＜0.01）. CONCLUSIONS Activating PI3K activity is a potential molecular mechanism to improve myocardial toxicity induced by sunitinib.

Objective:To comprehensively evaluate the high-quality development of some tertiary public hospitals in C city, and explore the high-quality development path of municipal public hospitals, so as to provide a basis for the formulation of relevant policies.Methods:Based on the relevant policy documents of the evaluation indicators for the high-quality development of public hospitals, and around the four dimensions of medical quality, economic efficiency, sustainable development and satisfaction, the entropy weight TOPSIS-RSR method was adopted to comprehensively evaluate the high-quality development of some tertiary public hospitals in C city in 2019 and 2020. It included all five municipal comprehensive tertiary public hospitals in C city, and included one provincial and two county-level tertiary public hospitals for comparative study.Results:In 2019 and 2020, the number of medical cooperation, the surplus of income and expenditure, and the entropy weight of scientific research project funding per 100 health technicians were large, which were the key indicators to evaluate the high-quality development of public hospitals, with the values of 0.096 and 0.109, 0.119 and 0.141, 0.123 and 0.124, respectively. According to the best classification principle, the provincial, municipal and county-level public hospitals in C city could be divided into three levels of " good" , " medium" and " poor" , and the development gap between these levels was large.Conclusions:The development of municipal public hospitals in C city has achieved remarkable results, but there are still such problems as uneven distribution of medical resources, insufficient motivation for talent training, relatively lagging discipline construction, and insufficient advantages and characteristics. In this regard, we should further optimize the allocation of medical resources, improve the operation and management system, clarify the social functions of public hospitals, and scientifically allocate core resources.

Objective To investigate the protective effect of mild hypothermia on cerebral ischemia-reperfusion injury in rats and the effect of mild hypothermia on the expression of inhibitor of differentiation 2 (Id2) protein.Methods A total of 72 adult male rats were randomly divided into a sham operation group,a normothermia group,and a mild hypothermia group.A model of middle cerebral artery occlusion was induced by a suture method.The mild hypothermia group was treated with low temperature (anal temperature 33±1 ℃,tympanic membrane temperature 31±1 ℃).Modified Neurological Severity Score (mNSS) was used to evaluate neurological deficits,triphenyltetrazolium chloride staining was used to detect infarct volume,and Western blot was used to detect the Id2 expression in the ischemic cortex at ischemia-reperfusion 6,12,24,and 72 h,respectively.ResultsThe mNSS scores in the mild hypothermia group were significantly lower than those in the normothermia group,the infarct volumes were significantly smaller than those in the normothermia group at ischemia-reperfusion 6,12,24,and 72 h (all P<0.001).Western blot analysis showed that the Id2 expressions in the ischemic cortex in the mild hypothermia group were significantly lower than those in the normothermia group at ischemia-reperfusion 6,12,24,and 72 h (all P<0.05).Conclusion s Mild hypothermia can decrease neurological deficits and reduce infarct volume after cerebral ischemia-reperfusion,its mechanism may be associated with the down-regulation of the Id2 expression.

Objective To explore the significance of expressions of glutamate transporters and γ-aminobutyric acid transporters in the rat model with cerebral ischemia.Methods The detections of the expressions of glutamate transporter-1 (EAAC-1) and γ-aminobutyric acid transporter-1 (GAT-1) in models with ischemia in vivo and hypoxia in vitro were performed by immunofluorescence,Westen-blot and real-time polymerase chain reaction (RT-PCR) methods.Results The expression of EAAC1 was reduced in the cerebrum of focal cerebral ischemic MACO rat model as well as in primary neurons cultured under hypoxia.The expression of GAT1 was elevated.Conclusion EAAC1 expression decreases while GAT1 expression increases under condition of cerebral ischemia and anoxia.

Objective To explore the significance of expressions of glutamate transporters and γ-aminobutyric acid transporters in the rat model with cerebral ischemia.Methods The detections of the expressions of glutamate transporter-1 (EAAC-1) and γ-aminobutyric acid transporter-1 (GAT-1) in models with ischemia in vivo and hypoxia in vitro were performed by immunofluorescence,Westen-blot and real-time polymerase chain reaction (RT-PCR) methods.Results The expression of EAAC1 was reduced in the cerebrum of focal cerebral ischemic MACO rat model as well as in primary neurons cultured under hypoxia.The expression of GAT1 was elevated.Conclusion EAAC1 expression decreases while GAT1 expression increases under condition of cerebral ischemia and anoxia.

Objective To observe the expressions of microRNA-126 (miR-126) and vascular endothelial growth factor (VEGF) in gastric carcinoma tissues,and their associations with clinicopathologic features in gastric carcinoma.Methods Fifty cases of gastric carcinoma and matched tumor adjacent tissue specimens were collected from January 2012 to March 2014 in Shangqiu First People's Hospital of He' nan Province.Expression levels of miR-126 and VEGF were examined using reverse transcriptase-polymerase chain reaction.Their correlations and the relationships between them and the clinicopathologic features in gastric carcinoma were analyzed.Results The expression levels of miR-126 in the tumor tissues and in the adjacent tissues were 0.652 ± 0.102 and 0.379 ± 0.069,and the expression levels of VEGF in the two kinds of tissues were 1.523 ± 0.142 and 0.604 ± 0.152,with statistical differences (t =8.374,P =0.001;t =29.508,P =0.000).The expressions of miR-126 and VEGF were significantly positively correlated (r =0.735,P =0.001).The expressions of miR-126 and VEGF were associated with TNM stage (t =22.981,P =0.001;t =18.053,P =0.001),depth of tumor invasion (t =26.792,P =0.001;t =20.234,P =0.001) and tumor node metastasis (t=26.668,P=0.001;t=14.857,P=0.001).Conclusion miR-126 is high expressed in the gastric carcinoma tissue,which may up-regulate the expression of VEGF,and lead to the formation of new blood vessels,then to promote gastric carcinogenesis and the development process.

This paper is to establish a three-dimensional finite element model (3D-FEM) of pelvic floor levator ani muscles in an old healthy women. We acquired the image data of the pelvic bones and pelvic floor muscles from CT and MRI scanning in a non-pregnant old healthy female volunteers. The 3-D reconstruction and mesh optimization of the whole pelvic bones and muscles with application of image processing software Mimics12.0 and Geomagic9.0 were obtained. Then we built the 3D-FEM of the musculoskeletal system of the pelvic bones and levator ani muscles with Ansys11.0 software. We obtained an accurate 3D-FEM of pelvic bones and levator ani muscles in the older healthy woman. The results showed that it was reliable to build 3D-FEM with CT and MRI scanning data and this model could vividly reflect the huge space anatomy of the real pelvic floor levator ani muscles. It avoids the defects to gain the model from the body of anatomical specimens in the past. The image data of model are closer to vivisection, and the model is more conducive to the latter finite element analysis.
Female ; Finite Element Analysis ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Middle Aged ; Muscle, Skeletal ; anatomy & histology ; diagnostic imaging ; Pelvic Floor ; anatomy & histology ; diagnostic imaging ; Tomography, X-Ray Computed ; methods