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Background and Objectives@#This study aims to clarify the systems underlying regulation and regulatory roles of hydrogen combined with 5-Aza in the myogenic differentiation of adipose mesenchymal stem cells (ADSCs). @*Methods@#and Results: In this study, ADSCs acted as an in vitro myogenic differentiating mode. First, the Alamar blue Staining and mitochondrial tracer technique were used to verify whether hydrogen combined with 5-Aza could promote cell proliferation. In addition, this study assessed myogenic differentiating markers (e.g., Myogenin, Mhc and Myod protein expressions) based on the Western blotting assay, analysis on cellular morphological characteristics (e.g., Myotube number, length, diameter and maturation index), RT-PCR (Myod, Myogenin and Mhc mRNA expression) and Immunofluorescence analysis (Desmin, Myosin and β-actin protein expression). Finally, to verify the mechanism of myogenic differentiation of hydrogen-bound 5-Aza, we performed bioinformatics analysis and Western blot to detect the expression of p-P38 protein. Hydrogen combined with 5-Aza significantly enhanced the proliferation and myogenic differentiation of ADSCs in vitro by increasing the number of single-cell mitochondria and upregulating the expression of myogenic biomarkers such as Myod, Mhc and myotube formation. The expressions of p-P38 was up-regulated by hydrogen combined with 5-Aza. The differentiating ability was suppressed when the cells were cultivated in combination with SB203580 (p38 MAPK signal pathway inhibitor). @*Conclusions@#Hydrogen alleviates the cytotoxicity of 5-Aza and synergistically promotes the myogenic differentiation capacity of adipose stem cells via the p38 MAPK pathway. Thus, the mentioned results present insights into myogenic differentiation and are likely to generate one potential alternative strategy for skeletal muscle related diseases.
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As an important measure starting for hospital management, hospital accreditation can effectively guide hospitals to improve their comprehensive service capabilities and management level. The accreditation results of 38 tertiary general hospitals in Jiangsu province from 2018 to 2020 showed that there were weaknesses existing in the development of hospitals, including the radiosity and influence of tertiary hospitals, patient service mode, construction of medical technology capabilities and disciplines, medical quality and safety, nursing quality management and specialized nursing, and information construction. The author suggested that hospitals should return to functional positioning, improve the service quality, strengthen construction of hospital disciplines and technical projects, consolidate the foundation of quality and safety management, improve the level of information technology construction, for references for promoting the high-quality sustainable development of tertiary general hospitals.
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Objective:To investigate the effects of allicin on the proliferation, migration and angiogenesis of rat vascular endothelial cells (RVES), and to explore the influencing mechanism of allicin on epidural fibrosis.Methods:According to the results of preliminary experiments, RVECs were divided into control group (0 mg/L), low concentration group (25 mg/L), medium concentration group (50 mg/L) and high concentration group (100 mg/L). The morphology, viability, migration rate, cell cycle, apoptosis rate and cell lumen formation ability were measured using fluorescence microscope, AnnexinV-FITC double staining, PI/RN-asestaining, scratch assay and Transwell experiments test. Western Blot was used to measure the protein expression level of JAK2, STAT3, p-STAT3, PCNA, Bax and Bcl-2 protein. Using random number method, 36 adult male SD rats were divided into sham operation group, saline group and allicin group, with 12 rats in each group. Hematoxylin-eosin (HE) staining, Masson staining and immunohistochemical staining were used to analysis the epidural fibrosis in each group.Results:With the increase of concentration of allicin, cell viability, cell migration and lumen formation ability significantly lower than that of control group ( P<0.05). With the increase of allicin concentration, the percentage of cells in the G1 and S phases gradually decreased ( P<0.05), the percentage of cells in the G2 phase and the apoptosis rate gradually increased ( P<0.05), and the cells were blocked in the G2/M phase. With the increase of allicin concentration, the protein expression levels of JAK2, STAT3, p-STAT3, PCNA and Bcl-2 were gradually down-regulated ( P<0.05), while the protein expression level of Bax was gradually up-regulated ( P<0.05), the ratio of p-STAT3/STAT3 was decreased ( P<0.05), and the ratio of Bax/Bcl-2 was increased ( P<0.05). There was no death, infection or abnormal gait in all the experimental animals. Dense scar tissue could be observed in the extradural area of the sham operation group and the epidural area of the control group, but there was obvious space between the epidural scar and the dura mater in the allicin group, and the density of collagen, the number of blood vessels, and the protein density of p-STAT3 were significantly lower than those in the control group ( P<0.05). Conclusion:Allicin inhibits angiogenesis and the severity of epidural scar after laminectomy, and the mechanism may be through inhibiting the JAK2/STAT3 signaling pathway of vascular endothelial cells.
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Objective:Through TTC staining, immunohistochemical analysis, RT-PCR and hind limb motor function evaluation and other experimental methods, to explore the regulatory mechanism of metformin on anti-apoptosis in rats with spinal cord injury (SCI).Methods:Establish a rat spinal cord injury model. Through Basso-Beattie -Bresnahan locomotor rating scale (BBB) and cant test to evaluate the recovery of hindlimb motor function in rats. The changes of necrotic area of spinal cord tissue were compared by TTC staining. Extraction of rat spinal cord tissue, by Dot blot analysis and immunohistochemical detection of the hydroxyl of DNA methylation level. By qPCR, Western Blot detection TET2mRNA and protein expression level, and the changes in the scope of spinal cord injury were detected by inhibiting the expression of TET2. The interaction between TET2 and Foxo3a was detected by immunoblotting and immunoprecipitation. Through RT-PCR assay Foxo3a downstream related changes in the level of gene expression.Results:Compared with the SCI+NS group, the necrotic area of the spinal cord tissue was reduced after metformin treatment, and the BBB score and the incline test score were higher ( P<0.05). At the same time, we found that the levels of TET2mRNA and protein increased significantly after SCI at 24 h, and the 5-hmC level of DNA increased. The levels of TET2mRNA and protein and 5-hmC increased further after the use of metformin. After using SC-1, compared with the SCI+MET group, the level of 5-hmC decreased and the area of infarction increased. After SCI, the mRNA levels of downstream genes Bim, P27kip, Bax increased significantly. After metformin treatment, the mRNA levels of Bim and Bax were lower than those in the SCI+NS group ( P<0.05). After SCI, the 5-hmC levels of downstream genes Bim, P27kip, Bax increased significantly. After metformin treatment, the 5-hmC levels of Bim and Bax were lower than those in the SCI+NS group ( P<0.05). Conclusion:Metformin can promote the interaction between TET2 and Foxo3a, increase the 5-hmC level of the overall DNA, and inhibit the activation of related apoptosis genes, thereby improving tissue damage and nerve function recovery after spinal cord injury.
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Objective:To analyze the curative effect of discectomy under Quadrant expandable channel associated with annulus repair for the treatment of adolescent lumbar disc herniation (ALDH).Methods:10 ALDH patients received discectomy under Quadrant expandable channel associated with annulus repair (annulus repair group) and 12 patients received discectomy (control group) in Clinical Medical College of Yangzhou University from January 2013 to December 2017 were retrospectively collected. The length of skin incision, amount of intraoperative bleeding, operation time and duration of hospitalization were compared. The degree of pain was assessed by visual analogue scale (VAS) before operation, 24 h, 1 week and 1 year after operation, and the lumbar function was assessed by Oswestry disability index (ODI) before operation, 1 week and 1 year after operation. At the last follow-up, the curative effect was evaluated by MacNab Scale, and the recurrence of lumbar disc herniation during the follow-up was recorded.Results:There were no significant differences in the amount of intraoperative bleeding, operation time and duration of hospitalization between the two groups ( P>0.05). The skin incision length of the annulus repair group was less than that of control group ( P<0.05). The postoperative VAS score and ODI score at each follow up time point in both groups were significantly improved when compared with the preoperative ones ( P<0.05). There were no statistically significant difference between the two groups in the VAS score and ODI score 1 week postoperative and 1 year postoperative ( P>0.05). According to the MacNab criteria, there was no statistically significant difference between the two groups in the excellent and good rate (annulus repair group: 9/10, control group: 10/12; P>0.05). There was no recurrence case in the annulus repair group, but two cases of recurrence (one recovered by conservative treatment, the other needed second operation) in the control group ( P<0.05). Conclusions:Discectomy under Quadrant expandable channel associated with annulus repair can achieve early satisfied outcome, reduce surgery related trauma, pain in the early period postoperative and recurrence rate after operation in the treatment of ALDH.
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Objective:To investigate the clinical efficacy of Dog-Bone double button in the treatment of acute acromioclavicular dislocation under shoulder arthroscopy.Methods:A retrospective analysis was conducted of the 20 patients with acute acromioclavicular dislocation who had been treated at Department of Sports Medicine, Northern Jiangsu People's Hospital of Jiangsu Province from November 2018 to December 2020 by Dog-Bone double button under shoulder arthroscopy. They were 11 males and 9 females, aged from 31 to 63 years. Recorded were their visual analogue scale (VAS), Constant-Murley shoulder function score and range of shoulder anteflexion at preoperation and the last follow-up, as well as complications and the X-ray parameters at one month postoperation and the last follow-up [including coracoclavicular distance (CCD), distance between the upper and lower Dog-Bone titanium plates (DDD), angle between the coracoid process tunnel and the tangent line of the superior clavicle (CTCA), and widths of the clavicle tunnel and the coracoid process tunnel].Results:The 20 patients were followed up for 6 to 12 months (average, 10.5 months). Their preoperative VAS score, Constant score, and range of shoulder anteflexion were 3.0 (3.0, 4.0), 57.0 (54.3, 61.5) and 130° (110°, 140°), which were significantly improved to 0 (0, 0.8), 90.0 (86.5, 91.0) and 170° (170°, 180°) at the last follow-up ( P<0.05). Their CCD, DDD, CTCA, and widths of the clavicle tunnel and the coracoid process at one month postoperation were (5.0±1.0) mm, (32.4±3.5) mm, 91.7° (88.5°, 104.9°), 3.0 (3.0, 3.0) mm and 3.0 (3.0, 3.0) mm, which were significantly improved to (6.3±1.3) mm, (32.8±3.7) mm, 84.8° (81.8°, 92.0°), 3.5 (3.4, 3.6) mm and 3.2 (3.1, 3.3) mm with the exception of DDD at one month postoperation ( P<0.05). The last follow-up observed postoperative reduction loss in only one patient. Conclusion:For acute acromioclavicular joint dislocation, the Dog-Bone fixation technique under shoulder arthroscopy can lead to fine surgical efficacy and patient satisfaction, because it has advantages of limited trauma, good functional recovery of the shoulder, and effective prevention of reduction loss.
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OBJECTIVE@#To construct a three-dimensional (3D) finite element mechanical model of total hip arthroplasty for comparison of biomechanical differences of the hip joint following capsule repair and postoperative rehabilitation.@*METHODS@#Six frozen specimens of hip joint posterior capsule ligament complex were collected in a bone-capsule-bone manner, and the load-strain curve and other mechanical properties of the specimens were tested using a universal material testing machine. Thin-section CT data of the pelvis and lower limbs obtained from a volunteer were imported into Mimics software to construct a 3D model of the hip joint. Digital models of the cup, femoral prosthesis and joint capsule were created in CATIA software and imported into Mimics to simulate total hip arthroplasty; the assembled data were imported into ABAQUS software. The properties of the capsule were set according to results of the mechanical test, anatomical studies, and constitutive equations, and the biomechanics of the anatomically repaired and conventionally repaired capsules were compared during hip flexion.@*RESULTS@#The results of testing on the 6 capsule specimens showed a mean ultimate tensile strain of (39.21±5.23)% and a mean of ultimate tensile strength of 1.65±0.38 MPa. The stress-strain curve of the finite element model was consistent with the results of mechanical test on the specimens and the biochemical characteristics of the capsule. The stress was distributed evenly in the anatomically repaired capsule during hip flexion but not in the capsule repaired through the conventional approach; the tensile stress in the lower part of the conventionally repaired capsule reached the ultimate tensile stress measured on the capsule specimens at a 90° flexion.@*CONCLUSIONS@#The finite element model allows dynamic, quantitative and visual assessment of stress distribution in the hip joint capsule, and compared with the conventional approach, anatomical repair can achieve better biomechanical properties of the capsule.
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Humans , Arthroplasty, Replacement, Hip , Biomechanical Phenomena , Finite Element Analysis , Hip Joint/surgery , Prognosis , Stress, MechanicalABSTRACT
Objective To explore the importance of establishing and improving modern hospital science and technology management system in public hospitals,as well as the ways of establishing such system,analyze the key points that need consideration in order to provide reference for establishing modern hospital science and technology management system in public hospitals.Methods Starting from the reform requirements and perspectives of the construction of modern hospital management system,and based on the theory of innovative governance,this paper probes into the innovative practice and achievements of our hospital in implementing the internal scientific and technological management system of modern hospitals from three aspects:the incentive mechanism,the restraint mechanism and the coordination mechanism of innovative governance of scientific and technological management system.Results Through the establishment and improvement of internal scientific and technological management system,such as reward policies for scientific research work,reward and punishment for papers,layout fee management guidelines,management methods for scientific research funds,project evaluation policies,selection and training of subject leaders,temporary management methods for medical research institutes,and implementation methods for scientific research integrity construction,the effect of talent aggregation is gradually presented,and the discipline,team and technology are stable.Step by step development;innovative achievements are increasingly fruitful,and the quality of connotation is constantly improving.Conclusions The key to the establishment of modern hospital science and technology management system is to continuing innovative exploration of the system of science and technology management and to build a good operation mechanism of science and technology innovation.
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Objective To compare the effect of different size needle gauges to the degenerative response in rat caudal discs.Methods A total of 40 Sprague Dawley (SD) rats,level 5/6,7/8 and 9/10 interverbral discs of rat caudal spine were punctured with 18 or 21 or 25-gauge needles respectively.Radiographs and magnetic resonance imaging (MRI) were obtained at 1,2,4 and 6 weeks postsurgery.At each time point,ten rats from each group were sacrificed for histological analysis.Real-time fluorescent quantitative polymerase chain reaction (qPCR) was used to examine mRNA expression level.Results Significant differences were identified in the disc height index (DHI ％) and MRI grade between 18 G and normal group,MRI grade,histological score between 21 G and normal group at 2,4,and 6 weeks postsurgery.Significant differences were also identified in the histological score and mRNA expression levels between 18 G and normal group,alcian blue stain and hypoxia inducible factor-1α (HIF-1 α) mRNA expression level between 21G and normal group at all time point postsurgery.Significant differences existed in DHI％,type Ⅱ collagen and aggrecan mRNA expression levels between 21 G and normal group,all type mRNA expression levels between 25 G and normal group at 4,6 weeks.There were significant differences in MRI grade and histological score between 25 G and normal group at 6 weeks.Significant differences existed in almost all parameters compared between 18 G and 25 G at all time point.There were significant differences in DHI％,MRI grade,histological score and HIF-1α mRNA expression levels between 18 G and 21 G at 4,6 weeks.There were significant differences in type Ⅱ collagen and aggrecan mRNA expression levels between 18 G and 21 G at all time point.Significant differences exist in DHI％ and HIF-1α mRNA expression level between 21 G and 25 G at 6 weeks.Compared with the 25 G group,the DHI％ and Pfirrmann scores and the pathological score of each time at 2,4 and 6 weeks after operation in 18 G group have significant difference (P ＜ 0.05).Conclusions The middle size needle (21G) is better to induce disc degeneration.The 2-week time point may be the better time frame to further experimental treatments.
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Objective To evaluate the efficacy of bone marrow fenestration technique used for ro-tator cuff repair at the foot-print zone of rotator cuff under arthroscopy. Methods A total of 30 patients with full-thickness rotator cuff tear ( from 3 cm to 5 cm) were enrolled for this retrospective study who had been treated at Department of Orthopaedics, The People's Hospital of North Jiangsu from January 2015 to December 2016. Of them, 15 were treated under arthroscopy with simple suture bridge technique ( SB group ) and the other 15 under arthroscopy with bone marrow fenestration and suture bridge techniques ( BMSB group ) . The 2 groups were compared in terms of visual analogue scale ( VAS ) , American Shoulder and Elbow Surgeons ( ASES ) scale, Constant scores,range of motion of the affected shoulder and rate of retear after surgery. Results All the patients received follow-up for 11 to 14 months. Significant improvements were achieved in both groups in VAS scores at 3 months ( 1.9 ± 0.6 and 0.9 ± 0.6 ) , ASES scores ( 90.7 ± 3.6 and 92.3 ± 4.2 ) and Constant scores ( 88.9 ± 2.5 and 87.4 ± 3.4 ) at the last follow-up, compared with the preoperative values ( 4.7 ± 1.1 and 4.3 ± 1.5, 58.2 ± 7.2 and 55.6 ± 4.4, and 57.3 ± 6.7 and 55.9 ± 10.3, respectively) ( P ＜0.05), but there were no significant differences between the 2 groups in ASES scores, Constant scores or range of motion of the affected shoulder at the last follow-up ( P＞ 0.05). The VAS scores at 3 months for the BMSB group (0.9 ± 0.6) were significantly lower than that for the SB group (1.9 ± 0.6) ( P ＜0.05). There was no significant difference either between the 2 groups in the retear rate [ 20.0% ( 3/15 ) for SB group versus 26.7% ( 4/15 ) for BMSB group ] ( P ＞ 0.05 ) . Conclusion Application of bone marrow fenestration technique in addition to suture bridge technique can obviously relieve pain after rotator cuff repair, though it shows no advantage in functional recovery of the shoulder joint.
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Fibrosis disease can occur in a variety of organs,the main pathological changes inside the tissues are that fiber connective tissue increases and parenchymal cells decrease.Continuous progress can cause organ damage,functional decline and even failure.These changes will do great harmful to human's health and life.This article summarizes the latest researches of microRNAs associated with fibrosis,in order to explore the pathogenesis and new targets for treatment of fibrosis diseases.
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Objective To explore the early clinical effects of lumbar discectomy associated with annulus repair in the treatment of lumbar disc herniation.Methods A prospective study was conducted to review 56 patients with lumbar disc herniation who accepted discectomy surgery in Subei People's Hospital of Jiangsu Province from January 2014 to September 2015,including 28 cases of discectomy associated with annulus repair (repair group) and 28 cases of discectomy (control group).Oswestry disability index and visual analog scale scores were recorded.Simultaneously,incision length,operative time,blood loss,hospitalization time,surgical complications,and postoperative recurrence of lumbar disc herniation were recorded.Results All patients completed the follow-up for 12 to 18 months (14.5 ± 1.3).There was no difference between the repair and control groups in the incision length,blood loss and hospitalization time (P ＞ 0.05).The operative time of the repair group was longer than that of the control group,but the difference was not statistically significant (P ＞ 0.05).The Oswestry disability index and visual analog scale scores for lumbar and lower limb pain significantly decreased in both groups after surgery (P ＜ 0.05).The visual analog scale scores at 24 hours and 3 days after surgery in the repair group were less than that in the control group (P ＜ 0.05).The satisfactory rate of treatment in the repair group was slightly higher than that in the control group,but the difference was not statistically significant (P ＞ 0.05).There was no recurrence in the repair group,but 2 recurrence cases in the control group (P ＞ 0.05).Conclusions These findings indicate that discectomy associated with annulus repair is a safe and reliable method to obtain remarkable early clinical results and can reduce the recurrent rate in the treatment of lumbar disc herniation.
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Objective To explore the mechanism of the role of mitomycin C(MMC)in regulating miR-200b expression and inducing fibroblasts apoptosis. Methods Fibroblasts cultured in vitro were treated with different concentrations of MMC for 5 min and continue culture for 24 h. The expression of miR-200b were analyzed by Real-time PCR. Cell apoptosis were observed using TUNEL staining. The expression of cleaved-PARP,Bax and Bcl-2 were detected by Western blot. The methylation level of miR-200b promoter were measured by BSP. Results After treated with MMC,The expression of miR-200b significantly downregulated.TUNEL Staining analysis demonstrated MMC could significantly induce human fibroblasts apoptosis. Western blot results showed cleaved-PARP,Bax increased and Bcl-2 decreased.The methylation ratio of miR-200b promotor increased and has a significant dose dependent. Conclusion MMC induced human fibroblasts apoptosis by promoting miR-200b promoter methylation.
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BACKGROUND:Statins can promote the mRNA expression of bone morphogenetic protein 2, aggrecan and type II col agen in intervertebral disc cel s, and they also can reverse the phenotype of dedifferentiated nucleus pulposus cel s to slow disc degeneration process. OBJECTIVE:To review the research progress of simvastatin modulating the biological characteristics and mobilizing endogenous stem cel s for the repair of intervertebral disc degeneration. METHODS:The first author retrieved the PubMed and CNKI databases for relevant articles published before January 2016 using the key words of“disc degeneration factor, Simvastatin AND stem cel s, endogenous stem cel s AND disc degeneration”in English and Chinese, respectively. Initial y, 102 relevant articles were retrieved, but only 48 articles were included in result analysis fol owing elimination of duplicate studies.RESULTS AND CONCLUSION:By summarizing a large number of studies on the treatment of intervertebral disc degeneration worldwide, we found that simvastatin may modulate the biological characteristics and function of nucleus pulposus mesenchymal stem cel s via promoting the expression of hypoxia-inducible factor 1αfor the endogenous stem cel-based therapy of intervertebral disc degeneration.
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BACKGROUND: Percutaneous vertebroplasty has been gradual y used to treat Kümmel disease because of less trauma and quick pain relief, but there is stil a high rate of bone cement leakage. OBJECTIVE: To investigate the clinical efficacy of percutaneous vertebroplasty with high-viscosity bone cement plus hyperextension position reset for treatment of Kümmel ’s disease. METHODS: The clinical data of 17 patients with Kümmel ’s disease were retrospectively analyzed, including 5 males and 12 females, aged 55-83 years, and al underwent percutaneous vertebroplasty with high-viscosity bone cement plus hyperextension position reset. The visual analog scale, Oswestry disability index score, vertebral body height and vertebral kyphosis angle were determined. The bone cement leakage, pulmonary embolism, adjacent vertebral fractures and other complications were recorded. RESULTS AND CONCLUSION: At the 12th Oswestry disability index scores and vertebral kyphosis angle of patients were significantly lower than those before treatment (P < 0.05), the vertebral body height was significantly higher than that before month of follow-up, the visual analog scale scores, treatment (P < 0.05). After treatment, there were three cases of bone cement leakage, which had no special discomfort and neurological symptoms, and one case of new fractures. These results demonstrate that hyperextension position reset combined with percutaneous vertebroplasty with high-viscosity bone cement in treatment of Kümmel ’s disease can effectively relieve back pain, improve function of the lower back, partial y restore vertebral height and reduce kyphosis angle.
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BACKGROUND:The pathogenesis of knee intraarticular adhesion is yet unknown. Excessive proliferation of fibroblasts is considered to cause knee intraarticular adhesion. OBJECTIVE:To study the preventive effects of methotrexate on knee intraarticular adhesion through fibroblast apoptosis induced by endoplasmic reticulum stress. METHODS:The viability of the cultured fibroblasts treated with methotrexate(10-5-10-9mol/L)or PBSwas determined after 24 hours. Fibroblast apoptosis was detected by Hoechst33342 staining. Endoplasmic reticulum stress-and apoptosis-related proteins, including cleaved-PARP, CHOP, Bax and Bcl-2, were determined by western blotassay. Eighteen healthy male New Zealand white rabbits were used to establish the knee intraarticular adhesion models, and equaly randomized into three groups, and received topical application of 2 or 1 g/L methotrexate, or normal saline (control). The preventive effects of methotrexate on knee intraarticular adhesion and CHOP expression in scar tissue were observed. RESULTS AND CONCLUSION:Methotrexate inhibited the proliferation and viability of fibroblasts in a dose-dependent manner. The number of apoptotic fibroblasts was significantly increased compared with control group. Protein expression of cleaved-PARP, CHOP, and bax was increased, while protein expression of bcl-2 was decreased with time. The animal experiment showed that preventive effects of 2 g/L methotrexate on knee intraarticular adhesion were superior to 1 g/L methotrexate treatment. CHOP expression in the scar tissue in the methotrexate groups was higher than the control group and that was higher in high-dose methotrexate group. Our results suggest that methotrexate prevents knee intraarticular adhesionviaendoplasmic reticulum stress-induced fibroblast apoptosis.
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Science and technology innovation is an important quality of young talents in the new period requirements and training objectives,as well as hospital's driving force and source of the future sustainable development.Under the innovation-driven strategy,characterized by cultivating young talents of science and technology innovation,with the efforts to develop and improve young talents cultivation way,our hospital aim to accelerate the development of young talent as soon as possible.By setting up a hospital's fund,we gradually formed a stable funding system including the four directions of clinical,nursing,management,education.With the development purposes of young researchers as the main body,adhere to improve the quality of hospital funds is the key,we aim at forming a reasonable fund scale.Through the top level design,strict process management,implementation of opening argument and a series of strong measures to ensure project quality,we promote youth science and technology innovation talents effectively.
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BACKGROUND:Recently, the number of elder patients with femoral neck fracture increased. It is controversial if patients aged over 75 years should receive total hip replacement or hemiarthroplasty. To select a reasonable surgical manner is of great significance for increasing surgical safety, improving hip joint function, elevating quality of life, decreasing postoperative complications, and reducing revision rate. OBJECTIVE:To retrospectively analyze data of patients aged over 75 years after hip replacement, to compare the advantages and disadvantages, and to find a precise indication. METHODS:Case data of 171 patients undergoing total hip replacement (observation group) (n=51) or hemiarthroplasty (control group) (n=120) were included. Their differences were compared using basic diseases, operation time, bleeding amount, postoperative complications, postoperative hospitalization day, Harris score at 1 week and 3 months after operation. RESULTS AND CONCLUSION:Patients in both groups were fol owed up for 3 to 39 months (averagely 23 months). No significant difference in basic diseases, average age, postoperative complications, postoperative hospitalization day, and Harris score at 1 week was detected between the two groups (P>0.05). Harris score and excellent and good rate at 3 months were better in the total hip replacement group than that in the hemiarthroplasty group (P<0.05). Results indicated that strict choice of indication achieved good short-period efficiency in two groups. Thus, hip function of elder patients was early recovered. Quality of life was obviously elevated. The recovery of hip function was relatively better at 3 months in observation group. The incidence of postoperative complications did not increase obviously. These results suggested that besides sufficient preparation, total hip replacement should be the first choice for elder patients.
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BACKGROUND:Differences of knee anthropometry between individuals are significant, while preoperative templating is not accurate in predicting the prosthesis size. OBJECTIVE:To improve the accuracy of pre-operative plan in predicting the prosthesis size in total knee arthroplasty using digital technologies. METHODBetween January 2013 and May 2004, 50 patients (20 men and 30 women;aged 54-82 years;mean age, 67.8 years) received primary total knee arthroplasty for osteoarthritis and were retrospectively analyzed. According to the treatment, the patients were divided into two groups. The digital group, a series of 21 patients, underwent 64-row MDCT before total knee replacement. CT images were imported into Mimics, and three-dimensional models of femur and tibia were reconstructed. Then, computer-aided design files of different sizes of prostheses provided by the manufacturers were imported into Mimics, too. Surgical simulation of osteotomy and prostheses implantation were performed in Mimics, component size was determined by the contour of distal femur and proximal tibia. The control group, a series of 29 patients, underwent primary total knee arthroplasty using conventional approaches. The agreement between preoperative plan and the actual prosthesis size was assessed during the surgery. Postoperative X-ray of low limb was taken to evaluate the accuracy of sizing and the efficacy of digital technologies was assessed. RESULTS AND CONCLUSION:The intraoperative and postoperative evaluation showed inaccurate sizing of femoral and tibial components in 1 case in digital group and in 11 cases in conventional group. The accuracy of prediction was 95%in digital group and 62%in conventional group, with significant differences between the two groups (P<0.05). Four overhanging and two notching cases were observed in conventional group, but none in digital group. The digital technologies provide an effective means for accurate prediction of prosthesis size and personalized surgical simulation.
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BACKGROUND:Vertebroplasty and kyphoplasty have been widely applied in the treatment of osteoporotic thoracolumbar compression fracture. However, cement leakage is a major problem in the application of this technology, especial y for the vertebral posterior wal ruptured patients. OBJECTIVE:To investigate the therapeutic efficacy of high viscosity bone cement and vertebroplasty in the treatment of osteoporotic thoracolumbar compression fracture. METHODS:A retrospective study was conducted in 20 cases receiving high viscosity bone cement and vertebroplasty surgery for osteoporotic thoracolumbar compression fracture. Clinical outcomes were evaluated mainly with use of Visual Analog Scale for lower back pain. Function of lower back pain was assessed using Oswestry Disability Index questionnaire. Quality of life was evaluated using 36-Item Short Form Health Survey and Frankel score was applied to evaluate neurological function. The anterior vertebral height of the fractured vertebrae was assessed with X-ray. The bone cement leakage, pulmonary embolism, incidence of nearby vertebral fractures and other complications were evaluated during fol ow-up. RESULTS AND CONCLUSION:Al patients were fol owed up for 12-18 months. The anterior vertebral height of the fractured vertebrae, the lower back pain and function, and quality of life were improved significantly after treatment (P<0.05). Al patients got the same neurological symptoms before surgery. The bone cement dispersion was good after treatment, detected by X-ray and CT scan, only two cases appeared with bone cement leakage, but no clinical symptoms were found. There was no cement toxicity or al ergic complications, pulmonary embolism, infection, nerve injury or new fractures. The high viscosity bone cement used in the treatment of osteoporotic thoracolumbar vertebral compression fractures can significantly relieve thoracic back pain, improve lower back function and quality of life, and greatly reduce the risk of bone cement leakage.