Objective To evaluate the diffusion distribution of bone cement in the vertebral body by quadrant method,and to analyze and evaluate the correlation between the diffusion distribution type of bone cement and new vertebral fractures after vertebral augmentation.Methods A total of 170 subjects who met the conditions from January 2020 to December 2021 were collected.According to the anteroposterior and lateral view of the spine,the injured vertebra was divided into four quadrants,and divided into homogeneous diffusion group and uneven diffusion group according to the postoperative diffusion distribution of bone cement in the injured vertebra.The incidence and types of refracture were followed up,and the VAS score and Cobb angle were compared between the two groups.Results 170 patients were followed up for at least 12 months,including 90 patients in homogeneous diffusion group and 80 patients in heterogeneous diffusion group.There were 33 cases of refracture(19.41％),12 cases of refracture(13.33％)in the diffuse homogeneous group,and 21 cases of refracture(26.25％)in the diffuse heterogeneous group,and the difference between the groups was statistically significant(P＜0.05).The site of refracture in the diffuse homogeneous group was mainly the clinical vertebral fracture,while the probability of refracture in the diffuse heterogeneous clinical vertebra and the operated vertebra was similar.The incidence of postoperative bone cement leakage in the diffuse homogeneous group was significantly lower than that in diffuse heterogeneous group(P＜0.05).The VAS score and Cobb angle were significantly improved in both groups after surgery and at the last follow-up compared with those before surgery,but there was no significant difference between groups.Conclusion The incidence of new vertebral fractures after vertebroplasty is closely related to the type of cement diffusion,and the risk of refracture defined as uneven cement diffusion by quadrant method is high.

Objective:To investigate the clinical efficacy of robot-assisted screw fixation for unstable pelvic ring multifocal fractures.Methods:A retrospective analysis was performed on 76 patients with unstable pelvic fractures treated with orthopaedic robot-assisted screw fixation in the Trauma Center of the Affiliated Central Hospital of Shandong First Medical University from January 2015 to June 2022, including 43 males and 33 females, aged 52.53±13.68 years (range, 16-87 years). There were 43 cases of falling injuries from high places, 22 cases of traffic accidents, 11 cases of crushing injuries and heavy objects. Fifty-five patients were employed before the injury, while 21 were not. Fractures were classified according to the Tile classification, with 72 cases classified as type B and 4 cases as type C. Robot-assisted fixation techniques included internal fixator (INFIX), anterior ring screws, sacroiliac screws, and LC-II screws. Intraoperative blood loss, fluoroscopy frequency, surgical time, and the success rate of initial guidewire placement were recorded. Fracture reduction quality was evaluated using the Matta criteria, and postoperative pelvic function recovery was assessed using the Majeed criteria.Results:A total of 150 surgical procedures were performed on 76 patients, including 34 cases of INFIX fixation, 48 cases of anterior ring screws, 61 cases of sacroiliac joint screws, and 7 cases of LC-II screws. The mean intraoperative fluoroscopy frequency was 46.63±17.50 times (range, 15-93 times). Intraoperative fluoroscopy frequency varied among different fixation techniques, with INFIX group at 16.44±4.32 times, LC-II group at 21.59±5.80 times, anterior ring screws group at 29.44±11.65 times, and sacroiliac screws group at 23.10±11.87 times. The intraoperative blood loss was 20 (10, 47.5) ml (range, 5-300 ml), and the surgical time was 105 (86, 150) min (range, 30-290 min). The mean surgical time varied among different fixation techniques. All patients were followed up for an average of 6.46±2.26 months (range, 3-16 months). Clinical healing was achieved in all patients within 6 months, with an average time of 3.14±0.50 months. At the last follow-up, fracture reduction quality assessed by the Matta score was excellent in 21 cases and good in 43 cases, with an excellent/good rate of 84% (64/76). The Majeed score was 81.82±9.14 points (range, 50-92 points). For patients who were employed before the injury, the Majeed score was 86.55±4.85 points (range, 60-92 points), with 49 cases rated as excellent, 5 cases as good, and 1 case as fair. For patients who were not employed before the injury, the Majeed score was 69.43±5.34 points (range, 50-73 points), with 18 cases rated as excellent, 2 cases as good, and 1 case as fair. The overall excellent and good rate was 97% (74/76). Among patients who underwent INFIX internal fixation, 8 cases experienced lateral femoral cutaneous nerve injury postoperatively, all of which recovered sensation after 3 months; 1 case using LC-II screws experienced screw loosening postoperatively and was advised to reduce activity, then the screw was removed after fracture healing at 6 months postoperatively; 1 case using anterior ring channel screws experienced surgical site infection postoperatively, which was controlled after debridement.Conclusion:In the treatment of unstable pelvic ring multiple fractures, robot-assisted screw fixation has less blood loss, less fluoroscopy times, high success rate of planning guide needle, satisfactory reduction quality and postoperative function.

Objective To observe the effectiveness of injecting mouse nerve growth factor ( mNGF) on the recovery of hand motor function among patients with cubital tunnel syndrome. Methods A total of 138 patients with moderate to severe cubital tunnel syndrome were randomly divided into groups designated as A, B and C, each of 46. Twenty micrograms of mNGF was injected daily 1 mm from the ulnar nerve at the cubital tunnel for the patients of group A and the injection site was moved 1 mm distally everyday along the nerve , but injected intramuscularly for those in group B. Those in group C received 500 μg of mecobalamin injected intramuscularly 3 times a week. The whole intervention consisted of two 4-week phases, with an interval of 2 months. Before and after the intervention, the function of internal hand muscles, hand function recovery rates and any electrophysiological changes in the ulnar nerve were measured and compared between the two groups. Results All of the patients showed significant improve-ment in hand muscle function and neuroelectrophysiology. The incidence of had muscle atrophy, Tinel′s sign, posi-tiveness in the paper clamping test and claw hand all significantly improved compared with before the treatment in all three groups. The average Disability of Arm Shoulder and Hand score in group A after the treatment was significantly higher than the group B and group C averages. The average ulnar nerve conduction velocity, incubation period and amplitude of group A after the treatment were all significantly better than before the treatment and better than the other groups′averages. After the treatment, the average hand function recovery in group A reached 91％, significantly high-er than in groups B ( 76％) and C ( 59％) . Conclusion Injecting mNGF next to the ulnar nerve is superior to in-jecting it intramuscularly in promoting the recovery of the ulnar nerve and hand function for patients with moderate to severe cubital tunnel syndrome.

Objective :To evaluate therapeutic effect of allisartan isoproxil tablet on carotid atherosclerosis (CAS) le‐sion in patients with mild to moderate essential hypertension (EH).Methods :A total of 120 patients with mild to moderate EH complicated CAS treated in our hospital were enrolled .They were randomly divided into valsartan group (n＝60 ,received valsartan 80mg／d) and allisartan isoproxil group (n＝60 ,received allisartan isoproxil tablet 240mg／d) ,both groups received measure by carotid vascular ultrasound before treatment ,24 weeks and 48 weeks af‐ter treatment and its result were compared between two groups .Results :Compared with before treatment ,there were significant reductions in IMT ,size ,thickness and number of carotid atherosclerotic plaques on 24 weeks and 48 weeks after treatment in two groups ,and above indexes of 48 weeks were significantly lower than those of 24 weeks , P＜0.05 or ＜0.01. The decreased value of IMT in allisartan isoproxil group was significantly higher than that of valsartan group ,and there were no significant difference between two groups in time point of size ,thickness and number of carotid atherosclerotic plaques , P＞0.05 all.Conclusion :Therapeutic effect of two drugs on size ,thick‐ness and number of carotid atherosclerotic plaques are similar ;but therapeutic effect of allisartan isoproxil tablet on IMT is significantly better than that of valsartan .

Objective To summarize clinical diagnosis and microsurgical treatment method of cerebellopontine angle epidermoid cyst presenting with trigeminal neuralgia.Methods Thirty-seven cases of cerebellopontine angle epidermoid cyst presenting with trigeminal neuralgia treated by microneurosurgery procedure were analyzed retrospectively.Results Complete resection was achieved in 31 cases,and subtotal was achieved in 6 cases,with no operative mortality.Postoperatively,the symptom of trigeminal neuralgia disappeared in 28 cases,was eased obviously in 6 cases,and was eased in 3 cases.The symptom of dizziness in all 6 cases vanished,and hearing in 3 cases was improved.Three cases appeared cerebrospinal fluid leakage,and 4 cases appeared oral herpes.Symptom in 1 case aggravated after 6 months,and oral medicine was ineffective.The pain symptom disappeared after reoperation.Conclusions The suboccipital retrosigmoid approach microneurosurgery is the principal treatment method for cerebellopontine angle epidermoid cyst presenting with trigeminal neuralgia.Microsurgical technique combined with surgical skill is the guarantee for increasing total removal rate of tumors and decreasing complications.

Objective:To explore a new method of the cultivation of adoptive immunotherapy cells.Methods: Mononuclear cells was isoplated by density gradient centrifugation and then proliferated by using CD 40-agonist monoclonal antibody 5C11、cytokine of IFN-αand IL-7(CD40 group)in vitro.During the culturing procedure ,the cell morphology was obersved by optical microscope.The percentage of T-lymphocytes, NK-T cells, Treg cells and the cell proliferation, which were compared with CIK group CD3mAb activated,was detected on the 9th day.Results:There was no significant difference of CD 4+/CD8+T cells percentage between the two groups.But the Treg cells percentage of CIK group was far higher than that of CD 40 group,while the percentage of CD3+CD56+NK-T cells was lower than that of CD 40 group.And a group of Mo-NK-DC cells were observed in the CD 40 group.Conclusion: The new method of adoptive immunity therapy has been established in this study could increase the percentage of NK -T cells which had the ability to kill tumor cells.Simultaneously ,it is reduced the amount of Treg cells significantly.

BACKGROUNDIn China, the prevalence of chronic kidney disease has increased significantly. Many studies shows that the spectrum of kidney disease had changed in recent years. We retrospectively analyzed the pathological types of renal biopsy and its spectrum change at the General Hospital of the Chinese People's Liberation Army from December 1987 to December 2012, in order to offer new supporting evidences for further specifying the distribution of renal pathological types in China.

METHODSAccording to the "Revised Protocol for the Histological Typing of Glomerulopathy" (WHO, 1995), pathological diagnosis of renal biopsy was classified, detection rate of each pathological type was summarized (i.e., percentage of total renal biopsy cases), study period was divided at an interval of 5 years, and age-stratified distribution change of main pathological types was analyzed.

RESULTSThe proportion of pathological types in 11 618 cases of renal biopsy was as follows: primary glomerulonephritis (PGN, 70.7%), secondary glomerulonephritis (SGN, 20.7%), tubular-interstitial nephropathy (4.0%), hereditary/rare nephropathy (0.3%), end-stage renal disease (0.9%), and unclassified renal disease (3.3%). Among PGN, there was IgA nephropathy (IgAN, 37.0%), membranous nephropathy (MN, 11.8%), mesangial proliferative glomerulonephritis (MsPGN, 8.9%), minimal change disease (MCD, 6.6%), and focal segmental glomerulosclerosis (3.9%). Among SGN there was lupus nephritis (LN, 5.5%), Henoch-Schönlein purpura glomerulonephritis (5.3%), hepatitis B virus-associated nephritis (HBVAN, 3.03%), diabetic nephropathy (2.2%), and hypertension/malignant hypertension-associated renal damage (1.9%). Pathological data were analyzed from 1987-1992 to 2008-2012 (after age adjustment). Detection rate of IgAN tended to rise (P < 0.001). Detection rates of MN and MCD rose significantly (P < 0.001), but detection rate of MsPGN dropped significantly (P < 0.001). Among SGN, detection rate of HBVAN tended to drop (P < 0.001).

CONCLUSIONIn China, PGN was the most common glomerulopathy (mostly IgAN), LN was the most common SGN, and detection rate of MN and MCD rose significantly.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy ; methods ; Child ; Child, Preschool ; China ; Female ; Glomerulonephritis, Membranous ; diagnosis ; Humans ; Kidney ; pathology ; Kidney Diseases ; diagnosis ; Male ; Middle Aged ; Young Adult

Objective To observe influence of continuous lumbar cistern drainage on levels of amyloid β-peptide (Aβ) subtype (Aβ1-42) in cerebrospinal fluid and plasma in patients with diffuse axonal injury (DAI) and investigate its clinical significance.Methods Eighty-one DAI patients were enrolled and randomized into treatment group (42 cases) and control group (39 cases).Patients in control group received simple conventional therapy,while the patients in treatment group received not only conventional therapy but 14 days of continuous lumbar cistern drainage.Levels of Aβ1-42 in cerebrospinal fluid and plasma were detected by ELISA assay before therapy and at 1,5,9,and 14 days after therapy.Prognosis was assessed using GOS at 6 months after therapy.Results Levels of Aβ1-42 in cerebrospinal fluid and plasma showed a decrease in the first place and a gradual decrease afterwards in both groups,but a bigger and earlier drop of Aβ1-42 levels was observed in treatment group.Two groups showed significant difference of Aβ1-42 levels at day 14 (P ＜ 0.05).At 6 months after therapy,GOS score between treatment and control groups was (4.1 ± O.5) and (3.4 ± 0.3) points respectively (P ＜0.05).Conclusion Continuous lumbar cistern drainage improves the prognosis of DAI and this may relates to the decrease of Aβ1-42 levels in cerebrospinal fluid and plasma.

ObjectiveTo investigate the association of phosphorylation of mammalian target protein of rapamycin (pmTOR) expression with glioma malignancy grades,and the correlation of pmTOR expression with Survivin and Ki-67,which represent tumor cell anti-apoptosis ability and reproductive activity.MethodsImmunohistochemistry EliVision method was employed to detect the expression of pmTOR,Survivin and Ki-67 in paraffin tissues from 87 patients with glioma (grade Ⅰ - Ⅱ 27 cases,grade Ⅲ24 cases and grade Ⅳ 36 cases).The association between positive expression rate,level of pmTOR and malignancy grades,and the correlation of its expression level with Survivin and Ki-67 were further evaluated.Results There was no significant difference in the positive expression rate of pmTOR among grade Ⅰ - Ⅱ(77.8％,21/27),grade Ⅲ(75.0％,18/24) and grade Ⅳ (72.2％,23/36) (P ＞ 0.05).However,the significant association between pmTOR expression level and malignancy grades was observed.The expression from 87 patients with glioma was significantly positively correlated with Survivin and Ki-67 expression level (r =0.858,P ＜ 0.01 ;r =0.708,P ＜ 0.01 ).ConclusionsThe expression level of pmTOR is associated with malignancy grades,tumor cell anti-apoptosis ability and reproductive activity.pmTOR may be served as a useful marker for predicting the biological behavior of glioma and a useful target for gene therapy.

ObjectiveTo compare the short-term efficacy and safety of autologous bone marrow mesenchymal stem cells transplantation on patients with early spinal cord injury by subarachnoid injection and by intravenous injection.MethodsNinety-six patients with early spinal cord injury were hospitalized and treated from November 2006 to March 2010.Thirty-eight cases (subarachnoid transplantation group) got transplantation by subarachnoid injection,32 cases (intravenous transplantation group) got transplantation by intravenous injection,26 cases (control group) were hospitalized in the same period but not transplanted.The motor and sensory functions of all three groups were evaluated according to the score standard developed by American Spinal Injury Association(ASIA) before treatment and at the first,the third,the sixth month after treatment.Meanwhile,routine blood test,coagulation,biochemical items and tumor markers were also examined in follow-up.ResultsThe motor and sensory function of three groups had different degree of recovery at the first month after treatment,and sensory function recovered muchsignificantly,but the comparison among three groups had no statistical significance.The scores of motor function increased in three groups at the third month after treatment,but still had no statistical significance (P＞ 0.05).The scores of sensory function of subarachnoid transplantation group[(130.9 ±41.6) scores] and intravenous transplantation group [ (131.2±22.7 ) scores ] increased obviously,and had significant difference compared with control group [ (109.3±36.4) scores] (P ＜ 0.05),but there were nosignificant difference between subarachnoid transplantation group and intravenous transplantation group (P ＞ 0.05).The scores of sensory and motor function of control group didn't increase obviously at the sixth month after treatment,while the scores of subarachnoid transplantation group and intravenous transplantation group gradually improved and had statistical significance compared with control group(P ＜ 0.05).The scores of sensory function was higher in subarachnoid transplantation group[ (151.6±46.9) scores ] than that in intravenous ransplantation group [(134.6 ±40.7) scores] (P ＜0.05).There were no obvious abnormality in the results of followed-up examination.Conclusions The safety and short-term efficacy of autologous bone marrow mesenchymal stem cells transplantation in treating early spinal cord injury by subarachnoid injection and intravenous injection is certified.The subarachnoid injection is better than intravenous injection,but the long-term efficacy need furter study.