Correlation between cognitive impairment and cortical atrophy in elderly patients with asymptomatic carotid artery stenosis / 中华健康管理学杂志

Objective:To analyze the correlation between cognitive impairment and cortical atrophy in elderly patients with asymptomatic carotid artery stenosis (ACAS).Methods:In this cross-sectional study, 40 consecutive elderly patients with ACAS treated in the Department of Neurology, Northern Jiangsu People′s Hospital from July 1, 2020 to June 30, 2021 (ACAS group), and 40 elderly healthy controls who accepted physical examination during the same period (control group) were included. Cognitive assessment was performed using the Mental State Examination Scale (MMSE) and the Montreal Cognitive Assessment Scale (MoCA), and brain magnetic resonance imaging scanning was performed in the ACAS group. The artificial intelligence technique was applied for brain lobe segmentation and cortical volume calculation. The χ2-test, independent sample t-test and Wilcoxon non-parametric test were used to analyze the difference of clinical data and cognitive scores between the two groups. In the ACAS group, the cortical volumes of the side with carotid stenosis was compared with that of the normal side, and Spearman′s correlation analysis was used to assess the correlation between cognitive scores and cortical atrophy. Results:Compared with the control group, the ACAS group got significantly lower scores of MMSE and MoCA, as well as lower scores of visuospatial executive function, attention and calculation, language function, abstraction ability and delayed recall [(25.60±2.49) vs (27.18±1.01), (22.05±3.59) vs (25.60±1.43), (2.73±1.04) vs (4.08±0.62), (4.53±0.93) vs (5.03±0.66), 2.00 (0.00) vs 3.00 (0.00), 1.00 (1.00) vs 2.00 (0.00), and (2.95±0.96) vs (3.35±0.62)] (all P<0.05). There was not significant differences in naming and orientation ability between the two groups (both P>0.05). The volume of cortical, temporal lobe, frontal lobe, parietal lobe and insular lobe on the side with carotid stenosis in the ACAS group were significantly smaller than those on the normal side [186.23 (177.97, 202.53) vs 194.67 (185.65, 204.82) cm 3, 54.74 (50.66, 56.95) vs 55.61 (51.24, 58.49) cm 3, 72.98 (70.76, 78.34) vs 75.27 (72.34, 80.66) cm 3, 53.66 (51.11, 57.86) vs 56.59 (52.80, 60.09) cm 3, 6.57 (6.35, 7.07) vs 6.72 (6.46, 7.34) cm 3] (all P<0.05). The MoCA score in the ACAS group was positively related to the cortical volume ratio of the two sides ( r=0.427, P<0.01). The attention ( r=0.353) and abstraction ( r=0.226) ability scores were positively correlated with the temporal lobe volume ratios of the two sides (both P<0.05). The visuospatial executive ( r=0.187) and language ( r=0.373) ability scores were positively correlated with frontal lobe volume ratios of the two sides (both P<0.05), and visuospatial executive ( r=0.386), naming ( r=0.344), language ( r=0.517), abstraction ( r=0.335) and delayed recall ( r=0.333) ability scores were positively correlated with parietal lobe volume ratios of the two sides (all P<0.05). Conclusion:In elderly patients with ACAS, the cognitive impairment and cortical atrophy on the sides with carotid stenosis are significant and a positive correlation is detected between them.

Tryptophan metabolism involved by gut microbiota and ischemic stroke / 国际脑血管病杂志

Tryptophan is one of the essential amino acids of human body. Its metabolites 5-hydroxytryptamine, kynurenine, tryptamine, and indole derivatives have the functions of immune regulation, nerve regulation, anti-inflammatory, anti-oxidation, anti-cancer, and metabolic regulation. In recent years, it has been found that dysregulation of tryptophan metabolism is closely associated with the onset and prognosis of ischemic stroke, and intestinal flora plays an important role in the regulation of tryptophan metabolism. This article reviews the research progress on the role and mechanism of tryptophan metabolism involved by intestinal flora in ischemic brain injury, and provides a new perspective for future basic and clinical research.

The application of grid locator in lumbar vertebroplasty / 中华骨科杂志

Objective:To compare the optimal gridpercutaneous vertebroplasty (PVP) and conventional PVP in the treatment of osteoporotic vertebral compression fractures (OVCFs).Methods:A retrospective cohort study was conducted of 102 patients with OVCFs who had underwent PVP between May 2016 and May 2019 at department of spine surgery, General Hospital of Northern Theater Command. According to the different surgical methods, they were divided into the optimalgrid PVP group (102 cases) and conventional PVP group (94 cases). In the optimal grid PVP group, there were 38 males and 64 females with an average age of 67.3±8.5 years old, and the course of disease was 2.3±1.2 days; the injured sites were lumbar vertebra, including 59 cases of L 1 vertebra, 31 cases of L 2 vertebra, 8 cases of L 3 vertebra, 3 cases of L 4 vertebra and 1 case of L 5 vertebra. In the conventional PVP group, there were 26 males and 68 females with an average age of 71.5±5.6 years old, and the course of disease was 2.1±1.1 days; the injured sites were lumbar vertebra, including 52 cases of L 1 vertebra, 33 cases of L 2 vertebra, 7 cases of L 3 vertebra and 2 cases of L 4 vertebra. The patients were prepared before operation. Then the best puncture point was selected, and the guide wire and working channel were inserted. Finally the bone cement was pushed. The operation time, intraoperative fluoroscopy times, bone cement dosage and bone cement leakage were compared between the two groups. Visual analogue scale (VAS), anterior heights and median heights of injured vertebra were compared between the two groups at postoperative 3 days, 3 months and the final follow-up. Results:There were no significant differences in the general clinical data between the two groups before operation ( P>0.05). All patients had no complications such as wound infection,pulmonary embolism,spinal cord embolism or death. The operation time, fluoroscopy times, bone cement dosage and bone cement permeability of the two groups were statistically significant different ( P<0.05), and the optimal grid group was better than the conventional group. VAS at 3 days, 3 months and the final follow-up was statistically significantlower in the optimal grid group than the conventional group ( P<0.05). There was no significant difference in the recovery of the anterior and middle edge heights of injured vertebra in the two groups 3 days after operation ( P>0.05), but there were statistical significant difference between the two groups3 months after operation and at the last follow-up ( P<0.05), whilethe optimal grid group was better than the conventional group. Conclusion:Compared with conventional PVP, the optimal grid PVP is safer and more effective in the treatment of osteoporotic vertebral compression fractures.

Roles of gap junction proteins and pannexins in cerebral ischemia / 国际脑血管病杂志

There are a wide range of gap junction proteins and pannexins between brain cells. The neurovascular unit, which are composed of neurons, glial cells and vascular cells, integrate and process information through cell membrane channels composed of gap junction proteins and pannexins, so as to maintain the dynamic balance of the nervous system. After cerebral ischemia, cell membrane channels play an important role in ischemic brain injury by participating in excitatory toxicity, inflammatory response, blood-brain barrier injury and other pathological mechanisms. Therefore, maintaining the normal function of gap junction proteins and pannnexins is essential to protect neurons from ischemic brain injury.

CT and MR features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage / 中华肝胆外科杂志

Objective To investigate the CT and MR imaging features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage.Methods A total of 36 patients diag-nosed with hepatic ischemia/necrosis by both medical imaging and clinical diagnosis shortly after hepato-splenic surgery and upper gastrointestinal hemorrhage were collected,including 9 patients with liver cancer resection,5 patients with liver cancer ablation(microwave ablation/radiofrequency ablation,argon-helium knife,alcohol injection),1 1 patients with spleen resection,and 11 patients with upper gastrointestinal bleeding.Conventional liver CT and/or MR plain and dynamic enhancement scan were performed to com-prehensively analyze the morphology and density/signal performance of the lesions.Results(1)Number of lesions:AU cases had multiple lesions.(2)Distribution of lesions:scattered in the liver lobes,clustered or regional distribution,mainly in the periphery of the liver.(3)Size of lesions:the boundary of the nodu-lar lesion was clear.and the single maximum diameter Was 1.0-1.5 ca.It can be fused into a wedge-shaped patch or a segmental/sub-segmental large patch with a slight mass effect.(4)CT density or MR sig-nal characteristics:CT plain scan showed slightly low density;MR plain scan showed slightly low signal on T1 WI,high signal on T2WI,slightly high signal on DWI and no lipid/fat on dual phase imaging;24 out of 36 cases(66.7％)showed no enhancement,while some lesions showed thin ring enhancement on the edge;emboli were found in the main and/or branches of portal vein(21/36 cases,58.3％).(5)In the short-term review(minimum 5 days),the lesions became smaller or disappeared,and the local liver volume be-came smaller or the surface was depressed.Conclusions Hepatic ischemia/necrosis OCCURS after hepato-splenic surgery and upper gastrointestinal hemorrhage.The imaging manifestations are multiple nodular or flaky hypovascular foci,and the short-term review shows a markedly improvement.It needs to be differentia-ted from infection and metastasis of malignant tumors after operation.

CT and MR features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage / 中华肝胆外科杂志

Objective@#To investigate the CT and MR imaging features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage.@*Methods@#A total of 36 patients diagnosed with hepatic ischemia/necrosis by both medical imaging and clinical diagnosis shortly after hepatosplenic surgery and upper gastrointestinal hemorrhage were collected, including 9 patients with liver cancer resection, 5 patients with liver cancer ablation (microwave ablation/radiofrequency ablation, argon-helium knife, alcohol injection), 11 patients with spleen resection, and 11 patients with upper gastrointestinal bleeding. Conventional liver CT and / or MR plain and dynamic enhancement scan were performed to comprehensively analyze the morphology and density/signal performance of the lesions.@*Results@#(1) Number of lesions: All cases had multiple lesions. (2) Distribution of lesions: scattered in the liver lobes, clustered or regional distribution, mainly in the periphery of the liver. (3) Size of lesions: the boundary of the nodular lesion was clear, and the single maximum diameter was 1.0-1.5 cm. It can be fused into a wedge-shaped patch or a segmental/sub-segmental large patch with a slight mass effect. (4) CT density or MR signal characteristics: CT plain scan showed slightly low density; MR plain scan showed slightly low signal on T1WI, high signal on T2WI, slightly high signal on DWI and no lipid/fat on dual phase imaging; 24 out of 36 cases (66.7%) showed no enhancement, while some lesions showed thin ring enhancement on the edge; emboli were found in the main and/or branches of portal vein (21/36 cases, 58.3%). (5) In the short-term review (minimum 5 days), the lesions became smaller or disappeared, and the local liver volume became smaller or the surface was depressed.@*Conclusions@#Hepatic ischemia/necrosis occurs after hepatosplenic surgery and upper gastrointestinal hemorrhage. The imaging manifestations are multiple nodular or flaky hypovascular foci, and the short-term review shows a markedly improvement. It needs to be differentiated from infection and metastasis of malignant tumors after operation.

Value of diffusion?weighted imaging in the evaluation of therapeutic effect of cyber knife on hepatocellular carcinoma / 中华放射学杂志

Objective To investigate the value of DWI in the evaluation of the therapeutic effect of cyber knife in the treatment of hepatocellular carcinoma.Methods Ninety patients who were clinically diagnosed with hepatocellular carcinoma (95 lesions) in the 5th Medical Center of General Hospital of PLA from February 2011 to December 2013 were retrospectively analyzed. All 90 patients underwent pre‐treatment dynamic contrast‐enhanced MRI scans of liver. Fourty six of them underwent liver MRI scan 3 months after treatment with cyber knife, and 49 patients underwent liver MRI scans 6 months after treatment. According to the evaluation criteria of solid tumor effect, complete necrosis tumor lesions and postoperative residual active lesions were determined. The ADC values of residual active tissue lesion, necrosis lesion in tumor and normal liver were measured. Paired sample t test was used to compare the difference of ADC values of tumor necrosis lesions and normal liver tissues between 3 and 6 months after treatment and before treatment, and ROC was used to evaluate the efficacy of ADC values in predicting complete tissue necrosis after treatment. Results In the 95 lesions, 91 lesions were completely necrotic, and active tissues were found in 4 lesions after treatment. There were statistically significant differences in the ADC values of the lesions at 3 and 6 months after treatment and before treatment (P<0.05),and the ADC values of the tissues after treatment were higher than those before treatment. There was no statistically significant difference in ADC values between 3 and 6 months after treatment and before treatment in normal liver tissue (P>0.05). The area under the ROC of using ADC value to predict the complete necrosis after treatment with cyber knife was 0.767, and the ADC value was 1.23×10‐3 mm2/s as the diagnostic cutoff value. The sensitivity and specificity of the diagnosis were 76.5% and 70.6%, respectively. Conclusion ADC values can distinguish the necrotic component from the active component of hepatocellular carcinoma after treatment, and can be used to evaluate the therapeutic effect of cyber knife in hepatocellular carcinoma.

Quantitative assessment of blood-brain barrier permeability and its application in patients with acute ischemic stroke / 国际脑血管病杂志

The occurrence,development and reperfusion treatment of ischemic stroke may damage the structure and function of the blood-brain barrier,leading to increased permeability of the blood-brain barrier,and then having cerebral edema or hemorrhagic transformation,and finally resulting in poor outcome.Quantitative assessment of blood-brain barrier permeability is now available.This article reviews the assessment methods of blood-brain barrier permeability and their application in patients with ischemic stroke.

Roles of Toll-like receptor 4 in cerebral ischemia / 国际脑血管病杂志

In recent years,studies have shown that inflammation is an important factor in secondaryischemic injury.The exploration of the related mechanisms of the occurrence of inflammation has become ahot spot in the field of cerebral ischemia.Toll-like receptor 4 (TLR4) signaling pathway is one of theclassical inflammatory pathways.Studies have shown that TLR4 is involved in the early inflammatoryresponse after cerebral ischemic injury and the late nerve repair.This article reviews the research progress ofthis signaling pathway in cerebral ischemia injury,so as to seek a therapeutic target against inflammatoryinjury caused by cerebral ischemia through the analysis of its potential research direction.

Analysis on adverse event in acupotomy therapy based on literature research / 中国针灸

OBJECTIVE@#To explore the current domestic situation of the adverse event in acupotomy so as to promote the standardization of acupotomy and improve the clinical effect and safety of acupotomy therapy.@*METHODS@#The method of retrospective journal researching was used. The case report about the adverse event in acupotomy from CNKI, WANFANG and VIP databases was retrieved and the types, the features, the causes, the numbers of the papers and the cases were analyzed.@*RESULTS@#Fifty-eight papers were included, with total 343 cases. It was indicated that the adverse events in acupotomy were mainly postoperative local pain, hematoma, swelling, nerve damage, tendon rupture, adhesion, injury, infection, syncope, anesthesia accident, undeserved hormone use, etc. The lower level of standardization of acupotomy in the clinical use may lead to adverse events.@*CONCLUSION@#Safe acupotomy treatment for some complicated diseases and dangerous parts remains to be improved, and the standardization of the acupotomy is an important approach to improve its safety. The related work needs to be carried out.

Percutaneous S2-alar-iliac screw fixation for lower lumbar spondylodiscitis with no neurological symptoms in elderly patients: analysis of short-term curative effect / 介入放射学杂志

Objective To evaluate the short-term efficacy of percutaneous S2-alar-iliac screw (S2AIS) fixation for the treatment of lower lumbar spondylodiscitis with no neurological symptoms in elderly patients.Methods The clinical data of 28 patients of lower lumbar spondylodiscitis with no neurological symptoms,who were admitted to the Ward of Spine,Department of Orthopaedics,General Hospital of Shenyang Military Region,China,to receive percutaneous S2AIS fixation,were retrospectively analyzed.The operation was performed by the same surgeon for all patients.A total of 56 S2AIS fixation procedures were accomplished.The patients' age varied from 71 to 79 years old.The spondylodiscitis was located at IAL5 or L5-S1.After the treatment,the patients were followed up for a mean of 6.67 months.The mean operative time,the amount of intraoperative blood loss,the postoperative bed time,the average hospitalization days and the postoperative wound healing were documented and analyzed.The Oswestry score,visual analogue score,erythrocyte sedimentation rate,C reactive protein level were determined before operation as well as at one week and 6 months after operation,and postoperative CT was performed to check the loosening of internal screw fixation.The results were compared and analyzed.Results The mean operative time was (158.12±4.32) min,the average amount of intraoperative blood loss was (25.34±3.23) ml,the average postoperative bed time was (1.34±0.35) d,and the average hospitalization time was (7.29±1.34) d.Poor surgical incision healing was seen in only one patient,and the postoperative wound healing rate was up to 96.42％.Loosening of right S2AIS was detected in one patient,with the screw loosening rate being 1.79％.The Oswestry scores determined at one week and 6 months after treatment were 32.21 and 23.20 respectively,which were significantly different from the preoperative score (P＜0.05).The visual analogue scores determined at one week and 6 months after treatment were 2.17 and 1.25 respectively,which were significantly different from the preoperative score (P＜0.05).At one week and 6 months after treatment,the erythrocyte sedimentation rates were 15.32 mm/h and 14.56 mm/h respectively,and the C reactive protein levels were 7.89 mg/L and 8.90 mg/L respectively,both of which were significantly different from the preoperative ones (both P＜0.05).Conclusion For the treatment of lower lumbar spondylodiscitis with no neurological symptoms in elderly patients,percutaneous S2AIS fixation has certain advantages,such as less trauma,less blood loss,early postoperative ambulation,remarkable improvement of clinical symptoms,etc.with satisfactory short-term clinical efficacy.

Risk factors for progressive cardiogenic stroke / 中华老年心脑血管病杂志

Objective To study the risk factors for progressive cardiogenic stroke (CS).Methods Seventy-one acute ischemic stroke patients admitted to our hospital from 2008-08-01 to 2014-12-31 were divided into progressive CS group (n=14) and non-progressive CS group (n=57).The NIHSS was used to assess the neurologic deficit when the patients were admitted and 30 days after the stroke onset.Their clinical data were retrospectively analyzed.The risk factors for progressive CS were analyzed by univariate logistic regression analysis and multivariate logistic regression analysis respectively,their critical thresholds were analyzed according to the ROC curve.Results The NIHSS improvent of the progressive CS group was significantly less than that of the non-progressive CS group (P＜0.01).The age was significantly older,the incidence of right-side infarction and the serum level of D-dimer were significantly higher while the serum level of glutamic pyruvic transaminase was significantly lower in progressive CS group than in non-progressive CS group (77.29±8.87 years vs 71.44±9.51 years,P=0.041;71.4％ vs 33.3％,P=0.009;2.82 mg/L vs 0.91 mg/L,P=0.048;13.79±4.44 U/L vs 21.98±17.34 U/L,P=0.002).Lo gistic regression analysis showed a significant difference in age,right-side infarction and serum D-dimer level between the two groups (P=0.030,P=0.007,P=0.025).The area under the ROC curve revealed that age ＞ 70.75 years and serum D-dimer level ＞1.23 mg/L were the risk factors for progressive CS.Conclusion Age,right-side infarction and serum D-dimer level are the risk factors for progressive CS and can thus be used as predictors of progressive CS.

Effect of preventing infection for a continuous pulsing water ball in lumbar surgery / 局解手术学杂志

Objective To study the effect of the continuous pulsing water ball in preventing infection in the multi-level posterior lumbar interbody fusion(PLIF).Methods From June 2016 to December 2016,thirty patients who were treated with multi-level posterior lumbar interbody fusion in our hospital were randomly divided into two groups.The 15 patients in the observation group were given continuous pulsing water ball,and the other 15 patients in the control group were given conventional dumping.The items including the time of intraoperative washing,the C-reactive protein(CRP),the time of suture clearing,postoperative fever cases and postoperative incision healing were oberved and compared between the two groups.Results The time of intraoperative washing was (2.13±0.15)min in the observation group and (5.59±1.24)min in the conrtrol group,and the difference was statistically significant (P<0.05).The postoperative CRP of 1st,3rd, and 5th day in the observation group was declining,whileas the control group was increasing.The time of suture clearing in the oberation group was 11.57 d, which was significantly less than 14.29 d the control group.The temperature of 3rd and 5th day after opreation in the obervation group was (37.1±2.26)℃ and (37.0±0.12)℃ respectively, which were significantly lower than (38.2±3.34)℃ and (37.5±0.25)℃ respectively the control group,and the difference was statistically significant(P<0.05).Conclusion Compared to the the conventional dumping,the continuous pulsing water ball has the some advantages in the multi-level posterior lumbar interbody fusion (PLIF),such as decreasing the washing time and reducing the local inflammatory reponse.

Application of preoperatively vertebral artery CTA in screw setting of upper cervical spine / 局解手术学杂志

Objective To study the application of cervical vertebral artery CT angiography(CTA) preoperatively in the screw setting of upper cervical spine.Methods The data of 170 patients who underwent upper cervical spine surgery from January 2014 to December 2015 in our hospital were retrospectively analyzed,of whom 80 cases with typeⅡodontoid fractures,90 cases with atlantoaxial dislocation;20 cases were operated with occipitocervical fusion,150 cases treated with atlantoaxial fusion.Seventy-eight cases were examinated by cervical vertebral artery CTA before sugery(observation group) but the other 92 cases(control group).The rate of the vertebral arterial lesion between the two groups were compared.Results Six cases with vertebral artery injury in control group,the incidence of arterial injury was 7％;unilateral vertebral artery was found in 3 cases,small congenital development of left cervical vertebral artery in 5 case,abnormal branch in 5 cases.The rate of dysplasia was 17％,and the rate of vertebral artery injury was 0.The rate of vertebral artery injury in control group was higher than observation group,the difference was significant(P<0.05).Conclusion Vertebral artery CTA examination preoperatively may become a routine examination,in order to make the operator carefully evaluate the relationship between the vertebral artery with atlantoaxial vertebral,choose the accurate screw-setting and avoid the vertebral artery injury in the upper cervical spine surgery.

Clinical features of traumatic thoracolumbar fractures / 局解手术学杂志

Objective To analyze the clinical features of traumatic thoracolumbar fractures,and to improve the level of prevention and treatment of traumatic thoracolumbar fractures.Methods A review of 527 patients with traumatic thoracolumbar fractures admitted to our hospital from January 2006 to December 2015 was performed to analyze their clinical features,who were divided into different groups according to the age,fracture level and etiology.Results Of the 527 patients,238 patients aged form 40 to 59 year-old,which accounting for about 45.2％.Combined thoracolumbar and other segments fracture were presented in 76 patients,accounting for about 14.4％,among which combined thoracolumbar and lumbar spine fracture in 42 patients (8.0％),thoracolumbar and thoracic spine fracture in 22 patients (4.2％),thoracolumbar and cervical spine fracture in 7 patients and thoracolumbar(1.3％),cervical spine,thoracic spine and lumbar spine fracture in 5 patients(0.9％).The sex ratio was 136∶49 (2.8),incidence of neurological deficit was 50.3％,incidence of combined injuries was 38.9％ in the 20 to 39 year-old patients.High fall,low fall and road traffic accident were the most common etiologies,accounting for 43.1％,23.3％ and 14.6％ respectively,other etiologies accounting for 19.0％.In the patients caused by struck by object group,the sex ratio was 52∶3 (17.3),incidence of neurological deficit was 60.0％,incidence of combined injuries was 47.3％ and mean ISS score was (21.4 ± 12.7) point,the values were significantly larger than the other patients (P ＜ 0.05).According to ASIA neurologic grading system,72 patients in grade A,17 patients in grade B,37 patients in grade C,95 patients in grade D,68 patients recovered 1 or more grades during hospitalization,which accounting 12.9％ of all the patients.Conclusion The epidemiological survey of traumatic thoracolumbar fractures reveals that the age from 40 to 59 year-old and high fall was the most common age and etiology for injuries of spinal fracture.The 20 to 39 year-old patients group and struck by object group presented with the highest sex ratio,incidence of neurological deficit and combined injuries,the prevention and treatment should be designed according to the injury features of different individuals.

Influence factor of Cs palsy after cervical decompression surgery / 局解手术学杂志

Objective To evaluate the clinical and radiological factors which affecting the recovery duration of C5 palsy after cervical decompression surgery.Methods The datas of 710 patients with degenerative cervical spine surgery in departement of spine surgery of orthopaedics of general hospital of Shenyang military region were retrospectively analyzed.The demographics,radiology,clinical information were recorded to analyze the relationship with the recovery duration of postoperative C5 palsy.Results C5 nerve root palsy occurred in 36 cases,of which 33 cases completely recovered within 2 years after surgery(18 cases recovered within postoperative 6 months),3 cases did not completely recovered during the following period.Factors related to longer recovery(over 6 months) included postoperative limbs muscles strength ≤2(P＜0.01),presence of multi-segment paresis involving more than the C5 root(P =0.002),loss of somatic sensation with pain(P =0.008),and the degree of posterior spinal cord shifting (P =0.040).Furthermore,multivariate analysis revealed that postoperative limbs muscles strength ≤2(P =0.010) had a significant effect on a recovery duration beyond 6 months.Conclusion The postoperative limbs muscles strength ≤2,the presence of multi-segment paresis involving more than the C5 root,the loss of somatic sensation with pain,and the degree of posterior spinal cord shifting are main factors which significantly influence the duration of recovery from postoperative C5 nerve root palsy.

Unilateral short-segment pedicle screw fixation for treatment of thoracolumbar fractures / 局解手术学杂志

Objective To assess the operation results of unilateral and bilateral short-segment pedicle screw fixation combined with in-termediate screws in thoracolumbar fractures .Methods A total of 73 patients with thoracolumbar fracture were included in our study .Among the 73 patients, 48 cases were treated by bilateral short-segment pedicle screw fixation and the other 25 cases were treated by unilateral short-segment pedicle screw fixation,with a mean follow-up of 24.6 months.Surgical time,surgical blood loss,surgical draining loss,hospital stays, hospitalization cost,Cobb’s angle,kyphosis of the vertebral body ,anterior height of the fracture vertebral body ,VAS and ODI scores between the two groups were compared .Results There were significant differences in the surgical time and hospitalization cost between two groups (P0.05).Conclusion Unilateral short-segment pedicle screw fixation combined with intermediate screws can significantly correct the kyphosis and achieve the clinical effect of bilateral short -segment pedicle screw fixation technique .Meanwhile , the unilateral short-segment pedicle screw fixation technique can significantly reduce the surgical time and hospitalization cost ,which is an ef-fective method for thoracolumbar fracture .

Study on Preparation Technology and in vitro Drug Release Behavior of Baicalin Monolithic Osmotic Pump Tablets / 中国药房

OBJECTIVE:To prepare Baicalin monolithic osmotic pump tablets and investigate its in vitro drug release behavior. METHODS:Using accumulative release rate as evaluation index,baicalin solid dispersion was prepared to improve solubility,sin-gle factor test and orthogonal test were used to optimize preparation technology(the amount of penetrating agent and pore-forming agent,weight gaining of coating film) of monolithic osmotic pump tablets using baicalin solid dispersion as intermediate. Release rate and mechanism of samples prepared by optimized technology were investigated in 3 kinds of release medium (water,0.1 mol/L HCl,simulated gastric fluid). RESULTS:The optimal preparation technology was that penetrating agent sodium chloride was 30 mg;pore-forming agent polyethylene glycol 400 was 20% amount of excipient cellulose acetate;weight gaining of coating film was 2%. RSD of 12 h accumulative release rate was 1.06%(n=3)for 3 batches of Baicalin monolithic osmotic pump tablets pre-pared by optimized technology. 12 h accumulative release rate of them in 3 kinds of medium were similar to each other,being all more than 80%. Release equation was in line with zero-order drug release model (r=0.9985). CONCLUSIONS:Prepared Ba-icalin monolithic osmotic pump tablets after optimization can release drug at controlled rate.

Efficacy and safety of a new percutaneous guide wire for percutaneous pedicle screw insertion / 局解手术学杂志

Objective The purpose was to compare the biomechanical characteristics of new percutaneous guide wire and conventional wire in cadaveric spines,and to evaluate the new percutaneous guide wire's efficacy and safety in a clinical trial.Methods Compared the push-out and penetration forces of the new percutaneous guide wire and conventional wire in fresh cadaveric lumbar spines from L1 to L5.And analyzed the related complications of new percutaneous guide wire by clinical experiment.Results Push-out forces caused the spiral part of the new percutaneous guide wire to bend or spread,so as to resist the anterior migration of the guide wire.The mean push-out forces of the new percutaneous guide wire and conventional wire were (15.5-+ 1.9) N and (5.7 ± 0.8) N respectively (P ＜ 0.01),and the mean penetration forces were (69.1 ±4.2) N and (37.1 ±4.8) N respectively (P ＜0.01).There was no wire breakage or anterior-wall penetration in the clinical trial of 222 new percutaneous guide wire.Conclusion The mean push-out and penetration forces of the new percutaneous guide wire were approximately 2 to 3 times greater than those of conventional wire.The new percutaneous guide wire effectively prevented guide-wire anterior migration and penetration of the anterior vertebral-body wall.The new percutaneous guide wire device could effectively improve the safety of percutaneous pedicle screw insertion procedures for patient with osteoporosis.

Guiding chunnel-assisted percutaneous pedicle screw placement for thoracolumbar vertebral fractures not accompanied by nerve injury / 介入放射学杂志

Objective To analyze the operation time,radiation exposure time and the screw placement accuracy of a newly-developed guiding chunnel-assisted percutaneous pedicle screw placement technique for thoracolumbar vertebral fractures not accompanied by nerve injury.Methods The clinical data of 35 patients with thoracolumbar vertebral fractures not accompanied by nerve injury,who were treated with newly-developed guiding chunnel-assisted percutaneous pedicle screw placement technique during the period from July 2010 to October 2012,were retrospectively analyzed.A total of 178 procedures of pedicle screw placement were performed in the 35 patients by the one and the same surgeon.The operation time and radiation exposure time of each pedicle screw placement procedure were recorded,and based on the findings of postoperative consecutive two CT scans of the operated vertebrae the screw placement accuracy was graded and evaluated.Results The technical success rate of screw placement was 100％.The mean time used for a single pedicle screw placement was (11.35±2.82) minutes,the average radiation exposure time was (8.06± 2.15) seconds.Screw placement accuracy of grade A was obtained in 156 screws (87.64％),grade B in 20 screws (11.24％),grade C in one screw (0.56％),and grade D in one screw (0.56％).Conclusion The newly-developed guiding chunnel-assisted percutaneous pedicle screw placement technique is very helpful in localizing the puncture point,in improving the screw placement accuracy,and in reducing both operation time and radiation exposure time.