OBJECTIVE: To compare clinical efficacy between side-opening and front-opening bone cement injectors in percutaneous kyphoplasty(PKP) for the management of thoracolumbar osteoporotic vertebral compression fractures(OVCFs). METHODS: A retrospective cohort study was conducted, comprising 62 patients with single-segment thoracolumbar OVCFs (T₁₁-L₂), who underwent bilateral PKP at our department during the period from June 2020 to October 2021. Patients were categorized into two groups based on the specific bone cement injector employed during the surgical procedure: the side-opening group (n=29) and the front-opening group (n=33). Among them, the side-opening group consisted of 6 male and 23 female patients, with a mean age of (73.32±9.11) years. The front-opening group included 7 male and 26 female patients, with a mean age of (71.29±10.39) years. The variables encompassed essential patient characteristics were recorded, such as gender, age, bone mineral density (BMD), and fracture level (T₁₁-L₂), as well as procedural aspects, including operation duration, cement injection volume, cement distribution type (lobular or diffuse), occurrence of cement leakage, pre-and post-operative visual analogue scale (VAS) pain scores, and vertebral compression ratio. RESULTS: All patients underwent successful surgery, with a mean follow-up duration of (15.37±3.03) months. There were no statistically significant differences in gender, age, BMD, fracture level, preoperative vertebral compression degree, and VAS scores between the side-opening group and the front-opening group (P>0.05). The operation time, the mean cement injection volumes, the distribution of bone cement within the vertebrae has no statistically significant difference between two groups(P>0.05). Both the side-opening and front-opening groups showed significant improvements in VAS scores at 3 days and 6 months after operation (P<0.05). However, there was no significant difference in VAS scores between the two groups at both 3 days and 6 months after the operation (P>0.05). CONCLUSION Side-opening bone cement injectors in bilateral PKP surgery for single-segment thoracolumbar OVCF achieve similar clinical efficacy as front-opening injectors, without significant improvement in cement distribution and containment.
Humans ; Female ; Male ; Kyphoplasty/instrumentation* ; Aged ; Bone Cements ; Fractures, Compression/surgery* ; Retrospective Studies ; Spinal Fractures/surgery* ; Thoracic Vertebrae/injuries* ; Lumbar Vertebrae/injuries* ; Osteoporotic Fractures/surgery* ; Middle Aged ; Aged, 80 and over

Umbilical cord mesenchymal stem cells (UC-MSCs) have been widely used in regenerative medicine, but there is limited research on the stability of UC-MSCs formulation during production. This study aims to assess the stability of the cell stock solution and intermediate product throughout the production process, as well as the final product following reconstitution, in order to offer guidance for the manufacturing process and serve as a reference for formulation reconstitution methods. Three batches of cell formulation were produced and stored under low temperature (2-8 ℃) and room temperature (20-26 ℃) during cell stock solution and intermediate product stages. The storage time intervals for cell stock solution were 0, 2, 4, and 6 h, while for intermediate products, the intervals were 0, 1, 2, and 3 h. The evaluation items included visual inspection, viable cell concentration, cell viability, cell surface markers, lymphocyte proliferation inhibition rate, and sterility. Additionally, dilution and culture stability studies were performed after reconstitution of the cell product. The reconstitution diluents included 0.9% sodium chloride injection, 0.9% sodium chloride injection + 1% human serum albumin, and 0.9% sodium chloride injection + 2% human serum albumin, with dilution ratios of 10-fold and 40-fold. The storage time intervals after dilution were 0, 1, 2, 3, and 4 h. The reconstitution culture media included DMEM medium, DMEM + 2% platelet lysate, 0.9% sodium chloride injection, and 0.9% sodium chloride injection + 1% human serum albumin, and the culture duration was 24 h. The evaluation items were viable cell concentration and cell viability. The results showed that the cell stock solution remained stable for up to 6 h under both low temperature (2-8 ℃) and room temperature (20-26 ℃) conditions, while the intermediate product remained stable for up to 3 h under the same conditions. After formulation reconstitution, using sodium chloride injection diluted with 1% or 2% human serum albumin maintained a viability of over 80% within 4 h. It was observed that different dilution factors had an impact on cell viability. After formulation reconstitution, cultivation in medium with 2% platelet lysate resulted in a cell viability of over 80% after 24 h. In conclusion, the stability of cell stock solution within 6 h and intermediate product within 3 h meets the requirements. The addition of 1% or 2% human serum albumin in the reconstitution diluent can better protect the post-reconstitution cell viability.

Objective To evaluate the impact of poor sleep quality on occurrence of post-traumatic stress disorder(PTSD)in trauma patients.Methods We prospectively recruited 256 trauma patients hospitalized in 4 general hospitals in Zunyi during the period from October,2021 to November,2022,and 226 of the participants completed the PTSD survey and assessment.The patients'sleep quality within a month before trauma was estimated using Pittsburgh Sleep Quality Index(PSQI),and their sleep quality within 7 days after admission was monitored by smart bracelet sleep monitoring;the PTSD Checklist-Civilian Version(PCL-C)was used to detect the occurrence of PTSD during the follow-up.Results The detection rate of PTSD in the patients was 19.47%at 1 month and 17.61%at 3 months after trauma.The patients who developed PTSD had poorer sleep quality before the trauma,as shown by significantly higher PSQI scale scores(P<0.001),than those without PTSD,and they showed a sleep abnormality rate as high as 72.73%prior to PTSD onset.Within 7 days after admission,the patients developing PTSD had lower sleep quality scores with more frequent night awakenings(P<0.05).A 1 month and 3 months after trauma,the patients with PTSD had significantly higher PSQI scores than those without PTSD(P<0.05).Conclusion PTSD is more likely to occur in trauma patients with poor sleep quality before trauma.

Objective To evaluate the impact of poor sleep quality on occurrence of post-traumatic stress disorder(PTSD)in trauma patients.Methods We prospectively recruited 256 trauma patients hospitalized in 4 general hospitals in Zunyi during the period from October,2021 to November,2022,and 226 of the participants completed the PTSD survey and assessment.The patients'sleep quality within a month before trauma was estimated using Pittsburgh Sleep Quality Index(PSQI),and their sleep quality within 7 days after admission was monitored by smart bracelet sleep monitoring;the PTSD Checklist-Civilian Version(PCL-C)was used to detect the occurrence of PTSD during the follow-up.Results The detection rate of PTSD in the patients was 19.47%at 1 month and 17.61%at 3 months after trauma.The patients who developed PTSD had poorer sleep quality before the trauma,as shown by significantly higher PSQI scale scores(P<0.001),than those without PTSD,and they showed a sleep abnormality rate as high as 72.73%prior to PTSD onset.Within 7 days after admission,the patients developing PTSD had lower sleep quality scores with more frequent night awakenings(P<0.05).A 1 month and 3 months after trauma,the patients with PTSD had significantly higher PSQI scores than those without PTSD(P<0.05).Conclusion PTSD is more likely to occur in trauma patients with poor sleep quality before trauma.

Objective To compare the safety and clinical efficacy of freehand and 3D printing navigation template assisted screw placement in patients with old odontoid fractures of type Ⅱ.Methods Total of 38 patients with old odontoid fractures of type Ⅱ were treated from November 2018 to December 2022,all of which presented as chronic neck pain.According to the dif-ferent methods of screw insertion into the pedicle,the patients were divided into a navigation template group and a freehand group.In the navigation template group,there were 17 patients including 9 males and 8 females with an average age of(51.30±13.20)years old,disease duration was(22.18±7.59)months.In the freehand group,there 21 patients including 7 males and 14 females with an average age of(49.46±11.92)years old,disease duration was(19.52±9.17)months.The intraoperative blood loss,operation time,and postoperative drainage output were recorded and compared between two groups.The accuracy of screw placement was evaluated by CT scan.Before operation and 1 year after operation,cervical pain was assessed by visual analogue scale(VAS),neurological changes were evaluated by the Japanese Orthopaedic Association(JOA)score,and the de-gree of spinal cord injury was assessed by the American Spinal Injury Association(ASIA)injury scale.Results All patients were followed up for(25.31±1.21)months.The operation time of template group(112.00±20.48)min had significantly shorter than that of the freehand group(124.29±15.24)min(P＜0.05),while there were no significant differences between two groups in terms of intraoperative blood loss,postoperative drainage,and hospital stay(P＞0.05).At 1 year after operation,in template group and freehand group,the VAS[(2.88±0.86),(2.90±0.83)]and JOA[(14.94±1.82),(14.62±2.19)]improved with pre-operative[VAS(4.71±0.92),(4.86±0.79)and JOA(12.18±2.30),(11.95±2.31)](P＜0.05),with no significant difference between two groups(P＞0.05).No significant improvement was observed in ASIA grading in either group at 1 year after opera-tion(P＞0.05),and there was no significant difference between two groups(P＞0.05).The template group had significantly better accuracy of screw placement in the pedicle of the axis than the freehand group(P＜0.05),while no significant difference was observed between two groups in the accuracy of screw placement in the pedicle of the atlas(P＞0.05).Conclusion In the treat-ment of type Ⅱ old odontoid fractures with posterior pedicle screw fixation,3D printing navigation template screw placement can significantly shorten the operation time,achieve similar clinical efficacy as free-hand screw placement,and significantly im-prove the accuracy of screw placement in the pedicle of the axis.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Background/Aims: Despite the high efficacy of direct-acting antivirals (DAAs), approximately 1–3% of hepatitis C virus (HCV) patients fail to achieve a sustained virological response. We conducted a nationwide study to investigate risk factors associated with DAA treatment failure. Machine-learning algorithms have been applied to discriminate subjects who may fail to respond to DAA therapy. Methods: We analyzed the Taiwan HCV Registry Program database to explore predictors of DAA failure in HCV patients. Fifty-five host and virological features were assessed using multivariate logistic regression, decision tree, random forest, eXtreme Gradient Boosting (XGBoost), and artificial neural network. The primary outcome was undetectable HCV RNA at 12 weeks after the end of treatment. Results: The training (n=23,955) and validation (n=10,346) datasets had similar baseline demographics, with an overall DAA failure rate of 1.6% (n=538). Multivariate logistic regression analysis revealed that liver cirrhosis, hepatocellular carcinoma, poor DAA adherence, and higher hemoglobin A1c were significantly associated with virological failure. XGBoost outperformed the other algorithms and logistic regression models, with an area under the receiver operating characteristic curve of 1.000 in the training dataset and 0.803 in the validation dataset. The top five predictors of treatment failure were HCV RNA, body mass index, α-fetoprotein, platelets, and FIB-4 index. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the XGBoost model (cutoff value=0.5) were 99.5%, 69.7%, 99.9%, 97.4%, and 99.5%, respectively, for the entire dataset. Conclusions Machine learning algorithms effectively provide risk stratification for DAA failure and additional information on the factors associated with DAA failure.

Background: Intrahepatic cholangiocarcinoma (ICC) is a highly desmoplastic tumor with poor prognosis even after curative resection. We investigated the associations between the composition of the ICC stroma and immune cell infiltration and aimed to develop a stromal-immune signature to predict prognosis in surgically treated ICC. Patients and methods: We recruited 359 ICC patients and performed immunohistochemistry to detect α-smooth muscle actin (α-SMA), CD3, CD4, CD8, Foxp3, CD68, and CD66b. Aniline was used to stain collagen deposition. Survival analyses were performed to detect prognostic values of these markers. Recursive partitioning for a discrete-time survival tree was applied to define a stromal-immune signature with distinct prognostic value. We delineated an integrated stromal-immune signature based on immune cell subpopulations and stromal composition to distinguish subgroups with different recurrence-free survival (RFS) and overall survival (OS) time. Results: We defined four major patterns of ICC stroma composition according to the distributions of α-SMA and collagen: dormant (α-SMAlow/collagenhigh), fibrogenic (α-SMAhigh/collagenhigh), inert (α-SMAlow/collagenlow), and fibrolytic (α-SMAhigh/collagenlow). The stroma types were characterized by distinct patterns of infiltration by immune cells. We divided patients into six classes. Class I, characterized by high CD8 expression and dormant stroma, displayed the longest RFS and OS, whereas Class VI, characterized by low CD8 expression and high CD66b expression, displayed the shortest RFS and OS. The integrated stromal-immune signature was consolidated in a validation cohort. Conclusion We developed and validated a stromal-immune signature to predict prognosis in surgically treated ICC. These findings provide new insights into the stromal-immune response to ICC.

OBJECTIVE: To explore clinical effect of Zero-profile intervertebral fusion with cage-titanium plate in treating multilevel cervical spondylotic myelopathy. METHODS: From January 2016 to January 2020, 107 patients with multisegmental cervical spondylotic myelopathy treated by surgery were retrospectively analyzed and divided into Hybrid group and control group according to different surgical methods. There were 54 patients in Hybrid group, including 42 males and 12 females, aged from 33 to 77 years old with an average of (57.3±9.5) years old;20 patients with C₃-C₆, 27 patients with C₄-C₇ and 7 patients with C₃-C₇;Zero-profile intervertebral fusion with cage-titanium plate internal fixation was performed. There were 53 patients in control group, including 34 males and 19 females;aged from 36 to 79 years old with an average of (57.8±8.9) years old;17 patients with C₃-C₆, 27 patients with C₄-C₇, and 9 patients with C₃-C₇;titanium plate interbody fusion fixation was performed. Operation time, blood loss and complications between two groups were compared, visual analogue scale (VAS), Japanese Orthopedic Association (JOA) scores and neck disability index (NDI) were used to assess recovery of clinical symptoms;cervical lordosis (CL), cervical sagittal vertical axis (C-SVA), and T₁ slope (T₁S) were measured and compared to evaluate cervical sagittal plane parameters. RESULTS: All patients were followed up, Hybrid group was followed up for 24 to 64 months with an average of (31.7±18.4) months, and control group was followed up for 24 to 65 months with an average of (32.6±15.8) months. There was no significant difference in follow-up time between two groups (P>0.05). Operation time and blood loss in Hybrid group were less than those in control group (P<0.05). VAS, JOA score and NDI were significantly improved between two groups at the lastest follow-up (P<0.05). There were no significant difference in VAS, JOA and NDI scores between two groups before and after operation (P>0.05). CL in both two groups at 3 months and the latest follow-up after operation were significantly improved than those before operation (P<0.05), there were no significant difference between two groups in T1S and C-SVA before and after operation (P>0.05). Postoperative dysphagia occurred in 2 patients in Hybrid group and 9 patients in control group, and had statistically difference in the incidence of dysphagia between two groups (χ²=5.112, P=0.024). During the follow-up, there were no complications such as loosening, displacement or fracture of internal fixation between two groups. CONCLUSION Compared with titanium plate interbody fusion, Zero-profile intervertebral fusion combined with cage-titanium plate for the treatment of multilevel cervical spondylotic myelopathy could shorten surgical time and blood loss, reduce surgical trauma and postoperative swallowing difficulties, and is conducive to early and rapid recovery.
Humans ; Male ; Female ; Middle Aged ; Spinal Fusion/instrumentation* ; Bone Plates ; Titanium ; Aged ; Spondylosis/surgery* ; Adult ; Cervical Vertebrae/surgery* ; Retrospective Studies ; Spinal Cord Diseases/surgery*

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.