Objective To examine the effects of carbon dioxide (CO2) pneumoperitoneum on local pancreas pathological changes, serum levels of amylase, IL-1, IL-6, and the positive rate of dissolubility adhesion molecule (CD11a/CD18 and CD11b/CD18) expression in rats with severe acute pancreatitis (SAP). Methods Fifty healthy male SpragueDawley (SD) rats were randomly divided into 3 groups: CO2 pneumoperitoneum group (n=20): SAP was induced by injecting 5% sodium taurocholate through retrogradely common biliopancreatic ducts via duodenal papilla， and then CO2 pneumoperitoneum was established at a pressure of 12 mm Hg (1 mm Hg=0.133 kPa) for 30 min; SAP group (n=20): The rats were treated as same as CO2 pneumoperitoneum group, except CO2 pneumoperitoneum； Simple operation group (n=10): Laparotomy was performed and nothing was done to duodenum and pancreas except for moving them softly. The blood samples were collected for examining serum levels of amylase, IL-1, IL-6, and the positive rates of CD11a/CD18 and CD11b/CD18 expression, and histopathologic examination of pancreas was performed. Results Compared with simple operation group, the pancreatic pathologic histology score, serum levels of amylase, IL-1, IL-6, and the positive rates of CD11a/CD18 and CD11b/CD18 expression were significantly higher in CO2 pneumoperitoneum group and SAP group (P=0.000). The levels of IL-1 and IL-6 were significantly lower in CO2 pneumoperitoneum group as compared to SAP group (P=0.000). There was no significant difference between CO2 pneumoperitoneum group and SAP group in pancreatic pathologic histology score (P=0.294), the level of serum amylase (P=0.073), the positive rates of CD11a/CD18 (P=0.155) and CD11b/CD18 expression (P=0.201). Conclusion CO2 pneumoperitoneum has inhibitory effect on the levels of IL-1 and IL-6, rather than the positive rates of CD11a/CD18 and CD11b/CD18 expression in SD rats with SAP.
Objective To investigate the application of Magnetoencephalograph (MEG), Wada test combined with neuronavigation in the surgical treatment of frontal and temporal epilepsy caused by focal cortical dysplasia (FCD ). Methods The epileptogenic focus and IQ, memory and language examination were performed in 34 patients with frontal and temporal epilepsy caused by FCD. MEG and Wada test were conducted to determine the language and memory advantage hemisphere, and to clarify the scope and memory function of language function areas. Operation was guided by the Medtronic stealhealth 7 surgical navigation system (USA) to remove the FCD and protect nerve function. IQ, memory and language examination were measured 1 year after operation, and the difference was observed before and after operation. The postoperative follow-up was 23 ~ 46 months, curative effect of epilepsy was determined according to the international anti-epilepsy union Engel’s standard. Results Thirty-four patients with epilepsy (21 temporal lobe epilepsy and 13 frontal lobe epilepsy) were included in this study. The examination process of MEG and Wada test was smooth. MEG can accurately locate the position of language function area. Twenty-eight patients’ dominant hemisphere of language was on the left and 6 was on the right side. Wada test can evaluate the patient’s memory function. Twenty-three patients’ dominant hemisphere of memory was located on the left, 8 on the right and 3 on the bilateral hemisphere. Compared with the dominant hemisphere and nondominant hemisphere, the memory score was significantly different (P<0.05). Statistics showed that the verbal IQ and total IQ increased (P<0.05)1 year after operation, but there was no significant change in memory IQ and Performance IQ (P>0.05). FCD patients recovered well without language, memory and limb impairment. The curative effect of epilepsy: 15 cases of Engel’sⅠgrade, 14 cases of Engel’sⅡgrade and 5 cases of Engel’s Ⅲ grade. Conclusion MEG, Wada test combined with neuronavigation was of important value in locating and guiding the surgical resection of FCD in patients with refractory frontal and temporal epilepsy, protecting cortical function, avoiding severe postoperative complications, and improving the therapeutic effect of epilepsy.
Objective To summarize the current research progress on the concept, clinical presentation, diagnosis, biomechanical changes, and pathological mechanisms of the medial meniscus posterior root tear (MMPRT), and its clinical correlations with tibial rotation. MethodsThe research literature on MMPRT and its relationship with tibial rotation at home and abroad in recent years was extensively consulted and summarized. Results MMPRT is a specific and common type of medial meniscus injury of the knee joint. The occurrence of posterior medial pumping pain events following low-energy trauma in patients provides important clues for the diagnosis of this injury, with MRI being the preferred imaging modality. The biomechanical effects generated by MMPRT are similar to those caused by total removal of the medial meniscus. And this injury is usually associated with tibial rotation. MMPRT induces pathological external rotation of the tibia, which can be restored by timely medial meniscus posterior root repair. Furthermore, changes in tibial rotation are related to the healing status after medial meniscus posterior root repair. ConclusionMMPRT is closely related to tibial rotation. Understanding the biomechanics, pathological mechanisms, and clinical correlations between the two is of great significance for improving the diagnosis and treatment strategies.
Pneumoconiosis ranks first among the newly-emerged occupational diseases reported annually in China, and imaging diagnosis is still one of the main clinical diagnostic methods. However, manual reading of films requires high level of doctors, and it is difficult to discriminate the staged diagnosis of pneumoconiosis imaging, and due to the influence of uneven distribution of medical resources and other factors, it is easy to lead to misdiagnosis and omission of diagnosis in primary healthcare institutions. Computer-aided diagnosis system can realize rapid screening of pneumoconiosis in order to assist clinicians in identification and diagnosis, and improve diagnostic efficacy. As an important branch of deep learning, convolutional neural network (CNN) is good at dealing with various visual tasks such as image segmentation, image classification, target detection and so on because of its characteristics of local association and weight sharing, and has been widely used in the field of computer-aided diagnosis of pneumoconiosis in recent years. This paper was categorized into three parts according to the main applications of CNNs (VGG, U-Net, ResNet, DenseNet, CheXNet, Inception-V3, and ShuffleNet) in the imaging diagnosis of pneumoconiosis, including CNNs in pneumoconiosis screening diagnosis, CNNs in staging diagnosis of pneumoconiosis, and CNNs in segmentation of pneumoconiosis foci to conduct a literature review. It aims to summarize the methods, advantages and disadvantages, and optimization ideas of CNN applied to the images of pneumoconiosis, and to provide a reference for the research direction of further development of computer-aided diagnosis of pneumoconiosis.
This study aimed to investigate biomechanical properties of synthetic implants for reconstructive surgery of pelvic floor dysfunction. In this dissertation, we chose four synthetic implants, i.e. total pelvic floor repair system (PROLIFT), gynecone TVT obtutator system (TVT-O), intra-vaginal sling placement device (IVS) and acellular dermal matrix (Renov), for tensile test respectively. The biomechanical properties of four synthetic implants were measured and analyzed using a material testing machine (Instron 4302 versatile material testing machine). The biomechanical parameters included ultimate stress strength, modulus of elasticity, maximum load and maximum elongation. The results showed that the maximum load of the four symthetic implants was TVT-O > IVS > PROLIFT > Renov, and the maximum load of TVT-O was significantly higher than PROLIFT and Renov ( P < 0.05). The ultimate stress strength was TVT-O > IVS > PROLIFT > Renov, with no significant differences among them ( P > 0.05). The maximum elongation of the four implants was TVT-O > PROLIFT > IVS > Renov, and the maximum elongation of TVT-O and PROLIFT were both significantly higher than Renov ( P < 0.05). The modulus of elasticity was IVS > Renov > TVT-O > PROLIFT, with no significant differences among them ( P > 0.05). Taken together, the present study demonstrates that the modulus of elasticity of IVS was the highest in the four synthetic implants; TVT-O had the highest mechanical strength; The maximum load, ultimate stress strength and maximum elongation of Renov were all the lowest; The mechanical properties of PROLIFT was the most stable, and its modulus of elasticity was the lowest in the four synthetic implants, which had good extensibility and elasticity. Therefore, it is necessary to pay attention to the biomechanical properties of new pelvic reconstructive materials for the clinical pelvic reconstructive surgery.
ObjectiveTo analyze the effect of mitochondrial ultrastructural changes caused by morphine toxicity on abnormal discharge of cat cerebral cortex, and to explore the possible mechanism of brain function damage caused by morphine dependence.MethodsTwelve domestic cats were divided into control group (3 cats) and morphine exposed group (9 cats) according to the method of random number table. After the model was successfully established by the method of dose increasing, the changes of mitochondrial ultrastructure of cortical neurons were observed under the electron microscope.ResultsElectroencephalogram (EEG) monitoring in morphine exposed group showed that the cortical EEG was widely abnormal, physiological waves were reduced, and abnormal discharges were frequent. And the electron microscopy showed that the number, morphology, internal membrane structure and the inclusion body in the matrix of neurons changed in various aspects. The EEG and electron microscopy of the control group were normal.ConclusionMorphine can damage neurons in the cerebral cortex and lead to abnormal discharge, which is closely related to the ultrastructural changes of neuron mitochondria. The toxicity of morphine mitochondria can be the initial mechanism of energy metabolism dysfunction of brain cells and eventually lead to the disorder of brain electrophysiological function.
Objective To investigate whether different degrees of primary varus knee affect joint function and stability in patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods A clinical data of 160 patients with primary varus knee, who were admitted between January 2020 and December 2021 and met the selection criteria, was retrospectively analyzed. All patients underwent primary ACL reconstruction using autologous single-bundle hamstring tendon. Patients were divided into three groups based on the hip-knee-ankle angle (HKA): group A (64 patients with HKA 0°-3°), group B (55 patients with HKA 3°-6°), and group C (41 patients with HKA 6°-9°). Except for the significant difference in HKA among the three groups (P<0.05), baseline data such as age, gender, affected side, body mass index, interval between injury and operation, Kellgren-Lawrence grading, posterior tibial slope, proportion of combined meniscal injuries, Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) objective score, anterior drawer test, Lachman test, pivot shift test, and the results of KT1000 (side-to-side difference, SSD) showed no significant difference (P>0.05). At last follow-up, joint stability was assessed through the anterior drawer test, Lachman test, pivot shift test, and SSD; joint function was evaluated using the Tegner score, Lysholm score, and IKDC objective score. Results All incisions in the three groups healed by first intention after operation. All patients were followed up 24-31 months, with an average of 26 months; there was no significant difference in the follow-up time among the three groups (Z=0.675, P=0.714). At last follow-up, the knee stability and functional assessment indicators in each group significantly improved when compared to preoperative ones (P<0.05); there was no significant difference among the three groups (P>0.05) in terms of the anterior drawer test, Lachman test, pivot shift test, IKDC objective scores, and the changes of the Lysholm scores and Tegner scores. The Kellgren-Lawrence grading and HKA at last follow-up were consistent with preoperative results in the three groups. ConclusionVarying degrees of primary varus knee do not affect early knee joint stability and functional recovery after ACL reconstruction, and there is no significant difference in effectiveness between different degrees of varus knee.
Objective To summarize the current management of anterior cruciate ligament (ACL) injury in children and adolescents, in order to provide reference for the management of ACL injury in children and adolescents. MethodsThe relevant literature at home and abroad in recent years was extensively accessed to summarize the management status of ACL injury in children and adolescent. Results The number of ACL injury in children and adolescents is increasing every year. The diagnosis of ACL mainly depends on symptoms and signs. Rehabilitation, physeal-sparing techniques, partial transphyseal techniques, all-epiphyseal techniques, and transphyseal techniques are used to treat ACL injury in children and adolescents. Conclusion Dynamic monitoring of knee joint in children and adolescents should be strengthened. The best treatment for ACL injury in children and adolescents is selected according to the patients’ actual age, bone age, Tanner stage, and physiological conditions such as menstruation, body growth speed, and other characteristics.
Objective To investigate the construction of a novel tissue engineered meniscus scaffold based on low temperature deposition three-dimenisonal (3D) printing technology and evaluate its biocompatibility. Methods The fresh pig meniscus was decellularized by improved physicochemical method to obtain decellularized meniscus matrix homogenate. Gross observation, HE staining, and DAPI staining were used to observe the decellularization effect. Toluidine blue staining, safranin O staining, and sirius red staining were used to evaluate the retention of mucopolysaccharide and collagen. Then, the decellularized meniscus matrix bioink was prepared, and the new tissue engineered meniscus scaffold was prepared by low temperature deposition 3D printing technology. Scanning electron microscopy was used to observe the microstructure. After co-culture with adipose-derived stem cells, the cell compatibility of the scaffolds was observed by cell counting kit 8 (CCK-8), and the cell activity and morphology were observed by dead/live cell staining and cytoskeleton staining. The inflammatory cell infiltration and degradation of the scaffolds were evaluated by subcutaneous experiment in rats. Results The decellularized meniscus matrix homogenate appeared as a transparent gel. DAPI and histological staining showed that the immunogenic nucleic acids were effectively removed and the active components of mucopolysaccharide and collagen were remained. The new tissue engineered meniscus scaffolds was constructed by low temperature deposition 3D printing technology and it had macroporous-microporous microstructures under scanning electron microscopy. CCK-8 test showed that the scaffolds had good cell compatibility. Dead/live cell staining showed that the scaffold could effectively maintain cell viability (>90%). Cytoskeleton staining showed that the scaffolds were benefit for cell adhesion and spreading. After 1 week of subcutaneous implantation of the scaffolds in rats, there was a mild inflammatory response, but no significant inflammatory response was observed after 3 weeks, and the scaffolds gradually degraded. Conclusion The novel tissue engineered meniscus scaffold constructed by low temperature deposition 3D printing technology has a graded macroporous-microporous microstructure and good cytocompatibility, which is conducive to cell adhesion and growth, laying the foundation for the in vivo research of tissue engineered meniscus scaffolds in the next step.
ObjectiveTo explore the effectiveness of one-stage posterior medial corner (PMC) repair or reconstruction combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction in treating KD-ⅢM dislocation. Methods The clinical data of 15 patients with knee KD-ⅢM dislocation who met the selection criteria between January 2016 and July 2019 were retrospectively analyzed. There were 9 males and 6 females, aged 22-61 years (mean, 40.3 years). Injuries were caused by violence of flexion, valgus, and external rotation, including 10 cases of traffic accident injuries, 3 cases of crush injuries, 1 case of winch injury, and 1 case of explosion injury. The time from injury to operation ranged from 3 days to 6 months, with an average of 18.5 days. PMC repair combined with PCL+ACL reconstruction was performed in 10 cases in acute stage (within 3 weeks after injury), including 3 cases of irreducible dislocation. PMC+PCL+ACL reconstruction was performed in 5 cases with chronic dislocation. Before operation and at last follow-up, the knee joint function was evaluated by Lysholm score and International Knee Documentation Committee (IKDC) 2000 score. KT-3000 was used to evaluate the forward stability of the knee (calculated the difference of tibial anterior displacement of both knees), the X-ray films of the stress position of the knee joint was used to evaluate the valgus of the knee (calculated the difference of medial joint space width of both knees) and the backward stability (calculated the difference of tibial posterior displacement of both knees), and the internal and external rotation stability was evaluated by knee flexion 30° tibial external rotation and knee flexion 90° tibial internal rotation tests (calculated the difference of tibial internal rotation and the difference of tibial external rotation of both knees). Results The operation time was 120-240 minutes, with an average of 186.5 minutes. Patients were followed up 24-48 months, with an average of 27.4 months. There was no complication such as infection, deep vein thrombosis, vascular injury, or heterotopic ossification. At last follow-up, the Lysholm score, IKDC2000 score, the difference of tibial anterior displacement of both knees, the difference of medial joint space width of both knees, the difference of tibial posterior displacement of both knees, the difference of tibial internal rotation and the difference of tibial external rotation of both knees significantly improved when compared with preoperative ones (P<0.05). According to the IKDC2000 valgus stability grading standard, there were 3 cases of grade C and 12 cases of grade D before operation, and 10 cases of grade A and 5 cases of grade B at last follow-up, which was significantly improved when compared with that before operation (Z=−4.930, P=0.000). At last follow-up, the pivot shift tests of 15 patients were negative. The anterior and posterior drawer tests of 10 patients were negative, 5 patients had mild instability, both the anterior and posterior drawer tests were positive. ConclusionKD-ⅢM dislocation of the knee joint can lead to the posterior medial and anterior instability. Acute dislocation combined with “dimple sign” requires surgical reduction as soon as possible to repair PMC and reconstruct PCL and ACL. In chronic patients, PMC is difficult to repair, it is recommended to reconstruct PMC, PCL, and ACL at one stage to improve knee joint stability. The early and middle effectiveness are satisfactory.