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Objective:To identify the incidence and risk factors related to lumbodorsal fasciitis in acute osteoporotic vertebral compression fractures (OVCF).Methods:The clinical data of 1182 acute OVCF hospitalized in Zhongda Hospital Southeast University between June 2016 and October 2020 were retrospectively analyzed, including 219 males and 963 females, aged 72.19±9.39 years (range, 45-98 years). The demographics, comorbidity profile, spine trauma, back pain duration, and vertebral fracture number of the OVCF with or without lumbodorsal fasciitis were summarized and compared. The independent risk factors of lumbodorsal fasciitis were identified by binary logistic regression analysis.Results:There were 532 cases of OVCF complicated with lumbodorsal fasciitis among 1,182 patients, and the incidence was 45.01%. The OVCF with fasciitis had higher ratio of males (23.5%, 125/532) than the OVCF without (14.5%, 94/650) fasciitis (χ 2=15.82, P<0.001). The OVCF with fasciitis were aged 74.57±9.21 years and significantly older than the OVCF (aged 70.24±9.60 years) without fasciitis ( t=7.85, P<0.001). The highest proportion of patients with OVCF combined with fasciitis was ≥80 years old (36.1%, 192/532), while most (34.6%, 225/650) of the OVCF without fasciitis were aged 60-70 years (χ 2=56.27, P<0.001). The OVCF with fasciitis had higher ratio of no evident spine trauma (37.0%, 197/532) and multiple vertebral fractures involving ≥3 vertebra (10.5%, 56/532) than the OVCF without fasciitis [26.3% (171/650), 3.2% (21/650); χ 2=17.67, P<0.001; χ 2=40.63, P<0.001]. The ratio of pre-hospital back pain >4 weeks was higher in the OVCF with (20.7%, 110/532) than without (7.4%, 48/650) fasciitis (χ 2=62.46, P<0.001). The OVCF with fasciitis had higher comorbidity of hypertension (52.8%, 281/532), coronary heart disease (14.7%, 78/532), and cerebral infarction (24.8%, 132/532) than the OVCF without fasciitis [42.8% (278/650), 9.9% (64/650), 17.9% (116/650); χ 2=11.85, P<0.001; χ 2=6.42, P=0.011; χ 2=8.56, P=0.003]. The OVCF with fasciitis had higher ratio of two comorbidities (23.7%, 126/532) than the OVCF without fasciitis (16.1%, 105/650) (χ 2=21.15, P<0.001). Binary logistic regression analysis showed significantly higher risk of lumbodorsal fasciitis in males than in females ( OR=1.69, P=0.001), in age group 60-<70、70-<80 and ≥80 years than in <60 years ( OR=2.28, P=0.002; OR=2.64, P<0.001; OR=4.90, P<0.001), in back pain for 2-<4 weeks and >4 weeks than in ≤1 week ( OR=1.70, P=0.005; OR=3.81, P<0.001), and in multiple fractures involving 2 and ≥3 vertebra than in single vertebrae ( OR=1.75, P=0.003; OR=3.36, P<0.001). Conclusion:Up to 45% of acute OVCF have concurrent lumbodorsal fasciitis. Male, aged ≥60 years, pre-hospital back pain ≥2 weeks, and fractures in ≥2 vertebra are independent risk factors of lumbodorsal fasciitis in OVCF.
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Objective:To identify the anatomical distribution of and factors related to single-segment osteoporotic vertebral compression fractures (OVCF).Methods:The radiology and clinical data of 944 patients with single-segment OVCF hospitalized in Zhongda Hospital Southeast University between June 2016 and October 2020 were retrospectively analyzed, including 175 males and 769 females, aged 72.1±9.6 years (range, 45-97 years). The anatomical distribution of OVCF was quantified. The demographics, comorbidity profile, spine trauma, back pain duration, vertebral compression degree, and bone mineral density of the OVCF patients in different anatomical segments were summarized and compared.Results:Of the 944 single-segment OVCF, 864 were located in the lower thoracic and lumbar spine that peaked at L 1 (Modal-1 group), and 80 were located in the middle and upper thoracic spine (Modal-2 group) that peaked at T 7, demonstrating an asymmetric bimodal distribution. The difference in the female/male ratio between the two groups was insignificant (χ 2=0.06, P=0.803). Patients in Modal-2 were aged 75.0±9.8 years and on average older than the patients (aged 71.8±9.6 years) in Modal-1 ( t=2.78, P=0.005). The female patients in Modal-2 (aged 75.0±9.6 years) were significantly older than that (aged 71.2±9.3 years) in Modal-1 ( t=3.17, P=0.002). The ratio of back pain duration for <1 week in Modal-2 (43.8%) was lower than that in Modal-1 (60.2%), and the ratio of back pain for 1-weeks (28.8%) was significantly higher than that (15.5%) in Modal-1 (χ 2=11.50, P=0.009). The most frequently reported spine traumas in Modal-2 (50.0%) were heavy lifting injury, lumbar sprain, and strenuous cough, which were significantly different from and less apparent than the fall on ground or crush injury to the spine (64.1%) in Modal-1 (χ 2=60.71, P<0.001). The anterior to posterior height ratio of the fractured vertebrae in Modal-2 was 0.78±0.13, 0.83±0.14, 0.84±0.13, and 0.78±0.18 in the OVCF patients complaining of back pain for <1 week, 1-weeks, 2-weeks, and >4 weeks respectively, showing no significant difference between groups ( F=1.01, P=0.009). In Modal-1, the anterior to posterior height ratio of the fractured vertebrae was lower in the OVCF patients complaining of back pain for 2-weeks (0.80±0.15) and >4 weeks (0.77±0.19) than in those with back pain for <1 week (0.85±0.11) and 1-weeks (0.86±0.14), with sinificant differences ( P<0.05). 32.4% (306/944) of the OVCF patients had one of the following geriatric comorbidities: hypertension, diabetes mellitus, coronary heart disease, cerebral infarction, and chronic obstructive pulmonary disease. The OVCF patients in Model-2 had higher comorbidity of coronary heart disease (21.3%) and cerebral infarction (36.3%) than those in Model-1 (11.6% and 20.3%). Bone mineral density information was available from 371 patients (308 females). In the age groups of <70, 70-, and >80 years, no significant difference was detected in the T-score values of the lumbar spine or hip joint between the OVCF patients in Model-1 and Model-2 ( F=0.13, P=0.880; F=0.62, P=0.538). Conclusion:Single-segment OVCF feature an asymmetric bimodal distribution that is demarcated by the T 10 vertebrae. The distribution pattern is not determined by gender or baseline bone mineral density but highlights the risk of mechanical stress and vertebral fragility within a specific segment. OVCF in the middle and upper thoracic spine is less frequent but common in older patients with higher comorbidity of coronary heart disease and cerebral infarction, which tend to be caused by less apparent spine trauma and maintain vertebral compression but complain of long back pain duration.
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To compare the clinical efficacy of treating Denis type B thoracolumbar burst fracture with allogenic bone and calcium sulfate implanting in injured vertebra.A total of 46 patients were randomly assigned into 2 groups.Group A( n=22) received allogenic bone implanting in injured vertebra while group B( n=21) had calcium sulfate grafting in injured vertebra.Group A was better than group B in maintaining tanterior vertebral body height and lessening the degree of bone defect ( P 0.05).
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@#ObjectiveTo observe the changes of artery diameters, cerebral blood flow and glutamate level in the early stage (2 h after the stimulus finished) of acute mechanical middle cerebral artery (MCA) vasospasm in cats. MethodsThe right MCA was persistently mechanically stimulated using a small smooth stainless steel nail in the field across the olfactory tract for 30 min. The diameter of MCA was recorded with metrical ocular of microscope. The changes of the perfusion index of brain tissue were observed through the Laser Doppler flowmetry monitor fixed on the skull. The level of glutamate were investigated through high performance liquid chromatography. ResultsThe diameter of MCA decreased to 68.8% of normal. 2 h later, the diameter of MCA recovered. The perfusion index of the cortex surface decreased to 42.6% of normal and up to 63.8% 2 h later. The level of glutamate raised about 40 times of normal and maintained a high level 2 h after the mechanical stimulus. ConclusionThe persistent mechanical stimulus can cause acute cerebral vasospasm. Reduce of cerebral blood flow and raise of excitatory amino acids were observed in the early stage of acute mechanical vasospasm.
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BACKGROUND:Cerebrovascular drag, occlusion and other mechanical stimulations inevitably occur during some craniocerebral operations, which cause acute mechanical cerebrovascular vasospasm. At present, the mechanism underlying the patho-physiology as well as the pathological prognosis of this acute mechanical vasospasm remains unclear.OBJECTIVE: To observe changes in the vascular diameter of the middle cerebral artery, cerebral blood flow (CBF), and ultrastructure of vascular wall and vascular endothelial cells, during the early stage (2 hours) of mechanical cerebral vasospasm in cats.DESIGN: Open experiment.SETTING: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; Beijing Institute of Neurosurgery.MATERIALS: Six healthy adult hybrid cats, of either gender, weighing from 2.5 to 3.5 kg, were provided by the China Medical Science Institute of Experimental Animals. Laser Doppler flowmetry (Periflux 5010, Sweden Perimed Company)was used.METHODS: This study was carried out in the Beijing Institute of Neurosurgery between August 2005 and March 2006. For all experimental surgical procedures, the cats were anesthetized by intraperitoneal injection of 200 g/L chloral hydrate, at 2 mL/kg, and then placed in a prone position. A median incision was made in the scalp and a square bone window, 8×10 mm, was opened at 1.5 cm posterior and 1.5 lateral to the anterior fontanel, after which the dura mater was pricked out. The fine detecting head of the Laser Doppler flowmetry was fixed to a region of the cerebral surfacewith no vessels or with only a few vessels. Subsequently, the cats were placed in lateral position. Under the surgical microscope, the right middle cerebral artery was exposed through a suborbital approach. Blunt apparatus was used to stimulate middle the middle cerebral artery repeatedly, at a frequency of 100 time/min within 30 minutes.The diameter of the middle cerebral artery was measured and a perfusion index of cortical brain tissue was monitored, separately, before and then at 0, 0.5, 1.0, 1.5, 2.0 hours after stimulation. Ultrastructural changes in the vascular wall and the vascular endothelial cells were observed during the early stage (2 hours) of mechanical cerebral vasospasm in cats.MAIN OUTCOME MEASURES: Diameter of the middle cerebral artery and the perfusion index of cortical brain tissue before and then at 0, 0.5, 1.0, 1.5, 2.0 hours after stimulation, as well as any ultrastructural changes in the vascular wall and endothelial cells 2 hours after stimulation.RESULTS: The results from six cats were were analyzed. ①The diameter of the middle cerebral artery was (0.617±0.129), (0.723±0.082), (0.840±0.084) mm 0, 0.5 and 1.0 hours after stimulation, respectively, which was significantly smaller than that before stimulation [(0.897±0.066) mm,t =4.74, 4.017, 1.299,P ＜ 0.01]. ② The perfusion index of cortical brain tissue was 67.8±18.5, 82.5±17.5, 89.8±24.0, 94.0±22.2 and 98.5±21.0 at 0, 0.5, 1.0,1.5 and 2.0 hours after stimulation, which was significantly lower than that before stimulation (159.2±23.5, t =4.716-7.469, P ＜ 0.01 ). ③ At the early stage of acute mechanical stimulation (2 hours) to middle cerebral artery, endothelial cell chromatin aggregated at the edge of the cells and achromocyte formed, but mitochondrial crista was unclear.CONCLUSION: Mechanical stimulation to the middle cerebral artery in cats can lead to cerebral vasospasm. Apoptosis of endothelial cells appears at the early stage of stimulation (2 hours). These results indicate that, in order to prevent against cerebral vasospasm, cerebrovascular mechanical stimulation should be as minimal as possible and that as few as possible craniocerebral operations should be performed.
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[Objective]To study the biocompatibility and security of the recombinant human bone morphogenetic protein-2(rhBMP-2) loaded amorphous calcium phosphate(ACP) delayed release nano-sized material and investigate the feasibility of the clinical use as a kind of bone substitute in bone engineering.[Method]The in vitro hemolyzation,cytotoxicity,microkernel test in marrow smear,acute systemic toxicity,pyrogenicity,subcuticular stimulation reaction and short-term intramuscular implantation,as well as endosseous implantation were performed on the rhBMP-2/ACP delayed release nano-sized material.[Result]The material-extracted liquid induced no hemolyzation,no toxic effects of genetic,no pyrogenic reaction in rabbits,no cytotoxicity cultured in rabbit bone marrow-derived mesenchymal stem cells(BMSCs) in vitro and no acute toxicity in mice.The intramuscular implantation and endosseous implantation in rabbits induced no inflammatory reaction,tissue necrosis and the material was degraded gradually,fused organically with tissues.[Conclusion]The biocompatibility and security of the rhBMP-2/ACP delayed release nano-sized material could meet the requirements given in biological standards for implanted biomaterials ISO10993 and GB/T16886,suggesting that it could be a good bone substitution for the clinical trial.
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[Objeetive] To develop the recombinant human bone morphogenetic protein-2(rhBMP-2)loaded amorphous calcium phosphate(ACP)delayed release nano-sized material,investigate its cytotoxicity of cell,and provide a reference for the experiment of composite material in vivo.[Method]The rhBMP-2/ACP delayed release nano-sized material were prepared by chemical wet method and cultured on rabbit bone marrow-derived mesenchymal stem cells(BMSCs)in vitro.Then the adhesion,proliferation,growth and functional expression of BMSCs were measured.[Result]Cytotoxicity test demonstrated that rhBMP-2/ACP delayed release nano-sized material had not affect the percentage of cell's proliferation with material-extracted liquid cultured with BMSCs and the cytotoxicity was graded zero.The adhesion,proliferation,configuration of the cells on the surface of this material were identical to the control group.[Conclusion]It was suggested that rhBMP-2/ACP delayed release nano-sized material might have good cellular biocompatibility,no cytotoxicity and not effected the normal functional expression of BMSCs in vitro.
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BACKGROUND: The neural stem cells (NSCs) will be clinically applied extensively in the future, and seeking of more promoting methods of the proliferation and differentiation of NSCs in vitro will be the study direction of NSCs.OBJECTIVE: To introduce an economic and time-saving method for NSCs proliferation.DESIGN: Observation and control experiment.SETTING: Beijing Neurosurgical Institute.MATERIALS: Four Wistar rats pregnant for 14 days with the body mass of (180±20) g (bought from Animal Department of Chinese Academyof Medical Sciences with the batch number of SCXK1100-0006 for experiment animals) were selected and fed at common temperature and humidity.The DMEM/F12 and B27 were bought from Gibco Corporation. The basic fibroblast growth factor (bFGF) and epidermal growth factor (EGF) were bought from PeproTech Company. The nidogen monoclonal antibody (MA),glial fibrillary acidic protein (GFAP) polyclonal antibody, galactocerebroside polyclonal antibody and microtubule-associated protein 2 (MAP2) were obtained from Chemicon Company. The fetal bovine serum (FCS) was provided by Hyclone company.METHODS: The experiment was conducted in the Department of Injury and Repair of Beijing Neurosurgical Institute from May to October 2004.Wistar rats were executed by dislocation and sterilized by putting into 75% alcohol. Four rats were used each time, the brain tissues of which were put into Hank's fluid. The cerebral pia mater and vessels were isolated under anatomical microscope, and the brain tissues were sheared off with eye scissors, which were filtered by 200 mesh copper grid and collected into 2 centrifuge tubes, and the supernatant was gotten rid off after that. ①Cells were divided into serum pre-culture group and control group according to whether there were serum pre-culture. The DMEM nutrient fluid of FCS (100 g/L) was added to serum pre-culture group, which was replaced by DMEM/F12 nutrient fluid of EGF, bFGF and B27 at 48 hours after culture. The cells in the control group were added with DMEM/F12 nutrient fluid of EGF, bFGF and B27 to culture in 5% CO2 incubator for one week at 37 ℃. The growth of NSCs at 48 hours after culture was observed in both groups under inverted contrast phase microscope.②On the 5th and 10th day after differentiation induced by 100 g/L FCS, nestin, GFAP, galactocerebroside and MAP2 were stained with immunofluorescence antibody,and the expressions of NSCs in both groups were observed under fluorescent microscope. The PBS buffer solution was used instead of first antibody in the control group, while other procedures were the same as above.MAIN OUTCOME MEASURES: ①Observation of NSCs growth at 48 hours after culture under contrast phase microscope in both groups. ②Detection of NSC specific antigen expressions with immunofluorescence stain in both groups.RESULTS: ①In the cells of the serum pre-culture group at 48 hours after culture, there were large number of regular NSC bulbs, most of which were aggregated by 8-10 cells. The proliferation of cell bulbs was accelerated after the nutrient fluid was replaced to DMEM/F12 nutrient fluid of EGF,bFGF and B27, while irregular lamellar cells could be seen in the control group at 48 hours after culture, and small regular cell bulbs were found at 4-5 days later. ②It could be seen under fluorescence microscope that on the 5th day after induced differentiation, the nestin, GFAP and galactocerebroside were positive, while MAP2 was negative. On the 10th day after induced differentiation, nestin and GFAP were positive, whereas the galactocerebroside and MAP2 were negative (no representation).CONCLUSION: Serum pre-culture can accelerate the bulb-aggregation of NSCs as well as promote the proliferation of NSCs.
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@# ObjectiveTo introduce a method of promoting neural stem cells proliferation.MethodsNeural stem cells were cultured with medium DMEM containing 10% fatal bovine serum for 48 h, then changed medium DMEM/F12 containing epidermal growth factor, basic fibroblast growth factor and B27. Immunohistochemistry was used to identify nestin expression.ResultsNeural stem cells got together fast and formed neurospheres within 48 h and expressed nestin. ConclusionPro-culture with serum can promotes neural stem cell proliferation.
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@#ObjectiveTo detect the ultrastructure of neural stem cells (NSCs) cultured in vitro .MethodsNSCs separated from the cortex of 17—19 days Wistar rat fetus were cultured and induced to differentiate in vitro. Electron microscopes were used to visualize the ultrastructure of these cells before and after differentiation.ResultsNSCs had the similar cellular size, morphology and intracellular structures pre-differentiation. Cells were able to proliferate via mitosis. The nucleus/cytoplasm ratio was very high. The nucleus was poly-morphological. Cells had very little cytoplasm and no mature organelles. After differentiation, several processes protruded out from cellular surface. Cells became flat shape, the volume of cytoplasm increased dramatically and various kinds of mature organelles appeared in the cytoplasm. Cells differentiated into two kinds of cells,neural cells and glial cells,with quite different morphology and intracellular structure. ConclusionNSC is one kind of original cells which can be induced to differentiate into mature neural cells and glial cells.
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Objective To evaluate the methods and results of revision surgery for posterior lumbar cage interbody fusion (cage-PLIF) with postoperative complications, and to analyse the surgical techniques for prevention of these complications. Methods From October 1996 to December 2002, 21 patients with postoperative complications of cage-PLIF underwent reoperations. There were 11 males and 10 females with an average of 43.4 years. The interval between primary and revision surgery ranged from 6 days to 1.5 years with an average of 0.6 year. 16 patients suffering from lumbar disc herniation were treated with the discecto-my and single uninstrumented cage fusion, 5 patients of lumbar spondylolisthesis were treated with cage-PLIF and pedicle screw instrumentation. The complications included cage displacement backward in 20 patients, forward in 1,and cage subsidence in 9 as well. 15 patients complained of low back pain wors-ening or leg radicular pain, of which 4 had intermittent claudication and 10 had leg numbness or weakness during rehabilitation. Revision surgery included re-implantation of the cage filled with iliac crest bone chips in 11 patients, iliac bone autograft after removal of original cages in 7 and decompression of involved nerve root witbout removal of migrated cage because of technical difficulty. Pedicle screw fixations were used in 12 and the intertransverse fusion both with autograft and allograft was added in 7. Results The mean follow-up was 14.2 months (ranged, 7 to 36 months). The cages presented slight retro-displacement in 4 patients shortly after reoperation, without involvement into spinal canal during the subsequent follow-up. Bony fusion occurred in 13 patients, and the pseudarthrosis in 3 patients without further migration of cages. The clinical symptoms relieved in 5 patients, improved in 9, no any change in 6, and worsened in 1. However, low back pain remained in 8 patients, and dysuria in 1 patiant at the last follow-up. Conclusion The results of revi-sion surgery are not satisfactory according to this study, the surgical treatments should be performed as soon as possible if conservative treatments is ineffective. The correct surgical indication and proper technical are the key of prevention of the postoperative complications.
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Objective To compare the effects of 0.9% NaCl (normal saline, NS), 10% hydroxyethyl starch (HES, 200/0.5) and hypertonic-hyperoncotic solution (HHS, 7.5% NaCl-10% HES 1:1) on cerebral extracellular excitatory amino acids (EAA) and inhibitory amino acids (IAA) in a rat model of traumatic head injury (THI) combined with acute hemorrhagic shock (AHS). Methods Nineteen healthy adult male SD rats weighing 300-350 g were randomized into 3 groups: NS group (n = 7); HES group ( n = 6) and HHS group ( n = 6). THI was produced by modified Feeney method (a 20g weight drops from a height of 40 cm on the parietal region) and AHS was induced by modified Wiggers method (Blood was removed from femoral artery and MAP was maintained at 40 mm Hg for 1 hour). Fluid resuscitation was started at 1 hour of AHS with 0.9% NS (3 times the volume of the removed whole blood) or 10% HES (in a one to one ratio) or HHS 4 ml?kg-1 administered over 15 min. The extracellular fluid of injured brain tissue was collected using intracerebral microdialysis before head injury (baseline) during THI + AHS (1h) and resuscitatin (2h) for determination of the levels of EAA (glutamate, aspartate) and IAA (glycine, GABA, taurine) by HPLC.Results The 5 amino acids were significantly increased during THI + AHS as compared with their baseline values. Glutamate level was further increased during resuscitation with NS. GABA and taurine concentrations were maintained at high level during resuscitation with HES or HHS. The increase in glutamate was inhibited by resuscitation with HES and the increase in glutamate, aspartate and glycine were inhibited by HHS. Conclusions In a rat model of THI combined with AHS, resuscitation with NS can increase cerebral extracellular EAA. Both HES and HHS resuscitation can inhibit the increase in cerebral extracellulaar EAA and HHS is more effective.