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Rotator cuff injury is the most important cause of shoulder joint pain and dysfunction. In recent years, the incidence of rotator cuff injuries has gradually increased, reaching 30%-50% in people >50 years old. In the clinical treatment of rotator cuff injuries, suture anchors are widely used to fix the tendon to the bone and keep it in place without loosening or moderate tension until physiological healing is completed. The materials of suture anchors are constantly updated in clinical practice and have undergone the evolution of metal suture anchors, biodegradable suture anchors, biostable suture anchors, biocomposite suture anchors, and all suture anchors.This article reviews the advantages and disadvantages of anchors of various materials reported in domestic and foreign literatures.
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Objective:To investigate the relationship between medical students' employment intention in primary healthcare unit and their learning and psychological state through a questionnaire survey among clinical undergraduates.Methods:A cross-sectional survey was conducted among 821 graduates of a Medical University in 2017 to investigate their employment intention, learning and psychological status and employment plan. The learning and psychological status was evaluated by a self-designed questionnaire. Independent-sample t test, variance analysis and multiple linear regression analysis were used to examine the relevant factors affecting medical students' employment intention in primary healthcare by SPSS 21.0 version. Results:A total of 810 questionnaires were distributed and 753 questionnaires were included in the analysis. The employment intention of working in primary healthcare units of medical students was (4.61±2.24). Students in the advanced class had lower willingness to work in primary healthcare unit (the group of students with higher entrance examination scores) ( P<0.05), and students with higher learning pressure and greater pressure of doctor-patient relationship were more reluctant to work in primary healthcare units ( P<0.05). In terms of the employment plan, students who focus on their professional counterparts are more willing to work in primary healthcare unit, while those who pay more attention to salary are less willing to work in primary healthcare unit ( P<0.05). Conclusion:Improving the incentive policies for working in primary healthcare unit, actively relieving psychological pressure of medical students, and increasing the training of doctor-patient communication can have a positive effect on improving the willingness of medical students to have an employment intention in primary healthcare unit.
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Objective:To investigate the relationship between medical students' employment intention in primary healthcare unit and their learning and psychological state through a questionnaire survey among clinical undergraduates.Methods:A cross-sectional survey was conducted among 821 graduates of a Medical University in 2017 to investigate their employment intention, learning and psychological status and employment plan. The learning and psychological status was evaluated by a self-designed questionnaire. Independent sample t-test, variance analysis and multiple linear regression analysis were used to examine the relevant factors affecting medical students' employment intention in primary healthcare by SPSS 21.0 version.Results:A total of 810 questionnaires were distributed and 753 questionnaires were included in the analysis. The employment intention of working in primary healthcare units of medical students was 4.61±2.24. Students in the advanced class had lower willingness to work in primary healthcare unit (the group of students with higher entrance examination scores) ( P<0.05), and students with higher learning pressure and greater pressure of doctor-patient relationship were more reluctant to work in primary healthcare units ( P<0.05). In terms of the employment plan, students who focus on their professional counterparts are more willing to work in primary healthcare unit, while those who pay more attention to salary are less willing to work in primary healthcare unit ( P<0.05). Conclusion:Improving the incentive policies for working in primary healthcare unit, actively relieving psychological pressure of medical students, and increasing the training of doctor-patient communication can have a positive effect on improving the willingness of medical students to have an employment intention in primary healthcare unit.
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Objective@#: To investigate the efficiency of diffusion tensor imaging (DTI) fiber-tracking based neuronavigation and assess its usefulness in the preoperative surgical planning, prognostic prediction, intraoperative course and outcome improvement. @*Methods@#: Seventeen patients with cerebral masses adjacent to corticospinal tract (CST) were given standard magnetic resonance imaging and DTI examination. By incorporation of DTI data, the relation between tumor and adjacent white matter tracts was reconstructed and assessed in the neuronavigation system. Distance from tumor border to CST was measured. @*Results@#: The sub-portion of CST in closest proximity to tumor was found displaced in all patients. The chief disruptive changes were classified as follows : complete interruption, partial interruption, or simple displacement. Partial interruption was evident in seven patients (41.2%) whose lesions were close to cortex. In the other 10 patients (58.8%), delineated CSTs were intact but distorted. No complete CST interruption was identified. Overall, the mean distance from resection border to CST was 6.12 mm (range, 0–21), as opposed to 8.18 mm (range, 2–21) with simple displacement and 2.33 mm (range, 0–5) with partial interruption. The clinical outcomes were analyzed in groups stratified by intervening distances (close, 10 mm). For the primary brain tumor patients, the proportion of completely resected tumors increased progressively from close to far grouping (42.9%, 50%, and 100%, respectively). Five patients out of seven (71.4%) experienced new neurologic deficits postoperatively in the close group. At meantime, motor deterioration was found in six cases in the close group. All patients in the far and moderate groups received excellent (modified Rankin Scale [mRS] score, 0–1) or good (mRS score, 2–3) rankings, but only 57.1% of patients in the close group earned good outcome scores. @*Conclusion@#: DTI fiber tracking based neuronavigation has merit in assessing the relation between lesions and adjacent white matter tracts, allowing prediction of patient outcomes based on lesion-CST distance. It has also proven beneficial in formulating surgical strategies.
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Objective To clarify the value of absorbable barbed suture in closure of galeal. Methods A total of 101 patients had craniotomy treated in Shengjing Hospital of China Medical University from October 2018 to February 2019 were divided into two groups according to the admission date. In the barbed suture group, 45 patients were sutured with QUILL by continuous stitching. In the control group, 56 patients were sutured with traditional stitchingby intermittent suture. Compare the differences in suture speed, average postoperative hospital stay, incision complication rate, and the average hospital costs of the two groups. Results The suture speed in barbed suture group was (0.330 ± 0.012) cm/min , and was significantly faster than that in control group (0.540 ± 0.016) cm/min;the postoperative average hospitalization days in barbed suture group was (10.91 ± 0.62) d, and was significantly shorter than that in control group (12.73 ± 0.41) d, there were significant differences (P<0.05) . However, the complications and hospital costs in two groups had no significant differences (P>0.05). Conclusions The use of absorbable barbed close epicranial aponeuroisiscan improve suture speed, shorten the postoperative average hospitalization days, which is worthy of promotion.
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Objective@#To establish a high-throughput sequencing method for a whole genome in different hepatitis B virus (HBV) concentrations.@*Methods@#Two method of amplicon-sequencing and direct sequencing without PCR amplification were used for library construction in the three plasmids, including the low HBV load sample, the moderate HBV load sample and the high HBV load sample. Whole genome sequencing was performed on Illumina MiSeq platform.@*Results@#There are significant differences in data yield between the two different library construction method. Only a few reads could be mapped to the HBV genome for direct sequencing. However, three samples were successfully amplified by the nested PCR amplification and amplicon-sequencing showed that all HBV samples had a good coverage and depth, which was not affected by HBV concentration. The alignment rate of HBV genome approached 80%. A total of 27 intra-host single nucleotide variations (iSNVs) were identified and 13 iSNVs were low-frequency mutation in three samples. Compared with the high HBV load sample, mutations in the reverse transcription (RT) region was more easily appeared in the low HBV sample and the moderate HBV load sample.@*Conclusions@#Integrating nested PCR with high-throughput sequencing to the HBV whole genome sequencing is not only a practical method to detect the infection of HBV with a high-sensitivity and accuracy, but also enables to detect the mutation in the infected patient with low HBV copy number.
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Objective To investigate the value of serum D-dimer in evaluating the severity and the prognosis of patients with acute spontaneous subrachnoid hemorrhage.Methods The clinical data of 157 patients with acute spontaneous subrachnoid hemorrhage were collected,and the level of D-dimer in elbow vein serum were measured.The severity of the disease was judged by Hunt-Hess classification,and the patients,brain CT scans were scored according to the modified Fisher scale.The patients were followed up for 3 months.Based on the modified RANKIN scale (mRS scale),patients were divided into unfavorable prognosis group (3≤ mRS ≤5) and good prognosis control group (1 ≤ mRS ≤2).Results In the 157 cases of spontaneous subrachnoid hemorrhage patients,there were 45 cases in the unfavorable prognosis group and 112 cases in the good prognosis control group.The level of D-dimer in the unfavorable prognosis group was significantly higher than the level of control group and there were significant differences between them (P ＜ 0.01).By the Spearman correlation analysis,the level of D-dimer was positively correlated with Hunt-Hess score (r =0.831,P ＜0.01),and it was also positively correlated with unfavourable prognosis mRS scale (r =0.834,P ＜0.01).Furthermore,regression analysis showed that high level of D-dimer was an independent risk factor for the poor prognosis of patients (OR =1.011,95％ CI:1.007-1.016,P ＜ 0.01).Through the receiver operating characteristic curve (ROC) analysis of the D-dimer in patients with poor prognosis,the area under ROC curve was 0.964 (95％ CI:0.93-0.98,P ＜ 0.01),sensitivity and specificity were 88.9％ and 99.1％,respectively.The cut-off point of D-dimer content was 739 μg/L.Conclusions The level of D-dimer in patients with acute spontaneous subrachnoid hemorrhage was closely related to the severity of the diseases,and high level of D-dimer was an independent risk factor for the prognosis of patients.
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Objective To retrospectively analyze and compare the intraoperative and postoperative clinical efficacies between the interhemispheric approach and pterional approach in craniotomy anterior communicating aneurysm clipping surgery.Methods A total of 21 cases of anterior communicating artery aneurysms with subarachnoid hemorrhage undergoing surgery of craniotomy clipping from January 2012 to December 2016 in the Department of Neurosurgery of Shengjing Hospital of China Medical University,in which 13 cases were treated by pterional approach and 8 cases were treated by interhemispheric approach.Two kinds of operation approaches were compared in operation time,intraoperative aneurysm rupture rate,intraoperative bleeding volume,average length of stay,incidence rate of postoperative fection,and Glasgow Outcome Scale (GOS).Results There were no significant difference in intraoperative aneurysm rupture rate,intraoperative bleeding volume,inicidence rate of postoperative infection rate,and GOS scores (P ＞ 0.05).But the opreration time and average length of stay in interhemispheric approach group were significantly shorter than the pterional approach group (P ＜ 0.05).Conclusions Approach of interhemispheric was a safe,effective,and convenient approach for the craniotomy of clipping in anterior communicating artery aneurysm.
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Objective To retrospectively analyze and compare the intraoperative and postoperative clinical efficacies between the interhemispheric approach and pterional approach in craniotomy anterior communicating aneurysm clipping surgery.Methods A total of 21 cases of anterior communicating artery aneurysms with subarachnoid hemorrhage undergoing surgery of craniotomy clipping from January 2012 to December 2016 in the Department of Neurosurgery of Shengjing Hospital of China Medical University,in which 13 cases were treated by pterional approach and 8 cases were treated by interhemispheric approach.Two kinds of operation approaches were compared in operation time,intraoperative aneurysm rupture rate,intraoperative bleeding volume,average length of stay,incidence rate of postoperative fection,and Glasgow Outcome Scale (GOS).Results There were no significant difference in intraoperative aneurysm rupture rate,intraoperative bleeding volume,inicidence rate of postoperative infection rate,and GOS scores (P ＞ 0.05).But the opreration time and average length of stay in interhemispheric approach group were significantly shorter than the pterional approach group (P ＜ 0.05).Conclusions Approach of interhemispheric was a safe,effective,and convenient approach for the craniotomy of clipping in anterior communicating artery aneurysm.
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Objective To investigate the expression of miR-29s in the glioma stem cells,and explore how the members of miR-29s affect the bio-logical behaviors of glioma stem cells. Methods Eight patient specimens were used to culture glioma stem cells. Real-time PCR was adopted to test the expression of miR-29s. CCK-8 analysis was performed to test the proliferation ,Transwell was used to test cell migration and invasion ,and flow-cytometry analysis was carried out to test apoptosis. Results miR-29a,miR-29b and miR-29c were decreased in glioma stem cells. Over-ex-pression of miR-29s could inhibit the proliferation,cell migration and invasion,but promote apoptosis of glioma stem cells. Conclusion miR-29s acts as a cancer suppressor gene in the glioma stem cells ,and miR-29a plays the dominant functional role in the family.
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Aim To explore the effect of shikonin on stemness maintance of glioma stem cells ( GSCs ). Methods After the U87-MG cells were cultured and isolated, the sphere cells were identified by immuno-fluorescent staining. The alteration of stemness of GSCs by shikonin treatment(2 μmol·L - 1 ) for 12 h, 24 h and 48 h was valued by morphological detection using optical microscope and sub-sphere forming assay. Mo-reover, the related markers of stem cells, such as CD133, were detected in shikonin treated GSCs by western blot assay. Protein expression of PI3K, p-PI3K, Akt and p-Akt was detected by western blot af-ter shikonin treatment alone. Furthermore, by combi-nation with insulin-like growth factor-1 ( IGF-1), we observed the alteration of stemness maintance of shiko-nin-treated GSCs. Results The presence of neural stem cell related markers CD133 and nestin proved the characteristics of GSCs. Shikonin treatment significant-ly inhibited the morphology of GSCs and the sub-sphere forming. Besides, the reduced expression of CD133 was detected in shikonin treated GSCs. Though, the expression of PI3K and Akt did not change compared with the control group, the expression of p-PI3K and p-Akt was reduced. Furthermore, the combination of IGF-1 markedly attenuated the inhibitory effect of shikonin on stemness maintance of GSCs. Conclusion The stemness maintance of GSCs can be significantly inhibited by shikonin treatment, in which PI3K/ Akt pathway is involved.
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Aim To investigate the signaling mecha-nisms in endothelial monocyte-activating polypeptide-Ⅱ( EMAP-Ⅱ)-induced increase in blood-tumor barri-er ( BTB ) permeability. Methods Relatively pure cerebral microvessel fragments were obtained from the cortex of 3-5 days old Wistar rats by using careful dis-section, enzyme digestion, and dextran centrifugation. Then, these fragments were seeded on dishes and cul-tured primarily. In vitro BTB models were constructed by co-cultivation of rat brain microvascular endothelial cells ( BMECs) with C6 glioma cells. Confluent mono-layers of co-cultured BMECs were divided randomly in-to 5 groups ( each n=6 ): control, EMAP-Ⅱ, H7 +EMAP-Ⅱ, C3 exoenzyme + EMAP-Ⅱ, and C3 ex-oenzyme + H7 + EMAP-Ⅱ groups. Transendothelial electric resistance values and horseradish peroxidase flux were measured to evaluate changes in the BTB permeability . The expression levels of tight junction-re-lated protein occludin and ZO-1 in BMECs were meas-ured by Western blot. Immunofluorescence was used to identify the expression and distribution of occludin and ZO-1 in BMECs. Also, Western blot were used to de-tect the expression levels of myosin light chain ( MLC) and phosphomyosin light chain ( pMLC ) in BMECs. Results Compared with control group, the BTB per-meability of EMAP-Ⅱ group was increased significant-ly. The expression levels of occludin and ZO-1 in BMECs were significantly decreased, accompanied with marked increase in the expression level of pMLC. These above-mentioned effects of EMAP-Ⅱ were sig-nificantly inhibited by pretreatment with H7 ( an inhib-itor of PKC ) or/and C3 exoenzyme ( an inhibitor of RhoA ) . Conclusion Signaling molecules PKC and RhoA play important roles in EMAP-Ⅱ-induced in-crease in BTB permeability; signaling pathways PKC-pMLC and RhoA-pMLC are involved in this process.
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Objective To observe effects of forced expression of miRNA -101 on glioma U251 cells proliferation and invasion. Meth ods MiRNA-101 oligoneucleotide was transfected into U 251 cells with liposome .MTT assay measured cell proliferation and Tr-answell assay detected cell invasion .Results Compared with control groups ,the growth and invasion of U251 cells transfected with miRNA-101 were decreased markably .Conclusions MiRNA-101 may play important role in inhibiting glioma cell growth and inva-sion.
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Objective To investigate the clinical features and microsurgical outcomes of patients with parasellar cavernous hemangiomas.Methods The clinical data and prognosis of 12 patients with parasellar cavemous hemangiomas treated with microsurgery were retrospectively analyzed.Magnetic resonance imaging showed that cavernous hemangiomas appeared slight hypointensity on T1WI,hyperintense on T2WI,and significant contrast on enhancing.Results Total resection and sub-total resection was achieved in 9 and 3 patients.No death occurred postoperatively.After operation,all patients were released from intracranial hypertension.In 6 patients who had visual disorder,5 patients improved and 1 patient had no change.In 5 patients who had eyeball motor disorder,3 patients improved and 2 patients had no change.In 4 patients who had pituitary gland dyshormonism,2 patients improved and 2 patients had no change.At postoperative early stage,diabetes insipidus and serum electrolyte disorder occurred in 3 patients,2 patients developed oculomotor paralysis.Patients were followed up (30.51 + 2.57) months.Three patients recovered from diabetes insipidus and serum electrolyte disorder,and 1 patient recovered from oculomotor paralysis.No patient suffered tumor recurrence or regrowth.Conclusions The correct diagnosis of parasellar cavernous hemangiomas can be achieved according to the preoperative MRI.Microsurgery is the first-line therapy for parasellar cavernous hemangiomas.
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Objective To analyze the complications ofventriculoperitoneal shunt in the treatment of pediatric hydrocephalus,and improve operative method,in order to reduce postoperative complications and improve the clinical curative effect.Methods A total of 39 infants with hydrocephalus who underwent adjustable shunt were retrospectively analyzed,including surgical methods,results,and complications,and put forward counter measures.Results Thirty cases of postoperative clinical symptoms obviously improved compared with preoperative,head CT review were clearly seen with ventricle retraction.Nine cases suffered with complications after operation.Obstruction of shunt tube was found in 4 cases,shunt exposed in 3 cases,and postoperative infection in 2 cases.Conclusions Ventriculoperitoneal shunt complications related to surgery itself.Improved surgical techniques,and taking appropriate treatment measures can effectively reduce the incidence of complications.
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Objective Aimed to clarify the molecular mechanism after subarachnoid hemorrhage （SAH） by investigating the expression of tight junction protein Claudin-5 and ZO-1 and the effects of SP600125 on them. Methods Seventy-five male Sprague Dawley rats （300 to 350 g） were randomly divided into sham,SAH,SAH ＋ DMSO （dimethyl sufoxide） solution,SAH ＋SP600125 （C-Jun N-terminal kinase inhibitor）10 mg/kg,and SAH ＋SP600125 30 mg/kg groups. The standard endovaseular perforation was performed to produce experimental SAH. The JNK inhibitor SP600125 was intraperitoneally administered at 1 hour before and 6 hours after SAH. Results At 24 hours after SAH,signs of microvessels injury were observed in brain cortex. Compared with the sham group,expression of Claudin-5 and ZO-1 was sig- nificantly decreased （P 〈 0.05 ）. JNK inhibitior SP600125 suppressed the decrease of Claudin-5 and ZO-1 expression, attenuated blood-brain barrier disruption in rats after SAH. Conclusions The blood-brain barrier disruption is an important mechanism of early brain injury after SAH. JNK inhibitor SP600125 improves neurological outcomes and provides neuropmtecfion against acute events after SAH such as bloodbrain barrier disruption and cell apoptosis.
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Objective To investigate the age-related pattern of normal skull bone marrow with 3. 0 T MR T1WI. Methods Cranial MR T1WI images which were defined to be normal were retrospectively reviewed in 360 cases. Patients with known diffuse bone marrow disease, focal lesions, history of radiation treatment or steroid therapy were excluded, while patients whose cranial MRI and follow-up visits were all normal were included in this study. All the subjects were divided into 7 groups according to the age: < 1, 1--2,3--5, 6--14, 15--29, 30--49, >50 years group. Mid- and para- sagittal T1WI images were used to be analyzed and the type of cranial bone marrow was classified according to the thickness of diploe and the pattern of the signal characteristics. Statistical analysis was conducted to reveal the relationship between the age and the type. Results The normal skull bone marrow could be divided into four types as follows: (1) Type- Ⅰ : 115 cases, 47 of which appeared type- Ⅰ a and the mean thickness was ( 1.24±0. 31 ) mm; 68 of which appeared type- Ⅰ b and the mean thickness was ( 1.76 ± 0. 37 ) mm. Type- Ⅱ : 57 cases and the mean thickness was (2.78 ±0.69) mm. Type-Ⅲ: 148 cases, 18 of which appeared type-Ⅲ a and the mean thickness was (2. 33±0. 65) mm; 88 of which appeared type-Ⅲ b and the mean thickness was (4. 01 ± 0. 86) mm; 42 of which appeared type-Ⅲ c and the mean thickness was (4. 31±0. 73) mm. Type-Ⅳ: 40 cases, 25 of which appeared type-Ⅳ a and the mean thickness was (5. 17 ± 1.02) mm; 15 of which appeared type-Ⅳ b and the mean thickness was (5.85±1.45) mm. (2) <1 year group: 40 cases, 20 of which appeared type- Ⅰ a, 20 type- Ⅰ b and the mean thickness of this group was ( 1.47 ± 0. 42 ) mm. 1-- 2 years group: 40 cases, 16 of which appeared type- Ⅰ a, 18 type- Ⅰ b, 6 type- Ⅱ and the mean thickness of this group was ( 1.68±0. 52) mm. 3--5 years group: 40 cases, 8 of which appeared type- Ⅰ a, 18 type-Ⅰb, 14 type-Ⅱ and the mean thickness of this group was (1.84±0.73) mm. 6--14 years group: 60 cases, 3 of which appeared type- Ⅰ a, 12 type- Ⅰ b, 27 type-Ⅱ , 12 type-Ⅲb, 6 type-Ⅲc, and the mean thickness of this group was (2.92±1. 00) mm. 15--29 years group: 60 cases, 7 of which appeared type-Ⅱ , 5 type-ma, 27 type-Ⅲb, 15 type-Ⅲc, 6 type-Ⅳa and the mean thickness of this group was (3.95 ± 0.97) mm. 30---49 years group: 60 cases, 3 of which appeared type-Ⅱ , 7 type-Ⅲa, 29 type-Ⅲb, 15 type-Ⅲc, 3 type-Ⅳa and 3 type-Ⅳb and the mean thickness of this group was (4. 30 ± 1.35) mm. ≥50 years group: 60 cases, 6 of which appeared type-Ⅲ a, 20 type-Ⅲb, 6 type-Ⅲc, 16 type-Ⅳa and 12 type-Ⅳb and the mean thickness of this group was (4.51 ± 1.40) mm. (3) There is a linear relationship between ages and types that is revealed by chi-square test (x2 = 266. 36, P < 0. 01 ). Conclusion There is characteristic in the distribution of normal skull bone marrow with age growing. And skull bone marrow transforms gradually from type- Ⅰ to Ⅳ with aging.
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Objective To explore the methods of labeling exogenous microglia with superparamagnetie iron oxide(SPIO)particles,and to monitor the labeled cells after transplantation into the normal rat and Alzheimer's disease(AD)model rat with MR scanning.Methods Microglia was labeled with SPIO particles by using transfection agent,hemagglutinating virus of Japan envelope(HVJ-E).Then the microglias which were labeled with SPIO were injected into the internal carotid artery of normal rat (n=5)and AD model rat(n=5).Three days after transplantation,follow-up serial T2*-weighted gradient-echo MR imaging was performed at 7.0T MRI system.MR images were correlated with histological findings.Results In the brain of normal rat,the labeled microglias were demonstrated as several dotty signalintensity decrease on T2*-weighted MR images.The dotty spots were sporadic around the brain.Histological analysis showed that most prussian blue staining-positive cells were well correlated with the area where a signal intensity decrease was observed in MRI.MR could detect the signal intensity change caused by a few labeled cells.In the brain of AD model rat,MR scan showed a well-defined hypointensity area in the region of Aβ42 iniection.Signal intensity decrease was not obvious in the region of saline injection.The number of iron-positive cells(454±47)/mm2 at sites of Aβ42 injection was much higher than that(83±13)/mm2 of saline injection(P＜0.05). Conclusion MR can be used as a non-invasive means of detecting transplanted labeled microglia in vivo,with the potential for future clinical application in cell therapy of AD.
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Aim To study the effect of sodium aescinate (10 mg?kg-1?d-1) on brain edema induced by intracerebral hemorrhage and the mechanism. Methods Male Wistar rats received an injection of 50 ?lautologous whole blood into the right basal ganglia and were killed 6, 24, 48 or 72 h later. Dry-wet-weighting technique, zymologic, immunohistochemical and Western blot methods were used to examine changes of water content, Na+ and K+ contents, glial fibrillary acidic protein(GFAP)-positive cells and expression of occludin, which is a tight junction(TJ)-associated protein. Results Compared with sham operation group, contents of water and Na+ were significantly higher(P