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OBJECTIVE: To investigate blood pressure rhythm (BPR) in Yin deficiency syndrome of hypertension (YDSH) patients and develop a random forest model for predicting YDSH. METHODS: Our study was consistent with technical processes and specification for developing guidelines of Evidence-based Chinese medicine clinical practice (T/CACM 1032-2017). We enrolled 234 patients who had been diagnosed with primary hypertension without antihypertensive medications prior to the enrollment. All participants were divided into Yin deficiency group (YX, n = 74) and non-Yin deficiency group (NYX, n = 160). Participants were professionally grouped by three experienced chief Traditional Chinese Medicine (TCM) physicians according to four examinations (i.e., inspection, listening and smelling, inquiry and palpation). We collected data on 24 h ambulatory blood pressure monitoring (ABPM) and YDSH rating scale. We divided 24 h of a day into 12 two-hour periods [Chen-Shi (7:00-9:00), Si-Shi (9:00-11:00), Wu-Shi (11:00-13:00), Wei-Shi (13:00-15:00), Shen-Shi (15:00-17:00), You-Shi (17:00-19:00), Xu-Shi (19:00-21:00), Hai-Shi (21:00-23:00), Zi-Shi (23:00-1:00), Chou-Shi (1:00-3:00), Yin-Shi (3:00-5:00), Mao-Shi (5:00-7:00)] according to the theory of "midnight-midday ebb flow". We used random forest to build the diagnostic model of YDSH, with whether it was Yin deficiency syndrome as the outcome. RESULTS: Compared with NYX group, YX group had more female participants with older age, lower waist circumference, body mass index (BMI), diastolic blood pressure (DBP), and smoking and drinking rate (all P ï¼ 0.05). The YDSH rating scores of YX group [28.5 (21.0-36.0)] were significantly higher than NYX group [13.0 (8.0-22.0)] (P < 0.001), and the typical symptoms of YX group included vexing heat in the chest, palms and soles, dizziness, dry eyes, string-like and fine pulse, soreness and weakness of lumbus and knees, palpitations, reddened cheeks, and tinnitus (all P < 0.05). The ratio of non-dipper hypertension in YX group was higher than in NYX group (56.9% vs 44.4%, P = 0.004). Compared with NYX group, 24 h DBP standard deviation (SD), nighttime DBP SD, Si-Shi DBP, Si-Shi mean arterial pressure (MAP), Hi-Shi systolic blood pressure (SBP), Hi-Shi DBP, Hi-Shi MAP, Zi-Shi SBP, Zi-Shi DBP, Zi-Shi MAP, Chou-Shi SBP SD, Chou-Shi DBP SD, Chou-Shi SBP coefficient of variation (CV) were lower in YX group (all P ï¼ 0.05). Binary Logistic Regression analysis showed that the diagnosis of YDSH was positively correlated with age, heart rate, YDSH rating scores, and four TCM symptoms including vexing heat in the chest, palms and soles, string-like and fine pulse, soreness and weakness of lumbus and knees, and reddened cheeks (all P ï¼ 0.05), but was negatively correlated with smoking (Pï¹¥0.05). In addition, the diagnosis of YDSH was positively correlated with daytime SBP SD, nighttime SBP SD, nighttime SBP CV, and Hi-Shi SBP CV, but was negatively correlated with 24 h SBP CV, daytime DBP SD, nighttime DBP SD, and Hi-Shi DBP (all P ï¼ 0.05). Hi-Shi SBP CV had independent and positive correlation with the diagnosis of YDSH after adjusting the variables of age, gender, course of hypertension, BMI, waist circumference, SBP, DBP, heart rate, smoking and drinking (P = 0.029). Diagnostic model of YDSH was established and verified based on the random forest. The results showed that the calculation accuracy, specificity and sensitivity were 77.3%, 77.8% and 76.9%, respectively. CONCLUSION: The BPR was significantly attenuated in YDSH patients, including lower 24 h DBP SD and nighttime DBP SD, and Hi-Shi SBP CV is independently correlated with the diagnosis of YDSH. The prediction accuracy of diagnosis model of YDSH based on the random forest was good, which could be valuable for clinicians to differentiate YDSH and non-Yin deficiency patients for more effective hypertensive treatment of TCM.
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Blood Pressure , Hypertension , Yin Deficiency , Humans , Female , Male , Middle Aged , Hypertension/physiopathology , Hypertension/drug therapy , Hypertension/diagnosis , Yin Deficiency/diagnosis , Yin Deficiency/physiopathology , Adult , Aged , Medicine, Chinese Traditional , Random ForestABSTRACT
Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.
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Objective:To investigate the risk factors of bone cement leakage and recompression of injured vertebrae after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF).Methods:A case-control study was performed to analyze the clinical data of 297 patients with single-segment OVCF who underwent PKP in First Affiliated Hospital of Soochow University from January 2017 to January 2021, including 67 males and 230 females; aged 60-92 years [(69.5±8.2)years]. According to the occurrence of bone cement leakage, the patients were divided into leakage group ( n=36) and no leakage group ( n=261). According to the occurrence of recompression of injured vertebrae, the patients were divided into recollapse group ( n=40) and no recollapse group ( n=257). The gender, age, fracture segment, type of fracture, fracture severity, cortical disruption, intravertebral cleft, preoperative and postoperative local kyphosis angle, correction value of local kyphosis angle, bone cement injection volume, bone cement distribution, and postoperative anti-osteoporosis treatment were recorded. Univariate analysis was used to analyze the correlation of those factors with bone cement leakage and recompression of injured vertebrae after PKP, followed by multivariate Logistic regression analysis to identify the independent risk factors. Results:Univariate analysis showed that fracture severity, cortical disruption and bone cement injection volume were related to bone cement leakage ( P<0.05 or 0.01). Gender, age, fracture segment, type of fracture, intravertebral cleft, preoperative and postoperative local kyphosis angle, correction value of local kyphosis angle, bone cement distribution, and postoperative anti-osteoporosis treatment were not related to bone cement leakage (all P>0.05). Univariate analysis showed that intravertebral cleft, bone cement distribution, and postoperative anti-osteoporosis treatment were associated with recompression of injured vertebrae (all P<0.01). Gender, age, fracture segment, type of fracture, fracture severity, cortical disruption, preoperative and postoperative local kyphosis angle, correction value of local kyphosis angle, and bone cement injection volume were not related to recompression of injured vertebrae (all P>0.05). Multivariate Logistic regression analysis showed that severe fracture ( OR=4.23, 95% CI 1.52-11.81, P<0.01), cortical disruption ( OR=3.29,95% CI 1.52-7.13, P<0.01), and bone cement injection volume >8 ml ( OR=2.31,95% CI 1.09-4.92, P<0.05) were significantly related to bone cement leakage. Multivariate Logistic regression analysis showed that intravertebral cleft ( OR=2.10, 95% CI 1.03-4.30, P<0.05), solid type of bone cement distribution ( OR=2.56, 95% CI 1.25-5.27, P<0.05) and no anti-osteoporosis treatment after operation ( OR=3.06, 95% CI 1.46-6.40, P<0.01) were significantly related to recompression of injured vertebrae. Conclusions:For OVCF patients, severe fracture, cortical disruption, and bone cement injection volume>8 ml are independent risk factors for bone cement leakage after PKP. Intravertebral cleft, solid type of bone cement distribution, and no anti-osteoporosis treatment after operation are independent risk factors for recompression of injured vertebrae after PKP.
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Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, the orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of suspected or confirmed COVID-19 patients, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of OVCF patients diagnosed with COVID-19, the authors jointly develop this expert consensus to systematically recommend the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures.
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Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.
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Objective@#To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) in the treatment of stage Ⅲ Kümmell＇s disease with no neurological symptom.@*Methods@#From January 2009 to June 2018, 45 patients underwent PKP for stage Ⅲ Kümmell＇s disease with no neurological symptom at Department of Orthopaedics, The First Hospital Affiliated to Soochow University. They were 12 males and 33 females, aged from 61 to 85 years (average, 70.9 years). Their visual analog scale (VAS) scores for back pain, Oswestry disability indexes (ODI), heights of fractured vertebrae and kyphosis cob angles were recorded and compared between preoperation, one day, 3 months and final follow-up after operation.@*Results@#All the 45 patients were followed up for 12 to 48 months (average, 28.0 months). Their VAS scores (2.4±0.7, 2.2±0.7 and 2.3±0.6), ODI sores (34.7±6.8, 34.2±6.5 and 34.1±6.6) and cobb angles (15.7°±2.2°, 15.8°±2.2° and 15.9°±2.4°) at one day, 3 months and final follow-up after operation were significantly lower than those (8.2±1.1, 75.3±9.0 and 25.2°±3.9°) before operation (P<0.001). Their anterior height ratios of the fractured vertebra (54.0%±4.3%, 53.7%±4.2% and 53.6%±4.0%) and median height ratios of the fractured vertebra (56.8%±4.0%, 56.5%±3.9% and 56.6%±3.9%) at one day, 3 months and final follow-up after operation were significantly higher than those (25.8%±3.9% and 27.2%±3.1%) before operation (P<0.001). The rate of cement leakage was 13.3%(6/45). No patients had neurological symptoms after operation.@*Conclusion@#PKP is a minimally invasive, safe and effective treatment for stage Ⅲ Kümmell's disease with no neurological symptom, because it can relieve the symptoms of the patients, restore the height of the fractured vertebral body and reduce the local kyphosis cobb angle.
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Objective To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) in the treatment of stage Ⅲ Kümmell's disease with no neurological symptom.Methods From January 2009 to June 2018,45 patients underwent PKP for stage Ⅲ Ktimmell's disease with no neurological symptom at Department of Orthopaedics,The First Hospital Affiliated to Soochow University.They were 12 males and 33 females,aged from 61 to 85 years (average,70.9 years).Their visual analog scale (VAS) scores for back pain,Oswestry disability indexes (ODI),heights of fractured vertebrae and kyphosis cob angles were recorded and compared between preoperation,one day,3 months and final follow-up after operation.Results All the 45 patients were followed up for 12 to 48 months (average,28.0 months).Their VAS scores (2.4 ±0.7,2.2 ±0.7 and 2.3 ±0.6),ODI sores (34.7 ±6.8,34.2 ±6.5 and 34.1 ±6.6) and cobb angles (15.7°± 2.2°,15.8° ± 2.2° and 15.9° ± 2.4°) at one day,3 months and final follow-up after operation were significantly lower than those (8.2 ± 1.1,75.3 ±9.0 and 25.2°±3.9°) before operation (P ＜ 0.001).Their anterior height ratios of the fractured vertebra (54.0％ ±4.3％,53.7％ ±4.2％ and 53.6％ ±4.0％) and median height ratios of the fractured vertebra (56.8％ ± 4.0％,56.5％ ± 3.9％ and 56.6％ ± 3.9％) at one day,3 months and final follow-up after operation were significantly higher than those (25.8％ ± 3.9％ and 27.2％ ±3.1％) before operation (P ＜ 0.001).The rate of cement leakage was 13.3％ (6/45).No patients had neurological symptoms after operation.Conclusion PKP is a minimally invasive,safe and effective treatment for stage Ⅲ Kümmell's disease with no neurological symptom,because it can relieve the symptoms of the patients,restore the height of the fractured vertebral body and reduce the local kyphosis cobb angle.
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The two-dimensional (2D) cell culture model is currently used to study cellular processes and drug screening for human diseases. However, the growth of cells is affected by many factors. For conventional 2D cell culture, many of the difficulties are encountered in accurately replicating the cell function in three-dimensional (3D) tissues. Compared with 2D cell culture, much attention is paid to the cell-to-cell and cell-matrix interactions for 3D cell culture systems, which can more closely mimic the growth environment for cultured cells. Therefore, the 3D cell culture system was more suitable for a variety of applications such as drug screening and cell proliferation. In this work, we prepared microarray-structured polymer films with different geometric structures by nanoimprint lithography and used the films as cell culture platforms for the culture of 293T cells. Through the adjustment of the surface morphology and water contact angle of the prepared films, the regulation of the morphological changes of cell growth was successfully realized. Experimental results demonstrated that the hydrophilic films with 10 μm-pillar microstructure are applicable to 3D cell culture, whereas the hydrophobic films with 3 μm-pillar microstructure are only suitable for 3D culture of cells with a smaller size and stiff cuticular layer. In addition, cells tended to the formation of spheroids on the hydrophobic films, while cells usually adhered to the surface and grew on the hydrophilic films. This work represents further technological progress in the development of 3D cell culture, thereby facilitating future studies of physiologically relevant processes.
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Humans , Cell Culture Techniques , Cell Proliferation , HEK293 Cells , PolymersABSTRACT
Objective To investigate the risk factors affecting Sandwich vertebral re-fracture after vertebral augmentation surgery for osteoporotic spine Sandwich fractures.Methods A retrospective case control study was conducted on the clinical data of 90 patients with osteoporotic spine Sandwich fractures treated with vertebral augmentation surgery from January 2004 to December 2015.There were 26 males and 64 females,aged (69.9 ± 7.4) years.The patients were divided into fracture group (n =15) and non fracture group (n =75) according to the incidence of re-fracture after operation during follow-up.Gender,age,height,weight,bone mineral density,cumulative number of cemented vertebrae,location of the Sandwich vertebrae in the thoracolumbar segment,the preoperative kyphosis angle of the Sandwich fracture segment,surgical approach,cement injection approach (unilateral or bilateral),cement injection volume,cement leakage between the Sandwich intervertebral spaces,the postoperative kyphosis angle of the Sandwich fracture segment,and follow-up duration were used as independent variables.Chi-square test and multivariate logistic regression analysis were used to analyze the risk factors of vertebral Sandwich fracture.Results There were 97 Sandwich vertebrae in 90 patients,and 226 fractured vertebrae were treated with initial intensive treatment.The mean follow-up was 18.1 months.There were no significant differences in gender,age,height,weight,cumulative number of cemented vertebrae,whether the Sandwich vertebrae was located at the thoracolumbar segment,the preoperative kyphosis angle of the Sandwich fracture segment,the cement injection approach (unilateral or bilateral),the volume of cement injection,and the cement leakage between the Sandwich intervertebral spaces (P ＞ 0.05).There were significant differences in bone mineral density,surgical approach,and postoperative kyphosis angle of the Sandwich fracture segment between the two groups (P ＜ 0.05).Further logistic regression analysis showed that bone mineral density ≤ 3.5 SD and segmental kyphosis (≥ 10°) were risk factors for Sandwich fracture (P ＜ 0.05).Conclusions The low bone mineral density (T value ≤-3.5 SD) and postoperative kyphotic angle (≥ 10°) are risk factors for re-fracture of Sandwich vertebrae.Vertebroplasty itself does not increase the risk of recurrent vertebral fractures.
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Objective To evaluate the clinical effects of minimally invasive percutaneous new C2transpedicular lag-screw fixation for management of Hangman's fractures.Methods From October 2015 to June 2017,25 patients who had Hang-man's fracture were operated with minimally invasive percutaneous new C2transpedicular lag-screw fixation assisted by infrared navigation,among them there were 18 male and 7 female,aged from 28 to 70 years[average(46.1±13.3)years].According to the Levine-Edwards classification:16 patients were TypeⅠ,6 patients were TypeⅡand 3 patients were TypeⅡA.The cause of the in-jury was road traffic accident in 20 patients and fall from height in 5 patients.19 patients were simple Hangman's fracture and oth-er associated lesions included odontoid fracture of TypeⅡ(2 patients),atlas fracture of TypeⅠ(2 patients),rupture of spleen(1 pa-tient),and rib fractures(1 patient).According to American Association for spinal cord injury,graded as spinal cord injury D in 3 cases and E in 22 cases.The clinical outcomes were evaluated by visual analog scale(VAS)scores and related indicators,such as operation time,the range of motion(ROM)of cervical spine and ratio of bony union were recorded.The pre-and post-operative VAS scores of neck pain were compared with repeated measures analysis of variance. Results The mean follow-up time was (12.5±6.0)months,ranging from 3 to 24 months.Satisfactory reduction was obtained in all cases(minimal translation≤2 mm with-out obvious C2,3angulation).The average operation time was(65.9±12.1)min.At first day,one month,three months and the last fol-low-up, VAS scores of neck pain decreased comparing with preoperational measurements. There was significant difference be-tween the pre-and post-operative VAS scores of neck pain(t=24.7,25.8,23.1,24.1,P<0.001).According to American Associa-tion for spinal cord injury,three cases restored from D to E.There was no spinal cord or vertebral artery injury during operation and there was no screw loosing or breakage and cervical malformation happened during follow-up period. Bony fusion was achieved in all of these cases and the range of neck rotation was stored normal at the last follow-up.The average time of Bony fu-sion was(3.4±0.8)months.Conclusion The primary clinical efficacies of minimally invasive percutaneous new C2transpedicu-lar lag-screw fixation for treatment of Hangman's fracture were satisfactory,which carries precision and safety,immediate stability and more reliable.So it could be considered as a new choice for management of Hangman's fractures.
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Objective To investigate the relationship between interleukin (IL)-28B gene polymorphisms (rs12979860 and rs8099917) and treatment response in patients with chronic hepatitis C in China.Methods Taqman probes single nucleotide polymorphism genotyping methods were used to detect the genotypes of rs12979860 (C/T) and rs8099917 (T/G) located at IL-28B gene in 105 included patients.The patients were treated with standard doses of pegylated interferon plus ribavirin and were followed up regularly for therapeutic response and adverse reaction.The relationship between IL-28B gene polymorphism and antiviral treatment response of patients were analyzed.Categorical data were analyzed using Pearson chi-square test or Fisher exact test.Results Totally 105 cases were included in our study and 2 cases lost to follow-up because of moving away.Eight-one cases (78.6%) of the remaining 103 patients were CC/TT genotype (CC/TT group) at rs12979860 and rs8099917, 19 cases (18.4%) were CT/TG (CT/TG group) and 3 cases (2.9%)were TT/TG (TT/TG group).No other genotypes were detected and linkage disequilibrium was discovered at the two polymorphism loci (r2=0.11).After 4 weeks of treatment, 35 cases (43.2%) in CC/TT group, 3 cases (15.8%) in CT/TG group and non in TT/TG group achieved rapid virological response (RVR).There were statistically significant differences among three groups (P=0.033).After 12 weeks of treatment, 45 cases (55.6%) in CC/TT group, 6 cases (31.6%) in CT/TG group and none in TT/TG group achieved early virological response (EVR).There were statistically significant differences among three groups (P=0.025).At the end of the treatment, 68 cases (83.9%) in CC/TT group, 10 cases (52.6%) in CT/TG group and only 1 case (33.3%) in TT/TG group achieved end-of-treatment response (ETR).There were significant statistical differences among the three groups (P=0.003).After 24 weeks of follow-up, 62 cases (76.5%) in CC/TT group, 9 cases (47.4%) in CT/TG group and 1 case (33.3%) in TT/TG group achieved sustained virological response (SVR).There were statistically significant differences among the three groups (P=0.014).One hundred and one cases in CC/TT group developed adverse events, among them 19 cases needed clinical treatment.There were 43 cases in CT/TG group developed adverse events and 9 cases needed treatment.Seven cases in TT/TG group developed adverse events and only 1 case needed treatment.There were no statistically significant difference among three groups (χ2=0.139,P>0.05).Conclusions The genotype of rs12979860 (C/T) and rs8099917 (T/G) at IL-28B gene could affect the treatment response in patients with chronic hepatitis C.RVR and SVR are higher in patients with genotype CC/TT, which might help to guide HCV treatment.
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To investigate the changes in respiratory function of COPD patients with osteoporotic vertebral compression fractures (OVCFs) after kyphoplasty (KP). Pain scores, pulmonary function parameters (PFT), and local kyphotic angle (LKA) were measured in 31 older patients (25 women, 6 men) with OVCFs before, 3 days after and 3 months after kyphoplasty. The preoperative and postoperative (3 days, 3 months) PFT parameters were as follows: % pred FVC, 74.33 ± 12.35, 85.23.8 ± 13.23, and 84.86 ± 14.01; % pred FEV1, 60.23 ± 11.2, 60.02 ± 11.90, and 60.78 ± 12.70; FEV1/FVC ratio (%), 68.22 ± 16.74, 59.56 ± 13.23, and 60.77 ± 12.28, % pred MVV 52.46 ± 14.37, 55.23 ± 15.68, and 62.12 ± 14.48, respectively. The preoperative mean VAS score was 8.01 ± 1.41 and significantly decreased to 2.52 ± 0.89 and 2.34 ± 0.78 at 3 days, 3 months after kyphoplasty, respectively. The preoperative local kyphotic angle degree was 21.96 ± 5.75°, significantly decreased to 13.48 ± 6.12° 3 days after KP, and maintained 3 month after KP. The decrease in the VAS scores correlated with the PFT parameters; however, there were no significant correlations between the PFT parameters and the LKA, the VAS scores and the LKA. Kyphoplasty under local anesthesia is a safety treatment for the COPD patients with OVCFS, and is able to improve the lung function impaired by OVCFs.
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Anesthesia, Local , Fractures, Compression/surgery , Kyphoplasty/methods , Lung/physiopathology , Osteoporotic Fractures/surgery , Pulmonary Disease, Chronic Obstructive/physiopathology , Spinal Fractures/surgery , Aged , Aged, 80 and over , Female , Follow-Up Studies , Fractures, Compression/complications , Humans , Kyphosis/diagnostic imaging , Kyphosis/etiology , Kyphosis/physiopathology , Lumbar Vertebrae/injuries , Lumbar Vertebrae/surgery , Male , Middle Aged , Musculoskeletal Pain/diagnosis , Musculoskeletal Pain/etiology , Osteoporotic Fractures/complications , Pain Measurement , Pulmonary Disease, Chronic Obstructive/complications , Radiography , Respiratory Function Tests , Spinal Fractures/complications , Thoracic Vertebrae/injuries , Thoracic Vertebrae/surgery , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To study clinical outcomes following anterior cervical discectomy and fusion (ACDF) using ROI-C compared to traditional cage with anterior plating in treating the cervical spondylotic myelopathy.</p><p><b>METHODS</b>A total of 66 patients with the cervical spondylotic myelopathy were treated with ACDF between April 2011 and October 2012. Twenty-three patients underwent ACDF using the ROI-C device were classified as the ROI-C group and 43 patients received traditional cage with anterior plating served as the titanium plate group. Related indicators, such as operation time, intraoperative blood loss, intraoperative fluoroscopy times, incidence of postoperative dysphagia and ratio of bone graft fusion were recorded and compared between two groups. The clinical outcomes were evaluated by Japanese Orthopaedic Association (JOA) scores and visual analog scale (VAS) scores. The pre- and postoperative results were compared with a paired sample t-test. The results between groups were compared utilizing the grouped t-test or χ² test.</p><p><b>RESULTS</b>All cases were followed up. The follow-up period was 12 to 38 months and 14 to 39 months in ROI-C group and titanium plate group respectively. For the age, gender, the JOA scores, VAS scores of neck pain and arm pain during preoperative, the surgical level constituent ratio and the follow-up time, there were no significant differences between two groups. In ROI-C group, the operation time was (123 ± 38) minutes, intraoperative blood loss was (84 ± 37)ml, exposure times to the X-ray C-arm machine was (3.5 ± 0.7) times, which were all significantly lower than titanium plate group ((165 ± 60) minutes, (128 ± 66) ml, (5.9 ± 1.2) times respectively, t = -3.27, -3.25, - 9.45, P = 0.02, 0.02, 0.00). The mean JOA scores increased significantly from pre-surgery to 1 month postoperatively, 3 months postoperatively, and last follow-up in ROI-C group (t = 11.94, 11.32, 10.60, all P = 0.00) and titanium plate group(t = 15.07, 19.51, 17.55, all P = 0.00). The mean VAS scores of neck pain and arm pain decreased significantly from pre-surgery to 1 month postoperatively, 3 months postoperatively, and last follow-up in ROI-C group (t = -16.64-- 9.68, all P = 0.00) and titanium group(t = -16.56--12.38, all P = 0.00). There was no significant difference on JOA scores and VAS scores of neck pain and arm pain between the two groups at the same time (P > 0.05). However, significant difference was observed in incidence of postoperative dysphagia (χ² = 6.79, P = 0.01). In addition, bony fusion was obtained in all cases at the last follow-up postoperatively. There was no significant difference on ratio of bone graft fusion between two groups.</p><p><b>CONCLUSION</b>The ROI-C leads to similar clinical outcomes compared to traditional cage combined with anterior plating for the treatment of the cervical spondylotic myelopathy, while the ROI-C carries a simpler operation, shorter operation time, less intraoperative blood loss, less exposure times to the X-ray and a lower risk of postoperative dysphagia.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Bone Plates , Cervical Vertebrae , General Surgery , Diskectomy , Methods , Follow-Up Studies , Spinal Fusion , Methods , Titanium , Treatment OutcomeABSTRACT
Objective To explore the characteristics of pathogenic bacteria and risk factors for stroke‐associated pneumonia (SAP) in senile patients in order to privide basis for early clinical intervention .Methods A retrospective study was carried out to review the clinical data of 689 SAP patients treated at a university hospital between January 1 ,2011 and December 12 ,2013 . The pathogens from sputum and their antibiotic resistance profiles were analyzed .Multivariate Logistic regression model was used to screen relevant factors for stroke‐associated pneumonia (SAP) in a case‐control analysis at 1∶1 ratio .Results Of the 684 bacterial strains isolated from sputum , 545 (79 .7% ) were gram‐negative bacteria . The top bacterial species were Pseudomonasaeruginosa,Klebsiellapneumoniae,Acinetobacterbaumannii,and Enterobacterspp.Gram‐negativebacteria were highly resistant to most of the antimicrobial agents . About 31 .8% of the Acinetobacter strains were resistant to imipenem .A total of 139 (20 .3% ) gram‐positive strains were isolated . Staphylococcus aureus was the most frequently isolated gram‐positive pathogen (51 .8% ) , of which 63 .9% were resistant to methicillin (MRSA) .Most gram‐positive bacteria were sensitive to vancomycin , teicoplanin and linezolid . Multivariate Logistic regression suggested that age ( OR = 5 .632 ) , NIH stroke scale (NIHSS) score (OR= 4 .126) ,dysphagia (OR= 3 .481) , totally bedridden (OR=3 .431) ,mechanical ventilation (OR=4 .214) ,hyperglycemia (OR=2 .076) ,hypoalbuminemia (OR=2 .008) ,and high serum cortisol (OR=1 .825) were the major risk factors for SAP in senile patients .Conclusions Multiple antibiotic‐resistant pathogens are usually identified in the senile SAP patients .Early intervention to control the risk factors of SAP is important for prevention of SAP in senile patients .
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BACKGROUND:With the extensive application of anterior titanium plate, postoperative complications such as dysphagia, titanium loose, screw exit and disc degeneration of neighboring segments induced more and more attention of researchers. However, the application of anterior cervical cage is expected to avoid these complications. ＜br> OBJECTIVE:To observe primary curative effect of anterior cervical cage ROI-C in anterior cervical spine surgery. ＜br> METHODS:A total of 32 patients with cervical spondylosis were treated with anterior cervical cage ROI-C in the Wuxi Ninth Hospital Affiliated to Soochow University from April to December 2013. The cage was implanted to promote interbody fusion. Of 32 cases, 23 cases affected cervical spondylotic myelopathy, 2 cases affected nerve root type cervical spondylosis, 3 cases affected cervical hyperextension injury, 1 case affected cervical disc herniation, 2 cases affected cervical instability and 1 case affected segmental cervical ossification of the posterior longitudinal ligament. Japanese Orthopaedic Association and NDI scores were determined to assess neurological symptoms and functional improvement before internal fixation and during final fol ow-up. Simultaneously, adverse reactions were recorded. ＜br> RESULTS AND CONCLUSION:A total of 32 patients finished the regular fol ow-up for 4 to 8 months. Clinical symptoms and spinal cord function of al patients were obviously improved. No ROI-C loosing or displacement or secondary surgery was found. The average fusion time was 4.2 months (3 to 5 months). Mean score of Japanese Orthopaedic Association was increased from 9.2 points pre-surgery to 13.8 points post-surgery. Japanese Orthopaedic Association and NDI scores were higher during final fol ow-up than before fixation (P＜0.05). These data indicated that ROI-C effectively restored intervertebral height in anterior cervical spine surgery, stably reconstructed cervical vertebra, obtained interbody fusion, effectively avoided related surgical complications induced by plate implantation, improved neurological symptoms and function, and showed good short-term effects.
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Objective To investigate the incidence of Mycobacterium tuberculosis (TB) infection among human immunodeficiency virus (HIV)-infected individuals in Shanghai and Yunnan Province and to analyze the risk factors of TB infection.Methods Seventy HIV-infected individuals from Yunnan Province and 67 from Shanghai were enrolled.T-SPOT.TB was employed to detect TB-specific T cells in the peripheral blood mononuclear cells (PBMC).CD4+ and CD8+ T cells in PBMC from the enrolled subjects were detected by flow cytometry.Data were analyzed using Mann-Whitney test,Fisher's exact test and Logistic regression.Results The incidence of latent tuberculosis (LTB) infection among HIV-infected individuals in Yunnan Province was 64.3 ％ (45/70),which was much higher than Shanghai (20.8％ [14/ 67]).The median CD4+ T cell count of HIV-infected individuals with LTB infection in Yunnan Province was 509/μL,while that in Shanghai was 324/μL,which was significant different (U=148,P=0.003).The median CD4+ T cell count in HIV single infected individuals from Yunnan Province was 418/μL,which was not significantly different from that of H IV + LTB individuals from that area (U =378,P =0.120).Moreover,the median CD8+ T cell counts of HIV-infected individuals with latent tuberculosis infection in Yunnan Province and Shanghai were 409/μL and 781/μL,respectively (U=109,P＜0.01).Conclusions The incidence of LTB infection among HIV-infected individuals in Yunnan Province is significantly higher than Shanghai.CD4+ and CD8+ T cell counts are correlated with TB infection among HIV-infected individuals.
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Objectives: To compare the efficacy of patient-controlled epidural analgesia and patient-controlled intravenous analgesia in postoperative analgesia after spinal fusion. Methods: The CNKI, Wanfang, CBM, Pubmed, Embase, Ovid, Cochrane library databases were searched by computer. The randomized controlled trails with patient-controlled epidural analgesia or patient-controlled intravenous analgesia after spinal fusion published from May 1985 to July 2013 were selected. All of them were assessed by the standard of Cochrane systematic review. Data of postoperative VAS and the rate of side effects after using the analgesic drugs were extracted into an electrical sheet, which was synthesized by a Meta-analysis with RevMan 5.2 software. Re-sult: Eight randomized controlled trails involving 482 patients met the inclusion criteria. And the quality grade of 3 literatures was A, 5 literatures was B. The result of meta-analysis showed that: ①Visual analogue score(VAS). The postoperative first day′s VAS[WMD=-0.47, 95%CI(-0.74, -0.20)], second day′s VAS[WMD=-0.66, 95%CI(-1.14, -0.19)] showed that the patient-controlled epidural analgesia had a good analgesic effect compared with the patient-controlled intravenous analgesia, and both had statistic differences(P0.05); ②The side effects. The patient-controlled epidural analgesia had a higher incidence of skin itch[RR=1.53, 95%CI(1.08, 2.16)], paresthesia[RR=3.34, 95%CI(1.12, 9.98)] after surgery than the patient-controlled intravenous analgesia, and both had statistic differences(P0.05). Conclusions: The patient-controlled epidural analgesia has better analgesic effects on the postoperative first and second day after spinal fusion, but obviously has a high-er incidence of skin itch and paresthesia than the patient-controlled intravenous analgesia.
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Objective To ascertain the utility and difference of sonography with echo-tracking (ET) technique and pulse-Doppler to assess vascular stiffness in rats with hypercholesterolemia and atherosclerosis.Methods Sonography associated with ET technique and pulse-Doppler were used to measure stiffness parameter (β),arterial compliance (AC),distensibility coefficient (DC),one-point pulse wave velocity (PWVβ),resistence index(RI),peak systolic velocity(PSV),end-diastolic velocity(EDV) and EDV/PSV of the aorta in cholesterol-fed SD rats (group T1,n =10,for 4 weeks;group T2,n =10,for 12 weeks) and normal control rats(group C1,n =10;group C2,n =10).All parameters and blood biochemical markers[total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-CH) and highdensity lipoprotein cholesterol (HDL-CH)] among groups were analyzed with ANOVE factor analysis.Correlation was analyzed with Pearson analysis.Light microscopic evaluation were used to demonstrate atherosclerotic changes in the aorta.Results The PWVβ value and PSV of the aorta between group T1 and T2 were significantly different (P =0.001,P ＜0.05).The β,PWVβ values of the aorta in group T1 and T2 were significantly higher than those of group C1 and C2 (P ＜0.05).AC and DC values of the aorta in group T1 and T2 were significantly lower than those of group C1 and C2 (P ＜0.05).Correlation analysis showsed that RI was positively correlated with systolic pressure(P ＜0.05).All parameters had correlated with each other among β,PWVβ,AC,DC,TG,TC,systolic pressure and diastolic pressure.DC and AC were negatively correlated with β and PWVβ,also DC was negatively correlated with TG.Light microscopy confirmed morphologic typical changes of aortic atherosclerosis in group T1 and T2.Conclusions Sonography with the ET method compared with pulse-Doppler is much more sensitive and it can be used to evaluate tissue elastic changes in arterial walls associated with atherosclerosis and hypercholesterolemia.PSV can reflect atherosclerosis of rat's abdominal aorta well,but pulse-Doppler is limited in the diagnosis of earlier atherosclerosis period.
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Objective To evaluate the relationship between CD4+ T lymphocyte count and results of enzyme-linked immunospot (ELISPOT) assay in human immunodeficiency virus (HIV)-Mycobacterium tuberculosis (M.tb) coinfected patients.Methods A total of 193 HIV-infected individuals in Yunnan Province and Shanghai were enrolled.T-SPOT.TB assay was employed to detect M.tb specific T lymphocyte in the peripheral blood mononuclear cells (PBMC).CD4+ T lymphocyte in PBMC from the enrolled subjects was detected by flow cytometry.Data were analyzed using t test.ResultsThe incidence of latent tuberculosis in HIV-infected individuals was 30.6％.The CD4+ T lymphocyte counts in HIV-infected individuals with active tuberculosis were 190×106/L,which were significantly lower than those in HIV-infected individuals with latent tuberculosis (484×106/L; t=6.665,P＜0.01).The HIV-infected individuals were stratified according to CD4+ T lymphocyte counts of ＞500×106/L,200×106-500×106/L,and ＜200×106/L and the constituent ratios of active tuberculosis/latent tuberculosis were 1∶16.2,1∶1.3 and 5.6∶1,respectively.Among 79 subjects with positive T-SPOT.TB results,20 were coinfected with active tuberculosis,in which 14 had CD4+ T lymphocyte counts of ＜200 ×106/L,5 had 200×105-500×106/L and 1 had ＞500×106/L.Fifty-two in 59 HIV/latent tuberculosis patients individuals had CD4+ T lymphocyte counts of ＞200×106/L.ConclusionsThe prevalence of latent tuberculosis in HIV-infected individuals is high in China.Cellular immunity in HIV-infected individuals with active tuberculosis is severely impaired.With the decrease of CD4 ′ T lymphocyte counts,patients with latent tuberculosis are prone to develop active tuberculosis in HIV-infected individuals.The negative predictive value of T-SPOT.TB is significantly diminished in patient with low CD4+ T lymphocyte counts,especially less than 200×106/L.
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Objective To investigate the clinical features, diagnosis, treatment and prognosis of muhisystemic invasive fungal diseases. Methods Twenty-one patients with multisystemic invasive fungal diseases who were hospitalized in department of infectious diseases from January 2001 to June 2008 were retrospectively reviewed. The pathogenic bacteria, involved organs, underlying diseases, clinical manifestations, treatments and prognoses of muhisystemic invasive fungal diseases were analyzed. Results Among 21 recruited cases, 17 had underlying diseases and 11 were treated with long-term immunosuppressive agents. The main pathogenic bacteria were Cryptococcus neoformans, Aspergillus and Candida parapsilosis. Lung and brain were involved in 16 cases (skin involve in 2 cases and lymph node involved in 1 case simultaneously), lung and lumbar involved in 2 cases, heart valves involved in 2 cases, and liver, spleen and bone marrow involved in 1 case. Eight cases were cured, 6 were improved and 7 died. Conclusions In this study, most of the 21 cases with multisystemic invasive fungal diseases are immunocompromised. The main pathogenic bacterium is Cryptococcus neoformans. The lung and brain are common organs involved. Prognosis is associated with early diagnosis and active anti-fungal treatment.
