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【Objective】 To analyze the clinical characteristics of stone culture and preoperative urine culture of patients with renal calculi in Songjiang area of Shanghai and the relationship with postoperative infection. 【Methods】 The clinical data of 213 patients with kidney stones treated at our hospital during Jan.2020 and Jun.2022 were retrospectively analyzed. All patients underwent preoperative clean midcourse urine culture, drug sensitivity test and stone culture. The gender difference between male and female patients and the difference in postoperative infection between stone/bacterial culture positive and negative patients were analyzed. 【Results】 Among the 213 patients, 47(22.1%) had positive urine culture, and the most common bacterium was Escherichia coli (20 strains, 42.6%). The proportion of Escherichia coli was significantly higher in female patients than in male patients [12 strains (48.0%) vs.8 strains (36.4%), P<0.05], while the proportion of Klebsiella pneumoniae was significantly higher in male patients than in female patients [5 strains (22.7%) vs. 3 strains (12.0%), P<0.05]. Drug sensitivity results showed the main Gram-negative bacteria were highly resistant to ampicillin/sulbactam, cefazolin and cefuroxime, but sensitive to imipenem, kanamycin and piperacillin/tazobactam. The main Gram-positive bacteria were highly resistant to clindamycin, erythromycin and levofloxacin, but sensitive to vancomycin, teicoplanin and linezolid. Stone culture was positive in 31 cases (14.6%), and the most common bacterium was Proteus mirabilis (9 strains, 29.0%). However, there was no significant difference in the main bacterial spectrum between male and female patients. The positive rate of urine culture/stone culture in patients with postoperative fever/urosepsis was significantly higher than that in patients with negative urine culture/stone culture (P<0.05). 【Conclusion】 Escherichia coli is the main urinary spectrum of patients with kidney stones in Songjiang area, which is greatly different from the stone culture results. In clinical practice, etiological detection and antibiotics are necessary to reduce the occurrence of postoperative infection.
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Objective:To observe the effects of self-designed Yiqi Huoxue Huayu Decoction on cardiac function and serum endothelin (ET-1) and matrix metalloproteinase-9 (MMP-9) levels in patients with chronic heart failure (GHF) complicated with atrial fibrillation.Methods:A total of 100 patients with GHF complicated with atrial fibrillation treated in our hospital from January 2019 to June 2021 were selected as the study subjects, and divided into experimental group and control group according to random number table method, with 50 patients in each group. Patients in both groups were given cardiotonic, diuretic, vasodilator and other conventional treatment, and patients in the experimental group added self-designed Yiqi Huoxue Huayu Decoction. TCM syndrome score, left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD) and left ventricular ejection fraction (LVEF), serum ET-1 and MMP-9 levels, clinical efficacy, safety and incidence of adverse reactions were observed and compared between 2 groups before and after treatment.Results:The total response rate was 82.0% (41/50) in the observation group and 62.0% (31/50) in the control group, and the difference was statistically significant ( χ 2=4.96, P=0.026). After treatment, the symptoms scores of palpitation, shortness of breath, fatigue, chest and hypochasm pain in the observation group were significantly significantly lower than those in the control group ( t=5.28, 5.29, 5.62, 5.42, P<0.01). After treatment, the LVEDD[(51.23±6.59)mm vs. (55.65±6.17)mm, t=3.46], LVESD[(43.10±4.76)mm vs. (45.99±5.31)mm, t=2.87], serum ET-1[(65.79±8.29)μg/L vs. (79.83±10.08)μg/L, t=7.61], MMP-9 [(175.86±24.81)ng/L vs. (189.49±26.13)ng/L, t=2.68] in experimental group were significantly lower than those in the control group ( P<0.05), while LVEF [(50.01±7.6)% vs. (46.25±6.96)%, t=2.57] was significantly higher than that of the control group ( P<0.05). There were no significant differences in GPT, GOT, UA, SCr levels between both groups before and after treatment ( P>0.05). There were no obvious adverse reactions betewwn both groups. Conclusion:The self-designed Yiqi Huoxue Huayu Decoction can relieve the clinical symptoms, improve the heart function and serum ET-1 and MMP-9 levels in patients with GHF complicated with atrial fibrillation safely.
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Objective:To explore the method and curative effect evaluation of repairing and rebuilding the long segmental bone defect after resection of long bone malignant tumors in adolescents.Methods:Reviewed our experience in 10 patients. Among them, 4 were male and 6 were female. The age was 10.2 years old (range, 6-16 years old). Including 7 cases of osteosarcoma, 3 cases of Ewing's sarcoma; 2 cases of humerus tumors, 7 cases of femoral tumors, and 1 case of tibial tumors-who presented between April 2015 and October 2019, in which the proportion of bone defect account for 71.4%-89.3% of the total length of diseased bone after tumor resection, with an average value of 80.9%. Considering the epiphyseal growth of young people, on the premise of ensuring enlarged tumor resection, we use traditional fibula autograft and prosthesis combined with steel plate, 3D printing design to retain the super-prosthesis of the epiphysis, and 3D printing bone trabecular was processed for the sake of making it grow successfully into the binding part of prosthesis and bone as we expect, simultaneously, the design of the short-force arm retaining the bilateral epiphysis can assit the steel plate and interlocking screws to enhance the stability.Results:The operation was completed successfully, and there were no complications such as nerve and blood vessel injury during the operation. After follow-up of 4-8 months, with an average follow-up of 22.9 months. One patient's review of X-ray film after 2 years of the operation showed that the transplanted fibula had a sign of bone resorption, and the internal fixation was in it's original position without obvious abnormalities. Two cases' auxiliary steel plates had fractured within one and a half to two years after surgery. With replacing the fractured steel plates, the internal fixation was good until now. According to the evaluation standards of the International Society of Limb Salvation: 2 cases of humerus osteosarcoma were respectively scored 23 points, 26 points, an average of 24.5 points; 4 cases of femoral osteosarcoma and 3 cases of femoral Ewing's sarcoma respectively scored 26 points and 25 points, 19 points, 30 points, 27 points, 24 points, 28 points (average, 25.6 points); 1 case of tibial osteosarcoma scored 26 points; all obtained relative satisfying treatment results.Conclusion:The combination of 3D printing and traditional machining techniques to produce an individualized long segmental prosthesis that preserves the epiphysis which applicated in the limb salvage treatment of bone malignant tumors can achieve excellent therapeutic effect.
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Objective To investigate the natural evolution of postoperative distal adding-on in Lenke 1A and 2A adoles-cent idiopathic scoliosis(AIS)patients,and to explore the risk factors for the progression of distal adding-on.Methods From Ju-ly 2006 to July 2012,a total of 197 AIS patients with Lenke 1A or 2A curves underwent posterior selective thoracic instrumenta-tion and fusion surgery.Among which,44 patients(22.3%)with postoperative distal adding-on were recruited in this study.There were 39 female and 5 male,with an average age of(15.0±2.1)years.The mean Cobb angle of main thoracic curve was 49.3°±9.3°. The first postoperative radiograph indicating distal adding-on and the last follow-up radiograph were compared:make the measure-ment of the disc angle below lowest instrumented vertebra(LIV),and the distance between the vertebra below LIV(LIV+1)and cen-tral sacral vertical line(CSVL).Distal adding-on could be classified into progressive group and non-progressive group according to its natural evolution during follow-up.If the disc angle increased> 5°or the LIV+1-CSVL distance increased>5 mm,the pa-tients were assigned into progressive group; Otherwise, the patients were assigned into non-progressive group. Using Student T test, χ2test or Fisher exact test, the predicted risk factors for progression were screened for further Logistic regression. Results Among the 44 patients enrolled in the study,17 patients(38.6%)had progressive adding-on while 27 patients(61.4%)had non-progressive adding-on.The Risser sign was significantly lower in progressive group than non-progressive group(t=4.399,P<0.001). Besides,more patients had LIV proximal to substantially stable vertebra(SSV)in progressive group than non-progressive group (Fisher exact test value=18.142,P<0.001).The improvement of shoulder imbalance was significantly better in progressive group than non-progressive group(t=3.011, P=0.002). According to Logistic regression, the low Risser sign and LIV proximal to SSV were independent risk factors for progression of distal adding-on.Moreover,the self-image domain of SRS-22 Scores was remark-ably lower in progressive group than non-progressive group(t=2.321,P=0.014).Conclusion Distal adding-on could be classi-fied into progressive group(40%)and non-progressive group(60%)according to its natural evolution.The risk factor for its progres-sion included skeletal immaturity and LIV proximal to SSV.Moreover,the progression of distal adding-on might compensate for the shoulder imbalance during follow-up.
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Objective To explore the feasibility and efficacy of posterior minimally invasive scoliosis surgery in Lenke 5C adolescent idiopathic scoliosis (AIS).Methods From November 2012 to March 2014,a total of 16 patients underwent posterior minimally invasive scoliosis surgery assisted by O-arm three-dimensional CT navigation were included.There were 14 female and 2 male,with an average age of (16.7± 1.6) years (ranged from 14 to 18 years).The mean Cobb angles of lumbar and thoracic curve were 48.7°±5.6°and 24.1°±5.4°,respectively.Results 16 patients were successfully completed the operation,the average operation time was (246±89) min,the average intraoperative blood loss was (192± 105) ml,and the fusion level was 4.9±0.5 on average.A total of 155 screws were inserted in the 16 patients,with a mean implant density of 98.9％±4.9％.All the patients were followed up for (26.4±3.9) months on average.The following radiographic parameters were evaluated before surgery,immediately after surgery and at the last follow-up:curve magnitude,apical vertebral translation (AVT),apical vertebral rotation (AVR),trunk shift,thoracic kyphosis (TK),thoracolumbar kyphosis (TLK),lumbar lordosis (LL) and sagittal vertical axis (SVA).The accuracy of pedicle screw placement was assessed according to postoperative CT scans.SRS-22 scores and complications were also recorded during the follow-up.Immediately after surgery,the correction rate of main lumbar curve was 80.1％±8.3％,and thoracic curve was 59.3％±8.7％,and a obvious improvement was noted in terms of AVT,AVR,trunk shift and TLK.At the last follow-up,except the increase of SVA from (-27.6± 19.5) mm to (-12.3±6.6) mm,no obvious changes of AVT,AVR,trunk shift,TK,TLK and LL were observed during the follow-up.According to CT evaluation,the satisfactory rate of pedicle screw placement was 94.2％,while the perforation rate was 5.8％ (9/155).Fusion across the facet joint were satisfactory.In SRS-22 assessment,the mean scores of functional,pain,self-image,mental state and satisfaction were (4.3 ± 0.5) points,(4.7 ± 0.6) points,(4.2 ± 0.7) points,(4.2 ± 0.5)points and (4.4 ± 0.6) points.No wound infection,implant failure and neurologic complications were found after surgery.Conclusion Wiltse approach assisted by O-arm three-dimensional CT navigation has the characteristics of small injury,less bleeding,high accuracy placement of pedicle screws and high self-satisfaction of patients.It is a feasible,safe and effective way to treat Lenke 5C AIS.
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BACKGROUND:Isobaric tags for relative and absolute quantitation (iTRAQ) mass spectrometry technology studys the information of relevant protein according to the ion signal shows different mass-to-charge ratio in the tandem mass spectrometry analysis. OBJECTIVE:To establish the protein spectrum of differential proteins in cerebrospinal fluid of acute spinal cord injury rat model, study the secondary injury mechanism and find an effective method of treating acute spinal cord injury from molecular level. METHODS:Acute spinal cord injury was produced in Sprague-Dawley rats and iTRAQ technology was applied to analyze the differential proteins in cerebrospinal fluid of acute spinal cord injury rat model. RESULTS AND CONCLUSION:Total 722 proteins have been identified in this study, including 107 differentialy expressed proteins, 63 downregulated proteins and 44 upregulated proteins. There were 19 proteins related to neurogenesis, including 14 up-regulation proteins and 5 down-regulation proteins. Seven proteins contributed to the regulation of neurogenesis. The differential proteins and growth factor identified in this study can be taken as the biomarkers of acute spinal cord injury or indicators of clinical monitoring of the progression, target treatment and efficacy assessment after acute spinal cord injury.
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BACKGROUND:In mass spectrometry analysis, the same protein in different samples labeled with isobaric tags for relative and absolute quantitation presents the same mass-to-charge ratio, while in the tandem mass spectrometry analysis, the ion signal shows different mass-to-charge ratio (114-121). Thus the quantitative information of the related proteins can be obtained. OBJECTIVE:To establish the protein spectrum of spinal cord tissue differences proteins after acute spinal cord injury, and to explore the spinal differential protein expression on the molecular level using isobaric tags for relative and absolute quantitation combined with LC-MS/MS mass spectrometry technique. METHODS:Eight Sprague Dawley rats were selected to establish the acute spinal cord injury models using Al en’s method. The rats were randomly divided into 0 hour spinal cord injury group and 8 hours spinal cord injury group, four rats in each group. The spinal cord tissues were col ected after injury, and the spinal cord tissue differences proteins were analyzed with isobaric tags for relative and absolute quantitation technique after acute spinal cord injury. RESULTS AND CONCLUSION:Total y 220 differential y expressed proteins were identified in this research, the number of up-regulation proteins was 116 and the number of down-regulation proteins was 104. There were 12 differential proteins related to neural regeneration, and among the 12 proteins, there were seven up-regulation proteins and five down-regulation proteins. The various identified differential proteins and significantly expressed nerve growth factors in this experiment can be used as the biomarkers of acute spinal cord injury or used as the strong evidence for the clinical management and monitoring of the injury process and target therapy of acute spinal cord injury, as wel as the effect evaluation.
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Objective:To analyze the clinical effect of different surgical methods on giant-cell tumor of bone (GCTB). Methods:Between January 2007 and June 2012, 37 patients receiving treatment for GCTB were enrolled in this study. These patients included 20 males and 17 females whose ages ranged from 20 to 56 (average=31.6). The prosthesis replacement and nonprosthetic replacement op-eration on the postoperative recurrence, limb function, comprehensive evaluation of the curative effect, as well as morbidity and recur-rence rate among different nations and in the upper and lower limbs of GCTB patients were analyzed. Results:The predilection age of the cases ranged from 20 to 50 years old. The incidence was higher in the Uighur population of Xinjiang, China. However, the recur-rence rate in ethnic difference was not statistically significant (P>0.05). Conclusion:The predilection age of GCTB cases was 20~50 years old, with higher morbidity in Uighur than in Han and other ethnic groups. The morbidity and recurrence rate were higher in the lower limbs than in the upper limbs of patients. The scraping bone graft and bone cement filling, the internal fixation of the scraping bone graft, and the artificial joint replacement of tumor resection were all reliable modes of treatment.