ABSTRACT
Objective To compare the clinical effects of vesselplasty and percutaneous kyphoplasty in the treatment of osteoporotic thoracolumbar vertebral fracture in the elderly.Methods A retrospective case control study was conducted to analyze 52 cases of OVCFs treated from August 2013 to May 2015.According to treatment method,the patients were assigned to vesselplasty (Group A) and percutaneous kyphoplasty (Group B).Group A (25 cases,38 vertebrae) included 11 males and 14 females,aged (63.6 ±8.3)years (range,60-89 years).In Group A,there were nine cases of T11,10 T12,13 L1,and six L2.Group B (27 cases,41 vertebrae) included 10 males and 17 females,aged (64.1 ±9.6)years (range,63-87 years).In Group B,there were seven cases of T11,13 T12,12 L1,and nine L2.The bone cement leakage before operation,after operation,and at the last follow-up were recorded.The operation time,average fluoroscopy frequency,visual analog score (VAS),vertebral reduction height,Cobb angle,and Oswestry disability index (ODI) changes were compared between two groups.Results All patients were followed up for 6-18 months (mean,12 months).The operation time was (29.3 ± 4.1)minutes in Group A and (35.7 ± 5.2) minutes in Group B (P ＜ 0.05).The number of fluoroscopy was (9.3 ± 1.5) times in Group A and (13.1 ±3.7)times in Group B (P ＜0.05).The VAS at the last follow up was (1.3 ±0.3) points in Group A and (1.4 ± 0.3) points in Group B;the ODI at the last follow up was 32.5 ± 6.7in Group A and 30.5 ± 5.3 in Group B;the injured vertebral height at the last follow up was (85.3 ±9.7)％ in Group A and (82.7 ±10.4)％ in Group B;the Cobb angle at the last follow up was (11.3 ±5.3) ° in Group A and (12.7 ± 6.1) ° in Group B.VAS,vertebral reduction height,and Cobb angle were all improved significantly compared with those before operation (P ＜ 0.05),but there was no significant difference between two groups (P ＞0.05).The leakage rate was 3％ in Group A and 26％ in Group B (P ＜ O.05).Conclusion Both vesselplasty and percutaneous kyphoplasty can quickly relieve the pain and effectively restore the height of injured vertebra.But vesselplasty can reduce bone cement leakage more effectively,thus being a better treatment for osteoporotic thoracolumbar vertebral fracture in the elderly.
ABSTRACT
Objective To observe the change of intima/media thickness ratio and expression of inflammatory factors in renal small artery of diabetic rats, and to explore the correlations of intim/media ratio with inflammatory factors and vascular lesions of diabetic nephropathy (DN) rats. Methods Seventy healthy SD rats were randomly divided into diabetic nephropathy group (DN, n=40) and normal control group (N, n=30). DN rat model was induced by intraperitoneal injection of streptozotocin (STZ). Thirty-five DN rats were successfully established. N group received same dose of citrate buffer. Rats were sacrificed after 4, 12, 24 weeks respectively.The intima/media thickness ratio in renal small artery was detected by immunofluorescence. The monocyte chemoattractant protein-1 (MCP-1) protein and mRNA expression of renal small artery were detected by immunohistochemistry and in-situ hybridization at each time point. Results Blood glucose and urine protein excretion (24 h) at different time points in DN group were significantly higher than those of N group (P＜0.05). From the 12th week, Scr, BUN, serum phosphorus were significantly higher than those of N group (P＜0.05). At the 4th week, renal small artery had the expression of MCP-1 protein and mRNA. The expression increased gradually with time, reached the highest at the 24th week, and was significantly higher than that of N group at each time point (P＜0.05). Immunofluorescence results showed that as compared to N group, in the first 4 weeks, intima/media thickness ratio in DN group was not different, at the 12th week the ratio was higher but without significant difference, at the 24th week the ratio was significantly higher (P＜0.05). Small artery intima/media thickness ratio of DN group was positively correlated with MCP-1, cholesterol, triglyceride, serum phosphate (r=0.742, P＜0.01; r=0.740, P＜0.01; r=0.829, P＜0.01; r=0.580, P＜0.01). Conclusions The arterioles intima/media thickness ratio of early DN is significantly correlated with MCP-1, lipids and phosphorus. MCP-1 may be involved in the DN vascular disease.
ABSTRACT
Objective To observe the expression of bone matrix proteins and the change of intima-tunica media thickness ratio in diabetic rat small renal artery and to explore their correlation and effects on diabetic nephropathy. Methods Seventy healthy SD rats were randomly divided into diabetic group(DN,n=40)and normal control group(N,n=30).DN rat model was induced by streptozotocin(STZ)intraperitoneal injection and the N group rats were given the same dose of citrate buffer.Thirty-five rats were successfully induced in DN group.The rats were sacrificed at week 4,12 and 24,respectively.The protein and mRNA expression of core-bind factor alpha 1(Cbfcd).bone morphogenetic protein 2(BMP-2)and matrix Gla protein(MGP)in smallrenal artery were detected by immunohistochemistry,in-situ hybridization and real-time PCR at each time point. Results Cbfctl and BMP-2 were expressed obviously in small renal artery of DN group by immunohistochemistry stain and in-situ hybridization from 4 to 24 weeks compared with N group at each time point,reaching the peak at week 24.Real-time PCR showed that the MGP mRNA was evidently increased at week 4,slightly decreased at week 12,lowest at week 24in DN group.The BMP-2 mRNA began to increase from week 4 onward,being peak at week 24in DN group.The ratio of intima to tunica media thickness had no significant difference in DN group compared with N group at week 4,but at week 12 and 24 there were significant difference between them.There was a positive correlation between Cbfα1 and BMP-2 expression,but they were negatively correlated with the expression of MGP.The ratio of intima to tunica media thickness was significantly-correlated with the expression of Cbfα1 and BMP-2. Conclusions The ratio of intima to tunica media thickness is positively correlated with Cbfα1 and BMP-2 in small renal artery of early DN.Cbfα1,BMP-2 and MGP may be involved in the progression of vascular lesions in DN.
ABSTRACT
Objective To summarize the experience of prophylaxis and treatment of acute renal failure (ARF) following orthotopic liver transplantation (OLT). Methods The clinical data of 63 cases of ARF following OLT were analyzed retrospectively. Results Preoperatively, 12 out of 63 patients had renal dysfunction to varying degrees, 28 had serious peritoneal fluid and advanced hyperbil-irubinemia. Postoperatively, complication included pulmonary infection (28 cases), MOSF (26 cases) and intraperitoneal dropsy or empyema (9 cases). Cyclosporin A, mycophenolate and tacrolimus were all used to prevent rejection. Dopamine was used in some patients to improve renal perfusion. Meanwhile, diuretic and albumin, and fresh blood plasma were used to support patients. Twelve severe cases received CRRT. Average treatment duration was 50 h. Twenty-six patients died within one month postoperatively with the mortality rate of this group being 41.27 %. Conclusions The etiology of ARF following OLT is multifactorial. It's important to evaluate renal function preoperatively and to avoid infection, apply immunosuppressant individually and improve renal perfusion postoperatively.