Analysis on off-label use of drugs in pediatric guidelines and consensus published by Chinese authors / 中华儿科杂志

Objective: To understand the current situation regarding pediatric off-label use of drugs recommendations in Chinese clinical practice guidelines and to make recommendations for standardized reporting format regarding off-label use of drugs for children. Methods: This cross-sectional study was carried out by systematically searching the databases for Chinese guideline consensus articles published in journals between 2018 and 2020 and extracting recommendations regarding off-label use of drugs from those articles. The essential characteristics of the included guidelines, the ranking of off-label drug types, the order of drug information, the type of off-label drug use, and the percentage of citation studies on which the recommendations were based were analyzed. Results: Among 108 studies that included Chinese off-label guidelines and consensus, 364 recommendations on pediatric off-label use of drugs were included. The Chinese Medical Association published the most, 48 out of the 108 studies (44.4%), and of those 14 studies (13.0%) were on infectious and parasitic diseases. Of the 364 recommendations on off-label use of drugs, the most commonly addressed drugs were 16 recommendations (4.4%) for cyclosporine A, 11 recommendations (3.0%) for methotrexate , and 11 recommendations (3.0%) for fentanyl. The most commonly addressed drug categories were as follows: 68 recommendations (18.6%) were immune system drugs, 66 recommendations (18.1%) were anti-infectives, and 56 recommendations (15.4%) were oncology drugs. The most commonly addressed drug information accounts were as follows: 364 recommendations (100.0%) were indications, 204 recommendations (56.0%) were dosages, and 198 recommendations (54.4%) were the route of administration. Based on the instructions approved by the Chinese Food and Drug Administration, the main forms of the off-label drug were as follows: 175 recommendations (48.1%) were unapproved indications, 127 recommendations (34.9%) were unapproved populations, and 72 recommendations (19.8%) were unapproved ages. Only 129 recommendations (35.4%) were cited, mainly including clinical guidelines (48 studies, 23.4%), reviews (22 studies, 10.7%), and pediatric randomized controlled trials (22 studies, 10.7%). Conclusions: Off-label use of drugs is commonly recommended in pediatric guidelines and consensus documents written by Chinese authors. However, the reporting of the recommendations varies widely, and the quality of the supporting evidence is poor.

Safety, Immunogenicity, and Efficacy of COVID-19 Vaccine in Children and Adolescents: A Systematic Review

AimTo identify the safety, immunogenicity, and protective efficacy of COVID-19 vaccine in children and adolescents. MethodsWe conducted a systematic review. Databases including PubMed, Web of Science, WHO COVID-19 database, and CNKI were searched on 23 July 2021. International Clinical Trials Registry Platform (ICTRP) was also searched to collect ongoing trials. We included published researches or ongoing clinical trials related to the safety, immunogenicity, and efficacy of COVID-19 vaccine in children or adolescents (aged [≤]18 years). Meta-analysis was performed if the consistency of the included studies was high. If not, descriptive analyses were performed. ResultsEight published studies with 2851 children or adolescents and 28 ongoing clinical trials were included. Among eight published studies, two (25.0%) were RCTs, two (25.0%) case series, and four (50.0%) case reports. The results showed selected COVID-19 vaccines had a good safety profile in children and adolescents. Injection site pain, fatigue, headache, and chest pain were the most common adverse events. Some studies reported a few cases of myocarditis and pericarditis. Two RCTs showed that the immune response to BNT162b2 in adolescents aged 12-15 years was non-inferior to that in young people aged 16-25 years, while a stronger immune response was detected with 3g CoronaVac injection. Only one single RCT showed the efficacy of BNT162b2 was 100% (95% CI: 75.3 to 100). Of the 28 ongoing clinical trials, twenty-three are interventional studies. Fifteen countries are conducting interventional clinical trials of COVID-19 vaccines in children and adolescents. Among them, China (10, 43.5%) and United Stated (9, 39.1%) were the top two countries with the most trials. BNT162b2 was the most common vaccine, which is under testing. ConclusionSome of the COVID-19 vaccines have potential protective effects in children and adolescents, but awareness is needed to monitor possible adverse effects after injection. Clinical trials of the COVID-19 vaccine in children and adolescents with long follow-up, large sample size, and different vaccines are still urgently needed.

Biomimetic Biphasic Electrospun Scaffold for Anterior Cruciate Ligament Tissue Engineering

Background@#Replacing damaged anterior cruciate ligaments (ACLs) with tissue-engineered artificial ligaments is challenging because ligament scaffolds must have a multiregional structure that can guide stem cell differentiation. Here, we designed a biphasic scaffold and evaluated its effect on human marrow mesenchymal stem cells (MSCs) under dynamic culture conditions as well as rat ACL reconstruction model in vivo. @*Methods@#We designed a novel dual-phase electrospinning strategy wherein the scaffolds comprised randomly arranged phases at the two ends and an aligned phase in the middle. The morphological, mechanical properties and scaffold degradation were investigated. MSCs proliferation, adhesion, morphology and fibroblast markers were evaluated under dynamic culturing. This scaffold were tested if they could induce ligament formation using a rodent model in vivo. @*Results@#Compared with other materials, poly(D,L-lactide-co-glycolide)/poly(ε-caprolactone) (PLGA/PCL) with mass ratio of 1:5 showed appropriate mechanical properties and biodegradability that matched ACLs. After 28 days of dynamic culturing, MSCs were fusiform oriented in the aligned phase and randomly arranged in a paving-stone-like morphology in the random phase. The increased expression of fibroblastic markers demonstrated that only the alignment of nanofibers worked with mechanical stimulation to promote effective fibroblast differentiation. This scaffold was a dense collagenous structure, and there was minimal difference in collagen direction in the orientation phase. @*Conclusion@#Dual-phase electrospun scaffolds had mechanical properties and degradability similar to those of ACLs. They promoted differences in the morphology of MSCs and induced fibroblast differentiation under dynamic culture conditions. Animal experiments showed that ligamentous tissue regenerated well and supported joint stability.

Biomimetic Biphasic Electrospun Scaffold for Anterior Cruciate Ligament Tissue Engineering

Background@#Replacing damaged anterior cruciate ligaments (ACLs) with tissue-engineered artificial ligaments is challenging because ligament scaffolds must have a multiregional structure that can guide stem cell differentiation. Here, we designed a biphasic scaffold and evaluated its effect on human marrow mesenchymal stem cells (MSCs) under dynamic culture conditions as well as rat ACL reconstruction model in vivo. @*Methods@#We designed a novel dual-phase electrospinning strategy wherein the scaffolds comprised randomly arranged phases at the two ends and an aligned phase in the middle. The morphological, mechanical properties and scaffold degradation were investigated. MSCs proliferation, adhesion, morphology and fibroblast markers were evaluated under dynamic culturing. This scaffold were tested if they could induce ligament formation using a rodent model in vivo. @*Results@#Compared with other materials, poly(D,L-lactide-co-glycolide)/poly(ε-caprolactone) (PLGA/PCL) with mass ratio of 1:5 showed appropriate mechanical properties and biodegradability that matched ACLs. After 28 days of dynamic culturing, MSCs were fusiform oriented in the aligned phase and randomly arranged in a paving-stone-like morphology in the random phase. The increased expression of fibroblastic markers demonstrated that only the alignment of nanofibers worked with mechanical stimulation to promote effective fibroblast differentiation. This scaffold was a dense collagenous structure, and there was minimal difference in collagen direction in the orientation phase. @*Conclusion@#Dual-phase electrospun scaffolds had mechanical properties and degradability similar to those of ACLs. They promoted differences in the morphology of MSCs and induced fibroblast differentiation under dynamic culture conditions. Animal experiments showed that ligamentous tissue regenerated well and supported joint stability.

Potent synthetic nanobodies against SARS-CoV-2 and molecular basis for neutralization

SARS-CoV-2, the causative agent of COVID-191, recognizes host cells by attaching its receptor-binding domain (RBD) to the host receptor ACE22-7. Neutralizing antibodies that block RBD-ACE2 interaction have been a major focus for therapeutic development8-18. Llama-derived single-domain antibodies (nanobodies, [~]15 kDa) offer advantages including ease of production and possibility for direct delivery to the lungs by nebulization19, which are attractive features for bio-drugs against the global respiratory disease. Here, we generated 99 synthetic nanobodies (sybodies) by in vitro selection using three libraries. The best sybody, MR3 bound to RBD with high affinity (KD = 1.0 nM) and showed high neutralization activity against SARS-CoV-2 pseudoviruses (IC50 = 0.40 g mL-1). Structural, biochemical, and biological characterization of sybodies suggest a common neutralizing mechanism, in which the RBD-ACE2 interaction is competitively inhibited by sybodies. Various forms of sybodies with improved potency were generated by structure-based design, biparatopic construction, and divalent engineering. Among these, a divalent MR3 conjugated with the albumin-binding domain for prolonged half-life displayed highest potency (IC50 = 12 ng mL-1) and protected mice from live SARS-CoV-2 challenge. Our results pave the way to the development of therapeutic nanobodies against COVID-19 and present a strategy for rapid responses for future outbreaks.

Transjugular intrahepatic portosystemic shunt by using covered stents of different diameters for the treatment of esophagogastric varices rupture with bleeding / 介入放射学杂志

Objective To assess the efficacy and safety of different diameter covered stents used in transjugular intrahepatic portosystemic shunt (TIPS) for esophagogastric varices with bleeding (EGVB). Methods The clinical data of 68 patients with portal hypertension due to cirrhosis, who received TIPS for EGVB during the period from Desember 2010 to February 2015, were retrospectively analyzed. Among the 68 patients, covered stent with diameter of 7mm was used in 30 (small stent group) and covered stent with diameter of 8mm was employed in 38 (big stent group). Using Kaplan-Meier method, the cumulative digestive tract no-rebleeding rate, the patency rate of shunt and the survival rate of both groups were analyzed. Logrank test was used to make comparison between the two groups, and chi-square test was conducted to compare the incidence of hepatic encephalopathy between the two groups. Results The operative success rate was 100％ in 68 patients. The patients were followed up for 0.1-52.3 months, with a mean of (19.4±16.0) months. The 3-, 6-and 12-month cumulative digestive tract no-rebleeding rates were 86.54％, 79.30％ and 74.90％ respectively in the small stent group, which were 91.87％, 85.93％ and 81.63％ respectively in the big stent group, but the differences between the two groups were not statistically significantly (X2=0.05, P=0.83). The 3-, 6-and 12-month cumulative patency rates of shunt in the small stent group were 95.00％, 80.19％ and 70.17％ respectively, which in the big stent group were 96.15％, 91.97％ and 81.07％ respectively, and no statistically significant differences existed between the two groups (X2=0.40, P=0.53). The 3-, 12-, 24-and 48-month cumulative survival rates in the small stent group were 93.33％, 86.67％, 75.11％ and64.38％ respectively, while those in the big stent group were 97.37％, 94.23％, 88.68％ and 76.02％ respectively, and the differences between the two groups were not statistically significantly (X2=2.21, P=0.14). Postoperative hepatic encephalopathy occurred in 15 patients (15/68, 22.06％), the incidences of hepatic encephalopathy in the small stent group and in the big stent group were 20.00％ (6/30) and 23.68％ (9/38) respectively, the difference between the two groups was not statistically significantly (X2=0.13, P=0.72). Conclusion Compared with the use of 7mm covered stent, the use of 8mm covered stent in TIPS neither can improve the curative effect nor can reduce the incidence of hepatic encephalopathy.

Associating liver partition and portal vein ligation for staged hepatectomy combined with hepatic artery reconstruction in the treatment of hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective To study the combined use of ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) with hepatic artery reconstruction in the treatment of hilar cholangiocarcinoma with hepatic arterial involvement.Methods The clinical data of 7 patients with hilar cholangiocarcinoma who underwent ALPPS combined with hepatic arterial resection and reconstruction were analyzed retrospectively.The technical points and the perioperative management were analyzed.Methods At the first stage,the relationship between the tumor and the vessels were explored,the portal vein of the part of the liver to be resected was ligated and the liver was transected with a CUSA (Cavitron Ultrasound Surgical Aspirator).Then the bile duct was cut and a hepaticojejunostomy was completed.Finally,under ultrasound guidance,a bile duct drainage tube was inserted transhepatically into the part of the liver which was to be resected.Two to three weeks later,and after enough hypertrophy of the liver remnant size was confirmed,tumor resection was completed with reconstruction of the hepatic artery.Results Seven patients underwent the second stage operation,with no perioperative death.Six patients developed pulmonary infection and were treated successfully with conservative treatment.Two patients developed postoperative bile leak with secondary abdominal infection.One patient developed postoperative hepatic artery thrombosis secondary to biliary tract infection.Conclusion ALPPS combined with hepatic artery reconstruction was safe and feasible in the treatment of hilar cholangiocarcinoma with hepatic arterial involvement.

Evaluation of three-dimensional CT reconstruction on the anatomic variation of inferior mesenteric artery and left colic artery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To demonstrate the clinical applicability of three-dimensional CT angiography by evaluating the anatomic features and variation of inferior mesenteric artery(IMA) and left colic artery(LCA) in order to provide reference to vessel ligation strategy in laparoscopic rectal cancer surgery.</p><p><b>METHODS</b>Clinical and image data of 123 patients receiving abdominal multislice CT at The Sixth Affiliated Hospital from 2014 to 2015 were retrospectively analyzed. The images were 3D-reconstructed with computer 3D CT angiography and arterial enhancement phase images were chosen for analysis. Linear distances from IMA root to abdominal aortic bifurcation and from LCA at IMA root level to IMA root were measured. Branch types of IMA, coursing pattern of LCA, and association between LCA and inferior mesenteric vein (IMV) site were summarized.</p><p><b>RESULTS</b>Of 123 cases, 80 were males and 43 were females, mean age was (46.8±16.6) years, body weight was (57.7±10.4) kg, and BMI was (21.3±3.6) kg/m. The average distance from IMA root to abdominal aortic bifurcation was (42.5±7.9) mm, and this distance was closely associated with body weight (OR=4.771, 95%CI: 1.398 to 16.283, P=0.013). Longer distance tended to appear in the heavier patients. LCA and sigmoid artery (SA) originating from same single IMA was found in 61(49.6%) cases; LCA and SA forking at same point in 35(28.5%) cases; LCA and SA coursing together and forking afterwards in 24(19.5%) cases, and LCA disappearing in 3(2.4%) cases. In 71(57.7%) patients, LCA ascended medial to the lateral border of left kidney, while in 16(13.0%) patients, LCA arranged below the inferior border of left kidney. When the LCA site was higher and the distance from LCA to IMA root was closer [distance from LCA to IMA root level was (24.2±9.9) mm, (30.0±15.2) mm and (66.6±12.3) mm, F=83.2, P<0.001]. At the level of IMA root, LCA located medial to IMV in 21(17.1%) cases, located just lateral to IMV in 54(43.9%) cases, and located lateral and ascended far away from IMV in 48(39.0%) cases.</p><p><b>CONCLUSION</b>3D-CT angiography is non-invasive, efficient and accurate in evaluating coursing features and variation of IMA and its branches, which can provide important reference to the surgeons, promising laparoscopic surgery smooth and safe.</p>

Finite element analysis of lumbar disc degeneration with sacroiliac joint disorder by gait simulation / 医用生物力学

Objective To explore the biomechanical mechanisms of correlation between lumbar disc degeneration and sacroiliac joint disorder though investigating the biomechanical characteristics of lumbar disc degeneration with sacroiliac joint disorders. Methods One normal healthy volunteer and two patients with lumbar disc herniation and sacroiliac joint disorders (one was with sacrum disorders and the other was ilium disorders) were selected. Their CT data were collected to establish three corresponding lumbar-pelvis finite-element models, and their gait data were also simultaneously collected to drive the AnyBody musculoskeletal model. The muscle force around the lumbar and pelvis as well as the hip joint force were acquired as loading condition for finite element analysis. The stress changes in L4 and L5 intervertebral discs and sacroiliac joints of the patients and normal volunteer were compared. Results There was no significant difference in the stress of the two sides of L4, L5 disc and two sacroiliac joints in normal model, with a bimodal stress curve. However, in the models of sacrum disorders and ilium disorders, the bimodal stress curve peaks changed, even disappeared. The peak stress differences in left and right side of L4 disc were 0.55 MPa and 0.80 MPa, respectively, the peak stress differences in left and right side of L5 disc were 4.05 MPa and 2.08 MPa, respectively, and the peak stress differences in left and right side of sacroiliac joints were 0.96 MPa and 3.32 MPa, respectively. Conclusions The lumbar disc degeneration with sacroiliac joint disorder leads to the tilt of the body loading line, and sacroiliac joint disorder can aggravate the imbalances of stress on the body sides. The impact of sacroiliac joint dysfunction cannot be ignored in the treatment of lumbar disc herniation.

Transjugular intrahepatic portasystemic shunt with Viatorr covered stent / 中国介入影像与治疗学

Objective To assess the efficacy and safety of transjugular intrahepatic portasystemic shunt (TIPS) with Viatorr covered stent in patients with portal hypertension-related complications.Methods Clinical data of 8 patients with por-tal hypertension-related complications were analyzed retrospectively.All the cases received TIPS with Viatorr covered stent.After the operation,the followed up was used to evaluate the therapeutic effect of TIPS by enhanced CT scan.Results All the operations of TIPS were technically successful.And all the cases were treated with Viatorr covered stents with diameter of 8 mm and covered segment length of 50-80 mm.For 1 case with cavernous transformation of portal vein,a 8 mm×40 mm E-Luminexx bare stent was implanted in the portal vein side.For 1 case with hepatic vein stenosis,a 8 mm× 40 mm Fluency covered stent was implanted in the hepatic vein side.After the operation,the portal pressure reduced from (33.08 [29.32,40.22])mmHg (preoperative) to (23.31 [21.43,26.51])mmHg (postoperative) with statistical difference (Z=-2.52,P=0.012).The patients were followed up for 1.1-7.7 months,and all the patients were alive without complications of portal hypertension.There were 2 cases with mild hepatic encephalopathy after operation.During the reexamination time of 1-7.7 months,all TIPS shunts remained patency.Conclusion TIPS with Viatorr stent is a safe and effective treatment for patients with portal hypertension-related complications.

Transjugular intrahepatic portasystemic shunt with Viatorr covered stent / 中国介入影像与治疗学

Objective To assess the efficacy and safety of transjugular intrahepatic portasystemic shunt (TIPS) with Viatorr covered stent in patients with portal hypertension-related complications.Methods Clinical data of 8 patients with por-tal hypertension-related complications were analyzed retrospectively.All the cases received TIPS with Viatorr covered stent.After the operation,the followed up was used to evaluate the therapeutic effect of TIPS by enhanced CT scan.Results All the operations of TIPS were technically successful.And all the cases were treated with Viatorr covered stents with diameter of 8 mm and covered segment length of 50-80 mm.For 1 case with cavernous transformation of portal vein,a 8 mm×40 mm E-Luminexx bare stent was implanted in the portal vein side.For 1 case with hepatic vein stenosis,a 8 mm× 40 mm Fluency covered stent was implanted in the hepatic vein side.After the operation,the portal pressure reduced from (33.08 [29.32,40.22])mmHg (preoperative) to (23.31 [21.43,26.51])mmHg (postoperative) with statistical difference (Z=-2.52,P=0.012).The patients were followed up for 1.1-7.7 months,and all the patients were alive without complications of portal hypertension.There were 2 cases with mild hepatic encephalopathy after operation.During the reexamination time of 1-7.7 months,all TIPS shunts remained patency.Conclusion TIPS with Viatorr stent is a safe and effective treatment for patients with portal hypertension-related complications.

Finite element analysis of lumbar disc degeneration with sacroiliac joint disorder by gait simulation / 医用生物力学

Objective To explore the biomechanical mechanisms of correlation between lumbar disc degeneration and sacroiliac joint disorder though investigating the biomechanical characteristics of lumbar disc degeneration with sacroiliac joint disorders.Methods One normal healthy volunteer and two patients with lumbar disc herniation and sacroiliac joint disorders (one was with sacrum disorders and the other was with ilium disorders) were selected.Their CT data were collected to establish three corresponding lumbar-pelvis finite-element models,and their gait data were also simultaneously collected to drive the AnyBody musculoskeletal model.The muscle force around the lumbar and pelvis as well as the hip joint force were acquired as loading condition for finite element analysis.The stress changes in L4 and L5 intervertebral discs and sacroiliac joints of the patients and normal volunteer were compared.Results There was no significant difference in the stress of the two sides of L4,L5 disc and two sacroiliac joints in normal model,with a bimodal stress curve.However,in the models of sacrum disorders and ilium disorders,the bimodal stress curve peaks changed,even disappeared.The peak stress differences in left and right side of L4 disc were 0.55 MPa and 0.80 MPa,respectively,the peak stress differences in left and right side of L5 disc were 4.05 MPa and 2.08 MPa,respectively,and the peak stress differences in left and right side of sacroiliac joints were 0.96 MPa and 3.32 MPa,respectively.Conclusions The lumbar disc degeneration with sacroiliac joint disorder leads to the tilt of the body loading line,and sacroiliac joint disorder can aggravate the imbalances of stress on the body sides.The impact of sacroiliac joint dysfunction cannot be ignored in the treatment of lumbar disc herniation.

Finite element analysis of lumbar disc degeneration with sacroiliac joint disorder by gait simulation / 医用生物力学

Objective To explore the biomechanical mechanisms of correlation between lumbar disc degeneration and sacroiliac joint disorder though investigating the biomechanical characteristics of lumbar disc degeneration with sacroiliac joint disorders.Methods One normal healthy volunteer and two patients with lumbar disc herniation and sacroiliac joint disorders (one was with sacrum disorders and the other was with ilium disorders) were selected.Their CT data were collected to establish three corresponding lumbar-pelvis finite-element models,and their gait data were also simultaneously collected to drive the AnyBody musculoskeletal model.The muscle force around the lumbar and pelvis as well as the hip joint force were acquired as loading condition for finite element analysis.The stress changes in L4 and L5 intervertebral discs and sacroiliac joints of the patients and normal volunteer were compared.Results There was no significant difference in the stress of the two sides of L4,L5 disc and two sacroiliac joints in normal model,with a bimodal stress curve.However,in the models of sacrum disorders and ilium disorders,the bimodal stress curve peaks changed,even disappeared.The peak stress differences in left and right side of L4 disc were 0.55 MPa and 0.80 MPa,respectively,the peak stress differences in left and right side of L5 disc were 4.05 MPa and 2.08 MPa,respectively,and the peak stress differences in left and right side of sacroiliac joints were 0.96 MPa and 3.32 MPa,respectively.Conclusions The lumbar disc degeneration with sacroiliac joint disorder leads to the tilt of the body loading line,and sacroiliac joint disorder can aggravate the imbalances of stress on the body sides.The impact of sacroiliac joint dysfunction cannot be ignored in the treatment of lumbar disc herniation.

Biomechanical analysis of the correlation between sacral tilt displacement and L₅S₁ disc degeneration / 中国骨伤

<p><b>OBJECTIVE</b>To biomechanical analysis of the correlation between sacral tilt displacement and L₅-S₁ disc degeneration.</p><p><b>METHODS</b>From July 2011 to July 2013, 81 patients with lumbar disc herniation and sacroiliac joint disorder including 45 males and 36 females with an average age of (45.39±1.30) years ranging from 18 to 65 years old were selected. The course of the disease ranged from 1 to 144 months with an average of (12.64±2.19) months. All patients were taken lumbar spine lateral X-ray films, the lumbar curvature angle, L₄-L₅ or L₅-S₁ intervertebral gap distance between points, and the lumbosacral angle was measured and correlated analyzed.</p><p><b>RESULTS</b>The lumbar curvature of female patients with L₅S₁DH were significantly larger than male patients [(22.18±8.62)° vs (16.17±4.97)°,<0.05]. Lumbar curvature and lumbosacral angle showed a positive correlation in LDH (=0.48,<0.01,y=7.25+0.38x,<0.01); Male patients with L₄-₅DH were more obvious (=0.55,<0.05, y=5.80+0.43x,<0.01); Female patients with L₅S₁DH were particularly evident(=0.74,<0.01,y=0.91x-5.30,<0.01). The lumbosacral angle and L₄-₅ intervertebral gap was a positive correlation in L₄-₅DH(=0.27,<0.05); While L₅-S₁ intervertebral gap and lumbosacral angle were not correlated(>0.05) in L₅S₁DH.</p><p><b>CONCLUSIONS</b>The sacral tilt displacement and L₅-S₁ disc degeneration were closely related to provide a new understanding philosophy and therapeutic approach for clinical treatment of intractable lumbar L₅S₁DH.</p>

Biomechanical analysis on the correlation between iliac rotation displacement and L(4,5) disc degeneration / 中国骨伤

<p><b>OBJECTIVE</b>To study the biomechanical relationship between iliac rotation displacement and L(4,5) disc degeneration, and to provide clinical evidences for the prevention and treatment of L(4,5) disc degeneration and herniation.</p><p><b>METHODS</b>From March 2012 to February 2014,68 patients with lumbar disc herniation combined with sacroiliac joint disorders were selected. Among them, 42 patients with L(4,5) disc herniation combined with sacroiliac joint disorders included 22 males and 20 females, ranging in age from 19 to 63 years old, with an average of (51.78 +/- 20.18) years old, and the duration of the disease ranged from 1 to 126 months with an average of (11.18 +/- 9.23) months. Twenty-six patients with L5S1 disc herniation combined with sacroiliac joint disorders included 11 males and 15 females, ranging in age from18 to 65 years old with an average of (45.53 +/- 27.23) years old, and the duration of the disease ranged from 0.5 to 103 months with an average of (11.99 +/- 12.56) months. Sixty-eight anteroposterior lumbar radiographs, 68 lateral lumbar radiographs,and 68 pelvic plain films were taken. The degree of lumbar scoliosis, pelvic tilt,and disc thickness were measured. The correlation between pelvic tilt and lumbar scoliosis ,lumbar scoliosis and disc thickness were studied by using linear and regression methods. The hiomechanical analysis was performed.</p><p><b>RESULTS</b>There was a positive correlation between pelvic tilt and lumbar scoliosis in patients with L(4,5) disk herniation (R=0.49, P=0.00). There was a causal relationship and good linear proportional relationship (Y=3.05+1.07X, P=0.00) in the two variables. There was a negative correlation between lumbar scoliosis and intervertebral space in male patients with L (4,5) disk herniation (R = -0.50, P=0.01). There was a causal relationship and good linear proportional relationship in the two variables (Y=13.09-0.27X, P=0.02). But there was a positive correlation between lumbar scoliosis and intervertebral space in male patients with L5S1 disk herniation (R=0.46, P=0.04).</p><p><b>CONCLUSION</b>Iliac rotational displacement are closely related with L(4,5) disc degeneration and herniation in biomechanics. A new concepts and therapeutic approach is provided for clinical treatment of chronic and refractory herniation of L(4,5) disc in patients</p>

Expressions of matrix metalloproteinase-2 and extracellular matrix metalloproteinase inducer in retinoblastoma / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To investigate expressions of matrix metalloproteinase-2 ( MMP-2 ) and extracellular matrix metalloproteinase inducer ( EMMPRlN) in retinoblastoma (Rb) and the relationships between MMP-2, EMMPRlN and tumor development.METHODS:lmmunohistochemical technique was used to detect expressions of MMP-2 and EMMPRlN in 39 cases of paraffin embedded Rb samples. Quantitative analysis of expressions of MMP-2 and EMMPRlN were assessed by measuring the mean gray scale of Rb tissue with LElCA lM50 Color Pathologic Analysis System. The differences of expressions of MMP-2 and EMMPRlN in each clinical and pathological stage were statistically analyzed, and the same step was also undertaken to study the relationship between Rb with MMP-2 positive expression and that with EMMPRlN positive expression.RESULTS:The positive expression rate of MMP-2 was 90% (Gray value: 109. 64 ± 14. 52; 35/39), and that of EMMPRlN was 85% (Gray value:108. 01±13. 60;33/39). The expressions of MMP - 2 and EMMPRlN were significantly higher in tumors of glaucomatous stage (Gray value:108. 21±11. 47 and 107. 56±14. 32) than those in intraocular stage ( Gray value: 121. 13 ± 11. 32 and 119. 34 ± 12. 66; P<0. 01 and P<0. 05). And the same conclusion can be concluded between those in extraocular stage (Gray value: 91. 03 ± 11. 71 and 92. 26 ± 12. 93) with those in glaucomatous stage (P<0. 01 and P<0. 05). The expressions of MMP-2 and EMMPRlN were significantly higher in tumors with optic nerve invasion (Gray value:103. 89±13. 39 and 105. 23±14. 00) than those without optic nerve invasion ( Gray value: 118. 39 ± 15. 11 and 117. 53±16. 13) (P<0. 01 and P<0. 05).CONCLUSlON:The positive expression levels of MMP-2 and EMMPRlN may correlate with tumor infiltration and metastasis.

Epidemiology investigation and biomechanics analyses for the correlation between sacroiliac joint disorder and lumbar intervertebral disc degeneration / 中国骨伤

<p><b>OBJECTIVE</b>To study the correlation between lumber disc degeneration and sacroiliac joint disorder, in order to provides a new understanding concepts and therapeutic approach for the prevention and treatment of chronic intractable low back pain.</p><p><b>METHODS</b>From August 2009 to October 2010,129 cases with lumbar disc herniation were studied with epidemiological methods. Among them, 61 patients with L4, disc herniation included 37 males and 24 females, ranging in aged from 20 to 75 years old, duration of the disease ranged from 1 to 144 months; The other 68 patients with L5S1 disc herniation included 32 males and 36 females,ranging in aged froml8 to 76 years old,duration of the disease ranged from 0.5 to 240 months. The clinical data, symptoms and signs,X-ray characteristics of lumbar spine and pelvis of the patients were investigated by epidemiological. The risk of lumbar disc herniation was calculated with case-control study; independent variables were screened with single factor analysis; the risk factors for lumbar disc herniation were determined with logistic regression analysis, and biomechanics analyses were taken.</p><p><b>RESULTS</b>Among 129 patients with lumbar disc herniation, 88 cases associated with sacroiliac joint disorders, sacroiliac joint disorder was a risk factor of lumbar disc herniation (OR = 4.61, P = 0.00); 47 cases associated with sacroiliac joint disorders in 61 patients with L4,5 disc herniation, iliac crest uneven caused by iliac rotational displacement was a high risk factor of L4,5 disc herniation (OR = 11.27, P = 0.00); 41 cases associated with sacroiliac joint disorders in 68 patients with L5S1 disc herniation, lumbar sacral angle abnormalities caused by sacral tilt shift was a high risk factor L5S1 disc herniation (OR = 2.31, P = 0.03).</p><p><b>CONCLUSION</b>Lumbar disc herniation and sacroiliac joint disorder are two of fallot, the two factors affect each other and there is a causal relationship. They are common exists in low back pain.</p>

X-ray characteristics of sacroiliac joint disorders and its clinical significance / 中国骨伤

<p><b>OBJECTIVE</b>To study the X-ray characteristics of sacroiliac joint disorders and its clinical significance,so as to provide clinical diagnosis basis for Tuina treatment of sacroiliac joint disorder.</p><p><b>METHODS</b>From July 2009 to March 2011,104 patients with sacroiliac joint disorder were reviewed,including 64 males and 40 females,ranging in age from 18 to 81 years, with an average of (45.39 +/- 1.30) years. The duration of the disease ranged from 1 to 144 months,with an average of (12.64 +/- 2.19) months. One hundred and four pelvic plain films and 97 lumbar spine lateral films of the patients with sacroiliac joint disorder were taken. On the lateral X-ray of lumbar,the sacral horizontal angles (lumbosacral angle) were measured; and on the X-ray of pelvis,the vertical distance of two side iliac crest (iliac crest difference), the distance from lateral border to medial margin of two hips (hip width),the clip angle between sacral spin connection and vertical axis were measured,and then the data were analyzed.</p><p><b>RESULTS</b>The mean difference of iliac crest was (10.34+/-0.73) mm; the mean width difference of hip'was (6.73+/-1.01) mm; and the mean difference of the iliac crest was larger than that of mean difference of hip (P<0.01). The occurrence rate of inequal width of hip was higher(P<0.01). The mean abnormal lumbosacral angle was (7.29 +/- 1.86) degrees,and the mean angle of sacral crest tilting to left or right was (3.18 +/- 0.47) degrees; the mean abnormal lumbosacral angle was larger than that of angle of sacral crest tilting to left or right (P<0.01), and the occurrence rate of sacral crest tilting to left or right was higher</p>

Diagnosis and treatment of abdominal compartment syndrome secondary to fulminant acute pancreatitis / 中华肝胆外科杂志

Objective To study the treatment of abdominal compartment syndrome(ACS) secondary to fulminant acute pancreatitis (FAP).Method A retrospective study was conducted from Jan.2009 to Dec.2011 to analyze the therapeutic results of 18 patients with ACS secondary to FAP.Results Three out of 7 patients who received non-operative therapy died (mortality rate 42.9％).Three out of 11 patients treated with early surgery died (mortality rate 27.3％),which was significantly better than those patients treated conservatively.Conclusion A reduction in intra-abdominal pressure improved the function of the viscera in the treatment of ACS secondary to FAP.The decompressive effects of early surgery was efficacious,and it reduced the mortality rate.

Duodenum-preserving pancreatic head resection (DPPHR) in treating patients with benign lesions in the head of the pancreas / 中华普通外科杂志

Objective To evaluate the procedure and the therapeutic efficacy of duodenumpreserving pancreatic head resection (DPPHR) in treating benign lesions in the head of the pancreas.Methods From February 2003 to August 2011,DPPHR was performed in 21 patients with benign lesions in the head of the pancreas.Thirteen patients were male and eight were female.Age ranged from 30 to 48 years,and the lesions ranged from 2.0 cm to 5.6 cm in diameter.Posterior superior pancreaticoduodenal artery was conserved in all patients.Results There was no hospital death.Pancreatic fistula was the main and the most often morbidity,occurring in 33.3％.After operation all patients with preoperative abdominal pain were completely pain free.Preoperative hypoglycemia in 2 patients turned to eugycemia.There was no recurrences report during following up.Concl~ions DPPHR was safe and effective in treating benign lesion in the head of pancreas.It was important in preserving blood supply to the duodenum by posterior superior pancreaticoduodenal artery.