Objective: To investigate the clinical effects of en bloc resection and debridement combined with gluteus maximus muscle flap in the treatment of ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Methods: A retrospective observational study was conducted. From May 2018 to February 2020, 8 patients with pressure ulcers on the ischial tuberosity combined with chronic osteomyelitis who met the inclusion criteria were admitted to Fuyang Minsheng Hospital, including 5 males and 3 females, aged 38-69 years, with unilateral lesions in 6 patients and bilateral lesions in 2 patients. According to the anatomical classification of Cierny-Mader osteomyelitis, there were 6 patients (7 sides) with focal type, and 2 patients (3 sides) with diffuse type. The wound areas were 3 cm×2 cm to 12 cm×9 cm on admission. The pressure ulcer and chronic osteomyelitis lesions were completely removed by en bloc resection and debridement. The chronic infectious lesions were transformed into sterile incisions like fresh wounds by one surgical procedure, and the gluteus maximus muscle flaps with areas of 10 cm×6 cm to 15 cm×9 cm were excised to transfer and fill the ineffective cavity. The wounds of 5 patients were sutured directly, and the wounds of 3 patients were closed by local flap transfer. The intraoperative blood loss volume and blood transfusion, and length of hospital stay of patients were recorded. The incision healing and flap survival of patients were observed after operation. The recurrence of pressure ulcer and osteomyelitis, the appearance of the affected area, and the secondary dysfunction and deformity of the muscle flap donor site of patients were observed during followed up. Results: The intraoperative blood loss volume of the 8 patients was 220 to 900 (430±150) mL; 5 patients received intraoperative blood transfusion, of which 2 patients received 3 U suspended red blood cells and 3 patients received 2 U suspended red blood cells. The length of hospital stay was 18 to 29 (23.5±2.0) d for the 8 patients. In this group of patients, the incisions of 7 patients healed, while in one case, the incision suture was torn off during turning over and healed after secondary suture. The flaps survived well in 3 patients who underwent local flap transfer. During the follow-up period of 6-20 months, no recurrence of pressure ulcer or osteomyelitis occurred in 8 patients, the affected part had skin with good texture, mild pigmentation, and no sinus tract formation, and no secondary dysfunction or deformity occurred in the donor site. Conclusions: The en bloc resection and debridement combined with gluteus maximus muscle flap has good clinical effects on ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Neither pressure ulcer nor osteomyelitis recurs post operation. The skin texture and appearance of the affected area are good, and the donor site has no secondary dysfunction or deformity.
Blood Loss, Surgical ; Debridement ; Female ; Humans ; Male ; Muscles/surgery* ; Osteomyelitis/surgery* ; Perforator Flap ; Pressure Ulcer/surgery* ; Reconstructive Surgical Procedures ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Treatment Outcome

OBJECTIVETo evaluate the value of transforaminal approach single interbody fusion cage combining with fixation with pedicle screws in treating lumbar instability.

METHODSFrom 2006 to 2009, 36 patients (39 interspaces) with lumbar instability were retrospectively analyzed, included 14 males and 22 females; aged from 45 to 68 years with an average of 54 years; course of disease was from 6 months to 12 years with an average of 4 years. Of them, instability in lumbar disc herniation had 8 cases, lumbar spinal stenosis 5 cases, postoperative instability in lumbar disc herniation 3 cases, lumbar spondylolysis 20 cases; unstable segment in L3,4 had 2 cases, L4,5 18 cases, L5S1 13 cases, and double segment 3 cases (both L4,5 and L5S1). All patients underwent decompression, reduction, interbody fusion with single cage from transforaminal approach with pedicle screws and posterolateral fusion. The clinical effects were evaluated according to imaging results and JOA scoring system.

RESULTSAll the patients were followed up from 8 to 32 months with an average of 18 months. The results of 38 intervertebral fusion, suspicious fusion of a vertebral space, fusion rate was 97.4% (38/39). Segmental lordosis angle after operation was increased (4.09 +/- 0.13) degrees than before operation (P < 0.01), and final follow-up was reduced (3.83 +/- 0.17) degrees than after operation (P > 0.05). JOA scoring before operation and final follow-up were respectively 8.14 +/- 1.09 and 13.54 +/- 1.19, there was statistically significant between the two periods (P < 0.01); the JOA score improvement rate (RIS): 28 cases got excellent result, 6 good and 2 fair, the rate of excellent and good was 94.4%.

CONCLUSIONThe path through the transforaminal approach single-fusion cage, implantation of pedicle screw fixation fusion surgery can simplify operations, reduce complications, and can obtain satisfactory clinical efficacy, which is an effective method for the treatment of lumbar instability.

Aged ; Bone Screws ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; pathology ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Diseases ; diagnostic imaging ; surgery ; therapy ; Spinal Fusion ; methods ; Tomography, X-Ray Computed ; Treatment Outcome

Objective : To analyze the application value of metagenomic next-generation sequencing (mNGS) in the detection of pathogenic bacteria in pulmonary infection ，and to provide a theoretical basis for clinical diagnosis. Methods : A retrospective study was conducted on 161 patients with suspected pulmonary infection，and samples of bronchoalveolar lavage fluid ，sputum and lung tissue were collected specimens ，pleural effusion and blood were simultaneously subjected to routine culture，respiratory pathogen nucleic acid detection and pathogenic microorgan- ism mNGS detection．The sensitivity ，specificity，positive predictive value ，and negative predictive value of the three detection methods were calculated respectively to evaluate the clinical application value of mNGS. Results: Among 161 patients with suspected pulmonary infection，113 cases were finally confirmed as pulmonary infection. Among the 161 patients enrolled，the sensitivity and negative predictive value of mNGS were improved compared with routine culture and nucleic acid detection of respiratory pathogens，and the difference was statistically signifi- cant(P＜0. 001) ．Although the specificity of mNGS was higher than that of respiratory pathogen nucleic acid de- tection，the difference was not statistically significant．The positive predictive value of mNGS was the highest，and was higher than that of respiratory pathogen nucleic acid detection，but had no statistical significance compared with conventional culture． Conclusion The sensitivity of mNGS in the diagnosis of pathogenic microorganisms in pul- monary infection is higher than that of conventional culture and nucleic acid detection of respiratory pathogens， which reduces the false negative rate of diagnosis and has a better comprehensive evaluation ; conventional culture detection has low sensitivity，but high specificity ; respiratory pathogen nucleic acid detection compared with con- ventional culture，the sensitivity is improved，but the specificity decreased.

Objective: To investigate the regulatory effect and mechanism of specific antagonist of acid-sensitive ion channel 3 (APETx2) on visceral sensitivity in mice with post-infectious irritable bowel syndrome (PI-IBS) ． Methods: The PI-IBS model was established by National Institutes of Health (NIH) mice infected with Trichinella spiralis．Gastrointestinal transport function was assessed by measuring the time to first black stool and the number of fecal pellets collected for 6 hours ; abdominal wall withdrawal reflex (AWR) was used to assess visceral sensitivity ; the expression of calcitonin gene-related peptide ( CGRP) in the colon tissue was detected by immunohistochemistry ; the expression of brain-derived neurotrophic factor (BDNF) and CGRP mRNA in the colon tissues was detected by quantitative real time polymerase chain reaction ( qRT-PCR) ． The expression levels of acid sensing ion channel 3 (ASIC3) ，CGRP，and transient receptor potential vanilloid 1 (TRPV1) protein in brain tissue were detected by Western blot analysis. Results: Compared with the control group，the PI-IBS group significantly reduced the time of first black stool，the number of fecal particles and AWR score within 6 hours significantly increased，the protein expression of CGRP in colon tissue，BDNF and CGRP mRNA significantly increased，and the protein expression of CGRP，ASIC3 and TRPV1 in brain tissue significantly increased．Compared with the control group，the PI-IBS group significantly reduced the time to first black stool，the number of fecal particles and AWR score within 6 hours significantly increased，the expression of CGRP protein in colon tissue，the expression of BDNF and CGRP mRNA significantly increased，and the protein expression of CGRP，ASIC3 and TRPV1 in brain tissue significantly increased ; compared with the PI-IBS group，the first time of black stool clearance in the APETx2 group was significantly prolonged，the number of fecal particles and AWR score within 6 hours were significantly reduced，the expression of CGRP protein in colon tissue，the expression of BDNF and CGRP mRNA was significantly reduced，the protein expression of CGRP，ASIC3 and TRPV1 in brain tissue was significantly reduced，and the difference was statistically significant (P＜0. 05) ． Conclusion APETx2 can alleviate visceral sensitivity and regulate gastrointestinal motility in PI-IBS mice by downregulating the expression of BDNF，CGRP，ASIC3 and TRPV1．APETx2 may provide a new therapeutic option for the treatment of IBS.

OBJECTIVETo compare the clinical effect of thoracolumbar fractures between single-segment pedicle screw fixation approach for the gap of paravertebral muscles and double-segment pedicle screw fixation approach for the stripping of paravertebral muscles.

METHODSFrom September 2008 to January 2010, 65 patients with incomplete compressed thoracolumbar fractures or burst thoracolumbar fractures with unilateral endplate injury were randomly divided into two groups. Thirty patients were treated with single-segment pedicle screw fixation through the gap of paravertebral muscles (treatment group). Thirty-five patients were treated with double-segment pedicle screw fixation through the stripping of the paravertebral muscles (control group). All the internal fixations were taken out during 10-12 months after operation. Operative time, perioperative blood loss volume and postoperative drainage volume were compared between two groups. At final follow-up, the change of neurological ASIA grade were recorded; and postoperative 5 days and final follow-up, compared Denis classification of lumbar and back pain between two groups; and analyzed the sagittal index and compressibility of anterior border of vertebral body by X -ray lateral projection.

RESULTSAll patients were follow-up from 14 to 22 months with an average of 18.3 months. No postoperative infection, secondary spinal cord injury was found. One case of control group occurred internal fixation breakage at the 11th month after operation and other internal fixation no loosening. There was no significant difference in operative time, the recovery of neurological function between the two groups (P > 0.05). Perioperative blood loss volume and postoperative drainage volume of treatment group was less than that of control group (P < 0.01). And in Denis classification of lumbar and back pain, the treatment group recovered more quickly, and the residual pain of lumbar and back was less than that of control group (P < 0.01). Postoperative posterior salient and compression of anterior border of vertebral body improved in two groups (P < 0.01), there was no significant difference in degree of improvement between two groups (P > 0.05); but both loss existed at final follow-up (P < 0.01), there was no significant difference in loss of posterior salient between two groups (P > 0.05). In the treatment group, the loss of rectify of anterior border of vertebral body existed, but it was less than that of the control group.

CONCLUSIONIn the premise of strict controlling surgery indications, the treatment of thoracolumbar fractures with single-segment pedicle screw fixation through the gap of paraspinal muscles, can effectively recover the height of vertebral body and rectify posterior salient, and reduce the fixed segment. Compared with the traditional operative method of double-segment pedicle screw fixation through the stripping of paraspinal muscle, it can obviously reduce the operation wound and the bleeding, lessen the pain of lumbar and back. And the recent clinical effect is satisfied.

Adult ; Bone Screws ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Humans ; Lumbar Vertebrae ; injuries ; Male ; Middle Aged ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries

OBJECTIVETo explore the clinical effect of transforaminal lumbar interbody fusion (with single cage) combined with unilateral pedicle screw fixation in treating lumbar instability.

METHODSThe clinical data of 50 patients with lumbar instability were retrospectively analyzed. They underwent treatment and obtained following up more than 8 months from 2009 to 2012. All patients complicated with refractory or recurrent lower back pain, and unilateral primarily or unilateral lower limb radiation pain, X-ray and CT films showed lumbar instability. The patients were respectively treated with transforaminal lumbar interbody fusion (with single cage) combined with unilateral or bilateral pedicle screw fixation. According to different fixation methods, they divided into unilateral fixation group and bilateral fixation group. There were 20 patients with 22 intervertebral spaces in unilateral fixation group, 8 males and 12 females, aged from 26 to 66 years old, 2 cases with isthmic spondylolisthesis of degree I, 8 cases with degenerative spondylolisthesis, 10 cases with lumbar disc herniation; fusion location with L3,4 was in 1 case, L4,5 was in 12 cases, L5S1 was in 9 cases. There were 30 patients with 30 intervertebral spaces in bilateral fixation group, 14 males and 16 females, aged from 41 to 62 years old, 4 cases with isthmic spondylolisthesis of degree I,14 cases with degenerative spondylolisthesis, 12 cases with lumbar disc herniation; fusion location with L3,4 was in 3 cases, L4,5 was in 15 case, L5S1 was in 12 cases. Operation time, intraoperative blood loss, postoperative drainage, complications were analyzed and intervertebral height, lordosis angle changes, fusion rate and clinical effect were compared between two groups.

RESULTSAll incisions obtained primary healing,lower limb radiation pain and low back pain disappeared basically, no infection, endorachis injury was found. Foot drop occurred in one case of bilateral fixation group and no iatrogenic neurological symptom was found in unilateral fixation group. All patients were followed up from 8 to 18 months with an average of (10.8?4.3)months. Ac- cording to JOA score improvement rate (RIS) to assess clinical effect, all patients got excellent and good results, there was no statistically significant difference between two groups. Two methods can both effectively increase the pathological intervertebral height. Unilateral fixation group was better than bilateral fixation group in aspect of operation time, intraoperative blood loss and postoperative drainage.

CONCLUSIONWith strict indication and good skills, transforaminal lumbar interbody fusion (with single cage) combined with unilateral pedicle screw fixation in treating lumbar instability has advantages of smaller traumatic, less blood loss, faster recovery for the patient and can reduce the economic cost.

Adult ; Aged ; Combined Modality Therapy ; Female ; Humans ; Intervertebral Disc Displacement ; physiopathology ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion ; methods ; Spondylolisthesis ; physiopathology ; surgery

Objective:To investigate the effect and related mechanism of quetiapine fumarate tablets combined with valproate sodium tablets in the treatment of depression, and its influence on quality of life.Methods:From January 2017 to January 2019, 96 patients with depression admitted to the Second People's Hospital of Lishui were divided into control group ( n=48) and observation group ( n=48) according to the random digital table method.The patients in the observation group were treated with quetiapine fumarate tablets combined with sodium valproate tablets, while the patients in the control group were treated with sodium valproate.Both two groups were treated for 8 weeks.The therapeutic efficacy, Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale (HAMD), 5-HT, substance P (SP), neuropeptide Y (NPY) and World Health Organization Quality of Life Scale (WHOQOL-BREEF) were compared before and after treatment. Results:The total effective rate of the observation group (91.67%) was higher than that of the control group (70.83%) (χ 2=6.838, P<0.05). After treatment, the scores of PSQI and HAMD in the observation group[(8.74±1.29)points and (14.35±1.37)points] were lower than those in the control group [(10.85±1.43)points and (21.19±2.09)points] ( t=7.591, 18.963, all P<0.05). After treatment, the serum levels of 5-HT [(43.17±7.46)μg/L] and NPY [(7.98±0.43)mg/L] in the observation group were higher than those in the control group [(34.36±5.18)μg/L and (6.59±0.37)mg/L], while the SP level [(3.98±0.54)mg/L] in the observation group was lower than that in the control group [(5.43±0.67)mg/L], the differences were statistically significant( t=6.721, 16.976, 11.674, all P<0.05). After treatment, the scores of environmental field [(65.78±2.63)points], social relationship[(60.31±3.25)points], psychology[(71.83±3.15)points] and physiology [(69.83±3.56)points] in the observation group were higher than those in the control group [(58.91±2.35)points, (54.73±2.32)points, (64.36±2.78)points, (61.15±2.89)points]( t=13.495, 9.682, 12.319, 13.115, all P<0.05). There was no statistically significant difference in adverse reactions between the two groups ( P>0.05). Conclusion:Quetiapine fumarate tablets combined with sodium valproate tablets is effective in the treatment of depression, which can increase serum 5-HT and NPY levels and decrease SP level, and improve the quality of life of patients.

Aim To evaluate the effects of Rutaecarpine(Rut)on the expression of SIRT1 and the senescence of vascular smooth muscle cells(VSMCs)induced by angiotensin Ⅱ.Methods VSMC senescencewas induced by exposure to AngⅡ(1 μmol·L-1)for 72 h.VSMCs were treated with different concentrations of Rut(0.3, 1, 3 μmol·L-1).TRPV1 competitive antagonist CAPZ(10 μmol·L-1)and AMPK inhibitor Compound C(1 μmol·L-1)were used to explore whether TRPV1/AMPK mediated the protective effect of Rut.The quantity of senescent cells were determined by senescence-associated SA-β-Gal staining, and the intracellular ROS level was measured by(DCFH-DA)fluorescent probe.The migration ability of VSMCs was evaluated by Wound-healing assay combined with Transwell assay.The protein level of longevity protein SIRT1 and senescence-related proteins p53, p21 and AMPK phosphorylation level were detected by Western blot.Results Rut significantly inhibited Ang Ⅱ-induced VSMC senescence and ROS production and prevented VSMCs migration.Preprocessing of TRPV1 antagonist CAPZ could abolish the protective effect of Rut.Ang Ⅱ inhibited the expression of longevity protein SIRT1.Rut recovered SIRT1 expression in a dose-dependent manner, while prevented the up-regulation of senescence-related proteins p53 and p21.Ang Ⅱ inhibited AMPK phosphorylation, pre-treatment with Rut restored AMPK phosphorylation level.CAPZ and Compound C eliminated the up-regulating function of Rut on SIRT1 expression.Conclusions Rut up-regulates the expression of SIRT1 and prevents the senescence and migration of VSMCs induced by Angiotensin Ⅱ, which is related to activation of the TRPV1/AMPK signaling pathway.

Objective: To detect the viscoelasticity of carotid artery in healthy volunteers using ultrasonic shear wave dispersion (SWD) technique, and explore the feasibility and influencing factors for SWD parameters. Methods: Forty-five healthy volunteers were recruited and divided into elder group (≥50 years old) and younger group (<50 years old) according to the age. The carotid arteries were examined by SWD at systole, axial elastic modulus (SWE_R) and viscous index (SWD_R) were obtained. The pulse wave velocity (PWV), a carotid artery circumferential elastic parameter was obtained and considered as the reference indicator. The difference of SWE_R, SWD_R and PWV were compared between two groups; and the correlation between them were analyzed by Pearson analysis, respectively. Results: ①Compared with the younger group, the carotid PWV increased, while SWE_R and SWD_R decreased in the elder group(all P<0.05). ②In all subjects, SWE_R was negatively correlated with PWV (r=-0.256, P<0.05). In the elder group, SWE_R was negatively correlated with systolic blood pressure (r=-0.357, P<0.05), and SWD_R was negatively correlated with PWV (r=-0.393, P<0.05). In the younger group, SWD_R was positively correlated with systolic blood pressure (r=0.366, P<0.05). Conclusions Compared with the elder group, the carotid viscoelasticity was higher in young people, and it is correlated with PWV. SWD can evaluate carotid viscoelasticity, and contribute to better understanding of its tissue characteristics.

As a rare endangered medical plant that newly cultivated,little experimental information is available for growth and metabolites of Tetrastigma hemsleyanum in response to nitrogen( N). The effects of different levels of N on growth of T. hemsleyanum and the content of phytochemicals( polysaccharide,total flavonoids and phenolics) and antioxidant activity( ABTS and FRAP) in stems and leaves were investigated in this study. A certain amount of N had positive effects on most of biological traits,and excessive dose of N went against growth of T. hemsleyanum. With N levels decreased,the polysaccharide content in stems and leaves had no significant change,while the total flavonoid and phenolic content,and antioxidant activities increased steadily. Antioxidant activities and total flavonoid and phenolic content had significant positive correlation. Excessive N fertilizer should be avoided by cultivation.
Antioxidants ; Flavonoids ; Nitrogen ; Phenols ; Phytochemicals ; Plant Extracts ; Plant Leaves ; Vitaceae