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In order to research and enhance bioavailability of chlorogenic acid and rutin[CA-R] via the oral route, chitosan coated composite phospholipid liposomes [C-CPLs] were applied to study on preparation, permeability and pharmacokinetic of C-CA-R-CPLs. TheC-CA-R-CPLs were prepared by the method of ethanol injection. The entrapment efficiency [EE], average particle sizes, polymer disperse index [PDI], zeta potential, shape and in vitro drug release were investigated to characterize physicochemical parameters of C-CA-R-CPLs. The penetration properties from C-CA-R-CPLs were studied through Caco-2 cells model and the pharmacokinetics in Sprague-Dawley [SD] rats were evaluated by rat jugular vein intubation tube. The EE of C-CA-R-CPLs of CA and R was 91.3+/-2.13% and 92.6+/-2.44%, particle size of C-CA-R-CPLs was 176.7+/-2.3 nm, PDI was 0.207+/-0.014 and zeta potential of 12.61+/-1.33 mV. CA-RCPLs and C-CA-R-CPLs were spherical or elliptical sphere and the bilayer of the CPL was observed obviously under transmission electron. The C [max], t1/2 and AUC[0-12] h values of CA and R for groups of C-CA-R-CPLs were significantly increased.In conclusion, TheC-CA-R-CPLs as a novel nano-formulation have potential to be used to enhance the oral bioavailability of poorlywater-soluble drugs after oral administration
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Objective To establish a method of simultaneously quantitative analysis for multi-components by single marker( QAMS)of galuteolin,apigenin-7-glucoside,7-methoxycoumarin,luteolin and apigenin in two species of Chamomiles from Xinjiang. Methods By using apigenin as the internal standard,the relative correction factors( RCF)of galuteolin,apigenin-7-glucoside,7-methoxycoumarin and luteolin were set and determined by UPLC. The contents of galuteolin,apigenin-7-glucoside,7-methoxycoumarin,luteolin and apigenin in 11 samples of Chamomiles were authentically determined by the external standard method,to verify the accuracy of QAMS. Results There is a good linear relationship within the range of standard curve for five compounds by the external standard method(r〉0. 999 3);the average recovery was 99. 7%,97. 5,98. 8%,100. 9%,99. 1%,for galuteolin,apigenin-7-glucoside,7-methoxycoumarin,luteolin and apigenin,respectively,with RSD as 1. 8%,0. 6%,0. 5%, 1. 8% and 1. 9%,respectively. The RCF for pigenin-7-glucoside,galuteolin,7-methoxycoumarin and luteolin to apigenin was 1. 441,2. 308,1. 117,1. 490,respectively,with RSD as 0. 07%,0. 04%,0. 09% and 0. 18%,respectively. No significant difference between the quantitative results by QAMS and external standard method was observed. Conclusion It is practical to determine content of galuteolin,apigenin-7-glucoside,7-methoxycoumarin,luteolin with RCF and apigenin by using external standard method,for the deficiency and expensive of the standard reference.
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Objective To evaluate the mid-term clinical and radiographic results of artificial disc replacement (ADR) for discogenic low back pain.Methods From July 2004 to July 2007,21 patients with discogenic low back pain,aged from 26 to 67 years,underwent lumbar ADR with the Charité Ⅲ artificial disc at 22 levels and Activ L prosthesis at 2 levels:L4-5 5 cases,L5S1 13 cases,L4-5 and L5S1 3 cases.The diagnosis was proved by discography in all the patients.The clinical and radiographic results were evaluated and compared between pre-,post-operation and finial follow-up.Results All patients were followed up for 4to 7 years (average,5.1 years).There were statistical differences between pre-operation and final follow-up in Oswestry disability index and Visual Analogue Scale for back pain and leg pain.All the prostheses were mobile without dislocation,breakage,subsidence or spontaneous fusion,only a slight scoliosis was noted in one patient.At the ADR levels,the anterior and posterior intervertebral height increased averagely 6.3 mm and 1.9 mm respectively,the lordosis increased 2.9°,and the mean range of motion (ROM) was 4.6°.At the adjacent level proximal to ADR,the intervertebral height and lordosis decreased slightly,and the ROM decreased 2.5°.The total lumbar lordosis increased 7.8°,and the total lumbar ROM increased 2.4°.According to MRI and CT scans,the degeneration of proximal adjacent disc and facet were not evident,however the degeneration of facets at the ADR levels was evident.Conclusion The 5 years results of ADR for discogenic low back pain were satisfactory,with preserved motion at the ADR level,and the degeneration of adjacent level was not evident.However,there was obvious degeneration in facet joints of the ADR level.
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ObjectiveTo evaluate the effectiveness at anterior lumbar interbody fusion (ALIF) with a single cage alone in treatment of lumbar degenerative disc disease(DDD).MethodsThirty-four patients aged from 26 to 67 years (mean,52) were enrolled in this study,including 10 males and 24 females.Preoperative diagnosis included:degenerative spondylolithesis in 11 cases,discogenic low back pain in 21,and revision for failed posterior surgery in 2.Objective level located in L4.5 in 12 cases,L5S1 in 20,and double discs(L4.5,L5S1) in 2.All the patients received extraperitoneal approach ALIF.Surgical time,blood loss,perioperative complications and postoperative ambulation were noted.Postoperative function status was evaluated by 100 mm Visual Analog Scale (VAS) and Oswestry Disability Index (ODI50).AP,lateral and dynamic X-rays were routinely taken during follow up,according to which disc height,migration of implant and bony fusion were measured.ResultsAll the surgeries were performed successfully with a mean surgical time of 90 min and blood loss of 200 ml.An injury to the bifurcation of vena cave was encountered in an early case,after meticulous repairing of the vessel,the surgery was finished successfully.Peritoneum rupture was noticed in one case.One case of postoperative cage migration was revised and reinforced with additional fixation system.All the patients were followed up for an average of 36 months(range,12-60).All the patients were satisfied with the pain relief and returned to normal social life and working.VAS decreased from preoperative 70 to postoperative 5,and ODI decreased from 41％ to 6％.All but one migration case reached sound fusion with a fusion rate of 97％.ConclusionOwing to multiple advantages,complete removal of degenerative disc,compressive bone graft,sufficient graft area,early ambulation,less complication,extrapefitoneal approach for ALIF comes up with satisfying clinical outcomes.This mini_invasive technique provides a valuable alternative to treatment of lumbar DDD when appropriate indication is selected.
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Objective To analyze the surgical treatment options and its results for thoracic and thoracolumbar disc herniation.Methods From June 2004 to December 2009,thirty-one patients of thoracic and thoracolumbar disc herniation with or without ossification of ligament flavum were surgically treated,including 22 males and 9 females,with a mean age of 54 years(range,24 to 71 years).According to Anand and Regan clinical classification,there was type 2 for 1 case,grade 3a for 2,grade 3b for 3,grade 4 for 6,and grade 5 for 19.The neurological status was Frankel B for 2 cases,C for 6,D for 11,and E for 12.Anterior surgeries were performed for 18 patients without ossification of ligament flavum.Anterior decompression was performed through the resection of posterior part of vertebral body,or subtotal resection of vertebral body,followed by strut graft and internal fixation.Posterior surgeries were performed for 13 patients with disc herniation and ossification of ligament flavum.The resection of hemi-articular process and total laminectomy was performed.Results The complications of 18 patients with anterior surgery included laceration of dura mater in 1 case,nerve root sleeve injury in 1 case,intercostal neuralgia in 3 cases,atelectasis in 1 case,and femoroiliac numbness in 2 cases.The complications of 13 patients with posterior surgery included intra-canal hematoma in 1 cases,leakage of cerebrospinal fluid in 2 cases,infection of incision in 1 cases,and pneumonia in 1 case.The patients were followed for 18 months(range,6 to 48 months).At final follow-up,the neurological status and local symptom improved in all patients,with Frankel C for 3 cases,D for 7,and E for 21;and Anand and Regan type 1 for 2 cases,2 for 1,3a for 1,4 for 2,5 for 10 and no symptom for 15.Conclusion For thoracic and thoracolumbar disc herniation,anterior surgery is suitable for patients mainly suffered anterior cord compression.Resection of posterior part of vertebral body or subtotal resection of vertebral body is often needed for sufficient decompression.Posterior surgery is suitable for patients with anterior and posterior cord compression due to ossification of ligament flavum,and the decompression can be obtained by resection of hemi-articular process and total laminectomy.
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AIM: Anterior cervical discectomy and Cage bone graft fusion followed by steel plate internal fixation can decompress the vertebral canal and then spinal cord in patients with multilevel cervical spondylotic myelopathy. Complete decompression is very important for such patients. This study is to investigate the effect of this technique on reconstruction of spinal function.METHODS:①Thirty-eight inpatients with multilevel cervical spondylotic myelopathy admitted to Department of Spine Surgery, Tianjin Hospital between April 2003 and February 2006 were involved in this study. The involved patients, 35 male and 3 female, were aged 43-72 years, with disease course of 0.5 to 5 years. Informed consents of therapeutic regimen were obtained from all the patients.②All the patients underwent anterior cervical discectomy and cage placement operation. The patients with destabilized combination underwent titanium-plate fixation, and those with stabilized combination underwent cage implantation alone. The cage used in the experiment was made of tetragonal polyether ether ketone (Intromed Company), and titatium-plate was Zephir plate (sofarmor Danek Company). The elastic modulus of tetragonal polyether ether ketone Cage was similar to bone tissue and could allow X-ray pass through, which was easy for postoperative fusion of implanted bone. The outer design of Cage bone graft with certain angle could allow cervical physiological antecurvature well recover; Surface radian was the same as end plate, and good fitness contributed to the good fusion rate of bone graft; The sawtooth antiskid design on the surface provided good stability immediately after implantation; Elastic modulus was between os integumentale and cancellous bone that made stress-shielding and subsidence of fusion cage reduced, and had good anticausticity and biocompatibility. ③ The clinical results were evaluated with Japanese Orthopaedic. Association (JOA) scoring system before, 2,8 and 24 weeks after operation: upper limb motor function (4 points), lower limb motor function (4 points), sensation (6 points) and bladder function (3 points). Higher scores indicated better function. Postoperatively, body examination and X-ray and MRI scanning of anteroposterior cervical vertebra were performed.RESULTS: Thirty-eight patients with multilevel cervical spondylotic myelopathy participated in the final analysis. Within postoperative several days, nervous symptoms improved obviously, muscle strength of lower limb was increased, limbs were more flexible after operation than before operation, and paresthesia of two upper limbs recovered in 38 patients. JOA was a score of (9.25±1.85) before operation, and it was (12.4±2.08) at postoperative 2 weeks, (13.2±2.07) at postoperative 8 weeks and (13.8±1.67) at postoperative 24 weeks.CONCLUSION: Multilevel discectomy and Cage implantation obviously improve sensorimotor function and lessen symptoms of patients with multilevel cervical spondylotic myelopathy.
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The doctors'medical treatment in the medical service is not a private right, but a public power. It orignates from the patients'rights. The purpose is to sustain and enhance the patients' health, However, in our actual lives, the side effect of market - oriented economy brings out the power partly to deviate from the primary aim. This kind of phenomenon is called as alienation of doctor's power. The doctor's power of alienation infringes upon the rights of patients, causeing the conflicts between both sides and forms disputes of medical treatment. Only could the patients's rights and the doctors's duties be wholly defined by law, that the patients rights can be taken to restrict the doctors power, and the relationship between the two sides can be harmonious.