Objective To evaluate the feasibility and therapeutic effect of kyphoplasty in treating severe osteoporotic vertebral compressive fractures. Methods Thirty-five patients (48 vertebral bodies) with severe osteoporotic compressive fractures were included. There were 33 females and 2 males with the mean age of 74.2 years. The average compressive rate of the affected vertebral bodies was 77.0%. The thoracolumbar vertebrae were treated with kyphoplasties. Percutaneous puncture direction was adjusted according to compressive rate and shape of the vertebral bodies. The inflatable bone tamp was inserted into the fractured vertebral body. The balloon was inflated with low pressure and dilate-relieve-dilate method was applied. The balloon was deflated and withdrawn, leaving a cavity within the vertebral body, which then fulfilled with visualized bone cement. Preoperative and postoperative symptom level, complications and radiographic findings were recorded. Results All 35 patients tolerated procedure well. The mean heights of the anterior, mid and posterior vertebral body had improved from (0.8±0.1) cm, (0.8±0.2) cm, (2.1 ±0.8) cm preoperatively to (1.2±0.3) cm, (1.3±0.2) cm, (2.3±1.0) cm respectively after operation (P ＜0.05). There was significance difference between preoperative and postoperative heights of the anterior and mid vertebral body. The mean kyphosis was improved from 28.2°±5.2° before operation to 19.1°±4.9° after operation. Conclusion Kyphoplasty is feasible and effective for severe osteoporotic vertebral compressive fractures.

Objective To study the clinical effect of the BacFuse for the lumbar disc herniation(LDH) and to discuss the affect for symptom of patients and structure of spine.Methods Collected the patients suffered from LDH retrospectively who had been implanted the BacFuse.There were 25 patients (29 surgical levels) included in the study.The clinical and X-ray assessment have been done on preoperation,postoperation,3 month,6 month and 12 month.Clinical index used visual analogue scale (VAS) score,oswestry disability index (ODI) score and Japanese Orthopaedic Association (JOA) score assessed clinical symptom and physical function.The intervertebral angle,posterior disk height and foraminal height were measured in X-ray.The patients were taken CT at preoperation and postoperation.The area and distance of herniated disc were measured in CT scan.Results In the aspect of clinical effect,25 cases were finished operation successly.The VAS score decreased from (6.61±1.29) points on preoperation to (2.78±1.00) points on the last follow-up,the ODI score decreased from (31.9±8.3) points to (15.9±6.4) points,the JOA score increased from (9.6± 3.0) points to (18.8± 3.2) points.In the aspect of spine structure,the intervertebral angle decreased from 10.1°±5.4° on preoperation to 8.4°±4.9° on the last follow-up,the posterior disk height increased from (0.65±0.29) cm on preoperation to (0.78±0.27) cm on the last follow-up and the foraminal height increased from (2.01±0.35) cm on preoperation to (2.16±0.37)cm.There was significant difference on posterior disk height and foraminal height between preoperation and postoperation,while the posterior disk height lost (0.07±0.12) cm (9.3％) and foraminal height lost (0.06±0.19) cm (2.7％).The CT showed that area of herniated disc decreased from (4.10±0.78) mm to (3.72±0.66) mm (9.3％) and distance of herniated disc decreased from (96.4±37.8) mm2 to (83.8±31.1) mm2 (7.4％).Conclusion BacFuse can relieve symptom and affect the biomechanics of the spine,makes the herniated disc retract partially,playing a Internal Retractor role in spine,and it is a new effective therapy for LDH.

OBJECTIVETo observe the effects of the grafting of a platelet-derived growth factor gene-modified artificial composite skin on rat wounds with full thickness defect.

METHODSPlatelet derived growth factor-B (PDGF-B) eukaryotic expression plasmid was constructed, and the fibroblasts were transfected with it by liposome mediation. Artificial composite skins 1 and 2 were constructed respectively. The skin1 was composed of keratinocyte, porcine acellular dermal matrix and PDGF-B gene-transfected fibroblasts while the skin 2 contained keratinocyte, porcine acellular dermal matrix and fibroblasts. The two kinds of composite skin were grafted onto wounds on the rat back to form composite skin group 1 (C1) and 2 (C2), respectively, with 18 rats in each group. Eight rats with wounds without treatment served as control (C) group. The survival rate of the composite skin was observed at 2 post-operative weeks (POWs). The rat wounds were examined grossly on 2, 4 and 6 POWs for the calculation of wound contraction rate. Wound tissue samples were harvested for histological examination.

RESULTS(1) Up to 2 POWs, 14 grafts in C1 group survived completely, 3 with partial survival and 1 failure. In C2 group, 10 skin grafts survived completely, 4 with partial survival and 4 failures. (2) A scab was formed in the wound at 2 POW in C group. The surface of the grafted skin in C1 group was smooth, elastic, and showed good anti-friction properly, and it was better in quality compared with that in other two groups at 6 POW. (3) The wound contraction rate of the grafts in C group of rats was higher than that in C1 and C2 groups at 2, 4 and 6 POWs, while that in C1 was lower than that in C2 group. (4) Capillary formation was more intense in the grafted skins in C1 group at 2 POWs, and the epithelia differentiated well into 7 to 10 layers of epithelial cells with compact and orderly arrangement and evenly distributed fibrous tissue at 6 POWs.

CONCLUSIONRepair of the wound with artificial composite skin containing PDGF-B gene could improve the quality of wound healing.

Animals ; Cells, Cultured ; Female ; Humans ; Proto-Oncogene Proteins c-sis ; genetics ; Rats ; Rats, Sprague-Dawley ; Skin Transplantation ; methods ; Skin, Artificial ; Swine ; Tissue Engineering ; Transfection ; Wound Healing

BACKGROUNDThe cross-section of thoracolumbar vertebral body is kidney-shaped with depressed posterior boundary. The anterior wall of the vertebral canal is separated from the posterior wall of the vertebral body on the lateral X-ray image. This study was designed to determine the sagittal distance between the anterior border of the vertebral canal and the posterior border of the vertebral body (DBCV) and to analyze the potential role of DBCV in the estimation of cement leakage during percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP).

METHODSWe retrospectively recruited 233 patients who had osteoporotic vertebral compression fractures and were treated with PVP or PKP. Computed tomography images of T11-L2 normal vertebrae were measured to obtain DBCV. The distance from cement to the posterior wall of the vertebral body (DCPW) of thoracolumbar vertebrae was measured from C-arm images. The selected vertebrae were divided into two groups according to DCPW, with the fracture levels, fracture grades and leakage rates of the two groups compared. A relative operating characteristic (ROC) curve was applied to determine whether the DCPW difference can be used to estimate the degree of cement leakage. The data were processed by statistical software SPSS version 21.0 using independent sample t-test and Chi-square tests.

RESULTSThe maximum DBCV was 6.40 mm and the average DBCV was 3.74 ± 0.95 mm. DBCV appeared to be longer in males than in females, but the difference was not statistically significant. The average DCPW of type-B leakage vertebrae (2.59 ± 1.20 mm) was shorter than that of other vertebrae (7.83 ± 2.38 mm, P < 0.001). The leakage rate of group DCPW ≤6.40 mm was lower than that of group DCPW >6.40 mm for type-C and type-S, but much higher for type-B. ROC curve revealed that DCPW only has a predictive value for type-B leakage (area under the curve: 0.98, 95% confidence interval: 0.95-0.99, P < 0.001), and when the cut-off value was 4.05 mm, the diagnostic sensitivity and the specificity were 94.87% and 93.02%, respectively.

CONCLUSIONSDepression of the thoracolumbar posterior vertebral body may be informative for the estimation of cement location on C-arm images. To reduce type-B leakage, DCPW should be made longer than DBCV on C-arm images for safety during PVP or PKP.

Aged ; Female ; Fractures, Compression ; surgery ; Humans ; Kyphoplasty ; methods ; Male ; Middle Aged ; Osteoporotic Fractures ; surgery ; Retrospective Studies ; Spinal Fractures ; surgery ; Vertebroplasty ; methods

OBJECTIVESTo study the roles of leptin in the development during puberty in girls and the its relationship with insulin (INS), growth hormone (GH), estradiol (E(2)) and testosterone (T).

METHODSOne hundred and fifty girls with simple obese aged 7 to 17 years, and 150 normal healthy girls and 150 girls with malnutrition matched for age (+/- 3 months) and height (+/- 2 cm) were selected. Serum levels of leptin, INS, GH, E(2) and T were measured for them.

RESULTSTheir serum level of leptin positively correlated with body mass index (BMI) and age. Serum level of leptin in girls increased steadily from Tanner stage B(1) to stage B(5). At Tanner stage B(2), serum level of leptin in the normal groups (7.72 microg/L) was not significantly different from that in those with malnutrition (7.36 microg/L), but significantly lower than that in the obese groups (12.85 microg/L). At other Tanner stages, there was significant difference in serum level of leptin among obese, normal and malnutrition groups. Serum level of leptin correlated negatively with serum GH and positively with serum INS, but not correlated with E(2) and T.

CONCLUSIONSLeptin may play a role in triggering development during puberty in girls. Serum level of leptin at Tanner stage B(2) may be the threshold dose to trigger the onset of puberty in girls. Quickly increasing level of leptin at Tanner stage B(5) may inhibit the increase of GH, which ushered the end of puberty in girls.

Adolescent ; Body Height ; physiology ; Body Mass Index ; Body Weight ; physiology ; Child ; Female ; Growth Hormone ; metabolism ; Humans ; Leptin ; blood ; physiology ; Puberty ; physiology ; Testosterone ; metabolism

OBJECTIVE: To systematically evaluate the relationship between rituximab and the occurence of pneumonia, and to provide evidenle-based reference in clinic. METHODS: Retrieved from PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, Wanfang database and other database, RCTs, quasi-RCTs, controlled clinical trials were searched from inception to Mar. 2017. After literature screening, data extraction, literature quality evaluation and analysis of bias risk referring to Cochrane Intervention Measure System Evaluation Manual (5. 3 edition), Meta-analysis was conducted by using RevMan 5. 3 software. RESULTS: A total of 16 literatures were finally included, consisting of 14 RCTs and 1 386 patients. The results of Meta-analysis showed that the incidence of rituximab associated pneumonia in observation group was lower than control group, but without statistical significance [OR=1. 19, 95％ CI (0. 75, 1. 91), Z=0. 74, P=0. 46]. Subgroup analysis was conducted according to sample size, multiple-center, intervention dose, there was no statistical significance in the incidence of rituximab-associated pneumonia between 2 groups (P＞0. 05). CONCLUSIONS: There was no significant difference in the incidence of pneumonia between observation group and control group, rituximab is not associated with the occurrence of pneumonia. Due to methodology limit of included studies, most of high quality long-term follow-up studies have not been included. Large-scale and high quality clinical studies are required for further valuation.

Cholangiocarcinoma is a malignant tumor originating from the bile duct epithelium, with the increasing incidence year by year. Its early symptoms are atypical and the diagnosis rate is low. Most of the patients are already in advanced stage when they are diagnosed, losing the best surgery period. Currently, the conservative treatments for unresectable extrahepatic cholangiocarcinoma include stent placement, radiofrequency ablation, radiotherapy and chemotherapy, targeted and immunotherapy and other systemic treatments. But due to the high malignancy of biliary tract tumors, the tendency to develop drug resistance and the limited population benefited from the emerging treatment modalities, we urgently need to explore new treatment strategies to break this bottleneck. As a new treatment for cholangiocarcinoma, photodynamic therapy has attracted much attention for its clinical application and therapeutic effects. In this paper, we summarize the principles of photodynamic therapy, the combination of photodynamic and other therapeutic modalities, especially the combination of photodynamic with emerging immune and targeted therapies, and describe the current hotspot directions of photodynamic therapy research at home and abroad to provide reference for clinical treatment and research.

Objective:To explore the clinical efficacy of percutaneous vertebroplasty(PVP) in the treatment of osteoporotic vertebral compression fractures(OVCF) patients with chronic kidney disease-mineral and bone disorder(CKD-MBD), and analyzed the efficacy of the operation in relieving pain and improving quality of life.Methods:This retrospective study selected 71 patients who underwent PVP treatment for OVCF at Beijing Friendship Hospital, Capital Medical University from December 2013 to December 2018. Among them, there were 24 males and 47 females, with an age range of 66-92 years and an average age of (73.7±8.4) years. Based on whether the patients had CKD-MBD, the patients were divided into two groups: 31 patients with CKD-MBD comprised the experimental group, and 40 patients without CKD-MBD comprised the control group. General patient information and perioperative data were collected, including surgical time, bone cement fill volume, preoperative, postoperative, and different follow-up timepoint visual analog scale (VAS) pain scores, analgesic medication usage scores, oswestry disability index (ODI) scores. Measure and record patient vertebral anterior, middle, and posterior heights and Cobb′s angle, as well as patient blood calcium, blood phosphorus, bone metabolic markers, serum 25-hydroxyvitamin D, parathyroid hormone, total hip bone density, femoral neck bone density, and bone fracture indicators. Measurement data were represented as mean±standard deviation( ± s), the comparison between groups was conducted using the t-test; and repeated measure ANOVA was used for comparison before and after operation; the comparison of count data between groups was conducted by Chi-square test. Results:The surgical duration for the patients in this group was 20-50 min, average (29.8±7.2) min, and the volume of bone cement used was 2.0-5.0 mL, average (3.0±1.0) mL. In the experimental group, VAS scores of postoperative pain, analgesic medication usage scores, and ODI showed statistically significant differences compared to preoperative values ( P<0.001). At the last follow-up, there were no statistically significant differences in analgesic medication usage scores and ODI compared to postoperative values, but VAS scores had improved to a certain extent compared to postoperative values, with statistical significance ( P<0.001). In the experimental group, vertebral anterior height increased from (2.26±0.20) cm preoperatively to (2.57±0.28) cm postoperatively, and vertebral middle height increased from (1.96±0.18) cm preoperatively to (2.21±0.16) cm postoperatively, both with statistically significant differences ( P<0.001). Three patients (9.7%) experienced recurrent fractures, including 1 case of surgical vertebral recurrent fracture (3.2%). The experimental group showed a general increasing trend in blood calcium levels, with the last follow-up blood calcium being (2.31±0.09) mmol/L, which was significantly higher than preoperative ( P=0.002). There was no statistically significant difference in the changes in blood phosphorus ( P>0.05), and parathyroid hormone levels showed a slight decrease in the last follow-up when compared to preoperative, but the difference was not statistically significant ( P>0.05). Both total hip bone mineral density(BMD) and femoral neck BMD at the last follow-up showed significant increases compared to preoperative values. The experimental group had higher levels of blood phosphorus and parathyroid hormone than the control group at both preoperative and last follow-up assessments, with statistical significance ( P<0.05). Conclusion:PVP can effectively alleviate pain and enhance the quality of life for patients with OVCF accompanied by CKD-MBD.

Objective:To analyze the safety and efficacy of single percutaneous vertebroplasty (PVP) in the treatment of multi-segment osteolytic spinal metastases.Methods:A retrospective analysis was conducted on 113 patients with multi-segment osteolytic spinal metastases treated with PVP at Beijing Friendship Hospital, Capital Medical University from January 2013 to December 2019, including 50 males and 63 females. The age ranged from 47 to 85 years, with a mean of (66.9±1.52) years. Patients were divided into two groups based on the number of affected vertebrae undergoing surgery: the conventional surgery group ( n=72), with a maximum of three vertebral bodies undergoing PVP during each surgery; the multivertebral surgery group ( n=41), received PVP on more than three vertebral bodies in one surgery. Visual analogue scale(VAS) of pain, Oswestry disability index (ODI), general health status (GH), and mental health status (MH) were assessed before and after PVP to evaluate the efficacy of the procedure. Complications of the patients were systematically assessed to evaluate safety. Measurement data was expressed as mean±standard deviation( ± s), independent sample t-test was used for inter-group comparison, and paired sample t-test was used for intra-group comparison; the comparison of count data was conducted using Chi-square test. Results:After 6 months of surgery, the ODI score, GH score and MH score of the conventional surgery group was (35.28±1.74)%, 57.85±2.11 and 61.20±3.67, all of which improved significantly compared to before surgery, and the difference was statistically significant ( P<0.05). After 6 months of surgery, the ODI score, GH score and MH score of the multivertebral surgery group was (35.67±1.92)%, 64.12±1.35 and 59.80±3.81, all of which improved significantly compared to before surgery, and the difference was statistically significant ( P<0.05). There was no significant difference in ODI score and MH score between the two groups after 6 months of surgery ( P>0.05). At one week after surgery, the pain VAS score in the conventional surgery group (3.51±0.21) was lower than that in the multivertebral surgery group (3.98±0.32), and the difference was statistically significant ( P<0.05). GH score in the conventional surgery group showed significantly greater improvement than that in the multivertebral surgery group after 6 months of surgery, and the difference was statistically significant ( P<0.05). Bone cement leakage occurred in 21 vertebra of the conventional surgery group, and 24 vertebra of the multivertebral surgery group, with leakage rates of 14.8% and 13.0%, respectively, with no statistical significance between the two groups ( P>0.05). Conclusions:Single PVP surgery can safely and effectively alleviate the pain of multi-segment osteolytic spinal metastases and improve spinal mobility. Meanwhile, improving mental health and reducing functional impairments. But the short-term pain relief and long-term general health of the multivertebral surgery group were lower than those of the conventional surgery group.

OBJECTIVETo study the diagnosis and treatment of a second primary malignant tumor induced by previous radiotherapy.

METHODSFrom March 1970 to March 1997, 108 nasopharyngeal cancer (NPC) patients who developed a second primary malignant tumor induced by radiotherapy were treated. There were squamous carcinoma 43 (39.8%), sarcoma 26 (24.1%), malignant fibrous histiocytoma 14 (13.0%), adenoid cystic carcinoma 12 (11.1%), thyroid papillary adenocarcinoma 8 (7.4%) and malignant melanoma 5 (4.6%). Fifty patients underwent operation, 32 received radiotherapy, 18 received chemotherapy and 8 received operation combined with chemotherapy.

RESULTSThe 3- and 5-year tumor-free survival rates were 64.0% and 36.0% in the operation group. They were 34.4% and 18.8% in the radiotherapy group.

CONCLUSIONSurgery, if not contra-indicated, is the first choice for the second primary malignant tumor induced by radiotherapy. Aggressive treatment for these patients is, hence, indicated clinically.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Neoplasms, Radiation-Induced ; diagnosis ; mortality ; therapy ; Neoplasms, Second Primary ; diagnosis ; mortality ; therapy ; Radiotherapy ; adverse effects ; Survival Rate