Volume 100 ·  Issue 01 ·  2020

The field of medical science and technology is an innovation highland where knowledge, technology, talents and capital investment are very concentrated. Breakthroughs in this field often bring revolutionary impacts on human health and economic and social development. This paper analyzes the challenges faced by the development of medical science and technology innovation in China, summarizes the key elements of medical innovation and development, and puts forward some thoughts and suggestions on basic research and independent innovation and development in the field of medical science and technology in China.

The vigorous development of anesthesiology in China has ensured the health and well-being of the people and improved the overall development level of medical institutions. Anesthesia is the basic guarantee for the benign development of multi-discipline in hospitals, but nowadays the development of multi-discipline puts forward more rigid demand for anesthesia. The government's high attention has brought the greatest help to the development of anesthesia discipline, and the development of anesthesia discipline in China will usher in huge opportunities and opportunities. In the aspect of anesthesia resources sinking and perioperative medicine, the future development path of anesthesia discipline has a new position.

At present, as the main force in the prevention and treatment of chronic pain diseases, the pain department gradually plays an important role in the clinical prevention and treatment of chronic pain diseases, and stands at the front line of protecting people's health. Under the background of rapid changes in science and technology, pain department must lay a solid foundation, develop and grow, seize the opportunity and meet the challenge. The further consolidation of the construction of pain discipline, the continuous improvement of the knowledge system of discipline, the sustainable development of talent training, the close combination of basic pain research and clinical practice, and the strengthening of the integration with the international frontier of pain medicine will vigorously promote the healthy development of pain discipline. Looking forward to the future, the development prospect of pain discipline in China is promising.

At present, there is no definite and effective treatment for Alzheimer's disease. Patients diagnosed with Alzheimer's disease should start high-dose cholinesterase inhibitor therapy as soon as possible. Leese's transparent transdermal patch can be used as an option for the treatment of Alzheimer's disease because of its advantages of stable drug absorption, few adverse reactions and convenient use, which is easy to reach early high doses.

Diseases related to bone metabolism abnormalities such as osteoporosis, osteoarthritis and tumor bone metastasis, often accompanied by acute and chronic pain, seriously affect the quality of life of patients^[1,2]。 With the improvement of medical and health level and the prolongation of the average life expectancy of the population in China, the social problems and economic burden related to this kind of chronic pain disease pose new and severe challenges to the public health system in China.

To compare and analyze the correlations between thumb ossification composite index (TOCI), Risser sign and digital skeletal age (DSA) scores and to verify the possibility of TOCI as a supplementary to Risser sign in the evaluation of growth potential of adolescent idiopathic scoliosis (AIS) patients.

Forty-nine AIS patients undergoing bracing treatment between May 2006 and May 2014 were selected from Nanjing Drum Tower Hospital. The follow-up interval was 4-6 months. The following data at each visit were routinely collected, including TOCI and DSA scores, as well as chronologic age and standing height. The height velocity (HV) at each visit was calculated based on the above data. All results were analyzed by Spearman correlation with TOCI and Risser sign.

There were strong correlations between TOCI and Risser sign and DSA scores (r=0.962, 0.813, both P<0.01). In AIS patients whose Risser sign were 0-1, the correlation between TOCI and DSA scores was more pronounced, compared with the correlation between Risser sign and DSA scores (0.918 vs 0.792, P<0.01). The HV averaged (7.1±2.1) cm/year in TOCI 5, significantly larger than these in other TOCI scores (all P<0.01).

The TOCI 5 can be a sign of high height velocity and high growth potential in AIS patients. TOCI is a valid indicator of skeletal maturity evaluation and can be used as a helpful supplementary to Risser sign, whose predictive ability may be better than Risser sign.

To investigate the impact of heterotopic ossification (HO) after cervical disc replacement (CDR) on clinical outcome and radiological outcome of adjacent segment.

The data of patients underwent single-level Prestige-LP CDR between January 2008 and March 2014 in West China Hospital with a minimum 36 months of follow-up were retrospectively analyzed in this study. The incidence of HO, whether it affected clinical outcome, and its impact on adjacent segment intervertebral disc height (IDH), range of motion (ROM) and adjacent segment degeneration were observed. The data were compared with independent sample t test between the two groups.

Ninety-two patients were included in this study, including 48 males and 44 females, the mean age was (44±8) years, and the mean follow-up was (62±23) months. At the final follow-up, 34 patients developed HO after CDR, but the incidence of Grade 4 HO was 7.6%. In both of the HO and non-HO groups, clinical outcomes at the final follow-up were all significantly improved when compared to those before the operation. And there was no significant differences in any clinical indexes between the HO and non-HO groups. The adjacent segment IDH before operation and at the final follow-up in the HO group and non-HO group were similar(t=0.596, 0.825 and t=0.877, 0.644, all P>0.05). The preoperative adjacent segment ROM of HO group was similar with that in non-HO group(t=0.056, 0.709, both P>0.05), but the adjacent segment ROM in HO group was higher than that in the non-HO group at the final follow-up (upper adjacent segment: 10.0°±2.0° vs 9.0°±1.3°; lower adjacent segment: 10.2°±1.9° vs 8.8°±1.3°, t=2.824, 4.022, both P<0.05). The incidence of adjacent segment degeneration of HO group was higher than that of non-HO group at the final follow-up(41.2% vs 19.0%, χ ²=5.343, P<0.05).

HO is a common phenomenon in the long-term follow-up after the CDR operation with Prestige LP prosthesis, but HO does not affect the improvement of clinical outcome. HO after CDR might be one of important risk factors accelerating adjacent segment degeneration.

To investigate the correlation between social support, resilience, self-esteem and post-traumatic stress disorder (PTSD) in intensive care unit (ICU) nurses.

A total of 717 ICU nurses from 24 provinces conducted these questionnaires (Chinese version of Impact of Event Scale-Revised(IES-R), Social Support Rate Score(SSRS), Cannor-Davidson Resilience(CD-RISC) and Self-Esteem Scale(SES)). There were 101 males and 616 females, with an average age of (30±5) years. With the aim to investigate PTSD impact factors, the ICU nurses were divided into the PTSD positive group (IES-R>35) and PTSD negative group (IES-R<35). The correlation between IES-R and other scales were analyzed with linear regression analysis.

In this investigation, 414 nurses were screened with PTSD and 303 nurses without. IES-R score was negatively correlated with SSRS, CD-RISC and SES (r=-0.275, -0.202, -0.709, all P<0.05). Multivariate regression analysis showed that ICU clinical experience was an independent risk factor for PTSD, and SES Score, SSRS Score and physical health status were protective factors. SES partially mediated the association of SSRS with IES-R, and the mediating effect were 51.5%. The area under characteristic curve (ROC) showed that SSRS score, CD-RISC score, SES score and PTSD risk score Logit (P) for prediction of PTSD was 0.629, 0.604, 0.831 and 0.848, respectively.

Social support, physical health and self-esteem are protective factors of PTSD, while ICU clinical experience is a risk factor. SES partially mediated the association of SSRS with IES-R.

To evaluate the effect of dexmedetomidine on lung injury and CCAAT/enhancer-binding protein homologous protein (CHOP) expression in elderly patients with lung cancer undergoing thoracoscopic lobectomy.

A total of 120 elderly patients with lung cancer who underwent elective thoracoscopic lobectomy were selected from the Second Affiliated Hospital of Zhengzhou University from October 2018 to March 2019. The random phenotype was divided into dexmedetomidine group (group D, n=60) and control group (group C, n=60). The elapsed time before postoperative awake and spontaneous breathing recovery and agitation occurrence were recorded. The mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SPO₂), oxygen partial pressure (PaO₂), alveolar-arterial oxygen partial pressure difference[P(A-a)O₂], end-tidal carbon dioxide partial pressure (P_ETCO₂), and airway pressure peak (P_peak) were recorded before the anesthetic induction (T₀), immediately after tracheal intubation (T₁), immediately after unilateral pulmonary ventilation(T₂), 1 hour after unilateral pulmonary ventilation (T₃), immediately after bilateral pulmonary ventilation (T₄), and at the end of surgery(T₅). The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-8, IL-10, super oxide dismutase (SOD) and malondialdehyde (MDA)were compared at the time of T₀, T₁, T₂, T₃, T₄ and T₅ in two groups. The ratios of alveolar damage (IQA), apoptotic index (AI), and the expression of CHOP mRNA and their protein in lung tissue were detected.

The recovery time of conscious and spontaneous breathing in group D were significantly shorter than that in group C (P<0.05). The MAP and HR of the two groups at T₁-T₅ were significantly lower than those at T₀(P<0.05).The levels of P_peak in group C at T₃-T₅ was significantly higher than those in group D (P<0.05). The SpO₂ values in the group D at T₁-T₅ were significantly higher than those in group C (P<0.05). The P(A-a)O₂ values in the group D at T₁-T₅ was significantly lower than those in group C (P<0.05).The levels of IL-6, IL-8 and MDA in group D at T₁-T₅ were significantly lower than those in group C(P<0.05). The levels of IL-10 and SOD in group D at T₁-T₅ were significantly higher than those in group C (P<0.05). The values of IQA, AI, and the expression of CHOP mRNA and their protein in the two groups at T₄ were significantly higher than those at T₂ (P<0.05). The values of IQA, AI, and the expression of CHOP mRNA and their protein in group D at T₄ were significantly lower than those in group C (P<0.05).

Dexmedetomidine could attenuate the extent of lung injury in elderly patients with lung cancer undergoing thoracoscopic lobectomy. The pulmonary protective mechanism could be related to the inhibition of inflammatory factors in dexmedetomidine, improving oxidative stress and reducing Chop-mediated apoptosis of lung tissue by the protein.

To evaluate clinical value of suspicious calcification in the diagnosis and surgical treatment of breast lesions using contrast-enhanced spectral mammography.

Ninty-four patients who underwent CESM with suspicious calcification on the low-energy(LE) images in Third Affiliated Hospital of Soochow University from April 2017 to April 2019 were collected.All patients were female, with an average age of 51 years (26 to 89 years).All patients underwent biopsy or surgery to obtain pathological results. Two experienced radiologists provide BI-RADS classification for LE images and CESM. To assess pairwise agreement between BI-RADS classification on CESM and LE images among readers, kappa test were calculated. Using pathology results as the gold standard,the diagnostic efficacy of LE images and CESM were analyzed by receiver operating characteristic (ROC)curve, and Z test was used to compare the areas under the ROC curves (AUC) among them, calculated the sensitivity, specificity. The intraclass correlation coefficient (ICC) was used to analyze the consistency of the maximum image diameter and pathological diameter of malignant lesions. Two experienced radiologists provided the preferred surgical treatment (breast conservation therapy versus mastectomy) for all malignant cases according the imaging findings. McNemars test was used to compare the difference between surgical decision making and final surgical procedure.

One hundred and three lesions were found in 94 patients, in which 49 were benign and 54 were malignant.Overall agreement on BI-RADS classification between LE imaging and CESM among readers was substantial (0.74 vs 0.86), CESM was higher than LE images. The sensitivity of LE images and CESM were 80.4%, 96.2%, specificity was 75.0%, 94.0%, AUC were 0.810, 0.960 respectively. There was significant difference of the AUC between LE images and CESM (Z=3.66, P<0.01). The ICC of malignant lesions measured on LE images and CESM and histopathological results were 0.86 and 0.96, respectively. Based on LE images, 44.4%(24/54) of patients recommended BCT, 55.6%(30/54) of patients recommended mastectomy, the difference was statistically significant (P=0.008). Based on CESM, 27.8%(15/54) of patients recommended breast conservation therapy, 72.2%(39/54) of patients recommended mastectomy,there was no significant statistically difference with the final surgical procedure (P=0.125).

CESM has a high diagnostic accuracy for suspicious calcification of breast. And its accuracy in assessing malignant lesion size is higher, which can provide a basis for preoperative surgical decision making.

To evaluate the clinical value of modified computed tomography angiography(CTA) in detecting bronchial artery-pulmonary artery fistula(BPF).

Retrospective analysis was performed on 246 patients with hemoptysis admitted to the First Affiliated Hospital of Wenzhou Medical University from July 2017 to December 2018, who underwent modified CTA and DSA examination at the same time. CT was performed with Toshiba Aquilion one 320 row 640-slice spiral CT scanner. All modified CTA images were read blindly by two radiologists above the attending doctors. The sensitivity, specificity and accuracy of the modified CTA in diagnosing BPF were calculated with the DSA results as the reference,and the consistency of the two tests was analyzed.

DSA detected 186 cases of positive and 60 cases of negative, modified CTA detected 160 cases of positive and 86 cases of negative. The sensitivity,specificity and accuracy of modified CTA for BPF diagnosis was 85.5%(159/186),98.3%(59/60), 88.6%(218/246) respectively, and they were with high consistency with DSA examination results (kappa=0.73,P<0.01).

Modified CTA has high diagnostic specificity for BPF,which can be used as the preferred method for non-invasive screening of suspected BPF patients.

To explore the feasibility of dynamic-enhanced magnetic resonance imaging (DCE-MRI) and blood oxygen level-dependent MRI (BOLD-MRI) in assessing the hemodynamics and tumor aggressiveness during treatment.

The colon cancer xenograft model was established in BALB/C nude mice with HCT116 cell line. Sixteen nude mice were randomly divided into treatment and control groups (aged 6 to 8 weeks, weighted 15 to 18 g, Certificate No. 11400700325797), which were treated with bevacizumab and saline by intraperitoneal injection on the 1st, 4th, 7th, 10th and 13th day. DCE-MRI and BOLD-MRI were performed before and on the 3th, 6th, 9th, 12th, and 15th day after treatment. The vascular maturity and microenvironment hypoxia were confirmed by pathology.

The tumor volume of treatment group was significantly smaller than that of control group after 15 days ((712±43) vs (1 051±112) mm³,P<0.01).The measurements of K^trans were (0.135±0.005),(0.147±0.006),(0.175±0.009),(0.161±0.006), (0.140±0.005),(0.116±0.008)/min (F=81.386, P<0.01); K_ep were (0.788±0.030),(0.804±0.036),(0.983±0.059), (1.105±0.091),(0.840±0.047),(0.786±0.041)/min(F=45.901,P<0.01);Ve were (0.652±0.006), (0.559±0.026), (0.466±0.016), (0.286±0.027), (0.363±0.020), (0.246±0.033) (F=384.290, P<0.01) and R2* values were (24.813±0.961), (24.675±1.070), (21.425±1.371), (17.850±0.885), (24.613±0.640), (27.013±0.734)/s (F=89.323, P<0.01) showed different trends with time in the treatment group, and the differences were statistically significant. The K^trans values and tumor vessel maturity index (VMI) were higher than baseline values during 3-12 d after treatment. CD31 positive staining rate and VMI had the strongest correlations with K^trans values (r=0.854 and 0.795), followed by AUC₁₈₀ (r=0.750 and 0.808), Ve (r=0.744 and 0.712) and K_ep values (r=0.729 and 0.758), all P<0.05. R2* value positively correlated with the positive staining rate of HIF-1α and fibronectin (r=0.810 and 0.816), all P<0.05.

DCE-MRI and BOLD-MRI are adequate to observe the tumor perfusion and hypoxia during anti-vascular treatment, and the R2* value can predict the tumor metastatic potential during the process of vascular normalization.

Brucellosis is the most common zoonotic infectious disease. Cardiovascular involvement is rare, but it is the leading cause of death in brucellosis, the most common is infectious endocarditis, infectious aneurysms are very rare, and obtaining the etiology is the gold standard for diagnosing brucellosis. This paper reports the diagnosis and treatment of a patient with Brucella infectious aortic aneurysm and osteomyelitis. The patient started with fever and low back pain, and aortic aneurysm lesions were found on imaging. The differential diagnosis included autoimmune aortic involvement, atherosclerotic aneurysm and infected aneurysm. The patient's blood culture reported Brucella, and the diagnosis was finally confirmed. Systemic inflammation is controlled after standardized anti-infective treatment, creating an opportunity for surgical management. It is hoped that this case will strengthen clinicians' understanding of brucellosis infectious aneurysm.

Duodenal papillary adenomas often involve pancreas and biliary tract. Pancreaticoduodenectomy is a traditional radical scheme, but this scheme has high technical requirements, long recovery period and limited clinical application. In order to solve this problem minimally invasively, this paper innovatively designs and develops an integrated portable¹²⁵I Particle internal and external biliary drainage tube, which adopts a three-lumen design, the central cavity plays the role of bile drainage, the particle cavity is separated on both sides of the central cavity, and its content contains radioactive particles, and the drainage tube plays the dual role of bile drainage and brachytherapy across the tumor area of the bile duct. Reports in this article¹²⁵I double-chain drainage tube was placed to radically cure duodenal papillary adenoma, which proved that this scheme was safe, feasible and effective.

A 53-year-old male patient was hospitalized for persistent atrial fibrillation and underwent radiofrequency ablation. After the operation, acute middle cerebral artery occlusion occurred. After that, stent thrombectomy was performed, and the vascular recanalization was successfully achieved. The patient recovered well.

Brucella is an intracellular parasitic bacterium that is highly infectious and often causes a class B infectious disease-brucellosis (brucellosis). Brucellosis not only causes huge economic losses, but also is a major risk factor threatening the health of the population. Human infection will cause multiple organ damage, and in severe cases, it can be disabled and lose the ability to work. Regardless of the extensiveness of the epidemic area and the severity of the harm, brucellosis can be called a worldwide infectious disease. The prevention and treatment of brucellosis is imminent. Only by early prevention, early detection and early treatment can the epidemic of this disease be controlled. In recent years, the continuous improvement of molecular biotechnology is of great significance to improve the early diagnosis and rapid screening of Brucella infection. In this paper, the latest molecular diagnostic technology for identifying Brucella is described, which provides some theoretical basis for the laboratory diagnosis of Brucella.

Doxorubicin is an anti-tumor anthracycline with dose-dependent and cumulative cardiotoxicity. The cardiotoxicity of doxorubicin is involved in a variety of mechanisms, among which the most studied mechanism is that mitochondrial complex I activates doxorubicin molecules into more reactive hemiquinones, leading to increased oxidative stress, which in turn causes apoptosis, necrosis, or autophagy of cardiomyocytes and ultimately leads to cardiotoxicity. In this paper, the research progress on the cellular and molecular mechanisms of doxorubicin-induced cardiotoxicity in recent years was reviewed from the aspects of oxidative stress, energy metabolism and cell damage.

Intracranial artery stenosis is an important cause of ischemic stroke. Willis ring, as a primary collateral branch, will lead to redistribution of cerebral blood flow when cerebral artery stenosis occurs. Intact Willis ring can play a compensatory role, thus maintaining cerebral perfusion and reducing infarct volume, which is a protective factor for stroke. Previous studies on Willis ring and cerebral artery stenosis mainly focused on extracranial carotid stenosis. The relationship between Willis ring variation and intracranial arterial blood flow has not been paid enough attention due to the limitation of research methods. This article reviewed the anatomical variation and physiological function of Willis ring, focused on the influence of Willis ring variation on the blood flow distribution of intracranial artery stenosis, and briefly introduced its evaluation methods.

Leukoencephalopathy (LBSL) with spinal cord and brainstem involvement and elevated white matter lactate is a rare autosomal recessive leukoencephalopathy, which is mainly manifested by slow progressive cerebellar ataxia, spasticity and dorsal column dysfunction. The causative gene of the disease is DARS2. This article expounds the clinical manifestations, pathogenesis, diagnosis, differential diagnosis, treatment and prognosis of LBSL, hoping to strengthen the doctor's understanding of this disease and improve the diagnosis rate.