BACKGROUND:Atlantoaxial anatomical structures were special. Compared with thoracolumbar vertebrae, there is no fixed anatomical marker for screw implantation. Moreover, pedicle structural variation is great. The current consensus view is to suggest an individualized program of pedicle screws. The development of orthopedic digital software technology provides a novel manner for preoperative design.
OBJECTIVE:To original y design 3D matrix model, to observe atlas pedicle channel, pedicle screw safety zone, to measure optimal program for screw fixation, and to simplify preoperative design of entering pedicle screw.
METHODS:Continuous atlas CT data of 12 healthy adults in picture archiving and communication system of People’s Hospital, Three Gorges University were imported into Mimics 10.01 software. There were seven males and five females, at the age of 30-65 years old, averagely 45 years. After three-dimensional reconstruction, the three-dimensional reconstruction models were imported into 3Dmax 2009 as .dwg format. The reference three-dimensional planes and the sites of nail insertion were determined by the atlas modeling. The modeling consisted of 17×17×2 elements and the transverse section angles ranged from 0° to 40° and the sagittal section angles ranged from 0° to 40° with a space of 2.5°. 578 elements were used to simulate pedicle screw array model. Perspective observation showed that the diameter was 3.5 mm, and length was 22 mm in pedicle channel. Thus, safety area, best screw channel and screw angle were analyzed.
RESULTS AND CONCLUSION:The total number of elements in the matrix study was 17×17×2×12 in 12 subjects. 175 screws in total of 6 936 units could safely meet the operative standard. No significant difference in the number of pedicle screw between left and right sides (P>0.05). Results indicated that the digital three-dimensional modeling technology is an effective, simple, accurate way in the preoperative design and measurement for atlas pedicle surgery.

Objective Moyamoya disease is a progressive cerebrovascular occlusive disease. The etiology of the disease is unknown. most think that Moyamoya usually presents with cerebral ischemia in children and intracranial hemorrhage in adults. But we have some adults present with cerebral ischemia .This article will help us know better about moyamoya disease in adults present with cerebral ischemia. And will let us know better about treatment and prognosis of this disease.Methods We reviewed our experience 88 adults angiographically diagnosed patients with moyamoya. There are 49 patients with moyamoya disease initially present with cerebral ischemia. We report their clinical presentation, radiological findings, management, and clinical outcomes. Results The incidence of moyamoya disease presents with cerebral ischemia is 55.7% in adults .The mean age of patients at symptom onset was 32 years (range, 18~64 years). Ischemic strokes or transient ischemic attacks were the predominant initial presentations.7 cases present intracranial haemorrhage in follow-up period. There was no difference in clinical representation, image and cerebral infarction in this 7 case.Conclusions Moyamoya usually presents with cerebral ischemia in adults higher than we think. diagnosis and treatment of moyamoya disease in adults is essential to minimize residual mental and physiologic deficits. If we find patients 30-40 years old ,with cerebral infarction that can’t explain in conventional mode, we should pursuit these patients, in order to exclude Moyamoya disease .Structured multicenter randomized clinical trials are needed to further assess the best treatment modalities for patients with moyamoya.

ObjectiveTo investigate the relationship between intervertebral disc pressure and clinical efficacy after the minimally invasive treatment of cervical disc herniation. MethodsForty-seven patients with cervical disc herniation treated by disc radiofrequency ablation, and monitored the intervertebral disc pressure after that. Moreover, the correlation between the pressure and the clinical efficacy was observed. ResultsAll cases were successfully completed under pressure monitoring. Forty-seven cases underwent a follow-up of 1-25 months,according to JOA score,using postoperative improvement rate (Hirabashi formula) to assess the clinical efficacy. High efficacy in 25 cases,fine efficacy in 19 cases,good efficacy in 3 cases,high and fine efficacy rate was 93.6％ (44/47). The postoperative intervertebral discpressure was significantly correlated with improvement rate after cervical minimally invasive surgery (P ＜0.05). ConclusionsRadiofrequency ablation treatment of cervical disc herniation is safe and effective minimally invasive technique. If the pressure in the postoperative intervertebral disc is 3 kPa,it will get better prognosis.

A novel unsaturated polyphosphoester (UPPE) was devised in our previous research, which is a kind of promising scaffold for improving bone regeneration. However, the polymerization process of UPPE scaffolds was unfavorable, which may adversely affect the bioactivity of osteoinductive molecules added if necessary, such as recombinant human bone morphogenetic protein-2 (rhBMP2). The purpose of this study was to build a kind of optimal scaffold named UPPE-PLGA-rhBMP2 (UPB) and to investigate the bioactivity of rhBMP2 in this scaffold. Furthermore, the cytotoxicity and biocompatibility of UPB scaffold was assessed in vitro. A W1/O/W2 method was used to fabricate PLGA-rhBMP2 microspheres, and then the microspheres were added to UPPE for synthesizing UPB scaffold. The morphological characters of PLGA-rhBMP2 microspheres and UPB scaffolds were observed under the scanning electron microscopy and laser scanning confocal microscopy. The cumulative release of UPB scaffolds was detected by using ELISA. The cytotoxicity and biocompatibility of UPB scaffolds were evaluated through examining the adsorption and apoptosis of bone marrow stromal cells (bMSCs) seeded on the surface of UPB scaffolds. The bioactivity of rhBMP2 in UPB scaffolds was assessed through measuring the alkaline phosphates (ALP) activity in bMSCs seeded. The results showed that UPB scaffolds sequentially exhibited burst and sustained release of rhBMP2. The cytotoxicity was greatly reduced when the scaffolds were immersed in buffer solution for 2 h. bMSCs attached and grew on the surface of soaked UPB scaffolds, exerting well biocompatibility. The ALP activity of bMSCs seeded was significantly enhanced, indicating that the bioactivity of rhBMP2 remained and still took effect after the unfavorable polymerization process of scaffolds. It was concluded that UPB scaffolds have low cytotoxicity, good biocompatibility and preserve bioactivity of rhBMP2. UPB scaffolds are promising in improving bone regeneration.

Objective To investigate the efficacy and safety of low-dose rituximab therapy and sequential maintenance for patients with refractory idiopathic thrombocytopenic purpura. Methods Thirty-three patients with refractory idiopathic thrombocytopenic purpura received intravenous rituximab at the dose of 100 mg once a week for 4 consecutive weeks. Complete blood cell count and serum concentrations of immunoglobulin (IgG,IgM and IgA) were monitored regularly. The numbers of CD3+ and CD19+ CD20+ lymphocyte cells were assayed by flow cytometry before and after therapy. Twenty-five patients with responses(complete response and response) were divided into maintained group (12 patients) and control group (13 patients) by random digits table method. The patients in maintained group were treated with rituximab 100 mg every 6 months. The efficacy of maintenance therapy was evaluated through long-term follow-up. Results The complete response(CR) rate, response (R) rate and no response(NR) rate were 48.48%(16/33), 27.27%(9/33) and 24.24% (8/33), respectively. As a result, total effective rate was 75.76% (25/33). There were no significant changes of peripheral blood white blood cell count,hemoglobin,serum immunoglobulin and CD3+lymphocyte counts before and after treatment (P>0.05). However, CD19+ CD20+ cells were almost depleted in patients treated with rituximab: (3.71±2.64)×106/L vs. (279.33±92.78)×106/L, P<0.01. Five patients suffered from allergic response, and 1 patient developed pneumonia and respiratory failure. The relapse rates of maintained group and control group were 1/12 and 4/13, respectively. Conclusions Treatment with low-dose rituximab may be an effective and safe approach in patients with idiopathic thrombocytopenic purpura. Relapse rates can be decreased through maintenance therapy with refractory low-dose rituximab. However, the optimal therapeutic schedule need further investigation.

BACKGROUNDHypocretin (HCRT) signaling plays an important role in the pathogenesis of narcolepsy and can be significantly influenced by Chinese herbal therapy. Our previous study showed that xingshentongqiao decoction (XSTQ) is clinically effective for the treatment of narcolepsy. To determine whether XSTQ improves narcolepsy by modulating HCRT signaling, we investigated its effects on SH-SY5Y cell proliferation, apoptosis, and HCRT receptor 1/2 (orexin receptor 1 [OX1R] and orexin receptor 2 [OX2R]) expression. The signaling pathways involved in these processes were also assessed.

METHODSThe effects of XSTQ on proliferation and apoptosis in SH-SY5Y cells were assessed using cell counting kit-8 and annexin V-fluorescein isothiocyanate assays. OX1R and OX2R expression was assessed by quantitative real-time polymerase chain reaction analysis. Western blotting for mitogen-activated protein kinase (MAPK) pathway activation was performed to further assess the signaling mechanism of XSTQ.

RESULTSXSTQ reduced the proliferation and induced apoptosis of SH-SY5Y cells. This effect was accompanied by the upregulation of OX1R and OX2R expression and the reduced phosphorylation of extracellular signal-regulated kinase (Erk) 1/2, p38 MAPK and c-Jun N-terminal kinase (JNK).

CONCLUSIONSXSTQ inhibits proliferation and induces apoptosis in SH-SY5Y cells. XSTQ also promotes OX1R and OX2R expression. These effects are associated with the repression of the Erk1/2, p38 MAPK, and JNK signaling pathways. These results define a molecular mechanism for XSTQ in regulating HCRT and MAPK activation, which may explain its ability to treat narcolepsy.

Apoptosis ; drug effects ; Blotting, Western ; Cell Proliferation ; drug effects ; Drugs, Chinese Herbal ; pharmacology ; Humans ; Mitogen-Activated Protein Kinases ; metabolism ; Orexin Receptors ; metabolism ; Real-Time Polymerase Chain Reaction

A novel unsaturated polyphosphoester (UPPE) was devised in our previous research, which is a kind of promising scaffold for improving bone regeneration. However, the polymerization process of UPPE scaffolds was unfavorable, which may adversely affect the bioactivity of osteoinductive molecules added if necessary, such as recombinant human bone morphogenetic protein-2 (rhBMP2). The purpose of this study was to build a kind of optimal scaffold named UPPE-PLGA-rhBMP2 (UPB) and to investigate the bioactivity of rhBMP2 in this scaffold. Furthermore, the cytotoxicity and biocompatibility of UPB scaffold was assessed in vitro. A W1/O/W2 method was used to fabricate PLGA-rhBMP2 microspheres, and then the microspheres were added to UPPE for synthesizing UPB scaffold. The morphological characters of PLGA-rhBMP2 microspheres and UPB scaffolds were observed under the scanning electron microscopy and laser scanning confocal microscopy. The cumulative release of UPB scaffolds was detected by using ELISA. The cytotoxicity and biocompatibility of UPB scaffolds were evaluated through examining the adsorption and apoptosis of bone marrow stromal cells (bMSCs) seeded on the surface of UPB scaffolds. The bioactivity of rhBMP2 in UPB scaffolds was assessed through measuring the alkaline phosphates (ALP) activity in bMSCs seeded. The results showed that UPB scaffolds sequentially exhibited burst and sustained release of rhBMP2. The cytotoxicity was greatly reduced when the scaffolds were immersed in buffer solution for 2 h. bMSCs attached and grew on the surface of soaked UPB scaffolds, exerting well biocompatibility. The ALP activity of bMSCs seeded was significantly enhanced, indicating that the bioactivity of rhBMP2 remained and still took effect after the unfavorable polymerization process of scaffolds. It was concluded that UPB scaffolds have low cytotoxicity, good biocompatibility and preserve bioactivity of rhBMP2. UPB scaffolds are promising in improving bone regeneration.
Bone Morphogenetic Protein 2 ; chemistry ; pharmacology ; Bone Regeneration ; drug effects ; Humans ; Lactic Acid ; chemistry ; pharmacology ; Phosphatidylinositol Phosphates ; chemistry ; pharmacology ; Polyglycolic Acid ; chemistry ; pharmacology ; Tissue Scaffolds

Objective To analyze and estimate, the treatment of patients with histologically confirmed subependymal giant-cell astroeytoma (SEGCA). Methods The data from 23 patients with SEG-CA who were diagnosed between February 1995 and February 2008 were retrospectively evaluated. Various combinations of surgery and radiotherapy had been used for treatment. Results Total resection was 16 cases, subtotal resection was 7 cases, radiotherapy was 17 cases. The average follow-up time was 53 months.One postoperative SEGCA recurrence. Epilepsy was totally disappeared in 17.6% (3/17), partly disappeared in 47.1%(8/17). All cases survived. Conclusions The key of treatment is total resection. The significance of radiotherapy is not sure. The overall prognosis of SEGCA is favorable.

Objective:To explore the anxiety level, influencing factors among surrogate decision-makers of patients with acute ischemic stroke during thrombolysis decision-making, and their correlation with decision-making duration.Methods:Acute ischemic stroke patients and their surrogate decision-makers who visited the Emergency Department of the First Affiliated Hospital of Zhengzhou University from September 2019 to December 2021 were selected as the research subjects.Sociodemographic data and disease related data of patients and surrogate decision-makers were collected.Surrogate decision-makers were evaluated with the state-trait anxiety inventory, decision participation expectation scale, Wake Forest physician trust scale, and perceived social support scale.SPSS 26.0 software was used for data processing.Pearson correlation analysis, Spearman correlation analysis and ridge regression analysis were used for statistical analysis.Results:The score of state anxiety of decision-makers was (49.47±9.04), and 18.2% (70/383) of decision-makers had a decision duration exceeding 15 minutes.The score of state anxiety of decision-makers was positively correlated with decision duration ( r=0.189, P<0.001). The influencing factors of state anxiety level of decision-makers included sociodemographic factors (age of decision-makers and patients, relationship between payers and patients, whether decision-makers bear the current medical expenses, type of medical insurance for patients), psychological factors (trust level in physicians, perceived social support), factors related to patient disease (numbers of stroke relapses, National Institutes of Health stroke scale scores for patients), characteristics of the decision-making process (whether patients participate in the decision-making process, and the role of decision-makers in the decision-making process) (all P<0.05). Conclusion:Most surrogate decision-makers experience anxiety.Medical staff should pay attention to the emotions of decision-makers and adopt appropriate communication skills when communicating with informed consent for thrombolysis, alleviate the anxiety of surrogate decision-makers, so as so reduce the decision-making duration.

Objective: To investigate the effects of health management based on the theory of protection motivation on fatigue status, neurological function recovery and life ability of stroke patients, and evaluate its clinical effects. Methods: A total of 120 stroke patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to January 2019 were selected as subjects. Randomized digital table method was used to divided them into observation group and control group, 60 cases in each group; the control group underwent routine nursing and follow-up of neurology, and the observation group was given health management based on protection motivation theory on the basis of the control group. The Fatigue Severity Scale (FSS) was used to assess the patient's fatigue, the European Stroke Scale (ESS) was used to evaluate the patient's neurological function, the modified Barthel index was used to assess the patient's viability. The fatigue, neurological recovery, and changes in living ability were compared between the two groups before and after the nursing intervention. Results: The Scores of FSS, MBI and ESS of the observation group were 45.34±8.84, 54.3±4.69 and 45.24±4.18 before intervention and 32.48±5.80, 75.50±4.93, 63.12±3.32 after intervention. The Scores of FSS, MBI and ESS of the control group was 44.97±8.47, 53.47±4.20, 43.48±5.67 before intervention and 39.59±7.43, 63.81±3.25, 55.32±3.48 after intervention. The difference after intervention between the two groups was statistically significant (t values were 15.335, 12.562, 5.843, P<0.01). The difference in the observation group before and after intervention was statistically significant (t values were 9.422, 24.133, 25.945, P<0.01). The differences in the control group before and after intervention was statistically significant (t values were 3.699, 15.082, 13.786, P<0.01). Conclusions Health management based on the theory of protection motivation is more effective than routine nursing to improve the fatigue, neurological function and life ability of stroke patients.