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OBJECTIVE@#To investigate the accuracy and safety of pedicle screw placement assisted by orthopedic robot and C-arm fluoroscopy.@*METHODS@#The clinical data of 36 patients with spinal diseases underwent surgical treatment from January 2019 to August 2020 was retrospectively analyzed. Among them, 18 cases were implanted pedicle screws assisted by orthopaedic robot(observation group), including 12 males and 6 females, aged from 16 to 61 years with an average of (38.44±3.60) years;there were 1 case of adolescent scoliosis, 1 case of spinal tuberculosis, 7 cases of lumbar spondylolisthesis, 4 cases of thoracic fracture and 5 cases of lumbar fracture. Another 18 cases were implanted pedicle screws assisted by C-arm fluoroscopy(control group), including 10 males and 8 females, aged from 18 to 58 years with an average of (43.22±2.53) years;there were 1 case of adolescent scoliosis, 6 cases of lumbar spondylolisthesis, 6 cases of thoracic fracture and 5 cases of lumbar fracture. The intraoperative fluoroscopy times, nail placement time and postoperative complications were recorded in two groups. CT scan was performed after operation. The Gertzbein-Robbins standard was used to evaluate the accuracy of pedicle screw placement which was calculated.@*RESULTS@#The number of intraoperative fluoroscopy in observation group was(6.89±0.20) times, which was significantly higher than that in control group(14.00±0.18)times(P<0.05). The placement time of each screw in observation group was(2.56±0.12) min, which was significantly different from that in control group(4.22±0.17) min (P<0.05). One case of incision infection occurred in control group after operation, and recovered after active dressing change. During the follow-up period, no serious complications such as screw loosening and fracture occurred in two groups, and there was no significant difference in complications between two groups(P>0.05). A total of 107 screws were placed in observation group, including 101 screws in class A, 4 in class B, 2 in class C, 0 in class D and 0 in class E, the accuracy rate of pedicle screw placement=[(number of screws in class A+B) / the number of all screws placed in the group] ×100%=98.1%(105/107); and a total of 104 screws were placed in control group, including 90 screws in class A, 4 in class B, 5 in class C, 5 in class D and 0 in class E, the accuracy rate of pedicle screw implantation=[(number of screws in class A+B/the number of all screws placed in the group]×100%=90.3% (94/104); there was significant difference between two groups (P<0.05).@*CONCLUSION@#Orthopaedic robot assisted pedicle screw placement has the advantages of less fluoroscopy times, shorter screw placement time and higher accuracy, which can further improve the surgical safety and has a broad application prospect in the orthopaedic.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Fluoroscopy/methods , Lumbar Vertebrae/surgery , Pedicle Screws , Retrospective Studies , Robotic Surgical Procedures/methods , Robotics , Scoliosis , Spinal Fusion/methods , Surgery, Computer-AssistedABSTRACT
BACKGROUND: The anatomical structure of cervical spine is complex, and the important structures of blood vessels, nerves, esophagus and trachea are adjacent to the tumor. The operation is difficult. OBJECTIVE: To explore the application of three-dimensional (3D) printing model in surgical resection and reconstruction of cervical tumor. METHODS: Eleven patients with cervical tumors, who were treated in the Gansu Provincial Hospital from September 2016 to December 2018, were selected, including 7 males and 4 females, at the age of 35-68 years. Eleven patients were scanned by cervical CT before operation. The image information obtained by CT was saved in DICOM format, and then the data were imported into Mimics 3D modeling software to reconstruct the 3D model. Finally, the reconstruction results were imported into the 3D printer in STL format, and the 1 ∶ 1 anatomical model was printed layer by layer according to the 3D model. According to the 3D printed model, the surgical resection and reconstruction plan of cervical tumor was made. After 6-12 months of follow-up, the visual analogue scale score and Oswestry dysfunction index were compared before and after surgery. This study was approved by the Ethics Committee of Gansu Provincial Hospital. RESULTS AND CONCLUSION: (1) Eleven cases were operated successfully, and no serious complications such as spinal cord, nerve root and vertebral artery injury occurred; postoperative X-ray reexamination showed that the lesion site was completely removed, and the implant was in a good position without loosening. (2) The visual analogue scale score and Oswestry dysfunction index of eleven patients were significantly improved in 1 week, 1 and 3 months after operation (P < 0.05). (3) The results showed that 3D printing model could make a complete resection and reconstruction plan before operation, including the specific resection scope, fixed segment, screw and steel plate size, familiar with the anatomical relationship between the focus and the surrounding tissue, avoid the injury of important nerves and blood vessels during operation, reduce the risk of operation and improve the clinical effect.
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Melatonin (MLT) is an endogenous chemical that has antitumor effects at high doses. However, it shows low oral bioavailability and short in vivo half-life, leading to drug resistance. Here, liposomal melatonin dry powder inhalers (LMD) were prepared, and were used for treatment of primary rat lung cancer by pulmonary delivery. Liposomal melatonin (LM) was prepared by the ethanol injection method to achieve an entrapment efficiency of 98.89%. LMD was obtained by freeze-drying after LM was mixed with mannitol. LMD appeared as spherical particles under a scanning electron microscope. The rehydrated liposomes had a small size of 65.15 nm and the zeta potential of -14.2 mV without change inentrapment efficiency. LMD had an aerodynamic particle size of 6.73 ± 0.012 μm and a fine particle fraction (FPF<8.06 μm) of 22.2%, suitable for pulmonary delivery. When administered with the same dose, LMD showed much higher inhibition on A549 lung cancer cells than MLT and gemcitabine. LMD of a large dose had no effect on the growth of normal lung epithelial cells (BEAS-2B). Rat lung cancer models were established after 45 days by instilling 3-methylcholanthrene (MCA) and N,N-dimethylnitrosamine (DEN) into the rat lungs once (the experiments had been approved by the ethics committee and carried out in accordance with relevant guidelines and regulations). Decreases of tumor nodules and inflammatory cells in the tumor-bearing rat lungs were observed after treatment of MLT, gemcitabine and LMD by pulmonary delivery compared with the models, wherein LMD was most effective. The efficiencies of inhibition of NF-κB p65, increase of Tunel detection (indicating enhancement of apoptosis), and decrease of malondialdehyde corresponded to LMD being most effective. Therefore, given the fact that LMD can deliver the drug into the tumor tissues of lungs, and it presents as a promising pulmonary inhalable regiment for treatment of lung cancer.
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Objective·To investigate the effects of ribosomal protein 16 (RPS16) on tumorigenesis and development of prostate cancer.Methods·Westem blotting (WB) was used to detect the differences of RPS16 levels in 25 cases of prostate cancer tissues and 33 prostate hyperplasia,and immunohistochemistry (IHC) was performed to detect RPS16 levels in 48 prostate cancer tissues and 42 benign tissues.The relationship between RPS16 level and clinical pathological parameters of the patients was analyzed.The RPS16 small interfering RNA (siRNA) was transiently transfected into DU145 and LNCaP cells by liposome method,including RPS16-siRNA1,RPS16-siRNA2 and RPS16-siRNA3.Random disturbance RPS16-siRNANC was used as negative control,cells without transfection were blank control.The efficiency of RNA interference was detected by WB 48-72 h after transfection.RPS16-siRNA with highest efficiency was chosen for subsequent cell proliferation assay,flow cytometry (FCM) and transwell assay in order to detect the effects of RPS 16 on cell proliferation,cell cycle and invasion ability of DU 145 and LNCaP cells.Results·WB results showed that the level of RPS 16 protein in the tissues of prostate cancer was higher than that of the benign group (P=0.008).IHC results showed RPS 16 protein level was significantly higher in tumor tissues than benign tissues (P=0.009).RPS16 expression was not correlated with age and metastasis,but significantly correlated with clinical stage (P=0.044) and pathological grade of the tumor (P=0.004).RPS 16 siRNA can not only significantly reduce the expression of RPS16 protein in DU145 and LNCaP cells,but also inhibit the proliferation and invasion of the cancer cells,so that the cell cycle arrested in G2/M phase.Conclusion·The high expression of RPS 16 protein could enhance the proliferation and invasive ability of prostate cancer cells.
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Objective To explore the protective effect and possible mechanism of Astragalus immortal prescription (AIP) from hepatic oxidative stress in mice irradiated by X ray.Methods Six to eight weeks old Kunming mice were randomly divided into normal control group,irradiation alone group,positive control group,and low,medium and high dose groups of AIP (10 rats in each group),physiological saline,thymus peptide and different concentration decocta of AIP were given respectively.After continuous gavage for 10 days,the whole body was irradiated with X ray at the dose of 8 Gy at a time,and then continued lavaging for 3 days,with weighing the mice and observing the diet,water intake and general condition.After killing the mice,the liver was take and the liver index was calculated;the morphological changes of the liver tissues were observed and the expressions of superoxide dismutase (SOD),malondiadehyde (MDA),glutathione peroxidase (GSH-Px) and nuclear factor erythroid 2-related factor 2 (Nrf2) in the liver tissues were detected.Results Compared with the normal control group,the weight of mice in model group decreased obviously (P＜0.01);pathological section showed that the liver cells were disordered,the central vein was congested and blocked seriously,the surrounding liver cells were denatured and necrotic;the activity of SOD and GSH-Px in liver tissues decreased,and the content of MDA increased (P＜0.05),the expression of Nrf2 protein increased significantly (P＜0.01).Compared with the radiation alone group,the weight of mice in positive control group and high dose AIP group increased significantly (P＜0.01);pathological section showed that the liver tissue structure was basically normal,the liver cells were radially arranged with the central vein as the center;the activity of SOD and GSH-Px in liver tissues increased,and the content of MDA decreased (P＜0.05),the expression of Nrf2 protein decreased significantly (P＜0.01).Conclusion AIP has protective effect from hepatic oxidative stress in mice irradiated by X ray,and the mechanism may be related to its antioxidant effects.
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Artesunate is one of artemisinin derivatives with anti-malarial and anti-inflammatory activities though its water solubility and bioavailability are low. Acute lung injury (ALI) is a seriously dispersive lung disease with a high mortality. In this study, artesunate liposomes were prepared with the film dispersion method, and then lyophilized to obtain the liposomal artesunate dry powder inhalers (LADPIs). The LADPIs were pulmonary-delivered into the lung to treat ALI in rats. The artesunate liposomes had the capsulation efficiency of 71.4%, the particle size of 47.3 nm, and the zeta potential of -13.7 mV. The LADPIs had the aerodynamic particle size of 4.2 μm and the fine particle fraction (FPF) of 34.5%. ALI was established in rats by instilling lipopolysaccharide (LPS) into the lungs. The rats quickly showed a reduction in movement and acceleration in breath followed by diarrhea and so on. The LADPIs were directly administrated into the lungs of ALI rats through airways after 1 h of LPS challenge. The treatment induced a reduction in ALI syndromes. Two inflammatory factors, including TNF-α and IL-6, were significantly reduced by the artesunate powder in the LADPI group similarly to the reduction in the positive drug dexamethasone group (P<0.05). Therefore, the anti-inflammatory effect of LADPIs contributed to the anti-ALI activity. Furthermore, the liposomal formulation improved drug bioavailability in the lung and increased therapeutic efficiency. The LADPIs are promising medicines for therapy of ALI through local drug administration.
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<p><b>OBJECTIVE</b>To study the imaging findings outcome of the percutaneous laser disc decompression (PLDD) and evaluate the middle-term safety and efficacy of PLDD.</p><p><b>METHODS</b>The imaging data of 22 cases suffered cervical spondylosis or lumbar spondylosis and treated by PLDD more than 3 years were retrospectively reviewed. To observe the intervertebral space of the invasive disc and the intervertebral disc hernia before and after the operation on the lateral projection of X-ray and the axial view of the MRI. To make a statistical analysis of the data.</p><p><b>RESULTS</b>There was no obvious change of disc height involving the anterior disc height, the intermediate disc height and the posterior disc height after the PLDD at the final follow-up (P > 0.05). At last time follow-up, the Sagittal Index (SI) are 0.10 - 0.54 and 0.06 - 0.39 before and after the PLDD in the treatment of cervical vertebra. The statistical difference were significant (P < 0.05). In lumbar vertebra, the SI is 0 - 0.71 and 0 - 0.48 disc before and after the PLDD. The statistical difference were very significant (P < 0.01).</p><p><b>CONCLUSIONS</b>The PLDD will not destroy the intervertebral space of the cervical and lumbar vertebra obviously; moreover, it can effectively reduce the disk hernia. The PLDD is a safe and effective Mini-invasive surgery for cervical vertebra and lumbar vertebra diseases.</p>