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    Research progress and development trend of lower extremity exoskeleton rehabilitation robot
    Jiyu HAN, Yanhong WANG, Daqian WAN
    JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE)    2022, 42 (2): 241-246.   DOI: 10.3969/j.issn.1674-8115.2022.02.017
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    Lower limb motor dysfunction caused by various causes is an important public health problem in the world today. Lower extremity exoskeleton rehabilitation robot is a new type of wearable bionic device, which is mainly used to realize the standing and walking of patients with lower extremity motor dysfunction. It is a hot research topic in rehabilitation medicine at present. By reviewing the history of lower extremity exoskeleton rehabilitation robot, some breakthroughs and developments are found to have been made in this field in recent years. In the future, if we can overcome the technical problems such as portability, intelligence and modularization, it will be possible to maximize the recovery of patients with lower limb dysfunction. In this paper, the key technologies and clinical applications of wearable lower extremity exoskeleton rehabilitation robot are reviewed comprehensively, and new prospects for the research and development in this field are proposed.

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    Review of immunosuppressive tumor microenvironment of pancreatic cancer
    Jing-wei LI, Li-wen WANG, Ling-xi JIANG, Qian ZHAN, Hao CHEN, Bai-yong SHEN
    JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE)    2021, 41 (8): 1103-1108.   DOI: 10.3969/j.issn.1674-8115.2021.08.018
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    Pancreatic cancer is a highly malignant tumor. The difficulty of early diagnosis and scarcity of effective clinical treatment strategies lead to poor prognosis. Tumor microenvironment (TME) of pancreatic cancer is composed of tumor cells, immune cells, stromal cells, extracellular matrix and soluble factors. TME plays an important role in the development, progression, invasion and metastasis of tumors. The pancreatic cancer microenvironment has significant immune cell infiltration, which is highly immunosuppressive. On the one hand, tumor cells edit the immune system so that cancer cells cannot be recognized by the immune system; on the other hand, they can recruit and activate various immunosuppressive cells such as pancreatic stellate cells, myeloid-derived inhibitory cells, tumor-associated macrophages, regulatory T cells and so on. These immunosuppressive cells can secrete immunosuppressive molecules, affect the function of anti-tumor immune cells, inhibit the host′s anti-tumor immune response, lead to tumor immune escape, and promote tumor development and metastasis. In this review, the mechanisms and effects of these immunosuppressive components are discussed and the updated results of immunotherapy on pancreatic cancer are studied, which may provide novel insights on TME and immunotherapy of pancreatic cancer.

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    Classification and treatment progress of MMRd-related endometrial cancer
    Qian YIN, Yin-cheng TENG
    JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE)    2021, 41 (11): 1509-1513.   DOI: 10.3969/j.issn.1674-8115.2021.11.016
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    Endometrial carcinoma is a very heterogeneous gynecological cancer. According to the latest molecular classification, endometrial carcinoma is divided into mismatch repair deficiency (MMRd)-related EC and non-MMRd-related EC. And MMRd-related EC is divided into three subtypes according to the characteristics of mutation: MLH1-hypermethylationged endometrial carcinoma (EC-met); Lynch syndrome-related endometrial carcinoma (EC-ls) and mismatch repair gene double somatic variants (EC-dspv). The three subtypes of EC have different pathogenesis and clinical characteristics. Therefore, they must be distinguished according to clinical and immunological characteristics in order to adopt precise treatments. This article mainly introduces the classification of MMRd-related endometrial carcinoma, and compares the three subtypes with the mismatch repair proficiency (MMRp) of EC in terms of clinical and immune features. Finally, this review introduces recent researches and clinical trials related to the treatment and prognosis of MMR.

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    Association of triglyceride-glucose index with cardiovascular disease in people without traditional risk factors
    ZHANG Tong, TIAN Xue, ZUO Yingting, ZHENG Manqi, ZHANG Yijun, WU Shouling, CHEN Shuohua, MA Gaoting, TONG Xu, WANG Anxin, MO Dapeng
    Journal of Shanghai Jiao Tong University (Medical Science)    2022, 42 (3): 267-274.   DOI: 10.3969/j.issn.1674-8115.2022.03.002
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    ·To examine the association of triglyceride-glucose index with cardiovascular disease (CVD) in participants without atherosclerotic CVD (ASCVD) risk factors.


    ·This study included 32 532 participants [64.01% male, mean age (48.26±12.89) years] who had no history of CVD and no ASCVD risk factors (including dyslipidemia, hypertension, smoking and diabetes) at baseline from Kailuan Study during 2006?2007. Participants were divided into 4 groups according to the quintiles of TyG index at baseline (Q1, Q2, Q3 and Q4). TyG index was calculated as ln[triglyceride (mg/dL)×fasting blood glucose (mg/dL)/2]. The outcome was the first occurrence of CVD from baseline to the end of follow-up (December 31, 2019). Baseline characteristics were compared with one-way ANOVA or Kruskal-Wallis test for continuous variables, and chi-square for categorized variables. Multivariable-adjusted Cox proportional hazards models were performed to evaluate the associations. Restricted cubic spline with 5 knots at the 5th, 25th, 50th, 75th and 95th percentile was used to explore the dose-response association between TyG index and incident CVD. A two-sided P<0.05 was considered statistically significant.


    ·During a median follow-up of 12.97 (12.67, 13.17) years, we observed 1 324 incident CVD events (including 1 084 cases of stroke and 255 cases of myocardial infarction). Compared with participants in the Q1 group, the multivariable adjusted hazard ratios in the Q2, Q3 and Q4 group were 1.16 (95%CI 0.97?1.38), 1.29 (95%CI 1.08?1.53) and 1.60 (95%CI 1.35?1.90) for CVD, 1.12 (95%CI 0.93?1.36), 1.21 (95%CI 1.00?1.46) and 1.44 (95%CI 1.20?1.73) for stroke, and 1.32 (95%CI 0.84?2.06), 1.64 (95%CI 1.07?2.51) and 2.41 (95%CI 1.60?3.65) for myocardial infarction, respectively. Sensitivity analyses yielded similar results. Subgroup analysis showed that the association between TyG index and CVD was consistent across different gender populations, and there was no significant interaction between gender and TyG index in relation to the risk of CVD. Multivariable-adjusted spline regression model showed a J-shaped association between TyG index and the risk of CVD, stroke and myocardial infarction. Similar results were observed when stroke and myocardial infarction were the interest of outcomes.


    ·Among the individuals without traditional ASCVD risk factors, there is an increased risk of incident CVD with increasing TyG index level.

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    Advances in resilience research
    Shuang-yi CHEN, Jian-yin QIU
    JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE)    2021, 41 (10): 1397-1400.   DOI: 10.3969/j.issn.1674-8115.2021.10.021
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    Resilience refers to the dynamic process of individual's positive adaptation to adversity, which is closely related to the symptoms of mental disorders and can be improved through intervention. This paper reviews the definition, evaluation method and intervention of resilience, and proposes that resilience can be used as an indicator of mental disorders related to stressor exposure, which has certain reference significance for improving individual resilience and promoting individual mental health development.

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    Application of a tent-pole screw technology in reconstruction of severe alveolar bone defect: a retrospective study of 30 patients
    WU Jing, ZHAO Zhengyi, ZOU Duohong, YANG Chi, ZHANG Zhiyuan
    Journal of Shanghai Jiao Tong University (Medical Science)    2022, 42 (6): 768-777.   DOI: 10.3969/j.issn.1674-8115.2022.06.011
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    ·To explore the effect of a tent-pole screw technology on reconstruction of severe alveolar bone defect.


    ·Thirty patients underwent tent-pole screw technology to reconstruct severe alveolar bone defects in the Department of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to January 2021 were enrolled. By analyzing and reconstructing the image data of cone-beam computed tomography (CBCT) before and 8 months after operation, the effects of repairing and reconstructing the horizontal, vertical and mixed alveolar bone defects were counted. The alveolar bone volumetric parameters were evaluated by micro-computed tomography (Micro-CT), and trabecular bone number (Tb. N), trabecular bone thickness (Tb. Th), bone volume/total volume (BV/TV) and bone mineral density (BMD) were calculated to assess the maturity of regenerated bone. The regeneration of alveolar bone and remanent scaffold were calculated by analyzing histological sections.


    ·Eight months after using the tent-pole screw, the vertical bone gain value was 4.81 (1.58, 7.66) mm, and the horizontal post-operative width was 3.96 (2.38, 5.67) mm. Additionally, the bone volume gain was 2 157.22 (776.59, 2 831.63) mm3. Micro-CT analysis of bone core, which was collected 8 months after the surgery, and Tb. N was (3.09±0.68)/mm, Tb. Th was (0.08±0.01) μm, BV/TV was (25.24±5.60)% and BMD was (0.24±0.05) g/cm3. Histological sections showed that the percentages of regenerated bone and remanent scaffold were (16.30±3.57)% and 34% (31.75%, 38.25%), respectively. These data suggested good new bone formation in targeted area. There were no complications or adverse events during surgery or post-operative healing.


    ·Based on “stability-oriented” alveolar ridge augmentation, using tent-pole screw, membrane pins and packaging structure in a standard operation procedure can achieve beneficial results for bone augmentation, while complications seldom occurre. The tent-pole screw may offer predictable and exceptional outcomes for implantation site preparation, especially for large alveolar defects, which will provide advantages to subsequent implantation and restoration.

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    Establishment and optimization of co-culture technology for breast cancer organoids
    Tian-hao ZHOU, Zhao-chen XIN, Shao-qian DU, Yuan CAO, Jing-xuan XU, Zeng-hong LAO, Hong-xia WANG
    JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE)    2021, 41 (8): 1017-1024.   DOI: 10.3969/j.issn.1674-8115.2021.08.004
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    ·To improve the cultivating and passaging method of breast cancer organoids, and establish a co-culture system enriching cancer associated fibroblasts (CAFs).


    ·Different types of collagenases (type Ⅰ, type Ⅲ and type Ⅳ) were used to digest fresh tissues from 5 breast cancer patients. The number of cells after tissue digestion was counted by cell counting method, and cell viability was analyzed by cell flow cytometry. Three-dimensional culture of primary breast cancer single cells was carried out by using culture system containing different contents of fibroblast growth factor 7 (FGF7), FGF10 and epidermal growth factor (EGF). The success rate of cell culture and the growing status of organoids were observed and compared. Different centrifugation speeds were used to compare the advantages and disadvantages of passaging methods and simplify the passaging steps. CCK8 assay was used to study the effect of CAFs on the growth of organoids in the co-culture system of primary CAFs and organoids, and the morphological changes of organoids were observed under optical microscope.


    ·Compared with type Ⅰ and type Ⅲ collagenase, type Ⅳ collagenase got the highest cell yields (P=0.045, P=0.017), and maintained the highest cell viability (P=0.005, P=0.048). By optimizing the composition of organoid medium (omitting FGF7 and FGF10, reducing EGF concentration) and passaging process (improving centrifugal velocity to 900×g), a more economical, effective and rapid method of organoid culture was obtained. Compared with organoids cultured alone, the growth rate (P<0.05) and heterogeneity of organoids increased when organoids were co-cultured with CAFs.


    ·The optimized culture system can significantly increase the success rate of organoids, simplify the culture steps and reduce the culture cost. The establishment of primary CAFs and organoids co-culture system provides a good in vitro model for the study of breast cancer heterogeneity and tumor microenvironment.

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    Protocols for diagnosis and treatment of temporomandibular joint osteoarthritis: experience from the TMJ Center of Shanghai Ninth People 's Hospital, Shanghai Jiao Tong University School of Medicine
    ZHANG Shanyong, YANG Chi
    Journal of Shanghai Jiao Tong University (Medical Science)    2022, 42 (6): 709-716.   DOI: 10.3969/j.issn.1674-8115.2022.06.003
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    Temporomandibular joint osteoarthritis (TMJOA) is the most common degenerative disease in the temporomandibular joint, mainly manifesting with pain in the joints and the muscles, joint locking, popping, crepitus, and limited mouth opening, which may undermine the quality of patients' life. The main pathological features of TMJOA include chronic synovitis, progressive articular cartilage degeneration, and abnormal subchondral bone remodeling. At present, its pathogenesis is still unclear, and abnormal mechanical load, trauma, heredity, metabolism, gender and age can all be regarded as pathogenic factors. Commonly used diagnostic methods for TMJOA include magnetic resonance imaging (MRI) and computed tomography [(CT/cone beam CT (CBCT)]. The staging standards of TMJOA mainly include Wilkes staging system and Yang's staging system. The clinical treatment of TMJOA mainly includes two categories: non-surgical treatment and surgical treatment. Non-surgical treatment includes health education, psychological consultation, medication, occlusion treatment, etc. Surgical treatment includes arthrocentesis, arthroscopic surgery, disc anchoring, autogenous tissue graft, and total joint replacement. This paper summarizes the diagnosis, staging, surgical treatment and postoperative evaluation of TMJOA on the basis of literature review, and proposes diagnosis and treatment protocols based on the experience of the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, so as to provide reference for clinicians.

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    Research progress in the role and mechanism of lactylation in diseases
    GE Lingling, HUANG Hongjun, LUO Yan
    Journal of Shanghai Jiao Tong University (Medical Science)    2023, 43 (3): 374-379.   DOI: 10.3969/j.issn.1674-8115.2023.03.014
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    Lactic acid is a product of cell respiration. After entering into cells, glucose is metabolized to pyruvate by glycolysis. When the oxygen supply is sufficient, pyruvate is converted to acetyl coenzyme A through pyruvate dehydrogenase in the mitochondrial matrix to participate in the tricarboxylic acid cycle and provide necessary energy for cells. Pyruvate is catalysed by lactate dehydrogenase in the cytoplasm to produce lactate while cells are grown under hypoxic conditions. Lactate not only provides energy for mitochondrial respiration, but also plays important roles in inflammatory responser, wound repair, memory formation and neuroprotection as well as tumor growth and metastasis and other pathophysiological processes through autocrine, paracrine, and endocrine forms, which affects the development and prognosis of diseases. Epigenetic modification regulates gene replication, transcription and translation by covalently adding or hydrolyzing functional groups on histones and DNA through related enzymes and affects the biological effects of cells. Histones are the major structural proteins of eukaryotic chromosomes. Their post-translational modifications, such as methylation and acetylation, affect their affinity with DNA, change chromatin structures, and are widely involved in regulation of gene expression. Recent studies have found that histones can undergo lactylation, which is a new epigenetic modification by adding lactate to lysine residues on histones. As the research deepens, numerous evidences reveal that lactylation also occurs on non-histone proteins. The discovery of lactylation has expanded our understanding of lactate functions in the pathogenesis of diseases. In this review, we summarize the roles and mechanisms of lactylation in tumor, inflammatory and neural system diseases, in order to provide new ideas for the research, diagnosis and treatment of these diseases.

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    Clinical characteristics and prognosis of pediatric acute leukemia patients with MLL gene rearrangements
    Qing LIU, Na ZHANG, Jing-bo SHAO, Hong LI, Kai CHEN, Cheng-kan DU, Zhen WANG, Hui JIANG
    JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE)    2021, 41 (7): 903-909.   DOI: 10.3969/j.issn.1674-8115.2021.07.009
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    ·To analyze the clinical characteristics and prognosis of pediatric acute leukemia (AL) patients with positive mixed linage leukemia (MLL) gene rearrangement (MLL-r).


    ·Forty-five children with MLL-r AL admitted to Shanghai Children′s Hospital, Shanghai Jiao Tong University from January 1, 2009 to December 31, 2019 were retrospectively analyzed. Fluorescence in situ hybridization and/or fluorescent real-time PCR were used to detect the MLL-r. Kaplan-Meier method was used to evaluate the survival of children. Log-rank test was used to compare the difference of survival rate. Univariate analysis and multivariate analysis were performed on the factors influencing survival, such as gender, age and the number of white blood cells.


    ·The incidence rate of MLL-r in children with AL in our center was 7.1%, and the incidence rate of MLL-r in children with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) were 5.4% and 13.3%, respectively. The difference between the two groups was statistically significant (P=0.002). The age of the two groups of children (>1 year and ≤1 year) and the number of white blood cells at the time of onset (≥50×109/L and <50×109/L) were compared. The differences were statistically significant (P=0.032 and 0.021). The main immunophenotype of children with MLL-r ALL was early precursor B-ALL, accounting for 79.2%. The main immunophenotype of children with MLL-r AML was M5, accounting for 77.8%. MLL partner gene analysis showed that MLL/AF4 accounted for 59.2% (16/27) of MLL-r ALL children, of which 68.7% (11/16) were children younger than 1 year old. Compared with the children younger than 1 year old in the non-MLL/AF4 group, the difference was statistically significant (P=0.034). The majority of children with MLL-r AML were MLL/AF9, accounting for 33.3%. Of the 45 patients, 42 cases were included for the prognosis analysis. The complete remission rate was 97.6% (41/42), and the median follow-up time was 26 (2?138) months. The median event-free survival (EFS) and overall survival (OS) time were 21 months and 24.5 months, respectively. The 3-year EFS and OS rates were (41.8±9.4) % and (60.9±9.3) %, respectively. The median duration of EFS and OS in children with MLL-r ALL were 21.5 months and 28 months, respectively, and the 3-year EFS and OS rates were (44.3±11.7) % and (58.2±12.1) %, respectively. The median EFS and OS time in children with MLL-r AML were 16 months and 23 months, respectively. The 2-year EFS and OS rates were (36.5±15.8) % and (64.7±14.5) %, respectively. Eight cases of ALL children relapsed, with a median recurrence time of 20 (2?36) months; 7 cases of AML children relapsed, with a median recurrence time of 16 (5?38) months, and the cumulative recurrence rates were 48.4% and 63.9%, respectively. There was no statistically significant difference between them (P=0.398). Univariate analysis showed that between the groups of MLL-r ALL children >1 year and ≤1 year, white blood cell count ≥50×109/L and <50×109/L, platelet count ≥30×109/L and <30×109/L, there were statistically significant differences in the EFS rate. The P values were 0.028, 0.024 and 0.027 respectively. Multivariate analysis showed that the number of white blood cells at onset was an independent prognostic factor affecting EFS in children with MLL-r ALL (RR=6.113, 95% CI 0.017?1.050, P=0.013).


    ·The incidence of MLL-r in children with AML is higher than that in children with ALL. The main immunophenotype of MLL-r ALL is early precursor B-ALL. The main immunophenotype of MLL-r AML is M5. Conventional chemotherapy produces a high response rate, which is likely to relapse. The number of white blood cells at the onset ≥50×109/L is a poor prognostic factor for children with MLL-r ALL.

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    Current situation, problems and directions of high-risk pregnancy research in China
    LIN Yi
    Journal of Shanghai Jiao Tong University (Medical Science)    2022, 42 (4): 403-408.   DOI: 10.3969/j.issn.1674-8115.2022.04.001
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    With the progressive initiation of the two- and three-child policy in China, and under the influence of various factors in society, the proportion of high-risk pregnancy has increased, especially those linked to advanced age conception (more than 35 years old). In pathological pregnancy, the incidence of recurrent miscarriage and preterm birth remains high. The diagnosis and treatment of common pregnancy complications such as preeclampsia and eclampsia are lagging behind. Diseases that cause maternal death have changed. The cases of deep vein thrombosis causing maternal deaths have increased. Expanding floating population increases the risk of adverse pregnancy outcomes. The widespread use of assisted reproduction has led to high risk of adverse pregnancy outcomes. The increase in the number of elder mothers has led to high risk in fetal birth defects. All of these have led to a new challenge in terms of maternal safety and care, urging scientists and clinicians to establish a more accurate risk assessment standard for pregnant women, especially for the elderly pregnant women, implement whole pregnancy management and standardized diagnosis and treatment, standardize the treatment for abortion, and establish a triple monitoring system for identifying maternal arterial rhythm, maternal heart rate and fetal heart rate. Finally, a hospital-home monitoring and warning system will be set up based on the Internet of things and information automation. This paper describes the current status, problems and directions of high-risk pregnancy research under the background of the new population policy, and provides new strategies for the protection of maternal and child health.

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    New progress and prospects of blood glucose monitoring technology
    JIA Weiping
    Journal of Shanghai Jiao Tong University (Medical Science)    2022, 42 (9): 1171-1175.   DOI: 10.3969/j.issn.1674-8115.2022.09.002
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    Glucose monitoring is an important part of diabetes management. For over a century, diabetes monitoring technology has developed from the initial urine glucose test, to the later blood glucose test, and finally to the current continuous glucose monitoring (CGM), which is evolving in a more convenient, accurate, minimally invasive, and even non-invasive direction. CGM refers to the technology that continuously measures glucose concentrations in the subcutaneous interstitial fluid by glucose sensors. It can detect hyperglycemia and hypoglycemia that are not easily recognized by traditional monitoring methods. Using the huge amounts of glucose data generated by CGM technology, diabetes management is expected to be more targeted, with glucose control more accurate. In this context, novel measure of glucose control represented by time in range (TIR) has been popularized, which can provide comprehensive information including hyperglycemia, hypoglycemia, and glucose fluctuation. Hence, the modern approach to glucose control should focus not only on glycosylated hemoglobin, but also pay attention to new metrics such as TIR. In the future, more mature, minimally invasive and even non-invasive glucose monitoring technologies that are comfortable, stable and highly accurate should be further developed to greatly improve the experience and enthusiasm of the patients in blood glucose monitoring. Meanwhile, closed-loop insulin infusion system should be further developed, to truly realize individualized and automated glucose control, as well as further improvement of glucose control in the patients with diabetes.

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    Practice for multidisciplinary diagnosis and treatment of dermatofibrosarcoma protuberans: expert consensus of Shanghai Ninth People 's Hospital, Shanghai Jiao Tong University School of Medicine (2020 edition)
    JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE)    2021, 41 (12): 1669-1675.   DOI: 10.3969/j.issn.1674-8115.2021.12.018
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    Dermatofibrosarcoma protuberans (DFSP) is a low- to intermediate-grade malignant soft tissue sarcoma occurring in the skin and subcutaneous tissues. The high misdiagnosis rate often delays the best treatment opportunity, and the wrong treatment method leads to the high recurrence rate of surgery. Traditional extended resection requires 3?5 cm expansion around the tumor, and the huge tissue defect increases the difficulty of surgery, which is also hard to be accepted. In Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, under the support of the multi-disciplinary treatment group, cutaneous spindle cell neoplasms multi-disciplinary team of accurate diagnosis and treatment normatively conducted treatment of DFSP comprehensive diagnosis and treatment. Modified Mohs micrographic surgery was used to remove the tumor while preserving as much normal tissue as possible. Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine expert consensus of diagnosis and treatment of specification of DFSP multidisciplinary specification was formed.

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    Review of clinical application of peripheral neuropathy scales
    Qun-feng WANG, Li CAO, Xing-hua LUAN
    JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE)    2021, 41 (11): 1518-1523.   DOI: 10.3969/j.issn.1674-8115.2021.11.018
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    Peripheral neuropathy (PN) refers to a group of diseases caused by the dysfunction and structural changes of peripheral motor, sensory and autonomic nerves. Scales for screening and assessing PN are continuously being used in clinical practice. This article summarizes PN score scales for four kinds of PN, including chronic inflammatory demyelinating polyradiculoneuropathy, Charcot-Marie-Tooth disease, diabetic PN and neuropathic pain, aiming to improve medical staff's understanding and application ability of the PN assessment scale.

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    Report of 3 cases of 47,XXX syndrome with growth retardation
    YANG-Li, Ya-qin FENG, Yu YANG, Li-ling XIE, Di-lan WANG, Hui HUANG
    JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE)    2021, 41 (11): 1425-1428.   DOI: 10.3969/j.issn.1674-8115.2021.11.004
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    To analyze the clinical data of 3 children with growth retardation, including height, chromosome karyotype, and the levels of growth hormone, insulin-like growth factor-1 and gonadal development. All the 3 cases of children were found to be slow in growth rate, no special face, and normal level of insulin-like growth factor-1; the 3 cases all underwent growth hormone provocation test, of which 1 case was partial growth hormone deficiency and 2 cases were idiopathic short; 3 cases of chromosomal karyotypes were 47, XXX, in line with the diagnosis of super-female syndrome.

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    Clinical features of 23 patients with 45,X/46,XY mosaicism
    Xiu-li CHEN, Hai-ying WU, Ming-cui FU, Hong-ying WANG, Ou XU, Lin-qi CHEN
    JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE)    2021, 41 (11): 1417-1424.   DOI: 10.3969/j.issn.1674-8115.2021.11.003
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    ·To analyze the clinical features of the patients with 45,X/46,XY mosaicism, and improve the understanding, diagnosis and treatment of the disease.


    ·The clinical manifestations, the level of sex hormones, and the gonads pathology of the patients with 45,X/46,XY mosaicism diagnosed by G-banding karyotype analysis and fluorescence in situ hybridization (FISH) were retrospectively analyzed, who were admitted in Children's Hospital of Soochow University from January 2014 to December 2020.


    ·Twenty-three patients with 45,X/46,XY mosaicism were included, among whom 11 cases were the female phenotype, and 12 cases were the male phenotype. In these patients, 12 patients were diagnosed by G-banding karyotype analysis, 10 patients were diagnosed by FISH, and only 1 patient was diagnosed by array-based comparative genomic hybridization. The age of the first diagnosis was 0.3?14.9 years. The mean age of the patients with the female phenotype was (9.3±3.9) years, which was bigger than that of the male phenotype [(4.4±3.7) years, P<0.05]. All the patients above 1 year old had different degrees of short stature, especially in the female phenotype patients. In the female phenotype patients, three patients had clitoromegaly, while the other patients had no masculine appearance of external genitalia. The external masculinisation scores (EMS) of the patients with the female phenotype were 0?2.5. Twelve patients with the male phenotype were in pre-adolescent state, among whom 4 patients had hypospadias combined with cryptorchidism, 3 patients had hypospadias, 3 patients had small testicles, and 2 patients had normal external genitalia. The EMS of them ranged from 4 to 12, with a mean score of 10.5. All the patients with the female phenotype had hypergonadotropic hypogonadism, while most of the patients with the male phenotype had gonadotropin levels matched with their age. There were 3 patients with the female phenotype having gonadoblastomas.


    ·The 45,X/46,XY mosaicism patients present a wide spectrum of manifestations. The risk of gonadal malignancy onset should be emphasized. EMS has guiding significance for clinical evaluation of these patients.

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    Diagnosis and treatment protocol of mandibular condylar fracture: experience from the TMJ Center of Shanghai Ninth People 's Hospital, Shanghai Jiao Tong University School of Medicine
    HE Dongmei, YANG Chi
    Journal of Shanghai Jiao Tong University (Medical Science)    2022, 42 (6): 695-701.   DOI: 10.3969/j.issn.1674-8115.2022.06.001
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    Mandibular condylar fracture is common in clinic. Improper treatment will cause sequelae such as malocclusion, ankylosis and limited mandibular development. This paper combines the literature review and the diagnosis and treatment experience of the team to provide reference for clinicians. Imaging diagnosis, especially coronal CT reconstruction, is the basis for classification and treatment of condylar fracture. According to the fracture location, it is divided into condylar (intracapsular) fracture, condylar neck fracture and subcondylar fracture. And intracapsular fracture can be further divided into four types: A, B, C and M. The treatment of condylar fracture includes non-surgical treatment and surgical treatment. For non-surgical treatment, intermaxillary elastic traction is recommended for malocclusion correction. The absolute indication of surgical treatment is the ramus stump dislocated out of the fossa. The relative indications include the stump of the mandibular ramus contacting the articular fossa, severe displacement or dislocation of the condylar neck and subcondylar fracture. The key points of successful operation include adequate exposure, anatomic reduction and stable fixation, protection of lateral pterygoid muscle attachment and articular cartilage, and reposition of the temporomandibular joint disc. For the condylar fracture combined with mandibular fracture, lingual fissure of the mandible should be closed during reduction and fixation for restoring the mandibular width and condylar position in the fossa. When the condylar fracture is combined with midface fracture, the condylar fracture and occlusal relationship should be restored first, and then the maxillary fracture should be fixed according to the lower dentition. The children under 6 years old have the stronge ability of condylar remodeling, so non-surgical treatment is commonly used. The healing and remodeling ability of condyle gradually decreases with age. The condyles of the teenagers over 12 years old are close to those of the adults, so the indications of surgical treatment for condyle fracture refer to the adults.

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    Preparation of cell membrane-coated nanoparticles and its application to antimicrobial
    Ting-wang SHI, Yun-feng CHEN
    JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE)    2021, 41 (7): 953-958.   DOI: 10.3969/j.issn.1674-8115.2021.07.017
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    Due to the complex pathophysiological characteristics of the infected microenvironment and the development of bacterial resistance, conventional antibiotic treatments are facing increasingly more clinical challenges. Cell membrane-coated nanoparticle (CMCNP) is a kind of biomimetic materials emerging in recent years which can be obtained by directly wrapping the membrane vesicles onto the nanoparticle cores through physical means. Recently, CMCNP has displayed a wide application prospect in the areas of targeting infected areas, neutralization of bacterial toxins and development of antibacterial vaccines with the help of biological functions of cell membrane vesicles and the superior physicochemical properties of nanoparticles. However, CMCNP is still at the experimental stage in the biomedical field, and its safety and effectiveness need to be further verified for clinical applications.

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    Progress in metabolism of the immune cells in tumor microenvironment
    LIN Jiayu, QIN Jiejie, JIANG Lingxi
    Journal of Shanghai Jiao Tong University (Medical Science)    2022, 42 (8): 1122-1130.   DOI: 10.3969/j.issn.1674-8115.2022.08.018
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    Metabolic reprogramming refers to cells' mechanism to change their metabolic patterns in order to meet the increased energy demand caused by growth and proliferation. By way of metabolic reprogramming such as the Warburg effect, tumor cells gain rich energy to support their own survival, growth, and metastasis. The tumor microenvironment (TME) is the internal environment in which tumor cells survive, containing not only tumor cells, but also stromal cells, immune cells, and other components that are closely related to tumor cells. Meanwhile, tumor cells regulate intercellular function and signaling via secreting cytokines, metabolites, and other molecules and shape a commonly hypoxic, acidic, and nutrient-deprived TME which contributes the most to immune resistance. However, rapidly proliferating tumor cells compete for relatively scarce nutrients with immune cells, consequently, producing an immunosuppressive metabolism microenvironment. Under the influence of immunosuppressive TME, immune cells generate tolerance phenotype-related metabolic adaptations through metabolic reprogramming to satisfy their own needs and further perform anti-tumor or immunosuppressive roles. The response of immune cells to tumor cells mainly depends on respective unique metabolic pathways, which are related to the type and function of immune cells. Moreover, the functional properties of immune cells are directly associated with the immunotherapy effects. Regulating metabolic pathways of immune cells provides a great direction for cancer therapy. In this paper, the main metabolic pathways of immune cells in TME is described, the relationship between their metabolic characteristics and immune functions is summarized, and the mechanism of metabolic pathways underlying the functions of immune cells is further discussed, providing new insights for unveiling tumor immunosuppressive microenvironment and improving the efficacy of tumor immunotherapy.

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    Application progress of machine learning in the study of facial features of patients with depression
    Xin LI, Qing FAN
    JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE)    2022, 42 (1): 124-129.   DOI: 10.3969/j.issn.1674-8115.2022.01.019
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    Major depressive disorder (MDD) is a mental illness that severely affects the quality of life, accompanied by changes in facial expressions and other behaviors. The current diagnosis for MDD mainly relies on self-reports and observations from doctors, which has subjective errors. There is a lack of objective and effective automated MDD detection methods. Facial expressions are important nonverbal behaviors, and the researchers have begun to use facial features to assist in identifying and diagnosing depression. As the core of artificial intelligence, machine learning has outstanding advantages in image feature extraction and classification. Taking IEEE Xplore database as the data source, this article sorts out the researches on the facial features of MDD patients based on machine learning from 2016 to 2021, and prospects the future research directions, to provide reference for clinical intelligent diagnosis and tracking of MDD in the future.

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