ABSTRACT
Objective:To evaluate the specialty of the clinical features, treatment procedure, clinical outcome, and prognosis in the patients with "sandwich" atlantoaxial dislocation (AAD).Methods:From 2008 to 2018, 160 cases with "sandwich" AAD were retrospectively selected from the case series of AAD in Peking University Third Hospital. The case series had 80 males and 80 females. The mean age at the initial visit was 35.5±14.6 years (range, 5-77). The clinical courses, treatment methodology and prognosis were reviewed. And the surgical approach, posterior fixation segment and the recovery of neurological function were mainly summarized. The atlantodental interval (ADI), the distance by which the odontoid exceeded the Chamberlain line and the cervical-medullary angle were analyzed.Results:The most common symptoms included weakness or numbness of the limbs (67.5%, 108/160), unstable gait (30%, 48/160) and vertigo (20%, 32/160). Among all, 130 cases (81.3%, 130/160) had myelopathy, with the Japanese Orthopaedic Association (JOA) scores from 4 to 16 (mean JOA scores 13.5±2.5). Cranial neuropathy was involved in 20 cases (12.5%). Radiological findings showed brainstem and/or cervical-medullar in 130 cases (81.3%), syringomyelia in 37 cases (23.1%) and Chiari malformation in 30 cases (18.8%). Computed tomography angiography (CTA) was performed in 90 cases, which showed vertebral artery anomalies in 55 cases (61.0%) and excessive medialized internal carotid artery in 5 cases (5.6%). All cases had no spinal cord or vertebral artery injury. The surgery included posterior occipito-cervical fusion (reducible dislocation, 145 cases), and transoral release followed by posterior fusion (irreducible dislocation, 15 cases). Fifty-seven cases were treated using alternative fixation technique. The average follow-up time was 50.5±22.4 months (range, 24 to 120 months). All of 152 cases (95.0%) achieved solid atlantoaxial fusion; there was no obvious osseous fusion formation on postoperative images in 6 cases (3.8%), but no atlantoaxial instability was found on dynamic radiographs; screw loosening happened in 2 patients (1.2%). Nine patients (5.6%) suffered complications, including 4 cases with recurrent dislocation, 2 screw loosening, 2 cases with bulbar paralysis and 1 wound infection. The mean postoperative JOA was 15.1±1.8 (range, 5-17), and the mean neurological improvement rate was 42.9%±33.3% in the patients with myelopathy.Conclusion:"Sandwich" AAD, a subgroup of AAD, has unique clinical features: earlier onset age and more severe myelopathy. The incidence of bone and vascular malformation is higher. So alternative surgical plan and hybrid fixation should be prepared for this subgroup of AAD.
ABSTRACT
BACKGROUND: High tibial osteotomy is a classic operation for the treatment of early simple medial compartment osteoarthritis of the knee. Three-dimensional (3D) printing can be used to make personalized surgical tools. We have used 3D printing technology to assist high tibial osteotomy for the treatment of knee osteoarthritis. OBJECTIVE: By comparing traditional methods, to analyze the advantages and disadvantages of the high tibial osteotomy assisted by personalized 3D printing osteotomy combined with arthroscopic debridement for the treatment of osteoarthritis of the knee with varus deformity. METHODS: Totally 47 cases undergoing lateral closed wedge high tibial osteotomy combined with knee joint debridement were randomly assigned to two groups. The 3D printing osteotomy group (n=21) received personalized 3D printing osteotomy. The traditional osteotomy group (n=26) received traditional osteotomy. The operation time, number of intraoperative C-arm fluoroscopy and blood loss, limb alignment on the affected side 1 month after surgery, and Hospital of Special Surgery scores on the affected side knee joints at 1, 3, 6,12 and 24 months after surgery were compared between the two groups. This study was approved by the Ethics Committee of First Hospital of Putian City. All patients signed the informed consent. RESULTS AND CONCLUSION: (1) The intraoperative 3D printing osteotomy module was consistent with the preoperative simulated place. (2) The operation time was significantly shorter in the 3D printing osteotomy group than in the traditional osteotomy group [(69. 71 ±3. 17), (92. 92±5. 91) minutes, (=-17. 21, P 0. 05). (4) In conclusion, compared with traditional osteotomy, personalized 3D printing-assisted osteotomy in lateral closed wedge high tibial osteotomy can significantly shorten the operation time, reduce the number of intraoperative C-arm fluoroscopy and the amount of blood loss, but there is no significant difference in knee function between the two groups at 2 years after surgery.
ABSTRACT
Objective To investigate the effect of pre-pregnancy age, alanine aminotransferase (ALT), blood glucose (GLU) level on premature birth. Methods Based on the free pre-marital health check-ups and pre-pregnancy eugenic health check-ups in Dongguan, the examination results of the subjects were obtained and the pregnancy outcomes were followed up. Logistic regression models were used to analyze the relationship between women’s pre-pregnancy age, ALT, and GLU levels and the incidence of premature birth. Results A total of 18 150 subjects were included in this study, and the overall incidence of premature birth was 6.06% (1,099/18,150). The women’s pre-pregnancy age 30 to 34 (RR=1.26, 95% CI:1.07～1.48), age>34 (RR=1.82, 95% CI:1.52～2.18), ALT≥40 U/L (RR=1.40, 95% CI: 1.09～1.80) and GLU>6.1 mmol/L(RR=1.74, 95% CI: 1.01～2.97) were the influencing factors of premature birth. Conclusion Older women, abnormal serum alanine aminotransferase level and hyperglycemia had an impact on the occurrence of premature birth, which has important guiding significance for health education of eugenics before pregnancy.
ABSTRACT
It is still an important and hard work to diagnose anaphylactic shock in forensic practice. However, no breakthrough progresses in the diagnosis of anaphylactic shock and relevant research have been made so far due to the problems we used to meet in actual postmortem examination ,which are short of specific pathological changes in autopsy, the condition progress of patients who occur anaphylactic shock and history of allergy. Furthermore, patients suffer from diseases such as coronary heart disease, pneumonia, asthma, skin irritation, etc, and blood serum allergy biomarkers degrade after hemolysis on account of a long time from death to autopsy ,which are also the difficulties we have to cope with. The aim of this review is to focus on present situation and diagnostic index of anaphylactic shock including the pathological changes and some experimental methods such as special stain, immunohistochemical and serological test to provide reference for diagnosis and study of anaphylactic shock.
ABSTRACT
In this study, the prophylactic effect of treatment of donor mice with naturally hypotoxic Ch. violaceum endotoxin on lethal GVHD induced in a murine P→F1 combination was observed. Treatment of the donors with the endotoxin inhibited GVH splenomegaly, attenuated clinical manifestations and improved survival rate and mean survival time of dead animals. In addition, treatment with the endotoxin could enhance the bone marrow cells to form CFU-S and promote the initial graftment rate of marrow allograft.
ABSTRACT
We had confirmed that treatment of donor mice with Ch. Violaceum endotoxin (lipopolysacchari-de,LPS)could inhibit GVHR. In this paper, its immunological mechanisms were explored. The results showed that the LPS could augment [3H] -TdR uptake by mouse spleen cells, but decrease their proliferative responses to LPS and Con A, and suppress unidirectional MLR and NK cell activity, with inhibitory rate of 64.5%, 66.1%, 51.7% and 59.3%, respectively, suggesting it had inhibitory effects on B, T lymphocytes and NK cells. In vitro experiments using mixtures of spleen cells from treated and normal mice showed there existed non-specific suppressor cell activity in LPS-and Con A-induced lymphocyte transformation but not in MLR and NK activity assays. That meant suppressor cells were not responsible for suppressive effects on T cells and NK cells which are thought to be main effector cells mediating GVHD.