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【Objective】 To explore the effects of nerve growth factor （NGF） on bladder function and axon injury repair in rats with traumatic spinal cord injury （t-SCI） so as to explore its molecular mechanism. 【Methods】 Traumatic spinal cord injury model was constructed in 30 male SD rats by modified Allen’s beating method. The rats were randomly divided into sham-operation group， injury group and NGF group， with 10 rats in each group. We used the BBB score to observe the motor function of the rats’ hind limbs before and after the operation. The BL-420 biometer experimental system detected the urodynamics. Six anterior roots of the left lumbar taken from the distal end of the anastomosis were stained with toluidine blue， and the number of myelinated axons was counted. We used HE to stain rat bladder tissue， TUNEL to stain the rats’ severely injured spinal cord， and observed the spinal cord apoptosis rate. Western blotting was used to detect the protein expressions of Raf-1， p-MEK-2， MEK-2， ERK1/2， and p-ERK1/2 in spinal cord tissue. 【Results】 The BBB score results showed that there was no difference in the scores of the sham-operation group， the injury group and the NGF group before the operation. After the operation， the scores of the injury group and the NGF group were significantly lower than those in the sham-operation group （P0.05）. 【Conclusion】 NGF may hinder the conduction of MAPK/ERK pathway， thereby affecting the repair of axon damage and improving the bladder function of t-SCI rats.
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BACKGROUND@#There is a certain correlation between vitamin nutritional status and cancer patients. Studies have shown that vitamin deficiency increases the risk of cancer. The purpose of this study is to understand the vitamin D nutritional status of cancer patients and to provide scientific basis for further nutritional intervention.@*METHODS@#Cancer patients who visited Shandong Cancer Hospital from July 2017 to June 2019 were included in this retrospective study. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured. Univariate analysis and multiple linear regression analysis were carried out using SPSS 20.0.@*RESULTS@#A total of 2,487 cancer patients were evaluable for this analysis. Mean 25(OH)D concentration was (12.70±6.82) ng/mL; the prevalence of vitamin D deficiency [25(OH)D concentration less than 20.00 ng/mL] was of 92.20%. In univariate analysis, age, body mass index (BMI), season and types of cancer were associated with 25(OH)D concentrations. In the multivariate analysis, BMI (β=0.71), age (β=-0.56), season (β=-0.99 for winter; β=-0.76 for autumn vs summer) and types of cancer (β=-1.17 for lung cancer; β=-1.45 for esophageal-gastric cancer; β=-1.05 for colorectal cancer vs other types of cancer) were independently and significantly associated with 25(OH)D levels (P<0.05).@*CONCLUSIONS@#Vitamin D deficiency was highly prevalent among cancer patients. Age, BMI, season and types of cancer may be associated with 25(OH)D levels, which indicate that monitoring of vitamin D level for cancer survivor should be taken into account.
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Objective@#To investigate the clinical practicability and prognostic value of Helsinki CT score in patients with traumatic brain injury (TBI).@*Methods@#A retrospective case series study was conducted to analyze the clinical data of 124 TBI patients admitted to First Affiliated Hospital of Xinjiang Medical University from September 2016 to October 2018. There were 91 males and 33 females, aged 14-84 years, with an average age of 49 years. Glasgow coma score (GCS) at admission ranged from 3-8 points in 45 patients, 9-12 points in 42 patients, and 13-15 points in 37 patients. According to Glasgow outcome scale (GOS) at 6 months after injury, 26 patients were classified into the poor prognosis group with GOS of 1-3 points and 98 patients were in the good prognosis group with GOS of 4-5 points. The prognosis-related risk factors were analyzed, and the role of Helsinki CT score to predict the adverse prognosis and mortality of TBI patients in the two groups was investigated. The sensitivity and specificity of Helsinki CT Score for 6-month poor prognosis were evaluated by receiver operation characteristic (ROC) curve and area under the curve (AUC).@*Results@#Univariate analysis suggested that there were significant differences in terms of subdural hematoma, intracranial hematoma, extradural hematoma, hematoma volume >25 cm3, intraventricular hemorrhage and suprasellar cistern pressure between the poor prognosis group and good prognosis group (P<0.05). Multivariate logistic regression analysis showed that the mortality and bad prognosis were related to the hemorrhage of ventricles, the pressure of suprasellar cistern and the disappearance of suprasellar cistern in the poor prognosis group and the good prognosis group (P<0.05), while intracranial hematoma and hematoma volume showed no association with mortality and poor prognosis (P>0.05). The Helsinki CT score could independently predict the adverse prognosis and mortality of TBI patients at 6 months (multivariate logistic regression: ORdeath=1.21, ORadverse prognosis=1.14). Helsinki CT score had a better predictive ability of 6-month mortality (AUC=0.85) than that of 6-month adverse prognosis (AUC=0.76), and had a predictive value for 6-month mortality and adverse prognosis.@*Conclusions@#Subdural hematoma, extradural hematoma, intraventricular hemorrhage and suprasellar cistern state (compression or disappearance) are the risk factors for the poor prognosis of TBI patients. Intraventricular hemorrhage and suprasellar cistern state are the main risk factors for predicting the mortality of 6 months. Helsinki CT score can independently predict the adverse prognosis and mortality of TBI patients at 6 months, and has relatively better value in predicting the mortality.
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The efficacy of decompressive craniectomy (DC) in reducing traumatic brain injury mortality has been affirmed,but there are also many serious complications.Syndrome of the trephined (ST) and paradoxical herniation (PH) are rare complications.ST is characterized by a series of neurological deterioration due to skin flaps subsidence from weeks to months after DC.These neurological impairments are closely related to the subsequent repair of skull defects.PH shows progressive decrease in consciousness on the basis of ST,changes in pupils on the side of skull defects,low touch pressure at the defect window,and obvious midline shift and brain stem compression on CT.ST and PH have common inducements in pathophysiology,including cerebrospinal fluid dynamics,atmospheric pressure,cerebral blood flow and brain material metabolism.There is no consensus on the diagnosis of ST and PH,and early cranioplasty is suggested in terms of treatment.This article reviews the clinical manifestations,pathophysiological changes,diagnosis and treatment of ST and PH after DC operation,so as to provide references for clinicians to further understand ST and PH.
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Objective To investigate the clinical practicability and prognostic value of Helsinki CT score in patients with traumatic brain injury(TBI).Methods A retrospective case series study was conducted to analyze the clinical data of 124 TBI patients admitted to First Affiliated Hospital of Xinjiang Medical University from September 2016 to October 2018.There were 91 males and 33 females,aged 14-84 years,with an average age of 49 years.Glasgow coma score(GCS)at admission ranged from 3-8 points in 45 patients,9-12 points in 42 patients,and 13-15 points in 37 patients.According to Glasgow outcome scale(GOS)at 6 months after injury,26 patients were classified into the poor prognosis group with GOS of 1-3 points and 98 patients were in the good prognosis group with GOS of 4-5 points.The prognosis-related risk factors were analyzed,and the role of Helsinki CT score to predict the adverse prognosis and mortality of TBI patients in the two groups was investigated.The sensitivity and specificity of Helsinki CT Score for 6-month poor prognosis were evaluated by receiver operation characteristic(ROC)curve and area under the curve(AUC).Results Univariate analysis suggested that there were significant differences in terms of subdural hematoma,intracranial hematoma,extradural hematoma,hematoma volume＞25 cm3,intraventricular hemorrhage and Suprasellar cistern pressure between the poor prognosis group and good prognosis group(P＜0.05).Multivariate logistic regression analysis showed that the mortality and bad prognosis were related to the hemorrhage of ventricles,the pressure of suprasellar cistern and the disappearance of suprasellar cistern in the poor prognosis group and the good prognosis group(P＜0.05),while intracranial hematoma and hematoma volume showed no association with mortality and poor prognosis(P＞0.05).The Helsinki CT score could independentiy predict the advetse prognosis and mortality of TBI patients at 6 months(multivariate logistic regression: ORdealth=1.21,ORadvene prognosis = 1.14).Helsinki CT score had a better predictive ability of 6-month mortality(AUC = 0.85)than that of 6-month advetse prognosis(AUC = 0.76),and had a predictive value for 6-month mortality and advetse prognosis.Conclusions Subdural hematoma,extradural hematoma,intraventricular hemorrhage and suprasellar cistern state(compression or disappearance)are the risk factots for the poor prognosis of TBI patients.Intraventricular hemorrhage and suprasellar cistern state are the main risk factots for predicting the mortality of 6 months.Helsinki CT score can independently predict the advetse prognosis and mortality of TBI patients at 6 months,and has relatively better value in predicting the mortality.
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Objective To investigate the effect of bone flap reduction on unilateral acute subdural hematoma (ASDH) under intracranial pressure monitoring.Methods A retrospective case control study was conducted to analyze the clinical data of 139 patients with unilateral ASDH admitted to the First Affiliated Hospital of Xinjiang Medical University from July 2014 to December 2017.There were 84 males and 55 females,aged 19-87 years (mean,53 years).At the time of admission,the Glasgow Coma Score (GCS) was 3-5 points in 63 patients and 6-8 points in 76.There were 40 patients with unilateral cavity dilation and 16 cases with bilateral pupil dilation.According to the different surgical methods,the patients were divided into study group (n =61) and control group (n =78).The study group removed the cranial hematoma under cranial pressure monitoring and determined whether to perform bone flap reduction according to the actual intracranial pressure.The control group was treated with craniotomy hematoma removal and standard large bone decompressed craniectomy (DC).The success rate of bone flap reduction in the study group was recorded.The complications at postoperative 3 months and the Glasgow Outcome Score (GOS) at postoperative 6 months were compared.Results All patients were followed up for 1-6 months,average 5.5 months.In the study group,23 patients underwent bone flap reduction,and the bone flap reduction rate was 38％.At postoperative 3 months,the study group showed better efficacy in subdural effusion (9:25),hydrocephalus (7 ∶19),and brain swelling in the skull defect area(5 ∶ 18) than the control group (P ＜0.05).Based on the GOS at 6 months after operation,in the study group,25 patients were with good results,nine with moderate disability,10 with heavy disability,seven with plant survival,and 10 died;in the control group,six patients were with good results,21 with moderate disability,15 with heavy disability,10 with plant survival,and 26 died.The number of patients with good prognosis (good and moderate disability) and the number of deaths in the study group were statistically different from those in the control group (P ＜ 0.05).Conclsion In the treatment of unilateral ASDH,bone flap reduction under intracranial pressure monitoring can reduce the incidence of complications and improve the life quality of patients.
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Objective To explore the clinical effect of periarticular knee fractures combined with anterolateral ligament (ALL) avulsion fracture.Methods From June 2014 to November 2015,13 patients with ALL avulsion fracture in periarticular knee fractures were fixed by the star plate,cannulated or screws suture anchor,including 9 male and 3 female with the mean age of 39.5 years (range from 28 to 51 years).6 patients were diagnosed distal femoral fracture,4 tibial plateau fracture,and 3 tibial intercondylar eminence avulsion fracture which all combined with ALL avulsion fracture.Postoperatively,all patients were treated with the adjustable knee brace for 3 months.Results All patients were followed up for 4-20 months,the mean follow-up time was 13.5 months.The average surgical time was 130 min (range from 90 to 210 min).In all 13 patients,ALL was found and identified.Bone union was obtained in all patients,and the bone union time was 11.4 weeks (10-12 weeks).7 cases were fixed with star plate,5 cases were fixed with hollow screw,and 1 case was fixed with anchor.All follow-up patients underwent anteroposterior and lateral X-rays.Pain,swelling and functional recovery of the knee joint were observed.Patients were assessed postoperatively with International Knee Documentation Committee (IKDC) score,Lysholm score,and Tegner activity scale to evaluate the clinical effect.At the last follow-up,all patients had full range of motion of the knee joint which from 0° to approximate 120°.The Lysholm,objective IKDC were 86.5 and 84.6 respectively.Among the 13 patients evaluated,9 patients were graded A,and 4 patients were graded B by subjective IKDC.The Tegner activity scale at the last follow-up was 6.7.Incision of poor healing in 1 case,and got healed after 32 d cleaning dressing.Conclusion This study confirmed the presence of the ALL.The fixation of ALL avulsion fracture in periarticular knee fractures can be an effective procedure at a minimum follow-up of 13.5 months.
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Objective To study the clinical efficacy of both acupuncture combined with flames and simple acupuncture and moxibustion treatment of nerve root cervical spondylosis,so as to provide appropriate basis for the improvement of nerve root cervical spondylosis treatment. Methods A total of 60 cases of nerve root cervical spondylosis were enrolled for the study and randomly divided into two groups with the treatment of acupuncture combined with dragon moxibustion group(treatment group,n=30)and simple acupuncture group(control group,n=30). The clinical symptoms before and after treatment,and signs changes between the two groups were compared. Results Patients of both two groups showed significant im?provement after treatments(P<0.05);CSR simplify McGill Pain Scale scores inquiry(P<0.05). The total effective rate of the treatment group was 96.67%,which was 90.0%in the control group,with statistically significant difference(P<0.05). It indicated that the combined use of acupuncture and moxibustion therapy had better efficacy than simple acupuncture treatment. Conclusion The combined use of acupuncture and moxibustion therapy with flames in nerve root cervical spondylosis showed better clinical effect,which can be used as a preferred method of clinical treatment pro?grams.
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BACKGROUND:Matrix protein is an essential component of the vascular wal , provides a necessary frame for the integrity of the vessel wal and physiological function of vascular wal cel s, and regulates cel s and smooth muscle. OBJECTIVE:To construct rat model of early aneurysm, and to evaluate differences in the expression of matrix structural proteins during cerebral aneurysm formation. METHODS:Twenty-eight healthy male Sprague-Dawley rats were randomized into control group (n=8) and model group (n=20). Aneurysm model was established by ligation of the left common carotid artery and right renal artery-induced hypertension in the model group. In the control group, only the left carotid artery bifurcation and bilateral carotid were exposed in rats. Rats in the model group were sacrificed at 15 and 30 days after model establishment. Right anterior cerebral artery in rats and olfactory artery bifurcation received immunohistochemical staining. The expressions of fibronectin,α-smooth muscle actin and col agen III were analyzed. RESULTS AND CONCLUSION:Compared with the control group, no significant difference in fibronectin expression was detected in right anterior cerebral artery and olfactory artery bifurcation in rats of the model group at 30 days after model establishment (P>0.05). However,α-smooth muscle actin and col agen III expressions were significantly reduced (P<0.05). These data confirmed that expression of structural proteins had differences and dynamic changes during early aneurysm formation in rats. Degradation of matrix structural protein in cerebral artery may be one of the key mechanism of aneurysm formation.
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Objective To explore the mechanism and characteristics of MRI of acute patellofemoral joint impingement syndrome as well as its arthroscopic diagnosis and treatment.Methods There were a total of 46 cases (9 males and 37 females)with acute patellofemoral joint impingement syndrome from September 2005 to October 2012 in our department,and their average age was 21.6 years old (ranging from 15 to 31 years old).The Q angle,lateral patellofemoral angle (LPA) and lateral shift distance (LSD) of all cases were measured by X-ray and MRI preoperatively.MRI checked the medial patellar retinaculum injury by 4 degrees:15 cases of degree Ⅰ,18 cases of degree Ⅱ,8 cases of degree Ⅲ,and 5 cases of degree Ⅳ.All operations were monitored under arthroscopy.Firstly,the hemarthrosis was cleared,and secondly arthroscopy was used to explore all around inside joints,the free cartilage and osteochondral fragment were taken out,and the impaired surface of cartilage was repaired.Medial patellar retinaculum was treated arthroscopically with radio frequency ablation in degree Ⅰ injury.Lateral patellar retinaculum was released when the time of injury was longer than 2 weeks (9 cases),and medial capsule and retinaculum structure were reefed with modified arthroscopy assistance for patients with medial patellar retinaculum injury of degree Ⅱ to Ⅲ with obvious patellar shift.The medial capsule and retinaculum structure were strengthened by open surgical method for patients with degree Ⅳ injury.Results Constant findings under arthroscopy were haemarthrosis (46 cases),chondral lesions involved in the lateral femoral condyle and medial marginal of patella (37 cases),osteochondral fragments (28 cases),and tear of the medical retinaculum (46 cases).All patients were available at follow-up,the average duration of follow-up was 18.2 months (ranging from 12-36 months).No infection,nerve and blood vessel injury,redislocation or other complications happened.Lysholm,Tegner and AAOS scores were used both preoperatively and postoperatively,and LPA and LSD were compared.Statistically,the difference between these two scores was significant (P＜0.05).The sport ability was improved among all patients.Conclusion Acute patellofemoral joint impingement syndrome can be treated effectively by modified suture of medial capsule and retinaculum structure combined with release of lateral retinaculum.The function of knee joint recovered well after operation with satisfactory objective and subjective effects.
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BACKGROUND:Vascular endothelial growth factor and transforming growth factor play a crucial role in embryonic development, wound healing, inflammation, cancer, ischemic hypoxia and other physiological and pathological processes, and participate in the development and progression of brain damage. OBJECTIVE: To evaluate the differences in the expression of vascular endothelial growth factor and transforming growth factor-α during the early phase of cerebral aneurysm formation in rats. METHODS:Twenty-eight healthy Sprague-Dawley rats were randomized into three groups. Sham operation group (n=8): the left carotid artery bifurcation and bilateral renal artery were only exposed, without ligation, and rats were kiled that day. 15 days group (n=10) and 30 days group (n=10): the left common carotid artery, internal carotid artery, external carotid artery and bilateral renal artery were ligated, to establish aneurysm model, and rats were kiled at 15 and 30 days, respectively. The bilateral sides of the anterior cerebral artery/olfactory artery bifurcations were harvested and observed under light microscopy for pathological changes. Immunohistological staining was performed to detect the expression of vascular endothelial growth factor and transforming growth factor-α. RESULTS AND CONCLUSION:The results showed that, no aneurysm formed in the sham operation group and 15 days group. In the 30 days group, one saccular aneurysm and five early aneurysm-like changes were found in the right anterior cerebral artery/olfactory artery bifurcations. In the sham operation group and 15 days group, no vascular endothelial growth factor was expressed. In the 30 days group, the positive rate of vascular endothelial growth factor was up to 80%, indicating that vascular endothelial growth factor is possibly involved in the formation of aneurysm. Transforming growth factor-α expression in the sham operation group and 15 days group was more apparent than that in the 30 days group, indicating that transforming growth factor-α is damaged or secretion is reduced in this process, which was possibly related to the formation of aneurysm.
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BACKGROUND:At present, scholars general y believe that the physical and chemical properties of titanium mesh are fine as easy plastic, easy cutting, good corrosion resistance and wear resistance, non-magnetic, less effect on CT or MRI results, good histocompatibility and resistance to stress. The titanium mesh is regarded as an ideal material for cranioplasty. ＜br> OBJECTIVE:To explore the clinical feasibility of primary reconstruction of comminuted and open skul fracture with titanium mesh. ＜br> METHODS:Sixty-two cases of comminuted and open skul fracture were analyzed retrospectively, including 49 males and 13 females, aged 7-69 years. Among these 62 patients, 30 patients underwent debridement and then after 6-12 months, they received titanium mesh reconstruction, serving as control group. Another 32 cases underwent debridement and titanium mesh reconstruction in the same time as observation group. Al the cases were fol owed-up for 1-2 years to observe wound healing, complications and hospitalization cost. ＜br> RESULTS AND CONCLUSION:During the fol ow-up, no wound infection and intracranial infection occurred in the two groups. The incidence of intracranial hematoma, epilepsy, and other complications was higher in the control group than the observation group (P＜0.05), and the hospitalization cost was also higher in the control group than the observation group (P＜0.05). These findings indicate that primary reconstruction with titanium mesh is feasible in the treatment of comminuted and open skul fracture and can significantly reduce the incidence of complications and hospitalization costs.
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BACKGROUND:Computer-assisted navigation technique has been widely applied in total knee arthroplasty. However, whether computer-assisted navigation total knee arthroplasty is better than traditional total knee arthroplasty remains unclear. OBJECTIVE:To systemical y evaluate and compare the limb and prosthesis alignment restoration post computer-assisted navigation and traditional total knee arthroplasty. METHODS:The PubMed/Medline, EMBASE, Cochrane CENTRAL, ScienceDirect database were searched from established to June 2013 and the randomized control ed trials about computer-assisted navigation and traditional total knee arthroplasty were selected. Meta analysis was performed with Rev Man 5.2 software. The evaluating data included the hip-knee-ankle mechanical axis or tibiofemoral angle, femoral prosthesis coronal angle, femoral prosthesis sagittal angle, tibial prosthesis coronal angle, and tibial prosthesis sagittal angle. The malalignment was defined as a deviation 2° or 3° from the natural line. RESULTS AND CONCLUSION:19 randomized control ed trials involving 2 654 cases (3 392 knees) were included in this study. Meta-analysis showed that, the limb alignment restoration post computer-assisted navigation was significantly better than traditional total knee arthroplasty (3°, P<0.000 01 and 2°, P=0.000 8). The 3° of femoral prosthesis coronal angle deviation post computer-assisted navigation was significantly superior to traditional total knee arthroplasty (P=0.002), while the 2° deviation had no significant difference between the two surgeries (P=0.290). The 3° deviation of femoral prosthesis sagittal angle post computer-assisted navigation was significantly better than traditional total knee arthroplasty (P=0.040);however, the 2° deviation had no significant difference between the two surgeries (P=0.950). 3° and 2°tibial prosthesis coronal angle deviation post computer-assisted navigation was significantly superior to traditional total knee arthroplasty (3°, P=0.030);the 2° deviation had no significant difference between the two surgeries (P=0.260). Computer-assisted navigation has better limb alignment, femoral and tibial prosthesis alignment 3° deviation than the traditional total knee arthroplasty, but the 2° deviation of femoral prosthesis coronal angle, femoral prosthesis sagittal angle, and tibial prosthesis sagittal angle had no significant difference between the two surgeries.