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ObjectiveTo re-evaluate the systematic reviews/Meta-analyses （SRs/MAs） of tonic traditional Chinese medicine （TCM） injections against cerebral ischemic stroke （CIS） and provide evidence support for clinical practice and decision-making. MethodTCM injections of different varieties were obtained after searching the three major drug catalogues. Seven Chinese and English databases were searched from database inception to March 13，2022，for the relevant SRs/MAs. The methodological quality，risk of bias，reporting quality，and quality of evidence were assessed by Assessment of Multiple Systematic Reviews-2 （AMSTAR-2），the Risk of Bias in Systematic Review （ROBIS），the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 （PRISMA 2020），and the Grading of Recommendations Assessment，Development，and Evaluation （GRADE）. In addition，the literature overlap matrix was established to calculate the corrected covered area （CCA） and evaluate the rate of overlaps of the original literature. ResultFive types of TCM injections and 18 SRs/MAs were included. AMSTAR 2 evaluation showed that the methodological quality of 18 SRs/MAs was extremely low，and 14 SRs/MAs had a high risk of bias assessed by ROBIS. The quality evaluation results reported by the PRISMA 2020 showed that the scores of the studies included ranged from 19.5 to 28.5，with 10 being of medium quality and eight of low quality. The evaluation with the GRADE system demonstrated that one outcome was moderate-quality evidence，15 outcomes were low-quality evidence，and 41 outcomes were very low-quality evidence. The CCA of the included SRs/MAs was 0.263，indicating a low rate of overlaps of the original literature. ConclusionTonic TCM injections are effective and safe in the treatment of CIS，but this conclusion should be treated with caution because of the low quality of methodology，reports，and evidence in published SRs/MAs. It is recommended to improve the study design，obtain clinical evidence of higher quality，and conduct systematic evaluations in strict accordance with procedures to standardize the reporting of research results.
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Patients with patulous Eustachian tubes(PET) usually suffer from annoying symptoms, such as tinnitus, autophony and aural fullness, due to the excessive opening of the Eustachian tube. There is no uniform standard of treatment, and conservative therapy combined with"Stepup"surgical intervention strategy is the main treatment. In this article, we reviewed various surgical treatments of patulous Eustachian tube in recent years, including key points of surgical operation, effectiveness, safety and complications. Full communication and evaluation are needed to establish appropriate patients' expectations preoperatively. A "Stepup" treatment strategy will be carried out, including conservative treatment, tympanic membrane surgery, Eustachian tube pharyngeal orifice constriction surgery, Eustachian tube tympanic orifice plug surgery and Eustachian tube muscle surgery, which aims to maintain normal Eustachian tube function and good middle ear ventilation.
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Humans , Eustachian Tube/surgery , Ear Diseases/diagnosis , Ear, Middle , Tympanic Membrane/surgery , Tinnitus , Otitis MediaABSTRACT
Objective:To explore the application effect of problem-based learning (PBL) combined with WeChat assisted teaching pattern in teaching rounds of encephalopathy department.Methods:Undergraduate interns of Batch 2018 from the encephalopathy department were enrolled in the study. The observation group ( n=36) was taught by PBL combined with WeChat teaching mode. The control group ( n=36) was taught by the conventional teaching mode. At the end of rotation, the scores of theoretical and practical skills tests of the two groups were compared, and at the same time, the results of the survey were compared according to the questionnaire. SPSS 19.0 was used for statistical analysis of the data. Results:The test scores of the observation group were significantly higher than those of the control group ( P<0.05). The recognition in nine aspects of the observation group was also significantly higher than that of the control group, such as the interaction with the teaching teachers, the effect of improving clinical learning interest and the ability of inspiring thinking and innovation ( P<0.05). There was no significant difference in recognition about improving the efficiency of clinical teaching rounds between two groups ( P>0.05). Conclusion:PBL combined with WeChat teaching rounds model has certain advantages over traditional rounds in TCM clinical teaching, which are mainly manifested in the mastery of clinical knowledge, the communication ability of interns, the ability of interaction and cooperation, the ability of innovation and thinking, and the improvement of learning initiative.
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In order to improve the operation difficulties in the narrow space of the nasal maxillary sinus, the nasal continuum minimally invasive surgical robot system is designed. The ball-and-socket joints and NiTiNol tubes are used as the main body of the continuum structure to improve the degree of freedom. The hardware systems and software systems are designed. The security control policies are planned. Finally, the robot confirmed prototype experiments are conducted and the feasibility of continuum robot confirmed through master-slave control experiment and animal experiment.
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Animals , Biomechanical Phenomena , Equipment Design , Minimally Invasive Surgical Procedures , Robotic Surgical Procedures , Robotics , SoftwareABSTRACT
ObjectiveTo investigate the effect of Zishen Huoxue prescription on promoting neurogenesis in hippocampal CA1 region of vascular dementia （VD） rats by regulating mitophagy. MethodThe 2-VO method was used to establish the VD rat model and 60 SD rats were randomly divided into sham operation group， model group， donepezil hydrochloride group， and Zishen Huoxue prescription low-dose（8.9 g·kg-1）， medium-dose（17.8 g·kg-1） and high-dose（35.6 g·kg-1） groups. Morris water maze test was performed to detect the escape latency and the number of crossing platform in each group. The expression of phosphatase and tensin homology-induced kinase 1 （PINK1） and Parkinson protein （Parkin） mRNA in hippocampal CA1 region was detected by Real-time fluorescent quantitative polymerase chain reaction（Real-time PCR）. Western blot was used to determine the expression of mitochondrial autophagy signaling pathway-related proteins Parkin， prohibitin 2 （PHB2）， mitofusin 2 （Mfn2） and dynamin-related protein 1 （Drp1） in hippocampal CA1 region. The neurogenesis in hippocampal CA1 region was tested by Brdu method. ResultCompared with the conditions in the sham operation group， the learning and spatial memory abilities of the model group were decreased （P<0.05）， with damaged mitochondrial structure and autolysosome formation in the hippocampal CA1 region. The expressions of Parkin， Pink1 mRNA and Parkin， PHB2， and Drp1 proteins were up-regulated （P<0.05）， while the expression of Mfn2 protein and the neuronal regeneration in hippocampal CA1 region were reduced （P<0.05， P<0.05）. Compared with the conditions in the model group， Zishen Huoxue prescription enhanced the learning and spatial memory abilities of VD rats （P<0.05）， increased the number of autophagosomes in hippocampal CA1 region and improved the mitochondrial structure. The expression of Parkin， Pink1 mRNA and Parkin， PHB2， and Drp1 proteins in hippocampal CA1 region was up-regulated （P<0.05， P<0.01）while the expression of Mfn2 protein was down-regulated（P<0.05， P<0.01）. The number of new neurons in hippocampal CA1 region was also increased（P<0.05， P<0.01）. ConclusionThe promoting effect of Zishen Huoxue prescription on the neurogenesis in hippocampal CA1 region of VD rats was related to the mitophagy mediated by Pink1/Parkin signaling pathway.
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Objective:To study the effect of astrocyte elevated gene-1 (AEG-1) on proliferation and metastasis of papillary thyroid cancer (PTC) by regulating cell autophagy and epithelial-mesenchymal transition (EMT).Methods:Normal thyroid cells Nthy-ori3-1 and PTC cells TPC-1, FTC-133, B-CPAP and SW579 were cultured in vitro. Real time fluorescent quantitative polymerase chain reaction (qRT-PCR) was used to detect the expression of AEG-1 in PTC cells. The PTC cells with the highest AEG-1 expression were selected for AEG-1 shRNA infection, and then divided into sh-NC group and sh-AEG-1 group. Cell counting kit-8 (CCK8) and EdU (5-ethynyl-2 ′- deoxyuridine) experiments were used to detect the effect of AEG-1 on the proliferation of PTC cells; Transwell test was used to detect the effect of AEG-1 on the metastasis of PTC cells; subcutaneous tumorigenesis test in nude mice was used to detect the effect of AEG-1 on the expression of autophagy related proteins and EMT related proteins. PTC cells in sh-NC group and sh-AEG-1 group were treated with rapamycin and transforming growth factor-β (TGF-β), respectively. CCK8 and transwell assay were used to detect the cell proliferation and metastasis ability of each group of cells, respectively. Results:Compared with normal thyroid cells Nthy-ori3-1, the expression level of AEG-1 in PTC cells was increased, with the highest expression in TPC-1 cells. After AEG-1 shRNA was transfected into TPC-1 cells, cell proliferation, metastasis and tumorigenicity in vivo were reduced ( P<0.05). Compared with the sh-NC group, the expression of autophagy-related proteins P62 and Beclin1 were increased and the expression of LC3B protein was decreased, and EMT-related proteins E-cadherin expression were increased and N-cadherin and Vimentin protein expression were decreased in the sh-AEG-1 group ( P<0.05). CCK8 and Transwell experiments showed that treatment with autophagy inducer Rapamycin and EMT inducer TGF-β attenuated the inhibitory effect of sh-AEG-1 on proliferation and metastasis ability of PTC cell ( P<0.05). Conclusions:AEG-1 promotes the proliferation and metastasis of PTC cells by inducing cell autophagy and EMT.
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Objective: “Same treatment for different diseases” is a unique treatment strategy in traditional Chinese medicine. Two kinds of malignant respiratory diseases endanger human health-chronic obstructive pulmonary disease (COPD) and lung cancer. Citrus Grandis Exocarpium (Huajuhong in Chinese, HJH), a famous herbal, is always applied by Chinese medicine practitioners to dispersion the lung to resolve phlegm based on “syndrome differentiation and treatment” theory. However, the common mechanism for HJH's treatment of COPD and lung cancer is not clear. Methods: In this study, based on network pharmacology and molecular docking technology, the common mechanism of HJH in the treatment of COPD and lung cancer was studied. The active ingredients and related targets of HJH were integrated from TCMSP, BATMAN-TAM, STP, and Pubchem databases. The standard names of these targets were united by UniProt database. Targets of COPD and lung cancer were enriched through GeneCards, NCBI (Gene), Therapeutic Target Database, and DisGeNET (v7.0) databases. Then the intersection targets of HJH and diseases were obtained. The STRING network and the Cytoscape 3.7.2 were used to construct PPI network, the DAVID database was used to perform GO and KEGG analysis. Then Cytoscape 3.6.1 was used to build “ingredient-target-signal pathway” network. Finally, AutoDock 1.5.6 software was used to perform molecular docking of key proteins and molecules. Results: Eleven active ingredients in HJH were obtained by searching the database, corresponding to 184 HJH-COPD-lung cancer targets intersection. The results of biological network analysis showed that naringenin, the active component in HJH, could mainly act on target proteins such as AKT1, EGFR. Then through positive regulation of vasoconstriction and other biological processes, naringenin could regulate estrogen signaling pathway, VEGF signaling pathway, HIF-1 signaling pathway, ErbB signaling pathway, PI3K-Akt signaling pathway to play an important role in the treatment of both COPD and lung cancer. Conclusion: Network pharmacology was employed to systematically investigate the active ingredients and targets of HJH in treatment of COPD and lung cancer. And then, the common pharmacodynamic network of HJH for the two malignant respiratory diseases was firstly described. Furthermore, naringenin was proved to strongly bind with AKT1 and EGFR. It may provide the scientific basis for understanding the “Same treatment for different diseases” strategy in traditional Chinese medicine and inspirit subsequent drug discovery for COPD, lung cancer and other malignant lung diseases.
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Purpose To investigate the clinicopathologic features of desmoplastic fibroma of bone (DF).Methods The clinical and pathologic profiles of 7 cases were retrospectively analyzed.Results Desmoplastic fibroma of bone was a rare neoplasm of bone,which typically occurred in young children and adolescents.The tumor showed infiltrative and locally aggressive nature,the most common sites were long tubular bones and mandible.Microscopically,the tumor was composed of sparse fibroblasts in a rich background of collagen fibers.Immunohistochemically,the tumor cells were positive for vimentin and SMA.Conclusion Desmoplastic fibroma is a rare,locally aggressive fibroblasticlesion of bone.It can make an accurate diagnosis by integrating the clinical location with histopathological features.Trauma,hormone and horomosome aberration may be related with its pathogenesis.
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Objective To evaluate the feasibility of MRI-guided vacuum-assisted breast biopsy in domestic clinical prac tice.Methods A total of 45 patients with 45 suspicious breast lesions were examined with MRI-guided vacuum assisted bi opsy.The complications were observed.And the followed-up was performed.Results In 45 suspected breast lesions,43 lesions (43/45,95.56％) were successfully sampled under MRI-guided vacuum-assisted biopsy and the pathologic diagnosis was obtained.For another 2 lesions (2/45,4.44％),the pathology diagnosis were not obtained.The time to perform MRI-guided biopsy was (45.87±8.41)min for one lesion.The 5 malignant lesions (5/45,11.11％) confirmed by biopsy pathology were consistent with postoperative pathological results.For the 38 benign lesions (38/45,84.44％) confirmed by biopsy pathology,there was no malignant performance found in MRI follow-up for 6 months.Because of successful MR imaging-guided core biopsy findings,the clinic treatments were changed in 14 patients (14/45,31.11％).Five cases (5/45,11.11％) with malignant tumors were diagnosed early.The surgical biopsy was avoided in 9 benign cases (9/45,20.00 ％) who suspected as malignant.In all 45 patients,no complications occurred,such as hematoma and infection.Con clusion MRI-Guided vacuum-assisted breast biopsy is sufficient and safe for obtaining histologic proof of lesions,and plays an important role in guiding clinic treatment of some lesions visible only by MRI.
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Purpose To investigate the clinicopathologic features of calcifying aponeurotic fibroma (CAF). Methods The clinical and pathologic profiles of 6 cases of CAF were retrospectively analyzed. Results CAF appeared a firm, painless and slowly growing mass with a predilection for the distal portions of the extremities in young children and adolescents. Microscopically, the tumor consis-ted mainly of benign appearing spindle cells, chondroid cells and calcific debris. Immunohistochemically, the tumor cells were positive for vimentin, HHF-35, S-100, Calponin and CD68. Conclusion CAF is a rare, locally aggressive fibroblastic lesion. It can make an accurate diagnosis by integrating the clinical location with histopathological features. Repeated minor trauma to the extremities and some embryologic cell nests maybe its pathogenesis.
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Objective To record the drilling feed force on different layers of fresh porcine femur, so as to provide reference for collecting and outputting the feedback signals of drilling feed force for orthopedic virtual surgery system. Methods The biological bone drilling feed force testing system was established by modifying the universal material testing machine and adjustable speed electric drill (drill bit Φ5.0 mm). The feed forces on 6 fresh porcine femoral shafts with a total of 162 drilling markers were collected at 3 different rotate speeds (n＝500, 800, 1 200 r/min) and 3 feed speeds (v＝30, 50, 70 mm/min), and their variation with corresponding tissues and locations were also analyzed. Results At the same drill marker of the fresh porcine femur, the drilling feed force on bilateral cortical bone was the largest (fmax＝103.63~142.59 N), while that on marrow cavity was the smallest, which was almost close to zero, and the drilling feed force on the middle part (f4,5,6＝124.69 N) was larger than that at two ends (f1,2,3,7,8,9＝121.84 N); the drilling feed force was smallest (f＝106.04 N) at v＝30 mm/min, n＝1 200 r/min, while the largest drilling feed force (fmax＝139.84 N) appeared at v＝70 mm/min、n＝500 r/min. Conclusions The modified drilling feed force testing system could efficiently collect the biological bone drilling data. The drilling feed force had a close relationship with bone structure, feed speed and rotate speed of electric drill as well. A larger bone density, smaller rotate speed of electric drill and higher feeding speed would lead to a larger drilling feed force, and vice versa. The accurate drilling feed force data and its variation tendency on porcine femoral obtained in this experiment could provide a reliable basis for force-feedback signal output in the virtual orthopedic surgery system.
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Virtual technology of cardiovascular interventional surgery can be used for surgical training, surgical navigation, surgical optimization and postoperative evaluation in cardiovascular interventional procedures. In this paper, the composition of virtual cardiovascular interventional operation system was introduced, and the research status of virtual cardiovascular interventional operation both at home and abroad was discussed, including detailed analysis on working principles of several representative products. Through the intensive study on force feedback used as the key techniques in virtual cardiovascular interventional surgery, the author investigated its future development as well as how to improve the training effect and success rate of cardiovascular interventional operation.
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A 22-year-old patient was admitted to the hospital with a solitary,gradually growing and painless mass in the left shoulder for 2 years.Physical examination revealed no abnormality except for the skin lesion.Skin examination showed an elevated lesion measuring about 3.5 cm× 2.0 cm × 1.5 cm with smooth surface and normal color,which was located in the subcutaeous tissue,indurated and movable.Resection of the tumor was performed under local anesthesia.On visual observation during operation,the tumor was sited in the subcutaneous fat tissue,nodular-like and surrounded locally by fibrous pseudocapsules with a grey incisal surface and mild texture.Microscopicalty,the tumor was extremely similar to breast fibroadenoma with multiple lobuli,and each of the lobuli was composed of tubiform structures,basal cell-like epithelial cell trabs and fibromyxoid stroma abundant in fibroblast-like spindle cells.No hair bulb or primitive dermal papillae were observed in the lobuli,which were separated by compact collagen fibers infiltrated by a few scattered inflammatory cells.Fibromyxoid strotma was surrounded by basal cell-like epithelial cell strabs in most lobuli,and some tubiform structures were filled with a little thin lightly eosinophilic material in a concentric arrangement.Immunohistochemistry showed that intralobular epithelial cells were strongly positive for cytokeratin 5/6,but negative for CAM5.2 or carcinoembryonic antigen (CEA).In addition,the lightly eosinophilic material in lumens was negative for periodic acid-Schiff (PAS) staining.These results suggested that the tubiform structures were immature follicles,but not sweat ducts.The patient was diagnosed with nodular fibrofolliculoma (NFF) based on the clinical manifestations,morphological features,immunohistochemical and PAS staining results.No relapse was observed in more than 3 months of postoperative follow-up.As a benign trichogenic adnexal neoplasm with unique clinicopathological manifestations,NFF may be a new entity of cutaneous adnexal neoplasm.
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<p><b>OBJECTIVE</b>To investigate the clinicopathologic features of calcium pyrophosphate dihydrate crystal deposition disease (CPPD-CDD).</p><p><b>METHODS</b>The clinical and pathologic profiles were retrospectively analysed in 20 cases of CPPD-CDD.</p><p><b>RESULTS</b>CPPD-CDD was far more common in women, most frequently involving joints, especially the knees and presenting with various arthrisis. Abnormally calcified and the articular damages were characteristic features by imageing. Histologically, multifocal indigo granular calcinosis was seen in synovium and sometimes appeared as needle-shaped or rhomboid crystals, which characterized the CPPD.</p><p><b>CONCLUSIONS</b>Though clinical symptoms of CPPD are quite variable, the definite diagnosis can be made by the abnormal calcification and joint damage radiographically and the indigo CPPD crystals histopathologically.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Chondrocalcinosis , Diagnostic Imaging , Pathology , General Surgery , Follow-Up Studies , Hip Joint , Diagnostic Imaging , Pathology , General Surgery , Intervertebral Disc , Diagnostic Imaging , Pathology , General Surgery , Knee Joint , Diagnostic Imaging , Pathology , General Surgery , Magnetic Resonance Imaging , Retrospective Studies , Spinal Diseases , Diagnostic Imaging , Pathology , General Surgery , Synovial Membrane , Pathology , Tomography, X-Ray ComputedABSTRACT
Objective To study the vibration frequencies and resonant peaks of different molecular groups in anti-diabetic drugs and to investigate the absorption spectra of these drugs in the range of terahertz, so as to accurately and efficiently identify similar drugs and provide foundation for understanding the contribution of such vibration in different molecular groups to pharmacology. Methods Using terahertz time domain spectroscopy (THz-TDS), six kinds of similar diabetes pills for treating diabetes mellitus (DM), including gliquidone, glipizide, gliclazide, glimepiride, repaglinide and metformin were tested to obtain their absorption spectra from 0.3~3.0 THz. Support vector machines (SVM) method was employed to separate these anti-diabetic drugs by selecting the experimental data from 1.5~2.0 THz. Results For gliquidone, glipizide, gliclazide, and glimepiride, an obvious resonance peak was found at 1.37 THz. According to the THz spectra, repaglinide and metformin could be easily separated from sulfonylurea drugs. Furthermore, with the help of SVM, the accuracy of discrimination for four kinds of sulfonylurea could reach 100%. Conclusions THz technology, as a new testing method, shall play a positive role in the drugs for their identification, quality control and distinguishing their chemical bonds/functional group.
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<p><b>OBJECTIVE</b>To create a 3-dimensional finite element model of knee ligaments and to analyse the stress changes of lateral collateral ligament (LCL) with or without displaced movements at different knee flexion conditions.</p><p><b>METHODS</b>A four-major-ligament contained knee specimen from an adult died of skull injury was prepared for CT scanning with the detectable ligament insertion footprints, locations and orientations precisely marked in advance. The CT scanning images were converted to a 3-dimensional model of the knee with the 3-dimensional reconstruction technique and transformed into finite element model by the software of ANSYS. The model was validated using experimental and numerical results obtained by other scientists. The natural stress changes of LCL at five different knee flexion angles (0 degree, 30 degree, 60 degree, 90 degree, 120 degree) and under various motions of anterior-posterior tibial translation, tibial varus rotation and internal-external tibial rotation were measured.</p><p><b>RESULTS</b>The maximum stress reached to 87%-113% versus natural stress in varus motion at early 30 degree of knee flexions. The stress values were smaller than the peak value of natural stress at 0 degree (knee full extension) when knee bending was over 60 degree of flexion in anterior-posterior tibial translation and internal-external rotation.</p><p><b>CONCLUSION</b>LCL is vulnerable to varus motion in almost all knee bending positions and susceptible to anterior-posterior tibial translation or internal-external rotation at early 30 degree of knee flexions.</p>
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Humans , Anterior Cruciate Ligament , Physiology , Collateral Ligaments , Physiology , Finite Element Analysis , Knee Joint , Physiology , Stress, MechanicalABSTRACT
Objective To report computer-aided three-dimensional visualization of simulated surgery for distal femoral fractures using software Unigraphics NX and Mimics. Methods The preoperative CT scans of 6 patients with distal femoral fractures were used for three-dimensional reconstruction of distal femoral fractures using software Mimics. Three-dimensional reconstruction of the surgical instruments using the modeling function of software Unigraphics NX. The assembly function of software Unigraphics NX was used to vi-sualize the simulated internal fixations of distal femoral fractures with both Less Invasive Stable System plates and the retrograde nails. The operative procedures simulated by the software Unigraphics NX were analyzed preoperatively. Results The simulated operative procedures were clearly and vividly visualized in three-dimensions, The fracture reduction and operative effects could be predicted. Conclusion This system of three-dimensional visualization of simulated surgery for distal femoral fractures using software Unigraphics NX and Mimics can help surgeons make preoperative predictions and select reliable methods to improve the reliability and effectiveness of the orthopaedic surgery.
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<p><b>OBJECTIVE</b>To establish a computer-aided three-dimensional visualization operation simulation system based on Mimics and Unigraphics NX software to provide reliable evidence for accurate preoperative surgical planning.</p><p><b>METHODS</b>The preoperative CT scans of 5 patients with intertrochanteric fractures were used for three-dimensional reconstruction of intertrochanteric fractures using Mimics software. Three-dimensional reconstruction of the surgical instruments was carried out using the modeling function of Unigraphics NX software, whose assembly function was used to visualize the simulates internal fixations of intertrochanteric fractures with dynamic hip screw (DHS) system. The operative procedures simulated by Unigraphics NX were analyzed preoperatively.</p><p><b>RESULTS</b>The virtual surgery procedures were clearly and vividly visualized in three dimensions. The fracture reduction and surgical effects could be predicted using this system.</p><p><b>CONCLUSIONS</b>This system of three-dimensional visualization of virtual surgery for intertrochanteric fractures has important values in surgical planning, risk assessment and clinical training, and can help improve the reliability and outcome of orthopedic surgery.</p>