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Objective:To evaluate the axial instrument strategy for atlantoaxial dislocation with complex vertebral artery variation.Methods:A total of 55 patients with atlantoaxial dislocation who underwent surgical treatment from January 2019 to December 2021 were retrospectively analyzed, including 14 males and 41 females, aged 54.0±12.8 years (range, 22-78 years). Among these patients, 10 patients with unilateral vertebral artery high ride with contralateral vertebral artery occlusion, 30 patients with bilateral vertebral artery high ride with single dominant vertebral artery, 15 patients with bilateral vertebral artery high ride. All patients underwent posterior reduction and internal fixation. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were used to evaluate the postoperative efficacy.Results:All patients completed the surgery successfully with a follow-up time of 14.6±5.5 months (range, 6-24 months). C 2 pedicle screw fixation was performed on the non-dominant side of unilateral vertebral artery high ride and the non-dominant side of bilateral vertebral artery high ride with one dominant vertebral artery (40 vertebraes). The dominant side of unilateral high vertebral artery and bilateral high vertebral artery with one dominant vertebral artery was fixed with C 2 medial "in-out-in" screw (10 vertebraes), C 2 isthmus screw (21 vertebraes), C 2 without screw (9 vertebraes) only extended the fixed segment. For bilateral vertebral artery high ride patients, one side was used C 2 "in-out-in" pedicle screws (right 10 vertebraes, left 5 vertebraes), and the other side was fixed with C 2 medial "in-out-in" screw (8 vertebraes), C 2 isthmus screw (5 vertebraes), C 2 without screw only extended the fixed segment (2 vertebraes). The JOA scores were 8.5±1.8, 13.9±1.3, and 14.4±1.1 preoperatively, 6 months postoperatively, and at the final follow-up, respectively, with statistically significant differences ( F=279.40, P<0.001). JOA at 6 months postoperatively and at the final follow-up was greater than preoperatively, and the differences were statistically significant ( P<0.05), whereas the differences in JOA scores at 6 months postoperatively and at the final follow-up was not statistically significant ( P>0.05). Preoperative, 6 months postoperatively and final follow-up cervical VAS scores were 3.7±1.9, 2.1±0.9 and 1.6±1.0, respectively, with statistically significant differences ( F=39.53, P<0.001). The cervical VAS at 6 months postoperatively and at the last follow-up was less than that before surgery, and the differences were statistically significant ( P<0.05). Cervical VAS scores at 6 months postoperatively were greater than at the last follow-up, with a statistically significant difference ( P<0.05). Conclusion:For patients with atlantoaxial dislocation with complex vertebral artery variation, C 2 lateral "in-out-in" screw, C 2 medial "in-out-in" screw, isthmus screw fixation or C 2 without screw only extended the fixed segment can obtain good clinical efficacy.
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Objective:To investigate the clinical effect of anterior cervical release and posterior fixation in the treatment of irreducible atlantoaxial dislocation with retropharyngeal internal carotid artery.Methods:Thirteen patients with irreducible atlantoaxial dislocation of retropharyngeal internal carotid artery from January 2015 to July 2019 were treated with anterior cervical release and posterior fixation. There were 8 males and 5 females, aged from 34 to 65 years with an average of 46.1±12.6 years. Positive, lateral and dynamic X-ray films, MR and CTA were performed before operation. There were 4 cases with bilateral retropharyngeal internal carotid artery and 9 cases with unilateral retropharyngeal internal pharyngeal artery. The time of operation, the amount of bleeding and intraoperative and postoperative complications were recorded. The main observations were Japanese Orthopaedic Association (JOA) score, atlantodental interval (ADI), Chamberlain line (CL), and changes in the morphology of the retropharyngeal internal carotid artery and implant fusion.Results:All the operations completed successfully. The operation time was 210-260 min, the average was 245±21 min; the blood loss was 350-600 ml, the average blood loss was 490±107 ml. There was no injury of internal carotid artery, vertebral artery, spinal cord or nerve root during the operation. All patients were followed up for 9 to 24 months, with an average of 15.1±6.2 months. Preoperative JOA score was 6.9±2.3 points, 1 month after operation was 13.5±2.5 points, and the last follow-up was 14.3±2.1 points. The difference was statistically significant ( F=30.91, P<0.001). The difference between 1 month after operation and before operation was statistically significant ( P<0.001), and the improvement rate of JOA score was 75.6%±15.2%. There was no significant difference between the last follow-up and 1 month after operation ( P>0.05). The preoperative ADI was 8.9±2.2 mm, 1 month after operation was 1.1±0.8 mm, and the last follow-up was 1.2±0.9 mm. The difference was statistically significant ( F=114.69, P<0.001). The difference between 1 month after operation and before operation was statistically significant ( P<0.001), and ADI had returned to normal level. There was no significant difference between the last follow-up and 1 month after operation ( P>0.05). The preoperative CL was 11.7±4.8 mm, 1 month after operation was 1.6±2.1 mm, and the last follow-up was 1.8±2.3 mm. The difference was statistically significant ( F=34.19, P<0.001). The difference between 1 month after operation and before operation was statistically significant ( P<0.001), and the position of odontoid process returned to normal level. There was no significant difference between the last follow-up and 1 month after operation ( P>0.05). Bone graft fusion was received at 6 to 12 months after operation, with an average of 10.2 months. Conclusion:CTA examination should be performed before anterior release of atlantoaxial dislocation to understand the position and shape of internal carotid artery. Anterior cervical release combined with posterior bone graft fusion is an effective method for the treatment of irreducible atlantoaxial dislocation with retropharyngeal internal carotid artery without increasing the risk of internal carotid artery injury.
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Objective:To evaluate the clinical efficacy of cervical anterior approach atlantodentoplasty for the treatment of irreducible atlantoaxial dislocation complicated with bony abnormality of atlanto-dental joint.Methods:Retrospective analysis was conducted to study the clinical data of 31 patients with irreducible atlantoaxial dislocation complicated with bony abnormality of atlanto-dental joint, including 7 males and 24 females; age ranged from 23 to 74 years, with an average of 49.0±12.0 years. All patients underwent cervical anterior approach soft tissue release, atlantodentoplasty and one-stage posterior occipito-cervical fixation and fusion. Twenty-one patients with atlantodental osteoarthritis underwent simplex atlantodental osteophyte resection, 5 patients with anterior tubercle hypertrophy of atlas and 5 patients with anterior tubercle hypertrophy of atlas and atlantodental osteoarthritis underwent atlantodental osteophyte resection and partial anterior tubercle resection. The operation time and blood loss of anterior procedure and total procedure were recorded. The anterior tubercle thickness (ATT), the atlantodental interval (ADI)were recorded before and 1 week after the operation. The available space of the cord (SAC), clivus-canal angle (CCA), cervicomedullaryangle (CMA), and the Japanese Orthopaedic Association (JOA) scores were recorded before the operation, 1 week, 3 months and 12 months after the operation, and at the last follow-up. The JOA improvement rate at the last follow-up was calculated, the time of postoperative bone graft fusion was recorded, and the complications were observed.Results:All patients were followed up for 12-60 months, with an average of 34.5±13.8 months. The operation time of anterior cervical atlantodentoplasty was 120.9±15.9 min, and the overall operation time was 315.1±31.4 min; The blood loss of anterior procedure was 101.2±31.2 ml, and that of overall procedure was 372.7±56.0 ml. The one week postoperative ATT (7.4±1.6 mm) of patients with anterior tubercle partial resection of atlas was lower than that before operation 10.8±1.5 mm ( t=4.94, P=0.001). The one week postoperative ADI 0.9±1.2 mm decreased compared with the preoperative ADI 8.3±2.2 mm ( t=17.91, P<0.001). The preoperative SAC was 10.4±2.8 mm, which increased to 19.2±3.6 mm one week after operation and 19.4±3.7 mm ( F=41.31, P<0.001) at last follow-up. The preoperative CCA was 119.4°±17.9°, which increased to 142.6°±13.0° one week after operation and 141.6°±12.2° ( F=35.86, P<0.001) at last follow-up. The preoperative CMA was 121.7°±14.1°, which increased to 148.9°±9.4° one week after operation and 149.4°±9.0° ( F=52.07, P<0.001) at last follow-up. The preoperative JOA score was 12.0±2.6, which was 14.3±1.3 one week after operation and 15.9±1.0 ( F=23.81, P<0.001) at last follow-up. JOA improvement rate was 78.9%±17.1%, while 23 cases were excellent (74.2%), 8 cases were good (25.8%), and the excellent and good rate was 100%; Thd fusion time of grafted bone was 5.7±1.5 months with the fusion rate of 100%; There were 12 patients with dysphagia after operation, all of which relieved spontaneously 5-10 days after operation; There were 3 cases of irritating choking after drinking or eating, and 2 cases were gradually alleviated 3-5 days after operation. One case was complicated with aspiration pneumonia due to stubborn choking, which gradually alleviated after 1 month of nasal feeding. No hardware failure or reduction loss, no serious complications such as esophageal injury, cerebrospinal fluid leakage, incision infection or vertebral artery injury occurred. Conclusion:Cervical anterior approach atlantodentoplasty for the treatment of irreducible atlantoaxial dislocation complicated with bony abnormality of atlanto-dental joint can anatomically reduce the atlantoaxial joint, and the clinical effect is satisfactory.
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Objective:To evaluate the prognostic value of combined detection of platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and squamous cell carcinoma antigen (SCC) for patients with advanced cervical squamous cell carcinoma undergoing radical radiotherapy.Methods:Clinical data of 127 patients with advanced cervical squamous cell carcinoma who received radical radiotherapy in the Affiliated Tumor Hospital of Nantong University from January 2016 to February 2019 were analyzed retrospectively. The enrolled cases were divided into the survival group and death group according to the survival at the end of 3 years after treatment. The laboratory indexes of peripheral blood were collected before treatment, PLR and NLR were calculated, and the differences of clinical parameters were compared between two groups. The prediction model was established, and the prediction efficiency of PLR, NLR and SCC alone and combined prediction models for 3-year overall survival (OS) in patients with advanced cervical squamous cell carcinoma was compared through the ROC curve. Univariate and multivariate analyses of prognosis were carried out by binary logistic regression model.Results:A total of 127 patients with advanced cervical squamous cell carcinoma were included in the study. There were 96 cases in the survival group and 31 cases in the death group. There were significant differences between two groups in FIGO stage, longest diameter of tumor, lymph node metastasis, PLR, NLR and SCC (all P<0.05). The area under ROC curve (AUC) of PLR, NLR and SCC was 0.660, 0.712 and 0.700, respectively. The AUC of PLR+NLR+SCC combined prediction model was increased to 0.784. Logistic multivariate analysis showed that FIGO Ⅲ, FIGO Ⅳ, lymph node metastasis, PLR≥205.555, NLR≥3.060 and SCC≥6.950 ng/ml were the independent risk factors for 3-year OS in patients with advanced cervical squamous cell carcinoma (all P<0.05). Conclusions:PLR, NLR and SCC have good value in predicting the 3-year OS of patients with advanced cervical squamous cell carcinoma, and the combined prediction model of PLR+NLR+SCC has higher prediction value.
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Objective:To observe the effect of insertion of in-out-in axis pedicle screws on the vertebral artery in the posterior occipitocervical surgery for atlantoaxial subluxation or instability.Methods:The data of 52 patients with atlantoaxial dislocation or instability were analyzed who had been treated by internal fixation with in-out-in pedicle screws in the posterior occipitocervical surgery from January 2015 to February 2021 at Department of Spine and Spinal Cord Surgery, Henan Provincial People's Hospital. There were 30 males and 22 females, aged from 17 to 65 years (mean, 41.2 years). There were 26 cases of unilateral vertebral artery high-riding, 3 cases of bilateral high-riding, 19 cases of unilateral narrow pedicle due to C2 and C3 fusion, and 4 cases of bilateral narrow pedicles. X-ray, CTA and MRI were performed before and 3 days after surgery. The patients' clinical symptoms were recorded. CTA was used to measure the diameter of the vertebral artery at the transverse foramina of C 2 and C 3 and to observe the effect of in-out-in screws on the morphology of the vertebral artery. X-ray and CT examinations were performed at 6 months after surgery to observe the bone fusion. Results:The surgery went on uneventfully in all the patients. In the 9 cases undergoing anterior and posterior surgery, the operation time averaged 271.2 min (from 213 to 352 min) and the bleeding volume 471.5 mL (from 230 to 830 mL). In the 43 cases undergoing posterior surgery, the operation time averaged 171.6 min (from 131 to 226 min) and the bleeding volume 395.9 mL (from 170 to 660 mL). There was no such complication as spinal or vascular injury. The CTA reexamination 3 days after surgery showed that the diameter of the vertebral artery was (2.92±0.55) mm and (3.04±0.54) mm, respectively at the cervical 2 and 3 transverse foramina, showing no significant change compared with the preoperative values [(2.91±0.68) mm and (3.11±0.50) mm] ( P>0.05) and that the vertebral artery was displaced externally and inferiorly in 21 cases. Follow-ups for all patients ranged from 7 to 24 months (mean, 11 months). At 6 months after surgery, bone fusion was observed by imaging and no breakage or displacement of the internal fixation was observed. Conclusion:The in-out-in pedicle screws in the posterior occipitocervical surgery may have little impact on the vertebral artery, leading to reliable clinical outcomes.
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Objective:To analyze the postoperative paravertebral muscle degeneration and its correlations with health related quality of life (HRQL) in patients undergoing minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF).Methods:The clinical data of the 50 patients were retrospectively analyzed who had undergone single-segmental MIS-TLIF at Department of Spinal Cord Surgery, The People's Hospital of Henan Province from January 2019 to December 2021. The relative volumes of lumbar posterior muscle (LM), the relative volumes of the psoas major (PM), and the rates of fatty degeneration (FD) of the fused segment and its adjacent segments were compared respectively between preoperation, 6 and 12 months postoperation. The correlations were analyzed between the HRQL scores [visual analog scale (VAS) for pain and Oswestry disability index (ODI)] and the relative LM volumes, the relative PM volumes, and the FD rates of the fused segment and its adjacent segments at 12 months postoperation.Results:Compared with the preoperative values, the relative LM volumes and the relative PM volumes of the fused segment and its adjacent segments at 6 and 12 months postoperation were significantly reduced while the FD rates significantly increased. However, the FD rate of the fused segment at 12 months postoperation (20.6% ± 6.1%) was significantly lower than that at 6 months postoperation (29.7% ± 8.2%) ( P < 0.05). The VAS score was strongly negatively or positively correlated with the relative LM volume ( r = -0.819, P < 0.001) and the FD rate ( r = 0.86, P < 0.001) of the fused segment, and moderately negatively correlated with the relative PM volume ( r = -0.435, P = 0.016). The ODI index was moderately negatively correlated with the relative LM volume ( r = -0.512, P = 0.004) and the relative PM volume ( r = -0.402, P = 0.020) of the fused segment, but moderately positively correlated with the FD rate of the fused segment ( r = 0.565, P = 0.001). There was a moderate negative correlation between the ODI index and the relative LM volume of the adjacent segments ( r = -0.478, P = 0.012). Conclusions:After MIS-TLIF, the volume of the paravertebral muscles decreases and the dorsal muscles develop fatty degeneration. The improvement of LM fatty degeneration may be observed by 12-month follow-up in the fused segment, but not in the adjacent segments. The LM volume and the FD rate of the fused segment are the most closely related to the postoperative HRQL.
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Objective:To investigate the effects of different surgical time points on the treatment efficacy of acute traumatic central cord syndrome (ATCCS).Methods:Retrospectively analyzed were the 84 ATCCS patients who had been treated at Department of Spinal Surgery, Henan Provincial People's Hospital from January 2013 to February 2021. According to the surgical timing, the patients were divided into 3 groups. In group A (surgery < 48 hours) of 16 cases, there were 11 males and 5 females, aged from 43 to 76 years; in group B (surgery within 3 to 7 days) of 41 cases, there were 31 males and 10 females, aged from 41 to 78 years; in group C (surgery within 8 to 14 days) of 27 cases, there were 15 males and 12 females, aged from 46 to 83 years. Anterior, posterior or combined anterior and posterior approaches were used according to their specific condition. The American Spinal Injury Association (ASIA) motor scores and Japanese Orthopaedic Association (JOA) scores at admission, 7 days and 12 months after operation, postoperative ICU duration, and complications were compared among the 3 groups.Results:There were no significant differences in the preoperative general information or surgical approaches among the 3 groups, showing they were comparable ( P> 0.05). In all patients, the ASIA motor scores and JOA scores at 7 days and 12 months after operation were significantly better than those at admission, and the ASIA motor scores and JOA scores at 12 months after operation were significantly better than those at 7 days after operation ( P<0.01). There was no significant difference in the ASIA motor score or JOA score between the 3 groups at 7 days or 12 months after operation ( P>0.05). The postoperative ICU duration in group A was 42 (26, 61) h, significantly longer than 23 (16, 35) h in group B and 24 (14, 38) h in group C ( P<0.05). There were no deaths in the 84 patients; there was no significant difference in the overall incidence of serious complications or in that of general complications among the 3 groups ( P>0.05). Conclusions:Surgery is safe and effective for ATCCS. However, decompression surgery within 2 weeks may achieve better outcomes.
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Objective:To compare the efficacy of posterior atlas uniaxial and polyaxial screw instrumentation and fusion with bone graft for Gehweiler type IIIb atlas fracture.Methods:A retrospective cohort study was performed to analyze the clinical data of 36 patients with Gehweiler type IIIb atlas fracture admitted to Henan Provincial People′s Hospital from January 2015 to October 2020. There were 29 males and 7 females, with age range of 23-82 years [(48.8±15.5)years]. All patients were treated with posterior atlas screw-rod internal fixation and fusion with bone graft, of which 14 received atlas uniaxial screw internal fixation (uniaxial screw group) and 22 received atlas polyaxial screw internal fixation (polyaxial screw group). The operation time and intraoperative blood loss were compared between the two groups. The atlas fracture union rate and atlantoaxial posterior arch bone fusion rate were compared between the two groups at 3 months and 6 months after operation. The anterior atlantodental interval (ADI), basion-dens interval (BDI) and lateral mass displacement (LMD) were compared between the two groups to evaluate the reduction of fracture fragments before operation, at 1, 3, 6 months after operation and at the last follow-up. At the same time, the visual analogue scale (VAS) and neck dysfunction index (NDI) were compared between the two groups to evaluate neck pain and functional recovery. The postoperative complications were observed.Results:All patients were followed up for 12-44 months [(27.2±9.9)months]. There was no significant difference in operation time or intraoperative blood loss between the two groups (all P>0.05). The atlas fracture union rate and atlantoaxial posterior arch bone fusion rate were 85.7% (12/14) and 78.6% (11/14) in uniaxial screw group at 3 months after operation, insignificantly different from those in polyaxial screw group [72.7% (16/22) and 77.3% (17/22)] (all P>0.05). All patients in the two groups achieved bone union and fusion at 6 months after operation. There was no significant difference in ADI between the two groups before and after operation (all P>0.05). The BDI in the two groups did not differ significantly before operation ( P>0.05), but a significantly higher value was found in uniaxial screw group at 1, 3, and 6 months after operation and at the last follow-up [(5.9±1.3)mm, (5.8±1.3)mm, (5.9±1.2)mm and (5.8±1.2)mm] than in polyaxial screw group [(3.1±0.6)mm, (3.1±0.6)mm, (3.1±0.6)mm and (3.1±0.6)mm] (all P<0.01). The two groups did not differ significantly before operation ( P>0.05), but LMD at 1, 3, and 6 months after operation and at the last follow-up was (1.6±0.8)mm, (1.5±0.8)mm, (1.5±0.7)mm and (1.5±0.9)mm in uniaxial screw group, significantly lower than that in polyaxial screw group [(4.8±1.6)mm, (4.6±1.6)mm, (4.9±1.6)mm and (4.9±1.6)mm] (all P<0.01). There was no significant difference in VAS between the two groups before operation ( P>0.05). The VAS at 1, 3, and 6 months after operation and at the last follow-up was 3.0(3.0, 4.0)points, 2.0(1.0, 2.0)points, 1.0(0.8, 2.0)points and 1.0(0.0, 1.3)points in uniaxial screw group and was 3.5(3.0, 4.0)points, 2.0(2.0, 3.0)points, 2.0(1.0, 2.0)points and 2.0(1.0, 3.0)points in polyaxial screw group. In comparison, the VAS scored much lower in uniaxial screw group than in polyaxial screw group at 6 months after operation and at the last follow-up (all P<0.01). There was no significant difference in NDI between the two groups before operation ( P>0.05). The NDI at 1, 3, and 6 months after operation and at the last follow-up was 34.9±6.3, 23.4±6.2, 13.9±2.7 and 9.4±2.8 in uniaxial screw group and was 33.2±6.1, 24.4±6.3, 18.1±4.1 and 12.7±3.2 in polyaxial screw group, showing a significantly lower NDI in uniaxial screw group than in polyaxial screw group at 6 months after operation and at the last follow-up (all P<0.01). The complication rate was 21.4% (3/14) in uniaxial screw group when compared to 22.7% (5/22) in polyaxial screw group ( P>0.05). Conclusion:For Gehweiler type IIIb atlas fracture, both techniques can attain atlas fracture union and atlantoaxial posterior arch bone fusion, but the posterior atlas uniaxial screw instrumentation and fusion is superior in reduction of atlas fracture displacement and lateral mass separation, neck pain relief and functional improvement.
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This study aims to explore the molecular mechanism of Ganoderma against gastric cancer based on network pharmacology, molecular docking, and cell experiment. The active components and targets of Ganoderma were retrieved from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP), and gastric cancer-related targets from GeneCards and Online Mendelian Inheritance in Man(OMIM). The protein-protein interaction(PPI) network of the common targets was constructed with STRING, followed by Gene Ontology(GO) term enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment analysis of the common genes based on Bioconductor and R language. The medicinal-disease-component-target network and medicinal-disease-component-target-pathway network were established by Cytoscape. Molecular docking was performed between β-sitosterol(the key component in Ganoderma) and the top 15 targets in the PPI network. Cell experiment was performed to verify the findings. A total of 14 active components and 28 targets of Ganoderma were retrieved, and the medicinal and the disease shared 25 targets, including caspase-3(CASP3), caspase-8(CASP8), caspase-9(CASP9), and B-cell lymphoma-2(BCL2). The common targets involved 72 signaling pathways and apoptosis and p53 signaling pathway may play a crucial role in the effect of Ganoderma against gastric cancer. β-sitosterol had strong binding activity to the top 15 targets in the PPI network. The in vitro cell experiment demonstrated that β-sitosterol inhibited gastric cancer AGS cell proliferation by inducing cell apoptosis and cell cycle arrest in the S phase, which might be related to the regulation of the p53 pathway. This study shows the multi-component, multi-target, and multi-pathway characteristics of Ganoderma against gastric cancer, which lays a scientific basis for further research on the molecular mechanism.
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Humanos , Ganoderma , Medicina Tradicional Chinesa , Simulação de Acoplamento Molecular , Farmacologia em Rede , Neoplasias Gástricas/genéticaRESUMO
Objective:To report the clinical manifestations and management of infectious spondylitis following vertebroplasty or kyphoplasty.Methods:Six cases of infectious spondylitis following vertebroplasty or kyphoplasty were analyzed retrospectively which had been treated at Department of Spinal Surgery, Henan Provincial People's Hospital between January 2014 and June 2019. They were 2 males and 4 females, aged from 64 to 81 years. Their visual analogue scale (VAS) scores ranged from 6 to 8 points; their spinal cord function was graded as C in 2 cases and E in 4 according to the American Spinal Cord Injury Association (ASIA) grading. All the patients were treated by sub-total resection of the infected vertebra, long segmental pedicle screw fixation and corresponding antibiotics therapy. The therapeutic efficacy was assessed by the inflammation indexes, imaging examinations and clinical manifestations.Results:The 6 patients were followed up for 12 to 42 months(mean 20.4 months). Their operation time ranged from 295 to 455 min (mean 370.8 min) and blood loss from 760 to 2, 250 mL (mean 1 536.7 mL). There were no such serious complications as dural tear, worsening of neurological symptoms or death. The last follow-up revealed normal body temperature and fine incision healing in all patients. Their inflammatory indexes returned to normal. Imaging examinations at the last follow-up showed no displacement of internal implants, no screw loosening or breakage of screws or rods, good bony fusion at the grafting site, and no inflammatory signals from the infected vertebra. At the last follow-up, their VAS for back pain ranged from 2 to 4 points, the ASIA grading was improved from C to D in 2 patients and maintained E in 4. Eventually, 4 patients recovered independent normal walking but 2 required a walker.Conclusions:Infectious spondylitis following vertebroplasty or kyphoplasty can lead to back pain and neurological dysfunction. Sub-total resection of the infected vertebra, long segmental pedicle screw fixation and corresponding antibiotics therapy can result in fine therapeutic outcomes.
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Objective:To explore the effect of MDR1(C3435T) gene polymorphism on tacrolimus metabolism early after pediatric liver transplantation.Methods:Preoperative blood samples of 90 donors and recipients of pediatric liver transplantation were collected and genotyped. According to the CYP3A5 genotype of donor/recipient, they were divided into four subgroups of recipient slow metabolism/donor slow metabolism (R/D-S), recipient fast metabolism/donor slow metabolism (R-F/D-S), recipient slow metabolism/donor fast metabolism (R-S/D-F) and recipient fast metabolism/donor fast metabolism (R/D-F). The values of concentration/daily dose (C 0/D) of tacrolimus in patients with different MDR1 genotypes were compared at the subgroup level. Results:The C 0/D value of MDR1 TT recipients was significantly higher than that of CC/ CT counterparts in the first week after liver transplantation ( P<0.01). The C 0/D value of CT recipients in R/D-S subgroup was significantly higher than that of CC counterparts in the 2nd week after operation ( P<0.05). The C 0/D value of CT recipients in R/D-F subgroup was significantly higher than that of CC counterparts in 2 weeks ( P<0.05) and 3 weeks ( P<0.01). Conclusions:MDR1(C3435T) gene polymorphism in recipients affects tacrolimus metabolism. Recipients with CC genotype metabolize faster than those with CT/TT genotypes. And the same daily dose and tacrolimus blood concentration are lower. Recipients with different MDR1 genotypes need to adjust the dosage of tacrolimus. This difference is more obvious in CYP3A5 fast metabolic subgroup, more attention should be paid to optimizing individualizing dosage regimens, reducing the incidence of adverse reactions and improving the efficacy.
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Objective:To compare the application value of prefabricated path with an awl for guiding pin and traditional screw placement during anterior odontoid screw fixation.Methods:A retrospective case-control study was conducted to analyze 35 patients with fresh odontoid fractures treated from January 2010 to August 2017 in Henan Provincial People's Hospital, including 25 males and 10 females with age range of 19-55 years (mean, 36.9 years). The preoperative odontoid fractures were classified into type IIA in 15 patients, type IIB in 20 patients according to Anderson and D'Alonzo classification. Among them, 16 patients in Group A were treated with prefabricated path by an awl for guiding pin during anterior odontoid screw fixation, and 19 patients in Group B were implanted screws according to traditional experience in anterior odontoid screw fixation. Operation time, intraoperative fluoroscopy time, success rate of first-time guiding pin implantation, intraoperative blood loss, fracture healing outcomes and American Spinal Injury Association (ASIA) grade at the latest follow-up were collected and compared between the two groups.Results:All patients were followed up for 13-20 months [(16.8±1.5)months]. Two groups had significant differences in operation time [Group A: (73.5±12.9)minutes; Group B: (82.6±13.6)minutes], intraoperative fluoroscopy time [Group A: (3.1±0.6)minutes, Group B: (7.0±0.9)minutes], and success rate of first-time guiding pin implantation (Group A: 94%, Group B: 58%) ( P<0.05), but not in intraoperative blood loss [Group A: (129.4±40.6)ml; Group B: (135.8±38.4)ml] and fracture healing rate (Group A: 94%, Group B: 95%) and ASIA grade at the latest follow-up (Group A: grade C in 1 patient, grade D in 3, grade E in 12; Group B: grade C in 2 patients, grade D in 2, grade E in 15) ( P>0.05). All patients were successfully operated without occurrence of cerebrospinal fluid leakage, neurovascular injury or incision infection. Conclusions:Prefabricated path with an awl for guiding pin during anterior odontoid screw fixation is superior to traditional experience, which can reduce operation time, intraoperative fluoroscopy time and improve the success rate of first-time guiding pin implantation. Meanwhile, there is no effect on intraoperative blood loss or fracture healing outcomes.
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Objective@#To investigate the efficacy of posterior atlantoaxial joint axial release, bone grafting and internal fixation for the treatment of irreducible atlantoaxial dislocation (IAAD) with partial reduction.@*Methods@#A retrospective case-control study was conducted to analyze the clinical data of 42 patients with IAAD admitted to Henan Provincial People's Hospital from January 2014 to October 2017. There were 17 males and 25 females, aged from 12 to 72 years [(47.2±11.3) years]. After more than 50% reduction by high weight skull traction, 18 patients underwent posterior atlantoaxial joint axial release, reduction, bone grafting and fusion with internal fixation (Group A), and 24 patients underwent anterior transoral or retropharyngeal release, reduction, posterior bone grafting and fusion with internal fixation (Group B). The operation time, intraoperative blood loss, preoperative and postoperative anterior atlantodental interval (ADI), clivus-canal angle (CCA), cervicomedullary angle (CMA), and Japanese Orthopaedic Association (JOA) scores between the two groups were compared. The improvement rate of JOA scores at the last follow-up of the two groups and the atlantoaxial joint fusion rate at 3 months and 6 months after surgery were calculated and compared. The complications were recorded.@*Results@#All patients were followed up for 12 to 40 months with an average of 24.6 months. Group A had significant decreases in operation time [(138.1±25.6) minutes ∶(242.8±38.1) minutes] and intraoperative blood loss [(179.3±48.7)ml ∶(218.2±42.6)ml] compared with Group B (P<0.05). There were significant differences between the ADI, CCA, CMA and JOA scores before operation and during the last follow-up in both Group A and Group B (P<0.05), but there was no significant difference between the two groups in terms of these scores (P>0.05). The JOA scores in Group A were excellent in eight patients, good in eight patients, and fair in two patients, with the improvement rate of 89%. The JOA scores in Group B were excellent in 13 patients, good in eight patients, and fair in three patients, with the improvement rate of 87% (P>0.05). In Group A, the atlanto-axial joint fusion rate was 83% at 3 months and 100% at 6 months postoperatively; in Group B, the fusion rate was 79% at 3 months and 100% at 6 months postoperatively (P > 0.05). There was no failure of internal fixation or loss of reduction in both groups.@*Conclusion@#Posterior atlantoaxial joint axial release, bone grafting and fusion with internal fixation can be used to treat the partially reducible IAAD through a single approach. The reduction effect was comparable to that of anterior transoral or retropharyngeal release, bone grafting and fusion, with less operation time and intraoperative blood loss.
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Objective To investigate the clinical efficacy of non-fusion and fusion internal fixation with posterior pedicle screw for odontoid fractures. Methods A retrospective case control study was conducted to analyze the clinical data of 46 patients with odontoid fractures admitted to Henan Provincial People's Hospital from January 2013 to June 2015. There were 35 males and 11 females, aged 19-62 years [(36. 9 ± 1. 6)years]. The preoperative odontoid fractures were classified as type IIA in five patients, type IIB in eight, type IIC in 22, shallow type III in six according to Anderson and D'Alonzo typing. The fractures of five patients were not classified. According to the ASIA grading, the preoperative spinal cord function was graded as D or E in the 46 patients. Among the patients, 15 underwent posterior pedicle screw non-fusion internal fixation ( Group A) , with 60 pedicle screws removed 12-29 months after operation. A total of 31 patients were treated with fusion internal fixation with posterior pedicle screw ( Group B) , with 124 pedicle screws free from removal after operation. The follow-up time, operation time, intraoperative fluoroscopy time, intraoperative blood loss as well as visual analog scale (VAS), cervical rotation degree, and neck disability index ( NDI) before operation, 1 year after surgery ( when no internal fixation was removed ) and at the last follow-up were compared between the two groups. Results There were no significant differences between the two groups in the follow-up time, operation time, intraoperative fluoroscopy time, intraoperative blood loss, VAS score, neck rotation degree, NDI score before operation and at 1 year after operation (P >0. 05). There were significant differences between two groups in VAS scores, neck rotation degree, NDI scores indicating driving and walking and recreational activities at the last follow-up ( P <0. 05 ) . There were no significant differences between two groups in other NDI scores items, including neck discomfort, personal care, lifting heavy objects, reading & watching TV, headache situation, attention, working status, and sleep disorder at the last follow-up ( P> 0. 05 ) . Conclusions Posterior pedicle screw internal fixation for odontoid process fracture has good curative effect. Non-fusion internal fixation with posterior pedicle screw is more conducive to the recovery of cervical spine rotation function, the relief of neck and back pain, and the improvement of patients' driving, walking and entertainment activities.
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To study the chemical constituents from the rhizome of Menispermum dauricum,fifteen compounds,N-methylcorydaldine( 1),thalifoline( 2),stepholidine( 3),acutumine( 4),daurisoline( 5),acutumidine( 6),dauricicoline( 7),bianfugecine( 8),6-O-demethylmenisporphine( 9),bianfugedine( 10),dauricoside( 11),eleutheroside D( 12),aristolactone( 13),aristoloterpenateⅠ( 14) and aristolochic acid( 15) were isolated from 75% ethanol extract of Menispermi Rhizoma by using thin layer chromatography and column chromatography methods. Their structures were identified based on their physicochemical properties and spectral data. Among them,compounds 12-15 were obtained from the genus Menispermum for the first time. Six alkaloids with higher contents were subjected to evaluate the anti-hypoxic activities by using MTT method. As a result,six alkaloids exhibited significant anti-hypoxia activities.
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Humanos , Alcaloides , Hipóxia , Menispermum , Extratos Vegetais , RizomaRESUMO
Objective To investigate the efficacy of posterior atlantoaxial joint axial release,bone grafting and internal fixation for the treatment of irreducible atlantoaxial dislocation (IAAD) with partial reduction.Methods A retrospective case-control study was conducted to analyze the clinical data of 42 patients with IAAD admitted to Henan Provincial People's Hospital from January 2014 to October 2017.There were 17 males and 25 females,aged from 12 to 72 years [(47.2 ± 11.3) years].After more than 50％ reduction by high weight skull traction,18 patients underwent posterior atlantoaxial joint axial release,reduction,bone grafting and fusion with internal fixation (Group A),and 24 patients underwent anterior transoral or retropharyngeal release,reduction,posterior bone grafting and fusion with internal fixation (Group B).The operation time,intraoperative blood loss,preoperative and postoperative anterior atlantodental interval (ADI),clivus-canal angle (CCA),cervicomedullary angle (CMA),and Japanese Orthopaedic Association (JOA) scores between the two groups were compared.The improvement rate of JOA scores at the last follow-up of the two groups and the atlantoaxial joint fusion rate at 3 months and 6 months after surgery were calculated and compared.The complications were recorded.Results All patients were followed up for 12 to 40 months with an average of 24.6 months.Group A had significant decreases in operation time [(138.1 ±25.6) minutes ∶ (242.8 ± 38.1) minutes] and intraoperative blood loss [(179.3 ± 48.7) ml ∶ (218.2 ± 42.6) ml] compared with Group B (P ＜0.05).There were significant differences between the ADI,CCA,CMA and JOA scores before operation and during the last follow-up in both Group A and Group B (P ＜ 0.05),but there was no significant difference between the two groups in terms of these scores (P ＞ 0.05).The JOA scores in Group A were excdlent in eight patients,good in eight patients,and fair in two patients,with the improvement rate of 89％.The JOA scores in Group B were excellent in 13 patients,good in eight patients,and fair in three patients,with the improvement rate of 87％ (P ＞0.05).In Group A,the atlanto-axial joint fusion rate was 83％ at 3 months and 100％ at 6 months postoperatively;in Group B,the fusion rate was 79％ at 3 months and 100％ at 6 months postoperatively (P ＞ 0.05).There was no failure of internal fixation or loss of reduction in both groups.Conclusion Posterior atlantoaxial joint axial release,bone grafting and fusion with intemal fixation can be used to treat the partially reducible IAAD through a single approach.The reduction effect was comparable to that of anterior transoral or retropharyngeal release,bone grafting and fusion,with less operation time and intraoperative blood loss.
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<p><b>OBJECTIVE</b>To evaluate whether the berberine treatment can improve endothelial repair capacity of early endothelial progenitor cells (EPCs) from prehypertensive subjects through increasing CXC chemokine receptor 4 (CXCR4) signaling.</p><p><b>METHODS</b>EPCs were isolated from prehypertensive and healthy subjects and cultured. In vivo reendothelialization capacity of EPCs from prehypertensive patients with or without in vitro berberine treatment was examined in a nude mouse model of carotid artery injury. The protein expressions of CXCR4/Janus kinase-2 (JAK-2) signaling of in vitro EPCs were detected by Western blot analysis.</p><p><b>RESULTS</b>CXCR4 signaling and alteration in migration and adhesion functions of EPCs were evaluated. Basal CXCR4 expression was significantly reduced in EPCs from prehypertensive patients compared with normal subjects (P<0.01). Also, the phosphorylation of JAK-2 of EPCs, a CXCR4 downstream signaling, was significantly decreased (P<0.01). Berberine promoted CXCR4/JAK-2 signaling expression of in vitro EPCs (P<0.01). Transplantation of EPCs pretreated with berberine markedly accelerated in vivo reendothelialization (P<0.01). The increased in vitro function and in vivo reendothelialization capacity of EPCs were inhibited by CXCR4 neutralizing antibody or pretreatment with JAK-2 inhibitor AG490, respectively (P<0.01).</p><p><b>CONCLUSION</b>Berberinemodified EPCs via up-regulation of CXCR4 signaling contributes to enhanced endothelial repair capacity in prehypertension, indicating that berberine may be used as a novel potential primary prevention means against prehypertension-related atherosclerotic cardiovascular disease.</p>
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Objective To investigate the clinical effect of 3D printing assisted percutaneous vertebroplasty (PVP) in treating severe osteoporotic vertebral compression fracture (OVCF) in elder patients.Methods A retrospective case series study was conducted on the clinical data of 58 elderly patients (58 vertebrae) with severe OVCF who underwent PVP treatment in spinal surgery department of Henan Provincial People's Hospital from June 2014 to June 2016.According to the treatment method,the patients were divided into Group A which adopted 3D printing of injured vertebrae before PVP and Group B which adopted routine PVP operation.Group A consisted of 28 cases (28 vertebrae),including eight males and 20 females,aged 64-91 years [(78.1 ±8.5) years].In terms of the distribution of injured vertebrae,there were four cases of T10,six cases of Tu,eight cases of T12,four cases of L1,and six cases of L2 in Group A.Group B consisted of 30 cases (30 vertebrae),including 10 males and 20 females,aged 65-90 years [(77.8 ± 8.2) years].In terms of the distribution of injured vertebrae,there were three cases of T10,seven T11,nine T12,six L1,and five L2.The operation time,visual analogue scale (VAS) before operation,1 day after operation and at the last follow up,Japanese Orthopedic Association (JOA) score,anterior compression ratio of injured vertebrae,and cement leakage rate were compared between the two groups.Results All the operations were completed successfully.The patients were followed up for 14-26 months [(18.7 ± 3.4)months] in Group A and for 12-28 months [(20.0 ± 5.4) months] in Group B.The operation time was (28.0 ± 3.4) min in Group A and (30.9 ±5.3) min in Group B (P ＜ 0.05).Both the VAS 1 d after operation of Group A [(2.3 ± 1.0) points] and Group B [(2.0 ± 0.8) points] and the VAS at the last follow up of Group A [(0.7 ± 0.7) points] and Group B [(0.8 ± 0.7) points] were significantly lower than those before operation (P ＜ 0.05),but there was no significant difference between thetwo groups (P ＞ 0.05).Both the JOA at day 1 after operation of Group A [(21.3 ± 2.2) points] and Group B [(20.7 ± 2.1) points] and the JOA at the last follow up of Group A [(24.7 ± 2.3) points] and Group B [(24.1 ± 2.0) points] were significantly higher than those before operation (P ＜ 0.05),but there was no significant difference between the two groups (P ＞ 0.05).The anterior compression ratio of injured vertebrae 1 d after operation of Group A (59.4 ± 7.9) ％ and Group B (59.1 ± 6.8) ％ and that at the last follow up of Group A (59.1 ± 7.8) ％ and Group B (58.7 ± 5.4) ％ were significantly improved than those before operation (P ＜ 0.05),but there was no significant difference between the two groups (P ＞ 0.05).There were three cases of bone cement leakage in Group A (11％) and 11 cases of bone cement leakage in Group B (37％) after PVP,and the difference was statistically significant (P ＜ 0.05).Conclusion Compared with conventional PVP,3D printingassisted PVP has lower leakage rate,shorter operation time,and better clinical effect in treating severe OVCF in the elderly.
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Tacrolimus is widely used as a first-line immunosuppressant after adult liver transplantation. However, because of narrow treatment window and pharmacokinetic individual differences, it is difficult to formulate individualized dosing regimens in short term. Pharmacokinetic parameters that estimated by population pharmacokinetics(PPK) can provide a preliminary individualized regimen for early postoperative patients. This paper collected literatures on PPK modeling of orally administered tacrolimus in adult liver transplantation patients through literature search. And multiple influencing factors of PPK model was mainly summarized, such as demographic characteristics, blood biochemical index, combined medication, liver and kidney function, genetic factors, postoperative time and dosage. It will provide literature support for the development of individualized dosing regimens for oral tacrolimus recipients using the PPK protocol for adult liver transplantation.
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Objective To investigate the effect of moxifloxacin and levofloxacin on the treatment of urinary tract infection and the incidence of adverse reactions.Methods 92 cases of patients with urinary tract infection from January 2015 to September 2016 in Hangzhou cancer hospital were selected and randomly divided into group A and group B with 46 cases in each group.Group A were treated with moxifloxacin treatment,group B were treated with levofloxacin in the treatment,compared with the treatment of two groups of patients.Results The clinical effective rate and clinical cure rate of group A were significantly higher than those of group B,the difference was statistically significant(P<0.05),there was no significant difference in the incidence of adverse reactions and bacterial clearance between the two groups.The incidence of adverse reactions in group A was 10.87％,drug cost was 275.47 yuan,the cost effectiveness ratio of 3.17,the incidence of adverse reactions in group B was 13.04％,drug cost was 45.50 yuan,cost-effectiveness ratio of 0.59,there was no significant difference in the incidence of adverse reactions between the two groups; the cost of drug and cost-effectiveness of group A was significantly better than group B,the difference was statistically significant(P<0.05).Conclusion Moxifloxacin is more effective in the treatment of urinary tract infections,but levofloxacin has lower drug costs.