Objective To investigate the prel iminary effectiveness of percutaneous kyphoplasty (PKP) in treating vertebral compressive fractures in patients with osteoporosis. Methods Between February 2008 and June 2010, 31 cases (31vertebrae) of osteoporotic vertebral compressive fractures were treated with PKP. Of 31 cases, 10 were male and 21 were female, aged from 64 to 80 years (mean, 70.7 years). All fractures were caused by mild trauma with an disease duration of 1-13 days. Affected vertebrae included T12 in 8 cases, L1 in 9 cases, L2 in 12 cases, and L4 in 2 cases. The effectiveness was evaluated with visual analogue scale (VAS), the Cobb’s angle, and the anterior vertebral height. Results The operation was completed successfully in all cases, without serious postoperative complication. Cement leakage occurred in 11 cases (35.5%), including 3 cases at the anterior vertebral edge, 4 cases at the lateral vertebra, and 4 cases at the puncture tunnel. All the cases were followed up 6-15 months (mean, 11 months). The mean fracture healing time was 11.5 weeks (range, 8-12 weeks). VAS score was decreased from 8.1 ± 1.2 preoperatively to 2.5 ± 0.6 at 3 months postoperatively and to 2.3 ± 0.8 at last follow-up; the Cobb’s angle was improved from (30.2 ± 5.3)° to (21.3 ± 3.6)° and (23.5 ± 3.8)° respectively; and the anterior vertebral height was increased from (13.98 ± 4.62) mmto (22.03 ± 4.93) mm and (22.56 ± 4.34) mm respectively. There were significant differences in VAS, the Cobb’s angle, and the anterior vertebral height between pre- and post-operation (P lt; 0.05), but there was no significant difference between 3 months postoperatively and last follow-up (P gt; 0.05). Conclusion PKP is effective for osteoporotic vertebral compressive fractures, which can rel ieve pain effectively, correct kyphosis, and prevent collapse of vertebra.
Detection of the fraction of exhaled nitric oxide (FeNO) is a safe, simple and easy method to assess airway inflammation noninvasively. Thus, FeNO detection has been paid more attention to diagnosis and guide treatment of pulmonary diseases. The common feature of pneumonia, asthma, chronic obstructive pulmonary disease and chronic cough is the existence of varying degrees of airway inflammation. In this review, FeNO production and its potential pathologic and physiologic role in various pulmonary diseases were discussed.
ObjectiveTo explore the correlation of preoperative D-dimer (DD) level with prognosis in Chinese esophageal cancer patients.MethodsPubMed, EMbase, Web of Science, Cochrane Library, CNKI, VIP, Wanfang, SinoMed databases were searched to identify potential studies which assessed prognostic value of preoperative DD level in Chinese esophageal cancer patients from the establishment date of each database to March 20, 2019. The Stata 12.0 software was applied to conduct the meta-analysis and the hazard ratio (HR) with 95% confidence interval (CI) was combined to evaluate the relation between preoperative DD level and survival of Chinese esophageal cancer patients.ResultsA total of 5 studies involving 1 277 patients were included. The quality score of each study was ≥6 points. The results showed that the elevated preoperative DD level was significantly associated with poor overall survival (OS, HR=1.49, 95%CI 1.05-2.10, P=0.025) and cancer-specific survival (CSS, HR=1.83, 95%CI 1.39-2.42, P<0.001). However, no significant relation of preoperative DD with disease-free survival (DFS) was observed (HR=1.55, 95%CI 0.89-2.70, P=0.125).ConclusionHigh preoperative DD level may be an independent prognostic factor for Chinese patients with esophageal cancer. More prospective studies with bigger sample sizes are still needed to verify our results.
ObjectiveTo investigate the difference between four transforaminal endoscopic approaches in the treatment of serious lumbar disc herniation.MethodsBetween October 2010 and February 2015, a total of 122 patients with serious lumbar disc herniation were enrolled and treated with discectomy under transforaminal endoscope. The patients were divided into 4 groups according to the different approaches. The transforaminal endoscopic spine system (TESSYS) technology was used in group A (31 cases), Yeung endoscopic spine system (YESS) technology was used in group B (30 cases), improved transforaminal endoscopic access (ITEA) technology was used in group C (31 cases), and interlaminar dorsal access (IDA) technology was used in group D (30 cases). There was no significant difference in gender, age, disease duration, lesion segment, and preoperative visual analogue scale (VAS) score of low back pain, VAS score of bilateral lower extremities pain, Oswestry disability index (ODI), intervertebral height, lumbar curvature index (LCI), and disc degeneration grading between groups (P>0.05). The removal volume of nucleus pulposus was compared; after operation, VAS score, ODI score, LCI, intervertebral height, and disc degeneration grading were used to evaluate the effectiveness.ResultsThe removal volumes of nucleus pulposus in groups A, B, C, and D were (3.6±0.9), (3.5±0.7), (4.6±1.0), (3.1±1.1) cm3, respectively. There were significant differences between groups (P<0.05). All incisions healed by first intention, and no early postoperative complications was found. All cases were followed up 12-35 months, with an average of 24 months. During follow-up, there was no recurrence of nucleus pulposus herniation, infection of intervertebral space, cerebrospinal fluid leakage, epidural hematoma, or other complications. At last follow-up, the VAS scores of low back pain and bilateral lower extremities pain, and ODI scores in each group significantly improved when compared with those before operation (P<0.05); there was no significant difference in the scores and improvements between groups after operation (P>0.05). At last follow-up, the disc degeneration grading in group B significantly improved when compared with that before operation (P<0.05); there was no significant difference between groups (P>0.05). At last follow-up, there was no significant difference in LCI of each group when compared with that before operation (P>0.05); and there was no significant difference in LCI and loss value between groups (P>0.05). There was no significant difference in the intervertebral height of the 4 groups at immediate after operation and last follow-up when compared with preoperative value (P>0.05), and there was no significant difference between groups at immediate after operation and last follow-up (P>0.05).ConclusionApplication of transforaminal endoscope in the treatment of serious lumbar disc herniation has great clinical outcomes. The ITEA technology can obtain a wider field of view and be more convenient to find and remove the degenerative nucleus pulposus. However, the appropriate approach should be selected according to the symptoms and characteristics of lumbar disc herniation.
This study is to investigate the inhibitory effect of different concentrations of zoledronic acid on the activity of osteoclasts, to obtain characteristics on inhibitory effect and to find the lowest effective concentration of zoledronic acid. Marrow cells of C57 mice (6 weeks) were cultured in vitro. Osteoclasts were induced by single nuclear cells. According to the concentration of zoledronic acid, we set up the experimental group with five different concentrations, i.e. 1×10–8 mol/L, 1×10–7 mol/L, 1×10–6 mol/L, 1×10–5 mol/L, and 1×10–4 mol/L. The control group did not contain any bisphosphonate. By tartrate resistant acid phosphatase staining, the number of multinuclear cells, cells through the filter and bone resorption lacune were counted. Five days after the cultivation, the number of multinuclear cells in the experimental group decreased with the increase of concentration of zoledronic acid. Inhibition on the formation of osteoclasts in vitro was effective at 1×10–6 mol/L. At the concentration of 1×10–5 mol/L, the effect of inhibition on migration of osteoclast and bone resorption was more obvious. The effect was further enhanced at concentration of 1×10–4 mol/L. However, the concentration and inhibition curves were gradually mild. The inhibitory effect on different concentrations of zoledronic acid on the activity of osteoclasts was different. The inhibition effect was obvious at 1×10–6 mol/L. We should pay attention to administrate appropriate concentration of zoledronic acid in the clinical applications.
Objective To analyze the characteristics of femoral neck fractures in young and middle-aged adults by means of medical image analysis and fracture mapping technology to provide reference for fracture treatment. Methods A clinical data of 159 young and middle-aged patients with femoral neck fractures who were admitted between December 2018 and July 2019 was analyzed. Among them, 99 patients were male and 60 were female. The age ranged from 18 to 60 years, with an average age of 47.9 years. There were 77 cases of left femoral neck fractures and 82 cases of right sides. Based on preoperative X-ray film and CT, the fracture morphology was observed and classified according to the Garden classification standard and Pauwels’ angle, respectively. Mimics19.0 software was used to reconstruct the three-dimensional models of femoral neck fracture, measure the angle between the fracture plane and the sagittal plane of the human body, and observe whether there was any defect at the fracture end and its position on the fracture surface. Through reconstruction, virtual reduction, and image overlay, the fracture map was established to observe the fracture line and distribution. Results According to Garden classification standard, there were 6 cases of type Ⅰ, 61 cases of type Ⅱ, 54 cases of type Ⅲ, and 38 cases of type Ⅳ. According to the Pauwels’ angle, there were 12 cases of abduction type, 78 cases of intermediate type, and 69 cases of adduction type. The angle between fracture plane and sagittal plane of the human body ranged from –39° to +30°. Most of them were Garden type Ⅱ, Ⅳ and Pauwels intermediate type. The fracture blocks were mainly in the form of a triangle with a long base and mainly distributed below the femoral head and neck junction area. Twenty-six cases (16.35%) were complicated with bone defects, which were mostly found in Garden type Ⅲ, Ⅳ, and Pauwels intermediate type, located at the back of femoral neck and mostly involved 2-4 quadrants. The fracture map showed that the fracture line of the femoral neck was distributed annularly along the femoral head and neck junction. The fracture line was dense above the femoral neck and scattered below, involving the femoral calcar. Conclusion The proportion of displaced fractures (Garden type Ⅲ, Ⅳ) and unstable fractures (Pauwels intermediate type, adduction type) is high in femoral neck fractures in young and middle-aged adults, and comminuted fractures and bone defects further increase the difficulty of treatment. In clinical practice, it is necessary to choose treatment plan according to fracture characteristics. Anatomic reduction and effective fixation are the primary principles for the treatment of femoral neck fracture in young and middle-aged adults.
ObjectiveTo investigate the effect and effectiveness analysis of different approaches of transforaminal endoscope on extirpation amount of nuclues pulposus.MethodsBetween August 2011 and December 2014, a total of 165 patients with lumbar disc herniation were retrospectively enrolled and were treated with nucleus pulposus discectomy through transforaminal endoscope. The patients were randomly divided into 4 groups according to different approach of transforaminal endoscope. The posterolateral approach (Yeung’s technology) was used in group A (42 cases), transforaminal endoscopic spine system (TESSYS) technology was used in group B (40 cases), improved transforaminal endoscopic access (ITEA) technology was used in group C (43 cases), and interlaminar approach (40 cases) was used in group D (40 cases). There was no significant difference in gender, age, disease duration, symptomatic side, and segments among 4 groups (P>0.05). The extirpation amount of nuclues pulposus was calculated and compared among 4 groups; the effectiveness was evaluated by pre- and post-operative visual analogue scale (VAS) score, Oswestry disability index (ODI), lumbar curvature index (LCI), and intervertebral height.ResultsThe discectomy amount of nucleus pulposus was (3.7±0.8), (3.6±0.7), (4.5±1.1), and (3.0±0.8) cm3 in groups A, B, C, and D, respectively. The amount of group C was significantly larger than that of the other 3 groups (P<0.05), and the amount of group D was significantly smaller than that of the other 3 groups (P<0.05); no significant difference was found between groups A and B (P>0.05). Cerebrospinal fluid leakage was found in 1 case; no other postoperative complications including intervertebral space infection and epidural hematoma was found. All the incisions healed by first intension. All the patients were followed up 12-24 months (mean, 18 months), and no typical symptoms of recurrence was found during the follow-up period. There was no significant difference in preoperative lower back pain VAS score, lower extremities VAS score, and ODI scores among 4 groups (P>0.05). The above scores at last follow-up were significantly improved when compared with preoperative ones in each group (P<0.05), but no significant difference of above scores and recovery values was found among 4 groups (P>0.05). The difference in LCI and intervertebral height at preoperation and at last follow-up were not significant between 4 groups (P>0.05). The difference in LCI and intervertebral height of each group between at preoperation and last follow-up were not significant (P>0.05). And the recovery value of LCI and the lost of height at last follow-up also showed no significant differences between 4 groups (P>0.05).ConclusionThe ITEA technology can give a wider field of view than other technologies. It is more convenient to find and remove the nucleus pulposus. However, the appropriate operative approaches should be chosen according to the symptoms and characteristics of lumbar disc herniation.
ObjectiveTo discuss the effect of three different ways of annulus fibrosus incision on the biomechanical strength of intervertebral disc. MethodsA total of 30 goats underwent intervertebral disc nucleus pulposus extraction at L3, 4 and L4, 5 by the working channel in group A (n=10), by circular incision in group B (n=10), and by square incision in group C (n=10). The body weight, male and female ratio, age, intraoperative blood loss, and wound healing time were recorded and compared among 3 groups. The survival rate and wound healing situation were observed after operation. At 24 weeks after operation, the goats were sacrificed, MRI images were taken to observe the signal intensity of nucleus pulposus. The disc height of L3, 4 and L4, 5 was measured to calculate the loss of disc height; biomechanical test was used to assess the strength of the disc and anulus. Histological staining was also conducted to observe the repair effect at L4, 5. ResultsThere was no significant difference in body weight, male to female ratio, age, intraoperative blood loss, and wound healing time among groups (P>0.05). All goats survived to the end of the experiment. MRI examination showed decreased signal intensity in 3 groups, indicating intervertebral disc degeneration. According to modified Thompson classification method, the degree of intervertebral disc degeneration of group A was significantly higher than that of groups B and C (P<0.05), but no significant difference was found between groups B and C (P>0.05). Difference was not significant in intervertebral space height before operation among 3 groups (P>0.05). But after 24 weeks, the intervertebral space height in group A was significantly higher than that in groups B and C (P<0.05), and the intervertebral space height loss in group A was significantly lower than that in groups B and C (P<0.05). The biomechanical strength in group A was also significantly higher than that in groups B and C (P<0.05), but no significant difference was found between group B and group C (P>0.05). HE and Masson staining showed good continuity of annulus fibrosus and clear layers in group A; poor continuity of annulus fibrosus and obvious scar tissues were observed in groups B and C. ConclusionApplication of working channel may have less destruction of annulus fibrosus, it plays a positive role in the maintenance of biomechanical strength and repair of annulus fibrosus.
目的探讨间断低氧预适应对大鼠肝大部切除术后残余肝脏合并缺血再灌注引发过氧化损伤的保护作用。 方法78只SD大鼠，用SPSS软件将其随机分为4组：假手术组（SO组，n=6）、肝切除组（PH组，n=24）、肝切除合并缺血再灌注损伤组（IR组，n=24）和间断低氧预适应组（IHP组，n=24）。以无创伤血管夹阻断IR组大鼠入肝血流后切除肝脏的左叶和中叶（约占全肝的70%），20 min后开放入肝血流，残余肝脏发生了缺血再灌注损伤。将IHP组大鼠暴露于10%的低氧环境中，每日持续1 h，连续进行1周，最后1次低氧暴露后行肝切除术（同IR组）。SO组大鼠在术后2 h取材检测，其余各组分别于术后2、6、12及24 h进行检测。检测血清转氨酶（ALT、AST）水平和肝匀浆组织中超氧化物歧化酶（SOD）活性及丙二醛（MDA）含量。 结果术后2 h，PH组、IR组和IHP组大鼠血清ALT和AST水平均高于SO组（P<0.05）。在术后6、12和24 h，IHP组大鼠血清ALT和AST均高于PH组，但低于IR组（均P<0.05）。与IR组相比，IHP组大鼠术后各时间点残余肝脏中SOD活性明显升高，而MDA含量则显著降低（均P<0.05）。 结论间断低氧预适应对残余肝脏缺血再灌注损伤具有保护作用，其机理可能与提高肝脏的抗氧化能力有关。
Objective To explore the factors of postoperative cough in lung cancer patients. Methods Totally 130 lung cancer patients of single medical team (average age of 58.75±9.34 years, 65 males and 65 females), from February 2016 to February 2017 in the Department of Thoracic Surgery of West China Hospital of Sichuan University, were investigated by Mandarin Chinese version of the Leicester Cough Questionnaire (LCQ-MC). We analyzed and calculated the preoperative and postoperative scores of LCQ-MC, Cronbach α and the influencing factor. Results The preoperative score of LCQ-MC's physiological dimension was significantly lower in the postoperative cough group (6.30±0.76) than that of the postoperative non-cough group (6.56±0.60,P=0.044), while the preoperative total score of LCQ-MC (19.53±1.78, 20.03±1.45) was not statistically different (P=0.080). The postoperative score of LCQ-MC was significantly lower in the postoperative cough group (17.32±2.79) than that of the postoperative non-cough group (19.70±1.39,P<0.001). And the scores of physiological, psychological and social dimension were significantly lower in the postoperative cough group (5.32 ±1.14, 5.73±1.14, 6.23±0.89) than those of the postoperative non-cough group (6.25±0.63, 6.67±0.54, 6.78±0.49) (P values were all less than 0.001). The result of multi-factor logistic regression analysis showed the condition of preoperative cough symptom (OR=0.354, 95%CI=0.126–0.994, P=0.049) and anesthesia time (OR=1.021, 95% CI=1.003–1.040, P=0.021) were the risk factors. Conclusion The risk factors of postoperative cough symptoms in lung cancer patients are the condition of preoperative cough symptoms and anesthesia time.