Objective:To investigate the effects of annulus fibrosus(AF)suture or not on the lumbar biome-chanics following microendoscopic discectomy(MED)through establishing finite element models(FEMs)of unsu-tured AF incision and sutured AF incision.Methods:A 27-year-old healthy young adult male volunteer was recruited and underwent lumbar CT to exclude spinal deformities,tumors,and other osseous pathologies.CT images of the L4/L5 segment were imported into the software Mimics for three-dimensional reconstruction and contour extraction.The resulting model was further processed using Geomagic,SolidWorks,and Workbench for solid modeling.An intact L4/5 segment model,an L4/5 model with an unsutured AF incision following MED(unsutured AF model),and an L4/5 model with a sutured AF incision following MED(sutured AF model)were established.Intervertebral range of motion(ROM),Von-Mises stress on the facet joints,and Von-Mises stress on the AF of the models were measured,and model validity was verified by comparison with previously pub-lished studies.After validation,the inferior end of the L5 vertebral body in all the three models was fixed.An axial load of 500N was applied to the superior end of the L4 vertebral body,and a bending moment of 7.5N·m was separately applied under six physiological loading conditions(flexion,extension,left/right lateral bending,and left/right axial rotation).The biomechanical properties of the three models at the L4/5 level,in-cluding intervertebral ROM and Von-Mises stress in facet joints,and Von-Mises stress on the AF were com-pared under different loading conditions.Results:No significant discrepancies were noted when data obtained under these six motion conditions were compared with the findings from prior literature,thus validating the models.Stress nephogram results revealed that under each motion condition,high-stress areas were located at the unsutured defect of the intervertebral disc AF and the surrounding facet joint processes.Compared with the intact model,the intervertebral ROM of the sutured AF model was 8.6802°,8.596°,4.8514°,5.0249°,2.2474°,and 1.9092°,respectively,under the six motions,while that of the unsutured AF model was 8.7475°,8.9453°,5.6441°,5.2546°,2.5886°,and 1.9487°,respectively.The ROM of the sutured AF model was 9％,19％,44％,38％,50％,and 40％higher than that of the intact model;Compared with the unsutured AF mod-el,it was reduced by 1％,4％,14％,4％,13％,and 2％respectively.For Von Mises stress on the AF under the six motion conditions,the stress of the sutured AF model was 2％,65％,21％,32％,51％,and 38％higher than that of the intact model,but 8％,48％,52％,10％,37％,and 48％lower than that of the unsu-tured AF model respectively.For Von-Mises stress in facet joints,the stress values of the sutured AF model were 12.109MPa,8.3601MPa,13.998MPa,12.969MPa,10.219MPa,and 10.074MPa respectively,while those of the unsutured AF model were 13.399MPa,9.6094MPa,18.175MPa,17.967MPa,12.409MPa,and 11.6384MPa respectively.The stress values of Von-Mises stress in facet joints of the sutured AF model was 5％,10％,32％,17％,31％,and 34％higher than that of the intact model;Compared with the unsutured AF model,it was decreased by 9％,13％,22％,27％,17％,and 13％respectively.Conclusions:Among the three con-structed L4/5 FEMs,the sutured AF model exhibits more favorable intervertebral ROM,and Von-Mises stress of facet joints and AF compared with the unsutured AF model.This indicates that AF suture contributes to enhancing intervertebral stability.

Objectives:To investigate the mid-term outcomes of percutaneous cement discoplasty(PCD)in the treatment of lumbar axial instability,and analyze its technical keypoints and indications.Methods:A retrospective analysis was conducted on 9 patients with axial lumbar instability treated with PCD from January 2018 to December 2019.There were 5 males and 4 females,aged 62-87 years(75.7±8.2 years),with a follow-up period of 0.5-3 years,averaged 2.3±1.0 years.Three cases had three-disc operation at the same time,three had double-space operation and three had single-space operation,involving L2/3 disc in 3 cases,L3/4 disc in 3 cases,L4/5 disc in 4 cases,and L5/S1 disc in 3 cases.Lumbar anteroposterior and lateral ra-diographs in supine and standing positions were performed before operation,at postoperative 1d,3,6,12 months and final follow-up to measure the height of intervertebral space of responsible level,as well as the sagittal area of intervertebral foramen at responsible level.Visual analogue scale(VAS)and Oswestry disability index(ODI)were used to evaluate the pain and function before surgery,at 1d,3 months,6 months,12 months and final follow-up after operation to assess the clinical efficacy.The amount of bone cement injected in each intervertebral disc,the time of operation and the amount of blood loss were recorded respectively.Results:All the patients successfully completed the operation,no bone cement leakage occurred.The VAS score and ODI after operation were significantly improved compared with those before operation(P＜0.05).The injection volume of bone cement per intervertebral disc was 3.50±0.73mL.The operative time of each disc was 16.33±1.28min,and the blood loss of each disc was 3.83±0.71mL.The height of intervertebral space of responsible level at various time points after operation was different from that before operation(P＜0.05),and there was no difference in any two time points after operation.The sagittal area of intervertebral foramen at each time point after operation was different from that before operation(P＜0.05),and there was difference be-tween postoperative 1d and the final follow-up values(P＜0.05).Conclusions:PCD can increase the height of the intervertebral space after surgery,relieve lumbar pain,and have a lasting effect in the treatment of lum-bar instability,which is safe with satisfactory mid-term effect,and not prone to bone cement leakage,but long-term large-sample follow-up is still needed.

Objective:To investigate the effects of annulus fibrosus(AF)suture or not on the lumbar biome-chanics following microendoscopic discectomy(MED)through establishing finite element models(FEMs)of unsu-tured AF incision and sutured AF incision.Methods:A 27-year-old healthy young adult male volunteer was recruited and underwent lumbar CT to exclude spinal deformities,tumors,and other osseous pathologies.CT images of the L4/L5 segment were imported into the software Mimics for three-dimensional reconstruction and contour extraction.The resulting model was further processed using Geomagic,SolidWorks,and Workbench for solid modeling.An intact L4/5 segment model,an L4/5 model with an unsutured AF incision following MED(unsutured AF model),and an L4/5 model with a sutured AF incision following MED(sutured AF model)were established.Intervertebral range of motion(ROM),Von-Mises stress on the facet joints,and Von-Mises stress on the AF of the models were measured,and model validity was verified by comparison with previously pub-lished studies.After validation,the inferior end of the L5 vertebral body in all the three models was fixed.An axial load of 500N was applied to the superior end of the L4 vertebral body,and a bending moment of 7.5N·m was separately applied under six physiological loading conditions(flexion,extension,left/right lateral bending,and left/right axial rotation).The biomechanical properties of the three models at the L4/5 level,in-cluding intervertebral ROM and Von-Mises stress in facet joints,and Von-Mises stress on the AF were com-pared under different loading conditions.Results:No significant discrepancies were noted when data obtained under these six motion conditions were compared with the findings from prior literature,thus validating the models.Stress nephogram results revealed that under each motion condition,high-stress areas were located at the unsutured defect of the intervertebral disc AF and the surrounding facet joint processes.Compared with the intact model,the intervertebral ROM of the sutured AF model was 8.6802°,8.596°,4.8514°,5.0249°,2.2474°,and 1.9092°,respectively,under the six motions,while that of the unsutured AF model was 8.7475°,8.9453°,5.6441°,5.2546°,2.5886°,and 1.9487°,respectively.The ROM of the sutured AF model was 9％,19％,44％,38％,50％,and 40％higher than that of the intact model;Compared with the unsutured AF mod-el,it was reduced by 1％,4％,14％,4％,13％,and 2％respectively.For Von Mises stress on the AF under the six motion conditions,the stress of the sutured AF model was 2％,65％,21％,32％,51％,and 38％higher than that of the intact model,but 8％,48％,52％,10％,37％,and 48％lower than that of the unsu-tured AF model respectively.For Von-Mises stress in facet joints,the stress values of the sutured AF model were 12.109MPa,8.3601MPa,13.998MPa,12.969MPa,10.219MPa,and 10.074MPa respectively,while those of the unsutured AF model were 13.399MPa,9.6094MPa,18.175MPa,17.967MPa,12.409MPa,and 11.6384MPa respectively.The stress values of Von-Mises stress in facet joints of the sutured AF model was 5％,10％,32％,17％,31％,and 34％higher than that of the intact model;Compared with the unsutured AF model,it was decreased by 9％,13％,22％,27％,17％,and 13％respectively.Conclusions:Among the three con-structed L4/5 FEMs,the sutured AF model exhibits more favorable intervertebral ROM,and Von-Mises stress of facet joints and AF compared with the unsutured AF model.This indicates that AF suture contributes to enhancing intervertebral stability.

Objectives:To investigate the mid-term outcomes of percutaneous cement discoplasty(PCD)in the treatment of lumbar axial instability,and analyze its technical keypoints and indications.Methods:A retrospective analysis was conducted on 9 patients with axial lumbar instability treated with PCD from January 2018 to December 2019.There were 5 males and 4 females,aged 62-87 years(75.7±8.2 years),with a follow-up period of 0.5-3 years,averaged 2.3±1.0 years.Three cases had three-disc operation at the same time,three had double-space operation and three had single-space operation,involving L2/3 disc in 3 cases,L3/4 disc in 3 cases,L4/5 disc in 4 cases,and L5/S1 disc in 3 cases.Lumbar anteroposterior and lateral ra-diographs in supine and standing positions were performed before operation,at postoperative 1d,3,6,12 months and final follow-up to measure the height of intervertebral space of responsible level,as well as the sagittal area of intervertebral foramen at responsible level.Visual analogue scale(VAS)and Oswestry disability index(ODI)were used to evaluate the pain and function before surgery,at 1d,3 months,6 months,12 months and final follow-up after operation to assess the clinical efficacy.The amount of bone cement injected in each intervertebral disc,the time of operation and the amount of blood loss were recorded respectively.Results:All the patients successfully completed the operation,no bone cement leakage occurred.The VAS score and ODI after operation were significantly improved compared with those before operation(P＜0.05).The injection volume of bone cement per intervertebral disc was 3.50±0.73mL.The operative time of each disc was 16.33±1.28min,and the blood loss of each disc was 3.83±0.71mL.The height of intervertebral space of responsible level at various time points after operation was different from that before operation(P＜0.05),and there was no difference in any two time points after operation.The sagittal area of intervertebral foramen at each time point after operation was different from that before operation(P＜0.05),and there was difference be-tween postoperative 1d and the final follow-up values(P＜0.05).Conclusions:PCD can increase the height of the intervertebral space after surgery,relieve lumbar pain,and have a lasting effect in the treatment of lum-bar instability,which is safe with satisfactory mid-term effect,and not prone to bone cement leakage,but long-term large-sample follow-up is still needed.

H 1-antihistamines are widely used in the treatment of various allergic diseases, but there are still many challenges in the safe and rational use of H 1-antihistamines in pediatrics, and there is a lack of guidance on the prescription review of H 1-antihistamines for children.In this paper, suggestions are put forward from the indications, dosage, route of administration, pathophysiological characteristics of children with individual difference and drug interactions, so as to provide reference for clinicians and pharmacists.

Antipyretic-analgesics are currently one of the most prescribed drugs in children.The clinical application of antipyretic-analgesics for children in our country still have irrational phenomenon, which affects the therapeutic effect and even poses hidden dangers to the safety of children.In this paper, suggestions were put forward from the indications, dosage form/route, dosage suitability, pathophysiological characteristics of children with individual differences and drug interactions in the symptomatic treatment of febrile children, so as to provide reference for the general pharmacists when conducting prescription review.

Objective: Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear. Methods: A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients' medical records. Multivariable logistic regression models were used to estimate the odds ratio ( Results: Overall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30-6.32), type 2 diabetes (T2DM) (3.57, 2.32-5.49), cardiovascular disease (CVD) (3.78, 1.81-7.89), fatty liver disease (7.53, 1.96-28.96), hyperlipidemia (2.15, 1.26-3.67), other lung diseases (6.00, 3.01-11.96), and electrolyte imbalance (10.40, 3.00-26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89-12.75), CVD (8.47, 6.03-11.89), and electrolyte imbalance (19.44, 11.47-32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25-9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46-29.64) within two weeks. Conclusion Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.
Adult ; Aged ; COVID-19/virology* ; China/epidemiology* ; Comorbidity ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome

BACKGROUND:Transplantation of mesenchymal stem cels to prevent and treat degeneration of the intervertebral disc is a feasible method. Mesenchymal stem cels co-transfected by SRY-related high mobility group-box gene 9 (SOX-9) and growth differentiation factor-5 (GDF-5) can differentiate into nucleus pulposus cels, in order to obtain greater effect of induction and proliferation of nucleus pulposus cels. OBJECTIVE:To investigate the effect of SOX-9 and GDF-5 co-transfection on the differentiation of rabbit bone marrow mesenchymal stem cels into nucleus pulposus cels. METHODS: We separated and cultured bone marrow mesenchymal stem cels from the bone marrow of rabbit aged 4 months. Passage 3 cels were divided into five groups andin vitro induced to differentiate into nucleus pulposus cels: non-transfected group, empty vector transfection group, SOX-9 transfection group, GDF-5 transfection group, SOX-9 and GDF-5 co-transfection group. At 14 days after transfection, RT-PCR was employed to assay SOX-9, GDF-5 and colagen type II mRNA expressions in bone marrow mesenchymal stem cels. The marker of nucleus pulposus cels-KRT19 expression was also detected by immunohistochemical staining. RESULTS AND CONCLUSION:In the co-transfection group, the mRNA expressions of SOX-9, GDF-5, and colagen type II were significantly higher than those in the SOX-9 transfection group, GDF-5 transfection group, and both these two groups, respectively (P < 0.05). Cels were positive for KRT19 in the SOX-9 and GDF-5 groups, and strongly positive for KRT19 in the co-transfection group. These findings indicate that double gene-transfected bone marrow mesenchymal stem cels are better than single gene-transfected cels with regard to differentiation into nucleus pulposus cels and secretion of extracelular matrix.

Objective To determine the prevalence of penicillinase-producing Neisseria gonorrhoeae(PPNG) and the distribution of blaTEM-135 gene variants in PPNG at several gonococcal antimicrobial surveillance sites in China, to compare N. gonorrhoeae multi-antigen sequence typing(NG-MAST)types of PPNG and its blaTEM-135 gene variants, and to assess the difference and association in NG-MAST types of blaTEM-135 gene variants among different regions. Methods A total of 572 N. gonorrhoeae isolates were collected at 6 gonococcal antimicrobial surveillance sites from Jiangsu, Shanghai, Zhejiang, Tianjin, Guangdong and Guangxi in 2012. After isolation, purification, and identification, cefalotin paper discs were used for detection of PPNG. DNA was extracted by QIAxtractor DX kits after cultivation of the PPNG strains. Then, mismatch amplification mutation assay (MAMA) PCR was performed to identify blaTEM-135 variants, and NG-MAST analysis to determine N. gonorrhoeae genotypes. Results Among the 572 N. gonorrhoeae strains, 38.1%(218/572) were identified as PPNG, and of the PPNG strains, 52.3% (114/218) were blaTEM-135 variants. The detection rate of PPNG at these surveillance sites from high to low was as follows: 51.7% (45/87, Zhejiang), 45.6%(36/79, Shanghai), 38.0% (78/205, Guangdong), 37.5% (12/32, Guangxi), 31.2% (24/77, Jiangsu) and 25.0%(23/92, Tianjin), and that of blaTEM-135 variants was as follows: 68.9%(31/45, Zhejiang), 58.3%(14/24, Jiangsu), 50.0%(39/78, Guangdong), 47.2%(17/36, Shanghai), 39.1%(9/23, Tianjin)and 33.3%(4/12, Guangxi). NG-MAST analysis showed that the ST2318, ST1768, ST1866, ST1053 and ST8726 types predominated among these bla TEM-135 variants, and a strong correlation was found between blaTEM-135 variants and some NG-MAST types, such as ST1768, ST1053 and ST8726 types. The distribution of NG-MAST types was significantly different between the surveillance site in Tianjin (in the Northern part of China) and the other sites (in the Southern part of China), but highly similar among the surveillance sites in Jiangsu, Zhejiang and Shanghai regions. Conclusions There is a high prevalence of PPNG and its blaTEM-135 variants at several gonococcal antimicrobial surveillance sites in China, with significant differences in NG-MAST genotype distribution of PPNG and its blaTEM-135 variants among different regions.

BACKGROUND:Platelet-rich plasma contains a variety of stimulating factors, and can also raise the proteoglycan and col agen synthesis. OBJECTIVE:To observe the effect of platelet-rich plasma on the proliferation of goat bone marrow mesenchymal stem cel s. METHODS:Blood samples were extracted from the jugular vein of Inner Mongolia Ximeng goats to harvest platelet-rich plasma using centrifugation method. Then, bone marrow was extracted from the goat’s ilium by puncture method to isolate and purify goat bone marrow mesechymal stem cel s using density gradient centrifugation method. After that, primary cel s at good state were cultured in L-DMEM complete medium containing 10%, 20%, 30%platelet-rich plasma or in simple L-DMEM complete medium. RESULTS AND CONCLUSION:Within 2-6 days of culture, cel s in the platelet-rich plasma groups proliferated faster than those in the control group, and with the increasing of platelet-rich plasma concentration, the cel s grew faster, with larger number and more mature morphology. At 4 days of culture, the cel doubling time was about 50, 35, 25 hours in the 10%, 20%, and 30%platelet-rich plasma groups, respectively. These findings indicate that goat platelet-rich plasma can dramatical y promote the proliferation of bone marrow mesenchymal stem cel s in a concentration-dependent manner.