Application of back-forward Bending CT localization image in the prediction of proximal junctional kyphosis after spinal deformity surgery in adults / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility of predicting proximal junctional kyphosis (PJK) in adults after spinal deformity surgery based on back-forward Bending CT localization images and related predictive indicators.@*METHODS@#A retrospective analysis was performed for 31 adult patients with spinal deformity who underwent posterior osteotomy and long-segment fusion fixation between March 2017 and March 2020. There were 5 males and 26 females with an average age of 62.5 years (range, 30-77 years). The upper instrumented vertebrae (UIV) located at T 5 in 1 case, T 6 in 1 case, T 9 in 13 cases, T 10 in 12 cases, and T 11 in 4 cases. The lowest instrumented vertebrae (LIV) located at L 1 in 3 cases, L 2 in 3 cases, L 3 in 10 cases, L 4 in 7 cases, L 5 in 5 cases, and S 1 in 3 cases. Based on the full-length lateral X-ray film of the spine in the standing position before and after operation and back-forward Bending CT localization images before operation, the sagittal sequence of the spine was obtained, and the relevant indexes were measured, including thoracic kyphosis (TK), lumbar lordosis (LL), local kyphosis Cobb angle (LKCA) [the difference between the different positions before operation (recovery value) was calculated], kyphosis flexibility, hyperextension sagittal vertical axis (hSVA), T 2-L 5 hyperextension C 7-vertebral sagittal offset (hC 7-VSO), and pre- and post-operative proximal junctional angle (PJA). At last follow-up, the patients were divided into PJK and non-PJK groups based on PJA to determine whether they had PJK. The gender, age, body mass index (BMI), number of fusion segments, number of cases with coronal plane deformity, bone mineral density (T value), UIV position, LIV position, operation time, intraoperative blood loss, osteotomy grading, and related imaging indicators were compared between the two groups. The hC 7-VSO of the vertebral body with significant differences between groups was taken, and the receiver operating characteristic curve (ROC) was used to evaluate its accuracy in predicting the occurrence of PJK.@*RESULTS@#All 31 patients were followed up 13-52 months, with an average of 30.0 months. The patient's PJA was 1.4°-29.0° at last follow-up, with an average of 10.4°; PJK occurred in 8 cases (25.8%). There was no significant difference in gender, age, BMI, number of fusion segments, number of cases with coronal plane deformity, bone mineral density (T value), UIV position, LIV position, operation time, intraoperative blood loss, and osteotomy grading between the two groups ( P>0.05). Imaging measurements showed that the LL recovery value and T 8-L 3 vertebral hC 7-VSO in the PJK group were significantly higher than those in the non-PJK group ( P>0.05). There was no significant difference in hyperextension TK, hyperextension LL, hyperextension LKCA, TK recovery value, LL recovery value, kyphosis flexibility, hSVA, and T 2-T 7, L 4, L 5 vertebral hC 7-VSO ( P>0.05). T 8-L 3 vertebral hC 7-VSO was analyzed for ROC curve, and combined with the area under curve and the comprehensive evaluation of sensitivity and specificity, the best predictive index was hC 7-L 2, the cut-off value was 2.54 cm, the sensitivity was 100%, and the specificity was 60.9%.@*CONCLUSION@#Preoperative back-forward Bending CT localization image can be used to predict the occurrence of PJK after posterior osteotomy and long-segment fusion fixation in adult spinal deformity. If the patient's T 8-L 2 vertebral hC 7-VSO is too large, it indicates a higher risk of postoperative PJK. The best predictive index is hC 7-L 2, and the cut-off value is 2.54 cm.

Effect of injury degree of osteoporotic vertebral compression fracture on bone cement cortical leakage after percutaneous kyphoplasty / 中国修复重建外科杂志

OBJECTIVE@#To analyze the correlation between bone cement cortical leakage and injury degree of osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP), and to provide guidance for reducing clinical complications.@*METHODS@#A clinical data of 125 patients with OVCF who received PKP between November 2019 and December 2021 and met the selection criteria was selected and analyzed. There were 20 males and 105 females. The median age was 72 years (range, 55-96 years). There were 108 single-segment fractures, 16 two-segment fractures, and 1 three-segment fracture. The disease duration ranged from 1 to 20 days (mean, 7.2 days). The amount of bone cement injected during operation was 2.5-8.0 mL, with an average of 6.04 mL. Based on the preoperative CT images, the standard S/H ratio of the injured vertebra was measured (S: the standard maximum rectangular area of the cross-section of the injured vertebral body, H: the standard minimum height of the sagittal position of the injured vertebral body). Based on postoperative X-ray films and CT images, the occurrence of bone cement leakage after operation and the cortical rupture at the cortical leakage site before operation were recorded. The correlation between the standard S/H ratio of the injured vertebra and the number of cortical leakage was analyzed.@*RESULTS@#Vascular leakage occurred in 67 patients at 123 sites of injured vertebrae, and cortical leakage in 97 patients at 299 sites. Preoperative CT image analysis showed that there were 287 sites (95.99%, 287/299) of cortical leakage had cortical rupture before operation. Thirteen patients were excluded because of vertebral compression of adjacent vertebrae. The standard S/H ratio of 112 injured vertebrae was 1.12-3.17 (mean, 1.67), of which 87 cases (268 sites) had cortical leakage. The Spearman correlation analysis showed a positive correlation between the number of cortical leakage of injured vertebra and the standard S/H ratio of injured vertebra ( r=0.493, P<0.001).@*CONCLUSION@#The incidence of cortical leakage of bone cement after PKP in OVCF patients is high, and cortical rupture is the basis of cortical leakage. The more severe the vertebral injury, the greater the probability of cortical leakage.

Risk factors of stroke-associated pneumonia for patients with mild to moderate acute ischemic stroke / 中国康复理论与实践

ObjectiveTo explore the risk factors of stroke-associated pneumonia (SAP) for patients with mild to moderate acute ischemic stroke (AIS). MethodsFrom October, 2016 to December, 2019, 321 patients with mild to moderate AIS in Beijing Bo'ai Hospital were collected and divided into SAP group (n = 71) and non-SAP group (n = 250) according to whether they were complicated with SAP. Gender, age, time from symptom onset to admission, systolic pressure, diastolic pressure, scores of National Institutes of Health Stroke Scale (NIHSS) at admission, and medical history were recorded. Laboratory indexes including the count of white blood cell and platelet, levels of D-dimer, hypersensitive C-reactive protein (hs-CRP) and α-hydroxybutyrate dehydrogenase (α-HBDH) were measured. ResultsUnivariate analysis showed that age, NIHSS score, history of hypertension, atrial fibrillation, prior cerebral infarction, the count of white blood cell and platelet, the levels of D-dimer, hs-CRP and α-HBDH were the influencing factors of SAP (P < 0.2). Multivariate Logistic regression showed that age > 70 years old (OR = 7.121, 95%CI 3.493 to 14.514, P < 0.001), NIHSS score > 4 (5 to 10, OR = 4.861, 95% CI 2.412 to 9.797, P < 0.001), the count of platelet > 300×109/L (OR = 6.978, 95% CI 1.864 to 26.128, P = 0.004), and the level of D-dimer > 1.0 mg/L (OR = 3.036, 95% CI, 1.518 to 6.071, P = 0.002) were the risk factors of SAP. The model fitted the original data well (HL = 1.509，P = 0.680) and appeared a good prediction (AUC = 0.847, 95% CI 0.796 to 0.898, P < 0.001). ConclusionAge > 70 years old, NIHSS score > 4 (5 to 10), the count of platelet > 300×109/L and the level of D-dimer > 1.0 mg/L were the risk factors of SAP for patients with mild to moderate AIS.

Study on large-scale resting-state functional networks in first-episode untreated adult patients with major depressive disorder / 中华行为医学与脑科学杂志

Objective:To investigate the value of large-scale brain network research based on independent component analysis (ICA) in discovering the changes of intrinsic functional connections within and between resting-state networks (RSNs) in first-episode untreated adult patients with major depressive disorder (MDD).Methods:From January 2019 to June 2021, twenty-three patients with MDD (MDD group) and 30 healthy volunteers (HC group) matched with gender, age and years of education were selected. All participants underwent resting-state brain function imaging (rs-fMRI), and the MDD group completed the 17-item Hamilton depression scale(HAMD-17). The independent component analysis (ICA) method was used to analyze rs-fMRI data, and meaningful RSNs were obtained. SPM12 and Gift softwares were used to compare the strength of intrinsic functional connection within and between the RSNs of the MDD group and HC group, and the Pearson correlation analysis was conducted by IBM SPSS statistics 25.0 to evaluate the correlation between the functional connection strength and HAMD-17 scores in MDD group.Results:Compared with the HC group, intrinsic functional connection strength of medial prefrontal cortex (mPFC) (MNI: x, y, z=-6, 54, 25)in MDD group was significantly enhanced, while the intrinsic functional connection strength of the left angular gyrus (AG) (MNI: x, y, z=-48, -66, 21), the left precuneus (PCu) (MNI: x, y, z=-6, -63, 33), the left dorsolateral prefrontal cortex (dlPFC) (MNI: x, y, z=-36, 12, 51)and the right anterior insula (AI) (MNI: x, y, z=36, 21, 0)were significantly weakened. Compared with the HC group, functional connection strength between posterior default mode net work(pDMN) and anterior default mode network(aDMN) in MDD group was significantly weakened ( t=-2.206, P=0.032), and function connection strength between pDMN and left frontal parietal network(lFPN) was significantly strengthened ( t=2.318, P=0.025). In MDD group, intrinsic functional connection strength of mPFC and the functional connection strength of pDMN-lFPN were positively correlated with the HAMD-17 score ( r=0.524, P=0.010; r=0.441, P=0.035). Conclusion:Large-scale brain network study based on the ICA can find abnormal functional connections within and between RSNs in first-episode untreated adult patients with MDD, and provide objective imaging markers for the clinical diagnosis and treatment of MDD.

Effects of hyperthermia on biological behavior of human laryngeal cancer Hep-2 cisplatin-resistant cell line / 肿瘤研究与临床

Objective:To investigate the effects of hyperthermia on the biological behavior of human laryngeal cancer Hep-2 cisplatin-resistant (Hep-2/CDDP) cell line and its possible mechanism.Methods:Hep-2/CDDP cell line was induced by high impact combined with increasing concentration method. Cell count method was used to detect the cell proliferation ability of Hep-2 parental cell group (Hep-2 cells without cisplatin-resistance and the cells were cultured with RPMI 1640 cultured medium without cisplatin), Hep-2/CDDP cell group and Hep-2/CDDP+cisplatin group (using RPMI 1640 cultured medium including 4 mg/L cisplatin). Hep-2/CDDP cell group and Hep-2 parental cell group were treated with cultured medium including 0, 0.004, 0.04, 0.4, 4, 40 mg/L cisplatin, respectively. The sensitivity of Hep-2/CDDP cells to cisplatin, vincristine and 5-fluorouracil was determined by using methyl thiazolyl tetrazolium (MTT) method. The half inhibitory concentration ( IC50) and resistance index (RI) were also calculated. Hep-2/CDDP cell group was divided into 4 subgroups: the cells in the control group were cultured for 24 h at 37 ℃; the cells in hyperthermia group were treated at 43 ℃ for 2 h and then re-cultured at 37 ℃ for 22 h; the cells in cisplatin group were cultured at 37 ℃ for 24 h in cultured medium containing 4 mg/L cisplatin. The cells in hyperthermia combined with cisplatin group were cultured in cultured medium containing 4 mg/L cisplatin, treated at 43 ℃ for 2 h and then re-cultured at 37 ℃ for 22 h. The effects of hyperthermia combined with cisplatin on the proliferation and early apoptosis of Hep-2/CDDP cells were detected by using MTT and flow cytometry. The interaction of hyperthermia combined with cisplatin on the proliferation and early apoptosis of HEP-2/CDDP cells was observed by using factorial analysis. Western blotting was used to detect the effect of hyperthermia combined with cisplatin on the expressions of wild-type p53 and PI3K in Hep-2/CDDP cells. Hep-2/CDDP cells were divided into 4 groups: the control group (Hep-2/CDDP cells were cultured for 24 h at 37 ℃); chemotherapy group was treated with 12 mg/L vincristine or 9 mg/L 5-fluorouracil; in the hyperthermia group, Hep-2/CDDP cells were treated at 43℃ for 2 h and then re-cultured at 37 ℃ for 22 h; in hyperthermia combined with chemotherapy group, the cells were cultured in a medium containing 12 mg/L vincristine or 9 mg/L 5-fluorouracil, treated at 43 ℃ for 2 h and then re-cultured at 37 ℃ for 22 h. MTT method was used to detect the effect of hyperthermia combined with vincristine and 5-fluorouracil on the proliferation of Hep-2/CDDP cells. Results:Hep-2/CDDP cell line was successfully established. There were no significant differences in the number of cells in Hep-2/CDDP cell group, Hep-2 parental cell line group and Hep-2/CDDP + cisplatin cell group at different time points (all P > 0.05), and the doubling time was 43.8, 40.6 and 43.5 h, respectively. The IC50 of Hep-2 parental cell line group and Hep-2/CDDP cell group to cisplatin was 4.771 mg/L and 42.749 mg/L, respectively, and the RI was 8.960. Hyperthermia combined with cisplatin could inhibit the proliferation of Hep-2/CDDP cells ( F = 327.91, P < 0.05) and promote the early apoptosis of Hep-2/CDDP cells ( F = 724.63, P < 0.05). Factorial analysis showed that hyperthermia combined with cisplatin had an interaction effect on the proliferation and early apoptosis of Hep-2/CDDP cells ( F = 185.68, 472.51, all P < 0.05). Western blotting showed that the relative expression levels of wild-type p53 protein and PI3K protein in the control group, hyperthermia group, cisplatin group and hyperthermia combined with cisplatin group were significantly different ( F = 547.76, 404.44, all P < 0.01). Hyperthermia combined with vincristine or 5-fluorouracil could inhibit the proliferation of Hep-2/CDDP cells ( F = 33.06, 34.61, all P < 0.05). Factorial analysis showed that hyperthermia combined with vincristine and 5-fluorouracil had no interaction effect on the proliferation of Hep-2/CDDP cells ( F = 0.64,0.60, all P > 0.05). Conclusions:Hyperthermia may reverse the resistance of Hep-2/CDDP cell line to cisplatin by upregulating wild-type p53 expression and inhibiting the PI3K pathway. Hep-2/CDDP cell line has cross-resistance to vincristine and 5-fluorouracil. Hyperthermia can increase the sensitivity of Hep-2/CDDP cell line to vincristine and 5-fluorouracil.

The value of textural analysis based on dynamic contrast-enhanced-MRI in predicting IDH genetic phenotypes of high-grade gliomas / 中华放射学杂志

Objective:To investigate the value of dynamic contrast-enhanced(DCE)-MRI based textural analysis in differentiating IDH mutated high-grade gliomas from IDH gene wild types.Methods:Twenty-nine patients with high grade gliomas collected from April 2016 to December 2019 in First People's Hospital of Changzhou were assessed retrospectively, including 10 patients with IDH mutation and 19 patients with IDH gene wild type. All patients underwent DCE, conventional plain and enhanced MR scanning. Omni Kinetics software was used to perform DCE-MRI data processing, volume transfer constant (K trans), ratio constant of tracer refluxing from tissue to plasma (Kep), extravascular extracellular space per unit volume of tissue (Ve), blood plasma volume (Vp) and area under the gadolinium concentration-time curve (AUC) were obtained. Five commonly used textural features, including Energy, Entropy, Inertia, Correlation, and Inver Difference Moment (IDM), were generated based on gray-level co-occurrence matrices. The independent samples t test (normal distributionand equal variance) or Mann-Whitney rank sum test (abnormal distribution or unequal variance) was used to compare the differences in textural features of DCE-MRI parameters between IDH mutated group and IDH gene wild type group. Receiver operating characteristic (ROC) curves were used to evaluate the efficiency of textural features of DCE-MRI parameters in differentiating IDH mutated high-grade gliomas from IDH gene wild types for statistically significant textural features. Results:Entropy of K trans and Ve for IDH mutated group were 5.368±1.458 and 6.698±1.081, respectively; while the corresponding values were 7.334±1.385 and 8.213±1.320 for IDH gene wild type group, respectively. The difference between the two groups was statistically significant ( t values were-3.570, -3.113, P values were 0.001, 0.004, respectively). Inverse difference moment of K trans and Ve for IDH mutated group were 0.567±0.147 and 0.417±0.106, respectively; while for IDH gene wild type group, the values were 0.393±0.119 and 0.296±0.101, respectively. The difference between the two groups was statistically significant ( t values were 3.452, 3.014, P values were 0.002, 0.006, respectively). In all textural features, the area under the ROC curve of entropy of K trans was the largest (0.874), and the sensitivity was the highest (100%), and the specificity of IDM of Ve was the highest (94.7%). Conclusion:Textural analysis of DCE-MRI can help to differentiate IDH mutated high-grade gliomas from IDH gene wild types.

Establishment of cisplatin-resistant melanoma cell line with stable expression of T-cadherin and its biological characteristics / 中南大学学报(医学版)

To establish cisplatin (CDDP)-resistant melanoma B16F10 (CDDP-R B16F10) cell line with stable expression of T-cadherin, and to study its biological characteristics.
 Methods: CDDP-R B16F10 cell line was exposure to high and gradually increased dose of CDDP. 3-(4.5-Dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) was used to test the proliferation of CDDP-R B16F10 cell line, and the sensitivity of CDDP-R B16F10 cell line to CDDP and paclitaxel was examined. The pEGFP-N1-T-cadherin, a plasmid vector encoding human T-cadherin, was generated by inserting T-cadherin cDNA into a pEGFP-N1 vector. The pEGFP-N1-T-cadherin was transfected into CDDP-R B16F10 cell line. The expression of T-cadherin mRNA and protein were measured by reverse transcription polymerase chain reaction (RT-PCR), Western blotting and immunohistochemistry SP method, respectively. The effect of T-cadherin combined with CDDP on proliferation of CDDP-R B16F10 cell line was determined by MTT assay. The sensitivity of CDDP-R B16F10 cell line with stably transfected T-cadherin to paclitaxel was examined by MTT assay.
 Results: The CDDP-R B16F10 cell line was established successfully. There was no difference in proliferation between the CDDP-R B16F10 cell line and B16F10 cell line (P>0.05). The IC50 of CDDP-R B16F10 cell line and B16F10 cell line to CDDP were 268.706 and 19.748 mg/L, respectively, and the resistance index was 13.61. The IC50 of CDDP-R B16F10 cell line and B16F10 cells to paclitaxel were 11.415 and 7.799 mg/L, respectively, and the resistance index was 1.46. The expression vector pEGFP-N1-T-cadherin was constructed successfully. RT-PCR, Western blotting and immunohistochemistry SP method showed that T-cadherin could be transcribed and expressed. MTT assay showed that T-cadherin combined with CDDP could inhibit the proliferation of CDDP-R B16F10 cell line (P0.05). 
 Conclusion: The CDDP-R B16F10 cell line with stable expression of T-cadherin is established successfully. T-cadherin can reverse the CDDP resistance to CDDP-R B16F10 cell line, and promote its sensitivity to paclitaxel.

Autogenous ossicles in ossiculoplasty: the auditory outcomes and prognostic factors / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the auditory outcomes and prognostic factors in ossiculoplasty using autogenous ossicles. METHODS A retrospective review was performed in 126 patients with cholesteatoma or chronic otitis media, who admitted to the Department of Otolaryngology in Jingzhou hospital affiliated to Tongji medical college from January 2014 to July 2016, and underwent canal wall-down tympanoplasty (CWDT) with ossiculoplasty using autogenous ossicles in a single stage. The postoperative complication and hearing thresholds were analyzed after 12 months' follow-up. RESULTS The rate of dry ear was 96.5％. We had not found any extrusion of prosthesis. There was no one with postoperative retraction pocket or recurrence of cholestatoma during the follow-up. Auditory outcomes showed air conduction threshold improved from (52.7±7.4)dB to (39.0±9.1)dB after operation, while the air-bone gaps improved from(27.4±6.9)dB to (20.8±6.2)dB. Postoperative outcomes were considered successful, if the postoperative air-bone gap was <20 dB. The successful hearing was achieved in 88 patients (69.8％). Prognostic factors were analyzed using multivariate analysis with logistic regression. And we found the presence of the stapes and the malleus handle was significantly favorable predictive factors. All the patients recovered well without severe complication. CONCLUSION Autogenous ossicles is very valuable in ossiculoplasty. The present stapes and malleus handle are important factors for the auditory outcomes in ossiculoplasty.

Sensory Modality Assessment and Rehabilitation Technique (SMART) for Disorders of Consciousness after Brain Injury / 中国康复理论与实践

@#Sensory Modality Assessment and Rehabilitation Technique (SMART) is one of the tools for assessing patients with disorders of consciousness (DOC) after brain injury, to detect signs and meaningful responses to the conscious presence of DOC patients, and to optimize the patient's potential communication and motor function through the development of a treatment plan, that can be used in the assessment, treatment, and long-term prognosis of patients with DOC. SMART can effectively reduce the misdiagnosis of DOC due to the environment, long observation and evaluation, the incorporation of family and care teams in the evaluation, and the normalization of the evaluation content. Besides an assessment tool, SMART provides treatment options. At present, the SMART treatment stage has been formalized, which can create personalized treatment plan for patients. The intervention after DOC evaluation can be divided into exploration, strengthening and education. SMART is advantaged in evaluation, treatment and prognosis, that can benefit the standardization of diagnosis and intervention of DOC in China.

Comparison of the accuracy of lower cervical anterior transpedicular screws between three-dimensional printing assembly navigation template and free hand placement / 中国组织工程研究

BACKGROUND:Lower cervical anterior transpedicular screw technology combines the advantages of the anterior and posterior surgery;therefore, the pressure releasing and reconstruction problems can be solved via one time anterior surgery, whereas, the difficulty and risk of the operation are increased. However, the three-dimensional (3D) printing assembly navigation template improves the safety and accuracy of screw placement. OBJECTIVE:To explore the feasibility and accuracy of 3D printing assembly navigation template in lower cervical anterior transpedicular screws and compare it with free hand pedicle screw placement. METHODS:Lower cervical spine specimens of six adult (2 males, 4 females, average age 58.5 years old ranged from 53 to 64 years) corpses were equal y and randomly divided into two groups. Group A underwent free hand pedicle screw placement. Groups B (lower cervical anterior transpedicular screws assisted by personalized 3D printing combined navigation template):Three cadaveric lower cervical spines were examined using CT and data in DICOM format were recorded. After data were processed using software Mimics for 3D model reconstruction, computer-assisted design of optimum trajactory for lower cervical (C3-C7) anterior transpedicular screws placement was worked out and made into a dril template, where the surface was created as the inverse of anterior surface of cervical vertebra. The dril template was materialized in a 3D printing and used to place the screws. Subsequently, CT scan was performed to evaluate the screw orientation and acceptability. RESULTS AND CONCLUSION:(1) Thirty screws were inserted in Group A. The pedicle perforation was classified by CT, Grade 1:22 screws, Grade 2:6 screws, Grade 3:2 screws;insertion rate was acceptable (Grades 1-2):28 (93%). Thirty screws were inserted in Group B. The pedicle perforation was classified by CT, Grade 1:25 screws, Grade 2:4 screws, Grade 3:1 screw;insertion rate was acceptable (Grades 1-2):29 (97%). There were no statistical y significant differences in the rate of acceptable insertion and orientation between two groups (P>0.05). (2) These results suggested that 3D printing combined navigation template consisted with dril hole cap and screw hole, with functions of double direction. Compared with the traditional method, personalized 3D printing combined navigation template can be used simply.

CT and pathologic analysis of ovarian fibrothecoma / 实用放射学杂志

Objective To explore the CT features and differential diagnosis of ovarian fibrothecoma,and to compare with postoperative pathological findings.Methods The clinical data,CT appearances and pathological signs of 15 patients with ovarian fibrothecoma and 7 patients with granulosa cell tumor were analyzed retrospectively.The plain CT values and enhanced CT values(ΔCT)of fibrothecomas and granulosa cell tumors were compared with each other.Results The ovarian fibrothecomas showed solid or cystic-solid masses with well-defined margin,mild delayed enhancement or no obvious enhancement on CT.The CT features were correspond to the pathological signs. The plain CT values of fibrothecoma and granulosa cell tumor had no significant difference(t=0.745,P=0.467).The mean ΔCT values of fibrothecoma was significantly lower than that of granulosa cell tumor(t=2.537,P=0.041).Conclusion Ovarian fibrothecoma has characteristic CT features,combined with the clinical data,which may help to improve the diagnosis.

A meta-analysis of short fusionversus long fusion for degenerative scoliosis / 中国组织工程研究

BACKGROUND:At present, the main purpose of treatment for degenerative scoliosis is to relieve symptoms, surgicaly correct scoliosis, restore balance and function of the spine, but what kind of techniques is superior has been controversial. OBJECTIVE:To systematicaly assess the clinical effectiveness and safety of short fusion versus long fusion for degenerative scoliosis. METHODS:The databases such as China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journals Database, WanFang Database, The Cochrane Library, PubMed, and EMbase published before May 2015 were electronicaly searched to colect the trials about the short fusion versus long fusion for degenerative scoliosis. Meta-analysis was performed by using RevMan 5.3.4 software. RESULTS AND CONCLUSION: Eleven studies were included, with 533 patients, including 272 cases in the short fusion group and 261 cases in the long fusion group. Meta-analysis results showed that: compare with short fusion group, long fusion group had better improvement of spine Cobb angle (P < 0.000 01) and lordosis angle (P < 0.000 01). No differences were found in the coronal imbalance (P=0.06) and lateral slippage (P=0.24) between the two groups. No significant difference was detected in Japanese Orthopaedic Association score (P=0.93), Visual analogue scale score (P=0.22), and Oswestry Disability Index score (P=0.13) between the two groups. The postoperative complications (P=0.000 6) and the rate of reoperation (P=0.03) were higher in the long fusion group than those in the short fusion group. The incidence of adjacent segment disease has no difference between the two groups (P=0.81). These findings suggest that long fusion is better than short fusion in improvement of the deformity of spine, but incidence of postoperative complications and the rate of reoperation are higher than those in the short fusion group. Comprehensive consideration should be given to the selection of a fixed fusion scheme.

A modified method forin vitroisolation and cultivation of periosteal cells in rabbits / 中国组织工程研究

BACKGROUND:Periosteum is considered as a source of seed cels for cel therapydue toits biological features. OBJECTIVE:To seek the optimal way to isolate and culture rabbit periosteal cels and identify their biological features. METHODS:Rabbit periosteum on facies medialis tibiae was taken out under aseptic conditions. Periosteal cels isolated through the digestion of type II colagenase with the explants culture method were cultured in DMEM/F12 complete medium. Cel ultrastructure was observedunderan inverted microscope. Periosteal cel proliferation was determined bycel counting kit-8assay. Cel surface antigensCD90 and CD105 were determined using flow cytometry. Osteogenic andlipogenic induction mediums were applied to induce periosteal cels to differentiate into osteocytes and adipocytes, respectively. After 2 weeks of induction, cels were harvestedfor alizarin red staining and oil red O staining to assay the calciumnodules and lipid droplet. RESULTS AND CONCLUSION:The digestion of type II colagenase with the explants culture method shortened the period of primary cels culture and enhanced the survival rate, which causedhigher purity and stronger reproductive activity of harvested periosteal cels. Primary cultured periosteal cels grew in form of spindle spiral or paralel. Alizarin red andOil red O staining verified the multi-directional differentiation potentiality of periosteal cels. These findings suggest that the periosteal cels with high purity,strong reproductive activity,andmulti-directional differentiation potentialitycanbe harvested in short time using digestion of type II colagenase with the explants culture method.

Application of a three-dimensional printing model of surgical decompression for cervical ossification of the posterior longitudinal ligament / 中国组织工程研究

BACKGROUND:Three-dimensional (3D) printing technology has been successful y used in the field of joint replacement, fracture fixation and spinal implant, but the potential of 3D printing technology in the field of surgery for ossification of posterior longitudinal ligament of cervical spine remains to be discussed. OBJECTIVE:To determine the application value of a 3D printing model in the selection of anterior and posterior surgical decompression for cervical ossification of the posterior longitudinal ligament. METHODS:A retrospective analysis was carried out involving 15 patients with ossification of the posterior longitudinal ligament col ected by computed tomography (CT) and printed by a 3D model pre-operatively between October 2014 and October 2015 in Affiliated Hospital of Xuzhou Medical University. There were isolated type (n=2), segmental type (n=6), continuous type (n=4), and combined type (n=3). The application value of a 3D printer model in patients with ossification of the posterior longitudinal ligament was evaluated by Japanese Orthopedic Association scores, Visual Analog Scale scores, symptoms, and imaging data 1 month pre-operatively, 1 month post-operatively, and at the final fol ow-up. RESULTS AND CONCLUSION:(1) Al 15 patients underwent successful treatment of cervical spine decompression surgery and were fol owed up for 4-16 months. The post-operative symptoms were relieved more significantly than the pre-operative symptoms. Using the posterior approach for cervical spinal surgery, 1 patient had incision fat necrosis and healed after negative pressure drainage. (2) Japanese Orthopedic Association scores 1 month pre-operatively, 1 month post-operatively, and at the final fol ow-up were 9.0±1.6, 11.7±1.8, and 15.5±1.4, respectively;the differences were statistical y significant (P<0.05). Visual Analog Scale scores 1 month pre-operatively, 1 month post-operatively, and at the final fol ow-up were 6.7±2.5, 2.13±1.4, and 1.4±0.5, respectively;the difference was statistical y significant (P<0.05). (3) The imaging results at fol ow-up showed that the anterior interbodies were fused, and the pivot of the posterior operation was healed wel without a re-closing phenomenon. (4) A 3D printer model was shown to be beneficial in observing the characteristics of cervical ossification of the posterior longitudinal ligament, performing the pre-operative evaluation, and simulating the surgical procedure. There was value for the choice of operative approach.

The value of susceptibility weighted imaging in evaluating ischemia-reperfusion injury of the rabbit kidney / 中华放射学杂志

Objective To explore the value of susceptibility weighted imaging (SWI) in the quantitative analysis of ischemia-reperfusion injury (IRI) of the rabbit kidneys . Methods Thirty New Zealand white rabbits were randomly assigned to IRI group (n=24, operation with clamping) and Sham group (n=6, operation without clamping). Left renal ischemia-reperfusion was performed by occlusion (calmping) of the left renal arterial for 60 minutes, followed by reperfusion. All the rabbits underwent MRI including T2WI and SWI before and 0.5 h, 12 h, 24 h and 48 h after the establishments of models . Three rabbits in IRI group were randomly sacrificed 0.5 h, 12 h, and 24 h after the establishment of model. The rest of the rabbits in IRI group and 6 rabbits in sham group were sacrificed for pathological examination 48 h after the establishment of model All specimen were cut into slices and stained with hematoxylin-eosin (HE). Region of interest ( ROI) was manually created by outlining the inner medulla, inner stripe of outer medulla, outer stripe of outer medulla, and cortex, then relative signal-to-noise ratio of the kidney (rSNR) to muscle in SWI sequence was recorded. and compared with histopathologic features. One-way ANOVA was performed to compare difference of rSNR to muscle in respective location at 5 time-points between Sham group and IRI group, and the differences between groups were tested using repetitive measure analysis of variance, repetitive measure analysis of variance was performed to compare difference of rSNR to muscle in respective location at respective time-points between Sham group and IRI group. Results rSNR value in the inner medulla 0.5 h, 12 h, 24 h and 48 h after the establishments of models were 0.28 ± 0.04, 0.98 ± 0.14, 0.69 ± 0.07, 0.57±0.06, 0.43±0.03, respectively (F=69.82,P<0.01), the inner stripe of outer medulla at the five time-points 0.08 ± 0.03, 0.57 ± 0.05, 0.32 ± 0.07, 0.16 ± 0.02, 0.04 ± 0.01, respectively(F=16.59,P<0.01), the outer stripe of outer medulla were 0.31 ± 0.04, 0.86 ± 0.09, 0.65 ± 0.07, 0.55 ± 0.06 0.43 ± 0.04(F=67.52,P<0.01), respectively,the cortex 0.05±0.01, 0.80±0.04, 0.68±0.07, 0.47±0.07, 0.36±0.08, respectively(F=118.96,P<0.01). The difference of the rSNR was statistically significant in the inner medulla, inner stripe of outer medulla, outer stripe of outer medulla, and cortex at the five different time-points. The differences between two groups were significant (F=206.29, 14.25, 42.8, 39.12, P all<0.05). The pathological findings in Sham group included normalglomerular structure l, clear cavity of tubular, no interstitial hyperemia and edema. The pathological findings in IRI group demonstated, at 0.5 h after IRI, Bowman's capsule cavity expansion, glomerular shrinkage, swelling of renal tubular epithelial cells, vacuoles degeneration, the tube cavity expansion, interstitial edema and congestion ecta became slender, andat 12 h after IR, Bowman's capsule expansion became more obvious, foam degeneration of renal tubular epithelial cells, apoptosis, partial loss of the brush border of the proximal convoluted tubule, formation of protein cast, and a small amount of inflammatory cells appeared in the renal interstitium, swelling of endothelial cells of the vasa recta, congestion of small vessels, and at 24 and 48 h after IRI, more serious injury of renal tubular in the outer stripe of outer medulla , massive necrosis of renal tubular epithelial cells, apoptosis, parts of the renal tubular had the contour lines, and renal tubular outline, increment in inflammatory cells, red cell and protein cast. Conclusion rSNR of SWI in the inner medulla, inner stripe of outer medulla, outer stripe of outer medulla, and cortex of the kidney varies with the degree of IRI over time, and is consistent with corresponding pathological feature, suggesting SWI is useful imaging tool to detect early damage of renal IRI quantitatively.

Retrograde endovascular angioplasty and conventional anterograde endovascular angioplasty for the treatment of below-the-knee arterial occlusion diseases：a comparative study / 介入放射学杂志

Objective To compare the clinical efficacy of transdorsal-to-plantar (TDP) or transplantar-to-dorsal (TPD) retrograde endovascular angioplasty in treating below-the-knee arterial occlusion diseases, and to compare it with conventional anterograde endovascular angioplasty. Methods A total of 96 patients with below-the-knee arterial occlusion diseases (112 diseased lower extremities in total), who were admitted to authors’ hospital during the period from Oct. 2009 to July 2011 to receive conventional anterograde endovascular angioplasty, were enrolled in this study. The clinical data were retrospectively analyzed. Among the 112 diseased lower extremities, conventional anterograde endovascular angioplasty failed in 27, and TDP or TPD retrograde endovascular angioplasty had to be carried out. A total of 71 patients (85 diseased lower limbs) were successfully treated with conventional anterograde endovascular angioplasty (routine group), while 20 patients (22 diseased lower limbs) were successfully treated with retrograde endovascular angioplasty (retrograde group). The preoperative ankle-brachial index(ABI), the coronary angiography-based thrombolysis in myocardial infarction (TIMI) flow score, the dorsal or plantar arterial pulse score, the postoperative limb salvage rate and target vessel patency rate were calculated, and the results were compared between the two groups. Results The technical success rate in the retrograde group and the routine group was 75.9% and 74.0%respectively (P>0.05). Preoperative ABI value of the retrograde group and the routine group was 0.55± 0.21 and 0.56±0.14 respectively, after the treatment which increased to 0.93±0.19 and 0.89±0.18 respectively (P>0.05). Preoperative TIMI score of the retrograde group and the routine group was 0.1 ±0.5 and 0.8 ±0.8 respectively, which significantly increased to 2.5±0.6 and 1.8±0.8 respectively (P0.05). Twenty-four months after endovascular angioplasty Kaplan-Meier analysis indicated that the limb salvage rate of the retrograde group and the routine group was 95.5%and 96.5%respectively (P>0.05). Conclusion Compared with conventional anterograde endovascular angioplasty for the treatment of below-the-knee arterial occlusion diseases, retrograde endovascular angioplasty via TDP or TPD path can immediately improve the blood flow with obvious improvement of ABI score, primary target vessel patency rate as well as the limb salvage rate. Therefore, retrograde endovascular angioplasty should be regarded as an effective supplementary technique when anterograde angioplasty fails.

Effect of Low-frequency Repetitive Transcranial Magnetic Stimulation on Memory and Cognition Impairment af-ter Stroke / 中国康复理论与实践

Objective To investigate the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) on post-stroke dis-function of cognition and memory by stimulating right dorsolateral prefrontal cortex. Methods 40 patients were randomized into the rTMS (n=19) and sham (n=21) groups. The function of cognition and memory were measured before treatment, after treatment and 2 months post-treatment with Montreal Cognitive Assessment (MoCA), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and Riv-ermead Behaviour Memory Test (RBMT). Results All scores improved in both groups after treatment and 2 months post-treatment (P<0.001), and improved more in the rTMS group than in the sham group (P<0.01). Conclusion Low-frequency rTMS may improve the func-tion of memory and cognition after stoke.

Effect of Low-frequency Repetitive Transcranial Magnetic Stimulation on Memory and Cognition Impairment after Stroke / 中国康复理论与实践

@#Objective To investigate the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) on post-stroke disfunction of cognition and memory by stimulating right dorsolateral prefrontal cortex. Methods 40 patients were randomized into the rTMS (n=19) and sham (n=21) groups. The function of cognition and memory were measured before treatment, after treatment and 2 months post-treatment with Montreal Cognitive Assessment (MoCA), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and Rivermead Behaviour Memory Test (RBMT). Results All scores improved in both groups after treatment and 2 months post-treatment (P< 0.001), and improved more in the rTMS group than in the sham group (P<0.01). Conclusion Low-frequency rTMS may improve the function of memory and cognition after stoke.

Retrograde endovascular angioplasty and conventional anterograde endovascular angioplasty for the treatment of below-the-knee arterial occlusion diseases：a comparative study / 介入放射学杂志

Objective To compare the clinical efficacy of transdorsal-to-plantar (TDP) or transplantar-to-dorsal (TPD) retrograde endovascular angioplasty in treating below-the-knee arterial occlusion diseases, and to compare it with conventional anterograde endovascular angioplasty. Methods A total of 96 patients with below-the-knee arterial occlusion diseases (112 diseased lower extremities in total), who were admitted to authors’ hospital during the period from Oct. 2009 to July 2011 to receive conventional anterograde endovascular angioplasty, were enrolled in this study. The clinical data were retrospectively analyzed. Among the 112 diseased lower extremities, conventional anterograde endovascular angioplasty failed in 27, and TDP or TPD retrograde endovascular angioplasty had to be carried out. A total of 71 patients (85 diseased lower limbs) were successfully treated with conventional anterograde endovascular angioplasty (routine group), while 20 patients (22 diseased lower limbs) were successfully treated with retrograde endovascular angioplasty (retrograde group). The preoperative ankle-brachial index(ABI), the coronary angiography-based thrombolysis in myocardial infarction (TIMI) flow score, the dorsal or plantar arterial pulse score, the postoperative limb salvage rate and target vessel patency rate were calculated, and the results were compared between the two groups. Results The technical success rate in the retrograde group and the routine group was 75.9% and 74.0%respectively (P>0.05). Preoperative ABI value of the retrograde group and the routine group was 0.55± 0.21 and 0.56±0.14 respectively, after the treatment which increased to 0.93±0.19 and 0.89±0.18 respectively (P>0.05). Preoperative TIMI score of the retrograde group and the routine group was 0.1 ±0.5 and 0.8 ±0.8 respectively, which significantly increased to 2.5±0.6 and 1.8±0.8 respectively (P0.05). Twenty-four months after endovascular angioplasty Kaplan-Meier analysis indicated that the limb salvage rate of the retrograde group and the routine group was 95.5%and 96.5%respectively (P>0.05). Conclusion Compared with conventional anterograde endovascular angioplasty for the treatment of below-the-knee arterial occlusion diseases, retrograde endovascular angioplasty via TDP or TPD path can immediately improve the blood flow with obvious improvement of ABI score, primary target vessel patency rate as well as the limb salvage rate. Therefore, retrograde endovascular angioplasty should be regarded as an effective supplementary technique when anterograde angioplasty fails.

Osteogenic differentiation of nucleus puplousus cells co-cultured with autologous periosteal cells / 中国组织工程研究

BACKGROUND:Periosteal cel s have been used in bone repair, but whether nucleus puplousus cel s co-cultured with autologous periosteal cel s can differentiate into osteoblasts in spinal fusion is rarely reported. OBJECTIVE:To isolate nucleus puplousus cel s and periosteal cel s so as to observe the osteogenic ability of nucleus puplousus cel s co-cultured with periosteal cel s or not. METHODS:Type II col agenase digestion method was used to isolate and purify nucleus pulposus cel s, which were confirmed by toluidine blue and immunohistochemical staining. Periosteal cel s were isolated histological y and cultured in complete medium, and cel surface antigens CD90, CD105 were identified by immunofluorescence staining. According to the experimental needs, the cel s were assigned into two groups. Nucleus pulposus cel s and periosteal cel s were co-cultured by osteogenic induction medium in the experimental group. Nucleus pulposus cel s in the control group were cultured alone in osteogenic induction medium. Cel morphology was observed by inverted microscopy, and cel proliferation was detected by cel counting kit-8. The osteogenic differentiation indexes of cel s in each group were measured using alkaline phosphatase staining, alizarin red staining, and type I col agen immunohistoehemical staining. The expression of osteopontin was tested by western blot assay. RESULTS AND CONCLUSION:CD105 and CD90 expressions of the periosteal cel s were positive. Nucleus puplousus cel s were positive for toluidine blue and col agen type II immunohistochemical staining. The proliferative ability of nucleus puplousus cel s was significantly higher in the experimental group than the control group at days 1, 3, 5, 7, 9. After 2 weeks of induction, the cel s were positive for alkaline phosphatase staining, alizarin red staining, and type I col agen immunohistoehemical staining, but the experimental group showed higher positive expressions than the control group (P<0.05). The expression of osteopontin was also higher in the experimental group than the control group. These findings indicate that nucleus puplousus cel s possess osteogenic ability, but have lower proliferative ability in vitro. After co-culture with periosteal cel s, the proliferative ability of nucleus puplousus cel s can be increased. Under osteogenic induction, nucleus puplousus cel s co-cultured with periosteal cel s have good compatibility and adhere with each other, which have stronger osteogenic ability than cel s cultured alone.