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Objective:To investigate the clinical efficacy of percutaneous vertebral-disc plasty (PVDP) in the treatment of very severe osteoporotic vertebral compression fractures (vsOVCF).Methods:A total of 26 patients with vsOVCF were treated by PVDP at Department of Spine Surgery, The Second Affiliated Hospital, Nantong University from November 2019 to August 2021. They were 8 males and 18 females with an age of (77.9±5.2) years. Fracture sites: T11 in 9 cases, T12 in 13 cases, L1 in 7 cases, and L2 in 2 cases. The loss of vertebral height exceeded 2/3 of its original height. The curative effects were evaluated by comparing the visual analogue scale (VAS), Oswestry disability index (ODI) and local kyphosis angle (LKA) at preoperation, 1 day postoperation and the last follow-up.Results:This cohort was followed up for 12(10, 15) months. No obvious neurological damage or other serious complications occurred. The VAS scores [(2.9±0.7) and (2.2±0.7) points] and ODIs [28.0%±4.8% and 16.9%±4.0%] at 1 day postoperation and the final follow-up were significantly lower than the preoperative values respectively [(6.7±0.8) points and 66.7%±6.0%], and the values at the last follow-up were significantly lower than those at 1 day postoperation ( P<0.05). The LKAs at 1 day postoperation and the last follow-up (18.1°±4.1° and 19.5°±4.4°) were significantly smaller than that before operation (32.0°±5.2°) ( P<0.05), but there was no significant difference between 1 day postoperation and the last follow-up in LKA ( P>0.05). Conclusion:PVDP is an effective surgical treatment of vsOVCF, because it can relieve pain and improve local kyphosis with satisfactory clinical outcomes.
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Objective:To explore the application effect of case-based learning (CBL), teaching mode combined with 3D printing in clinical teaching of sacral tumors.Methods:A total of 108 undergraduate interns and standardized residency training students who studied in our hospital from 2017 to 2018 were divided into the CBL teaching group ( n = 53) and the CBL combined with 3D printing teaching group ( n = 55) according to their study time. The combined teaching group used computer tomography (CT) data to reconstruct and print out a 3D model of sacral tumors based on CBL, and performed preoperative teaching on the invasion of the surrounding tissues of the tumor. The scores of the students in the two groups were evaluated respectively, and the students were surveyed by self-identification questionnaire (learning interest, self-learning ability, teamwork ability, comprehensive analysis ability and clinical thinking ability). The t-test (one-sided) was used for comparison between groups using stata 14.0. Results:The score of CBL teaching group (75.90±6.70) was lower than that of CBL combined with 3D printing teaching group (83.60±7.40). In terms of critical thinking ability evaluation, self-learning ability, learning interest, comprehensive analysis ability and clinical thinking ability, the CBL combined 3D printing teaching group was superior to the CBL teaching group, and the difference was statistically significant ( P<0.001). In terms of teamwork ability, there was no statistical difference between the two groups. Conclusion:The CBL teaching mode combined with 3D printing can improve academic performance, students' learning interest and clinical thinking ability of sacral tumors in the teaching of undergraduate interns and standardized residency training students.
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Objective:To analyze the effect of spine-pelvis sagittal parameters and sagittal orientation of facet joint on degeneration of cranial L 3,4 facet joint (facet joint degeneration, FJD) after L 4-S 1 posterior lumbar interbody fusion (PLIF). Methods:Patients with lumbar degenerative diseases who underwent L 4-S 1 PLIF from January 2012 to December 2016 were retrospectively investigated, there were 54 cases, including 28 males and 26 females. Age: 54.59±5.48 years (range, 45-60 years). X-ray, CT, MRI and Weishuapt grade was used to evaluate the degeneration of L 3,4 facet joint at the cranial adjacent segment. The general information and the sagittal parameters of spine pelvis at the last follow-up were compared between the two groups. The former included age, gender, body mass index (BMI), bone mineral density (BMD), follow-up time and preoperative diagnosis. The latter included lower lumbar lordosis angle (LLL), lumbar lordosis angle (LL), pelvis incidence (PI), pelvis tilt (PT), sacrum slope (SS), the height of the intervertebral space (HD), the angle of cranial facet joint, Oswestry disability index (ODI), Japanese Orthopedic Association (JOA) lumbar function score and improvement rate were compared at the same time. Independent sample t-test was used to compare continuous variables between groups; comparison of categorical variable components χ 2 test or Fisher's exact test. Multivariate logistic regression analysis was used to predict the risk factors of adjacent FJD. Results:Postoperative follow-up was 33.44±6.85 months (range, 24-36 months), there were 17 patients in the degenerative group and 37 patients in the non degenerative group. There were no significant differences in age, gender, BMI, BMD, follow-up time or preoperative diagnosis between the two groups. LLL, LL and SS also showed no significant difference. At the last follow-up, PI (56.28°±6.03° vs. 47.87°±8.30°, t=3.74, P=0.001), PT (17.90°±7.06° vs. 14.41°±5.51°, t=1.97, P=0.042) and the joint angle of the cephalic facet (58.48°±2.00° vs. 54.69°±3.01°, t=4.72, P=0.072) in the degenerative group were greater than those in the non-degenerative group. In the subgroup analysis of lumbar lordosis distribution, the difference between the two groups was statistically significant (χ 2=9.90, P=0.006). The HD in the degenerative group 7.50±3.60 mm was significantly lower than that in the non degenerative group 9.30±2.79 mm ( t=2.00, P=0.031). Multivariate logistic regression analysis showed that increase of PI ( OR=1.22, P=0.005) and magnified cephalic facet joint angle ( OR=2.04, P=0.008) were risk factors for adjacent segment facet degeneration. At the last follow-up, the ODI improvement rate in the degenerative group (58.14%±13.41% vs. 70.18%±8.03%, t=4.11, P<0.001) and the JOA score improvement rate (44.72%±9.53% vs. 68.86%±8.55%, t=0.43, P=0.001) were lower than those in the non degenerative group. Conclusion:The increase of PI and sagittal facet (increased joint angle of proximal facet) are risk factors of adjacent segment FJD after lumbar fusion; The abnormal distribution of lower lumbar lordosis and poor PT recovery in adjacent segment FJD patients after lumbar fusion are more obvious, which may be related to the increase of PI; After lumbar fusion, the orientation of adjacent facet joint tended to be sagittal.
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Objective:To evaluate the efficacy of somatosensory evoked potential (SEP) monitoring for prevention of deep venous thrombosis (DVT) in lower extremity of patients undergoing spinal surgery.Methods:A total of 120 patients of both sexes, aged 40-70 yr, of American Society of Anesthesiologists physical status ⅠorⅡ, without impairment of coagulation function, undergoing posterior lumbar interbody fusion, were selected and divided into 3 groups ( n=40 each) using the random number table method and envelope method: basic preventive measure group (group A), compression stocking group (group B) and SEP monitoring group (group C). In group B, elastic stockings were worn at 1 h before surgery.SEP monitoring was performed during surgery, and the intensity of current stimulation was 25 mA in group C. The flow velocity of popliteal vein in both lower extremities was measured using color Doppler ultrasound apparatus during surgery.Venous blood samples were taken to measure plasma D-dimer concentrations at 1 day before surgery, at the end of surgery and at 24 h after surgery.The DVT developed in lower extremities was diagnosed by ultrasound method during surgery and within 24 h after surgery. Results:Compared with A and B groups, the blood flow velocity of popliteal vein was significantly increased, and the plasma D-dimer concentration and incidence of DVT developed in lower extremity during surgery were decreased in group C ( P<0.05). Conclusion:SEP monitoring can effectively prevent the occurrence of DVT in lower extremity while it is used as an electrophysiological monitoring of the spinal cord in patients undergoing spinal surgery.
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Objective The aim of this study was to investigate the synergistic anti-tumor effect of cryptotanshinone and cis-platin in non-small cell lung cancer NCI-H1975 cells and its possible molecular mechanism. Methods NCI-H1975 cells were treated with control,cryptotanshinone,cisplatin or combination of cryptotanshinone and cisplatin groups(referred to as the combination group). The inhibitory rate of cell proliferation was determined in NCI-H1975 cells by CCK-8 assay;Flow cytometry was used to determine the rates of survival and cell apoptosis;The expression of apoptotic protein,anti-apoptotic protein,JAK2/STAT3 protein and its phosphorylation levels were detected in NCI-H1975 cells by Western blot. The localization and transcription activity of STAT3 cells were determined by laser confocal microscopy/luciferase assays. Results 1. The survival rates in cryptotanshinone,cisplatin and combination groups at each time-point were lower in NCI-H1975 cells than that in the control group(P<0. 05);The proliferation of NCI-H1975 cells in the combination group were inhibited when compared to the control,cryptotanshinone,or cisplatin groups(P<0. 05);2. After treatments for 24 h,the expression levels of Bcl-2 and Survivin protein were decreased(P<0. 01),the activity of Caspase3 and Caspase9 protein was increased(P<0. 01),and the expression levels of p-STAT3 and p-JAK2 protein were de-creased in NCI-H1975 cells(P<0. 01);3. After NCI-H1975 cells treated with the combination of cryptotanshinone and cisplatin, the STAT3 in the nucleus was decreased,and STAT3 activity was also decreased in the nucleus. Conclusion Cryptotanshinone com-bined with cisplatin can exert a synergistic antitumor effect on non-small cell lung cancer NCI-H1975 cells,and its mechanism is related to the inhibition of JAK2 and STAT3 phosphorylation signal pathways.
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Objective To discuss the clinical effects of different energy densities of enteral nutrition (EN) preparations on mechanical ventilation (MV) patients with acute severe traumatic brain injury (sTBI). Methods Sixty MV patients with acute sTBI admitted to the Department of Critical Care Medicine of Hangzhou Xiaoshan District First People's Hospital from July 2015 to December 2017 were divided into two groups according to different energy densities of nutritional preparations. Thirty patients of the control group were given nasal feeding with standard energy density EN (energy density 3.35 - 4.19 kJ/mL) and 30 patients of the observation group were given nasal feeding with relatively higher energy density (energy density 5.44 - 6.28 kJ/mL). The indexes of nutritional status between the two groups before and after treatment were compared: including prealbumin (PA), albumin (Alb), globulin (Glo), hemoglobin (Hb), 5-day and 1-week heat calorie compliance rates of reaching target calories, MV time and incidence of complications. Results There were no statistically significant differences in nutritional indicators before treatment between the two groups (all P > 0.05). The compliance rates of reaching target calories of the observation group on the 5 and 7 days after treatment were significantly higher than those in the control group [5 days: 66.67% (20/30) vs. 50.00% (15/30), 1 week: 81.33% (25/30) vs. 70.00% (21/30), both P < 0.05], and the MV time was significantly lower than that in the control group (hours: 92.48±12.04 vs. 128.88±16.29, P < 0.05); the levels of PA, Alb, Hb, Glo were significantly higher in the observation group than those in control group on the 21st day after treatment [PA (g/L): 0.28±0.11 vs. 0.15±0.04, Alb (g/L): 36.52±5.79 vs. 29.63±2.74, Hb (g/L): 92.40±9.50 vs. 81.10±8.60, Glo (g/L): 24.42±1.73 vs. 18.19±3.59, all P < 0.05]. Complications: the total incidence of abdominal distension, diarrhea and constipation of the observation group was 36.6% (11/30), while that of the control group was 66.7% (20/30), the difference between the two groups being statistically significant (P < 0.05). Conclusion High energy density enteral nutrition can improve the nutritional status of the organisms of MV patients with acute sTBI, reduce the time of MV and the incidence of complications, thus it is worthy to be widely applied clinically.
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Objective To evaluate the effect of a new type of fixation tape for tracheal catheter in intensive care patients.Methods A purposive sampling study was conducted. Ninety patients experienced oral tracheal intubation for mechanical ventilation, and admitted to respiratory intensive care unit (ICU) of the Second Affiliated Hospital of Nantong University from November 2015 to February 2017 were enrolled. All the patients were randomly (random number) divided into the control group and the observation group with 45 patients in each group. The patients in control group was treated with the traditional medical adhesive tape and fixation belt to fix endotracheal tube, while the patients in observation group was treated with a new type of tracheal catheter fixation tape. The fixation effect, skin complication rate, patient's comfort level, nursing workload and satisfaction were evaluated in both groups.Results There were 6 patients with mild displacement, 2 patients with moderate displacement and 1 patient with severe displacement in the control group, while there was no catheter displacement or detachment occurred in the observation group, and the difference between the two groups was statistically significant (χ2 = 2.944,P = 0.003). In the control group, there were 39 patients with facial skin redness,6 patients with facial skin damage, 36 patients with neck skin redness, and 2 patients with neck skin damage. In the observation group, there were no facial skin complications and only 2 patients with neck skin redness, and the skin complication rate was significantly higher than that of the control group (facial skin:Z = 9.173,P = 0.000; neck skin:Z = 7.549,P = 0.000). Compared with the control group, the patients' comfort levels were significantly elevated in the observation group (the intolerance patients: 9 vs. 24, the extreme discomfort patients: 4 vs. 8,Z = 3.695,P = 0.000). The total changing times of the fixation belt and operating time for each change in the observation group were significantly decreased as compared with those of control group [changing times of the fixation belt (times): 1.89±0.77 vs. 3.86±1.18, operating time for each change (minutes): 10.31±1.47 vs. 15.78±1.89, bothP < 0.01]. Nursing satisfaction in the observation group was significantly higher than that of the control group (100% vs. 33.3%,P < 0.01).Conclusions The new fixation tape for tracheal catheter could significantly reduce the catheter displacement and detachment rate, and decreasethe incidence of facial skin injury. It is easy to learn and worth to generalize clinically.
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BACKGROUND:Previous studies have shown that composite scaffold of chitosan and poly-L-lactic acid has good biocompatibility with some cells. OBJECTIVE:To study the biocompatibility of poly-L-lactic acid reinforced by chitosan and olfactory ensheathing cells. METHODS:In experimental group, olfactory ensheathing cells from Sprague-Dawley rats aged 1-3 days were incubated onto chitosan-reinforced poly-L-lactic acid film. And in control group, olfactory ensheathing cells were co-cultured with poly-L-lysine. The proliferative ability of olfactory ensheathing cells was detected and the cells were observed with immunofluorescence histochemical staining at 1, 3, 5, 7 days after culture. RESULTS AND CONCLUSION:Olfactory ensheathing cells could survive on the chitosan-reinforced poly-L-lactic acid film, and the cytotoxic grade wasⅠ. Morphology of the cells in the experimental group was round or oval, with little processes and the cells aggregated into groups. One day after implantation, the periphery cells of the mass extended short projections and gradual y spread outward;3 days after implantation, the cells spread and most of the cells generated projections, most of which were bipolar or tri-polar;5 days after implantation, cel processes significantly extended, most cells were bipolar and tri-polar cells, while some were oval cells and irregular triangular cells;7 days after implantation, the cel density increased, and cel processes extended. Cel morphology of the control group had similar characteristics as the experimental group. There was no obvious difference between the control and the experimental group in number, perimeter or area of the cells (P>0.05). It showed that chitosan-reinforced poly-L-lactic acid had good biocompatibility with olfactory ensheathing cells.
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Objective To investigate the effects of duration of surgery on flash-induced visual evoked potentials (VEP) in patients undergoing spinal surgery in prone position.Methods Eighty-two ASA Ⅰ or Ⅱ patients of both sexes aged 20-76 yr weighing 43-96 kg undergoing spinal surgery in prone position were divided into 3 groups according to the duration of surgery:group S≤2 h ( n =34) ; group M 2-4 h ( n =38) and group L≥4 h ( n =10).VEP was monitored using protektor VEP monitoring device (Xltek Co.,Canada).The latency,amplitude and recovery time of wave P100 were recorded before and 10 min after induction of anesthesia and at the end of surgery.Results Compared with group S,the amplitude of wave P1000 was significantly decreased at the end of surgery in group M,the lantency of wave P100 was significantly prolonged,while the amplitude of wave P100 was decreased at the end of surgery in group L ( P ＜ 0.05).Compared with group M,the lantency of wave P100 was significantly prolonged,while the amplitude of wave P100 was decreased at the end of surgery in group L ( P ＜ 0.05).Compared with groups S and M,the recovery time of wave P100 was significantly prolonged in group L ( P ＜0.05).There was no significant difference in the recovery time of wave P100 between groups S and M ( P ＞ 0.05).Conclusion Duration of surgery (≥4 h) can affect flash-induced VEP,the longer the duration,the stronger the effects.
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The present research was aimed to explore the biocompatibility of IKVAV self-assembling peptide nanofiber scaffold with olfactory ensheathing cells (OECs) of rats. The OECs were seeded onto the surface of coverslips covered with IKVAV self-assembling peptide nanofiber scaffold hydrogel (2D culture system), and implanted within IKVAV self-assembling peptide nanofiber scaffold hydrogel (3D culture system), respectively. The adhesion, viability of OECs were observed with inverted microscope. Then the characteristics for survival and adhesion of cells by image processing were observed, and statistical analysis on the number of S-100 positive cell, the area of the cell bodies and the perimeter of the cell and MTT method were carried out. It was found that the OECs could survive and migrate in IKVAV self-assembling peptide nanofiber scaffold. The result of the cell MTT exam, of the shape and quantity of cells had no significant difference compared to those of the OECs cultured with poly-L-lysine (PLL). It has been proved that IKVAV self-assembling peptide nanofiber scaffold has good biocompatibility with rat OECs.
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Animals , Rats , Animals, Newborn , Biocompatible Materials , Chemistry , Cell Proliferation , Cells, Cultured , Hydrogel, Polyethylene Glycol Dimethacrylate , Chemistry , Laminin , Chemistry , Nanofibers , Chemistry , Olfactory Bulb , Cell Biology , Peptide Fragments , Chemistry , Rats, Sprague-Dawley , Tissue Engineering , Methods , Tissue Scaffolds , ChemistryABSTRACT
BACKGROUND: Fibrin glue has been demonstrated to function as a kind of biomaterial with high quality. It has been used in nerve tissue engineering and proved to be a kind of scaffold for some cells.OBJECTIVE: To explore the biocompatibility of fibrin glue and olfactory ensheathing cells (OECs).DESIGN, TIME AND SETTING: An in vitro control trial based on cytology was performed at the Institute of Neurobiology,Nantong University from August 2007 to February 2008.MATERIALS: Fibrin glue was made of fibrin and catalyst, and OECs derived from rats' olfactory bulb were normally primary-cultured.METHODS: OECs were divided into control (OECs clone spheres were cultured alone) and in fibrin glue (OECs clone spheres were cultured and combined with fibrin glue) groups. After 1 week of culture, the proliferation of OECs were observed by convert microscope and detected by S-100 immunofluorescence histochemical staining.MAIN OUTCOME M EASURES: OECs morphology, cell count, the area of the cell bodies and the perimeter of the cell were determined.RESULTS: OECs could survive, migrate in fibrin glue, and float in the fibrin glue in the lower layer. After 7 days of incubation, cell body exhibited fusiform or triangle, predominantly bipolar or bipolar. The number of the S-100 positive cells was more, and cell bodies were larger in fibrin glue group than control group (P < 0.05). However, there was no obvious difference between two groups in cell perimeter (P > 0.05).CONCLUSION: Fibrin glue has good biocompatibility with OECs, and OECs can survive and migrate in fibrin glue.
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A great progress has been achieved in research on repair of nerve functional recovery following spinal cord injury because of the development of nerve tissue engineering.As an important part of nerve tissue engineering,cell scaffold is divided into natural biomaterials,synthetic materials and composite materials.Besides,nanotechnology has been applied to study scaffolds.However,there are many problems in the application of cell scaffold and further study is needed.With the continued development of biotechnique and cross-correlated technique,the cell transplantation scaffold will make more effect on repair of spinal cord injury.