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Objective:To explore the effect of hydrogen sulfide (H 2S) on modulating the subunit Kir6.2 of adenosine triphosphate sensitive potassium channels via the cyclic guanosine monophosphate-dependent protein kinase (cGMP/PKG) signaling pathway in epileptic rat models. Methods:Sixty adult male SD rats were randomly divided into the following six groups (10 rats in each group) by random number table method: control, epileptic, H 2S donor, H 2S donor+epileptic, KT5823 (one inhibitor of the cyclic guanosine monophosphate-dependent protein kinase)+H 2S donor+epileptic, and glibenclamide (one inhibitor of the adenosine triphosphate sensitive potassium channels)+H 2S donor+epileptic groups. Except the control group, SD rats were intraperitoneally injected with plentylenetetrazole to make the kindling models and their behaviours were recorded including the latency period, the grade, and the duration of the first epileptic seizure according to the Racine′s standard. The waveforms of electroencephalogram (EEG) in hippocampus were also recorded during the seizure. The mRNA and protein levels of PKG and Kir6.2 in hippocampus were evaluated by Western blotting and quantitative real-time polymerase chain reaction, and the hippocampal concentrations of cGMP and phosphorylation of cyclic guanosine monophosphate-dependent protein kinase (p-PKG) were detected by enzyme linked immunosorbent assay. Results:Rats in the epileptic group showed Ⅳ-Ⅴ grade of epileptic seizure [4.500 (4.000, 4.875)], short latency period [(10.37±8.21) min] but long duration [(69.50±24.37) s] of seizure. Compared to the epileptic group, rats in the H 2S donor group showed Ⅱ-Ⅲ grade of epileptic seizure ( P=0.004), significantly longer latency period ( P<0.001), and shorter duration of seizure ( P<0.001). Compared to the H 2S donor+epileptic group, rats in the KT5823+H 2S donor+epileptic group showed Ⅲ-Ⅳ grade of epileptic seizures, significantly shorter latency period ( P<0.001), and longer duration of seizure ( P<0.001). The results of EEG showed that the wave patterns in the epileptic group were spike or sharp waves and the amplitudes were largest [(190.570±23.590) μV]. Compared with the epileptic group, amplitudes were reduced ( P<0.001) in the H 2S donor+epileptic group. PKG mRNA and PKG protein were expressed differently among all groups (PKG mRNA: n=5, H=26.714, P<0.001; PKG protein: n=5, F=30.597, P<0.001). Compared with the control group, the expression of both PKG mRNA and PKG protein was decreased (PKG mRNA: 1.000±0.001 vs 0.782±0.064, P=0.023; PKG protein: 0.550±0.037 vs 0.145±0.020, P=0.042) in the epileptic group. Besides, Kir6.2 mRNA and Kir6.2 protein were expressed differently among all groups (Kir6.2 mRNA: n=5, H=27.761, P<0.001; Kir6.2 protein: n=5, F=60.659, P<0.001). Compared with the control group, the expression of both Kir6.2 mRNA and Kir6.2 protein was decreased (Kir6.2 mRNA: 1.000±0.001 vs 0.897±0.033, P=0.004; Kir6.2 protein: 0.384±0.035 vs 0.215±0.016, P=0.024) in the epileptic group. And the concentrations of cGMP and p-PKG were decreased (cGMP: P<0.001; p-PKG: P<0.001) in the epileptic group. The results in the H 2S donor+epileptic group were up-regulated (PKG mRNA: P=0.047; PKG protein: P<0.001; Kir6.2 mRNA: P=0.011; Kir6.2 protein: P<0.001; cGMP: P<0.001; p-PKG: P<0.001) compared with the epileptic group. However, the results in the KT5823+H 2S donor+epileptic group were down-regulated (PKG mRNA: P=0.015; PKG protein: P=0.027; Kir6.2 mRNA: P=0.013; Kir6.2 protein: P=0.017; cGMP: P=0.005; p-PKG: P<0.001) compared with the H 2S donor+epileptic group. Conclusion:A possible mechanism is that H 2S prevents the epileptic seizure from modulating the subunit Kir6.2 of ATP sensitive potassium channels via the cGMP/PKG signaling pathway.
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Objective To investigate the relationship of motor unit number estimation(MUNE)by multiple point stimulation with the outcome of surgical treatment patients with Hirayama disease(HD).Methods A total of 36 consecutive patients including unilateral in 26 cases and bilateral in 10 cases with Hirayama disease treated by anterior cervical discectomy decompression and fusion in Peking University Third Hospital from October 2007 to May 2015 were reviewed retrospectively.There were 35 males and 1 female,aged from 16-26 years(average,19.2 years).A total of 46 hands were enrolled.Odom criteria was used to evaluate the subjective outcome of surgical treatment.Multiple point stimulating technique was used to estimate the motor unit number of abductor pollicis brevis and abductor digitiminimi preoperatively and at the time of pre-operation and the latest follow-up.Hands were divided into two groups based on Odom criteria(Group A with excellent and good;Group B with fair and poor).The difference between the two groups were examined by t text.Results A total of 46 hands with complete clinical and electrophysiology data were followed up for 12-96 months(average,28.2 months).The outcome at the final follow-up according to Odom criteria was:Excellent in 8 cases,Good in 18 cases,Fair in 20 cases and no Poor case.MUNE of abductor pollicis brevis increased significantly after surgery from 139.6±68.4 to 188.2±60.4(t=-5.86,P<0.001).MUNE of abductor digitiminimi increased significantly after surgery from 75.0±66.3 to 104.2±80.4 significantly(t=-3.86,P<0.001).For two groups in age,follow-up period,preoperative MUNE of abductor pollicis brevis,and preoperative abductor digitiminimi,there was no significant difference.The illness course of Group A was 24.0±11.3 months,which was significantly shorter than Group B 34.9±21.2 months(t=-4.452,P<0.01).Group A had more increased MUNE of abductor pollicis brevis 65.6±64.1 compared with Group B 26.7±34.7(t=2.446,P<0.05)and Group A had more increased MUNE of abductor digitiminimi 42.6±59.3 compared with Group B 11.8±32.4 after surgery(t=2.088,P<0.05).Conclusion MUNE by multiple point stimulating technique could be used to evaluate the neurological function of Hirayama disease and the outcome of surgical treatment quantitatively.
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Objective To investigate the clinical efficacy of anterior cervical surgery by comparative analyzing hand dysfunction using brief Michigan hand questionnaire(Brief MHQ)in Hirayama disease patients.Methods From Aug 2011 to Dec 2016,27 patients of hirayama disease who underwent surgery were enrolled in this study.The study group consisted of 27 men.The mean follow-up period was 41.1 months.The levels of surgery included 18 cases of C4-C7,6 cases of C3-C6,2 cases of C4-C6 and 1 case of C5-T1.Brief MHQ were evaluated for the 27 patients.According to the Wilcoxon analysis,the unchanged domains were analyzed with the multifactor Logistic regression analysis by preoperative duration of symptoms,age of onset,and number of affected extremities.Dynamic flexion-extension lateral X-rays were performed at baseline and at final follow-up.Results No failure of internal fixation was detected on dynamic flexion-extension lateral X-rays.Five domains of preoperative Brief MHQ had lower scores,including Function,Satisfaction,Aesthetics,Activities of daily living,Work domain.With the exception of Aesthetics and Pain domain,all the other four domains showed significant improvement after surgery.The total score was 38.44±5.83 at base-line and 43.19±4.47 at follow-up.The score of Function was 5.19±1.36 at baseline 6.37±1.15 at follow-up;The score of Satisfaction was 5.56±1.22 at baseline 6.60±1.05 at follow-up;The score of Activities of daily living was 6.33±1.84 at baseline 7.60±1.47 at follow-up;The score of Work was 6.85±1.75 at baseline 7.67±1.33 at follow-up.The risk factors of postoperative outcomes reported in the literature included duration of disease at the time of surgery,age of onset,and extremity involvement.According to the Logistic regression,pre-operation duration was the risk factor for Aesthetics domain and the cut-off time was 1.75 years.Conclusion Four domains of Brief MHQ score were improved significantly after anterior surgery for patients with hirayama disease.Brief MHQ was useful to evaluate the hand dysfunction and clinical efficacy in patients with hirayama disease.
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Objective To assess the correlation of newly fracture and spinal sagittal parameters.Methods From March 2011 to December 2014,80 patients of osteoporosis vertebral compression fracture treated by PVP as observation group were studied.The whole-spine anteroposterior view and lateral view XRay Photographes of the patients were taken,the sagittal parameters such as Pelvic index (PI),sacral slope (SS),pelvic tilt (PT),thoracic kyphotic angle(TK),lumbar lordotic angle(LL),the C7/SFD ratio were recorded.The whole cases were divided into two groups according to the presence of new fracture or not after the last followup of one year,the index of two groups were compared,and the risk factors of newly vertebral compression fractures were analysed.Results There were no statistically significant difference in gender,age,body mass index,BMD,PI,TK,LL between the two trea ted groups (P＞0.05);there were statistically significant difference in SS,PT and the C7/SFD between the new vertebral fracture group and the control group (P＜0.05).The analytic results of Logistic regression model showed that the smaller SS,larger TK and C7/SFD were risk factors of newly vertebral compression fractures.Conclusion The newly occurred vertebral compression fractures,after the primary treatment of PVP,are associated with changed spinal sagittal parameters.
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BACKGROUND:Recent report addressing new vertebral fracture after vertebroplasty or bal oon kyphoplasty has increased gradual y. It remains controversial whether new vertebral fracture is induced by bone cement augmentation or osteoporosis. OBJECTIVE:To observe new vertebral fracture after conservative treatment and bone cement augmentation for osteoporotic vertebral compression fractures, analyze the relationship between new vertebral fracture and spinal sagittal parameters, and explore the risk factors for new vertebral fracture. METHODS:From June 2011 to December 2014, 160 patients with osteoporotic vertebral compression fractures in thoracic and lumbar vertebrae were selected from the Department of Spine Surgery, the Affiliated Hospital of Chengde Medical Col ege. According to therapeutic regimen, the patients were divided into two groups. The observation group (n=80) received vertebroplasty or kyphoplasty. The control group (n=80) underwent conservative treatment. At 1 day after surgery in the observation group and after walking in the control group, patients were subjected to anteroposterior and lateral X-ray in the entire length of the spine. Bone mineral density, number and location of new vertebral fractures and sagittal parameters during fol ow-up were recorded and compared between groups. After final fol ow-up, according to the appearance of new vertebral fracture, patients in both groups were assigned to two subgroups. The difference in above indicators was compared between the two subgroups. The relationship between new vertebral fracture and spinal sagittal parameters was analyzed. RESULTS AND CONCLUSION:(1) There were no statistical y significant differences in gender, age, body mass index, bone mineral density, pelvic index, sacral slope, pelvic tilt, thoracic kyphotic angle, lumbar lordotic angle, C7/sacro-femoral distance ratio and occurrence rate of new fractures between the two treated groups (P>0.05). (2) There were no statistical y significant differences in gender, age, body mass index, pelvic index, and lumbar lordotic angle between new vertebral fracture group and non-fracture group. There were statistical y significant differences in bone mineral density, sacral slope, pelvic tilt, thoracic kyphotic angle and the C7/sacro-femoral distance between the new vertebral fracture group and the control group (P<0.05). (3) Results confirmed that new vertebral compression fractures after vertebroplasty, Kyphoplasty or conservative treatment for osteoporotic vertebral compression fractures were definitely associated with osteoporosis and spinal sagittal imbalance.
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BACKGROUND:Sagittal imbalance induced by vertebral osteoporotic fractures has not been paid enough attention in previous studies. OBJECTIVE:To assess the correlation of osteoporotic vertebral compression fracture and spinal sagittal imbalance. METHODS:Sixty patients with old osteoporotic vertebral compression fracture, who were treated in the Department of Spine Surgery, the Affiliated Hospital of Chengde Medical Colege from February 2013 to August 2015, were enroled in this study as the observation group. Sixty healthy old people from physical examination center were enroled as the control group. The whole-spine anteroposterior and lateral X-ray films were taken in both groups. The number and the location of fractured vertebrae were recorded. Sagittal parameters of both groups including thoracic kyphotic angle, lumbar lordotic angle, T1-spinopelvic inclination angle and the C7plumb line/sacro-femoral distance (PL/SFD) ratio were measured and compared among groups. The observation group was dividedinto three subgroups according to the number of fractured vertebrae,i.e., single-vertebrae fracture subgroup, double-vertebrae fracture subgroup and above triple-vertebrae fracture subgroup. The C7PL/SFD ratio of the three subgroups was compared. The correlation between the number of fractured vertebrae and the C7PL/SFD ratio was analyzed. RESULTS AND CONCLUSION:(1) The thoracic kyphotic angle of the observation group was bigger than that of the control group (P< 0.05). The lumbar lordotic angle of the observation group was smaler than that of the control group (P< 0.05). The absolute value of the T1-spinopelvic inclination angle of the observation group (-1.81±1.48)° was smaler than that of the control group (-3.35±1.22)° (P< 0.05). The C7PL/SFDratio of the observation group was significantly bigger than that of the control group (P< 0.05). (2) In the observation group, there were 4 cases of single-vertebrae fracture, 25 cases of double-vertebrae fracture and 31 cases of above triple-vertebrae fracture. Significant differences in the C7PL/SFD ratio were determined among subgroups (P< 0.05). The number of fractured vertebrae was positively correlated with the C7PL/SFD ratio; the correlation coefficient was 0.747. (3) Results indicated that osteoporotic vertebral compression fracture can change spinal local sagittal alignment. Multiple compression fractures of vertebrae can cause spinal sagittal imbalance. The gravity center of human body shifts forward. The number of fractured vertebrae was positively correlated with the range of shift forward.
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<p><b>BACKGROUND</b>Open-door laminoplasty is widely used in the treatment of cervical spondylotic myelopathy (CSM). This study aimed to investigate the profiles of and correlation between objective and subjective short-term outcome assessments after open-door laminoplasty for CSM.</p><p><b>METHODS</b>We retrospectively analyzed surgical outcomes in 129 consecutive CSM patients who underwent open-door laminoplasty in Peking University Third Hospital from February 2008 to November 2011. Both objective and subjective assessments were evaluated before surgery, 3 months after surgery, and 1 year after surgery. We then analyzed the profiles of and correlation between objective and subjective short-term outcomes.</p><p><b>RESULTS</b>The Modified Japanese Orthopaedic Association (mJOA) score was significantly improved at 3 months (P < 0.01) and 1 year (P < 0.01) after surgery. Bivariate Logistic regression showed that sensory improvement contributed more to the recovery rate than motor function improvement at 3 months after surgery, while motor function contributed more to the recovery rate at 1 year after surgery. On the subjective assessment (the short form (SF)-36 ), there was no significant improvement at 3 months after surgery (P > 0.05), while physical function (PF), role-physical (RP), and social function (SF) were notably improved at 1 year after surgery (P < 0.01). Improved mJOA score correlated with improvements in PF, RP, bodily pain, general health (GH), vitality (VT), and SF (P < 0.05) at 3 months after surgery; PF, GH, VT, and SF were associated with improved mJOA scores at 1 year after surgery.</p><p><b>CONCLUSIONS</b>Patients benefit from surgery by postoperative restitution of neurological function with early recovery of sensory function, followed by a gradual transition to motor function improvement. At the early stage of recovery, improvement in the mJOA score essentially correlated with improvements in the physical domains of the SF-36, while at the later stage, mJOA score improvement was associated with improvements in both mental and physical domains of the SF-36.</p>
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Female , Humans , Male , Middle Aged , Laminoplasty , Reference Standards , Retrospective Studies , Spinal Cord Diseases , General SurgeryABSTRACT
BACKGROUND: Literatures report that double-bundle reconstruction is a better choice for posterior cruciate ligament (PCL),but Tibial-inlay technique exhibits no significant difference.OBJECTIVE: To evaluate the effect of Tibial-inlay technique used in the PCL reconstruction with allograft tendons.METHODS: Thirty-one patients with PCL rupture were verified by arthroscopy in the Department of Orthopaedics, at the Affiliated Hospital of Chengde Medical College between February 2006 and May 2008, including 14 knees caused by traffic accident injury,9 knees by crashing, and 8 knees by athletic injury. All the damaged PCLs were reconstructed with allograft tendons by Tibial-inlay technique under arthroscopy. During surgery, the remnants of the original PCL were retained as much as possible,PCL femoral tunnel was prepared. By using of allogeneic patella tendon with bone block at both ends or achilles tendon allograft with bone block at one side, the lateral bone block was chipped into trapezoidal block at a width of 1.0-1.5 cm and a length of 2 cm, that is, in addition to relying on friction force to fix between bone groove and bone graft, it can also generate compressive stress and increase its stability. The PCL tibial attached point was stripped, the trapezoid bone groove was prepared according to the size of bone block at the insertion site, and allogeneic bone block was embedded into bone groove, then the other end was introduced to femoral tunnel using pulling wire through the joint, after tensed at anterior drawer site, the extrusion screw was twisted forward to fix the tendon or bone. Before operation and during follow-ups, the posterior drawer test knee instability, joint activity, Lysholm knee function scores were recorded.RESULTS AND CONCLUSION: No severe complications, such as vascular nerve injury, rejection or infection, occurred in early stage after operations in 31 patients. All of them were followed up for 12-24 months. Posterior drawer test of all the subjects were above 2+ before operation, of which, 3+ and 4+ were 84%; the posterior drawer test re,suits were as the following after operation:4 cases of 0+ (normal), 17 cases of 1 +, 9 cases of 2+ and 1 case of 3+, which shows the improvement of retroposition (P ＜ 0.05);Lysholm score was remarkably improved at follow-up compared with preoperation (P ＜ 0.05), and there were significant improvements in the joint range of motion (P ＜ 0.05). The reconstruction of PCL by Tibial-inlay technique with allograft tendons has advantages of minimal trauma in surgery, reliable fixation and satisfactory outcome.
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BACKGROUND: Donor complications have been detected following autologous tendon transplantation for posterior cruciate ligament reconstruction. Although artificial tendon development and tissue-engineered tendon have achieved great progresses, there are some issues in clinical application. Since 1980's, allogenic tendon transplantation has aroused increasing attention. OBJECTIVE: To explore the selection of allogenic tendon materials and the effect of their application on reconstructing posterior cruciate ligament. METHODS: A total of 17 patients with posterior cruciate ligament injury of knee joint were treated with cryopreserved allogenic tendon by Tibial-inlay technique. During the operation, two tracts of tendons soaked in gentamicin saline for 15 minutes were conduplicated, and one end of the tendon was cancellous bone screw and fixed to the tibia attachment point of posterior cruciate ligament, and the other end was introduced into the joint through retention suture. The posterior joint capsule was repaired. The patient was placed at supine position, and the knee was flexed for 90°. The other end of the graft was introduced to femoral tunnel, and anterior drawer was tensed, and fixed by screw. RESULTS AND CONCLUSlN: The preoperative posterior drawer test of patients was >2+, including 7 cases of 3+ and 6 of 4+. The postoperative posterior drawer test was 0 in 4 cases, 1+ in 8 cases, 2+ in 4 cases and 3+ in 1 case, suggesting the posterior movement of the knee joint was significantly improved. Lysholm scores of patients were (48.5±4.3) points before operation and (88.3±5.4) points after operation. Results show that cryopreserved allogenic tendon by Tibial-inlay technique could restored function of posterior cruciate ligament with a favorable effect.
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Objective To investigate the biomechanicai characteristics of flexor profundus tendons repaired after decimeter wave therapy, and to observe the effect of decimeter wave therapy on early active mobilization. Methods A total of 56 Leghorn chickens were randomly divided into a therapy group and a control group with 28 chickens in each. The 3rd and 4th toes of their left feet were employed for the establishment of a tendon injury model. The flexor profundus tendons were cut and repaired. Gypsum support was applied and fixed with an adhesive plaster after the operation. The operated sites on toes Ⅲ and Ⅳ were exposed. The external fixation was removed 3 weeks later and the chickens were left free to move. Decimeter wave therapy ( frequency 915 MHz, power 8 Watts) was ap-plied for 10 minutes once daily on the left foot of each chicken in the therapy group from day 1 until 3 weeks after the operation. Sham decimeter wave therapy was applied to chickens in the control group. Four chickens from each group were randomly selected at the 1st, 7th, 10th, 14th, 18th, 21st and 28th days for biomechanical analysis. Biome-chanical parameters including tensile strength of rupture (Pmax), elongation ratio at rupture (δimax) and the tensile adhesion strength of the rupture zone (W0>) were observed at each time point. Results At the 7th, 10th, 14th, 18th, 21st and 28th day after the operation, the differences in Pmax, δmax and W0 between the therapy and control groups were statistically significant. The results of the therapy group were better than those of the control group. Conclusions Local decimeter wave therapy after flexor tendon repair can promote intrinsic healing and reduce ex-trinsic healing. The speed and quality of healing are improved. The elasticity and tenacity of the injured tendons are enhanced. Therefore decimeter wave therapy is helpful for early active mobilization training.
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Objective To investigate the analgesic effect and safety of intravenous flurbiprofen axetil combind with fentanyl and propofol on coloscopy.Methods Ninety patients undergone coloscopy were randomly assigned into three groups according to different analgesics received(30 in each,groupⅠ: fentanyl 1?g/kg;groupⅡ flurbiprofen axetil combined with fentany 0.5?g/kg;group Ⅲ: fentany 0.5?g/kg).Patients in group Ⅱ received intravenous flurbiprofen axetil 1mg/kg 10min before examination.All patients were given intravenous midazolam 0.02mg/kg 2mins before examination,however patients in group Ⅰ received intravenous fentanyl 1?g/kg followed by intravenous propofol 0.5-1mg/kg,whereas patients in group Ⅱ and Ⅲ received intravenous fentanyl 0.5?g/kg followed by equal dosage of propofol.Propofol was administrated according to patients' reaction during examination.After the examination all patients were transferred to recovery room.BP,HR and SpO2 were measured before and after drug administration,when the coloscope reached the splenic flexure of the colon and after the examination.Dosage of propofol and fentanyl,duration of coloscopy,side effects and patients' memory of pain during examination were recorded.Results Propofol dosages of the three groups were 82.0?23.8mg,73.0?25.0mg and 108.2?36.5mg,respectively.Propofol dosage of group Ⅲ was much larger than that of groups Ⅰand Ⅱ(P0.05).Dizziness and nausea occurred in 17 patients in group Ⅰ when they left the recovery room,whereas the same side effects only appeared in one patient in group Ⅱ and 3 patients in group Ⅲ,respectively.It was shown by follow-up that all patients of the three groups had no memory of pain.Conclusion Intravenous flurbiprofen axetil may strengthen intraoperative analgesia during coloscopy,reduce the dosage of fentanyl and propofol,and decrease the side effects of anesthesia.
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Objective To compare the influences of sulfentanyl or fentanyl combined with midazolam on respiratory function in slow induction of anesthesia.Methods Forty ASA Ⅰ-Ⅱ patients were divided into two groups.Anesthesia was induced with midazolam 0.03mg/kg in both groups,and fentanyl 2?g/kg(i.v.)was given in fentanyl group or sulfentanyl 0.2?g/kg(i.v.)in sulfentanyl group.Five minutes later,2ml of 1% decicaine was administered by cricothyroid membrane puncture to facilitate the intubation.Respiratory indexes(respiratory frequency,VT,MVV,PETCO2,SPO2),circulatory indexes(MAP,HR)and sedation level were measured before and 1,2,3,4,5 minute(s)after injection of drugs,at cricothyroid membrane puncture,and pre-and post-intubation.Results Patients showed respiratory depression(respiratory frequency was reduced)in both groups 2 minutes after injection of drugs.However,respiratory frequency was decreased more markedly in fentanyl group than that in sulfentanyl group.Ten out of 20 patients were obliged to receive breathing intervention in fentanyl group,but two in sulfentanyl group.Conclusion In combination with midazolam,sedative effect of sulfentanyl is stronger than that of fentanyl in equivalent analgesic dose,but with less respiratory depression.Sulfentanyl may be more suitable for slow induction of anesthesia.
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Objective To study the effects of total intravenous anesthesia and combined inhalation and intravenous anesthesia on arousing time and recovery quality in rectifying surgery of scoliosis. Methods Forty patients (ASAⅠ-Ⅱ) were divided randomly into total-intravenous anesthesia group and combined inhalation and intravenous anesthesia group (n=20 each). Target controlled infusion (TCI) with propofol (2-4?g/ml) was used for maintenance in total intravenous anesthesia group, while isoflurane (0.8%-1.5%) and nitrous oxide (50%) were used in combined inhalation and intravenous anesthesia group. TCI remifentanyl (2-6ng/ml) was used for maintenance in both groups. Results Arousing time were 19.7?5.1min in total intravenous anesthesia group, but 11.9?3.3 min in combined inhalation and intravenous anesthesia group (P