Application of 3D printing navigation template in hip arthroplasty / 国际外科学杂志

Hip arthroplasty is a common surgical method with good clinical effect. However, there are many influencing factors, among which the position of prosthesis is the key factor determining the prognosis. At present, 3D printing technology is widely used in hip replacement, which has an important effect in improving the position of hip replacement prosthesis. This paper reviews the application of 3D printing guide plate in hip arthroplasty.

Risk factors for bladder recurrence after radical resection of upper urothelial carcinoma / 中华泌尿外科杂志

Objective:To explore the risk factors of bladder recurrence in patients with upper urinary tract urothelial carcinoma (upper tract urothelial carcinoma, UTUC).Methods:We retrospectively analyzed the data of 815 patients underwent radical nephroureterectomy for upper tract urothelial carcinoma between June 2009 to June 2019.There were 519 males and 340 females, aged from 26-93 years old(average 66.5±9.6 years old). 396 patients were renal pelvic caicinoma.463 patients were ureteral caicinoma.675 patients were accompanied with hydronephrosis.664 patients were accompanied with preoperative gross hematuria. Preoperative diagnostic ureteroscopy was performed in 323 cases.283 patients had the history of smoking.48 patients were con-comitant with bladder carcinoma at the first diagnosis. Univariate analysis and logistic multivariate regression analysis were used to investigate the risk factors for bladder recurrence after UTUC radical surgery.Results:Among the 859 patients, 407 (47.4%) had low-stage tumor (T is/T a/T 1), 452 (52.6%) had high-stage tumor (T 2-T 4), 110 (12.8%) had low-stage tumor (G 1/G 2), and 749 (87.2%) had high-stage tumor (G 3). 126 (17.2%) of 859 patients had relapse during the follow-up period, the average follow-up time was 17 months, the median recurrence time was 12 months, 101(80.1%) of the relapse occurred within 2 years after operation. In univariate analysis, lower tumor stage ( P=0.047), higher tumor grade ( P=0.043), preoperative hematuria symptom ( P=0.023) and preoperative diagnostic ureteroscopy ( P=0.002) were closely related to bladder recurrence. Taking the above factors into the logistic multivariate regression analysis showed that tumor staging T is/T s/T 1 ( B=0.476, P=0.019), tumor grade G 3( B=0.848, P=0.024), preoperative hematuria symptom ( B=0.521, P=0.048), preoperative diagnostic ureteroscopy( B=0.521, P=0.002) were independent risk factors of postoperative recurrence of bladder. Conclusion:lower tumor stage, higher tumor grade, preoperative hematuria symptom and preoperative diagnostic ureteroscopy are the independent risk factors of postoperative bladder recurrence in patients with UTUC. Routine intravesical chemotherapy should be performed in patients with UTUC with the above risk factors, and routine diagnostic ureteroscopy is not recommended.

Research progress in immunotherapy against PD-1/PD-L1 for advanced urothelial carcinoma / 国际生物医学工程杂志

Cisplatin-based chemotherapy is not effective in patients with advanced urothelial carcinoma. Recently, the application of immunological checkpoint inhibitors has brought new insight to resolve this problem. Since May 2016, five drugs, including Atezolizumab, Pembrolizumab, Nivolumab, Avelumab, and Durvalumab, targeting the PD-1/PD-L1 pathway have been approved by the FDA for the treatment of cisplatin-ineligible patients with advanced urothelial carcinoma, of which Pembrolizumab and Atezolizumab are the first-line drugs in the above treatments. The clinical efficacy and safety of these drugs are similar in different trials, but only Pembrolizumab is supported by a current level I evidence from a large randomized phase clinical trials. The results show that in the case of cisplatin ineligibility, Pembrolizumab is more effective than the traditional salvage chemotherapy in overall survival rate. Pembrolizuma is most effective in the treatment of cisplatin-ineligible patients with advanced urothelial carcinoma, while Pembrolizumab and Atezolizumab have similar efficacy in clinical applications of patients with cisplatin ineffective.

Lateral rectus abdominis approach versus posteromedian sacrum approach for unstable sacral fracture complicated with lumbosacral plexus injury / 中华创伤骨科杂志

Objective To compare the lateral rectus abdominis approach versus posteromedian sacrum approach in the surgical treatment of unstable sacral fracture complicated with lumbosacral plexus injury.Methods From June 2010 to December 2014,33 unstable sacral fractures complicated with lumbosacral plexus injury were treated at Department of Orthopaedics,Spinal and Pelvic Surgery Center,Zhongnan Hospital.Of them,24 were fresh and 9 obsolete.The lateral rectus abdominis approach was adopted in 17 patients and the posteromedian sacrum approach in 16.All the patients received surgical treatment within 2 to 12 weeks (average,4.5 weeks) after injury.The 2 groups were compared in terms of operation time,bleeding volume,complications,weight-bearing time,visual analogue scale (VAS),European QOL Five Dimensional health scale (EQ-5D) and lumbosacral injury classification and severity scale (LSICS).Results The 2 groups were compatible due to their insignificant differences in baseline data (P ＞ 0.05).Their follow-up time ranged from 17 to 37 months (average,26.8 months).Perioperatively,infection and necrosis of the lumbosacral incision appeared in 2 patients and iatrogenic injury to the lumbosacral plexus in 3 patients.All the other incisions healed well without major complications like infection,pressure ulcer or implant failure.There were no significant differences between the 2 groups in operation time (235.8± 72.0 minutes versus 318.0 ± 64.7 minutes),intraoperative bleeding volume (558.8 ± 125.7 mL versus 734.0 ±98.0 mL),weight-bearing time (9.4 ±2.4 weeks versus 11.3 ±2.3 weeks),postoperative complications,VAS(1.1 ±0.6 points versus 1.0 ±0.6 points),EQ-5D (0.82 ±0.09 points versus 0.78 ±0.06 points) or LSICS (P ＞ 0.05).The final follow-ups revealed significant improvements in VAS,EQ-5D and LSICS in all the patients (P ＜ 0.05).Conclusion The lumbosacral plexus can be well decompressed via both the lateral rectus abdominis approach and the posteromedian sacrum approach,leading to satisfactory clinical outcomes.

Risk factors of renal function after radical nephroureterectomy for upper tract urothelial carcinoma / 中华泌尿外科杂志

Objective To investigate the risk factors which can lead to chronic kidney disease (CKD) after radical nephroureterectomy and guide adjuvant chemotherapy for the patients with upper tract urothelial carcinoma (UTUC).Methods 239 patients with UTUC,who were treated at our hospital from October 2010 to February 2015 was analyzed retrospectively.Serum creatinine levels were measured preoperatively and 1 month (range:21days to 35 days) after radical nephroureterectomy.129 males and 110 females patients were enrolled.Ages were from 41 to 94,and mean age was 66 years.All patients underwent radical surgery.The pathological stages included Ta/T1/T2/T3/T4,and grades included G1/G2/G3.We calculated GFR using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in consideration of age,sex,and serum creatinine level.The new-onset CKD after RNU was defined as when the calculated CKD-EPI GFR decreased to less than 60 ml/(min · 1.73 m2).These patients were divided into 2 groups which depended on whether they got CKD after RNU.Cohorts were stratified by gender,age,smoking,BMI,hypertension,diabetes mellitus (DM),tumor location,tumor size,multifocality,pathologic stage,grade,hydronephrosis and preoperative CKD-EPI GFR.The chi-square test was used to examine the relationship among the various cohorts and the CKD after RNU.The Kaplan-Meier method was adopted to identify the relationship between Overall survival (OS).Cancer-specific survival (CSS) and CKD.Univariate and multivariate analyses were performed to study the relationship between clinical factors and CKD after RNU using the Cox proportional hazards regression model and chi-square test.Results In our study,the median follow-up time was 41.3 (range from 2-82) months for 239 patients.Median CKD-EPI GFR for all patients before and after surgery was 71.4 (65.2-108.7) ml/(min · 1.73 m2) and 54.7 (37.6-93.8) ml/(min · 1.73 m2),meanwhile 105 cases became new-onset CKD.There was no significant difference in overall or cancer specific survival between CKD + and CKD-(P =0.137,P =0.190).However age (HR =1.825,95％ CI 1.203-2.768,P =0.017),hydronephrosis (HR =0.243,95 ％ CI 0.106-0.613,P =0.034) and preoperative CKD-EPI GFR (HR =0.237,95 ％ CI 0.109-0.524,P =0.021) were significantly correlative with postoperative new-onset CKD.Conclusion Age,absence of hydronephrosis and preoperative CKD-EPI GFR were independent risk factors predicting new-onset CKD.They can be the predictor of new-onset CKD.

Risk factors of renal function after radical nephroureterectomy for upper tract urothelial carcinoma / 中华泌尿外科杂志

Objective To investigate the risk factors which can lead to chronic kidney disease (CKD) after radical nephroureterectomy and guide adjuvant chemotherapy for the patients with upper tract urothelial carcinoma (UTUC).Methods 239 patients with UTUC,who were treated at our hospital from October 2010 to February 2015 was analyzed retrospectively.Serum creatinine levels were measured preoperatively and 1 month (range:21days to 35 days) after radical nephroureterectomy.129 males and 110 females patients were enrolled.Ages were from 41 to 94,and mean age was 66 years.All patients underwent radical surgery.The pathological stages included Ta/T1/T2/T3/T4,and grades included G1/G2/G3.We calculated GFR using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in consideration of age,sex,and serum creatinine level.The new-onset CKD after RNU was defined as when the calculated CKD-EPI GFR decreased to less than 60 ml/(min · 1.73 m2).These patients were divided into 2 groups which depended on whether they got CKD after RNU.Cohorts were stratified by gender,age,smoking,BMI,hypertension,diabetes mellitus (DM),tumor location,tumor size,multifocality,pathologic stage,grade,hydronephrosis and preoperative CKD-EPI GFR.The chi-square test was used to examine the relationship among the various cohorts and the CKD after RNU.The Kaplan-Meier method was adopted to identify the relationship between Overall survival (OS).Cancer-specific survival (CSS) and CKD.Univariate and multivariate analyses were performed to study the relationship between clinical factors and CKD after RNU using the Cox proportional hazards regression model and chi-square test.Results In our study,the median follow-up time was 41.3 (range from 2-82) months for 239 patients.Median CKD-EPI GFR for all patients before and after surgery was 71.4 (65.2-108.7) ml/(min · 1.73 m2) and 54.7 (37.6-93.8) ml/(min · 1.73 m2),meanwhile 105 cases became new-onset CKD.There was no significant difference in overall or cancer specific survival between CKD + and CKD-(P =0.137,P =0.190).However age (HR =1.825,95％ CI 1.203-2.768,P =0.017),hydronephrosis (HR =0.243,95 ％ CI 0.106-0.613,P =0.034) and preoperative CKD-EPI GFR (HR =0.237,95 ％ CI 0.109-0.524,P =0.021) were significantly correlative with postoperative new-onset CKD.Conclusion Age,absence of hydronephrosis and preoperative CKD-EPI GFR were independent risk factors predicting new-onset CKD.They can be the predictor of new-onset CKD.

The clinical value of multiple bladder biopsies in the diagnosis and treatment of non-muscle invasive bladder cancer / 中华泌尿外科杂志

Objective To evaluate the clinical value of multiple bladder biopsies in the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC) during transurethral resection of bladder tumor(TURBT).Methods The data of 408 NMIBC patients from January 2009 to December 2013 was analyzed retrospectively.There were 302 males and 106 females.The mean age of these 408 patients was 65 years old from 33 to 86 years.Bladder multipoint biopsies were performed in 216 patients (biopsy group),and were not performed in the other 192 patients (control group).The multipoint biopsies were taken from right and left bladder walls,anterior and posterior walls,dome,trigone,prostatic urethra and abnormal mucosa.There were 127 males and 89 females in the biopsy group,with a mean age of 64 years old (from 18 to 87 years).In the control group,118 males and 74 females aged between 15 and 92 years have an average age of 66 years old.There was no statistically significant difference in regard to gender and age between the two groups.The positive rate of biopsy and whether the diagnosis and treatment plan changed in the study group were recorded and the recurrence and progression rates were compared between study and control groups.Results Of these 216 multiple mucosa biopsies,the total abnormal detection rate was 48.1％ (104/216).There were urothelial carcinoma in 12.5％ (39/216),carcinoma in situ in 5.6％ (12/216),dysplasia in 9.7％ (21/216),cystitis in 20.4％.The final diagnosis were changed in fifteen patients (6.9％) due to the biopsy results,and 38 patients(17.6％) treatment plans were changed.The 1-,3-,and 5-year recurrence-free survival rates (RFS) of biopsy group and control groups were 96.3％ vs.85.4％(x2 =14.955,P=0.000),85.2％ vs.69.8％ (x2 =13.183,P =0.000) and 69.9％ vs.64.1％ (x2 =1.574,P =0.245);progression-free survival(PFS) were 99.1％ vs.96.3％ (x2 =8.253,P =0.006),94.0％ vs.87.0％ (x2 =5.901,P=0.017) and90.3％ vs.85.4％ (x2 =2.273,P=0.169).The 1-and 3-year RFS and PFS of biopsy group were higher than control group.There was no significant difference in the 5-year RFS and PFS between the two groups.Conclusions Multiple bladder biopsies could be helpful for pathological diagnosis and the post-TUR treatment of NMIBC.Furthermore,it may reduce the early recurrence and progression rates of NMIBC,but have no effect on long-term prognosis.

Advances in research on microwave radiation effects on inner ears / 军事医学

Inner ear is one of the most sensitive parts to microwave radiation.The effect of microwave radiation on the inner ear system is its damage to the vestibule and cochlea.The vestibular and cochlear injury is closely related to the balance of the human body and hearing loss.This article reviews the mechanism of microwave and effects of microwave radiation on the structure and function of the inner ear in order to provide data for future related research.

Effect of finger exercises on recovery of hand function and daily life ability in postoperative patients with bone trauma / 现代临床护理

Objective To investigate the effect of finger exercises on recovery of hand function and daily life ability in postoperative patients with bone trauma. Methods Ninety-eight phalanx trauma patients were equally divided into the treatment and control groups, those with odd admission number in the treatment group and those with even numbers in the control group: the control group was given postoperative routine care and the treatment group took finger exercises besides the routine nursing. The two groups were compared in terms of the treatment effect and the ability of daily life . Result The effective rate of the treatment group was higher than that of the control group and the ability of daily life was significantly better than that of the control group (all P < 0.05). Conclusion The postoperative finger exercises of the patients with bone trauma can increase the recovery of hand function , which is beneficial for the improvement their daily life ability.

Preoperative neutrophil-lymphocyte ratio predicts clinical outcome in patients with high grade T1 bladder cancer / 中华泌尿外科杂志

Objective To assess the value of preoperative neutrophil-lymphocyte ratio ( NLR) for predict the prognosis in patients with high grade T1 bladder.Methods From January 2004 to December 2014, the data of 307 patients diagnosed as bladder cancer of Stage 1 and high grade after undergoing TURBT were analyzed, including gender, age, smoking status, tumor number and size, hydronephrosis, intravesical instillations and preoperative blood transfusion of 307 patients diagnosed as bladder cancer of stage 1 and high grade after undergoing TURBT were analyzed retrospectively.All patients were primary urothelial carcinoma.According to preoperative NLR,patients were divided into the low NLR group( NLR≤2.42,n=197) and the high NLR group(NLR >2.42,n =110).Recurrence-free survival (RFS) and progression-free survival ( PFS) were calculated according to the Kaplan-Meier model and compared by the log-rank model.Cox regression models were used for multivariate analyses of the association between NLR and bladder cancer, then the prognostic factors affecting RFS and PFS were evaluated.Result of these 307 patients, the low NLR group accounted for 64.2%(197/307), and the high NLR group accounted for 35. 8%(110/307).The mean follow-up period was 71(range, 1-123)months.The recurrence rate in the low NLR group and the high NLR group recurrence rate were 19.2%( 38/197 ) and 34.5%( 38/110 ) respectively, RFS were 73.0(range, 2-123)months and 67.5(range, 1-122)months respectively.The progression rates were 4.1%(8/197) and 10.9%(12/110) respectively.The recurrence and progression rates in the high NLR group is higher than those in the low NLR group(P2.42(P=0.007,HR=1.912)and hydronephrosis (P<0.01, HR =2.485 ) are associated with higher risk of recurrence.Conclusion Elevated preoperative NLR is an independent predictor of RFS and PFS in patients with high grade T1 bladder cancer.

Closed reduction and open reduction and internal fixation for the treatment of postoperative joint not-re-set therapeutic effects analysis in the comminuted double ankle fracture / 中国综合临床

Objective To investigate the postoperative joint not?reset therapeutic effects in the commi?nuted double ankle fracture. Methods From August 2012 to February 2015 in Dongfeng Hospital Affiliated to Hubei Medical College,72 comminuted double ankle fracture postoperative joint not?reset patients were selected as the study subjects,and according to the order of admission were equally divided into the treatment group and the control group,36 patients of each group. The treatment group were treated with closed reduction internal fixa?tion,the control group were given the open reduction and internal fixation. The intraoperative and postoperative recovery of both groups were observed. Results All the operation were completed successfully, the operative time,blood loss and postoperative hospital stay in the treatment group were ( 89. 24 ± 10. 34 ) min, ( 67. 24 ±14. 87) ml and (11. 45±2. 34) d respectively,significantly less than the control group((123. 45±11. 98) min,(82. 14±13. 45) ml and (14. 98±2. 47) d),the differences were significant(t=6. 498,4. 988,5. 278,P<0. 05) . The postoperative 3 months ankle function excellent in the treatment group and the control group were 94. 4%(34/36) and 77. 8%(28/36) respectively,the differences was significant(χ2=5. 966,P<0. 05). The postoperative 3 months pain scores in the treatment group and control group were 1. 78 ± 0. 45 points and 2. 60 ±0. 44 points,the differences was significant(t=8. 355,P<0. 05),and significantly lower than the preoperative ((6. 44±0. 67) points, (6. 49±0. 40) points),the differences were significant(t=25. 983,17. 332,P<0. 05) . Conclusion The closed reduction internal fixation for the postoperative joint not?reset therapeutic in the com?minuted double ankle fracture has better minimally invasive,it can promote double ankle function recovery and relieve pain,it is a reliable way of clinical applications.

Implant fixation of tibial avulsion fracture of the posterior cruciate ligament:knee joint range of motion and functional evaluation / 中国组织工程研究

BACKGROUND:From the biological structure, the posterior cruciate ligament is surrounded by the synovial folds of posterior capsule, arising from the inner side of the medial femoral condyle to the posterior part of tibial intercondyloid spine. The main traditional treatment method for posterior cruciate ligament tibial avulsion fracture is open operation, but it is difficult in anatomic reduction, cannot ful y restore knee joint stability and has a great negative impact on the normal function of posterior cruciate ligament. OBJECTIVE:To investigate the effects of arthroscopic implant internal fixation in the treatment of tibial avulsion fracture of the posterior cruciate ligament. METHODS:120 patients with tibial avulsion fracture of the posterior cruciate ligament were randomly assigned into treatment group and control group, with 60 cases in each group. The control group was given the traditional open surgery, and the treatment group was given the arthroscopic surgery. After 3 months, International Knee Documentation Committee (IKDC) scores and Lysholm scores were detected in the two groups;the knee joint range of motion was determined before and 3 months after treatment. RESULTS AND CONCLUSION:Wounds were healed at stage I in al patients with no serious complications. There was no difference in the knee joint range of motion between the two groups before treatment, but the range of motion was increased significantly in both two groups at 3 months after treatment (P<0.05), meanwhile which was higher in the treatment group than the control group (P<0.05). At 3 months after treatment, the excel ent knee function rate was significantly higher in the treatment group (97%) than the control group (88%) according to the Lysholm scores;the IKDC scores were significantly higher in the treatment than the control group in terms of claudication, support, pain, swel ing, and squat (P<0.05). These results indicate that the arthroscopic implant fixation of tibial avulsion fracture of the posterior cruciate ligament has better short-term effects to promote recovery of knee joint function, but no serious complications.

Bilateral external fixation combined with limited internal fixation in the repair of open fractures of middle and distal tibia and fibula：reliable fixation on the broken ends / 中国组织工程研究

BACKGROUND:Open fracture of tibia and fibula is a common fracture of long bones. Simple external fixation is often difficult to achieve thorough and effective reduction and fixation. Shortcomings of open reduction and internal fixation highlighted in the high incidence of postoperative complications, and seriously affected the recovery of joint function. Therefore, external fixation combined with internal fixation for repair of open fractures of tibia and fibula has been extensively used in the clinic. OBJECTIVE:To explore the repair efficacy of bilateral external fixation combined with limited internal fixation on open fractures of middle and distal tibia and fibula. METHODS: Clinical data of 56 patients, who were identified by X-ray or CT examination and were diagnosed as having open fractures of middle and distal tibia and fibula in the Jining No.1 People’s Hospital, as the treatment group, were retrospectively analyzed from January 2009 to January 2013. Patients were subjected to thorough debridement, reduction of the fracture fragments, limited internal fixation and fixed bilateral external fixation within 8 hours. They received stage I suture. When the local conditions of the wound permitted, they received stage II grafting, and were repaired with adjacent muscle flap or free flap. The efficacy and postoperative complication were observed. Above data were compared with those of 44 patients with open fractures of middle and distal tibia and fibula who received reduction and internal fixation (control group). RESULTS AND CONCLUSION:Among the 56 patients in the treatment group, the outcomes were excelent in 35 cases, good in 16 cases, average in 4 cases and poor in 1 case. The excelent and good rate was 91%. Among the 44 patients in the control group, the outcomes were excelent in 23 cases, good in 10 cases, average in 7 cases and poor in 4 cases. The excelent and good rate was 75%. The excelent and good rate was significantly higher in the treatment group than that of the control group (P < 0.05). Significant differences in incision length, operation time, fracture healing time and bone nonunion rate were detected between the two groups, and above indexes were better in the treatment group than in the control group (P < 0.05). These findings verify that bilateral external fixation combined with limited internal fixation for open fractures of middle and distal tibia and fibula is reliable, can significantly reduce postoperative complications after internal fixation, promote the healing of fracture, and is conducive to the early recovery training of the affected limb.

Local injection of simvastatin for repair of mild-to-moderate unstable humeral fractures:effects on bone healing and bone density / 中国组织工程研究

BACKGROUND:Studies have shown that a single injection of smal-dose simvastatin can significantly improve bone microstructure and promote trabecular bone remodeling of the femoral condyle after osteoporosis. OBJECTIVE:To investigate the effect of local single injection of simvastatin on the prognosis of mild-to-moderate unstable humeral fractures. METHODS:A total of 93 patients with mild-to-moderate unstable humeral fracture were selected and randomized into injection group (49 cases) and normal group (44 cases). The normal group received normal physical therapy, and the injection group underwent local single injection of simvastatin based on the physical therapy. Bone mineral density and healing time were compared between two groups. RESULTS AND CONCLUSION:There was no difference in the bone mineral density between the two groups within 2 weeks after treatment (P>0.05), but the bone mineral density was significantly higher in the injection group than the normal group at 1-2 months after treatment (P<0.05). In addition, the injection group was superior to the normal group in the fol owing aspects:incidence of complications, excel ent-good rate of joint function recovery, and hospital stay. These findings indicate that the local injection of simvastatin based on conventional physical therapy can shorten the time of fracture healing, increase bone mineral density and improve the prognosis of patients with mild-to-moderate unstable proximal humeral fractures.

Association of genetic polymorphism of CCNE1 and RIP2 with bladder cancer risk / 天津医药

Objective To evaluate the relationship between the CCNE1 or RIP2, identified at a single nucleotide poly?morphism, and the risk, clinic stage and pathological grade of bladder cancer. Methods Peripheral venous blood samples were obtained from 176 patients with bladder cancer and 210 controls without cancer. DNA was extracted. Polymerase chain reaction (PCR) method was used to detect CCNE1 (rs8102137) and RIP2 (rs42490) polymorphism. According to the postoper?ative pathological results, patients with bladder cancer were determined the grading and staging. The genotype differences of medium gene and the distribution gene were analyzed and compared in bladder cancer group and control group. The relation?ship of CCNE1 (rs8102137) and RIP2 (rs42490) genotypes and clinical data of patients with bladder cancer was analyzed, and the relationship of them with the genetic susceptibility to bladder cancer was also analyzed. Results The genotype dis?tribution was with good group representative in control group. The frequency of CCNE1(rs8102137) variant allele was signifi?cantly higher in bladder cancer group (40.91%) than that of control group (30.95%,OR=1.54,95%CI:1.02-2.45, P<0.05). The frequency of RIP2 (rs42490) variant allele was significantly higher in bladder cancer group (72.73%) than that of control group (62.38%, OR=1.61, 95%CI:1.04-2.48, P<0.05). There were no significant differences in gene polymorphisms of CC?NE1(rs8102137) and RIP2 (rs42490) between different pathological grades and different clinical stages of bladder cancer. Conclusion The CCNE1 (rs8102137) and RIP2 (rs42490) polymorphism have interaction in occurrence of bladder cancer process. There is higher risk of bladder cancer in individuals carrying mutant alleles than that of individuals carrying wild type.

Comprehensive evaluation methods used in military pilot selection / 军事医学

Military pilot selection is an effective way to lower the training cost, ensure the safety of pilots and aircraft, and improve the military efficiency, which involves a comprehensive evaluation of medical fitness, psychology and flying aptitude of a pilot candidate.The concept and classification of comprehensive evaluation methods were introduced in this paper.Comprehensive evaluation methods used in domestic and overseas military pilot selection were reviewed.Finally, suggestions on the research and application of the military pilot selection system in China were raised.

The value of taking surgical margin specimens during transurethral resection of bladder tumor in the diagnosis and treatment of non-muscle invasive bladder cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of taking surgical margin specimens during transurethral resection of bladder tumor(TURBT) in the diagnosis and treatment of non-muscle invasive bladder cancer.</p><p><b>METHODS</b>The data of 356 patients with non-muscle invasive bladder cancer from June 2009 to January 2014 were analyzed retrospectively. A standardized protocol were performed during TURBT in 176 patients(surgical margin group), by taking surgical margin specimens from tumor base and 'normal'-appearing margin sites. The other 180 cases merely received general TURBT (general group). To observe the positive rate of surgical margin specimens and whether the diagnosis and treatment plan changed in the surgical margin group. Using Chi-square test to compare the recurrence and progression rates between surgical margin and general groups. To compare their recurrence-free survival time by Mann-Whitney U test. Results Of these 176 surgical margin specimens, the positive rate was 19. 3% (34/176),which consists of tumor base 11. 9% (21/176) and tumor normal-appearing margin 7. 4% (13/176). Following with urothelial carcinoma Ta stage in 1. 7% (3/176), T1 stage in 5. 7% (10/176), T2 stage in 8. 0% (14/176), carcinoma in situ (Tis) in 4. 0% (7/176). Among these 176 patients final diagnosis were changed in 10. 8% (19/176) patients due to the specimens results, and 18. 2% (32/176) patients altered their treatment plans. All 356 patients with a mean follow-up of 36. 8 months (6 to 60 months). Two groups of patients(surgical margin group vs. general group) recurrence rates respectively were 22. 2% (39/176) vs. 35. 6% (64/180), recurrence-free survival time were 33. 0 months vs. 23. 5 months and progression rates were 5. 7% (10/176) vs. 10. 6% (19/180). Compared with general group, patients who were taken additional surgical margin specimens showed significantly lower recurrence rate (χ2 = 7. 677, P = 0. 007) and longer recurrence-free survival time (U = 12 605,P = 0. 001). While the progression rate showed no statistical difference between them (χ2 = 2. 825, P = 0. 121).</p><p><b>CONCLUSION</b>Taking additional surgical margin specimens during transurethral resection of bladder tumor is helpful for pathological diagnosis and the planning of further treatment.</p>

Preparation and effect of bone targeting drug of the epirubicin-oxidized dextran-alendronate compound for osteosarcoma cells / 中国医师杂志

Objective To prepare a new bone-targeted drug of epirubicin-oxidized dextran-alendronate compound,and explore the effect of compound on osteosarcoma cells.Methods (1) Based on Schiff's base theory,we synthesized the compound.(2) We investigated physicochemical character with ultraviolet (UV),infrared (IR),and 1H-nuclear magnetic resonance (1H-NMR),molecular weight and aldehyde group content in oxidized dextran,alendronate content in oxidized dextran-alendronate compound,epirubicin drug loading capacity in the compound,and rate of charge for three matters,and affinity to bone in vitro though Hydroxyapatite (HA) absorbing test.(3) We investigated the compound's cytotoxicity effect through methyl thiazolyl tetrazolium (MTT) test,apoptosis influence through flow cytometry (FCM).Results (1) There were typical physicochemical characters.(2) Oxidized dextran molecular weight (MW) was 4 251 ± 68,number of average molecular weight (MN) was 2 551 ± 42,and molecular weight distribution width was 1.78.Aldehyde group content of oxidized dextran was (10.41 ± 0.2)mmol/mg,epirubicin drug loading capacity was (5.28 ± 0.23) ％,rate of charge was 5,and 2 ～ 3 between aldehyde group content in oxidized dextran and alendronate (ALN).(3) In the MTT test,epirubicin (EPI)-Dex-ALN,EPI,ALN obviously restrained osteosarcoma cell proliferation,the minimum concentration(μg/ml) was 1,1,and 40; IC50 (μg/ml) of EPI-Dex-ALN,EPI,ALN was 0.142,0.505,0.219; 0.251,0.739,and 0.518; 45.21,27.97,and 18.96 after 24 h,48 h,72 h; in FCM (flow cytometry),apoptosis and necrosis rate of EPI-Dex-ALN,ALN,and Dex was 80.13 ±4.05,97.01 ±2.58,31.53 ±6.9,and 14.01 ±2.51.Conclusions We successfully synthesized a new bone-targeted drug delivery system,which showed better bone affinity in vivo,and kept biological activity with powerful targeted function.

Clinical effect analysis of primary bone graft and VSD for open and complex pilon fractures / 国际外科学杂志

Objective To investigate the clinical effect of primary bone graft and VSD for open and complex Pilon fractures.Methods Fifty-six cases with open and complex Pilon fractures admitted in Dongfeng general hospital between January 2010 and January 2011 were treated with primary bone graft and VSD,the clinical datum were collected,for example soft tissue union,fracture union,incidence rate of traumatic arthritis,ankle article function scores.Results Fracture healed,no soft tissue infection happened,according to Helfer scores criteria,there were 22 excellent,21 good,8 fair,5 poor,excellent and good rate were 76.8％.Conclusions The method of primary bone graft and VSD resolved many questions simultaneously,for example fracture fixation,bone defect and soft tissue coverage,which has feature of simpler operation,lower infection incidence rate,better fracture union and article function than conventional methods.

Preparation and bone targeting effect of the epirubicin-oxidized dextran-alendronate compound / 中华骨科杂志

Objective To prepare a new bone-targeting drug of epirubicin-oxidized dextran-alendronate compound,and investigate the compound's bone targeting effect.Methods Based on Schiff base theory,we synthesized a new bone-targeted drug delivery system:epirubicin-oxidized dextran-alendronate compound.The physicochemical character was evaluated through ultra-violet (UV) spectroscopy,infrared (IR) spectroscopy and nuclear magnetic resonance (1H-NMR) spectroscopy.The character of affinity to bone in vitro was evaluated through HA absorbing test and the affinity to bone in vivo was evaluated by fluorescence microscopy.Drug distribution in different organs and different time point were investigated through liquid chromatograph.Results There were typical physicochemical characters of dextran,oxidized dextran,Dex-ALN compound,EPI-Dex-ALN compound through UV spectroscopy,IR spectroscopy and 1H-NMR spectroscopy,showed successful preparation of the bone targeting drug.HA binding rates were 86.13％,13.91％ in epirubicin-oxidized dextran-alendronate compound and epirubicin groups respectively through HA absorbing test in vitro.Luminescence microscope showed luminescence located in cortical bone,cancellous bone of metaphysic,no luminescence was found in bone marrow in affinity to bone in vivo.Compared by EPI group,IOD value of fluorescence in EPI-Dex-ALN group was 2.7 times.In HPLC drug concentration test,we detected drug concentration in different organs during the period of 10 min,1 h,2 h,24 h,48 h after injection in EPI,EPI-Dex-ALN compound group.The maximum concentration was at 2 h,and tissue distribute was different in different organs; there was statistical difference during the period of 10 min,1 h,2 h,24h,no statistical difference during the period of 48 h after injection in bone tissue between EPI group and EPI-Dex-ALN compound group.Conclusion We successfully synthesized a new bone-targeting drug delivery system,which showed better bone affinity in vivo and in vitro,and had powerful targeting function.