OBJECTIVETo provide a theoretical basis for designing of lumbar intervertebral disc prosthesis by collecting the data of the lumbar endplate morphology.

METHODSA total of 100 healthy adults were measured about the following parameters: lumbar lordosis, the Cobb angle of each segment, the concavity depth (ECD) of the endplate, the location of concavity apex (ECA) of the endplate. And a correlation analysis on lumbar lordosis and ECD, ECA was made, respectively.

RESULTSIn total, 100 volunteers were measured. The mean age of the volunteer was 40 years (range 20 - 50 years); the average depth of ECD was (2. 37 ± 1. 42) mm, the average location of ECA was (52. 21 ± 9. 70) %; the average depth of ECD of inferior endplate (IEP) was (2. 81 ± 1. 52) mm (0. 54 - 7. 60 mm), and the parameter of the superior endplate (SEP) was (1. 94 ± 1. 16)mm(0. 39 - 6. 10 mm). The average depth of ECD of the IEP was bigger than of the SEP for each lumbar vertebral body. Most of the location of ECA was at the back of the intervertebral body, the average location of ECA of IEP was (49. 60 ± 8. 78) % (22. 57% - 75. 58%), and the parameter of the SEP was (55. 03 ± 9. 90) % (16. 03% -75. 58%); the mean angle of lumbar lordosis was 39. 760 11. 25°(13. 8° - 72. 00°). There was no obvious correlation between the lumbar lordosis and the ECD (r -0. 193, P =0. 195), neither was the location of ECA(r =0. 080, P =0. 592).

CONCLUSIONMost of the location of ECA is at the back of the intervertebral body, the average depth of ECD is 2. 37 mm, the average location of ECA is 52. 21%.

Adult ; Humans ; Intervertebral Disc ; Lumbar Vertebrae ; anatomy & histology ; Lumbosacral Region ; anatomy & histology ; Middle Aged ; Prostheses and Implants ; Reference Standards ; Spine ; anatomy & histology ; Young Adult

BACKGROUND:The key of stem cells for treating nervous tissue injury is the transplantation of stem coils that have regeneration capacity.The structure and function of central nervous system were re-established by multiple action mechanisms.OBJECTIVE:To explore the effects and mechanisms of bone marrow mesenchymal stem cells(BMSCs)locally transplanted into rats with spinal cord injury on neurological recovery.METHODS:BMSCs were separated with density gradient centrifugation and cell attachment.10 mg/L BrdU was used for labeling before cell transplantation.Adult female Wistar rats were used to establish spinal cord injury models using an aneurysm clip,and they were then randomly divided into control group,saline group and transplantation group.In the transplantation group,BMSCs were transplanted into the damaged spinal cord by stereotaxis at day 7 following damage.In the saline group,an equal volume of saline was utilized.In the control group,the rats were left intact.Basso,Beattie and Bresnahan(BBB)locomotor rating scale was used before and at 7,14,30,60 and 90 days following damage.Rats were sacrificed at day 90.BrdU-positive cells,Brdu+neuron specific enolase,Brdu+glial fibrillary acidic protein(GFAP),Brdu+basic fibroblast growth factor(bFGF),and Brdu+brain-derived nerve growth factor(BDNF)immunohistochemistry double-staining cells and simple staining positive calls were observed.RESULTS AND CONCLUSION:The recovery of BBB function score was better in the transplantation group than in the control group(P＜0.05).The recovery speed of BBB function score was slower in the saline group than in the control group at 30 days following damage(P＜0.05).No significant difference was determined at day 90 compared with the control group(P＞0.05).BrdU-positive cells and double-staining cells of immunohistochemistry could be found at the center of damage site and 1 cm from caudal end to damaged site in rats of the transplantation group.The number of NSE,GFAP,bFGF and BDNF simple staining cells was significantly greater in the transplantation group than in the control and saline groups(P＜0.05).Results indicated that BMSC transplantation can improve the recovery of nervous function of rats with spinal cord injury.Its mechanism may be correlated with the differentiation of transplanted cells into neuron-like and glial cell-like cells,secretion or promoting secretion of neurotrophic factors in host.

Objective This paper explored the effect of the early clinical exposure in im-proving medical students' cognitive aspects of the doctor-patient relationship. Methods (1)From 280 undergraduate students of Grade 2010 who participated in early clinical exposure of Xi'an Jiaotong University College of Medicine and 280 undergraduate students of Grade 2011 who did not participate in the early clinical exposure, we selected 140 students respectively to conduct a simple random sam-pling survey. The results were analyzed by SPSS after using Microsoft Excellsoftware for entry. Statis-tical methods selected χ2-test/Fisher exact test(P<0.05). (2)We had an interview to students,teachers leading the project, instructor,experts engaging in the study of the doctor-patient relationship by using focus group discussion and in-depth interview, and then using thematic analysis to analyze the data. (3)The main aspects of questionnaires and interviews were: details, activity participation/interest, general cognitive on the doctor-patient relationship, passion for profession, choice of career, the effect in improving medical students' cognitive aspects of the doctor-patient relationship and the suggestions and comments. Results The effective questionnaires collected from Grade 2010 were 134, and124 from Grade 2011.The participation rate of the undergraduates of Grade 2010(participating group) was 94.0%(126/134), while the interest rate of undergraduates of Grade 2011 (control group) was only 76.6%(95/124). Participating group had a better cognitive understanding of doctor-patient relationship than control group(P=0.0192). The activities had significant effects on choice of career(P=0.0002), and no effect on passion for profession(P=0.7372). There was statistically significant difference on their views of employment(P=0.0002). The key words for the interview were: not enough preparation before activity, not reasonable timing, teachers leading the project, stimulation of professional pride. Conclusions Early clinical exposure activities can be effective in improving medical students' awareness of the current doctor-patient relationship. Still we have some shortages in the activity, some more exploration and amelioration should be made in late stage.

Objective To investigate the alternation of right ventricular volume and systolic function in patients with severe pulmonary regurgitation under percutaneous pulmonary valve implantation(PPVI) by real-time three-dimensional echocardiography(RT-3DE).Methods Ten patients with severe pulmonary regurgitation were enrolled.The 2D echocardiography images and real-time 3D full volume images on apical four-chamber view on a Philips IE33 system were acquired before PPVI and at 3 days,1 month,3months and 6 months after PPVI.Right ventricular end diastolic volume (EDV),end systolic volume(ESV),stroke volume (SV),ejection fraction(EF),fractional area change(FAC),tricuspid annular plane systolic excursion (TAPSE),right ventricular longitudinal strain-free wall(RVLSf) and right ventricular longitudinal strainseptum(RVLSs) were analysed using off-line TomTec software,the differences among the five groups were compared,and correlation analysis was made between the CMR and RT-3DE measurements.Results The level of pulmonary regurgitation had decreased or disappeared after PPVI.Compared with the preoperation,EDV,ESV at 3 days,1 month,3months and 6 months after operation had decreased significantly.EF,FAC,TAPSE,RVLS had increased significantly(all P ＜0.05).There were close correlation in EDV,ESV,EF between RT-3DE and CMR(pre-operation r =0.811,0.817,0.807,post-operation r =0.735,0.834,0.800,all P ＜0.055).Conclusions RV volume notably decreases while RV systolic function remarkably improves.The RT-3DE is a helpful technology in the evaluation of right ventricular volume and systolic function in patients after PPVI.

Objective To investigate the value of two-dimensional and three-dimensional transesophageal echocardiography (3DTEE) in transcatheter aortic valve implantation (TAVI). Methods Eleven patients with severe aortic stenosis and one patient with moderate to severe prosthetic valve regurgitation underwent TAVI in Zhongshan Hospital of Fudan University from May 2010 to December 2015. All patients received two-dimensional and three-dimensional transthoracic and transesophageal echocardiographic examination before surgery, during and after surgery.Results Procedural success was achieved in eleven patients, but one patient died in pericardial tamponade and aortic dissection three days after TAVI. The maximum and minimum diameter of aortic annule, the area of aortic annule and aortic valve were measured by multidetector computed tomography (MDCT) and 3DTEE before surgery. All parameters had strong correlations between MDCT and 3DTEE (r=0.98,P<0.01 for maximum diameter;r=0.97,P<0.01 for minimum diameter;r=0.97,P<0.01 for the area of aortic annule;r=0.99, P<0.01 for the area of aortic valve). There were good correlations for the area of aortic valve among MDCT, 3DTEE and equation of continuity (allr=0.99,P<0.01).ConclusionTwo-dimensional and three dimensional transesophageal echocardiography can quantify the size of aortic annular and comprehensively evaluate the anatomical structure of aorta rapidly and accurately, which can be used in guiding TAVI and monitoring its complications in real time.

Objective:To compare the clinical effect of anterior and posterior resection,bone grafting and internal fixation on the spinal tuberculosis.Methods:82 cases of patients with spinal tuberculosis in our hospital from February 2014 to August 2015 were selected and randomly divided into the control group and the observation group with 41 cases in each group.Both groups received conventional anti tuberculosis treament and underwent debridement bone graft and internal fixation treatment,the control group underwent anterior internal fixation,while the observation group underwent posterior internal fixation.The operation time,intraoperative blood loss,low back pain relief time,ambulation time and hospitalization time were compared between two groups.All patients were followed up for 6 months,the Frankel grade and serum Thl7 cell related factors levels were compared between two groups before and after operation.Results:The low back pain relief time,ambulation time and hospitalization time of observation group were significantly shorter than those of the control group(P＜0.01).After operation,the Frankel classification grade A and B ratio of observation group were significantly higher than those of the control group (P＜0.05),the serum IL-10,IL-17,IL-23 and TGF-beta 1 levels were significantly lower than those of the control group (P＜0.01).Conclusion:Anterior resection combined with posterior bone graft inFixation could effectively promote the rehabilitation of spinal tuberculosis,reduce the severity of spinal injury,relieve the inflammatory response and promote the recovery of immune function.

Objective To evaluate the left ventricle systolic function in patients with aortic stenosis (AS) underwent transcatheter aortic valve implantation(TAVI) by speckle tracking imaging and to observe the indicators in bicuspid aortic valves(BAV) and tricuspid aortic valves(TAV) groups.Methods Twenty nine patients with AS were enrolled,all of them underwent TAVI successfully.The regular echocardiography and 3D full-volume images were acquired on before and 3 days,1 month after TAVI.Longitudinal strain,circumferential strain,and three-dimensional left ventricle ejection fraction(3D-LVEF) were analyzed using Qlab software.Results Compared with the baseline,aortic valve blood flow velocity (AV),maximum aortic valve pressure gradient (AVPG-max),mean aortic valve pressure gradient (AVPG-mean),aortic valve area(AVA) after TAVI were improved significantly.Global longitudinal strain(GLS) had a improvement on 3 days after TAVI(all P ＜0.001),and further increased during 1 month after TAVI (all P ＜0.001).Global circumferential strain(GCS) were increased during 1 month after TAVI(all P ＜ 0.001).The 3D-LVEF after 1 month were improved significantly(all P ＜0.001).The BAV patients and TAV patients had similar changes in all of indicators observed.Conclusions The left ventricle systolic function has early improvement after TAVI,and further recovery during follow-up.The BAV patients can obtain a benefit from TAVI equally to the TAV patients.

Objective To investigate the difference between three-dimensional transesophageal echocardiography ( 3DTEE) and CT in measuring the size of aortic ring and the height of coronary ostium . Methods Fifteen patients were recruited and were treated with the transcatheter aortic valve implantation ( TAVI) . Routine transthoracic echocardiography ,two-dimensional echocardiography ( 2DTEE) ,3DTEE and CT examinations were taken preoperatively . Results The minimal diameter ,maximum diameter , perimeter ,area of the aortic ring measured by 3DTTE showed a close correlation and a strong consistency with those measured by CT [ r = 0 .88 , P < 0 .0001 ,ICC = 0 .928 (0 .788 - 0 .976) ; r = 0 .81 , P = 0 .0003 , ICC = 0 .890 ( 0 .673 - 0 .963) , r = 0 .85 , P = 0 .0001 ,ICC = 0 .914 ( 0 .744 - 0 .971) ; r = 0 .88 , P <0 .0001 ,ICC = 0 .932 (0 .799 - 0 .977) ] .The ostium height of the left and right coronary arteries measured by 3DTEE also showed a close correlation and a strong consistency with those measured by MDCT [ r =0 .87 , P < 0 .0001 ,ICC = 0 .923 ( 0 .777 - 0 .975) ; r = 0 .82 , P < 0 .0002 ,ICC = 0 .897 ( 0 .693 - 0 .965) ] . Besides ,inter-observer and intra-observer reproducibility for 3DTEE measurement data were very good . Conclusions 3DTEE has a high repeatability in evaluating minimal diameter , maximum diameter , perimeter ,area of the aortic ring and the height of coronary ostium ,which also shows good correlation with those measured by CT .

Objective:To investigate the risk factors of positive peritoneal cytology (PPC) in patients with endometrial cancer and the impact of PPC on patients' prognosis.Methods:The clinicopathological data of 202 patients who underwent initial surgical treatment and were diagnosed with endometrial cancer by postoperative pathology at Qilu Hospital of Shandong University from January 2015 to December 2019 were retrospectively analyzed, and the peritoneal fluid of patients were sent intraoperatively for cytological liquid-based smear examination. Logistic regression was used to perform univariate and multivariate analyses of PPC in the whole group of patients and the early-stage patients; Univariate analysis of the progression-free survival in the whole group of patients and the early-stage patients was performed by Kaplan-Meier method and compared by log-rank method, and multivariate analysis of the progression-free survival in the whole group of patients and the early-stage patients was performed by Cox proportional hazards model.Results:Of 202 patients, 183 (90.6%) had negative peritoneal cytology (NPC) and 19 (9.4%) had PPC; 180 patients (89.1%) were stage Ⅰ-Ⅱ and 22 (10.9%) were stage Ⅲ-Ⅳ; 180 patients (89.1%) had early-stage endometrial cancer. Deep myometrial infiltration ( OR = 3.57, 95% CI 1.02-12.45, P = 0.046) and lymph node metastasis ( OR = 7.16, 95% CI 1.70-30.23, P = 0.007) were independent risk factors for PPC in patients with endometrial cancer; deep myometrial infiltration was an independent risk factor for PPC in patients with early-stage endometrial cancer ( OR = 6.22, 95% CI 1.22-31.73, P = 0.028). The 3-year PFS rates for the whole group of patients with PPC and NPC were 72.9% and 92.7%, and the difference was statistically significant ( P = 0.001); the 3-year PFS rates for early-stage patients with PPC and NPC were 82.5% and 96.2%, and the difference was statistically significant ( P = 0.002). PPC was an independent risk factor for PFS in the whole group of patients with endometrial cancer ( HR = 4.80, 95% CI 1.14-20.17, P=0.032); PPC was also an independent risk factor for PFS in patients with early-stage endometrial cancer ( HR = 8.85, 95% CI 1.96-39.93, P = 0.005). Conclusions:Deep myometrial infiltration is an independent risk factor for PPC, and PPC is an independent risk factor for PFS in patients with endometrial cancer. Routine cytological examination of peritoneal fluid is recommended in patients with endometrial cancer.

Objective To evaluate the role of transthoracic echocardiography ( T T E ) and transesophageal echocardiography( T EE) in the process of transapical mitral valve repair using a novel edge‐to‐edge device( ValveClamp) and this device′s efficacy and safety in a preliminary clinical trial . Methods Six patients with moderate to severe or severe degenerative mitral regurgitation ( DM R) confirmed by T T E and T EE were enrolled . T T E was performed pre and post procedure as well as 30 days post procedures . Related cardiac structure and hemodynamic parameters ,including mitral regurgitation area ( MRA‐max ) , vena contracta width ( VCW ) ,mitral valve effective orifice area ( M VEOA ) ,left ventricular end diastolic diameter ( LVEDD ) , left ventricular end systolic diameter ( LVESD ) , left ventricular ejection fraction ( LVEF) ,max and mean mitral valve pressure gradient ( M VPG‐max and M VPG‐mean) were recorded and evaluated in a central core laboratory . Results All the procedures were successfully performed .M RA‐max , VCW and M VEOA decreased significantly post procedures ( all P ＜ 0 .000 ) , and they remained no significant changes within 30 days post procedures ( all P ＞ 0 .05 ) . M eanwhile ,M VPG‐max and M VPG‐mean slightly increased ( all P ＜0 .01 ) and left atrial anterior‐posterior dimension attenuated 30 days post procedures( P ＜0 .05) ,but all M VPG‐mean were lower than 5 mm Hg ( 1 mm Hg＝0 .133 kPa) . T here were no significant changes in other hemodynamic parameters ( all P ＞ 0 .05) . Conclusions T ransapical mitral valve repair using ValveClamp can be performed safely and a significant reduction in mitral regurgitation can be achieved in patients with DM R . T EE and T T E facilitate the patient selection for ValveClamp procedures as well as perioperative navigation and assessment .