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Objective:To investigate the difference of curative effect between zero-profile bridge-shaped locking cage (ROI-C) and anterior cage combined with titanium plate fixation in the treatment of two-level and three-level cervical spondylotic myelopathy.Methods:A total of 85 patients (43 males and 42 females), aged 52.3±8.0 years (range from 28 to 66 years) with bi- and three-level cervical spondylotic myelopathy who received surgical treatment from June 2017 to October 2019 were retrospectively analyzed. There were 63 cases of two levels and 22 cases of three levels. 45 cases were treated with zero-profile bridge-shaped locking cage ROI-C (ROI-C group), and 40 cases with anterior cage combined with titanium plate fixation (titanium plate group). The main observation indicators include operation time, intraoperative blood loss, cervical Cobb angle, fusion segment Cobb angle, average intervertebral height, pain visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) Score and neck disability index (NDI).Results:All of 85 patients were followed up for 16.9±2.0 months (range 12 to 22 months). The operation time of two-level ROI-C group was 110.37±8.25 min, which was shorter than 139.5±10.54 min of titanium plate group; the intraoperative blood loss was 15.74±8.10 ml, which was less than 23.71±9.70 ml of titanium plate group; the operation time of three-level ROI-C group was 130.00±5.70 min, which was shorter than 162.83±5.59 min of titanium plate group, while the difference in the intraoperative blood loss between the two groups had no statistical significance. One year after operation, Cobb angle of cervical vertebra in double and three-level ROI-C groups were 15.31°±1.55° and 15.20°±0.42°, respectively, which were largerthan 11.23°±2.03° and 9.20°±1.14° before operation; in titanium plate group, they were 15.89°±1.13° and 16.08°±1.88°, which were higher than 11.25°±2.01° and 9.00°±1.60° before operation, and the differences had statistical significance. The differences between the two groups before operation and 1 year after operation had no statistical significance. One year after operation, the VAS scores of double and three-level ROI-C groups were 1.83±0.66 points and 2.60±0.52 points, respectively, which were less than the preoperative 7.49±0.51 points and 7.60±0.52 points; the titanium plate group was 1.79±0.50 points and 2.41±0.51 points, which were less than the preoperative 7.61±0.63 points and 7.42±0.52 points, and the differences had statistical significance. There was no significant difference between the two groups before operation and 1 year after operation. One year after operation, the JOA scores of double and three-level ROI-C groups were 15.00±0.84 points and 14.70±0.95 points, respectively, which were higher than the preoperative 7.20±0.87 points and 6.60±1.27 points; the scores of titanium plate group were 15.29±0.85 points and 14.83±0.58 points, which were higher than the preoperative 6.89±1.03 points and 6.92±0.67 points, and the differences had statistical significance. The differences between the two groups had no statistical significance. The postoperative JOA improvement rate was excellent. Postoperative dysphagia occurred in 1 case (2.22%, 1/45) in ROI-C group and 8 cases (20.00%, 8/40) in titanium plate group, and the difference in the incidence rate between two groups had statistical significance ( χ2=5.32, P=0.02). Conclusion:Both ROI-C and anterior cage combined with titanium plate fixation in the treatment of double and three-level cervical spondylotic myelopathy can achieve good short-term clinical efficacy, with shorter operation time and lower incidence rate of postoperative dysphagia using ROI-C.
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Objective@#To investigate the clinical effect of percutaneous curved vertebroplasty in the treatment of thoracolum-bar osteoporotic vertebral compression fractures (OVCFs).@*Methods@#All of 85 patients with single thoracolumbar vertebral OVCFs who met the admission criteria from January 2017 to July 2018 were divided into three groups according to the random dig-its table method. They were treated with percutaneous curved vertebroplasty, routine unipedicular PVP and routine bipedicular PVP respectively. There were 25 patients in the percutaneous curved vertebroplasty group, 6 males and 19 females; aged 56-80 years, with an average age of 70.6±9.7 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 3 cases, L1 9 cases, L2 3 cases, L3 1 case, L4 1 case and L5 2 cases. There were 32 patients in the routine unipedicular PVP group, 6 males and 26 fe-males; aged 58-75 years, with an average age of 69.5±9.3 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 5 cases, L1 11 cases, L2 6 cases, L3 1 case, L4 1 case and L5 2 cases. There were 28 patients in the routine bipedicular PVP group, 5 males and 23 females; aged 59-81 years, with an average age of 69.8±8.8 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 4 cases, L1 10 cases, L2 4 cases, L3 1 case, L4 1 case and L5 2 cases. The operation time, injected cement volume, in-traoperative blood loss were recorded and analyzed. Preoperative, postoperative 1 week and 3 months visual analogue scale scores and oswestry disability index were adopted to value the clinical improvements. Preoperative, postoperative 1 week and 3 months relative vertebral height and kyphosis correction, and the cement leakage rate were measured and analyzed.@*Results@#There was no significant difference in the data of gender, age, VAS scores, ODI and distribution of fracture vertebrae among the three groups (P>0.05), and the baseline data was comparable. The average VAS score in the percutaneous curved vertebroplasty group was 2.3±0.5 at 1 week after surgery, that of the routine unipedicular PVP group was 2.4±0.4 and that of the routine bipe-dicular PVP group was 2.4±0.4; the average ODI in the percutaneous curved vertebroplasty group was 19.8%±3.9%, that of the routine unipedicular PVP group was 20.0%±4.1% and that of the routine bipedicular PVP group was 19.9%±3.8%; they were lower than the preoperative data, which were statistically significant (P<0.001). The average relative vertebral height in the percutaneous curved vertebroplasty group was 48.99%±9.23% at 3 months after surgery, that of the routine unipedicular PVP group was 47.11%±10.12% and that of the routine bipedicular PVP group was 46.71%±11.16%; the average kyphosis cor-rection in the percutaneous curved vertebroplasty group was 6.21%±1.94%, that of the routine unipedicular PVP group was 5.22%±2.07% and that of the routine bipedicular PVP group was 5.97%±2.09%; there was 1 cement leakage case in the per-cutaneous curved vertebroplasty group; those of the routine unipedicular PVP group were 4 cases and those of the routine bipe-dicular PVP group were 6 cases; there was no significant difference among the three groups (P>0.05). Operation time 39.10±2.00 min vs 38.70±1.70 min, injected cement volume 3.60±0.11 ml vs 3.50±0.13 ml and blood loss 5.10±0.30 ml vs 5.00±0.40 ml of the percutaneous curved vertebroplasty group and the routine unipedicular PVP group were less than those of the routine bipedicular PVP group, which were statistically significant (P<0.05).@*Conclution@#Percutaneous curved vertebroplasty could achieve satisfactory clinical outcomes for OVCFs, with advantages of less operation time, less blood loss, limited X-ray expo-sure, less injected cement volume, and more balanced augmentation for stabilization of the affected vertebrae and total verte-bral column.
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Objective To investigate the clinical effect of percutaneous curved vertebroplasty in the treatment of thoracolum?bar osteoporotic vertebral compression fractures (OVCFs). Methods All of 85 patients with single thoracolumbar vertebral OVCFs who met the admission criteria from January 2017 to July 2018 were divided into three groups according to the random dig?its table method. They were treated with percutaneous curved vertebroplasty, routine unipedicular PVP and routine bipedicular PVP respectively. There were 25 patients in the percutaneous curved vertebroplasty group, 6 males and 19 females; aged 56-80 years, with an average age of 70.6±9.7 years. Fracture vertebral body distribution:T10 2 cases,T11 4 cases,T12 3 cases, L1 9 cases, L2 3 cases, L3 1 case, L4 1 case and L5 2 cases. There were 32 patients in the routine unipedicular PVP group, 6 males and 26 fe? males; aged 58-75 years, with an average age of 69.5±9.3 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 5 cases, L1 11 cases, L2 6 cases, L3 1 case, L4 1 case and L5 2 cases. There were 28 patients in the routine bipedicular PVP group, 5 males and 23 females; aged 59-81 years, with an average age of 69.8±8.8 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 4 cases, L1 10 cases, L2 4 cases, L3 1 case, L4 1 case and L5 2 cases. The operation time, injected cement volume, in?traoperative blood loss were recorded and analyzed. Preoperative, postoperative 1 week and 3 months visual analogue scale scores and oswestry disability index were adopted to value the clinical improvements. Preoperative, postoperative 1 week and 3 months relative vertebral height and kyphosis correction, and the cement leakage rate were measured and analyzed. Results There was no significant difference in the data of gender, age, VAS scores, ODI and distribution of fracture vertebrae among the three groups (P>0.05), and the baseline data was comparable. The average VAS score in the percutaneous curved vertebroplasty group was 2.3±0.5 at 1 week after surgery, that of the routine unipedicular PVP group was 2.4±0.4 and that of the routine bipe?dicular PVP group was 2.4±0.4; the average ODI in the percutaneous curved vertebroplasty group was 19.8%±3.9%, that of the routine unipedicular PVP group was 20.0%±4.1% and that of the routine bipedicular PVP group was 19.9%±3.8%; they were lower than the preoperative data, which were statistically significant (P<0.001). The average relative vertebral height in the percutaneous curved vertebroplasty group was 48.99%±9.23% at 3 months after surgery, that of the routine unipedicular PVP group was 47.11%±10.12% and that of the routine bipedicular PVP group was 46.71%±11.16%; the average kyphosis cor?rection in the percutaneous curved vertebroplasty group was 6.21%±1.94%, that of the routine unipedicular PVP group was 5.22%±2.07% and that of the routine bipedicular PVP group was 5.97%±2.09%; there was 1 cement leakage case in the per?cutaneous curved vertebroplasty group; those of the routine unipedicular PVP group were 4 cases and those of the routine bipe?dicular PVP group were 6 cases; there was no significant difference among the three groups (P>0.05). Operation time 39.10± 2.00 min vs 38.70±1.70 min, injected cement volume 3.60±0.11 ml vs 3.50±0.13 ml and blood loss 5.10±0.30 ml vs 5.00±0.40 ml of the percutaneous curved vertebroplasty group and the routine unipedicular PVP group were less than those of the routine bipedicular PVP group, which were statistically significant (P<0.05). Conclution Percutaneous curved vertebroplasty could achieve satisfactory clinical outcomes for OVCFs, with advantages of less operation time, less blood loss, limited X?ray expo?sure, less injected cement volume, and more balanced augmentation for stabilization of the affected vertebrae and total verte?bral column.
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Objective To explore the high risk factors of stillbirth. Methods 176 cases of stillbirth were collected in the Obstetrics and Gynecology Hospital of Fudan University from January 1st, 2010 to December 31st, 2016. All cases were analyzed retrospectively, including general profile, high risk factors of stillbirth in different years and pregnancy periods. Results (1) The incidence of stillbirth was 0.178%(176/98 785). Stillbirth occured mostly at 28-28+6gestational weeks (10.8%,19/176), and the second peak was 29-29+6weeks(10.2%,18/176),while the third common period was 37-37+6weeks(9.1%,16/176).After 39 weeks,it maintained at a low level.(2)The top 5 high risk factors of stillbirth were infection (18.2%,32/176), unexplained (13.6%,24/176), hypertention disorders in pregnancy (13.1%, 23/176), umbilical cord torsion(12.5%,22/176)and fetal malformations(10.2%,18/176).(3)From 2010 to 2012,the top 3 high risk factors were unexplained, the umbilical cord torsion and infection, while hypertention in pregnancy,infection and fetal malformation became the top 3 high risk factors after 2013.(4)Early stillbirth (20-27+6weeks)accounted for 21.6%(38/176);and unexplained(47.4%,18/38),fetal edema(13.2%,5/38), infection(13.2%,5/38),umbilical cord torsion(5.3%,2/38)were the top 4 high risk factors.Late stillbirth(≥28 weeks)accounted for 78.4%(138/176),with infection(19.6%,27/138),hypertention in pregnancy(15.9%, 22/138), umbilical cord torsion (14.5%,20/138) and fetal malformation(12.3%,17/138)being the top 4 high risk factors. Conclusions More attention should be paid to maternal complications, especially infection and hypertension in pregnancy. Antenatal fetal monitoring, timely termination of pregnancy, standard management of stillbirth and looking for the causes may help reduce the incidence of stillbirth.
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Objective To observe the curative effect of autologous bone marrow stem cells implantation to bone inducing active material combined with core decompression in the treatment of early femoral head osteonecrosis (FHON).Methods From April,2010 to March,2012,in Department of Orthopaedics,the First Affiliated Hospital of Zhengzhou University,a total of 79 adult patients with 108 hips suffered from the early stage FHON were treated with autologous bone marrow stem cells implantation to bone inducing active material combined with core decompression through the core of the femoral canal,male of 65 cases,female of 14 cases,the mean age was 29.5 (20-50) years old.According to the etiology classification:the alcohol-induced FHON was in 54 patients with 66 hips,steroid-induced FHON in 14 patients with 20 hips,steroid and alcohol-induced ONFH was in 11patients with 22 hips.According to association research circulation osseous (ARCO)classifying,Ⅰ-A,Ⅰ-B,Ⅱ-A,Ⅱ-B phases were 6,16,8,and 78 hips,respectively.There were 43 hips in left side and 65 hips in the right side.Results All patients were followed up from 4 to 6 (4.8 ± 0.6) years.Compared with before operation,the scores of all patients were significantly increased (P ＜ 0.05).All patients with hip pain symptoms were relieved or disappeared.The healing tine of the patients in all age groups was statistically significant (P ＜ 0.05),and with the increase of age,the healing time was prolonged.The excellent and good rates of Ⅰ-A,Ⅰ-B,Ⅱ-Aand Ⅱ-B were 100％ (6 / 6),100％ (16/16),100％ (8/8),and 98.7％ (77/78).The X-ray showed that coarse channel osteogenic phenomenon is obvious,there is 1 case collapse of femoral head of stage Ⅱ-B,the rest were not collapse.Conclusion The treatment of early osteonecrosis of the femoral head with autologous bone marrow stem cells implantation to bone inducing active material combined with core decompressionis definitely effective,especially in patients with ARCO:Ⅰ-A,Ⅰ-B and Ⅱ-A phase,and the effect of ARCO:Ⅰ-A and Ⅱ-A is the best.
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To evaluate the feasibility and efficacy of modified Kloen approach for the treatment of ace tabular fractures through lateral window exposure beneath fascia iliaca with superior ramus of pubis exposure by internal small incision. Matta radiological criteria was employed to evaluate the post operation recovery, and modified D'Aubigne-Postel evaluation system was adopted for demonstration of hip joint function condition. There is no incision infection, neurovascular trauma or postoperative lymphorrhagia. 42 patients cooperated with the following up of 11.2 months. The average bone healing time was 13 weeks. Matta radiological criteria was to evaluate the postoperative fracture quality, 18 case with excellent recovery, 16 cases with good recovery, 4 cases with normal recovery and 1 case with bad recovery. Modified D'Aubigne-Postel evaluation was taken 6 months after surgery, 17 cases with excellent recovery, 22 cases with good recovery, 2 cases with normal recovery and 1 case with bad recovery. There was no internal fixation loosening, breakage or inguinal hernia. The modified Kloen approach can improve iliofemoral vascular activity, expense exposure range for restoration and fixation. Besides, the exposure of articular surface could ensure the condition of restoration quality, and avoid the incidence of postoperative hernia
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Objective To examine the distribution of systemic inflammation and risk factors of cardiovascular disease (CVD) in patients with psoriatic arthritis (PsA) by comparing with healthy controls.Methods Forty PsA patients and 44 controls were recruited into this cross-sectional study.We evaluated the disease activity and severity [erythrocyte sedimentation rate (ESR),C reactive protein(CRP) and Disease Activity Score (DAS)28],functional ability in patients with predominant axial involvement [Bath AS disease activity index (BASDAI) and Bath AS functional index (BASH)],traditional CVD risk factors and inflammation between these two groups of patients.Then,we compared risk factors for CVD between 40 consecutive PsA patients and 44 controls,adjusted for body mass index (BMI).The frequencies were compared using chi-square tests for categorical variables.Student's t-tests or Mann-Whitney U-tests were used forcontinuous variables where appropriate.Association between the traditionaland metabolic risk factors and the hs-CRP level were assessed using Spearman correlations.Finally,we also assessed the role of inflammation on the CVD risk factor by using a BMI and hs-CRP-adjusted model.Results The BMI of PsA patients was significantly higher than that of the controls.After adjusting for the BMI,PsA patients had a higher prevalence of hypertension (OR=5.615,95％CI 1.844-17.099) and diabetes mellitus (OR=10.655,95％CI 1.150-98.683) than the controls.PsA patients had significantly increased systolic and diastolic blood pressures [(SBP) and (DBP)],total cholesterol (TC)/high density lipoprotein cholesterol (HDL),insulin resistance,inflammatory markers (hsCRP,white cell count and platelet) and decreased HDL compared to the controls.As excepted,the hsCRP level [4.0 (2.1-13.9) vs 1.7 (1.3-2.2)],platelet and white cell counts were significantly increased in the PsA group reflecting underlying inflammation.Further adjustment for hsCRP level rendered the differences in the prevalence of hypertension (OR=3.544,95％CI 1.151-10.914);but the DBP,HDL and sugar levels were non-significantly different between the two groups,while the differences in other parameters were significant.Conclusion The data support the hypothesis that PsA may be associated with hypertension,obesity and dyslipidemia because of the shared inflammation pathway.
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Objective To investigate the mid?term follow?up results of bone grafting pedicled with the femoral quadra?tus augmented with a titanium mesh for alcohol?induced osteonecrosis of the femoral head and to analyze the technical factors affecting the surgical outcome. Methods Twenty cases (24 hips) treated with bone grafting pedicled with the femoral quadratus augmented with a titanium mesh between January 2008 and September 2009 were retrospectively reviewed. Control group includ?ed 18 cases (20 hips) treated with bone grafting pedicled with the femoral quadratus alone in the same period. All the hips were al?cohol?induced femoral head necrosis and were classified as ARCOⅡC or ARCOⅢA stage. The one hundred points method was used for outcome evaluation. Statistical analysis was performed using SPSS statistical package 13.0(SPSS Inc., USA). Results The titanium group has a longer operative time and more estimated blood loss than the bone?grafting group with statistical signifi?cance. For the twenty cases in the titanium group, two cases were lost to follow?up with another one case receiving total hip arthro?plasty due to severe collapse, and the rest were followed for an average of 62.7 (58 to 66) months. For the eighteen cases in bone-grafting group, one case was lost to follow?up with another one case receiving total hip arthroplasty due to severe collapse, and the rest were followed for an average of 61.3 (57 to 64) months. At the last follow?up, the titanium group had a successful rate of 85.7%(excellent in 13, good in 5 and fair in 2) with a five?year survival rate of 95.2%(20 out of 21 hips) and the bone?grafting group had a successful rate of 84.2%(excellent in 13, good in 3 and fair in 2) with a five?year survival rate of 94.7%(18 out of 19 hips). Clini?cal and radiographic outcomes were not statistically significant different between the two groups. Mild collapses were noted radio?graphically in both groups, with 7 out of 20 in titanium group and 5 out of 18 in the bone?grafting group. Among these mildly col?lapsed cases, the cases in titanium group had a relatively better clinical outcome than those in the control group and the cases with a larger mesh supporting area had an even better clinical outcome. Conclusion The mid?term follow?up results of bone grafting pedicled with the femoral quadratus augmented with a titanium mesh for alcohol?induced osteonecrosis of the femoral head were satisfactory. Factors affecting surgical outcomes included the placement of the titanium mesh, and the bone?grafting technique.
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Objective To analyze the clinical effect of the bone grafting pedicled with femoral quadratus for the osteonecrosis of femoral head.Methods The clinical operation data were analyzed from 355 patients with osteonecrosis of femoral head underwent by the surgery of the bone grafting pedicled with femoral quadrates in the First Affiliated Hospital of Zhengzhou University from August,2006 to June,2013.According to association research circulation osseous (ARCO) classifying,41,126,115,62,6 and 5 patients were in stage Ⅰ-C,Ⅱ-A,Ⅱ-B,Ⅱ-C,Ⅲ-A,and Ⅲ-B.The results were evaluated by the hundred forked method.Results All the patients obtained the outpatient followed-up after operation,the follow-up time was 1-8 (4.3 ± 1.8) years.The pain of the hip,the function of the joint,the motion of hip joint,and the X ray evaluation became better than preoperations.There were statistically significant differences in the healing time among all the age patients (P ＜ 0.05),along with the age growth,the healing time gradually extended.Compared with that before operation,the scores of all the stage patients after operation were higher (P ＜ 0.05).The rate of excellent and good results were 98.5％,98.0％,92.3％,89.7％,83.5％,81.3％ in stage Ⅰ-C,Ⅱ-A,Ⅱ-B,Ⅱ-C,Ⅲ-A,and Ⅲ-B,the excellent and good rate was 93.8％ of all the 355 patients.Conclusion Bone grafting pedicled with femoral quadratus is effective surgical method for the osteonecrosis of femoral head.
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<p><b>BACKGROUND</b>Steroids inhibit osteogenic differentiation and decrease bone formation while concomitantly inducing adipose deposition in osteocytes. This leads to the fatty degeneration and necrosis of bone cells commonly seen in osteonecrosis of the femoral head. The peroxisome proliferator-activated receptor-γ (PPARγ) is an adipogenic transcription factor linked to the development of this disease and responsible for inducing adipogenesis over osteogenesis in bone marrow mesenchymal stem cells (BMSCs). The aim of this study was to assess whether adipogenic differentiation could be suppressed, and thus osteogenic potential retained, by inhibiting PPARγ expression in BMSCs.</p><p><b>METHODS</b>Cells from the bone marrow of New Zealand rabbits were treated with 10(-7) mol/L dexamethasone and infected with one of three small interference RNA (siRNA) adenovirus vectors (S1, S2, and S3) or non-targeting control siRNA (Con) and compared with dexamethasone-treated (model) and untreated (normal) cells. Cells were grown for 21 days and stained with Sudan III for adipocyte formation. At various time points, cells were also assessed for changes in PPARγ, osteocalcin (OC), Runx2, alkaline phosphatase (ALP) activity, and triglyceride (TG) content.</p><p><b>RESULTS</b>Dexamethasone-treated model and control groups showed a significant increase in fatty acid-positive staining, which was inhibited in cells treated with PPARγ siRNA-treated, similar to normal untreated cells. All three siRNA groups significantly inhibited PPARγ mRNA and protein, adipocyte number, and TG content compared with the dexamethasone-treated model and control groups, matching that seen in normal cells. OC and Runx2 mRNA and protein, as well as ALP activity, were significantly higher in cells treated with siRNA against PPARγ, similar to that seen in the normal cells. These osteogenic markers were significantly lower in the dexamethasone-treated cell cultures.</p><p><b>CONCLUSIONS</b>The siRNA adenovirus vector targeting PPARγ can efficiently inhibit steroid-induced adipogenic differentiation in rabbit BMSCs and retain their osteogenic differentiation potential.</p>
Subject(s)
Animals , Rabbits , Adenoviridae , Genetics , Adipogenesis , Genetics , Cell Differentiation , Genetics , Mesenchymal Stem Cells , Cell Biology , Metabolism , PPAR gamma , Genetics , Metabolism , Pharmacology , RNA, Small Interfering , SteroidsABSTRACT
Objective To compare the analgesia effect and the safety of Flurbiprofen Axetil (FA) and Parecoxib Sodium (PS) after posterior lumbar fusion surgery. Methods 90 patients undergoing internal fixation of lumbar spine randomly assigned to 3 groups:those in Group A(n = 30) received 100 mg of FA; those in Group B (n=30) received 40 mg of PS and those in Group C received saline.The VAS scores of 2, 6, 12, 24, 48, 72 h after operation and the dose of tramadol hydrochloride (TH) used and the side effect was recorded respectively. Results Group A and B had significantly better analgesic effect than Group C(P<0.05). Group A and B had lower average dose of TH than Group C (P<0.05). The VAS scores in Group A was lower than that in Group B in 2 h after the surgery. The VAS scores after the surgery showed no significant difference between Group A and B in 6 , 12, 24 h after the surgery. The VAS scores in Group A was higer than that in Group B in 48,72 h after the surgery. Conclusion Both PS and FA can alleviate postoperative pain and have fewer adverse reactions.
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Objective To observe the damage degree and expression pattern of Caveolin-3 mRNA by ischemia-reperfusion injury in rabbits of skeletal muscle cell at different phases.Methods In this study,from April 2013 to December 2013,30 lower limbs of 15 Chinese White Rabbits were used and divided into two groups:all the left lower limbs were experimental group,which were made as an experimental model of ischemia-reperfusion injury by occluding left common iliac artery using noninvasive vascular.All the right lower limbs without surgical treatment were the control group.Gastrocnemius samples were obtained at 4h and 8h after reperfusion and handled by HE staining and observed by optical microscopy.By Real-time PCR,Caveolin-3/GAPDH mRNA were detected.Results HE stain showed:in control group,there was no edema,degeneration and inflammatory cell infiltration; in experi-meatal group,muscle cell degeneration had occured at ischemic 5 h.The edema was aggravated,a large number vacuole were formed and inflammatory cell were infiltrated at 4 h reperfusion.Reperfusion injury at 8h significantly reduced compared to 4 h.The Caveolin-3/GAPDH mRNA expression levels by SPSS 19.0 showed:Control group:1.026 ± 0.065,1.004 ±0.037,1.022 ±0.051,experimental group:1.159 ±0.073,1.445 ±0.053,1.208 ±0.058 at ischemic 5 h,4 h and 8 h reperfusion,respectively.On-line analysis of variance cases of ischemic 5 h and 4 h reperfusion and 8 h reperfusion,the experimental group than the control group were increased,with statistical significance (P ＜ 0.05).The experimental group of ischemic 5 h and 8 h reperfusion was no significant difference (P ＞ 0.05).It showed Caveolin-3 mRNA expression levels in ischemia-reperfusion 8 h group returned to normal.There was significant statistical difference between the ischemic 5 h and 4 h reperfusion (P ＜ 0.05).There was significant statistical difference between the 4 h reperfusion and 8 h reperfusion (P ＜ 0.05).Conclusion The expression of Caveolin-3 in experimental group showed a trend of first increased and then decreased.The expression levels of Caveolin-3 mRNA in skeletal muscle cells after ischemia-reperfusion injury is consistent with the development and progression of muscle cell damage.The results indicate that Caveolin-3 may play a control role in the injury and recovery of skeletal muscle cell.
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BACKGROUND:At present, occlusion of the drainage tube was commonly used to reduce the drainage volume after total hip arthroplasty so as to promote the incision healing and hip function rehabilitation. However, the occlusion time is a problem deserving further investigations. OBJECTIVE:To research the effects of temporarily clamping drainage tube on drainage volume in early stage after total hip arthroplasty. METHODS:From January to October 2013, 112 patients received unilateral total hip arthroplasty in the First Ward, Department of Orthopedics, First Affiliated Hospital, Zhengzhou University in China. They were randomly divided into four groups according to the admission time (n=28):occlusion of the drainage tube for 2, 4 and 6 hours and without occlusion of the drainage tube. Al tubes were pul ed out in postoperative 48 hours. Moreover, 48-hour postoperative hemoglobin and drainage volume, the healing of incision and the score of hip joint function when patients were fol owed up at 1.5 months postoperatively were recorded accurately. RESULTS AND CONCLUSION:48-hour hemoglobin drop level and 48-hour incision drainage volume were highest in the non-occlusion group, fol owed by 2-hour occlusion group, 4-hour occlusion group and 6-hour occlusion group (P0.05). Incision infection and tension split were not seen in each group. Six cases affected subcutaneous ecchymosis and swel ing accompanied by pain and four cases suffered from the venous plexus thrombosis of the calf muscle in the 6-hour occlusion group. One case experienced fat liquefaction separately in the 4-hour occlusion group and non-occlusion group. These results suggested that temporary occlusion of the drainage tube in the early stage of total hip arthroplasty could reduce the drainage volume of incision. The suitable time of clamping drainage tube was 4 hours, and there were no adverse effects on healing of incision and recovery of hip function.
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BACKGROUND:Deep vein thrombosis and pulmonary embolism are certainly related to seasons. OBJECTIVE:To analyze whether there is a seasonal pattern for deep venous thrombosis (DVT) after total hip and knee arthroplasty. METHODS:We retrospected 866 patients (1 114 joints) underwent total hip and knee arthroplasty. There were 506 cases of total hip arthroplasty, including 287 male cases and 219 female cases, and 608 cases of total knee arthroplasty, including 133 male cases and 475 female cases. The average age was (60.98±0.87) years. After arthroplasty, patients were given color Doppler ultrasound in the deep veins of the lower limbs and pelvis to analyze the correlation between occurrence of deep vein thrombosis and seasons. RESULTS AND CONCLUSION:There was a significant difference in the incidence of deep vein thrombosis in summer and winter (χ2=7.190, P=0.007), in summer and spring (χ2=6.995, P=0.008), as wel as in summer and autumn (χ2=5.663, P=0.017). No statistical differences were tested in spring and autumn, in autumn and winter, and in spring and winter (P>0.05). These findings indicate that there is a seasonal variation of deep venous thrombosis after arthroplasty, and the highest incidence of deep vein thrombosis is in winter.
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Objective To describe the general condition of workplace violence against emergency department nurses in five hospitals of Guangzhou;to investigate the status of the post-traumatic stress disorder in the emergency department nurses after suffering from workplace violence;to analyze the relative factors of post-traumatic stress disorder.Methods 143 emergency department nurses from 5 hospitals in Guangzhou were investigated by general information questionnaire,workplace violence questionnaire,PCLC and SSRS.The investigation data were analyzed.Results 86.7％ of emergency department nurses suffered from workplace violence during the past 1 year;the most popular style was non-physical violence.The emergency department nurses suffered from negative emotional experience,such as grievance,chagrin,low work passion,not focused spirit.The scores of PCL-C of emergency department nurses who had suffered from workplace violence were obviously higher than those who hadn't.21.8％ of the emergency department nurses who suffered from workplace violence in the past one year had certain degree of the signs of PTSD,12.1％ had obvious signs of PTSD.The influencing factors of PTSD:degree of hurt,objective support and availability of social support.Conclusions The situation of workplace violence which the emergency department nurses were faced with was more and more grave.The emergency department nurses who had suffered from workplace violence were in different degree of PTSD.The more social supports the nurses get,the better mental health status they will possess.
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Objective To discuss the anatomical and radiographic characteristics of acetabular fossa,and evaluate their value as a reference for achieving the anticipated inclination of the acetabular cup.Methods Sixteen adult normal pelvic specimens were studied.Central axis of acetabular fossa and its intersection with fossa edge and acetabular rim were marked.The radiographic appearance of the two intersections was evaluated.With radiographic templating,the relationship between the top of acetabular fossa and the central axis of acetabular cup at anticipated inclination was identified.Implantation of cementless acetabular cup was performed bilaterally on the pelvic specimens.The acetabular fossa was used as a reference for implantation on one side,and the acetabular positioning device was used on the other side.The discrepancy of acetabular inclination was recorded before and after operation in the two groups.Results Intersection of central axis of acetabular fossa with fossa top edge and acetabular rim corresponded to the most medial and lateral aspect of acetabular sourcil respectively on standard anteroposterior pelvic radiograph.There was close correlation between most medial aspect of acetabular sourcil and central axis of the acetabular cup at anticipated inclination of 40°±5°.For the group of using acetabular fossa as reference,the mean difference of inclination was 0.19°±3.14°(-6°-5°)before and after operation,and the discrepancy was 2.75°±2.89°(-2°-8°)for the control group.The difference between the two groups was statistically significant(t=-2.453,P=0.027).Conclusion In primary total hip replacement,if normal anatomy of acetabulum was found,the anticipated inclination of acetabular cup can be accurately obtained,based on the relationship between the top of acetabular fossa and anticipated inclination of acetabular cup on preoperative templating.
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Objective To investigate the affect of rhTNFR:Fc on the postoperative recovery of patients with inflammatory arthritis after arthroplasty. Methods Patients with inflammatory arthritis undergoing arthroplasty were included and divided into rhTNFR:Fc group (rhTNFR:Fc only or combined with conven-tional DMARDs) and conventional DMARDs group (monotherapy with or combination of conventional DMARDs). We retrospectively analyzed the incidence of postoperative infection, wound healing time, the febrile period (body temperature ≥37.5 ℃) and the duration of antibiotics treatment after arthroplasty. x2 test and t test were used for statistical analysis. Results Sixty-seven patients were included, 18 in the rhTNFR: Fc group and 49 in the conventional DMARDs group. One postoperative infection occurred in rhTNFR :Fc group but none in the DMARDs group. There was no significant difference by Fisher's exact test (P＞0.05). The febrile duration was (4±3) days in the rhTNFR :Fc group and (3±3) days in the conventional DMARDs group, the difference was not statistically significant (P＞0.05). The wound healing time was (14.0±3.1) days in the rhTNFR :Fc group and (14.7±2.9) days in the conventional DMARDs group, which was not statistically different(P＞0.05). The duration of antibiotics treatment after operation was (14.8±9.3) days in the rhTNFR: Fc group and (10.3±2.7) days in the conventional DMARDs group, the difference was statistically significant (P＜0.05). Conclusion Using rhTNFR:Fc during perioperative period in patients with inflammatory arthritis does not increase the risk of infectious complications or extending wound healing time and the febrile duration.
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Objective To investigate the effects and possible mechanisms of platelet-activating factor (PAF) on the invasion of ovarian cancer cells and to provide a potential target for ovarian cancer therapy.Methods ( 1 ) Serous type ovarian cancer cell line OVCA429 with platelet-activating factor receptor (PAFR) positive and mucinous type cell line RMUG-L (PAFR negative) were treated with 100 nmol/L of the PAF,cell invasion ability was determined by transwell cell migration assay.(2) For determination of the optimal PAF concentration,ovarian cancer cell OVCA429 was treated by 0,0.1,1,10,100,and 1000 nmol/L of PAF for 10 minutes or 24 hour,respectively.To observe the different time point of protein changes,OVCA429 were treated by 100 nmol/L of PAF for 0,5 minutes,10 minutes,30 minutes,1 hour or 12 hours,respectively.The total proteins of treated cells were extracted according to standard protocol.The expression of p38 mitogen-activated protein kinase (p38 MAPK),phosphorylated p38 MAPK (p-p38 MAPK),transcription factor response element-binding protein (CREB),phosphorylated CREB (p-CREB) and matrix metalloproteinase-2 (MMP-2) were detected by western blot.(3) To verify the pathway involved in the PAF induction of the cancer cell invasion,we repeated the experiments by adding the inhibitors when treating cells with PAF.The inhibitors used were as follows,PAFR inhibitor-WEB2076 (50 μmol/L),pp38 MAPK inhibitor-SB203580 (10 μmol/L),CREB binding protein (CBP)-CREB interaction inhibitor217505(25 μ mol/L).All treated cells were divided into 6 groups:control group,PAF group,PAF + WEB2076 group,PAF + SB203580 group,PAF + 217505 group and PAF + SB203580 + 217505group.Results ( 1 ) By transwell assay,100 nmol/L of PAF could improve the invasion ability of OVCA429 cell significantly [ PAF:( 118 ± 23 ) cells vs.control:(36 ± 8 ) cells,P ＜ 0.0l ],while the same treatment had no effect on RMUG-L cells [PAF:(45 t 13) cells vs.control:(53 ±9) cells,P＞0.05].(2) Even a very low concentration of PAF (0.1 nmol/L) could increase the expression of p-CREB and MMP-2,while the most effective concentration of PAF was 100 nmol/L.The highest p-CREB protein expression was detected at 10 minutes after administration of 100 nmol/L PAF,as well as the expression of p-p38 MAPK protein.Even 12 hours after treatment the p-p38 MAPK protein could be detected,while there was no significant difference in the expression of CREB ( P ＞ 0.05 ).(3) As compared with PAF group,both in PAF + WEB2076 group and PAF + SB203580 group,the expressions of p-p38 MAPK,p-CREB and MMP-2 protein were decreased significantly; in PAF + 217505 group,although the expression of p-p38 MAPK and p-CREB protein was significantly higher than the control group,the expression of MMP-2 protein was significantly lower; in PAF + SB203580 + 217505 group,the expression of these three proteins were also significantly lower,but there was no significant difference as compared with that in the PAF + WEB2076 or PAF + SB203580 group.Conclusion PAF could induce MMP-2 expression and contributed to PAFR positive ovarian cancer cell invasion via activation of CREB by phosphorylating of p38 MAPK.
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Objective To assess the CT characteristics of thoracoabdominal localized Castleman disease (LCD) in 55 cases and correlate with histopathologic features. Methods Fifty-five patients with LCD proved histopathologically in thorax ( n = 25 ) and abdomen ( n = 30 ) were collected during past 20 years. The unenhanced and contrast-enhanced CT were performed in all patients. Two radiologists reviewed CT images and the CT findings were analyzed simultaneously. Results In 54 patients with hyaline-vascular type ( n = 50 ) and mixed type ( n = 4 ) localized CD, the lesion typically presented as solitary mass (90. 7% , 49 cases), with irregular or lobular or infiltrative margin ( 83.3% , 45 cases),central calcification (38. 9%, 21 cases), marked enhancement (100% , 54 cases), focal non-necrosis low attenuation areas (72. 2%, 39 cases), lymphadenopathy (70.4%, 38 cases) and dilated feeding vessels adjacent to the mass (96.3%, 52 cases). One lesion with plasma cell type localized CD presented as a mass with irregular margin, mild enhancement and central necrosis. Four morphologic patterns wereclassified on CT, including solitary mass with well-circumscribed margin (n =4), irregular or lobular margin ( n = 30), infiltrative or halo-like margin ( n = 16 ), and multiple coalescent maasses ( n = 5 ). Conclusion CT features of thoracoabdominal localized CD are closely related to the location and pathological type. LCD with hyaline-vascular and mixed type has typical CT characteristics, while LCD with plasma cell type has no typical CT findings.
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Objective To discuss the treatment efficacy of the femoral-head osteonecrosis by umbrella strut bone grafting and bone marrow mesenchymal stem cells. Methods The femoral-head osteonecrosis models on one side were established in forty-two goats using liquid nitrogen, which were randomly classified into three groups after 8 weeks. Group A were conducted umbrella strut bone grafting and bone marrow mesenchymal stem cells transplantation, group B were conducted simple unit side muscle bone flap grafting, and group C were conducted umbrella strut bone grafting and Cancellous bone grafting transplantation. The health side of three groups was treated as self-control. The radiological and histology examination were made at 3,6treated lateral femoral-head shape restored,cystic cnlow-density area disappeared, the original collapse had repaired, and no further collapse of the femoral-head shaped for both group A and B. Bone fusion was good and bone column shadow had been vague for group A, while the bone fusion healed somewhat less and bone column shadow still clear for group B. Group C had irregular contour of femoral head, flat collapse, uneven density, and fracture cracks could be seen at weight-bearing area of femoral head, obviously was the poorest bone had different states: mature and arranged ruled for group A, childish and irregular arrangement for group B, thinning, sparse and fracture for group C. The percentage of empty lacunae counts decreased, while the percentage of trabecular bone area fraction increased for group A. In contrast with group B, and C, the difference was statistically significant (P ＜ 0.05), but the difference was no longer statistically significant when contrast with healthy sides (P ＞ 0.05). 6 months later, the radiological and histology examination showed that:group A and group B had been no significant difference comparing to normal femoral heads, while the femoral head of group C collapsed and disappeared completely. Group A and group B were no difference comparing the healthy side (P ＞ 0.05)in the area fraction of trabecualr bone and percentage of empty lacunae counts, neither it was between group A and group B(P ＞ 0. 05). Conclusion The treatment efficacy of the femoral-head osteonecrosis by umbrella strut bone grafting and bone marrow mesenchymal stem cells was good and was better than cancellous bone grafting transplantation and simple unit side muscle bone flap grafting.