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Objective:To evaluate the risk factors for adjacent vertebral compression fracture (AVCF) after fusion surgery of lumbar canal stenosis in the elderly.Methods:A retrospective cohort study was designed for 297 patients with lumbar canal stenosis who underwent fusion surgery in Hubei Provincial Hospital of Integrated Chinese and Western Medicine from January 2017 to December 2020. There were 42 males and 255 females, aged 68-85 years [(76.3±7.2)years]. The patients were divided into AVCF group ( n=67) and non-AVCF group ( n=230) according to with or without the occurrence of AVCF. The indicators recorded were the gender, age, body mass index, education level, number of combined basic diseases, course of the disease, preoperative bone mineral density, intraoperative bleeding volume, number of level fused during operation, postoperative blood transfusion volume, postoperative observation in the ICU, types of postoperative external fixation and time of external fixation. Univariate analysis was conducted to analyze the correlation between above risk factors and AVCF after fusion surgery of lumbar canal stenosis in the elderly. Multivariate Logistic regression analysis was used to determine the independent risk factors for the occurrence of AVCF in these patients. Results:In the univariate analysis, age, education level, preoperative bone mineral density, intraoperative bleeding volume, postoperative blood transfusion volume and postoperative observation in the ICU were correlated with AVCF after fusion surgery of lumbar canal stenosis in the elderly ( P<0.05 or 0.01), while there was no correlation of AVCF with gender, body mass index, number of combined basic diseases, course of the disease, number of level fused during operation, types of postoperative external fixation and time of external fixation (all P>0.05). Multivariate Logistic regression analysis showed that gender ( OR=4.02, 95% CI 1.35, 12.00, P<0.05), preoperative bone mineral density≤-2.5 SD ( OR=2.01, 95% CI 1.47, 2.75, P<0.01), intraoperative bleeding volume≥475 ml ( OR=1.01, 95% CI 1.00, 1.01, P<0.01) and postoperative blood transfusion volume≥434 ml ( OR=0.99, 95% CI 0.98, 1.00, P<0.01) were significantly associated with AVCF after fusion surgery of lumbar canal stenosis in the elderly. Conclusion:The female, bone mineral density≤-2.5 SD, intraoperative bleeding volume≥476 ml and postoperative blood transfusion volume≥434 ml are independent risk factors for AVCF after fusion surgery of lumbar canal stenosis in the elderly.
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Objective: To explore the peri-operative application of GLP-1 analogue and insulin on myocardial perfusion and clinical prognosis in patients of acute ST segment elevation myocardial infarction (STEMI) with stress-induced hyperglycemia. Methods: Our research was a prospective single center randomized control study. A total of 114 consecutive STEMI patients received percutaneous coronary intervention (PCI) within 12h of onset were enrolled, the patients had no diabetes while blood glucose ≥11.1mmol/L at immediate admission. Based on random number table, the patients were divided into 2 groups: Observation group, the patients received GLP-1 analogue, n=59 and Control group, the patients received insulin, n=55. The post-operative myocardial perfusion, indicators of myocardial damage and cardiac function, myocardial infarct area (MIA) and myocardial salvage index (MSI) were compared between 2 groups. The patients were followed-up for 6 months to record the incidence of major adverse cardiovascular events (MACE). Results: At peri-operative period, compared with Control group, Observation group had decreased peak values of creatine kinase isoenzyme (CK-MB) and troponin T (cTnT), P<0.05. At 6 months post-operation, compared with Control group, Observation group showed increased myocardial perfusion and left ventricular ejection fraction (LVEF), P<0.05, reduced MIA (15±12) g vs (20±14) g, P<0.05 and 12% elevated MSI as (0.64±0.13) vs (0.56±0.12), P<0.001. The MACE incidence was similar between 2 groups, P=0.217. Conclusion: In STEMI patients with stress-induced hyperglycemia, peri-operative application of GLP-1 analogue may safely regulate blood glucose, improve cardiac perfusion and function, reduce MIA; while it had no influence on myocardial perfusion at peri-operative period and no impact on MACE occurrence at 6 months post-operation.
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Objective To explore the feasibility of electromagnetic navigation for hepatic ducts exploration by choledochoscope based on a three-dimensional (3D) printing model.Methods The retrospective descriptive study was conducted.The clinical data of 1 patient with obstructive jaundice combined with secondary biliary tract dilation who was admitted to the Beijing Tsinghua Changgung Hospital in April 2016 were collected.Digital imaging and standardized format data of enhanced computed tomography (CT) scan were collected,3D reconstruction of liver and bile duct were done under a 3D printing model,and then a hollow model of bile duct was achieved.Choledochoscope with internal electromagnetic probe was inserted into the printed hepatic ducts.Four points of anatomical markers in left and right hepatic ducts and common hepatic duct were chosen as fiducial markers for calibration and registration.Results After registration,the scope can be tracked in main hepatic segmental bile ducts.The locations of choledochoscope matched precisely the navigation results.Conclusion Electromagnetic navigation may bring accurate tracking effectiveness for choledochoscopic examination.
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Objective:To study the impact of circadian variations on the efficacy of urokinase (UK) therapy in patients with acute myo- cardial infarction (AMI). Methods:Ninety-five AMI patients presenting with chest pain≤3 hours were given UK theerapy.They were divided into two groups according to their symptom onset time:late morning group (6:01—12:00,n=42) and other time group (12:01—6:00 next day,n=53).We obtained elbow venous blood samples at 3 time points:before UK therapy,30 and 60 minutes after UK ini- tiation respectively.Serum levels of AT-Ⅲ,PAI-1 Ag,PAI-1 activity,D-D,?_2-APL Ag were examined.The repatency of culprit vessels was also determined 120 minutes after UK administration. Results:①UK therapy in the late morning group(23 out of 42 patients) had lower repatency rate compared with the other time group(40 out of 53 patients) (P＜0.05).②The late morning group had a higher serum levels of PAI-1 Ag before UK thera- py (39.822?4.737 versus 37.406?4.696,P＜0.05).③The serum level of PAI-1 antigen at aforementioned three time points was 36.054?4.456,35.242?4.143 and 35.355?4.135 in reperfused patients compared with 42.7822?3.277,42.398? 4.565 and 42.395?5.223 in nonnperfused patients.The activity of PAI-1 was 15.234?2.671,13.256?4.532 and 11.830? 3.905 in reperfused patients versus 17.0743?3.665,16.447?4.469 and 16.928?4.248 in nonreperfused patients at three time points.Both of PAI-1 antigen and its activity was consistently lower in reperfused AMI patients as compared with the nonper- fused patients before and 30,120 minutes after UK therapy(P＜0.05).There was no significant difference in the serum levels of ?_2-APL Ag,D-D,and AT-Ⅲ activity between the two populations (P＞0.05). Conclusion:Our data showed circadian variations have an impact on the efficacy of UK therapy in patients with AMI,which suggests that there may exist a phenomenon of “morning resistance to thrombolysis therapy” due to increased level of PAI-1 Ag and activity.
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Objective To explore a new method of establishing rat model of acute myocardial infarction by off ventilator support,spurt and repeated cryoinjury.Methods Sixty Wistar rats with male and female in half were randomized into three experimental groups according to cryoinjury time with 20 rats in each group:15-second group(cryoinjury for 5 s each time,three times in total),25-second group(5 s each time,five times in total)and 40-second group(5 s each time,eight times in total).The heart was exposed through a 1.0-to 1.5-cm left lateral thoracotomy.Cryoinjury of the LV free wall(LVFW)was performed by applying for 5 s a round copper probe of 6-mm in diameter immersed in liquid nitrogen for 5 min to reach-190 ℃,then the thoracic cavity was closed immediately.When the rats' breath restored,the cryoinjury of the LVFW in situ was repeatedly to ensure a transmural injury according to the protocol.The survival rate during operation and in 28 days after operation was observed.Also infarct size was observed by heart pathological section stained with Masson's trichrome on day 28 after operation.Results Infarct size in all three groups was larger than 20% signified by transmural injury,and completely myocardiolysis and distinct infarct boundary were observed.The survival rate was 16/20 in 15-second group,5/20 in 40-second group(P0.05 vs 15-second group and 40-second group).The infarct size in 40-second group was larger than the other two groups(standard deviation:10.564 4% vs 5.192 6%,6.496 0% in 15,25-second group,respectively)and its survival rate was lowest.The procedure of 25-second group was more complicated and had a tendency of higher death rate than that in 15-second group.Conclusion Using spurt,repeated ultra low temperature cryoinjury for 15 s may be an ideal method to establish the rat model of acute myocardial infarction.