ABSTRACT
The purpose of this research was to compare the therapeutic efficacy of multiple-rod constructs vis-a-vis 2-rod constructs in the treatment of adult spinal deformity. A systematic review and meta-analysis were performed to determine whether the multiple-rod construct outperformed the 2-rod construct. We initially retrieved 357 papers, but only 12 were chosen for further meta-analysis. The rod breakage rates in the multiple-rod and the 2-rod groups were 10.66% and 29.87%, respectively. The multiple-rod construct inhibited rod breakage (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.19–0.41; p<0.001), pseudarthrosis (OR, 0.30; 95% CI, 0.18–0.50; p<0.001) and rod fracture at the osteotomy site (OR, 0.34; 95% CI, 0.13–0.89; p=0.03). Furthermore, the multiple-rod construct reduces the risk of revision surgery (OR, 0.38; 95% CI, 0.20–0.73; p=0.04) as well as the revision risk of pseudarthrosis/rod fracture in the multiple- rod group (OR, 0.31; 95% CI, 0.18–0.52; p<0.001), but increases the risk of caudal screw loosening (OR, 4.99; 95% CI, 1.87–13.30; p=0.001). There was no statistically significant difference in proximal junctional kyphosis (PJK) parameters (p=0.85), cerebrospinal fluid leakage (p=0.09), wound infection (p =0.71), age at surgery (p=0.62), gender distribution (p=0.93), body mass index (p =0.86), smoking status (p=0.05), hospital stay (p=0.09), osteoporosis (p=0.95), CoCr rod material (p=0.15), bone morphogenetic protein-2 (p=0.58), L5/S1 interbody fusion (p=0.07), high-grade osteotomies (p=0.07), the number of fusion levels (p=0.11), operation time (p=0.30), and blood loss volume (p=0.34). Regarding radiographic parameters, only preoperative sagittal vertical axis was found to be higher (weight means difference [WMD], 25.60; 95% CI, 15.43–35.77; p<0.001) in the multiple-rod group. There was no difference in preoperative Oswestry Disability Index (ODI) (WMD, −3.32; 95% CI, −7.38 to 0.73; p=0.11), but the multiple-rod group had a lower ODI at follow-up (WMD, −7.71; 95% CI, −11.62 to −3.86; p<0.001). Multiple-rod constructs could prevent rod breakage and pseudarthrosis while also lowering the revision rate, resulting in a better clinical outcome than the 2-rod construct. Nonetheless, due consideration should be given to PJK and screw loosening in multiple-rod constructs, possibly due to the increased stiffness caused by the multiple-rod structure.
ABSTRACT
Objective:To investigate the efficacy of flexion-lateral curvature-supination reduction combined with primary anterior surgery for the treatment of lower cervical dislocation with unilateral facet inter-locking.Methods:A retrospective analysis was performed in the 32 patients who had been admitted to Department of Spine Surgery, Honghui Hospital for lower cervical dislocation with unilateral facet interlocking from November 2015 to October 2018. According to their treatments, they were divided into 2 groups. In the emergency group treated by flexion-lateral curvature-supination reduction combined with primary anterior surgery, there were 13 males and 3 females, aged from 24 to 63 years. In the traction group treated by cranial traction reduction combined with secondary anterior surgery, there were 12 males and 4 females, aged from 20 to 64 years. The operation time, intraoperative blood loss, hospital stay, bone graft fusion, American Spinal Injury Association (ASIA) grade and Japanese Orthopaedic Association (JOA) score were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P<0.05). All patients were followed up from 26 to 40 months. The hospital stay for the emergency group [(7.2±1.2) d] was significantly shorter than that for the traction group[(10.9±1.2) d] ( P<0.05). There was no significant difference in the operation time, blood loss, ASIA grade or JOA score between the 2 groups ( P>0.05). All patients achieved osseous fusion of intervertebral space. Conclusion:Compared with traditional methods, flexion-lateral curvature-supination reduction combined with primay anterior surgery shows no significant difference in the recovery of neurological function but leads to a shorter hospital stay.
ABSTRACT
Objective:To compare the efficacy of forceful reduction percutaneous pedicle screw and ordinary percutaneous pedicle screw in the treatment of osteoporotic thoracolumbar burst fracture with kyphosis.Methods:A retrospective cohort study was conducted to analyze the clinical data of 566 patients with osteoporotic thoracolumbar burst fracture with kyphosis admitted to Honghui Hospital, Xi ′an Jiaotong University from January 2015 to December 2018, including 191 males and 375 females, with age range of 48-79 years [(61.7±10.7)years]. Fracture segments were located at T 11 in 134 patients, T 12 in 154, L 1 in 160, and L 2 in 118. All fractures were type IIIA according to the acute symptomatic osteoporotic thoracolumbar fracture classification (ASOTLF). The thoracolumbar osteoporotic fracture severity score assessment system (TLOFSAS) score was ≥5 points. A total of 275 patients underwent forceful reduction and percutaneous pedicle screw internal fixation (forceful reduction screw group), and 291 patients underwent common percutaneous pedicle screw internal fixation (common screw group). The operation time, intraoperative blood loss, times of X-ray exposure on patients and measures documented before operation, at 3 days after operation and at 2 years after operation including anterior height ratio of the injured vertebrae, sagittal Cobb angle of the injured vertebrae, Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) were compared between the two groups. Moreover, degree of correction of Cobb angle at 3 days after operation, loss of correction of Cobb angle at 2 years after operation and postoperative complications were observed. Results:All patients were followed up for 25-34 months [(29.9±3.4)months]. The operation time, intraoperative blood loss and times of X-ray exposure on patients in forceful reduction screw group were (69.4±10.2)minutes, (60.3±13.1)ml and (26.8±3.7)times, less than (80.6±11.9)minutes, (80.7±15.4)ml and (30.4±3.4)times in common screw group (all P<0.01). There was no significant difference in anterior height ratio of the injured vertebrae between the two groups before operation and at 3 days after operation (all P>0.05). The anterior height ratio of the injured vertebrae in forceful reduction screw group was (95.5±2.3)% at 2 years after operation, significantly higher than (85.4±1.7)% in common screw group ( P<0.01). There was no significant difference in sagittal Cobb angle of the injured vertebrae between the two groups before operation ( P>0.05). The sagittal Cobb of the injured vertebrae in forceful reduction screw group at 3 days and 2 years after operation were (7.9±1.6)° and (8.8±1.5)°, lower than (10.6±1.1)° and (12.3±1.2)° in common screw group ( P<0.05 or 0.01). There were no significant difference in JOA score and VAS between the two groups before operation, at 3 days and at 2 years after operation (all P>0.05). The degree of correction of Cobb angle in forceful reduction screw group was (19.4±2.5)°, higher than (17.3±2.6)° in common screw group ( P<0.05). The loss of correction of Cobb angle in forceful reduction group was less than that in common screw group at 2 years after operation, but the difference was not statistically significant ( P>0.05). The incidence of postoperative complications in forceful reduction screw group was 12.4% (34/275), compared to 14.1% (41/291) in common screw group ( P>0.05). There were no complications such as iatrogenic nerve injury, fracture or loosening of internal fixator or leakage of bone cement in the spinal canal in both groups. Conclusions:For osteoporotic thoracolumbar burst fracture with kyphosis, forceful reduction and percutaneous pedicle screw internal fixation can significantly shorten operation time, reduce intraoperative blood loss and times of X-ray exposure on patients, restore height of the injured vertebrae, correct kyphosis and maintain reduction height of the injured vertebrae in contrast with conventional percutaneous pedicle screw internal fixation.
ABSTRACT
Objective:To propose a new grading system-the posterior ligament-bone injury classification and severity (PLICS) score for subaxial cervical spine injury, and evaluate its value in guiding the approach selection for subaxial cervical fracture and dislocation.Methods:All of 394 cases of subaxial cervical fracture and dislocation who received single anterior reduction and fixation in our hospital from January 2002 to December 2015 were retrospectively analyzed. According to the inclusion and exclusion criteria, 354 cases were finally included in this study. The Patients experienced internal fixation failure, postoperative kyphosis or interspinal process space dilation during follow-up were included into the failure group. Other patients were included into the successful group. The difference of visual analogue scale (VAS), neck disability index (NDI), ASIA score and PLICS score before and after surgery between the two groups was compared respectively. The PLICS score is composed of left, right and posterior columns. The injury of the posterior column was classified into mild, moderate and severe degrees, with 1-3 points respectively. The evaluation of lateral column injury included ligament and bone structure. The evaluation of ligament injury included: 1 point for the subluxation of the facet joint, 2 points for the dislocation or the facet joint; Fractures of the lateral column was classified into mild, moderate and severe degrees, with 1-3 points respectively. For the evaluation of the lateral column, the highest score of ligament or bone structure injury was reflected as the score of posterior column injury and was taken into the calculation of the final PLICS score.Results:All 354 patients had complete follow-up data, and the average follow-up time was 18.0±4.0 months, including 339 patients of successful group and 15 patients of failure group. At the 12 month follow-up, the average VAS score of the patients in the successful group decreased from 6.9±0.6 before the operation to 1.9±0.6 ( t=22.481, P<0.0001), and the average VAS score of the patients in the failure group decreased from 5.6±1.0 to 1.1±0.3 ( t=77.252, P<0.0001). The difference between the two groups was statistically significant. The NDI score of the successful group was significantly lower than that of the failure group (7.1%±1.2% vs 15.7%±2.7%, t=24.993, P<0.0001). PLICS score in two groups of patients were analyzed. There was a significant difference in PLICS scores between the two groups ( t=8.777, P<0.0001). According to the PLICS score, the ROC operating curve of the failure of internal fixation after anterior-only surgery was determined. The area under the curve was 0.981, and the 95% confidence interval was 0.943, 1.000. When the PLICS score was 6.5, the maximum value of the Jordan index was 0.927, the sensitivity was 0.994, and the specificity was 0.067. Considering the clinical practicality of PLICS score and the different clinical outcomes of the sub-classification groups of the PLICS score=7, we finally set the threshold as PLICS score=7 with the unilateral severe lateral mass fracture. Conclusion:The PLICS score is based on the anatomy of the posterior three-column structure of the subaxial cervical spine. It gives consideration to the bony structures, including bilateral lateral mass, spinous process, lamina, and the ligament structures. What's more, the overall damage severity of the posterior three columns of the subaxial cervical spine was quantified according to the evaluation of the injury characteristics of each column of ligament-bone structure. In this study, PLICS score and clinical efficacy were compared between two groups of patients, and it was finally determined that when PLICS score ≥7 with the unilateral severe lateral mass fracture, the risk of internal fixation failure is higher for anterior-only approach surgery alone. For these patients, anterior and posterior approach surgery may be considered.
ABSTRACT
Objective:To explore the risk factors of residual back pain (RBP) in patients undergone PVP within 1 month and further analyze the correlation.Methods:Between March 2013 and January 2015, 1 316 patients with OVCF were treated by PVP. RBP after PVP was defined as a visual analogue scale (VAS) score of > 4 both 1 week and 1 month post-operatively. According to the pain relief, the patients were divided into two groups, the satisfied group and the unsatisfied group. All patients were scheduled for follow-up at1 week, 1 month, 3 months, and 1 year post-operatively, during which radiography and magnetic resonance imaging (T1-weighted, T2-weighted, and short time inversion recovery (STIR) sequences) were recommended to detect the existence of secondary OVCF. VAS scores and Oswestry disability index (ODI) were recorded. Demographic data, surgical information, anesthesia method, number of OVCF, injection amount of cement of single vertebral bone, imaging data and other comorbidity informations of patients in the two groups were analyzed by Logistic regression for the factors related to RBP after PVP.Results:Among 1 316 patients, 60 cases complained RBP, and the prevalence was 4.6%. VAS score and ODI of the two groups were significantly different at 1 week, 1 month and 3 months after surgery, suggesting there was a certain degree of residual pain in the lower back of patients in the unsatisfied group, which was more severe than that in the satisfied group. However, the above differences disappeared in the follow-up of 12 months after surgery.Univariate analysesshowed that preoperative bone mineral density (BMD), number of fracture, cement distribution and volume injected per level and lumbodorsal fascia contusion were associated with RBP after PVP ( P< 0.01, retrospectively). Multivariate analysis revealed that the absolute value of pre-operative BMD(odds ratio ( OR)=3.577, P=0.029), combined withlumbodorsal fascia contusion ( OR=3.805, P=0.002), number of fracture ( OR=3.440, P<0.001), satisfactory cement distribution ( OR=3.009, P=0.013) and combined with depression ( OR=3.426, P=0.028) were positively correlated with RBP after PVP, and these were risk factors. The injection amount of cement of single vertebral bone ( OR=0.079, P<0.001) was negatively correlated with RBP after PVP, which was a protective factor. Conclusion:Pre-operative low BMD, lumbodorsal fascial injury, multiple segment OVCF, insufficient cement injected volume, unsatisfactory cement distribution and depression were risk factors associated with RBP after PVP in patients with OVCF.
ABSTRACT
Objective To design bundle treatment plan in the early stage for severe human infection by avian influenza H7N9, and explore its clinical efficacy and application value. Methods Fifteen patients with severe human infection by avian influenza H7N9 in Guizhou Province from December 29th, 2016 to June 7th, 2017 were enrolled. Patients admitted from March 6th, 2017 to June 7th, 2017 served as a prospective observation period (bundle treatment group), and those from December 29th, 2016 to March 5th, 2017 were selected as a historical control period (conventional treatment group). Conventional treatment group was given conventional treatment such as isolation, anti-virus, symptomatic treatment, and traditional Chinese medicine and so on. Bundle treatment group was given bundle treatment on the basis of conventional treatment, including isolation, anti-virus, respiratory support, restrictive fluid management, immunotherapy, inhibition of inflammation, antibiotic therapy, nutritional support, prevention of hospital acquired infection (HAP), individual sedation, continuous blood purification (CBP) for acute kidney injury (AKI) and severe acute respiratory distress syndrome (ARDS) patients, and intensive care. A cluster of bundle treatment team was set up to ensure that all measures carried out smoothly. The gender, age, onset to diagnosis time, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, oxygenation index (PaO2/FiO2) at admission, the length of intensive care unit (ICU) stay, total hospitalization time and prognosis of the two groups were observed. Correlation analysis between bundle therapy and prognosis was analyzed by Spearman correlation analysis. Receiver operating characteristic (ROC) curve was drawn, and the clinical value of bundle treatment was analyzed. Results There was no significant difference in gender, age, onset to diagnosis time, APACHEⅡscore, PaO2/FiO2, the length of ICU stay, or total hospitalization time between bundle treatment group (n = 9) and conventional treatment group (n = 6), but the death patients in the bundle treatment group was significantly fewer than those in conventional treatment group (cases:2 vs. 5, χ2= 3.225, P = 0.041). Correlation analysis showed that there was a significant correlation between the mortality and whether received bundle treatment or not in patients who infected by avian influenza H7N9 (r = -0.875, P = 0.018). ROC curve analysis showed that the area under the ROC curve (AUC) of non-bundle treatment for predicting the death in patients with severe human infection by avian influenza H7N9 was 0.938, 95% confidence interval (95%CI) was 0.795-1.000, the sensitivity was 88.88%, and the specificity was 98.62%. Conclusions Early bundle therapy has a significant effect on severe human infection by avian influenza H7N9, which can improve the prognosis and reduce the mortality of patients. It is worthy for clinical application.
ABSTRACT
Objective To discuss the feasibility,the advantages and disadvantages,the clinical efficacy and the indications of minimally invasive transforaminal endoscopic debridement combined with allograft and posterial percutaneous internal fixation for thoracolumbar spinal tuberculosis.Methods All of 22 patients with thoracolumbar tuberculosis treated in our department from January 2012 to December 2013 were retrospectively reviewed.There are 11 male and female cases separately,with an average age of 54.1 ±10.2 years and with an average disease duration of 5.3 ± 1.9 months.Endoscopic lesion removal and allograft bone grafting combined with posterial percutaneous immobilization were performed on all these cases.The data of these patients were complete,and all patients had been followed up for more than 36 months.The clinical and radiographic results were recorded and analyzed.Results In this group,22 patients were followed-up for 41.9±2.5 months(36-48 months).The spinal kyphosis was not improved 3 months after surgery (t=0.3546,P=0.7029),but the amount of blood loss (30.5±7.9 ml) was less in the operation,the amount of postoperative analgesics(0.3±0.1 g) was low and the bed time(1.5±0.3 days) was short.No recurrence and no internal fixation failure was found after long term follow-up.Good clinical outcomes were achieved with the fusion rate reached above grade 2 in all patients(95.5％) except one.The neuralgia was relieved,and the spinal cord injury was recovered to ASIA E.The VAS score and SF-36 score which were recorded 1 month and 3 months after operative were all improved significantly compared with those before operation,and patients' life quality in the early period after operation was excellent.The incidence of complications was low(9.0％),and the patients were satisfied with the treatment process.Conclusion It may be a potential way to treat spinal tuberculosis with minimally invasive transforaminal endoscopic debridement combined with allograft and percutaneous internal fixation,which could be a powerful supplement to other therapeutic measures,and is worthy of further research and development.
ABSTRACT
Objective To explore value of CT features in diagnosis of traumatic diaphragmatic rupture.Methods A retrospective analysis was performed on totally 256 patients with suspected traumatic diaphragmatic rupture,among them 128 were confirmed after surgery.All patients underwent CT scan before surgery.The prevalence of CT findings were recorded,including diaphragm discontinuity or segmental non-recognition of diaphragm," collar" sign," intrathoracic herniation of abdominal contents" sign," dependent viscera" sign," dangling diaphragm" sign and " thickness of the diaphragm" sign.The sensitivity and specificity of each sign were calculated.Results The sensitivity of diaphragm discontinuity or segmental non-recognition of diaphragm,"collar" sign,"intrathoracic herniation of abdominal contents" sign,"dependent viscera" sign,"dangling diaphragm" sign and "thickness of the diaphragm" sign of diaphragmatic rupture was 75.00％ (96/128),84.37％ (108/128),78.13％ (100/128),76.56％ (98/128),54.68％ (70/128) and 46.87％ (60/128),respectively.The specificity was 93.75％ (120/128),98.43％ (126/128),98.43％ (126/128),99.21％ (127/128),93.75％ (120/128) and 84.38％ (108/128),respectively.The sensitivity and specificity of overall MSCT signs was 92.18％ and 100％,respectively.Conclusion CT features have high value in diagnosis of traumatic diaphragmatic rupture.
ABSTRACT
Objective To analyze CT imaging findings and pathological features of the thymic cyst.Methods The CT findings of 20 cases with thymic cyst confirmed by pathology were analyzed retrospectively.The analysis included the location,shape ,size ,density ,contour, unilocular or multilocular,with or without walls,enhancement and lesion periphery.The pathology results were compared to CT findings.Results All lesions were located in the anterior mediastinum,in which the location of left side in 12 cases,right side in 6 cases,median mediastinum in 2 cases.All lesions had clear border and unilocular,including round shape in 4 cases,oval shape in 8 cases,and irregular shape in 8 cases with triangular shape in 1 case,the size range was 2-6 cm.4 cases had obvious cyst wall.The CT value of the cyst had range of 4-53 HU,with 10 cases less than 10 HU and 10 cases greater than 10 HU.There was no enhancement within the cysts of 20 cases and the cyst wall had enhancement in 4 cases.All cases of pathological findings were confirmed as thymus cyst.Gross sample showed gray red or isabeling.The lesion was cystic in 18 cases,soft stereocyst in 2 cases,bright yellow liquid within the capsule in 10 cases,butter fat in 5 cases,chylomicrons in 3 cases,unilocular in 19 cases and multilocular in 1 case (butter fat).Microscope showed the fibrous capsule wall in all cases,lined with squamous epithelium,ciliated columnar epithelium,monolayer columnar epithelium,in which could be seen normal thymus tissue.The thickness of the wall was no more than 0.5 cm,and multilocular wall smooth,no obvious inflammatory response in the surrounding.Conclusion CT image findings can clearly show the thymic cyst site,shape,size,density and boundaries,unilocular or multilocular,with or without walls.The CT image can reflect pathological features of the thymic cyst,and can provide accurate and reliable information for the clinic.
ABSTRACT
Objective The study aimed to identify risk factors of lumbar disc herniation in patients after decompression,and provide theoretical basis for postoperaive rehabilitation.Methods A told of 169 patients with lumbar spinal stenosis underwent bilateral partial laminectomy were included in the study,24 patients in herniation group,and 145 patients without develop postoperative acute sciatica as a control group.The radiographic variables were measured.The threshold of risk factors was evaluated by multiple logistics analysis and receiver operating characteristic curve(ROC) analysis.Results The results revealed that preoperative retrolisthesis during extension was the independent risk factor for lumbar disc herniation(1.24,95％CI[1.07～1.43];P<0.01).The area under the curve(AUC) was 0.801,and the cutoff value was 6.89％.Conclusion The preoperative retrolisthesis was the risk factor of lumbar disc herniation.
ABSTRACT
Objective To investigate the relationship between the level of serum triglyceride and early pain after posterior lumbar interbody fusion.Methods A total of 79 patients who were admitted into our hospital from March 2016 to December 2016 were selected into the study,and these patients were divided into two groups according to the degree of pain which means 32 cases in the minor pain group and 47 cases in the intermediate pain group.The difference of serum triglyceride level 3 days after operation were compared between the two groups.Pearson correlation analysis was performed to test the correlation between the level of serum triglyceride and early post-surgical pain.Logistic regression analysis was performed to test the risk factors for early post-surgical pain.Results The data indicated the level of pain was significant higher in the intermediate pain group than that of the minor pain group.Level of serum triglyceride had a significantly positive correlation with the level of post-surgical pain and it was the risk factor of pain after posterior lumbar interbody fusion.Conclusion The level of serum triglyceride is the risk factor of early post-surgical pain of lumbar single level interbody infusion,and it should be adjusted in the perioperative treatment.
ABSTRACT
BACKGROUND:Elderly patients are more prone to unstable and osteoporotic fractures. In the clinical surgical treatment, different programs can be taken. Internal fixation was done previously. However, the precise choice of the methods of unstable and osteoporotic femoral fractures in the elderly was stil controversial. OBJECTIVE:To investigate the clinical effect of carbon-coated artificial femoral head replacement in the treatment of elderly patients with unstable and osteoporotic femoral fractures. METHODS:A retrospective analysis was performed in the Honghui Hospital Affiliated to Health Science Center, Xi’an Jiaotong University from February 2013 to February 2014 in 83 cases of unstable and osteoporotic femoral fractures. These patients were divided into control group (42 cases) and observation group (41 cases) according to treatment methods. Conventional internal fixation and artificial femoral head replacement were conducted. Operation time, intraoperative blood loss, postoperative bed time and hospital stay were observed in the two groups. Patients were fol owed up for 12 months. Recovery of hip function and complications were observed and compared between the two groups. RESULTS AND CONCLUSION:No significant difference in operation time and intraoperative blood loss was detected between the observation group and the control group (P>0.05). Postoperative bed time and hospital stay were significantly shorter in the observation group than in the control group (P<0.05). The excel ent and good rate of hip joint function was significantly higher in the observation group than in the control group, but the complication rate was significantly lower in the observation group than in the control group (P<0.05). These findings suggest that carbon-coated artificial femoral head replacement for unstable and osteoporotic femoral fractures in the elderly obtained good repair effects, had smal injury to the patient and less complications. Moreover, it can better improve hip function.
ABSTRACT
BACKGROUND:At present, humeral fractures can be mainly treated by antegrade screwed intramedul ary nail and traditional interlocking intramedul ary nail, but above methods easily induce rotator cuff injury. Results of relevant study revealed that retrograde intramedul ary nailing can solve the above problems. OBJECTIVE:To analyze biomechanical test results of retrograde improved screwed nail and to provide a basis for the further clinical use. METHODS:(1) According to the anatomical characteristics of the human humerus, specimens of humerus were subjected to biomechanical test. (2) A total of 80 cases of humeral fractures were selected from the Orthopeadic Surgery of Xi’an Red Cross Hospital Affiliated to Xi’an Jiaotong University School of Medicine from December 2013 to January 2015. Patients were randomly divided into improved nail group and prototype nail group (n=40), which were given improved nail and prototype nail, respectively. RESULTS AND CONCLUSION:(1) Anti-axial compression, anti-tension, anti-torsion, and anti-bending functions were significantly better in the improved screwed nail than in the prototype nail (P<0.05). (2) The excel ent and good rate of clinical curative effects was significantly higher in the improved nail group than in the prototype nail group. No infection, metal fracture or internal fixation loosening occurred in al patients of the two groups. These findings suggest that compared with traditional screwed nail, retrograde improved screwed nail had more advantages, more reasonable biomechanical design, more simple operation, and lower incidence of complications, so it is fit for clinical application.
ABSTRACT
Objective To analyze the difference in changes of upper airway between obstructive sleep apnea syndrome (OSAS) patients and normal population using dynamic radiography under sleeping and awake conditions.Methods 20 normal subjects and 20 OSAS patients underwent the dynamic digital radiography of the upper airway under sleeping and awake conditions.And the dynamic diameter changes of the upper airway at velopharyngeal,oropharynx and hypopharynx levels were measured and recorded.Results The velo-pharyngeal upper airway collapse in normal subjects under sleeping condition was significantly larger than that under awake condition (P <0.014).However no significant differences in the collapse of upper airway at oropharynx and hypopharynx level were observed between sleeping and awake conditions.For the OSAS patients,the upper airway collapses at velopharyngeal,oropharynx and hypopharynx levels under sleeping condition were significantly larger than those under awake condition respectively (P <0.000,P =0.001,P <0.013). During awake state,there were no significant differences in upper airway collapse at velopharyngeal,oropharynx and hypopharynx levels between normal subjects and OSAS patients under awake condition.During sleeping state,the upper airway collapses of OSAS patients were significantly larger than that of normal subjects at velopharyngeal and oropharyngeal levels (P =0.000,P =0.003). However,no significant difference was observed at hypopharynx level.Conclusion The normal upper airway represents obvious col-lapse at velopharyngeal level under sleeping condition.However,the upper airway in OSAS patients at velopharyngeal,oropharynx and hypopharynx level showed significant collapse under sleeping condition compared with that under awake condition.The upper airway of the OSAS patients represents obvious collapse at velopharyngeal and oropharyngeal level under sleeping condition,however no abnormal changes can be observed under awake condition.
ABSTRACT
Objective To evaluate the impact of the water transfer project from the Yangtze River to the Hanjiang River on the transmission of schistosomiasis.so as to provide scientific basis for the development of control strategy.Methods A field investigation on snail status,the infection situation of human and cattle as well as related endemic factors was performed in the project areas of the Qianjiang basin.Results There were 33 endemic villages and 48 non-endemic villages along the water transfer project.In endemic villages,the infection rates of human and cattle were 0.42% and 0.48%,respectively.In the endemic area,the snail area was 17.28 hm~2,the mean density of living snails was 0.043 No./0.1 m~2,meanwhile,no snail Was found in the non.endemic areas.Conclusion The surveillance on epidemic situation should be carried out for a long time in order to prevent the spreading of snails.
ABSTRACT
Aspergillus niger lipases are important biocatalysis widely used in industries for food processing and pharmaceutical preparation. High-level expression recombinants can lead to cost effective lipase large scale production. Full length gene synthesis is an efficient measure to enhance the expression level of the gene. In order to reduce the non-specific binding between oligonucleotides and bases mutation caused by the complicate secondary structure of DNA and excessive PCR amplification, a frequently phenomenon in one-step gene synthesis, we used a two-step method including assembly PCR (A-PCR) and digestion-ligation step to synthesis Aspergillus niger lipase gene lipA. Assisted by DNA2.0 and Gene2Oliga software, we optimized the codon usage and secondary structure of RNA and induced enzyme sites Cla I (237 site) and Pst I (475 site) into the gene. In the first step, fragments F1 (237 bp), F2 (238 bp) and F3 (422 bp) were separately synthesized by assembly PCR. In the second step, fragments F1, F2 and F3 were separately digested by Cla I and Pst I, and then ligated into a full length lipA gene. Two-step method efficiently enhanced successful ratio for full-length gene synthesis and dispersed the risk for gene redesign. The synthesized gene was cloned into pPIC9K vector and transferred into Pichia pastoris. After methanol inducement, the expression level of the codon optimized lipA-syn gene reached 176.0 U/mL, 10.8-fold of the original lipA gene (16.3 U/mL) in Pichia pastoris GS1115. The recombinant offers the possibility for lipase large-scale production.
Subject(s)
Base Sequence , Carboxylic Ester Hydrolases , Genetics , Cloning, Molecular , Genes, Synthetic , Genetic Engineering , Methods , Genetic Vectors , Genetics , Molecular Sequence Data , Pichia , Genetics , Metabolism , Recombinant Proteins , GeneticsABSTRACT
Objective To clarify the temperature curve of the irradiation target area,its adjacent tissue and the whole body during extracorpereal microwave irradiation, then to compare and optimize different irradiation models. Methods Different parts of the chest of adult New Zealand white rabbit were irradiated using different extracorporeal microwave irradiation models. The temperature of the irradiated skin, the subcutaneous and deep parts, the adjacent tissues and the anus was measured. The experiment was bi-factor and multi-level designed according to the repeatedly measured data and the rabbits was divided into group a,b,c and d. Results The increase rate of the surface temperature in the dorsal lung was similar between group d and group b1(F=10.04,P<0.01). However,the increase rate of the surface temperature in the ventral lung of group d was lower, and the mean temperature of this site measured 10 minutes later was also lower than group b1(F=10.04,P<0.01). The increase rate of the rectal temperature of group d was higher,and the mean rectal temperature tested 10 minutes later was also higher than group b1(F=7.04,P<0.01). Conclusions Multi-array irradiation could achieve satisfactory irradiation depth and appropriate therapeutic temperature. Well controlled extracorporeal microwave irradiation under is an ideal thermotherapy method.