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Objective:To investigate the effect of medial open wedge high tibial osteotomy (HTO) on moderate and severe medial compartmental knee osteoarthritis.Methods:This study retrospectively reviewed patients treated with medial open wedge HTO between January 2017 and January 2019. All cases were followed up for more than 2 years. There were 28 patients with severe osteoarthritis, including 11 males and 17 females, aged 56.36±5.06 years. There were 32 patients with moderate osteoarthritis, including 12 males and 20 females, aged 54.16±6.3 years. Kellgren-Lawrence (K-L) grading, hip-knee-ankle angle (HKA), weight bearing line (WBL) ratio, joint line convergence angle (JLCA), medial joint space (MJS), posterior tibial slope (PTS), medial meniscus extrusion (MME) and medial meniscus extrusion ratio (MMER) were evaluated on radiographs before and 2 years after surgery. The International Cartilage Repair Society (ICRS) of the cartilage of medial femoral condyle (MFC) and medial tibial condyle (MTC) were evaluated under arthroscopy. The clinical outcomes were assessed by the Western Ontario and McMaster University (WOMAC) score, visual analogue scale (VAS) and the degree of medial collateral ligament (MCL) pseudo-relaxation. Predictors of MCL pseudo-relaxation were screened by binary logistic regression analysis.Results:K-L grading, HKA, WBL ratio and MJS improved in both groups after surgery, with no statistical significance between groups ( P>0.05). The postoperative JLCA was improved, whereas MME and MMER were not. And the severe group was higher than the moderate group before and after surgery ( P<0.05). Cartilage of MFC: in the severe group, 2 cases of ICRS 3 grade, 26 of 4 grade improved to 11 of 2 grade, 12 of 3 grade, 5 of 4 grade; in the moderate group, 12 cases of ICRS 2 grade, 18 of 3 grade, 2 of 4 grade improved to 30 of 2 grade, 2 of 3 grade. Cartilage of MTC: in the severe group, 2 cases of ICRS 3 grade, 26 of 4 grade improved to 17 of 2 grade, 8 of 3 grade, 3 of 4 grade; in the moderate group, 11 of 2 grade, 8 of 3 grade, 3 of 4 grade improved to 27 of 2 grade, 5 of 3 grade. The postoperative WOMAC score of the severe group improved from 50.71±8.07 to 3.86±1.84, while in the moderate group it improved from 44.09±6.63 to 3.34±2.24. The postoperative VAS score of the severe group decreased from 7.14±1.21 to 3.34±2.24, whereas it decreased from 6.38±1.24 to 0.44±0.62 in the moderate group ( P<0.05). There was no significant difference between the postoperative groups ( P>0.05). In the severe group, the degree of pseudo-relaxation of the MCL improved from preoperative 25 of I degree, 3 of II degree to postoperative 28 of 0 degree at the 0° position, and from 25 of I degree, 3 of II degree to 24 of 0 degree, 4 of I degree at 30° position ( P<0.05). In the moderate group, the degree of pseudo-relaxation of the MCL improved from preoperative 31 of 0 degree, 1 of I degree to postoperative 32 of 0 degree at the 0° position, and from 28 of 0 degree, 4 of I degree to 32 of 0 degree at the 30° position ( P<0.05). JLCA ( OR=0.08, 95% CI: 0.007, 0.948, P=0.045), MME ( OR=0.11, 95% CI: 0.100, 1.32, P=0.082) and MMER ( OR=0.66, 95% CI: 0.422, 1.030, P=0.067) were independent predictors of MCL pseudo-relaxation (the difference was statistically significant at P<0.10). Conclusion:Medial open wedge HTO has significant short-term clinical effect on the treatment of moderate and severe medial compartmental knee osteoarthritis, which can effectively relieve pain symptoms, improve joint function, and restore medial knee stability. Preoperative large JLCA, MME and MMER indicate pseudo-relaxation of the MCL.
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Objective To investigate sedation of dexmedetomidine versus midazolam on me-chanically ventilated patients.Methods Seventy-six mechanically ventilated patients were randomly divided into midazolam group (group M)and dexmedetomidine group (group D).The loading dose and maintenance dose of midazolam was 0.06 mg/kg and 0.04-0.2 mg·kg-1 ·h-1 ,and 1 μg/kg and 0.2-0.7 μg·kg-1 ·h-1 for dexmedetomidine.The drug dose was adjusted according to Ramsay score scale.Time when Ramsay reach 2-4 score,the length of ICU stay,mechanical ventilation time,drug adverse reactions,the levels of inflammation factors were recorded and compared between two groups.Results The length of ICU stay and arousing time in group D was significantly lower than that of group M (P <0.05).The levels of TNF-α,hs-CRP in group D were lower after 24 hr treat-ment than that of group M(P <0.05).The levels of hs-CRP in group D were lower after 48 hr treat-ment than that of group M (P <0.01).Conclusion Dexmedetomidine treatment reduced the lengh of ICU stay and levels of inflammatory factors of mechanical ventilated patients.
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Objective To study the prognostic value of procalcitonin(PCT) and C?reactive protein ( CRP ) in critically ill patients with ventilator?associated pneumonia ( VAP )?Methods A single?center prospective observational study was conducted?A total of 67 cases patients with VAP admitted into intensive care unit(ICU) from November 2013 to October 2015 were enrolled and grouped as survivors(43 cases) and non?survivors(24 cases)?Blood samples for PCT and CRP were collected on the day of the pneumonia diagnosis,and the 4th and 8th day after the diagnosis?Results There were 24 cases(35?8 %) died among the 28 days after the pneumonia diagnosis?There was no significant difference between the survivor and non?survivor groups in terms of PCT on the day of the pneumonia diagnosis( P>0?05) ,or CRP on the day of the pneumonia diagnosis, and the 4th and 8th day after the diagnosis ( P>0?05)?But the PCT values on the 4th and 8th day were significantly higher in the non?survivor group than the survivor group(4 d:0?4(0?3,1?1) μg/L vs?4?7(2?3, 10?8) μg/L,P<0?05;8 d:0?2(0?1,1?7) μg/L vs?3?9(3?2,14?8) μg/L,P<0?05)?PCT levels decreased significantly from the day of the pneumonia diagnosis(0?7(0?4,4?2) μg/L) to the 8th day after the diagnosis (0?2(0?1,1?7) μg/L,P<0?05) in the survivor group?The PCT level above 1 μg/L on the 4th day after the diagnosis was the strongest predictor of mortality,with an odds ratio of 23?Conclusion PCT is found to be a more important prognostic marker compared to CRP in terms of predicting mortality in critically ill patients with VAP?The PCT level on the 4th day after the diagnosis is the strongest predictor of mortality in VAP.
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<p><b>BACKGROUND</b>Gastrodin, as one of the major components extracted from the Chinese herb Gastrodia elata Bl., has many biologic effects, one of which is anti-apoptosis. Apoptosis is considered to be one of the pathogenetic mechanisms in steroid-induced osteonecrosis of the femoral head (ONFH). Therefore, we performed this study to investigate whether gastrodin has the potential to prevent steroid-induced ONFH.</p><p><b>METHODS</b>All 18 male adult Wistar rats were divided equally into three groups: the steroid group, the gastrodin+steroid group, and the control group. Osteonecrosis was induced by low-dose lipopolysaccharide and subsequent high-dose methylprednisolone. Histomorphometric method was used to determine the incidence of osteonecrosis. Terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay was performed to detect apoptotic index of osteocytes and osteoblasts. Real-time PCR and Western blotting were performed to detect mRNA and protein expression of Bax, Bcl-2, and Caspase-3. Fisher's exact probability test and one-way analysis of variance (ANOVA) with Turkey's post hoc test were used to examine significant differences between groups.</p><p><b>RESULTS</b>The incidence of osteonecrosis in the gastrodin+steroid group (16.7%) was significantly lower than that in the steroid group (83.3%). According to TUNEL assay, the apoptotic indices in the steroid group, the gastrodin+steroid group, and the control group were 91.1%, 27.1%, and 5.4%, respectively, and the differences were significant between groups. Compared with the control group and the gastrodin+steroid group, the mRNA and protein expression levels of Bax and Caspase-3 were significantly higher in the steroid group, but the Bcl-2 mRNA and protein expression levels were significantly lower.</p><p><b>CONCLUSION</b>Gastrodin could prevent steroid-induced ONFH by anti-apoptosis.</p>
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Animals , Male , Rats , Apoptosis , Benzyl Alcohols , Therapeutic Uses , Femur Head Necrosis , Drug Therapy , Glucosides , Therapeutic Uses , Lipopolysaccharides , Pharmacology , Rats, Wistar , Steroids , PharmacologyABSTRACT
BACKGROUND:Though the effects of conservative or traditional open reduction and internal fixation in the treatment of thoracolumbar fractures are reliable and satisfactory for most cases, two methods also have shortages. Minimal-invasive percutaneous pedicle screw system provides a new available method. OBJECTIVE:To investigate the clinical effect of Sextant percutaneous pedicle screw system in the treatment of thoracolumbar fractures. METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or traditional open internal fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics of Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. RESULTS AND CONCLUSION:Except two patients in traditional open internal fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. Operative time, intraoperative blood loss, postoperative drainage amount and hospital day were better in percutaneous pedicle screw fixation group than in the traditional open internal fixation group (P0.05). The results show that percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, obeying indication strictly is very important for clinical application.
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BACKGROUND:Currently, one of common methods is discectomy, nerve root decompression and fusion rigid fixation from the midline approach for disc herniation which is inefficient by conservative treatments. Thus, it is causing degeneration and limiting lumbar physiological activity of adjacent segments. The treatment of non-fusion lumbar disc herniation with the traditional posterior midline incision approach has some disadvantages such as big incision, wide peeling, and back muscle denervation. OBJECTIVE:To observe therapeutic effects of dynamic stabilization system through Wiltse approach on lumbar disc herniation, and to compare the outcomes with traditional posterior approach. METHODA total of 46 patients, who had undergone discectomy and internal fixation using dynamic stabilization systems for lumbar disc herniation at the Renmin Hospital of Wuhan University from January 2011 to January 2013, were enrol ed in this study. The operation was performed through the traditional posterior approach in 25 patients and Wiltse approach in 21 patients. RESULTS AND CONCLUSION:Al 46 patients were fol owed up for 7 to 31 months (averagely, 13.8±2.4 months). The length of incision, intraoperative blood loss, and postoperative drainage amount were less in the Wiltse approach group than in the traditional posterior approach group (P0.05). Radiographs revealed that the position of implants was good in al patients, no loosing or breakage. These data verified that the early effect of dynamic stabilization system through Wiltse approach for lumbar disc herniation is similar to that of traditional posterior approach.
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BACKGROUND:The effects of both conservative and traditional open reduction and internal fixation are dissatisfactory in the treatment of thoracolumbar fractures, however, minimal-invasive percutaneous pedicle screw-rod systems provide a new available method. OBJECTIVE:To investigate the clinical effect of percutaneous pedicle screw fixation using Sextant minimal-invasive system in the treatment of thoracolumbar fractures. METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or open pedicle screw fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics, Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. They showed no neurological signs and symptoms. The operative time, intraoperablood loss, postoperative drainage amount, length of hospital stay, pre-and post-operative Cobb angle and anterior vertebral body height ratio were recorded and compared between two groups. RESULTS AND CONCLUSION:Except two patients in open pedicle screw fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. There were significant differences in operative time, intraoperative blood loss, postoperative drainage amount and length of hospital stay between two groups (P=0.000 0). The post-operative Cobb angle was significantly lower while anterior vertebral body height ratio was significantly higher at one week than those before fixation in two groups (P=0.000 0). No significant difference was found in correction loss between two groups at 8 months after operation. Experimental findings indicate that, percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, understanding the correct indications is very important for clinical application.
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BACKGROUND: Vertebral reconstruction is stil a chal enge for spinal surgeons. Ideal reconstruction materials should have good osteogenesis ability, reliable support performance, low price and simple operating steps. OBJECTIVE:To investigate the effect and feasibility of al ogenic cortical ring packed with autogenous cancellous bone in the reconstruction of rabbit cervical vertebra defect. METHODS:Cervical vertebra defect models were established by resection of the fourth cervical vertebra in rabbits. Frozen-dried humeral cortical ring of rabbits was made to prepare the al ogenic cortical ring which was packed with autogenous cancellous bone. Then, al ogenic cortical ring packed with autogenous cancellous bone, single al ogenic cortical ring and autogenous iliac bone were used to repair rabbit cervical vertebra defects. RESULTS AND CONCLUSION:The X-ray, histopathological examination, and scanning electron microscope examinations al showed that the bone union was most significant in group reconstructed with al ogenic cortical ring packed with autogenous cancellous bone. The alkaline phosphates activity in serum was higher in groups reconstructed with al ogenic cortical ring packed with autogenous cancellous bone and with autogenous iliac bone than in group reconstructed with only al ogenic cortical ring at 2 and 4 weeks after operation (P<0.01), but there was no difference between the former two groups. The biomechanical examination showed that the stability of al ogenic cortical ring packed with autogenous cancellous bone was higher than that of autogenous iliac bone at 1 month after operation (P<0.01). These findings indicate that the effect of al ogenic cortical ring packed with autogenous cancellous bone in the reconstruction of rabbit cervical vertebra defects is satisfactory, with a good biocompatibility, which is a promising method for the reconstruction of vertebral defects.
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Objective To study the single nucleotide polymorphisms (SNP) in 3 sites allele (T189M, R85H, C121W) of SCN1B and the association between gene distribution and epilepsy. Methods All 330 blood samples of refractory (80 cases), non-refractory (100 cases) epilepsy patients and healthy people (150 cases) were collected. Genomic DNA of leucocyte was extracted. SNPs of three sites allele of SCN1B were tested by allele-specific primer-polymerase chain reaction (ASP-PCR).Data were analyzed by SAS 8.1 statistical software. Results Epilepsy group and healthy group had significantly statistical difference in composition of 3 sites allele on single site genotype (x~2=11.19, 11.14 and 6.50, all P < 0.05).There was no statistical significance between refractory and non-refractory epilepsy group. On gene combination, in 27 different combinations of polymorphism, mutation frequency in 3 sites (CT + AG + CG) was highest in epilepsy group (18.40%).The next was one site in CT + GG + CC (16.80%).In healthy group, frequency of non-variant in CC + GG + CC was highest (16.67%), and the next was 2 sites in CT+ AG+CC (13.73%).Thirty-five cases in epilepsy group (28.80%) had 3 sites mutation compared with 10 cases in healthy group (9.71%), and their difference had statistical significance (x~2=12.54, P<0.05).Eighteen cases in refractory epilepsy group (30.51%) had 3 sites mutation compared with 21 cases in non-refractory epilepsy group (28.77%), and the difference had no statistical significance. Fifty cases in epilepsy group (40.00%) had 2 sites mutation compared with 41 cases in healthy group (40.20%), and there was no statistical significance between them; 25 cases in refractory epilepsy group (42.37%) had 2 sites mutation compared with 21 cases in non-refractory epilepsy group (28.71%), and their difference had no statistical significance. Conclusions Mutation, especially multisite mutation of SCN1B is relatively likely to cause epilepsy in human. Gene distribution and combination of three sites allele of SCN1B in refractory epilepsy is close to that in non-refractory epilepsy.
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, which will provide enough seed cells for peripheral nerve tissus engineering research.