ABSTRACT
Age estimation based on tissues or body fluids is an important task in forensic science. The changes of DNA methylation status with age have certain rules, which can be used to estimate the age of the individuals. Therefore, it is of great significance to discover specific DNA methylation sites and develop new age estimation models. At present, statistical models for age estimation have been developed based on the rule that DNA methylation status changes with age. The commonly used models include multiple linear regression model, multiple quantile regression model, support vector machine model, artificial neural network model, random forest model, etc. In addition, there are many factors that affect the level of DNA methylation, such as the tissue specificity of methylation. This paper reviews these modeling methods and influencing factors for age estimation based on DNA methylation, with a view to provide reference for the establishment of age estimation models.
Subject(s)
Humans , DNA Methylation , CpG Islands , Forensic Genetics , Neural Networks, Computer , Linear Models , Aging/geneticsABSTRACT
Objective:To evaluate the optimization efficacy of anterior quadratus lumborum block at supra-arcuate ligament (SA-AQLB) combined with general anesthesia for laparoscopic gynecological surgery.Methods:Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 28-64 yr, weighing 52-78 kg, with height of 154-166 cm, scheduled for elective laparoscopic gynecological surgery, were divided into general anesthesia group (group G, n=40) and SA-AQLB combined with general anesthesia group (group SG, n=40) using a random number table method.In group SG, bilateral SA-AQLB was performed under ultrasound guidance before anesthesia induction, and 0.4% ropivacaine 25 ml plus dexamethasone 5 mg was injected into both sides.Combined intravenous-inhalational anesthesia was applied in both groups.Patient-controlled intravenous analgesia (PCIA) with sufentanil 2 μg/kg (in 150 ml of normal saline) was performed after surgery.The PCIA pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Visual analogue scale (VAS) scores for abdomen, pelvis and shoulder pain were recorded at 1, 6, 12, 24 and 48 h after operation.Flurbiprofen was used for rescue analgesia when VAS score >4.The occurrence of intraoperative cardiovascular events and amount of sufentanil used during operation were recorded.The time to first pressing the analgesia pump, effective pressing times of PCA, requirement for rescue analgesia and consumption of sufentanil after operation were recorded.The extubation time, time to first flatus after operation, first ambulation time, length of hospital stay and development of postoperative adverse reactions such as nausea and vomiting, urinary retention and respiratory depression within 48 h after operation were recorded. Results:Compared with group G, the incidence of intraoperative hypertension and tachycardia was significantly decreased, the incidence of intraoperative hypotension and bradycardia was increased, the intraoperative consumption of sufentanil was reduced, the extubation time was shortened, the time to first pressing the analgesia pump was prolonged, the effective pressing times of PCA, requirement for rescue analgesia and postoperative consumption of sufentanil were reduced, the time to first flatus, first ambulation time and length of hospital stay were shortened, VAS scores for abdomen, pelvis and shoulder pain were decreased at each time point after operation, and the incidence of nausea and vomiting, urinary retention and respiratory depression after operation was decreased in group SG ( P<0.01). Conclusions:Compared with general anesthesia, the combination of SA-AQLB and general anesthesia can reduce the opioid consumption, inhibit intraoperative stress responses and postoperative hyperalgesia and promote early postoperative recovery when used for the patients undergoing laparoscopic gynecological surgery.
ABSTRACT
The incidence of venous thromboembolism（VTE）in patients with traumatic brain injury（TBI）, especially in patients with severe TBI, is significantly increased due to disturbance of consciousness and limb movement. In the acute phase of VTE, low molecular weight heparin（LMWH）is the most commonly used safe and effective measure to prevent thrombosis. Due to the changes of injury condition of trauma patients, the deviation of clinicians' understanding of VTE and the medication habits of various medical institutions, there are significant differences in the initial time and dose of LMWH prevention. Insufficient or excessive dose of LMWH will lead to thrombus or bleeding complications. In recent years, administration of LMWH with anti-X activity monitoring has been paid more and more attention in patients with TBI, playing an important role in reducing the incidence of thrombosis. The authors review the research progress in the application of LMWH with anti-X activity monitoring in thrombus prevention in patients with TBI from the aspects of mechanism in LMWH use with anti-X activity monitoring, LWMH medication time window and anti-X activity monitoring, LWMH dose adjustment and anti-X activity monitoring, in order to provide references for clinical treatment.
ABSTRACT
Objective To analyze the protective effect of luteolin on the pancreas of mice with severe acute pancreatitis and to explore its possible molecular mechanism. Methods Sixty healthy male C57/ BL mice of SPF grade were divided into three groups according to the random number table method, the control group, the severe acute pancreatitis (SAP) model group and the treatment group, 20 cases in each group. The model was established by the caerulein method. The levels of lipase, amylase, heme oxygenase (HO)-1, tumor necrosis factor (TNF)-α, malondialdehyde(MDA)and superoxide dismutase(SOD)were measured by ELASA method . The protein and mRNA levels of nuclear factor(NF)-κB, P38 and p-P38 in each group were determined by Western blotting and Real-time PCR. Results Compared with the control group, the pancreas dry-wet weight ratio, lipase and amylase, inflammatory factors HO-1, TNF-α levels, oxidative stress index MDA levels increased significantly, while SOD levels were significantly lower in the model group and the treatment group (P0. 05). Compared with the model mice, the levels of NF-κB, p-P38 protein and mRNA in the treated group decreased significantly (P<0. 05). Conclusion Luteolin has a protective effect on SAP mice. Its possible molecular mechanism is to relieve inflammatory stress and oxidative stress, and down-regulate the expression of NF-κB and p-P38 protein.
ABSTRACT
Objective To determine the prognostic indicators of severe acute respiratory distress syndrome (ARDS) by comprehensive analysis.Methods The clinical data of 71 patients with ARDS admitted from Feb.2012 to Apr.2017 were retrospectively collected and analyzed.The acute pathophysiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,occurrence of extrapulmonary organ dysfunction and mortality within 28d after final diagnosis were calculated.The risk factors were screened using the logistic regression analysis to construct the risk prediction model by dynamic recording and comparing the variation of each baseline index within 7 days,and ROC curve was used to evaluate the prediction efficiency of the model.Results Of the 71 cases analyzed,the overall mortality within 28d after final diagnosis was 57.7％(41/71).Single factor logistic regression analysis showed that the APACHE Ⅱ score,the occurrence of extrapulmonary organ dysfunction,the changing rate within 7 days of APACHE Ⅱ score,pH,CO2 partial pressure and oxygenation index were significantly related to mortality.Multiple logistic regression showed that the occurrence of extrapulmonary organ dysfunction and the changing rate within 7 days of APACHE Ⅱ score were the independent risk factors for the death of patients 28 days after admission.The prediction model of 28d mortality in ARDS patients was constructed using the single factor-and multiple logistic regression as covariant,the sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of the model were 93.9％,91.7％,93.3％ and 91.7％,respectively.Conclusions Occurrence of extrapulmonary organ dysfunction and changing rate within 7 days of APACHE Ⅱ score can be used as an indicator to evaluate the prognosis of patients with severe ARDS.
ABSTRACT
<p><b>BACKGROUND</b>Intervertebral disc degeneration (IDD) is a major cause of disc protrusion, likely to be associated with decrease of water content. This research aimed to evaluate IDD by diffusion-weighted imaging (DWI) with a 7.0 Tesla (T) magnetic resonance imaging (MRI) machine.</p><p><b>METHODS</b>A total of 24 healthy Sprague-Dawley rats were randomly selected and divided into four groups (A, B, C, and D), each consisting of 3 male and 3 female rats (28, 42, 56, and 70 days old, respectively). All the rats were imaged with a 7.0T MRI, producing T2WI, T1WI, and functional DWI sequences. Data were collected and apparent diffusion coefficient (ADC) charts were constructed. Nucleus pulposus and annulus fibrosus regions were identified, several regions of interest were chosen, and their ADC values were obtained. After imaging, rats were sacrificed and their intervertebral discs (L1-L6) were dissected, yielding a total of 144 discs. Protein was extracted for the purpose of Western blotting. Comparison among multiple samples used one-way analysis of variance and least significant difference methods.</p><p><b>RESULTS</b>7.0T MRI revealed evident decrease in signal intensity within intervertebral discs of Sprague-Dawley rats with age. Intervertebral disc ADC values significantly decreased from Group A (0.00154 ± 0.00008) to Group D (0.00107 ± 0.00007; P < 0.01); nucleus pulposus ADC values significantly decreased from Group A (0.00164 ± 0.00005) to Group D (0.00140 ± 0.00007; P < 0.01) and annulus fibrosus ADC values significantly decreased from Group A (0.00129 ± 0.00014) to Group D (0.00082 ± 0.00012; P < 0.01). Meanwhile, it also revealed evident decrease from high spinal level to low spinal level: nucleus pulposus ADC values in Group A significantly decreased from L1/L2 (0.00163 ± 0.00006) to L6/S1 (0.00139 ± 0.00004; P < 0.01). While annulus fibrosus ADC values did not differ significantly between levels in Group A (P > 0.05). Western blotting showed that aggrecan content of intervertebral discs decreased from Group A (1.88 ± 0.16) to Group D (0.17 ± 0.04) with age (P < 0.01); Type II collagen content of intervertebral discs decreased from Group A (2.22 ± 0.04) to Group D (0.20 ± 0.01) with age (P < 0.01). No significant differences in aggrecan and Type II collagen content of L1-L6 intervertebral discs in Group A were noted (P > 0.05). Mean ADC values of different intervertebral regions were positively correlated with aggrecan and Type II collagen content (aggrecan: r = 0.631, P < 0.01; Type II collagen: r = 0.680, P < 0.01).</p><p><b>CONCLUSION</b>7.0T MRI-DWI could be applied to effectively diagnose and research early IDD in tiny variations.</p>
ABSTRACT
Objective To investigate the role of Glial cells missing 2 (Gcm2) in pathogenesis of hypoparathyroidism by knocking out Gcm2 gene in adult mice.Methods Tamoxifen was used to induce conditional knock-out of Gcm2 gene in Gcm2E2fl/flCre-ER mice.Genotypes of knock-out mice were identified by PCR.The protein expression level of Gcm2 was measured by Western blotting.The serum calcium and phosphorus were detected by the calcium and phosphorus assay kits, and the serum parathyroid hormone (PTH) level was detected by ELISA.Parathyroid cell proliferation was tested by Ki-67 immunohistochemical assay.The mRNA expression levels of PTH and calcium sensing receptor (CaSR) were detected by Real-time PCR.Bone mineral density was detected by micro CT.Results Gcm2 gene of parathyroid was confirmed to be knocked out by PCR.Compared with wild type and solvent control groups, Gcm2 knock-out group showed markedly lower protein expression of Gcm2, notably higher serum phosphorus and lower serum calcium and PTH concentrations (all P<0.01).The proliferation of parathyroid cells in Gcm2 knock-out mice were significantly higher(both P<0.01).The mRNA levels of PTH and CaSR in parathyroid gland of the knock-out group were significantly reduced (all P<0.01).Bone mineral density was significantly higher in Gcm2 knock-out group (all P<0.01).Conclusion Knockout of Gcm2 can lead to hypoparathyroidism in adult mice, indicating that Gcm2 is probably a therapeutic target for hypoparathyroidism.
ABSTRACT
Objective To observe the efficacy of fire filiform-needle therapy in treating knee osteoarthritis (KOA) in the elderly.Method Eighty-one elderly KOA patients were randomized into a treatment group of 42 cases and a control group of 39 cases following registration order. The treatment group was intervened by fire filiform-needle therapy, while the control group was treated with ordinary acupuncture. The two groups were treated once every other day, 15 sessions as a treatment course. The Lysholm knee score and short-form Arthritis Impact Measurement Scales 2 (AIMS2-SF) were adopted to observe the activities of daily living and quality of life before and after the treatment, and the clinical efficacies of the two groups were compared.Result The total effective rate was 92.9％ in the treatment group, versus 82.1％ in the control group, and the total effective rate in the treatment group was significantly superior to the control group (P<0.05). Except for the squatting item of the Lysholm knee score in the control group, the Lysholm knee score and AIMS2-SF score were significantly changed after the treatment in both groups (P<0.05,P<0.01); except for the support item of the Lysholm knee score, the treatment group was superior to the control group in comparing the Lysholm knee score and AIMS2-SF score after the treatment (P<0.01).Conclusion Fire filiform- needle therapy can significantly enhance the activities of daily living and quality of life in elderly KOA patients.
ABSTRACT
Objective To observe the efficacy of fire filiform-needle therapy in treating knee osteoarthritis (KOA) in the elderly.Method Eighty-one elderly KOA patients were randomized into a treatment group of 42 cases and a control group of 39 cases following registration order. The treatment group was intervened by fire filiform-needle therapy, while the control group was treated with ordinary acupuncture. The two groups were treated once every other day, 15 sessions as a treatment course. The Lysholm knee score and short-form Arthritis Impact Measurement Scales 2 (AIMS2-SF) were adopted to observe the activities of daily living and quality of life before and after the treatment, and the clinical efficacies of the two groups were compared.Result The total effective rate was 92.9％ in the treatment group, versus 82.1％ in the control group, and the total effective rate in the treatment group was significantly superior to the control group (P<0.05). Except for the squatting item of the Lysholm knee score in the control group, the Lysholm knee score and AIMS2-SF score were significantly changed after the treatment in both groups (P<0.05,P<0.01); except for the support item of the Lysholm knee score, the treatment group was superior to the control group in comparing the Lysholm knee score and AIMS2-SF score after the treatment (P<0.01).Conclusion Fire filiform- needle therapy can significantly enhance the activities of daily living and quality of life in elderly KOA patients.
ABSTRACT
AIM: To explore the predisposing factors, population characteristics and clinical features of severe fungal keratitis. METHODS:The data of 233 cases 233 eyes of severe fungal keratitis in my hospital from January, 2008 to November, 2013 was retrospectively reviewed. The predisposing factors, population characteristics and clinical features were analyzed. RESULTS: In 233 cases of severe fungal keratitis, the number of male patients was 153 ( 65. 7%) and the number ratio of male to female was 1. 9:1. The average age of them was (52. 7±11. 3), and most of them were middle-aged and elderly people living in the rural area (78. 1%) and were farmers ( 66. 1%) with low literacy (59. 7%). In 233 cases, 188 cases (80. 7%) possessed a clear history of ocular trauma, mainly caused by plant-based trauma (60. 9%). 90 cases (57. 3%) were infected with Fusarium, and 47 cases ( 29. 9%) by Aspergillus. The main treatment of severe fungal keratitis was surgery (87. 9%). 83 cases ( 52. 9%) were treated with penetrating keratoplasty, and in Fusarium and Aspergillus infected patients with severe fungal keratitis, 58. 4% ( 80/137 ) were performed with penetrating keratoplasty. In addition, patients treated with eye enucleation or evisceration, 68. 4% (13/19) were infected with Fusarium species. CONCLUSION: Patients with severe fungalkeratitis in our hospital are mainly elderly male farmers living in rural, because of low economic condition and poor diagnosis consciousness. The main pathogens are Fusarium and Aspergillus species, and the major treatment is penetrating keratoplasty. Most of patients with poor clinical outcomes are infected with Fusarium species.
ABSTRACT
<p><b>OBJECTIVE</b>To study the effect of Fuzheng Sanjie recipe in regulating tumor-associated macrophages (TAMs) in Lewis lung cancer mice.</p><p><b>METHOD</b>Efforts were made to establish the Lewis lung cancer mouse model, weigh tumors and calculate the anti-tumor rate. The immunohistochemical method was used to examine the infiltration degree of CD68 + in tumor tissues in each group. ELISA was used to examine the content of IFN-γ, TGF-β, IL-4, IL-13, IL-6, IL-10, IL-12, TNF-α in mice serum.</p><p><b>RESULT</b>Compared with the tumor-bearing model group, all of the other groups showed higher tumor inhibition rates, i. e. 50.28% for the DDP group, 34.37% for the TCM-preventing group and 66.76% for the Chinese and western medicine group, with statistical difference (P < 0.05), but without statistical difference in the infiltration degree of CD68+. The expressions of the IFN-γ, IL-6, IL-12 in tumor-bearing groups were lower than that in the blank control group, but with higher contents of IL-4, IL-13, TGF-β. Intervened with different drugs, there were significant differences in content among some relevant cytokines (P < 0.05), as well as statistical differences among the TCM prevention group, the Chinese and western medicine group and the tumor-bearing control group (P <0. 05) , but without statistical difference in TNF-α and IL-10 content from the tumor-bearing control group (P < 0.05).</p><p><b>CONCLUSION</b>Fuzheng Sanjie recipe could reverse the immune remodeling effect and control the tumor growth by down-regulating the expressions of IL-4, IL-13, TGF-α in lung cancer immune microenvironment and up-regulating the expression of IFN-γ.</p>
Subject(s)
Animals , Humans , Male , Mice , Cell Line, Tumor , Disease Models, Animal , Drugs, Chinese Herbal , Interleukin-10 , Blood , Interleukin-12 , Blood , Interleukin-13 , Blood , Lung Neoplasms , Blood , Drug Therapy , Allergy and Immunology , Macrophages , Allergy and Immunology , Mice, Inbred C57BL , Transforming Growth Factor beta , Blood , Tumor Necrosis Factor-alpha , BloodABSTRACT
<p><b>OBJECTIVE</b>To investigate the changes in thyroglobulin antibodies (TgAb) and its influencing factors in differentiated thyroid cancer (DTC) patients with positive TgAb (>115 U/ml) after total thyroidectomy and radioiodine (¹³¹I) therapy.</p><p><b>METHODS</b>We collected the clinical data of 118 DTC patients with positive TgAb and analyzed their TgAb levels before surgery, before ¹³¹I therapy, and after ¹³¹I therapy with a median follow-up of 2.3 months and 5.2 months. Multiple linear regression (MLR) was applied to analyze the time of TgAb concentration decreased by more than 50% (T₅₀) and its influencing factors.</p><p><b>RESULTS</b>Compared with the previous TgAb levels, TgAb decreased significantly 2.3 months and 5.2 months after surgery or after ¹³¹I therapy, respectively (both P=0.000). The proportions of patients with TgAb decreased by more than 50% in each stage were 28.6%,33.3%, and 37.2%,respectively. The negative conversion ratios were 23.4%,48.9%, and 62.8%,respectively. MLR showed that only the interval between surgery and ¹³¹I therapy was correlated with T₅₀ (B=1.125, P=0.000).</p><p><b>CONCLUSIONS</b>The TgAb levels in DTC patients remarkably decrease after surgery and after ¹³¹I therapy. The interval between surgery and ¹³¹I therapy remarkably influences the lowering speed of TgAb levels. Prompt application of ¹³¹I therapy after surgery helps to lower TgAb levels.</p>
Subject(s)
Humans , Adenocarcinoma , Autoantibodies , Iodine Radioisotopes , Thyroglobulin , Thyroid Neoplasms , ThyroidectomyABSTRACT
<p><b>OBJECTIVE</b>To investigate the change of thyroglobulin antibodies (TgAb) after the application of selenious yeast tablet (SYT) in differentiated thyroid cancer (DTC) patients with positive TgAb (>115 U/ml).</p><p><b>METHODS</b>We enrolled 41 DTC patients with positive TgAb who had undergone total thyroidectomy and subsequent ¹³¹I therapy as well as applied SYT in group 1 (G1). Patients with an interval of more than 6 months between SYT use and ¹³¹I therapy or with repeated TgAb measurements before the use of SYTs were divided into group 2 (G2) and group 3 (G3), respectively. Changes in TgAb after application of SYT in both G1 and G2 were observed and analyzed by rank sum test. Comparison of TgAb gradient over certain time before and after the application was analyzed by t-test.</p><p><b>RESULTS</b>The proportions of patients with decreased or elevated TgAb were 85.4% and 14.6% in G1 and 90.9% and 9.1% in G2, respectively. Compared with the previous TgAb levels, TgAb decreased significantly after the application of SYT in either G1 (P=0.000) or G2(P=0.003). In G3, the TgAb level rose by 5.6% every month before applying SYT and fell 8.3% every month after the application (P=0.086).</p><p><b>CONCLUSION</b>Application of SYT in DTC patients with positive TgAb can effectively decrease the TgAb level.</p>
Subject(s)
Humans , Adenocarcinoma , Autoantibodies , Tablets , Thyroglobulin , Thyroid Neoplasms , Thyroidectomy , YeastsABSTRACT
Objective To study the development characteristics of cavum sepit pellucidun (CSP)in prematures,neonates,infants and adults with MRI.Methods Brain MR images of different subjects including 141 prematures,106 neonates,171 infants and 35 046 adults were observed to determine the incidence and shape of CSP,and to measure its transverse diameter.Results CSP incidences were 100% (141/141)in prematures,97.17% (103/106)in neonates,2.26%(4/177)in infants and 0.82% (287/35 046)in adults respectively,and the CSP was cylinder (44.00%)or triangle in shape (56.00%)in prematures,triangle (76.40%)or fissure in shape (23.60%)in neonates.For infants or adults,each shape accounted for about a third of three kinds of shape respectively.Its mean transverse diameters were 5.7 mm in prematures,4.1 mm in neonates,13.3 mm in infants and 14.3 mm in adults respectivity.Conclusion CSP has different performances at development periods in human being brain.Most close after birth,while fewer remain in the whole life.
ABSTRACT
Based on the organization and implementation of the comprehensive reform of countylevel public hospitals in 15 provinces (municipalities)in southern China,the research discussed the progress and problems of such reforr.The progress made and areas of the reform vary among provinces and municipalities.For example,the reform has completely covered all the counties in four provinces such as Zhejiang and Jiangsu province.Medicine markups have been canceled in all the pilot counties by adjusting the service prices to pave the way for hospital compensation.Contemporary hospital management,remuneration system and personnel system reform are also main targets of the reform,while the collaboration between superiors and subordinates,and hospital regulatory system have recently been included.Problems are also found with the current reform:for example,lack of attention for the system reform,no fundamental changes in place in the business orientation of hospitals,as well as problems in collaboration among departments,and hospital debts.
ABSTRACT
The network teaching platform of ophthalmology of Qingdao University , as the basis construction of the national key discipline , forms a perfect and complete set of teaching system with the aid of part of course information, part of network teaching resources and part of answer and interaction. The network teaching platform focuses on the construction of network teaching resources and answer and interaction. In the college teaching of ophthalmology, through building clinical teaching resource database and discussing on network platform, we carry out interactive and discussion-based teaching, and students can prepare before class and discuss after class. The application of network teaching platform of ophthal-mology in classroom teaching and teaching feedback can improve the teaching methods , deepen the teach-ing content, implement the sharing of teaching resources, and lay a solid foundation for ophthalmology teaching reform.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the effect of sympathectomy on the development and progression of scoliosis in bipedal C57BL/6J mice model.</p><p><b>METHODS</b>Sixty female 3-week-old C57BL/6J mice were selected to establish bipedal scoliotic mice model after amputations of forelimbs and tails. All mice were randomly divided into three groups, 20 mice for each group. Group 1 received daily intraperitoneal injection of 0.9% saline (5 mg/kg); while Group 2 and 3 received sympathectomy by daily intraperitoneal injection of propranolol (20 mg/kg) and guanethidine sulfate (40 mg/kg), respectively. Posteroanterior X-rays were obtained at 20th week. Curves were measured using Cobb method and scoliosis was defined as a Cobb angle of > 10°. Incidence of scoliosis and severity of curves were compared among groups using Chi-square test and One-way analysis of variance, respectively.</p><p><b>RESULTS</b>There were 17 (85.0%) mice presented scoliosis in Group 1; whereas 11 (55.0%) and 10 (50.0%) mice presented scoliosis in Group 2 and 3, respectively. The incidence of scoliosis was found to be higher in Group 1, and the difference was statistically significant (χ(2) = 6.172, P = 0.046). As for curve magnitudes, the mean Cobb angle was 20° ± 9° in Group 1, 10° ± 7° in Group 2, and 12° ± 8° in Group 3. The mean Cobb angle of Group 1 was significantly greater than those of Group 2 and 3 (F = 9.545, P < 0.001), but there was no significant difference in mean Cobb angle between Group 2 and 3.</p><p><b>CONCLUSIONS</b>Sympathetic nervous system may be involved in the development and progression of scoliosis in bipedal C57BL/6J mice model. Sympathectomy do not seem to dramatically decrease the incidence of scoliosis, probably due to that bipedalism itself may also be a cause of scoliosis in this animal model.</p>
Subject(s)
Animals , Female , Mice , Disease Models, Animal , Mice, Inbred C57BL , Random Allocation , Scoliosis , Pathology , Sympathectomy , Sympathetic Nervous System , Thoracic VertebraeABSTRACT
<p><b>OBJECTIVE</b>To study the factors associated with postoperative shoulder balance in Lenke Type 1 adolescent idiopathic scoliosis (AIS) patients with preoperative right-elevated shoulder after posterior thoracic fusion.</p><p><b>METHODS</b>A total of 34 Lenke Type 1 AIS patients were recruited between October 2006 to October 2008. There were 8 boys and 26 girls with an average age of 15.1 years (range, 12 - 19 years). Posterior thoracic fusion was performed in all the patients. There were 23 cases proximally fused to T4 and 11 cases fused to T5. Pearson's correlation analysis was made between radiographic shoulder height (RSH) at the latest follow-up and preoperative T1 tilt, clavicle angle (CA), coracoids process height (CPH), apical vertebral translation (AVT), RSH, coronal and bending proximal/main thoracic curve (PT and MT) Cobb angle, curve flexibility as well as correction ratio of the MT curve.</p><p><b>RESULTS</b>All patients presented right-elevated shoulder preoperatively, with an mean RSH of (-15.9 ± 5.8) mm. At the latest follow-up, PT curve correction was 44% ± 16%, and MT curve correction was 70% ± 10%. Of the 34 patients with an average postoperative RSH of (0.4 ± 7.9) mm, 32 patients had balanced shoulders, and only 2 patients had mild shoulder imbalance with left-elevated shoulder. The RSH at the latest follow-up was found to be negatively correlated with PT curve flexibility (r = -0.682, P < 0.01), but positively correlated with bending PT Cobb angle (r = 0.642, P < 0.01) and correction ratio of the MT curve (r = 0.557, P < 0.01). No significant correlations were found between RSH at the latest follow-up and preoperative T1 tilt, CA, CPH, AVT, RSH, coronal PT and MT Cobb angle, bending Cobb angle as well as flexibility of MT curve (P > 0.05).</p><p><b>CONCLUSIONS</b>For the Lenke Type 1 AIS patients with preoperative right-elevated shoulder, proximal fusion to T4 or T5 could improve shoulder balance significantly. However, the low PT curve flexibility and overcorrection of MT curve may be associated with postoperative shoulder imbalance in such patients.</p>
Subject(s)
Adolescent , Child , Female , Humans , Male , Young Adult , Follow-Up Studies , Postural Balance , Retrospective Studies , Scoliosis , General Surgery , Shoulder , Spinal Fusion , Thoracic Vertebrae , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To study the relationship between T1 tilt and cosmetic shoulder balance in adolescent idiopathic scoliosis (AIS) patients.</p><p><b>METHODS</b>Seventy-one Lenke type 2 AIS patients were recruited into the present study from January 2010 to December 2011. There were 61 female and 10 male patients, the average age was (15.1 ± 2.9) years (range 10-18 years); the average Risser sign was 2.8 (range 1-5). The patients were photographed from the back in neutral standing position on level ground wearing underpants. Also, all the patients had a standing posterior-anterior radiograph in a relaxed standing position. The cosmetic shoulder height (CSH), which included cosmetic inner shoulder height (CSHi) and cosmetic outer shoulder height (CSHo), were measured in the photographs. Positive value was defined as left shoulder was higher than the right shoulder, and negative value was defined as right shoulder was higher than the left shoulder. CSH > 5 mm was defined as positive CSH, CSH < -5 mm was defined as negative CSH, -5 mm ≤ CSH ≤ 5 mm was defined as leveled CSH. T1 tilts were measured in the posterior-anterior radiographs. Positive value was defined as the left proximal vertebral body up and right lower vertebral body down, and negative value was defined as the right proximal vertebral body up and left lower vertebral body down. T1 tilt > 5° was defined as positive T1 tilt, T1 tilt < -5° was defined as negative T1 tilt, -5° ≤ T1 tilt ≤ 5° was defined as leveled T1 tilt.</p><p><b>RESULTS</b>T1 tilt was found to be significantly correlated with CSHi and CSHo (r = 0.25 and 0.28, P < 0.05).For positive T1 tilt patients, there were 59.0% (36/61) patients with positive CSHo, 37.7% (23/61)with leveled CSHo, and 3.3% (2/61)with negative CSHo.For the patients with leveled T1 tilt, it was 3/10, 5/10 and 2/10.For positive T1 tilt patients, there were 83.6% (51/61) patients with positive CSHi, 11.5% (7/61) with leveled CSHi, and 4.9% (3/61) with negative CSHi; For the patients with leveled T1 tilt, it was 6/10, 2/10 and 2/10.</p><p><b>CONCLUSIONS</b>Although positive correlation is found between T1 tilt and cosmetic shoulder balance, positive T1 tilt is not an indicator of higher left shoulder.Elevated left shoulder, leveled shoulders and elevated right shoulder are all found in positive T1 tilt patients.</p>
Subject(s)
Adolescent , Child , Female , Humans , Male , Esthetics , Postural Balance , Radiography , Scoliosis , Diagnostic Imaging , Shoulder , Thoracic VertebraeABSTRACT
<p><b>OBJECTIVE</b>To recite early results and long-term outcomes after surgical repair of persistent truncus arteriosus (PTA).</p><p><b>METHODS</b>The clinic data of 54 patients underwent surgical repair for PTA from January 1999 to December 2009 was analyzed retrospectively. There were 36 male and 18 female patients, with a mean age of (9 ± 10) months (range, 1 to 38 months; median, 5 months). Preoperative mechanical ventilation was required in 5 patients. The surgical procedures were closure of ventricular septal defect and re-establishment of continuity between right ventricle and pulmonary artery. The right ventricular outflow tract (RVOT) was reconstructed by direct anastomosis pulmonary artery to right ventriculotomy with anterior wall patch enlargement (28 cases), or by inserting conduits (26 cases). Valvuloplasty were performed in 4 patients with truncal valves moderate to severe insufficiency and aortoplasty in 3 patients with interrupted aortic arch (IAA).</p><p><b>RESULTS</b>There were 3 patients (5.6%) died of pulmonary hypertensive crisis in hospital. The mean duration of ventilation was 6.8 days in 5 patients who were intubated before operation, while the others were 3.6 days. Forty-seven (92.2%) patients were followed-up for mean (6.8 ± 2.5) years (from 2.5 to 11.0 years). There were 2 patients with mild to moderate aortic regurgitation. One patient with aortic arch obstruction underwent balloon dilatation 2 years postoperatively. Among those patients who underwent direct anastomoses, 8 (32.0%) patients had pulmonary branch stenosis at 7 months to 1.5 years postoperatively, 12 (48.0%) patients were freedom from surgical reintervention 5.0 to 11.0 years postoperatively. Among those inserting conduits, 7 patients (31.8%) had conduit stenosis at 2.8 to 7.0 years after operation. Reoperations were performed for RVOT in 15 patients and there was no mortality.</p><p><b>CONCLUSIONS</b>It is difficult to treat the PTA patients with IAA, intra-mural coronary artery or mechanical ventilation support before operation. The technique of direct anastomosis between pulmonary artery and right ventricle offers the potential growth for RVOT, but bilateral pulmonary branch stenosis may be occurred at earlier period of postoperation in some patients.</p>