ABSTRACT
Objective:To compare the efficacy of fusion and non-fusion hybrid operation with Dynesys system with the traditional fusion operation with rigid instrumentation in the patients with multi-segment lumbar degenerative disease.Methods:A total of 30 patients with multi-segment lumbar degenerative disease who were subjected to operation from January 2017 to October 2019 in Shenzhen People's Hospital were included in the study. There were 13 males and 17 females, age: 60.8±13.2 years, range: 25 to 83 years. 28 patients with two segments, 1 with three segments, and 1 with four segments. The patients were divided into two groups, i.e the hybrid operation group (13 cases, 9 males and 4 females, average age: 56.6 years, range: 25 to 83 years) versus the traditional fusion group (17 cases, 4 males and 13 females, average age: 63.9 years, range: 46 to 80 years). The main outcome measures were visual analogue scale (VAS), Oswestry disability index (ODI), range of motion (ROM), adjacent segment degeneration (ASD) and complications.Results:There were no statistically significant differences in operation data, such as operation time, intraoperative blood loss, postoperative drainage volume and length of hospitalization, between the two groups. There were no significant differences for ROM in the surgical segments between the two groups before operation (hybrid group and traditional group were 9.6°±4.9° vs. 8.9°±6.1°, t=0.341, P=0.736, respectively). However, after 12 months follow-up, the ROM disappeared in the traditional group and was partially preserved in the hybrid group, with statistically significant differences (hybrid group and traditional group were 5.4°±2.7° vs. 0°, t=9.104, P=0.001, respectively). There was a statistical difference in intervertebral disc height between the two groups at 12 months post-operation, though no statistical difference was found before operation (8.8±1.9 mm vs. 10.5±1.7 mm, t=2.927, P=0.006). There was no statistically significant difference in the intervertebral disc height of the upper adjacent vertebrae between the two groups before and after operation. There were statistically significant differences in ODI scores before operation (63.4%±11.0% vs. 71.3%±9.2%, t=2.146, P=0.041), and 12 months post-operation (17.2%±2.1% vs. 15.5%±2.3%, t=2.091, P=0.046), while no statistical difference was found in VAS scores. Conclusion:The fusion and non-fusion hybrid operation with Dynesys system has comparable clinical efficacy with the traditional fusion operation with rigid instrumentation in the treatment of multisegment lumbar degenerative disease. Meanwhile, the hybrid surgery can preserve the motion of surgical segments and provide a dynamic stability of the vertebral body. The hybrid surgery can be used as a new surgical method for multi-segment lumbar degenerative disease.
ABSTRACT
Objective To study the distribution characteristics of peripheral blood stem cell-like memory T cells ( TSCM) in patients with gastric cancer and to analyze their relationship to clinicopathologi-cal characteristics and clinical application value. Methods Thirty-two patients hospitalized with gastric cancer in our hospital from July to December, 2018 were selected as the case group. Twenty-three healthy volunteers recruited during the same period served as the control group. The percentages of TSCM, naive T cells ( TN) and memory T cells ( TM) were detected by flow cytometry and the differences between the two groups were compared. The relationship of clinicopathological features to TN, TSCM, TSCM/TN ratio and TM was analyzed. Results The percentages of TN and TSCM in peripheral blood of the patients were signif-icantly lower than those of the healthy control group, while the ratio of TSCM to TN was significantly in-creased in the case group (all P<0. 05). The proportion of TN was negatively correlated with tumor TNM stage and invasion depth, and positively correlated with the degree of tissue differentiation. The ratio of TSCM to TN was positively correlated with TNM stage, invasion depth and lymph node metastasis. Conclu-sions TN and the ratio of TSCM to TN in peripheral blood of patients with gastric cancer are closely related to clinical and pathological characteristics such as tumor stage and invasion depth, which could be used as a new way to evaluate the immune status of patients. TSCM might have important clinical application value in adoptive cellular immunotherapy of gastric cancer, but large-scale multi-center clinical studies are needed for further evaluation.
ABSTRACT
Objective To analyze the serum gastric function and Helicobacter pylori ( HP ) infection in patients with gastric hyperplastic polyps and gastric fundic gland polyps.Methods From December 2017 to December 2018, 135 patients with gastric polyps and pathologically confirmed gastric hyperplastic polyps and gastric fundic gland polyps were enrolled in the hospital of Xuzhou Medical University.Among them, 68 patients with hyperplastic polyps, 67 cases of the gastric fundic gland polyps.Serum Hp antibodies ( UreA, UreB, VacA, CagA antibodies ) were qualitatively detected by immunoblotting.Eighty patients with chronic superficial gastritis were selected as the control group.Three groups of serum pepsinogen?I ( PG?I),pepsinogen?Ⅱ( PG?Ⅱ),gastrin were detected by enzyme?linked immunosorbent assay (ELISA).Gastrin?17( G?17) and calculate PGⅠ and PGⅡ ratio( PGR).Results The levels of serum PGⅡ(13.13(8.15,20.30) μg ／L) and G17 (8.44(3.72,27.17) pmol／L) in the gastric hyperplastic polyp group were higher than those in the control group (9.16(5.56,15.14) μg／L and 1.83(0.87,5.95) pmol／L) ( P＜0.05),and the PGR level was lower than the control group ( P＜0.05);serum PGI ( 120.12 ( 86.72,174.70) μg／L), PGII ( 11.92 ( 7.27,22.26) μg／L),G17 ( 5.68 ( 1.79, 14.65) pmol／L) in the gastric fundic gland polyp group was higher than the control group (( 101.32 (79.17,131.33) μg ／L,9.16 ( 5.56,15.14) μg ／L,1.83 ( 0.87,5.95) pmol／L) ( P 均＜0.05)) ( P＜0.05); serum G17 (8.44(3.72,27.17) pmol／L) level in gastric hyperplastic polyp group was higher than gastric fundus polyp group (5.68(1.79,14.65) pmol／L) ( P＜0.05); Hp infection rate in gastric hyperplastic polyp group61.76%(42／68)was higher than that in the gastric fundic gland polyp group40.30%(27／67) (P＜0.05),and type I Hp was the main one (P＜0.05).The serum PGⅡ and G17 levels in the gastric hyperplastic polyp group were higher than those of Hp negative ( all P＜0.05).There were no significant differences in serum PGI, PGⅡ, G17, and PGR levels between the HP?positive and negative?positive patients in the gastric fundus polyp group.The serum PGI and PGR levels in the hypertrophic polyp group were higher than those in the HPⅡ type ( all P＜0.05).There was no significant difference in the levels of serum PGⅠ,PGⅡ,G17,and PGR between the gastric fundic gland polyps group and the type Ⅱ.Conclusion Serum PG and G17 levels in patients with gastric hypertrophic polyps and gastric fundic gland polyps are higher than those in patients with chronic superficial gastritis.Patients with gastric hyperplastic polyps have higher HP infection rate and abnormal gastric function than gastric fundic gland polyps.
ABSTRACT
Objective To analyze the clinical value of transforaminal endoscopic minimally invasive surgery for the treatment of recurrent lumbar disc herniation.Methods Strictly included in the criteria,47 patients diagnosed with recurrent lumbar disc herniation who was treated unsuccessfully with conservative treatment were selected from our department from May 2011 to December 2015.There were 31 males and 16 females,with an average age of 43.45 ±3.37 years old (29-62 years old).There were L3,4 section in 4 cases,L4,5 section in 32 cases,and L5S1 section in 11 cases.The interval between the first operation and the reoperation was between 10 and 185 months,with an average of 49 months.In the first operation,there were 11 cases of posterior intervertebral disc endoscopy (MED) surgery,and 36 cases of decompression of vertebral disc nucleus pulposus surgery.Take a prone position under local anesthesia percutaneous puncture intervertebral foramen in the endoscopic minimally invasive surgery,intraoperative decompression of vertebral canal and nerve root canal,removal of intervertebral disc nucleus pulposus tissue,explore and release nerve root.The Oswestry disability index (ODI),visual analogue scale (VAS) and improved Macnab standard were used to assess the efficacy of the operation.Operation segments intervertebral height change,lumbar power X-ray slice of intervertebral Angle was measured according to preoperative and last follow-up of lumbar lateral X-ray observation,and lumbar spine motion (the range of motion,ROM) was calculated.Results All cases were successfully performed,no open surgery,and all cases were followed up.The average surgical blood volume was 10.3± 2.7 ml,the operation time was 63.5±11.6 min,no nerve root injury,dural injury,cerebrospinal fluid leakage,muscle strength decline,secondary obstruction,lumbar instability or other serious complications occurred.The follow-up time was from 18 to 52 months,with an average of 35.5±5.1 months.The preoperative ODI 51.35± 15.29 decreased to 3.31 ±2.17 at the last postoperative follow-up,the preoperative VAS score 8.11 ± 1.05 decreased to (1.03± 0.81) at the last postoperative follow-up,and the difference was statistically significant (P ＜ 0.05).As to the last follow-up evaluation of curative effect,according to the modified MacNab method,the fine rate was 87.2％;At the time of the last follow-up,surgery intervertebral disc height of front and rear section before and after surgery had no significant differences (P ＞ 0.05),the motion of operation segmental lumbar (the range of motion,ROM) had no significant difference (P ＞ 0.05).Conclusion Under the premise of strict control of surgical indications,the clinical efficacy of minimally invasive surgery for the treatment of recurrent lumbar disc herniation is reliable.The transforaminal approach does not affect the stability of the spine.The operation has the advantages of small trauma,fewer complications,and is safe and effective.
ABSTRACT
BACKGROUND:At present, vertebroplasty and spinal canal decompression are common methods for treatment of metastatic spinal tumors. Iodine-125 (125 I) radioactive seed implantation has been shown to control the tumor. However, there were few clinical studies on combined therapy using above-mentioned methods. OBJECTIVE:To compare the differences of 125I radioactive seed implantation combined with vertebroplasty and titanium al oy nail-rod fixation and vertebroplasty combined with titanium al oy nail-rod fixation for treating thoracolumbar metastases on pain control, general performance and improvement of the spinal cord function, and to evaluate clinical value of 125 I radioactive seed implantation combined with therapeutic plans. METHODS:Thoracolumbar metastases patients undergoing titanium al oy nail-rod fixation were selected in the Department of Spinal Surgery, Shenzhen Municipal People’s Hospital in China from October 2009 to March 2013. They were assigned to experimental and control groups according to with or without 125 I radioactive seed implantation. Improvement in neurological function was observed before and 2 weeks, 1, 6, and 12 months after titanium al oy nail-rod fixation in both groups. RESULTS AND CONCLUSION:Al patients were fol owed up for 7 to 29 months, averagely 15.8 months. There was no loosening of titanium al oy nail-rod fixation and the position of bone cement was good. No seed migration or radioactive spinal cord injury was observed. No relapse or diffusion in the surgical site was observed during fol ow up. Visual Analogue Scale and Karnofsky Performance Status scores were higher in the experimental group than in the control group (P0.05). Results indicated that 125 I radioactive seed implantation combined with vertebroplasty and titanium al oy nail-rod fixation for treatment of metastatic spinal tumors showed obvious outcomes in relieving cancer pain.