OBJECTIVETo compare the difference in the clinical efficacy on post-stroke insomnia between the low-frequency electric stimulation at the acupoints and the conventional western medication.

METHODSOne hundred and twenty patients of post-stroke insomnia were randomized into a low-frequency electric stimulation group, a medication group and a placebo group, 40 cases in each one. In the low-frequency electric stimulation group, the low-frequency electric-pulsing apparatus was used at Dazhui (GV 14) and Shenshu (BL 23), once a day; the treatment of 15 days made one session and 2 sessions were required. In the medication group, estazolam was taken orally, 1 mg each time. In the placebo group, starch capsules were taken orally, 1 capsule each time. All the drugs were taken before sleep every night, continuously for 15 days as one session, and 2 sessions were required. PSQI changes and clinical efficacy were observed before and after treatment in each group.

RESULTSPitlsburgh sleep quality index (PSQI) score was reduced in every group after treatment (all P < 0.01). In the low-frequency electric stimulation group and medication group, the score was reduced much more significantly as compared with the placebo group (both P < 0.01). In the placebo group, 1 case was rejected. The total effective rates were 95.0% (38/40), 92.5% (37/40) and 17.9% (7/39) in the low-frequency electric stimulation group, medication group and placebo group separately. The efficacy in the low-frequency electric stimulation group and medication group was better apparently than that in the placebo group (both P < 0.01).

CONCLUSIONThe low-frequency electric stimulation at the acupoints effectively and safely treats post-stroke insomnia and the efficacy of it is similar to that of estazolam.

Acupuncture Points ; Aged ; Aged, 80 and over ; Electric Stimulation ; Female ; Humans ; Male ; Middle Aged ; Sleep Initiation and Maintenance Disorders ; etiology ; therapy ; Stroke ; complications ; Treatment Outcome

Objective To investigate the clinical value of proximal femoral nail antirotation ( PFNA) in treatment of intertrochanteric fractures.Methods From April 2007 to July 2009,112 patients with intertrochanteric fractures were treated by using PFNA.There were 34 males and 78 females,at mean age of 76 years.Of all,80 patients were with type 31-A2 fracture and 32 with type 31-A3 fractures according to AO classification.According to Singh index classification,there were 4 patients at grade Ⅰ,21 at grade Ⅱ,70 at grade Ⅲ and 15 at grade Ⅳ.The fracture was caused by low-energy injury in 97 patients and by high-energy injury in 15.The Salvati-Wilson score was used to evaluate the hip function postoperatively.Results Ninety patients received 12-24 months follow-up (average 18.6 months).The Salvati-Wilson score was (29.98 ± 5.18 ) points.The result was excellent in 41 patients,good in 40,fair in 6 and poor in 3,with excellenct rate of 90％.The introduction of the nail in operation was difficult in 22 patients,of which 3 patients suffered femoral cortex rupture.Displacement or separation of the fracture segments occurred in 34 patients and distal locking difficulty in nine during the screw blade tapping process.Local complications included hip pain in 21 patients,thigh pain in 4,apparent coxa vara in 2 and delayed healing in 7.There were no cutting-out or femoral shaft fractures no matter what type of Singh index was.The systemic complications included cardiovascular and cerebrovascular disease in one patient,pulmonary infection in four,deep vein embolism in one and perineum congestion or swelling in seventeen.Conclusion PFNA is effective in treating intertrochanteric fractures especially osteoporotic fractures,but delayed healing of the fractures and the mismatch between the intramedullary nail and the proximal femoral morphology remain to be addressed.

OBJECTIVETo investigate the features and causes of complications of unilateral pedicle screw fixation combined with contralateral percutaneous translaminar facet screw fixation and lumbar interbody fusion in treating lower lumbar diseases.

METHODSThe clinical data of 166 patients with lower lumbar diseases who underwent unilateral pedicle screw fixation combined with contralateral percutaneous translaminar facet screw fixation and lumbar interbody fusion with intervertebral cages from January 2008 to December 2013 were retrospectively analyzed. There were 64 males and 102 females, aged from 24 to 74 years with a mean of 51.9 years old, suffered from lower lumbar lesions for 47.5 months on average (ranged, 8 months to 30 years). Among these patients, lumbar intervertebral disc degeneration was found in 49 patients, recurred lumbar intervertebral disc protrusion in 17 patients, massive lumbar intervertebral disc protrusion in 23 patients, lumbar intervertebral disc protrusion accompany with spinal canal stenosis in 27 patients, lumbar degenerative spondylolisthesis with degree I (Meyerding grade) in 21 patients, far lateral lumbar intervertebral disc protrusion in 5 patients. Single segmental diseases occurred in 124 patients and two segmental diseases in 42 patients. The diseases occurred at L(3,4) segment in 6 patients, at L(4,5) segment in 97 patients, at L5S1 segment in 21 patients, at L(2,3), and L(3,4) segments in 1 patient, at L(3,4) and L4,5) segments in 26 patients, and at L(4,5), and L5S1 segments in 15 patients.

RESULTSThere was no abnormal bleeding in the patients and no patient received blood transfusion. During the surgery, spinal dura mater injury with cerebrospinal fluid leakage complicated in 1 patient, a fracture of vertebral pedicle in 4 patients, and end plate injury in 2 patients. No postoperative cerebrospinal fluid, incision infection and skin necrosis were found after operation. Nerve root injury was found in 1 patient. According to the position of pedicles crew, 371 screws of 163 patients were in degree I and 3 screws of 3 patients were in degree II; position of translaminar facet screw, 199 screws of 157 patients were type I, 8 screws of 8 patients were type II, 1 screw of 1 patient was III. Translaminar facet screw was slightly short in 2 patients. Five patients were lost to follow-up, two patients were died. The remaining patients were followed up for 35.4 months on average (ranged, 12 to 60 months). During the follow-up period , end plate was cut off and intervertebral cages were embedded in 14 segments of 14 patients. Abnormal pain of both lower extremities was found in 1 patient. With the exception of 11 unidentified segments in 11 patients, 189 segments of 148 patients obtained intervertebral fusion. No loosening, displacement, breakage of pedicle screw or translaminar facet screw, displacement of intervertebral cages or obvious degeneration of adjacent segments were found. The coronal and sagittal planes balance of lumbar vertebra were obviously improved. Postoperative JOA score was significantly increased than that of preoperative.

CONCLUSIONUnilateral pedicle screw fixation combined with contralateral percutaneous translaminar facet screw fixation and lumbar interbody fusion with intervertebral cages is a good choice for the treatment of lower lumbar diseases, but it has a risk of complications. Abundant surgeon's surgical experience, careful operation, and rational use of imaging technique can effectively reduce the incidence of complications.

Adult ; Aged ; Bone Plates ; Female ; Humans ; Internal Fixators ; Intervertebral Disc Degeneration ; surgery ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion ; Spondylolisthesis ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo study the biological features and osteoblast/adipocyte phenotypes of bone marrow stromal cells (BMSCs) of Sprague-Dawley (SD) rats with Type I osteoporosis by induced culture.

METHODSSix-month-old SD rats were used in this study. 16 female rats were randomly divided into two groups. Eight rats were ovariectomied as experimental group to establish the modle of Type I osteoporosis, while other rats received sham-operation. Three month later BMSCs of 16 rats were isolated by discontinueous gradient centrifugation and then plated in alpha-MEM medium as primary culture. Secondary harvested cells were cultured for 14 days in alpha-MEM medium supplemented with dexamethasone, ascorbic acid, vitamin D3, beta-glycerophosphate or dexamethasone, 3-isobutyl-1-methylxanthine, insuline, and indomethine. The cells were screened by inverted microscope each day and cell growth was studied with cell counting. The osteoblast and adipocyte phenotypes were verified by cytochemistry staining, counted the percentage of positive stained cells.

RESULTSThe weight and bone mineral density of rats were statistically different between experimental group and control group. Gomori and Von Kossa's staining demonstrated positive osteoblast phenotypes of alkaline phosphatase and mineralized nods by osteogenic inducer, while Oil Red O staining identified BMSCs treated with adipogenic medium resulted in adipocyte formation and there was no significant difference in the percentage of positive stained cells between two groups.

CONCLUSIONThe model of Type I osteoporosis has been established successfully. BMSCs from SD rats with osteoporosis maintain their differentiation potential.

Adipocytes ; Animals ; Bone Density ; Bone Marrow Cells ; Cell Differentiation ; Cell Proliferation ; Cells, Cultured ; Female ; Mesenchymal Stromal Cells ; Osteoblasts ; Osteoporosis ; physiopathology ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo investigate the feasibility of repairing bone defect with methods of tissue-engineering and human bone morphogenetic protein-2 (hBMP-2) gene transfection in osteoporotic rats.

METHODSTwenty-four 6-month-old female Sprague-Dawley rats underwent ovariectomy, while 8 rats received sham-operations. Three months later, bone mesenchymal stem cells (BMSC) harvested from osteoporotic rats were divided into two groups randomly. Experimental group were transfected by recombinant plasmid carrying hBMP-2 gene, and control group left untreated. All BMSC were seeded into coralhydroxyapatite scaffolds. Then the cell/scaffold constructs were implanted into the defect site created in the ramus of mandible of osteoporotic rats respectively.

RESULTSPositive results were confirmed by immunohistochemistry and in situ hybridization in experimental group. New bone formation was found at the margin of the defect treated with the BMSC modified by hBMP-2 gene transfer at 4 weeks after implantation and appeared mature 8 weeks after the treatment. However, the amount of newly formed bone was much less and there was some adipose tissue at defect margins 8 weeks after implantation in control group.

CONCLUSIONSThe results of this experiment indicate that BMSC-mediated rhBMP-2 gene therapy in conjunction with bone tissue engineering may allow for successful treatment of large bone defects in osteoporosis rats.

Animals ; Bone Marrow Cells ; cytology ; Bone Morphogenetic Protein 2 ; genetics ; Female ; Genetic Therapy ; Humans ; Mandibular Diseases ; surgery ; Mesenchymal Stromal Cells ; cytology ; Osteogenesis ; physiology ; Osteoporosis, Postmenopausal ; therapy ; Rats ; Rats, Sprague-Dawley ; Tissue Engineering ; methods ; Transfection

OBJECTIVETo investigate the feasibility of utilizing self-designed score system for lower lumbar vertebral burst fractures to select surgical approach.

METHODSFrom January 2006 to December 2011, the clinical data of 56 patients with lower lumbar vertebra burst fractures who underwent surgical treatment were retrospectively analyzed. There were 42 males and 14 females with an average age of 43.1 years old (ranged, 19 to 65). Causes of injury included falling down (40 cases), traffic accidents (12 cases), and crashing injury by heavy objects(4 cases). Injury site was L3 in 37 cases, L4 in 16 cases, and L5 in 3 cases. According to the AO classification, 17 cases were type A3.1, 14 cases were type A3.2, 25 cases were type A3.3. According to Frankel grade of nerous function, 2 cases were grade B, 5 cases were grade C, 9 cases were grade D and 40 cases were grade E. Surgical methods and approaches were chosen based on the comprehensive evaluation of AO classification, condition of posterior column injury and spinal canal encroachment. Surgical methods and approaches included trans-vertebra fixation (15 cases), intra-vertebra pedicle screw fixation (21 cases), combination of anterior and posterior approaches (11 cases), one-stage posterior approaches (9 cases). Cobb angles, restorations of the affected vertebral anterior border height, and conditions of spinal canal encroachment were compared before and after surgery. Conditions of bone graft fusion and internal fixation (if bending, loosening or breakage existed) were observed. Spinal cord functions were assessed according to Frankel grade. Localized pain and working status of patients were also assessed at the last follow-up.

RESULTSNo incision infection was found and no spinal nerve symptoms improved in all of 56 patients. All patients were followed up for 12 to 60 months with a mean of 28.5 months, without internal fixation loosening or breakage. There was significant differences in Cobb angle, vertebral anterior border height and recovery of spinal canal encroachment between preoperative and postoperative instantly (P < 0.05), however, there was no significant difference between postoperative instantly and final follow-up (P > 0.05). Thirteen cases obtained fusion by trans-vertebra fixation, 20 cases obtained fusion by intra-vertebra fixation, and 20 cases were treated by the combination of anterior and posterior approaches or one-stage posterior approaches all of patients obtained fusion. Spinal nervous function recovered I to II grade, 1 case was grade C, 3 cases were grade D, 52 cases were grade E. Localized pain was assessed as P1 in 52 cases, P2 in 3 cases, and P3 in 1 case. Working status was classified into W1 in 12 cases, W2 in 39 cases, and W3 in 5 cases.

CONCLUSIONThe lower lumbar vertebra and thoracolumbar junction exhibit different injury characteristics due to variations in anatomy and biomechanics. A comprehensive score of the AO classification, posterior column injury and degree of spinal canal encroachment will guide the selection of surgical method and approach for the treatment of lower lumbar vertebra burst fractures.

Adult ; Aged ; Biomechanical Phenomena ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; surgery ; Spinal Fusion ; methods

OBJECTIVETo evaluate the method to correct the seconary nasolabial deformities after the surgical treatment in the patients with bilateral cleft lip.

METHODSFrom January 2000 to June 2003, forty patients with secondary deformities following repair of bilateral cleft lip were treated with a combined treatment procedures. AU of the forty cases underwent the following preoperative treatments: alveolar bone graft in 28 cases, preoperative orthodontics in 22 cases, prosthodontics in 20 cases and orthognathic surgery or distraction osteogenesis treatment in 20 cases, respectively. In order to improve the enlongation of nasal column, reconstruction of Cupid's bow, philtrum and correction procedures, continuous incision was made from the vermilion in median of the upper lip, the scar edge, the bilateral sides of the nasal column to the inner side of the nose, even extending the bilateral incision to nasolabial groove and nostril fundus.

RESULTSForty patients were got the follow-ups for 3 months to 3.5 years and the satisfactory rate reached 95%.

CONCLUSIONIt is natural to emphasize the setting up of odontomaxillary frame and then utilize the surgical procedure to correct the secondary nasolabial parenchyma deformities. The method could be feasible and reliable for the correction of the secondary nasolabial parenchyma deformities after bilateral cleft lip repair.

Adolescent ; Adult ; Cleft Lip ; surgery ; Female ; Follow-Up Studies ; Humans ; Lip ; pathology ; surgery ; Male ; Nose Deformities, Acquired ; etiology ; surgery ; Postoperative Care ; Postoperative Complications ; surgery ; Reproducibility of Results ; Surgical Procedures, Operative ; methods ; Treatment Outcome

BACKGROUND: Bioabsorbable biomaterials are of crucial importance in tissue engineering applications, and various factors affect their degradation. OBJECTIVE: To compare the degradation characteristics of concentrated growth factor (CGF) clot and CGF membrane in simulated body fluid (SBF) and simulated saliva fluid (SSF). METHODS: Fifteen volunteers were selected, and human blood samples were collected for the preparation of CGF clot or CGF membrane. All specimens from each subject were averagely divided into four groups: group A, CGF clot in SBF; group B, CGF clot in SSF; group C, CGF membrane in SBF; group D, CGF membrane in SSF. The specimens were subjected to the immersion test. The average daily rate of degradation of each group was calculated after the samples were thoroughly degraded, and weight loss ratio per unit time was also determined. RESULTS AND CONCLUSION: (1) The mean degradation time in groups A-D were (14.0±0.7), (9.7±0.9), (9.9±1.2) and (7.2±0.7) days, respectively. (2) By comparing CGF membrane with CGF clot in the same simulated fluid, the average daily degradation rate of CGF clot (groups A, B) was statistically significantly lower than counterparts of CGF membrane (groups C, D) (P < 0.05). By comparison between SBF and SSF, the average daily degradation rate in the SBF (groups A, B) was significantly lower than counterparts in the SSF (groups C, D) (P <0.05). Overall, the degradation rate of CGF membrane is higher than that of CGF clot under the same degradation environment; for CGF membrane or CGF clot, the degradation rate in SSF is higher than that in SBF.

Brain magnetic resonance imaging (MRI) of the elderly often reveals white matter changes (WMCs) with substantial variability across individuals.Our study was designed to explore MRI features and site-specific factors of ischemic WMCs.Clinical data of consecutive patients diagnosed with ischemic cerebral vascular disease who had undergone brain MRI were collected and analyzed.Multi-logistic regression analysis comparing patients with mild versus severe WMCs was performed to detect independent associations.Analyses of variance (ANOVAs) were used to detect regionally specific differences in lesions.We found that lesion distribution differed significantly across five cerebral areas,with lesions being predominant in the frontal lobe and parieto-occipital area.To explore WMCs risk factors,after adjusting for gender,diabetes mellitus,and hypertension,only age (P＜0.01),creatinine (P=0.01),alkaline phosphatase (ALP) (P=0.01) and low-density lipoprotein cholesterol (LDL-C) (P=0.03) were found to be independently associated with severe WMCs.Age (P＜0.001) was strongly associated with WMCs in the frontal lobe while hypertension was independently related to lesions in the basal ganglia (P=0.048) or infratentorial area (P=0.016).In conclusion,MRI of WMCs showed that ischemic WMCs occurred mostly in the frontal lobe and parieto-occipital area.The infratentorial area was least affected by WMCs.Typically,age-related WMCs were observed in the frontal lobes,while hypertension-related WMCs tended to occur in the basal ganglia and infratentorial area.

Syncope is a common emergency of children and adolescents,which has serious influence on the quality of life.Neurally-mediated syncope,including postural tachycardia syndrome,vasovagal syncope,orthostatic hypotension and orthostatic hypertension,is the main cause of syncope in children and adolescents.The main manifestations of neurally-mediated syncope are diverse,such as dizziness,headache,chest tightness,chest pain,pale complexion,fatigue,pre-syncope and syncope.Although the clinical manifestations are similar,each subtype of syncope has its hemodynamic feature and optimal treatment option.The diagnosis rate of syncope in children has been greatly improved on account of the development of the diagnostic procedures and methods.In recent years,with the promotion of head-up tilt test and drug-provocated head-up tilt test,the hemodynamic classification of neurally-mediated syncope gets continually refined.In recent years,with the effort of clinicians,an appropriate diagnostic protocol for children with syncope has been established.The initial evaluation consists of history taking,physical examination,standing test and standard electrocardiography.After the initial evaluation,some patients could be diagnosed definitely,such as postural tachycardia syndrome,orthostatic hypotension,and situational syncope.Those with a specific entity causing syncope need selective clinical and laboratory investigations.Patients for whom the cause of syncope remained undetermined should undergo head-up tilt test.The precise pathogenesis of neurally-mediated syncope is not entirely clear.In recent years,studies have shown that neurally-mediated syncope may be related to several factors,including hypovolemia,high catecholamine status,abnormal local vascular tension,decreased skeletal muscle pump activity and abnormal neurohumoral factors.Currently based on the possible pathogenesis,the individualized treatment of neurally-mediated syncope has also been studied in-depth.Generally,the management of neurallymediated syncope includes non-pharmacological and pharmacological interventions.Patient education is the fundamental part above all.In addition to exercise training,the first-line treatments mainly include oral rehydration salts,beta adrenoreceptor blockers,and alpha adrenoreceptor agonists.By analyzing the patient's physiological indexes and biomarkers before treatment,the efficacy of medication could be well predicted.The individualized treatment will become the main direction in the future researches.