BACKGROUND:Rehabilitation outcomes of patients with spinal cord injury are associated with degree of injury, therapeutic method, recovery time and subsequent treatment. Multidisciplinary, comprehensive, specialized rehabilitation unit can provide a better recovery after spinal cord injury. OBJECTIVE:To review the effect or combined effect of rehabilitation units after spinal cord injury. METHODS:A computer-based search of Springer and PubMed databases was done using the keywords of“spinal cord injury, rehabilitation practice, outcomes”, which appeared in the title and abstract. Final y, 44 English papers were included in result analysis. RESULTS AND CONCLUSION:Based on practical evidence, various rehabilitation practices are recognized, and then, the relevant information is connected with the outcomes to evaluate the efficacy of rehabilitation interventions. Studies have shown that age had no influence on rehabilitation outcomes in traumatic and non-traumatic mixed samples, and there is also little difference in the rehabilitation outcomes between male and female. Incidence of complications is lowest in the vast majority of patients with spinal cord injury who are initial y admitted to a specialist center of spinal cord injury. The hospital stay can be shorten in patients who can be admitted to a multidisciplinary, comprehensive, specialized division of spinal cord injury as early as possible. Patients who can receive regular, comprehensive outpatient fol ow-up show no significant differences in health perception, independence and depression, but the frequency and degree of certain secondary situations can be significantly reduced.

BACKGROUND: Animal experiments show that hormone can induce femoral capillaries poor filling, decrease capillaries density in unit area, and reduce capillaries in cancellous bone inferior to cartilage. However, the involved mechanism remains unclear.OBJECTIVE: To explore the changes of vascular endothelial growth factor (VEGF) during the progress of glucocorticoid induced osteonecrosis.METHODS: The Chinese white rabbits were randomly divided into horse serum plus prednisone group and pradnisone alone group. Typical osteonecrosis model was established by Matsui Method. 10 mL/kg horse serum was injected into horse serum plusprednisone group through the ear margin veins, followed by additional injection after 2 weeks and intraparit0neal injection of prednisone, 45 mg/kg per day for 5 consecutive days. The control group was only subjected to prednisona, 45 mg/kg per day for 5 consecutive days. The VEGF expression was observed by means of reverse transcription polymerase chain react.ion (RT-PCR)before, 7, 14 days after administration, 1, 3, 7, 21, 35 and 49 days following the first application of hormone. The capillaries were quantified.RESULTS ANDCONCLUSION: The VEGF was significantly increased 7 days following horse serum, and gradually decreased to levels before treatment 1 days following hormone. The VEGF mRNA, expression decreased with increasing hormone treatment, in particular at 7 and 21 days (P ＜ 0.05), but cannot restore to normal level. Micrevascular count was decreased gradually, and at 21 days decreased to the minimum, positively correlated with VEGF expression. Results show that adrenal glucocorticoid inhibited VEGF expression in bone tissue and restrained angiogenesis, resulting in ischemia and hypoxia of the local environment in bone tissue. VEGF expression highly correlates with microvascular count and osteonecrosis degree.

BACKGROUND:Ti6Al4V is a titanium aloy that is widely used in human joint replacement, but its modulus of elasticity is greater than human bone, resulting in the bad stability of the prosthesis. Ti35Nb3Zr2Ta, a new βtitanium aloy, has a lower modulus of elasticity, and maybe becomes a new-generation human joint prosthesis material that has a better biocompatibility. OBJECTIVE:To study the biocompatibility of Ti35Nb3Zr2Ta in prosthesis. METHODS:Wanfang, CNKI and PubMed databases were retrieved using a computer with “new β titanium;prosthesis; biocompatible” as keywords, and the retrieval time ranged from 2010 to 2015. Articles focusing on current application status for medical prosthesis materials and the biocompatibility of Ti35Nb3Zr2Ta in prosthesis were selected. RESULTS AND CONCLUSION:Compared with Ti6Al4V, Ti35Nb3Zr2Ta has higher surface roughness and smaler surface contact angle; the alkaline phosphatase activity and amount of calcium deposits in osteoblasts cultured at Ti35Nb3Zr2Ta is significantly higher than that at Ti6Al4V. Ti35Nb3Zr2Ta has good biocompatibility, and can be considered to be widely used as joint prosthesis material further.

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AIM:To investigate the effect of Notch-1 knockdown on the growth of dihydroartemisinin-inhibited human osteosarcoma cell line U-2OS.METHODS:U-2OS cells treated with different concentrations of dihydroartemisinin (5, 10, 15 and 20μmol/L) were collected.The expression of Notch-1, MMP-2, MMP-9 and Hes-1 at mRNA and protein levels was measured by real-time PCR and Western blotting, respectively.U-2OS cells were transfected with Notch-1 siRNA for 24 h and incubated with dihydroartemisinin for another 24 h.The cell apoptotic rate , protein expression of MMP-2, MMP-9 and Hes-1, and the migration ability were measured by MTT assay , Western blotting and Transwell experiment , respectively.RESULTS:Dihydroartemisinin (5, 10, 15 and 20 μmol/L) decreased the expression of Notch-1, MMP-2, MMP-9 and Hes-1 at mRNA and protein levels in a dose-dependent manner .Down-regulation of Notch-1 significantly en-hanced the effect of dihydroartemisinin on the cell apoptosis , the protein expression of MMP-2, MMP-9 and Hes-1, and mi-gration ability ( P<0.05 ) .CONCLUSION: Notch-1 pathway is involved in the process of dihydroartemisinin-inhibited U-2OS cell growth.Knockdown of Notch-1 augments the inhibitory effect of dihydroartemisinin on U-2OS cell viability.

BACKGROUND:Previous experiments have prepared shape memory polymer based on D,L-poly(lactic acid). According to domestic technical requirements for biological y evaluating biomaterials and medical equipments, tissue-engineered grafts must be subjected to preclinical experiment for biosecurity and cytocompatibility evaluation.
OBJECTIVE:To observe the biosecurity of the shape memory polymer based on D,L-poly(lactic acid).
METHODS:(1) Bacterial endotoxin test:polymer extract, endotoxin working standard solution and checking
standard water were added into limulus reagent, respectively. (2) Sensitization test:Polymer extract+Freund’s complete adjuvant+physiological saline and Freund’s complete adjuvant+physiological saline were injected into the scapula of Kunming mice. After induction by intradermal injection, local induction and excitation, stimulate skin erythema and edema degree were observed in animals. (3) Acute toxicity test:Kunming mice received intraperitoneal injection of 100%, 50%, 25%polymer leaching solution and physiological saline, respectively. (4) 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay for cel proliferation:The direct method was that human umbilical cord vascular endothelial cel s were inoculated onto the polymer film, lactic acid and glass, respectively;the indirect method was that human umbilical cord vascular endothelial cel s were inoculated into the polymer leaching solution, acrylamide solution and 1640 culture solution.
RESULTS AND CONCLUSION:This shape memory polymer based on D,L-poly(lactic acid) is free of bacterial contamination in compliance with the biosecurity standards, and it has no al ergenic and toxicity but has good cytocompatibility.

A series of poly (lacticacid-co-glycolicacid)-poly(ethylene glycol) (PLGA-PEG, PELGA) block copolymers and poly (ethylene glycol)-poly (lacticacid-co-glycolicacid)-poly (ethylene-glycol) (PELGE) was synthesized by ring-opening polymerization. PELGA nanoparticles and PELGE nanoparticles were prepared using the emulsion-solvent evaporation technique (O/W). To study the behavior and mechanism of the degradation of PELGA-NP and PELGA-NP, we determined the lactic acids by UV spectrophotometry. The method confirmed that degradation was much faster for polymers with a decrease in the LA content of the polymers or an increase in the PEG content of the polymers.
Biocompatible Materials ; chemistry ; Biodegradation, Environmental ; Drug Carriers ; Drug Delivery Systems ; Humans ; Lactic Acid ; chemical synthesis ; chemistry ; Microspheres ; Nanostructures ; Nanotechnology ; Polyesters ; chemical synthesis ; chemistry ; Polyethylene Glycols ; chemical synthesis ; chemistry ; Polyglactin 910 ; chemistry ; Polyglycolic Acid ; chemical synthesis ; chemistry ; Polymers ; chemical synthesis ; chemistry

UNLABELLEDA new kind of Interbody Cage made of multi-amino acid copolymer/tri-calcium phosphate (MAACP/TCP) composite was designed, and the purpose of this study was to evaluate immediate stability of MAACP/TCP Cage in a goat cervical spine model (C3-4). After the motion segment C3-4 was tested intact, 27 goat cervical spines were divided into three groups randomly. There were four groups group A. MAACP/TCP Cage group (n = 9), group B2 titanium Cage group (n = 9), group C2 autologous tricortical iliac crest bone group (n = 9) and group D: intact group (n = 27). Different Cage groups were implanted after complete discectomy (C3-4) was performed. Then they were tested in flexion, extension, axial rotation, and lateral bending with a nondestructive stiffness method. The range of motion (ROM) and relative stiffness were calculated and compared between groups. In comparison to the intact motion segment, MAACP/TCP Cage showed a significantly (P < 0.05) lower ROM and a significantly (P < 0.05) higher relative stiffness in flexion and lateral bending. In comparison to the tricortical iliac crest bone graft, MAACP/TCP Cage showed a significantly (P < 0.05) lower ROM and a significantly (P < 0.05) higher relative stiffness in extension, flexion and lateral bending. There was no significant (P > 0.05) difference in the ROM and relative stiffness between MAACP/TCP Cage and titanium Cage in extension, flexion and lateral bending. In comparison to titanium Cage, MAACP/TCP Cage showed a significantly (P < 0.05) higher ROM and a significantly (P < 0.05) lower relative stiffness in rotation.

CONCLUSIONMAACP/TCP Cage can provide enough immediate stability for cervical interbody fusion in a goat cervical spine model.

Absorbable Implants ; Amino Acids ; chemistry ; Animals ; Biomechanical Phenomena ; Calcium Phosphates ; chemistry ; Cervical Vertebrae ; surgery ; Evaluation Studies as Topic ; Female ; Goats ; Implants, Experimental ; Polymers ; chemistry ; Spinal Fusion ; instrumentation

Objective To analyze the efficacy and safety of nalbuphine in patients with sedative analgesia in intensive care unit (ICU). Methods A prospective observation was conducted. The adult patients with mild and moderate analgesia in general ICU of the First Affiliated Hospital of Zhengzhou University from January to November in 2017 were enrolled, and they were divided into nalbuphine group and sufentanil group in proper order. The nabobrown group was given 40 mg nabobrown, the sufentanil group was given 0.1 mg sufentanil, both of which were injected with 50 mL normal saline for continuous intravenous infusion in micro-pump. Infusion speed was checked according to pain level. The analgesic target was critical-care pain observation tool (CPOT) score < 2. The change in hemodynamics of patients in both groups were observed, and CPOT score and Richmond agitation-sedation scale (RASS) score were recorded before and l, 3, 5, 12, 24 hours after administration. The analgesic and sedative effects of two drugs were evaluated. Results A total of 141 patients were enrolled, including 71 patients in nalbuphine group and 70 in sufentanil group. There was no significant difference in general data including gender, age, body weight, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) or pain source, as well as baseline hemodynamics parameter between the two groups. At 1 hour and 3 hours after administration, nalbuphine had no effect on blood pressure, but the heart rate was decreased slightly, while the heart rate and blood pressure of the sufentanil group were decreased obviously. The two drugs could make the heart rate and blood pressure fluctuate obviously with the time of medication, but there was no statistical difference between the two drugs. The two drugs had no significant effect on pulse oxygen saturation (SpO2) during analgesia. The average dosage of nalbuphine was 0.03 (0.02, 0.05) mg·kg-1·h-1in the nalbuphine group, and the patient was satisfied with the analgesic effect until 3 hours after the use of the drug, and CPOT score was significantly decreased as compared with that before administration [1.0 (1.0, 2.0) vs. 3.0 (2.0, 4.0), P < 0.01], and the sedative effect was increased, RASS score was significantly lower than that before administration [0 (0, 1.0) vs. 1.0 (1.0, 2.0), P < 0.01]. No patients in naporphine group were treated with sufentanil due to unsatisfactory analgesia. The average dosage was 0.11 (0.06, 0.14) μg·kg-1·h-1in the sufentanil group, the patient was satisfied with the analgesic effect until 5 hours after administration, and the CPOT score was significantly lower than that before administration [1.0 (1.0, 2.0) vs. 4.0 (3.0, 6.0), P < 0.01], and the sedative effect was significantly increased, RASS score was significantly lower than that before administration [0 (-1.0, 0) vs. 2.0 (1.0, 2.0), P < 0.01]. The scores of CPOT and RASS in the sufentanil group were significantly higher than those of the naporphine group before use, so the decrease in the CPOT and RASS scores of the two drugs was further analyzed, which indicated the decrease in CPOT score of naporphine group was significantly lower than that in sufentanil group from 3 hours on [1.0 (0, 2.0) vs. 2.0 (1.0, 3.0), P < 0.05], and the decrease in RASS score of naporphine group was significantly lower than that in sufentanil group from 1 hour on [0 (0, 1.0) vs. 1.0 (0, 2.0), P < 0.01]. It suggested that naporphine could achieve sustained and stable analgesic effect and avoid excessive sedation caused by sufentanil. Conclusions Naporphine had a sustained and stable analgesic effect on patients with mild and moderate ICU analgesia. The onset time of naporphine was equivalent to sufentanil, and it had a certain sedative effect and less influence on hemodynamics.

Objective To evaluate the efficacy and safety of terlipressin for septic shock.Methods A randomized double-blind placebo-controlled pilot study was carried out in the general ICU of the First Affiliated Hospital of Zhengzhou University from June 1st 2015 to May 31st 2016.The septic shock patients with a mean arterial pressure below 65 mmHg despite adequate volume resuscitation were enrolled.Patients were randomized (random number) to give continuous infusions of either terlipressin[0.6-2.6 μg/(kg·h)] or norepinephrine(7-30 μg/min).Open label norepinephrine or other catecholamines were additionally infused if the mean arterial pressure failed to reach 65 mmHg.Treatment was continued until shock corrected,death or withdrawn from this study.Correcting rate of shock was the primary end point,the secondary end points included open labeled norepinephrine requirements,the 28 d survival rate and adverse events.The quantitative data of the two groups were compared by t test or Wilcoxon rank sum test.The enumeration data were compared by chi square test or Fisher exact probability method,and the survival data were analyzed by Kaplan-Meier method.Results A total of 28 patients were enrolled.The full analysis set was 28,the per-protocol set was 25,and the safety set was 28.The key demographics and baseline characteristics were similar between the two groups(P＞0.05).The results for the per-protocol set were followed up.The correcting rate of shock between the two groups were similar at the end of treatment[81.82％(9/11)vs.57.14％(8/14),P=0.190].The open label norepinephrine requirements of the trial group and control group for the 0,6,12,24,48 h time point were 0.661,0.921,1.583,1.241,2.143,1.371,1.071,1.261,0.370,1.001 μg/(kg·min),respectively with no significant difference(P＞0.05).The 28 d survival rate of the trial group and control group were 63.64％(7/11)and 50.00％(7/14) respectively with no statistical significance(P＞0.05).There was no significant difference in 28 d survival analyzed using Kaplan-Meier plot between two groups(P=0.470).There were two patients with ischemia of fingers,one patient with hyponatraemia and one patient with ischemia of intestine accompanied by hyponatraemia occurred after treatment with terlipressin,and one patient with isehemia of fingers occurred after treatment with norepinephrine.The incidence of adverse event for the trial group and control group were 30.77％(4/13) and 6.67％(1/15) with no significant difference(P=0.122).Conclusions Terlipressin is an effective agent for treating septic shock.The total adverse event rate of terlipressin was similar to that ofnorepinephrine.