Objective To analyze the influence factors of long-term efficacy of different fusion combined with pedicle fixation for lumbar spondylolysis.Methods The surgical and postoperative follow-up data of 196 cases with lumbar spondylolysis were analyzed retrospectively.Age,gender,body mass index ( BMI ),disease course,preoperative Japanese orthopaedic association (JOA) score,fusion segments,fusion method,immediate postoperative recovery rate and postoperative functional exercise,which might affectlong-term operation efficacy,were selected to undergo single-factor analysis and multivariate regression analysis.Results All the patients were followed up for 5-9 years and 5.4 years for average,163 cases got excellent or good curative effect,the rate of excellent and good effect was 83.2％( 163/196);33 cases got poor efficacy.There was no cerebrospinal membrane tear,cerebrospinal fluid leakage,infection,fracture fixation and other complications happened after operation.Single-factor analysis showed that disease course,BMI,preoperative JOA score and postoperative functional exercise had obvious relation with long-term efficacy (P ＜ 0.05 ) ;while age,fusion method,fusion segments,immediate postoperative recovery rate and gender had no significant relation with long-term efficacy (P ＞ 0.05).Multivariate regression analysis showed that disease course,preoperative JOA score,postoperative functional exercise were important factors influencing long-term efficacy (OR =1.423,2.089,1.320,P=0.023,0.012,0.034).Conclusions Disease course,preoperative JOA score,postoperative functional exercise are important factors influencing long-term efficacy of surgery for patients with lumbar spondylolysis.

BACKGROUND: Polymer micelles is a new type of drug carriers developed in recent years,with a wide range of carrying drugs,structural stability,excellent tissue permeability,long residence of drugs in vivo,and effective reaching the target.The performances of intelligent targeting and decreasing the initial burst release have become the focus of recent researches.OBJECTIVE: To obtain an intelligent targeting drug carrier of low critical solution temperature(LCST)at 40℃,to change drug release behavior through the changes of temperature,and to further improve the stability and drug release behavior of the micelles by core-crosslinking.METHODS: By radical polymerization of N-isopropylacrylamide(NIPAAm)and N,N-dimethylacrylamide(DMAAm),hydroxyl terminated poly(N-isopropylacrylamide-co-N,N-dimethyl acrylamide)[P(NIPAAm-co-DMAAm)]was synthesized.Molecular weight and LCST of P(NIPAAm-co-DMAAm)were regulated by adjusting the mercaptoethanol and monomer ratio,as well as the ratio of NIPAAm and DMAAm,Amphiphilic block copolymer P(NIPAAm-CO-DMAAm)-b-PCL was prepared via bulk ring-opening polymerization of ε-caprolactone by using the end hydroxyl group of P(NIPAAm-co-DMAAm)as initiator and stannous octoate as catalyst.The block copolymer reacted with acryloyl chloride to obtain amphiphilic block copolymers with unsaturated double bonds at the terminal.Drug loaded nano-micelles with different nuclear cross-linked degrees were prepared by dialysis method,and its release behavior was investigated.RESULTS AND CONCLUSION: Amphiphilic block copolymers,with the LCST of 42℃,were obtained with hydroxyl or acryloyl endgroup.By blending them at different ratios,thermo-sensitive drug-loaded nano-micelles with different core-cresslinking degrees were prepared.The drug release rate was faster at 43℃ than at 37℃.With the core-crosslinking degrees increasing,the release of paclitaxel gradually slowed.The results suggest that the drug release rate from micelles prepared from thermo-sensitive P(NIPAAm-co-DMAAm)-b-PCL can be regulated by the degree of cross-linking.

Objective To analyze the clinical effect of L-thyroxine combined with selenium yeast in patients with lymphocytic thyroiditis.Methods The clinical data of 96 patients with lymphocytic thyroiditis from March 2015 to September 2016 was analyzed retrospectively.The cases were divided into study group(48 cases)and control group(48 cases)according to double-blind method.The control group were treated with levothyroxine and the study group were treated with levothyroxine combined with selenium yeast.Free tetraiodothyronine(FT4),free triiodothyronine(FT3),thyrotropin(TSH),thyroglobulin antibody(TGAb),serum thyroid peroxidase antibody(TGAb)and serum thyroid peroxidase(TPOAb),the level of peripheral blood T cell subsets and the total effective rate between the two groups were compared.Results After treatment,the levels of FT4,FT3,TSH,TGAb and TPOAb in the two groups were significantly better than those before treatment(P<0.05).FT4,FT3,TSH,TGAb,TPOAb levels in the study group were significantly better than that in the control group(P<0.05).Compared with the control group,the T lymphocyte subsets of the study group after treatment were significantly better(P<0.05).Compared with the control group,the total effective rate of the study group was significantly higher(P<0.05).Conclusion The effect of L-thyroxine combined with selenium yeast in the treatment of lymphocytic thyroiditis patients is very significant.The treatment method is worthy of promotion in the clinical treatment.

BACKGROUND:The safety and efficacy of simultaneous bilateral total knee replacement or selective unilateral total knee arthroplasty in patients with severe osteoarthritis of the knees are stil controversial. OBJECTIVE:To compare safety and clinical efficacy of patients with osteoarthritis knees after simultaneous bilateral total knee replacement or selective unilateral total knee replacement. METHODS:Total y 60 cases with severe osteoarthritis of the knees (90 knees) undergoing total knee replacement were divided into unilateral total knee replacement group (n=30, 30 knees), and the simultaneous bilateral total knee replacement group (n=30, 60 knees). RESULTS AND CONCLUSION:There was no significant difference in the incidence of other complications such as infection, mortality, pulmonary embolism in patients of both groups (P>0.05). The incidence of cardiovascular complications, postoperative blood loss and blood transfusion were higher in the bilateral knee group than in the unilateral knee group (P<0.05). During fol ow-up at 1 year after replacement, no significant differences in range of motion, muscle strength of quadriceps and hospital for special surgery knee score were detected in patients of both groups (P>0.05). However, Visual Analogue Scale scores were significantly lower in the bilateral knee group than in the unilateral group (P<0.05). These data indicated that the risk of cardiovascular complications was high in patients receiving bilateral total knee replacement. Patients with severe cardiovascular disease should avoid simultaneous bilateral total knee arthroplasty.

Objective To observe the effect of rosuvastatin on vascular cell adhesion molecule-1 (VCAM -1),C-reactive protein (CRP),TG,TC and LDC in patients with acute cerebral infarction at the early stage.Methods According to the random number expression method,90 patients with acute cerebral infarction were divided into rosuvastatin treatment group and control group,with 45 cases in each group.The course of treatment was 21 days.The control group was given conventional western medicine (aspirin,mannitol etc.),the treatment group received rosuvastatin on the basis of the control group.Before and after treatment,the plasma VCAM-1,CRP,TG,TC,LDLch levels,clinical efficacy,efficacy of regulating dyslipidemia and drug safety were compared.Results After treatment,the CRP levels in the two groups were improved.After treatment for 7 days,14 days,the CRP levels of the treatment group were (23.68 ± 5.23) mg/L,(16.68 ± 6.76) mg/L,respectively,which improved more significantly than those of the control group [(30.12 ± 6.68) mg/L,(21.12 ± 6.35) mg/L],the differences were statistically significant (t =5.092,3.230,all P ＜ 0.05).After 21 days of treatment,the CRP of treatment group was better than the control group,but the difference was not statistically significant (P ＞ 0.05).The VCAM-1 levels of the two groups after treatment were improved.After treatment for 7 days,14 days,the VCAM-1 levels of the treatment group were (1 205.1 ±61.8)mg/L,(852.1 ± 60.2)mg/L,respectively,which were improved more significantly than those of the control group[(1 415.6 ± 62.9) mg/L,(963.1 ± 53.3) mg/L],there were statistically significant differences between the two groups (t =21.815,9.261,all P ＜ 0.05),21 days after treatment,there was no statistically significant difference (P ＞ 0.05).The levels of TG,TC,LDC in the two groups were all decreased after treatment for 7 days,14 days and 21 days,and the improvement in the treatment group was more obvious,the differences between the two groups were statistically significant (t =5.219,7.303,4.044,2.232,4.336,3.612,2.689,7.817,11.057,all P ＜0.05).Conclusion Compared with the conventional western medicine treatment,rosuvastatin can decrease the plasma levels of CRP,VCAM-1,TG,TC,LDC,further improve the pathological basis of ischemic cerebrovascular disease,eliminate the risk factors,it is more conducive to the prognosis of acute cerebral infarction.

BACKGROUND:The risk factors for patellofemoral pain syndrome are still unclear and research on risk factors is gradually becoming a hot topic in order to improve the therapeutic outcome of this disease. OBJECTIVE:To investigate the relationship between lower limb alignment and patellofemoral pain syndrome in young male runners. METHODS:In the same running population,21 patients with bilateral knee pain,29 patients with single knee pain and 20 normal runners were collected from January 2021 to July 2022.Full-length X-ray examination of both lower limbs in standing position was performed in all subjects.The lateral distal femoral angle,medial tibial proximal angle,joint line congruence angle,hip-knee-ankle angle,and knee physical valgus angle were measured and statistically analyzed. RESULTS AND CONCLUSION:There was no significant difference in the parameters between the left and right knees in each group(P>0.05).Compared with the normal group,no significant changes in lateral distal femoral angle,medial tibial proximal angle,joint line congruence angle,and hip-knee-ankle angle were observed in the single knee pain group and double knee pain group,while the knee physical valgus angle was significantly increased in these two groups(P<0.05).To conclude,increased knee physical valgus angle may be a risk factor for patellofemoral pain syndrome.

Objective To evaluate the safety and efficacy of CT-guided needle puncture biopsy of pancreatic lesions through gastrointestinal space.Methods Data of 96 patients with single pancreatic lesion who underwent CT-guided needle puncture biopsy through gastrointestinal space were retrospectively analyzed,and the success rate of puncture biopsy was recorded.The diagnostic efficacy of biopsy pathology was evaluated based on surgical pathology and follow-up results,and the relative complications were observed.Results Puncture biopsy was successfully completed in all 96 cases(96/96,100%).The sensitivity of biopsy pathology diagnosis was 97.75%(87/89),with specificity of 100%(7/7),positive predictive value of 100%(87/87),negative predictive value of 77.78%(7/9)and accuracy of 97.92%(94/96).Complications were noticed in 6 cases,including small amount of peripancreatic effusion in 3 cases,small amount of abdominal effusion in 1 case and intermittent fever in 2 cases,which were all improved.No other complication occurred.Conclusion CT-guided needle puncture biopsy of pancreatic lesions through gastrointestinal space was safe and effective.