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Currently, the total ureteral avulsion are mainly secondary to ureteroscopy, and it is rarely caused by uterine evacuation clinically. This paper reported a case of total ureter avulsion after uterine evacuation, treating by ileal replacement for ureter under general anesthesia, and the surgical outcome was good. Uterine evacuation is a routine, less risky procedure, but it also can lead to serious complications such as total ureteral avulsion or bladder rupture. For potential high-risk patients with uterine evacuation, preventive measures such as accurate localization under B-ultrasound guidance or pre-operative ureteral stents indwelling are useful to avoid the occurrence of such serious complications. If total ureteral avulsion occurs, ileal replacement for ureter is a viable and effective treatment.
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Solitary kidney, renal duplication and malrotation are rare congenital renal malformations in urology department, and probably contributed to some complications such as obstruction, hydronephrosis, infection, stones. In this case report, we firstly presented a male patient with rarely multiple renal malformations, including solitary kidney, renal duplication, misaligned malrotation of upper and lower moieties, and accompanied by complete staghorn stones and hydronephrosis, who was treated with open pyelolithotomy under general anesthesia. After the operation, obstruction, hydronephrosis, and infection were relieved.
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A recurrent misdiagnosed case of congenital left renal arteriovenous fistula (RAVF) with multiple left renal arteries and scoliosis was reported. The patient was admitted to hospital on 29 August 2020 due to repeated hematuria for one year. No abnormality was found in two flexible ureteroscope examinations, imaging and laboratory examinations after admission. It was found that the structure of blood vessels in the inferior pole of renal sinus was disordered, and the blood vessels were tortuous and clustered through careful reading of CT enhancement films. The dilated tortuous blood vessels were also seen around the renal pelvis, and hematuria was considered to be caused by renal vascular malformation. In order to confirm the etiology, digital subtraction angiography (DSA) of renal artery was performed. DSA showed a congenital left renal RAVF with three renal arteries, and the arteriovenous fistula of renal arteries was embolized. For patients presenting with severe gross hematuria, if tumor, stone, tuberculosis, or coagulation abnormalities were excluded by conventional imaging and/or laboratory examination the possibility of congenital renal vascular malformation should be suspected, and DSA examination should be performed. Endovascular embolization is an effective treatment for congenital RAVF.
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Objective To evaluate the clinical efficacy of gemcitabine plus cisplatin (GP) regimen and paclitaxel plus cisplatin (TP) regimen in the treatment of recurrent or metastatic nasopharyngeal carcinoma.Methods One hundred and thirty patients with recurrent or metastatic nasopharyngeal carcinoma of Qinhuangdao Harbor Hospital,Hebei Province between September 2012 and December 2017 were chosen,and were divided into GP group (68 cases) and TP group (62 cases)according to the selection of treatment.GP group was treated with GP regimen,and TP group was treated with TP regimen.The clinical efficacy and adverse reactions of the two groups were observed,and the serum epithelial cadherin (SE-CAD) and platelet-derived growth factor (PDGF-BB) were measured before and after chemotherapy.Results There was no significant difference in short-term efficacy between GP group and TP group (P＞0.05),and the total effective rates were 88.24％ (60/68) and 79.03％ (49/62) respectively;1 month after treatment,SE-CAD in GP group and TP group were (2.57 ± 0.81) and (2.50 ± 0.96) g/L,PDGF-BB were (102.22 ± 31.18) and (110.15 ± 37.21) ng/L,and the difference was not statistically significant (P＞0.05);progression-free survival (PFS) in GP group and TP group were 13 and 12 months,and overall survival (OS) were 17 and 16 months,and the difference was not statistically significant (P＞0.05);there were no significant difference in leucopenia,hemoglobin,thrombocytopenia and abnormal liver and kidney function between GP group and TP group (P＞0.05);the incidence of gastrointestinal reactions in GP group was 16.18％ (11/68),which was significantly lower than that in TP group was 38.71％(24/62),and the difference was statistically significant (P＜0.01).Conclusions GP and TP regimens are effective in the treatment of recurrent or metastatic nasopharyngeal carcinoma.There is no significant difference in SE-CAD and PDGF-BB levels between the two regimens after treatment,but GP regimen has a lower incidence of gastrointestinal reactions.
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Objective@#To summarize the technical points and clinical efficacy of pedicle subtraction osteotomy (PSO) in tunneling and to explore the related complications of this technique.@*Methods@#A total of 67 cases of old vertebral fractures of the thoracolumbar region from June 2012 to June 2017 were collected. According to the inclusion and exclusion criteria, a total of 41 cases were included in the study. There were 19 males and 22 females; aged 37-67 years, mean 60.1±12.7 years; 15 cases of non-surgical treatment after trauma, 13 cases of failure after surgery and 13 cases of osteoporosis. Injury segment: 9 cases of T11, 22 cases of T12, 8 cases of L1, 2 cases of LS. Preoperative patients were diagnosed by X-ray, CT plain and 3D reconstruction combined with MRI. There were 23 cases of intractable back pain, 16 cases of lower extremity root pain, and 2 cases of intermittent claudication. Patients were divided into the traditional PSO treatment group (21 cases) and modified PSO treatment group (20 persons) according to the random number method. The traditional group were treated with the "egg shell" technique, and the improved group were treated with tunnel forming technology. The procedure was divided into four steps: exposure (step 1), nail placement and resection of the posterior column complex (step 2), vertebral osteotomy (step 3), orthopedics and bone grafting (step 4). The operation time, bleeding volume and complications of each step were compared between the two groups. The clinical efficacy was evaluated using the visual analogue scale (VAS) score and the Oswestry disability index (ODI). The X-ray spine Cobb angle was measured to evaluate the Keloid deformity correction, and the bone graft fusion was observed by CT examination.@*Results@#All patients were followed up for 12 to 24 months. The total operation time of the traditional group was 273.3±21.1 min, and the total operation time of the modified group was 178.1±12.5 min, the difference between the two groups was statistically significant (t=8.981, P=0.0019). The differences between the two groups in steps 2 and 3 were statistically significant (t2=4.614, P2=0.036; t3=9.089, P3=0.020) . The difference in the total bleeding volume was statistically significant (t=8.529, P=0.011). The differences in the bleeding volume between the two groups in step 2 and step 3 were statistically significant (t2=11.933, P2=0.016; t3=6.972, P3=0.013). The Cobb angles of the traditional group before surgery, 1 week after surgery and half year after surgery were 40.2°±8.9°, 12.5°±6.8°, 10.4°±2.5°, respectively. The Cobb angles of the modified group before surgery, 1 week after operation and half year after surgery were 39.5°±6.3°, 10.4°±3.5°, 9.5°±1.9°, respectively. The differences in the Cobb angle between the preoperative, postoperative 1 week and postoperative half year were statistically significant(Fmodified group=189.573, Pmodified group=0.021; Ftraditional group=194.699, Ptraditional group=0.029). The bone fusion time in the osteotomy area was 3-6 months, with an average of 4.8 months. The VAC and ODI scores of half-year post operation of the traditional group were 2.1±0.3 and 34.1±4.3, and the improved group were 2.2±1.1 and 28.3±6.8, respectively, and the difference was not statistically significant. In the improved group, there were 1 case of over-excavation and 1 case of over-underexcavation (2/20), which were corrected in time during operation. In the traditional group, 4 cases (4/21) of dural tear occurred during the operation, and were repaired in time. Bone fusion was obtained half a year later. No clinical deaths, and no cases of surgical infection occured.@*Conclusion@#Tunnel forming technology is an alternative surgical procedure for treating old fractures of the thoracolumbar region with PSO, which can shorten the operation time, reducd intraoperative bleeding and reduce surgical complications.
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Objective@#To investigate the clinical efficacy of percutaneous fixation assisted by O-arm-based navigation for thoracolumbar fractures without neurologic deficits.@*Methods@#A retrospective case control study was conducted to analyze the clinical data of 35 thoracolumbar fracture patients without neurologic deficits admitted to Henan Provincial People's Hospital from January 2018 to December 2018. There were 26 males and 9 females, aged 17-51 years, with an average age of 30.4 years. The injured segments were distributed at T11 in 10 patients, T12 in 15, L1 in 11, and L2 in 4 patients. A total of 19 patients (22 vertebrae, 98 pedicle screws) were treated with O-arm guided navigation assisted percutaneous internal fixation (Group A), and 16 patients (18 vertebrae, 82 pedicle screws) were treated with C-arm guided percutaneous internal fixation (Group B). The operation time, accuracy rate of nail placement, complications, Cobb angle of fracture vertebral body, visual analogue score (VAS) and Japanese Orthopaedic Association (JOA) score were recorded and compared before operation, 7 days after operation and at the last follow-up.@*Results@#The patients were followed up for 2-12 months [(7.2±2.9)months] in Group A and 3-13 months [(7.1±3.3)months] in Group B. The operation time was (70.5±11.2)minutes in Group A and (81.3±10.9)minutes in Group B (P<0.01). A total of 93 screws were completely placed in the pedicle in Group A (accuracy rate of 95%), and 74 screws in Group B (accuracy rate of 90%) (P<0.01). There were no complications such as infection, pulmonary embolism, spinal cord, nerve injury or lower extremity deep vein thrombosis in either group. The Cobb angle of the fractured vertebral body at day 7 after operation in Group A and Group B was (9.4±2.1)° and (10.4±2.5)° respectively, while the Cobb angle of the fractured vertebral body at the final follow-up in Group A and Group B was (9.7±2.3)° and (11.4±2.9)° respectively. The postoperative Cobb angle was significantly increased compared with the preoperative Cobb angle (P<0.05), but there was no significant difference between the two groups (P>0.05). The VAS at day 7 after operation was (2.3±1.1)points and (2.8±1.0)points in Group A and Group B, respectively, while the VAS at the final follow-up was (0.7±0.7)points and (0.8±0.7)points in Group A and Group B respectively. The postoperative VAS was significantly decreased compared with the preoperative VAS (P<0.05), but there was no significant difference between the two groups (P>0.05). The JOA at day 7 after operation was (21.1±2.2)points and (21.8±2.5)points in Group A and Group B respectively, while the JOA at the final follow-up was (24.9±2.2)points and (23.8±1.9)points in Group A and Group B respectively. The postoperative JOA was significantly increased compared with the preoperative JOA (P<0.05), but there was no significant difference between the two groups (P>0.05).@*Conclusion@#For thoracolumbar fractures without neurologic deficits, percutaneous fixation assisted by O-arm-based navigation can shorten the operation time and deliver a higher accuracy rate in the placement of pedicle screws, in addition to the similar effects with percutaneous fixation assisted by C-arm in pain relief, function improvement and correction of fracture vertebral kyphosis.
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Objective To investigate the clinical efficacy of percutaneous fixation assisted by O-arm-based navigation for thoracolumbar fractures without neurologic deficits.Methods A retrospective case control study was conducted analyze the clinical data of 35 thoracolumbar fracture patients without neurologic deficits admitted to Henan Provincial People's Hospital from January 2018 10 December 2018.There were 26 males and 9 females,aged 17-51 years,with an average age of 30.4 years.The injured segments were distributed at T11 in 10 patients,T12 in 15,L1 in 11,and L2 in 4 patients.A total of 19 patients(22 vertebrae,98 pedicle screws)were treated with O-arm guided navigation assisted percutaneous internal fixation(Group A),and 16 patients(18 vertebrae,82 pedicle screws)were treated with C-arm guided percutaneous internal fixation(Group B).The operation time,accuracy rate of nail placement,complications,Cobb angle of fracture vertebral body,visual analogue score(VAS)and Japanese Orthopaedic Association(JOA)score were recorded and compared before operation,7 days after operation and at the last follow-up.Results The patients were followed up for 2-12 months [(7.2 ±2.9)months] in Group A and 3-13 months [(7.1±3.3)months] in Group B.The operation time was(70.5±11.2)minutes in Group A and(81.3±10.9)minutes in Group B(P＜0.01).A total of 93 screws were completely placed in the pedicle in Group A(accuracy rate of 95％),and 74 screws in Group B(accuracy rate of 90％)(P＜0.01).There were no complications such as infection,pulmonary embolism,spinal cord,nerve injury or lower extremity deep vein thrombosis in either group.The Cobb angle of the fractured vertebral body at day 7 after operation in Group A and Group B was(9.4±2.1)° and(10.4±2.5)° respectively,while the Cobb angle of the fractured vertebral body at the final follow-up in Group A and Group B was(9.7±2.3)°and(11.4±2.9)° respectively.The postoperative Cobb angle was significantly increased compared with the preoperative Cobb angle(P＜0.05),but there was no significant difference between the two groups(P＞0.05).The V AS at day 7 after operation was(2.3±1.1)points and(2.8±1.0)points in Group A and Group B,respectively,while the VAS at the final follow-up was(0.7±0.7)points and(0.8±0.7)points in Group A and Group B respectively.The postoperative VAS was significantly decreased compared with the preoperative VAS(P＜0.05),but there was no significant difference between the two groups(P ＞0.05).The JOA at day 7 after operation was(21.1±2.2)points and(21.8±2.5)points in Group A and Group B respectively,while the JOA at the final follow-up was(24.9±2.2)points and(23.8±1.9)points in Group A and Group B respectively.The postoperative JOA was significantly increased compared with the preoperative JOA(P＜0.05),but there was no significant difference between the two groups(P＞0.05).Conclusion For thoracolumbar fractures without neurologic deficits,percutaneous fixation assisted by O-arm-based navigation can shorten the operation time and deliver a higher accuracy rate in the placement of pedicle screws,in addition to the similar effects with percutaneous fixation assisted by C-arm in pain relief,function improvement and correction of fracture vertebral kyphosis.
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Objective To investigate the clinical efficacy of percutaneous vertebroplasty (PVP) with bone filling container (BFC) and percutaneous kyphoplasty (PKP) by unilateral puncture approach in the treatment of osteoporotic vertebral compression fractures.Methods A retrospective case control study was conducted on 65 patients (65 vertebral bodies) with osteoporotic vertebral compression fractures (OVCF) who received PVP from March 2015 to March 2017 in Henan Provincial People's Hospital.There were 21 males and 44 females,aged 60-91 years,with an average of 76.2 years.The patients were divided into PVP with BFC group (BFC group) and PKP group treated by unilateral puncture approach.There were 10 males and 23 females in BFC group,with an average age of 75.8 years (range,60-91 years).The injured segments were distributed at T10 in seven patients,T11 in nine,T12 in eight,L1 in five,and L2 in four patients.There were 11 males and 21 females in PKP group,with an average age of 76.7 years (range,60-88 years).The injured segments were distributed at T10 in five patients,T11 in seven,T12 in ten,L1 in eight,and L2 in two patients.The operation time,cement leakage,as well as pain visual analogue score (VAS),modified Oswestry dysfunction index (ODI) and the Cobb angle of the fractured vertebral body at 3 days after operation and 12 months after operation were recorded and compared.Results All operations were completed successfully,without serious complications.The patients were followed up for 16-29 months [(21.2 ± 4.5) months] in BFC group and 15-32 months [(23.8 ± 6.2) months] in PKP group.The operation time was (27.8 ± 3.6) minutes in BFC group and (31.0 ± 5.2) minutes in PKP group (P ＜ 0.05).Postoperative X-ray and CT showed that bone cements leakage occurred in three patients of BFC group (9％) and in ten patients of PKP group (31％) (P ＜0.05).The VAS at 3 days after operation in BFC group and PKP group was (2.3 ± 1.0) points and (2.1 ±0.8)points respectively.The VAS at 12 months after operation in BFC group and PKP group was (0.7 ± 0.7) points and (O.8 ± 0.7) points respectively.The postoperative VAS was significantly decreased compared with the preoperative VAS (P ＜0.05),but there was no significant difference between the two groups (P ＞ 0.05).The modified ODI at 3 days after operation in BFC group and PKP group were (31.5 ± 4.7) ％ and (30.4 ± 5.7) ％,respectively.The modified ODI at 12 months after operation in BFC group and PKP group was (16.7 ±4.9)％ and (15.1 ±5.6)％,respectively.The postoperative ODI were significantly decreased compared with the preoperative ODI(P ＜0.05),but there was no significant difference between the two groups (P ＞ 0.05).The Cobb angle of the fractured vertebral body at 3 days after operation in BFC group and PKP group was (9.2 ± 3.0) ° and (10.0 ±2.9)°,respectively.The Cobb angle of the fractured vertebral body at 12 months after operation was (9.6 ± 2.8)° and (10.3 ± 3.0)°respectively.The postoperative Cobb angle was significantly decreased compared with the preoperative Cobb angle (P ＜ 0.05),but there was no significant difference between the two groups (P ＞ 0.05).Conclusions For OVCF,PVP with BFC by unilateral puncture approach can shorten the operation time and reduce the leakage rate of bone cement.It has similar effects with PKP in pain relief,function improvement of daily life and the correction of fracture vertebral kyphosis.
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Objective To investigate the effect of microRNA361-5p on radiosensitivity of osteosarcoma cells and its downstream regulatory mechanisms.Methods The radioresistant osteosarcoma cell line HOS-R was constructed and the expression of microRNA-361-Sp in HOS and HOS-R cells was detected by RT-qPCR.The survival rate and apoptosis rate were detected by clone formation assay and flow cytometry in HOS-R cells treated with up-regulated or down-regulated of miR-361-Sp,or FOXM1 depletion.Dual fluorescent luciferase reporter and western blot assays were used to measure the relationship between miR-361-5p and FOXM1.he effects of miR-361-5p on radiosensitivity of osteosarcoma cells were determined by cloning formation assay and flow cytometry.Results RT-qPCR results showed that miR-361-5p was low expressed in HOS-R cells.Colony formation and flow cytometry assays demonstrated that overexpression of miR-361-5p significantly decreased the survival rate and increased the apoptosis rate of HOS-R cells.In contrast,FOXM1 downregulation inhibited cell survival rate and induced apoptosis.Moreover,miR-361-5p negatively regulated FOXM1 expression.Besides,FOXM1 overexpression attenuated the miR-361-5p upregulation-mediated promotion of radiosensitivity in HOS-R cells.Conclusion miR-361-5p was involved in the radiosensitivity of osteosarcoma cells by inhibiting FOXM1.
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Objective To investigate the effect of pressure ulcer risk warning system in the pressure ulcer management in patients undergoing thoracolumbar fracture surgery.Methods A retrospective case control study was performed to analyze the clinical data of 120 patients with thoracolumbar fracture who underwent posterior thoracolumbar pedicle screw fixation and intervertebral bone graft fusion surgery at People's Hospital of Henan Province from October 2016 to September 2018.There were 76 males and 44 females,aged 45-80 years [(59.2 ± 7.2) years].A total of 60 patients received treatment and care under the pressure ulcer early warning system (early warning group),while 60 patients were given assessment form for pressure ulcer management (control group).The time of filling in the assessment form,the implementation score of pressure ulcer prevention measures,the incidence of pressure ulcer,visual analogue pain score (VAS) and patient satisfaction were compared between the two groups.Results In the control group and early warning group,the time of filling in the form was (121.5 ± 9.0) minutes and (11.3 ± 2.0) minutes (P ＜ 0.01),the implementation score of pressure ulcer prevention measures was (85.9 ± 3.8) points and (96.0 ± 2.2)points (P ＜ 0.01),and the pressure ulcer incidence was 25％ (15 patients) and 3％ (two patients),respectively (P ＜0.01).In the control group,the preoperative VAS was (7.3 ± 1.3) points,and the VAS at 6 hours,24 hours,48 hours,72 hours after operation were (3.7 ± 1.1) points,(3.2 ± 0.9) points,(2.4 ± 1.0) points,(2.3 ± 0.8) points,respectively.In the early warning group,the preoperative VAS was (7.4 ± 1.3) points,and the VAS at 6 hours,24 hours,48 hours,72 hours after operation were (2.9 ± 0.7) points,(2.4 ± 0.7) points,(1.8 ± 0.7) points,(1.6 ± 0.8) points,respectively.There was no significant difference in preoperative VAS between the two groups (P ＞ 0.05),while significant differences were found between the postoperative VAS (P ＜ 0.01).The satisfaction score in the control group was (94.6 ± 1.4) points,while that of the early warning group was (98.3 ± 1.1) points (P ＜ 0.01).Conclusion For patients undergoing posterior thoracolumbar pedicle screw fixation and intervertebral bone graft fusion surgery,the pressure ulcer risk warning system is convenient and reduces the incidence of pressure ulcer,thus alleviating patients'pain and improving patients' satisfaction.
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Objective To investigate the clinical efficacy of posterior screw-rod single vertebra internal fixation for anterior atlas arch displaced fracture.Methods A retrospective case series study was conducted to analyze the clinical data of 13 patients with anterior atlas arch displaced fracture admitted to Henan Provincial People's Hospital from January 2010 to March 2016.There were eight males and five females,aged 28-62 years[(40,0±9.2)years].According to Frankel grading,there was one patient with grade C and 12 patients with grade D.All patients were treated with posterior cohesive reduction with screw-rod system.Operation time,blood loss,intraoperative and postoperative complications were recorded.The operation time,intraoperative blood loss,internal fixation position,fracture healing and bone graft fusion were recorded.The Japanese orthopedic- association(JOA)score,visual analogue scale(VAS),Frankel grade,and cervical motion range were compared before and at the last follow-up.The intraoperative and postoperative complications were recorded.Results All patients were followed up for 29～68 months[(48.2±14.5)months].The operation time was 50-75 minutes[(59.5±6.5)minutes],and blood loss was 55-80 ml[(62.5±8.3)ml].After operation,fracture lines were well reset,nerve compression was relieved,pillow neck pain was alleviated,and limb function was significantly improved.CT scans confirmed bony union in al 1 patients 6 months after operation.The JOA score at the last follow-up[(15.4±0.7)points]was significantly higher than that before operation[(7.9±1.3)points](P＜ 0.05).The preoperative VAS was significantly decreased from(6.2±0.9)points to(1.9±1.0)points at the last follow-up(P＜ 0.05).The range of motion of cervical spine was close to the normal level with 70°-91°[(80.7±7.0)°]of anteflexion and extension,131°-157°[(142.9±9.1)°]of horizontal rotation,and 78°-89°[(83.8±3.2)°]of lateral flexion.One patient with incision infection and five neck stiffness as well as limited neck movement were reported,but all were cured or improved significantly after symptomatic treatment.No internal fixation lossening or breakage was found.Conclusions Posterior screw-rod single vertebra internal fixation for anterior atlas arch displaced fracture has the advantages of shortened operation time,less bleeding,less complication,good reduction as well as restored motor function of atlantoaxial joint.
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Objective To investigate the different operation methods for kyphosis deformity of ankylosing spondylitis(AS)complicated with cervical vertebral fracture and their effects.Methods A retrospective case series study was conducted to analyze the clinical data of 19 patients with AS kyphosis complicated with cervical vertebral fracture admitted to Henan People's Hospital from April 2007 lo October 2017.There were 18 males and one female,aged 28-73 years,with an average age of 38.6 years.Among the patients,17 were complicated with spinal cord dysfunction.According to the American spinal injury association(ASIA)classification,there were four patients with grade A,five with grade B,five with grade C and three with grade D.According to the degree of nerve injury and the displacement of fracture,reduction and fixation or orthopedic fixation were selected;14 patients with severe nerve injury(ASIA grades A-C)were treated with reduction and fixation,of which six were treated by simple anterior approach,two by simple posterior approach,five by combined anterior-posterior approach,and one by combined anterior-posterior approach 2 months after Halo fixation.Five patients with ASIA grade D or E were treated with orthopedic fixation.Firstly,kyphosis was corrected with manual technique and the Halo external fixator was installed,and then surgical fixation fusion was performed via simple posterior approach(one patient)or combined anterior-posterior approach(four patients).Visual analogue scale(VAS)was used to evaluate the relief of neck pain.The improvement of nerve function,the effect of orthopedic fixation,the fracture healing time and the postoperative complications were recorded.Results One patient died 11 days after operation due to pulmonary infection and respiratory failure.The remaining patients were followed up for 1-10 years,with an average of 27.3 months.The neck pain in all patients was relieved significantly,and the VAS score[(2.9±0.9)points]decreased significantly 3 days after operation compared with that before operation[(8.2±1.0)points](P＜ 0.05).The nerve function of 12 patients improved significantly(P＜ 0.05).The chin-brow vertical angle of the patients after orthopedic fixation was 60-180(mean,11.8°),suggesting that the level vision function was restored.Fracture healing time ranged from 3 to 8 months,with an average of 3.9 months.There were 4 patients with cerebrospinal fluid leakage and three patients with pulmonary infection.No complications such as wound infection and aggravation of nerve injury occurred.Conclusions For AS kyphosis combined with cervical spine fracture,if without severe nerve injury,manual correction of kyphosis and installation of Halo frame followed by fixation and fusion can effectively correct spinal deformity and improve the quality of life.Patients with severe spinal cord injury should avoid stage I correction and receive reduction of fracture and long segment fusion fixation as far as possible to facilitate the recovery of nerve function.
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Objective:To discuss the clinical characteristics of the Pneumocystis jirovecii pneumonia (PCP) in the non-HIV-infected blood disease patients, and to analyze its risk factors, treatment methods, prognosis and prevention measures.Methods:A female patient aged 18years old was confirmed as acute myeloid leukemia (AML) , and experienced dyspnea, chest congestion and hypoxaemia during the recovery period of hemogram after chemotherapy.The chest CT showed the bilateral lung diffuse ground glass density images.The patient had a dry cough and the oxygen saturation was gradually decreased to 75％5dafter antibacteriological treatment.A repeat chest CT showed enlarged diffuse ground glass density images on both lungs.Considering about the possibility of PCP, the patient received oral trimethoprim/sulfamethoxazole (TMP/SMX) 1g, once every 6h, in combination with caspofungin.Results:Two days later, the symptoms of the patients were not improved.The patient was transferred to ICU and was diagnosed PCP by bronchoalveolar lavage.The patient was switched to oral TMP/SMX2g, once every 8h, in combination with caspofungin.Meanwhile, the patient received bi-level positive airway pressure ventilation (Bipap) for the increased work of breathing.Five days later, the symptoms of the patients were improved and the Bipap was stopped.The patient got better and discharged 5dlater.The patient continuely received oral TMP/SMX 2g, once every 8hfor 36d.Conclusion:Prevention of PCP should be focused, in the non-HIV-infected blood disease patients receiving chemotherapy.Diagnosis of PCP should be considered in these patients without prevention who once have suspected clinical manifestation of PCP in non-granulocytic phase.Early empirical treatment of PCP and ICU management in the non-HIV-infected blood disease patients with acute respiratory failure are the keys to reduce death and improve the prognosis of PCP.
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To summarize the technical points and clinical efficacy of pedicle subtraction osteotomy (PSO) in tunneling and to explore the related complications of this technique. Methods A total of 67 cases of old vertebral fractures of the thoracolumbar region from June 2012 to June 2017 were collected. According to the inclusion and exclusion criteria, a total of 41 cases were included in the study. There were 19 males and 22 females; aged 37-67 years, mean 60.1±12.7 years; 15 cases of non-surgical treatment after trauma, 13 cases of failure after surgery and 13 cases of osteoporosis. Injury segment: 9 cases of T11, 22 cases of T12, 8 cases of L1, 2 cases of LS. Preoperative patients were diagnosed by X?ray, CT plain and 3D reconstruction com?bined with MRI. There were 23 cases of intractable back pain, 16 cases of lower extremity root pain, and 2 cases of intermittent claudication. Patients were divided into the traditional PSO treatment group (21 cases) and modified PSO treatment group (20 per?sons) according to the random number method. The traditional group were treated with the"egg shell"technique, and the im? proved group were treated with tunnel forming technology. The procedure was divided into four steps: exposure (step 1), nail place?ment and resection of the posterior column complex (step 2), vertebral osteotomy (step 3), orthopedics and bone grafting (step 4). The operation time, bleeding volume and complications of each step were compared between the two groups. The clinical efficacy was evaluated using the visual analogue scale (VAS) score and the Oswestry disability index (ODI). The X?ray spine Cobb angle was measured to evaluate the Keloid deformity correction, and the bone graft fusion was observed by CT examination. Results All patients were followed up for 12 to 24 months. The total operation time of the traditional group was 273.3±21.1 min, and the to?tal operation time of the modified group was 178.1±12.5 min, the difference between the two groups was statistically significant (t=8.981, P=0.0019). The differences between the two groups in steps 2 and 3 were statistically significant (t2=4.614, P2=0.036; t3=9.089, P3=0.020). The difference in the total bleeding volume was statistically significant (t=8.529, P=0.011). The differences in the bleeding volume between the two groups in step 2 and step 3 were statistically significant (t2=11.933, P2=0.016; t3=6.972, P3=0.013). The Cobb angles of the traditional group before surgery, 1 week after surgery and half year after surgery were 40.2°±8.9°, 12.5°±6.8°, 10.4°±2.5°, respectively. The Cobb angles of the modified group before surgery, 1 week after operation and half year after surgery were 39.5°±6.3°, 10.4°±3.5°, 9.5°±1.9°, respectively. The differences in the Cobb angle between the preoperative, postoperative 1 week and postoperative half year were statistically significant (Fmodified group=189.573, Pmodified group=0.021; Ftraditional group=194.699, Ptraditional group=0.029). The bone fusion time in the osteotomy area was 3-6 months, with an average of 4.8 months. The VAC and ODI scores of half?year post operation of the traditional group were 2.1±0.3 and 34.1±4.3, and the improved group were 2.2± 1.1 and 28.3±6.8, respectively, and the difference was not statistically significant. In the improved group, there were 1 case of over?excavation and 1 case of over?underexcavation (2/20), which were corrected in time during operation. In the traditional group, 4 cases (4/21) of dural tear occurred during the operation, and were repaired in time. Bone fusion was obtained half a year later. No clinical deaths, and no cases of surgical infection occured. Conclusion Tunnel forming technology is an alternative surgical pro?cedure for treating old fractures of the thoracolumbar region with PSO, which can shorten the operation time, reducd intraoperative bleeding and reduce surgical complications.
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Objective To investigate the effect of LncRNA HULC on radiosensitivity of osteosarcoma cells. Methods Osteosarcoma cells OS732 was infected by shRNA HULC lentivirus, and the interference effect was determined by qRT-PCR. Osteosarcoma cells infected with shRNA HULC lentivirus were irradiated with 8 Gy X-rays. MTT, PI monochrome staining and Annexin V-FITC/PI double staining were used to detect cell proliferation, cell cycle and apoptosis, respectively. Western blot was used to detect the protein levels of p21, Cyclin D1, C-Caspase-3 and Cyt-C in cytoplasm and mitochondria. Plate cloning assay was used to evaluate cell radiosensitivity. Results The expression of HULC in osteosarcoma cells was significantly down-regulated by shRNA HULC lentivirus infection. Down-regulation of HULC or irradiation inhibited osteosarcoma cell proliferation [(100. 00±9. 65)％ vs. (71. 36±5. 27)％, (63. 48± 5. 93)％, t=4. 512, 5. 585, P<0. 05 ] , blocked cell cycle [ ( 50. 15 ± 5. 14 )％ vs. ( 62. 35 ± 4. 22 )％, (66. 05±5. 23)％,t=3. 177,3. 756,P<0. 05], induced cell apoptosis [(2. 98±0. 23)％ vs. (22. 61± 3. 26)％, (26. 14±2. 81)％,t=8. 898,10. 498,P<0. 05], promoted the expressions of p21 and Cyclin D1 in cells, down-regulated the level of C-Caspase-3 protein, increased the level of Cyt-C protein in cytoplasm, and down-regulated the level of Cyt-C protein in mitochondria. Downregulation of HULC combined with irradiation yield much more effects on cell proliferation inhibition [ ( 71. 36 ± 5. 27 )％, (63.48±5.93)％ vs. (49.32±5.76)％, t=4.890, 2.967, P<0.05], cell cycle arrest [(62.35± 4. 22)％, (66. 05±5. 23)％ vs. (77. 17±7. 54)％, t=2. 983, 2. 106, P<0. 05], apoptosis induction [(22. 61±3. 26)％, (26. 14±2. 81)％ vs. (36. 21±3. 26) ％,t=6. 164, 4. 564, P<0. 05] and the expressions of p21, Cyclin D1, C-Caspase-3 and Cyt-C in osteosarcoma cells. The radiosensitization ratio of down-regulation of HULC was 1. 432. Conclusions Down-regulation of HULC enhances radiosensitivity of osteosarcoma cells, which may be related to cell cycle arrest and apoptosis induction.
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Objective To evaluate the efficacy of modified posterior unilateral subtotal corpectomy osteotomy correction for old thoracolumbar vertebral fractures combined with kyphosis. Methods A retrospective case series study was conducted to analyze 18 patients with old thoracolumbar vertebral fractures combined with kyphosis admitted to the Henan Provincial People's Hospital from January 2012 to October 2016. There were 10 males and eight females, aged 25-70 years, with an average age of 38. 2 years. The injured segments and osteotomy segments included T11 in one patient, T12 in four, L1 in six, and L2 in seven. Five patients had neurological impairment symptoms classified as grade D according to Frankel's classification. All patients underwent the modified posterior unilateral subtotal corpectomy osteotomy correction. The operation time and intraoperative blood loss were recorded. The visual analogue score (VAS), Oswestry dysfunction index (ODI) and kyphosis Cobb angle were compared before operation, half a year after operation and at the last follow-up. The osteotomy fusion was evaluated by Suk criterion and Frankel grading was used to evaluate the recovery of nerve function. The complications were also recorded. Results All patients were followed up for 12-24 months, with an average of 17. 6 months. The operation time was 160-285 minutes [(190. 0 ± 42. 6) minutes, and the intraoperative blood loss was 500-800 ml [(610. 0 ± 134. 3) ml]. The difference of kyphosis Cobb angle between preoperative [(40.5±9.8)°] and [(5.5 ±1.6)°] at 6 months postoperatively had statistical significance (P <0. 05). Compared with the kyphosis Cobb angle of 6 months postoperatively [(5. 5 ± 1. 6)°], the Cobb angle at the final follow-up [(6. 2 ± 1. 5)°] did not change significantly (P>0. 05). The VAS score and ODI at 6 months after operation and at the final follow-up [(3. 1 ± 1. 3)points,(2. 7 ± 0. 7)points and 7. 5 ± 5. 1, 6. 4 ± 2. 5] were significantly different compared with those before operation [(7. 6 ± 2. 4)points, 68. 7 ± 10. 4] (P<0. 05). Bone cutting surface was healed osseously in all patients. The five patients with preoperative neurological impairment of grade D were assigned with grade E at the last follow up. There were two patients with dural rupture and one with pleural effusion during the operation. No complications such as nerve damage, infection or thrombosis occurred. No loosening, fracture or heterotopic ossification occurred during follow-up. Conclusion For old thoracolumbar vertebral fracture combined with kyphosis, the modified posterior unilateral vertebral column resection through unilateral approach can not only achieve the bone fusion between the injured vertebra and the adjacent vertebral body, but also avoid the shortening of the spine, correcting kyphosis and relieving pain, with low incidence of complications.
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Objective To investigate the clinical efficacy of unilateral approach painless vertebral augmentation in the treatment of severe osteoporotic vertebral compression fractures ( OVCFs) in the critically ill patients under lateral decubitus postition. Methods A retrospective case series study was conducted to analyze 97 patients with severe vertebral fractures admitted to the Henan Provincial People's Hospital from April 2004 to January 2017. There were 27 males and 70 females, aged 59-99 years [(78. 5 ± 13. 2) years]. There were 11 patients with three-segment fracture, nine patients with two-segment fracture and 77 patients with single fracture. All patients were treated with lateral decubitus unilateral approach for painless vertebral augmentation and received postoperative rehabilitation training guided by physicians. Preoperative and intraoperative blood loss were recorded. Preoperative and postoperative respiratory rate, heart rate, systolic pressure, oxygen saturation and acute physiology and chronic health evaluation score II ( APACHE II ) , height of vertebral compression site, and injured vertebrae Cobb angle were evaluated. The visual analogue scale ( VAS) and Oswestry dysfunction index ( ODI) were assessed to define function improvement. Meanwhile, the occurrence of re-fracture and complications were recorded. Results All patients were followed up for 3-8 months [(6.3 ±2.9)months]. The operation time was (69. 2 ± 25. 9) minutes, and the amount of intraoperative bleeding was (7. 5 ± 2. 6)ml. There were no significant differences in respiratory rate, heart rate, systolic blood pressure or oxygen saturation before operation and after operation ( P > 0. 05 ) . No surgical discontinuation or deterioration occurred. The APACHE II score was (15. 2 ± 3. 7) points before operation and (8. 4 ± 0.7)points at 24 hours after operation (P <0.05). The compression height parameter of the injured vertebraewas(17.2±3.6)mmbeforesurgery,(20.4±41.3)mmatoneweekaftersurgery,and(18.8± 1.3)mm at the last follow-up (P >0. 05). The Cobb angle was (25. 6 ± 9. 3)° before operation, (20.7±2.5)° at one week after operation and (18.5±3.1)° at the last follow-up (P>0.05). The VAS score was (8. 5 ± 1. 2)points before operation, (2. 1 ± 0. 3)points at one week after operation, and (3. 2 ± 1. 1)points at the last follow-up, respectively. The VAS scores at 1 week and the last follow-up were significantly improved compared with preoperative VAS ( P<0. 05 ) , but there was no significant difference between the former two (P>0. 05). The ODI value was 39. 9 ± 3. 4 before operation, 20. 2 ± 5. 2 at one week after operation, and 17. 2 ± 2. 0 at the last follow-up . The ODI values 1 week after operation and at the last follow-up were significantly improved compared with preoperative ODI ( P <0. 05),showing improvement trend during the follow-up (P<0. 05). No re-fracture occurred during the follow-up. No serious complications such as nerve injury, pulmonary embolism or death occurred during the operation and postoperative follow-up. Conclusions The unilateral approach painless vertebral augmentation for the treatment of severe OVCFs in critically ill patients under lateral decubitus position can improve the patient's operative tolerance and satisfaction, shorten the operation time, relieve postoperative pain and promote functional recovery. It is an alternative surgical procedure for the treatment of severe OVCFs in internal medicine.
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Objective@#To investigate the effects of donor-specific HLA antibodies(DSA) for graft failure in un-manipulated haploidentical hematopoietic stem cell transplantation(haplo-HSCT) and the feasible treatment for DSA.@*Methods@#HLA antibodies were examined using the Luminex-based single Ag assay for 92 patients who were going on haplo-SCT and the correlations of graft failure and DSA among the patients who had finished SCT were analyzed.@*Results@#Of the total 92 patients who were going on haplo-HSCT, sixteen (17.4%) patients were HLA Ab-positive, including six (6.5%) patients with antibodies corresponding to donor HLA Ags (DSA-positive). Among the patients who had finished the haplo-HSCT with conventional myeloablative conditioning regimen, the engraftment rate was significantly higher in DSA (-) patients than that in DSA (+) patients [92.3% (24/26) vs 25.0%(1/4), χ2=8.433, P=0.004] and DSA was the only factor relevant with graft failure in multiple-factor analysis [OR=12.0(95% CI 1.39-103.5), P=0.024]. Strategies to decrease antibody levels were taken for 4 patients, two were their first transplantations, and the other two patients were their second haplo-HSCT. Three of the four patients were HLA-I-DSA positive and had gained donor engraftment by means of donor platelet transfusions to decreased the level of DSA, the fourth patient with both HLA-I and HLA-II DSA also gained engraftment with the treatments of TBI, rituximab and donor platelet transfusion.@*Conclusion@#DSA is one of the key factors of graft failure in haplo-HSCT. Donors should be selected on the basis of an evaluation of HLA antibodies before transplantation. If haplo-HSCT from donors with DSA must be performed, then recipients should be treated for DSA to improve the chances of successful engraftment.
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Objective To investigate the clinical effect of 3D printing assisted percutaneous vertebroplasty (PVP) in treating severe osteoporotic vertebral compression fracture (OVCF) in elder patients.Methods A retrospective case series study was conducted on the clinical data of 58 elderly patients (58 vertebrae) with severe OVCF who underwent PVP treatment in spinal surgery department of Henan Provincial People's Hospital from June 2014 to June 2016.According to the treatment method,the patients were divided into Group A which adopted 3D printing of injured vertebrae before PVP and Group B which adopted routine PVP operation.Group A consisted of 28 cases (28 vertebrae),including eight males and 20 females,aged 64-91 years [(78.1 ±8.5) years].In terms of the distribution of injured vertebrae,there were four cases of T10,six cases of Tu,eight cases of T12,four cases of L1,and six cases of L2 in Group A.Group B consisted of 30 cases (30 vertebrae),including 10 males and 20 females,aged 65-90 years [(77.8 ± 8.2) years].In terms of the distribution of injured vertebrae,there were three cases of T10,seven T11,nine T12,six L1,and five L2.The operation time,visual analogue scale (VAS) before operation,1 day after operation and at the last follow up,Japanese Orthopedic Association (JOA) score,anterior compression ratio of injured vertebrae,and cement leakage rate were compared between the two groups.Results All the operations were completed successfully.The patients were followed up for 14-26 months [(18.7 ± 3.4)months] in Group A and for 12-28 months [(20.0 ± 5.4) months] in Group B.The operation time was (28.0 ± 3.4) min in Group A and (30.9 ±5.3) min in Group B (P ＜ 0.05).Both the VAS 1 d after operation of Group A [(2.3 ± 1.0) points] and Group B [(2.0 ± 0.8) points] and the VAS at the last follow up of Group A [(0.7 ± 0.7) points] and Group B [(0.8 ± 0.7) points] were significantly lower than those before operation (P ＜ 0.05),but there was no significant difference between thetwo groups (P ＞ 0.05).Both the JOA at day 1 after operation of Group A [(21.3 ± 2.2) points] and Group B [(20.7 ± 2.1) points] and the JOA at the last follow up of Group A [(24.7 ± 2.3) points] and Group B [(24.1 ± 2.0) points] were significantly higher than those before operation (P ＜ 0.05),but there was no significant difference between the two groups (P ＞ 0.05).The anterior compression ratio of injured vertebrae 1 d after operation of Group A (59.4 ± 7.9) ％ and Group B (59.1 ± 6.8) ％ and that at the last follow up of Group A (59.1 ± 7.8) ％ and Group B (58.7 ± 5.4) ％ were significantly improved than those before operation (P ＜ 0.05),but there was no significant difference between the two groups (P ＞ 0.05).There were three cases of bone cement leakage in Group A (11％) and 11 cases of bone cement leakage in Group B (37％) after PVP,and the difference was statistically significant (P ＜ 0.05).Conclusion Compared with conventional PVP,3D printingassisted PVP has lower leakage rate,shorter operation time,and better clinical effect in treating severe OVCF in the elderly.
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Objective To improve the recognition of therapy-related acute myeloid leukemia (t-AML). Methods One patient who was diagnosed as AML with inv (16) following treatment of Hodgkin lymphoma (HL) was reported. The pathomechanism, diagnosis, treatments and prognosis of t-AML were systematically studied by reviewing a series of literature. Results A 36-year-old female with a history of HL 2 years ago was diagnosed t-AML. Karyotype analysis demonstrated inv (16) and the fusion gene of CBFβ/MYH11 was positive by polymerase chain reaction (PCR). The fusion gene of CBFβ/MYH11 was still positive after receiving 3 courses of chemotherapy. The leukemia reached completely molecular biological remission after receiving haploidentical peripheral blood stem cell transplantation. The patient has now survived 1.5 years with leukemia free and in a good performance. Conclusions The t-AML is difficult to treat, but it is heterogeneous. Cytogenetics and molecular biology have important implications for the prognosis of t-AML. Currently, allogeneic hematopoietic stem cell transplantation is the only effective way to cure t-AML.