The Performance of Graduation from Traditional Growing Rods with Apical Control Technique in Patients with Congenital Early-Onset Scoliosis / 罕见病研究

  Objective  Different from other etiologies of early-onset scoliosis (EOS), congenital early-onset scoliosis (CEOS) is mainly linked to vertebral anomalies, such as formation failures and segmentation failures at the apex segments. So far, there is little research on CEOS patients who have completed traditional growing rods (TGR) treatment, and the initial outcomes of TGR with or without apical control technique (ACT) are different. Therefore, we compared the "final" results of CEOS patients who completed TGR treatment with or without ACT.  Methods  We conducted a retrospective study of CEOS patients who completed TGR treatment from 2007—2020. They either had final fusion or were followed up after reaching skeletal maturity. We split the patients into two groups based on whether they had ACT with TGR or not. The ACT-TGR group had apical vertebrectomy/hemivertebrectomy with short fusion and TGR. The TGR-only group had only TGR. We looked at their demographic features, radiographic measurements, and complications.  Results  This study enrolled 46 CEOS patients, of which 13 patients were in the ACT-TGR group and 33 patients in the TGR group. The ACT-TGR group had a longer distraction interval (1.17 years vs. 0.75 years). The ACT-TGR group had a larger preoperative main curve [87.00(63.50, 98.00)], but the residual curve degrees were comparable between the two groups at the last follow-up (P=0.354). At the last follow-up, the T1-12 and T1-S1 heights were similar between the two groups. The ACT-TGR group had a lower number of implant-related complications per patient (0.77 vs. 1.48). Three patients in the ACT-TGR group underwent final fusion, while 17 patients in the TGR group underwent final fusion (P=0.060).  Conclusions  Both ACT-TGR and traditional TGR coud effectively correct deformity and preserve spinal growth in CEOS patients. ACT-TGR had a better corrective effect on patients with severe deformity and did not have a significant impact on spinal height. For patients with acceptable correction, spontaneous fusion and without implant failure, retaining the implant and continuing observation could be a strategy for graduating from growing rod treatment.

The Clinical Outcomes and Perioperative Care of Neurofibromatosis Type 1 Thoracolumbar Kyphoscoliosis / 罕见病研究

  Objective  To evaluate the clinical outcomes and complications of posterior spinal fusion surgery in the treatment of neurofibromatosis type 1(NF1)thoracolumbar kyphoscoliosis, and to explore the mode of perioperative care for nurses provided to the patients.  Methods  We used the retrospective analysis on the 134 patients with NF1 thoracolumbar kyphoscoliosis admitted to our department from March 2012 to April 2022 and analyzed the clinical outcomes and perioperative complications by using the related statistics. We evaluated the Perioperative care by the nurses in the treatment of NF1 to explore the mode of nursing to the patients with the NF1, by using specific observation points and evaluation indicators.  Results  NF1 kyphoscoliosis patients had poor preoperative nutritional status and lung function. NF1 kyphoscoliosis underwent longer operation time, lost more blood in operation, had higher osteotomy grade and more postoperative complications. All the patients successfully completed the operation in our group. The correction rate of scoliosis was (52.8±22.7)%, and the correction rate of kyphosis was (57.3±34.6)%. 25 patients had complications but no such serious complications as nerve damage.  Conclusions  The practice of the perioperative nursing to NF1 type scoliosis patients facilitates the shortening of the recovery period, the prevention or timely detection of complications, and improvement of the therapeutic effect.

Multicenter study on the etiology characteristics of neonatal purulent meningitis / 中华传染病杂志

Objective:To study the distribution and antibiotics resistance of the main pathogens of neonatal purulent meningitis in different regions of China.Methods:A retrospective descriptive clinical epidemiological study was conducted in children with neonatal purulent meningitis which admitted to 18 tertiary hospitals in different regions of China between January 2015 to December 2019. The test results of blood and cerebrospinal fluid, and drug sensitivity test results of the main pathogens were collected. The distributions of pathogenic bacteria in children with neonatal purulent meningitis in preterm and term infants, early and late onset infants, in Zhejiang Province and other regions outside Zhejiang Province, and in Wenzhou region and other regions of Zhejiang Province were analyzed. The chi-square test was used for statistical analysis.Results:A total of 210 neonatal purulent meningitis cases were collected. The common pathogens were Escherichia coli ( E. coli)(41.4%(87/210)) and Streptococcus agalactiae ( S. agalactiae)(27.1%(57/210)). The proportion of Gram-negative bacteria in preterm infants (77.6%(45/58)) with neonatal purulent meningitis was higher than that in term infants (47.4%(72/152)), and the difference was statistically significant ( χ2=15.54, P=0.001). There were no significant differences in the constituent ratios of E. coli (36.5%(31/85) vs 44.8%(56/125)) and S. agalactiae (24.7%(21/85) vs 28.8%(36/125)) between early onset and late onset cases (both P>0.05). The most common pathogen was E. coli in different regions, with 46.7%(64/137) in Zhejiang Province and 31.5%(23/73) in other regions outside Zhejiang Province. In Zhejiang Province, S. agalactiae was detected in 49 out of 137 cases (35.8%), which was significantly higher than other regions outside Zhejiang Province (11.0%(8/73)). The proportions of Klebsiella pneumoniae, and coagulase-negative Staphylococcus in other regions outside Zhejiang Province (17.8%(13/73) and 16.4%(12/73)) were both higher than those in Zhejiang Province (2.9%(4/137) and 5.1%(7/137)). The differences were all statistically significant ( χ2=14.82, 12.26 and 7.43, respectively, all P<0.05). The proportion of Gram-positive bacteria in Wenzhou City (60.8%(31/51)) was higher than that in other regions in Zhejiang Province (38.4%(33/86)), and the difference was statistically significant ( χ2=6.46, P=0.011). E. coli was sensitive to meropenem (0/45), and 74.4%(32/43) of them were resistant to ampicillin. E. coli had different degrees of resistance to other common cephalosporins, among which, cefotaxime had the highest resistance rate of 41.8%(23/55), followed by ceftriaxone (32.4%(23/71)). S. agalactiae was sensitive to penicillin, vancomycin and linezolid. Conclusions:The composition ratios of pathogenic bacteria of neonatal purulent meningitis are different in different regions of China. The most common pathogen is E. coli, which is sensitive to meropenem, while it has different degrees of resistance to other common cephalosporins, especially to cefotaxime.

Melatonin promotes osteogenesis of bone marrow mesenchymal stem cells by improving the inflammatory state in ovariectomized rats / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effects of melatonin (MT) on bone mass and serum inflammatory factors in rats received ovariectomy (OVX) and to investigate the effects of MT on the levels of inflammatory factors in culture medium and osteogenic ability of bone marrow mesenchymal stem cells (BMSCs) stimulated by lipopolysaccharide.@*METHODS@#Fifteen 12-week-old Sprague Dawley (SD) rats were randomly divided into 3 groups. The rats in Sham group only received bilateral lateral abdominal incision and suture, the rats in OVX group received bilateral OVX, and the rats in OVX+MT group received 100 mg/(kg·d) MT oral intervention after bilateral OVX. After 8 weeks, the levels of serum inflammatory factors [interleukin-1β (IL-1β), IL-6, and tumor necrosis factor α (TNF-α)] were detected using ELISA assay. Besides, the distal femurs were detected by Micro-CT to observe changes in bone mass and microstructure, and quantitatively measured bone volume fraction, trabecular thickness, and trabecular number. The BMSCs were extracted from the femurs of three 3-week-old SD rats using whole bone marrow culture method and passaged. The 3rd-5th passage BMSCs were cultured with different concentrations of MT (0, 1, 10, 100, 1 000 µmol/L), and the cell viability was then detected using cell counting kit 8 (CCK-8) to select the optimal concentration of MT for subsequent experiments. Cells were devided into osteogenic induction group (group A) and osteogenic induction+1/5/10 μg/mL lipopolysaccharide group (group B-D). The levels of inflammatory factors (IL-1β, IL-6 and TNF-α) in cell culture medium were detected using ELISA assay after corresponding intervention. According to the results of CCK-8 method and ELISA detection, the cells were intervened with the most significant concentration of lipopolysaccharide for stimulating inflammation and the optimal concentration of MT with osteogenic induction, defining as group E, and the cell culture medium was collected to detect the levels of inflammatory factors by ELISA assay. After that, alkaline phosphatase (ALP) staining and alizarin red staining were performed respectively in groups A, D, and E, and the expression levels of osteogenic related genes [collagen type Ⅰ alpha 1 chain (Col1a1) and RUNX family transcription factor 2 (Runx2)] were also detected by real time fluorescence quantitative PCR (RT-qPCR).@*RESULTS@#ELISA and Micro-CT assays showed that compared with Sham group, the bone mass of the rats in the OVX group significantly decreased, and the expression levels of serum inflammatory factors (IL-1β, IL-6, and TNF-α) in OVX group significantly increased (P<0.05). Significantly, the above indicators in OVX+MT group were all improved (P<0.05). Rat BMSCs were successfully extracted, and CCK-8 assay showed that 100 µmol/L was the maximum concentration of MT that did not cause a decrease in cell viability, and it was used in subsequent experiments. ELISA assays showed that compared with group A, the expression levels of inflammatory factors (IL-1β, IL-6, and TNF-α) in the cell culture medium of groups B-D were significantly increased after lipopolysaccharide stimulation (P<0.05), and in a concentration-dependent manner. Moreover, the expression levels of inflammatory factors in group D were significantly higher than those in groups B and C (P<0.05). After MT intervention, the expression levels of inflammatory factors in group E were significantly lower than those in group D (P<0.05). ALP staining, alizarin red staining, and RT-qPCR assays showed that compared with group A, the percentage of positive area of ALP and alizarin red and the relative mRNA expressions of Col1a1 and Runx2 in group D significantly decreased, while the above indicators in group E significantly improved after MT intervention (P<0.05).@*CONCLUSION@#MT may affect the bone mass of postmenopausal osteoporosis by reducing inflammation in rats; MT can reduce the inflammation of BMSCs stimulated by lipopolysaccharide and weaken its inhibition of osteogenic differentiation of BMSCs.

Correlation of transcutaneous bilirubin level of shielded skin and total serum bilirubin level after phototherapy in premature infants / 中国新生儿科杂志

Objective:To study the correlation between transcutaneous bilirubin (TcB) level measured from shielded skin and total serum bilirubin (TSB) level after phototherapy in premature infants.Methods:From July 2019 to July 2021,preterm infants with jaundice admitted to the Department of Neonatology of our hospital and received phototherapy were prospectively enrolled in the study. The infants were assigned into 26~31w group, 32~34w group and 35~36w group according to their gestational ages. During phototherapy, the forehead, the chest and the perineum were shielded. TcBs were measured at the above mentioned areas three times each before and after phototherapy and TSB was measured from venous blood samples.Results:A total of 306 premature infants were included, with 51 cases in 26~31w group, 126 cases in 32~34w group and 129 cases in 35~36w group. Before phototherapy, TcBs of the forehead, the chest and the perineum of all infants were correlated with TSB ( r=0.699, 0.913, 0.734, P<0.001) with TcB of the chest showed the best correlation. A linear regression equation was established using the TSB before phototherapy and the TcB of the chest: TSB=0.634+0.912TcB. After phototherapy, TcBs of the forehead, the chest and the perineum of all infants were also correlated with TSB ( r=0.586, 0.879, 0.690, P<0.001) with TcB of the chest showed the best correlation and the linear regression equation was TSB=1.910+0.736TcB. Conclusions:For preterm infants with gestational age of 26~36w, TcB of the shielded chest skin after phototherapy is correlated with TSB and a linear regression model can be established.

The diffuse idiopathic skeletal hyperostosis classification based on CT and the correlation of ossification and sagittal spinal morphology / 中华骨科杂志

Objective:To investigate CT classification of diffuse idiopathic skeletal hyperostosis (DISH), and to analyze the correlation between the position of ossification in the anterolateral spine and the sagittal configuration of the spine.Methods:The medical records of 109 patients (70 male and 39 female) who underwent whole spine computerized tomography (CT) from October 2018 to October 2020 were retrospectively analyzed. The average age was 68.4±6.9 years old, ranging from 60 to 88 years old. High resolution CT volume rendering technique images were used to assess the degree of anterolateral spinal ossification in each vertebral space, and a CT grading system was established. Sagittal parameters such as thoracic kyphosis (TK), lumbar lordosis(LL), cervical lordosis (CL), sacral slope (SS), and thoracolumbar junction angle (TLJ) of the patients were measured. The sagittal morphology of the spine was divided into four types using the modified Abelin-Genevois (AG) sagittal classification. In AG type 1 patients, the kyphotic vertex was located in the middle of the thoracic spine (T 4-T 11). In AG type 2 patients, there was no significant kyphotic vertex. In AG type 3 patients, the kyphotic vertex was located in the thoracolumbar segment (T 12-L 2). In AG type 4 patients, the kyphotic vertex was located in the upper thoracic segment (T 1-T 3). Inter-observer and intra-observer reliability were calculated by intra-group correlation coefficient ( ICC). Statistical analysis was conducted to investigate the correlation between different AG types and ossification location and severity. Results:The new DISH grading system classifies the severity of anterolateral spinal ossification in each intervertebral space into grades 0 to 3 with an intra-observer ICC value of 0.871 and inter-observer ICC value of 0.874. Combined with Resnick's DISH diagnostic criteria, 97 patients (89.0%) in this study had four consecutive intervertebral spaces with ossification grade 1 or above. For these patients, in T 4-T 11, the standardized ossification grade of AG type 1 was 1.24±0.69, greater than that of AG type 2 (0.84±0.71) and AG type 3 (1.00±0.70), and the differences were statistically significant ( F=23.101, P<0.001). In T 12-L 2, the standardized ossification grade of AG type 3 was 1.44±0.87, which was higher than AG type 1 (1.06±0.84) and AG type 2 (0.72±0.63), the differences were statistically significant ( F=14.008, P<0.001). In this study, no patients with kyphosis apex in the cervicothoracic region (AG type4) were found. In T 1-T 3, there was no statistical difference between the three groups ( F=0.303, P=0.738); in the whole thoracic and lumbar spine (T 1-L 5), there was statistically significant difference in the total ossification grade ( F=14.374, P<0.001), there was no statistical difference between AG type 1 and AG type 3 ( P=0.254), both of which were higher than AG type 2 ( P<0.001). Conclusion:The new DISH ossification grading system proposed in this study has high credibility, which can be used in DISH's study. This study confirmed that the region where the apex of kyphosis is located is prone to anterolateral ossification of the spine.

Comparison of adjacent segment degeneration following single-segment minimally invasive and open transforaminal lumbar interbody fusion / 中华骨科杂志

Objective@#To compare the incidence of adjacent segment degeneration (ASDeg) and clinical outcomes of minimally invasive versus traditional transforaminal lumbar interbody fusion (TLIF) in the treatment of L 4,5 single-segment lumbar spinal stenosis (LSS) and explore the risk factors of ASDeg.@*Methods@#All of 115 patients with LSS who were treated by the same group of doctors from 2009 to 2013, with a minimum follow-up of 5 years. Thirty-eight patients underwent minimally invasive trans-foraminal lumbar interbody fusion (MIS-TLIF) and 77 patients underwent traditional TLIF. Standing radiographs at the preopera-tive period and the final follow-up were assessed. Radiological parameters included lumbar lordosis (LL), fused segment angle (FSA), disc height (DH) and range of motion (ROM). Babu classification was used to identify facet joint violation (FJV) in patients at 5-year follow-up. Clinical outcomes were assessed according to visual analog scale (VAS) score, Japanese Orthopaedic Associa-tion (JOA) score and Oswestry Disability Index (ODI). Student's t-test, Chi-square test, and non-parametric test were used as the main statistical methods.@*Results@#The mean age of MIS-TLIF group was 58.2±8.8 years, and that of TLIF group was 54.7±11.2 years, and there was no significant difference between the two groups. The mean follow-up time was 64.5±3.8 months in the MIS-TLIF group and 63.9±3.3 months in the TLIF group, and there was no significant difference between the two groups. There were 17 cases of degenerative spondylolisthesis in MIS-TLIF group (44.7%) and 35 cases of degenerative spondylolisthesis in TLIF group (45.5%), and there was no significant difference between the two groups. There was no significant difference in DH and ROM of L3,4, L4,5, L5S1 between the two groups before operation. There was no significant difference in VAS, JOA and ODI scores between the two groups before operation. The VAS, JOA and ODI scores were significantly improved at the last follow-up compared with those before operation. After 5-year follow-up, 56 cases (48.7%) had ASDeg. The incidence of ASDeg was 31.6% in MIS-TLIF group and 57.1% in TLIF group, and there was statistical differences between the two groups (χ2=6.656, P <0.01). Among them, 32 cases only had upper segment ASDeg (6 cases in MIS-TLIF group, 26 cases in TLIF group), 19 cases only had lower segment ASDeg (6 cases in MIS-TLIF group, 13 cases in TLIF group), and 5 cases had both upper and lower ASDeg (5 cases in the TLIF group). The DH of adjacent segments decreased after operation, but the loss of DH in MIS-TLIF group was smaller than that in TLIF group, including L3,4 segments (-4.9%±6.4% vs-8.7%±7.2%, t=-2.761, P <0.01), L5S1 segment (-4.7%±9.8% vs-10.5%±11.7%, t=-2.623, P <0.01). The ROM of adjacent segments increased in both groups, but the increase of ROM in MIS-TLIF group was smaller than that in TLIF group, including L 3,4 segments (1.1°±1.8° vs 2.3°±2.5°, t=-3.122, P <0.01), L5S1 segment (0.9°± 1.9 ° vs 1.8°±1.9 °, t=-2.353, P <0.01). The incidence of FJV was 54.2% in patients with ASDeg in MIS-TLIF group and 47.7% in patients with ASDeg in TLIF group. Chi-square analysis showed that FJV was related to ASDeg in both groups (χ2=3.869, P < 0.05).@*Conclusion@#Both of the two surgical methods have good clinical effects on L 4,5 single-segment LSS. The incidence of AS-Deg after MIS-TLIF is lower than that of TLIF. FJV is a risk factor for ASDeg.

Comparison of adjacent segment degeneration following single?segment minimally invasive and open transforaminal lumbar interbody fusion / 中华骨科杂志

Objective To compare the incidence of adjacent segment degeneration (ASDeg) and clinical outcomes of minimally invasive versus traditional transforaminal lumbar interbody fusion (TLIF) in the treatment of L 4,5 single?segment lumbar spinal stenosis (LSS) and explore the risk factors of ASDeg. Methods All of 115 patients with LSS who were treated by the same group of doctors from 2009 to 2013, with a minimum follow?up of 5 years. Thirty?eight patients underwent minimally invasive trans?foraminal lumbar interbody fusion (MIS?TLIF) and 77 patients underwent traditional TLIF. Standing radiographs at the preopera?tive period and the final follow?up were assessed. Radiological parameters included lumbar lordosis (LL), fused segment angle (FSA), disc height (DH) and range of motion (ROM). Babu classification was used to identify facet joint violation (FJV) in patients at 5?year follow?up. Clinical outcomes were assessed according to visual analog scale (VAS) score, Japanese Orthopaedic Associa?tion (JOA) score and Oswestry Disability Index (ODI). Student's t?test, Chi?square test, and non?parametric test were used as the main statistical methods. Results The mean age of MIS?TLIF group was 58.2±8.8 years, and that of TLIF group was 54.7±11.2 years, and there was no significant difference between the two groups. The mean follow?up time was 64.5±3.8 months in the MIS?TLIF group and 63.9±3.3 months in the TLIF group, and there was no significant difference between the two groups. There were 17 cases of degenerative spondylolisthesis in MIS?TLIF group (44.7%) and 35 cases of degenerative spondylolisthesis in TLIF group (45.5%), and there was no significant difference between the two groups. There was no significant difference in DH and ROM of L 3,4, L 4,5, L5S1 between the two groups before operation. There was no significant difference in VAS, JOA and ODI scores between the two groups before operation. The VAS, JOA and ODI scores were significantly improved at the last follow?up compared with those before operation. After 5?year follow?up, 56 cases (48.7%) had ASDeg. The incidence of ASDeg was 31.6% in MIS?TLIF group and 57.1% in TLIF group, and there was statistical differences between the two groups (χ2=6.656,P<0.01). Among them, 32 cases only had upper segment ASDeg (6 cases in MIS?TLIF group, 26 cases in TLIF group), 19 cases only had lower segment ASDeg (6 cases in MIS?TLIF group, 13 cases in TLIF group), and 5 cases had both upper and lower ASDeg (5 cases in the TLIF group). The DH of adjacent segments decreased after operation, but the loss of DH in MIS?TLIF group was smaller than that in TLIF group, including L 3,4 segments (-4.9%±6.4% vs-8.7%±7.2%, t=-2.761, P<0.01), L5S1 segment (-4.7%±9.8% vs-10.5%± 11.7%, t=-2.623, P<0.01). The ROM of adjacent segments increased in both groups, but the increase of ROM in MIS?TLIF group was smaller than that in TLIF group, including L 3,4 segments (1.1°± 1.8°vs 2.3°± 2.5°, t=-3.122, P<0.01), L5S1 segment (0.9°± 1.9°vs 1.8°±1.9°, t=-2.353, P<0.01). The incidence of FJV was 54.2% in patients with ASDeg in MIS?TLIF group and 47.7% in patients with ASDeg in TLIF group. Chi?square analysis showed that FJV was related to ASDeg in both groups (χ2=3.869,P <0.05). Conclusion Both of the two surgical methods have good clinical effects on L 4,5 single?segment LSS. The incidence of AS?Deg after MIS?TLIF is lower than that of TLIF. FJV is a risk factor for ASDeg.

Research in the mathematical model of transcutaneous bilirubin and total serum bilirubin after phototherapy in neonates / 临床儿科杂志

ObjectiveTo establish the mathematical model of transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) after phototherapy in neonates.MethodsNeonates with pathological jaundice were enrolled from October 2013 to June 2014. The neonates were divided into three groups by gestational age: full-term neonates (gestation age of 37-42 weeks), late preterm neonates (gestation age of 34-36+6 weeks), early and mid-preterm neonates (gestation age of 28-33+6 weeks). The neonates received single or double sided phototherapy. During the phototherapy, the forehead and chest were covered by opaque material. The TcB was measured at forehead, mid sternum, perineum area three times each before and after phototherapy. Mean-while the TSB was tested.Results Two hundred and sixty-one neonates with hyperbilirubinemia were enrolled, among whom there were 169 full-term neonates, 63 late preterm neonates and 29 early and mid-preterm neonates. Before phototherapy, there were signiifcantly correlation of TSB with TcB on forehead, mid sternum and perineum (r=0.813, 0.827, 0.754;P<0.001) and the best correlation was with TcB on mid sternum. The linear regression equation was TSB=1.35TcB-5.50. After phototherapy, there were signiifcantly correlateion of TSB with TcB on forehead, mid sternum, and perineum (r=0.751, 0.807, 0.683;P<0.001) and the best correlation was with TcB on mid sternum. The linear regression equation was TSB=1.01×TcB-0.62. Among three groups, the full-term neonates had the best correlation.ConclusionsAfter phototherapy, the TcB measured on mid sternum which was covered by opaque material is well correlated with TSB. The linear regression model can be established.