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Objective:To investigate the association of serum uric acid (SUA) with the outcome in patients with acute ischemic stroke (AIS) at one year after onset.Methods:Patients with AIS admitted to the Department of Neurology, Dagang Hospital, Tianjin Binhai New Area were included retrospectively. According to the modified Rankin Scale (mRS) score at 1 year after onset, patients were divided into a good outcome group (0-2) and a poor outcome group (>2). They were also divided into a survival group and a death group based on their survival status at 1 year after onset. The clinical baseline data and laboratory tests were compared. Multivariate logistic regression analysis was used to determine the associations of SUA with poor outcome and death in patients with AIS. Results:A total of 651 patients were enrolled, including 430 males (66.1%) aged 67.5±11.7 years. Four hundred and fourteen patients (63.6%) were in the good outcome group, and 237 (36.4%) were in the poor outcome group. There were 568 patients (87.3%) in the survival group and 43 (16.7%) in the death group. Univariate analysis showed that there were differences in age, atrial fibrillation, history of stroke or transient ischemic attack, baseline National Institutes of Health Stroke Scale (NIHSS) score, and pre-admission mRS score between the poor outcome group and the good outcome group. The homocysteine, SUA, white blood cell count, and creatinine in the poor outcome group were higher than those in the good outcome group, while the red blood cell count and hemoglobin were lower than those in the good outcome group (all P<0.05). There were differences in age, history of ischemic heart disease, atrial fibrillation, history of stroke or transient ischemic attack, baseline NIHSS score, pre-admission mRS score, and stroke etiology classification between the survival group and the death group. Hemoglobin and triglycerides in the survival group were higher than those in the death group, while the white blood cell count and creatinine were lower than those in the death group (all P<0.05). Multivariate logistic regression analysis showed that SUA was an independent risk factor for poor outcome in patients with AIS (odds ratio 1.004, 95% confidence interval 1.001-1.006; P<0.01), but there was no independent correlation with death. Conclusion:Higher SUA is an independent risk factor for poor outcome at one year after onset in patients with AIS.
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Objective:To explore the efficacy of stage I modified posterior vertebral column resection (mPVCR) in the treatment of postoperative infection after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF).Methods:A retrospective case series study was conducted to analyze the clinical data of 11 OVCF patients with post-PVP infection who were admitted to Zhengzhou Orthopedics Hospital from January 2016 to June 2022, including 4 males and 7 females, aged 61-81 years [(70.2±6.4)years]. Injured segments included T 9 in 1 patient, T 11 in 2, T 12 in 3, L 1 in 1, L 2 in 2, T 11-T 12 in 1, and T 12-L 1 in 1. American Spinal Injury Association (ASIA) grading was grade D in 5 patients and grade E in 6. All the patients were treated with stage I mPVCR. The operation time and intraoperative bleeding volume were recorded. The values of Visual Analogue Scale (VAS), Oswestry Dysfunction Index (ODI), and Cobb angle of the lesion segments before, at 2 weeks, 3 months after surgery, and at the last follow-up were compared. The loss of Cobb angle of the lesion segments at 2 weeks after surgery and at the last follow-up were compared, and the ASIA grading at the last follow-up was recorded. The infection control, bone healing, and the incidence of complications were observed at the last follow-up. Results:All the patients were followed up for 12-44 months [(26.0±9.4)months]. The operation time and intraoperative bleeding volume were 230-330 minutes [(279.2±28.6)minutes] and 500-1 100 ml [(840.9±184.1)ml] respectively. At 2 weeks, 3 months after surgery and at the last follow-up, the VAS scores were (4.0±0.8)points, (2.7±0.9)points, and (2.4±0.7)points respectively, which were all lower than that before surgery [(8.1±1.2)points] ( P<0.01); the ODI was (45.5±5.1)%, (30.0±6.5)%, and (18.5±3.6)% respectively, which were all lower than that before surgery [(78.7±6.2)%] ( P<0.01); the Cobb angle of the lesion segments were (7.9±1.4)°, (8.5±1.4)°, and (9.2±1.5)° respectively, which were lower than that before surgery [(25.5±9.2)°] ( P<0.01). The VAS and ODI were both improved at 3 months after surgery compared with those at 2 weeks after surgery ( P<0.05), while there was no significant difference in Cobb angle of the lesion segments ( P>0.05). The ODI was further improved at the last follow-up compared with that at 3 months after surgery ( P<0.05), while there were no significant differences in VAS or Cobb angle of the lesion segments ( P>0.05). The loss of Cobb angle correction of the lesion segment at the last follow-up was 0.96 (0.69, 1.45)° compared with that at 2 weeks after surgery and the rate of loss of Cobb angle correction of the lesion segment was 4.4(2.2, 7.4)%. At the last follow-up, the ASIA grading was grade E for all the patients, who were able to walk normally independently. The infection was all cured and good bony fusion was observed in the operated area at the last follow-up. Two patients had pleural effusion and pulmonary atelectasis, 1 incision fat liquefaction, and 1 pneumonia after the surgery. None of the patients had internal fixation failure and serious complications such as worsening neurological symptoms or death. Conclusion:Stage I mPVCR for the treatment of post-PVP infection in patients with OVCF is proved to attain significant pain relief and functional improvement, good correction results, effective reconstruction of spinal stability, complete removal of infected lesions, and few serious complications.
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Objective:To investigate the efficacy of one-stage posterior-anterior combined operation for the treatment of abnormal fusion after facet joint dislocation in the subaxial cervical spine.Methods:A retrospective study of case series was conducted to analyze the clinical data of 10 patients with abnormal fusion after facet joint dislocation in the subaxial cervical spine who had been admitted to Department of Spine Surgery, Zhengzhou Orthopedic Hospital from January 2015 to May 2023. There were 7 males and 3 females with an age of (41.2±3.1) years. Preoperative American Spinal Injury Association (ASIA) grading: 5 cases of grade A, 4 cases of grade B, and 1 cases of grade C. All the patients were treated with one-stage posterior-anterior combined operation. The surgical time and intraoperative bleeding volume were recorded. The ASIA grading was used to evaluate the improvements in nerve function of the spinal cord 3 months after surgery. The VAS scores, cervical intervertebral heights, and Cobb angles were compared between pre-surgery, 3 months after surgery, and the last follow-up. The fusion of intervertebral bone graft was evaluated 3 months after surgery using the Bridgell intervertebral fusion criteria. Complications were observed.Results:All patients were followed up for 15.5 (13.8, 20.5) months. The surgical time was (119.5±3.6) minutes, and the intraoperative bleeding volume (141.6±25.6) mL. Significant improvements in VAS score, cervical intervertebral height, and Cobb angle were observed at 3 months after surgery and the last follow-up compared with the pre-surgery values ( P<0.05), but there was no statistically significant difference between 3 months after surgery and the last follow-up ( P>0.05). ASIA grading 3 months after surgery: 4 cases of grade A, 4 cases of grade B, and 2 cases of grade C. By the Bridgell intervertebral fusion criteria at 3 months after surgery: 9 cases of grade Ⅰ and 1 cases of grade Ⅱ, showing good intervertebral fusion. Surgery went on well for all patients, showing no postoperative complications such as aggravation of nerve lesion or vascular injury. Conclusion:In the treatment of abnormal fusion after facet joint dislocation in the subaxial cervical spine, the efficacy of one-stage posterior-anterior combined operation is definite because it can effectively reduce pain, restore the height and physiological curvature of the cervical intervertebral space, and achieve good intervertebral fusion.
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Objective:To investigate the efficacy of the classified reduction based on CT two-dimensional images for the surgical treatment of single segment facet joint dislocation in subaxial cervical spine.Methods:A retrospective case series study was made on 105 patients with single segment facet joint dislocation in subaxial cervical spine admitted to Zhengzhou Orthopedic Hospital from January 2015 to October 2022. There were 63 males and 42 females, with the age range of 22-78 years [(47.5±3.6)years]. Preoperative American Spinal Cord Injury Association (ASIA) classification was grade A in 23 patients, grade B in 45, grade C in 22, grade D in 15 and grade E in 0. The classification of surgical approach was based on the presence or not of continuity between anterior and posterior subaxial cervical structures and the movability of the posterior cervical facet joint on CT two-dimensional images, including anterior cervical surgery if both were presented and posterior facet joint resection plus anterior cervical surgery if there was discontinuity between anterior and posterior subaxial cervical structures or posterior facet joint fusion. Reduction procedures were applied in accordance with the type of facet joint dislocation classified based on the position of the lower upper corner of facet joint, including skull traction or manipulative reduction for the dislocation locating at the dorsal side (type A), intraoperative skull traction and leverage technique for the dislocation locating at the top (type B) and intraoperative skull traction and leverage technique with boosting for the dislocation locating at the ventral side (type C). If the dislocation of two facet joints in the same patient was different, the priority of management followed the order of type C, type B and type A. The reduction success rate, operation time and intraoperative blood loss were recorded. The cervical physiological curvature was evaluated by comparing the intervertebral space height and Cobb angle before operation, at 3 months after operation and at the last follow-up. The fusion rate of intervertebral bone grafting was evaluated by Lenke grading at 3 months after operation. The spinal cord nerve injury was assessed with ASIA classification before operation and at 3 months after operation. Japanese Orthopedic Association (JOA) score was applied to measure the degree of cervical spinal cord dysfunction before operation and at 3 months after operation, and the final follow-up score was used to calculate the rate of spinal cord functional recovery. The occurrence of complications was observed.Results:All patients were followed up for 3-9 months [(6.0±2.5)months]. The reduction success rate was 100%. The operation time was 40-95 minutes [(58.6±9.3)minutes]. The intraoperative blood loss was 40 to 120 ml [(55.7±6.8)ml]. The intervertebral space height was (4.7±0.3)mm and (4.7±0.2)mm at 3 months after operation and at the last follow-up, significantly decreased from preoperative (3.1±0.5)mm (all P<0.01), but there was no significant difference in intervertebral space height at 3 months after operation and at the last follow-up ( P>0.05). The Cobb angle was (6.5±1.3)° and (6.3±1.2)° at 3 months after operation and at the last follow-up, significantly increased from preoperative (-5.4±2.2)° (all P<0.01), but there was no significant difference in Cobb angle at 3 months after operation and at the last follow-up ( P>0.05). The fusion rate of intervertebral bone grafting evaluated by Lenke grading was 100% at 3 months after operation. The ASIA grading was grade A in 15 patients, grade B in 42, grade C in 29, grade D in 12 and grade E in 7 at 3 months after operation. The patients showed varying degrees of improvement in postoperative ASIA grade except that 15 patients with preoperative ASIA grade A had partial recovery of limb sensation but no improvement in ASIA grade. The JOA score was (13.3±0.6)points and (13.1±0.6)points at 3 months after operation and at the last follow-up, significantly improved from preoperative (6.8±1.4)points (all P<0.01), but there was no significant difference in JOA score at 3 months after operation and at the last follow-up ( P>0.05). The rate of spinal cord functional recovery was (66.3±2.5)% at the last follow-up. All patients had no complications such as increased nerve damage or vascular damage. Conclusion:The classified reduction based on CT two-dimensional images for the surgical treatment of single segment facet joint dislocation in subaxial cervical spine has advantages of reduced facet joint dislocation, recovered intervertebral space height and physiological curvature, good intervertebral fusion and improved spinal cord function.
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Objective:To compare the clinical efficacies of precision targeted and traditional percutaneous vertebroplasty (PVP) in the treatment of refracture of injured vertebra after operation for Kümmell disease.Methods:A retrospective cohort study was conducted to analyze the clinical data of 23 Kümmell disease patients suffering from refracture of injured vertebra after PVP in Zhengzhou Orthopedic Hospital from October 2014 to October 2018. The patients included 7 males and 16 females, aged 53-89 years [(69.3±3.5)years]. There were 11 patients of stage I Kümmell disease and 12 patients of stage II Kümmell disease. The vertebral distribution of fracture was T 11 (3 patients), T 12 (9 patients), L 1 (8 patients) and L 2 (3 patients). Eleven patients received traditional PVP treatment (traditional PVP group) and 12 patients received precision targeted PVP treatment (targeted PVP group). The operation time, amount of bone cement injection and filling of bone cement in the fracture space were compared between the two groups. The visual analogue score (VAS) and Oswestry disability index (ODI) were also compared before operation, at 2 days, 1 month, 3 months, 6 months after operation, and at the last follow-up. The rates of bone cement leakage and re-collapse of injured vertebra were observed in the two groups. Results:The patients were followed up for 12-36 months [(24.2±2.6)months]. There were no significant differences in the operation time or amount of bone cement injection between the two groups (all P>0.05). All the fracture spaces in the targeted PVP group were fully filled with bone cement, while 4 patients in the traditional PVP group showed inadequate filling of the fracture area ( P<0.05). The VAS values in the targeted PVP group were (8.9±0.5)points, (1.6±0.2)points, (1.7±0.1)points, (1.8±0.1)points, (1.9±0.3)points, and (1.8±0.4)points before operation, at 2 days, 1 month, 3 months, 6 months after operation and at the last follow-up; and those in the traditional PVP group were (9.1±0.9)points, (1.8±0.4)points, (1.8±0.2)points, (2.0±0.4)points, (2.1±0.2)points, and (2.4±0.3)points, respectively. The VAS values of both groups were significantly decreased at 2 days, 1 month, 3 months, 6 months after operation, and at the last follow-up compared with those before operation (all P<0.05), but there was no significant difference between different time points after operation (all P>0.05). No significant differences were found in the VAS values between the two groups before operation and at 2 days, 1 month, 3 months and 6 months after operation (all P>0.05). However, the VAS value in the targeted PVP group was significantly lower than that in the traditional PVP group at the last follow-up ( P<0.05). The ODI values in the targeted PVP group were 38.5±4.3, 7.2±2.3, 7.3±2.0, 7.2±1.8, 7.3±2.4, and 7.4±2.5 before operation and at 2 days, 1 month, 3 months, 6 months after operation, and at last follow-up; and those in the traditional PVP group were 37.8±4.1, 7.5±2.5, 7.7±1.9, 7.9±2.4, 8.1±2.6, and 9.6±2.4, respectively. The ODI values of both groups were significantly decreased at 2 days, 1 month, 3 months, 6 months after operation and at the last follow-up compared with those before operation (all P<0.05), but there were no significant differences between different time points after operation (all P>0.05). The ODI values were not significantly different between the two groups before operation and at 2 days, 1 month, 3 months, 6 months after operation (all P>0.05), but the ODI value in the targeted PVP group was significantly lower than that in the traditional PVP group at the last follow-up ( P<0.05). There were no significant differences in the rates of bone cement leakage or re-collapse of injured vertebra between the two groups (all P>0.05). Conclusion:Compared with traditional PVP treatment for refracture of injured vertebra after operation for Kümmell disease, targeted PVP can make bone cement injection fully dispersed, greatly reduce pain and promote functional recovery.
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Objective:To compare the efficacies of posterior long segment instrumentation combined with transpedicular impaction bone grafting or with bone cement augmentation in treating stage III Kümmell disease.Methods:A retrospective cohort study was conducted to analyze the clinical data of 38 patients with stage III Kümmell disease who were admitted to Zhengzhou Orthopedic Hospital between January 2016 and December 2020. The study included 8 male and 30 female patients, with ages ranging from 59 to 81 years [(68.9±4.9)years]. The vertebral fractures occurred at T 8 in 1 patient, T 11 in 9 patients, T 12 in 10 patients, and L 2 in 10 patients. Seventeen patients underwent posterior long segment instrumentation combined with transpedicular impaction bone grafting (impaction bone grafting group), and 21 patients underwent posterior long segment instrumentation combined with bone cement augmentation (bone cement group). The surgical duration, intraoperative blood loss, and incidences of postoperative complications were compared between the two groups. Additionally, the visual analogue score (VAS), Japanese orthopedic association (JOA) score, and Cobb angle were compared before the operation, at 1 week and 3 months post-operation, and at the final follow-up for both groups. The study also compared bone healing at the last follow-up and postoperative complication rates between the two groups. Results:All the patients were followed up for 24-35 months [(28.7±2.9)months]. The impaction bone grafting group had a surgical duration of (150.7±25.4)minutes and intraoperative blood loss of (285.3±48.6)ml, significantly different from those in the bone cement group [(132.0±21.1)minutes, (251.4±44.8)ml] (all P<0.05). Before the operation, there were no significant differences in the VAS, JOA score, or Cobb angle between the two groups (all P>0.05).The VAS was (3.2±0.8)points, (2.7±0.5)points and (2.2±0.7)points in the impaction bone grafting group and was (2.7±0.6)points, (2.6±0.7)points and (2.4±0.8)points in the bone cement group at 1 week and 3 months post-operation and at the final follow-up, respectively. The VAS in the impaction bone grafting group was significantly higher than that in the bone cement group at 1 week post-operation ( P<0.05); however, no significant differences were found at 3 months post-operation or at the last follow-up (all P>0.05). There was no significant difference in the JOA score between the two groups at 1 week or 3 months post-operation, or at the final follow-up (all P>0.05). The Cobb angle in the impaction bone grafting group was (5.1±1.3)°, (5.9±1.8)° and (6.5±2.5)° at 1 week and 3 months post-operation, and at the final follow-up, significantly lower than that in the bone cement group [(8.4±1.6)°, (12.6±2.1)°, and (14.5±3.3)°] (all P<0.01). All the patients in the impaction bone grafting group achieved bone healing at the last follow-up. One patient in the impaction bone grafting group experienced delayed incision healing, whereas two patients in the bone cement group had poor bone healing. The complication rate was 5.9% (1/17) in the impaction bone grafting group and 9.5% (2/21) in the bone cement group ( P>0.05). Conclusions:Posterior long segment instrumentation combined with transpedicular impaction bone grafting or with bone cement augmentation are both effective in alleviating pain and improving the spinal function for stage III Kümmell disease. The former procedure is associated with longer surgical duration and increased intraoperative blood loss, but it can provide superior correction and maintenance of kyphosis deformity, promoting the healing of the injured vertebrae.
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Objective:To investigate the advantage of three dimensional(3D)-printed tissue compensators in radiotherapy for superficial tumors at irregular sites.Methods:A subcutaneous xenograft model of prostate cancer in nude mice was established. Mice were randomly divided into no tissue compensator group( n=6), common tissue compensator group( n=6), and 3D-printed tissue compensator group( n=6). Computed tomography (CT) images of nude mice in the 3D-printed tissue compensator group were acquired. Compensator models were made using polylactic acid, and material properties were evaluated by measuring electron density. CT positioning images of the three groups after covering the corresponding tissue compensators were acquired to delineate the gross tumor volume (GTV). Nude mice in the three groups were irradiated with 6 MV X-rays at the prescribed dose. The prescribed dose for the three groups was 1 500 cGy. The dose distribution in the GTV of the three groups was calculated and compared using the analytical anisotropic algorithm in the Eclipse 13.5 treatment planning system. The metal-oxide-semiconductor field-effect transistor was used to verify the actual dose received on the skin surface of nude mice. Results:The air gap in the 3D-printed tissue compensator group and the common tissue compensator group was 0.20±0.07 and 0.37±0.07 cm 3, respectively ( t=4.02, P<0.01). For the no tissue compensator group, common tissue compensator group, and 3D-printed tissue compensator group, the D95% in the target volume was (1 188.58±92.21), (1 369.90±146.23), and (1 440.29±45.78) cGy, respectively ( F=9.49, P<0.01). D98% was (1 080.13±88.30), (1 302.76±158.43), and (1 360.23±48.71) cGy, respectively ( F=11.17, P<0.01). Dmean was (1 549.08±44.22), (1 593.05±65.40), and (1 638.87±40.83) cGy, respectively ( F=4.59, P<0.05). The measured superficial dose was (626.03±26.75), (1 259.83±71.94), and (1 435.30±67.22) cGy, respectively ( F=263.20, P<0.001). The percentage variation in tumor volume growth after radiation was not significantly different between the common tissue compensator group and the 3D-printed tissue compensator group ( P>0.05). Conclusions:3D-printed tissue compensators fit well to the body surface, which reduces air gaps, effectively increases the dose on the body surface near the target volume, and provides ideas for radiotherapy for superficial tumors at some irregular sites.
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@#Objective To explore the high-sensitive solar terms and dominant meteorological factors in the onset of cerebral infarction,and to analyze the influence of daily temperature range and 24-hour temperature change on hospital admissions for cerebral infarction.Methods Patients with cerebral infarction who were hospitalized in the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine and the Second Hospital of Tianjin Medical University from January 2019 to December 2020 were retrospectively collected.The patients were grouped according to the twenty-four solar terms to explore the high-sensitive solar terms for the admission of cerebral infarction.A generalized linear Poisson regression model was established to explore the relationship between temperature changes and cerebral infarction admissions.Results This study finally included 17 518 patients with cerebral infarction.There were statistically significant differences in the daily temperature range among different solar terms (P<0.001).The larger stages of the daily temperature range were from “Awakening of Insects” to “Grain in Ear”,and from “Autumn Equinox” to “Beginning of Winter”.The high-sensitive solar term of cerebral infarction admission was“Cold Dew”,which was located in the period of large daily temperature range.Daily temperature range was associated with cerebral infarction admission after multivariate adjustment (RR=1.01,95%CI 1.00~1.02,P=0.017),and had a hysteresis effect.With the increase of daily temperature range,the risk of cerebral infarction admissions increased,especially in males.Conclusion “Cold Dew” is the high-sensitive solar term for cerebral infarction admission,and daily temperature range may be the dominant meteorological factor.The admission of cerebral infarction is related to the daily temperature range.
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Objective:Partial stereotactic ablative boost radiotherapy(P-SABR)is a method to deliver SABR boost to the gross tumor boost volume(GTVb), followed by conventionally fractionated radiotherapy to the whole tumor area(GTV). GTVb is the max volume receiving SABR while ensuring the critical organ-at-risk(OAR)falloff to 3 GyE/f. We investigated the potential advantage of proton therapy in treating bulky non-small cell lung cancer(the tumor length greater than 8 cm).Methods:Nine patients with bulky NSCLC treated with photon P-SABR in our institute were selected. For the treatment planning of proton therapy, the GTVb target area was gradually outwardly expanded based on the photon GTVb target area until the dose to critical OARs reached 3 GyE/f. The GTV and CTV areas remained the same as photon plan. A proton intensity-modulated radiation treatment plan(proton-IMPT), a photon intensity-modulated radiation treatment plan(photon-IMRT)and a photon volumetric modulated arc therapy(photon-VMAT)were created for each patient, respectively. The dosimetric parameters of different treatment plans were compared.Results:The volume ratio of GTVb-photon and GTVb-proton to GTV was(25.4±13.4)% and(69.7±30.0)%,respectively( P<0.001). In photon-IMRT, photon-VMAT, and proton-IMPT plan groups, the mean dose of CTV was(76.1±4.9)Gy, (78.2±3.6)Gy, and(84.7±4.9)Gy, respectively; the ratio of tumor volume with Biologic Effective Dose(BED)≥ 90 Gy to GTV volume was(70.7±21.7)%, (76.8±22.1)%,and(97.9±4.0)%,respectively. The actual dose and BED to the tumor area of the proton-IMPT plan group were significantly higher than those of the photon plan group(both P<0.05). Besides, the OARs dose was significantly decreased in the proton-IMPT group, with(49.2±22.0)%, (56.8±19.0)% and(16.1±6.3)% of the whole lung V5 for photon-IMRT, photon-VMAT and proton-IMPT, respectively(all P<0.001). Conclusions:Larger GTV boost target volume, higher BED and reduced OARs dose can be achieved in proton plans compared with photon plans. Proton P-SABR is expected to further improve the local control rate of bulky NSCLC with fewer adverse effects.
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Objective:To compare the clinical efficacy of long/short segment posterior instrumentation combined with transpedicular impaction bone grafting for stage III Kümmell's disease.Methods:A retrospective case control study was conducted to analyze the clinical data of 45 patients with stage III Kümmell's disease admitted to Zhengzhou Orthopaedics Hospital from June 2012 to June 2019, There were 8 males and 37 females, aged 58-84 years [(68.8±3.5)years]. Segment of injury was T 11 in 5 patients, T 12 in 18, L 1 in 15, and L 2 in 7. A total of 24 patients were treated with posterior long segment pedicle screw fixation combined with pedicle screw compression and bone grafting (long segment group), and 21 patients were treated with posterior short segment pedicle screw fixation combined with pedicle screw compression and bone grafting (short segment group). For patients with severe osteoporosis, pedicle screws were augmented with bone cement. The operation time and blood loss were compared between the two groups. The visual analogue scale (VAS) was used to evaluate the degree of low back pain, and the Japanese Orthopaedic Association (JOA) score was used to evaluate the lumbar function at postoperative 2 weeks and 1 year. According to X-ray film and CT examination, the bone healing of the grafted vertebral body and the changes of Cobb angle of injured vertebrae were further evaluated. The complications were observed. Results:All patients were followed up for 15-48 months[(31.2±2.3)months]. There were no significant differences between the two groups in operation time and intraoperative blood loss ( P>0.05). The bone grafts in the vertebrae healed well in both groups at 1 year after operation. The Cobb angle, VAS and JOA score in both groups improved at 2 weeks and 1 year after operation ( P<0.01). There was no significant difference in Cobb angle, VAS and JOA score between the two groups at 2 weeks after operation ( P>0.05). The Cobb angle in short segment group [(14.8±6.3)°] was significantly higher than that in long segment group [(8.5±3.3)°] at 1 year after operation ( P<0.01), but there was no significant difference in VAS and JOA scores between the two groups ( P>0.05). There was no loosening or breakage of internal fixation in both groups. Conclusions:For stage III Kümmell's disease, both long and short segment posterior instrumentation combined with transpedicular impaction bone grafting can effectively restore the vertebral height, improve kyphosis and reduce dysfunction. However, long segment can better maintain spine stability, prevent vertebral collapse and progression of local kyphosis Cobb angle when compared with short segment fixation.
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Objective:To investigate the efficacy of stage I anterior cervical reduction, decompression, interbody fusion and internal fixation of single-segment lower cervical injury of AO type C subtype F4.Methods:A retrospective case series study was made on 45 patients with single-segment lower cervical injury of AO C type F4 subtype admitted to Zhengzhou Orthopedic Hospital from January 2012 to December 2019. The study included 31 males and 14 females with the age of (48.5±3.7)years (range, 23-78 years). Segment of injury was located at C 4/5 in 11 patients, at C 5/6 in 19, and at C 6/7 in 15. Under general anesthesia, all patients (16 unilateral injury and 29 bilateral injury) underwent stage I anterior cervical reduction, decompression, interbody fusion and internal fixation within 24 hours after injury. The interbody fusion methods included autogenous iliac bone in 28 patients and cervical fusion cage in 17. The operation time, blood loss, reduction time and correction rate of zygapophysial joints, postoperative complications and incision healing were analyzed. The height of cervical intervertebral space and Cobb angle were measured through X-ray of lateral cervical vertebrae before operation and3 months after operation to assess the cervical physiological curvature. The type of injury was clarified according to Lenke classification through coronal and sagittal CT scanning to determine the intervertebral bone graft fusion rate. The intraspinal spinal cord decompression was observed through MRI. The nerve function was assessed before operation and 3 months after operation using American Spinal Injury Association (ASIA) scale and Japanese Orthopedic Association (JOA) score, and the improvement rate was measured. Results:All the patients were followed up for (6.1±3.6)months (range, 3-9 months). The operation time was (55.1±8.2)minutes (range, 40-75 minutes), and intraoperative blood loss was (45.2±5.3)ml (range, 40-80 ml). The Zygapophysial joint reduction took (2.1±0.5)minutes (range, 1.5-3.0 minutes), with a success rate of 100%. Surgical procedures were performed with no postoperative complications such as aggravated spinal cord injury, large vascular injury or esophageal lesion. All the patients obtained Class I incision healing at first stage. The height of cervical intervertebral space was improved from preoperative (3.3±0.6)mm to (4.9±0.8)mm at postoperative 3 months ( P<0.05). The Cobb angle was increased from preoperative (-4.6±3.6)° to (6.5±2.1)° at postoperative 3 months ( P<0.01). According to Lenke classification, the intervertebral body fusion was good at postoperative 3 months, including Grade A in 41 patients and Grade B in 4. The rest of the patients showed varying degrees of neurological recovery according to ASIA scale, except for 6 patients with ASIA Grade A. The JOA score was improved from preoperative (7.4±2.3)points to (15.0±3.2)points at postoperative 3 months ( P<0.05), with the improvement rate of (73.3±17.6)%. Conclusion:For stage I anterior cervical reduction, decompression, interbody fusion and internal fixation of single-segment lower cervical injury of AO type C subtype F4, early surgical decompression is needed so as to reduce the perched facet or dislocated zygapophyseal joints and effectively improve the cervical spinal cord function.
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Objective:To investigate the efficacy and safety of radiotherapy for all metastases in patients with metachronous oligo-metastatic prostate cancer after radical treatment.Methods:From October 2011 to February 2021, 41 patients with prostate cancer with less than 5 metastases after radical treatment were retrospectively analyzed in a single center. The median age at radiotherapy was 68 (57-81) years. Forty patients (98%) received androgen deprivation therapy (ADT). There were 28 patients in the hormone sensitive (HSPC) group and 13 patients in the hormone resistant (CRPC) group. The median initial PSA was 24.4 (7.4-399.0) ng/ml. Tumor stage: T 2 stage 11 patients, T 3 stage 27 patients, T 4 stage 3 patients.30 patients were in N 0 stage and 11 patients in N 1 stage. Gleason score was 7 in 12 patients, 8 in 9 patients, 9 in 18 patients, and 10 in 2 patients.33 patients were treated with surgery, and 8 patients were treated with radiotherapy. The time span from diagnosis to metastasis was 3.1 (0.2-1.8) years. Conventional imaging examination (CT/ MRI/bone scan) before radiotherapy was used in 7 patients, and PSMA PET/CT examination was used in 34 patients.The median PSA before radiotherapy was 1.3(0.1-33.8) ng/ml. There were 62 metastases in 41 patients, including 1 lesion in 28 patients, 2 lesions in 9 patients, 3 lesions in 2 patients, and 5 lesions in 2 patients. Fifty-four patients had bone metastases and eight had retroperitoneal lymph node metastases. Twenty-two bone metastases were located in the pelvis, 18 in the vertebral body, 12 in the ribs, one in the femur and one in the sternum.The median metastatic volume was 5.8(0.2-81.7) cm 3.Daily image-guided rotational intensity modulated radiotherapy was used to cover all metastases.Dose segmentation modes include 37.5Gy/7.5Gy/5F, 60Gy/3Gy/20F, 65-70Gy/2.6-2.8Gy/25F.The median biological effective dose (BED 3) was 120 (67-147) Gy. The primary endpoint was biochemical progression-free survival (BPFS), the secondary endpoints were acute and late toxic side effects, local relapse-free survival (LPFS), and overall survival (OS). Results:The median follow-up time was 21 months (range 5-72 months). All patients completed radiotherapy, and 16 patients had grade 1 to 2 acute toxicity and side effects, and no grade 3 or above acute and late stage side effects. 1-year LPFS was 97.1%.The 1-year and 2-year BPFS were 77.5% and 59.2%, respectively. The median BPFS time was 29 months (range 13.9-44.2 months). Univariate analysis showed that the HSPC group ( P<0.001) and the group with total metastatic volume ≤ 5.8cm 3 ( P=0.010) had higher BPFS. The median BPFS time was 37 months in the retroperitoneal lymph node metastases subgroup and 17 months in the bone metastases subgroup ( P=0.141). In the HSPC group, the median BPFS was 30(22-38) months. After radiotherapy, PSA decreased in all 28 patients, and increased in 6 patients. The median BPFS was 12(4-18) months. In the CRPC group, the median BPFS was 4(0-8) months. PSA decreased in 10 patients (76.9%) after radiotherapy, and PSA decreased in 6 patients. The median BPFS was 5(3-28) months. Three patients’PSA did not decrease after radiotherapy, and they were treated with new endocrine therapy drugs, chemotherapy, immunotherapy and other systemic therapy. Conclusions:For patients with metachronous metastases after radical treatment, full coverage radiotherapy has good safety and high local control rate. HSPC patients and patients with low tumor load could be recommended to receive radiotherapy for all metastatic lesions preferentially, and patients with only retroperitoneal lymph node metastases may have better prognosis after radiotherapy than patients with bone metastases.
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Objective:To evaluate the effect of setup errors from daily cone-beam computed tomography (CBCT) on the accumulated dose under different image-guidance (IG) strategies, aiming to investigate the appropriate IG strategies during radiotherapy for the spine metastases.Methods:A total of 720 CBCT scans of 36 vertebral lesions were obtained. All 36 lesions were divided into the simultaneous boosting (PTV 40 Gy/20f, GTV 60 Gy/20f, n=20) and conventional radiotherapy groups (PTV 40 Gy/20f, n=16). The actual fractionated plan was recalculated simulatively after transferring the isocenter of the initial plan according to the interfraction setup error. Under no daily image-guidance (no-DIG) strategies including twice imaging guidance weekly (TIG), initial 5 days then weekly imaging guidance (5D+ WIG), WIG and no imaging guidance (NIG), the dose deviation was calculated between the delivered dose accumulated by each actual fractionated plan and the dose distribution under DIG. The tolerance of dose deviation for the target was within ±5% and the D max of the spinal cord was limited below 45 Gy. Results:Under different image-guidance strategies of TIG, 5D+ WIG, WIG and NIG, the median dose deviation was approximately ±1% for the CTV D 95% and D max of spinal cord. However, the median dose deviation was beyond -5% for the PTV D 95% when conventional radiotherapy was given. The median dose deviation was approximately 10% for the D max of spinal cord and the proportion of cases whose maximum irradiated dose of spinal cord was more than 4500 cGy was ≥70%. Also, the median dose deviation was beyond -5% for the GTV D 95% and PTV D 95% when simultaneous boosting was delivered. Conclusions:Because the dose deviation of CTV and spinal cord is within the tolerance limit, the image-guidance strategies could be chosen according to the clinical practice when conventional radiotherapy is delivered. However, the dose deviation of spinal cord, GTV and PTV exceeds the tolerance limit under no-DIG strategies when simultaneous boosting is delivered. Hence, it is necessary to perform daily IGRT for the spine metastases.
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BACKGROUND:The cervical pedicle screws provide ideal three-column stability for cervical vertebra, but there is stil no a standard with the choice of pedicle screw place methods in cervical vertebra. Here, we try to seek a simpler, safer and accurate pedicle screw place method.OBJECTIVE:To evaluate the accuracy and security of transpedicular screw placement assisted by rapid prototyping individual navigation template. METHODS:Eight cadaver cervical specimens (C3-6) were selected to take CT-scan and data were saved in DICOM format. Three-dimensional (3D) software MIMICS was used to establish the C3~6 3D model, and designed the best pedicle screw channel. According to the morphological feature of the posterior cervical spine elements, the reverse template was designed. Then, the best pedicle screw channels were fused into bilateral navigation template. The navigation template was manufactured by rapid prototyping, and saved in STL format. Rapid prototyping technology was used to print out the navigation template. Cervical pedicle screws were inserted with the assistance of navigation templates fitted with the posterior structure of the vertebral body. Postoperative X-ray and CT scan were used to evaluate the accuracy of screw placement. RESULTS AND CONCLUSION:(1) Total y 64 screws were inserted with the assistance of individual navigation templates. Of them, 62 screws were completely in the pedicle;1 screw perforated the medial cortex of pedicle;1 screw perforated the lateral cortex of pedicle. Accuracy of screw placement was 97%. (2) The individual navigation template with a high accuracy rate is a feasible and safe method for cervical pedicle screw placement, which has great prospects for clinical application.
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Objective To investigate the relationship between ischemic time and thrombus types in patients with ST-segment elevation myocardial infarction (STEMI).Methods Eighty-two STEMI patients undergone emergency percutaneous coronary intervention (PCI) and coronary thrombus aspiration (CTA) from Sep.2012 to Apr.2016 were included and divided into 3 groups according to the ischemic time:≤4 hours (n=36),4-7 hours (n=30) and ＞7 hours (n=16).Visible aspirated thrombi were collected and separated into erythrocyte-rich type,platelet/fibrin-rich type and combined type thrombi by HE dying.The percentage difference of the 3 types thrombi was compared among the 3 groups.Results The percentage of platelet/fibrinrich type,erythrocyte-rich type and combined type thrombi in the 3 groups were as follows:in ≤4h group:61.1％(22/36),8.3％(3/36) and 30.6％(11/36),P=0.019;in 4-7h group:23.3％(7/30),10.0％(3/30) and 66.7％(20/30),P=0.012;and in ＞7h group:43.8％(7/16),12.5％(2/16) and 43.8％(7/16),P=0.913.For platelet/fibrin-rich type thrombi,the percentages in 3 periods were 61.1％(22/36),19.4％(7/36) and 19.4％(7/36),P=0.009;For combined type thrombi,the percentages in 3 periods were 28.9％(11/38),52.6％(20/38) and 18.4％(7/38),P=0.013;For erythrocyte-rich type thrombi,the percentages in 3 periods were 37.5％(3/8),37.5％(3/8) and 25.0％(2/8),P=0.895.Conclusions The types of intracoronary aspirated thrombi differ from various periods.Ischemia time may be an important predicted factor.
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Objective@#To investigate the impact of symptom onset to first medical contact (SO-to-FMC)time on the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI).@*Methods@#The clinical data of 341 consecutive STEMI patients, who were hospitalized to our hospital and received primary percutaneous coronary intervention(PCI) from August 2011 to April 2016, were retrospectively analyzed. The patients were divided into ≤90 min group (201 cases) and >90 min group (140 cases) according to the SO-to-FMC time. The treatment time, mortality and incidence of major adverse cardiac and cerebro-vascular events(MACCE) were analyzed. The risk factor of 1-year mortality after PCI and 1-year incidence of MACCE during the post-discharge follow-up period were analyzed by binary logistic regression analysis. The predictor of 4.5-year mortality after PCI was analyzed by multivariate Cox regression analysis. Methods The door to balloon time (104(88, 125) min vs. 111(92, 144)min, P=0.023), first medical contact to balloon time(146(119, 197) min vs. 177(125, 237)min, P=0.005), and symptom onset-to-balloon time(200(170, 257) min vs. 338(270, 474)min, P<0.001)were all significantly shorter in the ≤90 min group than in>90 min group. The 30-day mortality (2.99% (6/201) vs. 7.86%(11/140), P=0.042), 1-year mortality (2.89 (5/173) vs. 9.57(11/115), P=0.015), 1-year incidence of MACCE during the post-discharge follow-up period(1.16%(2/173) vs. 6.96%(8/115), P=0.021), and 4.5-year cumulative mortality(3.00% vs. 11.20%, P=0.007) after PCI were significantly lower in the ≤90 min group than in the >90 min group. Moreover, the 4.5-year incidence with free of MACCE (97.20% vs. 88.80%, P=0.025) during the post-discharge follow-up period was significantly higher in the ≤90 min group than in the >90 min group. In-hospital mortality was similar between the two groups (2.49%(5/201) vs. 6.43%(9/140), P=0.071).@*Results@#The door to balloon time (104(88, 125) min vs. 111(92, 144)min, P=0.023) , first medical contact to balloon time(146(119, 197) min vs. 177(125, 237)min, P=0.005), and symptom onset-to-balloon time(200(170, 257) min vs. 338(270, 474)min, P<0.001) were all significantly shorter in the ≤90 min group than in >90 min group. The 30-day mortality(2.99% (6/201) vs. 7.86%(11/140), P=0.042), 1-year mortality (2.89(5/173) vs. 9.57(11/115), P=0.015), 1-year incidence of MACCE during the post-discharge follow-up period (1.16%(2/173) vs. 6.96%(8/115), P=0.021), and 4.5-year cumulative mortality (3.00% vs. 11.20%, P=0.007) after PCI were significantly lower in the ≤90 min group than in the >90 min group. Moreover, the 4.5-year incidence with free of MACCE (97.20% vs. 88.80%, P=0.025) during the post-discharge follow-up period was significantly higher in the ≤90 min group than in the >90 min group. In-hospital mortality was similar between the two groups (2.49%(5/201) vs. 6.43%(9/140), P=0.071). Results of binary logistic regression analysis showed that the SO-to-FMC time >90 min was the risk factor of 1-year mortality(OR=2.90, 95%CI 1.22-6.92, P=0.016) and 1-year incidence of MACCE (OR=5.19, 95%CI 1.21-22.20, P=0.026) during the post-discharge follow-up period. Multivariate Cox regression analysis demonstrated that the SO-to-FMC time >90 min was the risk factor of 4.5-year mortality after PCI in patients with STEMI (HR=2.88, 95%CI 1.10-7.53, P=0.031).@*Conclusion@#Shorting the SO-to-FMC time can significantly reduce the treatment time of STEMI patients, short and long-term mortalities and the incidence of MACCE, and improve the prognosis of patients with STEMI.
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Ultra-low power consumption is desired in most wearable biomedical devices. The event-driven based Analog-to-Digital converter (ADC) could be an excellent candidate for low power system because of the reduction in sampling points for biosignals. In the existing event-driven based ADC architectures, two or more high precision comparators are utilized to sample the input signal. In this paper, we propose a new scheme utilizing only one high precision comparator to genertate samples with the assistance of a low precision one. From the Matlab simulations on real ECG signal, it is shown that around 25% reduction on the number of samples can be be achieved compared with the Nyquist sampling scheme.
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Conversión Analogo-Digital , Electrocardiografía/instrumentación , Electrocardiografía/métodos , Humanos , Procesamiento de Señales Asistido por Computador/instrumentaciónRESUMEN
Objective To explore the influence of seasonal variations on acute cerebral infarction outcome. Meth-ods We collected data from acute cerebral infarction patients in the Second Hospital of Tianjin Medical University from January 2009 to February 2012. All cases were classified by months and seasons into different groups to analyze the season-al variations retrospectively. Results (1) The percentage of good outcome of acute cerebral infarction show significant dif-ference between each month(P<0.01). The percentage of good outcome was highest in August(92.1%), lowest in Decem-ber(78.1%), second lowest in April(81.9%). The percentage of good outcome in summer(91.6%)was higher than spring (87.2%), autumn(86.4%)and winter(83.9%)(P<0.05). (2) Among those patients converted to bad outcome more pa-tients was attacked by cerebrovascular accident in winter(68.3%)than in summer(43.2%), and more patients was combined with a pulmonary infection in winter(69.5%)than in summer(48.6%)and in autumn(49.3%)(P<0.05). (3) Seasonal effect in acute cerebral infarction outcome was obvious in those≥65 years of age(P<0.05). Conclusion Seasonal changes are associated with the outcome and severity of acute cerebral infarction.
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Objective Investigating the relationship between the incidence of Primary Acute Cerebral Infarction (PACI) and seasonal variation to employ measures to prevent PACI with climate change. Methods A retrospective analysis of patients diagnosed with PACI between 2009 and 2013 in the department of Neurology of Second hospital of Tian Jin Medi-cal University (n=1 198 patients) was carried out. Combined with the general clinical data, we analyzed seasonal, monthly and weekly variation among PACI incidents. Results The incidence of PACI increases over years between 2009 to 2013 (P ＜ 0.01). Significant difference of incidents of PACI was observed between each season (P=0.047). Incidence of PACI peaked in winter(30.33 ± 9.63/month), while bottomed in spring(21.83 ± 5.36/month). Significant difference of incidents of PACI was also observed between each months(P=0.010). The monthly incidence was highest in January and February (33.25 ± 9.62/month)and lowest in March and April(20.75 ± 4.89/month). The seasonal variation was only found in the pa-tients who are complicated with pulmonary infection (P＜0.01) regardless of the presence or absence of other risk factors, such as smoking, drinking ,hypertension, coronary heart disease, and diabetes mellitus. The weekly variation of PACI was on-ly significant in patients younger than 65 years old(P=0.043). The peak incidence among a week was Monday(17.86%),and incidence bottomed on Friday (13.36%). Conclusion Our study revealed that the incidence of PACI increase over year be-tween 2009 to 2013 and it shew a characteristic variation with respect to season, month and week. Based on these results, we can formulate prevention measures accordingly.
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Objective To detect the changes in the expression of discoidin domain receptor 2(DDR2)and matrix metalloproteinase (MMP)-13 in different stages of cartilage and synovium damage of osteoarthritis rats.The relation between DDR2 and the degree of cartilage damage was explored.Methods Modified papain knee joint injection approach was adopted to establish animal model of OA.The expression and distribution of protein of DDR2 and MMP-13 were checked in articular cartilage and synovium at different stages of OA.Results The expressions of DDR2 in articular cartilage and synovium of experimental groups were different from those of the normal group (P＜0.01).They were higher in cartilage than those in the corresponding synovium.The expressions of MMP-13 demonstrated the same characteristics with those of DDR2,r=0.93(P＜0.01).Conclusions The important role of DDR2-MMP-13 in cartilage damage has been proven in the pathogenic process of OA.The upregulated expressions of DDR2 in articular cartilage and synovium have a detrimental effect on cartilage degeneration.
