The computer-assisted surgery (CAS) has significantly improved the accuracy, reliability and outcomes of traumatic, spinal, nerve surgery and many other operations with a less invasive way. The application of CAS for scaphoid fractures remains experimental. The related studies are scanty and most of them are cadaver researches. Some intrinsic defects from the registration procedure, scan and immobilization of limbs may inevitably result in deviations. Some deviations become more obvious with operations of small bones (such as scaphoid) although they are acceptable for spine and other orthopedic surgeries. We reviewed the current literatures on the applications of CAS for scaphoid operation and summarized technical principles, scan and registration methods, immobilization of limbs and their outcomes. On the basis of the data, we analyzed the limitations of this technique and envisioned its future development.

Microbial constituents naturally inhabiting the gastrointestinal tract may influence the homeostasis of the gut environment. The presence or overabundance of some bacterial taxa has been reported to be associated with complex diseases, and the metabolites of certain bacteria may contribute to diverse disorders by influencing signaling pathways. Therefore, the study of gut microbial population has emerged as a crucial field and a new potential area of clinical significance. Advances in the methods of microbiota analysis have shed light upon the details including species diversity, microfloral activities as well as the entire gut microbiota. Nevertheless, comprehensive reviews on this subject are still limited. For elucidating the appropriate selection strategy of the methods to address a particular research question, we comprehensively reviewed the continuously improving technologies, classical to newly developed, and dissected their relative advantages and drawbacks. In addition, aiming at the rapidly advancing next-generation sequencing, we enumerated the improvements in mainstream platforms and made the horizontal and vertical comparison among them. Additionally, we demonstrated the four main -omics methods, which may provide further mechanistic insights into the role of microbiota, to propel phylotyping analysis to functional analysis.

A series of factors can be involved in the perioperative period to cause an increase in cancer-related mortality. Unfortunately, volatile anesthesia might aggravate the deleterious effects. In this article, we review the association of diverse volatile anesthetic agents with immune system and cancer cell biology, and examine the effects on angeogenesis and postoperative metastasis or recurrence. Isoflurane, haloflurane and enflurane enhance immunosuppression and upregulate hypoxia-inducible-factor 1 and matrix metalloproteinases, leading to the cancer malignant progression, whereas roles of desflurane and sevoflurane are still unclear. As the effects of volatile anesthetics on tumor immunity have been known, it will be beneficial for using selective drugs into anesthesia and operation in cancer patients.

With an increasing incidence, diabetic retinopathy is one of the most important complications of diabetes mellitus (DM) and is also known as one of the major reasons of adult acquired blindness. It is widely accepted that the visual impairment of diabetic patients results from retinal microvascular changes. However, recent clinical experimental and neuroimaging studies suggest that the visual impairment of diabetic patients is also related to the pathophysiological changes of different parts of the visual pathway in diabetic retinopathy. Therefore, the magnetic resonance imaging (MRI) techniques have been widely used for evaluating the microstructural changes, white matter integrity, metabolite changes, and the whole or partial functional and anatomic changes in the diabetic retinopathy patients’ brains in order to fully understand the mechanism of vision loss of the diabetic retinopathy patients. This review focuses on the research progress in application of MRI of the visual pathway in diabetic retinopathy.

Ilex cornuta (I. cornuta) is a traditional Chinese medicine (TCM) that has been used in clinical practice for hundreds of years. In order to provide more information about the chemical basis of its pharmacological effects, phytochemical investigation on the roots of I. cornuta was conducted in this study. The roots of the plant were firstly extracted with 95% EtOH, and then the crude was partitioned with petroleum ether, EtOAc and n-butyl alcohol. Different chromatographies were employed to isolate the crude step by step and the crude was further purified by semipreparative high performance liquid chromatography (HPLC). As a result, two new triterpenoid saponins (1, 2), together with 12 known compounds (3–14), were isolated from the roots of I. cornuta. Their structures were determined based on nuclear magnetic resonance (NMR), mass spectrum (MS) technologies, chemical reactions as well as gas chromatography (GC). Compounds 4, 6, 8, 11, 12 and 13 were isolated from this genus for the first time. The structures of compounds 1 and 2 were determined as 3β-O-α-D-xylopyranosyl-(1→3)-α-L-2-O-acetylarabinopyranosyl-(1→2)-β-D glucopyranosyl-23-hydroxyl-20α(H)-urs-12-en-28-oic acid 28-O-β-D-glucopyranosyl ester (1) and 3β-O-α-D-xylopyranosly-(1→3)-α-L-2-O-acetylarabinopyranosyl-(1→2)-β-Dglucopyranosyl- 19α,23-dihydroxyl-20α(H)-urs-12-en-28-oic acid 28-O-β-D-glucopyranosyl ester (2).

The precise anatomy of the facial nerve branches innervating rat whisker pad and the distribution of their corresponding motor neurons in facial nucleus area were investigated. The extratemporal facial nerves of 6 rats were anatomically observed under a surgical microscope, and then the nerve specimens of facial nerve branches at 7 anatomical sites were taken and examined for the axons and myelin sheath using Luxol fast blue staining. The distribution of facial motor neurons innervating the facial branches was observed in 12 rats by retrograde labelling. The distal pes, a fusing architecture of the buccal and marginal mandibular branches, was found to furcate into superior, middle and inferior branches to innervate whisker pad. Histologically, the myelin sheath of each branch was morphologically consistent, and the nerve fiber bundles of facial nerve branches became increasingly thinner and scattered, particularly after crossing the distal pes site and innervating the whisker pad. The facial motor neurons innervating the buccal and marginal mandibular branches were clearly distributed in similar regions in facial nucleus. This study confirmed the highly spatial synergy between the buccal and marginal mandibular branches innervating the whisker pad from extratemporal anatomy and distribution of facial motor neurons.

Atrial septal defect (ASD) is a common acyanotic congenital cardiac disorder associated with genetic mutations. The objective of this study was to identify the genetic factors in a Chinese family with ASD patients by a whole exome sequencing approach. Causative ASD gene mutations were examined in 16 members from a three-generation family, among which 6 individuals were diagnosed as having ASD. One hundred and eighty-three unrelated healthy Chinese were recruited as a normal control group. Peripheral venous blood was collected from every subject for genetic analysis. Exome sequencing was performed in the ASD patients. Potential causal mutations were detected in non-ASD family members and normal controls by polymerase chain reaction and sequencing analysis. The results showed that all affected family members carried two novel compound mutations, c.1187delT of PCDHGA4 and c.2557insC of SLFN14, and these two mutations were considered to have synergetic function on ASD. In conclusion, the mutations of c.1187delT of PCDHGA4 and c.2557insC of SLFN14 may be pathogenic factors contributing to the development of ASD.

The aim of the present study was to explore the effects of annexin A1 (ANXA1) mimetic peptide AC2-26 on sepsis-induced cardiomyocyte apoptosis in vivo and in vitro and the underlying mechanisms. In the in vivo study, a rat septic model was established by the cecal ligation and puncture (CLP). The rats were divided into control group, sepsis group and AC2-26 group. The rats in the AC2-26 group were intraperitoneally injected with AC2-26 (1 mg/kg) 2 h before CLP, and those in the control group and sepsis group were injected with the same volume of normal saline. The myocardial tissue was examined by hematoxylin and eosin (HE) staining and transmission electron microscopy (TEM). Furthermore, myocardial apoptosis was measured by terminal dUTP nick end-labeling (TUNEL) assay. In the in vitro study, H9C2 cells were cultured and divided into three groups: control group, in which cells were only given the basic culture medium; LPS group, in which cells were treated with 10 μg/mL LPS; AC2-26 group, in which cells were treated with 0.5 μmol/L AC2-26 2 h before 10 μg/mL LPS was given. The apoptosis of H9C2 cells was detected by flow cytometry. The levels of lipoxin A4 receptor (LXA4), phosphoinositide-3-kinase (PI3K) and protein kinase B (PKB or AKT) protein were measured by Western blotting, the activity of NF-κB and the level of TNF-α by ELISA and the activities of caspase-3/8 by using the caspase activity kits. The in vivo study showed that the myocardial pathological damage and myocardial ultrastructural damage were significantly alleviated and the myocardial apoptosis significantly decreased in the AC2-26 group as compared with the sepsis group (P<0.05 for all). The in vivo study revealed that the apoptosis of H9C2 cells was profoundly ameliorated in the AC2-26 group relative to the sepsis group (P<0.05). The protein expression levels of LXA4 were significantly up-regulated, and those of PI3K and AKT prominently down-regulated in the AC2-26 group when compared with those in the LPS group (P<0.05 for all). The activity of NF-κB was greatly inhibited and the level of TNF-α markedly decreased in the AC2-26 group as compared with those in the LPS group (P<0.05 for all). AC2-26 treatment also significantly suppressed the activities of caspase-3/8 in H9C2 cells. In conclusion, these findings suggest that AC2-26 may alleviate the sepsis-induced cardiomyocyte apoptosis in vivo and in vivo through the LXA4/PI3K/AKT signaling pathway.

Dasatinib is a second-generation tyrosine kinase inhibitor (TKI) and it could be used as a second-line treatment for patients with chronic myeloid leukemia (CML). Yinishu, a generic dasatinib made in China, was approved by the China Food and Drug Administration in 2013 and it costs much less than the patented dasatinib SPRYCEL. The present study aimed to examine the efficacy and safety of Yinishu as a second-line treatment for CML by comparing the baseline clinical characteristics, rates of adverse events and efficacy between Yinishu and SPRYCEL groups. The results showed that there were no significant differences in the rates of optimal response between Yinishu and SPRYCEL for patients who started second-line treatment because of treatment failure. For patients who started second-line treatment because of intolerance of first-line treatment, their levels of BCR-ABL1/ABL1 on the international scale (BCR-ABL^IS) was maintained very low throughout the course of Yinishu treatment. Drug-related adverse events occurred with the same frequency in these two groups. It was confirmed that Yinishu was effective and safe as a secondline treatment for CML patients. Yinishu may be more suitable for patients who are economically unable to pay for the patented dasatinib SPRYCEL.

The G2019S mutation of the leucine-rich repeat kinase 2 (LRRK2) is the most common genetic cause of Parkinson’s disease (PD). However, the molecular mechanisms of LRRK2 mutation contributing to the onset and progression of PD have not been fully illustrated. We generated HEK293 cells stably transfected with α-synuclein and investigated the effect of LRRK2 G2019S mutation on the degradation of α-synuclein. The lysosomal activity was assessed by the protein degradation of glyceraldehyde-3-phosphate dehydrogenase and ribonuclease A. It was found that α-synuclein was mainly degraded in lysosomes. LRRK2 G2019S inhibited the degradation of α-synuclein, and promoted its aggregation. LRRK2 G2019S also decreased the activities of lysosomal enzymes including cathepsin B and cathepsin L. Furthermore, the inhibitory effect of LRRK2 G2019S on lysosomal functions did not depend on its kinase activity. These findings indicated that the inhibitory effect of LRRK2 G2019S on α-synuclein degradation could underlie the pathogenesis of aberrant α-synuclein aggregation in PD with LRRK2 mutation.

Epirubicin, which is a conventional chemotherapeutic drug for gastric cancer, has innate and adaptive chemoresistance. Recent studies revealed that epirubicin could induce autophagy as a defensive mechanism in drug resistance of mammary carcinoma. Another study implied that DJ-1 may be a chemoresistance-related gene. But the association between DJ-1 and drug resistance of epirubicin in gastric cancer is still ambiguous. In the present report, we explored whether and how DJ-1 conduced to epirubicin-induced apoptosis in gastric cancer. Epirubicin dose-dependently increased the expression of DJ-1 and induced autophagy. Knockdown of DJ-1 notably enhanced epirubicin-induced cell apoptosis, whereas overexpression of DJ-1 attenuated epirubicin-induced cell apoptosis. Further studies revealed that down-regulation of DJ-1 modulated epirubicinactivated autophagy which augmented epirubicin-induced apoptosis. In conclusion, our results validated that DJ-1 reduced epirubicin-induced apoptosis in gastric cancer cells via modulating epirubicin-activated autophagy.

The present study aimed to establish a list of parameters indicative of pathogen invasion and develop a predictive model to distinguish the etiologies of fever of unknown origin (FUO) into infectious and non-infectious causes. From January 2014 to September 2017, 431 patients with FUO were prospectively enrolled in the study population. This study established a list of 26 variables from the following 4 aspects: host factors, epidemiological factors, behavioral factors, and iatrogenic factors. Predefined predicted variables were included in a multivariate logistic regression analysis to develop a predictive model. The predictive model and the corresponding scoring system were developed using data from the confirmed diagnoses and 9 variables were eventually identified. These factors were incorporated into the predictive model. This model discriminated between infectious and non-infectious causes of FUO with an AUC of 0.72, sensitivity of 0.71, and specificity of 0.63. The predictive model and corresponding scoring system based on factors concerning pathogen invasion appear to be reliable screening tools to discriminate between infectious and non-infectious causes of FUO.

The risk factors associated with strangulated ovarian hernia (SOH) in female patients (<1 year old) were identified. A retrospective analysis was conducted regarding the data from 2006 to 2017. The patients were divided into 2 groups: SOH group (n=9) and non-SOH group (n=23). Patient demographics, clinical signs, preoperative examinations and intraoperative findings were compared between the two groups, and risk factors for SOH were tested using a binary logistic regression model. To explore whether greater ovary was more likely to be twisted, leading to SOH, all the patients were divided into ovary volume <5 cm³ and ≥5 cm³ groups and the association between ovarian volume and ovary torsion was assessed. Among a total of 32 female patients (<1 year old) with incarcerated ovarian herniation, 9 patients developed SOH. The single variate analysis revealed that times of manual reduction, ovarian volume, ovary with or without multiple cysts, ovary torsion or not and angle of ovary torsion were found to be significant factors associated with SOH. The multivariate analysis showed ovarian volume was evidenced as an independent risk factor for SOH. Furthermore, the incidence of ovary torsion was significantly higher in ovarian volume ≥5 cm³ group than in ovarian volume <5 cm³ group, indicating that larger ovary was more likely to result in ovary torsion, leading to SOH. Our study demonstrated that the odds of SOH increased with increasing ovarian volume in female patients (<1 year old) because the relatively greater ovary at this age was more likely to be incarcerated and twisted, leading to SOH.

Marjolin’s ulcer (MU) is a rare but aggressive epidermoid carcinoma observed in scars or wounds. This article provides comprehensive characteristics and prognostic details of MU. Clinical data of 40 patients with MU between January 2010 and December 2017 were analyzed retrospectively. Squamous cell carcinoma was the most common pathological type (35/40, 87.5%). Extended resection was performed to treat all cases with skin grafting or flap grafting. Follow-up duration ranged from 6 to 96 months (median, 52 months) and recurrence was noted in 9 cases. The 1-, 3- and 5-year recurrence-free survival (RFS) rates were 87.2%, 87.2%, 83.2% respectively and the recurrence rate was 22.5%. Univariate analysis revealed that cause of scars (P=0.044), lesion appearance (P=0.036), ultraviolet radiation exposure (P=0.000), depth (P=0.001) and histological grade (P=0.027) had a statistically significant correlation with prognosis of MU. Multivariate analysis revealed that depth (P=0.034, RR=2.681, 95%CI: 1.077–6.674) and histological grade (P=0.008, RR=2.820, 95%CI: 1.315–6.050) were independent prognostic factors for RFS. In conclusion, superficial infiltration and high-grade differentiation predict more favorable prognosis. Careful follow-up of high-risk groups is strongly recommended to prevent recurrence and improve prognosis.

The effects of essential oil from Carpesium abrotanoides L. (CAEO) on the proliferation and apoptosis of human hepatic cancer cells were investigated in this study. MTT assays indicated that CAEO inhibited the proliferation of HCC cells with the IC₅₀ values ranging from 41.28±3.06 to 130.36±20.79 μg/mL. Moreover, many obviously nuclear morphological changes of apoptotic cells in CAEO-treated HepG2 cells were detected by Hoechst 33258 staining and fluorescence microscopy. Flow cytometry was used to detect cell apoptosis and cell cycle, and noticeable findings showed that CAEO arrested cell-cycle at S and G2/M phases. The decreased Bcl-2/Bax protein ratio and the activation of caspase-3, caspase-9 were also detected by Western blotting. All results suggested that CAEO is a potential agent to fight against liver cancer, and the mitochondria-mediated intrinsic apoptotic pathway could be involved in CAEO-mediated apoptosis of human liver carcinoma cells.

Hepatoid adenocarcinoma of the stomach (HAS) is an extremely rare and unique gastric malignancy. The present study aimed to examine the relevance of the clinicopathological characteristics of HAS with patient prognosis. We retrospectively reviewed clinical data of 34 HAS patients treated at our institution between January 2010 and December 2016, as well as 294 cases reported prior to 2017 in research databases. Among these patients, 45.6% (115/252) had lesions in the gastric antrum and 77.0% (235/305) were male. Elevated levels of serum alpha-fetoprotein (AFP) were detected in most patients (75/93, 80.6%). Vascular invasion (199/286, 69.6%), lymph node metastasis (222/283, 78.4%), and preoperative distant metastasis (121/328, 36.9%) were commonly observed. The 5-year disease-free survival (DFS) and disease-specific survival (DSS) were 20.7% and 29.2%, respectively. DFS and DSS of patients receiving neoadjuvant therapy were significantly higher than those of patients receiving postoperative adjuvant therapy [DFS: P<0.001, hazard ratio (HR)=–1.831, 95% confidence interval (CI): 0.060–0.429; DSS: P<0.001, HR=–2.185, 95% CI: 0.032–0.401]. In conclusion, HAS exhibits distinct clinicopathological characteristics and a strikingly worse prognosis when compared with common gastric cancer. Complete surgery, early pTNM stage, and adjuvant therapy may predict a more favorable prognosis. Neoadjuvant therapy is strongly recommended for patients with lymph node metastasis or/and preoperative distant metastasis.

This study compared the therapeutic effect of first-line epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) with that of EGFR-TKI plus whole brain radiotherapy (WBRT) on patients with EGFR mutation-positive lung adenocarcinoma and brain metastases. A total of 139 patients with lung adenocarcinoma and brain metastases treated with first-line EGFRTKI therapy from September 2008 to December 2017 were enrolled in this study. The study endpoints were intracranial time to progression (TTP) and overall survival (OS). The effects of clinical pathological parameters and EGFR gene status on the study endpoints were compared. The results showed that the intracranial TTP was significantly longer in EGFR-TKI plus WBRT group than in EGFR-TKI group (median 30.0 vs.18.2 months, χ2=10.824, P=0.001), but no significant difference in the OS was noted between the two groups (median 48.0 vs. 41.1 months, χ2=0.012, P=0.912). Also, there was no statistically significant difference in the OS between patients treated with early and late radiotherapy (P=0.849) and between those with asymptomatic and those with symptomatic intracranial metastases (P=0.189). The OS and intracranial TTP of patients with intracranial oligometastases (≤3 metastatic sites) were not significantly different from those of patients with multiple intracranial metastases (P=0.104 and P=0.357, respectively), and exon 19 and exon 21 mutations didn’t show significant effects on the OS and intracranial TTP of patients (P=0.418 and P=0.386, respectively). In conclusion, there was no statistically significant difference in the OS between the EGFR-TKI alone group and EGFR-TKI plus WBRT group. However, simultaneous use of WBRT was found to significantly prolong intracranial TTP and improve cerebral symptoms, and thus EGFR-TKI and WBRT combined may be clinically beneficial for patients with EGFR mutation-positive lung adenocarcinoma and brain metastases.

Liver transplantation (LT) is most effective and promising approach for end-stage liver disease. However, there remains room for further improvement and innovation, for example, to reduce ischemic reperfusion injury, transplant rejection and immune tolerance. A good animal model of LT is essential for such innovation in transplant research. Although rat LT model has been used since the last century, it has never been an ideal model because the results observed in rat may not be applied to human because these two species are genetically distinct from each other. In this study, we for the first time performed LT using the tree shrew (Tupaia belangeri), a species in the Order Scandentia which is closely related with primates, and evaluated the possibility to adopt this species as a new model of LT. We performed LT on 30 animals using the two-cuff technique, examining the success rate, the survival rate and the immunological reaction. The recipient operation time was 60 min averagely, and we limited the time of the anhepatic phase within 20 min. Twenty-seven (90%) of the animals survived for at least 3 days after the transplantation. Thirteen animals that did not receive any immunosuppressive drug died in 8 days mostly because of acute rejection effect (n=9), similar to the reaction in human but not in experimental rat. The rest 14 animals that were given rapamycin survived significantly longer (38 days) and half of them survived for 60 days until the end of the study. Our results suggest that performing LT in tree shrews can yield high success rate and high survival rate. More importantly, the tree shrews share similar immunological reaction with human. In addition, previous genomics study found that the tree shrews share more proteins with human. In sum, the tree shrews may outperform the experimental rats and could be used as a better and cost-effective animal model for LT.

The purpose of this study was to analyze the components of inpatient costs for coronary artery bypass graft (CABG) according to preoperative risk stratification and to provide evidence for improvement of diagnosis-related groups (DRGs) payment. All patients (n=458) receiving an isolated CABG between January 2014 and December 2016 in a tertiary referral center, in southwest China, were analyzed. Hospital mortality was predicted by the EuroSCORE II for each patient. The patients were subdivided into two groups according to the observed mortality (1.97%, 9/458): a high-risk group (group H, predicted mortality ≥1.97%) and a low-risk group (group L, predicted mortality <1.97%). Clinical outcomes, resource use, in-hospital direct costs, and reimbursement expenses were compared between the two groups. Significant differences existed between group L and group H in postoperative mortality (0.4% vs. 3.4%; P=0.02), postoperative complications (10.6% vs. 45.7%; P<0.001), postoperative length of hospital stay (17.5±4.9 days vs. 18.8±6.5 days, P=0.01), in-hospital costs ($20 256±3096 vs. $23 334±6332; P<0.001), and reimbursement expenses ($7775±2627 vs. $9639±3917; P<0.001). In general, a higher EuroSCORE II was significantly associated with a worse clinical outcome and increased costs. The CABG cost data provide evidence for improvement of DRGs payment.

Post-translational modifications of cellular proteins with ubiquitin or ubiquitin-like proteins regulate many cellular processes, such as cell proliferation, differentiation, apoptosis, signal transduction, intercellular immune recognition, inflammatory response, stress response, and DNA repair. Nice4/UBAP2L is an important member in the family of ubiquitin-like proteins, and its biological function remains unknown. This study aimed to investigate the effect of UBAP2L on spinal cord injury (SCI). At first, rat bone marrow mesenchymal stem cells (BMSCs) were infected with adeno-associated virus to induce over-expression of Nice4. Subsequently, the infected BMSCs were transplanted into rats suffering from semi-sectioned SCI. The results showed that the over-expression of Nice4 significantly promoted the proliferation and differentiation of BMSCs. In addition, the transplantation of infected BMSCs into the injured area of SCI rats improved the function repair of SCI. Importantly, the immunohistochemical and hematoxylin-eosin staining and RT-PCR results showed that the number of neuronal cells, oligodendrocytes, and astrocytes was significantly increased in the injured area, along with significantly upregulated expression of cyclin D1 and p38 mitogen-activated protein kinase (MAPK). Meanwhile, the expression of caspase 3 protein was significantly down-regulated. In conclusion, the over-expression of Nice4 gene can promote the functional recovery in SCI rats by promoting cell proliferation and inhibiting apoptosis. The results of this study indicate an alternative option for the clinical treatment of SCI.

This study is aimed to explore the clinical application of the guiding template designed by three-dimensional printing data for the insertion of sacroiliac screws. A retrospective study of 7 cases (from July 2016 to December 2016), in which the guiding template printed by the threedimensional printing technique was used for the insertion of sacroiliac screws of patients with posterior ring injuries of pelvis, was performed. Totally, 4 males and 3 females were included in template group, aged from 38 to 65 years old (mean 50.86±8.90). Of them, 5 had sacral fractures (3 with Denis type I and 2 with type II) and 2 the separation of sacroiliac joint. Guiding templates were firstly made by the three-dimensional printing technique based on the pre-operative CT data. Surgical operations for the stabilization of pelvic ring by applying the guiding templates were carried out. A group of 8 patients with sacroiliac injuries treated by percutaneous sacroiliac screws were analyzed as a control group retrospectively. The time of each screw insertion, volume of intra-operative blood loss, and the exposure to X ray were analyzed and the Matta’s radiological criteria were used to evaluate the reduction quality. The Majeed score was used to evaluate postoperative living quality. The visual analogue scale (VAS) was applied at different time points to judge pain relief of coccydynia. All the 7 patients in the template group were closely followed up radiographically and clinically for 14 to 20 months, mean (16.57±2.44) months. Totally 9 sacroiliac screws for the S1 and S2 vertebra were inserted in the 7 patients. The time length for each screw insertion ranged from 450 to 870 s, mean (690.56±135.68) s, and the number of times of exposure to X ray were 4 to 8, mean (5.78±1.20). The intra-operative blood loss ranged from 45 to 120 mL, mean (75±23.32) mL. According to Matta’s radiology criteria, the fracture and dislocation reduction were excellent in 6 cases and good in 1. The pre-operative VAS score ranged from 5.2 to 8.1, mean (7.13±1.00). The average one-week/six-month post-operative VAS was (5.33±0.78) and (1.33±0.66), respectively (P<0.05 when compared with pre-operative VAS). The 12-month postoperative Majeed score ranged from 86 to 92, mean (90.29±2.21). The three-dimensional printed guiding template for sacroiliac screw insertion, which could significantly shorten the operation time, provide a satisfied outcome of the stabilization of the pelvic ring, and protect doctors and patients from X-ray exposure, might be a practical and valuable new clinical technique.

Biodistribution and toxicity assessment are critical for safe clinical use of newly developed medicines. Superparamagnetic iron oxide nanoparticles (SPION) are effective carriers for targeted drug delivery. This study aimed to examine the toxicity and biodistribution of SPION coated with polyethylenimine (PEI) (SPION-PEI) designed for small interfering RNA (siRNA) delivery both in vitro and in vivo. SPION-PEI/siRNA complexes were prepared at different weight ratios. Cytotoxic effects of SPION-PEI/siRNA on HSC-T6 cell viability were determined by using 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT). Rats were divided into three groups: a control group, a normal-saline group and a SPION-PEI/siRNA group. After a single intravenous injection, in vivo nanoparticle biodistribution and accumulation were evaluated by Prussian blue staining in the heart, liver, spleen, lung and kidney 8 h, 24 h, and 7 days after the injection. Their distribution was histologically studied at the three time points by measuring ironpositive areas (μm²) in organ sections stained with Prussian blue. The same organs were analyzed by H&E staining for any possible histopathological changes. Furthermore, biochemical indexes such as alanine amino transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen (BUN) and creatinine (CREA) were also assessed at all experimental time points. Electrophoresis exhibited that the SPION-PEI could retard siRNA altogether at weight ratios above 4. MTT assay showed that SPION-PEI loaded with siRNA had low cytotoxicity. In vivo study revealed that the liver and spleen were the major sites of SPION-PEI/siRNA deposition. The iron content was significantly increased in the liver and spleen, peaking 24 h after intravenous injection and then declining gradually. No evidence was found of irreversible histopathological damage to any of the organs tested. These results suggested that most SPION-PEI/siRNA complexes were distributed in the liver and spleen, which might be the target organs of SPION-PEI/siRNA complexes. SPIONPEI/siRNA may serve as in vivo carrier for biomedical medicines.

Qingkailing (QKL) is a modern preparation exploited according to the traditional Chinese medicine theory. It becomes the second leading cause of adverse drug events (ADEs) in all traditional Chinese medicine injections. The safety evaluation and rational use of QKL are of special importance. This retrospective study used data from Adverse Drug Reaction Monitoring Center of Hubei Province in China from January 2012 to December 2014. ADE cases induced by QKL were collected and analyzed according to patients’ demographics, characteristics of drugs involved, characteristics of ADEs, causality, and outcomes. A total of 1330 qualified ADEs were included. Most ADEs occurred within 30 min after administration and the 0–10 years old age group had the highest number of ADEs. The common ADEs included anaphylactic reaction, dyspnea and nausea. Serious reactions accounted for 5.19%. Combination with cephalosporin (74/146, 50.69%) caused more ADEs than other drugs did. Serious attention should be paid when QKL is used for children, and combination with cephalosporin should be avoided.

This study aimed to evaluate the clinical efficacy of acupuncture for intervening insulin resistance (IR) by meta-analysis of related randomized controlled trials (RCTs). Studies published prior to 31 January 2018 were searched on Pubmed, Medline, Cochrane Library, Embase databases and Chinese databases. Only RCTs, which examined acupuncture as the sole or adjunctive treatment for IR-related diseases, were included. The primary outcome was homeostasis model assessment for insulin resistance (HOMA-IR). The secondary outcomes consisted of fasting blood glucose (FBG), fasting insulin (FINS) and 2-h postprandial blood glucose (2h-PBG). The differences between groups were reported as mean differences (MD). All statistical analyses were performed using RevMan software 5.3. After carefully screening relevant studies, 9 RCTs involving 562 patients (279 in experimental group and 283 in control group) were enrolled in this study. The pooled results showed that acupuncture had significant effects on HOMA-IR (MD 0.70, 95% CI 0.04 to 1.35, P=0.04<0.05), FINS (MD 3.35 mU/L, 95% CI 1.99 to 4.7, P<0.001) and 2h-PBG (MD 1.03 mmol/L, 95% CI 0.25 to 1.82, P=0.01). However, the differences in FBG were not significant (MD 0.28 mmol/L, 95% CI–0.28 to 0.84, P=0.32>0.05). The present meta-analysis indicated that acupuncture can help to improve IR to a certain extent, which remains to be confirmed by further high-quality RCTs.