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AIM: To establish an intelligent diagnostic model of keratoconus for small-diameter corneas by data mining and analysis of patients' clinical data.METHODS: Diagnostic study. A total of 830 patients(830 eyes)were collected, including 338 male(338 eyes)and 492 female(492 eyes), with an average age of 14-36(23.19±5.71)years. Among them, 731 patients(731 eyes)had undergone corneal refractive surgery at Chongqing Nanping Aier Eye Hospital from January 2020 to March 2022, and 99 patients had a diagnosed keratoconus from January 2015 to March 2022. Corneal diameter ≤11.1 mm was measured by Pentacam in all patients. Two cornea specialists classified patients' data into normal corneas, suspect keratoconus, and keratoconus groups based on the Belin/Ambrósio enhanced ectasia display(BAD)system in Pentacam. The data of 665 patients were randomly selected as the training set and the other 165 patients as the validation set by computer random sampling method. Seven parametric corneal features were extracted by convolutional neural networks(CNN), and the models were built by Residual Network(ResNet), Vision Transformer(ViT), and CNN+Transformer, respectively. The diagnostic accuracy of models was verified by cross-entropy loss and cross-validation method. In addition, sensitivity and specificity were evaluated using receiver operating characteristic curve.RESULTS: The accuracy of ResNet, ViT, and CNN+Transfermer for the diagnosis of normal cornea and suspect keratoconus was 85.57%, 86.11%, and 86.54% respectively, and the area under the receiver operating characteristic curve(AUC)was 0.823, 0.830 and 0.842 respectively. The accuracy of models for the diagnosis of suspect keratoconus and keratoconus was 97.22%, 95.83%, and 98.61%, respectively, and the AUC was 0.951, 0.939, and 0.988 respectively.CONCLUSION: For corneas ≤11.1 mm in diameter, the data model established by CNN+Transformer has a high accuracy rate for classifying keratoconus, which provides real and effective guidance for early screening.
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OBJECTIVES@#To analyze the research status of forensic medicine in China from 2010 to 2019, obtain the development trend of forensic medicine and explore the hotspots and research frontiers.@*METHODS@#The forensic medical academic papers published on China National Knowledge Infrastructure (CNKI) database from 2010 to 2019 were collected. CiteSpace 5.7.R1, an information visualization analysis software, was used to analyze publication organizations, authors, keywords, and other elements.@*RESULTS@#The majority of the research institutions were universities, provincial and ministerial scientific research and forensic institutions. Forensic pathology was still an important branch of forensic medicine and a popular research direction. The "polymorphism" and "Y chromosome" had been the research hotspots in recent years. "Medical damage" and "standard" were the most novel studies.@*CONCLUSIONS@#In order to provide scientific basis and research direction for forensic research, this paper analyzes the cooperation network, research hotspots and research innovation in forensic research.
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Forensic Medicine , China , Forensic Pathology , SoftwareABSTRACT
Spinal bionic therapy is the application of bionics concept, by imitating the natural anatomical structure and physiological function of the spine, to treat spinal diseases using various modern technology, materials and equipment .How to repair or preserve the anatomical structure and function of spine to the maximum extent while treating spinal diseases is an important content of spinal bionic therapy.Firstly, the use of movable spinal implants not only preserves the spinal mobility function to a certain extent, reduces the degeneration of adjacent segments, but also reduces the incidence of internal fixation fracture and improves the long-term efficacy.Secondly, with the help of the development of three dimensional printing technology, personalized artificial prostheses can be made to fill the spinal structure with complex defects, and biological scaffolds and functional prostheses with anti-tumor drugs can not only realize the biomimetic and functional spine anatomy, but also become a multiplier of the efficacy of anti-tumor drugs.Thirdly, in the design and manufacture of spinal orthopaedic braces, computer aided design and manufacturing technology can make spinal orthopaedic braces more comfortable with better orthopaedic effect and ergonomic characteristics.How to apply bionics concepts and relate technologies to spinal surgery have not been determined yet, and no relevant diagnosis and treatment guidelines have been formulated.It is foreseeable that with the continuous development of medical technology, the content of spinal bionic therapy will be gradually enriched and improved, and become a powerful measure to overcome difficulties in the diagnosis and treatment of spinal surgery diseases.
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Humans , Bionics , Computer-Aided Design , Printing, Three-Dimensional , Prostheses and Implants , Spine/surgeryABSTRACT
Objective:To analyze the incidence and epidemiological characteristics of traumatic spinal cord injury in China in 2018.Methods:Multi-stage stratified cluster sampling was used to randomly select hospitals capable of treating patients with spinal cord injury from 3 regions，9 provinces and 27 cities in China to retrospectively investigate eligible patients with traumatic spinal cord injury admitted in 2018. National and regional incidence rates were calculated. The data of cause of injury，injury level，severity of injury，segment and type of fracture，complications，death and other data were collected by medical record questionnaire，and analyzed according to geographical region，age and gender.Results:Medical records of 4，134 patients were included in this study，with a male-to-female ratio of 2.99∶1. The incidence of traumatic spinal cord injury in China in 2018 was 50.484 / 1 million （95% CI 50.122-50.846）. The highest incidence in the Eastern region was 53.791 / 1 million （95% CI 53.217-54.365）. In the whole country，the main causes of injury were high falls （29.58%），as well as in the Western region （40.68%），while the main causes of injury in the Eastern and Central regions were traffic injuries （31.22%，30.10%）. The main injury level was cervical spinal cord in the whole country （64.49%），and the proportion of cervical spinal cord injury in the Central region was the highest （74.68%），and the proportion of lumbosacral spinal cord injury in the Western region was the highest （32.30%）. The highest proportion of degree of injury was incomplete quadriplegia （55.20%），and the distribution pattern was the same in each region. A total of 65.87% of the patients were complicated with fracture or dislocation，77.95% in the Western region and only 54.77% in the Central region. In the whole country，the head was the main combined injury （37.87%），as well as in the Eastern and Central regions，while the proportion of chest combined injury in the Western region was the highest （38.57%）. A total of 32.90% of the patients were complicated with respiratory complications. There were 23 patients （0.56%） died in hospital，of which 17（73.91%） died of respiratory dysfunction. Conclusions:The Eastern region of China has a high incidence of traumatic spinal cord injury. Other epidemiological features include high fall as the main cause of injury cervical spinal cord injury as the main injury level，incomplete quadriplegia as the main degree of injury，head as the main combined injury，and respiratory complications as the main complication.
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Currently, the expanding recreational use of synthetic cannabinoids (SCBs) threatens public health. SCBs produce psychoactive effects similar to those of tetrahydrocannabinol, the main component of cannabis, and additionally induce unexpected pharmacological side effects. SCBs are falsely advertised as legal and safe, but in reality, SCB abuse has been reported to cause acute intoxication and addictive disorders. However, because of the lack of scientific evidence to elucidate their dangerous pharmacological effects, SCBs are weakly regulated and continue to circulate in illegal drug markets. In the present study, the intravenous self-administration (IVSA) paradigm was used to evaluate the abuse potential of three SCBs (AM-1248, CB-13, and PB-22) in rats. All three SCBs maintained IVSA with a large number of infusions and active lever presses, demonstrating their reinforcing effects.The increase of active lever presses was particularly significant during the early IVSA sessions, indicating the reinforcementenhancing effects of the SCBs (AM-1248 and CB-13). The number of inactive lever presses was significantly higher in the SCB groups (AM-1248 and CB-13) than that in the vehicle group, indicating their impulsive effects. In summary, these results demonstrated that SCBs have distinct pharmacological properties and abuse potential.
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Currently, the expanding recreational use of synthetic cannabinoids (SCBs) threatens public health. SCBs produce psychoactive effects similar to those of tetrahydrocannabinol, the main component of cannabis, and additionally induce unexpected pharmacological side effects. SCBs are falsely advertised as legal and safe, but in reality, SCB abuse has been reported to cause acute intoxication and addictive disorders. However, because of the lack of scientific evidence to elucidate their dangerous pharmacological effects, SCBs are weakly regulated and continue to circulate in illegal drug markets. In the present study, the intravenous self-administration (IVSA) paradigm was used to evaluate the abuse potential of three SCBs (AM-1248, CB-13, and PB-22) in rats. All three SCBs maintained IVSA with a large number of infusions and active lever presses, demonstrating their reinforcing effects.The increase of active lever presses was particularly significant during the early IVSA sessions, indicating the reinforcementenhancing effects of the SCBs (AM-1248 and CB-13). The number of inactive lever presses was significantly higher in the SCB groups (AM-1248 and CB-13) than that in the vehicle group, indicating their impulsive effects. In summary, these results demonstrated that SCBs have distinct pharmacological properties and abuse potential.
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Objective:To evaluate the efficacy of parathyroid hormone 1-34 (PTH1-34) in the treat-ment of adjacent vertebral refracture after percutaneous kyphoplasty (PKP) for thoracolumbar osteoporotic com-pression fracture (OVCF).Methods:A retrospective study was made of the 43 OVCF patients who had been admitted to Department of Orthopedics, Shanxi Bethune Hospital for adjacent vertebral refracture after PKP from January 2014 to June 2018.Of them, 22 were treated by secondary PKP (group A), 9 by secondary PKP+PTH1-34 (group B), and 12 by merely PTH1-34 (group C).The vertebral heights of anterior border and middle-line and sagittal kyphosis cobb angle on X-ray films at 6 months after operation, the bone mineral den-sities of the left hip at admission, 6 and 12 months after operation, and the Oswestry Dysfunction Index (ODI) and Visual Analog Scale (VAS) scores at admission, 3, 6 and 12 months after operation were recorded and compared.Results:The 3 groups were compatible because there were no significant differences between them in the preoperative general data ( P>0.05).Recurrent OVCF was found in 3 patients in group A but not in group B or C.The vertebral heights and kyphosis cobb angle at 6 months after operation were significantly improved compared to the preoperative values in groups A and B ( P<0.05) but not in group C.The T values of bone mineral density at 6 and 12 months after operation in group B and at 12 months after operation in group C were significantly improved compared to their preoperative ones ( P<0.05) but not in group A.The post-operative ODI and VAS scores were significantly improved compared to the scores at admission in all the 3 groups ( P<0.05). Conclusions:In the treatment of adjacent vertebral refracture after PKP for elderly OVCF patients, PTH1-34 can significantly improve their bone mineral density, prevent collapse of the injured vertebra and reduce re-fracture of adjacent vertebral body.A combination of PTH1-34 and PKP is an effective treatment of adjacent vertebral refracture after PKP because it can restore the vertebral heights and reduce kyphosis deformity.
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Background@#Listeria monocytogenes is a gram-positive bacterium that causes listeriosis mainly in immunocompromised hosts. It can also cause foodborne outbreaks and has the ability to adapt to various environments. Peptide uptake in gram-positive bacteria is enabled by oligopeptide permeases (Opp) in a process that depends on ATP hydrolysis by OppD and F.Previously a putative protein Lmo2193 was predicted to be OppD, but little is known about the role of OppD in major processes of L. monocytogenes, such as growth, virulence, and biofilm formation. @*Objectives@#To determine whether the virulence traits of L. monocytogenes are related to OppD. @*Methods@#In this study, Lmo2193 gene deletion and complementation strains of L. monocytogenes were generated and compared with a wild-type strain for the following: adhesiveness, invasion ability, intracellular survival, proliferation, 50% lethal dose (LD50) to mice, and the amount bacteria in the mouse liver, spleen, and brain. @*Results@#The results showed that virulence of the deletion strain was 1.34 and 0.5 orders of magnitude higher than that of the wild-type and complementation strains, respectively.The function of Lmo2193 was predicted and verified as OppD from the ATPase superfamily.Deletion of lmo2193 affected the normal growth of L. monocytogenes, reduced its virulence in cells and mice, and affected its ability to form biofilms. @*Conclusions@#Deletion of the oligopeptide transporter Lmo2193 decreases the virulence of L. monocytogenes. These effects may be related to OppD's function, which provides a new perspective on the regulation of oligopeptide transporters in L. monocytogenes.
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Hypoxic microenvironment is a common phenomenon of liver diseases and runs through the whole process of the development and progression of liver diseases. In recent years, the research on liver fibrosis and hypoxic microenvironment of hepatocellular carcinoma has attracted more and more attention. Hypoxia-inducible factor (HIF) is the most important hypoxic stress factor found at present. This article reviews the characteristics of hypoxic microenvironment in the liver and liver diseases and further elaborates on the association of HIF overexpression with hepatocyte damage, formation of fibrosis, and malignant transformation of hepatocytes.
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Objective:To compare perioperative differences between posterior lumbar interbody fusion(PLIF)by a posterior median approach or open transforaminal lumbar interbody fusion(TLIF)and minimally invasive surgery TLIF(MIS-TLIF)by a paravertebral approach for lumbar spondylolisthesis(Ⅰ~Ⅱ°)in elderly patients.Methods:A retrospective study was conducted to analyze clinical data of patients aged 60 years and over with lumbar spondylolisthesis(n=68)who underwent PLIF or MIS-TLIF from January 2014 to December 2017.Patients were divided into the PLIF group(n=40, 12 males and 28 females)and the MIS-TLIF group(n=28, 6 males and 22 females)according to the type of surgery.Differences in operating time, blood loss, exposure frequency, postoperative drainage volume, indwelling duration, hospital stay length and complications were compared between the groups.Results:There was no significant difference in operative time between the PLIF group and the MIS-TLIF group(156±51)min vs.(153±38)min( P=0.77). There were significant differences in intraoperative blood loss and radiation exposure frequency between the PLIF group and the MIS-TLIF group(458±272)ml vs.(157±104)ml( P<0.001); (6.7±1.5)times vs.(30.6±6.9)times( P<0.01). There was no significant difference in intraoperative complications between the PLIF group and the MIS-TLIF group(25% or 10/40 vs.7.1% or 2/28, P=0.057). There were more postoperative drainage, longer indwelling time and hospitalization in the PLIF group than in the MIS-TLIF group(664±351)ml vs.(210±127)ml( P<0.001); (3.7±2.9)d vs.(2.2±0.8)d( P=0.002); (9.2±3.6)d vs.(6.9±1.7)d( P=0.001). The incidence of postoperative neurological complications was not significantly different between the PLIF group and the MIS-TLIF group(7.5% or 3/40 vs.14.3% or 4/28, P=0.365). The incidence of postoperative non-neurological complications was higher in the PLIF group than in the MIS-TLIF group(27.5% or 11/40 vs.7.1% or 2/28, P=0.036). Conclusions:Compared with PLIF, MIS-TLIF has the advantages of less intraoperative bleeding and postoperative drainage, shorter indwelling duration of urinary catheters, shorter hospital stays and fewer complications of non-neurological complications in treating Ⅰ-Ⅱ degree lumbar spondylolisthesis in the elderly, but it requires more radiation exposure.
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OBJECTIVE@#To investigate the outcomes of breast reconstruction with employing improved techniques throughout the tissue expander/implant two-stage breast reconstructed process, which involved the tissue expander placement, the saline filling intraoperatively and postoperatively, the implant selection, and the permanent implant replacement.@*METHODS@#In this study, 68 patients who had been provided immediate or delayed tissue expander/implant two-stage breast reconstruction with autologous fat injection post-mastectomy in Peking University Third Hospital from April 2014 to September 2018 were involved, and the relevant information was analyzed retrospectively. The enhancements of the techniques, involving the incision selection, the expander placement, the principle of expansion, the management of capsule, the prosthesis selection, and the assisted reconstruction method were summarized, and the reconstruction outcomes were evaluated objectively through three-dimensional surface imaging.@*RESULTS@#Among the 68 patients in this study, immediate reconstruction was conducted in 25 patients and 43 patients underwent delayed reconstruction. The median time of tissue expansion was 7.0 (3.0, 20.0) months, and the average volume of expansion was (372.8±87.2) mL. The median size of breast implant was 215 (100, 395) mL. The median number of injections for fat grafting was 1 (1, 3), and the average volume of fat grafting was (119.3±34.1) mL. The median follow-up time was 7.0 (4.0, 24.0) months. During the process of breast reconstruction, the tissue expander leakage was observed in two patients, and one of them underwent expander replacement due to the secondary infection. In the immediate reconstruction cases, the volume symmetry of bilateral breasts after reconstruction got even better than that before mastectomy (t=4.465, P<0.01). And in the delayed reconstruction cases, the volume between bilateral breasts also achieved good symmetry after reconstruction (t=0.867, P>0.1).@*CONCLUSION@#Good results of tissue expander/implant two-stage breast reconstruction could be achieved through the techniques enhancement, which involved the preferred transverse incision, the downward placement of expander, the rapid expansion of chest soft tissue, the release of capsule tension, the application of sizer in prosthesis selection, and the assisted autologous fat grafting.
Subject(s)
Humans , Breast Neoplasms , Mammaplasty , Mastectomy , Retrospective Studies , Tissue Expansion Devices , Treatment OutcomeABSTRACT
Cervical spondylotic myelopathy is a common and frequently-occurring disease in Orthopaedics, especially with multi-segmental cervical spondylotic myelopathy. There are several pathogenic factors for cervical spondylotic myelopathy. The clinical symptoms are serious, and the imaging manifestations are complex. Most of them are accompanied by serious neurological damage, which seriously affects the quality of life of patients. Furthermore, some patients have serious cervical spinal cord injury symptoms, which endanger their lives after mild trauma. Therefore, early diagnosis, early treatment and surgery are the most effective methods at present, which could effectively eliminate the factors of spinal cord compression and reconstruct the stability of cervical spine function. However, the choice of surgical approach and decompression fusion has always been the focus of debate. The primary purpose of surgery for cervical spondylotic myelopathy is to completely relieve the compression of spinal cord. According to the imaging characteristics of cervical spondylotic myelopathy, it is the key to the success of the operation to determine the decompression and reconstruction of cervical spondylotic myelopathy. Anterior approach can be adopted in patients with the compression factors located in front of the spinal cord, including disc protrusion, mild osteophyte or local ossification posterior longitudinal ligament, less lesion segments, small compression range, cervical kyphosis or local kyphosis deformity, easy resection of compression and sagittal imbalance correction. Decompression fusion can be selected through intervertebral space, subtotal vertebral body resection and mixed decompression for fusion and fixation. In order to retain the active function of cervical vertebrae, artificial disc replacement and fusion can be selected. For patients with the compression factors located in the posterior part of the spinal cord, including ligamentumflavum hypertrophy or ossification, congenital developmental spinal canal stenosis, there are many factors causing compression in front of the spinal cord. The range is larger, the lesion segment is longer. Thus, it is difficult to resect thoroughly in front of the spinal cord with higher risk of anterior surgery. Although the posterior approach is indirect decompression with the help of posterior spinal cord movement, it plays a good role in improving nerve function with fewer complications and relatively higher safety. There are absolute surgical indications and relative indications for two approaches. Combining anterior and posterior surgery has advantages of complete decompression and strong fixation. However, it has the advantages of great trauma and high risk, so it is necessary to apply it in clinical practice. Moreover, no matter how to choose the approach, we should use perfect imaging data combined with clinical symptoms and signs to clarify the pathological factors of spinal cord com pression, the severity of spinal cord injury, the scope of compression and the responsible segment, and formulate an individualized operation plan.
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Objective@#To investigate the clinical effect of posterior unilateral short segment screw fixation and bone graft fusion in the treatment of special upper cervical spine injuries.@*Methods@#A retrospective case series study was conducted to analyze the clinical data of 15 patients with upper cervical spine injury admitted to Shanxi Bethune Hospital from July 2012 to May 2017. There were nine males and six females, aged 10-69 years [(41.9±20.9)years]. There were eight patients with traumatic atlantoaxial dislocation, one with congenital atlantoaxial dislocation, two with atlantoaxial dislocation with nonunion of odontoid process, three with Anderson type II odontoid process fracture, and one with old odontoid process fracture. All patients had cervico-occipital pain to different degrees, slender unilateral pedicle and distinct stenosis of vertebral artery. All patients were treated with posterior unilateral screw fixation and bone graft fusion. The injury of spinal cord and vertebral artery, operation time and intraoperative blood loss were recorded. Visual analogue scale (VAS) was used to evaluate pain before and after operation, and Japanese Orthopaedic Association (JOA) score was used to evaluate spinal cord function and postoperative improvement rate before and at the last follow-up. The position of internal fixation and fusion of bone graft were observed by X-ray after operation.@*Results@#All 15 patients were followed up for 6-36 months [(20.4±8.6)months]. All the screws were implanted successfully at the first time, without spinal cord or vertebral artery injury. The operation time was 100-210 minutes [(131.3±32.0)minutes], and the intraoperative blood loss was 100-450 ml [(203.1±104.0)ml]. Preoperative VAS score was (7.9±0.9)points, and postoperative VAS score was (3.7±0.8)points (P<0.01). Preoperative JOA score was (12.1±4.4)points, and the JOA score at postoperative follow-up was (16.1±1.4)points, with the improvement rate of 68%. Postoperative X-ray showed good recovery of cervical spine sequence. One patient developed loosened internal fixation after the neck brace protection was removed one month after surgery, and the patient recovered after timely second surgical fixation and fusion. The remaining 14 patients did not have loosened internal fixation, fracture or loss of reduction, with bone fusion 6-12 months after surgery.@*Conclusion@#Posterior cervical unilateral short-segment screw fixation and bone graft fusion can restore cervical stability, relieve pain, and improve function recovery, which can be used as a complementary procedure to treat upper cervical spine injury with anatomic structure variation.
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Objective To investigate the clinical effect of posterior unilateral short segment screw fixation and bone graft fusion in the treatment of special upper cervical spine injuries.Methods A retrospective case series study was conducted to analyze the clinical data of 15 patients with upper cervical spine injury adrnitted to Shanxi Bethune Hospital from July 2012 to May 2017.There were nine males and six females,aged 10-69 years [(41.9±20.9)years].There were eight patients with traumatic atlantoaxial dislocation,one with congenital atlantoaxial dislocation,two with atlantoaxial dislocation with nonunion of odontoid process,three with Anderson type Ⅱ odontoid process fracture,and one with old odontoid process fracture.All patients had cervico-occipital pain to different degrees,slender unilateral pedicle and distinct stenosis of vertebral artery.All patients were treated with posterior unilateral screw fixation and bone graft fusion.The injury of spinal cord and vertebral artery,operation time and intraoperative blood loss were recorded.Visual analogue scale(VAS)was used to evaluate pain before and after operation,and Japanese Orthopaedic Association(JOA)score was used to evaluate spinal cord function and postoperative improvement rate before and at the last follow-up.The position of internal fixation and fusion of bone graft were ohserved by X-ray after operation.Results All 15 patients were followed up for 6-36 months [(20.4±8.6)months].All the screws were implanted successfully at the first time.Without spinal cord or vertehral artery injury.The operation time was 100-210 minutes [(131.3±32.0)minutes],and the intraoperative blood loss was 100-450 ml [(203.1±104.0)ml].Preoperative VAS score was(7.9 ±0.9)points.And postoperative VAS score was(3.7 ±0.8)points(P＜0.01).Preoperative JOA score was(12.1±4.4)points.And the JOA score at postoperative follow-up was(16.1±1.4)points.With the improvement rate of 68％.Postoperative X-ray showed good recovery of cervical spine sequence.One patient developed loosened internal fixation after the neck hrace protection was removed one month after surgery.And the patient recovered after timely second surgical fixation and fusion.The remaining 14 patients did not have loosened internal fixation.Fracture or loss of reduction.With bone fusion 6-12 months after surgery.Conclusion Posterior cervical unilateral short-segment screw fixation and bone graft fusion can restore cervical stability,relieve pain,and improve function recovery,which can he used as complementary procedure to treat upper cervical spine injury with anatomic structure variation.
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According to the procedures for the development of evidence-based medicine guidelines, a multi-disciplinary guideline development working group was established, after three rounds of discussions by the consensus expert group, a new evidencebased guideline for diagnosis and treatment of senile osteoporosis in China(2018) was developed. The grading of recommendations assessment, development and evaluation(GRADE) system was used to rate the quality of evidence and the strength of recommendations. Recommendations were derived from evidence body, and at the same time considered the balance of benefits and harms as well as values and preferences of Chinese patients. The guideline development working group developed 15 recommendations for the diagnosis and treatment of senile osteoporosis. The guideline covered the screening for senile osteoporosis, risk assessment, diagnosis, basic treatment, multiple anti-osteoporosis drugs, therapeutic effect monitoring and evaluation of senile osteoporosis. This guideline aims to serve as a tool for clinicians and patients for best decisions-making in China.
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Objective To investigate the clinical efficacy of short segment fixation with percutaneous pedicle screws or traditional open surgery for the type A1-A3 thoracolumbar compression fracture.Methods A retrospective case control study was conducted on the clinical data of 64 patients with thoracolumbar compression fracture admitted to Shanxi Dayi Hospital between January 2012 and February 2017.There were 44 males and 20 females,aged 21-65 years [(45.4 ± 11.1) years].There was one patient with injured segment at T11,29 at T12,27 at L1 and seven at L2.According to AO typing,there were 39 patients classified as Type A1,two as Type A2 and 23 as Type A3.The patients were divided into minimally invasive surgery group (n =37) and open surgery group (n =27).Minimally invasive surgery group was treated with minimally invasive percutaneous pedicle screw fixation and open reduction.The open surgery group was treated with traditional open pedicle screw short segment fixation and open reduction.The operation time,intraoperative blood loss,total hospitalization time,postoperative hospitalization time,visual analogue scale (VAS) before and after operation,local kyphosis of the fractured vertebra,segmental kyphosis and complications in two groups were recorded.Results All patients were followed up for 12-29 months,with an average of 13.2 months.Between the minimally invasive surgery group and open surgery group,no significant difference was found in the operation time [(106.4± 37.3) minutes vs.(131.3 ± 33.6) minutes] (P ＞ 0.05),and significant differences were found in intraoperative blood loss [(71.2 ± 34.9) ml vs.(409.3 ± 267.5) ml],total hospitalization time [(11.7 ± 7.2) days vs.(21.6 ± 12.8) days] and postoperative hospitalization time [(8.1 ± 7.4) days vs.(16.6 ± 10.6) days] (P ＜ 0.05).In the minimally invasive surgery group,VAS was (6.5 ±1.1) points preoperatively and was (2.3 ± 0.7) points and (1.0 ± 0.3) points immediately after operation and at final follow-up.In the open surgery group,VAS was (6.9 ± 1.0)points preoperatively and was (4.2 ± 1.0) points and (0.9 ± 0.4) points immediately after operation and at final follow-up (P ＜0.05).Compared with the preoperative VAS,those immediately after operation and at final follow-up were significantly decreased within the two groups (P ＜ 0.05).There were no significant differences in the preoperative VAS and VAS at final follow-up between the two groups (P ＞ 0.05),but significant difference was found in VAS immediately after operation between the two groups (P ＜ 0.05).In the minimally invasive surgery group,the local kyphosis of the fractured vertebra was (19.3 ± 3.8) °preoperatively,(3.4 ± 1.7) ° immediately after operation,and (4.6 ± 1.9) ° at final follow-up.In the open surgery group,the local kyphosis of the fractured vertebra was (19.6 ± 6.8) ° before operation,(1.6 ± 0.8) ° immediately after operation,and (2.4 ± 1.1) ° at final follow-up.The kyphosis of fractured vertebra immediately after operation and at final follow-up were significantly decreased within the two groups compared with the preoperative kyphosis(P ＜0.05),but no significant differences were found between the two groups (P ＞ 0.05).In the minimally invasive surgery group,the segmental kyphosis Cobb angle was (16.1 ± 9.1) ° before operation,(3.0-± 1.8) ° immediately after operation,and (5.9 ±1.8) ° at final follow-up.In the open surgery group,the segmental kyphosis Cobb angle was (15.2±12.0) ° before operation,(3.1 ± 1.4) ° immediately after operation,and (5.6 ± 2.1) ° at final follow-up.The segmental kyphosis Cobb angle immediately after operation and at final follow-up were significantly decreased within the two groups compared with the preoperative Cobb angle (P ＜ 0.05),but no significant differences were found between the two groups (P ＞ 0.05).No spinal cord injuries because of pedicle screws were observed after operation in either group.In the open surgery group,there was one patient with wound infection who recovered after dressing change,and no infection case was found in the minimally invasive surgery group.Conclusion For type A1-A3 thoracolumbar compression fractures,both the minimally invasive posterior pedicle screw fixation and the traditional open pedicle screw fixation can achieve satisfactory near-term results,and the former is better in intraoperative blood loss,immediate relief of pain after operation and shorter hospital stay than the latter.
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Hirayama disease(HD),also known as juvenile muscular atrophy of the distal upper extremity,is featured by concealed onset clinically and often occurs in male adolescence.In most cases,one or both of the asymmetrical distal muscles of the upper extremities are weak and atrophied without objective sensory abnormalities and this disease naturally stops developing after several years.Early Hirayama disease is similar to motor neuron diseases in clinical symptoms like amyotrophic lateral sclerosis.The limitation of medical diagnostic techniques and the lack of understanding by clinicians lead to a higher rate of misdiagnosis of Hirayama disease,making their treatment plan and prognosis completely different.Therefore,a timely and accurate diagnosis of Hirayama disease is essential.In recent years,domestic and foreign scholars conducted researches in the diagnosis of Hirayama disease mainly through clinical manifestation combined with the magnetic resonance imaging of the cervical flexion position and the application of various neurophysiological detection techniques.As the number of clinical cases gradually increases,Hirayama disease draws more attention of clinicians and there are more and more reports and researches on related cases.With the development of research and application of imaging and neuroelectrophysiological techniques,the importance and effectiveness of early diagnosis and treatment of the disease have been affirmed and emphasized,thus people acquire a better understanding of its pathogenesis,clinical diagnosis and treatment.Especially for those suspected patients with juvenile muscular atrophy of the distal upper extremity,it is more important to be vigilant against the possibility of Hirayama disease.Based on this reality,this paper will discuss the new understanding and research progress of pathogenesis,clinical diagnosis and treatment of Hirayama disease,which is very important for clinicians to better understand and pay more attention to this disease.
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Graft-versus-host disease (GVHD) is a frequently encountered serious complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT), it limits the success and widespread use of allo-HSCT. Mesenchymal stem cells (MSCs) are selected as ideal prophylactic and treatment means for GVHD during allo-HSCT due to their unique immunomodulatory and regenerative properties. Herein, the recent research progress about the prevantive and therapeutic effects of MSCs on GVHD and several issues related with the applications of MSC, including whether MSCs increasing risk of primary disease relapse and infection, impact of several clinical parameters on the clinical response to MSCs, and the prevantive and therapeutic effect of MSC-derived extracellular vesicles on GVHD are systematically reviewed.
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Humans , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem CellsABSTRACT
Objective To investigate the therapeutic influence of short segment fixation with navigated percutaneous pedicle screws in the treatment of thoracolumbar compression fracture and whether use of pedicle screw fixation affects the treatment efficacy.Methods A retrospective case control study was conducted on the clinical data of 38 patients with thoracolumbar compression fracture admitted between January 2014 and October 2016.There were 27 males and 11 females,with an average age of 35.9 years (range,21-59 years).There were 14 cases with injured segment at T12,14 cases at L1,and 10 cases at L2,all of which were classified as Type A according to AO typing.The patients were divided into screw group (n =22) and non-screw group (n =16).The pedicle screws were placed into the upper and lower adjacent segments of the fracture vertebra or the fracture vertebra by percutaneous fluoroscopyguided navigation.The operation time,intraoperative blood loss,Visual analogue scale (VAS) before and after operation,anterior vertebral body height,Cobb angle,and complications in two groups were recorded.Results All patients were followed up for 12-30 months,average 15.2 months.No significant differences were found between the screw group and the non-screw group with respect to operation time [(44.7 ±12.6)minutes vs.(39.3 ±11.9)minutes] and blood loss [(56.8 ±13)ml vs.(48.4 ± 11.0)ml](P ＞0.05).In the screw group,preoperative VAS was (6.7 ± 1.5) points,and VAS at postoperative 1 week,six months and 1 year were (2.3 ± 0.9) points,(1.1 ± 0.3) points and (0.9 ± 0.5) points,respectively (P ＜ 0.01).In the non-screw group,preoperative VAS was (6.1 ± 1.7) points,and VAS at postoperative 1 week,six months and 1 year were (2.1 ± 0.8) points,(1.2-± 0.6) points and (1.0-±0.6) points,respectively (P ＜0.01).No significant difference was found on VAS between the two groups (P ＞ 0.05).In the screw group,anterior vertebral body height was (59.5 ±-1 3.6) ％ preoperatively,and anterior vertebral body height at postoperative 1 week,six months and 1 year was (90.6±7.7)％,(89.3 ±8.3)％ and (88.4 ±7.9)％ (P＜0.01).In the non-screw group,preoperative anterior vertebral body height was (60.1 ± 12.5)％,and anterior vertebral body height at postoperative 1 week,six months and 1 year was (89.3 ±8.9)％,(88.4 ±9.1)％ and (86.5 ±8.7)％ (P ＜0.01).No significant difference was found on anterior vertebral body height between the two groups (P＞0.05).In the screw group,preoperative Cobb angle was (15.6 ±4.1)°,and Cobb angle at postoperative 1 week,six months and 1 year was (3.0 ±1.8)°,(5.0 ±1.9) ° and (5.9 ±1.8)°,respectively (P ＜ 0.01).In the non-screw group,preoperative Cobb angle was (16.2 ± 5.1) °,and Cobb angle at postoperative 1 week,six months and 1 year was (3.1 ±1.4)°,(5.2 ±2.3)° and (5.6 ± 2.1) °,respectively (P ＜ 0.01).No significant difference was found on Cobb angle between the two groups (P ＞ 0.05).No spinal cord injuries because of pedicle screws were observed after operation in both groups.Conclusions For thoracolumbar compression fracture,short segment fixation with navigated percutaneous pedicle screws has the advantages of shorter operation time,less bleeding,better postoperative pain relief,and fewer complications.In addition,the postoperative VAS,anterior vertebral body height and sagittal Cobb angle are improved significantly.However,use of pedicle screw fixation in fracture vertebra does not have significant influence on the treatment efficacy.
ABSTRACT
Aim To explore the effect of Klotho (KL) gene transfection on the apoptosis of MC3T3-E1 osteo-blasts induced by dexamethasone(DEX). Methods MC3T3-E1 osteoblasts were transfected by recombinant adenovirus containing KL gene(Ad-KL) and recombi-nant adenovirus containing green fluorescent protein (GFP) gene(Ad-GFP). The apoptosis model was con-structed. The transfection efficiency of Ad-KL and Ad-GFP in cells were observed using inverted fluorescent microscope, and the level of KL mRNA and protein was detected by qPCR and Western blot,respectively. The cell viability after different concentrations of DEX acting on the cells and the viability of every research group were determined by cell counting kit-8 (CCK-8) assay. The apoptotic rate was evaluated by flow cytom-etry. The level of mRNA and protein was analyzed by qPCR and Western blot, respectively. The level of caspase-9 protein was detected by immunofluorens-cence assay. Results Cells were transfected by Ad-KL and Ad-GFP successfully. KL group and KL +DEX group had higher level of KL mRNA and protein than that in other groups. The optimum concentration of DEX was 2.0 mmol·L-1. When DEX acting on the cells, the cells viability decreased and apoptotic rate increased obviously in DEX group and GFP + DEX group. The level of Bax mRNA and protein presented a upward trend in DEX group and GFP +DEX group, while the level of Bcl-2 mRNA and protein was oppo-site. But after KL transfecting MC3T3-E1 osteoblasts, the markers described above in KL group had more dramatic improvement than in DEX group and KL +DEX group. Conclusions High-dosage DEX can in-duce the apoptosis of MC3T3-E1 osteoblasts, and the pro-apoptosis effect of high-dosage DEX in MC3T3-E1 osteoblasts can be suppressed by up-regulating KL gene expression level, suggesting that the glucocorticoid-in-duced osteoporosis might be improved by up-regulating KL gene expression level, and it may be a new target for the treatment of latrogenic osteoporosis induced by high-dosage glucocorticoid in clinic.