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Objective:To evaluate the mid- and long-term outcomes of Dynesys hybrid surgery (in some segments act as a non-fusion device, in other segments act as an alternative of rigid fixation in combination with interbody fusion) in the treatment of multi-segmental lumbar degenerative disease (LDD).Methods:The data of 27 patients who received Dynesys hybrid surgery (hybrid group) for the treatment of LDD from May 2011 to September 2016 and completed the follow-up were retrospectively analyzed. Among them, there were 8 males and 19 females; their average age was 59.1±11.9 years (23-78 years). Main diagnosis: 13 cases of lumbar spinal stenosis, 14 cases of lumbar disc herniation; 4 cases of combined lumbar dynamic position instability, 7 cases of combined lumbar spondylolisthesis. There were 15 cases of two-segment disease, 11 cases of three-segment disease, and 1 case of four-segment disease. Segments distribution: 9 cases of L 3-L 5, 6 cases of L 4-S 1, 7 cases of L 3-S 1, 4 cases of L 2-L 5, and 1 case of L 2-S 1. Midline incision was used to exposure, followed by bilateral pedicle screws implantation, and interbody fusion cage with bone grafting were performed at the fusion level. Twenty-seven patients who underwent TLIF+rigid internal fixation during the same period were included as the control group. Clinical outcomes were measured by visual analog scale (VAS) for low back pain and leg pain, and Oswestry disability index (ODI). Radiological outcomes included fusion rate, intervertebral disc height (DH) of surgical segments and the proximal adjacent segment, range of motion (ROM) of non-fusion segments and the proximal adjacent segment. At the same time, the occurrence of complications was observed. Results:Patients of Hybrid group and control group were followed up for an average of 83.8±20.9 months (48-112 months) and 87.3±16.2 months (53-114 months), respectively. Baseline data of the two groups (average follow-up time, age, gender, surgical level, diagnosis) showed no significant difference. The operation time (183.0±27.8 min) and intraoperative blood loss (301.9±178.9 ml) in the hybrid group were significantly lower than those in the control group (operation time t=2.337, P=0.023; blood loss t=2.706, P=0.01). At the final follow-up, the VAS scores of low back pain and leg pain (low back pain t=12.164, P<0.001; leg pain t=20.603, P<0.001), as well as ODI were significantly improved ( t=22.827, P<0.001). A total of 32 segments received TLIF+Dynesys stabilization and 35 segments received Dynesys non-fusion stabilization in the hybrid group, with 28 segments (87.5%) achieved solid fusion at 1-year follow-up. There were 67 fusion segments in the control group, and the fusion rate at 1-year follow-up was 85.1%. DH of non-fusion segments were lower than that before surgery with statistical significance at final follow-up ( t=2.647, P=0.012), while DH of the fusion segments in the hybrid group and the surgical segments in the control group increased compared with that before surgery at the final follow-up. A certain degree of ROM (2.4°±1.5°) was retained of the non-fusion segments at the final follow-up; the ROM of proximal adjacent segments of non-fused segments was significantly smaller than that of proximal adjacent segments of fused segments ( t=2.126, P=0.044). In the hybrid group, screw loosening occurred in 4 patients (8 screws) and adjacent segment degeneration (ASD) occurred in 5 patients. In the control group, screw loosening occurred in 3 patients (6 screws), while ASD occurred in 8 patients. No screw fracture was observed during the follow-up period and no patients received reoperation. Conclusion:Hybrid surgery of Dynesys stabilization combined with interbody fusion is a safe and effective method for the treatment of multi-segmental LDD. Compared with multi-segmental fusion, this lumbar hybrid surgery has the advantages of less trauma and retaining partial segmental ROM.
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Objective@#To explore the efficacy and safety of recombinant human interleukin-11 (rhIL-11) in treatment of chemotherapy-induced thrombocytopenia of acute leukemia.@*Methods@#Acute leukemia patients with chemotherapy-induced thrombocytopenia [Platelets (Plt) < 50×109/L] in 6 centers nationwide from February 2016 to July 2016 were treated with rhIL-11 (2 mg/time, twice per day) by subcutaneous injection. Treatment lasted 7 days or at least until Plt≥ 50×109/L. The Plt recovery was observed during treatment.@*Results@#A total of 112 patients were enrolled, and 2 patients decided to drop out of study. The efficacy population consisted of 110 patients, and the total response rate reached 74.5% (82/110). The average variation of Plt during treatment was (70±54)×109/L, and recovery average time of Plt for the patients with favorable efficacy was (8.7±3.0) days. In treatment with severe thrombocytopenia, rhIL-11 alone could shorten the recovery time compared with rhIL-11 combined with Plt transfusion [(8.0±2.6) d vs. (9.6±3.5) d, t=2.17, P=0.03].@*Conclusion@#rhIL-11 twice a day of subcutaneous injection can effectively promote Plt recovery and reduce Plt transfusion with less adverse reactions, which is worthy of further application.
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Shanghai district and county health system performance evaluation conceptual frameworkwas proposed based on health services system performance assessment frameworks raised by some countries and international organizations,and combined with Shanghai district and county health system characteristics.This framework contains two first grade indices and seven second grade indices:In the long term goals,'health','satisfaction' and 'disease risk protection' are the county's longterm effects of health system performance assessment dimensions; in the medium-term goals,the'accessibility','cost',' efficiency' and 'quality' are the county' s medium-term effects of health system performance assessment dimensions.This study aimed to evaluate Shanghai county health system's overall performance.Further study is needed in constructing its third grade indices.
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Objective To compare the clinical efficacy and radiologic changes between constrained and non-constrained titanium plate in anterior cervical corpectomy and fusion (ACCF) in elderly cervical spondylosis patients.Methods A total of 58 elderly cervical spondylosis patients who underwent ACCF were divided into group 1 (patients treated with constrained titanium plates,n =30) and group 2 (patients treated with non-constrained titanium plates,n=28).The Japanese Orthopedic Association (JOA) score,fusion rate,the loss of segmental height and cervical lordosis were recorded.The clinical efficacy and imaging features were compared between the two groups.Results The improvement rate of JOA score had no significant differences between group 1 and group 2 [(77.7±18.6)％ vs.(75.8±23.2)％,t=0.340,P＞0.05].At 3 months after operation,the fusion rate was higher in group 2 than in group 1 (89.3％ vs.63.3％,x2 =5.327,P＜0.05).At 3,6 and 12 months after operation,there were no significant differences in the loss of segmental cervical height and lordosis between group 1 and group 2 [(2.42±3.05)mm vs.(0.98±2.86)mm,(3.95±3.65)mm vs.(2.34±2.97)mm,(3.60±4.33)mm vs.(2.40±2.96)mm,(1.64±2.33)° vs.(0.66 ± ±2.14)°,(2.13∧±±3.79)° vs.(0.70±2.99)°,(2.39±4.26)° vs.(0.86±3.25)°,respectively,all P ＞0.05].Conclusions The clinical efficacy is similar in ACCF with the two types of titanium plates.The non-constrained titanium plate can increase the fusion rate in early time,but may aggravate the loss of segmental cervical height and lordosis,which should be used with caution in elderly osteoporosis patients.
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Health appropriate technologies are applied nationwide in our country and have produced good results. But the informatization of health appropriate technologies lags behind and is still at a preliminary stage.As the network of Zhejiang basic health appropriate technologies has been estabished,this paper discusses some issues related with the informatization of health appropriate technologies.
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We examined the biocompatibility and the safety of a-calcium sulfate hemihydrate (CSH)/multi-walled carbon nanotube (MWCNT) composites for bone reconstruction application. The biocompatibility of the CSH/MWCNT composites was evaluated by the measures which taking L929 fibroblast cells cultured in the extracted liquid of the composite soaking solution and putting bone marrow stromal cells planted on the composite pellets in vitro, respectively. The cell proliferation was evaluated by MTT test and further observed using an inverted optical microscope and a scanning electric microscope. The toxicity of the composites was evaluated by acute and subacute systemic toxicity test. Long-term muscle and bone implantation in vivo tests were also conducted. L929 fibroblast cells grew well in the extracted liquid, as well as bone marrow stromal cells that could adhere on the surface of sample pellets and proliferated rapidly. MTT test showed that there were no significant differences between the experimental and control groups (P > 0.05). In vivo test manifested that the composites were no toxicity, no irritation to skin and good for bone defect reconstruction. It was proved that a-calcium sulfate hemihydrate (CSH)/multi-walled carbon nanotube (MWCNT) composites exhibited excellent biocompatibility for the potential application in bone tissue engineering.
Subject(s)
Animals , Rabbits , Biocompatible Materials , Chemistry , Bone Marrow Cells , Cell Biology , Bone Substitutes , Chemistry , Calcium Sulfate , Chemistry , Cell Line , Cell Proliferation , Fibroblasts , Cell Biology , Materials Testing , Nanotubes, Carbon , Chemistry , Stromal Cells , Cell Biology , Tissue Engineering , Methods , Toxicity TestsABSTRACT
Medical research institutions in Shanghai have been developing in at a slow pace because of problems such as out of date institution structures, unreasonable resource allocation and distribution,shortage of research resources, insufficient creativity, and unfocused effort and investment. Hence reform is the only way out. This research discussed the possible strategies for development and proposed some suggestions on the institution categorization, structure change, allocation of resource and overall arrangement.