BACKGROUND: Studies have shown that osteoporosis often leads to a failure in pedicle screw fixation. Considering that the use of ordinary pedicle screw fixation cannot achieve a strong and stable fixation of the osteoporotic vertebra,special measures to strengthen the internal fixation is indispensable.OBJECTIVE: To evaluate the effect of bone cement augmentation combined with expandable pedicle screw fixation on the fixation strength of osteoporotic thoracolumbar vertebrae.METHODS: Twenty osteoporotic thoracolumbar vertebral specimens were randomly divided into four groups: conventional pedicle screw group implanted with normal pedicle screw, and the other three groups implanted with expandable pedicle screw. Bone cement augmentation with polymethylmethacrylate (PMMA) and calcium sulfate was done in the PMMA group and calcium sulfate group, respectively, followed by expandable pedicle screw implantation. No bone cement was used in the expandable pedicle screw group. The maximum axial pull-out strength and yield energy absorption value of the unilateral pedicle were detected, and the maximum removal torque of the contralateral pedicle was determined. Bone cement leakage after augmentation was observed.RESULTS AND CONCLUSION: Compared with the conventional pedicle screw group, the other three groups showed a significant increase in the maximum pull-out strength, maximum removal torque and yield energy absorption values (P < 0.05). Moreover, these parameters were significantly higher in the PMMA and calcium sulfate groups than the expandable pedicle screw group and conventional pedicle screw group (P < 0.05), but there was no significant difference between the PMMA and calcium sulfate groups (P > 0.05). No leakage of bone cement was found in all the groups. To conclude, the combined use of expandable pedicle screw and can significantly enhance the stability of the osteoporotic thoracolumbar vertebrae, and the PMMA and calcium sulfate cements have similar effects.

Objective To investigate the characteristics and treatment effects in patients with spinal fractures associated with dural tears.Methods A retrospective analysis was made on 185 patients with spinal fractures presenting to hospital from February 2013 to February 2015.There were 103 males and 82 females,aged 17-73 years (mean,58 years).Causes of injury were high falls in 72 patients,traffic collisions in 58,hitting by heavy objects in 41,ground-level falls in 12,and collision events in two.Cervical spine fractures were seen in 65 patients,thoracic vertebra fractures in 51,and lumbosacral vertebral fractures 69.Neurologic deficit was assessed using the American Spinal Injury Association (ASIA) score,including grade A in 24 patients,grade B in 22,grade C in 26,grade D in 37 and grade E in 76.Eighty patients were managed by simply anterior surgery,97 by posterior surgery,and eight by anterior-posterior surgery.Twenty-one patients were found with dural tears (group A) and 164 patients without dural tears (group B).Incidence of dural tears in cervical,thoracic and lumbosacral vertebral fractures were recorded and compared.Preoperative neurologic deficit,laminar fracture and spinal canal encroachment rate were compared between groups.Neurological function and complications associated with dural repair were detected.Results In group A,ten patients were rated ASIA grade A,five grade B,three grade C,one grade D and two grade E.In group B,14 patients were rated ASIA grade A,17 grade B,23 grade C,36 grade D and 74 grade E.Group A accounted for 11％ (7/65) of cervical,10％ (5/51) of thoracic,and 13％ (9/69) of lumbosacral spine fractures (P ＞ 0.05).Nineteen patients (91％) in group A were complicated with neurological deficit,compared to ninety patients (54.9％) in group B (P ＜ 0.01).Eighteen patients (86％) in group A had laminar fractures,compared to fifteen patients (9.1％) in group B (P ＜ 0.01).In group A,rate of spinal canal encroachment was (62.3 ± 12.1)％ and 17 patients (81％) showed spinal canal encroachment of greater than 50％.While in group B,rate of spinal canal encroachment was (36.2 ± 15.6)％ and 25 patients (15.2％) showed spinal canal encroachment of greater than 50％ (P ＜ 0.01).For dural tears in group A,11 patients were treated by direct suturing,four by thoracolumbar fascia repair,three by artificial dural coverage and three by fibrin glue sealing.In group A,19 patients were followed up and one of them presented persistent cerebral spinal fluid leak that necessitated an irrigation and debridement to cure.ASIA score was improved from grade A to B in two patients,grade B to C in one,grade C to D in one and grade D to E in one at the final follow-up.Conclusions Majority patients with spinal fractures associated with dural tears exist severe neurologic deficit,spinal canal encroachment and laminar fractures.Incidence of dural tear in cervical,thoracic and lumbosacral vertebral fractures is similar.Incidence of complications related to dural tear repair is low,but the neurological function recovery is poor after operation.

[Abstract ] Objective The tension-free vaginal tape is the main method for treatment of stress urinary incontinence (SUI). The aim of the present study was to analyze the effect and safety of tension-free vaginal tape ( TVT) and tension-free vaginal tape-obtu-rater ( TVT-O) for female stress urinary incontinence and to sum up the experiences . Methods Clinical data of 142 patients who re-ceived anti-incontinence surgery ( TVT/TVT-O ) between January 2011 and May 2014 were retrospectively analyzed , 111 cases re-ceived TVT and 31 cases received TVT-O.The effect and the complication were analyzed at least 6 months post surgery .Incontinence quality of life ( I-QOL) and organ prolapse/urinary incontinence sexual function questionnaire ( P-ISQ) were used to observe the sub-jective symptoms .One hour pad test value was used to assesse the objective response . Results The effective rate post-TVT/TVT-O was 88.03%, and the cure rate was 95.07%6 months post surgery.In the group of TVT, I-QOL and P-ISQ score were 52.1 ±16.8 and 60.1 ±36.5 at time of pre-operation, and they were 92.1 ±17.1 and 62.2 ±37.8 at time of post-operation, respectively.In the group of TVT-O, they were 61.2 ±15.8 and 57.1 ±36.8 at time of pre-operation, and they were 91.3 ±20.1 and 62.1 ±35.9 at time of post-operation, respectively.Compared with pre-operation, I-QOL and P-ISQ score were obviously rised at time of post-operation ( P<0.05 ). The total incidence rate of surgery complication was 21.83%.And,in proper was urinary tract infection (16.9%),OAB (14.08%), bladder injury(11.26%), retention of urine(7.74%), nerve pain(2.81%), retropubic hematoma(1.41%), urethral injury(1.41%).All patients′surgeries were successful except three cases.One patient was cured after reoperation .The other two was improved with dislodge sling urinary incontinence . Conclusion TVT/TVT-O was a highly effective and safe method in the treatment of SUI .But we should not ignore the complications;the timely and effective treatment measures could improve the operation rate of success .

OBJECTIVE: As a subtype membrane receptor of tumor necrosis factor alpha, not much is known about the link between the soluble TNF receptor-I and obstructive sleep apnea hypopnea syndrome. We hypothesized that the TNF receptor might play an important role in the inflammation in patients with OSAHS, moreover this study was undertakan to investigate the effects of multimodality therapies on its periphery blood level. METHOD: Seventy-seven adults with habitual snoring and mean age of 34.9 +/- 11 years old consented to participate in the study. All participants were studied with overnight polysomnography, physical examination and a blood crew at baseline. According to the severity of OSAHS, they were categorized into three groups and one control group. Moderate and severe OSAHS groups returned for a repeat test of polysomnography and a blood crew at 3 months after the ENT surgery or continuous positive airway pressure (CPAP). serum levels were measured by using an immunoluminometric assay kit. RESULT: (1) Compared with control non-OSAHS group, serum sTNF-R I levels prior to treatment in OSAHS groups were significantly greater, with a mean serum levels at (742 +/- 258 & 340 +/- 102) pg/ml (P < 0.05), respectively. (2) Plasma solube tumor necrosis factor receptor-I responsed sensitively to the effect of comprehensive therapies when we compared its prior treatment levels with post ones. (3) Analysis was used to assess the associations adjusting for age, gender, BMI and weight ,a positive assosiation were found between apnea-hypopnea index (AHI) and sTNF-R I (r = 0.646, P < 0.01) a negative assosiation were found between lowest nadir oxygen saturation (LSaO2) and (r = 0.522, P < 0.01). CONCLUSION ln summary, independent of age, gender, BMI and weight ,our datas suggest a relationship can be found between the the severity of OSAHS and periphery blood level of soluble TNF receptor-I. Comprehensive therapies is effective in changing sTNF-R I. sTNF-R I may be recommended as a Inflammation factor of OSAHS.
Adult ; Biomarkers ; blood ; Continuous Positive Airway Pressure ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; Receptors, Tumor Necrosis Factor ; blood ; Sleep Apnea, Obstructive ; blood ; therapy ; Snoring ; blood ; Tumor Necrosis Factor-alpha

OBJECTIVETo systematically review the effectiveness of bone substitute augmentation combined with internal fixation versus internal fixation alone in treating proximal femoral fractures in the elderly.

METHODSSubject term and keywords were searched from Pubmed, Cochrane databases and CNKI from database foundation to August 2015. Randomized controlled studies and qusi-randomized controlled studies on bone substitutes augmentation combined with internal fixation versus internal fixation alone for the treatment of proximal femoral fractures in the elderly were chosen. Postoperative re-displacement, re-operation rate, complications (infection and bone ununion), functional outcome, quality of life scores and muscle strength were seen as outcome indicators. Enumeration data were statistical analyzed by risk difference and 95% confidence interval. Measurement data were analyzed by standardized mean difference and 95% confidence interval. If the same measurement data were evaluated by different standards in different studies, standardized mean differences and 95% confidence interval were used. The methods of statistical analysis were used by Cochrane databases.

RESULTSEleven RCTs (677 patients) were included. Meta-analysis results indicated that bone substitutes augmentation combined with internal fixation occurred fewer re-displacement [SMD = -0.75, 95% CI (-1.03, -0.47)] and obtained better function [SMD = 0.40, 95% CI (0.20, 0.59)]. While there were no significant differences in reoperation rate [RD = 0.02, 95% CI (-0.05, -0.09)], pain at 1 week after operation [MD = -1.79, 95% CI (-13.55, -9.96)], pain ranged from 6 to 8 weeks [MD = -7.24, 95% CI (-20.07, -5.59)], postoperative pain at 12 weeks [MD = -0.32, 95% CI (-4.9, -3.55)], muscle strength [MD = 1.25, 95% CI (-6.98, -9.48)], bone ununion [RD = 0.02, 95% CI (-0.01, -0.05)] and postoperative complications [MD = 0.01, 95% CI (-0.03, -0.04)].

CONCLUSIONCompared with single internal fixation, bone substitutes augmentation combined with internal fixation for the treatment of proximal femoral fractures in the elderly less occur re-displacement and could obtain better functional recovery.

Aged ; Aged, 80 and over ; Bone Substitutes ; administration & dosage ; Female ; Femoral Fractures ; surgery ; therapy ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Randomized Controlled Trials as Topic ; Treatment Outcome

Objective To investigate the role of and relationship between reactivity to autologous serum and dermatophagoides farinae (Df) in the pathogenesis of chronic urticaria (CU). Methods Autologous serum skin test (ASST) and skin prick test (SPT) to Df were carried out in 831 patients with CU. The correlation between reactivity to autologous serum and Df was statistically analyzed. Results The positivity rate of ASST and SPT to Df was 51.74% and 64.62%, respectively in the 831 patients. SPT was positive in 56.52% of patients with positive ASST and in 73.86% of those with negative ASST (P ＜ 0.05). In patients with positive ASST, the degree of autologous serum reactivity was negatively correlated with that of reactivity to Df (P ＜ 0.05). Conclusions The skin reactivity to Df and autologous serum plays an important role in the pathogenesis of CU, and the degree of the reactivity to Df and autologous serum is negatively correlated. To conduct ASST and SPT simultaneously in patients with CU may favor the clinical classification and therapy of CU.

Objective To discuss the application of longitudinal reduction of Chinese traditional medicine in surgical treatment of distal radius comminuted fractures in the elderly. Methods Before the operation, the 54 elderly patients with the fracture were reduced by longitudinal direction under anesthesia, then they were treated with minimally invasive plate osteosynthesis in the approach upon the reduction condition and fracture types. Results After 12-month follow-up, the fractures were all healed. The mean healing time of the fractures was 8 weeks (6-12 weeks). At the end of follow -up, the mean range of motion of the wrist was at 50°of flexion, 45°of extension, 30° of ulnar deviation, at 20° of radial deviation. According to the criteria of Gartland and Werley, the results were excellent in 35 cases, good in 17 cases, fair in 2 cases and poor in 0 case. Conclusions It is vital to provide a Chinese traditional longitudinal reduction before invasive surgical plate fixation in treatment of distal radius comminuted fractures, to avoid large-area exposure of fracture site, minimize the damage to the soft tissue, maintain reduction of post operation and achieve good wrist function.

Through morphological observation, HE staining, TRAP staining and toluidine blue staining of bone resorption pits to identify osteoclasts which obtained by 1α, 25-(OH)2 VitD3 inducing rabbit bone marrow cells. Three indicators-TRAP staining, TRAP enzyme activity detecting and the number and area of bone resorption pits were adapted to detect the effect of Sargentodoxae caulis on the activity of osteoclasts. Culturing MC3T3-E1 Subclong 14 cells and detecting the effect of S. caulis on differentiation and proliferation of them by MTT and detecting the alkaline phosphatase in cells. The results show that all of the low, middle and high doses of water and alcohol extracts of S. caulis have significant inhibition on osteoclast differentiation and bone resorption ability in a dose-dependent manner. The low and middle doses of water and alcohol extracts of S. caulis can stimulate differentiation and proliferation of MC3T3-ElSubclone 14 cells, which indicates S. caulis can prevent osteoporosis and the function could be achieved by inhibiting osteoclast activity and promoting the proliferation and differentiation of osteoblasts.
Animals ; Bone Resorption ; drug therapy ; physiopathology ; Cell Differentiation ; drug effects ; Cell Proliferation ; drug effects ; Cells, Cultured ; Drugs, Chinese Herbal ; pharmacology ; Humans ; Mice ; Osteoclasts ; cytology ; drug effects ; Rabbits

Objective To evaluate the clinical outcome of anterior subcutaneous internal fixator (ASIF) system with triple pedicle screws in stabilizing Tile type B pelvic fractures.Methods From August 2013 to April 2015,38 cases of pelvic fractures were stabilized with the ASIF system using triple pedicle screws.There were 24 male and 14 female cases,with the age range of 16-74 years [(41.5 ±5.5) years].Causes of injury were traffic accidents (n =28),crushing injury (n =6) and fall from height (n =4).All cases had Tile type B fractures,including 5 cases of type B1,29 type B2 and 4 type B3.Intraoperative blood loss,operation time,length of hospitalization and complications were detected.Postoperative function evaluation was done using the Majeed score.Results All cases were available for follow-up of 6.5-13.5 months (mean,10.5 months).Intraoperative blood loss was (30.8 ± 7.1)ml,operation time was (51.5 ± 9.2) minutes,and length of hospitalization was (5.0 ± 3.1) days.Among them,34 cases showed bilateral hip flexion over 95 degrees after operation,and 24 cases were able to squat fully 1.5 months after operation.No cases experienced nonunion,delayed union,superficial or deep surgical wound infection,urethral injury and dysuresia.Two cases developed temporary lateral femoral cutaneous nerve numbness.According to the Majeed score,excellent results were found in 32 cases (84％) and good results in 6 cases (16％).Conclusion ASIF system with triple pedicle screws results in high healing rate and few complications in the treatment of Tile type B pelvic fractures,and hence deserves popularization in clinic.

Objective To explore the effect of risk assessment tracking management in reducing unplanned extubation in patients with tracheal intubation.Methods From January to December 2015,120 patients with tracheal intubation in ICU were selected as the control group with routine nursing care of indwelling endotracheal intubation.From January to November 2016,120 patients with tracheal intubation were selected as the observation group,where the risk assessment and risk management were done on the basis of routine nursing as in the control group.The two groups were compared in terms of tracheal intubation and unplanned extubation related knowledge,the implementation of the risk assessment,the accuracy in risk assessment and the incidence of unplanned extubation.Result The tracheal intubation and unplanned extubation related knowledge in the observation group was lower than that of the control group (P＜0.001),The implementation rate of the risk assessment and the accuracy in risk assessment in the observation group were significantly higher than the control group,and the rate of unplanned extubation in the observation group was significantly lower than in the control group (all P＜0.01).Conclusion The implementation on risk assessment and extubation-preventing nursing quality tracing management can enhance the awareness and knowledge of preventing trachea cannula exodus,improve the quality of nursing and reduce the rate of unplanned extubation.