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Objective:To study the correlation between the acute-phase characteristics of motor evoked potential (MEP) and severities of spinal cord injury in patients with acute cervical hyperextension injury and central cord syndrome (CCS).Methods:Retrospectively analyzed were the data of 45 patients with acute cervical hyperextension injury and CCS (observation group) who had been admitted to Department of Orthopedics, Tongji Hospital Affiliated to Tongji University from December 2018 to July 2021 and 20 healthy controls. Examination of transcranial magnetic stimulation-induced MEP was performed in patients with CCS and healthy controls using a magpro x100 magnetic stimulator, and recording was conducted in bilateral abductor pollicis brevis (APB). The characteristics of MEP waveform latency, amplitude and motor threshold were described and compared between the healthy control and observation groups; the correlations were analyzed between the MEP latency and the severity of spinal cord injury [American Spinal Injury Association (ASIA) total score and motor function of Upper Extremity Motor Subscores (UEMS)] in the observation group. According to different MEP-induced states, the patients in the observation group were divided into a resting group ( n=19), a facilitation group ( n=18), and a no-waveform group ( n=8). The severity of spinal cord injury (ASIA total score) and the functional independence of the spinal cord (SCIM-Ⅲ score) were compared among the 3 groups to analyze the correlation between the MEP-induced state and the severity of spinal cord injury (ASIA total score). Results:The observation group had a significantly longer MEP latency [(30.16±6.32) ms], a significantly smaller amplitude [(0.54±0.30) mV] and a significantly higher motor threshold [(65%±11%)] than the healthy control group (all P<0.05). The MEP latency in the observation group was significantly correlated with ASIA total score ( r=-0.730, P<0.001) and UEMS ( r=-0.740, P<0.001). The ASIA total score and SCIM-Ⅲ score were significantly different among the 3 groups ( P<0.05), and the MEP-induced state was significantly correlated with the severity of spinal cord injury (ASIA total score) ( r=0.668, P<0.001). Conclusions:In patients with acute cervical hyperextension injury and CCS, the MEP latency is prolonged, the amplitude lowered, and the motor threshold enhanced. The MEP latency is strongly correlated with the severity of spinal cord injury and upper limb motor function. The MEP-induced state is also closely related to the severity of spinal cord injury.
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Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.
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Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.
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Objective:To evaluate the risk factors related to the mid-term outcomes of hip preserving surgery for early stages osteonecrosis of the femoral head (ONFH) basing on China-Japan Friendship Hospital (CJFH) classification system.Methods:From June 2012 to September 2016, there were consecutive 325 patients (432 hips) were enrolled and divided into different preserving surgery groups, namely core decompression (CD) group 141 hips and "lightbulb" operation (LB) group 291 hips, respectively. Harris hip score (HHS) was used to evaluate the clinical outcomes. The progression of ONFH was observed by radiography. Clinical failure was defined as worsen of HHS and/or radiographic evaluation. Clinical endpoint events were marked as significant hip pain (HHS<70), and/or collapse of the femoral head requiring further interventions. Potential risk factors, including sex, age, etiology, the duration from symptom onset to treatment, preoperative CJFH type, ARCO stage and HHS, were analyzed using univariate risk analysis and Cox regression multivariate risk model.Results:The rate of hip failure was 47.5% (67/141) in CD group, including type C+M 13.0% (3/23), L1 38.1% (24/63), L2 82.4% (14/17) and L3 68.4% (26/38), respectively. There was significant difference in age (χ 2=3.887, P=0.049), type of CJFH (χ 2=40.943, P=0.000) in CD group. The Cox regression analysis revealed that age≥40 ( HR=2.325, 95% CI 1.398, 3.866, P=0.000), pre-HHS 70-80 ( HR=2.163, 95% CI 1.140, 4.105, P=0.018) and <70 ( HR=2.597, 95% CI 1.173, 5.749, P=0.019), type L2 ( HR=35.052, 95% CI 7.721, 159.133, P=0.000) and L3 ( HR=13.242, 95% CI 3.104, 56.491, P=0.000) were associated with failure of core decompression. The rate of hip failure was 36.4%(106/291) in LB group, including type C+M 33.3% (1/3), L1 31.3% (41/131), L2 84.6% (22/26) and L3 32.1% (42/131), respectively. There were significant differences in age (χ 2=8.437, P=0.004), pre-HHS (χ 2=19.737, P=0.000) and type of CJFH (χ 2=29.265, P=0.000) in LB group. The Cox regression analysis showed that poor pre-HHS ( HR=5.102, 95% CI 2.339, 11.129, P=0.000), type L2 ( HR=32.761, 95% CI 6.165, 43.507, P=0.000) were associated with failure of "lightbulb" preserving surgery. Conclusion:The results of hip preserving surgery for ONFH are associated with age, preoperative HHS and CJFH typing. The prognosis depends on the severity of symptoms, the residual of weight-bearing joint surface and lateral pillar of the femoral head.
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According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.
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Spinal cord injury is still an unsolved medical problem for which the pathological process of spinal cord injury is complex and its molecular pathological mechanism has not been fully revealed. More and more opinions show that spinal cord injury has a unique molecular pathological mechanism at different severities and different stages. Even in the same type of injury, the individual genetic background or personal chronic diseases may affect the severity and prognosis of the injury. The whole-genome sequencing technology can analyze the dynamic development process of all pathological mechanisms of spinal cord injury from acute phase, subacute phase to chronic phase through sequencing analysis of the expression profile of damaged spinal cord tissue, which provides an important theoretical basis for precision intervention of specific pathological mechanisms of spinal cord injury in the future. Herein, the author analyzes the mechanism of spinal cord injury through gene expression profiling, gene expression regulation and post-translational modification, explores the potential and promising therapeutic targets, and thinks over the key scientific issues that need to be solved in the molecular pathological research of spinal cord injury.
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Objective@#To compare the efficacy of core decompression with autologous bone marrow mononuclear cell grafting with impacted bone grafting in treating bilateral femoral head necrosis.@*Methods@#From January 2011 to January 2017, a total of 44 patients with bilateral femoral head necrosis (88 hips) were admitted to the Department of Orthopaedics, China-Japan Friendship Hospital, including 35 males and 9 females with aged 34.9±7.2 years old (ranged from 22-48 years). Core decompression with autologous bone marrow mononuclear cell and impacted bone grafting were conducted to each hip joint for every patient. All patients were followed up for every 3 months at the first year postoperatively and for every 6 months thereafter. The following clinical measurement were recorded, Harris hip score (HHS), visual analogue score (VAS), the anterior-posterior and frog lateral radiographs, and CT. The 5-year survival rate of the hip was calculated with the endpoint event being defined as a need for total hip arthroplasty or other surgical intervention, or a HHS less than 70.@*Results@#The postoperative follow-up duration was 50.5±34.2 months in the impacted bone grafting group and 54.0±33.1 months in the core decompression with autologous bone marrow mononuclear cells group. Fifteen hips in the impacted bone grafting group and 13 hips in the core decompression with autologous bone marrow mononuclear cell group failed during the follow-up. The 5-year cumulative survival rates of the hips in two groups were 64.7% and 72.1%, respectively [HR=1.178, 95%CI(0.561, 2.477)]. In the impacted bone grafting group, the 5-year survival rates of the hip joints at the ARCO IIIB+IIIC and IIIA stages were 42.9% and 74.2%, respectively [HR=3.258, 95%CI(1.172, 9.059)]. In the core decompression with autologous bone marrow mononuclear cell group, the 5-year survival rates of hips at the ARCO stage I, II and IIIA stages were 50.0%, 75.3%, and 71.4%, respectively (χ2=0.757, P=0.685). Age, gender, BMI, preoperative HHS and etiology did not affect the effects of core decompression with autologous bone marrow mononuclear cell grafting or impacted bone grafting (P>0.05). The preoperative VAS of the impacted bone grafting group and the core decompression with autologous bone marrow mononuclear cell grafting group were 4.80±0.62 and 3.27±1.17, respectively (t=8.625, P<0.001). At the last follow-up, the VAS was reduced to 2.84±1.95 and 2.25±2.08, respectively (t=2.712, P=0.01; t=7.087, P<0.001) with significant difference in postoperative VAS between the two groups (t=2.489, P=0.017). The preoperative HHS of the impacted bone grafting group and the core decompression with autologous bone marrow mononuclear cell grafting group were 77.02±5.03 and 82.57±5.71, respectively (t=7.822, P<0.001). At the last follow-up, the HHS increased to 81.57±12.81 and 83.55±12.87, respectively. The difference between the preoperative and postoperative HHS was statistically significant in the impacted bone grafting group (t=2.389, P=0.021) but not in the core decompression with autologous bone marrow mononuclear cell grafting group (t=0.451, P=0.654). There was no significant difference in postoperative HHS between the two groups (t=1.353, P=0.183).@*Conclusion@#Both impacted bone grafting and core decompression with autologous bone marrow mononuclear cell grafting are safe and effective methods in treating femoral head necrosis. The ARCO stage is a risk factor affecting the prognosis of hips after impacted bone grafting, which has no effect on the mid-term survival of hips after core decompression with autologous bone marrow mononuclear cell grafting.
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Objective@#To study the threshold values of lactic acid (Lac)and buffuer excess (BE) when neonatal umbilical arterial blood gas is at pH <7.20.@*Methods@#A total of 2 518 pregnant women admitted in Beijing New Century Women and Children′s Hospital from January 2017 to February 2019 were enrolled.The general conditions in perinatal period and labor methods were counted.Umbilical cord arterial blood was immediately collected before the first cry of newborn and was detected on the Abbott I-STAT automatic blood gas analyzer from the United States, and then the umbilical arterial blood gas was measured.We analyzed the perinatal factors affecting umbilical arterial blood gas.We studied the threshold values of Lac and BE for neonal asphyxia by receiver operating characteristic curve.@*Results@#(1)Maternal anemia, Streptococcus agalactiae infection, precipitate labour, placenta abnormalities had no significant impact on neonatal umbilical artery blood gas.The Lac value in blood gas was higher in the group of premature rupture of fetal membranes and fetal intrauterine distress.The value of BE was lower in the group with premature rupture of fetal membranes and fetal distress (P<0.05). The Lac value in cesarean section group was the lowest[(1.79±1.25) mmol/L], while that in midwifery group was the highest[(4.45±1.58) mmol/L]. pH value was the lowest (7.25±0.07) in the midwifery group and the highest (7.31±0.06) in the cesarean section group.The value of BE was the lowest in the midwifery group[-(5.66±2.52) mmol/L], and the highest in the cesarean section group[-(2.99±2.28) mmol/L], with statistically significant differences among the three groups (P<0.05). (2) Multiple linear regression analysis showed that fetal delivery mode, fetal intrauterine distress, premature rupture of membranes, and gestational diabetes were the factors affecting Lac level in umbilical artery blood gas of newborns.Methods of delivery, intrauterine distress, premature rupture of membranes and placental abnormalities were the factors that affected the BE value of umbilical artery blood gas in newborns.(3) A total of 199 cases with pH value <7.2 were diagnosed as asphyxia, and the receiver operating characteristic curve of Lac and BE values of neonatal umbilical artery blood gas for the diagnosis of asphyxia was drawn.When Lac was >3.97 mmol/L, the sensitivity and specificity of the diagnosis of asphyxia were 0.864 and 0.791, respectively.When BE was ≤-6 mmol/L, the diagnostic sensitivity and specificity of asphyxia were 0.613 and 0.756, respectively.@*Conclusion@#Neonatal umbilical arterial blood gas is affected by many factors.The effect of accouche on umbilical arterial blood gas is large.When there is asphyxia with pH <7.2, the cut points of Lac and BE are >3.97 mmol/L and ≤-6 mmol/L, respectively.
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Objective@#To explore the current residents training of standardized training program and their attitude towards the program, so as to provide suggestions for optimizing the training system.@*Methods@#Questionnaire surveys were carried out among 1 427 resident physicians from 10 hospitals in 7 provinces and cities between March 2017 to May 2017. The investigation covered demographic information, current work and study, training effect and problems. Statistical description and χ2 test were used for analysis.@*Results@#Only 18.08% of the residents in standardized training program considered it as unnecessary, while 80% of them agreed with its effectiveness in improving their clinical skills and humanistic quality. 67.29% of them thought of resignation because of low income and high work pressure. Compared with " double track" residents, those of " double-track integration" complained of lower income and higher workload.@*Conclusions@#Chinese residents in standardized training program had a positive attitude towards the training system. However, the measures should be improved to prevent from possible occupational burnout. It is suggested that professionalism and professional identity education be improved, and subjective well-being feeling of residents be focused to avoid burnouts.
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Objective To explore the current residents training of standardized training program and their attitude towards the program,so as to provide suggestions for optimizing the training system.Methods Questionnaire surveys were carried out among 1 427 resident physicians from 10 hospitals in 7 provinces and cities between March 2017 to May 2017.The investigation covered demographic information,current work and study,training effect and problems.Statistical description and x2 test were used for analysis.Results Only 18.08％ of the residents in standardized training program considered it as unnecessary,while 80％ of them agreed with its effectiveness in improving their clinical skills and humanistic quality.67.29％ of them thought of resignation because of low income and high work pressure.Compared with " double track" residents,those of "double-track integration" complained of lower income and higher workload.Conclusions Chinese residents in standardized training program had a positive attitude towards the training system.However,the measures should be improved to prevent from possible occupational burnout.It is suggested that professionalism and professional identity education be improved,and subjective well-being feeling of residents be focused to avoid burnouts.
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The mammalian central nervous system (CNS) is considered an immune privileged system as it is separated from the periphery by the blood brain barrier (BBB). Yet, immune functions have been postulated to heavily influence the functional state of the CNS, especially after injury or during neurodegeneration. There is controversy regarding whether adaptive immune responses are beneficial or detrimental to CNS injury repair. In this study, we utilized immunocompromised SCID mice and subjected them to spinal cord injury (SCI). We analyzed motor function, electrophysiology, histochemistry, and performed unbiased RNA-sequencing. SCID mice displayed improved CNS functional recovery compared to WT mice after SCI. Weighted gene-coexpression network analysis (WGCNA) of spinal cord transcriptomes revealed that SCID mice had reduced expression of immune function-related genes and heightened expression of neural transmission-related genes after SCI, which was confirmed by immunohistochemical analysis and was consistent with better functional recovery. Transcriptomic analyses also indicated heightened expression of neurotransmission-related genes before injury in SCID mice, suggesting that a steady state of immune-deficiency potentially led to CNS hyper-connectivity. Consequently, SCID mice without injury demonstrated worse performance in Morris water maze test. Taken together, not only reduced inflammation after injury but also dampened steady-state immune function without injury heightened the neurotransmission program, resulting in better or worse behavioral outcomes respectively. This study revealed the intricate relationship between immune and nervous systems, raising the possibility for therapeutic manipulation of neural function via immune modulation.
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Objective To investigatethe relationship between urinary catecholamine levels and type Ⅱ diabetic nephropathy and neuropathy. Methods Allsubjects were collected fromTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology,and were divided into two groups:type Ⅱ diabetic patients (For 24 h urine, n=130, aged 27-81 years old, 75 men, 55 female; for random urine, n=115, aged 27-77 years old, 75 men, 40 female) and healthy control (For 24 h urine, n=118, aged 27-76 years old, 67 men, 51 female; for random urine, n=93, aged 25-74 years old, 57 men, 36 female).Based on the results of urinary albumin excretion, type Ⅱ diabetic patients were prospectively divided into two independent groups: patients with nephropathy (For 24 h urine, n=37; for random urine, n=32) and patients without nephropathy (For 24 h urine, n=32; for random urine, n=35). According to questionnaires, quantitative sensory testing and autonomic function test, type Ⅱ diabetic patients were divided into two different groups: patients with neuropathy (For 24 h urine, n=31; for random urine, n=23) and patients without neuropathy (For 24 h urine, n=30; for random urine, n=35). Urinary catecholamines(CAs) levels, including epinephrine (E), norepinephrine (NE), dopamine (DA) and total catecholamines (total CAs) levels, were measured using liquid chromatography tandem mass spectrometry (LC-MS / MS). The CAs levels in different groups have been discussed. The results were analyzed using χ2 test, independent t test and Mann-Whitney non-parametric test. Results Type Ⅱ diabetic patients with nephropathy show lower E (0.74±0.24) μg/24 h,NE(9.22±4.02) μg/24 h,DA(64.77±21.68) μg/24 h and total CAs(74.72±25.65) μg/24 h in 24-hour urine in comparison with the group without nephropathy(For E, 4.23±0.50 μg/24 h, U=10, P<0.001; for NE, (32.31±1.74) μg/24 h, t=-2.72, P=0.011; for DA, (219.58±27.51) μg/24 h, t=-2.88, P=0.007;fro CAs, (256.02±30.65) μg/24 h, t=-3.02, P=0.005) and the differences were statistically significant (P<0.05). The differences of NE, DA and total CAs between type Ⅱ diabetic patients with nephropathyand without nephropathy were statistically significant in random urine(P<0.05). Conclusion These results suggested that urine CAs levels in diabetic patients with nephropathy is lower than that in patients without nephropathy, which may be related to the occurrence and development of diabetic nephropathy.
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Objective To study the threshold values of lactic acid ( Lac) and buffuer excess ( BE) when neonatal umbilical arterial blood gas is at pH <7. 20. Methods A total of 2 518 pregnant women admitted in Beijing New Century Women and Children′s Hospital from January 2017 to February 2019 were enrolled. The general conditions in perinatal period and labor methods were counted. Umbilical cord arterial blood was immediately collected before the first cry of newborn and was detected on the Abbott I-STAT auto-matic blood gas analyzer from the United States,and then the umbilical arterial blood gas was measured. We analyzed the perinatal factors affecting umbilical arterial blood gas. We studied the threshold values of Lac and BE for neonal asphyxia by receiver operating characteristic curve. Results (1)Maternal anemia,Strep-tococcus agalactiae infection,precipitate labour,placenta abnormalities had no significant impact on neonatal umbilical artery blood gas. The Lac value in blood gas was higher in the group of premature rupture of fetal membranes and fetal intrauterine distress. The value of BE was lower in the group with premature rupture of fetal membranes and fetal distress ( P <0. 05 ). The Lac value in cesarean section group was the lowest [(1. 79 ± 1. 25) mmol/L],while that in midwifery group was the highest[(4. 45 ± 1. 58) mmol/L]. pH value was the lowest (7. 25 ± 0. 07) in the midwifery group and the highest (7. 31 ± 0. 06) in the cesarean section group. The value of BE was the lowest in the midwifery group[ －(5. 66 ± 2. 52) mmol/L],and the highest in the cesarean section group[ －(2. 99 ± 2. 28) mmol/L],with statistically significant differences among the three groups (P<0. 05). (2) Multiple linear regression analysis showed that fetal delivery mode, fetal intrauterine distress,premature rupture of membranes,and gestational diabetes were the factors affecting Lac level in umbilical artery blood gas of newborns. Methods of delivery,intrauterine distress,premature rup-ture of membranes and placental abnormalities were the factors that affected the BE value of umbilical artery blood gas in newborns. (3) A total of 199 cases with pH value <7. 2 were diagnosed as asphyxia,and the receiver operating characteristic curve of Lac and BE values of neonatal umbilical artery blood gas for the diagnosis of asphyxia was drawn. When Lac was >3. 97 mmol/L,the sensitivity and specificity of the diag-nosis of asphyxia were 0. 864 and 0. 791,respectively. When BE was≤－6 mmol/L,the diagnostic sensitivi-ty and specificity of asphyxia were 0. 613 and 0. 756,respectively. Conclusion Neonatal umbilical arterial blood gas is affected by many factors. The effect of accouche on umbilical arterial blood gas is large. When there is asphyxia with pH <7. 2,the cut points of Lac and BE are >3. 97 mmol/L and ≤ －6 mmol/L, respectively.
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Objective To investigate the operating strategies and essentials of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with tubular channel (Spotlight) to treat single-level lumbar degenerative diseases. Methods From November 2013 to December 2015, 97 patients (47 males and 50 females) underwent single-level lumbar degenerative diseases fol-lowing MIS-TLIF with Spotlight were analyzed, whose age were from 35-82 years old with the average age of 57.6±12.3 years old. The preoperative diagnosis was lumbar spinal stenosis in 63 cases, lumbar spondylolisthesis in 25 cases, and lumbar instability in 9 cases. The affected level was L3,4 in 9 cases, L4,5 in 66 cases, and L5S1 in 22 cases. According to distinct clinical manifestations and radiological characteristics, different approaches of Spotlight channels were employed. Unilateral decompression via unilateral channel was performed in 52 cases, bilateral decompression via unilateral channel was performed in 22 cases, and bilateral decom-pression via bilateral channel was performed in 23 cases. Clinical outcomes included operation duration, surgical blood loss, post-operative drainage volume and complications was recorded. Average intervertebral height, lumbar and surgical Cobb angle were utilized to evaluate the reduction of intervertebral height and lumbar lordosis. The low back and leg pain were represented as Visu-al Analogue Scale (VAS) score. The preoperative and postoperative Oswestry Disability Index (ODI) score were recorded individu-ally to evaluate patients'functional recovery. Besides, the Bridwell criterion was introduced to define the extent of the lumbar fu-sion. The MacNab criterion was used for assessment of postoperative efficacy. Results The operation duration was 189.8 ± 41.3 min, the volume of surgical blood loss was 143.9 ± 102.0 ml and the volume of postoperative drainage 75.0 ± 59.0 ml in all cases. Among them, operation time was 165.0±24.2 min, surgical blood loss was 99.5±54.1 ml and postoperative drainage was 48.4±27.6 ml in the operation group of unilateral decompression via unilateral channel. The date in the group of Bilateral decompression via unilateral channel were 208.9 ± 46.0 min, 151.4 ± 96.3 ml, 88.0 ± 51.3 ml and in the group of bilateral decompression via bilateral channel were 225.4±32.0 min, 236.0±126.3 ml, 122.8±81.7 ml. All the patients were followed up for 16-42 months, the average follow-up time was 24.9 ± 7.0 months. Low back VAS reduced from 6.10 ± 0.84 preoperatively to 1.59 ± 0.49 at the final follow-up, leg VAS decreased from 6.56±0.85 preoperatively to 1.59±0.57 at the last follow-up, and ODI reduced from 59.36％±5.52％preop-eratively to 15.89％±2.90％at the final follow-up, compared with preoperative, the differences were significant. Average interverte-bral height improved from 9.92±2.25 mm preoperatively to 12.24±1.78 mm at latest follow-up time, which had statistically signifi-cant difference. Operative segment and lumbar Cobb angle were 13.81°±6.10° and 32.32°±11.97° preoperative, at the time of lat-est follow-up improved to 14.25° ± 5.57° and 35.83° ± 9.89° , Compared with preoperative, lumbar Cobb angle was significantly in-creased but operative segment Cobb had no significant difference. According to the criteria of Bridwell, intervertebral fusion at fi-nal follow-up of I and II grades were 90 cases in total (92.8％). The MacNab criteria was used to evaluate the clinical efficacy, which 69 were excellent, 23 were good, and 5 were acceptable, the excellent and good rate was 94.8％. Conclusion The tech-nique of MIS-TLIF with the tubular channel (Spotlight) is safe and efficient for the treatment of single segment lumbar degener-ative diseases. Different strategies can be selected by different preoperative clinical manifestations and radiological features.
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Objective@#To evaluate the clinical effectiveness of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-level lumbar spondylolisthesis treatment with bilateral Spotlight tubular channels.@*Methods@#A total of 21 patients with lumbar spondylolisthesis whom underwent MIS-TLIF via bilateral Spotlight tubular channels were retrospectively analyzed from October 2014 to November 2015. The 21 patients included 11 males and 10 females ranged from 35 to 82 years (average aged 60.7 years). In term of spondylolisthesis category, there were 18 cases of degenerative spondylolisthesis and 3 cases of isthmic spondylolisthesis. With respect to spondylolisthesis degree, 17 cases were grade Ⅰ° and 4 cases were grade Ⅱ°. Besides, 17 cases at L4-5 and 4 cases at L5-S1were categorized by spondylolisthesis levels. Operation duration, blood loss, postoperative drainage and intraoperative exposure time were recorded, functional improvement was defined as an improvement in the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) was also employed at pre and post-operation (3 months and the last follow-up), to evaluate low back and leg pain. Furthermore, to evaluate the recovery of the intervertebral foramen and of lumbar sagittal curvature, average height of intervertebral space, Cobb angles of lumbar vertebrae and operative segments, spondylolisthesis index were measured. At the last follow-up, intervertebral fusion was assessed using Siepe evaluation criteria and the clinical outcome was assessed using the MacNab scale. Radiographic and functional outcomes were compared pre- and post-operation using the paired T test to determine the effectiveness of MIS-TLIF. Statistical significance was defined as P<0.05.@*Results@#All patients underwent a successful MIS-TLIF surgery. The operation time (235.2±30.2) mins, intraoperative blood loss (238.1±130.3) ml, postoperative drainage (95.7±57.1) ml and intraoperative radiation exposure (47.1±8.8) were recorded. Different significance between 3 months post-operative follow-up and pre-operation was exhibited (P<0.01) in respects of lumbar VAS (t=11.1, P<0.01) and leg VAS (t=17.8, P<0.01). Moreover, final follow-up compared with pre-operation, and final follow-up compared with 3 months post-operative follow-up, VAS scores were also statistical difference (P<0.01). At the final follow-up, there were significant differences compared with pre-operation in ODI scores (t=30.1, P<0.01). Comparison between 3 months post-operative follow-up and pre-operation, statistical distinctions were demonstrated (P<0.05) in terms of mean height of intervertebral space (t=-10.9, P<0.01), the Cobb angles of lumbar vertebrae (t=-2.4, P<0.05), operative segments Cobb angles (t=-5.2, P<0.01) and Lumbar spondylolisthesis incidence (t=17.1, P<0.01). In addition, there was statistical difference between final follow-up and pre-operation (P<0.05) as well. For instance, mean height of intervertebral space (t=-10.5, P<0.01), the Cobb angles of lumbar vertebrae (t=-2.7, P<0.05), operative segments Cobb angles (t=-4.2, P<0.01) and Lumbar spondylolisthesis incidence (t=18.6, P<0.01) were involved. All spondylolisthesis vertebrae were restored completely. Lastly, at the last follow-up, 12 cases of grade 1 and 7 cases of grade 2 fusion were present as determined by the Siepe evaluation criteria. McNab scale assessment classified 17 patients having excellent clinical outcome, 3 patients in good and 1 patient having a better clinical outcome.@*Conclusion@#MIS-TLIF with bilateral Spotlight tubular channels is a safe and effective approach for single segment lumbar spondylolisthesis.
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BACKGROUND: Measuring result of the lower limb alignment is often influenced by various factors, such as femoral bowing angle (FBA) in different positions.OBJECTIVE: To measure the FBA and femoral valgus correction angle (VCA) in different positions after CT reconstruction of lower limb model, and simulating X-ray examination, and to explore the rule of FBA affecting lower limb alignment.METHODS: Twenty patients undergoing CT angiography of lower extremity artery were enrolled, three-dimensional reconstruction of low limb was established on Mimics13.0 software based on CT data, and the FBA in standard posture was determined. All patients were divided into groups A (FBA > 2°), B (2° > FBA > 0°), C (0° > FBA > -2°) and D (FBA <-2°) (n=5 per group). Then each model was revolved through the vertical axis from 20° of internal rotation to 20° of external rotation by 2° for one motion, and 21 three-dimensional images were transformed into two-dimensional images to obtain the X-ray images of low limb. FBA and VCA in different positions were measured.RESULTS AND CONCLUSION: (1) The outcome measurements showed that FBA tended to be decreased in internal rotation and increased in external rotation. (2) VCA tended to be increased in external rotation and decreased in internal rotation. (3) FBA was positively correlated with VCA in the different positions (P < 0.01). (4) These results suggest that FBA can be altered with rotation and even expose influence on VCA. The bigger FBA is, the more influence on the lower limb alignment. Therefore, it is advisable to conduct the full length X-ray of lower limb in a standard posture, especially for the patients with larger FBA.
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BACKGROUND:Blood loss after total knee arthroplasty is a common problem that wil affect the clinical effects. As a kind of hemostatic medicine, tranexamic acid has been more and more used in reducing bleeding after joint replacement. However, there are few studies concerning the combined use of tranexamic acid with other hemostatic drugs. OBJECTIVE:To evaluate the efficacy and safety of intra-articular administration of cocktail wine (tranexamic acid plus diluted-epinephrine) on perioperative blood loss and transfusion in primary unilateral total knee arthroplasty. METHODS:From July 2013 to October 2015, 113 patients scheduled to undergo total knee arthroplasty were randomized into two groups. Cocktail wine group (57 patients) received intra-articular cocktail wine (3 g tranexamic acid plus 0.25 mg diluted-epinephrine;1:200 000). Tranexamic acid group (56 patients) received 3 g topical tranexamic acid alone. Al patients were not drain inserted after the operation. During perioperative period, intraoperative blood loss, postoperative dominant blood loss, occult blood loss and al ogeneic blood transfusion were observed. Within postoperative 90 days, the incidences of symptomatic deep venous thrombosis and pulmonary embolism were observed. RESULTS AND CONCLUSION:(1) The topical administration of cocktail wine significantly reduced total blood loss (P=0.007), hidden blood loss (P=0.000) and transfusion rate (0%vs. 5.4%), without increasing the risk of thromboembolic and hemodynamic complications (P>0.05). (2) Therefore, the hemostatic effect of topical tranexamic acid plus diluted-epinephrine was better than tranexamic acid alone. Their combination does not produce severe adverse reactions, and can be used as an important method to reduce blood loss after total knee arthroplasty.
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The mammalian brain is heterogeneous, containing billions of neurons and trillions of synapses forming various neural circuitries, through which sense, movement, thought, and emotion arise. The cellular heterogeneity of the brain has made it difficult to study the molecular logic of neural circuitry wiring, pruning, activation, and plasticity, until recently, transcriptome analyses with single cell resolution makes decoding of gene regulatory networks underlying aforementioned circuitry properties possible. Here we report success in performing both electrophysiological and whole-genome transcriptome analyses on single human neurons in culture. Using Weighted Gene Coexpression Network Analyses (WGCNA), we identified gene clusters highly correlated with neuronal maturation judged by electrophysiological characteristics. A tight link between neuronal maturation and genes involved in ubiquitination and mitochondrial function was revealed. Moreover, we identified a list of candidate genes, which could potentially serve as biomarkers for neuronal maturation. Coupled electrophysiological recording and single cell transcriptome analysis will serve as powerful tools in the future to unveil molecular logics for neural circuitry functions.
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Humanos , Antígenos de Diferenciación , Fenómenos Electrofisiológicos , Fisiología , Regulación de la Expresión Génica , Fisiología , Estudio de Asociación del Genoma Completo , Células Madre Embrionarias Humanas , Biología Celular , Metabolismo , Células Madre Pluripotentes Inducidas , Biología Celular , Metabolismo , Familia de Multigenes , Fisiología , Neuronas , Biología Celular , Metabolismo , Transcriptoma , FisiologíaRESUMEN
BACKGROUND:MicroRNAs (miRNAs) are widely involved in regulation of physiological processes, such as human development, cel proliferation, differentiation, and apoptosis, angiogenesis and lipid metabolism. MiRNAs also play an important regulating role in the pathological process of femoral head necrosis. At present, the research about the effect of icarin on miRNA expression in glucocorticoid- induced avascular necrosis is stil in the exploratory stage, and the specific targets, possible regulation mechanism and signaling pathway remain unclear. OBJECTIVE:To explore the effect of icarin on miRNA expression of bone microvascular endothelial cels in steroids-induced human femoral head lesionsin vitro. METHODS: Bone microvascular endothelial cels in cancelous bone of the femoral head were isolated and harvested in vitro. Icarin preconditioning preceded establishment of models of glucocorticoid-induced bone microvascular endothelial cel injury. Differential expression profiles and transcriptomes in glucocorticoid and normal groups were tested by miRNA microarrays. The most differentialy expressed miR-23b and miR-339 in microarray analysis were further confirmed by real-time quantitative PCR, Meanwhile the effects of icarin on the expression of miR-23b-5p and miR-339-5p were detected. RESULTS AND CONCLUSION:According to the microarray analysis, one miRNA was up-regulated and four mi RNAs were down-regulated in the glucocorticoid group (fold > 2,P < 0.05). Results of RT-qPCR revealed that miR-23b was down-regulated and miR-339 up-regulated in the glucocorticoid group, which were in agreement with the microarray analysis (P < 0.05). Icarin pretreatment effectively prevented the imbalances of miR-23b expression induced by glucocorticoid (P < 0.01). These findings indicate that Icarin may participate in the pathological process of steroid-induced femoral head necrosis through regulating the expression of miR-23b.
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BACKGROUND:At present, there stil remain controversies concerning the choice of tibial slope in unicompartmental knee arthroplasty, and the related biomechanical studies are rare. OBJECTIVE:To find the rational tibial slope in mobile-bearing unicompartmental knee arthroplasty through the results of finite element analysis. METHODS:A finite element model of normal knee was established and validated using the techniques of three-dimensional reconstruction and finite element pre-processing. Then the finite element models of unicompartmental knee arthroplasty with different tibial slopes were established based on the normal knee model. The finite element analyses were conducted after the boundary conditions and loads were unified. RESULTS AND CONCLUSION: The finite element models of unicompartmental knee arthroplasty with different tibial slopes were established successfuly. The results of the finite element analyses indicated that the posteromedial tibial cortical and cancelous bone stress increased gradualy as the posterior slope increasing, as wel as the load distribution and the cartilage contact pressures of lateral compartment. The anteromedial tibial cortical stress increased significantly with the anterior slope. A posterior tibial slope of 0°-7° can be recommended when implanting a mobile-bearing unicompartmental knee arthroplasty.