Risk factors for refracture of injured vertebrae after percutaneous vertebral augmentation for acute symptomatic thoracolumbar osteoporotic compression fractures / 中华创伤杂志

Objective:To investigate the risk factors of refracture of the injured vertebrae after percutaneous vertebral augmentation for acute symptomatic thoracolumbar osteoporotic compression fractures (ASTOCFs).Methods:A case-control study was conducted to analyze the clinical data of 2 237 ASTOCFs patients admitted to three hospitals from January 2010 to January 2019. There were 569 males and 1 668 females, with age range of 50-85 years [(66.7±4.8)years]. The patients underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). According to the radiographic outcomes, the patients were divided into refracture group ( n=315) and non-refracture group ( n=1 922). Data were recorded for the two groups, including basic demographics (gender, age, height and weight), personal habits (smoking and alcohol consumption), basic diseases (diabetes, hypertension, coronary heart disease and chronic obstructive pulmonary disease), preoperative bone mineral density, fracture segment, number of injured vertebrae, surgical method (PVP or PKP), surgical approach, bone cement viscosity, distance from cement to the upper and lower endplate, cement volume in injured vertebrae, cement leakage, postoperative exercise, and postoperative anti-osteoporosis treatment. The above data were analyzed to identify their correlation with postoperative refracture of the injured vertebrae by univariate analysis. The independent risk factors for postoperative refracture of the injured vertebrae were determined by multivariate Logistic regression analysis. Results:Univariate analysis showed that refracture of injured vertebrae was correlated with gender, age, diabetes, fracture segment, surgical method, distance from cement to the upper and lower endplate, postoperative exercise, and postoperative anti-osteoporosis treatment ( P<0.05 or 0.01), but there was no correlation with height, weight, smoking, alcohol consumption, hypertension, coronary heart disease, chronic obstructive pulmonary disease, preoperative bone mineral density, number of fractured vertebrae, surgical approach, bone cement viscosity, cement volume in injured vertebrae or cement leakage (all P>0.05). Multivariate Logistic regression analysis showed that female ( OR=1.92, 95% CI 1.34-2.64, P<0.01), age ≥80 years ( OR=1.21, 95%CI 1.17-1.25, P<0.01), diabetes ( OR=1.92, 95% CI 0.44-2.55, P<0.01), thoracolumbar fracture ( OR=1.46, 95% CI 1.82-7.51, P<0.05), PKP ( OR=4.56, 95% CI 0.86-1.44, P<0.05), no postoperative exercise ( OR=2.14,95% CI 0.27-0.38, P<0.01), and no postoperative anti-osteoporosis treatment ( OR=2.36,95% CI 0.13-0.47, P<0.05) were positively correlated with refracture of injured vertebrae. Conclusion:Female, age ≥80 years, diabetes, thoracolumbar fracture, PKP, no postoperative exercise, and no postoperative anti-osteoporosis treatment are independent risk factors for refracture of injured vertebrae after percutaneous vertebral augmentation for ASTOCFs.

Comparison of the effect of endoscopic discectomy through interlaminar approach for lumbar disc herniation under local or general anesthesia / 西安交通大学学报(医学版)

【Objective】 To investigate the effect or endoscopic discectomy via interlaminar approach in the treatment of lumbar disc herniation under local or general anesthesia. 【Methods】 We selected 78 patients with lumbar disc herniation （L5-S1） who underwent endoscopic discectomy via interlaminar approach from January 2018 to February 2020. According to the anesthesia method， they were divided into local anesthesia group （40 patients） and general anesthesia group （38 patients）. Baseline data， complications， operation time， length of hospital stay， hospitalization expenses， preoperative and postoperative VAS scores were compared between the two groups to evaluate the difference in clinical outcomes. 【Results】 There was no significant difference between the two groups in gender （23/17 vs. 20/18）， age （38.45±13.59 vs 37.39±13.35） years， preoperative VAS score （7.05±1.32 vs. 6.95±1.47）， or other baseline data （P>0.05）. The operation was completed successfully in both groups， and the operation time （83.57±13.24 vs. 86.28±15.43） minutes did not statistically differ （P>0.05）. No complications such as cerebrospinal fluid leakage， nerve injury， or wound infection occurred. In the local anesthesia group， the VAS pain score at 1d， 1 month and 6 months after surgery was 3.05±1.34， 1.90±0.98 and 1.80±1.09， respectively， which were significantly lower than those before surgery （P<0.001）. The VAS pain scores of the general anesthesia group at the above three time points were 3.24±2.01， 2.03±1.20 and 1.59±1.31， respectively， which were also significantly lower than those before surgery （P<0.001）， but the difference was not statistically significant compared with that of the local anesthesia group at the same time point （P>0.05）. However， compared with the general anesthesia group， the length of hospital stay （2.93±0.92） d and the cost of hospitalization （29 397.97±1 398.09） yuan in the local anesthesia group were decreased by 25.8% and 11.7%， respectively， with statistical significance （P<0.05）. 【Conclusion】 Endoscopic discectomy through interlaminar approach under local or general anesthesia can achieve good clinical outcomes in the treatment of lumbar disc herniation （L5-S1）. Compared with general anesthesia， local anesthesia brings a lower overall cost and a shorter hospital stay.

A study on the influence of contrast agent protocol on gem spectrum CT pulmonary angiography quality / 重庆医学

Objective To compare the image quality between large dose smart tracking technique and low dose test bolus technique for gem spectral CT pulmonary angiography(CTPA).Methods A total of 106 cases with suspected pulmonary embolism were divided into two groups.Group A(54 cases)was carried out with large dose smart tracking technique.Group B(52 cases)was carried out with low dose test bolus technique.We compared the image quality between the two groups.Results There were significant differences in the CT value of the right pulmonary artery and the content of iodine in the lower lobe of the right pulmonary artery of two groups(P<0.01).There was significant difference of image quality between the two groups(P<0.05).The rate of excellent or good image quality in group A was higher than that in group B,and the difference was statistically significant(P<0.05).Conclusion Large dose smart tracking technique can track the artifacts of pulmonary artery imaging with less artifacts and uniform vascular fixation.The image quality of pulmonary artery imaging is better than that of small dose contrast agent.

The value of quantitative analysis with spectral CT imaging in the diagnosis of non-small cell lung cancer with different pathological types / 中华放射学杂志

Objective To explore the value of quantitative parameters of spectral CT imaging in the diagnosis of non-small cell lung cancer (NSCLC) with different pathological types. Methods One hundred and thirty-six patients with NSCLC proved by pathology underwent chest plain and enhanced CT scan with gemstone spectral imaging (GSI) mode by Discovery CT750 HD, including 57 cases of squamous cell carcinoma (SQCC) and 79 cases of adenocarcinoma (ADC). All the cases were divided into two groups of tumor diameter>2 cm (120 cases, including 50 cases of SQCC and 70 cases of ADC) and diameter≤2 cm (16 cases, including 7 cases of SQCC and 9 cases of ADC). The slope between 40 and 65 keV(K40-65 keV) of spectral attenuation curve, effective atomic number (Eff-Z) and calcium concentration in plain scan (PS) and K40-65 keV of spectral attenuation curve, iodine concentration and water concentration in arterial phase (AP) of SQCC and ADC in the two groups were measured and compared respectively. Furthermore, all cases were classified according to the trend of spectral attenuation curve in PS. These quantitative parameters satisfying normal distribution were compared by two independent samples t test, while those parameters not satisfying normal distribution were compared by rank sum test. ROC curves was drawn for these parameters with statistical difference and area under the curve (AUC) was used to measure the differential diagnostic performance of each parameter. Chi square test was used to compare the differences of the trend of spectral attenuation curve in PS between SQCC and ADC. Results In the group of diameter>2 cm: (1) Comparison of quantitative parameters of spectral CT in PS:K40-65 keV, Eff-Z and calcium concentration of ADC were 0.69 ± 0.56, 7.76±0.19, and (4.11±2.93) mg/cm3, respectively. The corresponding parameters of SQCC were 0.19± 0.23, 7.59 ± 0.14, and (1.25 ± 1.59) mg/cm3, respectively. These parameters of ADC were significantly higher than SQCC (Z=-7.000,-6.249, t=-6.884, P0.05). The trend of spectrum attenuation curve in PS of all cases showed type Ⅱ. Conclusions Lung ADC and SQCC have different quantitative parameters in spectral CT imaging. These quantitative parameters are valuable in classifying the pathological type of NSCLC with diameter more than 2 cm.

Association of lumbar disc herniation with the interaction between environmental factors and Fas/FasL/Caspase-9 apoptosis-associated gene polymorphisms / 西安交通大学学报(医学版)

Objective To investigate the etiologic roles of apoptosis-associated genes,environmental factors and their interactions in lumbar disc herniation (LDH).Methods A case-control trial was conducted.We recruited 128 outpatients with LDH as case group and 132 normal people matched by age and gender as control group.Peripheral venous blood samples were collected and DNA was extracted from leukocytes.By using a modified Brucker Autoflex MALDI-TOF mass spectrometer,we analyzed 3 genes with 9 polymorphic sites,namely,Fas-1377G/A rs2234767,Fas-670G/A rs1800682,Fas rs2147420,Fas rs2296603,Fas rs7901 656,Fas rs1 57101 9,FasL-844C/T rs7631 10,CASP-9-1263A > G rs4645978,and CASP-9-712C > T rs4645981.The correlations between polymorphism of Fas,FasL and CASP-9 genes and the risk of LDH were evaluated by non-conditional Logistic regression model.Multiple Logistic regression model was performed to assess the interaction between apoptosis-associated genes and environment factors,such as lumbar vertebral loads,bed type,spare-time exercises and spare-time activities. Results There were preferable balances in case and control groups in age and gender without significant differences.However,the two groups differed significantly (P G (rs4645978),and FasL-844C/T TT and CASP-9-1263A>G GG genotypes might be the high risk genotypes of LDH.The gene-environment interaction analysis revealed that super-multiplicative and sub-multiplicative interactions respectively between FasL-844TT genotype and lumbar vertebral loads (3-4 level),and between CASP-9-rs4645978 GG and lumbar vertebral loads (3-4 level).Conclusion FasL,CASP-9 genes and lumbar vertebral loads and their interactions play important roles in the pathogenesis of LDH.It suggests that the risk of LDH may be codetermined by environmental factors and inherited susceptibility genes,and that the mechanisms of interactions vary in different genotypes and the same or different environmental factors.

Connection of magnetic antisense probe with SK-Br-3 oncocyte mRNA nucleotide detected by high resolution atomic force microscope / 生物医学工程学杂志

The present paper is aimed to detect superparamagnetic iron oxide labeled c-erbB2 oncogene antisense oligonucleotide probe (magnetic antisense probe) connected with SK-Br-3 oncocyte mRNA nucleotide by high resolution atomic force microscope (AFM). We transfected SK-Br-3 oncocyte with magnetic antisense probe, then observed the cells by AFM with high resolution and detected protein expression and magnetic resonance imagine (MRI). The high resolution AFM clearly showed the connection of the oligonucleotide remote end of magnetic antisense probe with the mRNA nucleotide of oncocyte. The expression of e-erbB2 protein in SK-Br3 cells were highly inhibited by using magnetic antisense probe. We then obtained the lowest signal to noise ratio (SNR) of SK-Br-3 oncocyte transfected with magnetic antisense probe by MRI (P<0.05). These experiments demonstrated that the high resolution AFM could be used to show the binding of magnetic antisense probe and SK-Br-3 mRNA of tumor cell nuclear.

A comparative study of high and low dose test bolus in 64 rows spiral CT cerebral angiography / 重庆医科大学学报

Objective:To evaluate the optimal scan delay time of 64 rows spiral CT cerebral angiography by the comparative study of high and low dose test bolus.Methods:Select 69 adult voluntaty patients,take test bolus with 20ml and 60ml contrast medium respectively,then getting 2 peak time of test bolus with high and low dose,calculate the difference of 2 peak time.Results:The arterial peak time difference between high and low dose test bolus of 69 cases,57(83%) cases are 10 seconds,while the venous peak time difference of the same 69 cases,59(85.5%) cases are 8 seconds.Conclusion:The scan delay time of 64 rows spiral CT cerebral angiography could be set by using a peak time of low dose test bolus,plus 8(seconds Median 10 seconds reduce 2 seconds scan time which are taken from the start slice to interest slice),so as to guarantee the satisfactory image quality and ensuring success of the examination.

CPG OLIGONUCLEOTIDES REGULATE OSTEOCLAST DIFFERENTIATION / 药物分析学报

Objective Bacterial DNA is a pathogen-derived molecule which can regulate the innate immune system by stimulating NF-κB activation. The activity of bacterial DNA relies on its content of unmethylated CpG dinucleotides in particular base contexts("CpG motif"). In light of the pivotal role played by NF-κB in osteoclast differentiation, the ability of CpG oligodeoxynucleotides (CpG ODN) coming from bacterial DNA to modulate osteoclastogenesis was studied. Methods Bone marrow mononuclear cells (BMM) were purified from Balb/c mice, cultured in α-MEM media containing 10% FCS in the presence of mouse M-CSF, with either RANKL or ODNs for 5 days. Osteoclast formation was evaluated on day 5 according to TRAP and May-Grunwald-Giemsa staining. Results CpG ODN alone could induce osteoclast formation in the low degree in BMM culture. The relationship between CpG ODN and RANKL was that CpG ODN could inhibit RANKL-induced osteoclastogenesis when present from the beginning of BMM culture, but strongly increased RANKL-induced osteoclastogenesis in RANKL-pretreated BMMs. Conclusion The mechanism of CpG ODN regulating osteoclast differentiation was bidirectional, which might be a potential therapy for treating metabolic bone disease.