Abstract: Objective To compare the midterm patency rates of individual and sequential saphenous vein grafts (SVG) as coronary bypass conduits of offpump coronary artery bypass grafting (OPCAB) and evaluate the impact of the grafting techniques (individual or sequential grafts) on the graft patencyafter OPCAB. Methods The clinical data of 398 patients in General Hospital of the People’s Liberation Army receiving OPCAB with individual and sequential grafts from June 2005 to March 2009 were retrospectively analyzed. There were 301 males and 97 females with their age ranged from 53 to 82 years (63.6±10.3 years). A total of 714 distal coronary anastomoses on 448 SVG were assessed by using 64multislice computed tomography (64MSCTA) at an average of 19.8±23.6 months (3 months to 5 years) after OPCAB procedure. The blood flow of grafts in the proximal segment of individual and sequential SVG and the patency rates of grafts and anastomoses were compared, and the effect of different locations on the patency rate of the anastomoses was analyzed. Results The mean blood flow in double SVG (37.11±16.70 ml/min vs. 25.15±14.24 ml/min, P0.042) and in triple SVG (37.56±19.58 ml/min vs. 25.15±14.24 ml/min, P=0.048) were both significantly higher than the flow in single SVG. The anastomoses on the sequential conduits had better patency (95.1％ vs. 90.1％, P=0.013). The patency of sideto side anastomoses was better than that of endtoside anastomoses (97.0% vs. 93.1%, P=0.002) and that of the individual endtoside anastomoses (97.0% vs. 90.1%, P=0.041). There was no significant difference between distal anastomoses in sequential and those in single grafts (P=0.253). No significant difference was observed between the two methods in regard to the three major coronary systems (including the anterior descending branch, the right coronary artery, and the circumflex branch). However, anastomoses on sequential grafts had superior patency to those on individual grafts in the right coronary system (P=0.008). Conclusion The midterm patency of a sequential SVG conduit after OPCAB is excellent and generally superior to that of an individual one. The best runoff coronary artery should be placed at the distal end and the poor coronary vessels should be arranged in the middle of the grafts.
Objective To investigate the relationship between single nucleotide polymorphism (SNP) and therapy response of some conventional chemotherapy drugs in breast cancer, and to explore the value of SNP in guiding individualized treatment. Methods Pub-Medline and Chinese CHKD periodical electronic databases were searched. Representative researches in this field were sorted out and concluded. Results Varied genes related to drug metabolism have SNP phenomenon, which are closely associated with interindividual diversity in drug response. Race, section, environment, and drug-drug or gene-gene interactions may have effect on the association.Conclusion The study on SNP has important application prospect in optimizing the individual drug-delivery. However, the combinatorial analyses of multi-SNPs and multi-genes and the prospective studies with large-scale samples and random controls are still needed.
Objective To explore the value of chemosensitivity assay in vitro on breast cancer. Methods In vitro chemosensitivity of 6 species of chemotherapeutic agents applied to 38 cases of breast cancer patients were detected by tissue culture-end point staining-computer image analysis (TECIA). Results The sensitivity to chemotherapeutic agents commonly used in the breast cancer level from high to low was as follow: Doxorubicin (ADM), Paclitaxel (TAX), Vinorelbine (NVB), Cyclophosphamide (CTX), Cisplatin (DDP) and Fluorouracil (FU). Conclusion Drugs sensitivity experiment of cancer in vitro by TECIA has an important value to instruct clinical medication and individual chemotherapy for breast cancer.
Survival data include the occurrence and duration of an event. As most survival data are distributed irregularly, the Kaplan-Meier method is often used in survival analysis; however, studies usually only report the Kaplan-Meier curve and median survival time and do not provide the original survival data, which creates issues for subsequent secondary research. This study introduced a systematic method whereby image processing software and R software were used to process and extract survival data from published Kaplan-Meier curves. It also introduced the specific steps required to obtain survival data using an example to show the accuracy and feasibility of the extraction method and provided references for the effective secondary use of survival data.
ObjectiveTo compare the effectiveness of single-bundle and double-bundle anterior cruciate ligament (ACL) reconstruction by two methods. MethodsQualified for the selective standard, 120 patients with ACL injury between May 2010 and April 2013 were divided into 4 groups: double-bundle reconstruction was performed by the conventional procedure in 30 cases (group A); anatomic double-bundle reconstruction was performed in the original ACL residual footprints in 30 cases (group B); single-bundle reconstruction was performed by the conventional procedure in 30 cases (group C); and anatomic single-bundle reconstruction was performed in the original ACL residual footprints in 30 cases (group D). There was no significant difference in gender, age, disease duration, pathogenesis, injury side, Lysholm scores, International Knee Documentation Committee (IKDC) ratings, Lachman test, anterior drawer test, and pivot shift test among groups (P>0.05). The impingement between the ACL implants and intercondylar notch was evaluated with postoperative immediate MRI scan and the three-dimensional digital model. Lachman test, anterior drawer test, and pivot shift test results, Lysholm scores, and IKDC ratings were used to compare the effectiveness among groups after operation. ResultsThree-dimensional digital model after operation showed impingement in 11 cases (36.7%) of group A, 1 case (3.3%) of group B, 9 cases (30.0%) of group C, and no impingement in group D. The impingement rates of groups A and C were significantly higher than that of groups B and D (P<0.05), but no significant difference was found between groups A and C, and between groups B and D (P>0.05). All incisions healed by first intention, and no early complication was found. The patients were followed up 24-30 months (mean, 26 months). Lysholm scores, Lachman test, anterior drawer test, and pivot shift test results at 24 months after operation were significantly better than preoperative ones in 4 groups (P<0.05), but no significant difference was shown among groups (P>0.05). The IKDC ratings of groups B and D were significantly better than that of groups A and C (P<0.05); but there was no significant difference between groups A and C, and between groups B and D (P>0.05). ConclusionCompared with the conventional procedure, the individual anatomic single- and double-bundle reconstruction in the original ACL residual footprints has decreased impingement rate and increased IKDC rating.
ObjectiveTo explore the effect of individualized health education prescription on glycemic control in out-patients with diabetes. MethodBetween January and May 2014, seventy-three out-patients with diabetes were given individualized health education prescription for 6 months. The we observed the change of HbA1c level, HbA1c standard rate and medication compliance of the patients. ResultsBefore the use of individualized health education prescription, HbA1c was (8.10±1.86)%, and HbA1c was (6.55±1.26)% after the intervention (P<0.001). HbA1c standard rate (72.6%) and medication compliance (the number of patients with high, medium, and poor compliance was 36, 27, and 10, respectively) after the intervention were both significantly better than those before (16.4%; 12, 42, and 19) the intervention (P<0.001). ConclusionsEducation prescription is effective in the management of blood glucose for patients with diabetes.
Individual patient data meta-analyses are conducted through development of collaboration with trial investigators, central collection and checking of individual patient data of all eligible trials, and pooling of patient data to produce the best estimate of effects of health care interventions. They ensure study data to be update, accessible, reliable and complete so as to minimize the risk of bias, and are the gold standard of systematic reviews addressing effects of health care interventions. Meta-analyses using individual patient data enable higher flexibility of data analyses and more completeness and balance of results interpretation. The study conduct differs between individual patient data versus conventional meta-analyses. This article discussed the steps of conducting individual patient data meta-analyses.
ObjectiveTo review individual treatment effect (ITE) models developed from randomized controlled trials, with the aim of systematically summarizing the current state of model development and assessing the risk of bias. MethodsPubMed and Embase databases were searched for studies published between 1990 and 14 June 2024. Data were extracted using the CHARMS inventory, and the PROBAST risk of bias tool was used to assess model quality. ResultsA total of 11 publications were included, containing 19 ITE models. The ITE modelling methods were regression models with interaction terms (n=8, 42.1%), dual-range models (n=5, 26.3%) and machine learning (n=6, 31.6%). The ITE models had a reporting rate of 78.9%, 73.2% and 10.5% for differentiation, calibration and clinical validity, respectively. Fourteen models were assessed as having a high risk of bias (73.7%), particularly in the area of statistical analysis, due to inappropriate handling of missing data (n=15, 78.9%), inappropriate consideration of model fit issues (n=5, 26.3%), etc. ConclusionCommon approaches to ITE model development include constructing interaction terms, dual procedure theory, and machine learning, but suffer from a low number of model developments, more complex modeling methods, and non-standardized reporting. In the future, emphasis should be placed on further exploration of ITE models, promoting diversified modeling methods and standardized reporting to improve the clinical promotion and practical application value of the models.
Objective To explore the application of individualized transiliac crest nail-grafting guide plate prepared by computer-aided design and three-dimensional (3D) printing technology in deep pelvic external fixator implantation. Methods Five patients with pelvic fractures were collected between May 2017 and February 2018. There were 4 females and 1 male with an average age of 52 years (range, 29-68 years). Pelvic fractures were classified as type B in 3 cases and type C in 2 cases by Tile classification. The interval between injury and operation was 6-14 days (mean, 9 days). The preoperative CT images of pelvic fractures were collected. The data was reconstructed by 3D imaging reconstruction workstation. An individualized transiliac crest nail-grafting guide plate was designed on the virtual 3D model. The individualized transiliac crest nail-grafting guide plate and the solid pelvic model were produced with the 3D printing technology. The individualized transiliac crest nail-grafting guide plate was used for intraoperative deep pin position on iliac crest after the preoperative simulation. The follow-up CT scans were used to determine the differences in distance from anterior superior iliac spine, convergence angle, and caudal angle between the preoperative plan and postoperative measurement. Results During the operation, the individualized transiliac crest nail-grafting guide plate was used to guide the placement of 20 pins. X-ray film and CT examination showed that all pins were well positioned. The average depth of pins was 83.16 mm (range, 70.13-100.53 mm). Fitted 3D reconstruction images showed that the entry point and orientation of the pins were all consistent with preoperative schemes. Compared with the planned nail path, there was no significant difference in the distance from anterior superior iliac spine, convergence angle, and caudal angle in the actual nail path (P>0.05). No loosening and rupture of pin, no damage of blood vessels and nerve, and shallow or deep infection occurred during 3 months follow-up, and the incisions healed by first intention. All patients were satisfied with the treatment process. The ranges of motion of hip and knee were normal, and the visual analogue scale (VAS) score was 0-3 (mean, 0.5). Conclusion The individualized transiliac crest nail-grafting guide plate technique is the improvement of traditional technique. It can increase accuracy and effective depth of pin position, enable patients to obtain pelvic mechanical stability quickly after operation, and reduce the risk of complications related to nail path.
ObjectiveTo study the feasibility of preparation of the individualized femoral prosthesis through computer assisted design and electron beammelting rapid prototyping (EBM-RP) metal three-dimensional (3D) printing technology. MethodsOne adult male left femur specimen was used for scanning with 64-slice spiral CT; tomographic image data were imported into Mimics15.0 software to reconstruct femoral 3D model, then the 3D model of individualized femoral prosthesis was designed through UG8.0 software. Finally the 3D model data were imported into EBM-RP metal 3D printer to print the individualized sleeve. ResultsAccording to the 3D model of individualized prosthesis, customized sleeve was successfully prepared through the EBM-RP metal 3D printing technology, assembled with the standard handle component of SR modular femoral prosthesis to make the individualized femoral prosthesis. ConclusionCustomized femoral prosthesis accurately matching with metaphyseal cavity can be designed through the thin slice CT scanning and computer assisted design technology. Titanium alloy personalized prosthesis with complex 3D shape, pore surface, and good matching with metaphyseal cavity can be manufactured by the technology of EBM-RP metal 3D printing, and the technology has convenient, rapid, and accurate advantages.