OBJECTIVE:To investigate the effects of mannitol combined with dexamethasone on related indexes of patients with infectious brain edema.METHODS:A total of 120 patients with infectious cerebral edema were divided into control group (60 cases) and observation group (60 cases) according to therapy plan.Control group was given Furosemide injection 20 mg+20％ Mannitol injection 1 g/(kg,time)+0.9％ Sodium chloride injection 10 mL intravenously,every 6 h,3 days later adjusting drug dose according to the disease condition of patients.Observation group was given Dexamethasone injection 10-20 mg+20％ Mannitol injection 1 g/(kg·time)+ 0.9％ Sodium chloride injection 10 mL intravenously,every 6 h,3 days later adjusting drug dose according to the disease condition of patients.A treatment course lasted for 7 d,and both groups were treated for 2 courses of treatment.The levels of NO,IL-1 and TNF-α,mortality and the occurrence of sequelae before and after treatment as well as the occurrence of ADR were observed in 2 groups.RESULTS:Before treatment,there was no statistical significance in the levels of NO,IL-1 or TNF-α between 2 groups (P＞0.05).After treatment,the levels of NO,IL-1 and TNF-α in 2 groups were significantly lower than before treatment,and the observation group was significantly lower than the control group,with statistical significance (P＜0.05).The incidence of mortality,sequelae and ADR in observation group were significantly lower than control group,with statistical significance (P＜0.05).CONCLUSIONS:Mannitol combined with dexamethasone can reduce inflammatory factor level,the incidence of sequelae and mortality,without increasing the incidence of ADR.

BACKGROUND:Deep vein thrombosis after total knee arthroplasty has attracted increasing attention in recent years,but how to detect deep vein thrombosis in the early time in clinical practice remains unclear.Whether it is necessary to perform type-B ultrasonic or other invasive examination in lower limbs has become a hot issue.OBJECTIVE:To explore the significance of D-Dimer and fibrin degradation products in the prediction of deep vein thrombosis after total knee arthroplasty.METHODS:56 patients received total knee arthroplasty were colected from Department of Orthopedics,The 306th Hospital of Chinese PLA,between December 2012 and February 2014.The D-Dimer and fibrin degradation products were dynamicaly monitored before operation and at 1,3,5,7,10 days post-operation.Al the patients received type-B ultrasonic examination in double lower limbs at 10 days post-operation,and divided into thrombus group and non-thrombus group.The D-Dimer and fibrin degradation products in the two groups were compared.RESULTS AND CONCLUSION:Deep vein thrombosis was found in 13 cases by ultrasonic-B postoperation,D-Dimer and fibrin degradation products showed no significant difference between the two groups at 1 week after operation (P＞0.05),but the difference was significant at 10 days (P＜0.01).D-Dimer and fibrin degradation products index should be monitored dynamicaly for at least 10 days after operation,which is helpful for the earlydiagnosis of thrombosis.

BACKGROUND:It is generaly believed that the spine wil be extended, and vertebral muscle atrophy, bone loss of vertebral body, increased height and area of intervertebral disc, changes of composition of intervertebral disc wil occur in the condition of weightlessness. These are likely to be the cause of high incidence of low back pain. OBJECTIVE:To observe changes in lumbar spine bone microstructure analysis of simulated weightlessness on rhesus lumbar spine biomechanics. METHODS:Fourteen young rhesus monkeys were randomly divided into two groups: control group (n=7;free activities in the cage during the experiment), and experimental group (n=7; the use of head-down-10° on a special bed by bundle lying to simulate weightlessness). RESULTS AND CONCLUSION:(1) The results of Micro-CT examination: in the experimental group, structure model index in trabecular bone of increased. Trabecular bone changed from plate-like to the rod-like change. The intersection number of bone tissue in unit length to non-bone tissue declined. The average width of the canal between the trabecular bone increased, suggesting that there have been signs of osteoporosis in the experimental group. (2) Under an optical microscope, in the experimental group, bone hyperplasia line was disordered and irregular. Thick endplate trabecularbone became smal, shalow, and arranged substantialy perpendicular to the direction of trabecular bone and cartilage endplate. The closer the endplate surface, the smaler trabecular bone was. Compared with the control group, these smal trabecular bones were thin and curved. Bone marrow cavity was oval. The degree of the connection between the trabecular bones is poor, reflecting the structural characteristics of significant osteoporosis. (3) It is indicated that weightlessness affected the biomechanical properties of rhesus lumbar motion unit.

Objective:To explore the setup errors of vacuum pad combined with breast bracket in linear accelerator intensity-modulated radiotherapy for breast cancer.Methods:The clinical data of 72 patients who received linear accelerator intensity-modulated radiotherapy after breast conserving surgery in Hai'an Hospital of Traditional Chinese Medicine from July 2017 to March 2022 were retrospectively analyzed. According to the radiotherapy fixation schemes, they were divided into vacuum pad group (24 patients), breast bracket group (27 patients) and vacuum pad combined with breast bracket group (21 patients). Cone-beam CT was used to analyze the setup errors of the fixation, and the mean value of the overall errors and the standard deviation of the system errors were calculated. The relative factors affecting the fixed setup errors were analyzed.Results:There were statistical differences among vacuum pad group, breast bracket group and vacuum pad combined with breast bracket group in the level of forward and backward (Z) direction translation error (2.11±0.41, 2.67±0.26 and 1.79±0.21) and Z direction rotation error (1.14±0.24, 1.05±0.21 and 0.91±0.22) ( F values were 45.86 and 6.21, both P < 0.05). The level of Z direction translation error in vacuum pad group was higher than that in vacuum pad combined with breast bracket group, and the difference was statistically significant ( t = 12.37, P = 0.001). The level of Z direction rotation error in breast bracket group was higher than that in vacuum pad combined with breast bracket group, and the difference was statistically significant ( t = 3.41, P = 0.001). In the breast bracket group, the planning target volume (PTV) extension boundary values in the left and right (X), up and down (Y), and Z directions were 2.02, 2.09 and 1.97; the PTV release boundary values in X, Y and Z directions of the vacuum pad group were 1.81, 2.07 and 2.25; the external boundary values of PTV in X, Y and Z directions of the vacuum pad combined with breast bracket group were 1.13, 1.51 and 1.49. The result of multifactor analysis showed that body mass index (BMI) ( OR = 4.208, 95% CI 1.438-12.312) and breast volume ( OR = 4.023, 95% CI 1.375-11.769) were the independent influencing factors of fixed setup errors (both P < 0.05). Conclusions:The application of vacuum pad combined with breast bracket in the fixed setup of linear accelerator intensity-modulated radiotherapy of breast cancer is helpful to reduce the fixed setup errors, but at the same time, the fixed setup errors is affected by the patient's BMI, breast volume and other factors.

Objective To evaluate the effects of turmeric volatile oil (TVO) combined with cisplatin on the proliferation and apoptosis of a human cutaneous squamous cell carcinoma cell line A431,and to explore their mechanisms.Methods Some cultured A431 cells at exponential growth phase were divided into several groups to be treated with 5,10,20,40 and 80 mg/L TVO,as well as high-glucose Dulbecco's modified Eagle's medium (DMEM) containing 1％ dimethyl sulfoxide (DMSO,control group),respectively.After 24-hour treatment,cell counting kit 8 (CCK8) assay was performed to estimate the proliferative activity of A431 cells in the above groups.Some other A431 cells were divided into 4 groups:control group treated with high-glucose DMEM containing 1％ DMSO,TVO group treated with 40 mg/LTVO,cisplatin group treated with 10 mg/L cisplatin,and TVO + cisplatin group treated with 40 mg/L TVO and 10 mg/L cisplatin.After 24-hour treatment,CCK8 assay was performed to estimate the cellular proliferative activity,inverted microscopy to observe changes in cell morphology,fluorescence microscopy to detect cell apoptosis after acridine orange (AO)/ethidium bromide (EB) double-staining,colorimetry to evaluate the activity of Caspase-3 and Caspase-9,and Western blot analysis to determine the protein expression of Caspase-3 and p-glycoprotein.Results After 24-hour treatment with 5,10,20,40 and 80 mg/L TVO,the cell proliferation rates were inhibited by (12.83 ± 6.4)％,(16.27 ± 11.4)％,(21.61 ± 9.1)％,(33.11 ± 2.0)％ and (46.00 ± 3.3)％ respectively,and the inhibition rates were all significantly higher in these groups than in the control group (4.03％ ± 1.4％,all P ＜ 0.05).The 50％ inhibitory concentration (IC50) of TVO at 24 hours was (61.66 ± 1.03) mg/L.Compared with the control group,the proliferation inhibition rates significantly increased in the TVO group,cisplatin group and TVO + cisplatin group (all P ＜ 0.05),suggesting that the combination of TVO and cisplatin showed synergistic inhibitory effects with a combination index of 1.366.Moreover,A431 cells turned round to different extents and became apoptotic in the TVO group and cisplatin group,and the TVO + cisplatin group showed obviously decreased number of cells and a large number of cell debris.The TVO + cisplatin group also showed significantly increased activity of Caspase-3 (1.520 ± 0.115) and Caspase-9 (2.760 ± 0.297) as well as protein expression of Caspase-3 (1.482 ± 0.016) compared with the TVO group (Caspase-3 activity:1.117 ± 0.095;Caspase-9 activity:1.259 ± 0.059;Caspase-3 protein expression:1.156 ± 0.006,all P ＜ 0.01) and cisplatin group (Caspase-3 activity:1.381 ± 0.089;Caspase-9 activity:1.829 ± 0.171;Caspase-3 protein expression:1.296 ± 0.021,all P ＜ 0.01),but significantly decreased p-glycoprotein expression (0.528 ± 0.014) compared with the TVO group (1.311 ± 0.011,P ＜ 0.01) and cisplatin group (1.169 ± 0.012,P ＜ 0.01).Conclusion TVO combined with cisplatin can synergistically inhibit the proliferation of A431 cells and induce cell apoptosis,which may be associated with activation of the caspase system and decreased expression of pglycoprotein.

Objective To investigate the effects of an ar?turmerone derivative(ATD)on the proliferation and apoptosis of A375 human melanoma cells. Methods Both A375 cells and human skin fibroblasts (HSFs) were cultured with different concentrations(5, 10, 20, 40 and 80μmol/L)of ATD, vincristine and ar?turmerone, separately, for 48 hours in vitro. Subsequently, cell counting kit?8 (CCK?8) was used to evaluate cell proliferation, inverted microscopy to observe cell morphology after acridine orange/ethidium bromide (AO/EB) staining, and a colorimetric method to estimate caspase?3 activity. DNA fragmentation assay and flow cytometry were performed to assess cell apoptosis, and flow cytometry was conducted to analyze cell cycle. Results ATD, vincristine and Ar?turmerone all inhibited the proliferation of A375 cells in a dose?dependent manner(ATD:R2=0.99, F=340.96, P<0.05;vincristine:R2=0.99, F=349.19, P<0.05;ar?turmerone:R2=0.89, F=25.41, P<0.05). The fifty percent inhibitory concentra?tions(IC50s)of ATD, vincristine and ar?turmerone against A375 cells were 15.96 ± 0.02μmol/L, 77.00 ± 0.04μmol/L and 356.95 ± 0.01μmol/L respectively. When the drug concentrations were 5 and 10μmol/L, the proliferation of HSFs was inhibited by 8%± 0.06%and 25%± 0.02%respectively by ATD, by 49%± 0.09%and 34%± 0.07%respectively by ar?turmerone, and by 33%± 0.04%and 29%± 0.08%respectively by vincristine, and the proliferation of A375 cells was inhibited by 26%± 0.06%and 39%± 0.02%respectively by ATD, by 6%± 0.09%and 10%± 0.07%respectively by ar?turmerone, and by 8% ± 0.04% and 17% ± 0.08% respectively by vincristine, with the inhibitory effects of the three drugs being significantly different from that of dimethyl sulfoxide(all P<0.05). ATD showed stronger inhibitory effects on the proliferation of A375 cells, but weaker cytotoxic effects on HSFs compared with ar?turmerone and vincristine(all P<0.05). Meanwhile, ATD, vincristine and ar?turmerone all induced the apoptosis of A375 cells(P<0.05), and caspase?3 activity increased with the increase in drug concentrations(ATD:R2=0.98, F=162.30, P<0.05;vincristine:R2=0.96, F=94.39, P<0.05;ar?turmerone:R2=0.95, F=57.35, P<0.05). The effect of ATD on caspase?3 activity was strongest, followed by that of vincristine and ar?turmerone. As flow cytometry showed, all the three drugs induced cell apoptosis to different degrees, and ATD showed a relatively strong effect on cell apoptosis, especially late apoptosis, compared with the other two drugs. In the ATD group, the number of A375 cells in G1 phase gradually increased, while that in G2 phase and S phase significantly decreased with the increase in drug concentrations. Conclusions ATD exhibited proliferation?inhibiting and apoptosis?inducing effects on A375 cells, and the effects were stronger than those of vincristine and ar?turmerone. It is quite possible that ATD affects cell proliferation and differentiation by activating caspase?3 and arresting cell cycle in the G1 phase.

BACKGROUND:Severe spinal angular kyphosis aggravated spinal cord injury and early degeneration, even caused incomplete paralysis or complete paralysis. Surgical treatment is the only solving approaches and method, but it is difficult, exhibits high risk, and easily affects postoperative complications. OBJECTIVE:To analyze the science and effectiveness of posterior vertebral column resection osteotomy combined with step correction in treatment of stiff angular kyphosis based on biomechanical principle. METHODS:A total of 90 cases underwent posterior vertebral column resection osteotomy combined with bilateral pedicle screw spinal cord gradual y shortening echelon tight closure and orthopedic fixation were selected, including 37 males and 52 females, at the average age of 47 years. Kyphotic angle, spinal sagittal imbalance, trunk side offset rate, operation time, intraoperative blood loss were compared and analyzed before and after treatment. RESULTS AND CONCLUSION:The kyphotic angles were 31°-138° (averagely 90.1°) preoperatively and 10°-90° (averagely 41.6°) postoperatively, with an improvement rate of 65%. The distance from C 7 plumb line to the S 1 upper edge was averagely 5.2 mm, with a correction rate of 73%. Intraoperative blood loss was 1 200-6 000 mL, averagely 2 089 mL. Operation time was 212-470 minutes, averagely 326 minutes. The patients were fol owed up for 20 to 35 months after the surgery. Osteotomy segments had achieved bone fusion in al patients, and no complications of spinal cord injury or orthopedic angle loss appeared. These data verified that in the accordance with cellbiomechanics and spinal biomechanical principles, bilateral pedicle screw spinal cord gradual y shortening echelon tight closure and orthopedic fixation protected utmost spinal cord cells against injury in the correction of thoracolumbar angular kyphosis. There is sufficient basis for cellphysiology and it accorded biomechanical and physiological characteristics. During the surgery, we should pay attention to protection and release of nerve root and avoid postoperative corresponding nerve root irritation. Ful fusion ensures kyphosis correction and avoids spine lateral offset, is an effective safeguard for the recovery of spinal function and postoperative orthopedic effect.

BACKGROUND:Orthopedic osteotomy at the apex of kyphosis is best for treatment of ankylosing spondylitis from a biomechanical aspect, but there is a high risk for intraoperative spinal cord injury.
OBJECTIVE:To explore the clinical efficacy of vertebral plate osteotomy+vertebra osteotomy+long-segment pedicle screw fixation in the treatment of ankylosing spondylitis with kyphotic deformity.
METHODS:Thirty-six patients with ankylosing spondylitis were subjected to pedicle subtraction osteotomy and Smith-Peterson osteotomy, and then fol owed up for 3 months to 2 years.
RESULTS AND CONCLUSION:After implantation, sagittal imbalance did not occur in 36 patients, and the improvement rate of sagittal imbalance was 64%. The improvement rates of thoracolumbar kyphosis and chin-brow vertical angle were 60%and 98%, respectively. The pain relief rate was 64%, and the Oswestry Disability Index was 95%. There were no pul ed nails, broken nails and broken robs after implantation. These findings indicate that the combination of selective osteotomy technique and long-segment internal fixation can achieve stable fixation effects, prevent sagittal imbalance, and avoid the occurrence of pul ing nails, breaking nails and breaking robs caused by osteoporosis.

BACKGROUND:The treatment difficulties of thoracolumbar angular kyphosis surgery are:low correction rate, hard to rebuild sagittal plane, easily induce neurological complications, postoperative loss of balance, high incidence of pseudarthrosis and postoperative loss of correction degree.
OBJECTIVE:To explore the safety and efficacy of modified posterior vertebral column resection osteotomy and bilateral pedicle screw combined with echelon tight closure spinal cord technique and implant fixation for severe spinal angular kyphosis.
METHODS:A total of 87 severe spinal angular kyphosis patients, 36 males and 51 females, who were treated in the Department of Orthopedics, the 306 Hospital of Chinese PLA from January 2006 to December 2013, were enrol ed in this study. They underwent posterior vertebral column resection, bilateral pedicle screw combined with echelon tight closure spinal cord, and implant fixation. Kyphosis, spinal sagittal imbalance, offset rate towards trunk side, operation time and intraoperative blood loss were observed before and after treatment.
RESULTS AND CONCLUSION:The preoperative average kyphosis was 90.1° (31°-138°). The postoperative average kyphosis was 27.9° (15°-57°). The improvement rate was 76%. The improvement rate of trunk sagittal offset was 76%. Intraoperative blood loss was 800-3 000 mL, and average blood loss was 2 300 mL. The operation time was 5-7 hours, averagely 5.9 hours. Before treatment, two patients affected neurologic symptoms in double lower extremity, and their Frankel classification was grade C and became grade E after treatment. Al patients were fol owed up for 9-57 months. Bony fusion was achieved in al patients. No complications of spinal cord injury appeared, and no orthopedic angle missing occurred. These results indicate that during posterior vertebral column resection for treating severe angular stiffness of the thoracic kyphosis, blood vessels could be maintained greatly. Blood vessel injury-induced ischemic changes in spinal cord and ischemic reperfusion injury could be avoided. To reduce hemorrhage and to keep effective blood volume in patients with low body mass are effective for early recovery after treatment. Bilateral pedicle screw combined with echelon tight closure spinal cord technique greatly protected spinal cord cells against injury. We should pay attention to the protection and loose of nerve root to avoid postoperative nerve root irritation. Sufficient bone fusion ensures kyphosis correction, avoids spine lateral offset, and plays a key role in spinal function and postoperative orthopedic effect.

Objective:To analyze the clinical characteristics, etiology and outcome of early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS).Methods:The clinical data of 265 neonates with NS admitted in the neonatal ward of the the Affiliated Hospital of Qingdao University from January 2014 to September 2020 were enrolled, including 76 cases of EONS and 189 cases of LONS. The general information, clinical manifestation, laboratory findings, pathogen distribution, treatment and outcome of the two groups were analyzed with SPSS25.0 statistical software.Results:The rates of meconium-stained amniotic fluid, prenatal maternal fever, abnormal white blood cell (WBC) count and neutrophil count in EONS group were significantly higher than those in LONS group ( P<0.05 or <0.01). However, the rates of indwelling central venous catheters, mechanical ventilation, fever, abdominal distension, abnormal platelet count and serum prealbumin level in LONS group were significantly higher than those in EONS group ( P<0.05 or <0.01). Staphylococcus epidermidis(135/265)and Staphylococcus aureus (22/265) were the most common gram-positive bacteria and Escherichia coli (13/265) was the most common gram-negative bacteria in NS. The proportion of gram-positive bacteria was the highest in both EONS group (85.5%) and LONS group (84.7%), which was mainly Staphylococcus epidermidis of coagulase negative staphylococci. The proportion of Listeria monocytogenes and Streptococcus infections in EONS group was significantly higher than that in LONS group ( P<0.05 or <0.01). The proportion of Staphylococcus aureus infection in LONS group was significantly higher than that in EONS group ( P<0.01). There was no significant difference in case fatality rate between EONS group and LONS group (6.6% vs 2.6%, P>0.05). Conclusions:Perinatal amniotic fluid pollution and prenatal maternal fever are risk factors for the occurrence of EONS, while indwelling central venous catheter and mechanical ventilation are risk factors for the occurrence of LONS. Abnormal platelet count and abnormal serum prealbumin are more common in the LONS group. The bacteria detected in EONS and LONS are mainly Staphylococcus epidermidis. Clinical diagnosis and treatment of EONS and LONS should be managed differently.