Objective To determine whether Rb gene is involved in the genesis of primary hepatocellular carcinoma(HCC). MethodsForty paraffin specimens of primary HCCs with corresponding adjacent liver tissues and normal liver tissues were investigated for Rb protein expression by tissue chip and SP immunohistochemical technique. ResultsLoss of Rb protein expression occurred in 17 of 40 tumor samples, whereas in 4 of 40 adjacent liver tissue samples, only 1 of 40 normal liver tissue specimens showed negative Rb staining.Rb protein deletion in HCC was higher than that in adjacent tissues and normal liver tissues (P＜0.05).Rb protein deletion rate doesn’t correlated remarkably with tumor size or phathology grade of HCC （Pgt;0.05）. ConclusionRb protein deletion may play an important role in the tumorigenesis of HCC.Tissue chip is an effective highthroughput technique platform for the study of tumor molecular pathology.
Objective To evaluate the clinical effectiveness and safety of tranexamic acid (TXA) in arthroscopic rotator cuff repair by meta-analysis. Methods Randomized controlled trials evaluating the clinical effectiveness and safety of TXA use in the perioperative period of arthroscopic rotator cuff repair were identified from the Cochrane Library, PubMed, Embase, VIP Chinese Science and Technology Periodical Database, Chinese National Knowledge Infrastructure, and Wanfang database, with a search time span from the inception of the database to August 2024. Meta-analysis was conducted using RevMan 5.3 software, and mean difference (MD) and risk difference (RD) were used as measures of effect size. Results A total of 7 randomized controlled trials were included. Meta-analysis demonstrated significant differences in good visual clarity [MD=9.10, 95% confidence interval (CI) (4.05, 14.15), P=0.0004] and operative time [MD=−12.07 min, 95%CI (−17.21, −6.93) min, P<0.00001]. There was no significant difference in mean arterial pressure [MD=−1.08 mm Hg (1 mm Hg=0.133 kPa), 95%CI (−3.13, 0.98) mm Hg, P=0.30] or adverse event rate [RD=0.02, 95%CI (−0.01, 0.06), P=0.22] between the two groups. Conclusion TXA is effective and safe in enhancing visual clarity and significantly reducing operative time in arthroscopic rotator cuff repair, without increasing the incidence of adverse events.
Objective To evaluate the efficacy and safety of tranexamic acid in arthroscopic anterior cruciate ligament reconstruction by meta-analysis. Methods The databases searched included Embase, PubMed, Cochrane Library, Wanfang, China National Knowledge Infrastructure and Chongqing VIP. The search time range was from the establishment of the databases to September 2022. All randomized controlled trials using tranexamic acid in arthroscopic anterior cruciate ligament reconstruction were collected. The outcome indicators were postoperative blood loss, postoperative joint cavity puncture rate, postoperative hematoma rate, postoperative Visual Analogue Scale score, and postoperative knee joint range of motion. RevMan 5.3 analysis software was selected for meta-analysis. Results A total of 6 articles were included, including 660 patients. Meta-analysis showed that the postoperative blood loss in the tranexamic acid group was lower than that in the control group [weighted mean difference (WMD)=−24.32 mL, 95% confidence interval (CI) (−33.73 mL, −14.91 mL), P<0.000 01]. The postoperative Visual Analogue Scale score in the tranexamic acid group was lower than that in the control group [WMD=−0.69, 95%CI (−1.21, −0.18), P=0.009]. The postoperative knee joint range of motion in the tranexamic acid group was higher than that in the control group [WMD=2.88°, 95%CI (0.55°, 5.21°), P=0.02]. The postoperative joint cavity puncture rate in the tranexamic acid group was lower than that in the control group [risk ratio (RR)=0.25, 95%CI (0.12, 0.53), P=0.0003]. The postoperative hematoma rate in the tranexamic acid group was lower than that in the control group [RR=0.40, 95%CI (0.21, 0.78), P=0.007]. Conclusion The patients who used tranexamic acid in in arthroscopic anterior cruciate ligament reconstruction have less postoperative bleeding, lower knee joint puncture rate and hematoma formation rate, which are conducive to pain relief and functional rehabilitation.
Objective To compare the effects of hypoxia-inducible drugs using deferoxamine (DFO) and accordion technique (AT) on activating the hypoxia-inducible factor 1α (HIF-1α)/vascular endothelial growth factor (VEGF) signaling pathway to promote bone regeneration and remodelling during consolidation phase of distraction osteogenesis (DO). Methods Forty-five specific-pathogen-free adult male Sprague-Dawley (SD) rats were randomly divided into the control group, DFO group, and AT group, with 15 rats in each group. All rats underwent osteotomy to establish a right femur DO model. Then, continuous distraction was started for 10 days after 5 days of latency in each group. During the consolidation phase after distraction, no intervention was performed in the control group; DFO was locally perfused into the distraction area in the DFO group starting at the 3rd week of consolidation phase; cyclic stress stimulation was given in the AT group starting at the 3rd week of consolidation phase. The general condition of rats in each group was observed. X-ray films were conducted at the end of the distraction phase and at the 2nd, 4th, and 6th weeks of the consolidation phase to observe the calcification in the distraction area. At the 4th and 6th weeks of the consolidation phase, peripheral blood was taken for ELISA detection (HIF-1α, VEGF, CD31, and Osterix), femoral specimens were harvested for gross observation, histological staining (HE staining), and immunohistochemical staining [HIF-1α, VEGF, osteopontin (OPN), osteocalcin (OCN)]. At the 6th week of the consolidation phase, Micro-CT was used to observe the new bone mineral density (BMD), bone volume/tissue volume (BV/TV), trabecular separation (Tb.Sp), trabecular number (Tb.N), and trabecular thickness (Tb.Th) in the distraction area, and biomechanical test (ultimate load, elastic modulus, energy to failure, and stiffness) to detect bone regeneration in the distraction area. Results The rats in all groups survived until the termination of the experiment. ELISA showed that the contents of HIF-1α, VEGF, CD31, and Osterix in the serum of the AT group were significantly higher than those of the DFO group and control group at the 4th and 6th weeks of the consolidation phase (P<0.05). General observation, X-ray films, Micro-CT, and biomechanical test showed that bone formation in the femoral distraction area was significantly better in the DFO group and AT group than in the control group, and complete recanalization of the medullary cavity was achieved in the AT group, and BMD, BV/TV, Tb.Sp, Tb.N, and Tb.Th, as well as ultimate load, elastic modulus, energy to failure, and stiffness in the distraction area, were better in the AT group than in the DFO group and control group, and the differences were significant (P<0.05). HE staining showed that trabecular bone formation and maturation in the distraction area were better in the AT group than in the DFO group and control group. Immunohistochemical staining showed that at the 4th week of consolidation phase, the expression levels of HIF-1α, VEGF, OCN, and OPN in the distraction area of the AT group were significantly higher than those of the DFO group and control group (P<0.05); however, at 6th week of consolidation phase, the above indicators were lower in the AT group than in the DFO group and control group, but there was no significant difference between groups (P>0.05). Conclusion Both continuous local perfusion of DFO in the distraction area and AT during the consolidation phase can activate the HIF-1α/VEGF signaling pathway. However, AT is more effective than local perfusion of DFO in promoting the process of angiogenesis, osteogenesis, and bone remodelling.
Glomerular filtration rate (GFR), which can be estimated by Gates method with dynamic kidney single photon emission computed tomography (SPECT) imaging, is a key indicator of renal function. In this paper, an automatic computer tomography (CT)-assisted detection method of kidney region of interest (ROI) is proposed to achieve the objective and accurate GFR calculation. In this method, the CT coronal projection image and the enhanced SPECT synthetic image are firstly generated and registered together. Then, the kidney ROIs are delineated using a modified level set algorithm. Meanwhile, the background ROIs are also obtained based on the kidney ROIs. Finally, the value of GFR is calculated via Gates method. Comparing with the clinical data, the GFR values estimated by the proposed method were consistent with the clinical reports. This automatic method can improve the accuracy and stability of kidney ROI detection for GFR calculation, especially when the kidney function has been severely damaged.
Objective To investigate the improved reduction technique for depression fractures of the lateral tibial plateau and its effectiveness. Methods Between January 2008 and December 2010, 48 patients (48 knees) with depression fractures of the lateral tibial plateau (Schatzker II or III fractures) were treated. There were 32 males and 16 females with an average age of 45.8 years (range, 16-79 years). All fractures were fresh closed fractures, which were caused by traffic accident in 27 cases, by falling from height in 5 cases, by crushing in 8 cases, and by sustained falls in 8 cases. According to Schatzker classification, 29 cases were classified as type II and 19 cases as type III. The lateral cortex was cut off to expose the depression and compacted cancellous bone was elevated to reset the articular surface. After reduction, autologous iliac bone graft and locking plate internal fixation were used. Results Healing of incision by first intention was achieved in all patients, and no complication occurred. All patients were followed up 1.7 years on average (range, 1-3 years). At last follow-up, the knee extension was ( — 0.5 ± 0.3)°, and the knee flexion was (136.9 ± 8.8)°. X-ray films showed that the fracture healing time was 52 weeks and no breakage of internal fixation occurred. According to Rasmussen clinical score, the results were excellent in 35 cases, good in 10 cases, and fair in 3 cases. According to Rasmussen radiographical score, the results were excellent in 41 cases, good in 7 cases; there were 41 excellent scores and 7 good scores of articular reduction; all gained good recovery of coronal and sagittal alignment and condylar width. The articular surface collapse was (1.0 ± 0.7) mm at immediate postoperatively and (1.2 ± 0.7) mm at last follow-up, showing no significant difference (t= — 1.42, P=0.20), but significant differences were found when compared with that at preoperation [(12.2 ± 8.0) mm, P lt; 0.05]. Conclusion This improved technique can provide a satisfactory effectiveness of fracture reduction and can avoid loss of reduction. The short-term effectiveness is good, but futher follow-up is necessary to determine the long-term results.
Based on the practice of large tertiary hospitals in clinical pathway (CP) entrance management, we implemented a fine CP management model with standardized clinical diagnosis and treatment, and encouraged the department to continuously optimize the path form, expand CP coverage and improve the entry rate in a flexible path. Combining PDCA cycles with CP management, it can promote the realization of management goals and achieve continuous improvement, while providing operable (repeatable) methods to the practice of hospital CP management.
目的 探讨结核病在18氟-脱氧葡萄糖（18F-FDG）正电子发射断层扫描术（PET）中的影像学表现，提高对PET/CT在肺部包块诊断作用的认识，减少误诊。 方法 回顾分析2010年3月收治的1例肺结核合并纵隔淋巴结结核病患者的误诊及诊断治疗经过，分析误诊原因并总结诊治经验，结合文献复习肺部包块在PET/CT中的表现及临床特点。 结果 患者为肺部包块伴纵隔淋巴结包块，胸部CT提示肺癌伴纵隔淋巴结转移，PET/CT也考虑左肺下叶肺癌伴淋巴结转移。最后经纵隔镜淋巴结活检确诊结核，并抗结核治疗好转。 结论 结核等感染性疾病常可导致18F-FDG的摄取增加而造成PET/CT阳性结果，因此在18F-FDG PET/CT呈现阳性结果时须注意鉴别病变良恶性，其中高标准摄入值包块尤其需要注意与结核病相鉴别。
ObjectiveTo systematically review the postoperative infection-related complications between cemented and cementless hemiarthroplasty in elderly patients with femoral neck fracture.MethodsCochrane Library, PubMed, Embase, China Biology Medicine Database, Chongqing VIP China Science and Technology Journal Database, China National Knowledge Infrastructure, and Wanfang Database were searched to collect randomized controlled trials of postoperative infection-related complications between cemented and cementless hemiarthroplasty in elderly patients with femoral neck fracture from inception to January 2018. A systematic review was performed to compare the postoperative deep infection, superficial wound infection, pneumonia infection, and urinary tract infection between cemented and cementless hemiarthroplasty. Analyses were conducted using Review Manager version 5.2.0 software.ResultsA total of 11 studies were included in the Meta-analysis, including 1 533 patients. There was no significant difference in the incidence of deep infection [odds ratio (OR)=1.62, 95% confidence interval (CI) (0.66, 3.94), P=0.29], superficial wound infection [OR=1.17, 95%CI (0.56, 2.47), P=0.68], pneumonia infection [OR=0.73, 95%CI (0.47, 1.13), P=0.16], or urinary tract infection [OR=1.10, 95%CI (0.65, 1.86), P=0.73] between the two groups.ConclusionWhen selecting a fixation method for hemiarthroplasty to treat eldly patients with femoral neck fracture, infection-related postoperative complications are not the determinant factor to consider.