ObjectiveTo observe the clinical effect of unilateral puncture percutaneous kyphoplasty (PKP) through transverse process-pedicle approach (TPA) for the treatment of lumbar osteoporotic vertebral fractures (OVF).MethodsFrom January 2014 to June 2019, a total of 220 OVF patients (321 fractured vertebral bodies) were enrolled, and PKP was performed by unilateral TPA puncture. The distribution of bone cement in vertebral body exceeding the midline of vertebral body was defined as the success of puncture, and the success rates of puncture of different vertebral bodies were recorded. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), anterior and middle heights of the vertebral body, and the local Cobb angle were compared between three time points namely before operation, 1 day after operation, and 6 months after operation. Surgery-related complications were recorded.ResultsThe 220 patients included 57 males and 163 females, with a mean age of (70.3±6.5) years, a mean course of disease of (18.7±17.7) d, and a mean bone mineral density of −3.3±0.6. The success rate of puncture from L1 to L5 was 81.7% (85/104), 95.2% (80/84), 100.0% (69/69), 97.6% (41/42), and 72.7% (16/22), respectively. The mean volume of bone cement injected into the vertebral bodies was (5.8±0.9) mL. Two patients were followed up for less than 6 months because of death or loss to follow-up, and the other 218 patients were followed up for 6-57 months, with an average of (19.6±8.7) months. Before surgery, 1 day after surgery, and 6 months after surgery, the median (lower quartile, upper quartile) of VAS scores was 6 (6, 8), 1 (1, 2), and 2 (1, 2), respectively, with statistically significant differences in all the two-two comparisons (P<0.017). At the three time points, the median (lower quartile, upper quartile) of ODI was 61% (54%, 66%), 26% (22%, 30%), and 25% (24%, 31%), respectively, the mean height of anterior vertebral body was (18.3±2.8), (22.6±3.0), and (22.6±3.1) mm, respectively, the mean height of middle vertebral body was (17.8±2.2), (22.9±2.8), and (22.9±2.7) mm, respectively, the mean local Cobb angle was (19.9±2.6), (14.4±2.8), (14.4±2.8)°, respectively, and the values at 1 day and 6 months after surgery all differed from those before surgery (P<0.017). A total of 32 cases (42 vertebrae) had bone cement leakage, of whom 4 cases had related symptoms. There were 32 re-fractures of the vertebral bodies, including 18 adjacent vertebral body fractures, with an incidence rate of 5.6%. There were 3 vertebral infections after operation, the incidence was 0.9%.ConclusionPatients with OVF of the lumbar spine undergoing unilateral TPA puncture for PKP surgery have a high success rate, definite clinical effect, and satisfactory correction of local deformities.
In 2020, the American Association of Hip and Knee Surgeons (AAHKS), the American Society of Regional Anesthesia and Pain Medicine (ASRA), the American Academy of Orthopaedic Surgeons (AAOS), the American Hip Society (THS), the American Knee Society (TKS) have worked together to develop clinical practice guidelines on the use of Opioids in primary total joint arthroplasty (TJA). This clinical practice guideline formulates recommendations for common and important questions related to the efficacy and safety of Opioids in primary TJA. This article interprets the guideline to help doctors make clinical decisions.
Objective To investigate the therapeutic effect of artificial dura mater on the prevention and treatment of cerebrospinal fluid (CSF) leakage associated with thoracolumbar fracture and dislocation. Methods A total of 58 patients with thoracolumbar fracture and dislocation combined with dura mater injury and CSF leakage were treated in Affiliated Hospital of Southwest Medical University from January 2011 to December 2016, including 30 males and 28 females, aged from 15 to 86 years, with an average of (51.8±16.3) years. All patients were treated with posterior pedicle screw system for decompression, reduction fixation and fusion, dura mater and spinal cord injury were investigated, and external nerve roots or caudate nerves were exposed. At the same time; the dura mater was sutured and repaired and partially covered with gelatinous sponge (group A, 24 cases), or after dura mater was sutured and repaired, the artificial dura mater was partially covered (group B, 34 cases). The curative effect and complications of the two different treatment methods were evaluated. Results All operations were successfully completed. The operative time was 110–340 minutes, with an average of (195.0±10.4) minutes; the intraoperative blood loss was 200–2 800 mL, with an average of (845.0±26.5) mL. In group A, 13 patients (54.1%) acquired wound healing, and the average CSF leakage duration was (13.4±1.6) days postoperatively, among whom 3 cases were complicated with pseudomeningocele; 11 cases (45.9%) failed and necessitated additional management. Among the 11 cases, 6 case had no decreasing tendency of CSF leakage after 10-day drainage, and after subarachnoid drainage was performed, CSF leakage disappeared about 15 days after operation; 3 (12.5%) with wound infection underwent operative incision debridement, after the repair of the dura sac, the subarachnoid CSF was drainage at the lumbar part combined with the systemic situation with antibiotics and other symptomatic treatment, and the patients were cured about 16 days after the operation; 2 (8.3%) with spinal meningitis underwent subarachnoid CSF drainage and administration of antibiotics, and the CSF leakage ceased about 14 days after operation. In group B, 27 patients (79.4%) acquired wound healing, and the average CSF leakage duration was (9.1±1.7) days postoperatively; among whom, 4 cases were complicated with pseudomeningocele; 7 cases (20.6%) failed and necessitated additional management. Among the 7 cases, 5 cases had no decreasing tendency of CSF leakage after 10-day drainage, and CSF leakage disappeared around 12 days after treatment; 1 case (2.9%) with wound infection and 1 case (2.9%) with spinal meningitis, both were cured after the treatment as in group A. Conclusion Dural suture repair combined with artificial dura mater mulch repair can more effectively repair the dura tears associated with thoracolumbar vertebral fracture dislocation and reduce the incidence of CSF leakage.
Transcranial magneto-acoustic-electrical stimulation is a new non-invasive neuromodulation technology, in which the induced electric field generated by the coupling effect of ultrasound and static magnetic field are used to regulate the neural rhythm oscillation activity in the corresponding brain region. The purpose of this paper is to investigate the effects of transcranial magneto-acoustic-electrical stimulation on the information transfer and communication in neuronal clusters during memory. In the experiment, twenty healthy adult Wistar rats were randomly divided into a control group (five rats) and stimulation groups (fifteen rats). Transcranial magneto-acoustic-electrical stimulation of 0.05~0.15 T and 2.66~13.33 W/cm2 was applied to the rats in stimulation groups, and no stimulation was applied to the rats in the control group. The local field potentials signals in the prefrontal cortex of rats during the T-maze working memory tasks were acquired. Then the coupling differences between delta rhythm phase, theta rhythm phase and gamma rhythm amplitude of rats in different parameter stimulation groups and control group were compared. The experimental results showed that the coupling intensity of delta and gamma rhythm in stimulation groups was significantly lower than that in the control group (P<0.05), while the coupling intensity of theta and gamma rhythm was significantly higher than that in the control group (P<0.05). With the increase of stimulation parameters, the degree of coupling between delta and gamma rhythm showed a decreasing trend, while the degree of coupling between theta and gamma rhythm tended to increase. The preliminary results of this paper indicated that transcranial magneto-acoustic-electrical stimulation inhibited delta rhythmic neuronal activity and enhanced the oscillation of theta and gamma rhythm in the prefrontal cortex, thus promoted the exchange and transmission of information between neuronal clusters in different spatial scales. This lays the foundation for further exploring the mechanism of transcranial magneto-acoustic-electrical stimulation in regulating brain memory function.
In this work, a new method of heart sound signal preprocessing is presented. First, the heart sound signals are decomposed by using multilayer wavelet transform. And then double parameters as thresholds are used in processing each layer after decomposition for denoising. Next, reconstruction of heart sound signals could be done after processing last layer. Four methods, i.e. wavelet transform, Hilbert-Huang transform (HHT), mathematical morphology, and normalized average Shannon energy, were used to extract the envelop of the heart sound signals respectively after reconstruction of heart sounds. All methods were improved in this study. We finally in our study chose 30 cases of raw heart sound signals, which were selected randomly from a database comed from The Clinical Medicine Institute of Montreal, and processed them by using the improved methods. The results were satisfactory. It showed that the extracted envelope with the original signal has a high degree of matching, whether it is a low frequency portion or high frequency portion. Most of all information of heart sound has been maintained in the envelope.
Objective To observe the effect of melatonin (MT) on retinal apoptosis in rats with ischemia-reperfusion injury (RIRI). Methods A total of 54 male healthy Sprague-Dawley adult rats were randomly divided into the normal control (CON) group (6 rats), RIRI group (24 rats) and MT group (24 rats). The rats of RIRI and MT group were induced using suture-occluded methods to establish RIRI model. The rats of MT group were injected with MT in the left carotid artery 30 minutes after RIRI, and RIRI group was injected with the same amount of saline. On 6, 24 hours and 3, 7 days after RIRI, the morphological changes of retina were evaluated by hematoxylin and eosin (HE) staining; the effects of MT on retinal cell apoptosis and Nrf2, HO-1 proteins were examined by immunohistochemistry staining. The correlation between active Caspase-3 and Nrf2 protein, active Caspase-3 and HO-1 protein in MT group were analyzed by linear regression analysis. Results HE staining results showed that the morphology of retinal cells was regular and retinal cells were well arranged in the CON and MT group. In the RIRI group, both the thickness of inner retinal layer and the number of retinal ganglion cells (RGC) were decreased. On 6, 24 hours and 3, 7 days after RIRI, the thickness of inner retinal layer (F=16.710, 62.303, 68.389, 57.132; P＜0.01) and RGC number (F=24.250, 11.624, 14.155, 32.442; P＜0.05) in MT group were more than those in RIRI group. Immunohistochemistry staining results showed that less active Caspase-3+ cells were observed in MT group as compared with those in RIRI group at each time points (F=49.118, 134.173, 76.225, 18.385; P＜0.01). There were more Nrf2+ (F=11.041, 31.480, 59.246, 6.740; P＜0.05) and HO-1+ cells (F=128.993, 21.606, 51.349, 8.244; P＜0.05) in MT group as compared with those in RIRI group at each time points. Linear regression analysis results showed that the difference of active Caspase-3+ cells were all linearly correlated with the Nrf2+ cells and HO-1+cells in the MT group (r2=0.810, 0.730; P＜0.01). Conclusion MT could reduce retinal cell apoptosis in RIRI rats, and its mechanism may be associated with increased Nrf2 and HO-1 expression, reduced active Caspase-3 expression.
Objective To evaluate the early effectiveness and summarize the initial application experiences of Mako robot-assisted total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) in adults. Methods Between August 2018 and January 2020, 55 cases of DDH (75 hips) were treated with Mako robot-assisted THA. There were 10 males and 45 females with an average age of 51 years (range, 30-73 years). There were 35 cases of unilateral hip and 20 cases of bilateral hips. The DDH was classified as Crowe type Ⅰin 29 hips, type Ⅱ in 20 hips, type Ⅲ in 6 hips, and type Ⅳ in 20 hips. The modified Harris score was 54.8±16.0, the hip joint range of motion was 90° (80°, 100°), and the leg length discrepancy (LLD) was 22.0 (10.5, 47.0) mm. The preoperative surgical plan was made in the robot system based on the CT data. The reaming and installation of the acetabular cup were completed with the assistance of the robot system. The distance between the rotation center of the hip joint and the teardrop (horizontal distance, vertical distance), inclination angle, and anteversion angle were measured on the pelvic X-ray film to evaluate the position of the acetabular prosthesis. The above indicators were compared with preoperative planning to evaluate the accuracy of robotic-assisted surgery. The modified Harris score, the range of motion, and the LLD were used to evaluate the early effectiveness. Results The 75 hips of THAs were completed with the assistance of Mako robots. There was no significant difference in the acetabular inclination angle, the horizontal distance and the vertical distance of the rotation center between the preoperative planning and the postoperative measurement values (P>0.05); the acetabular anteversion angle was significantly smaller than the postoperative measurement value (t=–2.482, P=0.015). Four hips located beyond the Lewinnek safety zone, and 71 hips located within the Lewinnek safety zone. All patients followed up 6-24 months (mean, 13 months). All incisions healed by first intention. At last follow-up, the modified Harris score was 85.5±11.2, the hip joint range of motion was 120° (110°, 120°), and the LLD was 3.8 (2.0, 8.1) mm; all improved significantly compared with preoperative ones (P<0.05). Except for one nerve injury case, there was no other complication. Conclusion Mako robot-assisted THA is a safe and effective method for adult DDH, which can optimize the acetabular cup positioning, hip function, and leg length, but the long-term effectiveness needs to be confirmed by further studies.
Transcranial magneto-acoustic electrical stimulation (TMAES) is a novel method of brain nerve regulation and research, which uses induction current generated by the coupling of ultrasound and magnetic field to regulate neural electrical activity in different brain regions. As the second special envoy of nerve signal, calcium plays a key role in nerve signal transmission. In order to investigate the effect of TMAES on prefrontal cortex electrical activity, 15 mice were divided into control group, ultrasound stimulation (TUS) group and TMAES group. The TMAES group received 2.6 W/cm2 and 0.3 T of magnetic induction intensity, the TUS group received only ultrasound stimulation, and the control group received no ultrasound and magnetic field for one week. The calcium ion concentration in the prefrontal cortex of mice was recorded in real time by optical fiber photometric detection technology. The new object recognition experiment was conducted to compare the behavioral differences and the time-frequency distribution of calcium signal in each group. The results showed that the mean value of calcium transient signal in the TMAES group was (4.84 ± 0.11)% within 10 s after the stimulation, which was higher than that in the TUS group (4.40 ± 0.10)% and the control group (4.22 ± 0.08)%, and the waveform of calcium transient signal was slower, suggesting that calcium metabolism was faster. The main energy band of the TMAES group was 0−20 Hz, that of the TUS group was 0−12 Hz and that of the control group was 0−8 Hz. The cognitive index was 0.71 in the TMAES group, 0.63 in the TUS group, and 0.58 in the control group, indicating that both ultrasonic and magneto-acoustic stimulation could improve the cognitive ability of mice, but the effect of the TMAES group was better than that of the TUS group. These results suggest that TMAES can change the calcium homeostasis of prefrontal cortex nerve clusters, regulate the discharge activity of prefrontal nerve clusters, and promote cognitive function. The results of this study provide data support and reference for further exploration of the deep neural mechanism of TMAES.
Electrical impedance tomography (EIT) plays a crucial role in the monitoring of pulmonary ventilation and regional pulmonary function test. However, the inherent ill-posed nature of EIT algorithms results in significant deviations in the reconstructed conductivity obtained from voltage data contaminated with noise, making it challenging to obtain accurate distribution images of conductivity change as well as clear boundary contours. In order to enhance the image quality of EIT in lung ventilation monitoring, a novel approach integrating the EIT with deep learning algorithm was proposed. Firstly, an optimized operator was introduced to enhance the Kalman filter algorithm, and Tikhonov regularization was incorporated into the state-space expression of the algorithm to obtain the initial lung image reconstructed. Following that, the imaging outcomes were fed into a generative adversarial network model in order to reconstruct accurate lung contours. The simulation experiment results indicate that the proposed method produces pulmonary images with clear boundaries, demonstrating increased robustness against noise interference. This methodology effectively achieves a satisfactory level of visualization and holds potential significance as a reference for the diagnostic purposes of imaging modalities such as computed tomography.
ObjectiveTo summarize and analyze the application of ex vivo liver resection and autotransplantation (ELRA) in the treatment of hepatobiliary diseases. MethodThe related literature about ELRA used to treat various hepatobiliary space-occupyingdiseases at home and abroad in recent years was comprehensively searched and summarized. ResultsELRA had overcome the limitations of limited operational space in traditional surgery for the treatment of hepatobiliary space-occupying diseases reduced dependence on donor livers, and avoided post-transplant rejection. It had been applied in the treatment of hepatic alveolar echinococcosis, liver cancer, cholangiocarcinoma, and rare liver space-occupying diseases. ConclusionsWith the maturation of ELRA techniques and the continuous improvement of ex vivo liver perfusion technology, along with rigorous preoperative evaluation and meticulous postoperative management, postoperative complications of ELRA have significantly decreased compared to the initial stages of its application. By strictly adhering to surgical indications, this procedure is expected to be used treatment in an increasing number of hepatobiliary space-occupying diseases.