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Objective:To investigate the safety and clinical efficacy of primary anterior lesion removal and bone graft fusion combined with secondary posterior fixation in the treatment of cervical suppurative spondylitis.Methods:Retrospective analysis was performed on the data of twenty cervical suppurative spondylitis patients treated with primary anterior lesion removal and bone graft fusion combinedwith secondary posterior fixation in our hospital from May 2016 to December 2020, including 14 males and 6 females. Aging from 40 to 87 years, with an average of 60.2±12.6 years. The laboratory tests of preoperative blood culture, such as white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and hypersensitive C-reactive protein (CRP) were performed.The selection and duration of antibiotic usewere guided according to bacterial culture and laboratory test results. visual analogue scale (VAS) score, Japanese Orthopeadic Association (JOA) score and Frankle classification of neurological function were evaluated before surgery, 3 months after surgery, and 12 months after surgery, so were the Cobb angle and segmental angle of cervical lordosis. Single factor repeated measure ANOVA was used for statistical analysis of data.Results:Surgeries were performed successfully for all the 20 patients. 9 cases of Staphylococcus aureus, 4 cases of Streptococcus and 2 case of Escherichia coli were detected by pathogen examination. The remaining 5 cases were negative in bacterial culture. All 20 patients were followed up for 18.3±6.7 months. WBC, ESR and CRP at 3 and 12 months after surgery were significantly lower than those before surgery ( F value: 17.90, 30.65, 18.64, P<0.001). The VAS at 3 months after surgery 1.35±0.49 and 12 months after surgery 1.15±0.48 were significantly lower than that before surgery 4.95±1.10 ( F=176.12, P<0.001). The JOA score at 3 months after surgery 15.40±1.93 and 12 months after surgery 16.06±1.36 were significantly better than that before surgery 11.45±2.78 ( F=65.33, P<0.001). The Cobb Angle of C 2-C 7 cervical lordosis after surgery 14.45°±4.36° and 12 months after surgery (13.70°±3.15°) were significantly larger than that before surgery (8.25°±4.36°) ( F=72.54, P<0.001). Cobb angle of the lesion segment after surgery (3.60°±1.90°) and 12 months after surgery (2.90°±1.44°) were significantly better than that before surgery (-3.55°±5.74°) (negative value indicated kyphosis) ( F=42.49, P<0.001). Bone fusion was observed in all graft areas at 12 months of follow-up. Conclusion:The treatment of cervical suppurative spondylitis with primary anterior lesion removal and bone graft fusion combined with secondary posterior fixation can effectively obtain intraspinal decompression, improve pain and nerve function, as well as restore cervical stability and correct kyphosis, with satisfactory clinical efficacy.
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The cultivation of interdisciplinary talents for life science is still in the state of exploration. The 4I training mode includes four key elements, interdisciplinary course setting, integration of cross project, instruction and administration across whole research and innovational evaluation at the end. Based on the 4I training mode, systematic and targeted design and arrangement would enhance the training level of interdisciplinary talents of life science in universities.
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Hepatocellular carcinoma (HCC) is a common malignant tumor and patients with HCC often have liver cirrhosis, with an extremely high 5-year recurrence rate and poor prognosis even after curative treatment. In recent years, sarcopenia has attracted more and more attention as a poor prognostic factor for various malignant tumors; however, there is still a lack of studies on the association between skeletal muscle index and prognosis of HCC in China. Evidence in foreign countries has shown that sarcopenia may be an a negative prognostic factor for HCC patients. This article reviews the etiology and possible pathogenesis of HCC-related sarcopenia and related intervention measures including nutritional supplementation, appropriate physical exercise, and medication, in order to provide a reference for related studies in China.
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Objective:To investigate the effect of rapamycin on hepatic ischemia-reperfusion injury (HIRI) in Sprague Dawley (SD) rats and its underlying mechanism.Methods:Forty-eight specific pathogen-free SD male rats with the body weight of 180-200 g and the age of 4-8 weeks were randomly divided into 3 groups, 16 rats each group. In the rapamycin group, the rats were injected with rapamycin intraperitoneally everyday lasting for 3 days before the surgery, and in the model group and the sham group, the rats were injected with normal saline intraperitoneally. The HIRI model was performed in the rapamycin group and the model group. Serum of 8 rats was randomly harvested from each group at 2 h and 24 h after the surgery and was used to detect level of alanine aminotransferase(ALT), total bilirubin, and lactate dehydrogenase. At the meantime, liver tissues were collected for HE staining, and enzyme-linked immunosorbent assay of superoxide dismutase(SOD), glutathione, hexokinase 2, phosphofructokinase 1(PFK1), and adenosine triphosphate. Polymerase chain reaction and Western blots were used to determine the levels of mammalian target of rapamycin(mTOR), ribosomal protein S6 kinase 1(S6K1), and protein kinase B and their phosphorylation levels respectively.Results:Two hours post the surgery, the serum level of ALT(150.9±18.7) U/L, total bilirubin(5.15±0.69) μmol/L, and lactate dehydrogenase(9 547±365) U/L were higher in the model group than sham group (42.4±10.7) U/L, (2.48±0.24) μmol/L, (4 424±376) U/L and rapamycin group (87.7±11.2) U/L, (3.09±0.12) μmol/L, (8 268±264) U/L, and all differences were statistically significant (all P<0.05). HE staining and serum assay showed that the lesion of liver tissuesand of liver function were damaged in the model group, and mitigated in the rapamycin group at 2h and 24h after the surgery. At 2h and 24h after the surgery, liver SOD, glutathione, hexokinase 2, PFK1, and adenosine triphosphate in the model group were lower than those in the sham group and the rapamycin group, and all differences were statistically significant (all P<0.05). The relative levels of mTOR, S6K1, and their phosphorylation level in the model group were higher than those in the sham group and the rapamycin group at 2 h and 24 h after the surgery, but the relative levels of protein kinase B and phosphorylated protein kinase B were lower than those in the sham group and the rapamycin group, and all differences were statistically significant (all P<0.05). Conclusions:Rapamycin improves glucose metabolism and reduces oxidative stress via upregulating the phosphorylated protein kinase B through inhibition of mTOR signaling pathway, thus alleviates HIRI in rats.
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Objective:To develope a deep-learning-based auto-segmentation model to segment organs at risk (OARs) in head and neck (H&N) region and compare with atlas-based auto-segmentation software (Smart segmentation).Methods:The auto-segmentation model consisted of classification model and segmentation model based on deep learning neural network. The classification model was utilized to classify CT slices into six categories in the cranio-caudal direction, and then the CT slices corresponding to the categories for different OARs were pushed to the segmentation model respectively. The CT image data of 150 patients were used for auto-segmentation model training and building atlas library in Smart segmentation software. Another 20 patients were used as testing dataset for both auto-segmentation model and Smart segmentation software. Dice similarity coefficient (DSC) and Hausdorff distance (HD) were used to evaluate the accuracy of two method, and auto-segmentation time cost was recorded. Paired Student′s t-test or non-parametric Wilcoxon signed-rank test was performed depending on result of normality test. Results:The DSC and HD of auto-segmentation model for brainstem, left eye, right eye, left optic nerve, right optic nerve, left temporal lobe, right temporal lobe, mandible, left parotid and right parotid were 0.88 and 4.41 mm, 0.89 and 2.00 mm, 0.89 and 2.12 mm, 0.70 and 3.00 mm, 0.80 and 2.24 mm, 0.81 and 7.98 mm, 0.84 and 8.82 mm, 0.89 and 5.57 mm, 0.70 and 11.92 mm, 0.77 and 11.27 mm respectively. The results of auto-segmentation model were better than those of Smart segmentation ( t=3.115-7.915, Z=-1.352 to -3.921, P<0.05) except left and right parotids. In addition, the speed of auto-segmentation model was 51.28% faster than that of Smart segmentation. Conclusions:In this study, the deep-learning-based auto-segmentation model demonstrated superior performance in accuracy and efficiency on segmenting OARs in H&N CT images, which was better than Smart segmentation software.
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Objective To analyze the effects of different doses of rapamycin on hepatic ischemia reperfusion injury in rats and the possible mechanism.Methods 48 Sprague-Dawley rats were randomly divided into four groups(n=12),low dose group (preoperative injection of low dose of rapamycin+ischemia),high dose group (preoperative high dose of rapamycin injection + ischemia),model group (preoperative injection of 0.9％ sodium chloride solution + ischemia),sham group (preoperative injection of 0.9％ sodium chloride solution,only dissected the first hepatic portal).Serum was collected 24 and 72 hours after surgery,ALT,AST,TNF-α and IL-6 concentrations were detected,Western blotting and PCR were performed to detect the expression of autophagy proteins,and HE staining was performed.Results 24 h after the operation,the liver tissue of the sham group was almost normal,the hepatic lobule structure of the model group disappeared,the liver cells were edema,vacuolar degeneration and necrosis,and the damage was reduced in the low dose and high dose group.24 h after surgery,levels of ALT,AST,TNF-α and IL-6 was on a declining curve in all groups,with statistically significant differences (P＜0.05).24 h after surgery,the relative expression levels of ULK1 (1.00±0 vs.4.76±2.62 vs.8.26±3.46 vs.12.95±6.45),microtubuleassociated protein 1 light chain 3(LC3,1.00±0 vs.2.88±0.59 vs.4.66± 1.22 vs.7.10±0.85) mRNA in sham group,model group,low dose group and high dose group were increased.While the relative mRNA expression levels of mammalian target of rapamycin (mTOR,1.00±0 vs.0.31 ±0.09 vs.0.18±0.04 vs.0.02± 0.01),P70 ribosomal protein kinase (S6K1,1.00±0 vs.0.57±0.34 vs.0.27±0.14 vs.0.03±0.01) showed a decreasing trend,and the differences were statistically significant (P＜0.05).24 h after surgery,the relative expressions of ULK1 and LC3 proteins in sham group,model group,low dose group and high dose group increased,while the phosphorylation of mTOR,S6K1 and ULK1 decreased,with statistically significant differences (P＜0.05).72 h after the operation,the results were agreed with those at 24 h after the operation.Conclusion Rapamycin activates autophagy through mTORC1-ULK1 signaling pathway to reduce HIRI,and the protective effect of high dose is better than that of low dose.
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Objective@#To investigate the clinical outcome of microfat injection on facial hypertrophic scar treatment.@*Methods@#A total of 22 patients had facial hypertrophic scar were treated with microfat injection. The microfat was injected into the scar three times for each case, with an interval of 2 months. The severity of scar was evaluated preoperatively and 1-month postoperatively, using modified Vancouver scar score, to evaluate the efficacy.@*Results@#Postoperative infection occurred in 1 case, and no further microfat injection was performed on him/her. All the other 21 cases have relieved cicatricial hyperemia, with the scar softening and flattening. The symptom of itching and pain were alleviated as well. The overall effective rate was 95.45%. The score of modified Vancouver scar scale was reduced from 12.82±2.15 preoperatively, to 7.05±1.76 6 months after the treatment (P<0.05).@*Conclusions@#The microfat injection can effectively improve the color and texture of the facial hypertrophic scar, and reduce the symptoms of itching and pain. It is a new choice for the treatment for hypertrophic scar.
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EGFR tyrosine kinase inhibitor (EGFR-TKI) has been used successfully in clinic for the treatment of solid tumors. In the present study, we reported the discovery of from our in-house diverse compound library, which was validated to be a potent and selective EGFR-TKI. showed excellent inhibitory activities against EGFR (IC = 0.81 nmol/L), EGFR (IC = 1.2 nmol/L) and EGFR (IC = 1.1 nmol/L), but was less effective or even inactive against other nine kinases. also displayed excellent antiproliferative activities against a panel of human cancer cell lines, and exhibited the ability to reduce colony formation and wound healing the same as gefitinib. We found that upon oral administration showed better anti-tumor activity in A431 bearing xenograft mouse models compared to gefitinib. In addition, showed better intestinal absorption than gefitinib and had favorable pharmacokinetic properties and microsomal metabolic stability in different species. These studies indicate that has strong antitumor activity and , and could be used for the development of anti-lung cancer agent targeting EGFR.
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Objective To compare the effectiveness of stereotactic hematoma aspiration and conservative treatment for supratentorial hypertensive intracerebral hemorrhage (HICH) with hematoma volume 25-40 ml. Methods Patients with supratentorial HICH admitted to the Department of Neurosurgery, the Fifth Affiliated Hospital of Zhengzhou University from January 2014 to January 2017 were retrospectively enrolled. The incidence of rebleeding, good outcome (defined as the modified Rankin Scale score 0-2 at 3 months after onset) rate, and mortality were compared between the stereotactic hematoma aspiration group and the conservative treatment group. Results A total of 204 patients were enrolled. Their mean age was 61. 3 ±9. 2 years, 114 were males, and their median hematoma volume was 32 ml (interquartile range 25- 39 ml), median baseline Glasgow Coma Scale score was 11 (interquartile range 9-14), and there was no patient with brain herniation. One hundred and twenty patients (58. 8％) underwent stereotactic hematoma aspiration and 84 (41. 2％) received conservative treatment. Compared with the conservative treatment group, the incidence of rebleeding in the stereotactic hematoma aspiration group was significantly lower (2. 5％ vs. 22. 6％, χ2 =20. 788, P < 0. 001), and the rate of good outcome was significantly higher at 3 months after onset (85. 0％ vs. 70. 2％; χ2 = 8. 305, P = 0. 004 ), but there was no significant difference in mortality (5. 0％ vs. 11. 9％, χ2 =3. 259, P =0. 071). Multivariable logistic regression analysis showed that advanced age (odds ratio [OR] 1. 77, 95％ confidence interval [CI] 1. 25-2. 46; P = 0. 006), previous stroke history (OR 1. 36, 95％ CI 1. 12-1. 64; P =0. 032), and conservative treatment (OR 1. 42, 95％ CI 1. 25-1. 78; P = 0. 021) were the independent risk factors for poor outcomes. Conclusions Stereotactic hematoma aspiration can significantly reduce the incidences of rebleeding and risk of the poor outcome in the supratentorial HICH patients with hematoma volume 25-40 ml. Therefore, early active surgical treatment should be considered.
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Objective To investigate the radiographic characteristics of posterosuperior fracture fragment of the injured vertebral body and its effects on the results of surgical treatment in thoracolumbar burst fractures.Methods A total of 45 patients with acute thoracolumbar burst treated by either anterior or posterior surgery from January 2014 to December 2015 were analyzed by retrospective casecontrol study.There were 24 males and 21 females with a mean age of 33.6 years (range,23-52 years).Fractured segments included T12 in six cases,L1 in 15,L2 in 14,L3 in 5,and L4 in 5.Based on AO classification,there were ten cases of A3 fractures and 35 cases of Ag fractures,among which four cases of A4 were combined with B2 injuries.Eleven patients underwent anterior surgery and 34 patients posterior surgery.The operation time and intraoperative blood loss were recorded.The following parameters were also measured pre-and post-operatively,namely the displacement and inversion angle of posterosuperior fracture fragment,Cobb angle,anteroposterior diameter (APD) of spinal canal,and American spinal injury association (ASIA) neurological scale.Results All patients were followed up for 11-24 months (mean,17 months).There were no complications except for one case of implant loosening at three months after anterior surgery.The average operation time was 138.3 minutes and intraoperative blood loss was 293.7 ml in anterior surgery while the average operation time was 77.5 minutes and intraoperative blood loss was 54.7 ml in posterior surgery (P ＜ 0.05).Compared with postoperative situation,the canal APD was increased by 55.5％ in anterior surgery and the corresponding increase was 14.9％ in posterior surgery (P ＜ 0.01).There was no significant difference between two groups in Cobb angle correction.Compared with situation before surgery,the postoperative ASIA grading was improved in 73％ of the patients in anterior surgery and while it was enhanced in 24％ of the patients in posterior surgery (P ＜ 0.05).On the aspect of spinal canal decompression,anterior surgery had obvious decompression effects.The canal APD of anterior surgery was 94.4％,which was larger than 88.5％ in posterior surgery,although the difference was not significant.Notably,when the fragment displacement was ≤ 8 mm,posterior surgery could achieve 97.4％ APD which was comparable with that of anterior surgery.In contrast,when the fragment displacement was ＞ 8 mm,the APD was much smaller in posterior surgery with only 78.5％ (P ＜ 0.05).Similarly,when the fragment inversion was ≤25° or ＞ 25°,the APD was significantly different in anterior surgery and posterior surgery (95.4％ vs.80.8％) (P ＜ 0.05).Conclusions Although posterior surgery for thoracolumbar burst fractures is easy to perform and has short operation time and little intraoperative blood loss,it cannot always guarantee adequate decompression of spinal canal.When the posterosuperior fragment displacement is ＞ 8 mm or when its inversion is ＞ 25°,stand-alone posterior indirect reduction technique is likely to lead to inadequacy of canal restoration.In this case,anterior surgery should be considered in order to achieve more complete canal decompression.Therefore,this radiographic characteristic of the posterosuperior fragment could serve as an approach reference for thoracolumbar burst fractures.
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Objective To clarify the relationship between the basivertebral foramen (BF) and the retropulsed bone fragment (RBF) in thoracolumbar burst fracture (TLBF) and further explain the mechanism of RBF formation.Methods From June 2013 to June 2016,Sixty-two patients suffering from TLBF with RBF were collected.The characteristics of RBF as well as the parameters of vertebral body were studied using CT reconstruction imaging.In the transverse images,the lengths of RBF (RL) and vertebral body (VL) were measured.In median sagittal images,the heights and widths of RBF (RH,RW) and vertebral body (VH,VW) were also obtained.The ratios of different parameters of RBF and vertebral body (RL/VL,RW/VW,RH/VH) were calculated,and then defined the location relationship of RBF and BF.Eight frozen cadaveric spine were selected and evaluated by Micro-CT scans.Each vertebral body was divided into three layers (Superior,Middle,Inferior).Each layer was further divided into 9 regions (R1-R9),named as SR1-SR9,MR1-MR9,IR1-IR9.Microarchitecture parameters of each region in each layer,including bone volume fraction (BV/TV),bone mineral density (BMD),trabecular connectivity (Corn.D),and trabecular number (Tb.N) and thickness (Tb.Th) were calculated,and their differences were also analyzed to see if the trabecular bone distribution would be affected by BF.In vitro study,burst fractures were simulated on cadaveric spines by using bursting fracture simulator,aiming to observe the RBF morphology and imaging findings to future investigate the relationship between RBF and BF.Results The length and height of RBF were close to half of vertebral body length and height (RL/VL:0.497±0.059,RH/VH:0.485±0.036).The width of RBF was usually one-third of vertebral body width (RW/VW:0.319±0.025),which indicated that the fracture block was often located in the posterior of vertebral body above the BF.BV/TV,Tb.N in the MR2 and MR5 regions were lowest than other regions and the SMI of MR2 and MR5 was largest than others.SR5 was the lowest region in superior lawyer that was corresponded to regions most affected by burst fracture.In simulated burst fractures,the fracture line of RBF went across the vertex or upper surface of the BF and the lower boundaries of RBF were also the upper bound of the BF.Moreover,the damage sites of posterior longitudinal ligament were mainly located at the edge of the BF.Conclusion At the bone defect region,the BF is the weakest area in the vertebral body which may affect the distribution of trabecular bone surrounding it.When subjected to vertical violence,these regions undergo fracture first which impact the anterior and lower boundaries of RBF.Ultimately,RBF was produced upon the BF,involving all or part of the upper bound of the BF.
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Objective To clarify the relationship between the basivertebral foramen (BF) and the retropulsed bone fragment (RBF) in thoracolumbar burst fracture (TLBF) and further explain the mechanism of RBF formation.Methods From June 2013 to June 2016,Sixty-two patients suffering from TLBF with RBF were collected.The characteristics of RBF as well as the parameters of vertebral body were studied using CT reconstruction imaging.In the transverse images,the lengths of RBF (RL) and vertebral body (VL) were measured.In median sagittal images,the heights and widths of RBF (RH,RW) and vertebral body (VH,VW) were also obtained.The ratios of different parameters of RBF and vertebral body (RL/VL,RW/VW,RH/VH) were calculated,and then defined the location relationship of RBF and BF.Eight frozen cadaveric spine were selected and evaluated by Micro-CT scans.Each vertebral body was divided into three layers (Superior,Middle,Inferior).Each layer was further divided into 9 regions (R1-R9),named as SR1-SR9,MR1-MR9,IR1-IR9.Microarchitecture parameters of each region in each layer,including bone volume fraction (BV/TV),bone mineral density (BMD),trabecular connectivity (Corn.D),and trabecular number (Tb.N) and thickness (Tb.Th) were calculated,and their differences were also analyzed to see if the trabecular bone distribution would be affected by BF.In vitro study,burst fractures were simulated on cadaveric spines by using bursting fracture simulator,aiming to observe the RBF morphology and imaging findings to future investigate the relationship between RBF and BF.Results The length and height of RBF were close to half of vertebral body length and height (RL/VL:0.497±0.059,RH/VH:0.485±0.036).The width of RBF was usually one-third of vertebral body width (RW/VW:0.319±0.025),which indicated that the fracture block was often located in the posterior of vertebral body above the BF.BV/TV,Tb.N in the MR2 and MR5 regions were lowest than other regions and the SMI of MR2 and MR5 was largest than others.SR5 was the lowest region in superior lawyer that was corresponded to regions most affected by burst fracture.In simulated burst fractures,the fracture line of RBF went across the vertex or upper surface of the BF and the lower boundaries of RBF were also the upper bound of the BF.Moreover,the damage sites of posterior longitudinal ligament were mainly located at the edge of the BF.Conclusion At the bone defect region,the BF is the weakest area in the vertebral body which may affect the distribution of trabecular bone surrounding it.When subjected to vertical violence,these regions undergo fracture first which impact the anterior and lower boundaries of RBF.Ultimately,RBF was produced upon the BF,involving all or part of the upper bound of the BF.
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Stereotactic body radiation therapy ( SBRT ) for locally advanced pancreatic cancer ( LAPC) shows good signs of efficacy as measured by local control,which can also reduce toxicity. The dose fractionation in foreign countries have changed from conventional fractionation to single fraction and finally moderate hypofractionation. It is similar to that in China, with the dose fractionation changing from conventional fractionation to moderate hypofractionation. This review introduces the latest research results of dose fractionation of SBRT for LAPC.
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Objective To analyze the outcome of applying venous flow-through flap in replantation of complex severed finger.Methods From March,2011 to August,2012,15 cases of complex severed fingers were repaired by flow-through flap with two sets of venous system of forearm vein and one stage repair of wound.The time from injury to operation was 1.5-5.5 h (mean 2.5 h).Vascular defect length ranged from 1.5 to 11.0 cm (mean 3.6 cm);and soft tissue defect of 1.5 cm × 3.0 cm to 11.0 cm × 11.0 cm.All digits had severe soft tissue defect and segmental defect of blood vessels.All the finger blood circulation was disorder.Results All flaps and replanted fingers survived completely,except 1 case of postoperative venous crisis occurred which was remission after the vascular transplantation,and 1 case of skin flap necrosis at the distal part which was healed after skin grafting; Fourteen cases were followed-up from 7 to 20 months.At the final followed-up the flaps were of good consistency and appearance.Function of the finger was graded excellent in 7 cases,good in 5 cases,and poor in 2 cases.All flaps and replanted fingers survived completely over a period of 12 to 30 months follow-up.The flaps were of good consistency and appearance.Function of the finger was graded excellent in 7 cases and good in 5 cases.Conclusion With less injury at donor site,and good repair results,venous flow-through flap is well indicated in complex finger replantation with soft tissue defect and vascule defect.