BACKGROUND:Titanium mesh is a new type of bone graft supports used for the treatment of spine, especial y the cervical spine disorders at home and abroad in recent years. But, at present, how to improve the cervical lordosis curvature during anterior surgery is the difficulty for the treatment of cervical spondylotic myelopathy.
OBJECTIVE:To observe the effect of straight titanium mesh and individual designed titanium mesh used in the bone graft fusion and internal fixation on the recovery of cervical curvature and Japanese Orthopaedic Association score during anterior cervical subtotal vertebrectomy in the patients with cervical spondylotic myelopathy.
METHODS:Forty-three patients with cervical spondylotic myelopathy treated with surgical indications of subtotal vertebrectomy and decompression internal fixation were included, and the patients were divided into two groups according to different internal fixation methods. There were 15 cases in the individual designed titanium mesh group and 28 cases in the straight titanium mesh group. The preoperative anteroposterior X-ray films of the cervical spine of al the patients were as the blank control group. The clinical data of the patients in two groups were retrospectively analyzed, and the postoperative Japanese Orthopaedic Association score, cervical curvature, intervertebral angles and intervertebral height were compared.
RESULTS AND CONCLUSION:The cervical lordosis angle and the intervertebral angle of surgery segment in the individual designed titanium mesh group were improved when compared with those in the straight titanium mesh group and the blank control group (P<0.01), and the straight titanium mesh group was better than the blank control group (P<0.05). The intervertebral height of surgery segment in the individual designed titanium mesh group and the straight titanium mesh group was increased for 3.69 mm and 3.22 mm respectively when compared with that in the blank control group, and there was significant difference between individual designed titanium mesh group and the straight titanium mesh group (P>0.05). There was no significant difference in Japanese Orthopaedic Association score between individual designed titanium mesh group and the straight titanium mesh group (P>0.05). During subtotal vertebrectomy for the treatment of cervical spondylotic myelopathy, cutting titanium mesh into trapezoidal shape to simulate the normal disc shape of former high to low can effectively restore the physiological curvature of cervical spine and the intervertebral height of surgery segment.

Objective To investigate the function of acid pocket in reflux esophagitis. Methods The 15 healthy controls and 24 reflux esophagitis patients were identified by reflux disease questionnaire (RDQ) and gastric endoscopy. The location of subjects' lower esophageal sphincter (LES) was determined by 4 channel esophageal manometry system. Then a single-channel pH electrode was positioned 1 cm below the distal border of the LES to monitor fasting pH for half an hour. After a standard meal, the pH was continuously measured for two hours. Then the electrode was moved to 5 cm above the proximal border of the LES to monitor the dynamic pH for 24 h.Results Acid pocket was found in 16 cases of reflux esophagitis patients(66.67%) and 10 cases of healthy individuals (10/15). Acid pocket occurred earlier in reflux esophagitis group than healthy controls [11.00(4.25-17.00) min vs 30.00(15.50-54.25) min, P＜0.05], and the average pH value was lower [1.84(1.59-2. 19) vs 2.32 (1.96-2.71), P＜0.05]. There was no statistic difference in mean pH value of gastroesophageal junction and the duration of acid pocket before the meal.Conclusion There is abnormal acid reflux in reflux esophagitis patients, and acid pocket with earlier occurrence and lower pH value may relevant to esophageal mucosal impairment.

Objective To prospectively assess the nutritional status in the patients with alimentary tract malignancy,and to elucidate the factors related to malnutrition.Methods The nutritional status of 328 patients with newly diagnosed alimentary tract malignancy was assessed using subjective global assessment(SGA)and serum levels of prealbumin and albumin.And the factors influencing the nutritional status of the patients with alimentary tract malignancy in different locations were analyzed.Results The prevalence of malnutrition was 64.43% in all,75.81% in colon cancer,63.24% in esophageal cancer,62.40% in gastric cancer and 60.27% in rectal cancer.The changes of nutritional status mainly manifested weight loss with the incidence of 67.39%,serum prealbumin level under 200 g/L with the incidence of 24.1% and serum albumin level less than 35 g/L with the incidence of 31.70%.And there was significant difference in weight loss and serum levels of prealbumin and albumin among the patients with different nutritional status(P=0.000).The factors that influence the nutritional status of the patients with alimentary tract malignancy include the location and TNM staging of tumors,and the age,appetite and digestive symptoms of the patients.Conclusion The patients with alimentary tract malignancy are susceptible to malnutrition due to the multiple factors such as the tumor location and metabolic impacts of tumor on host.Nutritional screening,assessment and early intervention should be emphasized in the inpatients with alimentary tract malignancy.

The purpose of this study is to explore the feasibility of wheat germ agglutinin (WGA) modified liposome as a vehicle for ophthalmic administration. Liposome loaded with 5-carboxyfluorescein (FAM) was prepared by lipid film hydration method. WGA was thiolated and then conjugated to the surface of the liposome via polyethylene glycol linker to constitute the WGA-modified and FAM-loaded liposome (WGA-LS/FAM). The amount of thiol groups on each WGA molecule was determined, and the bioactivity of WGA was estimated after it was modified to the surface of liposome. The physical and chemical features of the WGA-modified liposome were characterized and the ocular bioadhesive performance was evaluated in rats. The result showed that each thiolated WGA molecule was conjugated with 1.32 thiol groups. WGA-LS/FAM had a mean size of (97.40 +/- 1.39) nm, with a polydispersity index of 0.23 +/- 0.01. The entrapment efficacy of FAM was about (2.95 +/- 0.21)%, and only 4% of FAM leaked out of the liposome in 24 h. Erythrocyte agglutination test indicated that after modification WGA preserved the binding activity to glycoprotein. The in vivo ocular elimination of WGA-LS/FAM fitted first-order kinetics, and the elimination rate was significantly slower than that of the unmodified liposome, demonstrating WGA-modified liposome is bioadhesive and suitable for ophthalmic administration.
Absorption, Physicochemical ; Adhesiveness ; Administration, Ophthalmic ; Animals ; Drug Carriers ; Eye ; metabolism ; Fluoresceins ; chemistry ; Liposomes ; administration & dosage ; chemistry ; pharmacokinetics ; Male ; Particle Size ; Polyethylene Glycols ; chemistry ; Rats ; Rats, Sprague-Dawley ; Wheat Germ Agglutinins ; administration & dosage ; chemistry ; pharmacokinetics

OBJECTIVETo investigate clinical effects of strategy by stages for preventing respiratory complications of patients with acute cervical spinal cord injury (ACSCI).

METHODSFrom September 2009 to May 2013,the clinical data of 91 patients with ACSCI underwent surgery were retrospectively analyzed. Among the patients, 42 patients were divided into in-stages group, including 30 males and 12 females with an average age of 50 years old (ranged 28 to 76) which were treated with strategy by stages for preventing respiratory complications; others 49 patients which were not treated with the strategy regarded as control group, including 38 males and 11 females with an average age of 47 years old (ranged 30 to 77). All of them had definite history of trauma, and were admitted to orthopaedics within 48 h after trauma. In in-stages group, respiratory muscle strength training, high-dose ambroxol using and other treatment were performed to prevent respiratory complilcations according to preoperative, intraoperative and postoperative stage. While in control group, there were no systematic and effective measures utilized. Chi-square test was used to evaluate the difference for respiratory complications rate, the rate of tracheostomy or intubation and mortality caused by the respiratory complications between two groups.

RESULTSTen patients developed with respiratory complications in in-stages group (7 patients with pneumonia, 1 with atelectasis and 2 with respiratory failure), among which 3 patients underwent tracheostomy or intubation. In control group, 24 patients developed with respiratory complilcations (15 with pneumonia,3 with atelectasis and 6 with respiratory failure), among which 11 patients underwent tracheostomy or intubation. There was significant difference between two groups (χ2 = 6.12, 4.07; P = 0.013, 0.044). Five patients died because of respiratory complications, one case were in in-stages group and 4 in control group. There was significant difference between two groups (χ2 = l.39, P = 0.238).

CONCLUSIONThe strategy by stages is an effective method for preventing respiratory complications of ACSCI and can reduce the respiratory complications rate and improve the prognosis of respiratory complications.

Acute Disease ; Adult ; Aged ; Cervical Cord ; injuries ; Female ; Humans ; Male ; Middle Aged ; Pneumonia ; prevention & control ; Pulmonary Atelectasis ; prevention & control ; Respiratory Insufficiency ; prevention & control ; Retrospective Studies ; Spinal Cord Injuries ; complications ; Tracheostomy

Objective:To observe influence of alprostadil injection on contrast-induced nephropathy (CIN) in high risk patients after percutaneous coronary intervention (PCI).Methods: A total of 263 CIN high risk (CIN risk score ≥16 scores) patients were selected.According to random number table, patients were randomly divided into routine treatment group (n=121, received routine hydration therapy) and alprostadil group (n=142, received additional alprostadil injection based on routine treatment group).Serum creatinine (SCr), glomerular filtration rate(GFR), cystatin C (CysC) and β trace protein (β-TP) level before, 48h and 72h after PCI were measured and compared, and incidence rate of CIN, percentage of blood purification therapy and mortality were compared between two groups.Results: Compared with before PCI, there was significant rise in SCr level and significant reduction in GFR in both groups on 48h and 72h after PCI (P<0.01 all);Compared with routine treatment group, there were significant reductions in levels of SCr [72h: (190.04±28.92) μmol/L vs.(141.10±21.18) μmol/L], and significant rise in GFR [72h: (26.0±4.4) ml/min vs.(36.4±4.9) ml/min], and levels of CysC[72h: (1.75±0.74) mg/L vs.(1.47±0.55) mg/L] and β-TP [72h: (1.53±0.50) mg/L vs.(1.22±0.38) mg/L] significantly decreased in alprostadil group on 48h and 72h after PCI, P<0.05 or <0.01;there were significant reductions in incidence rate of CIN (30.6% vs.18.3%) and percentage of blood purification therapy (10.7% vs.3.5%) in alprostadil group, P=0.001, 0.045 respectively.There was no significant difference in mortality between two groups, P=0.728.Conclusion: Alprostadil injection can significantly improve kidney function, reduce incidence rate of CIN and percentage of blood purification therapy in CIN high risk patients after PCI, which is worth extending.

Objective To investigate the effects of pulsed electromagnetic fields(PEMFs)on proliferation and differentiation of endothelial progenitor cells(EPCs).Methods EPCs were isolated from rat bone marrow by density gradient centrifugation.EPCs were exposed to PEMFs from the 5th day to the end of culture.MTT was used to measure the proliferation of EPCs.The expression ofⅧ-related antigen and NOS_3 was evaluated by flow cytometry. Results Compared with the control,the proliferating ability of EPCs exposed to PEMFs was stronger;the number ofⅧ-related antigen and NOS_3 positive cells increased significantly in EPCs exposed in PEMFs.Conclusion PEMFs promotes the proliferation and differentiation of rat bone marrow EPCs.

Objective The mechanism and signaling mechanisms of fracture healing by vasoactive intestinal peptide (VIP) regulating are not clear.We established an selective cut off sensory/motor nerve combined with tibial fracture rat model to study the effects of VIP and microvessel density(MVD) during the fracture healing process after nerve injury.Methods 60 SD rats were randomly divided into 3 groups: tibial fracture + motor nerve (anterior root) cutting group (group ART);tibial fracture + posterior root (sensory nerve) cutting group (group PRT);tibial fracture group (group SO),and each group were 20.Three groups of rats in the model after the establishment of 1W, 2W, 3W, 4W these time points, were killed.The skeleton specimens were obtained in the vicinity of the fracture 5mm, to observe the expression of VIP and microvessel density of the law of change.Results Histology observation showed: new bone trabecular bone callus maturity of PRT group is lower than SO group and ART group at each time points;the immunohistochemical staining showed that compared with callus VIP average optical density of PRT group at 2w and 3w(0.156±0.015、0.163±0.012), SO group(0.216±0.012、0.223±0.010) and ART group(0.198±0.014、0.212±0.016) increased obviously(P<0.05).The detection of callus MVD indicated that compared with callus MVD average density of PRT group at 2w and 3w(26.4±2.2、32.3±2.0), SO group(38.2±2.3、40.6±2.6) and ART group(36.6±2.2、38.5±2.1) significant increased (P<0.05).At the 2nd, 3rd and 4th week, the wet weight of tibia was significantly increased in group ART and SO compared with group PRT(P<0.05),which increased more significantly at 2 weeks.Conclusion The effect of loss of sensory nerve innervation on the formation of microvessel density, callus maturity and fracture healing rate were more pronounced than loss of motor nerve innervation.

The diagnosis and treatment of the lacrimal passage obstruction with lacrimal endoscope was investigated and its subsidiary surgical procedures were evaluated. Ninety-three patients (109 eyes) with lacrimal passage obstruction, including presaccal canalicular obstruction (PSCO) and nasolacrimal duct obstruction (NLDO), were examined under a lacrimal endoscope, and the obstructions were treated with laser or micro-drill. All patients were followed up after the operation for 3-6 months. The difference between the laser and the micro-drill treatment was observed. During the period of follow-up, the curative rate was 82.57%. The healing rate in PSCO group and NLDO was 80.36% and 84.91% respectively (P>0.05). After treatment with the laser, the healing rate was 93.33% in the PSCO group and 66.67% in the NLDO group respectively (P<0.05). After treatment with the micro-drill, the healing rate in PSCO and NLDO groups was 65.39% and 94.28% respectively (P<0.01). The lacrimal passage obstruction can be observed and treated directly through the lacrimal endoscope. Choosing different surgical procedures in operation according to the locations of the obstruction is helpful to improve the effectiveness.
Endoscopy/*methods ; Follow-Up Studies ; Lacrimal Duct Obstruction/*diagnosis ; Lacrimal Duct Obstruction/*surgery ; Laser Therapy/*methods ; Young Adult

AlM: To study the clinical effect of the application of microscopic pterygium resection combined with different concentration of mitomycin C ( MMC) .
METHODS:A total of 110 cases of pterygium patients (120 eyes) were randomly divided into control group (58 eyes) and observation group (62 eyes) according to the odd and even number method. The control group adopted the pterygium resection combined 0. 3mg/mL MMC, and the observation group was given pterygium resection combined 0. 2mg/mL MMC. The cure rate and the recurrence rate, eyesight before and after the treatment, two groups of cornea and sclera wound healing situation, the incidence of postoperative complications were compared.
RESULTS: The cure rate and recurrence rate of the control group was 84. 5% and 15. 5% respectively, and the observation group was 93. 6% and 6. 5% respectively, the differences were statistically significant (P<0. 05). There were statistical differences of vision of the two groups before and after treatment (P<0. 05), and there were no statistical differences of the two groups between the two groups after treatment (P>0. 05). The cornea, sclera, wound healing time of the observation group were less than the control group, and there were statistical differences between the two groups ( P < 0. 05 ). The incidence of complications was 13. 8% in the control group and 3. 2% in observation group, with statistically significant difference (P<0. 05).
CONCLUSlON: The application effect of microscopic pterygium resection combined with MMC is remarkable, and the joint of 0. 2mg/mL concentration of MMC is more safe and effective, and is worth popularizing in clinical application.